Attached files
| file | filename |
|---|---|
| 10-Q - 10-Q - 21st Century Oncology Holdings, Inc. | a15-18065_110q.htm |
| EX-4.2 - EX-4.2 - 21st Century Oncology Holdings, Inc. | a15-18065_1ex4d2.htm |
| EX-32.2 - EX-32.2 - 21st Century Oncology Holdings, Inc. | a15-18065_1ex32d2.htm |
| EX-10.4 - EX-10.4 - 21st Century Oncology Holdings, Inc. | a15-18065_1ex10d4.htm |
| EX-10.3 - EX-10.3 - 21st Century Oncology Holdings, Inc. | a15-18065_1ex10d3.htm |
| EX-31.1 - EX-31.1 - 21st Century Oncology Holdings, Inc. | a15-18065_1ex31d1.htm |
| EX-32.1 - EX-32.1 - 21st Century Oncology Holdings, Inc. | a15-18065_1ex32d1.htm |
| EX-31.2 - EX-31.2 - 21st Century Oncology Holdings, Inc. | a15-18065_1ex31d2.htm |
Exhibit 99.1
Supplemental Consolidating Financial Information
21st Century Oncology, Inc.’s (“21C”) payment obligations under the senior secured credit facility, and senior notes are guaranteed by 21st Century Oncology Holdings, Inc. (“the Company”), which owns 100% of 21C and certain domestic subsidiaries of 21C, all of which are, directly or indirectly, 100% owned by 21C (the “Subsidiary Guarantors” and, collectively with the Company, the “Guarantors”). Such guarantees are full, unconditional and joint and several. The consolidated joint ventures, foreign subsidiaries and professional corporations of the Company are non-guarantors. The following supplemental financial information sets forth, on an unconsolidated basis, balance sheets, statements of operations and comprehensive income (loss), and statements of cash flows information for the Company, 21C, the Subsidiary Guarantors and the non-guarantor subsidiaries. The supplemental financial information reflects the investment of the Company and 21C and subsidiary guarantors using the equity method of accounting.
CONDENSED CONSOLIDATING BALANCE SHEETS (UNAUDITED)
as of September 30, 2015
(in thousands)
|
|
|
The Company |
|
21C |
|
Subsidiary |
|
Subsidiary |
|
Eliminations |
|
Consolidated |
| ||||||
|
ASSETS |
|
|
|
|
|
|
|
|
|
|
|
|
| ||||||
|
Current assets: |
|
|
|
|
|
|
|
|
|
|
|
|
| ||||||
|
Cash and cash equivalents |
|
$ |
8,149 |
|
$ |
8,004 |
|
$ |
17,307 |
|
$ |
14,333 |
|
$ |
— |
|
$ |
47,793 |
|
|
Restricted cash |
|
— |
|
— |
|
80 |
|
— |
|
— |
|
80 |
| ||||||
|
Marketable securities |
|
— |
|
— |
|
— |
|
622 |
|
— |
|
622 |
| ||||||
|
Accounts receivable, net |
|
— |
|
— |
|
83,830 |
|
65,394 |
|
— |
|
149,224 |
| ||||||
|
Income taxes receivable |
|
141 |
|
— |
|
2,362 |
|
— |
|
(2,503 |
) |
— |
| ||||||
|
Prepaid expenses |
|
— |
|
67 |
|
8,445 |
|
869 |
|
— |
|
9,381 |
| ||||||
|
Inventories |
|
— |
|
— |
|
4,818 |
|
344 |
|
— |
|
5,162 |
| ||||||
|
Deferred income taxes |
|
— |
|
— |
|
7,467 |
|
190 |
|
(7,466 |
) |
191 |
| ||||||
|
Other |
|
— |
|
— |
|
7,825 |
|
231 |
|
— |
|
8,056 |
| ||||||
|
Total current assets |
|
8,290 |
|
8,071 |
|
132,134 |
|
81,983 |
|
(9,969 |
) |
220,509 |
| ||||||
|
Equity investments in joint ventures |
|
— |
|
679,108 |
|
104,990 |
|
72 |
|
(782,934 |
) |
1,236 |
| ||||||
|
Property and equipment, net |
|
— |
|
— |
|
197,537 |
|
51,855 |
|
— |
|
249,392 |
| ||||||
|
Real estate subject to finance obligation |
|
— |
|
— |
|
11,625 |
|
— |
|
— |
|
11,625 |
| ||||||
|
Goodwill |
|
— |
|
— |
|
398,535 |
|
93,549 |
|
— |
|
492,084 |
| ||||||
|
Intangible assets, net |
|
— |
|
— |
|
57,545 |
|
16,889 |
|
— |
|
74,434 |
| ||||||
|
Deferred income taxes |
|
665 |
|
15,699 |
|
— |
|
— |
|
(16,364 |
) |
— |
| ||||||
|
Other assets |
|
— |
|
25,373 |
|
17,425 |
|
6,484 |
|
— |
|
49,282 |
| ||||||
|
Intercompany note receivable |
|
1,202 |
|
14,483 |
|
40,733 |
|
— |
|
(56,418 |
) |
— |
| ||||||
|
Total assets |
|
$ |
10,157 |
|
$ |
742,734 |
|
$ |
960,524 |
|
$ |
250,832 |
|
$ |
(865,685 |
) |
$ |
1,098,562 |
|
|
LIABILITIES AND EQUITY |
|
|
|
|
|
|
|
|
|
|
|
|
| ||||||
|
Current liabilities: |
|
|
|
|
|
|
|
|
|
|
|
|
| ||||||
|
Accounts payable |
|
$ |
— |
|
$ |
728 |
|
$ |
46,721 |
|
$ |
11,948 |
|
$ |
— |
|
$ |
59,397 |
|
|
Accrued expenses |
|
(7 |
) |
16,610 |
|
113,826 |
|
9,632 |
|
— |
|
140,061 |
| ||||||
|
Income taxes payable |
|
— |
|
1,355 |
|
— |
|
2,962 |
|
(2,503 |
) |
1,814 |
| ||||||
|
Deferred income taxes — current |
|
372 |
|
7,094 |
|
— |
|
— |
|
(7,466 |
) |
— |
| ||||||
|
Current portion of long-term debt |
|
— |
|
6,100 |
|
21,421 |
|
3,337 |
|
— |
|
30,858 |
| ||||||
|
Current portion of finance obligation |
|
— |
|
— |
|
481 |
|
— |
|
— |
|
481 |
| ||||||
|
Other current liabilities |
|
— |
|
— |
|
5,219 |
|
1,265 |
|
— |
|
6,484 |
| ||||||
|
Total current liabilities |
|
365 |
|
31,887 |
|
187,668 |
|
29,144 |
|
(9,969 |
) |
239,095 |
| ||||||
|
Long-term debt, less current portion |
|
15,616 |
|
956,652 |
|
30,449 |
|
6,479 |
|
— |
|
1,009,196 |
| ||||||
|
Finance obligation, less current portion |
|
— |
|
— |
|
12,057 |
|
— |
|
— |
|
12,057 |
| ||||||
|
Obligation to subsidiary |
|
245,805 |
|
— |
|
— |
|
— |
|
(245,805 |
) |
— |
| ||||||
|
Embedded derivative features of Series A convertible redeemable preferred stock and other financial instruments |
|
27,339 |
|
— |
|
— |
|
— |
|
— |
|
27,339 |
| ||||||
|
Other long-term liabilities |
|
— |
|
— |
|
34,008 |
|
5,853 |
|
— |
|
39,861 |
| ||||||
|
Deferred income taxes |
|
— |
|
— |
|
19,073 |
|
1,007 |
|
(16,364 |
) |
3,716 |
| ||||||
|
Intercompany note payable |
|
— |
|
— |
|
— |
|
56,418 |
|
(56,418 |
) |
— |
| ||||||
|
Total liabilities |
|
289,125 |
|
988,539 |
|
283,255 |
|
98,901 |
|
(328,556 |
) |
1,331,264 |
| ||||||
|
Series A convertible redeemable preferred stock |
|
370,478 |
|
— |
|
— |
|
— |
|
— |
|
370,478 |
| ||||||
|
Noncontrolling interests—redeemable |
|
— |
|
— |
|
— |
|
— |
|
19,934 |
|
19,934 |
| ||||||
|
Total 21st Century Oncology Holdings, Inc. shareholder’s (deficit) equity |
|
(649,446 |
) |
(245,805 |
) |
673,320 |
|
151,931 |
|
(579,446 |
) |
(649,446 |
) | ||||||
|
Noncontrolling interests—nonredeemable |
|
— |
|
— |
|
3,949 |
|
— |
|
22,383 |
|
26,332 |
| ||||||
|
Total (deficit) equity |
|
(649,446 |
) |
(245,805 |
) |
677,269 |
|
151,931 |
|
(557,063 |
) |
(623,114 |
) | ||||||
|
Total liabilities and (deficit) equity |
|
$ |
10,157 |
|
$ |
742,734 |
|
$ |
960,524 |
|
$ |
250,832 |
|
$ |
(865,685 |
) |
$ |
1,098,562 |
|
CONDENSED CONSOLIDATING STATEMENTS OF OPERATIONS
AND COMPREHENSIVE INCOME (LOSS) (UNAUDITED)
Three Months Ended September 30, 2015
(in thousands)
|
|
|
The Company |
|
21C |
|
Subsidiary |
|
Subsidiary |
|
Eliminations |
|
Consolidated |
| ||||||
|
Revenues: |
|
|
|
|
|
|
|
|
|
|
|
|
| ||||||
|
Net patient service revenue |
|
$ |
— |
|
$ |
— |
|
$ |
124,295 |
|
$ |
115,311 |
|
$ |
— |
|
$ |
239,606 |
|
|
Management fees |
|
— |
|
— |
|
13,669 |
|
511 |
|
— |
|
14,180 |
| ||||||
|
Other revenue |
|
— |
|
21 |
|
3,442 |
|
746 |
|
(10 |
) |
4,199 |
| ||||||
|
Intercompany revenue |
|
645 |
|
445 |
|
20,628 |
|
— |
|
(21,718 |
) |
— |
| ||||||
|
Total revenues |
|
645 |
|
466 |
|
162,034 |
|
116,568 |
|
(21,728 |
) |
257,985 |
| ||||||
|
Expenses: |
|
|
|
|
|
|
|
|
|
|
|
|
| ||||||
|
Salaries and benefits |
|
2 |
|
— |
|
88,489 |
|
54,149 |
|
— |
|
142,640 |
| ||||||
|
Medical supplies |
|
— |
|
— |
|
15,649 |
|
6,849 |
|
— |
|
22,498 |
| ||||||
|
Facility rent expenses |
|
— |
|
— |
|
11,398 |
|
5,423 |
|
— |
|
16,821 |
| ||||||
|
Other operating expenses |
|
— |
|
— |
|
9,548 |
|
6,501 |
|
— |
|
16,049 |
| ||||||
|
General and administrative expenses |
|
2 |
|
554 |
|
59,384 |
|
8,296 |
|
— |
|
68,236 |
| ||||||
|
Depreciation and amortization |
|
— |
|
— |
|
17,276 |
|
5,203 |
|
— |
|
22,479 |
| ||||||
|
Provision for doubtful accounts |
|
— |
|
— |
|
3,864 |
|
1,787 |
|
— |
|
5,651 |
| ||||||
|
Interest expense, net |
|
626 |
|
21,498 |
|
1,153 |
|
447 |
|
— |
|
23,724 |
| ||||||
|
Gain on BP settlement |
|
— |
|
— |
|
(5,796 |
) |
— |
|
— |
|
(5,796 |
) | ||||||
|
Electronic health records incentive payment |
|
— |
|
— |
|
179 |
|
(179 |
) |
— |
|
— |
| ||||||
|
Fair value adjustment of noncontrolling interest and earn-out liabilities |
|
(3,735 |
) |
— |
|
12 |
|
— |
|
— |
|
(3,723 |
) | ||||||
|
Fair value adjustment of embedded derivative and other financial instruments |
|
2,363 |
|
— |
|
— |
|
— |
|
— |
|
2,363 |
| ||||||
|
Loss on foreign currency transactions |
|
— |
|
— |
|
— |
|
337 |
|
— |
|
337 |
| ||||||
|
Intercompany expenses |
|
— |
|
— |
|
(22 |
) |
21,740 |
|
(21,718 |
) |
— |
| ||||||
|
Total expenses |
|
(742 |
) |
22,052 |
|
201,134 |
|
110,553 |
|
(21,718 |
) |
311,279 |
| ||||||
|
(Loss) income from equity investment |
|
(58,291 |
) |
(36,685 |
) |
2,121 |
|
4 |
|
92,851 |
|
— |
| ||||||
|
(Loss) income before income taxes |
|
(56,904 |
) |
(58,271 |
) |
(36,979 |
) |
6,019 |
|
92,841 |
|
(53,294 |
) | ||||||
|
Income tax (benefit) expense |
|
— |
|
19 |
|
49 |
|
1,084 |
|
— |
|
1,152 |
| ||||||
|
Net (loss) income |
|
(56,904 |
) |
(58,290 |
) |
(37,028 |
) |
4,935 |
|
92,841 |
|
(54,446 |
) | ||||||
|
Net income attributable to noncontrolling interests—redeemable and non-redeemable |
|
— |
|
— |
|
— |
|
— |
|
(2,458 |
) |
(2,458 |
) | ||||||
|
Net (loss) income attributable to 21st Century Oncology Holdings, Inc. shareholder |
|
(56,904 |
) |
(58,290 |
) |
(37,028 |
) |
4,935 |
|
90,383 |
|
(56,904 |
) | ||||||
|
Unrealized comprehensive (loss) income |
|
(2,273 |
) |
(2,273 |
) |
(2,273 |
) |
(2,688 |
) |
6,819 |
|
(2,688 |
) | ||||||
|
Comprehensive (loss) income |
|
(59,177 |
) |
(60,563 |
) |
(39,301 |
) |
2,247 |
|
99,660 |
|
(57,134 |
) | ||||||
|
Comprehensive income attributable to noncontrolling interests-redeemable and non-redeemable |
|
— |
|
— |
|
— |
|
— |
|
(2,043 |
) |
(2,043 |
) | ||||||
|
Comprehensive (loss) income attributable to 21st Century Oncology Holdings, Inc. shareholder |
|
$ |
(59,177 |
) |
$ |
(60,563 |
) |
$ |
(39,301 |
) |
$ |
2,247 |
|
$ |
97,617 |
|
$ |
(59,177 |
) |
CONDENSED CONSOLIDATING STATEMENTS OF OPERATIONS
AND COMPREHENSIVE INCOME (LOSS) (UNAUDITED)
Nine Months Ended September 30, 2015
(in thousands)
|
|
|
The Company |
|
21C |
|
Subsidiary |
|
Subsidiary |
|
Eliminations |
|
Consolidated |
| ||||||
|
Revenues: |
|
|
|
|
|
|
|
|
|
|
|
|
| ||||||
|
Net patient service revenue |
|
$ |
— |
|
$ |
— |
|
$ |
403,117 |
|
$ |
356,626 |
|
$ |
— |
|
$ |
759,743 |
|
|
Management fees |
|
— |
|
— |
|
43,811 |
|
1,450 |
|
— |
|
45,261 |
| ||||||
|
Other revenue |
|
— |
|
103 |
|
12,858 |
|
3,510 |
|
202 |
|
16,673 |
| ||||||
|
Intercompany revenue |
|
1,971 |
|
1,151 |
|
60,650 |
|
— |
|
(63,772 |
) |
— |
| ||||||
|
Total revenues |
|
1,971 |
|
1,254 |
|
520,436 |
|
361,586 |
|
(63,570 |
) |
821,677 |
| ||||||
|
Expenses: |
|
|
|
|
|
|
|
|
|
|
|
|
| ||||||
|
Salaries and benefits |
|
6 |
|
— |
|
272,772 |
|
164,218 |
|
— |
|
436,996 |
| ||||||
|
Medical supplies |
|
— |
|
— |
|
49,716 |
|
23,847 |
|
— |
|
73,563 |
| ||||||
|
Facility rent expenses |
|
— |
|
— |
|
34,255 |
|
16,363 |
|
— |
|
50,618 |
| ||||||
|
Other operating expenses |
|
— |
|
— |
|
27,192 |
|
19,854 |
|
— |
|
47,046 |
| ||||||
|
General and administrative expenses |
|
2 |
|
1,645 |
|
116,396 |
|
22,879 |
|
— |
|
140,922 |
| ||||||
|
Depreciation and amortization |
|
— |
|
— |
|
52,052 |
|
15,238 |
|
— |
|
67,290 |
| ||||||
|
Provision for doubtful accounts |
|
— |
|
— |
|
8,226 |
|
5,646 |
|
— |
|
13,872 |
| ||||||
|
Interest expense, net |
|
625 |
|
64,071 |
|
7,524 |
|
1,517 |
|
— |
|
73,737 |
| ||||||
|
Gain on BP settlement |
|
— |
|
— |
|
(5,796 |
) |
— |
|
— |
|
(5,796 |
) | ||||||
|
Early extinguishment of debt |
|
— |
|
31,076 |
|
6,314 |
|
— |
|
— |
|
37,390 |
| ||||||
|
Electronic health records incentive payment |
|
— |
|
— |
|
179 |
|
(179 |
) |
— |
|
— |
| ||||||
|
Fair value adjustment of noncontrolling interest and earn-out liabilities |
|
(652 |
) |
— |
|
134 |
|
— |
|
— |
|
(518 |
) | ||||||
|
Fair value adjustment of embedded derivative and other financial instruments |
|
8,922 |
|
— |
|
— |
|
— |
|
— |
|
8,922 |
| ||||||
|
Loss on foreign currency transactions |
|
— |
|
— |
|
— |
|
548 |
|
— |
|
548 |
| ||||||
|
Intercompany expenses |
|
— |
|
— |
|
(22 |
) |
63,794 |
|
(63,772 |
) |
— |
| ||||||
|
Total expenses |
|
8,903 |
|
96,792 |
|
568,942 |
|
333,725 |
|
(63,772 |
) |
944,590 |
| ||||||
|
(Loss) income from equity investment |
|
(129,752 |
) |
(34,194 |
) |
14,148 |
|
24 |
|
149,774 |
|
— |
| ||||||
|
(Loss) income before income taxes |
|
(136,684 |
) |
(129,732 |
) |
(34,358 |
) |
27,885 |
|
149,976 |
|
(122,913 |
) | ||||||
|
Income tax (benefit) expense |
|
— |
|
19 |
|
19 |
|
6,892 |
|
— |
|
6,930 |
| ||||||
|
Net (loss) income |
|
(136,684 |
) |
(129,751 |
) |
(34,377 |
) |
20,993 |
|
149,976 |
|
(129,843 |
) | ||||||
|
Net income attributable to noncontrolling interests—redeemable and non-redeemable |
|
— |
|
— |
|
— |
|
— |
|
(6,841 |
) |
(6,841 |
) | ||||||
|
Net (loss) income attributable to 21st Century Oncology Holdings, Inc. shareholder |
|
(136,684 |
) |
(129,751 |
) |
(34,377 |
) |
20,993 |
|
143,135 |
|
(136,684 |
) | ||||||
|
Unrealized comprehensive (loss) income |
|
(6,318 |
) |
(6,318 |
) |
(6,318 |
) |
(7,185 |
) |
18,954 |
|
(7,185 |
) | ||||||
|
Comprehensive (loss) income |
|
(143,002 |
) |
(136,069 |
) |
(40,695 |
) |
13,808 |
|
168,930 |
|
(137,028 |
) | ||||||
|
Comprehensive income attributable to noncontrolling interests-redeemable and non-redeemable |
|
— |
|
— |
|
— |
|
— |
|
(5,974 |
) |
(5,974 |
) | ||||||
|
Comprehensive (loss) income attributable to 21st Century Oncology Holdings, Inc. shareholder |
|
$ |
(143,002 |
) |
$ |
(136,069 |
) |
$ |
(40,695 |
) |
$ |
13,808 |
|
$ |
162,956 |
|
$ |
(143,002 |
) |
CONDENSED CONSOLIDATING STATEMENT OF CASH FLOWS (UNAUDITED)
Nine months Ended September 30, 2015
(in thousands)
|
|
|
The |
|
21C |
|
Subsidiary |
|
Subsidiary |
|
Eliminations |
|
Consolidated |
| ||||||
|
Cash flows from operating activities |
|
|
|
|
|
|
|
|
|
|
|
|
| ||||||
|
Net (loss) income |
|
$ |
(136,684 |
) |
$ |
(129,751 |
) |
$ |
(34,377 |
) |
$ |
20,993 |
|
$ |
149,976 |
|
$ |
(129,843 |
) |
|
Adjustments to reconcile net (loss) income to net cash provided by (used in) operating activities: |
|
|
|
|
|
|
|
|
|
|
|
|
| ||||||
|
Depreciation and amortization |
|
— |
|
— |
|
52,052 |
|
15,238 |
|
— |
|
67,290 |
| ||||||
|
Deferred rent expense |
|
— |
|
— |
|
98 |
|
55 |
|
— |
|
153 |
| ||||||
|
Deferred income taxes |
|
1 |
|
— |
|
1 |
|
(775 |
) |
— |
|
(773 |
) | ||||||
|
Stock-based compensation |
|
6 |
|
— |
|
— |
|
— |
|
— |
|
6 |
| ||||||
|
Provision for doubtful accounts |
|
— |
|
— |
|
8,226 |
|
5,646 |
|
— |
|
13,872 |
| ||||||
|
(Gain) loss on the sale of property and equipment |
|
— |
|
— |
|
(404 |
) |
261 |
|
— |
|
(143 |
) | ||||||
|
Gain on the sale of marketable securities |
|
— |
|
(2 |
) |
— |
|
— |
|
— |
|
(2 |
) | ||||||
|
Early extinguishment of debt |
|
— |
|
31,076 |
|
6,314 |
|
— |
|
— |
|
37,390 |
| ||||||
|
Gain on foreign currency transactions |
|
— |
|
— |
|
— |
|
298 |
|
— |
|
298 |
| ||||||
|
Fair value adjustment of noncontrolling interest and earn-out liabilities |
|
(652 |
) |
— |
|
134 |
|
— |
|
— |
|
(518 |
) | ||||||
|
Fair value adjustment of embedded derivative and other financial instruments |
|
8,922 |
|
— |
|
— |
|
— |
|
— |
|
8,922 |
| ||||||
|
Amortization of debt discount |
|
256 |
|
972 |
|
— |
|
— |
|
— |
|
1,228 |
| ||||||
|
Amortization of loan costs |
|
— |
|
3,666 |
|
— |
|
9 |
|
— |
|
3,675 |
| ||||||
|
Paid in kind interest on notes payable |
|
370 |
|
— |
|
— |
|
— |
|
— |
|
370 |
| ||||||
|
Equity interest in net loss (earnings) of joint ventures |
|
129,752 |
|
34,194 |
|
(14,148 |
) |
(24 |
) |
(149,976 |
) |
(202 |
) | ||||||
|
Distribution received from unconsolidated joint ventures |
|
— |
|
— |
|
2,946 |
|
— |
|
(2,840 |
) |
106 |
| ||||||
|
Changes in operating assets and liabilities: |
|
|
|
|
|
|
|
|
|
|
|
|
| ||||||
|
Accounts receivable and other current assets |
|
— |
|
53 |
|
(4,943 |
) |
(28,168 |
) |
— |
|
(33,058 |
) | ||||||
|
Income taxes payable |
|
— |
|
(82 |
) |
(406 |
) |
379 |
|
— |
|
(109 |
) | ||||||
|
Inventories |
|
— |
|
— |
|
(143 |
) |
(481 |
) |
— |
|
(624 |
) | ||||||
|
Prepaid expenses |
|
— |
|
31 |
|
2,093 |
|
68 |
|
— |
|
2,192 |
| ||||||
|
Accounts payable and other current liabilities |
|
— |
|
58 |
|
3,517 |
|
346 |
|
— |
|
3,921 |
| ||||||
|
Accrued deferred compensation |
|
— |
|
— |
|
863 |
|
194 |
|
— |
|
1,057 |
| ||||||
|
Accrued expenses / other current liabilities |
|
(7 |
) |
4,886 |
|
49,639 |
|
3,616 |
|
— |
|
58,134 |
| ||||||
|
Net cash provided by (used in) operating activities |
|
1,964 |
|
(54,899 |
) |
71,462 |
|
17,655 |
|
(2,840 |
) |
33,342 |
| ||||||
|
Cash flows from investing activities |
|
|
|
|
|
|
|
|
|
|
|
|
| ||||||
|
Purchases of property and equipment |
|
— |
|
— |
|
(24,557 |
) |
(9,038 |
) |
— |
|
(33,595 |
) | ||||||
|
Acquisition of medical practices |
|
— |
|
— |
|
(24,456 |
) |
(8,608 |
) |
— |
|
(33,064 |
) | ||||||
|
Restricted cash associated with medical practices |
|
— |
|
— |
|
6,970 |
|
— |
|
— |
|
6,970 |
| ||||||
|
Proceeds from the sale of property and equipment |
|
— |
|
— |
|
1,143 |
|
— |
|
— |
|
1,143 |
| ||||||
|
Purchase of marketable securities |
|
— |
|
(4,011 |
) |
— |
|
(622 |
) |
— |
|
(4,633 |
) | ||||||
|
Sale of marketable securities |
|
— |
|
4,013 |
|
— |
|
— |
|
— |
|
4,013 |
| ||||||
|
Loans to employees |
|
— |
|
— |
|
343 |
|
10 |
|
— |
|
353 |
| ||||||
|
Intercompany notes to / from affiliates |
|
2,500 |
|
— |
|
— |
|
— |
|
(2,500 |
) |
— |
| ||||||
|
Contribution of capital to joint venture entities |
|
— |
|
(4,680 |
) |
— |
|
— |
|
4,680 |
|
— |
| ||||||
|
Purchase of noncontrolling interest - non-redeemable |
|
— |
|
— |
|
— |
|
— |
|
— |
|
— |
| ||||||
|
Distributions received from joint venture entities |
|
— |
|
375 |
|
2,767 |
|
— |
|
(2,646 |
) |
496 |
| ||||||
|
Proceeds (payment) of foreign currency derivative contracts |
|
— |
|
— |
|
— |
|
— |
|
— |
|
— |
| ||||||
|
Premiums on life insurance policies |
|
— |
|
— |
|
(820 |
) |
(195 |
) |
— |
|
(1,015 |
) | ||||||
|
Change in other assets and other liabilities |
|
— |
|
— |
|
99 |
|
(54 |
) |
— |
|
45 |
| ||||||
|
Net cash (used in) provided by investing activities |
|
2,500 |
|
(4,303 |
) |
(38,511 |
) |
(18,507 |
) |
(466 |
) |
(59,287 |
) | ||||||
|
Cash flows from financing activities |
|
|
|
|
|
|
|
|
|
|
|
|
| ||||||
|
Proceeds from issuance of debt |
|
— |
|
963,900 |
|
2,615 |
|
6,336 |
|
— |
|
972,851 |
| ||||||
|
Principal repayments of debt |
|
— |
|
(821,575 |
) |
(90,564 |
) |
(12,232 |
) |
2,500 |
|
(921,871 |
) | ||||||
|
Repayments of finance obligation |
|
— |
|
— |
|
(168 |
) |
— |
|
— |
|
(168 |
) | ||||||
|
Transfers between subsidiaries |
|
(61,856 |
) |
(15,198 |
) |
66,520 |
|
10,534 |
|
— |
|
— |
| ||||||
|
Proceeds from issuance of noncontrolling interest |
|
— |
|
— |
|
4,680 |
|
3,230 |
|
(4,680 |
) |
3,230 |
| ||||||
|
Purchase of noncontrolling interest - non-redeemable |
|
— |
|
(15,000 |
) |
(1,233 |
) |
— |
|
— |
|
(16,233 |
) | ||||||
|
Proceeds from noncontrolling interest holders — redeemable and non-redeemable |
|
— |
|
— |
|
743 |
|
— |
|
— |
|
743 |
| ||||||
|
Cash distributions to noncontrolling interest holders—redeemable and non-redeemable |
|
— |
|
— |
|
— |
|
— |
|
(4,072 |
) |
(4,072 |
) | ||||||
|
Payments for contingent considerations |
|
— |
|
— |
|
(8,537 |
) |
— |
|
— |
|
(8,537 |
) | ||||||
|
Payments of call premium on long term debt |
|
— |
|
(18,563 |
) |
(6,314 |
) |
— |
|
— |
|
(24,877 |
) | ||||||
|
Cash distributions to shareholders |
|
— |
|
— |
|
— |
|
(9,558 |
) |
9,558 |
|
— |
| ||||||
|
Payments of loan costs |
|
— |
|
(26,481 |
) |
— |
|
— |
|
— |
|
(26,481 |
) | ||||||
|
Net cash (used in) provided by financing activities |
|
(61,856 |
) |
67,083 |
|
(32,258 |
) |
(1,690 |
) |
3,306 |
|
(25,415 |
) | ||||||
|
Effect of exchange rate changes on cash and cash equivalents |
|
— |
|
— |
|
— |
|
(14 |
) |
— |
|
(14 |
) | ||||||
|
Net (decrease) increase in cash and cash equivalents |
|
(57,392 |
) |
7,881 |
|
693 |
|
(2,556 |
) |
— |
|
(51,374 |
) | ||||||
|
Cash and cash equivalents, beginning of period |
|
65,541 |
|
123 |
|
16,614 |
|
16,889 |
|
— |
|
99,167 |
| ||||||
|
Cash and cash equivalents, end of period |
|
$ |
8,149 |
|
$ |
8,004 |
|
$ |
17,307 |
|
$ |
14,333 |
|
$ |
— |
|
$ |
47,793 |
|