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8-K - FORM 8-K - AMSURG CORPamsg-8k-2012-10-23.htm

 

 

Exhibit 99

Press Release

 

 

 

Contact:

Claire M. Gulmi

 

 

Executive Vice President and

 

 

Chief Financial Officer

 

 

(615) 665-1283

 

AMSURG REPORTS NET EARNINGS FROM CONTINUING OPERATIONS OF $0.49 PER DILUTED SHARE FOR THIRD-QUARTER 2012

¾¾¾¾¾¾¾¾¾¾¾

UPDATES GUIDANCE FOR 2012

¾¾¾¾¾¾¾¾¾¾¾

ENDS QUARTER WITH 15 CENTERS UNDER LETTER OF INTENT

 

NASHVILLE, Tenn. ─ (October 23, 2012) ─ Christopher A. Holden, President and Chief Executive Officer of AmSurg Corp. (NASDAQ: AMSG), today announced financial results for the third quarter ended September 30, 2012.  Revenues for the quarter were $226.4 million, a 16% increase from $194.8 million for the third quarter of 2011. Net earnings from continuing operations attributable to AmSurg common shareholders were $15.4 million, or $0.49 per diluted share, for the third quarter of 2012 compared with $13.0 million, or $0.42 per diluted share, for the third quarter of 2011.  The 2011 period included acquisition transaction costs of $0.03 per diluted share. Excluding these costs from the prior year, net earnings from continuing operations per diluted share attributable to AmSurg common shareholders increased 9% for 2012.

 

Revenues for the first nine months of 2012 increased 23% to $688.2 million from $560.1 million for the first nine months of 2011.  Net earnings from continuing operations attributable to AmSurg common shareholders increased to $47.4 million, or $1.50 per diluted share, for the first nine months of 2012 from $37.3 million, or $1.20 per diluted share, for the same period in 2011.  The 2011 period included acquisition transaction costs of $0.05 per diluted share. Excluding these costs from the prior year, net earnings from continuing operations per diluted share attributable to AmSurg common shareholders increased 20% for 2012.

 

Commenting on the announcement, Mr. Holden remarked, “We are pleased with AmSurg’s earnings performance for the third quarter, which met the high end of our guidance. We produced same-center revenue growth for the quarter of 2%, even though there was one less business day in the quarter compared with the third quarter last year.  With this extra day, same-center revenue would have increased 3% for the quarter.  Our revenue growth also reflected an increase in centers in operation to 229 at the end of the quarter, up from 223 at same time in 2011.  Our new centers contributed to an increase in total procedures for the quarter of 8%, while revenue per procedure increased 7%, as multi-specialty centers grew as a percentage of our center mix.

 

“We acquired one center during the third quarter and, at the end of the third quarter, had 15 centers under letter of intent, which generate annualized operating income in aggregate of approximately $60 million.  We acquired one of these centers in the fourth quarter, and we expect to complete the acquisition of many, if not all, of the remaining centers in the next 90 to 180 days.  To effect these potential transactions, we are considering a number of alternative

 

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AMSG Reports Third-Quarter Results

Page 2

October 23, 2012 

funding scenarios, with the dual goals of completing the current transactions and using the strength of our balance sheet to build a capital structure that will support our long-term growth objectives.  We expect that such a change in our capital structure could result in annual costs of $0.15 to $0.20 per diluted share above our current funding costs.  Although these costs would offset a portion of the incremental earnings anticipated from the acquisition of the immediate letter of intent pipeline, such a change would also be expected to enhance our ability to implement our future growth strategy.

 

            “Net cash flows from operating activities increased 16% for the third quarter of 2012 to $72.5 million from $62.6 million for the third quarter of 2011.  Excluding distributions to noncontrolling interests, net cash flows from operations rose 21% to $32.2 million from $26.5 million.  After capital expenditures for maintenance and acquisitions of $12.4 million for the third quarter of 2012, we primarily applied our free cash flow for the quarter to net repayments of long-term debt of $21.8 million.  At the end of the third quarter, our ratio of total debt to trailing 12 months EBITDA as calculated under our credit agreement improved to 2.5 compared with 2.8 at June 30, 2012 and 2.9 at the end of 2011.  We had cash and cash equivalents of $35.7 million at the end of the quarter and availability under our revolving credit facility of $179 million.

 

            “Based on our performance through the first nine months of 2012 and our outlook for the remainder of the year, we today adjust our financial guidance for 2012, while establishing our guidance for the fourth quarter of 2012, as follows:

 

·         Revenues in a range of $915 million to $925 million for 2012 compared with the previous range of $905 million to $925 million.

·         Same-center revenue increase of 3% for 2012, up from the prior range of 2% to 3%.

·         Center acquisitions for 2012 that generate annualized operating income in a range of $60 million to $65 million, including approximately $3.8 million from centers acquired in the first nine months of 2012.

·         Net cash flow provided by operating activities, less distributions to noncontrolling interests, in a range of $115 million to $120 million for 2012.

·         Net earnings from continuing operations per diluted share attributable to common shareholders for 2012 in a range of $1.98 to $2.01 compared with the previous range of $1.97 to $2.01. 

·         Net earnings from continuing operations per diluted share attributable to common shareholders for the fourth quarter of 2012 in a range of $0.48 to $0.51.”

 

            Mr. Holden concluded, “While we believe the unusual spike we have experienced in our acquisition activity is a consequence, in part, of the unresolved budget and tax issues facing the federal government, it is also reflective of trends we have discussed for some time.  The pressures on physician practices have grown more intense and become more complex due to increased government regulation, changing reimbursement policies, growing requirements for IT and other expenditures, and the economic downturn.

 

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AMSG Reports Third-Quarter Results

Page 3

October 23, 2012 

 

            “As a result, we expect to see an increase in consolidation momentum in the years to come, although this year’s surge does not necessarily mean we will expand our annual acquisition goals.  In addition, for reasons explained earlier, we believe our pipeline of centers under letter of intent affords us the opportunity to optimize our capital structure to support our growth for the long-term, rather than an opportunity to generate an immediate stair-step in our growth. 

 

            “Ultimately, we believe the centers under letter of intent at the end of the third quarter and the increasing trends toward consolidation validate our commitment to building the market leading position as the physician partner of choice.  In an industry that remains highly fragmented, we believe our success at differentiating AmSurg through our physician centric culture is one of our most important strengths and will support the long-term growth in our earnings and shareholder value.”

 

The information contained in the preceding paragraphs, including information regarding our future acquisition and financing plans and our financial results for future periods, is forward-looking information.  Forward-looking information involves known and unknown risks and uncertainties as described below.  There can be no assurance that we will be successful in acquiring the surgery centers described above, or that financing will be available to us or available on the terms currently anticipated.  The attainment of the financial targets set forth in this press release is dependent on the assumptions described above, and the Company’s actual results and performance could differ materially from those expressed or implied by the forward-looking information contained in this press release.

 

            AmSurg Corp. will hold a conference call to discuss this release today at 5:00 p.m. Eastern time.  Investors will have the opportunity to listen to the conference call over the Internet by going to www.amsurg.com and clicking “Investors” or by going to www.earnings.com at least 15 minutes early to register, download, and install any necessary audio software.  For those who cannot listen to the live broadcast, a replay will be available at these sites shortly after the call and continue for 30 days.

 

This press release contains forward-looking statements.  These statements, which have been included in reliance on the “safe harbor” provisions of the Private Securities Litigation Reform Act of 1995, involve risks and uncertainties.  Investors are hereby cautioned that these statements may be affected by important factors, including, but not limited to, the following risks: the risk that payments from third-party payors, including government healthcare programs, may decrease or not increase as the Company’s costs increase; adverse developments affecting the medical practices of the Company’s physician partners; the Company’s ability to maintain favorable relations with its physician partners; the Company’s ability to compete for physician partners, managed care contracts, patients and strategic relationships; the Company’s ability to acquire and develop additional surgery centers on favorable terms; the Company’s ability to grow revenues by increasing procedure volume while maintaining its operating margins and profitability at its existing centers; the Company’s ability to manage the growth in its business; the Company’s ability to obtain sufficient capital resources to complete acquisitions and develop new surgery centers; adverse weather and other factors beyond the Company’s control that may

 

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AMSG Reports Third-Quarter Results

Page 4

October 23, 2012 

 

affect the Company’s surgery centers; adverse impacts on the Company’s business associated with current and future economic conditions; the Company’s failure to comply with applicable laws and regulations; the risk of changes in legislation, regulations or regulatory interpretations that may negatively affect the Company; the risk of becoming subject to federal and state investigation; uncertainties regarding the impact of the Health Reform Law; the risk of regulatory changes that may obligate the Company to buy out interests of physicians who are minority owners of its surgery centers; potential liabilities associated with the Company’s status as a general partner of limited partnerships; liabilities for claims brought against our facilities; the Company’s legal responsibility to minority owners of its surgery centers, which may conflict with its interests and prevent it from acting solely in its best interests; risks associated with the potential write-off of the impaired portion of intangible assets; potential liability relating to the tax deductibility of goodwill; and other risk factors described in AmSurg’s Annual Report on Form 10-K for the fiscal year ended December 31, 2011 and other filings with the Securities and Exchange Commission.  Consequently, actual results, performance or developments may differ materially from the forward-looking statements included above. AmSurg disclaims any intent or obligation to update these forward-looking statements.

 

AmSurg Corp. acquires, develops and operates ambulatory surgery centers in partnership with physician practice groups throughout the United States.  At September 30, 2012, AmSurg owned and operated 229 centers.

 

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AMSG Reports Third-Quarter Results

Page 5

October 23, 2012 

AMSURG CORP.

Unaudited Selected Consolidated Financial and Operating Data

(Dollars in thousands, except per share amounts)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

For the Three Months

 

For the Nine Months

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Ended September 30,

 

Ended September 30,

Statement of Earnings Data:

 

2012 

 

2011 

 

 

2012 

 

 

2011 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Revenues

 

$

 226,399 

 

$

 194,840 

 

$

 688,191 

 

$

 560,088 

Operating expenses:

 

 

 

 

 

 

 

 

 

 

 

 

 

Salaries and benefits

 

 

 72,733 

 

 

 60,496 

 

 

 216,143 

 

 

 172,876 

 

Supply cost

 

 

 31,535 

 

 

 25,112 

 

 

 96,921 

 

 

 71,530 

 

Other operating expenses

 

 

 47,339 

 

 

 43,123 

 

 

 143,429 

 

 

 121,276 

 

Depreciation and amortization

 

 

 7,635 

 

 

 6,531 

 

 

 22,473 

 

 

 18,577 

 

 

Total operating expenses

 

 

 159,242 

 

 

 135,262 

 

 

 478,966 

 

 

 384,259 

Equity in earnings of unconsolidated affiliates

 

 

 392 

 

 

 147 

 

 

 1,103 

 

 

 147 

 

 

Operating income

 

 

 67,549 

 

 

 59,725 

 

 

 210,328 

 

 

 175,976 

Interest expense

 

 

 3,537 

 

 

 3,597 

 

 

 11,965 

 

 

 11,170 

 

 

Earnings from continuing operations before income taxes

 

 

 64,012 

 

 

 56,128 

 

 

 198,363 

 

 

 164,806 

Income tax expense

 

 

 10,247 

 

 

 8,451 

 

 

 32,451 

 

 

 25,617 

 

 

Net earnings from continuing operations

 

 

 53,765 

 

 

 47,677 

 

 

 165,912 

 

 

 139,189 

Discontinued operations:

 

 

 

 

 

 

 

 

 

 

 

 

 

Earnings (loss) from operations of discontinued interests in surgery centers, net of income tax

 

 

 - 

 

 

 59 

 

 

 (110) 

 

 

 817 

 

Loss on disposal of discontinued interests in surgery centers, net of income tax

 

 

 - 

 

 

 (119) 

 

 

 (1,553) 

 

 

 (1,384) 

 

 

Net loss from discontinued operations

 

 

 - 

 

 

 (60) 

 

 

 (1,663) 

 

 

 (567) 

 

 

Net earnings

 

 

 53,765 

 

 

 47,617 

 

 

 164,249 

 

 

 138,622 

Less net earnings attributable to noncontrolling interests:

 

 

 

 

 

 

 

 

 

 

 

 

 

Net earnings from continuing operations

 

 

 38,328 

 

 

 34,660 

 

 

 118,560 

 

 

 101,884 

 

Net (loss) earnings from discontinued operations

 

 

 - 

 

 

 (169) 

 

 

 (60) 

 

 

 289 

 

 

Total net earnings attributable to noncontrolling interests

 

 

 38,328 

 

 

 34,491 

 

 

 118,500 

 

 

 102,173 

 

 

Net earnings attributable to AmSurg Corp. common shareholders

 

$

 15,437 

 

$

 13,126 

 

$

 45,749 

 

$

 36,449 

Amounts attributable to AmSurg Corp. common shareholders:

 

 

 

 

 

 

 

 

 

 

 

 

 

Earnings from continuing operations, net of income tax

 

$

 15,437 

 

$

 13,017 

 

$

 47,352 

 

$

 37,305 

 

Discontinued operations, net of income tax

 

 

 - 

 

 

 109 

 

 

 (1,603) 

 

 

 (856) 

 

 

Net earnings attributable to AmSurg Corp. common shareholders

 

$

 15,437 

 

$

 13,126 

 

$

 45,749 

 

$

 36,449 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Earnings per share-basic:

 

 

 

 

 

 

 

 

 

 

 

 

 

Net earnings from continuing operations attributable to AmSurg Corp. common shareholders

 

$

 0.50 

 

$

 0.43 

 

$

 1.54 

 

$

 1.23 

 

Net loss from discontinued operations attributable to AmSurg Corp. common shareholders

 

 

 - 

 

 

 - 

 

 

 (0.05) 

 

 

 (0.03) 

 

 

Net earnings attributable to AmSurg Corp. common shareholders

 

$

 0.50 

 

$

 0.43 

 

$

 1.49 

 

$

 1.20 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Earnings per share-diluted:

 

 

 

 

 

 

 

 

 

 

 

 

 

Net earnings from continuing operations attributable to AmSurg Corp. common shareholders

 

$

 0.49 

 

$

 0.42 

 

$

 1.50 

 

$

 1.20 

 

Net loss from discontinued operations attributable to AmSurg Corp. common shareholders

 

 

 - 

 

 

 - 

 

 

 (0.05) 

 

 

 (0.03) 

 

 

Net earnings attributable to AmSurg Corp. common shareholders

 

$

 0.49 

 

$

 0.42 

 

$

 1.45 

 

$

 1.17 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Weighted average number of shares and share equivalents outstanding:

 

 

 

 

 

 

 

 

 

 

 

 

 

Basic

 

 

 30,819 

 

 

 30,436 

 

 

 30,727 

 

 

 30,424 

 

Diluted

 

 

 31,697 

 

 

 31,162 

 

 

 31,558 

 

 

 31,174 

 

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AMSG Reports Third-Quarter Results

Page 6

October 23, 2012 

 

AMSURG CORP.

Unaudited Selected Consolidated Financial and Operating Data, continued

(Dollars in thousands)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

For the Three Months

 

For the Nine Months

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Ended September 30,

 

Ended September 30,

Operating Data:

 

2012 

 

2011 

 

2012 

 

2011 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Continuing centers in operation at end of period (consolidated)

 

 

 227 

 

 

 221 

 

 

 227 

 

 

 221 

Continuing centers in operation at end of period (unconsolidated)

 

 

 2 

 

 

 2 

 

 

 2 

 

 

 2 

Average number of continuing centers in operation (consolidated)

 

 

 227 

 

 

 212 

 

 

 225 

 

 

 206 

New centers added during the period

 

 

 1 

 

 

 19 

 

 

 3 

 

 

 25 

Centers discontinued during the period

 

 

 - 

 

 

 2 

 

 

 2 

 

 

 6 

Centers under development/not opened at end of period

 

 

 - 

 

 

 1 

 

 

 - 

 

 

 1 

Centers under letter of intent at end of period

 

 

 15 

 

 

 5 

 

 

 15 

 

 

 5 

Average revenue per consolidated center

 

$

 999 

 

$

 918 

 

$

 3,053 

 

$

 2,716 

Same center revenues increase

 

 

2%

 

 

1%

 

 

3%

 

 

1%

Procedures performed during the period at consolidated centers

 

 

 375,376 

 

 

 347,369 

 

 

 1,143,556 

 

 

 1,003,970 

Income tax expense attributable to noncontrolling interests

 

$

 223 

 

$

 193 

 

$

 645 

 

$

 497 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Reconciliation of net earnings to EBITDA  (1):

 

 

 

 

 

 

 

 

 

 

 

 

 

Net earnings from continuing operations attributable to AmSurg Corp. common shareholders

 

$

 15,437 

 

$

 13,017 

 

$

 47,352 

 

$

 37,305 

 

Add:  income tax expense

 

 

 10,247 

 

 

 8,451 

 

 

 32,451 

 

 

 25,617 

 

Add:  interest expense, net

 

 

 3,537 

 

 

 3,597 

 

 

 11,965 

 

 

 11,170 

 

Add:  depreciation and amortization

 

 

 7,635 

 

 

 6,531 

 

 

 22,473 

 

 

 18,577 

 

 

EBITDA

 

$

 36,856 

 

$

 31,596 

 

$

 114,241 

 

$

 92,669 

 

(1)     EBITDA is defined as earnings before interest, income taxes and depreciation and amortization.  EBITDA should not be considered a measure of financial performance under generally accepted accounting principles.  Items excluded from EBITDA are significant components in understanding and assessing financial performance.  EBITDA is an analytical indicator used by management and the health care industry to evaluate company performance, allocate resources and  measure leverage and debt service capacity.  EBITDA should not be considered in isolation or as an alternative to net income, cash flows generated by operations, investing or financing activities, or other financial statement data presented in the consolidated financial statements as indicators of financial performance or liquidity.  Because EBITDA is not a measurement determined in accordance with generally accepted accounting principles and is thus susceptible to varying calculations, EBITDA as presented may not be comparable to other similarly titled measures of other companies.  Net earnings from continuing operations attributable to AmSurg Corp. common shareholders is the financial measure calculated and presented in accordance with generally accepted accounting principles that is most comparable to EBITDA as defined. 

 

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AMSG Reports Third-Quarter Results

Page 7

October 23, 2012 

 

AMSURG CORP.

Unaudited Selected Consolidated Financial and Operating Data, continued

(Dollars in thousands)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

September 30,

 

December 31,

Balance Sheet Data:

 

 

 

 

 

 

 

 

 

 

 

 

2012 

 

2011 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Assets

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Current assets:

 

 

 

 

 

 

 

Cash and cash equivalents

 

$

 35,682 

 

$

 40,718 

 

Accounts receivable, net of allowance of $23,414 and $18,844, respectively

 

 

 88,733 

 

 

 93,454 

 

Supplies inventory

 

 

 14,765 

 

 

 15,039 

 

Deferred income taxes

 

 

 3,027 

 

 

 2,129 

 

Prepaid and other current assets

 

 

 22,139 

 

 

 21,875 

 

 

Total current assets

 

 

 164,346 

 

 

 173,215 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Property and equipment, net

 

 

 144,599 

 

 

 144,558 

Investments in unconsolidated affiliates and long-term notes receivable

 

 

 11,883 

 

 

 10,522 

Goodwill

 

 

 1,250,451 

 

 

 1,229,298 

Intangible assets, net

 

 

 16,062 

 

 

 15,425 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Total assets

 

$

 1,587,341 

 

$

 1,573,018 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Liabilities and Equity

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Current liabilities:

 

 

 

 

 

 

 

Current portion of long-term debt

 

$

 12,274 

 

$

 10,800 

 

Accounts payable

 

 

 18,325 

 

 

 19,746 

 

Current income taxes payable

 

 

 - 

 

 

 1,796 

 

Accrued salaries and benefits

 

 

 25,324 

 

 

 22,224 

 

Other accrued liabilities

 

 

 9,568 

 

 

 9,088 

 

 

Total current liabilities

 

 

 65,491 

 

 

 63,654 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Long-term debt

 

 

 385,681 

 

 

 447,963 

Deferred income taxes

 

 

 131,646 

 

 

 114,167 

Other long-term liabilities

 

 

 28,772 

 

 

 28,131 

Commitments and contingencies

 

 

 

 

 

 

Noncontrolling interests - redeemable

 

 

 174,887 

 

 

 170,636 

Preferred stock, no par value, 5,000,000 shares authorized, no shares issued or outstanding

 

 

 - 

 

 

 - 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Equity:

 

 

 

 

 

 

 

Common stock, no par value, 70,000,000 shares authorized, 31,679,440 and 31,283,772 shares outstanding, respectively

 

 

 175,971 

 

 

 173,187 

 

Retained earnings

 

 

 488,807 

 

 

 443,058 

 

 

Total AmSurg Corp. equity

 

 

 664,778 

 

 

 616,245 

 

 

Noncontrolling interests - non-redeemable

 

 

 136,086 

 

 

 132,222 

 

 

Total equity

 

 

 800,864 

 

 

 748,467 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Total liabilities and equity

 

$

 1,587,341 

 

$

 1,573,018 

 

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AMSG Reports Third-Quarter Results

Page 8

October 23, 2012 

AMSURG CORP.

Unaudited Selected Consolidated Financial and Operating Data, continued

(Dollars in thousands)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

For the Three Months

 

For the Nine Months

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Ended September 30,

 

Ended September 30,

Statement of Cash Flow Data:

 

2012 

 

2011 

 

2012 

 

2011 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Cash flows from operating activities:

 

 

 

 

 

 

 

 

 

 

 

 

 

Net earnings

 

$

 53,765 

 

$

 47,617 

 

$

 164,249 

 

$

 138,622 

 

Adjustments to reconcile net earnings to net cash flows provided by operating activities:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Depreciation and amortization

 

 

 7,635 

 

 

 6,531 

 

 

 22,473 

 

 

 18,577 

 

 

Net loss (gain) on sale of long-lived assets

 

 

 - 

 

 

 (917) 

 

 

 599 

 

 

 (1,280) 

 

 

Share-based compensation

 

 

 1,707 

 

 

 1,591 

 

 

 5,119 

 

 

 4,762 

 

 

Excess tax benefit from share-based compensation

 

 

 (739) 

 

 

 (26) 

 

 

 (1,268) 

 

 

 (489) 

 

 

Deferred income taxes

 

 

 5,229 

 

 

 7,124 

 

 

 18,617 

 

 

 18,584 

 

 

Equity in earnings of unconsolidated affiliates

 

 

 (392) 

 

 

 (147) 

 

 

 (1,103) 

 

 

 (147) 

 

 

Increase (decrease) in cash and cash equivalents, net of effects

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

of acquisition and dispositions, due to changes in:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Accounts receivable, net

 

 

 1,896 

 

 

 863 

 

 

 4,831 

 

 

 (671) 

 

 

 

 

Supplies inventory

 

 

 10 

 

 

 54 

 

 

 343 

 

 

 121 

 

 

 

 

Prepaid and other current assets

 

 

 6 

 

 

 (1,026) 

 

 

 (325) 

 

 

 1,480 

 

 

 

 

Accounts payable

 

 

 (3,676) 

 

 

 1,367 

 

 

 (2,775) 

 

 

 (2,370) 

 

 

 

 

Accrued expenses and other liabilities

 

 

 6,126 

 

 

 (795) 

 

 

 3,510 

 

 

 (2,661) 

 

 

 

 

Other, net

 

 

 921 

 

 

 346 

 

 

 1,842 

 

 

 1,079 

 

 

 

 

 

Net cash flows provided by operating activities

 

 

 72,488 

 

 

 62,582 

 

 

 216,112 

 

 

 175,607 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Cash flows from investing activities:

 

 

 

 

 

 

 

 

 

 

 

 

 

Acquisition of interests in surgery centers and related transactions

 

 

 (6,125) 

 

 

 (142,826) 

 

 

 (16,097) 

 

 

 (188,500) 

 

Acquisition of property and equipment

 

 

 (6,231) 

 

 

 (5,029) 

 

 

 (20,800) 

 

 

 (15,332) 

 

Proceeds from sale of interests in surgery centers

 

 

 - 

 

 

 1,205 

 

 

 - 

 

 

 4,574 

 

 

 

 

 

Net cash flows used in investing activities

 

 

 (12,356) 

 

 

 (146,650) 

 

 

 (36,897) 

 

 

 (199,258) 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Cash flows from financing activities:

 

 

 

 

 

 

 

 

 

 

 

 

 

Proceeds from long-term borrowings

 

 

 16,833 

 

 

 157,541 

 

 

 50,211 

 

 

 230,525 

 

Repayment on long-term borrowings

 

 

 (38,622) 

 

 

 (34,691) 

 

 

 (111,139) 

 

 

 (99,543) 

 

Distributions to noncontrolling interests

 

 

 (40,307) 

 

 

 (36,038) 

 

 

 (123,066) 

 

 

 (103,398) 

 

Proceeds from issuance of common stock upon exercise of stock options

 

 

 5,256 

 

 

 132 

 

 

 11,928 

 

 

 4,760 

 

Repurchase of common stock

 

 

 (5,882) 

 

 

 - 

 

 

 (13,101) 

 

 

 (6,185) 

 

Capital contributions and ownership transactions by noncontrolling interests

 

 

 (110) 

 

 

 - 

 

 

 1,409 

 

 

 698 

 

Excess tax benefit from share-based compensation

 

 

 739 

 

 

 26 

 

 

 1,268 

 

 

 489 

 

Financing cost incurred

 

 

 (6) 

 

 

 (17) 

 

 

 (1,761) 

 

 

 (2,003) 

 

 

 

 

 

Net cash flows (used in) provided by financing activities

 

 

 (62,099) 

 

 

 86,953 

 

 

 (184,251) 

 

 

 25,343 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Net (decrease) increase in cash and cash equivalents

 

 

 (1,967) 

 

 

 2,885 

 

 

 (5,036) 

 

 

 1,692 

Cash and cash equivalents, beginning of period

 

 

 37,649 

 

 

 32,954 

 

 

 40,718 

 

 

 34,147 

Cash and cash equivalents, end of period

 

$

 35,682 

 

$

 35,839 

 

$

 35,682 

 

$

 35,839 

 

 

-END-