(?~~ Cass Wisniewski, CPA Senior VP & Chief Financial Officer Hurley Medical Center. November 29, 2017 RE:
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1 One Hurley Plaza Flint, Michigan November 29, RE: Officers Certificate for Hurley Medical Center Relating to the Annual Filing Issues Including: 1. City of Flint Hospital Building Authority, Building Authority Revenue Refunding Bonds, Series 2013B (Hurley Medical Center), $36,590,000, dated April 2, City of Flint Hospital Building Authority, Building Authority Revenue Rental Bonds, Series 2013A (Hurley Medical Center), $21,940,000, dated March 14, City of Flint Hospital Building Authority, Building Authority Revenue Rental Bonds (Hurley Medical Center), Series 2010, $35,215,000, dated March 25, 2010 I hereby certify that the Audited Financial Statement, June 30,, filed on November 29, constitutes the annual financial information required by the Continuing Disclosure Agreement. I further certify that the information complies with the Continuing Disclosure Agreement and the Rule as required. DAC shall be entitled to rely on this certificate. If you have further questions about this matter please do not hesitate to call. (?~~ Cass Wisniewski, CPA Senior VP & Chief Financial Officer Hurley Medical Center Clinical Excellence. Service to People.
2 HURLEY MEDICAL CENTER, MICHIGAN 1 City of Flint Hospital Building Authority, Building Authority Revenue Refunding Bonds, Series 2013B (Hurley Medical Center), $36,590,000, Dated: April 2, City of Flint Hospital Building Authority, Building Authority Revenue Rental Bonds, Series 2013A (Hurley Medical Center), $21,940,000, Dated: March 14, City of Flint Hospital Building Authority, Building Authority Revenue Rental Bonds (Hurley Medical Center), Series 2010, $35,215,000, Dated: March 25, 2010 Series 2013A,B GOVERNANCE AND MANAGEMENT Fiscal period ending June 30, No major changes in governance or management Series 2010 CHANGES IN GOVERNANCE AND MANAGEMENT, IF ANY Fiscal period ending June 30, No major changes in governance or management COMPETITION The Market Share, based on discharges, for Genessee County Hospital Genesys Health System 27.6% Hurley Medical Center 30.6% McLaren Regional Medical Center 28.3% All Others 13.5% Total 100.0% HISTORICAL OPERATIONS LICENSED AND STAFF BEDS Type of Beds Behavioral Health 60 Burn Care 13 Coronary Care 13 General Medical/ Surgical 180 Intensive Care 15 Neonatal Intensive Care 44 Neurotrama 18 Obstetrics 46 Pediatric 28 Pediatric Intensive Care 13 Physical Rehabilitation 13 Total Licensed Beds 443 Total Staffed Beds 418 UTILIZATION Licensed Beds 443 Discharges 22,197 Patient Days 110,228 Average Length of Stay (days) 4.97 Inpatient Surgeries 4,463 Observations 2,192 Emergency Room Visits 98,740 Other Outpatient Visits 402,395 Ambulatory Surgery Cases 6,551 Medicare Case Mix Index 1.55
3 SOURCES OF PATIENT SERVICE REVENUE Total Gross Revenue: Medicare 30.7% Medicaid 7.5% Medicaid HMO 37.9% Blue Cross 9.3% Commercial HMOs 4.0% All Others 10.6% Total Gross Revenue: 100.0% SUMMARY FINANCIAL INFORMATION SUMMARY OF REVENUE AND EXPENSES OF THE MEDICAL CENTER Net Patient Service Revenue 414,807 Other Operating Revenue 40,607 Total Operating Revenue 455,414 Operating Expenses: Depreciation and Amortization 16,837 Interest 5,161 All Other 417,895 Total Operating Expenses 439,893 Income (Loss) from Operations 15,521 Non Operating Revenues 903 Excess of Revenue over Expenses 14,618 SUMMARY BALANCE SHEET Net Patient Service Revenue Assets Current Assets: Cash 79,285 Patient Accounts Receivables 40,550 Other Receivables 8,378 Other Assets 17,138 Total Current Assets 145,351 Non current Assets Limited as to Use Investments 122,000 Restricted 28,064 Total Other Assets 47,948 Property, Plant and Equipment 103,988 Total Assets 447,351 Liabilities and Fund Net Assets Current Liabilities: Current Portion of Long term Debt 6,282 Accounts Payable and Other 18,507 Accrued Expenses 67,692 Total Current Liabilities 92,481 Other Liabilities Long term Debt, Less Current Portion 201,963 Total Liabilities 78, ,200 Fund Net Assets Total Liabilities and Fund Net Assets 447,351
4 MANAGEMENT'S DISCUSSION OF FINANCIAL PERFORMANCE HISTORICAL MAXIMUM ANNUAL DEBT SERVICE COVERAGE Revenues, Gains and Other Support in Excess of Expenses 15,521 Add: Depreciation and Amortization 13,837 Interest Expense 5,161 Income Available for Debt Service 34,519 Historical Maximum Annual Debt Service Requirement 11,123 Maximum Annual Debt Service Coverage Ratio (x) 3.10 HISTORICAL CAPITALIZATION Outstanding Long Term Debt 85,038 Unrestricted Net Assets 66,023 Total Capitalization 151,061 Long Term Debt to Capitalization 56.29% HISTORICAL LIQUIDITY Cash and Cash Equivalents 79,285 Investments 122,000 Total 201,285 Total Operating Expenses 439,893 plus Bad Debt Expense 3,913 less Depreciation & Amortization (16,837) Total 426,969 Days Cash on Hand Total Long Term Debt 85,038 Cash and Investments to Long Term Debt %
5 Management's Discussion of Financial Performance The Statement of Net Position The Medical Center's net position is the difference between its assets and liabilities reported in the statement of net position. The Medical Center's net position increased for the fiscal years ending June 30, and 2016, by $15.2 million and $45.4 million, respectively. The Medical Center's combined cash position increased in by $36.6 million to $201.3 million at June 30,. Respectively, the day s cash on hand increased from days in 2016, to days in. The major increase in cash was primarily due to the positive operating results and the declining accounts receivable despite increased patient volumes. The overall days in accounts receivable decreased from 47.2 days to 45.3 days. During 2016, some of the actuarial assumptions associated with the pension plan were changed and the investment market performed below expectations causing the unfunded liability in increase. In, the investment market outperformed and unfunded liability decreased. The Medical Center also made extra contributions of $12 million in and 2016, to help reduce the unfunded liability. Other balance sheet accounts remained stable and are within expected ranges for the reporting periods of and Operating Results and Changes in the Medical Center's Net Position In, the Medical Center's net position increased by $15.2 million. The primary cause of the increase in net position is the positive financial results for the year ended June 30,. Operating Income For the twelve months ending June 30,, the Medical Center experienced a net income from operations of $20.7 million. The comparable prior period operating income was $47.9 million. Inpatient activity decreased slightly from the prior year by 0.2% for both discharges and days reflecting a consistent average length of stay from year to year of There was a 3.1% decline in the Medicare CMI (case mix index) however the overall CMI for all payer groups showed a small improvement of 0.7% which still resulted in a decline in net patient revenue. The Medical Center s inpatient market share has remained strong as reflected in the Michigan Hospital Association s market analysis, showing the Medical Center s lead in market share for the last twelve published quarters. In additional to steady inpatient volumes, there was growth in the overall outpatient volumes reflecting an increase of outpatient revenue by 1.6%. Although the outpatient volumes have increased there has been a slight decline in the overall reimbursement rates. This decline has been partially offset by the continued reduction in bad debt write offs due to patient s being insured by the Medicaid Healthy Michigan Plan. Other Operating Revenues has increased approximately 13.6 % which reflects the professional revenue associated with higher patient volumes and an electronic medical record incentive payment. Operating expenses increased by 5.2% from the prior year. The largest increase reflects the additional salaries and wages and agency expenses associated with the increased FTE count. These increases are primarily associated with the growth of the outpatient volume and the general wage increases. The associated employment expenses increased corresponding including pension expense. The increase in the medical supplies reflects the higher costs associated with the new cardiac programs that opened midyear as well as the value analysis process to reduce the overall inventory associated with surgery procedures. Non operating Revenues and Expenses Non operating revenues consist primarily of investment earnings on cash balances, joint venture income and interest expense on outstanding longterm debt. Non Operating Revenue/Expense declined by $3.4 million over the prior year primarily due to the unrealized loss in the bond investment market in, as compared to an unrealized investment gain in of $2.8 million in The Medical Center s investment policy is restricted by the State of Michigan law Public Act 20, which restricts investments to US backed governmental securities. Also, in the prior year there was a gain on the sale of an ownership interest in a group purchase organization. Capital Asset and Debt Administration The Medical Center had $104 million invested in capital assets, net of accumulated depreciation, as detailed in Note 18 to the financial statements. There was $11.8 million of building infrastructure, clinical equipment and technology infrastructure assets purchased in. At year end, the Medical Center had $85 million in revenue bonds outstanding.
6 MEDICAL STAFF PHYSICIANS BY STAFF CATEGORY As of June 30, Number of Staff Category Physicians Active 411 Courtesy 46 Consulting 0 Emeritus 13 Provisional 119 Leave of Absence 4 TOTAL 593 PHYSICIANS BY MEDICAL DEPARTMENT As of June 30, Medical Department Number Percent Medicine % Surgery % Pediatrics % Family Practice % Radiology % Obstetrics/ Gynecology % Emergency Medicine % Psychiatry 7 1.2% Psychology % Anesthesiology 9 1.5% Pathology 6 1.0% Radiation Oncology 4 0.7% Pediatric Emergency Medicine 0 0.0% Total % TOP TWENTY ADMITTING PHYSICIANS As of June 30, Percent of Specialty Age Admissions Total Admissions 1 Pediatrics 41 1, % 2 Internal Medicine % 3 Internal Medicine % 4 Pediatrics % 5 Internal Medicine % 6 Geriatric Medicine % 7 Internal Medicine % 8 Psychology % 9 Internal Medicine % 10 Internal Medicine % 11 Pediatric Critical Care % 12 Internal Medicine % 13 Internal Medicine % 14 Internal Medicine % 15 Obstetrics/Gyncology % 16 Psychology % 17 Obstetrics/Gyncology % 18 Pediatrics % 19 Internal Medicine % 20 Surgical Critical Care % Total 48.2% Average Age 51
7 DISCHARGES BY SPECIALTY As of June 30, # of Average # of Additions Last Departures Last Specialty Physicians Age Discharges 3 Fiscal Years 3 Fiscal Years Allergy/ Immunology 0 0 Anesthesiology 3 1 Cardiology Cardiothoracic Surgery Dermatology 2 1 Diagnostic Radiology Emergency Medicine Endocrinology Family Practice Gastroenterology 2 1 General Surgery Geriatric Medicine , Hematology/ Oncology Infectious Disease 2 0 Internal Medicine , Interventional Radiology 1 1 Maternal/ Fetal Medicine Neonatology Nephrology Neuroradiology 0 0 Obstetrics/ Gynecology , Ophthalmology 1 2 Oral & Maxillofacial Surgery Orthopedic Surgery Otolaryngology Pathology 0 0 Pediatric Cardiology 14 0 Pediatric Critical Care Medicine Pediatric Dentistry Pediatric Endocrinology Pediatric Gastroenterology 0 0 Pediatric Hematology/ Oncology Pediatric Infectious Disease Pediatric Nephrology Pediatric Neurology Pediatric Psychology 0 0 Pediatric Pulmonology Pediatric Surgery Pediatrics , Physical Medicine & Rehabilitation 0 2 Plastic Surgery Podiatry 6 4 Psychology Pulmonary Medicine Radiation Oncology 2 2 Rheumatology 0 0 Surgical Critical Care , Telemedicine 0 3 Urology Vascular Surgery TOTAL , OTHER KEY POSITIONS ADDITIONS AND DEPARTURES As of June 30, Additions Last Departures Last 3 Fiscal Years 3 Fiscal Years CRNA Nurse Practitioners Physician Assistants Prosthesis 1 5
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