Cook County Health and Hospitals System. Financial Statements. Year To Date December 31, 2013

Transcription

1 Cook County Health and Hospitals System Financial Statements Year To Date December 31, As of March 14, 2014

2 Index Page 1. Mission Statement Attestation Statement Management Discussion and Analysis Combining Balance Sheet Assets Combining Balance Sheet Liabilities and Net Assets Combining Income Statement Comparative Income Statements: Cook County Health Facilities (Consolidated) Stroger Hospital ACHN (Clinics) Medicaid Expansion Oak Forest Health Center Provident Hospital Bureau of Health Department of Public Health Cermak Disclosure Checklist

3 COOK COUNTY HEALTH & HOSPITALS SYSTEM MISSION STATEMENT The Cook County Health and Hospitals 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. 3

4 Board of Directors Cook County Health and Hospitals System The accompanying financial statements of Cook County Health and Hospitals System and the related Management's Discussion and Analysis for the month ended December 31, 2013 have been prepared by Management who is responsible for their presentation and disclosure. The statements 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. John Cookinham, Chief Financial Officer Dorothy M. Loving, Executive Director of Finance 4

5 MANAGEMENT S DISCUSSION AND ANALYSIS INTRODUCTION This discussion and analysis provides the readers of the monthly unaudited financial statements of the Cook County Health and Hospital System (CCHHS) with an overview of the financial activities for the month ended December 31, 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. Hospital (JSH), Oak Forest Health Center (OFC) Provident Hospital (PHCC), the Department of Public Health (DPH), the Ambulatory and Community Health Network (ACHN), the Bureau of Health Services (BHS), CORE Center (for reporting purposes part of Stroger Hospital), and Cermak Health Services (CHS). Starting this fiscal year 2013, we have added the Medicaid Expansion. 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. In 2008 the Cook County Health and Hospital System Board was created by the Cook County Board of Commissioners to provide independent oversight of health care operations, and in 2010 the Cook County Board of Commissioners voted to make the Cook County Health and Hospital System Board permanent. In 2012 the Cook County Health and Hospitals System and Cook County Board Officials collaborated to cut Medicaid costs, help county taxpayers, and transform Cook County s hospital system by jump-starting national health care reform in Cook County. In November, 2012 the federal governmnent approved the 1115 Medicaid Waiver for Cook County, allowing CCHHS to enroll more than 115,000 individuals who will be eligible for Medicaid in 2014 into a Cook County network with no cost to the state of Illinois. An Medicaid Expansion allows the Cook County s Health System to early enroll certain uninsured patients into Medicaid. Specifically, these are patients who are not currently eligible for Medicaid, but who will be eligible in 2014 under the Accountable Care Act. Many of these individuals are patients who already are being treated by our system without compensation. The Waiver is funded entirely by the federal government. 5

6 FINANCIAL HIGHLIGHTS (IN THOUSANDS) The Cook County Health and Hospitals System finished the month with overall revenue of $85,749 and overall expenses was $93,690.. Net Patient revenue for the twelve months was $74,360. 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 $9,102. Other revenue consists primarily of parking revenue. Patient Accounts Receivable BEPA System Patient Accounts Receivable General As compared to November 30, 2013, Total Patient Accounts Receivable at the end of December-2013 reduced by 4 to 101 days. Additionally, there was a 4 day decrease in this figure, as compared to the previous month s figure. Days of Revenue Outstanding measures the average number of days charges remain in accounts receivable after service has been rendered before collection activities have been completed, including charity care and bad debt write-offs. Days of Revenue Outstanding is measured in charges, not cash collections. Days of Revenue Outstanding is a useful tool to measure collection efforts over time (i.e., whether this number is growing or decreasing). This number will be large due to the large number of Self-Pay patients CCHHS services and the processes CCHHS must complete before patient accounts are collected or written-off to bad debt. These processes include, but are not limited to, the following: Making an effort to attain third-party insurance coverage, including 1115 waiver and MANG applications; Processing charity care applications; Sending three (3) monthly statements before accounts are turned over to collections; Placing accounts bi-monthly with the collection agency; and Permitting patients to pay their account balances over time (time payment). Total billed accounts declined by $18.226M (-5.7%) as compared to the November-2013 balance. The decline in this figure indicates an increasing number of accounts are completing the collection process, which includes charity care and bad debt write-offs. The change in this figure does not translate dollar-for-dollar into actual cash receipts, as Medicaid pays CCHHS claims on a per-diem and Medicare pays CCHHS claims based upon the diagnosis, regardless of charges on the patient accounts. Additionally, charity 6

7 care and bad debt write-offs are part of the collection process and will not result in actual cash collections. Finally, the reimbursement for 1115 Waiver patients is made through a per-member-per-month payment, not a claim-by-claim basis. Inpatient Accounts Receivable Discharged Not Final Billed Inpatient discharged but not final billed accounts at the end of December-2013 decreased by $0.208M (-2.5%), as compared the November 30, 2013 balance. This decrease indicates that more inpatient accounts are moving to a Billed status, as compared to the previous month. The change in this figure does not translate dollar-for-dollar into actual cash receipts, as Medicaid pays CCHHS claims on a per-diem and Medicare pays CCHHS claims based upon the diagnosis, regardless of charges on the patient accounts. Additionally, charity care and bad debt write-offs are part of the collection process and will not result in actual cash collections. Finally, the reimbursement for 1115 Waiver patients is made through a per-member-per-month payment, not a claim-by-claim basis. Billed Inpatient Accounts Billed inpatient accounts at the end of December-2013 increased by $0.575M (0.4%) as compared to the November 30, 2013 balance. The increase in this number indicates fewer accounts had the collection process completed than in the previous month and that a lower number of accounts are being removed from active accounts receivable. CCHHS collection process includes charity care and bad debt write-offs. The change in this figure does not translate dollar-for-dollar into actual cash receipts, as Medicaid pays CCHHS claims on a per-diem and Medicare pays CCHHS claims based up on the diagnosis, regardless of charges on the patient accounts. Additionally, charity care and bad debt write-offs are part of the collection process and will not result in actual cash collections. Finally, the reimbursement for 1115 Waiver patients is made through a per-member-per-month payment, not a claim-by-claim basis. Outpatient Accounts Receivable Unbilled Outpatient Accounts The balance of unbilled outpatient accounts decreased by $0.955M (-8.8%) by the end of December-2013, as compared to the level of unbilled accounts as of November 30, This change indicates that more outpatient accounts are moving to a Billed status, as compared to the previous month. The change in this figure does not translate dollar-for-dollar into actual cash receipts due to Medicaid s and Medicare s reimbursement configuration. Billed Outpatient Accounts 7

8 The billed outpatient accounts receivable at the end of December-2013 fell by $18.801M (-11.7%), as compared to the balance as of November 30, The reduction in this figure, as compared to the prior month s balance, indicates a greater number of Out-Patient accounts had their collection and write-off related activities completed. The reduction of internal bill-holds from 20 days to 6 days will tend to cause a growth in the billed accounts receivable. The change in this figure does not translate dollar-for-dollar into actual cash receipts due to Medicaid and Medicare s reimbursement configuration and to charity care and bad debt write-offs. Carelink Program Activities (Charity Care) The volume and dollar amounts written-off to charity care are as follows: Cumulative Number of Accounts Through December-2013 Cumulative Value of Accounts Through December-2013 Number of Accounts for December-2013 Value of Accounts for Decembert-2013 In-Patient 423 $ 5.589M 423 $ 5.589M Out-Patient 20,289 $ 9.372M 20,289 $ 9.372M Totals 20,712 $ M 20,712 $ M The above data does not include bad-debt write-offs; it includes only the amounts written-off directly to charity care. Operating Expenses at the end of the month was $93,.690M broken down as follows: Salaries and Wages - $39.541M Benefits - $11.022M Supplies - $7.374M Purchased Services, Rental, and Other - $30.748M Insurance M Depreciation - $2.815M Utilities - $0.132M Nonoperating Revenue was $10.569M. The largest portions of this are attributed to property tax in the amount of $3.312M. Sales tax revenues are recognized by CCHHS when earned; this occurs when the underlying sales transactions occur. The amount recorded as Due from State of Illinois - Sales Tax represents the amounts earned by CCHHS, however, the cash is not yet received from the state. There is a 3 months lag from the time of the underlying sales transaction to the receipt of funds. 8

9 Taxes collected for the Health to date have been fully credited to the Health Fund except as mentioned in the previous paragraph. 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. 9

10 Accounts Receivable Comparison Cook County Health and Hospitals System Fiscal Year 2014 December-2013 BEPA Inpatient In-House $ 10,796, Discharged Not Final Billed $ 8,255, Billed $ 159,968, Total Inpatient Asccounts Receivable $ 179,021, Outpatient Unbilled $ 9,889, Billed $ 141,634, Total Outpatient Accounts Receivable $ 151,524, Combined Inpatient and Outpatient A/R Unbilled $ 28,942, Billed $ 301,603, Total IP and OP Accounts Receivable $ 330,545, Average Daily Revenue $ 3,268, Days of Revenue Outstanding

11 ASSETS CURRENT ASSETS: Cash and cash equivalents: Stroger Hospital ACHN (Clinics) Medicaid Expansion Cook County Health Facilities Combining Balance Sheet of General Funds (Unaudited) December 31, 2013 Stroger, ACHN & Medicaid Exp O F C (Oak Forest) Provident Hospital Bureau of Health Hospitals Total Dept of Public Health Cermak Intra-Activity Eliminations Grand Total Cash in banks ,083 1,083 Cash held by Cook Co Treas 725,183 37, ,905 96, , , ,681 (1,118,569) 11,666 Due from working cash fund 60,540 34,607 95,147 95,147 95,147 Total cash & cash equivalent 786,571 34,608 37, ,901 96, ,455 1,091, ,681 (1,118,569) 107,896 Property taxes receivable: Tax levy - current year , , ,244 Tax levy - prior year 29,382 34,626 64,008 3,912 5,243 2,969 76,132 8,452 84,584 Total property taxes rec 30,272 35,464 65,737 4,001 5,368 3,204 78,310 8, ,828 Receivables: Patient AR-net of allowances 66,695 66,695 (0) 1,918 68,613 68,613 Third-party settlements 3,019 3,019 3,019 3,019 Other receivables , ,462 Due from State 1,769 1,949 40,543 44, , ,468 47,992 Total receivables 72,378 1,963 40, , , , , ,085 Inventories 2,471 2, , ,701 TOTAL CURRENT ASSETS 891,692 72,035 78,266 1,041, , ,573 3,382 1,292, ,978 2,980 (1,118,569) 320,510 CAPITAL ASSETS: Depreciable assets - net 351,247 5, ,869 23,026 23,666 15, , ,241 TOTAL ASSETS 1,242,939 77,657 78,266 1,398, , ,240 18,414 1,710, ,998 3,608 (1,118,569) 739,751 11

12 LIABILITIES & NET POSITION CURRENT LIABILITIES: Stroger Hospital ACHN (Clinics) Medicaid Expansion Cook County Health Facilities Combining Balance Sheet of General Funds (Unaudited) December 31, 2013 Stroger, ACHN & Medicaid Exp O F C (Oak Forest) Provident Hospital Bureau of Health Hospitals Total Dept of Public Health Cermak Intra-Activity Eliminations Due to Cook County Treasurer 83,042 83, ,865 1,019,906 98,662 (1,118,569) Grand Total Accounts payable 13, ,893 46, ,848 62, ,037 Compensated absences 4, , , ,412 Deferred revenue 73,949 73,949 2,612 76,562 76,562 Third-party settlements Due to other co govt funds Due to others Interacct (payable)receivabl 149,524 47,711 (30,051) 167,183 5,811 42,221 (223,521) (8,306) 2 8,305 TOTAL CURRENT LIABILITIES 241, ,732 1, ,471 6,456 46, ,775 1,157, ,524 (1,118,569) 146,538 LONG-TERM LIABILITIES: Compensated absences longterm 23,727 2, , ,658 3,308 33, ,287 36,334 Reserve-tax objection suits 3,979 4,690 8, ,520 1,144 11,665 TOTAL LIABILITIES 269, ,189 2, ,999 7,512 49, ,484 1,200,715 2, ,812 (1,118,569) 194,537 NET POSITION: Investment in capital assets 351,247 5, ,869 23,026 23,666 15, , ,241 Beginning balance 617,108 (74,961) 74, ,846 94,096 97,016 (714,439) 93, ,816 (104,236) 131,100 Bond depreciation 1, , , ,815 Excess revenue (expenses) 3,203 7,741 1,296 12,240 (631) (1,315) (15,184) (4,890) (435) (2,615) (7,941) Ending balance 973,400 (61,532) 75, , , ,520 (714,070) 509, ,419 (106,203) 545,214 TOTAL LIABILITIES & NET POSITION 1,242,939 77,657 78,266 1,398, , ,240 18,414 1,710, ,998 3,608 (1,118,569) 739,751 12

13 Cook County Health Facilities Combining Income Statement of General Funds (Unaudited) December 31, 2013 Stroger ACHN Medicaid Stroger, ACHN O F C Provident Bureau of Hospitals Dept of Hospital (Clinics) Expansion & Medicaid Exp (Oak Forest) Hospital Health Total Public Health Cermak Grand Total REVENUE: Net patient service revenue 39,086 11,901 21,383 72,370 (0) 1,990 74,360 74,360 Grant revenue Other revenue Total Revenue: 39,525 11,946 21,383 72, ,998 74, ,180 OPERATING EXPENSES: Salaries and wages 24,730 2, , ,733 3,743 35, ,222 39,541 Employee benefits 6, , ,011 9, ,022 Supplies 1,560 1, , ,968 7, ,374 Purchased svs, rental & other 4, ,234 23, ,319 30, ,748 Insurance expense 1, , , ,058 Depreciation 1, , , ,815 Utilities TOTAL OPERATING EXPENSES 40,765 6,133 20,156 67, ,043 15,889 87,966 1,310 4,414 93,690 GAIN (LOSS) FROM OPERATIONS (1,241) 5,813 1,227 5,799 (960) (2,044) (15,889) (13,094) (1,001) (4,414) (18,509) NONOPERATING REVENUE: Property taxes , , ,312 Sales taxes , , ,520 Retirement plan contribution 2, , , ,737 TOTAL NONOPERATING REVENUE 4,444 1, , , ,799 10,569 NET INCOME (LOSS) 3,203 7,741 1,296 12,240 (631) (1,315) (15,184) (4,890) (435) (2,615) (7,941) 13

14 Cook County Health Facilities Comparative Income Statement of General Funds (Unaudited) Year to Date December 31, 2013 December 21, 2013 Inc (Dec) December 21, 2013 REVENUE: Net patient service revenue 74,360 74,360 Grant revenue Other revenue Total Revenue 75,180 75,180 OPERATING EXPENSES: Salaries and wages 39,541 39,541 Employee benefits 11,022 11,022 Supplies 7,374 7,374 Purchased svs, rental & other 30,748 30,748 Insurance expense 2,058 2,058 Depreciation 2,815 2,815 Utilities TOTAL OPERATING EXPENSES 93,690 93,690 GAIN (LOSS) FROM OPERATIONS (18,509) (18,509) NONOPERATING REVENUE: Property taxes 3,312 3,312 Sales taxes 2,520 2,520 Retirement plan contribution 4,737 4,737 TOTAL NONOPERATING REVENUE 10,569 10,569 NET INCOME (LOSS) (7,941) (7,941) 14

15 Stroger Hospital Comparative Income Statement of General Funds (Unaudited) Year to Date December 31, 2013 December 21, 2013 Inc (Dec) December 21, 2013 REVENUE: Net patient service revenue 39,086 39,086 Other revenue Total Revenue 39,525 39,525 OPERATING EXPENSES: Salaries and wages 24,730 24,730 Employee benefits 6,890 6,890 Supplies 1,560 1,560 Purchased svs, rental & other 4,447 4,447 Insurance expense 1,297 1,297 Depreciation 1,841 1,841 TOTAL OPERATING EXPENSES 40,765 40,765 GAIN (LOSS) FROM OPERATIONS (1,241) (1,241) NONOPERATING REVENUE: Property taxes Sales taxes Retirement plan contribution 2,932 2,932 TOTAL NONOPERATING REVENUE 4,444 4,444 NET INCOME (LOSS) 3,203 3,203 15

16 ACHN (Clinics) Comparative Income Statement of General Funds (Unaudited) Year to Date December 31, 2013 December 21, 2013 Inc (Dec) December 21, 2013 REVENUE: Net patient service revenue 11,901 11,901 Other revenue Total Revenue 11,946 11,946 OPERATING EXPENSES: Salaries and wages 2,992 2,992 Employee benefits Supplies 1,677 1,677 Purchased svs, rental & other Insurance expense Depreciation TOTAL OPERATING EXPENSES 6,133 6,133 GAIN (LOSS) FROM OPERATIONS 5,813 5,813 NONOPERATING REVENUE: Property taxes Sales taxes Retirement plan contribution TOTAL NONOPERATING REVENUE 1,928 1,928 NET INCOME (LOSS) 7,741 7,741 16

17 Medicaid Expansion Comparative Income Statement of General Funds (Unaudited) Year to Date December 31, 2013 December 21, 2013 Inc (Dec) December 21, 2013 REVENUE: Net patient service revenue 21,383 21,383 Total Revenue 21,383 21,383 OPERATING EXPENSES: Salaries and wages Employee benefits Supplies 5 5 Purchased svs, rental & other 19,234 19,234 Insurance expense TOTAL OPERATING EXPENSES 20,156 20,156 GAIN (LOSS) FROM OPERATIONS 1,227 1,227 NONOPERATING REVENUE: Retirement plan contribution TOTAL NONOPERATING REVENUE NET INCOME (LOSS) 1,296 1,296 17

18 Oak Forest Health Center Comparative Income Statement of General Funds (Unaudited) Year to Date December 31, 2013 December 21, 2013 Inc (Dec) December 21, 2013 REVENUE: Other revenue Total Revenue OPERATING EXPENSES: Salaries and wages Employee benefits Supplies Purchased svs, rental & other Insurance expense Depreciation TOTAL OPERATING EXPENSES GAIN (LOSS) FROM OPERATIONS (960) (960) NONOPERATING REVENUE: Property taxes Sales taxes Retirement plan contribution TOTAL NONOPERATING REVENUE NET INCOME (LOSS) (631) (631) 18

19 Provident Hospital Comparative Income Statement of General Funds (Unaudited) Year to Date December 31, 2013 December 21, 2013 Inc (Dec) December 21, 2013 REVENUE: Net patient service revenue 1,990 1,990 Other revenue 8 8 Total Revenue 1,998 1,998 OPERATING EXPENSES: Salaries and wages 2,733 2,733 Employee benefits Supplies Purchased svs, rental & other Insurance expense Depreciation TOTAL OPERATING EXPENSES 4,043 4,043 GAIN (LOSS) FROM OPERATIONS (2,044) (2,044) NONOPERATING REVENUE: Property taxes Sales taxes Retirement plan contribution TOTAL NONOPERATING REVENUE NET INCOME (LOSS) (1,315) (1,315) 19

20 Bureau of Health Comparative Income Statement of General Funds (Unaudited) Year to Date December 31, 2013 December 21, 2013 Inc (Dec) December 21, 2013 REVENUE: Other revenue Total Revenue OPERATING EXPENSES: Salaries and wages 3,743 3,743 Employee benefits 1,011 1,011 Supplies 3,968 3,968 Purchased svs, rental & other 6,319 6,319 Insurance expense Depreciation Utilities TOTAL OPERATING EXPENSES 15,889 15,889 GAIN (LOSS) FROM OPERATIONS (15,889) (15,889) NONOPERATING REVENUE: Property taxes Sales taxes Retirement plan contribution TOTAL NONOPERATING REVENUE NET INCOME (LOSS) (15,184) (15,184) 20

21 Dept of Public Health Comparative Income Statement of General Funds (Unaudited) Year to Date December 31, 2013 December 21, 2013 Inc (Dec) December 21, 2013 REVENUE: Grant revenue Total Revenue OPERATING EXPENSES: Salaries and wages Employee benefits Supplies 1 1 Purchased svs, rental & other Insurance expense Depreciation Utilities 3 3 TOTAL OPERATING EXPENSES 1,310 1,310 GAIN (LOSS) FROM OPERATIONS (1,001) (1,001) NONOPERATING REVENUE: Property taxes Sales taxes Retirement plan contribution TOTAL NONOPERATING REVENUE NET INCOME (LOSS) (435) (435) 21

22 Cermak Comparative Income Statement of General Funds (Unaudited) Year to Date December 31, 2013 December 21, 2013 Inc (Dec) December 21, 2013 REVENUE: Other revenue 0 0 Total Revenue 0 0 OPERATING EXPENSES: Salaries and wages 3,222 3,222 Employee benefits Supplies 9 9 Purchased svs, rental & other Insurance expense Depreciation Utilities 1 1 TOTAL OPERATING EXPENSES 4,414 4,414 GAIN (LOSS) FROM OPERATIONS (4,414) (4,414) NONOPERATING REVENUE: Property taxes Sales taxes Retirement plan contribution TOTAL NONOPERATING REVENUE 1,799 1,799 NET INCOME (LOSS) (2,615) (2,615) 22

23 OBJECTIVE: COOK COUNTY HEALTH AND HOSPITALS SYSTEM FINANCIAL STATEMENT DISCLOSURE CHECKLIST Fiscal Year 2013 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 Reviewed by Date Date 23