St. Joseph s Hospital Health Center CUSIP Base #: Notice of Conference Call In connection with:

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1 St. Joseph s Hospital Health Center CUSIP Base #: Notice of Conference Call In connection with: $142,745,000 Onondaga Civic Development Corporation TaxExempt Revenue Bonds (St. Joseph's Hospital Health Center Project), Series 2012 And $68,315,000 Onondaga Civic Development Corporation TaxExempt Revenue Bonds (St. Joseph's Hospital Health Center Project), Series 2014A Notice is hereby given that St. Joseph's Hospital Health Center ("SJHHC") shall conduct a conference call with interested parties at 3:00 PM EDT on Tuesday, December 1, To access the conference call, please dial and provide the passcode when prompted. Conference Call Details: Date: Tuesday, December 1, 2015 Time: 3:00PM EDT Dial In: Passcode: Materials: Presentation materials will be available on EMMA 48 hours in advance of the call. Recording will be available 1 hour after call has ended and will be available until January 1, To access the recording, call: Toll free number:

2 St. Joseph s Hospital Health Center and Subsidiaries Management s Discussion and Analysis For the Nine Months Ended September 30, 2015 Introduction The unaudited operating results and other financial information for the nine months ended September 30, 2015 for St. Joseph s Health and St. Joseph s Hospital Health Center and Subsidiaries are attached. The St. Joseph s Health (the System ) financial statements include St. Joseph s Hospital Health Center and Subsidiaries; St. Joseph s Hospital Health Center Foundation (the Foundation ); St. Joseph s Health Center Properties, Inc. and Subsidiaries (Properties); and Embracing Age. The System financial statements are presented for the single year, as the System parent, St. Joseph s Health, was formed in October The St. Joseph s Hospital Health Center and Subsidiaries financial statements have been prepared comparing the unaudited balance sheet as of September 30, 2015 to the audited balance sheet as of December 31, 2014, and the unaudited statement of operations for the nine months ended September 30, The consolidated balance sheet and statement of operations as of September 30, 2015 for St. Joseph s Hospital Health Center and Subsidiaries include St. Joseph s Hospital Health Center (the Hospital ); S.J. Management Company (SJM), a wholly owned subsidiary; SJLS, LLC (SJLS), a 51% owned subsidiary of SJM; St. Joseph s Physician Enterprise (SJPE); St. Joseph s Medical P.C. (SJMPC); and St. Joseph s Physician Health, P.C. (SJPHPC). The Hospital is the entity that is committed on the 2012 and 2014 loan agreements, however, consolidated financial statements for St. Joseph s Health and St. Joseph s Hospital Health Center and Subsidiaries have also been included in response to requests for this information and an understanding of the consolidated entities. The attached statements have been presented in the same groupings and format as the audited financial statements. As of July 1, 2015, St. Joseph s joined Trinity Health. The attached financial statements reflect adjusted book value of various assets and liabilities to fair market value as a nonrecurring adjustment related to the union as described under notforprofit accounting standards. These nonrecurring adjustments did not impact cash flow or compliance with debt covenants, and does not impact future operations. This accounting adjustments are based on a review process that includes assessing the economic characteristics of certain assets and liabilities by independent valuation professionals. St. Joseph s expects to substantially complete this assessment during the six months ended December 31, 2015 and may adjust the amounts recorded as of July 1, 2015 to reflect revised evaluations.

3 Other Significant Events or Key Issues during 2015 On January 20, 2015, the Hospital received temporary approval from the New York State Department of Health to open an additional 20 inpatient beds. This is a step to help improve patient flow and create efficiencies within the organization. The beds were staffed and in use by the end of April In February 2015, the Hospital achieved accreditation status as a Comprehensive Center for Bariatric Surgery from the American College of Surgeons Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program. On February 10, 2015, St. Joseph s was awarded LEEDGold certification for its stateoftheart emergency services building, operating suite and surgical tower. St. Joseph s is one of only 28 hospitals in the country to receive LEEDGold certification. On April 27, 2015, St. Joseph s Health announced that an agreement was signed to join Trinity Health, a leading national Catholic health system. Together, Trinity Health and St. Joseph s expect to provide better health, better care and lower operating costs for the communities served. Joining the Trinity Health System will enhance St. Joseph Health s ability to compete in an environment of constant change. Locally, it will help strengthen the 150year mission of Catholic health care in the community and benefit patients and employees by providing the clinical, operational, strategic and financial resources necessary to deliver the best care possible. On July 1, 2015 the union between the two systems took effect. May 8, 2015, the Hospital issued its 2014 audited financial statements containing a restatement of the 2013 financial statements. The restatement was due to an overstatement of amounts previously reported for cash and cash equivalents, patient accounts receivable, net patient service revenue and total net assets as of December 31, The overstatements were discovered by management during late On July 1, 2015, Embracing Age became 40% owner of Oswego Home Health Care in Fulton, NY. Embracing Age, an affiliate of St. Joseph s Health provides services to enable older people to continue living in their homes. In July 2015, St. Joseph s Health was named one of the 100 Great Community Hospitals by Becker s Hospital review and the Best Regional Hospital in New York State by U.S. News. St. Joseph s is the only hospital in Central New York to be named to the 100 Great Community Hospitals list, and one of only three hospitals in New York to make the list. St. Joseph s is also the only hospital in the region to achieve the U.S. News recognition. St. Joseph s Health earned the Magnet recognition for nursing excellence and was one of the first 30 hospitals in the nation to achieve ISO 9001 certification for its quality management program. Additionally, Healthgrades gave St. Joseph's the America's 50 Best Hospitals for Cardiac Surgery Award, the America's 100 Best Hospitals for Coronary Intervention Award and the Joint Replacement Excellence Award in 2015.

4 In July 2015, St. Joseph s Hospital Health Center was named a 2015 Most Wired hospital, according to the 2015 Most Wired Survey, released by the American Hospital Association s Health Forum and the College of Healthcare Information Management Executives (CHIME). This is the sixth year that the Hospital has made this list and is the only hospital in Central New York to ever be named to the list. On October 7th 2015, the St. Joseph s cardiovascular team performed the first MitraClip case in Central New York. MitraClip is a lessinvasive treatment option for high risk patients with mitral regurgitation, which is caused by a leaky heart valve. The MitraClip device is a small clip that is attached to the patient s mitral valve, allowing the valve to close more completely and helping to restore normal blood flow through the patient s heart. This procedure accesses a patient s inner organs via needlepuncture through the skin, rather than an "open" approach in which the inner organs are exposed. MitraClip is the only FDA approved alternative to mitral valve regurgitation surgery. St. Joseph s is the first to offer it in Central New York as we continue to be a leader in heart related treatment. On October 23, 2015, working in conjunction with the New York State Department of Health ( DOH ), it was determined that two confirmed cases of Legionella pneumonia were hospitalacquired. There was an additional case within the same 4 week time frame that was inconclusive as to whether or not this case was hospitalacquired at St. Joseph s. With an abundance of caution, we elected to impose complete water restrictions throughout the facility until we could assess the situation and determine the source of the water infection. This included bringing in bottled water and ice for use throughout the hospital, restricting water faucet use for hand washing only and imposing a no shower restriction. Within 24 hours, the Emergency Services building was deemed safe by the DOH and the water restriction was lifted for this area on October 24, Highlyengineered water filters were obtained and placed in all patient care areas to allow for use of the water faucets for drinking and shower filters were installed to allow for patient showering. This additional safety measure was implemented to allow time for clinical and engineering specialists to assess the situation and institute longterm solutions. Dr. Janet Stout, a national expert in Legionella, and water system engineering experts were retained to help assess St. Joseph s water supply and determine the best plan of action to eradicate any Legionella in the water system and prevent further potential outbreaks. Repeat frequent water testing has been instituted (exceeding the DOH guidelines), in addition modifications have been made to the Hospital s water ionization system (water purification system). Water treatment levels have been increased, daily checks of the treatment levels in the water are performed, and weekly testing of all water systems and weekly cultures for Legionella have all been instituted. No new cases of hospitalacquired Legionella have been reported. Water restrictions have been lifted throughout the Hospital with the exception of the Tower and one water loop system that had a number of positive cultures from sinks. Continued testing combined with adjustments to the ionization system will occur until we are confident that all bacteria has been flushed from the water system. The restrictions to the Tower and the one restricted water loop will be lifted when three (3) additional sets of cultures are negative and our water treatment levels are maximized.

5 As of this date, no third party claims have been initiated against the Hospital. We have notified the carrier who issued our pollution policy that we will be submitting a claim for the expenses we have been incurring. At this time it is too early to determine the extent of our claim and the extent of the coverage under our policy. Balance Sheet St. Joseph s Health: Assets: Refer to St. Joseph s Hospital Health Center and Subsidiaries explanation below. Liabilities: Refer to St. Joseph s Hospital Health Center and Subsidiaries explanation below. St. Joseph s Hospital Health Center and Subsidiaries: Assets: The changes in assets reported on the balance sheet as of September 30, 2015 reflect, in part, the result of nonrecurring adjustments made to recognize the assets at fair market value as of July 1, Those adjustments include a decrease in accounts receivable of $5,370,000; a decrease in Property, plant and equipment ( PP&E ) of $98,652,000; an increase in Other Assets (longterm) of $14,104,000; a decrease in Unamortized Debt Issuance Costs of $7,493,000; an increase in Investments in Affiliates of $3,562,000; and a decrease in Goodwill of $26,793,000. Cash and cash equivalents decreased by $2,380,000 of which $3,152,000 is attributed to the Hospital as explained below, a decrease of $128,000 from SJMPC and $775,000 from SJPHPC. The decrease in SJMPC s cash is a result of less cash needed, and therefore transferred, from the Hospital to cover their disbursements as receipts remained strong. SJPHPC s decrease in cash is a result of $5,800,000 in payments made to the Hospital to reduce the intercompany balance offset by deposits received. These decreases were offset by a $1,645,000 increase in SJM s cash balance. From December 31, 2014 to September 30, 2015 investments decreased by $7,666,000 which is due to the Hospital as explained below. Patient receivables increased by $6,110,000 and relates to the Hospital as discussed under the Hospital Only Assets section below and SJM. There was a $812,000 increase in Other Receivables, the majority of which is related to the Hospital and is discussed below under the Hospital Only Assets. Consolidated inventory decreased by $758,000 which was primarily accounted for by a decrease in the Hospital s inventory of $872,000 which is attributed to an increase in the usage of OR supplies. This decrease was partially offset by inventory of $113,000 being recorded for SJMPC; inventory had not previously been recorded by that entity due to materiality. Consolidated Prepaid Expenses decreased by $1,418,000 due to a decrease of $1,017,000 for the Hospital as described below as well as a decrease of $387,000 for SJMPC.

6 Property, plant and equipment ( PP&E ) decreased by approximately $117,221,000. In addition to the reduction of asset value previously described, there was also a reduction in net PP&E due to normal depreciation for all entities property, plant and equipment partially offset by normal additions, which were largely attributed to the Hospital as described below. A decrease of $6,109,000 in longterm assets limited to use was related entirely to the Hospital as explained below in the Hospital Only section. Liabilities: The changes in liabilities reported on the balance sheet as of September 30, 2015 reflect, in part, the result of nonrecurring adjustments made to recognize the liabilities at fair market value as of July 1, Those adjustments include an increase in Accrued Expenses and Other Liabilities of $2,821,000; an increase in Estimated Third Party Payor Settlements of $1,870,000; a decrease in Long Term Debt of $6,586,000; a decrease in Accrued Post Retirement Benefits of $1,572,000; a decrease in Accrued Pension Benefits of $12,051,000; and an increase in Other Liabilities of $12,468,000. There was a $3,155,000 decrease in accounts payable; $2,766,000 relates to the Hospital as discussed below. SJMPC also had a decrease in accounts payable from December 31, 2014 as a result of the timing of payments made on invoices. Accrued expenses increased by $4,521,000 which was the result of several factors. The Hospital accounted for the majority of the variance including normal increases of approximately $2,591,000 in accrued expenses as well as the adjustments discussed above; both are described in the Hospital Only section below. These increases were partially offset by a decrease in accrued expenses of approximately $320,000 for SJM. The Hospital attributed to the $10,719,000 increase in estimated third party payor settlements as described below in the Hospital Only section. A decrease of $19,159,000 in longterm debt is related to normal payments on debt held by the Hospital and SJMPC in addition to the adjustments discussed above. Other Liabilities increased from December 31, 2014 by approximately $11,546,000 as a result of the adjustments discussed above. St. Joseph s Hospital Health Center (the Hospital ): Assets: The changes in assets reported on the balance sheet as of September 30, 2015 reflect, in part, the result of nonrecurring adjustments made to recognize the assets at fair market value as of July 1, Those adjustments include a decrease in accounts receivable of $5,370,000; a decrease in Property, plant and equipment ( PP&E ) of $100,127,000; an increase in Other Assets (longterm) of $14,104,000; a decrease in Unamortized Debt Issuance Costs of $7,493,000; an increase in Investments in Affiliates of $551,000. Cash and cash equivalents decreased by $3,152,000 which is attributed to operating performance through September 2015 as well as $10,300,000 in spend related to general capital purchases. From December 31, 2014 to September 30, 2015 investments decreased by $7,666,000 which is due to the Hospital redeeming securities over the nine months ending September 30, 2015 of $19,130,000 partially offset by purchasing $10,503,000 in securities during the month of March

7 2015 as well as growth in the investments for interest earned and unrealized investment gains. Patient receivables increased by $5,386,000 due to an increase in accounts receivable over 90 days old relating in part from large payor processing backlogs that are being resolved. Other operational improvements have been made within patient accounting to improve collection activity including productivity tracking and monitoring, large balance focus and denials management. Other receivables increased by $424,000 as a result of an increase in the tuition reimbursement receivable as more employees are using this benefit and the forgiveness period was made longer when the policy was updated in May The increase in other receivables was partially offset by a decrease in the receivable for psychiatric services as adjustments were made to reflect what would reasonably be collected. Inventory decreased by $872,000 which was due to an increase in the usage of OR supplies. Prepaid Expenses decreased by $1,017,000 for the Hospital due to the amortization recognized on prepaid services contracts. Property, plant and equipment for the Hospital decreased by approximately $117,925,000 of which $28,081,000 relates to normal monthly depreciation as all large projects from 2014 are operational, offset by $10,300,000 of new capital purchases in The most significant change in value for property, plant and equipment is described above. Assets limited to use (longterm) decreased by $6,109,000 due to payments made out of the bond funds for periodic payment of interest and principal, partially offset by normal monthly payments paid in to the 2012 and 2014 bond funds. Amounts due from affiliates increased from December 31, 2014 by $21,959,000 due to increased intercompany activity with SJPHPC of $11,531,000, SJMPC of $9,052,000 and SJLS by $421,000. Liabilities: The changes in liabilities reported on the balance sheet as of September 30, 2015 reflect, in part, the result of nonrecurring adjustments made to recognize the liabilities at fair market value as of July 1, Those adjustments include an increase in Accrued Expenses and Other Liabilities of $2,212,000; an increase in Estimated Third Party Payor Settlements of $1,870,000; a decrease in Long Term Debt of $7,173,000; a decrease in Accrued Post Retirement Benefits of $1,572,000; a decrease in Accrued Pension Benefits of $12,051,000; and an increase in Other Liabilities of $12,468,000. Accounts payable decreased by $2,766,000 as outstanding invoices were reaching their maturity and therefore increased payments were made to vendors as compared to yearend. The $10,822,000 increase in the estimated third party payor settlement liability was attributed to an increase of $7,200,000 in Blue Cross Blue Shield ( BCBS ) settlements, $3,200,000 in Medicare and Medicaid meaningful use, $314,000 related to Bad Debt and Charity Care/Upper Payment Limit ( BDCC/UPL ) and $228,000 BCBS SJLS Subsidy. These increases were offset by decreases of $574,000 in Medicare cost report settlements and $1,500,000 relating to Medicaid rate adjustments. The remaining adjustment to Estimated Third Party Payor Settlements is described above. A decrease of $17,991,000 in longterm debt is related to normal debt payments on the various bonds and capital lease obligations of $10,818,000 in addition to the adjustment described above. Operations

8 St. Joseph s Health: Refer to St. Joseph s Hospital Health Center and Subsidiaries explanation below. St. Joseph s Hospital Health Center and Subsidiaries: The first nine months of 2015 resulted in an increase in net patient revenue less bad debts of $5,421,000 on a consolidated basis. Of this increase $4,750,000 relates to the Hospital, $1,017,000 relates to SJPHPC. The increase in SJPHPC s net patient revenue is due to increased revenues from new providers transferred from the Hospital in May See below under the Hospital Only for the explanation of the increase in net patient revenue less bad debts. Total operating expenses increased from September 30, 2014 by $23,302,000 which contributed to an unfavorable change of $14,610,000 in the income from operations for an operating loss of $23,447,000 for the period ended September 30, Salary expense increased by $2,500,000 and fringe benefits by $3,500,000 which relates primarily to the Hospital as described below. Supplies and other expenses increased by $6,826,000, of this most relates to the Hospital as explained below. Depreciation expense increased by $6,634,000 as a result of the completion of the Hospital s large projects in 2014 as indicated below. The Hospital s 2014 and 2012 bonds payable increased interest expense by approximately $2,397,000 over the prior year, as the 2014 debt was issued in April St. Joseph s Hospital Health Center (the Hospital ): Overall, for the nine months ending September 30, 2015, the Hospital reported an operating loss of $8,494,000, which was unfavorable to the prior year by $11,636,000. The Hospital reported a deficiency of revenue over expenses of approximately $10,247,000 which was $14,855,000 unfavorable compared to the year ended September 30, Net patient revenue less bad debts increased by $4,750,000, this was due to an increase of 266 outpatient surgeries and 28 inpatient surgeries, as well as an increase in case mix index from 1.74 to 1.77 in Bad debt expense decreased by $5,437,000 over September 30, 2014 due to a change in the Early Out vendor and more uncollectible accounts being written off to charity care rather than bad debt. In addition, bad debt expense was higher in 2014 due to the cleanup of patient receivables to prepare for the new electronic health record ( EHR") system, which also included a policy change to recognize bad debts prior to sending them to collection agencies. An increase in other revenue of $8,082,000 is related to the Hospital leasing their physicians and clinical affiliates to SJPHPC which did not begin in 2014 until May. In addition, $1,280,000 of the increase can be attributed to NYS grant money received for Medical Home and the Tobacco Cessation program. Salary expense increased $3,003,000 due to overtime and premium pay necessary to cover new nursing staff while they completed orientation. Fringe benefit costs increased by $3,124,000 due to an increase in employee health insurance expense as there has been an increase in high dollar claims in the first six months of Supplies and Other Expenses increased from September 2014 by $7,876,000. Contributing to this increase were malpractice insurance expense, temporary employment services, medical supplies, software maintenance and nonsalary physician costs. Surgical supplies have increased from September 2014 as a result of an increase in more expensive cardiac (TAVRs), heart valves and spinal surgeries. Temporary employment services have increased as the Hospital has experienced vacancies in nursing and therefore additional help has been brought in to fill these vacancies. Most of the nursing vacancies have been filled in

9 July 2015 and these expenses are expected to diminish once the new staff completes orientation. Nonsalary physician costs increased as a result of an increase in locum payments and additional agreements entered into with physician groups. Malpractice expense increased based on annual actuarial projections. Software maintenance contracts increased due to the implementation of the electronic medical record system in May System fees of $1,352,000 due to Trinity Health were accrued for the quarter ended September 30, Depreciation expense increased by $6,671,000 due to the increase in property, plant and equipment, the new EHR system going live in May 2014, Phase IIB Patient Tower being placed into service in September 2014 and the Co Generation Plant becoming operational in November The 2014 and 2012 bonds payable increased interest expense by approximately $2,500,000 as payments are due semiannually and the 2014 bonds were not issued until April The equity change in the unrestricted net assets of the Foundation has decreased from September 2014 by $3,093,000 as a result of increased payments made by the Foundation to the Hospital for the purchase of a Davinci robot used in surgical procedures. Conclusion Our recent affiliation with the large national Trinity Health System better positions us to address operational variances, leading to improved financial performance. Those initiatives include, but are not limited to, growth, revenue excellence, supply chain, physician network improvements and work force management. Through focused engagement with its members, Trinity Health ensures active system services support to achieve improved performance. Benefits have already begun to be realized in areas such as insurance, supply chain and some contract services. Combined with the recent union with Trinity Health and the significant investments the Hospital has made to position the System for success in the changing world of health care, the System expects to realize returns and optimize the benefits for our patients through improved flow, facilities, satisfaction and outcomes. SPECIAL NOTE CONCERNING FORWARDLOOKING STATEMENTS Certain statements or elements included in the Management s Discussion & Analysis section of this document may include certain forwardlooking statements which involves known and unknown risks and uncertainties inherent in the operation of a healthcare facility. Actual actions or results may differ materially from those discussed above. Specific factors that may cause such differences include competition from other healthcare facilities in the service area of St. Joseph s Health and St. Joseph Hospital Health Center and Subsidiaries, federal and state regulation of healthcare providers, and reimbursement policies of the state and federal governments and managed care organizations. In particular, statements proceeded by, followed by or that include the words believes, estimates, anticipates, plans, intends, scheduled, or other similar expressions are or may constitute forwardlooking statements.

10 Assets ST. JOSEPH'S HOSPITAL HEALTH CENTER Balance Sheets Hospital Only September 30, December 31, $ Change Current assets: Cash and cash equivalents $ 36,687,348 $ 39,839,023 $ (3,151,675) Investments $ 61,566,697 69,232,209 (7,665,512) Patient accounts receivable, net of allowance for charity care and doubtful accounts of approximately $7,558,000 in 2015 and $15,912,000 in 2014 $ 89,713,541 84,327,475 5,386,066 Other receivables $ 5,102,179 4,678, ,030 Inventories $ 5,479,778 6,351,919 (872,141) Prepaid expenses $ 4,219,625 5,236,300 (1,016,675) Assets limited as to use $ 6,750,000 6,605, ,000 Due from affiliates, net $ 48,066 (48,066) Estimated thirdparty payor settlements Total current assets $ 209,519, ,318,141 (6,798,973) Property and equipment, net $ 247,462, ,387,105 (117,924,693) Assets limited as to use $ 18,527,856 24,636,955 (6,109,099) Unamortized debt issuance costs $ 7,796,953 (7,796,953) Other assets $ 24,706,642 10,175,143 14,531,499 Investment in Affiliates $ 24,688,649 2,729,838 21,958,811 Accrued pension benefits $ 900, ,000 Investment in interest rate cap $ 18,564 86,883 (68,319) Equity interest in net assets of St. Joseph's Hospital $ Health Center Foundation, Inc. 18,873,551 21,826,460 (2,952,909) Total assets $ 544,696,842 $ 648,957,478 $ (104,260,636)

11 September 30, December 31, $ Change Current liabilities: Shortterm borrowings $ 1,751,113 $ 1,751,113 $ (0) Current portion of longterm debt $ 12,833,197 13,003,608 (170,411) Accounts payable $ 42,280,293 45,046,175 (2,765,882) Accrued expenses and other liabilities $ 51,231,442 46,428,955 4,802,487 Due to Affiliates, Net $ 614, ,327 Estimated thirdparty payor settlements 11,487, ,900 10,821,680 Total current liabilities $ 120,197, ,895,751 13,302,201 Longterm debt, net $ 252,374, ,366,211 (17,991,363) Accrued postretirement benefits $ 19,275,728 20,549,983 (1,274,255) Accrued pension benefits * 12,842,779 (12,842,779) Due to affiliates, net $ 8,531,564 6,378,233 2,153,331 Other liabilities 33,343,238 21,797,041 11,546,197 Net assets: Liabilities and Net Assets ST. JOSEPH'S HOSPITAL HEALTH CENTER Balance Sheets Total liabilities $ 433,723, ,829,998 (5,106,668) Unrestricted 97,275, ,514,811 (99,238,903) Temporarily restricted 10,366,880 10,380,959 (14,079) Permanently restricted 3,330,724 3,231,710 99,014 Total net assets 110,973, ,127,480 (99,153,968) Total liabilities and net assets $ 544,696,842 $ 648,957,478 $ (104,260,636)

12 ST. JOSEPH'S HOSPITAL HEALTH CENTER Statement of Operations Hospital Only September 30, September 30, $ Change Unrestricted revenues, gains and other support: Net patient service revenue (net of contractual allowances and discounts) $ 413,250,493 $ 413,937,488 $ (686,995) Provision for bad debt (7,168,319) (12,605,050) 5,436,731 Net patient service revenue less provision for bad debts 406,082, ,332,438 4,749,736 Other revenue 42,536,710 34,454,881 8,081,829 Total revenue, gains and other support 448,618, ,787,319 12,831,565 Expenses: Salaries and wages 185,585, ,582,768 3,003,157 Fringe benefits 50,873,084 47,749,453 3,123,631 Supplies and other expenses 178,627, ,751,001 7,876,152 Trinity System Management Fee 1,352,307 1,352,307 Depreciation and other expenses 29,490,712 22,819,331 6,671,381 Interest incurred and expensed 9,633,418 7,155,295 2,478,123 New York State gross receipts tax 1,550,206 1,587,502 (37,296) Total expenses 457,112, ,645,350 24,467,455 Income (loss) from operations (8,493,921) 3,141,969 (11,635,890) Nonoperating revenue: Investment income 1,214,827 1,402,180 (187,353) Gain (loss) on sale of assets 106, ,874 Change in fair value of interest rate cap (68,319) (413,723) 345,404 Equity in change in unrestricted net assets of St. Joseph's Hospital Health Center 0 Foundation Inc. (3,318,352) (224,945) (3,093,407) Equity in earnings of investees 311, ,703 (390,932) Excess (deficiency) of revenue over expenses (10,247,120) 4,608,184 (14,855,304)

13 ST. JOSEPH'S HOSPITAL HEALTH CENTER Statement of Changes in Net Assets September 30, September 30, $ Change Unrestricted net assets: Excess (deficiency) of revenues over expenses St. Joseph's Hospital Health Center $ (10,247,120) $ 4,608,184 $ (14,855,304) Change in net unrealized gains and losses on investments 1,088,925 4,043,290 (2,954,365) Equity transfer (to) from affiliates 1,553,748 (323,323) 1,877,071 Net assets released from restrictions used for purchase and renovation of property 2,454,513 1,516, ,657 Increase (decrease) in unrestricted net assets (5,149,934) 9,845,007 (14,994,941) Temporarily restricted net assets: Contributions received 189, ,015 (78,205) Equity in change in temporarily restricted net assets of St. Joseph's Hospital Health Center Foundation, Inc. 266, ,919 (235,490) Net assets released from restrictions used for operations (270,320) (329,315) 58,995 Net assets released from restrictions used for purchase and renovation of property (200,000) (200,000) assets (14,081) 440,619 (454,700) Permanently restricted net assets: Equity in change in permanently restricted net assets of St. Joseph's Hospital Health Center Foundation, Inc. 99, ,561 (2,547) Increase (decrease) in net assets (5,065,001) 10,387,187 (15,452,188) Net assets at beginning of year 114,038, ,480,759 (120,442,246) Net assets at end of year $ 110,973,512 $ 244,867,946 $ (133,894,434)

14 ST. JOSEPH'S HOSPITAL HEALTH CENTER AND SUBSIDIARIES Consolidated Balance Sheets September 30, 2015 December 31, 2014 Assets Hospital Total SJM Total Subtotal SJPE Total SJPHPC Total SJMPC Total Eliminations Consolidated Consolidated Change Current assets: Cash and cash equivalents $ 36,687,348 $ 3,184,012 $ 39,871,360 $ 35,656 $ 1,042,740 $ 1,036,991 $ $ 41,986,747 $ 44,366,481 $ (2,379,734) Investments 61,566,697 61,566,697 61,566,697 69,232,209 (7,665,512) Patient accounts receivable, net of allowance for charity care and doubtful accounts of approximately $28,000,000 in 2015 and $26,400,000 in ,713,541 4,693,758 94,407,299 1,205,286 2,643,051 (313,622) 97,942,014 91,831,583 6,110,431 Other receivables 5,102, ,789 5,880, , ,506 6,562,900 5,750, ,996 Inventories 5,479, ,096 5,688, ,213 5,802,087 6,560,522 (758,435) Prepaid expenses 4,219, ,024 4,907,649 36, ,549 (600,000) 4,574,814 5,992,365 (1,417,551) Assets limited as to use 6,750,000 6,750,000 6,750,000 6,605, ,000 Due from Affiliates, net 263,240 (263,240) Estimated thirdparty payor settlements Total current assets 209,519,168 9,553, ,072,847 35,656 2,590,068 4,400,310 (913,622) 225,185, ,602,304 (5,417,045) Property and equipment, net 247,462,412 3,080, ,543,156 21,982 1,879, ,445, ,665,787 (117,220,721) Assets limited as to use 18,527,856 18,527,856 18,527,856 24,636,955 (6,109,099) Unamortized debt issuance costs 7,796,953 (7,796,953) Other assets 24,706,642 24,706,642 2,891,017 27,597,659 13,505,630 14,092,029 Investment in Affiliates 24,688,649 24,688, ,749 3,011,540 (23,150,182) 4,682,756 1,018,721 3,664,035 Accrued pension benefits 900, , , ,000 Investment in interest rate cap 18,564 18,564 18,564 86,883 (68,319) Equity interest in net assets of St. Joseph's Hospital Health Center Foundation, Inc. 18,873,551 18,873,551 18,873,551 21,826,460 (2,952,909) Goodwill 26,792,693 (26,792,693) Total assets $ 544,696,842 $ 12,634,423 $ 557,331,265 $ 168,405 $ 2,612,050 $ 12,182,795 $ (24,063,804) $ 548,230,711 $ 695,932,386 $ (147,701,675)

15 September 30, 2015 December 31, 2014 Liabilities and Net Assets Hospital Total SJM Total Subtotal SJPE Total SJPHPC Total SJMPC Total Eliminations Consolidated Consolidated Change Current liabilities: Shortterm borrowings $ 1,751,113 $ $ 1,751,113 $ $ $ 900,000 $ $ 2,651,113 $ 2,651,113 $ (0) Current portion of longterm debt 12,833,197 12,833,197 2,254,117 15,087,314 15,000,039 87,275 Accounts payable 42,280,293 1,595,815 43,876,108 3, ,363 (913,622) 43,587,940 46,742,866 (3,154,926) Accrued expenses and other liabilities 51,231,442 1,482,090 52,713, ,202 2,452,109 (1,591,370) 54,183,473 49,662,818 4,520,655 Due to Affiliates, net 614, ,327 8,361,920 (8,206,570) 769, , ,468 Estimated thirdparty payor settlements 11,487,580 58,668 11,546,248 11,546, ,681 10,718,567 Total current liabilities 120,197,952 3,136, ,334, ,293 14,590,509 (10,711,562) 127,825, ,108,726 12,717,039 Longterm debt, net 252,374, ,374,848 19,647, ,022, ,181,599 (19,158,904) Accrued postretirement benefits 19,275,728 19,275,728 19,275,728 20,549,983 (1,274,255) Accrued pension benefits 12,842,779 (12,842,779) Due to Affiliates, net 8,531,564 8,531, ,610 12,508,632 (13,352,242) 8,531,564 6,641,747 1,889,817 Other liabilities 33,343,238 33,343, ,298 33,986,536 22,440,338 11,546,198 Net assets: ST. JOSEPH'S HOSPITAL HEALTH CENTER AND SUBSIDIARIES Consolidated Balance Sheets Total liabilities 433,723,330 3,136, ,859, ,610 13,120,925 34,881,653 (24,063,804) 461,642, ,765,172 (7,122,885) Unrestricted St. Joseph's Hospital Health Center 97,275,908 (20,546,736) 76,729,172 (675,205) (10,508,875) (22,698,858) 42,846, ,113,413 (168,267,179) Noncontrolling interest in SJLS, LLC 30,044,586 30,044,586 30,044,586 2,441,132 27,603,454 Total unrestricted net assets (deficit) 97,275,908 9,497, ,773,758 (675,205) (10,508,875) (22,698,858) 72,890, ,554,545 (140,663,725) Temporarily restricted 10,366,880 10,366,880 10,366,880 10,380,959 (14,079) Permanently restricted 3,330,724 3,330,724 3,330,724 3,231,710 99,014 Total net assets 110,973,512 9,497, ,471,362 (675,205) (10,508,875) (22,698,858) 86,588, ,167,214 (140,578,790) Total liabilities and net assets $ 544,696,842 $ 12,634,423 $ 557,331,265 $ 168,405 $ 2,612,050 $ 12,182,795 $ (24,063,804) $ 548,230,711 $ 695,932,386 $ (147,701,675)

16 ST. JOSEPH'S HOSPITAL HEALTH CENTER AND SUBSIDIARIES Consolidated Statement of Operations Unaudited Unaudited September 30, 2015 September 30, 2014 Hospital Total SJM Total Subtotal SJPE Total SJPHPC Total SJMPC Total Eliminations Consolidated Consolidated $ Change Unrestricted revenues, gains and other support: Net patient service revenue (net of contractual allowances and discounts) $ 413,250,493 $ 17,803,422 $ 431,053,915 $ $ 10,288,226 $ 23,245,963 $ (955,335) $ 463,632,769 $ 461,662,086 $ 1,970,683 Provision for bad debt (7,168,319) (1,223,869) (8,392,188) (97,056) (1,285,804) (9,775,048) (13,225,125) 3,450,077 Net patient service revenue less provision for bad debts 406,082,174 16,579, ,661,727 10,191,170 21,960,159 (955,335) 453,857, ,436,961 5,420,760 Other revenue 42,536, ,774 43,180, , ,508 3,946,776 (28,090,559) 19,367,209 18,096,048 1,271,161 Total revenue, gains and other support 448,618,884 17,223, ,842, ,000 10,357,678 25,906,935 (29,045,894) 473,224, ,533,009 6,691,921 Expenses: Salaries and wages 185,585,925 4,188, ,774,924 9,830,165 20,902,494 (13,686,461) 206,821, ,333,278 2,487,844 Fringe benefits 50,873,084 1,647,367 52,520,451 85,441 4,368,839 (1,419,405) 55,555,326 52,067,711 3,487,615 Supplies and other expenses 178,627,153 5,256, ,883, ,636 13,520,205 8,844,119 (13,940,028) 192,581, ,756,224 6,825,634 Trinity System Fee 1,352,307 1,352,307 65,307 91,503 1,509,117 1,509,117 Depreciation and other expenses 29,490, ,937 29,860,649 1, ,637 30,456,781 23,822,410 6,634,371 Interest incurred and expensed 9,633, ,633,606 (1,692) 563,204 10,195,118 7,798,047 2,397,071 New York State gross receipts tax 1,550,206 1,550,206 2,750 1,552,956 1,592,533 (39,577) Total expenses 457,112,805 11,463, ,576, ,636 23,503,671 35,364,796 (29,045,894) 498,672, ,370,203 23,302,075 Income from operations (8,493,921) 5,760,063 (2,733,858) (109,636) (13,145,993) (9,457,861) (25,447,348) (8,837,194) (16,610,154) Nonoperating revenue: Investment income 1,214,827 1,214,827 18,835 1,233,662 1,402,569 (168,907) Gain on sale of assets 106,874 (13,078) 93,796 93, ,914 (618,118) Change in fair value of interest rate cap (68,319) (68,319) (68,319) (413,723) 345,404 Equity in change in unrestricted net assets of St. Joseph's Hospital Health Center Foundation Inc. (3,318,352) (3,318,352) (3,318,352) (224,945) (3,093,407) Equity in earnings of investees 311, , , ,171 1,574,333 (778,162) Excess of revenue over expenses (10,247,120) 5,746,985 (4,500,135) (109,636) (13,145,993) (8,954,626) (26,710,390) (5,787,046) (20,923,344) Net income attributable to noncontrolling interest in SJLS, LLC (2,816,021) (2,816,021) (2,816,021) (2,406,122) (409,899) Excess (deficiency) of revenue over expenses St. Joseph's Hospital Health Center & Subsidiaries $ (10,247,120) $ 2,930,964 $ (7,316,156) $ (109,636) $ (13,145,993) $ (8,954,626) $ $ (29,526,411) $ (8,193,168) $ (21,333,243)

17 ST. JOSEPH'S HOSPITAL HEALTH CENTER Financial Ratios Hospital Only September 30, September 30, FINANCIAL INDICATORS Liquidity Ratios Days Cash on Hand Days in Accounts Receivable Current Ratio Profitability Ratios Operating Margin 1.59% 0.78%

18 ST. JOSEPH'S HOSPITAL HEALTH CENTER Financial Ratios Consolidated September 30, September 30, FINANCIAL INDICATORS Liquidity Ratios Days Cash on Hand Days in Accounts Receivable Current Ratio Profitability Ratios Operating Margin 5.61% 1.81%

19 ST. JOSEPH'S HOSPITAL HEALTH CENTER Utilization Data Hospital Only September 30, September 30, Utlization Data Licensed Beds Beds in Service Patient Days (excluding newborns) 102, ,358 Average length of stay (days) Percentage Occupancy (of beds in service) 86.6% 85.5% Inpatient Surgery 6,818 6,790 Outpatient Surgery 3,078 7,403 Emergency Room Visits 52,994 50,480 Clinic Visits 107, ,740 Dialysis Visits 46,491 46,538 CPEP Visits 10,186 10,088 Outpatient Visits excluding ED 407, ,338 Observation Days 5,035 7,219 Case Mix Index Medicare Percentage of Admission from Top 10 Physicians 20.7% 18.0% Total Number of Employees (FTE) 3,554 3,629 Total Number of Physicians on the Hospital's Medical Staff Discharges: Adult Medical 8,956 9,310 Adult Surgical 7,119 7,569 Obstretical 1,517 1,655 Psychiatric ICN Subtotal Discharges: 18,489 19,409 Newborn 1,384 1,452 Total Discharges: 19,873 20,861 Catheterizations: Inpatient Outpatient 1,052 1,239 Total Catheterizations: 1,572 1,956 Angioplasties: Inpatient Outpatient Total Angioplasties 1,317 1,417 Percentage of Gross Revenues by Payor Class Medicare 35% 37% Managed Care 30% 28% Blue Cross Blue Shield 17% 18% Medicaid 4% 3% Self Pay 1% 2% Other 13% 12%

20 St. Joseph's Health Consolidated Balance Sheet September 30, 2015 Assets St. Joseph's HHC St. Joseph's Properties consolidated HHC Foundation consolidated Embracing Age Eliminations September 30, 2015 December 31, 2014 Change Current assets: Cash and cash equivalents $ 41,986, ,889 2,277,002 1,621 44,707,259 46,735,074 (2,027,815) Investments 61,566,697 16,116, ,000 77,983,245 85,726,857 (7,743,612) Accounts receivable, net 97,942,014 3,515,893 2,707,344 (110,000) 104,055,251 98,941,447 5,113,803 Other receivables 6,562, , ,961 8,562 (52,875) 7,016,090 6,158, ,121 Deferred Taxes 188, , ,800 Inventories 5,802, ,232 6,461,320 7,393,803 (932,483) Prepaid expenses and other assets 4,574,816 55, , ,920,829 6,566,110 (1,645,281) Due from affiliates, net 561, ,145 (777,597) 0 150,399 (150,399) Assets limited as to use, net 6,750,000 6,750,000 6,605, ,000 Total current assets 225,185,261 21,039,057 6,488, ,946 (940,472) 252,082, ,466,459 (6,383,666) Property and equipment, net 252,445,065 59,257,794 6, ,709, ,778,923 (114,069,869) Assets limited as to use 18,527,856 18,527,856 24,636,955 (6,109,099) Unamortized debt issuance costs 0 8,135,885 (8,135,885) Other assets 27,597, ,232 28,159,890 13,720,862 14,439,028 Due from affiliates 11,906,123 (10,279,384) 1,626, ,538 1,062,201 Accrued Pension Benefits 900, , ,000 Investment in interest rate cap 18,564 18,564 86,883 (68,319) Investments in affiliates 4,682,756 2,091,753 6,774,509 2,209,588 4,564,921 Equity interest in net assets of St. Joseph's HHC Foundation 18,873,551 (18,873,551) 0 Goodwill 0 26,792,693 Total assets $ 548,230,711 21,039,057 80,305, ,140 (30,093,408) 619,799, ,392,786 (140,593,382)

21 St. Joseph's Health Consolidated Balance Sheet September 30, 2015 Liabilities and Net Assets St. Joseph's HHC St. Joseph's Properties September 30, 2015 December 31, 2014 consolidated HHC Foundation consolidated Embracing Age Eliminations St. Joseph's Health St. Joseph's Health Change Current liabilities: Shortterm borrowings $ 2,651,113 2,651,113 2,651,113 Current portion of longterm deb 15,087, ,106 2,978,535 66,132 18,516,087 18,214, ,720 Accounts payable 43,587, ,173 2,071, ,766,595 48,548,353 (2,781,758) Accrued expenses and other liabilities 54,183, ,463 8,105 (12,569) 54,396,474 50,203,384 4,193,089 Estimated thirdparty payor settlement 11,546,248 11,546, ,681 10,718,567 Due to affiliated entity 769,677 60, ,552 0 (1,022,737) 72,287 72,287 Total current liabilities 127,825, ,074 5,532,248 75,024 (1,035,306) 132,948, ,444,898 12,503,905 Longterm debt, net 272,022,695 1,608,932 25,474, , ,326, ,742,833 (27,415,922) Accrued postretirement benefits 19,275,728 19,275,728 20,549,983 (1,274,255) Accrued pension benefits 12,842,779 (12,842,779) Due to affiliated entity 8,531,564 1,107, ,559 (10,074,550) 192, ,877 (150,612) Other liabilities and deferred revenue 33,986,538 5,500 67,032 34,059,070 20,113,798 13,945,272 Total liabilities 461,642,288 2,165,506 32,181, ,162 (11,109,856) 485,802, ,037,168 (15,234,391) Net assets: 0 Unrestricted: Unrestricted 42,846,234 9,479,326 46,715,390 (606,022) (9,589,327) 88,845, ,922,599 (153,076,998) Noncontrolling interest in SJLS, LLC and SEHSS, In 30,044, ,836 30,178,422 2,545,350 27,633,072 Total unrestricted net assets 72,890,820 9,479,326 46,849,226 (606,022) (9,589,327) 119,024, ,467,950 (125,443,926) Temporarily restricted 10,366,880 6,227,766 1,275,000 (6,227,766) 11,641,880 11,655,959 (14,079) Permanently restricted 3,330,724 3,166,459 (3,166,459) 3,330,724 3,231,710 99,014 Total net assets 86,588,424 18,873,551 48,124,226 (606,022) (18,983,552) 133,996, ,355,618 (125,358,991) Commitments and contingent liabilities (note 9 Total liabilities and net assets $ 548,230,711 21,039,057 80,305, ,140 (30,093,408) 619,799, ,392,786 (140,593,382)

22 St. Joseph's Health Consolidated Statements of Operations and Changes in Net Assets September 30, 2015 St. Joseph's HHC St. Joseph's Properties September 30, 2015 YTD consolidated HHC Foundation consolidated Embracing Age Eliminations St. Joseph's Health Unrestricted revenues, gains and other support: Patient service revenue (net of contractual allowances and discounts) $ 463,632, ,632,769 Provision for bad debts (9,775,048) (9,775,048) Net patient service revenue less provision 453,857, ,857,721 Rental income real estate 6,169,509 (5,279,117) 890,392 Net sales and equipment rentals 10,303,763 49,887 (576,728) 9,776,922 Management fee income 831,056 (175,791) 655,265 Contribution revenue 94,856 94,856 Net assets released from restrictions used 270, , ,032 Gain (loss) on disposal of equipment 93,796 (49,125) 44,671 Other revenue 19,096, ,600 (3,775,765) 15,488,724 Total unrestricted revenues, gai 473,318, ,568 17,422,803 49,887 (9,807,401) 481,417,583 Expenses: Cost of sales 3,575,734 3,575,734 Salaries and wages 206,579,500 3,720,743 88, ,389,047 Intercompany Contract Labor System O 241, ,622 Fringe benefits 55,494, ,818 24,048 56,491,959 Intercompany Contract Labor Benefits 61,233 61,233 Supplies and other expenses 192,581,858 4,144,789 35,852 (6,768,924) 189,993,575 Trinity System Management Fee 1,509,117 4,431 37,110 1,550,658 Depreciation and amortization 30,456,781 2,051,285 2,109 32,510,175 Interest incurred and expensed 10,195, ,660 3,695 11,006,473 Management and general 740,746 (611,796) 128,950 Bad debt expense 213, ,938 Program services 144, ,574 Fund raising and events expenses 146, ,968 Community support 206,734 (68,886) 137,848 Contributions made to St. Joseph's HHC 2,218,662 (2,234,588) (15,926) Other Expenses 9,970 9,970 New York State gross receipts tax 1,552,956 1,552,956 Total expenses 498,672,278 3,472,085 15,525, ,508 (9,684,194) 508,139,754 Income from operations (25,353,552) (3,038,517) 1,897,726 (104,621) (123,207) (26,722,171) Investment income 1,233,662 (279,835) 2, ,600 Other income Change in fair value of interest rate cap (68,319) (68,319) Equity in change in unrestricted net assets o (3,318,352) 3,318,352 Equity in earnings of investees 796, ,907 1,023,078 Excess of revenues over expens (26,710,390) (3,318,352) 2,127,431 (104,621) 3,195,145 (24,810,787) Income tax expense 115, ,271 Excess of revenue over expenses (26,710,390) (3,318,352) 2,242,702 (104,621) 3,195,145 (24,695,516) Net income attributable to noncontrolling interest in SJLS, LLC and SEHSS, Inc (2,816,021) (2,816,021) Excess of revenues over expenses St. Joseph's Hospital Health Center and Subsidiaries $ (29,526,411) (3,318,352) 2,242,702 (104,621) 3,195,145 (27,511,537)

23 St. Joseph's Health Consolidated Statements of Operations and Changes in Net Assets September 30, 2015 St. Joseph's HHC St. Joseph's Properties September 30, 2015 consolidated HHC Foundation consolidated Embracing Age Eliminations St. Joseph's Health Change in unrestricted net assets: Excess of revenues over expenses St. Joseph's Hospital Health Center and Subsidiaries $ (29,526,411) (3,318,352) 2,242,702 (104,621) 3,195,145 (27,511,537) Change in net unrealized gains and losses on investments 1,088,925 1,088,925 Net assets released from restrictions used for property 2,454,514 2,454,514 Acquisition of Embracing Age (504,079) (504,079) Equity transfer (to) from affiliates 498, ,798 Increase (decrease) in unrestricted net assets St. Joseph's Hospital Health Center (25,484,174) (3,318,352) 2,242,702 (608,700) 3,195,145 (23,973,379) Noncontrolling interest in SJLS, LLC: Net income attributable to noncontrolling interest in SJLS, LLC 2,816,021 2,816,021 Distributions to noncontrolling interest partners (1,013,585) (1,013,585) Increase (decrease) in noncontrolling interest in SJLS, LLC 1,802,436 1,802,436 Increase (decrease) in unrestricted net assets (23,681,738) (3,318,352) 2,242,702 (608,700) 3,195,145 (22,170,943) Temporarily restricted net assets: Contributions received 189,812 1,070,813 (110,000) 1,150,625 Investment income (84,539) (84,539) Fund raising and event expense (381,133) 123,207 (257,926) Equity in change in temporarily restricted net assets of St. Joseph's Hospital Health Center Foundation, Inc. 266,429 (266,429) Net assets released from restrictions used for property (200,000) (200,000) Net assets released from restrictions used for operations (270,320) (338,712) (609,032) Increase (decrease) in temporarily restricted net assets (14,079) 266,429 (253,222) (872) Permanently restricted net assets Investment income (986) 0 (986) Contributions 100, ,000 Equity in change in permanently restricted net assets of 0 St. Joseph's Hospital Health Center Foundation, Inc. 99,014 (99,014) Increase (decrease) in permanently restricted net assets 99,014 99,014 (99,014) 99,014 Increase in net assets (23,596,803) (2,952,909) 2,242,702 (608,700) 2,842,909 (22,072,801) Net assets at beginning of year 110,185,227 21,826,460 45,881,524 (21,823,783) 156,069,428 Net assets at end of year $ 86,588,424 18,873,551 48,124,226 (608,700) (18,980,874) 133,996,627