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8-K - 8-K - 21st Century Oncology Holdings, Inc.a11-7245_18k.htm
EX-10.4 - EX-10.4 - 21st Century Oncology Holdings, Inc.a11-7245_1ex10d4.htm
EX-10.3 - EX-10.3 - 21st Century Oncology Holdings, Inc.a11-7245_1ex10d3.htm
EX-10.2 - EX-10.2 - 21st Century Oncology Holdings, Inc.a11-7245_1ex10d2.htm
EX-10.1 - EX-10.1 - 21st Century Oncology Holdings, Inc.a11-7245_1ex10d1.htm

Exhibit 99.1

 

 

RADIATION THERAPY SERVICES HOLDINGS, INC.

 

PRESS RELEASE

 

 

 

Contact:

Kerrin Gillespie

Chief Financial Officer

Radiation Therapy Services, Inc.

239-938-0971

Kerry.gillespie@rtsx.com

Investors:

Amy Glynn / Nick Laudico

The Ruth Group

646-536-7023 / 7030

aglynn@theruthgroup.com

nlaudico@theruthgroup.com

 

Radiation Therapy Services Holdings, Inc. Reports Fourth Quarter

and Fiscal Year 2010 Financial Results

 

2010 Highlights:

·                  Acquisitions of a Myrtle Beach, South Carolina-based radiation therapy facility and four physician practices, expanding into new market

·                  Issued $310.0 million of Senior Subordinated Notes in April 2010; completed exchange offer for Senior Subordinated Notes in January 2011

·                  Completed advanced technology upgrades in six key markets

·                  Selected by key academic medical centers to serve as Developer and Managing Partner of first Proton Beam Radiation Therapy Center in New York

·                  2011 Physician Fee Schedule results in stable to slightly favorable reimbursement environment

·                  Strengthened management team with appointments of new CFO and COO

 

FORT MYERS, FL, February 28, 2011 — Radiation Therapy Services Holdings, Inc. (“Radiation Therapy Services”), a leading operator of radiation therapy centers, today announced financial results for the fourth quarter and fiscal year ended December 31, 2010.

 

For the fourth quarter of 2010, total revenues were $137.5 million and the net loss was $102.3 million.  For fiscal year 2010, total revenues were $544.0 million and the net loss was $113.8 million. The quarterly and annual net losses were due primarily to goodwill impairment charges in certain financially distressed markets.

 

“We finished 2010 with many accomplishments despite continued challenging economic conditions,” said Dr. Daniel Dosoretz, President and Chief Executive Officer.  “As a

 

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result of the completion of strategic advanced technology upgrades in several markets, we were able to improve our RVUs per treatment at our same practice freestanding centers by 1.7%, compared to 2009, despite a 2.5% reduction in RVU values heading into 2010.  We believe these strategic upgrades will enable us to better meet future patient demands and prepare for more advanced treatments, including adaptive radiotherapy.

 

“We are also very pleased with our 2010 Myrtle Beach acquisitions, as the performance of those physician practices continues to exceed our expectations.  Lastly, we are very excited to be selected as developer and managing partner in the first proton beam radiation therapy center located in New York, which includes a consortium of five of the largest cancer center programs in New York City.  Looking forward, we expect a year of continued improvement in 2011 as we remain focused on growing our business, further deploying leading-edge technologies to advance patient care and making improvements in our operating performance.”

 

Fourth Quarter Financial 2010 Results

 

Total revenues increased 7.2% to $137.5 million in the fourth quarter of 2010, compared to $128.3 million in the fourth quarter of 2009.  The increase in revenue was principally due to $9.1 million in revenue from the May 2010 acquisition of the Myrtle Beach, South Carolina physician practices.

 

For the fourth quarter 2010, the Company reported 1,868 total treatments per day at its freestanding radiation oncology centers, up 2.3% as compared to the same period in 2009.

 

Same practice therapy revenue declined by 3.7% during the fourth quarter of 2010 principally as a result of lower volumes from the challenging economic environment in certain markets, including Michigan, Arizona and Nevada, and having one less treatment day versus the same period of the prior year.  Total RVUs per day at freestanding centers increased 1.2% in the fourth quarter versus the same period of the prior year.

 

Pro forma adjusted EBITDA for the fourth quarter of 2010 declined to $28.9 million, or 20.8% of total pro forma revenues, from $30.3 million, or 23.6% of total pro forma revenues for the fourth quarter of 2009, primarily resulting from the decrease in same practice treatments.  A reconciliation of net loss attributable to Radiation Therapy Services Holdings, Inc. shareholder determined in accordance with generally accepted accounting principles to pro forma adjusted EBITDA and total revenues determined in accordance with generally accepted accounting principles to total pro forma revenues for the quarters ended December 31, 2010 and 2009 is included in the attached supplemental information.

 

Net loss for the fourth quarter of 2010 was $102.3 million as compared to a net loss of $3.6 million for the fourth quarter of 2009.  The increase in net loss was primarily due to a goodwill impairment charge of $93.7 million related to the Company’s California, Arizona, Nevada and Florida East Coast markets as a result of the challenging economic environment in these areas.

 

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Fiscal Year Financial 2010 Results

 

Total revenues increased 3.7% to $544.0 million for 2010, compared to $524.5 million for 2009.  The increase in revenue was principally due to revenue from the May 2010 acquisition of the Myrtle Beach, South Carolina physician practices and recognition of additional reimbursement from CMS under the Physician Quality Reporting Initiative (“PQRI”) of $23.8 million and $6.2 million, respectively.

 

For 2010, the Company reported 1,886 total treatments per day at its freestanding radiation oncology centers, down 0.9% as compared to 2009.

 

Same practice therapy revenue declined by 3.6% during 2010 principally as a result of lower volumes from the challenging economic environment in certain markets, including Michigan, California, Arizona, Nevada and the East Coast of Florida, and having one less treatment day versus the same period of the prior year.  Total RVUs per day at freestanding centers increased 0.5% during 2010 versus 2009.

 

Pro forma adjusted EBITDA for 2010 increased to $115.7 million, or 20.5% of total pro forma revenues, from $113.4 million, or 21.6% of total pro forma revenues for 2009, principally as a result of the favorable impact associated with the acquisitions of the Myrtle Beach, South Carolina and Princeton, West Virginia physician practices and a $4.0 million improvement in our provision for bad debts, net of the effect of decreases in our same practice treatments.  As a percentage of total pro forma revenues, pro forma adjusted EBITDA declined principally due to the growth of ancillary practice revenues which have inherently lower margins as they do not entail significant capital investments and to a lesser extent decreases in same practice treatments.  A reconciliation of net loss attributable to Radiation Therapy Services Holdings, Inc. shareholder determined in accordance with generally accepted accounting principles to pro forma adjusted EBITDA and total revenues determined in accordance with generally accepted accounting principles to total pro forma revenues for the years ended December 31, 2010 and 2009 is included in the attached supplemental information.

 

Net loss for 2010 was $113.8 million as compared to a net loss of $7.7 million for 2009.  The increase in net loss in 2010 was primarily due to a goodwill impairment charge of $93.7 million recorded in the fourth quarter of 2010 related to the Company’s California, Arizona, Nevada and Florida East Coast markets as a result of the challenging economic environment in these areas and a loss on early extinguishment of debt of $10.9 million.

 

2011 Outlook

 

“We are encouraged by the finalization of the 2011 Physician Fee Schedule, which provides for approximately a 9% increase in RVUs based on the current mix of our radiation oncology services. However, we expect that a 7.9% decline in the conversion factor as a result of budget neutrality adjustments will partially offset this increase,

 

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resulting in an estimated 1-2% overall favorable impact in 2011,” continued Dr. Dosoretz.

 

“Similar to other healthcare providers, we believe in many markets patients are continuing to postpone visits to their primary care physicians and other providers that can lead to the early diagnosis and treatment of cancer.  Despite these specific market conditions, we remain very focused on numerous organic and corporate development initiatives that will better position the Company for long-term sustainable growth and improved patient care.

 

“We are making substantial improvements to our information systems to increase efficiencies and reduce costs; this includes the completion of pilots of our electronic health record solution in our Southwest Florida radiation oncology markets.  Combined with other actions taken to reduce our cost structure, these initiatives are expected to help us to preserve our margins in the near-term and will provide us with additional leverage as the Company continues to grow.

 

“We continue to be excited about the growth prospects in the large and growing radiation therapy market.  We expect that our continuous focus on clinical, operating and corporate development improvements will fortify Radiation Therapy Services’ position as the indisputable industry leader in the radiation oncology field and position the Company for sustainable success over the foreseeable future,” concluded Dr. Dosoretz.

 

Recent Developments

 

In February 2011, Radiation Therapy appointed Joseph M. Garcia to the newly created role of Chief Operating Officer.  Mr. Garcia brings to Radiation Therapy more than 15 years of operational experience in the healthcare services sector.  With the addition of Mr. Garcia to COO, and the March 2010 appointment of Mr. Kerrin E. Gillespie as Chief Financial Officer, Radiation Therapy has significantly expanded the breadth and experience of its executive management team.

 

Conference Call

 

Management will host a conference call on Tuesday, March 1, 2011 at 11:00 a.m. EST to discuss financial results, business conditions and other developments. The dial-in numbers are (877) 407-4018 for domestic callers, and (201) 689-8471 for international callers.  In addition, a telephonic replay of the call will be available until March 15, 2011.  The replay dial-in numbers are (877) 870-5176 for domestic callers and (858) 384-5517 for international callers.  Please use the conference ID number 365789 to access the replay.

 

About Radiation Therapy Services

 

Radiation Therapy Services, which operates radiation treatment centers primarily under the name of 21st Century Oncology, is a provider of advanced radiation therapy services

 

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to cancer patients.  The Company’s 95 treatment centers are clustered into 28 local markets in 16 states, including Alabama, Arizona, California, Delaware, Florida, Kentucky, Maryland, Massachusetts, Michigan, Nevada, New Jersey, New York, North Carolina, Rhode Island, South Carolina and West Virginia.  The Company is headquartered in Fort Myers, Florida.

 

Forward-Looking Statements

This press release contains forward-looking statements within the meaning of Section 27A of the Securities Act of 1933, as amended, and Section 21E of the Securities Act of 1934, as amended.  These statements are based on management’s current expectations or beliefs about the Company’s future plans, expectations and objectives, including, but not limited to, the Company’s expected financial results and estimates for 2011.  These forward-looking statements are not historical facts and are subject to risks and uncertainties that could cause the actual results to differ materially from those projected in these forward-looking statements including, but not limited to the Company’s actual financial results and those risk factors that may be described from time to time in the Company’s filings with the Securities and Exchange Commission.  Readers of this release are cautioned not to place undue reliance on forward-looking statements contained herein, which speak only as of the date stated, or if no date is stated, as of the date of this press release. The Company undertakes no obligation to publicly update or revise the forward-looking statements contained herein to reflect changed events or circumstances after the date of this release, unless required by law.

 

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RADIATION THERAPY SERVICES HOLDINGS, INC.

CONSOLIDATED BALANCE SHEETS

(in thousands, except share and per share amounts)

(unaudited)

 

 

 

December 31,

 

December 31,

 

 

 

2010

 

2009

 

 

 

 

 

 

 

ASSETS

 

 

 

 

 

Current assets:

 

 

 

 

 

Cash and cash equivalents

 

$

13,977

 

$

32,958

 

Accounts receivable, net

 

63,571

 

58,015

 

Income taxes receivable

 

 

483

 

Prepaid expenses

 

6,969

 

7,557

 

Inventories

 

1,426

 

1,436

 

Deferred income taxes

 

2,276

 

8,659

 

Other

 

3,534

 

6,153

 

Total current assets

 

91,753

 

115,261

 

 

 

 

 

 

 

Equity investments in joint ventures

 

20,136

 

18,663

 

Property and equipment, net

 

229,665

 

225,779

 

Real estate subject to finance obligation

 

8,100

 

74,248

 

Goodwill

 

770,898

 

826,641

 

Intangible assets, net

 

85,236

 

92,271

 

Other assets

 

30,542

 

26,362

 

Total assets

 

$

1,236,330

 

$

1,379,225

 

 

 

 

 

 

 

LIABILITIES AND EQUITY

 

 

 

 

 

 

 

 

 

 

 

Current liabilities:

 

 

 

 

 

Accounts payable

 

$

21,888

 

$

13,095

 

Accrued expenses

 

35,765

 

35,107

 

Income taxes payable

 

5,994

 

 

Current portion of long-term debt

 

8,780

 

13,961

 

Current portion of finance obligation

 

53

 

1,128

 

Other current liabilities

 

197

 

2,000

 

Total current liabilities

 

72,677

 

65,291

 

Long-term debt, less current portion

 

590,051

 

535,098

 

Finance obligation, less current portion

 

8,515

 

76,102

 

Other long-term liabilities

 

15,981

 

14,876

 

Deferred income taxes

 

33,527

 

58,557

 

Total liabilities

 

720,751

 

749,924

 

 

 

 

 

 

 

Noncontrolling interests - redeemable

 

7,371

 

7,294

 

 

 

 

 

 

 

Commitments and Contingencies

 

 

 

 

 

 

 

 

 

 

 

Equity:

 

 

 

 

 

Common stock, $0.01 par value, 1,000 shares authorized, issued and outstanding at December 31, 2010 and December 31, 2009

 

 

 

Additional paid-in capital

 

630,989

 

630,278

 

Retained deficit

 

(130,374

)

(14,886

)

Notes receivable from shareholder

 

(175

)

(225

)

Accumulated other comprehensive loss, net of tax

 

(3,391

)

(4,869

)

Total Radiation Therapy Services Holdings, Inc. shareholder’s equity

 

497,049

 

610,298

 

Noncontrolling interests - nonredeemable

 

11,159

 

11,709

 

Total equity

 

508,208

 

622,007

 

Total liabilities and equity

 

$

1,236,330

 

$

1,379,225

 

 



 

RADIATION THERAPY SERVICES HOLDINGS, INC.

CONSOLIDATED STATEMENTS OF OPERATIONS AND COMPREHENSIVE LOSS

(in thousands)

(unaudited)

 

 

 

Three Months Ended

 

Years Ended

 

 

 

December 31,

 

December 31,

 

 

 

2010

 

2009

 

2010

 

2009

 

 

 

 

 

 

 

 

 

 

 

Revenues:

 

 

 

 

 

 

 

 

 

Net patient service revenue

 

$

135,326

 

$

126,738

 

$

535,913

 

$

517,646

 

Other revenue

 

2,197

 

1,546

 

8,050

 

6,838

 

Total revenues

 

137,523

 

128,284

 

543,963

 

524,484

 

 

 

 

 

 

 

 

 

 

 

Expenses:

 

 

 

 

 

 

 

 

 

Salaries and benefits

 

76,327

 

62,962

 

282,302

 

259,532

 

Medical supplies

 

11,515

 

10,460

 

43,027

 

45,361

 

Facility rent expense

 

7,930

 

5,467

 

27,885

 

22,106

 

Other operating expenses

 

6,970

 

5,993

 

27,103

 

24,398

 

General and administrative expenses

 

19,360

 

12,768

 

65,798

 

54,537

 

Depreciation and amortization

 

12,113

 

12,174

 

46,346

 

46,416

 

Provision for doubtful accounts

 

444

 

975

 

8,831

 

12,871

 

Interest expense, net

 

13,902

 

15,409

 

58,505

 

62,502

 

Loss on sale of assets of a radiation treatment center

 

 

 

1,903

 

 

Early extinguishment of debt

 

 

 

10,947

 

 

Impairment loss

 

97,916

 

3,474

 

97,916

 

3,474

 

Total expenses

 

246,477

 

129,682

 

670,563

 

531,197

 

 

 

 

 

 

 

 

 

 

 

Loss before income taxes

 

(108,954

)

(1,398

)

(126,600

)

(6,713

)

Income tax (benefit) expense

 

(6,662

)

2,160

 

(12,810

)

1,002

 

 

 

 

 

 

 

 

 

 

 

Net loss

 

(102,292

)

(3,558

)

(113,790

)

(7,715

)

 

 

 

 

 

 

 

 

 

 

Net income attributable to noncontrolling interests- redeemable and non-redeemable

 

(41

)

(633

)

(1,698

)

(1,835

)

 

 

 

 

 

 

 

 

 

 

Net loss attributable to Radiation Therapy Services Holdings, Inc. shareholder

 

(102,333

)

(4,191

)

(115,488

)

(9,550

)

 

 

 

 

 

 

 

 

 

 

Other comprehensive income (loss):

 

 

 

 

 

 

 

 

 

Unrealized gain on derivative interest rate swap agreement and foreign currency translation, net of tax

 

665

 

594

 

1,478

 

1,801

 

Comprehensive loss

 

$

(101,668

)

$

(3,597

)

$

(114,010

)

$

(7,749

)

 



 

RADIATION THERAPY SERVICES HOLDINGS, INC.

Supplemental Financial Information (Unaudited)

Reconciliation of Pro-forma Adjusted EBITDA to Net Loss Attributable

to Radiation Therapy Services Holdings, Inc. Shareholder

 

 

 

Three Months Ended

 

Years Ended

 

 

 

December 31,

 

December 31,

 

 

 

2010

 

2009

 

2010

 

2009

 

(in thousands):

 

 

 

 

 

 

 

 

 

Total revenues

 

$

137,523

 

$

128,284

 

$

543,963

 

$

524,484

 

Pro-forma full period effect of acquisitions (a) 

 

1,327

 

 

21,445

 

 

Total pro-forma revenues

 

$

138,850

 

$

128,284

 

$

565,408

 

$

524,484

 

 

 

 

 

 

 

 

 

 

 

Net loss attributable to Radiation Therapy Services Holdings, Inc. shareholder

 

$

(102,333

)

$

(4,191

)

$

(115,488

)

$

(9,550

)

Income tax (benefit) expense

 

(6,662

)

2,160

 

(12,810

)

1,002

 

Interest expense, net

 

13,902

 

15,409

 

58,505

 

62,502

 

Depreciation and amortization

 

12,113

 

12,174

 

46,346

 

46,416

 

Impairment loss

 

97,916

 

3,474

 

97,916

 

3,474

 

Loss on sale of assets of a radiation treatment center

 

 

 

1,903

 

 

Early extinguishment of debt

 

 

 

10,947

 

 

Management fees (b) 

 

504

 

523

 

1,314

 

1,239

 

Non-cash expenses (c) 

 

1,031

 

1,197

 

3,534

 

5,042

 

Sale-lease back adjustments (d) 

 

(196

)

(1,582

)

(2,511

)

(6,031

)

Acquisition-related costs (e) 

 

3,162

 

242

 

4,811

 

2,437

 

Other expenses (f) 

 

757

 

779

 

2,031

 

1,886

 

Cost savings (g) 

 

 

 

 

5,023

 

Litigation settlement (h) 

 

 

81

 

2,771

 

 

Material weakness expenses (i) 

 

330

 

 

330

 

 

Physician contracting expenses (j) 

 

7,551

 

 

7,551

 

 

Pro-forma full period effect of acquisition EBITDA (a) 

 

776

 

 

8,565

 

 

 

 

 

 

 

 

 

 

 

 

Pro-forma Adjusted EBITDA (1) 

 

$

28,851

 

$

30,266

 

$

115,715

 

$

113,440

 

 

 

 

 

 

 

 

 

 

 

Pro-forma Adjusted EBITDA as a percentage of total pro-forma revenues

 

20.8

%

23.6

%

20.5

%

21.6

%

 



 


(1) Pro-forma Adjusted EBITDA is defined as income (loss) before interest expense (net of interest income), income taxes, depreciation and amortization, impairment loss, loss on sale of assets of a radiation treatement center, early extinguishment of debt, management fees from our sponsor, non-cash expenses including costs relating to stock compensation, amortization of straight-line rent and amortization of capital expenditures relating to repairs and maintenance, sale-lease back adjustments, acquisition-related costs, other expenses including loss on sale of assets, severance payments related to terminiation of employee staff reductions, tail premiums on termed physicians, cost savings implemented in 2009, litigation settlements with physicians, costs relating to remediation work on the material weakness associated with the provision for income taxes, costs associated with the restructuring of certain physician groups’ compensation agreements and pro-forma full period effect of acquisition EBITDA.

 

(a) Pro-forma amounts related to adjustments to total revenues and Pro-forma Adjusted EBITDA to reflect the full period effect of our acquisitions completed during 2010, including the purchase of the South Carolina physician practices in May 2010 and the acquisitions of the Princeton, West Virginia radiation oncology practice in December 2010.  The adjustments reflect the impact to our total revenues and Pro-forma Adjusted EBITDA as if the acquisition had occurred at the beginning of the year as follows: Pro-forma revenues includes $5.3 million related to Princeton, West Virginia practice and $16.1 million related to the South Carolina practices. Pro-forma acquisition EBITDA includes $3.1 million related to Princeton, West Virginia practice and $5.5 million related to the South Carolina practices.

 

(b) Management fees are fees paid to our sponsor, Vestar Capital Partners.

 

(c) Non-cash expenses including costs relating to stock compensation, amortization of straight-line rent and amortization of capital expenditures relating to warranty arrangements amortized to repairs and maintenance.

 

(d) Sale-lease back adjustments relates to the adjustment of benefit derived from the classification of operating leases as finance obligations reflecting a reclassification of interest expense and depreciation and amortization expense as rent expense.

 

(e) Acquisition related costs associated with the adoption of ASC 805 Business Combinations requiring prior capitalized costs be expensed, including professional fees and due diligence costs relating to the acquisition of physician practices.

 

(f) Other expenses include loss on sale of assets, severance payments related to termination of employee staff reductions, tail premiums paid on terminated physicians.

 

(g) Cost savings related to the planned initiative of cost cutting plans implemented during the fourth quarter of 2009.

 

(h) Litigation settlement relates to costs associated with the termination of physicians during 2010 as a result of the cost savings plans implemented in the fourth quarter of 2009.

 

(i) Material weakness expenses related to the costs associated with the remediation work on the material weakness for the provision for income taxes.

 

(j) Physician contracting expenses are costs associated with the restructuring of certain physician groups’ compensation arrangements.

 

We believe the Pro-forma Adjusted EBITDA provides useful information about our financial performance to investors, lenders, financial analysts and rating agencies since these groups have historically used EBITDA-related measures in the healthcare industry, along with other measures, to estimate the value of a company, to make informed investment decisions, to evaluate a company’s leverage capacity and its ability to meet its debt service requirements.  Pro-forma Adjusted EBITDA eliminates the uneven effect of non-cash depreciation of tangibles assets and amortization of intangible assets, much of which results from acquisitions accounted for under the purchase method of accounting.  Pro-forma Adjusted EBITDA is also used by us to measure individual performance for incentive compensation purposes and as an analytical indicator for purposes of allocating resources to our operating business and assessing their performance, both internally and relative to our peers, as well as to evaluate the performance of our operating management teams, and for purposes in the calculation of debt covenants and related disclosures.

 

Pro-forma Adjusted EBITDA is not intended as a substitute for net income (loss) attributable to Radiation Therapy Services Holdings, Inc. shareholder, operating cash flows or other cash flow data determined in accordance with accounting principles generally accepted in the United States. Due to varying methods of calculation, Pro-forma Adjusted EBITDA as presented may not be comparable to similarly titled measures of other companies.

 



 

RADIATION THERAPY SERVICES HOLDINGS, INC.

CONDENSED CONSOLIDATED STATEMENTS OF CASH FLOWS

(in thousands)

(unaudited)

 

 

 

Years ended

 

 

 

December 31,

 

 

 

2010

 

2009

 

Cash flows from operating activities

 

 

 

 

 

Net loss

 

$

(113,790

)

$

(7,715

)

Adjustments to reconcile net loss to net cash provided by operating activities:

 

 

 

 

 

Depreciation

 

39,011

 

31,837

 

Amortization

 

7,335

 

14,579

 

Deferred rent expense

 

1,180

 

3,199

 

Deferred income tax benefit

 

(19,698

)

(1,335

)

Stock-based compensation

 

1,030

 

962

 

Impairment loss

 

97,916

 

3,474

 

Provision for doubtful accounts

 

8,831

 

12,871

 

Loss on the sale of property and equipment

 

734

 

1,341

 

Loss on the sale of assets of a radiation treatment center

 

1,903

 

 

Write-off of pro-rata debt discount

 

494

 

 

Write-off of loan costs

 

1,593

 

 

Early extinguishment of debt

 

10,947

 

 

Write-off of acquisition-related costs

 

 

812

 

Amortization of debt discount

 

791

 

1,208

 

Amortization of loan costs

 

3,350

 

2,850

 

Equity interest in net earnings of joint ventures

 

(1,001

)

(880

)

Distribution received from unconsolidated joint ventures

 

980

 

 

Changes in operating assets and liabilities:

 

 

 

 

 

Accounts receivable and other receivables

 

(16,066

)

(3,790

)

Income taxes receivable / payable

 

6,477

 

13,141

 

Inventories

 

107

 

10

 

Prepaid expenses

 

4,425

 

2,006

 

Accounts payable

 

8,454

 

(965

)

Accrued expenses

 

3,991

 

(2,213

)

 

 

 

 

 

 

Net cash provided by operating activities

 

48,994

 

71,392

 

 

 

 

 

 

 

Cash flows from investing activities

 

 

 

 

 

Purchase of property and equipment

 

(43,781

)

(35,443

)

Acquisition of radiation centers

 

(43,388

)

(2,449

)

Restricted cash associated with earn-out provisions of acquisitions

 

 

2,269

 

Purchase of joint venture interests

 

(1,000

)

(13,593

)

Proceeds from the sale of property and equipment

 

1,693

 

144

 

Repayments from employees

 

457

 

478

 

Contribution of capital to joint venture entities

 

(3,711

)

(2,386

)

Distribution received from joint venture

 

27

 

 

Change in other assets and other liabilities

 

(2,808

)

(3,192

)

 

 

 

 

 

 

Net cash used in investing activities

 

(92,511

)

(54,172

)

 

 

 

 

 

 

Cash flows from financing activities

 

 

 

 

 

Proceeds from issuance of debt (net of original issue discount of $1,950)

 

316,550

 

 

Principal repayments of debt

 

(271,295

)

(29,693

)

Repayments of finance obligation

 

(302

)

(1,242

)

Payment of call premium on senior subordinated notes

 

(5,250

)

 

Proceeds from equity contribution

 

156

 

 

Payments of notes receivable from shareholder

 

50

 

25

 

Proceeds from issuance of noncontrolling interest

 

608

 

356

 

Cash distributions to noncontrolling interest holders - redeemable and non-redeemable

 

(3,176

)

(2,876

)

Deconsolidation of noncontrolling interest

 

(14

)

 

Payments of debt issue costs

 

(12,791

)

 

 

 

 

 

 

 

Net cash provided by (used in) financing activities

 

24,536

 

(33,430

)

 

 

 

 

 

 

Net decrease in cash and cash equivalents

 

(18,981

)

(16,210

)

Cash and cash equivalents, beginning of period

 

32,958

 

49,168

 

 

 

 

 

 

 

Cash and cash equivalents, end of period

 

$

13,977

 

$

32,958

 

 



 

RADIATION THERAPY SERVICES HOLDINGS, INC.

CONDENSED CONSOLIDATED STATEMENTS OF CASH FLOWS

(in thousands)

(unaudited)

 

 

 

Years ended

 

 

 

December 31,

 

 

 

2010

 

2009

 

Supplemental disclosure of cash flow information

 

 

 

 

 

Interest paid

 

$

57,688

 

$

57,371

 

Income taxes paid (refunded)

 

$

411

 

$

(10,776

)

Supplemental disclosure of non-cash transactions

 

 

 

 

 

Non-cash contribution of capital by controlling interest holder

 

$

602

 

$

 

Non-cash contribution of capital by noncontrolling interest holder

 

$

 

$

694

 

Non-cash deconsolidation of noncontrolling interest

 

$

(64

)

$

 

Accounts payable related to acceptance and delivery of medical equipment

 

$

 

$

2,063

 

Finance obligation related to real estate projects

 

$

3,756

 

$

17,866

 

Derecognition of finance obligation related to real estate projects

 

$

(72,117

)

$

 

Non-cash purchase of noncontrolling interest in a joint venture

 

$

(475

)

$

 

Non-cash use of vendor credit

 

$

2,027

 

$

 

Reduction in goodwill due to purchase price adjustment

 

$

 

$

188

 

Recorded noncash distribution receivable and equity contribution payable from equity investee

 

$

 

$

301

 

Recorded accounts payable related to the final purchase adjustment for an equity investee

 

$

 

$

1,900

 

 



 

RADIATION THERAPY SERVICES HOLDINGS, INC.

KEY OPERATING STATISTICS

(unaudited)

 

 

 

Three Months Ended

 

 

 

Years Ended

 

 

 

 

 

December 31,

 

%

 

December 31,

 

%

 

 

 

2010

 

2009

 

Change

 

2010

 

2009

 

Change

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Number of treatment days

 

63

 

64

 

 

 

254

 

255

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Total RVU’s - freestanding centers

 

2,678,540

 

2,688,604

 

-0.4

%

10,833,260

 

10,818,119

 

0.1

%

 

 

 

 

 

 

 

 

 

 

 

 

 

 

RVU’s per day - freestanding centers

 

42,517

 

42,009

 

1.2

%

42,651

 

42,424

 

0.5

%

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Percentage change in RVU’s per day - freestanding centers - same practice basis

 

-3.0

%

-1.7

%

 

 

-2.1

%

2.7

%

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Number of regions at period end

 

8

 

8

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Number of local markets at period end

 

28

 

28

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Treatment centers - freestanding

 

89

 

90

 

-1.1

%

 

 

 

 

 

 

Treatment centers - hospital / other groups

 

6

 

7

 

-14.3

%

 

 

 

 

 

 

 

 

95

 

97

 

-2.1

%

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Days sales outstanding at quarter end

 

41

 

44

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Percentage change in freestanding revenues - same practice basis

 

-3.7

%

-5.5

%

 

 

-3.6

%

-3.1

%

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Net patient service revenue - professional services only (in thousands)

 

$

38,674

 

$

31,493

 

 

 

$

143,487

 

$

129,909