Saint Luke s. L!j Health System. February 28, 2011

Transcription

1 Saint Luke s L!j Health System flity Saint Luke s Hosputil s a i n t I u k e s h e a It h S y Ste m. r g 23 Award Recipient Carol J. Meyer I7ice President, Finance February 28, 211 Commerce Bank, N.A. 1 Walnut, 6th Floor Kansas City, Missouri 6416 Attention: Merry Evans Corporate Trust Department Re: Saint Luke s Health System Health Facilities Revenue Bonds Series 23A and 23B Series 24A, Series 25A and 25B Series 28A, Series 28B and 28C Series 23A and B, and Series 21A Bond Continuing Disclosure Agreements Dear Merry: In accordance with the above referenced issues, please find the Saint Luke s Health System s Unaudited Consolidated Financial Statements as of December 31, 21 including consolidating schedules of the Combined Group. As of December 31, 21 Saint Luke s Health System, Inc., Saint Luke s Hospital of Kansas City, Saint Luke s Northland Hospital Corporation, Saint Luke s South Hospital, Inc., and Saint Luke s East Hospital are the members of the Obligated Group. Very truly yours, Carol J. Meyer/ CJM/slc cc: Jerry Berg 192 Elm Avenue, Kansas City, MO Phone: (816) Saint Lakes Health Syslom s an iqual Opportsnity implnyer. Services are provided on a nondiscriminatory basis.

2 Saint Luke s Health System, Inc. - Unaudited - Consolidated Balance Sheet - For the Period Ended 12/31/21 (Dollars in Thousands) Assets Current assets: Cash and cash equivalents $147,999 $154,47 Investments 152,98 139,472 Accounts receivable, net 129, ,469 Other receivables 16,253 11,9 Inventories 18,888 18,724 Prepaid expenses 16,479 2,85 Total current assets 481, ,247 Property and equipment, net 765, Assets limited as to use: Investments 221,66 194,114 Insurance reserve fund 22,288 22,451 Bond Funds 21,933 45,271 Restricted funds 14,944 13,811 By board Total assets limited as to use 281, ,172 Other assets: Investment in affiliates 1,65 9,677 Receivables from affiliate Interest in net assets of foundation 127, ,49 Deferred financing costs, net 8,817 8,4 Other 42,494 36,21 Total other assets 188,77 173,8 Total assets $1,717,167. $1,596,583 Page 1 of 6

3 Saint Luke s Health System, Inc. - - Unaudited Consolidated Balance Sheet For the Period Ended 12/31/21 Liabilities and net assets Current liabilities: Current maturities of long-term debt $1,37 $9615 Accounts payable ,457 Accrued salaries 41,185 34,559 Estimated third-party payor settlements 13,535 13,57 Other 3,315 3,14 Total current liabilities 149, Other noncurrent liabilities 63,392 87,311 Reserve for self-insured risks 23,875 22,77 Long-term debt, less current maturities ,147 Total liabilities 789,74 773,57 Net assets: Unrestricted 784, ,965 Non Controlling Interest 1, Total Unrestricted 785, ,857 Temporarily restricted 13,93 94,977 Permanently restricted 38,388 38,243 Total net assets 928,93 823,77 Total liabilities and net assets $1,717,167 $1,596,584 Page 2 of 6

4 Saint Luke s Health System, Inc. - Unaudited - Consolidated Statement of Operations Forthe Period Ended 12/31/21 Year-To-Date Year-To-Date (Dollars in Thousands) Unrestricted revenues and other support: Net patient service revenue 992, Other revenue 62,516 59,841 Total unrestricted revenues and other support 1,55,7 985,61 Expenses: Salaries and wages 44,384 41,24 Employee benefits 92,397 1,228 Supplies and other 364,68 34,334 Depreciation and amortization 6,731 56,23 Financing Costs 16,59 16,623 Bad debts 38,12 36,583 Total expenses 1,12,29 96,175 Operating Income 42,798 25,426 Other Income (loss): Realized Investment Income (Loss) 6,941 (7,938) Unrealized Investment Income 29,796 7,747 Unrealized Gain (Loss) on interest Swap (6,185) 22,14 Bond Loss (877) Other, net (3,492) (639) Total other income 26,183 84,184 Non Controlling Interest in Operating Income (5,295) (5,6) Excess of revenues over expenses 63,686 14,64 Contributions Property 672 6,494 Pension Liability 3,865 (3,417) Increase in unrestricted net assets $95,223 $17,681 Page 3 of 6

5 (Dollars in Thousands) SuitS Luket Sa,,,I Lukc NntlhIuud Wr(ght Mrnto,iut Andrrton County Critlcnton Stint Luke o East Mid nni Ear tntt96le Sami t,uko( South Corpossliuu Medical Gtoup Saint Luke s Health System, Inc. - Unaudited - Consolidating Balance Sheet For the Period Ended 12/31/21 Assats Current assets: Cash and cash oqoivaknts lnvesintcnts Accounts receivable, act Other receivables inventories Prcpaid expenses Total current assets Property and equipment, net $ $21371) $2, t ) 17, ,13 (6) , ,366 LI to , ,523 3,417 6, ,1 2, Assets limited us to me: Invesunents Insurance rcsetve fund Bond Funds Rcstrictcd funds By Board Total assets limited as to use , , Other assets: Investment in affiliates Receivables from afluliatc Interest in net assets of foundations Deferred Sinaneing costs, net Other Total other axceta Total assets 9, to , , , ( , $2, ,592 $216,47 $421 51)4, )9 512,41 Friday, February 11,211 Calendar Year Page 1 of4

6 Saint Luke s Health System, Inc. - Unaudited - Consolidating Balance Sheet For the Period Ended 12/31/21 (Dollar, in Thousands) Assa4a Cuncrit assels: Cash and cask equivalents )nvcsuncnls AcCoutxs receivable, act Other rcccivablc inventories Prcpaid expenses Total cwycnt assets Property and equipment, net Homceurc and Cobol Wcdtiek Hospice $9ona $67 $ II Cushisg iok Retention Group $4.25 IS. 14 ISO 73 Saint Luke, SuialLukc, Physiei.o Cardiovantlur Fastness Ceosullanlo $ Elimiaalions Totals SO (259) , (259) 491, $3724 I Assets limited as to L5C liwestesents insurance resavc fund Bood Funds Restricted funds By Board Total assets limited as to use Other assets: Investment in affiliates Receivables from affiliate interest in act assets of foundations Deferred financing costs, net Other Total other assets Total assets 5 221, , ,452 (12,199) (37.951) , , , It (3,13) 1,77 $11, $17,71 $23,922 $14,24 51,249 3O,4I) $1,717,167 Friday, February 11,211 Calendar Year Page2of4

7 (Dolbra in Thousands) S&ot Lukc n Saint Luke, Northland Wtight}ofrmorisl Andecton County Critlenton Snini luke, East 1.Iidwent Ear Institute Saint Luke, Soulit COrporation Medical Group Saint Luke s Health System, Inc. - Unaudited - Consolidating Balance Sheet For the Period Ended 12/31/21 Liabilities and net assets Current liabilities: Current maturities of long.tcrni rkbt Accounts payable Accrued salaries Esiimatcd third-puny payor settlements Other Total current liabilities Other nanctarrcnl liabilities Reserve for sclf.insurcd risks Long-term debt, less current maturities Total liabilities $1317 $ $ 33,59t t tOS $ $ (272) 34 6, lois , ,764 2, , , , ,399 1,74 13, , $ $ $ 671 1,394 Net assets: Unrestricted Non Contraliing Interest Total Unrestricted Temporarily restricted Permanently restricted Total net assets , (164) ,742 (1.2) , I7.4I (164) t , ,52 66, , Total liabilities and net assets $1,126, $12363 $2,141 $19,592 $216,147 $ $12,41 Friday, February 11,211 Calendar Year Page 3 of4

8 ts Health System, Inc. Saint Luke - Unaudited - Consolidating Balance Sheet For the Period Ended 12/31/21 (Dollars in Thounds) Nomcanrc and T41n,picr Cabot Ncdrirk Cashing Ripk Rclciition Groop Saint Lnkc, Saint T.nkr a Phynician Ca,diov,snlan Pnilaoas Consultants Eliminations Totals LIabIlities sad set assets Cu,rnnt lwbilkics CLITCIg matuotirs of long-tcrrn dcbl Accounts payablc Accrucd salaries Estisnatcd third-pony payor octtlcrncnaa Othcc Total cucn1 liabilities Other noncurrent liabiitics Itescroc for sclf-insurcd risks Long-Icon debt, Iran cwronl maturities Tess) liabilities so St so ( So 59 So ,175 So So (37.951) 216 I (259) , , (341.21) 149, , , (3821) 79,74 Nct assos: Unrestricted Non Controlling inicrest Tetal Unicsirietcd Temporarily zrnricscd Pcrmancntly rcstrictcd Tolalnci assets Total liabiitics and net assets (6.452) , (12.199) ) (6,452) 12, )3 (12.199) , ,37 9, (7 (9.393) 12, (12.199) , , ) 525,922 S14,24 51,24 (52.41) 51, Friday, February 11,211 Calendar Year Page 4 of 4

9 Saint Luke s Health System, Inc. - Unaudited - Consolidating Statements of Operations For the Period Ended 12/31/21 Actuals 21 (DoIImt in Thnmnnniio) Saint Lukc s Saint Luc s Wright Mcmorial Andcrson County Northland Crittenton Saint Luke s East Midwcoi Ear Saint Luke s South Institute Unrestricted revcnae, nd nlher rapport Nelpalient nemviee ravenne ,35 1, ) Olheoeevenno ,265 3, , Tol.tmrdrnvnnnm.ndnlheronpport i3y iy Corporation MCIIICOI Group ttt ss rr Espenson: Soloric, Id waor Employee berrelito Sort or and olbet Dqneeralioa nod nnlorlisstroi. Fio.ncrng Carlo Bad deol. Total exponaro Operating laconic , , ,792 26, ,494 9, , ,36 6, , , ,592 1, / ,31 97, , Other ineonir (loor) Rootized tnvmtment Income (Loni) Unrealized Inveertmrnl Income Unrealized Onh, (Lam) on Inlenort Sicnp Bond I.oar Other. reel Total adler income Non Conloolling Inlereat in Opasling Income Farms of reveflocs OVtt rojeenom hingenmosdamclo Incroone in tnrenflictrd nut mmmc 6.73 II 123 I ,56 (1) (6.185) (2) (677) (1.362) (1,15) (662) (49) 123 I 194 (127) (1.26) (6.16) (697) (7) (4.393) (199) 32, , ? () 589 (,13) (1.479) 14 (27) (to) (2) 36 (5) 31,953 (29) (3.322) 2119 (2.3) 1,1 111,145 (32) ,95 (29) Friday, February 11,211 Calendar Year Page 1 of2

10 Saint Luke s Health System, Inc. - Unaudited - Consolidating Statements of Operations For the Period Ended 12/31/21 Actuals 21 (Dollars in Thuttasndv) flomecare & Hospice Uneertheird revenues and nlbre supporl: SOrt patient semite revenue Other revenue Total unerutrieted revenues nod ether suppers W Cabot r He&iek Cushiog Risk Retention Group W SLCC Inc. Saint Luke s Eliminations Saint Luke s Physician Partners Health System (17) 942, (79,473) (79.39),jtsrzzr SalnTieu aid wages Employee benefits Supplies nod other Depureintion nod aneslizotiee Financing casts Bud debts Total capeeses Operating iaeosne , (.39) 2.42 (7.447) (1.133) 6.59 In I , ,153 (79,39) 1,12, ,214) OIlier income (loan): Realized Investment Income (Less) Unrealized Investment Income Unrealized Gain (Lam) on Interest Swap Bond Less Other. net Total other income Nest Cessleolling Interest in Operating Income Eseem ofresenstes ever expenses Other elmngea in net nmeln hscromeinnnsrtosieled net aneta (6.15) (77) 12 (164) 11,57) (3.491) 9 19 (125) 1,132 (1.37) 26,15 (5.296) 2.36 (524) 677 (5.399) (1.37) (4), ,39 (415) 69 (5.43) ,3;) 93,255 Friday, February 11, 211 Calendar Year Page 2 of2

11 STATE OF MISSOURI HEALTH FACILITIES REVENUE BONDS SAINT LUKE S HEALTH SYSTEM SERIES 23, 24, 25 and 28 Supplemental MTI No. 7, Section 52 (23124) Supplemental MTI No. 9(25) Supplemental MTI No. 1 (28) d) Historical Debt Service Coverage Ratio of at least 1. times 12)31/21 (In Thousands) Revenue over expenses $ 63,686 Expense Adjustments: Depreciation & Amortization 6,731 Financing Costs 1659 Swap Costs 4,766 Unrealized Investment (Gain) Loss (29,796) Bond Loss 877 Unrealized Swap (Gain) Loss 6,185 Income Available $ 122,958 Historical Debt Service 32,138 Historical Debt Service Coverage 3.8 e) Unrestricted Cash and Investments equal to at least 75 days of Operating Expenses 12/31/21 (In Thousands) Cash and cash equivalents $ 147,999 Investments, Short Term 152,98 Investments, Long Term 221,66 Total Cash and investments $ 521,757 Total Expenses $ 1,16,975 Less: Depreciation 6,731 Operating Expenses $ 956,244 Days Cash on Hand 199.2

12 STATE OF MISSOURI HEALTH FACILITIES REVENUE BONDS SAINT LUKE S HEALTH SYSTEM SERIES 21 Continuing Disclosure Agreement, Dated June 1, 21 Historical Debt Service Coverage Ratio of at least 1. times 12131/21 (In Thousands) Revenue overexpenses $ 63,686 Expense Adjustments: Depreciation & Amortization 6,731 Financing Costs 16,59 Swap Related costs 4,766 Unrealized Investment (Gain) Loss (29,796) Bond Loss 877 Unrealized Swap (Gain) Loss 6,185 Income Available $ 122,958 Historical Debt Service 32,138 Historical Debt Service Coverage 3.8 Unrestricted Cash and Investments equal to at least 75 days of Operating Expenses 12/31/21 (In Thousands) Cash and cash equivalents $ 147,999 Investments, Short Term 152,98 Investments, Long Term 221,66 Total Cash and investments $ 521,757 Total Expenses $ 1,16,975 Less: Depreciation 6,731 Operating Expenses $ 956,244 Days Cash on Hand Debt to capitalization 12/31/21 Longterm debt (including current maturities) 562,51 Divided by: Long-term debt (including current maturities) 562,51 Unrestricted net assets of the System 785,775 Total Capitalization 1,348,276 Debt to capitalization 41.7%

13 Saint Luke s Health System as of December 31, 21 Licensed Hospitals ii Licensed Beds 1,356 Staffed Beds 879 Primary Care Physician Offices 21 Employed Physicians 247 Behavioral Health Offices 2 Health & Fitness Facilities 2 Home Health/Hospice Offices 6 Employee Assistance Offices 5 The 879 staffed beds identified in the above table include beds for obstetrics (139) and beds for rehabilitation (41). 52 beds are available as skilled/swing beds.

14 UTILIZATION The following table shows the utilization statistics for the System for the three years ended December 31, 28, 29 and 21. Year Ended December 31, Admissions (excluding Newborns) 42,42 4,87 43,196 Average Length of Stay (Days) Patient Days (Census Days) 235,82 223, ,441 Average Daily Census Observation Patients 12,169 11,764 11,652 Emergency Room Visits 139, , ,61 Surgeries: Inpatient 9,12 8, Outpatient 19,538 17,666 17,459 Total Surgeries 28,64 26,466 26,482 Births (Newborn Admissions) 6,328 5,799 5,82 Home Health Admissions 5,882 5,948 6,25 Outpatient Visits 518, ,49 517,794

15 CREDENTIALED PHYSICIAN PROFILE (AS OF ) SPECIALTY NUMBER % BOARD CERTIFIED AVERAGE AGE PRIMARY CARE: % 48 FAMILY PRACTICE % 48 INTERNAL MEDICINE % 5 PEDIATRICS % 47 MEDICINE: % 51 ALLERGY & CLINICAL IMMUNOLOGY 5 1.% 63 CARDIOLOGY % 48 PEDIATRIC CARDIOLOGY 12 1.% 51 DERMATOLOGY 8 1.% 44 ENDOCRINOLOGY 12 1.% 48 GASTROENTEROLOGY % 51 GYNECOLOGIC ONCOLOGY 5 1.% 55 HEMATOLOGY/ONCOLOGY % 5 INFECTIOUS DISEASES 9 1.% 49 NEPHROLOGY 2 1.% 54 NEUROLOGY % 5 OPHTHALMOLOGY % 51 PODIATRY % 45 PSYCHIATRY % 53 PULMONARY DISEASE % 51 RADIATION ONCOLOGY 2 95.% 48 RHEUMATOLOGY 7 1.% 54 SURGERY: % 5 CARDIO/THORACIC SURGERY 1 1.% 52 COLON & RECTAL SURGERY % 49 DENTISTRY 4.% 48 NEUROLOGICAL SURGERY % 5 OBSTETRICS & GYNECOLOGY % 49 ORAL AND MAXILLOFACIAL SURGERY % 48 ORTHOPAEDIC SURGERY % 49 OTOLARYNGOLOGY 37 1.% 51 PLASTIC AND RECONSTRUCTIVE SURGERY 22 1.% 51 SURGERY (GENERAL) % 52 UROLOGY % 49 VASCULAR SURGERY 5 1.% 53 HOSPITAL BASED: % 47 ANESTHESIOLOGY % 49 EMERGENCY MEDICINE % 43 HOSPITALIST % 42 MATERNAL AND FETAL MEDICINE 5 1.% 47 NEONATOLOGY % 52 OCCUPATIONAL MEDICINE 3 1.% 57 PAIN MANAGEMENT % 52 PATHOLOGY, ANATOMIC 18 1.% 51 PATHOLOGY, LABORATORY MED 3 1.% 51 PHYSICAL MEDICINE AND REHAB % 47 RADIOLOGY % 48 FELLOW - CARDIOVASCULAR DISEASE 3 1.% 36 FELLOW - PULMONARY/CRITICAL CARE 6 1.% 31 GRAND TOTAL % 49

16 SAINT LUKES HEALTH SYSTEM TOP 25 INPATIENT ADMITTING PHYSICIANS for ALL SPECIALTIES For The Year Ended December TOTAL % OF TOTAL RANK SPECIALTY CASES PATIENTS 1 PSYCHIATRY % 2 FAMILY MEDICINE % 3 PSYCHIATRY % 4 PSYCHIATRY % 5 FAMILY MEDICINE % 6 HOSPITALIST % 7 HOSPITALIST % 8 INTERNAL MEDICINE % 9 HOSPITALIST % 1 HOSPITALIST % 11 HOSPITALIST % 12 PSYCHIATRY % 13 HOSPITALIST % 14 FAMILY MEDICINE % 15 PSYCHIATRY % 16 HOSPITALIST % 17 PERINATOLOGY 42 1.% 18 HOSPITALIST % 19 HOSPITALIST 394.9% 2 PSYCHIATRY 393.9% 21 HOSPITALIST 385.9% 22 OBSTETRICS 384.9% 23 PSYCHIATRY 381.9% 24 HOSPITALIST 378.9% 25 HOSPITALIST 359.9%

17 RATIO CALCULATIONS Debt Service Coverage Ratio (Dollars in Thousands) Net laconic Available For Debt Service Excess of revenues over expenses ($94,775) $14,64 $63,686 Depreciation and amortization 5,841 56,23 6,731 Interest expense 18,175 16,623 16,59 Swap-related costs - 4,736 4,766 Change in unrealized (gain) loss on investment companies, net 129,83 (74,529) (29,796) Net cumulative unrealized gain relating to the transfer of investments to trading (24,23) - Loss on bond defeasance 2, Change in unrealized (gain) loss on interest rate swap 27,949 (22,14) 6,185 Income available for debt service $11,73 $85,623 $122,958 Historical maximum annual debt service ( MADS ) $26,325 $3,742 $32,138 Historical MADS coverage ratio (1) These payments on swaps were included in Interest expense prior to 29. Days Cash on Hand t1 (Dollars in Thousands) Unrestricted cash and investments $398,787 $487,993 $521,757 Total operating expense $95,34 $96,175 $1,16,975 Less: Depreciation and amortization 5,841 56,23 6,731 $899,463 $93,972 $956,244 Daily operating expense $2,464 $2,477 $2,62 Days cash on hand (1) Above calculations do not include interest in net assets of foundations which aggregate $127.4 million as of December 31, 21. Debt to Capitalization (Dollars in Thousands) Long-term debt (including current maturities) $524,151 $513,762 $562,51 Divided by: Long-term debt (including current maturities) $524,151 $513,762 $562,51 Unrestricted net assets of the System 581, , ,775 Total Capitalization $1,15,434 $1,22,727 $1,348,276 Debt to Capitalization 47.4% 42.7% 41.7%

18 SOURCES OF GROSS PATIENT CHARGES The following table sets forth the System s payor mix as a percentage of gross patient charges for the three years ended December 31, 28, 29 and 21: Sources of Gross Patient Charges by Payor Medicare 42% 44% 45% Medicaid 12% 12% 12% Blue Cross/Blue Shield 14% 16% 17% United Healthcare 7% 2% 2% Aetna 3% 7% 6% Other commercial I 22% 19% 18% patients TOTAL 1% 1% 1% The Corporation terminated its contract with United Healthcare effective February, 29. Corporation entered into a new contract with United Healthcare effective September, 21. The EMPLOYEES As of December 31, 21, there are currently approximately 9, total employees within the System, consisting of approximately 7, full-time employees and 2,2 total nurses, comprising approximately 1,6 full-time employees. No employees are presently represented by a labor union and management of the System is not aware of any current union organizing activities among its employees. The System has no current material shortages of professional, technical or clinical employees. The System characterizes its relationship with its employees as good.