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, 2007
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
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71-0918189 |
(State or Other Jurisdiction of
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(I.R.S. Employer Identification No.) |
Incorporation or Organization) |
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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):
Large accelerated filer o Accelerated Filer þ Non-accelerated filer o
Indicate by check mark whether the registrant is a shell company (as defined in rule 12b-2 of
the Exchange Act). Yes o No þ
Number of shares of common stock, par value $0.01, outstanding as of August 2, 2007: 18,003,980
shares
LHC GROUP, INC.
INDEX
- 2 -
PART I FINANCIAL INFORMATION
ITEM 1. FINANCIAL STATEMENTS.
LHC GROUP, INC. AND SUBSIDIARIES
CONSOLIDATED BALANCE SHEETS
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June 30, |
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December 31, |
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2007 |
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2006 |
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(unaudited) |
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(in thousands, except share data) |
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ASSETS |
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Current assets: |
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Cash |
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$ |
13,318 |
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$ |
26,877 |
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Receivables: |
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Patient accounts receivable, less allowance for uncollectible accounts of
$7,671, and $5,769 at June 30, 2007 and December 31, 2006, respectively |
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61,087 |
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50,029 |
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Other receivables |
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2,133 |
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3,367 |
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Employee receivables |
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18 |
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34 |
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Amounts due from governmental entities |
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2,403 |
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|
2,518 |
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|
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65,641 |
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|
55,948 |
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Deferred income taxes |
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|
2,901 |
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|
1,935 |
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Prepaid income taxes |
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|
3,382 |
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Prepaid expenses and other current assets |
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3,743 |
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4,120 |
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Assets held for sale |
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467 |
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1,171 |
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Total current assets |
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89,452 |
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90,051 |
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Property, building, and equipment, net |
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12,068 |
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11,705 |
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Goodwill |
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48,319 |
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39,681 |
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Intangible assets, net |
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9,499 |
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8,262 |
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Other assets |
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3,723 |
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2,995 |
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Total assets |
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$ |
163,061 |
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$ |
152,694 |
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LIABILITIES AND STOCKHOLDERS EQUITY |
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Current liabilities: |
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Accounts payable and other accrued liabilities |
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$ |
4,787 |
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$ |
5,903 |
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Salaries, wages, and benefits payable |
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11,533 |
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10,572 |
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Amounts due to governmental entities |
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3,162 |
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3,223 |
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Amounts payable under cooperative endeavor agreements |
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56 |
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51 |
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Income taxes payable |
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|
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1,219 |
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Current portion of capital lease obligations |
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127 |
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211 |
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Current portion of long-term debt |
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431 |
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428 |
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Total current liabilities |
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20,096 |
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21,607 |
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Deferred income taxes, less current portion |
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2,732 |
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2,104 |
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Capital lease obligations, less current portion |
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104 |
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147 |
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Long-term debt, less current portion |
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2,979 |
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3,051 |
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Minority interests subject to exchange contracts and/or put options |
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155 |
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317 |
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Other minority interests |
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3,283 |
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3,579 |
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Stockholders equity: |
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Common stock $0.01 par value: 40,000,000 shares authorized;
20,712,482 and 20,682,317 shares issued and 17,762,423 and 17,732,258
shares outstanding
at June 30, 2007 and December 31, 2006, respectively |
|
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177 |
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177 |
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Treasury stock 2,950,059 shares at cost |
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(2,856 |
) |
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(2,856 |
) |
Additional paid-in capital |
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81,116 |
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80,273 |
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Retained earnings |
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55,275 |
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44,295 |
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Total stockholders equity |
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133,712 |
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121,889 |
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Total liabilities and stockholders equity |
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$ |
163,061 |
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$ |
152,694 |
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See accompanying notes.
- 1 -
LHC GROUP, INC. AND SUBSIDIARIES
CONSOLIDATED STATEMENTS OF INCOME
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Three Months Ended |
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Six months Ended |
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June 30, |
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June 30, |
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2007 |
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2006 |
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2007 |
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2006 |
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(unaudited) |
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(in thousands, except share and per share data) |
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Net service revenue |
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$ |
70,564 |
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$ |
49,968 |
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$ |
139,291 |
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$ |
95,760 |
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Cost of service revenue |
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36,081 |
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25,098 |
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70,698 |
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49,626 |
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Gross margin |
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34,483 |
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24,870 |
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68,593 |
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46,134 |
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General and administrative expenses |
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25,142 |
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16,733 |
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47,810 |
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31,542 |
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Operating income |
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9,341 |
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|
8,137 |
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|
20,783 |
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14,592 |
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Interest expense |
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|
94 |
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60 |
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|
176 |
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|
146 |
|
Non-operating income, including (gain) on
sales of assets |
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|
(305 |
) |
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|
(116 |
) |
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|
(598 |
) |
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|
(281 |
) |
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Income from continuing operations before income taxes
and minority interest and cooperative endeavor
allocations |
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|
9,552 |
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|
8,193 |
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|
|
21,205 |
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|
|
14,727 |
|
Income tax expense |
|
|
3,071 |
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|
|
2,581 |
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|
6,870 |
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|
|
4,313 |
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Minority interest and cooperative endeavor
allocations |
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|
1,107 |
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|
1,128 |
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2,914 |
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2,124 |
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Income from continuing operations |
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5,374 |
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|
4,484 |
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|
11,421 |
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|
8,290 |
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Loss from discontinued operations (net of income tax
benefit of $215 and $166 in the three months ended
June 30, 2007 and 2006, respectively, and $382 and
$329 in the six months ended June 30, 2007 and
2006, respectively) |
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|
336 |
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|
271 |
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|
597 |
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|
536 |
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Gain on sale of discontinued operations (net of
income taxes of $37 in the three months ended June
30, 2006, and $364 in the six months ended June 30,
2006) |
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43 |
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|
637 |
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Net income |
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|
5,038 |
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|
|
4,256 |
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|
10,824 |
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|
8,391 |
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Redeemable minority interests |
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|
122 |
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|
172 |
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|
156 |
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|
1,015 |
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Net income available to common stockholders |
|
$ |
5,160 |
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$ |
4,428 |
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$ |
10,980 |
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$ |
9,406 |
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Earnings per share basic: |
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Income from continuing operations |
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$ |
0.30 |
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$ |
0.27 |
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$ |
0.64 |
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$ |
0.50 |
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Loss from discontinued operations, net |
|
|
0.02 |
|
|
|
0.01 |
|
|
|
0.03 |
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|
|
0.03 |
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Gain on sale of discontinued operations, net |
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|
|
|
|
|
|
|
|
|
|
|
|
|
0.04 |
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|
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|
|
|
|
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Net income |
|
|
0.28 |
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|
|
0.26 |
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|
|
0.61 |
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|
|
0.51 |
|
Redeemable minority interests |
|
|
0.01 |
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|
|
0.01 |
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|
|
0.01 |
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|
|
0.06 |
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|
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Net income available to common shareholders |
|
$ |
0.29 |
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|
$ |
0.27 |
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|
$ |
0.62 |
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|
$ |
0.57 |
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Earnings per share diluted: |
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|
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Income from continuing operations |
|
$ |
0.30 |
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|
$ |
0.27 |
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|
$ |
0.64 |
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|
$ |
0.50 |
|
Loss from discontinued operations, net |
|
|
0.02 |
|
|
|
0.01 |
|
|
|
0.03 |
|
|
|
0.03 |
|
Gain on sale of discontinued operations, net |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
0.04 |
|
|
|
|
|
|
|
|
|
|
|
|
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|
Net income |
|
|
0.28 |
|
|
|
0.26 |
|
|
|
0.61 |
|
|
|
0.51 |
|
Redeemable minority interests |
|
|
0.01 |
|
|
|
0.01 |
|
|
|
0.01 |
|
|
|
0.06 |
|
|
|
|
|
|
|
|
|
|
|
|
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Net income available to common shareholders |
|
$ |
0.29 |
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|
$ |
0.27 |
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|
$ |
0.62 |
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|
$ |
0.57 |
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Weighted average shares outstanding: |
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Basic |
|
|
17,754,632 |
|
|
|
16,561,398 |
|
|
|
17,751,412 |
|
|
|
16,559,623 |
|
Diluted |
|
|
17,798,952 |
|
|
|
16,576,068 |
|
|
|
17,813,395 |
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|
16,569,727 |
|
See accompanying notes.
- 2 -
LHC GROUP, INC. AND SUBSIDIARIES
CONSOLIDATED STATEMENTS OF CASH FLOWS
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Six months Ended |
|
|
|
June 30, |
|
|
|
2007 |
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|
2006 |
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|
|
(unaudited) |
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|
(in thousands) |
|
Operating activities |
|
|
|
|
|
|
|
|
Net income |
|
$ |
10,824 |
|
|
$ |
8,391 |
|
Adjustments to reconcile net income to net cash provided by operating activities: |
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|
|
|
|
|
|
Depreciation expense |
|
|
1,449 |
|
|
|
1,135 |
|
Provision for bad debts |
|
|
4,089 |
|
|
|
2,044 |
|
Stock-based compensation expense |
|
|
581 |
|
|
|
350 |
|
Minority interest in earnings of subsidiaries |
|
|
2,711 |
|
|
|
2,099 |
|
Deferred income taxes |
|
|
(337 |
) |
|
|
(379 |
) |
Gain on divestitures and sale of assets |
|
|
|
|
|
|
(637 |
) |
Changes in operating assets and liabilities, net of acquisitions: |
|
|
|
|
|
|
|
|
Receivables |
|
|
(13,782 |
) |
|
|
(6,007 |
) |
Prepaid income taxes |
|
|
(3,382 |
) |
|
|
895 |
|
Prepaid expenses, other assets |
|
|
(340 |
) |
|
|
(329 |
) |
Accounts payable and accrued expenses |
|
|
(1,286 |
) |
|
|
3,205 |
|
Net amounts due under cooperative endeavor agreements |
|
|
5 |
|
|
|
9 |
|
Net amounts due governmental entities |
|
|
(61 |
) |
|
|
1,310 |
|
|
|
|
|
|
|
|
Net cash provided by operating activities |
|
|
471 |
|
|
|
12,086 |
|
|
|
|
|
|
|
|
Investing activities |
|
|
|
|
|
|
|
|
Purchases of property, building, and equipment |
|
|
(1,517 |
) |
|
|
(2,014 |
) |
Proceeds from sale of entities |
|
|
|
|
|
|
1,440 |
|
Cash paid for acquisitions, primarily goodwill and intangible assets |
|
|
(9,477 |
) |
|
|
(6,219 |
) |
|
|
|
|
|
|
|
Net cash used in investing activities |
|
|
(10,994 |
) |
|
|
(6,793 |
) |
|
|
|
|
|
|
|
Financing activities |
|
|
|
|
|
|
|
|
Principal payments on debt |
|
|
(69 |
) |
|
|
(1,065 |
) |
Payments on capital leases |
|
|
(127 |
) |
|
|
(231 |
) |
Proceeds from employee stock purchase plan |
|
|
173 |
|
|
|
|
|
Proceeds from exercise of options |
|
|
|
|
|
|
33 |
|
Minority interest distributions, net |
|
|
(3,013 |
) |
|
|
(2,319 |
) |
|
|
|
|
|
|
|
Net cash used in financing activities |
|
|
(3,036 |
) |
|
|
(3,582 |
) |
|
|
|
|
|
|
|
Change in cash |
|
|
(13,559 |
) |
|
|
1,711 |
|
Cash at beginning of period |
|
|
26,877 |
|
|
|
17,398 |
|
|
|
|
|
|
|
|
Cash at end of period |
|
$ |
13,318 |
|
|
$ |
19,109 |
|
|
|
|
|
|
|
|
Supplemental disclosures of cash flow information |
|
|
|
|
|
|
|
|
Interest paid |
|
$ |
148 |
|
|
$ |
162 |
|
|
|
|
|
|
|
|
Income taxes paid |
|
$ |
11,336 |
|
|
$ |
120 |
|
|
|
|
|
|
|
|
See accompanying notes.
- 3 -
LHC GROUP, INC. AND SUBSIDIARIES
NOTES TO 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. As of the date of this report, the Company, through its wholly
and majority-owned subsidiaries, equity joint ventures, and controlled affiliates, operated in
Louisiana, Alabama, Arkansas, Mississippi, Texas, West Virginia, Kentucky, Florida, Georgia and
Tennessee.
Unaudited Interim Financial Information
The consolidated balance sheet as of June 30, 2007 and the related consolidated statements of
income for the three months and six months ended June 30, 2007 and 2006, and cash flows for the six
months ended June 30, 2007 and 2006 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 months and six months ended June 30, 2007 are not necessarily
indicative of the results that may be expected for the year ending December 31, 2007.
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 in the Companys Annual Report as filed
with the Securities and Exchange Commission on Form 10-K for the year ended December 31, 2006,
which includes information and disclosures not included herein.
Adjustment to Net Service Revenue and Bad Debt Expense
In an effort to improve our processes and controls in billing and collections, during the
second quarter of 2007 we engaged outside consulting expertise to evaluate the billing process
related to our Long-Term Acute Care Hospitals (LTACH). The review identified claims which had been
collected, but had remaining balances on the books. In some cases, these remaining balances related
to contractual adjustments which had not been recorded or which had been incorrectly calculated and
recorded at discharge. This information led management to determine that the Company had
underestimated its revenue and bad debt adjustments related to certain commercial payers in our
LTACHs. Therefore the Company has made the following adjustments to the facility-based segment:
|
|
|
Increased contractual adjustments in the first quarter by $783,000 pre-tax which
reduces net service revenue. |
|
|
|
|
Increased contractual adjustments in the second quarter by $1.1 million pre-tax
which reduces net service revenue and increased bad debt expense by $223,000 pre-tax.
Of the $1.1 million pre-tax contractual adjustment, $213,000
relates to FY 2005 and $925,000 relates to FY 2006. These amounts
have been determined immaterial to those periods. |
- 4 -
Due to the
significance of the adjustment in the first quarter, the Company will amend the first quarter 2007
financials in a Form 10-Q/A.
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 reporting
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 and intangible assets.
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 any losses, receives a majority of any 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, which are 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 99%. 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 any losses,
receives a majority of any residual returns and generally has voting control over the entity.
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
- 5 -
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 entities as the Company owns 100% of the outstanding equity and the
Company absorbs a majority of any losses and receives a majority of any 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 any residual returns and the Companys obligation to
absorb a majority of any 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 any residual returns or an obligation to absorb a majority of any 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 Ended |
|
Six Months Ended |
|
|
June 30, |
|
June 30, |
|
|
2007 |
|
2006 |
|
2007 |
|
2006 |
Wholly-owned subsidiaries |
|
|
46.2 |
% |
|
|
36.1 |
% |
|
|
45.5 |
% |
|
|
36.4 |
% |
Equity joint ventures |
|
|
40.3 |
|
|
|
49.1 |
|
|
|
40.9 |
|
|
|
48.9 |
|
Cooperative endeavors |
|
|
1.4 |
|
|
|
1.5 |
|
|
|
1.3 |
|
|
|
1.6 |
|
License leasing arrangements |
|
|
10.0 |
|
|
|
11.1 |
|
|
|
9.8 |
|
|
|
11.2 |
|
Management services |
|
|
2.1 |
|
|
|
2.2 |
|
|
|
2.5 |
|
|
|
1.9 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
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.
For the Companys long-term acute care hospitals, revenue is recognized as services are
provided. 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 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
- 6 -
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.
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 under the terms of the related
contracts. Accordingly, the Company recognizes revenue from managed care payors consistent with
those terms.
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 Ended |
|
Six Months Ended |
|
|
June 30, |
|
June 30, |
|
|
2007 |
|
2006 |
|
2007 |
|
2006 |
Home-based services |
|
|
82.2 |
% |
|
|
72.3 |
% |
|
|
81.2 |
% |
|
|
71.6 |
% |
Facility-based services |
|
|
17.8 |
|
|
|
27.7 |
|
|
|
18.8 |
|
|
|
28.4 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
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 Ended |
|
Six Months Ended |
|
|
June 30, |
|
June 30, |
|
|
2007 |
|
2006 |
|
2007 |
|
2006 |
Payor: |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Medicare |
|
|
82.0 |
% |
|
|
85.8 |
% |
|
|
82.0 |
% |
|
|
86.1 |
% |
Medicaid |
|
|
5.6 |
|
|
|
4.1 |
|
|
|
5.9 |
|
|
|
4.5 |
|
Other |
|
|
12.4 |
|
|
|
10.1 |
|
|
|
12.1 |
|
|
|
9.4 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
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.
- 7 -
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 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 their 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, 2007 or 2006.
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. Revenue from patients covered
by private insurance is recognized in accordance with the terms of the individual contracts.
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 based on its collection efforts.
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 (RAP).
The Company submits a RAP for 60% of the estimated reimbursement for the initial episode at the
start of care. The full amount of the episode is billed after the episode has been completed. The
RAP received for that particular episode is deducted from the final payment. If a final bill is
not submitted within the greater of 120 days from the start of the episode, or 60 days from
- 8 -
the date the RAP was paid, any RAPs received for that episode will be recouped by Medicare
from any other claims in process for that particular provider. The RAP and final claim must then be
re-submitted. For any subsequent episodes of care contiguous with the first episode for a
particular patient, the Company submits a RAP for 50% instead of 60% of the estimated
reimbursement. 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.
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, 2007, our allowance for uncollectible accounts, as a percentage of patient
accounts receivable, was approximately 11.2%, or $7.7 million. For the six months ended June 30,
2007, the provision for bad debts increased to 2.9% of net service revenue compared to 2.1% of net
service revenue for the same period in 2006. 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.
The following table sets forth our aging of accounts receivable (based on the billing date) as
of June 30, 2007:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Payor |
|
0-30 |
|
|
31-60 |
|
|
61-90 |
|
|
91-120 |
|
|
121-150 |
|
|
151+ |
|
|
Total |
|
|
|
(in thousands) |
|
Medicare |
|
$ |
11,198 |
|
|
$ |
2,342 |
|
|
$ |
4,189 |
|
|
$ |
5,534 |
|
|
$ |
4,636 |
|
|
$ |
9,099 |
|
|
$ |
36,998 |
|
Medicaid |
|
|
2,546 |
|
|
|
423 |
|
|
|
878 |
|
|
|
862 |
|
|
|
1,036 |
|
|
|
3,909 |
|
|
|
9,654 |
|
Other |
|
|
4,914 |
|
|
|
1,833 |
|
|
|
1,822 |
|
|
|
1,904 |
|
|
|
1,938 |
|
|
|
9,695 |
|
|
|
22,105 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Total |
|
$ |
18,658 |
|
|
$ |
4,598 |
|
|
$ |
6,889 |
|
|
$ |
8,300 |
|
|
$ |
7,610 |
|
|
$ |
22,703 |
|
|
$ |
68,758 |
|
Goodwill and Intangible Assets
Goodwill and other intangible assets with indefinite lives are reviewed annually for
impairment or more frequently if circumstances indicate impairment may have occurred.
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.
Included in intangible assets, net are other intangible assets such as licenses to operate
home-based and/or facility-based services and trade names. The Company has valued these intangible
assets separately from goodwill for each acquisition completed after January 1, 2006. The Company
has concluded that these licenses and trade names 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 these intangible assets and the Company intends to renew and operate the
licenses and use these trade names indefinitely. Prior to January 1, 2006, the Company elected to
recognize the fair value of indefinite-lived licenses and trade names together with 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 aggregates the components of these two segments into two reporting units for
purposes of evaluating impairment.
- 9 -
Other Significant Accounting Policies
Due to/from Governmental Entities
The Companys critical access hospital and long-term acute care hospitals are reimbursed for
certain activities based on tentative rates. 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 are rendered and further adjusted as final
settlements are determined. These adjustments are accounted for as changes in estimates. There have
been no significant changes in estimates during the three months ended June 30, 2007 and 2006.
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, 2007 and 2006 was $759,000 and $570,000 respectively. Depreciation
expense for the six months ended June 30, 2007 and 2006 was $1.4 million and $1.1 million,
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.
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.
Several 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 $65,000 and $55,000 for the three months ended June 30,
2007 and 2006, respectively, and $121,000 and $120,000 for the six months ended June 30, 2007 and
2006, respectively. The cooperative endeavor agreements have terms expiring 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
- 10 -
services related to these arrangements are also typically provided by the healthcare
institution. The Company expenses these amounts as incurred.
Minority Interest Subject to Exchange Contracts and/or Put Options
The Company has a put option agreement with the minority interest holders of a majority-owned
subsidiary, St. Landry Extended Care Hospital, LLC (St. Landry), which allows the minority
interest holders to redeem their minority interests for cash. As of June 30, 2007, approximately
76.5% of the doctors have converted their minority interests to cash.
There were no redemptions in the six months ended June 30, 2007. In the six months ended June
30, 2007, the Company recorded a mark-to-market charge of $156,000 for these redeemable minority
interests. Included in minority interests subject to exchange contracts and/or put options
liability at June 30, 2007 and December 31, 2006 is $155,000 and $317,000, respectively, related to
these redeemable minority interests.
Stock-based Compensation
The Company has two stock option plans that are administered by the Compensation Committee of
the Board of Directors, which selects persons eligible to receive awards and determines the number
of shares and/or options subject to each award, the terms, conditions, performance measures and
other provisions of the award. Readers should refer to Note 6 of the Companys consolidated
financial statements in its Annual Report on Form 10-K for the year ended December 31, 2006 for
additional information related to these stock-based compensation plans.
The Company accounts for its stock-based compensation plans using the fair value recognition
provisions of 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.
Earnings Per Share
Basic per share information is computed by dividing the relevant amounts from the Consolidated
Statements of Income by the weighted-average number of shares outstanding during the period.
Diluted per share information is computed by dividing the relevant amounts from the Consolidated
Statements of Income 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:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Three Months Ended |
|
Six Months Ended |
|
|
June 30, |
|
June 30, |
|
|
2007 |
|
2006 |
|
2007 |
|
2006 |
Weighted average number of shares
outstanding for basic per share
calculation |
|
|
17,754,632 |
|
|
|
16,561,398 |
|
|
|
17,751,412 |
|
|
|
16,559,623 |
|
Effect of dilutive potential shares: |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Options |
|
|
7,871 |
|
|
|
1,454 |
|
|
|
7,856 |
|
|
|
1,197 |
|
Restricted stock |
|
|
36,449 |
|
|
|
13,216 |
|
|
|
54,127 |
|
|
|
8,907 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Adjusted weighted average shares
for diluted per share calculation |
|
|
17,798,952 |
|
|
|
16,576,068 |
|
|
|
17,813,395 |
|
|
|
16,569,727 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Recently Issued Accounting Pronouncements
In September 2006, the Financial Accounting Standards Board (FASB) issued SFAS No. 157,
Fair Value Measurements (SFAS No. 157), which defines fair value, establishes a framework for
measuring fair value in accounting principles generally accepted in the United States (GAAP) and
expands disclosures about fair value measurements. SFAS No. 157 will be effective for financial
statements issued for fiscal years beginning after
- 11 -
November 15, 2007, and interim periods within those fiscal years. The adoption of SFAS No. 157
is not expected to have a material effect on the Companys consolidated financial position or
results of operations.
In February 2007, the FASB issued SFAS No. 159, The Fair Value Option for Financial Assets and
Financial Liabilities Including an Amendment to FASB Statement No. 115 (SFAS No. 159), which
permits entities to choose to measure many financial instruments and certain other items at fair
value. SFAS No. 159 is effective as of the beginning of an entitys first fiscal year that begins
after November 15, 2007. The adoption of SFAS No. 159 is not expected to have a material effect on
the Companys consolidated financial position or results of operations.
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.
2007 Acquisitions
During the six
month period ended June 30, 2007, the Company acquired the existing operations
of twelve entities for $8.5 million in cash and $908,000 in acquisition costs. Goodwill of $8.2
million and other intangibles of $1.3 million were assigned to the home-based services segment.
The allocation of the purchase price to certain acquisitions during the six months ended June 30,
2007 has not been finalized and subject to change upon completion of
final valuation.
2007 Divestitures
The Company has reclassified the operations of one long-term acute care hospital out of
discontinued operations in the three months and six months ended June 30, 2007 and 2006. In the
first quarter of 2007, the Company reclassified the operations of one long-term acute care hospital
out of discontinued operations and the Company no longer holds the
assets for sale. The facility had previously been identified as held for sale and
accounted for in discontinued operations throughout the year ended December 31, 2006. Goodwill of
$401,000 and other assets related to this hospital were classified as assets held for sale at
December 31, 2006. The operating results for the three months and six months ended June 30, 2006,
previously disclosed in discontinued operations, have been reclassified to continuing operations in
the statement of income.
The Company has identified one pharmacy operation and one critical access hospital as held for
sale as of June 30, 2007. The assets related to these operations are classified as assets held for
sale on the balance sheet and operations are reported as discontinued
operations. On July 1, 2007, the Company sold the assets of the critical access
hospital to a third party.
The following table summarizes the operating results of divestitures which have been presented
as loss from discontinued operations in the accompanying consolidated statements of income:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Three Months Ended |
|
|
Six Months Ended |
|
|
|
June 30, |
|
|
June 30, |
|
|
|
2007 |
|
|
2006 |
|
|
2007 |
|
|
2006 |
|
Net service revenue |
|
$ |
1,000 |
|
|
$ |
1,273 |
|
|
$ |
2,066 |
|
|
$ |
3,542 |
|
Costs, expenses and minority interest and
cooperative endeavor allocations |
|
|
1,551 |
|
|
|
1,710 |
|
|
|
3,045 |
|
|
|
4,407 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Loss from discontinued operations before
income
tax benefit |
|
|
551 |
|
|
|
437 |
|
|
|
979 |
|
|
|
865 |
|
Income tax benefit |
|
|
215 |
|
|
|
166 |
|
|
|
382 |
|
|
|
329 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Loss from discontinued operations |
|
$ |
336 |
|
|
$ |
271 |
|
|
$ |
597 |
|
|
$ |
536 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
- 12 -
The changes in recorded goodwill by segment for the six month period ended June 30, 2007 were
as follows:
|
|
|
|
|
|
|
Six months |
|
|
|
Ended |
|
|
|
June 30, |
|
|
|
2007 |
|
|
|
(in thousands) |
|
Home-based services segment: |
|
|
|
|
Balance at December 31, 2006 |
|
$ |
35,740 |
|
Goodwill acquired during the period from acquisitions |
|
|
8,237 |
|
|
|
|
|
Balance at June 30, 2007 |
|
$ |
43,977 |
|
|
|
|
|
|
|
|
|
|
Facility-based services segment: |
|
|
|
|
Balance at December 31, 2006 |
|
$ |
3,941 |
|
Goodwill reclassified from held for sale during the period |
|
|
401 |
|
|
|
|
|
Balance at June 30, 2007 |
|
$ |
4,342 |
|
|
|
|
|
The above transactions were considered to be immaterial individually and in the aggregate.
Accordingly, no supplemental pro forma information is required.
4. Credit Arrangements
Long-Term Debt
Long-term debt consisted of the following:
|
|
|
|
|
|
|
|
|
|
|
June 30, |
|
|
December 31, |
|
|
|
2007 |
|
|
2006 |
|
|
|
(in thousands) |
|
Notes payable: |
|
|
|
|
|
|
|
|
Due in yearly installments of $50,000 through August 2010 at 6.25% |
|
$ |
200 |
|
|
$ |
190 |
|
Due in monthly installments of $20,565 through October 2015 at LIBOR
plus 225 basis points (7.65% at June 30, 2007) |
|
|
2,883 |
|
|
|
2,898 |
|
Due in monthly installments of $12,500 through November 2009 at 3.08% |
|
|
327 |
|
|
|
391 |
|
|
|
|
|
|
|
|
|
|
|
3,410 |
|
|
|
3,479 |
|
Less current portion of long-term debt |
|
|
431 |
|
|
|
428 |
|
|
|
|
|
|
|
|
|
|
$ |
2,979 |
|
|
$ |
3,051 |
|
|
|
|
|
|
|
|
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%.
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 (7.65% at June 30, 2007). The
note is collateralized by the Companys airplane and is payable in 119 monthly installments of
$20,565 followed by one balloon installment in the amount of $1,920,565.
Certain of the Companys loan agreements contain restrictive covenants, including limitations
on indebtedness and the maintenance of certain financial ratios. At June 30, 2007 and December 31,
2006, 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, 2007 and December 31, 2006, the borrowing limit was $22,500,000,
and no amounts were outstanding. Interest accrues on any 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, 2007). The annual
facility fee is 0.5% of the total availability. The agreement expires on April 15, 2010.
- 13 -
5. Income Taxes
The Company adopted the provisions of FASB Interpretation No. 48 Accounting for Uncertainty
in Income Taxes (FIN 48) effective January 1, 2007. The adoption did not have a material effect
on the consolidated financial position or results of operations of the Company. At the date of
adoption, the Company had no unrecognized tax benefits. The Company recognizes interest and
penalties related to uncertain tax positions in interest expense and general and administrative
expenses, respectively. As of June 30, 2007, there were no accrued interest or penalties relating
to unrecognized income tax benefits recognized in the statement of operations. There was no accrued
liability for interest or penalties related to unrecognized income tax benefits recognized in the
statement of financial position at June 30, 2007.
The Company is subject to both federal and state income tax for jurisdictions within which it
operates. Within these jurisdictions, the Company is open to examination for tax years ended after
December 31, 2002.
6. Stockholders Equity
The following table summarizes the activity in stockholders equity for the six month period
ended June 30, 2007 (amounts in thousands, except share data):
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Common Stock |
|
|
Additional |
|
|
|
|
|
|
|
|
|
Issued |
|
|
Treasury |
|
|
Paid-In |
|
|
Retained |
|
|
|
|
|
|
Amount |
|
|
Shares |
|
|
Amount |
|
|
Shares |
|
|
Capital |
|
|
Earnings |
|
|
Total |
|
Balances at December 31, 2006 |
|
$ |
177 |
|
|
|
20,682,317 |
|
|
$ |
(2,856 |
) |
|
|
2,950,059 |
|
|
$ |
80,273 |
|
|
$ |
44,295 |
|
|
$ |
121,889 |
|
Net income |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
10,824 |
|
|
|
10,824 |
|
Options exercised |
|
|
|
|
|
|
527 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Issuance of 1,167 shares of
vested restricted stock |
|
|
|
|
|
|
1,167 |
|
|
|
|
|
|
|
|
|
|
|
33 |
|
|
|
|
|
|
|
33 |
|
Nonvested stock compensation |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
548 |
|
|
|
|
|
|
|
548 |
|
Issuance of
vested restricted stock |
|
|
|
|
|
|
22,476 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Excess tax benefits from
issuance of nonvested stock |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
89 |
|
|
|
|
|
|
|
89 |
|
Issuance of common stock under
Employee Stock Purchase Plan |
|
|
|
|
|
|
5,995 |
|
|
|
|
|
|
|
|
|
|
|
173 |
|
|
|
|
|
|
|
173 |
|
Recording minority interest in
joint venture at redemption
value |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
156 |
|
|
|
156 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Balances at June 30, 2007 |
|
$ |
177 |
|
|
|
20,712,482 |
|
|
$ |
(2,856 |
) |
|
|
2,950,059 |
|
|
$ |
81,116 |
|
|
$ |
55,275 |
|
|
$ |
133,712 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Share Based Compensation
On January 20, 2005, the board of directors and stockholders of the Company approved the 2005
Long Term Incentive Plan (the Incentive Plan). The Incentive Plan provides for 1,000,000 shares
of common stock that may be issued or transferred pursuant to awards made under the plan. A
variety of discretionary awards for employees, officers, directors and consultants are authorized
under the Incentive Plan, including incentive or non-qualified statutory stock options and
restricted stock. All awards must be evidenced by a written award certificate which will include
the provisions specified by the compensation committee of the board of directors. The compensation
committee will determine the exercise price for non-statutory stock options. The exercise price
for any option cannot be less than the fair market value of our common stock as of the date of
grant.
Also on January 20, 2005, the 2005 Director Compensation Plan was adopted. The shares issued
under our 2005 Director Compensation Plan are issued from the 1,000,000 shares reserved for
issuance under our Incentive Plan.
Stock Options
At June 30, 2007, 21,000 options were issued and exercisable. During the six months ended June
30, 2007, 2,000 options were exercised and no options were forfeited. These options were excerised
through a net exercise transaction, in which 1,473 shares were returned to the Company and 527
shares were issued to the participant.
- 14 -
There were no options granted during the six months ended June 30, 2007. There were 15,500
options granted and 2,000 options exercised in the six months ended June 30, 2006. No options were
forfeited during the six month period ended June 30, 2006.
Nonvested Stock
During the six months ended June 30, 2007, 12,600 nonvested shares of stock were granted to
our independent directors under the 2005 Director Compensation Plan. Of these 12,600 shares, 9,100
shares vest in one year, while the remaining 3,500 shares vest one third immediately, and the
remaining two-thirds vest over the two year period following the grant date. During the six months
ended June 30, 2007, 114,571 nonvested shares were granted to employees pursuant to the 2005
Long-Term Incentive Plan. Of these 114,571 shares, 2,000 shares vest over a three year period while
the remaining 112,571 shares vest over a five year period. The fair value of nonvested shares is
determined based on the closing trading price of the Companys shares on the grant date. The
weighted average grant date fair values of nonvested shares granted during the six month period
ended June 30, 2007 were $30.41.
The following table represents the nonvested stock activity for the six months ended June 30,
2007:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Weighted |
|
|
|
|
|
|
average |
|
|
Number of |
|
grant date |
|
|
Shares |
|
fair value |
Nonvested shares outstanding at December 31, 2006 |
|
|
86,716 |
|
|
$ |
18.29 |
|
Granted |
|
|
127,171 |
|
|
|
30.41 |
|
Vested |
|
|
(23,644 |
) |
|
|
17.64 |
|
Forfeited |
|
|
|
|
|
|
|
|
Nonvested shares outstanding at June 30, 2007 |
|
|
190,243 |
|
|
$ |
26.47 |
|
As of June 30, 2007, there was $4.6 million of total unrecognized compensation cost related to
nonvested shares granted. That cost is expected to be recognized over the weighted average period
of 4.1 years. The total fair value of shares vested in the six month period ended June 30, 2007 was
$657,000. During the six months ended June 30, 2006, 8,164 shares vested. The Company records
compensation expense related to nonvested share awards at the grant date for shares that are
awarded fully vested, and over the vesting term on a straight line basis for shares that vest over
time. The Company has recorded $581,000 and $350,000 in compensation expense related to nonvested
stock grants in the six months ended June 30, 2007 and 2006 respectively.
Employee Stock Purchase Plan
The Company has a plan whereby eligible employees may purchase the Companys common stock at
95% of the market price on the last day of the calendar quarter. There are 250,000 shares reserved
for the plan. The Company issued 3,240 shares of common stock under the plan at a per share price
of $27.08 during the three months ended March 31, 2007 and 2,755 shares of common stock under the
plan at a per share price of $30.81 during the three months ended June 30, 2007. At June 30, 2007
there were 236,909 shares available for future issuance.
7. Commitments and Contingencies
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 $6.9 million and $7.2 million for the six months ended
June 30, 2007 and 2006, respectively. The Company has not
- 15 -
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, termination of the Companys rights to participate in federal
and state-sponsored programs, and suspension or revocation of the Companys licenses.
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 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.
- 16 -
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 services
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, 2007 |
|
|
Home-Based |
|
Facility-Based |
|
|
|
|
Services |
|
Services |
|
Total |
|
|
(in thousands) |
Net service revenue |
|
$ |
57,992 |
|
|
$ |
12,572 |
|
|
$ |
70,564 |
|
Cost of service revenue |
|
|
27,711 |
|
|
|
8,370 |
|
|
|
36,081 |
|
General and administrative expenses |
|
|
20,797 |
|
|
|
4,345 |
|
|
|
25,142 |
|
Operating income (loss) |
|
|
9,484 |
|
|
|
(143 |
) |
|
|
9,341 |
|
Interest expense |
|
|
63 |
|
|
|
31 |
|
|
|
94 |
|
Non-operating income, including gain on sale of assets |
|
|
213 |
|
|
|
92 |
|
|
|
305 |
|
Income (loss) from continuing operations before income
taxes and minority interest and cooperative endeavor allocations |
|
|
9,634 |
|
|
|
(82 |
) |
|
|
9,552 |
|
Minority interest and cooperative endeavor allocations |
|
|
987 |
|
|
|
120 |
|
|
|
1,107 |
|
Income (loss) from continuing operations before income taxes |
|
|
8,647 |
|
|
|
(202 |
) |
|
|
8,445 |
|
Total assets |
|
$ |
129,856 |
|
|
$ |
33,205 |
|
|
$ |
163,061 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Three Months Ended June 30, 2006 |
|
|
Home-Based |
|
Facility-Based |
|
|
|
|
Services |
|
Services |
|
Total |
|
|
(in thousands) |
Net service revenue |
|
$ |
36,148 |
|
|
$ |
13,820 |
|
|
$ |
49,968 |
|
Cost of service revenue |
|
|
16,843 |
|
|
|
8,255 |
|
|
|
25,098 |
|
General and administrative expenses |
|
|
12,688 |
|
|
|
4,045 |
|
|
|
16,733 |
|
Operating income |
|
|
6,617 |
|
|
|
1,520 |
|
|
|
8,137 |
|
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 |
|
|
6,652 |
|
|
|
1,541 |
|
|
|
8,193 |
|
Minority interest and cooperative endeavor allocations |
|
|
705 |
|
|
|
423 |
|
|
|
1,128 |
|
Income from continuing operations before income taxes |
|
|
5,947 |
|
|
|
1,118 |
|
|
|
7,065 |
|
Total assets |
|
$ |
84,467 |
|
|
$ |
33,328 |
|
|
$ |
117,795 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Six Months Ended June 30, 2007 |
|
|
Home-Based |
|
Facility-Based |
|
|
|
|
Services |
|
Services |
|
Total |
|
|
(in thousands) |
Net service revenue |
|
$ |
113,058 |
|
|
$ |
26,233 |
|
|
$ |
139,291 |
|
Cost of service revenue |
|
|
53,739 |
|
|
|
16,959 |
|
|
|
70,698 |
|
General and administrative expenses |
|
|
38,632 |
|
|
|
9,178 |
|
|
|
47,810 |
|
Operating income |
|
|
20,687 |
|
|
|
96 |
|
|
|
20,783 |
|
Interest expense |
|
|
116 |
|
|
|
60 |
|
|
|
176 |
|
Non-operating income, including gain on sale of assets |
|
|
416 |
|
|
|
182 |
|
|
|
598 |
|
Income from continuing operations before income taxes and
minority
interest and cooperative endeavor allocations |
|
|
20,987 |
|
|
|
218 |
|
|
|
21,205 |
|
Minority interest and cooperative endeavor allocations |
|
|
2,408 |
|
|
|
506 |
|
|
|
2,914 |
|
Income (loss) from continuing operations before income taxes |
|
|
18,579 |
|
|
|
(288 |
) |
|
|
18,291 |
|
Total assets |
|
$ |
129,856 |
|
|
$ |
33,205 |
|
|
$ |
163,061 |
|
- 17 -
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Six Months Ended June 30, 2006 |
|
|
Home-Based |
|
Facility-Based |
|
|
|
|
Services |
|
Services |
|
Total |
|
|
(in thousands) |
Net service revenue |
|
$ |
68,569 |
|
|
$ |
27,191 |
|
|
$ |
95,760 |
|
Cost of service revenue |
|
|
33,097 |
|
|
|
16,529 |
|
|
|
49,626 |
|
General and administrative expenses |
|
|
23,988 |
|
|
|
7,554 |
|
|
|
31,542 |
|
Operating income |
|
|
11,484 |
|
|
|
3,108 |
|
|
|
14,592 |
|
Interest expense |
|
|
95 |
|
|
|
51 |
|
|
|
146 |
|
Non-operating income, including gain on sale of assets |
|
|
188 |
|
|
|
93 |
|
|
|
281 |
|
Income from continuing operations before income taxes
and minority interest and cooperative endeavor
allocations |
|
|
11,577 |
|
|
|
3,150 |
|
|
|
14,727 |
|
Minority interest and cooperative endeavor allocations |
|
|
1,263 |
|
|
|
861 |
|
|
|
2,124 |
|
Income from continuing operations before income taxes |
|
|
10,314 |
|
|
|
2,289 |
|
|
|
12,603 |
|
Total assets |
|
$ |
84,467 |
|
|
$ |
33,328 |
|
|
$ |
117,795 |
|
|
|
|
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, intend, 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, 2007; |
|
|
|
|
our future sources of and needs for liquidity and capital resources; |
|
|
|
|
our expectations regarding any future indebtedness under our credit facility; |
|
|
|
|
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; |
|
|
|
|
the effect of adjustments and corrections to prior reimbursement levels by third-party payors on our
financial condition or results of operations; |
|
|
|
|
the effect of and applicability of annual caps established by third-party payors on our financial
condition or results of operations; |
|
|
|
|
possible changes in legislation and/or government regulations that would affect our business; |
|
|
|
|
possible effects of legal proceedings on our financial condition and results of operations; |
|
|
|
|
the sufficiency of our self-funded medical insurance plan; |
- 18 -
|
|
|
the impact that the cost of medical supplies may have on our financial condition or results of operations; |
|
|
|
|
the impact of interest rates on our business; |
|
|
|
|
our discussion of our disclosure controls and procedures; 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 and in other of our filings with the SEC, including our annual report on Form 10-K
for the year ended December 31, 2006. This report should be read in conjunction with that annual
report on Form 10-K, and all our other filings, including quarterly reports on Form 10-Q and
current reports on Form 8-K, made with the SEC through the date of 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.
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 clinic.
Since our founders began operations in 1994 with one home nursing agency in Palmetto, Louisiana, we
have grown to 155 service providers in Louisiana, Mississippi, Alabama, Texas, Arkansas, West
Virginia, Kentucky, Florida, Tennessee, and Georgia as of June 30, 2007. Approximately 58% and 54%,
respectively, of our net service revenue for the three months ended June 30, 2007 and 2006 was
derived from patients who do not reside in Metropolitan Statistical Areas (MSAs).
Segments
We operate in two segments for financial reporting purposes: home-based services and
facility-based services. We derived 82.2% and 72.3% of our net service revenue during the three
months ended June 30, 2007 and 2006,
respectively, and 81.2% and 71.6% of our net service revenue during the six months ended June
30, 2007 and 2006, respectively, from our home-based services segment and derived the balance of
our net service revenue from our facility-based services segment.
- 19 -
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, 2007, we owned and operated 127 home nursing
locations, 8 hospices, a diabetes self management company, a home health pharmacy, and a private
duty agency. Of our 138 home-based services locations, 95 are wholly-owned by us and 43 are
majority-owned or controlled by us through joint ventures. We also manage the operations of three
home nursing agencies 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 clinic. As of June 30, 2007, we owned and operated four long-term acute
care hospitals with seven locations, of which all but one are located within host hospitals. We
also owned and operated an outpatient rehabilitation clinic, a pharmacy, two medical equipment
locations, a health club, and a critical access hospital. Of these 13 facility-based services
locations, seven are wholly-owned by us and six 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 continue to decline.
Recent Developments
Medicare
Home-Based Services. The base payment rate for Medicare home nursing in 2007 is $2,339 per
60-day episode. 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 & Medicaid Services (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.
On June 29, 2007, CMS announced a 3.3% rate increase for hospice care and hospice services
provided during the twelve-month period beginning on October 1, 2007 through September 30, 2008. In
addition, CMS also announced that the hospice cap amount for the cap year ending October 31, 2007
was $21,410.
On April 27, 2007, CMS issued a Notice of Proposed Rulemaking regarding the Home Health
Prospective Payment System Refinement and Rate Update for Calendar Year 2008 (Proposed Rule). The
Proposed Rule includes changes to the base rate calculation, refinements to the payment system, and
new quality of care data collection requirements, among others. The Proposed Rule was open for
public comment for a period of 60 days from the date of the release. On June 22, 2007 we submitted
to CMS comments on the Proposed Rule, which comments were filed by us with the SEC on a Form 8-K
also dated June 22, 2007. According to the release issued by CMS, the Proposed Rule, including any
amendments thereto, will be effective on January 1, 2008. There is no guarantee that the changes
and refinements included within the Proposed Rule payment calculations will be included within any
final recommendations made by CMS for payments in Calendar year 2008. The Company has decided not
to provide speculative net impact reviews to its consolidated financial results of operations and
cash flows based upon the Proposed Rule. We will await determination of any final recommendation
by CMS for changes to the payment system before determining further reporting needs regarding our
Company consolidated financial results.
On April 20, 2007, CMS released a transmittal that provided for a correction of the hospice
cap amount for fiscal years ending October 31, 2004 and 2003. As a result of the correction, the
new cap amounts are $18,963 and $18,143 for fiscal 2004 and 2003, respectively, compared to the
prior rates of $19,636 and $18,661 for fiscal 2004
- 20 -
and 2003, respectively. Management completed an
analysis of the Companys potential cap exposure using the corrected rates for both fiscal 2004 and
fiscal 2003, and as a result of this analysis, has determined that the change will not have a
material impact to the Companys consolidated financial position, cash flows or results of
operations.
On April 2, 2007, CMS provided a time extension to health care providers to comply with the
National Provider Identifier (NPI) deadline implementation, as required under the regulations of
the Health Insurance Portability and Accountability Act (HIPAA) of 1996. The final rule establishes
the NPI as the standard unique health provider identifier for health care providers and requires
all covered entities to be in compliance with the provisions of such final rule by May 23, 2007
(the NPI Deadline). The NPI is an identifier that is to be used by covered entities to identify
health care providers, thus eliminating the current need for multiple identifiers for the same
provider. The NPI will be required for use on all health care claims and other HIPAA transactions.
The extension has been considered by CMS as it had become apparent that many covered entities were
not going to be able to fully comply with the NPI standard by the NPI Deadline. Management has
properly assigned the required NPI to each claim that will be processed from the NPI Deadline
forward, and management does not foresee the requirement having a material impact to the Companys
consolidated financial position, cash flows or results of operations as the Company.
On November 1, 2006, CMS released the final rule updating the home health perspective payment
systems for calendar year 2007. The rule finalizes the market basket increase of 3.3%, a 0.2%
increase over the proposed rule. This equates to a 3.1% update for urban home health agencies
(HHAs) and a 3.6% update for rural HHAs after accounting for changes in the wage index. The update
increases the national 60-day episode payment rate for urban home health agencies from the current
level of $2,264.38 to $2,339.00. Under the final rule, HHAs will get the full home health market
basket as long as they submit required quality data using the Outcome and Assessment Information
Set (OASIS). With some limited exceptions, if an HHA does not provide this data, then its home
health market basket update of 3.3% will be reduced by two percentage points. The final rule
discontinues the temporary 5% add-on payment for rural HHAs in 2007, except for episodes that begin
before January 1, 2007. The final rule does not modify the current case-mix methodology for 2007.
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% higher than the rates for the previous year.
In addition, CMS announced that the hospice cap amount for the year ended 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 (LTACH-DRG). 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, the Companys long-term acute care hospitals are
paid a pre-determined fixed amount applicable to the particular LTACH-DRG to which that patient is
assigned. The payment is further increased for severity based on co-morbidities, complications,
and procedures. The payment is decreased for short-stay outlier patients whose stay does not reach
a predetermined minimum assigned for the LTACH-DRG. In addition, extremely high cost patients,
after crossing a fixed loss threshold, receive an additional high-cost outlier payment intended to
account for resource utilization requirements above the LTACH-DRG payment.
On May 2, 2007 CMS published its annual long-term acute care hospital update for the LTACH
Rate Year which begins July 1, 2007. There are five major portions of the final rule that are
noteworthy for the operations of our long-term acute care hospitals. The Final Rule projects an
overall decrease in payments to all Medicare certified long-term acute care hospitals of 3.8%
compared to an impact estimated at 2.9% under the proposed rule. Included in the Final Rule are the
following: (1) an increase to the standard federal payment rate of 0.71% which is a base rate of
$38,356.45; (2) revisions to payment methodologies impacting short stay outliers, which reduce
payments by 0.9%; (3) adjustments to the wage index component of the federal payment resulting in
projected reductions in payments of 1.0%; (4) an increase in the high cost outlier threshold from
$18,477 per discharge in the proposed rule to
$22,954 in the Final Rule resulting in projected reductions of 2.5%; and (5) an extension of the
policy known as the 25 Percent Rule to all LTAC hospitals, with a three-year phase-in, which CMS
projects will not result in payment reductions for the first year of implementation but estimates
reductions of 2.4% in the second year of implementation. The Final Rule also states that the annual
update to the LTACH-DRG classifications and relative
- 21 -
weights will be made in a budget neutral
manner; effective October 1, 2007, which means that even after annual re-weighting of LTACH-DRGs,
total payments to LTACHs will not be reduced in 2008.
Our analysis has shown that the impact of this final rule to be a 3.29% reduction in payments
to the Companys long-term acute care hospitals. This reduction is less than the projected
decrease of 3.8% forecast by CMS in the final rule. The Company currently operates a total of
seven long-term acute care hospitals. Six of our hospitals are classified as hospitals within a
hospital (HwH) and one is classified as a freestanding.
The final rule regarding extension of the 25 Percent Rule to freestanding facilities will not
have an effect on our one existing freestanding location based on our analysis that no single
referral source is greater than 25% of Medicare discharges.
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 $1,780 per beneficiary effective January 1, 2007.
The Deficit Reduction Act of 2005 and the Tax Relief and Health Care Act of 2006 provided for an
exceptions process that effectively prevents application of the caps. The exceptions process
ends January 1, 2008. We are unable to predict whether Congress will extend the exceptions process
for 2008. We cannot assure you that one or more of our outpatient rehabilitation clinics will not
exceed the caps in the future.
Office of Inspector General
The Office of Inspector General (OIG) has a responsibility to report both to the Secretary of
the Department of Health and Human Services and to Congress any program and management problems
related to programs such as Medicare. The OIGs duties are carried out through a nationwide
network of audits, investigations and inspections. Each year, the OIG outlines areas it intends to
study relating to a wide range of providers. In fiscal year 2007, the OIG indicated its intent to
study topics relating to, among others, home health, hospice, long-term care hospitals, and certain
outpatient rehabilitation services. No estimate can be made at this time regarding the impact, if
any, of the OIGs findings.
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; |
- 22 -
|
|
|
accounting, legal and other professional services; and |
|
|
|
|
office supplies; |
|
|
|
Depreciation; and |
|
|
|
|
Provision for bad debts. |
Results of Operations
Three Months Ended June 30, 2007 Compared to Three Months Ended June 30, 2006
Net Service Revenue
Net service revenue for the three months ended June 30, 2007 was $70.6 million, an increase of
$20.6 million, or 41.2%, from $50.0 million in 2006. The increase in net service revenue is due
primarily to the increase in patient census in the home-based segment through acquisitions and
internal growth. For the three months ended June 30, 2007 and 2006, 82.0% and 85.8% respectively,
of our net service revenue was derived from Medicare.
Home-Based Services.
Net home-based services revenue for the three months ended June 30, 2007 was $58.0 million, an
increase of 60.4%, from $36.1 million for the three months ended June 30, 2006. Organic growth in
this service sector was approximately $16.5 million, or 54.4%. The increase in net home-based
service revenue is due primarily to the increase in patient census through acquisitions and
internal growth. Total admissions were 10,277 during the period, versus 5,852 for the same period
in 2006, a 75.6% increase. Organic growth in admissions was 70.7%. The Company also monitors
patient census as a key performance indicator within its home-based services. Average home-based
patient census for the three months ended June 30, 2007 was 16,283 patients, an increase of 66.0%
as compared to 9,807 patients for the three months ended June 30, 2006. Organic growth in
home-based patient census was 59.8%. 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.
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
For the three |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
For the three |
|
|
|
|
months ended |
|
|
|
|
|
For the three months |
|
|
|
|
|
months ended |
|
|
|
|
June 30, |
|
|
|
|
|
ended June 30, |
|
|
|
|
|
June 30, |
|
|
|
|
2007 |
|
2006 |
|
% |
|
2007 |
|
2006 |
|
% |
|
2007 |
|
2006 |
|
% |
|
|
Revenue |
|
Revenue |
|
Growth |
|
Admissions |
|
Admissions |
|
Growth |
|
Census |
|
Census |
|
Growth |
Organic |
|
$ |
46,756 |
|
|
$ |
30,280 |
|
|
|
54.4 |
% |
|
|
7,362 |
|
|
|
4,312 |
|
|
|
70.7 |
% |
|
|
12,779 |
|
|
|
7,996 |
|
|
|
59.8 |
% |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Acquired |
|
$ |
11,236 |
|
|
$ |
5,868 |
|
|
|
91.5 |
% |
|
|
2,915 |
|
|
|
1,540 |
|
|
|
89.3 |
% |
|
|
3,504 |
|
|
|
1,811 |
|
|
|
93.5 |
% |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Total |
|
$ |
57,992 |
|
|
$ |
36,148 |
|
|
|
60.4 |
% |
|
|
10,277 |
|
|
|
5,852 |
|
|
|
75.6 |
% |
|
|
16,283 |
|
|
|
9,807 |
|
|
|
66.0 |
% |
- 23 -
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
For the three |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
For the three |
|
|
|
|
months ended |
|
|
|
|
|
For the three months |
|
|
|
|
|
months ended |
|
|
|
|
June 30, |
|
|
|
|
|
ended June 30, |
|
|
|
|
|
June 30, |
|
|
|
|
2007 |
|
2006 |
|
|
|
|
|
2007 |
|
2006 |
|
|
|
|
|
2007 |
|
2006 |
|
|
|
|
Medicare |
|
Medicare |
|
% |
|
Medicare |
|
Medicare |
|
% |
|
Medicare |
|
Medicare |
|
% |
|
|
Census |
|
Census |
|
Growth |
|
Admits |
|
Admits |
|
Growth |
|
Episodes |
|
Episodes |
|
Growth |
Organic |
|
|
10,170 |
|
|
|
6,635 |
|
|
|
53.3 |
% |
|
|
5,278 |
|
|
|
3,227 |
|
|
|
63.6 |
% |
|
|
16,258 |
|
|
|
10,725 |
|
|
|
51.6 |
% |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Acquired |
|
|
2,052 |
|
|
|
1,309 |
|
|
|
56.8 |
% |
|
|
1,831 |
|
|
|
983 |
|
|
|
86.3 |
% |
|
|
3,002 |
|
|
|
1,252 |
|
|
|
139.8 |
% |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Total |
|
|
12,222 |
|
|
|
7,944 |
|
|
|
53.9 |
% |
|
|
7,109 |
|
|
|
4,210 |
|
|
|
68.9 |
% |
|
|
19,260 |
|
|
|
11,977 |
|
|
|
60.8 |
% |
Facility-Based Services.
Net service revenue for facility-based services for the three months ended June 30, 2007, decreased
9.0% to $12.6 million compared with $13.8 million for the three months ended June 30, 2006. The
decrease in facility-based net service revenue is due primarily to the revenue adjustment of $1.1
million taken in the second quarter relating to commercial patients in the Long-Term Acute Care
Hospitals (LTACHs). For additional information on the revenue and bad debt adjustments in the
LTACHS, see Item 1, Financial Statements Notes to the Unaudited Consolidated Financial
Statements Note 1 Adjustment to Net Service Revenue and Bad Debt Expense. Patient days
increased 3.1% to 11,453 in the three months ended June 30, 2007, from 11,110 in the three months
ended June 30, 2006.
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
For the three |
|
|
|
|
|
For the three |
|
|
|
|
|
|
|
|
|
|
months ended |
|
|
|
|
|
months ended |
|
|
|
|
|
For the three months |
|
|
|
|
June 30, |
|
|
|
|
|
June 30, |
|
|
|
|
|
ended June 30, |
|
|
|
|
|
|
|
|
|
|
|
|
2007 |
2006 |
|
|
|
|
|
|
|
2007 |
|
2006 |
|
% |
|
Patient |
|
Patient |
|
% |
|
2007 |
|
2006 |
|
% |
|
|
Revenue |
|
Revenue |
|
Growth |
|
Days |
|
Days |
|
Growth |
|
Discharges |
|
Discharges |
|
Growth |
Organic |
|
$ |
12,572 |
|
|
$ |
13,820 |
|
|
|
(9.0 |
)% |
|
|
11,453 |
|
|
|
11,110 |
|
|
|
3.1 |
% |
|
|
451 |
|
|
|
430 |
|
|
|
4.9 |
% |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Acquired |
|
|
|
|
|
|
|
|
|
|
|
% |
|
|
|
|
|
|
|
|
|
|
|
% |
|
|
|
|
|
|
|
|
|
|
|
% |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Total |
|
$ |
12,572 |
|
|
$ |
13,820 |
|
|
|
(9.0 |
)% |
|
|
11,453 |
|
|
|
11,110 |
|
|
|
3.1 |
% |
|
|
451 |
|
|
|
430 |
|
|
|
4.9 |
% |
Cost of Service Revenue
Cost of service revenue for the three months ended June 30, 2007 was $36.1 million, an
increase of $11.0 million, or 43.8%, from $25.1 million for the three months ended June 30, 2006.
Cost of service revenue represented approximately 51.1% and 50.2% of our net service revenue for
the three months ended June 30, 2007 and 2006, respectively.
Home-Based Services. Cost of home-based services revenue for the three months ended June 30,
2007 was $27.7 million, an increase of $10.9 million, or 64.5%, from $16.8 million for the three
months ended June 30, 2006. Approximately $9.1 million of this increase resulted from an increase
in salaries and benefits. Approximately $6.8 million of the increase in salaries and benefits
expense was due to acquisitions that occurred in 2006 and approximately $2.1 million of the
increase in salaries and benefits expense was due to acquisitions that occurred in 2007. The
remaining increase in salaries and benefits expense of approximately $127,000 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. Supplies and service expense increased
approximately $674,000. Of this $674,000, approximately $517,000 of the increase in supplies and
services expense was due to acquisitions in 2006 while $157,000 was due to acquisitions in 2007.
Transportation expense increased approximately $1.1 million. Of this $1.1 million, approximately
$672,000 of the increase in transportation expense was due to acquisitions in 2006, $217,000 was
due to acquisitions in 2007, and $234,000 was due to internal growth. Cost of home-based services
revenue represented approximately 47.8% and 46.6% of our net home-based services revenue for the
three months ended June 30, 2007 and 2006, respectively.
- 24 -
Facility-Based Services. Cost of facility-based services revenue for the three months ended
June 30, 2007 was $8.4 million, an increase of $100,000 or 1.4%, from $8.3 million for the three
months ended June 30, 2006. The entire increase resulted from an increase in supplies from internal
growth. The increase in supplies is due to the increase in patient days. Cost of facility-based
service revenue represented approximately 66.5% and 59.7% of our net facility-based services
revenue for the three months ended June 30, 2007 and 2006, respectively.
General and Administrative Expenses
General and administrative expenses for the three months ended June 30, 2007 were $25.1
million, an increase of $8.4 million, or 50.3%, from $16.7 million for the three months ended June
30, 2006. General and administrative expenses represented approximately 35.6% and 33.5% of our net
service revenue for the three months ended June 30, 2007 and 2006, respectively.
Home-Based Services. General and administrative expenses in the home-based services segment
for the three months ended June 30, 2007 were $20.8 million, an increase of $8.1 million, or 63.9%,
from $12.7 million for the three months ended June 30, 2006. Approximately $4.3 million of the
increase in general and administrative expenses was due to acquisitions that occurred in 2006 and
approximately $1.8 million of the increase in general and administrative expenses were due to
acquisitions that occurred in 2007. The remaining increase in general and administrative expenses
of approximately $2.0 million was primarily attributable to internal growth. Of the $2.0 million
attributable to internal growth, $805,000 is related to an increase in bad debt expense. General
and administrative expenses in the home-based services segment represented approximately 35.9% and
35.1% of our net service revenue for the three months ended June 30, 2007 and 2006, respectively.
Facility-Based Services. General and administrative expenses for the three months ended June
30, 2007 were $4.3 million, an increase of $300,000, or 7.4%, from $4.0 million for the same period
in 2006. The entire growth was attributable to internal growth and is due to an increase in bad
debt expense. General and administrative expenses in the facility-based services segment
represented approximately 34.6% and 29.3% of our net service revenue for the three months ended
June 30, 2007 and 2006, respectively.
Income Tax Expense
The effective tax rates for the three months ended June 30, 2007 and 2006 were 36.4% and 36.5%
respectively.
Minority Interest and Cooperative Endeavor Allocations
The minority interest and cooperative endeavor allocations expense remained consistent for the
three months ended June 30, 2007 at $1.1 million, compared to $1.1 million for the same period in
2006.
Discontinued Operations
Revenue from discontinued operations for the three months ended June 30, 2007 and 2006 was
$1.0 million and $1.3 million, respectively. Costs, expenses, and minority interest and cooperative
endeavor allocations were $1.6 million and $1.7 million, respectively, for the three months ended
June 30, 2007 and 2006. For the three months ended June 30, 2007, the loss from discontinued
operations was $336,000 as compared to a loss from discontinued operations of $271,000 for the same
period in 2006. In the second quarter of 2007, the Company placed its critical
access hospital into discontinued operations.
Six Months Ended June 30, 2007 Compared to Six Months Ended June 30, 2006
Net Service Revenue
- 25 -
Net service revenue for the six months ended June 30, 2007 was $139.3 million, an increase of
$43.5 million, or 45.5%, from $95.8 million in 2006. The increase in net service revenue is due
primarily to the increase in patient census in the home-based segment through acquisitions and
internal growth. For the six months ended June 30, 2007 and 2006, 82.0% and 86.1% respectively, of
our net service revenue was derived from Medicare.
Home-Based Services.
Net home-based services revenue for the six months ended June 30, 2007 was $113.1 million, an
increase of 64.9%, from $68.6 million for the six months ended June 30, 2006. Organic growth in
this service sector was approximately $32.0 million, or 53.1%. The increase in net home-based
service revenue is due primarily to the increase in patient census through acquisitions and
internal growth. Total admissions were 20,442 during the period, versus 11,422 for the same period
in 2006, a 79.0% increase. Organic growth in admissions was 72.8%. Average home-based patient
census for the six months ended June 30, 2007 was 16,009 patients, an increase of 67.9% as compared
to 9,535 patients for the six months ended June 30, 2006. Organic growth in home-based patient
census was 62.0%.
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
For the six |
|
|
|
|
For the six months |
|
|
|
|
|
For the six months |
|
|
|
|
|
months ended |
|
|
|
|
ended June 30, |
|
|
|
|
|
ended June 30, |
|
|
|
|
|
June 30, |
|
|
|
|
2007 |
|
2006 |
|
% |
|
2007 |
|
2006 |
|
% |
|
2007 |
|
2006 |
|
% |
|
|
Revenue |
|
Revenue |
|
Growth |
|
Admissions |
|
Admissions |
|
Growth |
|
Census |
|
Census |
|
Growth |
Organic |
|
$ |
92,422 |
|
|
$ |
60,379 |
|
|
|
53.1 |
% |
|
|
14,969 |
|
|
|
8,665 |
|
|
|
72.8 |
% |
|
|
12,608 |
|
|
|
7,785 |
|
|
|
62.0 |
% |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Acquired |
|
$ |
20,636 |
|
|
$ |
8,190 |
|
|
|
152.0 |
% |
|
|
5,473 |
|
|
|
2,757 |
|
|
|
98.5 |
% |
|
|
3,401 |
|
|
|
1,750 |
|
|
|
94.3 |
% |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Total |
|
$ |
113,058 |
|
|
$ |
68,569 |
|
|
|
64.9 |
% |
|
|
20,442 |
|
|
|
11,422 |
|
|
|
79.0 |
% |
|
|
16,009 |
|
|
|
9,535 |
|
|
|
67.9 |
% |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
For the six |
|
|
|
|
For the six months |
|
|
|
|
|
For the six months |
|
|
|
|
|
months ended |
|
|
|
|
ended June 30, |
|
|
|
|
|
ended June 30, |
|
|
|
|
|
June 30, |
|
|
|
|
2007 |
|
2006 |
|
|
|
|
|
2007 |
|
2006 |
|
|
|
|
|
2007 |
|
2006 |
|
|
|
|
Medicare |
|
Medicare |
|
% |
|
Medicare |
|
Medicare |
|
% |
|
Medicare |
|
Medicare |
|
% |
|
|
Census |
|
Census |
|
Growth |
|
Admits |
|
Admits |
|
Growth |
|
Episodes |
|
Episodes |
|
Growth |
Organic |
|
|
9,925 |
|
|
|
6,439 |
|
|
|
54.1 |
% |
|
|
10,736 |
|
|
|
6,428 |
|
|
|
67.0 |
% |
|
|
31,550 |
|
|
|
20,971 |
|
|
|
50.4 |
% |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Acquired |
|
|
2,069 |
|
|
|
1,208 |
|
|
|
71.3 |
% |
|
|
3,351 |
|
|
|
1,860 |
|
|
|
80.2 |
% |
|
|
4,874 |
|
|
|
2,040 |
|
|
|
138.9 |
% |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Total |
|
|
11,994 |
|
|
|
7,647 |
|
|
|
56.8 |
% |
|
|
14,087 |
|
|
|
8,288 |
|
|
|
70.0 |
% |
|
|
36,424 |
|
|
|
23,011 |
|
|
|
58.3 |
% |
Facility-Based Services.
Net service revenue for facility-based services for the six months ended June 30, 2007,
decreased 3.5% to $26.2 million compared with $27.2 million for the six months ended June 30, 2006.
The decrease in facility-based net service revenue is due primarily to the revenue adjustment of
$1.1 million taken in the six months ended June 30,
2007, relating to commercial patients in the LTACHs. For additional information on the revenue
and bad debt adjustments in the LTACHS, see Item 1, Financial Statements Notes to the Unaudited
Consolidated Financial Statements Note 1 Adjustment to Net Service Revenue and Bad Debt
Expense. Patient days increased 4.5% to 23,127 in the six months ended June 30, 2007, from 22,140
in the three months ended June 30, 2006.
- 26 -
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
For the six |
|
|
|
|
|
|
|
|
|
|
For the six months |
|
|
|
|
|
months ended |
|
|
|
|
|
For the six months |
|
|
|
|
ended June 30, |
|
|
|
|
|
June 30, |
|
|
|
|
|
ended June 30, |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
2007 |
|
2006 |
|
|
|
|
|
|
|
|
|
|
2007 |
|
2006 |
|
% |
|
Patient |
|
Patient |
|
% |
|
2007 |
|
2006 |
|
% |
|
|
Revenue |
|
Revenue |
|
Growth |
|
Days |
|
Days |
|
Growth |
|
Discharges |
|
Discharges |
|
Growth |
Organic |
|
$ |
26,233 |
|
|
$ |
27,191 |
|
|
|
(3.5 |
)% |
|
|
23,127 |
|
|
|
22,140 |
|
|
|
4.5 |
% |
|
|
922 |
|
|
|
883 |
|
|
|
4.4 |
% |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Acquired |
|
|
|
|
|
|
|
|
|
|
|
% |
|
|
|
|
|
|
|
|
|
|
|
% |
|
|
|
|
|
|
|
|
|
|
|
% |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Total |
|
$ |
26,233 |
|
|
$ |
27,191 |
|
|
|
(3.5 |
)% |
|
|
23,127 |
|
|
|
22,140 |
|
|
|
4.5 |
% |
|
|
922 |
|
|
|
883 |
|
|
|
4.4 |
% |
Cost of Service Revenue
Cost of service revenue for the six months ended June 30, 2007 was $70.7 million, an increase
of $21.1 million, or 42.5%, from $49.6 million for the six months ended June 30, 2006. Cost of
service revenue represented approximately 50.8% and 51.8% of our net service revenue for the six
months ended June 30, 2007 and 2006, respectively.
Home-Based Services. Cost of home-based services revenue for the six months ended June 30,
2007 was $53.7 million, an increase of $20.6 million, or 62.4%, from $33.1 million for the six
months ended June 30, 2006. Approximately $17.7 million of this increase resulted from an increase
in salaries and benefits. Approximately $13.4 million of the increase in salaries and benefits
expense was due to acquisitions that occurred in 2006 and approximately $3.3 million of the
increase in salaries and benefits expense was due to acquisitions that occurred in 2007. The
remaining increase in salaries and benefits expense of approximately $1.0 million 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. Supplies and service
expense increased approximately $1.2 million. Of this $1.2 million, approximately $1.0 million of
the increase in supplies and services expense was due to acquisitions in 2006 while $139,000 was
due to acquisitions in 2007. Transportation expense increased approximately $1.7 million. Of this
$1.7 million, approximately $1.2 million of the increase in transportation expense was due to
acquisitions in 2006, $308,000 was due to acquisitions in 2007, and $214,000 was due to internal
growth. Cost of home-based services revenue represented approximately 47.5% and 48.3% of our net
home-based services revenue for the six months ended June 30, 2007 and 2006, respectively.
Facility-Based Services. Cost of facility-based services revenue for the six months ended
June 30, 2007 was $17.0 million, an increase of $430,000 or 2.6%, from $16.5 million for the six
months ended June 30, 2006. The entire increase resulted from an increase in supplies from internal
growth. The increase in supplies is due to the increase in patient days. Cost of facility-based
service revenue represented approximately 64.6% and 60.8% of our net facility-based services
revenue for the six months ended June 30, 2007 and 2006, respectively.
General and Administrative Expenses
General and administrative expenses for the six months ended June 30, 2007 were $47.8 million,
an increase of $16.3 million, or 51.6%, from $31.5 million for the six months ended June 30, 2006.
General and administrative expenses represented approximately 34.3% and 32.9% of our net service
revenue for the six months ended June 30,
2007 and 2006, respectively.
Home-Based Services. General and administrative expenses in the home-based services segment
for the six months ended June 30, 2007 were $38.6 million, an increase of $14.6 million, or 61.0%,
from $24.0 million for the six months ended June 30, 2006. Approximately $4.0 million of the
increase in general and administrative expenses
- 27 -
was due to acquisitions that occurred in 2006 and
approximately $2.4 million of the increase in general and administrative expenses were due to
acquisitions that occurred in 2007. The remaining increase in general and administrative expenses
of approximately $8.2 million was primarily attributable to internal growth. Of the $8.2 million
attributable to internal growth, $1.4 million is related to an increase in bad debt expense.
General and administrative expenses in the home-based services segment represented approximately
34.2% and 35.0% of our net service revenue for the six months ended June 30, 2007 and 2006,
respectively.
Facility-Based Services. General and administrative expenses for the six months ended June
30, 2007 were $9.2 million, an increase of $1.6 million, or 21.5%, from $7.6 million for the same
period in 2006. The entire growth was attributable to internal growth. Of the $1.6 million
attributable to internal growth, $715,000 is due to an increase in bad debt expense. General and
administrative expenses in the facility-based services segment represented approximately 35.0% and
27.8% of our net service revenue for the six months ended June 30, 2007 and 2006, respectively.
Income Tax Expense
The effective tax rates for the six months ended June 30, 2007 and 2006 were 37.6% and 34.2%
respectively. The effective tax rate increase in the six months ended June 30, 2007 is primarily
due to the reduction in the tax credits related to the Gulf Opportunity Zone Act of 2005.
Minority Interest and Cooperative Endeavor Allocations
The minority interest and cooperative endeavor allocations expense for the six months ended
June 30, 2007 was $2.9 million, compared to $2.1 million for the same period in 2006. The increase
is due primarily to an increase in joint ventures and an increase in the income from operations
related to our joint ventures.
Discontinued Operations
Revenue from discontinued operations for the six months ended June 30, 2007 and 2006 was $2.1
million and $3.5 million, respectively. Costs, expenses, and minority interest and cooperative
endeavor allocations were $3.0 million and $4.4 million, respectively, for the six months ended
June 30, 2007 and 2006. For the six months ended June 30, 2007, the loss from discontinued
operations was $597,000, as compared to a loss from discontinued operations of $536,000 for the
same period in 2006. In the first quarter of 2007, the Company converted Louisiana Extended Care
Hospital of West Monroe back into continuing operations from discontinued operations. After having
the entity in discontinued operations for the year ended December 31, 2006, the Company decided to
make this change after we did not receive an offer that we felt was indicative of the value of the
entity. In the first quarter of 2007, the Company placed one pharmacy location into discontinued
operations, and in the second quarter of 2007, the Company placed its critical access hospital into
discontinued operations.
Liquidity and Capital Resources
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:
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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. |
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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 affects our cash flows from
operating activities. |
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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. |
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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. |
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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. |
Operating activities during the six months ended June 30, 2007 provided $471,000 in cash
compared to $12.1 million for the six months ended June 30, 2006. Net income provided cash of $10.8
million. Non-cash items such as depreciation and amortization, provision for bad debts,
equity-based compensation, minority interest in earnings of subsidiaries and deferred income taxes
totaled $8.5 million. These non-cash charges are offset primarily by an increase in accounts
receivable of $13.8 million due to increased revenue and an increase in prepaid federal and state
income taxes of $3.4 million.
Days sales outstanding, or DSO, for the three months ended June 30, 2007, was 75 days as
compared with 74 days for the same three-month period in 2006. DSO, when adjusted for acquisitions
and unbilled accounts receivables, was 70 days. The adjustment takes into account $3.7 million of
unbilled receivables that the Company is delayed in billing due to the lag time in receiving the
change of ownership after acquiring companies. For the comparable period in 2006, adjusted DSO was
65 days, taking into account $4.6 million in unbilled accounts receivable.
Investing activities used $11.0 million and $6.8 million in cash for the six months ended June
30, 2007 and 2006, respectively. In the six months ended June 30, 2007, cash used by investing
activities was $1.5 million for the purchases of property and equipment consisting primarily of
computer hardware, software, and licenses, and $9.5 million in the cost of acquisitions.
Financing activities used $3.0 million and $3.6 million in the six months ended June 30, 2007
and 2006, respectively. The $3.0 million cash used in financing activities in the six months ended
June 30, 2007 was for minority interest distributions.
At June 30, 2007, we had working capital of $69.4 million compared to $68.4 million at
December 31, 2006, an increase of $1.0 million. This increase in working capital was due primarily
to increases in accounts receivable due to increased revenue.
Indebtedness
Our total long-term indebtedness was $3.6 million at June 30, 2007 and $3.8 million at
December 31, 2006, respectively, including the current portions of $558,000 and $639,000. 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, may become
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. As of
June 30, 2007, 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%.
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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, and the failure to comply with certain covenants.
Contingencies
For a discussion of contingencies, see Item 1, Notes to Consolidated Financial Statements
Note 7 Commitments and Contingencies of this Form 10-Q, which discussion is incorporated herein
by reference.
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
For a discussion of critical accounting policies, see Item 1, Notes to Consolidated Financial
Statements Note 2 Significant Accounting Policies of this Form 10-Q, which discussion is
incorporated herein by reference.
ITEM 3. QUANTITATIVE AND QUALITATIVE DISCLOSURES ABOUT MARKET RISK
As of June 30, 2007, we had cash of $13.3 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
senior secured credit facility we entered into in April 2005. A hypothetical 100 basis point
adverse move (increase) in interest rates would not have materially affected the interest expense
for the six months ended June 30, 2007 since there were no amounts outstanding on the credit
agreement during this period.
ITEM 4. CONTROLS AND PROCEDURES
Evaluation of Disclosure Controls and Procedures
The Company maintains disclosure controls and procedures (as defined in Rule 13a-15(e) and
15d-15(e) promulgated under the Securities Exchange Act of 1934, as amended (the Exchange Act))
that are designed to ensure that information required to be disclosed in the Companys reports
filed under the Exchange Act, is recorded, processed, summarized and reported within the time
periods specified in the SECs rules and forms. Such information is also accumulated and
communicated to management, including the Companys Chief Executive Officer and Chief Financial
Officer, as appropriate, to allow timely decisions regarding required disclosure.
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Management of the
Company, under the supervision and with the participation of the Chief Executive Officer and Chief
Financial Officer, evaluated the effectiveness of the design and operation of the Companys
disclosure controls and procedures and based on that evaluation, the Companys Chief Executive
Officer and Chief Financial Officer concluded that the Company had a material weakness related to
the controls over the recording of contractual adjustments on commercial contract claims in its
Long-Term Acute Care Hospital (LTACH) business. The Companys management, including the Companys
principal executive and principal financial officers, has concluded that the Companys disclosure
controls and procedures were not effective as of June 30, 2007. To address the material weakness
described above, the Company has implemented additional manual controls and procedures over the
recording of contractual adjustments related to commercial contracts in the LTACHs. The Company
will work with outside consultants to continue identifying the appropriate methods of ensuring
these controls and procedures may not be circumvented in the future.
The design of any system of control is based upon certain assumptions about the likelihood of
future events, and there can be no assurance that any design will succeed in achieving its stated
objectives under all future events, no matter how remote, or that the degree of compliance with the
policies or procedures may not deteriorate. Because of their inherent limitations, disclosure
controls and procedures may not prevent or detect all misstatements. Accordingly, even effective
disclosure controls and procedures can only provide reasonable assurance of achieving their control
objectives.
Changes in Internal Controls
Other than the matter described in this Item 4, there have been no changes in the Companys
internal control over financial reporting (as defined in Exchange Act Rule 13a-15(f)) that occurred
during the three months ended June 30, 2007, that have materially affected, or are reasonably
likely to materially affect, the Companys internal control over financial reporting.
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.
There have been no material changes from the Risk Factors we previously disclosed in our Form
10-K for the year ended December 31, 2006 filed with the Securities and Exchange Commission on
March 16, 2007.
ITEM 2. UNREGISTERED SALES OF EQUITY SECURITIES AND USE OF PROCEEDS.
None
ITEM 3. DEFAULTS UPON SENIOR SECURITIES
None
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ITEM 4. SUBMISSION OF MATTERS TO A VOTE OF SECURITY HOLDERS
Our annual meeting of stockholders was held on June 14, 2007. At the annual meeting, the following
matters were voted on with the following results:
Election of Directors. At the annual meeting, John L. Indest, Ronald T. Nixon, and W.J.
Billy Tauzin were elected to serve as Class II directors for three-year terms expiring at the
2010 annual meeting of stockholders. Voting results were as follows:
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Name of Director |
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Votes For |
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Votes Withheld |
John L. Indest |
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16,904,047 |
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121,723 |
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Ronald T. Nixon |
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16,903,983 |
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121,787 |
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W.J. Billy Tauzin |
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16,900,280 |
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125,490 |
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The following persons continued as directors following the annual meeting: Keith G. Myers, Ted W.
Hoyt, George A. Lewis, Nancy G. Brinker, John B. Breaux, and Dan S. Wilford.
Ratification of Appointment of Independent Auditors. At the annual meeting, the stockholders
approved the appointment of the independent accounting firm of Ernst & Young LLP to serve as the
Companys independent auditors. Voting results were as follows:
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Votes For |
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Votes Withheld |
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Abstentions |
16,749,487
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263,569
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12,714 |
ITEM 5. OTHER INFORMATION
None
ITEM 6. EXHIBITS.
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3.1
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Certificate of Incorporation of LHC Group, Inc. (previously filed as
an exhibit to the Form S-1/A (File No. 333-120792) on February 14,
2005). |
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3.2
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Bylaws of LHC Group, Inc. (previously filed as an exhibit to the Form
S-1/A (File No. 333-120792) on May 9, 2005). |
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4.1
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Specimen Stock Certificate of LHCs Common Stock, par value $0.01 per
share (previously filed as an
exhibit to the Form S-1/ A (File No. 333-120792) on February 14, 2005). |
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4.2
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Reference is made to Exhibits 3.1 and 3.2 (previously filed as an
exhibit to the Form S-1/A (File No. 333-120792) on February 14, 2005
and May 9, 2005, respectively). |
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31.1
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Certification of Keith G. Myers, Chief Executive Officer pursuant to
Rule 13a-14(a)/15d-14(a), as adopted pursuant to Section 302 of the
Sarbanes-Oxley Act of 2002. |
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31.2
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Certification of Barry E. Stewart, Chief Financial Officer pursuant to
Rule 13a-14(a)/15d-14(a), as adopted pursuant to Section 302 of the
Sarbanes-Oxley Act of 2002. |
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32*
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Certification of Chief Executive Officer and Chief Financial Officer
of LHC Group, Inc. pursuant to 18 U.S.C. Section 1350, as adopted
pursuant to Section 906 of the Sarbanes-Oxley Act of 2002. |
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* |
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This exhibit is furnished to the SEC as an accompanying document and is not deemed to be filed
for purposes of Section 18 of the Securities Exchange Act of 1934 or otherwise subject to the
liabilities of that Section, and the document will not be deemed incorporated by reference into any
filing under the Securities Act of 1933. |
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SIGNATURES
Pursuant to the requirements of the Securities Exchange Act of 1934, the registrant has duly caused
this report to be signed on its behalf by the undersigned thereunto duly authorized.
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LHC GROUP, INC.
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Date August 9, 2007 |
/s/ Barry E. Stewart
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Barry E. Stewart |
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Executive Vice President and Chief Financial Officer |
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