Monongalia Health System (WV)

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1 Monongalia Health System (WV) 1 Monongalia County Building Commission (West Virginia), Refunding and Improvement Revenue Bonds (Monongalia Health System ), Series 2015, $51,450,000, Dated: April 28, Monongalia County Building Commission (West Virginia), Refunding Revenue Bonds (Monongalia Health System ), Series 2011, $22,505,000, Dated: April 20, Monongalia County Building Commission (West Virginia), Variable Rate Hospital Refunding and Improvement Revenue Bonds (Monongalia General Hospital), Series 2008A, $48,145,000, Dated: February 13, Monongalia Health System, Inc. Taxable Variable Rate Hospital Bonds, Series 2008B, $14,250,000 NAR Series 2015, 2011, 2008A Changes during the prior Fiscal Year in accounting policies Fiscal Year Ended June 30, 2017 No significant changes were made during the year.

2 Series 2015, 2011, 2008A A calculation of the Debt Service Coverage Ratio Fiscal years ended June 30 Debt Service Coverage Ratios 2017 Net Revenues Available for Debt Service Coverage 46,582,073 Maximum Annual Debt Service 11,196,039 Coverage Ratio 4.16 Series 2015, 2011, 2008A A calculation of the number of days of Days Cash on Hand Fiscal Year Ended June 30 Days Cash on Hand 2017 Total Unrestricted Cash and Investments 143,677,457 Average Daily Operating Expenses 722, Days Cash on Hand Series 2015 A calculation of the Leverage Ratio Fiscal Year Ended June 30 Historical Long-Term Capitalization 2017 Long-Term Indebtedness 165,191,498 Unrestricted Net Assets 199,228,417 Total Capitalization 364,419,915 Long-Term Debt to Capitalization 0.45 SELECTED OPERATING RESULTS Series 2015 Hospital Utilization Statistics Fiscal Year Ended June 30, 2017 Available Beds (Acute) 189 Discharges 8,106 Births 1,114 Patient Days 34,280 Average Length of Stay (Days) 4.2 Average Daily Census Percentage of Occupancy (Acute) 50.8 Medicare Case Mix 1.78 Overall Case Mix 1.62 Outpatient Visits 327,732 Emergency Room Visits 28,446 Imaging Services Procedures 71,025 Cardiac Cath Procedures 2,966 Inpatient Surgeries 3,231 Outpatient Surgeries 13,449 Total Surgeries 16,680 Laboratory Tests 904,391 Series 2015 Payor Mix Schedule Fiscal Year Ended June 30, 2017 Medicare 49.8% Medicaid 9.0% PEIA 6.5% Other Governmental 2.5% Managed Care 29.6% Private 1.2% Commercial 1.4% Total 100.0%

3 Series 2015 Summary of Financial Information Fiscal Year Ended June 30, 2017 Net Patient Service Revenue324,471,430 Rental income 452,041 Other Operating Revenue 7,734,055 Operating Revenue 332,657,526 Operating Expenses 323,714,558 Operating Income 8,942,968 Investment gains (losses) 11,703,119 Donations 2,542,484 Gain (loss) on sale of property and equipment (192,947) Change in beneficial interest in assets held by others (1,248,945) Changes in fair value of interest rate swap 6,385,572 Excess of unrestricted net assets acquired over liabilities assumed in the acquisition of Preston Memorial Hospital - Other Income (231,085) Net Income from Equity Affiliates (996,291) Excess of revenues and gains over Expenses and losses 26,904,875

4 MONONGALIA HEALTH SYSTEM, INC. OBLIGATED GROUP CONSOLIDATED FINANCIAL STATEMENTS June 30, 2017 Unaudited - Internally Prepared Consists of - Monongalia General Hospital, Mon Health System & Mon Elders, Inc.

5 Monongalia Health System Page 1 Consolidated Financial Operating Ratios June 30, 2017 YTD YTD YTD YTD Bond June 30 June 30 June 30 June 30 Covenants Master Trust Liquidity: Days in A/R-Net Cushion Ratio (1) Days Cash on Hand (2) Capital: Capital Expenses Debt Service Coverage (1) (3) Leverage Ratio (4) Profitability: (3) Operating Margin Total Margin Paid FTEs including Physicians 1, , , ,569.4 (1) Ratio calculated using the Gross Maximum Annual Debt Service for all outstanding bond issues (includes LOC on remarketing fees), plus the debt service from other debt of MHS. (2) Due to the industry classifying bad debt as a component of net revenue, the ratio has been historically recomputed to exclude it in the days cash on hand computation. (3) Excludes the affects of Non-Operating Income, Change in Fair Value of Interest Rate Swap, & Minimum Pension Liability, (4) Ratio is calculated by dividing Long Term Debt by Long Term Debt plus Unrestricted Net Assets.

6 Monongalia Health System Page 2 Consolidated Balance Sheet June 30, 2017 June 2017 June 2016 June 2017 June 2016 Balance Balance Balance Balance CURRENT ASSETS CURRENT LIABILITIES Cash $28,670,627 $47,805,136 Accounts Payable $6,905,405 $7,564,616 Accounts Receivable, Bonds & Notes Payable 2,689,389 2,689,550 Net of Allowances of : Obligation Under Capital Lease 589, ,783 37,568,801 37,542,474 43,483,091 41,688,602 Accr'd Sal/Payroll Liab 14,883,626 12,955,144 Inventories 6,325,264 6,694,292 Minimum Pension Cost 6,000,000 8,000,000 Prepaid and Other Current Assets 11,127,802 8,597,111 Other Current Liabilities 4,551,784 4,971, Total Current Liabilities 35,619,919 36,917,128 Total Current Assets 89,606, ,785,140 LONG-TERM LIABILITIES Bonds & Long-Term Notes 114,040, ,660,328 Obligation Under Capital Lease 47,872,016 48,485,601 PROPERTY, PLANT & EQUIPMENT Provision for Self Insurance 6,219,407 6,278,164 Land, Improvements, Bldgs, & Equip Interest Rate Swap Agreement 13,725,360 20,110,932 Net of Accum. Depr. of: Minimum Pension Cost 18,436,238 36,927, ,792, ,522, ,688, ,157,139 Liability for Rabbi Trust 2,322,624 1,862,683 Refundable Residency Fees 13,832,419 13,726,447 Leased Property-Net of Accumulated Amortization 49,777,223 48,862,198 Other Long Term Liabilities 1,417,071 1,320, TOTAL LONG-TERM LIABILITIES 217,865, ,372,428 OTHER ASSETS Equity Investments 12,191,492 12,173,508 TOTAL LIABILITIES 253,485, ,289,556 Investments - Board Designated 115,006, ,464,662 Investments - Restricted 15,377,311 15,478,393 NET ASSETS Other Assets 20,275,805 16,024,408 Permanently Restricted 580, ,741 Temporarily Restricted 7,628,926 9,064,720 Unrestricted 199,228, ,014, TOTAL OTHER ASSETS 162,851, ,140,971 TOTAL NET ASSETS 207,438, ,655, TOTAL ASSETS $460,923,583 $449,945,448 TOTAL LIABILITIES & NET ASSETS $460,923,583 $449,945,448 ============= ============= ============= =============

7 Monongalia Health System Page 3 Consolidating Balance Sheets June 30, 2017 MGH MHS MES YTD YTD YTD ADJUSTMENTS 06/30/17 Actual Actual Actual & ELIMINATIONS TOTAL CURRENT ASSETS Cash $10,739,778 $17,754,556 $176,293 $28,670,627 Accounts Receivable, Net of allowances of : ( 37,568, ) 43,474, ,396 43,483,091 Inventories 6,305, ,422 6,325,264 Intercompany Accounts & Notes Receivable 177, ,086 47,531 (709,004) 0 Prepaid and Other Current Assets 10,137, ,844 88,766 11,127, TOTAL CURRENT ASSETS 70,834,894 19,140, ,408 (709,004) 89,606, PROPERTY, PLANT & EQUIPMENT Land, Improvements, Bldgs, & Equip Net of accum. depr. of: ( 186,261,596 1,756,813 9,773,923 ) 132,304,054 14,177,809 12,206, ,688,137 Leased Property-Net of Accumulated Amortization 0 49,777, ,777,223 Equity Investments 1,388,411 10,803, ,191,492 Investments - Board Designated 94,905,980 1,815,296 18,285, ,006,830 Investments - Restricted 15,377, ,377,311 Other Assets 17,953,181 2,322, ,275, TOTAL OTHER ASSETS 129,624,883 14,941,002 18,285, ,851, TOTAL ASSETS $332,763,832 $98,036,519 $30,832,236 ($709,004) $460,923,583 ==== CURRENT LIABILITIES Accounts Payable $6,230,484 $284,421 $390,500 $6,905,405 Bonds & Notes Payable 2,145,828 39, ,097 2,689,389 Obligation Under Capital Lease 15, , ,715 Intercompany Accounts & Notes Payable 507, ,388 24,389 (709,004) 0 Accr'd Sal/Payroll Liab 13,454,310 1,180, ,398 14,883,626 Minimum Pension Cost 6,000, ,000,000 Other Current Liabilities 4,059,190 48, ,642 4,551, TOTAL CURRENT LIABILITIES 32,412,929 2,304,969 1,611,026 (709,004) 35,619,919 LONG-TERM LIABILITIES Bonds & Long-Term Notes 104,748,484 35,382 9,256, ,040,378 Obligation Under Capital Lease 0 47,872, ,872,016 Provision for Self Insurance 6,130, ,964 6,219,407 Interest Rate Swap Agreement 13,725, ,725,360 Minimum Pension Cost 18,436, ,436,238 Liability for Rabbi Trust 0 2,322, ,322,624 Refundable Residency Fees ,832,419 13,832,419 Other Long Term Liabilities 458, , ,417, TOTAL LONG-TERM LIABILITIES 143,498,950 51,188,668 23,177, ,865, TOTAL LIABILITIES 175,911,879 53,493,637 24,788,921 (709,004) 253,485,432 NET ASSETS Permanently Restricted 580, ,806 Temporarily Restricted 7,503, , ,628,926 Unrestricted 148,767,220 44,417,882 6,043, ,228, TOTAL NET ASSETS 156,851,952 44,542,882 6,043, ,438, TOTAL LIABILITIES & NET ASSETS $332,763,832 $98,036,519 $30,832,236 ($709,004) $460,923,583 ====

8 Mon Health System Page 4 Consolidating Balance Sheets June 30, 2016 MGH MHS MES YTD YTD YTD ADJUSTMENTS 06/30/16 Actual Actual Actual & ELIMINATIONS TOTAL CURRENT ASSETS Cash $25,328,949 $22,157,395 $318,791 $47,805,136 Accounts Receivable, Net of allowances of : ( 37,542, ) 41,678, ,955 41,688,602 Inventories 6,677, ,975 6,694,292 Intercompany Accounts & Notes Receivable 389, ,306 0 (804,284) 0 Prepaid and Other Current Assets 8,009, ,647 61,470 8,597,111 TOTAL CURRENT ASSETS 82,084,885 23,097, ,191 (804,284) 104,785,140 PROPERTY, PLANT & EQUIPMENT Land, Improvements, Bldgs, & Equip ( Net of accum. depr. of: 171,884,402 1,607,055 9,031,289 ) 122,511,816 12,655,345 11,989, ,157,139 Leased Property-Net of Accumulated Amortization 0 48,862, ,862,198 Equity Investments 444,279 11,729, ,173,508 Investments - Board Designated 87,254,338 1,004,895 17,205, ,464,662 Investments - Restricted 15,478, ,478,393 Other Assets 14,161,725 1,862, ,024,408 TOTAL OTHER ASSETS 117,338,735 14,596,807 17,205, ,140,971 TOTAL ASSETS $321,935,436 $99,211,698 $29,602,598 ($804,284) $449,945,448 ============= ============= ============= ============= ================ CURRENT LIABILITIES Accounts Payable 7,276,542 $173, ,473 $7,564,616 Bonds & Notes Payable 2,158,644 36, ,466 2,689,550 Obligation Under Capital Lease 185, , ,783 Intercompany Accounts & Notes Payable 392, ,896 23,901 (804,284) 0 Accr'd Sal/Payroll Liab 11,798, , ,449 12,955,144 Minimum Pension Cost 8,000, ,000,000 Other Current Liabilities 4,521,242 50, ,221 4,971,034 TOTAL CURRENT LIABILITIES 34,333,494 2,141,409 1,246,509 (804,284) 36,917,128 LONG-TERM LIABILITIES Bonds & Long-Term Notes 106,824,873 74,846 9,760, ,660,328 Obligation Under Capital Lease 15,890 48,469, ,485,601 Provision for Self Insurance 6,192, ,956 6,278,164 Interest Rate Swap Agreement 20,110, ,110,932 Minimum Pension Cost 36,927, ,927,804 Liability for Rabbi Trust 0 1,862, ,862,683 Refundable Resident Fees ,726,447 13,726,447 Other Long Term Liabilities 312,871 1,007, ,320,469 TOTAL LONG-TERM LIABILITIES 170,384,579 51,414,838 23,573, ,372,428 TOTAL LIABILITIES 204,718,073 53,556,247 24,819,519 (804,284) 282,289,556 NET ASSETS Permanently Restricted 576, ,741 Temporarily Restricted 8,938, ,000 1,223 9,064,720 Unrestricted 107,702,125 45,530,451 4,781, ,014,431 TOTAL NET ASSETS 117,217,363 45,655,451 4,783, ,655,892 TOTAL LIABILITIES & NET ASSETS $321,935,436 $99,211,698 $29,602,598 ($804,284) $449,945,448 ============= ============= ============= ============= ================

9 Monongalia Health System Page 5 Consolidated Statement of Revenues and Expenses For The Period Ended June 30, 2017 Y E A R T O D A T E Actual Prev Actual Inpatient Revenue $269,067,900 $260,934,781 Outpatient Revenue 394,640, ,013,992 Emergency Patient Revenue 52,072,536 51,238,346 Rentals 452, ,967 Other Operating Revenue 7,109,192 8,614, Total Operating Revenue 723,341, ,167,055 Less: Allowances Third Party Contractuals 421,366, ,278,031 Provision for Bad Debt 11,035,264 8,895, Total Allowances 432,401, ,173, Net Operating Revenue 290,940, ,993,490 Less Expenses: Salaries 108,015, ,089,444 Employee Benefits 34,360,796 27,652,291 Other Direct Expenses 111,502, ,039,202 Depreciation & Amortization 16,985,203 15,265,266 Interest 7,202,206 6,591,158 Insurance 2,497,496 3,255, Total Expenses 280,563, ,893, Net Operating Income 10,376,392 10,100,175 Investment Income 10,632,101 2,368,784 Equity Investment Income (1,031,959) (1,198,739) Contribution Rev./(Exp.) 2,480,815 3,050,917 Grant Revenue/Expenses (40,000) (104,650) Gain/(Loss) on Disposal of Equipment (16,832) (52,690) Other Non-Operating Rev./(Exp.) 0 (673,439) --- Total Non-Operating Income 12,024,125 3,390,184 Net Income Before Taxes 22,400,517 13,490,359 Less Corp Income Tax (5,853) (32,234) --- Net Income After Taxes $22,394,664 $13,458,125 =============== ============== Change in Fair Value of Interest Rate Swap 6,385,572 (7,129,295) Change in Accumulated Pension Benefit 12,250,966 (24,719,682) --- CHANGE IN UNRESTRICTED NET ASSETS $41,031,202 ($18,390,852) =============== ============== TEMPORARILY RESTRICTED NET ASSETS Change in Beneficial Interest (1,248,945) 1,187, NET CHANGE IN TEMP RESTRICTED NET ASSETS ($1,248,945) $1,187,607 =============== ============== TOTAL CHANGE IN NET ASSETS $39,782,257 ($17,203,245) =============== ==============

10 Mon Health System Page 6 Consolidating Statement of Revenues and Expenses For the Period Ended June 30, 2017 MGH MHS MES Adjustments Total YTD YTD YTD & YTD Actual Actual Actual Eliminations Actual Inpatient Revenue $269,067,900 $0 $0 $0 $269,067,900 Outpatient Revenue 394,640, ,640,256 Emergency Patient Revenue 52,072, ,072,536 Rentals 0 1,344,537 0 (892,496) 452,041 Other Operating Revenue 824,071 4,924,796 5,650,930 (4,290,605) 7,109, Total Operating Revenue 716,604,763 6,269,333 5,650,930 (5,183,101) 723,341,925 Less: Allowances Third Party Contractuals 421,366, ,366,428 Provision for Bad Debt 11,035, ,035, Total Allowances 432,401, ,401, Net Operating Revenue 284,203,071 6,269,333 5,650,930 (5,183,101) 290,940,233 Less Expenses: Salaries 106,134,887 3,913,108 2,257,867 (4,290,605) 108,015,257 Employee Benefits 32,939, , , ,360,796 Other Direct Expenses 111,392,245 (179,778) 1,182,914 (892,496) 111,502,883 Depreciation & Amortization 14,755,942 1,467, , ,985,203 Interest 4,726,653 1,832, , ,202,206 Insurance 2,414,530 42,769 40, ,497, Total Expenses 272,363,911 7,712,207 5,670,826 (5,183,101) 280,563, Net Operating Income 11,839,161 (1,442,874) (19,896) 0 10,376,392 Investment Income 8,020,030 1,333,448 1,278, ,632,101 Equity Investment Income (35,668) (996,291) 0 0 (1,031,959) Contribution Rev./(Exp.) 2,479, , ,480,815 Grant Revenue/Expenses (40,000) (40,000) Gain/(Loss) Disposal of Equipment (15,930) (999) 97 0 (16,832) Other Non-Operating Rev./(Exp.) Total Non-Operating Income 10,407, ,157 1,280, ,024,125 Net Income (Loss) Before Taxes 22,246,992 (1,106,717) 1,260, ,400,517 Less Corp Income Tax 0 (5,853) 0 0 (5,853) Net Income (Loss) After Taxes 22,246,992 (1,112,569) 1,260, ,394,664 Change in Fair Value of Interest Rate Swap 6,385, ,385,572 Change in Accumulated Pension 12,250, ,250, CHANGE IN UNRESTRICTED NET ASSETS 40,883,530 (1,112,569) 1,260, ,031,202 TEMPORARILY RESTRICTED NET ASSETS Change in Beneficial Interest (1,248,945) (1,248,945) NET CHANGE IN TEMP RESTRICTED NET ASSETS (1,248,945) (1,248,945) TOTAL CHANGE IN NET ASSETS $39,634,585 ($1,112,569) $1,260,240 $0 $39,782,257

11 Mon Health System Page 7 Consolidating Statement of Revenues and Expenses For the Period Ended June 30, 2016 MGH MHS MES Adjustments Total YTD YTD YTD & YTD Actual Actual Actual Eliminations Actual Inpatient Revenue $260,934,782 $0 $0 $0 $260,934,781 Outpatient Revenue 347,013, ,013,992 Emergency Patient Revenue 51,238, ,238,346 Rentals 0 495,759 0 (130,792) 364,967 Other Operating Revenue 2,539,182 4,606,771 5,449,966 (3,980,950) 8,614, Total Operating Revenue 661,726,302 5,102,530 5,449,966 (4,111,743) 668,167,055 Less: Allowances Third Party Contractuals 391,278, ,278,031 Provision for Bad Debts 8,895, ,895, Total Allowances 400,173, ,173, Net Operating Revenue 261,552,737 5,102,530 5,449,966 (4,111,743) 267,993,490 Less Expenses: Salaries 99,634,096 3,345,580 2,090,719 (3,980,950) 101,089,444 Employee Benefits 26,379, , , ,652,291 Other Direct Expenses 103,306,743 (448,105) 1,311,356 (130,792) 104,039,202 Depreciation & Amortization 13,759, , , ,265,266 Interest 4,843,675 1,084, , ,591,158 Insurance 3,192,978 26,548 36, ,255, Total Expenses 251,116,349 5,418,962 5,469,747 (4,111,743) 257,893, Net Operating Income 10,436,388 (316,432) (19,781) 0 10,100,175 Investment Income 1,315, , , ,368,784 Equity Investment Income 62,517 (1,261,256) 0 0 (1,198,739) Contribution Rev./(Exp.) 206,345 2,844, ,050,917 Grant Revenue/Expenses 0 (104,650) 0 0 (104,650) Gain/(Loss) on Disposal of Equipment (42,744) 0 (9,946) 0 (52,690) Other Non-Operating Rev./(Exp.) 0 (673,439) 0 0 (673,439) Total Non-Operating Income 1,541,802 1,691, , ,390,184 Net Income (Loss) Before Taxes 11,978,190 1,375, , ,490,359 Less Corp Income Tax 0 (32,234) 0 0 (32,234) Net Income (Loss) After Taxes 11,978,190 1,343, , ,458,125 Change in Fair Value of Interest Rate Swap (7,129,295) (7,129,295) Change in Accumulated Pension Benefit (24,719,682) (24,719,682) CHANGE IN UNRESTRICTED NET ASSETS (19,870,787) 1,343, ,723 0 (18,390,852) TEMPORARILY RESTRICTED NET ASSETS Change in Beneficial Interest 1,187, ,187, NET CHANGE IN TEMP RESTRICTED NET ASSETS 1,187, ,187,607 TOTAL CHANGE IN NET ASSETS ($18,683,180) $1,343,212 $136,723 $0 ($17,203,245)

12 Monongalia Health System Page 8 Statement Of Cash Flows -Direct Method June 30, 2017 YTD YTD June 2017 June 2016 Cash Flows from Operating Activities Cash Inflows: Operating Receipts $294,919,934 $266,988,761 Cash Inflows from Operating Activities 294,919, ,988,761 Cash Outflows: Payments to Vendors (118,761,110) (104,248,884) Payments to Staff (106,674,452) (100,169,713) Payments of Interest (7,593,588) (6,210,240) Payments of Income Taxes (5,853) (32,234) Other Operating Payments (45,644,713) (39,021,949) Cash Outflows for Operating Activities (278,679,715) (249,683,020) Net Cash (Used for) / Provided by Operating Activities 16,240,219 17,305,740 Cash Flows from Investing Activities Investment Income Proceeds 14,470,445 1,347,710 Investment Proceeds 9,182,508 8,001,732 Invested Funds (26,720,158) (8,057,275) Payments for Purchase of PP&E (29,491,694) (19,744,816) Affiliate Grant Payments 0 (104,650) Proceeds from Sale of PP&E Net Cash (Used for) / Provided by Investing Activities (32,557,965) (18,557,298) Cash Flows from Financing Activities Long Term Debt Payments (2,241,933) (1,193,647) Payments on Lease Obligation (574,829) (290,803) Net Cash (Used for) / Provided by Financing Activities (2,816,763) (1,484,450) Net Increase/(Decrease) in Cash (19,134,508) (2,736,008) Cash - Beginning of Period 47,805,135 50,541,144 Cash - End of Period $28,670,627 $47,805,136 ============== ==============

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