Honorable Rebeca Sosa, Chairwoman and Members, Board of County Commissioners

Transcription

1 TO: Honorable Carlos A. Gimenez Mayor Honorable Rebeca Sosa, Chairwoman and Members, Board of County Commissioners Darryl K. Sharpton, Chairman and Members, Public Health Trust Board of Trustees FROM: Carlos A. Migoya President & Chief Executive Officer DATE: November 18, 2014 RE: Fiscal Year 2014 Financial Report The continued pursuit of excellence at Health System propelled us to a second consecutive year with more than $50 million in surplus, even as we expanded programs, invested in our facilities, and positioned ourselves to make long-deferred increases to our employees compensation. Our caregivers, leaders, and other stakeholders are proving that public mission, academic partnership, and world-class care can all be accomplished together. Our community should be proud that s treasured mission is more secure than ever. The bottom line for the year ending September 30, 2014, showed $50.7 million of excess revenues over expenses more than four times the budget of $11.6 million. This nearly equaled the system s unprecedented surplus of $51.6 million last year, despite a more challenging environment and more aggressive re-investment in personnel, technology, and infrastructure. It was accomplished with a backdrop of more unfunded care, with self-pay representing 14.7 percent of total patient days well ahead of the 13.6 percent in the budget. must always provide its high standard of care to all Miami-Dade residents, regardless of their ability to pay, which further illustrates the need for to remain financially strong. ended 2014 with more than 41 days cash on hand, an improvement of nearly 14 days from the prior year. Other key indicators of the system s fiscal strength were equally positive accounts receivable are under 28 days, and our current ratio stands at More than $31.4 million of the 2014 surplus came directly from operations, rather than from one-time revenues such as charitable donations or bond-funded reimbursements for capital expenses. That figure includes a lift of nearly $15.2 million due to sales-tax revenues that

2 Fiscal Year 2014 Financial Report Page 2 of 3 exceeded budgeted levels in Miami-Dade County. All three of our hospital divisions Memorial Hospital, North Medical Center, and South Community Hospital contributed to the operating surplus. Effective expense management remained a central part of the success. continued to cut spending on contracts and purchased services, beating budget by more than 6 percent and even under-spending the prior year s total by more than $4.1 million., of course, entirely reinvests its budget surpluses into our operations. When we exceed our budgeted goals, we can expand and expedite our capital plans, grow our clinical programs, and ensure that our salary and benefit packages are sufficient to attract and retain the best employees. When earns money, our institution and our community benefit. It would, however, be dangerous to conclude that s transformation is complete. To the contrary, the 2014 utilization data illustrates why we need to wisely but aggressively expand our footprint. Bluntly put, served fewer patients in 2014 than Equivalent admissions fell by more than 2,700 cases, and surgical volume fell 3.2 percent. Some of this change may be attributable to the changing face of health care, with increasing focus on wellness and disease prevention, but must compete more aggressively in the era of Medicaid managed care and the increasing number of patients carrying insurance from the federal exchanges created by the Affordable Care Act. To that end, is already taking steps to become more accessible and attractive for a wide range of patients. In 2015, we will begin work on our new rehabilitation hospital expected to become an international destination for care as well as launching our urgent-care initiative. We are nurturing further growth in defining programs such as the Miami Transplant Institute, the Urology Center of Excellence at South, and our world-famous neurological surgery service. Major renovations at The Women s Hospital at Memorial and Holtz Children s Hospital are designed to boost volume in key maternity and pediatric services, as will capital investments to bring more patients into North Medical Center. The Miracle- Building Bond program will fully launch this month as the Citizens Advisory Committee is empaneled, further empowering to invest in the programs and equipment that will define our future. The other key initiative for 2015 is a disciplined implementation of our new partnership with employee labor unions. Our new agreements create platforms for cooperation on technology, staffing levels, and efficiency programs that will increase employment, enhance patient care, and reduce wasteful spending on overtime and other premium pay. We have a rare opportunity to be a national role model of labor-management cooperation, and we are fortunate to have employees who are eager to be a part of that work. The challenges that face in 2015 are entirely different from those we faced when this transformation began in 2011, but they are no less daunting. The post-crisis version of must meet the needs of patients and communities in the next generation of health care. We must be learning from best practices around the world without being afraid to blaze our own trail of innovation. We draw our confidence from our team. The world s best collection of nurses, doctors, therapists, and other caregivers is backed by an energized management team, a visionary Public Health Trust Board of Trustees, a peerless academic partnership, an inspiring family of community stakeholders, and an engaged family of elected officials in Miami, Tallahassee, and Washington. Without any one of these ingredients, our progress would have been impossible.

3 Fiscal Year 2014 Financial Report Page 3 of 3 Our executive team is privileged to work in this environment. We look forward to further implementing the strategies created by Trust Board Chairman Darryl K. Sharpton and his colleagues on behalf of Miami-Dade s residents. Together we are building the future of healthcare for the benefit of our entire community. If you have any questions, please feel free to call me. Attachment c: Honorable Bill Nelson, U.S. Senate Honorable Marco Rubio, U.S. Senate Honorable Frederica Wilson, U.S. House of Representatives Honorable Ileana Ros-Lehtinen, U.S. House of Representatives Honorable Debbie Wasserman Schultz, U.S. House of Representatives Honorable Mario Diaz-Balart, U.S. House of Representatives Honorable Joe Garcia, U.S. House of Representatives Honorable Eduardo Gonzalez, Chairman and Members, Miami-Dade Legislative Delegation

4 PUBLIC HEALTH TRUST JACKSON HEALTH SYSTEM COMBINED FINANCIAL STATEMENTS September 30, 2014

5 PUBLIC HEALTH TRUST JACKSON HEALTH SYSTEM COMBINED FINANCIAL STATEMENTS September 30, 2014 INDEX 1. Key Performance Indicators 2. Combined Balance Sheet 3. Combined Statement of Revenues, Expenses & Changes in Fund Net Assets 3A. Combined Statement of Revenues, Expenses & Changes in Fund Net Assets excluding Division of Managed Care 4. P &L 12 Month Trend Analysis 5. Combining Statement of Revenue & Expense Reflecting Allocated Corporate Overhead & Public Support Funding /Month 6. Combining Statement of Revenue & Expenses Reflecting Allocated Corporate Overhead & Public Support Funding /YTD 7. Combining Statement of Revenue & Expenses by Company 8. Combined Statement of Unrestricted/Restricted Cash Flow 9. Consolidated Portfolio Inventory Summary by Security /Account Type 10. Sales Tax Monthly Income Trend Analysis 11. Payor Mix Patient Days as % of Total Fiscal Year

6 (a) (b) (e) (f) (g) (h) (i) (j) (k) NEW KEY PERFORMANCE INDICATORS Fiscal Year 2014 (Dollars in 000) (d) (e) (l) YTD Sep-14 Sep-14 Sep-13 $ Variance % Variance Aug-14 YTD YTD YTD $ YTD Variance % YTD Variance Benchmark Status Actual Actual Actual Actual 2013 JHS Financial A A (1) Net Patient Revenue 100,529 83,530 95,290 16, , % 236.0% 94,671 1,024,225 1,005,096 1,015,080 19, , % 21.1% (2) Other Operating Revenue 19,488 10,085 18,433 9,403 (159,505) 93.2% (89.1)% 8, , , ,543 4,346 (201,365) 3.2% (58.9)% (4) Total Operating Revenue 120,017 93, ,723 26,402 14, % 14.2% 102,717 1,164,961 1,141,487 1,196,623 23,474 (23,010) 2.1% (1.9)% (6) Total Operating Expenses 138, , ,265 (17,359) 15,339 (14.3)% 12.4% 125,590 1,513,519 1,497,651 1,521,887 (15,868) (284) (1.1)% (0.0)% (7) Gain and (Loss) from Operations (18,934) (27,976) (18,542) 9,042 (392) 32.3% (2.1)% (22,873) (348,558) (356,165) (325,264) 7,606 (23,294) 2.1% (7.2)% (8) Total Net Non-operating Items (before GOB & Special Contributions) 30,464 29,540 30, (508) 3.1% (1.6)% 31, , , ,203 12,265 15, % 4.3% (9) Excess of Revs Over (Under) Expenses before GOB & Special Contrib. 11,530 1,564 12,429 9,965 (900) 637.2% (7.2)% 8,565 31,472 11,601 38,939 19,871 (7,467) 171.3% (19.2)% (10) GOB & Special Contributions 1,378-1,381 1,378 (3) 0.0% (0.2)% 1,455 19,190-12,610 19,190 6, % 52.2% (11) Excess of Revenues Over (Under) Expenses 12,908 1,564 13,810 11,344 (902) 725.3% (6.5)% 10,020 50,662 11,601 51,550 39,061 (887) 336.7% (1.7)% (12) Unrestricted Health Care Surtax 17,792 16,567 17,669 1, % 0.7% 18, , , ,164 15,189 10, % 5.0% (13) Miami Dade County Unrestricted Funds 11,420 11,492 11,094 (71) 327 (0.6)% 2.9% 11, , , ,127 (499) 4,275 (0.4)% 3.2% (14) Discharged Not Final Billed (DNFB) HIM 28,909 21,000 4,636 7,909 24, % 523.5% 38,556 28,909 21,000 8,352 7,909 20, % 246.2% Financial Ratios (15) Net Patient Revenue per Adjusted Patient Day 2,255 1,805 2, % 7.6% 2,084 1,890 1,804 1, % 25.5% (16) Total Cost per Adjusted Patient Day 3,117 2,628 2,909 (489) (208) (18.6)% (7.1)% 2,765 2,793 2,688 2,701 (105) (99) (3.9)% (3.7)% Liquidity Indicators (17) Days Net in Receivable (17.17) (18.96) (38.2)% (40.5)% (17.17) (18.96) (38.2)% (40.5)% (18) Days (Unrestricted) Cash on Hand % 50.0% % 50.0% (19) Current Ratio % 6.5% % 6.5% (20) Cash (Unrestricted) to Debt Ratio % (40.5)% % (40.5)% Utilization (21) Admissions excl. Newborn 4,698 4,848 4,629 (150) 69 (3.1)% 1.5% 4,685 56,432 58,106 57,877 (1,674) (1,445) (2.9)% (2.5)% (22) Observation Equivalent Days 1,112 1,193 1,416 (81) (305) (6.8)% (21.5)% 1,121 14,159 14,069 15, (1,276) 0.6% (8.3)% Total equivalent admissions 5,810 6,041 6,045 (231) (236) (3.8)% (3.9)% 5,806 70,591 72,175 73,312 (1,583) (2,721) (2.2)% (3.7)% (22) Admissions % through ED 65.16% 72.72% 64.57% (7.6)% 0.6% (10.4)% 0.9% 62.77% 66.05% 73.48% 64.29% (7.4)% 1.8% (10.1)% 2.7% (23) Hospital Patient Census Days excl. Newborn 32,132 32,914 32,364 (782) (232) (2.4)% (0.7)% 32, , , ,162 (6,436) (9,979) (1.6)% (2.5)% (24) Average Length of Stay (0.15) 0.7% (2.2)% (0.00) 1.3% (0.0)% (25) Outpatient Visits 27,679 29,070 25,024 (1,391) 2,655 (4.8)% 10.6% 27, , , ,590 (48,562) (29,153) (13.7)% (8.7)% (26) JMH Number of O/R Cases 1,097 1,119 1,106 (22) (9) (1.9)% (0.8)% 1,105 13,522 13,435 13, (435) 0.6% (3.1)% (27) Overtime % of Productive Hours 4.11% 2.32% 4.30% (1.79)% 0.19% (77.3)% 4.3% 4.29% 4.02% 2.31% 3.60% (1.71)% (0.42)% (74.3)% (11.6)% FTE's (28) JHS FTE per Adjusted Occupied Bed (0.38) (0.21) (5.7)% (3.1)% (0.24) (0.37) (3.6)% (5.8)% (29) Health System FTE's 10,270 10,080 10,159 (190) (111) (1.9)% (1.1)% 10,261 10,142 10,067 9,970 (75) (172) (0.7)% (1.7)% Payor Mix Self Pay Patient Days as % of Total (30) Memorial Hospital 15.73% 13.76% 13.90% -1.97% -1.83% (14.3)% (13.2)% 14.80% 15.41% 13.76% 13.60% -1.65% -1.81% (12.0)% (13.3)% (31) North 9.34% 11.30% 14.10% 1.96% 4.76% 17.3% 33.7% 12.61% 10.02% 11.25% 10.90% 1.23% 0.88% 10.9% 8.1% (32) South 14.92% 15.45% 19.40% 0.53% 4.48% 3.4% 23.1% 16.70% 15.35% 15.50% 15.10% 0.15% -0.25% 1.0% (1.7)% (33) Inpatient Charges as Percent of Total 72.07% 71.14% 71.19% -0.93% -0.88% (1.3)% (1.2)% 71.58% 71.64% 70.83% 70.66% -0.81% -0.98% (1.1)% (1.4)% (34) Realization Rate 29.82% 25.04% 27.97% -4.78% -1.85% (19.1)% (6.6)% 27.03% 24.45% 25.06% 24.79% 0.61% 0.34% 2.4% 1.4% Key: Positive variance or no major concerns Year-to-date numbers are ok or explained, but concern for future trend Negative variance or area of current concern Variance are Favorable (positive number) and Unfavorable (negative number) Note: A FY 13 - MTD & YTD Net patient revenue and Other operating revenue are adjusted for DSH reclass for consistency FS 1

7 Public Health Trust of Miami-Dade County (Consolidated) Combined Balance Sheet September 2014 (Amounts in thousands) Aug 14 Dollar Change Sep 13 Dollar Change ASSETS: Cash and Investments 163, ,317 60, ,367 58,079 Cash and Investments Restricted 11,524 12,889 (1,365) 15,774 (4,250) Cash and Investments Limited as to Use 1,747 62,840 (61,092) 7,827 (6,079) Gross Patient Accounts Receivable 636, ,980 (33,950) 594,645 41,385 Allowances for Contractuals and Bad Debt (557,932) (563,058) 5,127 (464,531) (93,400) Net Accounts Receivable 78, ,922 (28,824) 130,113 (52,015) Third Party Receivable 164, ,740 54, ,606 9,270 Due From Miami-Dade County 37,444 36,027 1,417 35,511 1,933 Other Receivables - Restricted 3,662 3, , Inventories 25,860 24,208 1,652 24,245 1,615 Prepaid Expenses and Other Current Assets 4,694 5,033 (339) 4, Total Current Assets 491, ,453 25, ,044 9,308 Due From Restricted Funds (0) (0) 0 0 (0) Cash and Investments Limited as to Use - LT 34,903 34, ,582 6,321 Cash and Investments Restricted - LT 53,179 53,610 (430) 59,441 (6,262) Capital Assets, Net 460, ,057 6, ,744 15,408 Other Assets 6,394 6,417 (23) 6,715 (321) Total Non-Current Assets 554, ,835 5, ,481 15,146 Total Assets Current Portion of Long Term Debt $ 1,045,980 8,005 $ 1,014,288 8,005 $ 31,691 0 $ 1,021,526 7,645 $ 24, Accounts Payable and Accrued Expenses 120, ,526 9, ,944 (9,911) Accrued Salaries and Payroll Taxes Withheld 137, ,658 4, ,813 (4,210) Due to Other Third Party 145, ,971 6, ,036 5,968 Due to Miami-Dade County 20,762 15,000 5,762 15,207 5,555 Other Restricted 1,758 1, ,051 (4,293) Other Current Liabilities 32,670 40,652 (7,982) 48,046 (15,376) Total Current Liabilities 465, ,262 18, ,741 (21,905) Long Term Debts, Excluding Current Portion 335, , ,126 (7,660) Other Liabilities 54,406 54, ,049 3,357 Total Liabilities 855, ,925 18, ,917 (26,208) NET ASSETS: Unrestricted Net Assets 9,408 3,895 5,513 (24,737) 34,144 Invested in Capital Assets 167, ,707 5, ,504 16,862 Restricted Net Assets 13,498 11,762 1,736 13,842 (344) Total Net Assets 190, ,363 12, ,609 50,662 Total Liabilities & Net Assets $ 1,045,980 $ 1,014,288 $ 31,691 $ 1,021,526 $ 24,454 Notes * Reserves for AR is comprised of $424 million in cont. adjustments, $34 million in charity care and $100 million in prov. for doubtful accounts. ** Amounts due to the University total $15.7 million reported in other current liab. FS-2

8 Combined Statement of Revenue, Expenses & Change in Fund Net Assets Public Health Trust of Miami-Dade County September 2014 (Amounts in thousands) Actual Month of September 2014 Sep 13 Actual $ Variance % Variance Actual YTD YTD 12 Months Ended September 30, 2014 Sep 13 Actual YTD $ Variance % Variance 98,202 81,255 (66,532) 16, , % (248)% Hospital and physician services 995, , ,199 18, ,425 2 % 20 % (626) (170) 716 (65)% (114)% Community Medical Practices 2,268 3,128 1,130 (860) 1,138 (27)% 101 % (36) 8 (20)% 6 % Primary Care Centers 1,857 2,164 1,824 (307) 33 (14)% 2 % 2,094 1,837 1, % 19 % Continuing Care (SNF) 24,475 22,377 21,371 2,099 3,105 9 % 15 % 100,529 83,530 (65,270) 16, , % (254)% Net Patient Service Revenue 1,024,225 1,005, ,523 19, ,702 2 % 20 % (81) 3 4,260 (84) (4,342) (2631)% (102)% Division of Managed Care 25,095 28,026 77,244 (2,931) (52,149) (10)% (68)% 3,939 1,763 4,372 2,175 (433) 123 % (10)% Grants Revenue 25,932 21,096 23,468 4,836 2, % 10 % 15,630 8, ,360 7,312 (154,730) 88 % (91)% Other Operating Revenue 89,709 87, ,389 2,440 (151,680) 3 % (63)% 120,017 93, ,723 26,402 6, % 6 % Total Operating Revenue 1,164,961 1,141,487 1,196,624 23,474 (31,663) 2 % (3)% 87,992 67,800 73,189 (20,191) (14,802) (30)% (20)% Salaries & Related Costs 869, , ,246 (48,534) (50,008) (6)% (6)% 27,383 30,273 31,328 2,891 3, % 13 % Contractual and Purchased Serv. 340, , ,565 21,467 4,105 6 % 1 % (107) 9 5, , % 102 % Division of Managed Care - Paid Claims 23,012 27,319 79,035 4,306 56, % 71 % 15,964 16,224 19, ,920 2 % 20 % Supplies 196, , ,092 (989) (585) (1)% 0 % 4,909 4,247 5,140 (662) 231 (16)% 4 % Depreciation 49,816 55,516 56,769 5,700 6, % 12 % 1,344 1,428 1, % 8 % Interest 16,432 17,141 17, % 4 % 1,467 1,609 (4,460) 142 (5,927) 9 % 133 % Other Operating Expenses 17,868 19,340 9,034 1,472 (8,834) 8 % (98)% 138, , ,265 (17,359) (6,686) (14)% (5)% Total Operating Expenses 1,513,519 1,497,651 1,521,888 (15,868) 8,369 (1)% 1 % (18,934) (27,976) (18,542) 9,042 (392) 32 % (2)% Gain (Loss) From Operations (348,558) (356,165) (325,264) 7,606 (23,294) 2 % (7)% (334) (9) 373 (19)% (112)% Investment Income (121) 180 (20)% 62 % 1,212 1,433 2,543 (221) (1,331) (15)% (52)% Other Income 15,128 17,433 14,621 (2,304) 507 (13)% 3 % 11,420 11,492 11,094 (71) 327 (1)% 3 % Dade County Unrestricted Funds 137, , ,127 (499) 4,275 0 % 3 % 17,792 16,567 17,669 1, % 1 % Unrestricted Health Care Surtax 227, , ,164 15,189 10,866 7 % 5 % 30,464 29,540 30, (508) 3 % (2)% Total Non-Operating Gain Net 380, , ,203 12,265 15,828 3 % 4 % 11,530 1,564 12,429 9,965 (900) 637 % (7)% Revenue & Gain in Excess of Exp. & Loss 31,472 11,601 38,939 19,871 (7,467) 171 % 19 % 0 0 (1,192) 0 1,192 0 % (100)% Capital Contributions Grants and Other % 0 % % 0 % JM Foundation 3, ,267 3,877 1,610 0 % 71 % 1, ,573 1,378 (1,195) 0 % (46)% Miami Dade County GOB 15, ,343 15,313 4,970 0 % 48 % 12,908 1,564 13,810 11,344 (902) 725 % (7)% Revenue & Gain after Extraordinary Loss 50,662 11,601 51,550 39,061 (887) 337 % 2 % FS-3

9 Combined Statement of Revenue, Expenses & Change in Fund Net Assets Public Health Trust of Miami-Dade County excluding Division of Managed Care September 2014 (Amounts in thousands) Actual Month of September 2014 Sep 13 Actual $ Variance % Variance Actual YTD YTD 12 Months Ended September 30, 2014 Sep 13 Actual YTD $ Variance % Variance 98,202 81,255 (66,532) 16, , % (248)% Hospital and physician services 995, , ,199 18, ,425 2 % 20 % (626) (170) 716 (65)% (114)% Community Medical Practices 2,268 3,128 1,130 (860) 1,138 (27)% 101 % (36) 8 (20)% 6 % Primary Care Centers 1,857 2,164 1,824 (307) 33 (14)% 2 % 2,094 1,837 1, % 19 % Continuing Care (SNF) 24,475 22,377 21,371 2,099 3,105 9 % 15 % 100,529 83,530 (65,270) 16, , % (254)% Net Patient Service Revenue 1,024,225 1,005, ,523 19, ,702 2 % 20 % 3,939 1,763 4,372 2,175 (433) 123 % (10)% Grants Revenue 25,932 21,096 23,468 4,836 2, % 10 % 15,630 8, ,360 7,312 (154,730) 88 % (91)% Other Operating Revenue 89,709 87, ,389 2,440 (151,680) 3 % (63)% 120,098 93, ,462 26,486 10, % 10 % Total Operating Revenue 1,139,866 1,113,460 1,119,380 26,406 20,486 2 % 2 % 87,992 67,800 73,189 (20,191) (14,802) (30)% (20)% Salaries & Related Costs 869, , ,246 (48,534) (50,008) (6)% (6)% 27,383 30,273 31,328 2,891 3, % 13 % Contractual and Purchased Serv. 340, , ,565 21,467 4,105 6 % 1 % 15,964 16,224 19, ,920 2 % 20 % Supplies 196, , ,092 (989) (585) (1)% 0 % 4,904 4,242 5,135 (662) 231 (16)% 5 % Depreciation 49,748 55,447 56,700 5,700 6, % 12 % 1,344 1,428 1, % 8 % Interest 16,432 17,141 17, % 4 % 1,467 1,609 (4,460) 142 (5,927) 9 % 133 % Other Operating Expenses 17,868 19,340 9,034 1,472 (8,834) 8 % (98)% 139, , ,534 (17,476) (12,518) (14)% (10)% Total Operating Expenses 1,490,438 1,470,264 1,442,784 (20,175) (47,655) (1)% (3)% (18,955) (27,965) (17,072) 9,010 (1,883) 32 % (11)% Gain (Loss) From Operations (350,573) (356,804) (323,403) 6,231 (27,169) 2 % (8)% (338) (8) 377 (16)% (112)% Investment Income (102) 196 (18)% 72 % 1,212 1,433 2,543 (221) (1,331) (15)% (52)% Other Income 15,128 17,433 14,621 (2,304) 507 (13)% 3 % 11,420 11,492 11,094 (71) 327 (1)% 3 % Dade County Unrestricted Funds 137, , ,127 (499) 4,275 0 % 3 % 17,792 16,567 17,669 1, % 1 % Unrestricted Health Care Surtax 227, , ,164 15,189 10,866 7 % 5 % 30,464 29,539 30, (504) 3 % (2)% Total Non-Operating Gain Net 380, , ,184 12,284 15,844 3 % 4 % 11,509 1,574 13,896 9,935 (2,387) 631 % 17 % Revenue & Gain in Excess of Exp. & Loss 29,456 10,941 40,781 18,515 (11,325) 169 % 28 % 0 0 (1,192) 0 1,192 0 % (100)% Capital Contributions Grants and Other % 0 % % 0 % JM Foundation 3, ,267 3,877 1,610 0 % 71 % 1, ,573 1,378 (1,195) 0 % (46)% Miami Dade County GOB 15, ,343 15,313 4,970 0 % 48 % 12,887 1,574 15,277 11,314 (2,390) 719 % 16 % Revenue & Gain after Extraordinary Loss 48,646 10,941 53,391 37,705 (4,745) 345 % 9 % FS-3A

10 P & L 12 Month Trend Analysis Public Health Trust of Miami-Dade County September 2014 Aug 14 Jul 14 Jun 14 May 14 Apr 14 Mar 14 Feb 14 Jan 14 Dec 13 Nov 13 Oct 13 Inpatient Services 255, , , , , , , , , , , ,435 Ambulatory Services 98,822 99,537 96,908 96, , , ,330 94,021 99,148 94,869 94, ,701 Gross Patient Service Revenue 353, , , , , , , , , , , ,136 Contractual Adjustments 184, , , , , , , , , , , ,970 Charity Care 27,815 28,192 24,380 24,702 26,637 29,077 29,200 28,357 29,605 25,886 28,658 33,614 Net Patient Revenue Adjustment Provision for Doubtful Accounts 40,937 46,564 39,152 35,916 36,132 37,540 42,107 38,151 44,812 47,147 42,363 43,622 Total Deductions From Revenue 253, , , , , , , , , , , ,206 Net Patient Service Revenue 100,529 94,671 82,939 82,234 87,326 86,056 87,558 78,712 80,801 81,204 79,267 82,929 Division of Managed Care (81) (76) (43) 1,607 2,126 2,140 3,160 2,994 3,451 3,433 3,175 3,209 Other Operating Revenue 15,630 6,325 9,681 6,650 6,756 7,188 5,696 6,045 6,386 6,294 6,319 6,739 Grants Revenue 3,939 1,797 2,730 2,346 1,952 1,459 2,367 1,830 1,725 1,464 1,874 2,450 Total Operating Revenue 120, ,717 95,306 92,837 98,160 96,843 98,781 89,580 92,362 92,395 90,636 95,327 Salaries & Related Costs 87,992 73,610 72,397 73,310 75,194 71,932 73,976 67,632 67,734 68,239 67,563 69,676 Contractual and Purchased Services 27,383 28,267 26,116 26,167 28,931 28,676 28,314 29,453 29,136 29,214 28,744 30,059 Supplies 15,964 16,879 17,441 16,034 16,158 16,038 18,697 16,339 15,413 16,134 15,609 15,971 Division of Managed Care Paid Claims (107) ,369 1,966 1,997 3,077 1,109 3,300 3,935 3,034 3,086 Interest 1,344 1,310 1,314 1,346 1,370 1,361 1,363 1,388 1,406 1,421 1,398 1,411 Provision for Self-Insured Claims Public Med/Assist. Trust F. Assess Depreciation 4,909 3,952 3,981 3,860 3,959 3,917 4,095 4,123 4,242 4,312 4,327 4,137 Other Operating Expenses Total Operating Expenses 138, , , , , , , , , , , ,845 Gain (Loss) From Operations (18,934) (22,873) (27,539) (30,749) (30,918) (28,566) (32,237) (31,967) (30,366) (32,355) (31,536) (30,518) Med. Edu. and Tert. Care Fund 1,235 1,429 1,235 1,170 1,752 1,170 1,170 1,170 1,170 1,040 1,235 1,235 Interest Income - Non. Operating Unrealized Gains and Losses (1) (1) (1) (1) (1) (1) (1) (1) (1) (1) (1) (1) Other Non-Operating (23) 7 (1,604) Dade County Unrestricted Funds 11,420 11,420 11,420 11,420 11,420 11,420 11,420 11,492 11,492 11,492 11,492 11,492 Unrestricted Health Care Surtax 17,792 18,547 18,341 19,279 20,961 18,667 18,568 22,412 18,906 17,529 19,154 16,873 TOTAL Non-Operating Gain Net 30,464 31,438 29,413 32,205 34,355 31,567 31,475 35,270 31,781 30,191 32,075 29,797 Revenue & Gain in Excess of Exp. & Loss 11,530 8,565 1,875 1,456 3,437 3,000 (762) 3,304 1,415 (2,165) 539 (721) Capital Contributions Grants and Other JM Contributions 0 0 2, Miami Dade Cty. GOB 1,378 1,455 1,730 1,741 1,286 1,304 2, ,186 Revenue & Gain after Extraordinary Loss 12,908 10,020 6,266 3,622 4,723 4,304 1,776 3,951 2,394 (963) 1, FS-4

11 Health System Sept 2014 Actual Combining Statement of Revenue & Expense Reflecting Allocated Corporate Overhead & Public Support Funding Memorial Hospital South North Physician Services JHS Health Plan Nursing Homes Primary Care Corrections Health Services Medical Towers Total Total Gross Inpatient Revenue 197,105 19,582 35,319 3, ,057 Total Gross Outpatient Revenue 70,451 13,543 12, ,545 98,822 Total Gross Revenue 267,556 33,125 47, ,407 1, ,878 Total Deductions from Revenue -188,881-24,339-36, ,313-1, ,349 Total Net Patient Revenue 78,675 8,786 10, , ,529 Other Operating Revenue 12, ,630 Managed Care Revenue Grant Revenue 3, ,939 Total Other Operating Revenue 16, ,488 Total Revenue 94,958 9,657 11, , ,017 Operating Expenses Salaries & Wages 55,756 3,753 4,298 1,225 1, , ,104 Benefits 16, ,888 Total Salaries & Benefits 71,942 4,518 5,151 1,394 1, , ,992 Purchased Services 11,354 1,305 2, ,340 Managed Care Paid Claims 2 2 UM AOA Purchased Service 9, ,933 Total Purchased Service 20,940 1,451 3, ,275 Supplies 12,109 1,684 1, ,964 Total Direct Operating Cost 104,991 7,653 9,720 2, ,632 1,534 2, ,230 Depreciation 3,345 1, ,909 Interest 1, ,344 Self Insurance HCCB Assessment Other Operating Expense Total Other Operating Cost 5,811 1, ,720 Total Operating Expenses Before Allocations 110,802 8,787 10,321 2, ,674 1,545 2, ,951 Allocated Corporate Services: Clinical Trials Office Corporate Administration 2, ,099 Financial Services Human Resources 1, ,761 Integrity Information Technology 3, ,018 Public Safety Revenue Cycle Management 3, ,681 Strategic Sourcing ,275 Total Allocated Corporate Services 12,374 1,402 1, ,374 Total Expenses Subject to Allocation -16,374-16,374 Total Operating Expenses Including Allocations 106,802 10,189 12,220 2, ,898 1,723 2, ,951 Excess of Operating Revenue over (under) Operating Expenses -11, , ,410-2, ,934 Non Operating Revenue and Expenses Investment Income Unrestricted Health Care Surtax 17,792 17,792 Miami Dade County Unrestricted Funds 11,420 11,420 Other Income 1, ,211 JMH Foundation Total Non Operating Revenue 30, ,464 Redistribution of Revenue -5,419 2,425 2, Total Non Operating Revenue After Redistribution 25,048 2,424 2, ,464 Excess of Revenue over (under) Expenses before GOB and County Special Contributions 13,204 1,892 1,898-1, ,065-2, ,530 Miami Dade County GOB Contributions Miami Dade County Special Contributions 1,378 1,378 Total Miami Dade GOB and Special Contributions 1,378 1,378 Excess of Revenue over (under) Expenses 14,583 1,892 1,898-1, ,065-2, ,908 FS-5

12 Health System Sept 2014 YTD Actual Combining Statement of Revenue & Expense Reflecting Allocated Corporate Overhead & Public Support Funding Memorial Hospital South North Physician Services JHS Health Plan Nursing Homes Primary Care Corrections Health Services Medical Towers Total Total Gross Inpatient Revenue 2,305, , ,399 37,144 3,001,310 Total Gross Outpatient Revenue 862, , ,539 13,125 4,513 19,249 1,188,266 Total Gross Revenue 3,168, , ,938 13,125 41,657 19,249 4,189,576 Total Deductions from Revenue -2,409, , ,666-10,857-17,182-17, ,165,351 Total Net Patient Revenue 758, , ,272 2,268 24,475 1, ,024,225 Other Operating Revenue 68,018 3,465 2,556 9, ,406 89,709 Managed Care Revenue 25,095 25,095 Grant Revenue 24,772 1,160 25,932 Total Other Operating Revenue 92,790 3,465 2,556 9,594 25, , , ,736 Total Revenue 851, , ,828 11,862 25,095 24,358 3, ,406 1,164,961 Operating Expenses Salaries & Wages 551,476 45,115 50,875 14,384 18,825 7,866 20, ,932 Benefits 127,615 9,001 9,732 2,247 4,965 1,822 3, ,322 Total Salaries & Benefits 679,091 54,116 60,607 16,631 23,790 9,688 24, ,254 Purchased Services 164,286 15,230 31,219 6,905 1,739 4,036 8,050 1,319 1, ,059 Managed Care Paid Claims 1 21,273 21,274 UM AOA Purchased Service 107, ,138 Total Purchased Service 272,167 15,368 31,336 6,905 23,012 4,090 7,976 1,342 1, ,471 Supplies 156,542 16,136 17, , , ,677 Total Direct Operating Cost 1,107,800 85, ,793 23,919 23,012 30,697 18,315 27,755 2,492 1,429,403 Depreciation 34,999 10,180 3, ,816 Interest 16, ,432 Self Insurance 5, , ,632 HCCB Assessment 8,773 1,021 1,441 11,236 Other Operating Expense Total Other Operating Cost 65,161 11,446 6, ,117 Total Operating Expenses Before Allocations 1,172,961 97, ,896 24,044 23,081 31,204 18,455 27,769 3,043 1,513,519 Allocated Corporate Services: Clinical Trials Office Corporate Administration 24,439 2,712 3, ,366 Financial Services 4, ,610 Human Resources 14,424 1,131 1, ,442 Integrity 1, ,099 Information Technology 40,731 4,843 7, ,311 Public Safety 4, ,265 Revenue Cycle Management 38,912 4,717 6, ,779 Strategic Sourcing 11,440 1,118 1, ,360 Total Allocated Corporate Services 141,865 15,960 22,085 1, ,473 2,123 1, ,014 Total Expenses Subject to Allocation -188, ,014 Total Operating Expenses Including Allocations 1,126, , ,981 25,421 23,285 33,677 20,578 29,420 3,319 1,513,519 Excess of Operating Revenue over (under) Operating Expenses -275,072-6,159-2,153-13,559 1,811-9,318-16,775-29,419 2, ,558 Non Operating Revenue and Expenses Investment Income Unrestricted Health Care Surtax 227, ,029 Miami Dade County Unrestricted Funds 137, ,402 Other Income 15, ,118 JMH Foundation 3,877 3,877 Total Non Operating Revenue 383, ,908 Redistribution of Revenue -67,459 29,413 30,328 3,421 4,297 Total Non Operating Revenue After Redistribution 316,519 29,403 30, ,421 4, ,908 Excess of Revenue over (under) Expenses before GOB and County Special Contributions 41,447 23,244 28,115-13,559 1,813-5,897-12,478-29,421 2,086 35,349 Miami Dade County GOB Contributions 15,313 15,313 Miami Dade County Special Contributions Total Miami Dade GOB and Special Contributions 15,313 15,313 Excess of Revenue over (under) Expenses 56,760 23,244 28,115-13,559 1,813-5,897-12,478-29,421 2,086 50,662 FS-6

13 Public Health Trust of Miami-Dade County Consolidated Combining Statement of Revenue & Expenses by Company Month of September 2014 (Amounts in thousands) Memorial South North Physician Services JHS Health Plan Primary Care Centers Corrections Health Services Skilled Nursing Facilities Property Management Revenue Inpatient Revenue 197,105 19,582 35, , , ,485 Outpatient Revenue 70,451 13,543 12, , ,822 98,154 Total Year Actual Gross Patient Service Revenue 267,556 33,125 47, , , , ,639 Deductions From Revenue: Contractual Adjustments 132,340 19,430 30, , ,116 Provisions For Charity Care 24,425 1, ,815 32,145 Net Patient Revenue Adjustment Provision for Doubtful Accounts 32,115 3,882 4, ,937 39,648 Total Deductions From Revenue 188,881 24,339 36, , , , ,909 Net Patient Service Revenue 78,675 8,786 10, , ,529 (65,270) Division of Managed Care (81) (81) 4,260 Other Operating Revenue 12, (90) , ,360 Grants Revenue 3, ,939 4,372 Total Operating Revenue 94,958 9,657 11, (81) , , ,723 Operating Expenses Salaries & Related Costs 71,942 4,518 5,151 1, ,170 1, ,992 73,189 Contractual and Purchased Services 20,940 1,451 3, (107) ,275 37,053 Supplies 12,109 1,684 1, ,964 19,884 Interest 1, ,344 1,458 Depreciation 3,345 1, ,909 5,140 Other Operating Expenses 1, ,467 (4,460) Total Operating Expenses 110,802 8,787 10,321 2,082 (102) 1,545 2,539 2, , ,265 Excess of operating revenue over (under) operating expenses (15,844) 870 1,399 (1,117) 21 (1,231) (2,539) (670) 177 (18,934) (18,542) Other Revenues (Expenses) Investment Income 40 (1) (334) Unrestricted Health Care Surtax 17, ,792 17,669 Miami Dade County Unrestricted Funds 11, ,420 11,094 Other Income 1, (3) 0 0 1,212 2,543 Miami Dade County Special Contributions (1,192) JM Foundation Miami Dade County GOB Contributions 1, ,378 2,573 Total Other Revenues (expenses) 31,845 (1) (3) ,842 32,353 Excess of revenues over (under) expenses 16, ,399 (1,117) 21 (1,231) (2,542) (670) ,908 13,810 FS-7

14 Public Health Trust Health System Combined Statement of Unrestricted / Restricted Cash Flow As of September 30, 2014 Audited Current Month Year to Date Year to Date September 30, 2014 September 30, 2014 September 30, 2013 Cash generated (used) by operations: Funds available for working capital/facilities improvements $12,908 $50,662 $51,550 Non cash expenses: Depreciation 4,909 49,816 56,769 Loss on disposal of capital assets 19 (234) 2,482 Total 17, , ,801 Cash provided (used) for current assets: Decreases (increases) in: Patient Receivable and Other Third Party payor (26,729) 40,812 14, Cash and Invst. Limited as to Use 61,093 6,080 4,261 Inventories, Prepaid Expenses and Other Receivables (1,497) (2,370) 948 Total 32,867 44,522 19,969 Cash provided (used) for current liabilities: Increases (decreases) in: Current Installment of Long Term Debt Accounts Payable and Accrued Expenses 14,452 (14,121) 491 Due to other third party 11,796 11,524 (26,369) Other Liabilities (7,982) (15,375) 18,588 Other- Restricted 308 (4,293) (645) Total 18,574 (21,905) (7,615) Decreases (increases) in: Cash and Invst. Limited as to Use (151) (6,321) (4,497) Cash and Invst. Restricted 431 6,262 7,134 Long Term Investment Cash provided (used) for Other Assets Cash provided (used) for Long Term Liabilities: - Increases (decreases) in: - Long Term Debt 26 (7,662) (7,299) Other Liabilities 180 3,357 (25,155) Total 206 (4,305) (32,454) Cash provided (used) for Prop., Plant and Equipment: Purchases of Prop. Plant and Equipment (11,022) (64,989) (41,758) - - Total (11,022) (64,989) (41,758) Net Increase in Cash and Cash Equivalents 58,764 53,829 51,790 - Cash, beginning of period 116, ,141 69,352 Cash, end of period 174, , ,141 FS-8

15 PUBLIC HEALTH TRUST CONSOLIDATED PORTFOLIO INVENTORY SUMMARY BY SECURITY/ACCOUNT TYPE September 30, 2014 # of Investments Description Par Value Avg. Interest Rate Market Value 1 Money Markets 612, % 612,298 1 Total Investments Portfolio 612,298 Wells Fargo interest bearing accts 0.250% 192,951,986 Wells Fargo Institutional Bank Deposit account 9,629, % 9,629,269 Bond Proceeds Invested at Miami-Dade County 0.452% 61,605,447 Total Cash and Investments $ 264,799,000 FS-9

16 PUBLIC HEALTH TRUST SALES TAX MONTHLY INCOME STATEMENT TREND ANALYSIS FISCAL YEAR 2012 Oct-11 # Nov-11 Dec-11 Jan-12 Feb-12 Mar-12 Apr-12 May-12 Jun-12 Jul-12 Aug-12 Sep-12 monthly est 14,482,634 14,779,176 17,607,553 15,330,625 15,914,413 17,395,891 15,855,155 15,355,434 15,563,007 14,907,488 15,041,626 14,844,604 mo portion of qtly est: 1,079,571 1,079,571 1,079,571 1,180,705 1,180,705 1,180,705 1,160,844 1,160,844 1,160,844 1,143,468 1,143,468 1,143,468 State revision to Sales Tax Projection 500,000 +/-est vs. actual rec'd; mo of 10,720 1,238, ,986 (106,944) (724,478) 335,025 (153,187) (295,446) (757,063) 16,220 +/-est vs. actual rec'd; qt of 257, , ,672 Monthly Revenue 15,562,205 15,858,747 18,697,844 17,750,016 18,024,509 18,469,652 16,291,521 17,251,673 16,570,664 16,255,510 15,894,703 16,004,292 FISCAL YEAR 2013 Oct-12 # Nov-12 Dec-12 Jan-13 Feb-13 Mar-13 Apr-13 May-13 Jun-13 Jul-13 Aug-13 Sep-13 monthly est 15,096,482 16,870,407 15,156,957 15,600,201 15,600,201 15,600,201 15,600,201 15,600,201 15,600,201 15,600,201 15,600,201 15,600,201 mo portion of qtly est: 1,207,668 1,273,109 1,273,109 1,273,109 1,273,109 1,273,109 1,273,109 1,273,109 1,273,109 1,273,109 1,273,109 1,273,109 State revision to Sales Tax Projection +/-est vs. actual rec'd; mo of (257,802) 981,343 3,665,869 1,457, ,194 2,964,808 1,053, , , ,814 +/-est vs. actual rec'd; qt of 338, , ,666 Monthly Revenue 16,304,150 18,143,516 16,172,264 17,854,653 20,877,588 18,331,229 17,574,504 20,369,247 17,926,959 17,365,758 17,575,066 17,177,124 FISCAL YEAR 2014 Oct-13 # Nov-13 Dec-13 Jan-14 Feb-14 Mar-14 Apr-14 May-14 Jun-14 Jul-14 Aug-14 Sep-14 monthly est 15,600,201 16,597,159 16,597,159 16,597,159 16,597,159 16,597,159 16,597,159 16,597,159 16,597,159 16,597,159 16,597,159 16,597,159 mo portion of qtly est: 1,273,109 1,416,470 1,416,470 1,416,470 1,416,470 1,416,470 1,416,470 1,416,470 1,416,470 1,416,470 1,416,470 1,416,470 State revision to Sales Tax Projection 1,140,319 +/-est vs. actual rec'd; mo of (485,039) 892,399 3,943, , ,794 2,307,416 1,265, ,211 (5,798) (221,497) +/-est vs. actual rec'd; qt of 454, , ,276 Monthly Revenue 16,873,310 19,153,948 17,528,590 18,906,028 22,411,799 18,568,363 18,667,423 20,960,934 19,278,655 18,340,840 18,547,107 17,792,132 Comments: Estimate was calculated based on same month prior year adjusted for percentage change of recent receipts vs. recent estimates. FS-10

17 Health System Hospitals Payor Mix Patient Days as % of Total Fiscal Year Actual % Variance Actual Actual % Variance FC Group Sept-14 Sept-14 Aug-14 YTD YTD Health System Combined percentages: Commercial 1.51% 1.30% 0.21% 1.59% 1.36% 1.32% 0.04% Medicaid 9.46% 17.35% 7.89% 9.59% 17.01% 17.41% 0.40% Medicare 14.84% 16.43% 1.59% 15.37% 15.50% 16.38% 0.88% Other 4.76% 2.96% 1.80% 4.63% 5.08% 2.99% 2.09% Managed Care 39.09% 27.78% 11.31% 38.69% 30.68% 27.68% 3.00% Self Pay 14.84% 13.59% 1.25% 14.69% 14.70% 13.57% 1.13% Potential Medicaid 15.50% 20.59% 5.09% 15.44% 15.67% 20.65% 4.98% Total % % 0.00% % % % 0.00% Memorial Hospital Combined percentages: Commercial 1.69% 1.49% 0.20% 1.82% 1.60% 1.50% 0.10% Medicaid 10.81% 19.01% 8.20% 11.18% 18.65% 19.00% 0.35% Medicare 12.35% 13.82% 1.47% 13.59% 13.63% 13.82% 0.19% Other 5.51% 3.37% 2.14% 5.43% 5.90% 3.40% 2.50% Managed Care 37.11% 25.74% 11.37% 36.52% 28.03% 25.72% 2.31% Self Pay 15.73% 13.76% 1.97% 14.80% 15.41% 13.76% 1.65% Potential Medicaid 16.80% 22.81% 6.01% 16.66% 16.78% 22.80% 6.02% Total % % 0.00% % % % 0.00% South Combined percentages: Commercial 0.18% 1.05% 0.87% 1.23% 0.77% 1.09% 0.32% Medicaid 4.47% 7.45% 2.98% 4.27% 8.36% 7.41% 0.95% Medicare 23.02% 24.49% 1.47% 17.52% 22.66% 24.54% 1.88% Other 3.16% 2.24% 0.92% 2.35% 2.67% 2.14% 0.53% Managed Care 45.97% 37.84% 8.13% 50.29% 41.85% 37.83% 4.02% Self Pay 14.92% 15.45% 0.53% 16.70% 15.35% 15.50% 0.15% Potential Medicaid 8.28% 11.48% 3.20% 7.64% 8.34% 11.49% 3.15% Total % % 0.00% % % % 0.00% North Combined percentages: Commercial 1.32% 0.36% 0.96% 0.40% 0.33% 0.42% 0.09% Medicaid 4.59% 14.44% 9.85% 3.10% 12.80% 14.49% 1.69% Medicare 24.52% 26.14% 1.62% 25.20% 22.03% 26.13% 4.10% Other 1.22% 1.09% 0.13% 1.07% 1.73% 1.14% 0.59% Managed Care 46.57% 32.78% 13.79% 44.58% 39.23% 32.66% 6.57% Self Pay 9.34% 11.30% 1.96% 12.61% 10.02% 11.25% 1.23% Potential Medicaid 12.44% 13.89% 1.45% 13.04% 13.86% 13.91% 0.05% Total % % 0.00% % % % 0.00% FS 11