FIRST QUARTER MARCH 31, This disclosure document is dated May 8, 2014.

Transcription

1 FIRST QUARTER MARCH 31, 2014 This disclosure document is dated May 8, 2014.

2 QUARTERLY REPORT OF FINANCIAL INFORMATION AND OPERATING DATA For Quarter-ended March 31, 2014 Relating to: The Health, Educational and Housing Facility Board of the County of Shelby, Tennessee Hospital Revenue Bonds - Series 2004, Series 2008A&B, Series 2008C, and Series 2012 This Quarterly Report of Financial Information and Operating Data ("Quarterly Report") is filed by Methodist Le Bonheur Healthcare pursuant to Continuing Disclosure Agreements entered into by Methodist Le Bonheur Healthcare in connection with the issuance of the Series 2004, Series 2008A&B, Series 2008C, and Series 2012 bonds (the "Securities") referenced above. This Quarterly Report relates to the Securities. The Securities are described in the Official Statements dated September 8, 2004, May 21, 2008, June 11, 2008, and May 2, 2012 related to the initial issuance and fixed rate conversion of the Securities. Contact Information: Chris McLean, Executive Vice President and CFO Methodist Le Bonheur Healthcare Finance Division 1211 Union Avenue, Suite 700 Memphis, TN Telephone: (901) chris.mclean@mlh.org

3 NOTE CONCERNING FORWARD-LOOKING STATEMENTS Certain of the discussions included in the narrative section(s) of the following document may include certain "forward-looking statements." In particular, statements preceded by, followed by, or that include forward-looking words such as "may," "will," "should," "believes," "estimates," "expects," "anticipates," "plans," "intends," "scheduled," or other similar expressions are or may constitute forward-looking statements. Methodist Le Bonheur Healthcare cautions that these forward-looking statements, which are subject to numerous assumptions, involve known and unknown risks and uncertainties inherent in the operation of healthcare facilities. Those risks and uncertainties include general economic and business conditions, competition from other healthcare facilities, federal and state regulation of healthcare providers, and reimbursement policies of the state and federal governments and managed care organizations. This document is marked with a dated date and speaks only as of that dated date. Readers are cautioned not to assume that any information has been updated beyond the dated date. Methodist Le Bonheur Healthcare assumes no duty to update forward-looking statements. Actual actions or results may differ materially from those discussed herein.

4 Methodist Le Bonheur Healthcare Financial Report as of March 31, 2014 (Unaudited) Combined Statement of Operations and Changes in Net Assets Methodist experienced an Operating Loss of $10.1 million in the first quarter of 2014 which was $20.0 million below the Operating Income of $9.9 million experienced in the first quarter of The primary reasons for the lower margins were losses associated with the start up of a new hospital in Olive Branch, MS of $2.4 million and lower payments per patient of 6.8% in The lower payment rates were due to increased self pay volumes and lower commercial volumes along with reduced TennCare Medicaid payments related to the implementation of the second phase of a rate redistribution process in Tennessee which lowered payments at the Children s hospital by $6.5 million. Listed below are additional details on factors impacting financial performance. Methodist s combined net patient service revenue increased by $1.5 million, or 0.4%, for the period ending March 31, 2014 over the same period last year. The increase was due to volume growth offset by lower payments per patient. A detailed breakdown of volume and payment rate changes is as follows: Inpatient volumes increased by 215 discharges, or 1.4%, due to a 1.3% increase at the adult campuses and a 1.6% increase at Le Bonheur. Payor mix of the increase was negative with commercial discharges down 237, or 4.6%, uninsured discharges up 163, or 13%, and Medicare up 297, or 4.9%. The lower commercial discharges are primarily due to the introduction of high deductible health plans by several large employers. The increased self pay volumes are due to continued high levels of unemployment in the market, limited number of uninsured patients signing up for insurance under the Accountable Care Act, and individuals continuing to opt out of their employer s health plans due to increased premiums along with higher deductibles and copayment levels. Outpatient volumes, as measured by outpatient equivalent discharges, increased by 14.2% due to continued expansion in the number of employed physicians, which accounted for 4.7% of the growth, and the opening of the new hospital in Olive Branch, which accounted for 3.4% of the growth. The remaining 6.1% of growth is due to growth at the Memphis hospitals. Unfortunately the payor mix of the growth is negative similar to the inpatient side with commercial volumes down and Medicare and uninsured volumes up. The lower commercial outpatient volumes were due to the introduction of high deductible health plans by several large employers in the market Payment rates per adjusted discharge decreased by 6.8%. Factors impacting payment rates were the negative inpatient and outpatient payor mixes outlined above, declines in TennCare/Medicaid rates, and declines in Medicare payment rates resulting from a lower blended rate due to the sequestration impact and lower wage index levels in the market. The reduced TennCare payment levels were due to the implementation of lower payments for Le Bonheur related to redistribution of payment rates across the State as mandated by the TennCare Bureau. TennCare payment rates were lower by $6.5 million due to this redistribution. Other revenue increased by $9.8 million, or 74.8%, compared to the same period last year. The increase is due primarily to a new agreement with AnovoRX, which allows outpatient prescriptions written by our oncology doctors and filled at the AnovoRX outpatient pharmacy to qualify for 340b drug pricing ($4.2 million), and to second year Stage 1 EHR payments from Medicare and Medicaid ($4.3 million). Salaries and benefits increased by $18.8 million, or 10.2%, for the period ending March 31, 2014 compared to the same period last year. Salaries increased by $18.0 million, or 12.5%, due primarily to an overall 2.5% pay increase limit for all associates, additional staff for our new Olive Branch hospital and acquired physician practices, offset by continued improvements in overall productivity levels. Salaries, excluding the new hospital and acquired physician practices, increased by 1.8%. Salaries per adjusted discharge increased by 4.4%. Benefit related expenses increased by $0.8 million, or 1.9%, due primarily to lower pension costs related to the impact of a higher discount rate and higher health insurance costs.

5 Methodist Le Bonheur Healthcare Financial Report as of March 31, 2014 (Unaudited) Supplies and other expenses increased by $9.4 million, or 6.1%, as compared to the same period in Supply costs have increased by $5.0 million, or 6.4%, due primarily to the new Olive Branch Hospital and acquired physician practices. Supplies, excluding the new hospital and acquired physician practices, increased by 3.9% due primarily to increased drug costs. Supplies per adjusted discharge declined by 1.2%. Other expenses have increased by $4.4 million, or 5.8%, due primarily to the new Olive Branch Hospital and acquired physician practices. Other expenses, excluding the new hospital and acquired physician practices, increased by only 1.0%. Investment income (which includes realized and unrealized returns), at $13.0 million, was $12.9 million lower than the same period last year. This was due to the impact of market factors on the investment portfolio in 2014, as follows: U.S. Equity was $11.7 million lower, International Equity was $2.8 million lower, Alternative Strategy was $0.4 million lower, and Fixed Income was $2.0 million higher than the prior period. The lower equity and alternative strategy returns, and higher fixed income returns in 2014 were in line with the returns of the overall markets, per the following: YTD YTD Index U.S. Equity +1.8% +10.6% S&P 500 Int l Equity +0.7% +5.1% MSCI EAFE Alternative +1.6% +3.8% HFR Eq Hdg Fixed Income +1.6% +0.5% BC Int Credit Change in fair value of interest rate swaps at $(5.1) million was $12.1 million lower than the same period last year. This was the result of LIBOR swap rates decreasing in 2014 compared to rates increasing in Combined Balance Sheet Cash and investments were $18.1 million lower than the same period last year. The decline was due primarily to lower operating and investment margins and higher accounts receivable, offset by lower capital expenditures. Net property and equipment increased by $60.2 million over the same period last year. This increase is a result of capital investments, which includes the construction of a new hospital in Olive Branch and a new emergency room for the University campus. Debt decreased by $16.1 million over the same period last year due to routine bond/other debt related payments. Total reserves for estimated professional and general liability costs were $10.4 million lower than the same period last year (current portion is included in accrued expenses and other current liabilities). The required reserve levels are actuarially determined and the estimates are updated on a semi-annual basis. The primary factors for the decrease were as follows: 1) reduced number of significant claims, 2) continued resolution of old claims below established reserves, 3) improved reserving processes, and 4) more timely resolution of significant claims during the year. Accrued pension liability decreased by $145.9 million compared to the same period last year. This decrease was due to the additional funding over expense of $12.8 million and the minimum pension liability adjustment of $133.1 million recorded at December 31, 2013 in accordance with FASB ASC Topic The positive pension liability adjustment was primarily due to an increase in the year-end discount rate from 3.92% in 2012 to 4.77% in 2013 and strong investment earnings with a total return on pension assets of 18.1% in Market values for Methodist s 2004 and 2007 fixed payor swaps improved by $21.2 million (therefore the liability decreased by $21.2 million) as longer-term LIBOR swap rates were at higher levels on March 31, 2014 compared to March 31, Financial Ratios The following is a table of financial ratios for the period ending March 31: YTD YTD Operating Margin -2.7% 2.5% Excess Margin 0.6% 8.8% Cash / Debt (%) 130.5% 130.3% Debt / Cash Flow (X) Days Cash on Hand Days in A/R

6 COMBINED STATEMENT OF OPERATIONS AND CHANGES IN NET ASSETS Three Months Ending March Difference Unrestricted revenues and other support: Net patient service revenue $ 361,945 $ 360,432 $ 1,513 Other revenue 22,838 13,064 9,774 Net assets released from restrictions used for operations 2,498 2, Total unrestricted revenues and other support 387, ,654 11,627 Expenses: Salaries and benefits 203, ,901 18,794 Supplies and other 162, ,305 9,381 Depreciation and amortization 24,094 21,449 2,645 Interest 6,909 6, Total expenses 397, ,734 31,650 Operating Income (10,103) 9,920 (20,023) Nonoperating gains (losses): Investment income, net 8,275 8, Change in fair value of interest rates swaps (5,101) 6,958 (12,059) Unrealized income on trading securities, net 4,734 17,731 (12,997) Loss on impairment of land Impairment loss on equity investee Loss on impairment of goodwill Total nonoperating gains, net 7,908 32,849 (24,941) Revenues, gains and other support in excess of expenses and losses, before noncontrolling interest (2,195) 42,769 (44,964) Noncontrolling interest (347) (382) 35 Revenues, gains and other support in excess of expenses and losses (2,542) 42,387 (44,929) Other changes in unrestricted net assets: Increase (decrease) in interest in consolidated affiliates (4,911) - (4,911) Accrued pension costs adjustments Net assets released from restrictions used for capital (59) (4,628) 342 (4,970) Increase (decrease) in unrestricted net assets $ (7,170) $ 42,729 $ (49,899) Change in net assets: Temporarily and permanently restricted net assets: Temporarily and permanently restricted contributions 2,494 3,416 (922) Net assets released from restrictions used for operations (2,498) (2,158) (340) Net assets released from restrictions used for capital (283) (342) 59 Incr (decr) in temporarily & permanently restricted net assets (287) 916 (1,203) Increase (decrease) in noncontrolling interests (2,302) (95) (2,207) Increase (decrease) in unrestricted net assets (7,170) 42,729 (49,899) Increase (decrease) in net assets (9,759) 43,550 (53,309) Net assets at beginning of year 1,189, , ,940 Net assets at March 31 $ 1,179,675 $ 924,044 $ 255,631

7 COMBINED STATEMENT OF OPERATIONS AND CHANGES IN NET ASSETS Three Months Ending March 31, 2014 Other Obligated Restricted Combined Affiliated & Group Group Group Eliminations Consolidated Unrestricted revenues and other support: Net patient service revenue $ 317,792 $ 1,216 $ 319,008 $ 42,937 $ 361,945 Other revenue 17,230 1,225 18,455 4,383 22,838 Net assets released from restrictions used for operations ,498 2,498 Total unrestricted revenues and other support 335,022 2, ,463 49, ,281 Expenses: Salaries and benefits 160, ,354 42, ,695 Supplies and other 145, ,734 16, ,686 Depreciation and amortization 20, ,023 3,071 24,094 Interest 6, , ,909 Total expenses 333,264 1, ,868 62, ,384 Operating Income 1, ,595 (12,698) (10,103) Nonoperating gains (losses): Investment income, net 7, , ,275 Change in fair value of interest rates swaps (5,101) - (5,101) - (5,101) Unrealized income on trading securities, net 4, , ,734 Loss on impairment of land Impairment loss on equity investee Loss on impairment of goodwill Total nonoperating gains, net 7, , ,908 Revenues, gains and other support in excess of expenses and losses, before noncontrolling interest 9, ,068 (12,263) (2,195) Noncontrolling interest (347) (347) Revenues, gains and other support in excess of expenses and losses 9, ,068 (12,610) (2,542) Other changes in unrestricted net assets: Increase (decrease) in interest in consolidated affiliates (4,911) (4,911) Accrued pension costs adjustments Net assets released from restrictions used for capital (4,628) (4,628) Increase (decrease) in unrestricted net assets 9, ,068 (17,238) (7,170) Intercompany transfers of assets (16,387) 131 (16,256) 16,256 - Increase (decrease) in unrestricted net assets $ (7,168) $ 980 $ (6,188) $ (982) $ (7,170) Change in net assets: Temporarily and permanently restricted net assets: Temporarily and permanently restricted contributions ,494 2,494 Net assets released from restrictions used for operations (2,498) (2,498) Net assets released from restrictions used for capital (283) (283) Incr (decr) in temporarily & permanently restricted net assets (287) (287) Increase (decrease) in noncontrolling interests (2,302) (2,302) Increase (decrease) in unrestricted net assets (7,168) 980 (6,188) (982) (7,170) Increase (decrease) in net assets (7,168) 980 (6,188) (3,571) (9,759) Net assets at December 31, ,020,510 2,333 1,022, ,591 1,189,434 Net assets at March 31, 2014 $ 1,013,342 $ 3,313 $ 1,016,655 $ 163,020 $ 1,179,675

8 COMBINED STATEMENT OF OPERATIONS AND CHANGES IN NET ASSETS Three Months Ending March 31, 2013 Other Obligated Restricted Combined Affiliated & Group Group Group Eliminations Consolidated Unrestricted revenues and other support: Net patient service revenue $ 330,371 $ 1,331 $ 331,702 $ 28,730 $ 360,432 Other revenue 8, ,837 4,227 13,064 Net assets released from restrictions used for operations ,158 2,158 Total unrestricted revenues and other support 339,014 1, ,539 35, ,654 Expenses: Salaries and benefits 159, ,550 24, ,901 Supplies and other 142, ,635 10, ,305 Depreciation and amortization 20, ,351 1,098 21,449 Interest 5, , ,079 Total expenses 327,779 1, ,487 36, ,734 Operating Income 11,235 (183) 11,052 (1,132) 9,920 Nonoperating gains (losses): Investment income, net 7, , ,160 Change in fair value of interest rates swaps 6,958-6,958-6,958 Unrealized income on trading securities, net 17, , ,731 Loss on impairment of land Impairment loss on equity investee Loss on impairment of goodwill Total nonoperating gains, net 32, , ,849 Revenues, gains and other support in excess of expenses and losses, before noncontrolling interest 43,344 (171) 43,173 (404) 42,769 Noncontrolling interest (382) (382) Revenues, gains and other support in excess of expenses and losses 43,344 (171) 43,173 (786) 42,387 Other changes in unrestricted net assets: Increase (decrease) in interest in consolidated affiliates Accrued pension costs adjustments Net assets released from restrictions used for capital Increase (decrease) in unrestricted net assets 43,344 (171) 43,173 (444) 42,729 Intercompany transfers of assets (1,022) 304 (718) Increase (decrease) in unrestricted net assets $ 42,322 $ 133 $ 42,455 $ 274 $ 42,729 Change in net assets: Temporarily and permanently restricted net assets: Temporarily and permanently restricted contributions ,416 3,416 Net assets released from restrictions used for operations (2,158) (2,158) Net assets released from restrictions used for capital (342) (342) Incr (decr) in temporarily & permanently restricted net assets Increase (decrease) in noncontrolling interests (95) (95) Increase (decrease) in unrestricted net assets 42, , ,729 Increase (decrease) in net assets 42, ,455 1,095 43,550 Net assets at December 31, ,749 2, ,107 75, ,494 Net assets at March 31, 2013 $ 845,071 $ 2,491 $ 847,562 $ 76,482 $ 924,044

9 COMBINED BALANCE SHEET As of March Difference Assets Current assets: Cash, cash equivalents, and short-term investments $ 799,102 $ 817,248 $ (18,146) Net patient accounts receivable 217, ,991 21,694 Due from third-party payors Pledge campaign 2,978 4,603 (1,625) Other current assets 50,485 43,619 6,866 Assets limited as to use-current portion (41) Total current assets 1,071,131 1,062,383 8,748 Assets limited as to use, less current portion 38,060 40,445 (2,385) Property and equipment, net 900, ,323 60,150 Swap market value Pledge campaign-long term 6,075 4,195 1,880 Other assets 48,365 50,911 (2,546) Total assets $ 2,064,104 $ 1,998,257 $ 65,847 Liabilities and Net Assets Current liabilities: Accounts payable $ 49,135 $ 60,176 $ (11,041) Accrued expenses and other current liabilities 83,708 85,127 (1,419) Due to third-party payors 23,464 10,790 12,674 Current installments of long-term debt 15,598 15,669 (71) Total current liabilities 171, , Long-term debt, excluding current installments 584, ,444 (15,984) Estimated professional and general liability costs 19,225 26,664 (7,439) Accrued pension liability 47, ,703 (145,925) Swap market value 54,362 75,558 (21,196) Other long-term liabilities 6,700 6, Total liabilities 884,430 1,074,213 (189,783) Net assets: Unrestricted 1,150, , ,095 Temporarily restricted 22,816 21,188 1,628 Permanently restricted 3,504 3, Total net assets attributable to MLH 1,177, , ,866 Noncontrolling interests 2,391 4,627 (2,236) Total net assets 1,179, , ,630 Total liabilities and net assets $ 2,064,104 $ 1,998,257 $ 65,847

10 COMBINED BALANCE SHEET As of March 31, 2014 Other Obligated Restricted Combined Affiliated & Group Group Group Eliminations Consolidated Assets Current assets: Cash, cash equivalents, and short-term investments $ 756,572 $ (10) $ 756,562 $ 42,540 $ 799,102 Net patient accounts receivable 194, ,697 22, ,685 Due from third-party payors Pledge campaign ,978 2,978 Other current assets 40, ,562 9,923 50,485 Assets limited as to use-current portion Total current assets 992, ,702 78,429 1,071,131 Assets limited as to use, less current portion 38,060-38,060-38,060 Property and equipment, net 770,721 1, , , ,473 Swap market value Pledge campaign-long term ,075 6,075 Other assets 34, ,563 13,802 48,365 Total assets $ 1,835,593 $ 2,445 $ 1,838,038 $ 226,066 $ 2,064,104 Liabilities and Net Assets Current liabilities: Accounts payable $ 44,550 $ 118 $ 44,668 $ 4,467 $ 49,135 Accrued expenses and other current liabilities 73, ,505 10,203 83,708 Due to third-party payors 23, , ,464 Current installments of long-term debt 14,918-14, ,598 Advances from affiliates (40,262) (1,302) (41,564) 41,564 - Other liabilities of discontinued operations Total current liabilities 115,624 (868) 114,756 57, ,905 Long-term debt, excluding current installments 579, ,002 5, ,460 Estimated professional and general liability costs 19,225-19,225-19,225 Accrued pension liability 47,778-47,778-47,778 Swap market value 54,362-54,362-54,362 Other long-term liabilities 6,260-6, ,700 Total liabilities 822,251 (868) 821,383 63, ,430 Net assets: Unrestricted 1,013,342 3,313 1,016, ,308 1,150,963 Temporarily restricted ,816 22,816 Permanently restricted ,504 3,504 Total net assets attributable to MLH 1,013,342 3,313 1,016, ,628 1,177,283 Noncontrolling interests ,391 2,391 Total net assets 1,013,342 3,313 1,016, ,019 1,179,674 Total liabilities and net assets $ 1,835,593 $ 2,445 $ 1,838,038 $ 226,066 $ 2,064,104

11 COMBINED BALANCE SHEET As of March 31, 2013 Other Obligated Restricted Combined Affiliated & Group Group Group Eliminations Consolidated Assets Current assets: Cash, cash equivalents, and short-term investments $ 779,930 $ (34) $ 779,896 $ 37,352 $ 817,248 Net patient accounts receivable 184, ,471 11, ,991 Due from third-party payors Pledge campaign ,603 4,603 Other current assets 37, ,069 5,550 43,619 Assets limited as to use-current portion Total current assets 1,002, ,003,358 59,025 1,062,383 Assets limited as to use, less current portion 40,445-40,445-40,445 Property and equipment, net 815,125 2, ,473 22, ,323 Swap market value Pledge campaign-long term ,195 4,195 Other assets 30, ,560 20,351 50,911 Total Assets $ 1,888,948 $ 2,888 $ 1,891,836 $ 106,421 $ 1,998,257 Liabilities and Net Assets Current liabilities: Accounts payable $ 56,256 $ 176 $ 56,432 $ 3,744 $ 60,176 Accrued expenses and other current liabilities 78, ,543 6,584 85,127 Due to third-party payors 9, , ,790 Current installments of long-term debt 14,756-14, ,669 Advances from affiliates (11,224) (326) (11,550) 11,550 - Other liabilities of discontinued operations Total current liabilities 147, ,136 23, ,762 Long-term debt, excluding current installments 594, ,679 5, ,444 Estimated professional and general liability costs 26,664-26,664-26,664 Accrued pension liability 193, , ,703 Swap market value 75,558-75,558-75,558 Other long-term liabilities 5,534-5, ,082 Total liabilities 1,043, ,044,274 29,939 1,074,213 Net assets: Unrestricted 845,071 2, ,562 47, ,868 Temporarily restricted ,188 21,188 Permanently restricted ,361 3,361 Total net assets attributable to MLH 845,071 2, ,562 71, ,417 Noncontrolling interests ,627 4,627 Total net assets 845,071 2, ,562 76, ,044 Total liabilities and net assets $ 1,888,948 $ 2,888 $ 1,891,836 $ 106,421 $ 1,998,257

12 COMBINED STATEMENT OF CASH FLOW As of March Increase (decrease) in cash due to: Change in net assets $ (9,759) $ 43,550 Discontinued operations - - Non-cash items: Depreciation / amortization 24,094 21,449 Pension expense funding (1,550) (3,905) Net change in market value swaps / bonds 5,101 (6,958) Extraordinary gain (loss) - - (Gain) / loss on disposal of assets Total non-cash items 27,656 10,654 Cash flows from operating activities: Net changes in working capital (22,535) (8,991) Changes in long term assets / liabilities 10,940 (6,053) Advances (to) from affiliates - - Total cash flows from operating activities (11,595) (15,044) Cash flows from financing / investing activities: Principal payments (206) (193) Advanced payment of debt - - Debt / OID / bond issue cost additions (reductions) Capital additions (23,989) (40,242) Proceeds from disposal of assets - (9) Asset transfers / disposals Notes payable - - Assets limited as to use 1,516 (69) Total cash flows from financing / investing activities (21,484) (40,197) Net increase (decrease) in cash $ (15,182) $ (1,037) Change in cash: Beginning balance $ 814,284 $ 818,285 Ending balance 799, ,248 Net increase (decrease) in cash $ (15,182) $ (1,037)

13 COMBINED STATEMENT OF CASH FLOW Three Months Ending March 31, 2014 Other Obligated Restricted Combined Affiliated & Group Group Group Eliminations Consolidated Increase (decrease) in cash due to: Change in net assets $ (7,168) $ 980 $ (6,188) $ (3,571) $ (9,759) Discontinued operations Non-cash items: Depreciation / amortization 20, ,023 3,071 24,094 Pension expense funding (1,550) - (1,550) - (1,550) Net change in market value swaps / bonds 5,101-5,101-5,101 Extraordinary gain (loss) (Gain) / loss on disposal of assets (9) - (9) Total non-cash items 24, ,565 3,091 27,656 Cash flows from operating activities: Net changes in working capital (18,765) (79) (18,844) (3,691) (22,535) Changes in long term assets / liabilities 7,533-7,533 3,407 10,940 Advances (to) from affiliates (5,305) (977) (6,282) 6,282 - Total cash flows from operating activities (16,537) (1,056) (17,593) 5,998 (11,595) Cash flows from financing / investing activities: Principal payments (222) (206) Advanced payment of debt Debt / OID / bond issue cost additions (reductions) Capital additions (20,684) - (20,684) (3,305) (23,989) Proceeds from disposal of assets (71) - Asset transfers / disposals 3,099-3,099 (2,263) 836 Notes payable Assets limited as to use 1,516-1,516-1,516 Total cash flows from financing / investing activities (15,982) - (15,982) (5,502) (21,484) Net increase (decrease) in cash $ (15,207) $ 9 $ (15,198) $ 16 $ (15,182) Change in cash: Beginning balance $ 771,779 $ (19) $ 771,760 $ 42,524 $ 814,284 Ending balance 756,572 (10) 756,562 42, ,102 Net increase (decrease) in cash $ (15,207) $ 9 $ (15,198) $ 16 $ (15,182)

14 COMBINED STATEMENT OF CASH FLOW Three Months Ending March 31, 2013 Other Obligated Restricted Combined Affiliated & Group Group Group Eliminations Consolidated Increase (decrease) in cash due to: Change in net assets $ 42,322 $ 133 $ 42,455 $ 1,095 $ 43,550 Discontinued operations Non-cash items: Depreciation / amortization 20, ,351 1,098 21,449 Pension expense funding (3,905) - (3,905) - (3,905) Net change in market value swaps / bonds (6,958) - (6,958) - (6,958) Extraordinary gain (loss) (Gain) / loss on disposal of assets Total non-cash items 9, ,513 1,141 10,654 Cash flows from operating activities: Net changes in working capital (7,570) 1 (7,569) (1,422) (8,991) Changes in long term assets / liabilities (5,669) - (5,669) (384) (6,053) Advances (to) from affiliates (2,545) (244) (2,789) 2,789 - Total cash flows from operating activities (15,784) (243) (16,027) 983 (15,044) Cash flows from financing / investing activities: Principal payments (224) (193) Advanced payment of debt Debt / OID / bond issue cost additions (reductions) Capital additions (39,092) (11) (39,103) (1,139) (40,242) Proceeds from disposal of assets (13) - (13) 4 (9) Asset transfers / disposals (7) 316 Notes payable Assets limited as to use (69) - (69) - (69) Total cash flows from financing / investing activities (38,820) (11) (38,831) (1,366) (40,197) Net increase (decrease) in cash $ (2,864) $ (26) $ (2,890) $ 1,853 $ (1,037) Change in cash: Beginning balance $ 782,794 $ (8) $ 782,786 $ 35,499 $ 818,285 Ending balance 779,930 (34) 779,896 37, ,248 Net increase (decrease) in cash $ (2,864) $ (26) $ (2,890) $ 1,853 $ (1,037)

15 COMBINED GROUP OPERATING STATISTICS For three months-ended Mar 31 Mar Licensed Beds 1,629 1,629 Beds in Service 1,360 1,346 Patient Days (inpatients) 84,957 91,421 Discharges (inpatients) 15,577 15,812 Occupancy 69.4% 75.5% Avg Length of Stay (days) ER Visits 76,609 78,829 Gross Outpatient to Total Revenue 49.6% 47.9% Outpatient Visits 68,394 67,225

16 MISCELLANEOUS The information set forth herein has been obtained from records and other sources which are considered reliable. The filing of this Quarterly Report shall not, under any circumstances, create any implication that there has been no change in the affairs of Methodist Le Bonheur Healthcare or in the other matters described herein since the date as of which such information is provided. The historical information set forth in this Quarterly Report is not necessarily indicative of future financial results of operations due to various factors, including, among others, those discussed in the Official Statements. The Official Statements are on file with the Municipal Securities Rulemaking Board. In the Continuing Disclosure Agreements, Methodist Le Bonheur Healthcare disclaims any contractual or tort liability for damages resulting in whole or in part from any breach of its Continuing Disclosure Agreements or from any statement made pursuant to its Agreements. See Continuing Disclosure of Information in the Official Statements.