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UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
Form 10-Q
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þ
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QUARTERLY REPORT PURSUANT TO SECTION 13 OR 15(d) OF THE
SECURITIES EXCHANGE ACT OF 1934. |
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For the quarterly period ended March 31, 2005 |
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TRANSITION REPORT PURSUANT TO SECTION 13 OR 15(d) OF THE
SECURITIES EXCHANGE ACT OF 1934. |
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For the transition period
from to . |
Commission File Number 333-80337
Team Health, Inc.
(Exact name of registrant as specified in its charter)
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Tennessee |
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62-1562558 |
(State or other jurisdiction of
incorporation or organization) |
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(IRS Employer
Identification Number) |
1900 Winston Road
Suite 300
Knoxville, Tennessee 37919
(865) 693-1000
(Address, zip code, and telephone number, including
area code, of registrants principal executive
office.)
Indicate by check mark whether the registrant (1) has filed
all reports required to be filed by Section 13 and 15(d) of
the Securities Exchange Act of 1934 during the preceding
12 months (or for such shorter periods that the registrant
was required to file such reports), and (2) has been
subject to such filing requirements for the past 90 days.
Yes þ No o
Indicate by check mark whether the registrant is an accelerated
filer (as defined in Exchange Act Rule 12b-2)
Yes o No þ
Indicate the number of shares outstanding of each of the
registrants classes of common stock, as of the latest
practicable date.
Common Stock par value $0.01 per share
9,731,649 shares as of May 6, 2005.
FORWARD LOOKING STATEMENTS
Statements in this document that are not historical facts are
hereby identified as forward looking statements for
the purposes of the safe harbor provided by Section 21E of
the Securities Exchange Act of 1934 (the Exchange
Act) and Section 27A of the Securities Act of 1933
(the Securities Act). Team Health, Inc.
(we, us or the Company)
cautions readers that such forward looking
statements,, including without limitation, those relating
to the Companys future business prospects, revenue,
working capital, professional liability expense, liquidity,
capital needs, interest costs and income, wherever they occur in
this document or in other statements attributable to the
Company, are necessarily estimates reflecting the judgment of
the Companys senior management and involve a number of
risks and uncertainties that could cause actual results to
differ materially from those suggested by the forward
looking statements. Such forward looking
statements should, therefore, be considered in light of
the factors set forth in Item 2. Managements
Discussion and Analysis of Financial Condition and Results of
Operations.
The forward looking statements contained in this
report are made under the caption Managements
Discussion and Analysis of Financial Condition and Results of
Operations. Moreover, the Company, through its senior
management, may from time to time make forward looking
statements about matters described herein or other matters
concerning the Company.
The Company disclaims any intent or obligation to update
forward looking statements to reflect changed
assumptions, the occurrence of unanticipated events or changes
to future operating results over time.
TEAM HEALTH, INC.
QUARTERLY REPORT FOR THE THREE MONTHS
ENDED MARCH 31, 2005
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Page | |
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Part 1. Financial Information |
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Item 1.
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Financial Statements (Unaudited) |
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Consolidated Balance Sheets March 31, 2005 and
December 31, 2004 |
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2 |
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Consolidated Statements of Operations Three months
ended March 31, 2005 and 2004 |
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3 |
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Consolidated Statements of Cash Flows Three months
ended March 31, 2005 and 2004 |
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4 |
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Notes to Consolidated Financial Statements |
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5 |
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Item 2.
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Managements Discussion and Analysis of Financial Condition
and Results of Operations |
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13 |
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Item 3.
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Quantitative and Qualitative Disclosures About Market Risk |
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22 |
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Item 4.
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Controls and Procedures |
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23 |
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Part 2. Other Information |
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Item 1.
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Legal Proceedings |
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24 |
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Item 2.
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Unregistered Sales of Equity Securities and Use of Proceeds |
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24 |
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Item 3.
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Defaults Upon Senior Securities |
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24 |
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Item 4.
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Submission of Matters to a Vote of Security Holders |
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24 |
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Item 5.
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Other Information |
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24 |
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Item 6.
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Exhibits |
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24 |
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Signatures |
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25 |
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1
PART 1. FINANCIAL INFORMATION
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Item 1. |
Financial Statements |
TEAM HEALTH, INC.
CONSOLIDATED BALANCE SHEETS
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March 31, | |
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December 31, | |
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2005 | |
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2004 | |
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(Unaudited) | |
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(In thousands, except | |
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per share data) | |
ASSETS |
Current assets:
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Cash and cash equivalents
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$ |
20,734 |
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$ |
17,931 |
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Short term investments
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49,771 |
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64,651 |
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Accounts receivable, less allowance for uncollectibles of
$136,501 and $126,351 in 2005 and 2004, respectively
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175,938 |
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160,852 |
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Prepaid expenses and other current assets
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6,537 |
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4,860 |
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Receivables under insured programs
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55,917 |
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51,307 |
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Total current assets
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308,897 |
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299,601 |
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Property and equipment, net
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17,316 |
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17,625 |
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Other intangibles, net
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10,511 |
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11,624 |
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Goodwill
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100,992 |
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95,197 |
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Deferred income taxes
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96,362 |
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96,708 |
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Receivables under insured programs
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37,874 |
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52,804 |
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Other
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37,741 |
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36,832 |
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$ |
609,693 |
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$ |
610,391 |
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LIABILITIES AND STOCKHOLDERS EQUITY (DEFICIT) |
Current liabilities:
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Accounts payable
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$ |
8,436 |
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$ |
12,004 |
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Accrued compensation and physician payable
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69,884 |
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75,160 |
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Other accrued liabilities
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81,169 |
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72,988 |
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Income taxes payable
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12,492 |
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4,670 |
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Current maturities of long-term debt
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2,500 |
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15,000 |
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Deferred income taxes
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20,531 |
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20,407 |
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Total current liabilities
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195,012 |
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200,229 |
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Long-term debt, less current maturities
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410,625 |
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413,125 |
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Other non-current liabilities
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184,639 |
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195,917 |
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Common stock, $0.01 par value 12,000 shares
authorized, 9,765 shares issued at March 31, 2005 and
9,729 shares issued at December 31, 2004
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98 |
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97 |
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Additional paid in capital
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1,092 |
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919 |
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Retained earnings (deficit)
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(180,969 |
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(198,891 |
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Less treasury shares at cost
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(814 |
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(787 |
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Accumulated other comprehensive earnings (loss)
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10 |
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(218 |
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$ |
609,693 |
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$ |
610,391 |
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See accompanying notes to financial statements.
2
TEAM HEALTH, INC.
CONSOLIDATED STATEMENTS OF OPERATIONS
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Three Months Ended | |
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March 31, | |
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2005 | |
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2004 | |
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(Unaudited) | |
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(In thousands) | |
Net revenue
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$ |
398,067 |
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$ |
397,302 |
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Provision for uncollectibles
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147,476 |
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135,892 |
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Net revenue less provision for uncollectibles
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250,591 |
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261,410 |
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Cost of services rendered
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Professional service expenses
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180,327 |
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194,711 |
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Professional liability costs
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5,243 |
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16,274 |
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Gross profit
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65,021 |
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50,425 |
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General and administrative expenses
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24,889 |
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24,694 |
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Management fee and other expenses
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404 |
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157 |
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Depreciation and amortization
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3,083 |
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3,485 |
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Interest expense, net
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7,191 |
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7,318 |
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Refinancing costs
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14,731 |
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Earnings before income taxes
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29,454 |
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40 |
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Provision for income taxes
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11,532 |
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76 |
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Net earnings (loss)
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17,922 |
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(36 |
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Dividends on preferred stock
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3,602 |
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Net earnings (loss) attributable to common stockholders
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$ |
17,922 |
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$ |
(3,638 |
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See accompanying notes to financial statements.
3
TEAM HEALTH, INC.
CONSOLIDATED STATEMENTS OF CASH FLOWS
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Three Months Ended | |
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March 31, | |
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2005 | |
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2004 | |
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(Unaudited) | |
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(In thousands) | |
Operating Activities
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Net earnings (loss)
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$ |
17,922 |
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$ |
(36 |
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Adjustments to reconcile net earnings (loss):
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Depreciation and amortization
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3,083 |
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3,485 |
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Amortization of deferred financing costs
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181 |
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300 |
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Write-off of deferred financing costs
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6,225 |
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Provision for uncollectibles
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147,476 |
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135,892 |
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Deferred income taxes
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321 |
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(3,524 |
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Loss on sale of equipment
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274 |
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31 |
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Equity in joint venture income
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(561 |
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(218 |
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Changes in operating assets and liabilities, net of acquisitions:
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Accounts receivable
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(162,558 |
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(135,210 |
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Prepaids and other assets
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(1,927 |
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(5,443 |
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Income tax receivables
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7,822 |
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(6,060 |
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Receivables under insured programs
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10,320 |
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14,103 |
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Accounts payable
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(3,158 |
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3,604 |
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Accrued compensation and physician payable
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(4,928 |
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(13,226 |
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Other accrued liabilities
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3,245 |
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(2,446 |
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Professional liability reserves
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(5,696 |
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1,543 |
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Net cash provided by (used in) operating activities
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11,816 |
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(980 |
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Investing Activities
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Purchases of property and equipment
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(2,376 |
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(925 |
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Sale of property and equipment
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171 |
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Cash paid for acquisitions, net
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(5,795 |
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(1,548 |
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Net change of short-term investments
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14,867 |
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Net purchases of investments by insurance subsidiary
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(130 |
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(201 |
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Other investing activities
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72 |
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9,241 |
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Net cash provided by investing activities
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6,809 |
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6,567 |
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Financing Activities
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Payments on notes payable
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(15,000 |
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(291,165 |
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Proceeds from notes payable
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430,000 |
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Payment of deferred financing costs
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(19 |
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(7,161 |
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Proceeds from sales of common stock
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113 |
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41 |
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Purchase of treasury stock
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(916 |
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(2,609 |
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Dividends paid on common stock
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(27,585 |
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Redemptions of preferred stock
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(162,448 |
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Net cash used in financing activities
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(15,822 |
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(60,927 |
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Net increase (decrease) in cash
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2,803 |
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(55,340 |
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Cash and cash equivalents, beginning of period
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17,931 |
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100,964 |
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Cash and cash equivalents, end of period
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$ |
20,734 |
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$ |
45,624 |
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Interest paid
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$ |
3,661 |
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$ |
10,263 |
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Taxes paid
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$ |
3,437 |
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$ |
9,975 |
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See accompanying notes to financial statements.
4
TEAM HEALTH, INC.
NOTES TO CONSOLIDATED FINANCIAL STATEMENTS
(Unaudited)
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Note 1. |
Basis of Presentation |
The accompanying unaudited consolidated financial statements
include the accounts of Team Health, Inc. (the
Company) and its wholly owned subsidiaries and have
been prepared in accordance with accounting principles generally
accepted in the United States for interim financial reporting
and with the instructions to Form 10-Q and Article 10
of Regulation S-X. Accordingly, they do not include all of
the information and notes required by accounting principles
generally accepted in the United States for complete financial
statements. Certain prior year amounts have been reclassified to
conform to the current year presentation.
In the opinion of management, the accompanying unaudited
consolidated financial statements contain all adjustments
(consisting of normal recurring items) necessary for a fair
presentation of results for the interim periods presented. The
results of operations for any interim period are not necessarily
indicative of results for the full year. The consolidated
balance sheet of the Company at December 31, 2004 has been
derived from the audited financial statements at that date, but
does not include all of the information and disclosures required
by accounting principles generally accepted in the United States
for complete financial statements. These financial statements
and footnote disclosures should be read in conjunction with the
December 31, 2004 audited consolidated financial statements
and the notes thereto included in the Companys
Form 10-K.
The preparation of the financial statements in conformity with
accounting principles generally accepted in the United States
requires management to make estimates and assumptions that
affect the amounts reported in the accompanying consolidated
financial statements and notes. Actual results could differ from
those estimates.
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Note 2. |
Implementation of New Accounting Standards |
On December 16, 2004, the FASB issued
SFAS No. 123 (revised 2004), Share-Based
Payment, which is a revision of SFAS No. 123,
Accounting for Stock-Based Compensation.
SFAS No. 123(R) supersedes APB Opinion No. 25,
Accounting for Stock Issued to Employees, and amends
SFAS No. 95, Statement of Cash Flows.
Generally, the approach in SFAS No. 123(R) is similar
to the approach described in SFAS No. 123. However,
SFAS No. 123(R) requires all share-based payments to
employees, including grants of employee stock options, to be
recognized in the income statement based on their fair values.
Pro forma disclosure is no longer an alternative.
The provisions of SFAS No. 123(R) are effective for
the Company beginning January 1, 2006. Early adoption is
permitted in periods in which financial statements have not been
issued. The Company expects to adopt SFAS No. 123(R)
beginning January 1, 2006.
The Company adopted the fair-value-based method of accounting
for share-based payments effective January 1, 2003 using
the prospective method described in SFAS No. 148,
Accounting for Stock-Based Compensation
Transition and Disclosure. Currently, the Company uses the
minimum value method to estimate the value of stock options
granted to employees. In accordance with the transition
provisions of SFAS No. 123(R) the Company will
continue to account for nonvested awards outstanding at the date
of adoption of SFAS No. 123(R) in the same manner as
they had been accounted for prior to adoption for financial
statement recognition purposes. For those options that are
granted after the adoption of SFAS No. 123(R), the
Company will no longer be permitted to use the minimum-value
method and instead will be required to use an acceptable
option-pricing model. The Company has not yet determined which
specific option-pricing model it will use.
SFAS No. 123(R) also requires the benefits of tax
deductions in excess of recognized compensation cost to be
reported as a financing cash flow, rather than an operating cash
flow as required under current literature. This requirement will
reduce net operating cash flows and increase net financing cash
flows in periods after
5
TEAM HEALTH, INC.
NOTES TO CONSOLIDATED FINANCIAL
STATEMENTS (Continued)
adoption. While the Company cannot estimate what those amounts
will be in the future (because they depend on, among other
things, when employees exercise stock options), the amounts
recognized in operating cash flows for such excess tax
deductions were $6,000 and $37,000 for the three months ended
March 31, 2005 and 2004, respectively.
Net revenue for the three months ended March 31, 2005 and
2004, respectively, consisted of the following (in thousands):
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Three Months Ended | |
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March 31, | |
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2005 | |
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2004 | |
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| |
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Fee for service revenue
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$ |
309,494 |
|
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$ |
284,939 |
|
Contract revenue
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|
80,950 |
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|
105,031 |
|
Other revenue
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|
7,623 |
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|
7,332 |
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$ |
398,067 |
|
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$ |
397,302 |
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Note 4. |
Other Intangible Assets |
The following is a summary of intangible assets and related
amortization as of March 31, 2005 and December 31,
2004 (in thousands):
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Gross Carrying | |
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Accumulated | |
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Amount | |
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Amortization | |
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| |
|
| |
As of March 31, 2005:
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|
|
Contracts
|
|
$ |
31,956 |
|
|
$ |
21,662 |
|
|
Other
|
|
|
448 |
|
|
|
231 |
|
|
|
|
|
|
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|
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Total
|
|
$ |
32,404 |
|
|
$ |
21,893 |
|
|
|
|
|
|
|
|
As of December 31, 2004:
|
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|
|
|
|
|
|
|
|
Contracts
|
|
$ |
31,956 |
|
|
$ |
20,560 |
|
|
Other
|
|
|
448 |
|
|
|
220 |
|
|
|
|
|
|
|
|
|
|
Total
|
|
$ |
32,404 |
|
|
$ |
20,780 |
|
|
|
|
|
|
|
|
Aggregate amortization expense:
|
|
|
|
|
|
|
|
|
|
For the three months ended March 31, 2005
|
|
$ |
1,113 |
|
|
|
|
|
|
|
|
|
|
|
|
Estimated amortization expense:
|
|
|
|
|
|
|
|
|
|
For the year ended December 31, 2005
|
|
$ |
4,147 |
|
|
|
|
|
|
For the year ended December 31, 2006
|
|
|
2,582 |
|
|
|
|
|
|
For the year ended December 31, 2007
|
|
|
2,151 |
|
|
|
|
|
|
For the year ended December 31, 2008
|
|
|
1,798 |
|
|
|
|
|
|
For the year ended December 31, 2009
|
|
|
688 |
|
|
|
|
|
6
TEAM HEALTH, INC.
NOTES TO CONSOLIDATED FINANCIAL
STATEMENTS (Continued)
Long-term debt as of March 31, 2005, consisted of the
following (in thousands):
|
|
|
|
|
Term Loan B
|
|
$ |
233,125 |
|
9% Senior Subordinated Notes
|
|
|
180,000 |
|
|
|
|
|
|
|
|
413,125 |
|
Less current portion
|
|
|
2,500 |
|
|
|
|
|
|
|
$ |
410,625 |
|
|
|
|
|
The Companys senior credit facilities at March 31,
2005 consisted of the following:
|
|
|
|
|
$80.0 million Senior Secured Revolving Credit Facility |
|
|
|
$233.1 million Senior Secured Term Loan B |
The interest rates for any senior revolving credit facility
borrowings are determined by reference to a grid that is based
on the consolidated ratio of total funded debt to earnings
before interest, taxes, depreciation and amortization (EBITDA),
as defined in the credit agreement. The interest rate on the
Term Loan B amount outstanding is equal to the euro dollar
rate plus 3.25% or the agent banks base rate plus 2.25%.
The interest rate at March 31, 2005, was 6.56% for the Term
Loan B. The Company also pays a commitment fee for the
revolving credit facility which was equal to 0.5% of the
commitment at March 31, 2005. No funds have been borrowed
under the revolving credit facility as of March 31, 2005,
but the Company had $5.1 million of standby letters of
credit outstanding against the revolving credit facility
commitment.
The Company has an obligation under the terms of the senior
credit facility agreement to obtain and maintain interest rate
hedge agreements at amounts such that 50% of the Companys
funded debt, as defined, was at fixed rates of interest. Such
hedge agreements are required to be maintained for at least the
first three years of the senior credit facility agreement. On
April 29, 2004, the Company entered into an interest rate
swap agreement that effectively converts $35.0 million of
its variable rate term loans to a fixed rate of 3.2% through
March 31, 2007.
The Company issued on March 23, 2004, 9% Senior
Subordinated Notes in the amount of $180.0 million, due
April 1, 2012.
The senior credit facility agreement and the 9% bond indenture
contain both affirmative and negative covenants, including
limitations on the Companys ability to incur additional
indebtedness, sell material assets, retire, redeem or otherwise
reacquire its capital stock, acquire the capital stock or assets
of another business, pay dividends, and requires the Company to
meet or exceed certain coverage and leverage ratios. In
addition, the senior credit agreement includes a provision for
the prepayment of a portion of the outstanding term loan amounts
at any year-end if the Company generates excess cash
flow as defined in the agreement. During the three months
ended March 31, 2005, the Company paid $15.0 million
of its outstanding Term B loan following its initial estimation
of amounts due for 2004 under the excess cash flow provision.
The Company at March 31, 2005 determined that an additional
$0.8 million was payable under such provision. The
$0.8 million was subsequently paid on April 20, 2005.
Effective March 23, 2004, the Company completed a tender
offer for its then outstanding 12% Senior Subordinated
Notes in the amount of $100.0 million, plus a call premium
of $8.2 million and entered into its current senior credit
facilities with a group of banks. As a result of the tender
offer, approximately $91.7 million of the 12% Senior
Subordinated Notes were repaid and in addition a related call
premium of approximately $7.5 million was paid on
March 23, 2004. The remainder of the approximately
$8.3 million 12% Senior Subordinated Notes outstanding
were subsequently repaid on April 21, 2004, along with a
call
7
TEAM HEALTH, INC.
NOTES TO CONSOLIDATED FINANCIAL
STATEMENTS (Continued)
premium of approximately $0.7 million. As a result of
entering into the new senior credit facilities and the
redemption of its 12% Subordinated Notes, the Company
recognized in the three months ended March 31, 2004,
refinancing costs of approximately $14.7 million
($9.0 million, net of related income tax benefit of
$5.7 million) principally relating to the write-off of
capitalized financing costs on its previously outstanding
long-term debt and the incurrence of the call premium to redeem
the 12% Senior Subordinated Notes. In addition, as a result
of repayment of underlying borrowings during the three months
ended March 31, 2004, the Company recorded as additional
interest expense approximately $1.7 million in the three
months ended March 31, 2004, related to an interest rate
swap agreement to reflect its value on a mark-to-market basis.
The interest rate swap agreement was subsequently terminated.
Effective April 6, 2005, the Company and its lenders agreed
to an amendment of the terms of its senior credit facility. As a
result of such amendment, the following occurred or was agreed
to:
|
|
|
|
|
the Company made a voluntary prepayment of its term debt in the
amount of $30.0 million |
|
|
|
the Companys existing term loan B was converted to a
new term loan C in the amount of $203.1 million |
|
|
|
the Companys senior credit facility lenders agreed to a
reduction in the pricing for term loan borrowings to LIBOR plus
275 basis points, a reduction of 50 basis points |
|
|
|
a further reduction or increase of up to 50 basis points in
the pricing for term loan borrowings from LIBOR plus
275 basis points in the event that the credit ratings for
the Companys borrowings are increased or decreased,
respectively, and |
|
|
|
the ability of the Company to repurchase at its option up to
$35.0 million of its outstanding 9% Subordinated Bonds
so long as the Company was in compliance with the terms and
covenants of its senior credit facility agreement. |
Following the amendment of the senior credit facility effective
April 6, 2005, the Companys term debt outstanding was
$203.1 million at an interest rate of 5.85%.
Aggregate maturities of long-term debt for periods subsequent to
the amendment date of April 6, 2005 are as follows (in
thousands):
|
|
|
|
|
2005
|
|
$ |
2,500 |
|
2006
|
|
|
2,500 |
|
2007
|
|
|
2,500 |
|
2008
|
|
|
2,500 |
|
Thereafter
|
|
|
373,125 |
|
|
|
|
|
|
|
$ |
383,125 |
|
|
|
|
|
8
TEAM HEALTH, INC.
NOTES TO CONSOLIDATED FINANCIAL
STATEMENTS (Continued)
|
|
Note 6. |
Professional Liability Insurance |
The Companys professional liability loss reserves consist
of the following (in thousands):
|
|
|
|
|
|
|
|
|
|
|
|
March 31, | |
|
December 31, | |
|
|
2005 | |
|
2004 | |
|
|
| |
|
| |
Estimated losses under self-insured programs
|
|
$ |
143,241 |
|
|
$ |
138,617 |
|
Estimated losses under commercial insurance programs
|
|
|
93,791 |
|
|
|
104,111 |
|
|
|
|
|
|
|
|
|
|
|
237,032 |
|
|
|
242,728 |
|
Less estimated payable within one year
|
|
|
|
|
|
|
|
|
|
Self-insured programs
|
|
|
4,281 |
|
|
|
3,907 |
|
|
Commercial insurance programs
|
|
|
55,917 |
|
|
|
51,307 |
|
|
|
|
|
|
|
|
|
|
|
60,198 |
|
|
|
55,214 |
|
|
|
|
|
|
|
|
|
|
$ |
176,834 |
|
|
$ |
187,514 |
|
|
|
|
|
|
|
|
The Company provides for its estimated professional liability
losses through a combination of self-insurance and commercial
insurance programs. During the period March 12, 1999
through March 11, 2003, the primary source of the
Companys coverage for such risks was a professional
liability insurance policy provided through one insurance
carrier. The commercial insurance carrier policy included an
insured loss limit of $130.0 million with losses in excess
of such limit remaining as a self-insured obligation of the
Company. Beginning March 12, 2003, such risks are
principally being provided for through self-insurance with a
portion of such risks (claims-made basis)
transferred to and funded into a captive insurance company. The
accounts of the captive insurance company are fully consolidated
with those of the other operations of the Company in the
accompanying financial statements.
The self-insurance components of our risk management program
include reserves for future claims incurred but not reported.
The Companys provisions for losses under its
self-insurance components are estimated using the results of
periodic actuarial studies performed by an independent actuarial
firm. Such actuarial studies include numerous underlying
estimates and assumptions, including assumptions as to future
claim losses, the severity and frequency of such projected
losses, loss development factors and others. The Companys
provisions for losses under its self-insured components are
subject to subsequent adjustment should future actuarial
projected results for such periods indicate projected losses are
greater or less than previously projected.
The Companys most recent actuarial valuation was completed
in April 2005. As a result of such actuarial valuation, the
Company realized a reduction in its provision for professional
liability losses of $7.6 million in the three months ended
March 31, 2005, related to its reserves for losses in prior
years. The Company had previously realized a $1.6 million
reduction in its professional liability loss liability in the
three months ended March 31, 2004, resulting from an
actuarial study completed in April 2004.
|
|
Note 7. |
Redemption of 10% Cumulative Preferred Stock |
During 2004, the Board of Directors of the Company authorized
the redemption of the Companys 10% Cumulative Preferred
Stock. On March 23, 2004, the Company redeemed its 10%
Cumulative Preferred Stock in the amount of approximately
$162.4 million, including accrued dividends.
|
|
Note 8. |
Common Stock Dividend and Related Compensatory Bonus
Payment |
The Companys Board of Directors declared a cash dividend
to shareholders of record as of March 18, 2004, in the
amount of approximately $27.6 million which was
subsequently paid on March 23, 2004. The
9
TEAM HEALTH, INC.
NOTES TO CONSOLIDATED FINANCIAL
STATEMENTS (Continued)
Board of Directors also authorized a compensatory payment to
holders of stock options in lieu of a cash dividend in the
amount of approximately $2.4 million of which
$1.3 million was paid and expensed on March 23, 2004.
The balance of such compensatory payment is being expensed and
paid as such stock options subsequently vest.
Effective January 1, 2003, the Company adopted the fair
value recognition provisions of SFAS No. 123,
Accounting for Stock-Based Compensation, prospectively to
all new awards granted to employees after January 1, 2003.
Prior to January 1, 2003 the Company applied the
recognition and measurement provisions of APB Opinion
No. 25, Accounting for Stock Issued to Employees,
and related Interpretations in accounting for options awarded.
Therefore, the expense related to stock-based employee
compensation included in the determination of net earnings
(loss) for the three months ended March 31, 2005 and 2004
is less than that which would have been recognized if the fair
value method had been applied to all awards. The following table
illustrates the effect on net earnings (loss) if the fair value
method had been applied to all outstanding and unvested awards
in each period (in thousands):
|
|
|
|
|
|
|
|
|
|
|
Three Months Ended | |
|
|
March 31, | |
|
|
| |
|
|
2005 | |
|
2004 | |
|
|
| |
|
| |
Net earnings (loss) attributable to common stockholders, as
reported
|
|
$ |
17,922 |
|
|
$ |
(3,638 |
) |
Add: Stock-based employee compensation expense included in
reported net earnings (loss) attributable to common
stockholders, net of related tax effects
|
|
|
36 |
|
|
|
8 |
|
Deduct: Total stock-based employee compensation expense
determined under the fair value method for all awards, net of
related tax effects
|
|
|
(63 |
) |
|
|
(39 |
) |
|
|
|
|
|
|
|
Pro forma net earnings (loss) attributable to common stockholders
|
|
$ |
17,895 |
|
|
$ |
(3,669 |
) |
|
|
|
|
|
|
|
Litigation
We are party to various pending legal actions arising in the
ordinary operation of our business such as contractual disputes,
employment disputes and general business actions as well as
professional liability actions. We believe that any payment of
damages resulting from these types of lawsuits would be covered
by insurance, exclusive of deductibles, would not be in excess
of related reserves, and such liabilities, if incurred, should
not have a significant negative effect on the results of
operations and financial condition of our Company.
Indemnity
In connection with the acquisition of a company that specializes
in providing medical staff providers to military treatment
facilities on May 1, 2002, subject to certain limitations,
the previous shareholders of such company and its related
entities have indemnified the Company up to a limit of
$10.0 million relating to any potential claims asserted
against the acquired company during the three years subsequent
to the date of its acquisition related to tax matters whose
origin was attributable to tax periods prior to May 1, 2002.
Healthcare Regulatory Matters
Laws and regulations governing the Medicare and Medicaid
programs are complex and subject to interpretation. Compliance
with such laws and regulations can be subject to future
governmental review and interpretation as well as significant
regulatory action. From time to time, governmental regulatory
agencies
10
TEAM HEALTH, INC.
NOTES TO CONSOLIDATED FINANCIAL
STATEMENTS (Continued)
will conduct inquiries and audits of the Companys
practices. It is the Companys current practice and future
intent to cooperate fully with such inquiries.
In addition to laws and regulations governing the Medicare and
Medicaid programs, there are a number of federal and state laws
and regulations governing such matters as the corporate practice
of medicine and fee splitting arrangements, anti-kickback
statutes, physician self-referral laws, false or fraudulent
claims filing and patient privacy requirements. The failure to
comply with any of such laws or regulations could have an
adverse impact on our operations and financial results. It is
managements belief that the Company is in substantial
compliance in all material respects with such laws and
regulations.
Acquisition Payments
As of March 31, 2005, the Company may have to pay up to
$3.0 million in future contingent payments as additional
consideration for acquisitions made prior to March 31,
2005. These payments will be made and recorded as additional
purchase price should the acquired operations achieve the
financial targets agreed to in the respective acquisition
agreements. During the three months ended March 31, 2005,
the Company made required payments of $5.8 million under
contingent payment provisions of agreements related to previous
acquisitions.
Office of Inspector General Information Request
On March 30, 2004, the Company received a subpoena from the
Department of HHS Office of Inspector General (OIG),
located in Concord, California, requesting certain information
for the period 1999 to present relating to its billing
practices. To date, the Company has produced and delivered to
the OIG certain requested information, and the OIG has stayed
further requests. The Company has learned in conversations with
representatives of the OIG and the United States Attorney for
the Northern District of California, the basis for the issuance
of the subpoena is a complaint filed in the United States
District Court for the Northern District of California
(Court) by an individual on behalf of the
government. The identity of the qui tam relator and portions of
the qui tam complaint remain sealed by the Court pending the
governments investigation. The portions of the complaint
not under seal allege that the Company engaged in certain
billing practices that resulted in the Companys receipt of
duplicate payments for the same medical service and that the
Company misled certain providers about the entities that were
performing their billing services. Additionally, the portions of
the complaint not under seal allege that the Company terminated
the employment of the individual who filed the complaint in
retaliation for that individuals bringing of these
allegations to the attention of the Company. The Company denies
these allegations and does not believe that any of its current
or prior billing practices would form the basis for a violation
of federal law.
The Company is fully cooperating with the OIG in its request
described herein and have been producing and delivering to the
OIG the requested documents. However, due to lack of more
specific information available to it at this time, it is unable
to ascertain the full scope of the governments inquiry or
the qui tam relators complaint. Management cannot predict
the outcome of this investigation or suit or their respective
durations. If this investigation results in current or prior
billing practices being identified as violative of applicable
laws or regulations, results in penalties being imposed upon the
Company, or results in an adverse determination in the qui tam
relators complaint against it, the impact could have a
material adverse effect on the Companys business and
financial condition.
11
TEAM HEALTH, INC.
NOTES TO CONSOLIDATED FINANCIAL
STATEMENTS (Continued)
|
|
Note 11. |
Comprehensive Earnings |
The components of comprehensive earnings (loss), net of related
taxes, are as follows (in thousands):
|
|
|
|
|
|
|
|
|
|
|
Three Months Ended | |
|
|
March 31, | |
|
|
| |
|
|
2005 | |
|
2004 | |
|
|
| |
|
| |
Net earnings (loss) attributable to common shareholders
|
|
$ |
17,922 |
|
|
$ |
(3,638 |
) |
Net change in fair market value of investments
|
|
|
(130 |
) |
|
|
|
|
Net change in fair value of interest rate swaps
|
|
|
358 |
|
|
|
1,149 |
|
|
|
|
|
|
|
|
Comprehensive earnings (loss)
|
|
$ |
18,150 |
|
|
$ |
(2,489 |
) |
|
|
|
|
|
|
|
|
|
Note 12. |
Segment Reporting |
The Company provides its services through five operating
segments which are aggregated into two reportable segments,
Healthcare Services and Management Services. The Healthcare
Services segment, which is an aggregation of healthcare
staffing, clinics, and occupation health, provides comprehensive
healthcare service programs to users and providers of healthcare
services on a fee-for-service as well as a cost plus basis. The
Management Services segment, which consists of medical group
management services and external billing and collection
services, provides a range of management and billing services on
a fee basis. These services include strategic management,
management information systems, third-party payer contracting,
financial and accounting support, benefits administration and
risk management, scheduling support, operations management and
quality improvement services.
Segment amounts disclosed are prior to any elimination entries
made in consolidation, except in the case of net revenue, where
intercompany charges have been eliminated. Certain expenses are
not allocated to the segments. These unallocated expenses are
corporate expenses, net interest expense, depreciation and
amortization, refinancing costs and income taxes. The Company
evaluates segment performance based on profit and loss before
the aforementioned expenses.
The following table presents financial information for each
reportable segment. Depreciation, amortization, impairment of
intangibles, management fee and other expenses separately
identified in the consolidated statements of operations are
included as a reduction to the operating earnings of each
segment in each period below (in thousands):
|
|
|
|
|
|
|
|
|
|
|
|
Three Months Ended | |
|
|
March 31, | |
|
|
| |
|
|
2005 | |
|
2004 | |
|
|
| |
|
| |
Net Revenue less provision for uncollectibles:
|
|
|
|
|
|
|
|
|
|
Healthcare Services
|
|
$ |
245,097 |
|
|
$ |
257,312 |
|
|
Management Services
|
|
|
5,494 |
|
|
|
4,098 |
|
|
|
|
|
|
|
|
|
|
$ |
250,591 |
|
|
$ |
261,410 |
|
|
|
|
|
|
|
|
Operating earnings:
|
|
|
|
|
|
|
|
|
|
Healthcare Services
|
|
$ |
44,390 |
|
|
$ |
30,608 |
|
|
Management Services
|
|
|
806 |
|
|
|
349 |
|
|
General Corporate
|
|
|
(8,550 |
) |
|
|
(8,868 |
) |
|
|
|
|
|
|
|
|
|
$ |
36,646 |
|
|
$ |
22,089 |
|
|
|
|
|
|
|
|
12
|
|
Item 2. |
Managements Discussion and Analysis of Financial
Condition and Results of Operations |
Introduction
We are a national provider of outsourced physician staffing and
administrative services to hospitals and other healthcare
providers in the United States and a provider of outsourced
physician staffing and administrative services to military
treatment facilities. In addition to providing physician
staffing, we also provide a broad array of non-physician health
care services, including specialty technical staffing,
para-professionals and nurse staffing on a permanent basis to
the military.
Our regional operating models include comprehensive programs for
emergency medicine, radiology, anesthesiology, inpatient care,
pediatrics and other health care services, principally within
hospital departments and other healthcare treatment facilities.
The following discussion provides an assessment of the
Companys results of operations, liquidity and capital
resources and should be read in conjunction with the
consolidated financial statements of the Company and notes
thereto included elsewhere in this document.
TRICARE Program
We are a provider of health care professionals that serve
military personnel and their dependents in military treatment
facilities nationwide. During 2004, the Department of Defense
made a decision to re-contract all of its outsourced health care
staffing positions. Such positions were formerly staffed through
managed care organizations, which in turn subcontracted with
staffing providers including our Company. The change made by the
military was to contract directly with health care staffing
providers by each branch of service. The re-contracting of such
services across all branches of the military was completed on
approximately November 1, 2004. Based on the results of
such re-contracting, we concluded that our revenue and operating
margins would be materially adversely affected and that a
portion of goodwill related to our military business had been
impaired. An impairment loss of $73.2 million was recorded
in 2004.
The three months ended March 31, 2005, represented the
first full quarterly period reflecting revenues under the new
contracts resulting from the militarys re-contracting
process. Our revenues derived from military health care
professionals totaled approximately $35.9 million in the
first three months of 2005 compared to approximately
$61.8 million in the same period in 2004. Revenues for the
full year 2004 totaled approximately $207.5 million,
reflecting our staffing revenues as both a subcontractor and a
direct contractor during the year.
Our net revenues and cash flow in the three months ended
March 31, 2005, have been affected as a result of the
re-contracting process. We won through competitive bidding a
number of new contracts. The staffing of such new contracts
requires locating, recruiting and hiring of new health care
staff, some of which are positions in significant demand in
todays workforce, such as nurses. Our realization of net
revenue in the initial months of certain of the new contracts
has been adversely affected by unfilled staffing positions
either due to worker shortages or due to certain positions being
prone to higher rates of turnover, leaving periods of vacancies
in such positions. Secondly, the billing process for our
military staffing services has changed following completion of
the re-contracting period. Our services are now billed directly
to the respective military treatment facilities or as a
subcontractor to a third-party direct contract holder who
requires payment from the military prior to reimbursing us. The
change in military billing practices and payment flow has caused
a slow-down in the payment cycle for our military staffing
services. The average days outstanding for our military staffing
accounts receivable totaled 107.0 days at March 31,
2005, an increase of 2.3 days from December 31, 2004.
Prior to the start of military staffing rendered under the new
contracting process, our average days outstanding for military
staffing accounts receivable was 56.1 days.
Critical Accounting Policies and Estimates
The consolidated financial statements of the Company are
prepared in accordance with accounting principles generally
accepted in the United States, which requires us to make
estimates and assumptions.
13
Management believes the following critical accounting policies,
among others, affect its more significant judgments and
estimates used in the preparation of its consolidated financial
statements.
Net Revenue. Net revenues consist of fee-for-service
revenue, contract revenue and other revenue. Net revenues are
recorded in the period services are rendered. Our net revenues
are principally derived from the provision of healthcare
staffing services to patients within healthcare facilities. The
form of billing and related risk of collection for such services
may vary by customer. The following is a summary of the
principal forms of our billing arrangements and how net revenue
is recognized for each.
A significant portion (78% and 74% of our net revenue in the
three months ended March 31, 2005 and in fiscal 2004,
respectively) resulted from fee-for-service patient visits.
Fee-for-service revenue represents revenue earned under
contracts in which we bill and collect the professional
component of charges for medical services rendered by our
contracted and employed physicians. Under the fee-for-service
arrangements, we bill patients for services provided and receive
payment from patients or their third-party payers.
Fee-for-service revenue is reported net of contractual
allowances and policy discounts. All services provided are
expected to result in cash flows and are therefore reflected as
net revenues in the financial statements. Fee-for-service
revenue is recognized in the period that the services are
rendered to specific patients and reduced immediately for the
estimated impact of contractual allowances in the case of those
patients having third-party payer coverage. The recognition of
net revenue (gross charges less contractual allowances) from
such visits is dependent on such factors as proper completion of
medical charts following a patient visit, the forwarding of such
charts to one of our billing centers for medical coding and
entering into our billing systems and the verification of each
patients submission or representation at the time services
are rendered as to the payer(s) responsible for payment of such
services. Net revenues are recorded based on the information
known at the time of entering of such information into our
billing systems as well as an estimate of the net revenues
associated with medical charts for a given service period that
have not been processed yet into our billing systems. The above
factors and estimates are subject to change. For example,
patient payer information may change following an initial
attempt to bill for services due to a change in payer status.
Such changes in payer status have an impact on recorded net
revenue due to differing payers being subject to different
contractual allowance amounts. Such changes in net revenue are
recognized in the period that such changes in payer become
known. Similarly, the actual volume of medical charts not
processed into our billing systems may be different from the
amounts estimated. Such differences in net revenue are adjusted
in the following month based on actual chart volumes processed.
Contract revenue represents revenue generated under contracts in
which we provide physician and other healthcare staffing and
administrative services in return for a contractually negotiated
fee. Contract revenue consists primarily of billings based on
hours of healthcare staffing provided at agreed to hourly rates.
Revenue in such cases is recognized as the hours are worked by
our staff. Additionally, contract revenue also includes
supplemental revenue from hospitals where we may have a
fee-for-service contract arrangement. Contract revenue for the
supplemental billing in such cases is recognized based on the
terms of each individual contract. Such contract terms generally
either provide for a fixed monthly dollar amount or a variable
amount based upon measurable monthly activity, such as hours
staffed, patient visits or collections per visit compared to a
minimum activity threshold. Such supplemental revenues based on
variable arrangements are usually contractually fixed on a
monthly, quarterly or annual calculation basis considering the
variable factors negotiated in each such arrangement. Such
supplemental revenues are recognized as revenue in the period
when such amounts are determined to be fixed and therefore
contractually obligated as payable by the customer under the
terms of the respective agreement.
Other revenue consists primarily of revenue from management and
billing services provided to outside parties. Revenue is
recognized for such services pursuant to the terms of the
contracts with customers. Generally, such contracts consist of
fixed monthly amounts with revenue recognized in the month
services are rendered or as hourly consulting fees recognized as
revenue as hours are worked in accordance with such
arrangements. Additionally, we derive a small percentage of our
revenues from providing administrative and billing services that
are contingent upon the collection of third-party physician
billings, either by us on their
14
behalf or other third-party billing companies. Such revenues are
not considered earned and therefore not recognized as revenue
until actual cash collections are achieved in accordance with
the contractual arrangements for such services.
Net Revenue Less Provision for Uncollectibles. Net
revenue less provision for uncollectibles reflects
managements estimate of billed amounts to ultimately be
collected. Management, in estimating the amounts to be collected
resulting from its over six million annual fee-for-service
patient visits and procedures, considers such factors as prior
contract collection experience, current period changes in payer
mix and patient acuity indicators, reimbursement rate trends in
governmental and private sector insurance programs, resolution
of credit balances, the estimated impact of billing system
effectiveness improvement initiatives and trends in collections
from self-pay patients. Such estimates are substantially
formulaic in nature and are calculated at the individual
contract level. The estimates are continuously updated and
adjusted if subsequent actual collection experience indicates a
change in estimate is necessary. Such provisions and any
subsequent changes in estimates may result in adjustments to our
operating results with a corresponding adjustment to our
accounts receivable allowance for uncollectibles on our balance
sheet.
Accounts Receivable. As described above and below, we
determine the estimated value of our accounts receivable based
on estimated cash collection run rates of estimated future
collections by contract for patient visits under our
fee-for-service contract revenue. Accordingly, we are unable to
report the payer mix composition on a dollar basis of our
outstanding net accounts receivable. Our days revenue
outstanding at March 31, 2005, was 64.7 days and at
December 31, 2004, was 63.3 days. The number of days
outstanding will fluctuate over time due to a number of factors.
The increase in average days revenue of approximately
1.4 days includes 1.0 day due to a longer billing
cycle related to the impact of new military staffing contracts
resulting from new billing routines with military facilities.
Fee-for-service accounts receivable includes an estimated
increase of $2.9 million or 1.1 average days outstanding
due to an increase in dollars related to physicians being
re-credentialed by payers. The re-credentialing process was
initiated by us and is intended to result in cost savings to us
in the form of lower bank fees and related billing and
collection costs. The impact of these increases was partially
offset by various other factors. Our allowance for doubtful
accounts totaled $136.5 million as of March 31, 2005.
Approximately 98% of our allowance for doubtful accounts is
related to gross fees for fee- for-service patient visits. Our
principal exposure for uncollectible fee-for-service visits is
centered in self pay patients and, to a lesser extent, for
co-payments and deductibles from patients with insurance. While
we do not specifically allocate the allowance for doubtful
accounts to individual accounts or specific payer
classifications, the portion of the allowance associated with
fee-for-service charges as of March 31, 2005, was
approximately 98% of self-pay accounts outstanding as
fee-for-service patient visits at March 31, 2005. Primary
responsibility for collection of fee-for-service accounts
receivable resides within our internal billing operations. Once
a claim has been submitted to a payer or an individual patient,
employees within our billing operations have responsibility for
the follow up collection efforts. The protocol for follow up
differs by payer classification. For self pay patients, our
billing system will automatically send a series of dunning
letters on a prescribed time frame requesting payment or the
provision of information reflecting that the balance due is
covered by another payer, such as Medicare or a third-party
insurance plan. Generally, the dunning cycle on a self pay
account will run from 90 to 120 days. At the end of this
period, if no collections or additional information is obtained
from the patient, the account is no longer considered an active
account and is transferred to a collection agency. Upon transfer
to a collection agency, the patient account is written-off as a
bad debt. Any subsequent cash receipts on accounts previously
written off are recorded as a recovery. For non-self pay
accounts, billing personnel will follow up and respond to any
communication from payers such as requests for additional
information or denials until collection of the account is
obtained or other resolution has occurred. For contract accounts
receivable, invoices for services are prepared in the various
operating areas of the Company and mailed to our customers,
generally on a monthly basis. Contract terms under such
arrangements generally require payment within thirty days of
receipt of the invoice. Outstanding invoices are periodically
reviewed and operations personnel with responsibility for the
customer relationship will contact the customer to follow up on
any delinquent invoices. Contract accounts receivable will be
considered as bad debt and written-off based upon the individual
circumstances of the customer situation after all collection
efforts have been exhausted, including legal action if
warranted, and it is the judgment of management that the account
is not expected to be collected.
15
Methodology for Computing Allowance for Doubtful
Accounts. We employ several methodologies for determining
our allowance for doubtful accounts depending on the nature of
the net revenue recognized. We initially determine gross revenue
for our fee-for-service patient visits based upon established
fee schedule prices. Such gross revenue is reduced for estimated
contractual allowances for those patient visits covered by
contractual insurance arrangements to result in net revenue. Net
revenue is then reduced for our estimate of uncollectible
amounts. Fee-for-service net revenue less provision for
uncollectibles represents our estimated cash to be collected
from such patient visits and is net of our estimate of account
balances estimated to be uncollectible. The provision for
uncollectible fee-for-service patient visits is based on
historical experience resulting from the over six million annual
patient visits. The significant volume of annual patient visits
and the terms of thousands of commercial and managed care
contracts and the various reimbursement policies relating to
governmental healthcare programs do not make it feasible to
evaluate fee-for-service accounts receivable on a specific
account basis. Fee-for-service accounts receivable collection
estimates are reviewed on a quarterly basis for each of our
fee-for-service contracts by period of accounts receivable
origination. Such reviews include the use of historical cash
collection percentages by contract adjusted for the lapse of
time since the date of the patient visit. In addition, when
actual collection percentages differ from expected results, on a
contract by contract basis supplemental detailed reviews of the
outstanding accounts receivable balances may be performed by our
billing operations to determine whether there are facts and
circumstances existing that may cause a different conclusion as
to the estimate of the collectibility of that contracts
accounts receivable from the estimate resulting from using the
historical collection experience. Facts and circumstances that
may result in an adjustment to the formulaic result are
generally few and are usually related to third-party payer
processing problems that are temporary in nature. Contract
related net revenues are billed based on the terms of the
contract at amounts expected to be collected. Such billings are
typically submitted on a monthly basis and aged trial balances
prepared. Allowances for estimated uncollectible amounts related
to such contract billings are made based upon specific accounts
and invoice periodic reviews once it is concluded that such
amounts are not likely to be collected. The methodologies
employed to compute allowances for doubtful accounts were
unchanged between 2005 and 2004.
Insurance Reserves. The nature of our business is such
that it is subject to professional liability lawsuits.
Historically, to mitigate a portion of this risk, we have
maintained insurance for individual professional liability
claims with per incident and annual aggregate limits per
physician for all incidents. Prior to March 12, 2003, we
obtained such insurance coverage from a commercial insurance
provider. Professional liability lawsuits are routinely reviewed
by our insurance carrier and management for purposes of
establishing ultimate loss estimates. Provisions for estimated
losses in excess of insurance limits have been provided at the
time such determinations are made. In addition, where as a
condition of a professional liability insurance policy the
policy includes a self-insured risk retention layer of coverage,
we have recorded a provision for estimated losses likely to be
incurred during such periods and within such limits based on our
past loss experience following consultation with our outside
insurance experts and claims managers.
Subsequent to March 11, 2003, we have provided for a
significant portion of our professional liability loss exposures
through the use of a captive insurance company and through
greater utilization of self-insurance reserves. Accordingly,
beginning on March 12, 2003, a substantial portion of our
provision for professional liability losses is based on periodic
actuarial estimates of such losses for periods subsequent to
March 11, 2003. An independent actuary firm is responsible
for preparation of the periodic actuarial studies.
Managements estimate of our professional liability costs
resulting from such actuarial studies is significantly
influenced by assumptions, which are limited by the uncertainty
of predicting future events, and assessments regarding
expectations of several factors. These factors include, but are
not limited to: the frequency and severity of claims, which can
differ significantly by jurisdiction; coverage limits of
third-party insurance; the effectiveness of our claims
management process; and the outcome of litigation.
Our commercial insurance policy for professional liability
losses for the period March 12, 1999 through March 11,
2003, included insured limits applicable to such coverage in the
period. In March 2003 we had an actuarial projection made of our
potential exposure for losses under the provisions of our
commercial insurance policy that ended March 11, 2003. The
results of that actuarial study indicated that we would incur a
loss for claim losses and expenses in excess of the
$130.0 million aggregate limit. Accordingly, we recorded a
16
loss estimate, discounted at 4%, of $50.8 million in our
statement of operations in 2003. Based on the results of an
annual actuarial study completed in April 2005, the updated
estimated loss discounted at 4% for claim losses and expenses in
excess of the $130.0 million aggregated limit was
$50.1 million as of March 31, 2005.
The payment of any losses realized by us under the aggregate
loss provision discussed above will only be after our previous
commercial insurance carrier has paid such losses and expenses
up to $130.0 million for the applicable prior periods. The
pattern of payment for professional liability losses for any
incurrence year typically is as long as six years. Accordingly,
our portion of our loss exposure under the aggregate policy
feature, if realized, is not expected to result in an outflow of
cash until 2006.
Since March 12, 2003, our professional liability costs
consist of annual projected costs resulting from an actuarial
study along with the cost of certain professional liability
commercial insurance premiums and programs available to us that
remain in effect. The provisions for professional liability
costs will fluctuate as a result of several factors, including
hours of exposure as measured by hours of physician and related
professional staff services as well as actual loss development
trends.
Our provisions for losses under the aggregate loss limits of our
policy in effect prior to March 12, 2003, and under our
captive insurance and self-insurance programs since
March 12, 2003, are subject to periodic actuarial
reevaluation. The results of such periodic actuarial studies may
result in either upward or downward adjustment to our previous
loss estimates.
The accounts of the captive insurance company are fully
consolidated with those of the other operations of the Company
in the accompanying financial statements.
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Impairment of Intangible Assets |
In assessing the recoverability of the Companys
intangibles we must make assumptions regarding estimated future
cash flows and other factors to determine the fair value of the
respective assets. If these estimates or their related
assumptions change in the future, we may be required to record
impairment charges for these assets.
Our critical accounting policies have been disclosed in the 2004
Annual Report on Form 10-K. There have been no changes to
these critical accounting policies or their application during
the three months ended March 31, 2005.
17
Results of Operations
The following discussion provides an analysis of our results of
operations and should be read in conjunction with our unaudited
consolidated financial statements. The operating results of the
periods presented were not significantly affected by general
inflation in the U.S. economy. Net revenue less the
provision for uncollectibles is an estimate of future cash
collections and as such it is a key measurement by which
management evaluates performance of individual contracts as well
as the Company as a whole. The following table sets forth the
components of net earnings (loss) as a percentage of net revenue
less provision for uncollectibles for the periods indicated:
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Three Months | |
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Ended March 31, | |
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2005 | |
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2004 | |
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Net revenue less provision for uncollectibles
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100.0 |
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100.0 |
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Professional services expenses
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72.0 |
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74.5 |
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Professional liability costs
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2.1 |
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6.2 |
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Gross profit
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25.9 |
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19.3 |
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General and administrative expenses
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9.9 |
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9.4 |
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Management fee and other expenses
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0.2 |
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0.1 |
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Depreciation and amortization
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1.2 |
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1.3 |
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Interest expense, net
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2.9 |
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2.8 |
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Refinancing costs
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5.6 |
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Earnings before income taxes
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11.8 |
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Provision (benefit) from income taxes
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4.6 |
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Net earnings (loss)
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7.2 |
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Dividends on preferred stock
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1.4 |
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Net earnings (loss) attributable to common stockholders
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7.2 |
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(1.4 |
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Three Months Ended March 31, 2005 Compared to the
Three Months Ended March 31, 2004 |
Net Revenues. Net revenue for the three months ended
March 31, 2005 increased $0.8 million, or 0.2%, to
$398.1 million from $397.3 million for the three
months ended March 31, 2004. The increase in net revenues
of $0.8 million included increases of $24.6 million in
fee-for-service revenue and $0.3 million in other revenue.
Such increases were substantially offset by a decrease in
contract revenue of $24.1 million. For the three months
ended March 31, 2005, fee-for-service revenue was 77.8% of
net revenue compared to 71.7% in 2004, contract revenue was
20.3% of net revenue compared to 26.4% in 2004 and other revenue
was 1.9% in both years. The change in the mix of net revenues is
principally due to a reduction in military staffing contract
revenues between periods.
Provision for Uncollectibles. The provision for
uncollectibles was $147.5 million for the three months
ended March 31, 2005, compared to $135.9 million for
the corresponding period in 2004, an increase of
$11.6 million or 8.5%. The provision for uncollectibles as
a percentage of net revenue was 37.1% in 2005 compared with
34.2% in 2004. The provision for uncollectibles is primarily
related to revenue generated under fee-for-service contracts
that is not expected to be fully collected. Excluding the effect
of the reduction in military staffing contract net revenues
between periods, the provision for uncollectibles as a
percentage of net revenues was 40.7% in 2005 and 40.5% in 2004.
Net Revenue Less Provision for Uncollectibles. Net
revenue less provision for uncollectibles for the three months
ended March 31, 2005 decreased $10.8 million, or 4.1%,
to $250.6 million from $261.4 million for the three
months ended March 31, 2004. The $10.8 million
decrease is primarily related to a net reduction of
$25.8 million in military staffing business as a result of
the militarys re-contracting process completed during
2004. Excluding the impact of the re-contracting process, net
revenue less provision for uncollectibles increased
$15.0 million. Same contract revenues, which consist of
contracts under management in both
18
periods, increased $20.6 million, or 11.5%, to
$200.0 million in 2005 compared to $179.4 million in
2004. The increase in same contract revenue of 11.5% consists of
an increase in estimated net revenue per billing unit as well as
an increase in overall patient dollar volume between periods.
Same contract revenue increased approximately 7.8% between
periods due to higher estimated net revenue per billing unit.
Approximately 2.3% of the increase in estimated net revenue per
billing unit is due to an increase in estimated amounts to be
collected for periods prior to 2005. The remainder of the
increase between periods is principally due to rate and level of
acuity increases.
Professional Service Expense. Professional service
expense, which includes physician costs, billing and collection
expenses, and other professional expenses, totaled
$180.3 million for the three months ended March 31,
2005 compared to $194.7 million for the three months ended
March 31, 2004, a decrease of $14.4 million or 7.4%.
The decrease of $14.4 million is primarily due to the
reduction in military staffing business partially offset by
increases in other staffing areas due to higher volumes as well
as an increase in average rates paid per hour of provider
service on a same contract basis.
Professional Liability Costs. Professional liability
costs were $5.2 million for the three months ended
March 31, 2005 compared with $16.3 million for the
three months ended March 31, 2004 for a decrease of
$11.0 million or 67.8%. Professional liability expenses
includes reductions in professional liability reserves relating
to prior years resulting from actuarial studies completed in
April of each year of $7.6 million in 2005 and
$1.6 million in 2004. Also contributing to the decrease is
the lowering of coverage limits for several contracts and a
reduction in loss exposures principally resulting from the
termination of staffing contracts in higher risk territories and
specialties.
Gross Profit. Gross profit was $65.0 million in the
first quarter 2005 compared to $50.4 million for the same
period in 2004 for an increase of $14.6 million between
periods. Included in the $14.6 million increase is a
$7.6 million reduction in professional liability costs as
the result of a recent actuarial study. The remaining increase
in gross profit is attributable to higher patient volumes and
average estimated collection rates per patient encounter
increasing faster than professional expenses and billing and
collection related costs. Gross profit as a percentage of
revenue less provision for uncollectibles increased to 25.9% in
2005 compared with 19.3% in 2004. Excluding the effect of the
actuarial adjustment of $7.6 million, the gross profit
percentage was 22.9% for the three months ended March 31,
2005 compared to 19.2% for the three months ended March 31,
2004.
General and Administrative Expenses. General and
administrative expenses increased $0.2 million to
$24.9 million for the three months ended March 31,
2005 from $24.7 million for the three months ended
March 31, 2004. General and administrative expenses as a
percentage of net revenue less provision for uncollectibles were
9.9% in 2005 compared to 9.4% in 2004. Included in the
$0.2 million increase in general and administrative
expenses in 2005 is a $1.1 million increase in management
incentive plan costs as well as increases related to
inflationary growth in salaries offset by $1.3 million of
expense related to a bonus to stock option holders in 2004 in
connection with the refinancing of the Companys debt
structure and a decrease in professional consulting expenses
between periods of $0.7 million.
Management Fee and Other Operating Expenses. Management
fee and other operating expenses were $0.4 million for the
three months ended March 31, 2005 and $0.2 million for
the corresponding period in 2004.
Depreciation and Amortization. Depreciation and
amortization was $3.1 million for the three months ended
March 31, 2005 compared to $3.5 million for the three
months ended March 31, 2004. Amortization expense decreased
$0.2 million due to certain of the Companys
intangibles becoming fully amortized in 2004.
Net Interest Expense. Net interest expense decreased
$0.1 million to $7.2 million in 2005, compared to
$7.3 million in 2004. The decrease in net interest expense
includes approximately a $2.1 million decrease related to a
realized hedge instrument loss as part of a debt refinancing in
2004 and lower net interest rates between periods, partially
offset by an increase due to an increased level of net
outstanding debt between periods.
19
Refinancing Costs. The Company expensed
$14.7 million in the three months ended March 31, 2004
of deferred financing costs and bond repayment premiums related
to its previously outstanding bank and bond borrowings that were
refinanced in 2004.
Earnings before Income Taxes. Earnings before income
taxes for the three months ended March 31, 2005 were
$29.5 million compared to $40,000 for the corresponding
period in 2004.
Provision for Income Taxes. Income taxes were
$11.5 million in 2005 compared to $0.1 million in 2004.
Net Earnings (Loss). Net earnings were $17.9 million
for the three months ended March 31, 2005 compared to a net
loss of $36,000 for the three months ended March 31, 2004.
Dividends on Preferred Stock. The Company recognized
$3.6 million of dividends for the three months ended
March 31, 2004.
Liquidity and Capital Resources
Our principal ongoing uses of cash are to meet working capital
requirements, fund debt obligations and to finance our capital
expenditures and acquisitions. Funds generated from operations
during the past two years have been sufficient to meet the
aforementioned cash requirements.
During the three months ended March 31, 2005, we reduced
our outstanding bank term debt by $15.0 million. The
repayment of such debt was made through the use of available
cash in the form of liquidated marketable securities. The debt
repaid consisted of $15.0 million of prepayments required
under the terms of the underlying senior credit facility
agreement due to excess cash flow, as defined
therein, in 2004. As a result of the foregoing repayments, we
had total debt outstanding of $413.1 million as of
March 31, 2005, compared to $428.1 million as of
December 31, 2004.
Effective April 6, 2005, we and our lenders agreed to an
amendment of the terms of our senior credit facility. As a
result of such amendment, the following occurred or was agreed
to:
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we made a voluntary prepayment of our term debt in the amount of
$30.0 million |
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our existing term loan B was converted to a new term
loan C in the amount of $203.1 million |
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our senior credit facility lenders agreed to a reduction in the
pricing for term loan borrowings to LIBOR plus 275 basis
points, a reduction of 50 basis points |
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a further reduction or increase of up to 50 basis points in
the pricing for term loan borrowings from LIBOR plus
275 basis points in the event that the credit ratings for
our borrowings are increased or decreased, respectively, and |
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the ability was granted to us to repurchase at our option up to
$35.0 million of our outstanding 9% Subordinated Bonds
so long as we are in compliance with the terms and covenants of
our senior credit facility agreement. |
Cash provided by operating activities in the three months ended
March 31, 2005 was $11.8 million compared to cash used
in operating activities in the corresponding period in 2004 of
$1.0 million. The $12.8 million increase in cash
provided by operating activities was principally due to a
decrease in interest and tax payments between periods and
operating cash flow used in 2004 relating to the refinancing.
Cash provided by investing activities in the three months ended
March 31, 2005, was $6.8 million compared to
$6.6 million in 2004. The $0.2 million increase in
cash provided by investing activities was principally due to an
increase resulting from the redemption of short-term investments
in 2005, offset by the redemption of assets held in a deferred
compensation plan which were liquidated as part of the
refinancing in 2004, as well as increased levels of capital
expenditures in 2005 and earnout payments related to previous
acquisitions in 2005. Cash used in financing activities in the
three months ended March 31, 2005 and 2004 was
$15.8 million and $60.9 million, respectively. The
$45.1 million decrease in cash used in financing activities
was due to the debt restructuring, preferred stock redemption
and dividend paid in 2004.
20
We spent $2.4 million in the first three months of 2005 and
$0.9 million in the first three months of 2004 for capital
expenditures. These expenditures were primarily for information
technology investments and related development projects.
We have historically been an acquirer of other physician
staffing businesses and interests. Such acquisitions in recent
years have been completed for cash. Cash payments made in
connection with acquisitions, including contingent payments,
were $5.8 million during the three months ended
March 31, 2005 and $1.5 million in the corresponding
period in 2004. Future contingent payment obligations are
approximately $3.0 million as of March 31, 2005.
Our senior credit facility at March 31, 2005 provides for
up to $80.0 million of borrowings under a senior revolving
credit facility and $233.1 million of term loans.
Borrowings outstanding under the senior credit facility mature
in various years with a final maturity date of March 31,
2011. The senior credit facility agreement contains both
affirmative and negative covenants, including limitations on our
ability to incur additional indebtedness, sell material assets,
retire, redeem or otherwise reacquire our capital stock, acquire
the capital stock or assets of another business, pay dividends,
and requires us to meet or exceed certain coverage, leverage and
indebtedness ratios. The senior credit agreement also includes a
provision for the prepayment of a portion of the outstanding
term loan amounts at any year-end if we generate excess
cash flow, as defined in the agreement. During the three
months ended March 31, 2005, we made prepayments totaling
$15.0 million on our bank term debt under the excess cash
flow provision calculation for 2004. Subsequent to
March 31, 2005, we made an additional final payment for
2004 of $0.8 million under such provision.
We began providing effective March 12, 2003, for
professional liability risks in part through a captive insurance
company. Prior to such date we insured such risks principally
through the commercial insurance market. The change in the
professional liability insurance program has resulted in
increased cash flow due to the retention of cash formerly paid
out in the form of insurance premiums to a commercial insurance
company coupled with a long period (typically 2-4 years or
longer on average) before cash payout of such losses occurs. A
portion of such cash retained is retained within our captive
insurance company and therefore not immediately available for
general corporate purposes. As of March 31, 2005, cash or
cash equivalents and related investments held within the captive
insurance company totaled approximately $24.4 million.
Based on the results of our most recent actuarial report,
anticipated cash outflow to the captive insurance company or
third-party insurance providers for 2005 is estimated at
$39.7 million.
In 2004, approximately $210.7 million of annual revenue
resulting from providing staffing services to the military was
subjected to a re-bidding process. Based on the results of the
re-bidding process in 2004, we were successful in winning
existing or new business contracts of approximately
$138.2 million in annual revenues or 66% of our annual
revenue that was re-bid. Overall, the operating margins realized
from such awards are lower than previous contract margins. Based
on the results of the re-bidding awards, we expect a decline in
annual earnings and cash flow from our military staffing
business in 2005. We do not expect the decline in earnings and
cash flow from our military staffing business, based on our
estimates of such earnings and cash flow, to result in any
violations of debt covenant financial ratio requirements under
our senior credit agreement.
We had as of March 31, 2005, total cash and cash
equivalents of approximately $20.7 million, short-term
investments of approximately $49.8 million and a revolving
credit facility borrowing availability of $74.9 million.
Our ongoing cash needs in the three months ended March 31,
2005, were met from internally generated operating sources.
Borrowings under our revolving credit facility were limited in
the period to $7.7 million for a seven day period as the
result of needing cash to meet bank funding obligations while
being invested in marketable securities. From time to time we
may repurchase our subordinated bonds up to the level approved
($35.0 million) under the terms of our amended senior
credit facility effective April 6, 2005.
We believe that our cash needs, other than for significant
acquisitions, will continue to be met through the use of our
remaining existing available cash, cash flows derived from
future operating results and cash generated from borrowings
under our senior revolving credit facility.
21
Inflation
We do not believe that general inflation in the
U.S. economy has had a material impact on our financial
position or results of operations.
Seasonality
Historically, our revenues and operating results have reflected
minimal seasonal variation due to the significance of revenues
derived from patient visits to emergency departments, which are
generally open on a 365 day basis, and also due to our
geographic diversification. Revenue from our non-emergency
department staffing lines is dependent on a healthcare facility
being open during selected time periods. Revenue in such
instances will fluctuate depending upon such factors as the
number of holidays in the period.
Recently Issued Accounting Standards
On December 16, 2004, the FASB issued
SFAS No. 123 (revised 2004), Share-Based
Payment, which is a revision of SFAS No. 123,
Accounting for Stock-Based Compensation.
SFAS No. 123(R) supersedes APB Opinion No. 25,
Accounting for Stock Issued to Employees, and amends
SFAS No. 95, Statement of Cash Flows.
Generally, the approach in SFAS No. 123(R) is similar
to the approach described in SFAS No. 123. However,
SFAS No. 123(R) requires all share-based payments to
employees, including grants of employee stock options, to be
recognized in the income statement based on their fair values.
Pro forma disclosure is no longer an alternative.
The provisions of SFAS No. 123(R) are effective for
the Company beginning January 1, 2006. Early adoption is
permitted in periods in which financial statements have not been
issued. The Company expects to adopt SFAS No. 123(R)
beginning January 1, 2006.
The Company adopted the fair-value-based method of accounting
for share-based payments effective January 1, 2003 using
the prospective method described in SFAS No. 148,
Accounting for Stock-Based Compensation
Transition and Disclosure. Currently, the Company uses the
minimum value method to estimate the value of stock options
granted to employees. In accordance with the transition
provisions of SFAS No. 123(R) the Company will
continue to account for nonvested awards outstanding at the date
of adoption of SFAS No. 123(R) in the same manner as
they had been accounted for prior to adoption for financial
statement recognition purposes. For those options that are
granted after the adoption of SFAS No. 123(R), the
Company will no longer be permitted to use the minimum-value
method and instead will be required to use an acceptable
option-pricing model. The Company has not yet determined which
specific option-pricing model it will use.
SFAS No. 123(R) also requires the benefits of tax
deductions in excess of recognized compensation cost to be
reported as a financing cash flow, rather than an operating cash
flow as required under current literature. This requirement will
reduce net operating cash flows and increase net financing cash
flows in periods after adoption. While the Company cannot
estimate what those amounts will be in the future (because they
depend on, among other things, when employees exercise stock
options), the amounts recognized in operating cash flows for
such excess tax deductions were $6,000 and $37,000 for the three
months ended March 31, 2005 and 2004, respectively.
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Item 3. |
Quantitative and Qualitative Disclosures About Market
Risk |
The Company is exposed to market risk related to changes in
interest rates. The Company does not use derivative financial
instruments for speculative or trading purposes.
The Companys earnings are affected by changes in
short-term interest rates as a result of its borrowings under
its senior credit facilities. Interest rate swap agreements are
used to manage a portion of the Companys interest rate
exposure.
The Company is obligated under the terms of its senior credit
facility agreement to have in place interest rate hedge
agreements at amounts such that 50% of the Companys funded
debt, as defined, is at fixed rates of
22
interest. Such hedge agreements are required to be maintained
for at least the first three years of the senior credit facility
agreement. The Company is a party to an interest rate swap
agreement that effectively converted $35.0 million of a
variable rate term loan to a fixed rate of 3.2% through
March 31, 2007. The agreement is a contract to exchange, on
a quarterly basis, floating interest rate payments based on the
euro dollar rate, for fixed interest rate payments over the life
of the agreement. This agreement exposes the Company to credit
losses in the event of non-performance by the counterparty to
the financial instrument. The counterparty to the Companys
interest rate swap agreement is a creditworthy financial
institution and the Company believes the counterparty will be
able to fully satisfy its obligations under the contracts.
At March 31, 2005, the fair value of the Companys
total debt, which has a carrying value of $413.1 million,
was approximately $409.1 million. The Company had
$233.1 million of variable debt outstanding at
March 31, 2005. If the market interest rates for the
Companys variable rate borrowings averaged 1% more during
the twelve months subsequent to March 31, 2005, the
Companys interest expense would increase, and earnings
before income taxes would decrease, by approximately
$2.3 million. This analysis does not consider the effects
of the reduced level of overall economic activity that could
exist in such an environment. Further, in the event of a change
of such magnitude, management could take actions in an attempt
to further mitigate its exposure to the change. However, due to
the uncertainty of the specific actions that would be taken and
their possible effects, the sensitivity analysis assumes no
changes in the Companys financial structure.
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Item 4. |
Controls and Procedures |
(a) The Company carried out an evaluation, under the
supervision and with the participation of the Companys
management, including the Companys Chairman and Chief
Executive Officer and the Companys Executive Vice
President of Finance and Administration, of the effectiveness of
the design and operation of the Companys disclosure
controls and procedures as defined in Rule 13a-15(e) and
15d-15(e) under the Securities Exchange Act of 1934, as amended
(the Exchange Act). Based upon that evaluation the
Companys Chief Executive Officer and the Companys
Executive Vice President of Finance and Administration concluded
that as of the end of the period covered by this report the
Companys disclosure controls and procedures (1) were
effective in timely alerting them to material information
relating to the Company (including its consolidated
subsidiaries) required to be included in the Companys
periodic SEC filings and (2) were adequate to ensure that
information required to be disclosed by the Company in the
reports filed or submitted by the Company under the Exchange Act
is recorded, processed and summarized and reported within the
time periods specified in the SECs rules and forms.
(b) There have been no significant changes in the
Companys internal control over financial reporting
identified in connection with the evaluation described in
paragraph (a) above that have materially affected or
are reasonably likely to materially affect, the Companys
internal control over financial reporting.
23
PART 2. OTHER INFORMATION
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Item 1. |
Legal Proceedings |
Team Health is a party to various pending legal actions arising
in the ordinary operation of its business such as contractual
disputes, employment disputes and general business actions as
well as malpractice actions. Team Health does not believe that
the results of such legal actions, individually or in the
aggregate, will have a material adverse effect on the
Companys business or its results of operations, cash flows
or financial condition.
See note 10 to the consolidated financial statements for a
description of legal actions to which we are party.
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Item 2. |
Unregistered Sales of Equity Securities and Use of
Proceeds |
None.
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Item 3. |
Defaults upon Senior Securities |
None.
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Item 4. |
Submission of Matters to a Vote of Security Holders |
None.
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Item 5. |
Other Information |
None.
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31 |
.1 |
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Certification by Lynn Massingale, M.D. pursuant to
18 U.S.C. Section 1350, as adopted pursuant to
Section 302 of the Sarbanes-Oxley Act of 2002. |
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31 |
.2 |
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Certification by Robert J. Abramowski pursuant to 18 U.S.C.
Section 1350, as adopted pursuant to Section 302 of
the Sarbanes-Oxley Act of 2002. |
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32 |
.1 |
|
Certification by Lynn Massingale, M.D. pursuant to
18 U.S.C. Section 1350, as adopted pursuant to
Section 906 of the Sarbanes-Oxley Act of 2002. |
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32 |
.2 |
|
Certification by Robert J. Abramowski pursuant to 18 U.S.C.
Section 1350, as adopted pursuant to Section 906 of
the Sarbanes-Oxley Act of 2002. |
24
SIGNATURES
Pursuant to the requirements of the Securities Exchange Act of
1934, the registrant has duly caused this report on
Form 10-Q to be signed on its behalf by the undersigned
thereunto duly authorized.
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Team Health, Inc.
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/s/ H. Lynn
Massingale, M.D.
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H. Lynn Massingale |
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Chief Executive Officer |
May 11, 2005
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/s/ Robert J. Abramowski
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Robert J. Abramowski |
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Executive Vice President Finance and Administration |
May 11, 2005
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/s/ David P. Jones
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David P. Jones |
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Chief Financial Officer |
May 11, 2005
25