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Table of Contents

 

 

UNITED STATES

SECURITIES AND EXCHANGE COMMISSION

Washington, D.C. 20549

 

 

FORM 10-Q/A

 

 

(Amendment No. 1)

(Mark One)

x QUARTERLY REPORT PURSUANT TO SECTION 13 OR 15(d) OF THE SECURITIES EXCHANGE ACT OF 1934

For the quarterly period ended June 30, 2014

OR

 

¨ 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  ¨    NO  x

(Note: As a voluntary filer not subject to the filing requirements of Sections 13 or 15(d) of the Exchange Act, the registrant has filed all reports pursuant to Section 13 or 15(d) of the Exchange Act during the preceding 12 months as if it were subject to such filing requirements.)

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  x    NO  ¨

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. (Check one):

 

Large accelerated filer   ¨    Accelerated filer   ¨
Non-accelerated filer   x    Smaller reporting company   ¨

Indicate by check mark whether the registrant is a shell company (as defined in Rule 12b-2 of the Exchange Act).    YES  ¨    NO  x

As of August 14, 2014, 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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EXPLANATORY NOTE

IASIS Healthcare LLC (the “Company”) is filing this Amendment No. 1 to its Quarterly Report on Form 10-Q/A (this “Amendment”) to restate and amend the Company’s previously issued condensed consolidated financial statements and related financial information for the quarter and nine months ended June 30, 2014 previously included in its Quarterly Report on Form 10-Q for the quarterly period ended June 30, 2014 (the “Original Filing”), which was previously filed with the Securities and Exchange Commission (“SEC”) on August 14, 2014 (the “Original Filing Date”). This Amendment also amends certain other items in the Original Filing as listed in “Items Amended in this Form 10-Q/A” below. In addition, concurrently with filing this Amendment, we are filing an amendment to our annual report on Form 10-K for the year ended September 30, 2014 and an amendment to our quarterly report on Form 10-Q for the quarter ended December 31, 2014, to restate and amend the Company’s previously issued audited consolidated financial statements and related financial information for the year ended September 30, 2014, and previously issued unaudited condensed consolidated financial statements and related financial information for the quarter ended December 31, 2014, respectively, and to amend certain other items within those reports.

Background

On April 13, 2015, the Audit Committee of our Board of Directors (the “Audit Committee”), after discussion with Company management and Ernst & Young LLP, our independent registered public accounting firm, determined that the following financial statements previously filed with the SEC should no longer be relied upon: (1) the audited consolidated financial statements included in our Annual Report on Form 10-K for the year ended September 30, 2014; and (2) the unaudited condensed consolidated financial statements included in our Quarterly Reports on Form 10-Q for the quarter and nine months ended June 30, 2014 and for the quarter ended December 31, 2014.

This determination occurred after Company management, through an internal review of the program settlement process described below, identified certain errors made by a former managed care division finance employee. The errors relate to the program settlement process for the Company’s largest managed Medicaid plan under the related state contract. This program settlement process reconciles estimated amounts due to or from the state based on the actual premium revenue and medical costs and contractually mandated limits on profits and losses. Although estimates of future program settlement amounts are recorded in current periods, the program settlement process typically occurs in the 18 months post-plan year, when actual (rather than projected) claims and member eligibility data become available and a net settlement amount is either due to or from the state. Accordingly, the errors did not involve any cash payments, and the Company’s cash position is not affected, as actual final program settlements are not paid until the end of this reconciliation process.

For the quarter and nine months ended June 30, 2014, the correction of this error decreases the Company’s consolidated net revenue and pre-tax earnings by approximately $21.8 million in each period relative to the amounts reported in the Original Filing, a decrease of 3.2% and 1.1%, respectively, relative to such amounts for the quarter and nine months ended June 30, 2014 reported in the Original Filing. Please refer to Note 1A—“Restatement of Previously Issued Condensed Consolidated Financial Statements” included in our condensed consolidated financial statements and notes thereto in this Amendment for more information regarding correction of this error.

Along with restating our financial statements to correct the error discussed above, we are making adjustments for certain previously identified immaterial accounting errors with respect to the quarter and nine months ended June 30, 2014. When these financial statements were originally issued, we assessed the impact of these unrecorded adjustments and concluded that they were not material individually or in the aggregate to our financial statements for the quarter and nine months ended June 30, 2014, or any other period. However, in conjunction with the restatement, we have determined that it would be appropriate within this Amendment to record all such previously unrecorded adjustments for the quarter and nine months ended June 30, 2014. Please refer to Note 1A—“Restatement of Previously Issued Condensed Consolidated Financial Statements” included in our condensed consolidated financial statements and notes thereto in this Amendment for more information regarding the impact of these adjustments.

In addition, our unaudited condensed consolidated financial statements for the quarter and nine months ended June 30, 2014, and 2013, respectively, have been retrospectively revised to reflect the operating results and cash flows of the Nevada operations as discontinued operations. On September 26, 2014, the Company approved and committed to a plan to dispose of its Nevada operations, which included one hospital in the Las Vegas area and all related physician operations. The sale of the Company’s Nevada operations closed on January 22, 2015. Please see Note 1 to our unaudited condensed consolidated financial statements appearing under “Item 1 – Financial Statements” of this report for additional related disclosures.

Because these revisions are treated as corrections of errors to our prior period financial results, the revisions are considered to be a “restatement” under U.S. generally accepted accounting principles. Accordingly, the revised financial information for the quarter and nine months ended June 30, 2014, included in this Amendment has been identified as “restated”.

Internal Controls

Our management has determined that there was a deficiency in our internal control over financial reporting that constitutes a material weakness, as defined by SEC regulations, as discussed in Item 4 of this Amendment.

 

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Items Amended in this Form 10-Q/A

For the convenience of the reader, this Amendment amends and restates the Original Filing. However, only the following items in the Original Filing have been amended as a result of, and to reflect, the restatement and adjustments described above:

 

    Part I, Item 1 – Financial Statements

 

    Part I, Item 2 – Management’s Discussion and Analysis of Financial Condition and Results of Operations

 

    Part I, Item 4 – Controls and Procedures

In accordance with applicable SEC rules, this Amendment includes new certifications required by Section 302 of the Sarbanes-Oxley Act of 2002, as amended, from our chief executive officer and chief financial officer dated as of the date of this Amendment.

Except as described above, no other changes have been made to the Original Filing. The Original Filing continues to speak as of the Original Filing Date and we have not updated the disclosures contained in the Original Filing to reflect any events that occurred after the Original Filing Date, other than those associated with the restatement and adjustments described above. Other events occurring after the Original Filing Date or other information necessary to reflect subsequent events have been disclosed in reports filed with the SEC subsequent to the Original Filing, including any amendments to those reports.

 

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TABLE OF CONTENTS

 

PART I. FINANCIAL INFORMATION

  1   

Item 1. Financial Statements

  1   

Item 2. Management’s Discussion and Analysis of Financial Condition and Results of Operations

  35   

Item 3. Quantitative and Qualitative Disclosures about Market Risk

  51   

Item 4. Controls and Procedures

  51   

PART II. OTHER INFORMATION

  52   

Item 1. Legal Proceedings

  52   

Item 1A. Risk Factors

  53   

Item 6. Exhibits

  53   

Signatures

  54   


Table of Contents

PART I.

FINANCIAL INFORMATION

Item 1. Financial Statements

IASIS HEALTHCARE LLC

CONDENSED CONSOLIDATED BALANCE SHEETS

(In Thousands)

 

     June 30,
2014
     September 30,
2013
 
    

Restated

(Unaudited)

        
ASSETS      

Current assets

     

Cash and cash equivalents

   $ 317,643       $ 438,131   

Accounts receivable, net

     336,649         371,006   

Inventories

     58,282         57,781   

Deferred income taxes

     14,691         26,096   

Prepaid expenses and other current assets

     184,929         126,412   

Assets held for sale

     —           119,141   
  

 

 

    

 

 

 

Total current assets

  912,194      1,138,567   

Property and equipment, net

  844,032      833,169   

Goodwill

  815,585      816,410   

Other intangible assets, net

  23,497      25,957   

Other assets, net

  60,445      66,162   
  

 

 

    

 

 

 

Total assets

$ 2,655,753    $ 2,880,265   
  

 

 

    

 

 

 
LIABILITIES AND EQUITY

Current liabilities

Accounts payable

$ 119,355    $ 129,542   

Salaries and benefits payable

  53,295      62,884   

Accrued interest payable

  9,682      27,519   

Medical claims payable

  69,108      57,514   

Other accrued expenses and current liabilities

  76,847      92,553   

Current portion of long-term debt, capital leases and other obligations

  13,180      13,221   

Advancement on divestiture

  —        144,803   

Liabilities held for sale

  —        3,208   
  

 

 

    

 

 

 

Total current liabilities

  341,467      531,244   

Long-term debt, capital leases and other obligations

  1,843,788      1,852,822   

Deferred income taxes

  114,677      115,592   

Other long-term liabilities

  117,482      123,120   

Non-controlling interests with redemption rights

  108,325      105,464   

Equity

Member’s equity

  120,306      142,262   

Non-controlling interests

  9,708      9,761   
  

 

 

    

 

 

 

Total equity

  130,014      152,023   
  

 

 

    

 

 

 

Total liabilities and equity

$ 2,655,753    $ 2,880,265   
  

 

 

    

 

 

 

See accompanying notes.

 

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IASIS HEALTHCARE LLC

CONDENSED CONSOLIDATED STATEMENTS OF OPERATIONS (UNAUDITED)

(In Thousands)

 

     Quarter Ended
June 30,
    Nine Months Ended
June 30,
 
     2014     2013     2014     2013  
     Restated           Restated        

Revenues

        

Acute care revenue before provision for bad debts

   $ 531,380      $ 518,142      $ 1,613,457      $ 1,533,490   

Less: Provision for bad debts

     (77,130     (81,710     (260,249     (233,456
  

 

 

   

 

 

   

 

 

   

 

 

 

Acute care revenue

  454,250      436,432      1,353,208      1,300,034   

Premium revenue

  178,498      139,804      503,212      422,059   
  

 

 

   

 

 

   

 

 

   

 

 

 

Total revenue

  632,748      576,236      1,856,420      1,722,093   

Costs and expenses

Salaries and benefits (includes stock-based compensation of $5,679, $947, $10,033 and $2,946, respectively)

  221,446      207,622      664,453      634,229   

Supplies

  75,104      73,865      227,415      224,379   

Medical claims

  165,943      116,640      436,754      348,556   

Rentals and leases

  18,198      13,356      54,444      38,968   

Other operating expenses

  110,337      102,713      311,586      298,427   

Medicare and Medicaid EHR incentives

  (2,940   (4,827   (9,294   (9,884

Interest expense, net

  32,267      32,770      98,300      99,986   

Depreciation and amortization

  23,422      23,862      70,648      70,645   

Management fees

  1,250      1,250      3,750      3,750   
  

 

 

   

 

 

   

 

 

   

 

 

 

Total costs and expenses

  645,027      567,251      1,858,056      1,709,056   

Earnings (loss) from continuing operations before gain on disposal of assets and income taxes

  (12,279   8,985      (1,636   13,037   

Gain on disposal of assets, net

  2,102      478      2,868      645   
  

 

 

   

 

 

   

 

 

   

 

 

 

Earnings (loss) from continuing operations before income taxes

  (10,177   9,463      1,232      13,682   

Income tax expense

  1,138      4,037      7,387      6,402   
  

 

 

   

 

 

   

 

 

   

 

 

 

Net (loss) earnings from continuing operations

  (11,315   5,426      (6,155   7,280   

Earnings (loss) from discontinued operations, net of income taxes

  (6,199   (331   (5,786   2,761   
  

 

 

   

 

 

   

 

 

   

 

 

 

Net earnings (loss)

  (17,514   5,095      (11,941   10,041   

Net earnings attributable to non-controlling interests

  (2,453   (1,941   (8,857   (3,189
  

 

 

   

 

 

   

 

 

   

 

 

 

Net earnings (loss) attributable to IASIS Healthcare LLC

$ (19,967 $ 3,154    $ (20,798 $ 6,852   
  

 

 

   

 

 

   

 

 

   

 

 

 

See accompanying notes.

 

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IASIS HEALTHCARE LLC

CONDENSED CONSOLIDATED STATEMENTS OF COMPREHENSIVE INCOME (LOSS) (UNAUDITED)

(In Thousands)

 

     Quarter Ended
June 30,
    Nine Months Ended
June 30,
 
     2014     2013     2014     2013  
     Restated           Restated        

Net earnings (loss)

   $ (17,514   $ 5,095      $ (11,941   $ 10,041   

Other comprehensive income

        

Change in fair value of highly effective interest rate hedges

     201        1,753        1,179        1,643   
  

 

 

   

 

 

   

 

 

   

 

 

 

Other comprehensive income before income taxes

  201      1,753      1,179      1,643   

Change in income tax expense

  (75   (651   (438   (611
  

 

 

   

 

 

   

 

 

   

 

 

 

Other comprehensive income, net of income taxes

  126      1,102      741      1,032   
  

 

 

   

 

 

   

 

 

   

 

 

 

Comprehensive income (loss)

  (17,388   6,197      (11,200   11,073   

Net earnings attributable to non-controlling interests

  (2,453   (1,941   (8,857   (3,189
  

 

 

   

 

 

   

 

 

   

 

 

 

Comprehensive income (loss) attributable to IASIS Healthcare LLC

$ (19,841 $ 4,256    $ (20,057 $ 7,884   
  

 

 

   

 

 

   

 

 

   

 

 

 

See accompanying notes.

 

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IASIS HEALTHCARE LLC

CONDENSED CONSOLIDATED STATEMENT OF EQUITY (UNAUDITED)

(In Thousands)

 

     Non-controlling
Interests with
Redemption
Rights
          Member’s
Equity
    Non-controlling
Interests
    Total Equity  
                 Restated           Restated  

Balance at October 1, 2013

   $ 105,464           $ 142,262      $ 9,761        152,023   

Net earnings (loss)

     8,851             (20,798     6        (20,792

Distributions to non-controlling interests

     (13,163          —          (59     (59

Repurchase of non-controlling interests

     (600          —          —          —     

Stock-based compensation

     —               10,033        —          10,033   

Other comprehensive income

     —               741        —          741   

Redemption of shares for payroll tax withholding requirements

     —               (1,838     —          (1,838

Acquisition related adjustments to redemption value of non-controlling interests with redemption rights

     235             —          —          —     

Other

     (2,530          (31     —          (31

Tax benefit from parent company

     —               5        —          5   

Adjustment to redemption value of non-controlling interests with redemption rights

     10,068             (10,068     —          (10,068
  

 

 

        

 

 

   

 

 

   

 

 

 

Balance at June 30, 2014

$ 108,325      $ 120,306    $ 9,708    $ 130,014   
  

 

 

        

 

 

   

 

 

   

 

 

 

See accompanying notes.

 

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IASIS HEALTHCARE LLC

CONDENSED CONSOLIDATED STATEMENTS OF CASH FLOWS (UNAUDITED)

(In Thousands)

 

     Nine Months Ended
June 30,
 
     2014     2013  
     Restated        

Cash flows from operating activities

    

Net earnings (loss)

   $ (11,941   $ 10,041   

Adjustments to reconcile net earnings (loss) to net cash provided by (used in) operating activities:

    

Depreciation and amortization

     70,648        70,645   

Amortization of loan costs

     5,559        5,510   

Amortization of deferred gain on sale-leaseback transaction

     (1,872     —     

Change in physician minimum revenue guarantees

     2,177        2,629   

Stock-based compensation

     10,033        2,946   

Deferred income taxes

     (1,015     11,897   

Income tax benefit from stock-based compensation

     —          16   

Income tax benefit from parent company

     5        103   

Gain on disposal of assets, net

     (2,868     (645

Loss (earnings) from discontinued operations, net

     5,786        (2,761

Changes in operating assets and liabilities, net of the effect of acquisitions and dispositions:

    

Accounts receivable, net

     (6,792     (20,531

Inventories, prepaid expenses and other current assets

     (53,406     (23,380

Accounts payable, other accrued expenses and other accrued liabilities

     10,552        (54,892

Income taxes and other transaction costs payable related to sale-leaseback of real estate

     (22,270     —     
  

 

 

   

 

 

 

Net cash provided by operating activities — continuing operations

  4,596      1,578   

Net cash provided by (used in) operating activities — discontinued operations

  (15,140   11,346   
  

 

 

   

 

 

 

Net cash provided by (used in) operating activities

  (10,544   12,924   
  

 

 

   

 

 

 

Cash flows from investing activities

Purchases of property and equipment

  (76,084   (78,532

Cash received (paid) for acquisitions, net

  (1,038   3,584   

Proceeds from sale of assets

  1,508      79   

Change in other assets, net

  (219   (2,445

Other, net

  (3,025   —     
  

 

 

   

 

 

 

Net cash used in investing activities — continuing operations

  (78,858   (77,314

Net cash used in investing activities — discontinued operations

  (5,242   (5,173
  

 

 

   

 

 

 

Net cash used in investing activities

  (84,100   (82,487
  

 

 

   

 

 

 

Cash flows from financing activities

Payment of long-term debt, capital leases and other obligations

  (10,084   (102,155

Proceeds from revolving credit facilities

  —        147,000   

Debt financing costs incurred

  —        (1,024

Distributions to non-controlling interests

  (13,222   (5,504

Cash received for the sale of non-controlling interests

  —        849   

Cash paid for the repurchase of non-controlling interests

  (600   (1,018

Other

  (1,838   —     
  

 

 

   

 

 

 

Net cash provided by (used in) financing activities — continuing operations

  (25,744   38,148   

Net cash provided by (used in) financing activities — discontinued operations

  (100   389   
  

 

 

   

 

 

 

Net cash provided by (used in) financing activities

  (25,844   38,537   
  

 

 

   

 

 

 

Change in cash and cash equivalents

  (120,488   (31,026

Cash and cash equivalents at beginning of period

  438,131      48,882   
  

 

 

   

 

 

 

Cash and cash equivalents at end of period

$ 317,643    $ 17,856   
  

 

 

   

 

 

 

Supplemental disclosure of cash flow information:

Cash paid for interest

$ 111,152    $ 112,789   
  

 

 

   

 

 

 

Cash paid for income taxes, net

$ 39,030    $ 2,122   
  

 

 

   

 

 

 

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, 2014 and 2013, 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 acute care hospitals primarily located in high-growth urban and suburban markets. At June 30, 2014, the Company owned or leased 15 acute care hospital facilities and one behavioral health hospital included in continuing operations, with a total of 3,601 licensed beds, several outpatient service facilities and more than 135 physician clinics. The Company operates in various regions, including:

 

    Salt Lake City, Utah;

 

    Phoenix, Arizona;

 

    five cities in Texas, including Houston and San Antonio; and

 

    West Monroe, Louisiana.

The Company also owns and operates Health Choice Arizona, Inc. and related entities (“Health Choice” or the “Plan”) that constitute a provider-owned, managed care organization and insurer that delivers healthcare services to over 266,000 members through multiple health plans, integrated delivery systems and managed care solutions. The Plan is headquartered 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, 2013, 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 notes thereto included in the Company’s Annual Report on Form 10-K for the fiscal year ended September 30, 2013, which was filed with the U.S. Securities and Exchange Commission (the “SEC”) on December 20, 2013.

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 or any other future periods.

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 (Restated)

The majority of the Company’s expenses are “cost of revenue” items. Costs that could be classified as “general and administrative” by the Company include the IASIS corporate office costs (excluding stock-based compensation costs), which were $11.5 million and $9.7 million for the quarters ended June 30, 2014 and 2013, respectively, and $39.9 million and $27.5 million for the nine months ended June 30, 2014 and 2013, respectively.

Cash and Cash Equivalents

The Company considers highly liquid investments with original maturities of three months or less to be cash equivalents. The Company maintains its cash and cash equivalents balance primarily with high credit quality financial institutions. The Company manages its credit exposure by placing its investments in U.S. Treasury securities or other high quality securities, and by periodically evaluating the relative credit standing of the financial institution.

As discussed in Note 3, cash generated from certain asset dispositions may be subject to prepayment requirements under our senior credit agreement and indenture.

Stock-Based Compensation (Restated)

Although IASIS has no stock option plan or outstanding stock options, the Company, through its parent, IAS, grants stock options for a fixed number of common shares to employees. The Company accounts for this stock-based incentive plan under the measurement and recognition provisions of Financial Accounting Standards Board (“FASB”) authoritative guidance regarding share-based payments (“Share-Based Payments Guidance”). Accordingly, the Company applies the fair value recognition provisions requiring all share-based payments to employees, including grants of employee stock options, to be recognized in the income statement based on the estimated grant date fair value of each stock-based award. In accordance with the provisions of the Share-Based Payments Guidance, the Company uses the Black-Scholes-Merton model in determining the fair value of its share-based payments. The fair value of compensation costs for time-vested options will generally be amortized on a straight-line basis over the requisite service periods of the awards, generally equal to the awards’ vesting periods, while the fair value of compensation costs for options with market-based conditions are recognized on a graded schedule generally over the awards’ vesting periods.

On October 18, 2013, IAS distributed $115.0 million in a cash dividend to its common stockholders. In connection with this shareholder distribution, the board of directors of IAS authorized management to modify the exercise price of all outstanding stock options to provide protection against the dilutive impact of the common stock dividend on the outstanding options’ intrinsic value. On January 23, 2014, the Company reduced the exercise price for each grant by $7.86 per option. Accordingly, as a result of the modification, an additional $4.0 million of stock-based compensation was recognized in the second quarter of fiscal 2014.

During the quarter ended June 30, 2014, the Company completed certain equity transactions that included the following: (1) the issuance to certain employees of 756,000 options to purchase the common stock of IAS; (2) the exercise by option holders of 1,149,663 options with near-term expiration dates to purchase the common stock of IAS on cashless net settlement basis; (3) the issuance to employees of 992,000 restricted stock units (“RSUs”) that vest at the end of a three year service period; and (4) the exchange of 802,272 out-of-the-money options to purchase the common stock of IAS for RSUs on a 5-for-1 basis that vest at the end of a three year service period. In connection with these equity compensation instruments, the Company recognized $3.7 million of stock-based compensation during the quarter ended June 30, 2014.

Fair Value of Financial Instruments

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 certain financial instruments. This authoritative guidance establishes a three-tier fair value hierarchy, which prioritizes the inputs used in measuring fair value. These tiers include: (i) Level 1, which is defined as quoted prices in active markets that can be accessed at the measurement date; (ii) Level 2, which is defined as inputs other than quoted prices in active markets that are observable, either directly or indirectly; and (iii) Level 3, which is defined as unobservable inputs resulting from the existence of little or no market data, therefore potentially requiring an entity to develop its own assumptions.

 

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IASIS HEALTHCARE LLC

NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (UNAUDITED)

 

Cash and cash equivalents, accounts receivable, inventories, prepaid and other current assets, accounts payable, salaries payable, accrued interest, medical claims payable, and other accrued expenses and other current liabilities are reflected in the accompanying unaudited condensed consolidated financial statements at amounts that approximate fair value because of the short-term nature of these instruments. The fair value of the Company’s capital leases and other long-term financing obligations also approximate carrying value as they bear interest at current market rates. The estimated fair values of the Company’s 8.375% senior notes due 2019 (the “Senior Notes”) and senior secured term loan facility were based upon quoted market prices at that date and are categorized as Level 2 within the fair value hierarchy.

The carrying values and fair values of the senior secured term loan facility and the Senior Notes as of June 30, 2014 and September 30, 2013 were as follows (in thousands):

 

     Carrying Amount      Fair Value  
     June 30,
2014
     September 30,
2013
     June 30,
2014
     September 30,
2013
 

Senior secured term loan facility

   $ 989,150       $ 996,154       $ 996,301       $ 1,003,258   

Senior Notes

     846,287         845,711         907,375         882,938   

The Company determines the fair value of its interest rate hedges 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 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 hedges as Level 2.

Discontinued Operations

The following table provides the components of discontinued operations (in thousands):

 

     Quarter Ended
June 30,
     Nine Months Ended
June 30,
 
     2014      2013      2014      2013  

Acute care revenue less provision for bad debts

   $ 14,223       $ 74,009       $ 37,097       $ 222,264   

Earnings (loss) before income taxes

     (9,484      (1,192      (8,431      4,862   

Income tax benefit (expense) from discontinued operations

     3,285         861         2,645         (2,101
  

 

 

    

 

 

    

 

 

    

 

 

 

Earnings (loss) from discontinued operations, net of income tax

$ (6,199 $ (331 $ (5,786 $ 2,761   
  

 

 

    

 

 

    

 

 

    

 

 

 

Effective October 1, 2013, the Company completed the sale of its Florida operations which primarily included three hospitals in the Tampa-St. Petersburg area and all related physician operations. Accordingly, the operating results and cash flows of the Florida operations are reported as discontinued operations for all periods presented. The aggregate proceeds from the sale were $144.8 million, which resulted in a gain on the sale of assets totaling $22.2 million during the quarter ended December 31, 2013. This gain was included in discontinued operations for the quarter ended December 31, 2013.

On September 26, 2014, the Company approved and committed to a plan to dispose of its Nevada operations, which included one hospital in the Las Vegas area and all related physician operations. The sale of the Company’s Nevada operations closed January 22, 2015. In connection with the Company’s restatement described in Note 1A, the Company’s Nevada operations have been reclassified herein as discontinued operations, and the operating results and cash flows of the Nevada operations have been retrospectively reported as discontinued operations for all periods presented in this Form 10-Q/A.

Recent Accounting Pronouncements

Newly Adopted

In February 2013, the FASB issued Accounting Standards Update (“ASU”) No. 2013-02, “Comprehensive Income — Reporting of Amounts Reclassified Out of Accumulated Other Comprehensive Income.” ASU 2013-02 requires entities to report the effect of significant reclassifications out of accumulated other comprehensive income on the respective line items in net income if the amount being reclassified is required under GAAP to be reclassified in its entirety to net income. For other amounts that are not required under GAAP to be reclassified in their entirety to net income in the same reporting period, an entity is required to cross-reference other disclosures required under GAAP that provide additional detail about those amounts. ASU 2013-02 is required to be applied prospectively and is effective for fiscal years beginning after December 15, 2012, and interim periods within those years. The Company has adopted this authoritative guidance effective October 1, 2013. At June 30, 2014, the Company’s only component of accumulated other comprehensive loss relates to unrecognized changes in fair value of interest rate swaps. No reclassifications out of accumulated other comprehensive loss into net earnings (loss) were made during the quarter and nine months ended June 30, 2014, as the Company determined that these cash flow hedges were highly effective.

 

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IASIS HEALTHCARE LLC

NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (UNAUDITED)

 

In July 2011, the FASB issued ASU No. 2011-06, “Other Expenses (Topic 720): Fees Paid to the Federal Government by Health Insurers”. Effective January 1, 2014, the Company adopted this new authoritative guidance relating to the recognition and income statement reporting of the mandated health insurer fee (“HIF”) to be paid to the federal government by health insurers, as part of Patient Protection and Affordable Care Act and the Health Care and Education Reconciliation Act of 2010, or collectively, Health Reform Law, which is imposed for calendar years beginning after December 31, 2013. The HIF is based on a company’s share of the industry’s net premiums written during the preceding calendar year, and is payable on September 30 of each year.

The Company estimates Health Choice’s portion of the HIF for the 2014 calendar year to be approximately $7.9 million. The final calculation and payment of the HIF will occur in the Company’s fiscal fourth quarter of 2014. The HIF is non-deductible for federal income tax purposes. ASU 2011-06 addresses how the HIF should be recognized and classified in the financial statements of health insurers. In accordance with ASU 2011-06, the Company recorded the estimated liability for the HIF in full with a corresponding deferred asset that is being amortized to expense on a straight-line basis. The Company’s estimated liability for the HIF is recorded within other accrued expenses and other current liabilities on the unaudited condensed consolidated balance sheet. The corresponding deferred asset is recorded within prepaid expenses and other current assets on the unaudited condensed consolidated balance sheet. During the quarter and nine months ended June 30, 2014, the Company recognized $4.0 million in other operating expenses related to amortization of the HIF, with a remaining deferred cost asset balance of $3.9 million. No such amounts were recorded at September 30, 2013 as the qualifying insurance coverage was not provided until January 1, 2014. Because Health Choice primarily serves individuals in government-sponsored programs, Health Choice must secure additional reimbursement from state partners for this added cost. The Company recognizes HIF revenue when there is a contractual commitment from the state to reimburse Health Choice for the full economic impact of the health insurer fee. This HIF revenue is recognized ratably throughout the year.

Recently Issued

In April 2014, the FASB issued ASU No. 2014-08, “Presentation of Financial Statements and Property, Plant, and Equipment—Reporting Discontinued Operations and Disclosures of Disposals of Components of an Entity.” Among other provisions and in addition to expanded disclosures, ASU 2014-08 changes the definition of what components of an entity qualify for discontinued operations treatment and reporting from a reportable segment, operating segment, reporting unit, subsidiary or asset group to only those components of an entity that represent a strategic shift that has, or will have, a major effect on an entity’s operations and financial results. Additionally, ASU 2014-08 requires disclosure about a disposal of an individually significant component of an entity that does not qualify for discontinued operations presentation in the financial statements, including the pretax profit or loss attributable to the component of an entity for the period in which it is disposed of or is classified as held for sale. The disclosure of this information is required for all of the same periods that are presented in the entity’s results of operations for the period. The provisions of ASU 2014-08 are effective prospectively for all disposals or classifications as held for sale of components of an entity that occur within annual periods beginning on or after December 15, 2014, and interim periods within those years. Early adoption is permitted.

In May 2014, the FASB issued ASU No. 2014-09, “Revenue from Contracts with Customers” which outlines a single comprehensive model for recognizing revenue and supersedes most existing revenue recognition guidance, including guidance specific to the healthcare industry. In addition, ASU 2014-09 will require new and enhanced disclosures. Companies can adopt the new standard either using the full retrospective approach, a modified retrospective approach with practical expedients, or a cumulative effect upon adoption approach. ASU 2014-09 will become effective for annual and interim reporting periods beginning after December 15, 2016. Early adoption is not permitted. The Company is currently evaluating the effect of the new revenue recognition guidance.

1A. RESTATEMENT OF PREVIOUSLY ISSUED CONDENSED CONSOLIDATED FINANCIAL STATEMENTS

The Company has restated its condensed consolidated financial statements for the quarter and nine months ended June 30, 2014. The determination to restate the Company’s condensed consolidated financial statements occurred after Company management, through an internal review of the program settlement process described below identified certain errors made by a former managed care division finance employee. Subject to restatement is the Company’s condensed consolidated balance sheet as of June 30, 2014, and the related condensed consolidated statements of operations, comprehensive income (loss), equity and cash flows for the quarter and nine months ended June 30, 2014 and affected footnotes. This restatement corrects errors for the quarter and nine months ended June 30, 2014 in the accounting for estimated program settlement amounts (the “program settlements”) for one of the Company’s managed Medicaid plans, and corrects certain other errors determined to be immaterial individually and in the aggregate to the condensed consolidated financial statements.

 

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IASIS HEALTHCARE LLC

NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (UNAUDITED)

 

Estimates of future program settlements are calculated and recorded based on projected and known medical claims and member eligibility. The program settlement process typically occurs in the 18 months post-plan year, when actual (rather than projected) medical claims and member eligibility information is fully available and a net settlement amount is either due to or from the state. In the third quarter of fiscal 2014, the Company’s revenue and receivables associated with these program settlements were overstated and other accrued expenses and other current liabilities were understated. These errors did not involve any cash payments, as actual final program settlements are not paid until the end of the reconciliation process.

The impact of the correction of errors on the affected line items of the Company’s consolidated balance sheet as of June 30, 2014 and the consolidated statements of operations, cash flows and comprehensive income (loss) for the quarter and nine months ended June 30, 2014 is set forth below (in thousands):

Consolidated Balance Sheet

as of June 30, 2014

 

     As Previously
Reported
     Adjustments     As Restated  

Deferred income taxes, current assets

   $ 15,491       $ (800   $ 14,691   

Prepaid expenses and other current assets

     181,224         3,705        184,929   

Total current assets

     909,289         2,905        912,194   

Property and equipment, net

     843,138         894        844,032   

Total assets

     2,651,954         3,799        2,655,753   

Other accrued expenses and other current liabilities

     61,308         15,539        76,847   

Total current liabilities

     325,928         15,539        341,467   

Deferred income taxes, noncurrent liabilities

     114,460         217        114,677   

Member’s equity

     132,263         (11,957     120,306   

Total equity

     141,971         (11,957     130,014   

Total liabilities and equity

     2,651,954         3,799        2,655,753   

Our unaudited condensed consolidated financial statements for the quarter and nine months ended June 30, 2014 and 2013, have been retrospectively revised to reflect the operating results and cash flows of the Nevada operations as discontinued operations. On September 26, 2014, the Company approved and committed to a plan to dispose of its Nevada operations, which included one hospital in the Las Vegas area and all related physician operations. The sale of the Company’s Nevada operations closed January 22, 2015. Please see Note 1 to our unaudited condensed consolidated financial statements for additional related disclosures.

Consolidated Statement of Operations

for the Quarter Ended June 30, 2014

 

     As Previously
Reported,
Revised for
Discontinued
Operations
    Adjustments     As Restated  

Premium revenue

   $ 200,281      $ (21,783   $ 178,498   

Total revenue

     654,531        (21,783     632,748   

Salaries and benefits

     222,542        (1,096     221,446   

Depreciation and amortization

     22,546        876        23,422   

Total costs and expenses

     645,247        (220     645,027   

Earnings (loss) from continuing operations before gain on disposal of assets, net

     9,284        (21,563     (12,279

Gain on disposal of assets, net

     332        1,770        2,102   

Earnings (loss) from continuing operations before income taxes

     9,616        (19,793     (10,177

Income tax expense

     7,784        (6,646     1,138   

Net earnings (loss) from continuing operations

     1,832        (13,147     (11,315

Net loss

     (4,324     (13,190     (17,514

Net loss attributable to IASIS Healthcare LLC

     (6,777     (13,190     (19,967

 

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IASIS HEALTHCARE LLC

NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (UNAUDITED)

 

Consolidated Statement of Operations

for the Nine Months Ended June 30, 2014

 

     As Previously
Reported,
Revised for
Discontinued
Operations
    Adjustments     As Restated  

Premium revenue

   $ 524,995      $ (21,783   $ 503,212   

Total revenue

     1,878,203        (21,783     1,856,420   

Salaries and benefits

     665,549        (1,096     664,453   

Depreciation and amortization

     69,772        876        70,648   

Total costs and expenses

     1,858,276        (220     1,858,056   

Earnings (loss) from continuing operations before gain on disposal of assets, net

     19,927        (21,563     (1,636

Gain on disposal of assets, net

     1,098        1,770        2,868   

Earnings from continuing operations before income taxes

     21,025        (19,793     1,232   

Income tax expense

     14,033        (6,646     7,387   

Net earnings (loss) from continuing operations

     6,992        (13,147     (6,155

Net earnings (loss)

     1,249        (13,190     (11,941

Net loss attributable to IASIS Healthcare LLC

     (7,608     (13,190     (20,798

Consolidated Statement of Comprehensive Loss

for the Quarter Ended June 30, 2014

 

     As Previously
Reported,
Revised for
Discontinued
Operations
    Adjustments     As Restated  

Net loss

   $ (4,324   $ (13,190   $ (17,514

Comprehensive loss

     (4,198     (13,190     (17,388

Comprehensive loss attributable to IASIS Healthcare LLC

     (6,651     (13,190     (19,841

Consolidated Statement of Comprehensive Loss

for the Nine Months Ended June 30, 2014

 

     As Previously
Reported,
Revised for
Discontinued
Operations
    Adjustments     As Restated  

Net earnings (loss)

   $ 1,249      $ (13,190   $ (11,941

Comprehensive income (loss)

     1,990        (13,190     (11,200

Comprehensive loss attributable to IASIS Healthcare LLC

     (6,967     (13,190     (20,057

 

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IASIS HEALTHCARE LLC

NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (UNAUDITED)

 

Consolidated Statement of Cash Flows

for the Nine Months Ended June 30, 2014

 

     As Previously
Reported,
Revised for
Discontinued
Operations
    Adjustments     As Restated  

Net earnings (loss)

   $ 1,249      $ (13,190   $ (11,941

Adjustments to reconcile net earnings (loss) to net cash provided by (used in) operating activities:

      

Depreciation and amortization

     69,772        876        70,648   

Stock-based compensation

     8,796        1,237        10,033   

Deferred income taxes

     (2,168     1,153        (1,015

Income tax benefit from parent

     9        (4     5   

Gain on disposal of assets, net

     (1,098     (1,770     (2,868

Changes in operating assets and liabilities, net of the effect of acquisitions and dispositions

      

Inventories, prepaid expenses and other current assets

     (42,611     (10,795     (53,406

Accounts payable, other accrued expenses and other accrued liabilities

     (11,941     22,493        10,552   

2. ACUTE CARE REVENUE AND ALLOWANCE FOR DOUBTFUL ACCOUNTS

Acute Care Revenue

The Company’s healthcare facilities have entered into agreements with third-party payors, including government programs and managed care health plans, under which the facilities are paid based upon established charges, the cost of providing services, predetermined rates per diagnosis, fixed per diem rates or discounts from established charges. Additionally, the Company offers discounts through its uninsured discount program to all uninsured patients receiving healthcare services who do not qualify for assistance under state Medicaid, other federal or state assistance plans, or charity care.

Acute care revenue is reported at the estimated net realizable amounts from third-party payors and others for services rendered, including estimated retroactive adjustments under reimbursement agreements with third-party payors. Retroactive adjustments are accrued on an estimated basis in the period the related services are rendered and are adjusted, if necessary, in future periods when final settlements are determined. The Company also records a provision for bad debts related to uninsured accounts to reflect its self-pay accounts receivable at the estimated amounts expected to be collected. The sources of the Company’s hospital net patient revenue by payor before the provision for bad debts are summarized as follows:

 

     Quarter Ended
June 30,
    Nine Months Ended
June 30,
 
     2014     2013     2014     2013  

Medicare

     20.5     21.1     20.8     21.5

Managed Medicare

     10.5     10.6     10.6     10.5

Medicaid and managed Medicaid

     12.8     10.8     12.2     11.3

Managed care and other

     42.6     39.6     41.7     39.3

Self-pay

     13.6     17.9     14.7     17.4
  

 

 

   

 

 

   

 

 

   

 

 

 

Total

  100.0   100.0   100.0   100.0
  

 

 

   

 

 

   

 

 

   

 

 

 

Allowance For Doubtful Accounts

The provision for bad debts and the associated allowance for doubtful accounts relate primarily to amounts due directly from patients. The Company’s estimation of its allowance for doubtful accounts is based primarily upon the type and age of the patient accounts receivable and the effectiveness of collection efforts. The Company’s policy is to reserve a portion of all self-pay

 

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IASIS HEALTHCARE LLC

NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (UNAUDITED)

 

receivables, including amounts due from the uninsured and amounts related to co-payments and deductibles, as these charges are recorded. The Company monitors accounts receivable balances and the effectiveness of reserve policies on at least a quarterly and reviews various analytics to support the basis for its estimates. These efforts primarily consist of reviewing the following:

 

    Historical write-off and collection experience using a hindsight or look-back approach;

 

    Revenue and volume trends by payor, particularly the self-pay components;

 

    Changes in the aging and payor mix of accounts receivable, including increased focus on accounts due from the uninsured and accounts that represent co-payments and deductibles due from patients;

 

    Cash collections as a percentage of net patient revenue less bad debts;

 

    Trending of days revenue in accounts receivable; and

 

    Various allowance coverage statistics.

The Company performs hindsight procedures to evaluate historical write-off and collection experience throughout the year to assist in determining the reasonableness of the process for estimating the allowance for doubtful accounts. The Company does not pursue collection of amounts related to patients who qualify for charity care under the Company’s guidelines. Charity care accounts are deducted from gross revenue and do not affect the provision for bad debts.

At June 30, 2014 and September 30, 2013, the Company’s net self-pay receivables, including amounts due from uninsured patients and co-payment and deductible amounts due from insured patients, were $293.7 million and $336.2 million, respectively. At June 30, 2014 and September 30, 2013, the Company’s allowance for doubtful accounts was $232.8 million and $255.7 million, respectively.

3. LONG-TERM DEBT AND CAPITAL LEASE OBLIGATIONS

Long-term debt and capital lease obligations consist of the following (in thousands):

 

     June 30,
2014
     September 30,
2013
 

Senior secured term loan facility

   $ 989,150       $ 996,154   

Senior Notes

     846,287         845,711   

Capital leases and other obligations

     21,531         24,178   
  

 

 

    

 

 

 
  1,856,968      1,866,043   

Less current maturities

  13,180      13,221   
  

 

 

    

 

 

 
$ 1,843,788    $ 1,852,822   
  

 

 

    

 

 

 

As of June 30, 2014, the senior secured term loan facility balance reflects an original issue discount (“OID”) of $2.8 million, which is net of accumulated amortization of $2.3 million. The Senior Notes balance reflects an OID of $3.7 million, which is net of accumulated amortization of $2.4 million.

As of June 30, 2014 and September 30, 2013, capital leases and other obligations includes a financing obligation totaling $10.5 million and $11.1 million, respectively, resulting from the Company’s sale-leaseback transactions which closed on September 26, 2013.

$1.325 Billion Senior Secured Credit Facilities

The Company is party to a senior credit agreement, which was amended on February 20, 2013 (the “Repricing Amendment”) as part of a repricing that lowered the interest rate, (the “Amended and Restated Credit Agreement”). The Amended and 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 of $1.007 billion outstanding as of the effective date of the Repricing Amendment, 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.

 

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IASIS HEALTHCARE LLC

NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (UNAUDITED)

 

Borrowings under the senior secured term loan facility (giving effect to the Repricing Amendment) 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 2.25% 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 3.25% 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 is 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 Amended and 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 Amended and 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 Amended and 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; (4) limitations on dividends and distributions; and (5) limitations on transactions with affiliates, in each case, subject to certain exceptions. The Amended and 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

The Company, together with its wholly owned subsidiary IASIS Capital Corporation (“IASIS Capital”) (together, the “Issuers”), have issued $850.0 million aggregate principal amount of 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, payable semi-annually, in cash in arrears, on May 15 and November 15 of each year.

The Company may redeem the Senior Notes, in whole or in part, at any time on or after May 15, 2014, at a price equal to 106.281% 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. Each subsequent year the redemption price declines 2.093% until 2017 and thereafter, at which point the redemption price is equal to 100% 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.

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; (6) impose restrictions on the ability of a subsidiary to pay dividends or make payments or distributions to the Company and its restricted subsidiaries; and (7) 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.

 

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NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (UNAUDITED)

 

4. INTEREST RATE SWAPS

In August 2011, the Company executed forward starting interest rate swaps with Citibank N.A. and Barclays Bank PLC, as counterparties, with notional amounts totaling $350.0 million, each agreement effective March 28, 2013 and expiring between September 30, 2014 and September 30, 2016. Under these agreements, the Company is required to make quarterly fixed rate payments at annual rates ranging from 1.6% to 2.2%. The counterparties are obligated to make quarterly floating rate payments to the Company based on the three-month LIBOR rate, each subject to a floor of 1.25%. The Company completed an assessment of these cash flow hedges during the quarters and nine months ended June 30, 2014 and 2013, and determined that these hedges were highly effective. Accordingly, no gain or loss related to these hedges has been reflected in the accompanying unaudited condensed consolidated statements of operations, and the change in fair value has been included in accumulated other comprehensive loss as a component of member’s equity.

 

     Total Notional
Amounts
 

Effective Dates

   (in thousands)  

Effective from March 28, 2013 to September 30, 2014

   $ 50,000   

Effective from March 28, 2013 to September 30, 2015

     100,000   

Effective from March 28, 2013 to September 30, 2016

     200,000   

The fair value of the Company’s interest rate hedges at June 30, 2014 and September 30, 2013, reflect liability balances of $4.7 million and $5.9 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 hedges 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 hedging agreements, as compared to the amount due the Company’s counterparties under the fixed interest rate component.

5. GOODWILL

The following table presents the changes in the carrying amount of goodwill (in thousands):

 

     Acute
Care
     Health
Choice
     Total  

Balance at September 30, 2013

   $ 810,653       $ 5,757       $ 816,410   

Adjustments related to acquisitions

     (825      —          (825
  

 

 

    

 

 

    

 

 

 

Balance at June 30, 2014

$ 809,828    $ 5,757    $ 815,585   
  

 

 

    

 

 

    

 

 

 

6. ACCUMULATED OTHER COMPREHENSIVE LOSS

The components of accumulated other comprehensive loss, net of income taxes, are as follows (in thousands):

 

     June 30,
2014
     September 30,
2013
 

Fair value of interest rate hedges

   $ (4,739    $ (5,918

Income tax benefit

     1,851         2,289   
  

 

 

    

 

 

 

Accumulated other comprehensive loss

$ (2,888 $ (3,629
  

 

 

    

 

 

 

7. INCOME TAXES (RESTATED)

For the quarter ended June 30, 2014, the Company recorded income tax expense of $1.1 million, for an effective tax rate of (11.2%), compared to income tax expense of $4.0 million, for an effective tax rate of 42.7% in the prior year quarter. For the nine months ended June 30, 2014, the Company recorded income tax expense of $7.4 million, for an effective tax rate of 599.6%, compared to income tax expense of $6.4 million, for an effective tax rate of 46.8% in the prior year period. The change in the effective tax rate was primarily due to the following: (1) an increase in nondeductible compensation, including stock-based compensation; (2) a $1.5 million expense related to an excess of cumulative compensation deductions over the realized tax benefit upon the exercise of employee stock options; (3) the HIF imposed by the Health Reform Law beginning in 2014, which is treated as a nondeductible excise tax; and (4) the decrease in net earnings from continuing operations, which magnified the rate impact of state income taxes (including the Texas margins tax), noncontrolling interests, and other adjustments.

 

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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, 2014 and September 30, 2013, the Company’s professional and general liability accrual for asserted and unasserted claims totaled $67.3 million and $68.2 million, respectively.

The Company is subject to claims and legal actions in the ordinary course of business relative to workers’ compensation matters. To cover these types of claims, the Company maintains workers’ compensation insurance coverage with a self-insured retention. The Company accrues the costs of workers’ compensation claims based upon estimates derived from its claims experience.

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”), the state of Utah’s Medicaid agency and the Centers for Medicare and 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 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, 2014, the Company has provided a performance guaranty in the form of a letter of credit totaling $44.9 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

In November 2010, the U.S. Department of Justice (“DOJ”) sent a letter to the Company 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”) during the period 2003 to the present. At that time, neither the precise number of procedures, number of claims, nor the hospitals involved were identified by the DOJ. The Company understands that the government is conducting a national initiative with respect to ICD procedures involving a number of healthcare providers and is seeking information in order to determine if ICD implantation procedures were performed in accordance with Medicare coverage requirements. On January 11, 2011, the Company entered into the tolling agreement with the DOJ and, subsequently, the DOJ has provided the Company 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 its

 

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hospitals. Applying the resolution model proposed by the DOJ, the Company believes that at least 131 of these procedure claims were properly documented for medical necessity and billed appropriately. The Company’s outside counsel has submitted to the DOJ summary justifications and supporting evidence relating to the medical claims at six of the Company’s hospitals. The Company continues to provide support for the remaining 63 of these cases that could have some likelihood of enforcement by the DOJ. If the Company is unable to place these claims in a non-enforcement or lesser enforcement category, the government may require repayment, which could impose a multiplier. Given the case-specific nature of the claims and the DOJ’s discretion to compromise claims, the Company is unable at this time to estimate any potential repayment obligation related to this matter. The tolling agreement between the Company and the government, as recently extended, is currently set to expire December 31, 2014.

On September 25, 2013, the Company voluntarily self-disclosed for resolution through the Self-Referral Disclosure Protocol established by CMS non-compliance by ten of its affiliated hospitals with a certain element of an exception of the Stark Law. Provisions of the Affordable Care Act that became effective on September 23, 2011 require, as an element of the Stark Law’s “whole-hospital” exception, that hospitals having physician ownership disclose such ownership on their public websites and in public advertising. The self-disclosure states that, on August 12, 2013, the Company discovered that the ten Company-affiliated hospitals partially owned by physicians did not consistently make such disclosures. The self-disclosure also states that, on August 13, 2013, the hospitals added the disclosures to those public websites that did not previously have them and began to include the disclosures in new public advertising. The self-disclosure explains that, as a result of the absence of the website and advertising disclosures, the referrals of direct and indirect physician owners (and physicians who are immediate family members of direct and indirect owners) to the physician-owned hospitals of Medicare beneficiaries did not consistently qualify for the Stark Law’s “whole-hospital” exception from September 23, 2011 through August 13, 2013. On October 21, 2013, the Company submitted a supplement to its self-disclosure, reporting Medicare payments to these hospitals for services resulting from referrals affected by the non-compliance and the hospitals’ profit distributions to physicians (and known immediate family members of physicians) with respect to their ownership interests in the hospitals during the same period. The Company has been in communication with CMS about resolving this matter but, at present, CMS has made no commitments, as a general matter or in this case, regarding the timing or substance of resolution of self-disclosed Stark Law noncompliance through the voluntary CMS Self-Referral Disclosure Protocol. As a result, the Company expresses no opinion as to its outcome other than to state that it could take up to one year or longer to resolve and, at this time, any repayment obligation or other penalties to be determined by CMS is unknown and not currently estimable.

 

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9. SEGMENT INFORMATION

The Company’s reportable operating segments consist of (1) acute care hospitals and related healthcare businesses, collectively 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, 2014 (Restated)  
     Acute Care      Health Choice      Eliminations      Consolidated  

Acute care revenue before provision for bad debts

   $ 531,380       $ —         $ —         $ 531,380   

Less: Provision for bad debts

     (77,130      —           —           (77,130
  

 

 

    

 

 

    

 

 

    

 

 

 

Acute care revenue

  454,250      —        —        454,250   

Premium revenue

  —        178,498      —        178,498   

Revenue between segments

  3,262      —        (3,262   —     
  

 

 

    

 

 

    

 

 

    

 

 

 

Total revenue

  457,512      178,498      (3,262   632,748   

Salaries and benefits (excludes stock-based compensation)

  206,838      8,929      —        215,767   

Supplies

  75,034      70      —        75,104   

Medical claims

  —        169,205      (3,262   165,943   

Rentals and leases

  17,750      448      —        18,198   

Other operating expenses

  97,278      13,059      —        110,337   

Medicare and Medicaid EHR incentives

  (2,940   —        —        (2,940
  

 

 

    

 

 

    

 

 

    

 

 

 

Adjusted EBITDA(1)

  63,552      (13,213   —        50,339   

Interest expense, net

  32,267      —        —        32,267   

Depreciation and amortization

  22,390      1,032      —        23,422   

Stock-based compensation

  5,679      —        —        5,679   

Management fees

  1,250      —        —        1,250   
  

 

 

    

 

 

    

 

 

    

 

 

 

Earnings (loss) from continuing operations before gain on disposal of assets and income taxes

  1,966      (14,245   —        (12,279

Gain on disposal of assets, net

  2,102      —        —        2,102   
  

 

 

    

 

 

    

 

 

    

 

 

 

Earnings (loss) from continuing operations before income taxes

$ 4,068    $ (14,245 $ —      $ (10,177
  

 

 

    

 

 

    

 

 

    

 

 

 

 

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     For the Quarter Ended June 30, 2013  
     Acute Care      Health Choice      Eliminations      Consolidated  

Acute care revenue before provision for bad debts

   $ 518,142       $ —         $ —         $ 518,142   

Less: Provision for bad debts

     (81,710      —           —           (81,710
  

 

 

    

 

 

    

 

 

    

 

 

 

Acute care revenue

  436,432      —        —        436,432   

Premium revenue

  —        139,804      —        139,804   

Revenue between segments

  1,940      —        (1,940   —     
  

 

 

    

 

 

    

 

 

    

 

 

 

Total revenue

  438,372      139,804      (1,940   576,236   

Salaries and benefits (excludes stock-based compensation)

  200,585      6,090      —        206,675   

Supplies

  73,825      40      —        73,865   

Medical claims

  —        118,580      (1,940   116,640   

Rentals and leases

  12,961      395      —        13,356   

Other operating expenses

  96,720      5,993      —        102,713   

Medicare and Medicaid EHR incentives

  (4,827   —        —        (4,827
  

 

 

    

 

 

    

 

 

    

 

 

 

Adjusted EBITDA(1)

  59,108      8,706      —        67,814   

Interest expense, net

  32,770      —        —        32,770   

Depreciation and amortization

  22,833      1,029      —        23,862   

Stock-based compensation

  947      —        —        947   

Management fees

  1,250      —        —        1,250   
  

 

 

    

 

 

    

 

 

    

 

 

 

Earnings from continuing operations before gain on disposal of assets and income taxes

  1,308      7,677      —        8,985   

Gain on disposal of assets, net

  478      —        —        478   
  

 

 

    

 

 

    

 

 

    

 

 

 

Earnings from continuing operations before income taxes

$ 1,786    $ 7,677    $ —      $ 9,463   
  

 

 

    

 

 

    

 

 

    

 

 

 

 

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     For the Nine Months Ended June 30, 2014 (Restated)  
     Acute Care      Health Choice      Eliminations      Consolidated  

Acute care revenue before provision for bad debts

   $ 1,613,457       $ —         $ —         $ 1,613,457   

Less: Provision for bad debts

     (260,249      —           —           (260,249
  

 

 

    

 

 

    

 

 

    

 

 

 

Acute care revenue

  1,353,208      —        —        1,353,208   

Premium revenue

  —        503,212      —        503,212   

Revenue between segments

  8,539      —        (8,539   —     
  

 

 

    

 

 

    

 

 

    

 

 

 

Total revenue

  1,361,747      503,212      (8,539   1,856,420   

Salaries and benefits (excludes stock-based compensation)

  630,760      23,660      —        654,420   

Supplies

  227,242      173      —        227,415   

Medical claims

  —        445,293      (8,539   436,754   

Rentals and leases

  53,279      1,165      —        54,444   

Other operating expenses

  283,143      28,443      —        311,586   

Medicare and Medicaid EHR incentives

  (9,294   —        —        (9,294
  

 

 

    

 

 

    

 

 

    

 

 

 

Adjusted EBITDA(1)

  176,617      4,478      —        181,095   

Interest expense, net

  98,300      —        —        98,300   

Depreciation and amortization

  67,511      3,137      —        70,648   

Stock-based compensation

  10,033      —        —        10,033   

Management fees

  3,750      —        —        3,750   
  

 

 

    

 

 

    

 

 

    

 

 

 

Earnings (loss) from continuing operations before gain on disposal of assets and income taxes

  (2,977   1,341      —        (1,636

Gain on disposal of assets, net

  2,868      —        —        2,868   
  

 

 

    

 

 

    

 

 

    

 

 

 

Earnings (loss) from continuing operations before income taxes

$ (109 $ 1,341    $ —      $ 1,232   
  

 

 

    

 

 

    

 

 

    

 

 

 

Segment assets

$ 2,314,576    $ 341,177    $ 2,655,753   
  

 

 

    

 

 

       

 

 

 

Capital expenditures

$ 74,958    $ 1,126    $ 76,084   
  

 

 

    

 

 

       

 

 

 

Goodwill

$ 809,828    $ 5,757    $ 815,585   
  

 

 

    

 

 

       

 

 

 

 

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NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (UNAUDITED)

 

     For the Nine Months Ended June 30, 2013  
     Acute Care      Health Choice      Eliminations      Consolidated  

Acute care revenue before provision for bad debts

   $ 1,533,490       $ —         $ —         $ 1,533,490   

Less: Provision for bad debts

     (233,456      —           —           (233,456
  

 

 

    

 

 

    

 

 

    

 

 

 

Acute care revenue

  1,300,034      —        —        1,300,034   

Premium revenue

  —        422,059      —        422,059   

Revenue between segments

  5,334      —        (5,334   —     
  

 

 

    

 

 

    

 

 

    

 

 

 

Total revenue

  1,305,368      422,059      (5,334   1,722,093   

Salaries and benefits (excludes stock-based compensation)

  613,663      17,620      —        631,283   

Supplies

  224,237      142      —        224,379   

Medical claims

  —        353,890      (5,334   348,556   

Rentals and leases

  37,776      1,192      —        38,968   

Other operating expenses

  280,928      17,499      —        298,427   

Medicare and Medicaid EHR incentives

  (9,884   —        —        (9,884
  

 

 

    

 

 

    

 

 

    

 

 

 

Adjusted EBITDA(1)

  158,648      31,716      —        190,364   

Interest expense, net

  99,986      —        —        99,986   

Depreciation and amortization

  67,549      3,096      —        70,645   

Stock-based compensation

  2,946      —        —        2,946   

Management fees

  3,750      —        —        3,750   
  

 

 

    

 

 

    

 

 

    

 

 

 

Earnings (loss) from continuing operations before gain on disposal of assets and income taxes

  (15,583   28,620      —        13,037   

Gain on disposal of assets, net

  645      —        —        645   
  

 

 

    

 

 

    

 

 

    

 

 

 

Earnings (loss) from continuing operations before income taxes

$ (14,938 $ 28,620    $ —      $ 13,682   
  

 

 

    

 

 

    

 

 

    

 

 

 

Segment assets

$ 2,387,601    $ 319,505    $ 2,707,106   
  

 

 

    

 

 

       

 

 

 

Capital expenditures

$ 77,993    $ 539    $ 78,532   
  

 

 

    

 

 

       

 

 

 

Goodwill

$ 810,969    $ 5,757    $ 816,726   
  

 

 

    

 

 

       

 

 

 

 

(1) Adjusted EBITDA represents net earnings from continuing operations before interest expense, income tax expense, depreciation and amortization, stock-based compensation and related expenses, gain on disposal of assets and management fees. Management fees represent monitoring and advisory fees paid to TPG, the Company’s majority financial sponsor, and certain other members of IASIS Investment LLC, majority shareholder of IAS. Management routinely calculates and communicates adjusted EBITDA and believes that it is useful to investors because it is commonly used as an analytical indicator within the healthcare industry to evaluate hospital performance, allocate resources and measure leverage capacity and debt service ability. In addition, the Company uses adjusted EBITDA as a measure of performance for its business segments and for incentive compensation purposes. Adjusted EBITDA should not be considered as a measure of financial performance under GAAP, and the items excluded from adjusted EBITDA are significant components in understanding and assessing financial performance. Adjusted EBITDA should not be considered in isolation or as an alternative to net earnings, cash flows generated by operating, investing, or financing activities or other financial statement data presented in the unaudited 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.

 

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NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (UNAUDITED)

 

10. SUPPLEMENTAL CONDENSED CONSOLIDATING FINANCIAL INFORMATION

The Senior Notes described in Note 3 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. The guarantees are subject to customary release provisions set forth in the Indenture for the Senior Notes.

Summarized unaudited condensed consolidating balance sheets at June 30, 2014 and September 30, 2013, unaudited condensed consolidating statements of operations for the quarters and nine months ended June 30, 2014 and 2013, unaudited condensed consolidating statements of comprehensive income (loss) for the quarters and nine months ended June 30, 2014 and 2013, and unaudited condensed consolidating statements of cash flows for the nine months ended June 30, 2014 and 2013, for the Company, segregating the parent company issuer, the subsidiary guarantors, the subsidiary non-guarantors and eliminations, are found below.

 

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IASIS Healthcare LLC

Condensed Consolidating Balance Sheet (Restated)

June 30, 2014 (unaudited)

(in thousands)

 

     Parent Issuer      Subsidiary
Guarantors
    Subsidiary
Non-Guarantors
     Eliminations     Condensed
Consolidated
 

Assets

            

Current assets

            

Cash and cash equivalents

   $ —         $ 304,805      $ 12,838       $ —        $ 317,643   

Accounts receivable, net

     —           88,725        247,924         —          336,649   

Inventories

     —           16,157        42,125         —          58,282   

Deferred income taxes

     14,691         —          —           —          14,691   

Prepaid expenses and other current assets

     —           42,138        142,791         —          184,929   
  

 

 

    

 

 

   

 

 

    

 

 

   

 

 

 

Total current assets

  14,691      451,825      445,678      —        912,194   

Property and equipment, net

  —        254,830      589,202      —        844,032   

Intercompany

  —        (109,718   109,718      —        —     

Net investment in and advances to subsidiaries

  2,040,211      —        —        (2,040,211   —     

Goodwill

  7,407      63,094      745,084      —        815,585   

Other intangible assets, net

  —        7,747      15,750      —        23,497   

Other assets, net

  22,853      26,813      10,779      —        60,445   
  

 

 

    

 

 

   

 

 

    

 

 

   

 

 

 

Total assets

$ 2,085,162    $ 694,591    $ 1,916,211    $ (2,040,211 $ 2,655,753   
  

 

 

    

 

 

   

 

 

    

 

 

   

 

 

 

Liabilities and Equity

Current liabilities

Accounts payable

$ —      $ 39,928    $ 79,427    $ —      $ 119,355   

Salaries and benefits payable

  —        24,810      28,485      —        53,295   

Accrued interest payable

  9,682      (3,220   3,220      —        9,682   

Medical claims payable

  —        —        69,108      —        69,108   

Other accrued expenses and current liabilities

  —        38,600      38,247      —        76,847   

Current portion of long-term debt, capital leases and other obligations

  10,071      3,109      23,605      (23,605   13,180   
  

 

 

    

 

 

   

 

 

    

 

 

   

 

 

 

Total current liabilities

  19,753      103,227      242,092      (23,605   341,467   

Long-term debt, capital leases and other obligations

  1,825,687      18,101      528,684      (528,684   1,843,788   

Deferred income taxes

  114,677      —        —        —        114,677   

Other long-term liabilities

  4,739      112,150      593      —        117,482   
  

 

 

    

 

 

   

 

 

    

 

 

   

 

 

 

Total liabilities

  1,964,856      233,478      771,369      (552,289   2,417,414   

Non-controlling interests with redemption rights

  —        108,325      —        —        108,325   

Equity

Member’s equity

  120,306      343,080      1,144,842      (1,487,922   120,306   

Non-controlling interests

  —        9,708      —        —        9,708   
  

 

 

    

 

 

   

 

 

    

 

 

   

 

 

 

Total equity

  120,306      352,788      1,144,842      (1,487,922   130,014   
  

 

 

    

 

 

   

 

 

    

 

 

   

 

 

 

Total liabilities and equity

$ 2,085,162    $ 694,591    $ 1,916,211    $ (2,040,211 $ 2,655,753   
  

 

 

    

 

 

   

 

 

    

 

 

   

 

 

 

 

23


Table of Contents

NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (UNAUDITED)

 

IASIS Healthcare LLC

Condensed Consolidating Balance Sheet

September 30, 2013

(in thousands)

 

     Parent Issuer      Subsidiary
Guarantors
    Subsidiary
Non-Guarantors
     Eliminations     Condensed
Consolidated
 
Assets             

Current assets

            

Cash and cash equivalents

   $ —         $ 430,047      $ 8,084       $ —        $ 438,131   

Accounts receivable, net

     —           124,700        246,306         —          371,006   

Inventories

     —           16,015        41,766         —          57,781   

Deferred income taxes

     26,096         —          —           —          26,096   

Prepaid expenses and other current assets

     —           26,187        100,225         —          126,412   

Assets held for sale

     —           119,141        —           —          119,141   
  

 

 

    

 

 

   

 

 

    

 

 

   

 

 

 

Total current assets

  26,096      716,090      396,381      —        1,138,567   

Property and equipment, net

  —        234,910      598,259      —        833,169   

Intercompany

  —        (218,630   218,630      —        —     

Net investment in and advances to subsidiaries

  2,072,847      —        —        (2,072,847   —     

Goodwill

  7,407      65,246      743,757      —        816,410   

Other intangible assets, net

  —        7,957      18,000      —        25,957   

Other assets, net

  27,287      24,895      13,980      —        66,162   
  

 

 

    

 

 

   

 

 

    

 

 

   

 

 

 

Total assets

$ 2,133,637    $ 830,468    $ 1,989,007    $ (2,072,847 $ 2,880,265   
  

 

 

    

 

 

   

 

 

    

 

 

   

 

 

 
Liabilities and Equity

Current liabilities

Accounts payable

$ —      $ 52,257    $ 77,285    $ —      $ 129,542   

Salaries and benefits payable

  —        28,686      34,198      —        62,884   

Accrued interest payable

  27,519      (3,229   3,229      —        27,519   

Medical claims payable

  —        —        57,514      —        57,514   

Other accrued expenses and current liabilities

  —        75,900      16,653      —        92,553   

Current portion of long-term debt, capital leases and other obligations

  10,071      3,150      23,641      (23,641   13,221   

Advance on divestiture

  —        144,803      —        —        144,803   

Liabilities held for sale

  —        3,208      —        —        3,208   
  

 

 

    

 

 

   

 

 

    

 

 

   

 

 

 

Total current liabilities

  37,590      304,775      212,520      (23,641   531,244   

Long-term debt, capital leases and other obligations

  1,832,275      20,547      549,200      (549,200   1,852,822   

Deferred income taxes

  115,592      —        —        —        115,592   

Other long-term liabilities

  5,918      116,601      601      —        123,120   
  

 

 

    

 

 

   

 

 

    

 

 

   

 

 

 

Total liabilities

  1,991,375      441,923      762,321      (572,841   2,622,778   

Non-controlling interests with redemption rights

  —        105,464      —        —        105,464   

Equity

Member’s equity

  142,262      273,320      1,226,686      (1,500,006   142,262   

Non-controlling interests

  —        9,761      —        —        9,761   
  

 

 

    

 

 

   

 

 

    

 

 

   

 

 

 

Total equity

  142,262      283,081      1,226,686      (1,500,006   152,023   
  

 

 

    

 

 

   

 

 

    

 

 

   

 

 

 

Total liabilities and equity

$ 2,133,637    $ 830,468    $ 1,989,007    $ (2,072,847 $ 2,880,265   
  

 

 

    

 

 

   

 

 

    

 

 

   

 

 

 

 

24


Table of Contents

NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (UNAUDITED)

 

IASIS Healthcare LLC

Condensed Consolidating Statement of Operations (Restated)

For the Quarter Ended June 30, 2014 (unaudited)

(in thousands)

 

     Parent Issuer     Subsidiary
Guarantors
    Subsidiary
Non-Guarantors
    Eliminations     Condensed
Consolidated
 

Revenues

          

Acute care revenue before provision for bad debts

   $ —        $ 127,116      $ 407,526      $ (3,262   $ 531,380   

Less: Provision for bad debts

     —          (13,293     (63,837     —          (77,130
  

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

Acute care revenue

  —        113,823      343,689      (3,262   454,250   

Premium revenue

  —        —        178,498      —        178,498   
  

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

Total revenues

  —        113,823      522,187      (3,262   632,748   

Costs and expenses

Salaries and benefits

  5,679      74,174      141,593      —        221,446   

Supplies

  —        17,716      57,388      —        75,104   

Medical claims

  —        —        169,205      (3,262   165,943   

Rentals and leases

  —        6,014      12,184      —        18,198   

Other operating expenses

  —        21,008      89,329      —        110,337   

Medicare and Medicaid EHR incentives

  —        (941   (1,999   —        (2,940

Interest expense, net

  32,267      —        12,232      (12,232   32,267   

Depreciation and amortization

  —        8,806      14,616      —        23,422   

Management fees

  1,250      (8,498   8,498      —        1,250   

Equity in earnings of affiliates

  (2,468   —        —        2,468      —     
  

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

Total costs and expenses

  36,728      118,279      503,046      (13,026   645,027   

Earnings (loss) from continuing operations before gain on disposal of assets and income taxes

  (36,728   (4,456   19,141      9,764      (12,279

Gain on disposal of assets, net

  —        2,102      —        —        2,102   
  

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

Earnings (loss) from continuing operations before income taxes

  (36,728   (2,354   19,141      9,764      (10,177

Income tax expense

  1,138      —        —        —        1,138   
  

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

Net earnings (loss) from continuing operations

  (37,866   (2,354   19,141      9,764      (11,315

Earnings (loss) from discontinued operations, net of income taxes

  5,667      (11,866   —        —        (6,199
  

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

Net earnings (loss)

  (32,199   (14,220   19,141      9,764      (17,514

Net earnings attributable to non-controlling interests

  —        (2,453   —        —        (2,453
  

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

Net earnings (loss) attributable to IASIS Healthcare LLC

$ (32,199 $ (16,673 $ 19,141    $ 9,764    $ (19,967
  

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

 

25


Table of Contents

NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (UNAUDITED)

 

IASIS Healthcare LLC

Condensed Consolidating Statement of Operations

For the Quarter Ended June 30, 2013 (unaudited)

(in thousands)

 

     Parent Issuer     Subsidiary
Guarantors
    Subsidiary
Non-Guarantors
    Eliminations     Condensed
Consolidated
 

Revenues

          

Acute care revenue before provision for bad debts

   $ —        $ 128,347      $ 391,735      $ (1,940   $ 518,142   

Less: Provision for bad debts

     —          (19,060     (62,650     —          (81,710
  

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

Acute care revenue

  —        109,287      329,085      (1,940   436,432   

Premium revenue

  —        —        139,804      —        139,804   
  

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

Total revenues

  —        109,287      468,889      (1,940   576,236   

Costs and expenses

Salaries and benefits

  947      68,615      138,060      —        207,622   

Supplies

  —        18,027      55,838      —        73,865   

Medical claims

  —        —        118,580      (1,940   116,640   

Rentals and leases

  —        4,447      8,909      —        13,356   

Other operating expenses

  —        24,288      78,425      —        102,713   

Medicare and Medicaid EHR incentives

  —        (973   (3,854   —        (4,827

Interest expense, net

  32,770      —        14,702      (14,702   32,770   

Depreciation and amortization

  —        7,822      16,040      —        23,862   

Management fees

  1,250      (8,245   8,245      —        1,250   

Equity in earnings of affiliates

  (23,968   —        —        23,968      —     
  

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

Total costs and expenses

  10,999      113,981      434,945      7,326      567,251   

Earnings (loss) from continuing operations before gain on disposal of assets and income taxes

  (10,999   (4,694   33,944      (9,266   8,985   

Gain on disposal of assets, net

  —        412      66      —        478   
  

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

Earnings (loss) from continuing operations before income taxes

  (10,999   (4,282   34,010      (9,266   9,463   

Income tax expense

  2,366      —        1,671      —        4,037   
  

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

Net earnings (loss) from continuing operations

  (13,365   (4,282   32,339      (9,266   5,426   

Earnings (loss) from discontinued operations, net of income taxes

  1,817      (2,148   —        —        (331
  

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

Net earnings (loss)

  (11,548   (6,430   32,339      (9,266   5,095   

Net earnings attributable to non-controlling interests

  —        (1,941   —        —        (1,941
  

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

Net earnings (loss) attributable to IASIS Healthcare LLC

$ (11,548 $ (8,371 $ 32,339    $ (9,266 $ 3,154   
  

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

 

26


Table of Contents

NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (UNAUDITED)

 

IASIS Healthcare LLC

Condensed Consolidating Statement of Operations (Restated)

For the Nine Months Ended June 30, 2014 (unaudited)

(in thousands)

 

     Parent Issuer     Subsidiary
Guarantors
    Subsidiary
Non-Guarantors
    Eliminations     Condensed
Consolidated
 

Revenues

          

Acute care revenue before provision for bad debts

   $ —        $ 382,918      $ 1,239,078      $ (8,539   $ 1,613,457   

Less: Provision for bad debts

     —          (50,443     (209,806     —          (260,249
  

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

Acute care revenue

  —        332,475      1,029,272      (8,539   1,353,208   

Premium revenue

  —        —        503,212      —        503,212   
  

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

Total revenues

  —        332,475      1,532,484      (8,539   1,856,420   

Costs and expenses

Salaries and benefits

  10,033      230,801      423,619      —        664,453   

Supplies

  —        54,488      172,927      —        227,415   

Medical claims

  —        —        445,293      (8,539   436,754   

Rentals and leases

  —        17,809      36,635      —        54,444   

Other operating expenses

  —        59,539      252,047      —        311,586   

Medicare and Medicaid EHR incentives

  —        (2,830   (6,464   —        (9,294

Interest expense, net

  98,300      —        36,816      (36,816   98,300   

Depreciation and amortization

  —        27,664      42,984      —        70,648   

Management fees

  3,750      (25,727   25,727      —        3,750   

Equity in earnings of affiliates

  (59,211   —        —        59,211      —     
  

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

Total costs and expenses

  52,872      361,744      1,429,584      13,856      1,858,056   

Earnings (loss) from continuing operations before gain (loss) on disposal of assets and income taxes

  (52,872   (29,269   102,900      (22,395   (1,636

Gain (loss) on disposal of assets, net

  —        3,080      (212   —        2,868   
  

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

Earnings (loss) from continuing operations before income taxes

  (52,872   (26,189   102,688      (22,395   1,232   

Income tax expense

  7,387      —        —        —        7,387   
  

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

Net earnings (loss) from continuing operations

  (60,259   (26,189   102,688      (22,395   (6,155

Earnings (loss) from discontinued operations, net of income taxes

  2,645      (8,431   —        —        (5,786
  

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

Net earnings (loss)

  (57,614   (34,620   102,688      (22,395   (11,941

Net earnings attributable to non-controlling interests

  —        (8,857   —        —        (8,857
  

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

Net earnings (loss) attributable to IASIS Healthcare LLC

$ (57,614 $ (43,477 $ 102,688    $ (22,395 $ (20,798
  

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

 

27


Table of Contents

NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (UNAUDITED)

 

IASIS Healthcare LLC

Condensed Consolidating Statement of Operations

For the Nine Months Ended June 30, 2013 (unaudited)

(in thousands)

 

     Parent Issuer     Subsidiary
Guarantors
    Subsidiary
Non-Guarantors
    Eliminations     Condensed
Consolidated
 

Revenues

          

Acute care revenue before provision for bad debts

   $ —        $ 375,957      $ 1,162,867      $ (5,334   $ 1,533,490   

Less: Provision for bad debts

     —          (55,840     (177,616     —          (233,456
  

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

Acute care revenue

  —        320,117      985,251      (5,334   1,300,034   

Premium revenue

  —        —        422,059      —        422,059   
  

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

Total revenues

  —        320,117      1,407,310      (5,334   1,722,093   

Costs and expenses

Salaries and benefits

  2,946      208,295      422,988      —        634,229   

Supplies

  —        53,939      170,440      —        224,379   

Medical claims

  —        —        353,890      (5,334   348,556   

Rentals and leases

  —        12,979      25,989      —        38,968   

Other operating expenses

  —        60,321      238,106      —        298,427   

Medicare and Medicaid EHR incentives

  —        (4,180   (5,704   —        (9,884

Interest expense, net

  99,986      —        47,057      (47,057   99,986   

Depreciation and amortization

  —        23,269      47,376      —        70,645   

Management fees

  3,750      (24,494   24,494      —        3,750   

Equity in earnings of affiliates

  (73,309   —        —        73,309      —     
  

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

Total costs and expenses

  33,373      330,129      1,324,636      20,918      1,709,056   

Earnings (loss) from continuing operations before gain on disposal of assets and income taxes

  (33,373   (10,012   82,674      (26,252   13,037   

Gain on disposal of assets, net

  —        566      79      —        645   
  

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

Earnings (loss) from continuing operations before income taxes

  (33,373   (9,446   82,753      (26,252   13,682   

Income tax expense

  4,731      —        1,671      —        6,402   
  

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

Net earnings (loss) from continuing operations

  (38,104   (9,446   81,082      (26,252   7,280   

Earnings (loss) from discontinued operations, net of income taxes

  (2,101   4,862      —        —        2,761   
  

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

Net earnings (loss)

  (40,205   (4,584   81,082      (26,252   10,041   

Net earnings attributable to non-controlling interests

  —        (3,189   —        —        (3,189
  

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

Net earnings (loss) attributable to IASIS Healthcare LLC

$ (40,205 $ (7,773 $ 81,082    $ (26,252 $ 6,852   
  

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

 

28


Table of Contents

NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (UNAUDITED)

 

IASIS Healthcare LLC

Condensed Consolidating Statement of Comprehensive Income (Loss) (Restated)

For the Quarter Ended June 30, 2014 (unaudited)

(In thousands)

 

     Parent Issuer     Subsidiary
Guarantors
    Subsidiary
Non-Guarantors
     Eliminations      Condensed
Consolidated
 

Net earnings (loss)

   $ (32,199   $ (14,220   $ 19,141       $ 9,764       $ (17,514

Other comprehensive income

            

Change in fair value of highly effective interest rate hedges

     201        —          —           —           201   
  

 

 

   

 

 

   

 

 

    

 

 

    

 

 

 

Other comprehensive income before income taxes

  201      —        —        —        201   

Change in income tax expense

  (75   —        —        —        (75
  

 

 

   

 

 

   

 

 

    

 

 

    

 

 

 

Other comprehensive income, net of income taxes

  126      —        —        —        126   
  

 

 

   

 

 

   

 

 

    

 

 

    

 

 

 

Comprehensive income (loss)

  (32,073   (14,220   19,141      9,764      (17,388

Net earnings attributable to non-controlling interests

  —        (2,453   —        —        (2,453
  

 

 

   

 

 

   

 

 

    

 

 

    

 

 

 

Comprehensive income (loss) attributable to IASIS Healthcare LLC

$ (32,073 $ (16,673 $ 19,141    $ 9,764    $ (19,841
  

 

 

   

 

 

   

 

 

    

 

 

    

 

 

 

 

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NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (UNAUDITED)

 

IASIS Healthcare LLC

Condensed Consolidating Statement of Comprehensive Income (Loss)

For the Quarter Ended June 30, 2013 (unaudited)

(In thousands)

 

     Parent Issuer     Subsidiary
Guarantors
    Subsidiary
Non-Guarantors
     Eliminations     Condensed
Consolidated
 

Net earnings (loss)

   $ (11,548   $ (6,430   $ 32,339       $ (9,266   $ 5,095   

Other comprehensive income

           

Change in fair value of highly effective interest rate hedges

     1,753        —          —           —          1,753   
  

 

 

   

 

 

   

 

 

    

 

 

   

 

 

 

Other comprehensive income before income taxes

  1,753      —        —        —        1,753   

Change in income tax expense

  (651   —        —        —        (651
  

 

 

   

 

 

   

 

 

    

 

 

   

 

 

 

Other comprehensive income, net of income taxes

  1,102      —        —        —        1,102   
  

 

 

   

 

 

   

 

 

    

 

 

   

 

 

 

Comprehensive income (loss)

  (10,446   (6,430   32,339      (9,266   6,197   

Net earnings attributable to non-controlling interests

  —        (1,941   —        —        (1,941
  

 

 

   

 

 

   

 

 

    

 

 

   

 

 

 

Comprehensive income (loss) attributable to IASIS Healthcare LLC

$ (10,446 $ (8,371 $ 32,339    $ (9,266 $ 4,256   
  

 

 

   

 

 

   

 

 

    

 

 

   

 

 

 

 

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NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (UNAUDITED)

 

IASIS Healthcare LLC

Condensed Consolidating Statement of Comprehensive Income (Loss) (Restated)

For the Nine Months Ended June 30, 2014 (unaudited)

(In thousands)

 

     Parent Issuer     Subsidiary
Guarantors
    Subsidiary
Non-Guarantors
     Eliminations     Condensed
Consolidated
 

Net earnings (loss)

   $ (57,614   $ (34,620   $ 102,688       $ (22,395   $ (11,941

Other comprehensive income

           

Change in fair value of highly effective interest rate hedges

     1,179        —          —           —          1,179   
  

 

 

   

 

 

   

 

 

    

 

 

   

 

 

 

Other comprehensive income before income taxes

  1,179      —        —        —        1,179   

Change in income tax expense

  (438   —        —        —        (438
  

 

 

   

 

 

   

 

 

    

 

 

   

 

 

 

Other comprehensive income, net of income taxes

  741      —        —        —        741   
  

 

 

   

 

 

   

 

 

    

 

 

   

 

 

 

Comprehensive income (loss)

  (56,873   (34,620   102,688      (22,395   (11,200

Net earnings attributable to non-controlling interests

  —        (8,857   —        —        (8,857
  

 

 

   

 

 

   

 

 

    

 

 

   

 

 

 

Comprehensive income (loss) attributable to IASIS Healthcare LLC

$ (56,873 $ (43,477 $ 102,688    $ (22,395 $ (20,057
  

 

 

   

 

 

   

 

 

    

 

 

   

 

 

 

 

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NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (UNAUDITED)

 

IASIS Healthcare LLC

Condensed Consolidating Statement of Comprehensive Income (Loss)

For the Nine Months Ended June 30, 2013 (unaudited)

(In thousands)

 

     Parent Issuer     Subsidiary
Guarantors
    Subsidiary
Non-Guarantors
     Eliminations     Condensed
Consolidated
 

Net earnings (loss)

   $ (40,205   $ (4,584   $ 81,082       $ (26,252   $ 10,041   

Other comprehensive income

           

Change in fair value of highly effective interest rate hedges

     1,643        —          —           —          1,643   
  

 

 

   

 

 

   

 

 

    

 

 

   

 

 

 

Other comprehensive income before income taxes

  1,643      —        —        —        1,643   

Change in income tax expense

  (611   —        —        —        (611
  

 

 

   

 

 

   

 

 

    

 

 

   

 

 

 

Other comprehensive income, net of income taxes

  1,032      —        —        —        1,032   
  

 

 

   

 

 

   

 

 

    

 

 

   

 

 

 

Comprehensive income (loss)

  (39,173   (4,584   81,082      (26,252   11,073   

Net earnings attributable to non-controlling interests

  —        (3,189   —        —        (3,189
  

 

 

   

 

 

   

 

 

    

 

 

   

 

 

 

Comprehensive income (loss) attributable to IASIS Healthcare LLC

$ (39,173 $ (7,773 $ 81,082    $ (26,252 $ 7,884   
  

 

 

   

 

 

   

 

 

    

 

 

   

 

 

 

 

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NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (UNAUDITED)

 

IASIS Healthcare LLC

Condensed Consolidating Statement of Cash Flows (Restated)

For the Nine Months Ended June 30, 2014 (unaudited)

(In thousands)

 

    Parent Issuer     Subsidiary
Guarantors
    Subsidiary
Non-Guarantors
    Eliminations     Condensed
Consolidated
 

Cash flows from operating activities

         

Net earnings (loss)

  $ (57,614   $ (34,620   $ 102,688      $ (22,395   $ (11,941

Adjustments to reconcile net earnings (loss) to net cash provided by (used in) operating activities:

         

Depreciation and amortization

    —          27,664        42,984        —          70,648   

Amortization of loan costs

    5,559        —          —          —          5,559   

Amortization of deferred gain on sale-leaseback transaction

    (1,872     —          —          —          (1,872

Change in physician minimum revenue guarantees

    —          133        2,044        —          2,177   

Stock-based compensation

    10,033        —          —          —          10,033   

Deferred income taxes

    (1,015     —          —          —          (1,015

Income tax benefit from parent company

    5        —          —          —          5   

Loss (gain) on disposal of assets, net

    —          (3,080     212        —          (2,868

Loss (earnings) from discontinued operations, net

    (2,645     8,431        —          —          5,786   

Equity in earnings of affiliates

    (59,211     —          —          59,211        —     

Changes in operating assets and liabilities, net of the effect of acquisitions and dispositions:

         

Accounts receivable, net

    —          (5,724     (1,068     —          (6,792

Inventories, prepaid expenses and other current assets

    —          (18,427     (34,979     —          (53,406

Accounts payable, other accrued expenses and other accrued liabilities

    (19,016     15,007        14,561        —          10,552   

Income taxes and other transaction costs payable related to sale-leaseback of real estate

    (18,901     (1,048     (2,321     —          (22,270
 

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

Net cash provided by (used in) operating activities — continuing operations

  (144,677   (11,664   124,121      36,816      4,596   

Net cash used in operating activities — discontinued operations

  —        (15,140   —        —        (15,140
 

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

Net cash provided by (used in) operating activities

  (144,677   (26,804   124,121      36,816      (10,544
 

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

Cash flows from investing activities

Purchases of property and equipment

  —        (44,282   (31,802   —        (76,084

Cash paid for acquisitions, net

  —        (1,038   —        —        (1,038

Proceeds from sale of assets

  —        1,495      13      —        1,508   

Change in other assets, net

  —        (3,753   3,534      —        (219

Other, net

  —        (2,724   (301   —        (3,025
 

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

Net cash used in investing activities — continuing operations

  —        (50,302   (28,556   —        (78,858

Net cash used in investing activities — discontinued operations

  —        (5,242   —        —        (5,242
 

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

Net cash used in investing activities

  —        (55,544   (28,556   —        (84,100
 

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

Cash flows from financing activities

Payment of long-term debt, capital leases and other obligations

  (8,010   —        (2,074   —        (10,084

Distributions to non-controlling interests

  —        (13,222   —        —        (13,222

Cash paid for the repurchase of non-controlling interests

  —        (600   —        —        (600

Other

  —        (1,838   —        —        (1,838

Change in intercompany balances with affiliates, net

  152,687      (27,134   (88,737   (36,816   —     
 

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

Net cash provided by (used in) financing activities — continuing operations

  144,677      (42,794   (90,811   (36,816   (25,744

Net cash used in financing activities — discontinued operations

  —        (100   —        —        (100
 

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

Net cash provided by (used in) financing activities

  144,677      (42,894   (90,811   (36,816   (25,844
 

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

Change in cash and cash equivalents

  —        (125,242   4,754      —        (120,488

Cash and cash equivalents at beginning of period

  —        430,047      8,084      —        438,131   
 

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

Cash and cash equivalents at end of period

$ —      $ 304,805    $ 12,838    $ —      $ 317,643   
 

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

 

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Table of Contents

NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (UNAUDITED)

 

IASIS Healthcare LLC

Condensed Consolidating Statement of Cash Flows

For the Nine Months Ended June 30, 2013 (unaudited)

(In thousands)

 

    Parent Issuer     Subsidiary
Guarantors
    Subsidiary
Non-Guarantors
    Eliminations     Condensed
Consolidated
 

Cash flows from operating activities

         

Net earnings (loss)

  $ (40,205   $ (4,584   $ 81,082      $ (26,252   $ 10,041   

Adjustments to reconcile net earnings (loss) to net cash provided by (used in) operating activities:

         

Depreciation and amortization

    —          23,269        47,376        —          70,645   

Amortization of loan costs

    5,510        —          —          —          5,510   

Change in physician minimum revenue guarantees

    —          132        2,497        —          2,629   

Stock-based compensation

    2,946        —          —          —          2,946   

Deferred income taxes

    11,897        —          —          —          11,897   

Income tax benefit from stock-based compensation

    16        —          —          —          16   

Income tax benefit from parent company

    103        —          —          —          103   

Gain on disposal of assets, net

    —          (566     (79     —          (645

Loss (earnings) from discontinued operations, net

    2,101        (4,862     —          —          (2,761

Equity in earnings of affiliates

    (73,309     —          —          73,309        —     

Changes in operating assets and liabilities, net of the effect of acquisitions and dispositions:

         

Accounts receivable, net

    —          11,906        (32,437     —          (20,531

Inventories, prepaid expenses and other current assets

    —          (22,006     (1,374     —          (23,380

Accounts payable, other accrued expenses and other accrued liabilities

    (19,621     (11,805     (23,466     —          (54,892
 

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

Net cash provided by (used in) operating activities — continuing operations

  (110,562   (8,516   73,599      47,057      1,578   

Net cash provided by operating activities — discontinued operations

  —        11,346      —        —        11,346   
 

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

Net cash provided by (used in) operating activities

  (110,562   2,830      73,599      47,057      12,924   
 

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

Cash flows from investing activities

Purchases of property and equipment

  —        (40,759   (37,773   —        (78,532

Cash (paid) received for acquisitions, net

  —        (849   4,433      —        3,584   

Proceeds from sale of assets

  —        1      78      —        79   

Change in other assets, net

  —        3,309      (5,754   —        (2,445
 

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

Net cash used in investing activities — continuing operations

  —        (38,298   (39,016   —        (77,314

Net cash used in investing activities — discontinued operations

  —        (5,173   —        —        (5,173
 

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

Net cash used in investing activities

  —        (43,471   (39,016   —        (82,487
 

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

Cash flows from financing activities

Payment of debt and capital lease obligations

  (94,598   (4,013   (3,544   —        (102,155

Proceeds from revolving credit facilities

  147,000      —        —        —        147,000   

Debt financing costs incurred

  (1,024   —        —        —        (1,024

Distributions to non-controlling interests

  —        (5,504   —        —        (5,504

Cash received for the sale of non-controlling interests

  —        849      —        —        849   

Cash paid for the repurchase of non-controlling interest

  —        (1,018   —        —        (1,018

Change in intercompany balances with affiliates, net

  59,184      24,381      (36,508   (47,057   —     
 

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

Net cash provided by (used in) financing activities — continuing operations

  110,562      14,695      (40,052   (47,057   38,148   

Net cash provided by financing activities — discontinued operations

  —        389      —        —        389   
 

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

Net cash provided by (used in) financing activities

  110,562      15,084      (40,052   (47,057   38,537   
 

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

Change in cash and cash equivalents

  —        (25,557   (5,469   —        (31,026

Cash and cash equivalents at beginning of period

  —        39,219      9,663      —        48,882   
 

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

Cash and cash equivalents at end of period

$ —      $ 13,662    $ 4,194    $ —      $ 17,856   
 

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

 

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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, 2014 and 2013, have been derived from our unaudited condensed consolidated financial statements. Our unaudited condensed consolidated financial statements for the quarter and nine months ended June 30, 2014, have been restated to reflect corrections to the Original Filing, which are discussed further in the Explanatory Note to this Amendment and in Note 1A to our unaudited condensed consolidated financial statements appearing under “Item 1 – Financial Statements” of this report. In addition, our unaudited condensed consolidated financial statements for the quarter and nine months ended June 30, 2014 and 2013, have been retrospectively revised to reflect the operating results and cash flows of the Nevada operations as discontinued operations, as discussed further in Note 1 to our unaudited condensed consolidated financial statements appearing under “Item 1 – Financial Statements” of this report. 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. Those risks and uncertainties include, among others, changes in governmental healthcare programs that could reduce our revenues, including the impact of sequestration; the uncertain impact of federal health reform; the possibility of Health Choice Arizona, Inc.’s (“Health Choice” or the “Plan”), contract with the Arizona Health Care Cost Containment System (“AHCCCS”) being discontinued and changes in the payment structure under that contract, as well as an inability to control costs at Health Choice; shifts in payor mix from commercial and managed care payors to Medicaid and managed Medicaid; our ability to retain and negotiate reasonable contracts with managed care plans; a growth in the level of uncompensated care at our hospitals; our ability to recruit and retain quality physicians and medical professionals; competition from other hospitals and healthcare providers impacting our patient volume; our failure to continually enhance our hospitals with the most recent technological advances in diagnostic and surgical equipment; the federal health reform law’s significant restrictions on hospitals that have physician owners; 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; claims brought against our facilities for malpractice, product liability and other legal grounds; difficulties with the integration of acquisitions that may disrupt our ongoing operations; our dependence on key management personnel; potential responsibilities and costs under environmental laws; 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; the possibility of an increase in interest rates, which would increase the cost of servicing our debt; and the risks associated with us being owned by equity sponsors who have the ability to control our financial decisions. 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, among others discussed in this report, are detailed in our Annual Report on Form 10-K for the fiscal year ended September 30, 2013, filed with 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 Original Filing Date or to reflect the occurrence of unanticipated events.

EXECUTIVE OVERVIEW

We are a leading provider of high quality, affordable healthcare services primarily in high-growth urban and suburban markets. As of June 30, 2014, as part of continuing operations, we owned or leased 15 acute care hospital facilities and one behavioral health hospital, with a total of 3,601 licensed beds, several outpatient service facilities, and more than 135 physician clinics. 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. We operate in various regions, including:

 

    Salt Lake City, Utah;

 

    Phoenix, Arizona;

 

    five cities in Texas, including Houston and San Antonio; and

 

    West Monroe, Louisiana.

 

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We also own and operate Health Choice, a provider-owned, managed care organization and insurer that delivers healthcare services to over 266,000 members through multiple health plans, integrated delivery systems and managed care solutions. The Plan is headquartered in Phoenix, Arizona.

In May 2014, Health Choice entered into an agreement with Humana Medical Plan, Inc. (“Humana”), under which Health Choice will provide administrative and managed care services to approximately 80,000 Humana managed Medicaid plan members in the state of Florida. During the quarter and nine months ended June 30, 2014, we incurred $2.0 million and $3.0 million, respectively, in startup related costs associated with Health Choice’s new third-party administration and management services organization business.

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 health plan operations 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, if any, these trends 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”) expands coverage of previously uninsured individuals, largely through expansion of Medicaid coverage and establishment of insurance exchanges (“Exchanges”) where individuals may purchase coverage. The Health Reform Law also contains an “individual mandate” that imposes financial penalties on individuals who fail to carry health insurance and employers that do not provide health insurance. In addition, the Health Reform Law reforms certain aspects of health insurance, reduces government reimbursement rates, 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.

As of April 15, 2014, the federal government has released information indicating that approximately 8.5 million individuals have enrolled in healthcare coverage through the Exchanges. Of those enrolled, the federal government states that approximately 80% of those have paid the related premiums, and 83% have selected plans including financial assistance. While the most significant provisions of the Health Reform Law that result in reducing the number of uninsured individuals generally became effective January 1, 2014, the employer mandate, which requires companies with 50 or more employees to provide health insurance or pay fines, as well as insurer reporting requirements, has been delayed until January 1, 2015. For employers with 50 to 99 employees, this requirement has been further delayed until January 1, 2016. Additionally, a number of state governors and legislatures, including Texas and Louisiana, have chosen not to participate in the expanded Medicaid program at this time; however, these states could choose to implement the expansion at a later date. While some states have currently chosen not to participate, other states such as Arizona and Nevada have expanded their Medicaid programs.

Because of the many variables involved, including the law’s complexity, the lack of implementing regulations or interpretive guidance for all of its provisions, gradual and partially delayed implementation, court challenges, possible reductions in funding by the U.S. Congress (“Congress”) and future reductions in Medicare and Medicaid reimbursement, the impact of the Health Reform Law, including how individuals and businesses will respond to the new choices and obligations under the law, is not yet fully known. We believe, however, that trends toward pay-for-performance reimbursement models focused on quality and cost control, which are encouraged by the Health Reform Law, are taking hold among private health insurers and will continue to do so.

One notable provision of the Health Reform Law is an annual health insurer fee (“HIF”) that applies to most health plans, including commercial health plans and Medicaid managed care plans like Health Choice. While characterized as a “fee” in the text of the Health Reform Law, the intent of Congress was to impose a broad based health insurance industry excise tax, with the understanding that the tax could be passed on to consumers, most likely through higher commercial insurance premiums. However, because Medicaid is a government-funded program, Medicaid health plans have no alternative but to look to their respective state partners for payment to offset the impact of this tax. We continue to work with our state partners to obtain reimbursement for the economic impact of this fee, and currently anticipate to be reimbursed in full. Currently, we project that our HIF payable by September 30, 2014 will be approximately $7.9 million.

Two Midnight Rule

In the Medicare program’s hospital inpatient prospective payment system (“IPPS”) final rule for federal fiscal year 2014, the Centers for Medicare and Medicaid Services (“CMS”) issued the “two midnight rule,” which revised its longstanding guidance to hospitals and physicians relating to when hospital inpatient admissions are deemed to be reasonable and necessary for payment under

 

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Medicare Part A. Under the two midnight rule, in addition to services that are designated as inpatient-only, surgical procedures, diagnostic tests and other treatments are generally appropriate for inpatient hospital admission and payment under Medicare Part A when the physician (i) expects the beneficiary to require a stay that crosses at least two midnights and (ii) admits the beneficiary to the hospital based upon that expectation. Conversely, hospital stays in which the physician expects the beneficiary to require care that spans less than two midnights are generally inappropriate for payment under Medicare Part A, and should be treated and billed as outpatient services under Part B.

While the IPPS final rule for federal fiscal year 2014 became effective on October 1, 2013, CMS initially indicated that, for a period of 90 days after the effective date of the rule, it would not permit recovery auditors and other Medicare review contractors to review inpatient admissions of one midnight or less that began between October 1, 2013 and December 31, 2013. CMS subsequently extended that delay to inpatient admissions that occur on or prior to September 30, 2014. CMS did, however, instruct Medicare Administrative Contractors (“MACs”) to review, on a pre-payment basis, a small sample (approximately 10 – 25) of inpatient hospital claims relating to admissions that occur between March 31, 2014 and September 30, 2014, and that span less than two midnights after admission in order to determine each hospital’s compliance with the new inpatient admission and medical review criteria. Hospitals can rebill denied inpatient hospital admissions in accordance with the rule.

On April 1, 2014, President Obama signed the Protecting Access to Medicare Act of 2014 (the “PAM Act”) into law. Among other things, the PAM Act extends the delay of the enforcement of the two midnight rule by recovery auditor and other Medicare review contractors through March 31, 2015, and authorizes CMS to continue to allow MACs to review, on a pre-payment basis, a small sample of inpatient hospital claims relating to admissions that span less than two midnights and that occur between March 31, 2014, and March 31, 2015, in order to determine hospital compliance with the new inpatient admission and medical review criteria.

We cannot predict whether Congress or CMS will further delay the review of inpatient admissions of one midnight or less by recovery auditors or other Medicare review contractors, the impact that any such reviews will have on our business and results of operations, or when they are allowed by CMS. In addition, legislation has been introduced in Congress that, among other things, would both generally prohibit Medicare review contractors from denying claims due to the length of a patient’s stay or a determination that services could have been provided in an outpatient setting and require CMS to develop a new payment methodology for services that are provided during short inpatient hospital stays. Federal lawsuits have also been filed challenging the two midnight rule primarily on the grounds that the implementation of the rule itself, and the payment reduction associated with the rule (i.e., 0.2% IPPS payment reduction to hospitals) violate the Administrative Procedure Act. We cannot predict whether legislation will be adopted or, if adopted, the amount of reimbursement that would be paid under any alternative payment methodology that would be developed by CMS. We also cannot predict whether federal court challenges to the two midnight rule will be successful.

Budget Control Act and Sequestration

The Budget Control Act of 2011 (the “BCA”) increased the nation’s borrowing authority and takes steps to reduce federal spending and the deficit. The deficit reduction portion of the BCA imposes caps, which began in federal fiscal year 2012, that reduce discretionary spending by more than $900 billion over ten years. The BCA also requires automatic spending reductions of $1.2 trillion for federal fiscal years 2013 through 2021, minus any deficit reductions enacted by Congress and debt service costs. The spending reductions have been extended through 2024. These automatic spending reductions are commonly referred to as “sequestration.” The spending reductions are split evenly between defense and non-defense discretionary spending, although certain programs (including Medicaid and Children’s Health Insurance Programs (“CHIP”)), are exempt from these automatic spending reductions, and Medicare expenditures cannot be reduced by more than two percent. Sequestration began on March 1, 2013, with CMS imposing a two percent reduction on Medicare claims beginning April 1, 2013. We are unable to predict what other deficit reduction initiatives may be proposed by the President or Congress or whether the President and the Congress will restructure or suspend sequestration. It is possible that changes in the law to end or restructure sequestration will result in greater spending reductions than currently required by the BCA.

Value-Based Reimbursement

The trend in the healthcare industry continues 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 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.

In addition, managed care organizations are implementing programs that condition payment on performance against specified measures. The quality measurement criteria used by managed care and commercial payors may be similar to or even more stringent than Medicare requirements.

 

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As we expect these trends towards value-based purchasing of healthcare services by Medicare and other payors to continue, we believe that our position as a high-quality, low cost provider in certain of our markets will prove beneficial as we continue to move towards a quality and value-based reimbursement system. 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.

State Medicaid Budgets

Over recent years, the states in which we operate experienced budget constraints as a result of increased costs and lower than expected tax collections. Health and human services programs, including Medicaid and similar programs, represent a significant portion of state budgets. The states in which we operate responded to these budget concerns, by decreasing funding for Medicaid and other healthcare programs or by making structural changes that resulted in a reduction in hospital reimbursement. In addition, many states have received waivers from CMS in order to implement or expand managed Medicaid programs.

Texas

The Texas legislature and the Texas Health and Human Services Commission (“THHSC”) recommended expanding Medicaid managed care enrollment in the state, and in December 2011, CMS approved a five-year Medicaid waiver that: (1) allows Texas to expand its Medicaid managed care program while preserving hospital funding; (2) provides incentive payments for improvements in healthcare delivery; and (3) directs more funding to hospitals that serve large numbers of uninsured patients. Certain of our acute care hospitals currently 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. Revenue recognized under these Texas private supplemental Medicaid reimbursement programs for the quarter and nine months ended June 30, 2014, was $17.6 million and $53.6 million, respectively, compared to $16.5 million and $45.7 million in the prior year periods. Under the Medicaid waiver, funds are distributed to participating hospitals based upon both the costs associated with providing care to individuals without third party coverage and the investment made to support coordinating care and quality improvements that transform the local communities’ care delivery systems. The responsibility to coordinate and develop plans that address the concerns of the local delivery care systems, including improved access, quality, cost effectiveness and coordination will be controlled primarily by government-owned public hospitals that serve the surrounding geographic areas. Complexities of the underlying methodologies in determining the funding for the state’s Medicaid supplemental reimbursement programs, along with a lack of sufficient resources at THHSC to administer the programs, has resulted in a delay in related reimbursements. As of June 30, 2014, we had $73.6 million in receivables due to our Texas hospitals in connection with these supplemental Medicaid reimbursement programs, including amounts due under the Texas Medicaid Disproportionate Share Hospital program (“Texas Medicaid DSH”), compared to receivables of $66.8 million at September 30, 2013. During the quarter ended June 30, 2014, we received cash of $37.0 million from the state of Texas related to the supplemental Medicaid reimbursement programs.

The THHSC has released proposed rules to change the Texas Medicaid DSH methodology for the state’s fiscal year 2014 and 2015. While changes to the Texas Medicaid DSH methodology have been proposed, details regarding its computation for the state’s upcoming fiscal year have not yet been finalized. Because deliberations regarding the Texas Medicaid DSH program are ongoing, we are unable to estimate the financial impact, if any, that proposed program changes may have on our results of operations. Texas has appropriated $160.0 million for fiscal year 2014 and $140.0 million for fiscal year 2015 to stabilize and improve the Texas Medicaid DSH program, including providing rate adjustments to recognize improvements in quality of patient care, the most appropriate use of care, and patient outcomes. These appropriations provide that the funding is contingent on “measurable progress” by THHSC toward a long-term plan. Funds appropriated for in 2015 may not be spent before the plan is finalized. During the quarter and nine months ended June 30, 2014, we recognized $7.5 million and $22.6 million, respectively, in Texas Medicaid DSH revenues, compared to $7.1 million and $21.4 million in the prior year periods.

Arizona

Beginning in July 2011, in an effort to control its budgeted expenditures and balance its budget, the state of Arizona implemented a plan to reduce its eligible Medicaid beneficiaries, particularly childless adults. Following implementation of this plan by the state of Arizona, Health Choice experienced a significant decline through the end of our fiscal year 2013 in its enrollees, premium revenue and earnings.

Effective January 1, 2014, Arizona expanded its Medicaid program under the Health Reform Law, which includes increased eligibility for adults, children and pregnant women, and the restoration of eligibility to childless adults that was previously eliminated. The expansion of the state’s Medicaid program under the Health Reform Law could potentially result in the addition of approximately 370,000 people to its Medicaid rolls. As a result of the Medicaid expansion, enrollment at Health Choice increased 10.4% for the quarter ended June 30, 2014, compared to the prior year quarter. In addition, in connection with the expanded Medicaid coverage, the state implemented a provider assessment effective January 1, 2014, to fund a portion of the expanded eligibility related to the childless adult population. During the quarter and nine months ended June 30, 2014, we incurred $1.3 million and $2.6 million, respectively, in provider tax assessments.

 

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If additional Medicaid program changes are implemented in the future in Arizona or other states in which we operate, our revenue and earnings could be significantly impacted.

Physician Alignment and Clinical Integration

In an effort to meet community needs and address coverage issues, we have made significant investments in order to align with physicians through various recruitment and employment strategies, as well as alternative means of alignment such as our formation of provider networks in certain markets. We believe that physician alignment promotes clinical integration, enhances quality of care and makes us more efficient and competitive in a healthcare environment trending toward value-based purchasing and pay-for-performance.

As we continue to focus on our physician alignment and integration strategies, 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. In response, we have formed our own provider networks in certain markets that include both employed and non-affiliated physicians, providing the infrastructure through which we are able to contract more efficiently with commercial payors, position ourselves for value based reimbursement and promote clinical integration. While we expect that employing physicians provides relief on cost pressures associated with on-call coverage and other professional fees, we anticipate the addition of new employed physicians would result in increased labor and other start-up related costs as we integrated the physicians and their related support staff into our healthcare delivery systems.

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

While the amount of uncompensated care, including discounts to the uninsured, bad debts and charity care, we deliver to the communities we serve continues to remain high in comparison to historical levels, we have experienced improvement during the quarter and nine months ended June 30, 2014. During the quarter ended June 30, 2014, our uncompensated care as a percentage of acute care revenue was 19.9%, compared to 21.6% in the prior year quarter. During the nine months ended June 30, 2014, our uncompensated care as a percentage of acute care revenue was 21.5%, compared to 22.6% in the prior year period. We believe the improvement in our uncompensated care as a percentage of acute care revenue can be attributed primarily to the impact of Medicaid expansion in the state of Arizona, which has resulted in lower self-pay volume and revenue for the quarter and nine months ended June 30, 2014, compared to the same prior year periods. During the quarter ended June 30, 2014, our self-pay admissions represented 6.1% of our total admissions, compared to 8.0% in the prior year quarter. During the nine months ended June 30, 2014, our self-pay admissions represented 7.1% of our total admissions, compared to 8.0% in the prior year period. The improvement in our uncompensated care as a percentage of acute care revenue has been mitigated somewhat by the higher acuity levels at which self-pay patients are presenting for treatment through our emergency rooms.

Additionally, the declines in our self-pay volume and revenue are being aided by increasing benefits from recent Exchange enrollment, given that certain Exchange enrollees previously were included in the uninsured population. During the quarter ended June 30, 2014, we experienced 305 Exchange related admissions, compared to 103 in the sequential quarter ended March 31, 2014.

We would expect uninsured volumes to continue to decline in the near future as the impact of the Health Reform Law is fully realized. However, if we were to experience growth in uninsured volume and revenue, our uncompensated care may increase and our results of operations could be adversely affected.

The percentages of our insured and uninsured hospital net receivables are summarized as follows (1):

 

     June 30,
2014
    September 30,
2013
 

Insured receivables

     83.5     81.4

Uninsured receivables

     16.5     18.6
  

 

 

   

 

 

 

Total

  100.0   100.0
  

 

 

   

 

 

 

 

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The percentages of hospital net receivables in summarized aging categories are as follows (1):

 

     June 30,
2014
    September 30,
2013
 

0 to 90 days

     61.7     61.8

91 to 180 days

     20.1     20.7

Over 180 days

     18.2     17.5
  

 

 

   

 

 

 

Total

  100.0   100.0
  

 

 

   

 

 

 

 

(1)  Excludes hospital receivables retained related to our discontinued Florida operations.

Adoption of Electronic Health Records (“EHR”)

The American Recovery and Reinvestment Act of 2009 (“ARRA”) included approximately $26.0 billion in funding for various healthcare information technology (“IT”) initiatives, including Medicare and Medicaid incentives for eligible hospitals and professionals to adopt and meaningfully use certified EHR technology (“EHR Incentive Programs”). In addition, eligible providers that fail to demonstrate meaningful use of certified EHR technology will be subject to reduced payments from Medicare, beginning in federal fiscal year 2015 for eligible hospitals and calendar year 2015 for eligible professionals. Implementation of the EHR Incentive Programs has been divided into three stages with increasing requirements for participation. Stage 1 requires providers to meet meaningful use objectives specified by CMS, which include electronically capturing health information in structured format, tracking key clinical conditions for coordination of care purposes, implementing clinical decision support tools to facilitate disease and medication management, using EHRs to engage patients and families, and reporting clinical quality measures and public health information. Our hospitals, as well as a number of our physician clinics, substantially met the Stage 1 requirements in our fiscal year 2012. Stage 2 introduces several new meaningful use measures, as well as imposes stricter requirements on certain existing Stage 1 measures. Providers must achieve meaningful use under the Stage 1 criteria before advancing to Stage 2 and are required to meet the criteria for the applicable stage based on their first year of attesting to meaningful use. Our hospitals and physician clinics whose first payment year was 2011 and 2012 are required to meet Stage 2 criteria beginning in 2014. Though we expect to continue to incur certain non-productive and other operating costs, as well as additional investments in hardware and software, we believe our historical investments in advanced clinical and other information systems, as well as quality of care programs, provides a solid platform to build upon for timely compliance with the healthcare IT initiatives and requirements of ARRA. During the quarter and nine months ended June 30, 2014, we recognized Medicare and Medicaid EHR incentives totaling $2.9 million and $9.3 million, respectively, compared to $4.8 million and $9.9 million in the prior year periods.

Revenue and Volume Trends

Total net revenue for the quarter ended June 30, 2014, increased 9.8% to $632.7 million, compared to $576.2 million in the prior year quarter. Total net revenue for the nine months ended June 30, 2014, increased 7.8% to $1.86 billion, compared to $1.72 billion in the prior year period. Total net revenue is comprised of acute care revenue, which is recorded net of the provision for bad debts, and premium revenue. Acute care revenue contributed $17.8 million to the increase in total net revenue for the quarter ended June 30, 2014, compared to the prior year quarter, while premium revenue at Health Choice contributed $38.7 million for the same period. Acute care revenue contributed $53.2 million to the increase in total net revenue for the nine months ended June 30, 2014, compared to the prior year period, while premium revenue at Health Choice contributed $81.2 million for the same period.

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. Acute care revenue is reported net of the provision for doubtful accounts. Other revenue includes medical office building rental income and other miscellaneous revenue.

Admissions decreased 3.0% and 3.6% for the quarter and nine months ended June 30, 2014, respectively, compared to the same prior year periods. These decreases are reflective of a decline in Medicare 1-day stays, an industry-wide decline in inpatient utilization, and a continued shift towards outpatient services. In addition, respiratory or flu-related volumes declined for the nine months ended June 30, 2014, as compared to the same prior year periods. Adjusted admissions increased 1.5% and 0.1% for the quarter and nine months ended June 30, 2014, compared to the same prior year periods. For the quarter and nine months ended June 30, 2014, our outpatient volumes were positively impacted by increases in outpatient surgeries of 4.4% and 4.6%, respectively, compared to the same prior year periods. Additionally, emergency room visits for the quarter ended June 30, 2014 increased 2.6% compared to the prior year, while decreasing 1.5% in the nine months ended June 30, 2014, compared to the prior year period.

 

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The following table provides the sources of our hospitals’ gross patient revenue by payor:

 

     Quarter Ended
June 30,
    Nine Months Ended
June 30,
 
     2014     2013     2014     2013  

Medicare

     27.1     27.9     27.5     28.1

Managed Medicare

     14.9     15.1     15.1     14.8

Medicaid and managed Medicaid

     21.5     19.7     20.9     20.3

Managed care and other

     31.2     30.2     30.5     29.9

Self-pay

     5.3     7.1     6.0     6.9
  

 

 

   

 

 

   

 

 

   

 

 

 

Total

  100.0   100.0   100.0   100.0
  

 

 

   

 

 

   

 

 

   

 

 

 

The following table provides the sources of our hospitals’ net patient revenue by payor before the provision for bad debts:

 

     Quarter Ended
June 30,
    Nine Months Ended
June 30,
 
     2014     2013     2014     2013  

Medicare

     20.5     21.1     20.8     21.5

Managed Medicare

     10.5     10.6     10.6     10.5

Medicaid and managed Medicaid

     12.8     10.8     12.2     11.3

Managed care and other

     42.6     39.6     41.7     39.3

Self-pay

     13.6     17.9     14.7     17.4
  

 

 

   

 

 

   

 

 

   

 

 

 

Total

  100.0   100.0   100.0   100.0
  

 

 

   

 

 

   

 

 

   

 

 

 

As noted in the above tables, our gross and net patient revenue by payor is experiencing a shift from self-pay to Medicaid and managed Medicaid and managed care payors. This shift is primarily a result of Arizona’s expansion of its Medicaid program under Health Care Reform, which become effective January 1, 2014, the initial benefit being experienced as Exchange enrollees begin accessing the healthcare system and the early signs of improvement in the underlying economic fundamentals in the markets we serve.

Net patient revenue per adjusted admission, which includes the impact of the provision for bad debts, increased 2.7% and 4.1% for the quarter and nine months ended June 30, 2014, compared to the same prior year periods.

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 for the fiscal year ended September 30, 2013, filed with the SEC on December 20, 2013, 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

Health Choice contracts with state Medicaid programs in Arizona and Utah to provide specified health services to qualified Medicaid enrollees through contracted providers. Most of its premium revenue is derived through a contract with AHCCCS, 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. Premium revenue includes revenue related to the program settlement process for the Arizona managed Medicaid plan under the related state contract. This program settlement process reconciles estimated amounts due to or from the state based on the actual premium revenue and medical costs and contractually mandated limits on profits and losses. Although estimates of future program settlement amounts are recorded in current periods, the program settlement process typically occurs in the 18 months post-plan year, when actual (rather than projected) claims and member eligibility data become available and a net settlement amount is either due to or from the state. Adjustments to the estimates of future program settlement amounts are recorded as a component of premium revenue.

 

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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). In accordance with CMS regulations, SNPs are now expected to meet additional requirements, including requirements relating to model of care, cost-sharing, disclosure of information and reporting of quality measures.

Premium revenue generated by Health Choice represented 28.2% and 27.1% of our consolidated net revenue for the quarter and nine months ended June 30, 2014, respectively, compared to 24.3% and 24.5% in the same prior year periods.

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 fiscal year ended September 30, 2013. 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, 2013. There have been no changes in the nature of our critical accounting policies or the application of those policies since September 30, 2013.

SELECTED OPERATING DATA

The following table sets forth certain unaudited operating data from continuing operations for each of the periods presented.

 

     Quarter Ended
June 30,
    Nine Months Ended
June 30,
 
     2014     2013     2014     2013  

Acute Care (1)

        

Number of acute care hospital facilities at end of period

     15        15        15        15   

Licensed beds at end of period (2)

     3,601        3,675        3,601        3,675   

Average length of stay (days) (3)

     5.0        4.9        5.0        4.9   

Occupancy rates (average beds in service)

     47.8     48.3     48.6     49.2

Admissions (4)

     24,930        25,710        75,576        78,380   

Adjusted admissions (5)

     47,032        46,346        138,771        138,575   

Patient days (6)

     123,985        126,291        378,095        386,017   

Adjusted patient days (5)

     233,904        227,656        694,248        682,475   

Net patient revenue per adjusted admission (7)

   $ 9,608      $ 9,495      $ 9,615      $ 9,225   

Health Choice

        

Covered lives (8)

     213,032        186,111        213,032        186,111   

Medical loss ratio (9)

     94.8     84.8     88.5     83.8

 

(1) Excludes the impact of our Nevada and Florida operations, which are reflected in discontinued operations.
(2) Includes St. Luke’s Behavioral Hospital in Phoenix, Arizona.
(3) Represents the average number of days that a patient stayed in our hospitals.
(4) 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.
(5) 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.
(6) Represents the number of days our beds were occupied by inpatients over the period.
(7) Includes the impact of the provision for bad debts as a component of revenue.
(8) Represents total lives enrolled across all health plan product lines. Includes dual-eligible lives, which are members eligible for Medicare and Medicaid benefits, under Health Choice’s contract with CMS to provide coverage as a MAPD SNP totaling 8,006 and 4,310 as of June 30, 2014 and 2013, respectively.
(9) 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, the results of our 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
June 30, 2014
    Quarter Ended
June 30, 2013
    Nine Months Ended
June 30, 2014
    Nine Months Ended
June 30, 2013
 

($ in thousands):

  Amount     Percentage     Amount     Percentage     Amount     Percentage     Amount     Percentage  

Revenues

               

Acute care revenue before provision for bad debts

  $ 531,380        $ 518,142        $ 1,613,457        $ 1,533,490     

Less: Provision for bad debts

    (77,130       (81,710       (260,249       (233,456  
 

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

Acute care revenue

  454,250      71.8   436,432      75.7   1,353,208      72.9   1,300,034      75.5

Premium revenue

  178,498      28.2   139,804      24.3   503,212      27.1   422,059      24.5
 

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

Total revenue

  632,748      100.0   576,236      100.0   1,856,420      100.0   1,722,093      100.0

Costs and expenses

Salaries and benefits

  221,446      35.0   207,622      36.1   664,453      35.8   634,229      36.8

Supplies

  75,104      11.9   73,865      12.8   227,415      12.3   224,379      13.0

Medical claims

  165,943      26.2   116,640      20.2   436,754      23.5   348,556      20.2

Rentals and leases

  18,198      2.9   13,356      2.3   54,444      2.9   38,968      2.3

Other operating expenses

  110,337      17.4   102,713      17.8   311,586      16.8   298,427      17.3

Medicare and Medicaid EHR incentives

  (2,940   (0.5 %)    (4,827   (0.8 %)    (9,294   (0.5 %)    (9,884   (0.6 %) 

Interest expense, net

  32,267      5.1   32,770      5.7   98,300      5.3   99,986      5.8

Depreciation and amortization

  23,422      3.7   23,862      4.2   70,648      3.8   70,645      4.1

Management fees

  1,250      0.2   1,250      0.2   3,750      0.2   3,750      0.2
 

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

Total costs and expenses

  645,027      101.9   567,251      98.5   1,858,056      100.1   1,709,056      99.1

Earnings (loss) from continuing operations before gain on disposal of assets and income taxes

  (12,279   (1.9 %)    8,985      1.5   (1,636   (0.1 %)    13,037      0.9

Gain on disposal of assets, net

  2,102      0.3   478      0.1   2,868      0.2   645      0.0
 

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

Earnings (loss) from continuing operations before income taxes

  (10,177   (1.6 %)    9,463      1.6   1,232      0.1   13,682      0.9

Income tax expense

  1,138      0.2   4,037      0.7   7,387      0.4   6,402      0.4
 

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

Net earnings (loss) from continuing operations

  (11,315   (1.8 %)    5,426      0.9   (6,155   (0.3 %)    7,280      0.5

Earnings (loss) from discontinued operations, net of income taxes

  (6,199   (1.0 %)    (331   0.0   (5,786   (0.3 %)    2,761      0.2
 

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

Net earnings (loss)

  (17,514   (2.8 %)    5,095      0.9   (11,941   (0.6 %)    10,041      0.7

Net earnings attributable to non-controlling interests

  (2,453   (0.4 %)    (1,941   (0.3 %)    (8,857   (0.5 %)    (3,189   (0.3 %) 
 

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

Net earnings (loss) attributable to IASIS Healthcare LLC

$ (19,967   (3.2 %)  $ 3,154      0.6 $ (20,798   (1.1 %)  $ 6,852      0.4
 

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

 

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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
June 30, 2014
    Quarter Ended
June 30, 2013
    Nine Months Ended
June 30, 2014
    Nine Months Ended
June 30, 2013
 

($ in thousands):

  Amount     Percentage     Amount     Percentage     Amount     Percentage     Amount     Percentage  

Acute care revenue

               

Acute care revenue before provision for bad debts

  $ 531,380        $ 518,142        $ 1,613,457        $ 1,533,490     

Less: Provision for bad debts

    (77,130       (81,710       (260,249       (233,456  
 

 

 

     

 

 

     

 

 

     

 

 

   

Acute care revenue

  454,250      99.3   436,432      99.6   1,353,208      99.4   1,300,034      99.6

Revenue between segments (1)

  3,262      0.7   1,940      0.4   8,539      0.6   5,334      0.4
 

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

Total acute care revenue

  457,512      100.0   438,372      100.0   1,361,747      100.0   1,305,368      100.0

Costs and expenses

Salaries and benefits

  212,517      46.5   201,532      46.0   640,793      47.1   616,609      47.2

Supplies

  75,034      16.4   73,825      16.8   227,242      16.7   224,237      17.2

Rentals and leases

  17,750      3.9   12,961      3.0   53,279      3.9   37,776      2.9

Other operating expenses

  97,278      21.3   96,720      22.1   283,143      20.8   280,928      21.5

Medicare and Medicaid

EHR incentives

  (2,940   (0.6 %)    (4,827   (1.1 %)    (9,294   (0.7 %)    (9,884   (0.8 %) 

Interest expense, net

  32,267      7.1   32,770      7.5   98,300      7.2   99,986      7.6

Depreciation and amortization

  22,390      4.9   22,833      5.2   67,511      4.9   67,549      5.1

Management fees

  1,250      0.3   1,250      0.2   3,750      0.3   3,750      0.3
 

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

Total costs and expenses

  455,546      99.6   437,064      99.7   1,364,724      100.2   1,320,951      101.1

Earnings (loss) from continuing operations before gain on disposal of assets and income taxes

  1,966      0.4   1,308      0.3   (2,977   (0.2 %)    (15,583   (1.1 %) 

Gain on disposal of assets, net

  2,102      0.5   478      0.1   2,868      0.2   645      0.0
 

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

Earnings (loss) from continuing operations before income taxes

$ 4,068      0.9 $ 1,786      0.4 $ (109   (0.0 %)  $ (14,938   (1.1 %) 
 

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

 

(1) Revenue between segments is eliminated in our consolidated results.

 

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Table of Contents

Quarters Ended June 30, 2014 and 2013

Total acute care revenue — Total acute care revenue for the quarter ended June 30, 2014, was $457.5 million, an increase of $19.1 million or 4.4% compared to $438.4 million in the prior year quarter. The increase in total acute care revenue is comprised primarily of an increase in adjusted admissions of 1.5% and an increase in net patient revenue per adjusted admission of 2.7%.

Net adjustments to estimated third-party payor settlements, also known as prior year contractuals, resulted in an increase in total acute care revenue for the quarters ended June 30, 2014 and 2013, of $0.5 million and $3.4 million, respectively.

Salaries and benefits — Salaries and benefits expense for the quarter ended June 30, 2014, was $212.5 million, or 46.5% of total acute care revenue, compared to $201.5 million, or 46.0% of total acute care revenue in the prior year quarter. Excluding the impact of stock-based compensation, salaries and benefits expense as a percentage of total acute care revenue was 45.2% for the quarter ended June 30, 2014, compared to 45.8% in the prior year quarter. Salaries and benefits expense as a percentage of total acute care revenue, excluding the impact of stock-based compensation, decreased primarily as a result of revenue growth and improvements in labor productivity.

Supplies — Supplies for the quarter ended June 30, 2014, were $75.0 million, or 16.4% of total acute care revenue, compared to $73.8 million, or 16.8% of total acute care revenue in the prior year quarter. The improvement in supplies as a percentage of total acute care revenue is the result of a decline in supply intensive surgical procedures as evidenced by a 4.1% decline in inpatient surgeries, as well as the impact of supply cost initiatives that have included improved pricing and more effective utilization.

Rentals and leases — Rentals and leases expense for the quarter ended June 30, 2014, was $17.8 million, compared to $13.0 million in the prior year quarter. The increase in rentals and leases expense is primarily due to $4.5 million of additional rent expense in the quarter ended June 30, 2014, resulting from the sale-leaseback of certain hospital real estate, which closed in the fourth quarter of fiscal year 2013.

Other operating expenses — Other operating expenses for the quarter ended June 30, 2014, were $97.3 million, or 21.3% of total acute care revenue, compared to $96.7 million, or 22.1% of total acute care revenue in the prior year quarter. Other operating expenses as a percentage of total acute revenue improved primarily due to a decline in professional fees associated with our supplemental Medicaid reimbursement programs in Texas.

Nine Months Ended June 30, 2014 and 2013

Total acute care revenue — Total acute care revenue for the nine months ended June 30, 2014, was $1.36 billion, an increase of $56.4 million or 4.3% compared to $1.31 billion in the prior year period. The increase in total acute care revenue is comprised primarily of an increase in adjusted admissions of 0.1% and an increase in net patient revenue per adjusted admission of 4.1%.

Net adjustments to estimated third-party payor settlements, also known as prior year contractuals, resulted in an increase in total acute care revenue for the nine months ended June 30, 2014 and 2013, of $4.7 million and $6.5 million, respectively.

Salaries and benefits — Salaries and benefits expense for the nine months ended June 30, 2014, was $640.8 million, or 47.1% of total acute care revenue, compared to $616.6 million, or 47.2% of total acute care revenue in the prior year period. Excluding the impact of stock-based compensation, salaries and benefits expense as a percentage of total acute care revenue was 46.3% for the nine months ended June 30, 2014, compared to 47.0% in the prior year period. Salaries and benefits expense as a percentage of total acute care revenue, excluding the impact of stock-based compensation, decreased primarily as a result of revenue growth and improvements in labor productivity.

Supplies — Supplies for the nine months ended June 30, 2014, were $227.2 million, or 16.7% of total acute care revenue, compared to $224.2 million, or 17.2% of total acute care revenue in the prior year period. The improvement in supplies as a percentage of acute care revenue is the result of a decline in supply intensive surgical procedures as evidenced by a 3.7% decline in inpatient surgeries, as well as the impact of supply cost initiatives that have included improved pricing and more effective utilization.

Rentals and leases — Rentals and leases expense for the nine months ended June 30, 2014, was $53.3 million, compared to $37.8 million in the prior year period. The increase in rentals and leases expense is primarily due to $13.2 million of additional rent expense in the nine months ended June 30, 2014, resulting from of the sale-leaseback of certain hospital real estate, which closed in the fourth quarter of fiscal year 2013.

Other operating expenses — Other operating expenses for the nine months ended June 30, 2014, were $283.1 million, or 20.8% of total acute care revenue, compared to $280.9 million, or 21.5% of total acute care revenue in the prior year period. Other operating expenses as a percentage of total acute care revenue improved primarily due to a decline in professional fees associated with our supplemental Medicaid reimbursement programs in Texas.

 

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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
June 30, 2014
    Quarter Ended
June 30, 2013
    Nine Months Ended
June 30, 2014
    Nine Months Ended
June 30, 2013
 

($ in thousands):

  Amount     Percentage     Amount     Percentage     Amount     Percentage     Amount     Percentage  

Premium and service revenue

               

Premium revenue

  $ 178,498        100.0   $ 139,804        100.0   $ 503,212        100.0   $ 422,059        100.0

Costs and expenses

               

Salaries and benefits

    8,929        5.0     6,090        4.5     23,660        4.7     17,620        4.2

Supplies

    70        0.0     40        0.0     173        0.0     142        0.0

Medical claims (1)

    169,205        94.8     118,580        84.8     445,293        88.5     353,890        83.8

Other operating expenses

    13,059        7.3     5,993        4.3     28,443        5.7     17,499        4.1

Rentals and leases

    448        0.3     395        0.3     1,165        0.2     1,192        0.3

Depreciation and amortization

    1,032        0.6     1,029        0.7     3,137        0.6     3,096        0.8
 

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

Total costs and expenses

  192,743      108.0   132,127      94.5   501,871      99.7   393,439      93.2
 

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

Earnings (loss) before income taxes

$ (14,245   (8.0 %)  $ 7,677      5.5 $ 1,341      0.3 $ 28,620      6.8
 

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

 

(1) Medical claims paid to our hospitals of $3.3 million and $1.9 million for the quarters ended June 30, 2014 and 2013, respectively, and $8.5 million and $5.3 million for the nine months ended June 30, 2014 and 2013, respectively, are eliminated in our consolidated results.

Quarters Ended June 30, 2014 and 2013

Premium revenue — Premium revenue from Health Choice was $178.5 million for the quarter ended June 30, 2014, an increase of $38.7 million or 27.7% compared to $139.8 million in the prior year quarter. The increase in premium revenue is attributable to a 14.5% increase in members, driven by growth in all of our product lines. Enrollment in our Medicare and Medicaid product lines increased 81.4% and 10.4%, respectively, compared to the prior year quarter. Premium revenue for our Medicaid product line has been impacted favorably by the expansion of the Medicaid program in Arizona, which has included the reinstatement of benefits for certain childless adult lives. We also recognized $4.0 million of revenue related to the new HIF as part of the Health Reform Law.

Medical claims — Prior to eliminations, medical claims expense was $169.2 million for the quarter ended June 30, 2014, compared to $118.6 million in the prior year quarter. Medical claims expense as a percentage of premium revenue was 94.8% for the quarter ended June 30, 2014, compared to 84.8% in the prior year quarter. Excluding the impact of the HIF revenue, medical claims as a percentage of premium revenue was 97.4% for the quarter ended June 30, 2014, compared to 84.8% in the prior year quarter. This increase is primarily attributable to additional medical expenses associated with the increase in childless adult members, resulting from the recent expansion of the Medicaid program in Arizona, a population that typically presents for medical treatment more frequently and at higher acuity levels, particularly as they are newly enrolled (and prior to effective management of their care). Additionally, we have incurred an increase in pharmacy costs resulting from an increase in specialty drug utilization, including $1.1 million of additional costs associated with a new drug used to cure Hepatitis C.

Other operating expenses — Other operating expenses for the quarter ended June 30, 2014, were $13.1 million, or 7.3% of premium revenue, compared to $6.0 million, or 4.3% of premium revenue in the prior year quarter. Other operating expenses increased primarily as a result of $2.0 million in start-up related costs associated with our new third-party administration and management services organization business and $4.0 million in HIF expense.

 

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Nine Months Ended June 30, 2014 and 2013

Premium revenue — Premium revenue from Health Choice was $503.2 million for the nine months ended June 30, 2014, an increase of $81.2 million or 19.2% compared to $422.1 million in the prior year period. The increase in premium revenue is attributable to a 6.2% increase in members, driven by growth in all of our product lines. Enrollment in our Medicare and Medicaid product lines increased 56.6% and 7.5%, respectively, compared to the prior year period. Premium revenue for our Medicaid product line has been impacted favorably by the expansion of the Medicaid program in Arizona, which has included the reinstatement of benefits for certain childless adult lives. Additionally, premium revenue for the nine months ended June 30, 2014, compared to the prior year period, increased as a result of additional reimbursement related to primary care physician Medicaid parity payments, which also includes a pass-through component impacting our medical expenses. We also recognized $4.0 million of revenue related to the new HIF as part of the Health Reform Law.

Medical claims — Prior to eliminations, medical claims expense was $445.3 million for the nine months ended June 30, 2014, compared to $353.9 million in the prior year period. Medical claims expense as a percentage of premium revenue was 88.5% for the nine months ended June 30, 2014, compared to 83.8% in the prior year period. Excluding the impact of the HIF revenue, medical claims as a percentage of premium revenue was 89.4% for the nine months ended June 30, 2014, compared to 83.8% in the prior year period. This increase is primarily attributable to additional medical expenses associated with the increase in childless adult members, resulting from the recent expansion of the Medicaid program in Arizona, a population that typically presents for medical treatment more frequently and at higher acuity levels, particularly as they are newly enrolled (and prior to effective management of their care). Additionally, we have incurred an increase in pharmacy costs resulting from an increase in specialty drug utilization, including $3.8 million of additional costs associated with a new drug used to cure Hepatitis C.

Other operating expenses — Other operating expenses for the nine months ended June 30, 2014, were $28.4 million, or 5.7% of premium revenue, compared to $17.5 million, or 4.1% of premium revenue in the prior year period. Other operating expenses increased primarily as a result of $3.0 million in start-up related costs associated with our new third-party administration and management services organization business and $4.0 million in HIF expense.

Income Tax Expense

Quarters ended June 30, 2014 and 2013

For the quarter ended June 30, 2014, we recorded income tax expense of $1.1 million, for an effective tax rate of (11.2%), compared to income tax expense of $4.0 million, for an effective tax rate of 42.7% in the prior year quarter. The change in the effective tax rate was primarily due to the following: (1) an increase in nondeductible compensation, including stock-based compensation; (2) a $1.5 million expense related to an excess of cumulative compensation deductions over the realized tax benefit upon the exercise of employee stock options; (3) the HIF imposed by the Health Reform Law beginning in 2014, which is treated as a nondeductible excise tax; and (4) the decrease in net earnings from continuing operations, which magnified the rate impact of state income taxes (including the Texas margins tax), noncontrolling interests, and other adjustments.

Nine months ended June 30, 2014 and 2013

For the nine months ended June 30, 2014, we recorded income tax expense of $7.4 million, for an effective tax rate of 599.6%, compared to income tax expense of $6.4 million, for an effective tax rate of 46.8% in the prior year period. The change in the effective tax rate was primarily due to the following: (1) an increase in nondeductible compensation, including stock-based compensation; (2) a $1.5 million expense related to an excess of cumulative compensation deductions over the realized tax benefit upon the exercise of employee stock options; (3) the HIF imposed by the Health Reform Law beginning in 2014, which is treated as a nondeductible excise tax; and (4) the decrease in net earnings from continuing operations, which magnified the rate impact of state income taxes (including the Texas margins tax), noncontrolling interests, and other adjustments.

LIQUIDITY AND CAPITAL RESOURCES

Overview of Cash Flow Activities for the Nine Months Ended June 30, 2014 and 2013

Our cash flows are summarized as follows (in thousands):

 

     Nine Month Ended
June 30,
 
     2014      2013  

Cash flows from operating activities

   $ (10,544    $ 12,924   

Cash flows from investing activities

   $ (84,100    $ (82,487

Cash flows from financing activities

   $ (25,844    $ 38,537   

 

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Operating Activities

Cash flows used in operating activities for the nine months ended June 30, 2014, which declined $23.5 million compared to the prior year period, were impacted by the payment of $22.3 million in income taxes, transaction fees and other costs, as well as $16.9 million of additional rent payments, associated with the recent sale-leaseback of certain hospital real estate. In addition, cash flows used in continuing operations were impacted by the timing of payments related to primary care physician Medicaid parity at Health Choice.

At June 30, 2014, we had $570.7 million in net working capital, compared to $491.4 million at September 30, 2013, excluding the impact of our assets and liabilities held for sale. Net accounts receivable decreased $34.4 million to $336.6 million at June 30, 2014, from $371.0 million at September 30, 2013. Our days revenue in accounts receivable at June 30, 2014, were 54, compared to 56 at September 30, 2013 and 59 at June 30, 2013.

Investing Activities

Cash flows used in investing activities increased $1.6 million for the nine months ended June 30, 2014, compared to the prior year period. Included in capital expenditures for the nine months ended June 30, 2014 is $17.0 million of costs associated with the ongoing construction of our new greenfield hospital, Mountain Point Medical Center, in Lehi, Utah. This project is expected to be completed in the spring/summer of 2015.

Financing Activities

Cash flows used in financing activities was $25.8 million for the nine months ended June 30, 2014, compared to cash provided of $38.5 million in the prior year period. The prior year period included proceeds from borrowings on our revolving credit facilities of $147.0 million, along with subsequent debt payments of $102.2 million. The nine months ended June 30, 2014, includes regular debt payments of $10.1 million and distributions to non-controlling interests of $5.2 million associated with the sale-leaseback of certain hospital real estate.

Capital Resources

As of June 30, 2014, 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, 2014, amounts outstanding under our senior secured credit facilities consisted of $992.0 million in term loans. In addition, we had $69.9 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 4.6% for both the quarter and nine months ended June 30, 2014, respectively, compared to 4.5% and 4.8% in the prior year periods.

$1.325 Billion Senior Secured Credit Facilities

We are party to a senior credit agreement, which was amended on February 20, 2013 (the “Repricing Amendment”) as part of a repricing that lowered the interest rate, (the “Amended and Restated Credit Agreement”). The Amended and 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 of $1.007 billion outstanding as of the effective date of the Repricing Amendment, 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 (giving effect to the Repricing Amendment) 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 2.25% 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 3.25% 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 are 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.

 

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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 Amended and 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 Amended and 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 Amended and 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; (4) limitations on dividends and distributions; and (5) limitations on transactions with affiliates, in each case, subject to certain exceptions. The Amended and 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

We and IASIS Capital Corporation (together, the “Issuers”) have issued $850.0 million aggregate principal amount of 8.375% senior notes due 2019 (“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, payable semi-annually, in cash in arrears, on May 15 and November 15 of each year.

We may redeem the Senior Notes, in whole or in part, at any time on or after to May 15, 2014, at a price equal to 106.281% 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. Each subsequent year the redemption price declines 2.093% until 2017 and thereafter, at which point the redemption price is equal to 100% 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.

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; (6) impose restrictions on the ability of a subsidiary to pay dividends or make payments or distributions to us and our restricted subsidiaries; and (7) 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 Original Filing Date:

 

     Moody’s    Standard & Poor’s

Corporate credit

   B2    B

Senior secured term loan facility

   Ba3    B

Senior secured revolving credit facility

   Ba3    BB-

Senior Notes

   Caa1    CCC+

Outlook

   Stable    Stable

 

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Other

We are party to interest rate swaps with Citibank, N.A. (“Citibank”) and Barclays Bank PLC (“Barclays”), as counterparties, with notional amounts totaling $350.0 million, each agreement effective March 28, 2013 and expiring between September 30, 2014 and September 30, 2016. Under these agreements, we are required to make quarterly fixed rate payments to the counterparties at annual rates ranging from 1.6% to 2.2%. The counterparties are obligated to make quarterly floating rate payments to us based on the three-month LIBOR rate, each subject to a floor of 1.25%.

 

     Total Notional
Amounts
 

Effective Dates

   (in thousands)  

Effective from March 28, 2013 to September 30, 2014

   $ 50,000   

Effective from March 28, 2013 to September 30, 2015

     100,000   

Effective from March 28, 2013 to September 30, 2016

     200,000   

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 2014 to be $115.0 million to $125.0 million, including the following significant expenditures:

 

    $50 million to $55 million for growth and new business projects;

 

    $45 million to $50 million in replacement or maintenance related projects at our hospitals; and

 

    $20 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 in our Annual Report on Form 10-K for the fiscal year ended September 30, 2013.

Including available cash at June 30, 2014, we have available liquidity as follows (in millions):

 

Cash and cash equivalents

   $  317.6   

Available capacity under our senior secured revolving credit facility

     230.1   
  

 

 

 

Net available liquidity at June 30, 2014

$ 547.7   
  

 

 

 

Net available liquidity assumes 100% participation from all lenders currently committed under our senior secured revolving credit facility. In addition to our available liquidity, we expect to generate sufficient operating cash flows in fiscal 2014. 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 in our Annual Report on Form 10-K for the fiscal year ended September 30, 2013.

 

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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, 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 in our Annual Report on Form 10-K for the fiscal year ended September 30, 2013.

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.

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, 2014, 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, 2014, we had outstanding variable rate debt of $992.0 million.

We have managed our market exposure to changes in interest rates by implementing a comprehensive interest rate hedging strategy that includes converting variable rate debt to fixed rate debt. We have executed interest rate swaps with Citibank and Barclays, as counterparties, with notional amounts totaling $350.0 million, each agreement effective March 28, 2013, and expiring between September 30, 2014 and September 30, 2016, at rates ranging from 1.6% to 2.2%. Our interest rate hedging agreements expose us to credit risk in the event of non-performance by our counterparties, Citibank and Barclays. However, we do not anticipate non-performance by either of our counterparties.

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 that interest rates would not exceed 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, 2014, the end of the period covered by the Original Filing. Based on this evaluation, at the time of the Original Filing, our Chief Executive Officer and Chief Financial Officer originally concluded that our disclosure controls and procedures were effective as of June 30, 2014.

Subsequent to the Original Filing, in connection with the restatement discussed in the Explanatory Note and in Note 1A to our consolidated financial statements with respect to the third and fourth fiscal quarters of our 2014 fiscal year and the first quarter of the 2015 fiscal year, our Company’s management, with the participation of our Chief Executive Officer and Chief Financial Officer, has identified a material weakness in the internal control over financial reporting. A material weakness is a deficiency, or a combination of deficiencies, in internal control over financial reporting such that there is a reasonable possibility that a material misstatement of the annual or interim financial statements will not be prevented or detected on a timely basis. For these periods, our

 

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management identified a lack of sufficient controls regarding appropriate segregation of duties with respect to our managed care business’ accounting for estimated program settlements under our largest state managed Medicaid contract. A lack of appropriate segregation of duties occurred because the managed care division finance employee charged with reviewing journal entries with respect to such program settlements also prepared the related supporting schedules. Solely as a result of such material weakness, our Chief Executive Officer and Chief Financial Officer have concluded that our disclosure controls and procedures were not effective as of June 30, 2014.

In light of the deficiency described above, we have performed additional analysis and reviews to provide reasonable assurance that the financial statements in this Amendment have been prepared in accordance with generally accepted accounting principles.

Remediation Plan

Our management team has developed a plan to address this material weakness. This plan includes the adoption of polices that specifically delineate responsibility for the preparation and review of estimated program settlement amounts and practices to ensure a separation of duties in these areas, as well as adding an additional level of review of supporting documentation and related journal entries. We believe that these steps will correct the material weakness described above.

Changes in Internal Control Over Financial Reporting

Except as discussed above, during the quarter ended June 30, 2014, there have been no changes in our internal controls that have materially affected or are reasonably likely to materially affect our internal control over financial reporting.

PART II. OTHER INFORMATION

Item 1. Legal Proceedings

In November 2010, the U.S. Department of Justice (“DOJ”) sent a letter to IAS requesting a 12-month tolling agreement in connection with an investigation into Medicare claims submitted by our hospitals in connection with the implantation of implantable cardioverter defibrillators (“ICDs”) during the period 2003 to the present. At that time, neither the precise number of procedures, number of claims, nor the hospitals involved were identified by the DOJ. We understand that the government is conducting a national initiative with respect to ICD procedures involving a number of healthcare providers and is seeking information in order to determine if ICD implantation procedures were performed in accordance with Medicare coverage requirements. On January 11, 2011, IAS entered into the tolling agreement with the DOJ and, subsequently, the DOJ provided us 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. Applying the resolution model proposed by the DOJ, we believe that at least 131 of these procedure claims were properly documented for medical necessity and billed appropriately. Our outside counsel has submitted to the DOJ summary justifications and supporting evidence relating to the medical claims at six of our hospitals. We continue to provide support for the remaining 63 of these cases that could have some likelihood of enforcement by the DOJ. If we are unable to place these claims in a non-enforcement or lesser enforcement category, the government may require repayment, which could impose a multiplier. Given the case-specific nature of the claims and the DOJ’s discretion to compromise claims, we are unable at this time to estimate any potential repayment obligation related to this matter. The tolling agreement between IAS and the government, as recently extended, is currently set to expire December 31, 2014.

On September 25, 2013, we voluntarily self-disclosed for resolution through the Self-Referral Disclosure Protocol established by CMS non-compliance by ten of our affiliated hospitals with a certain element of an exception of the Stark Law. Provisions of the Affordable Care Act that became effective on September 23, 2011 require, as an element of the Stark Law’s “whole-hospital” exception, that hospitals having physician ownership disclose such ownership on their public websites and in public advertising. The self-disclosure states that, on August 12, 2013, we discovered that the ten of our affiliated hospitals partially owned by physicians did not consistently make such disclosures. The self-disclosure also states that, on August 13, 2013, the hospitals added the disclosures to those public websites that did not previously have them and began to include the disclosures in new public advertising. The self-disclosure explains that, as a result of the absence of the website and advertising disclosures, the referrals of direct and indirect physician owners (and physicians who are immediate family members of direct and indirect owners) to the physician-owned hospitals of Medicare beneficiaries did not consistently qualify for the Stark Law’s “whole-hospital” exception from September 23, 2011 through August 13, 2013. On October 21, 2013, we submitted a supplement to our self-disclosure, reporting Medicare payments to these hospitals for services resulting from referrals affected by the non-compliance and the hospitals’ profit distributions to physicians (and known immediate family members of physicians) with respect to their ownership interests in the hospitals during the same period. We have been in communication with CMS about resolving this matter but, at present, CMS has made no commitments, as a general matter or in this case, regarding the timing or substance of resolution of self-disclosed Stark Law noncompliance through the

 

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voluntary CMS Self-Referral Disclosure Protocol. As a result, we express no opinion as to its outcome other than to state that it could take up to one year or longer to resolve and, at this time, any repayment obligation or other penalties to be determined by CMS is unknown and not currently estimable.

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 Amendment and other risk factors described in our Annual Report on Form 10-K for the fiscal year ended September 30, 2013, 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 fiscal year ended September 30, 2013.

Item 6. Exhibits

 

(a) List of Exhibits:

Exhibits: See the Index to Exhibits at the end of this report, which is incorporated herein by reference.

 

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SIGNATURES

Pursuant to the requirements of the Securities Exchange Act of 1934, the registrant has duly caused this report to be signed on its behalf by the undersigned thereunto duly authorized.

 

IASIS HEALTHCARE LLC
Date: May 15, 2015 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/A for the quarter ended June 30, 2014, filed with the SEC on May 15, 2015, formatted in Extensible Business Reporting Language (XBRL): (i) the condensed consolidated balance sheets at June 30, 2014 and September 30, 2013, (ii) the condensed consolidated statements of operations for the quarters and nine months ended June 30, 2014 and 2013, (iii) the condensed consolidated statements of comprehensive income (loss) for the quarters and nine months ended June 30, 2014 and 2013, (iv) the condensed consolidated statement of equity, (v) the condensed consolidated statements of cash flows for the nine months ended June 30, 2014 and 2013, and (vi) 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/A 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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