Accounting Standard Updates - HFMA Spring Conference 2018 - PPT Presentation

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Accounting Standard Updates - HFMA Spring Conference 2018 - PPT Presentation
Accounting Standard Updates

HFMA Spring Conference 2018

Presented by:

Kimberly Sokoloff, Health Care Assurance Services Senior Manager

Elizabeth Lasnier, Health Care Assurance Services Manager
Accounting Standard Updates - HFMA Spring Conference 2018 - PPT Presentation
Presenters
HFMA 2018 Spring Conference

                                       Kimberly Sokoloff, CPA
                                       Senior Manager – National Health Care Practice

                                       Kimberly.Sokoloff@mossadams.com

       1

                                       Elizabeth Lasnier, CPA
                                       Manager – National Health Care Practice

                                       Elizabeth.Lasnier@mossadams.com
Accounting Standard Updates - HFMA Spring Conference 2018 - PPT Presentation
Agenda

                              •   Revenue Recognition
HFMA 2018 Spring Conference

                              •   FASB Grants and Contracts Project
                              •   Leases
                              •   NFP Financial Statements
                              •   Financial Instruments
       2
                              •   Other Recent ASUs
                              •   Q&A
Recently Issued FASB Standards
Upcoming Effective Dates: The “Big Three” for NFP
                              Healthcare (Annual FS)
HFMA 2018 Spring Conference

                                    Not-for-Profit
                                      Financial                                    Revenue                               Leases
                                     Statements

       4

                                       CY 2018* (All)                     CY 2018* (Public)                        CY 2019* (Public)
                                                                          CY 2019* (Non-public)                    CY 2020* (Non-public)

                              *or FYs beginning in those years

                              NOTE: “Public” for Revenue and Leases includes NFPs with public debt (conduit or direct)
Revenue Recognition
Revenue Recognition – Scope

                                              •   Lease contracts
                                              •   Insurance contracts
HFMA 2018 Spring Conference

                                              •   Financial instruments
                               All contracts  •   Guarantees
                              with customers, •   Nonmonetary exchanges in the same line of business to facilitate sales
                                  except          to customers

       6

                                               • Contributions
                               Contracts not   • Collaborative arrangements
                              with customers
                               are excluded
Revenue Recognition – Model

                              Core principle:
HFMA 2018 Spring Conference

                                  Recognize revenue to depict the transfer of promised goods or services to
                                  customers in an amount that reflects the consideration to which the entity
                                  expects to be entitled in exchange for those goods or services.

                              Steps to apply the core principle:
       7

                                                                                                         5.
                                    1.                                                               Recognize
                                                       2.               3.              4.            revenue
                                 Identify                          Determine                        when (or as)
                                                   Identify                          Allocate
                               contract(s)                         transaction                            a
                                                 performance                       transaction
                                 with the                             price                         performance
                                                  obligations                         price
                                customer                                                            obligation is
                                                                                                      satisfied
Revenue Recognition – Disclosures

                                                                    •   Revenue recognized from contracts with
HFMA 2018 Spring Conference

                                                                        customers vs. other revenue sources
                              Contracts with Customers
                                                                    •   Impairment losses recognized on
                                                                        receivables or contract assets
                                                                    •   Performance obligation timing*
                                                                    •   Significant payment terms*
                              Performance Obligations               •   Nature of promised goods or services*
                                                                    •   Obligations for returns, refunds, warranty*
       8
                                                                    •   CY revenue for PY obligation*
                                                                    •   Significant financing component*
                                                                    •   Cost of obtaining a contract*
                                                                    •   Portfolio approach
                              Practical expedients and accounting   •   Invoice method
                              policy elections                      •   Immaterial promises
                                                                    •   Shipping and handling
                                                                    •   Sales taxes
                                                                    •   Loss contract unit of account
                                                                                  * Mostly optional for nonpublic entities
Revenue Recognition – Disclosures

                                                                    •   Qualitative and quantitative*
HFMA 2018 Spring Conference

                                                                        disaggregation of revenue into categories
                              Disaggregation of revenue
                                                                        that depict how revenue and cash flows
                                                                        are affected by economic factors
                                                                    •   Opening and closing balances
                                                                    •   Amount of revenue recognized from
                                                                        contract liabilities*
                              Information about contract balances
       9                                                            •   Timing of performance obligation vs. pay*
                                                                    •   Explanation of significant changes in
                                                                        contract balances*
                                                                    •   Transaction price allocated to remaining
                                                                        performance obligations*
                              Remaining performance obligations     •   Quantitative or qualitative explanation of
                                                                        when amounts will be recognized as
                                                                        revenue*

                                                                                  * Mostly optional for nonpublic entities
Revenue Recognition – Disclosures

                                                                   •   Short-term contract exemption
HFMA 2018 Spring Conference

                                                                   •   As-invoiced exemption
                              Remaining performance obligations:
                                                                   •   Sales- or usage-based royalty exemption
                              Optional exemptions
                                                                   •   Directly allocable variable consideration to
                                                                       wholly unsatisfied obligation exemption
                                                                   •   Optional disclosures elected, nature of
                              Optional exemption disclosures           obligation, remaining contract direction,
 10                                                                    additional consideration details
                                                                   •   Timing of satisfaction of performance
                                                                       obligations*
                              Significant judgments
                                                                   •   Transaction price and amounts allocated
                                                                       to performance obligations*
                              Contract costs                       •   Contract cost assets and changes*

                              Interim requirements                 •   Quantitative disclosures*

                                                                                 * Mostly optional for nonpublic entities
Considerations for Disaggregation of Revenue

                                                                   Timing of transfer of
HFMA 2018 Spring Conference

                                      Payor category                 goods or service
                                    (Medicare, Medicaid,
                                     Commercial, Self-
                                         Pay, etc.)

                                                            Example                        Service type
 11
                                                           categories                 (inpatient, outpatient,
                                                                                        home health, etc.)

                                  Contract type (fee for
                                   service, capitation,
                                          etc.)
                                                                        Geography
Disclosure Requirements – Disaggregated Revenue

                              Revenue Disaggregation by Payor
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                              The composition of patient care service revenue by primary payor for the years ended December 31 is as
                              follows:

                                                                                                              20x2                   20x1
                                      Medicare                                                                   $16,000                 $15,000
                                      Medicaid                                                                      6,000                    5,000
 12                                   Managed care                                                                 11,000                  10,500
                                      Commercial insurers                                                           4,000                    3,500
                                      Uninsured                                                                     1,800                    1,900
                                      Other                                                                         1,000                    1,000
                                                                                                                 $39,800                 $36,900

                                Source: AICPA Health Care Entities Revenue Recognition Implementation Issue Paper #8-6 – Presentation and Disclosure.
                                As of January 2018, this paper has not been finalized in the AICPA Audit & Accounting Revenue Recognition Guide.
Disclosure Requirements – Disaggregated Revenue

                              Revenue Disaggregation by Region, Service Line, Reimbursement, Timing
                                                                                                                                     20x2
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                                                                                                    Northeast            Central            Southeast       Total
                               Services lines:
                                 Hospital-inpatient                                                        $ 3,500             $ 1,000           $ 3,000       $ 7,500
                                 Hospital-outpatient                                                         4,500               2,000             2,000         8,500
                                 Physician services                                                          3,000               3,000             5,000        11,000
                                 Home health and hospice                                                     1,000                 800             2,000         3,800
                                 Retail sales                                                                2,000               2,000             4,000         8,000
                                 Other                                                                         400                 200               400         1,000
 13
                                                                                                          $ 14,400             $ 9,000           $16,400       $39,800
                               Method of reimbursement:
                                Fee for service                                                            $ 8,900             $ 5,300            $ 6,000     $ 20,200
                                Capitation and risk sharing                                                  3,100               1,500              6,000       10,600
                                Other                                                                        2,400               2,200              4,400        9,000
                                                                                                          $ 14,400            $ 9,000            $ 16,400     $39,800
                               Timing of revenue and recognition:
                                 Health care services transferred over time                               $12,400              $ 7,000           $12,400       $31,800
                                 Retail pharmacy and equipment sales at point in time                        2,000               2,000              4,000        8,000
                                                                                                          $ 14,400             $ 9,000           $ 16,400      $39,800

                              Source: AICPA Health Care Entities Revenue Recognition Implementation Issue Paper #8-6 – Presentation and Disclosure.
                              As of January 2018, this paper has not been finalized in the AICPA Audit & Accounting Revenue Recognition Guide.
List of AICPA Papers on the Issues

                               • Final (included in Revenue Recognition Guide):                    AICPA Revenue Recognition homepage
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                                                                                                   for Health Care:
                               - Self-pay patient balances (Issue 1)
                                                                                                   https://www.aicpa.org/interestareas/frc/ac
                               - Applying a portfolio approach (Issue 2)
                                                                                                   countingfinancialreporting/revenuerecogn
                               - Presentation and disclosures (Issue 6)                            ition/rrtf-healthcare.html

                               • Exposure period ended, to be finalized soon:
                               - Third-party settlements (Issue 8)
                               - Risk sharing arrangements (bundled payments) (Issue 9)
 14
                               - Performance obligations (Issue 10)

                               • Currently or soon to be out for exposure:
                               - Various issues fully or largely related to CCRCs (Issues 3,4,5)
                               - Accounting for contract costs (Issue 7)
Identify the Contract(s) with a Customer

                              A contract is an agreement between two or more parties that creates enforceable rights and obligations.
HFMA 2018 Spring Conference

                              ASC 606 says: “Enforceability of the rights and obligations in a contract is a matter of law. Contracts can
                              be written, oral, or implied by an entity’s customary business practices.”
                              Additionally:

                                              …collection of substantially                  …rights of parties and
                                              all consideration is                                        payment
 15
                                              probable                                              terms can be
                                                                                                         identified
                                                                           A contract
                                                                           exists if…

                                                                                          …it has approval and
                                              …it has commercial                    commitment of the parties as
                                              substance                                     to their obligations
Price Concessions

                              •       Explicit Price Concessions   •       Implicit Price Concessions
HFMA 2018 Spring Conference

                                  -   Contract discounts               - EMTALA – Role of Medical Screening Exam (MSE)
                                  -   Cash pay schedules           •       Implicit Price Concession Based on Portfolio
                                  -   Letter of agreement                  Approach
                                  -   Risk-based contract              -   Emergency vs Direct Admits
                                                                       -   Contract denials
 16
                                                                       -   Charity care
                                                                       -   Uninsured
                                                                       -   Pending Medicaid eligibility
                                                                       -   Dual eligible patients
Bad Debt Expense – Not Going Away, But Reduced

                              •   Bad Debt Expense: When a health care entity performs a credit assessment prior to providing services
HFMA 2018 Spring Conference

                                  to a patient and expects to collect substantially all of the discounted charges.
                              •   For example, an elective procedure in which historical experience supports collection of substantially
                                  all of the discounted charges.

 17
                                    Many health care providers believe their provision for bad debts for services provided
                                    to uninsured and insured patients with co-payments and deductibles will be
                                    significantly reduced, in comparison to current U.S. GAAP.
Portfolio Approach

                                 The standard is generally applied on a contract-by-contract basis with a customer.
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                                                               Portfolio Approach

 18

                                          Health care entities may use a portfolio approach as a practical
                                        expedient, whereby the revenue guidance is applied to a portfolio
                                                      of contracts with similar characteristics.
                                         The portfolio approach is allowed if the entity reasonably expects
                                        that the financial statement effects of applying the standard to the
                                           portfolio would not be materially different from applying the
                                                standard to individual contracts within that portfolio.
Application of the Portfolio Approach to Contracts with
                              Patients

                              •     Considerations for a health care entity to determine in grouping contracts with similar characteristics
HFMA 2018 Spring Conference

                                    for inclusion in a portfolio
                                  - Type of service – inpatient, outpatient, skilled nursing, home health, emergency room, elective procedure, etc.
                                  - Type of payors – insurance contract, insurance contract with patient responsibility, governmental programs, uninsured
                                    self-pay, etc.
                                  - Dates when contracts are entered into are close to each other

 19

                                       Using a portfolio of similar transactions to make certain estimates and judgments is not the
                                       same as applying the portfolio approach practical expedient.
Third-Party Settlements

                              •     Medicare/Medicaid –Variable consideration
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                              •     Complex rules
                              •     Timing
                              •     Patient is the Customer
                                  - Payor contract affects variable consideration

 20
Third-Party Settlements

                              •       Variable consideration should be estimated using on of the approaches below
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                                      • Reminder: The selected method should be applied consistently throughout the contract

                                  Expected value                                              Most likely amount

                                  •    Sum of probability-weighted amounts in a               •   The single most likely amount in a range
 21
                                       range of possible consideration amounts                    of possible consideration amounts
                                  •    Most utilized when there are a large                   •   Most utilized when there are two possible
                                       number of possible outcomes                                outcomes
Third-Party Settlements

                              •   When determining variable consideration amounts, think about:
HFMA 2018 Spring Conference

                                  • Historical and current reimbursement information, including third-party settlements
                                  • Historical and current experience with the fiscal intermediary
                                  • Current charges, allowable costs, and relevant patient statistics

                              •   Consider all information (historical, current and forecasted) that is reasonably available
                              •   Update estimates each reporting period
 22
                              •   Apply one method consistently throughout the contract
Third-Party Settlements

                              •   Evaluate the “constraint” of variable consideration revenue
HFMA 2018 Spring Conference

                              •   When assessing whether it is probable that a significant revenue reversal will not occur when the cash
                                  collections or payments are made based on final settlement, consider the following:
                                  • Whether settlement is outside of entity’s control (third-party payor controls settlement process)
                                  • Entity’s experience in estimating third-party settlements with government payors
                                  • Length of time before final settlement is known

 23
                                  • Whether payment terms may be changed
                                  • The number of possible consideration amounts – consider range of outcomes and whether there have been
                                    significant differences from reporting period to reporting period
Risk Sharing Arrangements

                              •   Arrangements with third-party payors should be considered in determining the transaction price for
HFMA 2018 Spring Conference

                                  services provided to a patient
                                  •   Customer is the patient

                              •   Different types of risk sharing arrangements
                                  • Bundled payment arrangements
                                  • Pay for performance contracts

 24
                                  • Contracts with shared savings or shared losses
                                  • Risk pool contracts
                                  • Capitation arrangements
Revenue Considerations for CCRCs

                              •   The following key issues related to CCRCs are still under review by the AICPA Healthcare
HFMA 2018 Spring Conference

                                  Revenue Recognition Task Force:
                                  • Recognizing monthly/periodic fees and nonrefundable entrance fees under different contract types
                                  • Calculating the obligation to provide future services and use of facilities
                                  • Assessing whether a significant financing component exists for refundable and nonrefundable
                                    entrance fees
 25

                                  • Accounting for contract acquisition costs
Grants and Contracts Project:
Clarifying the Scope and Accounting Guidance for
Contributions Received and Contributions Made
Scope

                              •   Applies to all entities (NFPs and business entities) that receive or make contributions
HFMA 2018 Spring Conference

                                  unless otherwise indicated.
                              •   Excludes transfers of assets from the government to business entities.
                              •   Applies to both contributions received by a recipient and contributions made by a
                                  resource provider.
 27                           •   The term used in the presentation of financial statements to label revenue (for example,
                                  contribution, grant, donation) that is accounted for within the Scope of Subtopic 958-605
                                  is not a factor for determining whether an agreement is within the scope of that
                                  guidance.
Grants and Contracts – Background
HFMA 2018 Spring Conference

                                   Project added to FASB’s Technical Agenda to improve and clarify
                                                         existing guidance

                                  ASU 2014-09, Revenue from Contracts with Customers, including related
                                                   disclosures, heightened the issue
 28                                  Raised question as to whether grants and contracts are in scope of that guidance
                                                              (reciprocal or nonreciprocal)

                                   Long-standing diversity in practice in classifying grants and contracts,
                                                  particularly from governmental entities
                                       Issue 1: Reciprocal Versus                    Issue 2: Conditional Versus
                                             Nonreciprocal                                  Unconditional
Issue 1: Reciprocal (Exchange) vs. Nonreciprocal
                              (Nonexchange/Contribution) Transactions
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 29
Issue 1: Reciprocal vs. Nonreciprocal Transactions:
                              Key Clarifications to the Scope of Subtopic 958-605

                                  The proposed ASU would clarify and refine existing guidance in Subtopic 958-605 by adding
HFMA 2018 Spring Conference

                                    paragraphs that would clarify the scope of the Subtopic as well as illustrative examples.

                              •   The resource provider is not synonymous with the general public, even a governmental
                                  entity. If a resource provider receives value indirectly by providing a societal benefit, this
                                  would be considered a nonreciprocal transaction.
 30                           •   If the primary beneficiary of a grant or contract is a third party, an NFP must use
                                  judgment to determine if the transaction is reciprocal or nonreciprocal.
                              •   Furthering a resource provider’s mission or “feel good” sentiment does not constitute
                                  commensurate value received.
                              •   The type of resource provider should not override the substance of the transaction.
Issue 2: Conditional vs. Unconditional Contributions
20th HFMA Western Region Symposium

                                     For a Donor-Imposed Condition to Exist:

                                              Proposed                                         Alternative
                                                ASU                                             Rejected
                                                                  A right to                                 A right to
                                                                  return/release must                        return/release must
  31
                                                                  exist; and                                 exist.

                                                                  The engagement                             Would have required
                                                                  must include a barrier                     a probability
                                                                  • Indicators and examples                  assessment about
                                                                    to help in determination
                                                                                                             whether it is likely a
                                                                                                             recipient NFP will
                                                                                                             fulfill the stipulations
Indicators to Determine a Barrier
HFMA 2018 Spring Conference

                                    To determine what is a barrier, an NFP would consider indicators,
                                        which would include, but are not limited to, the following:

                                   The inclusion of a measurable performance-related barrier or
                                                     other measurable barrier.

 32                                    Whether a stipulation is related to the purpose of the
                                                            agreement.
                                      The extent to which a stipulation limits discretion by the
                                                             recipient.

                                   The extent to which a stipulation requires an additional action
                                                             or actions.
NFP Revenue Recognition Decision Process
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 33
Transition Approach

                              •     Modified prospective
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                                  - Apply to all agreements
                                    o   Existing at the effective date (only apply to the portion
                                        of existing agreements not previously recognized)
                                    o   Entered into after the effective date

                              •     No restatement of prior amounts recognized
 34

                              •     Retrospective application permitted
Effective Date

                              The effective date is the same as the new Revenue Recognition standard (Topic 606), but
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                              allows for early implementation.

                              Annual periods beginning after December 15,            Annual periods beginning after December 15,
                              2017, including interim periods:                       2018, and interim periods beginning after
                              •   Public Business Entities                           December 15, 2019:
                                                                                     • All other entities
                              •   NFP that has issued, or is a conduit bond
 35
                                  obligor for, securities that are traded, listed,
                                  or quoted on exchange or an over-the-
                                  counter market
Timeline of the Project
HFMA 2018 Spring Conference

                                   Issued
                                  Proposed            Comment
                                   Update          Period Deadline    Final ASU
 36

                                  August 3, 2017   November 1, 2017    Q2 2018
Leases
ASU 2016-02: Leases (Topic 842)
HFMA 2018 Spring Conference

                                 A lease contract conveys the right to use an asset (the underlying asset) for a period of time in
                                                                  exchange for consideration.

 38
Identifying a Lease
                              (The new primary determinant for on/off balance sheet treatment)
HFMA 2018 Spring Conference

                                                                                                 That is explicitly or
                                                                                                 implicitly specified

                                                                    An identified asset
                                                                                             Supplier has no practical
                                                                                              ability to substitute and
                                                                                             would not economically
                                                                                             benefit from substituting
 39                                   Lease contracts in the                                           the asset
                                       scope of Topic 842
                                             involve
                                                                                             Decision-making authority
                                                                                             over the use of the asset

                                                                  The right to control the
                                                                 use during the lease term
                                                                                                The ability to obtain
                                                                                             substantially all economic
                                                                                              benefits from the use of
                                                                                                     the asset
Lessee Accounting Overview

                                                  Balance                  Income               Cash Flow
                                                   Sheet                  Statement             Statement
HFMA 2018 Spring Conference

                                                   Right-of-use                                  Cash paid for
                                                                           Amortization
                                                   (ROU) asset                                   principal and
                                                                             expense
                                                      Lease                                         interest
                                   Finance                               Interest expense
                                                     liability                                    payments

                                                   Right-of-use             Single lease        Cash paid for
 40
                                  Operating        (ROU) asset              expense on a           lease
                                                  Lease liability        straight-line basis     payments

                                Classification is similar to that in Topic 840, Leases
                                Recognition and measurement exemption for short-term leases
                                Other than public business entities may use risk-free rates for measurement of all lease
                                liabilities
Lessor Accounting Overview
HFMA 2018 Spring Conference

                                             Balance Sheet    Income Statement       Cash Flow Statement

                                                                                            Cash
                                                   Net        Interest income and
                                                                                         received for
                                 Finance      investment in     any profit on the
                                                                                            lease
                                                the lease             lease
                                                                                          payments

 41                                             Continue to      Lease income,              Cash
                                                 recognize        typically on a         received for
                                 Operating      underlying                                  lease
                                                               straight-line basis
                                                   asset                                  payments
Leases – Getting Ready
HFMA 2018 Spring Conference

                               Inventory of leases – What’s out there? Know your leases.

 42

                               Materiality – How modern is your capitalization policy?

                               Debt covenants – To what extent will capitalizing your
                               operating leases affect covenants based on leverage
                               ratios?
Leases – Getting Ready
HFMA 2018 Spring Conference

                               Review FASB updates – Proposed ASU issued in January
                               2018 would provide transition relief

 43                            IT systems – Does your current system capture all required
                               information?

                               Consider required assumptions and inputs – Have you
                               started considering your discount rates, likelihood of
                               exercising options, etc?
Not-for-Profit Financial Statements
NFP Financial Statements ASU – Key Objectives
                                               (recommended by FASB’s NFP Advisory Committee (NAC))
              HFMA
          Spring
HFMA 201820th       Western Region Symposium
                 Conference

                                                                                                      Improve information
                                                                                                            in financial
                                                            Update, not           Improve net asset      statements and         Better enable
                                                           overhaul, the            classification         notes about:       NFPs to “tell their
                                                           current model               scheme                 financial        financial story”
                                                                                                       performance, cash
                                                                                                       flows, and liquidity
   45

                                                                            Issued August 18, 2016, ASU No. 2016-14
Net Asset Classification
HFMA 2018 Spring Conference

                               Current                                      Temp.         Perm.
                                              Unrestricted
                                GAAP                                       Restricted    Restricted

                               GAAP           Without Donor
 46                                            Restrictions                With Donor Restrictions

                                 +               Amount,
                              Disclosures
                                               purpose, and                  Nature and amount
                                               type of board                of donor restrictions
                                               designations *
                                            * New disclosure requirement
Examples
                                  Net assets:
                                   Net assets without donor restriction:
                                                                                                            Minimum
HFMA 2018 Spring Conference

                                     Community Health Care                   $ 2,449
                                     Noncontrolling interests                     20                      presentation
                                                                               2,469                        required
                                   Net assets with donor restriction:            585
                                       Total net assets                      $ 3,054

                                                                           Net assets:
                                                                            Net assets without donor restriction:
 47                                                                           Community Health Care:
                                                                                Undesignated                                $   2,000
                                                                                Designated by Board for capital prospects         449
                                                                                                                                2,449
                                                                              Noncontrolling interests                             20
                                           Alternative                                                                          2,469
                                         disaggregation                     Net assets with donor restriction:
                                             allowed                         Time restrictions                                    50
                                                                             Purpose restrictions                                235
                                                                             Endowment funds                                     300
                                                                                                                                 585
                                                                                Total net assets                            $   3,054
Net Assets and Related Disclosures

                              •   Presentation of changes is similar to current guidance except that there are now two
HFMA 2018 Spring Conference

                                  classes of net assets as opposed to three.
                              •   Consistent with current guidance, an NFP will provide information about the nature and
                                  amounts of donor restrictions either on the face of the financial statement or the notes.
                              •   An NFP will now be required to disclose the amounts and purposes of board-designated
                                  net assets either on the face of the financial statement or the notes.
 48

                              •   Underwater endowment funds will be classified within net assets with donor restrictions,
                                  as opposed to current guidance, which requires them to be classified within unrestricted
                                  net assets.
                              •   Expanded from current guidance for underwater endowments, an NFP will be required
                                  to disclose the aggregate of the original gift amounts (or level required by law or donor),
                                  fair value, the aggregate amount of the deficiencies and any governing board policy
                                  decision to reduce or not spend from such funds.
Expenses

                              •     Requires all NFPs to present information about their expenses by nature and function
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                                    either:
                                  - In the statement of activities,
                                  - As a separate statement, or
                                  - In the notes to the financial statements.

 49                           • NFPs required to provide qualitative disclosures about methods used to allocate costs
                                among program and support functions.
Expenses Disclosure Example 1 – Draft
                                                                                            Health Care Services                                     Support Services
                                                                  Acute    Ambulatory     Physician     Post Acute   Health Plan     Research      MG&A        Fundraising      Total
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                              Salaries and benefits           $      1,742 $      321 $          688 $         459 $         229 $         229 $        688 $           229 $     4,585
                              Purchased services                       885        163            349           233           116           116          349             116       2,329
                              Supplies                                 428          79           169           113            56             56         169               56      1,125
                              Depreciation and amortization            214          39             85            56           28             28           85              28        564
                              Capitated purchased services             -          -              -             -             246           -            -               -           246
                              Rentals and leases                         57         11             23            15            8              8           23               8        151
                              Interest                                   35          7             14             9            5              5           14               5         93
                              Insurance                                   5          1              2             1            1              1            2               1         14
                              Other                                    241          44             95            64           32             32           95              32        635
 50
                                                              $      3,608 $      665 $        1,424 $         950 $         721 $         475 $      1,424 $           475 $     9,742

                               The financial statements report certain expense categories that are attributable to more than one health care service or
                               support function. Therefore, these expenses require an allocation on a reasonable basis that is consistently applied.
                               Costs not directly attributable to a function, including depreciation, amortization, interest and other occupancy costs, are
                               allocated to a function based on a square footage or units of service basis. Allocated health care services cost not
                               allocated on a units of service basis are otherwise allocated based on revenue.
Expenses Disclosure Example 2 – Draft
                                                                           Health Care Services                     Support Services
                                                                North Region Central Region South Region          MG&A        Fundraising        Total
HFMA 2018 Spring Conference

                              Salaries and benefits             $      1,376   $        917    $      1,376   $        688    $        229   $      4,585
                              Purchased services                         699            466             699            349             116          2,329
                              Supplies                                   338            225             338            169              56          1,125
                              Depreciation and amortization              169            113             169             85              28            564
                              Capitated purchased services                74             49              74             37              12            246
                              Rentals and leases                          45             30              45             23               8            151
                              Interest                                    28             19              28             14               5             93
                              Insurance                                    4              3               4              2               1             14
 51
                              Other                                      191            127             191             95              32            635

                                                                $      2,923   $       1,948   $      2,923   $       1,461   $        487   $      9,742

                              The financial statements report certain expense categories that are attributable to more than one health care service or
                              support function. Therefore, these expenses require an allocation on a reasonable basis that is consistently applied.
                              Costs not directly attributable to a function, including depreciation, amortization, interest and other occupancy costs, are
                              allocated to a function based on a square footage or units of service basis. Allocated health care services cost not
                              allocated on a units of service basis are otherwise allocated based on revenue.
Investment Return

                              •   The ASU requires investment return to be reported net of external and direct internal
HFMA 2018 Spring Conference

                                  investment expense.
                              •   NFP’s are no longer required to disclose investment expenses that have been netted.
                              •   An NFP will be precluded from including these investment expenses in the nature-by-
                                  function expense analysis.
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Year 1 Presentation of Net Investment Return

                              Format 1:                                               Format 2:
HFMA 2018 Spring Conference

                              Revenue                                    $   X,XXX    Revenue                                    $   X,XXX
                              Expenses                                        XXX     Expenses                                        XXX
                                                                                          Operating income                            XXX
                                 Operating income                             XXX
                                                                                      Investment return, net excluding
                              Investment return, net                          XXX     unrealized gains (losses) on other than
                              Less:                                                   trading securities excluded from
                                 Unrealized gains (losses) on other                   performance indicator                           XXX
                                 than trading securities excluded from
                                                                                      Performance indicator                           XXX
 53                              performance indicator                        (200)
                                                                                         Unrealized gains (losses) on other
                              Performance indicator                           XXX        than trading securities excluded from
                              Add:                                                       performance indicator                         200
                                 Unrealized gains (losses) on other                   Change in net assets without donor
                                 than trading securities excluded from                restrictions                               $    XXX
                                 performance indicator                         200
                              Change in net assets without donor
                              restrictions                               $    XXX
Cash Flows and Liquidity and Availability Disclosures

                              •     Cash Flow Statement
HFMA 2018 Spring Conference

                                  - Allow free choice between the Direct Method and the Indirect Method
                                    o   Indirect reconciliation no longer required for Direct Method

                              • Liquidity and Availability Disclosures
                                  - Qualitative information about how a NFP manages its liquid resources and liquidity risk
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                                  - Quantitative information about the availability of a NFP’s financial assets to meet those cash needs for
                                    general expenditures within one year of the balance sheet date
Liquidity Example Disclosure – Draft
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                              The System has certain board-designated and donor-restricted assets limited to use which are available for general expenditure within one year
                              in the normal course of operations. Accordingly, these assets have been included in the qualitative information above. The System has other
                              assets limited to use for donor-restricted purposes, debt service and for the professional and general liability captive insurance program.
                              Additionally, certain other board-designated assets are designated for future capital expenditures and an operating reserve. These assets limited
                              to use, which are more fully described in Notes ___ and ___ are not available for general expenditure within the next year and are not reflected in
                              the amounts above. However, the board-designated amounts could be made available, if necessary.

                              As part of the System’s liquidity management plan, cash in excess of daily requirements are invested in in short-term investments and money
                              market funds. Occasionally, the Board designates a portion of any operating surplus to an operating reserve, which was $1,200,000 as of
                              December 31, 2016. This fund established by the board of directors may be drawn upon, if necessary, to meet unexpected liquidity needs.

                              Additionally, the System maintains a $5 million line of credit, as discussed in more detail in Note ___. As of December 31, 2016, $5 million
                              remained available on the System’s line of credit.
Financial Instruments
ASU No. 2016-01 (Topic 825), Financial Instruments –
                              Classification and Measurement Amendments to Current GAAP

                              Targeted improvements, effective for CY 2019 (FY 2019-20); one year earlier for PBEs
HFMA 2018 Spring Conference

                                     Financial Assets

                                    • Equity investments (other than those under the equity method) measured at each
                                      reporting period at fair value through net income, with key exception: those without
                                      readily determinable fair value only marked to observable price changes
                                    • No more other-than-trading equity securities

 57                                  Financial Liabilities

                                    • Fair value change resulting from own credit for financial liabilities measured under fair
                                      value option will be recognized through other comprehensive income (OCI)*

                                     Disclosures
                                    • Entities other than public business entities (includes all NFPs) no longer required
                                      to disclose fair value of financial instruments not recognized at fair value on
                                      balance sheet*

                              *Entities can early adopt these provisions
ASU No. 2016-13, Financial Instruments—Credit Losses (Topic
                              326): Measurement of Credit Losses on Financial Instruments

                              Effective for CY 2021 (FY 2021-22); one year earlier for PBEs
HFMA 2018 Spring Conference

                                                                                 Trade receivables and student
                                Contributions (pledges)
                                                                                 loans (and other programmatic
                                receivable are excluded
                                                                                  loans) receivable are included

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                              CECL model not expected to result in significant impact on most entities
                              that aren’t financial institutions

                               • Likely already taking CECL considerations into account for their trade and loan receivables

                              More noteworthy is the change for Available-for-Sale Debt Securities: now
                              an allowance approach
ASU No. 2017-12, Hedge Accounting – Key Simplifications
                              Effective for CY 2020 (FY 2020-21); one year earlier for PBEs; early adoption allowed
HFMA 2018 Spring Conference

                               The concept of separately recording “ineffectiveness” will be eliminated

                               SIFMA rate will now be among the indexes eligible to be designated in
 59
                               a hedge of interest rate risk

                               Hedge Documentation – Initial quantitative effectiveness test can now
                               be performed anytime before issuance of next financial statements
                               (instead of immediately after entering the hedge).*

                              *Public Healthcare NFPs (those that have issued, or are a conduit bond obligor for, securities that are traded, listed or
                              quoted on an exchange or an over-the-counter market) have 3 months to document hedging relationships.
ASU No. 2017-12, Hedge Accounting – Key Simplifications
HFMA 2018 Spring Conference

                              Shortcut Method – Long-haul method may be used if use of the shortcut
                              method was not or no longer is appropriate.

                              Critical Terms Match – When hedging a group of forecasted transactions,
                              the timing of the derivative and transactions can be considered to “match,”
 60                           if the transactions occur and derivative matures within a 31-day period.

                              Qualitative Testing – Allowed after an initial quantitative test at hedge
                              inception if certain conditions are met.
AFI – Hedge Documentation – Private Company Alternative
HFMA 2018 Spring Conference

                               Statement of intent to hedge at inception
                               • Hedging instrument
                               • Hedge item or transaction
                               • Nature of risk being hedged
 61

                               Following will need to be finalized once FS are
                               made available for issuance
                               • Method of hedge effectiveness
                               • Qualitative or quantitative hedge effectiveness testing
Other Recent ASUs
1. Restricted Cash (ASU 2016-18)
2. Net Periodic Benefit Cost Presentation (ASU 2017-07)
3. Definition of a Business and Goodwill Impairment
   (ASU 2017-01 and ASU 2017-04)
ASU No. 2016-18, Restricted Cash

                              Effective for CY 2019 (FY 2019-2020); early adoption permitted
HFMA 2018 Spring Conference

                               Requires the statement of cash flows to
                               explain the change during the period in
                                                                          Does not provide a definition of restricted
                                 the total of cash, cash equivalents,
                                                                            cash or restricted cash equivalents
                                 restricted cash, and restricted cash
                                              equivalents
 63

                                                                          Requires entities to disclose the line items
                                                                           and amounts of cash, cash equivalents,
                                Includes restricted cash and restricted
                                                                            and amounts generally described as
                                cash equivalents in the beginning and
                                                                              restricted cash or restricted cash
                               ending totals of the cash flow statement
                                                                          equivalents reported within the statement
                                                                                      of financial position
ASU No. 2017-07, Improving the Presentation of Net Periodic
                              Pension Cost and Net Periodic Postretirement Benefit Cost

                              Effective for CY 2019 (FY 2019-2020); early adoption permitted
HFMA 2018 Spring Conference

                                                                         •   Net benefit cost contains several components with different nature
                                                                         •   No GAAP guidance on presentation
                                          Background                     •   Reduced predictive value and usefulness of information to users
                                                                         •   Board added project

 64

                                    Presentation of net
                                    benefit cost in the                  • Service cost in the same line item or items as other current
                                                                           employee compensation costs
                                    income statement                     • Remaining components in a separate line item or items outside
                                      (retrospective                       operating items, if applicable
                                       application)

                                     Capitalization of only service cost in assets (prospective application)
Other Recent ASUs
HFMA Spring Conference 2018

                                 ASU No.        • Provides a more robust framework to
                                 2017-01,         determine when a set of assets and       Effective for CY 2019
                                                  activities is a business and more
                               Clarifying the     consistency in applying the guidance,
                                                                                           (FY 2019-2020); early
                                                                                          adoption permitted, with
                               Definition of      reducing application costs, and                limitations
                                                  increasing operability in practice
                                a Business
 65

                                 ASU No.        • Changes the test for goodwill
                                 2017-04,         impairment to a one-step quantitative    Effective for CY 2022
                                                  impairment test whereby a goodwill       (FY 2022-2023); early
                                Accounting        impairment loss is measured as the         adoption permitted
                               for Goodwill       excess of a reporting unit’s carrying
                                                  amount over its fair value
                                Impairment
Recently Issued Standards (ASU)/FASB

                              - ASU 2015-14 | Revenue
HFMA 2018 Spring Conference

                              - ASU 2015‐07 | Fair Value Hierarchy Levels for Certain Investments Measured at Net Asset Value
                                (Topic 820)

                              - ASU 2015-16 | Simplifying the Accounting for Measurement – Period Adjustments

                              - ASU 2015‐17 | Income Taxes (Topic 740)

 66
                              - ASU 2016‐01 | Financial Instruments (Subtopic 825-10)

                              - ASU 2016-13 | Measurement of Credit Losses on Financial Instruments

                              - ASU 2016‐02 | Financial Leases

                              - ASU 2016‐14 | Not-for-Profit Entities (Topic 958)
Recently Issued Standards (ASU)/FASB (Continued)

                              - ASU 2016-07 |Equity Method of Accounting
HFMA 2018 Spring Conference

                              - ASU 2016‐15 & 18 | Statement of Cash Flows (Topic 320) Classification of Certain Cash Receipts and
                               Cash Payments

                              - ASU 2017-02 |Not-for-Profit Entities Consolidation

 67
                              - ASU 2017-04 |Goodwill Impairment

                              - ASU 2017-07 |Net Periodic Benefit Costs

                              - ASU 2017-12| Targeted Improvements to Accounting for Hedging Activities

                              - Proposed Grant vs. Contribution Guidance
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     HFMA 2018 Spring Conference

                    Questions?
HFMA 2018 Spring Conference

                              The material appearing in this presentation is for informational purposes only and should not be construed
                              as advice of any kind, including, without limitation, legal, accounting, or investment advice. This information
                               is not intended to create, and receipt does not constitute, a legal relationship, including, but nor limited to,
                                an accountant-client relationship. Although this information may have been prepared by professionals, it
                                  should not be used as a substitute for professional services. If legal, accounting, investment, or other
                                            professional advice is required, the services of a professional should be sought.

 69                             Assurance, tax, and consulting offered through Moss Adams LLP. Investment advisory services offered
                              through Moss Adams Wealth Advisors LLC. Investment banking offered through Moss Adams Capital LLC.
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