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2020 Audit Results Alameda Health System — a Public Hospital Authority

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2020 Audit Results Alameda Health System — a Public Hospital Authority Image Size 4” x 10.33” 2020 Audit Results Alameda Health System — A Public Hospital Authority November 17, 2020 Dear Audit Committee Members: Audit CommitteeCommittee Thank you for your continued engagement of Moss Adams LLP. We are pleased to have the opportunity to meet with you to discuss the results of our audit of the financial statements and federal program compliance of Alameda [Client] Health System (“the Health System”) for the year ended Alameda Health June 30, 2020. System – A Public The accompanying report, which is intended solely for the Health Authority use of the Audit Committee and management, presents important information regarding the financial statements of the Health System and our audit that we believe will be of interest to you. It is not intended for and should not be used by anyone other than these specified parties. 1 We conducted our audit with the objectivity and independence that you expect. We received the full support and assistance of the Health System’s personnel. We are pleased to serve and be associated with the Health System as its independent public accountants and look forward to our continued relationship. We look forward to discussing our report or any other matters of interest with you during this meeting. Your Dedicated Team Brian Conner, Kate Jackson, CPA CPA Engagement Concurring Other Team Partner Partner Members: Lisa Schick 2 Engagement In-Charge Glenn Bunting, John Feneis, Director, CPA Third-Party Engagement Reimbursement Senior Manager Practice, HCCG Agenda • Auditor Opinion & Report • Communication with Those Charged with Governance • Financial Highlights • Health Care Industry Focus 3 Auditor Opinion & Report Scope of Services We have performed the following services for Alameda Health System: • Annual financial statement audit for the year ended June 30, 2020 We have also performed the following nonattest services: • Assisted with tax preparation services 5 We will also perform the following nonattest services: • Annual single audit for the year ended June 30, 2020 • Assist with preparation of the auditee portion of the Data Collection Form Our Responsibility To express our opinion on To perform an audit in To consider internal control To communicate findings whether the financial accordance with generally over financial reporting as that, in our judgment, are statements prepared by accepted auditing a basis for designing audit relevant to your management with your standards issued by the procedures but not for the responsibilities in oversight are fairly AICPA, Government purpose of expressing an overseeing the financial presented, in all material Auditing Standards issued opinion on its effectiveness reporting process. respects, and in by the Comptroller General or to provide assurance However, we are not 6 accordance with U.S. of the United States, concerning such internal required to design GAAP. However, our audit and design the audit to control. procedures for the purpose does not relieve you or obtain reasonable, rather of identifying other matters management of your than absolute, assurance to communicate to you. responsibilities. about whether the financial statements are free of material misstatement. Auditor Report on the Financial Statements Unmodified Opinion • Financial statements are presented fairly and in accordance with U.S. GAAP 7 Other Auditor Reports GAGAS Report on Internal Control Over • No financial reporting findings Financial Reporting and on Compliance and • No compliance findings Other Matters 8 Communication with Those Charged with Governance Communication with Those Charge with Governance • Significant accounting policies • Accounting estimates are reasonable • No audit adjustments • No issues discussed prior to our retention as auditors 10 • No disagreements with management • No material weaknesses identified • No awareness of instances of fraud or noncompliance with laws and regulations Single Audit Requirement – CARES Act Grant Funding Provider Relief Grant Funds Received • Approximately $15.8 million received as of June 30, 2020. • Nonfederal entities that expend financial assistance of The receipt of HHS Grant $750,000 or more in federal awards will have a single or Funding under the CARES program-specific audit for their fiscal year that include the Act will likely subject the periods the funds are expended. District to a Single Audit • Additional guidance on what qualifies as a healthcare- under the Uniform related expense attributable to COVID-19 and what qualifies Guidance 11 as lost revenue was released in September and October 2020 . • More guidance is expected by November 2020. • Will require audits to also be conducted in accordance with government auditing standards. • Providers will have 9 months after their fiscal year end to file their Single Audit report. Financial Highlights Assets and Deferred Outflows (in millions) 2018 = $650 $300 2019 = $755 $250 2020 = $703 197 $200 189 180 174 154 151 $150 13 127 135 120 122 111 $100 84 90 86 71 $50 24 24 25 19 16 9 $0 Cash and Patient A/R, Due from Other current Capital Restricted Deferred cash net 3rd party assets assets, net cash outflows equivalents equivalents Liabilities and Deferred Inflows (in millions) $600 2018 = $925 502 $500 2019 = $1,055 2020 = $981 $400 356 342 $300 14 201 $200 181 185 131 120 109 108 98 83 83 $100 86 72 56 60 55 46 57 30 $0 A/P Due to Other current Liquidity Net pension Other Deferred 3rd party liabilities facility liability noncurrent inflows liabilities Net Patient Service Accounts Receivable Dollars (in millions) % Net Revenues $150 $127 $120 30.0% $125 22.5% $84 25.0% 21.2% $100 16.4% 20.0% $75 15.0% 15 $50 10.0% $25 5.0% $0 0.0% 2018 2019 2020 2018 2019 2020 Total Operating Expenses Year-to-Year Comparison Total Operating Expenses (in millions) June 30, 2019 June 30, 2018 $1,085 $1,075 Salaries, Wages 69% & Benefits 70% Physician Contract 16 Services Purchased Services 8% 9% Materials & Supplies Facilities 8% 7% Depreciation & Amortization 8% 8% Other 3% 1% 3% 2% 2% 2% Health Care Industry Focus Moss Adams At Moss Adams, we bring more West to business. More than a geographic focus, our concept of West embodies our spirit of optimism, openness, and enterprise. With a rare blend of inspiration and technical excellence, we empower our clients to discover and claim the future. This means you’ll get much more than just accounting, consulting, and wealth management services—you’ll get strategic and timely business advice. 18 Distinguished for our depth of industry knowledge, we take the time to understand each client’s business or individual situation, anticipate needs, and identify gaps before they become obstacles. This way, clients can grow, manage, and protect their prosperity with confidence. Our Expertise Our Reach 107 years in business 3,400+ professionals 19 25+ 110+ $768M locations countries served in revenue west of the through Praxity, AISBL earned 30+ Mississippi industries served Grand Canyon— At 277 miles long and up to 18 miles Crater Lake— wide, this icon serves as a testament A monument to perseverance, North America’s to determination and time. deepest lake filled to 1,949 feet over 720 years. Health Care Industry Experience Our health care professionals dedicate their careers to serving the industry. 3,400+ clients across the We cover the full spectrum of health care including: nation • Hospitals and health systems • Independent practice associations • Medical groups 40 20 • Community health centers practice partners • Behavioral health organizations • Long-term care • Surgery centers • Knox Keene licensed health plans 290+ professionals • Health care ancillary services Crater Lake— A monument to perseverance, North America’s deepest lake filled to 1,949 feet over 720 years. Hospitals & Health Systems Moss Adams has a dedicated Hospitals Practice serving more than 945 hospitals and hospital systems, ranging in size from 15 to over 1,600 beds, across the nation. Our work extends well beyond traditional accounting services and includes consulting and assistance on an array of issues in health care financial management. We leverage our deep knowledge of the national marketplace and local competitive environments to provide customized solutions that 21 make a difference to your organization. Who we serve: • Integrated health systems • University-based hospitals • Tertiary care teaching hospitals • Community and sole community hospitals • Hospital districts • Critical access hospitals • For-profit and not-for-profit • Pediatric hospitals organizations HEALTH CARE CONSULTING & ADDITIONAL EXPERTISE OPERATIONAL PROVIDER REIMBURSEMENT GOVERNMENT COMPLIANCE IMPROVEMENT Medicare & Medicaid Regulatory Compliance Revenue Cycle Enhancement Provider-based Licensure & Coding Validation Claims Recovery Certification Coding Department Redesign Additional Medical Education Litigation Support Services Uncompensated Care EHR Internal Controls Employer Health Benefits Medicare DSH Analysis & Corporate Compliance Financial Turnaround Appeals Worksheet S-10 LEAN TRANSFORMATION Performance Excellence Audit and tax are vital. But 3P & Innovation: redesign you have complex needs STRATEGY & INTEGRATION INFORMATION TECHNOLOGY processes, products, facilities that go beyond these core 22 functions. Our dedicated Provider Risk Analysis, Lean Management Systems and HIPAA Security and Privacy Contracting & Operational Design Strategy Deployment health care consulting team Network Security & Penetration provides a range of services M&A Support Lean operations Testing
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