Attached files
Exhibit 99.6
ELITE CENTER FOR MINIMALLY INVASIVE SURGERY LLC
FINANCIAL STATEMENTS
FOR THE YEAR ENDED DECEMBER 31, 2015
Exhibit 99.6
ELITE CENTER FOR MINIMALLY INVASIVE SURGERY LLC
TABLE OF CONTENTS
INDEPENDENT AUDITOR’S REPORT 1
FINANCIAL STATEMENTS
Balance Sheet 2
Statement of Income 3
Statement of Changes in Members’ Equity 4
Statement of Cash Flows 5
Notes to the Financial Statements 6
INDEPENDENT AUDITOR’S REPORT
To the Board of Directors
Elite Center for Minimally Invasive Surgery LLC
Houston, Texas
We have audited the accompanying financial statements of Elite Center for Minimally Invasive Surgery LLC (the “Company”), a Texas limited liability company, which comprise the balance sheet as of December 31, 2015, and the related statements of income, changes in members’ equity, and cash flows for the year then ended, and the related notes to the financial statements.
Management’s Responsibility for the Financial Statements
Management is responsible for the preparation and fair presentation of these financial statements in accordance with accounting principles generally accepted in the United States of America; this includes the design, implementation, and maintenance of internal control relevant to the preparation and fair presentation of financial statements that are free from material misstatement, whether due to fraud or error.
Auditor’s Responsibility
Our responsibility is to express an opinion on these financial statements based on our audit. We conducted our audit in accordance with auditing standards generally accepted in the United States of America. Those standards require that we plan and perform the audit to obtain reasonable assurance about whether the financial statements are free from material misstatement.
An audit involves performing procedures to obtain audit evidence about the amounts and disclosures in the financial statements. The procedures selected depend on the auditor’s judgment, including the assessment of the risks of material misstatement of the financial statements, whether due to fraud or error. In making those risk assessments, the auditor considers internal control relevant to the entity’s preparation and fair presentation of the financial statements in order to design audit procedures that are appropriate in the circumstances, but not for the purpose of expressing an opinion on the effectiveness of the entity’s internal control. Accordingly, we express no such opinion. An audit also includes evaluating the appropriateness of accounting policies used and the reasonableness of significant accounting estimates made by management, as well as evaluating the overall presentation of the financial statements.
We believe that the audit evidence we have obtained is sufficient and appropriate to provide a basis for our audit opinion.
Opinion
In our opinion, the financial statements referred to above present fairly, in all material respects, the financial position of Elite Center for Minimally Invasive Surgery LLC as of December 31, 2015, and the results of its operations and its cash flows for the year then ended in accordance with accounting principles generally accepted in the United States of America.
/s/ Desroches Partners, LLP
July 12, 2016
ELITE CENTER FOR MINIMALLY INVASIVE SURGERY LLC
BALANCE SHEET
DECEMBER 31, 2015
ASSETS
CURRENT ASSETS:
Cash and Cash Equivalents $ 229,494
Accounts Receivable 3,374,049
Prepaid Expenses and Other Current Assets 34,645
Total Current Assets 3,638,188
PROPERTY AND EQUIPMENT, NET 1,388,955
TOTAL ASSETS $ 5,027,143
LIABILITIES AND MEMBERS’ EQUITY
CURRENT LIABILITIES:
Accounts Payable $ 112,631
Accrued Expenses 304,359
Due to Affiliates 57,439
Current Portion of Deferred Lease Incentive Revenue 30,000
Current Portion of Notes Payable 757,992
Total Current Liabilities 1,262,421
LONG-TERM LIABILITIES:
Deferred Lease Incentive Revenue, Net of Current Portion 343,350
TOTAL LIABILITIES 1,605,771
COMMITMENTS AND CONTINGENCIES
MEMBERS’ EQUITY 3,421,372
TOTAL LIABILITIES AND MEMBERS’ EQUITY $ 5,027,143
The accompanying notes are an integral part of these financial statements
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ELITE CENTER FOR MINIMALLY INVASIVE SURGERY LLC
STATEMENT OF INCOME
FOR THE YEAR ENDED DECEMBER 31, 2015
REVENUES, NET:
Net Patient Revenue $ 1,949,599
Net Management Fee Revenue 7,119,484
Total Revenues, Net 9,069,083
OPERATING EXPENSES:
Insurance 39,207
Medical Supplies and Implants 490,301
Salaries and Wages 687,187
Employee Benefits 83,389
Professional Fees 127,651
Professional Services 149,927
Management Fees 97,480
Utilities 22,966
Repairs and Maintenance 299,143
Leases and Rent 709,759
Equipment and Supplies 48,616
Property Taxes 38,779
Office Expense 234,335
Depreciation 460,602
Total Operating Expenses 3,489,342
INCOME FROM OPERATIONS 5,579,741
OTHER INCOME (EXPENSE):
Sublease Rental Income 405,149
Interest Expense (10,942)
Other Income 35,932
Total Other Income 430,139
INCOME BEFORE PROVISION FOR STATE INCOME TAX 6,009,880
PROVISION FOR STATE INCOME TAX (53,858)
NET INCOME $ 5,956,022
The accompanying notes are an integral part of these financial statements
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ELITE CENTER FOR MINIMALLY INVASIVE SURGERY LLC
STATEMENT OF INCOME
FOR THE YEAR ENDED DECEMBER 31, 2015
BALANCE, DECEMBER 31, 2014 $ 1,135,754
Net Income 5,956,022
Contributions 229,282
Distributions (3,899,686)
BALANCE, DECEMBER 31, 2015 $ 3,421,372
The accompanying notes are an integral part of these financial statements
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ELITE CENTER FOR MINIMALLY INVASIVE SURGERY LLC
STATEMENT OF CASH FLOWS
FOR THE YEAR ENDED DECEMBER 31, 2015
CASH FLOW FROM OPERATING ACTIVITIES:
Net Income $ 5,956,022
Adjustments to Reconcile Net Income to Net Cash
Provided by Operating Activities:
Depreciation 460,602
Deferred Lease Incentive Revenue (48,204)
Change in Operating Assets and Liabilities:
Accounts Receivable (2,103,571)
Medical Supplies 302,696
Prepaid Expenses and Other Current Assets (9,555)
Accounts Payable (371,500)
Accrued Expenses (264,033)
Due to Affiliates 50,853
Net Cash Provided by Operating Activities 3,973,310
CASH FLOW FROM INVESTING ACTIVITIES:
Purchases of Property and Equipment (92,202)
CASH FLOW FROM FINANCING ACTIVITIES:
Principal Payments on Note Payable (401,343)
Contributions by Members 229,282
Distributions to Members (3,899,686)
Net Cash Used in Financing Activities (4,071,747)
NET CHANGE IN CASH AND CASH EQUIVALENTS (190,639)
CASH AND CASH EQUIVALENTS, BEGINNING OF YEAR 420,133
CASH AND CASH EQUIVALENTS, END OF YEAR $ 229,494
SUPPLEMENTAL DISCLOSURE OF CASH FLOW INFORMATION:
Cash Paid for Interest $ 10,331
Cash Paid for State Income Tax $ 24,713
The accompanying notes are an integral part of these financial statements
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ELITE CENTER FOR MINIMALLY INVASIVE SURGERY LLC
NOTES TO THE FINANCIAL STATEMENTS
NOTE 1 – ORGANIZATION
Elite Center for Minimally Invasive Surgery LLC (the “Company”) was formed on February 2, 2010 and amended October 21, 2010 in the State of Texas as a limited liability company. The Company was a multi-specialty center in the heart of Houston's Medical Center dedicated to delivering the best in orthopedics, spine and pain, as well as gastrointestinal (GI) and pediatric ear, nose and throat (ENT) care.
In connection with the Hospital Department Management Agreement dated May 1, 2015 (the “Management Agreement”), the Company changed the nature of its operations and now provides management services to a surgical facility in Houston, Texas.
The Company has an indefinite life unless terminated at an earlier date as provided for in the Company Agreement.
NOTE 2 – SUMMARY OF SIGNIFICANT ACCOUNTING POLICIES
This summary of significant accounting policies of the Company is presented to assist in understanding the Company’s financial statements. The financial statements and notes to the financial statements are the representation of the Company’s management, who is responsible for their integrity and objectivity.
Cash and Cash Equivalents
The Company defines cash and cash equivalents as cash on hand, cash in banks, and all highly liquid investments that are readily convertible to cash with original maturities of three months or less.
Accounts Receivable
Accounts receivables represent amounts owed to the Company that are expected to be collected within twelve months. Management evaluates receivables on an ongoing basis by analyzing current economic conditions, customer relationships, and previous payment histories. An allowance for doubtful accounts is established for specific accounts the Company considers uncollectible. As December 31, 2015, management determined no allowance was necessary as it considered all accounts receivable collectible.
Revenues
Prior to May 1, 2015, revenues are earned as providers perform medical services for patients. The patients are billed based on Current Procedural Terminology (“CPT”) codes for the medical procedures performed. CPT codes are numbers assigned to every task and service a medical practitioner may provide to a patient including medical, surgical and diagnostic services. CPT codes are developed, maintained and copyrighted by the American Medical Association. The patients are billed the normal billing amount, based on national averages, for a particular CPT code procedure. Revenues are reported at estimated net realizable amounts due from patients and third-party payers for services rendered. For the year ended December 31, 2015, revenues were reported net of contractual adjustments of $8,311,670.
Subsequent to May 1, 2015, revenues are based on the Management Agreement when they perform managerial services for the surgical facility. Revenues are reported at estimated net realizable value for services rendered. For the year ended December 31, 2015, there was no adjustment deemed necessary for bad debt expense.
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ELITE CENTER FOR MINIMALLY INVASIVE SURGERY LLC
NOTES TO THE FINANCIAL STATEMENTS
NOTE 2 – SUMMARY OF SIGNIFICANT ACCOUNTING POLICIES – CONTINUED
Property and Equipment
Property and equipment are stated at cost. Expenditures for additions, major renewals and betterments are capitalized, and expenditures for maintenance and repairs are charged against income as incurred. When property and equipment are retired or otherwise disposed of, the related cost and accumulated depreciation are removed from the accounts, and any resulting gain or loss is reflected in income.
The Company provides for depreciation or property and equipment using the straight-line method over the lesser of the lease term of improved leasehold property, or the estimated useful lives of the respective assets.
Deferred Lease Incentive Revenue
Deferred lease incentive revenue represents tenant improvement allowances received as consideration in connection with operating leases disclosed further in Note 6. The liability is amortized on a straight-line basis over the life of the lease and recorded as a reduction to rent expense in the accompanying statement of income.
Income Taxes
The Company is a limited liability company and, as such, is not subject to income tax. Taxable income or loss of the Company is included in the respective Members’ tax returns.
The Company is subject to Texas franchise tax, commonly referred to as the Texas margin tax, for the year ended December 31, 2015. Accordingly, a provision and liability for state income tax has been included in accrued expenses on the accompanying financial statements.
The Company applies a more-likely-than-not recognition threshold for all tax uncertainties. Accordingly, only those tax benefits that have a greater than fifty percent likelihood of being sustained upon examination by the taxing authorities are recognized. As applied to the Company, any tax uncertainties would principally relate to state income taxes, or uncertainties in its U.S. Federal income tax return that is used to determine state income tax liability. The Company’s management has reviewed the Company’s tax positions and determined there were no significant outstanding or retroactive tax positions exist with less than a 50% likelihood of being sustained upon examination by the taxing authorities.
Based on its evaluation, the Company has concluded that there are no significant uncertain tax positions requiring recognition in its financial statements. The Company’s evaluation was performed for the tax periods ended December 31, 2011 through December 31, 2015 for U.S. Federal and applicable states, the tax years that principally remain subject to examination by major tax jurisdictions as of December 31, 2015.
Fair Value Considerations
The Company uses fair value to measure financial and nonfinancial assets and liabilities that are recognized or disclosed at fair value in the financial statements on a recurring basis (at least annually). Fair value is defined as the price that would be received to sell an asset or paid to transfer a liability in an orderly transaction between market participants. The fair value hierarchy established and prioritized fair value measurements into three levels based on the nature of the inputs. The hierarchy gives the highest priority to inputs based on market data from independent sources (observable inputs- Level 1) and the lowest priority to a reporting entity's internal assumptions based upon the best information available when external market data is limited or unavailable (unobservable inputs- Level 3).
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ELITE CENTER FOR MINIMALLY INVASIVE SURGERY LLC
NOTES TO THE FINANCIAL STATEMENTS
NOTE 2 – SUMMARY OF SIGNIFICANT ACCOUNTING POLICIES – CONTINUED
Fair Value Considerations – Continued
The fair value option allows entities to choose, at specified election dates, to measure eligible financial assets and financial liabilities at fair value that are not otherwise required to be measured at fair value. If an entity elects the fair value option for an eligible item, changes in that item's fair value in subsequent reporting periods must be recognized in current earnings. The Company did not elect the fair value option for the measurement of any eligible assets or liabilities.
The Company's financial instruments (primarily cash and cash equivalents, receivables, payables, and debt) are carried in the accompanying balance sheet at amounts which reasonably approximate fair value.
Estimates
The preparation of the financial statements in conformity with accounting principles generally accepted in the United States of America requires management to make estimates and assumptions that affect the reported amount of assets and liabilities and disclosure of contingent assets and liabilities at the date of the financial statements and the reported amounts of revenues and expenses during the reporting period. Actual results could differ from those estimates. Estimates that have the most impact on financial position and results of operations primarily relate to the collectability of and contractual adjustments to accounts receivable, the useful lives of property and equipment, and certain accrued liabilities. Management believes these estimates and assumptions provide a reasonable basis for the fair presentation of the financial statements.
Subsequent Events
The Company has evaluated subsequent events through the date the financial statements were available for issuance on July 12, 2016 and determined there were no matters materially affecting the Company’s financial statements or related notes to the financial statements.
NOTE 3 – COMPANY AGREEMENT
The following are some of the significant terms of the Company Agreement:
Membership Interests
As specified in the Company Agreement, the Company has two classes of membership (Class A and Class B) and there is no limit on the number of authorized shares to be issued for each class of membership. The Company was initially capitalized by contributions aggregating $1,569,000 for 82.12 Class A units and $75,000 for 15 Class B units. Class B Members have special voting rights as specified in the Company Agreement.
Restrictions on Membership Interests
As defined in the agreement, no Class A Member, including spouse or ex-spouse, shall transfer any right, title or interest in their respective units without the approval of the Board of Directors.
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ELITE CENTER FOR MINIMALLY INVASIVE SURGERY LLC
NOTES TO THE FINANCIAL STATEMENTS
NOTE 3 – COMPANY AGREEMENT – CONTINUED
Restrictions on Membership Interests – Continued
As defined in the agreement, the Class B Member may transfer any or all interest in Class B units to any person subject to the right of first refusal granted to the Class A Members. Accordingly, the Class A Members shall have the right, but not the obligation, to purchase the Class B Member units for a period of 10 days for an agreed upon price as defined in the Company Agreement. Additionally, the Class A Members shall have the right and option, but not the obligation, to sell the Class A Members’ units in connection with the transfer of Class B Member units to said purchaser. The Class A Members must notify the Class B Member at least 30 days prior to said transfer.
If, at any time, the Class B Member desires to affect a Company sale to any person that is not an affiliate of the Class B Member, then the Class B Member shall have the option to require the Class A Members to transfer some or all of the units held by Class A Members to the respective purchaser at an agreed upon price as defined in the Company Agreement.
In the occurrence of a Terminating Event, as defined in the Company Agreement, the Company has a three-year period from the date of termination to purchase the Terminating Member’s units for an agreed upon price as defined in the Company Agreement.
Management and Liability of Members
The Operating Manager of the Company, except as otherwise expressly stated or provided in the Company Agreement, shall have full power and authority to take all action in connection with the Company’s affairs and to exercise exclusive management, supervision and control of the Company’s properties and business and shall have full power to do all things necessary or incident thereto, without the necessity of any further approval of a Member.
The Members of the Company shall not be personally liable for all or any part of the debts or other obligations of the Company, except for certain personal guaranties obtained in connection with said debts or other obligations.
Profits and Losses
The Company’s profits and losses shall be allocated to the Members in accordance with their outstanding units of membership interests (“sharing ratios”).
Distributions
The Operating Manager determines the cash available for distributions and distributions shall be issued at the Operating Manager’s discretion, but not less than once each year. Distributions made to the Members shall be allocated in accordance with their respective sharing ratios.
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ELITE CENTER FOR MINIMALLY INVASIVE SURGERY LLC
NOTES TO THE FINANCIAL STATEMENTS
NOTE 4 – PROPERTY AND EQUIPMENT
Property and equipment consist of the following at December 31, 2015:
Life
(Years)
Computers and Software 3 to 5 $ 77,350
Furniture and Equipment 7 121,631
Leasehold Improvements Up to 39 1,457,583
Medical Equipment 5 2,095,248
3,751,812
Less Accumulated Depreciation (2,362,857)
Total $ 1,388,955
For the year ended December 31, 2015, depreciation expense totaled $460,602.
NOTE 5 – NOTE PAYABLE
Note Payable at December 31, 2015 consists of the following:
Note payable to a former member in 23 monthly
installments of $25,000 and a final payment of
approximately $464,000 including interest at 1%;
maturing December 2016; on an unsecured basis. $ 757,992
Less: Current Portion (757,992)
Note Payable, net of Current Portion $ -
NOTE 6 – OPERATING LEASES
The Company leases office space under a noncancellable lease, the terms of which require escalating annual rent payments with an annual adjustment, if necessary, to reflect increases in building operating expenses. Per the terms of the Management Agreement (see Note 1), the office space is sub-leased to its sole customer. Accordingly, all future commitments are reduced by future sub-rental revenues which approximate $480,000 per year through April 2020. The Company also leases office equipment on a month to month basis. Rent expense, including month to month rentals, totaled $709,759 for the year ended December 31, 2015. Sublease rental income for the year ended December 31, 2015 totaled $405,149.
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ELITE CENTER FOR MINIMALLY INVASIVE SURGERY LLC
NOTES TO THE FINANCIAL STATEMENTS
NOTE 7 – RELATED PARTY TRANSACTIONS
As specified in the Company Agreement (see Note 3), the Class B Member provides certain administrative management services for the Company, the costs of which are determined by the Company Agreement. During the year ended December 31, 2015, the Company incurred expenses of $97,480. Accrued management fees owed to the Class B Member at December 31, 2015 totaled $126,847 and are included in accrued expenses on the accompanying balance sheet.
At various times during the ordinary course of business, the Company and its affiliates will pay expenses on behalf of one another. As of December 31, 2015, the Company owed an affiliate $67,959 for such costs.
As of December 31, 2015, the Company owed an affiliate $6,856 for margin tax expense related to prior years paid on behalf of the Company which is included in due to affiliates on the accompanying balance sheet.
NOTE 8 – CONCENTRATION OF CREDIT RISK
The financial instruments that potentially subject the Company to a concentration of credit risk consist primarily of accounts receivable and cash deposits. Prior to May 1, 2015, revenues were reported at estimated net realizable amounts due from patients and third-parties for services rendered. Generally, these receivables were unsecured. For the year ended December 31, 2015, three third-party payors accounted for 83% of gross patient revenues. As of and for the year ended December 31, 2015, one customer comprised 100% of management fee revenues and receivables.
At December 31, 2015, the Company had deposits in an interest-bearing account at a financial institution which from time to time may exceed the Federal Deposit Insurance Corporation insurance limits. Management believes any credit risk is low due to the overall financial strength of the financial institution.
NOTE 9 – LITIGATION
At times, the Company is a defendant in various legal proceedings arising in the ordinary course of business. While management believes the outcome of pending litigation and claims will not have a material adverse effect on the Company’s financial condition, operations, or cash flows, litigation is subject to inherent uncertainties.
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