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8-K - FORM 8-K - ALMOST FAMILY INCform8-k.htm
 
Exhibit 99.1

 
Almost Family, Inc.
Steve Guenthner
(502) 891-1000
 
 
The Ruth Group
Investor Relations
Nick Laudico/Zack Kubow
(646) 536-7030/7020
nlaudico@theruthgroup.com
zkubow@theruthgroup.com
 
Almost Family Reports Third Quarter 2011 Results

Third Quarter Results:
·  
Net service revenues were a record $86 million for the quarter
·  
Net income was $4.8 million, or $0.52 per diluted share
·  
Diluted EPS includes $0.02 of expenses related to governmental inquiries and $0.01 for acquisition costs, excluding which, diluted EPS would have been $0.54
·  
Visiting Nurse segment net revenues were $70 million, on 3% Medicare organic admission growth overall and 7% outside of Florida
·  
Personal Care segment net revenues grew to $16 million from a combination of the Cambridge acquisition and 3% organic volume growth

Louisville, KY, November 2, 2011 – Almost Family, Inc. (Nasdaq: AFAM), a leading regional provider of home health nursing and personal care services, announced today its financial results for the three-and nine months ended September 30, 2011.

Comments on Quarterly Results
William Yarmuth, Chief Executive Officer, commented on the quarterly results: “Despite particularly challenging times facing everyone in the home health industry, we are pleased to report our results for the quarter which include organic volume growth in both our VN and PC segments.  During the quarter, we also completed the second largest acquisition in the history of the Company, nearly doubling the size of our PC segment and expanding our total branch locations to over 150.  This acquisition, combined with improved performance in the balance of our PC segment, has helped us to improve that segment’s operating income by 87% as compared to the same quarter of last year. Finally, we are continuing to work on the operational management issues in our Florida VN operations described last quarter and view this as an opportunity to improve on the results we’ve reported for this quarter.”

Final Medicare Home Health Rule for 2012
On October 31, 2011 the Medicare program released its final rule for home health reimbursement rates which specify a reduction in the national standard 60 day episodic reimbursement rate of approximately 2.5%.   The final rule also includes a redistribution of reimbursement away from therapy intensive cases towards non-therapy intensive cases and removes certain diagnoses from consideration in determining reimbursement on individual patient cases.  The Company’s preliminary calculations suggest that the 2012 final rule may reasonably be expected to reduce its Medicare reimbursement for 2012 between 5.0% and 5.5% as compared to 2011 assuming no changes in the mix of patients the Company serves. The Company noted that the new rates impact episodes ended on or after January 1, 2012.  Accordingly, revenues and net income for the quarter ended December 31, 2011 will be partially impacted by these rates.

 
 

 
Almost Family Reports Third Quarter 2011 Results
Page 2
November 2, 2011


 Third Quarter Financial Results

Almost Family reported third quarter results that included the impact of the Medicare reimbursement rate cut for 2011 which reduced consolidated and Visiting Nurse (VN) segment revenue and pre-tax operating income by $3.8 million.

Net service revenues for the third quarter grew to $86.2 million, a 2% increase from $84.4 million reported in the third quarter of 2010, primarily as a result of the Cambridge Home Health Care Holdings, Inc. (Cambridge) acquisition, which closed in early August, offset by the VN segment’s Medicare rate cut.

The third quarter of 2011 was the second under the new regulatory rules regarding therapy reassessments and face-to-face physician encounters for patients in our VN segment.  During the quarter, the Company continued to experience softer than normal admission volumes and a decline in re-certifications.  Also, disruption in labor cost controls continued in Florida from the changes in management during the second quarter, resulted in lower margins and operating income in the Company’s VN segment.

Net income for the third quarter of 2011 was $4.8 million, or $0.52 per diluted share, down from third quarter of 2010 net income of $7.9 million, or $0.85 per diluted share. Fees and expenses related to governmental inquiries lowered third quarter 2011 EPS by approximately $0.02, while acquisition costs lowered third quarter 2011 EPS by approximately $0.01, without which diluted EPS would have been $0.54.  For the third quarter of 2010, investigation costs lowered operating results by approximately $0.02, while there were no acquisition costs.

Diluted EPS for the quarter were increased by $0.06 as a result of the Cambridge acquisition. Unallocated corporate overhead included approximately $373,000 of transitional expenses related to the Cambridge home office which is expected to be wound down over the next 4-5 quarters.

Third Quarter Segment Results

Net service revenues in the VN segment for the third quarter declined to $70.2 million, a 5% decrease from $74.1 million in the third quarter of 2010, after the $3.8 million effect of the Medicare rate cut, volume and related issues in our Florida cluster.  Medicare admissions grew 5%, of which 3% was organic, while completed episodes declined 3% as a result of a drop in re-certifications of 6%.  Our VN Medicare admissions grew 7% organically outside of Florida.

Operating income before corporate expenses in the VN segment for the third quarter of 2011 was $10.3 million, a $6.2 million decrease from $16.5 million reported for the third quarter of 2010 primarily as a result of the impact of the Medicare rate cut, volume and related issues in Florida, and the costs associated with implementing new regulations for face-to-face physician encounters and therapy reassessments.

 
 

 
Almost Family Reports Third Quarter 2011 Results
Page 3
November 2, 2011


Net service revenues in the Personal Care (PC) segment for the third quarter of 2011 grew 56% or $5.8 million to a record $16.0 million from $10.2 million in the third quarter of 2010 due primarily to our Cambridge acquisition.  Operating income before unallocated corporate expenses in the PC segment increased $1.2 million to $2.6 million in the third quarter of 2011 primarily due to the Cambridge acquisition.

Nine Month Period Ended September 30, 2011

Almost Family reported nine month results that included the impact of the Medicare reimbursement rate cut for 2011 which reduced consolidated and Visiting Nurse (VN) segment revenue and pre-tax operating income by $11.5 million. This was partially offset by the Cambridge acquisition and volume growth.  Net service revenues for the nine month period declined to $250.5 million, a 0.1% decrease from $250.8 million reported in the nine month period of 2010.

Net income for the nine month period of 2011 was $15.5 million, or $1.66 per diluted share, down from the nine month period of 2010 net income of $23.7 million, or $2.54 per diluted share. Fees and expenses related to governmental inquiries lowered year to date 2011 EPS by approximately $0.07 while deal costs lowered year to date 2011 EPS by approximately $0.03, without which diluted EPS would have been $1.76.  For the nine month period of 2010, investigation costs lowered operating results by approximately $0.03, while there were no deal costs.

Nine Month Period Segment Results

Net service revenues in the VN segment for the nine month period declined to $214.1 million, a 3.0% decrease from $220.6 million in the nine month period of 2010, after the effect of the previously mentioned Medicare rate cut which was partially offset by volume growth.  Medicare admissions grew 7%, of which 5% was organic, while completed episodes grew 3%.  Our VN Medicare admissions grew 10% organically outside of Florida.

Operating income before corporate expenses in the VN segment for the nine month period of 2011 was $35.1 million,  a $15.0 million decrease from $50.1 million reported for the nine month period of 2010 as a result of the impact of the Medicare rate cut, volume and related issues in Florida, and the costs associated with implementing new regulations for face-to-face physician encounters and therapy reassessments, all of which were partially offset by operating income before corporate expense from our Cambridge acquisition.

Net service revenues in the PC segment for the nine month period of 2011 grew 21% or $6.2 million to $36.4 million from $30.2 million in the nine month period of 2010, primarily due to our Cambridge acquisition.  Operating income before unallocated corporate expenses in the PC segment also increased 34% to $5.3 million from $3.9 million in the nine month period of 2010 as a result of the Cambridge acquisition.


 
 

 
Almost Family Reports Third Quarter 2011 Results
Page 4
November 2, 2011


Regulatory Inquiries

As previously announced, the US Senate Finance Committee issued a report on October 3, 2011, regarding their findings from inquiries following an April 2010 newspaper article related to Medicare home health therapy services.  The Senate Finance Committee’s report found “…none of the documents provided to the Committee by Almost Family show that executives ever pushed therapists to target thresholds or pursue more profitable clinical regimens.”  The Company is continuing to cooperate fully with investigators from the US Securities and Exchange Commission.  Fees and expenses associated with these inquiries and their impact on the Company’s financial results are described above.

Conference Call

A conference call to review the results will begin at 11:00 a.m. ET on November 2, 2011, and will be hosted by William Yarmuth, Chief Executive Officer, and Steve Guenthner, Chief Financial Officer. To participate in the conference call, please dial 1-877-407-0789 (USA) or 1-201-689-8562 (International).  In addition, a dial-up replay of the conference call will be available beginning November 2, 2011 at 2:00 p.m. ET and ending on November 15, 2011. The replay telephone number is 1-877-870-5176 (USA) or 1-858-384-5517 (International). Pin number 382262.

A live Web cast of the call will also be available from the Investor Relations section of the corporate Web site at http://www.almostfamily.com. A Web cast replay can be accessed on the corporate Web site beginning November 2, 2011 at approximately 2:00 p.m. ET and will remain available until December 2, 2011.



 
 

 
Almost Family Reports Third Quarter 2011 Results
Page 5
November 2, 2011



ALMOST FAMILY, INC. AND SUBSIDIARIES
 
CONSOLIDATED STATEMENTS OF INCOME
 
(UNAUDITED)
 
(In thousands, except per share data)
 
                         
   
Three Months Ended September 30,
   
Nine Months Ended September 30,
 
   
2011
   
2010
   
2011
   
2010
 
 Net service revenues
  $ 86,207     $ 84,379     $ 250,521     $ 250,813  
 Cost of service revenues (excluding depreciation & amortization)
    43,345       38,754       121,925       114,254  
 Gross margin
    42,862       45,625       128,596       136,559  
 General and administrative expenses:
                               
 Salaries and benefits
    24,832       22,835       72,777       67,957  
 Other
    9,993       9,516       29,852       28,761  
 Total general and administrative
     expenses
    34,825       32,351       102,629       96,718  
 Operating income
    8,037       13,274       25,967       39,841  
 Interest expense, net
    (41 )     (60 )     (140 )     (210 )
 Income before income taxes
    7,996       13,214       25,827       39,631  
 Income tax expense
    (3,154 )     (5,274 )     (10,331 )     (15,905 )
 Net income
  $ 4,842     $ 7,940     $ 15,496     $ 23,726  
                                 
 Per share amounts-basic:
                               
 Average shares outstanding
    9,296       9,143       9,271       9,101  
 Net income
  $ 0.52     $ 0.87     $ 1.67     $ 2.61  
                                 
 Per share amounts-diluted:
                               
 Average shares outstanding
    9,346       9,343       9,359       9,354  
 Net income
  $ 0.52     $ 0.85     $ 1.66     $ 2.54  


 
 

 
Almost Family Reports Third Quarter 2011 Results
Page 6
November 2, 2011


 
ALMOST FAMILY, INC. AND SUBSIDIARIES
 
CONSOLIDATED BALANCE SHEETS
 
(In thousands)
 
   
   
September 30, 2011
       
 ASSETS
 
(UNAUDITED)
   
December 31, 2010
 
 CURRENT ASSETS:
           
 Cash and cash equivalents
  $ 29,611     $ 47,943  
 Accounts receivable - net
    45,308       39,772  
 Prepaid expenses and other current assets
    6,316       3,513  
 Deferred tax assets
    7,591       8,521  
 TOTAL CURRENT ASSETS
    88,826       99,749  
                 
 PROPERTY AND EQUIPMENT - NET
    4,773       4,514  
 GOODWILL
    130,868       101,060  
 OTHER INTANGIBLE ASSETS
    19,735       14,285  
 OTHER ASSETS
    459       519  
    $ 244,661     $ 220,127  
                 
 LIABILITIES AND STOCKHOLDERS' EQUITY
               
 CURRENT LIABILITIES:
               
 Accounts payable
  $ 5,675     $ 5,424  
 Accrued other liabilities
    23,729       20,529  
 Current portion - capital leases and notes payable
    1,300       1,695  
 TOTAL CURRENT LIABILITIES
    30,704       27,648  
                 
 LONG-TERM LIABILITIES:
               
 Notes payable
    1,125       1,325  
 Deferred tax liabilities
    12,219       8,763  
 Other liabilities
    -       223  
 TOTAL LONG-TERM LIABILITIES
    13,344       10,311  
 TOTAL LIABILITIES
    44,048       37,959  
                 
 STOCKHOLDERS' EQUITY:
               
 Preferred stock, par value $0.05; authorized
               
 2,000 shares; none issued or outstanding
    -       -  
 Common stock, par value $0.10; authorized
               
 25,000; 9,367 and 9,239
               
 issued and outstanding
    938       924  
 Treasury stock, at cost, 13 and 4 shares
    (431 )     (139 )
 Additional paid-in capital
    100,300       97,073  
 Retained earnings
    99,806       84,310  
 TOTAL STOCKHOLDERS' EQUITY
    200,613       182,168  
    $ 244,661     $ 220,127  

 

 
 

 
Almost Family Reports Third Quarter 2011 Results
Page 7
November 2, 2011


 
 
ALMOST FAMILY, INC. AND SUBSIDIARIES
 
CONSOLIDATED STATEMENTS OF CASH FLOWS
 
(UNAUDITED)
 
(In thousands)
 
   
Nine Months Ended September 30,
 
   
2011
   
2010
 
 Cash flows from operating activities:
           
 Net income
  $ 15,496     $ 23,726  
 Adjustments to reconcile income to net cash provided by operating activities:
               
 Depreciation and amortization
    2,170       2,102  
 Provision for uncollectible accounts
    1,394       2,672  
 Stock-based compensation
    1,040       1,308  
 Deferred income taxes
    2,522       1,328  
      22,622       31,136  
 Change in certain net assets and liabilities, net of the effects of acquisitions:
               
 Decrease (increase) in:
               
 Accounts receivable
    (810 )     (6,456 )
 Prepaid expenses and other current assets
    250       (692 )
 Other assets
    60       11  
 (Decrease) increase in:
               
 Accounts payable and accrued expenses
    (2,718 )     3,280  
 Net cash provided by operating activities
    19,404       27,279  
                 
 Cash flows from investing activities:
               
 Capital expenditures
    (1,860 )     (1,952 )
 Acquisitions, net of cash acquired
    (35,689 )     (2,326 )
 Net cash used in investing activities
    (37,549 )     (4,278 )
                 
 Cash flows from financing activities:
               
 Proceeds from exercise of stock options
    292       381  
 Purchase of common stock in connection with share awards
    (440 )     (628 )
 Tax benefit from share awards
    1,556       1,258  
 Principal payments on capital leases and notes payable
    (1,595 )     (1,758 )
 Net cash used in financing activities
    (187 )     (747 )
                 
 Net change in cash and cash equivalents
    (18,332 )     22,254  
 Cash and cash equivalents at beginning of period
    47,943       19,389  
 Cash and cash equivalents at end of period
  $ 29,611     $ 41,643  
                 
 Summary of non-cash investing and financing activities:
               
 Settlement of Directors Deferred Compensation Plan
  $ 501     $ -  
 Acquisitions funded by notes payable
  $ 1,000     $ -  

 

 
 

 
Almost Family Reports Third Quarter 2011 Results
Page 8
November 2, 2011


 
ALMOST FAMILY, INC. AND SUBSIDIARIES
 
RESULTS OF OPERATIONS
 
(UNAUDITED)
 
(In thousands)
 
   
   
Three Months Ended September 30,
 
   
2011
   
2010
   
Change
 
   
Amount
   
% Rev
   
Amount
   
% Rev
   
Amount
   
%
 
Net service revenues:
                                   
 Visiting Nurse
  $ 70,230       81.5 %   $ 74,155       87.9 %   $ (3,925 )     -5.3 %
 Personal Care
    15,977       18.5 %     10,224       12.1 %     5,753       56.3 %
      86,207       100.0 %     84,379       100.0 %     1,828       2.2 %
Operating income before corporate expenses:
                                               
 Visiting Nurse
    10,276       14.6 %     16,537       22.3 %     (6,261 )     -37.9 %
 Personal Care
    2,589       16.2 %     1,382       13.5 %     1,207       87.3 %
      12,865       14.9 %     17,919       21.2 %     (5,054 )     -28.2 %
Corporate expenses
    4,828       5.6 %     4,645       5.5 %     183       3.9 %
Operating income
    8,037       9.3 %     13,274       15.7 %     (5,237 )     -39.5 %
Interest expense, net
    41       0.0 %     60       0.1 %     (19 )     -31.7 %
Income tax expense
    3,154       3.7 %     5,274       6.3 %     (2,120 )     -40.2 %
Net income
  $ 4,842       5.6 %   $ 7,940       9.4 %   $ (3,098 )     -39.0 %
                                                 
EBITDA
  $ 9,042       10.5 %   $ 14,447       17.1 %   $ (5,405 )     -37.4 %

 
   
Nine Months Ended September 30,
 
   
2011
   
2010
   
Change
 
   
Amount
   
% Rev
   
Amount
   
% Rev
   
Amount
   
%
 
Net service revenues:
                                   
 Visiting Nurse
  $ 214,127       85.5 %   $ 220,643       88.0 %   $ (6,516 )     -3.0 %
 Personal Care
    36,394       14.5 %     30,170       12.0 %     6,224       20.6 %
      250,521       100.0 %     250,813       100.0 %     (292 )     -0.1 %
Operating income before corporate expenses:
                                               
 Visiting Nurse
    35,092       16.4 %     50,118       22.7 %     (15,026 )     -30.0 %
 Personal Care
    5,290       14.5 %     3,940       13.1 %     1,350       34.3 %
      40,382       16.1 %     54,058       21.6 %     (13,676 )     -25.3 %
Corporate expenses
    14,415       5.8 %     14,217       5.7 %     198       1.4 %
Operating income
    25,967       10.4 %     39,841       15.9 %     (13,874 )     -34.8 %
Interest expense, net
    140       0.1 %     210       0.1 %     (70 )     -33.3 %
Income tax expense
    10,331       4.1 %     15,905       6.3 %     (5,574 )     -35.0 %
Net income
  $ 15,496       6.2 %   $ 23,726       9.5 %   $ (8,230 )     -34.7 %
                                                 
EBITDA
  $ 29,177       11.6 %   $ 43,251       17.2 %   $ (14,074 )     -32.5 %

 

 
 

 
Almost Family Reports Third Quarter 2011 Results
Page 9
November 2, 2011


 
ALMOST FAMILY, INC. AND SUBSIDIARIES
 
VISITING NURSE SEGMENT OPERATING METRICS
 
                                     
   
Three Months Ended September 30,
 
   
2011
   
2010
   
Change
 
   
Amount
   
% Rev
   
Amount
   
% Rev
   
Amount
   
%
 
Average number of locations
    100             88             12       13.6 %
                                             
All payors:
                                           
Patients Months
    51,739             51,832             (93 )     -0.2 %
Admissions
    15,043             14,359             684       4.8 %
Billable Visits
    475,046             469,992             5,054       1.1 %
                                             
Medicare Statisitics:
                                           
Revenue (in thousands)
  $ 64,508       91.9 %   $ 67,936       91.6 %   $ (3,428 )     -5.0 %
Billable visits
    400,111               394,668               5,443       1.4 %
Admissions
    13,662               13,030               632       4.9 %
Recertifications
    8,143               8,648               (505 )     -5.8 %
Episodes Completed
    21,176               21,763               (587 )     -2.7 %
                                                 
Revenue per completed episode
  $ 3,008             $ 3,156             $ (148 )     -4.7 %
Visits per episode
    18.3               18.1               0.2       1.1 %
                                                 
PERSONAL CARE OPERATING METRICS
 
                                                 
   
Three Months Ended September 30,
 
      2011               2010            
Change
 
   
Amount
           
Amount
           
Amount
   
%
 
Average number of locations
    48               22               26       118.2 %
                                                 
Admissions
    1,071               688               383       55.7 %
Patient months of care
    15,748               11,125               4,623       41.6 %
Patient days of care
    219,359               146,458               72,901       49.8 %
Billable hours
    891,139               565,429               325,710       57.6 %
Revenue per billable hour
  $ 17.93             $ 18.08             $ (0.15 )     -0.8 %

 

 
 

 
Almost Family Reports Third Quarter 2011 Results
Page 10
November 2, 2011


 
ALMOST FAMILY, INC. AND SUBSIDIARIES
 
VISITING NURSE SEGMENT OPERATING METRICS
 
                                     
   
Nine Months Ended September 30,
 
   
2011
   
2010
   
Change
 
   
Amount
   
% Rev
   
Amount
   
% Rev
   
Amount
   
%
 
Average number of locations
    95             86             9       10.5 %
                                             
All payors:
                                           
Patients Months
    156,675             153,753             2,922       1.9 %
Admissions
    46,008             43,436             2,572       5.9 %
Billable Visits
    1,437,293             1,407,168             30,125       2.1 %
                                             
Medicare Statisitics:
                                           
Revenue (in thousands)
  $ 197,567       92.3 %   $ 202,726       91.9 %   $ (5,159 )     -2.5 %
Billable visits
    1,215,570               1,177,389               38,181       3.2 %
Admissions
    42,037               39,390               2,647       6.7 %
Recertifications
    24,328               25,799               (1,471 )     -5.7 %
Episodes Completed
    65,630               64,042               1,588       2.5 %
                                                 
Revenue per completed episode
  $ 3,000             $ 3,139             $ (139 )     -4.4 %
Visits per episode
    18.1               18.0               0.1       0.6 %
                                                 
PERSONAL CARE OPERATING METRICS
 
                                                 
   
Nine Months Ended September 30,
 
      2011               2010            
Change
 
   
Amount
           
Amount
           
Amount
   
%
 
Average number of locations
    31               22               9       40.9 %
                                                 
Admissions
    2,584               2,214               370       16.7 %
Patient months of care
    37,583               33,751               3,832       11.4 %
Patient days of care
    503,243               432,882               70,361       16.3 %
Billable hours
    2,015,261               1,690,822               324,439       19.2 %
Revenue per billable hour
  $ 18.06             $ 17.84             $ 0.22       1.2 %


 
 

 
Almost Family Reports Third Quarter 2011 Results
Page 11
November 2, 2011


Non-GAAP Financial Measure
The information provided in some of the tables in this release includes certain non-GAAP financial measures as defined under Securities and Exchange Commission (SEC) rules.  In accordance with SEC rules, the Company has provided, in the supplemental information and the footnotes to the tables, a reconciliation of those measures to the most directly comparable GAAP measures.

EBITDA
Earnings before interest, taxes, depreciation and amortization (EBITDA) is not a measure of financial performance under accounting principles generally accepted in the United States of America.  It should not be considered in isolation or as a substitute for net income, operating income, cash flows from operating, investing or financing activities, or any other measure calculated in accordance with generally accepted accounting principles. The items excluded from EBITDA are significant components in understanding and evaluating financial performance and liquidity. Management routinely calculates and communicates EBITDA and believes that it is useful to investors because it is commonly used as an analytical indicator within our industry to evaluate performance, measure leverage capacity and debt service ability, and to estimate current or prospective enterprise value. EBITDA is also used in certain covenants contained in our credit agreement.

The following tables set forth a reconciliation of net income to EBITDA:

ALMOST FAMILY, INC. AND SUBSIDIARIES
 
RECONCILIATION OF EBITDA
 
(In thousands)
 
               
   
Three Months Ended September 30,
   
Nine Months Ended September 30,
 
   
2011
   
2010
   
2011
   
2010
 
Net income
  $ 4,842     $ 7,940     $ 15,496     $ 23,726  
Add back:
                               
Interest expense
    41       60       140       210  
Income tax expense
    3,154       5,274       10,331       15,905  
Depreciation and amortization
    695       736       2,170       2,102  
Amortization of stock-based
    compensation
    310       437       1,040       1,308  
Earnings before interest, income taxes, depreciation and amortization (EBITDA)
  $ 9,042     $ 14,447     $ 29,177     $ 43,251  
 
About Almost Family
Almost Family, Inc., founded in 1976, is a leading regional provider of home health nursing and personal care services, with branch locations in Florida, Kentucky, Ohio, New Jersey, Connecticut, Massachusetts, Missouri, Alabama, Illinois, Pennsylvania, and Indiana (in order of revenue significance). Almost Family, Inc. and its subsidiaries operate a Medicare-certified segment and a personal care segment. Altogether, Almost Family operates over 150 branch locations in 11 U.S. states.

 
 

 
Almost Family Reports Third Quarter 2011 Results
Page 12
November 2, 2011


Forward Looking Statements
All statements, other than statements of historical facts, included in this news release are forward-looking statements within the meaning of the Private Securities Litigation Reform Act of 1995. Forward-looking statements may be identified by the use of forward-looking terminology such as "may," "will," "expect," "believe," "estimate," "project," "anticipate," "continue," or similar terms, variations of those terms or the negative of those terms. These forward-looking statements are based on the Company's current plans, expectations and projections about future events.

Because forward-looking statements involve risks and uncertainties, the Company's actual results could differ materially from any future results, performance or achievements expressed or implied by such forward-looking statements. The potential risks and uncertainties which could cause actual results to differ materially include: regulatory approvals or third party consents may not be obtained, the impact of further changes in healthcare reimbursement systems, including the ultimate outcome of potential changes to Medicare reimbursement for home health services and to Medicaid reimbursement due to state budget shortfalls; the ability of the Company to maintain its level of operating performance and achieve its cost control objectives; changes in our relationships with referral sources; the ability of the Company to integrate acquired operations including obtaining synergies, integration objectives and anticipated timelines; government regulation; health care reform; pricing pressures from Medicare, Medicaid and other third-party payers; changes in laws and interpretations of laws relating to the healthcare industry including the Company's expectations with regard to the impact of the Medicare 2012 final rule; and the Company’s self-insurance risks.  For a more complete discussion regarding these and other factors which could affect the Company's financial performance, refer to the Company's various filings with the Securities and Exchange Commission, including its filing on Form 10-K for the year ended December 31, 2010, in particular information under the headings "Special Caution Regarding Forward-Looking Statements" and “Risk Factors.” The Company undertakes no obligation to update or revise its forward-looking statements.