MANAGEMENT'S DISCUSSION AND ANALYSIS AND BASIC FINANCIAL STATEMENTS

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1 MANAGEMENT'S DISCUSSION AND ANALYSIS AND BASIC FINANCIAL STATEMENTS West Jefferson Medical Center Years ended December 31,2004 and 2003 Under provisions of state law. this report is a public document, Acopy of the report has been submitted to the entity and other appropriate public officials. The report is available for public inspection at the Baton Rouge office of the Legislative Auditor and, where appropriate, at the office of the arish clerk of court. Release

2 West Jefferson Medical Center Management's Discussion and Analysis and Basic Financial Statements Years ended December 31,2004 and 2003 Contents Report of Independent Auditors 1 Management's Discussion and Analysis 3 Basic Financial Statements Balance Sheets 24 Statements of Revenues, Expenses, and Changes in Net Assets 26 Statements of Cash Flows 27 Notes to Basic Financial Statements 28

3 HI ERNST &YOUNG ERNST & YOUNG LLf» 701 Poydras Street New Orleans Louisiana * 04j fax: S5Q4J Report of Independent Auditors The Board of Directors West Jefferson Medical Center We have audited the accompanying financial statements of West Jefferson Medical Center (the "Medical Center") as of and for the years ended December 31, 2004 and These financial statements are the responsibility of the Medical Center's management. Our responsibility is to express an opinion on these financial statements based on our audits. We conducted our audits in accordance with auditing standards generally accepted in the United States and the standards applicable to financial audits contained in Government Auditing Standards, issued by the Comptroller General of the United States. Those standards require that we plan and perform the audit to obtain reasonable assurance about whether the financial statements are free of material misstatement. We were not engaged to perform an audit of the Medical Center's internal control over financial reporting. Our audits included consideration of internal control over financial reporting as a basis for designing audit procedures that are appropriate in the circumstances, but not for the purpose of expressing an opinion on the effectiveness of the Medical Center's internal control over financial reporting. Accordingly, we express no such opinion. An audit also includes examining, on a test basis, evidence supporting the amounts and disclosures in the financial statements, assessing the accounting principles used and significant estimates made by management, and evaluating the overall financial statement presentation. We believe that our audits provide a reasonable basis for our opinion. In our opinion, the financial statements referred to above present fairly, in all material respects, the financial position of the Medical Center at December 31, 2004 and 2003, and the results of its operations and its cash flows for the years then ended, in conformity with accounting principles generally accepted in the United States. In accordance with Government Auditing Standards, we have also issued our report dated April 1, 2005 on our consideration of the Medical Center's internal control over financial reporting and on our tests of its compliance with certain provisions of laws, regulations, contracts, grant agreements and other matters. The purpose of that report is to describe the scope of our testing of internal control over financial reporting and compliance and the results of that testing, and not to provide an opinion on the internal control over financial reporting or on compliance. That report is an integral part of an audit performed in accordance with Government Auditing Standards and should be considered in assessing the results of our audit. A Member Practice of Ernst & Young Global

4 The management's discussion and analysis on pages 3 through 23 is not a required part of the basic financial statements but is supplementary information required by the Governmental Accounting Standards Board. We have applied certain limited procedures, which consisted principally of inquiries of management regarding the methods of measurement and presentation of the required supplementary information. However, we did not audit the information and express no opinion on it. April 1,2005

5 West Jefferson Medical Center Management's Discussion and Analysis December 31,2004 This section of West Jefferson Medical Center's (the "Medical Center") annual financial report provides important background information and management's analysis of the Medical Center's financial performance during the year ended December 31, Please read this section in conjunction with the basic financial statements beginning on page 24 and the notes to the basic financial statements beginning on page 28 in this report. Required Financial Statements The Basic Financial Statements in this report are presented using Governmental Accounting Standards Board ("GASB") accounting principles. These financial statements offer short-term and long-term financial information about the Medical Center's activities. The balance sheets include all of the Medical Center's assets and liabilities and provide information about the nature and amounts of investments in resources (assets) and the obligations to Medical Center creditors (liabilities). They also provide the basis for computing rate of return, evaluating the capital structure of the Medical Center, and assessing the liquidity and financial flexibility of the Medical Center. All of the current year's revenues and expenses are accounted for in the statements of revenues, expenses, and changes in net assets. These statements measure changes in the Medical Center's operations over the current and prior year and can be used to determine whether the Medical Center has been able to recover all of its costs through its patient service revenue and other revenue sources. The final required financial statement is the statement of cash flows. The primary purpose of this statement is to provide information about the Medical Center's cash from operating, investing, and financing activities and provide answers to such questions as where did cash come from, what was cash used for, and what was the change in cash balance during the reporting period. Financial Analysis of the Medical Center The balance sheets and the statements of revenues, expenses, and changes in net assets report information about the Medical Center's activities. Increases or decreases in the Medical Center's net assets are one indicator of whether its financial health is improving or deteriorating. However, other nonfinancial factors such as changes in the health care industry, changes in Medicare and Medicaid regulations, and changes in managed care contracting should also be considered. A Member Practice of Ernst & Young Global 3

6 West Jefferson Medical Center Management's Discussion and Analysis (continued) December 31,2004 Financial Highlights for the Year Ended December 31, 2004 The following summarizes the Medical Center's financial highlights for the year ended December 31,2004: The Medical Center generated cash from operations of $21.8 million during the year ended December 31, Investments in property and equipment totaled $21.6 million. During 2004, the Medical Center issued bonds in the amount of $124.9 million and made principal repayments of $49.8 million. The Medical Center reported an increase in net patient service revenue of $10.8 million in This was a 6% increase compared to The increase was primarily driven by volume increases in Balance Sheets A summary of the Medical Center's balance sheets is presented in Table 1 below: TABLE 1 Condensed Balance Sheets December (OOOs Omitted) Dollar Change Percent Change Total current assets Property, plant, and equipment, net Board-designated investments Trustee-held assets Other assets Total assets Current liabilities Long-term debt and other long-term liabilities Total liabilities $ $ s 67, , ,706 69,913 7, ^06 32, , ,965 $ 68,211 Si (259) 131, ,747 17,744 3,920 7,358 16,959 52,169 3,695 S 322,284 3I 79,922 $ 28, , ,666 73, ,399 77,566 -% 6% 17% 294% 94% 25% 14% 67% 56% Net assets Total liabilities and net assets $ 186, , ,885 2,356 $ 322, ,922 1% 25% During 2004, the Medical Center's total assets increased by approximately $80 million (or approximately 25%) to $402 million.

7 West Jefferson Medical Center Management's Discussion and Analysis (continued) December 31,2004 Property, Plant, and Equipment The following table presents the components of property, plant, and equipment at December 31,2004 and TABLE 2 Property, Plant, and Equipment December 31 Dollar Percent Change Change (OOOs Omitted) Land and land improvements $ 17,142 $ 14,696 $ 2,446 17% Building and fixed equipment 143, ,178 4,454 3% Equipment 151, ,656 12,448 9% Subtotal 311, ,530 19,348 7% Less accumulated depreciation (182,256) (168,977) (13,279) (8)% Construction in progress 9,398 8,109 1,289 16% Property, plant, and equipment, net S 139,020 S 131,662 $ 7,358 6% Property, plant, and equipment increased approximately $7.4 million, or 6%, in 2004 as the Medical Center continued to enhance existing facilities. In addition, $0.8 million of assets, consisting primarily of land, was donated to the Medical Center by West Jefferson Service Corporation. Construction in progress increased approximately $1.3 million, or 16%, as the Medical Center began construction on its new Support Services Facility, scheduled for completion in the first quarter of Major projects funded or completed in 2004 included the following: The Neurosciences Stroke Center, which opened in September 2004; The Sleep Center, which opened in the West Jefferson Medical Plaza in November 2004; Relocation of Outpatient Rehab, which opened in August 2004, to the West Jefferson Medical Plaza; Construction of the CT Scan joint venture facility, which opened in August 2004, in the West Jefferson Medical Plaza;

8 West Jefferson Medical Center Management's Discussion and Analysis (continued) December 31,2004 Construction of the Support Services Facility scheduled for completion in the first quarter of 2006; Completion of the new Child Care Education Center, which opened in June 2004; Renovation of suites in the Physician Office Buildings; and Clinical and health information software applications. In Table 3, the Medical Center's fiscal year 2005 capital budget projects spending of up to $34.3 million for capital projects (excluding those projects approved in prior years). These projects will be financed primarily from the 2004A bond issue and funds generated from operations. More information about the Medical Center's capital assets is presented in the Notes to the Basic Financial Statements. Long-Term Debt TABLE 3 Fiscal Year 2005 Capital Budget Equipment purchases $ 12,186,500 Construction/renovation 22,114,500 Prior year approved items 1,343,000 Total $ 35,644,000 At year end, the Medical Center had $186.9 million in debt. Total debt increased in the current year by approximately $124.9 million due to the issuance of new bonds. This was offset by a decrease of approximately $49.8 million due to principal payments and the refunding of the 1993 bonds using the 2004B bond proceeds. More detailed information about the Medical Center's long-term liabilities is presented in the Notes to Basic Financial Statements. Total debt outstanding represents approximately 46% of the Medical Center's total assets at December 31, 2004, compared to approximately 35% in the prior year.

9 West Jefferson Medical Center Management's Discussion and Analysis (continued) December 31,2004 Net Assets The following table presents the components of the Medical Center's net assets at December 31, 2004 and TABLE 4 Components of Net Assets Invested capital assets, net of related debt Restricted Unrestricted Total net assets $ $ December (OOOs Omitted) Dollar Change 3,467 $ 1 19, (15,751) 18, ,183 17, , , ,241 S; 183,885 S1 2,356 Percentage Change (82)% 5% 12% 1% Net assets increased $2.4 million during 2004, indicating an overall improvement in financial condition. Refer to Table 5 and the pages that follow Table 5 for a discussion of operations.

10 West Jefferson Medical Center Management's Discussion and Analysis (continued) December 31,2004 Statements of Revenues and Expenses The following table presents a summary of the Medical Center's revenues and expenses for the years ended December 31, 2004 and TABLES Condensed Statements of Revenues and Expenses Operating revenue: Net patient service revenue Other operating revenue Total operating revenue Year ended December 31 Dollar Percent Change Change (OOOs Omitted) 181,513 9, ,490 $ 170,724 7, ,536 10,789 2,165 12,954 6% 28% 7% Operating expenses: Salaries, wages, and employee benefits Professional fees, medical and general supplies, and purchased services Other expenses Depreciation Interest expense, net Total operating expenses 89,757 69,090 12,280 14,107 4, ,567 84,343 68,800 9,333 12,394 4, ,606 5, ,947 1,713 (403) 9,961 6% 32% 14% (9)% 6% Income (loss) from operations Investment income, net, and other nonoperating income and expenses Revenues in excess of expenses Assessments by Jefferson Parish Change in net assets 1,923 1, (1,032) $ 2,356 $ (1,070) 6,647 5,577 (1,030) 4,547 $ 2,993 (5,182) (2,189) (2) (2,191) 280% (78)% (39)% -% (48)% Net Patient Service Revenue The Medical Center derived approximately 95% of its total operating revenue from patient services in fiscal year 2004, which was consistent with the prior year. The Medical Center's revenue is generated from services provided to patients drawn primarily

11 West Jefferson Medical Center Management's Discussion and Analysis (continued) December 31,2004 from communities located on the west bank of the Mississippi River in the Greater New Orleans area. Patient service revenue is generated by providing services to patients who are covered by Medicare, Medicaid, or managed care contracts, as well as by providing services to self-pay and indigent patients. Table 6 below presents the relative percentages of gross charges billed for patient services by payer for the fiscal years ended December 31, 2004 and Reimbursements to the Medical Center are made on behalf of patients by the federal and state governments under the Medicare and Medicaid programs, respectively, by commercial insurance carriers and health maintenance organizations, as well as by other patients on their own behalf The difference between the covered charges and the payments under government programs and established contracts is recognized as a contractual allowance. See Table 7 for a summary of allowances. TABLE 6 Payer Mix Year ended December Managed care/commercial 33% 33% Medicare Medicare HMO 9 9 Medicaid Self-pay and other Total patient revenues 100% 100% The following table presents the contractual allowances on gross billings by payer and the provision for doubtful accounts.

12 West Jefferson Medical Center Management's Discussion and Analysis (continued) December 31,2004 TABLE 7 Allowance Summary Contractual allowances: Managed care and commercial accounts Medicaid contractual allowances Medicare contractual allowances Other adjustments Total contractual allowances Doubtful accounts Year ended December (OOOs Omitted) $ 184,720 $ 73, ,907 17, ,258 32, ,544 58, ,788 14, ,988 25,936 $ 454,419 $ 403,924 Other Operating Revenue Other operating revenue includes income primarily generated by rent receipts from the Medical Center's professional office buildings and Medical Plaza as well as income from other miscellaneous services, such as its fitness centers and Alzheimer's day care services. Investment Income The Medical Center maintains investments that are shown in its Balance Sheets as both board-designated and restricted trustee-held funds. These funds are invested primarily in money market funds and securities issued by the U.S. Treasury and other federal agencies. Operating Revenue This discussion refers to the summarized activity presented in the Medical Center's Condensed Statements of Revenues and Expenses on page 8 for 2004 and Overall, net patient service revenue increased by approximately $10.8 million, or 6%, for fiscal year 2004 when compared to the prior year. The increase is primarily due to increases in volume as well as increases in rates paid by managed care payers. Inpatient gross revenue grew by approximately 6% in 2004 compared to the prior year after taking into consideration the prior year's increase in customary charges. This 10

13 West Jefferson Medical Center Management's Discussion and Analysis (continued) December 31,2004 increase in gross inpatient revenue resulted primarily from volume increases as well as slight increases in case mix index and average length of stay. Total inpatient admissions grew by approximately 2% to 16,796 admissions in General acute patient admissions increased by 4% to 14,789 in the current year. Total patient days increased by approximately 3% to 85,967 while general acute patient days increased by 5% to 68,125 patient days compared to the prior year. In addition, total average daily census increased by 2% to compared to Outpatient gross revenue was consistent in 2004 with the prior year after taking into consideration the prior year's increase in customary charges. Total outpatient units of service, excluding clinic operations and pharmacy outpatient units dispensed, increased by 1% in 2004 compared to the prior year. Clinic visits in 2004 of 68,618 were down 585 visits, or less than 1%, compared to prior year visits of 69,203. Included in the prior year total were 1,751 visits for a clinic that closed in early Comparing clinics in operation for all of 2004 and 2003 showed overall clinic visits up approximately 1% in Operating Expenses Salaries, wages, and employee benefits expenses increased approximately $5.4 million, or 6%, in 2004 when compared to the prior year. Salaries and wages expense increased by $6.3 million, or 9%, in the current year primarily due to the resumption of the merit and market increase programs which were deferred in 2003 as part of the plan to reduce overall operating expenses. In addition, the Medical Center experienced an increase of approximately 3% in full-time equivalent employees ("FTEs") paid in 2004 compared to the prior year. Employee group health insurance expense decreased by $2.2 million, or 31%, in the current year compared to 2003 primarily due to an overall decrease in the severity of covered claims. Also contributing to the increase in employee benefits was a $0.4 million increase in payroll taxes, primarily due to the increase in salaries noted above, as well as a $0.4 million increase in pension expense due to an increase in the actuarially determined pension expense in the current year. Professional fees, medical and general supplies, and purchased services in total were consistent with the prior year. 11

14 West Jefferson Medical Center Management's Discussion and Analysis (continued) December 31,2004 Viewing the components separately, professional fees decreased by approximately $1.0 million, or 10%, compared to the prior year. The decrease is primarily due to reductions in anesthesia and pediatric emergency room physician professional fees which were partially offset by an increase in emergency room physician professional fees. Medical and general supplies expense increased approximately $1.7 million, or 5%, over the prior year. The increase is primarily due to drug costs increasing by $1.2 million as a result of higher volume as well as the cost of newer drugs that replaced older drugs. Also contributing to the increase was a $0.3 million increase in blood supply expense primarily due to patient acuity. Purchased services decreased overall by approximately $0.4 million, or 2%, compared to the prior year primarily due to decreased consulting and management costs, lower collection services expenses and decreased medical purchased services. Decreases were also noted in management services costs and maintenance contracts expenses as well as decreases in expenses in the purchased services account. These decreases were partially offset by increases in contract labor costs and computer software maintenance costs. The changes in each separate component of purchased services are discussed below. Consulting and management costs decreased by $0.6 million compared to the prior year due to lower costs incurred on the project to review operating expenses for cost-saving opportunities, begun in 2003, which was completed in early Collection services expenses decreased by $0.4 million in the current year primarily due to renegotiated collection rates. In addition, process improvements resulted in accounts being referred for collection more timely which reduces overall collection expenses. Medical purchased services expenses decreased by $0.3 million due to lower physician coverage costs experienced in several departments. Management services costs and maintenance contract expenses decreased a combined $0.5 million due to lower costs incurred on the Medical Center's bio-medical services and equipment maintenance contracts. Costs recorded in the purchased services account decreased by $0.3 million primarily due to $1.0 million of linen expense recorded as purchased services in the prior year which was recorded in other expenses in the current year. In addition, the decrease in the current year is due to lower costs incurred for contract services in the Medical Center's Health Center Sports Therapy department. These decreases were partially offset by increased purchased service expenses incurred in the Emergency Department's Air Care service, Health Information, Dietary and Information Technology departments. 12

15 West Jefferson Medical Center Management's Discussion and Analysis (continued) December 31,2004 Partially offsetting the overall the decrease in purchased services expenses noted above were contract labor increases of $1.1 million, primarily due to nurse staffing requirements, as well as an increase of $0.6 million in software maintenance costs. Software maintenance costs increased primarily due to maintenance contract costs incurred on newer clinical and information technology software implemented to improve operating efficiencies. Other expenses increased by $2.9 million, or 32%, compared to the prior year primarily due to the $1.0 million in linen expenses in 2004 which, as noted above, were recorded as part of purchased services in The increase in other expenses also resulted from increases in equipment rental costs, advertising expenses and utilities costs. Equipment rental costs increased by $0.7 million primarily due to a full year of computer leasing expenses recorded in 2004 compared to six months recorded in the prior year at the inception of the lease. In addition, 2004 equipment rental expense includes a full year of hyperbaric equipment rent expense compared to six months in the prior year as the Medical Center's hyperbaric facility opened in June Advertising expenses increased by $0.2 million in the current year while overall utilities expenses increased by $0.2 million. The increases in other expenses noted above were partially offset by combined decreases of $0.4 million primarily in professional liability insurance and telecommunications expenses. Depreciation expense increased by $1.7 million, or 14%, over the prior year due to additions to the Medical Center's property, plant, and equipment. Interest expense, net of interest income from bond fund investments, decreased by $0.4 million, or 9%, primarily due to reduced interest expense of $0.8 million on the Series 1993 Revenue Bonds which were refunded by the Series 2004B Revenue Refunding Bonds in August Partially offsetting the decrease in interest expense on the Series 1993 Revenue Bonds was interest expense incurred on the Series 2004B Bonds as well as the Series 2004A Revenue Bonds. The Series 2004A Revenue Bonds transaction was completed in December Also partially offsetting the decrease in interest expense was lower bond interest income earned in 2004 compared to the prior year. 13

16 West Jefferson Medical Center Management's Discussion and Analysis (continued) December 31,2004 Financial Highlights for the Year Ended December 31,2003 Balance Sheets A summary of the Medical Center's balance sheets is presented in Table 8 below: TABLES Condensed Balance Sheets December (OOOs Omitted) Dollar Change Percent Change Total current assets Property, plant, and equipment, net Board-designated investments Trustee-held assets Other assets Total assets $ $ 68, , ,747 17,744 3, ,284 $ 66,461 : $ 1, , ,042 21,641 3,644 16,459 (18,295) (3,897) 276 $ 325,991! $ (3,707) 3% 14% (15)% (18)% 8% (1)% Current liabilities Long-term debt and other long-term liabilities Total liabilities $ 28, , $ 30,366! $ (1,633) 1 16, ,650 (6,618) (8,251) (5)% (6)% (6)% Net assets Total liabilities and net assets $ 183, , ,341 4,544 $ 325,991! $ (3,707) 3% (1)% During 2003, the Medical Center's total assets decreased by approximately $3.7 million (or approximately 1%) to $322.3 million. 14

17 West Jefferson Medical Center Management's Discussion and Analysis (continued) December 31,2004 Property, Plant, and Equipment The following table presents the components of property, plant, and equipment at December 31, 2003 and TABLE 9 Property, Plant, and Equipment December 31 Dollar Percent Change Change (OOOs Omitted) Land and land improvements Building and fixed equipment Equipment Subtotal Less accumulated depreciation Construction in progress Property, plant, and equipment, net $ 14,696 $ 8,783 $ 5,913 67% 139, , ,530 (168,977) 8, , , ,148 (156,953) 19,008 18,170 15,299 39,382 (12,024) (10,899) 15% 12% 16% (8)% (57)% $ 131,662 SE 115,203! E 16,459 14% Property, plant, and equipment increased approximately $16.5 million, or 14%, in 2003 as the Medical Center continued to enhance existing facilities. In addition, $5.1 million of assets, consisting primarily of land, was donated to the Medical Center by West Jefferson Service Corporation. Construction in progress decreased approximately $10.9 million, or 57%, as work on major projects was completed and capitalized in Major projects funded or completed in 2003 included the following: The new Oakwood Wellness Center which opened in July 2003; The new Hyperbaric Treatment Center which opened in June 2003; Construction of the new Child Care Education Center scheduled to open in 2004; Renovation of the cafeteria and vending area; Relocation of the Elder Plus office; Construction of the ambulatory surgery joint venture which opened in January 2003; and Renovation of suites in the Physician Office Buildings. In Table 10, the Medical Center's fiscal year 2004 capital budget projects spending of up to $15.8 million for capital projects (excluding those projects approved in prior years). These projects will be financed primarily from board-designated assets, with the 15

18 West Jefferson Medical Center Management's Discussion and Analysis (continued) December 31,2004 remaining funds from the 1998 bond offering and funds generated from operations. More information about the Medical Center's capital assets is presented in the notes to the basic financial statements. Long-Term Debt TABLE 10 Fiscal Year 2004 Capital Budget Equipment purchases $ 10,757,000 Construction/renovation 5,043,000 Prior year approved items 13,685,000 Total $ 29,485,000 At year end, the Medical Center had $112.4 million in debt. Total debt decreased in the current year by approximately $6.5 million due to principal payments. More detailed information about the Medical Center's long-term liabilities is presented in the Notes to Basic Financial Statements. No new long-term debt was incurred in the current year. Total debt outstanding represents approximately 35% of the Medical Center's total assets at December 31,2003, compared to approximately 37% in the prior year. Net Assets The following table presents the components of the Medical Center's net assets at December 31, 2003 and TABLE 11 Component of Net Assets Invested capital assets, net of related debt Restricted Unrestricted Total net assets $ $ December (OOOs Omitted) Dollar Change 19,218 : $ (3,678) 3i 22,896 17, ,923 21, ,378 (3,897) (14,455) 183,885! 5 179,341 3; 4,544 Percentage Change 623% (18)% (9)% 3% 16

19 West Jefferson Medical Center Management's Discussion and Analysis (continued) December 31,2004 Net assets increased $4.5 million during 2003, indicating an overall improvement in financial condition. Refer to Table 12 and the pages that follow Table 12 for a discussion of operations. Statements of Revenues and Expenses The following table presents a summary of the Medical Center's revenues and expenses for the years ended December 31, 2003 and TABLE 12 Condensed Statements of Revenues and Expenses Operating revenue: Net patient service revenue Other operating revenue Total operating revenue Year ended December (OOOs Omitted) 170,724 $ 7, , ,470 5, ,162 Dollar Change 11,254 2,120 13,374 Percent Change 7% 37% 8% Operating expenses: Salaries, wages, and employee benefits Professional fees, medical and general supplies, and purchased services Other expenses Depreciation Interest expense, net Total operating expenses 84^43 68,800 9,333 12,394 4, ,606 86,501 63,028 9,129 12,021 4, ,162 (2,158) 5, ,444 (2)% 9% 2% 3% 6% 3% Loss from operations Investment income, net, and other nonoperating income and expenses Revenues in excess of (less than) expenses Assessments by Jefferson Parish Change in net assets (1,070) 6,647 5,577 (1,030) $ 4,547 $ (10,000) 7,741 (2,259) (1,029) (3,288) $ 8,930 (1,094) 7,836 0) 7,835 89% (14)% 347% -% 238% 17

20 West Jefferson Medical Center Management's Discussion and Analysis (continued) December 31,2004 Net Patient Service Revenue The Medical Center derived approximately 96% of its total operating revenue from patient services in fiscal year 2003, which was consistent with the prior year. The Medical Center's revenue is generated from services provided to patients drawn primarily from communities located on the west bank of the Mississippi River in the Greater New Orleans area. Patient service revenue is generated by providing services to patients who are covered by Medicare, Medicaid, or managed care contracts, as well as by providing services to self-pay and indigent patients. Table 13 below presents the relative percentages of gross charges billed for patient services by payer for the fiscal years ended December 31,2003 and Reimbursements to the Medical Center are made on behalf of patients by the federal and state governments under the Medicare and Medicaid programs, respectively, by commercial insurance carriers and health maintenance organizations, as well as by other patients on their own behalf. The difference between the covered charges and the payments under government programs and established contracts is recognized as a contractual allowance. See Table 14 for a summary of allowances. TABLE 13 Payer Mix Year ended December Managed care/commercial 33% 34% Medicare Medicare HMO 9 11 Medicaid Self-pay and other Total patient revenues 100% 100% 18

21 West Jefferson Medical Center Management's Discussion and Analysis (continued) December 31,2004 The following table presents the contractual allowances on gross billings by payer and the provision for doubtful accounts. TABLE 14 Allowance Summary Year ended December (OOOs Omitted) Contractual allowances: Managed care and commercial accounts $ 171,544 $ 97,015 Medicaid contractual allowances 58,285 42,649 Medicare contractual allowances 133,788 85,490 Other adjustments 14,371 40,389 Total contractual allowances 377, ,543 Doubtful accounts 25,936 17,903 $ 403,924 $ 283,446 Other Operating Revenue Other operating revenue includes income primarily generated by rent receipts from the Medical Center's professional office buildings and Medical Plaza as well as income from other miscellaneous services, such as its fitness centers and Alzheimer's day care services. Investment Income The Medical Center maintains investments that are shown in its Balance Sheets as both board-designated and restricted trustee-held funds. These funds are invested primarily in money market funds and securities issued by the U.S. Treasury and other federal agencies. Operating Revenue This discussion refers to the summarized activity presented in the Medical Center's Condensed Statements of Revenues and Expenses on page 17 for 2003 and

22 West Jefferson Medical Center Management's Discussion and Analysis (continued) December 31,2004 Overall, net patient service revenue increased by approximately $11.3 million, or 7%, for fiscal year 2003 when compared to the prior year. The increase is primarily due to increases in volume, increases in rates paid by managed care payers and increases in the Medical Center's customary charges. In addition, in 2002 the Medical Center recorded a one-time write-off of $5.5 million of accounts receivable due from an insolvent managed care organization. Inpatient gross revenue grew by approximately 34% compared to the prior year's gross revenue. This increase primarily resulted from increases in the Medical Center's customary charges and increases in volume. Total inpatient admissions grew by approximately 5% to 16,541 admissions in 2003 while total patient days increased by 1% to 83,809 patient days in In addition, total average daily census increased by approximately 1% to The overall case mix index was consistent with the prior year. Outpatient gross revenue experienced an increase of 22% in 2003 compared to gross outpatient revenue in the prior year. In addition to the rate increases noted above, outpatient gross revenue also increased due to the following factors. Total outpatient units of service, excluding clinic operations and pharmacy outpatient units dispensed, increased by 1% in 2003, Total clinic visits in 2003 were down approximately 14% to 67,452 visits compared to 78,428 total visits in The 2002 total includes three clinics that were closed by December 2002 and one clinic that subsequently closed in Comparing those clinics in operation for all of 2003 and 2002 indicates that overall clinic visits increased by 7% to 67,452 in Other operating revenue increased in 2003 by approximately $2.1 million, or 37%, compared to the prior year. Included in the 39% increase in the current year were increases of approximately $0.7 million in rental income from the Medical Center's office space, approximately $1.0 million of membership and other revenue from the Marrero and Oakwood Fitness Centers, and approximately $0.3 million related to Alzheimer's day care services. 20

23 West Jefferson Medical Center Management's Discussion and Analysis (continued) December 31,2004 Operating Expenses In early 2003, the Medical Center's executive management team developed and implemented a number of initiatives to reduce overall operating expenses for the remainder of Among these initiatives were reductions of salary expense by deferring its merit increase program for 2003, as well as reductions through attrition and consolidation of vacant positions. In addition, the Medical Center reduced other operating expenses through renegotiated vendor contracts. The result of the initiatives discussed above was to control overall operating expenses, excluding depreciation and interest expense, by limiting the year-to-year increase to only 3% when compared to the prior year. Overall, the efforts described above, as well as the increase in net patient revenue, resulted in the Medical Center posting a 89% increase in income from operations in Salaries, wages, and employee benefits expenses decreased approximately $2.2 million, or 2%, in 2003 when compared to the prior year. Reviewing the components separately, salaries and wages expenses increased slightly, by $306,000 or less than 1%, in the current year primarily due to the expense reduction initiatives discussed above. Employee group health insurance costs decreased by 14% in the current year compared to The decrease is primarily due to recording charges to the plan at 30% of billed charges, which more closely approximates reimbursement rates of third-party payers, compared to recording 100% of billed charges in the prior year. The difference between the current-year billed charges and the amount charged to group health insurance expenses is recorded as a contractual allowance. Overall, salaries and wages expenses declined as a percentage of net patient service revenue in 2003 to 40% compared to 43% in the prior year. In addition, employee benefits as a percentage of net patient service revenue also decreased to 9% in the current year compared to 11% in Professional fees, medical and general supplies, and purchased services increased by approximately $5.8 million, or 9%, in 2003 compared to As a percentage of net patient service revenue, these costs were consistent at approximately 40% and 40% in 2003 and 2002, respectively. 21

24 West Jefferson Medical Center Management's Discussion and Analysis (continued) December 31,2004 Viewing the components separately, professional fees increased by approximately $3.7 million, or 55%, compared to the prior year. The increase is primarily due to including 12 months of anesthesia professional fees in the current year compared to 5 months in the prior year as the contract began in August The increase in anesthesia professional fees was partially offset by a decline in pediatric emergency room professional fees resulting from using Medical Center-based physicians effective July Prior to that time, the Medical Center had contracted with an external physician group. Medical and general supplies expense increased approximately $0.8 million, or 3%, over the prior year primarily due to an increase in medical supply costs associated with the operating room and special procedures. Medical supply expense for the operating room increased by $1.2 million over the prior year primarily due to increases in orthopedic and neurological implant procedures. Special procedures medical supply expense increased by approximately $0.7 million primarily due to an increase in volume. These increases were partially offset by decreased costs associated with patient volumes being shifted to an ambulatory surgery joint venture developed by West Jefferson Service Corporation, an affiliate of the Medical Center. Purchased services increased approximately $1.3 million, or 5%, when compared to the prior year due to an increase in consulting and management costs, contract labor costs, collection services expenses and medical purchased services which were partially offset by decreases in management services and maintenance contract expenses. Consulting and management costs increased approximately $1.0 million over the prior year primarily due to costs associated with the outside consulting firm engaged to review operating expenses for cost saving opportunities. Contract labor costs increased by approximately $0.2 million due to nurse staffing requirements while collection services costs also increased by approximately $0.2 million as the Medical Center continued its efforts to collect accounts. Medical purchased services increased by approximately $0.3 million in part due to costs associated with pediatric emergency room physician staffing, costs incurred on external lithotripsy services, as well as physician coverage costs incurred in several other departments. The increases noted above were partially offset by a decrease of approximately $0.2 million in management services costs that resulted primarily from termination of third-party management service contracts for the Medical Center's Home Health and Hospice agencies. Those savings were partially offset by increased biomedical maintenance costs as the Medical Center added additional equipment to its outsourced 22

25 West Jefferson Medical Center Management's Discussion and Analysis (continued) December 31,2004 maintenance management contract. Additionally, purchased services increases discussed above were partially offset by a decrease of $0.7 million in software maintenance contract costs primarily related to discontinued software and other services that are now performed by the Medical Center's information technology personnel. Other expenses increased by approximately $0.2 million, or 2%, in 2003 compared to the prior year. The increase is primarily attributable to increases in other direct expenses and equipment rental expenses of approximately $1.0 million, as well as increases in utilities and telecommunication expenses of approximately $0.6 million. These increases were partially offset by a decrease in professional liability and other insurance expenses of approximately $0.8 million and a decrease in amortization expense of approximately $0.1 million. Depreciation expense increased approximately $0.4 million, or 3%, from the prior year. The increase results from the $24.3 million of additions to property, plant, and equipment. Interest expense, net of interest income from bond fund investments, increased by approximately $0.3 million, or 6%, in 2003 when compared to the prior year. The increase is primarily due to a decrease in the interest income received on the Series 1998 bond fund which was partially offset by a decrease in interest expense recorded on the Series 1998 bonds. Contacting the Medical Center's Administration This financial report is designed to provide our citizens, customers, and creditors with a general overview of the Medical Center's finances and demonstrate the Medical Center's accountability for the money it receives. If you have questions about this report or need additional financial information, please contact the Medical Center's Administration. 23

26 West Jefferson Medical Center Balance Sheets Assets Current assets: Cash and cash equivalents Patient accounts receivable, less allowance for doubtful accounts of $13,346,000 in 2004 and $15,800,000 in 2003 Other receivables Inventory Prepaid expenses Assets whose use is limited and that are required for current liabilities Total current assets December $ 256,719 $ 1,829,273 49,438, ,074 3,516,685 4,094,188 9,966,370 67,952,435 47,769,788 1,632,859 3,420,269 4,401,412 9,157,943 68,211,544 Assets whose use is limited: By board for specific purposes, at fair value Trustee-held assets, at fair value Total assets whose use is limited Less amounts required for current liabilities Noncurrent assets whose use is limited Property, plant, and equipment, net Other assets: Unamortized financing costs Prepaid deferred compensation Other Total other assets Total assets 127,671,964 69,913, ,585,004 (9,966,370) 187,618, ,019,903 3,633,167 1,695,279 2,286,663 7,615,109 $ 402,206, ,904,578 17,744, ,648,789 (9,157,943) 118,490, ,661,579 1,277,040 1,192,718 1,450,412 3,920,170 $ 322,284,139 24

27 Liabilities and net assets Current liabilities: Accounts payable Accrued expenses Patient deposits and credit balances Due to government health care programs Bond interest payable Current installments of long-term debt Total current liabilities December $ 7,896,908 9,493, ,353 5,205,603 1,536,370 8,430,000 32,824,846 $ 5,277,207 8,604, ,928 5,459,524 2,187,943 6,970,000 28,732,707 Reserve for estimated malpractice claims Reserve for deferred compensation Long-term debt, net of original issue discount of $1,445,568 in 2004 and $726,232 in 2003 Total liabilities Net assets: Invested in capital assets, net of related debt Restricted Unrestricted Total net assets 3,000,000 1,695, ,444, ,964,557 3,466,992 18,591, ,183, ,241,524 3,000,000 1,192, ,473, ,399,193 19,217,811 17,744, ,922, ,884,946 Total liabilities and net assets S 402,206,081 $ 322,284,139 See accompanying notes. 25

28 West Jefferson Medical Center Statements of Revenues, Expenses, and Changes in Net Assets Operating revenue: Net patient service revenue Other operating revenue Total operating revenue Year ended December $ 181,512,791 9,977, ,490,387 $ 170,723,959 7,811, ,535,855 Operating expenses: Salaries and wages Employee benefits Professional fees Medical and general supplies Purchased services Other expenses Depreciation Interest expense, net of interest income from trusteeheld assets of $166,000 in 2004 and $157,000 in 2003 Total operating expenses Income (loss) from operations Investment income (loss) and other nonoperating income (expenses): Investment income Net unrealized losses on investments Net realized gains (losses) on investment sales Total investment income and other nonoperating income (expenses) before other revenue Donated assets Revenues in excess of expenses 75,041,214 14,715,421 9,319,748 32,879,980 26,890,227 12,280,426 14,106,758 4,333, ,567,042 1,923,345 2,894,038 (634,255) (1,687,778) 572, ,409 3,388,759 68,726,172 15,617,341 10,330,005 31,170,038 27,299,757 9,332,598 12,394,533 4,735, ,606,322 (1,070,467) 3,414,283 (3,837,563) 1,951,200 1,527,920 5,119,651 5,577,104 Assessments by Jefferson Parish Net assets, beginning of year Net assets, end of year (1,032,181) (1,029,924) 183,884, ,337,766 $ 186,241,524 $ 183,884,946 See accompanying notes. 26

29 West Jefferson Medical Center Statements of Cash Flows Operating activities Revenue collected Cash payments to employees and for employee-related costs Cash payments for operating expenses Net cash provided by operating activities Investing activities Purchases of investment securities Proceeds from sales and maturities of investments Investment income and other Net cash (used in) provided by investing activities Capital and related financing activities Interest payments, net Proceeds from sale of property, plant, and equipment Capital expenditures Principal payments on borrowings Proceeds from issuance of debt Debt financing costs Net cash provided by (used in) capital and related financing activities Noncapital financing activity Assessments by Jefferson Parish Cash used in noncapital financing activity Net increase (decrease) in cash and cash equivalents Cash and cash equivalents, beginning of year Cash and cash equivalents, end of year Reconciliation of income (loss) from operations to net cash provided by operating activities Income (loss) from operations Adjustments to reconcile income (loss) from operations to net cash provided by operating activities: Depreciation Amortization of bond financing costs Interest expense, net Loss (gain) on sale of property, plant, and equipment Bad debt expense Equity in earnings of other investment Changes in operating assets and liabilities: Accounts receivable, net Inventory and prepaid expenses Other receivables Accounts payable Accrued expenses and other liabilities Net cash provided by operating activities Year ended December $ 188,450,016 (90,795,492) (75,881,697) 21,772,827 (2,519,753,416) 2,449,817,201 1,213,086 (68,723,129) (4,879,877) 786,330 (21,564,048) (49,785,000) 124,935,000 (3,082,476) 46,409,929 (1,032,181) (1,032,181) (1,572,554) 1,829,273 $ 256,719 $179,815,018 (84,948,400) (81,391,641) 13,474,977 (8,795,749) 30,679,927 1,527,920 23,412,098 (4,745,570) 584,440 (24,314,512) (6,545,000) (35,020,642) (1,029,924) (1,029,924) 836, ,764 $ 1,829,273 $ 1,923,345 $ (1,070,467) 14,106,758 97,219 4,333, ,045 32,161,050 (836,251) (34,560,341) 210, ,639 2,619, ,586 $ 21,772,827 12,394,533 62,845 4,735,878 (3,328) 25,935,809 (95,141) (24,656,646) (1,439,018) (204,844) 313,728 (2,498,372) $ 13,474,977 See accompanying notes. 27

30 West Jefferson Medical Center Notes to Basic Financial Statements December 31, Organization and Significant Accounting Policies Organization West Jefferson Medical Center (the "Medical Center") operates an acute care hospital, physician clinics, medical office buildings, and a health and fitness center. The Medical Center operates under the jurisdiction of the Parish Council of Jefferson Parish, Louisiana (the "Parish") as Jefferson Parish Hospital Service District No. 1 and is exempt from federal and state income taxes. Basis of Accounting The Medical Center uses the accrual basis of accounting for proprietary funds. Under Governmental Accounting Standards Board ("GASB") Statement No. 20, Accounting and Financial Reporting for Proprietary Funds and Other Governmental Activities That Use Proprietary Fund Accounting, the Medical Center has elected not to apply Financial Accounting Standards Board pronouncements issued after November 30, As a governmental entity, the Medical Center also follows certain accounting and disclosure requirements promulgated by the GASB. Operating and Nonoperating Revenue The Medical Center's primary purpose is to provide diversified health care services to individuals, physicians, and businesses. As such, activities related to the ongoing operations of the Medical Center are classified as operating revenue. Operating revenue includes amounts generated from direct patient care, related support services, gains or losses from disposition of operating properties, and sundry revenue related to the operation of the Medical Center. Interest income from trustee-held investments is reported as a net component of interest expense. Additionally, rental income, gains and losses that are directly related to the ongoing operations of the Medical Center, and gifts, grants, and bequests not restricted by donors for specific purposes are reported as a component of other operating revenue. Investment income, realized and unrealized gains (losses) from board-designated investments, as well as donated assets are reported as a component of nonoperating income. 28

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