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UNITED STATES
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
(Registrant’s telephone number, including area code)
Not Applicable
(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 registrant’s 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
     
 Exhibit 4.2
     
 Exhibit 4.3
     
 Exhibit 10.1
     
 Exhibit 31.1
 Exhibit 31.2

 

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PART I.
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:
               
Member’s 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.

 

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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       Member’s     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.

 

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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 Company’s 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 Company’s 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)
Reclassifications
Certain prior year amounts have been reclassified to conform to the current year presentation. These reclassifications have no impact on the Company’s total assets or total liabilities and equity.
General and Administrative
The majority of the Company’s 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 Company’s option, the administrative agent’s 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 Company’s option, the administrative agent’s base rate plus an applicable margin ranging from 0.25% to 0.75%, such rate in each case depending on the Company’s 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 Company’s 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)
At March 31, 2011, amounts outstanding under the Company’s 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 Company’s 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 Company’s existing domestic subsidiaries, other than certain non-guarantor subsidiaries, which include Health Choice and the Company’s 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 Company’s subsidiaries that are not guarantors of the 8 3/4% notes.
See Note 12 for subsequent event discussion regarding the Company’s 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 Company’s existing debt, will convert to cash-pay, at which time all accrued interest becomes payable.
See Note 12 for subsequent event discussion regarding the Company’s 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 Company’s 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)
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 Company’s 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 Company’s 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 Company’s counterparties under the fixed interest rate component. Any change in the fair value of the Company’s interest rate swaps, net of income taxes, is included in other comprehensive loss as a component of member’s 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 Company’s 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 Company’s 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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IASIS HEALTHCARE LLC
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 Company’s excess cash on hand. The cancellation of the rollover options, which were associated with the Company’s 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 Company’s 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 Company’s opinion, would have a material adverse effect on the Company’s 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 Company’s 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 Company’s 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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IASIS HEALTHCARE LLC
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 Company’s 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 Choice’s 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 relator’s 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 Court’s dismissal of the qui tam complaint and the District Court’s denial of IAS’ motions concerning the relator’s 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 relator’s 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)
schedule for the filing of motions related to the relator’s 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 relator’s misappropriation of documents and, on January 14, 2011, IAS filed its motion to dismiss the relator’s 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 relator’s motion to transfer the action to the United States District Court for the Eastern District of Texas. The District Court dismissed relator’s 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 Company’s 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 Company’s 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. Luke’s 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 Company’s 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 panel’s 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 panel’s 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 vendor’s 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 Company’s 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 Company’s fiscal year beginning October 1, 2011, and is not expected to significantly impact the Company’s financial statement disclosures.

 

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IASIS HEALTHCARE LLC
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 Company’s fiscal year beginning October 1, 2011, and is not expected to significantly impact the Company’s 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 Company’s fiscal year beginning October 1, 2012, with early adoption permitted, and is not expected to significantly impact the Company’s financial position, results of operations or cash flows.
In December 2010, the FASB issued ASU No. 2010-28, “Intangibles—Goodwill 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 Company’s fiscal year beginning October 1, 2011, and is not expected to significantly impact the Company’s 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 Company’s 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 Company’s financial statement disclosures.

 

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IASIS HEALTHCARE LLC
NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (UNAUDITED)
10. SEGMENT AND GEOGRAPHIC INFORMATION
The Company’s 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 Company’s 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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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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IASIS HEALTHCARE LLC
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 Company’s 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 Company’s 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 Company’s existing domestic subsidiaries, other than non-guarantor subsidiaries which include Health Choice and the Company’s 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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IASIS HEALTHCARE LLC
NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (UNAUDITED)
IASIS Healthcare LLC
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:
                                       
Member’s 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  
 
                             

 

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IASIS HEALTHCARE LLC
NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (UNAUDITED)
IASIS Healthcare LLC
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:
                                       
Member’s 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  
 
                             

 

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IASIS HEALTHCARE LLC
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)
                                         
            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  
 
                             

 

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IASIS HEALTHCARE LLC
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)
                                         
            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  
 
                             

 

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IASIS HEALTHCARE LLC
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)
                                         
            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  
 
                             

 

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Table of Contents

IASIS HEALTHCARE LLC
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)
                                         
            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  
 
                             

 

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IASIS HEALTHCARE LLC
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)
                                         
            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)
IASIS Healthcare LLC
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)
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 Company’s existing credit facilities; fund a cash tender offer to repurchase any and all of the Company’s $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 Company’s 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 Company’s 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)
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 Company’s 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 Company’s 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 Company’s and its restricted subsidiaries’ obligations, including taxes and indebtedness; and (4) maintenance of the Company’s 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 Company’s (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 Company’s 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 Company’s 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)
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.   Management’s 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 Choice’s 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 law’s 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 Arizona’s 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 state’s 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 Arizona’s 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 Management’s 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. Luke’s 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 Choice’s 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 our’s and our restricted subsidiaries’ obligations, including taxes and indebtedness; and (4) maintenance of our’s 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:
         
    Moody’s   Standard & Poor’s
 
       
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, “Intangibles—Goodwill 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 bank’s 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 bank’s 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 relator’s 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 Court’s dismissal of the qui tam complaint and the District Court’s denial of IAS’ motions concerning the relator’s 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 relator’s 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 relator’s 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 relator’s misappropriation of documents and, on January 14, 2011, IAS filed its motion to dismiss the relator’s 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 relator’s motion to transfer the action to the United States District Court for the Eastern District of Texas. The District Court dismissed relator’s 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. Luke’s 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 panel’s 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 panel’s 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 vendor’s 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 Company’s 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 Company’s 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 Company’s 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 Company’s 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
 
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 Company’s 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 Company’s 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 Company’s 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 Company’s 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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