SELF REGIONAL HEALTHCARE AND AFFILIATES. Combined Financial Statements. September 30, 2013 and ( with Independent Auditors Report thereon )
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1 Combined Financial Statements September 30, 2013 and 2012 ( with Independent Auditors Report thereon )
2 Table of Contents September 30, 2013 and 2012 Page(s) Independent Auditors Report Management s Discussion and Analysis Combined Balance Sheets Combined Statements of Revenues, Expenses, and Changes in Net Position Combined Statements of Cash Flows Notes to Combined Financial Statements
3 To the Board of Trustees of Self Regional Healthcare and Affiliates Greenwood, South Carolina Independent Auditors Report Report on the Combined Financial Statements We have audited the accompanying combined balance sheets of Self Regional Healthcare and Affiliates (the Hospital ) as of September 30, 2013 and 2012, the related combined statements of revenues, expenses, and changes in net position and cash flows for the years then ended, and the related notes to the combined financial statements. Management s Responsibility for the Combined Financial Statements Management is responsible for the preparation and fair presentation of these combined financial statements in accordance with accounting principles generally accepted in the United States of America; this includes the design, implementation, and maintenance of internal control relevant to the preparation and fair presentation of combined financial statements that are free from material misstatement, whether due to fraud or error. Auditor s Responsibility Our responsibility is to express an opinion on these combined financial statements based on our audits. The consolidated financial statements of the Self Regional Healthcare Foundation and Subsidiary (the Foundation ) as of and for the years ended September 30, 2013 and 2012, were audited by other auditors whose report, dated November 11, 2013, expressed an unmodified opinion on those consolidated financial statements. Those consolidated financial statements were audited by other auditors, whose report has been furnished to us, and our opinion, insofar as it relates to the amounts for the Foundation, as of and for the years ended September 30, 2013 and 2012, is based solely on the report of the other auditors. 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 combined financial statements are free of material misstatement. An audit involves performing procedures to obtain audit evidence about the amounts and disclosures in the combined financial statements. The procedures selected depend on the auditor s judgment, including the assessment of the risks of material misstatement of the combined financial statements, whether due to fraud or error. In making those risk assessments, the auditor considers internal control relevant to the Hospital s preparation and fair presentation of the combined 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 Hospital 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 combined financial statements. (1)
4 To the Board of Trustees of Self Regional Healthcare and Affiliates Page Two We believe that the audit evidence we have obtained is sufficient and appropriate to provide a basis for our audit opinion. Opinion In our opinion, the combined financial statements referred to above present fairly, in all material respects, the financial position of the Hospital as of September 30, 2013 and 2012, and the results of its operations and cash flows for the years then ended in conformity with accounting principles generally accepted in the United States of America. Emphasis of Matter New Accounting Pronouncements As discussed in Note 1 to the combined financial statements, during the year ended September 30, 2013, the Hospital implemented new accounting guidance that requires retroactive adjustments to amounts previously reported as of and for the year ended September 30, 2012, with a cumulative effect adjustment to net position as of September 30, Our opinion is not modified with respect to this matter. Required Supplemental Information Management s Discussion and Analysis is not a required part of the combined financial statements, but is supplementary information required by Governmental Accounting Standards Board ( GASB ). We have applied certain limited procedures, which consisted primarily of inquiries of management regarding the methods of measurement and presentation of the supplementary information. However, we did not audit the information and express no opinion on it. December 17, 2013 (2)
5 Management s Discussion and Analysis September 30, 2013 and 2012 OVERVIEW OF THE COMBINED FINANCIAL STATEMENTS This discussion and analysis are intended to serve as an introduction to Self Regional Healthcare and Affiliates (the Hospital s ) audited combined financial statements. The Hospital s combined financial statements are comprised of two components: 1) audited combined financial statements and 2) notes to the audited combined financial statements. The audited combined financial statements include the Combined Balance Sheets; Combined Statements of Revenues, Expenses, and Changes in Net Position; and Combined Statements of Cash Flows for the fiscal years ended September 30, 2013 and The Hospital operates similar to a private business and therefore utilizes the enterprise fund method of accounting. This method provides both long-term and short-term financial information and requires that revenue and expenses are recognized on the full accrual basis. The Combined Balance Sheets present information on all of the Hospital s assets and liabilities, with the difference between the two reported as net position. Over time, increases or decreases in net position may serve as a useful indicator of whether the financial position of the Hospital is improving or deteriorating. The Combined Statements of Revenues, Expenses, and Changes in Net Position present information showing how the Hospital s net position changed during the most recent fiscal years. All changes in net position are reported as soon as the underlying event giving rise to the change occurs, regardless of the timing of the related cash flows. The Combined Statements of Cash Flows presents information about the Hospital s cash flows resulting from operating, investing, noncapital financing, and capital financing activities. It reports cash receipts, cash payments, and changes in the cash balance during the most recent fiscal year. FINANCIAL HIGHLIGHTS The assets of Self Regional Healthcare and Affiliates exceeded its liabilities at September 30, 2013 by $480 million, which represents the amount of Hospital s net position. This amount may be used to meet the Hospital s ongoing financial obligations and to finance capital improvement and expansion of services in the future. (3)
6 The Hospital s total net position increased $27.7 million in the twelve-month period ended September 30, This increase primarily represents the amount of excess revenues over expenses for the fiscal year along with change in restricted net position. The following is an analysis of Self Regional Healthcare and Affiliates financial performance in fiscal year FINANCIAL ANALYSIS Total Assets As seen in Table 1, total assets of the Hospital increased $43.2 million in Current assets increased $17.0 million, net capital assets increased $4.9 million, and other long-term assets increased $21.3 million. Table 1 Self Regional Healthcare and Affiliates Summary of Assets (in millions of dollars) Current assets $ 87.2 $ 70.2 Capital assets, net of accumulated depreciation Other long-term assets Total assets $ $ The increase in net capital assets was primarily due to capital equipment, construction projects and information technology additions. The increase in other long-term assets was primarily due to the increase of operating reserve cash. (4)
7 Total Liabilities and Net Position As seen in Table 2, total liabilities of the Hospital increased $15.6 million in fiscal year Current liabilities increased $8.2 million and long-term liabilities increased $7.4 million. Total net position increased $27.7 million. Unrestricted net position increased $21.7 million, net position invested in capital assets, net of related debt decreased $12.4 million, net position restricted for debt service increased $18.5 million, and net position restricted for specific purposes remained the same. Table 2 Self Regional Healthcare and Affiliates Summary of Liabilities and Net Position (in millions of dollars) Current liabilities $ 59.8 $ 51.6 Long-term liabilities Total liabilities Unrestricted net position Invested in capital assets, net of related debt Restricted for debt service Nonexpendable.8.9 Restricted for specific purposes Total net position Total liabilities and net position $ $ Total net position increased to reflect the Hospital s excess of revenue over expenses of $28.0 million and other changes to net position of $(0.3) million. (5)
8 Total Operating Revenues As seen in Table 3, total operating revenues increased by 1.2% or $4.1million in fiscal year Table 3 Self Regional Healthcare and Affiliates Summary of Total Operating Revenues (in millions of dollars) Inpatient revenue $ $ Outpatient revenue Gross patient service charges Contractual allowances Provision for bad debts Total revenue deductions Net patient service revenue Other operating revenue Total operating revenues $ $ In fiscal year 2013, gross patient service charges increased 1.6% due to growth in outpatient services offset by inpatient volume decreases. Gross patient service charges remained at the same aggregate level as fiscal year 2012 (no rate increase). Deductions from revenue increased 2.2% in fiscal 2013 due mostly to contractual payment arrangements with governmental and commercial payers. Net patient service charges increased 0.4% in fiscal year Excluded from gross patient service revenue for 2013 is $36.5 million of charity care charges provided by Self Regional Healthcare and Affiliates. (6)
9 Graph 1 presents gross patient service Charges by payor type in fiscal year 2013 for Self Regional Healthcare and Affiliates. Graph 1 Gross Patient Service Charges by Payor Type Uninsured, 10.1% Commercial, 24.4% Medicare, 52.0% Medicaid, 13.5% The largest consumers of healthcare services at Self Regional Healthcare and Affiliates were Medicare patients, comprising 52.0% of gross charges. Commercially insured and managed care patients comprised 24.4% of gross charges. Medicaid and uninsured patients comprised the balance of patients, representing 13.5% and 10.1% of gross charges, respectively. As compared to the prior fiscal year, Medicare increased by 1.1%, managed care/commercial decreased 1.1%, and Medicaid and the uninsured stayed the same. (7)
10 Graph 2 presents revenue deductions as a percentage of gross patient service charges in fiscal year 2013 and 2012 for Self Regional Healthcare and Affiliates. Graph 2 REVENUE DEDUCTIONS AS A PERCENTAGE OF GROSS PATIENT SERVICE CHARGES 2.1% 2.5% 70.0% 60.0% 50.0% 11.8% 13.6% 4.4% 5.5% 40.0% 30.0% 47.8% 44.8% 20.0% 10.0% 0.0% Medicare and Medicaid Provision for bad debts Other Charity Write-offs Deductions from gross patient service charges represent the difference between charges and the amount of payment received for services provided. Medicare and Medicaid contractuals are the largest category and represent a significant portion of the deductions. The next largest category, Other, is mostly discounts resulting from contracts with managed care companies along with contractuals from other governmental payors such as Champus. Bad debt results from patients who choose not to pay for their services without providing evidence of the lack of financial means to do so. Write-offs for charity are provided primarily to uninsured patients who do not have the financial means to pay for their healthcare services. Total deductions from charges increased from 66.1% in fiscal year 2012 to 66.4% in fiscal The increase in deductions was primarily due to an increase in contractual adjustments for managed care/commercial contracts, as well as smaller increases in charity write-offs and provisions for bad debts. The contractual deductions for Medicare and Medicaid decreased, but not enough to fully offset the other three increases. (8)
11 Operating Expenses In fiscal year 2013, total operating expenses decreased 0.2% over the prior year to $321 million. Graph 3 presents a break-down of operating expenses by major category in fiscal year 2013 for Self Regional Healthcare. Graph 3 Composition of Operating Expenses Professional Fees and Other, 20.6% Depreciation and Amortization, 8.4% Supplies, 18.6% Salaries, Wages and Benefits, 52.4% Salaries, wages and benefits expenses, which represent 52.4% of total operating expenses, decreased 1.1% to $168.2 million in fiscal year The decrease was due to implementation and utilization of productivity monitoring reports for the entire organization. Supplies and drugs expenses, which represent 18.6% of total operating expenses, stayed the same at $59.6 million. Several cost cutting and cost containment initiatives were put into place during the fiscal year that helped offset the supply costs increase caused by inflation. Professional fees and other expenses, which represent 20.6% of total operating expenses, increased 1.1% to $66.3 million. The increase was the result of additional physician services for hospital inpatient management (9)
12 Depreciation and amortization expenses, which represent 8.4% of total operating expenses, increased 0.3% to $27.0. CAPITAL ASSET AND DEBT ADMINISTRATION Capital Assets As seen in Table 4, the Hospital had a total net investment of $230.6 million in capital assets at the end of fiscal This amount represents a net increase (including additions and disposals) of $4.9 million, or 2.2%, over fiscal year Table 4 Self Regional Healthcare and Affiliates Capital Assets (in millions of dollars) Land and land improvements $ 8.2 $ 7.9 Buildings Fixed equipment Moveable and other equipment Gross capital assets Less accumulated depreciation (268.3) (247.2) Construction in progress Capital assets $ $ This year s major capital asset additions include: Ongoing construction and completion of a new Support Services Building to house back office functions Ongoing construction and completion of a new Medical Office Building in Laurens County Construction and opening of the Behavior Health Nursing unit (10)
13 Outstanding Debt As seen in Table 5, at September 30, 2013, the Hospital had $175.4 million in outstanding debt, which is a 10.9% increase over fiscal year Table 5 Self Regional Healthcare and Affiliates Outstanding Debt (in millions of dollars) Revenue bonds and notes payable $ $ Capital leases Total $ $ NEXT YEAR S BUDGET The budget for fiscal year 2014 includes a 1.6% increase in total operating revenues. Income from operations is budgeted at $18.4 million for an operating margin of 5.3%. REQUESTS FOR INFORMATION This financial report is designed to provide a general overview of Self Regional Healthcare and Affiliates finances. Questions concerning any of the information provided in this report or requests for additional financial information should be addressed to: Self Regional Healthcare Chief Financial Officer 1325 Spring Street Greenwood, SC (11)
14 Combined Balance Sheets September 30, 2013 and 2012 Assets As Adjusted Current assets: Cash and cash equivalents $ 14,927,947 $ 12,246,353 Assets whose use is limited 15,386,342 4,557,463 Patients accounts receivable, less allowance for uncollectible accounts of approximately $27,045,000 in 2013 and $25,029,000 in ,147,481 46,144,159 Inventories of drugs and supplies 2,650,069 2,552,428 Unconditional promises to give, net 645, ,420 Deposits, other receivables and prepaid expenses 4,401,791 4,041,389 Total current assets 87,158,833 70,167,212 Assets whose use is limited, net of current portion 384,413, ,072,829 Physician receivables, net 397, ,139 Capital assets, net 230,645, ,738,980 Unconditional promises to give, net of current portion 928,261 1,477,888 Prepaid pension cost 789, ,444 Other assets 1,167,934 1,245,082 Total assets $ 705,501,694 $ 662,258,574 (12) (continued)
15 Combined Balance Sheets September 30, 2013 and 2012 Liabilities and Net Position As Adjusted Current liabilities: Current installments of long-term debt $ 13,125,478 $ 2,858,815 Accounts payable 13,122,846 17,067,222 Accrued salaries, wages and benefits 11,007,972 11,097,882 Other accrued expenses 7,550,352 7,498,504 Estimated third-party payor settlements 14,971,168 13,096,849 Total current liabilities 59,777,816 51,619,272 Annuity obligations 88, ,306 Other postemployment benefit obligation 3,294,079 2,980,226 Long-term debt, excluding current installments 162,315, ,248,739 Total liabilities 225,475, ,949,543 Net position: Invested in capital assets, net of related debt 55,204,520 67,631,426 Restricted: Held by trustee under indenture agreement 29,169,992 10,669,280 Held under employee benefit plan agreement 907, ,826 By donor for specific activities or capital acquisitions 3,980,500 4,020,653 Nonexpendable 799, ,050 Unrestricted 389,964, ,266,796 Total net position 480,025, ,309,031 Total liabilities and net position $ 705,501,694 $ 662,258,574 The accompanying notes are an integral part of these combined financial statements. (13)
16 Combined Statements of Revenues, Expenses, and Changes in Net Position For the Years Ended September 30, 2013 and 2012 As Adjusted Operating revenues: Net patient service revenue, net of provision for bad debts of approximately $56,394,000 in 2013 and $44,837,000 in 2012 $ 343,253,459 $ 342,030,608 Other operating revenue 16,976,250 14,103,625 Total operating revenues 360,229, ,134,233 Operating expenses: Salaries and wages 132,992, ,251,418 Employee benefits 35,225,565 37,886,205 Supplies 59,642,369 59,898,107 Professional fees 18,779,716 14,812,543 Other expense 47,540,336 48,187,397 Depreciation and amortization 27,005,528 26,929,716 Total operating expenses 321,186, ,965,386 Operating income 39,043,383 34,168,847 Nonoperating revenues (expenses): Interest expense (7,532,395) (6,667,169) Investment income (loss), net (4,456,154) 12,777,130 Rental income 70, ,089 Noncapital grants and contributions 1,445,606 1,932,611 Contribution expense (379,795) (576,483) Fundraising expense (114,983) (23,875) Depreciation for Foundation (113,043) (113,566) Other 17,633 (8,478) Total nonoperating revenues (expenses) (11,062,313) 7,494,259 Excess of revenues over expenses before capital grants and contributions 27,981,070 41,663,106 Capital grants and contributions - 262,134 Excess of revenues over expenses 27,981,070 41,925,240 Contributions 241,419 12,135 Distributions (505,790) (718,733) Increase in net position 27,716,699 41,218,642 Net position, beginning of year 452,309, ,090,389 Net position, end of year $ 480,025,730 $ 452,309,031 The accompanying notes are an integral part of these combined financial statements. (14)
17 Combined Statements of Cash Flows For the Years Ended September 30, 2013 and 2012 As Adjusted Cash flows from operating activities: Receipts from and on behalf of patients $ 342,124,456 $ 334,961,665 Other receipts and payments, net 17,695,068 14,869,116 Payments to suppliers and contractors (132,705,302) (120,105,482) Payments to employees (167,994,434) (170,003,716) Net cash provided by operating activities 59,119,788 59,721,583 Cash flows from noncapital financing activities: Net change in unconditional promises to give 529, ,161 Net change in annuity obligations (12,836) (7,422) Receipts from noncapital grants and contributions 1,445,606 1,932,611 Net cash provided by noncapital financing activities 1,962,614 2,201,350 Cash flows from capital and related financing activities: Purchase of capital assets (29,146,790) (31,906,404) Proceeds from sale of capital assets 123, ,247 Capital grants and contributions - 262,134 Bond issuance costs - (1,117,765) Proceeds from long-term debt 18,573,945 67,722,398 Principal paid on long-term debt (3,311,591) (69,859,318) Interest paid on long-term debt (6,342,500) (6,721,254) Net cash used in capital and related financing activities (20,103,917) (41,408,962) Cash flows from investing activities: Increase in investments, net of earnings (26,219,537) (23,120,519) Contributions 241,419 12,135 Distributions paid (505,790) (718,733) Other (406,327) (434,748) Net cash used in investing activities (26,890,235) (24,261,865) Net increase (decrease) in cash and cash equivalents 14,088,250 (3,747,894) Cash and cash equivalents, beginning of year 54,648,847 58,396,741 Cash and cash equivalents, end of year $ 68,737,097 $ 54,648,847 Reconciliation of cash and cash equivalents to the balance sheet: Cash and cash equivalents in current assets $ 14,927,947 $ 12,246,353 Cash and cash equivalents in assets whose use is limited: Internally designated 23,613,941 30,671,148 Held by trustee under debt indenture 29,169,992 10,669,280 Under employee benefit plan agreement 907, ,826 Donor restricted for specific activities or capital acquisitions 118, ,240 Total cash and cash equivalents $ 68,737,097 $ 54,648,847 (15) (continued)
18 Combined Statements of Cash Flows, continued For the Years Ended September 30, 2013 and 2012 As Adjusted Reconciliation of operating income to net cash provided by operating activities: Operating income $ 39,043,383 $ 34,168,847 Adjustments to reconcile operating income to net cash provided by operating activities: Provision for bad debts 56,394,294 44,837,020 Depreciation and amortization 27,005,528 26,929,716 Loss on disposal of capital assets 349, ,864 Change in net operating assets and liabilities: Patient accounts receivable, net (59,397,616) (54,934,082) Deposits, other receivables and prepaid expenses (360,402) (23,313) Inventories of drugs and supplies (97,641) 232,447 Physician receivables, net 369, ,359 Other assets Accounts payable, accrued salaries, wages and benefits and other accrued expenses (6,374,748) 4,853,411 Other postemployment benefit obligation 313, ,195 Estimated third-party payor settlements 1,874,319 3,028,119 Net cash provided by operating activities $ 59,119,788 $ 59,721,583 Noncash investing and financing activities: Acquisition of equipment through capital lease obligation $ 881,274 $ 46,034 Acquisition of equipment through accounts payable $ 2,392,310 $ 3,522,883 The accompanying notes are an integral part of these combined financial statements. (16)
19 Notes to Combined Financial Statements September 30, 2013 and Description of Reporting Entity and Summary of Significant Accounting Policies Reporting Entity - The Greenwood County Hospital Board (the Board ) is a public body corporate of South Carolina and was established by Act No enacted by the General Assembly of the State of South Carolina on May 30, The members of the Board are appointed by the Governor of the State of South Carolina upon recommendation of the Board and the Greenwood County legislative delegation. The Board is empowered to operate Self Regional Healthcare ( SRH ), an acute care facility located in Greenwood, South Carolina, and other health care facilities as are necessary and convenient to benefit the residents of Greenwood County. The Board leases the original main hospital building and the land on which it stands from Greenwood County. The lease expires in 2047 and provides for annual rent of $1. Although legal title to the property is held by Greenwood County, such assets are recorded on the books of Self Regional Healthcare and reflected in the accompanying combined financial statements at the original cost to Greenwood County. Self Memorial Regional Health Services, Inc. ( SMRHS ) is a not-for-profit corporation established by the Board to provide health related services to the residents of Greenwood County and the surrounding area. The Board is the sole member and appoints the Board of Trustees of SMRHS. Further, SMRHS operates for the benefit of the Board and Self Regional Healthcare. Accordingly, SMRHS is reported as a blended component unit of the SRH, the primary government. SMRHS formed the Surgery Center at Self Memorial Hospital L.L.C. (the Surgery Center ). The Surgery Center, a joint venture with qualified physician investors, commenced operations during Under the terms of the operating agreement, SMRHS retains at least a 51% ownership in the Surgery Center. The remaining ownership percentage has been designated as a noncontrolling interest in the combined financial statements. Self Regional Physician Services L.L.C. ( SRPS ) is a wholly-owned subsidiary of Self Regional Healthcare. When formed, SRPS purchased substantially all of the assets of a physician group practice for the purpose of operating one or more physician group practices in the region. SRPS is controlled by the Board. Accordingly, SRPS is reported as a blended component unit of the SRH, the primary government. (17)
20 Self Regional Healthcare Foundation and Subsidiary (the Foundation ) was organized as an eleemosynary corporation on January 9, The purpose of the Foundation is to receive, hold, manage, invest, or arrange for investing and to acquire by gift, devise, bequest, purchase or otherwise use of property of any kind and funds exclusively for the benefit of Self Regional Healthcare and any other publicly supported hospital in the State of South Carolina. Members of the Board of Trustees of the Foundation are approved by the Board. Accordingly, the Foundation is reported as a blended component unit of the SRH, the primary government. The Foundation is the sole shareholder of Greenwood Medical Company, Inc. (the Subsidiary ), a for profit corporation. The Subsidiary, which owns several medical buildings in Greenwood, South Carolina, leases space to a variety of physician practices, laboratories, and durable medical equipment suppliers for medical practice sites. Accordingly, the accounts of the Subsidiary have been consolidated with the Foundation. Self Memorial Hospital Auxiliary, Inc. (the Auxiliary ) was organized as a not-for-profit entity on July 12, This corporation was established to engage in activities that are devoted to charitable purposes, and shall promote, enhance, and support SRH. Members of the Board of Trustees of the Auxiliary are approved by the Board. Accordingly, the Auxiliary is reported as a blended component unit of the SRH, the primary government. Self Medical Group, Inc. ( SMG ) was organized as a not-for-profit entity on July 27, This corporation was established to employ and manage physician practices. Members of the Board of Trustees of SMG are appointed by the Board. Accordingly, SMG is reported as a blended component unit of the SRH, the primary government. Combined Financial Statements - The accompanying combined financial statements include the accounts of SRH, SMRHS, the Surgery Center, SRPS, the Foundation, the Auxiliary, and SMG, jointly referred to as Self Regional Healthcare and Affiliates (the Hospital ). All intercompany balances between these entities have been eliminated in the combination. Enterprise Fund Accounting The Hospital uses enterprise fund accounting. Revenues and expenses are recognized on the accrual basis using the economic resources measurement focus. Pursuant to Governmental Accounting Standards Board ( GASB ) Statement No. 62, Codification of Accounting and Financial Reporting Guidance Contained in Pre-November 30, 1989 FASB and AICPA Pronouncements, the Hospital will only recognize GASB statements as authoritative guidance. Financial Accounting Standards Board ( FASB ) statements, including those issued after November 30, 1989 and AICPA pronouncements will no longer be authoritative and may be used as non-authoritative guidance. (18)
21 Adoption of New Accounting Policies During the year ended September 30, 2013, the Hospital implemented the provisions of GASB Statement No. 63, Financial Reporting of Deferred Outflows of Resources, Deferred Inflows of Resources, and Net Position, and Statement No. 65, Items Previously Reported as Assets and Liabilities. These statements provide financial reporting guidance related to deferred inflows of resources, deferred outflows of resources, and net position, which are elements of the balance sheet as defined in GASB Concepts Statement No. 4, Elements of Financial Statements. As a result of the application of the new guidance, the residual balance of all other combined balance sheet elements previously reported as net assets is now identified as net position. GASB Statement No. 65 further requires that costs associated with the issuance of longterm debt be expensed in the period incurred, rather than deferred and amortized over the term of the related debt. As a result of the retroactive application of this guidance, certain amounts previously reported as of and for the year ended September 30, 2012, have been restated and a cumulative effect adjustment has been recorded to net position as of September 30, The effect of this application on previously reported combined financial statement amounts is summarized below: 2012 As Previously Reported 2012 As Adjusted Adjustment Combined Balance Sheet: Unamortized bond issuance costs, net $ 3,354,988 $ (3,354,988) $ - Net position, September 30, 2012 $ 455,664,019 $ (3,354,988) $ 452,309,031 Net position, September 30, 2011 $ 413,530,862 $ (2,440,473) $ 411,090,389 Combined Statement of Revenues, Expenses and Changes in Net Position: 2012 As Previously Reported 2012 As Adjusted Adjustment Depreciation and amortization $ 26,015,201 $ 914,515 $ 26,929,716 Increase in net position $ 42,133,157 $ (914,515) $ 41,218,642 Net position, September 30, 2011 $ 413,530,862 $ (2,440,473) $ 411,090,389 Net position, September 30, 2012 $ 455,664,019 $ (3,354,988) $ 452,309,031 Use of Estimates - The preparation of the Hospital s combined financial statements in conformity with accounting principles generally accepted in the United States of America requires management to make estimates and assumptions that affect the amounts reported in the combined financial statements and accompanying notes. Actual results could differ from those estimates. (19)
22 Cash and Cash Equivalents - The Hospital considers all highly liquid investments with a maturity of three months or less when purchased, excluding amounts limited as to use, to be cash equivalents. The Hospital maintains bank accounts at various financial institutions covered by the Federal Deposit Insurance Corporation ( FDIC ). At various times throughout the year, the Hospital may maintain bank account balances in excess of FDIC insured limits. At September 30, 2013 and 2012, the Hospital s deposits had a carrying amount of approximately $14,920,000 and $12,239,000, respectively, and a bank balance of approximately $17,000,000 and $14,956,000, respectively. The Hospital had cash on hand of approximately $8,000 and $7,000 at September 30, 2013 and 2012, respectively. Patient Accounts Receivable - Patient accounts receivable are carried at the original charge less an estimate made for doubtful or uncollectible accounts. The estimate for doubtful or uncollectible accounts is based upon a review of the outstanding balances aged by financial class. Management uses historical collection percentages to determine collectability. Management also reviews troubled, aged accounts to determine collection potential. Patient accounts receivable are written off when deemed uncollectible. Recoveries of accounts previously written off are recorded as a reduction to provision for bad debts when received. Interest is not charged on patient accounts receivable. Inventories of Drugs and Supplies - Inventories of drugs and supplies are stated at the lower of cost, determined using the first-in, first-out method, or market. Unconditional Promises to Give, Net - Unconditional promises to give cash and other assets to the Foundation 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 gift is received. An allowance for uncollectible unconditional promises to give is estimated based on past experience and on analysis of collectability. Investments in Debt and Equity Securities - Investments in debt and equity securities are reported at fair value except for short-term highly liquid investments that have a remaining maturity at the time they are purchased of one year or less. These investments are carried at amortized cost. Interest, dividends, and gains and losses, both realized and unrealized, on investments in debt and equity securities are included in nonoperating revenues (expenses) when earned. Assets Whose Use is Limited - Assets whose use is limited include cash and cash equivalents and investments that are internally designated for operations and capital improvement, held by trustee under indenture agreement, for employee benefit plan agreement, and restricted by donor. (20)
23 Capital Assets - The Hospital s capital assets are reported at historical cost. Contributed capital assets are reported at their estimated fair value at the time of their donation. All capital assets other than land are depreciated or amortized (in the case of capital leases) using the straight-line method of depreciation using these asset lives or lease periods: Land improvements Buildings and building fixtures Fixed equipment Major movable equipment 3 to 25 years 5 to 30 years 5 to 20 years 3 to 20 years When properties are retired or otherwise disposed of, the cost of the assets and related allowances for depreciation are removed from the accounts, and any resulting gain or loss is recognized in operating income on the combined statement of revenues, expenses, and changes in net position. Costs of Borrowing - Except for capital assets acquired through gifts, contributions or capital grants, interest cost on borrowed funds during the period of construction of capital assets is capitalized as a component of the cost of acquisition of those assets. Annuity Obligations - The Foundation has received charitable gift annuities as contributions. The donors contributed assets to the Foundation or placed the assets under an irrevocable trust agreement in exchange for a promise by the Foundation to pay fixed amounts to the donors for the remainder of their lives. The Foundation has recognized the asset or beneficial interests received and the related liability for the annuity payments. Net Position - Net position of the Hospital is classified in four components. Net position invested in capital assets, net of related debt consist of capital assets net of accumulated depreciation and reduced by the current balances of any outstanding borrowings used to finance the purchase or construction of those assets. Restricted net position are noncapital and capital net position that must be used for a particular purpose, as specified by creditors, grantors, trustees, or donors external to the Hospital. Nonexpendable restricted net position represents the portion of net position attributable to noncontrolling interests. Unrestricted net position are remaining net position that do not meet the definition of invested in capital assets, net of related debt or restricted. Net Patient Service Revenue - 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 adjustments under reimbursement agreements with thirdparty payors. Third-party contractual revenue adjustments are accrued on an estimated basis in the period the related services are rendered. Such amounts are subject to audit by governmental agencies. Adjustments, if any, are included in contractual revenue adjustments in the year of determination. In compliance with GASB pronouncements, net patient service revenues have been reduced by the amount of provision for bad debts incurred by the Hospital. (21)
24 The Hospital s policy does not require collateral or other security for patient accounts receivable. The Hospital routinely accepts assignment of, or is otherwise entitled to receive, patient benefits payable under health insurance programs, plans or policies such as those related to Medicare, Medicaid, Blue Cross, health maintenance organizations and commercial insurance carriers. Charity Care - The Hospital provides care to patients who meet certain criteria under its charity care policy 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 revenue. Operating Revenues and Expenses - The Hospital s combined statement of revenues, expenses, and changes in net position distinguishes between operating and nonoperating revenues and expenses. Operating revenues result from exchange transactions associated with providing health care services, the Hospital s principal activity. Nonexchange revenues including grants and contributions received for purposes other than capital asset acquisition are reported as nonoperating revenues. Operating expenses are all expenses incurred to provide healthcare services, other than financing costs. Grants and Contributions - From time to time, the Hospital receives grants from Federal and state agencies as well as contributions from individuals and private organizations. Revenues from grants and contributions (including contributions of capital assets) are recognized when all eligibility requirements, including time requirements are met. Grants and contributions may be restricted for either specific operating purposes or for capital purposes. Amounts that are unrestricted or that are restricted to a specific operating purpose are reported as nonoperating revenues. Amounts restricted to capital acquisitions are reported after nonoperating revenues and expenses. Fundraising - The Foundation incurs expenses related to obtaining contributions and grants which are included in other nonoperating expenses. Amortization - Bond discounts and premiums are amortized over the respective lives of the bonds. (22)
25 Income Taxes - SRH, SMRHS, the Foundation, the Auxiliary, and SMG have been recognized by the Internal Revenue Service as not-for-profit organizations as described in section 501(c)(3) of the Internal Revenue Code ( IRC ) and are exempt from federal income taxes pursuant to section 501(a) of the IRC. SRPS, as a wholly-owned limited liability partnership of SMRHS, is not subject to federal income taxes. The Surgery Center is a limited liability company and, therefore, is not subject to income taxes. Greenwood Medical Company, Inc., as a wholly-owned subsidiary of the Foundation, is a for-profit entity, and as such, is subject to federal and state income taxes. The Hospital has determined that it does not have any unrecognized tax benefits or obligations as of September 30, Fiscal years ending on or after September 2010 remain subject to examination by federal and state tax authorities. Compensated Absences - The Hospital s employees earn paid time off ( PTO ) at varying rates depending on years of service. Accumulated PTO time may be carried over each year up to a maximum amount, depending on years of service. Risk Management - The Hospital is exposed to various risks of loss including torts; theft of, damage to, and destruction of assets; business interruption; errors and omissions; employee injuries and illnesses; natural disasters; medical malpractice; and, employee health, dental, and accident benefits. Commercial insurance coverage is purchased for claims arising from such matters. Settled claims have not exceeded this commercial coverage in any of the three preceding years. The Hospital is self-insured for amounts up to a specified level for health and medical coverage for its employees. The estimated liability is the total estimated amount to be paid for all known claims or incidents and a reserve for incurred but not reported claims. Reclassification - Patient service revenue includes gross patient service charges, allowance for contractual adjustments, charity care and provision for bad debts. Certain amounts included in the 2012 allowance for contractual adjustments were reclassified to the 2012 charity care. This reclassification resulted in no change to the net patient service revenue amount presented in (23)
26 2. Deposits and Assets Whose Use Is Limited The Hospital s investments generally are reported at fair value, as discussed in Note 1, and included in the assets whose use is limited on the combined balance sheets. At September 30, 2013 and 2012, the Hospital had the following investments with set maturities, all of which were held in the Hospital s name by a custodial bank that is the agent of the Hospital. Investment Maturities (in Years) September 30, 2013 Carrying Less More Amount Than Than 10 Investment Type U.S. Treasury obligations $ 23,375,090 $ 4,033,760 $ 15,637,890 $ 3,703,440 $ - U.S. Municipal bonds 4,578,948-2,541,386 2,037,562 - U.S. Corporate bonds 104,697,891 8,648,235 70,494,690 23,604,946 1,950,020 U.S. Government bonds 105,166,639 3,187,243 65,812,801 20,185,046 15,981,549 Total $ 237,818,568 $ 15,869,238 $ 154,486,767 $ 49,530,994 $ 17,931,569 Investment Maturities (in Years) September 30, 2012 Carrying Less More Amount Than Than 10 Investment Type U.S. Treasury obligations $ 23,958,730 $ 5,653,000 $ 15,342,255 $ 2,963,475 $ - U.S. Municipal bonds 7,008,080-5,011,547 1,996,533 - U.S. Corporate bonds 99,984,475 11,035,123 54,886,846 26,730,660 7,331,846 U.S. Government bonds 100,177,406 4,588,290 40,603,942 42,930,779 12,054,395 Total $ 231,128,691 $ 21,276,413 $ 115,844,590 $ 74,621,447 $ 19,386,241 (24)
27 The composition of assets whose use is limited at September 30, 2013 and 2012 is set forth in the following table. The Hospital s investments included in assets whose use is limited are categorized to give an indication of the level of risk assumed by the Hospital. Assets whose use is limited are comprised of the following: Internally designated for operations and capital improvements: Cash $ 7,261,541 $ 13,084,652 Money market funds 16,352,400 17,586,496 U. S. Municipal bonds 4,578,948 7,008,080 U. S. Treasury obligations 23,375,090 23,958,730 U. S. Government bonds 105,166, ,177,406 U. S. Mutual funds 65,289,792 49,997,481 U. S. Corporate bonds 104,309,467 99,984,475 U. S. Equities 24,360 26,300 Multi-manager structured product 39,000,000 39,000,000 Accrued interest 1,658,440 1,931, ,016, ,755,438 Held by trustee under indenture agreement: Cash 29,169,992 10,669,280 Held under employee benefit plan agreement: Cash 907, ,826 Donor restricted for specific activities or capital acquisitions: Money market funds 118, ,240 U. S. Corporate bonds 388, ,195 U. S. Equities 1,753,573 1,181,178 Foreign Equities 37,689 97,661 Exchange traded funds 408, ,836 Real-estate investment trusts - 13,638 2,706,565 2,373,748 Total 399,800, ,630,292 Less current portion 15,386,342 4,557,463 Long term portion $ 384,413,989 $ 362,072,829 Custodial Credit Risk - The Hospital s deposits are exposed to custodial credit risk if they are not covered by depository insurance and deposits are uncollateralized or are collateralized with securities held by the pledging financial institution s trust department or agent but not in the depositor-government s name. The deposit risk is that, in the event of the failure of a depository financial institution, the Hospital will not be able to recover deposits or will not be able to recover collateral securities that are in the possession of an outside party. (25)
28 Credit Risk - This is the risk that an issuer or other counterparty to an investment will not fulfill its obligations. The Hospital s investment policy provides guidelines for its fund managers and lists specific allowable investments so that no more than 15% of the portfolio s market value may be held in the lowest investment grade category ( BBB or B3 ). As of September 30, 2013, the Hospital held less than 5% of investments in the lowest investment grade category. Concentration of Credit Risk - The Hospital places no limit on the amount it may invest in any one issuer. The Hospital held less than 5% of the carrying amount of investments in any one issuer as of September 30, 2013 and Interest Rate Risk - This is the risk that changes in interest rates will adversely affect the fair value of an investment. The Hospital s Investment Policy authorizes a strategic asset allocation that is designed to provide an optimal return over the Hospital s investment horizon and within the Hospital s risk tolerance and cash requirements. Investment income (loss), net consists of the following: Interest and dividend income $ 5,891,959 $ 7,864,512 Increase (decrease) in fair value of investments, net (10,348,113) 4,912,618 Investment income (loss), net $ (4,456,154) $ 12,777, Net Patient Service Revenue The Hospital has agreements with third-party payors that provide for payments to the Hospital at amounts different from its established rates. A summary of the payment arrangements with major third-party payors follows: Medicare - 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. Outpatient services are reimbursed under a prospective payment system called the Ambulatory Payment Classification System ( APCs ). Inpatient nonacute services and defined capital and medical education costs related to Medicare beneficiaries are paid based a cost reimbursement methodology. The Hospital is reimbursed for cost reimbursable items on a tentative rate with final settlement determined after submission of annual cost reports by the Hospital and audits thereof by the Medicare fiscal intermediary. The Hospital s Medicare cost reports have been audited by the Medicare fiscal intermediary through (26)
29 Medicaid - Inpatient services rendered to Medicaid 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. Outpatient services are reimbursed at prospectively determined rates per procedure. The Hospital s Medicaid cost reports have been audited by the Medicaid fiscal intermediary through Revenue from the Medicare and Medicaid programs accounted for approximately 40 percent and 12 percent, respectively, of the Hospital s net patient service revenue for the year ended Revenue from the Medicare and Medicaid programs accounted for approximately 37 percent and 12 percent, respectively, of the Hospital s net patient service revenue for the year ended Laws and regulations governing the Medicare and Medicaid programs are extremely complex and subject to interpretation. As a result, there is at least a reasonable possibility that recorded estimates will change by a material amount in the near term. The 2013 and 2012 net patient service revenue decreased approximately $100,000 and decreased $1,600,000, respectively, due to prior year retroactive adjustments in excess of amounts previously estimated and to the addition of allowances estimated that are still subject to audits, reviews and investigations. The Hospital has also entered into payment agreements with certain commercial insurance carriers, health maintenance organizations and preferred provider organizations. The bases for payment to the Hospital under these agreements include prospectively determined rates per discharge, discounts from established charges, and prospectively determined daily rates. HITECH Funding for Meaningful Use of Electronic Health Records ( EHR ) - The Hospital recognizes revenue for incentives earned under the EHR program in the period in which all contingencies related to the payments are complete. Incentive payments received under the EHR program include a discharge-related portion, which is calculated by Centers for Medicare & Medicaid Services ( CMS ) based on the Hospital's most recently filed cost report. Such amounts are subject to adjustment at the time of settling the 12-month cost report for the Hospital's fiscal year that begins after the beginning of the payment year. As a result, there is at least a reasonable possibility that recorded estimates will change by a material amount in the near term. The EHR funding received is subject to CMS audit. The results of that audit and settlement could result in a potential payback in future periods. The Hospital achieved compliance with the Year 1 meaningful use requirements under the Medicaid program during fiscal year 2012 and, accordingly, received payments of approximately $1,095,000. The Hospital achieved compliance with Year 1 meaningful use requirements under the Medicare program during fiscal year 2013 and, accordingly received payments of approximately $2,265,000. Under the contingency model, no revenues were recorded in the accompanying statement of revenues, expenses, and changes in net position for the years ended September 30, 2013 and 2012 as all contingencies had not been met. (27)
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