e10vq
UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
Form 10-Q
QUARTERLY REPORT PURSUANT TO SECTION 13 OR 15(d)
OF THE SECURITIES EXCHANGE ACT OF 1934
For the quarterly period ended March 31, 2011
Commission file number 001-15925
COMMUNITY HEALTH SYSTEMS, INC.
(Exact name of registrant as specified in its charter)
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Delaware
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13-3893191 |
(State or other jurisdiction of
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(I.R.S. Employer |
incorporation or organization)
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Identification Number) |
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4000 Meridian Boulevard
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37067 |
Franklin, Tennessee
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(Zip Code) |
(Address of principal executive offices) |
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(Registrants telephone number)
615-465-7000
Indicate by check mark whether the Registrant (1) has filed all reports required to be filed
by Section 13 or 15(d) of the Securities Exchange Act of 1934 during the preceding 12 months (or
for such shorter period that the registrant was required to file such reports), and (2) has been
subject to such filing requirements for the past 90 days. Yes þ No o
Indicate by check mark whether the registrant has submitted electronically and posted on its
corporate web site, if any, every Interactive Data File required to be submitted and posted
pursuant to Rule 405 of Regulation S-T (§ 232.405 of this chapter) during the preceding 12 months
(or for such shorter period that the registrant was required to submit and post such files). Yes
þ No o
Indicate by check mark whether the registrant is a large accelerated filer, an accelerated
filer, a non-accelerated filer, or a smaller reporting company. See the definitions of large
accelerated filer, accelerated filer and smaller reporting company in Rule 12b-2 of the
Exchange Act. (Check one):
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Large accelerated filer þ
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Accelerated filer o
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Non-accelerated filer o
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Smaller reporting company o |
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(Do not check if a smaller reporting company) |
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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
As of April 20, 2011, there were outstanding 94,967,424 shares of the Registrants Common
Stock, $0.01 par value.
Community Health Systems, Inc.
Form 10-Q
For the Three Months Ended March 31, 2011
1
PART I FINANCIAL INFORMATION
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Item 1. |
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Financial Statements |
COMMUNITY HEALTH SYSTEMS, INC. AND SUBSIDIARIES
CONDENSED CONSOLIDATED BALANCE SHEETS
(In thousands, except share data)
(Unaudited)
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March 31, |
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December 31, |
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2011 |
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2010 |
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ASSETS |
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Current assets |
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Cash and cash equivalents |
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$ |
270,716 |
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$ |
299,169 |
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Patient accounts receivable, net of allowance for doubtful accounts of $1,699,935 and
$1,639,198 at March 31, 2011 and December 31, 2010, respectively |
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1,766,122 |
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1,714,542 |
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Supplies |
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329,275 |
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329,114 |
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Prepaid income taxes |
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65,030 |
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118,464 |
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Deferred income taxes |
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115,819 |
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115,819 |
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Prepaid expenses and taxes |
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112,486 |
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100,754 |
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Other current assets |
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176,545 |
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193,331 |
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Total current assets |
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2,835,993 |
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2,871,193 |
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Property and equipment |
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8,663,963 |
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8,528,335 |
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Less accumulated depreciation and amortization |
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(2,217,546 |
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(2,089,776 |
) |
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Property and equipment, net |
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6,446,417 |
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6,438,559 |
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Goodwill |
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4,225,768 |
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4,195,289 |
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Other assets, net |
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1,210,101 |
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1,193,082 |
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Total assets |
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$ |
14,718,279 |
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$ |
14,698,123 |
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LIABILITIES AND EQUITY |
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Current liabilities |
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Current maturities of long-term debt |
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$ |
65,952 |
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$ |
63,139 |
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Accounts payable |
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547,683 |
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526,338 |
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Deferred income taxes |
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8,882 |
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8,882 |
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Accrued interest |
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84,502 |
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146,415 |
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Accrued liabilities |
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898,810 |
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897,266 |
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Total current liabilities |
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1,605,829 |
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1,642,040 |
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Long-term debt |
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8,794,146 |
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8,808,382 |
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Deferred income taxes |
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608,177 |
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608,177 |
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Other long-term liabilities |
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952,406 |
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1,001,675 |
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Total liabilities |
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11,960,558 |
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12,060,274 |
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Redeemable noncontrolling interests in equity of consolidated subsidiaries |
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385,438 |
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387,472 |
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EQUITY |
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Community Health Systems, Inc. stockholders equity |
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Preferred stock, $.01 par value per share, 100,000,000 shares authorized;
none issued |
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Common stock, $.01 par value per share, 300,000,000 shares authorized;
94,927,260 shares issued and 93,951,711 shares outstanding at
March 31, 2011, and 93,644,862 shares issued and 92,669,313 shares
outstanding at December 31, 2010 |
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949 |
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936 |
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Additional paid-in capital |
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1,149,002 |
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1,126,751 |
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Treasury stock, at cost, 975,549 shares at March 31, 2011 and
December 31, 2010 |
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(6,678 |
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(6,678 |
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Accumulated other comprehensive loss |
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(192,640 |
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(230,927 |
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Retained earnings |
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1,360,706 |
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1,299,382 |
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Total Community Health Systems, Inc. stockholders equity |
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2,311,339 |
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2,189,464 |
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Noncontrolling interests in equity of consolidated subsidiaries |
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60,944 |
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60,913 |
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Total equity |
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2,372,283 |
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2,250,377 |
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Total liabilities and equity |
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$ |
14,718,279 |
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$ |
14,698,123 |
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See accompanying notes to the condensed consolidated financial statements.
2
COMMUNITY HEALTH SYSTEMS, INC. AND SUBSIDIARIES
CONDENSED CONSOLIDATED STATEMENTS OF INCOME
(In thousands, except share and per share data)
(Unaudited)
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Three Months Ended |
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March 31, |
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2011 |
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2010 |
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Net operating revenues |
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$ |
3,405,342 |
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$ |
3,125,507 |
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Operating costs and expenses: |
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Salaries and benefits |
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1,402,121 |
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1,269,574 |
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Provision for bad debts |
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407,871 |
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373,665 |
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Supplies |
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464,156 |
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429,597 |
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Other operating expenses |
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624,795 |
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567,084 |
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Rent |
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64,757 |
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63,635 |
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Depreciation and amortization |
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160,677 |
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146,706 |
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Total operating costs and expenses |
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3,124,377 |
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2,850,261 |
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Income from operations |
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280,965 |
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275,246 |
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Interest expense, net |
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164,172 |
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160,360 |
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Equity in earnings of unconsolidated affiliates |
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(18,130 |
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(12,588 |
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Income from continuing operations
before income taxes |
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134,923 |
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127,474 |
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Provision for income taxes |
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43,782 |
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40,989 |
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Income from continuing operations |
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91,141 |
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86,485 |
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Discontinued operations, net of taxes: |
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Loss from operations of entities sold and held for sale |
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(1,214 |
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(1,489 |
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Impairment of long-lived assets of hospital held for sale |
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(8,368 |
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Loss on sale |
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(3,234 |
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Loss from discontinued operations |
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(12,816 |
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(1,489 |
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Net income |
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78,325 |
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84,996 |
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Less: Net income attributable to noncontrolling interests |
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17,001 |
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14,989 |
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Net income attributable to Community Health Systems, Inc. |
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$ |
61,324 |
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$ |
70,007 |
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Basic earnings (loss) per share attributable to Community
Health Systems, Inc. common stockholders: |
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Continuing operations |
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$ |
0.81 |
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$ |
0.78 |
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Discontinued operations |
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(0.14 |
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(0.02 |
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Net income |
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$ |
0.67 |
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$ |
0.76 |
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Diluted earnings (loss) per share attributable to Community
Health Systems, Inc. common stockholders (1): |
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Continuing operations |
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$ |
0.80 |
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$ |
0.77 |
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Discontinued operations |
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(0.14 |
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(0.02 |
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Net income |
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$ |
0.67 |
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$ |
0.75 |
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Weighted-average number of shares outstanding: |
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Basic |
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91,008,405 |
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91,615,275 |
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Diluted |
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92,136,819 |
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92,836,451 |
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(1) |
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Total per share amounts may not add due
to rounding. |
See accompanying notes to the condensed
consolidated financial statements.
3
COMMUNITY HEALTH SYSTEMS, INC. AND SUBSIDIARIES
CONDENSED CONSOLIDATED STATEMENTS OF CASH FLOWS
(In thousands)
(Unaudited)
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Three Months Ended |
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March 31, |
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2011 |
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2010 |
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Cash flows from operating activities |
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Net income |
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$ |
78,325 |
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$ |
84,996 |
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Adjustments to reconcile net income to net cash provided by operating activities: |
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Depreciation and amortization |
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161,318 |
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147,679 |
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Stock-based compensation expense |
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9,918 |
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9,763 |
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Loss on sale |
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3,234 |
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Impairment of long-lived assets of hospital held for sale |
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8,368 |
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Excess tax benefit relating to stock-based compensation |
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(4,675 |
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(4,349 |
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Other non-cash expenses, net |
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(11,173 |
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(3,957 |
) |
Changes in operating assets and liabilities, net of effects of acquisitions and divestitures: |
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Patient accounts receivable |
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(56,454 |
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(94,204 |
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Supplies, prepaid expenses and other current assets |
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14,336 |
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(6,908 |
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Accounts payable, accrued liabilities and income taxes |
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(14,938 |
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167,470 |
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Other |
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(748 |
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(1,130 |
) |
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Net cash provided by operating activities |
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187,511 |
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299,360 |
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Cash flows from investing activities |
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Acquisitions of facilities and other related equipment |
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(45,422 |
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(180 |
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Purchases of property and equipment |
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(153,875 |
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(126,553 |
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Proceeds from disposition of ancillary operations |
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14,583 |
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Proceeds from sale of property and equipment |
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7,587 |
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346 |
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Increase in other non-operating assets |
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(32,277 |
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(36,991 |
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Net cash used in investing activities |
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(209,404 |
) |
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(163,378 |
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Cash flows from financing activities |
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Proceeds from exercise of stock options |
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18,125 |
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24,007 |
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Excess tax benefit relating to stock-based compensation |
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4,675 |
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4,349 |
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Stock buy-back |
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(40 |
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Proceeds from noncontrolling investors in joint ventures |
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863 |
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1,255 |
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Redemption of noncontrolling investments in joint ventures |
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(225 |
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Distributions to noncontrolling investors in joint ventures |
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(15,333 |
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(16,874 |
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Repayments of long-term indebtedness |
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(14,665 |
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(13,154 |
) |
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Net cash used in financing activities |
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(6,560 |
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(457 |
) |
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Net change in cash and cash equivalents |
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(28,453 |
) |
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135,525 |
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Cash and cash equivalents at beginning of period |
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299,169 |
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344,541 |
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Cash and cash equivalents at end of period |
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$ |
270,716 |
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$ |
480,066 |
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Supplemental disclosure of cash flow information: |
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Interest payments |
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$ |
226,124 |
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$ |
220,202 |
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Income taxes (refunds received) paid, net |
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$ |
(677 |
) |
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$ |
934 |
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See accompanying notes to the condensed consolidated financial statements.
4
COMMUNITY HEALTH SYSTEMS, INC. AND SUBSIDIARIES
NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (UNAUDITED) (Continued)
1. BASIS OF PRESENTATION
The unaudited condensed consolidated financial statements of Community Health Systems, Inc.
and its subsidiaries (the Company) as of March 31, 2011 and December 31, 2010 and for the
three-month periods ended March 31, 2011 and March 31, 2010, have been prepared in accordance with
accounting principles generally accepted in the United States of America (U.S. GAAP). In the
opinion of management, such information contains all adjustments, consisting only of normal
recurring adjustments, necessary for a fair presentation of the results for such periods. All
intercompany transactions and balances have been eliminated. The results of operations for the
three months ended March 31, 2011, are not necessarily indicative of the results to be expected for
the full fiscal year ending December 31, 2011. Certain information and disclosures normally
included in the notes to consolidated financial statements have been condensed or omitted as
permitted by the rules and regulations of the Securities and Exchange Commission (the SEC). The
Company believes the disclosures are adequate to make the information presented not misleading. The
accompanying unaudited condensed consolidated financial statements should be read in conjunction
with the consolidated financial statements and notes thereto for the year ended December 31, 2010,
contained in the Companys Annual Report on Form 10-K.
Noncontrolling interests in less-than-wholly-owned consolidated subsidiaries of the parent are
presented as a component of total equity on the condensed consolidated balance sheets to
distinguish between the interests of the parent company and the interests of the noncontrolling
owners. Noncontrolling interests that are redeemable or may become redeemable at a fixed or
determinable price at the option of the holder or upon the occurrence of an event outside of the
control of the Company are presented in mezzanine equity on the condensed consolidated balance
sheets.
During the three months ended March 31, 2011, the Company sold a multi-specialty physician
clinic and made the decision to sell a hospital. Accordingly, as of March 31, 2011, this hospital
has been classified as held for sale. The condensed consolidated statement of income for the three
months ended March 31, 2010 has been restated to reclassify the results of operations for these
entities to discontinued operations. The condensed consolidated balance sheet as of December 31,
2010 has been restated to present the long-lived assets of the disposal group as held for sale for
comparative purposes with the March 31, 2011 presentation.
Throughout these notes to the condensed consolidated financial statements, Community Health
Systems, Inc. (the Parent), and its consolidated subsidiaries are referred to on a collective
basis as the Company. This drafting style is not meant to indicate that the publicly-traded
Parent or any subsidiary of the Parent owns or operates any asset, business, or property. The
hospitals, operations and businesses described in this filing are owned and operated, and
management services provided, by distinct and indirect subsidiaries of Community Health Systems,
Inc.
2. ACCOUNTING FOR STOCK-BASED COMPENSATION
Stock-based compensation awards are granted under the Community Health Systems, Inc. 2000
Stock Option and Award Plan amended and restated as of March 24, 2009 (the 2000 Plan) and the
Community Health Systems, Inc. 2009 Stock Option and Award Plan amended and restated as of March
18, 2011 (the 2009 Plan).
The 2000 Plan allows for the grant of incentive stock options intended to qualify under
Section 422 of the Internal Revenue Code (IRC), as well as stock options which do not so qualify,
stock appreciation rights, restricted stock, restricted stock units, performance-based shares or
units and other share awards. Prior to being amended in 2009, the 2000 Plan also allowed for the
grant of phantom stock. Persons eligible to receive grants under the 2000 Plan include the
Companys directors, officers, employees and consultants. To date, all options granted under the
2000 Plan have been nonqualified stock options for tax purposes. Generally, vesting of these
granted options occurs in one-third increments on each of the first three anniversaries of the
award date. Options granted prior to 2005 have a 10-year contractual term, options granted in 2005
through 2007 have an eight-year contractual term and options granted in 2008 through February 2011
have a 10-year contractual term. As of March 31, 2011, 64,508 shares of unissued common stock were
reserved for future grants under the 2000 Plan.
5
COMMUNITY HEALTH SYSTEMS, INC. AND SUBSIDIARIES
NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (UNAUDITED) (Continued)
The 2009 Plan, which was adopted by the Board of Directors of the Parent as of March 24, 2009
and approved by stockholders on May 19, 2009, provides for the grant of incentive stock options
intended to qualify under Section 422 of the IRC and for the grant of stock options which do not so
qualify, stock appreciation rights, restricted stock, restricted stock units, performance-based
shares or units and other share awards. Persons eligible to receive grants under the 2009 Plan
include the Companys directors, officers, employees and consultants. Options granted in 2011 have
a 10-year contractual term. As of March 31, 2011, 2,954,289 shares of unissued common stock were
reserved for future grants under the 2009 Plan.
The exercise price of all options granted is equal to the fair value of the Companys common
stock on the option grant date.
The following table reflects the impact of total compensation expense related to stock-based
equity plans on the reported operating results for the respective periods (in thousands):
|
|
|
|
|
|
|
|
|
|
|
Three Months Ended |
|
|
|
March 31, |
|
|
|
2011 |
|
|
2010 |
|
Effect on income from continuing
operations before income taxes |
|
$ |
(9,918 |
) |
|
$ |
(9,763 |
) |
|
|
|
|
|
|
|
|
Effect on net income |
|
$ |
(6,298 |
) |
|
$ |
(5,931 |
) |
|
|
|
|
|
|
|
At March 31, 2011, $89.7 million of unrecognized stock-based compensation expense was
expected to be recognized over a weighted-average period of 29 months. Of that amount, $19.2
million related to outstanding unvested stock options was expected to be recognized over a
weighted-average period of 28 months and $70.5 million related to outstanding unvested restricted
stock, restricted stock units and phantom shares was expected to be recognized over a
weighted-average period of 29 months. There were no modifications to awards during the three months
ended March 31, 2011.
The fair value of stock options was estimated using the Black Scholes option pricing model
with the following assumptions and weighted-average fair values during the three months ended March
31, 2011 and 2010:
|
|
|
|
|
|
|
|
|
|
|
Three Months Ended |
|
|
March 31, |
|
|
2011 |
|
2010 |
Expected volatility |
|
|
31.2 |
% |
|
|
33.5 |
% |
Expected dividends |
|
|
|
|
|
|
|
|
Expected term |
|
4.0 |
years |
|
3.1 |
years |
Risk-free interest rate |
|
|
1.74 |
% |
|
|
1.48 |
% |
In determining expected term, the Company examined concentrations of option holdings and
historical patterns of option exercises and forfeitures, as well as forward-looking factors, in an
effort to determine if there were any discernable employee populations. From this analysis, the
Company identified two primary employee populations, one consisting of certain senior executives
and the other consisting of substantially all other recipients.
The expected volatility rate was estimated based on historical volatility. In determining
expected volatility, the Company also reviewed the market-based implied volatility of actively
traded options of its common stock and determined that historical volatility utilized to estimate
the expected volatility did not differ significantly from the implied volatility.
The expected term computation is based on historical exercise and cancellation patterns and
forward-looking factors, where present, for each population identified. The risk-free interest rate
is based on the U.S. Treasury yield curve in effect at the time of the grant. The pre-vesting
forfeiture rate is based on historical rates and forward-looking factors for each population
identified. The Company adjusts the estimated forfeiture rate to its actual experience.
6
COMMUNITY HEALTH SYSTEMS, INC. AND SUBSIDIARIES
NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (UNAUDITED) (Continued)
Options outstanding and exercisable under the 2000 Plan and the 2009 Plan as of March 31,
2011, and changes during the three months then ended, were as follows (in thousands, except share
and per share data):
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Weighted - |
|
|
|
|
|
|
|
|
|
|
Weighted - |
|
|
Average |
|
|
Aggregate |
|
|
|
|
|
|
|
Average |
|
|
Remaining |
|
|
Intrinsic |
|
|
|
|
|
|
|
Exercise |
|
|
Contractual |
|
|
Value as of |
|
|
|
Shares |
|
|
Price |
|
|
Term |
|
|
March 31, 2011 |
|
Outstanding at December 31, 2010 |
|
|
7,834,332 |
|
|
$ |
32.08 |
|
|
|
|
|
|
|
|
|
Granted |
|
|
1,329,000 |
|
|
|
37.96 |
|
|
|
|
|
|
|
|
|
Exercised |
|
|
(595,431 |
) |
|
|
30.44 |
|
|
|
|
|
|
|
|
|
Forfeited and cancelled |
|
|
(64,508 |
) |
|
|
34.84 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Outstanding at March 31, 2011 |
|
|
8,503,393 |
|
|
$ |
33.10 |
|
|
6.1 years |
|
$ |
59,253 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Exercisable at March 31, 2011 |
|
|
5,794,134 |
|
|
$ |
32.74 |
|
|
4.6 years |
|
$ |
42,636 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
The weighted-average grant date fair value of stock options granted during the three months
ended March 31, 2011 and 2010 was $10.34 and $8.47, respectively. The aggregate intrinsic value
(the number of in-the-money stock options multiplied by the difference between the Companys
closing stock price on the last trading day of the reporting period ($39.99) and the exercise price
of the respective stock options) in the table above represents the amount that would have been
received by the option holders had all option holders exercised their options on March 31, 2011.
This amount changes based on the market value of the Companys common stock. The aggregate
intrinsic value of options exercised during the three months ended March 31, 2011 and 2010 was $5.9
million and $9.7 million, respectively. The aggregate intrinsic value of options vested and
expected to vest approximates that of the outstanding options.
The Company has also awarded restricted stock under the 2000 Plan and the 2009 Plan to its
directors and employees of certain subsidiaries. The restrictions on these shares generally lapse
in one-third increments on each of the first three anniversaries of the award date. Certain of the
restricted stock awards granted to the Companys senior executives contain a performance objective
that must be met in addition to any vesting requirements. If the performance objective is not
attained, the awards will be forfeited in their entirety. Once the performance objective has been
attained, restrictions will lapse in one-third increments on each of the first three anniversaries
of the award date. Notwithstanding the above-mentioned performance objectives and vesting
requirements, the restrictions will lapse earlier in the event of death, disability or termination
of employment by the Company for any reason other than for cause of the holder of the restricted
stock, or change in control of the Company. Restricted stock awards subject to performance
standards are not considered outstanding for purposes of determining earnings per share until the
performance objectives have been satisfied.
7
COMMUNITY HEALTH SYSTEMS, INC. AND SUBSIDIARIES
NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (UNAUDITED) (Continued)
Restricted stock outstanding under the 2000 Plan and the 2009 Plan as of March 31, 2011, and
changes during the three months then ended, were as follows:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Weighted - |
|
|
|
|
|
|
|
|
|
|
Average |
|
|
|
|
|
|
|
|
|
|
Grant Date |
|
|
|
|
|
|
Shares |
|
Fair Value |
|
|
|
|
Unvested at December 31, 2010 |
|
|
2,125,291 |
|
|
$ |
27.92 |
|
|
|
|
|
Granted |
|
|
1,084,949 |
|
|
|
37.96 |
|
|
|
|
|
Vested |
|
|
(962,662 |
) |
|
|
27.27 |
|
|
|
|
|
Forfeited |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Unvested at March 31, 2011 |
|
|
2,247,578 |
|
|
|
33.04 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
On February 25, 2009, under the 2000 Plan, each of the Companys outside directors
received a grant of shares of phantom stock equal in value to approximately $130,000 divided by the
closing price of the Companys common stock on that date ($18.18), or 7,151 shares per director (a
total of 42,906 shares of phantom stock). Pursuant to a March 24, 2009 amendment to the 2000 Plan,
future grants of this type will be denominated as restricted stock unit awards. On May 19, 2009,
the newly elected outside director received a grant of 7,151 restricted stock units under the 2000
Plan, having a value at the time of $180,706 based upon the closing price of the Companys common
stock on that date of $25.27. On February 24, 2010, six of the Companys seven outside directors
each received a grant of 4,130 restricted stock units under the 2000 Plan, having a value at the
time of approximately $140,000 based upon the closing price of the Companys common stock on that
date of $33.90. One outside director, who did not stand for reelection in 2010, did not receive a
grant on February 24, 2010. On February 23, 2011, each of the Companys six outside directors
received a grant of 3,688 restricted stock units under the 2009 Plan, having a value at the time of
approximately $140,000 based upon the closing price of the Companys common stock on that date of
$37.96. Vesting of these shares of phantom stock and restricted stock units occurs in one-third
increments on each of the first three anniversaries of the award date. During the three months
ended March 31, 2011, 20,176 shares vested at a weighted-average grant date fair value of $24.61.
None of these grants were canceled during the three months ended March 31, 2011. As of March 31,
2011, there were 55,340 shares of phantom stock and restricted stock units unvested at a
weighted-average grant date fair value of $31.39.
Under the Directors Fees Deferral Plan, the Companys outside directors may elect to receive
share equivalent units in lieu of cash for their directors fees. These share equivalent units are
held in the plan until the director electing to receive the share equivalent units retires or
otherwise terminates his/her directorship with the Company. Share equivalent units are converted to
shares of common stock of the Company at the time of distribution based on the closing market price
of the Companys common stock on that date. The following table represents the amount of directors
fees which were deferred during each of the respective periods, and the number of share equivalent
units into which such directors fees would have converted had each of the directors who had
deferred such fees retired or terminated his/her directorship with the Company as of the end of the
respective periods (in thousands, except share equivalent units):
|
|
|
|
|
|
|
|
|
|
|
Three Months Ended |
|
|
|
March 31, |
|
|
|
2011 |
|
|
2010 |
|
Directors fees earned
and deferred into plan |
|
$ |
55 |
|
|
$ |
45 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Share equivalent units |
|
|
1,375 |
|
|
|
1,219 |
|
|
|
|
|
|
|
|
At March 31, 2011, a total of 20,176 share equivalent units were deferred in the plan
with an aggregate fair value of $0.8 million, based on the closing market price of the Companys
common stock at March 31, 2011 of $39.99.
8
COMMUNITY HEALTH SYSTEMS, INC. AND SUBSIDIARIES
NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (UNAUDITED) (Continued)
3. COST OF REVENUE
Substantially all of the Companys operating costs and expenses are cost of revenue items.
Operating costs that could be classified as general and administrative by the Company would include
the Companys corporate office costs at its Franklin, Tennessee office, which were $41.7 million
and $37.8 million for the three months ended March 31, 2011 and 2010, respectively. Included in
these amounts is stock-based compensation expense of $9.9 million and $9.8 million for the three
months ended March 31, 2011 and 2010, respectively.
4. USE OF ESTIMATES
The preparation of financial statements in conformity with U.S. GAAP requires management to
make estimates and assumptions that affect the amounts reported in the condensed consolidated
financial statements. Actual results could differ from these estimates under different assumptions
or conditions.
5. ACQUISITIONS AND DIVESTITURES
Acquisitions
Effective October 1, 2010, one or more subsidiaries of the Company completed the acquisition
of Forum Health based in Youngstown, Ohio, a healthcare system of two acute care hospitals, a
rehabilitation hospital and other healthcare providers. This healthcare system includes Northside
Medical Center (355 licensed beds) located in Youngstown, Ohio, and Trumbull Memorial Hospital (311
licensed beds) located in Warren, Ohio. This healthcare system also includes Hillside
Rehabilitation Hospital (69 licensed beds) located in Warren, Ohio, as well as several outpatient
clinics and other ancillary facilities. The total cash consideration paid for fixed assets and
working capital was approximately $93.4 million and $27.8 million, respectively, with additional
consideration of $40.3 million assumed in liabilities, for a total consideration of $161.5 million.
This acquisition transaction was accounted for as a purchase business combination. Based upon the
Companys final purchase price allocation relating to this acquisition as of March 31, 2011,
approximately $8.1 million of goodwill has been recorded.
Effective October 1, 2010, one or more subsidiaries of the Company completed the acquisition
of Bluefield Regional Medical Center (240 licensed beds) located in Bluefield, West Virginia. The
total cash consideration paid for fixed assets was approximately $35.4 million, with additional
consideration of $8.9 million assumed in liabilities as well as a credit applied at closing of $1.8
million for negative acquired working capital, for a total consideration of $42.5 million. This
acquisition transaction was accounted for as a purchase business combination. Based upon the
Companys final purchase price allocation relating to this acquisition as of March 31, 2011,
approximately $2.4 million of goodwill has been recorded.
Effective July 7, 2010, one or more subsidiaries of the Company completed the acquisition of
Marion Regional Healthcare System located in Marion, South Carolina. This healthcare system
includes Marion Regional Hospital (124 licensed beds), an acute care hospital, along with a related
skilled nursing facility and other ancillary services. The total cash consideration paid for fixed
assets and working capital was approximately $18.6 million and $5.8 million, respectively, with
additional consideration of $3.9 million assumed in liabilities, for a total consideration of $28.3
million. This acquisition transaction was accounted for as a purchase business combination. Based
upon the Companys final purchase price allocation relating to this acquisition as of March 31,
2011, no goodwill has been recorded.
Additionally, during the three months ended March 31, 2011, the Company paid approximately
$44.7 million to acquire the operating assets and related businesses of certain physician
practices, clinics and other ancillary businesses that operate within the communities served by its
hospitals. In connection with these acquisitions, the Company allocated approximately $9.9 million
of the consideration paid to property and equipment, $3.0 million to net working capital, $1.5
million to other intangible assets, and the remainder, approximately $30.3 million consisting of
intangible assets that do not qualify for separate recognition, was allocated to goodwill. These
acquisition transactions were accounted for as purchase business combinations.
Approximately $3.3 million and $0.6 million of acquisition costs related to prospective and
closed acquisitions were expensed during the three months ended March 31, 2011 and 2010,
respectively.
9
COMMUNITY HEALTH SYSTEMS, INC. AND SUBSIDIARIES
NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (UNAUDITED) (Continued)
Discontinued Operations
Effective February 1, 2011, the Company sold Willamette Community Medical Group, which is a
physician clinic operating as Oregon Medical Group (OMG), located in Springfield, Oregon, with a
carrying amount of net assets, including an allocation of reporting unit goodwill, of $19.7 million
to Oregon Healthcare Resources, LLC, for $14.6 million in cash.
In March 2011, the Company made the decision to sell one of its hospitals. Accordingly, this
hospital has been classified as held for sale as of March 31, 2011.
The Company has classified the results of operations for OMG and one hospital held for sale as
discontinued operations in the accompanying condensed consolidated statements of income for the
three months ended March 31, 2011 and 2010.
Net operating revenues and loss from discontinued operations for the respective periods are as
follows (in thousands):
|
|
|
|
|
|
|
|
|
|
|
Three Months Ended |
|
|
|
March 31, |
|
|
|
2011 |
|
|
2010 |
|
Net operating revenues |
|
$ |
20,794 |
|
|
$ |
35,215 |
|
|
|
|
|
|
|
|
|
Loss from operations of entities sold and held
for sale before income taxes |
|
|
(1,900 |
) |
|
|
(2,330 |
) |
Impairment of long-lived assets of hospital held for sale |
|
|
(13,095 |
) |
|
|
|
|
Loss on sale |
|
|
(5,061 |
) |
|
|
|
|
|
|
|
|
|
|
|
Loss from discontinued operations, before taxes |
|
|
(20,056 |
) |
|
|
(2,330 |
) |
Benefit from income taxes |
|
|
7,240 |
|
|
|
841 |
|
|
|
|
|
|
|
|
Loss from discontinued operations, net of taxes |
|
$ |
(12,816 |
) |
|
$ |
(1,489 |
) |
|
|
|
|
|
|
|
Interest expense was allocated to discontinued operations based on sale proceeds available for
debt repayment.
The long-lived assets as of December 31, 2010 of the physician clinic and hospital classified
as held for sale during the three months ended March 31, 2011 totaled approximately $23.5 million,
and are included in the accompanying condensed consolidated balance sheet in other assets, net.
The long-lived assets of the hospital held for sale, net of impairment as of March 31, 2011
are included in the accompanying condensed consolidated balance sheet in other assets, net.
6. INCOME TAXES
The total amount of unrecognized benefit that would affect the effective tax rate, if
recognized, was approximately $7.2 million as of March 31, 2011. It is the Companys policy to
recognize interest and penalties related to unrecognized benefits in its condensed consolidated
statements of income as income tax expense. During the three months ended March 31, 2011, the
Company decreased liabilities by $0.2 million and increased interest and penalties by
approximately $0.1 million. A total of approximately $1.4 million of interest and penalties is
included in the amount of the liability for uncertain tax positions at March 31, 2011.
The Company believes that it is reasonably possible that approximately $2.3 million of its
current unrecognized tax benefit may be recognized within the next 12 months as a result of a lapse
of the statute of limitations and settlements with taxing authorities.
The Company, or one of its subsidiaries, files income tax returns in the U.S. federal
jurisdiction and various state jurisdictions. The Company has extended the federal statute of
limitations for Triad Hospitals, Inc. (Triad) for the tax periods ended December 31, 1999,
December 31, 2000, April 30, 2001, June 30, 2001, December 31, 2001, December 31, 2002 and December
31, 2003. The Company is currently under examination by the Internal Revenue Service (IRS)
regarding the federal tax return of Triad for the tax periods ended December 31, 2004, December 31,
2005, December 31, 2006 and July 25, 2007. The Company believes the results of this examination
will not be material to its consolidated results of operations or consolidated financial position.
With few exceptions,
10
COMMUNITY HEALTH SYSTEMS, INC. AND SUBSIDIARIES
NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (UNAUDITED) (Continued)
the Company is no longer subject to state income tax examinations for years prior to 2007 and
federal income tax examinations with respect to Community Health Systems, Inc. federal returns for
years prior to 2007. The Companys federal income tax returns for the 2007 and 2008 tax years are
currently under examination by the IRS. The Company believes the results of this examination will
not be material to its consolidated results of operations or consolidated financial position.
Cash paid for income taxes, net of refunds received, resulted in a net cash refund of $0.7
million for the three months ended March 31, 2011 and net cash paid of $0.9 million for the three
months ended March 31, 2010.
7. GOODWILL AND OTHER INTANGIBLE ASSETS
The changes in the carrying amount of goodwill for the three months ended March 31, 2011, are
as follows (in thousands):
|
|
|
|
|
Balance as of December 31, 2010 (as previously reported) |
|
$ |
4,199,905 |
|
Goodwill allocated to disposal and hospital held for sale |
|
|
(4,616 |
) |
|
|
|
|
Balance as of December 31, 2010 (as adjusted) |
|
|
4,195,289 |
|
Goodwill acquired as part of acquisitions during 2011 |
|
|
30,532 |
|
Consideration adjustments and purchase price
allocation adjustments for prior years acquisitions |
|
|
(53 |
) |
|
|
|
|
Balance as of March 31, 2011 |
|
$ |
4,225,768 |
|
|
|
|
|
Goodwill is allocated to each identified reporting unit, which is defined as an operating
segment or one level below the operating segment (referred to as a component of the entity).
Management has determined that the Companys operating segments meet the criteria to be classified
as reporting units. At March 31, 2011, the hospital operations reporting unit, the home care agency
operations reporting unit, and the hospital management services reporting unit had approximately
$4.2 billion, $35.9 million and $33.3 million, respectively, of goodwill.
Goodwill is evaluated for impairment at the same time every year and when an event occurs or
circumstances change that, more likely than not, reduce the fair value of the reporting unit below
its carrying value. There is a two-step method for determining goodwill impairment. Step one is to
compare the fair value of the reporting unit with the units carrying amount, including goodwill.
If this test indicates the fair value is less than the carrying value, then step two is required to
compare the implied fair value of the reporting units goodwill with the carrying value of the
reporting units goodwill. The Company has selected September 30 as its annual testing date. The
Company performed its last annual goodwill evaluation as of September 30, 2010, which evaluation
took place during the fourth quarter of 2010. No impairment was indicated by this evaluation.
The Company estimates the fair value of the related reporting units using both a discounted
cash flow model as well as an EBITDA multiple model. The cash flow forecasts are adjusted by an
appropriate discount rate based on the Companys estimate of a market participants
weighted-average cost of capital. These models are both based on the Companys best estimate of
future revenues and operating costs and are reconciled to the Companys consolidated market
capitalization, with consideration of the amount a potential acquirer would be required to pay, in
the form of a control premium, in order to gain sufficient ownership to set policies, direct
operations and control management decisions.
The gross carrying amount of the Companys other intangible assets subject to amortization was
$62.3 million at March 31, 2011 and $60.5 million at December 31, 2010, and the net carrying amount
was $36.1 million at both March 31, 2011 and December 31, 2010. The carrying amount of the
Companys other intangible assets not subject to amortization was $44.8 million and $44.4 million
at March 31, 2011 and December 31, 2010, respectively. Other intangible assets are included in
other assets, net on the Companys condensed consolidated balance sheets. Substantially all of the
Companys intangible assets are contract-based intangible assets related to operating licenses,
management contracts, or non-compete agreements entered into in connection with prior acquisitions.
The weighted-average amortization period for the intangible assets subject to amortization is
approximately nine years. There are no expected residual values related to these intangible assets.
Amortization expense on these intangible assets was $1.9 million and $3.3 million during the three
months ended March 31, 2011 and 2010, respectively. Amortization expense on intangible assets is
estimated to be $6.1 million for the remainder of 2011, $6.8 million in 2012, $4.7 million in 2013,
$2.9 million in 2014, $2.5 million in 2015 and $13.1 million in 2016 and thereafter.
11
COMMUNITY HEALTH SYSTEMS, INC. AND SUBSIDIARIES
NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (UNAUDITED) (Continued)
The gross carrying amount of capitalized software for internal use was approximately $383.4
million and $356.5 million at March 31, 2011 and December 31, 2010, respectively, and the net
carrying amount considering accumulated amortization was approximately $217.9 million and $209.4
million at March 31, 2011 and December 31, 2010, respectively. The estimated amortization period
for capitalized internal-use software is generally three years, except for capitalized costs
related to significant system conversions, which is generally eight years. There is no expected
residual value for capitalized internal-use software. At March 31, 2011, there was approximately
$64.3 million of capitalized costs for internal-use software that is currently in the development
stage and will begin amortization once the software project is complete and ready for its intended
use. Amortization expense on capitalized internal-use software was $17.9 million and $9.1 million
during the three months ended March 31, 2011 and 2010, respectively. Amortization expense on
capitalized internal-use software is estimated to be $60.1 million for the remainder of 2011, $69.0
million in 2012, $33.4 million in 2013, $15.0 million in 2014, $14.6 million in 2015 and $25.8
million in 2016 and thereafter.
8. EARNINGS PER SHARE
The following table sets forth the components of the numerator and denominator for the
computation of basic and diluted earnings per share for income from continuing operations,
discontinued operations and net income attributable to Community Health Systems, Inc. common
stockholders (in thousands, except share data):
|
|
|
|
|
|
|
|
|
|
|
Three Months Ended |
|
|
|
March 31, |
|
|
|
2011 |
|
|
2010 |
|
Numerator: |
|
|
|
|
|
|
|
|
Income from continuing operations, net of taxes |
|
$ |
91,141 |
|
|
$ |
86,485 |
|
Less: Income from continuing operations attributable to
noncontrolling
interests, net of taxes |
|
|
17,001 |
|
|
|
14,989 |
|
|
|
|
|
|
|
|
Income from continuing operations attributable to
Community Health
Systems, Inc. common stockholders basic and diluted |
|
$ |
74,140 |
|
|
$ |
71,496 |
|
|
|
|
|
|
|
|
|
Loss from discontinued operations, net of taxes |
|
$ |
(12,816 |
) |
|
$ |
(1,489 |
) |
Less: Loss from discontinued operations attributable to
noncontrolling interests, net of taxes |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Loss from discontinued operations attributable to
Community
Health Systems, Inc. common stockholders basic
and diluted |
|
$ |
(12,816 |
) |
|
$ |
(1,489 |
) |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Denominator: |
|
|
|
|
|
|
|
|
Weighted-average number of shares outstanding basic |
|
|
91,008,405 |
|
|
|
91,615,275 |
|
|
|
|
|
|
|
|
|
|
Effect of dilutive securities: |
|
|
|
|
|
|
|
|
Restricted stock awards |
|
|
253,866 |
|
|
|
324,389 |
|
Employee stock options |
|
|
865,691 |
|
|
|
879,305 |
|
Other equity based awards |
|
|
8,857 |
|
|
|
17,482 |
|
|
|
|
|
|
|
|
Weighted-average number of shares outstanding diluted |
|
|
92,136,819 |
|
|
|
92,836,451 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Dilutive securities outstanding not included in the
computation of earnings
per share because their effect is antidilutive: |
|
|
|
|
|
|
|
|
Employee stock options |
|
|
4,395,292 |
|
|
|
5,360,231 |
|
12
COMMUNITY HEALTH SYSTEMS, INC. AND SUBSIDIARIES
NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (UNAUDITED) (Continued)
9. STOCKHOLDERS EQUITY
Authorized capital shares of the Company include 400,000,000 shares of capital stock
consisting of 300,000,000 shares of common stock and 100,000,000 shares of preferred stock. Each of
the aforementioned classes of capital stock has a par value of $0.01 per share. Shares of preferred
stock, none of which were outstanding as of March 31, 2011, may be issued in one or more series
having such rights, preferences and other provisions as determined by the Board of Directors
without approval by the holders of common stock.
On September 15, 2010, the Company commenced a new open market repurchase program for up to
4,000,000 shares of the Companys common stock, not to exceed $100 million in repurchases. This
program will conclude at the earliest of three years from the commencement date, when the maximum
number of shares has been repurchased or when the maximum dollar amount has been expended. During
the three months ended March 31, 2011, the Company did not repurchase any shares under this
program. The cumulative number of shares that have been repurchased and retired under this program
through March 31, 2011 is 451,272 shares at a weighted-average price of $30.81 per share.
On December 9, 2009, the Company commenced the predecessor open market repurchase program for
up to 3,000,000 shares of the Companys common stock, not to exceed $100 million in repurchases.
This program concluded in September 2010 when purchases approximately totaled the permitted maximum
dollar amount. During the three months ended March 31, 2010, the Company did not repurchase any
shares under this program. During the year ended December 31, 2010, the Company repurchased and
retired 2,964,528 shares, which is the cumulative number of shares that were repurchased under this
program, at a weighted-average price of $33.69 per share.
13
COMMUNITY HEALTH SYSTEMS, INC. AND SUBSIDIARIES
NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (UNAUDITED) (Continued)
The following schedule presents the reconciliation of the carrying amount of total equity,
equity attributable to the Company, and equity attributable to the noncontrolling interests for the
three-month period ended March 31, 2011 (in thousands):
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Community Health Systems, Inc. Stockholders |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Accumulated |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Redeemable |
|
|
|
|
|
|
|
Additional |
|
|
|
|
|
|
Other |
|
|
|
|
|
|
|
|
|
|
Total |
|
|
|
Noncontrolling |
|
|
|
Common |
|
|
Paid-in |
|
|
Treasury |
|
|
Comprehensive |
|
|
Retained |
|
|
Noncontrolling |
|
|
Stockholders |
|
|
|
Interests |
|
|
|
Stock |
|
|
Capital |
|
|
Stock |
|
|
Income (Loss) |
|
|
Earnings |
|
|
Interests |
|
|
Equity |
|
Balance, December 31, 2010 |
|
$ |
387,472 |
|
|
|
$ |
936 |
|
|
$ |
1,126,751 |
|
|
$ |
(6,678 |
) |
|
$ |
(230,927 |
) |
|
$ |
1,299,382 |
|
|
$ |
60,913 |
|
|
$ |
2,250,377 |
|
Comprehensive income: |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Net income |
|
|
11,656 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
61,324 |
|
|
|
5,345 |
|
|
|
66,669 |
|
Net change in fair value of
interest rate swaps |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
36,446 |
|
|
|
|
|
|
|
|
|
|
|
36,446 |
|
Net change in fair value of
available-for-sale securities |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
1,069 |
|
|
|
|
|
|
|
|
|
|
|
1,069 |
|
Amortization and recognition
of unrecognized pension
cost components |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
772 |
|
|
|
|
|
|
|
|
|
|
|
772 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Total comprehensive income |
|
|
11,656 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
38,287 |
|
|
|
61,324 |
|
|
|
5,345 |
|
|
|
104,956 |
|
Distributions to
noncontrolling interests,
net of contributions |
|
|
(8,903 |
) |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
(5,567 |
) |
|
|
(5,567 |
) |
Purchase of subsidiary shares from
noncontrolling interests |
|
|
(225 |
) |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Other reclassifications
of noncontrolling interests |
|
|
(1,971 |
) |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
253 |
|
|
|
253 |
|
Adjustment to redemption value
of redeemable noncontrolling
interests |
|
|
(2,591 |
) |
|
|
|
|
|
|
|
2,591 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
2,591 |
|
Issuance of common stock in
connection with the exercise
of stock options |
|
|
|
|
|
|
|
6 |
|
|
|
18,125 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
18,131 |
|
Cancellation of restricted stock
for tax withholdings on
vested shares |
|
|
|
|
|
|
|
(3 |
) |
|
|
(13,058 |
) |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
(13,061 |
) |
Excess tax benefit from exercise of
stock options |
|
|
|
|
|
|
|
|
|
|
|
4,675 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
4,675 |
|
Share-based compensation |
|
|
|
|
|
|
|
10 |
|
|
|
9,918 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
9,928 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Balance, March 31, 2011 |
|
$ |
385,438 |
|
|
|
$ |
949 |
|
|
$ |
1,149,002 |
|
|
$ |
(6,678 |
) |
|
$ |
(192,640 |
) |
|
$ |
1,360,706 |
|
|
$ |
60,944 |
|
|
$ |
2,372,283 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
14
COMMUNITY HEALTH SYSTEMS, INC. AND SUBSIDIARIES
NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (UNAUDITED) (Continued)
10. COMPREHENSIVE INCOME
The following table presents the components of comprehensive income, net of related taxes (in
thousands):
|
|
|
|
|
|
|
|
|
|
|
Three Months Ended |
|
|
|
March 31, |
|
|
|
2011 |
|
|
2010 |
|
Net income |
|
$ |
78,325 |
|
|
$ |
84,996 |
|
Net change in fair value of interest rate swaps |
|
|
36,446 |
|
|
|
(11,357 |
) |
Net change in fair value of available-for-sale securities |
|
|
1,069 |
|
|
|
155 |
|
Amortization and recognition of unrecognized pension cost components |
|
|
772 |
|
|
|
4,475 |
|
|
|
|
|
|
|
|
Comprehensive income |
|
|
116,612 |
|
|
|
78,269 |
|
Less: Comprehensive income attributable to noncontrolling interests |
|
|
17,001 |
|
|
|
14,989 |
|
|
|
|
|
|
|
|
Comprehensive income attributable to Community Health Systems, Inc. |
|
$ |
99,611 |
|
|
$ |
63,280 |
|
|
|
|
|
|
|
|
The net change in fair value of the interest rate swaps, the net change in fair value of
available-for-sale securities and the amortization and recognition of unrecognized pension cost
components are included in accumulated other comprehensive loss on the accompanying condensed
consolidated balance sheets.
11. EQUITY INVESTMENTS
As of March 31, 2011, the Company owned equity interests of 27.5% in four hospitals in Las
Vegas, Nevada, and 26.1% in one hospital in Las Vegas, Nevada, in which Universal Health Systems,
Inc. owns the majority interest, and an equity interest of 38.0% in three hospitals in Macon,
Georgia, in which HCA Inc. owns the majority interest.
Summarized combined financial information for the three months ended March 31, 2011 and 2010,
for these unconsolidated entities in which the Company owns an equity interest is as follows (in
thousands):
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Three Months Ended |
|
|
|
|
|
|
March 31, |
|
|
|
|
|
|
2011 |
|
2010 |
|
|
|
|
Revenues |
|
$ |
372,591 |
|
|
$ |
357,478 |
|
|
|
|
|
Operating costs and expenses |
|
|
317,987 |
|
|
|
324,520 |
|
|
|
|
|
Income from continuing operations before taxes |
|
|
54,584 |
|
|
|
32,932 |
|
|
|
|
|
The summarized financial information for the three months ended March 31, 2011 and 2010
was derived from the unaudited financial information provided to the Company by those
unconsolidated entities.
The Companys investment in all of its unconsolidated affiliates was $425.8 million and $409.5
million at March 31, 2011 and December 31, 2010, respectively, and is included in other assets, net
in the accompanying condensed consolidated balance sheets. Included in the Companys results of
operations is the Companys equity in pre-tax earnings from all of its investments in
unconsolidated affiliates, which was $18.1 million and $12.6 million for the three months ended
March 31, 2011 and 2010, respectively.
15
COMMUNITY HEALTH SYSTEMS, INC. AND SUBSIDIARIES
NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (UNAUDITED) (Continued)
12. LONG-TERM DEBT
Credit Facility and Notes
In connection with the consummation of the acquisition of Triad in July 2007, the Companys
wholly-owned subsidiary CHS/Community Health Systems, Inc. (CHS) obtained approximately $7.2
billion of senior secured financing under a new credit facility (the Credit Facility) with a
syndicate of financial institutions led by Credit Suisse, as administrative agent and collateral
agent, and issued approximately $3.0 billion aggregate principal amount of 8.875% senior notes due
2015 (the Notes). The Company used the net proceeds of $3.0 billion from the Notes offering and
the net proceeds of approximately $6.1 billion of term loans under the Credit Facility to acquire
the outstanding shares of Triad, to refinance certain of Triads indebtedness and the Companys
indebtedness, to complete certain related transactions, to pay certain costs and expenses of the
transactions and for general corporate uses. Specifically, the Company repaid its outstanding debt
under the previously outstanding credit facility, the 6.50% senior subordinated notes due 2012 and
certain of Triads existing indebtedness.
The Credit Facility consisted of an approximately $6.1 billion funded term loan facility with
a maturity of seven years, a $400 million delayed draw term loan facility with a maturity of seven
years and a $750 million revolving credit facility with a maturity of six years. As of December 31,
2007, the $400 million delayed draw term loan facility had been reduced to $300 million at the
request of CHS. During the fourth quarter of 2008, $100 million of the delayed draw term loan was
drawn by CHS, reducing the delayed draw term loan availability to $200 million at December 31,
2008. In January 2009, CHS drew down the remaining $200 million of the delayed draw term loan. The
revolving credit facility also includes a subfacility for letters of credit and a swingline
subfacility. The Credit Facility requires quarterly amortization payments of each term loan
facility equal to 0.25% of the outstanding amount of the term loans. On November 5, 2010, CHS
entered into an amendment and restatement of its existing Credit Facility. The amendment extends
by two and a half years, until January 25, 2017, the maturity date of $1.5 billion of the existing
term loans under the Credit Facility and increases the pricing on these term loans to LIBOR plus
350 basis points. If more than $50 million of the Notes remain outstanding on April 15, 2015,
without having been refinanced, then the maturity date for the extended term loans will be
accelerated to April 15, 2015. The maturity date of the balance of the term loans of approximately
$4.5 billion remains unchanged at July 25, 2014. The amendment also increases CHSs ability to
issue additional indebtedness under the uncommitted incremental facility to $1.0 billion from $600
million, permits CHS to issue Term A term loans under the incremental facility, and provides up to
$2.0 billion of borrowing capacity from receivable transactions, an increase of $0.5 billion, of
which $1.7 billion would be required to be used for repayment of existing term loans.
The term loan facility must be prepaid in an amount equal to (1) 100% of the net cash proceeds
of certain asset sales and dispositions by the Company and its subsidiaries, subject to certain
exceptions and reinvestment rights, (2) 100% of the net cash proceeds of issuances of certain debt
obligations or receivables based financing by the Company and its subsidiaries, subject to certain
exceptions, and (3) 50%, subject to reduction to a lower percentage based on the Companys leverage
ratio (as defined in the Credit Facility generally as the ratio of total debt on the date of
determination to the Companys EBITDA, as defined, for the four quarters most recently ended prior
to such date), of excess cash flow (as defined) for any year, commencing in 2008, subject to
certain exceptions. Voluntary prepayments and commitment reductions are permitted in whole or in
part, without any premium or penalty, subject to minimum prepayment or reduction requirements.
The obligor under the Credit Facility is CHS. All of the obligations under the Credit Facility
are unconditionally guaranteed by the Company and certain existing and subsequently acquired or
organized domestic subsidiaries. All obligations under the Credit Facility and the related
guarantees are secured by a perfected first priority lien or security interest in substantially all
of the assets of the Company, CHS and each subsidiary guarantor, including equity interests held by
the Company, CHS or any subsidiary guarantor, but excluding, among others, the equity interests of
non-significant subsidiaries, syndication subsidiaries, securitization subsidiaries and joint
venture subsidiaries.
16
COMMUNITY HEALTH SYSTEMS, INC. AND SUBSIDIARIES
NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (UNAUDITED) (Continued)
The loans under the Credit Facility bear interest on the outstanding unpaid principal amount
at a rate equal to an applicable percentage plus, at CHSs option, either (a) an Alternate Base
Rate (as defined) determined by reference to the greater of (1) the Prime Rate (as defined)
announced by Credit Suisse or (2) the Federal Funds Effective Rate (as defined) plus one-half of
1.0% or (3) the adjusted London Interbank Offered Rate (LIBOR) on such day for a three-month
interest period commencing on the second business day after such day plus 1%, or (b) a reserve
adjusted LIBOR for dollars (Eurodollar rate) (as defined). The applicable percentage for Alternate
Base Rate loans is 1.25% for term loans due 2014 and is 2.25% for term loans due 2017. The
applicable percentage for Eurodollar rate loans is 2.25% for term loans due 2014 and 3.5% for term
loans due 2017. The applicable percentage for revolving loans is 1.25% for Alternate Base Rate
revolving loans and 2.25% for Eurodollar revolving loans, in each case subject to reduction based
on the Companys leverage ratio. Loans under the swingline subfacility bear interest at the rate
applicable to Alternate Base Rate loans under the revolving credit facility.
CHS has agreed to pay letter of credit fees equal to the applicable percentage then in effect
with respect to Eurodollar rate loans under the revolving credit facility times the maximum
aggregate amount available to be drawn under all letters of credit outstanding under the
subfacility for letters of credit. The issuer of any letter of credit issued under the subfacility
for letters of credit will also receive a customary fronting fee and other customary processing
charges. CHS was initially obligated to pay commitment fees of 0.50% per annum (subject to
reduction based upon the Companys leverage ratio) on the unused portion of the revolving credit
facility. For purposes of this calculation, swingline loans are not treated as usage of the
revolving credit facility. With respect to the delayed draw term loan facility, CHS was also
obligated to pay commitment fees of 0.50% per annum for the first nine months after the closing of
the Credit Facility, 0.75% per annum for the next three months after such nine-month period and
thereafter, 1.0% per annum. In each case, the commitment fee was paid on the unused amount of the
delayed draw term loan facility. After the draw down of the remaining $200 million of the delayed
draw term loan in January 2009, CHS no longer pays any commitment fees for the delayed draw term
loan facility. CHS paid arrangement fees on the closing of the Credit Facility and pays an annual
administrative agent fee.
The Credit Facility contains customary representations and warranties, subject to limitations
and exceptions, and customary covenants restricting the Companys and its subsidiaries ability,
subject to certain exceptions, to, among other things (1) declare dividends, make distributions or
redeem or repurchase capital stock, (2) prepay, redeem or repurchase other debt, (3) incur liens or
grant negative pledges, (4) make loans and investments and enter into acquisitions and joint
ventures, (5) incur additional indebtedness or provide certain guarantees, (6) make capital
expenditures, (7) engage in mergers, acquisitions and asset sales, (8) conduct transactions with
affiliates, (9) alter the nature of the Companys businesses, (10) grant certain guarantees with
respect to physician practices, (11) engage in sale and leaseback transactions or (12) change the
Companys fiscal year. The Company is also required to comply with specified financial covenants
(consisting of a leverage ratio and an interest coverage ratio) and various affirmative covenants.
Events of default under the Credit Facility include, but are not limited to, (1) CHSs failure
to pay principal, interest, fees or other amounts under the credit agreement when due (taking into
account any applicable grace period), (2) any representation or warranty proving to have been
materially incorrect when made, (3) covenant defaults subject, with respect to certain covenants,
to a grace period, (4) bankruptcy events, (5) a cross default to certain other debt, (6) certain
undischarged judgments (not paid within an applicable grace period), (7) a change of control, (8)
certain ERISA-related defaults and (9) the invalidity or impairment of specified security
interests, guarantees or subordination provisions in favor of the administrative agent or lenders
under the Credit Facility.
The Notes were issued by CHS in connection with the Triad acquisition in the principal amount
of approximately $3.0 billion. The Notes will mature on July 15, 2015. The Notes bear interest at
the rate of 8.875% per annum, payable semiannually in arrears on January 15 and July 15, commencing
January 15, 2008. Interest on the Notes accrues from the date of original issuance. Interest is
calculated on the basis of a 360-day year comprised of twelve 30-day months.
Except as set forth below, CHS is not entitled to redeem the Notes prior to July 15, 2011.
17
COMMUNITY HEALTH SYSTEMS, INC. AND SUBSIDIARIES
NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (UNAUDITED) (Continued)
On and after July 15, 2011, CHS is entitled, at its option, to redeem all or a portion of the
Notes upon not less than 30 nor more than 60 days notice, at the redemption prices (expressed as a
percentage of principal amount on the redemption date), plus accrued and unpaid interest, if any,
to the redemption date (subject to the right of holders of record on the relevant record date to
receive interest due on the relevant interest payment date), if redeemed during the 12-month period
commencing on July 15 of the years set forth below:
|
|
|
|
|
Period |
|
Redemption Price |
2011 |
|
|
104.438 |
% |
2012 |
|
|
102.219 |
% |
2013 and thereafter |
|
|
100.000 |
% |
CHS is entitled, at its option, to redeem the Notes, in whole or in part, at any time prior to
July 15, 2011, upon not less than 30 or more than 60 days notice, at a redemption price equal to
100% of the principal amount of Notes redeemed plus the Applicable Premium (as defined), and
accrued and unpaid interest, if any, as of the applicable redemption date.
Pursuant to a registration rights agreement entered into at the time of the issuance of the
Notes, as a result of an exchange offer made by CHS, substantially all of the Notes issued in July
2007 were exchanged in November 2007 for new notes (the Exchange Notes) having terms
substantially identical in all material respects to the Notes (except that the Exchange Notes were
issued under a registration statement pursuant to the Securities Act of 1933, as amended).
References to the Notes shall also be deemed to include the Exchange Notes unless the context
provides otherwise.
As of March 31, 2011, the availability for additional borrowings under the Credit Facility was
$750 million pursuant to the revolving credit facility, of which $81.9 million was set aside for
outstanding letters of credit. CHS has the ability to amend the Credit Facility to provide for one
or more tranches of term loans in an aggregate principal amount of $1.0 billion, which CHS has not
yet accessed. CHS also has the ability to add up to $300 million of borrowing capacity from
receivable transactions (including securitizations) under the Credit Facility, which has not yet
been accessed. As of March 31, 2011, the weighted-average interest rate under the Credit Facility,
excluding swaps, was 3.3%.
The Company paid interest of $226.1 million and $220.2 million on borrowings during the three
months ended March 31, 2011 and 2010, respectively.
13. FAIR VALUE OF FINANCIAL INSTRUMENTS
The fair value of financial instruments has been estimated by the Company using available
market information as of March 31, 2011 and December 31, 2010, and valuation methodologies
considered appropriate. The estimates presented are not necessarily indicative of amounts the
Company could realize in a current market exchange (in thousands):
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
March 31, 2011 |
|
December 31, 2010 |
|
|
Carrying |
|
Estimated Fair |
|
Carrying |
|
Estimated Fair |
|
|
Amount |
|
Value |
|
Amount |
|
Value |
Assets: |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Cash and cash equivalents |
|
$ |
270,716 |
|
|
$ |
270,716 |
|
|
$ |
299,169 |
|
|
$ |
299,169 |
|
Available-for-sale securities |
|
|
32,733 |
|
|
|
32,733 |
|
|
|
31,570 |
|
|
|
31,570 |
|
Trading securities |
|
|
39,052 |
|
|
|
39,052 |
|
|
|
35,092 |
|
|
|
35,092 |
|
Liabilities: |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Credit Facility |
|
|
5,986,789 |
|
|
|
5,945,598 |
|
|
|
5,999,337 |
|
|
|
5,882,124 |
|
Senior notes |
|
|
2,784,331 |
|
|
|
2,930,508 |
|
|
|
2,784,331 |
|
|
|
2,923,548 |
|
Other debt |
|
|
39,656 |
|
|
|
39,656 |
|
|
|
36,122 |
|
|
|
36,122 |
|
Cash and cash equivalents. The carrying amount approximates fair value due to the
short-term maturity of these instruments (less than three months).
Available-for-sale securities. Estimated fair value is based on closing price as quoted in
public markets.
18
COMMUNITY HEALTH SYSTEMS, INC. AND SUBSIDIARIES
NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (UNAUDITED) (Continued)
Trading securities. Estimated fair value is based on closing price as quoted in public
markets.
Credit Facility. Estimated fair value is based on information from the Companys bankers
regarding relevant pricing for trading activity among the Companys lending institutions.
Senior notes. Estimated fair value is based on the average bid and ask price as quoted by the
bank who served as underwriter in the sale of these notes.
Other debt. The carrying amount of all other debt approximates fair value due to the nature
of these obligations.
Interest rate swaps. The fair value of interest rate swap agreements is the amount at which
they could be settled, based on estimates calculated by the Company using a discounted cash flow
analysis based on observable market inputs and validated by comparison to estimates obtained from
the counterparty. The Company incorporates credit valuation adjustments (CVAs) to appropriately
reflect both its own nonperformance or credit risk and the respective counterpartys nonperformance
or credit risk in the fair value measurements. In adjusting the fair value of its interest rate
swap agreements for the effect of nonperformance or credit risk, the Company has considered the
impact of any netting features included in the agreements.
The Company assesses the effectiveness of its hedge instruments on a quarterly basis. For the
three months ended March 31, 2011 and 2010, the Company completed an assessment of the cash flow
hedge instruments and determined the hedges to be highly effective. The Company has also determined
that the ineffective portion of the hedges do not have a material effect on the Companys
consolidated financial position, operations or cash flows. The counterparties to the interest rate
swap agreements expose the Company to credit risk in the event of nonperformance. However, at March
31, 2011, each swap agreement entered into by the Company was in a net liability position so that
the Company would be required to make the net settlement payments to the counterparties; the
Company does not anticipate nonperformance by those counterparties. The Company does not hold or
issue derivative financial instruments for trading purposes.
19
COMMUNITY HEALTH SYSTEMS, INC. AND SUBSIDIARIES
NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (UNAUDITED) (Continued)
Interest rate swaps consisted of the following at March 31, 2011:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Notional |
|
|
|
|
|
|
|
|
|
|
Amount |
|
Fixed Interest |
|
Termination |
|
Fair Value |
Swap # |
|
|
|
(in 000s) |
|
Rate |
|
Date |
|
(in 000s) |
1 |
|
|
|
$ |
300,000 |
|
|
|
5.1140 |
% |
|
August 8, 2011 |
|
$ |
5,095 |
|
2 |
|
|
|
|
100,000 |
|
|
|
4.7185 |
% |
|
August 19, 2011 |
|
|
1,682 |
|
3 |
|
|
|
|
100,000 |
|
|
|
4.7040 |
% |
|
August 19, 2011 |
|
|
1,689 |
|
4 |
|
|
|
|
100,000 |
|
|
|
4.6250 |
% |
|
August 19, 2011 |
|
|
1,646 |
|
5 |
|
|
|
|
200,000 |
|
|
|
4.9300 |
% |
|
August 30, 2011 |
|
|
3,790 |
|
6 |
|
|
|
|
200,000 |
|
|
|
3.0920 |
% |
|
September 18, 2011 |
|
|
2,527 |
|
7 |
|
|
|
|
100,000 |
|
|
|
3.0230 |
% |
|
October 23, 2011 |
|
|
1,444 |
|
8 |
|
|
|
|
200,000 |
|
|
|
4.4815 |
% |
|
October 26, 2011 |
|
|
4,599 |
|
9 |
|
|
|
|
200,000 |
|
|
|
4.0840 |
% |
|
December 3, 2011 |
|
|
4,815 |
|
10 |
|
|
|
|
100,000 |
|
|
|
3.8470 |
% |
|
January 4, 2012 |
|
|
2,477 |
|
11 |
|
|
|
|
100,000 |
|
|
|
3.8510 |
% |
|
January 4, 2012 |
|
|
2,490 |
|
12 |
|
|
|
|
100,000 |
|
|
|
3.8560 |
% |
|
January 4, 2012 |
|
|
2,493 |
|
13 |
|
|
|
|
200,000 |
|
|
|
3.7260 |
% |
|
January 8, 2012 |
|
|
4,859 |
|
14 |
|
|
|
|
200,000 |
|
|
|
3.5065 |
% |
|
January 16, 2012 |
|
|
4,601 |
|
15 |
|
|
|
|
250,000 |
|
|
|
5.0185 |
% |
|
May 30, 2012 |
|
|
12,306 |
|
16 |
|
|
|
|
150,000 |
|
|
|
5.0250 |
% |
|
May 30, 2012 |
|
|
7,395 |
|
17 |
|
|
|
|
200,000 |
|
|
|
4.6845 |
% |
|
September 11, 2012 |
|
|
11,056 |
|
18 |
|
|
|
|
100,000 |
|
|
|
3.3520 |
% |
|
October 23, 2012 |
|
|
3,846 |
|
19 |
|
|
|
|
125,000 |
|
|
|
4.3745 |
% |
|
November 23, 2012 |
|
|
6,793 |
|
20 |
|
|
|
|
75,000 |
|
|
|
4.3800 |
% |
|
November 23, 2012 |
|
|
4,278 |
|
21 |
|
|
|
|
150,000 |
|
|
|
5.0200 |
% |
|
November 30, 2012 |
|
|
10,260 |
|
22 |
|
|
|
|
200,000 |
|
|
|
2.2420 |
% |
|
February 28, 2013 |
|
|
4,867 |
|
23 |
|
|
|
|
100,000 |
|
|
|
5.0230 |
% |
|
May 30, 2013 |
|
|
8,478 |
|
24 |
|
|
|
|
300,000 |
|
|
|
5.2420 |
% |
|
August 6, 2013 |
|
|
28,369 |
|
25 |
|
|
|
|
100,000 |
|
|
|
5.0380 |
% |
|
August 30, 2013 |
|
|
9,144 |
|
26 |
|
|
|
|
50,000 |
|
|
|
3.5860 |
% |
|
October 23, 2013 |
|
|
2,903 |
|
27 |
|
|
|
|
50,000 |
|
|
|
3.5240 |
% |
|
October 23, 2013 |
|
|
2,825 |
|
28 |
|
|
|
|
100,000 |
|
|
|
5.0500 |
% |
|
November 30, 2013 |
|
|
9,729 |
|
29 |
|
|
|
|
200,000 |
|
|
|
2.0700 |
% |
|
December 19, 2013 |
|
|
3,697 |
|
30 |
|
|
|
|
100,000 |
|
|
|
5.2310 |
% |
|
July 25, 2014 |
|
|
11,507 |
|
31 |
|
|
|
|
100,000 |
|
|
|
5.2310 |
% |
|
July 25, 2014 |
|
|
11,507 |
|
32 |
|
|
|
|
200,000 |
|
|
|
5.1600 |
% |
|
July 25, 2014 |
|
|
22,554 |
|
33 |
|
|
|
|
75,000 |
|
|
|
5.0405 |
% |
|
July 25, 2014 |
|
|
8,158 |
|
34 |
|
|
|
|
125,000 |
|
|
|
5.0215 |
% |
|
July 25, 2014 |
|
|
13,519 |
|
35 |
|
|
|
|
100,000 |
|
|
|
2.6210 |
% |
|
July 25, 2014 |
|
|
3,046 |
|
36 |
|
|
|
|
100,000 |
|
|
|
3.1100 |
% |
|
July 25, 2014 |
|
|
4,636 |
|
37 |
|
|
|
|
100,000 |
|
|
|
3.2580 |
% |
|
July 25, 2014 |
|
|
5,116 |
|
38 |
|
|
|
|
200,000 |
|
|
|
2.6930 |
% |
|
October 26, 2014 |
|
|
3,680 |
(1) |
39 |
|
|
|
|
300,000 |
|
|
|
3.4470 |
% |
|
August 8, 2016 |
|
|
10,636 |
(2) |
40 |
|
|
|
|
200,000 |
|
|
|
3.4285 |
% |
|
August 19, 2016 |
|
|
6,666 |
(3) |
41 |
|
|
|
|
100,000 |
|
|
|
3.4010 |
% |
|
August 19, 2016 |
|
|
3,203 |
(4) |
42 |
|
|
|
|
200,000 |
|
|
|
3.5000 |
% |
|
August 30, 2016 |
|
|
7,142 |
(5) |
43 |
|
|
|
|
100,000 |
|
|
|
3.0050 |
% |
|
November 30, 2016 |
|
|
1,967 |
|
20
COMMUNITY HEALTH SYSTEMS, INC. AND SUBSIDIARIES
NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (UNAUDITED) (Continued)
|
|
|
(1) |
|
This interest rate swap becomes effective October 26, 2011, concurrent with the termination of swap #8. |
|
(2) |
|
This interest rate swap becomes effective August 8, 2011, concurrent with the termination of swap #1. |
|
(3) |
|
This interest rate swap becomes effective August 19, 2011, concurrent with the termination of swap #2 and #4. |
|
(4) |
|
This interest rate swap becomes effective August 19, 2011, concurrent with the termination of swap #3. |
|
(5) |
|
This interest rate swap becomes effective August 30, 2011, concurrent with the termination of swap #5. |
The Company is exposed to certain risks relating to its ongoing business operations. The risk
managed by using derivative instruments is interest rate risk. Interest rate swaps are entered into
to manage interest rate fluctuation risk associated with the term loans in the Credit Facility.
Companies are required to recognize all derivative instruments as either assets or liabilities at
fair value in the condensed consolidated balance sheet. The Company designates its interest rate
swaps as cash flow hedges. For derivative instruments that are designated and qualify as cash flow
hedges, the effective portion of the gain or loss on the derivative is reported as a component of
other comprehensive income (OCI) and reclassified into earnings in the same period or periods
during which the hedged transactions affect earnings. Gains and losses on the derivative
representing either hedge ineffectiveness or hedge components excluded from the assessment of
effectiveness are recognized in current earnings.
Assuming no change in March 31, 2011 interest rates, approximately $189.3 million of interest
expense resulting from the spread between the fixed and floating rates defined in each interest
rate swap agreement will be recognized during the next 12 months. If interest rate swaps do not
remain highly effective as a cash flow hedge, the derivatives gains or losses resulting from the
change in fair value reported through OCI will be reclassified into earnings.
The following tabular disclosure provides the amount of pre-tax gain (loss) recognized in the
condensed consolidated balance sheets as a component of OCI during the three months ended March 31,
2011 and 2010 (in thousands):
|
|
|
|
|
|
|
|
|
Derivatives in Cash Flow Hedging |
|
Amount of Pre-Tax Gain (Loss) Recognized in OCI |
Relationships |
|
on Derivative (Effective Portion) |
|
|
Three Months Ended March 31, |
|
|
2011 |
|
2010 |
Interest rate swaps |
|
$ |
4,113 |
|
|
$ |
(70,908 |
) |
The following tabular disclosure provides the location of the effective portion of the
pre-tax loss reclassified from accumulated other comprehensive loss (AOCL) into interest expense
on the condensed consolidated statements of income during the three months ended March 31, 2011 and
2010 (in thousands):
|
|
|
|
|
|
|
|
|
Location of Loss Reclassified from |
|
|
AOCL into Income (Effective |
|
Amount of Pre-Tax Loss Reclassified from AOCL |
Portion) |
|
into Income (Effective Portion) |
|
|
Three Months Ended March 31, |
|
|
2011 |
|
2010 |
Interest expense, net |
|
$ |
(52,923 |
) |
|
$ |
(53,164 |
) |
The fair values of derivative instruments in the condensed consolidated balance sheets as
of March 31, 2011 and December 31, 2010 were as follows (in thousands):
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Asset Derivatives |
|
|
|
Liability Derivatives |
|
|
March 31, 2011 |
|
December 31, 2010 |
|
|
|
March 31, 2011 |
|
December 31, 2010 |
|
|
Balance |
|
|
|
|
|
Balance |
|
|
|
|
|
|
|
Balance |
|
|
|
|
|
Balance |
|
|
|
|
Sheet |
|
|
|
|
|
Sheet |
|
|
|
|
|
|
|
Sheet |
|
|
|
|
|
Sheet |
|
|
|
|
Location |
|
Fair Value |
|
Location |
|
Fair Value |
|
|
|
Location |
|
Fair Value |
|
Location |
|
Fair Value |
Derivatives designated as
hedging instruments |
|
Other
assets, net |
|
$ |
|
|
|
Other
assets, net |
|
$ |
|
|
|
|
|
Other long-term
liabilities |
|
$ |
283,490 |
|
|
Other long-term
liabilities |
|
$ |
340,526 |
|
21
COMMUNITY HEALTH SYSTEMS, INC. AND SUBSIDIARIES
NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (UNAUDITED) (Continued)
14. FAIR VALUE
Fair Value Hierarchy
Fair value is a market-based measurement, not an entity-specific measurement. Therefore, a
fair value measurement should be determined based on the assumptions that market participants would
use in pricing the asset or liability. As a basis for considering market participant assumptions in
fair value measurements, the Company utilizes the U.S. GAAP fair value hierarchy that distinguishes
between market participant assumptions based on market data obtained from sources independent of
the reporting entity (observable inputs that are classified within Levels 1 and 2 of the hierarchy)
and the reporting entitys own assumption about market participant assumptions (unobservable inputs
classified within Level 3 of the hierarchy).
The inputs used to measure fair value are classified into the following fair value hierarchy:
Level 1: Quoted market prices in active markets for identical assets or liabilities.
Level 2: Observable market-based inputs or unobservable inputs that are corroborated by
market data.
Level 3: Unobservable inputs that are supported by little or no market activity and
are significant to the fair value of the assets or liabilities. Level 3 includes values
determined using pricing models, discounted cash flow methodologies, or similar
techniques reflecting the Companys own assumptions.
In instances where the determination of the fair value hierarchy measurement is based on
inputs from different levels of the fair value hierarchy, the level in the fair value hierarchy
within which the entire fair value measurement falls is based on the lowest level input that is
significant to the fair value measurement in its entirety. The Companys assessment of the
significance of a particular input to the fair value measurement in its entirety requires judgment
of factors specific to the asset or liability.
The following table sets forth, by level within the fair value hierarchy, the financial assets
and liabilities recorded at fair value on a recurring basis as of March 31, 2011 and December 31,
2010 (in thousands):
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
March 31, |
|
|
|
|
|
|
|
|
|
|
|
|
2011 |
|
|
Level 1 |
|
|
Level 2 |
|
|
Level 3 |
|
Available-for-sale securities |
|
$ |
32,733 |
|
|
$ |
32,733 |
|
|
$ |
|
|
|
$ |
|
|
Trading securities |
|
|
39,052 |
|
|
|
39,052 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Total assets |
|
$ |
71,785 |
|
|
$ |
71,785 |
|
|
$ |
|
|
|
$ |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Fair value of interest rate swap agreements |
|
$ |
283,490 |
|
|
$ |
|
|
|
$ |
283,490 |
|
|
$ |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Total liabilities |
|
$ |
283,490 |
|
|
$ |
|
|
|
$ |
283,490 |
|
|
$ |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
December 31, |
|
|
|
|
|
|
|
|
|
|
|
|
2010 |
|
|
Level 1 |
|
|
Level 2 |
|
|
Level 3 |
|
Available-for-sale securities |
|
$ |
31,570 |
|
|
$ |
31,570 |
|
|
$ |
|
|
|
$ |
|
|
Trading securities |
|
|
35,092 |
|
|
|
35,092 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Total assets |
|
$ |
66,662 |
|
|
$ |
66,662 |
|
|
$ |
|
|
|
$ |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Fair value of interest rate swap agreements |
|
$ |
340,526 |
|
|
$ |
|
|
|
$ |
340,526 |
|
|
$ |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Total liabilities |
|
$ |
340,526 |
|
|
$ |
|
|
|
$ |
340,526 |
|
|
$ |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
22
COMMUNITY HEALTH SYSTEMS, INC. AND SUBSIDIARIES
NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (UNAUDITED) (Continued)
Available-for-sale securities and trading securities classified as Level 1 are measured
using quoted market prices.
The valuation of the Companys interest rate swap agreements is determined using market
valuation techniques, including discounted cash flow analysis on the expected cash flows of each
agreement. This analysis reflects the contractual terms of the agreement, including the period to
maturity, and uses observable market-based inputs, including forward interest rate curves. The fair
value of interest rate swap agreements are determined by netting the discounted future fixed cash
payments and the discounted expected variable cash receipts. The variable cash receipts are based
on the expectation of future interest rates based on observable market forward interest rate curves
and the notional amount being hedged.
The Company incorporates CVAs to appropriately reflect both its own nonperformance or credit
risk and the respective counterpartys nonperformance or credit risk in the fair value
measurements. In adjusting the fair value of its interest rate swap agreements for the effect of
nonperformance or credit risk, the Company has considered the impact of any netting features
included in the agreements. The CVA on the Companys interest rate swap agreements at March 31,
2011 resulted in a decrease in the fair value of the related liability of $13.2 million and an
after-tax adjustment of $8.4 million to OCI. The CVA on the Companys interest rate swap agreements
at December 31, 2010 resulted in a decrease in the fair value of the related liability of $3.9
million and an after-tax adjustment of $2.5 million to OCI.
The majority of the inputs used to value its interest rate swap agreements, including the
forward interest rate curves and market perceptions of the Companys credit risk used in the CVAs,
are observable inputs available to a market participant. As a result, the Company has determined
that the interest rate swap valuations are classified in Level 2 of the fair value hierarchy.
15. RECENT ACCOUNTING PRONOUNCEMENTS
In August 2010, the Financial Accounting Standards Board (FASB) issued Accounting Standards
Update (ASU) 2010-24, which provides clarification to companies in the healthcare industry on the
accounting for professional liability insurance. This ASU states that receivables related to
insurance recoveries should not be netted against the related claim liability and such claim
liabilities should be determined without considering insurance recoveries. This ASU is effective
for fiscal years beginning after December 15, 2010 and was adopted by the Company on January 1,
2011. The adoption of this ASU had an immaterial impact to the condensed consolidated balance
sheet at March 31, 2011 and no impact to the condensed consolidated statement of income for the
three months ended March 31, 2011.
In August 2010, the FASB issued ASU 2010-23, which requires a company in the healthcare
industry to use its direct and indirect costs of providing charity care as the measurement basis
for charity care disclosures. This ASU also requires additional disclosures of the method used to
determine such costs. The Company adopted this ASU on January 1, 2011. In the ordinary course of
business, the Company renders services to patients who are financially unable to pay for hospital
care. Included in the provision for contractual allowances is the value (at the Companys standard
charges) of these services to patients who are unable to pay that is eliminated from net operating
revenues when it is determined they qualify under the Companys charity care policy. The estimated
cost incurred by the Company to provide these services to patients who are unable to pay was
approximately $30.7 million and $26.2 million for the three months ended March 31, 2011 and 2010,
respectively. The estimated cost of these charity care services was determined using a ratio of
cost to gross charges and applying that ratio to the gross charges associated with providing care
to charity patients for the period. Gross charges associated with providing care to charity
patients includes only the related charges for those patients who are financially unable to pay and
qualify under the Companys charity care policy and that do not otherwise qualify for reimbursement
from a governmental program.
23
COMMUNITY HEALTH SYSTEMS, INC. AND SUBSIDIARIES
NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (UNAUDITED) (Continued)
16. SEGMENT INFORMATION
The Company operates in three distinct operating segments, represented by hospital operations
(which includes its general acute care hospitals and related healthcare entities that provide
inpatient and outpatient healthcare services), home care agency operations (which provide in-home
outpatient care), and hospital management services (which provides executive management and
consulting services to non-affiliated acute care hospitals). Only the hospital operations segment
meets the criteria as a separate reportable segment. The financial information for the home care
agencies and hospital management services segments do not meet the quantitative thresholds for a
separate identifiable reportable segment and are combined into the corporate and all other
reportable segment.
The distribution between reportable segments of the Companys revenues and income from
continuing operations before income taxes is summarized in the following tables (in thousands):
|
|
|
|
|
|
|
|
|
|
|
Three Months Ended |
|
|
|
March 31, |
|
|
|
2011 |
|
|
2010 |
|
Revenues: |
|
|
|
|
|
|
|
|
Hospital operations |
|
$ |
3,335,758 |
|
|
$ |
3,057,335 |
|
Corporate and all other |
|
|
69,584 |
|
|
|
68,172 |
|
|
|
|
|
|
|
|
Total |
|
$ |
3,405,342 |
|
|
$ |
3,125,507 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Income from continuing operations
before income taxes: |
|
|
|
|
|
|
|
|
Hospital operations |
|
$ |
177,339 |
|
|
$ |
162,865 |
|
Corporate and all other |
|
|
(42,416 |
) |
|
|
(35,391 |
) |
|
|
|
|
|
|
|
Total |
|
$ |
134,923 |
|
|
$ |
127,474 |
|
|
|
|
|
|
|
|
17. CONTINGENCIES
The Company is a party to various legal proceedings incidental to its business. In the opinion
of management, any ultimate liability with respect to these actions will not have a material
adverse effect on the Companys consolidated financial position, cash flows or results of
operations. With respect to all litigation matters, the Company considers the likelihood of a
negative outcome. If the Company determines the likelihood of a negative outcome is probable and
the amount of the loss can be reasonably estimated, the Company records an estimated loss for the
expected outcome of the litigation. If the likelihood of a negative outcome is reasonably possible
and the Company is able to determine an estimate of the possible loss or a range of loss, the
Company discloses that fact together with the estimate of the possible loss or range of loss.
However, it is difficult to predict the outcome or estimate a possible loss or range of loss in
some instances because litigation is subject to significant uncertainties. For all of the legal
matters below, the Company believes that a negative outcome is reasonably possible, but the Company
is unable to determine an estimate of the possible loss or a range of loss.
In a letter dated October 4, 2007, the Civil Division of the Department of Justice notified
the Company that, as a result of an investigation into the way in which different state Medicaid
programs apply to the federal government for matching or supplemental funds that are ultimately
used to pay for a small portion of the services provided to Medicaid and indigent patients, it
believes the Company and three of its New Mexico hospitals have caused the State of New Mexico to
submit improper claims for federal funds in violation of the Federal False Claims Act. In a letter
dated January 22, 2008, the Civil Division notified the Company that based on its investigation, it
has calculated that these three hospitals received ineligible federal participation payments from
August 2000 to June 2006 of approximately $27.5 million. The Civil Division also advised the
Company that were it to proceed to trial, it would seek treble damages plus an appropriate penalty
for each of the violations of the False Claims Act. This investigation has culminated in the
federal governments intervention in a qui tam lawsuit styled U.S. ex rel. Baker vs. Community
Health Systems, Inc. The federal government filed its complaint in intervention on June 30, 2009.
The relator filed a second amended complaint on July 1, 2009. Both of these complaints expand the
time period during which alleged improper payments were made. The Company filed motions to dismiss
all of the federal governments and the relators claims on August 28, 2009. On March 19, 2010, the
court granted in part and denied in part the Companys motion to dismiss as to the relators
complaint. On July 7, 2010, the court denied the Companys
24
COMMUNITY HEALTH SYSTEMS, INC. AND SUBSIDIARIES
NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (UNAUDITED) (Continued)
motion to dismiss the federal governments complaint in intervention. The Company has filed
its answer and pretrial discovery has begun. The Company is vigorously defending this action.
On June 12, 2008, two of the Companys hospitals received letters from the U.S. Attorneys
Office for the Western District of New York requesting documents in an investigation it was
conducting into billing practices with respect to kyphoplasty procedures performed during the
period January 1, 2002, through June 9, 2008. On September 16, 2008, one of the Companys hospitals
in South Carolina also received an inquiry. Kyphoplasty is a surgical spine procedure that returns
a compromised vertebrae (either from trauma or osteoporotic disease process) to its previous
height, reducing or eliminating severe pain. The Company has been informed that similar
investigations have been initiated at unaffiliated facilities in Alabama, South Carolina, Indiana
and other states. The Company believes that this investigation is related to a qui tam settlement
between the same U.S. Attorneys office and the manufacturer and distributor of the Kyphon product,
which is used in performing the kyphoplasty procedure. The Company is cooperating with the
investigation by collecting and producing material responsive to the requests. The Company is
continuing to evaluate and discuss this matter with the federal government.
18. SUBSEQUENT EVENTS
The Company evaluated all material events occurring subsequent to the balance sheet date for
events requiring disclosure or recognition in the condensed consolidated financial statements.
On April 8, 2011, the Company received a document subpoena, dated March 31, 2011, from the
U.S. Department of Health and Human Services, Office of Inspector General (the OIG), in
connection with an investigation of possible improper claims submitted to Medicare and Medicaid.
The subpoena, issued from the OIGs Chicago, Illinois office, requested documents from all of the
Companys hospitals and appears to concern emergency department processes and procedures, including
the Companys hospitals use of the Pro-MED Clinical Information System, which is a third-party
software system that assists with the management of patient care and provides operational support
and data collection for emergency department management and has the ability to track discharge,
transfer and admission recommendations of emergency department physicians. The subpoena also
requests other information about the Companys relationships with emergency department physicians,
including financial arrangements. The subpoenas requests are very similar to those contained in
the Civil Investigative Demands received by the Companys Texas hospitals from the Office of the
Attorney General of the State of Texas on November 15, 2010.
On April 11, 2011, Tenet Healthcare Corporation (Tenet) filed suit against the Company,
Wayne T. Smith and W. Larry Cash in the U.S. District Court for the Northern District of Texas.
The suit alleges the Company committed violations of certain federal securities laws by making
certain statements in various proxy materials filed with the SEC in connection with the Companys
offer to purchase Tenet. Tenet alleges that the Company engaged in a practice to under-utilize
observation status and over-utilize inpatient admission status and asserts that by doing so, the
Company created undisclosed financial and legal liability to federal, state and private payors.
The suit seeks declaratory and injunctive relief and Tenets costs. On April 19, 2011, the Company
filed a motion to dismiss the complaint.
Until the court rules on the motion to dismiss, the Company and other defendants are not required to file a
formal answer to the complaint, however, on April 28, 2011, the Company responded to the allegations during its earnings release conference call as discussed in the
Companys Form 8-K furnished on April 28, 2011.
The Company will continue to vigorously defend this suit.
On April 18, 2011, the Company announced that it has offered $6.00 per share in cash to acquire
all outstanding shares of Tenet. The offer was made in a letter to Tenets Board of Directors on
April 18, 2011, and rejected by Tenet on April 22, 2011. On December 9, 2010, the Company made public its previous offer to acquire all
outstanding shares of Tenet for $6.00 per share, including $5.00 per share in cash and $1.00 per
share in the Companys common stock, which represented a premium of 40 percent over Tenets closing
stock price on December 9, 2010. The offer was made in a letter to Tenets Board of Directors on
November 12, 2010, and rejected by Tenet on December 6, 2010. On December 20, 2010, the Company
announced its intention to nominate director nominees for election to Tenets Board of Directors at
Tenets 2011 Annual Meeting of Stockholders, and on January 14, 2011, a full slate of 10
independent director nominees was nominated. All 10 positions on Tenets Board are up for election
at its 2011 annual meeting, which has been delayed until November 3, 2011.
On April 22, 2011, a joint motion was filed by the relator and the U.S. Department
of Justice in the case styled United States ex rel. and Reuille vs. Community Health Systems Professional
Services Corporation and Lutheran Musculoskeletal Center, LLC d/b/a Lutheran Hospital, in the United
States District Court for the Northern District of Indiana, Fort Wayne Division. The lawsuit was originally
filed under seal on January 7, 2009. The suit is brought under the False Claims Act and alleges that
Lutheran Hospital of Indiana billed the Medicare program for (a) false 23 hour observation after outpatient
surgeries and procedures, and (b) intentional assignment of inpatient status to one-day stays for cases that
do not meet Medicare criteria for inpatient intensity of service or severity of illness. The relator had worked
in the case management department of Lutheran Hospital of Indiana but was reassigned to another
department in the fall of 2006. This facility was acquired by the Company as part of the July 25, 2007
merger transaction with Triad. The complaint also includes allegations of age discrimination in Ms.
Reuilles 2006 reassignment and retaliation in connection with her resignation on October 1, 2008. The
Company had cooperated fully with the government in its investigation of this matter, but had been
unaware of the exact nature of the allegations in the complaint. On December 27, 2010, the government
filed a notice that it declined to intervene in this suit. The current motion contains additional information
about how the government intends to proceed with an investigation regarding allegations of improper
billing for inpatient care at other hospitals associated with Community Health Systems, Inc. . . . asserted in
other qui tam complaints in other jurisdictions. The motion states that the Department of Justice has now
consolidated its investigations of the Company and other related entities and that the Civil Division of
the Department of Justice, multiple United States Attorneys offices, and the Office of Inspector General for
the Department of Health and Human Services (the HHS) are now closely coordinating their
investigation of these overlapping allegations. The Attorney General of Texas has initiated an investigation;
the United States intends to work cooperatively with Texas and any other States investigating these
allegations. The motion also states that the Office of Audit Services for the Office of Investigations for
HHS has been engaged to conduct a national audit of certain of the Companys Medicare claims. The
government confirmed that it considers the allegations made in the complaint styled Tenet Healthcare
Corporation vs. Community Health Systems, Inc., et al. filed in the United States District Court for the
Northern District of Texas, Dallas Division on April 11, 2011 to be related to the allegations in the qui tam
and to what the government is now describing as a consolidated investigation. Because qui tam suits are
filed under seal, no one but the relator and the government knows that the suit has been filed or what
allegations are being made by the relator on behalf of the government. Initially, the government has 60 days
to make a determination about whether to intervene in a case and to act as the plaintiff or to decline to
intervene and allow the relator to act as the plaintiff in the suit, but extensions of time are frequently
granted to allow the government additional time to investigate the allegations. Even if, in the course of an
investigation, the court partially unseals a complaint to allow the government and a defendant to work to a
resolution of the complaints allegations, the defendant is prohibited from revealing to anyone even that the
partial unsealing has occurred. As the investigation proceeds, the Company may learn of additional qui tam
suits filed against the Company or its affiliated hospitals or related entities, or that contact letters, document
requests, or medical record requests the Company has received in the past from various governmental
agencies are generated from qui tam cases filed under seal. The motion filed on April 22, 2011 concludes
by requesting a stay of the litigation in the Reuille case for 180
days, and on April 25, 2011, the court granted the motion. The Companys management
company subsidiary, Community Health Systems Professional Services Corporation, the defendant in the
Reuille case, consented to the request for the stay. The Company is
cooperating fully with the government in its investigations and is currently unable to predict the outcome of
these investigations.
25
COMMUNITY HEALTH SYSTEMS, INC. AND SUBSIDIARIES
NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (UNAUDITED) (Continued)
19. SUPPLEMENTAL CONDENSED CONSOLIDATING FINANCIAL INFORMATION
In connection with the consummation of the Triad acquisition, CHS obtained approximately $7.2
billion of senior secured financing under the Credit Facility and issued the Notes in the aggregate
principal amount of approximately $3.0 billion. The Notes are senior unsecured obligations of CHS
and are guaranteed on a senior basis by the Company and by certain of its existing and subsequently
acquired or organized 100% owned domestic subsidiaries.
The Notes are fully and unconditionally guaranteed on a joint and several basis. The following
condensed consolidating financial statements present Community Health Systems, Inc. (as parent
guarantor), CHS (as the issuer), the subsidiary guarantors, the subsidiary non-guarantors and
eliminations. These condensed consolidating financial statements have been prepared and presented
in accordance with SEC Regulation S-X Rule 3-10 Financial Statements of Guarantors and Issuers of
Guaranteed Securities Registered or Being Registered.
The accounting policies used in the preparation of this financial information are consistent
with those elsewhere in the consolidated financial statements of the Company, except as noted
below:
|
|
|
Intercompany receivables and payables are presented gross in the supplemental
consolidating balance sheets. |
|
|
|
|
Cash flows from intercompany transactions are presented in cash flows from financing
activities, as changes in intercompany balances with affiliates, net. |
|
|
|
|
Income tax expense is allocated from the parent guarantor to the income producing
operations (other guarantors and non-guarantors) and the issuer through stockholders
equity. As this approach represents an allocation, the income tax expense allocation is
considered non-cash for statement of cash flow purposes. |
|
|
|
|
Interest expense, net has been presented to reflect net interest expense and interest
income from outstanding long-term debt and intercompany balances. |
The Companys intercompany activity consists primarily of daily cash transfers for purposes of
cash management, the allocation of certain expenses and expenditures paid for by the parent on
behalf of its subsidiaries, and the push down of investment in its subsidiaries. The Companys
subsidiaries generally do not purchase services from each other; thus, the intercompany
transactions do not represent revenue generating transactions. All intercompany transactions
eliminate in consolidation.
From time to time, the Company sells and/or repurchases noncontrolling interests in
consolidated subsidiaries, which may change subsidiaries between guarantors and non-guarantors.
Amounts for prior periods are restated to reflect the status of guarantors or non-guarantors as of
March 31, 2011.
26
COMMUNITY HEALTH SYSTEMS, INC. AND SUBSIDIARIES
NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (UNAUDITED) (Continued)
Condensed Consolidating Balance Sheet
March 31, 2011
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Parent |
|
|
|
|
|
|
Other |
|
|
Non- |
|
|
|
|
|
|
|
|
|
Guarantor |
|
|
Issuer |
|
|
Guarantors |
|
|
Guarantors |
|
|
Eliminations |
|
|
Consolidated |
|
|
|
(In thousands) |
|
ASSETS
|
Current assets: |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Cash and cash equivalents |
|
$ |
|
|
|
$ |
|
|
|
$ |
239,156 |
|
|
$ |
31,560 |
|
|
$ |
|
|
|
$ |
270,716 |
|
Patient accounts receivable,
net of allowance for doubtful accounts |
|
|
|
|
|
|
|
|
|
|
984,020 |
|
|
|
782,102 |
|
|
|
|
|
|
|
1,766,122 |
|
Supplies |
|
|
|
|
|
|
|
|
|
|
197,963 |
|
|
|
131,312 |
|
|
|
|
|
|
|
329,275 |
|
Deferred income taxes |
|
|
115,819 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
115,819 |
|
Prepaid expenses and taxes |
|
|
65,030 |
|
|
|
66 |
|
|
|
87,263 |
|
|
|
25,157 |
|
|
|
|
|
|
|
177,516 |
|
Other current assets |
|
|
|
|
|
|
1 |
|
|
|
122,258 |
|
|
|
54,286 |
|
|
|
|
|
|
|
176,545 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Total current assets |
|
|
180,849 |
|
|
|
67 |
|
|
|
1,630,660 |
|
|
|
1,024,417 |
|
|
|
|
|
|
|
2,835,993 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Intercompany receivable |
|
|
1,154,688 |
|
|
|
9,403,219 |
|
|
|
1,464,886 |
|
|
|
1,565,933 |
|
|
|
(13,588,726 |
) |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Property and equipment, net |
|
|
|
|
|
|
|
|
|
|
3,959,406 |
|
|
|
2,487,011 |
|
|
|
|
|
|
|
6,446,417 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Goodwill |
|
|
|
|
|
|
|
|
|
|
2,381,122 |
|
|
|
1,844,646 |
|
|
|
|
|
|
|
4,225,768 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Other assets, net of accumulated amortization |
|
|
|
|
|
|
124,628 |
|
|
|
472,653 |
|
|
|
612,820 |
|
|
|
|
|
|
|
1,210,101 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Net investment in subsidiaries |
|
|
1,609,673 |
|
|
|
5,533,091 |
|
|
|
2,179,643 |
|
|
|
|
|
|
|
(9,322,407 |
) |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Total assets |
|
$ |
2,945,210 |
|
|
$ |
15,061,005 |
|
|
$ |
12,088,370 |
|
|
$ |
7,534,827 |
|
|
$ |
(22,911,133 |
) |
|
$ |
14,718,279 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
LIABILITIES AND EQUITY
|
Current liabilities: |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Current maturities of long-term debt |
|
$ |
|
|
|
$ |
49,874 |
|
|
$ |
14,634 |
|
|
$ |
1,444 |
|
|
$ |
|
|
|
$ |
65,952 |
|
Accounts payable |
|
|
|
|
|
|
|
|
|
|
448,418 |
|
|
|
99,265 |
|
|
|
|
|
|
|
547,683 |
|
Deferred income taxes |
|
|
8,882 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
8,882 |
|
Accrued interest |
|
|
|
|
|
|
84,385 |
|
|
|
115 |
|
|
|
2 |
|
|
|
|
|
|
|
84,502 |
|
Accrued liabilities |
|
|
7,580 |
|
|
|
567 |
|
|
|
568,799 |
|
|
|
321,864 |
|
|
|
|
|
|
|
898,810 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Total current liabilities |
|
|
16,462 |
|
|
|
134,826 |
|
|
|
1,031,966 |
|
|
|
422,575 |
|
|
|
|
|
|
|
1,605,829 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Long-term debt |
|
|
|
|
|
|
8,722,005 |
|
|
|
44,060 |
|
|
|
28,081 |
|
|
|
|
|
|
|
8,794,146 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Intercompany payable |
|
|
|
|
|
|
4,311,012 |
|
|
|
8,717,061 |
|
|
|
6,056,381 |
|
|
|
(19,084,454 |
) |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Deferred income taxes |
|
|
608,177 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
608,177 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Other long-term liabilities |
|
|
9,232 |
|
|
|
283,490 |
|
|
|
379,462 |
|
|
|
280,222 |
|
|
|
|
|
|
|
952,406 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Total liabilities |
|
|
633,871 |
|
|
|
13,451,333 |
|
|
|
10,172,549 |
|
|
|
6,787,259 |
|
|
|
(19,084,454 |
) |
|
|
11,960,558 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Redeemable noncontrolling interests in
equity of consolidated subsidiaries |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
385,438 |
|
|
|
|
|
|
|
385,438 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Equity: |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Community Health Systems, Inc. stockholders
equity: |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Preferred stock |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Common stock |
|
|
949 |
|
|
|
|
|
|
|
1 |
|
|
|
2 |
|
|
|
(3 |
) |
|
|
949 |
|
Additional paid-in capital |
|
|
1,149,002 |
|
|
|
663,251 |
|
|
|
709,125 |
|
|
|
110,836 |
|
|
|
(1,483,212 |
) |
|
|
1,149,002 |
|
Treasury stock, at cost |
|
|
(6,678 |
) |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
(6,678 |
) |
Accumulated other comprehensive (loss) income |
|
|
(192,640 |
) |
|
|
(192,640 |
) |
|
|
(11,149 |
) |
|
|
|
|
|
|
203,789 |
|
|
|
(192,640 |
) |
Retained earnings |
|
|
1,360,706 |
|
|
|
1,139,061 |
|
|
|
1,217,844 |
|
|
|
190,348 |
|
|
|
(2,547,253 |
) |
|
|
1,360,706 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Total Community Health Systems, Inc.
stockholders equity |
|
|
2,311,339 |
|
|
|
1,609,672 |
|
|
|
1,915,821 |
|
|
|
301,186 |
|
|
|
(3,826,679 |
) |
|
|
2,311,339 |
|
Noncontrolling interests in equity
of consolidated subsidiaries |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
60,944 |
|
|
|
|
|
|
|
60,944 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Total equity |
|
|
2,311,339 |
|
|
|
1,609,672 |
|
|
|
1,915,821 |
|
|
|
362,130 |
|
|
|
(3,826,679 |
) |
|
|
2,372,283 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Total liabilities and equity |
|
$ |
2,945,210 |
|
|
$ |
15,061,005 |
|
|
$ |
12,088,370 |
|
|
$ |
7,534,827 |
|
|
$ |
(22,911,133 |
) |
|
$ |
14,718,279 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
27
COMMUNITY HEALTH SYSTEMS, INC. AND SUBSIDIARIES
NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (UNAUDITED) (Continued)
Condensed Consolidating Balance Sheet
December 31, 2010
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Parent |
|
|
|
|
|
|
Other |
|
|
Non- |
|
|
|
|
|
|
|
|
|
Guarantor |
|
|
Issuer |
|
|
Guarantors |
|
|
Guarantors |
|
|
Eliminations |
|
|
Consolidated |
|
|
|
(In thousands) |
|
ASSETS
|
Current assets: |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Cash and cash equivalents |
|
$ |
|
|
|
$ |
|
|
|
$ |
212,035 |
|
|
$ |
87,134 |
|
|
$ |
|
|
|
$ |
299,169 |
|
Patient accounts receivable,
net of allowance for doubtful accounts |
|
|
|
|
|
|
|
|
|
|
971,220 |
|
|
|
743,322 |
|
|
|
|
|
|
|
1,714,542 |
|
Supplies |
|
|
|
|
|
|
|
|
|
|
196,957 |
|
|
|
132,157 |
|
|
|
|
|
|
|
329,114 |
|
Deferred income taxes |
|
|
115,819 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
115,819 |
|
Prepaid expenses and taxes |
|
|
118,464 |
|
|
|
116 |
|
|
|
89,172 |
|
|
|
11,466 |
|
|
|
|
|
|
|
219,218 |
|
Other current assets |
|
|
|
|
|
|
41 |
|
|
|
138,923 |
|
|
|
54,367 |
|
|
|
|
|
|
|
193,331 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Total current assets |
|
|
234,283 |
|
|
|
157 |
|
|
|
1,608,307 |
|
|
|
1,028,446 |
|
|
|
|
|
|
|
2,871,193 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Intercompany receivable |
|
|
1,079,295 |
|
|
|
9,002,158 |
|
|
|
1,146,838 |
|
|
|
1,484,130 |
|
|
|
(12,712,421 |
) |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Property and equipment, net |
|
|
|
|
|
|
|
|
|
|
3,935,523 |
|
|
|
2,503,036 |
|
|
|
|
|
|
|
6,438,559 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Goodwill |
|
|
|
|
|
|
|
|
|
|
2,375,371 |
|
|
|
1,819,918 |
|
|
|
|
|
|
|
4,195,289 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Other assets, net of accumulated amortization |
|
|
|
|
|
|
131,352 |
|
|
|
460,476 |
|
|
|
601,254 |
|
|
|
|
|
|
|
1,193,082 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Net investment in subsidiaries |
|
|
1,510,062 |
|
|
|
5,316,212 |
|
|
|
2,061,042 |
|
|
|
|
|
|
|
(8,887,316 |
) |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Total assets |
|
$ |
2,823,640 |
|
|
$ |
14,449,879 |
|
|
$ |
11,587,557 |
|
|
$ |
7,436,784 |
|
|
$ |
(21,599,737 |
) |
|
$ |
14,698,123 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
LIABILITIES AND EQUITY
|
Current liabilities: |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Current maturities of long-term debt |
|
$ |
|
|
|
$ |
49,953 |
|
|
$ |
11,063 |
|
|
$ |
2,123 |
|
|
$ |
|
|
|
$ |
63,139 |
|
Accounts payable |
|
|
|
|
|
|
|
|
|
|
362,154 |
|
|
|
164,184 |
|
|
|
|
|
|
|
526,338 |
|
Deferred income taxes |
|
|
8,882 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
8,882 |
|
Accrued interest |
|
|
|
|
|
|
146,297 |
|
|
|
116 |
|
|
|
2 |
|
|
|
|
|
|
|
146,415 |
|
Accrued liabilities |
|
|
7,595 |
|
|
|
567 |
|
|
|
569,991 |
|
|
|
319,113 |
|
|
|
|
|
|
|
897,266 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Total current liabilities |
|
|
16,477 |
|
|
|
196,817 |
|
|
|
943,324 |
|
|
|
485,422 |
|
|
|
|
|
|
|
1,642,040 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Long-term debt |
|
|
|
|
|
|
8,734,473 |
|
|
|
44,819 |
|
|
|
29,090 |
|
|
|
|
|
|
|
8,808,382 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Intercompany payable |
|
|
|
|
|
|
3,668,003 |
|
|
|
8,384,585 |
|
|
|
5,913,971 |
|
|
|
(17,966,559 |
) |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Deferred income taxes |
|
|
608,177 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
608,177 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Other long-term liabilities |
|
|
9,522 |
|
|
|
340,526 |
|
|
|
372,693 |
|
|
|
278,934 |
|
|
|
|
|
|
|
1,001,675 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Total liabilities |
|
|
634,176 |
|
|
|
12,939,819 |
|
|
|
9,745,421 |
|
|
|
6,707,417 |
|
|
|
(17,966,559 |
) |
|
|
12,060,274 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Redeemable noncontrolling interests in
equity of consolidated subsidiaries |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
387,472 |
|
|
|
|
|
|
|
387,472 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Equity: |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Community Health Systems, Inc.
stockholders equity: |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Preferred stock |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Common stock |
|
|
936 |
|
|
|
|
|
|
|
1 |
|
|
|
2 |
|
|
|
(3 |
) |
|
|
936 |
|
Additional paid-in capital |
|
|
1,126,751 |
|
|
|
640,683 |
|
|
|
682,686 |
|
|
|
103,401 |
|
|
|
(1,426,770 |
) |
|
|
1,126,751 |
|
Treasury stock, at cost |
|
|
(6,678 |
) |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
(6,678 |
) |
Accumulated other comprehensive (loss) income |
|
|
(230,927 |
) |
|
|
(230,927 |
) |
|
|
(12,990 |
) |
|
|
|
|
|
|
243,917 |
|
|
|
(230,927 |
) |
Retained earnings |
|
|
1,299,382 |
|
|
|
1,100,304 |
|
|
|
1,172,439 |
|
|
|
177,579 |
|
|
|
(2,450,322 |
) |
|
|
1,299,382 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Total Community Health Systems, Inc.
stockholders equity |
|
|
2,189,464 |
|
|
|
1,510,060 |
|
|
|
1,842,136 |
|
|
|
280,982 |
|
|
|
(3,633,178 |
) |
|
|
2,189,464 |
|
Noncontrolling interests in equity
of consolidated subsidiaries |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
60,913 |
|
|
|
|
|
|
|
60,913 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Total equity |
|
|
2,189,464 |
|
|
|
1,510,060 |
|
|
|
1,842,136 |
|
|
|
341,895 |
|
|
|
(3,633,178 |
) |
|
|
2,250,377 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Total liabilities and equity |
|
$ |
2,823,640 |
|
|
$ |
14,449,879 |
|
|
$ |
11,587,557 |
|
|
$ |
7,436,784 |
|
|
$ |
(21,599,737 |
) |
|
$ |
14,698,123 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
28
COMMUNITY HEALTH SYSTEMS, INC. AND SUBSIDIARIES
NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (UNAUDITED) (Continued)
Condensed Consolidating Statement of Income
Three Months Ended March 31, 2011
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Parent |
|
|
|
|
|
|
Other |
|
|
Non- |
|
|
|
|
|
|
|
|
|
Guarantor |
|
|
Issuer |
|
|
Guarantors |
|
|
Guarantors |
|
|
Eliminations |
|
|
Consolidated |
|
|
|
(In thousands) |
|
Net operating revenues |
|
$ |
|
|
|
$ |
|
|
|
$ |
1,939,904 |
|
|
$ |
1,465,438 |
|
|
$ |
|
|
|
$ |
3,405,342 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Operating costs and expenses: |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Salaries and benefits |
|
|
|
|
|
|
|
|
|
|
746,661 |
|
|
|
655,460 |
|
|
|
|
|
|
|
1,402,121 |
|
Provision for bad debts |
|
|
|
|
|
|
|
|
|
|
243,783 |
|
|
|
164,088 |
|
|
|
|
|
|
|
407,871 |
|
Supplies |
|
|
|
|
|
|
|
|
|
|
264,240 |
|
|
|
199,916 |
|
|
|
|
|
|
|
464,156 |
|
Other operating expenses |
|
|
|
|
|
|
|
|
|
|
347,477 |
|
|
|
277,318 |
|
|
|
|
|
|
|
624,795 |
|
Rent |
|
|
|
|
|
|
|
|
|
|
30,833 |
|
|
|
33,924 |
|
|
|
|
|
|
|
64,757 |
|
Depreciation and amortization |
|
|
|
|
|
|
|
|
|
|
94,795 |
|
|
|
65,882 |
|
|
|
|
|
|
|
160,677 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Total operating costs and expenses |
|
|
|
|
|
|
|
|
|
|
1,727,789 |
|
|
|
1,396,588 |
|
|
|
|
|
|
|
3,124,377 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Income from operations |
|
|
|
|
|
|
|
|
|
|
212,115 |
|
|
|
68,850 |
|
|
|
|
|
|
|
280,965 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Interest expense, net |
|
|
|
|
|
|
28,103 |
|
|
|
121,366 |
|
|
|
14,703 |
|
|
|
|
|
|
|
164,172 |
|
Equity in earnings of unconsolidated affiliates |
|
|
(61,324 |
) |
|
|
(73,967 |
) |
|
|
(36,211 |
) |
|
|
|
|
|
|
153,372 |
|
|
|
(18,130 |
) |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Income from continuing operations
before income taxes |
|
|
61,324 |
|
|
|
45,864 |
|
|
|
126,960 |
|
|
|
54,147 |
|
|
|
(153,372 |
) |
|
|
134,923 |
|
Provision for (benefit from) income taxes |
|
|
|
|
|
|
(15,460 |
) |
|
|
45,832 |
|
|
|
13,410 |
|
|
|
|
|
|
|
43,782 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Income from continuing operations |
|
|
61,324 |
|
|
|
61,324 |
|
|
|
81,128 |
|
|
|
40,737 |
|
|
|
(153,372 |
) |
|
|
91,141 |
|
Discontinued operations, net of taxes: |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Loss from operations of entities sold and
held for sale |
|
|
|
|
|
|
|
|
|
|
(916 |
) |
|
|
(298 |
) |
|
|
|
|
|
|
(1,214 |
) |
Impairment of long-lived assets of
hospital held for sale |
|
|
|
|
|
|
|
|
|
|
(8,368 |
) |
|
|
|
|
|
|
|
|
|
|
(8,368 |
) |
Loss on sale |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
(3,234 |
) |
|
|
|
|
|
|
(3,234 |
) |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Loss from discontinued operations |
|
|
|
|
|
|
|
|
|
|
(9,284 |
) |
|
|
(3,532 |
) |
|
|
|
|
|
|
(12,816 |
) |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Net income |
|
|
61,324 |
|
|
|
61,324 |
|
|
|
71,844 |
|
|
|
37,205 |
|
|
|
(153,372 |
) |
|
|
78,325 |
|
Less: Net income attributable to
noncontrolling interests |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
17,001 |
|
|
|
|
|
|
|
17,001 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Net income attributable to Community
Health Systems, Inc. |
|
$ |
61,324 |
|
|
$ |
61,324 |
|
|
$ |
71,844 |
|
|
$ |
20,204 |
|
|
$ |
(153,372 |
) |
|
$ |
61,324 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
29
COMMUNITY HEALTH SYSTEMS, INC. AND SUBSIDIARIES
NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (UNAUDITED) (Continued)
Condensed Consolidating Statement of Income
Three Months Ended March 31, 2010
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Parent |
|
|
|
|
|
|
Other |
|
|
Non- |
|
|
|
|
|
|
|
|
|
Guarantor |
|
|
Issuer |
|
|
Guarantors |
|
|
Guarantors |
|
|
Eliminations |
|
|
Consolidated |
|
|
|
(In thousands) |
|
Net operating revenues |
|
$ |
|
|
|
$ |
|
|
|
$ |
1,795,098 |
|
|
$ |
1,330,409 |
|
|
$ |
|
|
|
$ |
3,125,507 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Operating costs and expenses: |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Salaries and benefits |
|
|
|
|
|
|
|
|
|
|
682,601 |
|
|
|
586,973 |
|
|
|
|
|
|
|
1,269,574 |
|
Provision for bad debts |
|
|
|
|
|
|
|
|
|
|
225,909 |
|
|
|
147,756 |
|
|
|
|
|
|
|
373,665 |
|
Supplies |
|
|
|
|
|
|
|
|
|
|
242,542 |
|
|
|
187,055 |
|
|
|
|
|
|
|
429,597 |
|
Other operating expenses |
|
|
|
|
|
|
|
|
|
|
306,657 |
|
|
|
260,427 |
|
|
|
|
|
|
|
567,084 |
|
Rent |
|
|
|
|
|
|
|
|
|
|
29,697 |
|
|
|
33,938 |
|
|
|
|
|
|
|
63,635 |
|
Depreciation and amortization |
|
|
|
|
|
|
|
|
|
|
85,419 |
|
|
|
61,287 |
|
|
|
|
|
|
|
146,706 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Total operating costs and expenses |
|
|
|
|
|
|
|
|
|
|
1,572,825 |
|
|
|
1,277,436 |
|
|
|
|
|
|
|
2,850,261 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Income from operations |
|
|
|
|
|
|
|
|
|
|
222,273 |
|
|
|
52,973 |
|
|
|
|
|
|
|
275,246 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Interest expense, net |
|
|
|
|
|
|
29,014 |
|
|
|
117,518 |
|
|
|
13,828 |
|
|
|
|
|
|
|
160,360 |
|
Equity in earnings of unconsolidated affiliates |
|
|
(70,007 |
) |
|
|
(82,544 |
) |
|
|
(26,402 |
) |
|
|
|
|
|
|
166,365 |
|
|
|
(12,588 |
) |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Income from continuing operations
before income taxes |
|
|
70,007 |
|
|
|
53,530 |
|
|
|
131,157 |
|
|
|
39,145 |
|
|
|
(166,365 |
) |
|
|
127,474 |
|
Provision for (benefit from) income taxes |
|
|
|
|
|
|
(16,477 |
) |
|
|
48,529 |
|
|
|
8,937 |
|
|
|
|
|
|
|
40,989 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Income from continuing operations |
|
|
70,007 |
|
|
|
70,007 |
|
|
|
82,628 |
|
|
|
30,208 |
|
|
|
(166,365 |
) |
|
|
86,485 |
|
Discontinued operations, net of taxes: |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Loss from operations of entities sold and
held for sale |
|
|
|
|
|
|
|
|
|
|
(821 |
) |
|
|
(668 |
) |
|
|
|
|
|
|
(1,489 |
) |
Impairment of long-lived assets of
hospital held for sale |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Loss on sale |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Loss from discontinued operations |
|
|
|
|
|
|
|
|
|
|
(821 |
) |
|
|
(668 |
) |
|
|
|
|
|
|
(1,489 |
) |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Net income |
|
|
70,007 |
|
|
|
70,007 |
|
|
|
81,807 |
|
|
|
29,540 |
|
|
|
(166,365 |
) |
|
|
84,996 |
|
Less: Net income attributable to
noncontrolling interests |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
14,989 |
|
|
|
|
|
|
|
14,989 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Net income attributable to Community
Health Systems, Inc. |
|
$ |
70,007 |
|
|
$ |
70,007 |
|
|
$ |
81,807 |
|
|
$ |
14,551 |
|
|
$ |
(166,365 |
) |
|
$ |
70,007 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
30
COMMUNITY HEALTH SYSTEMS, INC. AND SUBSIDIARIES
NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (UNAUDITED) (Continued)
Condensed Consolidating Statement of Cash Flows
Three Months Ended March 31, 2011
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Parent |
|
|
|
|
|
|
Other |
|
|
Non- |
|
|
|
|
|
|
|
|
|
Guarantor |
|
|
Issuer |
|
|
Guarantors |
|
|
Guarantors |
|
|
Eliminations |
|
|
Consolidated |
|
|
|
(In thousands) |
|
Cash flows from operating activities: |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Net cash (used in) provided by operating activities |
|
$ |
(21,885 |
) |
|
$ |
(83,202 |
) |
|
$ |
277,942 |
|
|
$ |
14,656 |
|
|
$ |
|
|
|
$ |
187,511 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Cash flows from investing activities: |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Acquisitions of facilities and other related equipment |
|
|
|
|
|
|
|
|
|
|
(10,727 |
) |
|
|
(34,695 |
) |
|
|
|
|
|
|
(45,422 |
) |
Purchases of property and equipment |
|
|
|
|
|
|
|
|
|
|
(64,312 |
) |
|
|
(89,563 |
) |
|
|
|
|
|
|
(153,875 |
) |
Proceeds from disposition of
ancillary operations |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
14,583 |
|
|
|
|
|
|
|
14,583 |
|
Proceeds from sale of property and equipment |
|
|
|
|
|
|
|
|
|
|
473 |
|
|
|
7,114 |
|
|
|
|
|
|
|
7,587 |
|
Increase in other non-operating assets |
|
|
|
|
|
|
|
|
|
|
(36,201 |
) |
|
|
3,924 |
|
|
|
|
|
|
|
(32,277 |
) |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Net cash used in investing activities |
|
|
|
|
|
|
|
|
|
|
(110,767 |
) |
|
|
(98,637 |
) |
|
|
|
|
|
|
(209,404 |
) |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Cash flows from financing activities: |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Proceeds from exercise of stock options |
|
|
18,125 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
18,125 |
|
Excess tax benefit relating to stock-based compensation |
|
|
4,675 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
4,675 |
|
Stock buy-back |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Proceeds from noncontrolling investors in joint ventures |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
863 |
|
|
|
|
|
|
|
863 |
|
Redemption of noncontrolling investments in joint ventures |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
(225 |
) |
|
|
|
|
|
|
(225 |
) |
Distributions to noncontrolling investors in joint ventures |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
(15,333 |
) |
|
|
|
|
|
|
(15,333 |
) |
Changes in intercompany balances with affiliates, net |
|
|
(915 |
) |
|
|
95,750 |
|
|
|
(138,566 |
) |
|
|
43,731 |
|
|
|
|
|
|
|
|
|
Repayments of long-term indebtedness |
|
|
|
|
|
|
(12,548 |
) |
|
|
(1,488 |
) |
|
|
(629 |
) |
|
|
|
|
|
|
(14,665 |
) |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Net cash provided by (used in) financing activities |
|
|
21,885 |
|
|
|
83,202 |
|
|
|
(140,054 |
) |
|
|
28,407 |
|
|
|
|
|
|
|
(6,560 |
) |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Net change in cash and cash equivalents |
|
|
|
|
|
|
|
|
|
|
27,121 |
|
|
|
(55,574 |
) |
|
|
|
|
|
|
(28,453 |
) |
Cash and cash equivalents at beginning of period |
|
|
|
|
|
|
|
|
|
|
212,035 |
|
|
|
87,134 |
|
|
|
|
|
|
|
299,169 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Cash and cash equivalents at end of period |
|
$ |
|
|
|
$ |
|
|
|
$ |
239,156 |
|
|
$ |
31,560 |
|
|
$ |
|
|
|
$ |
270,716 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
31
COMMUNITY HEALTH SYSTEMS, INC. AND SUBSIDIARIES
NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (UNAUDITED) (Continued)
Condensed Consolidating Statement of Cash Flows
Three Months Ended March 31, 2010
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Parent |
|
|
|
|
|
|
Other |
|
|
Non- |
|
|
|
|
|
|
|
|
|
Guarantor |
|
|
Issuer |
|
|
Guarantors |
|
|
Guarantors |
|
|
Eliminations |
|
|
Consolidated |
|
|
|
(In thousands) |
|
Cash flows from operating activities: |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Net cash (used in) provided by operating activities |
|
$ |
(15,289 |
) |
|
$ |
(82,693 |
) |
|
$ |
282,828 |
|
|
$ |
114,514 |
|
|
$ |
|
|
|
$ |
299,360 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Cash flows from investing activities: |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Acquisitions of facilities and other related equipment |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
(180 |
) |
|
|
|
|
|
|
(180 |
) |
Purchases of property and equipment |
|
|
|
|
|
|
|
|
|
|
(79,039 |
) |
|
|
(47,514 |
) |
|
|
|
|
|
|
(126,553 |
) |
Proceeds from disposition of
ancillary operations |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Proceeds from sale of property and equipment |
|
|
|
|
|
|
|
|
|
|
337 |
|
|
|
9 |
|
|
|
|
|
|
|
346 |
|
Increase in other non-operating assets |
|
|
|
|
|
|
|
|
|
|
(17,277 |
) |
|
|
(19,714 |
) |
|
|
|
|
|
|
(36,991 |
) |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Net cash used in investing activities |
|
|
|
|
|
|
|
|
|
|
(95,979 |
) |
|
|
(67,399 |
) |
|
|
|
|
|
|
(163,378 |
) |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Cash flows from financing activities: |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Proceeds from exercise of stock options |
|
|
24,007 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
24,007 |
|
Excess tax benefit relating to stock-based compensation |
|
|
4,349 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
4,349 |
|
Stock buy-back |
|
|
(40 |
) |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
(40 |
) |
Proceeds from noncontrolling investors in joint ventures |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
1,255 |
|
|
|
|
|
|
|
1,255 |
|
Redemption of noncontrolling investments in joint ventures |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Distributions to noncontrolling investors in joint ventures |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
(16,874 |
) |
|
|
|
|
|
|
(16,874 |
) |
Changes in intercompany balances with affiliates, net |
|
|
(13,027 |
) |
|
|
93,561 |
|
|
|
(12,121 |
) |
|
|
(68,413 |
) |
|
|
|
|
|
|
|
|
Repayments of long-term indebtedness |
|
|
|
|
|
|
(10,868 |
) |
|
|
(880 |
) |
|
|
(1,406 |
) |
|
|
|
|
|
|
(13,154 |
) |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Net cash provided by (used in) financing activities |
|
|
15,289 |
|
|
|
82,693 |
|
|
|
(13,001 |
) |
|
|
(85,438 |
) |
|
|
|
|
|
|
(457 |
) |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Net change in cash and cash equivalents |
|
|
|
|
|
|
|
|
|
|
173,848 |
|
|
|
(38,323 |
) |
|
|
|
|
|
|
135,525 |
|
Cash and cash equivalents at beginning of period |
|
|
|
|
|
|
|
|
|
|
238,495 |
|
|
|
106,046 |
|
|
|
|
|
|
|
344,541 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Cash and cash equivalents at end of period |
|
$ |
|
|
|
$ |
|
|
|
$ |
412,343 |
|
|
$ |
67,723 |
|
|
$ |
|
|
|
$ |
480,066 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
32
Item 2. Managements Discussion and Analysis of Financial Condition and
Results of Operations
You should read this discussion together with our unaudited
condensed consolidated financial
statements and accompanying notes included herein.
Throughout this Quarterly Report on Form 10-Q, Community Health
Systems, Inc., the parent
company, and its consolidated subsidiaries are referred to on a collective basis using words like
we, our, us and the Company. This drafting style is not meant to indicate that the
publicly-traded parent company or any subsidiary of the parent company owns or operates any asset,
business, or property. The hospitals, operations and businesses described in this filing are owned
and operated, and management services provided, by distinct and indirect subsidiaries of Community
Health Systems, Inc.
Executive Overview
We are one of the largest publicly-traded operators of hospitals in
the United States. We provide healthcare services through these
hospitals that we own and operate in non-urban and selected urban markets. We generate revenue
primarily by providing a broad range of general hospital healthcare services to patients in the
communities in which we are located. We currently own and operate 130 hospitals comprised of 126
general acute care hospitals and four stand-alone rehabilitation or psychiatric hospitals,
including one hospital held for sale at March 31, 2011. In addition, we own and operate home care
agencies, located primarily in markets where we also operate a hospital, and through our
wholly-owned subsidiary, Quorum Health Resources, LLC, or QHR, we provide management and consulting
services to non-affiliated general acute care hospitals located throughout the United States. For
the hospitals and home care agencies that we own and operate, we are paid for our services by
governmental agencies, private insurers and directly by the patients we serve. For our management
and consulting services, we are paid by the non-affiliated hospitals utilizing our services.
Our net operating revenues for the three months ended March 31,
2011 increased to
approximately $3.4 billion, as compared to approximately $3.1 billion for the three months ended
March 31, 2010. Income from continuing operations, before noncontrolling interests, for the three
months ended March 31, 2011 increased 5.4% over the three months ended March 31, 2010 to $91.1
million compared to $86.5 million. This increase in income from continuing operations during the
three months ended March 31, 2011, as compared to the three months ended March 31, 2010, is due
primarily to the execution of our revenue growth initiatives at those hospitals owned throughout
both periods, general rate and reimbursement increases and our effective management of operating
expenses. Our successful physician recruiting efforts have also been a key driver in the execution
of our operating strategies. Total inpatient admissions for the three months ended March 31, 2011
increased 1.4%, compared to the three months ended March 31, 2010, and adjusted admissions for the
three months ended March 31, 2011 increased 4.7%, compared to the three months ended March 31,
2010. This increase in inpatient and adjusted admissions was due primarily to acquisitions during
the past twelve months.
During the three months ended March 31, 2011, we sold a
multi-specialty physician clinic and
identified a hospital as held for sale. Accordingly, the related results of operations, adjustment
to fair value and the loss on sale have been classified as discontinued operations in the condensed
consolidated statements of income for the three-month periods ended March 31, 2011 and 2010.
Self-pay revenues represented approximately 12.3% and 11.4% of our
net operating revenues for
the three months ended March 31, 2011 and 2010, respectively. The amount of foregone revenue
related to providing charity care services as a percentage of net operating revenues was
approximately 4.4% and 4.0% for the three months ended March 31, 2011 and 2010, respectively.
Direct and indirect costs incurred by us in providing charity care services were approximately 0.9%
and 0.8% of net operating revenues for the three months ended March 31, 2011 and 2010,
respectively.
The Patient Protection and Affordable Care Act, or PPACA, was signed
into law on March 23,
2010. In addition, the Health Care and Education Affordability Reconciliation Act of 2010, or
Reconciliation Act, which contains a number of amendments to PPACA, was signed into law on March
30, 2010. These healthcare acts, referred to collectively as the Reform Legislation, include a
mandate that requires substantially all U.S. citizens to maintain medical insurance coverage which
will ultimately increase the number of persons with access to health insurance in the United
States. The Reform Legislation should result in a reduction in uninsured patients, which should
reduce our expense from uncollectible accounts receivable; however, this legislation makes a number
of other changes to Medicare and Medicaid, such as reductions to the Medicare annual market basket
update for federal fiscal years 2010 through 2019, a productivity offset to the Medicare market
basket update beginning October 1, 2011, and a reduction to the Medicare and Medicaid
disproportionate share payments, that could adversely impact the reimbursement received under these
programs. The various provisions in the Reform Legislation that directly or indirectly affect
reimbursement are scheduled to take effect over a
33
number of years, and we cannot predict their impact at this time. Other provisions of the
Reform Legislation, such as requirements related to employee health insurance coverage, should
increase our operating costs.
Also included in the Reform Legislation are provisions aimed at
reducing fraud, waste and
abuse in the healthcare industry. These provisions allocate significant additional resources to
federal enforcement agencies and expand the use of private contractors to recover potentially
inappropriate Medicare and Medicaid payments. The Reform Legislation amends several existing
federal laws, including the federal anti-kickback statute and the False Claims Act, making it
easier for government agencies and private plaintiffs to prevail in lawsuits brought against
healthcare providers. These amendments also make it easier for potentially severe fines and
penalties to be imposed on healthcare providers accused of violating applicable laws and
regulations.
In a number of markets, we have partnered with local physicians in
the ownership of our
facilities. Such investments have been permitted under an exception to the physician self-referral
law, or the Stark Law, that allows physicians to invest in an entire hospital (as opposed to
individual hospital departments). The Reform Legislation changes the whole hospital exception to
the Stark Law. The Reform Legislation permits existing physician investments in a whole hospital
to continue under a grandfather clause if the arrangement satisfies certain requirements and
restrictions, but physicians became prohibited, from the time the Reform Legislation became
effective, from increasing the aggregate percentage of their ownership in the hospital. The Reform
Legislation also restricts the ability of existing physician-owned hospitals to expand the capacity
of their facilities. Physician investments in hospitals that are under development are protected
by the grandfather clause only if the physician investments were made prior to the time the Reform
Legislation became effective and the hospital has a Medicare provider agreement with an effective
date on or prior to December 31, 2010.
The impact of the Reform Legislation on each of our hospitals will
vary depending on payor mix
and a variety of other factors. We anticipate that many of the provisions in the Reform
Legislation will be subject to further clarification and modification through the rule-making
process, the development of agency guidance and judicial interpretations. Moreover, a number of
state attorneys general are challenging the legality of certain aspects of the Reform Legislation.
Currently, rulings in five separate Federal District Courts, regarding the constitutionality of the
Reform Legislation, have been split, with three courts ruling in favor of the legislation and two
courts ruling that part or all of the Reform Legislation was unconstitutional. These decisions are
likely to be appealed and may ultimately end up before the United States Supreme Court. We cannot
predict the impact the Reform Legislation may have on our business, results of operations, cash
flow, capital resources and liquidity or the ultimate outcome of the judicial rulings.
Furthermore, we cannot predict whether we will be able to modify certain aspects of our operations
to offset any potential adverse consequences from the Reform Legislation.
On April 18, 2011, we announced that we have offered $6.00 per share
in cash to acquire all
outstanding shares of Tenet Healthcare Corporation, or Tenet. The offer was made in a letter to
Tenets Board of Directors on April 18, 2011, and rejected by Tenet on April 22, 2011. On December 9, 2010, we made public our previous
offer to acquire all outstanding shares of Tenet for $6.00 per share, including $5.00 per share in
cash and $1.00 per share in our common stock, which represented a premium of 40 percent over
Tenets closing stock price on December 9, 2010. The offer was made in a letter to Tenets Board
of Directors on November 12, 2010, and rejected by Tenet on December 6, 2010. On December 20,
2010, we announced our intention to nominate director nominees for election to Tenets Board of
Directors at Tenets 2011 Annual Meeting of Stockholders, and on January 14, 2011, a full slate of
10 independent director nominees was nominated. All 10 positions on Tenets Board are up for
election at its 2011 annual meeting, which has been delayed until November 3, 2011.
On April 11, 2011, Tenet filed suit against the Company, Wayne
T. Smith and W. Larry Cash
alleging we engaged in a practice to under-utilize observation status and over-utilize inpatient
admission status and asserts that by doing so, we created undisclosed financial and legal liability
to federal, state and private payors. Also, on April 22, 2011 the
Company was advised that the Department of
Justice has consolidated its investigations of the Company and other
related entities regarding allegations of
improper billing for inpatient care.
See Legal Proceedings in Part II, Item 1 of this Form 10-Q for a further discussion of these
matters.
As a result of our current levels of cash, available borrowing
capacity, long-term outlook on
our debt repayments and our continued projection of our ability to generate cash flows, we do not
anticipate a significant impact on our ability to invest the necessary capital in our business over
the next twelve months and into the foreseeable future. We believe there continues to be ample
opportunity for growth in substantially all of our markets by decreasing the need for patients to
travel outside their communities for healthcare services. Furthermore, we continue to benefit from
synergies from the acquisition of Triad Hospitals, Inc., or Triad, as well as our more recent
acquisitions and will continue to strive to improve operating efficiencies and procedures in order
to improve our profitability at all of our hospitals.
34
Sources of Consolidated Net Operating Revenues
The following table presents the approximate percentages of net
operating revenues derived
from Medicare, Medicaid, managed care, self-pay and other sources for the periods indicated. The
data for the periods presented are not strictly comparable due to the effect that hospital
acquisitions have had on these statistics.
|
|
|
|
|
|
|
|
|
|
|
Three Months Ended |
|
|
March 31, |
|
|
2011 |
|
2010 |
Medicare |
|
|
27.5 |
% |
|
|
27.8 |
% |
Medicaid |
|
|
9.6 |
% |
|
|
10.2 |
% |
Managed Care and other
third-party payors |
|
|
50.6 |
% |
|
|
50.6 |
% |
Self-pay |
|
|
12.3 |
% |
|
|
11.4 |
% |
|
|
|
|
|
|
|
|
|
Total |
|
|
100.0 |
% |
|
|
100.0 |
% |
|
|
|
|
|
|
|
|
|
As shown above, we receive a substantial portion of our revenues
from the Medicare and
Medicaid programs. Included in Managed Care and other third-party payors is net operating revenues
from insurance companies with which we have insurance provider contracts, Medicare Managed Care,
insurance companies for which we do not have insurance provider contracts, workers compensation
carriers, and non-patient service revenue, such as rental income and cafeteria sales. In the
future, we generally expect revenues received from the Medicare and Medicaid programs to increase
due to the general aging of the population. In addition, the Reform Legislation will increase the
number of insured patients which should reduce revenues from self-pay patients and reduce the
provision for bad debts. The Reform Legislation, however, imposes significant reductions in
amounts the government pays Medicare Managed Care plans. Other provisions in the Reform
Legislation impose minimum medical-loss ratios and require insurers to meet specific benefit
requirements. In addition, specified managed care programs, insurance companies, and employers are
actively negotiating the amounts paid to hospitals. The trend toward increased enrollment in
managed care may adversely affect our net operating revenue growth. There can be no assurance that
we will retain our existing reimbursement arrangements or that these third-party payors will not
attempt to further reduce the rates they pay for our services.
Net operating revenues include amounts estimated by management to be
reimbursable by Medicare
and Medicaid under prospective payment systems and provisions of cost-based reimbursement and other
payment methods. In addition, we are reimbursed by non-governmental payors using a variety of
payment methodologies. Amounts we receive for treatment of patients covered by these programs are
generally less than the standard billing rates. We account for the differences between the
estimated program reimbursement rates and the standard billing rates as contractual allowance
adjustments, which we deduct from gross revenues to arrive at net operating revenues. Final
settlements under some of these programs are subject to adjustment based on administrative review
and audit by third parties. We account for adjustments to previous program reimbursement estimates
as contractual allowance adjustments and report them in the periods that such adjustments become
known. Contractual allowance adjustments related to final settlements and previous program
reimbursement estimates impacted net operating revenues and net income by an insignificant amount
in each of the three-month periods ended March 31, 2011 and 2010. In the future, we expect the
percentage of revenues received from the Medicare program to increase due to the general aging of
the population.
Currently, several states utilize supplemental reimbursement
programs for the purpose of
providing reimbursement to providers to offset a portion of the cost of providing care to Medicaid
and indigent patients. These programs are designed with input from CMS and are funded with a
combination of state and federal resources, including, in certain instances, fees or taxes levied
on the providers. Similar programs are also being considered by other states. After these
supplemental programs are signed into law, we recognize revenue and related expenses in the period
in which amounts are estimable and collection is reasonably assured. Reimbursement under these
programs is reflected in net operating revenues and included as Medicaid revenues in the table
above, and fees, taxes or other program related costs are reflected in other operating costs and
expenses.
The payment rates under the Medicare program for hospital inpatient
and outpatient acute care
services are based on a prospective payment system, depending upon the diagnosis of a patients
condition. These rates are indexed for inflation annually, although increases have historically
been less than actual inflation. On August 16, 2010, CMS issued the final rule to adjust this index
by 2.6% for hospital inpatient acute care services that are reimbursed under the prospective
payment system. The final rule also makes other payment adjustments that, coupled with the 0.25%
reduction to hospital inpatient rates implemented pursuant to the Reform Legislation referred to
below, yield a net 0.4% reduction in reimbursement for hospital inpatient acute care services
beginning October 1, 2010. The Reform Legislation implemented a 0.25% reduction to hospital
inpatient rates effective April 1, 2010 and 0.25% reductions to hospital outpatient rates effective
each of January 1, 2010 and January 1, 2011. Reductions in the rate of increase or overall
reductions in Medicare reimbursement may cause a decline in the growth of our net operating
revenues. In addition, specified managed care programs, insurance companies and employers are
actively negotiating the amounts paid to hospitals. The trend toward increased enrollment in
managed care may adversely affect our net operating revenue growth.
35
Results of Operations
Our hospitals offer a variety of services involving a broad range of
inpatient and outpatient
medical and surgical services. These include general acute care, emergency room, general and
specialty surgery, critical care, internal medicine, obstetrics, diagnostic services, psychiatric
and rehabilitation services. The strongest demand for hospital services generally occurs during
January through April and the weakest demand for these services occurs during the summer months.
Accordingly, eliminating the effect of new acquisitions, our net operating revenues and earnings
are historically highest during the first quarter and lowest during the third quarter.
The following tables summarize, for the periods indicated, selected
operating data.
|
|
|
|
|
|
|
|
|
|
|
Three Months Ended |
|
|
March 31, |
|
|
2011 |
|
2010 |
|
|
(Expressed as a percentage of net operating |
|
|
revenues) |
Consolidated |
|
|
|
|
|
|
|
|
Net operating revenues |
|
|
100.0 |
% |
|
|
100.0 |
% |
Operating expenses (a) |
|
|
(87.0 |
) |
|
|
(86.5 |
) |
Depreciation and amortization |
|
|
(4.7 |
) |
|
|
(4.7 |
) |
|
|
|
|
|
|
|
|
|
Income from operations |
|
|
8.3 |
|
|
|
8.8 |
|
Interest expense, net |
|
|
(4.8 |
) |
|
|
(5.1 |
) |
Equity in earnings of unconsolidated
affiliates |
|
|
0.5 |
|
|
|
0.4 |
|
|
|
|
|
|
|
|
|
|
Income from continuing
operations
before income taxes |
|
|
4.0 |
|
|
|
4.1 |
|
Provision for income taxes |
|
|
(1.3 |
) |
|
|
(1.3 |
) |
|
|
|
|
|
|
|
|
|
Income from continuing
operations |
|
|
2.7 |
|
|
|
2.8 |
|
Loss from discontinued
operations, net of taxes |
|
|
(0.4 |
) |
|
|
(0.1 |
) |
|
|
|
|
|
|
|
|
|
Net income |
|
|
2.3 |
|
|
|
2.7 |
|
Less: Net income
attributable to
noncontrolling interests |
|
|
(0.5 |
) |
|
|
(0.5 |
) |
|
|
|
|
|
|
|
|
|
Net income attributable to
Community Health Systems,
Inc. |
|
|
1.8 |
% |
|
|
2.2 |
% |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Three Months Ended |
|
|
March 31, 2011 |
Percentage increase (decrease) from same period
prior year: |
|
|
|
|
Net operating revenues |
|
|
9.0 |
% |
Admissions |
|
|
1.4 |
|
Adjusted admissions (b) |
|
|
4.7 |
|
Average length of stay |
|
|
2.3 |
|
Net income attributable to Community
Health Systems, Inc. (c) |
|
|
(12.4 |
) |
Same-store percentage increase (decrease)
from same period prior year (d): |
|
|
|
|
Net operating revenues |
|
|
5.1 |
% |
Admissions |
|
|
(3.4 |
) |
Adjusted admissions (b) |
|
|
|
|
|
|
|
(a) |
|
Operating expenses include salaries and benefits, provision for bad debts, supplies, rent and other operating expenses. |
|
(b) |
|
Adjusted admissions is a general measure of combined inpatient and outpatient volume. We computed adjusted admissions
by multiplying admissions by gross patient revenues and then dividing that number by gross inpatient revenues. |
|
(c) |
|
Includes loss from discontinued operations. |
|
(d) |
|
Includes acquired hospitals to the extent we operated them in both periods. |
36
Three Months Ended March 31, 2011 Compared to Three Months Ended March 31, 2010
Net operating revenues increased $279.8 million to
approximately $3.4 billion for the three
months ended March 31, 2011, from approximately $3.1 billion for the three months ended March 31,
2010. Growth from hospitals owned throughout both periods contributed $160.8 million of that
increase and hospitals acquired in 2010 contributed $119.0 million. On a same-store basis, net
operating revenues increased 5.1%. The increased net operating revenues contributed by hospitals
that we owned throughout both periods were primarily attributable to general rate and reimbursement
increases.
On a consolidated basis, inpatient admissions increased by 1.4% and
adjusted admissions
increased by 4.7%. On a same-store basis, inpatient admissions decreased by 3.4% during the three
months ended March 31, 2011. This increase in inpatient and adjusted admissions was due primarily
to acquisitions during the past twelve months. This decrease in same-store inpatient admissions
was due primarily to a decrease in admissions from lower birth rates driven by the downturn in the
economy, reductions in one day stays of which over 75% related to non-Medicare patients,
reductions due to weather and certain service closures during the three months ended March 31,
2011, as compared to the three months ended March 31, 2010.
Operating expenses, excluding depreciation and amortization, as a
percentage of net operating
revenues, increased 0.5% to 87.0% for the three months ended March 31, 2011, compared to 86.5% for
the three months ended March 31, 2010. Salaries and benefits, as a percentage of net operating
revenues, increased 0.6% to 41.2% for the three months ended March 31, 2011, compared to 40.6% for
the three months ended March 31, 2010. This increase is due primarily to the impact of recent
acquisitions and an increase in the number of employed physicians, which offset efficiencies gained
at hospitals owned throughout both periods. Provision for bad debts as a percentage of net
operating revenues, remained consistent at 12.0% for each of the three-month periods ended March
31, 2011 and 2010. Supplies, as a percentage of net operating revenues, decreased 0.1% to 13.6% for
the three months ended March 31, 2011, as compared to 13.7% for the three months ended March 31,
2010. Other operating expenses, as a percentage of net operating revenues, increased 0.1% to 18.3%
for the three months ended March 31, 2011, as compared to 18.2% for the three months ended March
31, 2010. Rent, as a percentage of net operating revenues, decreased 0.1% to 1.9% for the three
months ended March 31, 2011, as compared to 2.0% for the three months ended March 31, 2010. Equity
in earnings of unconsolidated affiliates, as a percentage of net operating revenues, increased 0.1%
to 0.5% for the three months ended March 31, 2011, compared to 0.4% for the three months ended
March 31, 2010.
Depreciation and amortization, as a percentage of net operating
revenues, remained consistent
at 4.7% for each of the three-month periods ended March 31, 2011 and 2010.
Interest expense, net, increased by $3.8 million from
$160.4 million for the three months
ended March 31, 2010 to $164.2 million for the three months ended March 31, 2011. An increase in
interest rates during the three months ended March 31, 2011, compared to the three months ended
March 31, 2010, resulted in an increase in interest expense of $5.2 million. These increases were
offset by a decrease in interest expense of $0.8 million due to a decrease in our average
outstanding debt during the three months ended March 31, 2011, compared to March 31, 2010.
Additionally, interest expense decreased by $0.6 million as a result of more interest being
capitalized during the three months ended March 31, 2011, as compared to the three months ended
March 31, 2010, as the current year period had more major construction projects.
The net of the above mentioned changes resulted in income from
continuing operations before
income taxes increasing $7.4 million from $127.5 million for the three months ended March 31, 2010
to $134.9 million for the three months ended March 31, 2011.
Provision for income taxes increased from $41.0 million for the
three months ended March 31,
2010 to $43.8 million for the three months ended March 31, 2011, due primarily to an increase in
income from continuing operations before income taxes in the comparable period in 2010, as
discussed above. Our effective tax rates were 32.4% and 32.2% for the three months ended March 31,
2011 and 2010, respectively.
Income from continuing operations, as a percentage of net operating
revenues, decreased from
2.8% for the three months ended March 31, 2010 to 2.7% for the three months ended March 31, 2011.
The decrease in income from continuing operations, as a percentage of net operating revenues, is
primarily a result of the increase in salaries and benefits as a percentage of net operating
revenues. Net income, as a percentage of net operating revenues, decreased from 2.7% for the three
months ended March 31, 2010 to 2.3% for the three months ended March 31, 2011. The decrease in net
income, as a percentage of net operating revenues, is primarily due to the loss on discontinued
operations from the loss on sale, impairment of hospital held for sale and loss on entities sold
and held for sale.
37
Net income attributable to noncontrolling interests as a percentage
of net operating revenues,
remained consistent at 0.5% for each of the three-month periods ended March 31, 2011 and 2010.
Net income attributable to Community Health Systems, Inc. was
$61.3 million for the three
months ended March 31, 2011, compared to $70.0 million for the three months ended March 31, 2010,
representing a decrease of 12.4%. The decrease in net income is primarily due to the loss on
discontinued operations from the loss on sale, impairment of hospital held for sale and loss on
entities sold and held for sale.
Liquidity and Capital Resources
Net cash provided by operating activities decreased
$111.8 million, from $299.4 million for
the three months ended March 31, 2010 to $187.5 million for the three months ended March 31, 2011.
The decrease in cash flows, in comparison to the prior year period, is primarily from a decrease in
net income of $6.7 million and a decrease in cash flow from the change in accounts payable, accrued
liabilities and income taxes of $182.4 million, due primarily to the timing of payments during the
periods, which included accelerating the funding of our 401(k) Plan matching contribution in the
first quarter of 2011, compared to funding it in the second quarter of 2010. These decreases were
offset by an increase in depreciation and amortization expense, a non-cash expense of $13.6
million, an increase in other non-cash expenses of $4.3 million, an increase in cash flow from the
change in accounts receivable of $37.8 million, an increase in cash flow from the change in
supplies, prepaid expenses and other current assets of $21.2 million and an increase in cash flow
from the change in other assets and liabilities of $0.4 million.
The cash used in investing activities was $209.4 million for
the three months ended March 31,
2011, compared to $163.4 million for the three months ended March 31, 2010. The increase in cash
flows used in investing activities, in comparison to the prior year period, was primarily due to an
increase in cash used for acquisition of facilities and other related equipment of $45.2 million
and an increase in cash used for purchasing property and equipment of $27.3 million. Other changes
in cash used in investing activities were an increase in proceeds from the disposition of ancillary
operations of $14.6 million, a decrease in cash used for other non-operating assets of $4.7 million
and an increase in proceeds received from the sale of property and equipment of $7.2 million.
The cash used in financing activities was $6.6 million for the
three months ended March 31,
2011, compared to $0.5 million for the three months ended March 31, 2010. The increase in cash used
in financing activities is due primarily to a decrease in proceeds from the exercise of stock
options.
Capital Expenditures
Cash expenditures related to purchases of facilities were
$45.4 million for the three months
ended March 31, 2011, compared to $0.2 million for the three months ended March 31, 2010. The
expenditures during the three months ended March 31, 2011 were for the purchase of surgery centers
and physician practices and the settlement of working capital items from 2010 acquisitions. The
expenditures during the three months ended March 31, 2010 were for the purchase of non-hospital
facilities, and no hospitals were acquired during this period.
Excluding the cost to construct replacement hospitals, our cash
expenditures for routine
capital for the three months ended March 31, 2011 totaled $119.4 million, compared to $125.4
million for the three months ended March 31, 2010. These capital expenditures related primarily to
the purchase of additional equipment, minor renovations and information systems infrastructure.
Costs to construct replacement hospitals for the three months ended March 31, 2011 totaled $34.5
million, compared to $1.2 million for the three months ended March 31, 2010. The costs to construct
replacement hospitals for the three months ended March 31, 2011 represented both planning and
construction costs for the four replacement hospitals discussed below. The costs to construct
replacement hospitals for the three months ended March 31, 2010 represented planning costs for
future construction projects since there were no replacement hospitals under construction.
38
Pursuant to hospital purchase agreements in effect as of
March 31, 2011, as part of an
acquisition in 2007, we agreed to build a replacement hospital in Valparaiso, Indiana by April
2011, and as part of an acquisition in 2009, we agreed to build a replacement hospital in Siloam
Springs, Arkansas by February 2013. Due to delays in receiving government approved building and
zoning permits, the replacement facility in Valparaiso, Indiana is not expected to be completed
until the fourth quarter of 2012. Also, as required by an amendment to a lease agreement entered
into in 2005, we agreed to build a replacement facility at Barstow Community Hospital in Barstow,
California. Estimated construction costs, including equipment costs, are approximately $318.5
million for these three replacement facilities. In addition, in October 2008, after the purchase of
the noncontrolling owners interest in our Birmingham, Alabama facility, we initiated the purchase
of a site, which includes a partially constructed hospital structure, for a potential replacement
to our existing Birmingham facility. In September 2010, we received approval of our request for a
certificate of need from the Alabama Certificate of Need Review Board; however, this certificate of
need remains subject to an appeal process. Our estimated construction costs, including the
acquisition of the site and equipment costs, are approximately $280.0 million for the Birmingham
replacement facility.
Capital Resources
Net working capital was approximately $1.230 billion at
March 31, 2011, compared to
approximately $1.229 billion at December 31, 2010.
In connection with the consummation of the Triad acquisition in
July 2007, we obtained
approximately $7.2 billion of senior secured financing under a Credit Facility with a syndicate of
financial institutions led by Credit Suisse, as administrative agent and collateral agent. The
Credit Facility consisted of an approximately $6.1 billion funded term loan facility with a
maturity of seven years, a $300 million delayed draw term loan facility (reduced by us from $400
million) with a maturity of seven years and a $750 million revolving credit facility with a
maturity of six years. During the fourth quarter of 2008, $100 million of the delayed draw term
loan had been drawn down by us, reducing the delayed draw term loan availability to $200 million at
December 31, 2008. In January 2009, we drew down the remaining $200 million of the delayed draw
term loan. The revolving credit facility also includes a subfacility for letters of credit and a
swingline subfacility. The Credit Facility requires quarterly amortization payments of each term
loan facility equal to 0.25% of the outstanding amount of the term loans. On November 5, 2010, we
entered into an amendment and restatement of our existing Credit Facility. The amendment extends
by two and a half years, until January 25, 2017, the maturity date of $1.5 billion of the existing
term loans under the Credit Facility and increases the pricing on these term loans to London
Interbank Offered Rate, or LIBOR, plus 350 basis points. If more than $50 million of our Notes
remain outstanding on April 15, 2015, without having been refinanced, then the maturity date for
the extended term loans will be accelerated to April 15, 2015. The maturity date of the balance of
the term loans of approximately $4.5 billion remains unchanged at July 25, 2014. The amendment
also increases our ability to issue additional indebtedness under the uncommitted incremental
facility to $1.0 billion from $600 million, permits us to issue Term A term loans under the
incremental facility, and provides up to $2.0 billion of borrowing capacity from receivable
transactions, an increase of $0.5 billion, of which $1.7 billion would be required to be used for
repayment of existing term loans.
The term loan facility must be prepaid in an amount equal to
(1) 100% of the net cash proceeds
of certain asset sales and dispositions by us and our subsidiaries, subject to certain exceptions
and reinvestment rights, (2) 100% of the net cash proceeds of issuances of certain debt obligations
or receivables based financing by us and our subsidiaries, subject to certain exceptions, and (3)
50%, subject to reduction to a lower percentage based on our leverage ratio (as defined in the
Credit Facility generally as the ratio of total debt on the date of determination to our EBITDA, as
defined, for the four quarters most recently ended prior to such date), of excess cash flow (as
defined) for any year, commencing in 2008, subject to certain exceptions. Voluntary prepayments and
commitment reductions are permitted in whole or in part, without any premium or penalty, subject to
minimum prepayment or reduction requirements.
The obligor under the Credit Facility is CHS/Community Health
Systems, Inc., or CHS, a
wholly-owned subsidiary of Community Health Systems, Inc. All of our obligations under the Credit
Facility are unconditionally guaranteed by Community Health Systems, Inc. and certain existing and
subsequently acquired or organized domestic subsidiaries. All obligations under the Credit Facility
and the related guarantees are secured by a perfected first priority lien or security interest in
substantially all of the assets of Community Health Systems, Inc., CHS and each subsidiary
guarantor, including equity interests held by us or any subsidiary guarantor, but excluding, among
others, the equity interests of non-significant subsidiaries, syndication subsidiaries,
securitization subsidiaries and joint venture subsidiaries.
39
The loans under the Credit Facility bear interest on the outstanding
unpaid principal amount
at a rate equal to an applicable percentage plus, at our option, either (a) an Alternate Base Rate
(as defined) determined by reference to the greater of (1) the Prime Rate (as defined) announced by
Credit Suisse or (2) the Federal Funds Effective Rate (as defined) plus one-half of 1.0% or (3) the
adjusted LIBOR rate on such day for a three-month interest period commencing on the second business
day after such day plus 1%, or (b) a reserve adjusted LIBOR for dollars (Eurodollar rate) (as
defined). The applicable percentage for Alternate Base Rate loans is 1.25% for term loans due 2014
and 2.25% for term loans due 2017. The applicable percentage for Eurodollar rate loans is 2.25%
for term loans due 2014 and 3.5% for term loans due 2017. The applicable percentage for revolving
loans was initially 1.25% for Alternate Base Rate revolving loans and 2.25% for Eurodollar
revolving loans, in each case subject to reduction based on our leverage ratio. Loans under the
swingline subfacility bear interest at the rate applicable to Alternate Base Rate loans under the
revolving credit facility.
We have agreed to pay letter of credit fees equal to the applicable
percentage then in effect
with respect to Eurodollar rate loans under the revolving credit facility times the maximum
aggregate amount available to be drawn under all letters of credit outstanding under the
subfacility for letters of credit. The issuer of any letter of credit issued under the subfacility
for letters of credit will also receive a customary fronting fee and other customary processing
charges. We were initially obligated to pay commitment fees of 0.50% per annum (subject to
reduction based upon our leverage ratio), on the unused portion of the revolving credit facility.
For purposes of this calculation, swingline loans are not treated as usage of the revolving credit
facility. With respect to the delayed draw term loan facility, we were also obligated to pay
commitment fees of 0.50% per annum for the first nine months after the close of the Credit Facility
and 0.75% per annum for the next three months after such nine-month period and thereafter 1.0% per
annum. In each case, the commitment fee was based on the unused amount of the delayed draw term
loan facility. After the draw down of the remaining $200 million of the delayed draw term loan in
January 2009, we no longer pay any commitment fees for the delayed draw term loan facility. We also
paid arrangement fees on the closing of the Credit Facility and pay an annual administrative agent
fee.
The Credit Facility contains customary representations and
warranties, subject to limitations
and exceptions, and customary covenants restricting our and our subsidiaries ability, subject to
certain exception, to, among other things, (1) declare dividends, make distributions or redeem or
repurchase capital stock, (2) prepay, redeem or repurchase other debt, (3) incur liens or grant
negative pledges, (4) make loans and investments and enter into acquisitions and joint ventures,
(5) incur additional indebtedness or provide certain guarantees, (6) make capital expenditures, (7)
engage in mergers, acquisitions and asset sales, (8) conduct transactions with affiliates, (9)
alter the nature of our businesses, (10) grant certain guarantees with respect to physician
practices, (11) engage in sale and leaseback transactions or (12) change our fiscal year. We and
our subsidiaries are also required to comply with specified financial covenants (consisting of a
leverage ratio and an interest coverage ratio) and various affirmative covenants.
Events of default under the Credit Facility include, but are not
limited to, (1) our failure
to pay principal, interest, fees or other amounts under the credit agreement when due (taking into
account any applicable grace period), (2) any representation or warranty proving to have been
materially incorrect when made, (3) covenant defaults subject, with respect to certain covenants,
to a grace period, (4) bankruptcy events, (5) a cross default to certain other debt, (6) certain
undischarged judgments (not paid within an applicable grace period), (7) a change of control, (8)
certain ERISA-related defaults and (9) the invalidity or impairment of specified security
interests, guarantees or subordination provisions in favor of the administrative agent or lenders
under the Credit Facility.
As of March 31, 2011, the availability for additional
borrowings under our Credit Facility was
approximately $750 million pursuant to the revolving credit facility, of which $81.9 million was
set aside for outstanding letters of credit. We believe that these funds, along with internally
generated cash and continued access to the bank credit and capital markets, will be sufficient to
finance future acquisitions, capital expenditures and working capital requirements through the next
12 months and into the foreseeable future.
As of March 31, 2011, we are currently a party to the following
interest rate swap agreements
to limit the effect of changes in interest rates on approximately 89% of our variable rate debt. On
each of these swaps, we receive a variable rate of interest based on the three-month LIBOR in
exchange for the payment by us of a fixed rate of interest. We currently pay, on a quarterly basis,
a margin above LIBOR of 225 basis points for revolving credit and term loans due 2014 and 350 basis
points for term loans due 2017 under the Credit Facility.
40
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Notional |
|
|
|
|
|
|
|
|
|
|
|
|
Amount |
|
Fixed Interest |
|
Termination |
|
Fair Value |
Swap # |
|
|
|
(in 000s) |
|
Rate |
|
Date |
|
(in 000s) |
|
1 |
|
|
|
|
$ |
300,000 |
|
|
|
5.1140 |
% |
|
August 8, 2011 |
|
$ |
5,095 |
|
|
2 |
|
|
|
|
|
100,000 |
|
|
|
4.7185 |
% |
|
August 19, 2011 |
|
|
1,682 |
|
|
3 |
|
|
|
|
|
100,000 |
|
|
|
4.7040 |
% |
|
August 19, 2011 |
|
|
1,689 |
|
|
4 |
|
|
|
|
|
100,000 |
|
|
|
4.6250 |
% |
|
August 19, 2011 |
|
|
1,646 |
|
|
5 |
|
|
|
|
|
200,000 |
|
|
|
4.9300 |
% |
|
August 30, 2011 |
|
|
3,790 |
|
|
6 |
|
|
|
|
|
200,000 |
|
|
|
3.0920 |
% |
|
September 18, 2011 |
|
|
2,527 |
|
|
7 |
|
|
|
|
|
100,000 |
|
|
|
3.0230 |
% |
|
October 23, 2011 |
|
|
1,444 |
|
|
8 |
|
|
|
|
|
200,000 |
|
|
|
4.4815 |
% |
|
October 26, 2011 |
|
|
4,599 |
|
|
9 |
|
|
|
|
|
200,000 |
|
|
|
4.0840 |
% |
|
December 3, 2011 |
|
|
4,815 |
|
|
10 |
|
|
|
|
|
100,000 |
|
|
|
3.8470 |
% |
|
January 4, 2012 |
|
|
2,477 |
|
|
11 |
|
|
|
|
|
100,000 |
|
|
|
3.8510 |
% |
|
January 4, 2012 |
|
|
2,490 |
|
|
12 |
|
|
|
|
|
100,000 |
|
|
|
3.8560 |
% |
|
January 4, 2012 |
|
|
2,493 |
|
|
13 |
|
|
|
|
|
200,000 |
|
|
|
3.7260 |
% |
|
January 8, 2012 |
|
|
4,859 |
|
|
14 |
|
|
|
|
|
200,000 |
|
|
|
3.5065 |
% |
|
January 16, 2012 |
|
|
4,601 |
|
|
15 |
|
|
|
|
|
250,000 |
|
|
|
5.0185 |
% |
|
May 30, 2012 |
|
|
12,306 |
|
|
16 |
|
|
|
|
|
150,000 |
|
|
|
5.0250 |
% |
|
May 30, 2012 |
|
|
7,395 |
|
|
17 |
|
|
|
|
|
200,000 |
|
|
|
4.6845 |
% |
|
September 11, 2012 |
|
|
11,056 |
|
|
18 |
|
|
|
|
|
100,000 |
|
|
|
3.3520 |
% |
|
October 23, 2012 |
|
|
3,846 |
|
|
19 |
|
|
|
|
|
125,000 |
|
|
|
4.3745 |
% |
|
November 23, 2012 |
|
|
6,793 |
|
|
20 |
|
|
|
|
|
75,000 |
|
|
|
4.3800 |
% |
|
November 23, 2012 |
|
|
4,278 |
|
|
21 |
|
|
|
|
|
150,000 |
|
|
|
5.0200 |
% |
|
November 30, 2012 |
|
|
10,260 |
|
|
22 |
|
|
|
|
|
200,000 |
|
|
|
2.2420 |
% |
|
February 28, 2013 |
|
|
4,867 |
|
|
23 |
|
|
|
|
|
100,000 |
|
|
|
5.0230 |
% |
|
May 30, 2013 |
|
|
8,478 |
|
|
24 |
|
|
|
|
|
300,000 |
|
|
|
5.2420 |
% |
|
August 6, 2013 |
|
|
28,369 |
|
|
25 |
|
|
|
|
|
100,000 |
|
|
|
5.0380 |
% |
|
August 30, 2013 |
|
|
9,144 |
|
|
26 |
|
|
|
|
|
50,000 |
|
|
|
3.5860 |
% |
|
October 23, 2013 |
|
|
2,903 |
|
|
27 |
|
|
|
|
|
50,000 |
|
|
|
3.5240 |
% |
|
October 23, 2013 |
|
|
2,825 |
|
|
28 |
|
|
|
|
|
100,000 |
|
|
|
5.0500 |
% |
|
November 30, 2013 |
|
|
9,729 |
|
|
29 |
|
|
|
|
|
200,000 |
|
|
|
2.0700 |
% |
|
December 19, 2013 |
|
|
3,697 |
|
|
30 |
|
|
|
|
|
100,000 |
|
|
|
5.2310 |
% |
|
July 25, 2014 |
|
|
11,507 |
|
|
31 |
|
|
|
|
|
100,000 |
|
|
|
5.2310 |
% |
|
July 25, 2014 |
|
|
11,507 |
|
|
32 |
|
|
|
|
|
200,000 |
|
|
|
5.1600 |
% |
|
July 25, 2014 |
|
|
22,554 |
|
|
33 |
|
|
|
|
|
75,000 |
|
|
|
5.0405 |
% |
|
July 25, 2014 |
|
|
8,158 |
|
|
34 |
|
|
|
|
|
125,000 |
|
|
|
5.0215 |
% |
|
July 25, 2014 |
|
|
13,519 |
|
|
35 |
|
|
|
|
|
100,000 |
|
|
|
2.6210 |
% |
|
July 25, 2014 |
|
|
3,046 |
|
|
36 |
|
|
|
|
|
100,000 |
|
|
|
3.1100 |
% |
|
July 25, 2014 |
|
|
4,636 |
|
|
37 |
|
|
|
|
|
100,000 |
|
|
|
3.2580 |
% |
|
July 25, 2014 |
|
|
5,116 |
|
|
38 |
|
|
|
|
|
200,000 |
|
|
|
2.6930 |
% |
|
October 26, 2014 |
|
|
3,680 |
(1) |
|
39 |
|
|
|
|
|
300,000 |
|
|
|
3.4470 |
% |
|
August 8, 2016 |
|
|
10,636 |
(2) |
|
40 |
|
|
|
|
|
200,000 |
|
|
|
3.4285 |
% |
|
August 19, 2016 |
|
|
6,666 |
(3) |
|
41 |
|
|
|
|
|
100,000 |
|
|
|
3.4010 |
% |
|
August 19, 2016 |
|
|
3,203 |
(4) |
|
42 |
|
|
|
|
|
200,000 |
|
|
|
3.5000 |
% |
|
August 30, 2016 |
|
|
7,142 |
(5) |
|
43 |
|
|
|
|
|
100,000 |
|
|
|
3.0050 |
% |
|
November 30, 2016 |
|
|
1,967 |
|
41
|
|
|
(1) |
|
This interest rate swap becomes effective October 26, 2011, concurrent with the termination of swap #8. |
|
(2) |
|
This interest rate swap becomes effective August 8, 2011, concurrent with the termination of swap #1. |
|
(3) |
|
This interest rate swap becomes effective August 19, 2011, concurrent with the termination of swap #2 and #4. |
|
(4) |
|
This interest rate swap becomes effective August 19, 2011, concurrent with the termination of swap #3. |
|
(5) |
|
This interest rate swap becomes effective August 30, 2011, concurrent with the termination of swap #5. |
The Credit Facility and/or the Notes contain various covenants that
limit our ability to take
certain actions including, among other things, our ability to:
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incur, assume or guarantee additional indebtedness; |
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|
issue redeemable stock and preferred stock; |
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repurchase capital stock; |
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make restricted payments, including paying dividends and making investments; |
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redeem debt that is junior in right of payment to the notes; |
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create liens without securing the notes; |
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sell or otherwise dispose of assets, including capital stock of subsidiaries; |
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enter into agreements that restrict dividends from subsidiaries; |
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merge, consolidate, sell or otherwise dispose of substantial portions of our assets; |
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enter into transactions with affiliates; and |
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guarantee certain obligations. |
In addition, our Credit Facility contains restrictive covenants and
requires us to maintain
specified financial ratios and satisfy other financial condition tests. Our ability to meet these
restricted covenants and financial ratios and tests can be affected by events beyond our control,
and we cannot assure you that we will meet those tests. A breach of any of these covenants could
result in a default under our Credit Facility and/or the Notes. Upon the occurrence of an event of
default under our Credit Facility or the Notes, all amounts outstanding under our Credit Facility
and the Notes may become due and payable and all commitments under the Credit Facility to extend
further credit may be terminated.
We believe that internally generated cash, availability for
additional borrowings under our
Credit Facility of $750 million (consisting of a $750 million revolving credit facility, of which
$81.9 million is set aside for outstanding letters of credit as of March 31, 2011) and our ability
to amend the Credit Facility to provide for one or more tranches of term loans in an aggregate
principal amount of $1.0 billion, our ability to add up to $300 million of borrowing capacity from
receivable transactions (including securitizations) and our continued access to the bank credit and
capital markets will be sufficient to finance acquisitions, capital expenditures and working
capital requirements through the next 12 months. We believe these same sources of cash, borrowings
under our Credit Facility as well as access to bank credit and capital markets will be available to
us beyond the next 12 months and into the foreseeable future.
42
On December 22, 2008, we filed a universal automatic shelf
registration statement on Form
S-3ASR that will permit us, from time to time, in one or more public offerings, to offer debt
securities, common stock, preferred stock, warrants, depositary shares, or any combination of such
securities. The shelf registration statement will also permit our subsidiary, CHS, to offer debt
securities that would be guaranteed by us, from time to time in one or more public offerings. The
terms of any such future offerings would be established at the time of the offering.
The ratio of earnings to fixed charges for the three months ended
March 31, 2011 is as
follows:
|
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|
|
|
|
|
Three Months |
|
|
Ended |
|
|
March 31, 2011 |
Ratio of earnings to fixed charges (1) |
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1.64x |
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|
|
(1) |
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There are no shares of preferred stock outstanding. |
Off-balance Sheet Arrangements
Our consolidated operating results for the three months ended
March 31, 2011 and 2010,
included $63.1 million and $61.1 million, respectively, of net operating revenues and $5.6 million
and $6.0 million, respectively, of income from operations generated from five hospitals operated by
us under operating lease arrangements. In accordance with accounting principles generally accepted
in the United States of America, or U.S. GAAP, the respective assets and the future lease
obligations under these arrangements are not recorded on our condensed consolidated balance sheet.
Lease costs under these arrangements are included in rent expense and totaled approximately $3.1
million for each of the three-month periods ended March 31, 2011 and 2010. The current terms of these
operating leases expire between June 2012 and December 2020, not including lease extension options.
If we allow these leases to expire, we would no longer generate revenue nor incur expenses from
these hospitals.
In the past, we have utilized operating leases as a financing tool
for obtaining the
operations of specified hospitals without acquiring, through ownership, the related assets of the
hospital and without a significant outlay of cash at the front end of the lease. We utilize the
same operating strategies to improve operations at those hospitals held under operating leases as
we do at those hospitals that we own. We have not entered into any operating leases for hospital
operations since December 2000.
During the year ended December 31, 2010, we entered into an
agreement with the lessor of
Cleveland Regional Medical Center, or Cleveland Regional, our leased facility in Cleveland, TX, to
exchange our ownership interest in certain real estate at Hill Regional Medical Center, or Hill
Regional, in Hillsboro, TX for the lessors ownership interest in the real estate at Cleveland
Regional. The related lease agreement was amended to incorporate Hill Regional as a leased asset
with no change to the remaining lease term or payment schedule. No monetary consideration was
exchanged in this transaction, and the transaction qualifies as a non-taxable, like-kind exchange
under the regulations in Section 1031 of the Internal Revenue Code. The assets of Cleveland
Regional are included in the condensed consolidated balance sheet at fair value on the date of this
transaction; however, as a result of our continuing involvement in the Hill Regional assets, the
exchange with the lessor does not qualify for sale treatment under U.S. GAAP. Accordingly, the
transaction has been accounted for as a financing obligation and the assets of Hill Regional will
remain on the condensed consolidated balance sheet as assets recorded under a financing obligation.
Starting in the fourth quarter of 2010, future payments under the lease are amortized against the
financing obligation rather than recorded as rent expense.
Noncontrolling Interests
We have sold noncontrolling interests in certain of our subsidiaries
or acquired subsidiaries
with existing noncontrolling interest ownership positions. As of March 31, 2011, we have hospitals
in 25 of the markets we serve, with noncontrolling physician ownership interests ranging from less
than 1% to 40%, including one hospital that also had a non-profit entity as a partner. In addition,
we have three other hospitals with noncontrolling interests owned by non-profit entities.
Redeemable noncontrolling interests in equity of consolidated subsidiaries was $385.4 million and
$387.5 million as of March 31, 2011 and December 31, 2010, respectively. Noncontrolling interests
in equity of consolidated subsidiaries was $60.9 million at both March 31, 2011 and December 31,
2010. The amount of net income attributable to noncontrolling interests was $17.0
million and $15.0 million for the three months ended March 31, 2011 and 2010, respectively. As a
result of the change in the Stark Law whole hospital exception included in the Reform
Legislation, we will not introduce physician ownership at any of our wholly-owned facilities or
increase the aggregate percentage of physician ownership in any of our existing joint ventures.
43
Reimbursement, Legislative and Regulatory Changes
The Reform Legislation was enacted in the context of other ongoing
legislative and regulatory
efforts, which would reduce or otherwise adversely affect the payments we receive from Medicare and
Medicaid. Within the statutory framework of the Medicare and Medicaid programs, including programs
currently unaffected by the Reform Legislation, there are substantial areas subject to
administrative rulings, interpretations, and discretion which may further affect payments made
under those programs, and the federal and state governments might, in the future, reduce the funds
available under those programs or require more stringent utilization and quality reviews of
hospital facilities. Additionally, there may be a continued rise in managed care programs and
additional restructuring of the financing and delivery of healthcare in the United States. These
events could cause our future financial results to decline. We cannot estimate the impact of
Medicare and Medicaid reimbursement changes that have been enacted or are under consideration. We
cannot predict whether additional reimbursement reductions will be made or whether any such changes
would have a material adverse effect on our business, financial conditions, results of operations,
cash flow, capital resources and liquidity.
Inflation
The healthcare industry is labor intensive. Wages and other expenses
increase during periods
of inflation and when labor shortages occur in the marketplace. In addition, our suppliers pass
along rising costs to us in the form of higher prices. We have implemented cost control measures,
including our case and resource management program, to curb increases in operating costs and
expenses. We have generally offset increases in operating costs by increasing reimbursement for
services, expanding services and reducing costs in other areas. However, we cannot predict our
ability to cover or offset future cost increases, particularly any increases in our cost of
providing health insurance benefits to our employees as a result of the Reform Legislation.
Critical Accounting Policies
The discussion and analysis of our financial condition and results
of operations are based
upon our consolidated financial statements, which have been prepared in accordance with U.S. GAAP.
The preparation of these financial statements requires us to make estimates and judgments that
affect the reported amount of assets and liabilities, revenues and expenses, and related disclosure
of contingent assets and liabilities at the date of our consolidated financial statements. Actual
results may differ from these estimates under different assumptions or conditions.
Critical accounting policies are defined as those that are
reflective of significant judgments
and uncertainties, and potentially result in materially different results under different
assumptions and conditions. We believe that our critical accounting policies are limited to those
described below.
Third Party Reimbursement
Net operating revenues include amounts estimated by management to be
reimbursable by Medicare
and Medicaid under prospective payment systems and provisions of cost-reimbursement and other
payment methods. In addition, we are reimbursed by non-governmental payors using a variety of
payment methodologies. Amounts we receive for treatment of patients covered by these programs are
generally less than the standard billing rates. Contractual allowances are automatically calculated
and recorded through our internally developed automated contractual allowance system. Within the
automated system, actual Medicare DRG data and payors historical paid claims data are utilized to
calculate the contractual allowances. This data is automatically updated on a monthly basis. All
hospital contractual allowance calculations are subjected to monthly review by management to ensure
reasonableness and accuracy. We account for the differences between the estimated program
reimbursement rates and the standard billing rates as contractual allowance adjustments, which we
deduct from gross revenues to arrive at net operating revenues. The process of estimating
contractual allowances requires us to estimate the amount expected to be received based on payor
contract provisions. The key assumption in this process is the estimated contractual reimbursement
percentage, which is based on payor classification and historical paid claims data. Due to the
complexities involved in these estimates, actual payments we receive could be different from the
amounts we estimate and record. If the actual contractual reimbursement percentage under government
programs and managed care contracts differed by 1% at March 31, 2011 from our estimated
reimbursement percentage, net income for the three months ended March 31, 2011 would have changed
by approximately $33.1 million, and net accounts receivable at March 31, 2011 would have changed by
$52.4 million. Final settlements under some of these programs are subject to adjustment based on
administrative review and audit by third parties. We account for adjustments to previous program
reimbursement estimates as contractual allowance adjustments and report them in the periods that
such adjustments become known. Contractual allowance adjustments related to final settlements and
previous program reimbursement estimates impacted net operating revenues and net income by an
insignificant amount in each of the three-month periods ended March 31, 2011 and 2010.
44
Allowance for Doubtful Accounts
Substantially all of our accounts receivable are related to
providing healthcare services to
our hospitals patients. Collection of these accounts receivable is our primary source of cash and
is critical to our operating performance. Our primary collection risks relate to uninsured patients
and outstanding patient balances for which the primary insurance payor has paid some but not all of
the outstanding balance, with the remaining outstanding balance (generally deductibles and
co-payments) owed by the patient. At the point of service, for patients required to make a
co-payment, we generally collect less than 15% of the related revenue. For all procedures scheduled
in advance, our policy is to verify insurance coverage prior to the date of the procedure.
Insurance coverage is not verified in advance of procedures for walk-in and emergency room
patients.
We estimate the allowance for doubtful accounts by reserving a
percentage of all self-pay
accounts receivable without regard to aging category, based on collection history, adjusted for
expected recoveries and, if present, anticipated changes in trends. For all other non-self-pay
payor categories, we reserve 100% of all accounts aging over 365 days from the date of discharge.
The percentage used to reserve for all self-pay accounts is based on our collection history. We
believe that we collect substantially all of our third-party insured receivables, which include
receivables from governmental agencies.
Collections are impacted by the economic ability of patients to pay
and the effectiveness of
our collection efforts. Significant changes in payor mix, business office operations, economic
conditions or trends in federal and state governmental healthcare coverage could affect our
collection of accounts receivable. The process of estimating the allowance for doubtful accounts
requires us to estimate the collectability of self-pay accounts receivable, which is primarily
based on our collection history, adjusted for expected recoveries and, if available, anticipated
changes in collection trends. Significant change in payor mix, business office operations, economic
conditions, trends in federal and state governmental healthcare coverage or other third-party
payors could affect our estimates of accounts receivable collectability. If the actual collection
percentage differed by 1% at March 31, 2011 from our estimated collection percentage as a result of
a change in expected recoveries, net income for the three months ended March 31, 2011 would have
changed by $17.5 million, and net accounts receivable at March 31, 2011 would have changed by $27.7
million. We also continually review our overall reserve adequacy by monitoring historical cash
collections as a percentage of trailing net revenue less provision for bad debts, as well as by
analyzing current period net revenue and admissions by payor classification, aged accounts
receivable by payor, days revenue outstanding and the impact of recent acquisitions and
dispositions.
Our policy is to write-off gross accounts receivable if the balance
is under $10.00 or when
such amounts are placed with outside collection agencies. We believe this policy accurately
reflects our ongoing collection efforts and is consistent with industry practices. We had
approximately $2.2 billion and $2.1 billion at March 31, 2011 and December 31, 2010, respectively,
being pursued by various outside collection agencies. We expect to collect less than 3%, net of
estimated collection fees, of the amounts being pursued by outside collection agencies. As these
amounts have been written-off, they are not included in our gross accounts receivable or our
allowance for doubtful accounts. Collections on amounts previously written-off are recognized as a
reduction to bad debt expense when received. However, we take into consideration estimated
collections of these future amounts written-off in evaluating the reasonableness of our allowance
for doubtful accounts.
All of the following information is derived from our hospitals,
excluding clinics, unless
otherwise noted.
Patient accounts receivable from our hospitals represent
approximately 95% of our total
consolidated accounts receivable.
Days revenue outstanding was 47 days and 46 days at
March 31, 2011 and December 31, 2010,
respectively. Our target range for days revenue outstanding is 46 to 56 days.
Total gross accounts receivable (prior to allowance for contractual
adjustments and doubtful
accounts) was approximately $7.7 billion and $7.2 billion as of March 31, 2011 and December 31,
2010, respectively.
45
The approximate percentage of total gross accounts receivable (prior
to allowances for
contractual adjustments and doubtful accounts) summarized by payor category is as follows:
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|
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|
|
|
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|
|
March 31, |
|
December 31, |
|
|
2011 |
|
2010 |
Insured receivables |
|
|
64.9 |
% |
|
|
63.9 |
% |
Self-pay receivables |
|
|
35.1 |
% |
|
|
36.1 |
% |
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|
|
|
|
|
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Total |
|
|
100.0 |
% |
|
|
100.0 |
% |
For the hospital segment, the combined total of the allowance for
doubtful accounts and
related allowances for other self-pay discounts and contractuals, as a percentage of gross self-pay
receivables, was approximately 84% at both March 31, 2011 and December 31, 2010. If the receivables
that have been written-off, but where collections are still being pursued by outside collection
agencies, were included in both the allowances and gross self-pay receivables specified above, the
percentage of combined allowances to total self-pay receivables would have been approximately 91%
at both March 31, 2011 and December 31, 2010.
Goodwill and Other Intangibles
Goodwill represents the excess of cost over the fair value of net
assets acquired. Goodwill is
evaluated for impairment at the same time every year and when an event occurs or circumstances
change that, more likely than not, reduce the fair value of the reporting unit below its carrying
value. There is a two-step method for determining goodwill impairment. Step one is to compare the
fair value of the reporting unit with the units carrying amount, including goodwill. If this test
indicates the fair value is less than the carrying value, then step two is required to compare the
implied fair value of the reporting units goodwill with the carrying value of the reporting units
goodwill. We have selected September 30 as our annual testing date. Based on the results of our
most recent annual impairment test, we have concluded that we do not have any reporting units that
are at risk of failing step one of the goodwill impairment test.
Impairment or Disposal of Long-Lived Assets
Whenever events or changes in circumstances indicate that the
carrying values of certain
long-lived assets may be impaired, we project the undiscounted cash flows expected to be generated
by these assets. If the projections indicate that the reported amounts are not expected to be
recovered, such amounts are reduced to their estimated fair value based on a quoted market price,
if available, or an estimate based on valuation techniques available in the circumstances.
Professional Liability Insurance Claims
As part of our business of owning and operating hospitals, we are
subject to legal actions
alleging liability on our part. We accrue for losses resulting from such liability claims, as well
as loss adjustment expenses that are out-of-pocket and directly related to such liability claims.
These direct out-of-pocket expenses include fees of outside counsel and experts. We do not accrue
for costs that are part of our corporate overhead, such as the costs of our in-house legal and risk
management departments. The losses resulting from professional liability claims primarily consist
of estimates for known claims, as well as estimates for incurred but not reported claims. The
estimates are based on specific claim facts, our historical claim reporting and payment patterns,
the nature and level of our hospital operations, and actuarially determined projections. The
actuarially determined projections are based on our actual claim data, including historic reporting
and payment patterns which have been gathered over approximately a 20-year period. As discussed
below, although we purchase excess insurance on a claims-made basis that transfers risk to
third-party insurers, the liability we accrue does include an amount for the losses covered by our
excess insurance. We also record a receivable for the expected reimbursement of losses covered by
our excess insurance. Since we believe that the amount and timing of our future claims payments
are reliably determinable, we discount the amount we accrue for losses resulting from professional
liability claims using the risk-free interest rate corresponding to the timing of our expected
payments.
The net present value of the projected payments was discounted using
a weighted-average
risk-free rate of 1.3% and 1.4% in 2010 and 2009, respectively. This liability is adjusted for new
claims information in the period such information becomes known to us. Professional malpractice
expense includes the losses resulting from professional liability claims and loss adjustment
expense, as well
as paid excess insurance premiums, and is presented within other operating expenses in the
accompanying condensed consolidated statements of income.
46
Our processes for obtaining and analyzing claims and incident data
are standardized across all
of our hospitals and have been consistent for many years. We monitor the outcomes of the medical
care services that we provide and for each reported claim, we obtain various information concerning
the facts and circumstances related to that claim. In addition, we routinely monitor current key
statistics and volume indicators in our assessment of utilizing historical trends. The average lag
period between claim occurrence and payment of a final settlement is between four and five years,
although the facts and circumstances of individual claims could result in the timing of such
payments being different from this average. Since claims are paid promptly after settlement with
the claimant is reached, settled claims represent less than 1.0% of the total liability at the end
of any period.
For purposes of estimating our individual claim accruals, we utilize
specific claim
information, including the nature of the claim, the expected claim amount, the year in which the
claim occurred and the laws of the jurisdiction in which the claim occurred. Once the case accruals
for known claims are determined, information is stratified by loss layers and retentions, accident
years, reported years, geography, and claims relating to the acquired Triad hospitals versus claims
relating to our other hospitals. Several actuarial methods are used against this data to produce
estimates of ultimate paid losses and reserves for incurred but not reported claims. Each of these
methods uses our company-specific historical claims data and other information. This
company-specific data includes information regarding our business, including historical paid losses
and loss adjustment expenses, historical and current case loss reserves, actual and projected
hospital statistical data, a variety of hospital census information, employed physician
information, professional liability retentions for each policy year, geographic information and
other data.
Based on these analyses we determine our estimate of the
professional liability claims. The
determination of managements estimate, including the preparation of the reserve analysis that
supports such estimate, involves subjective judgment of management. Changes in reserving data or
the trends and factors that influence reserving data may signal fundamental shifts in our future
claim development patterns or may simply reflect single-period anomalies. Even if a change reflects
a fundamental shift, the full extent of the change may not become evident until years later.
Moreover, since our methods and models use different types of data and we select our liability from
the results of all of these methods, we typically cannot quantify the precise impact of such
factors on our estimates of the liability. Due to our standardized and consistent processes for
handling claims and the long history and depth of our company-specific data, our methodologies have
produced reliably determinable estimates of ultimate paid losses.
We are primarily self-insured for these claims; however, we obtain
excess insurance that
transfers the risk of loss to a third-party insurer for claims in excess of our self-insured
retentions. Our excess insurance is underwritten on a claims-made basis. For claims reported prior
to June 1, 2002, substantially all of our professional and general liability risks were subject to
a $0.5 million per occurrence self-insured retention and for claims reported from June 1, 2002
through June 1, 2003, these self-insured retentions were $2.0 million per occurrence. Substantially
all claims reported after June 1, 2003 and before June 1, 2005 are self-insured up to $4 million
per claim. Substantially all claims reported on or after June 1, 2005 are self-insured up to $5
million per claim. Management, on occasion, has selectively increased the insured risk at certain
hospitals based upon insurance pricing and other factors and may continue that practice in the
future. Excess insurance for all hospitals has been purchased through commercial insurance
companies and generally covers us for liabilities in excess of the self-insured retentions. The
excess coverage consists of multiple layers of insurance, the sum of which totals up to $95 million
per occurrence and in the aggregate for claims reported on or after June 1, 2003 and up to $145
million per occurrence and in the aggregate for claims incurred and reported after January 1, 2008.
For certain policy years, if the first aggregate layer of excess coverage becomes fully utilized,
then the self-insured retention could increase to $10 million per claim for any subsequent claims
in that policy year until our total aggregate coverage is met.
Effective January 1, 2008, the former Triad hospitals are
insured on a claims-made basis as
described above and through commercial insurance companies as described above for substantially all
claims occurring on or after January 1, 2002 and reported on or after January 1, 2008.
Substantially all losses for the former Triad hospitals in periods prior to May 1, 1999 were
insured through a wholly-owned insurance subsidiary of HCA Inc., or HCA, Triads owner prior to
that time, and excess loss policies maintained by HCA. HCA has agreed to indemnify the former Triad
hospitals in respect of claims covered by such insurance policies arising prior to May 1, 1999.
From May 1, 1999 through December 31, 2006, the former Triad hospitals obtained insurance coverage
on a claims incurred basis from HCAs wholly-owned insurance subsidiary with excess coverage
obtained from other carriers that is subject to certain deductibles. Effective for claims incurred
after December 31, 2006, Triad began insuring its claims from $1 million to $5 million through its
wholly-owned captive insurance company, replacing the coverage provided by HCA. Substantially all
claims occurring during 2007 were self-insured up to $10 million per claim.
There have been no significant changes in our estimate of the
reserve for professional
liability claims during the three months ended March 31, 2011.
47
Income Taxes
We must make estimates in recording provision for income taxes,
including determination of
deferred tax assets and deferred tax liabilities and any valuation allowances that might be
required against the deferred tax assets. We believe that future income will enable us to realize
certain deferred tax assets, subject to the valuation allowance we have established.
The total amount of unrecognized benefit that would impact the
effective tax rate, if
recognized, was approximately $7.2 million as of March 31, 2011. It is our policy to recognize
interest and penalties related to unrecognized benefits in our condensed consolidated statements of
income as income tax expense. A total of approximately $1.4 million of interest and penalties is
included in the amount of liability for uncertain tax positions at March 31, 2011. During the
three months ended March 31, 2011, we decreased liabilities by $0.2 million and increased interest
and penalties by approximately $0.1 million.
We believe it is reasonably possible that approximately
$2.3 million of our current
unrecognized tax benefit may be recognized within the next 12 months as a result of a lapse of the
statute of limitations and settlements with taxing authorities.
We, or one or more of our subsidiaries, file income tax returns in
the U.S. federal
jurisdiction and various state jurisdictions. We have extended the federal statute of limitations
for Triad for the tax periods ended December 31, 1999, December 31, 2000, April 30, 2001, June 30,
2001, December 31, 2001, December 31, 2002 and December 31, 2003. We are currently under
examination by the Internal Revenue Service, or IRS, regarding the federal tax return of Triad for
the tax periods ended December 31, 2004, December 31, 2005, December 31, 2006 and July 25, 2007. We
believe the results of this examination will not be material to our consolidated results of
operations or consolidated financial position. With few exceptions, we are no longer subject to
state income tax examinations for years prior to 2007 and federal income tax examinations with
respect to Community Health Systems, Inc. federal returns for years prior to 2007. Our federal
income tax returns for the 2007 and 2008 tax years are currently under examination by the IRS. We
believe the results of this examination will not be material to our consolidated results of
operations or consolidated financial position.
Recent Accounting Pronouncements
In August 2010, the Financial Accounting Standards Board, or
FASB, issued Accounting Standards
Update, or ASU, 2010-24, which provides clarification to companies in the healthcare industry on
the accounting for professional liability insurance. This ASU states that receivables related to
insurance recoveries should not be netted against the related claim liability and such claim
liabilities should be determined without considering insurance recoveries. This ASU is effective
for fiscal years beginning after December 15, 2010 and was adopted by us on January 1, 2011. The
adoption of this ASU had an immaterial impact to the condensed consolidated balance sheet at March
31, 2011 and no impact to the condensed consolidated statement of income for the three months ended
March 31, 2011.
In August 2010, the FASB issued ASU 2010-23, which requires a
company in the healthcare
industry to use its direct and indirect costs of providing charity care as the measurement basis
for charity care disclosures. This ASU also requires additional disclosures of the method used to
determine such costs. We adopted this ASU on January 1, 2011. In the ordinary course of business,
we render services to patients who are financially unable to pay for hospital care. Included in the
provision for contractual allowances is the value (at our standard charges) of these services to
patients who are unable to pay that is eliminated from net operating revenues when it is determined
they qualify under our charity care policy. The estimated cost incurred by us to provide these
services to patients who are unable to pay was approximately $30.7 million and $26.2 million for
the three months ended March 31, 2011 and 2010, respectively. The estimated cost of these charity
care services was determined using a ratio of cost to gross charges and applying that ratio to the
gross charges associated with providing care to charity patients for the period. Gross charges
associated with providing care to charity patients includes only the related charges for those
patients who are financially unable to pay and qualify under our charity care policy and that do
not otherwise qualify for reimbursement from a governmental program.
FORWARD-LOOKING STATEMENTS
Some of the matters discussed in this report include forward-looking
statements. Statements
that are predictive in nature, that depend upon or refer to future events or conditions or that
include words such as expects, anticipates, intends, plans, believes, estimates,
thinks, and similar expressions are forward-looking statements. These statements involve known
and
unknown risks, uncertainties, and other factors that may cause our actual results and
performance to be materially different from any future results or performance expressed or implied
by these forward-looking statements. These factors include the following:
48
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|
|
general economic and business conditions, both nationally and in the regions in which
we operate; |
|
|
|
|
implementation and effect of recently-adopted and potential federal and state
healthcare legislation; |
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|
risks associated with our substantial indebtedness, leverage and debt service
obligations; |
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demographic changes; |
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changes in, or the failure to comply with, governmental regulations; |
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potential adverse impact of known and unknown government investigations, audits, and
Federal and State False Claims Act litigation; |
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our ability, where appropriate, to enter into and maintain managed care provider
arrangements and the terms of these arrangements; |
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changes in, or the failure to comply with, managed care provider contracts could result
in disputes and changes in reimbursement that could be applied retroactively; |
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changes in inpatient or outpatient Medicare and Medicaid payment levels; |
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increases in the amount and risk of collectability of patient accounts receivable; |
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increases in wages as a result of inflation or competition for highly technical
positions and rising supply costs due to market pressure from pharmaceutical companies and
new product releases; |
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liabilities and other claims asserted against us, including self-insured malpractice
claims; |
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competition; |
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our ability to attract and retain, without significant employment costs, qualified
personnel, key management, physicians, nurses and other healthcare workers; |
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trends toward treatment of patients in less acute or specialty healthcare settings,
including ambulatory surgery centers or specialty hospitals; |
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changes in medical or other technology; |
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changes in U.S. GAAP; |
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the availability and terms of capital to fund additional acquisitions or replacement
facilities; |
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our ability to successfully acquire additional hospitals and complete the sale of
hospitals held for sale; |
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our ability to successfully integrate any acquired hospitals or to recognize expected
synergies from such acquisitions; |
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our ability to obtain adequate levels of general and professional liability insurance;
and |
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timeliness of reimbursement payments received under government programs. |
Although we believe that these statements are based upon reasonable
assumptions, we can give
no assurance that our goals will be achieved. Given these uncertainties, prospective investors are
cautioned not to place undue reliance on these forward-looking statements. These forward-looking
statements are made as of the date of this filing. We assume no obligation to update or revise them
or provide reasons why actual results may differ.
Item 3. Quantitative and Qualitative Disclosures about Market Risk
We are exposed to interest rate changes, primarily as a result of
our Credit Facility which
bears interest based on floating rates. In order to manage the volatility relating to the market
risk, we entered into interest rate swap agreements described under the heading
Liquidity and Capital Resources in Item 2. We do not anticipate any material changes in our
primary market risk exposures in 2011. We utilize risk management procedures and controls in
executing derivative financial instrument transactions. We do not execute
49
transactions or hold
derivative financial instruments for trading purposes. Derivative financial instruments related to
interest rate sensitivity of debt obligations are used with the goal of mitigating a portion of the
exposure when it is cost effective to do so.
A 1% change in interest rates on variable rate debt in excess of
that amount covered by
interest rate swaps would have resulted in interest expense fluctuating approximately $1.6 million
and $1.7 million for the three months ended March 31, 2011 and 2010, respectively.
Item 4. Controls and Procedures
Our Chief Executive Officer and Chief Financial Officer, with the
participation of other
members of management, have evaluated the effectiveness of our disclosure controls and procedures
(as defined in Rules 13a-15(e) and 15d-15(e) under the Securities and Exchange Act of 1934, as
amended), as of the end of the period covered by this report. Based on such evaluations, our Chief
Executive Officer and Chief Financial Officer concluded that, as of such date, our disclosure
controls and procedures were effective (at the reasonable assurance level) to ensure that the
information required to be included in this report has been recorded, processed, summarized and
reported within the time periods specified in the Commissions rules and forms and to ensure that
the information required to be included in this report was accumulated and communicated to
management, including our Chief Executive Officer and Chief Financial Officer, to allow timely
decisions regarding required disclosure.
There have been no changes in our internal control over financial
reporting during the quarter
ended March 31, 2011, that have materially affected or are reasonably likely to materially affect
our internal control over financial reporting.
PART II OTHER INFORMATION
Item 1. Legal Proceedings
From time to time, we receive various inquiries or subpoenas from
state regulators, fiscal
intermediaries, the Centers for Medicare and Medicaid Services and the Department of Justice
regarding various Medicare and Medicaid issues. In addition to the
subpoenas discussed below, we are currently responding to subpoenas for
matters such as: blood administration practices of a single physician at an Illinois hospital, DME
vendor relationships and patient choice discharge instructions at our Washington hospitals, and
operations of a cardiovascular surgery department at our Oregon hospital. In addition, we are
subject to other claims and lawsuits arising in the ordinary course of our business. We are not
aware of any pending or threatened litigation that is not covered by insurance policies or reserved
for in our financial statements or which we believe would have a material adverse impact on us;
however, some pending or threatened proceedings against us may involve potentially substantial
amounts as well as the possibility of civil, criminal, or administrative fines, penalties, or other
sanctions, which could be material. Settlements of suits involving Medicare and Medicaid issues
routinely require both monetary payments as well as corporate integrity agreements. Additionally,
qui tam or whistleblower actions initiated under the civil False Claims Act may be pending but
placed under seal by the court to comply with the False Claims Acts requirements for filing such
suits.
Community Health Systems, Inc. Legal Proceedings
On February 10, 2006, we received a letter from the Civil
Division of the Department of
Justice requesting documents in an investigation it was conducting involving the Company. The
inquiry related to the way in which different state Medicaid programs apply to the federal
government for matching or supplemental funds that are ultimately used to pay for a small portion
of the services provided to Medicaid and indigent patients. These programs are referred to by
different names, including intergovernmental payments, upper payment limit programs, and
Medicaid disproportionate share hospital payments. The February 2006 letter focused on our
hospitals in three states: Arkansas, New Mexico, and South Carolina. On August 31, 2006, we
received a follow up letter from the Department of Justice requesting additional documents relating
to the programs in New Mexico and the payments to the Companys three hospitals in that state.
Through the beginning of 2009, we provided the Department of Justice with requested documents, met
with its personnel on numerous occasions, and otherwise cooperated in its investigation. During the
course of the investigation, the Civil Division notified us that it believed that we and these
three New Mexico hospitals caused the State of New Mexico to submit improper claims for federal
funds, in violation of the Federal False Claims Act. At one point, the Civil Division calculated
that the three hospitals received ineligible federal participation payments from August 2000 to
June 2006 of approximately $27.5 million and said that if it proceeded to trial, it would seek
treble damages plus an appropriate penalty for each of the violations of the Federal False Claims
Act. This investigation has culminated in the federal governments intervention in a qui tam
lawsuit styled
U.S. ex rel. Baker vs. Community Health Systems, Inc., pending in the United States District
Court for the District of New Mexico. The federal government filed its complaint in intervention on
June 30, 2009. The relator filed a second amended complaint on July 1,
50
2009. Both of these
complaints expand the time period during which alleged improper payments were made. We filed
motions to dismiss all of the federal governments and the relators claims on August 28, 2009. On
March 19, 2010, the court granted in part and denied in part our motion to dismiss as to the
relators complaint. On July 7, 2010, the court denied our motion to dismiss the federal
governments complaint in intervention. We have filed our answer and pretrial discovery has begun.
We are vigorously defending this action.
On June 12, 2008, two of our hospitals received letters from
the U.S. Attorneys Office for
the Western District of New York requesting documents in an investigation it was conducting into
billing practices with respect to kyphoplasty procedures performed during the period January 1,
2002 through June 9, 2008. On September 16, 2008, one of our hospitals in South Carolina also
received an inquiry. Kyphoplasty is a surgical spine procedure that returns a compromised vertebrae
(either from trauma or osteoporotic disease process) to its previous height, reducing or
eliminating severe pain. We have been informed that similar investigations have been initiated at
unaffiliated facilities in Alabama, South Carolina, Indiana and other states. We believe that this
investigation is related to a qui tam settlement between the same U.S. Attorneys office and the
manufacturer and distributor of the Kyphon product, which is used in performing the kyphoplasty
procedure. We are cooperating with the investigation by collecting and producing material
responsive to the requests. We are continuing to evaluate and discuss this matter with the federal
government.
On April 19, 2009, we were served in Roswell, New Mexico with
an answer and counterclaim in
the case of Roswell Hospital Corporation d/b/a Eastern New Mexico Medical Center vs. Patrick
Sisneros and Tammie McClain (sued as Jane Doe Sisneros). The case was originally filed as a
collection matter. The counterclaim was filed as a putative class action and alleged theories of
breach of contract, unjust enrichment, misrepresentation, prima facie tort, Fair Trade Practices
Act and violation of the New Mexico RICO statute. On May 7, 2009, the hospital filed a notice of
removal to federal court. On July 27, 2009, the case was remanded to state court for lack of a
federal question. A motion to dismiss and a motion to dismiss misjoined counterclaim plaintiffs
were filed on October 20, 2009. These motions were denied. Extensive discovery has been conducted.
A motion for class certification for all uninsured patients was heard on March 3 through March 5,
2010 and on April 13, 2010, the state district court judge certified the case as a class action.
Discovery is ongoing. A hearing was conducted on March 1, 2011 to assess the sufficiency of the
methodology used to determine class damages and the court has the matter under advisement. We are
vigorously defending this action.
On December 7, 2009, we received a document subpoena from the
U.S. Department of Health and
Human Services, Office of the Inspector General, or OIG, requesting documents related to our
hospital in Laredo, Texas. The categories of documents requested included case management, resource
management, admission criteria, patient medical records, coding, billing, compliance, the Joint
Commission accreditation, physician documentation, payments to referral sources, transactions
involving physicians, disproportionate share hospital status, and audits by the hospitals Quality
Improvement organization. On January 22, 2010, we received a request for information or
assistance from the OIGs Office of Investigation requesting patient medical records from Laredo
Medical Center in Laredo, Texas for certain Medicaid patients with an extended length of stay.
Additional requests for records have also been received, including a request containing follow-up
questions received on January 5, 2011. We are cooperating fully with these investigations.
On September 20, 2010, we received a letter from the U.S.
Department of Justice, Civil
Division, advising us that an investigation is being conducted to determine whether certain
hospitals have improperly submitted claims for payment for implantable cardioverter defibrillators,
or ICD. The period of time covered by the investigation is 2003 to the present. The letter states
that the Department of Justices data indicates that many of our hospitals have claims that need to
be reviewed to determine if Medicare payment was appropriate. We understand that the Department of
Justice has submitted similar requests to many other hospitals and hospital systems across the
country as well as to the ICD manufacturers themselves. We are fully cooperating with the
government in this investigation. Because we are in the early stages of this investigation, we are
unable to evaluate the outcome of this investigation.
On November 15, 2010, we were served with substantially
identical Civil Investigative Demands
(CIDs) from the Office of Attorney General, State of Texas for all our 18 affiliated Texas
hospitals. The subject of the requests appears to concern emergency department procedures and
billing. We are cooperating fully with these requests. Because we are in the early stages of this
investigation, we are unable to evaluate the outcome of this investigation.
On April 8, 2011, we received a document subpoena, dated
March 31, 2011, from the U.S.
Department of Health and Human Services, OIG, in connection with an investigation of possible
improper claims submitted to Medicare and Medicaid. The subpoena, issued from the OIGs Chicago,
Illinois office, requested documents from all of our hospitals and appears to concern emergency
department processes and procedures, including our hospitals use of the Pro-MED Clinical
Information System, which is a third-party software system that assists with the management of
patient care and provides operational support and data collection for emergency
department management and has the ability to track discharge, transfer and admission
recommendations of emergency department physicians. The subpoena also requests other information
about our relationships with emergency department physicians, including
51
financial arrangements.
The subpoenas requests are very similar to those contained in the Civil Investigative Demands
received by our Texas hospitals from the Office of the Attorney General of the State of Texas on
November 15, 2010 (described above).
On April 11, 2011, Tenet Healthcare Corporation, or Tenet,
filed suit against the Company,
Wayne T. Smith and W. Larry Cash in the U.S. District Court for the Northern District of Texas.
The suit alleges we committed violations of certain federal securities laws by making certain
statements in various proxy materials filed with the Securities and Exchange Commission in
connection with our offer to purchase Tenet. Tenet alleges that we engaged in a practice to
under-utilize observation status and over-utilize inpatient admission status and asserts that by
doing so, we created undisclosed financial and legal liability to federal, state and private
payors. The suit seeks declaratory and injunctive relief and Tenets costs. On April 19, 2011, we
filed a motion to dismiss the complaint.
Until the court rules on the motion to dismiss, the Company and other defendants are not required to file a formal answer to the complaint,
however, on April 28, 2011, we responded to the allegations during our earnings release conference call
(see our Form 8-K furnished on April 28, 2011).
We will continue to vigorously defend this suit.
On April 22, 2011, a joint motion was filed by the relator and the U.S. Department
of Justice in the case styled United States ex rel. and Reuille vs. Community Health Systems Professional
Services Corporation and Lutheran Musculoskeletal Center, LLC d/b/a Lutheran Hospital, in the United
States District Court for the Northern District of Indiana, Fort Wayne Division. The lawsuit was originally
filed under seal on January 7, 2009. The suit is brought under the False Claims Act and alleges that
Lutheran Hospital of Indiana billed the Medicare program for (a) false 23 hour observation after outpatient
surgeries and procedures, and (b) intentional assignment of inpatient status to one-day stays for cases that
do not meet Medicare criteria for inpatient intensity of service or severity of illness. The relator had worked
in the case management department of Lutheran Hospital of Indiana but was reassigned to another
department in the fall of 2006. This facility was acquired by us as part of the July 25, 2007 merger
transaction with Triad Hospitals, Inc. The complaint also includes allegations of age discrimination in Ms.
Reuilles 2006 reassignment and retaliation in connection with her resignation on October 1, 2008. We had
cooperated fully with the government in its investigation of this matter, but had been unaware of the exact
nature of the allegations in the complaint. On December 27, 2010, the government filed a notice that it
declined to intervene in this suit. The current motion contains additional information about how the
government intends to proceed with an investigation regarding allegations of improper billing for inpatient
care at other hospitals associated with Community Health Systems, Inc. . . . asserted in other qui tam
complaints in other jurisdictions. The motion states that the Department of Justice has now consolidated
its investigations of the Company and other related entities and that the Civil Division of the Department
of Justice, multiple United States Attorneys offices, and the Office of Inspector General for the Department
of Health and Human Services, or HHS, are now closely coordinating their investigation of these
overlapping allegations. The Attorney General of Texas has initiated an investigation; the United States
intends to work cooperatively with Texas and any other States investigating these allegations. The motion
also states that the Office of Audit Services for the Office of Investigations for HHS has been engaged to
conduct a national audit of certain of the Companys Medicare claims. The government confirmed that it
considers the allegations made in the complaint styled Tenet Healthcare Corporation vs. Community Health
Systems, Inc., et al. filed in the United States District Court for the Northern District of Texas, Dallas
Division on April 11, 2011 to be related to the allegations in the qui tam and to what the government is now
describing as a consolidated investigation. Because qui tam suits are filed under seal, no one but the
relator and the government knows that the suit has been filed or what allegations are being made by the
relator on behalf of the government. Initially, the government has 60 days to make a determination about
whether to intervene in a case and to act as the plaintiff or to decline to intervene and allow the relator to
act as the plaintiff in the suit, but extensions of time are frequently granted to allow the government
additional time to investigate the allegations. Even if, in the course of an investigation, the court partially
unseals a complaint to allow the government and a defendant to work to a resolution of the complaints
allegations, the defendant is prohibited from revealing to anyone even that the partial unsealing has
occurred. As the investigation proceeds, we may learn of additional qui tam suits filed against us or our
affiliated hospitals or related entities, or that contact letters, document requests, or medical record requests
we have received in the past from various governmental agencies are generated from qui tam cases filed
under seal. The motion filed on April 22, 2011 concludes by requesting a stay of the litigation in the
Reuille case for 180 days, and on April 25, 2011, the court granted
the motion. Our management company subsidiary, Community Health Systems Professional
Services Corporation, the defendant in the Reuille case, consented to the request for the stay. We are cooperating fully with the government in its investigations and is
currently unable to predict the outcome of these investigations.
Triad
Hospitals, Inc. Legal Proceedings
In a case
styled U.S. ex rel. Bartlett vs. Quorum Health Resources, Inc., et al., pending in the Western
District of Pennsylvania, Johnstown Division, the relator alleges in his second amended complaint,
filed in January 2006 (the first amended complaint having been
dismissed), that QHR conspired
with an unaffiliated hospital to pay illegal remuneration in
violation of the federal anti-kickback
statute and the Stark Law, thus causing false claims to be filed. A renewed motion to dismiss
was filed in March 2006 asserting that the second amended complaint did not cure the
defects contained in the first amended complaint. In September 2006, the hospital and one of
the other defendants affiliated with the hospital filed for protection under Chapter 11 of
the federal bankruptcy code, which imposed an automatic stay on proceedings in the case.
Relators entered into a settlement agreement with the hospital, subject to confirmation of
the hospitals reorganization plan. The District Court conducted a status conference on January
30, 2009 and later convened another conference on March 30, 2009 and heard arguments on whether
to proceed with a motion to dismiss, but did not make a ruling. The government and relator have
reached a settlement with the hospital. On March 22, 2011, the court denied all defendants motions
to dismiss. We believe this case is without merit and will continue
to vigorously defend it.
Item 1A. Risk Factors
There have been no material changes with regard to risk factors
previously disclosed in our
most recent annual report on Form 10-K.
Item 2. Unregistered Sales of Equity Securities and Use of Proceeds
We have not paid any cash dividends since our inception, and do not
anticipate the payment of
cash dividends in the foreseeable future. Our Credit Facility limits our ability to pay dividends
and/or repurchase stock to an amount not to exceed $50 million in the aggregate after November 5,
2010, the date of our amendment and restatement of our Credit Facility. In addition, our Credit
Facility allows us to repurchase stock in an amount not to exceed the aggregate amount of proceeds
from the exercise of stock options. The indenture governing our Notes also limits our ability to
pay dividends and/or repurchase stock. As of March 31, 2011, under the most restrictive test under
these agreements, we have approximately $65.1 million remaining available with which to pay
permitted dividends and/or make stock and Note repurchases.
Item 3. Defaults Upon Senior Securities
None
Item 4. (Removed and Reserved)
Item 5. Other Information
None
52
Item 6. Exhibits
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No. |
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Description |
10.1
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Form of Nonqualified Stock Option Agreement (Employee) for Community Health Systems, Inc. 2009
Stock Option and Award Plan |
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10.2
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Form of Restricted Stock Award Agreement for Community Health Systems, Inc. 2009 Stock Option and
Award Plan |
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10.3
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|
Form of Performance Based Restricted Stock Award Agreement (Most Highly Compensated Executive
Officers) for Community Health Systems, Inc. 2009 Stock Option and Award Plan |
|
|
|
10.4
|
|
Form of Director Restricted Stock Unit Award Agreement for Community Health Systems, Inc. 2009
Stock Option and Award Plan |
|
|
|
12
|
|
Computation of Ratio of Earnings to Fixed Charges |
|
|
|
31.1
|
|
Certification of Chief Executive Officer pursuant to Section 302 of the Sarbanes-Oxley Act of 2002 |
|
|
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31.2
|
|
Certification of Chief Financial Officer pursuant to Section 302 of the Sarbanes-Oxley Act of 2002 |
|
|
|
32.1
|
|
Certification of Chief Executive Officer pursuant to 18 U.S.C. Section 1350, adopted pursuant to
Section 906 of the Sarbanes-Oxley Act of 2002 |
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32.2
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|
Certification of Chief Financial Officer pursuant to 18 U.S.C. Section 1350, adopted pursuant to
Section 906 of the Sarbanes-Oxley Act of 2002 |
|
|
|
101.INS
|
|
XBRL Instance Document* |
|
|
|
101.SCH
|
|
XBRL Schema Document* |
|
|
|
101.CAL
|
|
XBRL Calculation Linkbase Document* |
|
|
|
101.LAB
|
|
XBRL Label Linkbase Document* |
|
|
|
101.PRE
|
|
XBRL Presentation Linkbase Document* |
|
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|
|
Indicates a management contract or compensatory plan or arrangement. |
|
* |
|
Pursuant to applicable securities laws and regulations, we are deemed to have complied with the
reporting obligation relating to the submission of interactive data files in such exhibits and are
not subject to liability under any anti-fraud provisions of the federal securities laws as long as
we have made a good faith attempt to comply with the submission requirements and promptly amend the
interactive data files after becoming aware that the interactive data files fail to comply with the
submission requirements. Users of this data are advised pursuant to Rule 406T of Regulation S-T
that this interactive data file is deemed not filed or part of a registration statement or
prospectus for purposes of sections 11 or 12 of the Securities Act of 1933, is deemed not filed for
purposes of section 18 of the Securities Exchange Act of 1934, and otherwise is not subject to
liability under these sections. |
53
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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COMMUNITY HEALTH SYSTEMS, INC.
(Registrant)
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By: |
/s/ Wayne T. Smith
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Wayne T. Smith |
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Chairman of the Board,
President and Chief Executive Officer
(principal executive officer) |
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By: |
/s/ W. Larry Cash
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W. Larry Cash |
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Executive Vice President, Chief Financial
Officer and Director
(principal financial officer) |
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By: |
/s/ T. Mark Buford
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T. Mark Buford |
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Senior Vice President and Chief Accounting Officer
(principal accounting officer) |
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Date: April 29, 2011
54
Index to Exhibits
|
|
|
No. |
|
Description |
10.1
|
|
Form of Nonqualified Stock Option Agreement (Employee) for Community Health Systems, Inc. 2009
Stock Option and Award Plan |
|
|
|
10.2
|
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Form of Restricted Stock Award Agreement for Community Health Systems, Inc. 2009 Stock Option and
Award Plan |
|
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10.3
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|
Form of Performance Based Restricted Stock Award Agreement (Most Highly Compensated Executive
Officers) for Community Health Systems, Inc. 2009 Stock Option and Award Plan |
|
|
|
10.4
|
|
Form of Director Restricted Stock Unit Award Agreement for Community Health Systems, Inc. 2009
Stock Option and Award Plan |
|
|
|
12
|
|
Computation of Ratio of Earnings to Fixed Charges |
|
|
|
31.1
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Certification of Chief Executive Officer pursuant to Section 302 of the Sarbanes-Oxley Act of 2002 |
|
|
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31.2
|
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Certification of Chief Financial Officer pursuant to Section 302 of the Sarbanes-Oxley Act of 2002 |
|
|
|
32.1
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|
Certification of Chief Executive Officer pursuant to 18 U.S.C. Section 1350, adopted pursuant to
Section 906 of the Sarbanes-Oxley Act of 2002 |
|
|
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32.2
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|
Certification of Chief Financial Officer pursuant to 18 U.S.C. Section 1350, adopted pursuant to
Section 906 of the Sarbanes-Oxley Act of 2002 |
|
|
|
101.INS
|
|
XBRL Instance Document* |
|
|
|
101.SCH
|
|
XBRL Schema Document* |
|
|
|
101.CAL
|
|
XBRL Calculation Linkbase Document* |
|
|
|
101.LAB
|
|
XBRL Label Linkbase Document* |
|
|
|
101.PRE
|
|
XBRL Presentation Linkbase Document* |
|
|
|
|
|
Indicates a management contract or compensatory plan or arrangement. |
|
* |
|
Pursuant to applicable securities laws and regulations, we are deemed to have complied with the
reporting obligation relating to the submission of interactive data files in such exhibits and are
not subject to liability under any anti-fraud provisions of the federal securities laws as long as
we have made a good faith attempt to comply with the submission requirements and promptly amend the
interactive data files after becoming aware that the interactive data files fail to comply with the
submission requirements. Users of this data are advised pursuant to Rule 406T of Regulation S-T
that this interactive data file is deemed not filed or part of a registration statement or
prospectus for purposes of sections 11 or 12 of the Securities Act of 1933, is deemed not filed for
purposes of section 18 of the Securities Exchange Act of 1934, and otherwise is not subject to
liability under these sections. |
55