Attached files
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EX-31.1 - EXHIBIT 31.1 - IASIS Healthcare LLC | c20661exv31w1.htm |
EX-31.2 - EXHIBIT 31.2 - IASIS Healthcare LLC | c20661exv31w2.htm |
EXCEL - IDEA: XBRL DOCUMENT - IASIS Healthcare LLC | Financial_Report.xls |
Table of Contents
UNITED STATES
SECURITIES AND EXCHANGE COMMISSION
SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
FORM 10-Q
(Mark One)
þ | QUARTERLY REPORT PURSUANT TO SECTION 13 OR 15(d) OF THE SECURITIES EXCHANGE ACT OF 1934 |
For the quarterly period ended June 30, 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 incorporation or organization) |
(I.R.S. Employer Identification No.) |
|
DOVER CENTRE | ||
117 SEABOARD LANE, BUILDING E | ||
FRANKLIN, TENNESSEE | 37067 | |
(Address of principal executive offices) | (Zip Code) |
(615) 844-2747
(Registrants telephone number, including area code)
(Registrants telephone number, including area code)
Not Applicable
(Former name, former address and former fiscal year, if changed since last report)
(Former name, former address and former fiscal year, if changed since last report)
Indicate by check mark whether the registrant (1) has filed all reports required to be filed
by Section 13 or 15(d) of the Securities Exchange Act of 1934 during the preceding 12 months (or
for such shorter period that the registrant was required to file such reports), and (2) has been
subject to such filing requirements for the past 90 days. YES þ NO o
Indicate by check mark whether the registrant has submitted electronically and posted on its
corporate Web site, if any, every Interactive Data File required to be submitted and posted
pursuant to Rule 405 of Regulation S-T (§232.405 of this chapter) during the preceding 12 months
(or for such shorter period that the registrant was required to submit and post such files). YES
þ 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 August 15, 2011, 100% of the registrants common interests outstanding (all of which
are privately owned and are not traded on any public market) were owned by IASIS Healthcare
Corporation, its sole member.
TABLE OF CONTENTS
i
Table of Contents
PART I.
FINANCIAL INFORMATION
FINANCIAL INFORMATION
Item 1. | Financial Statements |
IASIS HEALTHCARE LLC
CONDENSED CONSOLIDATED BALANCE SHEETS
(In Thousands)
June 30, | September 30, | |||||||
2011 | 2010 | |||||||
(Unaudited) | ||||||||
ASSETS |
||||||||
Current assets |
||||||||
Cash and cash equivalents |
$ | 144,595 | $ | 144,511 | ||||
Accounts receivable, less allowance for doubtful accounts of
$145,092 and $125,406 at June 30, 2011 and September 30, 2010,
respectively |
295,823 | 209,173 | ||||||
Inventories |
65,446 | 53,842 | ||||||
Deferred income taxes |
31,565 | 15,881 | ||||||
Prepaid expenses and other current assets |
88,404 | 65,340 | ||||||
Total current assets |
625,833 | 488,747 | ||||||
Property and equipment, net |
1,129,151 | 985,291 | ||||||
Goodwill |
836,688 | 718,243 | ||||||
Other intangible assets, net |
33,385 | 27,000 | ||||||
Deposit for acquisition |
| 97,891 | ||||||
Other assets, net |
61,743 | 36,022 | ||||||
Total assets |
$ | 2,686,800 | $ | 2,353,194 | ||||
LIABILITIES AND EQUITY |
||||||||
Current liabilities |
||||||||
Accounts payable |
$ | 108,667 | $ | 78,931 | ||||
Salaries and benefits payable |
65,046 | 38,110 | ||||||
Accrued interest payable |
11,994 | 12,536 | ||||||
Medical claims payable |
99,530 | 111,373 | ||||||
Other accrued expenses and other current liabilities |
96,913 | 106,614 | ||||||
Current portion of long-term debt and capital lease obligations |
13,973 | 6,691 | ||||||
Total current liabilities |
396,123 | 354,255 | ||||||
Long-term debt and capital lease obligations |
1,867,460 | 1,044,887 | ||||||
Deferred income taxes |
118,380 | 109,272 | ||||||
Other long-term liabilities |
82,218 | 60,162 | ||||||
Non-controlling interests with redemption rights |
97,443 | 72,112 | ||||||
Equity |
||||||||
Members equity |
115,342 | 702,135 | ||||||
Non-controlling interests |
9,834 | 10,371 | ||||||
Total equity |
125,176 | 712,506 | ||||||
Total liabilities and equity |
$ | 2,686,800 | $ | 2,353,194 | ||||
See accompanying notes.
1
Table of Contents
IASIS HEALTHCARE LLC
CONDENSED CONSOLIDATED STATEMENTS OF OPERATIONS
(UNAUDITED)
(In Thousands)
Quarter Ended | Nine Months Ended | |||||||||||||||
June 30, | June 30, | |||||||||||||||
2011 | 2010 | 2011 | 2010 | |||||||||||||
Net revenue |
||||||||||||||||
Acute care revenue |
$ | 529,844 | $ | 438,211 | $ | 1,489,432 | $ | 1,300,445 | ||||||||
Premium revenue |
188,765 | 199,777 | 580,917 | 591,022 | ||||||||||||
Total net revenue |
718,609 | 637,988 | 2,070,349 | 1,891,467 | ||||||||||||
Costs and expenses |
||||||||||||||||
Salaries and benefits (includes
stock-based compensation of $330,
$118, $1,364 and $2,367,
respectively) |
211,114 | 170,035 | 597,063 | 514,688 | ||||||||||||
Supplies |
83,071 | 66,333 | 237,431 | 200,167 | ||||||||||||
Medical claims |
155,885 | 172,031 | 484,635 | 510,692 | ||||||||||||
Other operating expenses |
114,778 | 93,579 | 315,254 | 266,854 | ||||||||||||
Provision for bad debts |
60,685 | 49,416 | 175,100 | 142,901 | ||||||||||||
Rentals and leases |
11,774 | 10,067 | 34,229 | 30,487 | ||||||||||||
Interest expense, net |
27,597 | 16,711 | 60,984 | 50,065 | ||||||||||||
Depreciation and amortization |
26,312 | 24,007 | 74,942 | 71,909 | ||||||||||||
Management fees |
1,250 | 1,250 | 3,750 | 3,750 | ||||||||||||
Loss on extinguishment of debt |
23,075 | | 23,075 | | ||||||||||||
Total costs and expenses |
715,541 | 603,429 | 2,006,463 | 1,791,513 | ||||||||||||
Earnings from continuing operations
before gain (loss) on disposal of
assets and income taxes |
3,068 | 34,559 | 63,886 | 99,954 | ||||||||||||
Gain (loss) on disposal of assets, net |
(114 | ) | (149 | ) | 771 | (206 | ) | |||||||||
Earnings from continuing operations
before income taxes |
2,954 | 34,410 | 64,657 | 99,748 | ||||||||||||
Income tax expense |
1,389 | 12,683 | 24,078 | 36,544 | ||||||||||||
Net earnings from continuing operations |
1,565 | 21,727 | 40,579 | 63,204 | ||||||||||||
Loss from discontinued operations, net
of income taxes |
(15 | ) | (384 | ) | (6,069 | ) | (363 | ) | ||||||||
Net earnings |
1,550 | 21,343 | 34,510 | 62,841 | ||||||||||||
Net earnings attributable to
non-controlling interests |
(2,013 | ) | (2,002 | ) | (6,201 | ) | (6,063 | ) | ||||||||
Net earnings (loss) attributable to
IASIS Healthcare LLC |
$ | (463 | ) | $ | 19,341 | $ | 28,309 | $ | 56,778 | |||||||
See accompanying notes.
2
Table of Contents
IASIS HEALTHCARE LLC
CONDENSED CONSOLIDATED STATEMENT OF EQUITY
(UNAUDITED)
(In Thousands)
Non-controlling | ||||||||||||||||
Interests with | Non- | |||||||||||||||
Redemption | Members | controlling | ||||||||||||||
Rights | Equity | Interests | Total Equity | |||||||||||||
Balance at September 30, 2010 |
$ | 72,112 | $ | 702,135 | $ | 10,371 | $ | 712,506 | ||||||||
Net earnings |
6,144 | 28,309 | 57 | 28,366 | ||||||||||||
Distributions to non-controlling interests |
(7,308 | ) | | (87 | ) | (87 | ) | |||||||||
Repurchase of non-controlling interests |
(307 | ) | | (507 | ) | (507 | ) | |||||||||
Acquisition
related adjustments to redemption value of non-controlling interests
with redemption rights |
34,303 | | | | ||||||||||||
Stock-based compensation |
| 1,364 | | 1,364 | ||||||||||||
Other comprehensive income |
| 1,698 | | 1,698 | ||||||||||||
Contribution from parent company related
to tax benefit from Holdings Senior PIK
Loans interest |
| 7,201 | | 7,201 | ||||||||||||
Distributions to parent company in
connection with refinancing |
| (632,866 | ) | | (632,866 | ) | ||||||||||
Adjustment to redemption value of
non-controlling interests with redemption
rights |
(7,501 | ) | 7,501 | | 7,501 | |||||||||||
Balance at June 30, 2011 |
$ | 97,443 | $ | 115,342 | $ | 9,834 | $ | 125,176 | ||||||||
See accompanying notes.
3
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IASIS HEALTHCARE LLC
CONDENSED CONSOLIDATED STATEMENTS OF CASH FLOWS
(UNAUDITED)
(In Thousands)
Nine Months Ended | ||||||||
June 30, | ||||||||
2011 | 2010 | |||||||
Cash flows from operating activities |
||||||||
Net earnings |
$ | 34,510 | $ | 62,841 | ||||
Adjustments to reconcile net earnings to net cash provided by operating activities: |
||||||||
Depreciation and amortization |
74,942 | 71,909 | ||||||
Amortization of loan costs |
4,319 | 2,356 | ||||||
Stock-based compensation |
1,364 | 2,367 | ||||||
Deferred income taxes |
899 | 23,839 | ||||||
Income tax benefit from stock-based compensation |
| (1,770 | ) | |||||
Income tax benefit from parent company interest |
7,201 | 4,989 | ||||||
Fair value
change in interest rate swaps |
(695 | ) | | |||||
Loss (gain) on disposal of assets, net |
(771 | ) | 206 | |||||
Loss from discontinued operations, net |
6,069 | 363 | ||||||
Loss on extinguishment of debt |
23,075 | | ||||||
Changes in operating assets and liabilities, net of the effect of acquisitions and
dispositions: |
||||||||
Accounts receivable, net |
(32,494 | ) | 9,154 | |||||
Inventories, prepaid expenses and other current assets |
(13,572 | ) | (74,909 | ) | ||||
Accounts payable, other accrued expenses and other accrued liabilities |
(11,455 | ) | 13,137 | |||||
Net cash provided by operating activities continuing operations |
93,392 | 114,482 | ||||||
Net cash provided by (used in) operating activities discontinued operations |
3,260 | (567 | ) | |||||
Net cash provided by operating activities |
96,652 | 113,915 | ||||||
Cash flows from investing activities |
||||||||
Purchases of property and equipment, net |
(64,475 | ) | (53,465 | ) | ||||
Cash paid for acquisitions, net |
(155,428 | ) | | |||||
Proceeds from sale of assets |
150 | 50 | ||||||
Change in other assets, net |
1,385 | 1,856 | ||||||
Net cash used in investing activities |
(218,368 | ) | (51,559 | ) | ||||
Cash flows from financing activities |
||||||||
Proceeds from refinancing |
1,863,730 | | ||||||
Payment of debt and capital lease obligations |
(1,049,547 | ) | (6,772 | ) | ||||
Debt financing costs incurred |
(51,308 | ) | | |||||
Distributions to parent company |
(632,866 | ) | (124,962 | ) | ||||
Distributions to non-controlling interests |
(7,395 | ) | (6,921 | ) | ||||
Costs paid for the repurchase of non-controlling interests |
(814 | ) | (69 | ) | ||||
Net cash provided by (used in) financing activities |
121,800 | (138,724 | ) | |||||
Change in cash and cash equivalents |
84 | (76,368 | ) | |||||
Cash and cash equivalents at beginning of period |
144,511 | 206,528 | ||||||
Cash and cash equivalents at end of period |
$ | 144,595 | $ | 130,160 | ||||
Supplemental disclosure of cash flow information |
||||||||
Cash paid for interest |
$ | 58,283 | $ | 58,145 | ||||
Cash paid for income taxes, net |
$ | 17,587 | $ | 7,513 | ||||
Supplemental disclosure of non-cash investing and financing activities |
||||||||
Capital lease obligations resulting from acquisitions |
$ | 9,559 | $ | | ||||
See accompanying notes.
4
Table of Contents
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 nine
months ended June 30, 2011 and 2010, reflect the financial position, results of operations and cash
flows of IASIS Healthcare LLC (IASIS or the Company). The Companys sole member and parent
company is IASIS Healthcare Corporation (Holdings or IAS).
IASIS owns and operates medium-sized acute care hospitals in high-growth urban and suburban
markets. At June 30, 2011, the Company owned or leased 18 acute care hospital facilities and one
behavioral health hospital facility, with a total of 4,362 licensed beds, located in seven regions:
| Salt Lake City, Utah; |
| Phoenix, Arizona; |
| Tampa-St. Petersburg, Florida; |
| five cities in Texas, including Houston and 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
notes required by GAAP for complete financial statements. For further information, refer to the
consolidated financial statements and footnotes thereto included in the Companys Annual Report on
Form 10-K for the fiscal year ended September 30, 2010.
In the opinion of management, the accompanying unaudited condensed consolidated financial
statements contain all material adjustments (consisting of normal recurring items) necessary for a
fair presentation of results for the interim periods presented. The results of operations for any
interim period are not necessarily indicative of results for the full year.
Principles of Consolidation
The unaudited condensed consolidated financial statements include all subsidiaries and
entities under common control of the Company. Control is generally defined by the Company as
ownership of a majority of the voting interest of an entity. In addition, control is demonstrated
in most instances when the Company is the sole general partner in a limited partnership.
Significant intercompany transactions have been eliminated.
Use of Estimates
The preparation of the financial statements in conformity with GAAP requires management to
make estimates and assumptions that affect the amounts reported in the accompanying unaudited
condensed consolidated financial statements and notes. Actual results could differ from those
estimates.
Reclassifications
Certain prior year amounts have been reclassified to conform to the current year presentation.
These reclassifications have no impact on the Companys total assets or total liabilities and
equity.
5
Table of Contents
IASIS HEALTHCARE LLC
NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (UNAUDITED)
NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (UNAUDITED)
General and Administrative
The majority of the Companys expenses are cost of revenue items. Costs that could be
classified as general and administrative by the Company would include the IASIS corporate office
costs, which were $12.7 million and $7.7 million for the quarters ended June 30, 2011 and 2010,
respectively, and $33.5 million and $27.0 million for the nine months ended June 30, 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
On May 3, 2011, the Company completed a transaction to refinance its then 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 Corporation
(IASIS Capital), of $850.0 million aggregate
principal amount of 8.375% senior notes due 2019 (the Senior
Notes).
Proceeds from the Refinancing were used to refinance amounts outstanding under the Companys then
existing credit facilities; fund a cash tender offer to repurchase any and all of the Companys
$475.0 million aggregate principal amount of 8 3/4% senior subordinated notes due 2014; repay in full
the Holdings Senior Paid-in-Kind (PIK) Loans held at IAS; pay fees and expenses associated with
the Refinancing; and raise capital for general corporate purposes.
As part of the Refinancing, the Company distributed $632.9 million to IAS, which is comprised
of $402.9 million to fund the repayment of the Holdings Senior PIK Loans, including interest that
had accrued to the principal balance of the loans totaling $102.9 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.
Long-term debt and capital lease obligations consist of the following (in thousands):
June 30, | September 30, | |||||||
2011 | 2010 | |||||||
Senior secured term loan facility |
$ | 1,017,435 | $ | 570,260 | ||||
Senior Notes |
843,983 | | ||||||
8
3/4%
senior subordinated notes due 2014 |
| 475,000 | ||||||
Capital leases and other obligations |
20,015 | 6,318 | ||||||
1,881,433 | 1,051,578 | |||||||
Less current maturities |
13,973 | 6,691 | ||||||
$ | 1,867,460 | $ | 1,044,887 | |||||
As of June 30, 2011, the senior secured term loan facility balance reflects an original issue
discount (OID) of $5.0 million, which is net of
accumulated amortization of $122,000. The Senior Notes balance reflects an OID of $6.0 million,
which is net of accumulated amortization of
$128,000.
In connection with the Refinancing, the Company incurred a loss on extinguishment of debt
totaling $23.1 million, which is included in the accompanying unaudited condensed consolidated
statements of operations for the quarter and nine months ended June 30, 2011. The loss on
extinguishment of debt included the write-off of $8.3 million in existing deferred financing costs,
$4.9 million in creditor fees and $9.9 million in redemption premiums associated with the
repurchase of the 8 3/4% senior subordinated notes due 2014. Additionally, the Company incurred
$36.5 million in creditor fees and other related costs that have been included in other assets in
the accompanying unaudited condensed consolidated balance sheet at June 30, 2011.
6
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IASIS HEALTHCARE LLC
NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (UNAUDITED)
NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (UNAUDITED)
$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 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 at the
closing of the Refinancing, with the
remaining balance due upon maturity of the senior secured term loan facility. The senior secured
revolving credit facility does not require installment payments.
Borrowings under the senior secured term loan facility bear interest at a rate per annum equal
to, at the Companys option, either (1) a base rate (the base rate) determined by reference to
the highest of (a) the federal funds rate plus 0.50%, (b) the prime rate of Bank of America, N.A.
and (c) a one-month LIBOR rate, subject to a floor of 1.25%, plus 1.00%, in each case, plus a
margin of 2.75% per annum or (2) the LIBOR rate for the interest period relevant to such borrowing,
subject to a floor of 1.25%, plus a margin of 3.75% per annum. Borrowings under the senior secured
revolving credit facility generally bear interest at a rate per annum equal to, at the Companys
option, either (1) the base rate plus a margin of 2.50% per annum, or (2) the LIBOR rate for the
interest period relevant to such borrowing plus a margin of 3.50% per annum. In addition to paying
interest on outstanding principal under the Senior Secured Credit Facilities, the Company will be
required to pay a commitment fee on the unutilized commitments under the senior secured
revolving credit facility, as well as pay customary letter of credit fees and agency fees.
The Senior Secured Credit Facilities are unconditionally guaranteed by IAS and certain
subsidiaries of the Company (collectively, the Credit Facility Guarantors) and are required to be
guaranteed by all future material wholly-owned subsidiaries of the Company, subject to certain
exceptions. All obligations under the Restated Credit Agreement are secured, subject to certain
exceptions, by substantially all of the Companys assets and the assets of the Credit Facility
Guarantors, including (1) a pledge of 100% of the equity interests of the Company and the Credit
Facility Guarantors, (2) mortgage liens on all of the Companys material real property and that of
the Credit Facility Guarantors, and (3) all proceeds of the foregoing.
The Restated Credit Agreement requires the Company to mandatorily prepay borrowings under the
senior secured term loan facility with net cash proceeds of certain asset dispositions, following
certain casualty events, following certain borrowings or debt issuances, and from a percentage of
annual excess cash flow.
The Restated Credit Agreement contains certain restrictive 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 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 the Senior
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 Senior
Secured Credit Facilities (the Notes Guarantors) (the Indenture). The Indenture provides that
the Senior Notes are general unsecured, senior obligations of the Issuers, and initially will be
unconditionally guaranteed on a senior unsecured basis.
The Senior Notes bear interest at a rate of 8.375% per annum and will accrue from May 3, 2011.
Interest on the Senior Notes is payable semi-annually, in cash in arrears, on May 15 and November 15 of
each year, commencing on November 15, 2011.
7
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IASIS HEALTHCARE LLC
NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (UNAUDITED)
NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (UNAUDITED)
The Company may redeem the Senior 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 Senior 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 Senior 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 Senior Notes plus accrued and unpaid interest and
special interest, if any, to but excluding the redemption date, subject to compliance with certain
conditions.
The Indenture contains covenants that limit the Companys (and its restricted subsidiaries)
ability to, among other things: (1) incur additional indebtedness or liens or issue disqualified
stock or preferred stock; (2) pay dividends or make other distributions on, redeem or repurchase
the Companys capital stock; (3) sell certain assets; (4) make certain loans and investments; (5)
enter into certain transactions with affiliates; (5) impose restrictions on the ability of a
subsidiary to pay dividends or make payments or distributions to the Company and its restricted
subsidiaries; and (6) consolidate, merge or sell all or substantially all of the Companys assets.
These covenants are subject to a number of important limitations and exceptions.
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 Senior Notes to be due and payable immediately. If
the Company experiences certain kinds of changes of control, it must offer to purchase the Senior
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 Senior 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 Senior Notes, the Company entered into a registration
rights agreement (the Registration Rights Agreement) that provides holders of the Senior Notes
certain rights relating to registration of the Senior 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 Senior 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 Senior 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.
3. INTEREST RATE SWAPS
Effective March 2, 2009, the Company executed interest rate swap agreements with Citibank,
N.A. and Wachovia Bank, N.A. (currently Wells Fargo Bank, N.A.), as counterparties, with notional amounts totaling $425.0 million, of
which $225.0 million expired on February 28, 2011. As of June 30, 2011, two interest rate swap
agreements remain in effect with each agreement having a notional amount of $100.0 million
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 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.
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IASIS HEALTHCARE LLC
NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (UNAUDITED)
NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (UNAUDITED)
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 its 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 during the
quarters and nine months ended June 30, 2011 and 2010, and determined that the hedge was effective
for all periods except the quarter ended June 30, 2011. The
hedging ineffectiveness during the quarter ended June 30, 2011, was a result
of the Refinancing which established a LIBOR floor applicable to borrowings under the Senior
Secured Credit Facilities, the source of the Companys variable
rate debt. Accordingly, a gain resulting
from the $695,000 change in fair value of the Companys interest
rate swaps since March 31, 2011,
the last period that the hedge was deemed effective, has been reflected as a component of interest
expense in the accompanying unaudited condensed consolidated statement of operations.
No gain or loss has been reflected in the accompanying unaudited condensed consolidated
statements of operations for the periods that the cash
flow hedge was determined to be effective.
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.
The Company determines the fair value of its interest rate swaps in a manner consistent with
that used by market participants in pricing hedging instruments, which includes using a discounted
cash flow analysis based upon the terms of the agreements, the impact of the one-month forward
LIBOR curve and an evaluation of credit risk. Given the use of observable market assumptions and
the consideration of credit risk, the Company has categorized the valuation of its interest rate
swaps as Level 2.
The fair value of the Companys interest rate swaps at June 30, 2011 and September 30, 2010,
reflect liability balances of $2.3 million and $5.7 million, respectively, and are included in
other long-term liabilities in the accompanying unaudited condensed consolidated balance sheets.
The fair value of the Companys interest rate swaps reflects a liability because the effect of the
forward LIBOR curve on future interest payments results in less interest due to the Company under
the variable rate component included in the interest rate swap agreements, as compared to the
amount due the Companys counterparties under the fixed interest rate component. Any change in the
fair value of the Companys interest rate swaps, net of income taxes, from inception to March 31,
2011, is included in accumulated other comprehensive loss as a component of members equity in
the accompanying unaudited condensed consolidated balance sheets. Any change in fair value since
March 31, 2011, has been included as a component of interest expense in the accompanying unaudited
condensed consolidated statement of operations, as previously described.
4. ACQUISITIONS
Effective May 1, 2011, the Company acquired a 79.1% equity ownership interest in St. Joseph
Medical Center (St. Joseph), a 792-licensed bed acute care hospital facility located in downtown
Houston, Texas, in exchange for cash consideration of $156.8 million, subject to changes in net
assets. In accordance with the purchase agreement, independent investors, most of whom are
physicians on the medical staff of St. Joseph, retained an aggregate 20.9% ownership interest in
the hospital. This acquisition was accounted for as a business combination, which requires the
Company to allocate the purchase price 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 is currently working with third party valuation
experts to finalize the valuation of acquired assets; therefore, the fair values as recorded in the
accompanying unaudited condensed consolidated balance sheet at June
30, 2011, have been estimated based upon the most
accurate information available, and are subject to adjustment once the valuation is completed.
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IASIS HEALTHCARE LLC
NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (UNAUDITED)
NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (UNAUDITED)
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 (Wadley), 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; therefore, the
Company allocated the purchase price of these facilities to the assets acquired or liabilities assumed
based on their fair values. The excess of the purchase price allocation over those fair values was
recorded as goodwill. The Companys third-party valuation of acquired assets has been finalized,
and the appropriate fair values have been reflected in the accompanying unaudited condensed
consolidated balance sheet at June 30, 2011.
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 |
78,451 | | 78,451 | |||||||||
St. Joseph acquisition |
34,692 | | 34,692 | |||||||||
Other acquisitions |
5,302 | | 5,302 | |||||||||
Balance at June 30, 2011 |
$ | 830,931 | $ | 5,757 | $ | 836,688 | ||||||
See Note 4 for more information regarding the fair value assessment of acquired assets and assumed liabilities. |
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 | Nine Months Ended | |||||||||||||||
June 30, | June 30, | |||||||||||||||
2011 | 2010 | 2011 | 2010 | |||||||||||||
Net earnings |
$ | 1,550 | $ | 21,343 | $ | 34,510 | $ | 62,841 | ||||||||
Change in fair value of interest rate swaps |
| 56 | 2,708 | (1,092 | ) | |||||||||||
Change in income tax expense (benefit) |
| (21 | ) | (1,010 | ) | 407 | ||||||||||
Comprehensive income |
$ | 1,550 | $ | 21,378 | $ | 36,208 | $ | 62,156 | ||||||||
As a result of the Companys cash flow hedge being deemed ineffective during the quarter ended June 30, 2011, the change in fair value of the
Companys interest rate swaps since March 31, 2011, is included as a component of
interest expense in the accompanying unaudited condensed consolidated
statement of operations.
The components of accumulated other comprehensive loss, net of income taxes, are as follows
(in thousands):
June 30, | 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 | ) | ||
The fair value of the Companys interest rate swaps included as
a component of accumulated other comprehensive loss in the table
above represents the fair value as of March 31, 2011, the last
period the cash flow hedge was deemed effective.
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IASIS HEALTHCARE LLC
NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (UNAUDITED)
NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (UNAUDITED)
7. DISTRIBUTION TO PARENT
As part of the Refinancing, the Company distributed $632.9 million to IAS,
$402.9 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 $102.9 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.
During fiscal 2010, the Company distributed $125.0 million, net of a $1.8 million income tax
benefit, to IAS to fund the repurchase of certain shares of its outstanding preferred stock and
cancel certain vested rollover options to purchase its common stock. The holder of the IAS
preferred stock is represented by an investor group led by TPG, JLL Partners and Trimaran Fund
Management. The repurchase of preferred stock, which included accrued and outstanding dividends,
and the cancellation of rollover options, were funded by the Companys excess cash on hand. The
cancellation of the rollover options, which were associated with the Companys 2004
recapitalization, resulted in the Company recognizing $2.0 million in stock-based compensation
during the quarter ended March 31, 2010.
8. COMMITMENTS AND CONTINGENCIES
Net Revenue
The calculation of appropriate payments from the Medicare and Medicaid programs, as well as
terms governing agreements with other third-party payors, is complex and subject to interpretation.
Final determination of amounts earned under the Medicare and Medicaid programs often occurs
subsequent to the year in which services are rendered because of audits by the programs, rights of
appeal and the application of numerous technical provisions. In the opinion of management, adequate
provision has been made for adjustments that may result from such routine audits and appeals.
Professional, General and Workers Compensation Liability Risks
The Company is subject to claims and legal actions in the ordinary course of business,
including but not limited to claims relating to patient treatment and personal injuries. To cover
these types of claims, the Company maintains professional and general liability insurance in excess
of self-insured retentions through a commercial insurance carrier in amounts that the Company
believes to be sufficient for its operations, although, potentially, some claims may exceed the
scope of coverage in effect. Plaintiffs in these matters may request punitive or other damages that
may not be covered by insurance. The Company is currently not a party to any such proceedings that,
in the Companys opinion, would have a material adverse effect on the Companys business, financial
condition or results of operations. The Company expenses an estimate of the costs it expects to
incur under the self-insured retention exposure for professional and general liability claims using
historical claims data, demographic factors, severity factors, current incident logs and other
actuarial analysis. At June 30, 2011 and September 30, 2010, the Companys professional and general
liability accrual for asserted and unasserted claims totaled $65.2 million and $41.6 million,
respectively. The semi-annual valuations from the Companys independent actuary for professional
and general liability losses resulted in a change in related estimates for prior periods which
increased insurance expense by $948,000 during the nine months ended June 30, 2011, compared to a
decrease of $1.9 million during the same prior year period. No changes were reflected in the
quarters ended June 30, 2011 and 2010.
The
Company is subject to claims and legal actions in the ordinary course
of business relating
to workers compensation matters. To cover these types of claims, the Company maintains workers
compensation insurance coverage with a self-insured retention. The Company accrues the costs of
workers compensation claims based upon estimates derived from its claims experience. The
semi-annual valuations from the Companys independent actuary for workers compensation losses
resulted in a change in related estimates for prior periods which increased benefits expense by
$1.2 million and $801,000 during the nine months ended June 30, 2011 and 2010, respectively. No
changes were reflected in the quarters ended June 30, 2011 and 2010.
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IASIS HEALTHCARE LLC
NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (UNAUDITED)
NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (UNAUDITED)
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 June 30, 2011, the
Company has provided a performance guaranty in the form of letters of credit totaling $48.3 million
for the benefit of AHCCCS to support Health Choices obligations under its contract to provide and
pay for the healthcare services. The amount of the performance guaranty is generally based, in
part, upon the membership in the Plan and the related capitation revenue paid to Health Choice.
Acquisitions
The Company has acquired and in the future may choose to acquire businesses with prior
operating histories. Such businesses may have unknown or contingent liabilities, including
liabilities for failure to comply with healthcare laws and regulations, such as billing and
reimbursement, fraud and abuse and similar anti-referral laws. Although the Company has procedures
designed to conform business practices to its policies following the completion of any acquisition,
there can be no assurance that the Company will not become liable for previous activities of prior
owners that may later be asserted to be improper by private plaintiffs or government agencies.
Although the Company generally seeks to obtain indemnification from prospective sellers covering
such matters, there can be no assurance that any such matter will be covered by indemnification, or
if covered, that such indemnification will be adequate to cover potential losses and fines.
Other
On March 31, 2008, the United States District Court for the District of Arizona (District
Court) dismissed with prejudice the qui tam complaint against IAS, our parent company. The qui tam
action sought monetary damages and civil penalties under the federal False Claims Act (FCA) and
included allegations that certain business practices related to physician relationships and the
medical necessity of certain procedures resulted in the submission of claims for reimbursement in
violation of the FCA. The case dates back to March 2005 and became the subject of a subpoena by the
Office of Inspector General in September 2005. In August 2007, the case was unsealed and the U.S.
Department of Justice (DOJ) declined to intervene. The District Court dismissed the case from the
bench at the conclusion of oral arguments on IAS motion to dismiss. On April 21, 2008, the
District Court issued a written order dismissing the case with prejudice and entering formal
judgment for IAS and denying as moot IAS motions related to the relators misappropriation of
information subject to a claim of attorney-client privilege by IAS. Both parties appealed. On
August 12, 2010, United States Court of Appeals for the Ninth Circuit reversed the District Courts
dismissal of the qui tam complaint and the District Courts denial of IAS motions concerning the
relators misappropriation of documents and ordered that the qui tam relator be allowed leave to
file a Third Amended Complaint and for the District Court to consider IAS motions concerning the
relators misappropriation of documents. The District Court ordered the qui tam relator to file his
Third Amended Complaint by November 22, 2010, and set a schedule for the filing of motions related
to the relators misappropriation of documents. On October 20, 2010, the qui tam relator filed a
motion to transfer this action to the United States District Court for the Eastern District of
Texas. On November 22, 2010, the relator filed his Third Amended Complaint. On January 3, 2011, IAS
filed its renewed motion for sanctions concerning the relators misappropriation of documents and,
on January 14, 2011, IAS filed its motion to dismiss the relators Third Amended Complaint. On May
4, 2011, the District Court in Arizona heard oral arguments on all pending motions, including IAS
motion to dismiss and renewed motions for sanctions and the relators motion to transfer the action
to the United States District Court for the Eastern District of Texas. On June 1, 2011, the
District Court in Arizona issued a written order dismissing the relators Third Amended Complaint
with prejudice. The order also denied the relators motion to transfer the case to the Eastern
District of Texas, finding that the relator was attempting to engage in forum shopping, and
denied the relators request for leave to further amend the complaint. The District Court
expressly reserved decision on the collateral issue of sanctions against the relator and,
preliminary to further briefing on IAS pending motion for sanctions, directed the
relator to return all documents withheld to IAS within 20 days. IAS continues its vigorous pursuit
of sanctions and other remedies against the relator related to the misappropriation and misuse of
information subject to a claim of attorney-client privilege by IAS. Oral argument on IAS
pending motion for sanctions currently is set
for August 26, 2011. The District Courts dismissal
of this lawsuit with prejudice is appealable and the relator filed a notice of appeal on June 28,
2011. While the District Courts order in favor of IAS should effectively bring to an end the
relators qui tam litigation in the District Court that has been pending since March 2005, if the
appeal of the District Courts ruling was resolved in a manner unfavorable to IAS, it could have a
material adverse effect on the Companys business, financial condition and results of operations,
including exclusion from the Medicare and Medicaid programs. In addition, the Company may incur
material fees, costs and expenses in connection with defending the qui tam action.
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IASIS HEALTHCARE LLC
NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (UNAUDITED)
NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (UNAUDITED)
The Companys facilities obtain clinical and administrative services from a variety of
vendors. One vendor, a medical practice that furnished cardiac catheterization services under
contractual arrangements at Mesa General Hospital and St. Lukes Medical Center through March 31,
2008 and May 31, 2008, respectively, asserted that, because of deferred fee adjustments that it
claims were due under these arrangements, it was owed additional amounts for services rendered since
April 1, 2006 at both facilities. The Company and the vendor were unable to reach an agreement with
respect to the amount of the fee adjustment, if any, that was contractually required, nor with
respect to an appropriate methodology for determining such amount. On September 30, 2008, the
vendor filed a state court complaint for an aggregate adjustment in excess of the amount accrued by
the Company, in addition to certain tort claims. On March 20, 2009, the Company filed a Motion to
Dismiss and in the alternative to Compel Arbitration. On July 27, 2009, the court granted the
Companys Motion to Compel Arbitration on the grounds that the issues are to be determined by
binding arbitration. On December 24, 2010, after conducting the arbitration hearing, the
arbitration panel issued its decision rejecting the fees sought by the vendor, but did not adopt
the fees proposed by the Company. The arbitration panel rendered its judgment on the fair market
value of the vendors services at a point between the amounts the two parties argued were owed. On
July 22, 2011, the Company paid $15.0 million to discharge the liability resulting from the
arbitration panels decision, which includes all amounts required to be paid with respect to the
fair market value compensation for services rendered by the vendor, pre-judgment interest and
its attorneys fees, but excludes consideration of amounts that
may be recoverable by the Company from its
insurance carrier with respect to the Companys attorneys fees above its insurance limits. The payment of
this claim brings this arbitration dispute to a final resolution.
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
the Companys hospitals in connection with
the implantation of implantable cardioverter defibrillators
(ICDs) from 2003 through November 2010.
At that time, neither the precise number of procedures, number of claims nor the hospitals
involved were identified by the DOJ. The Company understands that the government is conducting a
national initiative with respect to ICD procedures involving a number of healthcare providers and
is seeking information in order to determine if ICD implantation procedures were performed in
accordance with Medicare coverage requirements. On January 11, 2011, IAS entered into the tolling
agreement with the DOJ and, subsequently, the DOJ has provided IAS with a list of 194 procedures
involving ICDs at 14 hospitals which are the subject of further medical necessity review by the
DOJ. The Company is cooperating fully with the government and, to date, the DOJ has not asserted
any claim against the Companys hospitals.
9. RECENTLY ISSUED ACCOUNTING PRONOUNCEMENTS
In July 2011,
the FASB issued Accounting
Standards Update (ASU) 2011-7, Health Care Entities
(Topic 954): Presentation and Disclosure of Patient Service Revenue,
Provision for Bad Debts, and the Allowance for Doubtful Accounts for Certain
Health Care Entities. ASU 2011-7 requires healthcare organizations to
present their provision for doubtful accounts related to patient service revenue as
a deduction from revenue, similar to contractual discounts. In addition, all healthcare
organizations will be required to provide certain disclosures designed to help users
understand how contractual discounts and bad debts affect recorded revenue in both interim
and annual financial statements. ASU 2011-7 is required to be applied retrospectively and is
effective for public companies for fiscal years, and interim periods within those years,
beginning December 15, 2011, with early adoption permitted. ASU
2011-7 is effective for the Companys fiscal year beginning
October 1, 2012, and
is not expected to significantly impact the Companys financial position, results of
operations or cash flows, although it will change the presentation of the Companys
revenues on its statements of operations, as well as requiring additional disclosures.
In December 2010, the FASB issued ASU No. 2010-29, Business Combinations (Topic 805):
Disclosure of Supplementary Pro Forma Information for Business Combinations. ASU 2010-29 clarifies
that, if a reporting entity presents comparative financial statements, the pro forma revenue and
earnings of the combined entity should be reported as though the business combinations that
occurred during the current year had occurred as of the beginning of the comparable prior annual
reporting period. The ASU is effective prospectively for business combinations for which the
acquisition date is on or after the beginning of the first annual reporting period beginning on or
after December 15, 2010. ASU No. 2010-29 is effective for the Companys fiscal year beginning
October 1, 2011, with early adoption permitted, and is an accounting principle which clarifies
disclosure requirements, and is not expected to significantly impact the Companys financial
statement disclosures.
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IASIS HEALTHCARE LLC
NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (UNAUDITED)
NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (UNAUDITED)
In December 2010, the FASB issued ASU No. 2010-28, IntangiblesGoodwill and Other (Topic
350): When to Perform Step 2 of the Goodwill Impairment Test for Reporting Units with Zero or
Negative Carrying Amounts. ASU 2010-28 requires Step 2 of the impairment test be performed in
circumstances where the carrying amount of a reporting unit is zero or negative and there are
qualitative factors that indicate it is more likely than not that a goodwill impairment exists. The
ASU is effective for fiscal years, and interim periods within those years, beginning after December
15, 2010. ASU 2010-28 is effective for the Companys fiscal year beginning October 1, 2011, and is
not expected to significantly impact the Companys financial position, results of operations or
cash flows.
In August 2010, the FASB issued ASU No. 2010-24, Health Care Entities (Topic 954):
Presentation of Insurance Claims and Related Insurance Recoveries. This ASU eliminates the practice
of netting claim liabilities with expected related insurance recoveries for balance sheet
presentation. Claim liabilities are to be determined with no regard for recoveries and presented
gross. Expected recoveries are presented separately. ASU 2010-24 is effective for fiscal years, and
interim periods within those years, beginning after December 15, 2010. ASU 2010-24 is effective for
the Companys fiscal year beginning October 1, 2011, and is not expected to significantly impact
the Companys financial position, results of operations or cash flows.
In August 2010, the FASB issued ASU No. 2010-23, Health Care
Entities (Topic 954): Measuring Charity Care for Disclosure. Due to the lack of comparability
existing as a result of the use of either revenue or cost as the basis for disclosure of charity
care, this ASU standardizes cost as the basis for charity care disclosures and specifies the
elements of cost to be used in charity care disclosures. ASU 2010-23 is effective for the Companys
fiscal year beginning October 1, 2011, and is not expected to significantly impact the Companys
financial statement disclosures.
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IASIS HEALTHCARE LLC
NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (UNAUDITED)
NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (UNAUDITED)
10. SEGMENT AND GEOGRAPHIC INFORMATION
The Companys acute care hospitals and related healthcare businesses are similar in their
activities and the economic environments in which they operate (i.e. urban and suburban markets).
Accordingly, the Companys reportable operating segments consist of (1) acute care hospitals and
related healthcare businesses, collectively Acute Care, and (2) Health Choice. The following is a
financial summary by business segment for the periods indicated (in thousands):
For the Quarter Ended June 30, 2011 | ||||||||||||||||
Acute Care | Health Choice | Eliminations | Consolidated | |||||||||||||
Acute care revenue |
$ | 529,844 | $ | | $ | | $ | 529,844 | ||||||||
Premium revenue |
| 188,765 | | 188,765 | ||||||||||||
Revenue between segments |
3,065 | | (3,065 | ) | | |||||||||||
Net revenue |
532,909 | 188,765 | (3,065 | ) | 718,609 | |||||||||||
Salaries and benefits (excludes
stock-based compensation) |
205,509 | 5,275 | | 210,784 | ||||||||||||
Supplies |
83,010 | 61 | | 83,071 | ||||||||||||
Medical claims |
| 158,950 | (3,065 | ) | 155,885 | |||||||||||
Other operating expenses |
108,658 | 6,120 | | 114,778 | ||||||||||||
Provision for bad debts |
60,685 | | | 60,685 | ||||||||||||
Rentals and leases |
11,378 | 396 | | 11,774 | ||||||||||||
Adjusted EBITDA (1) |
63,669 | 17,963 | | 81,632 | ||||||||||||
Interest expense, net |
27,597 | | | 27,597 | ||||||||||||
Depreciation and amortization |
25,425 | 887 | | 26,312 | ||||||||||||
Stock-based compensation |
330 | | | 330 | ||||||||||||
Management fees |
1,250 | | | 1,250 | ||||||||||||
Loss on extinguishment of debt |
23,075 | | | 23,075 | ||||||||||||
Earnings (loss) from continuing
operations before loss on
disposal of assets and income
taxes |
(14,008 | ) | 17,076 | | 3,068 | |||||||||||
Loss on disposal of assets, net |
(114 | ) | | | (114 | ) | ||||||||||
Earnings (loss) from
continuing operations before
income taxes |
$ | (14,122 | ) | $ | 17,076 | $ | | $ | 2,954 | |||||||
For the Quarter Ended June 30, 2010 | ||||||||||||||||
Acute Care | Health Choice | Eliminations | Consolidated | |||||||||||||
Acute care revenue |
$ | 438,211 | $ | | $ | | $ | 438,211 | ||||||||
Premium revenue |
| 199,777 | | 199,777 | ||||||||||||
Revenue between segments |
2,319 | | (2,319 | ) | | |||||||||||
Net revenue |
440,530 | 199,777 | (2,319 | ) | 637,988 | |||||||||||
Salaries and benefits (excludes
stock-based compensation) |
165,051 | 4,866 | | 169,917 | ||||||||||||
Supplies |
66,293 | 40 | | 66,333 | ||||||||||||
Medical claims |
| 174,350 | (2,319 | ) | 172,031 | |||||||||||
Other operating expenses |
87,451 | 6,128 | | 93,579 | ||||||||||||
Provision for bad debts |
49,416 | | | 49,416 | ||||||||||||
Rentals and leases |
9,650 | 417 | | 10,067 | ||||||||||||
Adjusted EBITDA(1) |
62,669 | 13,976 | | 76,645 | ||||||||||||
Interest expense, net |
16,711 | | | 16,711 | ||||||||||||
Depreciation and amortization |
23,115 | 892 | | 24,007 | ||||||||||||
Stock-based compensation |
118 | | | 118 | ||||||||||||
Management fees |
1,250 | | | 1,250 | ||||||||||||
Earnings from continuing
operations before loss on
disposal of assets and income
taxes |
21,475 | 13,084 | | 34,559 | ||||||||||||
Loss on disposal of assets, net |
(149 | ) | | | (149 | ) | ||||||||||
Earnings from continuing
operations before income
taxes |
$ | 21,326 | $ | 13,084 | $ | | $ | 34,410 | ||||||||
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IASIS HEALTHCARE LLC
NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (UNAUDITED)
NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (UNAUDITED)
For the Nine Months Ended June 30, 2011 | ||||||||||||||||
Acute Care | Health Choice | Eliminations | Consolidated | |||||||||||||
Acute care revenue |
$ | 1,489,432 | $ | | $ | | $ | 1,489,432 | ||||||||
Premium revenue |
| 580,917 | | 580,917 | ||||||||||||
Revenue between segments |
8,532 | | (8,532 | ) | | |||||||||||
Net revenue |
1,497,964 | 580,917 | (8,532 | ) | 2,070,349 | |||||||||||
Salaries and benefits (excludes
stock-based compensation) |
580,228 | 15,471 | | 595,699 | ||||||||||||
Supplies |
237,274 | 157 | | 237,431 | ||||||||||||
Medical claims |
| 493,167 | (8,532 | ) | 484,635 | |||||||||||
Other operating expenses |
295,913 | 19,341 | | 315,254 | ||||||||||||
Provision for bad debts |
175,100 | | | 175,100 | ||||||||||||
Rentals and leases |
32,991 | 1,238 | | 34,229 | ||||||||||||
Adjusted EBITDA (1) |
176,458 | 51,543 | | 228,001 | ||||||||||||
Interest expense, net |
60,984 | | | 60,984 | ||||||||||||
Depreciation and amortization |
72,273 | 2,669 | | 74,942 | ||||||||||||
Stock-based compensation |
1,364 | | | 1,364 | ||||||||||||
Management fees |
3,750 | | | 3,750 | ||||||||||||
Loss on extinguishment of debt |
23,075 | | | 23,075 | ||||||||||||
Earnings from continuing
operations before gain on
disposal of assets and income
taxes |
15,012 | 48,874 | | 63,886 | ||||||||||||
Gain on disposal of assets, net |
771 | | | 771 | ||||||||||||
Earnings from continuing
operations before income
taxes |
$ | 15,783 | $ | 48,874 | $ | | $ | 64,657 | ||||||||
Segment assets |
$ | 2,368,758 | $ | 318,042 | $ | 2,686,800 | ||||||||||
Capital expenditures |
$ | 64,104 | $ | 371 | $ | 64,475 | ||||||||||
Goodwill |
$ | 830,931 | $ | 5,757 | $ | 836,688 | ||||||||||
For the Nine Months Ended June 30, 2010 | ||||||||||||||||
Acute Care | Health Choice | Eliminations | Consolidated | |||||||||||||
Acute care revenue |
$ | 1,300,445 | $ | | $ | | $ | 1,300,445 | ||||||||
Premium revenue |
| 591,022 | | 591,022 | ||||||||||||
Revenue between segments |
8,331 | | (8,331 | ) | | |||||||||||
Net revenue |
1,308,776 | 591,022 | (8,331 | ) | 1,891,467 | |||||||||||
Salaries and benefits (excludes
stock-based compensation) |
497,916 | 14,405 | | 512,321 | ||||||||||||
Supplies |
200,030 | 137 | | 200,167 | ||||||||||||
Medical claims |
| 519,023 | (8,331 | ) | 510,692 | |||||||||||
Other operating expenses |
248,380 | 18,474 | | 266,854 | ||||||||||||
Provision for bad debts |
142,901 | | | 142,901 | ||||||||||||
Rentals and leases |
29,334 | 1,153 | | 30,487 | ||||||||||||
Adjusted EBITDA(1) |
190,215 | 37,830 | | 228,045 | ||||||||||||
Interest expense, net |
50,065 | | | 50,065 | ||||||||||||
Depreciation and amortization |
69,240 | 2,669 | | 71,909 | ||||||||||||
Stock-based compensation |
2,367 | | | 2,367 | ||||||||||||
Management fees |
3,750 | | | 3,750 | ||||||||||||
Earnings from continuing
operations before loss on
disposal of assets and income
taxes |
64,793 | 35,161 | | 99,954 | ||||||||||||
Loss on disposal of assets, net |
(206 | ) | | | (206 | ) | ||||||||||
Earnings from continuing
operations before income
taxes |
$ | 64,587 | $ | 35,161 | $ | | $ | 99,748 | ||||||||
Segment assets |
$ | 2,006,311 | $ | 293,150 | $ | 2,299,461 | ||||||||||
Capital expenditures |
$ | 53,288 | $ | 177 | $ | 53,465 | ||||||||||
Goodwill |
$ | 712,163 | $ | 5,757 | $ | 717,920 | ||||||||||
16
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IASIS HEALTHCARE LLC
NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (UNAUDITED)
NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (UNAUDITED)
(1) | Adjusted EBITDA represents net earnings from continuing operations before interest expense, income tax expense, depreciation and amortization, stock-based compensation, gain (loss) on disposal of assets, loss on extinguishment of debt and management fees. Management fees represent monitoring and advisory fees paid to TPG, the Companys majority financial sponsor, and certain other members of IASIS Investment LLC, majority shareholder of IAS. Management routinely calculates and communicates adjusted EBITDA and believes that it is useful to investors because it is commonly used as an analytical indicator within the healthcare industry to evaluate hospital performance, allocate resources and measure leverage capacity and debt service ability. In addition, the Company uses adjusted EBITDA as a measure of performance for its business segments and for incentive compensation purposes. Adjusted EBITDA should not be considered as a measure of financial performance under GAAP, and the items excluded from adjusted EBITDA are significant components in understanding and assessing financial performance. Adjusted EBITDA should not be considered in isolation or as an alternative to net earnings, cash flows generated by operating, investing, or financing activities or other financial statement data presented in the condensed consolidated financial statements as an indicator of financial performance or liquidity. Adjusted EBITDA, as presented, differs from what is defined under the Companys senior secured credit facilities and may not be comparable to similarly titled measures of other companies. |
11. SUPPLEMENTAL CONDENSED CONSOLIDATING FINANCIAL INFORMATION
The Senior Notes described in Note 2 are fully and unconditionally guaranteed on a joint and
several basis by all of the Companys existing domestic subsidiaries, other than non-guarantor
subsidiaries which include Health Choice and the Companys non-wholly owned subsidiaries.
Effective October 1, 2010, the operations and net assets of Wadley, acquired as part of the
Brim acquisition, are included in the subsidiary non-guarantor information in the following
summarized unaudited condensed consolidating financial statements.
Effective May 1, 2011, the operations and net assets of St. Joseph are included in the
subsidiary non-guarantor information in the following summarized unaudited condensed consolidating
financial statements.
Summarized condensed consolidating balance sheets at June 30, 2011 and September 30, 2010,
condensed consolidating statements of operations for the quarters and nine months ended June 30,
2011 and 2010, and condensed consolidating statements of cash flows for the nine months ended June
30, 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.
17
Table of Contents
IASIS HEALTHCARE LLC
NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (UNAUDITED)
NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (UNAUDITED)
IASIS Healthcare LLC
Condensed Consolidating Balance Sheet (unaudited)
June 30, 2011
(in thousands)
Condensed Consolidating Balance Sheet (unaudited)
June 30, 2011
(in thousands)
Subsidiary | Subsidiary | Condensed | ||||||||||||||||||
Parent Issuer | Guarantors | Non-Guarantors | Eliminations | Consolidated | ||||||||||||||||
Assets |
||||||||||||||||||||
Current assets: |
||||||||||||||||||||
Cash and cash equivalents |
$ | | $ | 136,874 | $ | 7,721 | $ | | $ | 144,595 | ||||||||||
Accounts receivable, net |
| 109,608 | 186,215 | | 295,823 | |||||||||||||||
Inventories |
| 24,015 | 41,431 | | 65,446 | |||||||||||||||
Deferred income taxes |
31,565 | | | | 31,565 | |||||||||||||||
Prepaid expenses and other
current assets |
| 33,823 | 54,581 | | 88,404 | |||||||||||||||
Total current assets |
31,565 | 304,320 | 289,948 | | 625,833 | |||||||||||||||
Property and equipment, net |
| 347,698 | 781,453 | | 1,129,151 | |||||||||||||||
Intercompany |
| (269,735 | ) | 269,735 | | | ||||||||||||||
Net investment in and advances
to subsidiaries |
2,030,278 | | | (2,030,278 | ) | | ||||||||||||||
Goodwill |
7,701 | 99,663 | 729,324 | | 836,688 | |||||||||||||||
Other intangible assets, net |
| 8,635 | 24,750 | | 33,385 | |||||||||||||||
Other assets, net |
37,589 | (24,978 | ) | 49,132 | | 61,743 | ||||||||||||||
Total assets |
$ | 2,107,133 | $ | 465,603 | $ | 2,144,342 | $ | (2,030,278 | ) | $ | 2,686,800 | |||||||||
Liabilities and Equity |
||||||||||||||||||||
Current liabilities: |
||||||||||||||||||||
Accounts payable |
$ | | $ | 31,947 | $ | 76,720 | $ | | $ | 108,667 | ||||||||||
Salaries and benefits payable |
| 30,372 | 34,674 | | 65,046 | |||||||||||||||
Accrued interest payable |
11,994 | (3,222 | ) | 3,222 | | 11,994 | ||||||||||||||
Medical claims payable |
| | 99,530 | | 99,530 | |||||||||||||||
Other accrued expenses and
other current liabilities |
| 42,216 | 54,697 | | 96,913 | |||||||||||||||
Current portion of long-term
debt and capital lease
obligations |
10,250 | 3,723 | 25,036 | (25,036 | ) | 13,973 | ||||||||||||||
Total current liabilities |
22,244 | 105,036 | 293,879 | (25,036 | ) | 396,123 | ||||||||||||||
Long-term debt and capital
lease obligations |
1,851,167 | 16,293 | 674,685 | (674,685 | ) | 1,867,460 | ||||||||||||||
Deferred income taxes |
118,380 | | | | 118,380 | |||||||||||||||
Other long-term liabilities |
| 81,593 | 625 | | 82,218 | |||||||||||||||
Total liabilities |
1,991,791 | 202,922 | 969,189 | (699,721 | ) | 2,464,181 | ||||||||||||||
Non-controlling interests with
redemption rights |
| 97,443 | | | 97,443 | |||||||||||||||
Equity: |
||||||||||||||||||||
Members equity |
115,342 | 155,404 | 1,175,153 | (1,330,557 | ) | 115,342 | ||||||||||||||
Non-controlling interests |
| 9,834 | | | 9,834 | |||||||||||||||
Total equity |
115,342 | 165,238 | 1,175,153 | (1,330,557 | ) | 125,176 | ||||||||||||||
Total liabilities and equity |
$ | 2,107,133 | $ | 465,603 | $ | 2,144,342 | $ | (2,030,278 | ) | $ | 2,686,800 | |||||||||
18
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IASIS HEALTHCARE LLC
NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (UNAUDITED)
NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (UNAUDITED)
IASIS Healthcare LLC
Condensed Consolidating Balance Sheet
September 30, 2010
(in thousands)
Condensed Consolidating Balance Sheet
September 30, 2010
(in thousands)
Subsidiary | Subsidiary | Condensed | ||||||||||||||||||
Parent Issuer | Guarantors | Non-Guarantors | Eliminations | Consolidated | ||||||||||||||||
Assets |
||||||||||||||||||||
Current assets: |
||||||||||||||||||||
Cash and cash equivalents |
$ | | $ | 143,599 | $ | 912 | $ | | $ | 144,511 | ||||||||||
Accounts receivable, net |
| 81,649 | 127,524 | | 209,173 | |||||||||||||||
Inventories |
| 22,793 | 31,049 | | 53,842 | |||||||||||||||
Deferred income taxes |
15,881 | | | | 15,881 | |||||||||||||||
Prepaid expenses and other
current assets |
| 23,577 | 41,763 | | 65,340 | |||||||||||||||
Total current assets |
15,881 | 271,618 | 201,248 | | 488,747 | |||||||||||||||
Property and equipment, net |
| 351,265 | 634,026 | | 985,291 | |||||||||||||||
Intercompany |
| (297,257 | ) | 297,257 | | | ||||||||||||||
Net investment in and advances to
subsidiaries |
1,823,973 | | | (1,823,973 | ) | | ||||||||||||||
Goodwill |
17,331 | 65,504 | 635,408 | | 718,243 | |||||||||||||||
Other intangible assets, net |
| | 27,000 | | 27,000 | |||||||||||||||
Deposit for acquisition |
| 97,891 | | | 97,891 | |||||||||||||||
Other assets, net |
12,018 | 17,967 | 6,037 | | 36,022 | |||||||||||||||
Total assets |
$ | 1,869,203 | $ | 506,988 | $ | 1,800,976 | $ | (1,823,973 | ) | $ | 2,353,194 | |||||||||
Liabilities and Equity |
||||||||||||||||||||
Current liabilities: |
||||||||||||||||||||
Accounts payable |
$ | | $ | 32,400 | $ | 46,531 | $ | | $ | 78,931 | ||||||||||
Salaries and benefits payable |
| 19,916 | 18,194 | | 38,110 | |||||||||||||||
Accrued interest payable |
12,536 | (3,237 | ) | 3,237 | | 12,536 | ||||||||||||||
Medical claims payable |
| | 111,373 | | 111,373 | |||||||||||||||
Other accrued expenses and
other current liabilities |
| 32,326 | 74,288 | | 106,614 | |||||||||||||||
Current portion of long-term
debt and capital lease
obligations |
5,890 | 801 | 20,570 | (20,570 | ) | 6,691 | ||||||||||||||
Total current liabilities |
18,426 | 82,206 | 274,193 | (20,570 | ) | 354,255 | ||||||||||||||
Long-term debt and capital lease
obligations |
1,039,370 | 5,517 | 547,170 | (547,170 | ) | 1,044,887 | ||||||||||||||
Deferred income taxes |
109,272 | | | | 109,272 | |||||||||||||||
Other long-term liabilities |
| 59,527 | 635 | | 60,162 | |||||||||||||||
Total liabilities |
1,167,068 | 147,250 | 821,998 | (567,740 | ) | 1,568,576 | ||||||||||||||
Non-controlling interests with
redemption rights |
| 72,112 | | | 72,112 | |||||||||||||||
Equity: |
||||||||||||||||||||
Members equity |
702,135 | 277,255 | 978,978 | (1,256,233 | ) | 702,135 | ||||||||||||||
Non-controlling interests |
| 10,371 | | | 10,371 | |||||||||||||||
Total equity |
702,135 | 287,626 | 978,978 | (1,256,233 | ) | 712,506 | ||||||||||||||
Total liabilities and equity |
$ | 1,869,203 | $ | 506,988 | $ | 1,800,976 | $ | (1,823,973 | ) | $ | 2,353,194 | |||||||||
19
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IASIS HEALTHCARE LLC
NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (UNAUDITED)
NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (UNAUDITED)
IASIS Healthcare LLC
Condensed Consolidating Statement of Operations (unaudited)
For the Quarter Ended June 30, 2011
(in thousands)
Condensed Consolidating Statement of Operations (unaudited)
For the Quarter Ended June 30, 2011
(in thousands)
Subsidiary | Subsidiary | Condensed | ||||||||||||||||||
Parent Issuer | Guarantors | Non-Guarantors | Eliminations | Consolidated | ||||||||||||||||
Net revenue |
||||||||||||||||||||
Acute care revenue |
$ | | $ | 192,609 | $ | 340,300 | $ | (3,065 | ) | $ | 529,844 | |||||||||
Premium revenue |
| | 188,765 | | 188,765 | |||||||||||||||
Total net revenue |
| 192,609 | 529,065 | (3,065 | ) | 718,609 | ||||||||||||||
Costs and expenses |
||||||||||||||||||||
Salaries and benefits |
| 95,012 | 116,102 | | 211,114 | |||||||||||||||
Supplies |
| 32,413 | 50,658 | | 83,071 | |||||||||||||||
Medical claims |
| | 158,950 | (3,065 | ) | 155,885 | ||||||||||||||
Other operating expenses |
| 35,306 | 79,472 | | 114,778 | |||||||||||||||
Provision for bad debts |
| 24,538 | 36,147 | | 60,685 | |||||||||||||||
Rentals and leases |
| 4,842 | 6,932 | | 11,774 | |||||||||||||||
Interest expense, net |
27,597 | | 12,002 | (12,002 | ) | 27,597 | ||||||||||||||
Depreciation and
amortization |
| 10,429 | 15,883 | | 26,312 | |||||||||||||||
Management fees |
1,250 | (7,313 | ) | 7,313 | | 1,250 | ||||||||||||||
Loss on extinguishment of
debt |
23,075 | | | | 23,075 | |||||||||||||||
Equity in earnings of
affiliates |
(39,530 | ) | | | 39,530 | | ||||||||||||||
Total costs and expenses |
12,392 | 195,227 | 483,459 | 24,463 | 715,541 | |||||||||||||||
Earnings (loss) from
continuing operations before
loss on disposal of assets and
income taxes |
(12,392 | ) | (2,618 | ) | 45,606 | (27,528 | ) | 3,068 | ||||||||||||
Loss on disposal of assets, net |
| (72 | ) | (42 | ) | | (114 | ) | ||||||||||||
Earnings (loss) from
continuing operations before
income taxes |
(12,392 | ) | (2,690 | ) | 45,564 | (27,528 | ) | 2,954 | ||||||||||||
Income tax expense |
82 | | 1,307 | | 1,389 | |||||||||||||||
Net earnings (loss) from
continuing operations |
(12,474 | ) | (2,690 | ) | 44,257 | (27,528 | ) | 1,565 | ||||||||||||
Earnings (loss) from
discontinued operations, net
of income taxes |
9 | (23 | ) | (1 | ) | | (15 | ) | ||||||||||||
Net earnings (loss) |
(12,465 | ) | (2,713 | ) | 44,256 | (27,528 | ) | 1,550 | ||||||||||||
Net earnings attributable to
non-controlling interests |
| (2,013 | ) | | | (2,013 | ) | |||||||||||||
Net earnings (loss)
attributable to IASIS
Healthcare LLC |
$ | (12,465 | ) | $ | (4,726 | ) | $ | 44,256 | $ | (27,528 | ) | $ | (463 | ) | ||||||
20
Table of Contents
IASIS HEALTHCARE LLC
NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (UNAUDITED)
NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (UNAUDITED)
IASIS Healthcare LLC
Condensed Consolidating Statement of Operations (unaudited)
For the Quarter Ended June 30, 2010
(in thousands)
Condensed Consolidating Statement of Operations (unaudited)
For the Quarter Ended June 30, 2010
(in thousands)
Subsidiary | Subsidiary | Condensed | ||||||||||||||||||
Parent Issuer | Guarantors | Non-Guarantors | Eliminations | Consolidated | ||||||||||||||||
Net revenue |
||||||||||||||||||||
Acute care revenue |
$ | | $ | 170,905 | $ | 269,625 | $ | (2,319 | ) | $ | 438,211 | |||||||||
Premium revenue |
| | 199,777 | | 199,777 | |||||||||||||||
Total net revenue |
| 170,905 | 469,402 | (2,319 | ) | 637,988 | ||||||||||||||
Costs and expenses |
||||||||||||||||||||
Salaries and benefits |
| 86,937 | 83,098 | | 170,035 | |||||||||||||||
Supplies |
| 27,907 | 38,426 | | 66,333 | |||||||||||||||
Medical claims |
| | 174,350 | (2,319 | ) | 172,031 | ||||||||||||||
Other operating expenses |
| 29,185 | 64,394 | | 93,579 | |||||||||||||||
Provision for bad debts |
| 21,589 | 27,827 | | 49,416 | |||||||||||||||
Rentals and leases |
| 4,268 | 5,799 | | 10,067 | |||||||||||||||
Interest expense, net |
16,711 | | 10,507 | (10,507 | ) | 16,711 | ||||||||||||||
Depreciation and
amortization |
| 10,271 | 13,736 | | 24,007 | |||||||||||||||
Management fees |
1,250 | (5,759 | ) | 5,759 | | 1,250 | ||||||||||||||
Equity in earnings of
affiliates |
(39,249 | ) | | | 39,249 | | ||||||||||||||
Total costs and
expenses |
(21,288 | ) | 174,398 | 423,896 | 26,423 | 603,429 | ||||||||||||||
Earnings (loss) from
continuing operations
before loss on disposal of
assets and income taxes |
21,288 | (3,493 | ) | 45,506 | (28,742 | ) | 34,559 | |||||||||||||
Loss on disposal of assets,
net |
| (31 | ) | (118 | ) | | (149 | ) | ||||||||||||
Earnings (loss) from
continuing operations
before income taxes |
21,288 | (3,524 | ) | 45,388 | (28,742 | ) | 34,410 | |||||||||||||
Income tax expense |
12,683 | | | | 12,683 | |||||||||||||||
Net earnings (loss) from
continuing operations |
8,605 | (3,524 | ) | 45,388 | (28,742 | ) | 21,727 | |||||||||||||
Earnings (loss) from
discontinued operations,
net of income taxes |
229 | (608 | ) | (5 | ) | | (384 | ) | ||||||||||||
Net earnings (loss) |
8,834 | (4,132 | ) | 45,383 | (28,742 | ) | 21,343 | |||||||||||||
Net earnings attributable
to non-controlling
interests |
| (2,002 | ) | | | (2,002 | ) | |||||||||||||
Net earnings (loss)
attributable to IASIS
Healthcare LLC |
$ | 8,834 | $ | (6,134 | ) | $ | 45,383 | $ | (28,742 | ) | $ | 19,341 | ||||||||
21
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IASIS HEALTHCARE LLC
NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (UNAUDITED)
NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (UNAUDITED)
IASIS Healthcare LLC
Condensed Consolidating Statement of Operations (unaudited)
For the Nine Months Ended June 30, 2011
(in thousands)
Condensed Consolidating Statement of Operations (unaudited)
For the Nine Months Ended June 30, 2011
(in thousands)
Subsidiary | Subsidiary | Condensed | ||||||||||||||||||
Parent Issuer | Guarantors | Non-Guarantors | Eliminations | Consolidated | ||||||||||||||||
Net revenue |
||||||||||||||||||||
Acute care revenue |
$ | | $ | 565,412 | $ | 932,552 | $ | (8,532 | ) | $ | 1,489,432 | |||||||||
Premium revenue |
| | 580,917 | | 580,917 | |||||||||||||||
Total net revenue |
| 565,412 | 1,513,469 | (8,532 | ) | 2,070,349 | ||||||||||||||
Costs and expenses |
||||||||||||||||||||
Salaries and benefits |
| 283,860 | 313,203 | | 597,063 | |||||||||||||||
Supplies |
| 94,713 | 142,718 | | 237,431 | |||||||||||||||
Medical claims |
| | 493,167 | (8,532 | ) | 484,635 | ||||||||||||||
Other operating expenses |
| 101,805 | 213,449 | | 315,254 | |||||||||||||||
Provision for bad debts |
| 72,180 | 102,920 | | 175,100 | |||||||||||||||
Rentals and leases |
| 14,167 | 20,062 | | 34,229 | |||||||||||||||
Interest expense, net |
60,984 | | 32,937 | (32,937 | ) | 60,984 | ||||||||||||||
Depreciation and
amortization |
| 30,376 | 44,566 | | 74,942 | |||||||||||||||
Management fees |
3,750 | (19,900 | ) | 19,900 | | 3,750 | ||||||||||||||
Loss on extinguishment
of debt |
23,075 | | | | 23,075 | |||||||||||||||
Equity in earnings of
affiliates |
(102,349 | ) | | | 102,349 | | ||||||||||||||
Total costs and
expenses |
(14,540 | ) | 577,201 | 1,382,922 | 60,880 | 2,006,463 | ||||||||||||||
Earnings (loss) from
continuing operations
before gain on disposal of
assets and income taxes |
14,540 | (11,789 | ) | 130,547 | (69,412 | ) | 63,886 | |||||||||||||
Gain on disposal of
assets, net |
| 420 | 351 | | 771 | |||||||||||||||
Earnings (loss) from
continuing operations
before income taxes |
14,540 | (11,369 | ) | 130,898 | (69,412 | ) | 64,657 | |||||||||||||
Income tax expense |
22,771 | | 1,307 | | 24,078 | |||||||||||||||
Net earnings (loss) from
continuing operations |
(8,231 | ) | (11,369 | ) | 129,591 | (69,412 | ) | 40,579 | ||||||||||||
Earnings (loss) from
discontinued operations,
net of income taxes |
3,603 | (9,612 | ) | (60 | ) | | (6,069 | ) | ||||||||||||
Net earnings (loss) |
(4,628 | ) | (20,981 | ) | 129,531 | (69,412 | ) | 34,510 | ||||||||||||
Net earnings attributable
to non-controlling
interests |
| (6,201 | ) | | | (6,201 | ) | |||||||||||||
Net earnings (loss)
attributable to IASIS
Healthcare LLC |
$ | (4,628 | ) | $ | (27,182 | ) | $ | 129,531 | $ | (69,412 | ) | $ | 28,309 | |||||||
22
Table of Contents
IASIS HEALTHCARE LLC
NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (UNAUDITED)
NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (UNAUDITED)
IASIS Healthcare LLC
Condensed Consolidating Statement of Operations (unaudited)
For the Nine Months Ended June 30, 2010
(in thousands)
Condensed Consolidating Statement of Operations (unaudited)
For the Nine Months Ended June 30, 2010
(in thousands)
Subsidiary | Subsidiary | Condensed | ||||||||||||||||||
Parent Issuer | Guarantors | Non-Guarantors | Eliminations | Consolidated | ||||||||||||||||
Net revenue |
||||||||||||||||||||
Acute care revenue |
$ | | $ | 517,001 | $ | 791,775 | $ | (8,331 | ) | $ | 1,300,445 | |||||||||
Premium revenue |
| | 591,022 | | 591,022 | |||||||||||||||
Total net revenue |
| 517,001 | 1,382,797 | (8,331 | ) | 1,891,467 | ||||||||||||||
Costs and expenses |
||||||||||||||||||||
Salaries and benefits |
| 261,713 | 252,975 | | 514,688 | |||||||||||||||
Supplies |
| 84,049 | 116,118 | | 200,167 | |||||||||||||||
Medical claims |
| | 519,023 | (8,331 | ) | 510,692 | ||||||||||||||
Other operating
expenses |
| 86,414 | 180,440 | | 266,854 | |||||||||||||||
Provision for bad debts |
| 65,352 | 77,549 | | 142,901 | |||||||||||||||
Rentals and leases |
| 12,750 | 17,737 | | 30,487 | |||||||||||||||
Interest expense, net |
50,065 | | 30,886 | (30,886 | ) | 50,065 | ||||||||||||||
Depreciation and
amortization |
| 30,129 | 41,780 | | 71,909 | |||||||||||||||
Management fees |
3,750 | (17,075 | ) | 17,075 | | 3,750 | ||||||||||||||
Equity in earnings of
affiliates |
(116,035 | ) | | | 116,035 | | ||||||||||||||
Total costs and expenses |
(62,220 | ) | 523,332 | 1,253,583 | 76,818 | 1,791,513 | ||||||||||||||
Earnings (loss) from
continuing operations before
gain (loss) on disposal of
assets and income taxes |
62,220 | (6,331 | ) | 129,214 | (85,149 | ) | 99,954 | |||||||||||||
Gain (loss) on disposal of
assets, net |
| 28 | (234 | ) | | (206 | ) | |||||||||||||
Earnings (loss) from
continuing operations before
income taxes |
62,220 | (6,303 | ) | 128,980 | (85,149 | ) | 99,748 | |||||||||||||
Income tax expense |
36,544 | | | | 36,544 | |||||||||||||||
Net earnings (loss) from
continuing operations |
25,676 | (6,303 | ) | 128,980 | (85,149 | ) | 63,204 | |||||||||||||
Earnings (loss) from
discontinued operations, net
of income taxes |
216 | (571 | ) | (8 | ) | | (363 | ) | ||||||||||||
Net earnings (loss) |
25,892 | (6,874 | ) | 128,972 | (85,149 | ) | 62,841 | |||||||||||||
Net earnings attributable to
non-controlling interests |
| (6,063 | ) | | | (6,063 | ) | |||||||||||||
Net earnings (loss)
attributable to IASIS
Healthcare LLC |
$ | 25,892 | $ | (12,937 | ) | $ | 128,972 | $ | (85,149 | ) | $ | 56,778 | ||||||||
23
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IASIS HEALTHCARE LLC
NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (UNAUDITED)
NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (UNAUDITED)
IASIS Healthcare LLC
Condensed Consolidating Statement of Cash Flows (unaudited)
For the Nine Months Ended June 30, 2011
(in thousands)
Condensed Consolidating Statement of Cash Flows (unaudited)
For the Nine Months Ended June 30, 2011
(in thousands)
Subsidiary | Subsidiary | Condensed | ||||||||||||||||||
Parent Issuer | Guarantors | Non-Guarantors | Eliminations | Consolidated | ||||||||||||||||
Cash flows from operating activities |
||||||||||||||||||||
Net earnings (loss) |
$ | (4,628 | ) | $ | (20,981 | ) | $ | 129,531 | $ | (69,412 | ) | $ | 34,510 | |||||||
Adjustments to reconcile net earnings
(loss) to net cash provided by (used in)
operating activities: |
||||||||||||||||||||
Depreciation and amortization |
| 30,376 | 44,566 | | 74,942 | |||||||||||||||
Amortization of loan costs |
4,319 | | | | 4,319 | |||||||||||||||
Stock-based compensation |
1,364 | | | | 1,364 | |||||||||||||||
Deferred income taxes |
899 | | | | 899 | |||||||||||||||
Income tax benefit from parent company
interest |
7,201 | | | | 7,201 | |||||||||||||||
Fair value change in interest rate swaps |
(695 | ) | | | | (695 | ) | |||||||||||||
Gain on disposal of assets, net |
| (420 | ) | (351 | ) | | (771 | ) | ||||||||||||
Loss (earnings) from discontinued
operations, net |
(3,603 | ) | 9,612 | 60 | | 6,069 | ||||||||||||||
Loss on extinguishment of debt |
23,075 | | | | 23,075 | |||||||||||||||
Equity in earnings of affiliates |
(102,349 | ) | | | 102,349 | | ||||||||||||||
Changes in operating assets and
liabilities, net of the effect of
acquisitions and dispositions: |
||||||||||||||||||||
Accounts receivable, net |
| (25,039 | ) | (7,455 | ) | | (32,494 | ) | ||||||||||||
Inventories, prepaid expenses and
other current assets |
| (39,764 | ) | 26,192 | | (13,572 | ) | |||||||||||||
Accounts payable, other accrued
expenses and other accrued
liabilities |
(542 | ) | 41,615 | (52,528 | ) | | (11,455 | ) | ||||||||||||
Net cash provided by (used in)
operating activities continuing
operations |
(74,959 | ) | (4,601 | ) | 140,015 | 32,937 | 93,392 | |||||||||||||
Net cash provided by (used in)
operating activities discontinued
operations |
3,603 | (343 | ) | | | 3,260 | ||||||||||||||
Net cash provided by (used in)
operating activities |
(71,356 | ) | (4,944 | ) | 140,015 | 32,937 | 96,652 | |||||||||||||
Cash flows from investing activities |
||||||||||||||||||||
Purchases of property and equipment, net |
| (29,328 | ) | (35,147 | ) | | (64,475 | ) | ||||||||||||
Cash paid for acquisitions, net |
| (154,022 | ) | (1,406 | ) | | (155,428 | ) | ||||||||||||
Proceeds from sale of assets |
| 12 | 138 | | 150 | |||||||||||||||
Change in other assets, net |
| (4,689 | ) | 6,074 | | 1,385 | ||||||||||||||
Net cash used in investing activities |
| (188,027 | ) | (30,341 | ) | | (218,368 | ) | ||||||||||||
Cash flows from financing activities |
||||||||||||||||||||
Proceeds from refinancing |
1,863,730 | | | | 1,863,730 | |||||||||||||||
Payment of debt and capital lease
obligations |
(1,048,034 | ) | | (1,513 | ) | | (1,049,547 | ) | ||||||||||||
Debt financing costs incurred |
(51,308 | ) | | | | (51,308 | ) | |||||||||||||
Distributions to
parent company in connection with refinancing |
(632,866 | ) | | | | (632,866 | ) | |||||||||||||
Distributions to non-controlling interests |
| (7,395 | ) | | | (7,395 | ) | |||||||||||||
Costs paid for repurchase of
non-controlling interests |
| (814 | ) | | | (814 | ) | |||||||||||||
Change in intercompany balances with
affiliates, net |
(60,166 | ) | 194,455 | (101,352 | ) | (32,937 | ) | | ||||||||||||
Net cash provided by (used in)
financing activities |
71,356 | 186,246 | (102,865 | ) | (32,937 | ) | 121,800 | |||||||||||||
Change in cash and cash equivalents |
| (6,725 | ) | 6,809 | | 84 | ||||||||||||||
Cash and cash equivalents at beginning of
period |
| 143,599 | 912 | | 144,511 | |||||||||||||||
Cash and cash equivalents at end of period |
$ | | $ | 136,874 | $ | 7,721 | $ | | $ | 144,595 | ||||||||||
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Table of Contents
IASIS HEALTHCARE LLC
NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (UNAUDITED)
NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (UNAUDITED)
IASIS Healthcare LLC
Condensed Consolidating Statement of Cash Flows (unaudited)
For the Nine Months Ended June 30, 2010
(in thousands)
Condensed Consolidating Statement of Cash Flows (unaudited)
For the Nine Months Ended June 30, 2010
(in thousands)
Subsidiary | Subsidiary | Condensed | ||||||||||||||||||
Parent Issuer | Guarantors | Non-Guarantors | Eliminations | Consolidated | ||||||||||||||||
Cash flows from operating activities |
||||||||||||||||||||
Net earnings (loss) |
$ | 25,892 | $ | (6,874 | ) | $ | 128,972 | $ | (85,149 | ) | $ | 62,841 | ||||||||
Adjustments to reconcile net earnings
(loss) to net cash provided by (used in)
operating activities: |
||||||||||||||||||||
Depreciation and amortization |
| 30,129 | 41,780 | | 71,909 | |||||||||||||||
Amortization of loan costs |
2,356 | | | | 2,356 | |||||||||||||||
Stock-based compensation |
2,367 | | | | 2,367 | |||||||||||||||
Deferred income taxes |
23,839 | | | | 23,839 | |||||||||||||||
Income tax benefit from stock-based
compensation |
(1,770 | ) | | | | (1,770 | ) | |||||||||||||
Income tax benefit from parent company
interest |
4,989 | | | | 4,989 | |||||||||||||||
Loss (gain) on disposal of assets,
net |
| (28 | ) | 234 | | 206 | ||||||||||||||
Loss (earnings) from discontinued
operations, net |
(216 | ) | 571 | 8 | | 363 | ||||||||||||||
Equity in earnings of affiliates |
(116,035 | ) | | | 116,035 | | ||||||||||||||
Changes in operating assets and
liabilities, net of the effect of
dispositions: |
||||||||||||||||||||
Accounts receivable, net |
| 1,385 | 7,769 | | 9,154 | |||||||||||||||
Inventories, prepaid expenses and
other current assets |
| (3,798 | ) | (71,111 | ) | | (74,909 | ) | ||||||||||||
Accounts payable, other accrued
expenses and other accrued
liabilities |
(8,613 | ) | 13,557 | 8,193 | | 13,137 | ||||||||||||||
Net cash provided by (used in)
operating activities continuing
operations |
(67,191 | ) | 34,942 | 115,845 | 30,886 | 114,482 | ||||||||||||||
Net cash used in operating activities
discontinued operations |
(216 | ) | (351 | ) | | | (567 | ) | ||||||||||||
Net cash provided by (used in)
operating activities |
(67,407 | ) | 34,591 | 115,845 | 30,886 | 113,915 | ||||||||||||||
Cash flows from investing activities |
||||||||||||||||||||
Purchases of property and equipment, net |
| (31,626 | ) | (21,839 | ) | | (53,465 | ) | ||||||||||||
Proceeds from sale of assets |
| 19 | 31 | | 50 | |||||||||||||||
Change in other assets, net |
| 1,960 | (104 | ) | | 1,856 | ||||||||||||||
Net cash used in investing activities |
| (29,647 | ) | (21,912 | ) | | (51,559 | ) | ||||||||||||
Cash flows from financing activities |
||||||||||||||||||||
Payment of debt and capital lease
obligations |
(6,079 | ) | | (693 | ) | | (6,772 | ) | ||||||||||||
Distribution to parent company in
connection with the repurchase of equity,
net |
(124,962 | ) | | | | (124,962 | ) | |||||||||||||
Distributions to non-controlling
interests |
| (179 | ) | (6,742 | ) | | (6,921 | ) | ||||||||||||
Costs paid for repurchase of
non-controlling interests |
| (69 | ) | | | (69 | ) | |||||||||||||
Change in intercompany balances with
affiliates, net |
198,448 | (81,064 | ) | (86,498 | ) | (30,886 | ) | | ||||||||||||
Net cash provided by (used in)
financing activities |
67,407 | (81,312 | ) | (93,933 | ) | (30,886 | ) | (138,724 | ) | |||||||||||
Change in cash and cash equivalents |
| (76,368 | ) | | | (76,368 | ) | |||||||||||||
Cash and cash equivalents at beginning of
period |
| 206,331 | 197 | | 206,528 | |||||||||||||||
Cash and cash equivalents at end of period |
$ | | $ | 129,963 | $ | 197 | $ | | $ | 130,160 | ||||||||||
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Table of Contents
Item 2. | Managements Discussion and Analysis of Financial Condition and Results of Operations |
The following discussion and analysis of financial condition and results of operations should
be read in conjunction with our unaudited condensed consolidated financial statements, the notes to
our unaudited condensed consolidated financial statements and the other financial information
appearing elsewhere in this report. Data for the quarters and nine months ended June 30, 2011 and
2010, has been derived from our unaudited condensed consolidated financial statements. References
herein to we, our and us are to IASIS Healthcare LLC and its subsidiaries. References herein
to IAS are to IASIS Healthcare Corporation, our parent company.
FORWARD LOOKING STATEMENTS
Some of the statements we make in this report are forward-looking within the meaning of the
federal securities laws, which are intended to be covered by the safe harbors created thereby.
Those forward-looking statements include all statements that are not historical statements of fact
and those regarding our intent, belief or expectations including, but not limited to, the
discussions of our operating and growth strategy (including possible acquisitions and
dispositions), financing needs, projections of revenue, income or loss, capital expenditures and
future operations. Forward-looking statements involve known and unknown risks and uncertainties
that may cause actual results in future periods to differ materially from those anticipated in the
forward-looking statements. Those risks and uncertainties include, among others, our ability to
retain and negotiate reasonable contracts with managed care plans, the impact of the federal
healthcare reform, changes in governmental healthcare programs, our hospitals competition for
patients from other hospitals and healthcare providers, the shift in payor mix from commercial and
managed care payors to medicaid and managed medicaid, our hospitals facing a growth in volume and
revenue related to uncompensated care, our ability to recruit and retain quality physicians, our
hospitals competition for staffing which may increase our labor costs and reduce profitability,
our failure to continually enhance our hospitals with the most recent technological advances in
diagnostic and surgical equipment that may adversely affect our ability to maintain and expand our
markets, our failure to comply with extensive laws and government regulations, the health reform
law that imposes significant restrictions on hospitals that have physician owners, expenses
incurred in connection with an appeal of the court order dismissing with prejudice the qui tam
litigation, the possibility that we may become subject to federal and state investigations in the
future, our ability to satisfy regulatory requirements with respect to our internal controls over
financial reporting under Section 404 of the Sarbanes-Oxley Act of 2002, a failure of our
information systems that would adversely affect our ability to properly manage our operations,
failure to effectively and timely implement electronic health record systems, an economic downturn
or other material change in any one of the regions in which we operate, potential liabilities
because of claims brought against our facilities, our ability to control costs at Health Choice
Arizona, Inc. (Health Choice or the Plan), the impact of any significant alteration to the
Arizona Health Care Cost Containment System (AHCCCS) payment structure of its contracts, the
possibility of Health Choices contract with the AHCCCS being discontinued, significant competition
from other healthcare companies and state efforts to regulate the sale of not-for-profit hospitals
that may affect our ability to acquire hospitals, difficulties with the integration of acquisitions
that may disrupt our ongoing operations, our dependence on key personnel, the loss of one or more
of which could have a material adverse effect on our business, potential responsibilities and costs
under environmental laws that could lead to material expenditures or liability, the possibility of
a decline in the fair value of our reporting units that could result in a material non-cash charge
to earnings, the risks and uncertainties related to our ability to generate sufficient cash to
service our existing indebtedness, our substantial level of indebtedness that could adversely
affect our financial condition, the possibility of an increase in interest rates, which would
increase the cost of servicing our debt and could reduce profitability, risks associated with us
being owned by equity sponsors who have the ability to control our financial decisions and those
risks, uncertainties and other matters detailed in our Annual Report on Form 10-K for the fiscal
year ended September 30, 2010, and in our subsequent filings with the Securities and Exchange
Commission (the SEC).
Although we believe that the assumptions underlying the forward-looking statements contained
in this report are reasonable, any of these assumptions could prove to be inaccurate and,
therefore, there can be no assurance that the forward-looking statements included in this report
will prove to be accurate. In light of the significant uncertainties inherent in the
forward-looking statements included in this report, you should not regard the inclusion of such
information as a representation by us or any other person that our objectives and plans will be
achieved. We undertake no obligation to publicly release any revisions to any forward-looking
statements contained herein to reflect events and circumstances occurring after the date hereof or
to reflect the occurrence of unanticipated events.
26
Table of Contents
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 June 30, 2011, we owned
or leased 18 acute care hospital facilities and one behavioral health hospital facility, with a
total of 4,362 licensed beds, located in seven regions:
| Salt Lake City, Utah; |
| Phoenix, Arizona; |
| Tampa-St. Petersburg, Florida; |
| five cities in Texas, including Houston and 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 197,000 members.
On May 3, 2011, we completed a transaction to refinance our then 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. Proceeds
from the Refinancing were used to refinance amounts outstanding under our then existing credit
facilities; fund a cash tender offer to repurchase any and all of our $475.0 million aggregate
principal amount of 8 3/4% 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, including future acquisitions and strategic growth initiatives, as well as
potential distributions to the equity holders of IAS. In connection
with the Refinancing, we incurred a loss on extinguishment of debt
totaling $23.1 million, along with an increase in interest costs
primarily resulting from the additional outstanding debt associated
with the transaction.
Effective May 1, 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 changes in net assets. In accordance with the purchase agreement, independent
investors, most of whom are physicians on the medical staff of St. Joseph, retained 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.
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.
27
Table of Contents
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 Patient Protection and Affordable Care Act, as amended by the Health Care and Education
Reconciliation Act of 2010 (collectively, the Health Reform Law), will change how healthcare
services are covered, delivered, and reimbursed through expanded coverage of previously uninsured
individuals and reduced government healthcare spending. In addition, as enacted, the law reforms
certain aspects of health insurance, expands existing efforts to tie Medicare and Medicaid payments
to performance and quality, places restrictions on physician owned hospitals, and contains
provisions intended to strengthen fraud and abuse enforcement. Because of the many variables
involved, including the laws complexity, lack of implementing regulations or interpretive
guidance, gradual and potentially delayed implementation, pending efforts to repeal or amend
portions of the Health Reform Law in the United States Congress and ongoing federal court cases
challenging the constitutionality of the Health Reform Law, the impact of the Health Reform Law,
including how individuals and businesses will respond to the new choice afforded them, is not yet
fully known.
Payor Mix Shift
Like others in the hospital industry, we have experienced a shift in our patient volumes and
revenue from commercial and managed care payors to self-pay and Medicaid, including 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 and the uninsured population. Additionally, we have recently experienced growth in our self-pay
revenue, resulting in large part, from increased volume and acuity levels associated with uninsured
patient decisions to defer non-emergent healthcare needs. 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 self-pay and Medicaid payor mixes to
continue until the U.S. economy experiences an economic recovery that includes job growth and a
meaningful decline in 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 project near term
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, most recently Texas and Arizona, by decreasing funding for Medicaid and other healthcare
programs or making structural changes that have resulted in a reduction in
hospital reimbursement. In addition, many states are seeking waivers from the Centers for Medicare and Medicaid Services (CMS) in order to implement
or expand managed Medicaid programs.
In
July 2011, in connection with the states reduced funding for Medicaid services in fiscal 2012, the
Texas Health and Human Services Commission (THHSC) issued a final rule implementing a statewide
acute care hospital inpatient Standard Dollar Amount (SDA) rate, along with an 8% reduction in
Medicaid hospital outpatient reimbursement. The THHSC also rebased all MS-DRG relative
weights concurrent with this SDA rate change. The new statewide SDA rate includes certain add-on
adjustments for geographic wage-index, indirect medical education and
trauma services. However, the new
statewide SDA rate does not include add-on adjustments for higher acuity services, such as neonatal and other womens
services, which are utilized by a majority of the Medicaid patients
we serve at our Texas hospitals.
28
Table of Contents
As Arizona continues working to eliminate its budget deficit, its current budget for fiscal
2011 included reimbursement cuts, including elimination of Medicaid coverage for some services and
a cut of up to 5% for all Medicaid providers, which began in April 2011. The Governor has signed the
states fiscal 2012 budget legislation, which includes another 5% cut to provider reimbursement
effective October 1, 2011, and a reduction of approximately 160,000 eligible Medicaid
beneficiaries, which represents approximately
11.5% of the total Medicaid population in the state and includes
approximately 100,000 childless adults. This reduction in eligible enrollees is to be
accomplished over a twelve month period, beginning July 2011, through enrollment caps, attrition
and more stringent eligibility requirements. While these structural changes to the Medicaid program
have been included in Arizonas approved fiscal 2012 budget, these changes require CMS approval
under the confines of the Health Reform Law. Arizona has received a
waiver
from CMS which
eliminates Medicaid coverage for the estimated 100,000
childless adults, and is currently waiting approval on the remaining
60,000 eligible beneficiaries, which represent families with income levels
that fall between 75% and 100% of the federal poverty level.
Additionally, AHCCCS has proposed a gain sharing plan, the details of which
have not been finalized, which would be implemented through
an annual reconciliation process with the managed Medicaid health
plans. If additional Medicaid spending cuts or other program changes
are implemented in the future in Arizona or other states in which we operate, our
revenue and earnings could be significantly impacted.
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.
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.
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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 from economic pressures and their
related decisions to 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 nine months
ended June 30, 2011, our uncompensated care as a percentage of acute care revenue, which includes
the impact of uninsured discounts and charity care, was 18.5% and 18.1%, respectively, compared to
16.7% and 16.0% 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, including increased acuity levels and continued increases in co-payments and
deductibles for insured patients, our uncompensated care will increase and our results of
operations could be adversely affected.
The percentages of our insured and uninsured gross hospital receivables (prior to allowances
for contractual adjustments and doubtful accounts) are summarized as follows:
June 30, | September 30, | |||||||
2011 | 2010 | |||||||
Insured receivables |
63.3 | % | 61.8 | % | ||||
Uninsured receivables |
36.7 | % | 38.2 | % | ||||
Total |
100.0 | % | 100.0 | % | ||||
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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.
The percentages of our gross hospital receivables in summarized aging categories are as
follows:
June 30, | September 30, | |||||||
2011 | 2010 | |||||||
0 to 90 days |
70.3 | % | 71.9 | % | ||||
91 to 180 days |
18.5 | % | 17.8 | % | ||||
Over 180 days |
11.2 | % | 10.3 | % | ||||
Total |
100.0 | % | 100.0 | % | ||||
The
shift in the age of our gross hospital receivables is primarily the
result of delays in
payments from Medicaid and managed care organizations, as such payors
implement administrative delays, including increased
efforts related to utilization reviews.
Revenue and Volume Trends
Net revenue for the quarter ended June 30, 2011, increased 12.6% to $718.6 million, compared
to $638.0 million in the prior year quarter. Net revenue for the nine months ended June 30, 2011,
increased 9.5% to $2.1 billion, compared to $1.9 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 acquisition effective October 1, 2010 and the St. Joseph acquisition effective May 1, 2011,
contributed $91.6 million and $189.0 million to the increase in total net revenue for the quarter
and nine months ended June 30, 2011, respectively, while premium revenue at Health Choice declined
$11.0 million and $10.1 million 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 nine months ended June 30, 2011,
was $22.4 million and $60.2 million,
respectively, compared to $22.4 million and $60.1 million
in the same prior year periods. The Texas private supplemental Medicaid reimbursement programs are currently being
reviewed by the THHSC, which is seeking a waiver from CMS to replace the states current private supplemental
reimbursement programs through the expansion of its managed Medicaid program. These efforts could result in the
restructuring of the administration and funding of the private
supplemental reimbursement programs. However, due to the uncertainty that the waiver
request will be approved by CMS and the nature of ongoing
deliberations with advocacy groups, we are unable to estimate
the impact, if any, this will have on our revenue and earnings.
The American Recovery and Reinvestment Act of 2009 provides for Medicare and Medicaid
incentive payments beginning in calendar 2011 for eligible hospitals and professionals that
implement certified electronic health record (EHR) technology and adopt the related meaningful
use requirements. We will recognize revenues related to the Medicare or Medicaid incentive payments
as we are able to complete attestations as to our eligible hospitals adopting, implementing or
demonstrating meaningful use of certified EHR technology. We have recognized revenue of $8.1
million related to Medicaid incentive payments during the quarter
ended June 30, 2011, which have helped to mitigate some of the
pressure we have experienced resulting from the impact of recent Medicaid
reimbursement cuts. We have
incurred and will continue to incur both capital costs and operating expenses in order to implement
our certified EHR
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technology and meet meaningful use requirements. These costs and expenses are
projected to continue over all stages of our certified EHR technology
and meaningful use implementation. As a result, the timing
of the expense recognition will not correlate with the receipt of the incentive payments and the
recognition of revenues. We have incurred operating expenses to implement our certified EHR
technology and meet meaningful use requirements of approximately $3.1 million during the nine months ended June
30, 2011. There can be no assurance that we will be able to demonstrate meaningful use of certified
EHR technology, and the failure to do so could have a material adverse effect on our results of
operations.
Admissions increased 20.0% and 10.2% for the quarter and nine months ended June 30, 2011,
respectively, compared to the same prior year periods. Adjusted admissions increased 20.0% and
12.9% for the quarter and nine months ended June 30, 2011, respectively, compared to the same prior
year periods. On a same-facility basis, admissions increased 0.9% and declined 1.5% for the quarter
and nine months ended June 30, 2011, respectively, compared to the same prior year periods, while
adjusted admissions increased 0.8% and 0.4% for the quarter and nine months ended June 30, 2011,
respectively, compared to the same prior year periods.
On a same-facility basis, our quarter and year-to-date inpatient volume has benefitted from an
increase in surgeries, particularly inpatient procedures which increased 5.1% and 0.4% for the
quarter and nine months ended June 30, 2011, and psychiatric
services which increased 11.8% and 8.7% for the same periods,
respectively, each compared to the same prior year periods. However,
hospital volumes continue to be 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 our volumes over the long-term will grow as a result of our business strategies,
including the strategic deployment of capital, 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, our increased marketing
efforts to promote our commitment to quality and patient satisfaction, and the general aging of the
population.
The sources of our net patient revenue by payor are summarized as follows:
Quarter | Nine Months | |||||||||||||||
Ended June 30, | Ended June 30, | |||||||||||||||
2011 | 2010 | 2011 | 2010 | |||||||||||||
Medicare |
24.8 | % | 22.9 | % | 24.6 | % | 23.4 | % | ||||||||
Managed Medicare |
7.7 | % | 8.7 | % | 8.1 | % | 8.4 | % | ||||||||
Medicaid and managed Medicaid |
15.2 | % | 15.4 | % | 14.8 | % | 15.2 | % | ||||||||
Managed care |
39.1 | % | 39.2 | % | 39.8 | % | 40.7 | % | ||||||||
Self-pay |
13.2 | % | 13.8 | % | 12.7 | % | 12.3 | % | ||||||||
Total |
100.0 | % | 100.0 | % | 100.0 | % | 100.0 | % | ||||||||
Our net patient revenue payor mix, as shown in the table above, has been impacted by our
recent acquisitions, which include hospitals with higher Medicaid and managed Medicaid utilization and lower
self-pay volume, as compared to our same-facility hospitals. The increase in our Medicaid and
managed Medicaid patient mix has been offset by the impact of Medicaid rate cuts experienced in
the states where we operate.
Net patient revenue per adjusted admission increased 0.7% and 1.4%, respectively, for the
quarter and nine months ended June 30, 2011, compared to the same prior year periods. On a
same-facility basis, net patient revenue per adjusted admission increased 4.1% and 3.5%,
respectively, for the quarter and nine months ended June 30, 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. As well, the impact of
state budgetary issues on Medicaid funding has resulted in rate
cuts to providers, which has caused a decline in pricing related to Medicaid and managed Medicaid
volumes. 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
is 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
26.3% and 28.1%, respectively, of our consolidated net revenue for the quarter and nine months
ended June 30, 2011, compared to 31.3% and 31.2% in the same prior year periods. The decline in
premium revenue as a percentage of our consolidated net revenue is
primarily the result of the
recent acquisitions in our acute care segment.
Most of the premium revenue at Health Choice is derived through a contract with AHCCCS to
provide specified health services to qualified Medicaid enrollees through contracted providers.
AHCCCS is the state agency that administers Arizonas Medicaid program. The contract requires
Health Choice to arrange for healthcare services for enrolled Medicaid patients in exchange for
fixed monthly premiums, based upon negotiated per capita member rates, and supplemental payments
from AHCCCS. Health Choice also contracts with CMS to provide coverage as a Medicare Advantage
Prescription Drug (MAPD) Special Needs Plan (SNP). This contract allows Health Choice to offer
Medicare and Part D drug benefit coverage to new and existing dual-eligible members (i.e., those
that are eligible for Medicare and Medicaid). Effective for this 2011 plan year, SNPs are required
to meet additional CMS requirements, including requirements relating to model of care,
cost-sharing, disclosure of information and reporting of quality measures.
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CRITICAL ACCOUNTING POLICIES AND ESTIMATES
A summary of significant accounting policies is disclosed in Note 2 to the consolidated
financial statements included in our Annual Report on Form 10-K for the year ended September 30,
2010. Our critical accounting policies are further described under the caption Critical Accounting
Policies and Estimates in Managements Discussion and Analysis of Financial Condition and Results
of Operations in our Annual Report on Form 10-K for the fiscal year ended September 30, 2010. There
have been no changes in the nature of our critical accounting policies or the application of those
policies since September 30, 2010.
SELECTED OPERATING DATA
The following table sets forth certain unaudited operating data for each of the periods
presented.
Quarter | Nine Months | |||||||||||||||
Ended June 30, | Ended June 30, | |||||||||||||||
2011 | 2010 | 2011 | 2010 | |||||||||||||
Acute Care: |
||||||||||||||||
Number of acute care hospital facilities
at end of period |
18 | 15 | 18 | 15 | ||||||||||||
Licensed beds at end of period (1) |
4,362 | 3,185 | 4,362 | 3,185 | ||||||||||||
Average length of stay (days) (2) |
4.9 | 4.8 | 4.9 | 4.8 | ||||||||||||
Occupancy rates (average beds in service) |
48.3 | % | 45.9 | % | 48.5 | % | 46.9 | % | ||||||||
Admissions (3) |
29,956 | 24,968 | 84,469 | 76,679 | ||||||||||||
Adjusted admissions (4) |
51,171 | 42,655 | 144,066 | 127,654 | ||||||||||||
Patient days (5) |
146,888 | 120,515 | 416,365 | 369,402 | ||||||||||||
Adjusted patient days (4) |
242,105 | 198,439 | 682,948 | 593,277 | ||||||||||||
Net patient revenue per adjusted admission |
$ | 10,267 | $ | 10,197 | $ | 10,258 | $ | 10,118 | ||||||||
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) |
3,188 | 3,185 | 3,188 | 3,185 | ||||||||||||
Average length of stay (days) (2) |
4.9 | 4.8 | 5.0 | 4.8 | ||||||||||||
Occupancy rates (average beds in service) |
47.5 | % | 45.9 | % | 47.9 | % | 46.9 | % | ||||||||
Admissions (3) |
25,195 | 24,968 | 75,543 | 76,679 | ||||||||||||
Adjusted admissions (4) |
42,985 | 42,655 | 128,200 | 127,654 | ||||||||||||
Patient days (5) |
124,534 | 120,515 | 376,230 | 369,402 | ||||||||||||
Adjusted patient days (4) |
204,192 | 198,439 | 612,646 | 593,277 | ||||||||||||
Net patient revenue per adjusted admission |
$ | 10,620 | $ | 10,197 | $ | 10,473 | $ | 10,118 | ||||||||
Health Choice: |
||||||||||||||||
Medicaid covered lives |
193,277 | 195,183 | 193,277 | 195,183 | ||||||||||||
Dual-eligible lives (7) |
4,271 | 4,256 | 4,271 | 4,256 | ||||||||||||
Medical loss ratio (8) |
84.2 | % | 87.3 | % | 84.9 | % | 87.8 | % |
(1) | Includes St. Lukes Behavioral Hospital. | |
(2) | Represents the average number of days that a patient stayed in our hospitals. | |
(3) | Represents the total number of patients admitted to our hospitals for stays in excess of 23 hours. Management and investors use this number as a general measure of inpatient volume. | |
(4) | Adjusted admissions and adjusted patient days are general measures of combined inpatient and outpatient volume. We compute adjusted admissions/patient days by multiplying admissions/patient days by gross patient revenue and then dividing that number by gross inpatient revenue. | |
(5) | Represents the number of days our beds were occupied by inpatients over the period. | |
(6) | Excludes the impact of the Brim acquisition, which was effective October 1, 2010, and the St. Joseph acquisition, which was effective May 1, 2011. | |
(7) | Represents members eligible for Medicare and Medicaid benefits under Health Choices contract with CMS to provide coverage as a MAPD SNP. | |
(8) | Represents medical claims expense as a percentage of premium revenue, including claims paid to our hospitals. |
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RESULTS OF OPERATIONS SUMMARY
Consolidated
The following table sets forth, for the periods presented, our results of consolidated
operations expressed in dollar terms and as a percentage of net revenue. Such information has been
derived from our unaudited condensed consolidated statements of operations.
Quarter Ended | Quarter Ended | Nine Months Ended | Nine Months Ended | |||||||||||||||||||||||||||||
June 30, 2011 | June 30, 2010 | June 30, 2011 | June 30, 2010 | |||||||||||||||||||||||||||||
($ in thousands) | Amount | Percentage | Amount | Percentage | Amount | Percentage | Amount | Percentage | ||||||||||||||||||||||||
Net revenue |
||||||||||||||||||||||||||||||||
Acute care revenue |
$ | 529,844 | 73.7 | % | $ | 438,211 | 68.7 | % | $ | 1,489,432 | 71.9 | % | $ | 1,300,445 | 68.8 | % | ||||||||||||||||
Premium revenue |
188,765 | 26.3 | % | 199,777 | 31.3 | % | 580,917 | 28.1 | % | 591,022 | 31.2 | % | ||||||||||||||||||||
Total net revenue |
718,609 | 100.0 | % | 637,988 | 100.0 | % | 2,070,349 | 100.0 | % | 1,891,467 | 100.0 | % | ||||||||||||||||||||
Costs and expenses |
||||||||||||||||||||||||||||||||
Salaries and benefits |
211,114 | 29.4 | % | 170,035 | 26.7 | % | 597,063 | 28.8 | % | 514,688 | 27.2 | % | ||||||||||||||||||||
Supplies |
83,071 | 11.6 | % | 66,333 | 10.4 | % | 237,431 | 11.5 | % | 200,167 | 10.6 | % | ||||||||||||||||||||
Medical claims |
155,885 | 21.7 | % | 172,031 | 27.0 | % | 484,635 | 23.4 | % | 510,692 | 27.0 | % | ||||||||||||||||||||
Other operating
expenses |
114,778 | 16.0 | % | 93,579 | 14.7 | % | 315,254 | 15.2 | % | 266,854 | 14.1 | % | ||||||||||||||||||||
Provision for bad debts |
60,685 | 8.4 | % | 49,416 | 7.7 | % | 175,100 | 8.5 | % | 142,901 | 7.6 | % | ||||||||||||||||||||
Rentals and leases |
11,774 | 1.6 | % | 10,067 | 1.6 | % | 34,229 | 1.7 | % | 30,487 | 1.6 | % | ||||||||||||||||||||
Interest expense, net |
27,597 | 3.8 | % | 16,711 | 2.6 | % | 60,984 | 2.9 | % | 50,065 | 2.7 | % | ||||||||||||||||||||
Depreciation and
amortization |
26,312 | 3.7 | % | 24,007 | 3.7 | % | 74,942 | 3.6 | % | 71,909 | 3.8 | % | ||||||||||||||||||||
Management fees |
1,250 | 0.2 | % | 1,250 | 0.2 | % | 3,750 | 0.2 | % | 3,750 | 0.2 | % | ||||||||||||||||||||
Loss on extinguishment
of debt |
23,075 | 3.2 | % | | | 23,075 | 1.1 | % | | | ||||||||||||||||||||||
Total costs and
expenses |
715,541 | 99.6 | % | 603,429 | 94.6 | % | 2,006,463 | 96.9 | % | 1,791,513 | 94.8 | % | ||||||||||||||||||||
Earnings from continuing
operations before gain
(loss) on disposal of
assets and income taxes |
3,068 | 0.4 | % | 34,559 | 5.4 | % | 63,886 | 3.1 | % | 99,954 | 5.2 | % | ||||||||||||||||||||
Gain (loss) on disposal
of assets, net |
(114 | ) | (0.0 | )% | (149 | ) | (0.0 | )% | 771 | 0.0 | % | (206 | ) | (0.0 | )% | |||||||||||||||||
Earnings from continuing
operations before income
taxes |
2,954 | 0.4 | % | 34,410 | 5.4 | % | 64,657 | 3.1 | % | 99,748 | 5.2 | % | ||||||||||||||||||||
Income tax expense |
1,389 | 0.2 | % | 12,683 | 2.0 | % | 24,078 | 1.1 | % | 36,544 | 1.9 | % | ||||||||||||||||||||
Net earnings from
continuing operations |
1,565 | 0.2 | % | 21,727 | 3.4 | % | 40,579 | 2.0 | % | 63,204 | 3.3 | % | ||||||||||||||||||||
Loss from discontinued
operations, net of
income taxes |
(15 | ) | (0.0 | )% | (384 | ) | (0.1 | )% | (6,069 | ) | (0.3 | )% | (363 | ) | (0.0 | )% | ||||||||||||||||
Net earnings |
1,550 | 0.2 | % | 21,343 | 3.3 | % | 34,510 | 1.7 | % | 62,841 | 3.3 | % | ||||||||||||||||||||
Net earnings
attributable to
non-controlling
interests |
(2,013 | ) | (0.3 | )% | (2,002 | ) | (0.3 | )% | (6,201 | ) | (0.3 | )% | (6,063 | ) | (0.3 | )% | ||||||||||||||||
Net earnings
(loss) attributable to IASIS
Healthcare LLC |
$ | (463 | ) | (0.1 | )% | $ | 19,341 | 3.0 | % | $ | 28,309 | 1.4 | % | $ | 56,778 | 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 | Nine Months Ended | Nine Months Ended | |||||||||||||||||||||||||||||
June 30, 2011 | June 30, 2010 | June 30, 2011 | June 30, 2010 | |||||||||||||||||||||||||||||
($ in thousands) | Amount | Percentage | Amount | Percentage | Amount | Percentage | Amount | Percentage | ||||||||||||||||||||||||
Acute care revenue |
||||||||||||||||||||||||||||||||
Acute care revenue |
$ | 529,844 | 99.4 | % | $ | 438,211 | 99.5 | % | $ | 1,489,432 | 99.4 | % | $ | 1,300,445 | 99.4 | % | ||||||||||||||||
Revenue between segments
(1) |
3,065 | 0.6 | % | 2,319 | 0.5 | % | 8,532 | 0.6 | % | 8,331 | 0.6 | % | ||||||||||||||||||||
Total acute care revenue |
532,909 | 100.0 | % | 440,530 | 100.0 | % | 1,497,964 | 100.0 | % | 1,308,776 | 100.0 | % | ||||||||||||||||||||
Costs and expenses |
||||||||||||||||||||||||||||||||
Salaries and benefits |
205,839 | 38.6 | % | 165,169 | 37.5 | % | 581,592 | 38.8 | % | 500,283 | 38.2 | % | ||||||||||||||||||||
Supplies |
83,010 | 15.6 | % | 66,293 | 15.0 | % | 237,274 | 15.8 | % | 200,030 | 15.3 | % | ||||||||||||||||||||
Other operating expenses |
108,658 | 20.4 | % | 87,451 | 19.9 | % | 295,913 | 19.8 | % | 248,380 | 19.0 | % | ||||||||||||||||||||
Provision for bad debts |
60,685 | 11.4 | % | 49,416 | 11.2 | % | 175,100 | 11.7 | % | 142,901 | 10.9 | % | ||||||||||||||||||||
Rentals and leases |
11,378 | 2.1 | % | 9,650 | 2.2 | % | 32,991 | 2.2 | % | 29,334 | 2.2 | % | ||||||||||||||||||||
Interest expense, net |
27,597 | 5.2 | % | 16,711 | 3.8 | % | 60,984 | 4.1 | % | 50,065 | 3.8 | % | ||||||||||||||||||||
Depreciation and
amortization |
25,425 | 4.8 | % | 23,115 | 5.2 | % | 72,273 | 4.8 | % | 69,240 | 5.3 | % | ||||||||||||||||||||
Management fees |
1,250 | 0.2 | % | 1,250 | 0.3 | % | 3,750 | 0.3 | % | 3,750 | 0.3 | % | ||||||||||||||||||||
Loss on extinguishment of
debt |
23,075 | 4.3 | % | | | 23,075 | 1.5 | % | | | ||||||||||||||||||||||
Total costs and expenses |
546,917 | 102.6 | % | 419,055 | 95.1 | % | 1,482,952 | 99.0 | % | 1,243,983 | 95.0 | % | ||||||||||||||||||||
Earnings (loss) from
continuing operations before
gain (loss) on disposal of
assets and income taxes |
(14,008 | ) | (2.6 | )% | 21,475 | 4.9 | % | 15,012 | 1.0 | % | 64,793 | 5.0 | % | |||||||||||||||||||
Gain (loss) on disposal of
assets, net |
(114 | ) | (0.0 | )% | (149 | ) | (0.0 | )% | 771 | 0.1 | % | (206 | ) | (0.0 | )% | |||||||||||||||||
Earnings (loss) from
continuing operations before
income taxes |
$ | (14,122 | ) | (2.6 | )% | $ | 21,326 | 4.9 | % | $ | 15,783 | 1.1 | % | $ | 64,587 | 5.0 | % | |||||||||||||||
(1) | Revenue between segments is eliminated in our consolidated results. |
Quarters Ended June 30, 2011 and 2010
Acute care revenue Acute care revenue for the quarter ended June 30, 2011, was $532.9
million, an increase of $92.4 million, or 21.0%, compared to $440.5 million in the prior year
quarter. The increase in acute care revenue, which includes the impact of the Brim and St. Joseph
acquisitions, is comprised of an increase in adjusted admissions of 20.0% and an increase in net
patient revenue per adjusted admission of 0.7%.
Net adjustments to estimated third-party payor settlements, also known as prior year
contractuals, resulted in an increase in acute care revenue of $406,000 and $2.2 million for the
quarters ended June 30, 2011 and 2010, respectively.
Salaries and benefits Salaries and benefits expense for the quarter ended June 30, 2011, was
$205.8 million, or 38.6% of acute care revenue, compared to $165.2 million, or 37.5% of acute care
revenue in the prior year quarter. The increase in our salaries and benefits expense as a
percentage of acute care revenue is primarily due to our recent acquisitions.
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Supplies Supplies expense for the quarter ended June 30, 2011, was $83.0 million, or 15.6%
of acute care revenue, compared to $66.3 million, or 15.0% of acute care revenue in the prior year
quarter. The increase in supplies as a percentage of acute care revenue is the result of our recent
acquisitions, which contributed an increase of 0.3%, and a shift in the mix of our surgical volume
to cases with more costly implant utilization, particularly in the
areas of orthopedics and cardiac services.
Other operating expenses Other operating expenses for the quarter ended June 30, 2011, were
$108.7 million, or 20.4% of acute care revenue, compared to $87.5 million, or 19.9% of acute care
revenue in the prior year quarter. The increase in our other operating expenses as a percentage of
acute care revenue is primarily due to our recent acquisitions.
Provision for bad debts Provision for bad debts for the quarter ended June 30, 2011, was
$60.7 million, or 11.4% of acute care revenue, compared to $49.4 million, or 11.2% 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 volume and revenue, including related
acuity levels, which have resulted primarily from patient decisions to defer non-emergent healthcare needs as
a result of economic pressures and high unemployment.
Nine Months Ended June 30, 2011 and 2010
Acute care revenue Acute care revenue for the nine months ended June 30, 2011, was $1.5
billion, an increase of $189.2 million or 14.5%, compared to $1.3 billion in the prior year period.
The increase in acute care revenue, which includes the impact of the Brim and St. Joseph
acquisitions, is comprised of an increase in adjusted admissions of 12.9% and an increase in net
patient revenue per adjusted admission of 1.4%.
Net adjustments to estimated third-party payor settlements, also known as prior year
contractuals, resulted in an increase in acute care revenue of $2.2 million and $4.7 million for
the nine months ended June 30, 2011 and 2010, respectively.
Salaries and benefits Salaries and benefits expense for the nine months ended June 30, 2011,
was $581.6 million, or 38.8% of acute care revenue, compared to $500.3 million, or 38.2% 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. Also, 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 our recent acquisitions, which
contributed an increase of 0.2%, and 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 nine months ended June 30, 2011, was $237.3 million, or
15.8% of acute care revenue, compared to $200.0 million, or 15.3% 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 nine months ended June 30, 2011,
were $295.9 million, or 19.8% of acute care revenue, compared to $248.4 million, or 19.0% 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. The remaining increase in our other operating expenses
as a percentage of acute care revenue is primarily due to our recent acquisitions.
Provision for bad debts Provision for bad debts for the nine months ended June 30, 2011, was
$175.1 million, or 11.7% of acute care revenue, compared to $142.9 million, or 10.9% of acute care
revenue in the prior year period. The increase in our provision for bad debts as a percentage of
acute care revenue is due to an increase in self-pay volume and revenue, including related
acuity levels, which have resulted primarily from patient decisions to defer non-emergent healthcare needs as
a result of economic pressures and high unemployment.
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Health Choice
The following table and discussion sets forth, for the periods presented, the results of our
Health Choice operations expressed in dollar terms and as a percentage of premium revenue. Such
information has been derived from our unaudited condensed consolidated statements of operations.
Quarter Ended | Quarter Ended | Nine Months Ended | Nine Months Ended | |||||||||||||||||||||||||||||
June 30, 2011 | June 30, 2010 | June 30, 2011 | June 30, 2010 | |||||||||||||||||||||||||||||
($ in thousands) | Amount | Percentage | Amount | Percentage | Amount | Percentage | Amount | Percentage | ||||||||||||||||||||||||
Premium revenue |
||||||||||||||||||||||||||||||||
Premium revenue |
$ | 188,765 | 100.0 | % | $ | 199,777 | 100.0 | % | $ | 580,917 | 100.0 | % | $ | 591,022 | 100.0 | % | ||||||||||||||||
Costs and expenses |
||||||||||||||||||||||||||||||||
Salaries and benefits |
5,275 | 2.8 | % | 4,866 | 2.4 | % | 15,471 | 2.7 | % | 14,405 | 2.4 | % | ||||||||||||||||||||
Supplies |
61 | 0.0 | % | 40 | 0.0 | % | 157 | 0.0 | % | 137 | 0.0 | % | ||||||||||||||||||||
Medical claims (1) |
158,950 | 84.2 | % | 174,350 | 87.3 | % | 493,167 | 84.9 | % | 519,023 | 87.8 | % | ||||||||||||||||||||
Other operating expenses |
6,120 | 3.2 | % | 6,128 | 3.1 | % | 19,341 | 3.3 | % | 18,474 | 3.2 | % | ||||||||||||||||||||
Rentals and leases |
396 | 0.3 | % | 417 | 0.2 | % | 1,238 | 0.2 | % | 1,153 | 0.2 | % | ||||||||||||||||||||
Depreciation and
amortization |
887 | 0.5 | % | 892 | 0.5 | % | 2,669 | 0.5 | % | 2,669 | 0.5 | % | ||||||||||||||||||||
Total costs and expenses |
171,689 | 91.0 | % | 186,693 | 93.5 | % | 532,043 | 91.6 | % | 555,861 | 94.1 | % | ||||||||||||||||||||
Earnings before income taxes |
$ | 17,076 | 9.0 | % | $ | 13,084 | 6.5 | % | $ | 48,874 | 8.4 | % | $ | 35,161 | 5.9 | % | ||||||||||||||||
(1) | Medical claims paid to our hospitals of $3.1 million and $2.3 million for the quarters ended June 30, 2011 and 2010, respectively, and $8.5 million and $8.3 million for the nine months ended June 30, 2011 and 2010, respectively, are eliminated in our consolidated results. |
Quarters Ended June 30, 2011 and 2010
Premium revenue Premium revenue was $188.8 million for the quarter ended June 30, 2011, a
decrease of $11.0 million or 5.5%, compared to $199.8 million in the prior year quarter. The
decline in premium revenue is primarily due to a 5.0% reduction in capitation rates in our Medicaid
product line, as a result of the provider cuts implemented by AHCCCS on April 1, 2011, and a 1.5%
decline in related member months, compared to the prior year quarter.
Medical claims Medical claims expense was $159.0 million for the quarter ended June 30,
2011, compared to $174.4 million in the prior year quarter. Medical claims expense as a percentage
of premium revenue was 84.2% for the quarter ended June 30, 2011, compared to 87.3% 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,
AHCCCS provider payment reductions, and improvements in care management and other operational
initiatives.
Nine Months Ended June 30, 2011 and 2010
Premium revenue Premium revenue was $580.9 million for the nine months ended June 30, 2011,
a decrease of $10.1 or 1.7%, compared to $591.0 million in the prior year period. The decline in
premium revenue is primarily due to a 5.0% reduction in capitation rates in our Medicaid product
line, as a result of the provider cuts implemented by AHCCCS on April 1, 2011, and a 1.6% decline
in related member months, compared to the prior year period.
Medical claims Medical claims expense was $493.2 million for the nine months ended June 30,
2011, compared to $519.0 million in the prior year period. Medical claims expense as a percentage
of premium revenue was 84.9% for the nine months ended June 30, 2011, compared to 87.8% 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, AHCCCS provider payment reductions, and improvements in care management and other
operational initiatives.
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LIQUIDITY AND CAPITAL RESOURCES
Overview of Cash Flow Activities for the Nine Months Ended June 30, 2011 and 2010
Our cash flows are summarized as follows (in thousands):
Nine Months | ||||||||
Ended June 30, | ||||||||
2011 | 2010 | |||||||
Cash flows from operating activities |
$ | 96,652 | $ | 113,915 | ||||
Cash flows from investing activities |
$ | (218,368 | ) | $ | (51,559 | ) | ||
Cash flows from financing activities |
$ | 121,800 | $ | (138,724 | ) |
Operating Activities
Operating cash flows decreased $17.3 million for the nine months ended June 30, 2011,
compared to the prior year period. Our operating cash
flows have been impacted by delays in payments from Medicaid and
managed care organizations, as such payors implement administrative
delays, including increased efforts related to utilization reviews.
At June 30, 2011, we had $229.7 million in net working capital, compared to $134.5 million at
September 30, 2010. Net accounts receivable increased $86.7 million to $295.8 million at June 30,
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 Brim and St.
Joseph acquisitions. Excluding
the impact of the Brim and St. Joseph acquisitions, our days revenue in accounts receivable at June 30, 2011, were
47, compared to 43 at September 30, 2010, and 45 at June 30, 2010.
Investing Activities
Capital expenditures for the nine months ended June 30, 2011, were $64.5 million, compared to
$53.5 million in the prior year period.
During
the nine months ended June 30, 2011, we paid $155.4 million
for acquisitions, which included the acquisition of St. Joseph.
Financing Activities
During the nine months ended June 30, 2011, we completed our Refinancing which resulted in
proceeds totaling $1.812 billion, net of creditors fees, original issue discounts and other
transaction costs totaling $62.6 million. The Refinancing proceeds were used to repay $567.3
million in our then existing senior secured credit facilities and repurchase our $475.0 million
aggregate principal amount of 8 3/4% senior subordinated notes due 2014, including $9.9 million in
redemption premiums.
Also, as part of the Refinancing, we distributed
$632.9 million to IAS, which is comprised of $402.9 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.
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.
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Capital Resources
As of June 30, 2011, we had the following debt arrangements:
| $1.325 billion senior secured credit facilities; and |
| $850.0 million in 8.375% senior notes due 2019. |
At June 30, 2011, amounts outstanding under our senior secured credit facilities consisted of
$1.022 billion in term loans. In addition, we had $85.2 million in letters of credit outstanding
under the revolving credit facility. The weighted average interest rate of
outstanding borrowings under the senior secured credit facilities was 4.4% and 3.8% for the quarter
and nine months ended June 30, 2011, respectively.
$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 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 at the closing of the
Refinancing, 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 Senior Secured Credit Facilities, we will be required to pay a commitment fee
on the unutilized commitments under the senior secured revolving credit facility, as
well as pay customary letter of credit fees and agency fees.
The 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.
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 certain restrictive 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 Senior Secured Credit
Facilities, cross-defaults, certain bankruptcy events and certain change of control events.
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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 Senior 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 Senior Secured
Credit Facilities (the Notes Guarantors) (the Indenture). The Indenture provides that the
Senior Notes are general unsecured, senior obligations of the Issuers, and initially will be
unconditionally guaranteed on a senior unsecured basis.
The Senior Notes bear interest at a rate of 8.375% per annum and will accrue from May 3, 2011.
Interest on the Senior 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 Senior 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 Senior 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 Senior 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 Senior 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 Senior Notes to be due and payable immediately. If
we experience certain kinds of changes of control, we must offer to purchase the Senior 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 Senior 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 Senior
Secured Credit Facilities and Senior Notes as of the date of this filing:
Moodys | Standard & Poors | |||||||
Corporate credit |
B2 | B | ||||||
Senior secured term loan facility |
Ba3 | B | ||||||
Senior secured revolving credit facility |
Ba3 | BB- | ||||||
8.375% senior notes due 2019 |
Caa1 | CCC+ | ||||||
Outlook |
Stable | Stable |
Other
As of June 30, 2011, we are a party to interest rate swap agreements with Citibank, N.A.
(Citibank) and Wells Fargo Bank, N.A. (Wells
Fargo) (formerly Wachovia Bank, N.A.), as counterparties, with notional amounts
totaling $200.0 million, in an effort to manage our 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.
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Capital Expenditures
We plan to finance our proposed capital expenditures with cash generated from operations,
borrowings under our Senior Secured Credit Facilities and other capital sources that may become
available. We expect our capital expenditures for fiscal 2011 to be approximately $95.0 million,
including the following significant expenditures:
| $25.0 million to $30.0 million for growth and new business projects; |
| $35.0 million to $40.0 million in replacement or maintenance related projects at our hospitals; and |
| $25.0 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, federal and state budget
initiatives, 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, leverage capacity 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 June 30, 2011, we have available liquidity as follows (in
millions):
Cash and cash equivalents |
$ | 144.6 | ||
Available capacity under our senior secured revolving credit facility |
214.8 | |||
Net available liquidity at June 30, 2011 |
$ | 359.4 | ||
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.
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 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 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.
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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.
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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 June 30, 2011, the following components of
our Senior Secured Credit Facilities bear interest at variable rates at specified margins above
either the agent banks alternate base rate or the LIBOR rate: (i) a $1.025 billion, seven-year
term loan; and (ii) a $300.0 million, five-year revolving credit facility. As of June 30, 2011, we
had outstanding variable rate debt of $1.022 billion.
We have managed our market exposure to changes in interest rates by converting $200.0 million
of our 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 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 Wells Fargo. However, we do not anticipate non-performance by Citibank or Wells Fargo.
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 current interest rates would
have no estimated impact on
pre-tax earnings and cash flows for the next twelve month period
given the 1.25% LIBOR floor that exists in our Senior Secured Credit
Facilities.
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 senior secured
revolving credit facility. Our ability to borrow funds under our 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
June 30, 2011. Based on this
evaluation, the principal executive officer and principal accounting officer concluded that our
disclosure controls and procedures are effective in timely alerting them to material information
required to be included in our periodic reports.
Changes in Internal Control Over Financial Reporting
During the period covered by this report, there has been no change in our internal control
over financial reporting that has materially affected or is reasonably likely to materially affect
our internal control over financial reporting.
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PART II. OTHER INFORMATION
Item 1. | Legal Proceedings |
On March 31, 2008, the United States District Court for the District of Arizona (District
Court) dismissed with prejudice the qui tam complaint against IAS, our parent company. The qui tam
action sought monetary damages and civil penalties under the federal False Claims Act (FCA) and
included allegations that certain business practices related to physician relationships and the
medical necessity of certain procedures resulted in the submission of claims for reimbursement in
violation of the FCA. The case dates back to March 2005 and became the subject of a subpoena by the
Office of Inspector General in September 2005. In August 2007, the case was unsealed and the U.S.
Department of Justice (DOJ) declined to intervene. The District Court dismissed the case from the
bench at the conclusion of oral arguments on IAS motion to dismiss. On April 21, 2008, the
District Court issued a written order dismissing the case with prejudice and entering formal
judgment for IAS and denying as moot IAS motions related to the relators misappropriation of
information subject to a claim of attorney-client privilege by IAS. Both parties appealed. On
August 12, 2010, United States Court of Appeals for the Ninth Circuit reversed the District Courts
dismissal of the qui tam complaint and the District Courts denial of IAS motions concerning the
relators misappropriation of documents and ordered that the qui tam relator be allowed leave to
file a Third Amended Complaint and for the District Court to consider IAS motions concerning the
relators misappropriation of documents. The District Court ordered the qui tam relator to file his
Third Amended Complaint by November 22, 2010, and set a schedule for the filing of motions related
to the relators misappropriation of documents. On October 20, 2010, the qui tam relator filed a
motion to transfer this action to the United States District Court for the Eastern District of
Texas. On November 22, 2010, the relator filed his Third Amended Complaint. On January 3, 2011, IAS
filed its renewed motion for sanctions concerning the relators misappropriation of documents and,
on January 14, 2011, IAS filed its motion to dismiss the relators Third Amended Complaint. On May
4, 2011, the District Court in Arizona heard oral arguments on all pending motions, including IAS
motion to dismiss and renewed motions for sanctions and the relators motion to transfer the action
to the United States District Court for the Eastern District of Texas. On June 1, 2011, the
District Court in Arizona issued a written order dismissing the relators Third Amended Complaint
with prejudice. The order also denied the relators motion to transfer the case to the Eastern
District of Texas, finding that the relator was attempting to engage in forum shopping, and
denied the relators request for leave to further amend the complaint. The District Court
expressly reserved decision on the collateral issue of sanctions against the relator and,
preliminary to further briefing on IAS pending motion for sanctions, directed the
relator to return all documents withheld to IAS within 20 days. IAS continues its vigorous pursuit
of sanctions and other remedies against the relator related to the misappropriation and misuse of
information subject to a claim of attorney-client privilege by IAS. Oral argument on IAS
pending motion for sanctions currently is set for August 26, 2011. The District Courts dismissal
of this lawsuit with prejudice is appealable and the relator filed a notice of appeal on June 28,
2011. While the District Courts order in favor of IAS should effectively bring to an end the
relators qui tam litigation in the District Court that has been pending since March 2005, if the
appeal of the District Courts ruling was resolved in a manner unfavorable to IAS, it could have a
material adverse effect on our business, financial condition and results of operations, including
exclusion from the Medicare and Medicaid programs. In addition, we may incur material fees,
costs and expenses in connection with defending the qui tam action.
Our facilities obtain clinical and administrative services from a variety of vendors. One
vendor, a medical practice that furnished cardiac catheterization services under contractual
arrangements at Mesa General Hospital and St. Lukes Medical Center through March 31, 2008 and May
31, 2008, respectively, asserted that, because of deferred fee
adjustments that it claims were due
under these arrangements, it was 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 we had accrued, 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 we proposed. The arbitration panel rendered its
judgment on the fair market value of the vendors services at a point between the amounts the two
parties argued were owed. On July 22, 2011, we paid $15.0 million to discharge the liability
resulting from the arbitration panels decision, which includes all amounts required to be paid
with respect to the fair market value compensation for services rendered by the vendor,
pre-judgment interest and its attorneys fees, but excludes consideration of amounts that may be
recoverable by us from our insurance carrier with respect to our
attorneys fees above our insurance
limits. The payment of this claim brings this arbitration dispute to a final resolution.
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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) from 2003 through November 2010. 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.
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PART II. OTHER INFORMATION
Item 6. | Exhibits |
(a) List of Exhibits:
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. | ||
101 | The following financial information from our quarterly report on Form 10-Q for the quarter ended June 30, 2011, filed with the SEC on August 15, 2011, formatted in Extensible Business Reporting Language (XBRL): (i) the condensed consolidated balance sheets at June 30, 2011 and September 30, 2010, (ii) the condensed consolidated statements of operations for the quarters and nine months ended June 30, 2011 and 2010, (iii) the condensed consolidated statement of equity, (iv) the condensed consolidated statements of cash flows for the nine months ended June 30, 2011 and 2010, and (v) the notes to the condensed consolidated financial statements (tagged as blocks of text). (1) |
(1) | The XBRL related information in Exhibit 101 to this quarterly report on Form 10-Q shall not be deemed filed for purposes of Section 18 of the Securities Exchange Act of 1934, as amended, or otherwise subject to liability of that section and shall not be incorporated by reference into any filing or other document pursuant to the Securities Act of 1933, as amended, except as shall be expressly set forth by specific reference in such filing or document. |
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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: August 15, 2011 | By: | /s/ John M. Doyle | ||
John M. Doyle | ||||
Chief Financial Officer |
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EXHIBIT INDEX
Exhibit No. | Description | |
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. | |
101
|
The following financial information from our quarterly report on Form 10-Q for the quarter ended June 30, 2011, filed with the SEC on August 15, 2011, formatted in Extensible Business Reporting Language (XBRL): (i) the condensed consolidated balance sheets at June 30, 2011 and September 30, 2010, (ii) the condensed consolidated statements of operations for the quarters and nine months ended June 30, 2011 and 2010, (iii) the condensed consolidated statement of equity, (iv) the condensed consolidated statements of cash flows for the nine months ended June 30, 2011 and 2010, and (v) the notes to the condensed consolidated financial statements (tagged as blocks of text). (1) |
(1) | The XBRL related information in Exhibit 101 to this quarterly report on Form 10-Q shall not be deemed filed for purposes of Section 18 of the Securities Exchange Act of 1934, as amended, or otherwise subject to liability of that section and shall not be incorporated by reference into any filing or other document pursuant to the Securities Act of 1933, as amended, except as shall be expressly set forth by specific reference in such filing or document. |
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