Pungo District Business Plan

Rural Community Hospitals of America LLC
Report Overview
RCHA System
Feasibility Key Assumptions
Feasibility Study
Income Statement
Sources and Uses
Balance Sheet
Community Next Step

Attachments
1. Detailed Feasibility Model
2. Market Study
3.
4.
Primary Service Area

Patient Destination
Medical Staff
Competitor Comparison
Utilization Data
Letter from National Rural Health Association regarding the OIG report
Stroudwater Replacement Hospital Study 2011
RCHA System
Feasibility Key Assumptions
A cash infusion of $3,000,000 is received in the latter half of FY 2014 and used for Working Capital
A new hospital will be built during FY 2017 and opening its doors on the first day of FY 2018
A Surgical program is built to start in FY 2018 with the opening of the new facility. It is projected to
ramp up through FY2020
Inpatient days are kept flat at an ADC of 5 through FY 2017. With the opening of the new facility,
inpatient volumes are projected to grow
Outpatient volumes are kept flat from FY 2014 through FY2017. With the opening of the new facility,
outpatient volumes are projected to grow
No rate increases are added to revenue. While rates are expected to increase, we want to keep
everything in FY 2014 dollars. No rate increases are added to expenses as well for the same reason
Realization rates are kept consistent with FY 2014 through the construction period. Realization
increases in FY 2018 as a result of the cost reimbursement on additional expense related to the
construction, namely depreciation and Interest on the loan
An FTE reduction is assumed in the latter half of FY 2014; FTEs reduce to 55 for the hospital. Wage
rates are kept flat
Feasibility Key Assumptions (Continued)
Benefits are kept flat at 18% of salaries, which is consistent with our other hospitals
Supplies and other operating expenses are projected as a percentage of net revenue
Management fees are added in the latter half of FY2014. They project at 11% of net revenue
The construction loan on the new facility is assumed to be $9,250,000 at 6.8% over 25 years
Interest is capitalized during the construction period and expensed starting in FY 2018.
Feasibility Study: Income Statement

Belhaven Community Hospital
Pro Forma Operating Results
Internal
Projected
FY 2013
FY2014
FY 2015
FY 2016
FY 2017
FY2018
FY2019
FY2020
Income Statement:
Income:
Gross Revenue:
Inpatient
Outpatient
Total
$6,372,322
9,318,918
15,691,240
$3,743,360
$6,977,860
10,721,220
$2,513,940
6,158,674
8,672,614
$2,513,940
6,158,674
8,672,614
$2,513,940
6,158,674
8,672,614
$3,443,754
6,738,272
10,182,026
$3,788,129
7,284,029
11,072,159
$4,525,092
7,888,413
12,413,505
Deductions
5,268,878
$4,404,368
3,408,337
3,408,337
3,408,337
3,319,340
3,758,998
4,381,967
10,422,362
66.42%
6,316,853
5,264,277
60.70%
5,264,277
60.70%
5,264,277
60.70%
6,862,685
67.40%
7,313,161
66.05%
8,031,538
64.70%
454,713
418,750
180,514
180,514
180,514
180,514
180,514
181,236
Total Operating Revenues
10,877,075
6,735,603
5,444,791
5,444,791
5,444,791
7,043,199
7,493,675
8,212,774
Expenses:
Salaries
Benefits
Supplies & Other
Management Expense
Other
Total Operating Expense
5,070,760
1,505,124
1,086,264
0
3,380,379
11,042,527
3,091,128
774,520
942,984
347,279
1,707,401
6,863,312
2,383,691
429,064
762,271
598,927
898,390
5,072,343
2,383,691
429,064
762,271
598,927
816,719
4,990,671
2,383,691
429,064
762,271
598,927
762,271
4,936,223
2,470,370
444,667
986,048
774,752
915,616
5,591,453
2,643,730
475,871
1,049,114
824,304
917,975
5,910,995
2,903,769
522,678
1,149,788
903,405
1,010,171
6,489,812
(165,452)
-1.52%
(127,709)
-1.90%
372,448
6.84%
454,120
8.34%
508,567
9.34%
1,451,747
20.61%
1,582,680
21.12%
1,722,962
20.98%
(915,473)
(5,118)
6,595
(6,948)
(920,944)
(2,931,824)
(1,110)
8,250
1,000
0
(2,923,684)
(563,104)
0
4,125
0
0
(558,979)
(563,104)
0
4,125
0
0
(558,979)
(563,104)
0
4,125
0
0
(558,979)
(771,225)
(614,271)
4,125
0
0
(1,381,371)
(741,225)
(603,316)
4,125
0
0
(1,340,416)
(711,225)
(591,591)
4,125
1
0
(1,298,691)
($1,086,396)
-9.99%
($3,051,393)
-45.30%
($186,531)
-3.43%
($104,860)
-1.93%
($50,412)
-0.93%
$70,375
1.00%
$242,264
3.23%
$424,272
5.17%
Net Patient Service Revenue

Realization Rate
Other Revenue
EBITDA
EBITDA %
Other Revenue (Expense)
Depreciation/Amortization
Interest Expense
Interest/ Investment Income
Other Revenue
Contributions
Total Other Revenue (Expense)
Total Net Gain/(Loss)
Margin %
Feasibility Study: Sources and Uses of Cash

Internal
FY 2013
Sources & Uses of Cash:

Sources:
Add Non-Cash Expenses
Cash from Operations
Increase in Current Liabilities
Increase in Equity
Decrease in Non-Cash Current Assets
Decrease in Other Assets
Decrease in restricted cash
New Long-Term Debt
Decrease in PP&E
Increase in Restricted Net Assets
Total
Uses:
Capital Expenditures
Principle Payments on Debt
Increase in Non-Cash Current Assets
Increase in PP&E
Increase in Restricted Cash
Increase in Other Assets
Decrease in Current Liabilities
Decrease in Restricted Net Assets
Decrease in Long-Term Debt
Decrease in Equity
Total
Net Source or Use of Cash
Beginning Cash
Ending Cash
Projected
FY2014
FY 2015
FY 2016
FY 2017
FY2018
FY2019
FY2020
($1,086,396)
915,473
(170,923)
($3,051,393)
2,931,824
(119,569)
($186,531)
563,104
376,573
($104,860)
563,104
458,245
($50,412)
563,104
512,692
$70,375
771,225
841,601
$242,264
741,225
983,490
$424,272
711,225
1,135,497
0
2,452,669
1,356,700
0
0
0
0
0
0
4,096,293
0
0
0
24,228
0
0
32,741
33,723
34,735
35,777
36,850
37,956
908,207
0
0
0
0
0
0
0
0
0
0
9,250,000
0
0
0
0
0
0
0
0
0
0
0
0
3,638,446
4,000,952
1,317,521
491,968
9,797,427
877,377
1,020,340
1,173,453
980,278
0
0
1,171,854
0
332,419
0
92,264
0
658,964
39,721
62,318
0
0
0
98,171
0
0
0
0
0
0
0
0
0
0
0
0
0
20,703
0
0
0
0
0
12,124,508
0
21,324
0
0
0
0
0
0
145,912
262,820
0
0
0
0
0
0
156,149
90,502
0
0
0
0
0
0
167,105
131,550
1
0
0
0
1
2,576,815
1,061,631
551,476
$1,613,107
859,174
3,141,778
1,613,107
$4,754,885
0
1,317,521
4,754,885
$6,072,406
20,703
471,265
6,072,406
$6,543,671
12,145,832
(2,348,405)
6,543,671
$4,195,266
408,732
468,646
4,195,266
$4,663,912
246,651
773,688
4,663,912
$5,437,600
298,656
874,796
5,437,600
$6,312,396
Feasibility Study: Balance Sheet (Assets)

Balance Sheet:
Current Assets
Cash
Short-term Investments
Restricted Cash-Current
Patient Accounts Receivable
County Appropriations Rec
Other Receivables
Estimated 3rd Party Rec
Supplies Inventory
Prepaid Expenses
Total
Restricted Cash
Internally Designated
Total
Fixed Assets, Net
Other Assets
Due from Parent
Total Assets
Internal
Projected
FY 2013
FY2014
FY 2015
FY 2016
FY 2017
FY2018
FY2019
FY2020
$1,613,107
0
138,892
357,417
389,939
124,137
$4,754,885
$0
$0
$1,721,554
$0
$162,690
$351,726
$387,348
$119,953
$6,072,406
0
0
793,247
0
167,571
351,726
398,968
123,552
$6,543,671
0
0
793,247
0
172,598
351,726
410,937
127,258
$4,195,266
0
0
793,247
0
177,776
351,726
423,266
131,076
$4,663,912
0
0
1,034,103
0
183,109
351,726
435,964
135,008
$5,437,600
0
0
1,101,983
0
188,602
351,726
449,042
139,058
$6,312,396
0
0
1,210,232
0
194,260
351,726
462,514
143,230
4,294,060
$7,498,156
7,907,470
8,399,437
6,072,356
6,803,822
7,668,012
8,674,358
10,217
$10,217
10,217
10,217
10,217
10,217
10,217
10,217
10,217
$10,217
10,217
10,217
10,217
10,217
10,217
10,217
6,511,219
$4,238,359
3,675,255
3,112,151
14,673,555
13,902,330
13,161,104
12,449,879
0
0
$0
$0
0
0
0
0
0
0
0
0
0
0
0
0
$10,815,496
$11,746,733
$11,592,942
$11,521,805
$20,756,128
$20,716,368
$20,839,334
$21,134,454
1,670,568
Feasibility Study: Balance Sheet (Liabilities)

Internal
Projected
FY 2013
Balance Sheet (Cont.):
Liabilities and Net Assets
Current Liabilities
Current Portion Long-term Debt
Accounts Payable
Accrued Payroll
Short-Term Payables
Estimated Third Party Payor Settlement
Payroll Taxes & Other Accrued Exp
Total
Long-term Debt
Total Liabilities
Net Assets
Beginning Net Assets
Community Working Capital Infusion
Donor Restricted
Net Income/(Loss) Current
Ending Net Assets
Total Liabilities and Net Assets
FY2014
FY 2015
FY 2016
FY 2017
FY2018
FY2019
FY2020
39,721
423,837
0
0
477,704
791,615
24,228
342,280
0
0
503,624
749,081
0
352,548
0
0
503,624
771,553
0
363,125
0
0
503,624
794,700
156,149
374,019
0
0
503,624
818,541
167,105
385,239
0
0
503,624
843,097
178,829
396,796
0
0
503,624
868,390
191,375
408,700
0
0
503,624
894,442
1,732,877
1,619,213
1,627,726
1,661,449
1,852,333
1,899,065
1,947,639
1,998,141
24,228
24,228
9,118,079
8,961,212
8,793,338
8,613,687
1,732,877
1,619,213
1,651,954
1,685,677
10,970,412
10,860,276
10,740,977
10,611,829
10,169,015
10,127,520
9,940,988
9,836,128
9,785,717
9,856,092
10,098,356
(1,086,396)
10,178,912
3,000,000
0
(3,051,393)
0
(186,531)
0
(104,860)
0
(50,412)
0
70,375
0
242,264
0
424,272
9,082,619
10,127,520
9,940,988
9,836,128
9,785,717
9,856,092
10,098,356
10,522,628
$10,815,496
$11,746,733
$11,592,942
$11,521,805
$20,756,128
$20,716,368
$20,839,334
$21,134,456
Community Next Steps
Determine the Board Members who will become the new board of Pungo District Hospital
Negotiate a change in control divestiture of Pungo District Hospital from Vidant back to the
community. The corporation would stay intact with all assets, liabilities and net worth as it
currently exists including cash, accounts receivable and accounts payable. Once the Vidant
board resigns and the new board is in place, the community now governs its hospital.
File the Medicare Form 855 change in control
Develop staffing plans and hire necessary employees
Review and revise existing human resource policies
Define and arrange for employee benefit programs
Designate a CEO and CNO
Establish vendor relationships for supplies and services
Review and revise operating policies and procedures for the new operating environment
Community Next Steps (continued)

Review and revise medical staff bylaws for the new operating environment
Review and revise corporate articles and bylaws
Purchase an information technology system to support the revenue cycle, accounts payable,
payroll and general ledger
Develop a Rural Health Clinic (RHC) to recruit new physicians into and provide a practice
location for local physicians that wish to participate
Develop new facility plans and obtain a Certificate of Need (CON) from the State for
construction
Complete architectural work, acquire a site, obtain financing, contract for and build a new
facility
Move into the new facility and have a community celebration
Community Steps (continued)

New Facilities: I-70 Community Hospital
10
Community Steps (continued)

New Facilities: Drumright Regional Hospital
Drumright Regional Hospital (acquired)

Drumright is a new 15-bed CAH facility located in Drumright, Oklahoma. HMC was involved in the planning and development of
the new 36,000 ft. facility which began in CY2002 , which opened for business in March 2005.
11
Community Next Steps (continued): Sample New Facility Drumright

Drumright Regional Hospital
Financial Trend
Net Patient Services Revenue
Other Revenue
Operating Expenses:
Salaries and Wages
Benefits
Supplies
Medical Specialist Fees
Purchased Services
Management Fees
Other Operating Expenses
Total Operating Expenses
City of Drumright
2008
Change in Ownership
2009 Annualized
RCHA
2010
2011
2012
2013
FYTD January 2014
FYTD January
Annualized
6,974,206
6,238,788
7,119,612
7,708,303
42.57%
8,194,364
41.27%
9,203,688
45.03%
3,156,604
44.19%
9,469,812
44.19%
17,084
335,910
37,081
793,010
606,318
207,672
13,432
40,296
6,991,290
6,574,698
7,156,693
8,501,313
8,800,682
9,411,360
3,170,036
9,510,108
2,511,525
620,628
1,725,644
2,948,710
388,714
967,728
305,734
921,600
3,047,666
695,235
1,673,729
3,683,214
662,639
819,575
139,932
645,258
276,000
683,057
3,989,824
544,116
876,074
36,250
682,393
394,873
806,236
3,941,896
531,886
786,248
6,100
870,163
1,014,682
760,692
1,313,500
182,764
294,297
300
249,890
345,000
241,606
3,940,500
548,292
882,891
900
749,670
1,035,000
724,818
1,528,728
1,250,026
764,864
6,386,525
6,297,350
6,666,656
6,909,675
7,329,766
7,911,667
2,627,357
7,882,071
604,765
277,348
490,037
1,591,638
1,470,916
1,499,693
542,679
1,628,037
Chapter 11 Entries
Depreciation and Amortization
Interest Expense
Interest Income
(761,229)
(576,315)
40,424
(859,084)
(514,211)
(883,009)
(504,328)
18,962
(854,891)
(455,243)
1,299
(776,477)
(445,338)
7,699
195,754
(736,347)
(493,862)
2,612
(237,609)
(183,091)
14
0
(712,827)
(549,273)
42
Net Income Before Taxes
(692,355)
(1,095,947)
(878,338)
282,803
256,800
467,850
121,993
365,979
E.B.I.T.D.A.
12
Community Next Steps (continued): Sample New Facility Drumright Volumes

Drumright Regional Hospital
Volume Trend
Patient Days
2010
2011
2012
2013
FYTD January 2014
2,829
3,524
3,867
3,870
1,349
FYTD January
Annualized
4,047
645
693
737
691
230
690
ER Visits
Surgeries
Outpatient Visits
Clinic Visits
3,143
368
5,058
3,861
2,886
378
4,159
5,988
3,037
361
5,553
7,828
3,027
298
4,911
7,340
983
105
1,664
2,419
2,949
315
4,992
7,257
Avg Length of Stay

Avg Daily Census
4.39
7.75
5.09
9.65
5.25
10.59
5.60
10.60
5.87
10.97
5.87
11.09
FTEs
FTEs per Adjusted Occupied Bed
66
2.92
69
3.25
71
2.73
67
2.82
66
2.83
66
2.80
Discharges
12
ATTACHMENT ONE
Detailed Feasibility Study
ATTACHMENT TWO
Market Study
Pungo Hospital
Market Study
February 2014
Table of Contents
Map
Demographic Summary
Population by Age trend
Population by Race
Education
Health Expenditures
Household Debt
Occupation
Household Status
Patient Destination
Discharges by hospital
Discharges by patient zip code
Medicare IP discharges and charges
Medical Staff
Primary Care physicians
Financial Info
Balance Sheet
Income Statement
Utilization Data
Pungo Hospital
Pungo Hospital - Primary Service Area: Map
ZIP
Area Name
Population
(2013)
27826
Fairfield
27885
Swanquarter
27824
Engelhard
1,577
27875
Scranton
1,036
27810
Belhaven
3,724
27860
Pantego
1,910
Totals
1,307
954
10,508
PSA Population makes

up 79% of total
Medicare discharges
I-1
Pungo Hospital Primary Service Area: Demographic Summary

PSA Demographics
2010
2013
2018
CENSUS ESTIMATE FORECAST
Population
10,507
10,508
10,510
Households
4,114
4,121
4,181
Families
2,686
2,689
2,730
44.3
44.7
45.3
Median Household Income
$37,508
$38,952
$41,818
Average Household Income
$43,812
$46,913
$49,602
2.55
2.55
2.51
1,939
2,070
2,445
18.50%
19.80%
23.30%
Median Age
Average Household Size

65+ Population
% 65+ Population
North Carolina Demographics
Population
2010
2013
2018
CENSUS ESTIMATE FORECAST
9,535,475 9,777,283 10,381,767
Households
3,745,160 3,842,476
4,081,047
Families
2,499,177 2,564,117
2,723,305
Median Age
37.3
37.7
38.7
Median Household Income
$43,643
$45,679
$47,967
Average Household Income
$59,053
$62,238
$64,961
2.55
2.54
2.54
1,234,049 1,346,725
1,668,340
Average Household Size

65+ Population
% 65+ Population
12.80%
Source: Tactician
I-2
13.70%
16.10%
Pungo Hospital Primary Service Area: Population by Age

PSA Population by Age
2010 CENSUS
2018 FORECAST
US
Area
Percent
Index*
Number
Percent
Number
Percent
Number
Percent
Age 0-4
505
4.80%
491
4.70%
498
4.70%
6.50%
73.44
Age 5-9
567
5.40%
550
5.20%
524
5.00%
6.60%
81.86
Age 10-14
593
5.60%
582
5.50%
568
5.40%
6.70%
84.26
Age 15-19
625
5.90%
626
6.00%
624
5.90%
7.10%
83.31
Age 20-24
507
4.80%
533
5.10%
638
6.10%
7.00%
69
Age 25-29
580
5.50%
547
5.20%
529
5.00%
6.80%
80.75
Age 30-34
628
6.00%
632
6.00%
575
5.50%
6.50%
92.43
Age 35-39
672
6.40%
652
6.20%
611
5.80%
6.50%
97.84
Age 40-44
672
6.40%
672
6.40%
644
6.10%
6.80%
94.5
Age 45-49
745
7.10%
701
6.70%
647
6.20%
7.40%
96.38
Age 50-54
832
7.90%
778
7.40%
638
6.10%
7.20%
109.62
Age 55-59
879
8.40%
871
8.30%
762
7.20%
6.40%
131.32
Age 60-64
765
7.30%
795
7.60%
808
7.70%
5.40%
133.64
Age 65-69
637
6.10%
680
6.50%
801
7.60%
4.00%
150.5
Age 70-74
461
4.40%
490
4.70%
584
5.60%
3.00%
145.97
Age 75-79
378
3.60%
399
3.80%
471
4.50%
2.40%
151.76
Age 80-84
221
2.10%
243
2.30%
281
2.70%
1.90%
113.05
Age 85+
242
2.30%
258
2.50%
308
2.90%
1.80%
129.42
10,509
100.00%
10,500
100.00%
10,511
100.00%
100.00%
Total
Median
Source: Tactician
2013 ESTIMATE
44.3
44.7
45.3
I-3
Pungo Hospital - Primary Service Area: Population by Race

Population by Race Trends
2010 CENSUS
Percent
Number
Percent
Number
Percent
5,949
5,921
5,847
247
56.34%
5.37%
33.79%
0.79%
0.24%
0.00%
1.12%
2.35%
245
55.63%
6.24%
33.66%
0.80%
0.22%
0.00%
1.11%
2.33%
10,509
100.00%
10,510
100.00%
Two or More
118
Other Race
247
56.62%
5.04%
33.84%
0.79%
0.24%
0.00%
1.12%
2.35%
10,506
100.00%
Hispanic
Black
529
3,555
Native American
83
Asian
25
Hawaiian / Pacific Islander
Source: Tactician
2018 FORECAST
Number
White
Total
2013 ESTIMATE
564
3,551
83
25
0
118
I-4
656
3,538
84
23
0
117
Pungo Hospital Primary Service Area: Educational Attainment
Educational Attainment Age 25+ (2010)

PSA
Description
US
Area
Number
Percent
Percent
Index*
No schooling completed
114
1.50%
1.30%
112.18
Nursery-4th grade
108
1.40%
0.80%
165.21
5th-6th grade
47
0.60%
1.80%
34.5
7th-8th grade
267
3.50%
2.20%
160.7
9th grade
246
3.20%
1.80%
174.17
10th grade
421
5.50%
2.20%
243.56
11th grade
276
3.60%
2.50%
144.53
94
1.20%
1.80%
69
2,813
36.50%
28.50%
128.14
553
7.20%
6.30%
114.2
12th grade no diploma

High school graduate, GED, or alternative
Some college, < 1 year
Some college, 1+ years, no degree
1,105
14.30%
15.00%
95.73
Associate's degree
596
7.70%
7.60%
101.66
Bachelor's degree
777
10.10%
17.70%
56.87
Master's degree
222
2.90%
7.30%
39.37
Professional school degree
47
0.60%
1.90%
31.89
Doctorate degree
15
0.20%
1.20%
16.15
7,701
100.00%
100.00%
Total
Source: Tactician
I-5
Pungo Hospital Primary Service Area: Personal Healthcare Expenditure
PSA Personal Healthcare Expenditures

Area Exp / US Exp /
Hhld $
Hhld $
Expenditu Area Exp

US Exp
Allocation
re Index* Allocation % Allocation % Index**
Total Health Care
$2,701
$3,380
79.9
6.50%
6.20%
105.68
Health Care Insurance
$1,303
$1,632
79.87
3.10%
3.00%
105.63
Health Care Services
$646
$813
79.48
1.60%
1.50%
105.13
Hospital Services
$106
$133
79.21
0.30%
0.20%
104.77
Physician Services
$171
$215
79.61
0.40%
0.40%
105.29
Dental Services
$246
$309
79.56
0.60%
0.60%
105.22
Eyecare Services
$30
$38
79.28
0.10%
0.10%
104.86
Other Medical Services
$92
$116
79.42
0.20%
0.20%
105.05
$751
$936
80.31
1.80%
1.70%
106.23
Health Care Supplies & Equipment
Source: Tactician
I-6
Pungo Hospital Primary Service Area: Households with Debt

Debts
PSA
Description
Number
US
Area
Percent of Percent of
Index*
Households Households
Households Having A Mortgage Debt
1,988
48.20%
46.70%
103.25
Installment Payment Debt
1,866
45.30%
46.70%
97
Other Lines of Credit Debt
64
1.60%
1.40%
112.18
1,838
44.60%
45.10%
98.95
Investment Real Estate Debt
225
5.50%
7.20%
75.98
Other Debt
281
6.80%
7.00%
97.28
3,148
76.40%
77.80%
98.15
Credit Card Debt
Hhlds with Any Debt
Source: Tactician
I-7
Pungo Hospital - Primary Service Area: 2010 Occupation

Occupation (2010)
PSA
Description
US
Area
Number
Percent
Percent
Index*
Management occupations
456
11.70%
9.70%
120.65
Business and financial operations occupations
111
2.80%
4.70%
60.53
Computer and mathematical occupations
20
0.50%
2.50%
20.7
Architecture and engineering occupations
26
0.70%
1.80%
36.91
Life, physical, and social science occupations
13
0.30%
0.90%
37.98
Community and social service occupations
85
2.20%
1.70%
128.66
Legal occupations
34
0.90%
1.20%
74.23
175
4.50%
6.20%
72.24
15
0.40%
1.90%
20.44
Health diagnosing and treating practitioners and other technical 160

occupations
4.10%
Health technologists and technicians
Education, training, and library occupations

Arts, design, entertainment, sports, and media occupations
Healthcare support occupations
3.80%
109.08
26
0.70%
1.70%
38.31
212
5.40%
2.50%
216.61
Fire fighting and prevention, and other protective service workers including
20
0.50%
supervisors
1.20%
Law enforcement workers including supervisors
176
4.50%
1.00%
Food preparation and serving related occupations
41.9
443.51
103
2.60%
5.70%
46.28
Building and grounds cleaning and maintenance occupations 182
4.70%
4.00%
116.21
Personal care and service occupations
52
1.30%
3.60%
37.17
Sales and related occupations
367
9.40%
11.10%
84.82
Office and administrative support occupations
489
12.50%
13.90%
90.07
Farming, fishing, and forestry occupations
245
6.30%
0.80%
832.87
Construction and extraction occupations
332
8.50%
5.10%
167.05
Installation, maintenance, and repair occupations
114
2.90%
3.30%
88.52
Production occupations
256
6.60%
5.90%
110.76
Transportation occupations
130
3.30%
3.50%
94.82
Material moving occupations
109
2.80%
2.50%
111
3,908
100.00%
100.00%
Total
* Area Index is '100' based. An Area Index value of 100 for a particular variable indicates that, for the area, the relative concentration of the
Source: Tactician variable is consistent with the average concentration of that variable across the US. Accordingly, an index value of 200 indicates that the relative
I-8
concentration of the variable is twice the national average, while an index value of 50 indicates that the relative concentration of the variable is half
the national average.
Pungo Hospital Primary Service Area: Household

Household Structure (2013)
PSA
Description
Percent
Percent
Index*
669
24.90%
32.70%
76.09
88
3.30%
4.30%
76.39
352
13.10%
12.80%
102.07
1,252
46.60%
40.20%
115.94
Lone Parent Male No Children
101
3.80%
3.20%
118.62
Lone Parent Female No Children
226
8.40%
6.80%
122.96
2,688
100.00%
100.00%
Lone Parent Male with Children

Lone Parent Female with Children
Married Couple Family No Children
Total
I-9
Area
Number
Married Couple Family with Children
Source: Tactician
US
PUNGO HOSPITAL
Patient Destination Data
Pungo Hospital Medicare IP Market Share and Charges 27810

Belhaven
Hospital
27810 Belhaven
2012
2012
2012
2012
M edicare
2012
M edicare
M edicare
ALOS
M edicare
M edicare
Discharges
M arket Share
Patient
Total Charges
Average Charge
Days
Per patient Day
-- ZIP Total --
323
100.00%
1,493
4.6
$9,016,626
VIDANT BEAUFT HSP WA

VIDANT MC GREENVILLE
VIDANT PUNGO HSP BELHAVEN
ALL OTHER HOSPITALS
46
95
151
31
14.20%
29.40%
46.70%
9.60%
200
710
435
148
4.3
7.5
2.9
4.8
$796,288
$5,765,120
$1,182,976
$1,272,242
II-1
$6,039.27
$
$
$
$
3,981
8,120
2,719
8,596
Pungo Hospital Medicare IP Market Share and Charges 27860 Pantego
Hospital
27860 Pantego
2012
2012
2012
M edicare
M edicare
Discharges
M arket Share
ALOS
2012
2012
M edicare
M edicare
M edicare
Patient
Total Charges
Average Charge
Days
-- ZIP Total --

ALL OTHER HOSPITALS
Per patient Day
143
100.00%
590
4.1
$3,592,892 $
6,090
27
47
58
11
18.90%
32.90%
40.60%
7.70%
126
253
148
63
4.7
5.4
2.6
5.7
$396,800
$2,430,976
$376,448
$388,668
3,149
9,609
2,544
6,169
II-2
$
$
$
$

Engelhard
Hospital
27824 Engelhard
2012
2012
2012
ALOS
M edicare
M edicare
M edicare
Discharges
M arket
Share
Patient
2012
2012
M edicare
M edicare
Total Charges Average Charge
Days
Per patient Day
-- ZIP Total --
93
100.00%
458
4.9
$2,997,928
JOHNSTON MEM HSP SMITHFIELD

THE OUTER BANKS HSP NAGS HEAD
UNIV HSP BROOKLYN DOWNSTATE
ALL OTHER HOSPITALS
2
2
2
8
33
44
2
2.20%
2.20%
2.20%
8.60%
35.50%
47.30%
2.20%
9
5
35
41
214
141
13
4.5
2.5
17.5
5.1
6.5
3.2
6.5
$42,976
$29,380
$198,528
$95,072
$2,205,184
$368,832
$57,956
II-3
$
$
$
$
$
$
$
$
6,546
4,775
5,876
5,672
2,319
10,305
2,616
4,458
Pungo Hospital Medicare IP Market Share and Charges 27826 Fairfield
Hospital
27826 Fairfield
2012
2012
2012
ALOS
M edicare
M edicare
M edicare
Discharges
M arket Share
Patient
2012
2012
M edicare
M edicare
Total Charges Average Charge
Days
Per patient Day
-- ZIP Total --
43
100.00%
164
3.8
$1,111,545 $

ALL OTHER HOSPITALS
6
9
21
7
14.00%
20.90%
48.80%
16.30%
22
43
62
37
3.7
4.8
3
5.3
$81,888
$546,688
$165,632
$317,337
II-4
$
$
$
$
6,778
3,722
12,714
2,671
8,577
Pungo Hospital Medicare IP Market Share and Charges 27875 Scranton
Hospital
27875 Scranton
2012
2012
2012
M edicare
M edicare
Discharges
M arket Share
ALOS
2012
2012
M edicare
M edicare
M edicare
Patient
Total Charges
Average Charge
Days
Per patient Day
-- ZIP Total --
25
100.00%
99
$499,212

ALL OTHER HOSPITALS
4
5
14
2
16.00%
20.00%
56.00%
8.00%
22
21
48
8
5.5
4.2
3.4
4
$51,560
$282,496
$114,800
$50,356
II-5
$
$
$
$
$
5,043
2,344
13,452
2,392
6,295

Swanquarter
Hospital
27885 Swanquarter
2012
2012
2012
M edicare
M edicare
Discharges
M arket Share
ALOS
2012
2012
M edicare
M edicare
M edicare
Patient
Total Charges
Average Charge
Days
Per patient Day
-- ZIP Total --
89
100.00%
371
4.2
$2,307,271
UNIV N CAROLINA HSP CHAPEL HIL

ALL OTHER HOSPITALS
5
12
30
40
2
5.60%
13.50%
33.70%
44.90%
2.20%
56
40
154
118
3
11.2
3.3
5.1
3
1.5
$535,168
$131,968
$1,298,688
$321,152
$20,295
II-6
$
$
$
$
$
$
6,219
9,557
3,299
8,433
2,722
6,765
PUNGO HOSPITAL
Primary Care Needs
Pungo Hospital Medical Staff : Need for Primary Care Physicians
Year
Population
Physician Type
Family Practice
Internal Medicine
Obstetrics/gynecology
Pediatrics
TOTAL
2013
10,508
2013 Population to Physician Need

Pungo Primary Service Area - 2013
Medical
Journal
GMENAC Economics
Solucient
AMA
2.65
5.23
2.37
1.08
3.03
2.08
2.00
3.00
1.04
0.96
1.07
1.12
1.35
1.05
1.46
1.56
8.06
9.32
6.89
6.75
III-1
Lifton
Associates
4.02
4.01
1.54
1.93
11.52
Mean Median
2.31 2.65
2.64 3.00
1.12 1.07
1.41 1.46
7.47 8.17
PUNGO HOSPITAL
Financial Info
Pungo Hospital - Financial Info: Balance Sheet

Balance Sheet:
Current Assets
Cash
Short-term Investments
Restricted Cash-Current
Patient Accounts Receivable
County Appropriations Rec
Other Receivables
Estimated 3rd Party Rec
Supplies Inventory
Prepaid Expenses
Total
Audited
FY2010
Audited
FY2011
$2,011,810 $1,316,050
0
0

Internal
FY2012
Internal
FY 2013
$551,476
$1,613,107
0
1,877,982
1,259,808
2,912,557
1,670,568
90,391
0
382,098
43,477
99,838
0
334,634
281,229
559,486
347,548
218,062
138,892
357,417
389,939
124,137
4,405,758
3,291,559
4,589,129
4,294,060
Restricted Cash
Restricted for Debt Service
Held by Trustee for Capital
Restricted by Donors
Total Assets
Total
1,732,332
3,621,590
2,117,839
1,732,877
Long-term Debt
2,538,057
1,531,984
39,721
Total Liabilities
4,270,389
5,153,574
2,157,560
1,732,877
6,834,605
6,016,165
9,517,362
10,169,015
12,000
(818,440) (1,243,480) (1,801,016)
(1,086,396)
1,771,483 (1,161,637)
10,217
1,771,483 (1,161,637)
10,217
Ending Net Assets
Total
Other Assets
Due from Parent
39,721
423,837
0
0
477,704
791,615
Internally Designated
5,265,868
4,827,765
6,446,414
6,511,219
614,928
47,452
0
0
0
0
0
Internal
FY 2013
92,264
525,426
0
0
852,509
647,640
Internal
FY2012
287,926
293,745
746,159
1,785,760
508,000
0
Audited
FY2011
323,181
258,188
222,059
0
925,794
3,110
Net Assets
Beginning Net Assets
Community Working Capital Infusion
Donor Restricted
Net Income/(Loss) Current
Less Current Portion
Fixed Assets, Net
Liabilities and Net Assets

Current Liabilities
Current Portion Long-term Debt
Accounts Payable
Accrued Payroll
Short-Term Payables
Estimated Third Party Payor Settlement
Payroll Taxes & Other Accrued Exp
Audited
FY2010
Total Liabilities and Net Assets
$10,286,554 $9,938,259 $9,873,906 $10,815,496
IV-1
6,016,165
4,784,685
7,716,346
9,082,619
$10,286,554 $9,938,259 $9,873,906 $10,815,496
Pungo Hospital - Financial Info: Income Statement

Audited
FY2011
Internal
FY2012
Internal
FY 2013
9,627,814
61.18%
11,093,827
9,777,922
64.67%
10,422,362
66.42%
410,691
213,737
150,208
454,713
10,038,505
11,307,564
9,928,130
10,877,075
5,587,566
427,951
4,285,555
5,199,819
1,429,002
1,447,682
10,351,188
10,351,188
1,671,641
11,972,713
2,873,562
10,950,065
5,070,760
1,505,124
1,086,264
0
3,380,379
11,042,527
EBITDA
EBITDA %
(312,683)
-3.11%
(665,149)
-5.88%
(1,021,935)
-10.29%
(165,452)
-1.52%
Other Revenue (Expense)

Depreciation/Amortization
Interest Expense
Interest/ Investment Income
Other Revenue
Contributions
Total Other Revenue (Expense)
(643,025)
(61,638)
32,068
166,838
0
(505,757)
(619,547)
(47,501)
14,404
74,313
(645,125)
(915,473)
(5,118)
6,595
(6,948)
Income Statement:
Net Patient Service Revenue
Realization Rate
Other Revenue
Expenses:
Salaries
Benefits
Supplies & Other
Management Expense
Other
Total Operating Expense

Margin %
Audited
FY2010
($818,440)
IV-1 -8.15%
(578,331)
(133,956)
0
(779,081)
($1,243,480) ($1,801,016)
-11.00%
-18.14%
(920,944)
($1,086,396)
-9.99%
IV-2
PUNGO HOSPITAL
Pungo Hospital Competitor Comparison: surrounding facilities map
V-1
Pungo Hospital Competitor Comparison: Profitability Ratios
Profitability Ratios
Number of Months
Total Margin %
Operating Margin
Nonoperating Margin
Deductible Ratio
Markup Ratio
Return on Total Assets
Return on Equity
Return on Investment (PLA)
Liquidity Ratios
Current Ratio
Average Payment Period
Days Cash on Hand - Short-Term Sources
Days Cash On Hand - All Sources
Days in Accounts Receivable
Source: Ingenix (CHIPS)
2010
Pungo
2011
2012
State
Average
2010
Beaufort
2011
12
12
12
12.
12
11
13
-3.9
-12.7
-18.4
-7.7
-7.8
-3.8
-12.3
-5.7
-13.4
-18.4
-8.6
-7.9
-7.7
-12.3
1.8
0.7
0.0
0.9
0.2
3.9
0.0
38.8
37.4
35.3
57.3
59.1
60.6
63.9
1.5
1.4
1.3
2.6
2.3
2.3
2.4
-4.0
-12.5
-18.2
-0.8
-11.9
-5.1
-14.4
-6.9
-25.9
-23.3
1.4
-31.7
-26.1
-45.1
0.0
-0.1
-0.1
0.1
0.0
0.0
-0.1
2012
2.5
1.0
1.6
6.5
2.5
1.0
1.6
60.7
127.5
70.6
54.9
60.7
127.5
70.6
70.5
59.0
18.4
48.0
70.5
59.0
18.4
92.1
59.0
18.4
94.2
92.1
59.0
18.4
74.6
52.6
86.1
65.3
74.6
52.6
86.1
V-2
Pungo Hospital Competitor Comparison: Profitability Ratios (Continued)
Capital & Asset Ratios

Capital Structure Ratios
Equity Financing
Long-Term Debt to Equity
Fixed Asset Financing
Cash Flow to Debt
Capital Expense
Long-Term Debt per Bed
Times Interest Earned
Asset Efficiency
Total Asset Turnover
Fixed Asset Turnover
Fixed Asset Turnover (PLA)
Current Asset Turnover
Net Fixed Assets per Bed
Average Age of Plant
Greenville
2011
2012
48.2
37.0
79.4
124.5
90.9
23.4
2010
2010
Outerbanks
2011
2012
45.9
74.9
92.1
90.9
85.9
18.9
0.5
0.5
95.7
92.5
57.0
1.8
2.1
24.7
33.5
70.5
252.6
208.2
9.5
7.1
6.6
7.0
5.5
4.6
334,152.4
334,355.9
328,494.6
86,102.4
2,730.5
3,208.6
0.0
0.0
0.0
12.7
47.8
0.0
0.89
1.12
1.10
0.82
0.86
0.86
2.12
2.33
2.59
3.30
3.66
4.15
0.97
1.04
1.12
1.51
1.63
1.81
1.72
2.53
2.11
1.24
1.27
1.21
367,654
349,222
355,285
151,177
150,107
153,412
6.5
9.2
9.9
7.2
8.1
9.3
V-3
Pungo Hospital Competitor Comparison: Capital & Asset Ratios

Equity Financing
Cash Flow to Debt
Capital Expense
Asset Efficiency
2010
Pungo
2011
2012
State
Average
2010
Beaufort
2011
58.5
48.1
78.1
71.1
37.6
19.7
31.9
42.2
32.0
0.5
63.9
73.7
0.0
158.1
2012
48.2
31.7
0.6
32.7
52.7
0.0
85.3
5.3
-12.1
-53.6
30.3
-9.2
1.1
-14.5
6.8
6.5
6.1
6.3
4.8
5.5
4.1
32,818.9
20,586.3
0.0
82,463.3
25,193.2
0.0
64,673.1
-5.8
-25.1
-102.6
12.1
-7.6
-2.8
-22.1
1.03
0.98
0.99
1.30
1.53
1.36
1.17
2.02
2.02
1.52
4.42
2.91
2.54
1.97
0.92
0.90
0.66
1.92
1.33
1.13
0.86
2.41
2.67
2.86
4.52
3.68
4.59
3.24
68,091
64,874
169,040
47,781
59,255
75,819
12.5
13.9
13.3
11.6
11.7
11.5
1.0
V-4
Pungo Hospital Competitor Comparison: Capital & Asset Ratios

(Continued)

Equity Financing
Cash Flow to Debt
Capital Expense
Asset Efficiency
Greenville
2011
2012
48.2
37.0
79.4
124.5
90.9
23.4
2010
2010
Outerbanks
2011
2012
45.9
74.9
92.1
90.9
85.9
18.9
0.5
0.5
95.7
92.5
57.0
1.8
2.1
24.7
33.5
70.5
252.6
208.2
9.5
7.1
6.6
7.0
5.5
4.6
334,152.4
334,355.9
328,494.6
86,102.4
2,730.5
3,208.6
0.0
0.0
0.0
12.7
47.8
0.0
0.89
1.12
1.10
0.82
0.86
0.86
2.12
2.33
2.59
3.30
3.66
4.15
0.97
1.04
1.12
1.51
1.63
1.81
1.72
2.53
2.11
1.24
1.27
1.21
367,654
349,222
355,285
151,177
150,107
153,412
6.5
9.2
9.9
7.2
8.1
9.3
V-5
Pungo Hospital Competitor Comparison: Volume Indicators
Volume Indicators
Hospital Beds
Facility Beds
General Services Beds Percentage
Hospital Discharges
Hospital Discharges per Bed
Hospital Patient Days
Facility Patient Days
Occupancy - Hospital
Occupancy - Facility
2010
Pungo
2011
2012
State
Average
2010
Beaufort
2011
2012
25.0
25.0
25.0
170.3
96.0
81.0
100.0
35.0
35.0
35.0
198.6
115.0
100.0
100.0
100.0
100.0
100.0
90.4
87.5
85.2
88.0
659
672
548
7,939
2,877
2,782
3,281
Volume Indicators
Hospital Beds
Facility Beds
General Services Beds Percentage
Hospital Discharges
Hospital Discharges per Bed
Hospital Patient Days
Facility Patient Days
Occupancy - Hospital
Occupancy - Facility
26.4
26.9
21.9
40.7
30.0
34.3
32.8
3,252
2,962
2,338
38,973
9,940
8,017
13,534
5,928
5,738
5,586
47,073
13,567
11,471
13,534
35.6
32.5
25.6
53.5
28.4
29.5
35.4
46.4
44.9
43.6
59.2
32.3
34.2
35.4
2010
Greenville
2011
2012
2010
718.0
718.0
718.0
21.0
21.0
21.0
845.0
845.0
845.0
21.0
21.0
21.0
Outerbanks
2011
2012
76.3
76.3
76.3
100.0
100.0
100.0
39,053
40,518
43,129
1,235
1,295
1,393
54.4
56.4
60.1
58.8
61.7
66.3
209,578
212,580
222,027
2,926
2,948
3,199
245,072
247,810
255,603
2,926
2,948
3,199
80.0
81.1
84.5
38.2
38.5
41.6
79.5
80.3
82.6
38.2
38.5
41.6
V-6
Pungo Hospital Competitor Comparison: LOS
Length of Stay
Hospital Length of Stay
Hospital Length of Stay (CMA)
Medicare Length of Stay
Medicare Length of Stay (CMA)
Medicaid Length of Stay
2010
Pungo
2011
2012
State
Average
2010
Beaufort
2011
2012
4.9
4.4
4.3
8.9
3.5
2.9
4.1
0.0
0.0
0.0
0.0
0.0
0.0
0.0
3.3
3.2
3.0
7.0
3.8
3.8
4.3
0.0
0.0
0.0
0.0
0.0
0.0
0.0
2.6
3.2
2.9
7.0
1.8
1.0
2.5
Length of Stay
Hospital Length of Stay
Hospital Length of Stay (CMA)
Medicare Length of Stay
Medicare Length of Stay (CMA)
Medicaid Length of Stay
2010
Greenville
2011
2012
2010
Outerbanks
2011
2012
5.4
5.2
5.1
2.4
2.3
2.3
0.0
0.0
0.0
0.0
0.0
0.0
6.2
6.1
5.9
2.8
2.7
2.7
0.0
0.0
0.0
0.0
0.0
0.0
5.3
5.3
5.5
1.9
2.0
2.0
V-7
Pungo Hospital Competitor Comparison: Payor Mix

Payer Mix
Medicare Percentage - Discharges
Medicare Percentage - Days
Medicaid Percentage - Discharges
Medicaid Percentage - Days
Medicare Outlier Payment Percentage
Mediare Case Mix Index
Outpatient Revenue Percentage
Inpatient Revenue Percentage
Routine Days Percentage
Intensive Care Unit Days Percentage
Coronary Care Unit Days Percentage
Payer Mix
Medicare Percentage - Discharges
Medicare Percentage - Days
Medicaid Percentage - Discharges
Medicaid Percentage - Days
Medicare Outlier Payment Percentage
Mediare Case Mix Index
Outpatient Revenue Percentage
Inpatient Revenue Percentage
Routine Days Percentage
Intensive Care Unit Days Percentage
Coronary Care Unit Days Percentage
2010
Pungo
2011
2012
State
Average
2010
Beaufort
2011
2012
70.4
68.2
72.6
45.9
52.2
48.7
45.7
47.0
49.2
50.9
46.1
57.8
63.5
47.9
10.8
9.2
8.2
18.5
31.5
26.1
24.7
5.7
6.6
5.5
12.6
16.5
9.3
14.9
0.0
0.0
0.0
2.0
0.2
0.2
0.1
0.0000
0.0000
0.0000
0.0000
0.0000
0.0000
54.7
53.0
100.0
58.2
78.0
77.8
73.5
45.3
47.0
0.0
47.6
22.0
22.2
26.5
62.5
70.6
66.7
83.4
89.5
91.4
92.3
0.0
6.0
10.9
8.4
10.5
3.1
2.1
0.0
0.0
0.0
0.0
0.0
0.0
0.0
2010
Greenville
2011
2012
2010
Outerbanks
2011
2012
38.0
38.8
40.0
38.2
40.7
41.9
44.2
44.9
46.2
44.4
48.1
49.4
24.8
25.6
23.5
21.0
20.0
18.6
24.5
25.8
25.1
16.9
17.8
16.5
9.9
9.1
8.1
0.0
0.0
0.0
0.0000
0.0000
0.0000
0.0000
0.0000
0.0000
27.8
28.5
28.5
80.5
79.4
76.8
72.2
71.5
71.5
19.5
20.6
23.2
78.4
80.0
80.4
100.0
100.0
100.0
21.6
0.6
2.6
0.0
13.3
15.1
0.0
0.0
0.0
0.0
0.0
0.0
V-8
Pungo Hospital Competitor Comparison: Pricing Indicators
Pricing Indicators
Hospital Gross Price per Discharge
Hospital Gross Price per Discharge (CMA,WIA)
Hospital Net Price per Discharge
Hospital Net Price per Discharge (CMA,WIA)
Pricing Indicators
Hospital Gross Price per Discharge
Hospital Gross Price per Discharge (CMA,WIA)
Hospital Net Price per Discharge
Hospital Net Price per Discharge (CMA,WIA)
2010
Pungo
2011
2012
State
Average
2010
Beaufort
2011
2012
$10,079
$9,889
$0
$29,194
$11,520
$10,900
$11,089
$0
$0
$0
$0
$0
$0
$6,170
$6,186
$0
$4,714
$4,297
$4,005
$0
$0
$0
$0
$0
$0
2010
Greenville
2011
2012
2010
Outerbanks
2011
2012
$39,196
$39,925
$41,202
$13,887
$14,598
$15,538
$11,373
$0
$0
$0
$0
$0
$0
$15,246
$15,080
$16,234
$7,878
$8,349
$8,696
$0
$0
$0
$0
$0
$0
V-9
Pungo Hospital Competitor Comparison: Cost Indicators
Cost Indicators
Hospital Cost per Discharge
Hospital Cost per Discharge (CMA,WIA)
Hospital Salaries per Discharge
Hospital Salaries per Discharge (CMA,WIA)
Hospital Capital Costs per Discharge
Hospital Capital Costs per Discharge (CMA,WIA)
Hospital General Service Cost per Discharge
Hospital General Service Cost per Discharge (CMA,WIA)
Hospital FTEs per Occupied Bed
Hospital FTEs per Occupied Bed (CMA)
Hospital Manhours per Discharge
Hospital Manhours per Discharge (CMA)
Facility Salary per FTE
Facility Salary per FTE (WIA)
Facility Wage Index
Facility Wage Index
2010
Pungo
2011
2012
State
Average
2010
Beaufort
2011
2012
$7,081
$7,195
$0
$11,967
$5,103
$4,695
$4,632
$0
$0
$0
$0
$0
$0
$3,645
$3,469
$0
$1,866
$1,634
$1,725
$0
$0
$0
$0
$0
$0
$450
$436
$0
$567
$233
$246
$181
$0
$0
$0
$4,951
$1,311
$1,254
$1,979
$0
$0
$0
86
90
79
$45,236
$37,819
$45,526
$0
$0
$0
$0
$0
$0
0.0000
0.0000
0.0000
$0
$0
$0
$3,352
$3,419
$0
$0
$0
$0
181
185
$41,838
$39,031
$38,805
$0
$0
$0
$0
$0
$0
0.0000
0.0000
0.0000
V-10
$4,951
5
201
$53,538
$59,252
Pungo Hospital Competitor Comparison: Pricing Indicators
Cost Indicators
Hospital Cost per Discharge
Hospital Cost per Discharge (CMA,WIA)
Hospital Salaries per Discharge
Hospital Salaries per Discharge (CMA,WIA)
Hospital Capital Costs per Discharge
Hospital Capital Costs per Discharge (CMA,WIA)
Hospital General Service Cost per Discharge
Hospital General Service Cost per Discharge (CMA,WIA)
Hospital FTEs per Occupied Bed
Hospital FTEs per Occupied Bed (CMA)
Hospital Manhours per Discharge
Hospital Manhours per Discharge (CMA)
Facility Salary per FTE
Facility Salary per FTE (WIA)
Facility Wage Index
Facility Wage Index
2010
Greenville
2011
2012
2010
Outerbanks
2011
2012
$14,930
$14,712
$15,098
$6,645
$6,859
$7,240
$0
$0
$0
$0
$0
$0
$5,501
$5,340
$5,409
$2,093
$2,221
$2,319
$0
$0
$0
$0
$0
$0
$1,311
$981
$939
$436
$357
$316
$0
$0
$0
$0
$0
$0
$6,688
$6,164
$6,587
$2,002
$2,196
$2,339
$0
$0
$0
$0
$0
$0
218
206
203
78
72
72
$52,451
$53,934
$55,332
$55,879
$64,150
$67,244
$0
$0
$0
$0
$0
$0
$61,074
$65,867
$70,063
$0
$0
$0
0.0000
0.0000
0.0000
0.0000
0.0000
0.0000
V-11
PUNGO HOSPITAL
Utilization Data
Pungo Hospital Utilization Data:
ACUTE ADMISSIONS
SWING BED ADMISSIONS
ACUTE DAYS
SWING BED DAYS
ACUTE ALOS
SWING BED ALOS
INPATIENT SURGERY
FY 2011
667
64
2,089
871
3.13
13.61
45
FY 2012
557
86
1,594
4,008
2.86
46.60
34
FY 2013
507
95
1,482
3,144
2.92
33.09
0
Lab Tests
OP Visits
OUTPATIENT SURGERY
ER Visits
FY 2011
30,615
5,067
215
5,488
FY 2012
28,196
5,316
209
5,412
FY 2013
24,118
4,960
0
5,928
RADIOLOGY
Radiograph
Ultrasound
CT Scans
MRI
FY 2011
6,985
359
1,142
269
FY 2012
5,160
87
1,056
239
FY 2013
4,254
312
1,534
202
Payor Mix
Medicare
Medicaid
Commercial
Self Pay
FY 2011
49.4%
22.6%
21.4%
6.7%
FY 2012
50.0%
21.9%
19.8%
8.3%
FY 2013
55.3%
18.0%
17.7%
9.0%
Ratios
FTEs Per AOB
Bad Debt % of Pat Rev
Contractual as % of Pat Rev
FY 2011
n/a
n/a
n/a
FY 2012
3.6
9.6%
35.3%
FY 2013
3.8
4.8%
33.6%
VI-1
Pungo Hospital Utilization Data: Graphs

ACUTE ADMISSIONS
SWING BED ADMISSIONS
800
100
90
80
70
60
50
40
30
20
10
0
700
600
500
400
667
300
557
507
FY 2012
FY 2013
200
100
0
FY 2011
95
64
FY 2011
ACUTE DAYS
FY 2012
FY 2013
SWING BED DAYS
2,500
4,500
4,000
2,000
3,500
3,000
1,500
1,000
86
2,500
2,000
2,089
1,594
4,008
3,144
1,500
1,482
500
1,000
500
0
871
0
FY 2011
FY 2012
FY 2013
FY 2011
VI-2
FY 2012
FY 2013
Pungo Hospital Utilization Data: Graphs (Continued)
INPATIENT SURGERY
Lab Tests
50
35,000
30,000
40
25,000
30
20,000
45
20
15,000
34
30,615
28,196
10,000
10
24,118
5,000
0
FY 2011
FY 2012
0
FY 2013
0
FY 2011
OUTPATIENT SURGERY
FY 2013
OP Visits
250
6,000
200
5,000
4,000
150
100
FY 2012
215
3,000
209
5,067
5,316
4,960
FY 2011
FY 2012
FY 2013
2,000
50
1,000
0
FY 2011
FY 2012
0
FY 2013
VI-3

ER Visits
Radiograph
7,000
8,000
6,000
7,000
5,000
6,000
4,000
5,000
3,000
5,488
5,412
4,000
5,928
3,000
2,000
6,985
5,160
2,000
1,000
1,000
0
FY 2011
FY 2012
FY 2013
FY 2011
Ultrasound
1,800
1,600
1,400
1,200
1,000
800
600
400
200
0
350
300
250
150
359
312
100
50
87
0
FY 2011
FY 2012
FY 2012
FY 2013
CT Scans
400
200
4,254
FY 2013
VI-4
1,534
1,142
1,056
FY 2011
FY 2012
FY 2013

MRI
FTEs Per AOB
300
250
3.5
3
200
150
2.5
269
100
2
239
1.5
202
3.8
FY 2012
FY 2013
50
0.5
0
FY 2011
FY 2012
FY 2013
Bad Debt % of Pat Rev
0
FY 2011
Contractual as % of Pat Rev
12.00%
40.00%
10.00%
35.00%
30.00%
8.00%
25.00%
6.00%
20.00%
9.6%
4.00%
15.00%
35.3%
33.6%
FY 2012
FY 2013
10.00%
4.8%
2.00%
0.00%
3.6
5.00%
0
FY 2011
0.00%
FY 2012
FY 2013
VI-5
0
FY 2011

MRI
300
250
200
150
269
100
239
202
50
0
FY 2011
FY 2012
FY 2013
VI-6
ATTACHMENT THREE
Letter from the National Rural Health Association
National Rural Health Letter regarding OIG
ATTACHMENT FOUR
Stroudwater Replacement Hospital Study 2011

Pungo District Business Plan

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Pungo District Business Plan

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Rural Community Hospitals of America LLC

Community Next Step

Primary Service Area

Feasibility Key Assumptions

Feasibility Key Assumptions (Continued)

Feasibility Study: Income Statement

Total Operating Revenues

Net Patient Service Revenue

Feasibility Study: Sources and Uses of Cash

Sources & Uses of Cash:

Feasibility Study: Balance Sheet (Assets)

Feasibility Study: Balance Sheet (Liabilities)

Community Next Steps

Community Next Steps (continued)

Community Steps (continued)

Community Steps (continued)

Drumright Regional Hospital (acquired)

Community Next Steps (continued): Sample New Facility Drumright

Net Patient Services Revenue

FYTD January 2014

Net Income Before Taxes

Community Next Steps (continued): Sample New Facility Drumright Volumes

FYTD January 2014

Avg Length of Stay

Pungo Hospital - Primary Service Area: Map

PSA Population makes

Pungo Hospital Primary Service Area: Demographic Summary

Median Household Income

Average Household Income

Average Household Size

North Carolina Demographics

Median Household Income

Average Household Income

Average Household Size

Pungo Hospital Primary Service Area: Population by Age

Pungo Hospital - Primary Service Area: Population by Race

Hawaiian / Pacific Islander

Pungo Hospital Primary Service Area: Educational Attainment

Educational Attainment Age 25+ (2010)

12th grade no diploma

Professional school degree

Pungo Hospital Primary Service Area: Personal Healthcare Expenditure

PSA Personal Healthcare Expenditures

Expenditu Area Exp

Total Health Care

Health Care Insurance

Health Care Services

Other Medical Services

Health Care Supplies & Equipment

Pungo Hospital Primary Service Area: Households with Debt

Households Having A Mortgage Debt

Installment Payment Debt

Other Lines of Credit Debt

Investment Real Estate Debt

Credit Card Debt

Hhlds with Any Debt

Pungo Hospital - Primary Service Area: 2010 Occupation

Business and financial operations occupations

Computer and mathematical occupations

Architecture and engineering occupations

Life, physical, and social science occupations

Community and social service occupations

Health diagnosing and treating practitioners and other technical 160

Education, training, and library occupations