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8-K - 8-K - AMSURG CORPamsg8k20151103.htm

 
Contact:
Claire M. Gulmi
 
 
Executive Vice President and
 
 
Chief Financial Officer
 
 
(615) 665-1283

AMSURG REPORTS THIRD-QUARTER ADJUSTED DILUTED EPS OF $1.03 AND
DILUTED EPS OF $0.83
———————————
INCREASES 2015 FINANCIAL GUIDANCE

NASHVILLE, Tenn. ─ (November 3, 2015) ─ AmSurg Corp. (NASDAQ: AMSG) today announced financial results for the third quarter ended September 30, 2015. The Company’s results for the quarter included:

Growth in net revenues of 29% to $650.2 million from $502.4 million for the third quarter of 2014;
Net earnings from continuing operations attributable to AmSurg common shareholders of $40.4 million. Adjusted net earnings increased 53% to $53.0 million from the third quarter of 2014;
Net earnings per diluted share from continuing operations attributable to AmSurg common shareholders of $0.83 and 49% growth in adjusted net earnings per diluted share to $1.03; and
Adjusted EBITDA of $133.2 million, up 39% from the third quarter of 2014.

See page 6 for a reconciliation of all GAAP and non-GAAP financial results.

“AmSurg continued to perform meaningfully better than we expected during the third quarter of 2015, resulting in our raising our financial guidance for the year for the third consecutive quarter,” said Christopher A. Holden, President and Chief Executive Officer of AmSurg. “Our strong results reflected outstanding organic growth for the quarter, with an acceleration in our Ambulatory Services same-center revenues for the third consecutive quarter and double-digit growth in Physician Services same-contract revenue growth for the second consecutive quarter.

“For the third quarter of 2015, Ambulatory Services produced same-center revenue growth of 6.6%, due primarily to improved reimbursement, increased volume and improved case mix. Physician Services produced same-contract revenue growth of 10.1%, driven by increased volume, improved reimbursement and higher acuity.

“In addition, the combination of AmSurg and Sheridan continued to be catalytic to our acquisition growth strategies in the third quarter. In a time of increasing industry integration and consolidation, this combination gives AmSurg a unique and nationally scaled platform that addresses strategically imperative needs of health systems as they focus on building integrated networks. The market reception for this platform continues to exceed our expectations.

“During the third quarter, Ambulatory Services purchased two ambulatory surgery centers (ASCs) and opened a de novo ASC. The division also entered into a new joint venture with a health system in California whereby we contributed two ASCs and the health system contributed a surgical hospital. In addition, subsequent to quarter end, Ambulatory Services acquired two ASCs. As previously announced, Physician Services purchased two anesthesia practices during the third quarter, and today we announced the acquisition of Valley Anesthesia in Phoenix, Arizona, one of the largest independent anesthesiology practices in the country.”

Ambulatory Services

Net revenues for Ambulatory Services grew 12% to $309.0 million for the third quarter of 2015 from $276.4 million for the third quarter of 2014. Same-center revenue rose 6.6% for third quarter of

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AMSG Reports Third-Quarter Results
 
 
Page 2
 
 
November 3, 2015
 
 



2015 compared with the third quarter of 2014, comprised of a 2.7% increase in procedures and a 3.9% increase in net revenue per procedure. Adjusted EBITDA was $55.4 million for the third quarter of 2015, a 16% increase from $47.9 million for the third quarter of 2014, while adjusted EBITDA margin increased 60 basis points to 17.9% from 17.3%.

At the end of the quarter, Ambulatory Services operated 253 ASCs and one surgical hospital. Ambulatory Services had five ASCs under letter of intent at the end of the third quarter and one center under development, which is expected to open in 2016.

Physician Services

For the third quarter of 2015, net revenues for Physician Services were $341.2 million. Adjusted EBITDA was $77.8 million for the quarter, and adjusted EBITDA margin was 22.8%.

Comparable-quarter revenue growth for Physician Services was 25.9%, of which 7.6% was from same-contract revenues, 2.9% from net new contract revenues and 15.4% from acquisition revenues. Same-contract growth in net revenues totaled 10.1% for the third quarter of 2015, which included a 5.0% increase in patient encounters and a 5.1% increase in net revenue per patient encounter.

Having completed the Valley Anesthesia transaction thus far in the fourth quarter, Physician Services continues to evaluate additional acquisition opportunities in its robust pipeline of potential transactions.

Liquidity

AmSurg had cash and cash equivalents of $187.4 million at the end of the third quarter. Subsequent to quarter end, the Company executed the accordion feature under its credit agreement, which increased its borrowing capacity to $500.0 million under its revolving credit facility.  A portion of this credit facility was used to fund acquisitions subsequent to quarter end. The remaining availability under the Company’s revolving credit facility is $244.0 million. Net cash flows from operations, less distributions to noncontrolling interests, were $118.7 million for the third quarter. The Company’s ratio of total debt at the end of the third quarter of 2015 to trailing 12 months EBITDA as calculated under the Company’s credit agreement was 4.4.

Guidance

AmSurg today has raised its financial and operating guidance for 2015 and established its financial guidance for the fourth quarter of the year. The Company’s guidance is as follows:

Revenues in a range of $2.52 billion to $2.54 billion, up from a range of $2.50 billion to $2.52 billion;
A same-center revenue increase of 4% to 5% for Ambulatory Services, compared with the prior range of 3% to 4%; affirms guidance for same-contract revenue growth of 8% to 10% in Physician Services;
Adjusted EBITDA of $486 million to $490 million, up from a range of $474 million to $480 million;
Adjusted EPS in a range of $3.66 to $3.69, up from a range of $3.52 to $3.59; and
For the fourth quarter of 2015, adjusted EPS in a range of $1.03 to $1.06.

Non-GAAP Adjusted EBITDA guidance for the full year of 2015 excludes interest expense, income taxes, depreciation, amortization, share-based compensation, transaction costs, changes in contingent purchase price consideration, gain or loss on deconsolidations and discontinued operations. Non-GAAP Adjusted EPS guidance for the fourth quarter and full year of 2015 exclude acquisition-related transaction costs, acquisition-related amortization expense, gains and losses on future deconsolidation transactions and share-based compensation expense, net of the tax impact thereon. The exact amount of such exclusions are not currently determinable but may be significant and may vary significantly from period to period (see page 6 for a reconciliation of all GAAP and non-GAAP financial results).


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AMSG Reports Third-Quarter Results
 
 
Page 3
 
 
November 3, 2015
 
 



Conference Call

AmSurg Corp. will hold a conference call to discuss this release Tuesday, November 3, 2015, at 5:00 p.m. Eastern time. Investors will have the opportunity to listen to the conference call over the Internet by going to www.amsurg.com and clicking “Investors” at least 15 minutes early to register, download, and install any necessary audio software. For those who cannot listen to the live broadcast, a replay will be available at these sites shortly after the call and continue for 30 days.

Safe Harbor

This press release contains forward-looking statements, including the Company’s financial and operating guidance for the fourth quarter and full year of 2015. These statements, which have been included in reliance on the “safe harbor” provisions of the Private Securities Litigation Reform Act of 1995, involve risks and uncertainties. Investors are hereby cautioned that these statements may be affected by important factors, including, but not limited to, the following risks: we may face challenges managing our Physician Services Division as a new business and may not realize anticipated benefits; we may become subject to investigations by federal and state entities and unpredictable impacts of the Patient Protection and Affordable Care Act, as amended by the Health Care and Education Reconciliation Act of 2010; we may not be able to successfully maintain effective internal controls over financial reporting; we may not be able to implement our business strategy, manage the growth in our business, and integrate acquired businesses; our substantial indebtedness and restrictions in our debt instruments could adversely affect our business or our ability to implement our growth strategy, or limit our ability to react to changes in the economy or our industry; we may not generate sufficient cash to service our indebtedness, including any future indebtedness; regulatory changes may obligate us to buy out interests of physicians who are minority owners of our surgery centers; we may not be able to successfully maintain our information systems and processes, implement new systems and processes, and maintain the security of those systems and processes; we may fail to effectively and timely transition to the ICD-10 coding system; we may be subject to litigation and investigations and liability claims for damages and other expenses not covered by insurance; we may be required to write-off a portion of our intangible assets; payments from third-party payors, including government healthcare programs, may decrease or not increase as our costs increase; there may be adverse developments affecting the medical practices of our physician partners; we may not be able to maintain favorable relations with our physician partners; we may not be able to grow our ambulatory services revenue by increasing procedure volume while maintaining operating margins and profitability at our existing surgery centers; we may not be able to compete for physician partners, managed care contracts, patients and strategic relationships; adverse weather and other factors beyond our control may affect our business; our legal responsibility to minority owners of our surgery centers may conflict with our interests and prevent us from acting solely in our best interests; we may be adversely impacted by changes in patient volume and patient mix; several client relationships generate a significant portion of our physician services revenues; our physician services contracts may be cancelled or not renewed or we may not be able to enter into additional contracts under terms acceptable to us; reimbursement rates, revenue and profit margin under our fee-for-service physician services payor contracts may decrease; we may not be able to timely or accurately bill for services; laws and regulations that regulate payments for medical services made by government healthcare programs could cause our revenues to decrease; we may not be able to enroll our physician services providers in the Medicare and Medicaid programs on a timely basis; our strategic partnerships with healthcare providers may not be successful; our segments of the market for medical services have a high level of competition; we may not be able to successfully recruit and retain physicians, nurses and other clinical providers; we may not be able to accurately assess the costs we will incur under new contracts; our margins may be negatively impacted by cross-

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AMSG Reports Third-Quarter Results
 
 
Page 4
 
 
November 3, 2015
 
 



selling to existing clients or selling bundled services to new clients; we may not be able to enforce non-compete agreements with our physicians and other clinical employees in some jurisdictions; there may be unfavorable changes in regulatory, economic and other conditions in the states where we operate; legislative or regulatory action may make our captive insurance company arrangement less feasible or otherwise reduce our profitability; our reserves with respect to our losses covered under our insurance programs may not be sufficient; and the other risk factors are described in AmSurg’s Annual Report on Form 10-K for the fiscal year ended December 31, 2014, as updated by other filings with the Securities and Exchange Commission. Consequently, actual results, performance or developments may differ materially from the forward-looking statements included above. AmSurg disclaims any intent or obligation to update these forward-looking statements.

About AmSurg

AmSurg’s Ambulatory Services Division acquires, develops and operates ambulatory surgery centers in partnership with physicians throughout the U.S. AmSurg’s Physician Services Division, Sheridan, provides outsourced physician services in multiple specialties to hospitals, ASCs and other healthcare facilities throughout the U.S., primarily in the areas of anesthesiology, children’s services, emergency medicine and radiology. Through these businesses as of September 30, 2015, AmSurg owned and operated 253 ASCs and one surgical hospital in 34 states and provided physician services to more than 360 healthcare facilities in 27 states. AmSurg has partnerships with, or employs, over 5,000 physicians in 38 states and the District of Columbia.


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AMSG Reports Third-Quarter Results
 
 
Page 5
 
 
November 3, 2015
 
 



AMSURG CORP.
Unaudited Selected Consolidated Financial and Operating Data
(In thousands, except earnings per share)

 
Three Months Ended September 30,
 
Nine Months Ended September 30,
Statement of Operations Data:
2015
 
2014
 
2015
 
2014
Revenues
$
712,719

 
$
555,543

 
$
2,058,649

 
$
1,093,331

Provision for uncollectibles
(62,492
)
 
(53,193
)
 
(196,027
)
 
(53,193
)
Net revenue
650,227


502,350


1,862,622


1,040,138

Operating expenses:
 
 
 
 
 
 
 
Salaries and benefits
327,532

 
240,337

 
950,107

 
406,539

Supply cost
45,638

 
41,886

 
134,012

 
120,564

Other operating expenses
98,852

 
81,262

 
294,424

 
191,243

Transaction costs
2,107

 
25,102

 
5,560

 
28,681

Depreciation and amortization
24,106

 
20,838

 
70,536

 
37,533

Total operating expenses
498,235


409,425


1,454,639


784,560

Net gain on deconsolidations
9,112

 

 
5,854

 
3,411

Equity in earnings of unconsolidated affiliates
4,935

 
2,158

 
11,575

 
3,461

Operating income
166,039


95,083


425,412


262,450

Interest expense, net
30,242

 
39,054

 
90,671

 
52,906

Debt extinguishment costs

 
16,887

 

 
16,887

Earnings from continuing operations before income taxes
135,797


39,142


334,741


192,657

Income tax expense
37,518

 
22

 
76,960

 
25,802

Net earnings from continuing operations
98,279


39,120


257,781


166,855

Net loss from discontinued operations

 
(1,697
)
 

 
(1,146
)
Net earnings
98,279


37,423


257,781


165,709

Less net earnings attributable to noncontrolling interests
55,618

 
47,257

 
160,407

 
139,387

Net earnings (loss) attributable to AmSurg Corp. shareholders
42,661


(9,834
)

97,374


26,322

Preferred stock dividends
(2,264
)
 
(2,239
)
 
(6,792
)
 
(2,239
)
Net earnings (loss) attributable to AmSurg Corp. common shareholders
$
40,397


$
(12,073
)

$
90,582


$
24,083

 
 
 
 
 
 
 
 
Amounts attributable to AmSurg Corp. common shareholders:
 
 
 
 
 
 
 
Earnings (loss) from continuing operations, net of income tax
$
40,397

 
$
(10,697
)
 
$
90,582

 
$
25,466

Loss from discontinued operations, net of income tax

 
(1,376
)
 

 
(1,383
)
Net earnings (loss) attributable to AmSurg Corp. common shareholders
$
40,397

 
$
(12,073
)
 
$
90,582

 
$
24,083

Basic earnings (loss) per share attributable to AmSurg Corp. common shareholders:
 
 
 
 
 
 
 
Net earnings (loss) from continuing operations
$
0.85

 
$
(0.23
)
 
$
1.90

 
$
0.70

Net loss from discontinued operations

 
(0.03
)
 

 
(0.04
)
Net earnings (loss)
$
0.85

 
$
(0.26
)
 
$
1.90

 
$
0.66

Diluted earnings (loss) per share attributable to AmSurg Corp. common shareholders:
 
 
 
 
 
 
 
Net earnings (loss) from continuing operations
$
0.83

 
$
(0.23
)
 
$
1.89

 
$
0.69

Net loss from discontinued operations

 
(0.03
)
 

 
(0.04
)
Net earnings (loss)
$
0.83

 
$
(0.26
)
 
$
1.89

 
$
0.65

Weighted average number of shares and share equivalents outstanding:
 
 
 
 
 
 
 
Basic
47,707

 
46,320

 
47,652

 
36,620

Diluted
51,275

 
46,320

 
48,050

 
37,026



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AMSG Reports Third-Quarter Results
 
 
Page 6
 
 
November 3, 2015
 
 



AMSURG CORP.
Unaudited Selected Consolidated Financial and Operating Data, continued
(In thousands, except earnings per share)
 
Three Months Ended September 30,
 
Nine Months Ended September 30,
 
2015
 
2014
 
2015
 
2014
Reconciliation of net earnings (loss) to Adjusted net earnings (1):
 
 
 
 
 
 
 
Net earnings (loss) attributable to AmSurg Corp. shareholders
$
42,661

 
$
(9,834
)
 
$
97,374

 
$
26,322

Loss from discontinued operations

 
1,877

 

 
1,893

Amortization of purchased intangibles
12,681

 
9,969

 
37,593

 
9,969

Share-based compensation
3,727

 
2,424

 
11,319

 
7,388

Transaction costs
2,107

 
25,102

 
5,560

 
28,681

Net gain on deconsolidations
(9,112
)
 

 
(5,854
)
 
(3,411
)
Net change in fair value of contingent consideration
1,928

 

 
8,338

 

Debt extinguishment costs

 
16,887

 

 
16,887

Deferred financing write-off

 
12,763

 

 
12,763

Total pre-tax adjustments
11,331

 
69,022

 
56,956

 
74,170

Tax effect (less $3.7 million charge to income tax expense for change in valuation allowance for 2015)
946

 
24,574

 
19,669

 
25,968

Total adjustments, net
10,385

 
44,448

 
37,287

 
48,202

Adjusted net earnings
$
53,046

 
$
34,614

 
$
134,661

 
$
74,524

 
 
 
 
 
 
 
 
Basic shares outstanding
47,707

 
46,320

 
47,652

 
36,620

Effect of dilutive securities, options and non-vested shares
3,568

 
3,904

 
3,534

 
1,572

Diluted shares outstanding, if converted
51,275


50,224

 
51,186

 
38,192

 
 
 
 
 
 
 
 
Adjusted earnings per share
$
1.03

 
$
0.69

 
$
2.63

 
$
1.95

 
 
 
 
 
 
 
 
Reconciliation of net earnings (loss) to Adjusted EBITDA (2):
 
 
 
 
 
 
 
Net earnings (loss) attributable to AmSurg Corp. shareholders
$
42,661

 
$
(9,834
)
 
$
97,374

 
$
26,322

Loss from discontinued operations

 
1,376

 

 
1,383

Interest expense, net
30,242

 
39,054

 
90,671

 
52,906

Income tax expense
37,518

 
22

 
76,960

 
25,802

Depreciation and amortization
24,106

 
20,838

 
70,536

 
37,533

EBITDA
134,527

 
51,456

 
335,541

 
143,946

Adjustments:
 
 
 
 
 
 
 
Share-based compensation
3,727

 
2,424

 
11,319

 
7,388

Transaction costs
2,107

 
25,102

 
5,560

 
28,681

Net gain on deconsolidations
(9,112
)
 

 
(5,854
)
 
(3,411
)
Net change in fair value of contingent consideration
1,928

 

 
8,338

 

Debt extinguishment costs

 
16,887

 

 
16,887

Total adjustments
(1,350
)
 
44,413

 
19,363

 
49,545

Adjusted EBITDA
$
133,177

 
$
95,869

 
$
354,904

 
$
193,491

 
 
 
 
 
 
 
 
Segment Information:
 
 
 
 
 
 
 
Ambulatory Services Adjusted EBITDA
$
55,353

 
$
47,853

 
$
162,965

 
$
145,475

Physician Services Adjusted EBITDA
77,824

 
48,016

 
191,939

 
48,016

Adjusted EBITDA
$
133,177

 
$
95,869

 
$
354,904

 
$
193,491

 
 
 
 
 
 
 
 
Net Revenue by Segment:
 
 
 
 
 
 
 
Ambulatory Services
$
308,983

 
$
276,419

 
$
903,884

 
$
814,207

Physician Services
341,244

 
225,931

 
958,738

 
225,931

Total net revenue
$
650,227

 
$
502,350

 
$
1,862,622

 
$
1,040,138

See footnotes on page 10

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AMSG Reports Third-Quarter Results
 
 
Page 7
 
 
November 3, 2015
 
 



AMSURG CORP.
Unaudited Selected Consolidated Financial and Operating Data, continued
(Dollars in thousands)

Operating Data- Ambulatory Services:
 
 
 
 
 
 
 
 
Three Months Ended September 30,
 
Nine Months Ended September 30,
 
2015
 
2014
 
2015
 
2014
Procedures performed during the period at consolidated centers
434,720

 
410,048

 
1,280,541

 
1,211,065

Centers in operation at end of period (consolidated)
240

 
233

 
240

 
233

Centers in operation at end of period (unconsolidated)
13

 
9

 
13

 
9

Average number of continuing centers in operation (consolidated)
239

 
233

 
237

 
233

New centers added during the period
3

 
4

 
6

 
6

Centers discontinued during the period

 
4

 

 
5

Centers under development at end of period
1

 
1

 
1

 
1

Centers under letter of intent at end of period
5

 
8

 
5

 
8

Average revenue per consolidated center
$
1,295

 
$
1,188

 
$
3,810

 
$
3,497

Same center revenues increase
6.6
%
 
1.7
%
 
5.5
%
 
0.6
%
Surgical hospitals in operation at end of period (unconsolidated)
1

 

 
1

 


Operating Data- Physician Services:
 
 
 
 
Three Months Ended September 30, 2015
 
Nine Months Ended September 30, 2015
Contribution to Net Revenue Growth:
 
 
 
Same contract
7.6
%
 
7.9
%
New contract
2.9

 
2.3

Acquired contract and other
15.4

 
11.4

Total net revenue growth
25.9
%
 
21.6
%
 
 
 
 
Same contract revenue growth
10.1
%
 
10.4
%

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AMSG Reports Third-Quarter Results
 
 
Page 8
 
 
November 3, 2015
 
 



AMSURG CORP.
Unaudited Selected Consolidated Financial and Operating Data, continued
(In thousands)
 
September 30,
 
December 31,
Balance Sheet Data:
2015
 
2014
Assets
 
 
 
Current assets:
 
 
 
Cash and cash equivalents
$
187,422

 
$
208,079

Restricted cash and marketable securities
11,789

 
10,219

Accounts receivable, net of allowance of $144,893 and $113,357, respectively
276,237

 
233,053

Supplies inventory
20,887

 
19,974

Prepaid and other current assets
91,651

 
115,362

Total current assets
587,986

 
586,687

Property and equipment, net
190,399

 
180,448

Investments in unconsolidated affiliates
112,877

 
75,475

Goodwill
3,589,317

 
3,381,149

Intangible assets, net
1,282,567

 
1,273,879

Other assets
24,074

 
25,886

Total assets
$
5,787,220

 
$
5,523,524

Liabilities and Equity
 
 
 
Current liabilities:
 
 
 
Current portion of long-term debt
$
19,982

 
$
18,826

Accounts payable
30,750

 
29,585

Accrued salaries and benefits
186,923

 
140,044

Accrued interest
17,846

 
29,644

Other accrued liabilities
130,563

 
67,986

Total current liabilities
386,064

 
286,085

Long-term debt
2,230,296

 
2,232,186

Deferred income taxes
645,711

 
633,480

Other long-term liabilities
90,671

 
89,443

Commitments and contingencies
 
 
 
Noncontrolling interests – redeemable
185,261

 
184,099

Equity:
 
 
 
Preferred stock, no par value, 5,000 shares authorized, 1,725 shares issued and outstanding
166,632

 
166,632

Common stock, no par value, 120,000 shares authorized, 48,455 and 48,113 shares issued and outstanding, respectively
897,007

 
885,393

Retained earnings
718,104

 
627,522

Total AmSurg Corp. equity
1,781,743

 
1,679,547

Noncontrolling interests – non-redeemable
467,474

 
418,684

Total equity
2,249,217

 
2,098,231

Total liabilities and equity
$
5,787,220

 
$
5,523,524



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AMSG Reports Third-Quarter Results
 
 
Page 9
 
 
November 3, 2015
 
 



AMSURG CORP.
Unaudited Selected Consolidated Financial and Operating Data, continued
(In thousands)
 
Three Months Ended September 30,
 
Nine Months Ended September 30,
Statement of Cash Flow Data:
2015
 
2014
 
2015
 
2014
Cash flows from operating activities:
 
 
 
 
 
 
 
Net earnings
$
98,279

 
$
37,423

 
$
257,781

 
$
165,709

Adjustments to reconcile net earnings to net cash flows provided by operating activities:
 
 
 
 
 
 
 
Depreciation and amortization
24,106

 
20,838

 
70,536

 
37,533

Amortization of deferred loan costs
2,083

 
14,649

 
6,238

 
15,645

Provision for uncollectibles
68,032

 
58,944

 
212,546

 
69,715

Net loss on sale of long-lived assets

 
1,857

 

 
2,468

Net gain on deconsolidations
(9,112
)
 

 
(5,854
)
 
(3,411
)
Share-based compensation
3,727

 
2,424

 
11,319

 
7,388

Excess tax benefit from share-based compensation
(246
)
 
(198
)
 
(3,779
)
 
(2,288
)
Deferred income taxes
4,610

 
13,516

 
7,309

 
31,388

Equity in earnings of unconsolidated affiliates
(4,935
)
 
(2,158
)
 
(11,575
)
 
(3,461
)
Debt extinguishment costs

 
4,536

 

 
4,536

Net change in fair value of contingent consideration
1,928

 

 
8,338

 

Increases (decreases) in cash and cash equivalents, net of acquisitions and dispositions:
 
 
 
 
 
 
 
Accounts receivable
(75,409
)
 
(49,008
)
 
(232,465
)
 
(65,758
)
Supplies inventory
(423
)
 
75

 
(533
)
 
68

Prepaid and other current assets
6,152

 
(22,104
)
 
36,479

 
(24,414
)
Accounts payable
3,012

 
(7,610
)
 
2,316

 
(10,007
)
Accrued expenses and other liabilities
52,112

 
47,599

 
64,760

 
48,368

Other, net
1,891

 
1,687

 
3,786

 
2,572

Net cash flows provided by operating activities
175,807

 
122,470


427,202


276,051

Cash flows from investing activities:
 
 
 
 
 
 
 
Acquisitions and related expenses
(37,458
)
 
(2,114,211
)
 
(233,490
)
 
(2,138,648
)
Acquisition of property and equipment
(14,341
)
 
(8,098
)
 
(47,006
)
 
(23,109
)
Proceeds from sale of interests in surgery centers

 
2,877

 

 
4,969

Purchases of marketable securities
(498
)
 
(3,486
)
 
(1,743
)
 
(3,486
)
Maturities of marketable securities
1,245

 

 
4,233

 

Other
(1,987
)
 
4,527

 
(3,974
)
 
2,082

Net cash flows used in investing activities
(53,039
)
 
(2,118,391
)

(281,980
)

(2,158,192
)
Cash flows from financing activities:
 
 
 
 
 
 
 
Proceeds from long-term borrowings
2,402

 
1,972,153

 
10,197

 
2,046,399

Repayment on long-term borrowings
(5,449
)
 
(300,717
)
 
(15,737
)
 
(403,043
)
Distributions to noncontrolling interests
(57,111
)
 
(47,433
)
 
(158,144
)
 
(139,443
)
Proceeds from preferred stock offering

 
172,500

 

 
172,500

Cash dividends for preferred shares
(2,264
)
 
(2,239
)
 
(6,792
)
 
(2,239
)
Proceeds from common stock offering

 
439,875

 

 
439,875

Proceeds from issuance of common stock upon exercise of stock options
276

 
504

 
2,356

 
2,150

Repurchase of common stock

 
(33
)
 
(3,684
)
 
(2,890
)
Excess tax benefit from share-based compensation
246

 
198

 
3,779

 
2,288

Payments of equity issuance costs

 
(24,366
)
 

 
(24,366
)
Financing cost incurred
(1
)
 
(65,673
)
 
(294
)
 
(65,673
)
Other
266

 
322

 
2,440

 
(176
)
Net cash flows provided by (used in) financing activities
(61,635
)
 
2,145,091


(165,879
)

2,025,382

Net increase (decrease) in cash and cash equivalents
61,133

 
149,170


(20,657
)

143,241

Cash and cash equivalents, beginning of period
126,289

 
44,911

 
208,079

 
50,840

Cash and cash equivalents, end of period
$
187,422

 
$
194,081


$
187,422


$
194,081


-MORE-

AMSG Reports Third-Quarter Results
 
 
Page 10
 
 
November 3, 2015
 
 




AMSURG CORP.
Footnotes to Reconciliations of Non-GAAP Measures to GAAP Measures

(1)
We believe the calculation of adjusted net earnings from continuing operations per diluted share attributable to AmSurg Corp. common shareholders provides a better measure of our ongoing performance and provides better comparability to prior periods because it excludes discontinued operations, the gains or loss from deconsolidations, which are non-cash in nature, transaction costs, including associated debt extinguishment costs and deferred financing write-off, and acquisition-related amortization expense (the majority of which relate to the Sheridan Transaction and which are of a nature and significance not generally associated with our historical individual center acquisition activity), changes in contingent purchase price consideration and share-based compensation expense. Adjusted net earnings from continuing operations per diluted share attributable to AmSurg Corp. common shareholders should not be considered as a measure of financial performance under accounting principles generally accepted in the United States, and the items excluded from it is a significant component in understanding and assessing financial performance. Because adjusted net earnings from continuing operations per diluted share attributable to AmSurg Corp. common shareholders is not a measurement determined in accordance with accounting principles generally accepted in the United States and is thus susceptible to varying calculations, it may not be comparable as presented to other similarly titled measures of other companies. For purposes of calculating adjusted earnings per share, we utilize the if-converted method to determine the number of diluted shares outstanding. In periods where utilizing the if-converted method is anti-dilutive, the mandatory convertible preferred stock will not be included in the calculation of diluted shares outstanding.

(2)
We define Adjusted EBITDA of AmSurg as earnings before interest expense, net , income taxes, depreciation, amortization, share-based compensation, transaction costs, changes in contingent purchase price consideration, gain or loss on deconsolidations and discontinued operations. Adjusted EBITDA should not be considered a measure of financial performance under generally accepted accounting principles. Items excluded from Adjusted EBITDA are significant components in understanding and assessing financial performance. Adjusted EBITDA is an analytical indicator used by management and the health care industry to evaluate company performance, allocate resources and measure leverage and debt service capacity. Adjusted EBITDA should not be considered in isolation or as an alternative to net income, cash flows from operations, investing or financing activities, or other financial statement data presented in the consolidated financial statements as indicators of financial performance or liquidity. Because Adjusted EBITDA is not a measurement determined in accordance with generally accepted accounting principles and is thus susceptible to varying calculations, Adjusted EBITDA as presented may not be comparable to other similarly titled measures of other companies. Net earnings from continuing operations attributable to AmSurg Corp. common shareholders is the financial measure calculated and presented in accordance with generally accepted accounting principles that is most comparable to Adjusted EBITDA as defined.



-END-