ELLIS HOSPITAL (d/b/a Ellis Medicine) Consolidated Financial Statements. December 31, 2012 and (With Independent Auditors Report Thereon)

Transcription

1 Consolidated Financial Statements (With Independent Auditors Report Thereon)

2 Consolidated Financial Statements Table of Contents Page Independent Auditors Report 1 Consolidated Balance Sheets 3 Consolidated Statements of Operations and Changes in Net Assets 5 Consolidated Statements of Cash Flows 7 8

3 KPMG LLP 345 Park Avenue New York, NY Independent Auditors Report The Board of Trustees Ellis Hospital : We have audited the accompanying consolidated financial statements of Ellis Hospital (d/b/a Ellis Medicine) (the Hospital), which comprise the consolidated balance sheets as of December 31, 2012 and 2011, and the related consolidated statements of operations and changes in net assets, and cash flows for the years then ended, and the related notes to the consolidated financial statements. Management s Responsibility for the Consolidated Financial Statements Management is responsible for the preparation and fair presentation of these consolidated financial statements in accordance with U.S. generally accepted accounting principles; this includes the design, implementation, and maintenance of internal control relevant to the preparation and fair presentation of consolidated financial statements that are free from material misstatement, whether due to fraud or error. Auditors Responsibility Our responsibility is to express an opinion on these consolidated financial statements based on our audits. We conducted our audits in accordance with auditing standards generally accepted in the United States of America. Those standards require that we plan and perform the audit to obtain reasonable assurance about whether the consolidated financial statements are free from material misstatement. An audit involves performing procedures to obtain audit evidence about the amounts and disclosures in the consolidated financial statements. The procedures selected depend on the auditors judgment, including the assessment of the risks of material misstatement of the consolidated financial statements, whether due to fraud or error. In making those risk assessments, the auditor considers internal control relevant to the entity s preparation and fair presentation of the consolidated financial statements in order to design audit procedures that are appropriate in the circumstances, but not for the purpose of expressing an opinion on the effectiveness of the entity s internal control. Accordingly, we express no such opinion. An audit also includes evaluating the appropriateness of accounting policies used and the reasonableness of significant accounting estimates made by management, as well as evaluating the overall presentation of the consolidated financial statements. We believe that the audit evidence we have obtained is sufficient and appropriate to provide a basis for our audit opinion. KPMG LLP is a Delaware limited liability partnership, the U.S. member firm of KPMG International Cooperative ( KPMG International ), a Swiss entity.

4 Opinion In our opinion, the consolidated financial statements referred to above present fairly in all material respects, the financial position of Ellis Hospital as of, and the results of their operations and changes in net assets, and their cash flows for the years then ended in accordance with U.S. generally accepted accounting principles. Albany, New York March 28,

5 Consolidated Balance Sheets Assets Current assets: Cash and cash equivalents $ 10,598,424 7,876,491 Patient accounts receivable (net of allowance for doubtful accounts of approximately $19,819,000 in 2012 and $18,995,000 in 2011) 39,087,942 36,728,375 Other receivables 4,176,273 3,469,406 Assets limited as to use 33,228,949 30,659,986 Inventories 5,018,169 5,142,782 Interest in net assets of Ellis Hospital Foundation, Inc. 850, ,000 Prepaid expenses 1,795,441 1,197,612 Total current assets 94,755,198 85,860,652 Assets limited as to use 25,789,050 29,284,149 Interest in net assets of Ellis Hospital Foundation, Inc. 14,655,677 14,324,592 Property and equipment, net 141,312,361 93,374,596 Other long term assets 2,791,180 1,590,904 Total assets $ 279,303, ,434,893 See accompanying notes to consolidated financial statements. 3

6 Liabilities and Net Assets Current liabilities: Current portion of long-term debt $ 5,229,389 4,616,738 Current portion of capital lease obligations 1,313,091 1,306,340 Accounts payable 29,377,719 23,517,339 Accrued benefit time 10,742,972 9,096,120 Accrued salaries, wages and related expenses 9,058,269 6,739,724 Accrued interest payable 138, ,555 Other current liabilities 5,825,602 5,461,484 Estimated third-party payor settlements 387,450 2,809,269 Total current liabilities 62,073,221 53,692,569 Long-term debt, net of current portion 40,610,714 31,311,969 Capital lease obligations, net of current portion 17,104,706 2,314,123 Estimated liability for self-insurance claims 13,473,223 11,427,287 Estimated third-party payor settlements 2,997,000 2,000,000 Accrued sick pay 6,770,695 5,729,354 Accrued pension costs 21,516,827 19,638,723 Other liabilities 2,071,898 1,736,026 Deferred credit 2,467, ,545,063 76,624,739 Total liabilities 166,618, ,317,308 Net assets: Unrestricted 97,083,041 77,487,333 Temporarily restricted 10,152,542 11,421,977 Permanently restricted 5,449,599 5,208,275 Total net assets 112,685,182 94,117,585 Commitments and contingencies (notes 8, 9, 10, 11 and 15) Total liabilities and net assets $ 279,303, ,434,893 4

7 Consolidated Statements of Operations and Changes in Net Assets Years ended Unrestricted revenue, gains and other support: Patient service revenue, net of contractual adjustments and discounts $ 371,561, ,001,847 Less provision for bad debts (14,458,118) (16,990,182) Net patient service revenue 357,103, ,011,665 Other operating revenue 10,877,240 10,434,411 Net assets released from restrictions used for operations 84,269 89,168 Total revenue, gains and other support 368,064, ,535,244 Expenses: Salaries and wages 188,270, ,368,674 Employee benefits 35,841,393 31,982,747 Supplies and other expenses 121,207, ,316,991 Depreciation and amortization 13,998,185 13,662,844 Interest 1,363,145 1,386,774 Insurance 5,332,995 3,927,700 Total expenses 366,013, ,645,730 Operating income 2,050,929 6,889,514 Nonoperating income: Investment gain 2,205,502 1,659,956 Contribution 1,209,641 Gain on extinguishment of debt 3,300,510 (Loss) gain on disposal of equipment (49,602) 23,065 Excess of revenues over expenses $ 8,716,980 8,572,535 5 (Continued)

8 Consolidated Statements of Operations and Changes in Net Assets Years ended Unrestricted net assets: Excess of revenues over expenses $ 8,716,980 8,572,535 Change in net unrealized gains (losses) on investments 603,386 (1,933,616) Change in interest in net assets of Ellis Hospital Foundation, Inc. 349,851 (1,227,036) Pension and post-retirement related changes other than net periodic benefit cost (4,559,153) (12,014,443) Transfer to/from restricted net assets (495,000) (500,000) Contributed property, plant and equipment 11,366,330 Net assets released from restrictions used for purchase of property and equipment 3,613,314 3,400,744 Increase (decrease) in unrestricted net assets 19,595,708 (3,701,816) Temporarily restricted net assets: Contributions, grants and contracts 1,740,779 3,384,679 Change in interest in net assets of Ellis Hospital Foundation, Inc. (201,090) (591,804) Net assets released from restrictions used for purchase of property and equipment (3,613,314) (3,400,744) Net assets released from restrictions used for operations (84,269) (89,168) Transfer from unrestricted net assets 500, ,000 Restricted income from investments 388, ,798 Decrease in temporarily restricted net assets (1,269,435) (15,239) Permanently restricted net assets: Transfer to unrestricted net assets (5,000) Change in interest in net assets of Ellis Hospital Foundation, Inc. 246,324 1,238,676 Increase in permanently restricted net assets 241,324 1,238,676 Change in net assets 18,567,597 (2,478,379) Net assets at beginning of year 94,117,585 96,595,964 Net assets at end of year $ 112,685,182 94,117,585 See accompanying notes to consolidated financial statements. 6

9 Consolidated Statements of Cash Flows Years ended Cash flows from operating activities: Change in net assets $ 18,567,597 (2,478,379) Adjustments to reconcile change in net assets to net cash provided by operating activities: Depreciation and amortization 13,998,185 13,662,844 Pension and post-retirement related changes other than net periodic benefit cost 4,559,153 12,014,443 Amortization of deferred financing costs 292, ,674 Provision for bad debts 14,458,118 16,990,182 Amortization of deferred credits (2,467,257) (510,467) Gain on extinguishment of debt (746,856) Net realized gain on sale of investments (2,188,621) (1,436,964) Change in net unrealized (gains) losses on investments (603,386) 2,048,882 Change in interest in net assets of Ellis Hospital Foundation, Inc. (395,085) 580,164 Contributed property, plant and equipment (12,267,000) Restricted contributions (1,740,779) (3,324,503) Changes in operating assets and liabilities: Patient accounts receivable (16,817,685) (13,769,442) Other receivables and prepaid expenses (1,304,696) (2,277,459) Inventories 124,613 (345,983) Accounts payable, accrued expenses and other liabilities 9,833,810 2,546,479 Estimated third-party payor settlements (1,424,819) (1,626,731) Estimated liability for self-insurance claims 2,045,936 1,463,287 Accrued pension costs (2,681,049) (3,557,371) Net cash provided by operating activities 21,242,653 20,118,656 Cash flows from investing activities: Purchase of property and equipment, net (47,942,480) (10,883,605) Net decrease(increase) in assets whose use is limited 4,624,033 (2,072,642) Net cash used in investing activities (43,318,447) (12,956,247) Cash flows from financing activities: Restricted contributions 1,740,779 3,324,503 Payments on capital lease obligations (1,767,085) (1,421,692) Payments on long-term debt (4,669,242) (4,427,181) Proceeds from long-term debt 30,239, ,177 Refinancing gain 746,856 Debt issuance costs (1,492,750) (389,000) Net cash provided by (used in) financing activities 24,797,727 (2,696,193) Net increase in cash and equivalents 2,721,933 4,466,216 Cash and cash equivalents at beginning of year 7,876,491 3,410,275 Cash and cash equivalents at end of year $ 10,598,424 7,876,491 Supplemental disclosures of cash flow information: Cash paid during the year for interest $ 1,369,971 1,404,324 Noncash investing and financing activities: Lease obligations incurred for capitalized equipment 15,614,185 4,121,446 Fixed asset purchases included in accounts payable 3,385,791 1,659,320 See accompanying notes to consolidated financial statements. 7

10 (1) Summary of Significant Accounting Policies (a) Description of Organization Ellis Hospital (the Hospital), located in Schenectady, New York, operates a 438 certified bed acute care not-for-profit hospital. Included as part of the Hospital is an 82-bed hospital based nursing facility and four primary care health centers. The Hospital is also financially interrelated with the Ellis Hospital Foundation, Inc., which seeks philanthropic support on behalf of the Hospital and grants funds to the Hospital under the direction of its Board of Trustees. In November 2006, the New York Commission on Health Care Facilities in the 21 st Century released its final report, which became law January 1, 2007, including two specific recommendations for changing how hospital services are provided in Schenectady County. One recommendation mandated the closure of Bellevue Woman s Hospital (Bellevue), which occurred and culminated in Bellevue s services and assets being transferred to the Hospital in November The other pertinent recommendation required St. Clare s Hospital (St. Clare s) and the Hospital to combine under a single governance structure and reduce their combined bed capacity. On June 16, 2008, St. Clare s surrendered its operating certificate and the New York Department of Health transferred responsibility for its services to the Hospital. The related assets were transferred to the Hospital in June Between June 2008 and June 2012, the Hospital leased St. Clare s former campus and assets for $1 per month. The Hospital and St. Clare s were each 50% members of the Visiting Nurse Service Association of Schenectady County (d/b/a Visiting Nurse Service of Schenectady and Saratoga Counties) (VNS), a nonprofit corporation organized in New York State that provides health and supportive services to individuals in their homes and in clinics in Schenectady and Saratoga Counties. As part of the June 2012 St. Clare s asset transfer referenced above, the Hospital became the sole member of VNS assuming St. Clare s former 50% interest. The consolidated financial statements include the accounts of the Hospital and VNS. All significant intercompany transactions have been eliminated. (b) Basis of Presentation The accompanying consolidated financial statements, which are presented on the accrual basis of accounting, have classified net assets and revenue, expenses, gains, and losses based on the existence or absence of donor-imposed restrictions. Accordingly, unrestricted net assets are amounts not subject to donor-imposed stipulations and are available for operations. Temporarily restricted net assets are those whose use has been limited by donors to a specific time period or purpose. Permanently restricted net assets are subject to donor-imposed stipulations that generally require the principal to be maintained in perpetuity. The Hospital considers events or transactions that occur after the consolidated balance sheet date, but before the financial statements are issued, to provide additional evidence relative to certain estimates or to identify matters that require additional disclosure. These consolidated financial statements were available to be issued on March 28, 2013 and subsequent events have been evaluated through that date. 8 (Continued)

11 (c) (d) Use of Estimates The preparation of the accompanying consolidated financial statements in conformity with accounting principles generally accepted in the United States of America requires management to make estimates and assumptions about future events. These estimates and underlying assumptions affect the reported amounts of assets and liabilities and disclosure of contingencies at the date of the consolidated financial statements and the reported amounts of revenues and expenses during the reporting period. Significant items subject to such estimates and assumptions include the allowance for doubtful accounts, contractual allowances, estimated third-party payor settlements, self-insurance liabilities, asset retirement obligations and the assumptions used to determine the pension and postretirement liabilities. These estimates and assumptions are based on management s best estimates and judgment. Management evaluates its estimates and assumptions on an ongoing basis using historical experience and other factors, including the current economic environment. Management adjusts such estimates and assumptions when facts and circumstances dictate. As future events and their effects cannot be determined with precision, actual results could differ significantly from these estimates. Changes in those estimates resulting from continuing changes in the economic environment will be reflected in the consolidated financial statements in future periods. Collective Bargaining Agreements At, the Hospital has approximately 16.9% and 18.9%, respectively, of its employees working under a collective bargaining agreement. This agreement with the New York State Nurses Association (NYSNA) expires in February Approximately 35% of VNS s employees are covered by one of two collective bargaining agreements. The New York State Nurses Association agreement covers all registered professional nurses (optional membership) for a three-year period ending March 31, The labor contract with the Service Employees International Union Local 1199 covering all home health care aides and personal care aides expired June 30, Negotiations on a new agreement are ongoing. The term and financial impact of a new agreement are not determinable at this time. (e) (f) (g) Cash and Cash Equivalents For purposes of the consolidated statements of cash flows, the Hospital considers all highly liquid debt instruments with original maturities of three months or less to be cash and cash equivalents, excluding assets limited as to use. Inventories Inventories are stated at the lower of cost or market, determined on an average cost method. Assets Limited as to Use Assets limited as to use include amounts held by bank trustees under indenture agreements and self-insurance trust arrangements, funds held in escrow, contributions from donors restricted for specific purposes (including unexpended income), endowment funds from donor-restricted resources (including unexpended income), the principal of which may not be expended by the governing board 9 (Continued)

12 and assets set aside by the Board of Trustees over which the Board retains control and may, at its discretion, subsequently use for other purposes. Investment income from assets held by trustees related to the self-insurance programs is included within operating income, all other investment income is included in nonoperating income in the consolidated statements of operations and changes in net assets. Investments are measured at fair value in the accompanying consolidated balance sheets. Investment income or loss (including net realized gains or losses on investments, interest and dividends) is included in the excess of revenues over expenses unless the income or loss is restricted by donor or law. Changes in net unrealized gains and losses on investments are excluded from the excess of revenues over expenses. Losses on other-than-temporarily impaired assets are included in the excess of revenues over expenses. (h) Investment Risks Investment securities are exposed to various risks, such as interest rate, market and credit. Due to the level of risk associated with certain investment securities and the level of uncertainty related to changes in the value of investment securities, it is at least reasonably possible that changes in values in the near term could materially affect the amounts reported in the accompanying consolidated balance sheets and consolidated statements of operations and changes in net assets. The Hospital continually reviews investments for impairment conditions that indicate that an other-than-temporary decline in market value has occurred. In conducting this review, numerous factors are considered which, individually or in combination, indicate that a decline is other-than-temporary and that a reduction of the carrying value is required. These factors include specific information pertaining to an individual company or particular industry and general market conditions that reflect prospects for the economy as a whole. During 2012 and 2011, the Hospital did not recognize any other-than-temporary losses as there were no significant unrealized losses. (i) Property and Equipment Property and equipment are stated at cost, if purchased or at fair value at date of receipt, if acquired by gift, less accumulated depreciation. Depreciation is computed by use of the straight-line method over the estimated useful lives of the assets ranging from 3 to 40 years. Equipment under capital lease obligations is amortized on the straight-line method over the shorter period of the lease term or the estimated useful life. Such amortization is included in depreciation and amortization expense in the accompanying consolidated financial statements. Gifts of long-lived assets such as land, buildings or equipment are reported as unrestricted support, and are excluded from the excess of revenues over expenses, unless explicit donor stipulations specify how the donated assets must be used. Gifts of long-lived assets with explicit restrictions that specify how the assets are to be used and gifts of cash or other assets that must be used to acquire long-lived assets are reported as restricted support. Absent explicit donor stipulations about how long those long-lived assets must be maintained, expirations of donor restrictions are reported when the donated or acquired long-lived assets are placed in service. 10 (Continued)

13 (j) (k) (l) (m) Deferred Financing Costs Deferred financing costs represent costs, relating to the 2004, 2011 and 2012 mortgage notes and the lease financing, which are amortized utilizing the straight-line method to expense over the life of the debt. Deferred financing costs are net of accumulated amortization of $2,490,762 and $2,338,885 as of, respectively. Amortization expense amounted to approximately $152,000 and $140,000 for 2012 and 2011, respectively. Deferred Credit As a result of the 1995 Dormitory Authority of the State of New York (DASNY) mortgage refinancing, present value savings were escrowed for future capital expenditures. During 1997, DASNY made these funds available to the Hospital to be used in facility renovations in lieu of further lowering the mortgage interest rate. The Hospital had no obligation to repay the funds provided the mortgage balance was paid and operations continued at the Hospital. The Hospital had recorded the funds received as a deferred credit and was accreting the credit annually through In 2012 the Hospital entered into a loan agreement to refinance the DASNY mortgage. As a result the deferred credit was written off in 2012 and recognized as part of the gain of refinancing of debt in the nonoperating section of the consolidated statement of operations and changes in net assets. Accrued Sick Pay The Hospital has accrued a liability for employees unused sick pay. It is the policy of the Hospital to provide for the payment of unused accrued sick time to qualified individuals who terminate their employment and are of retirement age. All eligible employees hired prior to January 1, 2011, who are at least age 55 and have five (5) or more years of service at time of retirement, will be provided this benefit payment option for accrued unused sick time up to a maximum of 960 hours, adjusted by percentages based on their age at time of separation from the Hospital. Beginning in 2013, each person s payout will be based on the lesser of each person s accrued balance at the time of separation or their accrued balance as of January 1, Since it cannot be determined when employees will use their accumulated sick time or be compensated at time of termination, the aforementioned accrual is classified as a noncurrent liability in the accompanying consolidated balance sheets. Excess of Revenues over Expenses The consolidated statements of operations and changes in net assets includes excess of revenues over expenses. Changes in unrestricted net assets which are excluded from excess of revenues over expenses, consistent with industry practice, include change in net unrealized gains and losses on investments other than trading securities, change in unrestricted interest in net assets of Ellis Hospital Foundation Inc., contributions of long-lived assets (including assets acquired using contributions which by donor restriction were to be used for the purposes of acquiring such assets), and pension and post-retirement related changes other than net periodic benefit cost. 11 (Continued)

14 (n) Net Patient Service Revenue and Provision for Bad Debts Net patient service revenue is reported at the estimated net realizable amounts from patients, third-party payors and others for services rendered, including estimated retroactive and prospective adjustments under reimbursement agreements with third-party payors. Third-party payors retain the right to review and propose adjustments to amounts reported by the Hospital. Such adjustments are accrued on an estimated basis in the period the related services are rendered and adjusted in future periods as final settlements are determined. The Hospital grants credit without collateral to patients, most of whom are local residents and are insured under third-party payor agreements. Additions to the allowance for doubtful accounts are made by means of the provision for bad debts. Accounts written off as uncollectible are deducted from the allowance. The amount of the provision for bad debts is based upon management s assessment of historical expected net collections, business and economic conditions, trends in Federal and state governmental health care coverage, and other collection indicators. Services rendered to individuals when payment is expected and ultimately not received are written off to the allowance for doubtful accounts. (o) (p) Charity Care The Hospital provides care to patients who meet certain criteria under its charity care policy without charges or at amounts less than its estimated rates. Because the Hospital does not pursue collection of amounts determined to qualify as charity care, they are not reported as revenue. The Hospital maintains records to identify and monitor the level of charity care they provide. Those records include the amount of charges for services and supplies furnished to patients at no charge or at reduced charges. Donor-Restricted Gifts Unconditional promises to give cash and other assets to the Hospital are reported at fair value at the date the promise is received. Conditional promises to give and indications of intentions to give are reported at fair value at the date the conditions are removed. Gifts are reported as either temporarily or permanently restricted support if they are received with donor stipulations that limit the use of the donated assets. When a donor restriction expires, that is, when a stipulated time restriction ends or purpose restriction is accomplished, temporarily restricted net assets are reclassified to unrestricted net assets and reported in the consolidated statements of operations and changes in net assets as net assets released from restrictions. The Hospital is subject to the New York Prudent Management of Institutional Funds Act (NYPMIFA or Act) which provides clear standards of fund management for those charged with governance of institutional or endowment funds. NYPMIFA updates and in some cases retains provisions of previous New York State laws governing the management of institutional funds. Among its various provisions, it requires that those responsible for managing institutional funds adopt a written investment policy; requires diversification of investments; and provides institutions with a process by which donor restrictions can be lifted. The Act allows an institution to determine the appropriate level of endowment expenditure, subject to donor-imposed restrictions expressed in 12 (Continued)

15 the gift instrument. However, it establishes a rebuttable presumption of imprudence if such expenditure in any year is greater than 7% of the fair market value of an endowment fund. The Hospital classifies as permanently restricted net assets (a) the original value of gifts donated to the permanent endowment, (b) the original value of subsequent gifts to the permanent endowment, and (c) accumulations to the permanent endowment made in accordance with the direction of the application donor gift instrument at the time the accumulation is added to the fund, if any. (q) Income Taxes The Hospital is a not-for-profit corporation as described in Section 501(c)(3) of the Internal Revenue Code (the Code) and is exempt from federal income taxes on related income pursuant to Section 501(a) of the Code. The Hospital recognizes the effect of income tax positions only if those positions are more likely than not of being sustained. Recognized income tax positions are measured at the largest amount that is greater than fifty percent likely of being realized upon settlement. Changes in recognition in measurement are reflected in the period in which the change in judgment occurs. The Hospital did not recognize the effect of any uncertain income tax positions in either 2012 or (r) Concentration of Credit Risk The Hospital maintains cash balances in depositories above FDIC insurance limitations amounting to approximately $9.1 million at December 31, (2) Net Patient Service Revenue As described in note (1)(n), net patient service revenue and accounts receivable are reported at the estimated net realizable amounts from third-party payors, patients, and others for services rendered, including estimated retroactive adjustments under reimbursement agreements with third-party payors. Retroactive adjustments are accrued on an estimated basis in the period the related services are rendered and adjusted in future periods as final settlements or adjustments become known or as years are no longer subject to audits, reviews, and investigations. See below for information relative to third-party reimbursement agreements. Inpatient acute care services rendered to Medicare program beneficiaries are paid at prospectively determined rates per discharge. These rates vary according to a patient classification system that is based on clinical, diagnostic and other factors. Under the New York Health Care Reform Act (NYHCRA), hospitals are authorized to negotiate reimbursement rates for inpatient acute care services with certain non-medicare payors except for Medicaid, Workers Compensation and No-Fault. These negotiated rates may take the form of rates per discharge, reimbursed costs, discounted charges or as per diem payments. Reimbursement rates for Medicaid, Workers Compensation and No-Fault are determined on a prospective basis as determined by the New York State Prospective Hospital Reimbursement Methodology (NYPHRM), which was subsequently adopted under the provisions of NYHCRA. These rates also vary according to a patient classification system defined by NYPHRM that is based on clinical, diagnostic and other factors. 13 (Continued)

16 NYPHRM was updated in 2009 to incorporate a statewide case-mix neutral base price and hospital specific wage equalization factors pursuant to the Healthcare Improvement Act. For all payors except Medicare, outpatient services are paid under various reimbursement methods including cost reimbursement, fee schedules and charges. Outpatient services rendered to Medicare beneficiaries are paid under a prospective payment system (PPS). Under the Medicare outpatient PPS, services provided to a beneficiary on the same day are grouped into ambulatory payment classifications (APCs) and paid at predetermined amounts. Under the Medicaid rate reform, services provided to a beneficiary on the same day are grouped into ambulatory payment groups and paid at predetermined amounts. Payments to the Hospital under both Medicaid and Medicare Part A for nursing facility patients are made utilizing a PPS reimbursement methodology. With the exception of Medicaid capital, the reimbursement is made at a predetermined rate depending on intensity of services rendered to patients regardless of the cost of delivering those services. Home care services rendered to Medicare program beneficiaries are reimbursed under a prospective reimbursement methodology. The reimbursement rates for individual episodes of care are determined using a patient assessment process that measures the level of care needed by each patient. Individuals requiring a higher level of care are reimbursed at a higher rate. These rates are adjusted for regional cost differentials. Prior to May 1, 2012, home care services rendered to Medicaid program beneficiaries were reimbursed on a fee-for-service basis. Individual service rates were computed on the basis of allowable fiscal and statistical data for base year period trended forward to the current year. These rates were held to the lower of costs trended forward or the regional cost guidelines established. Effective May 1, 2012, Medicaid implemented an episodic payment system, whereby providers were paid a pre-determined amount based on the beneficiary's health condition and care needs for a 60-day episode of care. Similar to Medicare services, payment adjustments exist for low and high utilization of services during a 60-day episode. The Hospital is eligible to receive funds from several pools established under NYHCRA. Amounts received or to be received from the pools have been included as increases to net patient service revenue. Differences between amounts recorded and final distributions from the pools will be included as adjustments to net patient service revenue in the year that such distributions are finalized. Revenue from Medicare and Medicaid accounted for 51% of net patient service revenue for the year ended December 31, 2012 and 49% for the year ended December 31, As such, the Hospital is dependent on these payors to carry out its operating activities. Cost reports supporting third-party patient service revenue have been audited and finalized through December 31, 2006 by the designated intermediaries. The laws and regulations governing the Medicare and Medicaid programs are complex and subject to interpretation. Compliance with laws and regulations can be subject to future government review and interpretation as well as significant regulatory action; failure to comply with such laws and regulations can result in fines, penalties and exclusion from the Medicare and Medicaid programs. The Hospital believes it is in compliance with applicable laws and regulations and retroactive adjustments, if any, would not be material to the consolidated financial position or consolidated results of operations of the Hospital. The Hospital has classified a portion of the accrual for estimated third-party payor settlements as long term 14 (Continued)

17 liabilities because such amounts, by their nature or by virtue of regulations or legislation will not be paid within one year. In 2012 and 2011, the Hospital s revenue was positively impacted by approximately $334,000 and $208,000, respectively, due to actual settlements and changes in previous estimates related to prior periods as a result of tentative and final settlements and years that are no longer subject to audits, reviews and investigations. A summary of patient service revenue, net of contractual adjustments and discounts, follows: Patient service revenue $ 1,171,854,936 1,103,338,600 Less provisions for contractual adjustments under third-party reimbursement programs and discounts 800,293, ,336,753 $ 371,561, ,001,847 (3) Charity Care As described in note (1)(o), the Hospital provides care to patients who meet certain criteria under its Patient Financial Assistance Program without charge or at amounts less than its established rates. Because the Hospital does not pursue collection of amounts determined to qualify as charity care, they are not reported as net patient service revenue. The Hospital maintains records to identify and monitor the level of charity care it provides. The cost of charity care was approximately $8,928,000 and $6,894,000 for 2012 and 2011, respectively. The cost of charity care provided was determined based on the application of a ratio of overall hospital costs to patient charges. Included in patient service revenues for 2012 and 2011 is approximately $6,506,000 and $6,859,000, respectively, from uncompensated care pools. (4) Patient Accounts Receivable and Related Allowance for Doubtful Accounts Patient accounts receivable are reflected net of an allowance doubtful accounts. In evaluating the collectability of patient accounts receivable, as described in note (1)(n), the Hospital analyzes its past collection history, business and economic conditions, trends in governmental and employee health care coverage and other collection indicators for each of its major categories of revenue by payor (for hospital inpatient, outpatient, medical group practice professionals, and skilled nursing facility services) to estimate the appropriate allowance for doubtful accounts. Management regularly reviews data about these major categories of revenue in evaluating the sufficiency of the allowance for doubtful accounts. Throughout the year the Hospital, after all reasonable collection efforts have been exhausted, will write off the difference between the standard rates (or discounted rates if negotiated) and the amounts actually collected against the allowance for doubtful accounts. In addition to the review of the categories of revenue, management monitors the write offs against established allowances to determine the appropriateness of the underlying assumptions used in estimating the allowance for doubtful accounts. 15 (Continued)

18 Accounts receivable, prior to adjustment for the allowance for doubtful accounts, is summarized as follows at December 31: Accounts receivable: Patients $ 8,503,596 10,970,442 Government 17,013,700 15,564,306 Commercial 31,398,650 25,384,568 Other 1,991,054 3,803,943 $ 58,907,000 55,723,259 Allowance for doubtful accounts is summarized as follows at December 31: Allowance for doubtful accounts: Patients $ 7,732,834 9,517,547 All other 12,086,224 9,477,337 $ 19,819,058 18,994,884 Bad debt expense for nonpatient related accounts receivable is reflected in total operating expenses on the consolidated statements of operations and changes in net assets. Patient related bad debt is reflected as a reduction in patient service revenues on the consolidated statements of operations and changes in net assets. (5) Assets Limited as to Use Assets limited as to use, carried at fair value at December 31 include the following: Cash and cash equivalents $ 5,664,510 3,074,734 Mutual funds 5,918,324 4,453,681 Equity securities 15,089,067 19,934,366 Corporate debt securities 7,328,192 9,505,396 U.S. Treasury obligations 25,017,906 22,975,958 59,017,999 59,944,135 Current portion 33,228,949 30,659,986 Long-term portion $ 25,789,050 29,284, (Continued)

19 Unrestricted investment income and gains and losses from assets limited as to use are comprised of the following at December 31: Investment income in other operating revenue: Interest and dividends $ 266, ,892 Realized gains on sales of investments, net 580, ,447 $ 847,090 1,016,339 Investment income in nonoperating income: Interest and dividends $ 597, ,439 Realized gains on sales of investments, net 1,608, ,517 $ 2,205,502 1,659,956 The following is a summary of assets limited as to use at December 31: Mortgage reserve fund $ 6,821,837 9,329,389 Funds held in escrow 251, ,620 Funds held in trust for self-insurance 15,835,351 15,498,545 Funds held for board-designation 29,515,345 28,345,366 Unexpended lease proceeds 905,889 Donor restricted principal and accumulated earnings 5,687,869 6,529,215 Total assets limited as to use $ 59,017,999 59,944,135 The Hospital considers funds held for board-designations and other funds that are anticipated to be used in the following year as current. The Mortgage Reserve Fund Agreement for the 1995 debt was modified when the debt was refinanced in 2012 (see footnote 10(a)). The revised agreement requires the Mortgage Reserve Fund hold 18 months of debt service payments at December 31, Based on this requirement, the Mortgage Reserve Fund for this debt was required to be $5,440,000 at December 31, The prior agreement required the fund to hold 24 months of debt service payments. Based on this requirement, the Mortgage Reserve Fund was required to be at $8,033,649 at December 31, The Hospital met the funding requirements for 2012 and The requirement for the 2004 debt for the ICU project was to begin funding the Mortgage Reserve Fund in 2006, with the requirement that the balance be $1,300,190 as of December 31, The balance of this Mortgage Reserve Fund was $1,313,227 and $1,111,963 at, respectively. 17 (Continued)

20 At, the Hospital s investment portfolio has equity and debt securities in an aggregate unrealized loss position of $701,135 and $1,254,489 and an associated aggregate fair value of $17,524,613 and $16,885,705, respectively. The following table presents the gross unrealized losses and fair value of the Hospital s investments with unrealized losses that are not deemed to be other-than-temporarily impaired, aggregated by investment category and length of time that individual securities have been in a continuous unrealized loss position at : Gross unrealized loss 2012 Fair value Debt securities: Loss position continuous for less than 12 months $ (141,982) 10,423,539 Loss position continuous for 12 months or greater (79,004) 2,584,196 Total $ (220,986) 13,007,735 Equity securities: Loss position continuous for less than 12 months $ (344,303) 3,821,133 Loss position continuous for 12 months or greater (135,846) 695,745 Total $ (480,149) 4,516,878 Gross unrealized loss 2011 Fair value Debt securities: Loss position continuous for less than 12 months $ (54,049) 5,251,105 Loss position continuous for 12 months or greater (53,328) 2,659,450 Total $ (107,377) 7,910,555 Equity securities: Loss position continuous for less than 12 months $ (1,038,495) 8,117,466 Loss position continuous for 12 months or greater (108,617) 857,684 Total $ (1,147,112) 8,975,150 Management reviewed the investments with unrealized losses, summarized in the preceding tables, and determined that the investments were not other-than-temporarily impaired. Management reached this conclusion in consultation with its investment advisors and portfolio managers, who relied on industry analyst reports, credit ratings, current market conditions, and other information they deemed relevant to their assessment. 18 (Continued)

21 (6) Other Operating Revenue The Hospital received funds from the federal government under the Medicare and Medicaid Electronic Health Records (EHR) Incentive Programs, due to meeting guidelines for Meaningful Use of EHR and related technology. To achieve the maximum reimbursement, the Hospital had to achieve Stage 1 for at least a 90-day period within the 2011 or 2012 federal fiscal year and for the entire year thereafter. The Hospital did achieve Stage 1 in 2011 and recorded approximately $3,600,000 of Meaningful Use dollars in other operating revenue. In 2012, the Hospital recorded approximately $2,906,000 representing year 2 of the Stage 1 incentive. (7) Interest in Net Assets of Foundation In accordance with ASC 958, Not-for-Profit Entities, the Hospital records its interest in the net assets of Ellis Hospital Foundation, Inc. (Foundation). ASC requires a beneficiary (Hospital) of financially interrelated organizations to recognize their interest in the net assets of the recipient organization (Foundation) and adjust that interest for its share of the change in net assets of the recipient organization. The Foundation was incorporated for the purpose of receiving gifts and bequests from the general public for the benefit of the Hospital. A summary of the Foundation s assets, liabilities, net assets and changes in net assets are as follows: Cash and investments $ 12,282,341 10,976,580 Pledges and other receivables 3,551,447 5,173,706 Total assets $ 15,833,788 16,150,286 Total liabilities $ 328,111 1,039,694 Net assets: Unrestricted $ 4,966,954 4,617,103 Temporarily restricted 5,776,798 5,977,888 Permanently restricted 4,761,925 4,515,601 Total net assets $ 15,505,677 15,110,592 Change in unrestricted net assets $ 349,851 (1,227,036) Change in temporarily restricted net assets (201,090) (591,804) Change in permanently restricted net assets 246,324 1,238,676 Total change in interest in net assets of Foundation $ 395,085 (580,164) The Foundation distributed approximately $1,662,000 and $3,318,000 in 2012 and 2011, respectively, to the Hospital for the purchase of certain Hospital equipment and operating expenses. 19 (Continued)

22 (8) Property and Equipment Property and equipment at December 31 is as follows: Land $ 4,296,826 2,956,826 Land improvements 4,563,490 3,874,611 Buildings 136,185, ,844,084 Fixed equipment 65,427,447 63,003,136 Moveable equipment 140,562, ,562,601 Leasehold improvements 1,316,425 1,177,542 Construction in progress 15,320,735 11,100, ,672, ,519,601 Less accumulated depreciation and amortization 226,360, ,145,005 Net property and equipment $ 141,312,361 93,374,596 Costs to complete the construction in progress as of December 31, 2012 are approximately $68,430,000, the majority of which relates to the improvements associated with women s health, particularly the maternity and breast cancer centers at the Bellevue campus (the Bellevue project) (approximately $5.7 million) and Emergency Room renovations at the Nott St. Campus (approximately $52 million). Included in property and equipment are the following amounts applicable to the capital leases: Moveable equipment and buildings $ 23,879,000 8,331,393 Less accumulated amortization 6,378,681 5,498,266 $ 17,500,319 2,833,127 Depreciation expense was $13,998,185 and $13,662,844 for the years ended, respectively, including amortization of assets under capital lease of $743,693 and $1,023,202, respectively. (9) Credit Facilities The Hospital has an unsecured $4,000,000 working capital line of credit available for use. The line of credit expires on June 30, 2013 and is renewable annually. Advances under the line are subject to interest at the LIBOR rate plus 2.0%. There were no drawdowns or repayments during 2012 or There were no amounts outstanding at. 20 (Continued)

23 (10) Long-Term Debt Long-term debt is comprised of the following at December 31: Mortgage payable (a) $ 13,680,260 16,630,158 ICU financing loan (b) 12,778,424 13,188,515 Restructuring loan (c) 4,607,143 5,892,857 Bellevue financing loan (d) 9,440, ,177 ED financing loan (e) 3,057,808 Health Service Building Loan (f) 2,276,461 Total 45,840,103 35,928,707 Less current portion 5,229,389 4,616,738 $ 40,610,714 31,311,969 (a) (b) In June 2012, the Hospital entered into a loan agreement for approximately $15.2 million with the Schenectady County Capital Resource Corporation (New York) in order to refinance approximately $15.2 million of debt. This agreement resulted in the issuance of the Schenectady County Capital Resource Corporation (New York) FHA Insured Tax Exempt Mortgage Hospital Revenue Refunding Bonds (Ellis Hospital Project), Series The refinancing transaction produced a $3.3 million gain on debt extinguishment for the Hospital, including, as referenced in Note 1(k), the write off of an existing deferred credit related to the 1995 debt that was refinanced. The gain is comprised of $2.3 million related to the write off of the remaining deferred credit, $1.4 million related to a refund from the existing debt service fund, offset by $371,000 related to the write off of unamortized debt issuance costs. Debt service payments on the loan commenced on August 1, 2012 and are payable monthly through October 1, Interest on the loan is fixed at 0.85%. The debt service payments on the loan are insured by the U.S. Department of Housing and Urban Development (HUD). The loan agreement has financial covenants, which the Hospital was in compliance with at December 31, In November 2004, the Hospital entered into a loan agreement for approximately $15.6 million with the Dormitory Authority of the State of New York (DASNY) in order to finance the construction of a new Intensive Care Unit. This agreement resulted in the issuance of the Dormitory Authority of the State of New York Ellis Hospital FHA Insured Mortgage Hospital Revenue Bonds, Series 2004 by DASNY. Debt service payments commenced on June 1, 2006 and are payable monthly through May 1, Interest on the loan is 5.06%. The debt service payments on the loan are insured by HUD. The loan agreement has various financial covenants, which the Hospital was in compliance with at December 31, (c) In November 2007, the Hospital entered into an interest free loan agreement to borrow $11,878,100 from the Health Facility Restructuring Program. In December 2008, the loan agreement was amended where by an additional $3,000,000 interest free loan was provided by DASNY. Payments 21 (Continued)

24 totaling $5,878,100 were made in The remaining $9,000,000 of this restructuring loan had a term of 84 monthly installments of $107,142 which commenced on September 1, (d) (e) (f) In December 2011, the Hospital entered into a loan agreement for $14,950,000 with Oppenheimer Multifamily Housing & Healthcare Finance in order to finance the Bellevue Woman s Center Expansion and Modernization Project. As of December 31, 2012, $9,440,007 has been drawn down. It is expected that the remaining $5,509,993 will be drawn down during During construction, no principal will be paid and the interest rate is fixed at 4.93%. Debt service payments in the amount of $86,788 will commence on December 1, 2013 and are payable monthly through November 1, The interest rate when payments commence is fixed at 4.93%. Debt service payments on the loan are insured by HUD. In September 2012, the Hospital entered into a loan agreement for $54,850,000 with Oppenheimer Multifamily Housing & Healthcare Finance in order to finance the Emergency Department Modernization Project. As of December 31, 2012, $3,057,808 has been drawn down. It is expected that the remaining $51,792,192 will be drawn down during 2013, 2014 and During construction, no principal will be paid and the interest rate is fixed at 4.4%. Debt service payments in the amount of $300,223 will commence on July 1, 2015 and are payable monthly through June 1, Debt service payments on the loan are insured by HUD. In August 2012, the Hospital entered into a loan agreement for $2,300,000 with NBT Bank, N.A. to partially finance the purchase of an existing building on the Ellis Health Center (former St. Clare s) campus for $3.9 million. The building will be used to house the Ellis Hospital Belanger School of Nursing. The interest rate is fixed at 2% for the first two years; a 5% fixed rate for years three through seven; and in years eight through ten the fixed interest rate will be set at 3% over the then 3 year Federal Home Loan Bank of NY index. Debt Service payments commenced on October 1, 2012 and are payable monthly through September 1, Principal maturities of long-term debt for the five years subsequent to December 31, 2012 and thereafter are as follows: 2013 $ 5,229, ,761, ,900, ,950, ,136,265 Thereafter 22,862,212 $ 45,840, (Continued)