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UNITED STATES
SECURITIES AND EXCHANGE COMMISSION
WASHINGTON, D.C. 20549
FORM 10-K
[X] ANNUAL REPORT PURSUANT TO SECTION 13 OR 15(d) OF THE SECURITIES EXCHANGE
ACT OF 1934
FOR THE FISCAL YEAR ENDED APRIL 30, 1999
OR
[ ] TRANSITION REPORT PURSUANT TO SECTION 13 OR 15(d) OF THE SECURITIES
EXCHANGE ACT OF 1934 [NO FEE REQUIRED]
FOR THE TRANSITION PERIOD FROM __________ TO ___________
COMMISSION FILE NO. 0-20488
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PMR CORPORATION
(EXACT NAME OF REGISTRANT AS SPECIFIED IN ITS CHARTER)
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DELAWARE 23-2491707
STATE OR OTHER JURISDICTION OF I.R.S. EMPLOYER IDENTIFICATION NO.
INCORPORATION OR ORGANIZATION
501 WASHINGTON STREET, 5TH FLOOR 92103
SAN DIEGO, CALIFORNIA (ZIP CODE)
(ADDRESS OF PRINCIPAL EXECUTIVE OFFICES)
(REGISTRANT'S TELEPHONE NUMBER, INCLUDING AREA CODE) (619) 610-4001
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SECURITIES REGISTERED PURSUANT TO SECTION 12(B) OF THE ACT: NONE
SECURITIES REGISTERED PURSUANT TO SECTION 12(G) OF THE ACT:
COMMON STOCK, PAR VALUE $.01 PER SHARE
Indicate by check mark whether the registrant (1) has filed all reports
required to be filed by Section 13 or 15(d) of the Securities Exchange Act of
1934 during the preceding 12 months (or for such shorter period that the
registrant was required to file such reports), and (2) has been subject to such
filing requirements for the past 90 days. Yes [X] No [ ]
Indicate by check mark if disclosure of delinquent filers pursuant to Item
405 of Regulation S-K is not contained herein, and will not be contained, to the
best of registrant's knowledge, in definitive proxy or information statements
incorporated by reference in Part III of this Form 10K or any amendment to this
Form 10K [ ]
As of June 30, 1999, the approximate aggregate market value of the Common
Stock held by non-affiliates of the registrant was $15,399,922, based upon the
closing price of the Common Stock reported on the Nasdaq National Stock Market
of $3.3125 per share. See footnote (1) below.
The number of shares of Common Stock outstanding as of June 30, 1999 was
6,988,878.
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(1) The information provided shall in no way be construed as an admission that
any person whose holdings are excluded from the figure is not an affiliate
or that any person whose holdings are included is an affiliate and any such
admission is hereby disclaimed. The information provided is included solely
for record keeping purposes of the Securities and Exchange Commission.
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PART I
Except for the historical information contained herein, the following
discussion contains forward-looking statements that involve risks and
uncertainties. The Company's actual results could differ materially from those
discussed below. Factors that could cause or contribute to such differences
include without limitation, those discussed in the description of the Company's
business below and the section entitled "Risk Factors," in Item 7 "Management's
Discussion and Analysis of Financial Condition and Results of Operations" and
elsewhere in this Annual Report, as well as those discussed in documents
incorporated herein by reference.
ITEM 1. BUSINESS
GENERAL
PMR Corporation and its subsidiaries ("PMR" or the "Company") is a
leading manager of specialized mental health care programs and disease
management services designed to treat individuals diagnosed with a serious
mental illness ("SMI"), primarily schizophrenia and bi-polar disorder (i.e.,
manic-depressive illness). PMR manages and administers the delivery of a broad
range of outpatient and community-based psychiatric services for SMI patients,
consisting of 37 intensive outpatient programs (the "Outpatient Programs"), two
case management programs (the "Case Management Programs") and four chemical
dependency and substance abuse programs (the "Chemical Dependency Programs"). In
July, 1998, the Company and Stadt Holdings (formerly, Stadtlander Drug
Distribution Co., Inc.) ("Stadtlander") formed a new company called Stadt
Solutions, LLC ("Stadt Solutions"). Stadt Solutions offers a specialty pharmacy
program for individuals with an SMI. Stadt Solutions presently serves
approximately 7,500 individuals through fifteen pharmacies in fourteen states.
In October, 1998, PMR, in conjunction with two California-based HMOs and a
California professional corporation (the "Medical Group"), launched a fully
capitated managed care product for SMI individuals that have Medicare as their
primary insurer. The product is a pilot project which will be expanded if
enrollment and profitability targets are met.
PMR, including Stadt Solutions, operates in approximately twenty-five
states and employs or contracts with more than 400 mental health and
pharmaceutical professionals and administers or provides services to
approximately 11,000 individuals diagnosed with SMI.
A four-decade old public policy trend of de-institutionalizing the
mentally ill from long-term care hospitals into the community has resulted in a
deterioration in SMI patient care and a fragmented and disjointed system of care
which typically fails to adequately provide the patient management or
coordination of benefits required by the medically complex SMI patient
population. Coordination and monitoring of patient services is essential to
avoid the debilitating effects of fragmented care delivered by diverse
outpatient providers which are reimbursed by disparate, uncoordinated funding
sources. PMR's clinical philosophy focuses on improving outcomes and lowering
costs by utilizing intensive, community-based treatment of the SMI population in
outpatient settings.
PMR-managed or administered Outpatient Programs serve as a
comprehensive alternative to inpatient hospitalization and include partial
hospitalization and lower intensity outpatient services. The Case Management
Programs provide an intensive, individualized primary care service which
consists of a proprietary case management model utilizing clinical protocols for
delivering care to SMI patients. The most rapidly growing segment of the
Company's business is the Stadt Solutions specialty pharmacy venture. This
service provides pharmacy distribution directly to patients or to the community
institutions that provide mental health services to such patients. Stadt
Solutions will provide additional value-added services to physicians and clients
relating to compliance, proper dosing, drug interactions and side effects.
PMR's objective is to be the leader in the management of cost-effective
programs which provide quality care and foster the successful recovery of
individuals from the devastating effects of SMI. The Company intends to achieve
this objective by (i) expanding Stadt Solutions' specialty pharmaceutical
services to individuals with SMI as well as providing clinical information
services to pharmaceutical companies, health care providers and public sector
purchasers; (ii) selectively obtaining new contracts for Outpatient and Case
Management Programs in existing markets (iii) establishing new programs and
ancillary services, and (iv) expanding its coordinated care pilot project
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within current markets and rolling out new markets if the project achieves
profitability and revenue targets during this fiscal year.
PMR was incorporated in the State of Delaware in 1988. The operations
of the Company include the operations of its wholly owned subsidiaries,
Psychiatric Management Resources, Inc., Collaborative Care Corporation,
Collaborative Care, Inc., and Twin Town Corporation, and its majority owned
subsidiary Stadt Solutions. The principal executive offices of the Company are
located at 501 Washington Street, 5th Floor, San Diego, California 92103. The
Company's telephone number is (619) 610-4001.
THE MARKET AND INDUSTRY BACKGROUND
According to the National Institute of Mental Health (the "NIMH") and
its National Advisory Mental Health Council (the "NAMHC"), serious mental
illnesses are neurobiological disorders of the brain and include schizophrenia,
schizoaffective disorder, manic-depressive illness and autism, as well as severe
forms of other disorders such as major depression, panic disorder and
obsessive-compulsive disorder. These diseases are chronic and represent one of
the highest cost segments of the health care system. Industry sources indicate
that approximately 2.8% of the adult population and 3.2% of children ages 9-17
are affected by SMI, for a total SMI population in the United States of
approximately 5.6 million people. According to industry sources, in 1995,
individuals diagnosed with SMI consumed $27 billion in direct medical costs
relating to the provision of mental health services and consumed more than $74
billion in total costs, including estimates of lost productivity. Based on the
industry data, the Company estimates that the direct medical expenditures
associated with SMI represent in excess of 25% of total direct mental health
care costs. However, the potential costs of direct medical care may exceed these
levels due to the approximately 2.2 million Americans estimated to be suffering
from untreated SMI. Substantially all costs of treating and managing the SMI
population are borne by federal, state and local programs, including Medicare
and Medicaid. The SMI population accesses care primarily through community
mental health centers ("CMHCs") and other community-based health care facilities
such as psychiatric and acute care hospitals and nursing homes. CMHCs typically
are not-for-profit organizations which lack access to capital, sophisticated
management information and financial systems, and comprehensive programs for
treating SMI patients.
Since 1955, the SMI population in the United States has experienced
extensive de-institutionalization resulting in the public psychiatric hospital
census declining from approximately 560,000 individuals in 1955 to approximately
72,000 individuals in 1994. The effect of de-institutionalization is exacerbated
by the fact that the general population grew 58% over this same period, while
the SMI incidence rate remained stable. Industry sources estimate that there are
approximately 763,000 individuals in the United States currently diagnosed with
SMI who otherwise would have received inpatient treatment prior to
de-institutionalization, of which 60%-75% are patients with schizophrenia or
bi-polar disorder. The result of this trend has been increased rates of
transinstitutionalism and homelessness among SMI patients. Transinstitutionalism
is a term utilized to describe the mechanism by which de-institutionalized
individuals receive care in one or more alternate settings such as nursing
homes, general hospitals, jails and prisons. Industry estimates indicate that
23% of nursing home residents have a mental disorder and that more than 98,000
acute care hospital beds are occupied by SMI patients. Furthermore,
approximately 10% of all prison and jail inmates are diagnosed with SMI and 35%
of the approximately 350,000 homeless individuals in the United States are
currently suffering from SMI disorders.
The most frequently occurring primary diagnosis of the SMI population
treated by PMR is schizophrenia, an incurable biological disorder which affects
approximately 1% of the general population. Approximately 70% of the patients
treated at the Company's programs are diagnosed with schizophrenia or
schizoaffective disorder. The remainder are afflicted with bi-polar disorder,
major depression, or other personality disorders. Industry sources indicate that
up to 50% of patients suffering from schizophrenia receive no treatment for
symptoms. In addition, due to the stigma and social constraints that accompany
schizophrenia, it is estimated approximately 25% of schizophrenics attempt to
end their lives through suicide. In general, each year a significant percentage
of individuals with schizophrenia are admitted for an inpatient hospitalization
and virtually all of the diagnosed population is prescribed a chronic medication
regimen. It is not uncommon that these individuals also suffer from a substance
abuse or chemical dependency diagnosis. Based on industry data, the Company
estimates that treatment
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for schizophrenia consumes approximately $20 billion in annual mental health
care expenditures. The direct medical costs of schizophrenia are consumed
primarily in CMHCs, nursing homes and acute care hospitals.
Since the introduction of Clozaril in the United States in 1989,
several pharmaceutical products have been developed for SMI patients that have
resulted in significant improvements in treatment. Although the specific
biological causes of SMI remain unknown, the efficacy of many treatment regimens
has been found to be comparable to that in other branches of medicine. For
example, with the exception of autism, medications exist which generate medical
responses in 60%-90% of patients with SMI. For schizophrenia and schizoaffective
disorder, research has shown that standard anti-psychotic medication will reduce
psychotic symptoms in 60% of patients and in 70%-85% of those experiencing
symptoms for the first time. These newer medications, with proper use and
compliance, offer significant potential for recovery to individuals afflicted
with SMI.
PROGRAMS AND OPERATIONS
OUTPATIENT PROGRAMS
PMR's Outpatient Programs are operated under management, administrative
or consulting contracts with acute care hospitals, psychiatric hospitals and
CMHCs, and consist principally of intensive outpatient programs which serve as
alternatives to inpatient care. These programs target patients in crisis or
those recovering from crisis and thus provide more intensive clinical services
than those generally available in a traditional outpatient setting. The Company
currently manages 37 Outpatient Programs in Arizona, Arkansas, California,
Colorado, Hawaii, Idaho, Kentucky, Michigan, Missouri, Nevada, North Carolina,
Ohio, Tennessee, Texas and West Virginia. The Company contracts with 32 separate
providers including Scripps Health, St. Mary's Health Center of the SSM Health
Care System, University of California, Irvine, and Presbyterian Hospital, North
Carolina. Typically, the Company's contracts are two to five years in length.
While contract expirations occur from time to time in the ordinary course of
business, the Company vigorously attempts to extend and renew existing
profitable contracts and to maintain its market share through the addition of
new contracts.
The Outpatient Programs consist principally of psychiatric partial
hospitalization programs which are ambulatory in nature and provide intensive,
coordinated clinical services to patients diagnosed with SMI. In 1996, the
Company introduced its structured outpatient clinic, which is a lower intensity
"step-down" outpatient service designed to continue the care, maintain the gains
achieved and prevent the relapse of patients who have completed the partial
hospitalization program. To further expand the Company's potential client
population, the Company broadened its structured outpatient program in August
1997 to include clients who are at a lower level of clinical risk.
Patients admitted to the Outpatient Programs undergo a complete
assessment and treatment planning process that includes psychiatric,
psycho-social, medical and other specialized evaluations under the care and
supervision of a psychiatrist. Each SMI individual is assigned a care
coordinator responsible for managing the comprehensive treatment available to
the patient, which includes specialty services for geriatric and dually
diagnosed patients. All Outpatient Programs provide programming five or six days
a week. Treatments include daily group psychotherapy and individual therapy
conducted by therapists, nurses and mental health specialists who are supervised
by the appropriate department of the hospital or CMHC and by senior clinical
managers in the programs. In Outpatient Programs where the Company retains
designated staffing responsibilities, the Company provides program
administrators and medical directors, and may provide nurses, community liaisons
and other clinical personnel. In these cases, the program administrator
generally has a degree in psychology or social work and several years of
experience in health care administration. Typically, the medical director is a
board-eligible or certified psychiatrist and the other professionals have
various levels of training in nursing, psychology or social work.
Through its Outpatient Programs, the Company brings management
expertise to the health care provider with respect to the establishment,
development and operation of an outpatient program for SMI patients that is not
usually available on an in-house basis. Services provided under Outpatient
Program management contracts include complete program design and administration
from start-up through ongoing program operation. These programs are
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intended to enhance the delivery of outpatient mental health services by
introducing proprietary clinical protocols and procedures, conducting quality
assurance and utilization reviews, identifying or supplying highly trained
personnel, and expanding the range of services provided. In addition, the
programs also enhance the management of financial and administrative services by
providing support to the providers and performing budget, financial and
statistical analyses designed to monitor facility performance. The Company
believes these comprehensive features enhance the efficiency and quality of care
provided by its Outpatient Programs. During the first quarter of fiscal year
2000, the Company has closed six Outpatient Program locations in Chicago,
Illinois; Bellevue, Washington; and San Francisco, Santa Ana, Riverside and San
Bernardino, California; and has opened three Outpatient Program locations in
Corona, California; Reno, Nevada; and Charleston, West Virginia.
CASE MANAGEMENT PROGRAMS
PMR's Case Management Programs were created in 1993 to treat the SMI
population in a managed care environment. The case management model was
developed in part from proprietary clinical protocols and assessment tools which
were acquired in 1993 from leading researchers in the field of psychiatric
rehabilitation. Specifically, the Company's programs provide SMI patients with
personalized, one-on-one services designed to stabilize their daily lives and
provide early intervention in crisis situations, thereby limiting the
catastrophic events which lead to inpatient hospitalizations. The Case
Management Programs utilize comprehensive protocols based upon a specific model
of intensive service coordination in conjunction with a case manager whose
responsibilities include consumer education, the development of crisis plans,
responding to crisis events, linking patients to emergency services, assessing
patient needs, reviewing patient treatment plans, and authorizing and reviewing
services. Case management services vary by market and need of the population and
may include 24-hour case management, crisis intervention, respite services,
housing assistance, medication management and routine health screening. PMR
believes that its Case Management Programs represent the core clinical tools for
managing the SMI population in either a capitated or fee-for-service environment
and enable its patients to live more healthy, independent, productive and
satisfying lives in the community.
PMR offers its case management services through long-term exclusive
management agreements with leading independent providers of case management
services. Pursuant to those agreements, the Company contributes its proprietary
protocols and/or management expertise and, when necessary, negotiates case
management rates and contracts on behalf of the providers. The Company may also
provide training, management information systems support, and accounting and
financial services. Presently, the Company has agreements with two case
management agencies in Tennessee.
PMR provides its Case Management services principally in Davidson
County, Tennessee, presently serving approximately 3,000 individuals located
primarily in Nashville, Tennessee. The Company also provides case management
services through a case management agency in Memphis, Tennessee as well as case
management services in Southern California as part of its managed care effort.
In 1998, the Company introduced its Urgent Care service in Nashville,
Tennessee. Urgent Care is a high acuity, crisis intervention service designed
for triage and stabilization of a patient at the time of highest clinical need.
The service involves physician intervention and combines a medical model for
crises and assessment and a case management model for on-going maintenance.
STADT SOLUTIONS
In July 1998, the Company and Stadtlander, a leading specialty pharmacy
company, formed Stadt Solutions, a Delaware limited liability company, to offer
specialty pharmaceutical services to individuals with SMI. Stadt Solutions also
offers site management and clinical information services to pharmaceutical
companies, health care providers and public sector purchasers. The ownership of
Stadt Solutions is held 50.1% by PMR and 49.9% by Stadtlander. Through December
31, 2000, Stadtlander is entitled to receive a priority distribution
approximately equivalent to the operating income Stadtlander expected to be
generated by Stadtlander's contributed base of approximately 6,000 clients. The
incremental operating income in excess of this base, if any, will be distributed
based on proportional ownership to the Company and Stadtlander through this
period. Beginning with calendar
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year 2001, the preferred payment to Stadtlander becomes a fixed amount which is
determined primarily based on the financial results in 2000.
The venture commenced business with approximately 6,000 clients
receiving the drug Clozaril, an anti-psychotic for schizophrenia, as well as
blood monitoring services through thirteen Stadtlander pharmacies in twelve
states. Stadt Solutions has opened two of its own pharmacies since its inception
in July 1998. Stadt Solutions will seek to offer patients expanded services,
including dispensing of all of the pharmaceuticals needed by these individuals
and providing disease management services to improve compliance and education
for the patient, the physician and family members. The Company believes that
Stadt Solutions is the first specialty pharmacy company devoted to serving the
needs of individuals with SMI.
In January 1999, Stadtlander Operating Company, L.L.C., a subsidiary of
Bergen Brunswig Corporation ("BBC") purchased the stock of Stadtlander Drug
Distribution Co., Inc. BBC is one of the nation's largest independent wholesale
drug distributors. In May 1999, BBC acquired PharMerica, Inc., a pharmacy
services company. Prior to consummation of the acquisition, the Company and
Stadt Solutions unsuccessfully sought a temporary restraining order to prevent
consummation of the acquisition alleging the acquisition would result in the
violation of certain non-competition and confidentiality provisions contained in
the Stadt Solutions Operating Agreement. The litigation is continuing. See "Item
3. Legal Proceedings".
SITE MANAGEMENT AND CLINICAL INFORMATION
In January 1997, the Company began the development of a site management
and clinical information division. This division was established to participate
in clinical trials and collect clinical information related to pharmaceutical
and non-pharmaceutical clinical practice. The Company's objective was to build a
business model that contributes to the Company's revenues and earnings and to
develop an information asset that can improve and define "best practices" for
the SMI patient population. In April 1998, the Company entered into reciprocal
enabling agreements with Vanderbilt University where the Company is able to
enter into project-specific research agreements with the University to develop
and carry out funded research projects.
The current research network includes six locations with qualified
investigators and study coordinators. PMR contributed the site management and
clinical information initiative to Stadt Solutions as part of Stadt Solutions'
formation in July 1998.
MANAGED CARE
In October 1998, the Company, in conjunction with Universal Care, a
Knox-Keene licensed health care service plan, HealthNet, a large HMO with
Medicare risk contracting capability, and the Medical Group launched a managed
care pilot project in Southern California. The pilot project is designed to
appeal to individuals who are deemed as disabled due to their SMI and therefore
have Medicare as their primary insurance. HealthNet holds the Medicare risk
contract and the individuals with SMI are enrolled in HealthNet's health plan.
Universal Care contracts with HealthNet to sub-capitate risk and provides
substantially all of the non-psychiatric care and case management network. The
Medical Group primarily provides and arranges for behavioral health services for
the SMI enrollees. The Company furnishes certain administrative services through
an agreement with Medical Group. The Company's services to the Medical Group
include, but are not limited to, billing and collection, member services,
utilization review, quality assurance, quality management, financing and
credentialing services. In addition, the Company also provides case management
services to the Medical Group's enrolled patients.
CHEMICAL DEPENDENCY PROGRAMS
Through a wholly-owned subsidiary, the Company operates and manages
programs devoted exclusively to substance abuse and rehabilitation in ambulatory
settings, primarily to patients of managed care organizations in Southern
California. The Company's Chemical Dependency Programs are operated either as
free-standing treatment services or as part of a Management Services Agreement
with health care providers. All programs have received accreditation by the
Joint Commission of American Health Organizations ("JCAHO").
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The Company operates four outpatient Chemical Dependency Programs in
Southern California under the name of Twin Town Treatment. The Company has
decided that its Chemical Dependency Programs are no longer a core strategic
asset of the Company and is currently evaluating alternatives with respect to
the future of such Programs.
PROGRAM LOCATIONS
STATE CITY SERVICE PROVIDED
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California San Diego Outpatient; Clinical Research
Culver City Outpatient
El Cajon Outpatient
Los Angeles Outpatient
Ventura Outpatient
Oakland Outpatient
Walnut Creek Outpatient
Vista Outpatient
Union City Outpatient
Garden Grove Managed Care
Rosemead Outpatient
Sacramento Clinical Research
Orange Outpatient; Chemical Dependency
San Jose Outpatient
La Jolla Outpatient
North Hollywood Chemical Dependency
Los Alamitos Chemical Dependency
Torrance Chemical Dependency
Encinitas Clinical Research
Alabama Birmingham Pharmacy*
Arizona Phoenix Outpatient
Tempe Outpatient
Arkansas Little Rock Outpatient (2); Clinical Research
Colorado Denver Outpatient
Georgia Atlanta Pharmacy*
Hawaii Honolulu Outpatient; Pharmacy*
Waipahu Outpatient
Idaho Boise Outpatient
Kentucky Bowling Green Outpatient
Mayfield Outpatient
Lexington Outpatient
Louisville Outpatient
Maine Portland Pharmacy*
Massachusetts Boston Pharmacy*
Michigan Detroit Outpatient; Clinical Research
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STATE CITY SERVICE PROVIDED
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Minnesota Minneapolis Pharmacy*
Missouri St. Louis Outpatient; Pharmacy*
Nevada Reno Outpatient
New York Long Island Pharmacy*
North Carolina Charlotte Outpatient
Ohio Cleveland Outpatient
Columbus Outpatient; Pharmacy
Dayton Outpatient
Pennsylvania Pittsburgh Pharmacy*
Philadelphia Pharmacy*
South Carolina Columbia Pharmacy*
Tennessee Kingsport Outpatient
Madison Outpatient
Nashville Outpatient; Case Management; Clinical Research;
Pharmacy
Memphis Case Management
Texas Austin Outpatient; Clinical Research
Utah Salt Lake City Pharmacy*
Washington Seattle Pharmacy*
West Virginia Charleston Outpatient
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* Pharmacy licensed through Stadtlander.
CONTRACTS
OUTPATIENT PROGRAMS
Each Outpatient Program is generally administered and operated pursuant
to the terms of written management, administrative or consulting contracts with
providers. These contracts generally govern the term of the program, the method
by which the program is to be managed by the Company, the responsibility of the
provider for licensure, billing, insurance and the provision of health care
services, and the methods by which the Company will be compensated. The
contracts are generally for a stated term between two and five years. Generally,
contracts may only be terminated with cause or upon the occurrence of certain
material events including changes in applicable laws, rules or regulations.
Revenues derived by the Company under these contracts generally fit
within three types of arrangements: (i) all-inclusive fee arrangements based on
fee-for-service rates (based on units of service provided) under which the
Company is responsible for substantially all direct program costs; (ii)
fee-for-service arrangements under which the provider maintains responsibility
for a large extent of direct program costs; and (iii) fixed fee arrangements
where the Company's fee is a fixed monthly sum and the provider assumes
responsibility for substantially all program costs. The all-inclusive
arrangements were in effect at 33 of the 39 Outpatient Programs operated during
fiscal
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1999 and constituted approximately 69.4% of the Company's consolidated revenues
for the year ended April 30, 1999. These contractual agreements are with
hospitals or CMHCs and require the Company to provide, at its own expense,
specific management personnel for each program site. Regardless of the type of
arrangement with the provider, all medical services rendered in the programs are
provided by the provider.
A significant number of the Company's contracts require the Company to
indemnify the provider for some or all of the fee paid to the Company if either
third-party reimbursement for mental health services provided to patients of the
programs is denied or if the fee paid to the Company is not reimbursable by
Medicare. See "Risk Factors -- Dependence Upon Medicare Reimbursement," "--
Sufficiency of Existing Reserves to Cover Reimbursement Risks," "Management's
Discussion and Analysis of Financial Condition and Results of Operations" and
"Business -- Regulatory Matters."
In order for the services furnished to Medicare beneficiaries in
Outpatient Programs managed by the Company to be reimbursable to the provider,
the program must be deemed to be "provider-based." In fiscal year 1998, HCFA's
Region IX office challenged the "provider-based" designation of certain
outpatient programs operated by Scripps Health a provider to which the Company
provided management services. In July 1998, HCFA's Region IX office notified
Scripps Health of its determination that certain of its programs were approved
as "provider-based" and that certain other of its program locations were not
"provider-based" because they did not meet HCFA's service area requirements. As
a result of HCFA's challenge and determination, the Company and Scripps Health
amended their contract, Scripps Health reconfigured certain of its partial
hospitalization programs, two locations were closed and one of the locations was
taken over by another provider who engaged the Company to manage the program.
One other program managed by the Company received notice that it did not meet
provider-based designation requirements because the Company was prohibited from
employing any personnel involved in the program furnished by the provider,
except as a consultant to the provider. This issue was never finally resolved
because the provider hospital closed for reasons unrelated to the notice.
Because the proper interpretation and application of the "provider-based"
criteria are not entirely clear, are applied on a case by case basis, and are
currently the subject of an ongoing rule making process, it is possible that
these challenges will emerge with other providers and that the Company may not
be able to amend its contracts to satisfy HCFA or its provider customers. See
"Regulatory Matters - Compliance with Medicare Guidelines; Reimbursement for
Partial Hospitalization Programs."
No Company Outpatient Program with a provider accounted for more than
10% of the Company's revenues for fiscal 1999.
As the Company-managed Outpatient Programs mature and increase in
number, the Company anticipates that as a matter of normal business development,
contract terminations may occur on a periodic basis. There can be no assurance
that the Company will be able to successfully replace such terminated contracts
or programs in the future.
CASE MANAGEMENT PROGRAMS
In the Fall of 1995, the Company commenced the operation of its Case
Management Programs with two case management agencies in Nashville, Tennessee
and Memphis, Tennessee. Commencing in July 1996, two managed care consortiums
became the payors for mental health care services under the Tennessee TennCare
Partners State Medicaid Managed Care Program ("TennCare"), and the Company had
contracts with both behavioral health organizations for case management programs
in Nashville and Memphis. These consortiums, known as Tennessee Behavioral
Health ("TBH") and Premier Behavioral Health ("Premier"), were fully at-risk for
the approximately 1.2 million individuals who qualified for coverage based on
Medicaid eligibility or indigency standards. The Company received notice of
termination of its contract with TBH effective December 10, 1997, but the
Company continued to provide services to, and receive payments from, TBH at
reduced rates. In February 1998, Magellan Health Services, Inc. acquired Merit
Behavioral Health Care, Inc., thereby becoming the managing shareholder of TBH.
Magellan, through its Green Spring subsidiary, is also the managing shareholder
of Premier. Beginning, July 1998, Magellan managed both Premier and TBH and as
of that date the Company has been paid the
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identical rates by both consortiums. Some uncertainty exists as to the future
structure of TennCare. See "Risk Factors -- Concentration of Revenues."
The Nashville Case Management Program is administered pursuant to a
management and affiliation agreement with the contracting provider and operates
through a wholly owned subsidiary of the Company. The Company is responsible for
developing and implementing detailed operating protocols relating to training
procedures, management information systems, utilization review, coordination of
quality assurance, contract development and other management and administrative
services, and the provision of mental health services. Pursuant to the terms of
the management and affiliation agreement, the Company manages and operates the
delivery of case management and other covered psychiatric services. The case
management provider is responsible for staff personnel and program facilities,
and retains final discretionary authority to approve the related policy manual,
staffing issues and overall program operations. The Nashville management and
affiliation agreement has a term of six years (ending April 30, 2002) and may
only be terminated for cause upon the occurrence of such events as (i) a loss of
accreditation or other required licensing or regulatory qualifications, (ii)
material breach by either party, (iii) certain legislative or administrative
changes that may adversely affect the continued operation of the program and
(iv) failure to achieve certain performance targets after designated notice and
cure periods.
The Memphis Case Management Program is also administered through a
wholly owned subsidiary of the Company which entered into a management and
affiliation agreement with a case management agency substantially similar to the
agreement entered into with the Nashville case management agency. Effective June
1, 1998, the Memphis management and affiliation agreement was terminated and the
parties entered into a Provider Services Agreement for a term of four years
pursuant to which the Company provides billing, contract development, quality
assurance and liaison services and allows the agency to utilize the Company's
protocols.
Case management contracts in Tennessee accounted for 12.3% and 21.6% of
the Company's consolidated revenues for fiscal 1999 and fiscal 1998,
respectively.
In May 1998, the Company closed its remaining Case Management programs
in Arkansas with its CMHC providers after previously anticipated changes to
Arkansas' reimbursement for case management services did not occur.
MARKETING AND DEVELOPMENT
PMR intends to focus increasing marketing and development efforts to
the expansion of the specialty pharmacy services to individuals with SMI as well
as clinical information services to pharmaceutical companies, health care
providers and public sector purchasers. The market is growing rapidly due to the
number of new drugs that have been introduced over the past five years for the
indication of schizophrenia. Numerous other drugs are in pre-approval
development for this indication as well as for bipolar disorder and major
depression. According to industry sources, in 1998 alone, pharmaceutical
companies invested approximately $4.8 billion to discover and develop medicines
acting on the central nervous system, including drugs for mental illnesses. The
Company, through Stadt Solutions, plans to develop new pharmacies to support
community-based agencies that employ prescribing physicians and assist the SMI
population in medication management and compliance.
PMR's principal marketing effort with respect to its Outpatient and
Case Management Programs is concentrated in the Company's existing markets in
the identification of prospective hospitals, CMHCs and case management agencies
which may be suitable providers for new programs or expansion of services.
Providers that may contract for the Company's services are identified through an
analysis of market need, discussions with key individuals in the prospective
area, and an assessment of the financial and clinical profile of the provider.
The Company also markets the benefits of its Outpatient, Case Management and
Urgent Care programs to managed care organizations and their provider networks
as public sector contracts are awarded. The Case Management Program is also
available to entities at risk for managed care for SMI patients. The Company has
decided that its Chemical Dependency Programs are no longer a core strategic
asset of the Company and is currently evaluating the need to continue related
marketing efforts related to those programs.
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The Company's marketing efforts with providers are undertaken by its
own marketing and development personnel who focus upon the dissemination of
information about the benefits of the Company's programs. The Company believes
that its ability to secure new contracts with providers is based on its
reputation for quality and the uniqueness of its services in its market areas.
REGULATORY MATTERS
COMPLIANCE WITH MEDICARE GUIDELINES; REIMBURSEMENT FOR PARTIAL
HOSPITALIZATION PROGRAMS
A significant component of the Company's revenues are derived from
payments made by providers to the Company for the management and administration
by the Company of Outpatient Programs managed for providers. The Company bills
its fees to the provider as a purchased management, administrative and
consultative support service. Substantially all of the patients admitted to
these programs are eligible for Medicare coverage and thus, the providers rely
upon payment from Medicare for the services. The providers are reimbursed their
costs on an interim basis by Medicare fiscal intermediaries and the providers
submit annual cost reimbursement reports to the fiscal intermediaries for audit
and payment reconciliation. The providers seek reimbursement of the Company's
fees from these fiscal intermediaries as part of their overall payments from
Medicare. Under certain of the Company's contracts the Company is obligated to
indemnify the provider for all or some portion of the Company's fees that may be
disallowed to the provider. In the event a significant amount of such fees are
disallowed for providers, there could be a material adverse effect upon the
Company's financial condition and results of operations. In addition, to the
extent that providers who contract with the Company for management services
suffer material losses in Medicare payments, there is a greater risk of
non-payment by the providers and a risk that the providers will terminate or not
renew their contracts with the Company. Thus, even though the Company is not
paid by Medicare, it may be adversely affected by reductions in Medicare
payments or other Medicare policies. See "Risk Factors-Dependence Upon Third
Party Reimbursement" below and "Item 7. Management's Discussion And Analysis Of
Financial Condition And Results Of Operations."
The Medicare Program was created in 1965 as part of the federal social
security system. It is administered by the U.S. Department of Health and Human
Services which has established the Health Care Financing Administration ("HCFA")
to administer and interpret the rules and regulations governing the Medicare
program and the benefits associated therewith. Applicable Medicare guidelines
permit the reimbursement of contracted management services provided that, among
other things, the associated fees are "reasonable." As a general rule, Medicare
guidelines indicate that the costs incurred by a provider for contract
management services relating to furnishing Medicare-covered services are deemed
"reasonable" if the costs incurred are comparable with marketplace prices for
similar services. Although management believes that the Company's fees for its
services are comparable with marketplace prices for similar services, the
determination of reasonableness may be interpreted by HCFA or a fiscal
intermediary in a manner inconsistent with the Company's belief. Notwithstanding
the Company's belief, a determination that the Company's fees may not be
"reasonable" may have a material adverse effect on the Company's business,
financial condition and results of operations.
HCFA has published criteria which partial hospitalization services must
meet in order to qualify for Medicare funding. In transmittal number 1303
(effective January 2, 1997) and in subsequent criteria published in Section
230.5 of the Medicare Hospital Manual, HCFA requires partial hospitalization
services to be: (i) incident to a physician's service; (ii) reasonable and
necessary for the diagnosis or treatment of the patient's conditions; and (iii)
provided by a physician with a reasonable expectation of improvement of the
patient from the treatment. The Medicare criteria for coverage, specifically
what is "reasonable and necessary" in particular cases is a subjective
determination on which health care professionals may disagree. Moreover, the
fiscal intermediaries which administer the Medicare program and evaluate and
process claims for payment, establish local medical review policies which the
affect of such policies may have a material adverse effect on the Company's
results of operations. How Medicare applies its "reasonable and necessary"
standard is not always consistent, and that standard may be interpreted in the
future in a manner which is more restrictive than currently prevailing
interpretations. The Company and its providers have quality assurance and
utilization review programs to monitor partial hospitalization programs managed
or administered by the Company to ensure that such programs operate in
compliance with the Company's understanding of all Medicare coverage
requirements.
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Further, the partial hospitalization programs managed by the Company
are required under HCFA's current interpretation of the Medicare regulations, to
be "provider-based" programs. This designation is important since partial
hospitalization services are covered only when furnished by or "under
arrangement" with, a "provider", i.e., a hospital or a CMHC. To the extent that
any particular partial hospitalization program is not deemed by HCFA to be
"provider based" under HCFA's current interpretation of the Medicare
regulations, there would not be Medicare coverage for the services furnished at
that site under Medicare's partial hospitalization benefit. HCFA has published
criteria for determining when programs operated in facilities separate from a
hospital's or CMHC's main premises may be deemed to be "provider-based"
programs. The proper interpretation and application of these criteria are not
entirely clear, and there is a risk that some or substantially all of the sites
managed by the Company may be found not to be "provider-based". If such a
determination is made and the Company is unable to satisfactorily restructure
its contract with the provider, HCFA may cease reimbursing for the services at
the provider, and HCFA may, in some situations, seek retrospective recoveries
from providers. Any such cessation of reimbursement for services or
retrospective recoveries could result in non-payment by providers, possibly
trigger indemnity claims, and have a material adverse effect on the Company's
business, financial condition and results of operations. In September, 1998,
HCFA published a proposed rule that would add to the existing standards that
must be met to obtain provider-based status. The comment period is open until
July 31, 1999, and the Company does not expect a final rule on provider-based
status to be effective prior to sometime in 2000, although it would be possible
for HCFA to publish a final rule effective earlier. The standards in the
proposed rule are similar to existing standards, although the proposed rule
would mandate that retrospective recoveries would ensue in most instances when
HCFA or its agents determined that a program or site was not "provider-based."
See "Risk Factors - Dependence Upon Third Party Reimbursement."
In fiscal year, 1998, HCFA's Region IX office challenged the
"provider-based" designation of certain outpatient programs operated by Scripps
Health a provider to which the Company provided management services. In July
1998, HCFA notified Scripps Health that certain of its programs were approved as
"provider-based" and that certain other of its program locations were not
"provider-based" because they did not meet HCFA's service area requirements. As
a result of HCFA's challenge and determination, the Company and Scripps Health
amended their contract, Scripps Health reconfigured certain of its partial
hospitalization programs, two locations were closed and one of the locations was
taken over by another provider who engaged the Company to manage the program. In
other instances, when the Company's customers have sought provider-based status
determinations from HCFA upon establishing a program, HCFA's Region IX Office
has interpreted the provider-based standards so as to prevent the Company from
employing any personnel involved in the programs furnished by the provider
except for "consultants" from the Company. This interpretation makes it more
difficult for the Company to furnish the services upon which the Company has
built its reputation and which its customers want. If the interpretation of
provider-based standards applied by HCFA's Region IX Office are applied by other
HCFA regional offices, or are adopted nationally as the correct interpretation,
PMR would have to re-negotiate the vast majority of its contracts to administer
partial hospitalization and other outpatient mental health programs. It is also
possible that if provider-based challenges emerge with other providers, the
Company may not be able to amend its contracts to satisfy HCFA or its provider
customers. In addition, there can be no assurance that HCFA will not challenge
the "provider-based" status of the Scripps Health program or any other Program
in the future. If the Company is unable to amend its contracts to satisfy any
"provider based" challenge in the future, the potential termination of any such
contracts could have a material adverse effect upon the Company's business,
financial condition and results of operations. "See "Business - Contracts -
Outpatient Programs."
Historically, CMHCs, unlike hospitals, were not surveyed by Medicare
before being permitted to participate in the Medicare program. However, HCFA now
requires prospective approval of all new CMHCs to confirm that they meet all
applicable Medicare conditions for furnishing partial hospitalization services.
In addition, HCFA will monitor existing CMHCs to assure compliance with
applicable conditions of furnishing partial hospitalization services. Because
the proper interpretation and application of such Medicare conditions are not
entirely clear, it is possible that these challenges may emerge with CMHCs
contracted with the Company and, if not found in compliance with the applicable
requirements, such CMHCs may be terminated from the Medicare program. It is also
possible that the government will attempt to recover payments made to such CMHCs
for services which had been furnished by the Company and paid for by Medicare,
which could possibly trigger indemnity claims
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which could be material. There may also be significant delays or suspension of
payments made to CMHCs contracted with the Company due to such increased
scrutiny and reviews by Medicare.
The Office of Inspector General ("OIG") of the United States Department
of Health and Human Services has reported that the vast majority of partial
hospitalization services furnished by CMHCs do not satisfy Medicare's coverage
criteria and that many CMHCs were not properly participating in the Medicare
program because they did not meet the statutory and regulatory definition of a
CMHC. Consequently, HCFA has implemented a program to review all partial
hospitalization services even more intensely for meeting Medicare coverage
criteria and to assure that all CMHCs meet the requirements for participation in
the Medicare program. This more intensive review and auditing of claims for
partial hospitalization services furnished by CMHCs to Medicare patients may
result in a greater number of claims being denied for the Company's customers.
The Company also expects more intensive reviews of claims, and increased audits
by HCFA and OIG, of Hospital outpatient mental health services and partial
hospitalization services including, the allowability of claims, medical
necessity issues and reasonableness of fees. Presently, one CMHC provider and
one hospital provider with whom the Company contracts are undergoing such
audits. The more intensive review of claims for partial hospitalization or other
outpatient mental health services furnished to Medicare patients may result in a
greater number of claims being denied for the Company's customers, or
disallowance of Company fees, which, as described above, may have a material
adverse effect on the Company's business, financial condition and results of
operations. In addition, if the scrutiny of CMHCs results in termination of
provider agreements between Medicare and CMHCs with which the Company has
contracts, there may be a material adverse effect on the Company's business,
financial condition and results of operations.
CHANGES IN MEDICARE'S PAYMENT FOR PARTIAL HOSPITALIZATION SERVICES
The Balanced Budget Act of 1997 requires the implementation of a
prospective payment system ("PPS") for all outpatient hospital services,
including partial hospitalization, for the calendar year beginning January 1,
1999. The initial date for publishing the proposed PPS rates was May 1998.
However, concerns over HCFA's compliance with year 2000 computer issues have
caused significant delays in the implementation of PPS. Under such a system, a
predetermined rate would be paid to providers regardless of the provider's
reasonable costs. The proposed rate is $206.71 per diem, subject to adjustment
up or down for wage levels in the area where the services are furnished. This
rate may be changed in the final regulation or a basis for payment other than
per diem, may be established. While the actual reimbursement rates have not been
determined and thus their effect, positive or negative, is unknown, the Company
anticipates that it will need to negotiate modifications to its contracts with
providers if PPS is implemented. The uncertainty regarding PPS has negatively
affected the Company's marketing of new programs due to providers' uncertainty
regarding the economic impact of the new rates. While the Company cannot predict
the impact of continued delays on the Company's marketing program, it could have
a material adverse effect on the Company's ability to sign new contracts and
retain existing contracts.
The Medicare partial hospitalization benefit has a coinsurance feature,
which means that the amount paid by Medicare is the provider's reasonable cost
less "coinsurance" which is ordinarily to be paid by the patient. The
coinsurance amount is 20% of the charges for the services and must be charged to
the patient by the provider unless the patient is indigent. If the patient is
indigent or if the patient does not pay the provider the billed coinsurance
amounts after reasonable collection efforts, the Medicare program has
historically paid those amounts as "allowable Medicare bad debts." The
allowability of Medicare bad debts to providers for whom the Company manages
partial hospitalization programs is significant since most of the patients in
programs managed by the Company are indigent or have very limited resources. The
Balanced Budget Act of 1997 reduces the amount of Medicare allowable bad debts
payable to hospital providers, as follows: a reduction by 40% for provider
fiscal years beginning on or after October 1, 1998; and by 45% for provider
fiscal years beginning on or after October 1, 1999. The Clinton Administration
has proposed an additional reduction to 55% for the budget year commencing
October 1, 1999, and also proposes extending this bad debt reduction to
community mental health centers. The reduction in "allowable Medicare bad
debts", as well as any future reductions that may be authorized, could have a
material adverse effect on Medicare reimbursement to the Company's hospital
providers and could further result in the restructuring or loss of provider
contracts with the Company.
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COMPLIANCE WITH MEDICAID REGULATIONS AND POTENTIAL CHANGES
Since the Company is involved with state Medicaid agencies and with
providers whose clients are covered by Medicaid, the programs managed by the
Company must be in compliance with the laws and regulations governing such
reimbursement. Likewise, Stadt Solutions' pharmacies must comply with Medicaid
criteria for its pharmacy services which are predominantly paid for by Medicaid.
Medicaid is a joint state and federally funded program established as
part of the Social Security Act in the mid-1960s to provide certain defined
health care benefits to poor, indigent or otherwise eligible general welfare
recipients. As states consider methods to control the cost of health care
services generally, and behavioral health services specifically, to Medicaid
recipients, and because such recipients are, as a group, heavy users of the type
of services which the Company offers, the effect of Medicaid reimbursement and
regulatory compliance with its rules could be material to the Company's
financial condition and results of operations.
Medicaid funding and the methods by which services are supplied to
recipients are changing rapidly. Many states have "carved out" behavioral health
services from the delivery of other health services to Medicaid recipients and
are separately procuring such services on a capitated basis requiring the
contractor, and permitting subcontracted providers, to assume financial risk for
the cost of providing care.
The Company cannot predict the extent or scope of changes which may
occur in the ways in which state Medicaid programs contract for and deliver
services to Medicaid recipients. All Medicaid funding is generally conditioned
upon financial appropriations to state Medicaid agencies by the state
legislatures and there are ever-increasing uncertain political pressures on such
legislatures in terms of controlling and reducing such appropriations. With
respect to the Company's case management programs reimbursed by behavioral
health organizations, the overall trend is generally to impose lower
reimbursement rates including incentives to assume risk not only by licensed
managed care organizations with whom state Medicaid agencies contract, but by
subcontracted providers, such as the Company. Consequently, any significant
reduction in funding for Medicaid programs could have a material adverse effect
on the Company's business, financial condition and results of operations.
The United States Congress continues to consider legislation to
substantially alter the overall Medicaid program, to give states greater
flexibility in the design and operation of their individual Medicaid program,
and to stabilize federal spending for such benefits. Various states are also
considering substantial health care reform measures which could modify the
manner in which all health services are delivered and reimbursed, especially
with respect to Medicaid recipients and with respect to other individuals funded
by public resources. The reduction in other public resources could have an
impact upon the delivery of services to Medicaid recipients.
Many of the patients served in the Outpatient Programs managed by the
Company are indigent or have very limited resources. Accordingly, many of those
patients have Medicaid coverage in addition to Medicare coverage. In some of the
states where the Company furnishes services, the state Medicaid plans have paid
the Medicare coinsurance amount. However, under the Balanced Budget Act of 1997,
states will no longer have to pay such amounts if the amount paid by Medicare
for the service equals or exceeds what Medicaid would have paid had it been the
primary insurer. To the extent that states take advantage of this new
legislation and refuse to pay the Medicare coinsurance amounts on behalf of the
Outpatient Program patients to the extent that they had in the past, it will
have an adverse effect on the providers with whom the Company contracts, and
thus, may have a material adverse effect on the Company's business, financial
condition and results of operations.
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COMPLIANCE WITH OTHER STATE REGULATORY CONSIDERATIONS
The Company is also sensitive to the particular nature of the delivery
of behavioral health services and various state and federal requirements with
respect to confidentiality and patient privacy. Indeed, federal and state laws
require providers of certain behavioral health services to maintain strict
confidentiality as to treatment records and, the fact of treatment. There are
specific requirements permitting disclosure, but inadequate or incorrect
disclosure, even if inadvertent or negligent, can trigger substantial criminal
and other penalties. See "Risk Factors-Privacy and Confidentiality Legislation"
below.
SPECIFIC LICENSING OF PROGRAMS AND PHARMACY SERVICES
The Company's Outpatient Programs are operated as outpatient
departments of hospitals or CMHCs, thus subjecting such programs to regulation
by federal, state and local agencies. These regulations govern licensure and
conduct of operations at the facilities, review of construction plans, addition
of services and facilities and audit of cost allocations, cost reporting and
capital expenditures. The facilities occupied by the programs must comply with
the requirements of municipal building, health and fire codes. Inclusion of
hospital space where the Outpatient Programs are furnished within the hospitals'
license, when required under applicable state laws, is a prerequisite to
participation in the Medicare programs. Additionally, the provider's premises
and programs are subject to periodic inspection and recertification.
Stadt Solutions' pharmacies are licensed and subject to all applicable
State Board of Pharmacy and United States Drug Enforcement Administration rules,
regulations and requirements and other applicable state and federal statutes and
regulations governing pharmacy services. Many of the pharmacy locations are
licensed through Stadlander, the minority shareholder. See "Risk Factors -
Pharmacy Services Regulations."
FALSE CLAIMS INVESTIGATIONS AND ENFORCEMENT OF HEALTH CARE FRAUD LAWS
The Office of the Inspector General within the U.S. Department of
Health and Human Services, as well as other federal, state, and private
organizations, are aggressively enforcing their interpretation of Medicare and
Medicaid laws and policies, and other applicable standards. Often in such
enforcement efforts, the government has relied on the Federal False Claims Act.
Under that law, if the government prevails in a case, it is entitled to treble
damages plus not less than $5,000 nor more than $10,000 per claim, plus
reasonable attorney fees and costs. In addition, a person found to have
submitted false claims can be excluded from governmental health care programs
including Medicare and Medicaid. If a provider contracting with the Company were
excluded from governmental health programs, no services furnished by that
provider would be covered by any governmental health program. Some of the
providers contracting with the Company are reported to be under active
investigation for health care fraud, although the Company is not aware of those
investigations relating to programs with which the Company is involved. If the
Company were excluded from governmental health programs, providers contracting
with the Company could not be reimbursed for amounts paid to the Company.
To prevail in a False Claims Act case, the government need show only
that incorrect claims were submitted with "reckless disregard" or in "deliberate
ignorance" of the applicable Medicare law. The government does not have to prove
that the claims were submitted with the intent to defraud a governmental or
private health care payor. The qui tam provisions of the Federal False Claims
Act permit individuals also to bring suits under the False Claims Act. The
incentive for an individual to do so is that he or she will usually be entitled
to approximately 15% to 30% of any ultimate recovery. Under the Federal False
Claims Act, the Office of the Inspector General, in conjunction with the
Department of Justice, have successfully made demands on thousands of providers
to settle alleged improper billing disputes at double alleged damages or more.
Although the Company does not bill governmental programs directly, it could
possibly be liable under the False Claims Act to the extent that it is found to
have "caused" false claims to have been presented.
There are many other civil and criminal statutes at the federal and
state levels that may penalize conduct related to submitting false claims for
health care services or for offering or receiving anything of value in exchange
for the referral of patients. The penalties under many of those statutes are
severe, and the government often need
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not prove intent to defraud in order to prevail. Management believes that the
Company is in material compliance with applicable regulatory and industry
standards. However, in light of the complexity of the policies governing
governmental health care programs together with changing and uncertain
interpretations of those policies, it is impossible to be absolutely assured
that the government (or a qui tam relator in the name of the government) will
not assert that some conduct by the Company, or conduct by one of the Company's
customers, has given rise to potentially a large liability. See "Risk Factors -
Anti-Remuneration Laws."
In the past, there have been occasions when Medicare fiscal
intermediaries have denied coverage for all or substantially all of the claims
submitted by the providers where the Company had a management or administrative
services contract. Such denials have occurred even though a physician has
certified that the Outpatient Program services were medically necessary.
Notwithstanding the Company's ongoing efforts to assure that the Outpatient
Program services furnished by it under contract are consistent with its
understanding of the Medicare coverage criteria, it is possible that there will
be future occasions when a substantial number of services furnished at a site
managed by the Company will be denied coverage. The Health Insurance Portability
and Accountability Act of 1996 grants the U.S. Department of Health and Human
Services broad authority to impose civil monetary penalties on providers for
certain activities. Among those activities are the repeated submission of claims
for services which are not medically necessary. If there were again to be
occasions when a Medicare fiscal intermediary denied a large number of claims
for a site managed by the Company, it is possible that the government would seek
sanctions from the provider and possibly from the Company. While the Company
believes that it would be inappropriate for the government to seek such
sanctions for services for which the coverage criteria are interpreted
differently at different times and which have been ordered by a physician, it is
not clear at this time how the government will apply this new authority.
COMPETITION
In general, the operation of psychiatric programs is characterized by
intense competition. General, community and specialty hospitals, including
national companies and their subsidiaries, provide many different health care
programs and services. The Company anticipates that competition will increase as
pressure to contain the rising costs of health care continues to intensify,
particularly as programs such as those operated by the Company are perceived to
help contain mental health care costs. Many other companies engaged in the
management of outpatient psychiatric programs compete with the Company for the
establishment of affiliations with acute care hospitals. Furthermore, while the
Company's existing competitors in the case management business are predominantly
not-for-profit CMHCs and case management agencies, the Company anticipates that
other health care management companies will eventually compete for this
business. Many of these present and future competitors are substantially more
established and have greater financial and other resources than the Company. In
addition, the Company's current and potential providers may choose to manage
mental health programs themselves rather than contract with the Company. There
can be no assurance that the Company will be able to compete effectively with
its present or future competitors, and any such inability could have a material
adverse effect on the Company's business, financial condition and results of
operations.
The Company believes that the proprietary nature of its policy and
procedures manuals and the level of service it provides and the expertise of its
management and field personnel provide it with a leading position in the
development and management of Outpatient Programs. The Company believes that the
Case Management Programs provide the means to effectively control costs in a
managed, public-sector mental health system by reducing the costs for the
population that consumes the largest portion of the treatment dollars, the SMI
population. In addition, the Company believes that the Company's case management
model provides state-of-the-art treatment and rehabilitation services which
serve to upgrade the existing provider network in a community. The Company
believes the benefits of its case management model are recognized as a
distinguishing feature for public-sector managed care efforts.
The Company's primary existing competitors in the case management
business are predominantly not-for-profit CMHCs and case management agencies.
The Company anticipates that mental health managed care companies will
eventually compete for this business. There can be no assurances that the
Company will be able to compete successfully with its present or future
competitors.
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The specialty pharmacy business is intensely competitive. There are
numerous local, regional and national companies which can dispense
pharmaceuticals locally or through the mail. There are also numerous companies
which provide lab work and analysis services necessary for blood monitoring.
Many of these companies have substantially greater resources than Stadt
Solutions. While the Company believes that Stadt Solutions is the first
specialty pharmacy company to focus on SMI and further believes that Stadt
Solutions offers value added disease management services not typically provided
by competitors, there can be no assurance that Stadt Solutions will be able to
compete successfully with its present or future competitors.
EMPLOYEES
As of June 30, 1999, the Company employed approximately 794 employees,
of which 406 are full-time employees. Approximately 685 employees staff the
clinical programs and approximately 109 are in corporate management including
finance, accounting, development, utilization review, training and education,
information systems, human resources and legal areas. None of the Company's
employees are subject to a collective bargaining agreement and the Company
believes that its employee relations are good. As of June 30, 1999, Stadt
Solutions employed approximately 115 employees of which 84 are full-time
employees. Approximately 74 employees staff the pharmacies and approximately 41
are in corporate management.
RISK FACTORS
The Company's business is subject to a number of risks, including the
risks described in this section and elsewhere in this Annual Report on Form
10-K. The Company's actual results could differ materially from the results
projected in this Report or in any other forward-looking statements presented by
management from time to time, due to some or all of such risks.
Dependence Upon Medicare Reimbursement. The Company's business could be
materially and adversely affected if HCFA or fiscal intermediaries deny
reimbursement or challenge reimbursement claims by providers who obtain services
from the Company. A significant component of the Company's revenues is derived
from payments made by providers to the Company for managing and administering
Outpatient Programs for providers. Substantially all of the patients admitted to
the Outpatient Programs are Medicare beneficiaries for whom Medicare payments
may be made if Medicare's coverage criteria are satisfied. A provider's Medicare
payments can be adversely affected if HCFA or fiscal intermediaries deny
coverage or claims for services furnished to Medicare eligible patients or
disallow costs claimed on the basis that such costs are unreasonable, relate to
uncovered services or are otherwise non-allowable. In addition, Medicare
payments are subject to changes in the law or interpretation of the law
governing Medicare coverage and payment.
In certain instances, providers are not obligated to pay the Company's
fee if coverage for claims submitted by the provider related to services
furnished by the Company are denied by Medicare's fiscal intermediary. In other
instances, the Company may be obligated to indemnify a provider to the extent
the Company's fee charged to the provider is disallowed by Medicare's fiscal
intermediary for reimbursement. The occurrence of either of these events with
respect to a significant number of providers or a significant amount of fees
could have a material adverse effect upon the Company's business, financial
condition and results of operations. See "Business -- Regulatory Matters --
Compliance With Medicare Guidelines; Reimbursement For Partial Hospitalization
Programs."
The Company's programs have in the past, and may in the future, from
time to time, be subject to Focused Medical Reviews or similar intensive audits.
A "Focused Medical Review" consists of an intensive review by fiscal
intermediaries of HCFA, on an industry-wide basis, of certain targeted claims.
Focused Medical Reviews may occur for a number of reasons including, without
limitation, an intermediary's concern about coverage for claims at a specific
site or because HCFA has identified certain services as being at risk of
inappropriate program payment. This generally occurs when HCFA identifies
significant industry-wide increases in payments for certain types of services,
as had been the case with partial hospitalization benefits.
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The Office of Inspector General ("OIG") of the United States Department
of Health and Human Services has reported that the vast majority of partial
hospitalization services furnished by CMHCs do not satisfy Medicare's coverage
criteria and that many CMHCs were not properly participating in the Medicare
program because they did not meet the statutory and regulatory definition of a
CMHC. Consequently, HCFA has implemented a program to review all partial
hospitalization services even more intensely for meeting Medicare coverage
criteria and to assure that all CMHCs meet the requirements for participation in
the Medicare program. This more intensive review and audits of claims for
partial hospitalization services furnished by CMHCs to Medicare patients may
result in a greater number of claims being denied for the Company's customers.
The Company also expects more intensive reviews of claims, and increased audits
by HCFA and OIG, of Hospital outpatient mental health services and partial
hospitalization services including, the allowability of claims, medical
necessity issues and reasonableness of fees, and presently one CMHC provider and
one hospital provider is undergoing such audits. The more intensive review of
claims for partial hospitalization or other outpatient mental health services
furnished to Medicare patients may result in a greater number of claims being
denied for the Company's customers, or disallowance of Company fees, which, as
described above, may have an adverse effect on the Company's business, financial
condition and results of operations. In addition, if the scrutiny of CMHCs
results in termination of provider agreements between Medicare and CMHCs with
which the Company has contracts, there may be an adverse effect on the Company's
business, financial condition and results of operations.
A CMHC outpatient program the Company formerly managed in Dallas,
Texas, was the subject of a civil investigation conducted by the OIG and U.S.
Attorney's Office in Dallas, Texas (previously disclosed in the Company's Annual
Report on Form 10-K/A for the year ended April 30, 1998 and the Quarterly Report
on Form 10-Q for the quarter ended October 31, 1998). Although the
investigations were terminated, it is still possible that the outpatient program
could be subject to recoupment of possible overpayment by Medicare.
Further, the partial hospitalization programs managed by the Company
are required under HCFA's current interpretation of the Medicare regulations, to
be "provider-based" programs. This designation is important since partial
hospitalization services are covered only when furnished by or "under
arrangement" with, a "provider", i.e., a hospital or a CMHC. To the extent that
any particular partial hospitalization program is not deemed by HCFA to be
"provider based" under HCFA's current interpretation of the Medicare
regulations, there would not be Medicare coverage for the services furnished at
that site under Medicare's partial hospitalization benefit. HCFA has published
criteria for determining when programs operated in facilities separate from a
hospital's or CMHC's main premises may be deemed to be "provider-based"
programs. The proper interpretation and application of these criteria are not
entirely clear, and there is a risk that some or substantially all of the sites
managed by the Company will be found not to be "provider-based". If such a
determination is made and the Company is unable to satisfactorily restructure
its contract with the provider, HCFA may cease reimbursing for the services at
the provider, and HCFA may, in some situations, seek retrospective recoveries
from providers. Any such cessation of reimbursement for services or
retrospective recoveries could result in non-payment by providers, possibly
trigger indemnity claims, and have a material adverse effect on the Company's
business, financial condition and results of operations.
In July 1998, HCFA notified Scripps Health that certain of its programs
were approved as "provider based" and that certain other of its program
locations were not "provider based" because they did not meet HCFA's service
area requirements. As a result of HCFA's challenge and determination, the
Company and Scripps Health amended their contract, Scripps Health reconfigured
certain of its partial hospitalization programs, two locations were closed and
one of the locations was taken over by another provider who engaged the Company
to manage the program. In other instances, when the Company's customers have
sought provider-based status determinations from HCFA upon establishing a
program, HCFA's Region IX Office has interpreted the provider-based standards so
as to prevent the Company from employing any personnel involved in the programs
furnished by the provider except for "consultants" from the Company. This
interpretation makes it more difficult for the Company to furnish the services
customers want and which the Company has made its reputation furnishing. If the
interpretation of provider-based standards applied by HCFA's Region IX Office
are applied by other HCFA regional offices, or are adopted nationally as the
correct interpretation, PMR would have to re-negotiate the vast majority of its
contracts to administer partial hospitalization and other outpatient mental
health programs. It is also possible that if provider-based challenges emerge
with other providers, the Company may not be able to amend its contracts to
satisfy HCFA or its provider customers. In addition, there can be no assurance
that HCFA will not challenge the "provider based"
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status of the Scripps Health program in the future. If the Company is unable to
amend its contracts to satisfy any "provider based" challenge in the future, the
potential termination of any such contracts could have a material adverse effect
upon the Company's business, financial condition and results of operations. See
"Business -- Contracts -- Outpatient Programs," "-- Regulatory Matters --
Compliance with Medicare Guidelines; Reimbursement for Partial Hospitalization
Programs."
Anti-Remuneration Laws. Medicare and Medicaid law prohibits, among
other things, an entity from paying or receiving, subject to certain exceptions
and "safe harbors", any remuneration to induce the referral of Medicare or
Medicaid beneficiaries or the purchase (or the arranging for or recommending of
the purchase) of items or services for which payment may be made under Medicare,
Medicaid, or other federally-funded healthcare programs. Several states have
similar laws which are not limited to services for which Medicare or Medicaid
payment is made. Sanctions for violating these federal and state
anti-remuneration laws may include imprisonment, criminal and civil fines, and
exclusion from participation in the Medicare or Medicaid programs or other
applicable programs.
The federal anti-remuneration law has been interpreted broadly by
courts, the OIG and administrative bodies. Because of the federal statute's
broad scope, the federal regulations establish certain safe harbors from
liability. Some of the Company's practices do not satisfy all of the
requirements necessary to fall within the applicable safe harbor. Nonetheless, a
practice that does not fall within a safe harbor is not necessarily unlawful,
but may be subject to scrutiny and challenge. Although the Company believes that
it is in substantial compliance with the legal requirements imposed by such laws
and regulations, there can be no assurance that the Company will not be subject
to scrutiny or challenge under such laws or regulations, or that any such
challenge would not have a material adverse effect upon the Company.
Privacy and Confidentiality Legislation. Most of the Company's
activities involve receipt or use by the Company of confidential medical
information concerning individual clients or members. In addition, the Company
uses aggregated (anonymous) data for research and analysis purposes. Legislation
has been proposed at the federal level and in several states to restrict the use
and disclosure of confidential medical information. To date, no such legislation
has been enacted that adversely impacts the Company's ability to provide its
services. However, confidentiality provisions of the Health Insurance
Portability and Accountability Act of 1996 require the Secretary of Health and
Human Services to establish health information privacy standards. In September
1997, the Secretary submitted recommendations to Congress to implement these
standards. If Congress does not enact health information privacy legislation by
August, 1999, the Secretary will be required to issue regulations on the
subject. Such federal legislation could have a material adverse effect on the
Company's operations.
Corporate Practice of Medicine Prohibitions. The laws of many states
prohibit physicians from splitting fees with non-physicians and prohibit
non-physician entities from practicing medicine. These laws vary from state to
state and are enforced by courts and regulatory agencies with varying and broad
discretion. The Company believes that its administrative and management services
with respect to its contractual arrangements do not violate such laws; however,
there can be no assurance that the Company's contractual arrangements would not
be successfully challenged as constituting the unlicensed practice of medicine
or that the enforceability of the provisions of such arrangements will not be
limited. In the event of action by any regulatory authority limiting or
prohibiting the Company or any affiliate from carrying on its business,
organizational modification of the Company or restructuring of its contractual
arrangements may be required.
Stark Laws. The Omnibus Budget Reconciliation Act of 1993 substantially
broadened the scope of the federal physician self-referral act commonly known as
"Stark I." "Stark II," which became effective in 1995, prohibits physicians from
referring Medicare or Medicaid patients for "designated health services" to an
entity with which the physician or an immediate family member of the physician
has a financial relationship. The Stark laws contain certain exceptions for
physician financial arrangements, and HCFA has published Stark II proposed
regulations which describe the parameters of these exceptions in more detail.
While Stark laws and regulations may apply to certain contractual arrangements
between the Company and physicians who may refer patients to or write
prescriptions ultimately filled by Stadt Solutions, the Company believes it is
in compliance with such laws and
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regulations. Any determination by a court or regulatory agency that the
Company's arrangements violate the Stark laws could have a material adverse
effect on the Company's operating results and financial condition.
State Self-Referral Laws. The Company may be subject to state statutes
and regulations that prohibit payments for referral of patients and referrals by
physicians to healthcare providers with whom the physicians have a financial
relationship. Some state statutes and regulations apply to services reimbursed
by governmental as well as private payors. Violation of these laws may result in
prohibition of payment for services rendered, loss of licenses, fines and
criminal penalties. The laws and exceptions or safe harbors may vary from the
federal Stark laws and vary significantly from state to state. The laws are
often vague, and, in many cases, have not been widely interpreted by courts and
regulatory agencies. The Company believes that it is in substantial compliance
with the legal requirements imposed by such laws and regulations, however there
can be no assurance that the Company will not be subject to scrutiny or
challenge under such laws or regulations, or that any such challenge would not
have a material adverse effect upon the Company.
Pharmacy Services Regulations. Various federal and state regulations
govern the purchase, distribution and management of prescription drugs and
affect or may affect Stadt Solutions. The Company believes that Stadt Solutions'
operations are in substantial compliance with existing laws which are material
to Stadt Solutions' operations. Any failure or alleged failure to comply with
applicable laws and regulations could have a material adverse effect on the
Company's operating results and financial condition.
Stadt Solutions' services are subject to state and federal statutes and
regulations governing the operation of pharmacies, repackaging of drug products,
dispensing of controlled substances, medical waste disposal, labeling,
advertising and adulteration of prescription drugs. Federal controlled substance
laws require Stadt Solutions to register its pharmacies and repackaging facility
with the United States Drug Enforcement Administration and to comply with
security, recordkeeping, inventory control and labeling standards in order to
dispense controlled substances. State controlled substance laws require
registration and compliance with state pharmacy licensure, registration or
permit standards promulgated by the state pharmacy licensing authority. Such
standards often address the qualifications of an applicant's personnel, the
adequacy of its prescription fulfillment and inventory control practices and the
adequacy of its facilities. In general, pharmacy licenses are renewed annually.
Pharmacists employed by each branch must also satisfy applicable state licensing
requirements. Any failure to comply with licensing requirements of any
applicable regulatory agency could impair Stadt Solutions' business and have a
material adverse effect on the Company's operating results and financial
condition.
Pharmacy Reimbursement. A substantial portion of the revenue for Stadt
Solutions is derived directly from Medicaid or other government-sponsored
healthcare programs. Should there be material changes to federal or state
reimbursement methodologies, regulations or policies, Stadt Solutions'
reimbursement from government sponsored programs could be adversely affected.
See "Compliance with Medicaid Regulations and Potential Changes" and see
"Business - Stadt Solutions."
Dependence on Pharmaceutical Industry. Stadt Solutions' business is
dependent on research, development, manufacturing and marketing expenditures of
pharmaceutical companies and the ability of such companies to develop, supply
and generate demand for drugs that meet Stadt Solutions' service model. Stadt
Solutions would be materially and adversely affected by unfavorable developments
in the pharmaceutical industry that related to psychiatric medications
including, among other things, supply shortages, adverse drug reactions, drug
recalls, government or private initiative to regulate the manner in which drug
manufacturers, health care providers or pharmacies promote or sell their
products and services. In addition, certain drugs pertaining to Stadt Solutions'
business could be rendered obsolete or uneconomical by the development of new
drugs and other technological advances, which could result in a material adverse
effect on Stadt Solutions' business, financial condition and results of
operations.
Dependence on Stadtlander. Stadt Solutions is dependent on Stadtlander
for various services including, but not limited to, management information
services, reimbursement services, and fulfillment services such as, purchasing,
receipt and delivery of materials to Stadt Solutions. Although Stadtlander is
obligated to provide such services to Stadt Solutions, there can be no assurance
that Stadtlander will be able to provide adequate or timely
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services or products, or that Stadtlander will remain in business, or be able to
comply with applicable government regulations or be able to maintain its
applicable licenses, permits or contracts with third parties necessary to
provide services to Stadt Solutions.
Impact of Health Care Reform and the Balanced Budget Act of 1997.
Political, economic and regulatory influences are subjecting the health care
industry in the United States to fundamental change. Changes in the law, new
interpretations of existing laws, or changes in payment methodology or amounts
may have a dramatic effect on the relative costs associated with doing business
and the amount of reimbursement provided by government or other third-party
payors. In addition to specific health care legislation, both the Clinton
Administration and various federal legislators have considered health care
reform proposals intended to control health care costs and to improve access to
medical services for uninsured individuals. These proposals have included
cutbacks to the Medicare and Medicaid programs and steps to permit greater
flexibility in the administration of the Medicaid program. In addition, some
states in which the Company operates are considering various health care reform
proposals. The Company anticipates that federal and state governments will
continue to review and assess alternative health care delivery systems and
payment methodologies, and that public debate on these issues will likely
continue in the future. Due to uncertainties regarding the ultimate features of
reform initiatives and their enactment, implementation and interpretation, the
Company cannot predict which, if any, of such reform proposals will be adopted,
when they may be adopted or what impact they may have on the Company.
Accordingly, there can be no assurance that future health care legislation or
other changes in the administration or interpretation of governmental health
care programs will not have an adverse effect on the Company's business,
financial condition and results of operations.
The Balanced Budget Act of 1997 has adversely affected reimbursements
to certain providers and payments to the Company. The Medicare benefit for
partial hospitalization and outpatient mental health services has a coinsurance
feature, which means that the amount payable by Medicare is reduced by the
"coinsurance" amount which is ordinarily to be paid by the patient. The Medicare
program has historically paid amounts designated as the patient's coinsurance
obligation where the patient is indigent or if the patient does not pay the
provider the billed coinsurance amounts after reasonable collection efforts.
Those amounts are characterized as "allowable Medicare bad debts." The
allowability of bad debts to providers is significant because most of the
patients in programs managed by the Company are indigent or have very limited
resources. The reduction in "allowable Medicare bad debts" under the Balanced
Budget Act, as well as any future reductions that may be authorized, could have
a material adverse impact on Medicare reimbursement to the Company's hospital
Providers and could further result in the restructuring or loss of provider
contracts with the Company. The Clinton Administration's proposal for an
additional reduction to 55% for the budget year commencing October 1, 1999, and
its proposal for extending this bad debt reduction to CMHCs could have an
adverse effect on Medicare reimbursement to the Company's hospital providers, on
reimbursement to CMHC providers, and could have a material adverse effect upon
the Company's business, financial condition and results of operations. See
"Business -- Regulatory Matters -- Compliance With Medicare Guidelines;
Reimbursement For Partial Hospitalization Programs."
In addition, under the Balanced Budget Act of 1997, state Medicaid
plans that have historically paid the Medicare coinsurance amount will no longer
have to pay such amounts if the amount paid by Medicare for the service equals
or exceeds what Medicaid would have paid had it been the primary insurer. Some
states where the Company does business have taken advantage of this new
legislation and refuse to pay the Medicare coinsurance amounts on behalf of the
Outpatient Program patients to the degree that they had in the past. To the
extent that additional states take advantage of this law, it will have an
adverse impact on the providers with whom the Company contracts, and thus may
have a material adverse effect on the Company's business, financial condition
and results of operations. See "Business -- Regulatory Matters -- Changes In
Medicare's Cost Based Reimbursement For Partial Hospitalization Services" and
"-- Compliance With Medicaid Regulations and Potential Changes."
The outpatient prospective payment system ("PPS") to be implemented
under the Balanced Budget Act of 1997 could have an adverse effect on the
business of certain providers and the Company. As presented in a proposed rule
in September, 1998, Medicare would pay for $206.71 for a day of partial
hospitalization services, subject to adjustment for wage costs in the provider's
area. In the proposed rule, HCFA specifically solicited
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comments on the appropriate rate for partial hospitalization services. It is
possible that the rate published in the final rule will differ from the proposed
rate, and may be lower. The payment for outpatient mental health services
furnished by hospitals will also be subject to a rate methodology and there may
be changes in the proposed rates and methodology for payment in the final rule.
The implementation of outpatient PPS is projected by HCFA to occur on July 1,
2000, but the actual effective date may differ. Both in contemplation of and in
reaction to PPS, the Company may need to negotiate modifications to its
contracts with providers, which could have a material adverse effect on the
Company's business, financial condition and results of operations. The
uncertainty regarding PPS has negatively effected the Company's marketing of new
programs due to provider's uncertainty regarding the economic impact of the new
rates. See "Business -- Regulatory Matters -- Changes in Medicare's Cost Based
Reimbursement For Partial Hospitalization Services."
Sufficiency of Existing Reserves to Cover Reimbursement Risks. The
Company maintains significant reserves to cover the potential impact of two
primary uncertainties: (i) the Company may have an obligation to indemnify
certain providers for some portions of its fee which may be subject to
disallowance upon audit of a provider's cost report by fiscal intermediaries;
and (ii) the Company may not receive full payment of the fees owed to it by a
provider during the periodic review of the provider's claims by the fiscal
intermediaries. The Company has been advised by HCFA that certain
program-related costs are not allowable for reimbursement. Although the Company
believes that its potential liability to satisfy requirements for potential
indemnity obligations or payment shortfalls has been adequately reserved in its
financial statements, there can be no assurance that such reserves will be
adequate. The obligation to pay the amounts estimated within the Company's
financial statements (or such greater amounts as are due), if and when they
become due, could have a material adverse effect upon the Company's business,
financial condition and results of operations. See "Management's Discussion and
Analysis of Financial Condition and Results of Operations," "Business -
Regulatory Matters - Compliance with Medicare Guidelines; Reimbursement for
Partial Hospitalization Programs.
Continuity of Management, Administrative Services and Consulting
Contracts. Substantially all of the revenues of the Company are derived from
contracts with providers, behavioral health organizations and case management
agencies. The continued success of the Company is subject to its ability to
maintain, renew, extend or replace existing management, administrative services
and consulting contracts and obtain new management, administrative services and
consulting contracts. These contracts generally have defined terms of duration
and many have automatic renewal provisions. The contracts often provide for
early termination either by the provider if specified performance criteria are
not satisfied or by the Company under various other circumstances.
Contract renewals and extensions are likely to be subject to competing
proposals from other contract management companies as well as consideration by
certain providers to terminate their mental health programs or convert their
mental health programs from independently managed programs to programs operated
internally. There can be no assurance that any provider or case management
agency will continue to do business with the Company following expiration of its
management contract or that such management contracts will not be terminated
prior to expiration. In addition, any changes in the Medicare or Medicaid
program which have the effect of limiting or reducing reimbursement levels for
mental health services provided by programs managed by the Company could result
in the early termination of existing management contracts and could adversely
affect the ability of the Company to renew or extend existing management
contracts and to obtain new management contracts. The termination or non-renewal
of a significant number of management contracts could result in a significant
decrease in the Company's net revenues and could have a material adverse effect
on the Company's business, financial condition and results of operations. See
"Business -- Contracts."
Concentration of Revenues. For fiscal 1999, no Company Outpatient
Program with a provider accounted for more than 10% of the Company's revenue. In
addition, although not attributed to a particular "customer," the Case
Management Programs accounted for 12.3% of the Company's revenue for fiscal
1999. These programs were largely operated under contracts with two managed care
consortiums in the State of Tennessee and management agreements with two case
management agencies. A termination or non-renewal of any of these contracts
could have a material adverse effect on the Company's business, financial
condition and results of operations. Further, the TennCare program has undergone
significant changes since its inception and has been subjected to substantial
criticism, which could result in additional structural changes which the Company
cannot predict with any degree of
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certainty, and which could have a material adverse effect on the Company's
business, financial condition and results of operations. For fiscal 1999, Stadt
Solutions' pharmacy services accounted for 34.7% of Company's total revenue. See
" -- Concentration of Revenues," "Management's Discussion and Analysis of
Financial Condition and Results of Operations," "Business --Programs and
Operations" -- Case Management Programs" and "Contracts -- Case Management
Programs."
Government Regulation. Mental health care is an area subject to
extensive regulation and frequent changes in those regulations. Changes in the
laws or new interpretations of existing laws can have a significant effect on
the methods of doing business, costs of doing business and amounts of
reimbursement available from governmental and other payors. In addition, a
number of factors, including changes in the healthcare industry and the
availability of investigatory resources, have resulted in increased scrutiny,
inquiry and investigations by various federal and state regulatory agencies
relating to the operation of healthcare companies, including the Company. The
Company is and will continue to be subject to varying degrees of regulation,
licensing, inquiry and investigation by health or social service agencies and
other regulatory and enforcement authorities in the various states and
localities in which it operates or intends to operate. The Company's business is
subject to a broad range of federal, state and local requirements including, but
not limited to, fraud and abuse laws, licensing and certification standards, and
regulations governing the scope and quality of care. Violations of these
requirements may result in civil and criminal penalties and exclusions from
participation in federal and state-funded programs. The Company at all times
attempts to comply with all such laws including applicable Medicare and Medicaid
regulations; however, there can be no assurance that the expansion or
interpretation of existing laws or regulations, or the imposition of new laws or
regulations, will not have a material adverse effect on the Company's provider
relationships or the Company's business, financial condition and results of
operations.
Risks Associated with Acquisitions. The Company currently intends as
part of its business strategy to pursue acquisitions of complementary businesses
as it seeks to compete in the rapidly changing healthcare industry. Acquisitions
involve numerous risks, including difficulties in assimilation of the operations
and personnel of the acquired business, the integration of management
information and accounting systems of the acquired business, the diversion of
management's attention from other business concerns, risks of entering markets
in which the Company has no direct prior experience, and the potential loss of
key employees of the acquired business. The Company's management will be
required to devote substantial time and attention to the integration of any such
businesses and to any material operational or financial problems arising as a
result of any such acquisitions. There can be no assurance that operation or
financial problems will not occur as a result of any such acquisitions. Failure
to effectively integrate acquired businesses could have a material adverse
effect on the Company's business, financial condition and results of operations.
The Company intends to continue to evaluate potential acquisitions of,
or investments in, companies which the Company believes will complement or
enhance its existing business. Future acquisitions by the Company may result in
potentially dilutive issuances of equity securities, the incurrence of
additional debt and amortization expenses related to goodwill and other
intangible assets which could adversely affect the Company's business, financial
condition and results of operations. There can be no assurance that the Company
will consummate any acquisition in the future or if consummated, that any such
acquisition will ultimately be beneficial to the Company.
Management of Growth. The Company expects that the Stadt Solutions
pharmacy services business and its Outpatient and Case Management Programs may
increase significantly as the Company pursues its growth strategy. If it
materializes, this growth will place significant demands on the Company's
management resources. The Company's ability to manage its growth effectively
will require it to continue to expand its operational, financial and management
information systems, and to continue to attract, train, motivate, manage and
retain key employees. If the Company is unable to manage its growth effectively,
its business, financial condition and results of operations could be adversely
affected.
Dependence on Key Personnel. The Company depends, and will continue to
depend, upon the services of its current senior management for the management of
the Company's operations and the implementation of its business strategy. In
addition, the Company's success is also dependent upon its ability to attract
and retain additional qualified management personnel to support the Company's
growth. The loss of the services of any or all
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such individuals or the Company's inability to attract additional management
personnel in the future may have a material adverse effect on the Company's
business, financial condition and results of operations.
The Company's success and growth strategy also will depend on its
ability to attract and retain qualified clinical, marketing and other personnel.
The Company competes with general acute care hospitals and other health care
providers for the services of psychiatrists, psychologists, social workers,
therapists and other clinical personnel. Demand for such clinical personnel is
high and they are often subject to competing offers. There can be no assurance
that the Company will be able to attract and retain the qualified personnel
necessary to support its business in the future. Any such inability may have a
material adverse effect on the Company's business, financial condition and
results of operations.
Psychiatric services competition. In general, the operation of
psychiatric programs is characterized by intense competition. General, community
and specialty hospitals, including national companies and their subsidiaries,
provide many different health care programs and services. The Company
anticipates that competition will become more intense as pressure to contain the
rising costs of health care continues to intensify, particularly as programs
such as those operated by the Company are perceived to help contain mental
health care costs. Many other companies engaged in the management of outpatient
psychiatric programs compete with the Company for the establishment of
affiliations with acute care hospitals. Furthermore, while the Company's
existing competitors in the case management business are predominantly
not-for-profit CMHCs and case management agencies, the Company anticipates that
other health care management companies will eventually compete for this
business. Many of these present and future competitors are substantially more
established and have greater financial and other resources than the Company. In
addition, the Company's current and potential providers may choose to operate
mental health programs themselves rather than contract with the Company. There
can be no assurance that the Company will be able to compete effectively with
its present or future competitors, and any such inability could have a material
adverse effect on the Company's business, financial condition and results of
operations.
Specialty pharmacy services competition. There are numerous local,
regional and national companies which can dispense pharmaceuticals locally or
through the mail. There are also numerous companies which provide lab work and
analysis services necessary for blood monitoring. Many of these companies have
substantially greater resources than Stadt Solutions. While the Company believes
that Stadt Solutions is the first specialty pharmacy company to focus on SMI and
that Stadt Solutions offers value added disease management services not
typically provided by competitors, there can be no assurance that Stadt
Solutions will be able to compete successfully with its present or future
competitors.
Availability and adequacy of insurance. The provision of mental health
care services entails an inherent risk of liability. In recent years,
participants in the industry have become subject to an increasing number of
lawsuits alleging malpractice or related legal theories, many of which involve
large claims and significant defense costs. The Company currently maintains
annually renewable liability insurance intended to cover such claims and the
Company believes that its insurance is in conformity with industry standards.
There can be no assurance, however, that claims in excess of the Company's
insurance coverage or claims not covered by the Company's insurance coverage
(e.g., claims for punitive damages) will not arise. A successful claim against
the Company not covered by, or in excess of, the Company's insurance coverage
could have a material adverse effect upon the Company's business, financial
condition and results of operations. In addition, claims asserted against the
Company, regardless of their merit or eventual outcome, could have a material
adverse effect upon the Company's reputation and ability to expand its business,
and could require management to devote time to matters unrelated to the
operation of the Company's business. There can be no assurance that the Company
will be able to obtain liability insurance coverage on commercially reasonable
terms in the future or that such insurance will provide adequate coverage
against potential claims.
Shares Eligible For Sale. Sales by holders of substantial amounts of
Common Stock could adversely affect the prevailing market price of the Common
Stock. The number of shares of Common Stock available for sale in the public
market is limited by restrictions under the Securities Act of 1933, as amended
(the "Securities Act"), including Rule 144 ("Rule 144") under the Securities
Act. As of June 30, 1999, the Company had 6,988,878 shares of Common Stock
outstanding. Of these shares, the officers and directors of the Company and
their affiliates own
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2,339,845 shares and may acquire up to 1,466,018 shares that may be issued upon
the exercise of outstanding stock options and warrants. These outstanding shares
and shares issued upon the exercise of the options and warrants are considered
"restricted securities" and may be sold, subject to the volume limitations under
Rule 144.
Possible Volatility of Stock Price. The market price of the Company's
Common Stock could be subject to significant fluctuations in response to various
factors and events, including, but not limited to, the liquidity of the market
for the Common Stock, variations in the Company's quarterly results of
operations, revisions to existing earnings estimates by research analysts and
new statutes or regulations or changes in the interpretation of existing
statutes or regulations or market conditions affecting the health care industry
generally or mental health services in particular, some of which are unrelated
to the Company's operating performance. In addition, the stock market in recent
years has generally experienced significant price and volume fluctuations that
often have been unrelated to the operating performance of particular companies.
These market fluctuations also may adversely affect the market price of the
Common Stock.
Concentration of Ownership, Anti-Takeover Provisions. The officers and
directors of the Company and their affiliates own over 20% of the Company's
issued and outstanding Common Stock (and over 30% including shares issuable upon
currently exercisable stock options and warrants). Although the officers and
directors do not have any arrangements or understandings among themselves with
respect to the voting of the shares of Common Stock beneficially owned by such
persons, such persons acting together could elect a majority of the Company's
Board of Directors and control the Company's policies and day-to-day management.
The Company's Board of Directors has the authority, without action by the
stockholders, to issue shares of preferred stock and to fix the rights and
preferences of such shares. The ability to issue shares of preferred stock,
together with certain provisions of Delaware law and certain provisions of the
Company's Restated Certificate of Incorporation, such as staggered terms for
directors, limitations on the stockholders' ability to call a meeting or remove
directors and the requirement of a two-thirds vote of stockholders for amendment
of certain provisions of the Restated Certificate of Incorporation or approval
of certain business combinations, may delay, deter or prevent a change in
control of the Company, may discourage bids for the Common Stock at a premium
over the market price of the Common Stock and may adversely affect the market
price of, and the voting and other rights of the holders of, the Common Stock.
Year 2000 Compliance. The year 2000 issue is the result of computer
applications being written using two digits rather than four to define the
applicable year. Computer applications may recognize a date using "00" as the
year 1900 rather than the year 2000, resulting in system failures or
miscalculations causing disruption of operations. The Company has reviewed its
material computer applications for year 2000 compliance and is working with
vendors and suppliers to make its computer applications year 2000 compliant.
However, if any such corrections cannot be completed on a timely basis, the year
2000 issue could have a material adverse impact on the Company's business,
financial condition and results of operations. Because of the many uncertainties
associated with year 2000 compliance issues, and because the Company's
assessment is necessarily based on information from third party vendors and
suppliers, there can be no assurance that the Company's assessment is correct or
as to the materiality or effect of any failure of such assessment to be correct.
The Company has surveyed its contract providers to verify that their
computer applications are year 2000 compliant with respect to Medicare's April
5, 1999 requirement for providers to establish a four digit "birth date" field
for electronic data interface with the Medicare payor. Although over 90% of the
contract providers have indicated to the Company that their software complies
with Medicare's requirements, there can be no assurance that remaining vendors
will assert their compliance or that any claimed compliance does not in fact
prove to be incorrect. Any disruption in the reimbursement process, or the
billing practices of providers or the payment practices of Medicare or other
payors, could have a substantial adverse impact on Medicare or Medicaid payments
to providers and, in turn, payments to the Company and upon the Company's
business, financial condition and results of operations. See "Management's
Discussion And Analysis of Financial Condition And Results of Operations --
Impact of Year 2000 Computer Issues."
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ITEM 2. PROPERTIES
The Company owns no real property, but currently leases and subleases
approximately 185,000 square feet comprised of (i) a lease for the Company's
corporate headquarters at 501 Washington Street, San Diego, California expiring
on April 3, 2002, (ii) a lease for its regional administration office in
Nashville, Tennessee expiring in November 2001, and (iii) approximately fifty
(50) leases for sites, averaging three years duration, none of which extend
beyond 2003. The Company carries property and liability insurance where required
by lessors and sublessors. The Company believes that its facilities are adequate
for its short term needs. Leases and sub-leases, other than the short-term and
month-to-month leases, generally provide for annual rental adjustments which are
either indexed to inflation or have been agreed upon, and typically provide for
termination on not less than ninety (90) days' written notice.
ITEM 3. LEGAL PROCEEDINGS
The Company is engaged in disputes with TBH regarding certain payments
made to the Company for case management services. TBH has made a claim based on
a sample review for approximately $4.2 million relating to payments made to the
Company for case management services. TBH later, based on a subsequent sample
review, reduced the claim to approximately $2.3 million. On April 8, 1999, TBH
sent Company formal notice of the dispute, triggering the dispute resolution
provisions of its contract. The Company provided a response denying liability
for the claim and believes that the claim is without merit. TBH has the right to
submit the dispute to binding arbitration, which has not occurred.
A qui tam suit was filed by Anastasios Giorgiadis, a former employee of
the Company, against a subsidiary of the Company in Federal District Court in
the Southern District of California. This suit was filed under seal and the
Company was first informed of it on July 20, 1998. Under the False Claims Act,
the Department of Justice must inform the court whether it will intervene and
take control of the qui tam suit. In September, 1998, the U.S. Attorney for the
Southern District of California filed a Notice of Election of the United States
to Decline Intervention relating to its decision not to intervene in the qui tam
suit filed by the former employee of the Company. The Department of Justice
decided not to intervene in this qui tam suit. On June 25, 1999, the Federal
District Court for the Southern District of California granted the Company's
Motion for Summary Judgment and dismissed the case. The United States gave
notice that it did not oppose the dismissal, and the Company's Motion was
unopposed by the relator.
In January 1999, Stadtlander Operating Company, L.L.C., a subsidiary of
Bergen Brunswig Corporation ("BBC") purchased the stock of Stadtlander Drug
Distribution Co., Inc. In May 1999, BBC acquired PharMerica, Inc. Prior to
consummation of the acquisition, the Company and Stadt Solutions unsuccessfully
sought a temporary restraining order to prevent consummation of the acquisition
alleging the acquisition would result in the violation of the non-compete
provisions and confidentiality requirements underlying the formation of Stadt
Solutions. The litigation is continuing.
From time to time, the Company has been involved in routine litigation
incidental to the conduct of its business. There are currently no material
pending litigation proceedings to which the Company is a party.
ITEM 4. SUBMISSION OF MATTERS TO A VOTE OF SECURITY HOLDERS.
On March 4, 1999, the Company held its Annual Meeting of Stockholder
where Susan Erskine and Richard Niglio were re-elected as directors of the
Company. The following directors continued in office after the meeting: Allen
Tepper, Daniel Frank, Charles McGettigan and Eugene Hill. In addition, the
Company's stockholders approved an amendment to the Company's 1997 Equity
Incentive Plan to increase the number of shares of common stock reserved for
issuance under the plan by 1,000,000, and ratified the selection of Ernst &
Young LLP as the Company's auditors for the fiscal year ending April 30, 1999.
The re-election of each of Susan Erskine and Richard Niglio as directors of the
Company was approved with 4,044,934.56 and 4,046,924.56 votes, respectively, in
favor and 29,800 and 27,800 votes, respectively, against. The Amendment to the
plan was approved with 2,284,224.56
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votes in favor, 505,598 votes against, and 311,860 abstentions. The ratification
of the selection of the auditors was approved with 4,070,924.56 votes in favor,
2,700 votes against, and 1,100 abstentions.
ITEM 4A. EXECUTIVE OFFICERS OF THE COMPANY
The executive officers of the Company and their ages and positions at
June 30, 1999, are as follows:
NAME AGE POSITION
---- --- --------
Allen Tepper ............... 51 Chairman of the Board
Mark P. Clein .............. 40 Chief Executive Officer
Fred D. Furman ............. 51 President
Susan D. Erskine ........... 47 Executive Vice President-Development, Secretary and Director
Daniel L. Frank ............ 42 President of Disease Management Division
Charles E. Galetto ......... 48 Senior Vice President-Finance and Treasurer
Allen Tepper co-founded the Company in 1988, has served as Chairman of
the Board since October 1989, and served as Chief Executive Officer of the
Company from October 1989 to May 1999, and President from October 1989 to April
1997. Mr. Tepper co-founded Consolidated Medical Corp., which was engaged in
out-patient clinic management for acute care hospitals in the Philadelphia area.
The company was subsequently sold to the Berwind Corporation in 1984 and Mr.
Tepper remained with the company until December 1986 as Senior Vice President.
Mr. Tepper holds a Masters of Business Administration degree from Northwestern
University and a Bachelors degree from Temple University.
Mark P. Clein has served as Chief Executive Officer of the Company
since May 1999, and served as Executive Vice President and Chief Financial
Officer of the Company from May 1996 to May 1999. Prior to joining the Company,
Mr. Clein was a Managing Director of Health Care Investment Banking for
Jefferies & Co., an investment banking firm, from August 1995 to May 1996, a
Managing Director of Rodman & Renshaw, Inc., an investment banking firm, from
March 1995 to August 1995, a Managing Director of Mabon Securities Corp., an
investment banking firm, from March 1993 to March 1995, a Vice President with
Sprout Group, an affiliate of Donaldson, Lufkin and Jenrette, Inc., from May
1991 to March 1993, and a Vice President and partner with Merrill Lynch Venture
Capital, Inc. from 1982 to February 1990 and from August 1990 to February 1991.
Mr. Clein holds a Masters of Business Administration degree from Columbia
University and a Bachelors degree from the University of North Carolina.
Fred D. Furman has served as President of the Company since April 1997.
Previously, he held the position of Executive Vice President -- Administration
and General Counsel from March 1995 to April 1997. Prior to joining the Company,
Mr. Furman was a partner at Kleinbard, Bell and Brecker, a Philadelphia law firm
from 1980 to March 1995. Mr. Furman is a member of the National Health Lawyers
Association. He holds a Juris Doctor degree and a Bachelors degree from Temple
University.
Susan D. Erskine co-founded the Company in 1988 and has served as
Executive Vice President, Secretary and a director of the Company since October
1989. Ms. Erskine previously served in several operational and marketing
management positions with acute care hospitals and health care management
organizations. Ms. Erskine holds a Masters in Health Science degree and
completed post-graduate work at Stanford University in Education and Psychology,
and she holds a Bachelors degree from the University of Miami.
Daniel L. Frank has served as President of the Disease Management
division of the Company since April 1998. This division is responsible for the
development of Stadt Solutions and its integrated managed care initiative. Mr.
Frank has also served as a director of the Company since 1992. Previously, Mr.
Frank was President of Coram
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Healthcare's Lithotripsy division from 1996 until its sale in 1997. Prior to
that, Mr. Frank was Chief Executive Officer of Western Medical Center - Anaheim
and Santa Ana Health, Inc. from 1993 to 1996. From 1991 to 1993, he was
President of Summit Ambulatory Network.
Charles E. Galetto has served as Senior Vice President-Finance and
Treasurer of the Company since August 1997. Prior to joining the Company, Mr.
Galetto was Vice President-Corporate Controller of Medtrans, a medical
transportation company, from June 1996 to July 1997 and Vice President, Chief
Financial Officer, Treasurer and Secretary of Data/Ware Development, Inc., a
computer hardware and software developer, from 1989 to May 1996. Mr. Galetto
holds a Bachelors degree from Wayne State University. Mr. Galetto will resign as
an officer and employee of the Company effective July 31, 1999.
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PART II
ITEM 5. MARKET PRICE OF AND DIVIDENDS ON THE COMPANY'S COMMON EQUITY AND RELATED
STOCKHOLDER MATTERS
(a) MARKET INFORMATION
The Company's Common Stock (NASDAQ symbol "PMRP") is traded publicly
through the NASDAQ National Market. The following table represents quarterly
information on the price range of the Company's Common Stock. This information
indicates the high and low sale prices reported by the NASDAQ National Market.
These prices do not include retail markups, markdowns or commissions:
HIGH LOW
------ ------
Quarters for the year ended April 30, 1999
First Quarter ........................ $15.25 $ 8.88
Second Quarter ....................... $10.31 $ 5.50
Third Quarter ........................ $ 8.88 $ 6.75
Fourth Quarter ....................... $ 8.88 $ 4.19
Quarters for the year ended April 30, 1998
First Quarter ........................ $24.13 $16.88
Second Quarter ....................... $24.50 $19.13
Third Quarter ........................ $23.63 $17.00
Fourth Quarter ....................... $19.50 $10.50
(b) HOLDERS
As of July 15, 1999 there were 103 holders of record of the Company's
Common Stock.
(c) DIVIDENDS
It is the policy of the Company's Board of Directors to retain earnings
to support operations and to finance continued growth of the Company rather than
to pay dividends. The Company has never paid or declared any cash dividends on
its Common Stock and does not anticipate paying any cash dividends in the
foreseeable future. The Company's credit facility contains certain restrictions
and limitations, including the prohibition against payment of dividends on
Common Stock.
(d) RECENT SALES OF UNREGISTERED SECURITIES
From May 1, 1998 to April 30, 1999, the Company has not sold any
unregistered securities.
ITEM 6. SELECTED FINANCIAL DATA
The following selected financial data should be read in conjunction
with the Company's consolidated financial statements and the accompanying notes
included elsewhere herein.
YEARS ENDED APRIL 30,
---------------------------------------------------------------------
1999 1998 1997 1996 1995
-------- -------- -------- -------- --------
(IN THOUSANDS, EXCEPT PER SHARE AMOUNTS)
INCOME STATEMENT INFORMATION
Revenues (1) ......................... $ 85,489 $ 67,524 $ 56,637 $ 36,315 $ 21,747
Net Income (loss)(2)(3) .............. (447) 1,788 3,107 918 (2,352)
Net Income (loss) per share
Basic .............................. (.06) .30 .66 .26 (.71)
Diluted ............................ (.06) .27 .55 .23 (.71)
WEIGHTED SHARES OUTSTANDING
Basic .............................. 6,924 6,053 4,727 3,484 3,336
Diluted ............................ 7,300 6,695 5,646 4,471 3,336
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PRO FORMA INFORMATION
Pro forma net income and earnings per
share as if cumulative change had
occurred for all periods presented:
Pro forma net income (loss) available to
common stock shareholders ......... 146 1,422 2,869 960 (2,360)
Pro forma earnings (loss) per share:
Basic ............................. .02 .24 .61 .28 (.71)
Diluted ........................... .02 .21 .51 .22 (.71)
AS OF APRIL 30,
---------------------------------------------------------------------
1999 1998 1997 1996 1995
-------- -------- -------- -------- --------
(in thousands)
BALANCE SHEET INFORMATION
Working Capital ...................... $ 52,233 $ 52,150 $ 17,036 $ 10,911 $ 8,790
Total Assets ......................... 70,966 70,449 32,450 21,182 14,811
Long Term Debt ....................... 294 392 0 0 126
Total Liabilities .................... 18,315 16,573 16,202 12,070 7,749
Stockholders' Equity ................. 52,651 53,876 16,248 9,112 7,062
(1) In fiscal 1999, approximately $30 million of revenues were attributable
to a new product line in pharmaceuticals, which commenced in July 1998
through the formation of Stadt Solutions.
(2) In fiscal 1999, the Company had a write-off of costs after income taxes
of $951,000 relating to a terminated acquisition.
(3) In fiscal 1999 and 1998, the Company had a special charge (credit)
after income taxes of ($154,000) and $1,194,000, respectively.
QUARTERS FOR THE YEARS ENDED,
--------------------------------------------------------------------------------------------------
APRIL 30, 1999 APRIL 30, 1998
--------------------------------------------- ---------------------------------------------
7/31/98 10/31/98 1/31/99 4/30/99 7/31/97 10/31/97 1/31/98 4/30/98
------- -------- ------- ------- ------- -------- ------- -------
(IN THOUSANDS, EXCEPT PER SHARE AMOUNTS)
Revenues ............ 17,851 22,417 21,989 23,232 16,177 17,561 16,522 17,264
Net income (loss) ... 478 89 178 (1,192) 970 1,162 1,327 (1,671)
Net income (loss) per
Share
Basic ............. .07 .01 .03 (.17) .19 .22 .19 (.24)
Diluted ........... .07 .01 .02 (.17) .17 .19 .18 (.22)
ITEM 7. MANAGEMENT'S DISCUSSION AND ANALYSIS OF FINANCIAL CONDITION AND RESULTS
OF OPERATIONS
The following discussion should be read in conjunction with the more
detailed information and consolidated financial statements and accompanying
notes, as well as the other financial information appearing elsewhere in this
document. Except for historical information, the following discussion contains
forward-looking statements that involve risks and uncertainties. The Company's
actual results could differ materially from those discussed herein. Factors that
could cause or contribute to such differences include, but are not limited to,
those discussed in "Risk Factors," as well as those discussed elsewhere in this
document.
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OVERVIEW
PMR is a leading manager of specialized mental health care programs and
disease management services designed to treat individuals diagnosed with SMI.
PMR manages and administers the delivery of a broad range of outpatient and
community-based psychiatric services for SMI patients, consisting of 37
Outpatient Programs, two Case Management Programs and four Chemical Dependency
Programs. Stadt Solutions, the Company's majority owned subsidiary with
Stadtlander, offers a specialty pharmacy program for individuals with SMI, which
presently serves approximately 7,500 individuals through fifteen pharmacies in
fourteen states. Stadt Solutions received the Company's clinical research and
information business upon formation. PMR, including Stadt Solutions, operates in
approximately twenty-five states and employs or contracts with more than 400
mental health and pharmaceutical professionals and provide services to
approximately 11,000 individuals diagnosed with SMI.
SOURCES OF REVENUE
Outpatient Programs. Outpatient Programs managed or administered by PMR
are the Company's primary source of revenue. Revenue under these programs is
derived primarily from services provided under three types of agreements: (i)
all-inclusive fee arrangements based on fee-for-service rates (based on units of
service provided) under which the Company is responsible for substantially all
direct program costs; (ii) fee-for-service arrangements under which the provider
maintains responsibility for a large extent of direct program costs; and (iii)
fixed fee arrangements where the Company's fee is a fixed monthly sum and the
provider assumes substantially all program costs. The all-inclusive arrangements
are in effect at 33 of the 39 Outpatient Programs operated during fiscal 1999
and constituted 69.4% of the Company's psychiatric care revenue for the year
ended April 30, 1999. These contractual agreements are with hospitals or CMHCs,
and require the Company to provide, at its own expense, specific management
personnel for each program site. Patients served by the Outpatient Programs
typically are covered by Medicare.
Revenue under the Outpatient Program is recognized at estimated net
realizable amounts when services are rendered based upon contractual
arrangements with providers. Under certain of the Company's contracts, the
Company is obligated to indemnify the provider for all or some portion of the
Company's fees that may not be deemed reimbursable to the provider by Medicare's
fiscal intermediaries. As of April 30, 1999, the Company had recorded $6.7
million in contract settlement reserves to provide for possible amounts
ultimately owed to its provider customers resulting from disallowance of costs
by Medicare and Medicare cost report settlement adjustments. Such reserves are
classified as non-current liabilities because ultimate determination of
substantially all of the potential contract disallowances is not anticipated to
occur during fiscal 1999. See "Risk Factors -- Dependence Upon Medicare
Reimbursement" and "-- Sufficiency of Existing Reserves to Cover Reimbursement
Risks."
Case Management Programs. For its Case Management Programs in
Tennessee, the Company receives a monthly case rate fee from the managed care
consortiums responsible for managing the TennCare program and is responsible for
planning, coordinating and managing psychiatric case management services for its
consumers who are eligible to participate in the TennCare program. The Company
also is responsible for providing a portion of the related outpatient clinical
care under certain of the agreements. Revenue under the TennCare program is
recognized in the period in which the related service is to be provided. These
revenues represent substantially all of the Company's case management revenues.
The urgent care program receives interim payments which are adjusted based on
inpatient utilization statistics which are compared to a baseline. Revenues are
recognized based on the quarterly calculation of the statistical trends. See
"Risk Factors -- Concentration of Revenues," "-- Concentration of Revenues" and
"--Limited Operating History of Case Management Programs."
Chemical Dependency Programs. In Southern California, the Company
contracts primarily with managed care companies and commercial insurers to
provide its outpatient chemical dependency services. The contracts are
structured as fee-for-service or case rate reimbursement and revenue is
recognized in the period in which the related service is delivered.
Pharmaceuticals. Through Stadt Solutions, the Company offers specialty
pharmaceutical services to individuals with SMI. Stadt Solutions also offers
site management and clinical information services to
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pharmaceutical companies, health care providers and public sector purchasers.
Stadt Solutions serves clients through a variety of pharmacies offering
anti-psychotic or other medications for individuals with schizophrenia or other
serious mental illnesses as well as offering blood monitoring services. Stadt
Solutions will seek to offer patients expanded services, including dispensing of
all of the pharmaceuticals needed by these individuals and providing disease
management services to improve compliance and education for the patient, the
physician and family members. Stadt Solutions records pharmaceutical revenue
when the product is sold to customers at pharmacies, net of any estimated
contractual allowances. See "Risk Factors - Pharmacy Services Regulations" "-
Pharmacy Reimbursement."
RESULTS OF OPERATIONS
The following table sets forth, for the periods indicated, the
percentage of revenue represented by the respective financial items:
YEAR ENDED APRIL 30,
---------------------------------
1999 1998 1997
----- ----- -----
Revenue .......................................... 100.0% 100.0% 100.0%
----- ----- -----
Operating expenses ............................... 75.7 71.5 73.7
Marketing, general and administrative ............ 14.4 13.6 10.7
Provision for bad debts .......................... 9.4 7.6 5.4
Depreciation and amortization .................... 1.3 1.6 1.2
Acquisition expense .............................. 1.9 -- --
Special Charge ................................... (.3) 3.0 --
Interest (income), expense ....................... (1.9) (1.8) (0.4)
----- ----- -----
Total expenses ................................... 100.5 95.5 90.6
----- ----- -----
Income (loss) before minority interest, income
taxes and cumulative change ...................... (.5) 4.5 9.4
Minority interest ................................ .8 -- --
----- ----- -----
Income before income taxes and cumulative change.. .3 4.5 9.4
Income tax expense ............................... .1 1.9 3.9
----- ----- -----
Net income before cumulative change .............. .2 2.6 5.5
Cumulative change, net of income tax benefit ..... .7 -- --
----- ----- -----
Net income (loss) ................................ (.5%) 2.6% 5.5%
===== ===== =====
YEAR ENDED APRIL 30, 1999 COMPARED TO YEAR ENDED APRIL 30, 1998
Revenue - Psychiatric Care. Revenues from psychiatric care decreased
from $67.5 million for the year ended April 30, 1998 to $55.8 million for the
year ended April 30, 1999, a decrease of $11.7 million, or 17.3%. The Outpatient
Programs recorded revenues of $43.7 million, a decrease of $5.7 million or 11.5%
as compared to fiscal 1998. The decrease in revenues was due to a net reduction
of five outpatient programs versus a year ago. This reduction was partially
offset by same site revenue growth of 8.6% in the Outpatient Programs. The
Outpatient Programs operated under an all-inclusive fee arrangement had
operating margins of 34.2% in the year ended April 30, 1999 as compared to 35.7%
in the year ended April 30, 1998. The Company's Case Management Programs
recorded revenues of $10.5 million, a decrease of $4.6 million, or 30.5%, from
the year ended April 30, 1998. The decrease in revenues was due to the
restructuring of the Company's relationship with Case Management, Inc. and the
termination of two Case Management Programs in Arkansas. Revenues from the
Company's Chemical Dependency and other programs not included as outpatient or
case management were $1.3 million, a decrease of 46.7% from the year ended April
30, 1998. The decrease in revenues was associated primarily with the Company's
termination of two Chemical Dependency Programs in Arkansas.
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Revenue - Pharmaceuticals. Revenues of $29.7 million from
pharmaceutical care represent sales of pharmaceutical products to approximately
7,500 individuals with SMI through 15 pharmacies serving Stadt Solutions since
its formation in July 1998.
Direct Operating Expenses - Psychiatric Care. Direct operating expenses
consist of costs incurred at the program sites and costs associated with the
field management responsible for administering the programs. Direct operating
expenses decreased from $48.2 million for the year ended April 30, 1998 to $38.6
million for the year ended April 30 ,1999, a decrease of $9.6 million, or 19.9%.
As a percentage of psychiatric care revenues, psychiatric care operating
expenses were 69.1%, down from 71.5% for the year ended April 30, 1998. The
overall decrease in direct operating expenses and the improvement in the
operating expense ratio was primarily due to the net closing of five Outpatient
Programs, three Case Management Programs and two Chemical Dependency Programs,
which in the aggregate, had lower patient volume and higher expense ratios than
the remaining programs. The Company also restructured its agreement with Case
Management, Inc., which reduced recognized revenue but improved operating
margins.
Cost of Sales - Pharmaceuticals. Cost of sales of pharmaceutical
products of $22.0 million represent the cost of providing such products since
the formation of Stadt Solutions in July 1998. The costs represent 74.1% of
pharmaceutical revenue and includes product costs.
Direct Operating Expenses - Pharmaceuticals. Direct operating expenses
of pharmaceutical care of $4.2 million consist of the operating costs incurred
at the 15 pharmacies serving Stadt Solutions and related billing costs since the
formation of Stadt Solutions in July 1998.
Marketing, General and Administrative. Marketing, general and
administrative expenses increased from $9.2 million for the year ended April 30,
1998 to $12.3 million for the year ended April 30, 1999, an increase of $3.1
million or 33.7%. The increase was related to investment in the corporate
headquarters to support existing and anticipated programs, including the Stadt
Solutions venture and a coordinated care initiative in Southern California. As a
percentage of total revenues, marketing, general and administrative expenses
were 14.4% for the year ended April 30, 1999, as compared to 13.6% for fiscal
year 1998. The increase in marketing, general and administrative expenses as a
percent of revenue was due to an increase in support costs related to the
coordinated care initiative without a proportionate increase in coordinated care
revenue, partially offset by a significant increase in pharmaceutical revenues
without proportionate increases in administrative expenses.
Provision for Bad Debts. Expenses related to the provision for bad
debts increased from $5.1 million for the year ended April 30, 1998 to $8.1
million for the year ended April 30, 1999, an increase of $3.0, or 58.8%. The
increase was due to reserve against revenue from sales of the new product
segment pharmaceutical products and to a higher provision rate for bad debt
associated with a less than expected collection experience in pharmaceutical
products and certain Outpatient Programs that were subject to a high level of
review from fiscal intermediaries. As a percentage of revenues, the provision
for bad debts increased to 9.4% of revenues for the year ended April 30, 1999
from 7.6% in fiscal 1998. The Company expects this accrual to fluctuate based on
the amount of claims under review in its Outpatient Programs and the number of
programs that the Company operates which serve a significant indigent
population.
Depreciation and Amortization. Depreciation and amortization expenses
increased from $1,065,000 for the year ended April 30, 1998 to $1,117,000 for
the year ended April 30, 1999, an increase of $52,000, or 4.9%. The increase was
due to additional capital expenditures associated with new Outpatient Programs
and increased capital expenditures for information systems.
Write-off of Costs Related to Terminated Acquisition. Acquisition
expenses consist of legal, advisory, accounting, consulting, and other costs
related to the terminated definitive merger agreement with Behavioral Health
Corporation. Previously capitalized acquisition expenses written-off for the
year ended April 30, 1999 were $1.6 million. No Acquisition expenses were
recorded in the year ended April 30, 1998.
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Special Charge Credit in Fiscal 1999. The special charge credit relates
primarily to a favorable settlement of disputes and the restructuring of the
relationship with Case Management, Inc. ("CMI"). The Company had incurred a
special charge relating to the closing of several programs identified in the
year ended April 30, 1998, which included a special charge relating to CMI. The
outcome of the dispute in August 1998, which was better than anticipated as of
April 30, 1998, involved the return of common stock that was previously issued
to CMI as part of the consideration for a restrictive covenant, a cash
settlement and the release of claims against the Company for certain
liabilities.
The Company has reflected the return of common stock as treasury stock
in the statement of stockholders' equity at a fair market value of $418,750, at
the date of settlement. At the time of original issuance, an intangible asset
for the common stock was valued at fair market value of $256,250 and was
amortized over the term of the restrictive covenant of 72 months. At April 30,
1998, the net book value of the intangible asset was $158,000 and was fully
reserved in the special charge. The other components of the special charge
credit were a cash settlement of $150,000 for accounts receivable which were
fully reserved, the release of certain liabilities relating to unemployment
taxes of $94,000, and other items of $15,542.
Additional components of the special charge credit include a charge of
$416,000 to write down certain goodwill and certain property and equipment. The
charges relate to goodwill at the Company's chemical dependency program and
property and equipment at the Company's chemical dependency program and several
additional sites. The write down of these assets resulted from a failure of the
chemical dependency business to provide sufficient cash flow to recover the
Company's investment in this line of business.
Net Interest Income. Interest income, net of interest expense,
increased from $1,187,000 for the year ended April 30, 1998 to $1,610,000 for
the year ended April 30, 1999, an increase of $423,000, or 35.6%. This increase
resulted from higher cash and cash equivalent and short-term investment balances
resulting from the completion of the Company's follow-on common stock offering
in October 1997, partially offset by non-recurring interest expense on income
taxes of $358,000.
Income (Loss) Before Minority Interest, Income Taxes and Cumulative
Change. Income (loss) before minority interest, income taxes and cumulative
change decreased from $3.0 million for the year ended April 30, 1998 to a loss
of $.4 million for the year ended April 30, 1999, a decrease of $3.4 million.
Minority Interest. Minority interest of $677,000 represents the
allocation of the operating losses of Stadt Solutions during the year ended
April 30, 1999 to the minority shareholder as required by the Stadt Solutions
Operating Agreement.
Cumulative Change. The cumulative change of $593,000 represents the
effect, net of income tax benefit of $411,000, of writing off previously
capitalized start-up costs. The Company adopted this change in accounting
principle in the first quarter of fiscal 1999 consistent with the requirements
of Accounting Standards Executive Committee's Statement of Position 98-5,
Reporting on Costs of Start-up Activities.
YEAR ENDED APRIL 30, 1998 COMPARED TO YEAR ENDED APRIL 30, 1997
Revenue. Revenue increased from $56.6 million for the year ended April
30, 1997 to $67.5 million for the year ended April 30, 1998, an increase of
$10.9 million, or 19.2%. The Outpatient Programs recorded revenue of $49.4
million, an increase of 23.5% as compared to fiscal 1997. The growth in
Outpatient Programs was the result of the addition of nine new programs in
fiscal 1998 and increases in "same-site" revenues of 11.7% compared to fiscal
1997. The remainder of the increase in revenue came from the growth in Case
Management Programs in Tennessee and Arkansas, which recorded revenue of $15.1
million, an increase of $1.4 million or 10.4% as compared to fiscal 1997.
Revenue from the Chemical Dependency Programs was $3.0 million, an increase of
1.0% as compared to fiscal 1997. The Company is currently in the process of
terminating or restructuring its relationship with a Tennessee case management
agency and during fiscal 1998 terminated its Arkansas Case Management Programs.
See "Business -- Programs and Operations --Case Management Programs." The
all-inclusive
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36
Outpatient Programs operated during fiscal 1998 had an operating margin for the
year ended April 30, 1998 of 35.7% as compared to 31.9% for the year ended April
30, 1997.
Operating Expenses. Operating expenses consist of costs incurred at the
program sites and costs associated with the field management responsible for the
administering the programs. Operating expenses increased from $41.7 million for
the year ended April 30, 1997 to $48.2 million for the year ended April 30,
1998, an increase of $6.5 million, or 15.6%. As a percentage of revenue,
operating expenses were 71.5%, down from 73.7% for the year ended April 30,
1997. The improvement in the operating expense ratio was due to reductions in
bonus expenses of $680,000 as well as operating leverage realized as a result of
revenue growth in the Outpatient and Case Management Programs which was spread
across existing fixed and semi-variable cost structures.
Marketing, General and Administrative. Marketing, general and
administrative expenses increased from $6.0 million for the year ended April 30,
1997 to $9.2 million for the year ended April 30, 1998, an increase of $3.2
million, or 53.3%. The increase was due to investment in both the regional and
home offices to support existing and anticipated programs. As a percentage of
revenue, marketing, general and administrative expenses were 13.6% for the year
ended April 30, 1998, as compared to 10.7% for the year ended April 30, 1997.
Provision for Bad Debts. Provision for bad debt expense increased from
$3.1 million for the year ended April 30, 1997 to $5.1 million for the year
ended April 30, 1998, an increase of $2.0 million, or 64.5%. The increase was
due to anticipated difficulties associated with collection of receivables
relating to program locations closed in the fourth quarter of fiscal 1998. As
part of a special charge in the fourth quarter of fiscal 1998, the Company
recorded approximately $2.4 million in additional bad debt expenses associated
with the closed programs.
Special Charge. A Special Charge of $4.4 million was recorded in the
fourth quarter to provide for costs associated with closing several programs,
resolving the provider based status associated with the Scripps Health programs
and resolving other regulatory matters. Included in this charge is a $2.4
million bad debt expense which was recorded in provision for bad debts. The
remaining $2.0 million was allocated to program closing costs which were $1.4
million and costs associated with noncancelable contract obligations which were
$600,000.
Depreciation and Amortization. Depreciation and amortization expense
increased from $701,000 for the year ended April 30, 1997 to $1,065,000 for the
year ended April 30, 1998, an increase of $364,000 or 51.9%. The increase was
due to additional capital expenditures associated with the start-up of new
programs during fiscal 1998 and as well as equipment and leasehold improvements
associated with the Company's corporate office.
Net Interest Income. Interest income increased from $217,000 for the
year ended April 30, 1997 to $1,187,000 for the year ended April 30, 1998, an
increase of $970,000 or 447.0%. This increase resulted from higher cash and cash
equivalent and short-term investment balances resulting from the completion of
the Company's common stock offering in October 1997.
Income Before Income Taxes. Income before income taxes decreased from
$5.3 million for the year ended April 30, 1997 to $3.0 million for the year
ended April 30, 1998, a decrease of $2.3 million, or 43.4%. Income before income
taxes as a percentage of revenue decreased from 9.4% to 4.5% over this period of
time.
LIQUIDITY AND CAPITAL RESOURCES
For the year ended April 30, 1999, net cash used in operating
activities was $6.8 million. Working capital at April 30, 1999 was $52.2
million, an increase of $83,000, as compared to working capital at April 30,
1998. Cash and cash equivalents and short-term investments at April 30, 1999
were $33.0 million, a decrease of $5.8 million or 14.9% as compared to April 30,
1998.
The Company experienced growth in accounts receivable due to
significant revenue increases partially offset by a decrease in days revenue
outstanding from 88 at April 30, 1998 to 76 at April 30, 1999. The decrease in
days revenue outstanding was due to a reclassification of approximately $3.0
million in current accounts receivable to notes and long term receivables and a
change in the receivables mix, with pharmacy related receivables, which
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37
experience shorter payment cycles comprising a larger portion of the base. The
largest source of accounts receivable growth has been from pharmaceutical
services, which has accumulated $6.9 million in accounts receivable since the
commencement of operations on July 1, 1998. The other significant use of cash
was leasehold improvements associated with recently opened sites and investment
in information technology.
Working capital available to finance fiscal 2000 obligations is
expected to be provided principally from operations, as well as from a $10
million line of credit from Sanwa Bank. Interest is payable under this line of
credit at either the bank's reference rate or the Eurodollar rate plus 2%. As of
April 30, 1999, no balance was outstanding under the line of credit. Working
capital is anticipated to be utilized during fiscal 2000 to continue expansion
of the Company's Outpatient and Case Management Programs, for expansion of Stadt
Solutions' pharmacy services, and for the development of a risk based
coordinated care project. Pursuant to the terms of the Stadt Solutions
Subscription Agreement and Operating Agreement, the Company invested
approximately $2.5 million into Stadt Solutions during the year ended April 30,
1999 to fund the second closing and provide sufficient working capital for
operations. The Company also anticipates using working capital and, if
necessary, incurring indebtedness in connection with, selective acquisitions.
In December 1998, the Board of Directors authorized the Company to
repurchase up to 350,000 shares of its common stock, approximately 5% of the
Company's outstanding common stock. Purchased shares will be used for corporate
purposes including issuance under PMR's stock compensation plans. The purchases
will be made from time to time in open market transactions. As of April 30,
1999, the Company repurchased 90,000 shares of its common stock at an average
price of $5.81 per share, or $523,750, in open market transactions. In May 1999,
the Company repurchased an additional 200,000 shares of its common stock at a
price of $3.75 per share, or $750,000, in open market transactions. These shares
were held in treasury.
The opening of a new Outpatient Program site typically requires $45,000
to $150,000 for office equipment, supplies, lease deposits, leasehold
improvements and the hiring and training of personnel prior to opening. These
programs generally experience operating losses through an average of the first
four months of operation. The Company expects to provide cash for the start up
of the site management and clinical information business as part of the growth
strategy of Stadt Solutions.
From time to time, the Company recognizes charges to operations as a
result of particular uncertainties associated with the health care reimbursement
rules as they apply to the Outpatient Programs. During fiscal 1998 and 1999, a
majority of the Company's psychiatric care revenue was derived from the
management of its Outpatient Programs. Since substantially all of the patients
of the Outpatient Programs are eligible for Medicare, collection of a
significant component of the Company's management fees is dependent upon
reimbursement of claims submitted to fiscal intermediaries by the hospitals or
CMHCs on whose behalf these programs are managed. Certain of the Company's
contracts with its providers contain warranty obligations that require the
Company to indemnify such providers for the portion of the Company's management
fee disallowed for reimbursement. Although the Company believes that its
potential liability to satisfy such requirements has been adequately reserved in
its financial statements, the obligation to pay such amounts, if and when they
become due, could have a material adverse effect on the Company's short term
liquidity. Certain factors are, in management's view, likely to lessen the
impact of any such effect, including the expectation that, if claims arise, they
will arise on a periodic basis over several years and that any disallowance will
merely be offset against obligations already owed by the provider to the
Company.
The Company maintains significant reserves to cover the potential
impact of two primary uncertainties: (i) the Company may have an obligation to
indemnify certain providers for some portions of its management fee which may be
subject to disallowance upon audit of a provider's cost report by fiscal
intermediaries; and (ii) the Company may not receive full payment of the
management fees owed to it by a provider during the periodic review of the
provider's claims by the fiscal intermediaries.
The Company has been advised by Health Care Financing Administration
that certain program-related costs are not allowable for reimbursement. The
Company may be responsible for reimbursement of the amounts previously paid to
the Company that are disallowed pursuant to indemnity obligations that exist
with certain
-37-
38
providers. Although the Company believes that its potential liability to satisfy
such requirements has been adequately reserved in its financial statements,
there can be no assurance that such reserves will be adequate. The obligation to
pay the amounts estimated within the Company's financial statements (or such
greater amounts as are due), if and when they become due, could have a material
adverse effect upon the Company's business, financial condition and results of
operations.
In the first quarter of fiscal year 2000, the Company has closed six
outpatient psychiatric program locations. In addition, in July, 1999, the
Company determined to restructure certain departments company-wide in an effort
to streamline functions and improve efficiencies. The restructuring will involve
the reduction in force and consolidation of responsibilities. The Company
anticipates that it will incur a charge related to such site closures and
restructure due to severance and lease obligations.
IMPACT OF INFLATION
A substantial portion of the Company's revenue is subject to
reimbursement rates that are regulated by the federal and state governments and
that do not automatically adjust for inflation. As a result, increased operating
costs due to inflation, such as labor and supply costs, without a corresponding
increase in reimbursement rates, may adversely affect the Company's earnings in
the future.
IMPACT OF YEAR 2000 COMPUTER ISSUES
The year 2000 issue is the result of computer applications being
written using two digits rather than four to define the applicable year. The
Company's computer applications (and computer applications used by any of the
Company's customers, vendors, payors or other business partners) may recognize a
date using "00" as the year 1900 rather than the year 2000. This could result in
system failures or miscalculations causing disruption of operations.
The Company has completed a thorough review of its material computer
applications and has identified and scheduled necessary corrections for its
computer applications. Corrections are currently being made and are expected to
be substantially implemented by the second quarter of fiscal 2000. The Company
expects that the total cost associated with these revisions will not be
material. These costs were primarily incurred during fiscal 1999 and charged to
expense as incurred. For externally maintained systems, the Company has begun
working with vendors to ensure that each system is currently year 2000 compliant
or will be made year 2000 compliant during 1999. The cost to be incurred by the
Company related to externally maintained systems is expected to be minimal. The
Company believes that by completing its planned corrections to its computer
applications, the year 2000 issue with respect to the Company's systems can be
mitigated. However, if such corrections cannot be completed on a timely basis,
the year 2000 issue could have a material adverse impact on the Company's
business, financial condition and results of operations. Because of the many
uncertainties associated with year 2000 compliance issues, and because the
Company's assessment is necessarily based on information from third party
vendors and suppliers, there can be no assurance that the Company's assessment
is correct or as to the materiality, worst case scenario or effect of any
failure of such assessment to be correct.
The Company has initiated a program to determine whether the computer
applications of its significant payors and contract providers will be upgraded
in a timely manner. The Company has not completed this review and it is unknown
whether computer applications of contract providers and Medicare and other
payors will be year 2000 compliant. The Company has not determined the extent to
which any disruption in the billing practices of providers or the payment
practices of Medicare or other payors caused by the year 2000 issues will affect
the Company's operations. However, any such disruption in the billing or
reimbursement process could have a substantial adverse impact on Medicare or
Medicaid payments to providers and, in turn, payments to the Company. Any such
disruption could have a material adverse effect upon the Company's business,
financial condition and results of operations. The Company has not established a
contingency plan in the event of any such disruption or worst case scenario.
Stadt Solutions has completed a review and assessment of its
applications and systems and is expected to complete all required remediation.
The cost to be incurred by Stadt Solutions related to such remediation, and the
-38-
39
extent of such remediation, is expected to be minimal. Stadt Solutions believes
that by completing the planned corrections to its applications and systems, the
year 2000 issue with respect to its applications and systems can be mitigated.
However, if such corrections cannot be completed on a timely basis, the year
2000 issue could have a material adverse impact on Stadt Solutions' business,
financial condition and results of operations. Because of the many uncertainties
associated with year 2000 compliance issues, including uncertainties or
disruption in the payment practices of Medicaid or other payors, and because
Stadt Solutions' assessment is necessarily based on information from third party
vendors and suppliers and Stadtlander, there can be no assurance that the
Company's assessment is correct or as to the materiality, worst case scenario or
effect of any failure of such assessment to be correct. Stadt Solutions has not
established a contingency plan in the event of any such disruption or worst case
scenario.
ITEM 7A. QUANTITATIVE AND QUALITATIVE DISCLOSURE ABOUT MARKET RISK.
The Company does not and did not invest in market risk sensitive
instruments in fiscal 1999. The Company had and has no exposure to market risk
with regard to changes in interest rates. The Company does not and has not used
derivative financial instruments for any purposes, including hedging or
mitigating interest rate risk.
ITEM 8. FINANCIAL STATEMENTS AND SUPPLEMENTARY DATA
Financial Statements and supplementary data of the Company are provided
at the pages indicated in Item 14(a).
ITEM 9. CHANGES IN AND DISAGREEMENTS WITH ACCOUNTANTS ON ACCOUNTING AND
FINANCIAL DISCLOSURE
There has not been any change of accountants or any disagreements with
the Company's accountants on any matter of accounting practice or financial
disclosure during the reporting periods.
-39-
40
PART III
ITEM 10. DIRECTORS AND EXECUTIVE OFFICERS
Information with regard to this item is incorporated by reference to
the definitive 1999 Proxy Statement to be filed with the Securities and Exchange
Commission within 120 days of April 30, 1999, under the caption "Election of
Directors." See "Item 4. Executive Officers of the Company" with regard to
Executive Officers.
ITEM 11. EXECUTIVE COMPENSATION
Information with regard to this item is incorporated by reference to
the definitive 1999 Proxy Statement to be filed with the Securities and Exchange
Commission within 120 days of April 30, 1999, under the caption "Additional
Information - Management Compensation."
ITEM 12. SECURITY OWNERSHIP OF CERTAIN BENEFICIAL OWNERS AND MANAGEMENT
Information with regard to this item is incorporated by reference to
the definitive 1999 Proxy Statement to be filed with the Securities and Exchange
Commission within 120 days of April 30, 1999, under the caption "Principal
Stockholders."
ITEM 13. CERTAIN RELATIONSHIPS AND RELATED TRANSACTIONS
Information with regard to this item is incorporated by reference to
the definitive 1999 Proxy Statement to be filed with the Securities and Exchange
Commission within 120 days of April 30, 1999, under the caption "Additional
Information - Certain Transactions."
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41
PART IV
ITEM 14. EXHIBITS, FINANCIAL STATEMENT SCHEDULES, AND REPORTS ON FORM 8-K
(a) THE FOLLOWING DOCUMENTS ARE FILED AS PART OF THIS ANNUAL REPORT ON
FORM 10K:
1. Financial Statements: The financial statements of PMR are
included as Appendix F of this report. See Table of Contents to
Financial Statements in Appendix F.
2. Financial Statement Schedules: Schedule II-PMR Corporation
Valuation and Qualifying Accounts is included in Appendix F of this
report. See Table of Contents to Financial Statements in Appendix
F.
3. The exhibits which are filed with this Report or which are
incorporated herein by reference are set forth in the Exhibit Index
on page 41.
(b) REPORTS ON FORM 8-K:
The Company did not file any reports on Form 8-K during the fourth
quarter of fiscal 1999.
(c) EXHIBITS:
EXHIBIT
NUMBER DESCRIPTION
------ -----------
3.1 The Company's Restated Certificate of Incorporation, filed with
the Delaware Secretary of State on March 9, 1998.+
3.2 The Company's Amended and Restated Bylaws.*
4.1 Common Stock Specimen Certificate.**
10.1 The Company's 1997 Equity Incentive Plan (filed as Exhibit 10.1).*
10.2 Form of Incentive Stock Option Agreement under the 1997 Plan
(filed as Exhibit 10.2).*
10.3 Form of Nonstatutory Stock Option Agreement under the 1997 Plan
(filed as Exhibit 10.).*
10.4 Outside Directors' Non-Qualified Stock Option Plan of 1992 (the
"1992 Plan") (filed as Exhibit 10.4).*
10.5 Form of Outside Directors' Non-Qualified Stock Option Agreement
(filed as Exhibit 10.5).*
10.6 Amended and Restated Stock Option Agreement dated April 30, 1996,
evidencing award to Allen Tepper (filed as Exhibit 10.6).*
10.7 Amended and Restated Stock Option Agreement dated April 30, 1996,
evidencing award to Susan Erskine (filed as Exhibit 10.7).*
10.8 Amended and Restated Stock Option Agreement dated February 1,
1996, evidencing award to Mark Clein (filed as Exhibit 10.8).*
10.9 Amended and Restated Stock Option Agreement dated February 1,
1996, evidencing award to Mark Clein (filed as Exhibit 10.9).*
10.10 Amended and Restated Warrant dated July 9, 1997, evidencing award
to Fred Furman (filed as Exhibit 10.11).*
10.11 Restated Management Agreement dated April 11, 1997 with Scripps
Health (filed as Exhibit 10.12).*
10.12 Amendment to Restated Management Agreement dated July 15, 1998
with Scripps Health.+
10.13 Sublease dated April 1, 1997 with CMS Development and Management
Company, Inc. (filed as Exhibit
-41-
42
EXHIBIT
NUMBER DESCRIPTION
------ -----------
10.13).*
10.14 Management and Affiliation Agreement dated April 13, 1995, between
Mental Health Cooperative, Inc. and Tennessee Mental Health
Cooperative, Inc. with Addendum (filed as Exhibit 10.14).
(Tennessee Mental Health Cooperative, Inc. subsequently changed
its name to Collaborative Care Corporation.)*
10.15 Second Addendum to Management and Affiliation Agreement dated
November 1, 1996 between Mental Health Cooperative, Inc. and
Collaborative Care Corporation (filed as Exhibit 10.15).***
10.16 Provider Services Agreement dated April 13, 1995, between
Tennessee Mental Health Cooperative, Inc. and Mental Health
Cooperative, Inc. (filed as Exhibit 10.15). (Tennessee Mental
Health Cooperative, Inc. subsequently changed its name to
Collaborative Care Corporation.)*
10.19 Provider Agreement dated December 4, 1995, between Tennessee
Behavioral Health, Inc. and Tennessee Mental Health Corporations,
Inc.+
10.20 Addendum No. 1 to Provider Agreement dated December 4, 1995,
between Tennessee Behavioral Health, Inc. and Tennessee Mental
Health Cooperative, Inc.+
10.21 Addendum No. 2 to Provider Agreement dated February 4, 1996,
between Tennessee Behavioral Health, Inc. and Tennessee Mental
Health Cooperative, Inc.+
10.22 Provider Participation Agreement dated December 1, 1995, among
Green Spring Health Services, Inc., AdvoCare, Inc. and Tennessee
Mental Health Cooperative, Inc.+
10.23 Amendment to Provider Participation Agreement dated February 13,
1996, among Green Spring Health Services, Inc., AdvoCare of
Tennessee, Inc. and Tennessee Mental Health Cooperative, Inc.+
10.24 Subscription Agreement dated June 8, 1998, between the Company and
Stadtlander Drug Distribution Co., Inc.+
10.25 Sanwa Bank California Credit Agreement dated February 2, 1996, as
amended on October 31, 1996.***
10.26 Transition and Services Agreement dated July 1, 1998, between
Stadt Solutions LLC, PMR Corporation and Stadtlander Drug
Distribution Company, Inc.
10.27 Operating Agreement dated July 1, 1998, between PMR Corporation
and Stadtlander Drug Distribution Company, Inc.
10.28 Stock Option dated September 8, 1998 granted to Daniel Frank.
10.29 Stock Option dated September 8, 1998 granted to Daniel Frank.
10.30 Form of Stock Option granted to Mark P. Clein, Fred D. Furman and
Susan Erskine, dated December 3, 1998.
21.1 List of Subsidiaries.
23.1 Consent of Ernst & Young LLP.
27.1 Financial Data Schedule.
- ------------
* Incorporated by reference to exhibits filed with the SEC in the
Company's Annual Report on Form 10-K for the year ended April 30, 1997.
** Incorporated by reference to the Company's Registration Statement on
Form S-18 (Reg. No. 23-20095-A).
*** Incorporated by reference to exhibits filed with the SEC in the
Company's Registration Statement on Form S-2 (Reg. No. 333-36313).
+ Previously filed.
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43
SIGNATURES
Pursuant to the requirements of Section 13 or 15(d) of the Securities
Exchange Act of 1934, the Company has duly caused this report to be signed on
its behalf by the undersigned, thereunto duly authorized, on July 26, 1999.
PMR Corporation
By: /s/ MARK P. CLEIN
-----------------------------------
Mark P. Clein
Chief Executive Officer
(Principal Executive Officer)
KNOW ALL PERSONS BY THESE PRESENTS, that each person whose signature
appears below constitutes and appoints Mark P. Clein and Fred D. Furman, and
each or any one of them, his true and lawful attorney-in-fact and agent, with
full power of substitution and re-substitution, for him and in his name, place
and stead, in any and all capacities, to sign any and all amendments (including
post-effective amendments) to this Form 10-K, and to file the same, with all
exhibits thereto, and other documents in connection therewith, with the
Securities and Exchange Commission, granting unto said attorneys-in-fact and
agents, and each of them, full power and authority to do and perform each and
every act and thing requisite and necessary to be done in connection therewith,
as fully to all intents and purposes as he might or could do in person, hereby
ratifying and confirming all that said attorneys-in-fact and agents, or any of
them, or their or his substitutes or substitute, may lawfully do or cause to be
done by virtue hereof.
Pursuant to the requirements of the Securities and Exchange Act of
1934, this report has been signed below by the following persons in the
capacities and on the dates indicated.
SIGNATURE TITLE DATE
--------- ----- ----
/s/ ALLEN TEPPER Chairman of the Board of Directors July 26, 1999
- ------------------------------------
Allen Tepper
/s/ MARK P. CLEIN Chief Executive Officer July 26, 1999
- ------------------------------------ and Director (Principal Executive Officer)
Mark P. Clein
/s/ FRED D. FURMAN President July 26, 1999
- ------------------------------------
Fred D. Furman
/s/ SUSAN D. ERSKINE Executive Vice President, Secretary and Director July 26, 1999
- ------------------------------------
Susan D. Erskine
/s/ DANIEL L. FRANK President of Disease Management Division July 26, 1999
- ------------------------------------ and Director
Daniel L. Frank
/s/ CHARLES E. GALETTO Senior Vice President - Finance & Treasurer July 26, 1999
- ---------------------------- (Principal Accounting Officer)
Charles E. Galetto
-43-
44
Consolidated Financial Statements
and Schedule
PMR Corporation
Years ended April 30, 1999 and 1998
with Report of Independent Auditors
45
PMR Corporation
Consolidated Financial Statements
and Schedule
Years ended April 30, 1999 and 1998
CONTENTS
Report of Independent Auditors........................................ F-1
Consolidated Financial Statements
Consolidated Balance Sheets........................................... F-2
Consolidated Statements of Operations................................. F-3
Consolidated Statements of Stockholders' Equity....................... F-4
Consolidated Statements of Cash Flows................................. F-5
Notes to Consolidated Financial Statements............................ F-6
Schedule
Schedule II - Valuation and Qualifying Accounts....................... S-1
46
Report of Ernst & Young LLP, Independent Auditors
The Board of Directors and Stockholders
PMR Corporation
We have audited the accompanying consolidated balance sheets of PMR Corporation
and subsidiaries as of April 30, 1999 and 1998, and the related consolidated
statements of operations, stockholders' equity and cash flows for each of the
three years in the period ended April 30, 1999. Our audits also included the
financial statement schedule listed in the index at item 14(a). These financial
statements are the responsibility of the Company's management. Our
responsibility is to express an opinion on these financial statements based on
our audits.
We conducted our audits in accordance with generally accepted auditing
standards. Those standards require that we plan and perform the audit to obtain
reasonable assurance about whether the financial statements are free of material
misstatement. An audit includes examining, on a test basis, evidence supporting
the amounts and disclosures in the financial statements. An audit also includes
assessing the accounting principles used and significant estimates made by
management, as well as evaluating the overall financial statement presentation.
We believe that our audits provide a reasonable basis for our opinion.
In our opinion, the financial statements referred to above present fairly, in
all material respects, the consolidated financial position of PMR Corporation
and subsidiaries at April 30, 1999 and 1998, and the consolidated results of its
operations and its cash flows for each of the three years in the period ended
April 30, 1999, in conformity with generally accepted accounting principles.
Also, in our opinion, the related financial statement schedule, when considered
in relation to the basic financial statements taken as a whole, presents fairly
in all material respect the information set forth therein.
As discussed in Note 1 to the financial statements, in 1999 the Company changed
its method of accounting for start-up and organizational costs.
San Diego, California
June 18, 1999
F-1
47
PMR Corporation
Consolidated Balance Sheets
APRIL 30,
----------------------------
1999 1998
----------------------------
ASSETS
Current assets:
Cash and cash equivalents $ 5,441,012 $ 18,522,859
Short-term investments, available for sale 27,509,554 20,257,045
Accounts receivable, net of allowance for uncollectible
amounts of $10,664,000 in 1999 and $8,182,000 in 1998 20,002,894 16,655,759
Prepaid expenses and other current assets 1,787,859 1,192,144
Income taxes receivable 2,212,815 --
Deferred income tax benefit 4,653,000 4,136,000
----------------------------
Total current assets 61,607,134 60,763,807
Furniture and office equipment, net of accumulated
depreciation of $1,532,000 in 1999 and $1,727,000 in
1998 2,863,934 3,492,449
Long-term receivables, net of allowance for uncollectible
amounts of $4,087,000 in 1999 and $900,000 in 1998 4,742,329 2,976,918
Deferred income tax benefit 1,206,000 2,080,000
Other assets 546,621 1,135,880
----------------------------
Total assets $ 70,966,018 $ 70,449,054
============================
LIABILITIES AND STOCKHOLDERS' EQUITY
Current liabilities:
Accounts payable $ 1,539,327 $ 469,462
Accrued expenses 1,852,335 2,974,400
Accrued compensation and employee benefits 2,083,082 2,178,693
Advances from case management agencies 846,353 1,686,477
Income taxes payable -- 1,304,353
Payable to related party 3,052,610 --
----------------------------
Total current liabilities 9,373,707 8,613,385
Note payable 294,073 392,024
Deferred rent expense 53,438 87,566
Contract settlement reserve 6,672,727 7,479,993
Minority Interest 1,921,057 --
Commitments
Stockholders' equity:
Convertible preferred stock, $.01 par value,
authorized shares - 1,000,000; issued and
outstanding shares - none in 1999 and 1998 -- --
Common stock, $.01 par value, authorized shares -
19,000,000; issued and outstanding shares - 6,988,878
in 1999 and 6,949,650 in 1998 69,889 69,496
Additional paid-in capital 48,123,385 47,959,557
Retained earnings 5,400,242 5,847,033
Treasury stock, 140,000 shares of common stock at cost (942,500) --
----------------------------
Total stockholders' equity 52,651,016 53,876,086
----------------------------
$ 70,966,018 $ 70,449,054
============================
See accompanying notes.
F-2
48
PMR Corporation
Consolidated Statements of Operations
YEAR ENDED APRIL 30,
--------------------------------------------
1999 1998 1997
--------------------------------------------
Revenue - psychiatric care $ 55,822,568 $ 67,523,950 $ 56,636,902
Revenue - pharmaceuticals 29,666,887 -- --
--------------------------------------------
Total revenue 85,489,455 67,523,950 56,636,902
Costs and expenses:
Direct operating expenses - psychiatric care 38,574,192 48,255,459 41,738,298
Cost of sales - pharmaceuticals 21,969,451 -- --
Direct operating expenses - pharmaceuticals 4,162,558 -- --
Marketing, general and administrative 12,305,721 9,186,401 6,034,960
Provision for bad debts 8,051,576 5,148,580 3,084,166
Depreciation and amortization 1,116,769 1,064,873 700,734
Write-off of costs related to terminated 1,612,240 -- --
acquisition
Special charge (credit) (262,408) 2,022,889 --
Net interest income (1,610,242) (1,186,637) (217,297)
--------------------------------------------
85,919,857 64,491,565 51,340,861
Income (loss) before minority interest, income
taxes and cumulative change (430,402) 3,032,385 5,296,041
Minority interest 676,729 -- --
--------------------------------------------
Income before income taxes and cumulative change 246,327 3,032,385 5,296,041
Income tax expense 100,429 1,244,000 2,172,000
--------------------------------------------
Net income before cumulative change 145,898 1,788,385 3,124,041
Cumulative change, net of income tax benefit (592,689) -- --
--------------------------------------------
Net income (loss) (446,791) 1,788,385 3,124,041
--------------------------------------------
Less dividends on:
Series C convertible preferred stock -- -- 17,342
--------------------------------------------
Net income (loss) available to common
shareholders $ (446,791) $ 1,788,385 $ 3,106,699
============================================
Earnings (loss) per common share before cumulative change:
Basic $ .02 $ .30 $ .66
============================================
Diluted $ .02 $ .27 $ .55
============================================
Earnings (loss) per common share:
Basic $ (.06) $ .30 $ .66
============================================
Diluted $ (.06) $ .27 $ .55
============================================
Shares used in computing earnings (loss) per share:
Basic 6,923,916 6,053,243 4,727,124
============================================
Diluted 6,923,916 6,695,321 5,645,947
============================================
Pro forma net income and earnings per share as if
cumulative change had occurred
for all periods presented:
Pro forma net income available to common
shareholders $ 145,898 $ 1,422,152 $ 2,868,566
============================================
Pro forma earnings per share:
Basic $ .02 $ .24 $ .61
============================================
Diluted $ .02 $ .21 $ .51
============================================
See accompanying notes.
F-3
49
PMR Corporation
Consolidated Statements of Stockholders' Equity
SERIES C PREFERRED COMMON
CONVERTIBLE STOCK STOCK ADDITIONAL
------------------------------------------------ PAID-IN
SHARES AMOUNT SHARES AMOUNT CAPITAL
---------------------------------------------------------------
Balance at April 30, 1996 700,000 $ 7,000 3,577,917 $35,778 $ 8,259,243
Issuance of common stock under
stock option plans including
realization of income tax
benefit of $369,000 -- -- 96,016 960 729,189
Dividend payable on Series C
preferred stock -- -- -- -- --
Proceeds from payment of
stockholder notes -- -- -- -- --
Exercise of warrants to
purchase common stock -- -- 657,524 6,575 3,104,801
Issuance of common stock for
consulting services -- -- 2,050 21 45,336
Conversion of Series C
convertible preferred stock (700,000) (7,000) 700,000 7,000 --
Net income -- -- -- -- --
---------------------------------------------------------------
Balance at April 30, 1997 -- -- 5,033,507 50,334 12,138,569
Issuance of common stock under
stock option plans including
realization of income tax
benefit of $1,687,355 -- -- 226,143 2,262 2,717,694
Issuance of common stock in
follow-on offering, net of
offering costs of $637,556 -- -- 1,690,000 16,900 33,103,294
Net income -- -- -- -- --
---------------------------------------------------------------
Balance at April 30, 1998 -- -- 6,949,650 69,496 47,959,557
Issuance of common stock under
stock option plans -- -- 37,228 373 148,598
Issuance of common stock for
compensation -- -- 2,000 20 15,230
Acquisition of treasury stock
at cost -- -- -- -- --
Net loss -- -- -- -- --
===============================================================
Balance at April 30, 1999 -- $ -- 6,988,878 $69,889 $48,123,385
===============================================================
NOTES
RECEIVABLE TOTAL
FROM RETAINED TREASURY STOCKHOLDERS'
STOCKHOLDERS EARNINGS STOCK EQUITY
-----------------------------------------------------------
Balance at April 30, 1996 $(141,547) $ 951,949 $ -- $ 9,112,423
Issuance of common stock under
stock option plans including
realization of income tax
benefit of $369,000 -- -- -- 730,149
Dividend payable on Series C
preferred stock -- (17,342) -- (17,342)
Proceeds from payment of
stockholder notes 141,547 -- -- 141,547
Exercise of warrants to
purchase common stock -- -- -- 3,111,376
Issuance of common stock for
consulting services -- -- -- 45,357
Conversion of Series C
convertible preferred stock -- -- -- --
Net income -- 3,124,041 -- 3,124,041
-----------------------------------------------------------
Balance at April 30, 1997 -- 4,058,648 -- 16,247,551
Issuance of common stock under
stock option plans including
realization of income tax
benefit of $1,687,355 -- -- -- 2,719,956
Issuance of common stock in
follow-on offering, net of
offering costs of $637,556 -- -- -- 33,120,194
Net income -- 1,788,385 -- 1,788,385
-----------------------------------------------------------
Balance at April 30, 1998 -- 5,847,033 -- 53,876,086
Issuance of common stock under
stock option plans -- -- -- 148,971
Issuance of common stock for
compensation -- -- -- 15,250
Acquisition of treasury stock
at cost -- -- (942,500) (942,500)
Net loss -- (446,791) -- (446,791)
===========================================================
Balance at April 30, 1999 $ -- $ 5,400,242 $(942,500) $ 52,651,016
===========================================================
See accompanying notes.
F-4
50
PMR Corporation
Consolidated Statements of Cash Flows
YEARS ENDED APRIL 30,
1999 1998 1997
----------------------------------------------
OPERATING ACTIVITIES
Net income (loss) $ (446,791) $ 1,788,385 $ 3,124,041
Adjustments to reconcile net income to net cash
provided by (used in) operating activities:
Write-off of costs related to terminated
acquisition 1,612,240 -- --
Special charge (credit) (262,408) 2,022,889 --
Depreciation and amortization 1,116,769 1,064,873 700,734
Issuance of stock for consulting services -- -- 45,357
Provision for bad debts 8,051,576 5,148,580 3,084,166
Cumulative effect of change in accounting
principle 592,689 -- --
Loss applicable to minority interest (676,729) -- --
Deferred income taxes 357,000 (782,000) (3,834,000)
Changes in operating assets and liabilities:
Accounts and notes receivable (13,164,122) (11,151,423) (4,980,050)
Prepaid expenses and other assets (364,550) (620,008) (250,630)
Accounts payable and accrued expenses (1,820,782) (404,697) 212,937
Accrued compensation and employee benefits (95,611) (773,174) 675,058
Advances from case management agencies (840,124) 759,765 (86,135)
Payable to related party 3,052,610 -- --
Other liabilities -- -- (127,213)
Contract settlement reserve (807,266) (1,311,935) 3,292,908
Income taxes receivable/payable (3,105,300) 1,288,715 1,394,511
Deferred rent expense (34,128) (5,256) (56,709)
----------------------------------------------
Net cash (used in) provided by operating activities (6,834,927) (2,975,286) 3,194,975
INVESTING ACTIVITIES
Proceeds from the sale and maturity of short term
investments 24,159,504 -- --
Purchases of short-term investments (31,412,013) (20,257,045) --
Purchases of furniture and office equipment (1,134,717) (2,927,837) (958,685)
----------------------------------------------
Net cash used in investing activities (8,387,226) (23,184,882) (958,685)
FINANCING ACTIVITIES
Proceeds from follow-on offering, net of offering
costs -- 33,120,194 --
Proceeds from sale of common stock and notes
receivable from stockholders 164,221 1,032,601 3,983,072
Investment by related party in subsidiary 2,597,786 -- --
Proceeds from note payable to bank -- 517,397 --
Payments on note payable to bank (97,951) (35,368) --
Acquisition of treasury stock (523,750) -- --
Cash dividend paid -- -- (89,081)
----------------------------------------------
Net cash provided by financing activities 2,140,306 34,634,824 3,893,991
----------------------------------------------
Net (decrease) increase in cash (13,081,847) 8,474,656 6,130,281
Cash at beginning of year 18,522,859 10,048,203 3,917,922
----------------------------------------------
Cash at end of year $ 5,441,012 $ 18,522,859 $ 10,048,203
==============================================
SUPPLEMENTAL INFORMATION:
Taxes paid $ 3,806,563 $ 1,330,725 $ 4,611,489
==============================================
Interest paid $ 396,170 $ 20,936 $ 17,612
==============================================
See accompanying notes.
F-5
51
PMR Corporation
Notes to Consolidated Financial Statements
April 30, 1999
1. ORGANIZATION AND SIGNIFICANT ACCOUNTING POLICIES
Organization, Business and Principles of Consolidation
PMR Corporation ("the Company") and its subsidiaries is a leading manager of
specialized mental health care programs and disease management services designed
to treat individuals diagnosed with a serious mental illness ("SMI"), primarily
schizophrenia and bi-polar disorder (i.e. manic-depressive illness). The Company
manages and administers the delivery of a broad range of outpatient and
community-based psychiatric services for SMI patients, consisting of intensive
outpatient programs, case management programs, chemical dependency and substance
abuse programs and a specialty pharmacy program for individuals with SMI.
The consolidated financial statements include the accounts of the Company, its
wholly-owned subsidiaries, Psychiatric Management Resources, Inc., Collaborative
Care Corporation, and Twin Town Corporation, and its majority-owned subsidiary
Stadt Solutions, LLC ("Stadt Solutions"). The Company has accounted for its
consolidation in accordance with Statement of Financial Accounting Standards No.
94, Consolidation of All Majority-Owned Subsidiaries. All intercompany balances
have been eliminated in consolidation. The Company does not consolidate any of
the organizations it manages as it does not have operating control as defined in
Emerging Issues Task Force Statement No. 97-2, Application of FASB Statement No.
94 and APB Opinion No. 16 to Physician Practice Management Entities and Certain
Other Entities with Contractual Management Arrangements (EITF 97-2).
Legislation, Regulations and Market Conditions
The Company is subject to extensive federal, state and local government
regulation relating to licensure, conduct of operations, ownership of
facilities, expansion of facilities and services and reimbursement for services.
As such, in the ordinary course of business, the Company's operations are
continuously subject to state and federal regulatory scrutiny, supervision and
control. Such regulatory scrutiny often includes inquiries, investigations,
examinations, audits, site visits and surveys, some of which may be non-routine.
The Company believes that it is in substantial compliance with applicable laws
and regulations. However, if the Company is ever found to have engaged in
improper practices, it could be subjected to civil, administrative or criminal
fines, penalties or restitutionary relief.
F-6
52
PMR Corporation
Notes to Consolidated Financial Statements (continued)
1. ORGANIZATION AND SIGNIFICANT ACCOUNTING POLICIES (CONTINUED)
Cash and Cash Equivalents
Cash and cash equivalents consist of highly liquid investments with maturities,
when acquired, of three months or less. Investments with original maturities of
three months or less that were classified as cash equivalents totaled $1,863,000
and $7,817,000 as of April 30, 1999 and 1998, respectively.
Short-Term Investments
Marketable equity securities and debt securities are classified as
available-for-sale because management has the intent and ability to sell the
securities prior to maturity for use in current operations. Available-for-sale
securities are carried at fair value, which approximates cost, with unrealized
gains and losses reported as a separate component of stockholders' equity. The
cost of debt securities in this category is adjusted for amortization of
premiums and accretion of discounts to maturity. Such amortization along with
realized gains and losses, interest and dividends are included in interest
income. The cost of securities sold is based on the specific identification
method.
Concentration of Credit Risk
The Company grants credit to contracting providers in various states without
collateral. Losses resulting from bad debts have traditionally not exceeded
management's estimates. At April 30, 1999, the Company has net current and long
term receivables aggregating $6,002,000 from two providers, each of which
comprise more than 10% of total net consolidated receivables. The Company
monitors the credit worthiness of these customers and believes the balances
outstanding, net of allowance at April 30, 1999, are fully collectible.
Through its Stadt Solutions subsidiary, the Company sells pharmaceutical
products and services to various customers and clients throughout the United
States. At April 30, 1999, no single pharmaceutical customer comprised more than
10% of total net consolidated receivables, although a substantial portion of the
pharmaceutical receivables are funded by Medicaid and other government-sponsored
healthcare programs.
Stadt Solutions obtains pharmaceutical products from one primary manufacturer
and two primary distributors. The Company believes there are alternative
manufacturers and distributors available for the supply and distribution of
their products.
F-7
53
PMR Corporation
Notes to Consolidated Financial Statements (continued)
1. ORGANIZATION AND SIGNIFICANT ACCOUNTING POLICIES (CONTINUED)
Substantially all of the Company's cash and cash equivalents is held at five
financial institutions. The Company monitors the financial status of these
institutions and does not believe the deposits are subject to a significant
degree of risk.
Use of Estimates
The preparation of financial statements in conformity with generally accepted
accounting principles requires management to make estimates and assumptions that
affect the reported amounts of assets and liabilities and related disclosures at
the date of the financial statements and the amounts of revenues and expenses
reported during the period. Actual results could differ from those estimates.
The Company's significant accounting estimates are the allowance for
uncollectible accounts and the contract settlement reserve.
Earnings Per Share
Statement of Financial Accounting Standards ("SFAS") No. 128, Earnings per
Share, requires dual presentation of basic and diluted earnings per share by
entities with complex capital structures. Basic EPS includes no dilution and is
computed by dividing net income by the weighted average number of common shares
outstanding for the period. Diluted EPS reflects the potential dilution of
securities that could share in the earnings of the entity. The Company has
calculated its earnings per share in accordance with SFAS No. 128 for all
periods presented.
F-8
54
PMR Corporation
Notes to Consolidated Financial Statements (continued)
1. ORGANIZATION AND SIGNIFICANT ACCOUNTING POLICIES (CONTINUED)
The following table sets forth the computation of basic and diluted earnings per
share:
YEARS ENDED APRIL 30,
----------------------------------------
1999 1998 1997
----------------------------------------
Numerator:
Net income (loss) available to common
stockholders $ (446,791) $1,788,385 $3,106,699
Preferred stock dividends -- -- 17,342
----------------------------------------
Net income (loss) available to common
stockholders after assumed conversion of
preferred stock $ (466,791) $1,788,385 $3,124,041
========================================
Denominator:
Weighted average shares outstanding for
basic earnings per share 6,923,916 6,053,243 4,727,124
----------------------------------------
Effects of dilutive securities:
Employee stock options -- 596,008 707,368
Warrants -- 46,070 119,825
Convertible preferred stock -- -- 91,630
----------------------------------------
Dilutive potential common shares -- 642,078 918,823
Shares used in computing diluted earnings
per common share 6,923,916 6,695,321 5,645,947
========================================
Earnings (loss) per common share, basic $ (.06) $ .30 $ .66
========================================
Earnings (loss) per common share, diluted $ (.06) $ .27 $ .55
========================================
At April 30, 1999, the Company had outstanding stock options under its stock
option plan and warrants. However, since the Company had a net loss, these
potentially dilutive securities were not included in the calculation of diluted
earnings per share as their effect was anti-dilutive.
Revenue Recognition and Contract Settlement Reserve - Psychiatric Care
The Company's outpatient psychiatric program customers are hospitals or
community mental health centers (the "providers"). Typical contractual
agreements with providers require the Company to provide, at its own expense,
specific management personnel for each program site. Revenue under these
programs is primarily derived from services provided under three types of
agreements: 1) all inclusive fee arrangements based on fee-for-service rates
(based on units of service provided) under which the Company is responsible for
substantially all direct program costs; 2) fee-for-service arrangements under
which the provider maintains responsibility for a larger extent of direct
program costs; and 3) fixed fee arrangements where the Company's fee is a fixed
monthly sum
F-9
55
PMR Corporation
Notes to Consolidated Financial Statements (continued)
1. ORGANIZATION AND SIGNIFICANT ACCOUNTING POLICIES (CONTINUED)
and the provider assumes responsibility for substantially all program costs.
Through the Outpatient Programs, the Company provides management and clinical
expertise to the providers with respect to the administration of an outpatient
program for SMI patients. Services provided under outpatient program management
contracts include specialized program design and administration from start-up
through the term of the contract. These programs managed or administered by the
Company are intended to enhance the delivery of outpatient mental health
services by introducing proprietary clinical protocols and procedures, assisting
in quality assurance and utilization review, assisting in training of personnel,
and coordinating a continuum of care for persons with serious mental illness. In
all cases, the Company provides on-site managerial or consultative personnel.
Patients served by the acute outpatient psychiatric programs are typically
covered by the Medicare program.
The Company has been retained to manage and provide the outpatient psychiatric
portion of a managed health care program funded by the State of Tennessee
("TennCare"). Under the terms of its agreements, the Company receives a monthly
case rate payment from the managed care consortium responsible for managing the
TennCare program, and is responsible for planning, coordinating and managing
psychiatric case management to residents of Tennessee who are eligible to
participate in the TennCare program using the proprietary treatment programs
developed by the Company. The Company offers its case management services
through long-term exclusive management agreements with leading independent
providers of case management services. Pursuant to those agreements, the Company
contributes its proprietary protocols and management expertise and, when
necessary, negotiates case management rates and contracts on behalf of the
Providers. The Company may also provide training, management information systems
support, and accounting and financial services. Presently, the Company has
agreements with two case management agencies in Tennessee. Revenue under this
program was approximately $10,534,000, $14,607,000 and $13,429,000 for the years
ended April 30, 1999, 1998 and 1997, respectively.
The Company also operates and manages chemical dependency rehabilitation
programs. Revenue from these programs was $1,104,000, $2,828,000 and $1,673,000
for the years ended April 30, 1999, 1998 and 1997, respectively.
The Company does not employ or bill for any services rendered by psychiatrists
or other professionals whose patients are enrolled in the programs managed by
the Company.
F-10
56
PMR Corporation
Notes to Consolidated Financial Statements (continued)
1. ORGANIZATION AND SIGNIFICANT ACCOUNTING POLICIES (CONTINUED)
Revenue under the acute outpatient psychiatric programs is recognized when
services are rendered based upon contractual arrangements with providers at the
estimated net realizable amounts. Under certain management contracts, the
Company is obligated under warranty provisions to indemnify the providers for
all or some portions of the Company's fees that may be disallowed as
reimbursable to the providers by Medicare's fiscal intermediaries. The Company
has recorded contract settlement reserves to provide for possible amounts
ultimately owed to its providers resulting from disallowance of costs by
Medicare and Medicare cost report settlement adjustments. Such reserve is
classified as a non-current liability as ultimate resolution of substantially
all of these issues is not expected to occur during fiscal 2000. Under the
provisions of the indemnification clause of the Company's management contracts,
the Company indemnified providers $3,661,000 and $634,000 for the years ended
April 30, 1998 and 1997, respectively. The Company was not required to indemnify
any providers during fiscal 1999.
Revenue - Pharmaceuticals
Through its Stadt Solutions subsidiary, the Company offers specialty
pharmaceutical services to individuals with SMI. Stadt Solutions also offers
site management and clinical information services to pharmaceutical companies,
health care providers and public sector purchasers. Stadt Solutions serves
clients through a variety of pharmacies offering the drug, Clorazil, an
anti-psychotic for schizophrenia, as well as blood monitoring services.
Stadt Solutions records pharmaceutical revenue when the product is sold to
customers at pharmacies, net of any estimated contractual allowances. A
substantial portion of the net revenue for Stadt Solutions is derived directly
from customers insured under Medicaid or other government-sponsored healthcare
programs.
Insurance
The Company carries "occurrence basis" insurance to cover general liability,
property damage and workers' compensation risks. Medical professional liability
risk is covered by a "claims made" insurance policy that provides for guaranteed
tail coverage. Loss reserves for incurred but not reported medical professional
liability claims are not material.
F-11
57
PMR Corporation
Notes to Consolidated Financial Statements (continued)
1. ORGANIZATION AND SIGNIFICANT ACCOUNTING POLICIES (CONTINUED)
Stock Options
SFAS No. 123, Accounting for Stock-Based Compensation, establishes the use of
the fair value based method of accounting for stock-based compensation
arrangements, under which compensation cost is determined using the fair value
of stock-based compensation determined as of the grant date, and is recognized
over the periods in which the related services are rendered. In accordance with
the provisions of SFAS No. 123, the Company has elected to follow Accounting
Principles Board Opinion No. 25, Accounting for Stock Issued to Employees (APB
25) and related Interpretations in accounting for its employee stock options.
Under APB 25, when the purchase price of restricted stock or the exercise price
of the Company's employee stock options equals or exceeds the fair value of the
underlying stock on the date of issuance or grant, no compensation expense is
recognized. In accordance with SFAS No. 123, the Company has presented pro forma
disclosures of net income and earnings per share as if SFAS No. 123 had been
applied.
Comprehensive Income
In 1999, the Company adopted SFAS No. 130, Reporting Comprehensive Income. SFAS
No. 130 requires that all components of comprehensive income, including net
income, be reported in the financial statements in the period in which they are
recognized. Comprehensive income is defined as the change in equity during a
period from transactions and other events and circumstances from non-owner
sources. Net income (loss) and other comprehensive income (loss), including
foreign currency translation adjustments and unrealized gains and losses on
investments, shall be reported, net of their related tax effect, to arrive at
comprehensive income (loss). Comprehensive income (loss) was not materially
different than net income (loss) for the years presented.
Change in Accounting Principal
In April 1998, the Accounting Standards Executive Committee issued Statement of
Position 98-5, Reporting on Costs of Start-Up Activities (SOP 98-5) which is
effective for fiscal years beginning after December 15, 1998. SOP 98-5 requires
costs of start-up activities and organization costs to be expensed as incurred.
In addition, all start-up costs and organization costs previously capitalized
must be written off. Initial application of SOP 98-5 is reported as the
cumulative effect of a change in accounting principle. In May 1999, the Company
incurred a charge of $593,000 representing the effect, net of income tax
benefits of $411,000 of writing off previously capitalized start-up costs.
F-12
58
PMR Corporation
Notes to Consolidated Financial Statements (continued)
2. INVESTMENTS
At April 30, 1999, the fair market value of marketable securities approximates
cost. The following is a summary of available-for-sale securities:
APRIL 30,
1999 1998
--------------------------
U.S. government securities $23,346,448 $16,752,478
U. S. corporate securities 3,663,106 2,005,187
Commercial paper 500,000 1,000,000
Certificate of deposit -- 499,380
--------------------------
Total debt securities $27,509,554 $20,257,045
==========================
At April 30, 1999, all investments contain contractual maturities of two years
or less. The balance sheet classification of available-for-sale securities is
based on management's intentions rather than actual maturity dates, therefore
classification of these securities may differ from stated maturities. As
management has the ability and intent to sell these available-for-sale
securities prior to maturity and views the portfolio as available for use in
current operations, the investments are classified as current at April 30, 1999.
3. LONG TERM RECEIVABLES
Long-term receivables at April 30, 1999 consist primarily of amounts due from
contracting Providers for which the Company has established specific payment
terms for receivable amounts which were past due or for which payment, due to
contract terms, is expected to exceed one year. Management expects to receive
payment on the long-term receivables as contract terms are met, none of which
are expected to exceed two years.
4. FURNITURE AND OFFICE EQUIPMENT
Furniture and office equipment consisted of the following at April 30:
1999 1998
---------------------------
Furniture and fixtures $ 2,796,010 $ 1,975,766
Leasehold improvements 1,056,145 1,133,641
Software 543,548 365,625
Start-up costs -- 1,744,457
---------------------------
4,395,703 5,219,489
Accumulated depreciation (1,531,769) (1,727,040)
---------------------------
$ 2,863,934 $ 3,492,449
===========================
F-13
59
PMR Corporation
Notes to Consolidated Financial Statements (continued)
4. FURNITURE AND OFFICE EQUIPMENT (CONTINUED)
Furniture and office equipment are stated at cost and are depreciated over their
estimated useful lives using the straight-line method over terms of three to
five years. Depreciation expense was $762,000, $710,000 and $344,000 for the
years ended April 30, 1999, 1998 and 1997, respectively.
5. OTHER ASSETS
Other assets consisted of the following at April 30:
1999 1998
---------------------------
Proprietary information and covenants not to compete $ 862,503 $ 1,118,753
Goodwill -- 978,858
Other 234,659 282,176
---------------------------
1,097,162 2,379,787
Accumulated amortization (550,541) (1,243,907)
---------------------------
$ 546,621 $ 1,135,880
===========================
Other assets are being amortized using the straight-line method over their
estimated useful lives. The estimated useful life of proprietary information and
covenants not to compete is five to ten years and goodwill is fifteen years.
Amortization expense was $355,000, $355,000 and $357,000 for the years ended
April 30, 1999, 1998 and 1997, respectively. Goodwill related to the Company's
chemical dependency programs of approximately $312,000 was written-off as a
Special Charge in 1999 related to an impairment under the provisions of SFAS No.
121, Accounting for the Impairment of Long-Lived Assets and for Long-Lived
Assets to be Disposed Of, due to the failure of this business to provide
sufficient cash flows.
See Note 14.
6. BORROWINGS
Line of Credit
The Company has a credit agreement with a bank that permits borrowings of up to
the lesser of 50% of the aggregate amount of eligible accounts receivable of the
Company or $10,000,000 for working capital needs. The credit agreement expires
on August 30, 2000 and is secured by substantially all of the Company's assets.
Interest on borrowings is payable monthly at either the Bank's reference rate or
at the Bank's Eurodollar rate plus 2%. There were no borrowings outstanding at
April 30, 1999 and 1998.
F-14
60
PMR Corporation
Notes to Consolidated Financial Statements (continued)
6. BORROWINGS (CONTINUED)
Equipment Note Payable
The Company has a promissory note for the purchase of office furniture, fixtures
and equipment. The note is secured by the assets acquired with proceeds from the
loan. The note matures in November 2002 and requires principal and interest
payments due monthly with interest accruing at 8.36%. There was $392,000 and
$482,000 outstanding under this note at April 30, 1999 and 1998, respectively.
7. STOCK OPTIONS AND WARRANTS
The Company's 1997 Equity Incentive Plan, as amended (the "1997 Plan") provides
for the granting of options to purchase up to 3,000,000 shares of common stock
to eligible employees. Under the 1997 Plan, options may be granted for terms of
up to ten years and are generally exercisable in cumulative annual increments of
20 percent each year, commencing one year after the date of grant. The 1997 Plan
also provides for the full vesting of all outstanding options under certain
change of control events. Option prices must equal or exceed the fair market
value of the common shares on the date of grant. The termination date of the
1997 Plan is October 6, 2008.
The Company has a non qualified stock option plan for its outside directors (the
"1992 Plan"). The 1992 Plan provides for the Company to grant each outside
director options to purchase 15,000 shares of the Company's common stock
annually, at the fair market value at the date of grant. Options for a maximum
of 525,000 shares may be granted under this plan. The options vest 30%
immediately and in ratable annual increments over the three year period
following the date of grant. In 1997, the board of directors amended the 1992
Plan to provide for full vesting of all outstanding options under certain change
of control events.
Warrants to purchase shares of the Company's common stock were issued in each of
the two years in the period ended April 30, 1997 to brokers in connection with
financing transactions. As of April 30, 1999, broker warrants to purchase 53,000
shares of the Company's common stock at $2.50 per share were outstanding. These
warrants expire on October 31, 1999.
Warrants to purchase shares of the Company's common stock were issued to a case
management agency in connection with a Management and Affiliation Agreement. On
September 1, 1995, the Company granted warrants to the case management agency to
purchase up to an aggregate of 550,000 shares of common stock at fair market
value over a seven year period if certain performance criteria are met. On
November 1, 1996, the
F-15
61
PMR Corporation
Notes to Consolidated Financial Statements (continued)
7. STOCK OPTIONS AND WARRANTS (CONTINUED)
Company granted additional warrants to the case management agency to purchase a
total of 30,000 shares of common stock (5,000 shares per year over six years
beginning May 1, 1997) at fair market value. As of April 30, 1999, warrants to
purchase 15,000 shares of the Company's common stock were outstanding at prices
ranging from $15.46 to $19.19. The warrants expire on September 1, 2002.
A summary of the Company's stock option and warrant activity and related
information is as follows:
WEIGHTED-AVERAGE
SHARES EXERCISE PRICE
---------------------------
Outstanding April 30, 1996 1,555,053 $ 6.63
---------
Granted 486,837 20.50
Exercised (96,016) 5.17
Forfeited (160,268) 8.44
---------
Outstanding April 30, 1997 1,785,606 14.72
Granted 105,000 19.78
Exercised (226,143) 4.42
Forfeited (60,855) 13.00
---------
Outstanding April 30, 1998 1,603,608 10.86
Granted 2,091,582 7.25
Exercised (37,230) 4.13
Forfeited (980,550) 14.90
---------
Outstanding April 30, 1999 2,677,410 $ 6.68
=========
At April 30, 1999 options and warrants to purchase approximately 1,119,000 and
68,000 shares of common stock, respectively, were exercisable and 833,149 shares
and 120,000 shares were available for future grant under 1997 Plan and the 1992
Plan, respectively. The weighted-average fair value of options granted was
$2.84, $12.37 and $15.21 in fiscal years 1999, 1998 and 1997, respectively.
F-16
62
PMR Corporation
Notes to Consolidated Financial Statements (continued)
7. STOCK OPTIONS AND WARRANTS (CONTINUED)
A summary of options outstanding and exercisable as of April 30, 1999 follows:
WEIGHTED-
WEIGHTED- AVERAGE
AVERAGE REMAINING
OPTIONS EXERCISE EXERCISE CONTRACTUAL OPTIONS WEIGHTED-AVERAGE
OUTSTANDING PRICE RANGE PRICE LIFE EXERCISABLE EXERCISE PRICE
- ------------------------------------------------------------------------------------------
156,247 $2.37-$3.50 $ 3.45 5.8 156,247 $ 3.45
476,786 $3.75-$4.75 $ 4.24 4.7 444,783 $ 4.26
1,804,526 $6.00-$8.00 $ 6.92 8.5 425,751 $ 7.07
199,045 $9.75-$11.38 $10.00 6.1 134,076 $10.02
40,806 $15.46-$23.38 $22.59 7.4 26,001 $22.42
--------- ---------
2,677,410 $2.37-$23.38 $ 6.68 7.5 1,186,858 $ 6.12
========= =========
Adjusted pro forma information regarding net income and net income per share is
required by SFAS 123, and has been determined as if the Company had accounted
for its employee stock options and stock purchase plan under the fair value
method of SFAS 123. The fair value for these options was estimated at the date
of grant using the "Black-Scholes" method for option pricing with the following
weighted-average assumptions for fiscal 1999, 1998 and 1997:
1999 1998 1997
------- ------- -------
Expected life (years) 5.0 5.0 6.0
Risk-free interest rate 4.71% 6.34% 6.5%
Annual dividend yield -- -- --
Volatility 69% 69% 88%
F-17
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PMR Corporation
Notes to Consolidated Financial Statements (continued)
7. STOCK OPTIONS AND WARRANTS (CONTINUED)
For purposes of pro forma disclosures, the estimated fair value of the options
granted is amortized to expense over the options' vesting period. The Company's
pro forma information for the years ended April 30, 1999, 1998 and 1997,
follows:
1999 1998 1997
------------- ------------- -------------
Pro forma net income (loss) $ (2,747,903) $ 354,343 $ 1,967,939
Pro forma earnings (loss) per
share, basic $ (.40) $ .06 $ .42
Pro forma earnings (loss) per
share, diluted $ (.40) $ .05 $ .35
8. INCOME TAXES
Income tax expense (benefit) consists of the following:
YEAR ENDED APRIL 30
1999 1998 1997
-------------------------------------------
Federal:
Current $ (524,000) $ 1,583,000 $ 4,868,000
Deferred 231,000 (612,000) (3,009,000)
-------------------------------------------
(293,000) 971,000 1,859,000
State:
Current (146,000) 443,000 1,138,000
Deferred 128,000 (170,000) (825,000)
-------------------------------------------
(18,000) 273,000 313,000
-------------------------------------------
$ (311,000) $ 1,244,000 $ 2,172,000
===========================================
The fiscal year 1999 income tax benefit is composed of approximately $100,000 of
income tax expense related to current operations and a $411,000 income tax
benefit relating to the cumulative effect of a change in accounting principal
(see Note 1). The cumulative effect of a change in accounting principal is
reported net of taxes in the consolidated statement of operations.
F-18
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PMR Corporation
Notes to Consolidated Financial Statements (continued)
8. INCOME TAXES (CONTINUED)
Deferred income taxes reflect the net tax effects of temporary differences
between the carrying amounts of assets and liabilities for financial reporting
purposes and the amounts used for income tax purposes.
APRIL 30,
1999 1998
-------------------------
Deferred tax assets:
Allowance for bad debts $ 4,518,000 $3,704,000
Contract settlement reserve 2,719,000 3,048,000
Other 907,000 234,000
Depreciation and amortization 725,000 254,000
Net operating loss carryforwards 494,000 --
Accrued compensation and employee benefits 362,000 405,000
Special Charge 320,000 885,000
-------------------------
Total deferred tax assets 10,045,000 8,530,000
Deferred tax liabilities:
Right to bill 3,059,000 1,401,000
Non-accrual experience method 1,127,000 913,000
-------------------------
Total deferred tax liabilities 4,186,000 2,314,000
-------------------------
Net deferred tax assets $ 5,859,000 $6,216,000
=========================
At April 30, 1999, the Company has federal and California net operating loss
carryforwards of approximately $1,281,000 and $793,000, respectively. The
federal and California tax loss carryforwards will begin expiring in 2019 and
2014, respectively, unless previously utilized.
Pursuant to Internal Revenue Code Section 382, the use of the Company's net
operating loss carryforwards may be limited if a cumulative change in ownership
of more than 50% occurs within any three year period.
A reconciliation between the federal income tax rate and the effective income
tax rate is as follows:
YEAR ENDED APRIL 30,
1999 1998 1997
--------------------------------
Statutory federal income tax rate 35% 35% 35%
State income taxes, net of federal tax 6 6 6
benefit
--------------------------------
Effective income tax rate 41% 41% 41%
--------------------------------
F-19
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PMR Corporation
Notes to Consolidated Financial Statements (continued)
9. CUSTOMERS
Approximately 30% of the Company's consolidated revenue for the year ended April
30, 1999 is derived from contracts with psychiatric care providers in the State
of California. Providers responsible for ten percent or more of the Company's
consolidated revenues at April 30, 1999 accounted for 12%, 22% and 23% of
revenue for the years ended April 30, 1999, 1998 and 1997, respectively. No
single pharmaceutical customer comprised more than 10% of the Company's total
consolidated revenue for the period ended April 30, 1999. A substantial portion
of the Company's pharmaceutical revenue is directly funded by Medicaid and other
government-sponsored healthcare programs.
10. EMPLOYEE BENEFITS
The Company maintains a tax deferred retirement plan under Section 401(k) of the
Internal Revenue Code for the benefit of all employees meeting minimum
eligibility requirements. Under the plan, each employee may defer up to 15% of
pre-tax earnings, subject to certain limitations. The Company will match 50% of
an employee's deferral to a maximum of 3% of the employee's gross salary. The
Company's matching contributions vest over a five year period.
The Company maintains a similar retirement plan for employees of the Stadt
Solutions subsidiary. Subject to minimum eligibility requirements, each employee
may defer up to 15% of pre-tax earnings, subject to certain limitations. The
Company will match 100% of an employee's deferral to a maximum of 3% of the
employee's gross salary, and 50% of an employee's deferral on the next 2% of the
employee's gross salary. The Company's matching contributions vest immediately.
The Company contributed $272,000, $265,000 and $186,000 to match employee
deferrals for the years ended April 30, 1999, 1998 and 1997, respectively.
11. RELATED PARTY
In July 1998, the Company and Stadtlander Drug Distribution Company (Stadlander)
formed Stadt Solutions to offer specialty pharmaceutical services to individuals
with SMI and also offer site management and clinical information services to
pharmaceutical companies, healthcare providers, and public sector purchasers. In
return for initial contributions of approximately $2.6 million by both the
Company and Stadtlander to fund the start-up of Stadt Solutions, the Company
received a 50.1% interest in and Stadtlander received a 49.9% interest in Stadt
Solutions. The Company consolidates the accounts of Stadt Solutions and records
a minority interest on their balance sheet for the respective ownership by
Stadtlander.
F-20
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PMR Corporation
Notes to Consolidated Financial Statements (continued)
11. RELATED PARTY (CONTINUED)
Based on the provisions of the Operating Agreement, profits and losses of Stadt
Solutions are allocated between the Company and Stadtlanders based upon their
respective proportional ownership percentages. This allocation is subject to
certain priority distributions to Stadtlander approximately equivalent to the
operating income Stadtlander expected to be generated by their contributed base
of approximately 6,000 clients. In addition, Stadt Solutions is required to
reimburse both the Company and Stadtlander for certain costs associated with the
business such as marketing, general and administrative expenses and cost of
sales related to the pharmaceutical products. Approximately $22.0 million of
costs and expenses were recorded in fiscal 1999 to Stadlander under the
Operating Agreement of which approximately $3.0 million is payable at April 30,
1999 and reflected as a related party payable in the accompanying balance sheet.
12. COMMITMENTS AND CONTINGENCIES
Leases
The Company leases its administrative facilities and certain program site
facilities under both cancelable and non-cancelable leasing arrangements.
Certain non-cancelable lease agreements call for annual rental increases based
on the consumer price index or as otherwise provided in the lease. The Company
also leases certain equipment under operating lease agreements. At April 30,
1999, future minimum lease payments for all leases with initial terms of one
year or more are $2,219,000, $1,639,000, $1,065,000, $227,000, $46,000 and
$4,000 for the years ended April 30, 2000, 2001, 2002, 2003, 2004 and
thereafter, respectively.
Rent expense totaled $2,716,000, $3,140,000 and $2,690,800 for the years ended
April 30, 1999, 1998 and 1997, respectively.
Litigation
The Company is engaged in disputes with Tennessee Behavioral Health ("TBH")
regarding certain payments made to the Company for case management services. TBH
has made a claim, based on a sample review, for approximately $4.2 million
relating to payments made to the Company for case management services. TBH
later, based on a subsequent sample review, reduced the claim to approximately
$2.3 million. On April 8, 1999, TBH sent the Company formal notice of the
dispute, triggering the dispute resolution provisions of its contract. The
Company provided a response denying liability for the claim and believes the
claim is without merit. TBH has the right to submit the dispute to binding
arbitration, which has not occurred.
F-21
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PMR Corporation
Notes to Consolidated Financial Statements (continued)
12. COMMITMENTS AND CONTINGENCIES (CONTINUED)
The Company is also a party to various legal proceedings arising in the normal
course of business. In management's opinion, the outcome of these proceedings is
not expected to have a material adverse effect on the Company's consolidated
financial position, results of operations or cash flows.
13. WRITE-OFF OF COSTS RELATED TO TERMINATED ACQUISITION
The Company wrote-off acquisition costs of $1.6 million related to a terminated
definitive merger agreement between the Company and Behavioral Health
Corporation in the second quarter of fiscal 1999.
14. SPECIAL CHARGE (CREDIT)
A summary of the special charge (credit) for the year ended April 30, 1999 is
as follows:
CMI settlement:
Return of common stock $(418,750)
Cash settlement (150,000)
Release of liabilities and other (109,542)
---------
(678,292)
Write off of goodwill 311,884
Write off of property and equipment 104,000
---------
$(262,408)
=========
The special charge (credit) relates primarily to a favorable settlement of
disputes and the restructuring of the relationship with Case Management, Inc.
("CMI"). The Company incurred a special charge relating to the closing of
several programs identified in the year ended April 30, 1998, which included a
special charge relating to CMI. During the second quarter of fiscal 1999, the
Company resolved its dispute with CMI. The ultimate outcome of the dispute
involved the return of common stock that was previously issued to CMI as part of
the consideration for a restrictive covenant, a cash settlement, and the release
of claims against the Company for certain liabilities.
The Company has reflected the return of common stock as treasury stock in the
statement of stockholders' equity at a fair market value of $418,750, at the
date of settlement. At the time of original issuance, an intangible asset for
the common stock was recorded at the fair market value of $256,250 of the stock
and was to be amortized over the term of the restrictive covenant of 72 months.
At April 30, 1998, the net book value of the intangible asset was $158,000 and
was fully reserved in the special charge. The other components of the special
charge (credit) were a cash settlement of $150,000 for accounts receivable which
were fully reserved, the release of certain liabilities relating to unemployment
taxes of $94,000, and other items of $15,542.
Additional components of the special charge (credit) include a charge of
$311,884 to write down certain goodwill and a charge of $104,000 to establish a
reserve for the write off of certain property and equipment. The charges relate
to goodwill at the Company's chemical dependency program and property and
equipment at the Company's chemical dependency program and several additional
sites (see Note 15).
A summary of the special charge for the year ended April 30, 1998 is as follows:
Site closure costs:
Estimated costs to resolve claims and
related legal costs incurred $ 720,693
Equipment and intangibles 250,651
Lease costs 167,462
Severance 97,886
Other costs 166,204
----------
1,402,896
Loss contract charge 619,993
----------
$2,022,889
==========
The special charge in 1998 resulted primarily from management's decision to
close ten program locations in the Mid-America Region, costs to be incurred in
connection with noncancelable operating commitments resulting from the HCFA
withdrawal of provider status for the Company's largest partial hospitalization
program, and costs related to the resolution of claims associated with
locations in the Company's Mid-America Region that were scheduled for closure.
The components of the impairment and exit costs resulting from closing program
locations consisted of severance, noncancelable facility lease commitments,
related legal costs, write-off of furniture and office equipment and intangible
assets, and other related costs.
F-22
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PMR Corporation
Notes to Consolidated Financial Statements (continued)
14. SPECIAL CHARGE (CREDIT) (CONTINUED)
At April 30, 1999 and 1998, accruals for special charges of approximately
$786,000 and $1,670,000, respectively, were included in accrued liabilities in
the consolidated balance sheet. An analysis of the accrual activity during 1999
is as follows:
Accrued special charges, April 30, 1998: $1,670,000
Site closure costs:
Estimated costs to resolve claims and
related legal costs (225,000)
Equipment and intangibles (251,000)
Lease costs (48,000)
Severance (57,000) (581,000)
---------
Loss contract charge (407,000)
Impairment of long term asset 104,000 (884,000)
---------
----------
ACCRUED SPECIAL CHARGES, APRIL 30, 1999: $ 786,000
==========
The components of the accrued special charges as of April 30, 1999 relate to:
Estimated costs to resolve claims and related legal costs $350,000
Lease costs 119,000
Loss contract charge 213,000
Long-term assets 104,000
---------
$786,000
=========
F-23
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PMR Corporation
Notes to Consolidated Financial Statements (continued)
14. SPECIAL CHARGE (CREDIT) (CONTINUED)
In February 1998, the Company announced that the outpatient program that it
formerly managed in Dallas, Texas was subject to a civil investigation being
conducted by the U.S. Department of Health and Human Services' Office of
Inspector General and the U.S. Attorney's office in Dallas, Texas (collectively,
the "Agencies"). The Dallas program was operational from January 1996 to
February 1998. In October 1998, the U.S. Attorney's office in Dallas, Texas
confirmed that it declined prosecution of any claims it may have against the
Company under the False Claims Act arising from Company management of the
Outpatient Program in Dallas. It is still possible, however, that the Outpatient
Program could be subject to recoupment of possible overpayments by Medicare.
Under the Company's management agreement with the Dallas program, the Company
was contractually responsible for resolving reimbursement issues and for
indemnification of certain costs incurred by the program if reimbursement was
not received for patient care provided. As of April 30, 1999, $350,000 was
included in accrued special charges.
15. SUBSEQUENT EVENTS
In May 1999, the Company repurchased 200,000 shares of its common stock at a
price of $3.75 per share, for a total of $750,000.
In May and June 1999, the Company closed five outpatient psychiatric program
locations. Plans have been implemented to close one additional site in July 1999
and two additional sites in August 1999. In accordance with the guidelines under
EITF 94-3, Liability Recognition for Certain Employee Termination Benefits and
Other Costs to Exit an Activity, the Company intends to take a charge of
approximately $500,000 related to these programs in the first quarter of fiscal
year 2000, primarily for severance and lease termination costs.
16. DISCLOSURES ABOUT REPORTABLE SEGMENTS
In accordance with the criteria of SFAS No. 131, Disclosures About Segments of
an Enterprise and Related Information, the Company determined that it operates
in three reportable segments: Outpatient Programs, Case Management Programs and
Pharmaceuticals. The Company's reportable segments are strategic business units
that offer different services to a variety of inpatient and outpatient
recipients (see Note 1).
F-24
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PMR Corporation
Notes to Consolidated Financial Statements (continued)
16. DISCLOSURES ABOUT REPORTABLE SEGMENTS (CONTINUED)
Accounting policies for segments are the same as those described in Note 1.
There are no intersegment revenues. All revenues are derived from services
performed in the United States.
Activities classified as Other in the following schedule relate primarily to
unallocated home office items and activity from the Company's chemical
dependency program. Assets for Outpatient Programs, Case Management Programs and
Pharmaceuticals consist primarily of cash, accounts receivable, furniture and
office equipment and intangible assets. The Company evaluates the performance of
each reportable segment based on income (loss) from operations before income
taxes and before the cumulative effect of a change in accounting principal.
F-25
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' PMR Corporation
Notes to Consolidated Financial Statements (continued)
16. DISCLOSURES ABOUT REPORTABLE SEGMENTS (CONTINUED)
A summary of reportable segments is as follows:
CASE
OUTPATIENT MANAGEMENT
PROGRAMS PROGRAMS PHARMACEUTICALS OTHER TOTAL
--------------------------------------------------------------------------------
1999
Revenues $ 43,662,377 $ 10,534,204 $ 29,666,887 $ 1,625,987 $ 85,489,455
Operating profit 14,603,771 1,268,794 2,275,262 (9,670,294) 8,477,533
Depreciation and
amortization 283,438 199,827 9,039 624,465 1,116,769
Acquisition expense -- -- -- 1,612,240 1,612,240
Special charge (credit) (262,408) -- -- -- (262,408)
Net interest (income)
expense -- -- (1,221) (1,609,021) (1,610,242)
Minority interest -- -- 676,729 -- 676,729
Income (loss) before
income taxes
and cumulative change 11,861,117 488,685 (679,441) (11,424,034) 246,327
Total assets 17,254,231 2,892,900 7,716,292 43,102,595 70,966,018
- ------------------------------------------------------------------------------------------------------------
1998
Revenues 49,449,846 15,133,568 -- 2,940,536 67,523,950
Operating profit 19,506,154 1,251,869 -- (10,675,933) 10,082,090
Depreciation and
amortization 502,277 143,976 -- 418,620 1,064,873
Special charge 2,022,889 -- -- -- 2,022,889
Net interest (income)
expense -- -- -- (1,186,637) (1,186,637)
Income (loss) before
income taxes 13,318,473 267,633 -- (10,553,721) 3,032,385
Total assets 19,710,939 2,634,273 -- 48,103,842 70,449,054
- ------------------------------------------------------------------------------------------------------------
1997
Revenues 40,000,000 13,690,251 -- 2,946,651 56,636,902
Operating profit (loss) 7,743,913 (561,133) -- 1,680,864 8,863,644
Depreciation and
amortization 324,070 120,650 -- 256,014 700,734
Net interest (income)
expense -- -- -- (217,297) (217,297)
Income (loss) before
income taxes 6,936,482 (44,462) -- (1,595,979) 5,296,041
Total assets 13,788,876 2,794,289 -- 15,866,373 32,449,538
- ------------------------------------------------------------------------------------------------------------
Revenues from one provider, which are included in the case management segment,
are greater than 10% of consolidated revenues for the year ended April 30, 1999
(see Note 9) and totaled approximately $10.5 million, $15.1 million, and $13.7
million for the years ended April 30, 1999, 1998 and 1997, respectively.
F-26
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Schedule II
73
Schedule II
PMR Corporation
Valuation and Qualifying Accounts
----------------------------------- -------------- -------------- --------------- ---------------
COL. A COL. B COL. C COL. D COL. E
----------------------------------- -------------- -------------- --------------- ---------------
ADDITIONS
--------------
DESCRIPTION BALANCE AT CHARGED TO BALANCE AT
BEGINNING OF COSTS AND DEDUCTIONS - END OF PERIOD
PERIOD EXPENSES DESCRIBE
----------------------------------- -------------- -------------- --------------- ---------------
Year ended April 30, 1999
Allowance for doubtful accounts $9,081,610 $8,051,576 $2,381,832(1) $14,751,354
Contract settlement reserve 7,479,993 1,983,123 2,790,389(2) 6,672,727
Year ended April 30, 1998
Allowance for doubtful accounts 5,081,177 5,148,580 1,148,147(3) 9,081,610
Contract settlement reserve 8,791,928 2,349,382 3,661,317(4) 7,479,993
Year ended April 30, 1997
Allowance for doubtful accounts 1,759,182 3,084,166 (237,829)(3) 5,081,177
Contract settlement reserve 5,499,020 3,927,371 634,463(4) 8,791,928
(1) Uncollectible accounts written off, net of recoveries and
reclassification of allowance from contractual settlement reserve
(2) Contract settlement reserve reclassified to allowance for doubtful
accounts
(3) Uncollectible accounts written off, net of recoveries
(4) Write off of hospital receivables based on disallowance of the Company's
fee on Provider's cost reimbursement report and the Company's indemnity
obligation
S-1