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EX-31.1 - EXHIBIT 31.1 - IASIS Healthcare LLCc20661exv31w1.htm
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Table of Contents

 
 
UNITED STATES
SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
FORM 10-Q
(Mark One)
     
þ   QUARTERLY REPORT PURSUANT TO SECTION 13 OR 15(d) OF THE SECURITIES EXCHANGE ACT OF 1934
For the quarterly period ended 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
(Registrant’s telephone number, including area code)
Not Applicable
(Former name, former address and former fiscal year, if changed since last report)
Indicate by check mark whether the registrant (1) has filed all reports required to be filed by Section 13 or 15(d) of the Securities Exchange Act of 1934 during the preceding 12 months (or for such shorter period that the registrant was required to file such reports), and (2) has been subject to such filing requirements for the past 90 days. YES þ NO o
Indicate by check mark whether the registrant has submitted electronically and posted on its corporate Web site, if any, every Interactive Data File required to be submitted and posted pursuant to Rule 405 of Regulation S-T (§232.405 of this chapter) during the preceding 12 months (or for such shorter period that the registrant was required to submit and post such files). YES 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 registrant’s common interests outstanding (all of which are privately owned and are not traded on any public market) were owned by IASIS Healthcare Corporation, its sole member.
 
 

 

 


 

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 Exhibit 31.1
 Exhibit 31.2
 EX-101 INSTANCE DOCUMENT
 EX-101 SCHEMA DOCUMENT
 EX-101 CALCULATION LINKBASE DOCUMENT
 EX-101 LABELS LINKBASE DOCUMENT
 EX-101 PRESENTATION LINKBASE DOCUMENT
 EX-101 DEFINITION LINKBASE DOCUMENT

 

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PART I.
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
               
Member’s 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.

 

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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.

 

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IASIS HEALTHCARE LLC
CONDENSED CONSOLIDATED STATEMENT OF EQUITY (UNAUDITED)
(In Thousands)
                                    
    Non-controlling                      
    Interests with             Non-        
    Redemption     Member’s     controlling        
    Rights     Equity     Interests     Total Equity  
 
                               
Balance at September 30, 2010
  $ 72,112     $ 702,135     $ 10,371     $ 712,506  
Net earnings
    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.

 

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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.

 

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IASIS HEALTHCARE LLC
NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (UNAUDITED)
1. ORGANIZATION AND BASIS OF PRESENTATION
The unaudited condensed consolidated financial statements as of and for the quarters and 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 Company’s sole member and parent company is IASIS Healthcare Corporation (“Holdings” or “IAS”).
IASIS owns and operates medium-sized acute care hospitals in high-growth urban and suburban markets. At 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 Company’s Annual Report on Form 10-K for the fiscal year ended September 30, 2010.
In the opinion of management, the accompanying unaudited condensed consolidated financial statements contain all material adjustments (consisting of normal recurring items) necessary for a fair presentation of results for the interim periods presented. The results of operations for any interim period are not necessarily indicative of results for the full year.
Principles of Consolidation
The unaudited condensed consolidated financial statements include all subsidiaries and entities under common control of the Company. Control is generally defined by the Company as ownership of a majority of the voting interest of an entity. In addition, control is demonstrated in most instances when the Company is the sole general partner in a limited partnership. Significant intercompany transactions have been eliminated.
Use of Estimates
The preparation of the financial statements in conformity with GAAP requires management to make estimates and assumptions that affect the amounts reported in the accompanying unaudited condensed consolidated financial statements and 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 Company’s total assets or total liabilities and equity.

 

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IASIS HEALTHCARE LLC
NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (UNAUDITED)
General and Administrative
The majority of the Company’s expenses are “cost of revenue” items. Costs that could be classified as “general and administrative” by the Company would include the IASIS corporate office costs, which were $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 Company’s then existing credit facilities; fund a cash tender offer to repurchase any and all of the Company’s $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.

 

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IASIS HEALTHCARE LLC
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 Company’s option, either (1) a base rate (the “base rate”) determined by reference to the highest of (a) the federal funds rate plus 0.50%, (b) the prime rate of Bank of America, N.A. and (c) a one-month LIBOR rate, subject to a floor of 1.25%, plus 1.00%, in each case, plus a margin of 2.75% per annum or (2) the LIBOR rate for the interest period relevant to such borrowing, subject to a floor of 1.25%, plus a margin of 3.75% per annum. Borrowings under the senior secured revolving credit facility generally bear interest at a rate per annum equal to, at the Company’s option, either (1) the base rate plus a margin of 2.50% per annum, or (2) the LIBOR rate for the interest period relevant to such borrowing plus a margin of 3.50% per annum. In addition to paying interest on outstanding principal under the 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 Company’s assets and the assets of the Credit Facility Guarantors, including (1) a pledge of 100% of the equity interests of the Company and the Credit Facility Guarantors, (2) mortgage liens on all of the Company’s material real property and that of the Credit Facility Guarantors, and (3) all proceeds of the foregoing.
The Restated Credit Agreement requires the Company to mandatorily prepay borrowings under the senior secured term loan facility with net cash proceeds of certain asset dispositions, following certain casualty events, following certain borrowings or debt issuances, and from a percentage of annual excess cash flow.
The Restated Credit Agreement contains 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.

 

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IASIS HEALTHCARE LLC
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 Company’s (and its restricted subsidiaries’) ability to, among other things: (1) incur additional indebtedness or liens or issue disqualified stock or preferred stock; (2) pay dividends or make other distributions on, redeem or repurchase the Company’s capital stock; (3) sell certain assets; (4) make certain loans and investments; (5) enter into certain transactions with affiliates; (5) impose restrictions on the ability of a subsidiary to pay dividends or make payments or distributions to the Company and its restricted subsidiaries; and (6) consolidate, merge or sell all or substantially all of the Company’s assets. These covenants are subject to a number of important limitations and exceptions.
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)
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 Company’s variable rate debt. Accordingly, a gain resulting from the $695,000 change in fair value of the Company’s 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 Company’s 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 Company’s interest rate swaps reflects a liability because the effect of the forward LIBOR curve on future interest payments results in less interest due to the Company under the variable rate component included in the interest rate swap agreements, as compared to the amount due the Company’s counterparties under the fixed interest rate component. Any change in the fair value of the Company’s interest rate swaps, net of income taxes, from inception to March 31, 2011, is included in accumulated other comprehensive loss as a component of member’s 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)
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 Company’s third-party valuation of acquired assets has been finalized, and the appropriate fair values have been reflected in the accompanying unaudited condensed consolidated balance sheet 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 Company’s cash flow hedge being deemed ineffective during the quarter ended June 30, 2011, the change in fair value of the Company’s 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 Company’s 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)
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 Company’s excess cash on hand. The cancellation of the rollover options, which were associated with the Company’s 2004 recapitalization, resulted in the Company recognizing $2.0 million in stock-based compensation during the quarter ended March 31, 2010.
8. COMMITMENTS AND CONTINGENCIES
Net Revenue
The calculation of appropriate payments from the Medicare and Medicaid programs, as well as terms governing agreements with other third-party payors, is complex and subject to interpretation. Final determination of amounts earned under the Medicare and Medicaid programs often occurs subsequent to the year in which services are rendered because of audits by the programs, rights of appeal and the application of numerous technical provisions. In the opinion of management, adequate provision has been made for adjustments that may result from such routine audits and appeals.
Professional, General and Workers’ Compensation Liability Risks
The Company is subject to claims and legal actions in the ordinary course of business, including but not limited to claims relating to patient treatment and personal injuries. To cover these types of claims, the Company maintains professional and general liability insurance in excess of self-insured retentions through a commercial insurance carrier in amounts that the Company believes to be sufficient for its operations, although, potentially, some claims may exceed the scope of coverage in effect. Plaintiffs in these matters may request punitive or other damages that may not be covered by insurance. The Company is currently not a party to any such proceedings that, in the Company’s opinion, would have a material adverse effect on the Company’s business, financial condition or results of operations. The Company expenses an estimate of the costs it expects to incur under the self-insured retention exposure for professional and general liability claims using historical claims data, demographic factors, severity factors, current incident logs and other actuarial analysis. At June 30, 2011 and September 30, 2010, the Company’s 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 Company’s independent actuary for professional and general liability losses resulted in a change in related estimates for prior periods which increased insurance expense by $948,000 during the 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 Company’s independent actuary for workers’ compensation losses resulted in a change in related estimates for prior periods which increased benefits expense by $1.2 million 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)
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 Choice’s obligations under its contract to provide and pay for the healthcare services. The amount of the performance guaranty is generally based, in part, upon the membership in the Plan and the related capitation revenue paid to Health Choice.
Acquisitions
The Company has acquired and in the future may choose to acquire businesses with prior operating histories. Such businesses may have unknown or contingent liabilities, including liabilities for failure to comply with healthcare laws and regulations, such as billing and reimbursement, fraud and abuse and similar anti-referral laws. Although the Company has procedures designed to conform business practices to its policies following the completion of any acquisition, there can be no assurance that the Company will not become liable for previous activities of prior owners that may later be asserted to be improper by private plaintiffs or government agencies. Although the Company generally seeks to obtain indemnification from prospective sellers covering such matters, there can be no assurance that any such matter will be covered by indemnification, or if covered, that such indemnification will be adequate to cover potential losses and fines.
Other
On March 31, 2008, the United States District Court for the District of Arizona (“District Court”) dismissed with prejudice the qui tam complaint against IAS, our parent company. The qui tam action sought monetary damages and civil penalties under the federal False Claims Act (“FCA”) and included allegations that certain business practices related to physician relationships and the medical necessity of certain procedures resulted in the submission of claims for reimbursement in violation of the FCA. The case dates back to March 2005 and became the subject of a subpoena by the Office of Inspector General in September 2005. In August 2007, the case was unsealed and the U.S. Department of Justice (“DOJ”) declined to intervene. The District Court dismissed the case from the bench at the conclusion of oral arguments on IAS’ motion to dismiss. On April 21, 2008, the District Court issued a written order dismissing the case with prejudice and entering formal judgment for IAS and denying as moot IAS’ motions related to the relator’s misappropriation of information subject to a claim of attorney-client privilege by IAS. Both parties appealed. On August 12, 2010, United States Court of Appeals for the Ninth Circuit reversed the District Court’s dismissal of the qui tam complaint and the District Court’s denial of IAS’ motions concerning the relator’s misappropriation of documents and ordered that the qui tam relator be allowed leave to file a Third Amended Complaint and for the District Court to consider IAS’ motions concerning the relator’s misappropriation of documents. The District Court ordered the qui tam relator to file his Third Amended Complaint by November 22, 2010, and set a schedule for the filing of motions related to the relator’s misappropriation of documents. On October 20, 2010, the qui tam relator filed a motion to transfer this action to the United States District Court for the Eastern District of Texas. On November 22, 2010, the relator filed his Third Amended Complaint. On January 3, 2011, IAS filed its renewed motion for sanctions concerning the relator’s misappropriation of documents and, on January 14, 2011, IAS filed its motion to dismiss the relator’s Third Amended Complaint. On May 4, 2011, the District Court in Arizona heard oral arguments on all pending motions, including IAS’ motion to dismiss and renewed motions for sanctions and the relator’s motion to transfer the action to the United States District Court for the Eastern District of Texas. On June 1, 2011, the District Court in Arizona issued a written order dismissing the relator’s Third Amended Complaint with prejudice. The order also denied the relator’s 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 relator’s 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 Court’s dismissal of this lawsuit with prejudice is appealable and the relator filed a notice of appeal on June 28, 2011. While the District Court’s order in favor of IAS should effectively bring to an end the relator’s qui tam litigation in the District Court that has been pending since March 2005, if the appeal of the District Court’s ruling was resolved in a manner unfavorable to IAS, it could have a material adverse effect on the Company’s business, financial condition and results of operations, including exclusion from the Medicare and Medicaid programs. In addition, the Company may incur material fees, costs and expenses in connection with defending the qui tam action.

 

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IASIS HEALTHCARE LLC
NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (UNAUDITED)
The Company’s facilities obtain clinical and administrative services from a variety of vendors. One vendor, a medical practice that furnished cardiac catheterization services under contractual arrangements at Mesa General Hospital and St. Luke’s Medical Center through March 31, 2008 and May 31, 2008, respectively, 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 Company’s Motion to Compel Arbitration on the grounds that the issues are to be determined by binding arbitration. On December 24, 2010, after conducting the arbitration hearing, the arbitration panel issued its decision rejecting the fees sought by the vendor, but did not adopt the fees proposed by the Company. The arbitration panel rendered its judgment on the fair market value of the vendor’s 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 panel’s 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 Company’s 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 Company’s 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 Company’s 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 Company’s fiscal year beginning October 1, 2012, and is not expected to significantly impact the Company’s financial position, results of operations or cash flows, although it will change the presentation of the Company’s 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 Company’s fiscal year beginning October 1, 2011, with early adoption permitted, and is an accounting principle which clarifies disclosure requirements, and is not expected to significantly impact the Company’s financial statement disclosures.

 

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IASIS HEALTHCARE LLC
NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (UNAUDITED)
In December 2010, the FASB issued ASU No. 2010-28, “Intangibles—Goodwill and Other” (Topic 350): When to Perform Step 2 of the Goodwill Impairment Test for Reporting Units with Zero or Negative Carrying Amounts. ASU 2010-28 requires Step 2 of the impairment test be performed in circumstances where the carrying amount of a reporting unit is zero or negative and there are qualitative factors that indicate it is more likely than not that a goodwill impairment exists. The ASU is effective for fiscal years, and interim periods within those years, beginning after December 15, 2010. ASU 2010-28 is effective for the Company’s fiscal year beginning October 1, 2011, and is not expected to significantly impact the Company’s financial position, results of operations or cash flows.
In August 2010, the FASB issued ASU No. 2010-24, “Health Care Entities” (Topic 954): Presentation of Insurance Claims and Related Insurance Recoveries. This ASU eliminates the practice of netting claim liabilities with expected related insurance recoveries for balance sheet presentation. Claim liabilities are to be determined with no regard for recoveries and presented gross. Expected recoveries are presented separately. ASU 2010-24 is effective for fiscal years, and interim periods within those years, beginning after December 15, 2010. ASU 2010-24 is effective for the Company’s fiscal year beginning October 1, 2011, and is not expected to significantly impact the Company’s financial position, results of operations or cash flows.
In 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 Company’s fiscal year beginning October 1, 2011, and is not expected to significantly impact the Company’s financial statement disclosures.

 

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IASIS HEALTHCARE LLC
NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (UNAUDITED)
10. SEGMENT AND GEOGRAPHIC INFORMATION
The Company’s acute care hospitals and related healthcare businesses are similar in their activities and the economic environments in which they operate (i.e. urban and suburban markets). Accordingly, the Company’s reportable operating segments consist of (1) acute care hospitals and related healthcare businesses, collectively “Acute Care”, and (2) Health Choice. The following is a financial summary by business segment for the periods indicated (in thousands):
                                 
    For the Quarter Ended 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)
                                 
    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  
 
                         

 

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IASIS HEALTHCARE LLC
NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (UNAUDITED)
     
(1)   Adjusted EBITDA represents net earnings from continuing operations before interest expense, income tax expense, depreciation and amortization, stock-based compensation, gain (loss) on disposal of assets, loss on extinguishment of debt and management fees. Management fees represent monitoring and advisory fees paid to TPG, the Company’s majority financial sponsor, and certain other members of IASIS Investment LLC, majority shareholder of IAS. Management routinely calculates and communicates adjusted EBITDA and believes that it is useful to investors because it is commonly used as an analytical indicator within the healthcare industry to evaluate hospital performance, allocate resources and measure leverage capacity and debt service ability. In addition, the Company uses adjusted EBITDA as a measure of performance for its business segments and for incentive compensation purposes. Adjusted EBITDA should not be considered as a measure of financial performance under GAAP, and the items excluded from adjusted EBITDA are significant components in understanding and assessing financial performance. Adjusted EBITDA should not be considered in isolation or as an alternative to net earnings, cash flows generated by operating, investing, or financing activities or other financial statement data presented in the condensed consolidated financial statements as an indicator of financial performance or liquidity. Adjusted EBITDA, as presented, differs from what is defined under the Company’s senior secured credit facilities and may not be comparable to similarly titled measures of other companies.
11. SUPPLEMENTAL CONDENSED CONSOLIDATING FINANCIAL INFORMATION
The Senior Notes described in Note 2 are fully and unconditionally guaranteed on a joint and several basis by all of the Company’s existing domestic subsidiaries, other than non-guarantor subsidiaries which include Health Choice and the Company’s non-wholly owned subsidiaries.
Effective October 1, 2010, the operations and net assets of Wadley, 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.

 

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

 

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IASIS HEALTHCARE LLC
NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (UNAUDITED)
IASIS Healthcare LLC
Condensed Consolidating Balance Sheet
September 30, 2010
(in thousands)
                                         
            Subsidiary     Subsidiary             Condensed  
    Parent Issuer     Guarantors     Non-Guarantors     Eliminations     Consolidated  
Assets
                                       
Current assets:
                                       
Cash and cash equivalents
  $     $ 143,599     $ 912     $     $ 144,511  
Accounts receivable, net
          81,649       127,524             209,173  
Inventories
          22,793       31,049             53,842  
Deferred income taxes
    15,881                         15,881  
Prepaid expenses and other current assets
          23,577       41,763             65,340  
 
                             
Total current assets
    15,881       271,618       201,248             488,747  
 
                                       
Property and equipment, net
          351,265       634,026             985,291  
Intercompany
          (297,257 )     297,257              
Net investment in and advances to subsidiaries
    1,823,973                   (1,823,973 )      
Goodwill
    17,331       65,504       635,408             718,243  
Other intangible assets, net
                27,000             27,000  
Deposit for acquisition
          97,891                   97,891  
Other assets, net
    12,018       17,967       6,037             36,022  
 
                             
Total assets
  $ 1,869,203     $ 506,988     $ 1,800,976     $ (1,823,973 )   $ 2,353,194  
 
                             
 
                                       
Liabilities and Equity
                                       
Current liabilities:
                                       
Accounts payable
  $     $ 32,400     $ 46,531     $     $ 78,931  
Salaries and benefits payable
          19,916       18,194             38,110  
Accrued interest payable
    12,536       (3,237 )     3,237             12,536  
Medical claims payable
                111,373             111,373  
Other accrued expenses and other current liabilities
          32,326       74,288             106,614  
Current portion of long-term debt and capital lease obligations
    5,890       801       20,570       (20,570 )     6,691  
 
                             
Total current liabilities
    18,426       82,206       274,193       (20,570 )     354,255  
 
                                       
Long-term debt and capital lease obligations
    1,039,370       5,517       547,170       (547,170 )     1,044,887  
Deferred income taxes
    109,272                         109,272  
Other long-term liabilities
          59,527       635             60,162  
 
                             
Total liabilities
    1,167,068       147,250       821,998       (567,740 )     1,568,576  
 
                                       
Non-controlling interests with redemption rights
          72,112                   72,112  
 
                                       
Equity:
                                       
Member’s equity
    702,135       277,255       978,978       (1,256,233 )     702,135  
Non-controlling interests
          10,371                   10,371  
 
                             
 
                                       
Total equity
    702,135       287,626       978,978       (1,256,233 )     712,506  
 
                             
Total liabilities and equity
  $ 1,869,203     $ 506,988     $ 1,800,976     $ (1,823,973 )   $ 2,353,194  
 
                             

 

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IASIS HEALTHCARE LLC
NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (UNAUDITED)
IASIS Healthcare LLC
Condensed Consolidating Statement of Operations (unaudited)
For the Quarter Ended 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 )
 
                             

 

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IASIS HEALTHCARE LLC
NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (UNAUDITED)
IASIS Healthcare LLC
Condensed Consolidating Statement of Operations (unaudited)
For the Quarter Ended 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  
 
                             

 

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IASIS HEALTHCARE LLC
NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (UNAUDITED)
IASIS Healthcare LLC
Condensed Consolidating Statement of Operations (unaudited)
For the 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  
 
                             

 

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IASIS HEALTHCARE LLC
NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (UNAUDITED)
IASIS Healthcare LLC
Condensed Consolidating Statement of Operations (unaudited)
For the 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  
 
                             

 

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IASIS HEALTHCARE LLC
NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (UNAUDITED)
IASIS Healthcare LLC
Condensed Consolidating Statement of Cash Flows (unaudited)
For the 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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IASIS HEALTHCARE LLC
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)
                                         
            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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Item 2.   Management’s Discussion and Analysis of Financial Condition and Results of Operations
The following discussion and analysis of financial condition and results of operations should be read in conjunction with our unaudited condensed consolidated financial statements, the notes to our unaudited condensed consolidated financial statements and the other financial information appearing elsewhere in this report. Data for the quarters and 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 Choice’s contract with the AHCCCS being discontinued, significant competition from other healthcare companies and state efforts to regulate the sale of not-for-profit hospitals that may affect our ability to acquire hospitals, difficulties with the integration of acquisitions that may disrupt our ongoing operations, our dependence on key personnel, the loss of one or more of which could have a material adverse effect on our business, potential responsibilities and costs under environmental laws that could lead to material expenditures or liability, the possibility of a decline in the fair value of our reporting units that could result in a material non-cash charge to earnings, the risks and uncertainties related to our ability to generate sufficient cash to service our existing indebtedness, our substantial level of indebtedness that could adversely affect our financial condition, the possibility of an increase in interest rates, which would increase the cost of servicing our debt and could reduce profitability, risks associated with us being owned by equity sponsors who have the ability to control our financial decisions and those risks, uncertainties and other matters detailed in our Annual Report on Form 10-K for the fiscal year ended September 30, 2010, and in our subsequent filings with the Securities and Exchange Commission (the “SEC”).
Although we believe that the assumptions underlying the forward-looking statements contained in this report are reasonable, any of these assumptions could prove to be inaccurate and, therefore, there can be no assurance that the forward-looking statements included in this report will prove to be accurate. In light of the significant uncertainties inherent in the forward-looking statements included in this report, you should not regard the inclusion of such information as a representation by us or any other person that our objectives and plans will be achieved. We undertake no obligation to publicly release any revisions to any forward-looking statements contained herein to reflect events and circumstances occurring after the date hereof or to reflect the occurrence of unanticipated events.

 

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EXECUTIVE OVERVIEW
We are a leading owner and operator of medium-sized acute care hospitals in high-growth urban and suburban markets. We operate our hospitals with a strong community focus by offering and developing healthcare services targeted to the needs of the markets we serve, promoting strong relationships with physicians and working with local managed care plans. At 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.

 

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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 law’s complexity, lack of implementing regulations or interpretive guidance, gradual and potentially delayed implementation, pending efforts to repeal or amend portions of the Health Reform Law in the United States Congress and ongoing federal court cases challenging the constitutionality of the Health Reform Law, the impact of the Health Reform Law, including how individuals and businesses will respond to the new choice afforded them, is not yet fully known.
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 state’s 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 women’s services, which are utilized by a majority of the Medicaid patients we serve at our Texas hospitals.

 

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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 state’s fiscal 2012 budget legislation, which includes another 5% cut to provider reimbursement effective October 1, 2011, and a reduction of approximately 160,000 eligible Medicaid beneficiaries, 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 Arizona’s 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 state’s 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 Arizona’s Medicaid program. The contract requires Health Choice to arrange for healthcare services for enrolled Medicaid patients in exchange for fixed monthly premiums, based upon negotiated per capita member rates, and supplemental payments from AHCCCS. Health Choice also contracts with CMS to provide coverage as a Medicare Advantage Prescription Drug (“MAPD”) Special Needs Plan (“SNP”). This contract allows Health Choice to offer Medicare and Part D drug benefit coverage to new and existing dual-eligible members (i.e., those that are eligible for Medicare and Medicaid). Effective for this 2011 plan year, SNPs are required to meet additional CMS requirements, including requirements relating to model of care, cost-sharing, disclosure of information and reporting of quality measures.

 

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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 Management’s Discussion and Analysis of Financial Condition and Results of Operations in our Annual Report on Form 10-K for the fiscal year ended September 30, 2010. There have been no changes in the nature of our critical accounting policies or the application of those policies since September 30, 2010.
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. Luke’s Behavioral Hospital.
 
(2)   Represents the average number of days that a patient stayed in our hospitals.
 
(3)   Represents the total number of patients admitted to our hospitals for stays in excess of 23 hours. Management and investors use this number as a general measure of inpatient volume.
 
(4)   Adjusted admissions and adjusted patient days are general measures of combined inpatient and outpatient volume. We compute adjusted admissions/patient days by multiplying admissions/patient days by gross patient revenue and then dividing that number by gross inpatient revenue.
 
(5)   Represents the number of days our beds were occupied by inpatients over the period.
 
(6)   Excludes the impact of the Brim acquisition, which was effective October 1, 2010, and the St. Joseph acquisition, which was effective May 1, 2011.
 
(7)   Represents members eligible for Medicare and Medicaid benefits under Health Choice’s contract with CMS to provide coverage as a MAPD SNP.
 
(8)   Represents medical claims expense as a percentage of premium revenue, including claims paid to our hospitals.

 

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RESULTS OF OPERATIONS SUMMARY
Consolidated
The following table sets forth, for the periods presented, our results of consolidated operations expressed in dollar terms and as a percentage of net revenue. Such information has been derived from our unaudited condensed consolidated statements of operations.
                                                                 
    Quarter Ended     Quarter Ended     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:
                 
    Moody’s     Standard & Poor’s  
Corporate credit
  B2   B
Senior secured term loan facility
  Ba3   B
Senior secured revolving credit facility
  Ba3   BB-
8.375% senior notes due 2019
  Caa1   CCC+
 
               
Outlook
  Stable   Stable
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 bank’s 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 relator’s misappropriation of information subject to a claim of attorney-client privilege by IAS. Both parties appealed. On August 12, 2010, United States Court of Appeals for the Ninth Circuit reversed the District Court’s dismissal of the qui tam complaint and the District Court’s denial of IAS’ motions concerning the relator’s misappropriation of documents and ordered that the qui tam relator be allowed leave to file a Third Amended Complaint and for the District Court to consider IAS’ motions concerning the relator’s misappropriation of documents. The District Court ordered the qui tam relator to file his Third Amended Complaint by November 22, 2010, and set a schedule for the filing of motions related to the relator’s misappropriation of documents. On October 20, 2010, the qui tam relator filed a motion to transfer this action to the United States District Court for the Eastern District of Texas. On November 22, 2010, the relator filed his Third Amended Complaint. On January 3, 2011, IAS filed its renewed motion for sanctions concerning the relator’s misappropriation of documents and, on January 14, 2011, IAS filed its motion to dismiss the relator’s Third Amended Complaint. On May 4, 2011, the District Court in Arizona heard oral arguments on all pending motions, including IAS’ motion to dismiss and renewed motions for sanctions and the relator’s motion to transfer the action to the United States District Court for the Eastern District of Texas. On June 1, 2011, the District Court in Arizona issued a written order dismissing the relator’s Third Amended Complaint with prejudice. The order also denied the relator’s 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 relator’s 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 Court’s dismissal of this lawsuit with prejudice is appealable and the relator filed a notice of appeal on June 28, 2011. While the District Court’s order in favor of IAS should effectively bring to an end the relator’s qui tam litigation in the District Court that has been pending since March 2005, if the appeal of the District Court’s 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. Luke’s 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 vendor’s 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 panel’s 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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