1 Children s Health Care d/b/a Children s Hospitals and Clinics of Minnesota May 27, 2016
2 CHILDREN S HOSPITALS AND CLINICS OF MINNESOTA Admits by Pediatric Service Line 2015 Admits % of Total Anesthesiology % Cardiology % Critical Care 1, % Emergency Medicine 9 0.1% Endocrinology 1 0.0% ENT/Otolaryngology % Gastroenterology % General Medicine % General Surgery % Hematology/Oncology 1, % Infectious Disease % Neonatology 2, % Neurology Neurosurgery % 1.3% Other Specialties % Pediatric 7, % Subspecialty Surgery % Urology % Totals 14, % Source: Children s internal records Table 2 Net Change in Admitting Physicians Beginning 1,198 1,145 1,178 1,136 1,051 of Year Net Change (53) 33 (42) (85) 64 End of Year 1,145 1,178 1,136 1,051 1,115 Source: Children s internal records
3 Table 3 Employee Collective Bargaining Agreements Occupation Number of Employees at 12/31/15 Union or Association Contract Expiration Dates at 12/31/15 Registered Nurses 1,535 Minnesota Nurses Assoc. (MNA) Service Workers 469 Local No Service Employees International Union (SEIU) 05/31/ /28/2018 Other 12 Local No. 70 (L70) 04/30/2017 Total Contract Employees 2,016 Source: Children s internal records.
4 Table 4 Acute Pediatric Service Line: Inpatient Discharges Volume and Market Share (excludes chemical dependency, psychiatry, neonates, and newborns) By Metropolitan * Hospital System - All Patient Origins (Ages 0-14) Hospital Children s System 9, % 8, % 9, % 10, % 9, % Fairview System 2, % 3, % 3, % 2, % 2, % Gillette 1, % 1, % 1, % 1, % 1, % Hennepin County % % % % % Allina System % % % % % North Memorial % % % % % Ridgeview % % % % % Methodist % % % % % Regions % % % % % HealthEast System % % % % % Lakeview % % % % % Maple Grove % % % % % Regina 3 0.0% 7 0.0% 1 0.0% 3 0.0% 2 0.0% Total 16, % 16, % 16, % 17, % 16, % *Metropolitan Hospital Systems are defined by the Minnesota Hospital Association (MHA) as Region 4 (7-County Metro) Reporting Hospitals, Region 4 Counties include: Anoka, Carver, Dakota, Hennepin, Ramsey, Scott and Washington Counties Source: MHA Region 4 Hospitals (7-County Metro Hospitals) Standard Market Share Report, All Patient Origins, Ages 0-14.
5 Table 5 Neonatology Service Line: Number of Patient Days and Market Share By Metropolitan * Hospital System - All Patient Origins (Ages 0-14) Hospital Children s System 29, % 34, % 39, % 41, % 40, % Allina System 18, % 13, % 10, % 11, % 10, % Fairview System 18, % 22, % 25, % 23, % 24, % Hennepin County 6, % 7, % 7, % 6, % 7, % North Memorial 6, % 5, % 4, % 4, % 4, % Methodist 3, % 3, % 3, % 3, % 4, % HealthEast System 4, % 3, % 4, % 5, % 5, % Regions 2, % 2, % 2, % 2, % 2, % Ridgeview 2, % 1, % 2, % 1, % 1, % Maple Grove 2, % 3, % 4, % 5, % 7, % Lakeview % % % % % Regina % % % % % Gillette 9 0.0% 6 0.0% 5 0.0% 5 0.0% 3 0.0% Total 93, % 98, % 105, % 108, % 110, % *Metropolitan Hospital Systems are defined by the Minnesota Hospital Association (MHA) as Region 4 (7-County Metro) Reporting Hospitals, Region 4 Counties include: Anoka, Carver, Dakota, Hennepin, Ramsey, Scott and Washington Counties Note: The neonatology service line is defined by MHA as DRG s: , which includes neonates hospitalized in all levels of NICU s (excludes normal newborns). Note: Children s acquired Allina s Special Care Nursery in Q Source: MHA Region 4 Hospitals (7-County Metro Hospitals) Standard Market Share Report, All Patient Origins
6 Table 6 December 31 st 2015 Number of Staffed and Licensed Beds Licensed Minneapolis St. Paul Total Regular Beds Bassinets Total Staffed Beds Source: Children s internal records.
7 Table 7 Admissions and Patient Days (All admissions including acute pediatrics, chemical dependency, psychiatry, newborns and neonates) For the Year Ended December 31, Admissions Perinatal Services 1,874 2,175 2,612 2,836 2,891 3,276 Intensive Care Services 1,746 2,190 2,237 2,156 2,600 2,032 Medical & Surgical Services 8,831 7,844 7,736 8,032 9,010 9,380 Total 12,451 12,209 12,585 13,024 14,501 14,688 Patient Days Perinatal Services 35,369 35,333 41,590 47,507 50,347 46,715 Intensive Care Services 10,955 14,068 14,125 15,875 17,272 17,713 Medical & Surgical Services 33,445 30,334 31,310 32,477 34,758 36,385 Total 79,769 79,735 87,025 95, , ,813 Average Daily Census Source: Children s internal records. Table 7 Discharges and Patient Days (All discharges including acute pediatrics, chemical dependency, psychiatry, newborns and neonates) For the Year Ended December 31, Discharges Perinatal Services 1,820 2,195 2,641 2,855 2,847 3,292 Intensive Care Services 1,135 1,456 1,587 1,538 1,995 1,234 Medical & Surgical Services 9,536 8,521 8,355 8,652 9,602 10,162 Total 12,491 12,172 12,583 13,045 14,444 14,688 Patient Days Perinatal Services 35,369 35,333 41,590 47,507 50,347 46,715 Intensive Care Services 10,955 14,068 14,125 15,875 17,272 17,713 Medical & Surgical Services 33,445 30,334 31,310 32,477 34,758 36,385 Total 79,769 79,735 87,025 95, , ,813 Average Daily Census Source: Children s internal records.
8 Table 8 Volume of Certain Outpatient Services For the Year Ended December 31, Outpatient Surgical 16,577 16,807 15,940 15,552 15,423 17,048 Cases Emergency 80,094 88,674 90,673 88,840 95,675 96,206 Department Visits Clinic Visits 130, , , , , ,785 Total 227, , , , , ,039 Source: Children s internal records. Table 9 Percent of Revenue by Payer Year Ended December 31, Medicaid 15.2% 16.4% 17.4% 15.3% 16.3% 16.6% Medicaid Managed Care 26.1% 25.7% 24.1% 26.7% 26.3% 26.4% HMO/PPO 55.4% 54.1% 54.4% 54.6% 53.9% 53.8% Commercial Insurance and Other 1.2% 1.2% 1.2% 1.8% 3.0% 1.5% Payers Self-Pay 2.1% 2.6% 2.9% 1.6% 0.5% 1.7% Total 100% 100% 100% 100% 100% 100% Source: Children s internal records.
9 Capitalization Table (Dollars in thousands) December 31, 2015 December 31, 2014 Series 1995B Bonds $14,000 $15,200 Series 2004A Bonds 19,325 20,050 Series 2004A-1 Bonds 18,300 19,025 Series 2004B Bonds 27,500 29,950 Series 2007A Bonds 93,250 95,300 Series 2010A Bonds 30,710 44,020 Total Long Term Debt $203,085 $223,545 Unrestricted net assets 691, ,479 Total long-term debt and unrestricted net $894,809 $865,024 assets Ratio of long-term debt to total capitalization 22.7% 25.8% CHILDRENS HOSPITALS AND CLINICS OF MINNESOTA Debt Service Coverage Table Fiscal Year Ended December 31, (Dollars in thousands) (Deficit) Excess of revenue over expenses $47,347 $47,771 Net change in unrealized losses (gains) on 31,419 (3,981) investments Change in unrealized interest rate swap (682) 10,626 valuation Financing costs* 4,641 5,343 Depreciation and amortization 40,564 39,415 Revenue available to pay debt service $123,289 $99,174 Actual long-term debt service $12,820 $13,253 Historical long-term debt service coverage ratio 9.6x 7.5x Maximum annual debt service* $13,639 $14,325 Historical coverage of maximum annual debt service* 9.0x 6.9x *Excludes cost of swaps
10 Fixed Payor Interest Rate Swaps December 31, 2015 (Dollars in thousands) Swap Fair Value Notional Amount Outstanding Rate Paid Rate Received Counter Party 2004A $(5,059) $20, % 70% LIBOR Piper Jaffray Financial Products, Inc. 2004B (4,727) 29, % LIBOR Piper Jaffray Financial Products, Inc. 2007A1 (11,513) 47, % LIBOR Piper Jaffray Financial Products, Inc. 2007A2 (11,516) 47, % LIBOR Piper Jaffray Financial Products, Inc. Totals $(32,815) $145,300
11 Consolidated Summary of Revenues and Expenses and Other Changes in Unrestricted Net Assets ($000) December December Revenue Net Patient Service Revenue $785,795 $755,743 Other 33,110 29,537 Foundation Transfers 8,275 9,186 Total Revenue 827, ,466 Expenses Salaries, Benefits and Other 727, ,714 Depreciation and Amortization 40,674 39,518 Financing costs 9,992 11,001 Total Expenses 778, ,233 Operating Income 48,876 33,233 Nonoperating Gains Investment Income, Net 17,851 18,937 Income on Investments Accounted for Under Equity Method 4,407 2,521 Net Change in Unrealized Losses on Investments (31,542) 3,730 Change in Interest Rate Swap Valuation 682 (10,626) Other 0 0 Total Nonoperating Gains, Net (8,602) 14,562 Excess of Revenue Over Expenses 40,274 47,795 Other Changes Net Assets Released from Restrictions Capital Acquisitions 5,441 6,878 Application of FAS 158 on the RSVP Plan 4,530 (8,354) Increase in Unrestricted Net Assets $50,245 $46,319 * Includes Children s Foundation and CHIN, which are not members of the Obligated Group. Children s Foundation and CHIN combined accounted for $24 and $(111) in the change in unrestricted net assets for the fiscal years ended December 31, 2014 and 2015, respectively.
12 Consolidated* Summary Statements of Financial Position ($000) Assets Cash, Cash Equivalents and Short Term Investments December 31, 2015 December 31, 2014 $21,897 $70,033 Other Current Assets 149, ,610 Donor Restricted Cash and 49,164 47,992 Investments Unrestricted Investments 496, ,124 Other Assets 47,783 49,682 Land, Building & Equipment Net 387, ,043 Total Assets $1,152,403 $1,144,484 Liabilities Current Liabilities $126,451 $147,917 Fair Value of Interest Rate Swaps 32,815 33,497 Long Term Debt Less Current 204, ,939 Portion Other Long Term Liabilities 25,119 23,132 Total Liabilities 388, ,485 Net Assets Unrestricted 691, ,479 Temporarily Restricted 42,295 43,372 Permanently Restricted 29,862 30,148 Total Net Assets 763, ,999 Total Liabilities and Net Assets $1,152,403 $1,144,484 * Includes Children s Foundation and CHIN, which are not members of the Obligated Group. Children s Foundation and CHIN combined had total net assets, which include both restricted and unrestricted net assets, of $83,982, and $79,949 as of December 31, 2014 and 2015, respectively. The combined unrestricted net assets of Children s Foundation and CHIN were $1,865 and $1,754 as of December 31, 2014 and 2015, respectively.
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