Attached files
file | filename |
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EX-31.1 - EXHIBIT 31.1 - IASIS Healthcare LLC | c17020exv31w1.htm |
EX-31.2 - EXHIBIT 31.2 - IASIS Healthcare LLC | c17020exv31w2.htm |
Table of Contents
UNITED STATES
SECURITIES AND EXCHANGE COMMISSION
SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
FORM 10-Q
(Mark One)
þ | QUARTERLY REPORT PURSUANT TO SECTION 13 OR 15(d) OF THE SECURITIES EXCHANGE ACT OF 1934 |
For the quarterly period ended March 31, 2011
OR
o | TRANSITION REPORT PURSUANT TO SECTION 13 OR 15(d) OF THE SECURITIES EXCHANGE ACT OF 1934 |
For the transition period from to .
COMMISSION FILE NUMBER: 333-117362
IASIS HEALTHCARE LLC
(Exact name of registrant as specified in its charter)
DELAWARE | 20-1150104 | |
(State or other jurisdiction of | (I.R.S. Employer | |
incorporation or organization) | Identification No.) | |
DOVER CENTRE | ||
117 SEABOARD LANE, BUILDING E | ||
FRANKLIN, TENNESSEE | 37067 | |
(Address of principal executive offices) | (Zip Code) |
(615) 844-2747
(Registrants telephone number, including area code)
(Registrants telephone number, including area code)
Not Applicable
(Former name, former address and former fiscal year, if changed since last report)
(Former name, former address and former fiscal year, if changed since last report)
Indicate by check mark whether the registrant (1) has filed all reports required to be filed
by Section 13 or 15(d) of the Securities Exchange Act of 1934 during the preceding 12 months (or
for such shorter period that the registrant was required to file such reports), and (2) has been
subject to such filing requirements for the past 90 days. YES þ NO o
Indicate by check mark whether the registrant has submitted electronically and posted on its
corporate Web site, if any, every Interactive Data File required to be submitted and posted
pursuant to Rule 405 of Regulation S-T (§232.405 of this chapter) during the preceding 12 months
(or for such shorter period that the registrant was required to submit and post such files). YES
o NO o
Indicate by check mark whether the registrant is a large accelerated filer, an accelerated
filer, a non-accelerated filer, or a smaller reporting company. See the definitions of large
accelerated filer, accelerated filer and smaller reporting company in Rule 12b-2 of the
Exchange Act.
Large accelerated filer o | Accelerated filer o | Non-accelerated filer þ | Smaller reporting company o |
Indicate by check mark whether the registrant is a shell company (as defined in Rule 12b-2 of
the Exchange Act). YES o NO þ
As of May 16, 2011, 100% of the registrants common interests outstanding (all of which are
privately owned and are not traded on any public market) were owned by IASIS Healthcare
Corporation, its sole member.
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Exhibit 4.1 |
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Exhibit 4.2 |
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Exhibit 4.3 |
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Exhibit 10.1 |
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Exhibit 31.1 | ||||||||
Exhibit 31.2 |
i
Table of Contents
PART I.
FINANCIAL INFORMATION
FINANCIAL INFORMATION
Item 1. | Financial Statements |
IASIS HEALTHCARE LLC
CONDENSED CONSOLIDATED BALANCE SHEETS
(In Thousands)
March 31, | September 30, | |||||||
2011 | 2010 | |||||||
(Unaudited) | ||||||||
ASSETS |
||||||||
Current assets: |
||||||||
Cash and cash equivalents |
$ | 178,616 | $ | 144,511 | ||||
Accounts receivable, less allowance for doubtful accounts of
$138,815 and $125,406 at March 31, 2011 and September 30,
2010, respectively |
251,147 | 209,173 | ||||||
Inventories |
59,050 | 53,842 | ||||||
Deferred income taxes |
29,289 | 15,881 | ||||||
Prepaid expenses and other current assets |
60,831 | 65,340 | ||||||
Total current assets |
578,933 | 488,747 | ||||||
Property and equipment, net |
1,002,090 | 985,291 | ||||||
Goodwill |
801,275 | 718,243 | ||||||
Other intangible assets, net |
34,067 | 27,000 | ||||||
Deposit for acquisition |
7,000 | 97,891 | ||||||
Other assets, net |
33,899 | 36,022 | ||||||
Total assets |
$ | 2,457,264 | $ | 2,353,194 | ||||
LIABILITIES AND EQUITY |
||||||||
Current liabilities: |
||||||||
Accounts payable |
$ | 89,583 | $ | 78,931 | ||||
Salaries and benefits payable |
43,181 | 38,110 | ||||||
Accrued interest payable |
12,477 | 12,536 | ||||||
Medical claims payable |
106,950 | 111,373 | ||||||
Other accrued expenses and other current liabilities |
124,508 | 106,614 | ||||||
Current portion of long-term debt and capital lease obligations |
7,675 | 6,691 | ||||||
Total current liabilities |
384,374 | 354,255 | ||||||
Long-term debt and capital lease obligations |
1,047,852 | 1,044,887 | ||||||
Deferred income taxes |
109,623 | 109,272 | ||||||
Other long-term liabilities |
71,043 | 60,162 | ||||||
Non-controlling interests with redemption rights |
89,265 | 72,112 | ||||||
Equity: |
||||||||
Members equity |
745,275 | 702,135 | ||||||
Non-controlling interests |
9,832 | 10,371 | ||||||
Total equity |
755,107 | 712,506 | ||||||
Total liabilities and equity |
$ | 2,457,264 | $ | 2,353,194 | ||||
See accompanying notes.
1
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IASIS HEALTHCARE LLC
CONDENSED CONSOLIDATED STATEMENTS OF OPERATIONS
(UNAUDITED)
(In Thousands)
Quarter Ended | Six Months Ended | |||||||||||||||
March 31, | March 31, | |||||||||||||||
2011 | 2010 | 2011 | 2010 | |||||||||||||
Net revenue: |
||||||||||||||||
Acute care revenue |
$ | 488,449 | $ | 437,574 | $ | 959,588 | $ | 862,234 | ||||||||
Premium revenue |
189,960 | 186,948 | 392,152 | 391,245 | ||||||||||||
Total net revenue |
678,409 | 624,522 | 1,351,740 | 1,253,479 | ||||||||||||
Costs and expenses: |
||||||||||||||||
Salaries and benefits (includes stock-based
compensation of $538, $2,128, $1,034 and $2,249,
respectively) |
196,036 | 174,171 | 385,949 | 344,653 | ||||||||||||
Supplies |
77,924 | 68,425 | 154,360 | 133,834 | ||||||||||||
Medical claims |
157,416 | 160,094 | 328,750 | 338,661 | ||||||||||||
Other operating expenses |
103,350 | 88,683 | 200,476 | 173,275 | ||||||||||||
Provision for bad debts |
54,801 | 45,536 | 114,415 | 93,485 | ||||||||||||
Rentals and leases |
11,289 | 10,145 | 22,455 | 20,420 | ||||||||||||
Interest expense, net |
16,510 | 16,622 | 33,387 | 33,354 | ||||||||||||
Depreciation and amortization |
24,584 | 24,025 | 48,630 | 47,902 | ||||||||||||
Management fees |
1,250 | 1,250 | 2,500 | 2,500 | ||||||||||||
Total costs and expenses |
643,160 | 588,951 | 1,290,922 | 1,188,084 | ||||||||||||
Earnings from continuing operations before gain (loss)
on disposal of assets and income taxes |
35,249 | 35,571 | 60,818 | 65,395 | ||||||||||||
Gain (loss) on disposal of assets, net |
540 | (161 | ) | 885 | (57 | ) | ||||||||||
Earnings from continuing operations before income taxes |
35,789 | 35,410 | 61,703 | 65,338 | ||||||||||||
Income tax expense |
13,500 | 13,270 | 22,689 | 23,861 | ||||||||||||
Net earnings from continuing operations |
22,289 | 22,140 | 39,014 | 41,477 | ||||||||||||
Earnings (loss) from discontinued operations, net of
income taxes |
(2,846 | ) | (25 | ) | (6,054 | ) | 21 | |||||||||
Net earnings |
19,443 | 22,115 | 32,960 | 41,498 | ||||||||||||
Net earnings attributable to non-controlling interests |
(2,417 | ) | (2,033 | ) | (4,188 | ) | (4,061 | ) | ||||||||
Net earnings attributable to IASIS Healthcare LLC |
$ | 17,026 | $ | 20,082 | $ | 28,772 | $ | 37,437 | ||||||||
See accompanying notes.
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IASIS HEALTHCARE LLC
CONDENSED CONSOLIDATED STATEMENT OF EQUITY
(UNAUDITED)
(In Thousands)
Non-controlling | |||||||||||||||||
Interests with | Non- | ||||||||||||||||
Redemption | Members | controlling | |||||||||||||||
Rights | Equity | Interests | Total Equity | ||||||||||||||
Balance at September 30, 2010 |
$ | 72,112 | $ | 702,135 | $ | 10,371 | $ | 712,506 | |||||||||
Net earnings |
4,134 | 28,772 | 54 | 28,826 | |||||||||||||
Distributions to non-controlling
interests |
(5,603 | ) | | (86 | ) | (86 | ) | ||||||||||
Repurchase of non-controlling
interests |
(118 | ) | | (507 | ) | (507 | ) | ||||||||||
Acquisition related adjustments to redemption value of non-controlling interests with redemption rights |
25,936 | | | | |||||||||||||
Stock-based compensation |
| 1,034 | | 1,034 | |||||||||||||
Other comprehensive income |
| 1,698 | | 1,698 | |||||||||||||
Contribution from parent company
related to tax benefit from
Holdings Senior PIK Loans
interest |
| 4,440 | | 4,440 | |||||||||||||
Adjustment to redemption value of
non-controlling interests with
redemption rights |
(7,196 | ) | 7,196 | | 7,196 | ||||||||||||
Balance at March 31, 2011 |
$ | 89,265 | $ | 745,275 | $ | 9,832 | $ | 755,107 | |||||||||
See accompanying notes.
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IASIS HEALTHCARE LLC
CONDENSED CONSOLIDATED STATEMENTS OF CASH FLOWS
(UNAUDITED)
(In Thousands)
Six Months Ended | ||||||||
March 31, | ||||||||
2011 | 2010 | |||||||
Cash flows from operating activities |
||||||||
Net earnings |
$ | 32,960 | $ | 41,498 | ||||
Adjustments to reconcile net earnings to net cash provided by operating activities: |
||||||||
Depreciation and amortization |
48,630 | 47,902 | ||||||
Amortization of loan costs |
1,636 | 1,564 | ||||||
Stock-based compensation |
1,034 | 2,249 | ||||||
Deferred income taxes |
2,278 | 19,589 | ||||||
Income tax benefit from stock-based compensation |
| (1,770 | ) | |||||
Income tax benefit from parent company interest |
4,440 | 3,275 | ||||||
Loss (gain) on disposal of assets, net |
(885 | ) | 57 | |||||
Loss (earnings) from discontinued operations, net |
6,054 | (21 | ) | |||||
Changes in operating assets and liabilities, net of the effect of acquisitions and
dispositions: |
||||||||
Accounts receivable, net |
(23,461 | ) | 1,578 | |||||
Inventories, prepaid expenses and other current assets |
4,461 | (6,165 | ) | |||||
Accounts payable, other accrued expenses and other accrued liabilities |
20,562 | 7,010 | ||||||
Net cash provided by operating activities continuing operations |
97,709 | 116,766 | ||||||
Net cash used in operating activities discontinued operations |
(231 | ) | (199 | ) | ||||
Net cash provided by operating activities |
97,478 | 116,567 | ||||||
Cash flows from investing activities |
||||||||
Purchases of property and equipment, net |
(42,234 | ) | (30,187 | ) | ||||
Payments for acquisitions |
(12,804 | ) | | |||||
Proceeds from sale of assets |
150 | 36 | ||||||
Change in other assets, net |
1,639 | 1,013 | ||||||
Net cash used in investing activities |
(53,249 | ) | (29,138 | ) | ||||
Cash flows from financing activities |
||||||||
Payment of debt and capital lease obligations |
(3,810 | ) | (5,138 | ) | ||||
Distribution to parent company in connection with the repurchase of equity, net |
| (124,962 | ) | |||||
Distributions to non-controlling interests |
(5,689 | ) | (5,277 | ) | ||||
Costs paid for the repurchase of non-controlling interests, net |
(625 | ) | (69 | ) | ||||
Net cash used in financing activities |
(10,124 | ) | (135,446 | ) | ||||
Change in cash and cash equivalents |
34,105 | (48,017 | ) | |||||
Cash and cash equivalents at beginning of period |
144,511 | 206,528 | ||||||
Cash and cash equivalents at end of period |
$ | 178,616 | $ | 158,511 | ||||
Supplemental disclosure of cash flow information |
||||||||
Cash paid for interest |
$ | 31,846 | $ | 31,837 | ||||
Cash paid (received) for income taxes, net |
$ | (241 | ) | $ | 6,188 | |||
Supplemental disclosure of non-cash investing and financing activities |
||||||||
Capital lease obligations resulting from acquisitions |
$ | 1,896 | $ | | ||||
See accompanying notes.
4
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IASIS HEALTHCARE LLC
NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (UNAUDITED)
1. ORGANIZATION AND BASIS OF PRESENTATION
The unaudited condensed consolidated financial statements as of and for the quarters and six
months ended March 31, 2011 and 2010, reflect the financial position, results of operations and
cash flows of IASIS Healthcare LLC (IASIS or the Company). The Companys sole member and parent
company is IASIS Healthcare Corporation (Holdings or IAS).
IASIS owns and operates medium-sized acute care hospitals in high-growth urban and suburban
markets. At March 31, 2011, the Company owned or leased 17 acute care hospital facilities and one
behavioral health hospital facility, with a total of 3,570 licensed beds, located in seven regions:
| Salt Lake City, Utah; |
| Phoenix, Arizona; |
| Tampa-St. Petersburg, Florida; |
| four cities in Texas, including San Antonio; |
| Las Vegas, Nevada; |
| West Monroe, Louisiana; and |
| Woodland Park, Colorado. |
The Company also owns and operates Health Choice Arizona, Inc. (Health Choice or the
Plan), a Medicaid and Medicare managed health plan in Phoenix, Arizona.
The unaudited condensed consolidated financial statements have been prepared in accordance
with U.S. generally accepted accounting principles (GAAP) for interim financial reporting and in
accordance with Rule 10-01 of Regulation S-X. Accordingly, they do not include all of the
information and notes required by GAAP for complete financial statements. The condensed
consolidated balance sheet of the Company at September 30, 2010, has been derived from the audited
consolidated financial statements at that date, but does not include all of the information and
footnotes required by GAAP for complete financial statements. For further information, refer to the
consolidated financial statements and footnotes thereto included in the Companys Annual Report on
Form 10-K for the fiscal year ended September 30, 2010.
In the opinion of management, the accompanying unaudited condensed consolidated financial
statements contain all material 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.
Principles of Consolidation
The unaudited condensed consolidated financial statements include all subsidiaries and
entities under common control of the Company. Control is generally defined by the Company as
ownership of a majority of the voting interest of an entity. In addition, control is demonstrated
in most instances when the Company is the sole general partner in a limited partnership.
Significant intercompany transactions have been eliminated.
Use of Estimates
The preparation of the financial statements in conformity with GAAP requires management to
make estimates and assumptions that affect the amounts reported in the accompanying unaudited
condensed consolidated financial statements and footnotes. Actual results could differ from those
estimates.
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IASIS HEALTHCARE LLC
NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (UNAUDITED)
NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (UNAUDITED)
Reclassifications
Certain prior year amounts have been reclassified to conform to the current year presentation.
These reclassifications have no impact on the Companys total assets or total liabilities and
equity.
General and Administrative
The majority of the Companys expenses are cost of revenue items. Costs that could be
classified as general and administrative by the Company would include the IASIS corporate office
costs, which were $10.8 million and $10.3 million for the quarters ended March 31, 2011 and 2010,
respectively, and $20.8 million and $19.3 million for the six months ended March 31, 2011 and 2010,
respectively.
Subsequent Events Consideration
The Company has evaluated its financial statements and disclosures for the impact of
subsequent events up to the date of filing its quarterly report on Form 10-Q with the Securities
and Exchange Commission.
2. LONG-TERM DEBT AND CAPITAL LEASE OBLIGATIONS
Long-term debt and capital lease obligations consist of the following (in thousands):
March 31, | September 30, | |||||||
2011 | 2010 | |||||||
Senior secured credit facilities |
$ | 567,315 | $ | 570,260 | ||||
Senior subordinated notes |
475,000 | 475,000 | ||||||
Capital leases and other obligations |
13,212 | 6,318 | ||||||
1,055,527 | 1,051,578 | |||||||
Less current maturities |
7,675 | 6,691 | ||||||
$ | 1,047,852 | $ | 1,044,887 | |||||
Senior Secured Credit Facilities
The $854.0 million senior secured credit facilities include: (i) a senior secured term loan of
$439.0 million; (ii) a senior secured delayed draw term loan of $150.0 million; (iii) a senior
secured revolving credit facility of $225.0 million, which includes a $100.0 million sub-limit for
letters of credit; and (iv) a senior secured synthetic letter of credit facility of $40.0 million.
All facilities mature on March 15, 2014, except for the revolving credit facility, which matures on
April 27, 2013. The term loans bear interest at an annual rate of LIBOR plus 2.00% or, at the
Companys option, the administrative agents base rate plus 1.00%. The revolving loans bear
interest at an annual rate of LIBOR plus an applicable margin ranging from 1.25% to 1.75% or, at
the Companys option, the administrative agents base rate plus an applicable margin ranging from
0.25% to 0.75%, such rate in each case depending on the Companys senior secured leverage ratio. A
commitment fee ranging from 0.375% to 0.50% per annum is charged on the undrawn portion of the
senior secured revolving credit facility and is payable in arrears.
Principal under the senior secured term loan is due in equal quarterly installments in an
aggregate annual amount equal to 1.0% of the original principal amount ($439.0 million) during the
first six years thereof, with the balance payable in four equal installments beginning April 2013.
Principal under the senior secured delayed draw term loan is due in equal quarterly installments in
an aggregate annual amount equal to 1.0% of the original principal amount ($150.0 million) until
March 31, 2013, with the balance payable in four equal installments during the final year of the
loan. The senior secured credit facilities are also subject to mandatory prepayment under specific
circumstances, including a portion of excess cash flow, a portion of the net proceeds from an
initial public offering, asset sales, debt issuances and specified casualty events, each subject to
various exceptions.
The senior secured credit facilities are (i) secured by a first mortgage and lien on the real
property and related personal and intellectual property of the Company and pledges of equity
interests in the entities that own such properties and (ii) guaranteed by certain of the Companys
subsidiaries. In addition, the senior secured credit facilities contain certain covenants which,
among other things, limit the incurrence of additional indebtedness, investments, dividends,
transactions with affiliates, asset sales, acquisitions, mergers and consolidations, liens and
encumbrances and other matters customarily restricted in such agreements.
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IASIS HEALTHCARE LLC
NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (UNAUDITED)
NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (UNAUDITED)
At March 31, 2011, amounts outstanding under the Companys senior secured credit facilities
consisted of a $421.4 million term loan and a $145.9 million delayed draw term loan. In addition,
the Company had $39.9 million and $44.7 million in letters of credit outstanding under the
synthetic letter of credit facility and the revolving credit facility, respectively. The weighted
average interest rate of outstanding borrowings under the senior secured credit facilities was 3.2%
and 3.3% for the quarter and six months ended March 31, 2011, respectively.
See Note 12 for
subsequent event discussion regarding the Companys refinancing transaction.
8 3/4% Senior Subordinated Notes
The
Company, together with its wholly owned subsidiary, IASIS Capital Corporation (IASIS
Capital), a holding company with no assets or operations, as issuers, have outstanding $475.0
million aggregate principal amount of 8 3/4% senior subordinated notes due
2014 (the 8 3/4% notes). The 8 3/4% notes are general
unsecured senior subordinated obligations and are subordinated in right of payment to all existing
and future senior debt of the Company. The Companys existing domestic subsidiaries, other than
certain non-guarantor subsidiaries, which include Health Choice and the Companys non-wholly owned
subsidiaries, are guarantors of the 8 3/4% notes. The 8
3/4% notes are effectively subordinated to all of the issuers and the
guarantors secured debt to the extent of the value of the assets securing the debt and are
structurally subordinated to all liabilities and commitments (including trade payables and capital
lease obligations) of the Companys subsidiaries that are not guarantors of the 8
3/4% notes.
See Note 12 for subsequent event discussion regarding the
Companys refinancing transaction.
Holdings Senior Paid-in-Kind Loans
IAS has outstanding unsecured Senior Paid-in-Kind (PIK) Loans, which were used to repurchase
certain preferred equity from its stockholders in fiscal 2007. The Holdings Senior PIK Loans mature
June 15, 2014, and bear interest at an annual rate equal to LIBOR plus 5.25%. At March 31, 2011,
the outstanding balance of the Holdings Senior PIK Loans was $400.9 million, which includes $100.9
million of interest that has accrued to the principal of these loans since the date of issuance.
In June 2012, the Holdings Senior PIK Loans, which rank behind the Companys existing debt, will
convert to cash-pay, at which time all accrued interest becomes payable.
See Note 12 for
subsequent event discussion regarding the Companys refinancing transaction.
3. INTEREST RATE SWAPS
Effective March 2, 2009, the Company executed interest rate swap agreements with Citibank,
N.A. and Wachovia Bank, N.A., as counterparties, with notional amounts totaling $425.0 million, of which $225.0 million expired on February 28, 2011.
As of March 31, 2011, two interest rate swap agreements remained in effect, with each agreement
having notional amounts of $100.0 million and expiring on February 29, 2012. The Company entered
into its interest rate swap arrangements to mitigate the floating interest rate risk on a portion
of its outstanding variable rate debt. Under the remaining agreements, the Company is required to make
monthly fixed rate payments to the counterparties, as calculated on the applicable notional
amounts, at an annual fixed rate of 2.0%. The counterparties are obligated to make monthly floating
rate payments to the Company based on the one-month LIBOR rate for the same referenced notional
amount.
The Company accounts for its interest rate swaps in accordance with the provisions of Financial Accounting Standards Board
(FASB)
authoritative guidance regarding accounting for derivative instruments and hedging activities,
which also includes enhanced disclosure requirements. In accordance with these provisions, the
Company has designated its interest rate swaps as a cash flow hedge instrument. The Company
assesses the effectiveness of this cash flow hedge on a quarterly basis, with any ineffectiveness
being measured using the hypothetical derivative method. The Company completed an assessment of its
cash flow hedge instrument during the quarters and six months ended March 31, 2011 and 2010, and
determined its hedging instruments to be highly effective in all periods. Accordingly, no gain or
loss resulting from hedging ineffectiveness is reflected in the Companys accompanying unaudited
condensed consolidated statements of operations.
The Company applies the provisions of FASB authoritative guidance regarding fair value
measurements, which provides a single definition of fair value, establishes a framework for
measuring fair value, and expands disclosures concerning fair value measurements. The Company
applies these provisions to the valuation and disclosure of its interest rates swaps. This
authoritative guidance establishes a three-tier fair value hierarchy, which prioritizes the inputs
used in measuring fair value. These tiers include: (i) Level 1, which is defined as quoted prices
in active markets that can be accessed at the measurement date; (ii) Level 2, which is defined as
inputs other than quoted
prices in active markets that are observable, either directly or indirectly; and (iii) Level
3, which is defined as unobservable inputs resulting from the existence of little or no market
data, therefore potentially requiring an entity to develop its own assumptions.
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IASIS HEALTHCARE LLC
NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (UNAUDITED)
NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (UNAUDITED)
The Company determines the fair value of its interest rate swaps in a manner consistent with
that used by market participants in pricing hedging instruments, which includes using a discounted
cash flow analysis based upon the terms of the agreements, the impact of the one-month forward
LIBOR curve and an evaluation of credit risk. Given the use of observable market assumptions and
the consideration of credit risk, the Company has categorized the valuation of its interest rate
swaps as Level 2.
The fair value of the Companys interest rate swaps at March 31, 2011 and September 30, 2010,
reflect liability balances of $3.0 million and $5.7 million, respectively, and are included in
other long-term liabilities in the accompanying unaudited condensed consolidated balance sheets.
The fair value of the Companys interest rate swaps reflects a liability because the effect of the
forward LIBOR curve on future interest payments results in less interest due to the Company under
the variable rate component included in the interest rate swap agreements, as compared to the
amount due the Companys counterparties under the fixed interest rate component. Any change in the
fair value of the Companys interest rate swaps, net of income taxes, is included in other
comprehensive loss as a component of members equity in the accompanying unaudited condensed
consolidated balance sheets.
4. ACQUISITIONS
Effective October 1, 2010, the Company acquired Brim Holdings, Inc. (Brim) in a
cash-for-stock transaction valued at $95.0 million, subject to changes in net working capital. Brim
operates Wadley Regional Medical Center, a 370-licensed bed acute care hospital facility located in
Texarkana, Texas, and Pikes Peak Regional Hospital, a 15-licensed bed critical access acute care
hospital facility, in Woodland Park, Colorado, through operating lease agreements with separate
parties. The Brim acquisition was accounted for as a business combination, which requires the
Company to allocate the purchase price of these facilities to assets acquired or liabilities
assumed based on their fair values. The excess of the purchase price allocation over those fair
values is recorded as goodwill. The Companys third-party valuation of acquired assets has been
finalized, and the appropriate fair values have been reflected in the accompanying unaudited
condensed consolidated balance sheet.
See
Note 12 for subsequent event discussion regarding the Companys
recent acquisition of St. Joseph Medical Center in Houston, Texas.
5. GOODWILL
The following table presents the changes in the carrying amount of goodwill (in thousands):
Acute | Health | |||||||||||
Care | Choice | Total | ||||||||||
Balance at September 30, 2010 |
$ | 712,486 | $ | 5,757 | $ | 718,243 | ||||||
Brim acquisition |
77,762 | | 77,762 | |||||||||
Other acquisitions |
5,270 | | 5,270 | |||||||||
Balance at March 31, 2011 |
$ | 795,518 | $ | 5,757 | $ | 801,275 | ||||||
For the six months ended March 31, 2011, goodwill increased by $83.0 million as a result of
the purchase of Brim and other entities. See Note 4 for more details regarding the fair value
assessment of acquired assets and liabilities.
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NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (UNAUDITED)
NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (UNAUDITED)
6. COMPREHENSIVE INCOME
Comprehensive income consists of two components: net earnings and other comprehensive income.
Other comprehensive income refers to revenues, expenses, gains and losses that under the FASB
authoritative guidance related to accounting for comprehensive income are recorded as elements of
equity, but are excluded from net earnings. The following table presents the components of
comprehensive income, net of income taxes (in thousands):
Quarter Ended | Six Months Ended | |||||||||||||||
March 31, | March 31, | |||||||||||||||
2011 | 2010 | 2011 | 2010 | |||||||||||||
Net earnings |
$ | 19,443 | $ | 22,115 | $ | 32,960 | $ | 41,498 | ||||||||
Change in fair value of interest rate swaps |
1,148 | (1,439 | ) | 2,708 | (1,148 | ) | ||||||||||
Change in income tax benefit (expense) |
(433 | ) | 539 | (1,010 | ) | 428 | ||||||||||
Comprehensive income |
$ | 20,158 | $ | 21,215 | $ | 34,658 | $ | 40,778 | ||||||||
The components of accumulated other comprehensive loss, net of income taxes, are as follows (in thousands):
March 31, | September 30, | |||||||
2011 | 2010 | |||||||
Fair value of interest rate swaps |
$ | (2,999 | ) | $ | (5,707 | ) | ||
Income tax benefit |
1,118 | 2,128 | ||||||
Accumulated other comprehensive loss |
$ | (1,881 | ) | $ | (3,579 | ) | ||
7. DISTRIBUTION TO PARENT
During fiscal 2010, the Company distributed $125.0 million, net of a $1.8 million income tax
benefit, to IAS to fund the repurchase of certain shares of its outstanding preferred stock and
cancel certain vested rollover options to purchase its common stock. The holder of the IAS
preferred stock is represented by an investor group led by TPG, JLL Partners and Trimaran Fund
Management. The repurchase of preferred stock, which included accrued and outstanding dividends,
and the cancellation of rollover options, were funded by the Companys excess cash on hand. The
cancellation of the rollover options, which were associated with the Companys 2004
recapitalization, resulted in the Company recognizing $2.0 million in stock-based compensation
during the quarter ended March 31, 2010.
See Note 12 for subsequent event discussion regarding the Companys distribution to IAS in
connection with its refinancing transaction.
8. COMMITMENTS AND CONTINGENCIES
Net Revenue
The calculation of appropriate payments from the Medicare and Medicaid programs, as well as
terms governing agreements with other third-party payors, is complex and subject to interpretation.
Final determination of amounts earned under the Medicare and Medicaid programs often occurs
subsequent to the year in which services are rendered because of audits by the programs, rights of
appeal and the application of numerous technical provisions. In the opinion of management, adequate
provision has been made for adjustments that may result from such routine audits and appeals.
Professional, General and Workers Compensation Liability Risks
The Company is subject to claims and legal actions in the ordinary course of business,
including but not limited to claims relating to patient treatment and personal injuries. To cover
these types of claims, the Company maintains professional and general liability insurance in excess
of self-insured retentions through a commercial insurance carrier in amounts that the Company
believes to be sufficient for its operations, although, potentially, some claims may exceed the
scope of coverage in effect. Plaintiffs in these matters may request punitive or other damages that
may not be covered by insurance. The Company is currently not a party to any such proceedings that,
in the Companys opinion, would have a material adverse effect on the Companys business, financial
condition or results of operations. The Company expenses an estimate of the costs it expects to
incur under the self-insured retention exposure for professional and general liability claims using
historical claims data, demographic factors, severity factors, current incident logs and other
actuarial analysis. At March 31, 2011 and September 30, 2010, the Companys professional and
general liability accrual for asserted and unasserted claims totaled $50.3 million and $41.6
million, respectively. The semi-annual valuations from the Companys independent actuary for
professional
and general liability losses resulted in a change in related estimates for prior periods which
increased insurance expense by $948,000 during the quarter and six months ended March 31, 2011,
compared to a decrease of $1.9 million during the same prior year periods.
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NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (UNAUDITED)
NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (UNAUDITED)
The Company is subject to claims and legal actions in the ordinary course of business relative
to workers compensation matters. To cover these types of claims, the Company maintains workers
compensation insurance coverage with a self-insured retention. The Company accrues the costs of
workers compensation claims based upon estimates derived from its claims experience. The
semi-annual valuations from the Companys independent actuary for workers compensation losses
resulted in a change in related estimates for prior periods which increased benefits expense by
$1.2 million during the quarter and six months ended March 31, 2011, compared to an increase of
$801,000 during the same prior year periods.
Health Choice
Health Choice has entered into capitated contracts whereby the Plan provides managed
healthcare services in exchange for fixed periodic and supplemental payments from the Arizona
Health Care Cost Containment System (AHCCCS) and the Centers for Medicare & Medicaid Services
(CMS). These services are provided regardless of the actual costs incurred to provide these
services. The Company receives reinsurance and other supplemental payments from AHCCCS to cover
certain costs of healthcare services that exceed certain thresholds. The Company believes that
current capitated payments received, together with reinsurance and other supplemental payments, are
sufficient to pay for the services Health Choice is obligated to deliver. As of March 31, 2011, the
Company has provided a performance guaranty in the form of letters of credit totaling $48.3 million
for the benefit of AHCCCS to support Health Choices obligations under its contract to provide and
pay for the healthcare services. The amount of the performance guaranty is generally based, in
part, upon the membership in the Plan and the related capitation revenue paid to Health Choice.
Acquisitions
The Company has acquired and in the future may choose to acquire businesses with prior
operating histories. Such businesses may have unknown or contingent liabilities, including
liabilities for failure to comply with healthcare laws and regulations, such as billing and
reimbursement, fraud and abuse and similar anti-referral laws. Although the Company has procedures
designed to conform business practices to its policies following the completion of any acquisition,
there can be no assurance that the Company will not become liable for previous activities of prior
owners that may later be asserted to be improper by private plaintiffs or government agencies.
Although the Company generally seeks to obtain indemnification from prospective sellers covering
such matters, there can be no assurance that any such matter will be covered by indemnification, or
if covered, that such indemnification will be adequate to cover potential losses and fines.
Other
On March 31, 2008, the United States District Court for the District of Arizona (District
Court) dismissed with prejudice the qui tam complaint against IAS, our parent company. The qui tam
action sought monetary damages and civil penalties under the federal False Claims Act (FCA) and
included allegations that certain business practices related to physician relationships and the
medical necessity of certain procedures resulted in the submission of claims for reimbursement in
violation of the FCA. The case dates back to March 2005 and became the subject of a subpoena by the
Office of Inspector General in September 2005. In August 2007, the case was unsealed and the U.S.
Department of Justice (DOJ) declined to intervene. The District Court dismissed the case from the bench
at the conclusion of oral arguments on IAS motion to dismiss. On April 21, 2008, the District
Court issued a written order dismissing the case with prejudice and entering formal judgment for
IAS and denying as moot IAS motions related to the relators misappropriation of information
subject to a claim of attorney-client privilege by IAS. Both parties appealed. On August 12, 2010,
United States Court of Appeals for the Ninth Circuit reversed the District Courts dismissal of the
qui tam complaint and the District Courts denial of IAS motions concerning the relators
misappropriation of documents and ordered that the qui tam relator be allowed leave to file a Third
Amended Complaint and for the District Court to consider IAS motions concerning the relators
misappropriation of documents. The District Court ordered the qui tam relator to file his Third
Amended Complaint by November 22, 2010, and set a
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IASIS HEALTHCARE LLC
NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (UNAUDITED)
NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (UNAUDITED)
schedule for the filing of motions related to the
relators misappropriation of documents. On October 20, 2010, the qui tam relator filed a motion to transfer this action to the United States
District Court for the Eastern District of Texas. On November 22,
2010, the relator filed his Third Amended Complaint. On January 3, 2011, IAS filed its renewed
motion for sanctions concerning the relators misappropriation of documents and, on January 14,
2011, IAS filed its motion to dismiss the relators Third Amended Complaint. On May 4, 2011, the
District Court in Arizona heard oral arguments on all pending motions, including IAS motion to
dismiss and renewed motions for sanctions and the relators motion to transfer the action to the
United States District Court for the Eastern District of Texas. The District Court dismissed
relators motion to transfer and took all other motions under advisement at the conclusion of oral
argument. While the District Court is expected to rule quickly, IAS anticipates that it could take
90 days or more for the District Court to issue its final opinion on IAS motion to dismiss and
renewed motion for sanctions. If the qui tam action were to be resolved in a manner unfavorable to
IAS, it could have a material adverse effect on the Companys business, financial condition
and results of operations, including exclusion from the Medicare and Medicaid programs. In
addition, the Company may incur material fees, costs and expenses in connection with defending the
qui tam action.
The Companys facilities obtain clinical and administrative services from a variety of
vendors. One vendor, a medical practice that furnished cardiac catheterization services under
contractual arrangements at Mesa General Hospital and St. Lukes Medical Center through March 31,
2008 and May 31, 2008, respectively, has asserted that, because of deferred fee adjustments that it
claims are due under these arrangements, it is owed additional amounts for services rendered since
April 1, 2006 at both facilities. The Company and the vendor were unable to reach an agreement with
respect to the amount of the fee adjustment, if any, that was contractually required, nor with
respect to an appropriate methodology for determining such amount. On September 30, 2008, the
vendor filed a state court complaint for an aggregate adjustment in excess of the amount accrued by
the Company, in addition to certain tort claims. On March 20, 2009, the Company filed a Motion to
Dismiss and in the alternative to Compel Arbitration. On July 27, 2009, the court granted the
Companys Motion to Compel Arbitration on the grounds that the issues are to be determined by
binding arbitration. On December 24, 2010, after conducting the arbitration hearing, the
arbitration panel issued its decision rejecting the fees sought by the vendor, but did not adopt
the fees proposed by the Company. The arbitration panel required both parties to agree upon a
settlement amount, based on the arbitration panels approved methodology, by January 21, 2011. The
Company has reviewed the methodology required by decision in binding
arbitration and has determined that it
will result in a payment to the vendor of approximately $15.2 million, which includes $5.8 million in pre-judgement interest and legal fees. Of the additional liability
resulting from the arbitration panels decision, $9.3 million ($6.1 million, net of income taxes)
is included in discontinued operations, related to the closure of Mesa General Hospital, for the six
months ended March 31, 2011. The arbitration panel has not rendered a decision with respect to any
of the vendors tort claims, which are expected to be addressed in separate proceedings. The Company
will continue to defend its interests in connection with this arbitration proceeding, but expresses
no opinion as to the outcome of matters not yet decided by the arbitration panel.
In November 2010, the DOJ sent a letter to IAS requesting a 12-month
tolling agreement in connection with an investigation into Medicare claims submitted by our
hospitals in connection with the implantation of implantable cardioverter defibrillators (ICDs)
during the period 2003 to the present. At that time, neither the precise number of procedures,
number of claims nor the hospitals involved were identified by the DOJ. The Company understands
that the government is conducting a national initiative with respect to ICD procedures involving a
number of healthcare providers and is seeking information in order to determine if ICD implantation
procedures were performed in accordance with Medicare coverage requirements. On January 11, 2011,
IAS entered into the tolling agreement with the DOJ and, subsequently, the DOJ has provided IAS
with a list of 194 procedures involving ICDs at 14 hospitals which are the subject of further
medical necessity review by the DOJ. The Company is cooperating fully with the government and, to
date, the DOJ has not asserted any claim against the Companys hospitals.
9. RECENTLY ISSUED ACCOUNTING PRONOUNCEMENTS
In August 2010, the FASB issued Accounting Standards
Update (ASU) No. 2010-23, Health Care Entities (Topic 954): Measuring Charity Care for
Disclosure. Due to the lack of comparability existing as a result of the use of either revenue or
cost as the basis for disclosure of charity care, this ASU standardizes cost as the basis for
charity care disclosures and specifies the elements of cost to be used in charity care disclosures.
ASU 2010-23 is effective for the Companys fiscal year beginning October 1, 2011, and is not
expected to significantly impact the Companys financial statement disclosures.
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NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (UNAUDITED)
NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (UNAUDITED)
Also
in August 2010, the FASB issued ASU No. 2010-24, Health
Care Entities (Topic 954):
Presentation of Insurance Claims and Related Insurance Recoveries. This ASU eliminates the practice of
netting claim liabilities with expected related insurance recoveries for balance sheet presentation. Claim
liabilities are to be determined with no regard for recoveries and presented gross. Expected recoveries are
presented separately. ASU 2010-24 is effective for fiscal years, and interim periods within those years,
beginning after December 15, 2010. ASU 2010-24 is effective for the Companys fiscal year beginning
October 1, 2011, and is not expected to significantly impact the Companys financial position, results of
operations or cash flows.
In October 2010, the FASB issued ASU No. 2010-26, Financial Services Insurance (Topic
944): Accounting for Costs Associated with Acquiring or Renewing Insurance Contracts. ASU 2010-26
provides guidance on accounting for deferred policy acquisition costs of internal replacements of
insurance and investment contracts. The amendments in this ASU specify that certain costs incurred
in the successful acquisition of new and renewal contracts should be capitalized. Those costs
include incremental direct costs of contract acquisition that result directly from and are
essential to the contract transaction(s) and would not have been incurred by the insurance entity
had the contract transaction(s) not occurred. ASU 2010-26 is effective for the Companys fiscal
year beginning October 1, 2012, with early adoption permitted, and is not expected to significantly
impact the Companys financial position, results of operations or cash flows.
In December 2010, the FASB issued ASU No. 2010-28, IntangiblesGoodwill and Other (Topic
350): When to Perform Step 2 of the Goodwill Impairment Test for Reporting Units with Zero or
Negative Carrying Amounts. ASU 2010-28 requires Step 2 of the impairment test be performed in
circumstances where the carrying amount of a reporting unit is zero or negative and there are
qualitative factors that indicate it is more likely than not that a goodwill impairment exists. The
ASU is effective for fiscal years, and interim periods within those years, beginning after December
15, 2010. ASU 2010-28 is effective for the Companys fiscal year beginning October 1, 2011, and is not expected to significantly impact the Companys financial position,
results of operations or cash flows.
In December 2010, the FASB issued ASU No. 2010-29, Business Combinations (Topic 805):
Disclosure of Supplementary Pro Forma Information for Business Combinations. ASU 2010-29 clarifies
that, if a reporting entity presents comparative financial statements, the pro forma revenue and
earnings of the combined entity should be reported as though the business combinations that
occurred during the current year had occurred as of the beginning of the comparable prior annual
reporting period. The ASU is effective prospectively for business combinations for which the
acquisition date is on or after the beginning of the first annual reporting period beginning on or
after December 15, 2010. ASU No. 2010-29 is effective for the Companys
fiscal year beginning October 1, 2011, with early adoption permitted, and is an accounting
principle which clarifies disclosure requirements, and is not expected to significantly impact the
Companys financial statement disclosures.
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NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (UNAUDITED)
NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (UNAUDITED)
10. SEGMENT AND GEOGRAPHIC INFORMATION
The Companys acute care hospitals and related healthcare businesses are similar in their
activities and the economic environments in which they operate (i.e. urban and suburban markets).
Accordingly, the Companys reportable operating segments consist of (1) acute care hospitals and
related healthcare businesses, collectively Acute Care, and (2) Health Choice. The following is a
financial summary by business segment for the periods indicated (in thousands):
For the Quarter Ended March 31, 2011 | ||||||||||||||||
Acute Care | Health Choice | Eliminations | Consolidated | |||||||||||||
Acute care revenue |
$ | 488,449 | $ | | $ | | $ | 488,449 | ||||||||
Premium revenue |
| 189,960 | | 189,960 | ||||||||||||
Revenue between segments |
2,807 | | (2,807 | ) | | |||||||||||
Net revenue |
491,256 | 189,960 | (2,807 | ) | 678,409 | |||||||||||
Salaries and benefits
(excludes stock-based
compensation) |
190,325 | 5,173 | | 195,498 | ||||||||||||
Supplies |
77,872 | 52 | | 77,924 | ||||||||||||
Medical claims |
| 160,223 | (2,807 | ) | 157,416 | |||||||||||
Other operating expenses |
96,425 | 6,925 | | 103,350 | ||||||||||||
Provision for bad debts |
54,801 | | | 54,801 | ||||||||||||
Rentals and leases |
10,891 | 398 | | 11,289 | ||||||||||||
Adjusted EBITDA (1) |
60,942 | 17,189 | | 78,131 | ||||||||||||
Interest expense, net |
16,510 | | | 16,510 | ||||||||||||
Depreciation and amortization |
23,697 | 887 | | 24,584 | ||||||||||||
Stock-based compensation |
538 | | | 538 | ||||||||||||
Management fees |
1,250 | | | 1,250 | ||||||||||||
Earnings from continuing
operations before gain on
disposal of assets and income
taxes |
18,947 | 16,302 | | 35,249 | ||||||||||||
Gain on disposal of assets, net |
540 | | | 540 | ||||||||||||
Earnings from continuing
operations before income
taxes |
$ | 19,487 | $ | 16,302 | $ | | $ | 35,789 | ||||||||
For the Quarter Ended March 31, 2010 | ||||||||||||||||
Acute Care | Health Choice | Eliminations | Consolidated | |||||||||||||
Acute care revenue |
$ | 437,574 | $ | | $ | | $ | 437,574 | ||||||||
Premium revenue |
| 186,948 | | 186,948 | ||||||||||||
Revenue between segments |
3,336 | | (3,336 | ) | | |||||||||||
Net revenue |
440,910 | 186,948 | (3,336 | ) | 624,522 | |||||||||||
Salaries and benefits
(excludes stock-based
compensation) |
167,096 | 4,947 | | 172,043 | ||||||||||||
Supplies |
68,375 | 50 | | 68,425 | ||||||||||||
Medical claims |
| 163,430 | (3,336 | ) | 160,094 | |||||||||||
Other operating expenses |
82,604 | 6,079 | | 88,683 | ||||||||||||
Provision for bad debts |
45,536 | | | 45,536 | ||||||||||||
Rentals and leases |
9,780 | 365 | | 10,145 | ||||||||||||
Adjusted EBITDA (1) |
67,519 | 12,077 | | 79,596 | ||||||||||||
Interest expense, net |
16,622 | | | 16,622 | ||||||||||||
Depreciation and amortization |
23,137 | 888 | | 24,025 | ||||||||||||
Stock-based compensation |
2,128 | | | 2,128 | ||||||||||||
Management fees |
1,250 | | | 1,250 | ||||||||||||
Earnings from continuing
operations before loss on
disposal of assets and income
taxes |
24,382 | 11,189 | | 35,571 | ||||||||||||
Loss on disposal of assets, net |
(161 | ) | | | (161 | ) | ||||||||||
Earnings from continuing
operations before income
taxes |
$ | 24,221 | $ | 11,189 | $ | | $ | 35,410 | ||||||||
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IASIS HEALTHCARE LLC
NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (UNAUDITED)
NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (UNAUDITED)
For the Six Months Ended March 31, 2011 | ||||||||||||||||
Acute Care | Health Choice | Eliminations | Consolidated | |||||||||||||
Acute care revenue |
$ | 959,588 | $ | | $ | | $ | 959,588 | ||||||||
Premium revenue |
| 392,152 | | 392,152 | ||||||||||||
Revenue between segments |
5,467 | | (5,467 | ) | | |||||||||||
Net revenue |
965,055 | 392,152 | (5,467 | ) | 1,351,740 | |||||||||||
Salaries and benefits
(excludes stock-based
compensation) |
374,719 | 10,196 | | 384,915 | ||||||||||||
Supplies |
154,264 | 96 | | 154,360 | ||||||||||||
Medical claims |
| 334,217 | (5,467 | ) | 328,750 | |||||||||||
Other operating expenses |
187,255 | 13,221 | | 200,476 | ||||||||||||
Provision for bad debts |
114,415 | | | 114,415 | ||||||||||||
Rentals and leases |
21,613 | 842 | | 22,455 | ||||||||||||
Adjusted EBITDA (1) |
112,789 | 33,580 | | 146,369 | ||||||||||||
Interest expense, net |
33,387 | | | 33,387 | ||||||||||||
Depreciation and amortization |
46,848 | 1,782 | | 48,630 | ||||||||||||
Stock-based compensation |
1,034 | | | 1,034 | ||||||||||||
Management fees |
2,500 | | | 2,500 | ||||||||||||
Earnings from continuing
operations before gain on
disposal of assets and income
taxes |
29,020 | 31,798 | | 60,818 | ||||||||||||
Gain on disposal of assets, net |
885 | | | 885 | ||||||||||||
Earnings from continuing
operations before income
taxes |
$ | 29,905 | $ | 31,798 | $ | | $ | 61,703 | ||||||||
Segment assets |
$ | 2,114,294 | $ | 342,970 | $ | 2,457,264 | ||||||||||
Capital expenditures |
$ | 42,187 | $ | 47 | $ | 42,234 | ||||||||||
Goodwill |
$ | 795,518 | $ | 5,757 | $ | 801,275 | ||||||||||
For the Six Months Ended March 31, 2010 | ||||||||||||||||
Acute Care | Health Choice | Eliminations | Consolidated | |||||||||||||
Acute care revenue |
$ | 862,234 | $ | | $ | | $ | 862,234 | ||||||||
Premium revenue |
| 391,245 | | 391,245 | ||||||||||||
Revenue between segments |
6,012 | | (6,012 | ) | | |||||||||||
Net revenue |
868,246 | 391,245 | (6,012 | ) | 1,253,479 | |||||||||||
Salaries and benefits
(excludes stock-based compensation) |
332,865 | 9,539 | | 342,404 | ||||||||||||
Supplies |
133,737 | 97 | | 133,834 | ||||||||||||
Medical claims |
| 344,673 | (6,012 | ) | 338,661 | |||||||||||
Other operating expenses |
160,929 | 12,346 | | 173,275 | ||||||||||||
Provision for bad debts |
93,485 | | | 93,485 | ||||||||||||
Rentals and leases |
19,684 | 736 | | 20,420 | ||||||||||||
Adjusted EBITDA (1) |
127,546 | 23,854 | | 151,400 | ||||||||||||
Interest expense, net |
33,354 | | | 33,354 | ||||||||||||
Depreciation and amortization |
46,125 | 1,777 | | 47,902 | ||||||||||||
Stock-based compensation |
2,249 | | | 2,249 | ||||||||||||
Management fees |
2,500 | | | 2,500 | ||||||||||||
Earnings from continuing
operations before loss on
disposal of assets and income
taxes |
43,318 | 22,077 | | 65,395 | ||||||||||||
Loss on disposal of assets, net |
(57 | ) | | | (57 | ) | ||||||||||
Earnings from continuing
operations before income
taxes |
$ | 43,261 | $ | 22,077 | $ | | $ | 65,338 | ||||||||
Segment assets |
$ | 1,991,583 | $ | 286,775 | $ | 2,278,358 | ||||||||||
Capital expenditures |
$ | 30,073 | $ | 114 | $ | 30,187 | ||||||||||
Goodwill |
$ | 712,163 | $ | 5,757 | $ | 717,920 | ||||||||||
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NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (UNAUDITED)
NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (UNAUDITED)
(1) | Adjusted EBITDA represents net earnings from continuing operations before interest expense, income tax expense, depreciation and amortization, stock-based compensation, gain (loss) on disposal of assets and management fees. Management fees represent monitoring and advisory fees paid to TPG, the Companys majority financial sponsor, and certain other members of IASIS Investment LLC, majority shareholder of IAS. Management routinely calculates and communicates adjusted EBITDA and believes that it is useful to investors because it is commonly used as an analytical indicator within the healthcare industry to evaluate hospital performance, allocate resources and measure leverage capacity and debt service ability. In addition, the Company uses adjusted EBITDA as a measure of performance for its business segments and for incentive compensation purposes. Adjusted EBITDA should not be considered as a measure of financial performance under GAAP, and the items excluded from adjusted EBITDA are significant components in understanding and assessing financial performance. Adjusted EBITDA should not be considered in isolation or as an alternative to net earnings, cash flows generated by operating, investing, or financing activities or other financial statement data presented in the condensed consolidated financial statements as an indicator of financial performance or liquidity. Adjusted EBITDA, as presented, differs from what is defined under the Companys senior secured credit facilities and may not be comparable to similarly titled measures of other companies. |
11. SUPPLEMENTAL CONDENSED CONSOLIDATING FINANCIAL INFORMATION
The 8 3/4% notes described in Note 2 are fully and unconditionally
guaranteed on a joint and several basis by all of the Companys existing domestic subsidiaries,
other than non-guarantor subsidiaries which include Health Choice and the Companys non-wholly
owned subsidiaries.
Effective October 1, 2010, the operations and net assets of Wadley Regional Medical Center,
acquired as part of the Brim acquisition, are included in the subsidiary non-guarantor information in the following
summarized unaudited condensed consolidating financial statements.
Summarized condensed consolidating balance sheets at March 31, 2011 and September 30, 2010,
condensed consolidating statements of operations for the quarters and six months ended March 31,
2011 and 2010, and condensed consolidating statements of cash flows for the six months ended March
31, 2011 and 2010, for the Company, segregating the parent company issuer, the subsidiary
guarantors, the subsidiary non-guarantors and eliminations, are found below. Prior year amounts
have been reclassified to conform to the current year presentation.
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NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (UNAUDITED)
NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (UNAUDITED)
IASIS Healthcare LLC
Condensed Consolidating Balance Sheet (unaudited)
March 31, 2011
(in thousands)
Condensed Consolidating Balance Sheet (unaudited)
March 31, 2011
(in thousands)
Subsidiary | Subsidiary | Condensed | ||||||||||||||||||
Parent Issuer | Guarantors | Non-Guarantors | Eliminations | Consolidated | ||||||||||||||||
Assets |
||||||||||||||||||||
Current assets: |
||||||||||||||||||||
Cash and cash equivalents |
$ | | $ | 175,063 | $ | 3,553 | $ | | $ | 178,616 | ||||||||||
Accounts receivable, net |
| 101,203 | 149,944 | | 251,147 | |||||||||||||||
Inventories |
| 23,319 | 35,731 | | 59,050 | |||||||||||||||
Deferred income taxes |
29,289 | | | | 29,289 | |||||||||||||||
Prepaid expenses and other
current assets |
| 26,524 | 34,307 | | 60,831 | |||||||||||||||
Total current assets |
29,289 | 326,109 | 223,535 | | 578,933 | |||||||||||||||
Property and equipment, net |
| 346,988 | 655,102 | | 1,002,090 | |||||||||||||||
Intercompany |
| (299,762 | ) | 299,762 | | | ||||||||||||||
Net investment in and advances
to subsidiaries |
1,862,317 | | | (1,862,317 | ) | | ||||||||||||||
Goodwill |
7,701 | 64,258 | 729,316 | | 801,275 | |||||||||||||||
Other intangible assets, net |
| 8,567 | 25,500 | | 34,067 | |||||||||||||||
Deposit for acquisition |
| 7,000 | | | 7,000 | |||||||||||||||
Other assets, net |
10,383 | 15,346 | 8,170 | | 33,899 | |||||||||||||||
Total assets |
$ | 1,909,690 | $ | 468,506 | $ | 1,941,385 | $ | (1,862,317 | ) | $ | 2,457,264 | |||||||||
Liabilities and Equity |
||||||||||||||||||||
Current liabilities: |
||||||||||||||||||||
Accounts payable |
$ | | $ | 31,814 | $ | 57,769 | $ | | $ | 89,583 | ||||||||||
Salaries and benefits payable |
| 22,237 | 20,944 | | 43,181 | |||||||||||||||
Accrued interest payable |
12,477 | (3,234 | ) | 3,234 | | 12,477 | ||||||||||||||
Medical claims payable |
| | 106,950 | | 106,950 | |||||||||||||||
Other accrued expenses and
other current liabilities |
| 50,173 | 74,335 | | 124,508 | |||||||||||||||
Current portion of long-term
debt and capital lease
obligations |
5,890 | 1,785 | 21,400 | (21,400 | ) | 7,675 | ||||||||||||||
Total current liabilities |
18,367 | 102,775 | 284,632 | (21,400 | ) | 384,374 | ||||||||||||||
Long-term debt and capital
lease obligations |
1,036,425 | 11,427 | 547,519 | (547,519 | ) | 1,047,852 | ||||||||||||||
Deferred income taxes |
109,623 | | | | 109,623 | |||||||||||||||
Other long-term liabilities |
| 70,415 | 628 | | 71,043 | |||||||||||||||
Total liabilities |
1,164,415 | 184,617 | 832,779 | (568,919 | ) | 1,612,892 | ||||||||||||||
Non-controlling interests with
redemption rights |
| 89,265 | | | 89,265 | |||||||||||||||
Equity: |
||||||||||||||||||||
Members equity |
745,275 | 184,792 | 1,108,606 | (1,293,398 | ) | 745,275 | ||||||||||||||
Non-controlling interests |
| 9,832 | | | 9,832 | |||||||||||||||
Total equity |
745,275 | 194,624 | 1,108,606 | (1,293,398 | ) | 755,107 | ||||||||||||||
Total liabilities and equity |
$ | 1,909,690 | $ | 468,506 | $ | 1,941,385 | $ | (1,862,317 | ) | $ | 2,457,264 | |||||||||
16
Table of Contents
IASIS HEALTHCARE LLC
NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (UNAUDITED)
NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (UNAUDITED)
IASIS Healthcare LLC
Condensed Consolidating Balance Sheet
September 30, 2010
(in thousands)
Condensed Consolidating Balance Sheet
September 30, 2010
(in thousands)
Subsidiary | Subsidiary | Condensed | ||||||||||||||||||
Parent Issuer | Guarantors | Non-Guarantors | Eliminations | Consolidated | ||||||||||||||||
Assets |
||||||||||||||||||||
Current assets: |
||||||||||||||||||||
Cash and cash equivalents |
$ | | $ | 143,599 | $ | 912 | $ | | $ | 144,511 | ||||||||||
Accounts receivable, net |
| 81,649 | 127,524 | | 209,173 | |||||||||||||||
Inventories |
| 22,793 | 31,049 | | 53,842 | |||||||||||||||
Deferred income taxes |
15,881 | | | | 15,881 | |||||||||||||||
Prepaid expenses and other
current assets |
| 23,577 | 41,763 | | 65,340 | |||||||||||||||
Total current assets |
15,881 | 271,618 | 201,248 | | 488,747 | |||||||||||||||
Property and equipment, net |
| 351,265 | 634,026 | | 985,291 | |||||||||||||||
Intercompany |
| (297,257 | ) | 297,257 | | | ||||||||||||||
Net investment in and advances to
subsidiaries |
1,823,973 | | | (1,823,973 | ) | | ||||||||||||||
Goodwill |
17,331 | 65,504 | 635,408 | | 718,243 | |||||||||||||||
Other intangible assets, net |
| | 27,000 | | 27,000 | |||||||||||||||
Deposit for acquisition |
| 97,891 | | | 97,891 | |||||||||||||||
Other assets, net |
12,018 | 17,967 | 6,037 | | 36,022 | |||||||||||||||
Total assets |
$ | 1,869,203 | $ | 506,988 | $ | 1,800,976 | $ | (1,823,973 | ) | $ | 2,353,194 | |||||||||
Liabilities and Equity |
||||||||||||||||||||
Current liabilities: |
||||||||||||||||||||
Accounts payable |
$ | | $ | 32,400 | $ | 46,531 | $ | | $ | 78,931 | ||||||||||
Salaries and benefits payable |
| 19,916 | 18,194 | | 38,110 | |||||||||||||||
Accrued interest payable |
12,536 | (3,237 | ) | 3,237 | | 12,536 | ||||||||||||||
Medical claims payable |
| | 111,373 | | 111,373 | |||||||||||||||
Other accrued expenses and
other current liabilities |
| 32,326 | 74,288 | | 106,614 | |||||||||||||||
Current portion of long-term
debt and capital lease
obligations |
5,890 | 801 | 20,570 | (20,570 | ) | 6,691 | ||||||||||||||
Total current liabilities |
18,426 | 82,206 | 274,193 | (20,570 | ) | 354,255 | ||||||||||||||
Long-term debt and capital lease
obligations |
1,039,370 | 5,517 | 547,170 | (547,170 | ) | 1,044,887 | ||||||||||||||
Deferred income taxes |
109,272 | | | | 109,272 | |||||||||||||||
Other long-term liabilities |
| 59,527 | 635 | | 60,162 | |||||||||||||||
Total liabilities |
1,167,068 | 147,250 | 821,998 | (567,740 | ) | 1,568,576 | ||||||||||||||
Non-controlling interests with
redemption rights |
| 72,112 | | | 72,112 | |||||||||||||||
Equity: |
||||||||||||||||||||
Members equity |
702,135 | 277,255 | 978,978 | (1,256,233 | ) | 702,135 | ||||||||||||||
Non-controlling interests |
| 10,371 | | | 10,371 | |||||||||||||||
Total equity |
702,135 | 287,626 | 978,978 | (1,256,233 | ) | 712,506 | ||||||||||||||
Total liabilities and equity |
$ | 1,869,203 | $ | 506,988 | $ | 1,800,976 | $ | (1,823,973 | ) | $ | 2,353,194 | |||||||||
17
Table of Contents
IASIS HEALTHCARE LLC
NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (UNAUDITED)
NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (UNAUDITED)
IASIS Healthcare LLC
Condensed Consolidating Statement of Operations (unaudited)
For the Quarter Ended March 31, 2011
(in thousands)
Condensed Consolidating Statement of Operations (unaudited)
For the Quarter Ended March 31, 2011
(in thousands)
Subsidiary | Subsidiary | Condensed | ||||||||||||||||||
Parent Issuer | Guarantors | Non-Guarantors | Eliminations | Consolidated | ||||||||||||||||
Net revenue: |
||||||||||||||||||||
Acute care revenue |
$ | | $ | 188,517 | $ | 302,739 | $ | (2,807 | ) | $ | 488,449 | |||||||||
Premium revenue |
| | 189,960 | | 189,960 | |||||||||||||||
Total net revenue |
| 188,517 | 492,699 | (2,807 | ) | 678,409 | ||||||||||||||
Costs and expenses: |
||||||||||||||||||||
Salaries and benefits |
| 95,505 | 100,531 | | 196,036 | |||||||||||||||
Supplies |
| 31,533 | 46,391 | | 77,924 | |||||||||||||||
Medical claims |
| | 160,223 | (2,807 | ) | 157,416 | ||||||||||||||
Other operating expenses |
| 33,771 | 69,579 | | 103,350 | |||||||||||||||
Provision for bad debts |
| 22,149 | 32,652 | | 54,801 | |||||||||||||||
Rentals and leases |
| 4,735 | 6,554 | | 11,289 | |||||||||||||||
Interest expense, net |
16,510 | | 10,545 | (10,545 | ) | 16,510 | ||||||||||||||
Depreciation and
amortization |
| 9,951 | 14,633 | | 24,584 | |||||||||||||||
Management fees |
1,250 | (6,406 | ) | 6,406 | | 1,250 | ||||||||||||||
Equity in earnings of
affiliates |
(36,030 | ) | | | 36,030 | | ||||||||||||||
Total costs and expenses |
(18,270 | ) | 191,238 | 447,514 | 22,678 | 643,160 | ||||||||||||||
Earnings (loss) from
continuing operations before
gain on disposal of assets and
income taxes |
18,270 | (2,721 | ) | 45,185 | (25,485 | ) | 35,249 | |||||||||||||
Gain on disposal of assets, net |
| 128 | 412 | | 540 | |||||||||||||||
Earnings (loss) from
continuing operations before
income taxes |
18,270 | (2,593 | ) | 45,597 | (25,485 | ) | 35,789 | |||||||||||||
Income tax expense |
13,500 | | | | 13,500 | |||||||||||||||
Net earnings (loss) from
continuing operations |
4,770 | (2,593 | ) | 45,597 | (25,485 | ) | 22,289 | |||||||||||||
Earnings (loss) from
discontinued operations, net
of income taxes |
1,711 | (4,558 | ) | 1 | | (2,846 | ) | |||||||||||||
Net earnings (loss) |
6,481 | (7,151 | ) | 45,598 | (25,485 | ) | 19,443 | |||||||||||||
Net earnings attributable to
non-controlling interests |
| (2,417 | ) | | | (2,417 | ) | |||||||||||||
Net earnings (loss)
attributable to IASIS
Healthcare LLC |
$ | 6,481 | $ | (9,568 | ) | $ | 45,598 | $ | (25,485 | ) | $ | 17,026 | ||||||||
18
Table of Contents
IASIS HEALTHCARE LLC
NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (UNAUDITED)
NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (UNAUDITED)
IASIS Healthcare LLC
Condensed Consolidating Statement of Operations (unaudited)
For the Quarter Ended March 31, 2010
(in thousands)
Condensed Consolidating Statement of Operations (unaudited)
For the Quarter Ended March 31, 2010
(in thousands)
Subsidiary | Subsidiary | Condensed | ||||||||||||||||||
Parent Issuer | Guarantors | Non-Guarantors | Eliminations | Consolidated | ||||||||||||||||
Net revenue: |
||||||||||||||||||||
Acute care revenue |
$ | | $ | 174,795 | $ | 266,115 | $ | (3,336 | ) | $ | 437,574 | |||||||||
Premium revenue |
| | 186,948 | | 186,948 | |||||||||||||||
Total net revenue |
| 174,795 | 453,063 | (3,336 | ) | 624,522 | ||||||||||||||
Costs and expenses: |
||||||||||||||||||||
Salaries and benefits |
| 88,167 | 86,004 | | 174,171 | |||||||||||||||
Supplies |
| 28,704 | 39,721 | | 68,425 | |||||||||||||||
Medical claims |
| | 163,430 | (3,336 | ) | 160,094 | ||||||||||||||
Other operating expenses |
| 27,340 | 61,343 | | 88,683 | |||||||||||||||
Provision for bad debts |
| 21,440 | 24,096 | | 45,536 | |||||||||||||||
Rentals and leases |
| 4,056 | 6,089 | | 10,145 | |||||||||||||||
Interest expense, net |
16,622 | | 10,635 | (10,635 | ) | 16,622 | ||||||||||||||
Depreciation and
amortization |
| 9,948 | 14,077 | | 24,025 | |||||||||||||||
Management fees |
1,250 | (5,752 | ) | 5,752 | | 1,250 | ||||||||||||||
Equity in earnings of
affiliates |
(40,574 | ) | | | 40,574 | | ||||||||||||||
Total costs and expenses |
(22,702 | ) | 173,903 | 411,147 | 26,603 | 588,951 | ||||||||||||||
Earnings (loss) from
continuing operations before
loss on disposal of assets and
income taxes |
22,702 | 892 | 41,916 | (29,939 | ) | 35,571 | ||||||||||||||
Loss on disposal of assets, net |
| (17 | ) | (144 | ) | | (161 | ) | ||||||||||||
Earnings (loss) from
continuing operations before
income taxes |
22,702 | 875 | 41,772 | (29,939 | ) | 35,410 | ||||||||||||||
Income tax expense |
13,270 | | | | 13,270 | |||||||||||||||
Net earnings (loss) from
continuing operations |
9,432 | 875 | 41,772 | (29,939 | ) | 22,140 | ||||||||||||||
Earnings (loss) from
discontinued operations, net
of income taxes |
15 | (38 | ) | (2 | ) | | (25 | ) | ||||||||||||
Net earnings (loss) |
9,447 | 837 | 41,770 | (29,939 | ) | 22,115 | ||||||||||||||
Net earnings attributable to
non-controlling interests |
| (2,033 | ) | | | (2,033 | ) | |||||||||||||
Net earnings (loss)
attributable to IASIS
Healthcare LLC |
$ | 9,447 | $ | (1,196 | ) | $ | 41,770 | $ | (29,939 | ) | $ | 20,082 | ||||||||
19
Table of Contents
IASIS HEALTHCARE LLC
NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (UNAUDITED)
NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (UNAUDITED)
IASIS Healthcare LLC
Condensed Consolidating Statement of Operations (unaudited)
For the Six Months Ended March 31, 2011
(in thousands)
Condensed Consolidating Statement of Operations (unaudited)
For the Six Months Ended March 31, 2011
(in thousands)
Subsidiary | Subsidiary | Condensed | ||||||||||||||||||
Parent Issuer | Guarantors | Non-Guarantors | Eliminations | Consolidated | ||||||||||||||||
Net revenue: |
||||||||||||||||||||
Acute care revenue |
$ | | $ | 372,803 | $ | 592,252 | $ | (5,467 | ) | $ | 959,588 | |||||||||
Premium revenue |
| | 392,152 | | 392,152 | |||||||||||||||
Total net revenue |
| 372,803 | 984,404 | (5,467 | ) | 1,351,740 | ||||||||||||||
Costs and expenses: |
||||||||||||||||||||
Salaries and benefits |
| 188,848 | 197,101 | | 385,949 | |||||||||||||||
Supplies |
| 62,300 | 92,060 | | 154,360 | |||||||||||||||
Medical claims |
| | 334,217 | (5,467 | ) | 328,750 | ||||||||||||||
Other operating expenses |
| 66,499 | 133,977 | | 200,476 | |||||||||||||||
Provision for bad debts |
| 47,642 | 66,773 | | 114,415 | |||||||||||||||
Rentals and leases |
| 9,325 | 13,130 | | 22,455 | |||||||||||||||
Interest expense, net |
33,387 | | 20,935 | (20,935 | ) | 33,387 | ||||||||||||||
Depreciation and
amortization |
| 19,947 | 28,683 | | 48,630 | |||||||||||||||
Management fees |
2,500 | (12,587 | ) | 12,587 | | 2,500 | ||||||||||||||
Equity in earnings of
affiliates |
(62,819 | ) | | | 62,819 | | ||||||||||||||
Total costs and
expenses |
(26,932 | ) | 381,974 | 899,463 | 36,417 | 1,290,922 | ||||||||||||||
Earnings (loss) from
continuing operations
before gain on disposal of
assets and income taxes |
26,932 | (9,171 | ) | 84,941 | (41,884 | ) | 60,818 | |||||||||||||
Gain on disposal of
assets, net |
| 492 | 393 | | 885 | |||||||||||||||
Earnings (loss) from
continuing operations
before income taxes |
26,932 | (8,679 | ) | 85,334 | (41,884 | ) | 61,703 | |||||||||||||
Income tax expense |
22,689 | | | | 22,689 | |||||||||||||||
Net earnings (loss) from
continuing operations |
4,243 | (8,679 | ) | 85,334 | (41,884 | ) | 39,014 | |||||||||||||
Earnings (loss) from
discontinued operations,
net of income taxes |
3,594 | (9,589 | ) | (59 | ) | | (6,054 | ) | ||||||||||||
Net earnings (loss) |
7,837 | (18,268 | ) | 85,275 | (41,884 | ) | 32,960 | |||||||||||||
Net earnings attributable
to non-controlling
interests |
| (4,188 | ) | | | (4,188 | ) | |||||||||||||
Net earnings (loss)
attributable to IASIS
Healthcare LLC |
$ | 7,837 | $ | (22,456 | ) | $ | 85,275 | $ | (41,884 | ) | $ | 28,772 | ||||||||
20
Table of Contents
IASIS HEALTHCARE LLC
NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (UNAUDITED)
NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (UNAUDITED)
IASIS Healthcare LLC
Condensed Consolidating Statement of Operations (unaudited)
For the Six Months Ended March 31, 2010
(in thousands)
Condensed Consolidating Statement of Operations (unaudited)
For the Six Months Ended March 31, 2010
(in thousands)
Subsidiary | Subsidiary | Condensed | ||||||||||||||||||
Parent Issuer | Guarantors | Non-Guarantors | Eliminations | Consolidated | ||||||||||||||||
Net revenue: |
||||||||||||||||||||
Acute care revenue |
$ | | $ | 346,096 | $ | 522,150 | $ | (6,012 | ) | $ | 862,234 | |||||||||
Premium revenue |
| | 391,245 | | 391,245 | |||||||||||||||
Total net revenue |
| 346,096 | 913,395 | (6,012 | ) | 1,253,479 | ||||||||||||||
Costs and expenses: |
||||||||||||||||||||
Salaries and benefits |
| 174,776 | 169,877 | | 344,653 | |||||||||||||||
Supplies |
| 56,142 | 77,692 | | 133,834 | |||||||||||||||
Medical claims |
| | 344,673 | (6,012 | ) | 338,661 | ||||||||||||||
Other operating expenses |
| 57,229 | 116,046 | | 173,275 | |||||||||||||||
Provision for bad debts |
| 43,763 | 49,722 | | 93,485 | |||||||||||||||
Rentals and leases |
| 8,482 | 11,938 | | 20,420 | |||||||||||||||
Interest expense, net |
33,354 | | 20,379 | (20,379 | ) | 33,354 | ||||||||||||||
Depreciation and
amortization |
| 19,858 | 28,044 | | 47,902 | |||||||||||||||
Management fees |
2,500 | (11,316 | ) | 11,316 | | 2,500 | ||||||||||||||
Equity in earnings of
affiliates |
(76,786 | ) | | | 76,786 | | ||||||||||||||
Total costs and
expenses |
(40,932 | ) | 348,934 | 829,687 | 50,395 | 1,188,084 | ||||||||||||||
Earnings (loss) from
continuing operations
before gain (loss) on
disposal of assets and
income taxes |
40,932 | (2,838 | ) | 83,708 | (56,407 | ) | 65,395 | |||||||||||||
Gain (loss) on disposal of
assets, net |
| 59 | (116 | ) | | (57 | ) | |||||||||||||
Earnings (loss) from
continuing operations
before income taxes |
40,932 | (2,779 | ) | 83,592 | (56,407 | ) | 65,338 | |||||||||||||
Income tax expense |
23,861 | | | | 23,861 | |||||||||||||||
Net earnings (loss) from
continuing operations |
17,071 | (2,779 | ) | 83,592 | (56,407 | ) | 41,477 | |||||||||||||
Earnings (loss) from
discontinued operations,
net of income taxes |
(13 | ) | 37 | (3 | ) | | 21 | |||||||||||||
Net earnings (loss) |
17,058 | (2,742 | ) | 83,589 | (56,407 | ) | 41,498 | |||||||||||||
Net earnings attributable
to non-controlling
interests |
| (4,061 | ) | | | (4,061 | ) | |||||||||||||
Net earnings (loss)
attributable to IASIS
Healthcare LLC |
$ | 17,058 | $ | (6,803 | ) | $ | 83,589 | $ | (56,407 | ) | $ | 37,437 | ||||||||
21
Table of Contents
IASIS HEALTHCARE LLC
NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (UNAUDITED)
NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (UNAUDITED)
IASIS Healthcare LLC
Condensed Consolidating Statement of Cash Flows (unaudited)
For the Six Months Ended March 31, 2011
(in thousands)
Condensed Consolidating Statement of Cash Flows (unaudited)
For the Six Months Ended March 31, 2011
(in thousands)
Subsidiary | Subsidiary | Condensed | ||||||||||||||||||
Parent Issuer | Guarantors | Non-Guarantors | Eliminations | Consolidated | ||||||||||||||||
Cash flows from operating activities |
||||||||||||||||||||
Net earnings (loss) |
$ | 7,837 | $ | (18,268 | ) | $ | 85,275 | $ | (41,884 | ) | $ | 32,960 | ||||||||
Adjustments to reconcile net earnings (loss) to
net cash provided by (used in) operating
activities: |
||||||||||||||||||||
Depreciation and amortization |
| 19,947 | 28,683 | | 48,630 | |||||||||||||||
Amortization of loan costs |
1,636 | | | | 1,636 | |||||||||||||||
Stock-based compensation |
1,034 | | | | 1,034 | |||||||||||||||
Deferred income taxes |
2,278 | | | | 2,278 | |||||||||||||||
Income tax benefit from parent company
interest |
4,440 | | | | 4,440 | |||||||||||||||
Gain on disposal of assets, net |
| (492 | ) | (393 | ) | | (885 | ) | ||||||||||||
Loss (earnings) from discontinued
operations, net |
(3,594 | ) | 9,589 | 59 | | 6,054 | ||||||||||||||
Equity in earnings of affiliates |
(62,819 | ) | | | 62,819 | | ||||||||||||||
Changes in operating assets and
liabilities, net of the effect of acquisitions and
dispositions: |
||||||||||||||||||||
Accounts receivable, net |
| (14,608 | ) | (8,853 | ) | | (23,461 | ) | ||||||||||||
Inventories, prepaid expenses and
other current assets |
| (7,168 | ) | 11,629 | | 4,461 | ||||||||||||||
Accounts payable, other accrued
expenses and other accrued
liabilities |
(3,653 | ) | 36,641 | (12,426 | ) | | 20,562 | |||||||||||||
Net cash provided by (used in) operating
activities continuing operations |
(52,841 | ) | 25,641 | 103,974 | 20,935 | 97,709 | ||||||||||||||
Net cash used in operating activities
discontinued operations |
| (231 | ) | | | (231 | ) | |||||||||||||
Net cash provided by (used in) operating
activities |
(52,841 | ) | 25,410 | 103,974 | 20,935 | 97,478 | ||||||||||||||
Cash flows from investing activities |
||||||||||||||||||||
Purchases of property and equipment, net |
| (18,200 | ) | (24,034 | ) | | (42,234 | ) | ||||||||||||
Payments for acquisitions |
| (11,432 | ) | (1,372 | ) | | (12,804 | ) | ||||||||||||
Proceeds from sale of assets |
| 12 | 138 | | 150 | |||||||||||||||
Change in other assets, net |
| (5,910 | ) | 7,549 | | 1,639 | ||||||||||||||
Net cash used in investing activities |
| (35,530 | ) | (17,719 | ) | | (53,249 | ) | ||||||||||||
Cash flows from financing activities |
||||||||||||||||||||
Payment of debt and capital lease obligations |
(2,945 | ) | | (865 | ) | | (3,810 | ) | ||||||||||||
Distributions to non-controlling interests |
| (5,689 | ) | | | (5,689 | ) | |||||||||||||
Costs paid for repurchase of non-controlling
interests |
| (625 | ) | | | (625 | ) | |||||||||||||
Change in intercompany balances with
affiliates, net |
55,786 | 47,898 | (82,749 | ) | (20,935 | ) | | |||||||||||||
Net cash provided by (used in) financing
activities |
52,841 | 41,584 | (83,614 | ) | (20,935 | ) | (10,124 | ) | ||||||||||||
Change in cash and cash equivalents |
| 31,464 | 2,641 | | 34,105 | |||||||||||||||
Cash and cash equivalents at beginning of period |
| 143,599 | 912 | | 144,511 | |||||||||||||||
Cash and cash equivalents at end of period |
$ | | $ | 175,063 | $ | 3,553 | $ | | $ | 178,616 | ||||||||||
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IASIS HEALTHCARE LLC
NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (UNAUDITED)
NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (UNAUDITED)
IASIS Healthcare LLC
Condensed Consolidating Statement of Cash Flows (unaudited)
For the Six Months Ended March 31, 2010
(in thousands)
Condensed Consolidating Statement of Cash Flows (unaudited)
For the Six Months Ended March 31, 2010
(in thousands)
Subsidiary | Subsidiary | Condensed | ||||||||||||||||||
Parent Issuer | Guarantors | Non-Guarantors | Eliminations | Consolidated | ||||||||||||||||
Cash flows from operating activities |
||||||||||||||||||||
Net earnings (loss) |
$ | 17,058 | $ | (2,742 | ) | $ | 83,589 | $ | (56,407 | ) | $ | 41,498 | ||||||||
Adjustments to reconcile net earnings (loss) to
net cash provided by (used in) operating
activities: |
||||||||||||||||||||
Depreciation and amortization |
| 19,858 | 28,044 | | 47,902 | |||||||||||||||
Amortization of loan costs |
1,564 | | | | 1,564 | |||||||||||||||
Stock-based compensation |
2,249 | | | | 2,249 | |||||||||||||||
Deferred income taxes |
19,589 | | | | 19,589 | |||||||||||||||
Income tax
benefit from stock-based
compensation |
(1,770 | ) | | | | (1,770 | ) | |||||||||||||
Income tax benefit from parent company
interest |
3,275 | | | | 3,275 | |||||||||||||||
Loss (gain) on disposal of assets, net |
| (59 | ) | 116 | | 57 | ||||||||||||||
Loss (earnings) from discontinued
operations, net |
13 | (37 | ) | 3 | | (21 | ) | |||||||||||||
Equity in earnings of affiliates |
(76,786 | ) | | | 76,786 | | ||||||||||||||
Changes in operating assets and
liabilities, net of the effect of
dispositions: |
||||||||||||||||||||
Accounts receivable, net |
| (1,735 | ) | 3,313 | | 1,578 | ||||||||||||||
Inventories, prepaid expenses and
other current assets |
| (7,050 | ) | 885 | | (6,165 | ) | |||||||||||||
Accounts payable, other accrued
expenses and other accrued
liabilities |
1,762 | (4,873 | ) | 10,121 | | 7,010 | ||||||||||||||
Net cash provided by (used in) operating
activities continuing operations |
(33,046 | ) | 3,362 | 126,071 | 20,379 | 116,766 | ||||||||||||||
Net cash used in operating activities
discontinued operations |
(13 | ) | (186 | ) | | | (199 | ) | ||||||||||||
Net cash provided by (used in) operating
activities |
(33,059 | ) | 3,176 | 126,071 | 20,379 | 116,567 | ||||||||||||||
Cash flows from investing activities |
||||||||||||||||||||
Purchases of property and equipment, net |
| (17,975 | ) | (12,212 | ) | | (30,187 | ) | ||||||||||||
Proceeds from sale of assets |
| 8 | 28 | | 36 | |||||||||||||||
Change in other assets, net |
| 1,588 | (575 | ) | | 1,013 | ||||||||||||||
Net cash used in investing activities |
| (16,379 | ) | (12,759 | ) | | (29,138 | ) | ||||||||||||
Cash flows from financing activities |
||||||||||||||||||||
Payment of debt and capital lease obligations |
(4,607 | ) | 48 | (579 | ) | | (5,138 | ) | ||||||||||||
Distribution to parent company in connection
with the repurchase of equity, net |
(124,962 | ) | | | | (124,962 | ) | |||||||||||||
Distributions to non-controlling interests |
| (5,277 | ) | | | (5,277 | ) | |||||||||||||
Costs paid
for repurchase of non-controlling
interests |
| (69 | ) | | | (69 | ) | |||||||||||||
Change in intercompany balances with
affiliates, net |
162,628 | (29,516 | ) | (112,733 | ) | (20,379 | ) | | ||||||||||||
Net cash provided by (used in) financing
activities |
33,059 | (34,814 | ) | (113,312 | ) | (20,379 | ) | (135,446 | ) | |||||||||||
Change in cash and cash equivalents |
| (48,017 | ) | | | (48,017 | ) | |||||||||||||
Cash and cash equivalents at beginning of period |
| 206,331 | 197 | | 206,528 | |||||||||||||||
Cash and cash equivalents at end of period |
$ | | $ | 158,314 | $ | 197 | $ | | $ | 158,511 | ||||||||||
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IASIS HEALTHCARE LLC
NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (UNAUDITED)
NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (UNAUDITED)
12. SUBSEQUENT EVENTS
Acquisition of St. Joseph Medical Center
On
May 2, 2011, the Company acquired a 79.1% equity ownership interest in St. Joseph Medical
Center (St. Joseph) located in downtown Houston, Texas,
in exchange for cash consideration of $156.8 million, subject to customary closing adjustments. In accordance with the purchase
agreement, independent investors, most of whom are physicians on the medical staff of St. Joseph,
will retain an aggregate 20.9% ownership interest in the hospital. St. Joseph is a 792-licensed
bed acute care hospital facility that generates approximately $245.0 million in annual net revenue.
Refinancing Transaction
Overview
On May 3, 2011, the Company completed a transaction to refinance its existing debt (the
Refinancing). The Refinancing included $1.325 billion in new senior secured credit facilities
and the issuance by the Company, together with its wholly owned
subsidiary IASIS Capital,
of $850.0 million aggregate principal amount of 8.375% senior notes due 2019. Proceeds from
the Refinancing were used to refinance amounts outstanding under the Companys existing credit
facilities; fund a cash tender offer to repurchase any and all of the
Companys $475.0 million
aggregate principal amount of 83/4% senior subordinated notes due 2014; repay in full the Holdings
Senior PIK Loans; pay fees and expenses associated with the Refinancing; and raise capital for
general corporate purposes.
On May 3, 2011, as part of the Refinancing, the Company distributed $630.9 million to IAS,
$400.9 million to fund the repayment of the Holdings Senior PIK Loans, which included interest that
had accrued to the principal balance of the loans totaling $100.9 million, and $230.0 million to be
held for future acquisitions and strategic growth initiatives, as well as potential distributions
to the equity holders of IAS.
$1.325 Billion Senior Secured Credit Facilities
In connection with the Refinancing, the Company entered into a new senior
credit agreement (the Restated Credit Agreement).
The Restated Credit Agreement provides for senior secured financing of up to $1.325 billion
consisting of (1) a $1.025 billion senior secured term loan facility with a seven-year maturity and
(2) a $300.0 million senior secured revolving credit facility with a five-year maturity, of which
up to $150.0 million may be utilized for the issuance of letters of credit (together, the New
Senior Secured Credit Facilities). Principal under the senior secured term loan facility
is due in consecutive equal quarterly installments in an aggregate annual amount equal to 1% of the
principal amount outstanding on the closing date, with the remaining balance due upon maturity of
the senior secured term loan facility. The senior secured revolving credit facility does not
require installment payments.
Borrowings under the senior secured term loan facility bear interest at a rate per annum equal
to, at the Companys option, either (1) a base rate (the base rate) determined by reference to
the highest of (a) the federal funds rate plus 0.50%, (b) the prime rate of Bank of America, N.A.
and (c) a one-month LIBOR rate, subject to a floor of 1.25%, plus 1.00%, in each case, plus a
margin of 2.75% per annum or (2) the LIBOR rate for the interest period relevant to such borrowing,
subject to a floor of 1.25%, plus a margin of 3.75% per annum. Borrowings under the
senior secured revolving credit facility generally bear interest at a rate per annum equal to, at
the Companys option, either (1) the base rate plus a margin of 2.50% per annum, or (2) the LIBOR
rate for the interest period relevant to such borrowing plus a margin of 3.50% per annum.
In addition to paying interest on outstanding principal under the New Senior Secured Credit
Facilities, the Company will be required to pay a commitment fee in
respect of the unutilized commitments under the senior secured revolving credit facility, as
well as pay customary letter of credit fees and agency fees.
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IASIS HEALTHCARE LLC
NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (UNAUDITED)
NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (UNAUDITED)
The New Senior Secured Credit Facilities are unconditionally guaranteed by IAS and certain
subsidiaries of the Company (collectively, the Credit Facility Guarantors) and are required to be
guaranteed by all future material wholly-owned subsidiaries of the Company, subject to certain
exceptions. All obligations under the Restated Credit Agreement are secured, subject to certain
exceptions, by substantially all of the Companys assets and the assets of the Credit Facility
Guarantors, including (1) a pledge of 100% of the equity interests of the Company and the Credit
Facility Guarantors, (2) mortgage liens on all of the Companys material real property and that of
the Credit Facility Guarantors, and (3) all proceeds of the foregoing.
The Restated Credit Agreement requires the Company to mandatorily prepay borrowings under the
senior secured term loan facility with net cash proceeds of certain asset dispositions, following
certain casualty events, following certain borrowings or debt issuances, and from a percentage of
annual excess cash flow.
The Restated Credit Agreement contains a number of affirmative covenants, including, among
other things: (1) the delivery of financial statements and other reports; (2) compliance with laws;
(3) payment of the Companys and its restricted subsidiaries obligations, including taxes and
indebtedness; and (4) maintenance of the Companys and its restricted subsidiaries material
properties.
The Restated Credit Agreement also contains a number of negative covenants, including, among
other things: (1) limitations on the incurrence of debt and liens; (2) limitations on investments
other than, among other exceptions, certain acquisitions that meet certain conditions; (3)
limitations on the sale of assets outside of the ordinary course of business; (5) limitations on
dividends and distributions; and (6) limitations on transactions with affiliates, in each case,
subject to certain exceptions. The Restated Credit Agreement also contains certain customary events
of default, including, without limitation, a failure to make payments under the New Senior Secured
Credit Facilities, cross-defaults, certain bankruptcy events and certain change of control events.
8.375% Senior Notes due 2019
In connection with the Refinancing,
the Company and IASIS Capital (together, the Issuers)
issued $850.0 million aggregate
principal amount of 8.375% senior notes due 2019 (the Notes), which mature on May 15, 2019,
pursuant to an indenture, dated as of May 3, 2011, among the
Issuers and certain of the Issuers
wholly owned domestic subsidiaries that guarantee the New Senior Secured Credit Facilities (the
Notes Guarantors) (the
Indenture). The Indenture provides that the Notes are general unsecured, senior obligations of
the Issuers, and initially will be unconditionally guaranteed on a senior unsecured basis.
The Notes bear interest at a rate of 8.375% per annum and will accrue from May 3, 2011.
Interest on the notes is payable semi-annually, in cash in arrears, on May 15 and November 15 of
each year, commencing on November 15, 2011.
The
Company may redeem the Notes, in whole or in part, at any time prior to May 15, 2014, at a
price equal to 100% of the aggregate principal amount of the Notes plus a make-whole premium and
accrued and unpaid interest and special interest, if any, to but excluding the redemption date. In
addition, the Company may redeem up to 35% of the Notes before May 15, 2014, with the net cash
proceeds from certain equity offerings at a redemption price equal to 108.375% of the aggregate
principal amount of the Notes plus accrued and unpaid interest and special interest, if any, to but
excluding the redemption date, subject to compliance with certain conditions.
The Indenture contains covenants that limit the Companys (and its restricted subsidiaries)
ability to, among other things: (1) incur additional indebtedness or liens or issue disqualified
stock or preferred stock; (2) pay dividends or make other distributions on, redeem or repurchase
the Companys capital stock; (3) sell certain assets; (4) make certain loans and investments; (5)
enter into certain transactions with affiliates; (5) impose restrictions on the ability of a
subsidiary to pay dividends or make payments or distributions to the Company and its restricted
subsidiaries; and (6) consolidate, merge or sell all or substantially all of the Companys assets.
These covenants are subject to a number of important limitations and exceptions.
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IASIS HEALTHCARE LLC
NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (UNAUDITED)
NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (UNAUDITED)
The Indenture also provides for events of default, which, if any of them occurs, may permit
or, in certain circumstances, require the principal, premium, if any, interest and any other
monetary obligations on all the then outstanding Notes to be due and payable immediately. If the
Company experiences certain kinds of changes of control, it must offer to purchase the Notes at
101% of their principal amount, plus accrued and unpaid interest and special interest, if any, to
but excluding the repurchase date. Under certain circumstances, the Company will have the ability
to make certain payments to facilitate a change of control transaction and to provide for the
assumption of the Notes by a new parent company resulting from such change of control transaction.
If such change of control transaction is facilitated, the Issuers will be released from all
obligations under the Indenture and the Issuers and the trustee will execute a supplemental
indenture effectuating such assumption and release.
Registration Rights Agreement
In
connection with the issuance of the Notes, the Company entered into a registration rights agreement (the
Registration Rights Agreement) that
provides holders of the Notes certain rights relating to registration of the Notes under the
Securities Act of 1933, as amended (the Securities Act).
Pursuant
to the Registration Rights Agreement, the Company will file
a registration statement on or prior to 180 days after the issuance of the Notes, enabling
noteholders to exchange the privately placed notes for publicly registered notes with substantially
identical terms; use commercially reasonable efforts to cause the registration statement to become
effective on or prior to 270 days after the closing of the offering; and use commercially
reasonable efforts to consummate the exchange offer within 30 business days after the effective
date of the registration statement, or longer if required by the federal securities laws.
If
the Company fails to comply with any of the requirements described
above or if the shelf registration statement or the exchange offer registration statement is
declared effective but thereafter ceases to be effective or usable (in either case, a Registration
Default), the annual interest rate borne by the Notes will be increased by 0.25% per annum during
the 90-day period immediately following such Registration Default and will increase by 0.25% per
annum at the end of each subsequent 90-day period, but in no event shall such increase exceed 1.00%
per annum.
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Item 2. | Managements Discussion and Analysis of Financial Condition and Results of Operations |
The following discussion and analysis of financial condition and results of operations should
be read in conjunction with our unaudited condensed consolidated financial statements, the notes to
our unaudited condensed consolidated financial statements and the other financial information
appearing elsewhere in this report. Data for the quarters and six months ended March 31, 2011 and
2010, has been derived from our unaudited condensed consolidated financial statements. References
herein to we, our and us are to IASIS Healthcare LLC and its subsidiaries. References herein
to IAS are to IASIS Healthcare Corporation, our parent company.
FORWARD LOOKING STATEMENTS
Some of the statements we make in this report are forward-looking within the meaning of the
federal securities laws, which are intended to be covered by the safe harbors created thereby.
Those forward-looking statements include all statements that are not historical statements of fact
and those regarding our intent, belief or expectations including, but not limited to, the
discussions of our operating and growth strategy (including possible acquisitions and
dispositions), financing needs, projections of revenue, income or loss, capital expenditures and
future operations. Forward-looking statements involve known and unknown risks and uncertainties
that may cause actual results in future periods to differ materially from those anticipated in the
forward-looking statements. Those risks and uncertainties include, among others, our ability to
retain and negotiate reasonable contracts with managed care plans, the impact of the federal
healthcare reform, changes in governmental healthcare programs, our hospitals competition for
patients from other hospitals and healthcare providers, the shift in payor mix from commercial and
managed care payors to medicaid and managed medicaid, our hospitals facing a growth in volume and
revenue related to uncompensated care, our ability to recruit and retain quality physicians, our
hospitals competition for staffing which may increase our labor costs and reduce profitability,
our failure to continually enhance our hospitals with the most recent technological advances in
diagnostic and surgical equipment that may adversely affect our ability to maintain and expand our
markets, our failure to comply with extensive laws and government regulations, the health reform
law that imposes significant restrictions on hospitals that have physician owners, expenses
incurred in connection with an appeal of the court order dismissing with prejudice the qui tam
litigation, the possibility that we may become subject to federal and state investigations in the
future, our ability to satisfy regulatory requirements with respect to our internal controls over
financial reporting under Section 404 of the Sarbanes-Oxley Act of 2002, a failure of our
information systems that would adversely affect our ability to properly manage our operations,
failure to effectively and timely implement electronic health record systems, an economic downturn
or other material change in any one of the regions in which we operate, potential liabilities
because of claims brought against our facilities, our ability to control costs at Health Choice
Arizona, Inc. (Health Choice or the Plan), the impact of any significant alteration to the
Arizona Health Care Cost Containment System (AHCCCS) payment structure of its contracts, the
possibility of Health Choices contract with the AHCCCS being discontinued, significant competition
from other healthcare companies and state efforts to regulate the sale of not-for-profit hospitals
that may affect our ability to acquire hospitals, difficulties with the integration of acquisitions
that may disrupt our ongoing operations, our dependence on key personnel, the loss of one or more
of which could have a material adverse effect on our business, potential responsibilities and costs
under environmental laws that could lead to material expenditures or liability, the possibility of
a decline in the fair value of our reporting units that could result in a material non-cash charge
to earnings, the risks and uncertainties related to our ability to generate sufficient cash to
service our existing indebtedness, our substantial level of indebtedness that could adversely
affect our financial condition, the possibility of an increase in interest rates, which would
increase the cost of servicing our debt and could reduce profitability, risks associated with us
being owned by equity sponsors who have the ability to control our financial decisions and those
risks, uncertainties and other matters detailed in our Annual Report on Form 10-K for the fiscal
year ended September 30, 2010, and in our subsequent filings with the Securities and Exchange
Commission (the SEC).
Although we believe that the assumptions underlying the forward-looking statements contained
in this report are reasonable, any of these assumptions could prove to be inaccurate and,
therefore, there can be no assurance that the forward-looking statements included in this report
will prove to be accurate. In light of the significant uncertainties inherent in the
forward-looking statements included in this report, you should not regard the inclusion of such
information as a representation by us or any other person that our objectives and plans will be
achieved. We undertake no obligation to publicly release any revisions to any forward-looking
statements contained herein to reflect events and circumstances occurring after the date hereof or
to reflect the occurrence of unanticipated events.
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EXECUTIVE OVERVIEW
We are a leading owner and operator of medium-sized acute care hospitals in high-growth urban
and suburban markets. We operate our hospitals with a strong community focus by offering and
developing healthcare services targeted to the needs of the markets we serve, promoting strong
relationships with physicians and working with local managed care plans. At March 31, 2011, we
owned or leased 17 acute care hospital facilities and one behavioral health hospital facility, with
a total of 3,570 licensed beds, located in seven regions:
| Salt Lake City, Utah; |
| Phoenix, Arizona; |
| Tampa-St. Petersburg, Florida; |
| four cities in Texas, including San Antonio; |
| Las Vegas, Nevada; |
| West Monroe, Louisiana; and |
| Woodland Park, Colorado. |
We also own and operate Health Choice, a Medicaid and Medicare managed health plan in Phoenix,
Arizona, that serves over 195,000 members.
Effective
October 1, 2010, we acquired Brim Holdings, Inc. (Brim) in
a cash-for-stock transaction value at $95.0 million, subject to
changes in net working capital. Brim operates Wadley Regional Medical
Center, a 370-licensed bed acute care hospital facility in
Texarkana, Texas, of which Brim owns a 72.7% equity interest, and
Pikes Peak Regional Hospital, a 15-licensed bed critical access acute
care hospital facility in Woodland Park, Colorado. Brim generates
approximately $120.0 million in annual net revenue.
On
May 2, 2011, we acquired a 79.1% equity ownership interest in St. Joseph Medical
Center (St. Joseph) in downtown Houston, Texas, in
exchange for cash consideration of $156.8
million, subject to customary closing adjustments. In accordance with the purchase agreement,
independent investors, most of whom are physicians on the medical staff of St. Joseph, will retain
an aggregate 20.9% ownership interest in the hospital. St. Joseph is a 792-licensed bed acute care
hospital facility that generates approximately $245.0 million in annual net revenue.
On May 3, 2011, we completed a transaction to refinance our existing debt (the Refinancing).
The Refinancing included $1.325 billion in new senior secured
credit facilities and the issuance by
us, together with our wholly owned subsidiary IASIS Capital
Corporation (IASIS Capital), of $850.0
million aggregate principal amount of 8.375% senior notes due 2019.
Significant Industry Trends
The following sections discuss recent trends that we believe are significant factors in our
current and/or future operating results and cash flows. Certain of these trends apply to the entire
acute care hospital industry, while others may apply to us more specifically. These trends could be
short-term in nature or could require long-term attention and resources. While these trends may
involve certain factors that are outside of our control, the extent to which these trends affect
our hospitals and our ability to manage the impact of these trends play vital roles in our current
and future success. In many cases, we are unable to predict what impact these trends, if any, will
have on us.
The Impact of Health Reform
The recently enacted Patient Protection and Affordable Care Act, as amended by the Health Care
and Education Reconciliation Act of 2010 (collectively, the Health Reform Law), will change how
healthcare services are covered, delivered, and reimbursed through expanded coverage of previously
uninsured individuals and reduced government healthcare spending. In addition, as enacted, the law
reforms certain aspects of health insurance, expands existing efforts to tie Medicare and Medicaid
payments to performance and quality, places restrictions on physician owned hospitals, and contains
provisions intended to strengthen fraud and abuse enforcement. Because of the many variables
involved, including the laws complexity, lack of implementing regulations or interpretive
guidance, gradual and potentially delayed implementation, pending efforts to repeal or amend
portions of the Health Reform Law in the United States Congress and ongoing federal court cases
challenging the constitutionality of the
Health Reform Law, the impact of the Health Reform Law, including how individuals and
businesses will respond to the new choice afforded them, is not yet fully known.
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Payor Mix Shift
Like others in the hospital industry, in recent quarters we have experienced a shift in our
patient volumes and revenue from commercial and managed care payors to Medicaid and managed
Medicaid. This has resulted in pressures on pricing and operating
margins created from expending the
same amount of resources to provide patient care, but for less reimbursement. This shift is
reflective of continued high unemployment and the resulting increases in states Medicaid rolls.
The decline in managed care volume and revenue mix is not only indicative of the depressed labor
market, but also utilization behavior of the insured population resulting from higher deductible
and co-insurance plans implemented by employers, which, in turn, has resulted in the
deferral of elective and non-emergent procedures. Given the high rate of unemployment and its
impact on the economy, particularly in the markets we serve, we expect the elevated levels in our
Medicaid and managed Medicaid payor mixes to continue until the U.S. economy experiences an
economic recovery that includes job growth and declining unemployment.
State Medicaid Budgets
The states in which we operate have experienced budget constraints as a result of increased
costs and lower than expected tax collections. Many states have experienced or projected shortfalls
in their budgets, and economic conditions may increase these budget pressures. Health and human
services programs, including Medicaid and similar programs, represent a significant portion of
state budgets. The states in which we operate continue to respond to these budget concerns by
decreasing funding for Medicaid and other healthcare programs or making structural
changes that have resulted in a reduction in Medicaid and other
hospital reimbursement. Additional Medicaid spending cuts or other
program changes may be implemented in the future in the states in which we operate.
Value-Based Reimbursement
There is a trend in the healthcare industry towards value-based purchasing of healthcare
services. These value-based purchasing programs include both public reporting and financial
incentives tied to the quality and efficiency of care provided by facilities. The Health Reform Law
recently enacted by Congress expands the use of value-based purchasing initiatives in federal
healthcare programs. We expect programs of this type to become more common in the healthcare
industry.
Medicare requires providers to report certain quality measures in order to receive full
reimbursement increases for inpatient and outpatient procedures that previously were awarded
automatically. CMS has expanded, through a series of rulemakings, the number of patient care
indicators that hospitals must report. Additionally, we anticipate that CMS will continue to expand
the number of inpatient and outpatient quality measures. We have invested significant capital and
resources in the implementation of our advanced clinical system that assists us in monitoring and
reporting these quality measures. CMS makes the data submitted by hospitals, including our
hospitals, public on its website.
Medicare no longer pays hospitals additional amounts for the treatment of certain preventable
adverse events, also known as hospital acquired conditions (HACs), unless the condition was
present at admission. The Health Reform Law, meanwhile, prohibits the use of federal funds under
the Medicaid program to reimburse providers for treating HACs. The Health Reform Law also requires
the U.S. Department of Health and Human Services (the Department) to implement a value-based
purchasing program for inpatient hospital services. Beginning in federal fiscal year 2013, the
Department will reduce inpatient hospital payments for all discharges by a percentage specified by
statute ranging from 1% to 2% and pool the total amount collected from these reductions to fund
payments to reward hospitals that meet or exceed certain quality performance standards established
by the Department.
Many large commercial payors currently require providers to report quality data. Several
commercial payors have announced that they will stop reimbursing hospitals for certain preventable
adverse events. A number of state hospital associations have also announced policies addressing the
waiver of patient bills for care related to a serious adverse event. In addition, managed care
organizations may begin programs that condition payment on performance against specified measures.
The quality measurement criteria used by commercial payors may be similar to or even
more stringent than Medicare requirements.
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We expect these trends towards value-based purchasing of healthcare services by Medicare and
other payors to continue. Because of these trends, if we are unable to meet or exceed quality of
care standards in our facilities, our operating results could be significantly impacted in the
future.
Physician Alignment and Integration
In an effort to meet community needs and address coverage issues, we continue to seek
alignment with physicians through various recruitment and employment strategies. Our ability to
attract and retain skilled physicians to our hospitals is critical to our success and is affected
by the quality of care at our hospitals. This is one reason we have taken significant steps in
implementing our expanded quality of care initiatives. We believe intense efforts focusing on
quality of care will enhance our ability to recruit and retain the skilled physicians necessary to
make our hospitals successful.
We experience certain risks associated with the integration of medical staffs at our
hospitals. As we continue to focus on our physician employment strategy, we face significant
competition for skilled physicians in certain of our markets as more hospital providers adopt a
physician staffing model approach, coupled with a general shortage of physicians across most
specialties. This increased competition has resulted in efforts by managed care organizations to
align with certain provider networks in the markets in which we operate. While we expect that
employing physicians should provide relief on cost pressures associated with on-call coverage and
other professional fees, we anticipate incurring additional labor and other start-up related costs
as we continue the integration of employed physicians.
We also face risk from competition for outpatient business. We expect to mitigate this risk
through continued focus on our physician employment strategy, the development of new access points
of care, our commitment to capital investment in our hospitals, including updated technology and
equipment, and our commitment to our quality of care initiatives that some competitors, including
individual physicians or physician groups, may not be equipped to implement.
Uncompensated Care
Like others in the hospital industry, we continue to experience high levels of uncompensated
care, including charity care and bad debts. These elevated levels are driven by the number of
uninsured and under-insured patients seeking care at our hospitals, the increased acuity levels at
which these patients are presenting for treatment, primarily resulting economic pressures and their
related decisions to previously defer care, increasing healthcare costs and other factors beyond
our control, such as increases in the amount of co-payments and deductibles as employers continue
to pass more of these costs on to their employees. In addition, as a result of high unemployment
and its continued impact on the economy, we believe that our hospitals may continue to experience
high levels of or possibly growth in bad debts and charity care. During the quarter and six months
ended March 31, 2011, our uncompensated care as a percentage of acute care revenue, which includes
the impact of charity care, was 13.6% and 14.3%, respectively, compared to 12.2% and 12.5% in the
same prior year periods.
We continue to monitor our self-pay admissions on a daily basis and continue to focus on the
efficiency of our emergency rooms, point-of-service cash collections, Medicaid eligibility
automation and process-flow improvements. While we continue to be successful at qualifying many uninsured
patients for Medicaid or other third-party coverage, which has helped to alleviate some of the
pressure created from the growth in our uncompensated care, we have
recently experienced a delay associated with the administrative
functions of the Medicaid qualification process at the state levels.
These delays are not indicative of eligibility issues, but rather
staffing cut-backs as states continue working to address their budgetary
issues.
We anticipate that if we experience further growth in uninsured volume and revenue over the
near-term, along with continued increases in co-payments and deductibles for insured patients, our
uncompensated care will increase and our results of operations could be adversely affected.
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The percentages of insured and uninsured gross hospital receivables (prior to allowances for
contractual adjustments and doubtful accounts) are summarized as follows:
March 31, | September 30, | |||||||
2011 | 2010 | |||||||
Insured receivables |
63.8 | % | 61.8 | % | ||||
Uninsured receivables |
36.2 | % | 38.2 | % | ||||
Total |
100.0 | % | 100.0 | % | ||||
The percentages in the table above are calculated using gross receivable balances. Uninsured
receivables and insured receivables are net of discounts and contractual adjustments recorded at
the time of billing. Included in insured receivables are accounts that are pending approval from
Medicaid. These receivables were 3.0% of gross hospital receivables at both March 31, 2011 and
September 30, 2010.
The percentages of gross hospital receivables in summarized aging categories are as follows:
March 31, | September 30, | |||||||
2011 | 2010 | |||||||
0 to 90 days |
71.6 | % | 71.9 | % | ||||
91 to 180 days |
15.9 | % | 17.8 | % | ||||
Over 180 days |
12.5 | % | 10.3 | % | ||||
Total |
100.0 | % | 100.0 | % | ||||
Revenue and Volume Trends
Net revenue for the quarter ended March 31, 2011, increased 8.6% to $678.4 million, compared
to $624.5 million in the prior year quarter. Net revenue for the six months ended March 31, 2011,
increased 7.8% to $1.35 billion, compared to $1.25 billion in the prior year period. Net revenue is
comprised of acute care and premium revenue. Acute care revenue, which includes the impact of the
Brim Holdings, Inc. (Brim) acquisition on October 1, 2010, contributed $50.9 million and $97.4
million to the increase in total net revenue for the quarter and six months ended March 31, 2011,
respectively, while premium revenue at Health Choice contributed $3.0 million and $907,000 for the
same periods, respectively.
Acute Care Revenue
Acute care revenue is comprised of net patient revenue and other revenue. A large percentage
of our hospitals net patient revenue consists of fixed payment, discounted sources, including
Medicare, Medicaid and managed care organizations. Reimbursement for Medicare and Medicaid services
are often fixed regardless of the cost incurred or the level of services provided. Similarly, a
greater percentage of the managed care companies we contract with reimburse providers on a fixed
payment basis regardless of the costs incurred or the level of services provided. Net patient
revenue is reported net of discounts and contractual adjustments. The contractual adjustments
principally result from differences between the hospitals established charges and payment rates
under Medicare, Medicaid and various managed care plans. Additionally, discounts and contractual
adjustments result from our uninsured discount and charity care programs. Other revenue includes
medical office building rental income and other miscellaneous revenue.
Certain of our acute care hospitals receive supplemental Medicaid reimbursement, including
reimbursement from programs for participating private hospitals that enter into indigent care
affiliation agreements with public hospitals or county governments in the state of Texas. Under the
CMS approved programs, affiliated hospitals, including our Texas hospitals, have expanded the
community healthcare safety net by providing indigent healthcare services. Participation in
indigent care affiliation agreements by our Texas hospitals has resulted in an increase in acute
care revenue by virtue of the hospitals entitlement to supplemental Medicaid inpatient
reimbursement. Revenue recognized under these Texas private supplemental Medicaid reimbursement
programs for the quarter and six months ended March 31, 2011, was $19.7 million and $36.7 million,
respectively, compared to $21.8 million and $37.7 million in the same prior year periods.
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Admissions increased 7.0% and 5.4% for the quarter and six months ended March 31, 2011,
respectively, compared to the same prior year periods. Adjusted admissions increased 10.8% and 9.3%
for the quarter and six months ended March 31, 2011, respectively, compared to the same prior year
periods. On a same-facility basis, admissions declined 0.9% and 2.6% for the quarter and six
months ended March 31, 2011, respectively, compared to the same prior year periods, while adjusted
admissions increased 2.0% and 0.3% for the quarter and six months ended March 31, 2011,
respectively, compared to the same prior year periods.
On a same-facility basis, our quarter and year-to-date inpatient volume has been negatively
impacted, in part, by an overall industry-wide decline in obstetric related services, the impact of
high unemployment and patient decisions to defer or cancel elective procedures, general primary
care and other non-emergent healthcare procedures until their conditions become more acute, all
resulting from the impact of the current economic environment. The deferral of non-emergent
procedures has also been facilitated by an increase in the number of high deductible employer
sponsored health plans, which ultimately shifts more of the medical cost responsibility onto the
patient.
We
believe the recent growth in our outpatient volume
is attributable, in part, to the continued investment in our physician alignment strategy, the
development of increased access points of care, including
physician clinics, urgent care centers, outpatient imaging centers and ambulatory surgery centers, and our increased
marketing efforts to promote our commitment to quality and patient satisfaction.
We believe our volumes over the long-term will grow as a result of our business strategies,
including the strategic deployment of capital, the expansion of our physician base and the general
aging of the population.
The sources of our net patient revenue by payor are summarized as follows:
Quarter | Six Months | |||||||||||||||
Ended March 31, | Ended March 31, | |||||||||||||||
2011 | 2010 | 2011 | 2010 | |||||||||||||
Medicare |
24.7 | % | 24.9 | % | 24.4 | % | 23.7 | % | ||||||||
Managed Medicare |
8.0 | % | 8.8 | % | 8.2 | % | 8.2 | % | ||||||||
Medicaid and managed Medicaid |
14.3 | % | 15.0 | % | 14.3 | % | 15.7 | % | ||||||||
Managed care |
39.3 | % | 39.4 | % | 39.9 | % | 40.5 | % | ||||||||
Self-pay |
13.7 | % | 11.9 | % | 13.2 | % | 11.9 | % | ||||||||
Total |
100.0 | % | 100.0 | % | 100.0 | % | 100.0 | % | ||||||||
Consistent with industry trends, we have experienced a shift in our patient volumes and
revenue out of commercial and managed care payors. While we have seen some recent moderation, this shift has resulted in higher than normal
Medicaid and managed Medicaid utilization. Given the high rate of unemployment and its impact on
the economy, particularly in the markets we serve, we expect the elevated levels in our Medicaid
and managed Medicaid payor mixes to continue until the U.S. economy experiences an economic
recovery that includes job growth and declining unemployment. Additionally, we continue to experience growth in our self-pay revenue, resulting in large part, from increased acuity levels associated with previous patient decisions to defer non-emergent healthcare needs.
Net patient revenue per adjusted admission increased 0.5% and 1.7%, respectively, for the
quarter and six months ended March 31, 2011, compared to the same prior year periods. On a
same-facility basis, net patient revenue per adjusted admission increased 1.8% and 3.2%,
respectively, for the quarter and six months ended March 31, 2011, compared to the same prior year
periods. While our net patient revenue per adjusted admission continues to increase, we have
experienced moderating rates of pricing growth resulting from the impact of high unemployment and
other industry pressures, including elevated levels of Medicaid and managed Medicaid, which
typically result in lower reimbursement on a per adjusted admission basis, the impact of state
budgetary issues on Medicaid funding, which has resulted in rate freezes and, in some cases, rate
cuts to providers, which has caused a decline in pricing related to Medicaid and managed Medicaid
volumes, and the growth of our outpatient business, which is the
result of continued focus on our physician alignment strategies and
the development of various access points of care. As states continue working through their budgetary issues, any additional cuts to Medicaid
funding would negatively impact our future pricing and earnings.
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See Item 1 Business Sources of Acute Care Revenue and Item 1 Business
Government Regulation and Other Factors included in our Annual Report on Form 10-K filed with the
SEC on December 21, 2010, for a description of the types of payments we receive for services
provided to patients enrolled in the traditional Medicare plan, managed Medicare plans, Medicaid
plans, managed Medicaid plans and managed care plans. In those sections, we also discussed the
unique reimbursement features of the traditional Medicare plan,
including the annual Medicare regulatory updates published by CMS that impact reimbursement
rates for services provided under the plan. The future potential impact to reimbursement for
certain of these payors under the Health Reform Law was also addressed in such Annual Report on
Form 10-K.
Premium Revenue
Premium revenue generated under the AHCCCS and CMS contracts with Health Choice represented
28.0% and 29.0%, respectively, of our consolidated net revenue for the quarter and six months ended
March 31, 2011, compared to 29.9% and 31.2% in the same prior
year periods. Most of the premium revenue at
Health Choice is derived through a contract with AHCCCS to provide specified health services to
qualified Medicaid enrollees through contracted providers. AHCCCS is the state agency that
administers Arizonas Medicaid program. The contract requires Health Choice to arrange for
healthcare services for enrolled Medicaid patients in exchange for fixed monthly premiums, based
upon negotiated per capita member rates, and supplemental payments from AHCCCS. Health Choice also
contracts with CMS to provide coverage as a Medicare Advantage Prescription Drug (MAPD) Special
Needs Plan (SNP). This contract allows Health Choice to offer Medicare and Part D drug benefit
coverage to new and existing dual-eligible members (i.e., those that are eligible for Medicare and
Medicaid). Effective for this 2011 plan year, SNPs are required to meet additional CMS
requirements, including requirements relating to model of care, cost-sharing, disclosure of
information and reporting of quality measures.
The Health Reform Law reduces, over a three-year period, premium payments to managed Medicare
plans such that CMS managed care per capita premium payments are, on average, equal to traditional
Medicare. The Health Reform Law implements fee adjustments based on service benchmarks and quality
ratings. The Congressional Budget Office estimated that, as a result of these changes,
payments to plans will be reduced by $138.0 billion between 2010 and 2019, while CMS estimated the
reduction to be $145.0 billion.
Premiums received from AHCCCS and CMS to provide services to our members may be affected by
the significant budgetary concerns that the state of Arizona is facing. As Arizona continues
working to eliminate its budget deficit, its current budget for fiscal 2011 includes reimbursement
cuts, including elimination of Medicaid coverage for some services and a cut of up to 5% for all
Medicaid providers beginning in April 2011. In an effort to relieve some of the budget pressures,
on May 18, 2010, voters passed a sales tax referendum that would temporarily raise money at the
state level to help fund these budgetary shortfalls. The Governor has
signed the states fiscal 2012 budget legislation, which includes another 5% cut to provider
reimbursement effective October 1, 2011, and a reduction of
approximately 160,000 eligible Medicaid beneficiaries,
specifically childless adults, which represents approximately 11.5%
of the total Medicaid population in the state. This reduction in
eligible enrollees is projected to be accomplished over a twelve
month period through enrollment caps, attrition and more stringent
eligibility requirements. While these structural changes to the
Medicaid program have been included in Arizonas approved fiscal 2012 budget,
these changes require CMS approval under the confines of the Health
Reform Law. Arizona has requested from
CMS a new Medicaid waiver that eliminates Medicaid coverage for these specific childless adults. Elimination
of these members from Medicaid eligibility could materially impact our premium revenue and
earnings. Depending upon member mix, we generally believe Health Choice could continue to
experience a decline in rates received on a per member per month basis, which may negatively impact
our premium revenue over the near-term.
CRITICAL ACCOUNTING POLICIES AND ESTIMATES
A summary of significant accounting policies is disclosed in Note 2 to the consolidated
financial statements included in our Annual Report on Form 10-K for the year ended September 30,
2010. Our critical accounting policies are further described under the caption Critical Accounting
Policies and Estimates in Managements Discussion and Analysis of Financial Condition and Results
of Operations in our Annual Report on Form 10-K for the fiscal year ended September 30, 2010. There
have been no changes in the nature of our critical accounting policies or the application of those
policies since September 30, 2010.
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SELECTED OPERATING DATA
The following table sets forth certain unaudited operating data for each of the periods
presented.
Quarter | Six Months | |||||||||||||||
Ended March 31, | Ended March 31, | |||||||||||||||
2011 | 2010 | 2011 | 2010 | |||||||||||||
Acute Care: |
||||||||||||||||
Number of acute care hospital facilities
at end of period |
17 | 15 | 17 | 15 | ||||||||||||
Licensed beds at end of period (1) |
3,570 | 2,884 | 3,570 | 2,884 | ||||||||||||
Average length of stay (days) (2) |
5.0 | 4.9 | 4.9 | 4.8 | ||||||||||||
Occupancy rates (average beds in service) |
51.3 | % | 49.0 | % | 48.2 | % | 48.0 | % | ||||||||
Admissions (3) |
28,311 | 26,458 | 54,513 | 51,711 | ||||||||||||
Adjusted admissions (4) |
47,583 | 42,932 | 92,895 | 84,999 | ||||||||||||
Patient days (5) |
141,670 | 128,336 | 269,477 | 248,887 | ||||||||||||
Adjusted patient days (4) |
229,147 | 201,615 | 440,843 | 394,838 | ||||||||||||
Net patient revenue per adjusted admission |
$ | 10,183 | $ | 10,130 | $ | 10,252 | $ | 10,079 | ||||||||
Same-Facility Acute Care (6): |
||||||||||||||||
Number of acute care hospital facilities
at end of period |
15 | 15 | 15 | 15 | ||||||||||||
Licensed beds at end of period (1) |
3,185 | 2,884 | 3,185 | 2,884 | ||||||||||||
Average length of stay (days) (2) |
5.1 | 4.9 | 5.0 | 4.8 | ||||||||||||
Occupancy rates (average beds in service) |
51.1 | % | 49.0 | % | 48.0 | % | 48.0 | % | ||||||||
Admissions (3) |
26,211 | 26,458 | 50,348 | 51,711 | ||||||||||||
Adjusted admissions (4) |
43,779 | 42,932 | 85,215 | 84,999 | ||||||||||||
Patient days (5) |
132,412 | 128,336 | 251,696 | 248,887 | ||||||||||||
Adjusted patient days (4) |
212,409 | 201,615 | 408,454 | 394,838 | ||||||||||||
Net patient revenue per adjusted admission |
$ | 10,307 | $ | 10,130 | $ | 10,399 | $ | 10,079 | ||||||||
Health Choice: |
||||||||||||||||
Medicaid covered lives |
190,915 | 195,392 | 190,915 | 195,392 | ||||||||||||
Dual-eligible lives (7) |
4,331 | 4,186 | 4,331 | 4,186 | ||||||||||||
Medical loss ratio (8) |
84.3 | % | 87.4 | % | 85.2 | % | 88.1 | % |
(1) | Includes St. Lukes Behavioral Hospital. | |
(2) | Represents the average number of days that a patient stayed in our hospitals. | |
(3) | Represents the total number of patients admitted to our hospitals for stays in excess of 23 hours. Management and investors use this number as a general measure of inpatient volume. | |
(4) | Adjusted admissions and adjusted patient days are general measures of combined inpatient and outpatient volume. We compute adjusted admissions/patient days by multiplying admissions/patient days by gross patient revenue and then dividing that number by gross inpatient revenue. | |
(5) | Represents the number of days our beds were occupied by inpatients over the period. | |
(6) | Excludes the impact of the Brim acquisition, which was effective October 1, 2010. | |
(7) | Represents members eligible for Medicare and Medicaid benefits under Health Choices contract with CMS to provide coverage as a MAPD SNP. | |
(8) | Represents medical claims expense as a percentage of premium revenue, including claims paid to our hospitals. |
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RESULTS OF OPERATIONS SUMMARY
Consolidated
The following table sets forth, for the periods presented, our results of consolidated
operations expressed in dollar terms and as a percentage of net revenue. Such information has
been derived from our unaudited condensed consolidated statements of operations.
Quarter Ended | Quarter Ended | Six Months Ended | Six Months Ended | |||||||||||||||||||||||||||||
March 31, 2011 | March 31, 2010 | March 31, 2011 | March 31, 2010 | |||||||||||||||||||||||||||||
($ in thousands) | Amount | Percentage | Amount | Percentage | Amount | Percentage | Amount | Percentage | ||||||||||||||||||||||||
Net revenue: |
||||||||||||||||||||||||||||||||
Acute care revenue |
$ | 488,449 | 72.0 | % | $ | 437,574 | 70.1 | % | $ | 959,588 | 71.0 | % | $ | 862,234 | 68.8 | % | ||||||||||||||||
Premium revenue |
189,960 | 28.0 | % | 186,948 | 29.9 | % | 392,152 | 29.0 | % | 391,245 | 31.2 | % | ||||||||||||||||||||
Total net revenue |
678,409 | 100.0 | % | 624,522 | 100.0 | % | 1,351,740 | 100.0 | % | 1,253,479 | 100.0 | % | ||||||||||||||||||||
Costs and expenses: |
||||||||||||||||||||||||||||||||
Salaries and benefits |
196,036 | 28.9 | % | 174,171 | 27.9 | % | 385,949 | 28.6 | % | 344,653 | 27.5 | % | ||||||||||||||||||||
Supplies |
77,924 | 11.5 | % | 68,425 | 11.0 | % | 154,360 | 11.4 | % | 133,834 | 10.7 | % | ||||||||||||||||||||
Medical claims |
157,416 | 23.2 | % | 160,094 | 25.6 | % | 328,750 | 24.3 | % | 338,661 | 27.0 | % | ||||||||||||||||||||
Other operating expenses |
103,350 | 15.2 | % | 88,683 | 14.2 | % | 200,476 | 14.8 | % | 173,275 | 13.8 | % | ||||||||||||||||||||
Provision for bad debts |
54,801 | 8.1 | % | 45,536 | 7.3 | % | 114,415 | 8.5 | % | 93,485 | 7.5 | % | ||||||||||||||||||||
Rentals and leases |
11,289 | 1.7 | % | 10,145 | 1.6 | % | 22,455 | 1.7 | % | 20,420 | 1.6 | % | ||||||||||||||||||||
Interest expense, net |
16,510 | 2.4 | % | 16,622 | 2.7 | % | 33,387 | 2.4 | % | 33,354 | 2.7 | % | ||||||||||||||||||||
Depreciation and amortization |
24,584 | 3.6 | % | 24,025 | 3.8 | % | 48,630 | 3.6 | % | 47,902 | 3.8 | % | ||||||||||||||||||||
Management fees |
1,250 | 0.2 | % | 1,250 | 0.2 | % | 2,500 | 0.2 | % | 2,500 | 0.2 | % | ||||||||||||||||||||
Total costs and expenses |
643,160 | 94.8 | % | 588,951 | 94.3 | % | 1,290,922 | 95.5 | % | 1,188,084 | 94.8 | % | ||||||||||||||||||||
Earnings from continuing
operations before gain (loss)
on disposal of assets and
income taxes |
35,249 | 5.2 | % | 35,571 | 5.7 | % | 60,818 | 4.5 | % | 65,395 | 5.2 | % | ||||||||||||||||||||
Gain (loss) on disposal of
assets, net |
540 | 0.1 | % | (161 | ) | (0.0 | %) | 885 | 0.1 | % | (57 | ) | (0.0 | %) | ||||||||||||||||||
Earnings from continuing
operations before income taxes |
35,789 | 5.3 | % | 35,410 | 5.7 | % | 61,703 | 4.6 | % | 65,338 | 5.2 | % | ||||||||||||||||||||
Income tax expense |
13,500 | 2.0 | % | 13,270 | 2.2 | % | 22,689 | 1.7 | % | 23,861 | 1.9 | % | ||||||||||||||||||||
Net earnings from continuing
operations |
22,289 | 3.3 | % | 22,140 | 3.5 | % | 39,014 | 2.9 | % | 41,477 | 3.3 | % | ||||||||||||||||||||
Earnings (loss) from
discontinued operations, net
of income taxes |
(2,846 | ) | (0.4 | %) | (25 | ) | (0.0 | %) | (6,054 | ) | (0.5 | %) | 21 | 0.0 | % | |||||||||||||||||
Net earnings |
19,443 | 2.9 | % | 22,115 | 3.5 | % | 32,960 | 2.4 | % | 41,498 | 3.3 | % | ||||||||||||||||||||
Net earnings attributable to
non-controlling interests |
(2,417 | ) | (0.4 | %) | (2,033 | ) | (0.3 | %) | (4,188 | ) | (0.3 | %) | (4,061 | ) | (0.3 | %) | ||||||||||||||||
Net earnings attributable to
IASIS Healthcare LLC |
$ | 17,026 | 2.5 | % | $ | 20,082 | 3.2 | % | $ | 28,772 | 2.1 | % | $ | 37,437 | 3.0 | % | ||||||||||||||||
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Acute Care
The following table and discussion sets forth, for the periods presented, the results of our
acute care operations expressed in dollar terms and as a percentage of acute care revenue.
Such information has been derived from our unaudited condensed consolidated statements of
operations.
Quarter Ended | Quarter Ended | Six Months Ended | Six Months Ended | |||||||||||||||||||||||||||||
March 31, 2011 | March 31, 2010 | March 31, 2011 | March 31, 2010 | |||||||||||||||||||||||||||||
($ in thousands) | Amount | Percentage | Amount | Percentage | Amount | Percentage | Amount | Percentage | ||||||||||||||||||||||||
Acute care revenue: |
||||||||||||||||||||||||||||||||
Acute care revenue |
$ | 488,449 | 99.4 | % | $ | 437,574 | 99.3 | % | $ | 959,588 | 99.4 | % | $ | 862,234 | 99.3 | % | ||||||||||||||||
Revenue between segments (1) |
2,807 | 0.6 | % | 3,336 | 0.7 | % | 5,467 | 0.6 | % | 6,012 | 0.7 | % | ||||||||||||||||||||
Total acute care revenue |
491,256 | 100.0 | % | 440,910 | 100.0 | % | 965,055 | 100.0 | % | 868,246 | 100.0 | % | ||||||||||||||||||||
Costs and expenses: |
||||||||||||||||||||||||||||||||
Salaries and benefits |
190,863 | 38.9 | % | 169,224 | 38.4 | % | 375,753 | 38.9 | % | 335,114 | 38.6 | % | ||||||||||||||||||||
Supplies |
77,872 | 15.9 | % | 68,375 | 15.5 | % | 154,264 | 16.0 | % | 133,737 | 15.4 | % | ||||||||||||||||||||
Other operating expenses |
96,425 | 19.6 | % | 82,604 | 18.7 | % | 187,255 | 19.4 | % | 160,929 | 18.5 | % | ||||||||||||||||||||
Provision for bad debts |
54,801 | 11.2 | % | 45,536 | 10.3 | % | 114,415 | 11.9 | % | 93,485 | 10.8 | % | ||||||||||||||||||||
Rentals and leases |
10,891 | 2.2 | % | 9,780 | 2.2 | % | 21,613 | 2.2 | % | 19,684 | 2.3 | % | ||||||||||||||||||||
Interest expense, net |
16,510 | 3.3 | % | 16,622 | 3.8 | % | 33,387 | 3.4 | % | 33,354 | 3.8 | % | ||||||||||||||||||||
Depreciation and amortization |
23,697 | 4.8 | % | 23,137 | 5.3 | % | 46,848 | 4.9 | % | 46,125 | 5.3 | % | ||||||||||||||||||||
Management fees |
1,250 | 0.2 | % | 1,250 | 0.3 | % | 2,500 | 0.3 | % | 2,500 | 0.3 | % | ||||||||||||||||||||
Total costs and expenses |
472,309 | 96.1 | % | 416,528 | 94.5 | % | 936,035 | 97.0 | % | 824,928 | 95.0 | % | ||||||||||||||||||||
Earnings from continuing operations
before gain (loss) on disposal of
assets and income taxes |
18,947 | 3.9 | % | 24,382 | 5.5 | % | 29,020 | 3.0 | % | 43,318 | 5.0 | % | ||||||||||||||||||||
Gain (loss) on disposal of assets, net |
540 | 0.1 | % | (161 | ) | (0.0 | %) | 885 | 0.1 | % | (57 | ) | (0.0 | %) | ||||||||||||||||||
Earnings from continuing operations
before income taxes |
$ | 19,487 | 4.0 | % | $ | 24,221 | 5.5 | % | $ | 29,905 | 3.1 | % | $ | 43,261 | 5.0 | % | ||||||||||||||||
(1) | Revenue between segments is eliminated in our consolidated results. |
Quarters Ended March 31, 2011 and 2010
Acute care revenue Acute care revenue for the quarter ended March 31, 2011, was $491.3
million, an increase of $50.3 million, or 11.4%, compared to $440.9 million in the prior year
quarter. The increase in acute care revenue, which includes the impact of the Brim acquisition, is
comprised of an increase in adjusted admissions of 10.8% and an increase in net patient revenue per
adjusted admission of 0.5%.
Net adjustments to estimated third-party payor settlements, also known as prior year
contractuals, resulted in an increase in acute care revenue of $443,000 and $571,000 for the
quarters ended March 31, 2011 and 2010, respectively.
Salaries and benefits Salaries and benefits expense for the quarter ended March 31, 2011,
was $190.9 million, or 38.9% of acute care revenue, compared to $169.2 million, or 38.4% of acute
care revenue in the prior year quarter. Included in the prior year quarter was $2.0 million of
stock-based compensation incurred in connection with the repurchase of certain equity by our parent
company. Excluding all stock-based compensation for both periods, salaries and benefits expense as a
percentage of acute care revenue was 38.7% for the quarter ended March 31, 2011, compared to 37.9%
in the prior year quarter. The increase in our salaries and benefits expense as a percentage of
acute care revenue is due to the expansion of our employed physician base, which requires
additional investments in labor and other practice-related costs, including infrastructure and
physician support staff.
Supplies Supplies expense for the quarter ended March 31, 2011, was $77.9 million, or 15.9%
of acute care revenue, compared to $68.4 million, or 15.5% of acute care revenue in the prior year
quarter. The increase in supplies as a percentage of acute care revenue is primarily the result of
a shift in the mix of our surgical volume to cases with more costly implant utilization,
particularly in the area of orthopedics.
Other operating expenses Other operating expenses for the quarter ended March 31, 2011,
were $96.4 million, or 19.6% of acute care revenue, compared to $82.6 million, or 18.7% of acute
care revenue in the prior year quarter. Included in the current year quarter was $1.4 million in
settlement costs related to a terminated vendor contract for services provided from fiscal years
2006 to 2008 and $556,000 in costs related to the start-up of our physician professional liability captive insurance program. Other
operating expenses in the current year quarter also included a $948,000 increase in
insurance expense resulting from changes in prior year actuarial estimates associated with our
professional and general liability reserves, compared to a $1.9 million reduction in the prior year
quarter.
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Provision for bad debts Provision for bad debts for the quarter ended March 31, 2011, was
$54.8 million, or 11.2% of acute care revenue, compared to $45.5 million, or 10.3% of acute care
revenue in the prior year quarter. The increase in our provision for bad debts as a percentage of
acute care revenue is due to an increase in self-pay revenue and related acuity, primarily
resulting from previous patient decisions to defer non-emergent healthcare needs, as a result of
economic pressures and high unemployment, and administrative delays in qualifying patients for Medicaid, as states have reduced staffing levels in efforts to address their budgetary issues.
Six Months Ended March 31, 2011 and 2010
Acute care revenue Acute care revenue for the six months ended March 31, 2011, was $965.1
million, an increase of $96.8 million or 11.1%, compared to $868.2 million in the prior year
period. The increase in acute care revenue, which includes the impact of the Brim acquisition, is
comprised of an increase in adjusted admissions of 9.3% and an increase in net patient revenue per
adjusted admission of 1.7%.
Net adjustments to estimated third-party payor settlements, also known as prior year
contractuals, resulted in an increase in acute care revenue of $1.8 million and $2.5 million for
the six months ended March 31, 2011 and 2010, respectively.
Salaries and benefits Salaries and benefits expense for the six months ended March 31,
2011, was $375.8 million, or 38.9% of acute care revenue, compared to $335.1 million, or 38.6% of
acute care revenue in the prior year period. Included in the prior year period was $2.0 million of
stock-based compensation incurred in connection with the repurchase of certain equity by our parent
company. Excluding all stock-based compensation for both periods, salaries and benefits expense as a
percentage of acute care revenue was 38.8% for the six months ended March 31, 2011, compared to
38.3% in the prior year period. Included in the current year period was $1.3 million in
severance related costs associated with the transition of our executive management. The remaining
increase in our salaries and benefits expense as a percentage of acute care revenue is due to the
expansion of our employed physician base, which requires additional investments in labor and other
practice-related costs, including infrastructure and physician support staff.
Supplies Supplies expense for the six months ended March 31, 2011, was $154.3 million, or
16.0% of acute care revenue, compared to $133.7 million, or 15.4% of acute care revenue in the
prior year period. The increase in supplies as a percentage of acute care revenue is primarily the
result of a shift in the mix of our surgical volume to cases with more costly implant utilization,
particularly in the area of orthopedics.
Other operating expenses Other operating expenses for the six months ended March 31, 2011,
were $187.3 million, or 19.4% of acute care revenue, compared to $160.9 million, or 18.5% of acute
care revenue in the prior year period. Included in the current year period was $3.1 million in
settlement costs related to a terminated vendor contract for services provided from fiscal years
2006 to 2008 and $1.0 million in costs related to the start-up of our physician professional liability captive insurance program.
Other operating expenses in the current year period also included a $948,000 increase in insurance
expense resulting from changes in prior year actuarial estimates associated with our professional
and general liability reserves, compared to a $1.9 million reduction in the prior year period.
Provision for bad debts Provision for bad debts for the six months ended March 31, 2011,
was $114.4 million, or 11.9% of acute care revenue, compared to $93.5 million, or 10.8% of acute
care revenue in the prior year period. The increase in our provision for bad debts as a percentage
of acute care revenue is due to an increase in self-pay revenue and related acuity, primarily
resulting from patient decisions to defer non-emergent healthcare needs, as a result of
economic pressures and high unemployment, and administrative delays in qualifying patients for Medicaid, as states have reduced staffing levels in efforts to address their budgetary issues.
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Health Choice
The following table and discussion sets forth, for the periods presented, the results of our
Health Choice operations expressed in dollar terms and as a percentage of premium revenue. Such
information has been derived from our unaudited condensed consolidated statements of operations.
Quarter Ended | Quarter Ended | Six Months Ended | Six Months Ended | |||||||||||||||||||||||||||||
March 31, 2011 | March 31, 2010 | March 31, 2011 | March 31, 2010 | |||||||||||||||||||||||||||||
($ in thousands) | Amount | Percentage | Amount | Percentage | Amount | Percentage | Amount | Percentage | ||||||||||||||||||||||||
Premium revenue: |
||||||||||||||||||||||||||||||||
Premium revenue |
$ | 189,960 | 100.0 | % | $ | 186,948 | 100.0 | % | $ | 392,152 | 100.0 | % | $ | 391,245 | 100.0 | % | ||||||||||||||||
Costs and expenses: |
||||||||||||||||||||||||||||||||
Salaries and benefits |
5,173 | 2.7 | % | 4,947 | 2.6 | % | 10,196 | 2.6 | % | 9,539 | 2.4 | % | ||||||||||||||||||||
Supplies |
52 | 0.0 | % | 50 | 0.0 | % | 96 | 0.0 | % | 97 | 0.0 | % | ||||||||||||||||||||
Medical claims (1) |
160,223 | 84.3 | % | 163,430 | 87.4 | % | 334,217 | 85.2 | % | 344,673 | 88.1 | % | ||||||||||||||||||||
Other operating expenses |
6,925 | 3.7 | % | 6,079 | 3.3 | % | 13,221 | 3.4 | % | 12,346 | 3.2 | % | ||||||||||||||||||||
Rentals and leases |
398 | 0.2 | % | 365 | 0.2 | % | 842 | 0.2 | % | 736 | 0.2 | % | ||||||||||||||||||||
Depreciation and amortization |
887 | 0.5 | % | 888 | 0.5 | % | 1,782 | 0.5 | % | 1,777 | 0.5 | % | ||||||||||||||||||||
Total costs and expenses |
173,658 | 91.4 | % | 175,759 | 94.0 | % | 360,354 | 91.9 | % | 369,168 | 94.4 | % | ||||||||||||||||||||
Earnings before income taxes |
$ | 16,302 | 8.6 | % | $ | 11,189 | 6.0 | % | $ | 31,798 | 8.1 | % | $ | 22,077 | 5.6 | % | ||||||||||||||||
(1) | Medical claims paid to our hospitals of $2.8 million and $3.3 million for the quarters ended March 31, 2011 and 2010, respectively, and $5.5 million and $6.0 million for the six months ended March 31, 2011 and 2010, respectively, are eliminated in our consolidated results. |
Quarters Ended March 31, 2011 and 2010
Premium revenue Premium revenue was $190.0 million for the quarter ended March 31, 2011, an
increase of $3.0 million or 1.6%, compared to $186.9 million in the prior year quarter.
Medical claims Medical claims expense was $160.2 million for the quarter ended March 31,
2011, compared to $163.4 million in the prior year quarter. Medical claims expense as a percentage
of premium revenue was 84.3% for the quarter ended March 31, 2011, compared to 87.4% in the prior
year quarter. The decrease in medical claims as a percentage of premium revenue is primarily the
result of declining medical claims costs, resulting from a general
decline in medical utilization, as well as improvements in care management and other operational initiatives.
Six Months Ended March 31, 2011 and 2010
Premium revenue Premium revenue was $392.2 million for the six months ended March 31, 2011,
an increase of $907,000 or 0.2%, compared to $391.2 million in the prior year period.
Medical claims Medical claims expense was $334.2 million for the six months ended March 31,
2011, compared to $344.7 million in the prior year period. Medical claims expense as a percentage
of premium revenue was 85.2% for the six months ended March 31, 2011, compared to 88.1% in the
prior year period. The decrease in medical claims as a percentage of premium revenue is primarily
the result of declining medical claims costs, resulting from a general decline in medical
utilization, as well as improvements in care management and other operational initiatives.
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LIQUIDITY AND CAPITAL RESOURCES
Overview of Cash Flow Activities for the Six Months Ended March 31, 2011 and 2010
Our cash flows are summarized as follows (in thousands):
Six Months | ||||||||
Ended March 31, | ||||||||
2011 | 2010 | |||||||
Cash flows from operating activities |
$ | 97,478 | $ | 116,567 | ||||
Cash flows from investing activities |
$ | (53,249 | ) | $ | (29,138 | ) | ||
Cash flows from financing activities |
$ | (10,124 | ) | $ | (135,446 | ) |
Operating Activities
Operating cash flows decreased $19.1 million for the six months ended March 31, 2011, compared
to the prior year period. The decrease in operating cash flows has been impacted by both the efforts
of managed care payors to extend payments and administrative delays in the Medicaid qualification process at the state
levels, as a result of staffing cut-backs as states continue working to address their budgetary issues.
At March 31, 2011, we had $194.6 million in net working capital, compared to $134.5 million at
September 30, 2010. Net accounts receivable increased $42.0 million to $251.1 million at March 31,
2011, from $209.2 million at September 30, 2010. The increase in net working capital and net
accounts receivable is primarily the result of the acquisition of Brim
and increased accounts receivable as previously discussed. Excluding the impact of Brim, our days revenue in
accounts receivable at March 31, 2011, were 47, compared to 43 at September 30, 2010, and 47 at
March 31, 2010.
Investing Activities
Capital expenditures for the six months ended March 31, 2011, were $42.2 million, compared to
$30.2 million in the prior year period.
During the six months ended March 31, 2011, we paid $12.8 million for acquisitions, which
included a $7.0 million deposit related to the acquisition of St. Joseph.
Financing Activities
During the six months ended March 31, 2011 and 2010, pursuant to the terms of our existing senior
secured credit facilities, we made net payments of $2.9 million. Additionally, we made payments totaling $865,000 on capital leases and other
debt obligations during the six months ended March 31, 2011, compared to $2.2 million in the prior year
period.
During fiscal 2010, we distributed $125.0 million, net of a $1.8 million income tax benefit,
to IAS to fund the repurchase of certain shares of its outstanding preferred stock and cancel
certain vested rollover options to purchase its common stock. The holder of the IAS preferred stock
is represented by an investor group led by TPG, JLL Partners and Trimaran Fund Management. The
repurchase of preferred stock, which included accrued and outstanding dividends, and the
cancellation of rollover options were funded by our excess cash on hand. The cancellation of the
rollover options, which were associated with our 2004 recapitalization, resulted in the recognition
of $2.0 million in stock-based compensation during the quarter ended March 31, 2010.
Capital Resources
As of March 31, 2011, we had the following debt arrangements:
| $854.0 million senior secured credit facilities; and |
| $475.0 million in 83/4% senior subordinated notes due 2014. |
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At March 31, 2011, amounts outstanding under our existing senior secured credit facilities
consisted of a $421.4 million term loan and a $145.9 million delayed draw term loan. In addition,
we had $39.9 million and $44.7 million in letters of credit outstanding under the synthetic letter
of credit facility and the revolving credit facility, respectively. The weighted average interest
rate of outstanding borrowings under the senior secured credit facilities was 3.2% and 3.3% for the
quarter and six months ended March 31, 2011, respectively.
Overview of Refinancing Transaction
On May 3, 2011, we completed a transaction to refinance our existing debt (the Refinancing).
The Refinancing included $1.325 billion in new senior secured credit facilities and the issuance by
us, together with our wholly owned subsidiary IASIS Capital, of $850.0 million aggregate principal
amount of 8.375% senior notes due 2019. Proceeds from the Refinancing were used to refinance
amounts outstanding under our existing credit facilities; fund a cash tender offer to repurchase
any and all of our $475.0 million aggregate principal amount of 83/4% senior subordinated notes due 2014;
repay in full the senior paid-in-kind loans of IAS; pay fees and expenses associated with the
Refinancing; and raise capital for general corporate purposes.
As part of the Refinancing, we distributed $630.9 million to IAS, $400.9 million to fund the
repayment of the IAS senior paid-in-kind loans and $230.0 million to be held for future acquisitions and strategic
growth initiatives, as well as potential distributions to the equity holders of IAS.
$1.325 Billion Senior Secured Credit Facilities
In connection with the Refinancing, we entered into a new senior credit agreement (the Restated Credit Agreement).
The Restated Credit Agreement provides for senior secured financing of up to $1.325 billion
consisting of (1) a $1.025 billion senior secured term loan facility with a seven-year maturity and
(2) a $300.0 million senior secured revolving credit facility with a five-year maturity, of which
up to $150.0 million may be utilized for the issuance of letters of credit (together, the New
Senior Secured Credit Facilities). Principal under the senior secured term loan facility
is due in consecutive equal quarterly installments in an aggregate annual amount equal to 1% of the
principal amount outstanding on the closing date, with the remaining balance due upon maturity of
the senior secured term loan facility. The senior secured revolving credit facility does not
require installment payments.
Borrowings under the senior secured term loan facility bear interest at a rate per annum equal
to, at our option, either (1) a base rate (the base rate) determined by reference to the highest
of (a) the federal funds rate plus 0.50%, (b) the prime rate of Bank of America, N.A. and (c) a
one-month LIBOR rate, subject to a floor of 1.25%, plus 1.00%, in each case, plus a margin of 2.75%
per annum or (2) the LIBOR rate for the interest period relevant to such borrowing, subject to a
floor of 1.25%, plus a margin of 3.75% per annum. Borrowings under the senior secured
revolving credit facility generally bear interest at a rate per annum equal to, at our option,
either (1) the base rate plus a margin of 2.50% per annum, or (2) the LIBOR rate for the interest
period relevant to such borrowing plus a margin of 3.50% per annum. In addition to paying
interest on outstanding principal under the New Senior Secured Credit Facilities, we will be
required to pay a commitment fee in respect of the unutilized commitments under the senior secured
revolving credit facility, as well as pay customary letter of credit fees and agency fees.
The New Senior Secured Credit Facilities are unconditionally guaranteed by IAS and certain of
our subsidiaries (collectively, the Credit Facility Guarantors) and are required to be guaranteed
by all of our future material wholly owned subsidiaries, subject to certain exceptions. All
obligations under the Restated Credit Agreement are secured, subject to certain exceptions, by
substantially all of our assets and the assets of the Credit Facility Guarantors, including (1) a
pledge of 100% of our equity interests and that of the Credit Facility Guarantors, (2) mortgage
liens on all of our material real property and that of the Credit Facility Guarantors, and (3) all
proceeds of the foregoing.
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The Restated Credit Agreement requires us to mandatorily prepay borrowings under the senior
secured term loan facility with net cash proceeds of certain asset dispositions, following certain
casualty events, following certain borrowings or debt issuances, and from a percentage of annual
excess cash flow.
The Restated Credit Agreement contains a number of affirmative covenants, including, among
other things: (1) the delivery of financial statements and other reports; (2) compliance with laws;
(3) payment of ours and our restricted subsidiaries obligations, including taxes and
indebtedness; and (4) maintenance of ours and our restricted subsidiaries material properties.
The Restated Credit Agreement also contains a number of negative covenants, including, among
other things: (1) limitations on the incurrence of debt and liens; (2) limitations on investments
other than, among other exceptions, certain acquisitions that meet certain conditions; (3)
limitations on the sale of assets outside of the ordinary course of business; (5) limitations on
dividends and distributions; and (6) limitations on transactions with affiliates, in each case,
subject to certain exceptions. The Restated Credit Agreement also contains certain customary events
of default, including, without limitation, a failure to make payments under the New Senior Secured
Credit Facilities, cross-defaults, certain bankruptcy events and certain change of control events.
8.375% Senior Notes due 2019
In connection with the Refinancing, we and IASIS Capital (together, the Issuers) issued $850.0 million aggregate
principal amount of 8.375% senior notes due 2019 (the Notes), which mature on May 15, 2019,
pursuant to an indenture, dated as of May 3, 2011, among the Issuers and certain of the Issuers
wholly owned domestic subsidiaries that guarantee the New Senior Secured Credit Facilities (the
Notes Guarantors)
(the
Indenture). The Indenture provides that the Notes are general unsecured, senior obligations of
the Issuers, and initially will be unconditionally guaranteed on a senior unsecured basis.
The Notes bear interest at a rate of 8.375% per annum and will accrue from May 3, 2011.
Interest on the notes is payable semi-annually, in cash in arrears, on May 15 and November 15 of
each year, commencing on November 15, 2011.
We may redeem the Notes, in whole or in part, at any time prior to May 15, 2014, at a
price equal to 100% of the aggregate principal amount of the Notes plus a make-whole premium and
accrued and unpaid interest and special interest, if any, to but excluding the redemption date. In
addition, we may redeem up to 35% of the Notes before May 15, 2014, with the net cash
proceeds from certain equity offerings at a redemption price equal to 108.375% of the aggregate
principal amount of the Notes plus accrued and unpaid interest and special interest, if any, to but
excluding the redemption date, subject to compliance with certain conditions.
The Indenture contains covenants that limit our (and our restricted subsidiaries) ability to,
among other things: (1) incur additional indebtedness or liens or issue disqualified stock or
preferred stock; (2) pay dividends or make other distributions on, redeem or repurchase our capital
stock; (3) sell certain assets; (4) make certain loans and investments; (5) enter into certain
transactions with affiliates; (5) impose restrictions on the ability of a subsidiary to pay
dividends or make payments or distributions to us and our restricted subsidiaries; and (6)
consolidate, merge or sell all or substantially all of our assets. These covenants are subject to a
number of important limitations and exceptions.
The Indenture also provides for events of default, which, if any of them occurs, may permit
or, in certain circumstances, require the principal, premium, if any, interest and any other
monetary obligations on all the then outstanding Notes to be due and payable immediately. If we
experience certain kinds of changes of control, we must offer to purchase the Notes at 101% of
their principal amount, plus accrued and unpaid interest and special interest, if any, to but
excluding the repurchase date. Under certain circumstances, we will have the ability to make
certain payments to facilitate a change of control transaction and to provide for the assumption of
the Notes by a new parent company resulting from such change of control transaction. If such change
of control transaction is facilitated, the Issuers will be released from all obligations under the
Indenture and the Issuers and the trustee will execute a supplemental indenture effectuating such
assumption and release.
Credit Ratings
The table below summarizes our corporate rating, as well as our credit ratings for the New Senior Secured Credit Facilities and Notes as of the date of this filing:
Moodys | Standard & Poors | |||
Corporate credit |
B2 | B | ||
Senior secured term loan facility |
Ba3 | B | ||
Senior secured revolving credit facility |
Ba3 | BB- | ||
8.375% senior notes due 2019 |
Caa1 | CCC+ | ||
Outlook |
Stable | Stable |
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Other
As of March 31, 2011, we are a party to interest rate swap agreements with Citibank, N.A.
(Citibank) and Wachovia Bank, N.A. (Wachovia), as counterparties, with notional amounts
totaling $200.0 million, in an effort to manage exposure to floating interest rate risk on a
portion of our variable rate debt. The arrangements with our counterparties include an interest
rate swap agreement with a notional amount of $100.0 million maturing on February 29, 2012. Under
these agreements, we are required to make monthly interest payments to our counterparties at fixed
annual interest rate of 2.0%. Our counterparties are obligated to make monthly interest payments to
us based upon the one-month LIBOR rate in effect over the term of the agreement.
As of March 31, 2011, we provided a performance guaranty in the form of letters of credit
totaling $48.3 million for the benefit of AHCCCS to support our obligations under the Health Choice
contract to provide and pay for healthcare services. The amount of the performance guaranty is
based in part upon the membership in the plan and the related capitation revenue paid to us.
Capital Expenditures
We plan to finance our proposed capital expenditures with cash generated from operations,
borrowings under our New Senior Secured Credit Facilities and other capital sources that may become
available. We expect our capital expenditures for fiscal 2011 to be approximately $120.0 million
(including $10.0 million to $15.0 million related to our newly acquired hospital, St. Joseph), including the
following significant expenditures:
| $35.0 million to $40.0 million for growth and new business projects; |
| $30.0 million to $35.0 million in replacement or maintenance related projects at our hospitals; |
| $20.0 million to $25.0 million related to our newly acquired facilities; and |
| $20.0 million in hardware and software costs related to information systems projects, including healthcare IT stimulus initiatives. |
Liquidity
We rely on cash generated from our operations as our primary source of liquidity, as well as
available credit facilities, project and bank financings and the issuance of long-term debt. From
time to time, we have also utilized operating lease transactions that are sometimes referred to as
off-balance sheet arrangements. We expect that our future funding for working capital needs,
capital expenditures, long-term debt repayments and other financing activities will continue to be
provided from some or all of these sources. Each of our existing and projected sources of cash is
impacted by operational and financial risks that influence the overall amount of cash generated and
the capital available to us. For example, cash generated by our business operations may be impacted
by, among other things, economic downturns, weather-related catastrophes and adverse industry
conditions. Our future liquidity will be impacted by our ability to access capital markets, which
may be restricted due to our credit ratings, general market conditions, and by existing or future
debt agreements. For a further discussion of risks that can impact our liquidity, see our risk
factors beginning on page 35 of our Annual Report of Form 10-K for the fiscal year ended September
30, 2010.
Including available cash at March 31, 2011, and the impact of our New Senior Secured Credit
Facilities, we have available liquidity as follows (in millions):
Cash and cash equivalents |
$ | 178.6 | ||
Available capacity under our new senior secured revolving credit facility |
214.8 | |||
Net available liquidity at March 31, 2011, adjusted for the impact of
our new senior secured revolving credit facility |
$ | 393.4 | ||
Net available liquidity assumes 100% participation from all lenders currently participating in
our senior secured revolving credit facility. In addition to our available liquidity, we expect to
generate significant operating cash flows in fiscal 2011. We will also utilize proceeds from our
financing activities as needed.
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Based upon our current level of operations and anticipated growth, we believe we have
sufficient liquidity to meet our cash requirements over the short-term (next 12 months) and over
the next three years. In evaluating the sufficiency of our liquidity for both the short-term and
long-term, we considered the expected cash flow to be generated by our operations, cash on hand and
the available borrowings under our New Senior Secured Credit Facilities, compared to our anticipated
cash requirements for debt service, working capital, capital expenditures and the payment of taxes,
as well as funding requirements for long-term liabilities.
We are unable at this time to extend our evaluation of the sufficiency of our liquidity beyond
three years. We cannot assure you, however, that our operating performance will generate sufficient
cash flow from operations or that future borrowings will be available under our New Senior Secured
Credit Facilities, or otherwise, to enable us to grow our business, service our indebtedness, or
make anticipated capital expenditures and tax payments. For more information, see our risk factors
beginning on page 35 of our Annual Report on Form 10-K for the fiscal year ended September 30,
2010.
One element of our business strategy is to selectively pursue acquisitions and strategic
alliances in existing and new markets. Any acquisitions or strategic alliances may result in the
incurrence of, or assumption by us, of additional indebtedness. We continually assess our capital
needs and may seek additional financing, including debt or equity as considered necessary to fund
capital expenditures and potential acquisitions or for other corporate purposes. Our future
operating performance and our ability to service or refinance our debt will be subject to future economic
conditions and to financial, business and other factors, many of which are beyond our control. For
more information, see our risk factors beginning on page 35 of our Annual Report on Form 10-K for
the fiscal year ended September 30, 2010.
SEASONALITY
The patient volumes and acute care revenue of our healthcare operations are subject to
seasonal variations and generally are greater during the quarter ended March 31 than other
quarters. These seasonal variations are caused by a number of factors, including seasonal cycles of
illness, climate and weather conditions in our markets, vacation patterns of both patients and
physicians and other factors relating to the timing of elective procedures.
RECENT ACCOUNTING PRONOUNCEMENTS
In August 2010, the
Financial Accounting Standards Board (FASB) issued
Accounting Standards Update (ASU) No. 2010-23, Health Care Entities (Topic 954): Measuring
Charity Care for Disclosure. Due to the lack of comparability existing as a result of the use of
either revenue or cost as the basis for disclosure of charity care, this ASU standardizes cost as
the basis for charity care disclosures and specifies the elements of cost to be used in charity
care disclosures. ASU 2010-23 is effective for our fiscal year beginning October 1, 2011, and is not
expected to significantly impact our financial statement disclosures.
Also in August 2010,
the FASB issued ASU No. 2010-24, Health Care Entities (Topic 954):
Presentation of Insurance Claims and Related Insurance Recoveries. This ASU eliminates the
practice of netting claim liabilities with expected related insurance recoveries for balance sheet
presentation. Claim liabilities are to be determined with no regard for recoveries and presented gross.
Expected recoveries are presented separately. ASU 2010-24 is effective for fiscal years, and interim
periods within those years, beginning after December 15, 2010. ASU 2010-24 is effective for our
fiscal year beginning October 1, 2011, and is not expected to significantly impact our financial
position, results of operations or cash flows.
In October 2010, the FASB issued ASU No. 2010-26, Financial Services Insurance (Topic
944): Accounting for Costs Associated with Acquiring or Renewing Insurance Contracts. ASU 2010-26
provides guidance on accounting for deferred policy acquisition costs of internal replacements of
insurance and investment contracts. The amendments in this ASU specify that certain costs incurred
in the successful acquisition of new and renewal contracts should be capitalized. Those costs
include incremental direct costs of contract acquisition that result directly from and are
essential to the contract transaction(s) and would not have been incurred by the insurance entity
had the contract transaction(s) not occurred. ASU 2010-26 is effective for our fiscal year
beginning October 1, 2012, with early adoption permitted, and is not expected to significantly
impact our financial position, results of operations or cash flows.
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In December 2010, the FASB issued ASU No. 2010-28, IntangiblesGoodwill and Other (Topic
350): When to Perform Step 2 of the Goodwill Impairment Test for Reporting Units with Zero or
Negative Carrying Amounts. ASU 2010-28 requires Step 2 of the impairment test be performed in
circumstances where the carrying amount of a reporting unit is zero or negative and there are
qualitative factors that indicate it is more likely than not that a goodwill impairment exists. The
ASU is effective for fiscal years, and interim periods within those years, beginning after December
15, 2010. ASU 2010-28
is effective for our fiscal year beginning October 1, 2011, and is not expected to significantly impact our financial position, results of
operations or cash flows.
In December 2010, the FASB issued ASU No. 2010-29, Business Combinations (Topic 805):
Disclosure of Supplementary Pro Forma Information for Business Combinations. ASU 2010-29 clarifies
that, if a reporting entity presents comparative financial statements, the pro forma revenue and
earnings of the combined entity should be reported as though the business combinations that
occurred during the current year had occurred as of the beginning of the comparable prior annual
reporting period. The ASU is effective prospectively for business combinations for which the
acquisition date is on or after the beginning of the first annual reporting period beginning on or
after December 15, 2010. ASU No. 2010-29 is effective for our fiscal
year beginning October
1, 2011, with early adoption permitted, and is an accounting principle which clarifies
disclosure requirements, and is not expected to significantly impact our financial statement disclosures.
Item 3. | Quantitative and Qualitative Disclosures about Market Risk |
We are subject to market risk from exposure to changes in interest rates based on our
financing, investing and cash management activities. At March 31, 2011, the following components
of our existing senior secured credit facilities bear interest at variable rates at specified
margins above either the agent banks alternate base rate or the LIBOR rate: (i) a $439.0 million,
seven-year term loan; (ii) a $150.0 million delayed draw term loan; and (iii) a
$225.0 million, six-year revolving credit facility. As of March 31, 2011, we had
outstanding variable rate debt of $567.3 million.
After the Refinancing and as of the date of this report, our New Senior Secured Credit
Facilities consist of a $1.025 billion senior secured term loan and a $300.0 million senior secured
revolving credit facility (of which $85.2 million of capacity has been utilized by outstanding
letters of credit) that each bear interest at variable rates at specified margins above either the
agent banks alternate base rate or the LIBOR rate, subject to a 1.25% floor.
We have managed our market exposure to changes in interest rates by converting $200.0 million
of this variable rate debt to fixed rate debt through the use of interest rate swap agreements. Our
interest rate swaps provide for a total notional amount of $200.0 million from March 1, 2011 through February 29, 2012, at a
rate of 2.0% in accordance with the terms of the specific agreements.
Our interest rate swap agreements expose us to credit risk in the event of non-performance by
our counterparties, Citibank and Wachovia. However, we do not anticipate non-performance by
Citibank or Wachovia.
Although changes in the alternate base rate or the LIBOR rate would affect the cost of funds
borrowed in the future, we believe the effect, if any, of reasonably possible near-term changes in
interest rates on our remaining variable rate debt or our consolidated financial position, results
of operations or cash flows would not be material. Holding other variables constant, including
levels of indebtedness, a 0.125% increase in interest rates would have an estimated impact on
pre-tax earnings and cash flows for the next twelve month period of $1.0 million.
We currently believe we have adequate liquidity to fund operations during the near term
through the generation of operating cash flows, cash on hand and access to our
new senior secured revolving credit
facility. Our ability to borrow funds under our new senior secured revolving credit facility is subject to the
financial viability of the participating financial institutions. While we do not anticipate any of
our current lenders defaulting on their obligations, we are unable to provide assurance that any
particular lender will not default at a future date.
Item 4. | Controls and Procedures |
Evaluations of Disclosure Controls and Procedures
Under the supervision and with the participation of our management team, including our Chief
Executive Officer and Chief Financial Officer, we conducted an evaluation of our disclosure
controls and procedures, as such term is defined under Rule 13a-15(e) and 15d-15(e) promulgated
under the Securities Exchange Act of 1934, as amended, as of March 31, 2011. Based on this
evaluation, the principal executive officer and principal accounting officer concluded that our
disclosure controls and procedures are effective in timely alerting them to material information
required to be included in our periodic reports.
Changes in Internal Control Over Financial Reporting
During the period covered by this report, there has been no change in our internal control
over financial reporting that has materially affected or is reasonably likely to materially affect
our internal control over financial reporting.
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PART II. OTHER INFORMATION
Item 1. | Legal Proceedings |
On March 31, 2008, the United States District Court for the District of Arizona (District
Court) dismissed with prejudice the qui tam complaint against IAS, our parent company. The qui tam
action sought monetary damages and civil penalties under the federal False Claims Act (FCA) and
included allegations that certain business practices related to physician relationships and the
medical necessity of certain procedures resulted in the submission of claims for reimbursement in
violation of the FCA. The case dates back to March 2005 and became the subject of a subpoena by the
Office of Inspector General in September 2005. In August 2007, the case was unsealed and the U.S.
Department of Justice (DOJ) declined to intervene. The District Court dismissed the case from the bench
at the conclusion of oral arguments on IAS motion to dismiss. On April 21, 2008, the District
Court issued a written order dismissing the case with prejudice and entering formal judgment for
IAS and denying as moot IAS motions related to the relators misappropriation of information
subject to a claim of attorney-client privilege by IAS. Both parties appealed. On August 12, 2010,
United States Court of Appeals for the Ninth Circuit reversed the District Courts dismissal of the
qui tam complaint and the District Courts denial of IAS motions concerning the relators
misappropriation of documents and ordered that the qui tam relator be allowed leave to file a Third
Amended Complaint and for the District Court to consider IAS motions concerning the relators
misappropriation of documents. The District Court ordered the qui tam relator to file his Third
Amended Complaint by November 22, 2010, and set a schedule for the filing of motions related to the
relators misappropriation of documents. On October 20, 2010, the qui tam relator filed a motion to
transfer this action to the United States District Court for the Eastern District of Texas.
On November 22, 2010, the relator filed his Third Amended Complaint. On
January 3, 2011, IAS filed its renewed motion for sanctions concerning the relators
misappropriation of documents and, on January 14, 2011, IAS filed its motion to dismiss the
relators Third Amended Complaint. On May 4, 2011, the District Court in Arizona heard oral
arguments on all pending motions, including IAS motion to dismiss and renewed motions for
sanctions and the relators motion to transfer the action to the United States District Court for
the Eastern District of Texas. The District Court dismissed relators motion to transfer and took
all other motions under advisement at the conclusion of oral argument. While the District Court is
expected to rule quickly, IAS anticipates that it could take 90 days or more for the District Court
to issue its final opinion on IAS motion to dismiss and renewed motion for sanctions. If the qui
tam action were to be resolved in a manner unfavorable to IAS, it could have a material
adverse effect on our business, financial condition and results of operations, including
exclusion from the Medicare and Medicaid programs. In addition, we may incur material
fees, costs and expenses in connection with defending the qui tam action.
Our facilities obtain clinical and administrative services from a variety of
vendors. One vendor, a medical practice that furnished cardiac catheterization services under
contractual arrangements at Mesa General Hospital and St. Lukes Medical Center through March 31,
2008 and May 31, 2008, respectively, has asserted that, because of deferred fee adjustments that it
claims are due under these arrangements, it is owed additional amounts for services rendered since
April 1, 2006 at both facilities. We were unable to reach an agreement with the vendor with
respect to the amount of the fee adjustment, if any, that was contractually required, nor with
respect to an appropriate methodology for determining such amount. On September 30, 2008, the
vendor filed a state court complaint for an aggregate adjustment in excess of the amount of our accrual, in addition to certain tort claims. On March 20, 2009,
we filed a Motion to Dismiss and in the alternative to Compel Arbitration. On July 27, 2009, the court granted our Motion to Compel Arbitration on the grounds that the issues are to be determined by
binding arbitration. On December 24, 2010, after conducting the arbitration hearing, the
arbitration panel issued its decision rejecting the fees sought by the vendor, but did not adopt
the fees proposed by us. The arbitration panel required both parties to agree upon a
settlement amount, based on the arbitration panels approved methodology, by January 21, 2011. We have
reviewed the methodology required by decision in binding arbitration and has determined that it
will result in a payment to the vendor of approximately
$15.2 million, which includes $5.8 million in pre-judgement
interest and legal fees. Of the additional liability
resulting from the arbitration panels decision, $9.3 million ($6.1 million, net of income taxes)
is included in discontinued operations, related to the closure of Mesa General Hospital, for the six
months ended March 31, 2011. The arbitration panel has not rendered a decision with respect
to any of the vendors tort claims, which are expected to be addressed in separate proceedings. We will continue to defend our interests in connection with this arbitration proceeding, but
expresses no opinion as to the outcome of matters not yet decided by the arbitration panel.
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In
November 2010, the DOJ sent a letter to IAS requesting a 12-month
tolling agreement in connection with an investigation into Medicare claims submitted by our
hospitals in connection with the implantation of implantable cardioverter defibrillators (ICDs)
during the period 2003 to the present. At that time, neither the precise number of procedures,
number of claims nor the hospitals involved were identified by the DOJ. We understand that the
government is conducting a national initiative with respect to ICD procedures involving a
number of healthcare providers and is seeking information in order to determine if ICD implantation
procedures were performed in accordance with Medicare coverage requirements. On January 11, 2011,
IAS entered into the tolling agreement with the DOJ and, subsequently, the DOJ has provided IAS
with a list of 194 procedures involving ICDs at 14 hospitals which are the subject of further
medical necessity review by the DOJ. We are cooperating fully with the government and, to
date, the DOJ has not asserted any claim against our hospitals.
Item 1A. | Risk Factors |
Reference is made to the factors set forth under the caption Forward-Looking Statements in
Part I, Item 2 of this Form 10-Q and other risk factors described in our Annual Report on Form 10-K
for the year ended September 30, 2010, which are incorporated herein by reference. There have not
been any material changes to the risk factors previously disclosed in our annual report on Form
10-K for the year ended September 30, 2010.
PART II. OTHER INFORMATION
Item 6. | Exhibits |
(a) List of Exhibits:
4.1 | Indenture, dated as of May 3, 2011, among IASIS Healthcare LLC, IASIS Capital Corporation, the Guarantors named therein and The Bank of New York Mellon Trust Company, N.A, as trustee, relating to the 8.375% Senior Notes due 2019 (incorporated by reference to the Companys Current Report on Form 8-K dated May 6, 2011). | |||
4.2 | Registration Rights Agreement dated as of May 3, 2011 by and among IASIS Healthcare LLC, IASIS Capital Corporation, the Guarantors named therein and Merrill Lynch, Pierce, Fenner & Smith Incorporated, Barclays Capital Inc., Citigroup Global Markets Inc., Goldman, Sachs & Co., J.P. Morgan Securities LLC, Deutsche Bank Securities Inc. and SunTrust Robinson Humphrey, Inc. (incorporated by reference to the Companys Current Report on Form 8-K dated May 6, 2011). | |||
4.3 | Supplemental Indenture, dated as of May 2, 2011 among IASIS Healthcare LLC, IASIS Capital Corporation, the Guarantors named therein and The Bank of New York Mellon Trust Company, N.A. (formerly The Bank of New York Trust Company, N.A.), as trustee, relating to the 83/4% Senior Subordinated Notes due 2014 (incorporated by reference to the Companys Current Report on Form 8-K dated May 6, 2011). | |||
10.1 | Restatement Agreement, dated as of May 3, 2011, among IASIS Healthcare LLC, IASIS Healthcare Corporation, the lenders party thereto and Bank of America, N.A., as administrative agent and attached thereto as Exhibit A, the Amended and Restated Credit Agreement, dated as of May 3, 2011, among IASIS Healthcare LLC, IASIS Healthcare Corporation, Bank of America, N.A., as administrative agent, swing line lender and L/C issuer and each lender from time to time party thereto (incorporated by reference to the Companys Current Report on Form 8-K dated May 6, 2011). | |||
31.1 | Certification of Principal Executive Officer Pursuant to Rule
15d-14(a) under the Securities Exchange Act of 1934, as adopted
pursuant to Section 302 of the Sarbanes-Oxley Act of 2002. |
|||
31.2 | Certification of Principal Financial Officer pursuant to Rule
15d-14(a) under the Securities Exchange Act of 1934, as adopted
pursuant to Section 302 of the Sarbanes-Oxley Act of 2002. |
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SIGNATURES
Pursuant to the requirements of the Securities Exchange Act of 1934, the registrant has duly
caused this report to be signed on its behalf by the undersigned thereunto duly authorized.
IASIS HEALTHCARE LLC | ||||||
Date: May 16, 2011
|
By: | /s/ John M. Doyle
|
||||
Chief Financial Officer |
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EXHIBIT INDEX
Exhibit No. | Description | |||
4.1 | Indenture, dated as of May 3, 2011, among IASIS Healthcare LLC, IASIS Capital Corporation, the Guarantors named therein and The Bank of New York Mellon Trust Company, N.A, as trustee, relating to the 8.375% Senior Notes due 2019 (incorporated by reference to the Companys Current Report on Form 8-K dated May 6, 2011). | |||
4.2 | Registration Rights Agreement dated as of May 3, 2011 by and among IASIS Healthcare LLC, IASIS Capital Corporation, the Guarantors named therein and Merrill Lynch, Pierce, Fenner & Smith Incorporated, Barclays Capital Inc., Citigroup Global Markets Inc., Goldman, Sachs & Co., J.P. Morgan Securities LLC, Deutsche Bank Securities Inc. and SunTrust Robinson Humphrey, Inc. (incorporated by reference to the Companys Current Report on Form 8-K dated May 6, 2011). | |||
4.3 | Supplemental Indenture, dated as of May 2, 2011 among IASIS Healthcare LLC, IASIS Capital Corporation, the Guarantors named therein and The Bank of New York Mellon Trust Company, N.A. (formerly The Bank of New York Trust Company, N.A.), as trustee, relating to the 83/4% Senior Subordinated Notes due 2014 (incorporated by reference to the Companys Current Report on Form 8-K dated May 6, 2011). | |||
10.1 | Restatement Agreement, dated as of May 3, 2011, among IASIS Healthcare LLC, IASIS Healthcare Corporation, the lenders party thereto and Bank of America, N.A., as administrative agent and attached thereto as Exhibit A, the Amended and Restated Credit Agreement, dated as of May 3, 2011, among IASIS Healthcare LLC, IASIS Healthcare Corporation, Bank of America, N.A., as administrative agent, swing line lender and L/C issuer and each lender from time to time party thereto (incorporated by reference to the Companys Current Report on Form 8-K dated May 6, 2011). | |||
31.1 | Certification of Principal Executive Officer Pursuant to Rule
15d-14(a) under the Securities Exchange Act of 1934, as
adopted pursuant to Section 302 of the Sarbanes-Oxley Act of
2002. |
|||
31.2 | Certification of Principal Financial Officer pursuant to Rule
15d-14(a) under the Securities Exchange Act of 1934, as
adopted pursuant to Section 302 of the Sarbanes-Oxley Act of
2002. |
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