South Carolina Jobs-Economic Development Authority, Hospital Refunding Revenue Bonds and Improvement Revenue Bonds (AnMed Health Project), Series 2009B, $112,000,000, Dated: May 13, 2009 South Carolina Jobs-Economic Development Authority, Hospital Revenue Bonds (Anderson Area Medical Center, Inc.), Series 1999, $60,600,000, Dated: July 28, 1999 Utilization Calendar Yr September 30, 2013 2012-15 mth 2012 2011 2010 Licensed Beds 533 533 533 533 533 Staffed Beds 387 365 358 379 385 Average Adult Census 281 261 256 253 255 Percent Occupancy 72.50% 71.60% 71.40% 66.76% 65.90% Patient Days 102,442 119,572 93,545 92,247 93,152 Average Length of Stay 4.3 4.3 4.3 4.2 4.2 Admissions 23,489 27,293 21,489 21,701 22,040 Newborn Deliveries 1,903 2,458 1,959 1,994 2,004 Surgical Cases IP 6,574 7,943 6,412 6,770 6,739 Surgical Cases OP 9,222 11,001 8,841 8,558 8,183 CV Surgery Visits 217 237 188 170 194 Emergency Visits 112,320 137,628 107,784 106,664 106,026 Outpatient Registrations 337,841 426,492 340,634 327,809 345,948 Lab Procedures 3,114,453 3,713,639 2,957,026 3,166,765 3,110,677 Cath Lab Procedures 6,749 9,529 7,782 8,335 8,719 Medicare CMI 1.5748 1.5772 1.5821 1.5196 1.5845 All Payor CMI 1.3592 1.3464 1.3512 1.2846 1.2991 Sources of Patient Revenue CY 2013 FY 2012-15 mth FY 2012 FY 2011 FY 2010 Insurance 0.0% 0.0% 0.0% 0.0% 0.0% Medicare 56.6% 55.6% 55.8% 55.9% 56.1% Medicaid 12.5% 12.8% 12.9% 11.5% 11.1% Self Pay 5.4% 4.8% 4.7% 6.1% 7.6% Managed Care 17.4% 18.9% 19.0% 20.0% 19.4% Commercial 3.0% 3.2% 3.2% 3.1% 2.7% Other 5.1% 4.8% 4.4% 3.5% 3.1% Total 100.0% 100.0% 100.0% 100.0% 100.0%
Market Shares by Service Area Primary Service Area Percentage of Anderson County Patients Served AnMed Health 75.5% 76.4% 76.1% Greenville Memorial 15.3% 12.1% 11.1% St. Francis 5.5% 5.6% 5.1% GA or NC Hospitals 0.0% 0.0% 1.6% Self Regional 1.0% 1.0% 1.1% Oconee Memorial Hospital 0.9% 1.0% 0.9% Palmetto Baptist-Easley 0.6% 0.7% 0.8% Other 1.2% 3.2% 3.3% Secondary Service Area Percentage of Abbeville County Patients Served (Inpatients) AnMed Health 12.0% 9.9% 10.4% Self Regional 60.4% 56.4% 51.6% Abbeville County 18.0% 22.1% 25.3% Greenville Memorial 5.0% 3.9% 3.5% GA or NC Hospitals 0.0% 0.0% 3.9% St. Francis 1.0% 1.5% 0.9% Other 3.6% 6.2% 4.4% Percentage of Oconee County Patients Served (Inpatients) AnMed Health 9.6% 8.0% 9.1% Oconee Memorial Hospital 66.5% 68.2% 64.3% Greenville Memorial 14.2% 14.1% 13.3% St. Francis 6.5% 5.4% 5.5% GA or NC Hospitals 0.0% 0.0% 3.5% Palmetto Baptist-Easley 0.0% 0.5% 0.5% Other 3.2% 3.8% 3.8% Percentage of Pickens County Patients Served (Inpatients) AnMed Health 5.2% 4.9% 5.7% Palmetto Baptist-Easley 32.2% 32.4% 31.5% Greenville Memorial 31.1% 29.2% 28.8% St. Francis 18.3% 18.0% 16.4% Cannon Memorial 6.2% 6.9% 7.2% Oconee Memorial Hospital 3.9% 4.5% 4.2% GA or NC Hospitals 0.0% 0.0% 1.5% Other 3.1% 4.1% 4.7%
Summary of Consolidated Revenues and Expenses (dollars in thousands) Calendar Year September 30, Net patient service revenue 450,090 514,577 404,062 472,512 Other operating revenue 12,292 17,317 14,791 8,453 Net assets released from restrictions 841 688 552 693 Total unrestricted revenues and 463,222 532,582 419,406 481,659 other support Operating Expenses: Advancement 2,776 2,569 1,829 1,654 General and administrative services 110,061 116,975 94,092 86,336 Clinical and support services 71,835 86,533 69,043 68,268 Patient care services 105,303 120,655 95,680 95,963 Network operations 63,149 66,852 50,176 40,203 Medical affairs 45,910 55,816 45,832 45,515 Depreciation and amortization 38,667 48,312 39,136 38,075 Interest 9,533 12,265 9,891 10,343 Provision for uncollectible accounts - - - 96,624 Total operating expenses 447,235 509,977 405,680 482,981 Income (loss) from operations 15,987 22,605 13,726 (1,322) Nonoperating gains (losses): Change in net unrealized gains and losses Investment gains (loss) 14,350 12,437 9,660 11,189 Loss on refunding Series 1999 bonds Loss on refunding Series 2003 bonds Loss on refunding Series 2007 bonds Other gains (loss) 648 (374) (337) (300) Total nonoperating gains (losses) 68,118 42,329 38,114 (5,564) Excess (deficiency) of revenues and gains over expenses and losses 84,106 64,934 51,840 (6,886) Selected Consolidated Financial Data (dollars in thousands) Calendar Year September 30, Excess (deficiency) of revenues and gains over expenses and losses 84,106 64,934 51,840 (6,886) Change in net unrealized gains and losses Loss on refunding Series 1999 bonds - - 0 0 Loss on refunding Series 2003 bonds - - - 0 Loss on refunding Series 2007 bonds - - - 0 Adjusted excess margin 30,986 34,668 23,049 9,566..
Calendar Year September 30, Total nonoperating gains (losses) 68,118 42,329 38,114 (5,564) Change in net unrealized gains and losses Loss on refunding Series 1996 bonds Loss on refunding Series 1999 bonds - - 0 0 Loss on refunding Series 2003 bonds - - - 0 Loss on refunding Series 2007 bonds - - - 0 Adjusted nonoperating gains (losses) 14,998 12,063 9,323 10,889 Summary of Balance Sheet Information (dollars in thousands) Calendarl Year September 30, Assets Current assets: Cash and cash equivalents 40,407 30,819 26,768 36,385 Patient accounts receivable, net of allowance 64,486 54,858 56,432 58,861 Other receivables 9,425 6,691 8,106 8,755 Inventories 3,409 3,037 3,065 3,031 Prepaid expenses and other current assets 8,162 7,418 15,459 7,060 Assets whose use is limited, required for current liabilities 9,121 8,754 6,908 7,225 Total current assets 135,010 111,577 116,737 121,317 Assets whose use is limited, excluding amounts required for current liabilities 378,025 317,084 311,726 224,984 Property, plant and equipment, net 250,122 254,873 257,572 277,093 Unamortized bond issuance costs 5,219 5,368 5,471 5,890 Cash surrender value of life insurance 6,427 6,922 6,875 6,567 Other assets 8,211 8,953 9,012 9,458 Due from related entities 465 1,490 317 Total assets 783,478 706,267 707,392 645,626
Liabilities and net assets Current liabilities: Accounts payable 14,877 13,807 12,502 14,120 Accrued payroll and employee benefits 33,030 25,022 29,042 25,790 Accrued liabilities 4,752 5,071 6,589 3,552 Estimated third-party payor settlements 8,759 6,150 7,357 1,886 Due to related entities 421 0 0 65 Current installments of long-term debt 5,620 5,250 5,250 4,980 Total current liabilities 67,460 55,300 60,739 50,393 Interest Rate Swap Instrument 5,462 11,193 11,891 10,764 Accrued pension cost 12,053 66,358 70,454 70,454 Long-term debt, excluding current installments 241,543 247,435 247,519 253,126 Other liabilities Total liabilities 326,518 380,286 390,604 384,738 Minority interest in consolidated subsidiary 0 0 0 0 Net assets: Unrestricted 454,606 323,480 314,324 258,678 Temporarily restricted 2,354 2,501 2,465 2,210 Total Net Assets 456,960 325,981 316,788 260,888 Total Liabilities and Net Assets 783,478 706,267 707,392 645,626 Historical Debt Service Coverage Ratio Calendar Year September 30, Excess (deficiency) of revenues and gains over expenses and losses 84,106 64,934 51,840 (6,886) Less change in net unrealized gains and losses Plus interest, depreciation and amortization 48,200 60,577 49,027 48,418 Income available for debt service 79,186 95,245 72,076 57,985 Historical long-term debt service coverage requirement 16,043 16,043 16,043 16,043 Historical debt service coverage ratio 4.94 5.94 4.49 3.61
Historical Long-Term Debt and Capitalization 2013 Long Term Debt: Current installments of long term debt 5,620 5,250 LT Debt, Net of Orig Issue Discount/Premium 241,543 247,435 xx xx Total Long-Term Debt 247,163 252,685 Less: Unamortized Discounts (1,167) (895) Current Installments of Long-Term debt 5,620 5,250 Net Long-Term Debt 242,710 248,330 Plus: Unrestricted Net Assets 454,606 323,480 Total Capitalization 697,316 571,810 Net Long-Term Debt as a percentage of Total Capitalization 34.81% 43.43%