FINANCIAL REPORT (UNAUDITED) FOR THE SIX MONTHS ENDED
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1 FINANCIAL REPORT (UNAUDITED) FOR THE SIX MONTHS ENDED JUNE 30, 2018
2 ATRIUM HEALTH FINANCIAL REPORT FOR THE SIX MONTHS ENDED JUNE 30, 2018 INDEX Page Financial Highlights 1-3 Comparative Balance Sheet 4 Comparative Statement of Operations 5 Comparative Statement of Cash Flows 6 Utilization Information Attachment A
3 ATRIUM HEALTH FINANCIAL HIGHLIGHTS OBLIGATED GROUP FOR THE SIX MONTHS ENDED JUNE 30, 2018 EXECUTIVE SUMMARY The consolidated financial statements and highlights presented on pages 1 through 6 reflect the financial position, results of operations, and cash flows of Atrium Health s Obligated Group (referred to as Atrium Health, formerly Carolinas HealthCare System) which includes controlled operations, divisions and health related entities (the Primary Enterprise) and its Foundation. Although there are some affiliates of the Primary Enterprise that are not part of the Obligated Group, the statements presented herein represent the Obligated Group and, because there are no designated affiliates at this time, the Combined Group in all material respects. Overview/Summary For the six months ended June 30, 2018 Atrium Health reported Earnings Before Interest, Taxes, Depreciation and Amortization (EBITDA) of $345 million or 11.1% which was $15 million above the prior year. Operating income of $141 million or 6.9% was $9 million ahead of the prior year. The improvement in EBITDA was primarily a result of improved commercial and government reimbursement. Comparative Statement of Operations-Actual versus Prior Year (pg.5) Net patient revenue was $105 million or 3.9% above the first six months of 2017 primarily due to the impact of net reimbursement increases, additional governmental payer settlements, and growth in some specific patient volumes. Bedded discharges were 0.8% greater than the prior year, although inpatient discharges were 2.3% above Outpatient surgery, endoscopy procedures, and radiology procedures experienced 0.5%, 7.7%, and 2.6% growth respectively. Emergency room visits were 2.0% below the first six months of 2017, although Medical Group urgent care and virtual visits grew 1.9%, suggesting that patients are choosing more appropriate, and affordable, care locations. Total Medical Group patient visits grew 0.2% from June 30, Governmental payer settlements and greater North Carolina Medicaid supplemental payment program revenues contributed to net patient revenue growth, but was somewhat offset by a decrease in commercial payer mix. Other operating revenue was $23 million or 8.2% above the first six months of 2017 due to growth in retail sales of specialty pharmaceuticals. Unreimbursed charges as a percent of gross revenue decreased from 8.4% at June 30, 2017 to 8.1% through the first six months of
4 Total personnel costs increased $47 million or 2.7%. Salaries growth in the first six months was primarily a result of market and performancebased salary adjustments, an increase in Medical Group providers and provider compensation, but were offset to some degree by decreases in total personnel as a result of slightly lower patient volumes, increased clinical labor productivity, and workforce efficiencies in non-clinical areas. Benefits cost increased at a higher rate than salaries, driven primarily by the impact of cumulative net actuarial investment losses on pension plan assets through the July 1, 2017 plan measurement date. Supplies expense was $34 million or 6.8% above the first six months of 2017 due primarily to increased pharmaceutical costs, higher implant volumes and routine inflationary increases. Professional fees increased $15 million or 22.5% due to increases in marketing, legal and consulting fees. Purchased services expense increased $9 million due to higher software and equipment maintenance costs and referred tests. Other operating expense was $7 million above the prior year, due to higher Medicaid supplemental payment program assessments. Comparative Balance Sheet (pg.4) The Obligated Group s total unrestricted cash position, including investments designated for capital improvements, increased approximately $125 million from March 31 due primarily to cash provided by operations ($324 million) and favorable changes in the market value of investments during the quarter ($50 million), offset by net retirements of commercial paper ($155 million) and by capital spending ($84 million). As a result, days cash on hand increased to 309 days from 304 days at March 31, Other accounts receivable decreased $47 million or 24.5% from March 31 largely due to the receipt of 2018 Medicaid supplemental payment program proceeds accrued in the first quarter ($59 million) offset by the timing of semiannual sales and use tax refunds. The $54 million increase in Investments Designated for Capital Improvements reflects $10 million of contributions and favorable changes in the market value of investments during the second quarter. Salaries and benefits payable increased $11 million or 4.0% from March 31 due to the timing of pay periods and accruals for semi-annual physician compensation payments. Other liabilities and accruals increased $27 million or 16.8% due primarily to the timing of semiannual payments made for interest on the Atrium Health s long-term debt and accruals for annual incentive pay for nonphysician teammates. Estimated third-party payer settlements increased $43 million or 23.9% primarily as a result of 2018 Medicaid supplemental payment program proceeds received in the second quarter, offset by the routine settlement of prior year cost report and third-party payer reserves. 2
5 Current portion of long-term debt decreased after Atrium Health s planned retirement of $155 million of taxable commercial paper in the second quarter. Atrium Health had $30 million of commercial paper outstanding as of June 30, Pension liability decreased $11 million or 2.9% primarily as a result of $10 million of planned contributions to the pension plan beyond actuarially determined contribution amounts during the second quarter. Comparative Statement of Cash Flows (pg.6) Net cash provided by operating activities ($278 million) provided the major source of cash for the first six months of Significant uses of cash were for the Obligated Group s capital expenditures ($183 million) and debt service ($75 million). Non-Operating Activity (pg.5) Net non-operating activity, which consists primarily of investment results, including unrealized gains and losses, was $279 million less than the six months ended June 30, The return on investments designated for capital improvements was 0.3%, compared to 7.6% for the quarter ended June 30,
6 ATRIUM HEALTH OBLIGATED GROUP COMPARATIVE BALANCE SHEET (dollars in thousands) JUNE 30, 2018 MARCH 31, 2018 $ CHANGE % CHANGE ASSETS AND DEFERRED OUTFLOWS OF RESOURCES CURRENT ASSETS Cash and Cash Equivalents $ 157,029 $ 89,801 $ 67, % Short-Term Investments 8,609 10,538 (1,929) -18.3% Patient Accounts Receivable - Net 716, ,802 (31,976) -4.3% Other Accounts Receivable 143, ,793 (46,478) -24.5% Assets Limited as to Use - Investments 35,765 32,820 2, % Inventories 66,081 66,229 (148) -0.2% Prepaid Expenses 91,239 89,917 1, % TOTAL CURRENT ASSETS $ 1,218,864 $ 1,227,900 $ (9,036) -0.7% CAPITAL ASSETS $ 6,011,567 $ 5,911,749 $ 99, % Less accumulated depreciation (2,941,302) (2,859,725) (81,577) 2.9% $ 3,070,265 $ 3,052,024 $ 18, % OTHER NONCURRENT ASSETS Assets Limited as to Use: Investments Designated for Capital Improvements $ 4,192,825 $ 4,138,362 $ 54, % Other Long-Term Investments 328, ,529 5, % Other Assets Limited as to Use - Investments 114, ,085 4, % Other Assets 224, ,979 (5,607) -2.4% TOTAL OTHER NONCURRENT ASSETS $ 4,860,281 $ 4,800,955 $ 59, % TOTAL ASSETS $ 9,149,410 $ 9,080,879 $ 68, % DEFERRED OUTFLOWS OF RESOURCES $ 235,818 $ 245,055 $ (9,237) -3.8% TOTAL ASSETS AND DEFERRED OUTFLOWS OF RESOURCES $ 9,385,228 $ 9,325,934 $ 59, % LIABILITIES, DEFERRED INFLOWS OF RESOURCES AND NET POSITION CURRENT LIABILITIES Accounts Payable $ 274,457 $ 270,457 $ 4, % Salaries and Benefits Payable 289, ,579 11, % Other Liabilities and Accruals 186, ,990 26, % Estimated Third-Party Payer Settlements 221, ,781 42, % Current Portion of Long-Term Debt 69, ,564 (154,796) -68.9% TOTAL CURRENT LIABILITIES $ 1,042,445 $ 1,112,371 $ (69,926) -6.3% LONG-TERM DEBT, less current portion $ 1,763,551 $ 1,764,491 $ (940) -0.1% OTHER LIABILITIES Commitments and Contingencies $ 100,461 $ 101,074 $ (613) -0.6% Other Liabilities 215, ,526 (1,145) -0.5% Pension Liability 360, ,741 (10,584) -2.9% Interest Rate Swap Liability 179, ,028 (8,879) -4.7% TOTAL OTHER LIABILITIES $ 855,148 $ 876,369 $ (21,221) -2.4% DEFERRED INFLOWS OF RESOURCES $ 55,120 $ 56,725 $ (1,605) -2.8% NET POSITION $ 5,668,964 $ 5,515,978 $ 152, % TOTAL LIABILITIES, DEFERRED INFLOWS OF RESOURCES AND NET POSITION $ 9,385,228 $ 9,325,934 $ 59, % The Obligated Group includes the Primary Enterprise and Atrium Health Foundation. Comparative financial statement amounts may differ from those previously reported because of subsequently available information that results in adjustments to better allocate net revenues and/or expenses to the appropriate period within a fiscal year or because of adjustments that are made to conform to the 2018 presentation. Thus, certain March 31, 2018 balance sheet amounts as well as certain six months ended June 30, 2017 statement of operations and statement of cash flows amounts previously reported were accordingly adjusted. 4
7 ATRIUM HEALTH OBLIGATED GROUP COMPARATIVE STATEMENT OF OPERATIONS FOR THE SIX MONTHS ENDED JUNE 30, 2018 (dollars in thousands) $ CHANGE % CHANGE REVENUE Net Patient Revenue $ 2,803,006 $ 2,697,697 $ 105, % Other Operating Revenue 299, ,907 22, % NET OPERATING REVENUE $ 3,102,738 $ 2,974,604 $ 128, % OPERATING EXPENSES Salaries and Wages $ 1,410,894 $ 1,379,240 $ 31, % Benefits 357, ,977 15, % TOTAL PERSONNEL $ 1,768,250 $ 1,721,217 $ 47, % Supplies $ 537,373 $ 503,131 $ 34, % Professional Fees 79,255 64,699 14, % Purchased Services 212, ,588 9, % Utilities 33,219 31,472 1, % Other Operating Expense 126, ,060 6, % TOTAL PERSONNEL AND OTHER EXPENSES $ 2,757,775 $ 2,644,167 $ 113, % EARNINGS BEFORE INTEREST, TAXES, DEPRECIATION AND AMORTIZATION $ 344,963 $ 330,437 $ 14, % Depreciation and Amortization $ 165,093 $ 158,943 $ 6, % Interest Expense 38,330 39,129 (799) -2.0% TOTAL OPERATING EXPENSE $ 2,961,198 $ 2,842,239 $ 118, % OPERATING INCOME $ 141,540 $ 132,365 $ 9, % NON-OPERATING INCOME Interest and dividend income $ 31,278 $ 21,031 $ 10, % Net (decrease) increase in the fair value of investments (19,600) 270,001 (289,601) % Other, net (7) (116) % TOTAL NON-OPERATING INCOME $ 11,671 $ 290,916 $ (279,245) -96.0% NET INCOME $ 153,211 $ 423,281 $ (270,070) -63.8% The Obligated Group includes the Primary Enterprise and Atrium Health Foundation Comparative financial statement amounts may differ from those previously reported because of subsequently available information that results in adjustments to better allocate net revenues and/or expenses to the appropriate period within a fiscal year or because of adjustments that are made to conform to the 2018 presentation. Thus, certain March 31, 2018 balance sheet amounts as well as certain six months ended June 30, 2017 statement of operations and statement of cash flows amounts previously reported were accordingly adjusted. 5
8 ATRIUM HEALTH OBLIGATED GROUP COMPARATIVE STATEMENT OF CASH FLOWS FOR THE SIX MONTHS ENDED JUNE 30, (dollars in thousands) Cash flows from operating activities: Receipts from patients and third party payers $ 2,860,877 $ 2,680,557 Payments to suppliers for goods and services (1,003,582) (920,203) Payments to employees for services (1,848,185) (1,845,100) Receipts from others, net 268, ,028 Net cash provided by operating activities $ 277,721 $ 201,282 Noncapital financing activities Proceeds from the issuance of commercial paper 210, ,000 Retirements of commercial paper (210,000) (135,000) Other activities (1,113) (627) Net cash used in noncapital financing activities $ (1,113) $ (627) Cash flows from capital and related financing activities: Purchase of capital assets, net $ (182,729) $ (136,694) Donated funds designated for building and equipment purchases 6,603 5,274 Principal payments, refunding and retirements on short- and long-term debt (32,833) (31,828) Interest payments on short- and long-term debt (41,844) (39,679) Decrease in other assets affecting capital and related financing activities 8, Other contributions 6, Net cash used in capital and related financing activities $ (235,470) $ (201,489) Cash flows from investing activities: Withdrawal from investments limited as to use $ - $ 6,000 Contribution to investments limited as to use (17,537) (2,500) Investment earnings 2,405 3,428 (Increase) decrease in other trusteed assets (2,985) 251 (Purchase) sale of investments (2,191) (2,470) Net cash (used in) provided by investing activities $ (20,308) $ 4,709 Increase in cash and cash equivalents $ 20,830 $ 3,875 Cash and cash equivalents, beginning of year 136, ,411 Cash and cash equivalents, end of year $ 157,029 $ 151,286 Reconciliation of operating income to net cash provided by operating activities: Operating income $ 141,540 $ 132,365 Interest expense considered capital financing activity 38,330 39,129 Adjustments to reconcile operating income to net cash provided by operating activities: Depreciation and amortization 165, ,943 Decrease (increase) in patient account receivables, net 12,338 (32,659) (Increase) decrease in inventories and other current assets (66,706) 11,772 (Increase) decrease in other assets affecting operating activities (3,206) 6,995 Decrease accounts payable and other current liabilities (39,781) (136,364) Decrease in other liabilities affecting operating activities (14,815) (12,817) Increase in estimated third party payer settlements 44,928 33,918 Net cash provided by operating activities $ 277,721 $ 201,282 The Obligated Group includes the Primary Enterprise and Atrium Health Foundation Comparative financial statement amounts may differ from those previously reported because of subsequently available information that results in adjustments to better allocate net revenues and/or expenses to the appropriate period within a fiscal year or because of adjustments that are made to conform to the 2018 presentation. Thus, certain March 31, 2018 balance sheet amounts as well as certain six months ended June 30, 2017 statement of operations and statement of cash flows amounts previously reported were accordingly adjusted. 6
9 ATTACHMENT A The Charlotte-Mecklenburg Hospital Authority d/b/a Atrium Health Utilization Information For the Six Months Ended June 30, 2018
10 The table below summarizes certain information concerning utilization of the Obligated Group's physician services group and principal inpatient facilities during the six months ended June 30, 2018 and Summary Utilization Information Six Months Ended June 30, Medical Group (1)(2) Practice locations Total Physicians 1,794 1,746 Patient visits (including faculty) 3,032,706 3,037,818 Total Acute Care Facilities Adjusted patient days (excluding newborn) (3) 750, ,445 Adjusted discharges (excluding newborn) (3) 158, ,570 Surgical Procedures (8) (9) (11) 48,900 49,135 Carolinas Medical Center and Levine Children's Hospital Licensed beds (4) Beds in service (4) Average daily census Percentage occupancy of licensed beds (4) 83.3% 83.0% Percentage occupancy of beds in service (4) 83.3% 83.0% Patient days (excluding newborn) 136, ,179 Adjusted patient days (excluding newborn) (3) 271, ,983 Average length of stay (days) Discharges (excluding newborn) 22,216 22,361 Adjusted discharges (excluding newborn) (3) 44,183 44,496 Emergency room visits 63,107 65,470 Surgical procedures 16,589 17,012 Newborn deliveries 3,320 3,438 Carolinas Medical Center - Mercy (5) Licensed beds Beds in service Average daily census Percentage occupancy of licensed beds 64.9% 59.9% Percentage occupancy of beds in service 64.9% 59.9% Patient days 24,307 22,442 Adjusted patient days (excluding newborn) 44,158 40,431 Average length of stay (days) Discharges (excluding newborn) 6,298 6,025 Adjusted discharges (excluding newborn) 11,442 10,854 Emergency room visits 17,735 18,805 Surgical procedures 5,751 5,577 Carolinas HealthCare System NorthEast Licensed beds Beds in service Average daily census Percentage occupancy of licensed beds 67.0% 62.2% Percentage occupancy of beds in service 67.3% 62.5% Patient days (excluding newborn) 55,416 51,478 Adjusted patient days (excluding newborn) (3) 116, ,485 Average length of stay (days) Discharges (excluding newborn) 11,448 11,227 Adjusted discharges (excluding newborn) (3) 24,085 24,532 Emergency room visits 61,364 61,512 Surgical procedures (6) 5,795 6,153 Newborn deliveries 1,330 1,423 Carolinas HealthCare System Pineville (7) Licensed beds Beds in service Average daily census Percentage occupancy of licensed beds 91.2% 87.3% Percentage occupancy of beds in service 91.2% 87.3% Patient days (excluding newborn) 38,778 37,116 Adjusted patient days (excluding newborn) (3) 81,857 79,143 Average length of stay (days) Discharges (excluding newborn) 8,771 8,505 Adjusted discharges (excluding newborn) (3) 18,515 18,135 Emergency room visits 48,529 50,554 Surgical procedures (8) 5,536 5,430 Newborn deliveries 1,108 1,117 Page 1 of 5
11 Summary Utilization Information Six Months Ended June 30, Carolinas HealthCare System Cleveland Licensed beds Beds in service Average daily census Percentage occupancy of licensed beds 38.4% 34.0% Percentage occupancy of beds in service 57.6% 50.9% Patient days (excluding newborn) 16,771 14,838 Adjusted patient days (excluding newborn) 47,694 44,592 Average length of stay (days) Discharges (excluding newborn) 4,246 3,616 Adjusted discharges (excluding newborn) 12,075 10,867 Emergency room visits 33,836 34,901 Surgical procedures (9) 3,407 3,488 Newborn deliveries Carolinas HealthCare System Union Licensed beds (10) Beds in service (10) Average daily census Percentage occupancy of licensed beds (10) 51.1% 51.7% Percentage occupancy of beds in service (10) 57.7% 56.4% Patient days (excluding newborn) 16,842 16,551 Adjusted patient days (excluding newborn) (3) 51,575 48,937 Average length of stay (days) Discharges (excluding newborn) 4,479 4,439 Adjusted discharges (excluding newborn) (3) 13,716 13,125 Emergency room visits 40,375 40,215 Surgical procedures (11) 4,516 4,543 Newborn deliveries Carolinas HealthCare System University Licensed beds Beds in service Average daily census Percentage occupancy of licensed beds 75.8% 65.7% Percentage occupancy of beds in service 75.8% 65.7% Patient days (excluding newborn) 13,711 11,889 Adjusted patient days (excluding newborn) (3) 52,204 47,655 Average length of stay (days) Discharges (excluding newborn) 3,510 3,127 Adjusted discharges (excluding newborn) (3) 13,364 12,534 Emergency room visits 49,132 49,513 Surgical procedures 4,328 3,980 Newborn deliveries Carolinas HealthCare System Kings Mountain Licensed beds Beds in service Average daily census Percentage occupancy of licensed beds 50.6% 55.2% Percentage occupancy of beds in service 61.6% 62.7% Patient days (excluding newborn) 6,132 6,696 Adjusted patient days (excluding newborn) 22,588 22,617 Average length of stay (days) Discharges (excluding newborn) 1,321 1,408 Adjusted discharges (excluding newborn) 4,866 4,756 Emergency room visits 17,138 18,056 Surgical procedures Page 2 of 5
12 Summary Utilization Information Six Months Ended June 30, Carolinas HealthCare System Lincoln Licensed beds Beds in service Average daily census Percentage occupancy of licensed beds 53.2% 44.6% Percentage occupancy of beds in service 53.2% 44.6% Patient days (excluding newborn) 9,725 8,162 Adjusted patient days (excluding newborn) 31,686 26,669 Average length of stay (days) Discharges (excluding newborn) 2,298 2,221 Adjusted discharges (excluding newborn) 7,487 7,257 Emergency room visits 22,871 23,165 Surgical procedures 1,395 1,471 Newborn deliveries Carolinas HealthCare System Stanly Licensed beds Beds in service Average daily census Percentage occupancy of licensed beds 39.1% 40.5% Percentage occupancy of beds in service 45.4% 47.0% Patient days (excluding newborn) 7,716 7,994 Adjusted patient days (excluding newborn) 25,405 26,220 Average length of stay (days) Discharges (excluding newborn) 1,914 2,089 Adjusted discharges (excluding newborn) 6,302 6,852 Emergency room visits 16,085 15,919 Surgical procedures 1,091 1,099 Newborn deliveries Carolinas HealthCare System Anson Licensed beds Beds in service Average daily census Percentage occupancy of licensed beds 12.2% 7.1% Percentage occupancy of beds in service 12.2% 7.1% Patient days (excluding newborn) Adjusted patient days (excluding newborn) 5,124 4,713 Average length of stay (days) Discharges (excluding newborn) Adjusted discharges (excluding newborn) 2,330 2,162 Emergency room visits 7,859 7,531 Surgical procedures 21 6 Carolinas Rehabilitation - Charlotte, Mount Holly, and NorthEast (12) Licensed beds (13) Beds in service (13) Average daily census Percentage occupancy of licensed beds (13) 80.5% 77.8% Percentage occupancy of beds in service (13) 80.5% 77.8% Patient days 21,854 21,533 Adjusted patient days 27,996 27,571 Average length of stay (days) Discharges 1,385 1,404 Behavioral Health Centers (14) Licensed beds (15) Beds in service (15) Average daily census Percentage occupancy of licensed beds (15) 94.6% 90.2% Percentage occupancy of beds in service (15) 95.7% 94.6% Patient days 22,608 22,204 Adjusted patient days 37,564 40,934 Average length of stay (days) Discharges 2,501 2,457 Page 3 of 5
13 Six Months Ended June 30, Nursing Centers (16) Licensed beds Average daily census Percentage occupancy of licensed beds 84.7% 89.3% Patient days 89,261 94,089 (1) Includes physician practices that are owned, managed or staffed by the Medical Group. (2) Certain statistics for the six months ended June 30, 2017 have been restated to be comparable with the six months ended June 30, (3) Adjusted patient days and adjusted discharges for the acute care facilities includes utilization in joint ventures in which the Obligated Group has an ownership interest, based on the percentage of ownership in such joint venture. (4) Licensed beds and beds in service for Carolinas Medical Center for the six months ended June 30, 2018 and 2017 reflect the weighted average of a temporary increase of 80 licensed beds due to high census effective August 30, 2010, set to expire August 31, (5) (6) (7) (8) (9) (10) (11) (12) (13) Summary Utilization Information Carolinas Medical Center - Mercy is a facility of Carolinas Medical Center. Inpatient surgical procedures for Carolinas HealthCare System NorthEast for the six months ended June 30, 2018 and 2017 have been restated to be consistent with other acute care facilities. Includes 29-bed CHS Rehabilitation, a facility of Carolinas HealthCare System Pineville. Includes surgeries at Carolina Orthopedic Surgery Associates. Surgical procedures for the six months ended June 30, 2017 has been restated to be comparable with the surgical procedures for the six months ended June 30, Includes surgeries at Cleveland Ambulatory Services. Licensed beds and beds in service for Carolinas HealthCare System Union for the six months ended June 30, 2018 reflect the weighted average of a permanent increase of 7 licensed beds effective May 1, Includes surgeries at Union West Surgery Center. Includes Carolinas Rehabilitation-Charlotte, Carolinas Rehabilitation-Mount Holly, and Carolinas Rehabilitation-NorthEast. Licensed beds and beds in service for Carolinas Rehabilitation for the six months ended June 30, 2018 and 2017 reflect the weighted average of a temporary increase of 7 licensed beds at Carolinas Rehabilitation - Charlotte effective December 11, 2013, which was set to expire January 27, 2016, was extended through March 31, 2017, and expired March 31, (14) Includes Carolinas HealthCare System Behavioral Health - Charlotte and Carolinas HealthCare System Behavioral Health - Davidson, both facilities of Carolinas Medical Center. Separate utilization information for these facilities is available upon request. (15) Licensed beds and beds in service for Behavioral Health Centers for the six months ended June 30, 2018 reflect the weighted average of a permanent reduction of 4 licensed beds. First Step Behavioral Health, which was operated as part of Carolinas HealthCare System Union, returned their 4 licensed beds to the state effective July 24, (16) Includes Huntersville Oaks, Sardis Oaks, Cleveland Pines, Jesse Helms Nursing Center, and Stanly Manor. Separate utilization information for these facilities is available upon request. Page 4 of 5
14 The table below summarizes the surgical procedures performed at ambulatory surgery centers operated by joint ventures in which the Obligated Group has a membership interest. None of the joint venture entities in the table are a member of the Obligated Group. (1) Summary Utilization Information Six Months Ended June 30, Carolina Center for Specialty Surgery (1) 1,274 1,241 Gateway Ambulatory Surgery Center, LLC (1) 3,135 3,265 TOTAL 4,409 4,506 Total surgical procedures for the six months ended June 30, 2018 and 2017 have been restated to be consistent with the definition of surgeries at the other acute care facilities. Page 5 of 5
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