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Natividad Medical CenterBoard of TrusteesFebruary 1, 2013
Financial StatementsFor December 31, 2012
1
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Average Daily CensusTotal Hospital - Monthly
2
88.2
105.3
96.9 100.2
95.6
83.1 78.6
90.9
84.3
98.4 103.4
88.0 93.4
60.0
70.0
80.0
90.0
100.0
110.0
120.0
12/11 1/12 2/12 3/12 4/12 5/12 6/12 7/12 8/12 9/12 10/12 11/12 12/12
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Ave. Daily Census and Length of StayTotal Hospital - Annual
3
82.7
90.1
92.3 92.692.5
93.6 93.0
4.1
4.4 4.3
4.3 4.3
4.2 4.2
3.5
4.0
4.5
5.0
5.5
76
78
80
82
84
86
88
90
92
94
96
FY 2007 FY 2008 FY 2009 FY 2010 FY 2011 FY 2012 FY 2013
ADC ALOS
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Average Daily Census by UnitMedical Surgical, ICU and OB.
4
29
34
28
31 33
28 26
28 29
33 32
28 30
7 9
5 6 4
7 4
8 5 5
7 5
7
21 23 23
25 26
19 20
26
21 22
24 21
18
0
10
20
30
40
12/11 01/12 02/12 03/12 04/12 05/12 06/12 07/12 08/12 09/12 10/12 11/12 12/12
Med/Surg ICU OB/Gyn
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Average Daily Census by UnitNICU, Pediatrics, Rehab., and Psych.
5
10
8
10
5
8
7
3 4
6
11 11
6
9
3 3
5 5
2 3
2 2 2 3
2 2 2
12
14 14
17
14
10 11
13 13
15 15
14 14
8
14
12
10
9
9
12
10 9 10
12 12 13
0
5
10
15
20
12/11 01/12 02/12 03/12 04/12 05/12 06/12 07/12 08/12 09/12 10/12 11/12 12/12
NICU Peds Acute Rehab Psychiatric
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DeliveriesMonthly
6
0
50
100
150
200
250
300
12/11 01/12 02/12 03/12 04/12 05/12 06/12 07/12 08/12 09/12 10/12 11/12 12/12
210
251 225
254 251
205 213
256
219 214
257
206 197
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Deliveries – Average Per MonthAnnual
7
221 223 225 236 234 225
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Emergency Room VisitsMonthly
8
3,390 3,705
3,889 3,936
3,587
3,972 3,763 3,812 3,902
4,021 4,133
3,724
3,667
2,000
3,000
4,000
5,000
12/11 01/12 02/12 03/12 04/12 05/12 06/12 07/12 08/12 09/12 10/12 11/12 12/12
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Emergency Room VisitsAverage Per Day
9
109 110 125
117 120 128 125 123 126
134 133 124 118
0
20
40
60
80
100
120
140
160
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E.R. Visits – Average Per MonthAnnual
10
3,528 3,758 3,736 3,797 3,877
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Payor Mix Current and Past Four Years
11
Payor FY 09 FY 10 FY 11 FY 12 FY 13 Change % Change
Medicaid 26.56% 23.39% 21.87% 21.17% 23.90% 2.73% 12.90%Medicaid Managed Care 23.48% 27.09% 29.02% 30.29% 24.25% -6.04% -19.94%Medicare 17.98% 17.26% 17.42% 17.18% 19.06% 1.88% 10.94%Managed Care 16.81% 17.34% 17.25% 16.56% 16.38% -0.18% -1.09%MIA 4.64% 4.94% 5.29% 5.23% 5.38% 0.15% 2.87%Self Pay 7.23% 8.42% 7.60% 7.65% 8.92% 1.27% 16.60%Short Doyle 3.31% 1.57% 1.55% 1.91% 2.11% 0.20% 10.64%
Total 100.0% 100.0% 100.0% 100.0% 100.0%
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Payor Mix Current and Past Two Years
12
21.9%
29.0%
17.4% 17.3%
5.3%7.6%
1.6%
21.2%
30.3%
17.2% 16.6%
5.2%
7.7%
1.9%
23.9% 24.3%
19.1%
16.4%
5.4%
8.9%
2.1%
Medicaid Medicaid Managed
Care
Medicare Managed Care
MIA Self Pay Short Doyle
FY 11 FY12 FY13
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Net Revenues Government and Payors
13
FY 2009 FY 2010 FY 2011 FY 2012 FY 2013Other 4.2$ 6.4$ 5.7$ 5.5$ 5.3$ Government 41.2$ 34.8$ 59.2$ 41.4$ 39.5$ Total Government 45.4$ 41.2$ 64.9$ 46.9$ 44.8$
Medicare 17.7$ 21.5$ 22.3$ 22.1$ 26.4$ Medi-Cal 20.4$ 20.5$ 20.0$ 20.3$ 21.3$ Medi-Cal Mgd Care 26.2$ 32.0$ 34.1$ 33.9$ 26.8$ Managed Care 50.0$ 54.1$ 57.1$ 51.7$ 47.9$ Short Doyle 2.0$ 1.9$ 2.0$ 2.2$ 2.3$ Self-Pay 1.6$ 1.3$ 1.0$ 1.03$ 0.97$ Total Payor 117.9$ 131.3$ 136.4$ 131.2$ 125.7$
Grand Total 163.3$ 172.5$ 201.3$ 178.1$ 170.5$
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Net RevenuesGovernment and Payor Segment
14
$45.4 $41.2 $64.9
$46.9 $44.8
$117.9 $131.3
$136.4 $131.2 $125.7
$-$20.0 $40.0 $60.0 $80.0
$100.0 $120.0 $140.0 $160.0 $180.0 $200.0 $220.0
FY 2009 FY 2010 FY 2011 FY 2012 FY 2013
Total Government Total Payor
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Net Revenues Payor Segment
15
$17.7 $20.4
$26.2
$50.0
$2.0 $1.6
$26.4 $21.3
$26.8
$47.9
$2.3 $0.97 $-
$10.0
$20.0
$30.0
$40.0
$50.0
$60.0
Medicare Medi-Cal Medi-Cal Mgd Care
Managed Care Short Doyle Self-Pay
in millions
FY 2009 FY 2010 FY 2011 FY 2012 FY 2013
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Net Income or <Loss>Monthly
16
2,623
506 434 361 194 (741)
(2,472)
(533) (165)261
985 40 76
-$3,500
-$1,500
$500
$2,500
$4,500
$6,500
$8,500
12/11 01/12 02/12 03/12 04/12 05/12 06/12 07/12 08/12 09/12 10/12 11/12 12/12
in thousands
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Net Income or <Loss>Actual and Budget
17
Actual Budget Variance
Month - Net Income or <Loss> $76,000 $296,000 ($220,000)
YTD - Net Income or <Loss> $664,000 $1,774,000 ($1,110,000)
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Revenue, Expense, Profit Per APDAnnual
18
$3,000$3,398 $3,456 $3,634
$4,291$3,843
$3,698$3,922
$3,097
$3,159$3,284
$3,339 $3,602 $3,743 $3,670 $3,847
-$97
$239 $171 $295$689
$100 $28 $76$265$94 $0 $0 $0 $0 $0
FY07 FY08 FY09 FY10 FY11 FY12 FY13 Budget FY13
TOTAL REVENUE PER APD TOTAL EXPENSE PER APD INCOME (LOSS) PER APD COUNTY CONTRIB. PER APD
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Revenue, Expense, Profit Per APDMonthly
19
4,476
3,410 3,697 3,895 3,969 3,862 3,840
3,462 3,844
3,570 3,580 3,797 3,979
3,788 3,295 3,585 3,811
3,919 4,059
4,573
3,600 3,888
3,505 3,357 3,786
3,959
688
116 112 84 50 (198)
(734)
(139) (44) 65 223 11 20
-$1,000
$0
$1,000
$2,000
$3,000
$4,000
$5,000
TOTAL REVENUE PER APD TOTAL EXPENSE PER APD INCOME (LOSS) PER APD
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Cash - PatientsMonthly
20
$11,493
$11,108
$12,196
$9,666
$9,853
$12,643$9,976
$10,438
$10,568
$8,780$9,720
$10,918$11,331
$0
$2,000
$4,000
$6,000
$8,000
$10,000
$12,000
$14,000
$16,000
12/11 01/12 02/12 03/12 04/12 05/12 06/12 07/12 08/12 09/12 10/12 11/12 12/12
in thousands
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Cash – Patients – Average Per MonthAnnual
21
$7,811$9,305
$10,809$11,539 $11,222
$10,293
in thousands
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Month End Cash Balance22
$59.9$54.7
$53.9 $55.8
$68.2 $68.6
$70.6
$62.2 $62.9$58.6 $57.4 $54.1 $53.0
$63.1
$61.4
$58.3$66.2 $63.8 $61.6
$67.0$61.0 $57.4
$57.0 $53.9 $50.4 $50.4
$0
$10
$20
$30
$40
$50
$60
$70
$80
Actual Actual Actual Actual Actual Actual Actual Actual Actual Actual Actual Actual Actual
12/11 01/12 02/12 03/12 04/12 05/12 06/12 07/12 08/12 09/12 10/12 11/12 12/12
in millions
Act/Est Budget
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Patient Accounts ReceivableMonthly
23
$127.4$134.3
$121.7 $121.2$130.7
$120.0$114.4 $112.7 $110.0 $115.2
$134.8$132.4 $127.7
$0.0
$25.0
$50.0
$75.0
$100.0
$125.0
$150.0
$175.0
in millions
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Days in ARMonthly
24
62.3 64.7
56.6 55.5 58.5
55.1 56.4 56.8 53.3 54.7
60.3 60.5 63.4
20.0
30.0
40.0
50.0
60.0
70.0
80.0
90.0
100.0
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Days in ARYear to Year Comparison
25
66.9 66.6 58.5
56.6
63.4
-
20.0
40.0
60.0
80.0
2009 2010 2011 2012 2013
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Days Cash on HandAnnual
26
66 72 109
141 154 119
32 31
32
0
20
40
60
80
100
120
140
160
180
200
FY2008 FY2009 FY2010 FY2011 FY2012 YTD FY2013
Days of Cash on Hand
BBB 125
A 179
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Long Term Debt Ratio27
45%41%
36% 34%32% 30%
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Key Points28
•Average Daily Census (ADC) for December is 93.4 or 5.4 higher than the November census of 88.0 ADC.
• The YTD ADC was (.3) patients lower than budget and (1.0) ADC lower than the prior year.
•Gross Patient Revenues:
●Total patient revenue of $ 62.7 M for December was ($ 1.0 M) lower than budget. YTD total patient revenue is $ 4.6 M higher than budget and was $ .2 M higher than the prior year to date average.
Deductions from Revenue:
• Deductions from revenue were $ 1.0 M lower than budget and Net Patient Revenue was ($ .1M) lower than budget. YTD deductions from revenue were ($8.4 M) higher than budget and was ($ 2.9 M) higher than the prior year to date average.
•Government Funding:
• Government funding is being accrued at the FY 2013 Budget level and has been adjusted to reflect changes to Year to date funding that is known and is ($ 0.9 M) below budget.
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Key Points29
•Salaries, Wages and Benefits YTD has a favorable variance of $ .9 M.
• On dollars per APD, SWB are $ 48 under budget for the current year.
• Paid FTE’s are 856.6 or 14.1 FTE’s lower than budget while FTE’s per adjusted occupied bed are 6.7 or .8 lower than budget.
Registry has an unfavorable variance YTD of ($ 509 K).
• RN fees are over budget by ($ 115 K) over in Therapy by ($ 114 K) and over in Temp Staff by ($ 280K)
•Physician fees/salaries have a favorable variance of $ 127 K.
• Non-employed physicians ($ 380 K).
• Payroll Residency Program $ 353 K.
• Payroll Staff Physicians $ 154 K.
•Supplies have a favorable variance of $ 844 K.
• Supplies expense per adjusted patient day are under budget by $ 37 and $ 33 lower than the prior year average per APD.
• Other Operating Expense has a favorable variance of $ 557 K.
• Other operating expense per adjusted patient day are under budget by $ 24 and $ 16 lower than the prior year average per APD.
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Key Points30
•Utilities and Telephone has a favorable variance of $ 80 K.
• Utilities & Telephone expense per adjusted patient day are under budget by $ 4 and $ 1 lower than the prior year average per APD.
•Purchased Services has a favorable variance of $ 1.5 M.
• Adjusted for volume, purchased services per adjusted patient day are $ 68 favorable to budget year to date and $ 22 lower than the prior year average.
Net income year to date is $ 664 K but is ($ 1.10 M) negative variance vs. budget.
The current cash balance is $ 53.0 M. at December 31, vs. a budgeted cash balance of $ 50.4 M, yielding a positive variance at 12/31 of $ 2.6 M excluding the $14.2M in the County’s NMC Reserve Fund. Patient account collections were $ 11.5 M. for December up from $ 10.9 in November.
The schedule below shows the change in year-end cash forecasted month by month for FY 2013.
July Aug Sept. Oct. Nov. Dec.$1.1M ($0.1M) $2.9 M ($3.6M) $ .7 M $ .5 M