VIRTUA HEALTH, INC. Operating Data Update for Secondary Market Continuing Disclosure Requirements Fiscal Year 2012 FACILITIES Hospitals Virtua - West Jersey Health System (Virtua- WJHS) is a 691 licensed-bed tax-exempt health system that operates three general acute care hospitals, which are located in Berlin (Camden County), Marlton (Burlington County), and Voorhees (Camden County), New Jersey. On May 22, 2011, Virtua- WJHS opened a new hospital in Voorhees as a replacement for the former Voorhees hospital. The new hospital, inclusive of beds added in 2012 for a new joint replacement institute, has approximately 100 more licensed beds in comparison to the old campus. Virtua- Memorial Hospital of Burlington County (Virtua - Memorial) is a 383 licensed-bed tax-exempt acute care hospital located in Mount Holly (Burlington County), New Jersey. Virtua - WJHS maintains majority equity ownership in joint ventures with physicians. Virtua- WJHS and local physicians own Summit Surgical, LLC (Surgical), an ambulatory surgery center (ASC) in which Virtua- WJHS maintains 54.88% equity ownership as of December 2012. Virtua- WJHS and a local physician formed Virtua Radiation Oncology Associates, LLC, in which Virtua- WJHS maintains 51.00% equity ownership as of December 2012. Virtua- WJHS and local physicians formed South Jersey Musculoskeletal Institute (doing business under the trade name Advanced Surgical Institute), an ASC in which Virtua- WJHS maintains 52.05% equity ownership as of December 2012. Virtua- WJHS and local physicians formed Ambulatory Surgery Center at Virtua Washington Township, LLC, an ASC in which Virtua- WJHS maintains 57.00% equity ownership as of December 2012. Virtua- WJHS and physicians formed Jersey Shore, LLC, an ASC in which Virtua- WJHS maintains 51.00% equity ownership as of December 2012. Virtua- WJHS and physicians formed Ramapo Valley Surgical, an ASC in which Virtua- WJHS maintains 51.00% equity ownership as of December 2012. Virtua- Memorial also maintains majority equity ownership in joint ventures with physicians. Virtua- Memorial and local physicians formed Vantage Surgical Center, LLC, an ASC in which Virtua- Memorial maintains 51.00% equity ownership as of December 2012. Virtua- Memorial and local physicians formed Memorial Ambulatory Surgery Center, LLC, an ASC in which Virtua- Memorial maintains a 54.17% equity ownership as of December 2012. The following chart identifies the licensed bed complement of each Virtua hospital: Location of Facilities by Hospital, Town and County Virtua- Virtua- Virtua- Virtua- Virtua- Classification WJHS WJHS WJHS WJHS Memorial Total of Berlin, Marlton, Voorhees, Total Mt. Holly, Virtua Licensed Camden Burlington Camden Burlington Beds County County County County Medical/Surgical 89 180 222 491 279 770 ICU 6 18 26 50 26 76 Behavioral Health - - - - 22 22 OB/GYN - - 88 88 30 118 Pediatrics - - 16 16 14 30 Intensive Nursery - - 46 46 12 58 Total 95 198 398 691 383 1,074 General Nursery 0 0 84 84 50 134
Nursing Homes Virtua Health and Rehabilitation Center (VHRC) at Mt. Holly is a 180-bed nursing home facility in Mount Holly, Burlington County, New Jersey. Sixty beds are utilized for sub-acute care. All 180 beds are Medicare and Medicaid certified. For 2012, VHRC at Mt. Holly was 94.7% occupied and its payer mix consisted of 54% Medicaid, 20% Medicare, 17% Private Pay and 9% Managed Care/Other. Virtua Health and Rehabilitation Center (VHRC) at Berlin is a 128-bed nursing home facility on the campus of the Virtua - WJHS Berlin Hospital, Camden County, New Jersey. Thirty-four beds are utilized for sub-acute care. All 128 beds are Medicare and Medicaid certified. For 2012, VHRC at Berlin was 96.0% occupied and its payer mix consisted of 54% Medicaid, 21% Medicare, 16% Private Pay and 9% Managed Care/Other. Home Health Virtua - WJHS operates Virtua - Home Care at West Jersey, which is a Medicare certified home care agency. Home care services include skilled nursing care, nutritional counseling, physical, speech and occupational therapies, social workers, and home health aides. During 2012, over 82,300 home health visits were provided to the community. Virtua Memorial also operates a Medicare certified home care agency. In addition, Community Nursing Services, a subsidiary of Virtua, operates a freestanding, non-certified home care agency. Together, they constitute Burlington County s largest voluntary, non-profit home care provider. They offer a wide range of home health services that include skilled nursing care, nutritional counseling, physical, speech and occupational therapies, social workers, home health aides and homemaker services. During 2012, over 75,600 home health visits were provided to the community. In addition, grant funded services available include adult and child health promotions, special child health services, case management and public health nursing visits. Ambulatory and Health Fitness Summit Health Virtua, Inc. (Summit) is a not-for-profit health care organization, which currently consists of a fitness center and certain ambulatory services. Summit operates The William G. Rohrer Center for Health Fitness on the campus of Virtua - WJHS Voorhees, Camden County, New Jersey. The facility opened in July 2000 and consists of a two-story building encompassing approximately 82,000 square feet of space. The year 2012 ended with total memberships of 3,194. The mission of the Center for Health Fitness is to provide the services and resources for an individual who requires a medically integrated fitness program, and to improve the overall quality of life and the health status of the members of the community. Summit previously had an ASC, which, as of February 1, 2006, was divested and reorganized as a joint venture with physicians (Surgical). Virtua s equity ownership in Surgical was transferred from Summit to Virtua - WJHS during 2009. Physician Services Virtua Medical Group (VMG) is not-for-profit professional association consisting of multispecialty physician practices and services, which are essential to the delivery of Virtua s services. Virtua Surgical Group is a not-for-profit professional association consisting of a surgical multi-specialty group. All of Virtua s employed physicians are employed by VMG under Virtua. VMG has acquired select primary care and specialty practices within the community and also employs physicians in specialties essential to the delivery of Virtua s services.
MEDICAL AND DENTAL STAFF Virtua WJHS The average age of the Medical Staff members with admitting privileges is 49.4 years. 91% of the Medical Staff are board certified, 6% are board eligible and 3% are not certified. Virtua WJHS STAFF CLASSIFICATION NUMBER OF MEDICAL STAFF Active 569 Associate with privileges 711 Affiliate without privileges 84 16 Consulting Total 1,380
Virtua WJHS s top twenty admitting physicians by specialty for the year ending December 31, 2012: Specialty Cases Percent of Total Cases Rank Pt. Days Age Percent of Total Patient Stay Individual or Group Practice INTERNAL MEDICINE 1525 3.79% 1 6,784 58 3.97% Group INTERNAL MEDICINE 1209 3.00% 2 5,953 55 3.49% Individual INTERNAL MEDICINE 853 2.12% 3 3,835 31 2.25% Group INTERNAL MEDICINE 791 1.97% 4 3,493 45 2.05% Group INTERNAL MEDICINE 727 1.81% 5 3,391 34 1.99% Group INTERNAL MEDICINE 719 1.79% 6 3,534 55 2.07% Group INTERNAL MEDICINE 692 1.72% 7 3,393 39 1.99% Group INTERNAL MEDICINE 667 1.66% 8 3,264 52 1.91% Group INTERNAL MEDICINE 620 1.54% 9 2,987 58 1.75% Group INTERNAL MEDICINE 557 1.38% 10 2,761 65 1.62% Individual OB/GYN 447 1.11% 11 1,462 53 0.86% Group INTERNAL MEDICINE 443 1.10% 12 2,341 41 1.37% Group FAMILY PRACTICE 416 1.03% 13 1,191 43 0.70% Group ORTHOPEDICS 409 1.02% 14 1,280 48 0.75% Group INTERNAL MEDICINE 404 1.00% 15 1,986 42 1.16% Group INTERNAL MEDICINE 385 0.96% 16 2,036 33 1.19% Group INTERNAL MEDICINE 382 0.95% 17 1,780 36 1.04% Group INTERNAL MEDICINE 349 0.87% 18 1,777 47 1.04% Group INTERNAL MEDICINE 344 0.85% 19 1,342 41 0.79% Group PEDIATRICS 339 0.84% 20 896 70 0.52% Group Total 12,278 30.50% 55,486 32.50%
MEDICAL AND DENTAL STAFF Virtua Memorial The average age of the Medical Staff members with admitting privileges is 49.7 years. 89% of the Medical Staff are board certified, 8% are board eligible and 3% are not certified. Virtua Memorial STAFF CLASSIFICATION NUMBER OF MEDICAL STAFF Active 290 Associate with privileges 184 Affiliate without privileges 24 0 Consulting Total 498
Virtua Memorial s top twenty admitting physicians by specialty for the year ending December 31, 2012: Specialty Cases Percent of Total Cases Rank Pt. Days Age Percent of Total Patient Stay Individual or Group Practice FAMILY PRACTICE 705 3.40% 1 3,586 37 3.90% Group GENERAL MEDICINE 687 3.31% 2 3,832 42 4.17% Group PSYCHIATRY 497 2.40% 3 3,101 58 3.37% Group OB/GYN 495 2.39% 4 1,481 54 1.61% Group INTERNAL MEDICINE 419 2.02% 5 2,155 41 2.34% Group PEDIATRICS 418 2.01% 6 1,063 59 1.16% Group INTERNAL MEDICINE 378 1.82% 7 1,878 34 2.04% Group GENERAL MEDICINE 369 1.78% 8 1,956 36 2.13% Group GENERAL MEDICINE 335 1.61% 9 1,618 37 1.76% Group GENERAL MEDICINE 326 1.57% 10 1,843 33 2.00% Group ORTHOPEDICS 312 1.50% 11 756 55 0.82% Group INTERNAL MEDICINE 300 1.45% 12 1,811 32 1.97% Group INTERNAL MEDICINE 296 1.43% 13 1,573 33 1.71% Group OB/GYN 296 1.43% 14 815 59 0.89% Group PEDIATRICS 293 1.41% 15 715 60 0.78% Group INTERNAL MEDICINE 292 1.41% 16 1,399 41 1.52% Group PEDIATRICS 288 1.39% 17 760 59 0.83% Group INTERNAL MEDICINE 287 1.38% 18 1,740 44 1.89% Group INTERNAL MEDICINE 287 1.38% 19 1,340 40 1.46% Group INTERNAL MEDICINE 282 1.36% 20 1,415 43 1.54% Group Total 7,562 36.45% 34,837 37.89%
Medical Staff Integration The Medical Staff is accountable to the Board of Trustees for the quality and appropriateness of care delivered and for the ethical conduct of its members. It is organized to ensure that patient care at Virtua consistently achieves high quality standards. The Virtua Medical Staff is comprised of the Virtua-West Jersey and Virtua-Memorial divisions, which are governed by a single set of by-laws, to more effectively achieve the above-mentioned purposes through integration and cooperation. The Quality and Safety Committee is comprised of board members, physicians, and administration whose primary responsibility is the quality and safety of our patients. The Board of Trustees of Virtua has the power and authority to appoint and remove Medical Staff members and to award clinical privileges to such persons consistent with the by-laws. The Medical Executive Committee may make recommendations on such matters. Virtua has established or acquired select primary care and specialty practices, within its community. Virtua will only strategically employ physicians who will help meet the needs of the community. Those physicians that Virtua employs must meet specific criteria, including the willingness to align with Virtua s goals and the objectives as well as the ability to demonstrate the values of Virtua, and provide excellent clinical care. The purchase price of any acquired practice in each case has been based on the assets acquired by Virtua, with the physicians and their office staff becoming employees of Virtua. Other physicians employed by Virtua are in specialties essential to the delivery of services including: hospitalists, cardiologists, anesthesiologists, neurologists, perinatologists, pain specialists, gynecological oncologists, breast care specialists, as well as faculty of the family practice residency program. Virtua will continue to evaluate ways to align with the physicians in its community, particularly in consideration of changes driven by national healthcare reform. Virtua received approval in December 2012 from the Centers for Medicare and Medicaid Services relative to its application to establish a Medicare Shared Saving s Program Accountable Care Organization (ACO). Employee/Labor Relations EMPLOYEES Virtua currently ranks in the 97th percentile nationally in employee engagement as measured by an annual employee survey administered by Avatar HR Solutions International, Inc. Accordingly, management considers its relationship with the employees to be very good. Every year since 2007, Virtua has been named #1 Best Place to Work in the Delaware Valley by the Philadelphia Business Journal in the 1,000 employee plus category. In 2012, Virtua was also elected to the Philadelphia Business Journal's Best Place to Work Hall of Fame for the fifth consecutive year. In 2012 and 2011, South Jersey Biz named Virtua among its "Best Places to Work." Virtua s employed registered nurses are represented by labor unions under bargaining relationships that were established prior to the creation of Virtua in 1997. Registered nurses working at Virtua-Memorial and CNS are represented by the Health Professionals and Allied Employees ( HPAE ) union. Effective May 31, 2011 the HPAE membership ratified a 3-year contract, which runs through May 31, 2014. Registered nurses working at Virtua-Berlin, Virtua-Camden, Virtua-Marlton, Virtua-Voorhees, Summit Surgical Center, and Virtua- Home Care at West Jersey are represented by JNESO. The JNESO membership ratified a new contract effective May 13, 2012 that runs through February 28, 2015. There are no other unions at Virtua or any of its affiliates. Management is unaware of any current organizing effort by any union. There are no representation issues before the NLRB.
Employee Benefits Virtua provides its employees with a comprehensive benefits package. This package includes group medical and dental insurance, prescription drug coverage, life insurance, accidental death & dismemberment, long-term disability insurance, flexible spending accounts, voluntary vision plan, paid time off program, educational assistance, and an employee assistance program. In December 2003, Virtua froze its defined benefit program for all employees except those who have at least 10 years of service and were at least 50 years of age. As of December 31, 2012, the Virtua Pension Equity Plan funded status for accounting expense purposes, measured by comparing projected benefit obligation to the fair value of assets, was 83.2%. For retirement savings programs, Virtua has a 401(k) savings plan consisting of an employer contribution of 1.5% of pay without any required employee contributions, plus a 50% Virtua match on the first 6% of employee contributions by non-bargaining unit employees and nurses represented by HPAE. Employees may also contribute to a voluntary 403(b) plan. Pension benefits for registered nurses represented by JNESO are funded, based on hours worked, through the central pension fund of the IUOE. Paid Full Time Equivalents The following chart identifies the composition of the labor force by hospital: Virtua WJHS Virtua Memorial Total RNs 625 448 1,073 LPNs 24 2 26 Orderlies/Aides 199 107 306 Professional/Management 451 176 627 Service 392 142 534 Clerical, Technical & Other 716 384 1,100 Total 2,407 1,259 3,666 Full time equivalents per 4.42 4.08 4.30 adjusted occupied bed
Utilization Statistics Virtua - WJHS The following table sets forth select historical utilization statistics of Virtua - WJHS for the five years ended December 31, 2012. This table reports inpatient admissions and excludes newborns and same day surgical cases from the statistics and average length of stay (ALOS) and percentage occupancy calculations. 2008 2009 2010 2011 2012 Licensed Beds 592 592 592 661 691 Admissions Medical/Surgical 22,955 23,321 24,401 25,751 25,696 ICU/CCU 1,270 1,335 1,287 1,202 1,605 OB/GYN 5,666 5,927 5,731 5,731 5,888 Pediatrics 779 812 830 785 1,056 Total 30,670 31,395 32,249 33,469 34,245 Patient Days Medical/Surgical 113,149 117,000 118,484 116,038 110,975 ICU/CCU 7,672 8,121 7,686 9,200 12,360 OB/GYN 17,991 18,787 18,025 18,411 18,454 Pediatrics 2,188 2,348 2,184 2,090 3,077 Total 140,970 146,256 146,379 145,739 144,866 ALOS Medical/Surgical 4.9 5.0 4.9 4.5 4.3 ICU/CCU 6.0 6.1 6.0 7.7 7.7 OB/GYN 3.2 3.2 3.1 3.2 3.1 Pediatrics 2.8 2.9 2.6 2.7 2.9 Total 4.6 4.7 4.5 4.4 4.2 Percentage Occupancy 65.0% 67.7% 67.7% 65.3% 58.6% Other Selected Utilization Statistics 2008 2009 2010 2011 2012 Newborn (including Neonatal) Admissions 5,301 5,572 5,411 5,443 5,562 Emergency Room Visits (net) 105,323 117,192 110,474 116,014 123,696 Same Day Surgeries 9,251 9,956 9,967 10,078 10,370 Outpatient/Clinic Visits 135,650 142,113 151,303 159,686 160,625 Home Health Admissions 9,185 9,708 10,210 10,887 9,970
Management s Discussion of Utilization Performance Virtua - WJHS Inpatient Inpatient admissions have increased every year, and by 11.7% in total from 2008 to 2012. This has been driven by a combined medical/surgical and ICU/CCU admission increase of 12.7%. OB/GYN and pediatric admissions combined have increased by 7.7%. During this time, there has also been greater utilization of observation status relative to emergency room patients, which has increased from 5,869 in 2008 to 6,089 patients in 2012. Patients held for observation whom are ultimately not admitted are discharged with an outpatient status. Patient days increased by 2.8% from 2008 to 2012. This is attributable to the inpatient admission increase, as the overall average length of stay has decreased from 4.60 to 4.23, or by approximately 8.0%. The average length of stay decline specifically for medical/surgical patients is the main factor with regards to the overall reduction. The overall year-to-year fluctuation in patient days is a function of the annual changes in total admissions and average length of stay. Outpatient Outpatient volumes continue to grow year over year. Emergency room visits net of admissions have increased by 17.4% from 2008 to 2012, increasing each year except for from 2009 to 2010. Same day surgical cases have increased by 12.1% from 2008 to 2012. Outpatient/Clinic visits have increased each year and in total by 18.4% from 2008 to 2012. Home health admissions declined from 2011 to 2012, but have increased by 8.5% from 2008 to 2012.
Utilization Statistics Virtua - Memorial The following table sets forth select historical utilization statistics of Virtua - Memorial for the five years ended December 31, 2012. This table reports inpatient admissions and excludes newborns and same day surgical cases from the statistics and average length of stay (ALOS) and percentage occupancy calculations. 2008 2009 2010 2011 2012 Licensed Beds 383 383 383 383 383 Admissions Medical/Surgical 12,086 11,933 12,365 13,057 12,194 ICU/CCU 1,519 1,549 1,595 1,696 1,794 OB/GYN 2,356 2,347 2,692 2,881 2,682 Pediatrics 657 732 313 385 331 Behavioral Health 1,004 952 1,068 1,032 1,029 Total 17,622 17,517 18,033 19,051 18,030 Patient Days Medical/Surgical 61,099 62,931 60,447 64,236 60,968 ICU/CCU 7,219 7,545 6,738 7,650 7,256 OB/GYN 7,167 6,842 7,710 8,168 7,839 Pediatrics 1,427 1,685 760 1,185 746 Behavioral Health 6,621 6,724 6,399 6,574 6,375 Total 83,533 85,727 82,054 87,813 83,184 ALOS Medical/Surgical 5.1 5.3 4.9 4.9 5.0 ICU/CCU 4.8 4.9 4.2 4.5 4.0 OB/GYN 3.0 2.9 2.9 2.8 2.9 Pediatrics 2.2 2.3 2.4 3.1 2.3 Behavioral Health 6.6 7.1 6.0 6.0 6.2 Total 4.7 4.9 4.6 4.6 4.6 Percentage Occupancy 59.5% 61.3% 58.7% 62.8% 59.3% Other Selected Utilization Statistics 2008 2009 2010 2011 2012 Newborn (including Neonatal) Admissions 2,166 2,135 2,557 2,799 2,556 Emergency Room Visits(net) 58,430 63,764 54,637 56,084 56,841 Same Day Surgeries 7,427 5,211 5,216 4,837 4,305 Outpatient/Clinic Visits 113,285 113,358 113,602 113,547 115,920 Home Health Admissions 5,780 6,199 6,423 6,548 6,407
Management s Discussion of Utilization Performance Virtua - Memorial Inpatient Despite declining from 2011 to 2012, inpatient admissions have increased by 2.3% from 2008 to 2012. Combined medical/surgical and ICU/CCU admissions have increased by 2.8%, OB/GYN admissions by 13.8%, and behavioral health admissions by 2.5%. These increases have offset a decline in pediatric admissions, which have decreased by approximately 50% from 2008 to 2012. Pediatric admissions do, however, represent the smallest volume category and accounted for less than 2% of 2012 admissions. There has also been greater utilization of observation status relative to emergency room patients, which has increased from 3,088 to 3,359 patients from 2008 to 2012. Patients held for observation ultimately either become inpatient admissions or they are discharged as outpatients. Patient days have essentially been flat from 2008 to 2012. This is attributable to a decrease in the total average length of stay, which was 4.74 in 2008 and is 4.61 in 2012. Overall, the average length of stay has been relatively stable across all volume categories. The overall year-to-year fluctuation in patient days is a function of the annual changes in total admissions and average length of stay. The percentage of occupancy has also been stable. Outpatient Emergency room visits net of admissions have decreased by 2.7% in total over the 2008 to 2012 period. This decrease is largely due to the opening of a satellite emergency department in Virtua-Memorial s service area, which initially resulted in a 14.3% visit reduction from 2009 to 2010, The 42% decline in same day surgeries is primarily the result of the hospital based same day surgical center being divested and reorganized as a joint venture with local physicians. Outpatient/Clinic visits have been very stable year over year from 2008 to 2012, increasing in total by 2.3%. Home health admissions have increased by 10.8% from 2008 to 2012.
Virtua - WJHS The following table indicates the Virtua WJHS payer mix based on total gross revenues during the past five fiscal years: Payer 2008 2009 2010 2011 2012 Managed Care 37.7% 37.7% 37.7% 35.6% 34.9% Medicare 36.4% 35.9% 36.0% 35.5% 33.0% Blue Cross 8.6% 8.5% 8.5% 8.6% 5.9% Commercial 3.7% 4.3% 4.2% 4.8% 5.3% Medicaid 6.1% 6.2% 6.3% 7.0% 8.1% Self Pay 5.3% 4.6% 4.5% 5.4% 6.1% Other 2.2% 2.8% 2.8% 3.1% 6.7% Total 100.0% 100.0% 100.0% 100.0% 100.0% Virtua - Memorial The following table indicates the Virtua - Memorial payer mix based on total gross revenues during the past five fiscal years: Payer 2008 2009 2010 2011 2012 Managed Care 29.0% 31.2% 31.2% 28.7% 26.8% Medicare 38.3% 37.1% 37.1% 38.6% 42.2% Blue Cross 9.9% 9.2% 9.2% 9.1% 5.1% Commercial 3.2% 3.4% 3.4% 3.8% 3.9% Medicaid 7.5% 6.9% 7.0% 8.1% 7.9% Self Pay 10.3% 6.5% 5.6% 6.0% 6.7% Other 1.8% 5.7% 6.5% 5.7% 7.4% Total 100.0% 100.0% 100.0% 100.0% 100.0%
FINANCIAL PERFORMANCE Virtua - WJHS The following selected financial data for the five years ended December 31, 2012 are derived from the audited financial statements: 2008 2009 2010 2011 2012 Net patient service revenue $558,281,000 $574,882,000 $616,581,000 $669,073,000 $661,047,000 Other revenue 30,835,000 29,683,000 29,207,000 27,253,000 29,748,000 Total revenue 588,855,000 604,565,000 645,788,000 696,326,000 690,795,000 Total expense 539,846,000 565,477,000 597,438,000 656,504,000 649,901,000 Income from operations (sub-total) 49,009,000 39,088,000 48,350,000 39,822,000 40,894,000 Equity income in unconsolidated 1,000,000 9,489,000 8,220,000 6,622,000 7,219,000 subsidiaries Income from operations 50,009,000 48,577,000 56,570,000 46,444,000 48,113,000 Non-operating gains(losses)net (84,248,000) 68,156,000 48,913,000 5,168,000 64,307,000 Excess of revenue and gains over expenses and losses ($34,239,000) $116,733,000 $105,483,000 $51,612,000 $112,420,000 Management s Discussion and Analysis of Financial Performance Virtua WJHS Financial performance has been consistently strong for each year from 2008 to 2012. Income from operations has been in the $46.4 million to $56.6 million range. The 2012 total revenue amount reflects the accounting classification change effective in 2012 with regards to the reporting of the provision for bad debts as an offset to revenues. Total revenue, comparable to the 2008 through 2011 amounts that include the provision for bad debts as an expense, would be $723,115,000 for 2012. Accordingly, net patient service revenues have shown steady growth year over year due to a combination of inpatient and outpatient volume increases, payer rate increases, and an overall increase in case mix. The excess of revenue and gains over expenses has fluctuated much more than the income from operations, as the financial market declines resulted in a significant nonoperating investment loss in 2008. There have been significant unrealized investment gains in 2009, 2010 and 2012. The equity income in unconsolidated subsidiaries represents Virtua s share of the net gain of certain physician joint ventures. The accounting for the financial results of these joint ventures changed from the consolidation to the equity method effective with the 2008 results.
Virtua - Memorial The following selected financial information for the five years ended December 31, 2012 is derived from the audited financial statements: 2008 2009 2010 2011 2012 Net patient service revenue $310,695,000 $309,083,000 $307,945,000 $319,969,000 $308,221,000 Other revenue 9,038,000 9,843,000 9,188,000 8,720,000 13,780,000 Total revenue 319,733,000 318,926,000 317,133,000 328,689,000 322,001,000 Total expense 280,553,000 281,991,000 293,758,000 302,752,000 291,682,000 Income from operations (sub-total) 39,180,000 36,935,000 23,375,000 25,937,000 30,319,000 Equity income in unconsolidated subsidiaries (822,000) 492,000 1,262,000 2,167,000 2,738,000 Income from operations 38,358,000 37,427,000 24,637,000 28,104,000 33,057,000 Non-operating gains(losses)net (12,364,000) 9,789,000 7,008,000 570,000 8,372,000 Excess of revenue and gains over expenses and losses $25,994,000 $47,216,000 $31,645,000 $28,674,000 $41,429,000 Management s Discussion and Analysis of Financial Performance Virtua Memorial Income from operations has also been strong from 2008 to 2012 and trending upward since a decline from 2009 to 2010. The 2012 total revenue amount reflects the accounting classification change effective in 2012 with regards to the reporting of the provision for bad debts as an offset to revenues. Total revenue, comparable to the 2008 through 2011 amounts that include the provision for bad debts as an expense, would be $333,731,000 for 2012. Moderate expense increases have enabled the continuation of favorable operating results, as 2012 total expenses adjusted for the provision for bad debt reclassification would be $303,412,000. The excess of revenue and gains over expenses has fluctuated much more than the income from operations, as the financial market declines resulted in a non-operating investment loss in 2008. Unrealized investment gains have been very positive for 2009, 2010, and 2012. The equity income in unconsolidated subsidiaries represents Virtua s share of the net gain of physician joint ventures, which has steadily increased year over year.
DEBT SERVICE COVERAGE The following debt service coverage ratio is for the Virtua Obligated Group. The Maximum Annual Debt Service (MADS) level applies to the Virtua Obligated Group s long-term indebtedness and includes the Series 1998, Series 2003, Series 2004, Series 2006, Series 2009 and Series 2011 bonds. 2012 (Deficiency) Excess of Revenue and Gains Over Expenses and Losses Depreciation & Amortization Expense, Net of Joint Venture $153,666,000 69,126,000 Interest Expense, Net of Joint Venture 23,537,000 Line of Credit Interest Expense - Other Non-Cash Expenses: Provision for Bad Debt, Net of Joint Venture 44,121,000 Net Unrealized Loss on Investments - Total Funds Available for Debt Service $290,450,000 Maximum Annual Debt Service $42,192,000 Debt Service Coverage Ratio 6.88