TULARE LOCAL HEALTH CARE DISTRICT dba TULARE REGIONAL MEDICAL CENTER
Finance Committee Meeting
Tuesday, September 25, 2018, 6:30 PM.
TRMC Administrative Offices (Annex Lab Building, 2nd Floor)
869 North Cherry Street, Tulare, CA (Enter parking lot from Merritt Avenue)
Finance Committee Members: Mike Jamaica and Senovia Gutierrez
AGENDA

Call to Order:
0 Roll Call
a Welcome and Introductions

Public Comment: The public may comment on any item of public interest within the jurisdiction of the
Tulare Local Healthcare District Board of Directors. In the interest of time and equal opportunity,
speakers are requested to observe a 3?minute maximum time limit (subject to change at the Chair?s
direction). In accordance with the Brown Act, if a member of the public addresses an item not on the
posted agenda, no response, or action on the item may occur during the meeting.

Finance Committee - Review and Recommend the following for Board Approval:
0 June, 2018 Draft internal Financial Statements:
Comments, Balance Sheet, and Statement of Revenue and Expenses
AccountsReceivableUpdate
- Accounts Payable Update
- Supplemental Payment Recoveries Update
a Cash Report Update

0 Update on Adventist Health Line of Credit activities
a Financial Services Transition to Adventist Health Management Agreement Information only
. Other

0 Adjourn

 

Tulare Local Healthcare District dba Tulare Regional Medical Center

Agenda Item: CFO Reports

 

Board Meeting Date: September 26, 2018

June, 2018 Draft of Internal Statements: Balance Sheet and Statement of Revenue
and Expenses - Notes and Disclaimer:

The June Statement was prepared based on the following facts:

There has not been a financial audit of the Tulare Local Health Care District dba
Tulare Regional Medical Center's accounting books and records for the FYE June
30, 2017. As such, there are numerous items that we believe need to be adjusted
to the FYE 6/30/17 financial statements, and these will need to be addressed in?
depth at the time the District has an audit completed for these 2017 2018
periods.

In the meantime, and in order to close the books and prepare a draft statement
for the 12 months ended June 30, 2018 (FYE 2018), we have attempted to identify
adjustments that are allocable to the FYE 2017 statements, and simultaneously
identify those items that appear to be allocable to the FYE 2018 statements.

The premise that we used to develop these draft statements was to, as best could
be determined, adjust the respective Balance Sheet items for these months to the
most appropriate supportable documentation, bank statement balances,
gross accounts receivable and corresponding expected net collections, the latest
Supplemental Payment program estimates, and accounts payable invoices or
accruals for certain expenses.

As such, we are unable to make any conclusive representations as to the accuracy
or completeness of the Tulare Local Health Care District dba Tulare Regional
Medical Center June 30, 2018 Draft Internal Financial Statements. The FYE's 2017
and FYE 2018 books and records must be further analyzed, reconciled, and stated
in accordance with uniform and accepted accounting procedures, and audited by
an independent financial auditor.

Note: The audits for 2017 and 2018 have commenced in mid-September,
2018, and the reports are expected to be completed in November.

 

TULARE REGIONAL MEDICAL CENTER
Balance Sheet for the period ended 6130/2018
Unaudited - See Attached Notes and Disclaimer

 

 

 

 

 

KEY COMPONENTS (ONLY) Prior Month Current Month Last year Increase! Incl(Dec)
May June June (Decrease) percentage
Cash and cash equivalents $270,181 $2,993,731 $2,088,851 $904,879 43.3%
Gross pt accounts receivable 42,900,321 40,323,941 81,064,255 (40,740,314) 
Net pt accounts receivable 850,030 462,415 24,894,581 (24,432,166) 
Misc receivables 6,770,159 2,392,566 16,323,168 (13,930,602) 
Net capital assets 169,447,679 166,034,974 165,771,986 262,989 0.2%
TOTAL ASSETS $198,201,277 $192,409,361 $229,017,364 ($36,608,002) 
Accounts payable 37,362,077 39,004,084 19,675,741 19,328,343 98.2%
Est current 3rd party payor settlements 6,366,077 5,961,395 34,319 5,927,076 17270.5%
Debt borrowings, net of curr maturities 101,549,706 102,108,373 99,839,816 2,268,557 2.3%
TOTAL LIABILITIES 162,709,061 164,978,030 137,395,269 27,582,761 20.1%
Total net assets 35,492,215 27,431,331 91,622,094 (64,190,763) 
TOTAL LIABILITIES a NET ASSETS $198,201,276 $192,409,361 $229,017,363 ($36,608,002) 

 

 

TULARE REGIONAL MEDICAL CENTER
Balance Sheet for the period ended 613012018
Unaudited - See Attached Notes and Disclaimer

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Prior Month Current Month Last year Increase! Inc/(Dec)
May June June (Decrease) percentage
Current assets:
Cash and cash equivalents $270,181 $2,993,731 $2,088,851 $904,879 43.3%
use assets avail for curr debt 6,166,780 6,166,780 6,166,780 - 0.0%
Patient accounts receivable:
Gross pt accounts receivable 42,900,321 40,323,941 81,064,255 (40,740,314) 
Contractual allowances (32,370,466) (30,237,704) (54,242,881) 24,005,177 
Provision for bad debts charity (9,679,825) (9,623,822) (1,926,793) (7,697,028) 399.5%
Net pt accounts receivable 850,030 462,415 24,894,581 (24,432,166) 
Other receiv. 8: phys. advances
Tax revenue receivable 7,404,659 8,062,846 5,769,785 2,293,061 39.7%
Misc receivables 6,770,159 2,392,566 16,323,168 (13,930,602) 
Physician advances 13,604 12,291 267,700 (255,409) 
Total other receivables 14,188,422 10,467,703 22,360,653 (11,892,950) 
Inventories 1,156,500 110,756 1,170,647 (1,059,891) 
Prepaid expenses deposits 839,808 786,879 740,469 46,410 6.3%
Total current assets 23,471,721 20,988,264 57,421,981 (36,433,717) 
Assets limited as to use:
GO bond construction fund - - - - 0.0%
Restricted trust funds, other 4,830,936 4,935,182 5,372,456 (437,274) 
Total limited use assets 4,830,936 4,935,182 5,372,456 (437,274) 
Capital assets:
Land 8! land improvements 3,301,871 3,301,871 3,301,871 - 0.0%
improvements 45,382,391 45,634,689 45,382,391 252,298 0.6%
Leasehold improvements 607,391 607,391 607,391 - 0.0%
Major movable equipment 38,195,077 40,759,576 38,262,991 2,496,585 6.5%
Construction in progress 148,310,249 145,613,442 142,236,501 3,376,941 2.4%
Gross capital assets 235,796,979 235,916,969 229,791,145 6,125,824 2.7%
Accumulated depreciation (66,349,300) (69,881,995) (64,019,159) (5,862,835) 9.2%
Net capital assets 169,447,679 166,034,974 165,771,986 262,989 0.2%
Bond issuance costs 8: other assets 450,941 450,941 450,941 - 0.0%
Intercom pa ny receivable - - - - 0.0%
TOTAL ASSETS $198,201,277 $192,409,361 $229,017,364 ($36,608,002) 
Current liabilities:
Current maturities of debt borrowings $1,205,011 $1,175,398 $2,072,413 ($897,015) 
Accounts payable 37,362,077 39,004,084 19,675,741 19,328,343 98.2%
Other accrued liabilities 4,828,556 4,794,806 9,850,422 (5,055,616) 
Accrued payroll 8: related liabilities 147,492 183,110 - 183,110 0.0%
Est current 3rd party payer settlements 6,366,077 5,961,395 34,319 5,927,076 17270.5%
Self insurance program accrual 360,000 360,000 440,000 (80,000) 
Total current liabilities 50,269,213 51,478,793 32,072,895 19,405,899 60.5%
Long-term liabilities:
Deferred revenue 10,890,142 11,390,864 5,482,558 5,908,306 107.8%
Debi borrowings, Ilci. of cm. maturities 101,543,705 102,108,373 39,339,316 2,253,557 2.3%
TOTAL LIABILITIES 162,709,061 164,978,030 137,395,269 27,582,761 20.1%
Net assets:
Retained Earnings 61,008,603 53,275,638 95,877,940 (42,602,302) 
Increase in net assets (25,516,388) (25,844,307) (4,255,846) (21,588,461) 507.3%
Total net assets 35,492,215 27,431,331 91,622,094 (64,190,763) 
Intercom pany payable - - - 0.0%
TOTAL LIABILITIES a NET ASSETS $198,201,276 $192,409,361 $229,017,353 (536,608,002) (163%)

 

TULARE REGIONAL MEDICAL CENTER
Statement of revenue and expenditures
For the Twelth Months Ending Saturday, June 30, 2018
Unaudited - See Attached Notes Disclaimer

 

KEY COMPONENTS (ONLY) January February March April May June YTD FY18 YTD FY17
Total operating revenue I (85,206) 24,924 (1,419,066) (696,479) 59,262 1,140,828 11,751,028 71,364,705
Professional fees 733,032 706,624 554,975 528,729 498,942 485,616 6,731,696 7,283,568
Physicians fees 6,100 - - - - 2,220,974 6,301,287
Purchased services 312,671 269,322 354,615 319,842 375,595 322,569 5,143,951 11,414,565
Purchased HCCA Labor 0 - - - - (146,759) 13,635,335 39,993,337
Operating expenses be?ore 1,588,424 1,557,496 1,622,797 1,477,817 1,554,736 1,276,313 36,118,301 79,505,772
(1,673,630) (1,532,572) (3,041,863) (2,174,296) (1,495,474) (135,485) (24,367,273) (8,141,067)

Excess of revenues over expenses (1,522,088). (1,697,965) (3,099,311) (2,307,413) (1,934,196) (327,919) (25,844,307) (4,600,972)

Net patient revenue
Supplemental funds
Other operating revenue

Total operating revenue

Salaries 81 wages

Employee benefits
Professional fees
Professional fees, physicians
Supplies

Purchased services
Purchased HCCA Labor
Repairs 81 maintenance
Utilities 81 phone

Building 8: equipment rental
Insurance

Other operating expenses

Operating expenses before 


Depreciation 8: amortization
Property tax income
Investment income

Interest expense

Grants 81 contributions

Other income

Total other revenue/(expenses)

Excess of revenues over expenses

increase in net assets

TULARE REGIONAL MEDICAL CENTER
Statement of revenue and expenditures

For the Twelth Months Ending June 30. 2018
Unaudited - See Attached Notes 8. Disclaimer

 

 

 

 

 

July August September October November December January February March April May June YTD FY18 YTD FY17
E55408 $4,000,227 $2,977,039 ($4,142,461) ($76,297) ($3,079) $74,711 ($5,272) ($1,691,169) ($757,425) ($13,369) $364,645 $6,437,503 $53,453,314
1,254,200 1,254,200 697,350 (2,290,051) 212,141 2,322,055 (199,956) - - - - (73,353) 3,172,037 10,401,515
244,230 366,926 347,716 39,736 - 40,039 30,196 272,103 60,946 73,131 354,536 2,091,433 2,504,376
5,493,707 4,041,365 (6,034,796) 175,530 2,313,976 (35,206) 24,924 (1,419,066) (696,479) 59,262 1,140,323 11,751,023 71,364,705

- 5,543 - 93 - 110,137 139,222 254,713 316,730 230,977 223,369 196,046 1,532,445 0

. - - 7,134 46,979 13,935 103,996 31,947 30,964 112,176 457,130 (1)

391,421 607,690 493,303 512,355 369,363 643,640 733,032 706,624 554,975 523,729 493,942 435,616 6,731,696 7,233,563
111,275 643,439 554,215 526,435 (45,536) 19,946 6,100 - - - - 2,220,974 6,301,237
325,652 637,290 466,364 195,233 97,739 (39,633) 10,990 23,349 24,223 27,354 65,163 21,454 2,210,634 3,334,964
554,973 335,343 576,933 594,033 (53,904) 231,350 312,671 269,322 354,615 319,342 375,595 322,569 5,143,951 11,414,565
2,929,903 3,901,430 2,635,135 2,357,921 1,907,655 - 0 - - - - (146,759) 13,635,335 39,993,337
11,742 35,132 22,253 16,406 36,572 (7,061) 2,352 13,491 19,102 36,729 56,231 35,737 234,242 472,532
39,233 153,704 135,169 127,033 (45,002) 134,134 93,233 30,396 33,096 91,630 99,214 106,503 1,259,004 1,560,939
73,339 164,350 59,251 36,257 53,545 46,362 42,556 36,669 33,226 40,444 37,330 27,371 656,249 637,746
119,930 92,325 97,414 33,705 33,705 34,773 33,703 33,703 33,303 33,703 33,703 33,700 1,064,194 1,270,010
125,273 239,913 102,343 99,232 14,364 39,105 62,031 59,734 33,971 36,407 23,115 31,900 922,447 1,736,775
6, )82,745 7,471,274 5,243,440 4,543,363 2,419,006 1,275,337 1,533,424 1,557,496 1,622,797 1,477,317 1,554,736 1,276,313 36,113,301 79,505,772
593,637 (1,972,567) (1,201,575) (10,633,664) (2,243,426) 1,033,539 (1,673,630) (1,532,572) (3,041,363) (2,174,296) (1,495,474) (135,435) (24,367,273) (3,141,067)

115,5 66) (216,566) (216,566) (216,373) (210,562) (210,339) (210,339) (209,723) (207,731) (207,639) (207,576) (207,374) (2,537,515) (3,515,497)
145,090 145,090 151,023 (155,369) 429,009 645,693 154,239 154,239 132,330 157,466 157,466 157,466 2,324,397 6,317,915
29,152 22,650 9,747 (2,323) (203,799) (190,205) 269,162 (43,575) 12,327 (21,013) (329,633) (30,045) (437,561) 122,769
(63,940) (64,231) (61,766) (61,633) (61,539) (61,476) (61,520) (61,379) (45,424) (61,331) (53,979) (112,431) (776,356) (337,953(102,5401,055,401

106,264) (113,107) (117,562) (436,213) (51,941) 133,623 151,542 (165,393) (57,443) (133,117) (433,722) (192,434) (1,477,034) 3,540,095
592,423 (2,035,674) (1,319,137) (11,069,377) (2,295,367) 1,222,217 (1,522,033) (1,697,965) (3,099,311) (2,307,413) (1,934,196) (327,919) (25,344,307) (4,600,972)
3592.423 ($2,035,674) ($1,319,137) ($11,069,377) ($2,295,367) $1,222,217 ($1,522,033) ($1,697,965) ($3,099,311) ($2,307,413) ($1,934,196) ($327,919) ($25,844,307) ($4,600,972)

 

WULARE REGIONAL MEDICAL CENTER
AGED TRIAL BALANCE (CERNER HOSPITAL AND CLINIC ONLY, NO CREDITS)

AS OF JUNE 30, 2018

Total Est
Unbilled Est Cash 241-270 Est Cash 271:365 Est Cash 366+ Cash Grand Total

   
     

 

 

 

 

 

 

 

 

Commercial Contracted 97,539 0 846,595 39,745 697,807" 16,194 1,028,681 55,939 2,670,622
Commercial Insurance 20,936 0 215,042 7,137 259,586 4,535 470,341 11,672 965,905
Medi-Cal 164,674 22,378 401,280 56,230 531,572 24,109 1,890,919 102,717 2,988,446
Medi?C-al Managed Care 126,502 0 1,994,116 57,198 1,744,073 19,742 2,277,718 76,940 6,142,409
Medic-are 605,805 29,129 341,827 70,781 309,898 17,238 782,341 117,148 2,039,871
Medic-are Advantage 68,147 0 274,783 4,835 319,225 2,759 1,881,112 7,594 2,543,267
Self Pay 120,181 3,846 1,189,929 4,681 1,498,859 2,938 7,082,043 11,465 9,891,012
Workers Compensation 3,958 1,533 39,919 1,901 76,074 6,510 25,822 9,944 145,773

 

  

     

 

   

   

      
    

     

Grand Total "1,207,743 55,385 5,303,491 242,510 5,437,093 15,433,979 393,419 27,337,305

   

   
 

  
   

   
  

 

 

 

 

 

 

 

 

 

 

Commercial Contracted 110,725 0 780,027 18,196 1,161,718 18,196 2,052,470
Commercial Insurance 15,219 0 172,130 3,261 547,208 3,261 734,557
Medi?Cal 120,386 5,968 427,868 19,367 1,123,861 25,335 1,672,114
Medi-Cal Managed Care 145,399 2,155,588 30,079 3,987,819 30,083 6,288,807
Medicare 679,425 46,997 313,672 17,239 954,135 64,237 1,947,232
Medicare Advantage 109,067 302,482 2,564 2,043,646 2,564 2,455,196
Self Pay 119,481 1,521,665 3,043 8,131,179 6,867 9,772,325
Workers Compensation 5,588 2,164 38,021 3,571 69,768 5,734 113,377

   
 

 

 

 

TU LARE REGIONAL MEDICAL CENTER

Summary of Accounts Dayables as of September 21, 2018

 

 

 

 

 

 

 

 

 

TRMC date range:

Vendors 0-30 31-60 61-90 91?120 +121 Accrued Payable as of September 30, 2018 Grand Total
Post-Petition 256,716.98 40,086.36 866,532.16 660,013.56 6,027,986.33 7,851,335.39
pre-pe?tion 27,853,897.10 27,85 3,897.10
Accrued Payable as of September 30, 2018 450,000.00 450,000.00
Grand Total 256,716.98 40,086.36 866,532.16 660,013.56 $3,881,883.43 450,000.00 36,155,232.49

 

 

Page 1 of 1

 

September 21, 2018

 

 

 

 

Tulare Regional Medical Center

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Government Reporting Estimated
Updated as of: Impact 
8/24/2018 Date At Risk

Report FPE Filed (Millions)
A8915 FY14 (100% ACA) 6/30/2014 3/29/2018 0.150
A8915 FY15 (100% ACA) 6/30/2015 3/8/2018 0.202
A8915 FY16 (100% ACA) 6/30/2016 12/28/2017 0.201
A8915 FY17 (100% ACA and non-ACA) 6/30/2017 3/15/2018 0.958
DSH Survey FY13-14 6/30/2014 2.370
DSH Survey FY14-15 6/30/2015 4/30/2018 3.168
DSH Survey FY17-18 - MMCS Days Validation 6/30/2016 8/17/2018
Earlimart RHC - Medicare CR FY17 6/30/2017 7/30/2018 -
Earlimart RHC - Medicare CR FY18 (Short Period) 10/29/2017 7/30/2018 
Medi-Cal Cost Report FY17 6/30/2017 7/10/2018 -
Medi-Cal Cost Report FY18 (Short Period) 10/29/2017 -
Medicare Cost Report FY15 Desk Review 6/30/2015 2/28/2018 0.050
Debts) 6/30/2016
Medicare Cost Report FY16 Desk Review 6/30/2016 8/10/2018 0.942
Medicare Cost Report FY17 6/30/2017 2/1/2018 (0.314)
Debts) I 6/30/2017 4/9/2018 0.381
Medicare Cost Report FY18 (Short Period) 10/29/2017 5/31/2018 0.102
Amended (Bad Derbts) I 10/29/2017
OSHPD Annual FY 17 6/30/2017 1/31/2018 
OSHPD Annual FY18 (Short Period) 10/29/2017 8/9/2018 
OSHPD Annual Utilization Report (AUR) FY17 12/31/2017 6/7/2018 -
OSHPD Qtly 093017 9/30/2017 1/12/2018 
OSHPD Qtly 123117 (Short Period) 10/29/2017 3/25/2018 
PPS Recon FY15 (Hillman) - DHCS Audit 6/30/2015
PPS Recon FY16 (Kingsburg) 6/30/2016 NA 
PPS Recons FY17 (Hillman, Earlimart, Lindsay) 6/30/2017
Rate Range IGT (RRIGT) 17-18
State Controllers Office - Govt Compensation 12/31/2017 8/7/2018 
State Controllers Report I 6/30/2017 2/8/2018 I -

8.210

 

 

 

 

 

 

 

 

 

 

TULARE REGIONAL MEDICAL CENTER Updated: 9/20/2018 Total
CASH RECEIPTS AND DISHURSEMENTS from
7/13 7/20 7/27 8/3 8/10 8/17 8/24 8/31 9/7 9/14 12/01/17
CASH IN
Receipts 51,898 106,247 124,424 62,646 53,791 42,066 32,627 24,366 60,445 29,521 3,141,525
DSH Payment (570,235)
Property Taxes 77,187 1,889,588
Property Rentals and Evolutions 0 22,263 50,700 0 31,017 947 661 25,178 0 9,318 217,430
Short Term Loans (332,637) 0 0 (10,352)
Supplemental - 597,785 0 0 0 0 2,322,001
Supplemental - HQAF, Et602,952 0 0 2,697,652
Payments Excluded frorr AH LOC 0 0 0 0 (46,456) 0 (243,093) (241,519) 0 0 (531,068)
Other Extraordinary Receipts 0 0 0 0 4,159 0 0 0 0 0 313,298
Adventist Health Line of Credit 0 0 0 0 932,894 176,310 434,260 775,117 393,001 402,117 3,113,699
Total Cash in 129,085 128,510 175,125 62,646 975,406 817,108 224,454 853,456 453,446 440,956 12,583,538
EXPENSES
Revenue Bonds 0 0 0 0 103,179 0 0 0 103,179 0 412,716
Payroll 8: Related Expen::es 0 93,794 68,954 117,178 110,461 0 153,742 37,097 115,192 486 2,684,706
Insurance 149,085 0 14,992 992 67,546 0 0 14,992 0 67,546 1,229,225
Utilities/Phone/Internet 4,604 80,301 42,624 0 4,892 0 137,204 981 12,302 3,126 1,103,051
Legal/ Bankruptcy Counsel 0 0 0 0 150,000 0 0 150,000 0 0 1,075,000
Consulting Purchased Services 15,000 0 37,354 0 412,797 20,000 0 391,785 0 20,000 2,205,078
Physicians Software Fees 83,168 0 125,751
Supplies - Medical 1,283 64,789 66,072
Leases and Rentals 0 0 7,999 41,852 4,880 2,592 4,410 0 8,568 0 179,093
IGT Advances 443,483
Third Party Payments 48,026
Other 50,441 47,264 38,281 48,028 43,332 64,996 140,528 43,965 26,442 41,141 1,614,426
Post-Petition Expense Catch-up 0 0 0 0 0 10,000 0 68,543 20,725 42,932 142,200
Assumed Liabilities, Pre 31 Post 0 0 0 0 37,475 12,460 0 0 0 0 49,935
Start-up Repairs 0 0 0 0 0 69,611 715 0 48,680 161,200 280,205
Total Expense 219,130 221,358 210,204 208,049 934,561 179,659 436,599 707,363 419,537 401,219 11,658,968
Difference (90,045) (92,848) (35,079) (145,403) 40,845 637,449 (212,145) 146,094 33,909 39,737 924,570
Cash Balance Forward 512,011 419,163 384,084 238,681 279,526 916,975 704,831 850,924 884,833 924,570

 

NOTE: $784,664 of Build America Bonds funds were received by the District in February, 2018 and in July, 2018 and were paid to Tulare County Tax Assessor.
These have bee-1 removed from this report as these are not District funds.