Owensboro Health 4th Quarter (March May 2016) FY Ending May 31, 2016 Table of Contents Officer s Certificate of Compliance. 3 Management Discussion and Analysis.. 4 Utilization Statistics and Financial Information. 7 Bad Debt and Charity Analysis.. 13 Bond issue CUSIPs 14
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Management Discussion and Analysis For the Fourth Quarter Of Fiscal Year Ending May 31, 2016 The discussion set forth below should be read in conjunction with the Owensboro Health, Inc. ( OH ) consolidated financial statements for the twelve months ended May 31, 2016. The financial statements included with this report are unaudited. OH provides directly and indirectly through its affiliates a broad range of primary, secondary and tertiary healthcare services. OH owns and operates a hospital, Owensboro Health Regional Hospital ( OHRH ), located in Owensboro, Kentucky licensed for 447 acute care beds and 30 rehabilitation beds and operates outpatient clinics providing services in the eleven counties in its service area. OH entered into a lease agreement with Muhlenberg Community Hospital on July 1 st of 2015. Currently doing business as Owensboro Health Muhlenberg Community Hospital, OHMCH is licensed for 90 acute care beds and 45 long term care beds. Tenant is wholly owned and/or controlled by OHI, an entity that qualifies for tax exempt status under Section 501 (c) (3) of the Internal Revenue Code. OHMCH is not a member of the Obligated Group. OH is a nonstock, nonprofit Kentucky corporation and exempt from federal income taxation under Section 501(a) of the Internal Revenue Code of 1986, as amended and an organization described in Section 501(c) (3) Code. Its primary and secondary service areas include an eleven county region in Western Kentucky and Southern Indiana. The OH System has no direct hospital competitors in its primary service area (Daviess County) and maintains an approximate 90% market share in Daviess County. As such, it is a regional referral center and is also classified under Medicare as a Sole Community Hospital and Rural Referral Center. Basis of Presentation The accompanying interim consolidated financial statements as of May 31, 2016 and for the twelve months then ended have been prepared in accordance with U.S. generally accepted accounting principles applied on a basis substantially consistent with that of the 2015 audited consolidated financial statements of OH. They do not include all of the information and footnotes required by the U.S. generally accepted accounting principles for complete consolidated financial statements. In the opinion of the management, all adjustments considered necessary for a fair presentation have been included. OH presumes that users of this interim financial information have read or have access to OH s audited financial statements and that the adequacy of additional disclosures needed for a fair presentation may be determined in that context. OH s audited financial statements for the years ended May 31, 2015 and 2014 are on file, pursuant to the OH s continuing disclosure requirements and the information contained therein is incorporated herein. Accordingly, footnotes and other disclosures that would substantially duplicate the disclosures contained in OH s most recent audited financial statements have been omitted. Seasonal variations caused by various factors can and do impact the volumes and net operating revenue of OH. Therefore, monthly and periodic operating results are not necessarily representative of the operations for a full year when comparing a quarter s performance to a full year. These same variations need to also be considered and do apply when making year to year comparisons. Page 4 of 17
Results of Operations For the twelve months ended May 31, 2016, consolidated operating earnings before interest, depreciation and amortization ( Operating EBIDA ) was $55.1 million or 9.5% compared to $71.4 million or 14.3% for the same twelve month period of last year. EBIDA decreased from prior year as a result of strategic decisions and initiatives to compete effectively in the changing competitive market. It should be noted that Owensboro Health, Inc. continues to exceed the bond covenant requirements. Strategic initiatives continue to drive increases in several key areas. The additional providers, affiliation with Owensboro Health Muhlenberg Community Hospital and new bypass for easy access to the hospital supported volume growth. For the twelve months ended May 31, 2016, OHRH admissions increased by 6.4% and patient days by 8.0%. Total surgical cases increased by 4.4% both inpatient and outpatient cases. Emergency and Urgent Care visits increased by 1.3%. However, as reflected in the utilization statistics, Cath Lab cases decreased by 7.2%. The decrease in Cath Lab cases was attributed to losses of Cardiologists through retirement and turnovers. We currently are onboarding several Cardiologists which will offset the loss of these providers. Patient acuity was higher compared to prior year. Total Case Mix Index was 1.5015 in FY 2016 vs. 1.4364 in FY 2015. Medicare Case Mix Index was 1.6682 in FY 2016 vs. 1.6485 in FY 2015. Accounting Standard Update requires healthcare entities to record provision for bad debts as deduction from revenue to clearly present net patient service revenue. Compared to prior year, consolidated gross revenues increased by 22.6% or $292.4 million; of which Inpatient revenues increased by 24.3% or $129.3 million and outpatient revenues increased by 21.4% or $163.1 million. Consolidated net patient operating revenues less provision for Bad Debt had a 16.6% or $80.7 million increase for the same period from the previous year. In comparison, Bad Debt increased by $10.3 million or 39.4%. Charity was comparable to last year. As a percent of net patient revenue, Charity and Bad Debt were 8.6% in FY 2016 vs. 7.9% in FY 2015. Other operating revenues were $1.7 million or 12.4% higher than prior year primarily from the 340B drug pricing program and pay for performance. Total operating expenses increased $90.7 million or 17.6% compared to the previous year. Personnel increased by $72.4 million or 29.1% primarily from higher volume, clinic growth and market adjustments in the latter part of FY 2015. Consequently, higher volume, patient acuity and surgery cases drove supplies up by $16.5 million or 17.8% and professional fees by $4.4 million or 15.9%. Depreciation and amortization decreased by $8.0 million or 15.1%. The electronic health record software and related hardware were fully amortized last year. We continue to focus in containing controllable expenses. Non-operating losses were $0.2 million for FY 2016 compared to $6.7 million non-operating gains for the same period in FY 2015. Investment losses of $0.8 million in FY 2016 versus investment gains of $6.8 million in FY 2015 attributed to the current FY variance. In summary, the consolidated operating margin was (3.9%) for FY 2016 vs. (2.8%) for FY 2015. Net patient revenue less provision for Bad Debts increased by $80.7 million or 16.6%. Other operating revenue increased by $1.7 million or 12.4%. To previous year, expenses increased by $90.7 million or 17.6% primarily from personnel, supplies and professional fee which were mitigated by decreased depreciation and amortization as mentioned above. Operating earnings before interest, depreciation and amortization ( Operating EBIDA ) was $55.2 million in FY 2016 compared to $71.4 million in FY 2015. This decrease was driven by a variety factors as indicated below. Page 5 of 17
The additional investments in personnel, additional providers, and additional access points for the communities we serve resulted in the volume growth experienced at the hospital and various outpatient departments. This further generated additional admissions, ED visits, inpatient and outpatient surgeries, and validated that the strategic plan to enhance additional access points. However, the current year EBIDA was weaker than prior year primarily from these initial investments and start-up expenses. As we continue to invest in our employees, recruit key physicians and focus on efficiency, we expect positive financial growth with the maturation of the strategic plan. OHI continues to exceed its Rate and Liquidity Covenants under the Master Indenture as described in the Official Statement (the Rate and Liquidity Covenants ). The current major capital project is for the three new outpatient health care and health related facilities in Hopkins, Muhlenberg, and Henderson counties. The amount spent to date was $4.0 million of the $65.6 million. Contracts have been awarded. Final plans are being completed. Owensboro Health hosted groundbreakings on June 28, 2016 for outpatient facilities in Henderson, Madisonville and Hopkins counties. Expected projects completion dates are the fall and last quarter of 2017. Page 6 of 17
Owensboro Medical Health System (KY) 1 Kentucky Economic Development Finance Authority, $92,470,000, Hospital Revenue Bonds (Owensboro Health, Inc.), Series 2015A, $67,585,000 and Hospital Revenue Refunding Bonds (Owensboro Health, Inc.), Series 2015B, $24,885,000, Dated: August 13, 2015 2 Kentucky Economic Development Finance Authority (Owensboro Medical Health System, Inc.) $527,340,000 consisting of Hospital Revenue Bonds, Series 2010A, $460,645,000 and Hospital Revenue Refunding Bonds, Series 2010B, $66,695,000 Dated: March 3, 2010 Series 2015A&B OWENSBORO MEDICAL HEALTH SYSTEM, INC. AND AFFILIATED ENTITIES Utilization Statistics Fiscal Year Ended May 31 4th Qtr FYTD 2016 4th Qtr FYTD 2015 % Change Beds: Licensed (Acute and Rehab) 447 447 0.0% Licensed (SNF)* 30 30 0.0% Staffed (Acute, Rehab, SNF) 354 354 0.0% Admissions: Acute, Rehab, SNF 17,994 16,914 6.4% Discharges: Acute, Rehab, SNF 18,197 16,979 7.2% Deliveries 2,123 1,961 8.3% Patient Days: Acute, Rehab, SNF 87,735 81,252 8.0% Newborn 4,119 3,786 8.8% Other Statistics: Average Length of Stay (days) 4.9 4.8 1.5% Average Daily Census 240 223 7.7% Surgical Cases: Inpatient 4,224 3,888 8.6% Outpatient 8,746 8,186 6.8% Endoscopy 4,939 4,978-0.8% ASC** 6,068 5,918 2.5% Cath Lab Cases *** 2,767 2,983-7.2% Emergency Department Visits 73,074 68,718 6.3% Urgent Care Visits (Total) 67,184 69,743-3.7% Home Health Visits 20,361 20,474-0.6% CMI - Total 1.5015 1.4364 4.5% CMI - Medicare 1.6682 1.6485 1.2% * Skilled Nursing Facility ** Ambulatory Surgery Center *** See Management Discussion and Analysis Page 7 of 17
Series 2015A&B, 2010A&B OWENSBORO MEDICAL HEALTH SYSTEM, INC. AND AFFILIATED ENTITIES Condensed Consolidated Statements of Operations and Changes in Net Assets Information (in thousands) Fiscal Year Ended May 31 4th Qtr FYTD 2016 4th Qtr FYTD 2015 % Change Unrestricted revenue: Net patient service revenue $ 604,215 $ 513,245 17.7% Provision for Bad Debts $ (36,442) $ (26,134) 39.4% Net Patient Service Revenue Less Provision for Bad Debts $ 567,774 $ 487,111 16.6% Other operating revenue $ 14,994 $ 13,340 12.4% Total unrestricted revenue* $ 582,768 $ 500,451 16.4% Patient service and other expenses: Personnel $ 320,877 $ 248,455 29.1% Professional fees $ 31,874 $ 27,498 15.9% Drugs and supplies $ 109,234 $ 92,766 17.8% Plant maintenance and operation $ 19,958 $ 17,420 14.6% Kentucky provider tax $ 4,305 $ 3,698 16.4% Other expenses $ 41,365 $ 39,248 5.4% Depreciation and amortization $ 45,247 $ 53,291-15.1% Interest expense $ 32,592 $ 32,327 0.8% Total patient service and other expenses* $ 605,452 $ 514,703 17.6% Operating income $ (22,685) $ (14,252) 59.2% Nonoperating gains (losses), net $ (212) $ 6,651-103.2% Excess (deficiency) of revenue and gains over expenses and losses before minority interest* $ (22,896) $ (7,601) 201.2% Noncontrolling interest $ 481 $ (196) -345.9% Excess (deficiency) of revenue and gains over expenses and losses $ (22,416) (7,797) 187.5% Increase (decrease) in unrestricted net assets $ (39,577) $ (18,155) 118.0% Increase (decrease) in temporarily restricted net assets $ 10,553 $ (850) -1341.5% Net assets, beginning of period $ 324,465 $ 343,838-5.6% Net assets, end of period* $ 295,442 $ 324,834-9.0% Operating EBIDA Calculation: Operating Income $ (22,685) $ (14,252) 59.2% Plus: Depreciation and amortization $ 45,247 $ 53,291-15.1% Plus: Interest Expense $ 32,592 $ 32,327 0.8% EBIDA $ 55,155 $ 71,365-22.7% Total unrestricted revenue* $ 582,768 $ 500,451 16.4% Operating EBIDA Margin 9.5% 14.3% -33.6% * The sum of the individual amounts may not agree due to rounding. Page 8 of 17
Series 2015A&B, 2010A&B OWENSBORO MEDICAL HEALTH SYSTEM, INC. AND AFFILIATED ENTITIES Condensed Consolidated Balance Sheet Information (in thousands) Fiscal Year Ended May 31 4th Qtr FYTD 2016 4th Qtr FYTD 2015 % Change Assets Current assets Cash and cash equivalents $ 9,374 $ 24,256-61.4% Investments $ 156,070 $ 171,566-9.0% Patient accounts receivable, net $ 90,568 $ 69,209 30.9% Inventories $ 12,053 $ 9,557 26.1% Prepaid expenses and other current assets $ 16,762 $ 7,592 120.8% Assets limited as to use, current portion $ 23,843 $ 22,117 7.8% Total current assets $ 308,670 $ 304,297 1.4% Assets limited as to use, less current portion $ 105,041 $ 37,943 176.8% Property and equipment, net $ 600,747 $ 608,553-1.3% Deferred compensation plan assets $ 8,508 $ 7,372 15.4% Goodwill, net $ 13,872 $ 13,196 5.1% Other assets $ 2,757 $ 2,839-2.9% Total assets $ 1,039,595 $ 974,200 6.7% Liabilities and net assets Current liabilities: Current maturities of long-term debt $ 6,586 $ 6,175 6.7% Accounts payable $ 23,354 $ 19,125 22.1% Accrued payroll and related liabilities $ 22,268 $ 21,744 2.4% Other current liabilities $ 35,791 $ 34,392 4.1% Due to third-party payors $ 22,984 $ 22,096 4.0% Total current liabilities $ 110,983 $ 103,532 7.2% Deferred compensation plan obligations $ 8,508 $ 7,372 15.4% Long-term debt, less current maturities $ 124 $ - 0.0% Accrued pension cost $ 69,172 $ 48,391 42.9% Bond Obligations $ 555,359 $ 490,440 13.2% Other long-term liabilities $ 7 $ - 0.0% Total liabilities* $ 744,153 $ 649,735 14.5% Net assets Unrestricted $ 294,168 $ 322,974-8.9% Temporarily restricted $ 1,274 $ 1,210 5.3% Total net assets $ 295,442 $ 324,465-8.9% Total liabilities and net assets $ 1,039,595 $ 974,200 6.7% * The sum of individual amounts may not agree due to rounding. Page 9 of 17
Series 2015A&B, 2010A&B OWENSBORO MEDICAL HEALTH SYSTEM, INC. (OHRH ONLY) Sources of Revenue Revenue By Payor Fiscal Year Ended May 31 4th Qtr FYTD 2016 4th Qtr FYTD 2015 % Change Medicare 49.0% 48.3% 1.5% Medicaid 18.0% 18.0% 0.2% Commercial Insurance 8.1% 8.4% -3.7% Anthem-Blue Cross 17.3% 17.0% 1.5% Self Pay/ Other 5.9% 4.5% 30.2% Humana 1.8% 3.8% -53.9% TOTAL 100.0% 100.0% 0.0% Series 2015A&B, 2010A&B Nonoperating Gains and Investment Income (in thousands) Fiscal Year Ended May 31 4th Qtr FYTD 2016 4th Qtr FYTD 2015 % Change Investment gains (losses), net $ (780) $ 6,816-111.4% Contributions and other $ 635 $ 204 211.3% Equity in income (loss) of affiliates $ (67) $ (369) -81.9% Total nonoperating gains (losses) $ (212) $ 6,651-103.2% Interest and dividend income $ 4,010 $ 3,858 3.9% Net realized gains (losses) on sales of securities $ (668) $ 3,664-118.2% Net unrealized gains (losses) on trading securities $ (3,617) $ (146) 2381.0% Management fees and other $ (506) $ (561) -9.8% Total Investment gains (losses), net $ (780) $ 6,816-111.4% Page 10 of 17
Series 2015A&B, 2010A&B OWENSBORO MEDICAL HEALTH SYSTEM, INC. AND AFFILIATED ENTITIES Liquidity of Obligated Group (in thousands) Fiscal Year Ended May 31 4th Qtr FYTD 2016 4th Qtr FYTD 2015 % Change Unrestricted Cash and Investments Cash and Cash Equivalents $ 3,987 $ 22,038-81.9% Investments $ 155,491 $ 170,983-9.1% Total $ 159,478 $ 193,021-17.4% Total Patient Service and Other Expenses $ 565,245 $ 512,317 10.3% Less: Depreciation and Amortization $ 44,102 $ 53,066-16.9% Total $ 521,143 $ 456,086 14.3% Days in Year 366 365 0.3% Daily Expenses $ 1,424 $ 1,250 14.0% Days Cash on Hand 112 154-27.5% Bond Covenant Requirement: Days Cash on Hand 70 70 0.0% Series 2015A&B, 2010A&B Debt Service Calculation for Obligated Group (in thousands) Fiscal Year Ended May 31 4th Qtr FYTD 2016 4th Qtr FYTD 2015 % Change Income Available for Debt Service: Excess (Deficiency) of Revenue and Gains $ (19,629) $ (7,743) 153.5% over Expenses and Losses Interest Expense $ 32,569 $ 32,323 0.8% Depreciation and Amortization $ 44,102 $ 53,066-16.9% Net realized (Gains) Losses on investments $ 668 $ (3,664) -118.2% Net Unrealized (Gains) Losses on investments $ 3,617 $ 146 2377.3% Net (Gains) Losses on sale and disposals of property and equipment $ 4 $ (12) -135.8% Equity in (Income) of Affiliates $ (1,116) $ (438) 154.7% Net Income Available for Debt Service $ 60,214 $ 73,678-18.3% Historical Actual Annual Debt Service Requirements $ 39,029 $ 38,498 1.4% Historical Actual Annual Debt Service Coverage Ratio 1.54 1.91-19.4% Pro Forma Maximum Annual Debt Service Requirements $ 41,487 $ 37,913 9.4% Pro Forma Maximum Annual Debt Service Coverage Ratio 1.45 1.94-25.3% Bond Covenant Requirement: Historical Actual Annual Debt Service Coverage Ratio 1.20 1.20 0.0% Page 11 of 17
Series 2015A&B, 2010A&B OWENSBORO MEDICAL HEALTH SYSTEM, INC. AND AFFILIATED ENTITIES Capitalization (in thousands) Fiscal Year Ended May 31 4th Qtr FYTD 2016 4th Qtr FYTD 2015 % Change Series 2015 A Bonds $ 67,585 $ - 0.0% Series 2015 B Bonds $ 23,730 $ - 0.0% Series 2010 A Bonds $ 440,930 $ 451,280-2.3% Series 2010 B Bonds $ 36,975 $ 64,565-42.7% Total Long-Term Debt $ 569,220 $ 515,845 10.3% Less: Current Maturities $ (6,460) $ (6,175) 4.6% Less: Unamortized premiums and discounts, net $ (13,861) $ (19,230) -27.9% Net Long-Term Debt $ 548,899 $ 490,440 11.9% Total Unrestricted Net Assets (Obligated Group) $ 285,346 $ 322,139-11.4% Total Capitalization $ 834,245 $ 812,579 2.7% Net Long-Term Debt as a Percentage of Total Capitalization 65.8% 60.4% 9.0% Page 12 of 17
Bad Debt and Charity Analysis FY 2016 vs. FY 2015 (Amounts in Thousands) Twelve Months Ended May 31, 2016 Actual Actual PY Var FY 2016 FY 2015 Fav (Unf) % Change Inpatient Revenue $ 661,453 532,119 129,334 24.3% Outpatient Revenue 924,199 761,076 163,123 21.4% Patient Service Revenue 1,585,652 1,293,195 292,457 22.6% Contractual Allowances (968,871) (767,622) (201,249) 26.2% Charity (12,566) (12,328) (238) 1.9% Bad Debt (36,442) (26,134) (10,308) 39.4% Net Patient Service Revenue 567,774 487,112 80,662 16.6% Other Operating Revenues 14,994 12,222 2,772 22.7% Net Operating Revenues $ 582,768 499,334 83,434 16.7% Bad Debt as % of Gross Pt Rev 2.3% 2.0% Bad Debt as % of Net Pt Rev 6.4% 5.4% Bad Debt and Charity as % of Net Pt 8.6% 7.9% Page 13 of 17
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