SUNY Board of Trustees

Audit Committee Presentation

October 28, 2011

Stony Brook University Hospital, Stony Brook University

REPORT ON RESULTS OF 2010 AUDITS OF:

University Hospital of Brooklyn – State University of New York Health Science Center of Brooklyn

University Hospital of the State University of New York Upstate Medical Center

Presentation Outline

Required Communications to those Charged with Governance

Highlights of Audited Financial Statements

Hospital Financial Ratios

Required Communicationswith those Charged

with Governance

Required Communications with those Charged with Governance

Auditor’s Responsibility under Generally Accepted Auditing Standards Plan and perform an audit of the annual financial statements as of December 31, 2010 to

obtain reasonable assurance about whether the financial statements are free of material misstatements, whether caused by error or fraud. An audit in accordance with auditing standards generally accepted in the United States of America does not provide absolute assurance relative to or any guarantee of the accuracy of the financial statements and is subject to the inherent risk that errors or fraud, if they exist, may not be detected.

Professional standards also require that we obtain a sufficient understanding of the Hospitals’ internal control to plan the audits of the financial statements. However, such understanding is required for the purpose of determining our audit procedures and not to provide any assurance concerning such internal control. Our audit procedures may identify significant deficiencies or material weaknesses in internal control which would be communicated, in writing. As a result of our audit procedures, we did not identify any significant deficiencies or material weaknesses in internal control.

The auditor is responsible for communicating significant matters related to the financial statement audits that are, in the auditor’s professional judgment, relevant to the responsibilities of those charged with governance in overseeing the financial reporting process.

Required Communications with those Charged with Governance

Qualitative Aspects of Accounting Practices Generally accepted accounting principles provide for the Hospitals to make

accounting estimates and judgments about the accounting policies and financial statement disclosures.

Management is responsible for the selection and use of appropriate accounting policies.

No new accounting policies were adopted and the application of existing policies was not changed during 2010.

We noted no transactions entered into by the Hospitals during the year for which there is a lack of authoritative guidance or consensus.

All significant transactions have been recognized in the financial statements in the proper period.

There were no significant changes to the accounting policies used by the Hospitals as described in note 1 to the financial statements for SUNY Upstate and note 2 to the financial statements for Stony Brook and Brooklyn.

Required Communications with those Charged with Governance

Management Judgments and Accounting Estimates Accounting estimates are an integral part of the financial statements prepared by

management and are based on management’s knowledge and experience about past and current events and assumptions about future events. Certain accounting estimates are particularly sensitive because of their significance to the financial statements and because of the possibility that future events affecting them may differ significantly from those expected.

The most sensitive estimates affecting the Hospitals’ financial statements were: Allowances for doubtful accounts and allowances for contractual adjustments in

order to present patient accounts receivable at the net realizable amount. The Hospitals operate under reimbursement contracts with third parties which

provide for various retroactive and prospective adjustments and settlements. The Hospitals maintain insurance coverage for professional and general liability

through the NYS self insurance program. A provision is made for estimated medical malpractice claims (including estimates of the ultimate costs for both reported claims and claims incurred but not reported) based on information provided by the Office of NYS Attorney General and estimated actuarial assumptions. The Hospitals record an offsetting receivable for the same amount.

We evaluated the key factors and assumptions used to develop these estimates in determining that they are reasonable in relation to the financial statements taken as a whole.

Required Communications with those Charged with Governance

Corrected and Uncorrected MisstatementsProfessional standards require us to accumulate all known and likely misstatements

identified during the audit, other than those that are trivial, and communicate them to the appropriate level of management. The following misstatements were detected as a result of audit procedures performed:

Upstate - the following misstatements detected were corrected by management: Accrued expenses and supplies and other expense were both decreased by

approximately $1.9m to properly reflect contracts payable. Accrued benefits and employee benefits expense were both increased by

approximately $1.4m to properly adjust the sick leave accrual.Upstate - the following unadjusted differences, which are considered to be immaterial,

were not corrected by management: Understatement of the balance sheet of $635k and overstatement of changes in net

assets of $557k, related to net revenue charge postings, capital assets, and employee benefits expense.

Stony Brook - there were no misstatements identified during the audit.Brooklyn - there were no misstatements identified during the audit.

 

Required Communications with those Charged with Governance

Disagreements with Management

Professional standards define a disagreement with management as a financial accounting, reporting or auditing matter, whether or not resolved to our satisfaction, that could be significant to the financial statements or the auditor’s report. We are pleased to report that no such disagreements arose during the course of our audits.

Management Representations

We have requested certain representations from management that are included in the respective Hospitals’ management representation letters.

Management Consultations with Other Independent Accountants

In some cases, management may decide to consult with other accountants about auditing and accounting matters, similar to obtaining a “second opinion” on certain situations. If a consultation involves application of an accounting principle to the Hospitals’ financial statements or a determination of the type of auditor’s opinion that may be expressed on those statements, our professional standards require the consulting accountant to check with us to determine that the consultant has all the relevant facts. To our knowledge, there were no such consultations with other accountants.

 

 

Required Communications with those Charged with Governance

Other Audit Findings or Issues

We generally discuss a variety of matters, including the application of accounting principles and auditing standards, with management each year prior to retention as the Hospitals’ auditors. However, these discussions occurred in the normal course of our professional relationship and our responses were not a condition to our retention.

 

 

Highlights of the Audited Financial Statements

Highlights of the Audited Financial Statements

2010 2009 2010 2009 2010 2009 2010 2009

ASSETS 976,430 955,009 617,399 558,551 781,945 791,887 2,375,774 2,305,447

LIABILITIES 628,548 638,336 512,414 456,614 671,595 668,758 1,812,557 1,763,708

NET ASSETS 347,882 316,673 104,985 101,937 110,350 123,129 563,217 541,739

OPERATING REVENUES 832,555 767,164 542,034 504,800 464,328 453,991 1,838,917 1,725,955

OPERATING EXPENSES 829,105 771,097 574,505 512,327 513,629 532,790 1,917,239 1,816,214

CHANGE IN NET ASSETS 31,209 34,727 3,047 23,955 (12,779) (1,884) 21,477 56,798

(In thousands of $)

UpstateStony Brook Downstate Total

Hospital Financial Ratios

Hospital Financial Ratios

Desired

trend 2010 2009 2008 2010 2009 2008 2010 2009 2008 2009 2008

DAYS CASH ON HAND p 61 63 36 47 40 4 46 54 25 14 3

DAYS IN ACCOUNTS RECEIVABLE p 63 71 91 60 64 68 61 67 66 65 61

CURRENT RATIO p 2.0 2.2 2.2 1.3 1.4 1.3 1.5 1.8 2.0 1.9 1.6

DEBT TO EQUITY RATIO p 0.7 0.8 0.9 2.7 2.4 2.9 1.1 0.9 0.9 N/A N/A

OPERATING MARGIN * p 3.9% 4.6% 3.1% 1.0% 6.0% -11.7% -3.3% -2.2% 1.0% 0.3% -1.9%

NET MARGIN p 3.9% 4.6% 7.2% 0.6% 4.9% -5.4% -2.8% -0.4% 3.3% N/A N/A

NYS APPROPRIATIONS (in millions) 55.4 69.3 72.5 42.4 46.5 48.5 41.2 47.1 51.1 N/A N/A

(excluding professional liability

insurance expense/benefit)

* Calculated using excess (deficiency) of revenue over expenses

State Hospital organizations.

UpstateStony Brook Governmental**

** 2011 Ingenix Almanac of Financial and Operating Indicators. Amounts included represent the median values for Government-

Downstate