MAIN LINE HEALTH SYSTEM CONTINUING DISCLOSURE DOCUMENT APPENDIX A
Medical Staff As of June 30, 2016, the Main Line Health System s ( MLHS ) active medical staff for Main Line Health ( MLH ) hospitals consisted of 1,715 physicians who practice in the areas indicated in the chart below. Of the active staff physicians, approximately 93% are board certified in one or more specialties. Total % Active Number Active Active Other Medical Board Certified Board Average Physicians Physicians Staff Physicians Certified Age 1,715 301 2,016 93% 1,884 51.2 Active Physicians by Department Anesthesiology 84 Dermatology 31 Emergency Medicine 52 Family Medicine 184 Medicine 465 Medical Hem/Onc 41 Neurology 23 Neurosurgery 18 Ob/Gyn 102 Ophthalmology 52 Oral Surgery/Dentistry 38 Orthopedic Surgery 102 Otolaryngology 30 Pathology 14 Pediatrics 153 Psychiatry 29 Radiation Oncology 8 Radiology 51 Physical Med & Rehab 24 Surgery 178 Urology 36 Total 1,715
Historical Utilization of Patient Services The following table presents utilization statistics for the System for the fiscal year ended June 30, 2016. Licensed Beds 1,387 Staffed Beds 1,387 Discharges 58,676 Outpatient Visits 1,227,263 Patient Days 303,603 Average Length of Stay (Acute) 4.163 Case-Mix Index (Acute) 1.586 Average Daily Census 830 Emergency room visits 174,039 Surgical Cases 14,752 Sources of Patient Revenue The following table presents the payor mix for the System for the fiscal year ended June 30, 2016. Hospital Net Patient Revenue By Payor Medicare (fee for service) 355.118 25% Medicaid (fee for service) 16.699 1% Blue Cross * 486.108 35% Other Managed Care 488.747 35% Other Commercial and Self Pay 49.598 4% Total 1,396.269 100% * Includes traditional indemnity, HMO, PPO and Medicare plans.
Certain Financial Information Main Line Health System and Affiliates For the year ended June 30, 2016 Net patient service revenue 1,620.72 Provision for bad debts (37.98) Investment income and other revenue 65.51 Net assets released from restrictions used for operations 12.17 Total unrestricted operating revenues, gains and other support 1,660.42 Operating expenses 1,548.19 Operating income 112.23
Indebtedness and Other Obligations MLH is party to an amended Amended and Restated Master Trust Indenture, originally dated November 1, 1997, which provides for, among other things, the issuance from time to time of general unsecured debt obligations of MLHS. Under the Master Trust Indenture MLHS is the sole member of the Obligated Group, while certain subsidiaries of MLHS (i.e., Main Line Health, Inc., Main Line Hospitals, Inc., Riddle Hospital and Mirmont Treatment Center) are Obligated Group Affiliates. Only MLHS is directly obligated to pay the bondholders the principal or interest on any bonds issued pursuant to the Master Trust Indenture. MLHS and each Obligated Group Affiliate are parties to an Amended and Restated Contribution Agreement dated June 30, 2014 pursuant to which each Obligated Group Affiliate agrees, jointly and severally, to transfer to MLHS amounts necessary for MLHS to pay the principal of and premium, if any, and interest on all currently outstanding bonds issued under the Master Trust Indenture when due and to satisfy any other obligations of MLHS arising under the Master Trust Indenture. MLHS entered into the Eighth Supplement to the Amended and Restated Master Trust Indenture as of May 1, 2015 in connection with the issuance of the Series 2015 Bonds ( 2015 Bonds ). MLHS issued a portion of the Series 2015 Bonds ( 2015 Bonds ) with a par amount of $16,645,000 through the Chester County Health and Education Facility Authority as of May 1, 2015. MLHS used the 2015 Bond proceeds to: (i) refinance a portion of the Chester County Authority s Health System Revenue Bonds, Series 2010A, originally issued in the principal amount of $164,510,000, of which $149,370,000 in principal amount was outstanding; and (ii) pay certain expenses incurred in connection with the issuance of the 2015 Bonds. This transaction resulted in a loss on refinancing of $120,000, which is included in the June 30, 2015 consolidated statements of operations and change in net assets as a non-recurring charge. In addition to the $16,645,000 issued in May 2015, during fiscal year 2016, the Chester County Health and Education Authority issued an additional $33,355,000 of the 2015 Bonds at par to fund the acquisition, construction, renovation, relocation, expansion and/or equipping of certain healthcare facilities of Bryn Mawr Hospital. The aggregate principal amount of the 2015 bonds is $50,000,000. MLHS issued the Series A of 2012 Bonds ( 2012A Bonds ) with a par amount of approximately $60,100,000 through the Montgomery County Industrial Development Authority, dated as of June 1, 2012. MLHS used the 2012A Bond proceeds to: (i) pay the costs associated with the acquisition, construction, renovation, relocation, expansion, and / or equipping of certain health care facilities of Main Line Health; (ii) refund all of the Pennsylvania Economic Development Financing Authority s Main Line Health Revenue Bonds, Series 2007, in the aggregate principal amount of $34.6 million and (iii) pay the costs and expenses incurred in connection with the issuance of the Series 2012A Bonds.
MLHS issued the Series A of 2010 Bonds ( 2010A Bonds ) with a par amount of approximately $164,500,000 through the Chester County Health and Education Facilities Authority, dated as of July 1, 2010. MLHS used the 2010A Bond proceeds to: (i) refinance a portion of the Chester County Authority s Health System Revenue Bonds, Series 1997B, originally issued in the principal amount of $199,100,000, of which $176,900,000 in principal amount was outstanding; (ii) refinance all of the Chester County Authority's Health System Revenue Bonds, Series 2004A and 2004B, originally issued in the principal amount of $67,100,000, of which $67,100,000 in principal amount was outstanding; (iii) finance or reimburse certain capital expenditures for Main Line Health; and (iv) pay certain expenses incurred in connection with the issuance of the Series 2010A Bonds. Summary Statement of Annual Debt Service Coverage Ratio Main Line Health System and Affiliates For the year ended June 30, 2016 Revenues in excess of (less than) expenses 127.85 Depreciation and amortization 99.55 Interest expense 8.34 Income available for debt service 235.74 Proforma maximum annual debt service 26.90 Proforma maximum annual debt service coverage ratio (1) 8.76 x (1) Annual Required Debt Service Coverage Ratio is defined in accordance with the Master Indenture.
Summary of Liquidity Main Line Health System and Affiliates For the year ended June 30, 2016 Cash and cash equivalents 136.87 Mutual funds - primarily US government obligations 195.24 Mutual funds - marketable equity securities 93.49 US Government obligations 178.11 Corporate bonds 713.93 Certificates of deposit and other commercial paper 121.10 Other, including alternative assets 91.78 Total Cash and Investments 1,530.51 Days of Unrestricted Cash on Hand 380.1 Ratio of Unrestricted Cash to Long Term Debt 6.4 Pensions and Benefits MLHS had non-contributory benefit plans for the employees and retirees. Plan benefits are principally based on years of service and the employee s compensation. MLHS policy is to fund annually at least the minimum amount required by the Employee Retirement Income Security Act of 1974. Estimated employer contributions expected during fiscal year 2017 are projected to be approximately $67,322,000. The projected benefit obligation is $1,479,301,000 as of June 30, 2016. The fair value of plan assets was $965,320,000 at June 30, 2016.