Local News: NRMC Board Discusses Long Term Care Debt (8/31/22)


The Nevada Regional Medical Center Board of Trustees met in regular session Tuesday evening. Much of the meeting discussion was used to discuss the financial relationship between the hospital and the Long Term Care Commission.

Photo by Sarah Haney | Daily Mail Editor

The Nevada Regional Medical Center Board of Trustees met in regular session Tuesday evening in the hospital’s Mezzanine Conference Room.

Discussing his report, NRMC Managing Director Jason Anglin had several things to note. “In July, the first month of our fiscal year, we recorded a net operating loss of $81,173 and a net profit of $11,204,” he said. “Comparatively, a nice improvement from a net loss of $399,151 in June.”

July also did not include recognition of earnings for the Paycheck Protection Program (PPP) COVID relief and recognition of the Supplier Relief Fund, Anglin noted.

The hospital’s cash bail days increased from 52.2 days to 43.1 days. Gross accounts receivable decreased from 76.2 days to 79.8 days.

Anglin noted that the main behavioral health unit held an open house and grand reopening on Monday, with the unit due to be open September 1.

Giving an update on the HVAC project and energy savings, Anglin added “We have engaged ESP for the detailed energy study. The cost for the next phase of the study is $11,540.”

Then in his report, Anglin discussed bond refinancing. “We are looking at the bond refinancing process,” he said. “This week we had calls with Stifel, an investment bank and financial services company, and Gilmore Bell (Bond Counsel). Stifel provided us with refinancing projections and set out a timeline for us. discussed with Gilmore Bell what elements (other debt, capital) could be considered included in a bond refinance Gilmore Bell drafted a board resolution that would allow us to consider including equity elements in a bond refinance purchased between the adoption of the resolution and the bond refinancing.

Turning to the nature of the financial relationship between the hospital and long-term care, Anglin wanted to clarify the numbers represented as a debt the hospital owes to LTC, and vice versa.

“In February 2017, NRMC entered into a capital lease agreement with Moore-Few Care Center to purchase properties 625 and 627 S. Ash,” he noted. “The terms of the capital lease were for 15 years, with monthly payments and transfer of ownership to NRMC at the end of the lease. Interest was at the 90-day Treasury bill rate adjusted every three years, which at the time was a higher rate than LTC was doing on CDs.”

As it stands, NRMC has paid $490,809.09 in principal and interest on the capital lease through July 31, 2022, leaving a balance of $789,668.83.

Additionally, on June 30, 2017, the hospital’s bond days were 20 and ACA (the bond insurers) worked with the Nevada City Council to change the hospital’s management company and transfer Nevada City Nursing Home Money (Long-Term Care). On November 30, 2017, Long Term Care funded $1,000,000 from NRMC by Nevada City Ordinance.

On June 30, 2018, the hospital’s bail days were 11 and ACA again worked with the city council to transfer long-term care money to the hospital. Nevada City Order 8261 was approved and transferred $650,000 from long-term care to the hospital.

Discussing the financial relationship between the hospital and long-term care, Anglin noted, “Think of NRMC as a supplier to LTC. NRMC provides services to LTC for food, maintenance, HR, etc. .through costs such as employee health insurance claims that are billed to NRMC.These costs are passed on to LTC, as NRMC administers and pays on behalf of LTC and LTC, then, must reimburse NRMC.

The second biggest expense, Anglin added, is the cost of meals. NRMC prepares and delivers meals to Moore-Few Care Center and Barone Alzheimers Care Center and NRMC charges $4 per meal. “This amount has not been adjusted since 2015,” Anglin added. “According to the 2021 cost report, the cost per meal for the hospital was $6. Since the pricing of services provided by NRMC has not been adjusted since 2015, NRMC charges for services provided below cost.

The pass-through costs and service costs provided by NRMC are called “intercompany charges” and are charged to LTC. NRMC does not charge LTC for NRMC’s operational costs – only for the cost of services used by LTC.

Historically, LTC has reimbursed NRMC for these expenses on a monthly basis. As of July 31, 2022, long-term care owed $727,034.44 for expenses from February through July. Normally, this balance that LTC owes NRMC would be around $100,000. “The increase from $100,000 to $700,000 adds to the hospital’s financial challenges and decreases days of available cash,” Anglin added.

In summary, the hospital’s liability to LTC is $2,439,668.83. However, LTC owes NRMC $727,034.44 for expenses and services provided by NRMC. This results in a net balance of $1,712,634.39 for LTC from NRMC.


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