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UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549


Form 10-Q

(Mark One)

þ   QUARTERLY REPORT PURSUANT TO SECTION 13 OR 15(d) OF THE SECURITIES EXCHANGE ACT OF 1934
     
    For the quarterly period ended June 30, 2004

OR

     
o   TRANSITION REPORT PURSUANT TO SECTION 13 OR 15(d) OF THE SECURITIES EXCHANGE ACT OF 1934
     
    For the transition period from ________ to ________

Commission file number: 000-50574


Symbion, Inc.

(Exact Name of Registrant as Specified in its Charter)
     
Delaware
(State or Other Jurisdiction of
Incorporation or Organization)
  62-1625480
(I.R.S. Employer
Identification No.)
     
40 Burton Hills Boulevard, Suite 500
Nashville, Tennessee

(Address Of Principal Executive Offices)
  37215
(Zip Code)
(615) 234-5900
(Registrant’s Telephone Number, Including Area Code)

     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 is an accelerated filer (as defined in Rule 12b-2 of the Exchange Act). Yes o No þ

     As of July 31, 2004, there were 20,920,766 shares of the registrant’s common stock outstanding.



 


TABLE OF CONTENTS

PART I FINANCIAL INFORMATION
Item 1. Financial Statements
CONDENSED CONSOLIDATED BALANCE SHEETS
CONDENSED CONSOLIDATED STATEMENTS OF OPERATIONS
CONDENSED CONSOLIDATED STATEMENTS OF CASH FLOWS
NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS
Item 2. Management’s Discussion and Analysis of Financial Condition and Results of Operations
Item 3. Quantitative and Qualitative Disclosures about Market Risk
Item 4. Controls and Procedures
PART II OTHER INFORMATION
Item 2. Changes in Securities, Use of Proceeds and Issuer Purchases of Equity Securities
Item 4. Submission of Matters to a Vote of Security Holders
Item 6. Exhibits and Reports on Form 8-K
SIGNATURES
EXHIBIT INDEX
EX-31.1 SECTION 302 CEO CERTIFICATION
EX-31.2 SECTION 302 CFO CERTIFICATION
EX-32.1 SECTION 906 CEO CERTIFICATION
EX-32.2 SECTION 906 CFO CERTIFICATION


Table of Contents

PART I FINANCIAL INFORMATION

Item 1. Financial Statements.

SYMBION, INC.

CONDENSED CONSOLIDATED BALANCE SHEETS

(dollars in thousands, except per share amounts)
                 
    December 31,   June 30,
    2003
  2004
    (audited)
  (unaudited)
ASSETS
               
Current assets:
               
Cash and cash equivalents
  $ 17,658     $ 20,837  
Accounts receivable, less allowance for doubtful accounts $12,532 and $12,978, respectively
    21,673       21,845  
Inventories
    5,371       5,569  
Prepaid expenses and other current assets
    4,380       4,513  
 
   
 
     
 
 
Total current assets
    49,082       52,764  
Property and equipment:
               
Land
    1,276       1,301  
Buildings and improvements
    32,845       33,692  
Furniture and equipment
    48,854       53,322  
Computers and software
    6,645       5,945  
 
   
 
     
 
 
 
    89,620       94,260  
Less accumulated depreciation
    (26,906 )     (32,281 )
 
   
 
     
 
 
Property and equipment, net
    62,714       61,979  
Goodwill
    116,654       151,899  
Other intangible assets, net
    1,022       986  
Investments in and advances to affiliates
    13,778       20,128  
Other assets
    9,534       3,493  
 
   
 
     
 
 
Total assets
  $ 252,784     $ 291,249  
 
   
 
     
 
 
LIABILITIES AND STOCKHOLDERS’ EQUITY
               
Current liabilities:
               
Accounts payable
  $ 3,800     $ 4,826  
Accrued payroll and benefits
    6,533       6,052  
Other accrued expenses
    9,139       7,128  
Current maturities of long-term debt
    3,631       2,234  
 
   
 
     
 
 
Total current liabilities
    23,103       20,240  
Long-term debt, less current maturities
    101,037       18,906  
Other liabilities
    4,609       5,459  
Convertible debentures
    3,071        
Minority interests
    16,949       17,375  
Stockholders’ equity:
               
Preferred stock, $0.01 par value; 16,946,316 shares authorized at December 31, 2003 and 10,000,000 at June 30, 2004:
               
Series A convertible preferred stock, 4,341,726 shares designated, issued and outstanding at December 31, 2003 and no shares designated, issued and outstanding at June 30, 2004
    13,590        
Series B convertible preferred stock, 2,604,590 shares designated, issued and outstanding at December 31, 2003 and no shares designated, issued and outstanding at June 30, 2004
    8,152        
Common stock, 225,000,000 shares, $0.01 par value, authorized at December 31, 2003 and at June 30, 2004; 10,612,687 shares issued and outstanding at December 31, 2003 and 20,913,121 shares issued and outstanding at June 30, 2004
    106       209  
Additional paid-in-capital
    61,746       202,453  
Stockholder notes receivable
    (305 )     (313 )
Retained earnings
    20,726       26,920  
 
   
 
     
 
 
Total stockholders’ equity
    104,015       229,269  
 
   
 
     
 
 
Total liabilities and stockholders’ equity
  $ 252,784     $ 291,249  
 
   
 
     
 
 

See accompanying notes.

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SYMBION, INC.

CONDENSED CONSOLIDATED STATEMENTS OF OPERATIONS

(in thousands, except per share amounts)
(unaudited)
                                 
    Three Months Ended   Six Months Ended
    June 30,
  June 30,
    2003
  2004
  2003
  2004
Revenues
  $ 44,053     $ 52,727     $ 85,508     $ 104,674  
Operating expenses:
                               
Salaries and benefits
    11,326       13,738       22,228       27,319  
Supplies
    8,590       10,563       16,209       20,846  
Professional and medical fees
    2,362       2,708       4,487       5,306  
Rent and lease expense
    2,665       3,282       5,326       6,439  
Other operating expenses
    3,519       4,556       6,802       8,926  
 
   
 
     
 
     
 
     
 
 
Cost of revenues
    28,462       34,847       55,052       68,836  
General and administrative expense
    4,178       4,633       8,089       9,177  
Depreciation and amortization
    2,273       2,746       4,512       5,458  
Provision for doubtful accounts
    670       832       1,070       1,529  
Income on equity investments
    (55 )     (366 )     (158 )     (487 )
Impairment and loss on disposal of long-lived assets
                      16  
Gain on sale of long-lived assets
          (77 )           (157 )
 
   
 
     
 
     
 
     
 
 
Total operating expenses
    35,528       42,615       68,565       84,372  
 
   
 
     
 
     
 
     
 
 
Operating income
    8,525       10,112       16,943       20,302  
Minority interests in income of consolidated subsidiaries
    (3,036 )     (3,538 )     (5,930 )     (6,958 )
Interest expense, net
    (1,138 )     (696 )     (2,097 )     (3,273 )
 
   
 
     
 
     
 
     
 
 
Income before income taxes
    4,351       5,878       8,916       10,071  
Provision for income taxes
    320       2,263       504       3,877  
 
   
 
     
 
     
 
     
 
 
Net income
  $ 4,031     $ 3,615     $ 8,412     $ 6,194  
 
   
 
     
 
     
 
     
 
 
Net income per share:
                               
Basic
  $ 0.38     $ 0.17     $ 0.80     $ 0.34  
Diluted
  $ 0.32     $ 0.17     $ 0.66     $ 0.32  
Weighted average number of common shares outstanding and common equivalent shares:
                               
Basic
    10,537       20,822       10,523       18,479  
Diluted
    12,653       21,401       12,677       19,397  

See accompanying notes.

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SYMBION, INC.

CONDENSED CONSOLIDATED STATEMENTS OF CASH FLOWS

(in thousands)
(unaudited)
                 
    Six Months Ended
    June 30,
    2003
  2004
Cash flows from operating activities:
               
Net income
  $ 8,412     $ 6,194  
Adjustments to reconcile net income to net cash provided by operating activities:
               
Depreciation and amortization
    4,512       5,458  
Impairment and loss on disposal of long-lived assets
          16  
Gain on sale of long-lived assets
          (157 )
Minority interests
    5,930       6,958  
Income taxes
    504       3,877  
Distributions to minority partners
    (4,505 )     (6,909 )
Income on equity investments
    (158 )     (487 )
Provision for bad debts
    1,070       1,529  
Changes in operating assets and liabilities, net of effects of acquisitions and dispositions:
               
Accounts receivable
    (829 )     (1,102 )
Other assets
    (2,018 )     (1,024 )
Other liabilities
    (1,086 )     (2,146 )
 
   
 
     
 
 
Net cash provided by operating activities
    11,832       12,207  
 
   
 
     
 
 
Cash flows from investing activities:
               
Payments for acquisitions, net of cash acquired
    16       (38,311 )
Purchases of property and equipment, net
    (7,058 )     (4,399 )
Change in other assets
    (1,564 )     618  
 
   
 
     
 
 
Net cash used in investing activities
    (8,606 )     (42,092 )
 
   
 
     
 
 
Cash flows from financing activities:
               
Principal payments on long-term debt
    (9,739 )     (97,165 )
Proceeds from debt issuances
    6,898       13,500  
Proceeds from capital contributions by minority partners
    242       947  
Proceeds from initial public offering, net
          115,506  
Other financing activities
          276  
 
   
 
     
 
 
Net cash provided by (used in) financing activities
    (2,599 )     33,064  
 
   
 
     
 
 
Net increase in cash and cash equivalents
    627       3,179  
Cash and cash equivalents at beginning of period
    21,648       17,658  
 
   
 
     
 
 
Cash and cash equivalents at end of period
  $ 22,275     $ 20,837  
 
   
 
     
 
 

See accompanying notes.

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SYMBION, INC.

NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS

Unaudited
June 30, 2004

1. Organization

     Symbion, Inc. (the “Company”), through its wholly-owned subsidiaries, owns interests in limited partnerships and limited liability companies which own and operate surgery centers in joint-ownership with physicians and physician groups, hospitals and hospital networks. As of June 30, 2004, the Company owned and operated 37 surgery centers and managed eight additional surgery centers in 20 states. The Company owns a majority interest in 26 of the 37 surgery centers and consolidates 32 of these centers for financial reporting purposes. The Company’s surgery centers include three facilities that are licensed as hospitals, two of which are owned and one of which is managed. In addition to the surgery centers, the Company also operates a diagnostic center and manages three physician networks, including two physician networks in markets in which the Company also operates surgery centers.

2. Significant Accounting Policies and Practices

Basis of Presentation

     The accompanying unaudited condensed consolidated financial statements have been prepared in accordance with generally accepted accounting principles for interim financial information and with the instructions to Form 10-Q and Article 10 of Regulation S-X. Accordingly, the accompanying unaudited condensed consolidated financial statements do not include all of the information and footnotes required by generally accepted accounting principles for complete consolidated financial statements. In the opinion of management, all adjustments considered necessary for a fair presentation have been included. All adjustments are of a normal, recurring nature. Certain amounts from the previous period have been reclassified to conform to the current year presentation. Operating results for the quarter and six months ended June 30, 2004, are not necessarily indicative of the results that may be expected for the year ending December 31, 2004. For further information, refer to the consolidated financial statements and related footnotes included in the Company’s Annual Report on Form 10-K for the year ended December 31, 2003.

Principles of Consolidation

     The accompanying unaudited condensed consolidated financial statements include the accounts of the Company and its wholly-owned subsidiaries, as well as its interest in limited partnerships and limited liability companies controlled by the Company through ownership of a majority voting interest or other rights granted to the Company by contract as the sole general partner to manage and control the ordinary course of the affiliate’s business. The accompanying unaudited condensed consolidated financial statements also include the accounts of a variable interest entity in which the Company is the primary beneficiary. The limited partner or minority member responsibilities are to supervise the delivery of medical services with their rights being restricted to those that protect their financial interests. Under certain of the partnership and operating agreements governing these limited partnerships and limited liability companies, the Company could be removed as the sole general partner or managing member for certain events such as material breach, gross negligence or bankruptcy. These protective rights do not preclude consolidation of the respective limited partnerships and limited liability companies. All significant intercompany balances and transactions are eliminated in consolidation.

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Accounts Receivable

     Accounts receivable consist of receivables from federal and state agencies (under the Medicare and Medicaid programs), managed care health plans, commercial insurance companies, employers and patients. The Company recognizes that revenues and receivables from government agencies are significant to its operations, but it does not believe that there are significant credit risks associated with these government agencies. Concentration of credit risk with respect to other payors is limited because of the large number of such payors. Accounts receivable are recorded net of contractual adjustments and allowances for doubtful accounts to reflect accounts receivable at net realizable value. Accounts receivable at December 31, 2003 and June 30, 2004, respectively, were as follows (in thousands):

                 
    December 31, 2003
  June 30, 2004
Surgery centers
  $ 20,922     $ 21,259  
Physician networks
    751       586  
 
   
 
     
 
 
Total
  $ 21,673     $ 21,845  
 
   
 
     
 
 

     The following table sets forth by type of payor the percentage of the Company’s accounts receivable for consolidated surgery centers as of December 31, 2003 and June 30, 2004:

                 
Payor
  December 31, 2003
  June 30, 2004
Private insurance
    62.9 %     58.1 %
Medicare and Medicaid
    15.0       16.5  
Other government
    0.3       0.4  
Self-pay
    17.6       18.7  
Other
    4.2       6.3  
 
   
 
     
 
 
Total
    100.0 %     100.0 %
 
   
 
     
 
 

Goodwill

     Goodwill represents the excess of the purchase price over the fair value of net identifiable assets acquired. Through December 31, 2001, goodwill was amortized on a straight-line basis over the expected periods to be benefited, generally twenty years. In June 2001, the Financial Accounting Standards Board (“FASB”) issued Statement of Financial Accounting Standards (“SFAS”) No. 141, Business Combinations, and SFAS No. 142, Goodwill and Other Intangible Assets. SFAS No. 141 requires that the purchase method of accounting be used for business combinations initiated after June 30, 2001 and prohibits the use of the pooling-of-interests method of accounting for those business combinations. Effective January 1, 2002, the amortization of all goodwill was discontinued upon the adoption of SFAS No. 142. SFAS No. 142 no longer permits the amortization of goodwill and other indefinite lived intangible assets over a set period; rather these assets must be tested for impairment at least annually using a fair value method. The Company will perform a goodwill impairment test whenever events or changes in facts or circumstances indicate that impairment may exist, or at least annually during the fourth quarter each year.

     Changes in the carrying amount of goodwill are as follows (in thousands):

         
Balance at December 31, 2003
  $ 116,654  
Purchase price allocations
    35,483  
Finalized purchase price allocations
    (238 )
 
   
 
 
Balance at June 30, 2004
  $ 151,899  
 
   
 
 

     The purchase price allocation of $35.5 million includes $31.8 million related to the Company’s Series A convertible preferred stock and Series B convertible preferred stock which converted into common stock and the right to receive cash upon completion of the Company’s initial public offering as discussed in Note 6. The purchase price allocation of $35.5 million also includes $3.7 million of goodwill related to 204,500 shares of the Company’s common stock that were issued to the former stockholders of Physicians Surgical Care, Inc. (“PSC”) pursuant to an earn-out provision in the Company’s purchase agreement with PSC. The earn-out was based on the 2003 financial results of one of the surgery centers acquired from PSC in March 2002.

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Revenues

     Revenues consist of the following for the three months and six months ended June 30, 2003 and 2004, respectively (in thousands):

                                 
    Three Months   Six Months
    Ended June 30,
  Ended June 30,
    2003
  2004
  2003
  2004
Patient service revenues
  $ 39,640     $ 49,276     $ 76,762     $ 97,741  
Physician service revenues
    922       1,000       1,782       2,004  
Other service revenues
    3,491       2,451       6,964       4,929  
 
   
 
     
 
     
 
     
 
 
Total revenues
  $ 44,053     $ 52,727     $ 85,508     $ 104,674  
 
   
 
     
 
     
 
     
 
 

     The following table sets forth by type of payor the percentage of the Company’s patient service revenues generated for the three months and six months ended June 30, 2003 and 2004, respectively, for surgery centers in which the Company owned an interest as of June 30, 2003 and 2004, respectively:

                                 
    Three Months   Six Months
    Ended June 30,
  Ended June 30,
Payor
  2003
  2004
  2003
  2004
Private insurance
    76.2 %     74.9 %     76.1 %     75.3 %
Government
    19.0       19.9       19.3       19.9  
Self-pay
    2.9       3.6       2.8       3.1  
Other
    1.9       1.6       1.8       1.7  
 
   
 
     
 
     
 
     
 
 
Total
    100.0 %     100.0 %     100.0 %     100.0 %
 
   
 
     
 
     
 
     
 
 

Stock-Based Compensation

     SFAS No. 123, Accounting for Stock-Based Compensation, encourages, but does not require, companies to record compensation cost for stock-based employee compensation plans at fair value. The Company has elected to record stock options in accordance with Accounting Principles Board (“APB”) Opinion No. 25, Accounting for Stock Issued to Employees, and related interpretations thereof and, accordingly, recognizes no compensation expense for options granted when the exercise price equals, or is greater than, the market price of the underlying stock on the date of grant (the “intrinsic value method”).

     Had the Company used the Black-Scholes estimates to determine compensation expense for options granted, net income and net income per share attributable to common stockholders would have been reduced to the following pro forma amounts (in thousands, except per share amounts):

                                 
    Three Months   Six Months
    Ended June 30,
  Ended June 30,
    2003
  2004
  2003
  2004
Net income as reported
  $ 4,031     $ 3,615     $ 8,412     $ 6,194  
Pro forma compensation expense for stock option grants, net of taxes
    (475 )     (448 )     (959 )     (941 )
 
   
 
     
 
     
 
     
 
 
Pro forma net income
  $ 3,556     $ 3,167     $ 7,453     $ 5,253  
 
   
 
     
 
     
 
     
 
 
Basic earnings per share:
                               
As reported
  $ 0.38     $ 0.17     $ 0.80     $ 0.34  
Pro forma
    0.34       0.15       0.71       0.28  
Diluted earnings per share:
                               
As reported
  $ 0.32     $ 0.17     $ 0.66     $ 0.32  
Pro forma
    0.28       0.15       0.59       0.27  

Use of Estimates

     The preparation of financial statements in conformity with accounting principles generally accepted in the United States requires management to make estimates and assumptions that affect the amounts reported in the

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accompanying unaudited condensed consolidated financial statements and notes. Actual results could differ from those estimates.

Recent Accounting Standards

     In December 2003, the FASB issued Interpretation No. 46(R), Consolidation of Variable Interest Entities, an Interpretation of Accounting Research Bulletin No. 51. FIN 46(R) requires certain variable interest entities (“VIEs”) to be consolidated by the primary beneficiary of the entity if the equity investors in the entity do not have the characteristics of a controlling financial interest or do not have sufficient equity at risk for the entity to finance its activities without additional subordinated financial support from other parties. FIN 46(R) is effective for all new VIEs created or acquired after January 31, 2003. For VIEs created or acquired prior to February 1, 2003, the provisions of FIN 46(R) for public companies must be applied for the first interim or annual period beginning after March 15, 2004, with early adoption allowed. The Company adopted FIN 46(R) on December 31, 2003. The Company has not entered into or acquired any VIEs subsequent to January 31, 2003. The Company has determined that it is the primary beneficiary of a VIE created on July 31, 2002. The Company entered into a development agreement with a group of physicians to develop a surgery center in which the Company has no ownership interest. The surgery center opened on October 16, 2002. Under the development agreement, a limited liability company in which the Company owns a majority of the ownership interests manages the surgery center, leases certain fixed assets to the surgery center and provides working capital to the surgery center. In addition, the investors in the surgery center have insufficient equity at risk. At December 31, 2003, the Company began consolidating this VIE in the accompanying condensed consolidated balance sheet. The Company, as permitted by FIN 46(R), did not restate prior period information upon adoption. The adoption of FIN 46(R) did not have a material effect on the Company’s results of operations.

     In May 2003, the FASB issued SFAS No. 150, Accounting for Certain Financial Instruments with Characteristics of both Liabilities and Equity. This statement generally requires liability classification for two broad classes of financial instruments. Under SFAS No. 150, instruments that represent, or are indexed to, an obligation to buy back the issuer’s shares, regardless of whether the instrument is settled on a net-cash or gross physical basis are required to be classified as liabilities. Obligations that can be settled in shares, but either derive their value predominately from some other underlying, have a fixed value, or have a value to the counterparty that moves in the opposite direction as the issuer’s shares, are also required to be classified as liabilities under this statement. SFAS No. 150 must be applied immediately to instruments entered into or modified after May 31, 2003 and to all other instruments that exist as of the beginning of the first interim financial reporting period beginning after June 15, 2003. On November 5, 2003 the FASB agreed to defer indefinitely the effective date of the statement for certain types of noncontrolling interests that are classified as equity in the financial statements of subsidiaries, but are classified as liabilities in the financial statements of related parent companies. As a result of the deferral, companies should continue to account for these interests as minority interests. The Company does not expect SFAS No. 150 to have a material impact on its consolidated financial position or results of operations.

3. Reverse Stock Split and Initial Public Offering

     On February 5, 2004, the Company’s Board of Directors approved a 1-for-4.4303 reverse stock split of the Company’s common stock in connection with its initial public offering. All information related to common stock, options to purchase common stock, warrants to purchase common stock and earnings per share data presented in the accompanying unaudited condensed consolidated financial statements and related notes have been restated to reflect the effect of the reverse stock split of the Company’s common stock.

     On February 11, 2004, the Company completed an initial public offering of 8,280,000 shares of its common stock at a price of $15.00 per share, including 1,080,000 shares sold following exercise in full by the underwriters of an option granted to them by the Company to purchase the additional shares to cover over-allotments. The Company received net proceeds of $115.5 million in the offering, after deducting underwriting discounts and commissions. The Company used the net proceeds to repay indebtedness and to pay holders of the Company’s Series A and Series B convertible preferred stock in connection with the conversion of those shares to common stock upon the completion of the offering as discussed in Note 6.

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4. Acquisitions, Developments and Dispositions

     During the second quarter of 2003, the Company opened two newly developed surgery centers. One of the newly developed surgery centers, located in Knoxville, Tennessee, replaced a surgery center that the Company managed in the same market. The other newly developed surgery center is located in Worcester, Massachusetts and opened in May 2003. The Company entered into management contracts with both of these newly developed surgery centers. The Company has a majority interest in the surgery center located in Worcester, Massachusetts and consolidates this surgery center for financial reporting purposes. The Company has a 25% ownership interest in the surgery center located in Knoxville, Tennessee and accounts for this surgery center under the equity method.

     During the second quarter of 2004, the Company acquired a minority interest in Valley Ambulatory Surgery Center, L.P. for approximately $6.5 million, using cash from operations. The center has six operating suites and one minor procedure room. The center is a multi-specialty ambulatory surgery center located in a suburb of Chicago, Illinois. Subject to certain conditions, including regulatory approvals, the Company has agreed to purchase the capital stock of the general partner of the center for an additional $7.0 million. At the time the Company purchases the capital stock of the general partner, the Company expects to consolidate this facility for financial reporting purposes.

5. Long-Term Debt and Convertible Debentures

     The Company’s long-term debt is summarized as follows (in thousands):

                 
    December 31,   June 30,
    2003
  2004
Senior Credit Facility
  $ 63,600     $ 10,500  
Notes payable to banks
    4,800       4,478  
Secured term loans
    6,241       5,332  
Senior Subordinated Notes
    29,106        
Capital lease obligations
    921       830  
 
   
 
     
 
 
 
    104,668       21,140  
Less current maturities
    (3,631 )     (2,234 )
 
   
 
     
 
 
 
  $ 101,037     $ 18,906  
 
   
 
     
 
 

     The Company’s senior secured credit facility (the “Senior Credit Facility”) provides senior secured financing of up to $110.0 million, through a revolving credit line. The Senior Credit Facility terminates and is due and payable on July 18, 2006. At December 31, 2003, the Company had $63.6 million of outstanding debt under the Senior Credit Facility. The Company used $63.6 million of the proceeds from the initial public offering to repay indebtedness outstanding under the Senior Credit Facility. At June 30, 2004, the Company had $10.5 million of outstanding debt under the Senior Credit Facility. At the Company’s option, loans under the Senior Credit Facility bear interest at Bank of America’s base rate or the Eurodollar rate in effect on the applicable borrowing date, plus an applicable margin. Both the applicable base rate margin and applicable Eurodollar rate margin will vary depending upon the ratio of the Company’s consolidated funded indebtedness to earnings before income taxes and depreciation and amortization (“EBITDA”). During the first quarter of 2004, the Company entered into the First Amendment to the Senior Credit Facility, which changed certain financial covenants and definitions. Availability of funds under the Senior Credit Facility is limited by, among other things, the Company’s ratio of indebtedness to EBITDA.

     In July 2003, the Company entered into an agreement through which DLJ Investment Partners II, L.P. and its affiliates agreed to purchase the Company’s 143/4% Senior Subordinated Notes due 2008 in the aggregate principal amount of up to $40.0 million. During 2003, the Company issued notes in the aggregate principal amount of about $29.1 million, and may issue up to an additional $10.9 million of notes at any time before July 18, 2005. At December 31, 2003, the outstanding balance of the Senior Subordinated Notes was $29.1 million. The Company used proceeds from the initial public offering and certain borrowings under the Senior Credit Facility to repay all outstanding indebtedness under the Senior Subordinated Notes. At June 30, 2004, the Company had no outstanding indebtedness under the Senior Subordinated Notes.

     In connection with the 2002 acquisition of PSC, the Company issued convertible debentures totaling $3.2 million to various persons in exchange for additional ownership interests in certain of PSC’s surgery centers. The convertible

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debentures bore interest at 4.0% per year and would have matured on April 1, 2005. The convertible debentures automatically converted into shares of common stock at $13.87 per share upon the completion of the Company’s initial public offering.

At June 30, 2004, the Company was in compliance with all covenants required by each long-term debt agreement.

6. Series A Convertible Preferred Stock and Series B Convertible Preferred Stock

     The Company issued Series A convertible preferred stock and Series B convertible preferred stock in April 2002 in connection with the PSC acquisition. The Series A convertible preferred stock and Series B convertible preferred stock automatically converted into shares of common stock upon the completion of the Company’s initial public offering. When converted, each share of Series A convertible preferred stock and Series B convertible preferred stock entitled the holder to receive 0.2257 of a share of common stock and a cash payment of $4.20 for the Series A holders and $5.22 for the Series B holders, for a total cash payment of $31.8 million. The cash payment of $31.8 million was reflected as additional purchase price for PSC and recorded as an addition to goodwill during the first quarter of 2004 upon completion of the initial public offering.

7. Earnings Per Share

     Basic and diluted income per share are based on the weighted average number of common shares outstanding and the dilutive impact of outstanding options and warrants to purchase shares (net income in thousands):

                                 
    Three Months   Six Months
    Ended June 30,
  Ended June 30,
    2003
  2004
  2003
  2004
Numerator for basic and diluted income per share:
                               
Net income
  $ 4,031     $ 3,615     $ 8,412     $ 6,194  
 
   
 
     
 
     
 
     
 
 
Denominator:
                               
Denominator for basic income per share weighted-average shares outstanding
    10,537,445       20,822,095       10,522,702       18,479,262  
Effect of dilutive securities:
                               
Employee stock options
    295,484       408,938       333,897       387,181  
Warrants
    189,527       169,861       189,527       163,653  
Preferred stock
    1,567,910             1,567,910       353,211  
Common stock held in escrow
    62,535             62,535       14,087  
 
   
 
     
 
     
 
     
 
 
Denominator for diluted income per share — adjusted weighted-average shares outstanding
    12,652,901       21,400,894       12,676,571       19,397,394  
 
   
 
     
 
     
 
     
 
 
Basic net income per share
  $ 0.38     $ 0.17     $ 0.80     $ 0.34  
Diluted net income per share
  $ 0.32     $ 0.17     $ 0.66     $ 0.32  

     The effects of warrants to purchase 19,643 shares of common stock for the three months and six months ended June 30,