North Shore-Long Island Jewish Health System, Inc. (North Shore-LIJ)

North Shore-Long Island Jewish Health System, Inc. (North Shore-LIJ) ANNUAL FINANCIAL INFORMATION AND OPERATING DATA FOR THE YEAR ENDED DECEMBER 31, 2013 Contents Management s Discussion and Analysis of Recent Financial Performance...1 Utilization Statistics North Shore-LIJ Obligated Group... 11 Payer Mix North Shore-LIJ Obligated Group... 12 Long-Term Debt Service Coverage Ratio North Shore-LIJ Obligated Group... 13

Management s Discussion and Analysis of Recent Financial Performance Management s Discussion and Analysis of Recent Financial Performance contains forwardlooking statements within the meaning of the United States Private Securities Litigation Reform Act of 1995, Section 21E of the United States Securities Exchange Act of 1934, as amended, and Section 27A of the United States Securities Act of 1933, as amended. The achievement of certain results or other expectations contained in such forward-looking statements involves known and unknown risks, uncertainties and other factors which may cause actual results, performance or achievements described to be materially different from any future results, performance or achievements expressed or implied by such forward-looking statements. North Shore-Long Island Jewish Health System, Inc. ( North Shore- LIJ or the Health System ) expressly disclaims any obligation or undertaking to issue any updates or revisions to those forward-looking statements if or when their expectations change, or events, conditions or circumstances on which such statements are based occur. Management s Discussion and Analysis of Recent Financial Performance is based upon the financial results of the Health System, since the members of the North Shore-LIJ obligated group (the Obligated Group ) represented 94.3% of the total consolidated operating revenue and 95.0% of the consolidated total assets of the Health System for the year ended and as of 2013. Accordingly, the discussion below includes the financial results of entities that are not members of the Obligated Group. For further information, see the Audited Consolidated Financial Statements of North Shore-LIJ for the years ended 2013 and 2012 (the Audited Consolidated Financial Statements ) for the consolidating and combining schedules of the entire Health System and the Obligated Group. Certain prior year amounts have been reclassified from amounts previously reported to conform to the 2013 presentation. These reclassifications have no impact on the net assets previously reported. As a result of these financial statement reclassifications, certain financial ratios and key indicators previously reported in Management s Discussion and Analysis of Recent Financial Performance posted on the Electronic Municipal Market Access ( EMMA ) website have been revised to also conform to the 2013 presentation. Refer to Note 2 to the Audited Consolidated Financial Statements for additional information. Beginning in 2014, the operating results of most of the physician practices associated with Lenox Hill Hospital ( Lenox ) will be included with the financial results reported for Lenox due to the migration of the physician employment agreements from the individual practices to Lenox. The operating results for these physician practices are currently reported in the Other Health System Entities column of the consolidating schedules included in the Audited Consolidated Financial Statements and the quarterly unaudited interim consolidated financial statements posted on EMMA. Introduction For the year ended 2013, North Shore-LIJ s operating income [ a ] and operating income margin were $84.0 million and 1.2%, respectively, compared to $97.9 million and 1.5% for the year ended 2012. Operating cash flow margin was 6.8% for the year ended 2013, compared to 6.7% for the year ended 2012. [a ] Excess of operating revenue over operating expenses in the consolidated statement of operations is referred to as operating income for purposes of the Management s Discussion and Analysis of Recent Financial Performance. 1

Investments in the following areas contributed to the growth of total operating expenses slightly exceeding the growth of total operating revenue for the year ended 2013 compared to the year ended 2012: (1) facilities and programs to enhance capacity and rebuild infrastructure, (2) clinical initiatives, (3) investments to further prepare for the migration from fee-for-service to riskbased payment models, including the creation in 2013 of one of New York s first provider owned health insurance companies, (4) safety, quality and service initiatives, and (5) ambulatory and physician network expansion. However, expense reductions as a result of the implementation of productivity and efficiency efforts and supply chain initiatives (including programs to review the standardization, distribution and utilization of medical and surgical supplies as well as pharmaceuticals) helped control the growth rate of expenses. Operating revenue growth was primarily attributable to physician and ambulatory volume growth, increased managed care payment rates and revenue cycle initiatives. North Shore-LIJ s net income [b] and net income margin for the year ended 2013 was $284.9 million and 4.0%, respectively, compared to $254.0 million and 3.8% for the year ended 2012. Investment income, including net realized gains and losses, the change in net unrealized gains and losses and the change in value of equity method investments, contributed to the net income reported for each of these periods. North Shore-LIJ s liquidity and debt to capitalization ratio improved over the period from 2012 to 2013. Days cash on hand during this period increased 3.9 days to 111.2 days, and the debt to capitalization ratio decreased from 42.7% as of 2012 to 40.1% as of 2013. Management continues to focus on market share growth, safety, quality and service improvements, developing new revenue streams associated with population health management and riskbased payment models, and maintaining the balance sheet and positive operating results so that North Shore-LIJ can continue to invest in people, programs and facilities to meet the health care needs of its patients, their families and the communities it serves. Operations and Net Income Overview Operating Income, Operating Cash Flow and Net Income The following table presents a summary of key operating performance results and measures for North Shore-LIJ for the years ended 2012 and 2013. The results of operations of The Long Island Home ( LIH ) have been included in this and other tables presented herein since its July 1, 2012 acquisition date. Results of operations of LIH for the six months prior to July 1, 2012 are excluded from the Audited Consolidated Financial Statements. For further information on the acquisition of LIH refer to Non-Operating Gains and Losses herein and Note 1 to the Audited Consolidated Financial Statements. [b] Excess of revenue and gains and losses over expenses in the consolidated statement of operations is referred to as net income for purposes of the Management s Discussion and Analysis of Recent Financial Performance with the following exceptions: 2013 net income excludes non-recurring early retirement program costs 2012 net income excludes the non-cash loss on refunding and refinancing of long-term debt 2012 net income excludes the non-cash contribution received in the acquisition of LIH 2

($ s In Millions) 2012 [2] 2013 [2] Operating income $97.9 $84.0 Operating margin 1.5% 1.2% Operating cash flow [1] $444.1 $475.5 Operating cash flow margin [1] 6.7% 6.8% Net income $254.0 $284.9 Net income margin 3.8% 4.0% [1] Operating income before interest and depreciation and amortization. [2] Derived from the Audited Consolidated Financial Statements. Operating Revenue and Volume For the year ended 2013, total operating revenue increased by $395.0 million or 6.0%, compared to the year ended 2012, of which, $50.0 million or 0.8% of the increase related to having a full year of LIH revenue in 2013. The following table presents consolidated North Shore-LIJ operating revenue and certain volume statistics for the years ended 2012 and 2013: ($ s In Millions) 2012 [2] 2013 [2] Operating Revenue: Net patient service revenue $5,598.4 $5,853.5 Physician practice revenue $758.4 $875.1 Provision for bad debts ($98.0) ($91.3) Total patient revenue, net of provision for bad debts $6,258.8 $6,637.3 Other operating revenue $302.7 $324.6 Net assets released from restrictions used for operations $45.3 $39.9 Total operating revenue $6,606.8 $7,001.8 Volume: * Discharges (excluding nursery) [1] 260,048 257,247 Ambulatory surgery visits 133,340 144,228 Emergency room visits (treated and released) 504,953 503,363 Health center visits [1] 985,399 1,027,561 Other outpatient visits 999,328 1,093,162 [1] Includes 2,440 and 5,658 LIH discharges and 30,749 and 68,302 LIH health center visits for the years ended 2012 (from the July 1, 2012 acquisition date) and 2013, respectively. [2] Dollar amounts are derived from the Audited Consolidated Financial Statements. * Volume statistics for both periods exclude physician practice visits and include statistics from North Shore-LIJ entities that are not members of the Obligated Group. 3

North Shore-LIJ s core business revenue consists of net patient service revenue and physician practice revenue (collectively referred to as total patient revenue and reported net of the provision for bad debts). For the year ended 2013, North Shore-LIJ s total patient revenue increased by $378.5 million or 6.0%, compared to the year ended 2012. This increase, which is net of a $23.9 million revenue reduction associated with the sequestration cuts on Medicare payments, occurred as a result of continued growth in physician and ambulatory services, increases in managed care payment rates, revenue cycle initiatives and the acquisition of LIH. During the same period, excluding the impact of the LIH acquisition, total patient revenue increased by $329.4 million, or 5.3%. The growth in physician and ambulatory services resulted from continued physician recruitment efforts, migration of services from inpatient care settings to outpatient care settings and the opening of new ambulatory centers. Together, charity care and the provision for bad debts represent uncompensated care. The estimated cost of uncompensated care remained relatively constant at approximately 3% of total patient revenue for both periods presented. The major components of other operating revenue are hospital grants and contracts, laboratory and other ancillary services, meaningful use ( MU ) electronic health record incentive payments, and other miscellaneous items. Other operating revenue increased by $21.9 million for the year ended 2013 compared to the year ended 2012 primarily as a result of increased revenue from laboratory and other ancillary services. MU payments are federally funded by a provision of the American Recovery and Reinvestment Act of 2009 to encourage the adoption and meaningful use of health information technology. Operating Expenses Total operating expenses for the year ended 2013 increased by $408.9 million or 6.3%, compared to the year ended 2012, of which, $50.1 million or 0.8% of the increase related to having a full year LIH expenses in 2013. Summarized below are the consolidated North Shore-LIJ operating expenses for the years ended 2012 and 2013: Operating Expenses: ($ s In Millions) Year ended 2012 [1] Year ended 2013 [1] Salaries and employee benefits $4,177.8 $4,497.2 Supplies and expenses $1,984.9 $2,029.1 Depreciation and amortization $275.6 $307.3 Interest expense $70.6 $84.2 Total operating expenses $6,509.0 $6,917.9 [1] Derived from the Audited Consolidated Financial Statements. For the year ended 2013, salaries and employee benefits increased by $319.4 million or 7.6%, compared to the year ended 2012, primarily due to continued investments in strategic initiatives related to the changes in health care delivery and payment models, including investments in physicians and staff to support program expansion within the hospitals and the ambulatory network, and investments to establish health insurance companies to provide certain health insurance products in New York State. Refer to Strategic Vision and Future Capital Plans in Appendix A of the 4

Series 2013A taxable bonds Offering Memorandum for additional information on the health insurance companies. Wage increases, the acquisition of LIH and incremental staffing investments in various other safety, quality and service initiatives throughout North Shore-LIJ also contributed to the expense growth. Supplies and expenses for the year ended 2013 increased by $44.2 million or 2.2%, compared to the year ended 2012, primarily due to investments in safety, quality and service initiatives, program expansion, newly acquired physician practices, information technology and the acquisition of LIH. The investments in information technology, including electronic health record and other clinical software, are intended to ensure that North Shore-LIJ maintains what management believes is a competitive advantage regarding physician satisfaction and retention, and improves clinical and operational processes. Supply chain improvement efforts (which include standardization, distribution and utilization initiatives for medical and surgical supplies as well as pharmaceuticals) along with productivity and efficiency efforts, helped control the growth rate of supplies and expenses. Depreciation and amortization for the year ended 2013 increased by $31.7 million or 11.5%, compared to the year ended 2012, primarily due to continued investments in facilities (including new buildings that opened in 2013 on the Long Island Jewish Medical Center campus), programs and information technology. The increase in interest expense of $13.6 million from the year ended 2012 to the year ended 2013 was primarily due to the issuance of the Series 2012B and 2013A bonds in September 2012 and 2013, respectively. Non-Operating Gains and Losses The following table presents a summary of non-operating gains and losses for North Shore-LIJ for the years ended 2012 and 2013: ($ s In Millions) 2012 [1] 2013 [1] Non-Operating Gains and Losses: Investment income $42.6 $100.3 Change in net unrealized gains and losses and change in value of equity method investments $123.5 $106.0 Change in fair value of interest rate swap agreements designated as derivative instruments [2] ($4.5) $1.0 Loss on refunding and refinancing of long-term debt ($4.6) - Contribution received in the acquisition of LIH $12.8 - Early retirement program costs - ($33.2) Other non-operating gains and losses ($5.5) ($6.3) Total non-operating gains and losses $164.4 $167.7 [1] Derived from the Audited Consolidated Financial Statements. [2] Refer to Interest Rate Swap Agreements herein. Total non-operating gains and losses for the years ended 2013 and 2012 were primarily driven by investment returns. Refer to the Audited Consolidated Financial Statements for more information on North Shore-LIJ s investments. 5

During 2013, North Shore-LIJ offered an early retirement option to certain employees aged 62 and older. Under the program, eligible employees who opted for early retirement will receive salary continuation payments based on years of service, and medical benefits until Medicare eligible. A charge of $33.2 million for the early retirement program costs is reflected within non-operating gains and losses in the consolidated statement of operations for the year ended 2013. In 2012, North Shore-LIJ recorded a non-cash loss on the refunding of long-term debt of $1.8 million related to the Series 2012A bond issue and a non-cash loss on refinancing of long-term debt of $2.8 million related to the conversion and remarketing of its Series 2009B, C and D bonds from variable rate to fixed rate. On July 1, 2012 (the LIH Acquisition Date ), North Shore-LIJ acquired LIH by means of an inherent contribution where no consideration was transferred. North Shore-LIJ accounted for the business combination by applying the acquisition method and, accordingly, a contribution received in the acquisition of LIH of $12.8 million was recorded for the excess of LIH s assets over liabilities, measured at fair value as of the LIH Acquisition Date. Other Changes in Unrestricted Net Assets For a complete list of other changes in unrestricted net assets for the years ended 2013 and 2012, refer to the Audited Consolidated Financial Statements. Pension and Other Postretirement Liability Adjustments North Shore-LIJ maintains several pension and other postretirement benefit plans for its employees. For the year ended 2013, North Shore-LIJ, recorded an increase in unrestricted net assets of $248.8 million, compared to a decrease in unrestricted net assets of $78.5 million for the year ended 2012, associated with pension and other postretirement liability adjustments. These adjustments relate to changes in discount rates and investment gains and losses on pension plan assets, and were made in accordance with the provisions of the Accounting Standards Codification Topic 715, Compensation - Retirement Benefits, which requires North Shore-LIJ to recognize the funded status (the difference between the projected benefit obligations and the fair value of plan assets) of its defined benefit and postretirement plans in the consolidated statements of financial position with a corresponding adjustment to unrestricted net assets. The combined fair value of plan assets at 2013 and 2012 as a percentage of the projected benefit obligations of North Shore-LIJ s non-contributory defined benefit pension plans was 86% and 69%, respectively. Refer to Note 10 to the Audited Consolidated Financial Statements for more information. Fundraising For the years ended 2013 and 2012, North Shore-LIJ received $66.8 million and $75.5 million, respectively, in new net pledges and cash donations. Of the $66.8 million received during 2013, $32.1 million was in pledges and $34.7 million was in cash. Of the $75.5 million received during 2012, $41.3 million was in pledges and $34.2 million was in cash. Cash and pledges are generally received by the North Shore-Long Island Jewish Health System Foundation, Inc. (the Foundation ), which was formed to solicit, receive and administer funds to be used for major modernization projects, capital acquisitions, special programs and other health care services for the benefit of the members of the Obligated Group and other affiliated tax-exempt organizations of North Shore-LIJ. The Foundation is not a member of the Obligated Group. 6

Statement of Financial Position Overview Liquidity and Capital Resources Unrestricted cash and investments increased to $2.01 billion as of 2013, from $1.83 billion as of 2012, resulting in 111.2 days cash on hand as of 2013, an increase of 3.9 days cash on hand from 2012. Management attributes this growth to positive operating results, gains on investments and the use of a systematic strategic capital allocation process which assesses capital expenditures within the context of operations, capital market conditions affecting investment performance, fundraising and debt capacity. Total unrestricted cash and investments are comprised of cash and cash equivalents and marketable securities and other investments (as defined in the Audited Consolidated Financial Statements), and certain management designated funds included in assets limited as to use in the consolidated financial statements. The following chart presents the total unrestricted cash and investments, in millions, included in the days cash on hand calculations and the days cash on hand at 2011, 2012 and 2013: Total Unrestricted Cash and Investments and Days Cash on Hand $2,000 104.1 107.3 111.2 $2,015 110 $1,828 90 $1,750 $1,638 70 Management Designated [1] $1,500 $1,779 $1,950 50 Unrestricted Cash and Investments [2] $1,250 $1,592 30 Days Cash on Hand [3] $1,000 12/31/11 12/31/12 12/31/13 10 [1] Management designated funds included in days cash on hand, which are included in assets limited as to use in the consolidated financial statements, were $46.2 million, $48.6 million and $64.8 million, as of 2011, 2012 and 2013, respectively. [2] Comprised of cash and cash equivalents and marketable securities and other investments per the consolidated financial statements. [3] Days cash on hand at 2011 and 2012 have been restated above from 102.6 and 105.7 days, respectively, due to the financial statement reclassifications noted in the third paragraph of page 1 of Management s Discussion and Analysis of Recent Financial Performance, to be consistent with the 2013 calculation. 7

Although total unrestricted cash and investments increased, North Shore-LIJ s cash to debt measurement has decreased slightly to 105% at 2013 from 106% at 2012, as a result of the $250 million Series 2013A bond issue. Except for $47.4 million used to reimburse certain 2013 capital expenditures previously paid with cash, the remaining proceeds of the Series 2013A bond issue, net of costs of issuance, are to be used for general corporate initiatives, including future capital projects and capital investments, and were excluded from total unrestricted cash and investments as of 2013. Patient Accounts Receivable Days of total patient revenue in patient accounts receivable were 42 days and 44 days as of 2013 and 2012, respectively. Property, Plant and Equipment Management monitors and manages capital spending in relation to operations, capital market conditions affecting investments, fundraising and debt capacity. North Shore-LIJ continues to invest its capital to meet the ongoing needs of the communities it serves. Capital expenditures totaled $485.3 million and $489.5 million for the years ended 2013 and 2012, respectively. Of these amounts, $78.0 million and $105.6 million for the years ended 2013 and 2012, respectively, were financed from the proceeds of prior bond issues, including $47.4 million in 2013 from the Series 2013A bond issue, previously noted. Net assets released from restrictions for capital asset acquisitions totaled $46.1 million and $38.6 million for the years ended 2013 and 2012, respectively. Capital expenditures as a percentage of depreciation and amortization were 158% and 178% for the years ended 2013 and 2012, respectively. Accounts Payable Days of supply expense in accounts payable were 95 days and 91 days as of 2013 and 2012, respectively. Debt The following table presents a summary of North Shore-LIJ s total outstanding debt, debt to capitalization, long-term debt to cash flow and long-term debt service coverage ratio as of and for the years ended 2012 and 2013: ($ s In Millions) 12/31/12 [4] 12/31/13 [4] Total outstanding debt [1] $1,718.1 $1,912.0 Debt to capitalization [2] 42.7% 40.1% Long-term debt / Cash flow [3] 3.8x 3.6x Long-term debt service coverage 3.5x 3.7x [1] Total outstanding debt includes long-term debt, capital lease obligations and short-term borrowings. [2] Capitalization is defined as the sum of total outstanding debt and unrestricted and temporarily restricted net assets. [3] Cash flow is defined as net income before all items defined in footnote [c] on the next page, except for interest expense. [4] Derived from the Audited Consolidated Financial Statements. 8

North Shore-LIJ s total debt profile as of 2013 was comprised of 14.0% variable rate debt and 86.0% fixed rate debt. However, the majority of the long-term variable rate debt is hedged under interest rate swap agreements. As such, the effective variable and fixed rate debt is 8.0% and 92.0%, respectively, of the total outstanding debt. Total outstanding debt, including short-term borrowings, increased from 2012 to 2013, primarily due to the issuance of the Series 2013A bonds, partially offset by scheduled principal payments. As a result of the increase in unrestricted net assets exceeding the increase in total outstanding debt, debt to capitalization improved to 40.1% at 2013 from 42.7% at 2012. Long-term debt to cash flow also improved to 3.6x at 2013, compared to 3.8x at December 31, 2012. The long-term debt service coverage ratio improved to 3.7x for the year ended 2013 compared to 3.5x for the year ended 2012, with a maximum annual debt service ( MADS ) of $155.6 million and $136.0 million as of 2013 and 2012, respectively. MADS occurs in 2014 and 2013, respectively, for the 2013 and 2012 calculations. Income available for debt service [c] for the years ended 2013 and 2012 was $569.5 million and $481.2 million, respectively. North Shore-LIJ primarily uses its short-term borrowings under revolving credit facilities to bridge capital expenditures to be paid with donations and/or bond issues. Short-term borrowings were $110.5 million as of 2013 and 2012. Interest Rate Swap Agreements Certain members of North Shore-LIJ have entered into various interest rate swap agreements with financial institutions, matched or related to the term and rate of various bond issues or debt agreements. As of 2013 and 2012, the aggregate fair value of the interest rate swap agreements was a liability of $7.2 million and $11.1 million, respectively. Swap agreements expose North Shore-LIJ to credit risk in the event of nonperformance by the counterparties. North Shore-LIJ believes that the risk of material impact to its consolidated statement of financial position arising from nonperformance by the counterparties is low. For additional information on the interest rate swap agreements, refer to Note 7 to the Audited Consolidated Financial Statements. Commitments and Contingencies For information on commitments and contingencies, refer to Note 15 to the Audited Consolidated Financial Statements and to Regulatory Reviews, Audits and Investigations and Other Litigation in Appendix A of the Series 2013A taxable bonds Offering Memorandum. [c] Net income as defined in footnote [b] before depreciation and amortization, interest expense, the change in net unrealized gains and losses and change in value of equity method investments and the change in fair value of interest rate swap agreements designated as derivative instruments. 9

Summary Revenue growth associated with increased physician and ambulatory volume and increased managed care payment rates, combined with investments related to the changing models of health care delivery and payment, and expense reductions from supply chain and other productivity and efficiency initiatives, all contributed to the positive operating results for North Shore-LIJ for the year ended 2013. Income from operations and the use of a systematic strategic capital allocation process, along with favorable investment returns, have enabled North Shore-LIJ to maintain its balance sheet and improve its days cash on hand, debt to capitalization and long-term debt service coverage ratios from 2012. North Shore-LIJ continues to focus on improving operating performance despite the challenges and factors pressuring operating margins in the health care industry. Management is focused on reducing operating expenses with operational efficiency efforts, program consolidation and supply chain initiatives, as well as creating additional revenue opportunities through new and enhanced facilities, physician recruitment efforts, health insurance products, and initiatives to prepare for the migration from fee-forservice to risk-based payment models. North Shore-LIJ continues to invest in strategic capital projects and technology, including electronic health record and other clinical software, to maintain what management believes is a competitive advantage regarding physician satisfaction and retention, and to improve clinical outcomes and operational processes. In addition, North Shore-LIJ is making strategic investments in physicians who support key clinical service lines and staff to support the growth in the ambulatory network and outpatient volume, and various other safety, quality and service initiatives. Management continues to monitor strategic capital needs in relation to operations, capital market conditions affecting investment returns, fundraising and debt capacity, so that North Shore-LIJ can continue to invest in people, programs and facilities to meet the health care needs of its patients, their families and the communities it serves. 10

North Shore - Long Island Jewish Obligated Group Utilization Statistics 2012 2013 Inpatient Discharges (excl. Nursery) (1) 257,608 251,589 Patient Days (excl. Nursery) 1,477,763 1,445,372 Average Length of Stay (in Days) 5.74 5.74 Average Daily Census 4,038 3,960 Licensed Beds (excl. Nursery) 5,467 5,451 Beds Available (2) 4,765 4,687 Occupancy Percentage (2) 85.0% 83.9% Normal Newborn Discharges 24,896 24,688 Total Discharges 282,504 276,277 Outpatient Emergency Room Visits 504,953 503,363 Emergency Room Admissions (1) 168,571 161,552 Total ER Encounters 673,524 664,915 Health Center Visits 925,598 927,630 Ambulatory Surgery Visits (1) 133,340 141,345 Home Care Visits 565,392 580,678 Other Outpatient Visits and Encounters (3) 894,359 983,904 (1) The decrease in Discharges and Emergency Room Admissions, and increase in Ambulatory Surgery Visits are primarily related to the migration of less acute medical services from inpatient to outpatient care settings. (2) Beds Available, which vary primarily based upon need, are reported as the number of beds at the end of each reporting period. Occupancy Percentage is calculated using the average beds available for the reporting period. (3) Other Outpatient Visits and Encounters increased primarily due to the opening of new imaging centers and the expansion of imaging services under the Obligated Group. 11

North Shore - Long Island Jewish Obligated Group Payer Mix Percent of Gross Revenue (Inpatient & Outpatient) 2012 2013 Medicare (1) 43% 42% Medicaid (2) 17% 18% Commercial 34% 33% Self Pay and Other 6% 7% Total 100% 100% (1) Includes Medicare Managed Care. (2) Includes Medicaid Managed Care. 12

NORTH SHORE-LONG ISLAND JEWISH OBLIGATED GROUP LONG-TERM DEBT SERVICE COVERAGE RATIO (LTDSCR) (In thousands ) Long-Term Debt Service Coverage Ratio Calculation: 2013 INCOME AVAILABLE FOR DEBT SERVICE (1): Excess of revenue and gains and losses over expenses $ 289,275 Add: Interest 82,611 Add: Depreciation and amortization Add/(Subtract): Change in net unrealized gains and losses and change in value of equity 290,494 method investments Add/(Subtract): Change in fair value of interest rate swap agreements designated as derivative (73,014) instruments Add: Early retirement program costs (965) 32,392 Income Available for Debt Service (A) $ 620,793 DEBT SERVICE: Maximum Annual Principal & Interest (2) 150,371 Total Debt Service (B) $ 150,371 Ratio (A) / (B) 4.1 : 1.0 (1) Calculated in accordance with the Third Supplement to the Master Trust Indenture dated September 1, 2011. (2) Maximum annual debt service occurs in 2014. NOTE: The LTDSCR above is presented for the North Shore-Long Island Jewish Obligated Group pursuant to Section 3 of the Agreement to Provide Continuing Disclosure, and as such, the components of the calculation differ from the LTDSCR disclosed in Management's Discussion and Analysis of Recent Financial Performance, which is based on the consolidated financial results of North Shore-Long Island Jewish Health System, Inc. 13