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Northwell
Health
Northwell Health, Inc.

MANAGEMENT’S DISCUSSION AND ANALYSIS

OF RECENT FINANCIAL PERFORMANCE

FOR THE NINE MONTHS ENDED SEPTEMBER 30, 2019 and 2018
Financial Highlights

Nine Months Nine Months

Financial Results Ended Ended
($’s In Millions) September 30, September 30,
2018 2019

Operating revenue [1] $8,397.1 $9,178.0

Operating income $97.0 $130.8
Operating margin 1.1% 1.4%
Operating cash flow margin 6.8% 6.8%

Selected Other Information December 31, September 30,

($’s In Millions) 2018 2019

Unrestricted cash and investments $3,051.1 $3,261.4

Days cash on hand 102 103
Total outstanding debt $3,542.2 $4,018.5
Unrestricted cash to debt [2] 91.0% 86.8%
Debt to capitalization 48.5% 48.6%
Long-term debt service coverage (12-months ended) 3.3x 3.2x

[1] Excludes operating revenue of the health insurance companies.

[2] Unrestricted cash for this ratio includes management designated sinking funds. Refer to Liquidity and Capital Resources
section herein for further information.
1
Management’s Discussion and Analysis of Recent Financial Performance

Northwell Health, Inc. (“Northwell”), together with its member corporations and affiliated
entities, constitutes an integrated health care delivery system serving the greater New York metropolitan
area, and is comprised of 19 owned hospitals, three long-term care facilities, four certified home health
care agencies, a hospice network, over 750 ambulatory and physician practice locations, The Feinstein
Institutes for Medical Research, joint ventures and other entities (collectively referred to as “Northwell”).

Management’s Discussion and Analysis of Recent Financial Performance contains “forward-

looking statements” within the meaning of the United States Private Securities Litigation Reform Act of
1995, Section 21E of the United States Securities Exchange Act of 1934, as amended, and Section 27A of
the United States Securities Act of 1933, as amended. The achievement of certain results or other
expectations contained in such forward-looking statements involves known and unknown risks,
uncertainties and other factors which may cause actual results, performance or achievements described
to be materially different from any future results, performance or achievements expressed or implied by
such forward-looking statements. Northwell expressly disclaims any obligation or undertaking to issue any
updates or revisions to those forward-looking statements if or when their expectations change, or events,
conditions or circumstances on which such statements are based occur.

Management’s Discussion and Analysis of Recent Financial Performance is based upon the
consolidated financial results of Northwell. The members of the Northwell Health Obligated Group (the
“Obligated Group”) represented 82.9% of the total consolidated operating revenue and 84.1% of the total
consolidated assets of Northwell for the year ended and as of December 31, 2018. Accordingly, the
discussion below includes the financial results of entities that are not members of the Obligated Group.
Refer to the Audited Consolidated Financial Statements of Northwell for the years ended December 31,
2018 and 2017 (the “Audited Consolidated Financial Statements”) for the consolidating and combining
schedules of Northwell and the Obligated Group.

Effective January 1, 2019, Northwell adopted Accounting Standards Update No. (“ASU”) 2016-02,
Leases, which requires the rights and obligations arising from lease contracts to be recognized as assets
and liabilities in the statement of financial position for both finance leases (formerly capital leases) and
operating leases. The most significant impact of adoption of ASU 2016-02 is the recognition of right-of-
use leased assets and obligations pertaining to operating leases, as well as enhanced disclosures related
to leases. The accounting for finance leases remains substantially unchanged as a result of adoption. Refer
to Note C and Note K to the Northwell Consolidated Financial Statements for the Nine Months Ended
September 30, 2019 and 2018 (the “Unaudited Interim Consolidated Financial Statements”) for additional
information.

As a result of Northwell’s 2017 decision to exit the health insurance business, the net operating
results of the health insurance companies are separately reported within the consolidated statements of
operations for the nine months ended September 30, 2019 and 2018 in the Unaudited Interim
Consolidated Financial Statements, below the operating results from Northwell’s continuing operations.
Refer to Note E to the Unaudited Interim Consolidated Financial Statements for additional information.

2
Introduction

For the nine months ended September 30, 2019, Northwell’s operating income[a] and operating
margin were $130.8 million and 1.4%, respectively, compared to $97.0 million and 1.1% for the nine
months ended September 30, 2018. Operating cash flow margin was 6.8% for both the nine month periods
ended September 30, 2019 and 2018. Operating revenue grew by $780.9 million or 9.3% for the nine
months ended September 30, 2019 compared to the nine months ended September 30, 2018, while
operating expenses increased $740.0 million or 8.9%, excluding the health insurance companies.

Operating revenue growth was primarily attributable to increases in volume (primarily associated
with inpatient discharges and the ambulatory and physician network expansion including investments in
the Northwell Health Cancer Institute[b] and clinical joint ventures), inpatient case mix and payment rates,
as well as continued revenue cycle initiatives.

The increase in operating expenses was partially attributable to incremental costs associated with
the increased patient volume, routine cost of living wage adjustments and the impact of inflation on
supply and expense price trends. In addition, continued investments in the following areas contributed to
the growth of total operating expenses: (1) facilities and programs to enhance capacity and rebuild
infrastructure; (2) investments in population health management and to further prepare for the expansion
of value-based payment models; (3) safety, quality and patient experience initiatives; (4) ambulatory and
physician network expansion; (5) information technology (“IT”), including investments in electronic health
records, digital health technology and telehealth services; and (6) mission-driven investments in medical
research, education and behavioral health services. Expense reductions as a result of the implementation
of productivity and efficiency efforts, program consolidation, and supply chain initiatives (including the
continuous review of programs to improve standardization, distribution, utilization and contracting),
helped control the growth rate of expenses.

Northwell’s net income[c] and net margin for the nine months ended September 30, 2019 were
$456.6 million and 4.8%, respectively, compared to $132.6 million and 1.6% for the nine months ended
September 30, 2018. Investment income, including net realized gains and losses and the change in net
unrealized gains and losses and change in value of equity method investments, which totaled $365.7
million and $62.4 million for the nine months ended September 30, 2019 and 2018, respectively, affected
the net income amounts reported for each of these periods.

Management continues to focus on i) patient experience, safety and quality improvements, ii)
market share growth, iii) population health management, iv) medical research and education, and v)
diversifying revenue streams within the Northwell business model, including entering into joint venture
arrangements with various partners. Maintaining the balance sheet and improving operating results also
remain top management priorities so that Northwell can continue to invest in people, programs and
facilities to successfully adapt and respond to changes in the health care industry while continuing to meet
the needs of patients and families in all the communities it serves.

[a]
Total excess of operating revenue over operating expenses in the consolidated statements of operations is referred to as
“operating income” for purposes of Management’s Discussion and Analysis of Recent Financial Performance.
[b]
Cancer care throughout Northwell was recently branded as the Northwell Health Cancer Institute with centralized leadership.
[c]
Excess of revenue and gains and losses over expenses in the consolidated statements of operations is referred to as “net
income” for purposes of Management’s Discussion and Analysis of Recent Financial Performance with the following exceptions:
 2019 net income excludes the $0.5 million loss on refunding of long-term debt
 2018 net income excludes the $75.8 million non-cash contribution received in the acquisition of Mather
 2018 net income excludes the $64.2 million gain on sale of property

3
Operations and Net Income Overview

Operating Income, Operating Cash Flow and Net Income

The following table presents a summary of key operating performance results and measures for
Northwell for the nine months ended September 30, 2018 and 2019.

Nine Months Ended Nine Months Ended

($’s In Millions) September 30, 2018 September 30, 2019

Operating income $97.0 $130.8

Operating margin 1.1% 1.4%
Operating cash flow [1] $573.2 $626.8
Operating cash flow margin 6.8% 6.8%
Net income $132.6 $456.6
Net margin 1.6% 4.8%

[1] Total operating income before interest and depreciation and amortization.

4
Operating Revenue and Volume

For the nine months ended September 30, 2019, operating revenue excluding the health
insurance companies increased by $780.9 million or 9.3%, compared to the nine months ended
September 30, 2018.

The following table presents consolidated Northwell operating revenue and certain volume
statistics for the nine months ended September 30, 2018 and 2019.

Nine Months Ended Nine Months Ended

($’s In Millions) September 30, 2018 September 30, 2019
Operating Revenue: [1]
Net patient service revenue $6,429.5 $6,969.8
Physician practice revenue $1,376.1 $1,534.8
Total patient revenue $7,805.6 $8,504.6
Other operating revenue $541.4 $622.1
Net assets released from restrictions used for operations $50.0 $51.2
Total operating revenue $8,397.1 $9,178.0
Volume: [2]
Discharges (excluding nursery) 225,662 227,718
Ambulatory surgery visits 162,822 166,427
Emergency room visits (treated and released) 504,427 503,430
Health center visits (includes GoHealth urgent care
centers) 1,024,266 1,118,277
Home care admissions 40,601 42,221
Other outpatient visits 1,588,036 1,656,656

[1] Excludes operating revenue of the health insurance companies.

[2] Volume statistics for both periods exclude physician practice visits, but include statistics from Northwell entities
including clinical joint ventures that are not members of the Obligated Group.

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 Northwell’s core business revenue consists of net patient service revenue and physician practice
revenue (collectively referred to as “total patient revenue”). For the nine months ended September 30,
2019, Northwell’s total patient revenue increased by $699.0 million or 9.0%, compared to the nine months
ended September 30, 2018. The increase occurred primarily as a result of increases in volume (primarily
related to inpatient discharges and the continued growth in physician and ambulatory services), growth
in inpatient case mix, increases in payment rates, the impact of new medications and therapies advancing
cancer care, and revenue cycle initiatives. The growth in physician and ambulatory services resulted from
continued physician recruitment efforts in a wide range of specialties including anesthesiology and
oncology, and the acquisition of existing and the opening of new ambulatory centers providing
ambulatory surgery, cancer care and imaging services including several majority-owned ambulatory
surgery centers with joint venture partners. Revenue growth was negatively affected by an increase in
inpatient denial activity from managed care payers.

Uncompensated care represents services rendered to patients without insurance or with balances
after insurance who meet the eligibility requirements of Northwell’s financial assistance policy or who
otherwise are unable to pay for the care rendered. For the nine months ended September 30, 2019, the
estimated cost of uncompensated care was approximately 3% of total patient revenue. Financial
assistance is one aspect of the multitude of community benefit programs provided by Northwell. Refer to
page 58 of Northwell’s annual report available via the attached link, for additional information on
community benefit programs provided by Northwell.

https://www.northwell.edu/sites/northwell.edu/files/2019-08/Northwell-Health-2018-Annual-
Report.pdf

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 The major components of other operating revenue are laboratory services, grants and contracts,
specialty and retail pharmacy sales, rental income and health plan risk pool revenue (unrelated to the
health insurance companies). Other operating revenue increased by $80.6 million or 14.9% for the nine
months ended September 30, 2019 compared to the nine months ended September 30, 2018. The
increase was primarily a result of increased revenue from laboratory services and specialty and retail
pharmacy sales.

Operating Expenses

Operating expenses excluding the health insurance companies for the nine months ended
September 30, 2019 increased by $740.0 million or 8.9% from the nine months ended September 30,
2018.

Summarized below are the consolidated Northwell operating expenses for the nine months ended
September 30, 2018 and 2019.

Nine Months Ended Nine Months Ended

($’s In Millions) September 30, 2018 September 30, 2019
Operating Expenses: [1]
Salaries and employee benefits $5,311.3 $5,790.3
Supplies and expenses $2,520.1 $2,761.2
Depreciation and amortization $368.1 $389.0
Interest expense $107.5 $106.7
Total operating expenses $8,307.1 $9,047.1

[1] Excludes operating expenses of the health insurance companies.

For the nine months ended September 30, 2019, salaries and employee benefits increased by
$479.0 million or 9.0%, compared to the nine months ended September 30, 2018. The increase was due
to staffing investments associated with the volume increases and the continued investments in strategic
initiatives related to the changes in health care delivery and payment models. These investments included
adding physicians and staff to support program expansion within the hospitals and the ambulatory
network, and to support population health initiatives. Wage increases and staffing investments in IT,
medical research and various safety, quality and patient experience initiatives throughout Northwell also
contributed to the growth in salaries and employee benefits. Productivity and efficiency efforts, including
savings from the consolidation of certain services and functions, helped to control the increase in salaries
and employee benefits.

Supplies and expenses for the nine months ended September 30, 2019 increased by $241.0 million
or 9.6%, compared to the nine months ended September 30, 2018. The increase was primarily due to
medical supply and pharmaceutical costs associated with the increase in volume and inpatient case mix
and the cost of new implantable medical devices and medications. Investments in safety, quality and
patient experience initiatives, IT, and new physician practices and ambulatory centers also contributed to
the increase. Supply chain improvement efforts (which include standardization, distribution, utilization
and contracting initiatives) along with productivity and efficiency efforts, helped control the growth rate
of supplies and expenses including the impact of inflation. In addition, the mild winter of 2019 resulted in
a decrease in snow removal and utility costs.

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 Depreciation and amortization for the nine months ended September 30, 2019 increased by $20.9
million or 5.7%, compared to the nine months ended September 30, 2018. The increase was primarily due
to continued investments in IT, facilities and programs.

Interest expense was $106.7 million for the nine months ended September 30, 2019, compared
to $107.5 million for the nine months ended September 30, 2018. The decrease was primarily due to the
effect of scheduled principal payments on existing debt.

Non-Operating Gains and Losses

The following table presents a summary of non-operating gains and losses for Northwell for the
nine months ended September 30, 2018 and 2019.

Nine Months Ended Nine Months Ended

($’s In Millions) September 30, 2018 September 30, 2019
Non-Operating Gains and Losses:
Investment income $100.6 $125.1
Change in net unrealized gains and losses and
change in value of equity method
investments ($38.2) $240.6
Change in fair value of interest rate swap
agreements designated as derivative
instruments $0.8 ($0.7)
Non-operating net periodic benefit cost ($14.0) ($12.8)
Loss on refunding of long-term debt - ($0.5)
Contribution received in the acquisition of John
T. Mather Memorial Hospital $75.8 -
Gain on sale of property $64.2 -
Other non-operating gains and losses ($13.5) ($26.4)
Total non-operating gains and losses $175.6 $325.3

Due to the changes in the investment markets during the nine months ended September 30, 2019
and 2018, Northwell’s net unrealized gains and losses relating to investments have fluctuated. Refer to
the Audited Consolidated Financial Statements and the Unaudited Interim Consolidated Financial
Statements for more information on Northwell’s investments.

Refer to Debt section herein for further information on the refunding transaction related to the
2019 bond issue.

On January 1, 2018, Northwell acquired John T. Mather Memorial Hospital (“Mather”) by means
of an inherent contribution where no consideration was transferred by Northwell. Northwell accounted
for the business combination by applying the acquisition method, and accordingly, the inherent
contribution is valued as the excess of Mather’s assets over liabilities. In determining the inherent
contribution received, all assets and liabilities were measured at their fair values as of the acquisition date.
The fair value of the net assets acquired without donor restrictions of $75.8 million was recorded as a
contribution within non-operating gains and losses in the consolidated statement of operations for the
nine months ended September 30, 2018. Refer to Note 1 to the Audited Consolidated Financial
Statements for additional information.

Northwell held title to a remainder interest in a property located in Brea, California that was
donated in a prior year. In June 2018, the property was sold and Northwell recognized a $64.2 million gain
on sale of property for its share of the sale proceeds received.

8
Other Changes in Net Assets Without Donor Restrictions

For a complete list of other changes in net assets without donor restrictions for the nine months
ended September 30, 2019 and 2018, refer to the Unaudited Interim Consolidated Financial Statements.

Fundraising

For the nine months ended September 30, 2019 and 2018, Northwell received $41.2 million and
$54.5 million, respectively, in new net pledges and cash donations. Of the $41.2 million received during
2019, $17.7 million was in pledges and $23.5 million was in cash. Of the $54.5 million received during
2018, $21.9 million was in pledges and $32.6 million was in cash.

Cash and pledges are generally received by the Northwell Health Foundation (the “Foundation”),
which was formed to solicit, receive and administer funds to be used for major modernization projects,
capital acquisitions, special programs and other health care services for the benefit of the members of the
Obligated Group and other affiliated tax-exempt organizations of Northwell. The Foundation is not a
member of the Obligated Group.

9
Statement of Financial Position Overview

Days cash on hand, long-term debt to cash flow and long-term debt service coverage ratios for
September 30, 2019 are calculated using twelve months of operating results, covering the period October
1, 2018 through September 30, 2019.

Liquidity and Capital Resources

Unrestricted cash and investments increased to $3.26 billion as of September 30, 2019 compared
to $3.05 billion as of December 31, 2018, resulting in 103 days cash on hand as of September 30, 2019, an
increase of 1 day from December 31, 2018, primarily attributable to gains in the investment markets. Total
unrestricted cash and investments are comprised of cash and cash equivalents, marketable securities and
other investments. Refer to Note H to the Unaudited Interim Financial Statements and Note 4 to the
Audited Consolidated Financial Statements for more information.

The following chart presents the total unrestricted cash and investments, in millions, used in the
days cash on hand calculation and the days cash on hand at December 31, 2017 and 2018 and September
30, 2019.

Total Unrestricted Cash and Investments and Days Cash on Hand

$3,500 105 103 110

102

$3,250 90

$3,000 70

- Unrestricted cash and

investments [1]

Days Cash on Hand

$2,750

$2,500
$2,983
$3,051
$3,261 50

30

$2,250 10
12/31/17 12/31/18 9/30/19

[1] Refer to Note H to the Unaudited Interim Financial Statements and Note 4 to the Audited Consolidated Financial Statements
for more information.

In order to provide for future repayment of debt with bullet maturities, management has
established sinking funds amounting to $227.6 million, $171.0 million and $92.7 million at September 30,
2019, and December 31, 2018 and 2017, respectively. These sinking fund amounts are excluded from total
unrestricted cash and investments and the days cash on hand calculation reflected in the above chart.
Also excluded are funds designated by management to pay malpractice and other self-insurance liabilities,
as well as unspent taxable bond proceeds and other funds designated by management to fund future
capital expenditures and investments.

10
 Northwell’s cash to debt ratio decreased to 86.8% at September 30, 2019 from 91.0% at
December 31, 2018, primarily due to the 2019 bond transactions referred to in the Debt section. The cash
to debt ratio has been calculated for both periods including the management designated sinking funds
with the unrestricted cash and investments, but excluding the other management designated funds noted
in the paragraph above.

In September 2019, $364.0 million of management designated malpractice and other self-
insurance assets were transferred to the Northwell Health Cash Balance Plan, a noncontributory defined
benefit pension plan, which resulted in certain financial benefits and cash flow savings including the
avoidance of $15.0 million in variable rate Pension Benefit Guarantee Corporation premiums in 2019.
Refer to Note H to the Unaudited Interim Financial Statements for further information.

Patient Accounts Receivable

Days of total patient revenue in patient accounts receivable were 45 days as of September 30,
2019 compared to 46 days at December 31, 2018.

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Northwell
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Property, Plant and Equipment

Management monitors and manages capital spending in relation to operations, capital market
conditions affecting investments, fundraising and debt capacity. Capital additions (including assets
acquired under finance lease obligations) totaled $559.5 million and $617.5 million for the nine months
ended September 30, 2019 and 2018, respectively.

Net assets released from restrictions for capital asset acquisitions totaled $42.2 million and $27.1
million for the nine months ended September 30, 2019 and 2018, respectively.

11
 Capital expenditures as a percentage of depreciation and amortization were 140% and 167% for
the nine months ended September 30, 2019 and 2018, respectively.

Accounts Payable

Days of supplies and expenses in accounts payable were 95 days and 94 days as of September 30,
2019 and December 31, 2018, respectively.

Debt

The following table presents a summary of Northwell’s total outstanding debt, debt to
capitalization, long-term debt to cash flow and long-term debt service coverage ratio as of and for the
year ended December 31, 2018 and twelve months ended September 30, 2019.

($’s In Millions) 12/31/18 9/30/19

Total outstanding debt[1] $3,542.2 $4,018.5

Debt to capitalization[2] 48.5% 48.6%
Long-term debt / cash flow[3] 4.9x 5.3x
Long-term debt service coverage 3.3x 3.2x

[1] Total outstanding debt includes long-term debt, finance lease obligations and short-term borrowings.
[2] Capitalization is defined as the sum of total outstanding debt and total net assets, excluding those related to permanent
endowments.
[3] Long-term debt includes long-term debt and finance lease obligations, net of current portions. Cash flow is defined as net
income before all items defined in footnote [d] on the following page, except for interest expense.

In September 2019, Northwell Healthcare, Inc. (HCI), a member of the Obligated Group, issued
$447.7 million of taxable Northwell Health Series 2019A bonds. The Series 2019A taxable bonds were
issued by HCI as a joint and several general obligation of the Obligated Group. The Series 2019A taxable
bonds bear interest at a fixed rate, payable semi-annually, with a maturity date of November 1, 2049. The
proceeds from the Series 2019A taxable bonds will primarily be used for capital investments. The Series
2019A taxable bond issue was increased by an amount equal to the previously anticipated 2020 borrowing
needs in order to take advantage of historically favorable interest rates at the time of the issuance.

In September 2019, the Obligated Group issued $41.1 million of tax-exempt revenue bonds
through the Dormitory Authority of the State of New York (DASNY) Series 2019A bonds. The DASNY Series
2019A bonds were sold at a premium of $4.3 million and bear interest at a fixed rate, payable semi-
annually, with a final maturity date of May 1, 2033. The proceeds from the DASNY Series 2019A bonds,
along with existing trustee-held Series 2009E debt service funds, were used to refund $49.9 million in
Series 2009E bonds of the Obligated Group. The refunding transaction resulted in an overall net present
value savings to the Obligated Group of approximately $5.4 million.

In September 2019, the Obligated Group also issued $161.2 million of tax-exempt revenue bonds
through the DASNY Series 2019B bonds. The DASNY Series 2019B bonds were sold at a premium of $20.9
million and bear interest at a fixed rate, payable semi-annually through May 1, 2048, with mandatory
purchase dates ranging from May 1, 2022 through May 1, 2026. The proceeds from the DASNY Series
2019B bonds were and will be used to finance capital projects for certain members of the Obligated
Group.

12
 Northwell’s total debt profile as of September 30, 2019 was comprised of 2.4% variable rate debt
and 97.6% fixed rate debt. However, as most of the long-term variable rate debt is hedged under interest
rate swap agreements, the effective variable and fixed rate debt is 1.0% and 99.0%, respectively, of the
total outstanding debt. Total outstanding debt increased by $476.3 million from December 31, 2018 to
September 30, 2019, primarily due to the 2019 bond transactions discussed above, partially offset by
principal payments on debt.

Debt to capitalization was 48.6% at September 30, 2019, compared to 48.5% at December 31,
2018. Long-term debt to cash flow increased to 5.3x at September 30, 2019, compared to 4.9x at
December 31, 2018, primarily due to the 2019 bond transactions discussed above.

The long-term debt service coverage ratio decreased to 3.2x for the twelve months ended
September 30, 2019 from 3.3x for the year ended December 31, 2018. For the September 30, 2019 and
December 31, 2018 calculations, maximum annual debt service was $281.8 million and $248.8 million,
respectively, and occurs in 2022 for the September 30, 2019 calculation and 2019 for the December 31,
2018 calculation. Income available for debt service[d] for the twelve months ended September 30, 2019
and December 31, 2018 was $898.1 million and $831.8 million, respectively.

Northwell primarily uses its short-term borrowings under revolving credit facilities to bridge
capital expenditures to be paid with donations and/or bond issues. Short-term borrowings were $0.8
million and $103.5 million as of September 30, 2019 and December 31, 2018, respectively, and the total
credit currently available under such arrangements is $292 million, including amounts outstanding.

[d]
Net income as defined in footnote [c] before depreciation and amortization, interest expense, the change in net unrealized
gains and losses and change in value of equity method investments, and the change in fair value of interest rate swap agreements
designated as derivative instruments.
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Interest Rate Swap Agreements

Certain members of Northwell have entered into various interest rate swap agreements with
financial institutions, matched or related to the term and rate of various bond issues or debt agreements.
As of September 30, 2019 and December 31, 2018, the aggregate fair value of the interest rate swap
agreements was a liability of $6.9 million and $4.9 million, respectively.

Swap agreements expose Northwell to credit risk in the event of nonperformance by the
counterparties. Northwell believes that the risk of material impact to its consolidated financial statements
arising from nonperformance by the counterparties is low.

Commitments and Contingencies

For information on commitments and contingencies, refer to Note L to the Unaudited Interim
Financial Statements and Note 13 to the Audited Consolidated Financial Statements.

Summary

Revenue growth associated with increased volume, inpatient case mix and payment rates,
revenue cycle initiatives and growth in physician and ambulatory services, coupled with expense
reductions from supply chain and other productivity and efficiency initiatives, partially offset by
investments, including those related to ambulatory and physician network growth, patient experience,
quality and safety initiatives, medical research and education, behavioral health services and population
health management, all contributed to the operating results for Northwell for the nine months ended
September 30, 2019.

Despite the challenges and factors pressuring operating margins, Northwell continues to focus on
improving operating performance, as evidenced by the decisions to wind down the health insurance
companies and withdraw from New York State’s insurance markets. While management continues to
believe that operating a provider owned health insurance company could be an effective strategy to
manage population health, there are multiple other strategies and tactics currently in place to achieve
similar goals to which Northwell remains committed.

Management also continues to focus on creating additional revenue opportunities through new
and enhanced facilities, building a more diversified business model (including expanding joint venture
partnerships), physician recruitment efforts, the on-going expansion of value-based payment models
associated with population health management, and revenue cycle initiatives, as well as operating
expense reductions with operational efficiency efforts, program consolidation and supply chain initiatives.

Northwell continues to invest in strategic capital projects and technology, including electronic
health records, digital health technology and telehealth services, to maintain what management believes
is a competitive advantage regarding patient and physician satisfaction and retention, and to improve
clinical outcomes, patient experience, and operational processes. In addition, Northwell is making
strategic investments in physicians who support key clinical service lines and staff to support the growth
in the physician and ambulatory network, and in various other safety, quality and service initiatives.
Management continues to monitor strategic capital needs in relation to operations, capital market
conditions affecting investment returns, fundraising and debt capacity, so that Northwell can continue to
invest in people, programs and facilities in order to successfully adapt and respond to changes in the
health care industry while continuing to meet the needs of the patients and families in all the communities
it serves.

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