Attached files
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EX-32.1 - EX-32.1 - PROSPECT MEDICAL HOLDINGS INC | a10-13078_1ex32d1.htm |
EX-31.2 - EX-31.2 - PROSPECT MEDICAL HOLDINGS INC | a10-13078_1ex31d2.htm |
EX-31.1 - EX-31.1 - PROSPECT MEDICAL HOLDINGS INC | a10-13078_1ex31d1.htm |
EX-32.2 - EX-32.2 - PROSPECT MEDICAL HOLDINGS INC | a10-13078_1ex32d2.htm |
UNITED STATES
SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
Form 10-Q
x Quarterly report pursuant to Section 13 or 15(d) of the Securities Exchange Act of 1934
For the quarterly period ended June 30, 2010
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: 1-32203
Prospect Medical Holdings, Inc.
(Exact name of registrant as specified in its charter)
Delaware |
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33-0564370 |
(State or other jurisdiction of incorporation or |
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(I.R.S. Employer Identification No.) |
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10780
Santa Monica Blvd., Suite 400 |
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90025 |
(Address of principal executive offices) |
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(Zip Code) |
(310) 943-4500
(Registrants 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 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 during the preceding 12 months (or for such shorter period that the registrant was required to submit and post such files). Yes o 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):
Large accelerated filer o |
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Accelerated filer o |
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Non-accelerated filer o |
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Smaller reporting company x |
Indicate by check mark whether the registrant is a shell company (as defined in Rule 12b-2 of the Exchange Act): Yes o No x
The number of shares of the issuers common stock, par value $0.01 per share, outstanding as of August 12, 2010 was 21,189,413
PROSPECT MEDICAL HOLDINGS, INC.
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3 |
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3-4 |
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5 |
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6 |
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7 |
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Managements Discussion and Analysis of Financial Condition and Results of Operations |
36 |
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63 |
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64 |
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65 |
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65 |
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65 |
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65 |
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65 |
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65 |
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66 |
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67 |
PROSPECT MEDICAL HOLDINGS, INC.
CONDENSED CONSOLIDATED BALANCE SHEETS
(in thousands)
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June 30, |
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September 30, |
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2010 |
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2009 |
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(Unaudited) |
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ASSETS |
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Current assets: |
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Cash and cash equivalents |
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$ |
50,941 |
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$ |
37,768 |
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Restricted cash |
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2,793 |
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1,395 |
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Investments, primarily restricted certificates of deposit |
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634 |
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665 |
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Patient accounts receivable, net of allowance for doubtful accounts of $18,219 and $11,715 at June 30, 2010 and September 30, 2009, respectively |
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42,609 |
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36,806 |
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Due from government payers |
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754 |
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6,427 |
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Other receivables |
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4,039 |
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1,711 |
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Refundable income taxes, net |
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1,558 |
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Deferred income taxes, net |
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6,567 |
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6,644 |
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Inventories of supplies |
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4,130 |
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4,137 |
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Prepaid expenses and other current assets |
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4,955 |
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5,380 |
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Total current assets |
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117,422 |
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102,491 |
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Property, improvements and equipment, net |
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63,638 |
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63,724 |
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Deferred financing costs, net |
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6,841 |
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8,205 |
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Goodwill |
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153,250 |
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153,250 |
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Intangible assets, net |
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43,158 |
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46,425 |
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Other assets |
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568 |
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1,051 |
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Total assets |
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$ |
384,877 |
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$ |
375,146 |
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The accompanying notes are an integral part of these condensed consolidated financial statements.
PROSPECT MEDICAL HOLDINGS, INC.
CONDENSED CONSOLIDATED BALANCE SHEETS
(in thousands, except share amounts)
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June 30, |
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September 30, |
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2010 |
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2009 |
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(Unaudited) |
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LIABILITIES AND SHAREHOLDERS EQUITY |
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Current liabilities: |
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Accrued medical claims and other healthcare costs payable |
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$ |
14,745 |
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$ |
16,824 |
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Accounts payable and other accrued liabilities |
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37,362 |
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31,773 |
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Accrued salaries, wages and benefits |
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18,777 |
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24,903 |
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Due to government payers |
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13,834 |
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13,834 |
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Income taxes payable, net |
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301 |
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Current portion of capital leases |
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757 |
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820 |
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Current portion of long-term debt |
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22,183 |
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3,805 |
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Other current liabilities |
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868 |
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629 |
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Total current liabilities |
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108,827 |
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92,588 |
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Long-term debt, net of current maturities |
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157,329 |
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172,539 |
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Deferred income taxes, net |
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29,897 |
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29,975 |
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Malpractice reserves |
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1,866 |
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2,824 |
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Capital leases, net of current portion |
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617 |
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569 |
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Other long-term liabilities |
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158 |
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162 |
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Total liabilities |
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298,694 |
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298,657 |
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Commitments Contingencies and Subsequent Events |
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Shareholders equity: |
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Common stock, $0.01 par value; 40,000,000 shares authorized; 21,188,910 and 20,619,278 shares issued and outstanding at June 30, 2010 and September 30, 2009,respectively |
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212 |
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206 |
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Additional paid-in capital |
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97,014 |
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94,498 |
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Accumulated deficit |
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(10,008 |
) |
(18,303 |
) |
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Total shareholders equity |
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87,218 |
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76,401 |
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Noncontrolling interest |
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(1,035 |
) |
88 |
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Total Prospect Medical Holdings, Inc.s shareholders equity |
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86,183 |
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76,489 |
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Total liabilities and shareholders equity |
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$ |
384,877 |
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$ |
375,146 |
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The accompanying notes are an integral part of these condensed consolidated financial statements.
PROSPECT MEDICAL HOLDINGS, INC.
CONDENSED CONSOLIDATED STATEMENTS OF OPERATIONS
(in thousands, except per share amounts)
(Unaudited)
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Three Months Ended |
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Nine Months Ended |
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2010 |
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2009 |
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2010 |
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2009 |
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Revenues: |
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Net Hospital Services revenues |
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$ |
69,540 |
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$ |
66,470 |
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$ |
209,490 |
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$ |
139,701 |
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Medical Group revenues |
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47,367 |
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47,848 |
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140,175 |
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144,138 |
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Total revenues |
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116,907 |
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114,318 |
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349,665 |
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283,839 |
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Operating expenses: |
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Hospital operating expenses |
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52,347 |
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51,278 |
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154,630 |
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96,281 |
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Medical Group cost of revenues |
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37,422 |
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36,968 |
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111,130 |
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111,535 |
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General and administrative |
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13,435 |
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17,740 |
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43,564 |
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43,505 |
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Depreciation and amortization |
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2,078 |
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2,162 |
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6,236 |
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5,751 |
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Total operating expenses |
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105,282 |
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108,148 |
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315,560 |
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257,072 |
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Operating income from unconsolidated joint venture |
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482 |
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535 |
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1,514 |
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1,482 |
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Operating income |
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12,107 |
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6,705 |
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35,619 |
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28,249 |
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Other (income) expense: |
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Interest expense and amortization of deferred financing costs, net |
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7,109 |
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8,648 |
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21,208 |
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21,294 |
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(Gain) loss on interest rate swap arrangements |
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(3,694 |
) |
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5,019 |
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Total other expense, net |
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7,109 |
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4,954 |
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21,208 |
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26,313 |
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Income before income taxes |
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4,998 |
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1,751 |
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14,411 |
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1,936 |
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Provision for income taxes |
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2,791 |
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1,989 |
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7,239 |
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2,065 |
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Net income (loss) |
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2,207 |
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(238 |
) |
7,172 |
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(129 |
) |
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Net loss attributable to noncontrolling interest |
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(640 |
) |
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(1,123 |
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5 |
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Net income (loss) attributable to Prospect Medical Holdings, Inc. |
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$ |
2,847 |
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$ |
(238 |
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$ |
8,295 |
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$ |
(134 |
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Per share data: |
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Net income (loss) attributable to Prospect Medical Holdings, Inc. per common share |
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Basic |
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$ |
0.14 |
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$ |
(0.01 |
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$ |
0.40 |
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$ |
(0.01 |
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Diluted |
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$ |
0.12 |
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$ |
(0.01 |
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$ |
0.37 |
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$ |
(0.01 |
) |
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Weighted average shares outstanding: |
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Basic |
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20,989 |
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20,520 |
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20,814 |
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20,512 |
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Diluted |
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23,119 |
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20,520 |
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22,567 |
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20,512 |
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The accompanying notes are an integral part of these condensed consolidated financial statements.
PROSPECT MEDICAL HOLDINGS, INC.
CONDENSED CONSOLIDATED STATEMENTS OF CASH FLOWS
(in thousands)
(Unaudited)
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Nine Months Ended |
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2010 |
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2009 |
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Operating activities |
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Net income (loss) |
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$ |
7,172 |
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$ |
(129 |
) |
Adjustments to reconcile net income (loss) to net cash provided by (used in) operating activities: |
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Depreciation and amortization |
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6,235 |
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5,751 |
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Amortization of deferred financing costs, net |
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1,404 |
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259 |
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Amortization of original issue discount |
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1,385 |
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Provision for bad debts |
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21,993 |
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12,283 |
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Payment-in-kind interest expense |
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277 |
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Amortization of other comprehensive income related to interest rate swap arrangements |
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659 |
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Deferred income taxes, net |
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(1,628 |
) |
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Stock-based compensation |
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1,895 |
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766 |
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(Gain) loss on sale of assets |
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(7 |
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34 |
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Loss on interest rate swap agreements |
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5,019 |
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Change in assets and liabilities: |
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Patient and other receivables |
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(24,449 |
) |
(9,016 |
) |
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Prepaid expenses and other |
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425 |
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431 |
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Inventories of supplies |
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7 |
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133 |
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Refundable income taxes, net |
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1,558 |
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2,654 |
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Income taxes payable, net |
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301 |
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Deposits and other assets |
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481 |
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171 |
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Accrued medical claims and other healthcare costs payable |
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(2,079 |
) |
(2,617 |
) |
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Accounts payable and other accrued liabilities |
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(1,259 |
) |
(3,009 |
) |
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Net cash provided by operating activities |
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15,062 |
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12,038 |
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Investing activities |
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Purchases of property, improvements and equipment |
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(2,268 |
) |
(764 |
) |
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Cash paid for acquisitions, net of cash received |
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(2,310 |
) |
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Capitalized expenses related to acquisitions |
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(37 |
) |
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Decrease (increase) in restricted certificates of deposit |
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31 |
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(28 |
) |
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Net cash used in investing activities |
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(2,237 |
) |
(3,139 |
) |
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Financing activities |
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Borrowings (repayments) on line of credit, net |
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2,681 |
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(1,671 |
) |
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Repayments on Class 4 Creditors Trust Note |
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(897 |
) |
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Repayments of term loans |
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(8,904 |
) |
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Payments on capital leases |
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(625 |
) |
(395 |
) |
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Change in restricted cash |
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(1,399 |
) |
1,047 |
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Proceeds from exercises of stock options and warrants |
|
627 |
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Cash paid for deferred financing costs, net |
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(39 |
) |
(972 |
) |
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Net cash (used in) provided by financing activities |
|
348 |
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(10,895 |
) |
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Increase (decrease) in cash and cash equivalents |
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13,173 |
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(1,996 |
) |
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Cash and cash equivalents at beginning of period |
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37,768 |
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33,583 |
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Cash and cash equivalents at end of period |
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$ |
50,941 |
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$ |
31,587 |
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Supplemental disclosure of cash flow information |
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Equipment acquired under capital lease |
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$ |
631 |
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$ |
509 |
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Interest paid |
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$ |
12,305 |
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$ |
19,441 |
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Income taxes paid, net |
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$ |
5,380 |
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$ |
1,523 |
|
The accompanying notes are an integral part of these condensed consolidated financial statements.
PROSPECT MEDICAL HOLDINGS, INC.
NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS
June 30, 2010
(Unaudited)
1. Organization
Prospect Medical Holdings, Inc. (Prospect, Company or the Parent Entity) is a Delaware corporation. Prior to the August 8, 2007 acquisition of Alta Hospitals System, LLC (Alta), which was previously known as Alta Healthcare System, Inc., the Company was primarily engaged in providing management services to affiliated physician organizations that operate as independent physician associations (Medical Groups) or medical clinics. Following the Alta acquisition and acquisition of a majority stake in Brotman Medical Center, Inc., a California corporation (Brotman), on April 14, 2009 (see Note 8), and as of June 30, 2010, the Company owns and operates five community-based hospitals in Southern California, and its operations are organized into three primary reportable segments: Hospital Services, Medical Group and Corporate as discussed below.
Effective August 16, 2010, the Company entered into a definitive merger agreement (see Note 14).
Hospital Services Segment
Alta and Brotman (collectively, the Hospital Services segment) own and operate five hospitals in Los Angeles County, all accredited by the Joint Commission (formerly the Joint Commission on Accreditation of Healthcare Organizations), with a total of 759 licensed beds served by 727 on-staff physicians at June 30, 2010. Alta owns (i) Alta Hollywood Hospitals, Inc., a California corporation, dba Hollywood Community Hospital and Van Nuys Community Hospital; and (ii) Alta Los Angeles Hospitals, Inc., a California corporation, dba Los Angeles Community Hospital and Norwalk Community Hospital. On April 14, 2009 (the Acquisition Date), the Company increased its existing approximately 33.1% ownership stake in Brotman, to approximately 72% via an investment of approximately $2.5 million in cash, thereby obtaining a controlling interest. Brotman owns and operates Brotman Medical Center, located in Culver City, California.
The hospitals in Hollywood, Los Angeles and Norwalk offer a comprehensive range of medical and surgical services, including general acute care hospital services, pediatrics, obstetrics and gynecology, pediatric sub-acute care, general surgery, medical-surgical services, orthopedic surgery, and diagnostic, outpatient, skilled nursing and urgent care services. The hospital in Van Nuys provides acute inpatient and outpatient psychiatric services on a voluntary basis. Brotman offers a comprehensive range of inpatient and outpatient services, including general surgery, orthopedic, spine and neurosurgery, cardiology, diagnostic outpatient, rehabilitation, psychiatric and detox services. In addition, Brotman has an active emergency room that plays an integral part in providing emergency services to the West Los Angeles area.
The table below gives a brief overview of the Companys hospitals and the locations they serve:
Name/Location |
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Primary Service |
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Number of Beds |
Hollywood Community Hospital |
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Medical/Surgical |
|
100 licensed beds/100 staffed beds |
Los Angeles Community Hospital |
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Medical/Surgical |
|
130 licensed beds/121 staffed beds |
Norwalk Community Hospital |
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Medical/Surgical |
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50 licensed beds/50 staffed beds |
Van Nuys Community Hospital |
|
Psychiatric |
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59 licensed beds/59 staffed beds |
Brotman Medical Center |
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Medical/Surgical |
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420 licensed beds/272 staffed beds |
Admitting physicians are primarily practitioners in the local area. The Hospitals have payment arrangements with Medicare, Medi-Cal (the California version of Medicaid) and other third party payers, including some commercial insurance carriers, health maintenance organizations (HMOs) and preferred provider organizations (PPOs).
Medical Group Segment
The Medical Group segment is a healthcare management services organization that provides management services to affiliated physician organizations that operate as independent physician associations (Medical Groups). The affiliated physician organizations enter into agreements with HMOs to provide HMO enrollees with a full range of medical services in exchange for fixed, prepaid monthly fees known as capitation payments. The Medical Groups contract with physicians (primary care and specialist) and other healthcare providers to provide enrollees with all medical services. Prospect currently manages the provision of prepaid healthcare services for its affiliated physician organizations in Southern California. The network consists of the following physician organizations as of June 30, 2010 (stand alone or individually referred to as, an Affiliate):
Prospect Medical Group, Inc. (PMG)
Prospect Health Source Medical Group, Inc. (PHS)
Prospect Professional Care Medical Group, Inc. (PPCM)
APAC Medical Group, Inc. (APA) (Inactive)
Genesis HealthCare of Southern California, Inc. (Genesis)
Prospect NWOC Medical Group, Inc. (PNW)
StarCare Medical Group, Inc. (PSC)
Santa Ana/Tustin Physicians Group, Inc. (SATPG)
AMVI/Prospect Health Network (AMVI/Prospect)
Nuestra Familia Medical Group, Inc. (Nuestra)
Upland Medical Group, a Professional Medical Group (UMG)*
Pomona Valley Medical Group, Inc. (PVMG)*
* PVMG and UMG are collectively referred to as the ProMed Entities.
These Affiliates are managed by the following two medical management company subsidiaries that are wholly-owned by Prospect:
Prospect Medical Systems, Inc. (PMS)
ProMed Healthcare Administrators, Inc. (PHCA)
All of the Affiliates are wholly-owned by PMG, with the exception of Nuestra, which is 55% owned by a nominee physician shareholder pursuant to an assignable option agreement described below, and AMVI/Prospect which is a 50/50 Joint Venture between AMVI and PMG. PMG is owned by the same nominee physician shareholder pursuant to a separate assignable option agreement. The results of all of these entities, with the exception of AMVI/Prospect, are consolidated in the accompanying unaudited condensed consolidated financial statements.
The Medical Group segment manages services for the following enrollees under contracts with various health plans (in thousands, unaudited):
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As of June 30, |
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Member Category |
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2010 |
|
2009 |
|
|
|
|
|
|
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Commercial owned |
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122 |
|
136 |
|
Commercial - managed(l) |
|
8 |
|
1 |
|
Senior owned |
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22 |
|
21 |
|
Senior - managed(1) |
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1 |
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0 |
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Medi-Cal owned |
|
11 |
|
12 |
|
Medi-Cal - managed(1) |
|
12 |
|
8 |
|
Total |
|
176 |
|
178 |
|
(1) Represents members that we manage on behalf of third parties in exchange for a management fee.
Corporate Segment
Corporate segment reflects certain expenses incurred at Prospect Medical Holdings, Inc. (the Parent Entity) not specifically allocable to the Hospital Services or Medical Group segments. These include and are not limited to salaries, benefits and other compensation for corporate employees, financing, insurance, rent, operating supplies, legal, accounting, SEC compliance, and Sarbanes-Oxley compliance. The Company does not allocate interest expense, gain or loss on interest rate swaps and income taxes to the other reporting segments.
2. Summary of Significant Accounting Policies
Basis of Presentation
The accompanying unaudited condensed consolidated financial statements of the Company have been prepared in conformity with U.S. Generally Accepted Accounting Principles (U.S. GAAP) for interim consolidated financial information and with the instructions for Form 10-Q and Article 10 of Regulation S-X. In accordance with the instructions and regulations of the Securities and Exchange Commission (SEC) for interim reports, certain information and footnote disclosures normally included in financial statements prepared in conformity with U.S. GAAP for annual reports have been omitted or condensed. All adjustments (consisting of normal recurring adjustments) and disclosures considered necessary for fair presentation have been included in the accompanying unaudited condensed consolidated financial statements.
The unaudited results of operations for the three months and nine months ended June 30, 2010 are not necessarily indicative of the results to be expected for the full year. The information included in this Quarterly Report on Form 10-Q should be read in conjunction with the audited consolidated financial statements for the year ended September 30, 2009 and notes thereto included in the Companys Annual Report on Form 10-K filed with the SEC on December 21, 2009.
Principles of Consolidation
The unaudited condensed consolidated financial statements include the accounts of the Company and all wholly owned and majority owned subsidiaries and controlled entities in accordance with the accounting guidance for consolidations. All adjustments considered necessary for a fair presentation of the results as of the date of, and for the interim periods presented, which consist solely of normal recurring adjustments, have been included. All significant intercompany balances and transactions have been eliminated in consolidation.
Effect of Recent Accounting Pronouncements
Effective the first quarter of fiscal year 2010, the Company adopted the revised accounting guidance for business combinations, which changed its previous accounting practices regarding business combinations. The more significant changes include an expanded definition of a business and a business combination; recognition of assets acquired, liabilities assumed and noncontrolling interests (including goodwill) measured at fair value at the acquisition date; recognition of acquisition-related expenses and restructuring costs separately from the business combination; recognition of assets acquired and liabilities assumed at their acquisition-date fair values with subsequent changes recognized in earnings. The guidance also amends and clarifies the application issues on initial recognition and measurement, subsequent measurement and accounting, and disclosure of assets and liabilities arising from contingencies in a business combination. The adoption did not have a material impact on the Companys condensed consolidated financial statements for prior periods; but the pronouncement will impact the accounting for any acquisitions subsequent to that date.
Effective in the first quarter of fiscal year 2010, the Company adopted revised accounting guidance which requires noncontrolling interests (formerly minority interest) to be presented as a separate component from the Companys equity in the equity section of the consolidated balance sheets. As required by this guidance, the Company has adjusted the presentation of noncontrolling interests in the prior period unaudited condensed consolidated financial statements so that they are comparable to those of the fiscal year 2010 period. The adoption of this accounting guidance had no impact on the Companys results of operations and did not have a material impact on the Companys financial position.
In January 2010, the Financial Accounting Standards Board (FASB) issued guidance to amend the disclosure requirements related to recurring and nonrecurring fair value measurements. The guidance requires new disclosures on the transfers of assets and liabilities between Level 1 (quoted prices in active market for identical assets or liabilities) and Level 2 (significant other observable inputs) of the fair value measurement hierarchy, including the reasons and the timing of the transfers. Additionally, the guidance requires a roll forward of activities on purchases, sales, issuance, and settlements of the assets and liabilities measured using significant unobservable inputs (Level 3 fair value measurements). Disclosures regarding transfers are required beginning January 1, 2010 and the Level 3 rollforward is to be disclosed in reporting periods beginning after December 15, 2010. Since the Company had no transfers between categories, the additional disclosures are not applicable for the periods presented.
On October 1, 2009, the Company adopted guidance on fair value measurement for nonfinancial assets and liabilities, except for items that are recognized or disclosed at fair value in the financial statements on a recurring basis (at least annually). Adoption of the new guidance did not have a material impact on the Companys financial statements.
In June 2008, the FASB issued guidance for the accounting of share-based payment awards. Under the guidance, unvested share-based payment awards that contain non-forfeitable rights to dividends or dividend equivalents are deemed participating securities and, therefore, are included in computing earnings per share (EPS) pursuant to the two-class method. The two-class method determines earnings per share for each class of common stock and participating securities according to dividends or dividend equivalents and their respective participation rights in undistributed earnings. The Company adopted the guidance effective October 1, 2009. The adoption of this guidance did not impact net income attributable to the Company per common share for prior periods and is not expected to have an impact on future periods until such time as the Company declares a regular quarterly dividend.
In June 2009, the FASB issued revised guidance for the accounting of variable interest entities. This revised guidance replaces the quantitative-based risks and rewards approach with a qualitative approach that focuses on identifying which enterprise has the power to direct the activities of a variable interest entity that most significantly impact the entitys economic performance and has the obligation to absorb losses or the right to receive benefits from the entity that could be potentially significant to the variable interest entity. The accounting guidance also requires an ongoing reassessment of whether an enterprise is the primary beneficiary and requires additional disclosures about an enterprises involvement in variable interest entities. This accounting guidance is effective for the Company beginning in the first quarter of fiscal 2011. The Company is currently evaluating the impact that the adoption of this guidance will have on its consolidated financial statements.
In June 2009, the FASB issued revised guidance for the accounting of transfers of financial assets. This guidance eliminates the concept of a qualifying special-purpose entity, removes the scope exception for qualifying special-purpose entities when applying the accounting guidance related to the consolidation of variable interest entities, changes the requirements for derecognizing financial assets, and requires enhanced disclosure. This accounting guidance is effective for the Company beginning in the first quarter of fiscal 2011. The Company is currently evaluating the impact that the adoption of this guidance will have on its consolidated financial statements.
Use of Estimates
The preparation of financial statements in conformity with U.S. GAAP requires Management to make estimates and assumptions that affect the reported amounts of assets, liabilities, revenues and expenses, and the disclosure of contingent assets and liabilities at the dates, and for the periods, that the unaudited condensed consolidated financial statements are prepared. Actual results could materially differ from those estimates. Principal areas requiring the use of estimates include third party settlements, receivables for medical services, allowances for contractual discounts and doubtful accounts, accruals for medical claims, impairment of goodwill, long-lived assets and intangible assets, valuation of interest rate swaps, share-based payments, professional and general liability claims and workers compensation claims, reserves for outcome of legislation and valuation allowances against deferred tax assets.
Restricted Cash
At June 30, 2010, restricted cash primarily represent amounts set aside pursuant to the JHA loan agreements (see Note 7), totaling $2,560,000 held in escrow for property taxes, maintenance and emergency room construction. Additionally, $233,000 was held in a restricted account in connection with workers compensation arrangements.
Investments
The Company is required to keep restricted deposits by certain HMOs for the payment of claims. Such restricted deposits are classified as a current asset in the accompanying unaudited condensed consolidated balance sheet, as they are restricted for payment of current liabilities.
Due from/to Government Payers
Following the acquisition of Brotman, effective April 14, 2009, the Company consolidated Brotmans estimated liability to the Centers for Medicare and Medicaid Services (CMS) arising out of outlier payments received for services provided by Brotman to Medicare eligible inpatients, primarily for the last four months of calendar year 2005 and all of calendar year 2006.
While Brotman reports financial statements on a fiscal year ending September 30, Medicare cost reports are filed on a calendar year basis. Acute care hospitals receive Medicare reimbursement payments pursuant to a prospective payment methodology primarily based on the diagnosis of the patient, but are entitled to receive additional payments, referred to as outliers for patients whose treatment is very costly. When Brotman acquired the hospital in 2005, CMS provided a ratio of cost to charges (the RCC) based on the statewide average. Payments on this basis were an interim estimate, subject to final determination upon auditing of the Hospitals cost reports. The Hospital filed its Medicare cost reports, but determined that its outlier reimbursement for services provided in fiscal years 2005 and 2006 might be subject to adjustment based on certain outlier reconciliation rules. The Company believes that CMS has not conducted any outlier reconciliations under current regulations, has not formally notified the Hospital of any pending reconciliation to be conducted regarding their cost reports and has not determined the amount of any liability at this point related to possible overpayments. As of June 30, 2010 and September 30, 2009, an estimated liability of $13,834,000 was included in the accompanying unaudited condensed consolidated balance sheet related to this matter. Brotman and Alta have also accrued estimated third party settlement net receivables in the amount of $754,000 for filed cost reporting years and estimates for the nine months ended June 30, 2010. At September 30, 2009, estimated net receivables for cost reports not yet finalized were approximately $1,575,000. Normal estimation differences between final settlements and amounts accrued in previous years are reflected in net patient service revenue in the year of final settlement, which amounts totaled approximately $517,000 and $1,087,000 in the three month and nine month periods ended June 30, 2009, respectively, and $377,000 in each of the three month and nine month periods ended June 30, 2010.
The following is a summary of due from and due to governmental payers (in thousands):
|
|
June 30, |
|
September 30, |
|
||
|
|
2010 |
|
2009 |
|
||
|
|
(Unaudited) |
|
|
|
||
Due from government payers: |
|
|
|
|
|
||
Medi-Cal Disproportionate Share (DSH) |
|
$ |
|
|
$ |
4,852 |
|
Medicare cost report settlement |
|
754 |
|
1,575 |
|
||
|
|
$ |
754 |
|
$ |
6,427 |
|
Due to government payers: |
|
|
|
|
|
||
Outlier liability |
|
$ |
13,834 |
|
$ |
13,834 |
|
Revenues
Revenues by reportable operating segment are comprised of the following amounts (in thousands, unaudited):
|
|
Three Months Ended |
|
Nine Months Ended |
|
||||||||
|
|
2010 |
|
2009 (1) |
|
2010 |
|
2009 (1) |
|
||||
Net Hospital Services |
|
|
|
|
|
|
|
|
|
||||
Inpatient |
|
$ |
60,169 |
|
$ |
59,039 |
|
$ |
181,219 |
|
$ |
127,839 |
|
Outpatient |
|
8,786 |
|
6,651 |
|
25,559 |
|
10,315 |
|
||||
Other |
|
585 |
|
780 |
|
2,712 |
|
1,547 |
|
||||
Total net Hospital Services revenues |
|
$ |
69,540 |
|
$ |
66,470 |
|
$ |
209,490 |
|
$ |
139,701 |
|
Medical Group |
|
|
|
|
|
|
|
|
|
||||
Capitation |
|
$ |
46,790 |
|
$ |
47,369 |
|
$ |
139,172 |
|
$ |
143,005 |
|
Management fees |
|
293 |
|
149 |
|
604 |
|
437 |
|
||||
Other |
|
284 |
|
330 |
|
399 |
|
696 |
|
||||
Total Medical Group revenues |
|
$ |
47,367 |
|
$ |
47,848 |
|
$ |
140,175 |
|
$ |
144,138 |
|
Total revenues |
|
$ |
116,907 |
|
$ |
114,318 |
|
$ |
349,665 |
|
$ |
283,839 |
|
(1) Brotman revenues have been included in the accompanying unaudited condensed consolidated financial statements effective April 14, 2009, when the Company acquired a majority stake in Brotman. Accordingly, the three months and nine months ended June 30, 2009 include 77 days for each periods operations of Brotman.
The Company presents segment information externally the same way Management uses financial data internally to make operating decisions and assess performance. The Companys operations are organized into three reporting segments: (i) Hospital Services, (ii) Medical Group, and (iii) Corporate (see Note 9).
Comprehensive Income (Loss)
Comprehensive income (loss) includes net income (loss) attributable to Prospect, net of taxes, and changes in the fair value of interest rate swaps subject to hedge accounting that are recorded as other comprehensive income. As of April 1, 2008, the Companys swaps ceased to be eligible for hedge accounting. As a result, all further changes in fair value of the swaps were recorded in the condensed consolidated statements of operations and the effective portion of the swaps of approximately $5.4 million, after tax, that was recorded in other comprehensive income through June 30, 2008 continued to be amortized to interest expense, using the effective interest method over the remaining life of the swaps. The remaining unamortized portion of the interest rate swaps was expensed in July 2009 in connection with the Companys termination of such swaps.
Reclassification
Certain prior period amounts have been reclassified to conform to the current period presentation with no impact on the unaudited condensed consolidated net loss.
Subsequent Events
The Companys unaudited condensed consolidated financial statements are considered issued when filed with the SEC. Accordingly, the Company has evaluated subsequent events up to the filing date of this Form 10-Q with the SEC (see Note 14).
3. Property, Improvements and Equipment
Property, improvements and equipment consisted of the following (in thousands):
|
|
June 30, |
|
September 30, |
|
||
|
|
2010 |
|
2009 |
|
||
|
|
(Unaudited) |
|
|
|
||
Property, improvements and equipment: |
|
|
|
|
|
||
Land and land improvements |
|
$ |
31,028 |
|
$ |
31,028 |
|
Buildings and improvements |
|
24,298 |
|
23,665 |
|
||
Leasehold improvements |
|
2,480 |
|
2,029 |
|
||
Equipment |
|
21,847 |
|
20,255 |
|
||
Furniture and fixtures |
|
892 |
|
913 |
|
||
|
|
80,545 |
|
77,890 |
|
||
Less accumulated depreciation |
|
(16,907 |
) |
(14,166 |
) |
||
Property, improvements and equipment, net |
|
$ |
63,638 |
|
$ |
63,724 |
|
4. Equity-Based Compensation Plans
On August 13, 2008, following shareholder approval, the Company adopted the 2008 Omnibus Equity Incentive Plan (2008 Plan) to provide flexibility in implementing equity awards, including incentive stock options (ISO), non-qualified stock options (NQSO), restricted stock grants, stock appreciation rights (SAR) and performance based awards to employees, directors and outside consultants, as determined by the Compensation Committee of the Board of Directors (the Committee). In conjunction with the adoption of the 2008 Plan, effective August 13, 2008, additional equity awards under the Companys 1998 Stock Option Plan (1998 Plan) were discontinued and new equity awards are now granted under the 2008 Plan. Remaining authorized shares under the 1998 Plan which were not subject to outstanding awards as of August 13, 2008, were canceled on August 13, 2008. The 1998 Plan will remain in effect as to outstanding equity awards granted under the 1998 Plan prior to August 13, 2008. At the inception of the 2008 Plan, 4,000,000 shares were reserved for issuance under the 2008 Plan. As of June 30, 2010, there were 805,250 shares available for future grants under the 2008 Plan.
Under the terms of the 2008 Plan, the exercise price of an ISO may not be less than 100% of the fair market value of the Companys common stock on the date of grant and, if granted to a shareholder owning more than 10% of the Companys common stock, then not less than 110%. Stock options granted under the 2008 Plan have a maximum term of 10 years from the grant date, and are exercisable at such time and upon such terms and conditions as determined by the Committee. Stock options granted to employees generally vest over four years, while options granted to certain executives typically vest over a shorter period, subject to continued service. In the case of an ISO, the amount of the aggregate fair market value of common stock (determined at the time of grant) with respect to which ISO are exercisable for the first time by an employee during any calendar year may not exceed $100,000.
The base price, above which any appreciation of a SAR issued under the 2008 Plan is measured, will in no event be less than 100% of the fair market value of the Companys stock on the date of grant of the SAR or, if the SAR is granted in tandem with a stock option, the exercise price under the associated option. The restrictions imposed on shares granted under a restricted stock award will lapse in accordance with the vesting requirements specified by the Committee in the award agreement. Such vesting requirements may be based on the continued service of the participant with the Company for a specified time, or on the attainment of specified performance goals established by the Committee in its discretion. If the vesting requirements of a restricted stock award are not satisfied prior to the termination of the participants service, the unvested portion of the award will be forfeited and the shares of common stock subject to the unvested portion of the award will be returned to the Company.
Stock Options Activity
The following table summarizes information about our stock options outstanding as of June 30, 2010 and activity during the nine month period then ended (unaudited):
|
|
|
|
|
|
|
|
Weighted |
|
||
|
|
|
|
|
|
|
|
Average |
|
||
|
|
|
|
Weighted |
|
|
|
Remaining |
|
||
|
|
|
|
Average |
|
Aggregate |
|
Contractual |
|
||
|
|
|
|
Exercise |
|
Intrinsic |
|
Term |
|
||
|
|
Shares |
|
Price |
|
Value |
|
(Months) |
|
||
Outstanding as of September 30, 2009 |
|
4,333,335 |
|
$ |
3.00 |
|
|
|
|
|
|
Granted |
|
430,000 |
|
$ |
4.46 |
|
|
|
|
|
|
Exercised |
|
(173,858 |
) |
$ |
2.59 |
|
$ |
689,582 |
|
|
|
Forfeited |
|
(20,000 |
) |
$ |
4.49 |
|
|
|
|
|
|
Expired |
|
(58,420 |
) |
$ |
6.44 |
|
|
|
|
|
|
Outstanding as of June 30, 2010 |
|
4,511,057 |
|
$ |
3.10 |
|
$ |
13,300,533 |
|
39 |
|
Vested and exercisable as of June 30, 2010 |
|
3,507,719 |
|
$ |
3.06 |
|
$ |
10,483,150 |
|
38 |
|
The aggregate intrinsic value is calculated as the difference between the exercise price of the underlying awards and the quoted price of our common stock for those awards that have an exercise price below the quoted value.
Stock-Based Compensation Expense
Stock-based compensation expense for all share-based payments in exchange for employee services (including stock options and restricted stock) is measured at fair value on the date of grant, estimated using an option pricing model and is recognized in the financial statements, net of estimated forfeitures over the awards requisite service period.
Compensation expenses for stock-based awards are measured and recognized in the financial statements, net of estimated forfeitures over the awards requisite service period. The Company uses the Black-Scholes option pricing model and a single option award approach to estimate the fair value of options granted. Estimated forfeitures will be revised in future periods if actual forfeitures differ from the estimates and will impact compensation cost in the period in which the change in estimate occurs. The determination of fair value using the Black-Scholes option-pricing model is affected by the Companys stock price as well as assumptions regarding a number of complex and subjective variables, including expected stock price volatility, risk-free interest rate, expected dividends and projected employee stock option exercise behaviors. Equity-based compensation is classified within the same line items as cash compensation paid to employees. Cash retained as a result of excess tax benefits relating to share-based payments are presented in the statement of cash flows as a financing cash inflow.
The weighted average assumptions used in determining the value of options granted and a summary of the methodology applied to develop each assumption are as follows (unaudited):
|
|
Nine Months Ended |
|
|
|
|
June 30, 2010 |
|
|
Weighted average fair value of option grants |
|
$ |
1.70 |
|
Weighted average market price of the Companys common stock on the date of grant |
|
$ |
4.46 |
|
Weighted average expected life of the options |
|
3.16 years |
|
|
Risk-free interest rate |
|
1.39 |
% |
|
Weighted average expected volatility |
|
54.51 |
% |
Expected TermThe expected term of options granted represents the period of time that they are expected to be outstanding. The Company has adopted the simplified method of determining the expected term for plain vanilla options, as allowed under the Securities and Exchange Commission Staffs shortcut approach. The simplified method states that the expected term is equal to the sum of the vesting term plus the contract term, divided by two. Plain vanilla options are defined as those granted at-the-money, having service time vesting as a condition to exercise, providing that non-vested options are forfeited upon termination and that there is a limited time to exercise the vested options after termination of service, usually 90 days, and providing the options are non-transferable and non-hedgeable.
Risk-Free Interest RateThe Company bases the risk-free interest rate on the implied yield in effect at the time of option grant on U.S. Treasury zero-coupon issues with equivalent remaining terms.
Expected VolatilityThe Company estimates the volatility of the common stock at the date of grant based on the average of the historical volatilities of a group of peer companies. Since the Companys shares did not become publicly traded until May 2005 and trading volume has been limited, Management believes there is currently not sufficient historical volatility data available to predict the stocks future volatility. The Company has identified a group of comparable companies to calculate historical volatility from publicly available data for sequential periods approximately equal to the expected terms of the option grants. In selecting comparable companies, Management considered several factors including industry, stage of development, size and market capitalization.
Expected Dividend Yields The Company has never paid any cash dividends on its common stock and does not anticipate paying any cash dividends in the foreseeable future.
ForfeituresShare-based compensation is recognized only for those awards that are ultimately expected to vest. Compensation expense is recorded net of estimated forfeitures. Those estimates are revised in subsequent periods if actual forfeitures differ from those estimates. The Company used data since May 2005 to estimate pre-vesting option forfeitures.
During the nine months ended June 30, 2010, an aggregate of 430,000 options were issued under the 2008 Plan, of which 220,000 were granted to Samuel S. Lee in connection with his employment as the Chief Executive Officer of the Company and 200,000 were granted to Mike Heather in connection with his employment as Chief Financial Officer of the Company. As of June 30, 2010, all of the options granted to the Chief Executive Officer had vested and two-thirds of options granted to the Chief Financial Officer had vested.
Stock-based compensation expense for stock options recognized in the three months ended June 30, 2010 and 2009 was approximately $181,000 and $163,000, respectively, and in the nine months ended June 30, 2010 and 2009, was approximately $1,038,000 and $665,000, respectively. At June 30, 2010, there were 1,003,338 unvested options with related unamortized compensation expense of approximately $735,000, which will be recognized ratably over a weighted average remaining vesting period of 44 months.
Restricted Stock Award Activities
On August 15, 2008, the Company granted 200,000 shares of restricted stock to its Chief Financial Officer with a grant date fair value of $2.40 per share. As of June 30, 2010, all such shares had fully vested. On December 18, 2009, the Company granted an aggregate of 210,000 shares of restricted stock to its Chief Executive Officer and Chief Financial Officer. As of June 30, 2010, all of the shares granted to the Chief Executive Officer had vested and two-thirds of the shares granted to the Chief Financial Officer had vested. Compensation expense relating to restricted stock recorded in the three months ended June 30, 2010 and 2009 was approximately $67,000 and $33,000, respectively and in the nine months ended June 30, 2010 and 2009, was approximately $789,000 and $113,000, respectively.
On November 12, 2009, the Company granted an aggregate of 36,000 shares of restricted stock to outside members of the Board of Directors. Approximately $144,000 of expense relating to these shares, which vested immediately was included in general and administrative expense in the accompanying unaudited condensed consolidated financial statements during the nine months ended June 30, 2010.
5. Earnings per Share
The Company calculates basic net income (loss) per share by dividing net income (loss) attributable to common shareholders by the weighted average number of common shares outstanding. Diluted earnings per share is computed by dividing net income (loss) attributable to common shareholders by the weighted average number of common shares outstanding, after giving effect to potentially dilutive shares computed using the treasury stock method. Such shares are excluded if determined to be anti-dilutive.
The calculations of basic and diluted net income (loss) per share attributable to Prospect are as follows (in thousands, except share and per-share amounts, unaudited):
|
|
Three Months Ended |
|
Nine Months Ended |
|
||||||||
|
|
2010 |
|
2009 |
|
2010 |
|
2009 |
|
||||
Net income (loss) attributable to Prospect Medical Holdings, Inc. |
|
$ |
2,847 |
|
$ |
(238 |
) |
$ |
8,295 |
|
$ |
(134 |
) |
|
|
|
|
|
|
|
|
|
|
||||
Weighted average common shares outstanding - basic |
|
20,989,275 |
|
20,520,166 |
|
20,814,321 |
|
20,512,351 |
|
||||
Dilutive effect of stock options and warrants |
|
2,129,949 |
|
|
|
1,752,392 |
|
|
|
||||
Weighted average common shares outstanding - diluted |
|
23,119,224 |
|
20,520,166 |
|
22,566,713 |
|
20,512,351 |
|
||||
|
|
|
|
|
|
|
|
|
|
||||
Basic |
|
$ |
0.14 |
|
$ |
(0.01 |
) |
$ |
0.40 |
|
$ |
(0.01 |
) |
Diluted |
|
$ |
0.12 |
|
$ |
(0.01 |
) |
$ |
0.37 |
|
$ |
(0.01 |
) |
The Company excludes equity instruments from the calculation of diluted earnings per share if the effect of including such instruments is anti-dilutive. Accordingly, a certain number of stock options and warrants have been excluded from the calculation of diluted earnings per share totaling 60,000 shares during the nine months ended June 30, 2010 and no shares during the three months ended June 30, 2010, and totaling 4,819,851 shares during each of the three months and nine months ended June 30, 2009, respectively.
6. Related Party Transactions
Prospect has a controlling financial interest in an affiliated physician organization included in its unaudited condensed consolidated financial statements which is owned by a nominee physician shareholder designated by the Company. The control is effectuated through assignable option agreements and management services agreements, which provide the Company with a unilateral right to establish or effect a change of the nominee shareholder for the affiliated physician organizations at will, and without the consent of the nominee, on an unlimited basis and at nominal cost through the term of the management agreement. Jacob Y. Terner, M.D. was, through August 8, 2008, the sole shareholder, sole director and Chief Executive Officer of Prospect Medical Group, Inc. (PMG) and was the Chief Executive Officer of most of PMGs subsidiary physician organizations. Dr. Terner also served as the sole shareholder and a director and officer of Nuestra Familia Medical Group, Inc. (Nuestra), an affiliated physician organization. Dr. Terner is a shareholder of the Company, and formerly served as its Chairman and Chief Executive Officer through part of fiscal year 2008.
The Company had an employment agreement with Dr. Terner that expired on August 1, 2008 and provided for base compensation (most recently $400,000 per year) and further provided that if the Company terminated Dr. Terners employment without cause, the Company would pay him $12,500 for each month of past service as the Chief Executive Officer, commencing as of July 31, 1996, up to a maximum of $1,237,500. Dr. Terner resigned as the Chief Executive Officer of the Company effective March 19, 2008 and resigned as the Chairman of the Board of Directors effective May 12, 2008. In consideration of Dr. Terners resignation and other promises in his resignation agreement, the Company agreed to pay to his family trust the sum of $19,361.10 each month during the twelve-month period ending on April 30, 2009 and the sum of $42,694.45 each month during the twenty-four month period ending on April 30, 2011, for the total sum of $1,257,000, which amount was recorded as a general and administrative expense in the third quarter of fiscal 2008. In September 2009, the Company ceased making payments to Dr. Terner following its determination that Dr. Terner was not entitled to receive the payments. Subsequently, Dr. Terner filed a complaint against the Company seeking restoration of the payments. The Company and Dr. Terner are currently litigating this dispute. Dr. Terner no longer serves as the nominee shareholder of the Companys affiliated physician organizations.
Dr. Arthur Lipper currently serves as the nominee shareholder of PMG and Nuestra and as the sole director of PMG and its subsidiary physician organizations and the Chief Executive Officer, President and Treasurer of all subsidiary physician organizations, except the ProMed Entities. Dr. Lipper serves as one of two directors of Nuestra, as the sole director of the ProMed Entities, and as a Vice President of Nuestra and the ProMed Entities.
On August 1, 2005 and subsequently amended on October 25, 2007, Prospect Medical Management, Inc. (now known as Prospect Hospital Advisory Services, Inc. (PHAS)), an affiliate of the Company, entered into a consulting services agreement, to provide administrative, financial and management consulting services to Brotman for a monthly fee of $100,000 plus expenses. The agreement had an initial term of one year and automatically renewed for additional one-year terms unless terminated by either party with 90 days written notice. As discussed in Note 8, Brotman, which filed a voluntary petition for bankruptcy protection under Chapter 11 of the U. S. Bankruptcy Code on October 25, 2007, emerged from Chapter 11 bankruptcy proceeding on April 14, 2009 (the Effective Date). On the Effective Date, the Company increased its approximately 33.1% ownership stake in Brotman, to approximately 72% via an incremental investment of approximately $2.5 million. For the 195 days ended April 13, 2009, total fees earned and paid under the consulting services agreement were approximately $650,000. Beginning April 14, 2009, amounts earned under the agreement have been eliminated in consolidation.
On December 15, 2009, Brotman initiated a rights offering (Rights Offering), whereby existing shareholders of the Company could subscribe to purchase up to $5,500,000 of Brotman convertible subordinated promissory notes (the Brotman Notes). The Brotman Notes are due three years from the date of issuance, bear interest at 15% per annum, and are convertible at the option of the holder into shares of Brotman at $3.34 per share. PHAS exercised its right to purchase a portion of its pro rata (approximately 72%) share of the Brotman Notes and, effective January 7, 2010, purchased $3,500,000 of such Brotman Notes. Additionally, PHAS planned on exercising its right to purchase any Brotman Notes offered that were not purchased by other Brotman shareholders. Brotman intended to use the remainder of the Rights Offering to repay approximately $2 million currently due to Prospect.
As a result of the Rights Offering, Culver Hospital Holdings, a minority shareholder of Brotman, filed a shareholder complaint against Prospect Medical Holdings, PHAS, Brotman, and each of the Brotman Board of Directors. The court granted a preliminary injunction that enjoins Prospect from taking the following actions: (1) acquiring Culvers share of convertible promissory notes, (2) converting the Brotman Notes into shares of Brotman common stock, (3) converting Brotmans debt owed to Prospect into shares of Brotman common stock, and (4) using the proceeds of the Rights Offering to repay debt that Brotman owes to Prospect. Prospect has filed a notice of appeal.
Effective December 15, 2009, the Board of Directors of Brotman authorized certain designated officers to enter into an amendment to the consulting services agreement between Brotman and PHAS (Amended and Restated Consulting Services Agreement). The Amended and Restated Consulting Services Agreement, which was executed on February 1, 2010, states inter alia, that effective April 14, 2009, PHAS shall be entitled to receive a monthly fee of 4.5% of Brotmans net operating revenue. To the extent Brotman does not have sufficient cash to make such cash payment, or is otherwise restricted in its ability to pay all amounts due by agreements applicable to Brotman or PHAS, then PHAS shall be entitled to receive shares of common stock of Brotman. All amounts under this agreement are eliminated in consolidation.
PMG, an affiliated physician organization of the Company, entered into a risk pool sharing agreement, dated May 1, 2005, with Brotman. Under the agreement, PMG and Brotman agreed to establish a Hospital Control Program (as defined) to serve HMO enrollees and earn incentive revenue or incur penalties by sharing in the risk for hospitalization based on inpatient services utilized. Risk pools are generally settled in the following year. For the three months and nine months ended June 30, 2009, all incentive revenue earned under the agreement was compromised pursuant to Brotmans Chapter 11 Plan of Reorganization. Beginning April 14, 2009, all amounts earned under the agreement are eliminated in consolidation.
In connection with the above-described risk-sharing agreement, Prospect Medical Systems, Inc. (PMS) and Brotman entered into an Administrative Services Agreement, dated October 1, 2005, as amended on October 1, 2009, that provides for the administration by PMS of the payment of claims under such risk-sharing arrangement, with all administrative fees being eliminated in consolidation.
On August 31, 2005, PMG, entered into a joint marketing agreement with Brotman. The agreement is for an initial term of 20 years, renewable for successive five-year terms unless terminated by either party with 180 days written notice. During the term of this agreement, Brotman will contract exclusively with PMG with regard to full risk contracting with HMOs for all lines of business, including Medicare, Medi-Cal and commercial enrollees. Brotman will not merge into, consolidate with, or sell substantially all of its assets (unless the purchaser or surviving entity expressly assumes these managed care exclusivity arrangements), alter such agreements without the consent of PMG, and agrees to be bound by the exclusivity provision.
On March 1, 2010, Alta entered into an agreement with an HMO, pursuant to which, Alta would provide hospital, medical, and other healthcare services to approximately 2,000 senior HMO enrollees under a fixed capitation arrangement (Capitation Arrangement). Concurrently, on March 1, 2010, Alta entered into a risk pool sharing agreement with PMG and Prospect Health Source Medical Group (PHS) and a management services agreement with PMS. Under the risk pool sharing agreement, Alta, PMG and PHS agreed to establish a Hospital Control Program (as defined) to serve the HMO enrollees, pursuant to which, PMG is allocated 90% residual interest in the profit or loss, after deductions for costs to Alta hospitals. Under the management services agreement, PMS would provide non-hospital and non-physician support activities that are required under the agreement with the HMO, in return for a monthly management fee of 10% of earned revenue (as defined). All amounts earned under the risk pool sharing and management services agreements are eliminated in consolidation.
7. Long-Term Debt
Long-term debt consists of the following (in thousands):
|
|
June 30, |
|
September 30, |
|
||
|
|
2010 |
|
2009 |
|
||
|
|
(Unaudited) |
|
|
|
||
Prospects debt: |
|
|
|
|
|
||
Senior secured notes |
|
$ |
160,000 |
|
$ |
160,000 |
|
Less original issue discount |
|
(10,671 |
) |
(11,980 |
) |
||
|
|
149,329 |
|
148,020 |
|
||
Brotmans debt: |
|
|
|
|
|
||
Senior secured revolving credit facility |
|
5,453 |
|
2,888 |
|
||
Secured credit facilities term loan : A (net of discount) |
|
15,730 |
|
15,655 |
|
||
Secured credit facilities term loan: B |
|
6,250 |
|
6,250 |
|
||
Subordinated promissory Note |
|
2,750 |
|
3,531 |
|
||
|
|
30,183 |
|
28,324 |
|
||
Less current maturities |
|
(22,183 |
) |
(3,805 |
) |
||
Long-term debt |
|
$ |
157,329 |
|
$ |
172,539 |
|
Prospects Debt:
Senior Secured Notes
On July 29, 2009, the Company closed the offering of $160 million in 12.75% senior secured notes due 2014 (the Notes) at an issue price of 92.335%. The sale was executed in accordance with Rule 144A under the Securities Act of 1933 and Regulation S under the Securities Act of 1933. Concurrent with the issuance of the Notes, the Company entered into a three year $15 million revolving credit facility which was undrawn at closing and is still undrawn, with any future borrowings bearing interest at London Interbank Offered Rate (LIBOR) plus 7.00%, with a LIBOR floor of 2.00%.
The Company used the net proceeds from the sale of the Notes to repay all remaining amounts outstanding under its former $155 million senior secured credit facility, plus a prepayment premium of approximately $2.6 million. The Company reflected the prepayment premium, together with the write-off of approximately $560,000 of deferred financing costs related to its former credit facilities, as interest expense in the fourth quarter of fiscal 2009. Capitalized deferred financing costs and original issue discount related to the Notes is being amortized over the term of the related debt using the effective interest method.
The terms of the Notes are governed by an indenture among the Company, certain of its subsidiaries and affiliates (as guarantors), and U.S. Bank National Association (as trustee) (the Indenture). Interest is payable semi-annually in arrears on January 15 and July 15. The terms of the revolving senior secured credit facility are governed by the Credit Agreement, dated as of July 29, 2009, among the Company, Royal Bank of Canada (as administrative agent), Jefferies Finance LLC (as co-syndication agent) and the lenders party thereto (the Credit Agreement).
The Notes and the revolving senior secured credit facility are jointly and severally guaranteed on a senior secured basis by all of the Companys restricted subsidiaries (as such term is defined in the Indenture) other than Brotman, Nuestra and certain immaterial subsidiaries. The Notes are secured pari passu with the revolving credit facility on a first priority basis by liens on substantially all of the Companys assets and the assets of the subsidiary guarantors (other than accounts receivable) including all the mortgages on the Company and its subsidiary guarantors hospital properties (but excluding a pledge of, or mortgage on, the stock, properties or other assets of Brotman, AMVI/Prospect Health Network and certain immaterial subsidiaries). The lenders under the revolving credit facility have a first priority lien on certain of the accounts receivable of the Company and the subsidiary guarantors while the holders of the Notes have a second priority lien on such collateral.
The Indenture requires the Company to offer to repurchase the Notes at 101% of their principal amount in the event of a change of control of the Company and at 100% of the principal amount with certain proceeds of sales of assets. The Indenture also contains certain covenants that, among other things, limit the Companys ability, and the ability of its restricted subsidiaries to: pay dividends or distributions on capital stock or equity interests, prepay subordinated indebtedness or make other restricted payments; incur additional debt; make investments; create liens on assets; enter into transactions with affiliates; engage in other businesses; sell or issue capital stock of restricted subsidiaries; merge or consolidate with another company; transfer and sell assets; create dividend and other payment restrictions affecting subsidiaries; and designate restricted and unrestricted subsidiaries. The Credit Agreement contains a number of customary covenants as well as covenants requiring the Company to maintain a maximum consolidated leverage ratio, minimum fixed charge coverage ratio and a maximum consolidated total leverage ratio. As of June 30, 2010, the Company was in compliance with the financial covenants of the Indenture and Credit Agreement.
Pursuant to its definitive Prospectus filed with the SEC on form S-4 on October 26, 2009, the Company offered to exchange (the Exchange Offer) up to $160 million of its 12¾% Senior Secured Notes, Series B, due 2014 (the Exchange Notes and together with the Original Notes, the Notes) for an equal amount of the Notes issued on July 29, 2009 (the Original Notes). The Exchange Notes are substantially identical to the Original Notes, except that the offer and sale of the Exchange Notes have been registered under the Securities Act of 1933, as amended, and the Exchange Notes do not bear any legend restricting their transfer. The Exchange Offer was finalized on December 3, 2009, at which time $159 million of the $160 million aggregate principal amount of private notes had been tendered and accepted for exchange.
The Notes will mature on July 15, 2014. Prior to July 15, 2012, the Company may redeem up to 35% of the original principal amount of the Notes at a redemption price equal to 112.75% of the principal amount of the Notes redeemed, plus any accrued and unpaid interest, with the proceeds of certain equity offerings. From July 15, 2012 until July 15, 2013, the Company may redeem all, or any portion, of the Notes at a redemption price equal to 106.375% of the principal amount of the Notes redeemed, plus any accrued and unpaid interest. After July 15, 2013, but before the maturity date of July 15, 2014, the Company may redeem all, or any portion, of the Notes at a redemption price equal to 100% of the principal amount of the Notes redeemed, plus any accrued and unpaid interest.
Effective July 23, 2009, the Company terminated the former master swap agreement and the swap arrangements thereunder by payment, on July 29, 2009, of $11.7 million to the swap counterparty in final settlement of all amounts owing under the swap arrangements. All related amounts included in accumulated other comprehensive loss, including related deferred income taxes (of approximately $4.2 million) was recorded as interest expense (and to the tax provision) as of the effective date of the swap terminations.
Brotmans Debt:
Brotman has debt under a Senior Secured Revolving Credit Facility, Secured Term Loans and an Unsecured Subordinated Promissory Note entered into in conjunction with affecting its Plan of Reorganization. The Company has not guaranteed any portion of Brotmans debt or other obligations. Given the Companys majority ownership in Brotman, effective April 14, 2009, all Brotman debt is included in the Companys consolidated financial statements. The Company has no obligation to fund Brotmans operations. Under the senior secured revolving credit agreement, the Company is permitted to make additional investments in Brotman in an aggregate amount not to exceed $10,000,000, provided that such investments can exceed $10,000,000 if the amounts are funded solely with the proceeds of Equity Interests of the Company (as defined).
Senior Secured Revolving Credit Facility
On April 14, 2009, the Effective Date of the Plan of Reorganization, Brotman obtained a commitment from Gemino Healthcare Finance, LLC (Gemino) for a three year, $6.0 million (subsequently increased to $7.0 million pursuant to an amendment described below), senior credit facility secured by Brotmans accounts receivable. The facility expires on the earlier of April 14, 2012 and the Los Angeles Jewish Home for Aging (JHA) loan (see below) maturity date and bears interest at LIBOR plus 7% per annum (11.0% as of June 30, 2010, given a LIBOR floor of 4%). Interest is incurred based on the greater of $2 million or the actual outstanding principal balance. The agreement also includes an unused line fee of 0.5% per annum and a collateral line fee, based on the average outstanding principal balance, of 0.5% per annum. Loan fees associated with the Gemino loan totaling approximately $120,000, were capitalized and have been included as deferred financing costs in the accompanying unaudited condensed consolidated balance sheet as of June 30, 2010, with the amount being amortized over the term of the related debt using the effective interest method. The senior credit facility agreement contains customary covenants for facilities of this type, including restrictions on the payment of dividends, change in ownership and management, asset sales, incurrence of additional indebtedness, sale-leaseback transactions, and related party transactions. Brotman must also comply with certain financial covenants. Prior to the February 17, 2010 amendment discussed below, Brotman was required to comply with a fixed charge coverage ratio of not less than (i) 1.10:1.00 for the fiscal quarter ended June 30, 2009, (ii) 1.15:1.00 originally for the fiscal quarter ended September 30, 2009; and (iii) 1.20:1.00 for each fiscal quarter ending thereafter. As of September 30, 2009, Brotman was not in compliance with these financial covenants.
Pursuant to an amendment entered into effective December 11, 2009, the Gemino credit agreement was amended to provide, among other things, a waiver of the specified events of default and the amendment to the definition of fixed charge coverage ratio. Under the amended credit agreement, the fixed charge coverage ratio was amended to require not less than (i) 1.00:1.00 for the fiscal quarters ended December 31, 2009 and March 31, 2010; (ii) 1.05:1.00 for the fiscal quarters ended June 30, 2010 and ending September 30, 2010, (iii) 1.10:1.00 for the fiscal quarters ending December 31, 2010 and March 31, 2011, and (iv) 1.20:1.00 for the fiscal quarter ending June 30, 2011 and each fiscal quarter ending thereafter. As of June 30, 2010, Brotman was in compliance with the required financial covenants under the amended credit agreement. Pursuant to an amendment entered into effective February 17, 2010, the Gemino credit agreement and promissory note were amended to increase the loan commitment by $1.0 million, to a total commitment of $7.0 million.
Secured Credit Facilities Term Loans: A and B
On April 14, 2009, the effective date of the Plan of Reorganization, JHA agreed to provide Brotman with up to $22.25 million in financing, consisting of two term loans: (i) a Term A Loan of $16 million (the Term A Loan) with a 24-month term and (ii) a Term B Loan of up to $6.25 million, with a term of 36 months (the Term B Loan). Subject to the notification requirements set forth in the loan agreements, the term of the Term A Loan can be extended up to 36 months. Interest on the Term A Loan is payable at 10% per annum for the first year of the loan, and 7.5% thereafter. Interest on the Term B Loan is payable at 10% per annum for the term of the loan. The Term A Loan and Term B Loan are secured by certain of Brotmans personal property, and a mortgage on certain of Brotmans real property. The proceeds of the JHA loans were used to repay all existing senior secured loans at Brotman as of April 14, 2009. Loan fees associated with the JHA loans totaling approximately $1,549,000, were capitalized and have been included as deferred financing costs in the accompanying unaudited condensed consolidated balance sheet as of June 30, 2010, with that amount being amortized over the term of the related debt using the effective interest method.
With respect to the Term A Loan, JHA was granted the right (Put Right) to declare the unpaid loan amount, including remaining interest and any other amounts due and payable under the loan agreements, immediately due and payable at any time after April 14, 2010 and prior to the date which is twenty-four months after the Closing Date, subject to JHA providing written notification to Brotman of its exercise of the Put Right at least 180 days in advance. Effective February 10, 2010, JHA and Brotman entered into an amendment to the Term A Loan, whereby the earliest date on which JHA could provide notice of its exercise of the Put Right was extended from April 14, 2010 to October 14, 2010, effectively extending the earliest maturity date for the Term A Loan to April 14, 2011. Brotman and JHA are currently negotiating a comprehensive amendment to and extension of the Term A Loan, pending completion of which, amounts owing under this loan have been reflected as current in the accompanying June 30, 2010 unaudited condensed consolidated balance sheet.
As part of the JHA financing, Brotman granted JHA an option to purchase certain Brotman-owned property, where JHA plans to construct a senior living facility, for a purchase price equal to the outstanding principal balance of the Term A Loan plus any prepaid amounts. In connection with JHAs option right, Brotman is required to deposit $130,000 monthly into a reserve account (up to a maximum of $3,120,000), with such funds specifically earmarked for the construction of a new Brotman emergency room. Additionally, Brotman is required to deposit $10,000 monthly into a reserve account for capital improvements and a Tax and Insurance Deposit Account.
In accordance with relevant accounting pronouncements, the Term A Loan, which contains a real estate purchase option, is recorded at its present value, with any excess of the proceeds over that amount recorded as an option deposit liability account. The present value of the loan is estimated using discounted cash flow analyses based on market rates obtained from independent third parties for similar type debt. Based on an estimated market interest rate of 10.0%, the present value of the loan was estimated to be approximately $15,655,000 at inception. The difference of $345,000 between the recorded present value and the face value of the loan has been recorded as a discount against the loan and is being amortized to interest expense, using the effective interest rate method, over the term of the loan. The Company began amortizing the discount during the current quarter in the amount of $75,000.
Subordinated Promissory Note
On April 14, 2009, the Effective Date of the Plan of Reorganization, Brotman executed a $4,000,000 unsecured Class 4 Note, to be held by the Creditor Trust for the benefit of holders of allowed Class 4 claims (as defined in the Plan of Reorganization) and paid pro rata to holders of allowed Class 4 claims. The Note bears interest at 7.50% per annum and is payable in sixteen equal quarterly installments of principal and accrued interest through February 15, 2013. The Note contains a covenant which, so long as amounts remain outstanding under the Note, restricts Brotman from paying Prospect Hospital Advisory Services, Inc. a consulting fee of more than $100,000 per month, as specified in the Amended and Restated Consulting Services Agreement (see Note 6). As such, although the amount of the consulting fee was increased to 4.5% of Brotmans net operating revenue effective April 14, 2009, the amount of such consulting fee actually paid in cash will not exceed $100,000 per month until such time as permitted by applicable agreement, or the Creditor Trust Note has been amended or repaid.
8. Acquisitions
Brotman Medical Center, Inc.
On August 31, 2005, the Company invested $1 million for an approximately 33.1% stake in Brotman, a 420-bed licensed and accredited acute care hospital, located in Culver City, California, with the intention of offering joint contracting to HMOs operating in Brotmans service area. Brotman incurred significant losses before and after the Companys initial investment and, on October 25, 2007 (the Petition Date), Brotman filed for bankruptcy protection under Chapter 11 of the U.S. Bankruptcy Code. Effective April 22, 2008, Samuel S. Lee (Prospects CEO and Chairman of the Board) was appointed Chairman of the Board of Directors of Brotman. On April 14, 2009 (The Effective Date), the U.S. Bankruptcy Court confirmed and declared effective the final Chapter 11 Plan of Reorganization (the Plan of Reorganization) of Brotman whereby, among other things, all of Brotmans outstanding securities were canceled and, in exchange for their pro rata share of the New Value Contribution (as defined in the Plan of Reorganization) totaling $3,500,000, holders of Brotmans existing securities would receive new common stock in Brotman in the same percentage as their pro rata share of the New Value Contribution. Pursuant to the terms of the Plan, the Company made additional cash investments in Brotman, totaling $2,519,000, thereby acquiring an additional 38.86% ownership interest, which brought its total ownership interest to approximately 72%.
For financial accounting purposes, the additional investment in Brotman was referred to as the Brotman Acquisition. As required by U.S. GAAP, the business combination, which was achieved in stages, provides for recognition of assets at current fair value with respect to the proportion of the Companys incremental ownership interest in Brotman. The aggregate cost of the acquired assets, which includes cash paid of $2.5 million and expenses incurred in connection with the acquisition totaling $37,000, were allocated to the assets acquired and liabilities assumed. The excess of the consideration over the estimated fair value of the assets and liabilities assumed has been allocated to goodwill and an identifiable intangible asset. Due to negative net book value of assets acquired, goodwill attributable to the noncontrolling (formerly minority) interest was not recognized. As the noncontrolling interest in Brotman exceeds 20%, the accounting basis in the acquired ownership in Brotman have not been pushed-down to the financial statements of Brotman and have been reflected in the Parent Company financial statements. The results of operations of Brotman have been included in the consolidated financial statements since the April 14, 2009 acquisition date. Brotmans operations for the three months and nine months ended June 30, 2010 reflected a net loss. The Company does not have the intent or ability, including under the terms of its debt agreements, to provide significant financial support to Brotman. Prior to October 1, 2009, a pro rata share of net income attributable to minority interest was not included under minority interest in the Companys consolidated statement of operations, as the cumulative minority share of such income did not exceed their cumulative share of prior losses absorbed by the Company. Effective October 1, 2009, with the adoption date of new accounting literature (see Note 2), a pro rata share of net loss attributable to noncontrolling interest was reported as a component of equity separate from the Companys equity in the unaudited condensed consolidated balance sheet and as net loss attributable to noncontrolling interest in the unaudited condensed consolidated statement of operations.
As discussed at Note 6, on December 15, 2009, Brotman initiated a rights offering (Rights Offering), whereby existing shareholders of Brotman could subscribe to purchase up to $5,500,000 of Brotman convertible subordinated promissory notes (the Brotman Notes). The Brotman Notes are due three years from the date of issuance, bear interest at 15% per annum and are convertible at the option of the holder into shares of Brotman, at $3.34 per share. PHAS exercised its right to purchase a portion of its pro rata (approximately 72%) share of the Brotman Notes and, effective January 7, 2010, purchased $3,500,000 of such Brotman Notes. Additionally, PHAS planned on exercising its right to purchase any Brotman Notes offered that were not purchased by other Brotman shareholders. Brotman intended to use the remainder of the Rights Offering to repay approximately $2 million currently due to Prospect. As a result of the Rights Offering, Culver Hospital Holdings, a minority shareholder of Brotman, filed a shareholder complaint against Prospect Medical Holdings, PHAS, Brotman, and each of the Brotman Board of Directors. The court granted a preliminary injunction that enjoins Prospect from taking the following actions: (1) acquiring Culvers share of convertible promissory notes, (2) converting the Brotman Notes into shares of Brotman common stock, (3) converting Brotmans debt owed to Prospect into shares of Brotman common stock, and (4) using the proceeds of the Rights Offering to repay debt Brotman owes to Prospect. Prospect has filed a notice of appeal.
The following is an analysis of the final allocation of assets acquired and liabilities assumed and the goodwill and identifiable intangible asset amount recognized in connection with the Brotman Acquisition, as of April 14, 2009 (in thousands):
Assets acquired |
|
$ |
53,302 |
|
Liabilities assumed |
|
(78,119 |
) |
|
Net liabilities assumed |
|
(24,817 |
) |
|
Total purchase consideration |
|
(2,556 |
) |
|
Purchase consideration in excess of net liabilities assumed |
|
(27,373 |
) |
|
Identifiable intangibletrade name |
|
3,000 |
|
|
Goodwill |
|
$ |
24,373 |
|
The assets acquired include the relative percentage (38.83%) of the step-up in basis of the assets acquired to estimated fair value, amounting to $10,547,000.
Goodwill from the Brotman Acquisition is primarily related to new capacity for future growth, new geographic coverage, additional types of hospital services and in-place workforce. Through the Brotman Acquisition, the Company expanded into a new service market in the West Los Angeles, California area. As a stock purchase, the goodwill acquired in the Brotman Acquisition is not deductible for income tax purposes. Brotman recorded income related to discharge of debt upon emergence from the Chapter 11 Bankruptcy reorganization.
The following unaudited proforma financial information for the three month and nine month periods ended June 30, 2009 gives effect to the acquisition of Brotman as if it had occurred on October 1, 2008. Such unaudited proforma information is based on historical financial information with respect to the acquisition and does not include any synergies or operational or other changes that might have been effected by the Company. Significant proforma adjustments include increased depreciation related to fixed assets acquired (in thousands, unaudited).
|
|
Three Months Ended |
|
Nine Months Ended |
|
||
|
|
June 30, 2009 |
|
June 30, 2009 |
|
||
|
|
|
|
|
|
||
Net revenue |
|
$ |
149,563 |
|
$ |
345,225 |
|
Net loss attributable to common shareholders |
|
$ |
(4,111 |
) |
$ |
(2,752 |
) |
Net loss per share: |
|
|
|
|
|
||
Basic |
|
$ |
(0.20 |
) |
$ |
(0.13 |
) |
Diluted |
|
$ |
(0.20 |
) |
$ |
(0.13 |
) |
Since emergence from bankruptcy, Brotman has continued to incur losses and experience liquidity issues. Management continues to implement operational improvements aimed at returning Brotman to profitability and is evaluating financing requirements and alternatives. Prospect has limited ability to fund Brotmans post-acquisition operations (Note 7).
9. Segment Information
The Companys operations are organized into three reporting segments: (i) Hospital Serviceswhich is comprised of the Alta and Brotman reporting units, owns and operates five hospitalsLos Angeles Community Hospital, Hollywood Community Hospital, Norwalk Community Hospital, Van Nuys Community Hospital and Brotman Medical Center; (ii) Medical Groupwhich is comprised of the Prospect and ProMed reporting units, provides management services to affiliated physician organizations that operate as independent physician associations; and (iii) Corporate, which represents expenses incurred in Prospect Medical Holdings, Inc. (the Parent Entity), that were not allocated to the other reporting segments.
The accounting policies of the reporting segments are the same as those described in the summary of significant accounting policies (see Note 2). The Company evaluates financial performance and allocates resources primarily based on earnings from continuing operations before interest expense, interest income, income taxes, depreciation and amortization, as well as income or loss from operations before income taxes, excluding infrequent or unusual items.
The reporting segments are strategic business units that offer different services within the healthcare industry. Business in each reporting segment is conducted by one or more direct or indirect wholly-owned subsidiaries of the Company and certain affiliated physician organizations controlled through assignable option agreements and management services agreements.
The following table summarizes certain information for each of the reporting segments regularly provided to and reviewed by the chief operating decision maker (in thousands, unaudited):
|
|
As of and for the Three Months Ended June 30, 2010 |
|
|||||||||||||
|
|
Hospital |
|
Medical Group |
|
Corporate |
|
Intersegment |
|
Consolidated |
|
|||||
Revenues from external customers |
|
$ |
69,540 |
|
$ |
47,367 |
|
$ |
|
|
$ |
|
|
$ |
116,907 |
|
Intersegment revenues |
|
|
|
325 |
|
|
|
(325 |
) |
|
|
|||||
Total revenues |
|
69,540 |
|
47,692 |
|
|
|
(325 |
) |
116,907 |
|
|||||
Operating income (loss) |
|
12,093 |
|
3,292 |
|
(3,278 |
) |
|
|
12,107 |
|
|||||
Interest expense and amortization of deferred financing costs, net |
|
1,414 |
|
130 |
|
5,565 |
|
|
|
7,109 |
|
|||||
Income (loss) before income taxes |
|
$ |
10,679 |
|
$ |
3,162 |
|
$ |
(8,843 |
) |
$ |
|
|
$ |
4,998 |
|
Identifiable segment assets (liabilities) |
|
$ |
269,503 |
|
$ |
104,935 |
|
$ |
14,198 |
|
$ |
(3,759 |
) |
$ |
384,877 |
|
Segment capital expenditures, net of dispositions |
|
$ |
830 |
|
$ |
53 |
|
$ |
2 |
|
$ |
|
|
$ |
885 |
|
Segment goodwill |
|
$ |
130,912 |
|
$ |
22,338 |
|
$ |
|
|
$ |
|
|
$ |
153,250 |
|
|
|
As of and for the Three Months Ended June 30, 2009 |
|
|||||||||||||
|
|
Hospital |
|
Medical Group |
|
Corporate |
|
Intersegment |
|
Consolidated |
|
|||||
|
|
|
|
|
|
|
|
|
|
|
|
|||||
Revenues from external customers |
|
$ |
66,470 |
|
$ |
47,848 |
|
$ |
|
|
$ |
|
|
$ |
114,318 |
|
Intersegment revenues |
|
|
|
|
|
|
|
|
|
|
|
|||||
Total revenues |
|
66,470 |
|
47,848 |
|
|
|
|
|
114,318 |
|
|||||
Operating income (loss) |
|
7,327 |
|
3,240 |
|
(3,862 |
) |
|
|
6,705 |
|
|||||
Interest expense and amortization of deferred financing costs, net |
|
1,106 |
|
(20 |
) |
7,562 |
|
|
|
8,648 |
|
|||||
Loss on interest rate swap arrangements |
|
|
|
|
|
(3,694 |
) |
|
|
(3,694 |
) |
|||||
Income (loss) before income taxes |
|
$ |
6,221 |
|
$ |
3,260 |
|
$ |
(7,730 |
) |
$ |
|
|
$ |
1,751 |
|
Identifiable segment assets (liabilities) |
|
$ |
289,326 |
|
$ |
160,346 |
|
$ |
(87,498 |
) |
$ |
|
|
$ |
362,174 |
|
Segment capital expenditures, net of dispositions |
|
$ |
187 |
|
$ |
50 |
|
$ |
|
|
$ |
|
|
$ |
237 |
|
Segment goodwill |
|
$ |
127,708 |
|
$ |
22,338 |
|
$ |
|
|
$ |
|
|
$ |
150,046 |
|
|
|
As of and for the Nine Months Ended June 30, 2010 |
|
|||||||||||||
|
|
Hospital |
|
Medical Group |
|
Corporate |
|
Intersegment |
|
Consolidated |
|
|||||
Revenues from external customers |
|
$ |
209,490 |
|
$ |
140,175 |
|
$ |
|
|
$ |
|
|
$ |
349,665 |
|
Intersegment revenues |
|
|
|
565 |
|
|
|
(565 |
) |
|
|
|||||
Total revenues |
|
209,490 |
|
140,740 |
|
|
|
(565 |
) |
349,665 |
|
|||||
Operating income (loss) |
|
36,537 |
|
8,558 |
|
(9,476 |
) |
|
|
35,619 |
|
|||||
Interest expense and amortization of deferred financing costs, net |
|
3,873 |
|
510 |
|
16,825 |
|
|
|
21,208 |
|
|||||
Income (loss) before income taxes |
|
$ |
32,664 |
|
$ |
8,048 |
|
$ |
(26,301 |
) |
$ |
|
|
$ |
14,411 |
|
Identifiable segment assets (liabilities) |
|
$ |
269,503 |
|
$ |
104,935 |
|
$ |
14,198 |
|
$ |
(3,759 |
) |
$ |
384,877 |
|
Segment capital expenditures, net of dispositions |
|
$ |
2,106 |
|
$ |
148 |
|
$ |
14 |
|
$ |
|
|
$ |
2,268 |
|
Segment goodwill |
|
$ |
130,912 |
|
$ |
22,338 |
|
$ |
|
|
$ |
|
|
$ |
153,250 |
|
|
|
As of and for the Nine Months Ended June 30, 2009 |
|
|||||||||||||
|
|
Hospital |
|
Medical Group |
|
Corporate |
|
Intersegment |
|
Consolidated |
|
|||||
|
|
|
|
|
|
|
|
|
|
|
|
|||||
Revenues from external customers |
|
$ |
139,701 |
|
$ |
144,138 |
|
$ |
|
|
$ |
|
|
$ |
283,839 |
|
Intersegment revenues |
|
|
|
|
|
|
|
|
|
|
|
|||||
Total revenues |
|
139,701 |
|
144,138 |
|
|
|
|
|
283,839 |
|
|||||
Operating income (loss) |
|
27,509 |
|
9,480 |
|
(8,740 |
) |
|
|
28,249 |
|
|||||
Interest expense and amortization of deferred financing costs, net |
|
1,198 |
|
(51 |
) |
20,147 |
|
|
|
21,294 |
|
|||||
Loss on interest rate swap arrangements |
|
|
|
|
|
5,019 |
|
|
|
5,019 |
|
|||||
Income (loss) before income taxes |
|
$ |
26,311 |
|
$ |
9,531 |
|
$ |
(33,906 |
) |
$ |
|
|
$ |
1,936 |
|
Identifiable segment assets (liabilities) |
|
$ |
289,326 |
|
$ |
160,346 |
|
$ |
(87,498 |
) |
$ |
|
|
$ |
362,174 |
|
Segment capital expenditures, net of dispositions |
|
$ |
562 |
|
$ |
114 |
|
$ |
|
|
$ |
|
|
$ |
676 |
|
Segment goodwill |
|
$ |
127,708 |
|
$ |
22,338 |
|
$ |
|
|
$ |
|
|
$ |
150,046 |
|
(1) Prospect files consolidated tax returns and allocates costs for shared services and corporate overhead to each of the reporting segments. With the exception of the Brotman Acquisition, all acquisition-related debt, including those related to the Medical Group and Hospital Services segment, is recorded at the Parent entity level. As such, the Company does not allocate interest expense, and gain or loss on interest rate swaps to the operating segments.
(2) Prospect Medical Group, Inc. (which serves as a holding company for the other affiliated physician organizations) files consolidated tax returns.
(3) The information above reflects the Hospital Services segment results for the periods since Brotmans acquisition, which during the three months and nine months ended June 30, 2009, represent 77 days of Brotman operations.
10. Income Taxes
The Company recorded a tax provision of approximately $2,791,000 and $7,239,000 for the three months and nine months ended June 30, 2010, at effective tax rates of 68% and 54%, respectively; and a tax provision of approximately $1,989,000 and $2,065,000 for the three months and nine months ended June 30, 2009, at effective tax rates of 114% and 107% respectively. The high effective tax rates in the fiscal 2010 and 2009 periods was primarily due to the consolidated group not being able to recognize the tax benefit from Brotmans loss for Federal tax purposes.
As part of the Brotman Acquisition, Management of the Company adopted ASC 740-10, accounting for uncertain tax positions. The Company determined that no material unrecognized tax benefits existed at the date of acquisition and as of June 30, 2010. Since its inception in 2005, Brotman maintains substantial net operating loss carryfowards which are open for examination by the taxing authorities.
11. Fair Value of Financial Investments
The Company adopted the revised accounting guidance for fair value measurements and disclosure of its financial assets and liabilities and its non-financial assets and liabilities on October 1, 2008 and October 1, 2009, respectively. The guidance defines fair value, establishes guidelines for measuring fair value and expands disclosure regarding fair value measurements. It does not create or modify any current GAAP requirements to apply fair value accounting. However, it provides a single definition for fair value that is to be applied consistently for all prior accounting pronouncements. The adoption of this guidance did not have a material impact on the Companys financial position or results of operations. The guidance establishes a fair value hierarchy that prioritizes the inputs to valuation techniques used to measure fair value. The three levels of the fair value hierarchy are described below:
· Level 1Unadjusted quoted prices in active markets that are accessible at the measurement date for identical, unrestricted assets or liabilities;
· Level 2Quoted prices in markets that are not active, or inputs that are observable, either directly or indirectly, for substantially the full term of the asset or liability; and
· Level 3Prices or valuation techniques that require inputs that are both significant to the fair value measurement and unobservable (supported by little or no market activity).
Financial Items Measured at Fair Value on a Recurring Basis
The following table sets forth the Companys financial assets and liabilities measured at fair value on a recurring basis and where they are classified within the hierarchy as of June 30, 2010 (in thousands):
|
|
Total |
|
Level 1 |
|
Level 2 |
|
Level 3 |
|
||||
|
|
|
|
|
|
|
|
|
|
||||
Investments, primarily restricted certificates of deposit |
|
$ |
634 |
|
$ |
634 |
|
$ |
|
|
$ |
|
|
The Companys investments are classified within Level 1 of the fair value hierarchy because they are valued using quoted market prices.
Nonfinancial Items Measured at Fair Value on a Nonrecurring Basis
Nonfinancial assets such as goodwill and identifiable intangible assets are measured at fair value when there is an indicator of impairment and recorded at fair value only when impairment is recognized. No impairment charges related to goodwill and intangible assets were recorded for the three months and nine months ended June 30, 2010. See Note 8 for additional information regarding goodwill and intangible assets relating to the Brotman acquisition. The remaining goodwill and intangible assets related to the prior acquisitions of Alta and ProMed. Management of the Company evaluates their intangibles and goodwill quarterly for triggering events that may be indicators of impairment. The Company performs an annual impairment test on the goodwill and intangibles. The impairment test at September 30, 2009 resulted in no impairment charges. In addition, no triggering events were identified that would cause impairment based on an analysis as of June 30, 2010.
Effective April 1, 2009, the Company adopted the accounting guidance for disclosure regarding fair value of financial instruments. This adoption requires that the fair value of financial instruments be disclosed in the body or notes of an entitys financial statements in both interim and annual periods. The adoption also requires the disclosure of methods and assumptions used to estimate fair values. It does not require comparative disclosures for periods preceding adoption. The fair values of the Companys current financial assets and liabilities approximate their reported carrying amounts. The carrying values and the fair values of non-current financial assets and liabilities that qualify as financial instruments under the guidance are as follows (in thousands, unaudited).
|
|
As of June 30, 2010 |
|
||||
|
|
Carrying |
|
Fair Value |
|
||
Assets: |
|
|
|
|
|
||
Long-term notes receivable (included in Other Assets) |
|
$ |
314 |
|
$ |
290 |
|
Liabilities: |
|
|
|
|
|
||
Long-term debt |
|
$ |
157,329 |
|
$ |
175,974 |
|
Included in other assets were long-term notes receivable, which amount was received as part of the consideration for the sale of three medical clinics in April 2004, the fair value of such notes receivable was estimated based on expected future payments discounted at risk-adjusted rates. The fair value of the Companys long-term debt was determined based on quoted market prices with respect to Prospects Notes and based on expected future payments discounted at risk-adjusted rates of 10% with respect to Brotmans debt.
12. Litigation and Contingencies
The Company is in the process of finalizing certain post-closing matters related to the 2007 ProMed acquisition, including closing balance sheet reconciliations, escrow reconciliations and other matters. The Company has recorded estimated settlement accrual amounts relating to such matters in the accompanying unaudited condensed consolidated financial statements.
The collective bargaining agreement entered into between Hollywood Community Hospital, which is one of the hospitals under the consolidated group of Alta Hospitals System, LLC, and Service Employees International Union, United Healthcare Workers-West (SEIU), covers a small group of Hollywood Community Hospitals employees and will expire on May 9, 2011. The collective bargaining agreements entered into between Brotman and the California Nurses Association (CNA) and Brotman and the SEIU both expired on February 28, 2010. Both parties are currently engaged in good faith bargaining negotiations and we currently do not anticipate that any changes arising from any new agreements will have a material adverse effect on the results of our Hospital Services operations in fiscal 2010.
Many of the Companys payer and provider contracts are complex in nature and may be subject to differing interpretations regarding amounts due for the provision of medical services. Such differing interpretations may not come to light until a substantial period of time has passed following contract implementation. Liabilities for claims disputes are recorded when the loss is probable and can be estimated. Any adjustments to reserves are reflected in current operations.
The State of California has enacted Assembly Bill 1838 (AB1383) effective January 1, 2010, to provide supplemental payments to certain medical facilities which serve a disproportionate share of indigent and low income patients. The bill did not receive the necessary appropriations and cannot be implemented until it is approved by the Center for Medicare and Medicaid Services (CMS), which is anticipated to occur sometime in 2010 and applied retroactively to April 3, 2009. Under this proposed program, participating hospitals, including the Companys hospitals, would be assessed a fee to be paid into a pool of funds to which the federal government will contribute matching funds. These funds will then be distributed to qualifying hospitals based on a prescribed formula. The Company anticipates that it will be a net beneficiary from the fund. No amounts have been recognized in the Companys financial statements, since Management cannot currently predict whether CMS will ultimately approve this program or the ultimate timing and amounts that the Company will have to pay into the fund or receive from the fund.
The Company is also subject to a variety of claims and suits that arise from time to time in the ordinary course of its business, acquisitions, or other transactions. While Management currently believes that resolving all of these matters, individually or in the aggregate, will not have a material adverse impact on the Companys consolidated financial position or results of operations, the litigation and other claims that the Company faces are subject to inherent uncertainties and Managements view of these matters may change in the future. Should an unfavorable final outcome occur, there exists the possibility of a materially adverse impact on the Companys consolidated financial position, results of operations and cash flows for the period in which the effect becomes probable and reasonably estimable.
The Company believes that the lines and amounts of insurance coverage that it, its subsidiaries, and its affiliated physician organizations maintain, and that it requires its contracted physician providers to maintain, are customary in its industry and adequate for the risks insured. The Company cannot assure, however, that it will not become subject to claims not covered or that exceed its insurance coverage amounts.
Total actuarially determined incurred but not reported claims and case reserves for estimated malpractice liabilities at June 30, 2010 were $1,866,000. These estimates may change in the future, and such changes may be material.
Total actuarially determined incurred but not reported claims and case reserves for estimated workers compensation liabilities at June 30, 2010 were $3,034,000 and included in accounts payable and other accrued liabilities in the condensed consolidated balance sheet. These estimates are included in other accrued liabilities and may change in the future, and such changes may be material.
Total actuarially determined incurred but not reported claims and case reserves for estimated medical services liabilities under the fixed capitation arrangement at June 30, 2010 were $14,745,000. These estimates may change in the future, and such changes may be material.
Total incurred but not reported claims for estimated hospital services under the Capitation Arrangements (see Note 6) at Alta and Brotman at June 30, 2010 were $2,927,000. These estimates are included under Other Accrued Liabilities in the condensed consolidated balance sheets at June 30, 2010, may change in the future, and such changes may be material.
13. Condensed consolidating financial statements of Prospect Medical Holdings, Inc. and subsidiaries as of June 30, 2010 and September 30, 2009 and for the three months and nine months ended June 30, 2010 and 2009
As discussed in Note 7, on July 29, 2009, the Company closed the offering of $160 million in 12.75% senior secured notes due 2014 (the Notes) and entered into a three year $15 million revolving credit facility. The Notes and the revolving senior credit facility are jointly and severally guaranteed on a senior secured basis by all of the Companys restricted subsidiaries (the Guarantors), other than Brotman, Nuestra and certain immaterial subsidiaries. The Notes are secured pari passu with the revolving credit facility on a first priority basis by liens on substantially all of the Companys assets and assets of the subsidiary guarantors (other than accounts receivable and proceeds therefrom) including all mortgages on the Company and its subsidiary guarantors hospital properties (but excluding a pledge of, or mortgage on, the stock, properties or other assets of Brotman, AMVI/Prospect Health Network and certain immaterial subsidiaries). The lenders under the revolving credit facility have a first priority lien on certain of the accounts receivable of the Company and the subsidiary guarantors, while the holders of the Notes have a second priority lien on such collateral (see Note 7).
The Company conducts all of its business through and derives virtually all of its income from its subsidiaries. Therefore, the Companys ability to make required payments with respect to its indebtedness (including the Notes) and other obligations depends on the financial results and condition of its subsidiaries and its ability to receive funds from its subsidiaries.
Pursuant to Rule 3-10 of Regulation S-X, the following summarized consolidating information is provided for the Company (the Parent), the Guarantors, and the Companys non-Guarantor subsidiaries with respect to the Notes as of September 30, 2009, as of and for the three months and nine months ended June 30, 2010 and for the three months and nine months ended June 30, 2009. This summarized financial information has been prepared from the books and records maintained by the Company, the Guarantors and the non-Guarantor subsidiaries. The summarized financial information may not necessarily be indicative of the results of operations or financial position had the Guarantors or non-Guarantor subsidiaries operated as independent entities. In addition, intercompany activities between subsidiaries and the Parent are presented within operating activities on the unaudited condensed consolidating statement of cash flows.
Unaudited condensed consolidating financial statements for the Company and its subsidiaries, including the Parent only, the combined Guarantor Subsidiaries and the combined Non-Guarantor Subsidiaries are as follows:
PROSPECT MEDICAL HOLDINGS, INC.
CONDENSED CONSOLIDATING BALANCE SHEETS
As of June 30, 2010
(in thousands)
(Unaudited)
|
|
Parent |
|
Combined Guarantor |
|
Combined |
|
|
|
|
|
|||||
|
|
Company |
|
Subsidiaries |
|
Subsidiaries |
|
Elimination |
|
Consolidated |
|
|||||
ASSETS |
|
|
|
|
|
|
|
|
|
|
|
|||||
Current assets: |
|
|
|
|
|
|
|
|
|
|
|
|||||
Cash and cash equivalents |
|
$ |
(287 |
) |
$ |
48,158 |
|
$ |
3,070 |
|
$ |
|
|
$ |
50,941 |
|
Restricted cash |
|
|
|
|
|
2,793 |
|
|
|
2,793 |
|
|||||
Investments |
|
|
|
634 |
|
|
|
|
|
634 |
|
|||||
Patient accounts receivable, net |
|
|
|
21,907 |
|
20,702 |
|
|
|
42,609 |
|
|||||
Due from government payers |
|
|
|
78 |
|
676 |
|
|
|
754 |
|
|||||
Other receivables |
|
|
|
4,039 |
|
|
|
|
|
4,039 |
|
|||||
Refundable income taxes, net |
|
(355 |
) |
355 |
|
|
|
|
|
|
|
|||||
Deferred income taxes, net |
|
4,323 |
|
2,244 |
|
|
|
|
|
6,567 |
|
|||||
Inventories of supplies |
|
|
|
1,500 |
|
2,630 |
|
|
|
4,130 |
|
|||||
Prepaid expenses and other current assets |
|
661 |
|
2,502 |
|
1,792 |
|
|
|
4,955 |
|
|||||
Intercompany accounts |
|
64,555 |
|
(87,193 |
) |
22,556 |
|
82 |
|
|
|
|||||
Total current assets |
|
68,897 |
|
(5,776 |
) |
54,219 |
|
82 |
|
117,422 |
|
|||||
Property, improvements and equipment, net |
|
21 |
|
55,133 |
|
8,484 |
|
|
|
63,638 |
|
|||||
Deferred financing costs, net |
|
6,070 |
|
|
|
771 |
|
|
|
6,841 |
|
|||||
Goodwill |
|
|
|
153,250 |
|
|
|
|
|
153,250 |
|
|||||
Intangible assets, net |
|
|
|
43,158 |
|
|
|
|
|
43,158 |
|
|||||
Other assets |
|
3,764 |
|
562 |
|
|
|
(3,758 |
) |
568 |
|
|||||
Total assets |
|
$ |
78,752 |
|
$ |
246,327 |
|
$ |
63,474 |
|
$ |
(3,676 |
) |
$ |
384,877 |
|
LIABILITIES AND SHAREHOLDERS EQUITY |
|
|
|
|
|
|
|
|
|
|
|
|||||
Current liabilities: |
|
|
|
|
|
|
|
|
|
|
|
|||||
Accrued medical claims and other healthcare costs payable |
|
$ |
|
|
$ |
14,445 |
|
$ |
300 |
|
$ |
|
|
$ |
14,745 |
|
Accounts payable and other accrued liabilities |
|
12,171 |
|
12,187 |
|
13,004 |
|
|
|
37,362 |
|
|||||
Accrued salaries, wages and benefits |
|
3,320 |
|
7,972 |
|
7,485 |
|
|
|
18,777 |
|
|||||
Due to government payers |
|
|
|
|
|
13,834 |
|
|
|
13,834 |
|
|||||
Income taxes payable, net |
|
(1,513 |
) |
1,871 |
|
(57 |
) |
|
|
301 |
|
|||||
Current portion of capital leases |
|
|
|
288 |
|
469 |
|
|
|
757 |
|
|||||
Current portion of long-term debt |
|
|
|
|
|
22,183 |
|
|
|
22,183 |
|
|||||
Other current liabilities |
|
27 |
|
841 |
|
|
|
|
|
868 |
|
|||||
Total current liabilities |
|
14,005 |
|
37,604 |
|
57,218 |
|
|
|
108,827 |
|
|||||
Long-term debt, net of current maturities |
|
149,329 |
|
|
|
11,758 |
|
(3,758 |
) |
157,329 |
|
|||||
Deferred income taxes, net |
|
8,911 |
|
20,986 |
|
|
|
|
|
29,897 |
|
|||||
Malpractice reserves |
|
|
|
816 |
|
1,050 |
|
|
|
1,866 |
|
|||||
Capital leases, net of current portion |
|
|
|
590 |
|
27 |
|
|
|
617 |
|
|||||
Other long-term liabilities |
|
45 |
|
112 |
|
1 |
|
|
|
158 |
|
|||||
Total liabilities |
|
172,290 |
|
60,108 |
|
70,054 |
|
(3,758 |
) |
298,694 |
|
|||||
Shareholders equity (deficit): |
|
|
|
|
|
|
|
|
|
|
|
|||||
Common stock |
|
212 |
|
(53 |
) |
(114 |
) |
167 |
|
212 |
|
|||||
Additional paid-in capital |
|
96,758 |
|
256 |
|
|
|
|
|
97,014 |
|
|||||
Accumulated deficit |
|
(190,508 |
) |
186,016 |
|
(6,466 |
) |
950 |
|
(10,008 |
) |
|||||
Total shareholders equity (deficit) |
|
(93,538 |
) |
186,219 |
|
(6,580 |
) |
1,117 |
|
87,218 |
|
|||||
Noncontrolling interest |
|
|
|
|
|
|
|
(1,035 |
) |
(1,035 |
) |
|||||
Total Prospect Medical Holdings, Inc.s shareholders equity (deficit) |
|
(93,538 |
) |
186,219 |
|
(6,580 |
) |
82 |
|
86,183 |
|
|||||
Total liabilities and shareholders equity |
|
$ |
78,752 |
|
$ |
246,327 |
|
$ |
63,474 |
|
$ |
(3,676 |
) |
$ |
384,877 |
|
PROSPECT MEDICAL HOLDINGS, INC.
CONDENSED CONSOLIDATING BALANCE SHEETS
As of September 30, 2009
(in thousands)
|
|
Parent |
|
Combined |
|
Combined |
|
Elimination |
|
Consolidated |
|
|||||
ASSETS |
|
|
|
|
|
|
|
|
|
|
|
|||||
Current assets: |
|
|
|
|
|
|
|
|
|
|
|
|||||
Cash and cash equivalents |
|
$ |
(514 |
) |
$ |
36,995 |
|
$ |
1,287 |
|
$ |
|
|
$ |
37,768 |
|
Restricted cash |
|
|
|
|
|
1,395 |
|
|
|
1,395 |
|
|||||
Investments |
|
|
|
665 |
|
|
|
|
|
665 |
|
|||||
Patient accounts receivable, net |
|
|
|
19,543 |
|
17,263 |
|
|
|
36,806 |
|
|||||
Due from government payers |
|
|
|
5,642 |
|
785 |
|
|
|
6,427 |
|
|||||
Other receivables |
|
8 |
|
1,703 |
|
|
|
|
|
1,711 |
|
|||||
Refundable income taxes, net |
|
1,545 |
|
13 |
|
|
|
|
|
1,558 |
|
|||||
Deferred income taxes, net |
|
4,323 |
|
2,321 |
|
|
|
|
|
6,644 |
|
|||||
Inventories of supplies |
|
|
|
1,477 |
|
2,660 |
|
|
|
4,137 |
|
|||||
Prepaid expenses and other current assets |
|
72 |
|
2,491 |
|
2,817 |
|
|
|
5,380 |
|
|||||
Intercompany accounts |
|
90,190 |
|
(119,113 |
) |
28,841 |
|
82 |
|
|
|
|||||
Total current assets |
|
95,624 |
|
(48,263 |
) |
55,048 |
|
82 |
|
102,491 |
|
|||||
Property, improvements and equipment, net |
|
19 |
|
54,725 |
|
8,980 |
|
|
|
63,724 |
|
|||||
Deferred financing costs, net |
|
6,878 |
|
|
|
1,327 |
|
|
|
8,205 |
|
|||||
Goodwill |
|
|
|
153,250 |
|
|
|
|
|
153,250 |
|
|||||
Intangible assets, net |
|
|
|
46,425 |
|
|
|
|
|
46,425 |
|
|||||
Other assets |
|
6 |
|
715 |
|
330 |
|
|
|
1,051 |
|
|||||
Total Assets |
|
$ |
102,527 |
|
$ |
206,852 |
|
$ |
65,685 |
|
$ |
82 |
|
$ |
375,146 |
|
LIABILITIES & SHAREHOLDERS EQUITY |
|
|
|
|
|
|
|
|
|
|
|
|||||
Current liabilities: |
|
|
|
|
|
|
|
|
|
|
|
|||||
Accrued medical claims and other healthcare costs payable |
|
$ |
|
|
$ |
16,613 |
|
$ |
211 |
|
$ |
|
|
$ |
16,824 |
|
Accounts payable and other accrued liabilities |
|
7,102 |
|
10,548 |
|
14,123 |
|
|
|
31,773 |
|
|||||
Accrued salaries, wages and benefits |
|
4,151 |
|
11,543 |
|
9,209 |
|
|
|
24,903 |
|
|||||
Due to government payers |
|
|
|
|
|
13,834 |
|
|
|
13,834 |
|
|||||
Income taxes payable, net |
|
(1,029 |
) |
1,086 |
|
(57 |
) |
|
|
|
|
|||||
Current portion of capital leases |
|
|
|
383 |
|
437 |
|
|
|
820 |
|
|||||
Current portion of long-term debt |
|
|
|
|
|
3,805 |
|
|
|
3,805 |
|
|||||
Other current liabilities |
|
13 |
|
616 |
|
|
|
|
|
629 |
|
|||||
Total current liabilities |
|
10,237 |
|
40,789 |
|
41,562 |
|
|
|
92,588 |
|
|||||
Long-term debt, net of current maturities |
|
148,020 |
|
|
|
24,519 |
|
|
|
172,539 |
|
|||||
Deferred income taxes, net |
|
8,912 |
|
21,063 |
|
|
|
|
|
29,975 |
|
|||||
Malpractice reserves |
|
|
|
914 |
|
1,910 |
|
|
|
2,824 |
|
|||||
Capital leases, net of current portion |
|
|
|
299 |
|
270 |
|
|
|
569 |
|
|||||
Other long-term liabilities |
|
78 |
|
84 |
|
|
|
|
|
162 |
|
|||||
Total liabilities |
|
167,247 |
|
63,149 |
|
68,261 |
|
|
|
298,657 |
|
|||||
Shareholders equity (deficit): |
|
|
|
|
|
|
|
|
|
|
|
|||||
Common stock |
|
206 |
|
(53 |
) |
(114 |
) |
167 |
|
206 |
|
|||||
Additional paid-in-capital |
|
94,242 |
|
256 |
|
|
|
|
|
94,498 |
|
|||||
Accumulated deficit |
|
(159,168 |
) |
143,500 |
|
(2,462 |
) |
(173 |
) |
(18,303 |
) |
|||||
Total shareholders equity (deficit) |
|
(64,720 |
) |
143,703 |
|
(2,576 |
) |
(6 |
) |
76,401 |
|
|||||
Noncontrolling interest |
|
|
|
|
|
|
|
88 |
|
88 |
|
|||||
Total Prospect Medical Holdings, Inc.s shareholders equity (deficit) |
|
(64,720 |
) |
143,703 |
|
(2,576 |
) |
82 |
|
76,489 |
|
|||||
Total liabilities and shareholders equity |
|
$ |
102,527 |
|
$ |
206,852 |
|
$ |
65,685 |
|
$ |
82 |
|
$ |
375,146 |
|
PROSPECT MEDICAL HOLDINGS, INC.
CONDENSED CONSOLIDATING STATEMENTS OF OPERATIONS
For the Three Months Ended June 30, 2010
(in thousands)
(Unaudited)
|
|
Parent |
|
Combined |
|
Combined |
|
|
|
|
|
|||||
|
|
Company |
|
Subsidiaries |
|
Subsidiaries |
|
Elimination |
|
Consolidated |
|
|||||
|
|
|
|
|
|
|
|
|
|
|
|
|||||
Revenues: |
|
|
|
|
|
|
|
|
|
|
|
|||||
Net Hospital Services revenues |
|
$ |
|
|
$ |
41,305 |
|
$ |
29,394 |
|
$ |
(1,159 |
) |
$ |
69,540 |
|
Medical Group revenues |
|
|
|
46,809 |
|
883 |
|
(325 |
) |
47,367 |
|
|||||
Total revenues |
|
|
|
88,114 |
|
30,277 |
|
(1,484 |
) |
116,907 |
|
|||||
Operating expenses: |
|
|
|
|
|
|
|
|
|
|
|
|||||
Hospital operating expenses |
|
|
|
24,892 |
|
27,455 |
|
|
|
52,347 |
|
|||||
Medical Group cost of revenues |
|
|
|
36,874 |
|
548 |
|
|
|
37,422 |
|
|||||
General and administrative |
|
3,275 |
|
8,737 |
|
2,907 |
|
(1,484 |
) |
13,435 |
|
|||||
Depreciation and amortization |
|
3 |
|
1,831 |
|
244 |
|
|
|
2,078 |
|
|||||
Total operating expenses |
|
3,278 |
|
72,334 |
|
31,154 |
|
(1,484 |
) |
105,282 |
|
|||||
Operating income from unconsolidated joint venture |
|
|
|
482 |
|
|
|
|
|
482 |
|
|||||
Operating (loss) income |
|
(3,278 |
) |
16,262 |
|
(877 |
) |
|
|
12,107 |
|
|||||
Other expense: |
|
|
|
|
|
|
|
|
|
|
|
|||||
Interest expense and amortization-deferred financing cost, net |
|
5,565 |
|
136 |
|
1,408 |
|
|
|
7,109 |
|
|||||
Total other expense, net |
|
5,565 |
|
136 |
|
1,408 |
|
|
|
7,109 |
|
|||||
Income (loss) before income taxes |
|
(8,843 |
) |
16,126 |
|
(2,285 |
) |
|
|
4,998 |
|
|||||
Provision for income taxes |
|
2,090 |
|
701 |
|
|
|
|
|
2,791 |
|
|||||
Net income (loss) |
|
(10,933 |
) |
15,425 |
|
(2,285 |
) |
|
|
2,207 |
|
|||||
Loss attributable to noncontrolling interest |
|
|
|
|
|
|
|
(640 |
) |
(640 |
) |
|||||
Net income (loss) attributable to Prospect Medical Holdings, Inc. |
|
$ |
(10,933 |
) |
$ |
15,425 |
|
$ |
(2,285 |
) |
$ |
640 |
|
$ |
2,847 |
|
PROSPECT MEDICAL HOLDINGS, INC.
CONDENSED CONSOLIDATING STATEMENTS OF OPERATIONS
For the Three Months Ended June 30, 2009
(in thousands)
(Unaudited)
|
|
Parent |
|
Combined |
|
Combined |
|
|
|
|
|
|||||
|
|
Company |
|
Subsidiaries |
|
Subsidiaries |
|
Elimination |
|
Consolidated |
|
|||||
Revenues: |
|
|
|
|
|
|
|
|
|
|
|
|||||
Net Hospital Services revenues |
|
$ |
|
|
$ |
36,582 |
|
$ |
30,138 |
|
$ |
(250 |
) |
$ |
66,470 |
|
Medical Group revenues |
|
|
|
47,167 |
|
681 |
|
|
|
47,848 |
|
|||||
Total revenues |
|
|
|
83,749 |
|
30,819 |
|
(250 |
) |
114,318 |
|
|||||
Operating expenses: |
|
|
|
|
|
|
|
|
|
|
|
|||||
Hospital operating expenses |
|
|
|
23,244 |
|
28,034 |
|
|
|
51,278 |
|
|||||
Medical Group cost of revenues |
|
|
|
36,478 |
|
490 |
|
|
|
36,968 |
|
|||||
General and administrative |
|
3,859 |
|
10,358 |
|
3,773 |
|
(250 |
) |
17,740 |
|
|||||
Depreciation and amortization |
|
3 |
|
1,962 |
|
197 |
|
|
|
2,162 |
|
|||||
Total operating expenses |
|
3,862 |
|
72,042 |
|
32,494 |
|
(250 |
) |
108,148 |
|
|||||
Operating income from unconsolidated joint venture |
|
|
|
535 |
|
|
|
|
|
535 |
|
|||||
Operating (loss) income |
|
(3,862 |
) |
12,242 |
|
(1,675 |
) |
|
|
6,705 |
|
|||||
Other expense: |
|
|
|
|
|
|
|
|
|
|
|
|||||
Interest expense and amortization-deferred financing cost, net |
|
7,562 |
|
3 |
|
1,083 |
|
|
|
8,648 |
|
|||||
Gain on interest rate swap arrangements |
|
(3,694 |
) |
|
|
|
|
|
|
(3,694 |
) |
|||||
Total other expense, net |
|
3,868 |
|
3 |
|
1,083 |
|
|
|
4,954 |
|
|||||
Income (loss) before income taxes |
|
(7,730 |
) |
12,239 |
|
(2,758 |
) |
|
|
1,751 |
|
|||||
Provision for income taxes |
|
805 |
|
1,184 |
|
|
|
|
|
1,989 |
|
|||||
Net income (loss) |
|
(8,535 |
) |
11,055 |
|
(2,758 |
) |
|
|
(238 |
) |
|||||
Income (loss) attributable to noncontrolling interest |
|
|
|
|
|
|
|
|
|
|
|
|||||
Net income (loss) attributable to Prospect Medical Holdings, Inc. |
|
$ |
(8,535 |
) |
$ |
11,055 |
|
$ |
(2,758 |
) |
$ |
|
|
$ |
(238 |
) |
PROSPECT MEDICAL HOLDINGS, INC.
CONDENSED CONSOLIDATING STATEMENTS OF OPERATIONS
For the Nine Months Ended June 30, 2010
(in thousands)
(Unaudited)
|
|
Parent |
|
Combined |
|
Combined |
|
|
|
|
|
|||||
|
|
Company |
|
Subsidiaries |
|
Subsidiaries |
|
Elimination |
|
Consolidated |
|
|||||
|
|
|
|
|
|
|
|
|
|
|
|
|||||
Revenues: |
|
|
|
|
|
|
|
|
|
|
|
|||||
Net Hospital Services revenues |
|
$ |
|
|
$ |
119,939 |
|
$ |
95,148 |
|
$ |
(5,597 |
) |
$ |
209,490 |
|
Medical Group revenues |
|
|
|
138,540 |
|
2,199 |
|
(564 |
) |
140,175 |
|
|||||
Total revenues |
|
|
|
258,479 |
|
97,347 |
|
(6,161 |
) |
349,665 |
|
|||||
Operating expenses: |
|
|
|
|
|
|
|
|
|
|
|
|||||
Hospital operating expenses |
|
|
|
71,209 |
|
83,421 |
|
|
|
154,630 |
|
|||||
Medical Group cost of revenues |
|
|
|
109,561 |
|
1,569 |
|
|
|
111,130 |
|
|||||
General and administrative |
|
9,466 |
|
28,454 |
|
11,805 |
|
(6,161 |
) |
43,564 |
|
|||||
Depreciation and amortization |
|
10 |
|
5,509 |
|
717 |
|
|
|
6,236 |
|
|||||
Total operating expenses |
|
9,476 |
|
214,733 |
|
97,512 |
|
(6,161 |
) |
315,560 |
|
|||||
Operating income from unconsolidated joint venture |
|
|
|
1,514 |
|
|
|
|
|
1,514 |
|
|||||
Operating (loss) income |
|
(9,476 |
) |
45,260 |
|
(165 |
) |
|
|
35,619 |
|
|||||
Other (income) expense: |
|
|
|
|
|
|
|
|
|
|
|
|||||
Interest expense and amortization-deferred financing cost, net |
|
16,825 |
|
544 |
|
3,839 |
|
|
|
21,208 |
|
|||||
Total other expense, net |
|
16,825 |
|
544 |
|
3,840 |
|
|
|
21,208 |
|
|||||
Income (loss) before income taxes |
|
(26,301 |
) |
44,716 |
|
(4,004 |
) |
|
|
14,411 |
|
|||||
Provision for income taxes |
|
5,039 |
|
2,200 |
|
|
|
|
|
7,239 |
|
|||||
Net income (loss) |
|
(31,340 |
) |
42,516 |
|
(4,004 |
) |
|
|
7,172 |
|
|||||
Income (loss) attributable to noncontrolling interest |
|
|
|
|
|
|
|
(1,123 |
) |
(1,123 |
) |
|||||
Net income (loss) attributable to Prospect Medical Holdings, Inc. |
|
$ |
(31,340 |
) |
$ |
42,516 |
|
$ |
(4,004 |
) |
$ |
(1,123 |
) |
$ |
8,295 |
|
PROSPECT MEDICAL HOLDINGS, INC.
CONDENSED CONSOLIDATING STATEMENTS OF OPERATIONS
For the Nine Months Ended June 30, 2009
(in thousands)
(Unaudited)
|
|
Parent |
|
Combined |
|
Combined |
|
Elimination |
|
Consolidated |
|
|||||
Revenues: |
|
|
|
|
|
|
|
|
|
|
|
|||||
Net Hospital Services revenues |
|
$ |
|
|
$ |
109,813 |
|
$ |
30,138 |
|
$ |
(250 |
) |
$ |
139,701 |
|
Medical Group revenues |
|
|
|
141,981 |
|
2,157 |
|
|
|
144,138 |
|
|||||
Total revenues |
|
|
|
251,794 |
|
32,295 |
|
(250 |
) |
283,839 |
|
|||||
|
|
|
|
|
|
|
|
|
|
|
|
|||||
Operating expenses: |
|
|
|
|
|
|
|
|
|
|
|
|||||
Hospital operating expenses |
|
|
|
68,496 |
|
28,035 |
|
(250 |
) |
96,281 |
|
|||||
Medical Group cost of revenues |
|
|
|
110,046 |
|
1,489 |
|
|
|
111,535 |
|
|||||
General and administrative |
|
8,731 |
|
30,782 |
|
3,992 |
|
|
|
43,505 |
|
|||||
Depreciation and amortization |
|
9 |
|
5,546 |
|
196 |
|
|
|
5,751 |
|
|||||
Total operating expenses |
|
8,740 |
|
214,870 |
|
33,712 |
|
(250 |
) |
257,072 |
|
|||||
Operating income from unconsolidated joint venture |
|
|
|
1,482 |
|
|
|
|
|
1,482 |
|
|||||
Operating (loss) income |
|
(8,740 |
) |
38,406 |
|
(1,417 |
) |
|
|
28,249 |
|
|||||
Other expense: |
|
|
|
|
|
|
|
|
|
|
|
|||||
Interest expense and amortization-deferred financing cost, net |
|
20,147 |
|
65 |
|
1,082 |
|
|
|
21,294 |
|
|||||
Loss on interest rate swap arrangements |
|
5,019 |
|
|
|
|
|
|
|
5,019 |
|
|||||
Total other expense, net |
|
25,166 |
|
65 |
|
1,082 |
|
|
|
26,313 |
|
|||||
Income (loss) before income taxes |
|
(33,906 |
) |
38,341 |
|
(2,499 |
) |
|
|
1,936 |
|
|||||
Provision (benefit) for income taxes |
|
(781 |
) |
2,996 |
|
(150 |
) |
|
|
2,065 |
|
|||||
Net income (loss) |
|
(33,125 |
) |
35,345 |
|
(2,349 |
) |
|
|
(129 |
) |
|||||
|
|
|
|
|
|
|
|
|
|
|
|
|||||
Income attributable to noncontrolling interest |
|
|
|
|
|
|
|
5 |
|
5 |
|
|||||
Net income (loss) attributable to Prospect Medical Holdings, Inc. |
|
$ |
(33,125 |
) |
$ |
35,345 |
|
$ |
(2,349 |
) |
$ |
(5 |
) |
$ |
(134 |
) |
PROSPECT MEDICAL HOLDINGS, INC.
CONDENSED CONSOLIDATING STATEMENTS OF CASH FLOWS
For the Nine Months Ended June 30, 2010
(in thousands)
(Unaudited)
|
|
Parent |
|
Combined |
|
Combined |
|
|
|
|
|
|||||
|
|
Company |
|
Subsidiaries |
|
Subsidiaries |
|
Elimination |
|
Consolidated |
|
|||||
|
|
|
|
|
|
|
|
|
|
|
|
|||||
Operating activities |
|
|
|
|
|
|
|
|
|
|
|
|||||
Net income (loss) |
|
$ |
(31,340 |
) |
$ |
42,516 |
|
$ |
(4,004 |
) |
$ |
|
|
$ |
7,172 |
|
Adjustments to reconcile net income (loss) to net cash provided by (used in) operating activities: |
|
|
|
|
|
|
|
|
|
|
|
|||||
Depreciation and amortization |
|
10 |
|
5,509 |
|
716 |
|
|
|
6,235 |
|
|||||
Amortization of deferred financing costs, net |
|
847 |
|
|
|
557 |
|
|
|
1,404 |
|
|||||
Amortization of original issue discount |
|
1,310 |
|
|
|
75 |
|
|
|
1,385 |
|
|||||
Provision for bad debts |
|
|
|
6,126 |
|
15,867 |
|
|
|
21,993 |
|
|||||
Stock-based compensation |
|
1,895 |
|
|
|
|
|
|
|
1,895 |
|
|||||
Gain on sale of assets |
|
|
|
(7 |
) |
|
|
|
|
(7 |
) |
|||||
Intercompany accounts |
|
25,636 |
|
(31,868 |
) |
6,232 |
|
|
|
|
|
|||||
Change in assets and liabilities: |
|
|
|
|
|
|
|
|
|
|
|
|||||
Patient and other receivables |
|
8 |
|
(5,259 |
) |
(19,198 |
) |
|
|
(24,449 |
) |
|||||
Prepaid expenses and other |
|
(592 |
) |
(9 |
) |
1,026 |
|
|
|
425 |
|
|||||
Inventories of supplies |
|
|
|
(24 |
) |
31 |
|
|
|
7 |
|
|||||
Refundable income taxes, net |
|
1,900 |
|
(342 |
) |
|
|
|
|
1,558 |
|
|||||
Income taxes payable, net |
|
(484 |
) |
785 |
|
|
|
|
|
301 |
|
|||||
Deposits and other assets |
|
(3,758 |
) |
151 |
|
330 |
|
3,758 |
|
481 |
|
|||||
Accrued medical claims and other healthcare costs payable |
|
|
|
(2,169 |
) |
90 |
|
|
|
(2,079 |
) |
|||||
Accounts payable and other accrued liabilities |
|
4,221 |
|
(1,777 |
) |
(3,703 |
) |
|
|
(1,259 |
) |
|||||
Net cash provided by (used in) operating activities |
|
(347 |
) |
13,632 |
|
(1,981 |
) |
3,758 |
|
15,062 |
|
|||||
Investing activities |
|
|
|
|
|
|
|
|
|
|
|
|||||
Purchases of property, improvements and equipment |
|
(14 |
) |
(2,131 |
) |
(123 |
) |
|
|
(2,268 |
) |
|||||
Increase in restricted certificates of deposit |
|
|
|
31 |
|
|
|
|
|
31 |
|
|||||
Net cash used in investing activities |
|
(14 |
) |
(2,100 |
) |
(123 |
) |
|
|
(2,237 |
) |
|||||
Financing activities |
|
|
|
|
|
|
|
|
|
|
|
|||||
Borrowings (repayments) on Brotman line of credit |
|
|
|
|
|
6,439 |
|
(3,758 |
) |
2,681 |
|
|||||
Repayments on Brotman Creditors Trust Note |
|
|
|
|
|
(897 |
) |
|
|
(897 |
) |
|||||
Payments on capital leases |
|
|
|
(369 |
) |
(256 |
) |
|
|
(625 |
) |
|||||
Change in restricted cash |
|
|
|
|
|
(1,399 |
) |
|
|
(1,399 |
) |
|||||
Proceeds from exercises of stock options and warrants |
|
627 |
|
|
|
|
|
|
|
627 |
|
|||||
Cash paid for deferred financing costs, net |
|
(39 |
) |
|
|
|
|
|
|
(39 |
) |
|||||
Net cash (used in) provided by financing activities |
|
588 |
|
(369 |
) |
3,887 |
|
(3,758 |
) |
348 |
|
|||||
Increase in cash and cash equivalents |
|
227 |
|
11,163 |
|
1,783 |
|
|
|
13,173 |
|
|||||
Cash and cash equivalents at beginning of period |
|
(514 |
) |
36,995 |
|
1,287 |
|
|
|
37,768 |
|
|||||
Cash and cash equivalents at end of period |
|
$ |
(287 |
) |
$ |
48,158 |
|
$ |
3,070 |
|
$ |
|
|
$ |
50,941 |
|
PROSPECT MEDICAL HOLDINGS, INC.
CONDENSED CONSOLIDATING STATEMENTS OF CASH FLOWS
For the Nine Months Ended June 30, 2009
(in thousands)
(Unaudited)
|
|
Parent |
|
Combined |
|
Combined |
|
Elimination |
|
Consolidated |
|
|||||
Operating activities |
|
|
|
|
|
|
|
|
|
|
|
|||||
Net income (loss) |
|
$ |
(33,125 |
) |
$ |
35,345 |
|
$ |
(2,349 |
) |
$ |
|
|
$ |
(129 |
) |
Adjustments to reconcile net income (loss) to net cash provided by (used in) operating activities: |
|
|
|
|
|
|
|
|
|
|
|
|||||
Depreciation and amortization |
|
10 |
|
5,544 |
|
197 |
|
|
|
5,751 |
|
|||||
Amortization of deferred financing costs, net |
|
102 |
|
|
|
157 |
|
|
|
259 |
|
|||||
Payment-in-kind interest expense |
|
277 |
|
|
|
|
|
|
|
277 |
|
|||||
Gain on interest rate swap arrangements |
|
5,019 |
|
|
|
|
|
|
|
5,019 |
|
|||||
Provision for bad debts |
|
|
|
5,904 |
|
6,379 |
|
|
|
12,283 |
|
|||||
Loss on disposal of assets |
|
34 |
|
|
|
|
|
|
|
34 |
|
|||||
Stock-based compensation |
|
766 |
|
|
|
|
|
|
|
766 |
|
|||||
Deferred income taxes, net |
|
(1,628 |
) |
|
|
|
|
|
|
(1,628 |
) |
|||||
Amortization of other comprehensive income |
|
659 |
|
|
|
|
|
|
|
659 |
|
|||||
Intercompany |
|
32,976 |
|
(33,790 |
) |
814 |
|
|
|
|
|
|||||
Changes in asset and liabilities: |
|
|
|
|
|
|
|
|
|
|
|
|||||
Patient and other receivables |
|
54 |
|
(6,505 |
) |
(3,166 |
) |
601 |
|
(9,016 |
) |
|||||
Prepaid expenses and other |
|
74 |
|
56 |
|
301 |
|
|
|
431 |
|
|||||
Inventories of supplies |
|
|
|
(121 |
) |
254 |
|
|
|
133 |
|
|||||
Refundable income taxes, net |
|
4,214 |
|
(1,560 |
) |
|
|
|
|
2,654 |
|
|||||
Deposits and other assets |
|
|
|
171 |
|
|
|
|
|
171 |
|
|||||
Accrued medical claims and other healthcare costs payable |
|
|
|
(2,617 |
) |
|
|
|
|
(2,617 |
) |
|||||
Accounts payable and other accrued liabilities |
|
(2,012 |
) |
935 |
|
(1,331 |
) |
(601 |
) |
(3,009 |
) |
|||||
Net cash provided by (used in) operating activities |
|
7,420 |
|
3,362 |
|
1,256 |
|
|
|
12,038 |
|
|||||
|
|
|
|
|
|
|
|
|
|
|
|
|||||
Investing activities |
|
|
|
|
|
|
|
|
|
|
|
|||||
Purchases of property, improvements and equipment |
|
|
|
(764 |
) |
|
|
|
|
(764 |
) |
|||||
Cash paid for acquisitions, net of cash received |
|
(2,519 |
) |
209 |
|
|
|
|
|
(2,310 |
) |
|||||
Decrease in restricted certificates of deposit |
|
|
|
(28 |
) |
|
|
|
|
(28 |
) |
|||||
Capitalized expense related to acquisitions |
|
(37 |
) |
|
|
|
|
|
|
(37 |
) |
|||||
Net cash (used in) provided by investing activities |
|
(2,556 |
) |
(583 |
) |
|
|
|
|
(3,139 |
) |
|||||
|
|
|
|
|
|
|
|
|
|
|
|
|||||
Financing activities |
|
|
|
|
|
|
|
|
|
|
|
|||||
Payments on capital leases |
|
|
|
(259 |
) |
(136 |
) |
|
|
(395 |
) |
|||||
Repayment of note payable |
|
(8,654 |
) |
|
|
(250 |
) |
|
|
(8,904 |
) |
|||||
Repayments on line of credit |
|
|
|
|
|
(1,671 |
) |
|
|
(1,671 |
) |
|||||
Cash paid for deferred financing costs, net |
|
(972 |
) |
|
|
|
|
|
|
(972 |
) |
|||||
Change in restricted cash |
|
|
|
|
|
1,047 |
|
|
|
1,047 |
|
|||||
Net cash used in financing activities |
|
(9,626 |
) |
(259 |
) |
(1,010 |
) |
|
|
(10,895 |
) |
|||||
|
|
|
|
|
|
|
|
|
|
|
|
|||||
Increase (decrease) in cash and cash equivalents |
|
(4,762 |
) |
2,520 |
|
246 |
|
|
|
(1,996 |
) |
|||||
Cash and cash equivalents at beginning of period |
|
(40 |
) |
33,698 |
|
(75 |
) |
|
|
33,583 |
|
|||||
Cash and cash equivalents at end of period |
|
$ |
(4,802 |
) |
$ |
36,218 |
|
$ |
171 |
|
$ |
|
|
$ |
31,587 |
|
14. Subsequent Event
As further described in a Form 8-K filed with the SEC on Monday, August 16, 2010, on that date the Company entered into a definitive merger agreement to be acquired for $8.50 per share in cash by an entity sponsored by Leonard Green & Partners, L.P. Certain stockholders of the Company will also participate as post-merger stockholders in the acquiring entity.
Item 2. Managements Discussion and Analysis of Financial Condition and Results of Operations.
Forward-Looking Statements
The following discussion of our financial condition and results of operations (MD&A) should be read in conjunction with the accompanying unaudited condensed consolidated financial statements and notes to those statements appearing elsewhere in this Report.
Certain prior period amounts have been reclassified to conform to the current period presentation with no impact on the unaudited condensed consolidated net loss.
This discussion contains forward-looking statements that involve risks and uncertainties. These forward-looking statements are often accompanied by words such as believe, should, anticipate, plan, expect, potential, scheduled, estimate, intend, seek, goal, may and similar expressions. These statements include, without limitation, statements about our market opportunity, our growth strategy, competition, expected activities and future acquisitions and investments and the adequacy of our available cash resources. Investors are urged to read these statements carefully, and are cautioned that matters subject to forward-looking statements involve risks and uncertainties, including economic, regulatory, competitive and other factors that may affect our business. These statements are not guarantees of future performance and are subject to risks, uncertainties and assumptions. Although we believe that the expectations reflected in the forward-looking statements are reasonable, we cannot guarantee future results, levels of activity, performance, or achievements. Moreover, we do not assume any responsibility for the accuracy and completeness of such statements in the future, and we do not undertake to update or revise any forward-looking statements to reflect future events or new information.
Forward-looking statements involve known and unknown risks and uncertainties that may cause our actual results in future periods to differ materially from those projected or contemplated in the forward-looking statements as a result of, but not limited to, the following factors:
· Government regulation;
· Changes in the regulatory and healthcare policy environment;
· Compliance with debt covenants;
· Receipt of reimbursement from third party payers and collections of accounts receivable from uninsured patients;
· Growth of uninsured and underinsured patients;
· Decreases in the number of Health Maintenance Organization (HMO) enrollees using our affiliated independent physician organizations (IPA) networks;
· Concentration of revenues with a limited number of payers and HMOs;
· Risk-sharing arrangements and volume and timing of healthcare claims;
· Healthcare costs;
· Ability to maintain required working capital;
· Ability to acquire advanced diagnostic and surgical equipment and information technology systems;
· Ability to make acquisitions and integrate the operations of acquired hospitals;
· Reliance on key executive management and key physicians;
· Labor costs;
· Competition;
· Changes to the manner and extent to which healthcare services are covered, delivered and reimbursed that will occur, or may occur, as a result of the enactment in March 2010 of the Patient Protection and Affordable Care Act, as amended by the Healthcare and Education Reconciliation Act of 2010;
· Ability to sufficiently respond to, or comply with, governmental agency surveys and audits;
· Economic trends generally and local economic conditions in Southern California;
· Medical malpractice and workers compensation claims and HMO bad-faith liability claims;
· Weather conditions, severity of annual flu seasons and other factors;
· Losses at Brotman could have a significant negative impact on our consolidated financial position and our ability to refinance Brotman debt on favorable terms; and
· Certain risks more fully described under the heading Risk Factors in our other SEC filings and in Part II, Item 1A of this Quarterly Report on Form 10-Q.
Investors should also refer to our Annual Report on Form 10-K filed with the Securities and Exchange Commission on December 21, 2009 for a discussion of risk factors. A copy of the Form 10-K annual report can be found on the internet at www.prospectmedicalholdings.com or through the SECs electronic data system called EDGAR at www.sec.gov. Given these risks and uncertainties, we can give no assurances that results projected in any forward-looking statements will in fact occur and therefore caution investors not to place undue reliance on them.
Overview
Prior to the acquisition of Alta and Brotman, our organization was focused solely on providing management services to affiliated physician organizations that operate as Independent Physician Associations (Medical Groups). With the acquisition of Alta and Brotman, we now own and operate five hospitals in Southern California and our operations are organized into three reporting segments: Hospital Services, Medical Group and Corporate. The Hospital Services segment includes the results of operations and financial position of Brotman beginning April 14, 2009.
Hospital Services Segment
Alta and Brotman (collectively, the Hospital Services segment) own and operate five hospitals in Los Angeles County, all accredited by the Joint Commission (formerly the Joint Commission on Accreditation of Healthcare Organizations), with a total of 759 licensed beds served by 727 on-staff physicians at June 30, 2010. Alta owns (i) Alta Hollywood Hospitals, Inc., a California corporation, dba Hollywood Community Hospital and Van Nuys Community Hospital; and (ii) Alta Los Angeles Hospitals, Inc., a California corporation, dba Los Angeles Community Hospital and Norwalk Community Hospital. On April 14, 2009 (the Acquisition Date), the Company increased its existing approximately 33.1% ownership stake in Brotman, to approximately 72% via an investment of approximately $2.5 million in cash, thereby obtaining a controlling interest. Brotman owns and operates Brotman Medical Center, located in Culver City, California.
Operating revenue of our Hospital Services segment consists primarily of payments for services rendered, including estimated retroactive adjustments under reimbursement arrangements with third party payers. In some cases, reimbursement is based on formulas and reimbursable amounts are not considered final until cost reports are filed and audited or otherwise settled by the various programs. We accrue for amounts that we believe will ultimately be due to or from Medicare and other third party payers and report such amounts as net patient revenues in the accompanying unaudited condensed consolidated financial statements. We closely monitor our historical collection rates, as well as changes in applicable laws, rules and regulations and contract terms, to assure that provisions are made using the most accurate information available. However, due to the complexities involved in these estimations, actual payments from payers may be materially different from the amounts we estimate and record. A summary of the payment arrangements with major third party payers follows:
Medicare: Medicare is a Federal program that provides certain hospital and medical insurance benefits to persons aged 65 and over, some disabled persons with end-stage renal disease and certain other beneficiary categories. Inpatient services rendered to Medicare program beneficiaries are paid at prospectively determined rates per discharge, according to a patient classification system based on clinical, diagnostic and other factors. Outpatient services are paid based on a blend of prospectively determined rates and cost-reimbursed methodologies. We are also reimbursed for various disproportionate share and Medicare bad debt components at tentative rates, with final settlement determined after submission of the annual Medicare cost report and audit thereof by the Medicare fiscal intermediary. Normal estimation differences between final settlements and amounts accrued in previous years are reflected in net patient service revenue.
Medi-Cal: Medi-Cal is a joint Federal-State funded healthcare benefit program that is administered by the State of California to provide benefits to qualifying individuals who are unable to afford care. As such, Medi-Cal constitutes the version of the Federal Medicaid program that is applicable to California residents. Inpatient services rendered to Medi-Cal program beneficiaries are paid at contracted per diem rates. The per diem rates are not subject to retrospective adjustment. Outpatient services are paid based on prospectively determined rates per procedure.
Managed care: We also receive payment from certain commercial insurance carriers, HMOs and PPOs. The basis for payment is in accordance with negotiated contracted rates or at our standard charges for services provided.
Self-Pay: Self-pay patients represent those patients who do not have health insurance and are not covered by some other form of third party arrangement. Such patients are evaluated, at the time of service or shortly thereafter, for their ability to pay based upon Federal and State poverty guidelines, qualifications for Medi-Cal, as well as our local hospitals indigent and charity care policy.
Hospital revenues depend upon inpatient occupancy levels, the medical and ancillary services and therapy programs ordered by physicians and provided to patients, the volume of outpatient procedures and the charges or negotiated payment rates for such services. Charges and reimbursement rates for inpatient routine services vary depending on the type of services provided (e.g., medical/surgical, intensive care or behavioral health) and the geographic location of the hospital. Inpatient occupancy levels fluctuate for various reasons, many of which are beyond our control. The percentage of patient service revenue attributable to outpatient services has generally increased in recent years, primarily as a result of advances in medical technology that allow more services to be provided on an outpatient basis, as well as increased pressure from Medicare, Medi-Cal and private insurers to reduce hospital stays and provide services, where possible, on a less expensive outpatient basis. We believe that our experience with respect to our increased outpatient levels mirrors the general trend occurring in the healthcare industry and we are unable to predict the rate of growth and resulting impact on our future revenues.
Patients are generally not responsible for any difference between customary hospital charges and amounts reimbursed for such services under Medicare, Medi-Cal, some private insurance plans, and managed care plans, but are responsible for services not covered by such plans, exclusions, deductibles or co-insurance features of their coverage. The amount of such exclusions, deductibles and co-insurance has generally been increasing each year. Indications from recent Federal and State legislation are that this trend will continue. Collection of amounts due from individuals is typically more difficult than from governmental or business payers and increases in uninsured and self-pay patients unfavorably impact the collectability of our patient accounts, thereby increasing our provision for doubtful accounts and charity care provided.
The State of California has enacted assembly bill 1838 (AB1383) effective January 1, 2010, to provide supplemental payments to certain medical facilities which serve a disproportionate share of indigent and low income patients. The bill did not receive the necessary appropriations and cannot be implemented until it is approved by the Center for Medicare and Medicaid Services (CMS), which is anticipated to occur sometime in 2010 and applied retroactively to April 3, 2009. Under this proposed program, participating hospitals, including the Companys hospitals, would be assessed a fee to be paid into a pool of funds to which the federal government will contribute matching funds. These funds will then be distributed to qualifying hospitals based on a prescribed formula. The Company anticipates that it will be a net beneficiary from the fund. No amounts have been recognized in the Companys financial statements, since Management cannot currently predict whether CMS will ultimately approve this program or the ultimate timing and amounts that the Company will have to pay into the fund or receive from the fund.
Operating expenses of our Hospital Services segment generally consist of salaries, benefits and other compensation paid to healthcare professionals that are employees of our hospitals, medical supplies, consultant and professional services, and provision for doubtful accounts.
General and administrative expenses of our Hospital Services segment generally consists of salaries, benefits and other compensation for our hospital administrative employees, insurance, rent, operating supplies, legal, accounting and marketing.
Hospital Services Results of Operations
The following table sets forth the unaudited results of operations for our Hospital Services segment and is used in the discussion below (in thousands):
|
|
Three
Months Ended |
|
Nine
Months Ended |
|
||||||||||||||||||
|
|
2010 |
|
2009 |
|
Increase |
|
% |
|
2010 |
|
2009 |
|
Increase |
|
% |
|
||||||
Net Hospital Services revenues: |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
||||||
Medicare |
|
$ |
36,270 |
|
$ |
30,734 |
|
$ |
5,536 |
|
18.0 |
% |
$ |
109,769 |
|
$ |
65,493 |
|
$ |
44,276 |
|
67.6 |
% |
Medi-Cal |
|
17,427 |
|
22,766 |
|
(5,339 |
) |
-23.5 |
% |
51,164 |
|
56,344 |
|
(5,180 |
) |
-9.2 |
% |
||||||
Managed care |
|
7,692 |
|
8,383 |
|
(691 |
) |
-8.2 |
% |
29,245 |
|
11,377 |
|
17,868 |
|
157.1 |
% |
||||||
Self pay |
|
7,566 |
|
3,807 |
|
3,759 |
|
98.7 |
% |
16,600 |
|
4,940 |
|
11,660 |
|
236.0 |
% |
||||||
Other |
|
585 |
|
780 |
|
(195 |
) |
-25.0 |
% |
2,712 |
|
1,547 |
|
1,165 |
|
75.3 |
% |
||||||
Total net Hospital Services revenues |
|
69,540 |
|
66,470 |
|
3,070 |
|
4.6 |
% |
209,490 |
|
139,701 |
|
69,789 |
|
50.0 |
% |
||||||
Hospital Services operating expenses: |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
||||||
Salaries, wages and benefits |
|
31,273 |
|
29,461 |
|
1,812 |
|
6.2 |
% |
95,206 |
|
61,278 |
|
33,928 |
|
55.4 |
% |
||||||
Supplies |
|
4,885 |
|
6,360 |
|
(1,475 |
) |
-23.2 |
% |
16,014 |
|
10,738 |
|
5,276 |
|
49.1 |
% |
||||||
Provision for doubtful accounts |
|
7,352 |
|
8,578 |
|
(1,226 |
) |
-14.3 |
% |
21,993 |
|
12,286 |
|
9,707 |
|
79.0 |
% |
||||||
Other operating expenses |
|
8,837 |
|
6,879 |
|
1,958 |
|
28.5 |
% |
21,417 |
|
11,979 |
|
9,438 |
|
78.8 |
% |
||||||
Total Hospital Services operating expenses |
|
52,347 |
|
51,278 |
|
1,069 |
|
2.1 |
% |
154,630 |
|
96,281 |
|
58,349 |
|
60.6 |
% |
||||||
General and administrative |
|
3,845 |
|
6,595 |
|
(2,750 |
) |
-41.7 |
% |
14,644 |
|
12,813 |
|
1,831 |
|
14.3 |
% |
||||||
Depreciation and amortization |
|
1,255 |
|
1,270 |
|
(15 |
) |
-1.2 |
% |
3,679 |
|
3,098 |
|
581 |
|
18.8 |
% |
||||||
Total non-medical expenses |
|
5,100 |
|
7,865 |
|
(2,765 |
) |
-35.2 |
% |
18,323 |
|
15,911 |
|
2,412 |
|
15.2 |
% |
||||||
Operating income |
|
$ |
12,093 |
|
$ |
7,327 |
|
$ |
4,766 |
|
65.0 |
% |
$ |
36,537 |
|
$ |
27,509 |
|
$ |
9,028 |
|
32.8 |
% |
The following table sets forth selected operating items, expressed as a percentage of total net Hospital Services revenue (unaudited):
|
|
Three Months Ended |
|
Nine Months Ended |
|
||||
|
|
June 30, |
|
June 30, |
|
||||
|
|
2010 |
|
2009 |
|
2010 |
|
2009 |
|
|
|
|
|
|
|
|
|
|
|
Net Hospital Services revenues: |
|
|
|
|
|
|
|
|
|
Medicare |
|
52.2 |
% |
46.2 |
% |
52.4 |
% |
46.9 |
% |
Medi-Cal |
|
25.1 |
% |
34.3 |
% |
24.4 |
% |
40.3 |
% |
Managed care |
|
11.1 |
% |
12.6 |
% |
14.0 |
% |
8.1 |
% |
Self pay |
|
10.9 |
% |
5.7 |
% |
7.9 |
% |
3.5 |
% |
Other |
|
0.7 |
% |
1.2 |
% |
1.3 |
% |
1.2 |
% |
Total net Hospital Services revenues |
|
100.0 |
% |
100.0 |
% |
100.0 |
% |
100.0 |
% |
Hospital Services operating expenses: |
|
|
|
|
|
|
|
|
|
Salaries, wages and benefits |
|
45.0 |
% |
44.3 |
% |
45.4 |
% |
43.9 |
% |
Supplies |
|
7.0 |
% |
9.6 |
% |
7.6 |
% |
7.7 |
% |
Provision for doubtful accounts |
|
10.6 |
% |
12.9 |
% |
10.5 |
% |
8.8 |
% |
Other operating expenses |
|
12.7 |
% |
10.3 |
% |
10.2 |
% |
8.6 |
% |
Total Hospital Services operating expenses |
|
75.3 |
% |
77.1 |
% |
73.7 |
% |
69.0 |
% |
General and administrative |
|
5.5 |
% |
9.9 |
% |
7.0 |
% |
9.2 |
% |
Depreciation and amortization |
|
1.8 |
% |
1.9 |
% |
1.8 |
% |
2.2 |
% |
Total non-medical expenses |
|
7.3 |
% |
11.8 |
% |
8.8 |
% |
11.4 |
% |
Operating income |
|
17.4 |
% |
11.1 |
% |
17.5 |
% |
19.6 |
% |
The following table shows certain selected historical operating statistics for our hospitals (unaudited):
|
|
Three Months Ended |
|
Nine Months Ended |
|
||||||||||||
|
|
June 30, |
|
June 30, |
|
||||||||||||
|
|
2010 |
|
2009 |
|
Increase |
|
2010 |
|
2009 |
|
Increase |
|
||||
|
|
|
|
|
|
|
|
|
|
|
|
|
|
||||
Net inpatient revenues (in thousands) (1) |
|
$ |
60,169 |
|
$ |
59,039 |
|
1.9 |
% |
$ |
181,219 |
|
$ |
127,839 |
|
41.8 |
% |
Net outpatient revenues (in thousands)(1) |
|
$ |
8,786 |
|
$ |
6,651 |
|
32.1 |
% |
$ |
25,559 |
|
$ |
10,315 |
|
147.8 |
% |
Other services revenues (in thousands) |
|
$ |
585 |
|
$ |
780 |
|
-25.0 |
% |
$ |
2,712 |
|
$ |
1,547 |
|
75.2 |
% |
Number of hospitals at end of period |
|
5 |
|
5 |
|
0.0 |
% |
5 |
|
5 |
|
0.0 |
% |
||||
Licensed beds at end of the period |
|
759 |
|
759 |
|
0.0 |
% |
759 |
|
759 |
|
0.0 |
% |
||||
Average licensed beds |
|
759 |
|
759 |
|
0.0 |
% |
759 |
|
759 |
|
0.0 |
% |
||||
Average available beds |
|
616 |
|
616 |
|
0.0 |
% |
616 |
|
616 |
|
0.0 |
% |
||||
Admissions (2) |
|
5,608 |
|
5,451 |
|
2.9 |
% |
17,660 |
|
12,675 |
|
39.3 |
% |
||||
Adjusted patient admissions (3) |
|
6,372 |
|
6,056 |
|
5.2 |
% |
19,868 |
|
13,655 |
|
45.5 |
% |
||||
Net inpatient revenue per admission |
|
$ |
10,729 |
|
$ |
10,831 |
|
-0.9 |
% |
$ |
10,262 |
|
$ |
10,086 |
|
1.7 |
% |
Patient days |
|
35,881 |
|
36,800 |
|
-2.5 |
% |
112,175 |
|
84,329 |
|
33.0 |
% |
||||
Adjusted patient days |
|
41,024 |
|
40,072 |
|
2.4 |
% |
126,872 |
|
90,625 |
|
40.0 |
% |
||||
Average length of patients stay (days) |
|
6.4 |
|
6.3 |
|
1.6 |
% |
6.4 |
|
4.5 |
|
41.2 |
% |
||||
Net inpatient revenue per patient day |
|
$ |
1,677 |
|
$ |
1,604 |
|
4.5 |
% |
$ |
1,616 |
|
$ |
1,516 |
|
6.6 |
% |
Outpatient visits |
|
12,829 |
|
10,930 |
|
17.4 |
% |
40,578 |
|
21,109 |
|
92.2 |
% |
||||
Net outpatient revenue per visit |
|
$ |
685 |
|
$ |
609 |
|
12.5 |
% |
$ |
630 |
|
$ |
489 |
|
28.8 |
% |
Occupancy rate for licensed beds (4) |
|
51.4 |
% |
52.7 |
% |
-2.5 |
% |
51.4 |
% |
40.7 |
% |
26.3 |
% |
||||
Occupancy rate for available beds (4) |
|
63.3 |
% |
64.9 |
% |
-2.4 |
% |
63.3 |
% |
50.2 |
% |
26.1 |
% |
(1) Net inpatient revenues include self-pay revenues of approximately $5,541,000 and $3,309,000, for the three months ended June 30, 2010 and 2009, respectively, and $10,449,000 and $4,306,000, for the nine months ended June 30, 2010 and 2009, respectively. Net outpatient revenues include self-pay revenues of approximately $2,047,000 and $581,000 for the three months ended June 30, 2010 and 2009, respectively, and $6,174,000 and $634,000, for the nine months ended June 30, 2010 and 2009, respectively.
(2) Charity care admissions represent 0.4% and 0.6% of total admissions for the three months ended June 30, 2010 and 2009, respectively, and represent 0.8% and 0.7% of total admissions for the nine months ended June 30, 2010 and 2009, respectively. Based on the Companys gross charge rates, revenues foregone under the charity policy, including indigent accounts, were approximately $240,000 and $832,000 for the three months ended June 30, 2010 and 2009, respectively, and approximately $2,156,000 and $1,456,000 for the nine months ended June 30, 2010 and 2009, respectively.
(3) Adjusted patient admissions are total admissions adjusted for outpatient volume. Adjusted admissions are computed by multiplying admissions (inpatient volume) by the sum of gross inpatient charges and gross outpatient charges and then dividing the resulting amount by gross inpatient charges.
(4) Utilization of licensed beds represents patient days divided by average licensed beds divided by number of days in the period. Occupancy rates are affected by many factors, including the population size and general economic conditions within particular market service areas, the degrees of variation in medical and surgical products, outpatient use of hospital services, quality and treatment availability at competing hospitals and seasonality.
(5) The three months and nine months ended June 30, 2009 include only 77 days of Brotman operating results, as the Company acquired a majority stake in, and began consolidating, Brotman, effective April 14, 2009.
Three Months Ended June 30, 2010 Compared to Three Months Ended June 30, 2009
Net Hospital Services revenues
Net Hospital Services revenues increased $3,070,000 to approximately $69,540,000 for the three months ended June 30, 2010, from approximately $66,470,000 for the three months ended June 30, 2009. Included in Net Hospital Services revenues in the fiscal 2010 period was capitation revenue of approximately $2,486,000 earned under the Capitation Arrangement entered into on March 1, 2010 (see Note 6 to the unaudited condensed consolidated financial statements). On a same-store basis, excluding revenue earned under the Capitation Arrangement for the three months ended June 30, 2010, net Alta Hospital Services revenues increased 3.7%. This increase was primarily attributable to increased inpatient admissions, increased outpatient visits and increased Medicare reimbursement rates, offset by decreased Medi-Cal inpatient days. The increase in inpatient admissions, on a same-store basis, reflects the successful marketing effort in the targeted Medicare service lines, while the increase in outpatient visits was attributable primarily to an increase in flu-related outpatient visits.
Salaries, Wages and Benefits
Salaries, wages and benefits (SWB), as a percentage of net Hospital Services revenues increased 1.6% to 45.0% for the three months ended June 30, 2010, as compared to 44.3% for the three months ended June 30, 2009. This increase primarily relates to Brotman, which offset efficiencies gained in our hospitals owned throughout both periods. On a same-store basis, SWB as a percentage of net Alta Hospital Services revenues, net of revenue earned under the Capitation Arrangement, decreased 5.1% to 42.8% for the three months ended June 30, 2010, as compared to 45.1% for the three months ended June 30, 2009. This decrease in same-store SWB expense as a percent of revenue was primarily the result of a decrease in same-store patient days, decreased length of patient stays, and improved efficiencies, offset by increased labor expense due to inflation and merit rate increases and the conversion of certain hospital personnel from contracted to salaried basis and increased health benefit costs
Supplies
Supplies, as a percentage of net Hospital Services revenues, decreased 27.1% to 7.0% for the three months ended June 30, 2010, as compared to 9.6% for the three months ended June 30, 2009. On a same-store basis, supplies as a percentage of net Alta Hospital Services revenues, net of revenue earned under the Capitation Arrangement, decreased 14.5% to 5.3% for the three months ended June 30, 2010, as compared to 6.2% for the three months ended June 30, 2009. The decrease was primarily the result of a decrease in same-store patient days, decreased length of patient stays and decreased utilization of pharmaceuticals as a result of the outsourcing of our sub-acute pharmacy and improved efficiencies.
Provision for Doubtful Accounts
Provision for doubtful accounts, as a percentage of net Hospital Services revenues, decreased 17.8% to 10.6% for the three months ended June 30, 2010, as compared to 12.9% for the three months ended June 30, 2009. On a same-store basis, provision for doubtful accounts as a percentage of net Alta Hospital Services revenues, net of revenue earned under the Capitation Arrangement, decreased 11.7% to 5.2% for the three months ended June 30, 2010, as compared to 6.0% for the three months ended June 30, 2009. The provision for doubtful accounts relates principally to self-pay amounts due from patients and commercial managed care amounts. The fluctuation was due to an increase in same-store commercial managed care collection rate and decreased bad debt write-off experience in the fiscal 2010 period.
Other Operating Expenses
Other operating expenses, as a percentage of net Hospital Services revenues, increased 23.3% to 12.7% for the three months ended June 30, 2010, as compared to 10.3% for the three months ended June 30, 2009. Included in other operating expenses in the fiscal 2010 period was claims expense of approximately $2,550,000 incurred under the Capitation Arrangement. On a same-store basis, other operating expenses as a percentage of net Alta Hospital Services revenues, adjusted for the effect of the Capitation Arrangement, decreased 9.1% to 6.0% for the three months ended June 30, 2010, as compared to 6.6% for the three months ended June 30, 2009. This decrease was due primarily to the reduction in registry costs, in line with decreased patient days, decreased length of patient stays and decreased contract labor costs as a result of the conversion of certain hospital personnel from contracted to salaried basis.
General and Administrative
General and administrative expenses (G&A) consist primarily of utilities, insurance, purchased services and property taxes. G&A were $3,845,000 for the three months ended June 30, 2010, or 5.5% of net Hospital Services revenue, compared to $6,595,000 for the three months ended June 30, 2009, or 9.9% of net Hospital Services revenue. On a same-store basis, G&A, as a percentage of net Alta Hospital Service revenues, net of revenue earned under the Capitation Arrangement, decreased 18.8% to 7.3% for the three months ended June 30, 2010, as compared to 9.0% for the three months ended June 30, 2009. This decrease was due primarily to lower malpractice costs and adjustments related to certain vendor credits.
Depreciation and Amortization
Depreciation and amortization expense decreased 1.2% in the three months ended June 30, 2010 to $1,255,000 compared to $1,270,000 in the three months ended June 30, 2009. On a same-store basis, depreciation and amortization expenses as a percentage of Altas net Hospital Services revenues, net of revenue earned under the Capitation Arrangement, for the three months ended June 30, 2010 were approximately 2.7% compared to 3.0% for the three months ended June 30, 2009. This decrease was due primarily to the accelerated write-off of certain hospital equipment in the fiscal 2009 period. Included in depreciation and amortization expense was amortization of identifiable intangibles of approximately $394,000 and $383,000 in the three months ended June 30, 2010 and 2009, respectively.
Operating Income
Our Hospital Services segment reported operating income of approximately $12,093,000 and $7,327,000 for the three months ended June 30, 2010 and 2009, respectively. This increase was the result of the changes discussed above. These operating results from the Hospital Services segment include certain corporate expense allocations for insurance, professional fees, and amortization of identifiable intangibles that relate to this segment.
Nine Months Ended June 30, 2010 Compared to Nine Months Ended June 30, 2009
Net Hospital Services Revenues
Net Hospital Services revenues increased $69,789,000 to approximately $209,490,000 for the nine months ended June 30, 2010, from approximately $139,701,000 for the nine months ended June 30, 2009. Included in Net Hospital Services revenues in the fiscal 2010 period was capitation revenue of approximately $3,350,000 earned under the Capitation Arrangement. On a same-store basis, excluding revenue earned under the Capitation Arrangement for the nine months ended June 30, 2010, net Alta Hospital Services revenues increased 1.3%. This increase was primarily attributable to increased inpatient admissions, increased outpatient visits and increased Medicare reimbursement rates, offset by decreased Medi-Cal inpatient days. The increase in inpatient admissions, on a same-store basis, reflects the successful marketing effort in the targeted Medicare service lines, while the increase in outpatient visits was attributable primarily to an increase in flu-related outpatient visits.
Salaries, Wages and Benefits
SWB, as a percentage of net Hospital Services revenues increased 0.4% to 45.4% for the nine months ended June 30, 2010, as compared to 43.9% for the nine months ended June 30, 2009. This increase primarily relates to Brotman, which offset efficiencies gained in our hospitals owned throughout both periods. On a same-store basis, SWB, as a percentage of net Alta Hospital Services revenues, net of revenue earned under the Capitation Arrangement, increased 0.5% to 42.2% for the nine months ended June 30, 2010, as compared to 44.0% for the nine months ended June 30, 2009. This slight increase in same-store SWB expense as a percent of revenue was primarily the result of increased labor expense due to inflation and merit rate increases and the conversion of certain hospital personnel from contracted to salaried basis and increased health benefit costs, offset by a decrease in same-store patient days, decreased length of patient stays, and improved efficiencies.
Supplies
Supplies, as a percentage of net Hospital Services revenues, decreased 1.3% to 7.6% for the nine months ended June 30, 2010, as compared to 7.7% for the nine months ended June 30, 2009. On a same-store basis, supplies as a percentage of net Alta Hospital Services revenues, net of revenue earned under the Capitation Arrangement, decreased 9.8% to 5.5% for the nine months ended June 30, 2010, as compared to 6.1% for the nine months ended June 30, 2009. The decrease was primarily the result of a decrease in same-store patient days, decreased length of patient stays and decreased utilization of pharmaceuticals as a result of the outsourcing of our sub-acute pharmacy and improved efficiencies.
Provision for Doubtful Accounts
Provision for doubtful accounts, as a percentage of net Hospital Services revenues, increased 19.3% to 10.5% for the nine months ended June 30, 2010, compared to 8.8% for the nine months ended June 30, 2009. This increase is primarily attributable to the current year inclusion of Brotman, which has historically had a higher percentage of self-pay patients and to the impact of the current economic conditions on individuals ability to pay. On a same-store basis, provision for doubtful accounts as a percentage of net Alta Hospital Services revenues, net of revenue earned under the Capitation Arrangement, increased 1.9% to 5.5% for the nine months ended June 30, 2010, as compared to 5.4% for the nine months ended June 30, 2009. The provision for doubtful accounts relates principally to self-pay amounts due from patients and commercial managed care amounts. The fluctuation was due to increased self-pay outpatient visits and also the impact of current economic conditions on individuals ability to pay.
Other Operating Expenses
Other operating expenses, as a percentage of net Hospital Services revenues, increased 18.6% to 10.2% for the nine months ended June 30, 2010, as compared to 8.6% for the nine months ended June 30, 2009. Included in other operating expenses in the fiscal 2010 period were claims expenses of approximately $3,411,000 incurred under the Capitation Arrangement. On a same-store basis, other operating expenses as a percentage of net Alta Hospital Services revenues, adjusted for the effect of the Capitation Arrangement, decreased 13.2% to 5.9% for the nine months ended June 30, 2010, as compared to 6.8% for the nine months ended June 30, 2009. This decrease was due primarily to the reduction of registry costs, in line with decreased patient days, decreased length of patient stays and decreased contract labor costs as a result of the conversion of certain hospital personnel from contracted to salaried basis.
General and Administrative
G&A consist primarily of utilities, insurance, purchased services and property taxes. G&A were $14,644,000 for the nine months ended June 30, 2010, or 7.0% of net Hospital Services revenue, compared to $12,813,000 for the nine months ended June 30, 2009, or 9.2% of net Hospital Services revenue. On a same-store basis, G&A, as a percentage of net Alta Hospital Service revenues, net of revenue earned under the Capitation Arrangement, was consistent at 8.7% for the nine months ended June 30, 2010, as compared the nine months ended June 30, 2009.
Depreciation and Amortization
Depreciation and amortization expense increased 18.8% in the nine months ended June 30, 2010 to $3,679,000 compared to $3,098,000 in the nine months ended June 30, 2009, primarily relates to Brotman. On a same-store basis, depreciation and amortization expenses as a percentage of Altas net Hospital Services revenues, net of revenue earned under the Capitation Arrangement, for the nine months ended June 30, 2010 were approximately 2.6% compared to 3.0% for the nine months ended June 30, 2009. This decrease was due primarily to the accelerated write-off of certain hospital equipment in the fiscal 2009 period. Included in depreciation and amortization expense was amortization of identifiable intangibles of approximately $1,185,000 and $1,017,000 in the nine months ended June 30, 2010 and 2009, respectively.
Operating Income
Our Hospital Services segment reported operating income of approximately $36,537,000 and $27,509,000 for the nine months ended June 30, 2010 and 2009, respectively. This increase was the result of the changes discussed above. These operating results from the Hospital Services segment include certain corporate expense allocations for insurance, professional fees, and amortization of identifiable intangibles that relate to this segment.
Medical Group Segment
The Medical Group segment provides management services to affiliated physician organizations that operate as independent physician associations (Medical Groups). The affiliated physician organizations enter into agreements with HMOs to provide HMO enrollees with a full range of medical services in exchange for fixed, prepaid monthly fees known as capitation payments. The Medical Groups contract with primary care and specialist physicians and other healthcare providers to provide enrollees with all necessary medical services.
Through our management subsidiariesPMS and PHCAwe have entered into long-term agreements to provide management services to each of our affiliated physician organizations in exchange for a management fee. The management services we provide include HMO contracting, physician recruiting, credentialing and contracting, human resources services, claims administration, financial reporting services, provider relations, patient eligibility and related services, medical management including utilization management and quality assurance, data collection, and management information systems.
Our management subsidiaries currently provide management services to ten affiliated physician organizations, which include PMG, Nuestra Familia Medical Group, Inc. (Nuestra), eight other affiliated physician organizations that PMG owns or controls, and one affiliated physician organization (AMVI/Prospect Health Network) that is an unconsolidated joint venture in which PMG owns a 50% interest. PMG, which was our first affiliated physician organization, has acquired the ownership interest in all of our other affiliated physician organizations, except Nuestra. Both PMG and Nuestra are owned by our physician shareholder nominee, Dr. Arthur Lipper, and controlled through assignable option agreements and management services agreements (see Note 6 to the condensed consolidated Financial Statements). While PMG is itself an affiliated physician organization that performs the same business in its own service area as all of our other affiliated physician organizations do in theirs, PMG also serves as a holding company for our other affiliated physician organizations, except Nuestra.
The affiliated physician organizations provided medical services to a combined total of approximately 176,000 HMO enrollees as of June 30, 2010, including approximately 21,000 enrollees that we manage for the economic benefit of two independent third parties, and for which we earn management fee income.
As of June 30, 2010, our Medical Groups have contracts with approximately 16 HMOs, from which our revenue was primarily derived. HMOs offer a comprehensive healthcare benefits package in exchange for a capitation amount per enrollee that does not vary through the contract period regardless of the quantity or cost of medical services required or used. HMOs enroll members by entering into contracts with employer groups or directly with individuals to provide a broad range of healthcare services for a prepaid charge, with minimal deductibles or co-payments required of the members. The contracts between our affiliated physician organizations and the HMOs provide for the provision of medical services by the affiliated physician organization to the HMO enrollees in consideration for the prepayment of the fixed monthly capitation amount per enrollee.
Our Medical Group business has developed primarily through acquisitions of Medical Groups by PMG, and is concentrated in Orange County, Los Angeles County, Riverside County and San Bernardino County, all within the State of California.
Medical Group revenues consist primarily of amounts received for medical services provided by our affiliated physician organizations under capitated contracts with HMOs. Capitation revenue under HMO contracts is prepaid monthly to the affiliates based on the number of covered HMO enrollees. Capitation revenue may be subsequently adjusted to reflect changes in enrollment as a result of retroactive terminations or additions. These adjustments have historically not had a material effect on capitation revenue. Variability in capitation revenue exists under Medicares capitation model referred to as Risk Adjustment. Under the model, capitation with respect to Medicare enrollees is subject to subsequent adjustment by CMS based on the acuity of the enrollees to whom services were provided. Capitation for the current year is paid based on data submitted for each Medicare enrollee for preceding periods. Capitation is paid at interim rates during the year and is adjusted in subsequent periods after the final data is compiled. Positive or negative capitation adjustments are made for Medicare enrollees with conditions requiring more or less healthcare services than assumed in the interim payments. Since we do not have the information necessary to reliably predict these adjustments, periodic changes in capitation amounts earned as a result of risk adjustment are recognized once those changes are communicated to us by the health plans.
Management fees were primarily comprised of amounts earned from managing the operations of AMVI, Inc. (our joint venture partner in the AMVI/Prospect Health Network joint venture) and certain other third party entities. Management fee revenue is recognized in the month the services are delivered.
Medical Group revenues also included incentive payments from HMOs under pay-for-performance programs for quality medical care based on various criteria. These incentives are generally received in the third and fourth quarters of our fiscal year and are recorded when such amounts are known since we do not maintain the information necessary to independently and reliably estimate these amounts.
We also potentially earn additional incentive revenue or incur penalties under HMO contracts by sharing in the risk for hospitalization based upon inpatient services utilized. These amounts are included in capitation revenue. Shared risk deficits are generally not payable until and unless we generated future risk-sharing surpluses. Risk pools are generally settled in the following year. Management estimates risk pool incentives based on information received from the HMOs or hospitals with whom the risk-sharing arrangements were in place, and who typically maintain the information and record keeping related to the risk pool arrangements. Differences between actual and estimated settlements are recorded when the final outcome is known. Risk pool and pay-for-performance incentives are affected by many factors, some of which are beyond our control, and may vary significantly from year to year.
As discussed in Note 6 to the accompanying unaudited financial statements, effective March 1, 2010, we entered into a Global Capitation Arrangement whereby we agreed to provide hospital, medical and other healthcare services to approximately 2,000 senior members.
We have increased our membership through acquisitions in previous years. These increases through acquisitions were offset by HMO enrollment declines at our Medical Groups, similar to the recent HMO enrollment trends in California. The following table sets forth the approximate number of members, by category (in thousands, unaudited):
|
|
As of June 30, |
|
||||
|
|
|
|
|
|
% Increase |
|
Member Category |
|
2010 |
|
2009 |
|
(Decrease) |
|
Commercial owned |
|
122 |
|
136 |
|
-10 |
% |
Commercial - managed(l) |
|
8 |
|
1 |
|
700 |
% |
Senior owned |
|
22 |
|
21 |
|
5 |
% |
Senior - managed(1) |
|
1 |
|
0 |
|
100 |
% |
Medi-Cal owned |
|
11 |
|
12 |
|
-8 |
% |
Medi-Cal - managed(1) |
|
12 |
|
8 |
|
50 |
% |
Total |
|
176 |
|
178 |
|
-1 |
% |
(1) Represents members that we manage on behalf of third parties in exchange for a management fee.
The following table details total paid member months, by member category (in thousands, unaudited):
|
|
Three Months Ended |
|
Nine Months Ended |
|
||||||||
|
|
June 30, |
|
June 30, |
|
||||||||
|
|
|
|
|
|
% Increase |
|
|
|
|
|
% Increase |
|
|
|
2010 |
|
2009 |
|
(Decrease) |
|
2010 |
|
2009 |
|
(Decrease) |
|
Commercial - owned |
|
366 |
|
412 |
|
-11 |
% |
1,134 |
|
1,290 |
|
-12 |
% |
Commercial - managed(1) |
|
18 |
|
4 |
|
350 |
% |
28 |
|
12 |
|
133 |
% |
Senior - owned |
|
66 |
|
64 |
|
3 |
% |
197 |
|
194 |
|
2 |
% |
Senior - managed(1) |
|
1 |
|
0 |
|
100 |
% |
3 |
|
1 |
|
200 |
% |
Medi-Cal - owned |
|
33 |
|
35 |
|
-6 |
% |
101 |
|
103 |
|
-2 |
% |
Medi-Cal - managed(1) |
|
33 |
|
24 |
|
38 |
% |
83 |
|
71 |
|
17 |
% |
Total |
|
517 |
|
539 |
|
-4 |
% |
1,546 |
|
1,671 |
|
-8 |
% |
(1) Represents members that we manage on behalf of third parties in exchange for a management fee.
Our operating expenses include costs related to the provision of medical care services (medical group cost of revenues) and general and administrative expenses. Our results of operations depend on our ability to effectively manage expenses related to health benefits and accurately predict costs incurred.
Expenses related to medical care services include payments to contracted primary care physicians and payments to contracted specialists. In general, primary care physicians are paid on a capitation basis, while specialists are paid on either a capitation or a fee-for-service basis.
Capitation payments are fixed in advance of periods covered and are not subject to significant accounting estimates. These payments are expensed in the period the providers are obligated to provide services. Fee-for-service payments are expensed in the period services are provided to our members. Medical care costs include actual historical claims experience and estimates of incurred but not reported amounts (IBNR). We estimate our IBNR monthly, based on a number of factors, including prior claims experience. As part of this review, we also consider estimates of amounts to cover uncertainties related to fluctuations in provider billing patterns, claims payment patterns, membership and medical cost trends. These estimates are adjusted each month as more information becomes available. In addition to our own IBNR estimation process, we obtain semi-annual reviews of our IBNR liability from independent actuaries. We believe that our process for estimating IBNR is adequate and appropriate, but there can be no assurance that medical care costs will not materially differ from such estimates. In addition to contractual reimbursements to providers, we also make discretionary incentive payments to physicians, which are in large part based on the pay-for-performance, shared risk revenues and any favorable senior capitation risk-adjustment payments we receive. Since we record these revenues generally in the third or fourth quarter of each fiscal year, when the incentives and capitation adjustments due from the health plans are known, we also historically adjust interim accruals of discretionary physician bonuses in the same period. Because incentives and risk-adjustment revenues form the basis for these discretionary bonuses, variability in earnings due to fluctuations in revenues are mitigated by the recording of physician bonuses.
General and administrative expenses (G&A) are largely comprised of wage and benefit costs and other administrative expenses. G&A functions include, and are not limited to, claims processing, information systems, provider relations, finance and accounting services, and legal and regulatory services.
Medical Group Results of Operations
The following tables summarize our net operating revenue, cost of revenues and operating income from Medical Group operations and are used in the discussions below (in thousands, unaudited):
|
|
Three Months Ended |
|
Nine Months Ended |
|
||||||||||||||||||
|
|
June 30, |
|
June 30, |
|
||||||||||||||||||
|
|
2010 |
|
2009 |
|
Increase |
|
% |
|
2010 |
|
2009 |
|
Increase |
|
% |
|
||||||
Medical Group revenues: |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
||||||
Capitation |
|
$ |
46,790 |
|
$ |
47,369 |
|
$ |
(579 |
) |
-1.2 |
% |
$ |
139,172 |
|
$ |
143,005 |
|
$ |
(3,833 |
) |
-2.7 |
% |
Management fees |
|
293 |
|
149 |
|
144 |
|
96.6 |
% |
604 |
|
437 |
|
167 |
|
38.2 |
% |
||||||
Other operating revenues |
|
284 |
|
330 |
|
(46 |
) |
-14.0 |
% |
399 |
|
696 |
|
(297 |
) |
-42.7 |
% |
||||||
Total Medical Group revenues |
|
47,367 |
|
47,848 |
|
(481 |
) |
-1.0 |
% |
140,175 |
|
144,138 |
|
(3,963 |
) |
-2.7 |
% |
||||||
Medical Group cost of revenues: |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
||||||
PCP capitation |
|
8,087 |
|
8,335 |
|
(248 |
) |
-3.0 |
% |
24,679 |
|
25,470 |
|
(791 |
) |
-3.1 |
% |
||||||
Specialist capitation |
|
10,189 |
|
10,940 |
|
(751 |
) |
-6.9 |
% |
30,823 |
|
33,086 |
|
(2,263 |
) |
-6.8 |
% |
||||||
Claims expense |
|
18,180 |
|
17,139 |
|
1,041 |
|
6.1 |
% |
53,693 |
|
52,301 |
|
1,392 |
|
2.7 |
% |
||||||
Physician salaries |
|
795 |
|
605 |
|
190 |
|
31.4 |
% |
1,787 |
|
1,670 |
|
117 |
|
7.0 |
% |
||||||
Other cost of revenues |
|
171 |
|
(51 |
) |
222 |
|
435.3 |
% |
148 |
|
(992 |
) |
1,140 |
|
114.9 |
% |
||||||
Total Medical Group cost of revenues |
|
37,422 |
|
36,968 |
|
454 |
|
1.2 |
% |
111,130 |
|
111,535 |
|
(405 |
) |
-0.4 |
% |
||||||
Gross margin |
|
9,945 |
|
10,880 |
|
(935 |
) |
-8.6 |
% |
29,045 |
|
32,603 |
|
(3,558 |
) |
-10.9 |
% |
||||||
General and administrative |
|
6,315 |
|
7,286 |
|
(971 |
) |
-13.3 |
% |
19,454 |
|
21,961 |
|
(2,507 |
) |
-11.4 |
% |
||||||
Depreciation and amortization |
|
820 |
|
889 |
|
(69 |
) |
-7.8 |
% |
2,547 |
|
2,644 |
|
(97 |
) |
-3.7 |
% |
||||||
Total other expenses |
|
7,135 |
|
8,175 |
|
(1,040 |
) |
-12.7 |
% |
22,001 |
|
24,605 |
|
(2,604 |
) |
-10.6 |
% |
||||||
Income from unconsolidated joint venture |
|
482 |
|
535 |
|
(53 |
) |
-9.9 |
% |
1,514 |
|
1,482 |
|
32 |
|
2.2 |
% |
||||||
Operating income |
|
$ |
3,292 |
|
$ |
3,240 |
|
$ |
52 |
|
1.6 |
% |
$ |
8,558 |
|
$ |
9,480 |
|
$ |
(922 |
) |
-9.7 |
% |
Medical cost ratio |
|
80.0 |
% |
77.3 |
% |
|
|
|
|
79.9 |
% |
77.4 |
% |
|
|
|
|
The following table sets forth selected operating items, expressed as a percentage of total revenue (unaudited):
|
|
Three Months Ended |
|
Nine Months Ended |
|
||||
|
|
June 30, |
|
June 30, |
|
||||
|
|
2010 |
|
2009 |
|
2010 |
|
2009 |
|
Medical Group revenues: |
|
|
|
|
|
|
|
|
|
Capitation |
|
98.8 |
% |
99.0 |
% |
99.3 |
% |
99.2 |
% |
Management fees |
|
0.6 |
% |
0.3 |
% |
0.4 |
% |
0.3 |
% |
Other operating revenues |
|
0.6 |
% |
0.7 |
% |
0.3 |
% |
0.5 |
% |
Total Medical Group revenues |
|
100.0 |
% |
100.0 |
% |
100.0 |
% |
100.0 |
% |
Medical Group cost of revenues: |
|
|
|
|
|
|
|
|
|
PCP capitation |
|
17.1 |
% |
17.4 |
% |
17.6 |
% |
17.7 |
% |
Specialist capitation |
|
21.5 |
% |
22.9 |
% |
22.0 |
% |
23.0 |
% |
Claims expense |
|
38.4 |
% |
35.8 |
% |
38.3 |
% |
36.3 |
% |
Physician salaries |
|
1.7 |
% |
1.3 |
% |
1.3 |
% |
1.2 |
% |
Other cost of revenues |
|
0.4 |
% |
-0.1 |
% |
0.1 |
% |
-0.7 |
% |
Total Medical Group cost of revenues |
|
79.1 |
% |
77.3 |
% |
79.3 |
% |
77.5 |
% |
Gross margin |
|
20.9 |
% |
22.7 |
% |
20.7 |
% |
22.5 |
% |
General and administrative |
|
13.3 |
% |
15.2 |
% |
13.9 |
% |
15.2 |
% |
Depreciation and amortization |
|
1.7 |
% |
1.9 |
% |
1.8 |
% |
1.8 |
% |
Total other expenses |
|
15.0 |
% |
17.1 |
% |
15.7 |
% |
17.0 |
% |
Income from unconsolidated joint venture |
|
1.0 |
% |
1.1 |
% |
1.1 |
% |
1.0 |
% |
Operating income |
|
6.9 |
% |
6.7 |
% |
6.1 |
% |
6.5 |
% |
Three Months Ended June 30, 2010 Compared to Three Months Ended June 30, 2009
Capitation Revenue
Capitation revenue for the three months ended June 30, 2010 was approximately $46,790,000, representing a decrease of approximately $579,000 or 1.2% from capitation revenue for the three months ended June 30, 2009, of approximately $47,369,000.
The decrease in the fiscal 2010 period was due primarily to a decrease in commercial enrollment given current unemployment levels, partly offset by commercial and senior rate increases and increased senior enrollment. In addition, the Company recognized a senior risk adjustment net settlement of approximately $1,300,000 that, in prior years, was recognized in the fourth quarter. The change in recognition timing is due to timing of notification by the HMOs.
Management Fee Revenue
Management fee revenue for the three months ended June 30, 2010 was approximately $293,000, representing an increase of approximately $144,000 or 96.6% from management fee revenue for the three months ended June 30, 2009, of approximately $149,000.
The increase during the fiscal 2010 period was due primarily to the management fee earned under the new management agreement entered with an unaffiliated medical group effective May 1, 2010. Under the agreement, Prospect currently manages approximately 11,000 HMO enrollees with monthly management fees ranging from 7.5% to 12.5% of revenues, depending on the type of revenues managed. The agreement is for an initial three-year period, with an automatic renewal provision and 90-day cancellation provision.
Other Operating Revenue
Other operating revenue for the three months ended June 30, 2010 was approximately $284,000, representing a decrease of approximately $46,000 or 14.0% over other revenue for the three months ended June 30, 2009, of approximately $330,000.
Amounts represent incentive payments from HMOs under pay-for-performance programs for quality medical care based on various criteria. The incentives are recorded when such amounts are known. The decrease in other revenue during the fiscal 2010 period was primarily the result of timing of receipt of pay-for-performance monies.
PCP Capitation Expense
Primary care physician (PCP) capitation expense for the three months ended June 30, 2010 was approximately $8,087,000, representing a decrease of $248,000 or 3.0% over PCP capitation expense for the three months ended June 30, 2009, of approximately $8,335,000.
The decrease during the fiscal 2010 period was primarily due to decreased enrollment, partly offset by market rate adjustments made as part of our effort to attract new physicians and their members.
Specialist Capitation Expense
Specialist Capitation expense for the three months ended June 30, 2010 was approximately $10,189,000, representing a decrease of $751,000 or 6.9% from specialist capitation expense for the three months ended June 30, 2009, of approximately $10,940,000.
The decrease during the fiscal 2010 period was due to a combination of decreased enrollment and moving more of certain specialties to a fee-for-service basis in the current year period, which move was considered more beneficial to the Company.
Claims Expense
Claims expense for the three months ended June 30, 2010 was approximately $18,180,000, representing an increase of $1,041,000 or 6.1% over claims expense for the three months ended June 30, 2009, of approximately $17,139,000. The increase was due primarily to moving more of certain specialties to a fee-for-service basis in the current fiscal period, which move was considered more beneficial to the Company.
Physician Salaries Expense
Physician salaries expense for the three months ended June 30, 2010 was approximately $795,000, representing an increase of $190,000 or 31.4% over physician salaries expense for the three months ended June 30, 2009, of approximately $605,000.
The increase was primarily as a result of changing our hospitals compensation structure from employees to contracted providers, which was considered preferable for the Company.
Other Cost of Revenues
Other cost of revenues for the three months ended June 30, 2010 was approximately $171,000, compared to a net recovery expense of approximately $51,000 for the three months ended June 30, 2009.
The change was primarily due to a decrease in stop-loss incurrence recoveries.
Medical Cost Ratio
Medical care costs as a percentage of medical revenues (the medical cost ratio, a non-GAAP measure) largely determine our gross margin. Our gross margin decreased to 21.0% for the three months ended June 30, 2010, from 22.7% for the three months ended June 30, 2009.
The decrease in our gross margin percentage between the fiscal 2010 and 2009 periods was primarily due to changes in the level of receipts for stop-loss insurance recoveries, increased claims expense, and certain market rate adjustments given to our contracted physicians as discussed above.
General and Administrative
G&A were approximately $6,315,000 for the three months ended June 30, 2010, representing 13.3% of total Medical Group revenues, as compared with approximately $7,286,000 or 15.2% of total Medical Group revenues, for the fiscal 2009 period.
The decrease during the fiscal 2010 period was primarily due to the elimination of certain personnel, facility and outside service costs, in connection with the consolidation of certain administrative functions among our Medical Groups and decreased legal costs.
Depreciation and Amortization
Depreciation and amortization expense for the three months ended June 30, 2010 decreased to approximately $820,000 from $889,000 for the same period of the prior year, primarily due to retirement of certain office equipment.
Income from Unconsolidated Joint Venture
The income from unconsolidated joint venture for the three months ended June 30, 2010 was $482,000 compared to $535,000 for the same period of the prior year, which decrease was primarily due to increased claims costs for OneCare members.
Operating Income
Our Medical Group segment reported operating income of approximately $3,292,000 and $3,240,000, for the three months ended June 30, 2010 and 2009, respectively, as a result of the changes discussed above. The operating results of the Medical Group segment include certain corporate expense allocations for insurance, professional fees, and amortization of identifiable intangibles that relate to this segment.
Nine Months Ended June 30, 2010 Compared to Nine Months Ended June 30, 2009
Capitation Revenue
Capitation revenue for the nine months ended June 30, 2010 was approximately $139,172,000 representing a decrease of approximately $3,833,000 or 2.7% from capitation revenue for the nine months ended June 30, 2009, of approximately $143,005,000.
The decrease in the fiscal 2010 period was due primarily to a decrease in commercial enrollment given current unemployment levels, partly offset by commercial and senior rate increases and increased senior enrollment.
Management Fee Revenue
Management fee revenue for the nine months ended June 30, 2010 was approximately $604,000 representing an increase of approximately $167,000 or 38.2% from management fee revenue for the nine months ended June 30, 2009, of approximately $437,000.
The increase during the fiscal 2010 period was due primarily to the management fee earned under the new management agreement entered with an unaffiliated medical group effective May 1, 2010, and partly to an increase in management fee percentage with OneCare. Under the agreement, Prospect currently manages approximately 11,000 HMO enrollees with monthly management fees ranging from 7.5% to 12.5% of revenues depending on the type of revenues managed. The agreement is for an initial three-year period, with automatic renewal provision and 90-day cancellation provision.
Other Operating Revenue
Other operating revenue for the nine months ended June 30, 2010 was approximately $399,000, representing a decrease of approximately $297,000 or 42.7% over other revenue for the nine months ended June 30, 2009, of approximately $696,000.
Amounts represent incentive payments from HMOs under pay-per-performance programs for quality medical care based on various criteria. The incentives are recorded when such amounts are known.
PCP Capitation Expense
Primary care physician (PCP) capitation expense for the nine months ended June 30, 2010 was approximately $24,679,000, representing a decrease of $791,000 or 3.1% over PCP capitation expense for the nine months ended June 30, 2009, of approximately $25,470,000.
The decrease during the fiscal 2010 period was primarily due to decreased enrollment, partly offset by market rate adjustments made as part of our effort to attract new physicians and their members.
Specialist Capitation Expense
Specialist Capitation expense for the nine months ended June 30, 2010 was approximately $30,823,000, representing a decrease of $2,263,000 or 6.8% from specialist capitation expense for the nine months ended June 30, 2009, of approximately $33,086,000.
The decrease during the fiscal 2010 period was due to a combination of decreased enrollment and moving more of certain specialties to a fee-for-service basis in the current year period, which move was considered more beneficial to the Company.
Claims Expense
Claims expense for the nine months ended June 30, 2010 was approximately $53,693,000, representing an increase of $1,392,000 or 2.7% over claims expense for the nine months ended June 30, 2009, of approximately $52,301,000. The increase was due primarily to moving more of certain specialties to a fee-for-service basis in the current fiscal period, which move was considered more beneficial to the Company.
Physician Salaries Expense
Physician salaries expense for the nine months ended June 30, 2010 was approximately $1,787,000, representing an increase of $117,000 or 7.0% over physician salaries expense for the nine months ended June 30, 2009, of approximately $1,670,000.
The increase was primarily as a result of changing our hospitals compensation structure from employees to contracted providers, which was considered preferable for the Company.
Other Cost of Revenues
Other cost of revenues for the nine months ended June 30, 2010 was approximately $148,000, compared to a net recovery of approximately $992,000 for the nine months ended June 30, 2009.
The change was primarily due to unusually high stop-loss insurance recoveries, resulting in a contra expense in the prior year period.
Medical Cost Ratio
Medical care costs as a percentage of medical revenues (the medical cost ratio, a non-GAAP measure) largely determine our gross margin. Our gross margin decreased to 20.7% for the nine months ended June 30, 2010, from 22.6% for the nine months ended June 30, 2009.
The decrease in our gross margin percentage between the fiscal 2010 and 2009 periods was primarily due to changes in the level of stop-loss insurance recoveries, increased claims expense, and certain market rate adjustments given to our contracted physicians, as discussed above.
General and Administrative
G&A were approximately $19,454,000 for the nine months ended June 30, 2010, representing 13.9% of total Medical Group revenues, as compared with approximately $21,961,000 or 15.2% of total Medical Group revenues, for the fiscal 2009 period.
The decrease in G&A expenses during the fiscal 2010 period was primarily due to the elimination of certain personnel, facility and outside service costs, in connection with the consolidation of certain administrative functions among our Medical Groups.
Depreciation and Amortization
Depreciation and amortization expense for the nine months ended June 30, 2010 decreased to approximately $2,547,000 from $2,644,000 for the same period of the prior year, primarily due to retirement of certain office equipment.
Income from Unconsolidated Joint Venture
The income from unconsolidated joint venture for the nine months ended June 30, 2010 increased to $1,514,000 from $1,482,000 for the same period of the prior year. The increase was primarily due to increased risk pool income in the fiscal 2010 period.
Operating Income
Our Medical Group segment reported operating income of approximately $8,558,000 and $9,480,000, for the nine months ended June 30, 2010 and 2009, respectively, as a result of the changes discussed above. The operating results of the Medical Group segment include certain corporate expense allocations for insurance, professional fees, and amortization of identifiable intangibles that relate to this segment.
Corporate Segment
Certain expenses incurred at the Parent Entity not specifically allocable to the Hospital Services or Medical Group segments are recorded in the Corporate segment. These expenses include salaries (including stock-based compensation), benefits, financing, rent, supplies, legal, SEC compliance, and Sarbanes-Oxley compliance. We do not allocate interest expense, gain or loss on interest rate swaps and income taxes to the other reporting segments.
The following table summarizes our corporate expense for the Parent Entity, and is used in the discussion below (in thousands, unaudited):
|
|
Three Months Ended |
|
Nine Months Ended |
|
||||||||||||||||||
|
|
June 30, |
|
June 30, |
|
||||||||||||||||||
|
|
2010 |
|
2009 |
|
Increase |
|
% |
|
2010 |
|
2009 |
|
Increase |
|
% |
|
||||||
Operating Expenses: |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
||||||
General and administrative |
|
$ |
3,275 |
|
$ |
3,859 |
|
$ |
(584 |
) |
-15.1 |
% |
$ |
9,466 |
|
$ |
8,731 |
|
$ |
735 |
|
8.4 |
% |
Depreciation and amortization |
|
3 |
|
3 |
|
|
|
0.0 |
% |
10 |
|
9 |
|
1 |
|
11.0 |
% |
||||||
Total Operating Expenses |
|
3,278 |
|
3,862 |
|
(584 |
) |
-15.1 |
% |
9,476 |
|
8,740 |
|
736 |
|
8.4 |
% |
||||||
Other (Income) Expense: |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
||||||
Interest expense and amortization of deferred financing costs, net |
|
5,565 |
|
7,562 |
|
(1,997 |
) |
-26.4 |
% |
16,825 |
|
20,147 |
|
(3,322 |
) |
-16.5 |
% |
||||||
(Gain) loss in value of interest rate swap arrangements |
|
|
|
(3,694 |
) |
3,694 |
|
100.0 |
% |
|
|
5,019 |
|
(5,019 |
) |
-100.0 |
% |
||||||
Total Other Expense, net |
|
5,565 |
|
3,868 |
|
1,697 |
|
43.8 |
% |
16,825 |
|
25,166 |
|
(8,341 |
) |
-33.1 |
% |
||||||
Total Corporate Expenses |
|
$ |
8,843 |
|
$ |
7,730 |
|
$ |
1,113 |
|
14.4 |
% |
$ |
26,301 |
|
$ |
33,906 |
|
$ |
(7,605 |
) |
-22.4 |
% |
The following table sets forth selected operating items, expressed as a percentage of total consolidated revenues:
|
|
Three Months Ended |
|
Nine Months Ended |
|
||||
|
|
June 30, |
|
June 30, |
|
||||
|
|
2010 |
|
2009 |
|
2010 |
|
2009 |
|
Operating Expenses: |
|
|
|
|
|
|
|
|
|
General and administrative |
|
2.8 |
% |
3.3 |
% |
2.7 |
% |
3.1 |
% |
Depreciation and amortization |
|
0.0 |
% |
0.0 |
% |
0.0 |
% |
0.0 |
% |
Total Operating Expenses |
|
2.8 |
% |
3.3 |
% |
2.7 |
% |
3.1 |
% |
Other (Income) Expense: |
|
|
|
|
|
|
|
|
|
Interest expense and amortization of deferred financing costs, net |
|
4.8 |
% |
6.5 |
% |
4.8 |
% |
7.0 |
% |
(Gain) loss in value of interest rate swap arrangements |
|
0.0 |
% |
-3.2 |
% |
0.0 |
% |
1.8 |
% |
Total Other Expense, net |
|
4.8 |
% |
3.3 |
% |
4.8 |
% |
8.8 |
% |
Total Corporate Expenses |
|
7.6 |
% |
6.6 |
% |
7.5 |
% |
11.9 |
% |
Three Months Ended June 30, 2010 Compared to Three Months Ended June 30, 2009
General and Administrative
G&A expense for the three months ended June 30, 2010 was approximately $3,275,000, representing approximately 2.8% of total consolidated revenues, compared to approximately $3,859,000 or approximately 3.3% of total consolidated revenues, for the three months ended June 30, 2009. The change in G&A expenses during the fiscal 2010 period was due primarily to decreased accruals for annual incentive compensation, offset by increased administrative payroll and legal costs.
Interest Expense and Amortization of Deferred Financing Costs, net
Interest expense and amortization of deferred financing costs, net for the three months ended June 30, 2010 was approximately $5,565,000, compared to approximately $7,562,000 for the three months ended June 30, 2009, a decrease of approximately 26.4%.
Following our refinance on July 29, 2009, (see Note 7 to the unaudited condensed consolidated financial statements), the effective interest rate on our debt facilities was reduced, resulting in the decrease in quarterly interest expense.
Gain in Value of Interest Rate Swap Arrangements
We had two interest rate swaps in place in connection with our prior debt financing. These swaps did not qualify for hedge accounting during the fiscal 2009 period and as such, all changes in fair value of those swaps were treated as an expense.
Concurrent with the Senior Secured Note transaction on July 29, 2009, we terminated the interest rate swap arrangements and expensed all previously unamortized swap fluctuation amounts. Accordingly, there were no interest rate swaps in existence or related expense during the quarter ended June 30, 2010.
Nine Months Ended June 30, 2010 Compared to Nine Months Ended June 30, 2009
General and Administrative
G&A expense for the nine months ended June 30, 2010 was approximately $9,466,000, representing 2.7% of total consolidated revenues, compared to approximately $8,731,000 or 3.1% of total consolidated revenues, for the nine months ended June 30, 2009. The fluctuation in G&A expense percentage during the fiscal 2010 period was due primarily to decreased accruals for annual incentive compensation and legal costs, offset by increased administrative payroll costs and accruals for annual incentive stock-based compensation.
Interest Expense and Amortization of Deferred Financing Costs, net
Interest expense and amortization of deferred financing costs, net for the nine months ended June 30, 2010 was approximately $16,825,000, compared to approximately $20,147,000 for the nine months ended June 30, 2009, a decrease of approximately 16.5%.
Following our refinance on July 29, 2009, (see Note 7 to the unaudited condensed consolidated financial statements), the effective interest rate on our debt facilities was reduced, resulting in the decrease in quarterly interest expense.
Loss in Value of Interest Rate Swap Arrangements
We had two interest rate swaps in place in connection with our prior debt financing. These swaps did not qualify for hedge accounting during the fiscal 2009 period and as such, all changes in fair value of those swaps were treated as an expense.
Concurrent with the Senior Secured Note transaction on July 29, 2009, we terminated the interest rate swap arrangements and expensed all previously unamortized swap fluctuation amounts. Accordingly, there were no interest rate swaps in existence or related expense during the fiscal 2010 period.
Consolidated Results of Operations
Three Months Ended June 30, 2010 Compared to Three Months Ended June 30, 2009
Provision for Income Taxes
Income tax provision for the three months ended June 30, 2010 was approximately $2,791,000 compared to $1,989,000 in the three months ended June 30, 2009 with the fluctuation as a result of the change in income before taxes. The effective tax rate was 56% for the three months ended June 30, 2010 compared to 114% for the three months ended June 30, 2009. The higher effective tax rate in the fiscal 2009 period was primarily due to the consolidated group not being able to recognize the tax benefit from Brotmans loss for Federal tax purposes.
Net Loss Attributable to Noncontrolling Interest
Net loss attributable to noncontrolling interests, net of tax for the three months ended June 30, 2010 was approximately $640,000, as compared to none for the three months ended June 30, 2009. The decrease was due to consolidation of Brotman in the current year period. As discussed in Note 8 to the accompanying condensed consolidated financial statements, prior to October 1, 2009, a pro rata share of net income (loss) attributable to minority interest in Brotman was not included under minority interest in the Companys consolidated statement of operations, as the cumulative minority share of such income did not exceed their cumulative share of prior losses absorbed by the Company.
Net Income (Loss) Attributable to Prospect Medical Holdings, Inc.
Net income (loss) attributable to Prospect Medical Holdings, Inc.s common shareholders for the three months ended June 30, 2010 was approximately $2,847,000 or $0.12 per diluted share, as compared to net loss of approximately $238,000 or $0.01 per diluted share, for the three months ended June 30, 2009, which change was the result of the items discussed above.
Nine Months Ended June 30, 2010 Compared to Nine Months Ended June 30, 2009
Provision for Income Taxes
Income tax provision for the nine months ended June 30, 2010 was approximately $7,239,000, compared to $2,065,000 for the nine months ended June 30, 2009, with the change being due to the change in income before taxes. The effective tax rate was lower at 50% for the nine months ended June 30, 2010 compared to 107% for the nine months ended June 30, 2009. The higher effective tax rate in the fiscal 2009 period was primarily due to the consolidated group not being able to recognize the tax benefit from Brotmans loss for Federal tax purposes.
Net Loss Attributable to Noncontrolling Interest
Net loss, net of tax attributable to noncontrolling interests for the nine months ended June 30, 2010 was approximately $1,123,000, as compared to net income of $5,000 for the nine months ended June 30, 2009. The change was due to consolidation of Brotman in the current year period. As discussed in Note 8 to the accompanying condensed consolidated financial statements, prior to October 1, 2009, a pro rata share of net income (loss) attributable to minority interest in Brotman was not included under minority interest in the Companys consolidated statement of operations, as the cumulative minority share of such income did not exceed their cumulative share of prior losses absorbed by the Company.
Net Income (Loss) Attributable to Prospect Medical Holdings, Inc.
Net income (loss) attributable to Prospect Medical Holdings, Inc.s common shareholders for the nine months ended June 30, 2010 was approximately $8,295,000 or $0.37 per diluted share, as compared to a net loss of approximately $134,000 or $0.01 per diluted share, for the nine months ended June 30, 2009. This change was the result of the items discussed above.
Liquidity and Capital Resources
Our primary sources of cash have been funds provided by borrowings under our credit facilities, by the issuance of equity securities and by cash flow from operations. Prior to the August 8, 2007 acquisition of Alta, our primary sources of cash from operations were healthcare capitation revenues, fee-for-service revenues, risk pool payments and pay-for-performance incentives earned by our affiliated physician organizations. With the Alta acquisition and subsequently, Brotman, our sources of cash from operations now include payments for Hospital Services rendered under reimbursement arrangements with third party payers, which include the Federal government under the Medicare program, the State government under the Medi-Cal program, private insurers, HMOs, PPOs, and self-pay patients.
Our primary uses of cash include healthcare capitation and claims payments by our Medical Groups, administrative expenses, debt service, acquisitions, costs associated with the integration of acquired businesses, information systems and, with the acquisition of Alta and subsequently, Brotman, operating, capital improvement and administrative expenses related to our hospital operations. Our Medical Groups generally receive capitation revenue prior to processing provider capitation and claims payments. However, our hospitals receive payments for services rendered generally 30 to 90 days after the medical care is rendered. For some payors , the time lag between service and reimbursement can exceed one year.
Our investment strategies are designed to provide safety and preservation of capital, sufficient liquidity to meet the cash flow needs of our business operations and attainment of a competitive return. As of June 30, 2010, we invested our cash in interest bearing money market accounts, interest-bearing certificates of deposit and non interest-bearing checking accounts. All of these amounts are classified as current assets and included in cash and cash equivalents in our condensed consolidated balance sheets.
Cash Flow from Operations
Net cash provided by operating activities was approximately $15,062,000 for the nine months ended June 30, 2010 compared to net cash provided by operating activities of approximately $12,038,000 for the nine months ended June 30, 2009. Key positive and negative factors contributing to the change between the 2010 and 2009 periods include the following:
· Increased income from operations before income taxes of $7,854,000, excluding interest expense, income taxes, depreciation and amortization, and loss from on interest rate swap arrangements in the nine months ended June 30, 2010 compared to the nine months ended June 30, 2009;
· Lower interest payments of $7,136,000 for the nine months ended June 30, 2010 compared to the nine months ended June 30, 2009, primarily due to lower effective interest rate on Prospects new debt facilities (see Note 7 to the unaudited condensed consolidated financial statements) and the consolidation of Brotman for only part of the fiscal 2009 period;
· Lower income tax refunds of $1,976,000 received in the nine months ended June 30, 2010, compared to the nine months ended June 30, 2009; and
· Higher Medi-Cal DSH receipts for approximately $15,757,000 in the nine months ended June 30, 2010 compared to $11,675,000 in the nine months ended June 30, 2009.
Net cash used in investing activities was approximately $2,237,000 for the nine months ended June 30, 2010, compared to a use of approximately $3,139,000 for the nine months ended June 30, 2009. During the nine months ended June 30, 2010 we spent $2,268,000 for capital expenditures for replacement equipment and general improvements, primarily at our Alta facilities. During the nine months ended June 30, 2009, we invested approximately $2,310,000 in connection with the Brotman acquisition; and approximately $764,000 of capital expenditures for equipment, renovations and upgrades of existing facilities.
Net cash provided by financing activities was approximately $348,000 for the nine months ended June 30, 2010, as compared to a use of approximately $10,895,000 for the nine months ended June 30, 2009. During the first nine months of 2010, net cash provided by financing activities reflect the net proceeds from Brotmans revolving line of credit and cash proceeds from exercises of stock options and warrants, offset by increased deposits into restricted cash as required by Brotmans JHA financing, principal repayments on Brotmans Creditors Trust Note and repayment of capital lease obligations. During the first nine months of 2009, we spent approximately $8,904,000 on repayments of our former term debt, approximately $1,671,000 on net repayment of Brotmans revolving line of credit, approximately $972,000 of financing costs in connection with the issuance of Prospects senior secured notes and approximately $395,000 on principal repayments of capital lease obligations.
As of June 30, 2010, we had working capital of approximately $8,594,000 as compared to working capital of approximately $9,903,000 at September 30, 2009, with the current year decrease being primarily the result of classifying Brotmans Term A JHA Loan as current at June 30, 2010.
As of June 30, 2010 and September 30, 2009, cash, cash equivalents and investments (including restricted amounts) totaled approximately $54,368,000 and $39,828,000, respectively.
Prospect Note Offering
On July 29, 2009, the Company closed the offering of $160 million in 12.75% senior secured notes due 2014 (the Notes) at an issue price of 92.335%. The sale was executed in accordance with Rule 144A under the Securities Act of 1933 and Regulation S under the Securities Act of 1933. Also, in connection with the issuance of the Notes, the Company entered into a three year $15 million revolving credit facility, which was undrawn at closing. The interest rate under the revolving credit facility will be at LIBOR plus an applicable margin of 7.00%, with a LIBOR floor of 2.00%. The Company used the net proceeds from the sale of the Notes to repay all amounts outstanding under the Former Credit Facility, plus a prepayment premium of approximately $2.6 million.
Brotman Financing
As part of Brotmans emergence from bankruptcy on April 14, 2009, financing was secured from the Los Angeles Jewish Home for the Aging (JHA) and Gemino Healthcare Finance, LLC (Gemino).
The JHA financing was comprised of two term debt components, a $16.0 million tranche secured by assets on the west side of the Brotman campus commonly referred to as Delmas West and a $6.25 million tranche on the main hospital pavilion on the east side of the property. The $16.0 million tranche contains an option for JHA to acquire the Delmas West parcel for a purchase price equal to the outstanding debt within 24 months of the effective date of the bankruptcy. If JHA does not exercise its option, Brotman will be required to refinance the $16.0 million tranche on or before April 14, 2011. With respect to the $16.0 million tranche of the JHA facility, JHA also has the right to declare the unpaid loan amount, immediately due and payable at any time after April 14, 2010 and prior to April 14, 2011, provided that JHA gives 180 days written notice of exercise. Effective February 10, 2010, JHA and Brotman entered into an amendment to the Term A loan, whereby the earliest date on which JHA could provide notice of its exercise of the Put Right was extended from April 14, 2010 to October 14, 2010, effectively extending the earliest maturity date for the Term A Loan to April 14, 2011. Brotman and JHA are currently negotiating a comprehensive amendment to, and extension of, the Term A Loan, pending completion of which amounts owing under this loan have been reflected as current in the Companys June 30, 2010 unaudited condensed consolidated balance sheet. In addition, the $6.25 million tranche of the JHA transaction will mature on April 14, 2012 and Brotman will need to secure financing to retire this portion of the debt.
The Gemino financing was comprised of a $6.0 million (which was increased to $7.0 million pursuant to an amendment described below), senior credit facility secured by accounts receivable. The facility expires on the earlier of April 14, 2012 and the JHA loan (see above) maturity date and bears interest at LIBOR plus 7% per annum, with a LIBOR floor of 4%. Interest is incurred based on the greater of $2 million or the outstanding principal balance. The agreement also includes an unused line fee of 0.5% per annum and a collateral line fee, based on the average outstanding principal balance, of 0.5% per annum. The senior credit facility agreement contains customary covenants for facilities of this type, including restrictions on the payment of dividends, change in ownership/management, asset sales, incurrence of additional indebtedness, sale-leaseback transactions, and related party transactions. Brotman must also comply with financial covenants. Prior to a recent amendment discussed below, Brotman was required to comply with a fixed charge coverage ratio of not less than (i) 1.10:1.00 for the fiscal quarter ending June 30, 2009, (ii) 1.15:1.00 for the fiscal quarter ending September 30, 2009; and (iii) 1.20:1.00 for each fiscal quarter ending thereafter. As of September 30, 2009, Brotman was not in compliance with the required financial covenants under the Gemino credit agreement. Pursuant to an amendment entered into effective December 11, 2009, the Gemino credit agreement was amended to provide, among other things, a waiver of the specified events of default and the amendment to the definition of fixed charge coverage ratio. Under the amended credit agreement, the fixed charge coverage ratio was amended to require not less than (i) 1.00:1.00 for the fiscal quarters ended December 31, 2009 and March 31, 2010; (ii) 1.05:1.00 for the fiscal quarters ended June 30, 2010 and ending September 30, 2010; (iii) 1.10:1.00 for the fiscal quarters ending December 31, 2010 and March 31, 2011; and (iv) 1.20:1.00 for the fiscal quarter ending June 30, 2011 and each fiscal quarter ending thereafter. As of June 30, 2010, Brotman was in compliance with the required financial covenants under the amended credit agreement. Pursuant to an amendment entered into effective February 17, 2010, the Gemino credit agreement and promissory note were amended to increase the loan commitment by $1.0 million to a total commitment of $7.0 million as set forth above.
The Class 4 Note, which was executed on April 14, 2009, the Effective Date of Brotmans Plan of Reorganization, for the benefit of the allowed Class 4 claims (as defined in the Plan of Reorganization) bears interest at 7.50% per annum and is payable in sixteen equal quarterly installments of principal and accrued interest through February 15, 2013. The Note contains a covenant which, so long as amounts remain outstanding under the Note, restricts Brotman from paying Prospect in cash a consulting fee of more than $100,000 per month, as specified in the Amended and Restated Consulting Services Agreement (see Note 6 to the accompanying unaudited condensed consolidated financial statements). As such, although the amount of the consulting fee was increased to 4.5% of Brotmans net operating revenue retroactive to April 14, 2009, the amount of such consulting fee actually paid in cash will not exceed $100,000 per month until such time permitted by applicable agreement or the Creditor Trust Note has been amended or repaid. For the period April 14, 2009 through June 30, 2010, total principal repayments on the Class 4 Note were approximately $1.3 million.
We anticipate attempting to finance future acquisitions and potential business expansion with a combination of debt, issuances of equity instrument and cash flow from operations.
In order to meet our long-term liquidity needs, we may incur, from time to time, additional bank indebtedness. Banks and traditional commercial lenders do not generally make loans to companies without substantial tangible net worth. Since, by the nature of our business, we accumulate substantial goodwill and intangibles on our balance sheet, it may be difficult for us to obtain this type of financing in the future. We may issue additional equity and debt securities, the availability and terms of which will depend upon market and other conditions. The corporate lending and equity markets have been affected by the current credit market conditions, resulting in both a reduction in the number of transactions as well as the amount of funds raised. Transactions that have been consummated are completed at lower valuations in the case of equity offerings and at higher interest costs in the case of debt offerings. Our ability to issue any debt or equity instruments in a public or private sale is also restricted under certain circumstances, pursuant to contractual restrictions in agreements with our lenders and the indenture governing the Notes (see above). There can be no assurance that additional financing will be available upon terms acceptable to us, if at all. The failure to raise the funds necessary to finance our future cash requirements could adversely affect our ability to pursue our strategy and could adversely affect our future results of operations.
Off-Balance Sheet Arrangements
None.
Critical Accounting Policies
The accounting policies described below are considered critical in preparing our unaudited condensed consolidated financial statements. Critical accounting policies require difficult, subjective or complex judgments, often as a result of the need to make estimates about the effect of matters that are inherently uncertain. The judgments and uncertainties affecting the application of these policies include significant estimates and assumptions made by us using information available at the time the estimates are made. Actual results could differ materially from those estimates.
Consolidation of Financial Statements
Under applicable financial reporting requirements, the financial statements of the Medical Groups with which we have management services agreements are consolidated with our own financial statements. As provided by the FASB issued interpretation guidance, the consolidation is required because we are deemed to hold a controlling financial interest in such organizations through a nominee shareholder. We can, through the assignable option agreements, change the nominee shareholder at will on an unlimited basis and for nominal cost. There is no limitation on our designation of a nominee shareholder except that any nominee shareholder must be a licensed physician or otherwise permitted by law to hold shares in a professional medical corporation. The operations of our affiliated physician organizations have a significant impact on our financial statements. The financial statements of Brotman have been included in our consolidated financial statements since April 14, 2009, when we acquired a majority stake in that entity. All intercompany accounts and balances have been eliminated in consolidation.
Revenue Recognition
Third Party and Patient Reimbursement
Operating revenue of the Hospital Services segment consists primarily of net patient service revenue. A summary of the payment arrangements with major third party payers follows:
Medicare: Medicare is a Federal program that provides certain hospital and medical insurance benefits to persons aged 65 and over, some disabled persons and persons with end-stage renal disease. Inpatient services rendered to Medicare program beneficiaries are paid at prospectively determined rates per discharge, according to a patient classification system based on clinical, diagnostic, and other factors. Outpatient services are paid based on a blend of prospectively determined rates and cost-reimbursed methodologies. We are also reimbursed for various disproportionate share and Medicare bad debt components at tentative rates, with final settlement determined after submission of annual Medicare cost reports and audits thereof by the Medicare fiscal intermediary.
Medi-Cal: Medi-Cal is a joint Federal-State funded healthcare benefit program that is administered by the State of California to provide benefits to qualifying individuals who are unable to afford care. Inpatient services rendered to Medi-Cal program beneficiaries are paid at contracted per diem rates. The per diem rates are not subject to retrospective adjustment. Outpatient services are paid based on prospectively determined rates per procedure provided.
Managed care: We also receive payment from certain commercial insurance carriers, HMOs and PPOs. The basis for payment is in accordance with negotiated contracted rates or at our standard charges for services provided where no prior contract is in place.
Self-Pay: Self-pay patients represent those patients who do not have health insurance and are not covered by some other form of third party arrangement. Such patients are evaluated, at the time of service or shortly thereafter, for their ability to pay based upon Federal and State poverty guidelines, qualifications for Medi-Cal, as well as our local hospitals indigent and charity care policy.
We recognize revenues in the period in which services are provided. Accounts receivable primarily consist of amounts due from third party payers and patients. Amounts we receive for treatment of patients covered by governmental programs, such as Medicare and Medi-Cal, and other third party payers such as HMOs, PPOs and other private insurers, are generally less than our established billing rates. Accordingly, our gross revenues and accounts receivable are reduced to net realizable value through an allowance for contractual discounts.
For Medicare and Medi-Cal programs, provisions for contractual adjustments are made to reduce patient charges to the estimated cash receipts based on each programs principles of payment/reimbursement (i.e., either prospectively determined or retrospectively determined costs). Under the Medi-Cal programs prospective reimbursement systems, there is no adjustment or settlement of the difference between the actual cost to provide the service and the predetermined reimbursement rates. Certain types of payments by the Medicare program (e.g. Medicare Disproportionate Share Hospital and Medicare Allowable Bad Debts) are subject to retroactive adjustment in future periods. Final settlements under these programs are subject to adjustment based on administrative review and audit by third party intermediaries, which can take several years to resolve completely. Adjustments related to final settlements for 2005 through 2008 cost report years increased our revenues by approximately $517,000 and $1,087,000 in each of the three month and nine month period ended June 30, 2009, respectively; and adjustments related to final settlements for 2009 cost report year increased our revenues by $377,000, in each of the three month and nine month periods ended June 30, 2010.
Estimates for contractual allowances under managed care health plans are primarily based on the payment terms of contractual arrangements, such as predetermined rates per diagnosis, per diem rates or discounted fee for service rates.
We closely monitor our historical collection rates, as well as changes in applicable laws, rules and regulations and contract terms, to ensure that provisions are made using the most appropriate and current information available. However, due to the complexities involved in these estimations, actual payments from payers may be materially different from the amounts we estimate and record. If the actual contractual reimbursement percentage under government programs and managed care contracts differed by 1% from our estimated percentage, we project that our consolidated net hospital services revenue and net income would have changed by approximately $2.5 million and $1.4 million, respectively, for the three months ended June 30, 2010 and by approximately $7.8 million and $4.1 million, respectively, for the nine months ended June 30, 2010. The process of determining the allowance requires us to estimate the amount expected to be received based on payer contract provisions, historical collection data as well as other factors and requires a high degree of judgment. This process is impacted by changes in legislation, managed care contracts and other related factors. A significant increase in our estimate of contractual discounts for Medicare, Medi-Cal and managed care plans would significantly lower our earnings. This would adversely affect our results of operations, financial condition, liquidity and future access to capital.
Provision for Doubtful Accounts
Substantially all of our accounts receivable are related to providing healthcare services to our hospital patients. Collection of these accounts receivable is a primary source of cash and is critical to our operating performance. Our hospitals provide services to patients with healthcare coverage, as well as to those without healthcare coverage. Those patients with healthcare coverage are often responsible for a portion of their bill referred to as the co-payment or deductible. This portion of the bill is determined by the patients individual healthcare or insurance plan. Patients without healthcare coverage are evaluated at the time of service, or shortly thereafter, for their ability to pay based on Federal and State poverty guidelines, qualification for Medi-Cal, as well as our policies for indigent and charity care. We maintain a uniform policy whereby patient account balances are characterized as charity and indigent care only if the patient meets certain percentages of the Federal poverty level guidelines. Because we do not pursue collection of amounts determined to qualify as charity care, they are not reported in net revenues or in accounts receivable, net. We manage our provision for doubtful accounts using hospital-specific goals and benchmarks such as total cash collections, point-of-service cash collections, accounts receivable days outstanding (AR Days), and accounts receivable aging. Accounts receivable balances are reserved at increasing percentages as they age. We establish a partial reserve in the allowance for doubtful accounts for self-pay balances on the date of discharge. All hospital receivables are fully reserved if they have been outstanding for greater than 365 days from the date of discharge.
Statements are sent to self-pay patients indicating the outstanding balances on their accounts. If an account is still outstanding after a period of time, it is referred to third party collection agencies for assistance in collecting the amount due. Our policy is to write-off all self-pay accounts after all collection efforts have been exhausted. All accounts that have been placed with third party collection agencies are written off. Patient responsibility accounts represent the majority of our write-offs. Accounts that are identified as self-pay accounts with insignificant balances are automatically written off in accordance with our collection policy. Non self-pay accounts are reviewed monthly and written-off on a case-by-case basis.
The largest component of our allowance for doubtful accounts relates to self-pay accounts. These accounts include both amounts payable by uninsured patients and co-payments and deductibles payable by insured patients. In general, we attempt to collect deductibles, co-payments and self-pay accounts prior to the time of service for non-emergency care. If we do not collect the self-pay portion from the patient prior to the delivery of care, the accounts are handled through our billing and collections processes. We verify each patients insurance coverage as early as possible before a scheduled admission or procedure, including with respect to eligibility, benefits and authorization/pre-certification requirements, in order to notify patients of the amounts for which they will be responsible. We attempt to verify insurance coverage within a reasonable amount of time for all emergency room visits and urgent admissions in compliance with applicable laws.
The table below shows the net accounts receivable and allowance for doubtful accounts by payer (in thousands, unaudited):
|
|
June 30, 2010 |
|
September 30, 2009 |
|
||||||||||||||
|
|
Accounts |
|
Allowance |
|
Net |
|
Accounts |
|
Allowance |
|
Net |
|
||||||
Medicare |
|
$ |
15,389 |
|
$ |
1,548 |
|
$ |
13,841 |
|
$ |
9,919 |
|
$ |
1,064 |
|
$ |
8,855 |
|
Medi-Cal |
|
17,945 |
|
1,404 |
|
16,541 |
|
15,383 |
|
883 |
|
14,500 |
|
||||||
Managed care |
|
10,161 |
|
1,133 |
|
9,028 |
|
10,803 |
|
1,324 |
|
9,479 |
|
||||||
Self-pay |
|
16,911 |
|
13,812 |
|
3,099 |
|
11,391 |
|
8,183 |
|
3,208 |
|
||||||
Other |
|
422 |
|
322 |
|
100 |
|
1,025 |
|
261 |
|
764 |
|
||||||
Total |
|
$ |
60,828 |
|
$ |
18,219 |
|
$ |
42,609 |
|
$ |
48,521 |
|
$ |
11,715 |
|
$ |
36,806 |
|
When considering the adequacy of our allowances for doubtful accounts, accounts receivable balances are routinely reviewed in conjunction with healthcare industry trends/indicators, historical collection rates by payer and other business and economic conditions that might reasonably be expected to affect the collectability of the balance. We believe that our principal risk of collection continues to be uninsured patient accounts and patient accounts for which the primary insurance payer has paid but patient responsibility amounts (generally deductibles and co-payments) remain outstanding. If our actual collection rate changed by 1% from the estimated percentage that we used, we project that our allowance for doubtful accounts and consolidated net income would have changed by approximately $3.4 million and $1.8 million, respectively, in each of the three month and nine month periods ended June 30, 2010. The provision for doubtful accounts as a percentage of net patient revenues was 10.9% for the nine months ended June 30, 2010 compared to 9.4% for the nine months ended June 30, 2009. The increase was attributable primarily to the current year inclusion of Brotman, which historically has a higher percentage of self-pay patients. Excluding Brotman, the provision for doubtful accounts as a percentage of net patient revenues was 5.4% for the nine months ended June 30, 2010, compared to 5.5% for the nine months ended June 30, 2009, which decrease was due primarily to improved collection efforts.
Of the accounts receivable identified as due from third party payers at the time of billing, a small percentage may convert to self-pay upon denials from third party payers. Those accounts are closely monitored on a routine basis for potential denial and are reclassified to the proper payer group as appropriate.
Third party payer and self-pay balances, as a percent of total gross billed accounts receivable are summarized in the tables below:
|
|
June 30, 2010 |
|
September 30, 2009 |
|
||||||||||||||||
|
|
Medicare |
|
Medi-Cal |
|
Managed |
|
Self-Pay |
|
Total |
|
Medicare |
|
Medi-Cal |
|
Managed |
|
Self-Pay |
|
Total |
|
|
|
(Unaudited) |
|
|
|
|
|
|
|
|
|
|
|
||||||||
0 - 60 days |
|
80 |
% |
66 |
% |
56 |
% |
20 |
% |
65 |
% |
84 |
% |
77 |
% |
50 |
% |
25 |
% |
68 |
% |
61 - 120 days |
|
12 |
% |
19 |
% |
23 |
% |
21 |
% |
18 |
% |
9 |
% |
11 |
% |
22 |
% |
23 |
% |
14 |
% |
121 - 180 days |
|
5 |
% |
10 |
% |
15 |
% |
18 |
% |
10 |
% |
3 |
% |
7 |
% |
16 |
% |
28 |
% |
10 |
% |
Over 180 days |
|
3 |
% |
5 |
% |
6 |
% |
41 |
% |
7 |
% |
4 |
% |
5 |
% |
12 |
% |
24 |
% |
8 |
% |
Total |
|
100 |
% |
100 |
% |
100 |
% |
100 |
% |
100 |
% |
100 |
% |
100 |
% |
100 |
% |
100 |
% |
100 |
% |
The increase in over 180 days self-pay accounts receivable as a percentage of total net self-pay receivable is primarily attributable to the impact of current conditions on individuals ability to pay.
Our AR Days from Hospital Services operations were 56.6 days at June 30, 2010 compared to 51.6 days at September 30, 2009. AR Days at June 30, 2010 and September 30, 2009 are within our target range. AR Days are calculated as our accounts receivable from Hospital Services operations on the last date in the relevant quarter divided by our net patient revenues for the quarter ended on that date divided by the number of days in the quarter.
Although we believe that our existing allowance for doubtful accounts reserve policies for all payer classes are appropriate and responsive to both the current healthcare environment and the overall economic climate, we will continue to 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 payer classification, aged accounts receivable by payer, days revenue outstanding, and the impact of our recent acquisition of Brotman.
Medical Group Segment
Operating revenue of our Medical Groups consists primarily of capitation payments for medical services provided by our affiliated physician organizations under contracts with HMOs. Capitation revenue under HMO contracts is prepaid monthly to the affiliated physician organizations based on the number and type of enrollees assigned to physicians in our affiliated physician organizations.
Capitation revenue paid by HMOs is recognized in the month in which the affiliated physician organization is obligated to provide services. Capitation revenue may be subsequently adjusted to reflect changes in enrollment as a result of retroactive terminations or additions. Such retroactive terminations or additions have historically not had a material effect on capitation revenue.
Under the Risk Adjustment model, capitation for the current year is paid based on data submitted for each enrollee for previous periods. Capitation is paid at interim rates during the year and is adjusted in subsequent after the final data has been processed by CMS. Positive or negative capitation adjustments are made for Medicare enrollees with conditions requiring more or less healthcare services than assumed in the interim payments. Since we cannot reliably predict these adjustments, periodic changes in capitation amounts earned as a result of risk adjustment are recognized when those changes are communicated from the health plans, generally in the fourth quarter of the fiscal year to which the adjustments relate. We recorded approximately $4.3 million and $1.6 million in increased capitation revenue in the fourth quarter of fiscal 2009 and 2008, respectively, and approximately $1.7 million in each of the three month and nine month periods ended June 30, 2010 and none in each of the three month and nine month periods ended June 30, 2009 for risk adjustment factors.
We also earn additional incentive revenue or incur penalties under HMO contracts by sharing in the risk for hospital related expenses including inpatient services utilized. As of June 30, 2010, except for two contracts where we are contractually obligated for down-side risk, shared risk deficits are not payable unless and until we generate future risk-sharing surpluses. Risk pools are generally settled in the third or fourth quarter of the following calendar year. Due to the lack of access to timely information necessary to estimate the related costs, shared-risk amounts receivable from the HMOs are recorded when such amounts are known. We also receive incentives under pay-for-performance programs for quality medical care based on various criteria. Pay-for-performance payments are generally recorded in the third and fourth quarters of our fiscal year when such amounts are known, once we are in receipt of information necessary to reliably estimate these amounts. Risk pool and pay-for-performance incentives are affected by many factors, some of which are beyond our control, and may vary significantly from year to year.
Management fee revenue is earned in the month the services have been performed.
Accrued Medical Claims
Our affiliated physician organizations are responsible for the medical services their contracted or employed physicians provide to an assigned HMO enrollee. The cost of healthcare services is recognized in the period in which it is provided and includes an estimate of the cost of services which have been incurred but not reported. The determination of our claims liability and other healthcare costs payable is particularly important to the determination of our financial position and results of operations and requires the application of significant judgment by our Management, and as a result, is subject to an inherent degree of uncertainty.
Our medical care costs include actual historical claims experience and IBNR. We, together with our independent actuaries, estimate medical claims liabilities using actuarial methods based upon historical data, adjusted for payment patterns, cost trends, product mix, utilization of healthcare services and other relevant factors. The estimation methods and the resulting reserves are frequently reviewed and updated, and adjustments, if necessary, are reflected in the period they become known. While we believe our estimates are adequate and appropriate, it is possible that future events could require us to make significant adjustments or revisions to these estimates. In assessing the adequacy of accruals for medical claims liabilities, we consider our historical experience, the terms of existing contracts, our knowledge of trends in the industry, information provided by our customers and information available from other sources, as appropriate.
The most significant estimates involved in determining our claims liability concern the determination of claims payment completion factors and trended per member per month cost estimates.
We consider historical activity for the current month, plus the prior 24 months, in our IBNR calculation. For the fifth month of service prior to the reporting date and earlier, we estimate our outstanding claims liability based upon actual claims paid, adjusted for estimated completion factors. Completion factors seek to measure the cumulative percentage of claims expense that will have been paid for a given month of service as of a date subsequent to that month of service. Completion factors are based upon historical payment patterns. For the four months of service immediately prior to the reporting date, actual claims paid are not a reliable measure of our ultimate liability, given the delay inherent between the patient/physician encounter and the actual submission of a claim for payment. For these months of service we estimate our claims liability based upon trended per member per month (PMPM) cost estimates. These estimates reflect recent trends in payments and expense, utilization patterns, authorized services and other relevant factors.
The following unaudited tables reflect (i) the change in our estimate of claims liability as of June 30, 2010 that would have resulted had we changed our completion factors for all applicable months of service included in our IBNR calculation (i.e., the preceding 5th through 25th months) by the percentages indicated; and (ii) the change in our estimate of claims liability as of June 30, 2010 that would have resulted had we changed trended PMPM factors for all applicable months of service included in our IBNR calculation (i.e., the preceding 1st through 4th months) by the percentages indicated. Changes in estimate of the magnitude indicated in the ranges presented are considered reasonably likely.
Increase (Decrease) in |
|
Increase (Decrease) in |
|
|
|
|
(in thousands) |
|
|
(3 |
)% |
$ |
(4,322 |
) |
(2 |
)% |
$ |
(2,882 |
) |
(1 |
)% |
$ |
(1,441 |
) |
1 |
% |
$ |
1,441 |
|
2 |
% |
$ |
2,882 |
|
3 |
% |
$ |
4,322 |
|
Increase (Decrease) in |
|
Increase (Decrease) in |
|
|
|
|
(in thousands) |
|
|
(3 |
)% |
$ |
(770 |
) |
(2 |
)% |
$ |
(513 |
) |
(1 |
)% |
$ |
(257 |
) |
1 |
% |
$ |
257 |
|
2 |
% |
$ |
513 |
|
3 |
% |
$ |
770 |
|
The following table shows the components of the change in medical claims and benefits payable (in thousands, unaudited):
|
|
Nine Months Ended |
|
||||
|
|
June 30, |
|
||||
|
|
2010 |
|
2009 |
|
||
IBNR as of beginning of period |
|
$ |
16,824 |
|
$ |
20,480 |
|
Healthcare claims expense incurred during the period: |
|
|
|
|
|
||
Current year |
|
55,599 |
|
53,648 |
|
||
Prior years |
|
(1,906 |
) |
(1,347 |
) |
||
Total incurred |
|
53,693 |
|
52,301 |
|
||
Healthcare claims paid during the period: |
|
|
|
|
|
||
Current year |
|
(41,687 |
) |
(37,923 |
) |
||
Prior years |
|
(14,085 |
) |
(16,995 |
) |
||
Total paid |
|
(55,772 |
) |
(54,918 |
) |
||
IBNR as of end of period |
|
$ |
14,745 |
|
$ |
17,863 |
|
Through June 30, 2010, the $1,928,000 change in estimate related to IBNR as of September 30, 2009 represented approximately 11.3% of the IBNR balance as of September 30, 2009, approximately 2.7% of fiscal 2009 claims expense, and after consideration of tax effect, approximately 78.8% of net loss for the year then ended.
Through June 30, 2009, the $1,347,000 change in estimate related to IBNR as of September 30, 2008 represented approximately 6.5% of the IBNR balance as of September 30, 2008, approximately 2.3% of fiscal 2008 claims expense, and after consideration of tax effect, approximately 68.7% of net loss from continuing operations for the year then ended.
Past fluctuations in IBNR estimates might also be a useful indicator of the potential magnitude of future changes in these estimates. Quarterly IBNR estimates include provisions for adverse development based on historical volatility. We maintain similar provisions at fiscal year end.
We also regularly evaluate the need to establish premium deficiency reserves for the probability that anticipated future healthcare costs could exceed future capitation payments from the HMOs. To date, we have determined that no material premium deficiency reserves have been necessary.
Goodwill and Intangible Assets
The FASB issued guidance for business combination requires acquired intangible assets to be separately recognized upon meeting certain criteria. Such intangible assets include, but are not limited to, trade and service marks, non-compete agreements, customer lists and licenses.
The FASB issued guidance for goodwill and other intangible assets requires that goodwill and indefinite life intangible assets not be subject to amortization but be evaluated for impairment on at least an annual basis, or more frequently if certain indicators are present. Such indicators include adverse changes in market value and/or stock price, laws and regulations, profitability, cash flows, our ability to maintain enrollment and renew payer contracts on favorable terms. A two-step impairment test is used to identify potential goodwill impairment and to measure the amount of goodwill impairment loss to be recognized (if any). The first step consists of estimating the fair value of the reporting unit based on recognized valuation techniques, which include a weighted combination of (i) the guideline company method that utilizes revenue or earnings multiples for comparable publicly-traded companies, and (ii) a discounted cash flow model that utilizes future cash flows, the timing of those cash flows, and a discount rate (or weighted average cost of capital which considers the cost of equity and cost of debt financing expected by a representative market participant) representing the time value of money and the inherent risk and uncertainty of the future cash flows. If the estimated fair value of the reporting unit is less than its carrying value, a second step is performed to compute the amount of the impairment by determining the implied fair value of the goodwill, which is compared to its corresponding carrying value.
Long-lived assets, including property, improvements and equipment and amortizable intangibles, are evaluated for impairment whenever events or changes in circumstances indicate that the carrying value of such assets may not be recoverable. We consider assets to be impaired and write them down to fair value if estimated undiscounted cash flows associated with those assets are less than their carrying amounts.
We performed our annual goodwill impairment analysis for each reporting unit that constitutes a business for which discrete financial information is produced and reviewed by operating segment management and provides services that are distinct from the other reporting units. For the Hospital Services segment, the reporting unit for the annual goodwill impairment analysis was determined to be at the segment level. For the Medical Group segment, we have determined that ProMed individually and Prospect (which includes all the other affiliated physician organizations) each represent a reporting unit, based on operational characteristics. The ProMed Entities are geographically and managerially their own reporting unit.
Our impairment test at September 30, 2009 resulted in no impairment charges. In addition, no triggering events were identified that would cause impairment analysis as of June 30, 2010.
The assessment of impairment indicators, measurement of impairment loss, selection of appropriate valuation methodology, assumptions and discount factors, involve significant judgment and requires Management to project future results which are inherently uncertain.
Recent Accounting Pronouncements
Effective the first quarter of fiscal 2010, we adopted the revised accounting guidance for business combinations, which changed its previous accounting practices regarding business combinations. The more significant changes include an expanded definition of a business and a business combination; recognition of assets acquired, liabilities assumed and noncontrolling interests (including goodwill) measured at fair value at the acquisition date; recognition of acquisition-related expenses and restructuring costs separately from the business combination; recognition of assets acquired and liabilities assumed at their acquisition-date fair values with subsequent changes recognized in earnings. The guidance also amends and clarifies the application issues on initial recognition and measurement, subsequent measurement and accounting, and disclosure of assets and liabilities arising from contingencies in a business combination. The adoption did not have a material impact on our condensed consolidated financial statements for prior periods; but the pronouncement will impact the accounting for any acquisitions subsequent to that date.
Effective in the first quarter of fiscal year 2010, we adopted revised accounting guidance which requires noncontrolling interests (formerly referred to as minority interest) to be presented as a separate component from the Companys equity in the equity section of the consolidated balance sheets. As required by this guidance, we have adjusted the presentation of noncontrolling interests in the prior period unaudited condensed consolidated financial statements for comparability with the fiscal year 2010 period. The adoption of this accounting guidance had no impact on our results of operations and did not have a material impact on our financial position.
In January 2010, the Financial Accounting Standards Board (FASB) issued guidance to amend the disclosure requirements related to recurring and nonrecurring fair value measurements. The guidance requires new disclosures on the transfers of assets and liabilities between Level 1 (quoted prices in active market for identical assets or liabilities) and Level 2 (significant other observable inputs) of the fair value measurement hierarchy, including the reasons and the timing of the transfers. Additionally, the guidance requires a roll forward of activities on purchases, sales, issuance, and settlements of the assets and liabilities measured using significant unobservable inputs (Level 3 fair value measurements). Disclosures regarding transfers are required beginning January 1, 2010 and the Level 3 rollforward is to be disclosed in reporting periods beginning after December 15, 2010. Since we had no transfers between categories, the additional disclosures are not applicable to us for the periods presented.
On October 1, 2009, we adopted guidance on fair value measurement for nonfinancial assets and liabilities, except for items that are recognized or disclosed at fair value in the financial statements on a recurring basis (at least annually). Adoption of the new guidance did not have a material impact on our consolidated financial statements.
In June 2008, the FASB issued guidance for the accounting of share-based payment awards. Under the guidance, unvested share-based payment awards that contain non-forfeitable rights to dividends or dividend equivalents are deemed participating securities and, therefore, are included in computing earnings per share (EPS) pursuant to the two-class method. The two-class method determines earnings per share for each class of common stock and participating securities according to dividends or dividend equivalents and their respective participation rights in undistributed earnings. The Company adopted the guidance effective October 1, 2009. The adoption of this guidance did not impact our net income per common share for prior periods and is not expected to have an impact on future periods until such time as we declare a regular quarterly dividend.
In June 2009, the FASB issued revised guidance for the accounting of variable interest entities. This revised guidance replaces the quantitative-based risks and rewards approach with a qualitative approach that focuses on identifying which enterprise has the power to direct the activities of a variable interest entity that most significantly impact the entitys economic performance and has the obligation to absorb losses or the right to receive benefits from the entity that could be potentially significant to the variable interest entity. The accounting guidance also requires an ongoing reassessment of whether an enterprise is the primary beneficiary and requires additional disclosures about an enterprises involvement in variable interest entities. This accounting guidance is effective for us beginning in the first quarter of fiscal 2011. We are currently evaluating the impact that the adoption of this guidance will have on its consolidated financial statements.
In June 2009, the FASB issued revised guidance for the accounting of transfers of financial assets. This guidance eliminates the concept of a qualifying special-purpose entity, removes the scope exception for qualifying special-purpose entities when applying the accounting guidance related to the consolidation of variable interest entities, changes the requirements for derecognizing financial assets, and requires enhanced disclosure. This accounting guidance is effective for us beginning in the first quarter of fiscal 2011. We are currently evaluating the impact that the adoption of this guidance will have on its consolidated financial statements.
Legal and Other Loss Contingencies
We are subject to contingencies, such as legal proceedings and claims arising out of our business. We record accruals for such contingencies when it is probable that a liability will be incurred and the amount of loss can be reasonably estimated. A significant amount of Management estimation is required in determining when, or if, an accrual should be recorded for a contingent matter and the amount of such accrual, if any.
We are in the process of finalizing certain post-closing matters related to the 2007 ProMed acquisition, including closing balance sheet reconciliations, escrow reconciliations and other matters. We have recorded an estimated settlement amount relating to such matters in the accompanying unaudited condensed consolidated financial statements.
Acquisitions
Our business has grown through a series of business combinations. These business combinations were all accounted for using the purchase method of accounting, and accordingly, the operating results of each acquisition have been included in our consolidated financial statements since their effective date of acquisition. The purchase price for each business combination was allocated to the assets, including the identifiable intangible assets, and liabilities, based on estimated fair values determined using independent appraisals where appropriate. The excess of purchase price over the net tangible assets acquired was allocated to goodwill and other intangible assets.
We have historically funded our acquisition program with debt, the sale of our common stock, and cash flow from operations. The assets that we and our affiliated physician organizations have acquired have been largely goodwill and intangible assets. The acquisition of physician organizations consists primarily of HMO contracts, physician contracts and the right to manage each physician organization through a management services agreement. The physician organizations we acquire generally do not have significant tangible net equity; therefore, our acquired assets are predominantly goodwill and other intangible assets. The acquisition of hospital operations consists primarily of trade names, covenants-not-to-compete and property, improvements and equipment.
The following table summarizes all business combinations during the three years ended June 30, 2010:
Business Combinations |
|
Effective Date |
|
Purchase Price |
|
Location |
|
|
Alta |
|
August 8, 2007 |
|
$ |
154,935,000 |
|
Los Angeles County |
|
Brotman (increased investment to a 72% interest) |
|
April 14, 2009 |
|
$ |
2,556,000 |
|
Los Angeles County |
|
Divestitures
On August 1, 2008, we completed the sale of all of the outstanding stock of the AV Entities for total cash consideration of $8,000,000. As required by ASC 360-10-35, the assets and liabilities of the AV Entities and their operations have been presented in our recently filed Form 10-K as discontinued operations for all periods presented. All references to operating results reflect our ongoing operations, excluding the AV Entities, unless otherwise noted.
Inflation
According to U.S. Bureau of Labor Statistics Data, the national healthcare cost inflation rate has exceeded the general inflation rate for the last four years. We use various strategies to mitigate the negative effects of healthcare cost inflation. Specifically, we try to control physician and hospital costs through contracts with independent providers of healthcare services and close monitoring of cost trends, emphasizing preventive healthcare and appropriate use of specialty and hospital services.
While we currently believe our strategies to mitigate healthcare cost inflation will continue to be successful, competitive pressures, new healthcare and pharmaceutical product introductions, demands from healthcare providers and customers, applicable regulations or other factors may affect our ability to control healthcare costs.
Item 3. Quantitative and Qualitative Disclosures about Market Risk.
Not applicable
Item 4. Controls and Procedures
Evaluation of Disclosure Controls and Procedures
We carried out an evaluation as of June 30, 2010, under the supervision and with the participation of our Management, including our Chief Executive Officer and Chief Financial Officer, of the effectiveness of the design and operation of our disclosure controls and procedures as defined in Rule 13a-15(e) of the Securities Exchange Act of 1934. Based upon that evaluation and in light of the material weakness in the financial reporting process at Brotman Medical Center discussed below, the Chief Executive Officer and Chief Financial Officer concluded that our disclosure controls and procedures were ineffective as of that date in ensuring that information required to be disclosed in the reports that we file with, or submit to, the Securities and Exchange Commission (the SEC) under the Securities Exchange Act of 1934 is recorded, processed, summarized and reported within the time periods specified in the SECs rules and forms. In addition, based on that evaluation, the Chief Executive Officer and Chief Financial Officer concluded that our disclosure controls and procedures were ineffective as of June 30, 2010 in ensuring that information required to be disclosed by us in the reports that we file or submit under the Securities Exchange Act of 1934 is accumulated and communicated to our Management, including the Chief Executive Officer and Chief Financial Officer, as appropriate to allow timely decisions regarding required disclosures.
See below for discussion of material weaknesses in internal control over financial reporting at Brotman, which became a majority-owned subsidiary effective April 14, 2009.
Summary of Material Weaknesses in Internal Control over Financial Reporting:
As part of our preliminary assessment of internal control over financial reporting, we identified several deficiencies within the financial reporting process of Brotman. We believe the combination of these deficiencies creates an environment where there is a reasonable possibility that a material misstatement of Brotmans financial statements would not be detected in a timely manner. We have assessed a material weakness in the financial reporting process of Brotman and its related impact on the corporate consolidating financial reporting process. The deficiencies within the financial reporting process are the lack of a formalized month-end close process, limited staff training and financial accounting expertise and a lack of department accounting policies and procedures.
During the financial reporting close for the period ended September 30, 2009, Brotman was unable to implement a structured close process which resulted in multiple delays and iterations of their financial statements. Account reconciliations were not prepared in an accurate or timely manner which resulted in a significant amount of post-close adjustments. Brotmans accounting department did not demonstrate a sufficient amount of expertise or training to sufficiently complete the steps needed to execute an accurate or timely close. Additionally, Brotmans accounting department did not utilize or implement policies and procedures to organize or streamline the financial close process.
To address these deficiencies, we are in the process of implementing significant changes in the Brotman accounting department. We added additional resources and personnel with experience in understanding complexities of the business and the required financial reporting process. Additional control processes and oversight procedures have been implemented; however, a longer evaluation period is needed to reasonably validate that such processes and procedures are operating at a level to have fully remediated the material weakness as of June 30, 2010. At Brotman, we continue to expend significant efforts on financial reporting activities, integration of operations and expansion of our disclosure controls and procedures.
Remediation Steps to Address Material Weaknesses:
Based on findings of material weaknesses in our internal control over financial reporting, we have taken steps to strengthen our internal controls within the financial reporting process. We have added to the expertise and depth of personnel within the Brotman accounting department, including the appointment of a new Controller, with specific and significant expertise in the critical areas identified above. We also added additional resources to assist in the review and preparation of significant account balance reconciliations as well as the implementation of new policies and procedures. Senior Management has increased its scrutiny and oversight of Brotmans financial statements and has performed significant top-down financial statement analysis to gain additional assurance as to the accuracy of Brotmans financial information. As previously stated, we will continue to work on and improve the financial reporting process of Brotman and its impact on the corporate consolidating financial reporting process. In review, the principal measures that we are in the process of undertaking to remediate these deficiencies are as follows:
· Hired a new Controller and added additional resources to implement a sound financial reporting process;
· Enhanced Brotmans accounting and finance policies and implemented more robust monitoring control procedures and analytics to prevent and detect a potential misstatement on a timely basis;
· Developed a financial reporting responsibility matrix, close calendar and checklist for Brotman, whereby all general ledger accounts and financial statement line items are specifically assigned to a specific member of the accounting department to perform monthly, quarterly and year-end analysis. The analysis will be reviewed periodically by senior members of the accounting department team for accuracy and integrity;
· Developed a formal monthly, quarterly and annual reporting package, including specific reporting and information for identified key risk areas, with formal sign off by the financial executive with specific oversight for each area;
· Documented formal accounting policies and procedures with regular compliance reviews of key risk areas to evaluate the designing and effectiveness of controls; and
· Enhanced the corporate financial reporting process oversight of the above mentioned controls and processes.
Changes in Internal Control over Financial Reporting
Except as discussed above, regarding Brotman, there have been no changes in our Internal Control that occurred during the three months ended June 30, 2010 that have materially affected, or are reasonably likely to materially affect, our internal control over financial reporting.
We and our affiliated physician organizations are parties to legal actions arising in the ordinary course of business. We believe that liability, if any, under these claims will not have a material adverse effect on our consolidated financial position or results of operations.
Our business is subject to a number of risks, including those set forth below or previously disclosed in the Companys Annual Report on Form 10-K filed with the SEC on December 21, 2009.
Our proposed merger may cause disruption in our business and, if the merger does not occur, we will have incurred significant expenses and may need to pay a termination fee and expenses under the merger agreement, which could have a material adverse effect on our business and cause our stock price to decline.
As described in Note 14 (Subsequent Events) above, on August 16, 2010, the Company entered into a definitive merger agreement to be acquired by an entity sponsored by Leonard Green & Partners, L.P.
The announcement of the proposed merger may result in a loss of key personnel and may disrupt our business and operations and adversely impact our relationships with third parties, which could have an adverse effect on our operating results. The merger agreement generally requires us to operate our business in the ordinary course pending consummation of the merger, but includes certain contractual restrictions on the conduct of our business that may affect our ability to execute on our business strategies and attain our financial goals.
Consummation of the merger is subject to various customary closing conditions, and the merger agreement may be terminated by any of the parties if the merger is not completed by February 15, 2011. The merger agreement contains certain other termination rights for both parties, and if the merger agreement under specified circumstances we may be obligated to pay a termination fee of up to $6.2 million and expenses of the other parties not to exceed $2.25 million.
We cannot predict whether the closing conditions to the merger agreement will be satisfied, and there is no assurance that the proposed merger will be completed. If the closing conditions set forth in the merger agreement are not satisfied or waived, or if the merger is not completed for any other reason, the market price of our common stock may decline.
These matters, alone or in combination, could have a material adverse effect on our business, financial condition, results of operations and stock price.
Item 2. Unregistered Sales of Equity Securities and Use of Proceeds.
None.
Item 3. Defaults Upon Senior Securities.
None.
None
None
The following documents are being filed as exhibits to this report:
Exhibit No. |
|
Title |
10.1 |
|
Agreement and Plan of Merger, dated as of August 16, 2010, by and among Prospect Medical Holdings, Inc., Ivy Holdings Inc. and Ivy Merger Sub Corp. (incorporated by reference to Exhibit 2.1 to the Current Report on Form 8-K of Prospect Medical Holdings, Inc. filed on August 16, 2010). |
|
|
|
10.2 |
|
Fund Guarantee, dated as of August 16, 2010, by and among Prospect Medical Holdings, Inc., Green Equity Investors V, L.P. and Green Equity Investors Side V, L.P. (incorporated by reference to Exhibit 2.2 to the Current Report on Form 8-K of Prospect Medical Holdings, Inc. filed on August 16, 2010). |
|
|
|
31.1 |
|
Certification of Chief Executive Officer pursuant to Rules 13a-14(a)/15d-14(a) under the Securities Exchange Act of 1934, as amended. |
|
|
|
31.2 |
|
Certification of Chief Financial Officer pursuant to Rules 13a-14(a)/15d-14(a) under the Securities Exchange Act of 1934, as amended. |
|
|
|
32.1 |
|
Certification of Chief Executive Officer pursuant to 18 U.S.C. Section 1350, as adopted pursuant to Section 906 of the Sarbanes-Oxley Act of 2002. |
|
|
|
32.2 |
|
Certification of Chief Financial Officer pursuant to 18 U.S.C. Section 1350, as adopted pursuant to Section 906 of the Sarbanes-Oxley Act of 2002. |
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.
|
PROSPECT MEDICAL HOLDINGS, INC. |
|
(Registrant) |
|
|
August 16, 2010 |
/s/ SAMUEL S. LEE |
|
Samuel S. Lee |
|
Chief Executive Officer |
|
(Principal Executive Officer) |
|
|
August 16, 2010 |
/s/ MIKE HEATHER |
|
Mike Heather |
|
Chief Financial Officer |
|
(Principal Financial Officer) |