Natividad Medical CenterBoard of TrusteesFebruary 1, 2013

Financial StatementsFor December 31, 2012

1

Average Daily CensusTotal Hospital - Monthly

2

88.2

105.3

96.9 100.2

95.6

83.1 78.6

90.9

84.3

98.4 103.4

88.0 93.4

60.0

70.0

80.0

90.0

100.0

110.0

120.0

12/11 1/12 2/12 3/12 4/12 5/12 6/12 7/12 8/12 9/12 10/12 11/12 12/12

Ave. Daily Census and Length of StayTotal Hospital - Annual

3

82.7

90.1

92.3 92.692.5

93.6 93.0

4.1

4.4 4.3

4.3 4.3

4.2 4.2

3.5

4.0

4.5

5.0

5.5

76

78

80

82

84

86

88

90

92

94

96

FY 2007 FY 2008 FY 2009 FY 2010 FY 2011 FY 2012 FY 2013

ADC ALOS

Average Daily Census by UnitMedical Surgical, ICU and OB.

4

29

34

28

31 33

28 26

28 29

33 32

28 30

7 9

5 6 4

7 4

8 5 5

7 5

7

21 23 23

25 26

19 20

26

21 22

24 21

18

0

10

20

30

40

12/11 01/12 02/12 03/12 04/12 05/12 06/12 07/12 08/12 09/12 10/12 11/12 12/12

Med/Surg ICU OB/Gyn

Average Daily Census by UnitNICU, Pediatrics, Rehab., and Psych.

5

10

8

10

5

8

7

3 4

6

11 11

6

9

3 3

5 5

2 3

2 2 2 3

2 2 2

12

14 14

17

14

10 11

13 13

15 15

14 14

8

14

12

10

9

9

12

10 9 10

12 12 13

0

5

10

15

20

12/11 01/12 02/12 03/12 04/12 05/12 06/12 07/12 08/12 09/12 10/12 11/12 12/12

NICU Peds Acute Rehab Psychiatric

DeliveriesMonthly

6

0

50

100

150

200

250

300

12/11 01/12 02/12 03/12 04/12 05/12 06/12 07/12 08/12 09/12 10/12 11/12 12/12

210

251 225

254 251

205 213

256

219 214

257

206 197

Deliveries – Average Per MonthAnnual

7

221 223 225 236 234 225

Emergency Room VisitsMonthly

8

3,390 3,705

3,889 3,936

3,587

3,972 3,763 3,812 3,902

4,021 4,133

3,724

3,667

2,000

3,000

4,000

5,000

12/11 01/12 02/12 03/12 04/12 05/12 06/12 07/12 08/12 09/12 10/12 11/12 12/12

Emergency Room VisitsAverage Per Day

9

109 110 125

117 120 128 125 123 126

134 133 124 118

0

20

40

60

80

100

120

140

160

E.R. Visits – Average Per MonthAnnual

10

3,528 3,758 3,736 3,797 3,877

Payor Mix Current and Past Four Years

11

Payor FY 09 FY 10 FY 11 FY 12 FY 13 Change % Change

Medicaid 26.56% 23.39% 21.87% 21.17% 23.90% 2.73% 12.90%Medicaid Managed Care 23.48% 27.09% 29.02% 30.29% 24.25% -6.04% -19.94%Medicare 17.98% 17.26% 17.42% 17.18% 19.06% 1.88% 10.94%Managed Care 16.81% 17.34% 17.25% 16.56% 16.38% -0.18% -1.09%MIA 4.64% 4.94% 5.29% 5.23% 5.38% 0.15% 2.87%Self Pay 7.23% 8.42% 7.60% 7.65% 8.92% 1.27% 16.60%Short Doyle 3.31% 1.57% 1.55% 1.91% 2.11% 0.20% 10.64%

Total 100.0% 100.0% 100.0% 100.0% 100.0%

Payor Mix Current and Past Two Years

12

21.9%

29.0%

17.4% 17.3%

5.3%7.6%

1.6%

21.2%

30.3%

17.2% 16.6%

5.2%

7.7%

1.9%

23.9% 24.3%

19.1%

16.4%

5.4%

8.9%

2.1%

Medicaid Medicaid Managed

Care

Medicare Managed Care

MIA Self Pay Short Doyle

FY 11 FY12 FY13

Net Revenues Government and Payors

13

FY 2009 FY 2010 FY 2011 FY 2012 FY 2013Other 4.2$ 6.4$ 5.7$ 5.5$ 5.3$ Government 41.2$ 34.8$ 59.2$ 41.4$ 39.5$ Total Government 45.4$ 41.2$ 64.9$ 46.9$ 44.8$

Medicare 17.7$ 21.5$ 22.3$ 22.1$ 26.4$ Medi-Cal 20.4$ 20.5$ 20.0$ 20.3$ 21.3$ Medi-Cal Mgd Care 26.2$ 32.0$ 34.1$ 33.9$ 26.8$ Managed Care 50.0$ 54.1$ 57.1$ 51.7$ 47.9$ Short Doyle 2.0$ 1.9$ 2.0$ 2.2$ 2.3$ Self-Pay 1.6$ 1.3$ 1.0$ 1.03$ 0.97$ Total Payor 117.9$ 131.3$ 136.4$ 131.2$ 125.7$

Grand Total 163.3$ 172.5$ 201.3$ 178.1$ 170.5$

Net RevenuesGovernment and Payor Segment

14

$45.4 $41.2 $64.9

$46.9 $44.8

$117.9 $131.3

$136.4 $131.2 $125.7

$-$20.0 $40.0 $60.0 $80.0

$100.0 $120.0 $140.0 $160.0 $180.0 $200.0 $220.0

FY 2009 FY 2010 FY 2011 FY 2012 FY 2013

Total Government Total Payor

Net Revenues Payor Segment

15

$17.7 $20.4

$26.2

$50.0

$2.0 $1.6

$26.4 $21.3

$26.8

$47.9

$2.3 $0.97 $-

$10.0

$20.0

$30.0

$40.0

$50.0

$60.0

Medicare Medi-Cal Medi-Cal Mgd Care

Managed Care Short Doyle Self-Pay

in millions

FY 2009 FY 2010 FY 2011 FY 2012 FY 2013

Net Income or <Loss>Monthly

16

2,623

506 434 361 194 (741)

(2,472)

(533) (165)261

985 40 76

-$3,500

-$1,500

$500

$2,500

$4,500

$6,500

$8,500

12/11 01/12 02/12 03/12 04/12 05/12 06/12 07/12 08/12 09/12 10/12 11/12 12/12

in thousands

Net Income or <Loss>Actual and Budget

17

Actual Budget Variance

Month - Net Income or <Loss> $76,000 $296,000 ($220,000)

YTD - Net Income or <Loss> $664,000 $1,774,000 ($1,110,000)

Revenue, Expense, Profit Per APDAnnual

18

$3,000$3,398 $3,456 $3,634

$4,291$3,843

$3,698$3,922

$3,097

$3,159$3,284

$3,339 $3,602 $3,743 $3,670 $3,847

-$97

$239 $171 $295$689

$100 $28 $76$265$94 $0 $0 $0 $0 $0

FY07 FY08 FY09 FY10 FY11 FY12 FY13 Budget FY13

TOTAL REVENUE PER APD TOTAL EXPENSE PER APD INCOME (LOSS) PER APD COUNTY CONTRIB. PER APD

Revenue, Expense, Profit Per APDMonthly

19

4,476

3,410 3,697 3,895 3,969 3,862 3,840

3,462 3,844

3,570 3,580 3,797 3,979

3,788 3,295 3,585 3,811

3,919 4,059

4,573

3,600 3,888

3,505 3,357 3,786

3,959

688

116 112 84 50 (198)

(734)

(139) (44) 65 223 11 20

-$1,000

$0

$1,000

$2,000

$3,000

$4,000

$5,000

TOTAL REVENUE PER APD TOTAL EXPENSE PER APD INCOME (LOSS) PER APD

Cash - PatientsMonthly

20

$11,493

$11,108

$12,196

$9,666

$9,853

$12,643$9,976

$10,438

$10,568

$8,780$9,720

$10,918$11,331

$0

$2,000

$4,000

$6,000

$8,000

$10,000

$12,000

$14,000

$16,000

12/11 01/12 02/12 03/12 04/12 05/12 06/12 07/12 08/12 09/12 10/12 11/12 12/12

in thousands

Cash – Patients – Average Per MonthAnnual

21

$7,811$9,305

$10,809$11,539 $11,222

$10,293

in thousands

Month End Cash Balance22

$59.9$54.7

$53.9 $55.8

$68.2 $68.6

$70.6

$62.2 $62.9$58.6 $57.4 $54.1 $53.0

$63.1

$61.4

$58.3$66.2 $63.8 $61.6

$67.0$61.0 $57.4

$57.0 $53.9 $50.4 $50.4

$0

$10

$20

$30

$40

$50

$60

$70

$80

Actual Actual Actual Actual Actual Actual Actual Actual Actual Actual Actual Actual Actual

12/11 01/12 02/12 03/12 04/12 05/12 06/12 07/12 08/12 09/12 10/12 11/12 12/12

in millions

Act/Est Budget

Patient Accounts ReceivableMonthly

23

$127.4$134.3

$121.7 $121.2$130.7

$120.0$114.4 $112.7 $110.0 $115.2

$134.8$132.4 $127.7

$0.0

$25.0

$50.0

$75.0

$100.0

$125.0

$150.0

$175.0

in millions

Days in ARMonthly

24

62.3 64.7

56.6 55.5 58.5

55.1 56.4 56.8 53.3 54.7

60.3 60.5 63.4

20.0

30.0

40.0

50.0

60.0

70.0

80.0

90.0

100.0

Days in ARYear to Year Comparison

25

66.9 66.6 58.5

56.6

63.4

-

20.0

40.0

60.0

80.0

2009 2010 2011 2012 2013

Days Cash on HandAnnual

26

66 72 109

141 154 119

32 31

32

0

20

40

60

80

100

120

140

160

180

200

FY2008 FY2009 FY2010 FY2011 FY2012 YTD FY2013

Days of Cash on Hand

BBB 125

A 179

Long Term Debt Ratio27

45%41%

36% 34%32% 30%

Key Points28

•Average Daily Census (ADC) for December is 93.4 or 5.4 higher than the November census of 88.0 ADC.

• The YTD ADC was (.3) patients lower than budget and (1.0) ADC lower than the prior year.

•Gross Patient Revenues:

●Total patient revenue of $ 62.7 M for December was ($ 1.0 M) lower than budget. YTD total patient revenue is $ 4.6 M higher than budget and was $ .2 M higher than the prior year to date average.

Deductions from Revenue:

• Deductions from revenue were $ 1.0 M lower than budget and Net Patient Revenue was ($ .1M) lower than budget. YTD deductions from revenue were ($8.4 M) higher than budget and was ($ 2.9 M) higher than the prior year to date average.

•Government Funding:

• Government funding is being accrued at the FY 2013 Budget level and has been adjusted to reflect changes to Year to date funding that is known and is ($ 0.9 M) below budget.

Key Points29

•Salaries, Wages and Benefits YTD has a favorable variance of $ .9 M.

• On dollars per APD, SWB are $ 48 under budget for the current year.

• Paid FTE’s are 856.6 or 14.1 FTE’s lower than budget while FTE’s per adjusted occupied bed are 6.7 or .8 lower than budget.

Registry has an unfavorable variance YTD of ($ 509 K).

• RN fees are over budget by ($ 115 K) over in Therapy by ($ 114 K) and over in Temp Staff by ($ 280K)

•Physician fees/salaries have a favorable variance of $ 127 K.

• Non-employed physicians ($ 380 K).

• Payroll Residency Program $ 353 K.

• Payroll Staff Physicians $ 154 K.

•Supplies have a favorable variance of $ 844 K.

• Supplies expense per adjusted patient day are under budget by $ 37 and $ 33 lower than the prior year average per APD.

• Other Operating Expense has a favorable variance of $ 557 K.

• Other operating expense per adjusted patient day are under budget by $ 24 and $ 16 lower than the prior year average per APD.

Key Points30

•Utilities and Telephone has a favorable variance of $ 80 K.

• Utilities & Telephone expense per adjusted patient day are under budget by $ 4 and $ 1 lower than the prior year average per APD.

•Purchased Services has a favorable variance of $ 1.5 M.

• Adjusted for volume, purchased services per adjusted patient day are $ 68 favorable to budget year to date and $ 22 lower than the prior year average.

Net income year to date is $ 664 K but is ($ 1.10 M) negative variance vs. budget.

The current cash balance is $ 53.0 M. at December 31, vs. a budgeted cash balance of $ 50.4 M, yielding a positive variance at 12/31 of $ 2.6 M excluding the $14.2M in the County’s NMC Reserve Fund. Patient account collections were $ 11.5 M. for December up from $ 10.9 in November.

The schedule below shows the change in year-end cash forecasted month by month for FY 2013.

July Aug Sept. Oct. Nov. Dec.$1.1M ($0.1M) $2.9 M ($3.6M) $ .7 M $ .5 M