MANAGEMENT S DISCUSSION OF FINANCIAL PERFORMANCE. As of March 31, 2016

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1 MANAGEMENT S DISCUSSION OF FINANCIAL PERFORMANCE As of March 31, 2016

2 Management s Discussion of Financial Performance Introduction The consolidated financial statement information and other data for the six months ended March 31, 2016 and 2015 are derived from the consolidated financial statements and other records of Memorial Health System (MHS). The consolidated financial statements include all adjustments, consisting of normal recurring and other accruals, which MHS management considers necessary for a fair presentation of financial position, results of operations and changes in net assets, and cash flows for these periods in conformity with generally accepted accounting principles (GAAP) in the United States. All references, unless otherwise noted, compare the six months ended March 31, 2016 to the six months ended March 31, Nature of Operations The principal operating activities of MHS consist of the following: Memorial Health System-Corporate is the sole corporate member of Memorial Medical Center (MMC), Passavant Area Hospital (PAH), Abraham Lincoln Memorial Hospital (ALMH), Taylorville Memorial Hospital (TMH), Memorial Physician Services (MPS), Memorial Behavioral Health (MBH), MHS QALICB, LLC (QALICB), Memorial Home Services (MHSvc), Memorial Health Ventures (MHV), Memorial Health Partners (MHP) and Abraham Lincoln Healthcare Foundation (ALHF). MMC is a teaching tertiary hospital with 500-licensed beds located in Springfield, Illinois. MMC is academically affiliated with the Southern Illinois University School of Medicine (SIU SOM). Memorial Medical Center Foundation (MMCF) is responsible for soliciting and maintaining donated funds and providing grants to MHS affiliates and other organizations. PAH is a 121-licensed bed hospital located in Jacksonville, Illinois. PAH is the sole corporate member of Passavant Physician Association (PPA), Jacksonville CRNA s Incorporated (CRNA), and Passavant Area Hospital Foundation (PAHF). PPA provides health care and health care related activities for supporting and benefiting the operation of health care facilities. CRNA consists of certified registered nurse anesthetists for providing services to patients at PAH. PAHF is responsible for soliciting and maintaining donated funds and providing grants to PAH. ALMH is a 25 bed critical access hospital (CAH) located in Lincoln, Illinois. Under the federal Rural Hospital Flexibility Program, which governs CAHs, ALMH receives costbased reimbursement for Medicare services, but cannot exceed an inpatient census of more than 25 acute inpatients and swing bed patients. ALHF is responsible for soliciting and maintaining donated funds and providing grants to ALMH. TMH is a 25 bed CAH located in Taylorville, Illinois. TMH provides medical/surgical services. Taylorville Memorial Hospital Foundation (TMHF) is responsible for soliciting and maintaining donated funds and providing grants to TMH. MPS provides outpatient and ambulatory care services through arrangements with physicians and other healthcare professionals. MPS operates ten physician clinics in five communities within the MHS s primary service area. MPS is the sole corporate member of Memorial Properties (MP).

3 Nature of Operations - Continued HealthCare Network Properties, LLC d/b/a Memorial Properties (MP) manages and leases various medical related real estate properties. Currently, MP owns five properties which are leased primarily to MPS physicians and other unrelated physician groups. MHSvc provides home health care and hospice services and is the sole shareholder of Memorial Home Services of Central Illinois (MHSCI), a for-profit corporation, which operates four retail locations for durable medical equipment. MBH (formerly MHCCI) provides comprehensive behavioral health and rehabilitation services with 14 locations serving Sangamon, Menard, Logan, Mason, and Morgan counties. MHV manages joint ventures in which MHS has entered with other healthcare professionals and organizations. Operations include MHS s outpatient service and Memorial ExpressCare. MHP provides the coordination of patient care activities across the healthcare continuum, through partnerships and information exchange with providers, in order to facilitate the appropriate delivery of health care services and improve population health. QALICB facilitates transactions under the New Markets Tax Credit (NMTC) program relating to the SIU Center for Family Medicine Expansion and Renovation project (CFM Project). All operations and costs associated with the CFM Project are recorded on QALICB s financial records, as required by the NMTC program. Unrestricted Cash and Investments MHS had $578,925 in cash and investments on March 31, This represents a decrease of $36,675 from the prior year. The decrease in unrestricted cash and investments balances was largely attributed to the increase in receivables by $35,636 from the prior year and the acquisition of property and equipment. Assets Whose Use is Limited Total Assets Whose Use is Limited includes cash and investments which decreased $7,478 from the prior year. This is primarily due to the decrease in self-insurance trust by $1,618. Bond trustee assets decreased $3,665 from prior year due in large part to MMC making a $3, Series debt payment and PAH refinancing its debt. Receivables Total receivables increased by $35,636 from the prior year in large part because of the net patient accounts receivable increase of $34,087. MHS has experienced an increase in days in accounts receivable directly associated with delayed collection of payments from the State of Illinois. The increase in days in accounts receivable from the State of Illinois went from 17.0 days in March 2015 to 28.7 days in March Property, Plant & Equipment Net property, plant and equipment increased $39,391 due to the construction of Memorial Medical Center s Advancing Care by Design project and routine capital purchases. 2

4 Current Liabilities Total current liabilities decreased by $5,402 from the prior year. MP disbursed its annual debt payment of $2,500 and exercised its optional redemption to pay the remaining debt balance of $1,745 in January. Long-term Debt MHS increased its long-term debt (excluding current portion) from $374,543 to $414,520. During fiscal year 2015, MHS made $37,322 in remaining draws of the Series 2014B bonds, QALICB received $16,770 in QLICI loans to finance the CFM Project, and long-term debt balances were reduced by normal principal payments. MHS reported $1,951 in capital leases as of March 31, Other Liabilities Total other liabilities increased $39,990 mainly due to a $36,273 increase in the pension obligation based on results of the actuarial valuation analysis. Actuarial assumptions included a change in the effective mortality table and applicable discount rate, which contributed to the overall increase in the pension obligation. Net Assets Total net assets decreased $29,594 largely due to the $42,481 decrease for the excess of revenue over expenses discussed below. Revenues Net patient service revenues increased by $21,777 or 5.3% from the prior year. An outpatient gross charges increase of $82,074 and a $67,129 increase in inpatient gross charges were largely offset by a $138,544 increase in contractual allowances and a decrease of $10,098 in charity. Medicaid Assessment decreased by $5,542 and in aggregate total revenues grew by $18,981 or 3.9%. Utilization Total inpatient discharges for all of MHS s hospitals increased 1.0% and outpatient visits decreased 0.6% from fiscal years 2015 to Expenses Total expenses increased by $49,615 or 11.3% from the prior year. Salaries rose by $13,441 or 8.1% due primarily from annual compensation adjustments and a 4.9% increase in FTE s. Benefits increased $6,779 or 12.5% primarily due to increased internal health insurance claims, and the increase in FTE s. Physician fees increased $6,770 or 19.6% primarily due to additional academic support provided to the Southern Illinois University School of Medicine. Income from Operations Income from operations of $12,302 or a 2.5% operating margin reflects a decrease by $30,634 from the prior year due to the operating activity previously discussed. Nonoperating Gains (Losses) A nonoperating gain of $10,336 decreased $11,847 compared to prior year largely due to changes in the fair market value of investments. Realized and unrealized gains on investment 3

5 balances decreased by $6,401 or 44.8% from the prior year. Contributions and other decreased $3,945, based on donor behavior. Excess of Revenues over Expenses Due to income from operations totaling $12,302 and a nonoperating gain of $10,336, MHS reported excess revenues over expenses of $22,638. Major Projects PAH Inpatient Adult Psychiatry Program: To meet the mental health needs in the region, PAH has been renovating the west wing of the third floor of the hospital to establish an inpatient adult psychiatric unit. Project completion is estimated by July 1, 2016 with a total project cost of $3.5 million. SIU Center for Family Medicine Facility Expansion: MHS provides support to SIU s Family and Community Medicine Department to operate the Center for Family Medicine and the Family Medicine Residency Program through academic support and access to real estate. In continued support, MHS will be expanding and renovating the existing facility to increase the size of the facility from 30,000 to 60,000 square feet at an estimated project cost of $16.3 million. Construction began in September 2015 and is expected to be completed and fully operational by March MHS continues renovation of an office building at 400 West Lawrence for the System s Finance and Patient Billing departments. The additional space will aid for clinical expansion at affiliate campuses and further integrate the MHS Finance related departments. The project is expected to be completed in August of 2016 with an estimated project cost of $8.9 million. Awards and Recognition Memorial Medical Center Honored for Eye Donations: Saving Sight, a nonprofit organization that helps provide corneas for more than 3,000 patients in need of transplants each year, presented Memorial Medical Center with its Excellence in Eye Donation award on March 24. Last year, MMC staff facilitated 132 eye donations, which resulted in 161 individuals receiving restored sight through a cornea transplant. Overall, the hospital achieved a 71% consent rate for eye donations. Memorial Home Services Rated 5 Stars in Patient Satisfaction: In January 2016, The Centers for Medicare & Medicaid Services (CMS) rated Memorial Home Services home health programs as 5 (out of 5) Stars on the Home Health Care Consumer Assessment of Healthcare Providers and Systems (HHCAHPS). The HHCAHPS Survey is a national, standardized, 34-item survey of patients experience of care received from their home health agency. The surveys are conducted by independent survey vendors and can be completed via mail, phone or through a mix of both. Star Ratings are intended to be an easy and convenient tool for consumers to use when choosing a home health provider. Only 37% of all agencies were designated as a 5 Star Agency. Memorial Home Services Designated Center of Excellence : Memorial Home Services has been designated as an Oasis Center of Excellence by Fazzi, a national home health consulting group. Using a standardized patient assessment tool developed by the federal Centers for Medicare and Medicaid (CMS), Fazzi evaluated over 600 U.S. home health agencies for patient 4

6 care quality, with only 12 agencies (2%) achieving the Center of Excellence designation. In addition to recognize the efforts of the Memorial Home Services team, this recognition is important as it appears that Oasis quality scoring will be an important component of CMS home health value-based purchasing program targeted for implementation in Memorial Recognized in Top 25 Percent of U.S. Hospitals for EHR Performance: Information Services is supporting Memorial s outstanding patient care in an important way with awardwinning clinical usage of our electronic patient health record (EHR). In December, performance of the medical center s EHR benchmarked in the top 25% of all hospitals in the nation, according to the Electronic Medical Record Adoption Model (EMRAM). The Health Information and Management Systems Society (HIMSS) established the EMRAM in 2005 to measure hospitals progress toward a fully electronic patient health record and paperless care processes. Memorial was recognized for HIMSS Stage 6 performance on the zero-to-seven scale, with one important component of the designation reflecting effective clinical decision-making based on information from the EHR, resulting in improved care for patients. Memorial Medical Center, Carle Foundation Hospital and OSF Healthcare are the only three hospitals in the region with the designation. Information Services and Clinical Operations continue to work toward HIMSS Stage 7 performance, a level attained by only 3.7% of all USA hospitals 5

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