budgeting final

12
6. Wish records supplies using the FIFO method. Assuming that there has been an average rate of inflation of 2.5 percent in recent years, if Wish used LIFO would they have reported a higher or lower increase in net assets than they did using FIFO? 7. In their notes, Wish indicates that it performs eight functions, listed below. Which of these eight qualify as program services, as opposed to support services? a. Wish granting b. Chapter support c. Program-related support ..d. Committee and board support e. Training and development f. Public information g. Fund-raising h. Management and general 8. Wish had a decrease in net assets for the year ending August 31, 2002. Would you say that a sizeable portion of that decrease resulted from stock market losses on Wish's investment portfo- lio?Explain. 9. Did the amount of land Wish owned increase or decrease during the year ending August 31, 2002? How do you know? 10. How much did permanently restricted net assets change during the year ending August 31, 2002? How much of the temporarily restricted net assets as of August 31, 2002 are restricted for the specific purpose of yvish fulfillment? 11. Does Wish include any provision (I.e., liability) for lawsuits in its financial statements? How do you know? 12. What is the Program Services Expense Ratio for Wish for the year ending August 31, 2002? 13. What were fund-raising costs, as a percent of total revenue and other support, for the years ending August 31, 2002 and 2001? Case Study Problem 14-13. For the Major Medical Center financial statements on the following pages, complete the following: ai Read the auditor's opinion letter. Are any flags raised? b. Review the financial statements. Search for unusual items. What things catch your eye on the balance sheet, operating statement, and cash flow statement? c. Review the notes. Do any of them raise cause for concern? Chapter 14 • Financial Statement Analysis 557 14. a. What percent did Program Service Expenses grow from 2001 to 2002? b. What percent did Support Service Expenses grow from 2001 to 2002? c. Which is growing at a faster rate, Program Service Expenses or Support Service Expenses? 15. Did Wish meet any donor restrictions during the year ending August 31, 2002, allowing restricted contributions to become unrestricted? If so, how much? 16. What is the unrestricted total margin for the year ending August 31, 2002? 17. From the combined statement of cash flows we see that the change in contributions receivable required a negative adjustment of $710,659 for the year ending August 31,2002. How would you interpret this adjustment? Explain. 18. Cash used for investing activities was over $9 mil- lion. Should we be concerned with this cash decrease? Why or why not? i9. Looking at Wish's assets on the combined statements of financial position, would you consider investments to be short-term or long- term? Why? 20. Assuming that the obli~ation to international affil- iates is short-term, and deferred rent islong-term, what is the.current""ratio for 2002? .. 21. What is the ratio of total debt to equity for 2002? 22. Based on your calculation of total margin, current ratio, and debt to equity, in Questions 16, 20," and 21, and your overall review of the financial statements and notes of Wish, how would you categorize their financial position?"Circle just one .. answer. a._Weak b. Neutral c. Strong 23. What is your overall assessment of the finances ofWish? d. Calculate the following ratios: common size, current, quick, days of cash on hand, receiv- abies turnover, average collection period, fixed asset turnover, total asset turnover, debt, debt to equity, times-interest-earned, operating margin, total margin, ROA, and RONA. e. What do you think of Major Medical Center's financial status?

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Page 1: Budgeting Final

6. Wish records supplies using the FIFO method.Assuming that there has been an average rate ofinflation of 2.5 percent in recent years, if Wishused LIFO would they have reported a higheror lower increase in net assets than they didusing FIFO?

7. In their notes, Wish indicates that it performseight functions, listed below. Which of theseeight qualify as program services, as opposed tosupport services?a. Wish grantingb. Chapter supportc. Program-related support..d. Committee and board supporte. Training and developmentf. Public informationg. Fund-raisingh. Management and general

8. Wish had a decrease in net assets for the yearending August 31, 2002. Would you say that asizeable portion of that decrease resulted fromstock market losses on Wish's investment portfo-lio? Explain.

9. Did the amount of land Wish owned increase ordecrease during the year ending August 31, 2002?How do you know?

10. How much did permanently restricted netassets change during the year ending August31, 2002? How much of the temporarilyrestricted net assets as of August 31, 2002 arerestricted for the specific purpose of yvishfulfillment?

11. Does Wish include any provision (I.e., liability)for lawsuits in its financial statements? How doyou know?

12. What is the Program Services Expense Ratio forWish for the year ending August 31, 2002?

13. What were fund-raising costs, as a percent oftotal revenue and other support, for the yearsending August 31, 2002 and 2001?

Case Study Problem

14-13. For the Major Medical Center financial statements onthe following pages, complete the following:ai Read the auditor's opinion letter. Are any flagsraised?

b. Review the financial statements. Search for unusualitems. What things catch your eye on the balancesheet, operating statement, and cash flow statement?

c. Review the notes. Do any of them raise cause forconcern?

Chapter 14 • Financial Statement Analysis 557

14. a. What percent did Program Service Expensesgrow from 2001 to 2002?

b. What percent did Support Service Expensesgrow from 2001 to 2002?

c. Which is growing at a faster rate, ProgramService Expenses or Support Service Expenses?

15. Did Wish meet any donor restrictions during theyear ending August 31, 2002, allowing restrictedcontributions to become unrestricted? If so, howmuch?

16. What is the unrestricted total margin for the yearending August 31, 2002?

17. From the combined statement of cash flows wesee that the change in contributions receivablerequired a negative adjustment of $710,659 forthe year ending August 31,2002. How would youinterpret this adjustment? Explain.

18. Cash used for investing activities was over $9 mil-lion. Should we be concerned with this cashdecrease? Why or why not?

i9. Looking at Wish's assets on the combinedstatements of financial position, would youconsider investments to be short-term or long-term? Why?

20. Assuming that the obli~ation to international affil-iates is short-term, and deferred rent is long-term,what is the.current""ratio for 2002? ..

21. What is the ratio of total debt to equity for2002?

22. Based on your calculation of total margin, currentratio, and debt to equity, in Questions 16, 20,"and 21, and your overall review of the financialstatements and notes of Wish, how would youcategorize their financial position?" Circle just one ..answer.a._Weakb. Neutralc. Strong

23. What is your overall assessment of the financesof Wish?

d. Calculate the following ratios: common size,current, quick, days of cash on hand, receiv-abies turnover, average collection period, fixedasset turnover, total asset turnover, debt, debt toequity, times-interest-earned, operating margin,total margin, ROA, and RONA.

e. What do you think of Major Medical Center'sfinancial status?

Page 2: Budgeting Final

558 Part V • FinancialAnalysis

10 Major Medical Center and Hospital Support, Inc. are fictional organizations. Any similarity'to real organizations ispurely coincidental.

IN SINGER AND OLD, GPAsApril 30, 2013

.CASE STUDYMajor Medical Center10

IN SINGER AND OLD, GPAs2650 East 38th StreetNew York, New York 10089

Report of Independent Auditors

Board of TrusteesMajor Medical CenterWe have audited the accompanying statements of financial position of Major Medical Center(the "Medical Center") as of December 31, 2012 and 2011, and the related statements ofoperations, changes in net assets, and cash flows for the years then ended. These financialstatements are the responsibility of xhe Medical Center's management. Our responsibility isto express an opinion on these financial statements based on our audits, .

W~ conducted our audits in accordance with generally accepted auditing standards.Those standards require that we plan and perform the audit to obtain reasonable assur-ance about whether the financial statements are free of material misstatement. An auditincludes examining, on a test basis, evidence supporting the amounts and disclosures inthe financial statements. An audit also includes assessing the accounting principles usedand significant estimates made by management, as well as evaluating the overall financial.statement presentation. We believe that our audits provide a reasonable basis for ouropinion.

In our opinion, the financial statements referred to above present fairly, in all materialrespects, the financial position of Major Medical Center at December 31, 2012 and 2011, andthe results of its operations, changes in net assets, and cash flows for the years then ended,in conformity with generally accepted accounting principles.

Page 3: Budgeting Final

•I~

'.

Chapter 14 • Financial Statement Analysis . 559

Major Medical CenterStatements of Financial Position

December 31

2012 2011

(In Thousands)

AssetsCurrent Assets

Cash and cash equivalentsAssets limited as to use-compensating balance for letters

of creditShort-term investmentsReceivables for patient care, net of allowance for

doubtful accounts (2012-$27,232; 2011-$31,934)Pledges receivableInventories, at average costDue from third-party reimbursement programsReceivables for government grantsOtherTotal Current Assets

Assets limited as to use:Sinking fundCompensating balance for standby letters of credit

Long-term investmentsDue from affiliates, netPledges receivable, net of allowance for uncollectible pledges

(2012-$2,218; 2011-$4,453)Property, plant, and equipment netDeferred financing costsOther

Liabilitiesand Net AssetsCurrent Liabilities

Current portion of long-term debtAccounts payable and accrued expensesAccrued salaries and related liabilitiesDue to third-party reimbursement programs, netAdvances on government grantsTotal Current Liabilities

long-term debt, less current portionAccrued post-retirement benefitsOther noncurrent liabilitiesTotal LiabilitiesCommitments and contingenciesNet Assets

UnrestrictedTemporarily restrictedPermanently restrictedTotal Net Assets

See accompanying notes.

(

}I

Page 4: Budgeting Final

See accompanying notes.

560 Part V • Financial Analysis

•l!,..

$1,132

196,45344,860117,83818,8562,2145,253

385,474751146

$ 897

2011

$369,512 .13,8502,863

386,225

PermanentlyRestricted

(In Thousands)

(4,708)(139)-m

$ 8,262

Year ended December 31

7,253252

(2,863)~.

4,4967,519

5,421169

207,14144,456137,50522,5412,4574,456

418,5562,429139

$ 2,568

2012

$402,92113,3564,708

420,985

Net Assets

TemporarilyRestricted

(In Thousands)

$ 3,023

89738,0142,568

2,568$40,582

$37,117897

Unrestricted

Net Assets at December 31, 2010Increase in unrestricted net assetsRestricted contributions, grants, and other receiptsInvestment income restricted for specific purposesNet assets released from restrictions for:Operating expensesCapital asset acquisitions

Change in net assetsNet Assets at December 31, 2011Increase in unrestricted net assetsRestricted contributions, grants, and other receiptsInvestment income restricted for specific purposesNet assets released from restrictions for:Operating expensesCapital asset acquisitions

Change in net assetsNet Assets on December 31, 2012

See accompanying notes.

Major Medical CenterStatements of Operations

Major Medical CenterStatements of Changes in Net Assets

Operating RevenueNet patient service revenueOther revenueNet assets released from restrictionsTotal Operating Revenue

Operating ExpensesSalaries and wagesEmployee benefitsSupplies and expensesDepreciation and amortizationResearchInterestTotal Operating Expenses

Operating IncomeNet assets released from restrictions used for capital acquisitionsIncrease in unrestricted net assets

Page 5: Budgeting Final

Chapter 14 • Financial Statement Analysis 561

Major Medical Center-Statements of Cash Flows

Year Ended December 31

Operating ActivitiesOperating incomeChange in temporarily restricted'net assets

Adjustments to reconcile change in net assetsto cash provided by operations:Depreciation and amortizationInvestment income earned on assets limited as to useChanges in operating assetsand liabilities:(Increase) decrease in receivables for patient care(Increase) decrease in due from third-party reimburseme!1t programsIncrease in accounts payable and accrued expenses and accruedsalaries and related liabilities

Net effect of increasesand decreases in other assets and liabilitiesCash provided by operations

Investing ActivitiesAcquisitions of property, plant, and equipment, netLessamounts provided by restricted funds

Increase in investmentsCash used in investing activities

Financing ActivitiesNet payment from (to) affiliatesIncrease in deferred financing costsRepayments of long-term debtDeposits into sinking fund, as required by mortgage loan agreementIncrease in compensating balances for standby letters of credit(Increase) decrease in pledges receivableCash used in financing activitiesNet (decrease) increase in cash and cash equivalentsCash and cash equivalents at beginning of yearCash and cash equivalents at end of year

2012 2011

(In Thousands)""

$ 2,429 $ 751743 4,496

3,172 5,247

22,541 18,856(774) (698)

(2,105) 7,589(8,413) 4,500

9,654 1,4122,286 (8,707)26,361 28,199

(10,043) (12,998)139 146(618) (70)

(10,522) (12,922)

126 (1,773)(1,323)(13,326) (9,510)

(303)(1,923)

(30) (3,190)(16,779) (14,473) ,

(940) 8049,005 8,201

$ 8,065 $ 9,005

See accompanying nbtes,

Notes to Financial Statements1. Organization and Summary of Significant Accounting Policies

OrganizationMajor Medical Center (the "Medical Center") is a not-for-profit corporation, The Medical'Center provides health, care and related services, The accompanying financial statementsdo not include the accounts of the Research Foundation, a not-for-profit corporation thatsolicits funds and awards grants to the Medical Center for research purposes, nor forHospital Support, Inc., which provides certain support services.

Temporarily and Permanently Restricted Net AssetsTemporarily restricted net assets are those whose use by the Medical Center has been limit-ed by donors to a specific time period or purpose. Permanently restricted n~t assets have

Page 6: Budgeting Final

562 Part V • Financial Analysis

Assets Limited as to. UseAssets classified as limited as to use represent assets whose use is restricted for specificpurposes under terms of agreements.

(2,218)

~

$1,8143,145962

5,921

Lessallowance foruncollectible pledges receivable

Lessthan one yearOne year to five yearsIn excessof five years

PledgesUnconditional promises to give cash and other assets are reported at their net present valueat the date the promise is received. The gifts are reported as either temporarily or perma-nently restricted support if they are received with donor stipulations that limit the useof thedonated assets. Pledges receivable, discounted at 10 percent, are expected to be paid as

follows (in thousands):

Property, Plant, and EquipmentProperty, plant, and equipment purchased are carried at cost, and those acquired by gifts andbequests are carried at appraised or fair market value established at the date of acquisition.Capitalized leases are recorded at the fair market value at the inception of the leases. The carry-ing amounts of assets and the related accumulated depreciation are removed from the accountswhen such assets are disposed of, and any resulting gain or loss is included in operations.Depreciation of assets used in operations is recorded on the straight-line method over theestimated usefulliyes of the assets. Capitalized leases are amortized over the lease term.

Investment Gains, Losses, and IncomeInvestment income, which includes real gains and losses, earned on permanently restrictedand temporarily restricted funds upon which restrictions have been placed by donors, isadded to temporarily restricted funds. All other investment income is reflected in the accom-panying statements of operations.

Receivables for Patient CarePatient accounts receivable from third-party programs for which the Medical Center receivespayment under reimbursement formulas or negotiated rates are stated at the estimated netamounts receivable from such payors, which are generally less than the established charges

of the Medical Center.

InvestmentsInvestments consist of u.s. Treasury bonds and notes, certificates of deposit, and money mar-ket funds. Investments are carried at fair value. Amounts classified as long-term investments,consisting primarily of money market funds, represent permanently restricted net assets.

been restricted by donors to be maintained by the Medical Center in perpetuity. When adonor restriction expires (i.e., when a stipulated time restriction ends or purpose restrictionis accomplished), temporarily restricted net assets are reclassified as unrestricted net assetsand reported in the statements of operations as net assets released from restrictions. Donor-restricted contributions whose restrictions are met within the same year as received arereflected as temporarily restricted contributions and net assets released from restrictions inthe accompanying financial statements.

r

Page 7: Budgeting Final

1',,.,',

I

II

I~~

I

Chapter 14 • Financial StatementAnalysis 563

Accrued Post-Retirement Benefits 'The Medical Center accounts for post-retirement health care and life insurance benefits onthe accrual basis of accounting,

Uncompensated CareAs a matter of policy, the Medical Center provides significant amounts of partially or totallyuncompensated patient care., For accounting purposes, such uncompensated care is treatedeither as charity care or bad debt expense. The Medical Center has defined charity care foraccounting and disclosure purposes as the difference between its customary charges andthe sliding scale rates given to patients in need of financial assistance. Since payment of thisdifference is not sought, charity care allowances are not reported as revenue. Patients whodo not qualify for sliding scale fees and all uninsured inpatients who do not qualify forMedicaid assistance are billed at the Medical Center's full rates. Uncollected balancesfor these patients are categorized as bad debts. Total uncompensated care for all patientservices approximated $22 million and $20 million in 2012 and 2011, respectively.

Use of EstimatesThe preparation of financial statements in conformity with generally accepted accountingprinciples requires management to make estimates and assumptions that affect the reportedamount of assets and liabilities and the disclosure of contingent assets and liabilities at thedate of the financial statements. Estimates also affect the reported amounts of revenue. andexpenses during the repoiting period. Actual results could differ from these estimates.Management believes that the amounts. recorded based on estimates and assumptions arereasonable, and any differences between estimates and actual should not have a materialimpact on the Medical Center's financial position. '

Operating IncomeTransactions deemed by management to be ongoing, major, or central to the provision ofhealth care services are reported as operating revenue and expenses, and are included inoperating income. Operating income also includes investment income and realized gainsand losses from the sale of investments.

Tax StatusThe Medical Center is exempt from federal income taxes under Section 501(c)(3) of theInternal Revenue Code. The Medical Center has been classified as an organization that is nota private foundation under Section 509(a)(l). Contributions received by the Medical Centerqualify as tax-deductible charitable contributions.

2. Third-Party Reimbursement Programs

The Medical Center has agreements with third-party payers that provide for payments to theMedical Center at amounts different .from its established charges. Payment arrangementsinclude prospectively determined rates per discharge, reimbursement of costs, discountedcharges, and per diem payments. Patient service revenue is recorded at the Medical Center'sestablished charges when patient services are performed. Adjustments for differencesbetween established charges and payment amounts are deducted directly from receivablesfor patient care and patient service revenue in the year incurred.

Federal and state regulations provide for certain retrospective adjustments to current andprior years' payment rates based on industrywide and hospital-specific data. The MedicalCenter has estimated the potential impact of such retrospective adjustments based on informa-tion presently available, and adjustments are accrued on an estimated basis in the period theservices are rendered and are adjusted in future periods as final settlements are determined. 'Management believes that amounts recorded in the accompanying financial statements willnot be materially affected upon the final settlement of such retrospective adjustments.

Page 8: Budgeting Final

4. Property, Plant, and Equipment

A summary of property, plant, and equipment is as follows at December 31:

Approximately $45,673,000 and $45,706,000 of fully depreciated assets are included inbuildings and equipment at December 31, 2012 and 2011, respectively. Substantially allproperty, plant, and equipment is pledged as collateral under various loan agreements.

Hospitals are reimbursed for Medicare inpatient services under the national IJIU:>lJCe-

tive payment system ("PPS") and other methodologies of the Medicare program for patient.services. Such Medicare payments are based on a blend of national industry and hospital-specific data. The Medicaid program pays rates determined by the state, primarily on abasis of prospectively determined rates per discharg~. The Medical Center is paid bynon-Medicare/Medicaid payers based on negotiated contract amounts or, if such contractsdo not exist, at th~ Medical Center's established charges. In addition, the state has requesteda waiver from the federal government that will allow it to enroll substantially all of itsMedicaid participants into Medicaid managed care programs. The ultimate outcome andeffect of these changes and proposals on the Medical Center's future operations cannotpresently be determined. In 2012, net revenue from the Medicare and Medicaid programsaccounted for 44 percent and 23 percent, respectively, of total net patient service revenue.

3. Assets Limited as to Use

A summary of assets limited as to use is as follows at December 31: .

13,16113,410

$ 249

$13,410

5821,341

2012 2011

(In Thousands)

14,21114,487

1,923$16,410

$ 276

2012 2011

(In Thousands)

$ 4,980 $ 4,980

58,827 58,827164,592 140,707228,399 204,514141,502125, l4886,897 79,36611,658 10,411$98,555 $89,777

Sinking Funds:Cash and cash equivalentsU.s. government andagency obligations

Total Sinking FundsCollateral for Standby Letters'of Credit:Cash and cash equivalentsCorporate bonds

Total Collateral forStandbyLetters of Credit

TotalAssets Limited as to Use

Projects in progress

LandBuildingsEquipment

Lessaccumulated depreciation

Page 9: Budgeting Final

Chapter 14 • Financial Statement Analysis '565

Capitalized equipment leases, induded in property, plant, and equipment, are as follows atDecember 31:

2012 2011(In Thousands)

5. Long-Term Debt

A summary of long-term debt is as follows at December 31:

2012 2011(In Thousands)

FHA Section 242 insuredmortgage loan (a) $20,865 $

FHA Section 241mortgage loan (a) 10,941 12,125

2005 mortgage loan (b) 2,216 2,7581998 insured mortgage loan (a) 15,492Various mortgages, havinginterest rates ranging from 3.5%to 10.0%, maturing at variousdates through 2008 2,020 2,892

Capitalized leases (c) 31,105 25,93067,147 59,197

Lesscurrent portion 11,608 11,488) $55,539 $47,709

Assets recorded undercapital leases

Lessaccumulated amortization$67,43435,911$31,523

$51,69527,108$24,587 f

jI,j',

!VI[;!~:

I,

a. As a condition of these borrowings, the Medical Center is required to establish and main-tain a sinking fund. Amounts deposited into the sinking fund, together with investmentearnings therein, are available for principal payments and purchases of specified levels ofcapital assets. Assets on deposit in the sinking fund at December 31, 2012 and 2011, arein compliance with the required amCiunts.

b. Annual principal payments for all long-term debt, excluding capital leases and requiredsinking fund balances for the next five years, are as follows:

20132014201520162017

PrincipalPayments

$2,7894,6884,1574,0893,746

RequiredSinking Fund

Balance

(In Thousands)

$15,46114,93714,16213,12911,831

Page 10: Budgeting Final

c. Future minimum payments, by year and in the aggregate, under capitalized leases consist-ed of the following at December 31, 2012 (in thousands):

Advances on government grants of $1,587,000 at December 31, 2012, as reflected in theaccompanying statement of financial position, represent amounts received from the grantingagencies in excess of claims made at that date. The receivable amount of $467,000 atDecember 31, 2011, represents claims made in excess of advances received from the grantingagencies at that date.

9. Professional Liability Insurance

The Medical Center participates in a pooled program with certain other health care facilities(principally medical centers) for professional liability insurance. This participation is with

6. Retirement and Similar Benefits

The Medical Center provides retirement and similar benefits to its union employees throughseveral defined benefit multi-employer pension plans and to its nonunion employees through anoncontributory defined benefit pension plan and tax-deferred annuity plans. Payments to thedefined benefit multi-empioyer union plans are made in accordance with contractual arrange-ments under which contributions are generally based on gross salaries and are funded on a cur-rent basis. The Medical Center contributes amounts to the nonunion plan sufficient to meet theminimum funding requirements. set forth in the Employee Retirement Income Security Act of1974. The Medical Center's pension expense under all existing plans aggregated approximately$10,202,000 and $10,683,000 for the years ended December 31, 2012 and 2011, respectively.

7~ Other Post-Retirement Benefits

In addition to the pension plans and the tax-sheltered annuity plans described in Note 6, the •.Medical Center sponsors a defined benefit health care plan that provides post-retirementmedical, dental, and life insurance benefits to certain full-time employees hired prior to July1,2004, and who have worked 10 years and attained age 65 while in service with the MedicalCenter. The plan contains cost-sharing features such as deductibles and coinsurance.

Effective in May 2012, the Medical Center changed the type of the plan from basic hospi-\ .tal plus major medical to a point-of-service plan for nonunion employees. The effects of thischange have been reflected in the actuary's calculation for the plan year ended December 31,2012. At the end of 2012 and 2011, the accrued post-retirement benefit cost was $6,023,000and $6,017,000, respectively. As of December 31, 2012 and 2011, the plan was unfunded.

8. Government. Grants

The Medical Center receives grants from various government agencies. For the contractyears ending June 30, 2013, 2014, and 2015, these grant awards are as follows:

$11,1029,8528)044,7441,518850

36,270(5,165)

$31,105

Amount(In Thousands)

$3,7913,5133,765

20132014201520162017

ThereafterTotal minimum lease payments

Less amounts representing interestPresent value of lease payments

Contract YearEnding June 30:

201320142015

Page 11: Budgeting Final

Chapter 14 • Financial Statement Analysis 567

captive insurance companies and, with the other health care facilities, in a pooled layer foradditional insurance with commercial insurance companies.

During 2011, the Medical Center had an aggregate deposit of $2,000,000 with two of thecaptive insurance companies. During 2012, these deposits were replaced with two letters ofcredit of $1,000,000 each. The deposits were included in other current assets in the accom-panying 2011 statement of financial position.

Malpractice claims in excess of insurance coverage have been asserted against the MedicalCenter by various claimants. The claims are in various stages of processing, and some may ulti-mately be brought to trial. Medical Center management and counsel are unable to concludeabout the ultimate outcome of the actions. There are known incidents occurring throughDecember 31, 2012, that may result in the assertion oF'additional claims, and other claims maybe asserted arising from services provided to patients in the past. It is the opinion of MedicalCenter management, based on prior experience, that adequate insurance is maintained to cover

all significant professional liability losses,

10. Transactions with AffiliatesThe amounts. due from affiliates in the accompanying statements of financial position atDecember 31, 2012 and 2011, include a $1,900,000 loan receivable and accrued interestthereon from Hospital Support, Inc. The loan, which does not have specified repaymentterms, bears interest at the prime rate, which approximated 7.75 percent at December 31,

2012 and 2011.

11. Tempora"rily and Permanently Restricted Net Assets

Temporarily restricted net assets are available for the following purposes at DJ~cember 31:

2012 2011

(In Thousands)

Research and educationPlant replacement and expansion

$ 8177,445$8,262=

$2,5025,017$7,519

Permanently restricted net assets at both December 31, 2012 and 2011, consist of invest-ments to be held in perpetuity and whose income is restricted as to use.

12. Other Operating Revenue

Other operating revenue consisted of the following for the year ended December 31:

2012 2011

Government grantincomeReal estate rentalsInvestment income and gainson sale of investments

Faculty practice and researchoverhead

Dining room and parkinglot income

Grants and contributionsOther

(In Thousands)

$ 1,668 $ 5,0532,838 2,651

1,077 1,044

5,703 2,079

996 958343 499731 1,566

$13,356 $13,850

Page 12: Budgeting Final

568 Part V • Financial Analysis

13. Concentration of Credit Risk

Significant concentrations. of patients accounts receivable include 30 percent and 37 percentfrom government-related programs, 6 percent and 8 percent from Empire Blue Cross andBlue Shield, and 27 percent and 23 percent from Cambridge Health Plans at December 31,

2012 and 2011, respectively.At December 31, 2012, 95 percent of the Medical Center's cash and cash equivalents

balance was held at one financial institution.

14. Fair Value of Financial Instruments

The following methods and assurnptions were used by the Medical Center in estimating itsfair value disclosures for financiaUnstruments: The carrying amount reported in the state-ments of financial position for cash and cash equivalents approximates its fair value. Short-term investments consist prirnarily of government and other debt securities. Fair values arebased on quoted market prices. Long-term investments consist primarily of money marketfunds. Fair values are based on quoted market prices. Assets limited as to use consist prima-rily of government securities. Fair values are based on quoted market prices. Most of thelong-term debt of the Medical Center was refinanced during 2006. The carrying value of theMedical Center's long-term debt at December 31, 2012, approximates its fair value.

15. ContingenciesThe Medical Center is a defendant in various legal actions arising out of the normal courseof its operations, the final outcome of which cannot presently be determined. The amountsclaimed would be material to the financial position of the Medical Center. Medical Centermanagement is of the opinion that ultimate liability, if any, with respect to all of these mat-ters will not have a material adverse effect on the Medical Center's financial position.

Approximately 67 percent of the Medical Center's employees are members of variousunions. Of these employees, approximately 70 -percent are covered by contracts expiring

during 2013.

Suggested Readings

Emery, Douglas R, John D. Finnerty, and John D. Stowe_Corporate Financial Management, 3rd ed .. UpperSaddle River, N.J.: Prentice Hall, 2007.

Finkler, Steven A. Finance & Accounting for NonfinancialManagers, 3rd ed. New York, N.Y.: Aspen publishers,

2003.Fraser, Lyn M., and Aileen Ormiston. Understanding

Financial Statements, 8th ed. Upper Saddle River, N.J.:Prentice Hall, 2006.

Ingenix St. Anthony. The 2008 Almanac of HospitalFinancial & Operating Indicators. United States:

Ingenix, 2008.Revsine, Lawrence, Daniel W. Collins, and W. Bruce

Johnson. Financial Reporting & Analysis, 3rd ed. UpperSaddle River, N.].: Prentice Hall, 2004.

Werner, Michael 1., and Kumen H. Jones. Introduction toFinancial Accounting: A UserPerspective, 3rd ed. UpperSaddle River, N.].: Prentice Hall, 2004.