Effects of the System Restructuring and Support Agreement by and among Daughters of Charity Ministry Services Corporation, Daughters of Charity Health System, Certain Funds Managed by BlueMountain Capital Management, LLC, and Integrity Healthcare, LLC on the Availability and Accessibility of Healthca r e Services to the Communities Served by Seton Medical Center Prepared for the Office of the California Attorney General ­ October 2, 2015 ­ MDS Consulting, a VHA business ­ 24596 Hawthorne Boulevard ­ Torrance, CA 90505 ­ P: 424 237 2525 ■ F: 424 247 8248 ­ www.MDSconsulting.com ­ © 2015 VHA Inc. All rights reserved. TABLE OF CONTENTS ­ INTRODUCTION & PURPOSE ............................................................................................................................... 5 ­ Reasons for the Transaction ..................................................................................................................... 8 ­ Transaction Process and Objectives ......................................................................................................... 8 ­ Timeline of the Transaction .................................................................................................................... 13 ­ Summary of Agreements ........................................................................................................................ 17 ­ System Restructuring and Support Agreement ...................................................................................... 18 ­ Transitional Consulting Services Agreement .......................................................................................... 22 ­ Debt Facility Commitment Letter ........................................................................................................... 24 ­ Deposit Escrow Agreement..................................................................................................................... 24 ­ Purchase Option Agreements ................................................................................................................. 25 ­ IT Agreement .......................................................................................................................................... 26 ­ Mitigation Plans ...................................................................................................................................... 27 ­ Performance Improvement Plan............................................................................................................. 28 ­ Health System Management Agreement ............................................................................................... 28 ­ Use of Net Sale Proceeds ........................................................................................................................ 30 ­ PROFILE OF DAUGHTERS OF CHARITY HEALTH SYSTEM ......................................................................................... 31 ­ Daughters of Charity Health System ....................................................................................................... 31 ­ Daughters’ Inpatient Volume .................................................................................................................. 34 ­ Financial Profile ....................................................................................................................................... 34 ­ Daughters’ Payer Mix .............................................................................................................................. 39 ­ Unionized Employees .............................................................................................................................. 40 ­ PROFILE OF THE HOSPITAL & SETON COASTSIDE .................................................................................................. 41 ­ Seton ....................................................................................................................................................... 41 ­ Overview of the Hospital ........................................................................................................................ 42 ­ Key Statistics ........................................................................................................................................... 43 ­ Programs and Services ............................................................................................................................ 44 ­ Accreditations, Certifications, and Awards ............................................................................................. 45 ­ Quality Measures .................................................................................................................................... 46 ­ Seismic Issues .......................................................................................................................................... 48 ­ Measure A Funding ................................................................................................................................. 49 ­ Master Plan ............................................................................................................................................. 50 ­ Patient Utilization Trends ....................................................................................................................... 51 ­ Payer Mix ................................................................................................................................................ 53 ­ Medi-Cal Managed Care ......................................................................................................................... 54 ­ Medical Staff ........................................................................................................................................... 55 ­ Unionized Employees/Associates ........................................................................................................... 56 ­ Financial Profile ....................................................................................................................................... 57 ­ Capital Expenditures ............................................................................................................................... 58 ­ Cost of Hospital Services ......................................................................................................................... 58 ­ Charity Care ............................................................................................................................................. 59 ­ Community Benefit Services ................................................................................................................... 60 ­ PROFILE OF BLUEMOUNTAIN & INTEGRITY ......................................................................................................... 62 ­ BlueMountain Capital Management, LLC ............................................................................................... 62 ­ Integrity Healthcare, LLC ......................................................................................................................... 63 ­ ANALYSIS OF THE HOSPITAL’S SERVICE AREA ....................................................................................................... 65 ­ Service Area Definition ........................................................................................................................... 65 ­ 2 ­ Service Area Map .................................................................................................................................... 66 ­ Health Professional Shortage Areas, Medically Underserved Areas, & Medically Underserved ­ Populations ............................................................................................................................................. 67 ­ STEMI Receiving Centers in San Mateo County ...................................................................................... 69 ­ Certified Stroke Centers in San Mateo County ....................................................................................... 70 ­ Demographic Profile ............................................................................................................................... 71 ­ Medi-Cal Eligibility .................................................................................................................................. 73 ­ Selected Health Indicators ...................................................................................................................... 73 ­ 2013 Community Health Needs Assessment .......................................................................................... 75 ­ Hospital Supply, Demand, & Market Share ............................................................................................ 76 ­ Hospital Market Share ............................................................................................................................ 77 ­ Market Share by Payer Type ................................................................................................................... 78 ­ Market Share by Service Line .................................................................................................................. 79 ­ Market Share by ZIP Code ....................................................................................................................... 80 ­ Service Availability by