PeaceHealth Financial Statements - Mike Kreidler

Transcription

I, - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -PEACEHEALTHConsolidated Financial StatementsJune 30, 2013 and 2012(With Independent Auditors' Report Thereon)

PEACEHEALTHConsolidated Financial StatementsJune 30,2013 and 2012Table of ContentsPage(s)Independent Auditors' ReportIFinancial Statements:Consolidated Balance Sheets2-3Consolidated Statements of Operations4Consolidated Statements of Changes in Net Assets5Consolidated Statements of Cash FlowsNotes to Consolidated Financial Statements67-36

KPMG LLPSuite 38001300 South West Fifth AvenuePortland, OR -The Board of DirectorsPeaceHealth:We have audited the accompanying consolidated financial statements ofPeaceHealth (a Washington notfor-profit corporation), which comprise the consolidated balance sheets as of June 30, 2013 and 2012, andthe related consolidated statements of operations, changes in net assets, and cash flows for the years thenended, and the related notes to the consolidated financial statements.Management's Responsibility for the Consolidated Financial StatementsManagement is responsible for the preparation and fair presentation of these consolidated financialstatements in accordance with U.S. generally accepted accounting principles; this includes the design,implementation, and maintenance of internal control relevant to the preparation and fair presentation ofconsolidated financial statements that are free from material misstatement, whether due to fraud or error.Auditors' ResponsibilityOur responsibility is to express an opinion on these consolidated financial statements based on our audits.We conducted our audits in accordance with auditing standards generally accepted in the United States ofAmerica. Those standards require that we plan and perform the audit to obtain reasonable assurance aboutwhether the consolidated financial statements are free from material misstatement.An audit involves performing procedures to obtain audit evidence about the amounts and disclosures in theconsolidated financial statements. The procedures selected depend on the auditors' judgment, including theassessment of the risks of material misstatement of the consolidated financial statements, whether due tofraud or error. In maldng those risk assessments, the auditor considers internal control relevant to theentity's preparation and fair presentation of the consolidated financial statements in order to design auditprocedures that are appropriate in the circumstances, but not for the purpose of expressing an opinion onthe effectiveness of the entity's internal control. Accordingly, we express no such opinion. An audit alsoincludes evaluating the appropriateness of accounting policies used and the reasonableness of significantaccounting estimates made by management, as well as evaluating the overall presentation of theconsolidated financial statements.We believe that the audit evidence we have obtained is sufficient and appropriate to provide a basis for ouraudit opinion.OpinionIn our opinion, the consolidated financial statements referred to above present fairly in all materialrespects, the financial position of PeaceHealth as of June 30, 2013 and 2012, and the results of itsoperations, changes in net assets, and its cash flows for the years then ended in accordance withU.S. generally accepted accounting principles.Portland, OregonOctober I, 2013KPMG llP Is a Delaware limited liabilitY !)artnership,the u.s. member firm or KPMG lnternallor al Coopera\llte("KPMG International"), a Swiss entity.

PEACEHEALTIIConsolidated Ba:lance SheetsJune 30, 2013 and 2012(In thousands)2013AssetsCurrent assets:Cash and cash equivalentsShort-term investmentsAccounts receivable, net of allowance for doubtfulaccounts of 95,196 and 82,009Other receivables92,689276,979 265,51238,707- ----- Inventory ofsuppliesr--- -------------- - 6.;i8118,725Prepaid expenses and other29,770Assets whose use is limited that are required for current liabilities758,963Total current assets -Ass ets whOSj) \lSJ;is limited:Cash and investmentsInvestments in joint ventures and ,258807,534- - - - - - -908,2123--- -- -642,736 - - - 40,83834,952Total assets whose use is limitedLess current portion ·Net assets whose use is limitedProperty, plant, and equipment:Land and improvementsBuildings, fixed equipment, and otherMoveable equipmentConstruction in progressTotal property, plant, and equipmentLess accumulated depreciationNet property, plant, and equipmentInterest in net assets of related foundationsOther assets Total 7161,2362,401,2772,315,891 2,66338,0923,084,6932,925,774See accompanying notes to consolidated financial staten1ents.2(Continued)

PEACEHEALTHConsolidated Balance SheetsJune 30, 2013 and 2012- - - - - - - - - - - - - - - - - - - ( m - t n o u s a n a s ) -----Liabilities and Net Assets2013Current liabilities:Accounts payableAccrued payroll, payroll taxes, and employee benefitsAccrued interest payableOther current liabilitiesMedical claims payableReimbursement settlements payableCurrent portion oflong-tenn ther long-term liabilities263,816324,921Long-term debt due after one ,64411,3801,616,8281,475,176Total current liabilitiesNet assets:UnrestrictedTemporarily restrictedPermanently restrictedTotal net assets 20123,084,693 Total liabilities and net assetsSee accompanying notes to consolidated financial statements.32,925,774

PEACEHEALTHConsolidated Statements of OperationsYears ended June 30, 2013 and 2012(In thousands)2013Revenues:Net patient service revenue before provision for bad debtsProvision for bad debts Net patient service revenue20122,145,535(161,192)1,984,343'IL.,J)C'S ----------Eremium rallenueOther operating revenue2,103,580(133,814)1,969,766-- --141,59811:r52 oilt\ez7""T,V.JVTotal revenues2,170,757Expenses:Salaries and wages-------payrolttax Js-arrd-benefits --- Professional feesMedical claims expenseSupplies and other expensesDepreciation and amortization of other assetsInterest and amortization of deferred financing costsIncome from operationsOther income (loss):Investment income, net(Loss) gain on investments recorded on the equity methodChange in valuation of interest rate swapsOtherExcess (deficiency) of revenues over expensesNet assets released from restrictions for property, plant and equipmentChange in interest in net assets of related foundationsChange in pension liabilityOther changes in unrestricted net assetsIncrease (decrease) in unrestricted net assetsSee accompanying notes to consolidated financial statements.42,185,516989,540·- -251-,40'7-- ----36,06559,126650,211150,29924,261Total expenses -- 4(6,695)23,016653(57,499)656124,82ilJ76,477)

PEACEHEALTHConsolidated Statements of Changes in Net AssetsYears ended June 30,2013 and 2012(In thousands)------------------------------:Net assets at June 30, 20 II cted1,504,62946,29511,168Deficiency of revenues over expensesOther restricted contributionsNet assets released from restrictionsChange in interest in net assets of related foundationsChange in pension liabilityOther changes in net assets(43,303)23,016653(57,499)656Change in net assetsNet assets at June 30, 2012Excess of revenues over expensesOther restricted contributionsNet assets released from restrictionsChange in interest in net assets of related foundationsChange in pension liabilityOther changes in nel assets203(239)ISee accompanying notes to consolidated financial (8,666)(463)1,7086,57154727,964(6,695) 1,562,0921,428,15296,441Change in net assetsNet assets at June 30, 1,6521,552,98037,79826,0501,616,828

PEACEHEALTHConsolidated Statements of Cash FlowsYears ended June 30,2013 and 2012(In thousands)2013Cash flows from operating activities:Change in net assetsAdjustments to reconcile change in net assets to net cash provided byoperating activities:Depreciation and amortizationGain on sale of land held for sale and property, plant, and equipment:Provision for bad debtsChange in pension liability'I41,652 I51,482(2,524)161,192(27,964)ill,71 8)---------- IR tricted aont ibutions -- -------------- (32,091)Net change in unrealized (gains) losses -on investments(3,615)Realized gains on investments(50,809)Valuation adjustments on swap arrangements6,600Impairment of intangible assets1,138Equity investment loss (gain)(11,776)Increase in interest in net assets of related foundations--- esChanges in operating assets and liabilities:Increase in:Accounts receivable, netOther assetsIncrease in:Accounts payableAccrued payroll, payroll taxes, and employee benefitsOther liabilitiesNet cash provided by operating activitiesCash flows from investing activities:Purchase of property, plant, and equipmentProceeds· from sale of land held for sale and property, plant, and equipmentCapital contributions to joint venturesPurchase of investmentsSales and maturities of investmentsChange in securities lending assetDecrease in assets whose use is limited, otherNet cash used in investing activitiesCash flows from financing activities:Proceeds from long-term borrowingsPrincipal payments on long-term debtProceeds from restricted contributionsDeferred financing costs expendedSwap contract tennination fees expendedChange in securities lending liability2012(86,916)149,648(2,180)133,8I4 8(I83,972)(1 84)22,204174,420176,136(107,490)I 193,87923,4595,186(306,919)- (216,378)10,300(23,459)Net cash provided by (used iH) financing activitiesNet decrease in cash and cash equivalentsCash and cash equivalents at beginning of year Cash and cash equivalents at end of yearSee accompanying notes to consolidated financial 34592,689147,179

PEACEHEALTHNotes to Consolidated Financial StatementsJune 30,2013 and 2012---------------------l(mtllousands of lollars)c--------------(1)Organization(a)Corporate StructurePeaceHealth (the Corporation) is a Washington not-for-profit corporation with its corporate officelocated in Vancouver, Washington, which is sponsored by the Sisters of St. Joseph of Peace, and isrecognized to be a Private Pontifical Juridic Person by the Roman Catholic Church. At June 30,2013, the following regional healthcare delivery systems and operating divisions were componentsof the Corporation:Northwest Network:PeaceHealth Ketchikan Medical CenterPeaceHealth St. Joseph Medical CenterPeace Island Medical CenterColumbia Network:PeaceHealth St. John Medical CenterPeaceHealth Southwest Medical Center (Southwest)Oregon Network:PeaceHealth Sacred Heart Medical Center at University DistrictPeaceHealth Sacred Heart Medical Center at RiverBendPeaceHealth Cottage Grove Community Medical CenterPeaceHealth Peace Harbor HospitalSystemwide Organizations:PeaceHealth Medical GroupPeaceHealth LaboratoriesPeaceHealth Self-insured TrustsColumbia United Providers (CUP)These healthcare delivery systems and operating divisions, provide inpatient, outpatient, primarycare and home care services in Alaska, Washington and Oregon. The Corporation operates thesebusinesses primarily in Ketchikan, Alaska; Bellingham, Longview and Vancouver, Washington;Springfield, Eugene, Florence and Cottage Grove, Oregon.The Corporation included the following controlled affiliates at June 30, 2013:Southwest Washington Health SystemProperty and Buildings, LLCHealth VenturesPooled Income Funds (including Charitable Life Income Funds)PeaceHealth Southwest Medical Center FoundationThe consolidated financial statements inclnde the accounts of the Corporation and its controlledaffiliates. All significant intercompany transactions and balances have been eliminated.7(Continued)

PEACEHEALTHNotes to Consolidated Financial StatementsJune 30,2013 and 2012(In thousands of dollars)(b)Future Affiliation,,The Corporation has entered into an agreement to affiliate with United General Hospital in SedroWooley, Washington. United General Hospital is a Critical Access Hospital with approximately 40,000 in net operating revenue annually. Management anticipates this affiliation will be completedduring fiscal year 2014.(2)Summary ofSiguificarit Xccoimtirig Poiicieies! (a)EstimatesThe preparation of consolidated financial statements in conformity with accounting principlesgenerally accepted in the United States of America requires management to make estimates and-- -- assumptions-that-affect the Teported -amounts-of assets-and liabilities-and-disclosure- oi'C Jntingent --- - assets and liabilities at the date of the consolidated financial statements and the reported amounts ofrevenues and expenses during the reporting period. Actual results may differ from those estimates.The significant estimates in the Corporation's consolidated financial statements include accountsreceivable allowances, reimbursement settlements payable, valuation of alternative investments,interest rate swaps, pension obligations, incurred but not reported amounts related to accruedhealthcare costs, and liabilities related to self-insurance programs.(b)Cash and Cash EquivalentsCash and cash equivalents consist of petty cash, cash in demand bank accounts, and all highly liquiddebt instruments purchased with an original maturity of three months or less other than thoseamounts included in assets whose use is limited by the board of directors. The Corporation held cashequivalents of approximately 83,567 and 117,787 as ofJune 30, 2013 and 2012, respectively.The Corporation maintains cash and cash equivalents on deposit at various institutions, which, attimes, exceed the insured limits of the Federal Deposit Insurance Corporation. This exposes theCorporation to potential risk of loss in the event the institution becomes insolvent.(c)Short-Term InvestmentsShort-term investments consist primarily of certificates of deposit, U.S. govermnent, and otherinvestment-grade securities, which are carried at fair value. Investment income or loss (includingrealized and unrealized gains and losses and interest and dividends) is included in the excess ofrevenues over expenses.(d)Inventory of SuppliesInventory is valued on weighted average cost.(e)Other ReceivablesOther receivables primarily consist of amounts receivable from the federal goverrnnent related togrants for electronic health record implementation, amounts receivable from the state of Oregon and8(Continued)

PEACEHEALTHNotes to Consolidated Financial StatementsJune 30,2013 and 2012- - - - - - - - - - - - - - - - - - - , c m - r n o u s a n a s of IO!lars)' - - - -third-party payors related to Medicaid programs, amounts receivable from excess insurance carriersand other miscellaneous amounts due.(/)Assets Whose Use is LimitedThe majority of these assets have been set aside by management of the Corporation for future capitalimprovements and other purposes, over which management retains control and may, at its discretion,subsequently use for other purposes. Amounts required to meet current liabilities of the Corporationhave been reclassified as current in the consolidated balance sheets at June 30, 2013 and 2012. Theseitems consist primarily of investments in marketable equity and fixed income securities, mutualfunds, aud investments in joint ventures. Money market funds and all marketable securities havereadily determinable market values and are, therefore, carried at fair value. The investments in jointventures and other are accounted for using the equity or cost method.(g)Property, Plant and EquipmentProperty, plant and equipment are stated at cost at the date of acquisition or fair value at the date ofdonation. Improvements and replacements of plant and equipment are capitalized. Maintenance andrepairs are expensed as they are incurred. When property, plant and equipment is sold or retired, thecost and the related accumulated depreciation are removed from the accounts, and the resulting gainor Ioss is recorded.The Corporation assesses potential impairment of its long-lived assets when there is evidence thatevents or changes in circumstances have made recovery of the asset's carrying value unlikely. Animpairment loss is indicated when the sum of expected undiscounted future net cash flows is lessthan the carrying amount. The loss recognized is the difference between the fair value and thecarrying amount. No impairment losses related to property, plant and equipment were recognizedduring the years ended June 30, 2013 and 2012.In addition to consideration of impairment due to the events or changes in circumstances describedabove, management regularly evaluates the remaining lives of long-lived assets. If estimates arerevised, the carrying value of affected assets is depreciated or amortized over remaining lives.The Corporation has capitalized salary and wages along with related benefit costs in the amount of 3,897 during fiscal year 2013 related to the development of software for internal use.9(Continued)

PEACEHEALTHNotes to Consolidated Financial StatementsJune 30, 2013 and 2012(In thousands of dollars)(h)DepreciationDepreciation on property, plant and equipment is computed using the straight-line method over thefollowing estimated useful lives:Land improvementsBuildings and improvements -- - --- IFixed-equipmen5 - 25 years5 - 80 years 0-2"-years----- - --------- Leasehold improvementsShorter of remaining length ofthe lease or useful life3-20 yearsMoveable equipment(i)-- OtherAssets-- - -- ------Other assets include intangible assets, primarily deferred financing costs, trade names and goodwill.The deferred financing costs are amortized over the lives of the related debt issuances using theeffective interest method The intangibles have indefinite useful lives. Intangible assets withindefinite lives are evaluated annually for impairment. Impairment losses of 6,600 and 0 wererecognized during the years ended June 30, 2013 and 2012, which is included in other income (loss)on the consolidated statements of operations.(j)Other Long-Term LiabilitiesThe caption other long-term liabilities on the consolidated balance sheets consists primarily of theestimated fair value associated with the Corporation's interest rate swaps of approximately 91,617and 154,591 at June 30, 2013 and 2012, respectively; the liability for the Southwest pension plan ofapproximately 57,620 and 85,857 at June 30, 2013 and June 30, 2012, respectively; and thelong-term portion of the liability for the self-insurance programs of approximately 51,850 and 47,746 at June 30,2013 and 2012, respectively.(k)Contributions and GrantsContributions and grants are recognized as revenue upon receipt of the donor's pledge to contribute.Contributions and grants are considered to be available for unrestricted use unless specificallyrestricted by the donor. Amounts pledged that are restricted by the donor for specific purposes arereported as temporarily restricted or permanently restricted support. Unconditional promises to givethat are silent as to the due date are presumed to be time restricted by the donor until received andare reported as temporarily restricted net assets.A donor restriction expires when an unconditional promise with an implied time restriction iscollected or when the purpose for the restriction is accomplished. Upon expiration, temporarilyrestricted net assets are reclassified to unrestricted net assets and are reported in the consolidatedstatements of operations as net assets released from restrictions. Restricted contributions received inthe same year in which the restrictions are met are recorded as an increase in restricted support at thetime of receipt and as net assets released from restrictions at the time restrictions are met.10(Continued)

PEACEHEALTHNotes to Consolidated Financial StatementsJune 30,2013 and 2012----------------(Jn-thuusamls of lollars)·--------------Pennanently restricted net assets include the principal amount of contributions with the stipulationfrom the donor that the principal be maintained in perpetuity and only the income is available to beexpended for purposes specified by the donor, if any.(I)Interest in Net Assets ofRelated FoundationsThe Corporation accounts for activities with its unconsolidated related foundations in accordancewith applicable accounting guidance. That guidance requires the Corporation to recognize itsinterests in the net assets of these foundations on the consolidated balance sheet as the asset captioninterest in net assets of related foundations, and the annual changes as shown in the consolidatedstatement of changes in net assets.(m)Net Patient Service RevenuesThe Corporation has agreements with third-party payors that provide for payments of amountsdifferent from established charges. The Corporation's net patient service revenue came from thefollowing dCommercial and otherPrivate pay36%10There is a corresponding significant concentration of credit risk in net accounts receivable balancesat June 30, 2013 and 2012:2013MedicareMedicaidCommercial and otherPrivate pay201230%927%59263I100"/o100%9Reimbursement for inpatient services rendered to Medicare recipients has been made principallyunder a prospective pricing system based on diagnosis-related groups. Most outpatient servicesprovided to Medicare patients are reimbursed based on prospectively detennined rates. Services toMedicaid patients are also reimbursed based on a combination of prospectively determined rates andcost reimbursement methodology. Continuation of these reimbursement programs at the presentlevel, and on the present basis, is dependent upon future policies of federal and state goverrunentalagencies. The Corporation has four critical access hospitals that are exempt from both inpatient andoutpatient prospective payment systems. Inpatient and outpatient services rendered to Medicare andMedicaid program beneficiaries at critical access hospitals are reimbursed based on costs. InterimII(Continued)

PEACEHEALTHNotes to Consolidated Financial StatementsJnne 30,2013 and 2012(In thousands of dollars)reimbursement to critical access hospitals is based upon tentative rates and retroactive adjustment ismade to actual cost during final settlement by either the Medicare fiscal intermediary or theapplicable state's Medicaid agency. Charges made on behalf of providers employed by the medicalgroups in the Corporation are generally reimbursed on a fee schedule.The Corporation has estimated payments for services rendered to Medicare and MeJlk !id ].lali"ntsJJrinci of t,h" a ]ic a ble . g ov :t'lll ne t1li agencies andbelieves that an adequate provision has been made in the accompanying consolidate- nailci al -- - statements for final settlement. Estimates of final settlements due to and due from Medicare,Medicaid, and other third-party payors have been reflected net as reimburSement settlement payablein the accompanying consolidated balance sheets. Differences between the net amounts accrued andsubsequent settlements are recorded in operations at the time of settlement. The net amount of- -ad,iustmeilti! from fiiialiiittion-atid hird-party-settlements resulted in an decrease in net patient service revenue of 3,500 in 2013 and an increasein net patient service revenue of 13,700 in 2012.----- -· -- dmin th y.eaLb appL)ling the ].laymen!Laws and regulations governing the Medicare and Medicaid programs are extremely complex andsubject to interpretations. As a result, there is at least a reasonable possibility that that recordedestimates associated with these programs will change by a material amount in the near term.The Corporation has also entered into payment agreements with certain commercial insurancecarriers, health maintenance organizations, and preferred provider organizations. The basis forpayment to the Corporation nuder these agreements includes prospectively determined rates per nnitof service and discounts from established charges. Most arrangements provide for payment orreimbursement to the Corporation at amounts different than established rates. Contractual discountsrepresent the difference between established rates for services and amounts paid or reimbursed bythese third-party payors.The Corporation provides for an allowance against patient accounts receivable for amounts thatcould become uncollectible. The Corporation estimates this allowance based on the aging ofaccounts receivable, historical collection experience by payor, and other relevant factors. There arevarious factors that can impact the collection trends, such as changes in the economy, which in turnhave an impact on unemployment rates and the number of uninsured and nnderinsured patients, theincreased burden of copayments to be made by patients with insurance coverage and businesspractices related to collection efforts. These factors continuously change and can have an impact oncollection trends and the estimation process used by the Corporation. Net bad debt wtite-offs duringfiscal year 2013 were 148,005.(n)Premium Revenue and Accrued Healthcare CostsThe Corporation's majority-owned subsidiary, CUP, receives premium revenues that consist ofpremiums paid by the State of Washington for healthcare services. Premium revenues are receivedon a prepaid basis and are recognized as revenue during the month with which the premiums areassociated. CUP's premium revenues were received under two primary contract sources at the Stateof Washington (the State), the Basic Health Plan and Healthy Options.12(Continued)

PEACEHEALTHNotes to Consolidated Financial StatementsJune 30, 2013 and 2012--------------------------------------- ("m t h ou s an d s o f ·a nonna r s) ------------------------------The contract with the State expired on July 1, 2012. CUP has entered into an agreement with anotherhealth plan that has been awarded the contract from the State for the period July I, 2012 throughDecember 31, 2013. Under this contract, in return for receiving a defined premium amount from theother health plan, CUP will be responsible for providing medical, hospital, pharmaceutical andrelated medical services to Healthy Options and Basic Health Plan members assigned to CUP fromthe other plan. Under the terms of its contract with the other health plan, CUP will continue toperform most of the administrative services for assigned members that it previously performed underthe expiring contract.Under these contracts, the Corporation recognized premium revenues of 92,358 and 141,598 forthe years ended June 30, 2013 and 2012, respectively, which is included as premium revenue in theaccompanying consolidated statements of operations. The related medical expense recognized byCUP was 59,126 and 97,121 for the years ended June 30, 2013 and 2012, respectively, and isincluded in medical claims expense in the consolidated statements of operations.CUP has stop-loss reinsurance indemnifying it against the cost of providing services to individualenrolled participants at 90% in excess of 125 for hospital charges up to a maximum of 1,000 peryear for each enrolled member.(o)Other Operating RevenueOther operating revenue includes revenue from nonpatient care services, clinical space rentalrevenues, and contributions both unrestricted in nature and those released from restriction to supportoperating activities, grants from the federal govermnent to help fund electronic health recordimplementation (discussed below in Meaningful Use) and other miscellaneous revenue.(p)Meaningful UseThe Health mformation Technology for Economic and Clinical Health Act, part of the AmericanRecovery and Reinvestment Act of 2009, created an incentive program, beginning in 2011, topromote the "meaningful use" of Electronic Health Records (EHR). To qualify, providers must attestthat they are using certified EHR in a "meaningful" way by meeting objectives at establishedthresholds, as defined by the Centers for Medicare and Medicaid Services. Meaningful use revenuesare recognized as grant revenue. Grant revenue is recognized when there is reasonable assurance thatthe grant will be received and that the organization will comply with the conditions attached to thegrant. Meaningful use revenues of 18,730 and 7,111 were recognized for the years ended June 30,2013 and 2012, respectively, and are included in other operating revenue in the accompanyingconsolidated statements of operations. The amount recognized is based on management's bestestimate and is subject to audit and potential retrospective adjustments.(q)Income from OperationsIncome from operations excludes certain items that the Corporation deems outside the scope of itsprimary business.13(Continued)------·II

PEACEHEALTHNotes to Consolidated Financial StatementsJune 30, 2013 and 2012(In thousands of dollars)(r)Excess ofRevenues over ExpensesExcess of revenues over expenses includes results from the Corporation's operating and nonoper

Liabilities and Net Assets Current liabilities: Accounts payable Accrued payroll, payroll taxes, and employee benefits Accrued interest payable Other current liabilities Medical claims payable Reimbursement settlements payable Current portion oflong-tenn debt Total current liabilities Other long-term liabilities Long-term debt due after one year