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8-K - 8-K - 21st Century Oncology Holdings, Inc.a12-6727_18k.htm

Exhibit 99.1

 

 

RADIATION THERAPY SERVICES HOLDINGS, INC.

 

Contact:

Bryan J. Carey

Chief Financial Officer

(239) 931-7281

BCarey@rtsx.com

Investors:

Amy Glynn / Nick Laudico

The Ruth Group

646-536-7023 / 7030

aglynn@theruthgroup.com

nlaudico@theruthgroup.com

 

RADIATION THERAPY SERVICES REPORTS PRELIMINARY FOURTH QUARTER AND YEAR ENDED 2011 FINANCIAL RESULTS

 

Fourth Quarter 2011 Highlights:

 

·                  Total company pro forma revenues grew by 23. 3% to $171.2 million

·                  Domestic same practice treatments per day increased 3.0%

·                  International treatments increased 13.6%

·                  Pro Forma Adjusted EBITDA of $28.8 million

 

Full Year 2011 Business Highlights

 

·                  Completed strategic acquisitions in Argentina, Redding, CA and Goldsboro, NC, further building market presence

·                  Obtained CONs in attractive markets of Conway, SC and Asheville, NC

·                  Increased revolver by $50 million and amended Senior Credit Facility to support continued growth

·                  Appointed Bryan J. Carey as permanent Chief Financial Officer

·                  Implemented strategies to partially offset reductions in 2012 reimbursement

·                  Pro Forma Adjusted EBITDA of $122.8 million

 

FORT MYERS, FL, March 7, 2012 — Radiation Therapy Services Holdings, Inc (“the Company”), a leading operator of radiation therapy centers, today announced preliminary financial results for the fourth quarter and year ended December 31, 2011.

 

Dr. Daniel Dosoretz, President and Chief Executive Officer, said, “During the fourth quarter, we saw a continued trend of improving volumes, with domestic same practice treatments per day up 3.0%.  This increase reflects a continued rebound in services in some of our key markets, such as Florida and Michigan, as well as the impact of our marketing initiatives.  The 13.1% increase in same practice RVUs per day also reflects our continuing mix shift towards more clinically appropriate and sophisticated radiation oncology services.”

 



 

“Over the past several years, we have made strategic investments in our infrastructure across management, technology development, marketing, billing, finance and IT, as we build a better platform that we believe will allow us to expand our leadership position and drive growth over the long-term. Additionally, we continued to execute our strategy to strengthen our integrated approach to cancer care.  Acquisitions remain an important part of our expansion and our acquisition pipeline remains strong with both small and mid-sized opportunities.  Importantly, the acquisitions that we completed during 2011, in Argentina, California and North Carolina, continue to exceed our expectations. Our Medical Developers operations in Latin America grew fourth quarter revenues by over $15.0 million, or 28.2%, on a year-over-year basis.  These results reflect the robust Latin American radiation oncology market, successful ramp-up of operations at new centers and our ability to integrate advanced technology developed in the U.S. to these emerging markets.”

 

“Looking ahead at 2012, we continue to evaluate and implement initiatives to partially offset the rate reductions mandated by the CMS Physician Fee Schedule Final Rule for 2012, which was announced in November.  In addition to these strategies and our growth initiatives, we expect that the continued diversification of our global payor base through expanded Latin American operations will also help to mitigate the rate reduction. We continue to be the leader in the radiation therapy market and remain focused on accelerating delivery of the most advanced care in the world to the patients and communities we serve,” concluded Dr. Dosoretz.

 

Recent Developments

 

In line with Radiation Therapy’s goal to provide its patients with the highest quality of care, the Company has conducted primary research to determine what factors are most important to its patient population. The key finding was that patients prefer Radiation Therapy centers due to the superior patient experience.  In efforts to reinforce this superior patient experience, Radiation Therapy is currently in the process of a significant rebranding initiative.  The rebranding also supports the Company’s strategic expansion into different specialties that will enable them to provide patients with an integrated approach to cancer care, and improved outcomes.

 

Fourth Quarter 2011 Results

 

Total pro forma revenues for the fourth quarter were $171.2 million, an increase of 23.3% compared to $138.9 million in pro forma revenues in the same quarter of 2010. The increase in revenue was principally due to $20.4 million in revenues from the March 2011 acquisition of Medical Developers, LLC (“Medical Developers”), which operates 30 physician practices in Latin America.

 

Domestic same practice treatments per day increased 3.0% in the fourth quarter 2011, reflecting improving volumes, compared to the prior year period.  Domestic same practice therapy revenue per treatment increased by 1.7% from the fourth quarter of 2010, primarily due to the mix shift towards more clinically appropriate and sophisticated radiation oncology services, which resulted in an increase in Relative Value Units (“RVUs”), partially offset by a reduction in the conversion factor for fiscal year 2011.

 



 

Total RVUs per day at same practice domestic freestanding centers increased 13.1% in the fourth quarter versus the same period of the prior year principally as a result of an increase in RVU values heading into 2011 and a mix shift towards more advanced sophisticated radiation oncology services.

 

Adjusted earnings before interest, taxes, depreciation, amortization, stock-based compensation and other non-cash and pro forma items (“Pro Forma Adjusted EBITDA”) in the fourth quarter of 2011 was $28.8 million, or 16.8% of total pro forma revenues, compared to $28.9 million, or 20.8% of total pro forma revenues, in the fourth quarter of 2010. Pro Forma Adjusted EBITDA margins declined in the quarter versus the prior year period due primarily to growth in integrated care practices in which professional service revenues are largely paid out as physician compensation, investments made in key personnel and higher bad debt expense, as the fourth quarter of 2010 included a one-time benefit to bad debt expense.  A reconciliation of net loss attributable to Radiation Therapy Services Holdings, Inc. shareholders, determined in accordance with generally accepted accounting principles to Pro Forma Adjusted EBITDA and total revenues, determined in accordance with generally accepted accounting principles, to total pro forma revenues for the quarters ended December 31, 2011 and 2010 is included in the attached supplemental information.

 

During the fourth quarter of 2011, the Company performed an annual impairment test of its goodwill and trade name, and recorded a non-cash, pre-tax impairment charge of $121.6 million in certain regional divisions.  The goodwill impairment charge is attributable to revisions of the Company’s financial forecasts largely as a result of reductions in reimbursement. The trade name write-down is concurrent with the expected significant rebranding initiative currently underway by the Company.  Additional impairment amounts of approximately $1.5 million have been recorded during the quarter for certain leasehold improvements for a planned facility office closing in Maryland and equipment deposits.

 

Preliminary income tax benefit in the fourth quarter of 2011 was $20.2 million, compared to an income tax benefit of $6.7 million in the fourth quarter of 2010. Further information regarding our income tax provision and related accounts will be provided upon completion of our 2011 audit and the filing our annual Form 10-K.

 

Including the impairment charge of $123.1 million and $97.9 million for the fourth quarter of 2011 and 2010, respectively, the preliminary net loss for the fourth quarter of 2011 was $111.7 million, compared to a net loss of $102.3 million in the fourth quarter of 2010.

 

Full Year 2011 Results

 

Total pro forma revenues for the year ended December 31, 2011 was $666.5 million, an increase of 17.9% compared to $565.4 million in pro forma revenues in the prior year. The increase in revenue was principally due to revenue from the May 2010 acquisition of the Myrtle Beach, S.C. physician practices and the March 2011 acquisition of Medical Developers, which operates 30 physician practices in Latin America, of $16.4 million and $60.5 million, respectively.

 



 

Domestic same practice treatments per day increased 0.4% for the full year 2011 compared to the prior year, reflecting volume improvement throughout 2011 as well as the contribution from marketing initiatives. Same practice therapy revenue per treatment increased 1.9% compared to the full year 2010 principally as a result of a mix shift towards more clinically appropriate and sophisticated radiation oncology services, which resulted in an increase in RVUs, partially offset by a reduction in the conversion factor for fiscal year 2011.

 

Total RVUs per day at same practice domestic freestanding centers increased 11.6% in the full year 2011 versus the prior year principally as a result of an increase in RVU values in 2011, compared to 2010 and a mix shift towards more advanced radiation oncology services.

 

Pro Forma Adjusted EBITDA increased 6.1% for the full year 2011 to $122.8 million, or 18.4% of total pro forma revenues, from $115.7 million, or 20.5% of total pro forma revenues, in the prior year. Pro Forma Adjusted EBITDA margins declined in the full year 2011 versus the previous year due primarily to growth in integrated care practices in which professional service revenues are largely paid out as physician compensation, investments made in key personnel and higher bad debt expense, as the fourth quarter of 2010 included a one-time benefit to bad debt expense.  A reconciliation of net loss attributable to Radiation Therapy Services Holdings, Inc. shareholders, determined in accordance with generally accepted accounting principles to Pro Forma Adjusted EBITDA and total revenues, determined in accordance with generally accepted accounting principles, to total pro forma revenues for the year ended December 31, 2011 and 2010 is included in the attached supplemental information.

 

Preliminary income tax benefit for the year ended December 31, 2011 was $25.4 million, compared to an income tax benefit of $12.8 million in 2010. Further information regarding our income tax provision and related accounts will be provided upon completion of our 2011 audit and the filing our annual Form 10-K.

 

Including the pre-tax impairment loss of $123.1 million taken in the fourth quarter of 2011, the preliminary net loss for the full year 2011 was $349.9 million, compared to a net loss of $113.8 million in 2010 which included an impairment loss of $97.9 million.

 

Conference Call

 

Management will host a conference call Thursday, March 8, 2012 at 11:00 a.m. EST to discuss financial results, other developments and business conditions. The dial-in numbers are (877) 407-0789 for domestic callers and (201) 689-8562 for international callers.  In addition, a telephonic replay of the call will be available until March 22, 2012.  The replay dial-in numbers are (877) 870-5176 for domestic callers and (858) 384-5517 for international callers.  Please use the conference ID number 388547 to access the replay.

 



 

About Radiation Therapy Services Holdings, Inc.

 

Radiation Therapy Services Holdings, Inc., which operates radiation treatment centers primarily under the name 21st Century Oncology, is a provider of advanced radiation therapy services to cancer patients. In total, the Company operates 127 treatment centers, including 96 centers located in 16 U.S. states, 30 centers located in nine countries in Latin America and 1 center located in India.  The Company is headquartered in Fort Myers, Florida.  RTSX.

 

Forward-Looking Statements

 

This press release contains forward-looking statements within the meaning of Section 27A of the Securities Act of 1933, as amended, and Section 21E of the Securities Act of 1934, as amended.  Statements preceded by, followed by or that otherwise include the words “believes”, “expects”, “anticipates”, “intends”, “projects”, “estimates”, “plans”, “may increase”, “forecast” and similar expressions or future or conditional verbs such as “will”, “should”, “would”, “may” and “could” are generally forward-looking in nature and not historical facts. Forward-looking statements are based on management’s current expectations or beliefs about the Company’s future plans, expectations and objectives, including, but not limited to, the Company’s expected financial results and estimates for 2011.  These forward-looking statements are not historical facts and are subject to risks and uncertainties that could cause the actual results to differ materially from those projected in these forward-looking statements including, but not limited to reductions in Medicare reimbursement, healthcare reform, decreases in payments by managed care organizations and other commercial payers and other risk factors that may be described from time to time in the Company’s filings with the Securities and Exchange Commission.  Readers of this release are cautioned not to place undue reliance on forward-looking statements contained herein, which speak only as of the date stated, or if no date is stated, as of the date of this press release. The Company undertakes no obligation to publicly update or revise the forward-looking statements contained herein to reflect changed events or circumstances after the date of this release, unless required by law.

 

Financial Tables on Following Pages

 

###

 


 


 

RADIATION THERAPY SERVICES HOLDINGS, INC.

CONSOLIDATED BALANCE SHEETS

(in thousands, except share and per share amounts)

 

 

 

December 31,

 

December 31,

 

 

 

2011

 

2010

 

 

 

(unaudited)

 

 

 

ASSETS

Current assets:

 

 

 

 

 

Cash and cash equivalents

 

$

10,177

 

$

13,977

 

Accounts receivable, net

 

87,094

 

63,571

 

Prepaid expenses

 

5,731

 

6,969

 

Inventories

 

4,308

 

2,647

 

Deferred income taxes

 

2,969

 

2,276

 

Other

 

6,025

 

2,313

 

Total current assets

 

116,304

 

91,753

 

 

 

 

 

 

 

Equity investments in joint ventures

 

692

 

20,136

 

Property and equipment, net

 

236,411

 

229,665

 

Real estate subject to finance obligation

 

13,719

 

8,100

 

Goodwill

 

556,547

 

770,898

 

Intangible assets, net

 

42,393

 

85,236

 

Other assets

 

32,526

 

30,542

 

Total assets

 

$

998,592

 

$

1,236,330

 

 

 

 

 

 

 

LIABILITIES AND EQUITY

 

 

 

 

 

 

Current liabilities:

 

 

 

 

 

Accounts payable

 

$

27,748

 

$

21,888

 

Accrued expenses

 

42,596

 

35,765

 

Income taxes payable

 

5,310

 

5,994

 

Current portion of long-term debt

 

13,945

 

8,780

 

Current portion of finance obligation

 

161

 

53

 

Other current liabilities

 

6,615

 

197

 

Total current liabilities

 

96,375

 

72,677

 

Long-term debt, less current portion

 

665,088

 

590,051

 

Finance obligation, less current portion

 

14,105

 

8,515

 

Other long-term liabilities

 

22,659

 

15,981

 

Deferred income taxes

 

10,343

 

33,527

 

Total liabilities

 

808,570

 

720,751

 

 

 

 

 

 

 

Noncontrolling interests - redeemable

 

12,728

 

7,371

 

 

 

 

 

 

 

Commitments and Contingencies

 

 

 

 

 

 

 

 

 

 

 

Equity:

 

 

 

 

 

Common stock, $0.01 par value, 1,025 shares authorized, 1,025 and 1,000 shares issued and outstanding at December 31, 2011 and December 31, 2010

 

 

 

Additional paid-in capital

 

648,703

 

630,989

 

Retained deficit

 

(483,815

)

(130,374

)

Notes receivable from shareholder

 

(125

)

(175

)

Accumulated other comprehensive loss, net of tax

 

(4,890

)

(3,391

)

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

 

159,873

 

497,049

 

Noncontrolling interests - nonredeemable

 

17,421

 

11,159

 

Total equity

 

177,294

 

508,208

 

Total liabilities and equity

 

$

998,592

 

$

1,236,330

 

 



 

RADIATION THERAPY SERVICES HOLDINGS, INC.

CONSOLIDATED STATEMENTS OF COMPREHENSIVE LOSS

(in thousands)

(unaudited)

 

 

 

Three Months Ended

 

Years Ended

 

 

 

December 31,

 

December 31,

 

 

 

2011

 

2010

 

2011

 

2010

 

 

 

 

 

 

 

 

 

 

 

Revenues:

 

 

 

 

 

 

 

 

 

Net patient service revenue

 

$

168,385

 

$

135,326

 

$

638,690

 

$

535,913

 

Other revenue

 

1,273

 

2,197

 

6,027

 

8,050

 

Total revenues

 

169,658

 

137,523

 

644,717

 

543,963

 

 

 

 

 

 

 

 

 

 

 

Expenses:

 

 

 

 

 

 

 

 

 

Salaries and benefits

 

88,055

 

76,327

 

326,782

 

282,302

 

Medical supplies

 

13,975

 

11,515

 

51,838

 

43,027

 

Facility rent expense

 

8,867

 

7,930

 

33,375

 

27,885

 

Other operating expenses

 

9,164

 

6,970

 

33,992

 

27,103

 

General and administrative expenses

 

23,174

 

19,360

 

81,688

 

65,798

 

Depreciation and amortization

 

15,002

 

12,113

 

54,084

 

46,346

 

Provision for doubtful accounts

 

3,974

 

444

 

16,117

 

8,831

 

Interest expense, net

 

15,395

 

13,902

 

60,656

 

58,505

 

Loss on sale of assets of a radiation treatment center

 

 

 

 

1,903

 

Early extinguishment of debt

 

 

 

 

10,947

 

Impairment loss

 

123,079

 

97,916

 

360,639

 

97,916

 

Loss on investments

 

250

 

 

250

 

 

Gain on fair value adjustment of previously held equity investment

 

 

 

(234

)

 

Foreign currency transaction loss

 

72

 

 

106

 

 

(Gain) loss on forward currency derivative contracts

 

505

 

 

672

 

 

Total expenses

 

301,512

 

246,477

 

1,019,965

 

670,563

 

 

 

 

 

 

 

 

 

 

 

Loss before income taxes

 

(131,854

)

(108,954

)

(375,248

)

(126,600

)

Income tax benefit

 

(20,157

)

(6,662

)

(25,365

)

(12,810

)

 

 

 

 

 

 

 

 

 

 

Net loss

 

(111,697

)

(102,292

)

(349,883

)

(113,790

)

 

 

 

 

 

 

 

 

 

 

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

 

(349

)

(41

)

(3,558

)

(1,698

)

 

 

 

 

 

 

 

 

 

 

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

 

(112,046

)

(102,333

)

(353,441

)

(115,488

)

 

 

 

 

 

 

 

 

 

 

Other comprehensive (loss) income:

 

 

 

 

 

 

 

 

 

Unrealized gain on derivative interest rate swap agreements, net of tax

 

9

 

816

 

2,428

 

1,679

 

Unrealized loss on foreign currency translation

 

(4,101

)

 

(4,909

)

 

Unrealized loss on other comprehensive income from share of equity investee

 

 

(151

)

 

(201

)

Other comprehensive (loss) income:

 

(4,092

)

665

 

(2,481

)

1,478

 

 

 

 

 

 

 

 

 

 

 

Comprehensive loss:

 

(115,789

)

(101,627

)

(352,364

)

(112,312

)

Comprehensive (income) loss attributable to noncontrolling interests- redeemable and non-redeemable

 

233

 

(41

)

(2,914

)

(1,698

)

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

 

$

(115,556

)

$

(101,668

)

$

(355,278

)

$

(114,010

)

 



 

RADIATION THERAPY SERVICES HOLDINGS, INC.

CONSOLIDATED STATEMENTS OF CASH FLOWS

(in thousands)

(unaudited)

 

 

 

Years Ended

 

 

 

December 31,

 

 

 

2011

 

2010

 

Cash flows from operating activities

 

 

 

 

 

Net loss

 

$

(349,883

)

$

(113,790

)

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

 

 

 

 

 

Depreciation

 

45,972

 

39,011

 

Amortization

 

8,112

 

7,335

 

Deferred rent expense

 

1,271

 

1,180

 

Deferred income taxes

 

(28,378

)

(19,698

)

Stock-based compensation

 

1,461

 

1,030

 

Provision for doubtful accounts

 

16,117

 

8,831

 

Loss on the sale/disposal of property and equipment

 

235

 

734

 

Loss on sale of assets of a radiation treatment center

 

 

1,903

 

Write off of pro-rata debt discount

 

 

494

 

Write off of loan costs

 

 

1,593

 

Early extinguishment of debt

 

 

10,947

 

Termination of a derivative interest rate swap agreement

 

(1,880

)

 

Impairment loss

 

360,639

 

97,916

 

Loss on investments

 

250

 

 

Gain on fair value adjustment of previously held equity investment

 

(234

)

 

Loss on foreign currency transactions

 

98

 

 

Loss on forward currency derivative contracts

 

672

 

 

Amortization of debt discount

 

847

 

791

 

Amortization of loan costs

 

4,524

 

3,350

 

Equity interest in net loss (earnings) of joint ventures

 

1,036

 

(1,001

)

Distribution received from unconsolidated joint ventures

 

52

 

980

 

Changes in operating assets and liabilities:

 

 

 

 

 

Accounts receivable and other receivables

 

(20,780

)

(16,066

)

Income taxes payable

 

(4,393

)

6,477

 

Inventories and other current assets

 

(1,622

)

107

 

Prepaid expenses

 

2,839

 

4,425

 

Accounts payable

 

2,808

 

8,454

 

Accrued expenses / other long-term liabilities

 

5,001

 

3,991

 

 

 

 

 

 

 

Net cash provided by operating activities

 

44,764

 

48,994

 

 

 

 

 

 

 

Cash flows from investing activities

 

 

 

 

 

Purchase of property and equipment

 

(36,612

)

(43,781

)

Acquisition of medical practices

 

(59,886

)

(43,388

)

Purchase of joint venture interests

 

 

(1,000

)

Proceeds from the sale of property and equipment

 

6

 

1,693

 

Repayments from employees

 

338

 

457

 

Contribution of capital to joint venture entities

 

(799

)

(3,711

)

Distribution received from joint venture entities

 

581

 

27

 

Proceeds from the sale of equity interest in a joint venture

 

312

 

 

Payment of foreign currency derivative contracts

 

(1,486

)

 

Proceeds from sale of investments

 

1,035

 

 

Purchase of investments

 

(79

)

 

Change in other assets and other liabilities

 

(192

)

(2,808

)

 

 

 

 

 

 

Net cash used in investing activities

 

(96,782

)

(92,511

)

 

 

 

 

 

 

Cash flows from financing activities

 

 

 

 

 

Proceeds from issuance of debt (net of original issue discount of $625 and $1,950, respectively)

 

111,205

 

316,550

 

Principal repayments of debt

 

(57,777

)

(271,295

)

Repayments of finance obligation

 

(95

)

(302

)

Payment of call premium on senior subordinated notes

 

 

(5,250

)

Proceeds from equity contribution

 

3

 

156

 

Payments of notes receivable from shareholder

 

50

 

50

 

Proceeds from issuance of noncontrolling interest

 

4,120

 

608

 

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

 

(4,428

)

(3,176

)

Deconsolidation of noncontrolling interest

 

(33

)

(14

)

Payments of loan costs

 

(4,809

)

(12,791

)

 

 

 

 

 

 

Net cash provided by financing activities

 

48,236

 

24,536

 

 

 

 

 

 

 

Effect of exchange rate changes on cash and cash equivalents

 

(18

)

 

 

 

 

 

 

 

Net decrease in cash and cash equivalents

 

(3,800

)

(18,981

)

Cash and cash equivalents, beginning of period

 

13,977

 

32,958

 

 

 

 

 

 

 

Cash and cash equivalents, end of period

 

$

10,177

 

$

13,977

 

 



 

 

 

Years Ended

 

 

 

December 31,

 

 

 

2011

 

2010

 

Supplemental disclosure of cash flow information

 

 

 

 

 

Interest paid

 

$

56,748

 

$

57,688

 

Income taxes paid

 

$

5,802

 

$

411

 

Supplemental disclosure of noncash transactions

 

 

 

 

 

Recorded finance obligation related to real estate projects

 

$

11,623

 

$

3,756

 

Recorded derecognition of finance obligation related to real estate projects

 

$

(5,829

)

$

(72,117

)

Recorded noncash deconsolidation of noncontrolling interest

 

$

49

 

$

(64

)

Recorded noncash purchase of controlling interest in a joint venture

 

$

 

$

(475

)

Recorded noncash contribution of capital by controlling interest holder

 

$

 

$

602

 

Recorded noncash use of vendor credit

 

$

 

$

2,027

 

Recorded capital lease obligations related to the purchase of equipment

 

$

4,701

 

$

 

Recorded issuance of Parent equity units related to the acquisition of medical practices

 

$

16,250

 

$

 

Recorded issuance of senior subordinated notes related to the acquisition of medical practices

 

$

16,047

 

$

 

Recorded earn-out accrual related to the acquisition of medical practices

 

$

2,340

 

$

 

Recorded additional consideration related to the acquisition of medical practices

 

$

561

 

$

 

Recorded other non-current liabilities related to non-controlling interest related to the acquisition of medical practices

 

$

1,364

 

$

 

Recorded issuance of notes payable related to the acquisition of medical practices

 

$

4,005

 

$

 

Recorded noncash dividend declared to noncontrolling interest

 

$

221

 

$

 

Recorded issuance of redeemable noncontrolling interest

 

$

71

 

$

 

 



 

RADIATION THERAPY SERVICES HOLDINGS, INC.

Supplemental Financial Information (Unaudited)

Reconciliation of Pro-forma Revenue and Adjusted EBITDA to Net Loss Attributable

to Radiation Therapy Services Holdings, Inc. Shareholder

 

 

 

Three Months Ended

 

Years Ended

 

 

 

December 31,

 

December 31,

 

 

 

2011

 

2010

 

2011

 

2010

 

(in thousands):

 

 

 

 

 

 

 

 

 

Total revenues

 

$

169,658

 

$

137,523

 

$

644,717

 

$

543,963

 

Pro-forma full period effect of acquisitions (a) 

 

1,587

 

1,327

 

21,782

 

21,445

 

Total pro-forma revenues

 

$

171,245

 

$

138,850

 

$

666,499

 

$

565,408

 

 

 

 

 

 

 

 

 

 

 

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

 

$

(112,046

)

$

(102,333

)

$

(353,441

)

$

(115,488

)

Income tax benefit

 

(20,157

)

(6,662

)

(25,365

)

(12,810

)

Interest expense, net

 

15,395

 

13,902

 

60,656

 

58,505

 

Depreciation and amortization

 

15,002

 

12,113

 

54,084

 

46,346

 

Loss on sale of assets of a radiation treatment center

 

 

 

 

1,903

 

Early extinguishment of debt

 

 

 

 

10,947

 

Impairment loss

 

123,079

 

97,916

 

360,639

 

97,916

 

Loss on investments

 

250

 

 

250

 

 

Gain on fair value adjustment of previously held equity investment

 

 

 

(234

)

 

Loss on forward currency derivative contracts

 

505

 

 

672

 

 

Management fees (b) 

 

648

 

504

 

1,562

 

1,314

 

Non-cash expenses (c) 

 

800

 

1,031

 

3,970

 

3,534

 

Sale-lease back adjustments (d) 

 

(243

)

(196

)

(925

)

(2,511

)

Acquisition-related costs (e) 

 

2,112

 

3,162

 

6,400

 

4,811

 

Other expenses (f) 

 

1,083

 

757

 

2,120

 

2,031

 

Litigation settlement (g) 

 

1,294

 

 

2,232

 

2,771

 

Costs associated with the provision for income taxes (h) 

 

452

 

330

 

996

 

330

 

Physician contracting expenses (i) 

 

 

7,551

 

 

7,551

 

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

 

650

 

776

 

9,172

 

8,565

 

 

 

 

 

 

 

 

 

 

 

Pro-forma Adjusted EBITDA (1) 

 

$

28,824

 

$

28,851

 

$

122,788

 

$

115,715

 

 

 

 

 

 

 

 

 

 

 

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

 

16.8

%

20.8

%

18.4

%

20.5

%

 



 


(1) Pro-forma Adjusted EBITDA is defined as income (loss) before interest expense (net of interest income), income taxes, depreciation and amortization, foreign currency derivative contract loss, gain on fair value adjustment of previously held equity investment, management fees from our sponsor, non-cash expenses including costs relating to stock compensation, amortization of straight-line rent and amortization of capital expenditures relating to repairs and maintenance, sale-lease back adjustments, acquisition-related costs, other expenses including loss on sale of assets, severance payments related to termination of employee staff reductions and tail premiums on termed physicians, litigation settlements with physicians, costs associated with the provision for income taxes, costs associated with the restructuring of certain physician groups’ compensation agreements and pro-forma full period effect of acquisition EBITDA.

 

(a) Pro-forma amounts related to adjustments to total revenues and Pro-forma Adjusted EBITDA to reflect the full period effect of our acquisitions completed during 2010 and 2011.  The adjustments reflect the impact to our total revenues and Pro-forma Adjusted EBITDA as if the acquisitions had occurred at the beginning of the year.

 

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

 

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

 

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

 

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

 

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

 

(g) Litigation settlement relates to costs associated with the termination of physicians during 2010 and 2011.

 

(h) Expenses related to the costs associated with process improvements in the provision for income taxes.

 

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

 

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

 

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

 



 

RADIATION THERAPY SERVICES HOLDINGS, INC.

KEY OPERATING STATISTICS

(unaudited)

 

 

 

Three Months Ended

 

 

 

Years Ended

 

 

 

 

 

December 31,

 

%

 

December 31,

 

%

 

Domestic U.S.

 

2011

 

2010

 

Change

 

2011

 

2010

 

Change

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Number of treatment days

 

63

 

63

 

 

 

255

 

254

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Total RVU’s - freestanding centers

 

3,043,976

 

2,678,540

 

13.6

%

12,366,538

 

10,833,260

 

14.2

%

 

 

 

 

 

 

 

 

 

 

 

 

 

 

RVU’s per day - freestanding centers

 

48,317

 

42,517

 

13.6

%

48,496

 

42,651

 

13.7

%

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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

 

13.1

%

-3.0

%

 

 

11.6

%

-2.1

%

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Total treatments - freestanding centers

 

121,319

 

117,675

 

3.1

%

491,902

 

478,952

 

2.7

%

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Treatments per day - freestanding centers

 

1,926

 

1,868

 

3.1

%

1,929

 

1,886

 

2.3

%

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Percentage change in revenue per treatment - freestanding centers - same practice basis

 

1.7

%

0.9

%

 

 

1.9

%

0.7

%

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Percentage change in treatments per day - freestanding centers - same practice basis

 

3.0

%

-3.0

%

 

 

0.4

%

-4.3

%

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Number of regions at period end (global)

 

9

 

8

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Number of local markets at period end

 

28

 

28

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Treatment centers - freestanding (global)

 

118

 

89

 

32.6

%

 

 

 

 

 

 

Treatment centers - hospital / other groups (global)

 

9

 

6

 

50.0

%

 

 

 

 

 

 

 

 

127

 

95

 

33.7

%

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Days sales outstanding at quarter end

 

39

 

41

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Percentage change in freestanding revenues - same practice basis

 

4.7

%

-3.7

%

 

 

2.7

%

-3.6

%

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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

 

$

44,358

 

$

38,674

 

 

 

$

166,090

 

$

143,487

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Three Months Ended

 

 

 

Years Ended

 

 

 

 

 

December 31,

 

%

 

December 31,

 

%

 

International

 

2011

 

2010 *

 

Change

 

2011 *

 

2010 *

 

Change

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Number of treatments

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

2-D treatments

 

1,404

 

1,331

 

 

 

5,411

 

5,646

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

3-D treatments

 

1,875

 

1,634

 

 

 

6,888

 

6,010

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

IMRT treatments

 

453

 

319

 

 

 

1,478

 

1,047

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Total

 

3,732

 

3,284

 

13.6

%

13,777

 

12,703

 

8.5

%

 


* includes full period operating statistics, including period prior to our acquisition on March 1, 2011