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8-K - 8-K - AMSURG CORPamsg8k20160224.htm
 
Contact:
Claire M. Gulmi
 
 
Executive Vice President and
 
 
Chief Financial Officer
 
 
(615) 665-1283

AMSURG REPORTS 21% GROWTH IN FOURTH-QUARTER NET REVENUES,
39% GROWTH IN ADJUSTED DILUTED EPS OF $1.07 AND DILUTED EPS OF $1.26
———————————
PROVIDES 2016 FINANCIAL GUIDANCE

NASHVILLE, Tenn. ─ (February 24, 2016) ─ AmSurg Corp. (NASDAQ: AMSG) today announced financial results for the fourth quarter and year ended December 31, 2015. The Company’s results for the quarter included:

Growth of 21% in net revenues to $704.3 million from $581.8 million for the fourth quarter of 2014;
Net earnings from continuing operations attributable to AmSurg common shareholders of $64.3 million and adjusted net earnings of $56.7 million, up 43% compared with the fourth quarter of 2014;
Net earnings per diluted share from continuing operations attributable to AmSurg common shareholders of $1.26 and a 39% increase in adjusted net earnings per diluted share to $1.07; and
Adjusted EBITDA of $137.4 million, an increase of 24% compared with the fourth quarter of 2014.

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

For fiscal 2015, net revenues were $2.57 billion, a 58% increase from $1.62 billion for fiscal 2014. Net earnings from continuing operations attributable to AmSurg common shareholders were $154.9 million for 2015, and adjusted net earnings increased 68% to $191.3 million from $114.2 million for 2014. Net earnings per diluted share from continuing operations attributable to AmSurg common shareholders were $3.18 for 2015, and adjusted net earnings per diluted share increased 35% to $3.71. For 2015, weighted average diluted shares outstanding, if dilutive securities, options and non-vested shares were converted, increased 24% from 2014, primarily related to the equity issued to complete the acquisition of Sheridan Healthcare in July 2014. Adjusted EBITDA for 2015 was $492.3 million.

“AmSurg had an exceptional year for 2015, the first full year following our transformative acquisition of Sheridan Healthcare in July 2014,” said Christopher A. Holden, President and Chief Executive Officer of AmSurg. “We exceeded every element of our 2015 financial guidance that was provided in our 2014 fourth-quarter news release.

“Our strong organic growth was evident in the 6.0% same-center revenue growth of Ambulatory Services for 2015 and the 9.9% same contact growth of Physician Services. As expected, the combination of AmSurg and Sheridan has indeed proven catalytic to our acquisition growth strategy, as we deployed $963 million in capital for acquisitions during 2015, completed 16 transactions, expanded our platform into the large, attractive markets of Phoenix and Atlanta and created significant growth momentum for 2016. Our strong cash flow, combined with our December equity offering, enabled us to execute on this large acquisition pipeline, significantly reducing our leverage ratio to 4.1.


AMSG Reports Fourth-Quarter Results
 
 
Page 2
 
 
February 24, 2016
 
 



“Our outstanding financial and operating performance and strong profitable growth continued in the fourth quarter of 2015. We drove organic growth for the quarter through a 6.9% increase in same-center revenues for Ambulatory Services and an 8.3% increase in same contract revenue for Physician Services. This growth reflects increased volume and improved reimbursement for the quarter for both divisions.

“During the fourth quarter, Ambulatory Services purchased two ambulatory surgery centers (ASCs) and entered into three joint ventures with new health system partners. As a result of our joint venture activity, we contributed six of our existing centers and obtained an interest in two additional ASCs that were contributed by our new partners. As previously announced, Physician Services completed three acquisitions in the fourth quarter, including the acquisition of Valley Anesthesia in Phoenix, Arizona; Premier Emergency Medical Specialists, also in Phoenix; and Northside Anesthesiology Consultants in Atlanta, Georgia.”

Ambulatory Services

Net revenues for Ambulatory Services grew 10% to $326.2 million for the fourth quarter of 2015 from $295.7 million for the fourth quarter of 2014. Same-center revenue rose 6.9% for fourth quarter of 2015 compared with the fourth quarter of 2014, comprised of a 2.2% increase in procedures and a 4.7% increase in net revenue per procedure. Adjusted EBITDA was $63.3 million for the fourth quarter of 2015, a 22% increase from $51.9 million for the fourth quarter of 2014, and adjusted EBITDA margin increased 180 basis points to 19.4% from 17.6%.

At the end of the quarter, Ambulatory Services operated 257 ASCs and one surgical hospital. Ambulatory Services had five ASCs under letter of intent at the end of the fourth quarter and one center under development, which is expected to open in late 2016.

Physician Services

For the fourth quarter of 2015, net revenues for Physician Services increased 32% to $378.1 million from $286.1 million for the fourth quarter of 2014. Adjusted EBITDA increased 25% to $74.1 million for the quarter compared with $59.1 million for the fourth quarter of 2014, and adjusted EBITDA margin was 19.6% compared with 20.7%.

Comparable-quarter increase in Physician Services revenues was comprised of growth of 6.2% in same-contract revenues, 1.7% in net new contract revenues and 24.3% in acquisition revenues. Same-contract growth in net revenues totaled 8.3% for the fourth quarter of 2015, which included a 6.6% increase in patient encounters and a 1.7% increase in net revenue per patient encounter.

Physician Services continues to evaluate additional acquisition opportunities in its robust pipeline of potential transactions.

Liquidity

At the end of 2015, AmSurg had cash and cash equivalents of $106.7 million and availability under its $500 million revolving credit facility of $325 million. Net cash flows from operations, less distributions to noncontrolling interests, were $54.0 million for quarter and $323.1 million for full-year 2015. Although 2015 capital expenditures for maintenance and acquisitions were more than $1 billion, the Company’s ratio of total debt at the end of 2015 to trailing 12 months EBITDA as calculated under the Company’s credit agreement was 4.1 compared with 5.3 at the end of 2014.


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AMSG Reports Fourth-Quarter Results
 
 
Page 3
 
 
February 24, 2016
 
 



Guidance

AmSurg today established its financial and operating guidance for 2016 and for the first quarter of the year. The Company’s guidance is as follows:

Revenues in a range of $3.09 billion to $3.13 billion;
A same-center revenue increase of 3.0% to 5.0% for Ambulatory Services and same-contract revenue growth of 4.0% to 6.0% in Physician Services;
Adjusted EBITDA of $590 million to $600 million;
Adjusted EPS in a range of $4.26 to $4.34; and
For the first quarter of 2016, adjusted EPS in a range of $0.77 to $0.80, which includes the seasonally higher salary-related expenses historically experienced in Physician Services.

Non-GAAP Adjusted EBITDA guidance for the full year of 2016 excludes interest expense, income taxes, depreciation, amortization, share-based compensation, transaction costs, changes in contingent purchase price consideration, gain or loss on deconsolidations and discontinued operations. Non-GAAP Adjusted EPS guidance for the first quarter and full year of 2016 exclude acquisition-related transaction costs, acquisition-related amortization expense, gains and losses on future deconsolidation transactions and share-based compensation expense, net of the tax impact thereon. The exact amount of such exclusions are not currently determinable but may be significant and may vary significantly from period to period (see page 6 for a reconciliation of all GAAP and non-GAAP financial results).

Conference Call

AmSurg Corp. will hold a conference call to discuss this release Wednesday, February 24, 2016, at 5:00 p.m. Eastern time. Investors will have the opportunity to listen to the conference call over the Internet by going to www.amsurg.com and clicking “Investors” at least 15 minutes early to register, download, and install any necessary audio software. For those who cannot listen to the live broadcast, a replay will be available at these sites shortly after the call and continue for 30 days.

Safe Harbor

This press release contains forward-looking statements, including the Company’s financial and operating guidance for the first quarter and full year of 2016. These statements, which have been included in reliance on the “safe harbor” provisions of the Private Securities Litigation Reform Act of 1995, involve risks and uncertainties. Investors are hereby cautioned that these statements may be affected by important factors, including, but not limited to, the following risks: we may face challenges managing our Physician Services Division as a new business and may not realize anticipated benefits; we may become subject to investigations by federal and state entities and unpredictable impacts of the Patient Protection and Affordable Care Act, as amended by the Health Care and Education Reconciliation Act of 2010; we may not be able to successfully maintain effective internal controls over financial reporting; we may not be able to implement our business strategy, manage the growth in our business, and integrate acquired businesses; our substantial indebtedness and restrictions in our debt instruments could adversely affect our business or our ability to implement our growth strategy, or limit our ability to react to changes in the economy or our industry; we may not generate sufficient cash to service our indebtedness, including any future indebtedness; regulatory changes may obligate us to buy out interests of physicians who are minority owners of our surgery centers; we may not be able to successfully maintain our information systems and processes, implement new systems and processes, and maintain the security of those systems and processes; we may fail to effectively and timely transition to the ICD-10 coding system; we may be subject to litigation and investigations and liability claims for damages and other expenses not covered by insurance; we may be required to write-off a portion of our intangible assets; payments

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AMSG Reports Fourth-Quarter Results
 
 
Page 4
 
 
February 24, 2016
 
 



from third-party payors, including government healthcare programs, may decrease or not increase as our costs increase; there may be adverse developments affecting the medical practices of our physician partners; we may not be able to maintain favorable relations with our physician partners; we may not be able to grow our ambulatory services revenue by increasing procedure volume while maintaining operating margins and profitability at our existing surgery centers; we may not be able to compete for physician partners, managed care contracts, patients and strategic relationships; adverse weather and other factors beyond our control may affect our business; our legal responsibility to minority owners of our surgery centers may conflict with our interests and prevent us from acting solely in our best interests; we may be adversely impacted by changes in patient volume and patient mix; several client relationships generate a significant portion of our physician services revenues; our physician services contracts may be cancelled or not renewed or we may not be able to enter into additional contracts under terms acceptable to us; reimbursement rates, revenue and profit margin under our fee-for-service physician services payor contracts may decrease; we may not be able to timely or accurately bill for services; laws and regulations that regulate payments for medical services made by government healthcare programs could cause our revenues to decrease; we may not be able to enroll our physician services providers in the Medicare and Medicaid programs on a timely basis; our strategic partnerships with healthcare providers may not be successful; our segments of the market for medical services have a high level of competition; we may not be able to successfully recruit and retain physicians, nurses and other clinical providers; we may not be able to accurately assess the costs we will incur under new contracts; our margins may be negatively impacted by cross-selling to existing clients or selling bundled services to new clients; we may not be able to enforce non-compete agreements with our physicians and other clinical employees in some jurisdictions; there may be unfavorable changes in regulatory, economic and other conditions in the states where we operate; legislative or regulatory action may make our captive insurance company arrangement less feasible or otherwise reduce our profitability; our reserves with respect to our losses covered under our insurance programs may not be sufficient; and the other risk factors are described in AmSurg’s Annual Report on Form 10-K for the fiscal year ended December 31, 2014, as updated by other filings with the Securities and Exchange Commission. Consequently, actual results, performance or developments may differ materially from the forward-looking statements included above. AmSurg disclaims any intent or obligation to update these forward-looking statements.

About AmSurg

AmSurg’s Ambulatory Services Division acquires, develops and operates ambulatory surgery centers in partnership with physicians throughout the U.S. AmSurg’s Physician Services Division, Sheridan, provides outsourced physician services in multiple specialties to hospitals, ASCs and other healthcare facilities throughout the U.S., primarily in the areas of anesthesiology, children’s services, emergency medicine and radiology. Through these businesses as of December 31, 2015, AmSurg owned and operated 257 ASCs and one surgical hospital in 34 states and the District of Columbia and provided physician services to more than 450 healthcare facilities in 29 states. AmSurg has partnerships with, or employs, over 5,000 physicians and other healthcare professionals in 38 states and the District of Columbia.



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AMSG Reports Fourth-Quarter Results
 
 
Page 5
 
 
February 24, 2016
 
 



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

 
Three Months Ended December 31,
 
Year Ended December 31,
Statement of Earnings Data:
2015
 
2014
 
2015
 
2014
Revenues
$
774,309

 
$
645,619

 
$
2,832,958

 
$
1,738,950

Provision for uncollectibles
(70,047
)
 
(63,808
)
 
(266,074
)
 
(117,001
)
Net revenue
704,262


581,811


2,566,884


1,621,949

Operating expenses:
 
 
 
 
 
 
 
Salaries and benefits
364,285

 
288,037

 
1,314,392

 
694,576

Supply cost
50,210

 
43,732

 
184,222

 
164,296

Other operating expenses
103,370

 
93,685

 
397,794

 
284,928

Transaction costs
2,764

 
5,209

 
8,324

 
33,890

Depreciation and amortization
26,957

 
22,811

 
97,493

 
60,344

Total operating expenses
547,586


453,474


2,002,225


1,238,034

Net gain on deconsolidations
30,840

 

 
36,694

 
3,411

Equity in earnings of unconsolidated affiliates
4,577

 
3,577

 
16,152

 
7,038

Operating income
192,093


131,914


617,505


394,364

Interest expense, net
30,915

 
30,379

 
121,586

 
83,285

Debt extinguishment costs

 

 

 
16,887

Earnings from continuing operations before income taxes
161,178


101,535


495,919


294,192

Income tax expense
36,830

 
22,301

 
113,790

 
48,103

Net earnings from continuing operations
124,348


79,234


382,129


246,089

Net loss from discontinued operations
(1,013
)
 
(150
)
 
(1,013
)
 
(1,296
)
Net earnings
123,335


79,084


381,116


244,793

Less net earnings attributable to noncontrolling interests
57,762

 
51,705

 
218,169

 
191,092

Net earnings attributable to AmSurg Corp. shareholders
65,573


27,379


162,947


53,701

Preferred stock dividends
(2,264
)
 
(2,264
)
 
(9,056
)
 
(4,503
)
Net earnings attributable to AmSurg Corp. common shareholders
$
63,309


$
25,115


$
153,891


$
49,198

 
 
 
 
 
 
 
 
Amounts attributable to AmSurg Corp. common shareholders:
 
 
 
 
 
 
 
Earnings from continuing operations, net of income tax
$
64,310

 
$
25,311

 
$
154,892

 
$
50,777

Loss from discontinued operations, net of income tax
(1,001
)
 
(196
)
 
(1,001
)
 
(1,579
)
Net earnings attributable to AmSurg Corp. common shareholders
$
63,309

 
$
25,115

 
$
153,891

 
$
49,198

Basic earnings (loss) per share attributable to AmSurg Corp. common shareholders:
 
 
 
 
 
 
 
Net earnings from continuing operations
$
1.31

 
$
0.53

 
$
3.22

 
$
1.29

Net loss from discontinued operations
(0.02
)
 

 
(0.02
)
 
(0.04
)
Net earnings
$
1.28

 
$
0.53

 
$
3.20

 
$
1.25

Diluted earnings (loss) per share attributable to AmSurg Corp. common shareholders:
 
 
 
 
 
 
 
Net earnings from continuing operations
$
1.26

 
$
0.53

 
$
3.18

 
$
1.28

Net loss from discontinued operations
(0.02
)
 

 
(0.02
)
 
(0.04
)
Net earnings
$
1.24

 
$
0.53

 
$
3.16

 
$
1.24

Weighted average number of shares and share equivalents outstanding:
 
 
 
 
 
 
 
Basic
49,277

 
47,384

 
48,058

 
39,311

Diluted
52,888

 
47,828

 
51,612

 
39,625



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AMSG Reports Fourth-Quarter Results
 
 
Page 6
 
 
February 24, 2016
 
 



AMSURG CORP.
Unaudited Selected Consolidated Financial and Operating Data, continued
(In thousands, except earnings per share)
 
Three Months Ended December 31,
 
Year Ended December 31,
 
2015
 
2014
 
2015
 
2014
Reconciliation of net earnings to Adjusted net earnings (1):
 
 
 
 
 
 
 
Net earnings attributable to AmSurg Corp. shareholders
$
65,573

 
$
27,379

 
$
162,947

 
$
53,701

Loss from discontinued operations
1,695

 
327

 
1,695

 
2,220

Amortization of purchased intangibles
15,173

 
12,179

 
52,766

 
22,148

Share-based compensation
3,690

 
2,716

 
15,009

 
10,104

Transaction costs
2,764

 
5,209

 
8,324

 
33,890

Net gain on deconsolidations
(30,840
)
 

 
(36,694
)
 
(3,411
)
Net change in fair value of contingent consideration
466

 

 
8,804

 

Debt extinguishment costs

 

 

 
16,887

Deferred financing write-off

 

 

 
12,763

Total pre-tax adjustments
(7,052
)
 
20,431

 
49,904

 
94,601

Tax effect (including impact of certain discrete items)
1,852

 
8,172

 
21,521

 
34,140

Total adjustments, net
(8,904
)
 
12,259

 
28,383

 
60,461

Adjusted net earnings
$
56,669

 
$
39,638

 
$
191,330

 
$
114,162

 
 
 
 
 
 
 
 
Basic shares outstanding
49,277

 
47,384

 
48,058

 
39,311

Effect of dilutive securities, options and non-vested shares
3,611

 
3,891

 
3,554

 
2,152

Diluted shares outstanding, if converted
52,888


51,275

 
51,612

 
41,463

 
 
 
 
 
 
 
 
Adjusted earnings per share
$
1.07

 
$
0.77

 
$
3.71

 
$
2.75

 
 
 
 
 
 
 
 
Reconciliation of net earnings to Adjusted EBITDA (2):
 
 
 
 
 
 
 
Net earnings attributable to AmSurg Corp. shareholders
$
65,573

 
$
27,379

 
$
162,947

 
$
53,701

Loss from discontinued operations
1,001

 
196

 
1,001

 
1,579

Interest expense, net
30,915

 
30,379

 
121,586

 
83,285

Income tax expense
36,830

 
22,301

 
113,790

 
48,103

Depreciation and amortization
26,957

 
22,811

 
97,493

 
60,344

EBITDA
161,276

 
103,066

 
496,817

 
247,012

Adjustments:
 
 
 
 
 
 
 
Share-based compensation
3,690

 
2,716

 
15,009

 
10,104

Transaction costs
2,764

 
5,209

 
8,324

 
33,890

Net gain on deconsolidations
(30,840
)
 

 
(36,694
)
 
(3,411
)
Net change in fair value of contingent consideration
466

 

 
8,804

 

Debt extinguishment costs

 

 

 
16,887

Total adjustments
(23,920
)
 
7,925

 
(4,557
)
 
57,470

Adjusted EBITDA
$
137,356

 
$
110,991

 
$
492,260

 
$
304,482

 
 
 
 
 
 
 
 
Segment Information:
 
 
 
 
 
 
 
Ambulatory Services Adjusted EBITDA
$
63,264

 
$
51,902

 
$
226,229

 
$
197,377

Physician Services Adjusted EBITDA
74,092

 
59,089

 
266,031

 
107,105

Adjusted EBITDA
$
137,356

 
$
110,991

 
$
492,260

 
$
304,482

 
 
 
 
 
 
 
 
Net Revenue by Segment:
 
 
 
 
 
 
 
Ambulatory Services
$
326,166

 
$
295,728

 
$
1,230,050

 
$
1,109,935

Physician Services
378,096

 
286,083

 
1,336,834

 
512,014

Total net revenue
$
704,262

 
$
581,811

 
$
2,566,884

 
$
1,621,949

See footnotes on page 10

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AMSG Reports Fourth-Quarter Results
 
 
Page 7
 
 
February 24, 2016
 
 



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

Operating Data- Ambulatory Services:
 
 
 
 
 
 
 
 
Three Months Ended December 31,
 
Year Ended December 31,
 
2015
 
2014
 
2015
 
2014
Procedures performed during the period at consolidated centers
448,721

 
434,285

 
1,729,262

 
1,645,350

Centers in operation at end of period (consolidated)
236

 
237

 
236

 
237

Centers in operation at end of period (unconsolidated)
21

 
9

 
21

 
9

Average number of continuing centers in operation (consolidated)
239

 
235

 
238

 
233

New centers added during the period
5

 
4

 
11

 
10

Centers discontinued during the period

 
1

 

 
6

Centers under development at end of period
1

 
2

 
1

 
2

Centers under letter of intent at end of period
5

 
5

 
5

 
5

Average revenue per consolidated center
$
1,363

 
$
1,258

 
$
5,174

 
$
4,755

Same center revenues increase (consolidated)
6.9
%
 
1.1
%
 
6.0
%
 
0.7
%
Surgical hospitals in operation at end of period (unconsolidated)
1

 

 
1

 


Operating Data- Physician Services:
 
 
 
 
Three Months Ended 
 December 31, 2015
 
Year Ended December 31,

2015
 
2015
Contribution to Net Revenue Growth:
 
 
 
Same contract
6.2
%
 
7.5
%
New contract
1.7

 
2.0

Acquired contract and other
24.3

 
14.9

Total net revenue growth
32.2
%
 
24.4
%
 
 
 
 
Same contract revenue growth
8.3
%
 
9.9
%


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AMSG Reports Fourth-Quarter Results
 
 
Page 8
 
 
February 24, 2016
 
 



AMSURG CORP.
Unaudited Selected Consolidated Financial and Operating Data, continued
(In thousands)
 
December 31,
 
December 31,
Balance Sheet Data:
2015
 
2014
Assets
 
 
 
Current assets:
 
 
 
Cash and cash equivalents
$
106,660

 
$
208,079

Restricted cash and marketable securities
13,506

 
10,219

Accounts receivable, net of allowance of $167,411 and $113,357, respectively
337,330

 
233,053

Supplies inventory
21,406

 
19,974

Prepaid and other current assets
75,771

 
92,900

Total current assets
554,673

 
564,225

Property and equipment, net
189,168

 
180,448

Investments in unconsolidated affiliates
169,170

 
75,475

Goodwill
3,970,210

 
3,381,149

Intangible assets, net
1,641,811

 
1,273,879

Other assets
21,450

 
25,886

Total assets
$
6,546,482

 
$
5,501,062

Liabilities and Equity
 
 
 
Current liabilities:
 
 
 
Current portion of long-term debt
$
20,377

 
$
18,826

Accounts payable
32,561

 
29,585

Accrued salaries and benefits
202,537

 
140,044

Accrued interest
30,480

 
29,644

Other accrued liabilities
119,237

 
67,986

Total current liabilities
405,192

 
286,085

Long-term debt
2,405,130

 
2,232,186

Deferred income taxes
699,498

 
611,018

Other long-term liabilities
96,183

 
89,443

Commitments and contingencies
 
 
 
Noncontrolling interests – redeemable
175,732

 
184,099

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

 
166,632

Common stock, no par value, 120,000 and 70,000 shares authorized, respectively, 54,294 and 48,113 shares issued and outstanding, respectively
1,345,418

 
885,393

Retained earnings
781,413

 
627,522

Total AmSurg Corp. equity
2,293,463

 
1,679,547

Noncontrolling interests – non-redeemable
471,284

 
418,684

Total equity
2,764,747

 
2,098,231

Total liabilities and equity
$
6,546,482

 
$
5,501,062



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AMSG Reports Fourth-Quarter Results
 
 
Page 9
 
 
February 24, 2016
 
 



AMSURG CORP.
Unaudited Selected Consolidated Financial and Operating Data, continued
(In thousands)
 
Three Months Ended December 31,
 
Year Ended December 31,
Statement of Cash Flow Data:
2015
 
2014
 
2015
 
2014
Cash flows from operating activities:
 
 
 
 
 
 
 
Net earnings
$
123,335

 
$
79,084

 
$
381,116

 
$
244,793

Adjustments to reconcile net earnings to net cash flows provided by operating activities:
 
 
 
 
 
 
 
Depreciation and amortization
26,957

 
22,811

 
97,493

 
60,344

Amortization of deferred loan costs
2,124

 
2,070

 
8,362

 
17,715

Provision for uncollectibles
74,881

 
69,559

 
287,427

 
139,274

Net (gain) loss on sale of long-lived assets
(12
)
 
375

 
(12
)
 
2,843

Net gain on deconsolidations
(30,840
)
 

 
(36,694
)
 
(3,411
)
Share-based compensation
3,690

 
2,716

 
15,009

 
10,104

Excess tax benefit from share-based compensation
(222
)
 
(889
)
 
(4,001
)
 
(3,177
)
Deferred income taxes
11,728

 
(608
)
 
19,037

 
30,780

Equity in earnings of unconsolidated affiliates
(4,577
)
 
(3,577
)
 
(16,152
)
 
(7,038
)
Debt extinguishment costs

 

 

 
4,536

Net change in fair value of contingent consideration
466

 

 
8,804

 

Increases (decreases) in cash and cash equivalents, net of acquisitions and dispositions:
 
 
 
 
 
 
 
Accounts receivable
(93,769
)
 
(71,905
)
 
(326,234
)
 
(137,663
)
Supplies inventory
191

 
(274
)
 
(342
)
 
(206
)
Prepaid and other current assets
(10,599
)
 
15,323

 
25,880

 
(9,091
)
Accounts payable
815

 
1,567

 
3,131

 
(8,440
)
Accrued expenses and other liabilities
1,840

 
17,807

 
66,600

 
66,175

Other, net
4,749

 
2,261

 
8,535

 
4,833

Net cash flows provided by operating activities
110,757

 
136,320


537,959


412,371

Cash flows from investing activities:
 
 
 
 
 
 
 
Acquisitions and related expenses
(729,199
)
 
(45,410
)
 
(962,689
)
 
(2,184,058
)
Acquisition of property and equipment
(13,299
)
 
(17,108
)
 
(60,305
)
 
(40,217
)
Proceeds from sale of interests in surgery centers
7,114

 
2,100

 
7,114

 
7,069

Purchases of marketable securities
(2,241
)
 
(2,988
)
 
(3,984
)
 
(6,474
)
Maturities of marketable securities

 
3,486

 
4,233

 
3,486

Other
2,780

 
(7,023
)
 
(1,194
)
 
(4,941
)
Net cash flows used in investing activities
(734,845
)
 
(66,943
)

(1,016,825
)

(2,225,135
)
Cash flows from financing activities:
 
 
 
 
 
 
 
Proceeds from long-term borrowings and revolving credit facility
549,936

 
2,559

 
560,133

 
2,048,958

Repayment on long-term borrowings and revolving credit facility
(376,849
)
 
(5,432
)
 
(392,586
)
 
(408,475
)
Distributions to noncontrolling interests
(56,755
)
 
(50,654
)
 
(214,899
)
 
(190,097
)
Proceeds from preferred stock offering

 

 

 
172,500

Proceeds from common stock offering
466,777

 

 
466,777

 
439,875

Proceeds from issuance of common stock upon exercise of stock options
228

 
480

 
2,584

 
2,630

Repurchase of common stock

 
(1,725
)
 
(3,684
)
 
(4,615
)
Payments of equity issuance costs
(19,058
)
 
(128
)
 
(19,058
)
 
(24,494
)
Financing costs incurred
(817
)
 
(138
)
 
(1,111
)
 
(65,811
)
Other
(20,136
)
 
(341
)
 
(20,709
)
 
(468
)
Net cash flows provided by (used in) financing activities
543,326

 
(55,379
)

377,447


1,970,003

Net increase (decrease) in cash and cash equivalents
(80,762
)
 
13,998


(101,419
)

157,239

Cash and cash equivalents, beginning of period
187,422

 
194,081

 
208,079

 
50,840

Cash and cash equivalents, end of period
$
106,660

 
$
208,079


$
106,660


$
208,079


-MORE-

AMSG Reports Fourth-Quarter Results
 
 
Page 10
 
 
February 24, 2016
 
 




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

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

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



-END-