CAH Financial Indicators Report: Summary of Indicator Medians by State

Flex Monitoring Team Data Summary Report No. 18: : Summary of Indicator Medians by State March 2016

The Flex Monitoring Team is a consortium of the Rural Health Research Centers located at the Universities of Minnesota, North Carolina at Chapel Hill, and Southern Maine. Under contract with the federal Office of Rural Health Policy (PHS Grant No. U27RH01080), the Flex Monitoring Team is cooperatively conducting a performance monitoring project for the Medicare Rural Hospital Flexibility Program (Flex Program). The monitoring project is assessing the impact of the Flex Program on rural hospitals and communities and the role of states in achieving overall program objectives, including improving access to and the quality of health care services; improving the financial performance of Critical Access Hospitals; and engaging rural communities in health care system development. The authors of this report are the Team at the North Carolina Rural Health Research and Policy Analysis Center, Cecil G. Sheps Center for Health Services Research. Email: CAH.finance@schsr.unc.edu Flex Monitoring Team http://www.flexmonitoring.org University of Minnesota Division of Health Services Research & Policy 420 Delaware Street, SE, Mayo Mail Code 729 Minneapolis, MN 55455-0392 612.624.8618 University of North Carolina at Chapel Hill Cecil B. Sheps Center for Health Services Research 725 Martin Luther King, Jr. Boulevard, CB #7590 Chapel Hill, NC 27599-7590 919.966.5541 University of Southern Maine Muskie School of Public Service PO Box 9300 Portland, ME 04104-9300 207.780.4435 2010, University of North Carolina at Chapel Hill, for use in the public domain.

The Medicare Rural Hospital Flexibility Program The Medicare Rural Hospital Flexibility Program (Flex Program), created by Congress in 1997, allows small hospitals to be licensed as Critical Access Hospitals (CAHs) and offers grants to States to help implement initiatives to strengthen the rural health care infrastructure. To participate in the Flex Program, States are required to develop a rural health care plan that provides for the creation of one or more rural health networks, promotes regionalization of rural health services in the State, and improves the quality of and access to hospital and other health services for rural residents of the State. Consistent with their rural health care plans, states may designate eligible rural hospitals as CAHs. CAHs must be located in a rural area or an area treated as rural; be more than 35 miles (or 15 miles in areas with mountainous terrain or only secondary roads available) from another hospital, or be certified before January 1, 2006 by the State as being a necessary provider of heath care services. CAHs are required to make available 24-hour emergency care services that a State determines are necessary. CAHs may have a maximum of 25 acute care and swing beds, and must maintain an annual average length of stay of 96 hours or less for their acute care patients. CAHs are reimbursed by Medicare on a cost basis (i.e., for the reasonable costs of providing inpatient, outpatient, and swing bed services). The legislative authority for the Flex Program and cost-based reimbursement for CAHs are described in the Social Security Act, Title XVIII, Sections 1814 and 1820, available at http://www.ssa.gov/op_home/ssact/title18/1800.htm. 1

Introduction All hospitals, regardless of size and organizational structure, benefit from comparative data on financial condition and performance. The unique reimbursement and organizational structure of critical access hospitals (CAHs) make it important to have financial indicators that capture their own circumstances for performance assessment. CAHs differ from urban and other rural hospitals that are paid under the Medicare Prospective Payment System (PPS) in important aspects that affect the most appropriate way to measure financial condition. Unlike PPS hospitals, CAHs receive cost-based reimbursement for inpatient and outpatient care, and the incentives, financial management, and utilization practices under these two payment methods differ substantially. There are also organizational differences between CAHs and other hospitals that may affect financial performance; for instance, CAHs have relaxed staffing rules under Medicare, and they have limits on bed-size and average length of stay (and low volume hospitals have been found to face substantially more annual variation in demand for services, making financial planning difficult). This Briefing Paper presents state and national median values of the twenty-two financial indicators included in the, a report that is distributed to each CAH administrator annually. As part of ongoing work of the Flex Monitoring Team, these indicators were specifically designed to capture the financial performance of CAHs. In order to identify the indicators that were most relevant to the financial performance of CAHs, a Technical Advisory Group (TAG) of four individuals knowledgeable in CAH financial and operational issues, data, and reporting practices was selected to provide advice to a research team from the University of North Carolina at Chapel Hill. The TAG evaluated frequently used indicators of hospital financial performance for their applicability to CAHs. 1 Their evaluation relied on three criteria: feasibility (whether the indicator can be accurately calculated from Medicare cost report data 2 ), importance (whether the indicator is an important measure of the financial management of CAHs), and usefulness (whether the indicator is useful to CAH administrators). The TAG retained 13 of the most frequently used indicators from the review. In addition, 7 other financial ratios were added that are not commonly used in the financial assessment of larger hospitals, but that group members believed capture important attributes of CAH financial management. Two more have been added since. The resulting 22 indicators fall under six domains: profitability, liquidity, capital structure, revenue, cost, and utilization. In the pages that follow, a brief description of the domains and the indicators within them is provided, along with a table that allows comparison across states. The Appendix to this report includes the median values for each indicator by state, enabling the values for all indicators for one state to be viewed on a single page. More detailed information about the definition and interpretation of the indicators can be found in the document Briefing Paper No. 7. Financial Indicators for Critical Access Hospitals May 2005 which can be downloaded from the Flex Monitoring Team website: http://www.flexmonitoring.org/publications/bp7/ 1 The list of potential indicators resulted from a review of financial ratios in articles, peer-reviewed journals, and other industry and scientific publications. 2 Medicare cost reports were selected as the data source for calculating indicator values because they are the only national data that use standard definitions, have sufficient detail, and will eventually include data for all CAHs. 2

The following table includes, by state, the total number of Critical Access Hospitals with a Medicare Cost Report for at least 360 days in period, the minimum required to be included in the calculation of medians. The number of CAHs for a particular indicator may be less than the number in the table if there were unusable data for one or more CAHs in the state. State 2013 Number of CAHs State 2013 Number of CAHs AK 9 NC 20 AL 3 ND 34 AR 29 NE 64 AZ 11 NH 13 CA 29 NM 7 CO 29 NV 11 FL 13 NY 13 GA 28 OH 33 HI 9 OK 33 IA 82 OR 25 ID 25 PA 12 IL 50 SC 5 IN 35 SD 37 KS 82 TN 15 KY 27 TX 78 LA 26 UT 11 MA 3 VA 7 ME 15 VT 8 MI 35 WA 38 MN 75 WI 51 MO 34 WV 19 MS 31 WY 16 MT 45 *Median values calculated ONLY for states with post-conversion Medicare Cost Report data for at least 2 critical access hospitals in 2013 3

Profitability Indicators Profitability is the net result of a large number of reimbursement and managerial policies and decisions and it reflects the combined effects of liquidity, asset management, and debt on operating results. Profitability indicators measure the ability to generate the financial return required to replace assets, meet increases in service demands, and compensate investors (in the case of a for-profit organization). Total Margin measures the control of expenses relative to revenues. Total margin formula: Net income Total revenue Cash Flow Margin measures the ability to generate cash flow from providing patient care services. Cash flow margin formula: Net income (Contributions, investments, and appropriations + Depreciation expense + Interest expense) Net patient revenue + Other income Contributions, investments, and appropriations Return on Equity measures the net income generated by equity investment (net assets). Return on equity formula: Net income Net assets Operating margin measures the control of operating expenses relative to operating revenues. Operating margin formula: Net operating income Operating revenue Total Margin Cash Flow Margin Return on Equity Operating Margin State % % % % US 2.51 6.72 5.16 0.99 AK 8.20 10.47 10.81 6.65 AL -5.67-7.55-18.95-13.22 AR -0.22 6.09 2.27-1.39 AZ 4.62 6.68 10.78 1.84 CA 2.33 4.23 5.27 1.15 CO 2.13 2.73 4.03-2.47 FL -2.30 2.00-1.53-3.40 GA 0.89 0.90 12.46-4.09 HI 1.61-19.27 0.80-24.19 IA 2.97 8.82 3.82 1.21 ID 2.66 6.88 6.14-0.02 IL 3.85 9.37 6.15 2.78 IN 3.28 9.62 9.64 4.99 KS -0.90-3.94-3.09-7.90 KY -0.51 2.98 5.07-2.65 LA 2.81 6.43 5.82 2.11 MA 5.70 9.09 3.72 2.65 ME 1.55 4.56 3.72 0.21 MI 2.93 7.51 6.66 2.90 MN 3.20 8.93 5.41 2.87 MO 2.31 8.99 5.48 0.62 MS -0.93 1.53-3.24-3.47 MT 4.06 3.74 7.96-3.40 NC 1.62 6.51 4.00 1.63 ND -0.03 5.59 0.67-0.80 NE 3.84 11.05 4.75 2.59 NH 3.10 9.18 5.45 2.75 NM 1.48 7.88 2.11 4.88 NV 4.34 8.06 11.69 3.21 NY 2.17 5.61 11.35-1.85 OH 4.55 9.49 8.27 4.10 OK 1.31 4.26 5.01-2.41 OR 3.88 5.39 5.76 0.89 PA 4.85 11.76 16.88 3.39 SC -4.32-4.10-6.37-7.55 SD 2.98 8.79 5.16 2.98 TN 0.50 6.23 16.42 0.50 TX 4.57 7.51 11.04 3.52 UT 5.35 13.16 6.82 4.85 VA 9.13 1.56 23.54-2.73 VT 4.82 7.81 9.59 3.23 WA 0.82 3.87 2.71-0.85 WI 4.93 10.09 5.91 3.71 WV 1.73 5.36 7.19 1.22 WY 6.79 8.27 7.18 0.70 4

Liquidity Indicators A liquid asset is one that trades in an active market and hence can be quickly converted to cash at the going market price. An analysis of liquidity asks the question will the organization be able to pay off its debts as they come due over the next year or so? Liquidity indicators measure the ability to meet cash obligations in a timely manner. Current Ratio measures the number of times shortterm obligations can be paid using short-term assets. Current ratio formula: Current assets Current liabilities Days Cash on Hand measures the number of days an organization could operate if no cash was collected or received. Days cash on hand formula: Cash + Marketable securities + Unrestricted investments (Total expenses Depreciation) / Days in period Days Revenue in Accounts Receivable measures the number of days that it takes an organization to collect its receivables. Days revenue in accounts receivable formula: Net patient accounts receivable (Net patient service revenue) / Days in period State Current Ratio Days Cash on Hand Days Revenue in Accounts Receivable Times Days Days US 2.29 68.83 54.20 AK 3.17 37.94 88.42 AL 0.98 28.70 90.36 AR 1.50 11.13 57.33 AZ 2.21 20.55 51.95 CA 2.12 67.82 59.54 CO 3.19 93.70 53.64 FL 1.49 17.07 45.39 GA 2.27 29.15 50.54 HI 2.13 12.15 77.24 IA 2.41 128.89 49.32 ID 2.76 88.43 58.70 IL 2.50 112.82 59.08 IN 2.12 54.58 50.03 KS 2.11 47.21 57.93 KY 1.47 27.67 60.05 LA 4.15 91.98 60.52 MA 1.00 157.45 43.53 ME 1.25 59.72 40.45 MI 1.78 68.61 47.52 MN 2.78 133.79 54.45 MO 2.08 79.11 51.18 MS 1.37 14.18 56.38 MT 2.61 85.97 63.37 NC 1.73 39.53 53.48 ND 2.07 62.92 55.47 NE 3.23 139.84 56.94 NH 1.55 171.55 46.90 NM 3.79 101.45 57.53 NV 2.34 66.02 70.33 NY 1.52 75.28 44.53 OH 2.02 47.46 47.90 OK 2.14 21.58 58.02 OR 2.75 68.92 59.11 PA 1.44 48.68 52.89 SC 1.58 41.08 59.56 SD 2.37 43.59 49.35 TN 1.53 14.22 50.07 TX 2.69 65.33 57.99 UT 4.30 114.17 52.82 VA 2.18 98.34 45.64 VT 1.29 122.99 50.34 WA 2.55 54.97 55.57 WI 2.86 121.25 52.48 WV 1.42 29.13 52.97 WY 3.89 106.89 57.94 5

Capital Structure Indicators The extent to which an organization uses debt financing, or financial leverage, has three important implications. First, debt allows notfor-profit organizations to provide more services than it could if it were financed only by contributed capital and retained earnings. Second, creditors look to the equity to provide a margin of safety, so the higher the proportion of total capital provided by the owners, the less the risk faced by creditors. Third, if the organization earns more on investments financed with borrowed funds than it pays in interest, the return on owner s capital is magnified, or leveraged up. Capital structure indicators measure the extent of debt and equity financing. Equity Financing measures the percentage of total assets financed by equity. Equity financing formula: Net assets Total assets Debt Service Coverage measures the ability to pay obligations related to long-term debt, principal payments and interest expense. Debt service coverage formula: Net income + Depreciation exp. + Interest exp. Current portion of long-term debt * (365 / Days in period) + Interest expense Long-Term Debt to Capitalization measures the percentage of total capital that is debt. Long-term debt to capitalization formula: Long-term debt Long-term debt + Net assets State Equity Financing Debt Service Coverage Long-term Debt to Capitalization % Times % US 60.32 2.73 26.16 AK 80.22 11.66 4.72 AL 37.92-15.14 3.83 AR 59.98 2.84 24.58 AZ 60.25 4.56 19.59 CA 53.99 2.27 34.43 CO 55.76 2.71 35.49 FL 30.23 1.11 50.58 GA 51.67 2.21 35.28 HI 77.24 0.24 6.89 IA 59.62 3.67 29.66 ID 64.34 5.17 16.37 IL 55.39 3.38 30.51 IN 68.87 6.43 23.49 KS 61.32 1.27 20.71 KY 37.76 1.06 46.90 LA 67.33 9.54 16.77 MA 51.76 13.35 32.44 ME 55.34 5.56 32.32 MI 64.43 1.94 22.69 MN 62.20 3.09 29.48 MO 62.20 2.54 28.86 MS 53.39 2.05 18.94 MT 64.51 3.02 20.92 NC 62.56 3.39 27.78 ND 58.24 2.12 28.99 NE 64.90 2.81 26.43 NH 54.29 4.20 35.57 NM 88.30 0.24 0.00 NV 77.08 2.83 9.42 NY 47.97 4.13 38.46 OH 70.11 2.26 14.95 OK 58.97 1.54 10.78 OR 48.42 3.65 37.49 PA 31.11 3.38 65.04 SC 41.14 0.15 39.23 SD 61.02 2.55 27.78 TN 41.43 3.54 53.31 TX 73.42 1.95 9.55 UT 88.03 2.07 1.72 VA 72.34-0.55 3.74 VT 55.66 6.48 33.97 WA 52.69 2.42 36.25 WI 63.62 3.77 29.00 WV 44.53 2.59 30.86 WY 82.19 5.87 8.27 6

Revenue Indicators Most organizations receive revenues from many sources and relative profitability often varies among sources. A substantial proportion of revenue from commercial and private payers reduces reliance on the fixed margins of Medicare and Medicaid. Revenue indicators measure the amount and mix of different sources of revenue. Outpatient Revenues to Total Revenues measures the percentage of total revenues that are for outpatient revenues (including, for example, Rural Health Clinics, free-standing clinics, and home health clinics). Outpatient revenues to total revenues formula: Total outpatient revenue Total patient revenue Patient Deductions measures the allowances and discounts per dollar of total patient revenues. Patient deductions formula: Contractual allowances and discounts Gross total patient revenue Medicare Inpatient Payer Mix measures the percentage of total inpatient days that are provided to Medicare patients. Medicare inpatient payer mix formula: Medicare inpatient days Total inpatient days Nursery bed days NF Swing bed days Hospital Medicare Outpatient Payer Mix measures the percentage of total outpatient charges that are for Medicare patients. Medicare outpatient payer mix formula: Outpatient Medicare charges Total outpatient charges Hospital Medicare Outpatient Cost to Charge measures outpatient Medicare costs per dollar of outpatient Medicare charges. Medicare outpatient cost to charge formula: Outpatient Medicare costs Outpatient Medicare charges Medicare Acute Inpatient Cost per Day measures the measures the average daily cost of a Medicare acute inpatient. Medicare revenue per day formula: Medicare acute inpatient cost Medicare inpatient days (excl HMO) 7

State Outpatient Revenues to Total Revenues Medicare Patient Inpatient Deductions Payer Mix Medicare Outpatient Payer Mix 8 Medicare Outpatient Cost to Charge Medicare Revenue per Day % % % % % $ US 74.43 39.92 73.01 37.90 0.47 2305 AK 56.24 15.34 60.75 32.33 0.74 3975 AL 67.55 52.02 91.81 39.32 0.42 1251 AR 69.07 49.70 69.91 40.63 0.48 1510 AZ 80.10 55.75 46.18 22.58 0.37 2331 CA 64.83 50.62 57.90 38.89 0.38 3769 CO 74.99 35.46 78.52 40.12 0.51 2794 FL 72.10 69.77 66.63 32.05 0.26 1422 GA 67.25 50.23 65.65 29.51 0.38 1460 HI 55.33 38.22 36.72 12.14 0.76 2430 IA 79.67 34.54 77.67 43.69 0.52 2273 ID 68.04 33.46 65.46 34.94 0.56 2698 IL 81.34 51.02 78.85 41.66 0.37 2079 IN 80.82 56.08 64.80 32.33 0.33 2363 KS 69.92 29.54 86.99 47.67 0.57 1963 KY 77.44 60.42 70.40 34.31 0.33 1458 LA 73.34 50.41 68.42 32.75 0.44 1921 MA 82.61 49.37 70.36 31.92 0.38 2299 ME 76.23 40.06 69.41 41.86 0.49 2420 MI 83.36 43.56 61.98 36.63 0.42 2609 MN 73.69 33.00 65.43 36.70 0.50 2873 MO 77.78 47.74 77.40 41.81 0.39 2086 MS 66.60 37.77 87.87 40.28 0.47 1565 MT 64.91 21.65 74.17 38.93 0.57 2303 NC 74.73 53.30 68.82 42.67 0.36 1944 ND 67.72 22.69 87.70 43.47 0.61 1705 NE 73.54 22.89 81.25 48.27 0.57 2655 NH 79.82 44.34 77.37 38.41 0.43 3065 NM 70.29 48.69 58.33 32.06 0.37 2639 NV 76.08 42.78 57.13 38.28 0.39 3732 NY 73.81 48.35 79.66 28.52 0.44 2116 OH 79.27 52.60 58.83 27.50 0.36 2528 OK 71.05 43.49 83.45 39.04 0.50 1879 OR 75.69 40.53 53.78 37.64 0.52 3572 PA 73.07 54.30 63.66 31.45 0.33 1593 SC 78.17 49.07 58.55 28.15 0.40 1989 SD 70.21 28.74 87.07 48.27 0.53 1925 TN 84.44 65.19 70.45 28.41 0.31 1810 TX 76.38 51.32 73.77 33.15 0.48 2219 UT 72.45 34.05 56.78 26.29 0.51 2507 VA 76.69 62.15 78.41 38.93 0.31 1842 VT 74.12 45.36 64.22 35.30 0.43 2474 WA 75.04 41.93 71.61 36.36 0.50 3361 WI 77.03 41.38 64.86 30.66 0.45 2722 WV 78.40 42.35 68.81 32.49 0.45 1564 WY 66.90 26.70 67.27 40.19 0.60 2793

Cost Indicators Most organizations incur labor, supply, and capital costs. Cost management reduces the likelihood of financial problems due to low productivity, poor inventory management, and excessive asset acquisition costs. Cost indicators measure the amount and mix of different types of costs. Salaries to Net Patient Revenue measures the percentage of patient revenue that are labor costs. Salaries to patient revenue formula: Salary Expense Net Patient Revenue Average Age of Plant measures the average age in years of the fixed assets of an organization. Average age of plant formula: Accumulated depreciation Depreciation expense * (365 / Days in period) FTEs per Adjusted Occupied Bed measures the number of full-time employees per each occupied bed. FTEs per adjusted occupied bed formula: Number of FTEs Adjusted occupied beds 1 1. (Inpatient days NF Swing days Nursery days) * (Total patient revenue / (Total inpatient revenue Inpatient NF revenue Other LTC Revenue)) / Days in period Average Salary per FTE measures the price and mix of labor. Salary Expense Number of FTEs Salaries to Net Patient Revenue Average Age of Plant FTEs per Adjusted Occupied Bed Average Salary per FTE State % Years FTEs Dollars US 45.57 9.77 5.86 50,845 AK 46.63 10.44 12.76 57,940 AL 46.49 13.02 3.25 41,405 AR 47.06 9.18 4.96 42,014 AZ 47.42 10.11 6.07 57,096 CA 41.52 11.13 10.34 59,647 CO 48.93 8.16 7.85 54,854 FL 51.97 6.02 4.31 53,287 GA 45.87 12.90 6.35 43,677 HI 63.76 13.80 6.40 58,104 IA 42.31 8.78 5.27 49,728 ID 47.52 9.30 9.43 54,168 IL 40.07 9.06 4.86 48,370 IN 39.99 7.94 5.22 53,834 KS 52.62 10.46 5.90 45,342 KY 43.57 7.38 4.16 46,360 LA 53.72 9.02 4.82 46,999 MA 46.71 9.31 3.66 84,274 ME 49.49 12.31 6.32 63,577 MI 43.60 14.37 5.85 56,424 MN 42.15 10.46 7.30 56,193 MO 42.26 7.90 4.88 49,220 MS 43.49 4.45 4.99 48,200 MT 53.17 12.75 10.15 48,179 NC 41.03 10.61 5.39 50,537 ND 49.58 12.38 6.29 45,696 NE 46.00 7.34 6.62 50,738 NH 43.12 11.29 6.24 63,981 NM 41.90 5.78 5.82 59,572 NV 38.81 10.60 7.52 61,524 NY 53.76 10.58 3.99 47,212 OH 37.94 10.84 5.41 51,989 OK 44.06 7.42 4.76 47,215 OR 46.14 9.16 7.27 73,082 PA 42.76 12.28 6.34 48,854 SC 48.76 23.03 5.20 50,315 SD 47.95 10.39 5.72 48,350 TN 46.18 7.38 3.40 46,380 TX 49.88 9.33 4.84 44,496 UT 38.22 11.79 5.31 58,654 VA 36.52 8.09 3.70 57,973 VT 49.10 9.44 7.08 69,924 WA 50.47 11.77 6.72 65,970 WI 39.61 10.46 6.40 61,089 WV 46.61 10.08 5.47 46,283 WY 49.43 10.09 11.91 55,828 9

Utilization Indicators Overhead costs are incurred on all assets, whether used or not. More patient activity generates higher revenues and reduces unit costs by spreading fixed costs over more patients. Utilization indicators measure the extent to which fixed assets (beds) are fully occupied. Average Daily Census Swing-SNF Beds measures the average number of swing-snf beds occupied per day. Average daily census swing-snf beds formula: Inpatient swing bed SNF days Days in period Average Daily Census Acute Beds measures the average number of acute care beds occupied per day. Average daily census acute beds formula: Inpatient acute care bed days Days in period State Swing-SNF Beds Days Acute Beds Days US 1.52 3.22 AK 0.86 1.23 AL 4.77 1.52 AR 1.38 5.82 AZ 0.60 3.44 CA 0.37 5.57 CO 1.42 1.98 FL 0.64 5.31 GA 1.98 3.01 HI 0.59 0.05 IA 1.99 2.99 ID 0.78 2.76 IL 1.65 4.49 IN 1.03 6.85 KS 2.02 1.78 KY 2.29 6.05 LA 2.17 4.01 MA 1.47 8.70 ME 2.58 7.81 MI 0.05 4.29 MN 1.11 2.63 MO 2.18 4.32 MS 4.66 3.25 MT 1.34 1.24 NC 1.51 5.92 ND 1.57 1.28 NE 1.53 2.04 NH 3.87 7.67 NM 0.54 5.36 NV 0.44 5.16 NY 2.87 2.02 OH 1.93 6.63 OK 1.59 2.01 OR 0.74 6.38 PA 1.51 6.70 SC 2.56 2.89 SD 1.66 1.42 TN 1.96 3.03 TX 1.49 2.27 UT 1.53 2.45 VA 2.94 4.96 VT 0.77 11.63 WA 1.11 2.94 WI 1.16 4.68 WV 1.67 3.51 WY 0.98 3.50 10

Appendix 2013 Median indicator values by state 11

2013 Median Indicator Values for Alabama and the United States Indicator AL US Total Margin -5.67 2.51 Cash Flow Margin -7.55 6.72 Return on Equity -18.95 5.16 Operating Margin -13.22 0.99 Current Ratio 0.98 2.29 Days Cash on Hand 28.70 68.83 Net Days Revenue in Accounts Receivable 90.36 54.20 Equity Financing 37.92 60.32 Debt Service Coverage -15.14 2.73 Long-Term Debt to Capitalization 3.83 26.16 Outpatient Revenues to Total Revenues 67.55 74.43 Patient Deductions 52.02 39.92 Medicare Inpatient Payer Mix 91.81 73.01 Medicare Outpatient Payer Mix 39.32 37.90 Medicare Outpatient Cost to Charge 0.42 0.47 Medicare Revenue per Day 1251 2305 Salaries to Net Patient Revenue 46.49 45.57 Average Age of Plant 13.02 9.77 FTEs per Adjusted Occupied Bed 3.25 5.86 Average Salary per FTE 41405 50845 Average Daily Census Swing-SNF Beds 4.77 1.52 Average Daily Census Acute Beds 1.52 3.22 Number of Included CAHs 3 1275

2013 Median Indicator Values for Alaska and the United States Indicator AK US Total Margin 8.20 2.51 Cash Flow Margin 10.47 6.72 Return on Equity 10.81 5.16 Operating Margin 6.65 0.99 Current Ratio 3.17 2.29 Days Cash on Hand 37.94 68.83 Net Days Revenue in Accounts Receivable 88.42 54.20 Equity Financing 80.22 60.32 Debt Service Coverage 11.66 2.73 Long-Term Debt to Capitalization 4.72 26.16 Outpatient Revenues to Total Revenues 56.24 74.43 Patient Deductions 15.34 39.92 Medicare Inpatient Payer Mix 60.75 73.01 Medicare Outpatient Payer Mix 32.33 37.90 Medicare Outpatient Cost to Charge 0.74 0.47 Medicare Revenue per Day 3975 2305 Salaries to Net Patient Revenue 46.63 45.57 Average Age of Plant 10.44 9.77 FTEs per Adjusted Occupied Bed 12.76 5.86 Average Salary per FTE 57940 50845 Average Daily Census Swing-SNF Beds 0.86 1.52 Average Daily Census Acute Beds 1.23 3.22 Number of Included CAHs 9 1275

2013 Median Indicator Values for Arizona and the United States Indicator AZ US Total Margin 4.62 2.51 Cash Flow Margin 6.68 6.72 Return on Equity 10.78 5.16 Operating Margin 1.84 0.99 Current Ratio 2.21 2.29 Days Cash on Hand 20.55 68.83 Net Days Revenue in Accounts Receivable 51.95 54.20 Equity Financing 60.25 60.32 Debt Service Coverage 4.56 2.73 Long-Term Debt to Capitalization 19.59 26.16 Outpatient Revenues to Total Revenues 80.10 74.43 Patient Deductions 55.75 39.92 Medicare Inpatient Payer Mix 46.18 73.01 Medicare Outpatient Payer Mix 22.58 37.90 Medicare Outpatient Cost to Charge 0.37 0.47 Medicare Revenue per Day 2331 2305 Salaries to Net Patient Revenue 47.42 45.57 Average Age of Plant 10.11 9.77 FTEs per Adjusted Occupied Bed 6.07 5.86 Average Salary per FTE 57096 50845 Average Daily Census Swing-SNF Beds 0.60 1.52 Average Daily Census Acute Beds 3.44 3.22 Number of Included CAHs 11 1275

2013 Median Indicator Values for Arkansas and the United States Indicator AR US Total Margin -0.22 2.51 Cash Flow Margin 6.09 6.72 Return on Equity 2.27 5.16 Operating Margin -1.39 0.99 Current Ratio 1.50 2.29 Days Cash on Hand 11.13 68.83 Net Days Revenue in Accounts Receivable 57.33 54.20 Equity Financing 59.98 60.32 Debt Service Coverage 2.84 2.73 Long-Term Debt to Capitalization 24.58 26.16 Outpatient Revenues to Total Revenues 69.07 74.43 Patient Deductions 49.70 39.92 Medicare Inpatient Payer Mix 69.91 73.01 Medicare Outpatient Payer Mix 40.63 37.90 Medicare Outpatient Cost to Charge 0.48 0.47 Medicare Revenue per Day 1510 2305 Salaries to Net Patient Revenue 47.06 45.57 Average Age of Plant 9.18 9.77 FTEs per Adjusted Occupied Bed 4.96 5.86 Average Salary per FTE 42014 50845 Average Daily Census Swing-SNF Beds 1.38 1.52 Average Daily Census Acute Beds 5.82 3.22 Number of Included CAHs 29 1275

2013 Median Indicator Values for California and the United States Indicator CA US Total Margin 2.33 2.51 Cash Flow Margin 4.23 6.72 Return on Equity 5.27 5.16 Operating Margin 1.15 0.99 Current Ratio 2.12 2.29 Days Cash on Hand 67.82 68.83 Net Days Revenue in Accounts Receivable 59.54 54.20 Equity Financing 53.99 60.32 Debt Service Coverage 2.27 2.73 Long-Term Debt to Capitalization 34.43 26.16 Outpatient Revenues to Total Revenues 64.83 74.43 Patient Deductions 50.62 39.92 Medicare Inpatient Payer Mix 57.90 73.01 Medicare Outpatient Payer Mix 38.89 37.90 Medicare Outpatient Cost to Charge 0.38 0.47 Medicare Revenue per Day 3769 2305 Salaries to Net Patient Revenue 41.52 45.57 Average Age of Plant 11.13 9.77 FTEs per Adjusted Occupied Bed 10.34 5.86 Average Salary per FTE 59647 50845 Average Daily Census Swing-SNF Beds 0.37 1.52 Average Daily Census Acute Beds 5.57 3.22 Number of Included CAHs 29 1275

2013 Median Indicator Values for Colorado and the United States Indicator CO US Total Margin 2.13 2.51 Cash Flow Margin 2.73 6.72 Return on Equity 4.03 5.16 Operating Margin -2.47 0.99 Current Ratio 3.19 2.29 Days Cash on Hand 93.70 68.83 Net Days Revenue in Accounts Receivable 53.64 54.20 Equity Financing 55.76 60.32 Debt Service Coverage 2.71 2.73 Long-Term Debt to Capitalization 35.49 26.16 Outpatient Revenues to Total Revenues 74.99 74.43 Patient Deductions 35.46 39.92 Medicare Inpatient Payer Mix 78.52 73.01 Medicare Outpatient Payer Mix 40.12 37.90 Medicare Outpatient Cost to Charge 0.51 0.47 Medicare Revenue per Day 2794 2305 Salaries to Net Patient Revenue 48.93 45.57 Average Age of Plant 8.16 9.77 FTEs per Adjusted Occupied Bed 7.85 5.86 Average Salary per FTE 54854 50845 Average Daily Census Swing-SNF Beds 1.42 1.52 Average Daily Census Acute Beds 1.98 3.22 Number of Included CAHs 29 1275

2013 Median Indicator Values for Florida and the United States Indicator FL US Total Margin -2.30 2.51 Cash Flow Margin 2.00 6.72 Return on Equity -1.53 5.16 Operating Margin -3.40 0.99 Current Ratio 1.49 2.29 Days Cash on Hand 17.07 68.83 Net Days Revenue in Accounts Receivable 45.39 54.20 Equity Financing 30.23 60.32 Debt Service Coverage 1.11 2.73 Long-Term Debt to Capitalization 50.58 26.16 Outpatient Revenues to Total Revenues 72.10 74.43 Patient Deductions 69.77 39.92 Medicare Inpatient Payer Mix 66.63 73.01 Medicare Outpatient Payer Mix 32.05 37.90 Medicare Outpatient Cost to Charge 0.26 0.47 Medicare Revenue per Day 1422 2305 Salaries to Net Patient Revenue 51.97 45.57 Average Age of Plant 6.02 9.77 FTEs per Adjusted Occupied Bed 4.31 5.86 Average Salary per FTE 53287 50845 Average Daily Census Swing-SNF Beds 0.64 1.52 Average Daily Census Acute Beds 5.31 3.22 Number of Included CAHs 13 1275

2013 Median Indicator Values for Georgia and the United States Indicator GA US Total Margin 0.89 2.51 Cash Flow Margin 0.90 6.72 Return on Equity 12.46 5.16 Operating Margin -4.09 0.99 Current Ratio 2.27 2.29 Days Cash on Hand 29.15 68.83 Net Days Revenue in Accounts Receivable 50.54 54.20 Equity Financing 51.67 60.32 Debt Service Coverage 2.21 2.73 Long-Term Debt to Capitalization 35.28 26.16 Outpatient Revenues to Total Revenues 67.25 74.43 Patient Deductions 50.23 39.92 Medicare Inpatient Payer Mix 65.65 73.01 Medicare Outpatient Payer Mix 29.51 37.90 Medicare Outpatient Cost to Charge 0.38 0.47 Medicare Revenue per Day 1460 2305 Salaries to Net Patient Revenue 45.87 45.57 Average Age of Plant 12.90 9.77 FTEs per Adjusted Occupied Bed 6.35 5.86 Average Salary per FTE 43677 50845 Average Daily Census Swing-SNF Beds 1.98 1.52 Average Daily Census Acute Beds 3.01 3.22 Number of Included CAHs 28 1275

2013 Median Indicator Values for Hawaii and the United States Indicator HI US Total Margin 1.61 2.51 Cash Flow Margin -19.27 6.72 Return on Equity 0.80 5.16 Operating Margin -24.19 0.99 Current Ratio 2.13 2.29 Days Cash on Hand 12.15 68.83 Net Days Revenue in Accounts Receivable 77.24 54.20 Equity Financing 77.24 60.32 Debt Service Coverage 0.24 2.73 Long-Term Debt to Capitalization 6.89 26.16 Outpatient Revenues to Total Revenues 55.33 74.43 Patient Deductions 38.22 39.92 Medicare Inpatient Payer Mix 36.72 73.01 Medicare Outpatient Payer Mix 12.14 37.90 Medicare Outpatient Cost to Charge 0.76 0.47 Medicare Revenue per Day 2430 2305 Salaries to Net Patient Revenue 63.76 45.57 Average Age of Plant 13.80 9.77 FTEs per Adjusted Occupied Bed 6.40 5.86 Average Salary per FTE 58104 50845 Average Daily Census Swing-SNF Beds 0.59 1.52 Average Daily Census Acute Beds 0.05 3.22 Number of Included CAHs 9 1275

2013 Median Indicator Values for Idaho and the United States Indicator ID US Total Margin 2.66 2.51 Cash Flow Margin 6.88 6.72 Return on Equity 6.14 5.16 Operating Margin -0.02 0.99 Current Ratio 2.76 2.29 Days Cash on Hand 88.43 68.83 Net Days Revenue in Accounts Receivable 58.70 54.20 Equity Financing 64.34 60.32 Debt Service Coverage 5.17 2.73 Long-Term Debt to Capitalization 16.37 26.16 Outpatient Revenues to Total Revenues 68.04 74.43 Patient Deductions 33.46 39.92 Medicare Inpatient Payer Mix 65.46 73.01 Medicare Outpatient Payer Mix 34.94 37.90 Medicare Outpatient Cost to Charge 0.56 0.47 Medicare Revenue per Day 2698 2305 Salaries to Net Patient Revenue 47.52 45.57 Average Age of Plant 9.30 9.77 FTEs per Adjusted Occupied Bed 9.43 5.86 Average Salary per FTE 54168 50845 Average Daily Census Swing-SNF Beds 0.78 1.52 Average Daily Census Acute Beds 2.76 3.22 Number of Included CAHs 25 1275

2013 Median Indicator Values for Illinois and the United States Indicator IL US Total Margin 3.85 2.51 Cash Flow Margin 9.37 6.72 Return on Equity 6.15 5.16 Operating Margin 2.78 0.99 Current Ratio 2.50 2.29 Days Cash on Hand 112.82 68.83 Net Days Revenue in Accounts Receivable 59.08 54.20 Equity Financing 55.39 60.32 Debt Service Coverage 3.38 2.73 Long-Term Debt to Capitalization 30.51 26.16 Outpatient Revenues to Total Revenues 81.34 74.43 Patient Deductions 51.02 39.92 Medicare Inpatient Payer Mix 78.85 73.01 Medicare Outpatient Payer Mix 41.66 37.90 Medicare Outpatient Cost to Charge 0.37 0.47 Medicare Revenue per Day 2079 2305 Salaries to Net Patient Revenue 40.07 45.57 Average Age of Plant 9.06 9.77 FTEs per Adjusted Occupied Bed 4.86 5.86 Average Salary per FTE 48370 50845 Average Daily Census Swing-SNF Beds 1.65 1.52 Average Daily Census Acute Beds 4.49 3.22 Number of Included CAHs 50 1275

2013 Median Indicator Values for Indiana and the United States Indicator IN US Total Margin 3.28 2.51 Cash Flow Margin 9.62 6.72 Return on Equity 9.64 5.16 Operating Margin 4.99 0.99 Current Ratio 2.12 2.29 Days Cash on Hand 54.58 68.83 Net Days Revenue in Accounts Receivable 50.03 54.20 Equity Financing 68.87 60.32 Debt Service Coverage 6.43 2.73 Long-Term Debt to Capitalization 23.49 26.16 Outpatient Revenues to Total Revenues 80.82 74.43 Patient Deductions 56.08 39.92 Medicare Inpatient Payer Mix 64.80 73.01 Medicare Outpatient Payer Mix 32.33 37.90 Medicare Outpatient Cost to Charge 0.33 0.47 Medicare Revenue per Day 2363 2305 Salaries to Net Patient Revenue 39.99 45.57 Average Age of Plant 7.94 9.77 FTEs per Adjusted Occupied Bed 5.22 5.86 Average Salary per FTE 53834 50845 Average Daily Census Swing-SNF Beds 1.03 1.52 Average Daily Census Acute Beds 6.85 3.22 Number of Included CAHs 35 1275

2013 Median Indicator Values for Iowa and the United States Indicator IA US Total Margin 2.97 2.51 Cash Flow Margin 8.82 6.72 Return on Equity 3.82 5.16 Operating Margin 1.21 0.99 Current Ratio 2.41 2.29 Days Cash on Hand 128.89 68.83 Net Days Revenue in Accounts Receivable 49.32 54.20 Equity Financing 59.62 60.32 Debt Service Coverage 3.67 2.73 Long-Term Debt to Capitalization 29.66 26.16 Outpatient Revenues to Total Revenues 79.67 74.43 Patient Deductions 34.54 39.92 Medicare Inpatient Payer Mix 77.67 73.01 Medicare Outpatient Payer Mix 43.69 37.90 Medicare Outpatient Cost to Charge 0.52 0.47 Medicare Revenue per Day 2273 2305 Salaries to Net Patient Revenue 42.31 45.57 Average Age of Plant 8.78 9.77 FTEs per Adjusted Occupied Bed 5.27 5.86 Average Salary per FTE 49728 50845 Average Daily Census Swing-SNF Beds 1.99 1.52 Average Daily Census Acute Beds 2.99 3.22 Number of Included CAHs 82 1275

2013 Median Indicator Values for Kansas and the United States Indicator KS US Total Margin -0.90 2.51 Cash Flow Margin -3.94 6.72 Return on Equity -3.09 5.16 Operating Margin -7.90 0.99 Current Ratio 2.11 2.29 Days Cash on Hand 47.21 68.83 Net Days Revenue in Accounts Receivable 57.93 54.20 Equity Financing 61.32 60.32 Debt Service Coverage 1.27 2.73 Long-Term Debt to Capitalization 20.71 26.16 Outpatient Revenues to Total Revenues 69.92 74.43 Patient Deductions 29.54 39.92 Medicare Inpatient Payer Mix 86.99 73.01 Medicare Outpatient Payer Mix 47.67 37.90 Medicare Outpatient Cost to Charge 0.57 0.47 Medicare Revenue per Day 1963 2305 Salaries to Net Patient Revenue 52.62 45.57 Average Age of Plant 10.46 9.77 FTEs per Adjusted Occupied Bed 5.90 5.86 Average Salary per FTE 45342 50845 Average Daily Census Swing-SNF Beds 2.02 1.52 Average Daily Census Acute Beds 1.78 3.22 Number of Included CAHs 82 1275

2013 Median Indicator Values for Kentucky and the United States Indicator KY US Total Margin -0.51 2.51 Cash Flow Margin 2.98 6.72 Return on Equity 5.07 5.16 Operating Margin -2.65 0.99 Current Ratio 1.47 2.29 Days Cash on Hand 27.67 68.83 Net Days Revenue in Accounts Receivable 60.05 54.20 Equity Financing 37.76 60.32 Debt Service Coverage 1.06 2.73 Long-Term Debt to Capitalization 46.90 26.16 Outpatient Revenues to Total Revenues 77.44 74.43 Patient Deductions 60.42 39.92 Medicare Inpatient Payer Mix 70.40 73.01 Medicare Outpatient Payer Mix 34.31 37.90 Medicare Outpatient Cost to Charge 0.33 0.47 Medicare Revenue per Day 1458 2305 Salaries to Net Patient Revenue 43.57 45.57 Average Age of Plant 7.38 9.77 FTEs per Adjusted Occupied Bed 4.16 5.86 Average Salary per FTE 46360 50845 Average Daily Census Swing-SNF Beds 2.29 1.52 Average Daily Census Acute Beds 6.05 3.22 Number of Included CAHs 27 1275

2013 Median Indicator Values for Louisiana and the United States Indicator LA US Total Margin 2.81 2.51 Cash Flow Margin 6.43 6.72 Return on Equity 5.82 5.16 Operating Margin 2.11 0.99 Current Ratio 4.15 2.29 Days Cash on Hand 91.98 68.83 Net Days Revenue in Accounts Receivable 60.52 54.20 Equity Financing 67.33 60.32 Debt Service Coverage 9.54 2.73 Long-Term Debt to Capitalization 16.77 26.16 Outpatient Revenues to Total Revenues 73.34 74.43 Patient Deductions 50.41 39.92 Medicare Inpatient Payer Mix 68.42 73.01 Medicare Outpatient Payer Mix 32.75 37.90 Medicare Outpatient Cost to Charge 0.44 0.47 Medicare Revenue per Day 1921 2305 Salaries to Net Patient Revenue 53.72 45.57 Average Age of Plant 9.02 9.77 FTEs per Adjusted Occupied Bed 4.82 5.86 Average Salary per FTE 46999 50845 Average Daily Census Swing-SNF Beds 2.17 1.52 Average Daily Census Acute Beds 4.01 3.22 Number of Included CAHs 26 1275

2013 Median Indicator Values for Maine and the United States Indicator ME US Total Margin 1.55 2.51 Cash Flow Margin 4.56 6.72 Return on Equity 3.72 5.16 Operating Margin 0.21 0.99 Current Ratio 1.25 2.29 Days Cash on Hand 59.72 68.83 Net Days Revenue in Accounts Receivable 40.45 54.20 Equity Financing 55.34 60.32 Debt Service Coverage 5.56 2.73 Long-Term Debt to Capitalization 32.32 26.16 Outpatient Revenues to Total Revenues 76.23 74.43 Patient Deductions 40.06 39.92 Medicare Inpatient Payer Mix 69.41 73.01 Medicare Outpatient Payer Mix 41.86 37.90 Medicare Outpatient Cost to Charge 0.49 0.47 Medicare Revenue per Day 2420 2305 Salaries to Net Patient Revenue 49.49 45.57 Average Age of Plant 12.31 9.77 FTEs per Adjusted Occupied Bed 6.32 5.86 Average Salary per FTE 63577 50845 Average Daily Census Swing-SNF Beds 2.58 1.52 Average Daily Census Acute Beds 7.81 3.22 Number of Included CAHs 15 1275

2013 Median Indicator Values for Massachusetts and the United States Indicator MA US Total Margin 5.70 2.51 Cash Flow Margin 9.09 6.72 Return on Equity 3.72 5.16 Operating Margin 2.65 0.99 Current Ratio 1.00 2.29 Days Cash on Hand 157.45 68.83 Net Days Revenue in Accounts Receivable 43.53 54.20 Equity Financing 51.76 60.32 Debt Service Coverage 13.35 2.73 Long-Term Debt to Capitalization 32.44 26.16 Outpatient Revenues to Total Revenues 82.61 74.43 Patient Deductions 49.37 39.92 Medicare Inpatient Payer Mix 70.36 73.01 Medicare Outpatient Payer Mix 31.92 37.90 Medicare Outpatient Cost to Charge 0.38 0.47 Medicare Revenue per Day 2299 2305 Salaries to Net Patient Revenue 46.71 45.57 Average Age of Plant 9.31 9.77 FTEs per Adjusted Occupied Bed 3.66 5.86 Average Salary per FTE 84274 50845 Average Daily Census Swing-SNF Beds 1.47 1.52 Average Daily Census Acute Beds 8.70 3.22 Number of Included CAHs 3 1275

2013 Median Indicator Values for Michigan and the United States Indicator MI US Total Margin 2.93 2.51 Cash Flow Margin 7.51 6.72 Return on Equity 6.66 5.16 Operating Margin 2.90 0.99 Current Ratio 1.78 2.29 Days Cash on Hand 68.61 68.83 Net Days Revenue in Accounts Receivable 47.52 54.20 Equity Financing 64.43 60.32 Debt Service Coverage 1.94 2.73 Long-Term Debt to Capitalization 22.69 26.16 Outpatient Revenues to Total Revenues 83.36 74.43 Patient Deductions 43.56 39.92 Medicare Inpatient Payer Mix 61.98 73.01 Medicare Outpatient Payer Mix 36.63 37.90 Medicare Outpatient Cost to Charge 0.42 0.47 Medicare Revenue per Day 2609 2305 Salaries to Net Patient Revenue 43.60 45.57 Average Age of Plant 14.37 9.77 FTEs per Adjusted Occupied Bed 5.85 5.86 Average Salary per FTE 56424 50845 Average Daily Census Swing-SNF Beds 0.05 1.52 Average Daily Census Acute Beds 4.29 3.22 Number of Included CAHs 35 1275

2013 Median Indicator Values for Minnesota and the United States Indicator MN US Total Margin 3.20 2.51 Cash Flow Margin 8.93 6.72 Return on Equity 5.41 5.16 Operating Margin 2.87 0.99 Current Ratio 2.78 2.29 Days Cash on Hand 133.79 68.83 Net Days Revenue in Accounts Receivable 54.45 54.20 Equity Financing 62.20 60.32 Debt Service Coverage 3.09 2.73 Long-Term Debt to Capitalization 29.48 26.16 Outpatient Revenues to Total Revenues 73.69 74.43 Patient Deductions 33.00 39.92 Medicare Inpatient Payer Mix 65.43 73.01 Medicare Outpatient Payer Mix 36.70 37.90 Medicare Outpatient Cost to Charge 0.50 0.47 Medicare Revenue per Day 2873 2305 Salaries to Net Patient Revenue 42.15 45.57 Average Age of Plant 10.46 9.77 FTEs per Adjusted Occupied Bed 7.30 5.86 Average Salary per FTE 56193 50845 Average Daily Census Swing-SNF Beds 1.11 1.52 Average Daily Census Acute Beds 2.63 3.22 Number of Included CAHs 75 1275

2013 Median Indicator Values for Mississippi and the United States Indicator MS US Total Margin -0.93 2.51 Cash Flow Margin 1.53 6.72 Return on Equity -3.24 5.16 Operating Margin -3.47 0.99 Current Ratio 1.37 2.29 Days Cash on Hand 14.18 68.83 Net Days Revenue in Accounts Receivable 56.38 54.20 Equity Financing 53.39 60.32 Debt Service Coverage 2.05 2.73 Long-Term Debt to Capitalization 18.94 26.16 Outpatient Revenues to Total Revenues 66.60 74.43 Patient Deductions 37.77 39.92 Medicare Inpatient Payer Mix 87.87 73.01 Medicare Outpatient Payer Mix 40.28 37.90 Medicare Outpatient Cost to Charge 0.47 0.47 Medicare Revenue per Day 1565 2305 Salaries to Net Patient Revenue 43.49 45.57 Average Age of Plant 4.45 9.77 FTEs per Adjusted Occupied Bed 4.99 5.86 Average Salary per FTE 48200 50845 Average Daily Census Swing-SNF Beds 4.66 1.52 Average Daily Census Acute Beds 3.25 3.22 Number of Included CAHs 31 1275

2013 Median Indicator Values for Missouri and the United States Indicator MO US Total Margin 2.31 2.51 Cash Flow Margin 8.99 6.72 Return on Equity 5.48 5.16 Operating Margin 0.62 0.99 Current Ratio 2.08 2.29 Days Cash on Hand 79.11 68.83 Net Days Revenue in Accounts Receivable 51.18 54.20 Equity Financing 62.20 60.32 Debt Service Coverage 2.54 2.73 Long-Term Debt to Capitalization 28.86 26.16 Outpatient Revenues to Total Revenues 77.78 74.43 Patient Deductions 47.74 39.92 Medicare Inpatient Payer Mix 77.40 73.01 Medicare Outpatient Payer Mix 41.81 37.90 Medicare Outpatient Cost to Charge 0.39 0.47 Medicare Revenue per Day 2086 2305 Salaries to Net Patient Revenue 42.26 45.57 Average Age of Plant 7.90 9.77 FTEs per Adjusted Occupied Bed 4.88 5.86 Average Salary per FTE 49220 50845 Average Daily Census Swing-SNF Beds 2.18 1.52 Average Daily Census Acute Beds 4.32 3.22 Number of Included CAHs 34 1275

2013 Median Indicator Values for Montana and the United States Indicator MT US Total Margin 4.06 2.51 Cash Flow Margin 3.74 6.72 Return on Equity 7.96 5.16 Operating Margin -3.40 0.99 Current Ratio 2.61 2.29 Days Cash on Hand 85.97 68.83 Net Days Revenue in Accounts Receivable 63.37 54.20 Equity Financing 64.51 60.32 Debt Service Coverage 3.02 2.73 Long-Term Debt to Capitalization 20.92 26.16 Outpatient Revenues to Total Revenues 64.91 74.43 Patient Deductions 21.65 39.92 Medicare Inpatient Payer Mix 74.17 73.01 Medicare Outpatient Payer Mix 38.93 37.90 Medicare Outpatient Cost to Charge 0.57 0.47 Medicare Revenue per Day 2303 2305 Salaries to Net Patient Revenue 53.17 45.57 Average Age of Plant 12.75 9.77 FTEs per Adjusted Occupied Bed 10.15 5.86 Average Salary per FTE 48179 50845 Average Daily Census Swing-SNF Beds 1.34 1.52 Average Daily Census Acute Beds 1.24 3.22 Number of Included CAHs 45 1275

2013 Median Indicator Values for Nebraska and the United States Indicator NE US Total Margin 3.84 2.51 Cash Flow Margin 11.05 6.72 Return on Equity 4.75 5.16 Operating Margin 2.59 0.99 Current Ratio 3.23 2.29 Days Cash on Hand 139.84 68.83 Net Days Revenue in Accounts Receivable 56.94 54.20 Equity Financing 64.90 60.32 Debt Service Coverage 2.81 2.73 Long-Term Debt to Capitalization 26.43 26.16 Outpatient Revenues to Total Revenues 73.54 74.43 Patient Deductions 22.89 39.92 Medicare Inpatient Payer Mix 81.25 73.01 Medicare Outpatient Payer Mix 48.27 37.90 Medicare Outpatient Cost to Charge 0.57 0.47 Medicare Revenue per Day 2655 2305 Salaries to Net Patient Revenue 46.00 45.57 Average Age of Plant 7.34 9.77 FTEs per Adjusted Occupied Bed 6.62 5.86 Average Salary per FTE 50738 50845 Average Daily Census Swing-SNF Beds 1.53 1.52 Average Daily Census Acute Beds 2.04 3.22 Number of Included CAHs 64 1275

2013 Median Indicator Values for Nevada and the United States Indicator NV US Total Margin 4.34 2.51 Cash Flow Margin 8.06 6.72 Return on Equity 11.69 5.16 Operating Margin 3.21 0.99 Current Ratio 2.34 2.29 Days Cash on Hand 66.02 68.83 Net Days Revenue in Accounts Receivable 70.33 54.20 Equity Financing 77.08 60.32 Debt Service Coverage 2.83 2.73 Long-Term Debt to Capitalization 9.42 26.16 Outpatient Revenues to Total Revenues 76.08 74.43 Patient Deductions 42.78 39.92 Medicare Inpatient Payer Mix 57.13 73.01 Medicare Outpatient Payer Mix 38.28 37.90 Medicare Outpatient Cost to Charge 0.39 0.47 Medicare Revenue per Day 3732 2305 Salaries to Net Patient Revenue 38.81 45.57 Average Age of Plant 10.60 9.77 FTEs per Adjusted Occupied Bed 7.52 5.86 Average Salary per FTE 61524 50845 Average Daily Census Swing-SNF Beds 0.44 1.52 Average Daily Census Acute Beds 5.16 3.22 Number of Included CAHs 11 1275

2013 Median Indicator Values for New Hampshire and the United States Indicator NH US Total Margin 3.10 2.51 Cash Flow Margin 9.18 6.72 Return on Equity 5.45 5.16 Operating Margin 2.75 0.99 Current Ratio 1.55 2.29 Days Cash on Hand 171.55 68.83 Net Days Revenue in Accounts Receivable 46.90 54.20 Equity Financing 54.29 60.32 Debt Service Coverage 4.20 2.73 Long-Term Debt to Capitalization 35.57 26.16 Outpatient Revenues to Total Revenues 79.82 74.43 Patient Deductions 44.34 39.92 Medicare Inpatient Payer Mix 77.37 73.01 Medicare Outpatient Payer Mix 38.41 37.90 Medicare Outpatient Cost to Charge 0.43 0.47 Medicare Revenue per Day 3065 2305 Salaries to Net Patient Revenue 43.12 45.57 Average Age of Plant 11.29 9.77 FTEs per Adjusted Occupied Bed 6.24 5.86 Average Salary per FTE 63981 50845 Average Daily Census Swing-SNF Beds 3.87 1.52 Average Daily Census Acute Beds 7.67 3.22 Number of Included CAHs 13 1275

2013 Median Indicator Values for New Mexico and the United States Indicator NM US Total Margin 1.48 2.51 Cash Flow Margin 7.88 6.72 Return on Equity 2.11 5.16 Operating Margin 4.88 0.99 Current Ratio 3.79 2.29 Days Cash on Hand 101.45 68.83 Net Days Revenue in Accounts Receivable 57.53 54.20 Equity Financing 88.30 60.32 Debt Service Coverage 0.24 2.73 Long-Term Debt to Capitalization 0.00 26.16 Outpatient Revenues to Total Revenues 70.29 74.43 Patient Deductions 48.69 39.92 Medicare Inpatient Payer Mix 58.33 73.01 Medicare Outpatient Payer Mix 32.06 37.90 Medicare Outpatient Cost to Charge 0.37 0.47 Medicare Revenue per Day 2639 2305 Salaries to Net Patient Revenue 41.90 45.57 Average Age of Plant 5.78 9.77 FTEs per Adjusted Occupied Bed 5.82 5.86 Average Salary per FTE 59572 50845 Average Daily Census Swing-SNF Beds 0.54 1.52 Average Daily Census Acute Beds 5.36 3.22 Number of Included CAHs 7 1275

2013 Median Indicator Values for New York and the United States Indicator NY US Total Margin 2.17 2.51 Cash Flow Margin 5.61 6.72 Return on Equity 11.35 5.16 Operating Margin -1.85 0.99 Current Ratio 1.52 2.29 Days Cash on Hand 75.28 68.83 Net Days Revenue in Accounts Receivable 44.53 54.20 Equity Financing 47.97 60.32 Debt Service Coverage 4.13 2.73 Long-Term Debt to Capitalization 38.46 26.16 Outpatient Revenues to Total Revenues 73.81 74.43 Patient Deductions 48.35 39.92 Medicare Inpatient Payer Mix 79.66 73.01 Medicare Outpatient Payer Mix 28.52 37.90 Medicare Outpatient Cost to Charge 0.44 0.47 Medicare Revenue per Day 2116 2305 Salaries to Net Patient Revenue 53.76 45.57 Average Age of Plant 10.58 9.77 FTEs per Adjusted Occupied Bed 3.99 5.86 Average Salary per FTE 47212 50845 Average Daily Census Swing-SNF Beds 2.87 1.52 Average Daily Census Acute Beds 2.02 3.22 Number of Included CAHs 13 1275

2013 Median Indicator Values for North Carolina and the United States Indicator NC US Total Margin 1.62 2.51 Cash Flow Margin 6.51 6.72 Return on Equity 4.00 5.16 Operating Margin 1.63 0.99 Current Ratio 1.73 2.29 Days Cash on Hand 39.53 68.83 Net Days Revenue in Accounts Receivable 53.48 54.20 Equity Financing 62.56 60.32 Debt Service Coverage 3.39 2.73 Long-Term Debt to Capitalization 27.78 26.16 Outpatient Revenues to Total Revenues 74.73 74.43 Patient Deductions 53.30 39.92 Medicare Inpatient Payer Mix 68.82 73.01 Medicare Outpatient Payer Mix 42.67 37.90 Medicare Outpatient Cost to Charge 0.36 0.47 Medicare Revenue per Day 1944 2305 Salaries to Net Patient Revenue 41.03 45.57 Average Age of Plant 10.61 9.77 FTEs per Adjusted Occupied Bed 5.39 5.86 Average Salary per FTE 50537 50845 Average Daily Census Swing-SNF Beds 1.51 1.52 Average Daily Census Acute Beds 5.92 3.22 Number of Included CAHs 20 1275

2013 Median Indicator Values for North Dakota and the United States Indicator ND US Total Margin -0.03 2.51 Cash Flow Margin 5.59 6.72 Return on Equity 0.67 5.16 Operating Margin -0.80 0.99 Current Ratio 2.07 2.29 Days Cash on Hand 62.92 68.83 Net Days Revenue in Accounts Receivable 55.47 54.20 Equity Financing 58.24 60.32 Debt Service Coverage 2.12 2.73 Long-Term Debt to Capitalization 28.99 26.16 Outpatient Revenues to Total Revenues 67.72 74.43 Patient Deductions 22.69 39.92 Medicare Inpatient Payer Mix 87.70 73.01 Medicare Outpatient Payer Mix 43.47 37.90 Medicare Outpatient Cost to Charge 0.61 0.47 Medicare Revenue per Day 1705 2305 Salaries to Net Patient Revenue 49.58 45.57 Average Age of Plant 12.38 9.77 FTEs per Adjusted Occupied Bed 6.29 5.86 Average Salary per FTE 45696 50845 Average Daily Census Swing-SNF Beds 1.57 1.52 Average Daily Census Acute Beds 1.28 3.22 Number of Included CAHs 34 1275

2013 Median Indicator Values for Ohio and the United States Indicator OH US Total Margin 4.55 2.51 Cash Flow Margin 9.49 6.72 Return on Equity 8.27 5.16 Operating Margin 4.10 0.99 Current Ratio 2.02 2.29 Days Cash on Hand 47.46 68.83 Net Days Revenue in Accounts Receivable 47.90 54.20 Equity Financing 70.11 60.32 Debt Service Coverage 2.26 2.73 Long-Term Debt to Capitalization 14.95 26.16 Outpatient Revenues to Total Revenues 79.27 74.43 Patient Deductions 52.60 39.92 Medicare Inpatient Payer Mix 58.83 73.01 Medicare Outpatient Payer Mix 27.50 37.90 Medicare Outpatient Cost to Charge 0.36 0.47 Medicare Revenue per Day 2528 2305 Salaries to Net Patient Revenue 37.94 45.57 Average Age of Plant 10.84 9.77 FTEs per Adjusted Occupied Bed 5.41 5.86 Average Salary per FTE 51989 50845 Average Daily Census Swing-SNF Beds 1.93 1.52 Average Daily Census Acute Beds 6.63 3.22 Number of Included CAHs 33 1275