COMBINED BALANCE SHEET June 30, 2018 and 2017 ASSETS CURRENT ASSETS Cash & Cash Equivalents $ 45,595,758 $ 35,242,106 Investments 171,400,775 156,784,353 Receivables - Net 68,900,306 70,971,441 Notes Receivable 779,344 787,393 Due From Affiliates 4,218 4,053 Inventories 8,668,952 8,321,801 Prepaid Expense 2,389,391 5,404,048 Assets Whose Use is Limited - Held by Trustee 1,476,579 6,443,688 Total $ 299,215,323 $ 283,958,883 ASSETS WHOSE USE IS LIMITED Held by Trustee: Under Trust Agreements $ 17,013,762 $ 13,620,407 Held by Trustee: Under Bond Indenture Agreements 11,837,860 3,212,176 Total $ 28,851,622 $ 16,832,583 PROPERTY, PLANT AND EQUIPMENT Land and Improvements $ 19,501,344 $ 18,320,683 Buildings 264,120,119 252,218,446 Leasehold Improvements 1,715,833 1,715,833 Equipment 241,195,940 233,542,412 Construction in Progress 22,256,725 11,938,996 Total $ 548,789,961 $ 517,736,370 Accumulated Depreciation (343,898,850) (321,167,027) Total $ 204,891,111 $ 196,569,343 OTHER ASSETS Unamortized Bond Issue and Other Costs $ 5,661,402 $ 7,114,838 Other 5,449,721 6,263,522 Total $ 11,111,123 $ 13,378,360 TOTAL ASSETS $ 544,069,179 $ 510,739,169 LIABILITIES AND NET ASSETS CURRENT LIABILITIES Accounts Payable $ 9,301,348 $ 14,758,042 Estimated Third Party Payable - 925,531 Deferred Revenue 658,036 504,982 Accrued Expenses 29,869,657 28,247,964 Current Portion of Long-Term Debt 6,372,122 6,772,328 Total $ 46,201,163 $ 51,208,847 LONG TERM LIABILITIES Special Assessments Payable $ 677,941 $ 728,195 Revenue Bonds Payable 207,547,155 180,276,527 Pension & Post Employment/Retirement Benefit 3,425,820 11,687,578 Other 15,737,797 13,677,744 Total $ 227,388,713 $ 206,370,044 TOTAL LIABILITIES $ 273,589,876 $ 257,578,891 NET ASSETS $ 270,479,303 $ 253,160,278 TOTAL LIABILITIES AND NET ASSETS $ 544,069,179 $ 510,739,169
COMBINED STATEMENT OF OPERATIONS For the Six Months Ended June 30, 2018 and 2017 UNRESTRICTED OPERATING REVENUE Net Patient Service Revenue $ 269,184,439 $ 267,420,638 Provision for Bad Debts (4,232,174) (5,599,982) Net Patient Service Revenue Less Provision for Bad Debts $ 264,952,265 $ 261,820,656 Other Operating Revenue 23,503,975 18,555,282 Total Unrestricted Operating Revenue $ 288,456,240 $ 280,375,938 UNRESTRICTED OPERATING EXPENSES Patient Care Services $ 41,472,092 $ 43,015,568 Clinic Professional Services 95,427,434 89,662,900 Other Professional Services 48,117,966 44,599,872 Other Services 1,812,390 2,021,334 General Services 12,408,431 12,831,236 Administrative Services 33,883,655 36,552,310 Bond Issue Carrying Costs 231,284 298,800 Real Estate Taxes 444,713 498,321 Interest 3,906,178 3,983,623 Depreciation and Amortization 13,680,875 13,744,577 Insurance 1,167,964 1,259,605 Employee Benefits and Payroll Taxes 30,649,929 29,687,456 Total Unrestricted Operating Expenses $ 283,202,911 $ 278,155,602 NET INCOME FROM OPERATIONS $ 5,253,329 $ 2,220,336 Other Income - Primarily Investments 2,311,768 2,283,005 EXCESS OF REVENUE OVER EXPENSE $ 7,565,097 $ 4,503,341 Unrealized Gain (Loss) on Investments (2,928,323) 8,022,888 INCREASE IN UNRESTRICTED NET ASSETS $ 4,636,774 $ 12,526,229
COMBINED STATEMENT OF CASH FLOWS For the Six Months Ended June 30, 2018 and 2017 CASH FLOW FROM OPERATING ACTIVITIES: Increase in Unrestricted Net Assets : $ 4,636,774 $ 12,526,229 Adjustments to Reconcile Change in Net Assets to Net Cash from Operating Activities : Depreciation and Amortization 13,706,733 13,516,294 Provision for Bad Debts 4,232,174 5,599,982 (Gain) Loss on Investments (515,365) (632,426) Loss on Disposal of Equipment 104,015 152,423 Excess of Revenue Over Expenses - Limited Use Assets (201,335) (87,742) Unrealized (Gain) / Loss 2,928,323 (8,022,888) Effect on Operating Cash Flows from Changes in: Receivables 173,467 (11,152,277) Due from Affiliates 6,210 (1,124) Inventories 347,322 167,727 Prepaid Expense (951,676) (2,528,656) Accounts Payable (5,669,203) (3,950,451) Due to Affiliates - (8,226) Estimated Third Party Payable (2,347,385) (1,710,234) Accrued Expenses 2,228,979 (2,833,118) Deferred Revenue 60,558 (24,498) NET CASH PROVIDED BY OPERATING ACTIVITIES $ 18,739,591 $ 1,011,015 CASH FLOW FROM INVESTING ACTIVITIES: Acquisitions of Property and Equipment $ (14,896,884) $ (11,775,481) Sale of Property and Equipment - 446,805 Investments in Assets Whose Use is Limited (4,614,000) (5,727,000) Transfers from Assets Whose Use is Limited 16,410,193 4,069,874 Purchases of Investments (11,214,244) (14,419,348) Sales of Investments 8,903,992 10,767,687 Advances on Notes Receivable (832,000) (658,750) Payments Received on Notes Receivable 134,776 438,258 NET CASH PROVIDED (USED) BY INVESTING ACTIVITIES $ (6,108,167) $ (16,857,955) CASH FLOW FROM FINANCING ACTIVITIES: Payments of Long-Term Debt $ (986,318) $ (70,513) Payments for Financing Costs - - Proceeds from Sale of Bonds - - NET CASH USED BY FINANCING ACTIVITIES $ (986,318) $ (70,513) NET CHANGE IN CASH AND CASH EQUIVALENTS $ 11,645,106 $ (15,917,453) CASH AND CASH EQUIVALENTS BEGINNING OF PERIOD 33,950,652 51,159,559 CASH AND CASH EQUIVALENTS END OF PERIOD $ 45,595,758 $ 35,242,106
Ratios June 30, 2018 Trailing 12-Month Days Cash On Hand: 2017 6-30-17 6-30-18 Basis 6-30-18 Operating Expense $ 562,639,527 $ 278,155,602 $ 283,202,911 $ 567,686,836 Depreciation & Amortization 27,128,909 13,516,294 13,706,733 27,319,348 Total $ 535,510,618 $ 264,639,308 $ 269,496,178 $ 540,367,488 Unrestricted Cash & Investments $ 216,996,533 Days Cash on Hand 146.57 Trailing 12-Month Maximum Annual Debt Service Coverage: 2017 6-30-17 6-30-18 Basis 6-30-18 Excess of Revenue Over Expense $ 2,762,915 $ 4,503,341 $ 7,565,097 $ 5,824,671 Interest Expense 8,247,286 3,983,623 3,906,178 8,169,841 Depreciation & Amortization 27,128,909 13,516,294 13,706,733 27,319,348 Income Available for Debt Service $ 38,139,110 $ 22,003,258 $ 25,178,008 $ 41,313,860 6-30-18 Maximum Annual Debt Service $ 16,697,900 Maximum Annual Debt Service Coverage Ratio 2.47 Debt to Capitalization: 6-30-18 Long Term Debt $ 206,971,788 Accrued Pension Liability 3,425,820 Net Assets 270,479,303 Total $ 480,876,911 Debt to Capitalization Ratio 43.04%
Altru Health System & Affiliates Combined Balance Sheet June 30, 2018 and 2017 ASSETS Current Assets Cash & Cash Equivalents $ 45,769,679 $ 35,427,184 Investments 172,934,821 158,172,120 Due from Restricted Assets 47,236 35,246 Receivables - Net 68,904,499 70,975,799 Notes Receivable 779,344 787,393 Inventories 8,668,952 8,321,800 Prepaid Expense 2,390,803 5,405,458 Limited Use Assets - Current 1,476,579 6,443,688 Total $ 300,971,913 $ 285,568,688 Assets Whose Use is Limited or Restr. Under Trust Agreement $ 17,013,762 $ 14,575,346 Under Bond Indenture Agreements 11,837,860 3,212,176 By Donors 13,159,526 11,754,580 Total $ 42,011,148 $ 29,542,102 Property, Plant & Equipment Land & Improvements $ 19,501,344 $ 18,320,683 Buildings 265,835,952 253,934,279 Equipment 241,316,875 233,663,347 Construction in Progress 22,256,725 11,938,996 Total $ 548,910,896 $ 517,857,305 Less: Accumulated Depr. (343,983,598) (321,247,580) Total $ 204,927,298 $ 196,609,725 Other Assets Unamortized Costs $ 5,661,402 $ 6,343,778 Other 5,449,721 6,079,642 Total $ 11,111,123 $ 12,423,420 Total Assets $ 559,021,482 $ 524,143,935 LIABILITIES AND NET ASSETS Current Liabilities Accounts Payable $ 9,339,987 $ 14,778,394 3rd Party Payor Settlements - 925,531 Accrued Expenses 29,906,717 28,295,832 Long Term Debt - Current 6,372,122 6,772,328 Unearned Income 658,036 504,982 Total $ 46,276,862 $ 51,277,067 Long Term Liabilities Special Assessments Payable $ 677,941 $ 728,195 Bonds Payable 207,547,155 180,276,527 Pension/Health Benefit 3,455,490 11,791,693 Other 15,760,569 13,701,934 Total $ 227,441,155 $ 206,498,349 Net Assets Unrestricted $ 272,134,765 $ 255,476,830 Temporarily Restricted 9,716,148 7,634,550 Permanently Restricted 3,452,552 3,257,139 Total $ 285,303,465 $ 266,368,519 Total Liabilities & Net Assets $ 559,021,482 $ 524,143,935
Altru Health System & Affiliates Combined Statement of Operations For the Six Months Ended June 30, 2018 and 2017 Unrestr. Revenues & Gains: Net Patient Service Rev. $ 269,184,439 $ 267,420,638 Provision for Bad Debt (4,232,175) (5,616,068) Other Operating Revenue 23,440,282 18,524,346 Total Revenue $ 288,392,546 $ 280,328,916 Expenses: Nursing Services $ 41,471,536 $ 43,014,680 Clinic Professional Serv. 95,427,434 89,662,900 Other Professional Serv. 47,366,069 43,742,412 Other Services 2,733,479 2,895,215 General Services 12,437,800 12,862,022 Administrative Services 33,956,993 36,757,398 Bond Issue Costs 231,284 298,800 Real Estate Taxes 444,712 498,321 Interest 3,906,178 3,983,623 Depreciation & Amortization 13,682,972 13,746,688 Insurance 1,168,324 1,259,965 Employee Benefits 30,696,290 29,730,994 Total Expense $ 283,523,071 $ 278,453,018 Operating Income $ 4,869,475 $ 1,875,898 Other Income - Primarily Investments 2,487,683 2,431,065 Excess of Revenues Over Expenses $ 7,357,158 $ 4,306,963 Change in Unrealized Gains and Losses (2,983,659) 8,089,027 Increase in Unrestricted Net Assets $ 4,373,499 $ 12,395,990