Attached files
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EX-32.2 - EXHIBIT 32.2 - Nobilis Health Corp. | exhibit32-2.htm |
EX-32.1 - EXHIBIT 32.1 - Nobilis Health Corp. | exhibit32-1.htm |
EX-31.1 - EXHIBIT 31.1 - Nobilis Health Corp. | exhibit31-1.htm |
EX-31.2 - EXHIBIT 31.2 - Nobilis Health Corp. | exhibit31-2.htm |
UNITED STATES
SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
FORM 10-Q/A
Amendment No. 2
(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, 2015
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: 001-37349
NOBILIS HEALTH CORP.
(Exact name of registrant as specified in its charter)
British Columbia | 98-1188172 |
(State or other jurisdiction of | (I.R.S. Employer |
incorporation or organization) | Identification No.) |
11700 Katy Freeway, Suite 300, Houston, Texas | 77079 |
(Address of principal executive offices) | (Zip Code) |
(713)355-8614
(Registrants telephone
number, including area code)
N/A
(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 [ ] NO [ X ]
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 [ ] | Smaller reporting company [X] |
Indicate by check mark whether the registrant is a shell
company (as defined in Rule 12b-2 of the Exchange Act).
YES
[ ] NO [X]
Indicate the number of shares outstanding of each of the
registrants classes of common stock as of the latest practicable date.
70,893,636 common shares as of August 13, 2015.
1
TABLE OF CONTENTS
A list of our healthcare facilities (the Nobilis Facilities) and the abbreviations by which we refer to them in this Quarterly Report on Form 10-Q for the fiscal quarter ended June 30, 2015 (Quarterly Report) appear below:
Healthcare Facility | Abbreviation | |
Northstar Healthcare Surgery Center - Houston | NHSC-H | |
Kirby Surgical Center | Kirby | |
Microsurgery Institute of Dallas | MSID | |
Northstar Healthcare Surgery Center - Scottsdale | NHSC-S | |
First Nobilis Hospital | FNH | |
First Nobilis Surgical Center | FNSC | |
Victory Medical Center Houston | VMC-H |
In this Quarterly Report, the terms "Nobilis", "we", "us", "our", "ours", or "the Company" refers to Nobilis Health Corp. and all of its subsidiaries.
2
EXPLANATORY NOTE
As described in the Current Report on Form 8-K filed on January 5, 2016, we are filing this Amendment No. 2 on Form 10-Q/A (this Form 10-Q/A or Amended Filing) to amend our Quarterly Report on Form 10-Q for the quarter ended June 30, 2015, originally filed with the Securities and Exchange Commission (the SEC) on August 14, 2015 and amended by the Quarterly Report on Form 10-Q filed with the SEC on September 28, 2015 (together, the Original Filing), to restate our unaudited condensed consolidated financial statements and related footnote disclosures for the three months ended June 30, 2015. This Form 10-Q/A also amends certain other Items in the Original Filing, as listed below.
Background
We are filing this Form 10-Q/A to: (i) correct managements evaluation of the effectiveness of the Company’s disclosure controls and procedures included under Part I Item 4 as a result of the identification of a material weakness that existed as of June 30, 2015; and (ii) restate the financial statements as a result of the identification of errors related to: (1) accounting for warrants and options issued in the Companys private placements in 2013, 2014 and 2015 and options granted to non-employees; (2) business combination accounting with respect to the Athas and First Nobilis transactions that occurred in December and September 2014, respectively, (3) reclassification of contingently redeemable noncontrolling interests to temporary equity, (4) share-based compensation matters and (5) calculations of fully diluted shares outstanding for application of the treasury stock method. As a result of the decision to file this amended filing, we are taking this opportunity to also correct other errors that were previously uncorrected. In addition, conforming changes occur throughout the Amended Filing because of changes to the financial statements. Accordingly, we hereby amend and replace in its entirety Part IItem 4 (Controls and Procedures) of the Original Filing and have made some amendments to Part I Item 1 (Financial Statements), Part I Item 2 (Managements Discussion and Analysis of Financial Condition and Results of Operations), Part II - Item 1A (Risk Factors) and Part II - Item 6 (Exhibits) of the Original Filing. For the convenience of the reader, this 10-Q/A sets forth the Original Filing, as modified and superseded where necessary to reflect these revisions. The restatement is further discussed in Note 2 to the Companys financial statements included in Part I Item 1 Financial Statements contained herein.
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, at June 30, 2015. For a discussion of managements consideration of our disclosure controls and procedures and the material weakness identified, see Part I, Item 4 included in this Form 10-Q/A.
In accordance with applicable SEC rules, this Form 10-Q/A includes new certifications required by Sections 302 and 906 of the Sarbanes-Oxley Act of 2002, as amended, from our Chief Executive Officer and Chief Financial Officer dated as of the filing date of this Form 10-Q/A. Accordingly, the Registrant hereby amends Park II – Item 6 of the Original Filing to reflect the filing of the new certifications.
Except as described above, this Amended Filing does not amend, update or change any other items or disclosures in the Original Filing and does not purport to reflect any information or events subsequent to the filing thereof. As such, this Amended Filing speaks only as of the date the Original Filing was filed, and the Registrant has not undertaken herein to amend, supplement or update any information contained in the Original Filing to give effect to any subsequent events and any forward-looking statements represent management's views as of the Original Filing Date and should not be assumed to be accurate as of any date thereafter. Accordingly, this Amended Filing should be read in conjunction with the Registrant’s filings made with the SEC subsequent to the filing of the Original Filing, including any amendment to those filings.
3
PART I.
FINANCIAL INFORMATION
Item 1. Financial Statements
NOBILIS HEALTH CORP. AND SUBSIDIARIES
CONSOLIDATED
BALANCE SHEETS
(In thousands)
June 30, | December 31, | |||||
2015 | 2014 | |||||
(Restated) | (Restated) | |||||
(unaudited) | ||||||
Assets | ||||||
Current Assets: | ||||||
Cash and cash equivalents | $ | 31,668 | $ | 7,568 | ||
Trade accounts receivable, net | 49,930 | 40,461 | ||||
Medical supplies | 2,499 | 1,412 | ||||
Prepaid expenses and other current assets | 3,115 | 3,554 | ||||
Total current assets | 87,212 | 52,995 | ||||
Property and equipment, net | 11,587 | 9,087 | ||||
Intangible assets, net | 20,215 | 19,609 | ||||
Goodwill | 31,656 | 21,589 | ||||
Notes receivable | 150 | 659 | ||||
Investments in associates | 2,495 | 880 | ||||
Other long-term assets | 203 | 234 | ||||
Total Assets | $ | 153,518 | $ | 105,053 | ||
Liabilities, Contingently Redeemable Noncontrolling Interests and Equity | ||||||
Current Liabilities: | ||||||
Trade accounts payable | $ | 17,428 | $ | 10,528 | ||
Accrued liabilities | 10,851 | 8,558 | ||||
Lines of credit | - | 5,420 | ||||
Subordinated notes payable | - | 635 | ||||
Current portion of warrant and stock option liabilities | 263 | 300 | ||||
Current portion of debt | 868 | 3,437 | ||||
Current portion of capital leases | 1,299 | 257 | ||||
Other current liabilities | 543 | 1,485 | ||||
Total current liabilities | 31,252 | 30,620 | ||||
Long-term capital leases, net of current portion | 1,820 | 573 | ||||
Lines of credit | 1,500 | - | ||||
Long-term debt, net of current portion | 18,054 | 10,582 | ||||
Warrant and option liabilities, net of current portion | 12,540 | 6,357 | ||||
Other long-term liabilities | 73 | 252 | ||||
Total liabilities | 65,239 | 48,384 | ||||
Contingently redeemable noncontrolling interests | 15,899 | 12,867 | ||||
Shareholders' Equity: | ||||||
Common stock (no par value;
authorized unlimited shares, 70,867,494 and
59,418,227 shares issued and outstanding, respectively) |
- | - | ||||
Additional paid in capital | 209,554 | 176,356 | ||||
Accumulated deficit | (141,158 | ) | (136,576 | ) | ||
Accumulated other comprehensive loss | (22 | ) | (111 | ) | ||
Total shareholders equity attributable to Nobilis Health Corp. | 68,374 | 39,669 | ||||
Noncontrolling interests | 4,006 | 4,133 | ||||
Total shareholders' equity | 72,380 | 43,802 | ||||
Total Liabilities, Contingently Redeemable Noncontrolling Interests and Equity | $ | 153,518 | $ | 105,053 |
The accompanying notes are an integral part of the unaudited consolidated financial statements.
4
NOBILIS HEALTH CORP. AND SUBSIDIARIES
CONSOLIDATED
STATEMENTS OF OPERATIONS
(In thousands, except share and per share
amounts)
(Unaudited)
Three months ended June 30, | Six months ended June 30, | |||||||||||
2015 | 2014 | 2015 | 2014 | |||||||||
(Restated) | (Restated) | (Restated) | Restated) | |||||||||
Revenues: | ||||||||||||
Patient and net professional fees | $ | 45,366 | $ | 15,114 | $ | 80,424 | $ | 27,235 | ||||
Contracted marketing revenues | 2,839 | - | 3,649 | - | ||||||||
Factoring revenues | 662 | - | 2,645 | - | ||||||||
Total revenue | 48,867 | 15,114 | 86,718 | 27,235 | ||||||||
Cost of revenues | 910 | - | 971 | - | ||||||||
Gross Profit | 47,957 | 15,114 | 85,747 | 27,235 | ||||||||
Operating expenses: | ||||||||||||
Salaries and benefits | 9,028 | 2,003 | 16,672 | 3,918 | ||||||||
Drugs and supplies | 7,940 | 2,405 | 12,889 | 3,969 | ||||||||
General and administrative | 20,602 | 6,006 | 33,800 | 11,912 | ||||||||
Depreciation and amortization | 955 | 305 | 1,592 | 603 | ||||||||
Total operating expenses | 38,525 | 10,719 | 64,953 | 20,402 | ||||||||
Corporate costs: | ||||||||||||
Salaries and benefits | 1,001 | 470 | 1,992 | 1,029 | ||||||||
General and administrative | 6,524 | 680 | 12,515 | 1,236 | ||||||||
Legal expenses | 741 | 351 | 1,212 | 622 | ||||||||
Depreciation | 30 | 29 | 56 | 61 | ||||||||
Total corporate costs | 8,296 | 1,530 | 15,775 | 2,948 | ||||||||
Income from operations | 1,136 | 2,865 | 5,019 | 3,885 | ||||||||
Other expense (income): | ||||||||||||
Interest expense | 294 | 60 | 784 | 113 | ||||||||
Change in fair value of warrant and option liabilities | (1,670 | ) | (372 | ) | 1,704 | (746 | ) | |||||
Other income, net | (1,277 | ) | (85 | ) | (1,412 | ) | (66 | ) | ||||
Total other (income) expense | (2,653 | ) | (397 | ) | 1,076 | (699 | ) | |||||
Net income before income taxes and noncontrolling interests | 3,789 | 3,262 | 3,943 | 4,584 | ||||||||
Income tax | 454 | 158 | 606 | 238 | ||||||||
Net income | 3,335 | 3,104 | 3,337 | 4,346 | ||||||||
Net income attributable to noncontrolling interests | 3,745 | 2,505 | 8,242 | 3,864 | ||||||||
Net (loss) income attributable to Nobilis Health Corp. | $ | (410 | ) | $ | 599 | $ | (4,905 | ) | $ | 482 | ||
Net (loss) income per basic common share | $ | (0.01 | ) | $ | 0.01 | $ | (0.08 | ) | $ | 0.01 | ||
Net (loss) income per fully diluted common share | $ | (0.01 | ) | $ | 0.01 | $ | (0.08 | ) | $ | 0.01 | ||
Weighted average shares outstanding (basic) | 63,531,390 | 43,411,318 | 61,872,658 | 43,301,603 | ||||||||
Weighted average shares outstanding (fully diluted) | 63,531,390 | 43,953,947 | 61,872,658 | 43,925,019 |
The accompanying notes are an integral part of the unaudited consolidated financial statements.
5
NOBILIS HEALTH CORP. AND SUBSIDIARIES
CONSOLIDATED
STATEMENTS OF COMPREHENSIVE LOSS
(In thousands)
(Unaudited)
Three months ended June 30, | Six months ended June 30, | |||||||||||
2015 | 2014 | 2015 | 2014 | |||||||||
(Restated) | (Restated) | (Restated) | (Restated) | |||||||||
Net income | $ | 3,335 | $ | 3,104 | $ | 3,337 | $ | 4,346 | ||||
Other comprehensive income (loss): | ||||||||||||
Foreign currency translation adjustments | 44 | 10 | 57 | (53 | ) | |||||||
Comprehensive income | 3,379 | 3,114 | 3,394 | 4,293 | ||||||||
Less comprehensive income attributable to noncontrolling interest | (3,745 | ) | (2,505 | ) | (8,242 | ) | (3,864 | ) | ||||
Comprehensive (loss) income attributable to Nobilis Health Corp. | $ | (366 | ) | $ | 609 | $ | (4,848 | ) | $ | 429 |
The accompanying notes are an integral part of the unaudited consolidated financial statements.
6
NOBILIS HEALTH CORP. AND SUBSIDIARIES
CONSOLIDATED
STATEMENTS OF CASH FLOWS
(In thousands)
(Unaudited)
Six months ended June 30, | ||||||
2015 | 2014 | |||||
(Restated) | (Restated) | |||||
CASH FLOWS FROM OPERATING ACTIVITIES: | ||||||
Net income | $ | 3,337 | $ | 4,346 | ||
Adjustments to reconcile net income attributable to Nobilis to net cash provided by operating activities: | ||||||
Depreciation and amortization | 1,648 | 664 | ||||
Provision for bad debts | 200 | - | ||||
Change in fair value of warrant and option liabilities | 1,704 | (746 | ) | |||
Foreign currency gain (loss) | 57 | (53 | ) | |||
Share-based compensation | 10,126 | 180 | ||||
Recoupment of Indemnified expenses | (1,700 | ) | - | |||
Amortization of deferred financing fees | 33 | - | ||||
Changes in operating assets and liabilities: | ||||||
Trade accounts receivable | (6,949 | ) | (1,464 | ) | ||
Medical supplies | (425 | ) | (101 | ) | ||
Prepaids and other current assets | 701 | (242 | ) | |||
Other long-term assets | (39 | ) | 464 | |||
Trade accounts payable and accrued liabilities | (2,432 | ) | (846 | ) | ||
Other current liabilities | (942 | ) | (38 | ) | ||
Other long-term liabilities | (103 | ) | - | |||
Net cash provided by operating activities | 5,216 | 2,164 | ||||
CASH FLOWS FROM INVESTING ACTIVITIES: | ||||||
Purchase of property and equipment | (1,177 | ) | (1,124 | ) | ||
Investment in associate | (120 | ) | (150 | ) | ||
Note receivable | (197 | ) | - | |||
Purchase of interest acquired in subsidiary | - | (346 | ) | |||
Proceeds of sale of ownership interests of subsidiary | - | 230 | ||||
Acquisition of Victory | (1,436 | ) | - | |||
Acquisition of Peak | (850 | ) | - | |||
Deconsolidation of imaging centers and urgent care clinic | (166 | ) | - | |||
Net cash used for investing activities | (3,946 | ) | (1,390 | ) | ||
CASH FLOWS FROM FINANCING ACTIVITIES: | ||||||
Distributions to noncontrolling interests | (5,644 | ) | (2,158 | ) | ||
Proceeds from exercise of stock options | 432 | 28 | ||||
Proceeds from exercise of stock warrants | 4,335 | - | ||||
Proceeds from private placement | 28,395 | - | ||||
Payments on capital lease obligations | (304 | ) | (24 | ) | ||
Proceeds from debt and lines of credit | 21,500 | - | ||||
Payments of debt and lines of credit | (25,227 | ) | (34 | ) | ||
Deferred financing fees | (657 | ) | - | |||
Net cash provided by (used for) financing activities | 22,830 | (2,188 | ) | |||
NET INCREASE (DECREASE) IN CASH AND CASH EQUIVALENTS | 24,100 | (1,414 | ) | |||
CASH AND CASH EQUIVALENTS Beginning of period | 7,568 | 5,602 | ||||
CASH AND CASH EQUIVALENTS End of period | $ | 31,668 | $ | 4,188 |
The accompanying notes are an integral part of the unaudited consolidated financial statements.
7
NOBILIS HEALTH CORP. AND SUBSIDIARIES
NOTES TO THE
CONSOLIDATED FINANCIAL STATEMENTS
(In thousands, except per share
amounts and as otherwise noted)
1. Nature of Operations and Basis of Presentation
Nature of Operations
Nobilis Health Corp. was incorporated on March 16, 2007 under the name "Northstar Healthcare Inc." pursuant to the provisions of the British Columbia Business Corporations Act ("BCBCA"). On December 5, 2014, Northstar Healthcare Inc. changed its name to Nobilis Health Corp. (the Company, we, our, us).
We own and manage healthcare facilities (the "Nobilis Facilities") in Texas and Arizona; including hospitals and ambulatory surgery centers (ASC), referred to as the "Nobilis ASCs". The Nobilis ASCs are licensed ASCs that provide scheduled surgical procedures in a limited number of clinical specialties, which enables them to develop routines, procedures and protocols to maximize operating efficiency and productivity while offering an enhanced healthcare experience for both physicians and patients. In December 2014, the Company expanded its services to health care marketing and factoring of receivables when it acquired 100% interests of Athas Health, LLC (Athas).
The Nobilis ASCs do not offer the full range of services typically found in traditional hospitals, but instead focus on certain clinical specialties, including orthopedic surgery, podiatric surgery, ENT, pain management, gastro- intestinal, gynecology, and general surgery. Nobilis hospitals focus on these same specialties with the ability to take on more complex cases.
The accompanying consolidated financial statements should be read in conjunction with the consolidated financial statements incorporated by reference in the Companys Annual Report on Form 10-K/A for the year ended December 31, 2014 filed on January 12, 2016 (the 10-K/A). If not materially different, certain footnote disclosures included in the 10-K/A have been omitted from this 10-Q/A.
The interim consolidated financial information in this report has not been audited. In the opinion of management, all adjustments, which consist of normal recurring adjustments necessary for a fair statement of the interim period consolidated financial statements, have been made. Results of operations reported for the interim periods are not necessarily indicative of results for the entire year.
The preparation of consolidated financial statements in conformity with accounting principles generally accepted in the United States of America (U.S. GAAP) requires management to make estimates and assumptions that affect the reported amounts of assets, liabilities, revenues, and expenses, and the disclosures of contingent assets and liabilities. These accounting estimates reflect the best judgement of management, but actual results could differ.
For comparability, certain prior period amounts have been reclassified, where appropriate, to conform to the financial statement presentation used in the current period.
Recent Accounting Pronouncements
In May 2014, Financial Accounting Standards Board (FASB) issued guidance that introduces a new five-step revenue recognition model in which an entity should recognize revenue to depict the transfer of promised goods or services to customers in an amount that reflects the consideration to which the entity expects to be entitled in exchange for those goods or services. This guidance also requires disclosures sufficient to enable users to understand the nature, amount, timing, and uncertainty of revenue and cash flows arising from contracts with customers, including qualitative and quantitative disclosures about contracts with customers, significant judgments and changes in judgments, and assets recognized from the costs to obtain or fulfill a contract. In April 2015, the FASB decided to delay the effective date for the guidance. The guidance is effective for fiscal years beginning after December 15, 2017, including interim periods within that reporting period. The Company is currently evaluating the new guidance to determine the impact it will have on its consolidated financial statements.
In June 2014, the FASB issued amended guidance on the accounting for certain share-based employee compensation awards. The amended guidance applies to share-based employee compensation awards that include a performance target that affects vesting when the performance target can be achieved after the requisite service period. These targets are to be treated as a performance condition. As such, the performance target should not be reflected in estimating the grant-date fair value of the award and compensation cost should be recognized in the period in which it becomes probable that the performance target will be achieved. The amendments are effective for annual periods and interim periods within those annual periods beginning after December 15, 2015. The Company does not expect adoption will have a material impact on its consolidated financial statements.
In February 2015, the FASB issued amended guidance on the consolidation of legal entities including limited partnerships and limited liability corporations. The guidance modifies the consolidation models to be analyzed in determining whether a reporting entity should consolidate certain types of legal entities. The guidance must be applied using one of two retrospective application methods and will be effective for fiscal years beginning after December 15, 2015, and for interim periods within those fiscal years. Early adoption is permitted, including adoption in any interim period. The Company does not expect adoption will have a material impact on its consolidated financial statements.
8
In April 2015, the FASB issued guidance in order to simplify the presentation of debt issuance costs. The guidance requires that debt issuance costs related to a recognized debt liability be presented as a direct deduction from the carrying amount of the debt liability rather than as a deferred charge asset as required under current guidance. The guidance also requires that the amortization of debt issuance costs be reported as interest expense. The guidance is effective for the Company starting January 1, 2016 and must be applied on a retrospective basis. Early adoption is permitted. The Company has chosen to early adopt this guidance as of the interim period ended March 31, 2015. No retrospective application was deemed necessary, as the Company did not have any debt issuance costs prior to the three months ended March 31, 2015. Approximately $0.6 million of debt issuance costs have been deducted from the carrying amount of debt as of June 30, 2015.
In June 2015, the FASB issued Accounting Standards Update No. 2015-10: Technical Corrections and Improvements (ASU 2015-10). ASU 2015-10 is part of an initiative to clarify the Accounting Standards Codification (Codification), correct unintended application of guidance, and make minor improvements to the Codification that are not expected to have a significant effect on current accounting practice or create a significant administrative cost to most entities. ASU 2015-10 covers a wide range of topics in the Codification and is effective for fiscal years, and interim periods within those fiscal years, beginning after December 15, 2015; early adoption is permitted. The Company is currently evaluating the provisions of this accounting update and assessing the impact, if any, it may have on its financial position and results of operations.
2. Restatement of Condensed Consolidated Financial Statements
On December 29, 2015, our Audit Committee of the Board of Directors, after consultation with management and the Company's predecessor auditors concluded that the Company's financial statements as of and for periods ended June 30, 2015 and 2014, should be restated because the financial statements did not properly account for the following items:
|
Accounting for warrants and options issued in private placements and options issued to non-employees as liabilities The Company determined that FASB ASC 815-40-15-7I (ASC 815-40), Contracts in entities own equity, should have been applied to the accounting for warrants and options issued in private placements and for options issued to non-employees. This accounting would have resulted in the Company classifying warrants and options issued in connection with 2013, 2014 and 2015 private placements by the Company as liabilities rather than as stockholders equity. Similarly, this same accounting is applicable to stock options issued to non-employees once the performance conditions of such awards are completed. The Company first issued options to non-employees during the second quarter of 2014. Once recorded as liabilities, the warrants and options must be revalued each quarter with changes in their valuation reflected in earnings. |
At December 31, 2013, the warrant and stock option liabilities recognized for the proper application of ASC 815-40 in the Companys balance sheet totaled $2.4 million. During the three months ended June 30, 2014, $372 thousand of income was recognized for decreases in the value of such liabilities (a total of $746 thousand of income for the six months ended June 30, 2014). | |
At December 31, 2014, the warrant and stock option liabilities recognized for the proper application of ASC 815-40 in the Companys balance sheet totaled $6.7 million. During the three months ended June 30, 2015, $1.7 million of income was recognized for decreases in the value of such liabilities (a total of $1.7 of expense for the six months ended June 30, 2015). | |
|
Recognition of the full fair value of noncontrolling interests in the acquisition of First Nobilis as required by U.S. GAAP instead of at a pro-rata value permitted under IFRS We initially adopted U.S. GAAP effective January 1, 2013 in connection with our filings made with the U.S. Securities & Exchange Commission for registration of our stock in early 2015. Previously we prepared our financial statements under International Financial Reporting Standards (IFRS). The Company determined that FASB ASC 805, Business Combinations (ASC 805) was not properly applied in the initial adoption of U.S. GAAP by the Company and its application to the First Nobilis acquisition completed in September 2014. Under U.S. GAAP, noncontrolling interests should be measured at fair value on the acquisition date [ASC 805-20-30-1] whereas under IFRS these may be measured at their proportionate share of the recognized amount of the acquirees identifiable net assets [IFRS 3.19]. |
The impact of the proper application of ASC 805 as of the date of acquisition (September 2014) is a reduction in noncontrolling interests of $2.0 million; a decrease in acquired intangible assets of $1.4 million and a decrease in recognized goodwill of $0.6 million. Amortization expense recognized since the acquisition date will decrease by $15 thousand quarterly because of this change. |
9
|
Adjustments to the acquisition accounting for the Athas transaction The Company determined that it did not properly apply ASC 805 in its initial accounting for the Athas acquisition completed in December 2014. The Company incorrectly used an earlier version of the report of the independent valuation firm that was later modified and, secondly, incorrectly gave recognition of Athas deferred rent as a liability in the acquisition accounting. |
Also, we corrected the Companys accounting policies related to accounts receivable factoring activities which commenced with the Athas acquisition. Under ASC 310-10-25-3, factoring revenue is recognized over the period from purchase of the account receivable until its collection. Correction for these accounting policies affects the initial acquisition accounting for the Athas transaction because it included accounts receivable for transactions recognized before the factoring purchase date. | |
The impact of the proper application of ASC 805 as of the date of acquisition is an increase in acquired intangible assets of $1.4 million, a reduction of liabilities of $260 thousand and a decrease in recognized goodwill of $1.7 million. Amortization expense recognized since the acquisition date will increase by $15 thousand quarterly because of this change. | |
The impact of the proper application of ASC 310-10-25-3 as of the date of acquisition was a decrease in acquired accounts receivable of $1.7 million, a reduction in accrued liabilities of $0.3 million and a corresponding increase in goodwill of $1.4 million. This correction of the Companys accounting policies will impact the timing of revenue recognition in the future. However, this change had no discernable impact on revenues for the three months ended June 30, 2015. Revenues and accounts receivable as of and for the six months ended June 30, 2015 increased by $735 thousand. | |
|
Reclassification of Contingently Redeemable Noncontrolling Interests to Temporary Equity The Company determined that it did not properly apply SEC Accounting Series Release No. 268, Presentation of Financial Statements of Redeemable Preferred Stock (ASR 268) in classifying contingently redeemable noncontrolling interests associated with Northstar Healthcare Dallas Management, LLC and First Nobilis. Agreements with the third party equity owners in these entities give these owners limited rights to require the Company to repurchase their equity interests upon the occurrence of certain events. The contingently redeemable noncontrolling interests associated with these entities should be classified in the Companys balance sheet as temporary or mezzanine equity in accordance with ASR 268. |
The impact of the proper application of ASR 268 is a reclassification of $15.9 million of contingently redeemable noncontrolling interests from permanent equity to temporary or mezzanine equity at June 30, 2015 and $12.9 million at December 31, 2014. | |
|
Other Adjustments We have also identified and made correction for certain other accounting matters affecting our previous financial statements. These include (i) corrections for stock-based compensation expense for expected term, forfeitures and related assumptions in determining the grant date valuations of option awards, (ii) corrections to the accounting for options issued to non-employees to measure such awards as of the date that performance was completed, and (iii) corrections to the calculations of fully diluted shares outstanding for application of the treasury stock method. The combined impact of these other corrections was an decrease in compensation expense of $9 thousand for the quarter ended June 30, 2014 (decrease of $5 thousand for the six months ended June 30, 2014) and an increase of $470 thousand for the quarter ended June 30, 2015 (increase of $1.1 million for the six months ended June 30, 2015). |
Along with restating our financial statements as of and for the fiscal years ended December 31, 2013 and 2014 to correct the errors discussed above, we have recorded adjustments for certain previously identified accounting errors related to the periods covered by this Form 10-Q/A. In conjunction with our need to restate our financial statements as a result of the errors noted above, we have determined that it would be appropriate to make adjustments within this Form 10-Q/A for all such previously unrecorded adjustments.
We initially became aware of the above matters as part of the preparation of our financial statements during the third quarter of 2015 and review by the Companys newly engaged independent registered public accounting firm. The adjustments do not impact the Company's previously reported cash, cash equivalents or cash flows from operating, financing or investing activities. Overall, the adjustments increased revenue by $735 thousand for the six months ended June 30, 2015.
10
The Company has restated certain amounts included in these financial statements as follows:
As of June 30, 2015 | As of December 31, 2014 | |||||||||||||||||
As Reported |
Adjustments | Restated | As Reported |
Adjustments | Restated | |||||||||||||
Assets | ||||||||||||||||||
Current Assets: | ||||||||||||||||||
Cash and cash equivalents | $ | 31,668 | $ | - | $ | 31,668 | $ | 7,568 | $ | - | $ | 7,568 | ||||||
Trade accounts receivable, net | 51,148 | (1,218 | ) | 49,930 | 42,175 | (1,714 | ) | 40,461 | ||||||||||
Medical supplies | 2,499 | - | 2,499 | 1,412 | - | 1,412 | ||||||||||||
Prepaid expenses and other | 3,115 | - | 3,115 | 3,554 | - | 3,554 | ||||||||||||
Total current assets | 88,430 | (1,218 | ) | 87,212 | 54,709 | (1,714 | ) | 52,995 | ||||||||||
Property and equipment, net | 11,587 | - | 11,587 | 9,087 | - | 9,087 | ||||||||||||
Intangible assets, net | 20,149 | 66 | 20,215 | 19,543 | 66 | 19,609 | ||||||||||||
Goodwill | 32,537 | (881 | ) | 31,656 | 22,470 | (881 | ) | 21,589 | ||||||||||
Notes receivable | 150 | - | 150 | 659 | - | 659 | ||||||||||||
Investments in associates | 2,495 | - | 2,495 | 880 | - | 880 | ||||||||||||
Other long-term assets | 203 | - | 203 | 234 | - | 234 | ||||||||||||
Total Assets | $ | 155,551 | $ | (2,033 | ) | $ | 153,518 | $ | 107,582 | $ | (2,529 | ) | $ | 105,053 | ||||
Liabilities, Contingently Redeemable Noncontrolling Interests and Equity | ||||||||||||||||||
Current Liabilities: | ||||||||||||||||||
Trade accounts payable | $ | 17,428 | $ | - | $ | 17,428 | $ | 10,528 | $ | - | $ | 10,528 | ||||||
Accrued liabilities | 11,614 | (763 | ) | 10,851 | 9,112 | (554 | ) | 8,558 | ||||||||||
Lines of credit | - | - | - | 5,420 | - | 5,420 | ||||||||||||
Subordinated notes payable | - | - | - | 635 | - | 635 | ||||||||||||
Current portion of warrant and stock option liabilities | - | 263 | 263 | - | 300 | 300 | ||||||||||||
Current portion of debt | 868 | - | 868 | 3,437 | - | 3,437 | ||||||||||||
Current portion of capital leases | 1,299 | - | 1,299 | 257 | - | 257 | ||||||||||||
Other current liabilities | 543 | - | 543 | 1,485 | - | 1,485 | ||||||||||||
Total current liabilities | 31,752 | (500 | ) | 31,252 | 30,874 | (254 | ) | 30,620 | ||||||||||
Long-term capital leases, net of | ||||||||||||||||||
current portion | 1,820 | - | 1,820 | 573 | - | 573 | ||||||||||||
Lines of credit | 1500 | - | 1500 | |||||||||||||||
Long-term debt, net of current portion | 18,054 | - | 18,054 | 10,582 | - | 10,582 | ||||||||||||
Warrant and stock option liabilities, net of current portion | - | 12,540 | 12,540 | - | 6,357 | 6,357 | ||||||||||||
Other long-term liabilities | 73 | - | 73 | 252 | - | 252 | ||||||||||||
Total liabilities | 53,199 | 12,040 | 65,239 | 42,281 | 6,103 | 48,384 | ||||||||||||
Contingently redeemable noncontrolling interests | 15,899 | 15,899 | 12,867 | 12,867 | ||||||||||||||
Shareholders' Equity: | ||||||||||||||||||
Common stock, no par value | - | - | - | - | - | - | ||||||||||||
Additional paid in capital | 215,842 | (6,288 | ) | 209,554 | 179,293 | (2,937 | ) | 176,356 | ||||||||||
Accumulated deficit | (135,312 | ) | (5,846 | ) | (141,158 | ) | (132,866 | ) | (3,710 | ) | (136,576 | ) | ||||||
Accumulated other comprehensive income | (54 | ) | 32 | (22 | ) | (111 | ) | - | (111 | ) | ||||||||
Total shareholders equity attributable to Nobilis Health Corp. | 80,476 | (12,102 | ) | 68,374 | 46,316 | (6,647 | ) | 39,669 | ||||||||||
Noncontrolling interests | 21,876 | (17,870 | ) | 4,006 | 18,985 | (14,852 | ) | 4,133 | ||||||||||
Total shareholders' equity | 102,352 | (29,972 | ) | 72,380 | 65,301 | (21,499 | ) | 43,802 | ||||||||||
Total Liabilities, Contingently Redeemable Noncontrolling Interests and Equity | $ | 155,551 | $ | (2,033 | ) | $ | 153,518 | $ | 107,582 | $ | (2,529 | ) | $ | 105,053 |
11
Quarter Ended June 30, 2015 | Quarter Ended June 30, 2014 | |||||||||||||||||
As Reported |
Adjustments | Restated | As Reported |
Adjustments | Restated | |||||||||||||
Revenues: | ||||||||||||||||||
Patient and net professional fees | $ | 45,366 | $ | - | $ | 45,366 | $ | 15,114 | $ | - | $ | 15,114 | ||||||
Contracted marketing revenues | 2,839 | - | 2,839 | - | - | - | ||||||||||||
Factoring revenues | 662 | - | 662 | - | - | - | ||||||||||||
Total revenue | 48,867 | - | 48,867 | 15,114 | - | 15,114 | ||||||||||||
Cost of revenues | 910 | - | 910 | - | - | - | ||||||||||||
Gross Profit | 47,957 | - | 47,957 | 15,114 | - | 15,114 | ||||||||||||
Operating expenses: | ||||||||||||||||||
Salaries and benefits | 9,028 | - | 9,028 | 2,003 | - | 2,003 | ||||||||||||
Drugs and supplies | 7,940 | - | 7,940 | 2,405 | - | 2,405 | ||||||||||||
General and administrative | 20,587 | 15 | 20,602 | 6,006 | - | 6,006 | ||||||||||||
Depreciation and amortization | 955 | - | 955 | 305 | - | 305 | ||||||||||||
Total operating expenses | 38,510 | 15 | 38,525 | 10,719 | - | 10,719 | ||||||||||||
Corporate costs: | ||||||||||||||||||
Salaries and benefits | 1,001 | - | 1,001 | 470 | - | 470 | ||||||||||||
General and administrative | 6,054 | 470 | 6,524 | 689 | (9 | ) | 680 | |||||||||||
Legal expenses | 741 | - | 741 | 351 | - | 351 | ||||||||||||
Depreciation | 30 | - | 30 | 29 | - | 29 | ||||||||||||
Total corporate costs | 7,826 | 470 | 8,296 | 1,539 | (9 | ) | 1,530 | |||||||||||
Income from operations | 1,621 | (485 | ) | 1,136 | 2,856 | 9 | 2,865 | |||||||||||
Other expense (income): | ||||||||||||||||||
Interest expense | 294 | - | 294 | 60 | - | 60 | ||||||||||||
Change in fair value of
warrant and stock option liabilities |
- | (1,670 | ) | (1,670 | ) | - | (372 | ) | (372 | ) | ||||||||
Other income, net | (1,277 | ) | - | (1,277 | ) | (85 | ) | - | (85 | ) | ||||||||
Total other (income) expense | (983 | ) | (1,670 | ) | (2,653 | ) | (25 | ) | (372 | ) | (397 | ) | ||||||
Net income before income taxes and noncontrolling interests | 2,604 | 1,185 | 3,789 | 2,881 | 381 | 3,262 | ||||||||||||
Income tax | 454 | - | 454 | 158 | - | 158 | ||||||||||||
Net income | 2,150 | 1,185 | 3,335 | 2,723 | 381 | 3,104 | ||||||||||||
Net income attributable to noncontrolling interests | 3,738 | 7 | 3,745 | 2,505 | - | 2,505 | ||||||||||||
Net (loss) income attributable to Nobilis Health Corp. | $ | (1,588 | ) | $ | 1,178 | $ | (410 | ) | $ | 218 | $ | 381 | $ | 599 | ||||
Net (loss) income per basic common share | $ | (0.02 | ) | $ | 0.01 | $ | (0.01 | ) | $ | 0.01 | $ | - | $ | 0.01 | ||||
Net (loss) income per fully diluted common share | $ | (0.02 | ) | $ | 0.01 | $ | (0.01 | ) | $ | 0.01 | $ | - | $ | 0.01 | ||||
Weighted average shares outstanding (basic) | 63,531,390 | - | 63,531,390 | 43,411,318 | - | 43,411,318 | ||||||||||||
Weighted average shares outstanding (fully diluted) | 63,531,390 | - | 63,531,390 | 44,641,426 | (231,532 | ) | 44,409,894 |
12
Six Months Ended June 30, 2015 | Six Months Ended June 30, 2014 | |||||||||||||||||
As Reported |
Adjustments | Restated | As Reported |
Adjustments | Restated | |||||||||||||
Revenues: | ||||||||||||||||||
Patient and net professional fees | $ | 80,424 | $ | - | $ | 80,424 | $ | 27,235 | $ | - | $ | 27,235 | ||||||
Contracted marketing revenues | 3,649 | - | 3,649 | - | - | - | ||||||||||||
Factoring revenues | 1,910 | 735 | 2,645 | - | - | - | ||||||||||||
Total revenue | 85,983 | 735 | 86,718 | 27,235 | - | 27,235 | ||||||||||||
Cost of revenues | 971 | - | 971 | - | - | - | ||||||||||||
Gross Profit | 85,012 | 735 | 85,747 | 27,235 | - | 27,235 | ||||||||||||
Operating expenses: | ||||||||||||||||||
Salaries and benefits | 16,672 | - | 16,672 | 3,918 | - | 3,918 | ||||||||||||
Drugs and supplies | 12,889 | - | 12,889 | 3,969 | - | 3,969 | ||||||||||||
General and administrative | 33,770 | 30 | 33,800 | 11,912 | - | 11,912 | ||||||||||||
Depreciation and amortization | 1,592 | - | 1,592 | 603 | - | 603 | ||||||||||||
Total operating expenses | 64,923 | 30 | 64,953 | 20,402 | - | 20,402 | ||||||||||||
Corporate costs: | ||||||||||||||||||
Salaries and benefits | 1,992 | - | 1,992 | 1,029 | - | 1,029 | ||||||||||||
General and administrative | 11,424 | 1,091 | 12,515 | 1,241 | (5 | ) | 1,236 | |||||||||||
Legal expenses | 1,212 | - | 1,212 | 622 | - | 622 | ||||||||||||
Depreciation | 56 | - | 56 | 61 | - | 61 | ||||||||||||
Total corporate costs | 14,684 | 1,091 | 15,775 | 2,953 | (5 | ) | 2,948 | |||||||||||
Income from operations | 5,405 | (386 | ) | 5,019 | 3,880 | 5 | 3,885 | |||||||||||
Other expense (income): | ||||||||||||||||||
Interest expense | 784 | - | 784 | 113 | - | 113 | ||||||||||||
Change in fair value of warrant and stock option liabilities | - | 1,704 | 1,704 | - | (746 | ) | (746 | ) | ||||||||||
Other income, net | (1,412 | ) | - | (1,412 | ) | (66 | ) | - | (66 | ) | ||||||||
Total other (income) expense | (628 | ) | 1,704 | 1,076 | 47 | (746 | ) | (699 | ) | |||||||||
Net income before income taxes and noncontrolling interests | 6,033 | (2,090 | ) | 3,943 | 3,833 | 751 | 4,584 | |||||||||||
Income tax | 606 | - | 606 | 238 | - | 238 | ||||||||||||
Net income | 5,427 | (2,090 | ) | 3,337 | 3,595 | 751 | 4,346 | |||||||||||
Net income attributable to noncontrolling interests | 8,228 | 14 | 8,242 | 3,864 | - | 3,864 | ||||||||||||
Net (loss) income attributable to Nobilis Health Corp. | $ | (2,801 | ) | $ | (2,104 | ) | $ | (4,905 | ) | $ | (269 | ) | $ | 751 | $ | 482 | ||
Net (loss) income per basic common share | $ | (0.05 | ) | $ | (0.03 | ) | $ | (0.08 | ) | $ | (0.01 | ) | $ | 0.02 | $ | 0.01 | ||
Net (loss) income per fully diluted common share | $ | (0.05 | ) | $ | (0.03 | ) | $ | (0.08 | ) | $ | (0.01 | ) | $ | 0.02 | $ | 0.01 | ||
Weighted average shares outstanding (basic) | 61,872,658 | - | 61,872,658 | 43,301,603 | - | 43,301,603 | ||||||||||||
Weighted average shares outstanding (fully diluted) | 61,872,658 | - | 61,872,658 | 43,301,603 | 623,362 | 43,924,965 |
13
Six Months Ended June 30, 2015 | Six Months Ended June 30, 2014 | |||||||||||||||||
As Reported |
Adjustments | Restated | As Reported |
Adjustments | Restated | |||||||||||||
CASH FLOWS FROM OPERATING ACTIVITIES: | ||||||||||||||||||
Net loss | $ | 5,427 | $ | (2,090 | ) | $ | 3,337 | $ | 3,595 | $ | 751 | $ | 4,346 | |||||
Adjustments to reconcile net loss to net cash provided by operating activities: | ||||||||||||||||||
Depreciation and amortization | 1,648 | - | 1,648 | 664 | - | 664 | ||||||||||||
Provision for bad debts | 200 | - | 200 | - | - | - | ||||||||||||
Change in fair value of warrant and stock option liabilities | - | 1,704 | 1,704 | (746 | ) | (746 | ) | |||||||||||
Foreign currency gain (loss) | 57 | - | 57 | (53 | ) | - | (53 | ) | ||||||||||
Share-based compensation | 9,035 | 1,091 | 10,126 | 185 | (5 | ) | 180 | |||||||||||
Recoupment of Indemnified expenses | (1,700 | ) | - | (1,700 | ) | - | - | - | ||||||||||
Amortization of deferred financing fees | 33 | - | 33 | - | - | - | ||||||||||||
Changes in operating assets and liabilities: | - | - | - | - | - | |||||||||||||
Trade accounts receivable | (6,453 | ) | (496) | (6,949 | ) | (1,464 | ) | - | (1,464 | ) | ||||||||
Medical supplies | (425 | ) | - | (425 | ) | (101 | ) | - | (101 | ) | ||||||||
Prepaids and other current assets | 701 | - | 701 | (242 | ) | - | (242 | ) | ||||||||||
Other long-term assets | (39 | ) | - | (39 | ) | 464 | - | 464 | ||||||||||
Trade accounts payable and accrued liabilities | (2,223 | ) | (209 | ) | (2,432 | ) | (846 | ) | - | (846 | ) | |||||||
Other current liabilities | (942 | ) | - | (942 | ) | (38 | ) | - | (38 | ) | ||||||||
Other long-term liabilities | (103 | ) | - | (103 | ) | - | - | - | ||||||||||
Net cash provided by operating activities | 5,216 | - | 5,216 | 2,164 | - | 2,164 | ||||||||||||
CASH FLOWS FROM INVESTING ACTIVITIES: | ||||||||||||||||||
Purchase of property and equipment | (1,177 | ) | - | (1,177 | ) | (1,124 | ) | - | (1,124 | ) | ||||||||
Investment in associate | (120 | ) | - | (120 | ) | (150 | ) | - | (150 | ) | ||||||||
Note receivable | (197 | ) | - | (197 | ) | - | - | - | ||||||||||
Purchase of interest acquired in subsidiary | - | - | - | (346 | ) | - | (346 | ) | ||||||||||
Proceeds of sale of ownership interests of subsidiary | - | - | - | 230 | - | 230 | ||||||||||||
Acquisition of Victory | (1,436 | ) | - | (1,436 | ) | - | - | - | ||||||||||
Acquisition of Peak | (850 | ) | - | (850 | ) | - | - | - | ||||||||||
Deconsolidation of imaging centers and urgent care clinic | (166 | ) | - | (166 | ) | - | - | - | ||||||||||
Net cash used for investing activities | (3,946 | ) | - | (3,946 | ) | (1,390 | ) | - | (1,390 | ) | ||||||||
CASH FLOWS FROM FINANCING ACTIVITIES: | ||||||||||||||||||
Distributions to noncontrolling interests | (5,644 | ) | - | (5,644 | ) | (2,158 | ) | - | (2,158 | ) | ||||||||
Proceeds from exercise of stock options | 432 | - | 432 | 28 | - | 28 | ||||||||||||
Proceeds from exercise of stock warrants | 4,335 | - | 4,335 | - | - | - | ||||||||||||
Proceeds from private placement | 28,395 | - | 28,395 | - | - | - | ||||||||||||
Payments on capital lease obligations | (304 | ) | - | (304 | ) | (24 | ) | - | (24 | ) | ||||||||
Proceeds from debt and lines of credit | 21,500 | - | 21,500 | - | - | - | ||||||||||||
Payments of debt and lines of credit | (25,227 | ) | - | (25,227 | ) | (34 | ) | - | (34 | ) | ||||||||
Deferred financing fees | (657 | ) | - | (657 | ) | - | - | - | ||||||||||
Net cash provided by (used for) financing activities | 22,830 | - | 22,830 | (2,188 | ) | - | (2,188 | ) | ||||||||||
NET INCREASE (DECREASE) IN CASH AND CASH EQUIVALENTS | 24,100 | - | 24,100 | (1,414 | ) | - | (1,414 | ) | ||||||||||
CASH AND CASH EQUIVALENTS Beginning | 7,568 | - | 7,568 | 5,602 | - | 5,602 | ||||||||||||
CASH AND CASH EQUIVALENTS Ending | $ | 31,668 | $ | - | $ | 31,668 | $ | 4,188 | $ | - | $ | 4,188 |
14
The adjustments also affect tables and disclosures within Notes 5, 6, 8, 9, 12, 13, 14, 16 and 18 as labeled therein.
3. Deconsolidations
During the three month period ended March 31, 2015, we completed the deconsolidation of two imaging centers and one urgent care clinic in Houston. We resigned as the manager of these facilities resulting in loss of control and our rights to exercise significant influence. We retained investments in these facilities that are accounted for as cost method investments as of January 1, 2015. The revaluation of our remaining investments in these facilities resulted in no gain or loss due to the short term these investments were held. The deconsolidation resulted in the reversal of $0.7 million of goodwill.
4. Investments in Associates
In March 2014, the Company acquired an ownership interest in Group of Pioneers Diagnostics (GOP), LLC, representing 40% of the outstanding share interests in GOP. The investment was previously accounted for using the equity method of accounting. In March 2015, the Company resigned as manager of GOP resulting in the loss of ability to exercise significant influence over the operating and financial activities of the investee. As a result, the investment will be accounted for under the cost method accounting. The carrying value of this investment at June 30, 2015 was $0.2 million, and is reflected in investments in associates in the consolidated balance sheets.
5. Business Combinations (Restated)
First Nobilis, LLC (First Nobilis)
In September 2014, the Company formed First Nobilis, a Texas limited liability Company. First Nobilis is owned 51% by the Company and 49% by a third party. First Nobilis formed two subsidiary Texas limited liability companies to be the new operating entities.
Upon formation of First Nobilis, effective September 1, 2014, Nobilis contributed $7.5 million in cash to the new entity. For a 49% ownership interest, a third party contributed medical supplies, intangible assets, and certain accounts payables and accounts receivables. This transaction was treated as a business combination. The fair value of the intangible assets and liabilities acquired were determined by independent third party valuation experts. The carrying amounts of all other net assets acquired approximate their fair values due to their short term nature.
Athas Health, LLC (Athas)
In December 2014, the Company completed its acquisition of Athas for total consideration of approximately $31.2 million (all $ denominations in US dollars). Athas is based in Dallas, Texas, and focuses on the delivery of specialized healthcare services in seven states through the use of contracted marketing services and factoring of receivables. The purchase price for Nobilis to acquire all of the ownership interests in Athas was broken down as follows: $3.0 million in cash upon closing, the issuance of a promissory note by Nobilis to the sellers for $12.0 million, the issuance at closing of 6,666,666 shares of Nobilis common stock that are subject to a lock up of up to two years, and the issuance of an additional 4,666,666 shares of Nobilis common stock issued over two years with half issued on the first anniversary of the closing and the second half issued on the second anniversary of the closing. Under the two year lock up period, the stock issued as part of the purchase price is subject to restrictions on transfer and may not be sold or pledged until the lock out period is released.
The fair value of the intangible assets acquired was determined by independent third party valuation experts. The carrying amounts of all other net assets acquired approximate their fair values due to their short term nature. The value of the stock issued for consideration was determined by third party valuation experts using the published stock price on the date of closing, less a discount for lack of marketability as a result of the two year lock up period on the shares issued.
Victory Medical Center Houston, L.P. (Victory)
In April 2015, the Company acquired a 55% ownership interest in Victory Medical Center Houston, L.P., which owns and operates Victory Healthcare Houston Hospital, surgical hospital located in the Texas Medical Center in Houston, Texas. The Company paid $1.4 million in cash and assumed certain leases and loans of Victory.
The fair values assigned to certain assets acquired and liabilities assumed in relation to the Companys acquisition have been prepared on a preliminary basis with information currently available and are subject to change. Specifically, the Company is further assessing the valuation of certain tangible and intangible assets acquired and obligations assumed pending the final appraisals. The Company expects to finalize its analysis during 2016.
Subsequent to the acquisition date of April 24, 2015, the Partnership had $2.3 million in revenues and a net loss of $0.7 million which is included in the Companys June 30, 2015 consolidated statements of operations.
15
The costs related to the transaction were nominal and were expensed during the three months ended June 30, 2015. These costs are included in the corporate general and administrative expenses in the June 30, 2015 consolidated statements of operations.
The following table summarizes the fair values of the identifiable assets acquired and liabilities assumed at the date of acquisition (in thousands):
April 24, 2015 | |||
Net assets acquired: | |||
Cash | $ | 64 | |
Trade accounts receivable | 2,500 | ||
Other receivables | 6,325 | ||
Prepaid expenses and other current assets | 44 | ||
Inventory | 662 | ||
Property and equipment | 4,860 | ||
Other long-term assets | 2 | ||
Trademark | 280 | ||
Medicare license | 940 | ||
Hospital license | 13 | ||
Goodwill | 9,447 | ||
Net assets acquired | $ | 25,137 | |
Net liabilities acquired: | |||
Trade accounts payable | $ | 6,266 | |
Accrued liabilities | 3,198 | ||
Long-term portion of Capital Leases | 2,278 | ||
Long-term portion of Note Payable | 6,052 | ||
Total liabilities acquired | $ | 17,794 | |
Consideration: | |||
Cash, net of cash acquired | $ | 1,436 | |
Debt assumed | 5,907 | ||
Total consideration | $ | 7,343 |
Peak Surgeon Innovations, LLC (Peak)
In June 2015, the Company acquired Peak, a provider of intraoperative neuromonitoring ("IOM") services for hospitals, surgery centers and other healthcare facilities. The Company acquired a 100% ownership interest in Peak for cash consideration of $0.9 million and stock consideration of $0.7 million provided to Bryan Hasse (the Seller). In addition to such cash and stock consideration, the Seller is eligible to receive a potential earnout payment (in cash or stock at the option of Seller) upon achievement by the IOM service line of certain EBITDA performance metrics.
The fair values assigned to certain assets acquired and liabilities assumed in relation to the Companys acquisition have been prepared on a preliminary basis with information currently available and are subject to change. Specifically, the Company is further assessing the valuation of certain tangible and intangible assets acquired and obligations assumed pending the final appraisals. The Company expects to finalize its analysis during 2016.
Subsequent to the acquisition date of June 1, 2015, Peak had $0.3 million in revenues and net income of $0.1 million which is included in the Companys June 30, 2015 consolidated statements of operations.
The costs related to the transaction were nominal and were expensed during the three months ended June 30, 2015. These costs are included in the corporate general and administrative expenses in the June 30, 2015 consolidated statements of operations.
16
The following table summarizes the preliminary fair values of the identifiable assets acquired and liabilities assumed at the date of acquisition (in thousands):
June 1, 2015 | |||
Net assets acquired: | |||
Cash | $ | 1 | |
Trade accounts receivable | 315 | ||
Prepaid expenses and other current assets | 4 | ||
Goodwill | 1,318 | ||
Net assets acquired | $ | 1,638 | |
Net liabilities acquired: | |||
Trade accounts payable | $ | 138 | |
Consideration: | |||
Cash, net of cash acquired | $ | 850 | |
Stock issued as consideration | 650 | ||
Total consideration | $ | 1,500 |
Unaudited Supplemental Pro Forma Information
The following unaudited supplemental pro forma financial information includes the results of operations for Athas, First Nobilis and Victory, and is presented as if each acquired company had been consolidated as of the beginning of the year immediately preceding the year in which the company was acquired. The Company utilized all historical data which was available and practicable to obtain. Certain information was not practicable to obtain for the three and six months ended June 30, 2014 for victory due to the bankruptcy proceedings of their former parent company. The unaudited supplemental pro forma financial information has been provided for illustrative purposes only and does not purport to be indicative of the actual result that would have been achieved by the combined companies for the periods presented, or of the results that may be achieved by the combined companies in the future. Further, results may vary significantly from the results reflected in the following unaudited supplemental pro forma financial information because of future events and transactions, as well as other factors.
Unaudited pro forma information for the Peak acquisition is not presented in the pro forma disclosure because the effects of such transaction are considered immaterial to the Companys consolidated financial statements.
The unaudited supplemental pro forma financial information presented below has been prepared by adjusting the historical results of the Company to include historical results of the acquired businesses described above and was then adjusted: (i) to increase amortization expense resulting from the intangible assets acquired; (ii) to adjust earnings per share to reflect the common shares issued as part of the purchase consideration; (iii) to reduce interest expense from debt which was retained by the seller upon acquisition of the respective businesses; (iv) to adjust the carrying value of net property and equipment to its fair value and to increase depreciation expense for the incremental increase in the value of property and equipment; (v) to decrease expenses for management services which were provided by the preceding parent entity and to concurrently increase expenses for management services which are now provided by the Company; (vi) to adjust noncontrolling interest to properly reflect the minority ownership percentages which were not purchased by the Company; and (vii) to reverse income from discontinued operations. The unaudited supplemental pro forma financial information does not include adjustments to reflect the impact of other cost savings or synergies that may result from these acquisitions.
17
The Companys unaudited supplemental pro forma financial information is as follows (in thousands except for per share amounts):
Three months | Three months | Six months | Six months | |||||||||
ended | ended | ended | ended | |||||||||
June 30, 2015 | June 30, 2014 | June 30, 2015 | June 30, 2014 | |||||||||
(Restated) | (Restated) | (Restated) | (Restated) | |||||||||
Revenue | $ | 48,867 | $ | 24,472 | $ | 87,291 | $ | 52,144 | ||||
Income (loss) before from operations | 1,136 | (2,021 | ) | 4,352 | (220 | ) | ||||||
Net income attributable to noncontrolling interest | 3,738 | 793 | 7,985 | 2,817 | ||||||||
Net loss attributable to common stockholders | (410 | ) | (2,206 | ) | (5,483 | ) | (1,681 | ) | ||||
Net loss per basic common share | $ | (0.01 | ) | $ | (0.04 | ) | $ | (0.09 | ) | $ | (0.03 | ) |
6. Trade Accounts Receivable (Restated)
A detail of accounts receivable as of June 30, 2015 and December 31, 2014 is as follows (in thousands):
June 30, | December 31, | |||||
2015 | 2014 | |||||
(Restated) | (Restated) | |||||
Trade accounts receivable | $ | 51,287 | $ | 40,985 | ||
Allowance for doubtful accounts | (1,584 | ) | (1,391 | ) | ||
Receivables transferred | (429 | ) | (873 | ) | ||
Receivables purchased | 656 | 1,740 | ||||
Trade accounts receivable, net | $ | 49,930 | $ | 40,461 |
Bad debt expense was $0.2 million for the three and six months ended June 30, 2015 and was nil for the three and six months ended June 30, 2014.
As of June 30, 2015 and December 31, 2014, there remained a balance of $0.4 million and $0.9 million, respectively, in transferred receivables pursuant to the terms of the original agreement. The Company, from time to time, transfers to the third party certain of its accounts receivable payments on a non-recourse basis. For the three months ended June 30, 2015 and 2014, the Company received advanced payments of $0.5 million and $0.1 million, respectively. During the same time period, the Company transferred $2.1 million and $2.2 million of receivables, respectively. For the six months ended June 30, 2015 and 2014, the Company received advanced payments of $1.1 million and $0.3 million, respectively. During the same time period, the Company transferred $3.8 million and $3.8 million of receivables, respectively. Concurrently, upon collection of these transferred receivables, payment will be made to the transferee.
Athas Health, LLC (Athas) purchases receivables from physicians, at a discount, on a nonrecourse basis. The discount and purchase price vary by speciality. These purchased receivables are billed and collected by Athas, and Athas retains 100% of what is collected after paying the discounted purchase price. Following the transfer of the receivable, the transferor has no continued involvement and there are no restrictions on the receivables.
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7. Concentrations
A summary of certain information about our payor concentration is as follows:
MEDICAL SERVICES SEGMENT
PATIENT AND NET
PROFESSIONAL FEE REVENUE BY PAYORS OF THE NOBILIS FACILITIES
FOR THE
THREE MONTHS ENDED JUNE 30, 2015 AND 2014
2015 Patient and Net | 2014 Patient and Net | |||||
Payors | Professional Fee Revenue | Professional Fee Revenue | ||||
by Payor Mix | by Payor Mix | |||||
Private insurance and other private pay | 95.0% | 97.3% | ||||
Workers compensation | 4.6% | 1.7% | ||||
Medicare | 0.4% | 1.0% | ||||
Total | 100.0% | 100.0% |
MARKETING & FACTORING SEGMENT
PATIENT AND NET
PROFESSIONAL FEE REVENUE BY PAYORS OF THE NOBILIS FACILITIES
FOR THE
THREE MONTHS ENDED JUNE 30, 2015 AND 2014
2015 Patient and Net | 2014 Patient and Net | |||||
Payors | Professional Fee Revenue | Professional Fee Revenue | ||||
by Payor Mix | by Payor Mix | |||||
Private insurance and other private pay | 100.0% | 0.0% | ||||
Workers compensation | 0.0% | 0.0% | ||||
Medicare | 0.0% | 0.0% | ||||
Total | 100.0% | 0.0% |
CONSOLIDATED SEGMENTS
PATIENT AND NET
PROFESSIONAL FEE REVENUE BY PAYORS OF THE NOBILIS FACILITIES
FOR THE
THREE MONTHS ENDED JUNE 30, 2015 AND 2014
2015 Patient and Net | 2014 Patient and Net | |||||
Payors | Professional Fee Revenue | Professional Fee Revenue | ||||
by Payor Mix | by Payor Mix | |||||
Private insurance and other private pay | 95.5% | 97.3% | ||||
Workers compensation | 4.1% | 1.7% | ||||
Medicare | 0.4% | 1.0% | ||||
Total | 100.0% | 100.0% |
MEDICAL SERVICES SEGMENT
PATIENT AND NET
PROFESSIONAL FEE REVENUE BY PAYORS OF THE NOBILIS FACILITIES
FOR THE
SIX MONTHS ENDED JUNE 30, 2015 AND 2014
2015 Patient and Net | 2014 Patient and Net | |||||
Payors | Professional Fee Revenue | Professional Fee Revenue | ||||
by Payor Mix | by Payor Mix | |||||
Private insurance and other private pay | 95.0% | 96.9% | ||||
Workers compensation | 4.5% | 2.2% | ||||
Medicare | 0.5% | 0.9% | ||||
Total | 100.0% | 100.0% |
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MARKETING & FACTORING SEGMENT
PATIENT AND NET
PROFESSIONAL FEE REVENUE BY PAYORS OF THE NOBILIS FACILITIES
FOR THE
SIX MONTHS ENDED JUNE 30, 2015 AND 2014
2015 Patient and Net | 2014 Patient and Net | |||||
Payors | Professional Fee Revenue | Professional Fee Revenue | ||||
by Payor Mix | by Payor Mix | |||||
Private insurance and other private pay | 100.0% | 0.0% | ||||
Workers compensation | 0.0% | 0.0% | ||||
Medicare | 0.0% | 0.0% | ||||
Total | 100.0% | 0.0% |
CONSOLIDATED SEGMENTS
PATIENT AND NET
PROFESSIONAL FEE REVENUE BY PAYORS OF THE NOBILIS FACILITIES
FOR THE
SIX MONTHS ENDED JUNE 30, 2015 AND 2014
2015 Patient and Net | 2014 Patient and Net | |||||
Payors | Professional Fee Revenue | Professional Fee Revenue | ||||
by Payor Mix | by Payor Mix | |||||
Private insurance and other private pay | 95.3% | 96.4% | ||||
Workers compensation | 4.2% | 2.6% | ||||
Medicare | 0.5% | 1.0% | ||||
Total | 100.0% | 100.0% |
Two facilities represent approximately 76.63% of the Companys contracted marketing revenue and five facilities represent approximately 78.82% of the Companys contracted marketing accounts receivable for the six months ended and as of June 30, 2015.
8. Net Intangible Assets (Restated)
Intangible assets at June 30, 2015 and December 31, 2014 consist of the following (in thousands):
June 30, 2015 | December 31, 2014 | |||||||||||||||||||||||||||||
(Restated) | (Restated) | |||||||||||||||||||||||||||||
Term | Net | Net | ||||||||||||||||||||||||||||
(in | Historical | Accumulated | Accumulated | Book | Historical | Accumulated | Accumulated | Book | ||||||||||||||||||||||
years) | Cost | Additions | Amortization | Impairment | Value | Cost | Amortization | Impairment | Value | |||||||||||||||||||||
Definite Life | ||||||||||||||||||||||||||||||
Non-compete agreements | 10-15 | $ | 2,765 | $ | - | $ | 952 | $ | - | $ | 1,813 | $ | 2,765 | $ | 857 | $ | - | $ | 1,908 | |||||||||||
Internally developed software | 5 | 1,980 | - | 231 | - | 1,749 | 1,980 | 33 | - | 1,947 | ||||||||||||||||||||
Trade secret methodology | 10 | 5,620 | - | 328 | - | 5,292 | 5,620 | 47 | - | 5,573 | ||||||||||||||||||||
Physician relationships | 15-20 | 2,800 | - | 117 | - | 2,683 | 2,800 | 47 | - | 2,753 | ||||||||||||||||||||
Unfavorable lease | 8 | (290 | ) | - | (28 | ) | - | (262 | ) | (290 | ) | (11 | ) | - | (279 | ) | ||||||||||||||
Indefinite Life | ||||||||||||||||||||||||||||||
Tradenames | 1,000 | - | - | - | 1,000 | 1,000 | - | - | 1,000 | |||||||||||||||||||||
Trademark | 5,610 | 280 | - | - | 5,890 | 5,610 | - | - | 5,610 | |||||||||||||||||||||
Medicare license | 8,498 | 940 | - | 7,401 | 2,037 | 8,498 | - | 7,401 | 1,097 | |||||||||||||||||||||
Hospital license | - | 13 | - | - | 13 | |||||||||||||||||||||||||
Total | $ | 27,983 | $ | 1,233 | $ | 1,600 | $ | 7,401 | $ | 20,215 | $ | 27,983 | $ | 973 | $ | 7,401 | $ | 19,609 |
Amortization expense was $0.3 million and nil for the three months ended June 30, 2015 and 2014, respectively, and $0.6 million and nil for the six months ended June 30, 2015 and 2014, respectively. Estimated amortization expense of intangible assets is $0.6 million for the remainder of 2015, $1.3 million for each of the next four years and $6.2 million thereafter.
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9. Goodwill (Restated)
The following table provides information on changes in the carrying amount of goodwill, which is included in the accompanying consolidated balance sheets as of June 30, 2015 and December 31, 2014 (in thousands):
December 31, | ||||||
June 30, 2015 | 2014 | |||||
(Restated) | (Restated) | |||||
Cost | $ | 45,956 | $ | 35,889 | ||
Accumulated impairment | (14,300 | ) | (14,300 | ) | ||
Total | $ | 31,656 | $ | 21,589 |
December 31, | ||||||
June 30, 2015 | 2014 | |||||
Cost | (Restated) | (Restated) | ||||
BALANCE - beginning of period | $ | 35,889 | $ | 15,528 | ||
January 2014 business combination | - | 701 | ||||
September 2014 business combination | - | 649 | ||||
December 2014 business combination | - | 19,011 | ||||
Deconsolidation of imaging centers and urgent care clinic | (701 | ) | - | |||
April 2015 business combination | 9,447 | - | ||||
June 2015 business combination | 1,321 | - | ||||
Total cost | $ | 45,956 | $ | 35,889 | ||
Accumulated impairment | ||||||
BALANCE - beginning of period | $ | (14,300 | ) | $ | (14,300 | ) |
Impairment charges during the period | - | - | ||||
Total accumulated impairment | $ | (14,300 | ) | $ | (14,300 | ) |
10. Lines of Credit
On March 31, 2015, the Company secured a $5.0 million revolving line of credit (the revolver) from General Electric Capital Corporation. The revolver bears interest at a rate of 4% plus LIBOR per annum (4.70% at June 30, 2015) and requires quarterly payments. Principal amounts borrowed under the revolver may be repaid and re-borrowed periodically, maturing in March 2020. The revolver is collateralized by the accounts receivable and physical equipment of all of the Companys 100% owned subsidiaries as well as the Companys ownership interest in all less than wholly owned subsidiaries. The Company had $1.5 million outstanding on this revolver as of June 30, 2015.
11. Debt
On March 31, 2015, the Company secured a $20.0 million term loan from General Electric Capital Corporation. The term loan bears interest at a rate of 4% plus LIBOR per annum (4.70% at June 30, 2015) and requires quarterly payments of principal and interest until the term loan matures in March 2020. The term loan is collateralized by the accounts receivable and physical equipment of all of the Companys 100% owned subsidiaries as well as the Companys ownership interest in all less than wholly owned subsidiaries.
The $20.0 million term loan primarily served to refinance all previously held debt and lines of credit. Debt issuance costs associated with the new credit facility approximated $0.6 million and are being amortized over the life of the loan.
21
Debt at June 30, 2015 consisted of the following (in thousands):
June 30, | December 31, | |||||
2015 | 2014 | |||||
Lines of credit | $ | 1,500 | $ | 5,420 | ||
Subordinated notes payable | - | 635 | ||||
Term loan | 19,550 | 14,019 | ||||
Total debt | 21,050 | 20,074 | ||||
Less: current portion | 868 | 9,492 | ||||
Less: amortized loan fees | 628 | - | ||||
Long-term debt, net of current portion | $ | 19,554 | $ | 10,582 |
12. Share Based Compensation (Restated)
The Company granted a total of 650,000 stock options during the three months ended June 30, 2015. Of the granted options, 75,000 of those vest ratably over a one year period, and 200,000 vest ratably over a three year period.
The following table summarizes stock option activity for the six months ended June 30, 2015:
Weighted- | |||||||||
Weighted- | Average | ||||||||
Shares | Average | Remaining | |||||||
Underlying | Exercise | Life | |||||||
Options | Price | (years) | |||||||
Outstanding at December 31, 2014 | 3,118,218 | $ | 1.45 | 9.80 | |||||
Granted | 1,301,782 | $ | 4.33 | 9.77 | |||||
Exercised | (336,120 | ) | $ | 1.24 | - | ||||
Forfeited | (407,213 | ) | $ | 1.14 | - | ||||
Outstanding at June 30, 2015 | 3,676,667 | $ | 2.13 | 9.69 | |||||
Exercisable at June 30, 2015 | 1,257,611 | $ | 2.59 | 9.76 |
(The table above includes 650,000 options issued to non-employees. See Note 14 for discussion regarding the classification of these options in the balance sheet.)
The total intrinsic value of stock options exercised during the six months ended June 30, 2015 and 2014 was $2.7 million and $1.5 million, respectively. The total intrinsic value for all in-the-money vested outstanding stock options at June 30, 2015 was $6.9 million. Assuming all stock options outstanding at June 30, 2015 were vested, the total intrinsic value of in-the-money outstanding stock options would have been $22.4 million.
The Company recorded compensation expense relative to employee stock options of $1.0 million and $0.1 million for the three months ended June 30, 2015 and 2014, respectively, and $3.0 million and $0.1 million for the six months ended June 30, 2015 and 2014, respectively.
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The fair values of stock options used in recording compensation expense are computed using the Black-Scholes option pricing model. The table below shows the assumptions used in the model for employee options awarded during the six months ended June 30, 2015.
Six months ended | |||
June | |||
30, 2015 | |||
(Restated) | |||
Expected price volatility | 113% - 122% | ||
Risk free interest rate | 1.34% - 1.87% | ||
Expected annual dividend yield | 0% | ||
Expected option term (years) | 5 - 6 | ||
Expected forfeiture rate | 0% - 8.8% | ||
Grant date fair value per share | $ | 2.53 - $6.10 |
For stock options, the Company recognizes share-based compensation net of estimated forfeitures and revises the estimates in the subsequent periods if actual forfeitures differ from the estimates. Forfeiture rates are estimated based on historical experience as well as expected future behavior.
13. Shareholders Equity (Restated)
In April 2015, the Company issued, through a private placement agreement, 7,847,668 Units, at a price of Cdn$9.00 per Unit. Each Unit is comprised of one treasury unit (a Treasury Unit) and one-half of one common share from Donald L. Kramer, Healthcare Ventures, Ltd (a company wholly owned by Dr. Kramer), Harry Fleming or from treasury. Each Treasury Unit is comprised of one-half of one common share of the Company and one-half of one common share purchase warrant exercisable for one additional share at a price of Cdn$11.50. Through the private placement, the Company raised proceeds of $28.4 million, net of offering costs and commissions of $1.9 million. As part of the private placement, the Company also granted 392,383 options to the underwriter at a price of Cdn$9.00.
Earnings per share (EPS)
A detail of the Companys EPS is as follows (in thousands except for share and per share amounts):
Three months | Three months | Six months | Six months | |||||||||
ended | ended | ended | ended | |||||||||
June 30, 2015 | June 30, 2014 | June 30, 2015 | June 30, 2014 | |||||||||
(Restated) | (Restated) | (Restated) | (Restated) | |||||||||
Net loss (income) attributable to Nobilis Health Corp. | $ | (410 | ) | $ | 599 | $ | (4,905 | ) | $ | 482 | ||
Issued common shares at beginning of period | 61,234,803 | 42,729,547 | 59,418,227 | 42,729,547 | ||||||||
Effect of investment in subsidiary | - | 431,771 | - | 393,603 | ||||||||
Effect of private placement | 974,205 | - | 489,794 | - | ||||||||
Effect of June 2015 acquisition | 21,698 | - | 10,909 | - | ||||||||
Effect of stock based compensation | 119,011 | 250,000 | 217,230 | 178,453 | ||||||||
Effect of stock warrants | 1,181,673 | - | 1,736,498 | - | ||||||||
Weighted average common shares at end of period | 63,531,390 | 43,411,318 | 61,872,658 | 43,301,603 | ||||||||
Basic net loss per common share | $ | (0.01 | ) | $ | 0.01 | $ | (0.08 | ) | $ | 0.01 |
23
Three months | Six months | |||||
ended | ended | |||||
June 30, 2014 | June 30, 2014 | |||||
(Restated) | (Restated) | |||||
Net loss (income) attributable to Nobilis Health Corp. | $ | 599 | $ | 482 | ||
Weighted average common shares (basic) | 43,411,318 | 43,301,603 | ||||
Effect of stock based compensation | 501,133 | 570,182 | ||||
Effect of stock warrants | 41,496 | 53,233 | ||||
Weighted average common shares at end of period | 43,953,947 | 43,925,018 | ||||
Basic net loss per common share | $ | 0.01 | $ | 0.01 |
As the Company is in a loss position for the three and six months ended June 30, 2015, the calculation of dilutive shares is unnecessary. Any increase in weighted-average share amounts would result in an anti-dilutive per share amount.
14. Warrants and Options Liabilities (Restated)
Warrants and Options Issued in Private Placements
The Company issued warrants and compensatory options in connection with private placements completed in December 2013, September 2014 and April 2015. These warrants and options have exercise prices denominated in Canadian dollars and as such may not be considered indexed to our stock in accordance with ASC 815-40-15-7I. Hence, these warrants and options are classified as liabilities under the caption Warrant and Option Liabilities and recorded at estimated fair value at each reporting date, computed using the Black-Scholes valuation method. Changes in the liability from period to period are recorded in the Statements of Operations under the caption Change in fair value of warrant and option liabilities.
The estimated fair values of warrants and options accounted for as liabilities were determined on the date of the private placements and at each balance sheet date following using the Black Scholes pricing model with the following inputs:
June 30, 2015 | December 31, 2014 | ||
Risk free interest rate | 0.11% - 0.64% | 0.13% - 0.67% | |
Expected life in years | 0.5 1.9 | 1 - 2 | |
Expected volatility | 71% - 82% | 73% - 146% | |
Expected dividend yield | 0% | 0% |
The changes in fair value of the warrants and options liability during the periods ended June 30, 2015 and 2014 were as follows:
Balance at January 1, 2014 | $ | 2,401 | |
Change in fair value recorded in earnings | (746 | ) | |
Balance at June 30, 2014 | $ | 1,655 | |
Balance at January 1, 2015 | $ | 6,657 | |
Issuance of warrants and options | 12,797 | ||
Transferred to equity upon exercise | (8,823 | ) | |
Change in fair value recorded in earnings | 1,109 | ||
Balance at June 30, 2015 | $ | 11,740 |
The following warrants and options were outstanding at June 30, 2015:
24
Number of | Remaining | ||||||||
Exercise price | warrants | contractual | |||||||
in Cnd$ | and options | life (years) | |||||||
2013 Options | Cnd$0.95 | 43,143 | 0.50 | ||||||
2014 Options | Cnd$1.37 | 178,365 | 1.25 | ||||||
2015 Warrants | Cnd$11.50 | 3,923,834 | 1.90 | ||||||
2015 Options | Cnd$9.00 | 392,383 | 1.90 | ||||||
Outstanding and exercisable at June 30, 2015 | 4,537,725 |
Options Issued to Non-Employees
As discussed in Note 12, the Company has issued options to professionals providing services to the organization. These professionals do not meet the definition of an employee under U.S. GAAP. At June 30, 2015, there were 650,000 options issued and outstanding to these non-employees.
Under U.S. GAAP, the value of these option awards is determined at the performance completion date (e.g. vesting date). The Company recognizes expense for such estimated total value of the awards during the period from their issuance until performance completion since the professional services are being rendered during this time. The total expense recognized is adjusted to the final value of the award as determined on the performance completion date.
The estimated and final values of the option awards are determined using the Black Scholes pricing model with the following inputs:
June 30, 2015 | December 31, 2014 | |||||
Risk free interest rate | 0.28% - 1.85% | 0.67% - 2.00% | ||||
Expected life of warrants and options | 1 6 years | 2 - 6 years | ||||
Expected volatility | 76% - 119% | 113% - 127% | ||||
Expected dividend yield | 0% | 0% |
The Company recorded expense for non-employee stock options of $1.7 million and $9 thousand for the six months ended June 30, 2015 and 2014, respectively.
After the performance completion date, options issued to non-employees will be reclassified from equity to liabilities. Under U.S. GAAP, such options may not be considered indexed to our stock in accordance with ASC 815-40-15-7I because they have exercise prices denominated in Canadian dollars. Hence, these will be classified as liabilities under the caption Warrant and Option Liabilities and recorded at estimated fair value at each reporting date, computed using the Black-Scholes valuation method. Changes in the liability from period to period will be recorded in the Statements of Operations under the caption Change in fair value of warrant and option liabilities. At June 30, 2015, the performance completion date was reached for 166,667 non-employee options. Accordingly, the Company reclassified $468 thousand from equity to liabilities during the six months ended June 30, 2015 for the value of the options at the performance completion date. At June 30, 2015, these options had increased in value to $1.1 million. The change in value of these options totaling $596 thousand has been recognized in earnings.
15. Income Taxes
The Company files a consolidated federal income tax return. Deferred tax assets and liabilities are recognized for future tax consequences attributable to differences between the financial statement carrying amounts of existing assets and liabilities and their respective tax bases. Deferred tax assets and liabilities are measured using enacted tax rates expected to apply to taxable income in the periods in which the deferred tax assets are expected to be realized. The Company has determined that its deferred tax assets are not realizable on a more-likely-than-not basis and has recorded a full valuation allowance as of June 30, 2015 and December 31, 2014.
Reported tax expense is attributable to current state taxes only.
16. Business Segment Information (Restated)
25
A summary of the business segment information as of June 30, 2015 is as follows (in thousands):
Six months ended June 30, 2015 | ||||||||||||
(Restated) | ||||||||||||
Medical | Marketing & | |||||||||||
Services | Factoring | Corporate | Total | |||||||||
`Revenues | $ | 77,488 | $ | 9,230 | $ | - | $ | 86,718 | ||||
Cost of goods sold | - | 971 | - | 971 | ||||||||
Gross Profit | 77,488 | 8,259 | - | 85,747 | ||||||||
Operating expenses | 58,063 | 6,890 | - | 64,953 | ||||||||
Corporate costs | - | - | 15,775 | 15,775 | ||||||||
Income (loss) from operations | $ | 19,425 | $ | 1,369 | $ | (15,775 | ) | $ | 5,019 | |||
Other data: | ||||||||||||
Depreciation and amortization expense | $ | 901 | $ | 691 | $ | 56 | $ | 1,648 | ||||
Interest expense | $ | - | $ | 80 | $ | 704 | $ | 784 | ||||
Income tax expense | $ | 527 | $ | 79 | $ | - | $ | 606 | ||||
Intangible assets | $ | 5,739 | $ | 14,476 | $ | - | $ | 20,215 | ||||
Goodwill | $ | 12,645 | $ | 19,011 | $ | - | $ | 31,656 | ||||
Capital expenditures | $ | 1,365 | $ | 127 | $ | - | $ | 1,492 | ||||
Non-cash acquisition of property | $ | 4,860 | $ | - | $ | - | $ | 4,860 | ||||
Non-cash acquisition of intangibles and goodwill | $ | 11,998 | $ | - | $ | - | $ | 11,998 | ||||
Total assets | $ | 85,714 | $ | 41,545 | $ | 26,259 | $ | 153,518 | ||||
Total liabilities | $ | 23,168 | $ | 5,604 | $ | 36,467 | $ | 65,239 |
Three months ended June 30, 2015 | ||||||||||||
(Restated) | ||||||||||||
Medical | Marketing & | |||||||||||
Services | Factoring | Corporate | Total | |||||||||
Revenues | $ | 43,643 | $ | 5,224 | $ | - | $ | 48,867 | ||||
Cost of goods sold | - | 910 | - | 910 | ||||||||
Gross Profit | 43,643 | 4,314 | - | 47,957 | ||||||||
Operating expenses | 34,712 | 3,813 | - | 38,525 | ||||||||
Corporate costs | - | - | 8,296 | 8,296 | ||||||||
Income (loss) from operations | $ | 8,931 | $ | 501 | $ | (8,296 | ) | $ | 1,136 | |||
Other data: | ||||||||||||
Depreciation and amortization expense | $ | 612 | $ | 344 | $ | 29 | $ | 985 | ||||
Interest expense | $ | - | $ | 1 | $ | 293 | $ | 294 | ||||
Income tax expense | $ | 400 | $ | 54 | $ | - | $ | 454 | ||||
Capital expenditures | $ | 838 | $ | 130 | $ | - | $ | 968 | ||||
Non-cash acquisition of property | $ | 4,860 | $ | - | $ | - | $ | 4,860 | ||||
Non-cash acquisition of intangibles and goodwill | $ | 11,998 | $ | - | $ | - | $ | 11,998 |
The Company created the Marketing & Factoring operation segment in December 2014 following the acquisition of Athas. Prior to the acquisition of Athas, the Company operated under one operating segment and therefore, has not presented a prior period comparison of segment information.
17. Litigation
The Company is involved in disputes or legal actions arising in the ordinary course of business. Management does not believe the outcome of such disputes or legal actions will have a material adverse effect on the Companys financial position, results of operations or cash flows.
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Effective June 30, 2015, the Company, Northstar Healthcare Subco, LLC (Subco and, together with the Company, Nobilis) entered into a Confidential Agreement (the Agreement) with Athas, certain seller parties (the Athas Sellers) to the Membership Interest Purchase Agreement dated as of November 26, 2014 (the MIPA) and certain other parties. Pursuant to the Agreement, the Athas Sellers agreed to reduce by 836,029 the number of common shares, in the aggregate, that were to be issued on the first and second anniversaries of the MIPAs closing as contingent purchase price payments (the Contingent Shares). In addition, the Agreement accomplished (i) the financing of a $2.7 million debt owed by counterparties to the Agreement, (ii) recoupment of $1.7 million of indemnified expenses, and (iii) indemnification of counterparties with respect to litigation. Also pursuant to the Agreement, the Company accelerated the issuance of the remaining 3,830,638 Contingent Shares, which will be subject to restrictions on transfer.
18. Supplemental Cash Flows Information (Restated)
Six months ended June 30, | ||||||
2015 | 2014 | |||||
(Restated) | (Restated) | |||||
SUPPLEMENTAL DISCLOSURE OF CASH FLOW INFORMATION: | ||||||
Cash paid for interest | $ | 846 | $ | 71 | ||
Cash paid for taxes | $ | 603 | $ | 238 | ||
SUPPLEMENTAL SCHEDULE OF NON-CASH INVESTING AND FINANCING ACTIVITIES: | ||||||
Non-cash acquisition of property and equipment | $ | 4,860 | $ | - | ||
Non-cash acquisition of goodwill | $ | 10,765 | $ | - | ||
Non-cash acquisition of intangibles | $ | 1,233 | $ | - | ||
Non-cash deconsolidation of property and equipment | $ | 2,828 | $ | - | ||
Non-cash deconsolidation of goodwill | $ | 701 | $ | - | ||
Non-cash purchase of medical equipment through capital lease | $ | 315 | $ | - | ||
Athas settlement in lieu of contingent shares | $ | 5,685 | $ | - |
19. Subsequent Events
On July 30, 2015, the company formed Marsh Lane Surgical Hospital, LLC (Marsh Lane), a Texas limited liability company and wholly owned subsidiary of the Company and closed the purchase of certain assets (the Acquisition) pursuant to an asset purchase agreement (the Purchase Agreement) by and among Marsh Lane, the Company, Victory Parent Company, LLC, a Texas limited liability company (VPC), and Victory Medical Center Plano, LP, a Texas limited partnership (Victory Plano). The Acquisition was closed following the conclusion of bankruptcy proceedings in the U.S. Bankruptcy Court for the Northern District of Texas, Fort Worth Division (the Bankruptcy Court) initiated by Victory Plano. On June 12, 2015, Victory Plano filed for relief under Chapter 11 of Title 11 of the United States Bankruptcy Code in the Bankruptcy Court. Following the Bankruptcy Courts entry into the Sale Motion and Bidding Procedures Order, on July 29, 2015, the Bankruptcy Court entered into a Sale Order approving the terms and conditions of the Purchase Agreement and certain other financial arrangements as described below.
As consideration for the purchase of Victory Planos assets, Marsh Lane paid approximately $1.3 million in cash to be used by Victory Plano and VPC to cure and pay certain defaults under contracts assumed by Marsh Lane. The Purchaser also assumed Victory Planos indebtedness to LegacyTexas Bank in the amount of approximately $4.5 million. Marsh Lane also assumed Victory Planos capital equipment leases and its real estate lease.
In connection with the Purchase Agreement, Marsh Lane (the Borrower) entered into a Loan Agreement (the Loan Agreement) dated as of July 30, 2015 with LegacyTexas Bank, successor to ViewPoint Bank, N.A. (Legacy). The principal amount of the term loan (the Term Note) pursuant to the Loan Agreement is $4.5 million, which bears interest on the outstanding principal amount thereof at an annual rate equal to the lesser of the Applicable Rate (4.00% per annum plus the applicable LIBOR Rate) and the maximum lawful rate permitted under Texas or federal law, whichever is higher. All outstanding principal on the Term Note under the Loan Agreement is due and payable on July 30, 2020.
In connection with the Purchase Agreement and the Loan Agreement, on July 30, 2015, the Company entered into a guaranty (the Guaranty) to guaranty the Borrowers obligations under the Loan Agreement. Pursuant to the Guaranty, the Company irrevocably and unconditionally guaranteed the full and punctual payment and performance of all Loan Agreement obligations, in the manner and to the extent set forth in the Guaranty. The guaranty and payment of obligations under the Guaranty are expressly subordinated in the manner and extent set forth in the Subordination Agreement.
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In connection with the Purchase Agreement and entry into the Legacy Loan Documents, Northstar Healthcare Acquisitions, L.L.C., a Delaware limited liability company and wholly owned subsidiary of the Company (Northstar), entered into the Second Amendment to Credit Agreement and Conditional Waiver, dated as of July 30, 2015, by and among the Northstar, General Electric Capital Corporation (GE Capital), and the other Credit Parties named therein, (the Credit Agreement Amendment). The Credit Agreement Amendment, among other things, amended certain covenants, definitions and other terms contained in the Credit Agreement to accommodate the transactions contemplated by Purchase Agreement and the entry into the Legacy Loan Documents, and GE Capital granted the Company additional time to incorporate into the Credit Agreement several new subsidiaries formed during the Companys recent acquisitions and new service lines.
We have evaluated subsequent events through May 13, 2015, the date the consolidated financial statements were issued.
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Item 2. Managements Discussion and Analysis of Financial Condition and Results of Operations
Forward-Looking Statements
This Amendment No. 2 to our Quarterly Report on Form 10-Q/A (this Quarterly Report) and the documents that are incorporated by reference in this Quarterly Report contain certain forward-looking statements within the meaning of Canadian and United States securities laws, including the safe harbor for forward-looking statements contained in the Private Securities Litigation Reform Act of 1995. Forward-looking statements include all statements that do not relate solely to historical or current facts and may be identified by the use of words such as may, believe, will, expect, project, estimate, anticipate, plan or continue. These forward-looking statements are based on current plans and expectations and are subject to a number of risks, uncertainties and other factors which could significantly affect current plans and expectations and our future financial condition and results. These factors, which could cause actual results, performance and achievements to differ materially from those anticipated, include, but are not limited to:
- the risk that we may face challenges managing our new Marketing Segment and may not realize anticipated benefits;
- our ability to successfully maintain effective internal controls over financial reporting, including the impact of material weaknesses identified by management and our ability to remediate such control deficiencies;
- our ability to implement our business strategy, manage the growth in our business, and integrate acquired businesses;
- the risk of litigation and investigations, and liability claims for damages and other expenses not covered by insurance;
- the risk that payments from third-party payers, including government healthcare programs, may decrease or not increase as costs increase;
- adverse developments affecting the medical practices of our physician limited partners;
- our ability to maintain favorable relations with our physician limited partners;
- our ability to grow revenues by increasing case and procedure volume while maintaining profitability at the Nobilis Facilities;
- failure to timely or accurately bill for services;
- our ability to compete for physician partners, patients and strategic relationships;
- the risk of changes in patient volume and patient mix;
- the risk that laws and regulations that regulate payments for medical services made by government healthcare programs could cause our revenues to decrease;
- the risk that contracts are cancelled or not renewed or that we are not able to enter into additional contracts under terms that are acceptable to us; and
- the risk of potential decreases in our reimbursement rates.
The foregoing are significant factors we think could cause our actual results to differ materially from expected results. However, there could be additional factors besides those listed herein that also could affect us in an adverse manner.
You should read this Quarterly Report completely and with the understanding that actual future results may be materially different from what we expect. You are cautioned not to unduly rely on forward-looking statements when evaluating the information presented in this Quarterly Report or our other disclosures because current plans, anticipated actions, and future financial conditions and results may differ from those expressed in any forward-looking statements made by or on behalf of Nobilis.
We have not undertaken any obligation to publicly update or revise any forward-looking statements. All of our forward-looking statements speak only as of the date of the document in which they are made or, if a date is specified, as of such date. Subject to an mandatory requirements of applicable law, we disclaim any obligation or undertaking to provide any updates or revisions to any forward-looking statement to reflect any change in our expectations or any changes in events, conditions, circumstances or information on which the forward-looking statement is based. All subsequent written and oral forward-looking statements attributable to us or persons acting on our behalf are expressly qualified in their entirety by the foregoing factors and the risk factors set forth elsewhere in this report and in our Form 10-K/A filed on January 12, 2016.
Overview
The purpose of this section, Managements Discussion and Analysis of Financial Condition and Results of Operations (MD&A), is to provide a narrative explanation of our financial statements that enables investors to better understand our business, to enhance our overall financial disclosures, to provide the context within which our financial information may be analyzed, and to provide information about the quality of, and potential variability of, our financial condition, results of operations and cash flows. Our core business is the ownership, operation and management of outpatient surgery centers and surgical hospitals (the Medical Segment). We are also a provider of marketing services to our own affiliated entities as well as to third parties through our subsidiary Athas Health, LLC (Athas), which is a separate reportable business segment (the Marketing Segment ).
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Unless otherwise indicated, all financial and statistical information included in MD&A relates to our continuing operations, with dollar amounts expressed in thousands (except per share, per case and per procedure). Continuing operations information includes the results of 7 of our 8 healthcare facilities (the Nobilis Facilities) operated throughout the three and six months ended June 30, 2015 and 2014. The Nobilis Facilities are located in Texas and Arizona and consist of two hospitals in Houston, Texas and five ambulatory surgery centers, referred to as the "Nobilis ASCs" of which three are located in Houston, Texas, one in Dallas, Texas and one in Scottsdale, Arizona. Continuing operation information does not include the results of our recent acquisition of a Dallas-area hospital, which took place after June 30, 2015.
Restatement
As discussed in the Explanatory Note and in Note 2 of the Notes to Consolidated Financial Statements included in Part I- Item 1 of this 10-Q/A, we are restating our unaudited condensed consolidated financial statements and related disclosures for the three and six months ended June 30, 2015. The following discussion and analysis of our financial condition and results of operations incorporates the restated amounts.
Recent Developments
Acquisition of Peak Surgeon Innovations, LLC. In June 2015, the Company acquired Peak Surgeon Innovations, LLC ("Peak"), a provider of intraoperative neuromonitoring ("IOM") services for hospitals, surgery centers and other healthcare facilities. The Company acquired a 100% ownership interest in Peak for cash consideration of approximately $0.9 million and stock consideration of approximately $0.7 million provided to Bryan Hasse (the Seller). In addition to such cash and stock consideration, the Seller is eligible to receive a potential earnout payment (in cash or stock at the option of Seller) upon achievement by the IOM service line of certain EBITDA performance metrics.
Acquisition of Victory Plano Hospital, LP. On Jul 30, 2015, Marsh Lane Surgical Hospital, LLC (Marsh Lane), a Texas limited liability company and wholly owned subsidiary of the Company, closed the purchase of certain assets (the Acquisition) pursuant to an asset purchase agreement (the Purchase Agreement) by and among Marsh Lane, the Company, Victory Parent Company, LLC, a Texas limited liability company (VPC), and Victory Medical Center Plano, LP, a Texas limited partnership (Victory Plano). The Acquisition was closed following the conclusion of bankruptcy proceedings in the U.S. Bankruptcy Court for the Northern District of Texas, Fort Worth Division (the Bankruptcy Court) initiated by Victory Plano. On June 12, 2015, Victory Plano filed for relief under Chapter 11 of Title 11 of the United States Bankruptcy Code in the Bankruptcy Court. Following the Bankruptcy Courts entry into the Sale Motion and Bidding Procedures Order, on July 29, 2015, the Bankruptcy Court entered into a Sale Order approving the terms and conditions of the Purchase Agreement and certain other financial arrangements.
As consideration for the purchase of Victory Planos assets, Marsh Lane paid approximately $1.3 million in cash to be used by Victory Plano and VPC to cure and pay certain defaults under contracts assumed by Marsh Lane. The Purchaser also assumed Victory Planos indebtedness to Legacy Texas Bank in the amount of approximately $4.5 million. Marsh Lane also assumed Victory Planos capital equipment leases and its real estate lease.
Surgical Assist. In June 2015, the Company established Nobilis Surgical Assist, LLC to launch its surgical assist ancillary service line. A third party will handle staffing of cases performed at the Nobilis Facilities, as well as certain administrative matters associated with this service line's operation. Together with the acquisition of Peak, the Company anticipates increased facility efficiency and revenue per case with the addition of these ancillary services.
Revenue Model and Case Mix
Revenues earned by the Nobilis Facilities vary depending on the procedures performed. For every medical procedure performed there are usually three separately invoiced patient billings:
-
the surgical center fee for the use of infrastructure, surgical equipment, nursing staff, non-surgical professional services, supplies and other support services, which is earned by the Nobilis Facilities;
-
the professional fee, which is separately earned, billed and collected by the physician performing the procedure, separate and apart from the fees charged by the Nobilis Facilities; and
-
the anesthesiology fee, which is separately earned, billed and collected by the anesthesia provider, separate and apart from the fees charged by the Nobilis Facilities and the physicians.
Overall revenue depends on procedure volume, case mix and payment rates of the respective payers.
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The following table sets out the net patient service revenues, the number of procedures performed and the net patient service revenue per procedure at each of the Nobilis Facilities for six months ended June 30, 2015 and 2014:
Net Patient Service Revenue | Net Patient Service Revenue | |||||||||||||||||
($)(in thousands) | Number of Cases (1) | ($) per Case (2) | ||||||||||||||||
Nobilis | 2015 | 2014 | 2015 | 2014 | 2015 | 2014 | ||||||||||||
Facility | ||||||||||||||||||
NHSC-H | $ | 10,477 | $ | 8,040 | 1,007 | 491 | $ | 10,405 | 16,375 | |||||||||
KIRBY | 6,009 | 5,020 | 1,930 | 1,769 | 3,113 | 2,838 | ||||||||||||
MSID | 16,891 | 13,839 | 1,633 | 870 | 10,343 | 15,906 | ||||||||||||
NHSC-S | 8,151 | 31 | 549 | 15 | 14,847 | - | ||||||||||||
FNH | 30,573 | - | 1,121 | - | 27,273 | - | ||||||||||||
FNSC | 2,717 | - | 888 | - | 3,060 | - | ||||||||||||
VMC-H | 2,379 | - | 380 | - | 6,261 | - | ||||||||||||
Total | 77,197 | 26,930 | 7,508 | 3,145 | 10,282 | 8,563 | ||||||||||||
Year over Year Growth | 187% | 139% | 20% |
Notes | |
(1) |
This table refers to all cases performed, regardless of their contribution to net patient service revenue. |
(2) |
Calculated by dividing net patient service revenues by the number of cases. |
The Nobilis Facilities focus on a limited number of high-volume, non-emergency procedures, most of which are billed on an out of network basis. Billing on an out of network basis means that we bill to entities not participating in the health insurance companies' ("Third Party Payors") provider networks, which negotiate discounted fees with providers and facilities in return for access to the patient populations covered by those Third Party Payors. The case mix at each Nobilis Facility is a function of the clinical specialties of the physicians on the medical staff and the equipment and infrastructure at each facility. The Nobilis Facilities intend to continue to refine their case mix as opportunities arise. The following table sets forth the combined number of cases and procedures by medical specialty performed for three months ended June 30, 2015 and 2014:
MEDICAL SERVICES SEGMENT
CASE AND PROCEDURE MIX
OF THE NOBILIS FACILITIES
FOR THE THREE MONTHS ENDED JUNE 30, 2015
AND 2014
2015 | 2015 % | 2015 | 2015 % | 2014 | 2014 % | 2014 | 2014 % | |||||||||||||||||
Specialty | Cases | Cases | Procedures | Procedures | Cases | Cases | Procedures | Procedures | ||||||||||||||||
Pain Management | 1,237 | 27.8% | 4,368 | 37.9% | 779 | 47.3% | 3,046 | 53.5% | ||||||||||||||||
Musculoskeletal Interventions | 175 | 3.9% | 537 | 4.7% | - | 0.0% | - | 0.0% | ||||||||||||||||
Interventional Headache Procedure | 38 | 0.9% | 135 | 1.2% | - | 0.0% | - | 0.0% | ||||||||||||||||
Orthopedics | 275 | 6.2% | 626 | 5.4% | 215 | 13.1% | 697 | 12.2% | ||||||||||||||||
Spine | 300 | 6.8% | 456 | 4.0% | 10 | 0.6% | 28 | 0.7% | ||||||||||||||||
Podiatry | 145 | 3.3% | 453 | 3.9% | 77 | 4.7% | 474 | 8.3% | ||||||||||||||||
Gastro-intestinal | 95 | 2.1% | 186 | 1.6% | 20 | 1.2% | 27 | 0.5% | ||||||||||||||||
General Surgery | 181 | 4.1% | 403 | 3.5% | 62 | 3.8% | 144 | 2.5% | ||||||||||||||||
Plastic & Reconstructive | 421 | 9.5% | 961 | 8.3% | - | 0.0% | - | 0.0% | ||||||||||||||||
Bariatrics | 1,006 | 22.6% | 2,439 | 21.2% | 353 | 21.4% | 816 | 14.3% | ||||||||||||||||
Gynecology | 241 | 5.4% | 258 | 2.2% | 1 | 0.1% | 1 | 0.0% | ||||||||||||||||
Urology | 6 | 0.2% | 6 | 0.2% | - | 0.0% | - | 0.0% | ||||||||||||||||
Ear, Nose, Throat (E.N.T.) | 157 | 3.5% | 518 | 4.5% | 129 | 7.8% | 457 | 8.0% | ||||||||||||||||
Neuromonitoring | 165 | 3.7% | 165 | 1.4% | - | 0.0% | - | 0.0% | ||||||||||||||||
TOTAL | 4,442 | 100.0% | 11,511 | 100.0% | 1,646 | 100.0% | 5,690 | 100.0% |
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The following table for the Marketing Segment only includes cases generated through our marketing activities that are performed at the non-Nobilis Facilities during the reporting period after the acquisition of Athas.
MARKETING SEGMENT
CASE AND PROCEDURE MIX OF THE
NOBILIS FACILITIES
FOR THE THREE MONTHS ENDED JUNE 30, 2015 AND 2014
2015 | 2015 % | 2015 | 2015 % | 2014 | 2014 % | 2014 | 2014 % | |||||||||||||||||
Specialty | Cases | Cases | Procedures | Procedures | Cases | Cases | Procedures | Procedures | ||||||||||||||||
Pain Management Musculoskeletal | 150 | 44.4% | 150 | 44.4% | - | 0.0% | - | 0.0% | ||||||||||||||||
Interventions Interventional Headache | 104 | 30.8% | 104 | 30.8% | - | 0.0% | - | 0.0% | ||||||||||||||||
Procedure | 84 | 24.8% | 84 | 24.9% | - | 0.0% | - | 0.0% | ||||||||||||||||
TOTAL | 338 | 100.0% | 338 | 100.0% | - | 0.0% | - | 0.0% |
CONSOLIDATED SEGMENTS
CASE AND PROCEDURE MIX OF
THE NOBILIS FACILITIES
FOR THE THREE MONTHS ENDED JUNE 30, 2015 AND
2014
2015 | 2015 % | 2015 | 2015 % | 2014 % | 2014 | 2014 % | ||||||||||||||||||
Specialty | Cases | Cases | Procedures | Procedures | 2014 Cases | Cases | Procedures | Procedures | ||||||||||||||||
Pain Management | 1,387 | 29.0% | 4,518 | 38.1% | 779 | 47.3% | 3,046 | 53.5% | ||||||||||||||||
Musculoskeletal | 279 | 5.8% | 641 | 5.4% | - | 0.0% | - | 0.0% | ||||||||||||||||
Interventions | ||||||||||||||||||||||||
Interventional Headache Procedure | 122 | 2.6% | 219 | 1.8% | - | 0.0% | - | 0.0% | ||||||||||||||||
Orthopedics | 275 | 5.8% | 626 | 5.3% | 215 | 13.1% | 697 | 12.2% | ||||||||||||||||
Spine | 300 | 6.3% | 456 | 3.8% | 10 | 0.6% | 28 | 0.7% | ||||||||||||||||
Podiatry | 145 | 3.0% | 453 | 3.8% | 77 | 4.7% | 474 | 8.3% | ||||||||||||||||
Gastro-intestinal | 95 | 2.0% | 186 | 1.6% | 20 | 1.2% | 27 | 0.5% | ||||||||||||||||
General Surgery | 181 | 3.8% | 403 | 3.4% | 62 | 3.8% | 144 | 2.5% | ||||||||||||||||
Plastic & Reconstructive | 421 | 8.8% | 961 | 8.1% | - | 0.0% | - | 0.0% | ||||||||||||||||
Bariatrics | 1,006 | 21.0% | 2,439 | 20.6% | 353 | 21.4% | 816 | 14.3% | ||||||||||||||||
Gynecology | 241 | 5.0% | 258 | 2.2% | 1 | 0.1% | 1 | 0.0% | ||||||||||||||||
Urology | 6 | 0.1% | 6 | 0.1% | - | 0.0% | - | 0.0% | ||||||||||||||||
Ear, Nose, Throat (E.N.T.) | 157 | 3.3% | 518 | 4.4% | 129 | 7.8% | 457 | 8.0% | ||||||||||||||||
Neuromonitoring | 165 | 3.5% | 165 | 1.4% | - | 0.0% | - | 0.0% | ||||||||||||||||
TOTAL | 4,780 | 100.0% | 11,849 | 100.0% | 1,646 | 100.0% | 5,690 | 100.0% |
Note:
A procedure is defined as the actual surgery or surgeries that are performed on the date of service for each patient (case). Each case typically includes numerous procedures. In Managements Discussion and Analysis of Financial Condition and Results of Operations in the 2014 Annual Report, we provided the number of unique procedures per case as the total number of procedures during the period (i.e. a patient may have had three different procedures performed, however, one of the three procedures might have been performed numerous times during the case). In this Quarterly Report, we calculated the total number of procedures performed on a case, regardless of the fact that the same procedure may have been performed numerous times. These tables refer to all cases and procedures performed, regardless of their contribution to net patient service revenue.
Our total cases performed for the three months ended June 30, 2015, were 4,780, representing a total increase of 3,134 cases, or 190.4%, from the 1,646 cases in the same period in 2014. Cases at our existing facilities, or same center facilities, were 2,804, representing 1,158 of the total increase. The consolidated marketing programs are attributable to 833 of the increase, with 338 cases reported under the Marketing segment, and the remaining under the Medical Services segment. Cases generated by new facilities during the reporting period are attributable to 1,638 of the increase. Case volume primarily increased under the specialties of pain management, musculoskeletal interventions, spine and bariatric surgeries.
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Our procedure volume for the three months ended June 30, 2015, increased by 108.2% to 11,849 from 5,690 during the prior corresponding period. Since case reimbursement is based on case type, an increase or decrease in the number of procedures per case has no effect on our reimbursement and net patient service revenue per case.
We receive payments for surgical procedures and related services from private health insurance plans, workers compensation, directly from patients and from government payer plans. A substantial portion of net patient service revenues generated by the Nobilis Facilities is based on payments received from private (non-government) insurance plans. We receive a relatively small amount of revenue from Medicare or Medicaid procedures. We also receive a relatively small portion of revenue directly from uninsured patients, who pay out of pocket for the services they receive. Insured patients are responsible for services not covered by their health insurance plans, and for deductibles, co-payments and co-insurance obligations under their plans. The amount of these deductibles, co-payments and coinsurance obligations has increased in recent years but does not represent a material component of the revenue generated by the Nobilis Facilities. The surgical center fees of the Nobilis Facilities are generated by our physician limited partners and the other physicians who use the Nobilis Facilities to provide services. The surgical center fees are billed and collected directly by the Nobilis Facilities.
Patient and net professional fees and contracted marketing revenues are reported as the estimated net realizable amounts from patients, third-party Payors, and others for services rendered. Revenue is recognized upon the performance of the patient service. The amounts that we actually collect from third-party Payors, including private insurers, may vary even for identical procedures performed. An additional factor in the determination of net patient service revenue is our payer mix, as between private health insurance plans, workers compensation, directly from patients and from government payer plans. We review and evaluate historical collections and payment data, payer mix and current economic conditions on a periodic basis and adjust the estimated collections as a percentage of gross billings, which we use to determine net patient service revenue, as required based on final settlements and collections.
The following tables set out the payor mix at our Medical Segment, our Marketing Segment and on a consolidated basis for the three months ended June 30, 2015 and 2014. This information is not intended to provide a comprehensive comparison of financial results, as reimbursement by insurance carrier varies based on deductibles, plan coverage and cases performed.
MEDICAL SERVICES SEGMENT
PATIENT AND NET
PROFESSIONAL FEE REVENUE BY PAYORS OF THE NOBILIS FACILITIES
FOR THE
THREE MONTHS ENDED JUNE30, 2015 AND 2014
2015 Patient and Net | 2014 Patient and Net | |||
Payors | Professional Fee Revenue | Professional Fee Revenue | ||
by Payor Mix | by Payor Mix | |||
Private insurance and other private pay | 95.0% | 97.3% | ||
Workers compensation | 4.6% | 1.7% | ||
Medicare | 0.4% | 1.0% | ||
Total | 100.0% | 100.0% |
MARKETING & FACTORING SEGMENT
PATIENT AND NET
PROFESSIONAL FEE REVENUE BY PAYORS OF THE NOBILIS FACILITIES
FOR THE
THREE MONTHS ENDED JUNE30, 2015 AND 2014
2015 Patient and Net | 2014 Patient and Net | |||
Payors | Professional Fee Revenue | Professional Fee Revenue | ||
by Payor Mix | by Payor Mix | |||
Private insurance and other private pay | 100.0% | 0.0% | ||
Workers compensation | 0.0% | 0.0% | ||
Medicare | 0.0% | 0.0% | ||
Total | 100.0% | 0.0% |
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CONSOLIDATED SEGMENTS
PATIENT AND NET
PROFESSIONAL FEE REVENUE BY PAYORS OF THE NOBILIS FACILITIES
FOR THE
THREE MONTHS ENDED JUNE 30, 2015 AND 2014
2015 Patient and Net | 2014 Patient and Net | |||
Payors | Professional Fee Revenue | Professional Fee Revenue | ||
by Payor Mix | by Payor Mix | |||
Private insurance and other private pay | 95.5% | 97.3% | ||
Workers compensation | 4.1% | 1.7% | ||
Medicare | 0.4% | 1.0% | ||
Total | 100.0% | 100.0% |
RESULTS OF OPERATIONS AS A PERCENTAGE OF PATIENT AND NET
PROFESSIONAL FEES
FOR THE THREE MONTHS ENDED JUNE 30, 2015 AND 2014
Three months ended June 30, | ||||||
2015 | 2014 | |||||
Revenues: | 100% | 100% | ||||
Cost of revenues | 1.9% | 0.0% | ||||
Gross Profit | 98.1% | 100% | ||||
Operating expenses: | ||||||
Salaries and benefits | 18.5% | 13.3% | ||||
Drugs and supplies | 16.2% | 15.9% | ||||
General and administrative | 42.2% | 39.7% | ||||
Amortization | 2.0% | 2.0% | ||||
Total operating expenses | 78.9% | 70.9% | ||||
Corporate costs: | ||||||
Salaries and benefits | 2.0% | 3.1% | ||||
General and administrative | 13.4% | 4.5% | ||||
Legal expenses | 1.5% | 2.3% | ||||
Amortization | 0.1% | 0.2% | ||||
Total corporate costs | 17.0% | 10.1% | ||||
Income from operations | 2.2% | 19.0% | ||||
Other expense (income): | ||||||
Interest expense | 0.6% | 0.4% | ||||
Change in fair value of warrant and stock option liabilities | -3.4% | -2.5% | ||||
Other expense (income), net | -2.6% | -0.6% | ||||
Total other expense (income) | -5.4% | -2.7% | ||||
Net income before income taxes and noncontrolling interests | 7.6% | 21.7% | ||||
Income tax | 0.9% | 1.0% | ||||
Net income | 6.7% | 20.7% | ||||
Net income attributable to noncontrolling interests | 7.7% | 16.6% | ||||
Net income attributable to Nobilis Health Corp. | -1.0% | 4.1% |
Consolidated Revenues
Our total revenues for the three months ended June 30, 2015, totaled $48.9 million, an increase of $33.8 million or 223.8%, compared to $15.1 million from the prior corresponding period. The Marketing segment accounted for $5.0 million of the increase. The Medical Services segment increased by $28.8 million, or 190.7%, compared to $15.1 million from the prior corresponding period. Same center facilities growth represented $6.5 million of the three month period increase, while the remaining $22.3 million increase is attributable to newly acquired facilities.
Operating Salaries
Operating salaries and benefits for the three months ended June 30, 2015, totaled $9.0 million, an increase of $7.0 million, or 350.0%, from $2.0 million the prior corresponding period. The Marketing segment accounted for $2.2 million of the increase while the Medical Services segment increased by $4.8 million, or 240.0% . Staffing costs at newly acquired facilities accounted for $4.1 million of the Medical Services segments increase. The remaining $0.7 million increase is attributable to additional staffing at same center facilities driven by increased case volumes. Operating salaries and benefits as a percent of revenues were 18.5% compared to 13.3% in the prior corresponding period. The increase was a result of the higher staffing needs at newly acquired hospitals.
Medical supplies
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Drugs and medical supplies expense for the three months ended June 30, 2015, totaled $7.9 million, an increase of $5.5 million or 229.2% from the prior corresponding period. Medical supplies costs at newly acquired facilities accounted for $4.6 million of the increase with the remaining $0.9 million attributable to same center growth. Drugs and medical supplies as a percent of revenues increased to 16.2% from 15.9% from the prior corresponding period due to lower operating margins at a newly acquired hospital.
Operating General and Administrative
Our operating general and administrative expense for three months ended June 30, 2015, totaled $20.6 million, an increase of $14.6 million, or 243.3%, from the prior corresponding period. The Marketing Segment contributed to $1.3 million of the increase. The remaining $13.3 million increase is due to an increase in marketing expenses, physician contracting, general infrastructure development, such as rent, telecommunication, travel, and consulting, and an increase in operations associated with the newly acquired medical services facilities. Newly acquired facilities contributed to $2.9 million of the increase. Marketing expenses allocated to the Medical Services segment increased by $5.3 million to $6.1 million for the three months ended June 30, 2015, from $0.8 million for the corresponding period in 2014. The increase in marketing expenses is related to our strategic growth initiatives of growing our bariatric, spine, podiatry and gynecological brands. For the development of the marketing programs, the Company enters into independent contractor agreements with physicians to provide services to the Company including administrative, management and marketing services. This expense increased by $0.9 million to $1.7 million for the three months ended June 30, 2015 from $0.8 million for the corresponding period in 2014. Expenses related to general infrastructure development increased by $1.1 million to $1.7 million in 2015 from $0.6 million in 2014.
In addition, operating general and administrative expenses contained revenue cycle management expenses. From time to time, we transfer to third parties certain of our accounts receivable payments on a non-recourse basis in return for advancement on payment to achieve a faster cash collection. The advancement payment varies by specialty and on average represents between 20% and 50% of the amounts transferred. We do not have any other relationship with third parties of this nature other than the vendor relationship described herein. For three months ended June 30, 2015 and 2014 we received advancement payments of $0.5 million and $0.1 million, respectively. During the same period, we transferred $2.1 million and $2.2 million, respectively, of receivables, net of advancement payment, representing a decrease in revenue cycle management expenses of $0.1 million.
Depreciation
Depreciation for the three months ended June 30, 2015, totaled $1.0 million, an increase of $0.7 million or 233.3% from the prior corresponding period. This increase is primarily due to an increase in property and equipment from newly acquired facilities.
Corporate General and Administrative
In total, corporate costs for the three months ended June 30, 2015, totaled $8.3 million, representing an increase of $6.8 million or 443.3% from the prior corresponding period. The increase was primarily attributable to additional corporate staff and legal expenses related to mergers and acquisitions, and non-cash compensation. Corporate salaries and benefits increased by $0.5 million to $1.0 million for the three months ended June 30, 2015 from $0.5 million for the corresponding period in 2014. Legal expenses increased by $0.4 million to $0.7 million for the three months ended June 30, 2015 from $0.3 million for the corresponding period in 2014. Non-cash compensation increased by $6.6 million to $6.7 million for the three months ended June 30, 2015 from $0.1 million for the corresponding period in 2014. The increase in non-cash compensation is attributable to an accelerated vesting of senior executive share-based compensation related to a change of positions. We present corporate costs as a separate section from the operating expenses of the revenue generating facilities to illustrate our operational efficiency.
Net income attributable to non-controlling interests are based on ownership percentages in the Nobilis Facilities that are owned by third parties.
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Six months ended June 30, 2015
The Nobilis Facilities focus on a limited number of high-volume, non-emergency procedures, most of which are billed on an out of network basis. The case mix at each Nobilis Facility is a function of the clinical specialties of the physicians on the medical staff and the equipment and infrastructure at each facility. The Nobilis Facilities intend to continue to refine their case mix as opportunities arise. The following table sets forth the combined number of cases and procedures by medical specialty performed for six months ended June 30, 2015 and 2014:
MEDICAL SERVICES SEGMENT
CASE AND PROCEDURE MIX
OF THE NOBILIS FACILITIES
FOR THE SIX MONTHS ENDED JUNE 30, 2015 AND
2014
2015 | 2015 % | 2015 | 2015 % | 2014 | 2014 % | 2014 | 2014 % | |||||||||||||||||
Specialty | Cases | Cases | Procedures | Procedures | Cases | Cases | Procedures | Procedures | ||||||||||||||||
Pain Management | 2,286 | 29.8% | 8,083 | 39.7% | 1,400 | 44.5% | 5,610 | 54.4% | ||||||||||||||||
Musculoskeletal Interventions | 358 | 4.7% | 1,224 | 6.0% | - | 0.0% | - | 0.0% | ||||||||||||||||
Interventional Headache Procedure | 58 | 0.8% | 155 | 0.8% | - | 0.0% | - | 0.0% | ||||||||||||||||
Orthopedics | 646 | 8.4% | 1,299 | 6.4% | 377 | 12.0% | 1,119 | 10.8% | ||||||||||||||||
Spine | 322 | 4.2% | 591 | 2.9% | 17 | 0.5% | 50 | 0.5% | ||||||||||||||||
Podiatry | 244 | 3.2% | 863 | 4.2% | 152 | 4.8% | 828 | 8.0% | ||||||||||||||||
Gastro-intestinal | 182 | 2.4% | 341 | 1.7% | 38 | 1.2% | 50 | 0.5% | ||||||||||||||||
General Surgery | 315 | 4.1% | 682 | 3.4% | 164 | 5.2% | 338 | 3.3% | ||||||||||||||||
Plastic & Reconstructive | 785 | 10.2% | 1,893 | 9.3% | - | 0.0% | - | 0.0% | ||||||||||||||||
Bariatrics | 1,676 | 21.8% | 3,750 | 18.4% | 707 | 22.5% | 1,384 | 13.4% | ||||||||||||||||
Gynecology | 340 | 4.4% | 375 | 1.9% | 27 | 0.9% | 36 | 0.3% | ||||||||||||||||
Urology | 7 | 0.0% | 7 | 0.0% | - | 0.0% | - | 0.0% | ||||||||||||||||
Ear, Nose, Throat (E.N.T.) | 289 | 3.8% | 919 | 4.5% | 263 | 8.4% | 905 | 8.8% | ||||||||||||||||
Neuromonitoring | 165 | 2.2% | 165 | 0.8% | - | 0.0% | - | 0.0% | ||||||||||||||||
TOTAL | 7,673 | 100.0% | 20,347 | 100.0% | 3,145 | 100.0% | 10,320 | 100.0% |
The following table for the Marketing Segment only includes cases generated through our marketing activities that performed at the non-Nobilis Facilities during the reporting period after the acquisition of Athas.
MARKETING SEGMENT
CASE AND PROCEDURE MIX OF THE
NOBILIS FACILITIES
FOR THE SIX MONTHS ENDED JUNE 30, 2015 AND 2014
2015 | 2015 % | 2015 | 2015 % | 2014 | 2014 % | 2014 | 2014 % | |||||||||||||||||
Specialty | Cases | Cases | Procedures | Procedures | Cases | Cases | Procedures | Procedures | ||||||||||||||||
Pain Management | 278 | 44.6% | 278 | 44.6% | - | 0.0% | - | 0.0% | ||||||||||||||||
Musculoskeletal Interventions | 228 | 36.6% | 228 | 36.6% | - | 0.0% | - | 0.0% | ||||||||||||||||
Interventional Headache Procedure | 117 | 18.8% | 117 | 18.8% | - | 0.0% | - | 0.0% | ||||||||||||||||
TOTAL | 623 | 100.0% | 623 | 100.0% | - | 0.0% | - | 0.0% |
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CONSOLIDATED SEGMENTS
CASE AND PROCEDURE MIX OF
THE NOBILIS FACILITIES
FOR THE SIX MONTHS ENDED JUNE 30, 2015 AND
2014
2015% | 2015 | 2015 % | 2014 % | 2014 | 2014 % | |||||||||||||||||||
Specialty | 2015 Cases | Cases | Procedures | Procedures | 2014 Cases | Cases | Procedures | Procedures | ||||||||||||||||
Pain Management | 2,564 | 30.9% | 8,361 | 39.9% | 1,400 | 44.5% | 5,610 | 54.4% | ||||||||||||||||
Musculoskeletal Interventions | 586 | 7.1% | 1,452 | 6.9% | - | 0.0% | - | 0.0% | ||||||||||||||||
Interventional Headache Procedure | 175 | 2.1% | 272 | 1.3% | - | 0.0% | - | 0.0% | ||||||||||||||||
Orthopedics | 646 | 7.8% | 1,299 | 6.2% | 377 | 12.0% | 1,119 | 10.8% | ||||||||||||||||
Spine | 322 | 3.9% | 591 | 2.8% | 17 | 0.5% | 50 | 0.5% | ||||||||||||||||
Podiatry | 244 | 2.9% | 863 | 4.1% | 152 | 4.8% | 828 | 8.0% | ||||||||||||||||
Gastro-intestinal | 182 | 2.2% | 341 | 1.6% | 38 | 1.2% | 50 | 0.5% | ||||||||||||||||
General Surgery | 315 | 3.8% | 682 | 3.3% | 164 | 5.2% | 338 | 3.3% | ||||||||||||||||
Plastic & Reconstructive | 785 | 9.5% | 1,893 | 9.0% | - | 0.0% | - | 0.0% | ||||||||||||||||
Bariatrics | 1,676 | 20.2% | 3,750 | 17.9% | 707 | 22.5% | 1,384 | 13.4% | ||||||||||||||||
Gynecology | 340 | 4.1% | 375 | 1.8% | 27 | 0.9% | 36 | 0.3% | ||||||||||||||||
Urology | 7 | 0.0% | 7 | 0.0% | - | 0.0% | - | 0.0% | ||||||||||||||||
Ear, Nose, Throat (E.N.T.) | 289 | 3.5% | 919 | 4.4% | 263 | 8.4% | 905 | 8.8% | ||||||||||||||||
Neuromonitoring | 165 | 2.0% | 165 | 0.8% | - | 0.0% | - | 0.0% | ||||||||||||||||
TOTAL | 8,296 | 100.0% | 20,970 | 100.0% | 3,145 | 100.0% | 10,320 | 100.0% |
Note:
A procedure is defined as the actual surgery or surgeries that are performed on the date of service for each patient (case). Each case typically includes numerous procedures. In Managements Discussion and Analysis of Financial Condition and Results of Operations in the 2014 Annual Report, we provided the number of unique procedures per case as the total number of procedures during the period (i.e. a patient may have had three different procedures performed, however, one of the three procedures might have been performed numerous times during the case). In this Quarterly Report, we calculated the total number of procedures performed on a case, regardless of the fact that the same procedure may have been performed numerous times. These tables refer to all cases and procedures performed, regardless of their contribution to net patient service revenue.
Our total cases performed for the six months ended June 30, 2015, were 8,296, representing a total increase of 5,151 cases, or 163.8%, from the 3,145 cases in the same period in 2014. Cases at same center facilities were 5,119, representing 1,984 of the total increase. The consolidated marketing programs are attributable to 1,541 of the increase, with 623 cases reported under the Marketing segment, and the remaining under the Medical Services segment. Cases generated by new facilities during the reporting period are attributable to 2,544 of the increase. Case volume primarily increased under the specialties of pain management, musculoskeletal interventions, spine and bariatric surgeries.
Our procedure volume for the six months ended June 30, 2015, increased by 103.2% to 20,970 from 10,320 during the prior corresponding period. Since case reimbursement is based on case type, an increase or decrease in the number of procedures per case has no effect on our reimbursement and net patient service revenue per case.
We receive payments for surgical procedures and related services from private health insurance plans, workers compensation, directly from patients and from government payer plans. A substantial portion of net patient service revenues generated by the Nobilis Facilities is based on payments received from private (non-government) insurance plans. We receive a relatively small amount of revenue from Medicare or Medicaid procedures. We also receive a relatively small portion of revenue directly from uninsured patients, who pay out of pocket for the services they receive. Insured patients are responsible for services not covered by their health insurance plans, and for deductibles, co-payments and co-insurance obligations under their plans. The amount of these deductibles, co-payments and coinsurance obligations has increased in recent years but does not represent a material component of the revenue generated by the Nobilis Facilities. The surgical center fees of the Nobilis Facilities are generated by our physician limited partners and the other physicians who use the Nobilis Facilities to provide services. The surgical center fees are billed and collected directly by the Nobilis Facilities.
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Patient and net professional fees and contracted marketing revenues are reported as the estimated net realizable amounts from patients, third-party payors, and others for services rendered. Revenue is recognized upon the performance of the patient service. The amounts that we actually collect from third-party payors, including private insurers, may vary even for identical procedures performed. An additional factor in the determination of net patient service revenue is our payer mix, as between private health insurance plans, workers compensation, directly from patients and from government payer plans. We review and evaluate historical collections and payment data, payer mix and current economic conditions on a periodic basis and adjust the estimated collections as a percentage of gross billings, which we use to determine net patient service revenue, as required based on final settlements and collections.
The following tables set out the payer mix at our Medical Segment, our Marketing Segment and on a consolidated basis for the six months ended June 30, 2015 and 2014. This information is not intended to provide a comprehensive comparison of financial results, as reimbursement by insurance carrier varies based on deductibles, plan coverage and cases performed.
MEDICAL SERVICES SEGMENT
PATIENT AND NET
PROFESSIONAL FEE REVENUE BY PAYORS OF THE NOBILIS FACILITIES
FOR THE
SIX MONTHS ENDED JUNE 30, 2015 AND 2014
2015 Patient and Net | 2014 Patient and Net | |||
Payors | Professional Fee Revenue | Professional Fee Revenue | ||
by Payor Mix | by Payor Mix | |||
Private insurance and | ||||
other private pay | 95.0% | 96.9% | ||
Workers compensation | 4.5% | 2.2% | ||
Medicare | 0.5% | 0.9% | ||
Total | 100.0% | 100.0% |
MARKETING & FACTORING SEGMENT
PATIENT AND NET
PROFESSIONAL FEE REVENUE BY PAYORS OF THE NOBILIS FACILITIES
FOR THE
SIX MONTHS ENDED JUNE 30, 2015 AND 2014
2015 Patient and Net | 2014 Patient and Net | |||
Payors | Professional Fee Revenue | Professional Fee Revenue | ||
by Payor Mix | by Payor Mix | |||
Private insurance and other private pay | 100.0% | 0.0% | ||
Workers compensation | 0.0% | 0.0% | ||
Medicare | 0.0% | 0.0% | ||
Total | 100.0% | 0.0% |
CONSOLIDATED SEGMENTS
PATIENT AND NET
PROFESSIONAL FEE REVENUE BY PAYORS OF THE NOBILIS FACILITIES
FOR THE
SIX MONTHS ENDED JUNE 30, 2015 AND 2014
2015 Patient and Net | 2014 Patient and Net | |||
Payors | Professional Fee Revenue | Professional Fee Revenue | ||
by Payor Mix | by Payor Mix | |||
Private insurance and other private pay | 95.3% | 96.4% | ||
Workers compensation | 4.2% | 2.6% | ||
Medicare | 0.5% | 1.0% | ||
Total | 100.0% | 100.0% |
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RESULTS OF OPERATIONS AS A PERCENTAGE OF PATIENT AND NET
PROFESSIONAL FEES
FOR THE SIX MONTHS ENDED JUNE 30, 2015 AND 2014
Six months ended June 30, | ||||||
2015 | 2014 | |||||
Revenues: | 100% | 100% | ||||
Cost of revenues | 1.1% | 0.0% | ||||
Gross Profit | 98.9% | 100% | ||||
Operating expenses: | ||||||
Salaries and benefits | 19.2% | 14.4% | ||||
Drugs and supplies | 14.9% | 14.6% | ||||
General and administrative | 39.0% | 43.7% | ||||
Amortization | 1.8% | 2.2% | ||||
Total operating expenses | 74.9% | 74.9% | ||||
Corporate costs: | ||||||
Salaries and benefits | 2.3% | 3.8% | ||||
General and administrative | 14.4% | 4.5% | ||||
Legal expenses | 1.4% | 2.3% | ||||
Amortization | 0.1% | 0.2% | ||||
Total corporate costs | 18.2% | 10.8% | ||||
Income from operations | 5.8% | 14.3% | ||||
Other expense (income): | ||||||
Interest expense | 0.9% | 0.4% | ||||
Change in fair value of warrant and stock option liabilities | 2.0% | -2.7% | ||||
Other expense (income), net | -1.6% | -0.2% | ||||
Total other expense (income) | 1.3% | -2.5% | ||||
Net income before income taxes and noncontrolling interests | 4.5% | 16.8% | ||||
Income tax | 0.7% | 0.9% | ||||
Net income | 3.8% | 15.9% | ||||
Net income attributable to noncontrolling interests | 9.5% | 14.2% | ||||
Net income attributable to Nobilis Health Corp. | -5.7% | 1.7% |
Consolidated Revenues
Our total revenues for the six months ended June 30, 2015, totaled $86.7 million, an increase of $59.5 million or 218.8%, compared to $27.2 million from the prior corresponding period. The Marketing segment accounted for $8.5 million of the increase, while the Medical Services segment increased by $51.0 million, or 187.5%, compared to $27.2 million from the prior corresponding period. Same center facilities growth represented $11.3 million of the six month period increase, while the remaining $39.0 million is attributable to newly acquired facilities.
Operating Salaries
Operating salaries and benefits for the six months ended June 30, 2015, totaled $16.7 million, an increase of $12.8 million or 328.2%, from $3.9 million the prior corresponding period. The Marketing segment accounted for $4.4 million of the increase while the Medical Services segment increased by $8.4 million, or 215.4% . Staffing costs at newly acquired facilities accounted for $7.6 million of the Medical Services segments increase. The remaining $0.8 million increase is attributable to additional staffing at same center facilities driven by increased case volumes. Operating salaries and benefits as a percent of revenues were 19.2% compared to 14.4% in the prior corresponding period. The increase was a result of the higher staffing needs at newly acquired hospitals.
Medical supplies
Drugs and medical supplies expense for the six months ended June 30, 2015, totaled $12.9 million, an increase of $8.9 million or 222.5% from the prior corresponding period. Medical supplies costs at newly acquired facilities accounted for $7.3 million of the increase with the remaining $1.6 million attributable to same center growth. Drugs and medical supplies as a percent of revenues increased to 14.9% from 14.6% from the prior corresponding period due to lower operating margins at a newly acquired hospital.
Operating General and Administrative
Our operating general and administrative expense for six months ended June 30, 2015, totaled $33.8 million, an increase of $21.9 million, or 184.0%, from the prior corresponding period. The Marketing Segment contributed to $1.7 million of the increase. The remainder of the $20.2 million increase is due to an increase in marketing expenses, physician contracting, general infrastructure development, such as rent telecommunication, travel, and consulting, and an increase in operations associated with the newly acquired medical services facilities. Newly acquired facilities contributed to $7.1 million of the increase. Marketing expenses allocated to the Medical Services segment increased by $9.8 million to $11.7 million for the six months ended June 30, 2015, from $1.9 million for the corresponding period in 2014. The increase in marketing expenses is related to our purchase of Athas in December 2014, and the associate creation of our Marketing business segment, and strategic growth initiatives of growing our bariatric, spine, podiatry and gynecological brands. For the development of the marketing programs, the Company enters into independent contractor agreements with physicians to provide services to the Company including administrative, management and marketing services. This expense increased by $1.4 million to $3.1 million for the six months ended June 30, 2015 from $1.7 million for the corresponding period in 2014. Expenses related to general infrastructure development increased by $1.7 million to $3.1 million in 2015 from $1.3 million in 2014.
39
In addition, our operating general and administrative expenses contained revenue cycle management expenses. From time to time, we transfer to third parties certain of our accounts receivable payments on a non-recourse basis in return for advancement on payment to achieve a faster cash collection. The advancement payment varies by specialty and on average represents between 20% and 50% of the amounts transferred. We do not have any other relationship with third parties of this nature other than the vendor relationship described herein. For six months ended June 30, 2015 and 2014 we received advancement payments of $1.1 million and $0.3 million, respectively. During each respective periods, we transferred $3.8 million and $3.8 million, respectively, of receivables, net of advancement payment.
Depreciation
Depreciation for the six months ended June 30, 2015, totaled $1.6 million, an increase of $1.0 million or 166.7% from the prior corresponding period. This increase is primarily due to an increase in property and equipment from newly acquired facilities.
Corporate General and Administrative
In total, corporate costs for the six months ended June 30, 2015, totaled $15.8 million, representing an increase of $12.9 million or 444.8% from the prior corresponding period. The increase was primarily attributable to additional corporate staff and legal expenses related to mergers and acquisitions, and non-cash compensation. Corporate salaries and benefits increased by $1.0 million to $2.0 million for the six months ended June 30, 2015 from $1.0 million for the corresponding period in 2014. Legal expenses increased by $0.6 million to $1.2 million for the six months ended June 30, 2015 from $0.6 million for the corresponding period in 2014. Non-cash compensation increased by $10.0 million to $10.2 million for the six months ended June 30, 2015 from $0.2 million for the corresponding period in 2014. The increase in non-cash compensation is attributable to an accelerated vesting of senior executive share-based compensation related to a change of Company positions and additional stock based compensation granted to the companys Chief Executive Officer. We present corporate costs as a separate section from the operating expenses of the revenue generating facilities to illustrate our operational efficiency.
Net income attributable to non-controlling interests are based on ownership percentages in the Nobilis Facilities that are owned by third parties.
Liquidity, Capital Resources and Financial Condition
We are dependent upon cash generated from operating activities of the Nobilis Facilities, which are the major source of financing for our operations, growth initiatives, acquisitions and for meeting our contractual obligations. Our primary sources of liquidity are cash generated from operating activities of the Nobilis Facilities, available cash and cash equivalents, and available borrowings under our term loan with General Electric Capital Corporation (the Term Loan) described in Note 9 Lines of Credit. We expect to be able to fund our operating activities for the remainder of 2015 with cash flows generated from our operations, available cash and cash equivalents, financing activities and access to the Term Loan.
Cash and cash equivalents at June 30, 2015 and December 31, 2014 were $31.7 million and $7.6 million, respectively. For the six months ended June, 2015, we experienced operating cash flows of approximately $5.2 million, primarily attributable to increased case volumes.
As of June 30, 2015, the Company had consolidated net working capital of $56.0 million compared to $22.4 million as of December 31, 2014. The increase is primarily due to increased cash related to a private placement (as described below), and increased accounts receivables related to increased case volumes. Total accounts receivable were $49.9 million with accounts payables and accrued liabilities totaling $28.3 million.
We have a $25 million debt financing facility with GE Capital, Healthcare Financial Services (GE). Pursuant to the Credit Agreement and ancillary agreements (collectively, the Loan Agreement), the term loan bears interest at a rate of 4% plus LIBOR per annum and amortizes over 20 years with required quarterly payments of principal and interest until the loan matures in March 2020. The revolving loan also bears interest at a rate of 4% plus LIBOR per annum and amounts borrowed under the revolver may be repaid and re-borrowed periodically with a maturity of March 2020. The credit facility is collateralized by the accounts receivable and physical equipment of all 100% owned subsidiaries as well as the Companys ownership interest in all less-than-wholly owned subsidiaries.
In May 2015, the Company issued, through a private placement agreement, 7,847,668 Units, at a price of Cdn$9.00 per Unit. Each Unit is comprised of one treasury unit (a Treasury Unit) and one-half of one common share from Donald L. Kramer, Healthcare Ventures, Ltd (a company wholly owned by Dr. Kramer), Harry Fleming or from treasury. Each Treasury Unit is comprised of one-half of one common share of the Company and one-half of one common share purchase warrant exercisable for one additional share at a price of Cdn$11.50. Through the private placement, the Company raised proceeds of $28.4 million, net of offering costs and commissions of $1.9 million.
40
Critical Accounting Policies
A summary of significant accounting policies is included in our Form 10-K/A. Our critical accounting policies are further described under the caption Critical Accounting Policies in Managements Discussion and Analysis of Financial Condition and Results of Operations in our Form 10-K/A There have been no changes in the nature of our critical accounting policies or the application of those policies since December 31, 2014.
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. We do not, however, hold or issue financial instruments or derivatives for trading or speculative purposes. At June 30, 2015, the following components of our Loan Agreement bears interest at variable rates at specified margins above either the agent banks alternate base rate or the LIBOR rate: (i) a $20 million, 5-year term loan; and (ii) a $5 million, 5-year revolving credit facility.
Although changes in the alternate base rate or the LIBOR rate would affect the cost of funds borrowed in the future, we believe the effect, if any, of reasonably possible near-term changes in interest rates on our remaining variable rate debt or our consolidated financial position, results of operations or cash flows would not be material. Holding other variables constant, including levels of indebtedness, a 0.125% increase in current interest rates would have no estimated impact on pre-tax earnings and cash flows for the next twelve month period given the 0.70215% LIBOR floor that exists in our Loan Agreement.
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 Loan Agreement is subject to, among other things, 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
Evaluation of Disclosure Controls and Procedures
We maintain disclosure controls and procedures, as defined in Rules 13a-15(e) and 15d-15(e) of the Securities Exchange Act of 1934, consisting of controls and other procedures designed to give reasonable assurance that information we are required to disclose in the reports we file or submit under the Securities Exchange Act of 1934 is recorded, processed, summarized and reported within the time periods specified in the Securities and Exchange Commissions rules and forms and that such information is accumulated and communicated to management, including our chief executive officer and our chief financial officer, to allow timely decisions regarding such required disclosure. At the time that the Original Filing was filed on May 14, 2015, our management, including our chief executive officer and chief financial officer, concluded that our internal control over financial reporting and disclosure controls and procedures were effective as of June 30, 2015.
Subsequent to that evaluation, our CEO and our CFO have concluded that our Companys disclosure controls and procedures were not effective as of as of June 30, 2015 as a result of identified material weaknesses in the Companys internal control discussed below.
The following control deficiencies that constituted material weaknesses in connection with the preparation of our financial statements as of June 30, 2015 were identified:
|
We did not maintain a sufficient complement of personnel with an appropriate level of accounting knowledge, experience, and training in the application of U.S. GAAP necessary to support our operations; and |
|
We did not apply the appropriate level of review and oversight to the accounting and disclosure for significant, infrequently occurring transactions such as for business combinations and private placements. |
Remediation Plan
In light of these material weaknesses, in preparing our financial statements as of and for the periods ended June 30, 2015 and 2014, we performed additional analyses and procedures to ensure that our consolidated financial statements included in this Form 10-Q/A have been prepared in accordance with U.S. GAAP.
Our management has been actively engaged in remediation efforts to address the material weaknesses, as well as other identified areas of risk. These remediation efforts, outlined below, are intended to address the identified material weaknesses and to enhance our overall control environment.
41
|
On July 9, 2015, we appointed Mr. Kenny Klein to serve as the Company's Chief Financial Officer. Our previous CFO, assumed other responsibilities with our accounting and finance organization. |
|
During the third quarter of 2015, the Company strengthened its accounting and financial reporting group with the addition of five new professionals with knowledge, experience, and training in the application of U.S. GAAP to our accounting and finance organization. This group is complemented by the engagement during the fourth quarter of 2015 of third-party accounting specialists who will assist us with significant, infrequently occurring transactions. |
|
We are currently reviewing and implementing remediation steps providing for more detailed supervisory review processes as part of our financial statement close process. |
Our executive management team, together with our Board of Directors, is committed to achieving and maintaining a strong control environment, high ethical standards, and financial reporting integrity.
Changes in Internal Control Over Financial Reporting
There was no change in our internal control over financial reporting during the three months ended June 30, 2015 that has materially affected, or is reasonably likely to materially affect, our internal control over financial reporting, except as noted above with respect to the identified material weaknesses regarding personnel and oversight of significant, infrequently occurring transactions.
Part II
Item 1. Legal Proceedings
There have been no material changes to the legal proceedings we previously described in our 2014 Annual Report during the three months ended June 30, 2015.
Item 1A. Risk Factors
There have been no material changes in our risk factors from those disclosed in our Form 10-K/A filed on January 12, 2016. .
Item 2. Unregistered Sales of Equity Securities and Use of Proceeds
On May 1, 2015, Bryan Hasse (the Seller) and Northstar Subco, LLC (the Purchaser), a wholly owned indirect subsidiary of the Company, entered into a Membership Interest Purchase Agreement, as amended on May 28, 2015, pursuant to which Purchaser purchased 100% of the units of Peak Surgeon Innovations, LLC and Seller received 89,749 shares of our common shares, valued at C$8.83 per share. In connection with this issuance to Seller, we relied on the exemption from registration under Section 4(a)(2) of the Securities Act based on our belief that the transaction did not involve any public offering.
The proceeds will be used for general working capital.
Item 3. Defaults Upon Senior Securities
None.
Item 4. Mine Safety Disclosures
Not applicable.
Item 5. Other Information
None.
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Item 6. Exhibits
Exhibit | Description |
10.1 |
Confidential Agreement effective as of June 30, 2015, by and among Nobilis Health Corp,, Northstar Healthcare Subco, LLC, and certain other parties (incorporated by reference to Exhibit 10.1 to Nobilis Health Corp.s Quarterly Report on Form 10- Q/A filed with the SEC on September 28, 2015). |
31.1* | |
31.2* | |
32.1* | |
32.2* |
*filed herewith
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Signature
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.
NOBILIS HEALTH CORP.
Date: January 12, 2016
By: | /s/ Kenneth Klein | |
Kenneth Klein | ||
Chief Financial Officer | ||
(Principal Financial and Duly Authorized | ||
Officer) |
44