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GREAT PLAINS REGIONAL MEDICAL CENTER UNAUDITED CONSOLIDATED BALANCE SHEET March 31, 2015 ASSETS CURRENT ASSETS: CASH $ 16,545,582 GROSS PATIENT RECEIVABLE 46,060,155 PATIENT RECEIVABLE ALLOWANCES (40,142,691) NET PATIENT RECEIVABLE 5,917,464 OTHER RECEIVABLES 110,100 RELATED PARTY RECEIVABLES - INVENTORY 1,296,090 PREPAID EXPENSES 993,226 TOTAL CURRENT ASSETS 24,862,462 PROPERTY, PLANT & EQUIPMENT: LAND & IMPROVEMENTS 2,406,429 BUILDING & IMPROVEMENTS 59,278,940 EQUIPMENT 26,329,530 ACCUMULATED DEPRECIATION & AMORTIZATION (40,534,617) EQUIP IN PROGRESS (DN PMTS) 75,481 NET PLANT, PROPERTY, & EQUIPMENT 47,555,762 INTANGIBLE ASSETS: BOND ISSUE COSTS 1,100,779 ACCUM AMORTIZATION BOND ISSUE COSTS (329,108) START-UP COSTS (NET OF AMORT) 21,099 OTHER INTANGIBLE ASSETS 84,000 NET INTANGIBLE ASSETS 876,770 OTHER ASSETS: INVESTMENT IN HEARTLAND HEALTHCARE RRG 700,022 INVESTMENT IN JOINT VENTURE - INVESTMENT IN OHN, LIFECARE, AND WATERSTONE 47,517 SCHOLARSHIP RECEIVABLE 5,425 PHYSICIAN RECRUITMENT 1,180,135 ACC AMORT PHYSICIAN RECRUITMENT (811,937) TOTAL OTHER ASSETS 1,121,161 RESTRICTED CASH INTERNALY DESIGNATED BY BOARD 6,281,378 BOND FUND 911,188 DEBT SERVICE RESERVE FUND 2,702,294 TOTAL RESTRICTED CASH 9,894,860 GRAND TOTAL ASSETS $ 84,311,016 2
GREAT PLAINS REGIONAL MEDICAL CENTER UNAUDITED CONSOLIDATED BALANCE SHEET March 31, 2015 LIABILITIES AND EQUITY CURRENT LIABILITIES: ACCOUNTS PAYABLE $ 1,778,012 SALARIES PAYABLE 1,368,815 PAYROLL TAXES & DEDUCTIONS 389,847 REFUNDS - ACCRUED INTEREST 594,202 PAYABLE TO THIRD-PARTY PAYORS - OTHER LIABILITIES 26,014 DUE TO RELATED PARTIES - TOTAL CURRENT LIABILITIES 4,156,891 LONG TERM LIABILITIES: NOTES & LEASES PAYABLE - MORTGAGES PAYABLE 34,635,000 TOTAL LONG TERM LIABILITIES 34,635,000 TOTAL LIABILITIES 38,791,891 MINORITY INTEREST IN JOINT VENTURE 170,266 EQUITY: OPERATING FUND 46,586,559 CURRENT NET INCOME(LOSS) (1,237,700) TOTAL FUND BALANCES AND EQUITY 45,348,858 TOTAL LIABILITIES AND EQUITY $ 84,311,016 3
Great Plains Regional Medical Center UNAUDITED QUARTERLY STATEMENT OF OPERATIONS (in thousands) Fiscal Years Ended JUNE 30 2012* 2013* 2014* 9 Mths Ended March 31, 2015 * Operating Revenues Net patient service revenue $44,124 $46,338 $46,779 $38,291 Other operating revenue 2,628 1,113 1,766 1,361 Total Operating Revenues 46,752 47,451 48,545 39,652 Operating Expenses: Salaries and wages 16,079 16,538 16,058 11,905 Depreciation and amortization 5,669 5,476 5,172 3,240 Interest 1,940 1,877 1,847 1,362 Provision for bad debts 6,444 7,122 6,284 4,866 Other operating expenses 20,628 20,052 22,560 19,649 Total operating expenses 50,760 51,065 51,921 41,022 Income (loss) from operations (4,008) (3,614) (3,376) (1,370) Non-operating Revenues Investment income & Other 452 496 1,122 201 Gain (Loss) on Disposal of Equipment 61 286 0 0 Total non-operating gains 512 781 1,122 201 Incr (decr) in unrestricted net assets ($3,496) ($2,833) ($2,254) ($1,169) Minority Interest in Joint Venture (25) (58) (102) (69) Excess (Deficiency) of Revenue over Expenses ($3,521) ($2,891) ($2,356) ($1,238) * Consolidated information HISTORICAL UTILIZATION STATISTICS Fiscal Years Ended JUNE 30 2012 2013 2014 9 Mths Ended March 31, 2015* Admissions (excluding newborns) 1,924 1,924 1,753 1,466 Discharges (excluding newborns) 1,931 1,929 1,759 1,462 Patient Days (excluding newborns) 7,754 7,547 7,025 5,386 Avg. Daily Census 21 21 19 20 Occupancy Percentage * 37% 37% 31% 32% Acute Average Length of Stay 3.3 3.3 3.6 3.22 Births 415 442 417 301 ER Visits 11,942 13,733 13,862 10,143 Surgeries 3,476 3,351 3,192 2,297 * Based on staffed beds of 54 4
MANAGEMENT DISCUSSION GREAT PLAINS REGIONAL MEDICAL CENTER Great Plains Regional Medical Center has experienced some very positive changes in management this year. The Board of Directors, along with executive search firm Witt/Kieffer, appointed a new CEO in February 2014. In compliment, a new CFO familiar to the Organization, started in August of 2013. Management appointed an interim COO that started in August 2013. Since the arrival of the CEO we have a full management team and have identified focused strategies to address operational issues. Physician Relations Through business development, GPRMC has secured a relationship with 2 additional Cardiology physicians affiliated with the Oklahoma Heart Hospital. These 2 physicians began part-time practice in May 2014 and have made an immediate impact of approximately 2-4 cardiac cath cases and 6-8 cardiac stress tests per week. Their current primary service draw is in the peripheral communities to Elk City thereby increasing patient flow to GPRMC. These physician also plan to open an additional clinic in the region in 3/2015. GPRMC had a family practice physician leave the community in February 2014 but quickly recruited a family practice physician and a nurse practitioner in March 2014. The pair have quickly filled the void of the exiting physician plus captured many patients that could not find a family practice home. The Practice continues to see 30+ per day in and produces $90k+ in monthly revenues for 2014 and continues to grow. Through Business Development, a local orthopedic surgeon has started doing 15 20 cases per week at GPRMC a solid mix of IP/OP surgical case volume. This surgeon is based in Western Oklahoma but previously had not affiliated with GPRMC. This fills the need left by a retiring orthopedic surgeon that stopped performing surgery in January 2014, this surgeon still has an office based practice and assists with surgical overflow and ER Call. We have 1 psychiatrist that left the community at the end of May. Overall this is a + perception in the community. The Gero-Psych program will continue to operate in an efficient capacity via telemedicine through a cooperative partnership with the INTEGRIS Health System. We will evaluate the need for a FT Psychiatrist in the community. Effective 4/16/2014 GPRMC has secured a new ER physician contract to provide our Hospital and Community with board certified emergency medicine trained physicians. There is a slight cost increase but the agreement is heavily structured towards quality of care and outcome measures produced in the emergency department. The community has responded in a remarkably positive manner. Overall ER volume is consistent with patient throughput times for both discharge and admission trending positively. Overall admission percentage is slightly increasing due to acuity and improved case management functions. 5
In August of 2014 GPRMC, The University of Oklahoma, and OU Health Sciences began a residency program for general surgery that will be staffed with 4th year GS residents. This program will provide additional rural training venues for the GS program and additional service coverage for the Hospital. This dramatically increases the likelihood that patients have the ability to stay at the facility for service instead of being transferred to another facility. Cole Wootton MD (Urology) began his professional practice in Elk City and GPRMC in August 2014. Cole is from the area and completed his fellowship at the University of Kentucky in 6/2014. His patient volumes have grown quickly. Subsequently GPRMC has employed and additional part-time Urologist to work in the community 2 days per week and cover Emergency Room call 2 weeks per month. There is anticipated additional surgical volume from this placement. In October 2014, Michael Robinson MD (FP) relocated his primary practice to the campus of GPRMC. This is overall very positive as he also delivers babies thus making GPRMC his primary campus. GPRMC has recruited 2 additional Family Practice physicians to begin their Primary practice in the community. Brad Whinery MD (FP) began practice 1/2015. Also joining Dr. Whinery are 2 female NP s in the same clinic. The clinic has been very successful in Q3 and continues to grow. James Bass MD (FP) is anticipated began practice 4/2015. The practice is in its infancy. GPRMC has elected to employ 1 additional OB/GYN physician. This physician has practiced in the community for approximately 15 years and had planned to leave the community. The employment solidifies the presence of Women s Services on a continuous uninterrupted basis until an additional physician can be recruited to the community. GPRMC s busiest General Surgeon, Francis Abraham, MD suffered a broken left arm in early March and was out of Practice for approximately 5-6 weeks. This had a substantial impact on surgical volume as his case load is approximately 70 cases per month. GPRMC recruitment plan/goals for 2015 include: 2 Family Practice Placement for 2015 and 2016 1 OB/GYN - Update: Candidate to be placed late 2015, early 2016 1 Orthopedic surgeon Update: Pending support of in-market ortho. Interviewed Ortho PA for partnership clinic in Elk City. 1 ENT Update: 2 Candidates interviewed 1 Contract offered status pending. 1 Psychiatrist Update: 1 candidate interviewed, 1 contract offered 1/2015 6
Strength Our new facility (2009) continues to be the dominant facility in Western Oklahoma with no current major Capital needs. The ability to attract Patients and Physicians is tremendous. Despite physician turnover, the access to Primary Care and Subspecialty physicians continues to be effective. GPRMC Nursing and Allied staff are among the best in the region and are remarkable for critical care in the ER and ICU. GPRMC has a strong relationship with a regional University and provides an on campus extension of the nursing program. Weakness GPRMC has not been as effective as possible in Physician recruitment and retention in the last 3 years. The Management team currently strives to create an environment of collaboration and innovative physician engagement. The Facility does experience a modest distrust in the community given the recent history of physician turnover in both the ER and Outpatient arena. Opportunity GPRMC has a tremendous opportunity to re-engage the physician base and grow the facility. On the same note, re-engage the community to support the facility locally through patient volume and charitable endeavors of the GPRMC Foundation. Physician recruitment and retention will be a majority focus. There is an underlying regional opportunity to strengthen GPRMC through more formalized affiliations with surround hospitals and their communities. Historically, GPRMC has been open to these discussions but a fierce level of independence often exists in the outlying communities. Threat There continues to be high level interest in Western Oklahoma Healthcare by larger organizations such as INTEGRIS, Mercy, St. Anthony, and Community Health Systems. This is perceived as both a threat and an Opportunity depending on the intent. There are 2 facilities in our region that are pursuing the feasibility of JV ASC opportunities. The ACA and absence of Medicaid expansion are threats to Rural Healthcare in Oklahoma. 7