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" '() -./34569:;<6   FGHI JK L L"$8/;K$AB]:4 "$KOf67cI R$-o0%eZawmc6"$-_nD6Քu"$-ppoyʕfJ+z"$Idk"[`g-"$+c$12ji1$"$$>۹ʚ. "$o&9.+DE"${rn eK}-/"$?;9 PWcU 2$$$$$$$$$$$$$"$` Drʙ-U > 0e0e    f A@ A5% 8c8c     ?1 d0u0@Ty2 NP'p<'pA)BCD|E||s " 0e@        @ABC DEEFGHIJK5%LMNOPQRSTUWYZ[ \]^_ `abN E5%  N E5%  N F   5%    !"?N@ABC DEFFGHIJK5%LMNOPQRSTUWYZ[ \]^_ `abp Ufwwwf@8 g4BdBdF0(p@p@ Qʚ; f8ʚ;<4!d!d<@0<<4dddd<@0<<4dddd<@0<x~0___PPT10 >___PPT9 / 0z?  O  =y BReport on the Capital Crisis: Impact on Hospitals January 2009 65(4  BackgroundjHospitals primarily rely on borrowed money, philanthropy and reserves to provide the capital required to update facilities and purchase life-saving technologies to meet community needs.* Borrowed money (debt) primarily comes from bond offerings and loans from banks and other financial institutions. Philanthropy refers to charitable donations received by hospitals from organizations or individuals. Reserves refer to the savings hospitals build up over time by having a positive net income and a return on invested money. Capital refers to the money used to fund investments in facilities and equipment. This report provides the results of the AHA Survey,  The Capital Crisis: Survey of Impact on Hospitals. Survey was sent to all non-federal hospital CEOs in late December 2008 via fax and e-mail. Data was collected through January 6, 2009. A total of 639 responses were received. Sample is representative of the non-federal hospital field.4  k  _c Z rKkSurvey HighlightsHospitals ability to borrow is severely constrained. 9 out of 10 hospitals are finding it harder or even impossible to access to tax-exempt bonds  a critical source of borrowing for the majority of hospitals. Other important sources of debt such as banks and other financial institutions are becoming more difficult to access as well. 9 out of 10 hospitals report that attracting charitable donations has become harder. The broader effects of the economic slowdown play into hospital capital decisions as uncertainty mounts, operating performance declines and the value of reserves falls due to stock market and other investment woes. Nearly half of hospitals have put capital projects on hold and many have even stopped projects already in process. Of those hospitals putting projects on hold: 82% have put facilities projects on hold. 65% have put clinical technology projects on hold. 62% have put information technology projects on hold. Postponing capital projects affects a hospital s ability to meet community needs as well as move toward larger U.S. health care system goals such as improved quality, efficiency and coordination of care.~6     6eBTax-exempt bonds are a critical source of financing for hospitals.CCqMany hospitals find it significantly more difficult or even impossible to access tax-exempt bonds and other sources of capital.  }The highest percentage of hospitals are postponing facilities projects, with clinical and information technology projects close behind.ztA number of factors related to the current economic crisis play a role in the decision to postpone capital projects.uu[Postponed facilities projects would respond to a variety of community health service needs.\\TPostponing facilities projects affects a hospital s ability to meet community needs and meet larger U.S. health care system goals such as improved quality and efficiency.Postponed clinical technology purchases were expected to ensure equipment is up-to-date as well as improve quality and efficiency for the majority of hospitals putting such projects on hold.   VProjects put on hold represent the majority of the capital budget for these hospitals.WW /f5r9{<?@BCGH>  0` ̙33` ` ff3333f` 333MMM` f` f` 3>?" dd@?" dd@ @` n?" dd@   @@``PV   @ ` `p>> N0 PH  (    0ߑ   =Click to edit presentation title Click to edit presentation content Click to edit presentation body copy Click to edit presentation body copy Click to edit presentation body copy Click to edit subtopic material Click to edit subtopic material!#p@    6 @@  QClick to edit slide title  f  0 -"@  6"@ J$0     0, "^ `  Z*H  0޽h ? ̙33  2_Default Design 0 N0 4, (    6t `  T Click to edit Master title style! !f  0 -"@  6"@ J$0  ~  C HA0AHA_ppt A ReverseLogoSm"@ `H  0޽h ? ̙330 (    NXmĶmĶ z'   n*  N''NNuu  NPmĶmĶ  @'  p*  N''NNuud  c $ ?da  4  NlmĶmĶ  MU  RClick to edit Master text styles Second level Third level Fourth level Fifth level!     S   TmĶmĶ z   n*  N''NNuu   TpmĶmĶ  @  p*  N''NNuuH  0.k ? ̙3380___PPT10.\$p ,(  ,  , N!mĶmĶ z'   v* N''NNuu , N%mĶmĶ  @'  x* N''NNuu , T/mĶmĶ z   v* N''NNuu , Tl:mĶmĶ  @  x* N''NNuuH , 0.k ? ̙3380___PPT10.\$l0 N0 {s (    0l `    G  Tf ?"6@ NNN?N>g /EMBARGOED UNTIL JANUARY 22, 2009 AT 11:30 AM ET00*H  0޽h ? ̙33y___PPT10Y+D=' = @B + 0 N0 `8 (  8 ~ 8 s *xK@@   x 8 c $PL  M 8 TMf ?"6@ NNN?N` W*Equity (selling an ownership share) is another less frequently used source of capital.XX H 8 0޽h ? ̙33___PPT10i.i` l+D=' = @B + 0 N0 6(  ~  s *HO@@   x  c $Th  H  0޽h ? ̙33___PPT10i.i` l+D=' = @B + 50  |h(  | |0 HA ?'   | 0zZ VPercent of Hospitals by Importance of Various External Sources of Capital to HospitalsWW | 6s WV bEquity/Venture Capital0G | 6 >WH  Y Taxable Bonds0 G | 6 W-  X Philanthropy0  G | 6$P5\ o#Banks/Financial Services Companies0$#G  | 6,zqW \Tax-exempt Bonds0G  | H @@   H | 0޽h ? ̙33y___PPT10Y+D=' = @B +F  90 me (   0 HA ?     0p OPercent of Hospitals* Finding Access to Various Types of Capital More DifficultPP  6u   bEquity/Venture Capital0G  64[ n  Y Taxable Bonds0 G  6B   X Philanthropy0  G  6  e o#Banks/Financial Services Companies0$#G  6(  \Tax-exempt Bonds0G   Tlf ?"6@ NNN?N *Excludes those hospitals indicating that they don t use that source of capitalPP    H  @@   H  0޽h ? ̙33y___PPT10Y+D=' = @B +: 0 aY(    00 d OPercent of Hospitals Postponing Capital Projects because of Economic Situation *P O 0  `A ?     6 @ rNearly half of hospitals surveyed are postponing capital projects and some even stopped those already in progress.ssH  0޽h ? ̙33y___PPT10Y+D=' = @B + 0  (  ~  s *@@   3  0d Percent of Hospitals by Type of Project Put on Hold [Includes only those hospitals that indicated they had put projects on hold]63M 0  `A ?   H  0޽h ? ̙33y___PPT10Y+D=' = @B + <0 $p(   0 HA ?{`  $  0ph rPercent of Hospitals Indicating Key Factors as  Very or  Somewhat Important in Decision to Put Projects on Hold [Includes only hospitals that indicated they had put projects on hold] 6 rH   H @@   :   3 3f<q   6 y  ZVery Important0G :   3 < y   6x  P ^Somewhat Important0G H  0޽h ? ̙33y___PPT10Y+D=' = @B + @0 C;P(   0 HA ?  [  0lph Percent of Hospitals Citing Services Affected by Facilities Projects Put on Hold [Includes only those hospitals that indicated they had put facilities projects on hold] 6 QY  H  @@   H  0޽h ? ̙33y___PPT10Y+D=' = @B +- ?0 TL0(   0 HA ?I  l  0p{ Percent of Hospitals Citing Anticipated Benefits of Facilities Projects Put on Hold [Includes only those hospitals that indicated they had put facilities projects on hold] D SY  H< @@   H  0޽h ? ̙33y___PPT10Y+D=' = @B +2 B0 YQ(   0 HA ?y  q  0$. 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" '() -./34569:;<6   FGHI JK L L"$8/;K$AB]:4 "$KOf67cI R$-o0%eZawmc6"$-_nD6Քu"$-ppoyʕfJ+z"$Idk"[`g-"$+c$12ji1$"$$>۹ʚ. "$o&9.+DE"${rn eK}-/"$?;9 PWcU 2$$$$$$$$$$$$$"$` Drʙ-U > 0e0e    f A@ A5% 8c8c     ?1 d0u0@Ty2 NP'p<'pA)BCD|E||s " 0e@        @ABC DEEFGHIJK5%LMNOPQRSTUWYZ[ \]^_ `abN E5%  N E5%  N F   5%    !"?N@ABC DEFFGHIJK5%LMNOPQRSTUWYZ[ \]^_ `abp Ufwwwf@8 g4BdBdsF0(p@p@ Qʚ; f8ʚ;<4!d!d@0<4dddd@0<4dddd@0x~0___PPT10 >___PPT9 / 0z?  O  =y BReport on the Capital Crisis: Impact on Hospitals January 2009 65(4  BackgroundjHospitals primarily rely on borrowed money, philanthropy and reserves to provide the capital required to update facilities and purchase life-saving technologies to meet community needs.* Borrowed money (debt) primarily comes from bond offerings and loans from banks and other financial institutions. Philanthropy refers to charitable donations received by hospitals from organizations or individuals. Reserves refer to the savings hospitals build up over time by having a positive net income and a return on invested money. Capital refers to the money used to fund investments in facilities and equipment. This report provides the results of the AHA Survey,  The Capital Crisis: Survey of Impact on Hospitals. Survey was sent to all non-federal hospital CEOs in late December 2008 via fax and e-mail. Data was collected through January 6, 2009. A total of 639 responses were received. Sample is representative of the non-federal hospital field.4  k  _c Z rKkSurvey HighlightsHospitals ability to borrow is severely constrained. 9 out of 10 hospitals are finding it harder or even impossible to access to tax-exempt bonds  a critical source of borrowing for the majority of hospitals. Other important sources of debt such as banks and other financial institutions are becoming more difficult to access as well. 9 out of 10 hospitals report that attracting charitable donations has become harder. The broader effects of the economic slowdown play into hospital capital decisions as uncertainty mounts, operating performance declines and the value of reserves falls due to stock market and other investment woes. Nearly half of hospitals have put capital projects on hold and many have even stopped projects already in process. Of those hospitals putting projects on hold: 82% have put facilities projects on hold. 65% have put clinical technology projects on hold. 62% have put information technology projects on hold. Postponing capital projects affects a hospital s ability to meet community needs as well as move toward larger U.S. health care system goals such as improved quality, efficiency and coordination of care.~6     6eBTax-exempt bonds are a critical source of financing for hospitals.CCqMany hospitals find it significantly more difficult or even impossible to access tax-exempt bonds and other sources of capital.  }The highest percentage of hospitals are postponing facilities projects, with clinical and information technology projects close behind.ztA number of factors related to the current economic crisis play a role in the decision to postpone capital projects.uu[Postponed facilities projects would respond to a variety of community health service needs.\\TPostponing facilities projects affects a hospital s ability to meet community needs and meet larger U.S. health care system goals such as improved quality and efficiency.Postponed clinical technology purchases were expected to ensure equipment is up-to-date as well as improve quality and efficiency for the majority of hospitals putting such projects on hold.   VProjects put on hold represent the majority of the capital budget for these hospitals.WW /f5r9{<?@BCGH0 N0 ,$(    0  P   H  0޽h ? ̙33y___PPT10Y+D=' = @B +rW_# W1 ՜.+,0H    On-screen ShowMonigleM ' TimesArialTimes New Roman2_Default DesignMicrosoft Graph ChartSlide 1 BackgroundSurvey HighlightsCTax-exempt bonds are a critical source of financing for hospitals.Many hospitals find it significantly more difficult or even impossible to access tax-exempt bonds and other sources of capital. Slide 6The highest percentage of hospitals are postponing facilities projects, with clinical and information technology projects close behind.uA number of factors related to the current economic crisis play a role in the decision to postpone capital projects.\Postponed facilities projects would respond to a variety of community health service needs.Postponing facilities projects affects a hospitals ability to meet community needs and meet larger U.S. health care system goals such as improved quality and efficiency.Postponed clinical technology purchases were expected to ensure equipment is up-to-date as well as improve quality and efficiency for the majority of hospitals putting such projects on hold. Slide 13WProjects put on hold represent the majority of the capital budget for these hospitals.  Fonts UsedDesign TemplateEmbedded OLE Servers Slide Titles_㜨cdokocdoko