Cook County Health and Hospitals System. Financial Statements for the Month Ended June 30, 2010

Transcription

1 Cook County Health and s System Financial Statements for the Month Ended June 30, 2010 As of August 10, 2010 Page 1 of 10 Page 1 of 17

2 Index 1. Mission Statement 2. Attestation Statement 3. Management Discussion and Analysis 4. Balance Sheet Assets 5. Balance Sheet Liabilities and Net Assets 6. Income Statement 7. Disclosure Checklist Page 2 of 10 Page 2 of 17

3 COOK COUNTY HEALTH & HOSPITALS SYSTEM MISSION STATEMENT The Cook County Health and s System will deliver integrated health services with dignity and respect regardless of a patient's ability to pay; and, Foster partnerships with other health providers and communities to enhance the health of the public; and, Advocate for policies, which promote and protect the physical, mental and social well being of the people of Cook County. Page 3 of 10 Page 3 of 17

4 Board of Directors Cook County Health and s System The accompanying financial statement of Cook County Health and s System and the related Management's Discussion and Analysis for the month ended June 30, 2010 have been prepared by Management who is responsible for their presentation and disclosure. The statement have not been compiled, reviewed or audited by independent accountants. CCHHS maintains an internal control structure designed to provide reasonable assurance that assets are safeguarded and that transactions are properly executed, recorded and summarized to produce reliable records and reports, To the best of Management's knowledge and belief the statements were prepared in conformity with generally accepted accounting principles and governmental accounting standards using the accrual basis of accounting and are based on recorded transactions and Management's best estimates and judgment. Michael D. Ayres, Chief Financial Officer Dorothy M. Loving, Executive Director of Finance Page 4 of 10 Page 4 of 17

5 MANAGEMENT S DISCUSSION AND ANALYSIS INTRODUCTION In May 2008, the Cook County Board of Commissioners renamed the Cook County Health Facilities as the Cook County Health and System (CCHHS). This discussion and analysis provides the readers of the monthly unaudited financial statements of the CCHHS with an overview of the financial activities and financial activities for the month ended June 30, This discussion focuses on the significant financial issues and major financial activities during the current month. It should be read in conjunction with the accompanying financial statements of the CCHHS. The CCHHS includes the following entities: John H. Stroger Jr. (JSH); Oak Forest (OFH); Provident (PHCC); the Department of Public Health (DPH); the Ambulatory and Community Health Network (ACHN); the Bureau of Health Services (BHS); and Cermak Health Services (CHS). Collectively, these entities provide primary, intermediate, acute, and tertiary medical care to patients, without regard to their ability to pay. The Bureau of Health Services oversees the operational, planning, and policy activities of the CCHHS. The CCHHS is included in the reporting entity of the Cook County, Illinois, as an enterprise fund. As an enterprise fund, the CCHHS financial statements are prepared using proprietary fund accounting that focuses on the determination of changes in net assets, financial position, and cash flows in a manner similar to private sector businesses. The financial statements are prepared on an accrual basis of accounting, which recognizes revenue when earned and expenses when incurred. SUMMARY OF OPERATING AND FINANCIAL HIGHLIGHTS The Cook County Health and Systems continues to undertake significant restructuring with a focus on operational efficiency so that the system can better fulfill its mission of serving the health care needs of the region. FINANCIAL HIGHLIGHTS (IN THOUSANDS) The Cook County Health and s System finished the seven months of the fiscal year with overall revenue of $540,300 and overall expenses was $597,728. Net Patient revenue for seven months was $271,020 UP from the previous month by $52,900. Net Patient revenue consists of all charges including automated contractual allowances and bad debt adjustments. Write-off of Bad Debt is a CCHHS Board approved policy, Other revenue was $4,037 up from the previous month by $1,984. Other revenue consists primarily of parking and cafeteria revenue. Page 5 of 10 Page 5 of 17

6 Patient AR-net of allowances for seven months was $263,428 UP from the previous month by $27,629. The total System inpatient and outpatient AR increased by.64% or 2.9 million dollars in June as compared to May. Inpatient unbilled accounts increased in June by 8.8 million dollars. The increase in the June unbilled IP accounts is almost all at the Stroger facility. Management has engaged additional coding resources to reduce the backlog of unbilled IP accounts at Stroger. Outpatient unbilled accounts for the system were.7 million dollars higher in June as compared to May. The level of outstanding accounts receivable over 120 days old increased by approximately 1% in June as compared to May. At the end of June 59.3% of inpatient accounts were greater than 120 days old and 64.9% of outpatient accounts were greater than 120 days old. Operating Expenses at the end of seven months was $597,728 broken down as follows: Salaries and Wages - $305,216 Benefits - $82,849 Supplies - $65,957 Purchased Services, Rental, and Other - $92,555 Depreciation - $20,357 Utilities - $5,349 Insurance - $25,446 Nonoperating Revenue was $265,242. The largest portions of this are attributed to sales tax in the amount of $137,088 and property tax in the amount of $78,827. Taxes collected for the Health to date have been fully credited to the Health Fund. OVERVIEW OF THE FINANCIAL STATEMENTS This discussion and analysis are intended to serve as an introduction to the CCHHS financial statements. CCHHS basic monthly unaudited financial statements are comprised of fund financial statements. A fund is a grouping of related accounts that is used to maintain control over resources that have been segregated for specific activities or objectives. The CCHHS, like other state and local governments, uses fund accounting to ensure and demonstrate compliance with finance-related legal requirements. Page 6 of 10 Page 6 of 17

7 Cook County Health Facilities Combining Balance Sheet of General Funds (Unaudited) (In Thousands) June 30, 2010 Stroger ACHN (Clinics) Total Stroger & ACHN Oak Forest Provident Bureau of Health s Total Dept of Public Health Cermak Grand Total ASSETS CURRENT ASSETS: Cash and cash equivalents: Cash in banks , ,504 Cash held by Cook Co Treas 348, ,086 60,560 84, ,316 79,803 5, ,692 Due from working cash fund 60,618 34,607 95,226 95,226 95,226 Total cash & cash equivalent 409,531 34, ,140 61,056 84, ,043 79,805 5, ,421 Property taxes receivable: Tax levy - current year 32,315 19,286 51,601 7,714 9,918 1,873 71,107 8,206 79,313 Tax levy - prior year 33,843 17,525 51,369 7,010 9,007 1,712 69,098 7,467 76,565 Total property taxes rec 66,159 36, ,970 14,724 18,925 3, ,205 15, ,878 Receivables: Patient AR-net of allowances 220, ,661 23,657 19, , ,428 Third-party settlements Other receivables Due from State - sales taxes 14,507 7,583 22,090 2,967 3, ,673 3,297 4,474 37,443 Interacct (payable)receivabl (105,435) (105,435) 8,547 (17,133) 113,929 (92) (2) (93) Total receivables 129,967 7, ,605 35,330 5, , ,480 3,295 4, ,250 Inventories 6,454 6,454 1, , ,198 TOTAL CURRENT ASSETS 612,110 79, , , , ,373 1,031,689 98,774 10,284 1,140,747 CAPITAL ASSETS: Depreciable assets - net 409,409 6, ,957 28,361 24,416 4, , ,197 TOTAL ASSETS 1,021,520 85,605 1,107, , , ,701 1,504,751 98,826 10,368 1,613,944 Page 7 of 10 Page 7 of 17

8 Cook County Health Facilities Combining Balance Sheet of General Funds (Unaudited) (In Thousands) June 30, 2010 Stroger ACHN (Clinics) Total Stroger & ACHN Oak Forest Provident Bureau of Health s Total Dept of Public Health Cermak Grand Total LIABILITIES & NET ASSETS CURRENT LIABILITIES: Due to Cook County Treasurer 207, , , , ,500 Accounts payable 14, ,504 3,750 4,555 14,667 38, ,007 Accrued salaries, wages, & other liabilities 8,146 1,056 9,202 1,560 1, ,361 (95) ,976 Compensated absences 24,354 3,010 27,363 4,612 4,643 2,703 39,322 1,646 1,761 42,729 Defferred revenue 143, ,668 25,241 15, , ,765 Third-party settlements 1,594 1,594 1,594 1,594 Due to others 213 1,486 1,700 1,700 TOTAL CURRENT LIABILITIES 192, , ,593 35,377 28, , ,717 2,512 3, ,270 LONG-TERM LIABILITIES: Reserve-tax objection suits 3,202 1,659 4, , ,244 TOTAL LIABILITIES 195, , ,454 36,041 29, , ,256 3,217 3, ,514 OPERATING NET ASSETS: Invested in capital assets, net of related debt 409,409 6, ,957 28,361 24,416 4, , ,197 Beginning balance 440,235 (214,351) 225,883 91,057 87,283 (187,746) 216,478 80,033 6, ,305 Bond depreciation 14, ,041 1,891 1,454 1,947 20, ,357 Excess revenue (expenses) (38,403) 79,193 40,790 (16,571) (8,021) (89,574) (73,376) 15, (57,428) Ending balance 825,778 (128,107) 697, , ,132 (271,046) 636,496 95,608 7, ,430 TOTAL LIABILITIES & OPERATING NET ASSETS 1,021,520 85,605 1,107, , , ,701 1,504,751 98,826 10,368 1,613,944 Page 8 of 10 Page 8 of 17

9 Cook County Health Facilities Combining Income Statement of General Funds (Unaudited) (In Thousands) June 30, 2010 Stroger ACHN (Clinics) Total Stroger & ACHN Oak Forest Provident Bureau of Health s Total Dept of Public Health Cermak Grand Total REVENUE: Net patient service revenue 159,969 74, ,329 17,605 19, , ,020 Other revenue 1, , ,155 1, ,037 Total Revenue: 161,625 74, ,207 17,781 19, ,169 1, ,058 OPERATING EXPENSES: Salaries and wages 175,541 22, ,912 32,433 31,458 20, ,197 6,325 16, ,216 Employee benefits 44,817 6,375 51,191 9,604 8,971 6,460 76,228 1,870 4,751 82,849 Supplies 15,368 17,707 33,075 3,531 3,355 25,672 65, ,957 Purchased svs, rental & other 28,514 3,203 31,717 4,662 9,292 43,035 88, ,879 92,555 Depreciation 14, ,041 1,891 1,454 1,947 20, ,357 Utilities 3, ,500 1, , ,349 Insurance expense 15,909 2,569 18,478 4,400 2,567 25,446 25,446 TOTAL OPERATING EXPENSES 298,102 52, ,915 57,660 57,787 97, ,869 9,249 24, ,728 GAIN (LOSS) FROM OPERATIONS (136,477) 21,769 (114,708) (39,878) (38,606) (97,507) (290,700) (7,389) (24,582) (322,670) NONOPERATING REVENUE: Property taxes 32,101 19,174 51,275 7,670 9,861 1,863 70,668 8,159 78,827 Cigarette taxes 4,574 2,730 7,303 1,092 1, ,064 1,161 11,225 Sales taxes 40,783 32,588 73,371 10,128 15,206 2, ,538 12,731 22, ,088 Interest income (1) Retirement plan contribution 20,611 2,932 23,542 4,417 4,116 2,971 35, ,187 38,093 TOTAL NONOPERATING REVENUE 98,074 57, ,498 23,308 30,585 7, ,323 22,912 25, ,242 NET INCOME (LOSS) (38,403) 79,193 40,790 (16,571) (8,021) (89,574) (73,376) 15, (57,428) Page 9 of 10 Page 9 of 17

10 OBJECTIVE: COOK COUNTY HEALTH AND HOSPITALS SYSTEM FINANCIAL STATEMENT DISCLOSURE CHECKLIST Fiscal Year 2010 The object of this checklist is to help determine if the form and contents of the financial statements are in conformity with the accounting standards applicable to financial statement basis of accounting. DISCLOSURE PRINCIPLES: Note: Management can comply with a disclosure principle by making disclosure in body of financial statements or in the notes accompanying the financial statements. In a compilation engagement, management's election to omit substantially all disclosures applies to all disclosure principles in GAAP financial statements. Yes, N/A, No? If no, state reason (immaterial, estimated, etc.) FINANCIAL STATEMENT REFERENCES: 1. Do the financial statements reference footnotes (MD&A) or selected information? Yes GENERAL DISCLOSURES: A. Estimates: 1. General disclosure about use of estimates (MD&A)? Yes 2. Disclosure of possible changes in estimates? Yes B. Vulnerabilities do to concentrations in following areas disclosed?: 1. Customers? Yes 2. Suppliers? Yes 3. Lenders? Yes 4. Products? Yes 5. Supply of materials, labor or supplies? Yes 6. Location of assets in geographic area? Yes C. Related parties (FASB 57): 1. Known common control and economic dependency disclosure? Yes 2. Known transactions with related parties disclosed? Yes OTHER DISCLOSURE AREAS TO BE CONSIDERED: 1. Method of consolidations? Yes 2. Accounting changes including changes in GAAP and in estimates? Yes 3. Business combinations? Yes 4. Discontinues operations? Yes 5. Going concern? Yes COMMENTS: Completed by Date Reviewed by Date Page 10 of 10 Page 10 of 17

11 Cook County Health and s System Financial Operations and Statistical Reports (Non GAAP) For the Month Ended June 30, 2010 Page 1 of 7 Page 11 of 17

12 Index 1. Actual vs. Budget Cash Receipts 2. Actual vs. Budget Expenditures 3. Actual vs. Budget Expenses per Adjusted Patient Days 4. Payer Mix 5. Utilization Factors Page 2 of 7 Page 12 of 17

13 Year-To-Date Cash Receipts Actual to Budget Comparison by Payer Type (Non-GAAP Budget Basis) John H. Stroger, Jr., of Cook County Through June-2010 Payer Type Actual Budget Variance Medicaid $ 78,822,898 $ 100,124,039 $ (21,301,141) Medicare 28,394,571 24,104,110 4,290,461 Third Party 4,544,789 6,037,643 (1,492,854) Self-Pay 2,283,399 1,803, ,947 Totals $ 114,045,657 $ 132,069,244 $ (18,023,587) Provident of Cook County Through June-2010 Payer Type Actual Budget Variance Medicaid $ 3,464,885 $ 15,559,617 $ (12,094,732) Medicare 3,893,125 4,646,575 (753,450) Third Party 1,437,397 1,352,580 84,817 Self-Pay 90,579 99,474 (8,895) Totals $ 8,885,986 $ 21,658,246 $ (12,772,260) Oak Forest of Cook County Through June-2010 Payer Type Actual Budget Variance Medicaid $ 9,969,829 $ 19,941,347 $ (9,971,518) Medicare 1,920,667 2,323,288 (402,621) Third Party 350, ,895 (42,633) Self-Pay 167, ,926 (20,559) Totals $ 12,408,125 $ 22,845,456 $ (10,437,331) CCHHS Totals Through June-2010 Payer Type Actual Budget Difference Medicaid $ 92,257,612 $ 135,625,002 $ (43,367,390) Medicare 34,208,363 31,073,973 3,134,390 Third Party 6,332,448 7,783,118 (1,450,670) Self-Pay 2,541,345 2,090, ,493 Totals $ 135,339,768 $ 176,572,945 $ (41,233,177) The data reflected in this report comes from the Comptroller's ledger. At the time of presentation, the June-2010 Comptroller's ledger was not available. Page 3 of 7 Page 13 of 17

14 Cook County Health Facilities Appropriated Expenditures Budget and Actual (Non-GAAP Budget Basis) June 30, 2010 Year to Date Actual Budget Variance STROGER HOSPITAL Salaries and wages 197,912, ,928,773 (2,983,537) Supplies 33,075,333 39,354,059 6,278,726 Purchased svs, rental & other 31,716,735 34,545,680 2,828,945 Utilities 3,499,925 7,917,377 4,417,452 Total 266,204, ,745,889 10,541,586 OAK FOREST HOSPITAL Salaries and wages 32,432,744 36,453,312 4,020,568 Supplies 3,531,049 3,595,316 64,267 Purchased svs, rental & other 4,662,052 7,647,845 2,985,793 Utilities 1,138,007 1,958, ,002 Total 41,763,852 49,654,482 7,890,630 PROVIDENT HOSPITAL Salaries and wages 31,458,134 33,487,863 2,029,729 Supplies 3,355,363 4,451,985 1,096,622 Purchased svs, rental & other 9,292,236 13,898,465 4,606,229 Utilities 689,352 1,345, ,736 Total 44,795,085 53,183,401 8,388,316 BUERAU OF HEALTH Salaries and wages 20,393,608 (9,127,988) (29,521,596) Supplies 25,671,705 35,909,924 10,238,219 Purchased svs, rental & other 43,034,618 61,138,667 18,104,049 Total 89,099,931 87,920,604 (1,179,327) DEPT OF PUBLIC HEALTH Salaries and wages 6,324,567 7,376,132 1,051,565 Supplies 62, ,991 99,377 Purchased svs, rental & other 970,079 2,245,932 1,275,853 Utilities 21,355 60,986 39,631 Total 7,378,615 9,845,041 2,466,426 CERMAK Salaries and wages 16,694,792 21,787,827 5,093,035 Supplies 261, , ,821 Purchased svs, rental & other 2,878,828 2,907,246 28,418 Total 19,834,937 25,380,211 5,545,274 GRAND TOTAL Salaries and wages 305,216, ,905,919 (20,310,236) Supplies 65,957,381 84,158,412 18,201,031 Purchased svs, rental & other 92,554, ,383,835 29,829,287 Utilities 5,348,639 11,281,460 5,932,821 Total 469,076, ,729,627 33,652,904 Page 4 of 7 Page 14 of 17

15 Cook County Health Facilities System Expenses per Adjusted Patient Days Budget and Actual (Non-GAAP Budget Basis) As of June 30, 2010 Institution Actual Budget Variance Stroger $ 4,123 $ 4, % Oak Forest $ 3,435 $ 3, % Provident $ 4,453 $ 4, % Page 5 of 7 Page 15 of 17

16 Payer Mix Comparison By Charges Cook County Health And s System For The Prior 13 Months Ending June % 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% 9.0% 35.7% 5.3% 50.0% 9.0% 35.3% 5.3% 50.4% 9.2% 34.8% 5.3% 50.7% 9.2% 34.3% 5.2% 51.3% 9.2% 33.8% 5.4% 51.6% 9.3% 33.3% 5.4% 52.0% 12.2% 29.1% 5.4% 53.3% 10.3% 27.9% 6.2% 55.6% 10.5% 28.8% 6.1% 54.6% 10.6% 29.1% 6.0% 54.3% 10.5% 29.4% 5.7% 54.4% 10.6% 29.7% 5.7% 54.0% 10.7% 29.7% 5.7% 53.9% Jun-09 Jul-09 Aug-09 Sep-09 Oct-09 Nov-09 Dec-09 Jan-10 Feb-10 Mar-10 Apr-10 May-10 Jun-10 Medicare Medicaid Commercial Self Pay Page 6 of 7 Page 16 of 17

17 Cook County Health & s System Utilization Factors 2010 YTD YTD YTD %% J.H. Stroger June Total Budget Variance Variance Admissions 2,019 13,886 13, % Patient days 9,135 64,218 66,975 (2,757) -4.1% Adjusted Patient Days 15, , ,196 2, % Emergency Room Visits 10,618 70,701 76,926 (6,225) -8.1% Case Mix Index Average Length of Stay % Provident Admissions 366 2,451 2,734 (283) -10.4% Patient days 1,325 9,339 10,785 (1,446) -13.4% Adjusted Patient Days 2,367 16,222 16,962 (740) -4.4% Emergency Room Visits 3,461 22,295 22,990 (695) -3.0% Case Mix Index Average Length of Stay % Oak Forest Admissions 287 1,940 1, % Patient days 1,845 12,457 13,059 (602) -4.6% Adjusted Patient Days 3,382 22,667 21,629 1, % Emergency Room Visits 2,753 17,648 18,464 (816) -4.4% Case Mix Index Average Length of Stay - Acute (1.5) -48.4% Average Length of Stay - Rehab % The Rehab Average Length of Stay does not include 1 patient whose length of stay was 510 days (1/28/09-6/22/10). If this patient were included, then the Rehab Average Length of Stay would have been days. Total System Admissions 2,672 18,277 18,310 (33) -0.2% Patient Days 12,305 86,014 90,819 (4,805) -5.3% Adjusted Patient Days 21, , ,787 2, % Emergency Room Visits 16, , ,380 (7,736) -6.5% Cook County Health & s System ACHN - Clinics Fantus/Stroger Campus 36, , ,248 10, % West Cluster 6,652 47,131 46, % South Cluster 6,428 46,770 40,241 6, % South Suburban Cluster 5,851 37,552 28,947 8, % Total ACHN Visits 55, , ,073 26, % Page 7 of 7 Page 17 of 17