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UNITED STATES SECURITIES AND EXCHANGE COMMISSION

Washington, DC 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 June 30, 2004

Commission File Number 000-33009


MEDCATH CORPORATION

(Exact name of registrant as specified in its charter)

     
Delaware   56-2248952
(State or other jurisdiction of   (IRS Employer Identification No.)
incorporation or organization)    

10720 Sikes Place, Suite 300
Charlotte, North Carolina 28277

(Address of principal executive offices, including zip code)

(704) 708-6600
(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 [X ] No [  ]

Indicate by check mark whether the registrant is an accelerated filer (as defined in Rule 12b-2 of the Exchange Act).

Yes [  ] No [X]

As of July 31, 2004, there were 18,012,911 shares of $0.01 par value common stock outstanding.



 


 

MEDCATH CORPORATION

FORM 10-Q

TABLE OF CONTENTS

         
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2


 

PART I. FINANCIAL INFORMATION

Item 1. Financial Statements

MEDCATH CORPORATION

CONSOLIDATED BALANCE SHEETS
(In thousands, except share data)

(Unaudited)
                 
    June 30,   September 30,
    2004
  2003
Current assets:
               
Cash and cash equivalents
  $ 89,839     $ 94,199  
Accounts receivable, net
    97,533       86,306  
Medical supplies
    21,052       16,424  
Due from affiliates
    23       187  
Deferred income tax assets
    3,226       3,145  
Prepaid expenses and other current assets
    5,508       7,668  
 
   
 
     
 
 
Total current assets
    217,181       207,929  
Property and equipment, net
    457,581       436,947  
Investments in and advances to unconsolidated affiliates, net
    4,925       5,486  
Goodwill
    75,000       75,000  
Other intangible assets, net
    14,906       17,095  
Other assets
    3,479       6,840  
 
   
 
     
 
 
Total assets
  $ 773,072     $ 749,297  
 
   
 
     
 
 
Current liabilities:
               
Accounts payable
  $ 45,326     $ 42,360  
Income tax payable
    227       278  
Accrued compensation and benefits
    24,433       20,356  
Accrued property taxes
    4,808       4,723  
Accrued construction and development costs
    14,614       15,340  
Other accrued liabilities
    12,880       11,667  
Current portion of long-term debt and obligations under capital leases
    12,073       49,287  
 
   
 
     
 
 
Total current liabilities
    114,361       144,011  
Long-term debt
    352,201       300,884  
Obligations under capital leases
    10,373       10,814  
Deferred income tax liabilities
    5,565       3,951  
Other long-term obligations
    7,602       7,164  
 
   
 
     
 
 
Total liabilities
    490,102       466,824  
Minority interest in equity of consolidated subsidiaries
    13,256       17,419  
Stockholders’ equity:
               
Preferred stock, $0.01 par value, 10,000,000 shares authorized; none issued
           
Common stock, $0.01 par value, 50,000,000 shares authorized; 18,081,811 issued and 18,012,911 outstanding at June 30, 2004; 18,011,520 issued and 17,942,620 outstanding at September 30, 2003
    180       180  
Paid-in capital
    358,549       357,707  
Accumulated deficit
    (88,004 )     (91,092 )
Accumulated other comprehensive loss
    (617 )     (1,347 )
Treasury stock, at cost, 68,900 shares held
    (394 )     (394 )
 
   
 
     
 
 
Total stockholders’ equity
    269,714       265,054  
 
   
 
     
 
 
Total liabilities, minority interest and stockholders’ equity
  $ 773,072     $ 749,297  
 
   
 
     
 
 

See notes to consolidated financial statements.

3


 

MEDCATH CORPORATION

CONSOLIDATED STATEMENTS OF OPERATIONS
(In thousands, except per share data)

(Unaudited)
                                 
    Three Months Ended June 30,
  Nine Months Ended June 30,
    2004
  2003
  2004
  2003
Net revenue
  $ 180,785     $ 142,343     $ 510,697     $ 398,631  
Operating expenses:
                               
Personnel expense
    57,070       43,693       160,509       126,845  
Medical supplies expense
    51,837       37,722       141,433       98,286  
Bad debt expense
    9,778       6,448       33,277       16,585  
Other operating expenses
    38,969       32,924       110,490       95,747  
Pre-opening expenses
          1,854       5,531       7,049  
Depreciation
    11,747       10,734       33,198       30,121  
Amortization
    290       282       870       1,156  
Loss (gain) on disposal of property, equipment and other assets
    27       6       (21 )     94  
 
   
 
     
 
     
 
     
 
 
Total operating expenses
    169,718       133,663       485,287       375,883  
 
   
 
     
 
     
 
     
 
 
Income from operations
    11,067       8,680       25,410       22,748  
Other income (expenses):
                               
Interest expense
    (7,300 )     (6,456 )     (21,087 )     (18,904 )
Interest income
    212       312       606       1,103  
Other income, net
    11       93       17       196  
Equity in net earnings of unconsolidated affiliates
    900       1,075       2,624       2,893  
 
   
 
     
 
     
 
     
 
 
Total other expenses, net
    (6,177 )     (4,976 )     (17,840 )     (14,712 )
 
   
 
     
 
     
 
     
 
 
Income before minority interest and income taxes
    4,890       3,704       7,570       8,036  
Minority interest share of earnings of consolidated subsidiaries
    (2,852 )     (2,288 )     (2,821 )     (4,990 )
 
   
 
     
 
     
 
     
 
 
Income before income taxes
    2,038       1,416       4,749       3,046  
Income tax expense
    (658 )     (638 )     (1,661 )     (1,290 )
 
   
 
     
 
     
 
     
 
 
Net income
  $ 1,380     $ 778     $ 3,088     $ 1,756  
 
   
 
     
 
     
 
     
 
 
Earnings per share, basic
  $ 0.08     $ 0.04     $ 0.17     $ 0.10  
 
   
 
     
 
     
 
     
 
 
Earnings per share, diluted
  $ 0.07     $ 0.04     $ 0.17     $ 0.10  
 
   
 
     
 
     
 
     
 
 
Weighted average number of shares, basic
    17,990       17,990       17,974       18,004  
Dilutive effect of stock options
    826       11       482       52  
 
   
 
     
 
     
 
     
 
 
Weighted average number of shares, diluted
    18,816       18,001       18,456       18,056  
 
   
 
     
 
     
 
     
 
 

See notes to consolidated financial statements.

4


 

MEDCATH CORPORATION

CONSOLIDATED STATEMENT OF STOCKHOLDERS’ EQUITY
(In thousands)

(Unaudited)
                                                                 
                                    Accumulated        
    Common Stock
  Paid-in   Accumulated   Other
Comprehensive
  Treasury Stock
   
    Shares
  Par Value
  Capital
  Deficit
  Loss
  Shares
  Amount
  Total
Balance, September 30, 2003
    17,943     $ 180     $ 357,707     $ (91,092 )   $ (1,347 )     69     $ (394 )   $ 265,054  
Exercise of stock options
    70               842                               842  
Comprehensive income:
                                                               
Net income
                      3,088                         3,088  
Change in fair value of interest rate swaps, net of income tax expense
                            730                   730  
 
                                                           
 
 
Total comprehensive income
                                                            3,818  
 
   
 
     
 
     
 
     
 
     
 
     
 
     
 
     
 
 
Balance, June 30, 2004
    18,013     $ 180     $ 358,549     $ (88,004 )   $ (617 )     69     $ (394 )   $ 269,714  
 
   
 
     
 
     
 
     
 
     
 
     
 
     
 
     
 
 

See notes to consolidated financial statements.

5


 

MEDCATH CORPORATION

CONSOLIDATED STATEMENTS OF CASH FLOWS
(In thousands)

(Unaudited)
                 
    Nine Months Ended June 30,
    2004
  2003
Net income
  $ 3,088     $ 1,756  
Adjustments to reconcile net income to net cash provided by operating activities:
               
Bad debt expense
    33,277       16,585  
Depreciation and amortization
    34,068       31,277  
Loss (gain) on disposal of property, equipment and other assets
    (21 )     94  
Amortization of loan acquisition costs
    1,469       1,088  
Undistributed earnings of unconsolidated affiliates
    767       (2,893 )
Minority interest share of earnings of consolidated subsidiaries
    2,821       4,990  
Deferred income taxes
    1,155       622  
Change in assets and liabilities that relate to operations:
               
Accounts receivable
    (44,280 )     (25,003 )
Medical supplies
    (4,628 )     (3,229 )
Due from affiliates
    164       (6 )
Prepaid expenses and other current assets
    2,178       (5,444 )
Other assets
    2,619       (177 )
Accounts payable and accrued liabilities
    7,796       12,448  
 
   
 
     
 
 
Net cash provided by operating activities
    40,473       32,108  
 
   
 
     
 
 
Investing activities:
               
Purchases of property and equipment
    (53,456 )     (72,145 )
Proceeds from sale of property and equipment
    2,470       687  
Repayments of loans under management agreements
    733       125  
Investments in and advances to affiliates, net
          939  
Acquisition of increased ownership in hospitals
          (811 )
Other investing activities
          183  
 
   
 
     
 
 
Net cash used in investing activities
    (50,253 )     (71,022 )
 
   
 
     
 
 
Financing activities:
               
Short-term debt repayments
          (4,500 )
Proceeds from issuance of long-term debt
    67,139       64,079  
Repayments of long-term debt
    (51,003 )     (18,205 )
Repayments of obligations under capital leases
    (2,942 )     (2,419 )
Payment of loan acquisition costs
    (263 )     (968 )
Investments by minority partners
    843       646  
Distributions to minority partners
    (8,977 )     (6,537 )
Advances to minority partners
    (112 )     (481 )
Purchase of common stock for treasury
          (394 )
Proceeds from exercised stock options
    735        
 
   
 
     
 
 
Net cash provided by financing activities
    5,420       31,221  
 
   
 
     
 
 
Net decrease in cash and cash equivalents
    (4,360 )     (7,693 )
Cash and cash equivalents:
               
Beginning of year
    94,199       118,768  
 
   
 
     
 
 
End of period
  $ 89,839     $ 111,075  
 
   
 
     
 
 
Supplemental schedule of noncash investing and financing activities:
               
Capital expenditures financed by capital leases
  $ 1,402     $ 4,503  
Capital expenditures included in accrued construction and development costs
          1,508  
Capital expenditures included in other accrued liabilities
    1,220        
Deferred tax asset related to exercised stock options
    107        

See notes to consolidated financial statements.

6


 

MEDCATH CORPORATION

NOTES TO CONSOLIDATED FINANCIAL STATEMENTS
(All tables in thousands, except per share)

1.   Business and Organization

     MedCath Corporation (the Company) is a healthcare provider focused primarily on the diagnosis and treatment of cardiovascular disease. The Company owns and operates hospitals in partnership with physicians whom it believes have established reputations for clinical excellence as well as with community hospital systems. Each of the Company’s majority-owned hospitals (collectively, the Hospital Division) is a freestanding licensed general acute care hospital, that provides a wide range of health services, and the medical staff at each hospital includes qualified physicians in various specialties. The Company opened its first hospital in 1996, and as of June 30, 2004 has ownership interests in and operates 13 hospitals. These hospitals include 12 majority-owned hospitals and one in which the Company owns a minority interest. The Company’s 13 hospitals have a total of 759 licensed beds, of which 664 were staffed and available at June 30, 2004, and are located in nine states: Arizona, Arkansas, California, Louisiana, New Mexico, Ohio, South Dakota, Texas and Wisconsin.

     The Company accounts for all but one of its owned and operated hospitals as consolidated subsidiaries. The Company owns a minority interest in Heart Hospital of South Dakota and neither has substantive control over the hospital nor is its primary beneficiary under the revised version of Financial Accounting Standards Board (FASB) Interpretation No. 46 Consolidation of Variable Interest Entities, an interpretation of ARB No. 51, (hereinafter, FIN 46-R). Therefore, the Company is unable to consolidate the hospital’s results of operations and financial position, but rather is required to account for its minority ownership interest in the hospital as an equity investment. See also Note 3 below.

     In addition to its hospitals, the Company owns and/or manages cardiac diagnostic and therapeutic facilities (the Diagnostics Division). The Company began its cardiac diagnostic and therapeutic business in 1989, and as of June 30, 2004 owns and/or manages 26 cardiac diagnostic and therapeutic facilities. Eleven of these facilities are located at hospitals operated by other parties and offer invasive diagnostic and sometimes therapeutic procedures. The remaining 15 facilities are not located at hospitals and offer only diagnostic services. The Company also provides consulting and management services (CCM) tailored primarily to cardiologists and cardiovascular surgeons, which is included in the corporate and other division.

2.   Summary of Significant Accounting Policies

     Basis of Presentation - The Company’s unaudited interim consolidated financial statements as of June 30, 2004 and for the three months and nine months ended June 30, 2004 and 2003 have been prepared in accordance with accounting principles generally accepted in the United States of America (hereafter, generally accepted accounting principles) and pursuant to the rules and regulations of the Securities and Exchange Commission (the SEC). These unaudited interim consolidated financial statements reflect, in the opinion of management, all material adjustments (consisting only of normal recurring adjustments) necessary to fairly state the results of operations and financial position for the periods presented. All intercompany transactions and balances have been eliminated. The results of operations for the three months and nine months ended June 30, 2004 are not necessarily indicative of the results expected for the full fiscal year ending September 30, 2004 or future fiscal periods.

     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 SEC, although the Company believes the disclosure is adequate to make the information presented not misleading. The accompanying unaudited interim consolidated financial statements and notes thereto should be read in conjunction with the Company’s audited consolidated financial statements and notes thereto included in the Company’s Annual Report on Form 10-K for the fiscal year ended September 30, 2003.

     Use of Estimates – The preparation of financial statements in conformity with generally accepted accounting principles requires management to make estimates and assumptions that affect reported amounts of assets and liabilities, revenues and expenses and related disclosures of contingent assets and liabilities in the consolidated financial statements and accompanying notes. There is a reasonable possibility that actual results may vary significantly from those estimates.

     Pre-opening Expenses – Pre-opening expenses consist of operating expenses incurred during the development of a new venture and prior to its opening for business. Such costs specifically relate to ventures under development and are expensed as incurred. The Company did not incur any pre-opening expenses during the three months ended June 30, 2004; however, it did record approximately $5.5 million during the nine months ended June 30, 2004 relating to hospitals under development and opened during the first six months of the fiscal year. The Company recorded pre-opening expenses of approximately $1.9 million and $7.0 million during the three months and nine months ended June 30, 2003, respectively.

7


 

MEDCATH CORPORATION
NOTES TO CONSOLIDATED FINANCIAL STATEMENTS - Continued

     Stock-Based Compensation – As of June 30, 2004, the Company has two stock-based compensation plans, including a stock option plan under which it may grant incentive stock options and nonqualified stock options to officers and other key employees and an outside director’s stock option plan under which it may grant nonqualified stock options to nonemployee directors. The Company accounts for stock options under both of these plans in accordance with Accounting Principles Board (APB) Opinion No. 25, Accounting for Stock Issued to Employees, as permitted under Statement of Financial Accounting Standards (SFAS) No. 123, Accounting for Stock-Based Compensation. The Company also provides prominent disclosure of the information required by SFAS No. 148, Accounting for Stock-Based Compensation, in its annual and interim financial statements.

     Under APB Opinion No. 25, compensation cost is determined based on the intrinsic value of the equity instrument award. No stock-based employee compensation cost is reflected in net income for the three months and nine months ended June 30, 2004 and 2003, as all options granted during those periods under the Company’s stock option plans had an exercise price equal to the market value of the underlying shares of common stock at the date of grant.

     Had compensation expense for the Company’s stock options been recognized based on the fair value of the option award at the grant date under the methodology prescribed by SFAS No. 123, the Company’s net income for the three months and nine months ended June 30, 2004 and 2003 would have been impacted as follows:

                                 
    Three Months Ended June 30,
  Nine Months Ended June 30,
    2004
  2003
  2004
  2003
Net income, as reported
  $ 1,380     $ 778     $ 3,088     $ 1,756  
Deduct: Total stock-based employee compensation expense determined under fair value method, net of related income taxes
  $ 465     $ 414     $ 1,416     $ 1,361  
 
   
 
     
 
     
 
     
 
 
Proforma net income
  $ 915     $ 364     $ 1,672     $ 395  
 
   
 
     
 
     
 
     
 
 
Earnings per share, basic
                               
As reported
  $ 0.08     $ 0.04     $ 0.17     $ 0.10  
Pro forma
  $ 0.05     $ 0.02     $ 0.09     $ 0.02  
Earnings per share, diluted
                               
As reported
  $ 0.07     $ 0.04     $ 0.17     $ 0.10  
Pro forma
  $ 0.05     $ 0.02     $ 0.09     $ 0.02  

3. Adoption of FASB Interpretation No. 46

     In December 2003, the FASB released FIN 46-R, which provides a new consolidation method of accounting. FIN 46-R established the effective dates for public entities to apply FIN 46 and FIN 46-R based on the nature of the variable interest entity and the date upon which the public company became involved with the variable interest entity. The Company adopted and applied the provisions of FIN 46 and FIN 46-R effective March 31, 2004. The Company was not required to apply either FIN 46 or FIN 46-R prior to March 31, 2004 as the Company was not involved with variable interest entities created after January 31, 2003 or any variable interest entities created before February 1, 2003 that were special purpose entities, which required early application.

     Upon application of FIN 46-R, the Company determined that one of its majority-owned subsidiaries was the primary beneficiary of a managed entity in the Diagnostics Division, and accordingly began consolidating this managed entity effective March 31, 2004. The Company does not hold any equity ownership interest in the managed entity, either directly or through its majority-owned subsidiary, but rather has a management relationship with the entity. The managed entity owns a diagnostic and therapeutic facility, which is located at a community hospital, and operates that facility under a services agreement with the hospital. The managed entity receives service fees from the hospital as well as revenue from patients and third-party payors for procedures performed in the facility. The Company’s majority-owned subsidiary manages the diagnostic and therapeutic facility in exchange for management fees equal to 100% of

8


 

MEDCATH CORPORATION
NOTES TO CONSOLIDATED FINANCIAL STATEMENTS - Continued

the managed entity’s net operating results. As summarized below, the consolidation of this managed entity did not result in a cumulative effect of an accounting change as the managed entity has a $0 equity balance and $0 cumulative earnings. The managed entity operates at breakeven due to the 100% management fee structure with the Company’s majority-owned subsidiary.

     The Company recognized the following assets and liabilities, net of intercompany eliminations, in its consolidated balance sheet as of March 31, 2004, the effective date of consolidating this managed entity:

         
Accounts receivable, net
  $ 224  
Prepaid expenses and other current assets
    18  
Property and equipment, net
    808  
 
   
 
 
Total assets
    1,050  
 
   
 
 
Accounts payable and other accrued liabilities
    254  
Current portion of long- term debt
    205  
Long- term debt
    591  
 
   
 
 
Total liabilities
    1,050  
 
   
 
 
Cumulative effect of an accounting change
  $ 0  
 
   
 
 

     The managed entity’s long-term debt represents unsecured notes payable relating to the financing of leasehold improvements at the diagnostic and therapeutic facility. These notes payable accrue interest at a fixed rate of 8.00%, with payments of principal and interest due quarterly, and mature September 2007. The managed entity’s creditors, including the note holders, do not have recourse to the general credit of the Company or its majority-owned subsidiary.

     The Company’s consolidation of the managed entity’s results of operations began April 1, 2004 and resulted in an increase in the Company’s net revenue of $3.6 million and an increase in the Company’s operating expenses of $3.6 million, for the three months ended June 30, 2004, but did not have any impact on net income as the managed entity operates at breakeven as a result of the management fee structure, as previously discussed.

     The Company also has a significant variable interest in its one unconsolidated affiliate hospital, Heart Hospital of South Dakota, but has determined that it is not the primary beneficiary under FIN 46-R, and accordingly has continued to account for its investment in this hospital using the equity method of accounting. This hospital, which has 55 licensed beds, three catheterization labs, and three operating rooms opened in March 2001 as a limited liability company. The Company, along with physician partners and a community hospital, each hold an approximately 33.33% ownership interest in the hospital. The Company also guarantees approximately 50% of the real estate debt and 30% of the equipment debt and manages the hospital’s operations pursuant to a management agreement. Historically, the Company has provided senior subordinated working capital loans to this hospital; however, no such loans were outstanding at June 30, 2004. Under the terms of the hospital’s operating agreement, the Company is committed to providing working capital loans up to $12 million and additional guarantees of indebtedness as may be required in future periods. The Company’s maximum exposure to loss as a result of its involvement with this hospital includes the Company’s equity investment, performance under the guarantees of indebtedness (see Note 7), annual management fees, and any amounts outstanding under the senior subordinated working capital loans.

     The Company has variable interests in several other entities in its Diagnostics Division as well as at one of its majority-owned hospitals which the Company has continued to evaluate on an ongoing basis. However, at June 30, 2004, none of these variable interests were determined to be significant under FIN 46-R.

4. Goodwill and Other Intangible Assets

     As required by SFAS No. 142, Goodwill and Other Intangibles, the Company has designated September 30, its fiscal year end, as the date it will perform the annual goodwill impairment test for all of its reporting units. Goodwill of a reporting unit will also be tested between annual tests if an event occurs or circumstances change that indicate an impairment may exist. During the three months and nine months ended June 30, 2004, no events or circumstances changed that indicated interim impairment testing was necessary and as such, no impairment was recognized during the three months and nine months ended June 30, 2004.

     As of June 30, 2004 and September 30, 2003, the Company’s other intangible assets, net, included the following:

9


 

MEDCATH CORPORATION
NOTES TO CONSOLIDATED FINANCIAL STATEMENTS - Continued

                                 
    June 30, 2004
  September 30, 2003
    Gross           Gross    
    Carrying   Accumulated   Carrying   Accumulated
    Amount
  Amortization
  Amount
  Amortization
Amortized other intangible assets:
                               
Management contracts
  $ 20,598     $ (10,562 )   $ 20,598     $ (9,716 )
Loan acquisition costs
    12,572       (8,703 )     12,251       (7,063 )
Other
    1,446       (445 )     1,446       (421 )
 
   
 
     
 
     
 
     
 
 
Total
  $ 34,616     $ (19,710 )   $ 34,295     $ (17,200 )
 
   
 
     
 
     
 
     
 
 

     Amortization expense recognized for the management contracts and other intangible assets totaled $290,000 and $282,000 for the three months ended June 30, 2004 and 2003, respectively, and $870,000 and $1.2 million for the nine months ended June 30, 2004 and 2003, respectively. The Company recognizes amortization expense for loan acquisition costs as a component of interest expense. For the three months ended June 30, 2004 and 2003, amortization expense for loan acquisition costs was $539,000 and $373,000, respectively, and for the nine months ended June 30, 2004 and 2003, amortization expense for loan acquisition costs was $1.5 million and $1.1 million, respectively. In July 2004, the Company repaid a significant portion of its debt as part of a financing transaction, which will result in the write-off of certain of the loan acquisition costs during the fourth quarter of fiscal 2004. See Note 15 below.

5. Business Development and Changes in Operations

     As of June 30, 2004, the Company’s four most recently opened hospitals were committed (and had paid and accrued amounts) under their construction contracts as set forth in the table below:

                         
    Amount   Amount   Amount
    Committed
  Paid
  Accrued
Louisiana Heart Hospital
  $ 22,398     $ 22,193     $ 205  
Texsan Heart Hospital
  $ 29,974     $ 29,146     $ 828  
The Heart Hospital of Milwaukee
  $ 15,712     $ 15,712     $  
Heart Hospital of Lafayette
  $ 13,630     $ 12,863     $ 757  

     The Company did not capitalize any interest expense during the three months ended June 30, 2004. However, the Company capitalized interest expense as part of the capitalized costs of its newly developed hospitals of approximately $257,000 during the three months ended June 30, 2003 and approximately $642,000 and $951,000, respectively, during the nine months ended June 30, 2004 and 2003.

10


 

MEDCATH CORPORATION
NOTES TO CONSOLIDATED FINANCIAL STATEMENTS - Continued

6. Accounts Receivable

     Accounts receivable, net, consists of the following:

                 
    June 30,   September 30,
    2004
  2003
Receivables, principally from patients, third-party payors and hospitals
  $ 121,051     $ 106,634  
Amounts due to third-party payors for estimated settlements under reimbursement programs
    (10,644 )     (10,191 )
Other
    4,006       3,344  
 
   
 
     
 
 
 
    114,413       99,787  
Less allowance for doubtful accounts
    (16,880 )     (13,481 )
 
   
 
     
 
 
Accounts receivable, net
  $ 97,533     $ 86,306