LHC GROUP, INC.
UNITED STATES SECURITIES AND EXCHANGE COMMISSION
WASHINGTON, D.C. 20549
FORM 10-Q
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þ |
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Quarterly report pursuant to Section 13 or 15 (d) of the Securities Exchange Act of 1934 |
For the quarterly period ended June 30, 2006
or
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o |
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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:0-8082
LHC GROUP, INC.
(Exact Name of Registrant as Specified in Charter)
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Delaware
(State or Other Jurisdiction of
Incorporation or Organization)
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71-0918189
(I.R.S. Employer Identification No.) |
420 West Pinhook Rd, Suite A
Lafayette, LA 70503
(Address of principal executive offices including zip code)
(337) 233-1307
(Registrants telephone number, including area code)
Indicate by check mark whether the issuer (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 þ No o
Indicate by check mark whether the registrant is a large accelerated filer, an accelerated
filer, or a non-accelerated filer. See definition of accelerated filer and large accelerated
filer in Rule 12b-2 of the Exchange Act. (Check one):
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Large accelerated filero
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Accelerated Filer o
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Non-accelerated filer þ |
Indicate by check mark whether the registrant is a shell company (as defined in rule 12b-2 of
the Exchange Act). Yeso Noþ
Number of shares of common stock, par value $0.01, outstanding as of August 10, 2006: 17,815,775
shares
LHC GROUP, INC.
INDEX
- 2 -
PART I FINANCIAL INFORMATION
ITEM 1. FINANCIAL STATEMENTS.
LHC GROUP, INC. AND SUBSIDIARIES
CONDENSED CONSOLIDATED BALANCE SHEETS
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|
|
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June 30, |
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December 31, |
|
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|
2006 |
|
|
2005 |
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|
(unaudited) |
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|
|
|
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|
(in thousands, except share data) |
|
ASSETS |
|
|
|
|
|
|
|
|
Current assets: |
|
|
|
|
|
|
|
|
Cash |
|
$ |
19,109 |
|
|
$ |
17,398 |
|
Receivables: |
|
|
|
|
|
|
|
|
Patient accounts receivable, less allowance for uncollectible accounts of
$3,328, and $2,544 at June 30, 2006 and December 31, 2005, respectively |
|
|
43,442 |
|
|
|
34,810 |
|
Other receivables |
|
|
2,542 |
|
|
|
3,365 |
|
Employee receivables |
|
|
35 |
|
|
|
1,888 |
|
Amounts due from governmental entities |
|
|
4,066 |
|
|
|
4,519 |
|
|
|
|
|
|
|
|
|
|
|
50,085 |
|
|
|
44,582 |
|
Deferred income taxes |
|
|
998 |
|
|
|
152 |
|
Income taxes recoverable |
|
|
|
|
|
|
869 |
|
Prepaid expenses and other current assets |
|
|
3,574 |
|
|
|
3,714 |
|
Assets held for sale |
|
|
935 |
|
|
|
|
|
|
|
|
|
|
|
|
Total current assets |
|
|
74,701 |
|
|
|
66,715 |
|
Property, building, and equipment, net |
|
|
11,110 |
|
|
|
10,224 |
|
Goodwill |
|
|
29,400 |
|
|
|
26,103 |
|
Other assets |
|
|
2,584 |
|
|
|
1,576 |
|
|
|
|
|
|
|
|
Total assets |
|
$ |
117,795 |
|
|
$ |
104,618 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
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|
LIABILITIES AND STOCKHOLDERS EQUITY |
|
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|
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|
|
|
|
|
|
|
|
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Current liabilities: |
|
|
|
|
|
|
|
|
Accounts payable and other accrued liabilities |
|
$ |
4,527 |
|
|
$ |
6,474 |
|
Salaries, wages, and benefits payable |
|
|
7,273 |
|
|
|
6,124 |
|
Amounts due to governmental entities |
|
|
3,937 |
|
|
|
3,080 |
|
Amounts payable under cooperative endeavor agreements |
|
|
46 |
|
|
|
37 |
|
Income taxes payable |
|
|
3,705 |
|
|
|
|
|
Current portion of capital lease obligations |
|
|
326 |
|
|
|
400 |
|
Current portion of long-term debt |
|
|
425 |
|
|
|
1,406 |
|
|
|
|
|
|
|
|
Total current liabilities |
|
|
20,239 |
|
|
|
17,521 |
|
Deferred income taxes, less current portion |
|
|
2,040 |
|
|
|
1,573 |
|
Capital lease obligations, less current portion |
|
|
190 |
|
|
|
347 |
|
Long-term debt, less current portion |
|
|
3,190 |
|
|
|
3,274 |
|
Minority interests subject to exchange contracts and/or put options |
|
|
472 |
|
|
|
1,511 |
|
Other minority interests |
|
|
3,371 |
|
|
|
1,948 |
|
Stockholders equity: |
|
|
|
|
|
|
|
|
Common stock $0.01 par value: 40,000,000 shares authorized;
19,507,887 shares issued and 16,557,828 shares outstanding
at June 30, 2006 and December 31, 2005, respectively |
|
|
166 |
|
|
|
166 |
|
Treasury stock 2,950,059 shares at cost |
|
|
(2,856 |
) |
|
|
(2,856 |
) |
Additional paid-in capital |
|
|
59,039 |
|
|
|
58,596 |
|
Retained earnings |
|
|
31,944 |
|
|
|
22,538 |
|
|
|
|
|
|
|
|
Total stockholders equity |
|
|
88,293 |
|
|
|
78,444 |
|
|
|
|
|
|
|
|
Total liabilities and stockholders equity |
|
$ |
117,795 |
|
|
$ |
104,618 |
|
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|
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See accompanying notes.
- 1 -
LHC GROUP, INC. AND SUBSIDIARIES
CONDENSED CONSOLIDATED STATEMENTS OF INCOME
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|
Three Months Ended June 30, |
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|
Six Months Ended June 30, |
|
|
|
2006 |
|
|
2005 |
|
|
2006 |
|
|
2005 |
|
|
|
(unaudited) |
|
|
|
(in thousands, except share and per share data) |
|
Net service revenue |
|
$ |
49,557 |
|
|
$ |
36,024 |
|
|
$ |
94,961 |
|
|
$ |
71,425 |
|
Cost of service revenue |
|
|
25,014 |
|
|
|
18,711 |
|
|
|
48,999 |
|
|
|
36,282 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Gross margin |
|
|
24,543 |
|
|
|
17,313 |
|
|
|
45,962 |
|
|
|
35,143 |
|
General and administrative expenses |
|
|
16,805 |
|
|
|
10,547 |
|
|
|
31,678 |
|
|
|
20,415 |
|
Equity-based compensation expense(1) |
|
|
|
|
|
|
3,352 |
|
|
|
|
|
|
|
3,856 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Operating income |
|
|
7,738 |
|
|
|
3,414 |
|
|
|
14,284 |
|
|
|
10,872 |
|
Interest expense |
|
|
60 |
|
|
|
426 |
|
|
|
146 |
|
|
|
758 |
|
Non-operating income, including (gain) or loss on
sales of assets |
|
|
(116 |
) |
|
|
(22 |
) |
|
|
(280 |
) |
|
|
(565 |
) |
|
|
|
|
|
|
|
|
|
|
|
|
|
Income from continuing operations before income taxes
and minority interest and cooperative endeavor
allocations |
|
|
7,794 |
|
|
|
3,010 |
|
|
|
14,418 |
|
|
|
10,679 |
|
Income tax expense |
|
|
2,451 |
|
|
|
364 |
|
|
|
4,205 |
|
|
|
2,744 |
|
Minority interest and cooperative endeavor
allocations |
|
|
1,070 |
|
|
|
1,192 |
|
|
|
2,099 |
|
|
|
2,632 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Income from continuing operations |
|
|
4,273 |
|
|
|
1,454 |
|
|
|
8,114 |
|
|
|
5,303 |
|
Loss from discontinued operations (net of income taxes
of $37 and $347 in the three months ended June 30, 2006 and
2005, respectively and $219 and $691 in the six months ended
June 30, 2006 and 2005, respectively) |
|
|
(60 |
) |
|
|
(567 |
) |
|
|
(360 |
) |
|
|
(1,129 |
) |
Gain on sale of discontinued operations (net of income
taxes of $27 and $390 for the three and six months ended
June 30, 2006
respectively) |
|
|
43 |
|
|
|
|
|
|
|
637 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Net income |
|
|
4,256 |
|
|
|
887 |
|
|
|
8,391 |
|
|
|
4,174 |
|
Redeemable minority interests |
|
|
172 |
|
|
|
(1,487 |
) |
|
|
1,015 |
|
|
|
(1,487 |
) |
|
|
|
|
|
|
|
|
|
|
|
|
|
Net income (loss) available to common stockholders |
|
$ |
4,428 |
|
|
$ |
(600 |
) |
|
$ |
9,406 |
|
|
$ |
2,687 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Earnings per share basic: |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Income from continuing operations |
|
$ |
0.26 |
|
|
$ |
0.11 |
|
|
$ |
0.49 |
|
|
$ |
0.42 |
|
Loss from discontinued operations, net |
|
|
|
|
|
|
(0.04 |
) |
|
|
(0.02 |
) |
|
|
(0.09 |
) |
Gain on sale of discontinued operations, net |
|
|
|
|
|
|
|
|
|
|
0.04 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Net income |
|
|
0.26 |
|
|
|
0.07 |
|
|
|
0.51 |
|
|
|
0.33 |
|
Redeemable minority interests |
|
|
0.01 |
|
|
|
(0.11 |
) |
|
|
0.06 |
|
|
|
(0.12 |
) |
|
|
|
|
|
|
|
|
|
|
|
|
|
Net income (loss) available to common shareholders |
|
$ |
0.27 |
|
|
$ |
(0.04 |
) |
|
$ |
0.57 |
|
|
$ |
0.21 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Earnings per share diluted: |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Income from continuing operations |
|
$ |
0.26 |
|
|
$ |
0.11 |
|
|
$ |
0.49 |
|
|
$ |
0.42 |
|
Loss from discontinued operations, net |
|
|
|
|
|
|
(0.04 |
) |
|
|
(0.02 |
) |
|
|
(0.09 |
) |
Gain on sale of discontinued operations, net |
|
|
|
|
|
|
|
|
|
|
0.04 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Net income |
|
|
0.26 |
|
|
|
0.07 |
|
|
|
0.51 |
|
|
|
0.33 |
|
Redeemable minority interests |
|
|
0.01 |
|
|
|
(0.11 |
) |
|
|
0.06 |
|
|
|
(0.12 |
) |
|
|
|
|
|
|
|
|
|
|
|
|
|
Net income (loss) available to common shareholders |
|
$ |
0.27 |
|
|
$ |
(0.04 |
) |
|
$ |
0.57 |
|
|
$ |
0.21 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Weighted average shares outstanding: |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Basic |
|
|
16,561,398 |
|
|
|
13,174,690 |
|
|
|
16,559,623 |
|
|
|
12,632,932 |
|
Diluted |
|
|
16,576,068 |
|
|
|
13,277,039 |
|
|
|
16,569,727 |
|
|
|
12,741,401 |
|
|
|
|
(1) |
|
Equity-based compensation related to the KEEP units is allocated as follows, and
does not include stock-based compensation related to FAS 123(R): |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Three Months Ended |
|
|
Six Months Ended |
|
|
|
June 30, |
|
|
June 30, |
|
|
|
(unaudited) |
|
|
|
(in thousands) |
|
|
|
2006 |
|
|
2005 |
|
|
2006 |
|
|
2005 |
|
Cost of service revenue |
|
$ |
|
|
|
$ |
546 |
|
|
$ |
|
|
|
$ |
565 |
|
General and administrative expenses |
|
|
|
|
|
|
2,806 |
|
|
|
|
|
|
|
3,291 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Total equity-based compensation expense |
|
$ |
|
|
|
$ |
3,352 |
|
|
$ |
|
|
|
$ |
3,856 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
See accompanying notes.
- 2 -
LHC GROUP, INC. AND SUBSIDIARIES
CONDENSED CONSOLIDATED STATEMENTS OF CASH FLOWS
|
|
|
|
|
|
|
|
|
|
|
Six Months Ended |
|
|
|
June 30, |
|
|
|
2006 |
|
|
2005 |
|
|
|
(unaudited) |
|
|
|
(in thousands) |
|
Operating activities |
|
|
|
|
|
|
|
|
Net income |
|
$ |
8,391 |
|
|
$ |
4,174 |
|
Adjustments to reconcile net income to net cash provided by (used
in) operating activities: |
|
|
|
|
|
|
|
|
Depreciation expense |
|
|
1,135 |
|
|
|
775 |
|
Provision for bad debts |
|
|
2,044 |
|
|
|
1,132 |
|
Equity-based compensation expense |
|
|
|
|
|
|
3,856 |
|
Compensation expense |
|
|
350 |
|
|
|
98 |
|
Minority interest in earnings of subsidiaries |
|
|
2,099 |
|
|
|
2,656 |
|
|
Deferred income taxes |
|
|
(379 |
) |
|
|
511 |
|
Gain on divestitures and sale of assets |
|
|
(637 |
) |
|
|
(510 |
) |
Changes in operating assets and liabilities, net of acquisitions: |
|
|
|
|
|
|
|
|
Receivables |
|
|
(6,007 |
) |
|
|
(18,638 |
) |
Prepaid expenses, other assets |
|
|
(329 |
) |
|
|
(1,339 |
) |
Accounts payable and accrued expenses |
|
|
4,100 |
|
|
|
(1,382 |
) |
Net amounts due under cooperative endeavor agreements |
|
|
9 |
|
|
|
207 |
|
Net amounts due governmental entities |
|
|
1,310 |
|
|
|
1,526 |
|
|
|
|
|
|
|
|
Net cash provided by (used in) operating activities |
|
|
12,086 |
|
|
|
(6,934 |
) |
Investing activities |
|
|
|
|
|
|
|
|
Purchases of property, building, and equipment |
|
|
(2,014 |
) |
|
|
(1,462 |
) |
Proceeds from sale of entities |
|
|
1,440 |
|
|
|
873 |
|
Cash paid for acquisitions, primarily goodwill |
|
|
(6,219 |
) |
|
|
(386 |
) |
|
|
|
|
|
|
|
Net cash used in investing activities |
|
|
(6,793 |
) |
|
|
(975 |
) |
Financing activities |
|
|
|
|
|
|
|
|
Issuance of common stock, net of underwriting discounts of $3,430 |
|
|
|
|
|
|
45,570 |
|
Dividends paid |
|
|
|
|
|
|
(227 |
) |
Principal payments on debt |
|
|
(1,065 |
) |
|
|
(1,468 |
) |
Payments on capital leases |
|
|
(231 |
) |
|
|
(343 |
) |
Proceeds from issuance of debt |
|
|
|
|
|
|
483 |
|
Net payments from lines of credit and revolving debt arrangements |
|
|
|
|
|
|
(14,288 |
) |
Proceeds from exercise of options |
|
|
33 |
|
|
|
|
|
Offering costs incurred |
|
|
|
|
|
|
(1,704 |
) |
Minority interest distributions, net |
|
|
(2,319 |
) |
|
|
(2,714 |
) |
|
|
|
|
|
|
|
|
Net cash
provided by (used in) financing activities |
|
|
(3,582 |
) |
|
|
25,309 |
|
|
|
|
|
|
|
|
Change in cash |
|
|
1,711 |
|
|
|
17,400 |
|
Cash at beginning of period |
|
|
17,398 |
|
|
|
2,911 |
|
|
|
|
|
|
|
|
Cash at end of period |
|
$ |
19,109 |
|
|
$ |
20,311 |
|
|
|
|
|
|
|
|
Supplemental disclosures of cash flow information |
|
|
|
|
|
|
|
|
Interest paid |
|
$ |
162 |
|
|
$ |
700 |
|
|
|
|
|
|
|
|
Income taxes paid |
|
$ |
120 |
|
|
$ |
5,821 |
|
|
|
|
|
|
|
|
Supplemental disclosure of non-cash transactions:
The Company sold a clinic for promissory notes totaling $946,000 and recognized a loss on the
sale of $28,000.
See accompanying notes.
- 3 -
LHC GROUP, INC. AND SUBSIDIARIES
NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS
(Unaudited)
1. Organization
LHC Group, Inc. (the Company) is a healthcare provider specializing in the post-acute
continuum of care primarily for Medicare beneficiaries in rural markets in the southern United
States. The Company provides home-based services, primarily through home nursing agencies and
hospices, and facility-based services, primarily through long-term acute care hospitals and
outpatient rehabilitation clinics. The Company, through its wholly and majority-owned subsidiaries,
equity joint ventures, and controlled affiliates, currently operates in Louisiana, Mississippi,
Arkansas, Alabama, West Virginia and Texas.
The Company operated as Louisiana Health Care Group, Inc. (LHCG), until March 2001, when the
shareholders of LHCG transferred to The Health Care Group, Inc. (THCG), all of the issued and
outstanding shares of common stock of LHCG in exchange for shares in THCG. On January 1, 2003, the
Company began operating as LHC Group, LLC, a Louisiana limited liability company. The THCG
shareholders exchanged their shares for membership interests in the Company (units).
Prior to February 9, 2005, the Company operated under the terms of an operating agreement
which provided that the Company did not have a finite life and that the members personal liability
was limited to his or her capital contribution. There was only one class of member interest.
Plan of Merger and Recapitalization
In January 2005, LHC Group, LLC established a wholly-owned Delaware subsidiary, LHC Group,
Inc. Effective February 9, 2005, LHC Group, LLC merged with and into LHC Group, Inc. In connection
with the merger, each outstanding membership unit in LHC Group, LLC was converted into shares of
the $0.01 par value common stock of LHC Group, Inc. based on an exchange ratio of three-for-two.
LHC Group, Inc. has 40,000,000 shares of $0.01 par value common stock authorized and 5,000,000
shares of $0.01 par value preferred stock authorized. All references to common stock, share, and
per share amounts have been retroactively restated to reflect the merger and recapitalization as if
the merger and recapitalization had taken place as of the beginning of the earliest period
presented.
As used herein, the Company includes LHC Group, Inc. and all predecessor entities.
Initial Public Offering
On June 9, 2005, the Company began its initial public offering of 4,800,000 shares of its
common stock at a price of $14.00 per share. The Company offered 3,500,000 shares along with
1,300,000 shares that were sold by certain stockholders of LHC Group. The Company received no
proceeds from the sale of the shares by the selling stockholders. The shares began trading on the
NASDAQ National Market under the symbol LHCG on June 9, 2005. The initial public offering was
completed on June 14, 2005. The underwriters exercised an option to purchase an additional 720,000
shares from certain stockholders solely to cover over-allotments. The Company received
$45,570,000, net of underwriting discounts of $3,430,000 in proceeds from the offering. The
Company incurred $3,963,000 in costs related to the initial public offering.
Unaudited Interim Financial Information
The condensed consolidated balance sheet as of June 30, 2006 and the related condensed
consolidated statements of income and cash flows for the three and six months ended June 30, 2006
and 2005 and related notes (interim financial information) have been prepared by LHC Group, Inc.
and are unaudited. In the opinion of management, all adjustments (consisting of normal recurring
accruals) considered necessary for a fair presentation in accordance with accounting principles
generally accepted in the United States have been included. Operating results for the three and
- 4 -
six months ended June 30, 2006 are not necessarily indicative of the results that may be
expected for the year ended December 31, 2006.
Certain information and footnote disclosures normally included in financial statements
prepared in accordance with accounting principles generally accepted in the United States have been
condensed or omitted from the interim financial information presented. These consolidated financial
statements should be read in conjunction with the notes to the consolidated financial statements
included in the Companys Consolidated Financial Statements our annual report on Form 10-K for the
year ended December 31, 2005, which includes information and
disclosures not included herein, as
filed with the Securities and Exchange Commission in the Form 10-K.
2. Significant Accounting Policies
Use of Estimates
The preparation of financial statements in conformity with accounting principles generally
accepted in the United States requires management to make estimates and assumptions that affect the
reported amounts of assets and liabilities and disclosure of contingent assets and liabilities at
the date of the financial statements and the reported revenue and expenses during the reported
period. Actual results could differ from those estimates.
Critical Accounting Policies
The most critical accounting policies relate to the principles of consolidation, revenue
recognition, accounts receivable and allowances for uncollectible accounts, and accounting for
goodwill.
Principles of Consolidation
The consolidated financial statements include all subsidiaries and entities controlled by the
Company. Control is generally defined by the Company as ownership of a majority of the voting
interest of an entity. The consolidated financial statements include entities in which the Company
absorbs a majority of the entitys expected losses, receives a majority of the entitys expected
residual returns, or both, as a result of ownership, contractual or other financial interests in
the entity.
All significant inter-company accounts and transactions have been eliminated in consolidation.
Business combinations accounted for as purchases have been included in the consolidated financial
statements from the respective dates of acquisition.
The following describes the Companys consolidation policy with respect to its various
ventures excluding wholly owned subsidiaries:
Equity Joint Ventures
The Companys joint ventures are structured as limited liability companies in which the
Company typically owns a majority equity interest ranging from 51% to 98%. Each member of all but
one of the Companys equity joint ventures participates in profits and losses in proportion to
their equity interests. The Company has one joint venture partner whose participation in losses is
limited. The Company consolidates these entities as the Company absorbs a majority of the entities
expected losses, receives a majority of the entities expected residual returns and generally has
voting control.
Cooperative Endeavors
The Company has arrangements with certain partners that involve the sharing of profits and
losses. Unlike the equity joint ventures, the Company owns 100% of the equity in these cooperative
endeavors. In these cooperative endeavors, the Company possesses interests in the net profits and
losses ranging from 67% to 70%. The Company has one cooperative endeavor partner whose
participation in losses is limited. The Company consolidates these
- 5 -
entities as the Company owns 100% of the outstanding equity and the Company absorbs a majority
of the entities expected losses and receives a majority of the entities expected residual returns.
License Leasing Arrangements
The Company, through wholly owned subsidiaries, leases home health licenses necessary to
operate certain of its home nursing agencies. As with wholly owned subsidiaries, the Company owns
100% of the equity of these entities and consolidates them based on such ownership as well as the
Companys right to receive a majority of the entities expected residual returns and the Companys
obligation to absorb a majority of the entities expected losses.
Management Services
The Company has various management services agreements under which the Company manages certain
operations of agencies and facilities. The Company does not consolidate these agencies or
facilities, as the Company does not have an ownership interest and does not have a right to receive
a majority of the agencies or facilities expected residual returns or an obligation to absorb a
majority of the agencies or facilities expected losses.
The following table summarizes the percentage of net service revenue earned by type of
ownership or relationship the Company had with the operating entity:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Three Months |
|
Six Months |
|
|
Ended June 30, |
|
Ended June 30, |
|
|
2006 |
|
2005 |
|
2006 |
|
2005 |
Wholly owned subsidiaries |
|
|
35.4 |
% |
|
|
22.7 |
% |
|
|
35.9 |
% |
|
|
26.0 |
% |
Equity joint ventures |
|
|
49.3 |
|
|
|
59.6 |
|
|
|
49.1 |
|
|
|
56.1 |
|
Cooperative endeavors |
|
|
1.6 |
|
|
|
2.6 |
|
|
|
1.7 |
|
|
|
2.8 |
|
License leasing arrangements |
|
|
11.4 |
|
|
|
11.6 |
|
|
|
11.4 |
|
|
|
11.7 |
|
Management services |
|
|
2.3 |
|
|
|
3.5 |
|
|
|
1.9 |
|
|
|
3.4 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
100.0 |
% |
|
|
100.0 |
% |
|
|
100.0 |
% |
|
|
100.0 |
% |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Revenue Recognition
The Company reports net service revenue at the estimated net realizable amount due from
Medicare, Medicaid, commercial insurance, managed care payors, patients, and others for services
rendered. Under Medicare, the Companys home nursing patients are classified into a group referred
to as a home health resource group prior to the receipt of services. Based on this home health
resource group, the Company is entitled to receive a prospective Medicare payment for delivering
care over a 60 day period referred to as an episode. Medicare adjusts these prospective payments
based on a variety of factors, such as low utilization, patient transfers, changes in condition and
the level of services provided. In calculating the Companys reported net service revenue from home
nursing services, the Company adjusts the prospective Medicare payments by an estimate of the
adjustments. The Company calculates the adjustments based on a historical average of these types of
adjustments. For home nursing services, the Company recognizes revenue based on the number of days
elapsed during the episode of care.
Under Medicare, patients in the Companys long-term acute care facilities are classified into
long-term diagnosis-related groups. Based on this classification, the Company is then entitled to
receive a fixed payment from Medicare. This fixed payment is also subject to adjustment by Medicare
due to factors such as short stays. In calculating reported net service revenue for services
provided in the Companys long-term acute care hospitals, the Company reduces the prospective
payment amounts by an estimate of the adjustments. The Company calculates the adjustment based on a
historical average of these types of adjustments for claims paid. For the Companys long-term acute
care hospitals, revenue is recognized as services are provided.
For hospice services, the Company is paid by Medicare under a per diem payment system. The
Company receives one of four predetermined daily or hourly rates based upon the level of care the
Company furnished. The Company records net service revenue from hospice services based on the daily
or hourly rate. The Company recognizes revenue for hospice as services are provided.
- 6 -
Under Medicare, the Company is reimbursed for rehabilitation services based on a fee schedule
for services provided adjusted by the geographical area in which the facility is located. The
Company recognizes revenue as these services are provided.
The Companys Medicaid reimbursement is based on a predetermined fee schedule applied to each
service provided. Therefore, revenue is recognized for Medicaid services as services are provided
based on this fee schedule. The Companys managed care payors reimburse the Company in a manner
similar to either Medicare or Medicaid. Accordingly, the Company recognizes revenue from managed
care payors in the same manner as the Company recognizes revenue from Medicare or Medicaid.
The Company records management services revenue as services are provided in accordance with
the various management services agreements to which the Company is a party. The agreements
generally call for the Company to provide billing, management, and other consulting services suited
to and designed for the efficient operation of the applicable home nursing agency, hospice, or
inpatient rehabilitation facility. The Company is responsible for the costs associated with the
locations and personnel required for the provision of the services. The Company is generally
compensated based on a percentage of net billings or an established base fee. In addition, for
certain of the management agreements, the Company may earn incentive compensation.
Net service revenue was comprised of the following:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Three Months |
|
Six Months |
|
|
Ended June 30, |
|
Ended June 30, |
|
|
2006 |
|
2005 |
|
2006 |
|
2005 |
Home-based services |
|
|
73.9 |
% |
|
|
68.8 |
% |
|
|
72.8 |
% |
|
|
69.4 |
% |
Facility-based services |
|
|
26.1 |
|
|
|
31.2 |
|
|
|
27.2 |
|
|
|
30.6 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
100.0 |
% |
|
|
100.0 |
% |
|
|
100.0 |
% |
|
|
100.0 |
% |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
The following table sets forth the percentage of net service revenue earned by category of
payor:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Three Months |
|
Six Months |
|
|
Ended June 30, |
|
Ended June 30, |
|
|
2006 |
|
2005 |
|
2006 |
|
2005 |
Payor: |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Medicare |
|
|
84.7 |
% |
|
|
88.0 |
% |
|
|
84.8 |
% |
|
|
86.3 |
% |
Medicaid |
|
|
4.3 |
|
|
|
4.7 |
|
|
|
4.8 |
|
|
|
4.5 |
|
Other |
|
|
11.0 |
|
|
|
7.3 |
|
|
|
10.4 |
|
|
|
9.2 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
100.0 |
% |
|
|
100.0 |
% |
|
|
100.0 |
% |
|
|
100.0 |
% |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Home-Based Services
Home Nursing Services. The Company receives a standard prospective Medicare payment for
delivering care. The base payment, established through federal legislation, is a flat rate that is
adjusted upward or downward based upon differences in the expected resource needs of individual
patients as indicated by clinical severity, functional severity, and service utilization. The
magnitude of the adjustment is determined by each patients categorization into one of 80 payment
groups, known as home health resource groups, and the costliness of care for patients in each group
relative to the average patient. The Companys payment is also adjusted for differences in local
prices using the hospital wage index. The Company performs payment variance analyses to verify the
models utilized in projecting total net service revenue are accurately reflecting the payments to
be received.
Medicare rates are subject to change. Due to the length of the Companys episodes of care, a
situation may arise where Medicare rate changes affect a prior periods net service revenue. In the
event that Medicare rates experience change, the net effect of that change will be reflected in the
current reporting period.
Final payments from Medicare may reflect one of five retroactive adjustments to ensure the
adequacy and effectiveness of the total reimbursement: (a) an outlier payment if the patients care
was unusually costly; (b) a low utilization adjustment if the number of visits was fewer than five;
(c) a partial payment if the patient transferred to another provider before completing the episode;
(d) a change-in-condition adjustment if the patients medical status changes significantly,
resulting in the need for more or less care; or (e) a payment adjustment based upon the level
- 7 -
of therapy services required in the population base. Management estimates the impact of these
payment adjustments based on historical experience and records this estimate during the period the
services are rendered.
Hospice Services. The Companys Medicare hospice reimbursement is based on an
annually-updated prospective payment system. Hospice payments are also subject to two caps. One
cap relates to individual programs receiving more than 20% of its total Medicare reimbursement from
inpatient care services. The second cap relates to individual programs receiving reimbursements in
excess of a cap amount, calculated by multiplying the number of beneficiaries during the period
by a statutory amount that is indexed for inflation. The determination for each cap is made
annually based on the 12-month period ending on October 31 of each year. This limit is computed on
a program-by-program basis. None of the Companys hospices exceeded either cap during the six
months ended June 30, 2006 or 2005.
Facility-Based Services
Long-Term Acute Care Services. The Company is reimbursed by Medicare for services provided
under the long-term acute care hospital prospective payment system, which was implemented on
October 1, 2002. Each patient is assigned a long-term care diagnosis-related group. The Company is
paid a predetermined fixed amount applicable to that particular group. This payment is intended to
reflect the average cost of treating a Medicare patient classified in that particular long-term
care diagnosis-related group. For selected patients, the amount may be further adjusted based on
length of stay and facility-specific costs, as well as in instances where a patient is discharged
and subsequently readmitted, among other factors. Similar to other Medicare prospective payment
systems, the rate is also adjusted for geographic wage differences.
Outpatient Rehabilitation Services. Outpatient therapy services are reimbursed on a fee
schedule, subject to annual limitations. Outpatient therapy providers receive a fixed fee for each
procedure performed, adjusted by the geographical area in which the facility is located. The
Company recognizes revenue as the services are provided. There are also annual per Medicare
beneficiary caps that limit Medicare coverage for outpatient rehabilitation services.
Accounts Receivable and Allowances for Uncollectible Accounts
The Company reports accounts receivable net of estimated allowances for uncollectible accounts
and adjustments. Accounts receivable are uncollateralized and primarily consist of amounts due from
third-party payors and patients. To provide for accounts receivable that could become uncollectible
in the future, the Company establishes an allowance for uncollectible accounts to reduce the
carrying amount of such receivables to their estimated net realizable value. The credit risk for
other concentrations of receivables is limited due to the significance of Medicare as the primary
payor. The Company does not believe that there are any other significant concentrations of
receivables from any particular payor that would subject it to any significant credit risk in the
collection of accounts receivable.
The amount of the provision for bad debts is based upon the Companys assessment of historical
and expected net collections, business and economic conditions, and trends in government
reimbursement. Uncollectible accounts are written off when the Company has determined the account
will not be collected.
A portion of the estimated Medicare prospective payment system reimbursement from each
submitted home nursing episode is received in the form of a request for accelerated payment before
all services are rendered. The estimated episodic payment is billed at the commencement of the
episode. The Company requests an accelerated payment for 60% of the estimated reimbursement at the
initial billing for the initial episode of care per patient and the remaining reimbursement is
requested upon completion of the episode. For any subsequent episodes of care contiguous with the
first episode of care for the patient, the Company requests an accelerated payment for 50% of the
estimated reimbursement at initial billing. The remaining 50% reimbursement is requested upon
completion of the episode. The Company has earned net service revenue in excess of billings
rendered to Medicare. Only a nominal portion of the amounts due to the Medicare program represent
cash collected in advance of providing services.
- 8 -
Goodwill
Goodwill and other intangible assets with indefinite lives are reviewed annually, or more
frequently if circumstances indicate impairment may have occurred. Principally all of the Companys
intangible assets are goodwill.
The Company estimates the fair value of its identified reporting units and compares those
estimates against the related carrying value. For each of the reporting units, the estimated fair
value is determined based on a multiple of earnings before interest, taxes, depreciation, and
amortization or on the estimated fair value of assets in situations when it is readily
determinable.
The Company has concluded that licenses to operate home-based and/or facility-based services
have indefinite lives, as management has determined that there are no legal, regulatory,
contractual, economic or other factors that would limit the useful life of the licenses and the
Company intends to renew and operate the licenses indefinitely. Accordingly, the Company has
elected to recognize the fair value of these indefinite-lived licenses and goodwill as a single
asset for financial reporting purposes.
Components of the Companys home nursing operating segment are generally represented by
individual subsidiaries or joint ventures with individual licenses to conduct specific operations
within geographic markets as limited by the terms of each license. Components of the Companys
facility-based services are represented by individual operating entities. Effective January 1,
2004, management began aggregating the components of these two segments into two reporting units
for purposes of evaluating impairment. Prior to January 1, 2004, management evaluated each
operating entity separately for impairment. Modifications to the Companys management of the
segments and reporting provided management with a basis to change the reporting unit structure.
Other Significant Accounting Policies
Due to/from Governmental Entities
The Company records revenue related to their critical access hospital at the lower of cost or
charges, limited by cost caps depending on the payor. Final reimbursement is determined based on
submission of annual cost reports and audits by the fiscal intermediary. Adjustments are accrued
on an estimated basis in the period the related services were rendered and further adjusted as
final settlements are determined. These adjustments are accounted for as changes in estimates.
Also included in the due to/from governmental entities account are reimbursements that the
Company is due from the government as well as payments that are expected to be recouped by the
government from the Company related to outlier payments for two long term acute care hospitals.
Property, Building, and Equipment
Property, building, and equipment are stated at cost. Depreciation is computed using the
straight-line method over the estimated useful lives of the individual assets, generally ranging
from three to ten years and up to thirty-nine years on buildings. Depreciation expense for the
three months ended June 30, 2006 and 2005 was $577,000 and $384,000, respectively and $1,135,000
and $775,000 for the six months ended June 30, 2006 and 2005, respectively.
Capital leases are included in equipment. Capital leases are recorded at the present value of
the future rentals at lease inception and are amortized over the shorter of the applicable lease
term or the useful life of the equipment. Amortization of assets under the capital lease
obligations is included in depreciation and amortization expense.
- 9 -
Long-Lived Assets
The Company reviews the recoverability of long-lived assets whenever events or circumstances
occur which indicate recorded costs may not be recoverable. If the expected future cash flows
(undiscounted) are less than the carrying amount of such assets, the Company recognizes an
impairment loss for the difference between the carrying amount of the assets and their estimated
fair value.
Income Taxes
The Company accounts for income taxes using the liability method. Under the liability method,
deferred taxes are determined based on differences between the financial reporting and tax bases of
assets and liabilities, and are measured using the enacted tax laws that will be in effect when the
differences are expected to reverse. Management provides a valuation allowance for any net deferred
tax assets when it is more likely than not that a portion of such net deferred tax assets will not
be recovered.
Minority Interest and Cooperative Endeavor Agreements
The interest held by third parties in subsidiaries owned or controlled by the Company is
reported on the consolidated balance sheets as minority interest. Minority interest reported in the
consolidated statements of income reflects the respective interests in the income or loss of the
subsidiaries attributable to the other parties, the effect of which is removed from the Companys
consolidated results of operations.
Two of the Companys home health agencies have cooperative endeavor agreements with third
parties that allow the third parties to be paid or recover a fee based on the profits or losses of
the respective agencies. The Company accrues for the settlement of the third partys profits or
losses during the period the amounts are earned. Under the agreements, the Company has incurred net
amounts due to the third parties of $55,000 and $95,000 for the three months ended June 30, 2006
and 2005, respectively and $120,000 and $231,000 for the six months ended June 30, 2006 and 2005,
respectively. The cooperative endeavor agreements have terms expiring through at the end of June
2008.
For agreements where the third party is a healthcare institution, the agreements typically
require the Company to lease building and equipment and receive housekeeping and maintenance from
the healthcare institutions. Ancillary services related to these arrangements are also typically
provided by the healthcare institution.
Minority Interest Subject to Exchange Contracts and/or Put Options
During 2004, in conjunction with the acquisition/sale of joint venture interests, the Company
entered into agreements with minority interest holders in three of its majority owned subsidiaries
that allowed these minority interest holders to put their minority interests to the Company in the
event the Company is sold, merged or otherwise acquired or completes an initial public offering
(IPO). These put options were deemed to be part of the underlying minority interest shares, thus
rendering the shares to be puttable shares. In September and November of 2004, the Company entered
into forward exchange contracts with the minority interest holders in two of these subsidiaries,
Acadian Home Health Care Services, LLC (Acadian) and Hebert, Thibodeaux, Albro and Touchet
Therapy Group, Inc. (Hebert) which required the minority interest holders in these subsidiaries
to sell their interests to the Company in the event of an IPO. In conjunction with the Companys
IPO, the forward exchange contracts were consummated and the minority interest holders of Acadian
and Hebert sold their minority interests to the Company in exchange for cash and shares of the
Companys common stock. The Company had accrued the cash payment of approximately $2.2 million to
be paid under these forward exchange contracts. This amount was paid in full in 2005.
In the third majority-owned subsidiary, St. Landry Extended Care Hospital, LLC (St. Landry),
the put option allows the minority interest holders to convert their minority interests into shares
of the Company based upon St. Landrys EBITDA for the prior fiscal year in relation to the
Companys EBITDA over the same period. The put option became exercisable by the minority interest
holders in St. Landry upon the completion of the IPO. However, due to applicable laws and
regulations, the minority interest holders can not convert their minority interests in St. Landry
unless certain conditions are met including, but not limited to, the Company having stockholders
equity in excess of $75 million at the end of its most recent fiscal year or on average during the
previous three fiscal years. If the St. Landry minority interest holders do not or are unable to
convert their minority interests into shares of the Company, the minority interest holders shall
have the option to redeem their minority interests at any time following
- 10 -
thirty days after the IPO for cash consideration equal to the value of the shares the minority
interest holders would have received if they had converted their minority interests into shares of
the Company multiplied by the average closing price of the Companys shares for the thirty days
preceding the date of the minority interest holders exercise of the redemption option. As of
December 31, 2005 and June 30, 2006, the Company had exceeded $75 million in stockholders equity.
As of June 30, 2006, approximately 59% of the doctors have converted their minority interests to
cash.
The above put/redemption options and exchange agreements have been presented in the historical
financial statements under the guidance in Accounting Series Release (ASR) No. 268 and Emerging
Issues Task Force (EITF) Topic D-98, which generally require a public companys stock subject to
redemption requirements that are outside the control of the issuer to be excluded from the caption
stockholders equity and presented separately in the issuers balance sheet. Under EITF Topic
D-98, once it becomes probable that the minority interest would become redeemable, the minority
interest should be adjusted to its current redemption amount. As noted above, the St. Landry put
option allowed the minority interest holders in St. Landry to have their interests redeemed for
cash upon the completion of the IPO and therefore the Company recorded an adjustment of
approximately $1.5 million to minority interests subject to exchange contracts and/or put options
and to retained earnings which represents the redemption value of St. Landrys interests at June
30, 2005. In September 2005, certain minority interest holders redeemed their interests in St.
Landry. This resulted in a cash payment of approximately $214,000. In connection with the partial
redemption of certain minority interests in September 2005, we decreased our minority interests by
approximately $149,000 and increased our retained earnings by the same amount. Simultaneously, we
recorded goodwill of $214,000 to represent the value of the minority interests redeemed. Also at
the end of the third quarter of 2005, we recorded a mark to market charge of $404,000.
In November 2005, the agreement was amended to allow minority interest holders to redeem their
minority interests based on the St. Landrys rolling twelve month EBITDA in relation to the
Companys EBITDA over the same period. At December 31, 2005, the Company recorded an additional
mark-to-market benefit of $266,000 to mark the liability to redemption value at the end of the
quarter.
In connection with the partial redemption of certain minority interest in the six months ended
June 30, 2006, the Company decreased our minority interests by approximately $939,000 and increased
our retained earnings by the same amount. Simultaneously, the Company recorded goodwill of
$889,000 to represent the value of the minority interests redeemed. Also for the six months ended
June 30, 2006, the Company recorded a mark-to-market benefit of $76,000.
Equity-Based Compensation Expense
During 2003, the Company began sponsoring a Key Employee Equity Participation Plan (KEEP
Plan) whereby certain individuals are granted participation equity units (KEEP Units). The KEEP
Plan was terminated in conjunction with the initial public offering when the outstanding units were
converted to 481,680 shares of common stock. The KEEP Plan functioned as a stock appreciation
rights plan whereby an individual was entitled to receive, on a per KEEP Unit basis, the increase
in estimated fair value of the Companys common stock from the date of grant until the date that
the employee dies, retires, or is terminated for other than cause. Accordingly, the KEEP Units were
subject to variable accounting until such time as the obligation to the employee was settled. The
Company had a call right, under which it could purchase all or portion of the KEEP Units. The
individuals receiving KEEP Units vested in those rights in a graded manner over a five-year period
and, accordingly, the Company recorded compensation expense for the vested portion of the KEEP
Units. The KEEP Units had no exercise price.
Compensation expense, and a corresponding increase in paid-in capital, was also recognized
each period for any change in value associated with certain KEEP Units that were held by an officer
of the Company.
In conjunction with the initial public offering, the outstanding KEEP Units were converted to
common stock. In conjunction with this conversion, the Company incurred a charge to equity based
compensation of approximately $3.0 million. The Company did not incur any expenses relating to the
KEEP Units in 2006.
- 11 -
Stock-based Compensation
On January 20, 2005, the 2005 Long-Term Incentive Plan was adopted by the Companys board of
directors. There are 1,000,000 shares available for issuance under this plan. The Plan went into
effect at the close of the initial public offering. Also during 2005, stock options and restricted
stock were granted to the independent members of our Board of Directors in accordance with the 2005
Director Compensation Plan. Both the shares and options were issued from the 1,000,000 shares
reserved for issuance under the 2005 Long-Term Incentive Plan.
The Company previously accounted for these issuances of restricted stock and stock option
grants in accordance with Accounting Principles Board Opinion No. 25, Accounting for Stock Issued
to Employees and related interpretations (APB 25). Accordingly, the Company did not recognize
compensation cost in connection with the issuance of the stock options, as the options granted had
an exercise price equal to the market value of LHC Group, Inc. common stock on the date of grant.
The Company did recognize compensation cost in connection with the issuance of restricted stock.
The Company adopted Statement of Financial Accounting Standards (SFAS) No. 123(R) (revised
2004), Share-Based Payment, a revision of SFAS No. 123, Accounting for Stock-Based Compensation, on
January 1, 2006 using the modified prospective method. This method requires compensation cost to
be recognized beginning with the effective date (a) based on the requirements of SFAS No. 123(R)
for all share-based payments granted after the effective date and (b) based on the requirements of
SFAS No. 123 for all awards granted to employees prior to the effective date of SFAS No. 123(R)
that remain unvested on the effective date.
SFAS 123(R) applies to new awards issued on or after January 1, 2006, as well as awards that
were outstanding as of December 31, 2005. Prior periods were not restated to reflect the impact of
adopting the new standard.
Stock Options
The Company uses the Black-Scholes option pricing model to estimate the fair value of
stock-based awards with the following weighted-average assumptions.
|
|
|
|
|
|
|
|
|
|
|
Six Months Ended June 30, |
|
|
2006 |
|
2005 |
Risk free interest rate |
|
|
5.03 |
% |
|
|
3.72 |
% |
Expected life (years) |
|
|
5 |
|
|
|
5 |
|
Volatility |
|
|
38.39 |
|
|
|
41.62 |
|
Expected annual dividend yield |
|
|
|
|
|
|
|
|
The following table represents stock options activity for the six month period ended June 30,
2006:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Weighted |
|
|
Number of |
|
average exercise |
|
|
Shares |
|
price |
Options outstanding at December 31, 2005 |
|
|
13,500 |
|
|
$ |
14.45 |
|
Options granted |
|
|
15,500 |
|
|
|
19.75 |
|
Options exercised |
|
|
(2,000 |
) |
|
|
14.45 |
|
Options forfeited or expired |
|
|
|
|
|
|
|
|
Options outstanding at June 30, 2006 |
|
|
27,000 |
|
|
|
17.49 |
|
Options exercisable at June 30, 2006 |
|
|
27,000 |
|
|
|
17.49 |
|
The Company has recorded $134,000 in compensation expense related to stock option grants in
the periods ended June 30, 2006. The proforma expense for the same periods in 2005 was $66,000.
Restricted Stock
During 2005, 24,500 shares of restricted stock were issued to our independent directors under
the 2005 Director Compensation Plan. One third of these shares vested immediately, and the
remaining will vest over a two year period. On January 3, 2006, the Company granted 76,114 shares
of restricted stock to certain members of management. These shares were granted pursuant to the
2005 Long-Term Incentive Plan. These shares vest over a five year period. During the three month
period ended June 30, 2006, 8,731 shares of restricted stock were forfeited
- 12 -
and 13,500 shares were granted to newly appointed directors and officers with the same vesting
schedules as shares previously issued.
As of January 1, 2006, there were 16,333 shares of restricted stock outstanding at an average
market value at the date of award of $14.44. During the six months ended June 30, 2006, the
Company granted 89,614 shares of restricted stock at the fair value of $18.14. During the six
months ended June 30, 2006, 8,168 shares of restricted stock vested and 8,731 shares were
forfeited.
The Company has recorded $222,000 in compensation expense related to restricted stock grants
in the six month period ended June 30, 2006.
Earnings Per Share
Basic per share information is computed by dividing the item by the weighted-average number of
shares outstanding during the period. Diluted per share information is computed by dividing the
item by the weighted-average number of shares outstanding plus dilutive potential shares.
The following table sets forth shares used in the computation of basic and diluted per share
information for the three and six months ended June 30, 2006 and 2005.
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Three Months Ended |
|
|
Six Months Ended |
|
|
|
June 30, |
|
|
June 30, |
|
|
|
2006 |
|
|
2005 |
|
|
2006 |
|
|
2005 |
|
Weighted average number of shares
outstanding for basic per share
calculation |
|
|
16,561,398 |
|
|
|
13,174,690 |
|
|
|
16,559,623 |
|
|
|
12,632,932 |
|
Effect of dilutive potential shares: |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Options |
|
|
1,454 |
|
|
|
|
|
|
|
1,197 |
|
|
|
|
|
Restricted stock |
|
|
13,216 |
|
|
|
102,349 |
|
|
|
8,907 |
|
|
|
108,469 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Adjusted weighted average shares
for diluted per share calculation |
|
|
16,576,068 |
|
|
|
13,277,039 |
|
|
|
16,569,727 |
|
|
|
12,741,401 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Recently Issued Accounting Pronouncements
In July 2006, the FASB issued FASB Interpretation No. 48, Accounting for the Uncertainty in
Income Taxes, (FIN 48). FIN 48 is an interpretation of FASB Statement No. 109, Accounting for
Income Taxes, and it seeks to reduce the diversity in practice associated with certain aspects of
measurement and recognition in accounting for income taxes. In addition, FIN 48 requires expanded
disclosure with respect to the uncertainty in income taxes and is effective as of the beginning of
our 2007 fiscal year. The Company is currently evaluating the impact, if any, that FIN 48 will have
on the financials statements.
3. Acquisitions and Divestitures
The following acquisitions were completed pursuant to the Companys strategy of becoming the
leading provider of post-acute healthcare services to Medicare patients in selected rural markets
in the southern United States. The purchase price of each acquisition was determined based on the
Companys analysis of comparable acquisitions and target markets potential cash flows. Goodwill
generated from the acquisitions was recognized based on the expected contributions of each
acquisition to the overall corporate strategy. The Company expects the goodwill recognized in
connection with the acquisition of existing operations to be fully tax deductible.
2006 Acquisitions
During the six month period ended June 30, 2006, the Company acquired the existing operations
of four entities and the minority interest in one of its joint ventures for $4,950,000 in cash and
$238,000 in acquisition costs. Goodwill of $3.9 million was assigned to the home based services
segment.
- 13 -
In conjunction with certain minority interest holders redeeming their interests in St. Landry,
$889,000 of goodwill, which is deductible for income tax purposes, was recognized in the facility
based services segment.
2006 Divestitures
The Company sold one of its long-term acute care hospitals during the six month period ended
June 30, 2006 for $1.2 million. The Company recognized a gain of $960,000 on the sale of this
hospital. In conjunction with this transaction, the Company allocated and retired $155,000 of
goodwill related to this hospital. The Company sold a clinic in the three months ended June 30,
2006 for promissory notes totaling $946,000 and recognized a loss on the sale of $28,000. Goodwill
of $891,000 was retired in conjunction with the sale of the clinic. Additionally, the Company
closed one location of another clinic and terminated virtually all of its private duty business
during the six month period ended June 30, 2006. Finally, the Company also sold one of its home
health agencies during the three month period ended June 30, 2006 for $250,000 and retired goodwill
of $50,000. The Company recognized a gain of $98,000 on the sale of this agency. The Company has
identified a long-term acute care hospital as held for sale as of June 30, 2006. Goodwill of
$402,000 and other assets related to this hospital are classified as assets held for sale on the
balance sheet.
The following table summarizes the operating results of these divestitures which have been
presented as loss from discontinued operations in the accompanying consolidated statements of
income:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Three Months |
|
|
Six Months |
|
|
|
Ended |
|
|
Ended |
|
|
|
June 30, |
|
|
June 30, |
|
|
|
2006 |
|
|
2005 |
|
|
2006 |
|
|
2005 |
|
Net service revenue |
|
$ |
1,683 |
|
|
$ |
2,434 |
|
|
$ |
4,343 |
|
|
$ |
4,568 |
|
Costs, expenses and minority interest and
cooperative endeavor allocations |
|
|
1,780 |
|
|
|
3,348 |
|
|
|
4,922 |
|
|
|
6,388 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Loss from discontinued operations before income taxes |
|
|
(97 |
) |
|
|
(914 |
) |
|
|
(579 |
) |
|
|
(1,820 |
) |
Income taxes |
|
|
37 |
|
|
|
347 |
|
|
|
219 |
|
|
|
691 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Loss from discontinued operations |
|
$ |
(60 |
) |
|
$ |
(567 |
) |
|
$ |
(360 |
) |
|
$ |
(1,129 |
) |
|
|
|
|
|
|
|
|
|
|
|
|
|
The changes in recorded goodwill by segment for the three month period ended June 30, 2006
were as follows:
|
|
|
|
|
|
|
Six Months |
|
|
|
Ended |
|
|
|
June 30, |
|
|
|
2006 |
|
|
|
(in thousands) |
|
Home-based services segment: |
|
|
|
|
Balance at December 31, 2005 |
|
$ |
21,692 |
|
Goodwill acquired during the period from acquisitions |
|
|
3,411 |
|
Goodwill retired during the period |
|
|
(50 |
) |
Goodwill acquired during the period from purchase of minority interest |
|
|
495 |
|
|
|
|
|
|
|
|
|
|
Balance at June 30, 2006 |
|
$ |
25,548 |
|
|
|
|
|
Facility-based services segment: |
|
|
|
|
Balance at December 31, 2005 |
|
$ |
4,411 |
|
Goodwill retired during the period from sale of business |
|
|
(1,046 |
) |
Goodwill classified as held for sale during the period |
|
|
(402 |
) |
Goodwill acquired during the period from redemption of minority
interest |
|
|
889 |
|
|
|
|
|
Balance at June 30, 2006 |
|
$ |
3,852 |
|
|
|
|
|
The above transactions were considered to be immaterial individually and in the aggregate.
Accordingly, no supplemental pro forma information is required.
- 14 -
4. Credit Arrangements
Long-Term Debt
Long-term debt consisted of the following:
|
|
|
|
|
|
|
|
|
|
|
June 30, |
|
|
December 31, |
|
|
|
2006 |
|
|
2005 |
|
|
|
(in thousands) |
|
Notes payable: |
|
|
|
|
|
|
|
|
Due in monthly installments of $143,000 through July 2006 at 5.5% |
|
$ |
|
|
|
$ |
842 |
|
Due in
yearly installments of $50,000 through August 2010 at 6.25% |
|
|
250 |
|
|
|
250 |
|
Due in monthly installments of $20,565 through October 2015 at LIBOR
plus 225 basis points (8.02% at June 30, 2006) |
|
|
2,911 |
|
|
|
2,929 |
|
Due in monthly installments of $48,500 through March 2006 at 5.7% |
|
|
|
|
|
|
144 |
|
Due in monthly installments of $12,500 through November 2009 at 3.08% |
|
|
454 |
|
|
|
515 |
|
|
|
|
|
|
|
|
|
|
|
3,615 |
|
|
|
4,680 |
|
Less current portion of long-term debt |
|
|
425 |
|
|
|
1,406 |
|
|
|
|
|
|
|
|
|
|
$ |
3,190 |
|
|
$ |
3,274 |
|
|
|
|
|
|
|
|
In August 2005, the Company entered into a promissory note with Bancorp Equipment Finance,
Inc. to purchase an airplane, for a principal amount of $2,975,000 with interest on any outstanding
principal balance at the one month LIBOR rate plus 225 basis points. The note is collateralized by
the airplane and is payable in 119 monthly installments of $20,565 followed by one balloon
installment in the amount of $1,920,565.
In August 2005, the Company entered into a promissory note with the seller of A-1 Nursing
Registry, Inc. (A-1) in conjunction with the purchase of the assets of A-1. The principal amount
of the note is $250,000 and it bears interest at 6.25%.
Certain of the Companys loan agreements contain certain restrictive covenants, including
limitations on indebtedness and the maintenance of certain financial ratios. At June 30, 2006 and
at December 31, 2005, the Company was in compliance with all covenants.
Other Credit Arrangements
The Company maintains a revolving-debt arrangement. Under the terms of this arrangement, the
Company may be advanced funds up to a defined limit of eligible accounts receivable not to exceed
the borrowing limit. At June 30, 2006 and December 31, 2005, the borrowing limit was $22,500,000,
and the amounts outstanding were $0. Interest accrues on outstanding amounts at a varying rate and
is based on the Wells Fargo Bank, N.A. prime rate plus 1.5% (9.75% at June 30, 2006). The annual
facility fee is 0.5% of the total availability. The agreement expires on April 15, 2010.
5. Key Employee Equity Participation Plan
The Company had reserved up to 6.5% of the value of the Companys stock for issuance under the
KEEP Plan. In conjunction with the initial public offering the 481,680 units became completely
vested and were converted to common stock. During 2005, the Company incurred a charge to equity
based compensation of $3.9 million. A summary of the changes in the KEEP Units outstanding is as
follows:
|
|
|
|
|
|
|
|
|
|
|
June 30, |
|
|
December 31, |
|
|
|
2006 |
|
|
2005 |
|
Outstanding at beginning of period |
|
|
|
|
|
|
481,680 |
|
Granted |
|
|
|
|
|
|
375,180 |
|
Exercised |
|
|
|
|
|
|
|
|
Converted |
|
|
|
|
|
|
(481,680 |
) |
|
|
|
|
|
|
|
Outstanding at end of period |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Number of KEEP Units vested at end of period |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
The KEEP Units were accounted for at their estimated fair value. Accordingly, no pro forma net
income or per share information was required for prior periods.
- 15 -
6. Shareholders Equity
The following table summarizes the activity in stockholders equity for the six month period
ended June 30, 2006 (amounts in thousands, except per share data):
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Common Stock |
|
|
Additional |
|
|
|
|
|
|
|
|
|
Issued |
|
|
Treasury |
|
|
Paid-In |
|
|
Retained |
|
|
|
|
|
|
Amount |
|
|
Shares |
|
|
Amount |
|
|
Shares |
|
|
Capital |
|
|
Earnings |
|
|
Total |
|
Balances at December 31, 2005 |
|
$ |
166 |
|
|
|
19,507,887 |
|
|
$ |
(2,856 |
) |
|
|
2,950,059 |
|
|
$ |
58,596 |
|
|
$ |
22,538 |
|
|
$ |
78,444 |
|
Net income |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
8,391 |
|
|
|
8,391 |
|
Compensation expense |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
282 |
|
|
|
|
|
|
|
282 |
|
Stock options issued |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
128 |
|
|
|
|
|
|
|
128 |
|
Stock options exercised |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
33 |
|
|
|
|
|
|
|
33 |
|
Recording minority interest in
joint venture at redemption
value |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
1,015 |
|
|
|
1,015 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Balances at June 30, 2006 |
|
$ |
166 |
|
|
|
19,507,887 |
|
|
$ |
(2,856 |
) |
|
|
2,950,059 |
|
|
$ |
59,039 |
|
|
$ |
31,944 |
|
|
$ |
88,293 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
7. Commitments and Contingencies
Contingent Convertible Minority Interests
During 2004, in conjunction with the acquisition/sale of joint venture interests, the Company
entered into agreements with minority interest holders in three of its majority owned subsidiaries
that allowed these minority interest holders to put their minority interests to the Company in the
event the Company is sold, merged or otherwise acquired or completes an initial public offering
(IPO). These put options were deemed to be part of the underlying minority interest shares, thus
rendering the shares to be puttable shares. In September and November of 2004, the Company entered
into forward exchange contracts with the minority interest holders in two of these subsidiaries,
Acadian Home Health Care Services, LLC (Acadian) and Hebert, Thibodeaux, Albro and Touchet
Therapy Group, Inc. (Hebert) which required the minority interest holders in these subsidiaries
to sell their interests to the Company in the event of an IPO. In conjunction with the Companys
IPO, the forward exchange contracts were consummated and the minority interest holders of Acadian
and Hebert sold their minority interests to the Company in exchange for cash and shares of the
Companys common stock. The Company had accrued the cash payment of approximately $2.2 million to
be paid under these forward exchange contracts. This amount was paid in full in 2005.
In the third majority owned subsidiary, St. Landry Extended Care Hospital, LLC (St. Landry),
the put option allows the minority interest holders to convert their minority interests into shares
of the Company based upon St. Landrys EBITDA for the prior fiscal year in relation to the
Companys EBITDA over the same period. The put option became exercisable by the minority interest
holders in St. Landry upon the completion of the IPO. However, due to applicable laws and
regulations, the minority interest holders can not convert their minority interests in St. Landry
unless certain conditions are met including, but not limited to, the Company having stockholders
equity in excess of $75 million at the end of its most recent fiscal year or on average during the
previous three fiscal years. If the St. Landry minority interest holders do not or are unable to
convert their minority interests into shares of the Company, the minority interest holders shall
have the option to redeem their minority interests at any time following thirty days after the IPO
for cash consideration equal to the value of the shares the minority interest holders would have
received if they had converted their minority interests into shares of the Company multiplied by
the average closing price of the Companys shares for the thirty days preceding the date of the
minority interest holders exercise of the redemption option. As of December 31, 2005 and June
30, 2006, the company had exceeded $75 million in stockholders equity. As of June 30, 2006,
approximately 59% of the doctors have converted their minority interests to cash.
The above put/redemption options and exchange agreements have been presented in the historical
financial statements under the guidance in Accounting Series Release (ASR) No. 268 and Emerging
Issues Task Force (EITF) Topic D-98, which generally require a public companys stock subject to
redemption requirements that are outside the control of the issuer to be excluded from the caption
stockholders equity and presented separately in the issuers balance sheet. Under EITF Topic
D-98, once it becomes probable that the minority interest would become redeemable, the minority
interest should be adjusted to its current redemption amount. As noted above, the St.
- 16 -
Landry put option allowed the minority interest holders in St. Landry to have their interests
redeemed for cash upon the completion of the IPO and therefore the Company recorded an adjustment
of approximately $1.5 million to minority interests subject to exchange contracts and/or put
options and to retained earnings which represents the redemption value of St. Landrys interests at
June 30, 2005. In September 2005, certain minority interest holders redeemed their interests in
St. Landry. This resulted in a cash payment of approximately $214,000. In connection with the
partial redemption of certain minority interests in September 2005, we decreased our minority
interests by approximately $149,000 and increased our retained earnings by the same amount.
Simultaneously, we recorded goodwill of $214,000 to represent the value of the minority interests
redeemed. Also at the end of the third quarter of 2005, we recorded a mark-to-market charge of
$404,000.
In November 2005, the agreement was amended to allow minority interest holders to redeem their
minority interests based on the St. Landrys rolling twelve month EBITDA in relation to the
Companys EBITDA over the same period. At December 31, 2005, the Company recorded an additional
mark to market benefit of $266,000 to mark the liability to redemption value at the end of the
quarter.
In connection with the partial redemption of certain minority interest in the six months ended
June 30, 2006, we decreased our minority interests by approximately $939,000 and increased our
retained earnings by the same amount. Simultaneously, we recorded goodwill of $889,000 to
represent the value of the minority interests redeemed. Also for the six months ended June 30,
2006, we recorded a mark-to-market benefit of $76,000.
Contingencies
The terms of several joint venture operating agreements grant a buy/sell option that would
require the Company to either purchase or sell the existing membership interest in the joint
venture within 30 days of the receipt of the notice to exercise the provision. Either the Company
or its joint venture partner has the right to exercise the buy/sell option. The party receiving the
exercise notice has the right to either purchase the interests held by the other party or sell its
interests to the other party. The purchase price formula for the interests is set forth in the
joint venture agreement and is typically based on a multiple of the earnings before income taxes,
depreciation and amortization of the joint venture. Total revenue earned by the Company from joint
ventures subject to these arrangements was $3.7 million and $3.5 million for the three months ended
June 30, 2006 and 2005, respectively and $7.2 million and $6.7 million for the six months ended
June 30, 2006 and 2005, respectively. The Company has not received notice from any joint venture
partners of their intent to exercise the buy/sell option nor has the Company notified any joint
venture partners of any intent to exercise the buy/sell option.
The Company is involved in various legal proceedings arising in the ordinary course of
business. Although the results of litigation cannot be predicted with certainty, management
believes the outcome of pending litigation will not have a material adverse effect, after
considering the effect of the Companys insurance coverage, on the Companys consolidated financial
statements.
Compliance
The laws and regulations governing the Companys operations, along with the terms of
participation in various government programs, regulate how the Company does business, the services
offered, and interactions with patients and the public. These laws and regulations, and their
interpretations, are subject to frequent change. Changes in existing laws or regulations, or their
interpretations, or the enactment of new laws or regulations could materially and adversely affect
the Companys operations and financial condition.
The Company is subject to various routine and non-routine governmental reviews, audits, and
investigations. In recent years, federal and state civil and criminal enforcement agencies have
heightened and coordinated their oversight efforts related to the healthcare industry, including
with respect to referral practices, cost reporting, billing practices, joint ventures, and other
financial relationships among healthcare providers. Violation of the laws governing the Companys
operations, or changes in the interpretation of those laws, could result in the imposition of
fines, civil or criminal penalties, the termination of the Companys rights to participate in
federal and state-sponsored programs, and the suspension or revocation of the Companys licenses.
- 17 -
If the Companys long-term acute care hospitals fail to meet or maintain the standards for
Medicare certification as long-term acute care hospitals, such as average minimum length of patient
stay, they will receive payments under the prospective payment system applicable to general acute
care hospitals rather than payment under the system applicable to long-term acute care hospitals.
Payments at rates applicable to general acute care hospitals would likely result in the Company
receiving less Medicare reimbursement than currently received for patient services. Moreover, all
of the Companys long-term acute care hospitals are subject to additional Medicare criteria because
they operate as separate hospitals located in space leased from, and located in, a general acute
care hospital, known as a host hospital. This is known as a hospital within a hospital model.
These additional criteria include requirements concerning financial and operational separateness
from the host hospital.
The Company anticipates there may be changes to the standard episode-of-care payment from
Medicare in the future. Due to the uncertainty of the revised payment amount, the Company cannot
estimate the impact that changes in the payment rate, if any, will have on its future financial
statements. In August 2004, the Centers for Medicare and Medicaid Services, or CMS, adopted new
regulations that implement significant changes affecting long-term acute care hospitals. Among
other things, these new regulations, which became effective in October 2004, implemented new rules
that provide long-term acute care hospitals operating in the hospital within a hospital model with
lower rates of reimbursement for Medicare admissions from their host hospitals that are in excess
of specified percentages.
These new rules also reclassified certain long-term acute care hospital diagnosis related
groups, which could result in a decrease in reimbursement rates. Further, the new rules kept in
place the financial penalties associated with the failure to limit to no greater than 5% the total
number of Medicare patients discharged to the host hospital and subsequently readmitted to a
long-term acute care hospital located within the host hospital.
The Company believes that it is in material compliance with all applicable laws and
regulations and is not aware of any pending or threatened investigations involving allegations of
potential wrongdoing. While no such regulatory inquiries have been made, compliance with such laws
and regulations can be subject to future government review and interpretation as well as
significant regulatory action, including fines, penalties, and exclusion from the Medicare program.
8. Segment Information
The Companys segments consist of (a) home-based services and (b) facility-based services.
Home-based services include home nursing services and hospice services. Facility-based serviced
include long-term acute care services and outpatient rehabilitation services. The accounting
policies of the segments are the same as those described in the summary of significant accounting
policies.
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Three Months Ended June 30, 2006 |
|
|
Home-Based |
|
Facility-Based |
|
|
|
|
Services |
|
Services |
|
Total |
|
|
(in thousands) |
Net service revenue |
|
$ |
36,602 |
|
|
$ |
12,955 |
|
|
$ |
49,557 |
|
Cost of service revenue |
|
|
17,435 |
|
|
|
7,579 |
|
|
|
25,014 |
|
General and administrative expenses |
|
|
12,806 |
|
|
|
3,999 |
|
|
|
16,805 |
|
Equity-based compensation expense |
|
|
|
|
|
|
|
|
|
|
|
|
Operating income |
|
|
6,361 |
|
|
|
1,377 |
|
|
|
7,738 |
|
Interest expense |
|
|
42 |
|
|
|
18 |
|
|
|
60 |
|
Non operating income, including gain on sale of assets |
|
|
(77 |
) |
|
|
(39 |
) |
|
|
(116 |
) |
Income from continuing operations before income
taxes and minority interest and cooperative endeavor allocations |
|
|
6,396 |
|
|
|
1,398 |
|
|
|
7,794 |
|
Minority interest and cooperative endeavor allocations |
|
|
647 |
|
|
|
423 |
|
|
|
1,070 |
|
Income from continuing operations before income taxes |
|
|
5,749 |
|
|
|
975 |
|
|
|
6,724 |
|
Total assets |
|
$ |
84,467 |
|
|
$ |
33,328 |
|
|
$ |
117,795 |
|
- 18 -
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Three Months Ended June 30, 2005 |
|
|
Home-Based |
|
Facility-Based |
|
|
|
|
Services |
|
Services |
|
Total |
|
|
(in thousands) |
Net service revenue |
|
$ |
24,776 |
|
|
$ |
11,248 |
|
|
$ |
36,024 |
|
Cost of service revenue |
|
|
11,766 |
|
|
|
6,945 |
|
|
|
18,711 |
|
General and administrative expenses |
|
|
8,057 |
|
|
|
2,490 |
|
|
|
10,547 |
|
Equity-based compensation expense |
|
|
2,346 |
|
|
|
1,006 |
|
|
|
3,352 |
|
Operating income |
|
|
2,607 |
|
|
|
807 |
|
|
|
3,414 |
|
Interest expense |
|
|
286 |
|
|
|
140 |
|
|
|
426 |
|
Non operating income, including gain on sale of assets |
|
|
(17 |
) |
|
|
(5 |
) |
|
|
(22 |
) |
Income from continuing operations before income taxes
and minority interest and cooperative endeavor
allocations |
|
|
2,338 |
|
|
|
672 |
|
|
|
3,010 |
|
Minority interest and cooperative endeavor allocations |
|
|
934 |
|
|
|
258 |
|
|
|
1,192 |
|
Income from continuing operations before income taxes |
|
|
1,404 |
|
|
|
414 |
|
|
|
1,818 |
|
Total assets |
|
$ |
57,107 |
|
|
$ |
39,745 |
|
|
$ |
96,852 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Six Months Ended June 30, 2006 |
|
|
Home-Based |
|
Facility-Based |
|
|
|
|
Services |
|
Services |
|
Total |
|
|
|
|
|
|
(in thousands) |
|
|
|
|
Net service revenue |
|
$ |
69,254 |
|
|
$ |
25,707 |
|
|
$ |
94,961 |
|
Cost of service revenue |
|
|
33,780 |
|
|
|
15,219 |
|
|
|
48,999 |
|
General and administrative expenses |
|
|
24,145 |
|
|
|
7,533 |
|
|
|
31,678 |
|
Equity-based compensation expense |
|
|
|
|
|
|
|
|
|
|
|
|
Operating income |
|
|
11,329 |
|
|
|
2,955 |
|
|
|
14,284 |
|
Interest expense |
|
|
96 |
|
|
|
50 |
|
|
|
146 |
|
Non operating income, including gain on sale of assets |
|
|
(188 |
) |
|
|
(92 |
) |
|
|
(280 |
) |
Income from continuing operations before income taxes and
minority interest and cooperative endeavor allocations |
|
|
11,421 |
|
|
|
2,997 |
|
|
|
14,418 |
|
Minority interest and cooperative endeavor allocations |
|
|
1,238 |
|
|
|
861 |
|
|
|
2,099 |
|
Income from continuing operations before income taxes |
|
|
10,183 |
|
|
|
2,136 |
|
|
|
12,319 |
|
Total assets |
|
$ |
84,467 |
|
|
$ |
33,328 |
|
|
$ |
117,795 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Six Months Ended June 30, 2005 |
|
|
Home-Based |
|
Facility-Based |
|
|
|
|
Services |
|
Services |
|
Total |
|
|
|
|
|
|
(in thousands) |
|
|
|
|
Net service revenue |
|
$ |
49,550 |
|
|
$ |
21,875 |
|
|
$ |
71,425 |
|
Cost of service revenue |
|
|
23,267 |
|
|
|
13,015 |
|
|
|
36,282 |
|
General and administrative expenses |
|
|
15,135 |
|
|
|
5,280 |
|
|
|
20,415 |
|
Equity-based compensation expense |
|
|
2,699 |
|
|
|
1,157 |
|
|
|
3,856 |
|
Operating income |
|
|
8,449 |
|
|
|
2,423 |
|
|
|
10,872 |
|
Interest expense |
|
|
503 |
|
|
|
255 |
|
|
|
758 |
|
Non operating gain, including gain on sale of assets |
|
|
(31 |
) |
|
|
(534 |
) |
|
|
(565 |
) |
Income from continuing operations before income taxes and
minority interest and cooperative endeavor allocations |
|
|
7,977 |
|
|
|
2,702 |
|
|
|
10,679 |
|
Minority interest and cooperative endeavor allocations |
|
|
2,056 |
|
|
|
576 |
|
|
|
2,632 |
|
Income from continuing operations before income taxes |
|
|
5,921 |
|
|
|
2,126 |
|
|
|
8,047 |
|
Total assets |
|
$ |
57,107 |
|
|
$ |
39,745 |
|
|
$ |
96,852 |
|
9. Subsequent Events
On July 19, 2006, the Company closed its public offering of 4,000,000 shares of common stock
at a price of $19.25 per share. Of the 4,000,000 shares of common stock offered, 1,000,000 shares
were offered by the Company, with the remaining 3,000,000 shares of common stock sold by the
selling stockholders identified in the prospectus supplement. The underwriters exercised an
over-allotment of an additional 600,000 shares.
The Company intends to use the net proceeds of approximately $21 million from the offering to
fund future acquisitions and for other general corporate purposes. LHC
Group, Inc. will receive no proceeds from the sale of shares by the selling stockholders, all of
which were sold by the selling stockholders.
On July 31, 2006, the Company completed its acquisition of the Kentucky-based assets of
Lifeline Home Health Care, a privately-held company based in Somerset, Kentucky. This acquisition
involves an approximate total
- 19 -
patient census of 2,400 as well as approximately 350 Lifeline employees. As a result of the
acquisition, the Company now has 17 locations in 29 Kentucky counties with a population of over
750,000 people. In 2005, Lifeline reported Kentucky-based revenue of approximately $23 million.
Lifeline was purchased for approximately $15 million in cash.
ITEM 2. MANAGEMENTS DISCUSSION AND ANALYSIS OF FINANCIAL CONDITION AND RESULTS OF OPERATIONS
CAUTIONARY NOTICE REGARDING FORWARD-LOOKING STATEMENTS
This Managements Discussion and Analysis of Financial Condition and Results of
Operations contains forward-looking statements. Forward-looking statements relate to
expectations, beliefs, future plans and strategies, anticipated events or trends and similar
expressions concerning matters that are not historical facts or that necessarily depend upon future
events. In some cases, you can identify forward-looking statements by terms such as may, will,
should, could, would, expect, plan, anticipate, believe, estimate, project,
predict, potential, and similar expressions. Specifically, this report contains, among others,
forward-looking statements about:
|
|
|
our expectations regarding financial condition or results of operations for periods after June 30, 2006; |
|
|
|
|
our future sources of and needs for liquidity and capital resources; |
|
|
|
|
our expectations regarding the size and growth of the market for our services; |
|
|
|
|
our business strategies and our ability to grow our business; |
|
|
|
|
the implementation or interpretation of current or future regulations and legislation; |
|
|
|
|
the reimbursement levels of third-party payors; and |
|
|
|
|
our discussion of our critical accounting policies. |
The forward-looking statements contained in this report reflect our current views about
future events, are based on assumptions and are subject to known and unknown risks and
uncertainties. Many important factors could cause actual results or achievements to differ
materially from any future results or achievements expressed in or implied by our forward-looking
statements. Many of the factors that will determine future events or achievements are beyond our
ability to control or predict. Important factors that could cause actual results or achievements to
differ materially from the results or achievements reflected in our forward-looking statements
include, among other things, the factors discussed in the Part II, Item 1A Risk Factors, included
in this report.
You should read this report, the information incorporated by reference into
this report and the documents filed as exhibits to this report completely and with the
understanding that our actual future results or achievements may be materially different from what
we expect or anticipate.
The forward-looking statements contained in this report reflect our views and
assumptions only as of the date this report is signed. Except as required by law, we assume no
responsibility for updating any forward-looking statements.
- 20 -
We qualify all of our forward-looking statements by these cautionary
statements. In addition, with respect to all of our forward-looking statements, we claim the
protection of the safe harbor for forward-looking statements contained in the Private Securities
Litigation Reform Act of 1995.
Unless the context otherwise requires, we, us, our, and the Company refer to LHC Group,
Inc. and its consolidated subsidiaries.
Overview
We provide post-acute healthcare services primarily to Medicare beneficiaries in rural markets
in the southern United States. We provide these post-acute healthcare services through our home
nursing agencies, hospices, long-term acute care hospitals and outpatient rehabilitation clinics.
Since our founders began operations in 1994 with one home nursing agency in Palmetto, Louisiana, we
have grown to 99 locations in Louisiana, Alabama, Arkansas, Mississippi, Texas, and West Virginia
as of June 30, 2006.
Segments
We operate in two segments for financial reporting purposes: home-based services and
facility-based services. We derived 73.9% and 68.8% of our net service revenue during the three
months ended June 30, 2006 and 2005, respectively, and 72.9% and 69.4% of our net service revenue
during the six months ended June 30, 2006 and 2005, respectively, from our home-based services
segment and derived the balance of our net service revenue from our facility-based services
segment.
Through our home-based services segment we offer a wide range of services, including skilled
nursing, private duty nursing, physical, occupational, and speech therapy, medically-oriented
social services, and hospice care. As of June 30, 2006, we owned and operated 81 Medicare-certified
home nursing locations and six Medicare-certified hospices. Of these 87 home-based services
locations, 43 are wholly-owned by us and 44 are majority-owned or controlled by us through joint
ventures. We also manage the operations of three home nursing agencies and one hospice in which we
have no ownership interest. We intend to increase the number of home nursing agencies that we
operate through continued acquisition and development, primarily in underserved rural markets, as
we implement our growth strategy. As we acquire and develop home nursing agencies, we anticipate
the percentage of our net service revenue and operating income derived from our home-based services
segment will increase.
We provide facility-based services principally through our long-term acute care hospitals and
outpatient rehabilitation clinics. As of June 30, 2006, we owned and operated four long-term acute
care hospitals with seven locations, all located within host hospitals. We also owned and operated
one critical access hospital, two outpatient rehabilitation clinics and provided contract
rehabilitation services to third parties. Of these ten facility-based services locations, three are
wholly-owned by us and seven are majority-owned or controlled by us through joint ventures. We also
manage the operations of one inpatient rehabilitation facility in which we have no ownership
interest. Because of the recent changes in the regulations applicable to long-term acute care
hospitals operated as hospitals within hospitals, we do not intend to expand the number of hospital
within a hospital long-term acute care hospitals that we operate. Due to our emphasis on expansion
through the acquisition and development of home nursing agencies, we anticipate that the percentage
of our net service revenue and operating income derived from our facility-based segment will
decline.
Recent Developments
Medicare
Home-Based Services. The current base payment rate for Medicare home
nursing is $2,264. Since the inception of the prospective payment system in October 2000, the base
episode rate payment has varied due to both the impact of annual market basket based increases and
Medicare-related legislation.
Home health payment rates are updated annually by either the full home health market basket
percentage, or by the home health market basket percentage as adjusted by Congress. The Centers
for Medicare and Medicaid Services, or CMS, establishes the home health market basket index,
which measures inflation in the prices of an appropriate mix of goods and services included in home
health services.
- 21 -
The passage of the Medicare Modernization Act of 2003, or MMA, resulted in two changes in
Medicare reimbursement. First, for episodes ended on or after April 1, 2004 through December 31,
2006, the base episode rate increase was reduced by 0.8%. Secondly, a 5.0% payment increase was
provided for services furnished in a non-Metropolitan Statistical Area, or MSA, setting for
episodes ending on or after April 1, 2004 and before April 1, 2005.
On January 1, 2006, a 2.8% market basket increase went into effect along with new Core Based
Statistical Area, or CBSA, designations and wage indices. This increase represented a 3.6%
market basket update minus the 0.8% reduction mandated by MMA. However, the Deficit Reduction
Act, or DRA, provided for a one-year freeze on the Medicare home health payment rate in 2006, in
essence, taking away the original 2.8% market basket adjustment. This Act also provided a 5.0%
rural add on for one-year beginning January 1, 2006. As of June 30, 2006, approximately 54% of our
Medicare census was derived from patients who reside in rural CBSAs. In addition, the DRA
instituted quality reporting requirements for home health agencies beginning in 2007. In essence,
agencies that report the required data will receive the market basket update. Those that do not
report will receive the market basket minus 2%.
In July 2006, CMS issued a proposed rule proposing a 3.1% increase in Medicare payment rates
to home health agencies for 2007. In accordance with the DRA, agencies that submit the required
quality data would receive payments based on the full proposed home health market basket update of
3.1% for 2007. If an agency does not submit the required quality data, then the home health market
basket percentage will be reduced by 2% to 1.1% for 2007. According to CMS, rural home health
agencies that participate in the ongoing quality measurement effort will see an estimated 3.3%
increase in payment, while urban agencies who continue to provide quality data will experience an
estimated 2.9% increase in payments. The final rule relating to these proposals is expected later
in the fall. The company cannot predict whether Congress will introduce legislation this year that
would negatively impact the anticipated market basket increase.
Additionally, later this year, CMS is anticipated to propose significant case mix changes to
the home health payment system. The company cannot predict the impact of those changes at this
time.
In August 2006, CMS announced the payment rates for hospice care furnished from October 1,
2006 through September 30, 2007. These rates are 3.4% more than the rates for the previous year.
In addition, CMS announced that the hospice cap amount for the year ending October 31, 2006 is
$20,585.
Facility-Based Services. Under the long-term acute care hospital prospective payment system
implemented on October 1, 2002, each patient discharged from our long-term acute care hospitals is
assigned a long-term care diagnosis-related group. CMS establishes these long-term care
diagnosis-related groups by categorizing diseases by diagnosis, reflecting the amount of resources
needed to treat a given disease. For each patient, we are paid a pre-determined fixed amount
applicable to the particular long-term care diagnosis-related group to which that patient is
assigned. Effective for discharges on or after October 1, 2005, CMS has published the new relative
weights applicable to the long-term care diagnosis-related group system. The updated regulations
provide for a 3.4% increase in the standard federal rate, a budget neutrality factor of 0, which
became effective July 1, 2005, and a decrease in the high cost outlier fixed loss threshold to
$10,501. In addition, on May 6, 2005 CMS published a final rule increasing the Medicare payment
rates for long-term acute care hospitals by 3.4% for patient discharges taking place on or after
July 1, 2005 through June 30, 2006.
CMS has also stated its intention to develop long-term acute care hospital patient-specific
criteria to refine the definition of such facilities. Comments included in the May 6, 2005 rule indicate that CMS has
awarded a contract to Research Triangle Institute for the purpose of evaluating patient and
facility level characteristics for long-term care hospitals in order to differentiate the role of
long-term acute care hospitals from general acute care hospitals. This evaluation is in response
to the June 2004 MedPAC Report recommending that CMS examine defining long-
- 22 -
term acute care
hospitals by facility and patient criteria. CMS has also charged Research Triangle Institute with
examining the present role of Quality Improvement organizations with regard to long-term care acute
hospitals.
On May 2, 2006, CMS issued a rule under the long-term care hospital prospective payment system
for the 2007 rate year starting July 1, 2006. The rule provides for no increase in the Medicare
payment rates to long-term acute care hospitals for discharges taking place on or after July 1,
2006 through June 30, 2007. Therefore, CMS has ruled that the long-term care hospital prospective
payment system federal rate will remain at $38,086.04 for the 2007 rate year. In addition, CMS
adopted the Rehabilitation, Psychiatric and Long-Term Care market basket to replace the excluded
hospital with capital market basket that is currently used as the measure of inflation for
calculating the annual update to the long-term care hospital prospective payment system federal
rate. The rule also revised the payment adjustment formula for short-stay outlier cases, which
overall comprise 37% of long-term care hospital prospective payment system discharges. These are
cases where a patient is discharged early and the hospitals costs are significantly below average.
The rule made a number of other regulatory changes aimed at curbing the long-term care hospital
Medicare margin growth that has occurred since implementation of the prospective payment system in
2002 (growth CMS says will reach 7.8% in 2006). CMS also contends that long-term care hospital
Medicare margins increased from 7.8% in fiscal year 2003 to 12.7% in fiscal year 2004. The high
cost outlier will increase for the rate year 2007 to $14,887.
Under Medicare, we are reimbursed for rehabilitation services based on a fee schedule for
services provided adjusted by the geographical area in which the facility is located. Outpatient
therapy services are subject to an annual cap of $1,750 per beneficiary effective January 1, 2006.
The Deficit Reduction Act of 2005 included a medical review policy to the statutory therapy cap
that allows claims over the cap to be approved on a case-by-case basis on the basis of medical
necessity. This exceptions process is in effect for only for one year; it ends on December 31,
2006. We are unable to predict whether Congress will renew the exceptions process this year
before it adjourns.
Components of Expenses
Cost of Service Revenue
Our cost of service revenue consists primarily of the following expenses incurred by our
clinical and clerical personnel in our agencies and facilities:
|
|
|
salaries and related benefits; |
|
|
|
|
transportation, primarily mileage reimbursement; and |
|
|
|
|
supplies and services, including payments to contract therapists. |
General and Administrative Expenses
Our general and administrative expenses consist primarily of the following expenses incurred
by our home office and administrative field personnel:
|
|
|
salaries and related benefits; |
|
|
|
|
insurance; |
|
|
|
|
costs associated with advertising and other marketing activities; and |
|
|
|
|
rent and utilities; |
|
|
|
accounting, legal and other professional services; and |
|
|
|
|
office supplies; |
- 23 -
|
|
|
Provision for bad debts. |
Equity-Based Compensation Expense
Under our KEEP Plan certain of our employees were granted KEEP Units. The KEEP Units, which
have no exercise price, vested over a five-year period. The KEEP Units functioned as stock
appreciation rights whereby an individual is entitled to receive, on a per unit basis, the increase
in estimated fair value, as determined by us, of our units from the date of grant until the date
upon which the employee dies, retires or is terminated for any reason other than cause.
Accordingly, the KEEP Units were subject to variable accounting until such time as the obligation
to the employee was settled. At the initial public offering price of $14.00 per share, upon the
completion of the offering all obligations relating to our KEEP Units were settled by conversion
into shares of our common stock and we incurred a final, non-recurring equity-based compensation
charge in the amount of approximately $3.0 million (net of taxes of $1.7 million).
Our equity-based compensation expense was allocated to our home-based and facility-based
services segments in accordance with our home office allocation, which is calculated based on the
percentage of our net service revenue contributed by each segment during the applicable period.
Results of Operations
Three Months Ended June 30, 2006 Compared to Three Months Ended June 30, 2005
Net Service Revenue
Net service revenue for the three months ended June 30, 2006 was $49.6 million, an increase of
$13.6 million, or 37.8%, from $36.0 million in 2005. For the three months ended June 30, 2006 and
2005, 84.7% and 88.0%, respectively, of our net service revenue was derived from Medicare.
Home-Based Services
Net service revenue for the three months ended June 30, 2006 was $36.6 million, an increase of
47.6%, from $24.8 million for the three months ended June 30, 2005. Organic growth in this service
sector was approximately $7.1 million, or 30.3%. Total admissions were 5,852 during the period,
versus 4,006 for the same period in 2005, a 46.1 % increase. Organic admissions increased 13.8%.
The Company also monitors patient census as a key performance indicator within its home based
services. LHC Groups average home based patient census for the three months ended June 30, 2006
was 9,807 patients, an increase of 30.5% as compared to 7,517 patients for the three months ended
June 30, 2005. Organic home-based patient census increased 12.9%. Organic growth includes growth
on same store locations (owned for greater than 12 months), and growth from de novo locations.
Growth from acquired locations owned less than 13 months is not included. The average patient
census for the first quarter of 2005 was 6,539. Average census is calculated by taking the average
of the ending census of each week during the period. Organic census
for the first quarter of 2006 was 7,614 and for the first quarter of
2005 it was 6,164.
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
2005 |
|
2006 |
|
% |
|
2005 |
|
2006 |
|
% |
|
2005 |
|
2006 |
|
% |
|
|
Revenue |
|
Revenue |
|
Growth |
|
Admissions |
|
Admissions |
|
Growth |
|
Census |
|
Census |
|
Growth |
Organic |
|
$ |
23,588 |
|
|
$ |
30,734 |
|
|
|
30.3 |
% |
|
|
3,789 |
|
|
|
4,312 |
|
|
|
13.8 |
% |
|
|
7,080 |
|
|
|
7,996 |
|
|
|
12.9 |
% |
Acquired |
|
$ |
1,188 |
|
|
$ |
5,868 |
|
|
|
393.9 |
% |
|
|
217 |
|
|
|
1,540 |
|
|
|
609.7 |
% |
|
|
437 |
|
|
|
1,811 |
|
|
|
314.4 |
% |
Total |
|
$ |
24,776 |
|
|
$ |
36,602 |
|
|
|
47.6 |
% |
|
|
4,006 |
|
|
|
5,852 |
|
|
|
46.1 |
% |
|
|
7,517 |
|
|
|
9,807 |
|
|
|
30.5 |
% |
- 24 -
Facility-Based Services
Net service revenue for the three months ended June 30, 2006 was $13.0 million, an increase of
$1.8 million, or 16.1%, from $11.2 million for the three months ended June 30, 2005. Organic
growth in this service sector was approximately $1.6 million, or 16.4%. The increase in net
service revenue resulted in part due to an increase in patient days of 5.6% to 11,110 in the three
months ended June 30, 2006 from 10,519 in the three months ended June 30, 2005. Outpatient visits
decreased to 5,157 at June 30, 2006, a 55.7% decrease as compared to 11,639 for the three months
ended June 30, 2005 due to the sale of one of our clinics and the closing of one location of
another clinic.
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
2005 |
|
2006 |
|
|
|
|
|
|
|
|
|
|
2005 |
|
2006 |
|
% |
|
Patient |
|
Patient |
|
% |
|
2005 |
|
2006 |
|
% |
|
|
Revenue |
|
Revenue |
|
Growth |
|
Days |
|
Days |
|
Growth |
|
Discharges |
|
Discharges |
|
Growth |
Organic |
|
$ |
9,914 |
|
|
$ |
11,536 |
|
|
|
16.4 |
% |
|
|
9,351 |
|
|
|
9,907 |
|
|
|
5.9 |
% |
|
|
358 |
|
|
|
379 |
|
|
|
5.9 |
% |
Acquired |
|
$ |
1,334 |
|
|
$ |
1,419 |
|
|
|
6.4 |
% |
|
|
1,168 |
|
|
|
1,203 |
|
|
|
3.0 |
% |
|
|
47 |
|
|
|
51 |
|
|
|
8.5 |
% |
Total |
|
$ |
11,248 |
|
|
$ |
12,955 |
|
|
|
15.2 |
% |
|
|
10,519 |
|
|
|
11,110 |
|
|
|
5.6 |
% |
|
|
405 |
|
|
|
430 |
|
|
|
6.2 |
% |
Cost of Service Revenue
Cost of service revenue for the three months ended June 30, 2006 was $25.0 million, an
increase of $6.3 million, or 33.7%, from $18.7 million for the three months ended June 30, 2005.
Cost of service revenue represented approximately 50.5% and 52.0% of our net service revenue for
the three months ended June 30, 2006 and 2005, respectively.
Home-Based Services. Cost of service revenue for the three months ended June 30, 2006 was
$17.4 million, an increase of $5.6 million, or 47.5%, from $11.8 million for the three months ended
June 30, 2005. Approximately $4.3 million of this increase resulted from an increase in salaries
and benefits. Approximately $4.1 million of the increase in salaries and benefits expense was due
to acquisitions. The remaining increase in salaries and benefits expense of approximately $200,000
was primarily attributable to internal growth. The remaining increase in cost of service revenue
was attributable to increases in supplies and services expense and transportation expense of $1.0
million and $300,000, respectively.
Facility-Based Services. Cost of service revenue for the three months ended June 30, 2006 was
$7.6 million, an increase of $700,000, or 10.1%, from $6.9 million for the three months ended June
30, 2005. Approximately $500,000 of this increase resulted from an increase in salaries and
benefits. Supplies and services expense contributed approximately $100,000 of the increase in
cost of service revenue. Transportation expense increased approximately $100,000 compared to the
three months ended June 30, 2005.
General and Administrative Expenses
General and administrative expenses for the three months ended June 30, 2006 was $16.8
million, an increase of $6.3 million, or 60.0%, from $10.5 million for the three months ended June
30, 2005. One time fees for recruitment and compensation to new management and directors totaled
$0.3 million during the period. Public company costs of SEC filings and Sarbanes-Oxley totaled $0.4
million during the period. The remaining $5.6 million increase was attributable to the Companys
growth. General and administrative expenses represented approximately 33.9% and 29.3% of our net
service revenue for the three months ended June 30, 2006 and 2005, respectively.
Home-Based Services. General and administrative expenses for the three months ended June 30,
2006 was $12.8 million, an increase of $4.7 million, or 58.0%, from $8.1 million for the three
months ended June 30, 2005. Approximately $1.2 million of this increase resulted from internal
growth, $3.5 million was incurred as a result of acquisition or development activity.
Facility-Based Services. General and administrative expenses for the three months ended June
30, 2006 were $4.0 million, an increase of $1.5 million, or 60.0%, from $2.5 million for the same
period in 2005. Approximately
- 25 -
$400,000 was attributable to acquisition and internal development
activity during 2005. The remaining increase of $1.1 million is attributable to internal growth.
Equity-Based Compensation Expense
There was no equity-based compensation expense for the three months ended June 30, 2006, which
was a decrease of $3.4 million from the same period in 2005. Equity-based compensation expense
related to the Key Equity Employee Participation Units, or KEEP Units, was zero in the three months
ended June 30, 2006 due to the conversion of all of the KEEP units to common stock
in connection with the initial public offering in the second quarter of 2005.
Income Tax Expense
The effective tax rates for the three months ended June 30, 2006 and 2005 were 36.5% and
20.1%, respectively. The effective tax rate for the three months ended June 30, 2005 decreased due
to the Company recording an income tax benefit of $342,000 related to a $900,000 equity-based
compensation charge stemming from shares issued by one of the Companys principal shareholders to
an officer of the Company in 2001. At the time, the Company did not believe it would be able to
deduct the equity-based compensation charge for income tax purposes. In conjunction with the
initial public offering, the Company determined that it will be able to deduct the $900,000
equity-based compensation charge and as a result has recognized an income tax benefit associated
with that charge of $342,000.
Minority Interest and Cooperative Endeavor Allocations
The minority interest and cooperative endeavor allocations expense for the three months ended
June 30, 2006 was $1.1 million, compared to $1.2 million for the same period in 2005.
Discontinued Operations
The Company sold one of its home health agencies during the three month period ended June 30,
2006 for $250,000. The Company recognized a gain of $98,000 on the sale of this agency. The
Company also sold a clinic during the three months ended June 30, 2006 for promissory notes
totaling $946,000 and recognized a loss on the sale of $28,000. The operations of this home health agency,
clinic, the private duty business and the location of another clinic that was closed during the
quarter are included in discontinued operations in the consolidated statement of income.
Revenue from discontinued operations for the three months ended June 30, 2006 and 2005 was
$1.7 million and $2.4 million, respectively. Costs, expenses, and minority interest and
cooperative endeavor allocations were $1.8 million and $3.3 million respectively, for the three
months ended June 30, 2006 and 2005. Losses from discontinued operations were $60,000 and $567,000
for the three months ended June 30, 2006 and 2005, respectively.
Six Months Ended June 30, 2006 Compared to Six Months Ended June 30, 2005
Net Service Revenue
Net service revenue for the six months ended June 30, 2006 was $94.7 million, an increase of
$23.3 million, or 32.6%, from $71.4 million in 2005. For the six months ended June 30, 2006 and
2005, 84.8% and 86.3%, respectively, of our net service revenue was derived from Medicare.
- 26 -
Home-Based Services
Net service revenue for the six months ended June 30, 2006 was $69.3 million, an increase of
39.8%, from $49.6 million for the six months ended June 30, 2005. Organic growth in this service
sector was approximately $13.5 million, or 28.5%. Total admissions were 11,422 during the period,
versus 8,157 for the same period in 2005, a 40.0 % increase. Organic admissions increased 14.6%.
LHC Groups average home based patient census for the six months ended June 30, 2006 was 9,535
patients, an increase of 29.7% as compared to 7,349 patients for the six months ended June 30,
2005. Organic home-based patient census increased 12.1%. The average patient census for the first
quarter of 2006 was 9,138 while the average patent census for the second quarter of 2006 was 9,807.
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
2005 |
|
2006 |
|
% |
|
2005 |
|
2006 |
|
% |
|
2005 |
|
2006 |
|
% |
|
|
Revenue |
|
Revenue |
|
Growth |
|
Admissions |
|
Admissions |
|
Growth |
|
Census |
|
Census |
|
Growth |
Organic |
|
$ |
47,520 |
|
|
$ |
61,064 |
|
|
|
28.5 |
% |
|
|
7,563 |
|
|
|
8,665 |
|
|
|
14.6 |
% |
|
|
6,942 |
|
|
|
7,785 |
|
|
|
12.1 |
% |
Acquired |
|
$ |
2,030 |
|
|
$ |
8,190 |
|
|
|
303.4 |
% |
|
|
594 |
|
|
|
2,757 |
|
|
|
364.1 |
% |
|
|
407 |
|
|
|
1,750 |
|
|
|
330.0 |
% |
Total |
|
$ |
49,550 |
|
|
$ |
69,254 |
|
|
|
39.8 |
% |
|
|
8,157 |
|
|
|
11,422 |
|
|
|
40.0 |
% |
|
|
7,349 |
|
|
|
9,535 |
|
|
|
29.7 |
% |
Facility-Based Services
Net service revenue for the six months ended June 30, 2006 was $25.7 million, an increase of
$3.8 million, or 17.5%, from $21.9 million for the six months ended June 30, 2005. Organic growth
in this service sector was approximately $3.6 million, or 19.1%. The increase in net service
revenue resulted in part due to an increase in patient days of 9.2% to 22,809 in the six months
ended June 30, 2006 from 20,895 in the six months ended June 30, 2005. Outpatient visits decreased
to 13,932 at June 30, 2006, a 39.8% decrease as compared to 23,124 for the six months ended June
30, 2005 due to the sale of one of our clinics and the closing of one location of another clinic.
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
2005 |
|
2006 |
|
|
|
|
|
|
|
|
|
|
2005 |
|
2006 |
|
% |
|
Patient |
|
Patient |
|
% |
|
2005 |
|
2006 |
|
% |
|
|
Revenue |
|
Revenue |
|
Growth |
|
Days |
|
Days |
|
Growth |
|
Discharges |
|
Discharges |
|
Growth |
Organic |
|
$ |
19,205 |
|
|
$ |
22,867 |
|
|
|
19.1 |
% |
|
|
18,428 |
|
|
|
20,341 |
|
|
|
10.4 |
% |
|
|
669 |
|
|
|
784 |
|
|
|
17.2 |
% |
Acquired |
|
$ |
2,670 |
|
|
$ |
2,840 |
|
|
|
6.4 |
% |
|
|
2,467 |
|
|
|
2,468 |
|
|
|
0.0 |
% |
|
|
93 |
|
|
|
99 |
|
|
|
6.5 |
% |
Total |
|
$ |
21,875 |
|
|
$ |
25,707 |
|
|
|
17.5 |
% |
|
|
20,895 |
|
|
|
22,809 |
|
|
|
9.2 |
% |
|
|
762 |
|
|
|
883 |
|
|
|
15.9 |
% |
Cost of Service Revenue
Cost of service revenue for the six months ended June 30, 2006 was $49.0 million, an increase
of $12.7 million, or 35.0%, from $36.3 million for the six months ended June 30, 2005. Cost of
service revenue represented approximately 51.6% and 50.8% of our net service revenue for the six
months ended June 30, 2006 and 2005, respectively.
Home-Based Services. Cost of service revenue for the six months ended June 30, 2006 was $33.8
million, an increase of $10.5 million, or 45.1%, from $23.3 million for the six months ended June
30, 2005. Approximately $7.8 million of this increase resulted from an increase in salaries and
benefits due to acquisition or development activity. The increase in salaries and benefits expense
due to internal growth accounted for approximately $500,000 of the increase in this category. Supplies and services expense and transportation expense
contributed approximately $1.4 million and $800,000, respectively, to the increase in cost of
service revenue.
Facility-Based Services. Cost of service revenue for the six months ended June 30, 2006 was
$15.2 million, an increase of $2.2 million, or 16.9%, from $13.0 million for the six months ended
June 30, 2005. Approximately $1.6 million of this increase resulted from an increase in salaries
and benefits. Of this increase in salaries and benefits, $600,000 was incurred as a result of
acquisition and internal development activity. The remaining $1.0 million
- 27 -
increase in salaries and
benefits resulted from internal growth within our facility-based services segment. Supplies and
services expense contributed approximately $500,000 of the increase in cost of service revenue.
Transportation expense increased approximately $100,000 over this same period.
General and Administrative Expenses
General and administrative expenses for the six months ended June 30, 2006 were $31.7 million, an
increase of $11.3 million, or 55.4%, from $20.4 million for the six months ended June 30, 2005. One
time fees for recruitment and compensation to new management and directors totaled $0.3 million
during the period. Public company costs of SEC filings and Sarbanes-Oxley totaled $1.0 million
during the period. The remaining $10.0 million increase was attributable to the Companys growth.
Home-Based Services. General and administrative expenses for the six months ended June 30,
2006 were $24.1 million, an increase of $9.0 million, or 59.6%, from $15.1 million for the six
months ended June 30, 2005. Approximately $6.1 million of this increase was attributable to
acquisition or internal development activity. Internal growth accounted for approximately $2.9
million.
Facility-Based Services. General and administrative expenses for the six months ended June
30, 2006 were $7.5 million, an increase of $2.2 million, or 41.5%, from $5.3 million for the six
months ended June 30, 2005. The majority, or $1.5 million, of the increase was attributable to
internal growth. The remaining increase of $700,000 was due to acquisition and internal
development activity during the 2005 period.
Equity-Based Compensation Expense
There was no equity-based compensation expense for the six months ended June 30, 2006, which
was a decrease of $3.9 million from the same period in 2005. Equity-based compensation expense
related to the KEEP Units was zero in the six months ended June 30, 2006 due to the conversion of
all of the KEEP units to common stock in connection with the initial public
offering in the second quarter of 2005.
Income
Tax Expense
The effective tax rates for the six months ended June 30, 2006 and 2005 were 34.1% and
34.1%, respectively.
Minority Interest and Cooperative Endeavor Allocations
The minority interest and cooperative endeavor allocations expense for the six months ended
June 30, 2006 was $2.1 million, a decrease of approximately $500,000, compared to $2.6 million for
the six months ended June 30, 2005. The decrease was attributable to the conversion of certain
minority interests after the initial public offering.
Discontinued Operations
The Company sold one of its long-term acute care hospitals during the six month period ended
June 30, 2006 for $1.2 million. The Company recognized a gain of $960,000 on the sale of this
hospital. The Company also sold a clinic in the six months ended June 30, 2006 for promissory
notes totaling $946,000 and recognized a loss on the sale of $28,000. The Company also
closed one other location of another clinic. Additionally, the Company closed virtually all of its
private duty business during the six month period ended June 30, 2006. Finally, the Company
sold one of its home health agencies during the six month period ended June 30, 2006 for $250,000. The Company recognized a gain of $98,000 on the sale of this agency. The results
of these operations are reported as discontinued operations in the accompanying consolidated
statement of income.
Revenue from discontinued operations for the six months ended June 30, 2006 and 2005 was $4.3
million and $4.6 million, respectively. Costs, expenses, and minority interest and cooperative
endeavor allocations were $4.9
- 28 -
million and $6.4 million respectively, for the six months ended June
30, 2006 and 2005. Losses from discontinued operations were $360,000 and $1.1 million for the six
months ended June 30, 2006 and 2005, respectively.
Liquidity and Capital Resources
The Company completed its initial public offering on June 14, 2005. The net offering proceeds
received by us, after deducting the total expenses of $7,393,000 (including $3,430,000 in
underwriting discounts and commissions), were approximately $41,607,000. As of June 30, 2006, $21.9
million of the net offering proceeds have been used to repay the following indebtedness: (1) $21.1
million on the credit facility, bearing interest at prime plus 1.5% and due April 10, 2010, with
Residential Funding Corporation; (2) $643,000 of outstanding obligations under our loan agreement,
bearing interest at 12.0% and due July 1, 2006, with The Catalyst Fund, Ltd. and Southwest/Catalyst
Capital, Ltd.; and (3) approximately $178,000 of outstanding indebtedness assumed by us in
connection with acquisitions completed by us in 2004. Additionally, $3.3 million has been used to
pay minority interest holders for their interests and $14.0 million has been used to fund
acquisitions since the initial public offering.
Our principal source of liquidity for our operating activities is the collection of our
accounts receivable, most of which are collected from governmental and third party commercial
payors. Our reported cash flows from operating activities are impacted by various external and
internal factors, including the following:
|
|
|
Operating Results Our net income has a significant impact on our operating cash
flows. Any significant increase or decrease in our net income could have a material impact
on our operating cash flows. |
|
|
|
|
Start Up Costs Following the completion of an acquisition, we generally incur
substantial start up costs in order to implement our business strategy. There is generally
a delay between our expenditure of these start up costs and the increase in net service
revenue, and subsequent cash collections, which adversely effects our cash flows from
operating activities. |
|
|
|
|
Timing of Payroll Our employees are paid bi-weekly on Fridays; therefore, operating
cash flows decline in reporting periods that end on a Friday. Conversely, for those
reporting periods ending on a day other than Friday, our cash flows are higher because we
have not yet paid our payroll. |
|
|
|
|
Medical Insurance Plan Funding We are self funded for medical insurance purposes. Any
significant changes in the amount of insurance claims submitted could have a direct impact
on our operating cash flows. |
|
|
|
|
Medical Supplies A significant expense associated with our business is the cost of
medical supplies. Any increase in the cost of medical supplies, or in the use of medical
supplies by our patients, could have a material impact on our operating cash flows. |
Cash used in investing activities is primarily for acquisitions of home nursing agencies and
other healthcare facilities and property and equipment, while cash provided by financing activities
is derived from the proceeds from our revolving debt arrangement.
Operating
activities during the six months ended June 30, 2006 provided
$12.1 million in cash
and used $6.9 million in cash for the six months ended June 30, 2005. Net income provided for cash
of $8.4 million. Non-cash items such as depreciation and amortization, provision for bad debts,
equity-based compensation, compensation expense, minority interest in earnings of subsidiaries,
deferred income taxes and gain on sale of assets totaled $5.6 million. Changes in operating
assets and liabilities, excluding cash, offset these non-cash charges.
Days sales outstanding, or DSO, for the three months ended June 30, 2006 was 77 days compared
to 94 days for the same three-month period in 2005. DSO, when adjusted for acquisitions and
unbilled accounts receivables, was 69 days. The adjustment takes into account $4.6 million of unbilled receivables that the
Company is delayed in billing at this time due to the lag time in receiving the change of ownership
recognition after acquiring companies. There were no such adjustments for the comparable period in
2005.
Investing activities used $6.8 million and $975,000 in cash for the six months ended June 30,
2006 and 2005, respectively. In the six months ended June 30, 2006, cash provided by investing
activities was $1.4 million primarily
- 29 -
from the sale of one of our long-term acute care hospitals,
offset in part by cash used of $2.0 million for the purchases of property and equipment and $6.2
million in business acquisitions.
Financing
activities used $3.6 million in the six months ended June 30, 2006 and provided
$25.3 million in the six months ended June 30, 2005. Cash used in financing activities in the six
months ended June 30, 2006 included net principal payments on debt and capital leases of $1.3
million.
At June 30, 2006, we had working capital of $54.5 million compared to $49.2 million at
December 31, 2005, an increase of $5.3 million.
On July 19, 2006, the Company closed its public offering of 4,000,000 shares of common stock
at a price of $19.25 per share. Of the 4,000,000 shares of common stock offered, 1,000,000 shares
were offered by the Company, with the remaining 3,000,000 shares of common stock sold by the
selling stockholders identified in the prospectus supplement. The underwriters exercised an
over-allotment of an additional 600,000 shares, all of which were sold by the selling stockholders.
The additional net cash provided to the Company after this offering amounted to approximately $21
million.
On July 31, 2006, the Company completed its acquisition of the Kentucky-based assets of
Lifeline Home Health Care, a privately-held company based in Somerset, Kentucky. This acquisition
involves an approximate total patient census of 2,400 as well as approximately 350 Lifeline
employees. As a result of the acquisition, the Company now has 17 locations in 29 Kentucky
counties with a population of over 750,000 people. In 2005, Lifeline reported Kentucky-based
revenue of approximately $23 million. Lifeline was purchased for approximately $15 million in
cash.
Indebtedness
Our total long-term indebtedness was $4.1 million at June 30, 2006 and $5.4 million at
December 31, 2005, respectively, including the current portions of $751,000 and $1.8 million,
respectively. In April 2005, we entered into an amended and restated senior secured credit facility
with Residential Funding Corporation due April 15, 2010. We, together with certain of our
subsidiaries, are borrowers under the credit facility. Our obligations and the obligations of our
subsidiary borrowers under our credit facility agreement are secured by a lien on substantially all
of our assets (including the capital stock or other forms of ownership interests we hold in our
subsidiaries and affiliates) and the assets of those subsidiaries and affiliates.
Our credit facility makes available to us up to $22.5 million in revolving loans. The total
availability may be increased up to a maximum of $25.0 million, subject to certain terms and
conditions. Total availability under our credit facility may be limited from time to time based on
the value of our receivables. This facility was paid in full as of the quarter ended June 30, 2005.
As of June 30, 2006 and December 31, 2005, we had no outstanding balance under our credit
facility.
Interest on outstanding borrowings under our credit facility accrues at a variable base rate
(based on Wells Fargo Banks prime rate or the federal funds rate), plus a margin of 1.5%.
Our credit facility contains customary affirmative, negative and financial covenants. For
example, we are restricted in incurring additional debt, disposing of assets, making investments,
allowing fundamental changes to our business or organization, and making certain payments in
respect of stock or other ownership interests, such as dividends and stock repurchases. Financial
covenants include requirements that we maintain: a debt to EBITDA ratio of no greater than 1.5 to
1.0 and a fixed charge coverage ratio of not less than 1.4 to 1.0.
Our credit facility also contains customary events of default. These include bankruptcy and
other insolvency events, cross-defaults to other debt agreements, a change in control involving us
or any subsidiary guarantor (other than due to this offering), and the failure to comply with
certain covenants.
- 30 -
Contingent Convertible Minority Interests
During 2004, in conjunction with the acquisition/sale of joint venture interests, the Company
entered into agreements with minority interest holders in three of its majority owned subsidiaries
that allowed these minority interest holders to put their minority interests to the Company in the
event the Company is sold, merged or otherwise acquired or completes an initial public offering
(IPO). These put options were deemed to be part of the underlying minority interest shares, thus
rendering the shares to be puttable shares. In September and November of 2004, the Company entered
into forward exchange contracts with the minority interest holders in two of these subsidiaries,
Acadian Home Health Care Services, LLC (Acadian) and Hebert, Thibodeaux, Albro and Touchet
Therapy Group, Inc. (Hebert) which required the minority interest holders in these subsidiaries
to sell their interests to the Company in the event of an IPO. In conjunction with the Companys
IPO, the forward exchange contracts were consummated and the minority interest holders of Acadian
and Hebert sold their minority interests to the Company in exchange for cash and shares of the
Companys common stock. The Company had accrued the cash payment of approximately $2.2 million to
be paid under these forward exchange contracts. This amount was paid in full in 2005.
In the third majority owned subsidiary, St. Landry Extended Care Hospital, LLC (St. Landry),
the put option allows the minority interest holders to convert their minority interests into shares
of the Company based upon St. Landrys EBITDA for the prior fiscal year in relation to the
Companys EBITDA over the same period. The put option became exercisable by the minority interest
holders in St. Landry upon the completion of the IPO. However, due to applicable laws and
regulations, the minority interest holders can not convert their minority interests in St. Landry
unless certain conditions are met including, but not limited to, the Company having stockholders
equity in excess of $75 million at the end of its most recent fiscal year or on average during the
previous three fiscal years. If the St. Landry minority interest holders do not or are unable to
convert their minority interests into shares of the Company, the minority interest holders shall
have the option to redeem their minority interests at any time following thirty days after the IPO
for cash consideration equal to the value of the shares the minority interest holders would have
received if they had converted their minority interests into shares of the Company multiplied by
the average closing price of the Companys shares for the thirty days preceding the date of the
minority interest holders exercise of the redemption option. As of December 31, 2005 and June
30, 2006, the company had exceeded $75 million in stockholders equity. As of June 30, 2006,
approximately 59% of the doctors have converted their minority interests to cash.
The above put/redemption options and exchange agreements have been presented in the historical
financial statements under the guidance in Accounting Series Release (ASR) No. 268 and Emerging
Issues Task Force (EITF) Topic D-98, which generally require a public companys stock subject to
redemption requirements that are outside the control of the issuer to be excluded from the caption
stockholders equity and presented separately in the issuers balance sheet. Under EITF Topic
D-98, once it becomes probable that the minority interest would become redeemable, the minority
interest should be adjusted to its current redemption amount. As noted above, the St. Landry put
option allowed the minority interest holders in St. Landry to have their interests redeemed for
cash upon the completion of the IPO and therefore the Company recorded an adjustment of
approximately $1.5 million to minority interests subject to exchange contracts and/or put options
and to retained earnings which represents the redemption value of St. Landrys interests at June
30, 2005. In September 2005, certain minority interest holders redeemed their interests in St.
Landry. This resulted in a cash payment of approximately $214,000. In connection with the partial
redemption of certain minority interests in September 2005, we decreased our minority interests by
approximately $149,000 and increased our retained earnings by the same amount. Simultaneously, we
recorded goodwill of $214,000 to represent the value of the minority interests redeemed. Also at
the end of the third quarter of 2005, we recorded a mark-to-market charge of $404,000.
In November 2005, the agreement was amended to allow minority interest holders to redeem their
minority interests based on the St. Landrys rolling twelve month EBITDA in relation to the
Companys EBITDA over the same period. At December 31, 2005, the Company recorded an additional
mark-to-market benefit of $266,000 to mark the liability to redemption value at the end of the
quarter.
In connection with the partial redemption of certain minority interest in the six months ended
June 30, 2006, we decreased our minority interests by approximately $939,000 and increased our
retained earnings by the same amount. Simultaneously, we recorded goodwill of $889,000 to
represent the value of the minority interests redeemed. Also for the six months ended June 30,
2006, we recorded a mark to market benefit of $76,000.
- 31 -
Off-Balance Sheet Arrangements
We do not currently have any off-balance sheet arrangements with unconsolidated entities or
financial partnerships, such as entities often referred to as structured finance or special purpose
entities, which would have been established for the purpose of facilitating off-balance sheet
arrangements or other contractually narrow or limited purposes. In addition, we do not engage in
trading activities involving non-exchange traded contracts. As such, we are not materially exposed
to any financing, liquidity, market or credit risk that could arise if we had engaged in these
relationships.
Critical Accounting Policies
We prepare our consolidated financial statements in accordance with generally accepted
accounting principles, or GAAP. Accordingly, we make estimates and assumptions that affect our
reported amounts of assets, liabilities, revenues and expenses, as well as the disclosure of
contingent assets and liabilities. In some cases, we could reasonably have used different
accounting policies and estimates. Changes in the accounting estimates are reasonably likely to
occur from period to period. Accordingly, actual results could differ materially from our
estimates. To the extent that there are material differences between these estimates and actual
results, our financial condition or results of operations will be affected. We base our estimates
on past experience and other assumptions that we believe are reasonable under the circumstances,
and we evaluate these estimates on an ongoing basis. We refer to accounting estimates of this type
as critical accounting policies and estimates, which we discuss further below.
Principles of Consolidation
Our consolidated financial statements include all subsidiaries and entities controlled by us.
We define control as ownership of a majority of the voting interest of an entity. Our
consolidated financial statements also include entities in which we absorb a majority of the
entitys expected losses, receive a majority of the entitys expected residual returns, or both, as
a result of ownership, contractual or other financial interests in the entity.
The decision to consolidate or not consolidate an entity would not impact our earnings, as we
would include our portion of these entities profits and losses either through consolidation or the
equity method of accounting if we did not consolidate.
All significant intercompany accounts and transactions have been eliminated in consolidation.
Business combinations accounted for as purchases have been included in the consolidated financial
statements from the respective dates of acquisition.
The following table summarizes the percentage of net service revenue earned by type of
ownership or relationship we had with the operating entity:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Three Months |
|
Six Months |
|
|
Ended June 30, |
|
Ended June 30, |
|
|
2006 |
|
2005 |
|
2006 |
|
2005 |
Wholly owned subsidiaries |
|
|
35.4 |
% |
|
|
22.7 |
% |
|
|
35.9 |
% |
|
|
26.0 |
% |
Equity joint ventures |
|
|
49.3 |
|
|
|
59.6 |
|
|
|
49.1 |
|
|
|
56.1 |
|
Cooperative endeavors |
|
|
1.6 |
|
|
|
2.6 |
|
|
|
1.7 |
|
|
|
2.8 |
|
License leasing arrangements |
|
|
11.4 |
|
|
|
11.6 |
|
|
|
11.4 |
|
|
|
11.7 |
|
Management services |
|
|
2.3 |
|
|
|
3.5 |
|
|
|
1.9 |
|
|
|
3.4 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
100.0 |
% |
|
|
100.0 |
% |
|
|
100.0 |
% |
|
|
100.0 |
% |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
The following discussion sets forth our consolidation policy with respect to our equity joint
ventures, cooperative endeavors, license leasing arrangements and management services agreements.
- 32 -
Equity Joint Ventures
Our equity joint ventures are structured as limited liability companies in which we typically
own a majority equity interest ranging from 51.0% to 98.0%. Each member of all but one of our
equity joint ventures participates in profits and losses in proportion to their equity interests.
We have one equity joint venture partner whose participation in losses is limited. We consolidate
these entities, as we absorb a majority of the entities expected losses, receive a majority of the
entities expected residual returns and generally have voting control.
Cooperative Endeavors
We have arrangements with certain partners that involve the sharing of profits and losses.
Unlike our equity joint ventures, we own 100.0% of the equity interests in our cooperative
endeavors. In these cooperative endeavors, we possess interests in the net profits and losses
ranging from 67.0% to 70.0%. We have one cooperative endeavor partner whose participation in losses
is limited. We consolidate these entities, as we own 100.0% of the outstanding equity interests,
absorb a majority of the entities expected losses and receive a majority of the entities expected
residual returns.
License Leasing Arrangements
We lease, through our wholly-owned subsidiaries, home health licenses necessary to operate
certain of our home nursing agencies. As with our wholly owned subsidiaries, we own 100.0% of the
equity interests of these entities and consolidate them based on such ownership, as well as our
right to receive a majority of the entities expected residual returns and our obligation to absorb
a majority of the entities expected losses.
Management Services
We have various management services agreements under which we manage certain operations of
agencies and facilities. We do not consolidate these agencies or facilities, as we do not have an
equity interest and do not have a right to receive a majority of the agencies or facilities
expected residual returns or an obligation to absorb a majority of the agencies or facilities
expected losses.
Revenue Recognition
We report net service revenue at the estimated net realizable amount due from Medicare,
Medicaid, commercial insurance, managed care payors, patients, and others for services rendered.
Under Medicare, our home nursing patients are classified into a home health resource group prior to
the receipt of services. Based on this home health resource group we are entitled to receive a
prospective Medicare payment for delivering care over a 60 day period. Medicare adjusts these
prospective payments based on a variety of factors, such as low utilization, patient transfers,
changes in condition and the level of services provided. In calculating our reported net service
revenue from our home nursing services, we adjust the prospective Medicare payments by an estimate
of the adjustments. We calculate the adjustments based on a rolling average of these types of
adjustments for claims paid during the preceding three months. Historically we have not made any
material revisions to reflect differences between our estimate of the Medicare adjustments and the
actual Medicare adjustments. For our home nursing services, we recognize revenue based on the
number of days elapsed during the episode of care.
Under Medicare, patients in our long-term acute care facilities are classified into long-term
care diagnosis-related groups. Based on this classification, we are then entitled to receive a
fixed payment from Medicare. This fixed payment is also subject to adjustment by Medicare due to
factors such as short stays. In calculating our reported net service revenue for services provided
in our long-term acute care hospitals, we reduce the prospective payment amounts by an estimate of
the adjustments. We calculate the adjustment based on a historical average of these types of
adjustments for claims paid during the preceding three months. For our long-term acute care
hospitals we recognize revenue as services are provided.
For hospice services we are paid by Medicare under a prospective payment system. We receive
one of four predetermined daily or hourly rates based upon the level of care we furnish. We record
net service revenue from our hospice services based on the daily or hourly rate. We recognize
revenue for hospice as services are provided.
- 33 -
Under Medicare we are reimbursed for our rehabilitation services based on a fee schedule for
services provided adjusted by the geographical area in which the facility is located. We recognize
revenue as these services are provided.
Our Medicaid reimbursement is based on a predetermined fee schedule applied to each service we
provide. Therefore, we recognize revenue for Medicaid services as services are provided based on
this fee schedule. Our managed care payors reimburse us in a manner similar to either Medicare or
Medicaid. Accordingly, we recognize revenue from our managed care payors in the same manner as we
recognize revenue from Medicare or Medicaid.
We record management services revenue as services are provided in accordance with the various
management services agreements to which we are a party. The agreements generally call for us to
provide billing, management, and other consulting services suited to and designed for the efficient
operation of the applicable home nursing agency, hospice or inpatient rehabilitation facility. We are
responsible for the costs associated with the locations and personnel required for the provision of
the services. We are generally compensated based on a percentage of net billings or an established
base fee. In addition, for certain of the management agreements, we may earn incentive
compensation.
Accounts Receivable and Allowances for Uncollectible Accounts
We report accounts receivable net of estimated allowances for uncollectible accounts and
adjustments. Accounts receivable are uncollateralized and primarily consist of amounts due from
third-party payors and patients who receive final bills once all documentation is completed. Using
detailed accounts receivable aging reports produced by our billing system, our collections
department monitors and pursues payment. We have adopted a charity care policy that provides the
criteria a patient must meet in order to be considered indigent and his or her balance considered
for write-off. All other accounts that are deemed uncollectible are turned over to an outside
collection agency for further collection efforts. To provide for accounts receivable that could
become uncollectible in the future, we establish an allowance for uncollectible accounts to reduce
the carrying amount of such receivables to their estimated net realizable value. The credit risk
for concentrations of receivables is limited due to the significance of Medicare as the primary
payor. The amount of the provision for bad debts is based upon our assessment of historical and
expected net collections, business and economic conditions, trends in government reimbursement and
other collection indicators.
A portion of the estimated Medicare prospective payment system reimbursement from each
submitted home nursing episode is received in the form of a request for accelerated payment, or
RAP, before all services are rendered. The estimated episodic payment is billed at the commencement
of the episode. We receive a RAP for 60.0% of the estimated reimbursement at the initial billing
for the initial episode of care per patient and the remaining reimbursement is received upon
completion of the episode. For any subsequent episodes of care contiguous with the first episode of
care for a patient we receive a RAP for 50.0% of the estimated reimbursement at initial billing.
The remaining 50.0% reimbursement is received upon completion of the episode. We have earned net
service revenue in excess of billings rendered to Medicare. Only a nominal portion of the amounts
due to the Medicare program represent cash collected in advance of providing services.
Our Medicare population is paid at a prospectively set amount that can be determined at the
time services are rendered. Our Medicaid reimbursement is based on a predetermined fee schedule
applied to each individual service we provide. Our managed care contracts are structured similar to
either the Medicare or Medicaid payment methodologies. Because of our payor mix, we are able to
calculate our actual amount due at the patient level and adjust the gross charges down to the
actual amount at the time of billing. This negates the need for an estimated contractual allowance
to be booked at the time we report net service revenue for each reporting period.
At June 30 2006, our allowance for doubtful accounts, as a percentage of patient accounts
receivable, was approximately 7.1%. For the six months ended June 30, 2006, the provision for doubtful
accounts increased to 2.2% of net service revenue compared to 1.6% of net service revenue for the
six months ended June 30, 2005. Adverse changes in general economic conditions, billing operations,
payor mix, or trends in federal or state governmental coverage could affect our collection of
accounts receivable, cash flows and results of operations.
- 34 -
The following table sets forth our aging of accounts receivable as of June 30, 2006:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Payor |
|
0-30 |
|
|
31-60 |
|
|
61-90 |
|
|
91-120 |
|
|
121-150 |
|
|
150+ |
|
|
Total |
|
|
|
(in thousands) |
|
Medicare |
|
$ |
14,082 |
|
|
$ |
1,526 |
|
|
$ |
1,886 |
|
|
$ |
2,696 |
|
|
$ |
2,744 |
|
|
$ |
5,612 |
|
|
$ |
28,546 |
|
Medicaid |
|
|
1,249 |
|
|
|
354 |
|
|
|
577 |
|
|
|
563 |
|
|
|
708 |
|
|
|
3,771 |
|
|
|
7,222 |
|
Other |
|
|
921 |
|
|
|
701 |
|
|
|
1,180 |
|
|
|
962 |
|
|
|
1,056 |
|
|
|
6,182 |
|
|
|
11,002 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Total |
|
$ |
16,252 |
|
|
$ |
2,581 |
|
|
$ |
3,643 |
|
|
$ |
4,221 |
|
|
$ |
4,508 |
|
|
$ |
15,565 |
|
|
$ |
46,770 |
|
Intangible Assets
Goodwill represents substantially all of the intangible assets reflected on our consolidated
balance sheet, included elsewhere in this prospectus. Goodwill is the excess purchase price over
the estimated fair market value of the net assets we have acquired in business combinations. On
June 29, 2001, the Financial Accounting Standards Board, or FASB, issued Statement of Financial
Accounting Standard, or SFAS No. 142, Goodwill and Other Intangible Assets, which changed the
accounting for goodwill and intangible assets. Under SFAS No. 142, goodwill and indefinite lived
intangible assets are no longer amortized but are reviewed annually or more frequently if
impairment indicators arise, for impairment. Prior to the adoption of SFAS No. 142, goodwill had
been amortized on a straight-line basis over 25 years through December 31, 2001. We adopted SFAS
No. 142 effective January 1, 2002.
We completed our annual impairment test under SFAS No. 142 as of October 1, 2005, based on the
estimated fair value of the business and we determined that no impairment of goodwill existed. Due
to the allocation of goodwill to businesses that have been sold or have been held for sale as of
March 31, 2006, we also completed an impairment test as of March 31, 2006. No impairment of
goodwill existed. We concluded no impairment indicators were present at December 31, 2005.
We have concluded that licenses to operate home-based and/or facility-based services have
indefinite lives, as we have determined that there are no legal, regulatory, contractual, economic
or other factors that would limit the useful life of the licenses and we intend to renew and
operate the licenses indefinitely. Accordingly, we have elected to recognize the fair value of
these indefinite-lived licenses and goodwill as a single asset for financial reporting purposes, as
permitted by SFAS No. 141, Business Combinations.
We estimate the fair value of our identified reporting units and compare those estimates
against the related carrying value. For each of the reporting units, the estimated fair value is
determined based on a multiple of EBITDA or on the estimated fair value of assets in situations
when it is readily determinable.
Components of our home-based services segment are generally represented by individual
subsidiaries or joint ventures with individual licenses to conduct specific operations within
geographic markets as limited by the terms of each license. Components of our facility-based
services are represented by individual operating entities. Effective January 1, 2004 we began
aggregating the components of these two segments into two reporting units for purposes of
evaluating impairment. Prior to January 1, 2004 we evaluated each operating entity separately for
impairment. Modifications to our management of the segments and reporting provided us with a basis
to change the reporting unit structure.
ITEM 3. QUANTITATIVE AND QUALITATIVE DISCLOSURES ABOUT MARKET RISK
As of June 30, 2006, we had cash of $19.1 million, which consisted of highly liquid money
market instruments with maturities less than 90 days. Because of the short maturities of these
instruments, a sudden change in market interest rates would not be expected to have a material
impact on the fair value of the portfolio. We would not expect our operating results or cash flows to be materially affected by the effect of a sudden
change in market interest rates on our portfolio. At times, cash in banks is in excess of the FDIC
insurance limit. The Company has not experienced any loss as a result of those deposits and does
not expect any in the future.
Our exposure to market risk relates to changes in interest rates for borrowings under the new
senior secured
- 35 -
credit facility we entered into in April 2005. There were no amounts outstanding
under our credit facility as of June 30, 2006; however, any future borrowings are expected to bear
interest at variable rates.
ITEM 4. CONTROLS AND PROCEDURES
Evaluation of Disclosure Controls and Procedures
(a) We maintain disclosure controls and procedures designed to provide reasonable assurance that
information required to be disclosed in our reports under the Securities and Exchange Act of 1934,
as amended, is recorded, processed, summarized and reported within the time periods specified in
the SECs rules and forms, and that such information is accumulated and communicated to our
management, including our chief executive officer and chief financial officer, as appropriate, to
allow timely decisions regarding required disclosure. Our management, with the participation and
oversight of our chief executive officer and chief financial officer, evaluated the design and
effectiveness of our disclosure controls and procedures as of the end of the period covered by this
report. As previously reported in our Form 10-K for the year ended December 31, 2005, in conducting
this evaluation for the period ended December 31, 2005 a material weakness was identified in our
internal control over financial reporting relating to preventing posting errors within the patient
billing system for certain rebilled accounts. Specifically, our personnel lacked sufficient
knowledge and experience in our billing and revenue management software and we did not establish
appropriate controls to detect or correct errors relating to these rebilled transactions. On the
basis of this finding, our chief executive officer and our chief financial officer concluded that
our disclosure controls and procedures were not effective, as of the end of the December 31, 2005
period. The correction of these posting errors resulted in a $900,000 increase to revenue for the
year ended December 31, 2005. The potential effects of these posting errors on our financial
statements issued during the interim periods of 2005 were not material. In connection with the 2005
audit of our financial statements, Ernst & Young, LLP, our independent registered public accounting
firm, issued a management letter which noted that we had this material weakness in our internal
control over financial reporting. No other material weaknesses in our internal control over
financial reporting were identified in the management letter.
Although the Companys remediation efforts are well underway with respect to the above
referenced material weakness, the deficiency will not be considered remediated until the new
internal controls over financial reporting implemented to remediate the material weakness are fully
implemented and operational for a period of time and are successfully tested, and management
concludes that these controls are operating effectively. As of June 30, 2006, the Companys chief
executive officer and chief financial officer concluded that because additional testing is required
to determine if the material weakness described in the Companys annual report on Form 10-K for the
year ended December 31, 2005 has been fully remedied, the Company did not maintain effective
disclosure controls and procedures as of the end of the period covered by this report.
(b) There have been no changes in our internal control over financial reporting during the
period covered by this report that materially affected, or are reasonably likely to materially
affect, our internal control over financial reporting. Subsequent to identifying the material
weakness in our internal control over financial reporting with respect to our rebilled
transactions, we initiated the process of improving our internal controls over these transactions
through additional training on our software for those individuals recording these transactions,
strict procedural controls and documentation requirements over rebilled transactions, and newly
established monitoring, review and approval controls over these transactions.
On September 21, 2005, the SEC extended the compliance dates related to Section 404 of the
Sarbanes-Oxley Act for non-accelerated filers. Under this extension a company that is not required
to file its annual and quarterly reports on an accelerated basis (non-accelerated filer) must begin
to comply with the internal control over financial reporting requirements for its first fiscal year
ending on or after July 15, 2007. We anticipate that we will become an accelerated filer in calendar 2006 and therefore we will be required to comply with these
requirements for the year ending December 31, 2006. We are currently in the process of documenting
our internal control structure.
- 36 -
PART II OTHER INFORMATION
ITEM 1. LEGAL PROCEEDINGS.
We are involved in litigation and proceedings in the ordinary course of business. We do not
believe that the outcome of any of the matters in which we are currently involved, individually or
in the aggregate, will have a material adverse effect upon our business, financial condition, or
results of operations.
ITEM 1A. RISK FACTORS.
You should carefully consider the risks described below before investing in the Company. The
risks and uncertainties described below are not the only ones we face. Other risks and
uncertainties that we have not predicted or assessed may also adversely affect us.
If any of the following risks occurs, our earnings, financial condition or business could be
materially harmed, and the trading price of our common stock could decline, resulting in the loss
of all or part of your investment.
More than 80% of our net service revenue is derived from Medicare. If there are changes in Medicare
rates or methods governing Medicare payments for our services, or if we are unable to control our
costs, our net service revenue and net income could decline materially.
For the six months ended June 30, 2006 and 2005, we received 84.8% and 86.3%, respectively, of
our net service revenue from Medicare. Reductions in Medicare rates or changes in the way Medicare
pays for services could cause our net service revenue and net income to decline, perhaps
materially. Reductions in Medicare reimbursement could be caused by many factors, including:
|
|
|
administrative or legislative changes to the base rates under the applicable prospective payment systems; |
|
|
|
|
the reduction or elimination of annual rate increases; |
|
|
|
|
the imposition or increase by Medicare of mechanisms, such as co-payments, shifting more responsibility
for a portion of payment to beneficiaries; |
|
|
|
|
adjustments to the relative components of the wage index used in determining reimbursement rates; |
|
|
|
|
changes to case mix or therapy thresholds; |
|
|
|
|
the reclassification of home health resource groups or long-term care diagnosis-related groups; or |
|
|
|
|
further limitations on referrals to long-term acute care hospitals from host hospitals. |
We generally receive fixed payments from Medicare for our services based on the level of care
provided to our patients. Consequently, our profitability largely depends upon our ability to
manage the cost of providing these services. Medicare currently provides for an annual adjustment
of the various payment rates, such as the base episode rate for our home nursing services, based
upon the increase or decrease of the medical care expenditure category of the Consumer Price Index,
which may be less than actual inflation. This adjustment could be eliminated or reduced in any
given year. Our base episode rate for home nursing services is also subject to an annual market
basket adjustment. Further, Medicare routinely reclassifies home health resource groups and
long-term care diagnosis-related groups. As a result of those reclassifications, we could receive
lower reimbursement rates depending on the case mix of the patients we service. If our cost of
providing services increases by more than the
annual Medicare price adjustment, or if these reclassifications result in lower reimbursement
rates, our net income could be adversely impacted.
We are subject to extensive government regulation. Any changes in the laws governing our business,
or the interpretation and enforcement of those laws or regulations, could cause us to modify our
operations and could negatively impact our operating results.
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As a provider of healthcare services, we are subject to extensive regulation on the federal,
state and local levels, including with regard to:
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agency, facility and professional licensure, certificates of need and permits of approval; |
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conduct of operations, including financial relationships among healthcare providers,
Medicare fraud and abuse, and physician self-referral; |
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maintenance and protection of records, including the Health Insurance Portability and
Accountability Act of 1996, or HIPAA; |
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environmental protection, health and safety; |
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certification of additional agencies or facilities by the Medicare program; and |
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payment for services. |
The laws and regulations governing our operations, along with the terms of participation in
various government programs, regulate how we do business, the services we offer, and our
interactions with patients and other providers. These laws and regulations, and their
interpretations, are subject to frequent change. Changes in existing laws or regulations, or their
interpretations, or the enactment of new laws or regulations could increase our costs of doing
business and cause our net income to decline. If we fail to comply with these applicable laws and
regulations, we could suffer civil or criminal penalties, including the loss of our licenses to
operate and our ability to participate in federal and state reimbursement programs.
We are subject to various routine and non-routine governmental reviews, audits, and
investigations. In recent years federal and state civil and criminal enforcement agencies have
heightened and coordinated their oversight efforts related to the healthcare industry, including
with respect to referral practices, cost reporting, billing practices, joint ventures and other
financial relationships among healthcare providers. A violation or change in the interpretation of
the laws governing our operations, or changes in the interpretation of those laws, could result in
the imposition of fines, civil or criminal penalties, the termination of our rights to participate
in federal and state-sponsored programs, or the suspension or revocation of our licenses to
operate. If we become subject to material fines or if other sanctions or other corrective actions
are imposed upon us, we may suffer a substantial reduction in net income.
If any of our agencies or facilities fail to comply with the conditions of participation in the
Medicare program, that agency or facility could be terminated from Medicare, which would adversely
affect our net service revenue and net income.
Our agencies and facilities must comply with the extensive conditions of participation in the
Medicare program. These conditions of participation vary depending on the type of agency or
facility, but in general require our agencies and facilities to meet specified standards relating
to personnel, patient rights, patient care, patient records, administrative reporting and legal
compliance. If an agency or facility fails to meet any of the Medicare conditions of participation,
that agency or facility may receive a notice of deficiency from the applicable state surveyor. If
that agency or facility then fails to institute and comply with a plan of correction to correct the
deficiency within the time period provided by the state surveyor, that agency or facility could be
terminated from the Medicare program. We respond in the ordinary course to deficiency notices
issued by state surveyors, and none of our facilities or agencies have ever been terminated from
the Medicare program for failure to comply with the
conditions of participation. Any termination of one or more of our agencies or facilities from the
Medicare program for failure to satisfy the Medicare conditions of participation would affect
adversely our net service revenue and net income.
In addition, if our long-term acute care hospitals fail to meet or maintain the standards for
Medicare certification as long-term acute care hospitals, such as for average minimum length of
patient stay, they will receive reimbursement under the prospective payment system applicable to
general acute care hospitals rather than the system applicable to long-term acute care hospitals.
Payments at rates applicable to general acute care hospitals would likely result in our long-term
acute care hospitals receiving less Medicare reimbursement than they currently
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