1. HFMA Mid-Year Meeting Board Financial Reporting Thursday, May 23, 2019
Presented by Douglas Wismer, FHFMA, CFO
Thayer County Health Services

2. Board Financial Packet
Title Page
Table of Contents
Management Discussion and Analysis
Key Ratios
Key Statistics
Financial Statements
Exhibits:
Key Activity Graphs
Revenue Cycle KPI Graphs

3. Management Discussion and Analysis
CFO Narrative to Board – explains monthly financial performance
Introduction
Excess of Revenue over Expenses:
Monthly and Year-to-Date (YTD) margins – EBIDA/total margin
Patient service revenue variances
Deduction from revenue variances
Other operating revenue variances
Operating expense variances
Patient days and average daily census (ADC)
Other statistical variances
FTE variances
Liquidity
Cash and investment variances
Net patient accounts receivable variances
Accounts payable variances
Other asset/liability variances – i.e., building project, debt, etc.

4. Key Ratios Ratios: Content: Actual Budget Prior Year
Liquidity – days cash on hand; gross and net days in patient AR
Margin – operating, total and EBIDA margins
Deductions – contractuals, administrative adjustments, bad debt, and charity care
Operating expenses – compensation ratio, FTEs/AOB, costs/APD
Debt –LTD to capitalization, debt service coverage
Capital assets – average age of plant
Payor mix – Medicare, Medicaid, Blue Cross, Commercial, WC, and Private Pay
Content:
Actual
Budget
Prior Year
Variances – amount/% to budget and prior year
CAH benchmarks – Nebraska and National (2017 Flex Monitoring Report)
Highlighting ratios – met target (green); missed target (red)

5. Key Statistics Statistics: Content: Actual Budget Prior Year
Admissions – acute/nursery/swing combined
Patient days – acute/nursery/swing separated
ADC – average daily census (excluding observation patients)
Adjusted patient days
Other Activity – ER, Imaging, Lab, Observation, OP, Pharmacy, Rehab, Specialty, Surgery
Clinic visits – Hebron and satellite clinics
FTEs – paid and contracted (CEO, CFO, CRNAs, ER MD weekend coverage)
Content:
Actual
Budget
Prior Year
Variances – amount/% to budget and prior year
Highlighting ratios – met target (green); missed target (red)

6. Financial Statements Statements of Net Position:
Current month
Budget
Prior Year
Year End Audited
Statements of Revenues, Expenses, and Changes in Net Position:
Variances – amount/% to budget and prior year
Statements of Cash Flow:
Budget – not budgeted in FY18; new budget for FY19
Variances – amount/% to budget (starting in FY19) and prior year
Comparative Statements of Revenues, Expenses, and Changes in Net Position;
Month to month comparison
Year-to-date compared to budget (YTD and annual) and prior year (YTD and annual)

7. Exhibits Revenue Cycle KPI: Key Activity Graphs:
Patient days and visits (ER, Home Care, Observation, FP Clinic)
Ancillary departments (Lab, Meals, Ambulance, Surgeries, Specialty Clinic, Scripts)
Imaging (X-rays, Ultrasounds, Nuclear Medicine, CT Scans, Mammograms, MRIs)
Cardiopulmonary (Sleep Studies, Cardiac Rehab – including Stress Tests, EKGs)
Rehab Therapies (OT, PT, ST)
Graph current year, budget, and prior year by month
Revenue Cycle KPI:
Days in Accounts Receivable (Gross, Net, DNFB)
Revenue (gross and net) and Collections
Linear relationship for gross and net revenue
FY16 to FY19 by month

8. Thayer County Health Services
Financial Statement Packet
For the Nine Months Ended March 31, 2019 and 2018
Presented to the Board of Trustees
Wednesday, April 24, 2019

9. Thayer County Health Services
Financial Statement Packet
For the Nine Months Ended March 31, 2019 and 2018
Table of Contents
Page
Management's Discussion and Analysis
1 - 2
Key Ratios 3
Key Statistics 4
Financial Statements:
- Statements of Net Position 5
- Statements of Revenue, Expenses and Change in Net Position
6 - 7
- Statements of Cash Flow 8
Exhibits:
- Key Activity Graph (Patient Days and Visits) A
- Key Activity Graph (Ancillary Departments) B
- Key Activity Graph (Imaging) C
- Key Activity Graph (Cardiopulmonary) D
- Key Activity Graph (Therapies - PT, OT, ST) E
- Days in Accounts Receivable (FY16 to FY19) F
- Revenue and Collections (FY16 to FY19) G

10. Thayer County Health Services
Key Ratios
For the Nine Months Ended March 31, 2019 and 2018
March
Ratio Description
Year-to-Date
CAH Benchmarks
Actual
Budget
Prior Year
Variance
Nebraska
National %
Days Cash on Hand-Total
54.8
64.3
46.2
(9.5)
-14.8%
8.5
18.4%
160.5
78.2
Days In Patient AR - Gross (using 90 day average revenue)
55.4
45.0
75.1
10.4
23.0%
(19.7)
-26.3%
58.1
47.6
Days In Patient AR - Net (using 90 day average net revenue)
48.8
58.0
3.8
8.5%
(9.2)
-15.9%
51.2
50.8
Operating Margin
0.9%
0.3%
Total Margin
1.4%
1.8%
Total EBIDA Margin
9.7%
6.1%
15.8%
16.3%
20.9%
-0.5%
-3.1%
-5.0%
-24.2%
Contractual adjustments as % of total patient service revenue
14.2%
17.0%
-2.1%
-12.8%
-2.8%
-16.5% NA
0.1%
1.1%
1.0%
-1.0%
-92.3%
-0.9%
-91.8%
Administrative adjustments as % of total patient service revenue
1.6%
1.2%
0.5%
46.2%
0.4%
33.8%
5.4%
2.0%
-1.9%
3.4%
168.4%
7.2%
-386.5%
Bad Debt as % of total patient service revenue
4.2%
2.6%
2.2%
108.5%
1.5%
58.9%
0.0%
-98.4%
Charity Care as % of total patient service revenue
-0.4%
-81.3%
-0.2%
-68.2%
21.3%
19.9%
20.0%
6.8%
1.3%
6.3%
Total Deductions as % of total patient service revenue
20.1%
21.2%
0.2%
-1.1%
25.3%
44.9%
50.3%
53.3%
51.6%
-3.0%
-5.6%
-1.3%
-2.5%
Labor Compensation Ratio
51.4%
53.2%
52.4%
-1.8%
-3.4%
45.5%
6.5
7.0
0.0
(0.5)
-7.0%
FTE's per Adjusted Occupied Bed
6.7
6.3
5.8
0.3
5.0%
0.8
14.3%
6.9
5.5
$ ,914
2,718
3,122
196
(208)
-6.7%
Total Cost/Adjusted Patient Day
$ ,039
2,700
2,620
339
12.5%
419
16.0% $
128
161 32
25.1%
(1)
Supply Exp Per Adjusted Patient Day $
126
127 31
24.6% 30
23.5%
Long Term Debt to Capitalization
21.6%
22.6%
24.2%
-4.4%
-10.5%
26.4%
31.3%
Debt Service Coverage
2.3
3.1
1.9
(0.8)
-25.5%
0.4
19.2%
3.2
3.7
Average Age of Plant
5.6
(0.9)
-14.2%
-13.9%
9.1
11.0
Payor Mix
58.6%
55.0%
53.6%
3.6%
6.5%
9.3%
Medicare
56.3%
-2.3%
7.3%
8.0%
-31.5%
-37.5%
Medicaid
7.5%
2.7%
0.7%
10.3%
19.3%
18.8%
19.0%
Blue Cross
17.6%
17.8%
-1.2%
-6.4%
14.6%
14.0%
16.5%
0.6%
4.3%
-11.5%
Commercial
16.4%
15.3%
2.4%
17.1%
0.8%
-83.3%
-0.6%
-75.0%
Worker's Compensation
-0.3%
-25.0%
-0.1%
-10.0%
2.3%
3.7%
2.1%
-1.4%
-37.8%
9.5%
Private Pay
2.8%
-29.7%
-7.1%
100.0%
Total
Target, budget amount, or benchmark not available
Met target
Missed target
No budget amount available to calculate result or no distinction for meeting or missing budgeted payor mix

11. Thayer County Health Services
Key Statistics
For the Nine Months Ended March 31, 2019 and 2018
March
Year-to-Date
Variance
Actual
Budget
Prior Year %
Admissions: 29 32
(3)
-9.4%
Inpatient (Acute, Nursery, Swing)
245
285
277
(40)
-14.0%
(32)
-11.6%
Patient Days 53 64 96
(11)
-17.2%
(43)
-44.8%
Acute
503
578
583
(75)
-13.0%
(80)
-13.7% - 5 1
(5)
-100.0%
(1)
Nursery 42 45
-6.7% 10
31.3% 98 50 21 48
96.0% 77
366.7%
Swing
487
450
436 37
8.2% 51
11.7%
151
119
118
26.9% 33
28.0%
Total Patient Days
1,032
1,073
1,051
(41)
-3.8%
(19)
-1.8%
4.9
3.8
1.0
1.1
Average Daily Census (excl obs)
3.9
(0.1)
624
666
572
(42)
-6.3%
51.6
9.0%
Adjusted Patient Days
5,261
6,002
5,922
(742)
-12.4%
(661)
-11.2%
Other Activity: 89
131
120
-32.1%
(31)
-25.8%
Cardiopulmonary Visits (incl EKG, Rehab, Sleep, Stress)
791
1,179
1,167
(388)
-32.9%
(376)
-32.2% 85
106
-11.5%
(21)
-19.8%
ER Visits
817
862
874
(45)
-5.2%
(57)
-6.5% 82 73
(82)
(73)
Home Care Visits
292
735
812
(443)
-60.3%
(520)
-64.0%
445
435
-1.1%
2.3%
Imaging Procedures (incl Echo/Vascular)
3,497
4,056
4,038
(559)
-13.8%
(541)
-13.4%
3,128
3,579
4,096
(451)
-12.6%
(968)
-23.6%
Laboratory Tests
26,379
32,215
32,503
(5,836)
-18.1%
(6,124)
-18.8% 27 24 36 3
12.5%
(9)
-25.0%
Observation Days
157
211
198
(54)
-25.6%
-20.7%
1,528
1,399
1,409
129
9.2%
8.4%
Outpatient Visits (excl ER/Specialty)
12,481
12,592
12,595
(111)
-0.9%
(114)
4,195
3,485
3,953
710
20.4%
242
6.1%
Pharmacy Scripts - Clinics/Hospital
30,652
31,365
32,518
(713)
-2.3%
(1,866)
-5.7%
1,142
1,820
2,367
(678)
-37.3%
(1,225)
-51.8%
Pharmacy Scripts - Retail
13,116
16,380
20,388
(3,264)
-19.9%
(7,272)
-35.7%
1,364
935
1,094
429
45.9%
270
24.7%
Rehab Services Visits (OT, PT, ST)
12,301
8,397
8,558
3,904
46.5%
3,743
43.7%
360
234
204
126
53.8%
156
76.5%
Specialty Clinic Visits (incl Behavioral Health/Chemo)
2,826
2,100
1,920
726
34.6%
906
47.2% 11
29.7% 15
45.5%
Surgeries & Scopes
404
330
279 74
22.4%
125
44.8%
Clinic Visits: 16 39 17
(23)
-58.4%
-5.9%
Bruning Clinic
144
347
325
(203)
(181)
-55.7%
-97.0%
Chester Clinic 49
190
(69)
-58.5%
(141)
-74.2% 19
-55.0%
(20)
-51.3%
Davenport Clinic
232
380
377
(148)
-39.0%
(145)
-38.5% 40 55 62
(15)
-27.8%
(22)
-35.5%
Deshler Clinic
264
499
505
(235)
-47.1%
(241)
-47.7%
1,097
1,267
1,277
(170)
(180)
-14.1%
Hebron Clinic
9,878
11,405
11,415
(1,527)
(1,537)
-13.5%
(36)
Milligan Clinic
317
(317)
1,173
1,403
1,464
(230)
-16.4%
(291)
Total Clinics
10,567
12,749
13,129
(2,182)
-17.1%
(2,562)
-19.5%
FTEs:
128.7
136.3
125.9
(7.6)
-5.6%
2.8
2.2%
Paid
124.1
122.1
(12.2)
-9.0%
2.0
1.6%
2.7
2.9
0.0%
(0.2)
-6.9%
Contracted
40.7%
-2.6%
131.4
139.0
128.8
-5.5%
2.6
2.0%
Total FTEs
127.9
126.0
(11.1)
-8.0%
1.9
1.5%
Met target
Missed target

12. Thayer County Health Services Statements of Net Position
March 31, 2019 and 2018
March 31
June 30,
2019
Budget
2018
Current assets:
Current liabilities:
Cash and investments:
Current portion of long-term debt
$ ,917
963,700
935,661
911,840
Cash and cash equivalents
$ ,277
311,800
499,231
663,293
Accounts payable
538,413
358,100
681,507
633,351
Money market account
1,816,348
2,427,800
1,719,110
874,658
Accrued expenses:
Certificates of deposit -
116,300
115,038
115,382
Salaries, wages, paid time off & benefits
916,951
818,000
901,304
767,769
Total cash and investments
2,790,625
2,855,900
2,333,379
1,653,333
Interest
7,072
10,000
7,482
27,984
Patient accounts receivable - net:
Amounts receivable to third party programs:
Gross patient accounts receivable
3,670,671
2,985,800
4,662,804
3,759,921
Due (from) to Medicare
445,299
80,000
333,900
Less contractual adjustment allowance
(326,800)
(299,000)
(507,470)
(403,117)
Due (from) to Medicaid
(99,530)
(99,700)
(281,720)
Less allowance for uncollectible accounts
(762,000)
(312,600)
(1,339,000)
(512,000)
Net third party program receivable
345,769
(19,700)
52,180
Net patient accounts receivable
2,581,871
2,374,200
2,816,334
2,844,804
Construction retainage payable
100,000
Total current liabilities
2,760,122
2,130,100
2,678,134
2,340,944
Other receivables
218,777
307,200
374,939
350,191
Inventories
583,405
459,900
435,218
517,971
Prepaid expenses
278,753
225,400
260,826
279,758
Long-term liabilities:
Amounts receivable from third party programs:
Bruning State Bank note, less current portion
Due from (to) Medicare
(225,000)
Long-term debt, less current portion
4,843,101
4,822,000
5,795,642
5,663,263
Due from (to) Medicaid
277,700
Total long-term liabilities
52,700
Total current assets
6,453,431
6,222,600
6,220,696
5,698,757
Total liabilities
7,603,223
6,952,100
8,473,776
8,004,207
Capital assets:
Deferred inflows of resources - unearned revenue
516,450
516,000
1,324,720
1,122,652
Non-depreciable capital assets (CWIP)
390
435,153
Depreciable capital assets - Net:
Land, buildings, and improvements
25,503,035
26,215,000
25,762,128
Equipment
9,379,585
11,368,500
11,123,919
9,223,411
Net position:
Less accumulated depreciation
(15,654,858)
(18,350,400)
(15,568,292)
(13,548,504)
Balance at beginning of year
Net depreciable capital assets
19,227,762
19,233,100
21,317,755
21,177,942
Revenue in excess of expenses
Capital assets - Net
19,228,152
21,752,908
Capital grants and contributions
Net position at end of period
Other assets
15,032
TOTAL ASSETS
$ 25,681,583
25,455,700
27,988,636
26,876,699
TOTAL LIABILITIES AND NET POSITION

13. Thayer County Health Services
Statements of Revenues, Expenses, and Changes in Net Position
For the Nine Months Ended March 31, 2019 and 2018
March
Year-to-Date
Variance
Actual
Budget
Prior Year %
Patient service revenue
Inpatient
Outpatient
Home health revenue
Professional fees
Total patient service revenue
Deductions from revenue
Contractual adjustments
Administrative adjustments
Provision for bad debts
Charity care
Total deductions from revenue
Net patient service revenue $
Net patient service revenue %
Other operating revenue
Pharmacy revenue
340B revenue
EHR incentive
Other
Total other operating revenue
Total revenue
Salaries and wages
Employee benefits
Management fee - CHI
Total compensation expense
340B expense
Contract services/professional fees
Depreciation & amortization
Equipment lease/rental
Insurance
Maintenance & repairs
Minor equipment
Pharmacy
Supplies
Training/travel/dues/licenses
Utilities
Total operating expenses
Operating income (loss) $
Operating income (loss) %
Non-operating revenue (expense)
Tax revenue
Interest income
Interest expense
Gain (loss) on disposal of capital assets
Total non-operating revenue - net
Excess of revenue over expenses
Total margin %
EBIDA $
EBIDA %
Capital grants and contributions - net
Increase (decrease) in unrestricted net position

14. Thayer County Health Services
Statements of Cash Flows
For the Nine Months Ended March 31, 2019 and 2018
March
Year-to-Date
Variance
Actual
Budget
Prior Year %
Increase in cash and cash equivalents:
Cash flows from operating activities:
Cash received from patients, third-party payers, and other operating revenue
Cash paid for employee compensation and fringe benefits
Cash paid to suppliers and contractors
Net cash provided by operating activities
Cash flows from noncapital financing activities:
Tax funds received
Noncapital grants and contributions received - net of fund-raising expense
Net cash provided by noncapital financing activities
Cash flows from capital and related financing activities:
Capital grants and contributions received
Capital expenditures
Principal payments on long-term debt and capital lease obligations
Proceeds from issuance of long-term debt
Proceeds from sale of capital assets
Interest paid - Net of amounts capitalized
Net cash used in capital and related financing activities
Cash flows from investing activities:
Interest received
Net investments in short-term investments
Net cash provided by (used in) investing activities
Net increase in cash and cash equivalents
Cash and cash equivalents at beginning
Cash and cash equivalents at end
Reconciliation of gain from operations to net cash provided by operating activities:
Income from operations
Adjustments to reconcile gain from operations to net cash provided by operating activities:
Depreciation and amortization
Provision for bad debts
Changes in operating assets and liabilities:
Patient accounts receivable
Other receivables
Inventories
Prepaid expenses and other assets
Amounts receivable from/payable to third-party reimbursement programs
Accounts payable
Accrued salaries, wages, paid time off, and benefits
Construction retainage payable
Unearned revenue
Total adjustments

15. Thayer County Health Services
Statements of Revenues, Expenses, and Changes in Net Position - Comparative by Month
For the Nine Months Ended March 31, 2019 and 2018
FY19 Actual Amounts
FY19 Budget Amounts
Prior Year Amounts
Patient service revenue
July
August
September
October
November
December
January
February
March
Total
YTD Mar
Annual
Inpatient
Outpatient
Home health revenue
Professional fees
Total patient service revenue
Deductions from revenue
Contractual adjustments
Administrative adjustments
Provision for bad debts
Charity care
Total deductions from revenue
Net patient service revenue $
Net patient service revenue %
Other operating revenue
Pharmacy revenue
340B revenue
EHR incentive
Other
Total other operating revenue
Total revenue
Operating expenses
Salaries and wages
Employee benefits
Management fee - CHI
Total compensation expense
340B expense
Contract services/professional fees
Depreciation & amortization
Equipment lease/rental
Insurance
Maintenance & repairs
Minor equipment
Pharmacy
Supplies
Training/travel/dues/licenses
Utilities
Total operating expenses
Operating income (loss) $
Operating income (loss) %
Non-operating revenue (expense)
Tax revenue
Interest income
Interest expense
Gain (loss) on disposal of capital assets
Total non-operating revenue - net
Excess of revenue over expenses
Total margin %
EBIDA $
EBIDA %
Capital grants and contributions - net
Increase (decrease) in unrestricted net position
Significant variance in current month from monthly trends

16. Thayer County Health Services
Statistical Graphs - Imaging
For the Nine Months Ended March 31, 2019

18. Questions & Answers
Doug Wismer’s contact information: Work – (402) Cell – (402)