S-1/A
As filed with the Securities and Exchange Commission on
December 15, 2005
Registration No. 333-127115
SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
Amendment No. 6
to
Form S-1
REGISTRATION STATEMENT
UNDER
THE SECURITIES ACT OF 1933
EMERGENCY MEDICAL SERVICES CORPORATION
EMERGENCY MEDICAL SERVICES L.P.
(Exact Name of Registrants as Specified in their Charters)
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Delaware
(State or Other Jurisdiction of
Incorporation or Organization) |
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4119, 8011 and 8741
(Primary Standard Industrial
Classification Code No.)
6200 S. Syracuse Way
Greenwood Village, Colorado 80111
(303) 495-1200 |
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20-3738384
20-2076535
(I.R.S. Employer
Identification Nos.) |
(Address, including zip code, and telephone number, including
area code, of registrants principal executive offices) |
William A. Sanger
Chief Executive Officer
Emergency Medical Services Corporation
6200 S. Syracuse Way
Greenwood Village, Colorado 80111
(303) 495-1200
(Name, address, including zip code, and telephone number,
including area code, of agent for service)
Copies To:
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Lynn Toby Fisher, Esq.
Joel I. Greenberg, Esq.
Kaye Scholer LLP
425 Park Avenue
New York, New York 10022
(212) 836-8000 |
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Todd Zimmerman, Esq.
General Counsel
Emergency Medical Services Corporation
6200 S. Syracuse Way
Greenwood Village, Colorado 80111
(303) 495-1200 |
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James J. Clark, Esq.
Noah B. Newitz, Esq.
Cahill Gordon & Reindel LLP
80 Pine Street
New York, New York 10005
(212) 701-3000 |
Approximate date of commencement of proposed sale to
public: As soon as practicable after this Registration
Statement becomes effective.
If any of the securities being registered on this form are to be
offered on a delayed or continuous basis pursuant to
Rule 415 under the Securities Act of 1933, check the
following
box. o
If this form is filed to register additional securities for an
offering pursuant to Rule 462(b) under the Securities Act,
check the following box and list the Securities Act registration
statement number of the earlier effective registration statement
for the same
offering. o
If this form is a post-effective amendment filed pursuant to
Rule 462(c) under the Securities Act, check the following
box and list the Securities Act registration statement number of
the earlier effective registration statement for the same
offering. o
If this form is a post-effective amendment filed pursuant to
Rule 462(d) under the Securities Act, check the following
box and list the Securities Act registration statement number of
the earlier effective registration statement for the same
offering. o
CALCULATION OF REGISTRATION FEE
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Proposed Maximum |
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Proposed Maximum |
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Title Of Each Class Of |
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Amount To Be |
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Offering Price |
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Aggregate Offering |
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Amount Of | |
Securities To Be Registered |
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Registered(1) |
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Per Share |
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Price |
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Registration Fee | |
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Class A Common Stock, par value $0.01 per share
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shares |
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(2) |
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$ |
172,500,000(2) |
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$ |
20,304 |
(3) |
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1,148,325 shares |
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(4) |
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$ |
7,937,657(4) |
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935 |
(3) |
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(1) |
Includes shares that the underwriters have the option to
purchase solely to cover over-allotments, if any. |
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(2) |
Estimated solely for the purpose of calculating the registration
fee pursuant to Rule 457(o) of the Securities Act of 1933,
as amended. |
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(3) |
Previously paid. |
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(4) |
Estimated solely for the purpose of calculating the registration
fee pursuant to Rule 457(f)(2) of the Securities Act of
1933, as amended, based upon a book value of $10.3685 per share
at June 30, 2005. |
The Registrants hereby amend this Registration Statement on
such date or dates as may be necessary to delay its effective
date until the Registrants shall file a further amendment which
specifically states that this Registration Statement shall
thereafter become effective in accordance with Section 8(a)
of the Securities Act of 1933 or until this Registration
Statement shall become effective on such date as the Commission,
acting pursuant to said Section 8(a), may determine.
EXPLANATORY NOTE
The offering of the class A common stock will be made by
two prospectuses, one for use in the initial public offering and
one for use in the issuance of class A common stock in
exchange for class B units of Emergency Medical Services
L.P. The prospectus relating to the class A common stock
registered hereby to be offered in the initial public offering
(the IPO Prospectus) is set forth following this
page. The prospectus relating to the issuance of class A
common stock in exchange for class B units of Emergency
Medical Services L.P. is substantially the same as the form of
IPO Prospectus, except that:
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it contains different front and back cover pages; |
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the section captioned The Offering has been replaced
with a section captioned The Exchange, which
describes the exchange and clarifies that references in the
prospectus to this offering refer to the initial
public offering of the class A common stock; |
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the section captioned Formation of Holding Company
has been expanded to state that the issuance of class A
common stock in exchange for class B units will occur
automatically, without any vote or consent of the class B
unitholders, upon the completion of our public offering and to
include information concerning the mechanics of authorizing the
exchange; |
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the section captioned Use of Proceeds has been
replaced with a new section captioned Use of
Proceeds; |
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a new subsection captioned Tax Consequences of the
Exchange has been added to the section captioned
Material U.S. Federal Income Tax Considerations; |
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a new section captioned Comparison of Rights of EMS L.P.
Class B Unitholders and EMSC Class A
Stockholders has been added to describe the differences in
the rights attaching to the class B units and the
class A common stock; and |
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the section captioned Underwriters has been replaced
with a section captioned Plan of Distribution. |
These changed pages are included in this registration statement
immediately following the IPO Prospectus.
The
information in this prospectus is not complete and may be
changed. We may not sell these securities until the registration
statement filed with the Securities and Exchange Commission is
effective. This prospectus is not an offer to sell these
securities and it is not soliciting an offer to buy these
securities in any jurisdiction where the offer or sale is not
permitted.
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SUBJECT TO COMPLETION, DATED
DECEMBER 2, 2005
Prospectus
7,800,000 Shares
Emergency Medical Services
Corporation
Class A Common
Stock
Emergency Medical Services Corporation is offering
7,800,000 shares of class A common stock in an
underwritten offering. This is our initial public offering, and
no public market currently exists for our class A common
stock.
Our class A common stock has been accepted for listing on
the New York Stock Exchange under the symbol EMS,
subject to official notice of issuance. We anticipate that the
initial public offering price will be between $15.00 and
$17.00 per share.
Investing in our class A common stock involves a high
degree of risk. See Risk Factors beginning on
page 9.
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Per Share | |
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Offering price
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$ |
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Underwriting discounts and commissions
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Proceeds to Emergency Medical Services Corporation, before
expenses
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Neither the Securities and Exchange Commission nor any state
securities commission has approved or disapproved of these
securities or determined if this prospectus is truthful or
complete. Any representation to the contrary is a criminal
offense.
Certain of our existing stockholders have granted the
underwriters an option to purchase up to 1,170,000 additional
shares of our class A common stock to cover
over-allotments, if any. We will not receive any proceeds from
the sale of shares of our class A common stock by the
selling stockholders. The underwriters can exercise this right
at any time within 30 days from the date of this
prospectus. The underwriters expect to deliver the shares of
class A common stock to our investors on or
about ,
2005.
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Banc of America Securities LLC |
JPMorgan |
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CIBC World Markets |
Credit Suisse First Boston |
Goldman, Sachs & Co. |
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2005
amr
american medical response® |
emcare®
emergency medicine. customer driven. |
You should rely only on the information contained in this
prospectus. We have not, and the underwriters have not,
authorized anyone to provide you with different information. We
are not making an offer to sell these securities in any
jurisdiction where the offer or sale is not permitted. You
should assume that the information in this prospectus is
accurate on the date on the front cover of this prospectus only.
Our business, financial condition, results of operations and
prospects may have changed since that date.
TABLE OF CONTENTS
INDUSTRY AND MARKET DATA
The market data and other statistical information used
throughout this prospectus are based on independent industry
publications, government publications, reports by market
research firms or other published independent sources. Some data
are also based on our good faith estimates, which are derived
from our review of internal surveys, as well as the independent
sources listed above. Although we believe these sources are
reliable, we have not independently verified the information.
None of the independent industry publications used in this
prospectus were prepared on our or our affiliates behalf
and none of the sources cited in this prospectus consented to
the inclusion of any data from its reports, nor have we sought
their consent.
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SUMMARY
This summary highlights selected information contained
elsewhere in this prospectus and does not contain all of the
information you need to consider in making your investment
decision. This summary is qualified in its entirety by the more
detailed information and the combined and consolidated financial
statements and notes thereto appearing elsewhere in this
prospectus. You should read carefully this entire prospectus and
should consider, among other things, the matters set forth in
the section entitled Risk Factors before deciding
whether to invest in our common stock.
Company Overview
Emergency Medical Services Corporation is a leading provider of
emergency medical services in the United States. We operate our
business and market our services under the AMR and EmCare
brands. AMR is the leading provider of ambulance services in the
United States, based on net revenue and number of transports.
EmCare is the leading provider of outsourced emergency
department staffing and related management services in the
United States, based on number of contracts with hospitals and
affiliated physician groups. Approximately 86% of our fiscal
2004 net revenue was generated under exclusive contracts.
For the fiscal year ended August 31, 2004, we generated net
revenue of $1.6 billion, of which AMR and EmCare
represented approximately 66% and 34%, respectively, and net
income of $37.3 million.
AMR. Over its 50 years of operating history, AMR has
developed the largest network of ambulance services in the
United States. AMR has an 8% share of the total ambulance
services market and a 21% share of the private provider
ambulance market, with net revenue approximately twice that of
our only national competitor. During fiscal 2004, AMR treated
and transported approximately 3.7 million patients in
34 states. AMR has approximately 2,855 contracts with
communities, government agencies, healthcare providers and
insurers to provide ambulance transport services. For fiscal
2004, approximately 57% of AMRs net revenue was generated
from emergency 911 ambulance services, 32% from non-emergency
ambulance services and the balance generated from the provision
of training, dispatch centers and other services to communities
and public safety agencies.
EmCare. Over its 33 years of operating history,
EmCare has become the largest provider of outsourced emergency
department staffing and related management services to
healthcare facilities. EmCare has a 6% share of the total
emergency department services market and a 9% share of the
outsourced emergency department services market, and has 32%
more emergency department staffing contracts than our principal
national competitor. In addition, EmCare has become one of the
leading providers of hospitalist services, the staffing of
physicians that specialize in the care of acutely ill patients
in an inpatient setting. During fiscal 2004, EmCare had
approximately 5.3 million patient visits in 38 states.
We contract with our hospital customers and our healthcare
professionals directly and through our affiliated physician
groups and managed companies. Through its 4,500 affiliated
physicians and 333 exclusive contracts with hospitals and
independent physician groups, EmCare provides emergency
department, hospitalist and radiology staffing, management and
other administrative services.
We are issuing our class A common stock in this offering.
After completion of this offering, we will have no material
assets other than direct ownership of approximately 22.1% of the
equity interest in Emergency Medical Services L.P., or
EMS L.P., the Delaware limited partnership that holds all
of the capital stock of AMR and EmCare. Onex Corporation and its
affiliates will hold the remaining 77.9% of our equity through
their ownership of LP exchangeable units in EMS L.P. The
Onex entities will control 97.7% of our voting power through our
class B special voting stock. Our only source of cash flow
from operations is distributions from EMS L.P. pursuant to
the partnership agreement.
Emergency Medical Services Industry
We operate in the ambulance and emergency department services
markets, two large and growing segments of the emergency medical
services market. Most communities are required by law to provide
emergency ambulance services and most hospitals are required to
provide emergency department services. Approximately 43% of all
hospital admissions originated from the emergency department in
2003, and a substantial portion of patients enter the hospital
by way of ambulance transport. We believe that growth in our
emergency medical services markets will continue due to
increased outsourcing for these services driven by increased
outpatient services and emergency department visits, coupled
with the need for enhanced
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technology, changes in reimbursement rates and increased federal
funding for disaster preparedness and response.
Ambulance services encompass both 911 emergency response and
non-emergency transport services. We believe the ambulance
services market represents annual expenditures of approximately
$12 billion. The ambulance services market is highly
fragmented, with more than 14,000 private, public and
not-for-profit service providers accounting for an estimated
36 million ambulance transports in 2004. Given demographic
trends, we expect the total number of ambulance transports to
continue to grow at a steady rate of 1% to 2% per year.
We believe the physician reimbursement component of the
emergency department services market represents annual
expenditures of approximately $10 billion. There are
approximately 4,700 hospitals in the United States that operate
emergency departments, of which approximately 67% outsource
their physician staffing and management for this department. The
market for outsourced emergency department staffing and related
management services is highly fragmented, with more than
800 national, regional and local providers.
Competitive Strengths
We believe the following competitive strengths position our
company to capitalize on the favorable trends occurring within
the healthcare industry and the emergency medical services
markets.
Significant Scale and Geographic Presence. We believe our
significant scale and broad geographic presence provide a
competitive advantage over local and regional providers through
our: (i) broad program offering and cost efficiencies
generated by our technology investment, which may be too costly
for certain providers to replicate; (ii) national
contracting and preferred provider relationships with managed
care organizations and healthcare systems; and
(iii) ability to recruit and retain quality personnel.
Long-Term Relationships with Existing Customers. We
believe our long-term, well-established relationships with
communities and healthcare facilities enhance our ability to
retain existing customers and win new contracts. AMR and EmCare
have maintained relationships with their ten largest customers
for an average of 34 and 12 years, respectively. We believe
our industry-leading contract retention rates reflect our
ability to deliver on our service commitments to our customers
over extended time periods.
Strong Financial Performance. One of the key factors our
potential customers evaluate is financial stability. We believe
our ability to demonstrate consistently strong financial
performance will continue to differentiate our company and
provide a competitive advantage in winning new contracts and
renewing existing contracts.
Focus on Risk Management. Our risk management initiatives
are enhanced by the use of our professional liability claims
database and comprehensive claims management at EmCare, and by
our risk/safety program at AMR. Over the last three years, our
workers compensation, auto, general and professional liability
claims per 100,000 ambulance transports decreased 8.4% at AMR
and our professional liability claims per 100,000 emergency
department visits decreased 14.0% at EmCare.
Investment in Core Technologies. AMR uses proprietary
technology to improve chart documentation, determine
transportation service levels and track response times and other
data for hospitals. EmCare uses proprietary physician
recruitment software to improve recruitment efficiency and
retention rates.
Proven and Committed Management Team. We are led by an
experienced senior management team with an average of
21 years of experience in the healthcare industry. Our
Chairman and Chief Executive Officer, William Sanger, has over
30 years of experience within the healthcare services
industry, with leadership roles in numerous areas of healthcare.
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Business Strategy
We intend to leverage Emergency Medical Services
competitive strengths to pursue our business strategy:
Increase Revenue from Existing Customers. We believe our
long track record of delivering excellent service and innovative
programs for both communities and hospitals, coupled with our
breadth of services, creates opportunities for us to increase
revenue from our existing customer base.
Grow Our Customer Base. We believe we have a unique
competency in the treatment, management and billing of episodic
and unscheduled care. We will continue to pursue additional
outsourcing opportunities for ambulance transports and emergency
department, hospitalist and radiology services and expanding our
public/private ambulance partnerships with local fire
departments.
Pursue Select Acquisition Opportunities. We plan to
pursue select acquisitions in our core businesses, explore the
acquisition of complementary businesses and seek opportunities
to expand the scope of services in which we can leverage our
core competencies.
Utilize Technology to Differentiate Our Services and Improve
Operating Efficiencies. We intend to continue to invest in
technologies that broaden our services in the marketplace,
improve patient care, enhance our billing efficiencies and
increase our profitability.
Continued Focus on Risk Management. We will continue to
conduct aggressive risk management programs for loss prevention
and early intervention. We will continue to develop and utilize
clinical fail safes and use technology in our
ambulances to reduce vehicular incidents.
Implement Cost Rationalization Initiatives. We will
continue to rationalize our cost structure by aligning
compensation with productivity and eliminating costs in our
national and regional corporate support structure.
Company History
In February 2005, an investor group led by Onex Partners LP and
Onex Corporation, and including members of our management,
purchased our operating subsidiaries AMR and
EmCare from Laidlaw International, Inc. Laidlaw had
acquired AMR and EmCare in 1997.
The purchase price for AMR and EmCare totaled
$828.8 million. We funded the purchase price and related
transaction costs with equity contributions of
$219.2 million, the issuance and sale of
$250.0 million principal amount of our senior subordinated
notes and borrowings under our senior secured credit facility,
including a term loan of $350.0 million and approximately
$20.2 million under our revolving credit facility. We
intend to use approximately $100.0 million of the net
proceeds from this offering to repay debt outstanding under our
senior secured credit facility.
Since completing our acquisition of AMR and EmCare, we have
operated through a holding company, EMS L.P., that is a limited
partnership. As described in Formation of Holding
Company, our new holding company will be a Delaware
corporation upon completion of this offering. This prospectus
gives effect to our reorganization.
The class A common stock we are selling in this offering
will represent approximately 18.9% of our equity and 2.3% of our
combined voting power. Following this offering, our initial
equity investors, including management and entities affiliated
with Onex Corporation, will continue to own approximately 81.1%
of our equity and 97.7% of our combined voting power. The Onex
entities will hold their equity in the form of LP exchangeable
units in EMS L.P., which are exchangeable on a one-for-one basis
for shares of our class B common stock, and they will have
the benefit of the voting rights attributable to that
class B common stock through one share of class B
special voting stock. See Formation of Holding
Company. Our class B common stock has ten votes per
share and our class A common stock has one vote per share.
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In exchange for an annual management fee of $1.0 million,
an affiliate of Onex Corporation provides us with corporate
finance and strategic planning consulting services. Our
management agreement has an initial term ending
February 10, 2010, subject to automatic one-year renewals
unless terminated by either party by notice given at least
90 days prior to the scheduled expiration date. The annual
fee may be increased to up to $2.0 million upon approval of
majority of the members of each of AMRs and EmCares
board of directors who are not affiliated with Onex. We have no
other arrangements by which Onex affiliates will receive
payments or compensation from us other than on an equivalent
basis to class A stockholders. See Certain
Relationships and Related Party Transactions
Management Fee Agreement with Onex Partners Manager LP.
Risk Factors
Investing in our class A common stock involves risks. You
should refer to the section entitled Risk Factors
for a discussion of certain risks you should consider before
deciding whether to invest in our class A common stock.
Executive Offices
Our principal executive offices are located at
6200 S. Syracuse Way, Suite 200, Greenwood
Village, Colorado 80111 and our telephone number at that address
is (303) 495-1200. Our website address is
www.emsc.net. The website addresses for our business
segments are www.amr.net and www.emcare.com.
Information contained on these websites is not part of this
prospectus and is not incorporated in this prospectus by
reference.
4
The Offering
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Class A common stock offered by us |
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7,800,000 shares |
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Over-allotment shares of class A common stock offered by
the selling stockholders |
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1,170,000 shares |
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Class A common stock outstanding after this offering |
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8,948,325 shares |
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Use of proceeds |
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We intend to use $100.0 million of the net proceeds from
this offering to repay debt outstanding under our senior secured
credit facility, and the balance for general corporate purposes.
See Use of Proceeds. Certain of the underwriters of
this offering or their affiliates are lenders under our senior
secured credit facility and, in that capacity, will receive a
portion of the net proceeds of this offering. |
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Proposed NYSE symbol |
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EMS |
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The number of shares of class A common stock being offered
in this offering represents 18.9% of our common stock
outstanding and 2.3% of our combined voting power. The number of
shares of our common stock to be outstanding after this offering
excludes the 32,107,500 shares of class B common stock
issuable on exchange of the LP exchangeable units and the
3,509,219 shares of class A common stock issuable upon
the exercise of options. |
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Following this offering, we will have the following securities
outstanding: |
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8,948,325 shares of class A common stock, |
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142,545 shares of class B common stock, |
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one share of class B special voting stock, and |
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32,107,500 LP exchangeable units of EMS L.P. |
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At any time at the option of the holder: |
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each LP exchangeable unit is exchangeable into one share of
class B common stock, and |
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each share of class B common stock is convertible into one
share of class A common stock. |
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Our securities are entitled to vote on all matters subject to a
vote of holders of common stock, voting together as a single
class, as follows: |
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class A common stock is entitled to one vote per share, |
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class B common stock is entitled to ten votes per share
(reducing to one vote per share under certain limited
circumstances), and |
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one share of class B special voting stock, held for the
benefit of the holders of LP exchangeable units, is entitled to
a number of votes equal to the number of votes that could be
cast if all the then outstanding LP exchangeable units were
exchanged for class B common stock. |
The holders of the LP exchangeable units may therefore exercise
voting rights with respect to Emergency Medical Services as
though they held the same number of shares of our class B
common stock.
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Except as otherwise indicated, all of the information presented
in this prospectus assumes the following: |
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our formation as a holding company named Emergency Medical
Services Corporation, as described under Formation of
Holding Company, |
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the anticipated 1.5-for-1 stock split based upon an assumed
initial public offering price of $16.00 per share, which is
the mid-point of the range set forth in the cover page of this
prospectus, and |
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no exercise of the underwriters over-allotment option. |
5
Summary of Historical Combined, Consolidated and Pro Forma
Consolidated Financial Information and Other Data
The summary combined financial data of AMR and EmCare for the
year ended August 31, 2002 (Predecessor
Pre-Laidlaw Bankruptcy), the nine months ended May 31, 2003
(Predecessor Pre-Laidlaw Bankruptcy), and as of and
for the three months ended August 31, 2003
(Predecessor Post-Laidlaw Bankruptcy), the year
ended August 31, 2004 (Predecessor Post-Laidlaw
Bankruptcy) and the five months ended January 31, 2005
(Predecessor Post-Laidlaw Bankruptcy) are derived
from our audited combined historical financial statements
included in this prospectus. As a result of a correction to
AMRs method of calculating its accounts receivable
allowances, we determined that the allowances were understated
at various balance sheet dates. The audited combined financial
statements included in this prospectus are restated to correct
this error. There were no adjustments necessary to income
subsequent to May 31, 2003.
The summary combined historical financial data for the five
months ended January 31, 2004 (Predecessor
Post-Laidlaw Bankruptcy) and the three months and eight months
ended September 30, 2004 (Predecessor
Post-Laidlaw Bankruptcy) are derived from the unaudited combined
historical financial statements included in this prospectus. The
summary consolidated financial data for the three months and
eight months ended September 30, 2005 (Successor) are
derived from the unaudited consolidated historical financial
statements included elsewhere in this prospectus. The interim
financial statements include, in the opinion of management, all
adjustments, consisting of normal accruals, necessary for a fair
presentation of the information for those periods. The results
of operations for the interim periods may not be indicative of
results that may be expected for the full fiscal year.
The summary pro forma consolidated financial information and
other data for the year ended August 31, 2004, the five
months ended January 31, 2005 and the eight months ended
September 30, 2005 reflect the acquisition of AMR and
EmCare by Emergency Medical Services and the completion of this
offering, and should be read in conjunction with our unaudited
pro forma consolidated financial statements included elsewhere
in this prospectus which, with respect to statement of
operations data, give effect to the acquisition and this
offering as if they occurred as of September 1, 2003,
September 1, 2004 and February 1, 2005, respectively,
and with respect to balance sheet data, give effect to this
offering as if it occurred as of September 30, 2005. The
unaudited pro forma consolidated financial information is
presented for informational purposes only and does not purport
to represent what our results of operations would have been if
our acquisition of AMR and EmCare and this offering had occurred
as of the dates indicated or what such results will be for
future periods.
Effective as of January 31, 2005, we acquired AMR and
EmCare from Laidlaw and, in connection with the acquisition, we
changed our fiscal year to December 31 from August 31. For all
periods prior to the acquisition, the AMR and EmCare businesses
formerly owned by Laidlaw are referred to as the
Predecessor. For all periods from and subsequent to
the acquisition, these businesses are referred to as the
Successor. As a result of the acquisition, we
include as a reporting period of the Predecessor our
pre-acquisition period ended January 31, 2005.
You should read the summary information in conjunction with
Selected Combined and Consolidated Financial Information
and Other Data, Unaudited Pro Forma Consolidated
Financial Data, Managements Discussion and
Analysis of Financial Condition and Results of Operations
and the combined and consolidated financial statements and
related notes included in this prospectus.
6
|
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|
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|
|
|
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|
|
|
|
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|
Predecessor (Pre-Acquisition) | |
|
|
|
|
|
|
|
|
|
|
|
|
|
| |
|
|
| |
|
|
|
|
|
|
|
|
|
|
|
|
|
(Pre-Laidlaw | |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Bankruptcy) | |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
As Restated | |
|
|
(Post-Laidlaw Bankruptcy) | |
|
|
|
|
|
|
|
| |
|
|
| |
|
|
Successor (Post-Acquisition) | |
|
Unaudited Pro Forma | |
|
|
|
|
Nine | |
|
|
Three | |
|
|
|
|
|
|
|
|
| |
|
| |
|
|
|
|
Months | |
|
|
Months | |
|
|
|
Five Months Ended | |
|
Three Months | |
|
Eight Months | |
|
|
Three Months | |
|
Eight Months | |
|
|
|
Five Months | |
|
Eight Months | |
|
|
Year Ended | |
|
Ended | |
|
|
Ended | |
|
Year Ended | |
|
January 31, | |
|
Ended | |
|
Ended | |
|
|
Ended | |
|
Ended | |
|
Year Ended | |
|
Ended | |
|
Ended | |
|
|
August 31, | |
|
May 31, | |
|
|
August 31, | |
|
August 31, | |
|
| |
|
September 30, | |
|
September 30, | |
|
|
September 30, | |
|
September 30, | |
|
August 31, | |
|
January 31, | |
|
September 30, | |
|
|
2002 | |
|
2003 | |
|
|
2003 | |
|
2004 | |
|
2004 | |
|
2005 | |
|
2004 | |
|
2004 | |
|
|
2005 | |
|
2005 | |
|
2004 | |
|
2005 | |
|
2005 | |
|
|
| |
|
| |
|
|
| |
|
| |
|
| |
|
| |
|
| |
|
| |
|
|
| |
|
| |
|
| |
|
| |
|
| |
|
|
|
|
|
|
|
|
|
|
|
(unaudited) | |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
(unaudited) | |
|
|
(unaudited) | |
|
|
|
|
|
|
|
|
|
|
|
|
|
(dollars in thousands) | |
|
|
|
|
|
|
|
|
|
Statement of Operations Data:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Net revenue
|
|
$ |
1,415,786 |
|
|
$ |
1,103,335 |
|
|
|
$ |
384,461 |
|
|
$ |
1,604,598 |
|
|
$ |
667,506 |
|
|
$ |
696,179 |
|
|
$ |
413,869 |
|
|
$ |
1,077,749 |
|
|
|
$ |
456,245 |
|
|
$ |
1,187,653 |
|
|
$ |
1,604,598 |
|
|
$ |
696,179 |
|
|
$ |
1,187,653 |
|
Compensation and benefits
|
|
|
960,590 |
|
|
|
757,183 |
|
|
|
|
264,604 |
|
|
|
1,117,890 |
|
|
|
461,923 |
|
|
|
481,305 |
|
|
|
286,628 |
|
|
|
751,238 |
|
|
|
|
319,292 |
|
|
|
822,595 |
|
|
|
1,117,890 |
|
|
|
481,305 |
|
|
|
822,595 |
|
Operating expenses
|
|
|
219,321 |
|
|
|
163,447 |
|
|
|
|
55,212 |
|
|
|
218,277 |
|
|
|
90,828 |
|
|
|
94,882 |
|
|
|
55,863 |
|
|
|
147,524 |
|
|
|
|
66,156 |
|
|
|
168,700 |
|
|
|
218,277 |
|
|
|
94,882 |
|
|
|
168,700 |
|
Insurance expense
|
|
|
66,479 |
|
|
|
69,576 |
|
|
|
|
34,671 |
|
|
|
80,255 |
|
|
|
36,664 |
|
|
|
39,002 |
|
|
|
18,404 |
|
|
|
51,674 |
|
|
|
|
21,048 |
|
|
|
60,382 |
|
|
|
80,255 |
|
|
|
39,002 |
|
|
|
60,382 |
|
Selling, general and administrative expenses
|
|
|
61,455 |
|
|
|
37,867 |
|
|
|
|
12,017 |
|
|
|
47,899 |
|
|
|
22,016 |
|
|
|
21,635 |
|
|
|
12,093 |
|
|
|
31,270 |
|
|
|
|
15,654 |
|
|
|
38,248 |
|
|
|
47,899 |
|
|
|
21,635 |
|
|
|
38,248 |
|
Laidlaw fees and compensation charges
|
|
|
5,400 |
|
|
|
4,050 |
|
|
|
|
1,350 |
|
|
|
15,449 |
|
|
|
6,436 |
|
|
|
19,857 |
|
|
|
3,657 |
|
|
|
10,095 |
|
|
|
|
|
|
|
|
|
|
|
|
15,449 |
|
|
|
19,857 |
|
|
|
|
|
Depreciation and amortization expenses
|
|
|
67,183 |
|
|
|
32,144 |
|
|
|
|
12,560 |
|
|
|
52,739 |
|
|
|
22,079 |
|
|
|
18,808 |
|
|
|
12,669 |
|
|
|
34,627 |
|
|
|
|
14,843 |
|
|
|
38,811 |
|
|
|
55,869 |
|
|
|
23,232 |
|
|
|
38,811 |
|
Impairment losses
|
|
|
262,780 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Restructuring charges
|
|
|
3,777 |
|
|
|
1,288 |
|
|
|
|
1,449 |
|
|
|
2,115 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
1,381 |
|
|
|
|
|
|
|
|
|
|
|
|
2,115 |
|
|
|
|
|
|
|
|
|
Laidlaw reorganization charges
|
|
|
8,761 |
|
|
|
3,650 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Income (loss) from operations
|
|
|
(239,960 |
) |
|
|
34,130 |
|
|
|
|
2,598 |
|
|
|
69,974 |
|
|
|
27,560 |
|
|
|
20,690 |
|
|
|
24,555 |
|
|
|
49,940 |
|
|
|
|
19,252 |
|
|
|
58,917 |
|
|
|
66,844 |
|
|
|
16,266 |
|
|
|
58,917 |
|
Interest expense
|
|
|
(6,418 |
) |
|
|
(4,691 |
) |
|
|
|
(908 |
) |
|
|
(9,961 |
) |
|
|
(4,137 |
) |
|
|
(5,644 |
) |
|
|
(5,138 |
) |
|
|
(8,679 |
) |
|
|
|
(12,824 |
) |
|
|
(34,407 |
) |
|
|
(47,051 |
) |
|
|
(18,555 |
) |
|
|
(29,895 |
) |
Realized gain (loss) on investments
|
|
|
|
|
|
|
|
|
|
|
|
90 |
|
|
|
(1,140 |
) |
|
|
|
|
|
|
|
|
|
|
(1,140 |
) |
|
|
(1,191 |
) |
|
|
|
(34 |
) |
|
|
(40 |
) |
|
|
(1,140 |
) |
|
|
|
|
|
|
(40 |
) |
Interest and other income
|
|
|
369 |
|
|
|
304 |
|
|
|
|
22 |
|
|
|
240 |
|
|
|
1,403 |
|
|
|
714 |
|
|
|
162 |
|
|
|
210 |
|
|
|
|
91 |
|
|
|
189 |
|
|
|
240 |
|
|
|
714 |
|
|
|
189 |
|
Fresh-start accounting adjustments(1)
|
|
|
|
|
|
|
46,416 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Income (loss) before income taxes and cumulative change in
accounting principle
|
|
|
(246,009 |
) |
|
|
76,159 |
|
|
|
|
1,802 |
|
|
|
59,113 |
|
|
|
24,826 |
|
|
|
15,760 |
|
|
|
18,439 |
|
|
|
40,280 |
|
|
|
|
6,485 |
|
|
|
24,659 |
|
|
|
18,893 |
|
|
|
(1,575 |
) |
|
|
29,171 |
|
Income tax expense
|
|
|
(1,374 |
) |
|
|
(829 |
) |
|
|
|
(8,633 |
) |
|
|
(21,764 |
) |
|
|
(9,800 |
) |
|
|
(6,278 |
) |
|
|
(7,191 |
) |
|
|
(15,710 |
) |
|
|
|
(3,479 |
) |
|
|
(10,657 |
) |
|
|
(5,764 |
) |
|
|
629 |
|
|
|
(12,462 |
) |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Income (loss) before cumulative effect of a change in accounting
principle
|
|
|
(247,383 |
) |
|
|
75,330 |
|
|
|
|
(6,831 |
) |
|
|
37,349 |
|
|
|
15,026 |
|
|
|
9,482 |
|
|
|
11,248 |
|
|
|
24,570 |
|
|
|
|
3,006 |
|
|
|
14,002 |
|
|
|
13,129 |
|
|
|
(946 |
) |
|
|
16,709 |
|
Cumulative effect of a change in accounting principle(2)
|
|
|
|
|
|
|
(223,721 |
) |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Net income (loss)
|
|
$ |
(247,383 |
) |
|
$ |
(148,391 |
) |
|
|
$ |
(6,831 |
) |
|
$ |
37,349 |
|
|
$ |
15,026 |
|
|
$ |
9,482 |
|
|
$ |
11,248 |
|
|
$ |
24,570 |
|
|
|
$ |
3,006 |
|
|
$ |
14,002 |
|
|
$ |
13,129 |
|
|
$ |
(946 |
) |
|
$ |
16,709 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Predecessor (Pre-Acquisition) | |
|
|
|
|
|
|
|
|
|
|
|
|
|
| |
|
|
| |
|
|
|
|
|
|
|
|
|
|
|
|
|
(Pre-Laidlaw | |
|
|
|
|
|
|
|
Successor | |
|
|
|
|
|
|
|
|
Bankruptcy) | |
|
|
|
|
|
|
|
(Post- | |
|
|
|
|
|
|
|
|
As Restated | |
|
|
(Post-Laidlaw Bankruptcy) | |
|
|
|
|
Acquisition) | |
|
|
|
|
|
|
|
|
| |
|
|
| |
|
|
|
|
| |
|
|
|
|
|
|
|
|
|
|
Nine | |
|
|
Three | |
|
|
|
|
|
|
|
|
|
|
Eight | |
|
|
|
|
|
|
|
|
Year | |
|
Months | |
|
|
Months | |
|
Year | |
|
Five Months Ended | |
|
|
|
Eight Months | |
|
|
|
|
Months | |
|
|
|
|
|
|
|
|
Ended | |
|
Ended | |
|
|
Ended | |
|
Ended | |
|
January 31, | |
|
|
|
Ended | |
|
|
|
|
Ended | |
|
|
|
|
|
|
|
|
August 31, | |
|
May 31, | |
|
|
August 31, | |
|
August 31, | |
|
| |
|
|
|
September 30, | |
|
|
|
|
September 30, | |
|
|
|
|
|
|
|
|
2002 | |
|
2003 | |
|
|
2003 | |
|
2004 | |
|
2004 | |
|
2005 | |
|
|
|
2004 | |
|
|
|
|
2005 | |
|
|
|
|
|
|
|
|
| |
|
| |
|
|
| |
|
| |
|
| |
|
| |
|
|
|
| |
|
|
|
|
| |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
(unaudited) | |
|
|
|
|
|
(unaudited) | |
|
|
|
|
(unaudited) | |
|
|
|
|
|
|
|
|
|
|
|
|
|
(dollars in thousands) | |
|
|
|
|
|
|
|
|
|
|
|
Other Financial Data:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Cash flow provided by (used in):
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Operating activities
|
|
$ |
156,544 |
|
|
$ |
58,769 |
|
|
|
$ |
30,009 |
|
|
$ |
127,679 |
|
|
$ |
18,627 |
|
|
$ |
15,966 |
|
|
|
|
|
|
$ |
99,961 |
|
|
|
|
|
|
|
$ |
108,462 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Investing activities
|
|
|
(57,347 |
) |
|
|
(98,835 |
) |
|
|
|
(15,136 |
) |
|
|
(81,516 |
) |
|
|
(10,881 |
) |
|
|
(21,667 |
) |
|
|
|
|
|
|
(73,910 |
) |
|
|
|
|
|
|
|
(917,422 |
) |
|
|
|
|
|
|
|
|
|
|
|
|
|
Financing activities
|
|
|
(36,066 |
) |
|
|
(8,060 |
) |
|
|
|
(47,222 |
) |
|
|
(47,328 |
) |
|
|
(7,532 |
) |
|
|
10,856 |
|
|
|
|
|
|
|
(20,699 |
) |
|
|
|
|
|
|
|
804,442 |
|
|
|
|
|
|
|
|
|
|
|
|
|
Capital expenditures
|
|
|
57,438 |
(3) |
|
|
34,768 |
|
|
|
|
18,079 |
|
|
|
42,787 |
|
|
|
14,224 |
|
|
|
14,045 |
|
|
|
|
|
|
|
(30,217 |
) |
|
|
|
|
|
|
|
34,947 |
|
|
|
|
|
|
|
|
|
|
|
|
|
EBITDA(4)
|
|
$ |
(172,777 |
) |
|
$ |
(111,031 |
)(5) |
|
|
$ |
15,428 |
|
|
$ |
121,753 |
|
|
$ |
49,639 |
|
|
|
39,498 |
|
|
|
|
|
|
|
83,376 |
|
|
|
|
|
|
|
|
97,688 |
|
|
|
|
|
|
|
|
|
|
|
|
|
EBITDA, as adjusted(4) |
|
$ |
59,355 |
|
|
|
|
|
|
$ |
94,852 |
|
|
|
|
|
|
|
$ |
102,948 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
As of September 30, 2005 | |
|
|
| |
|
|
Consolidated | |
|
Pro Forma | |
|
|
| |
|
| |
Balance Sheet Data:
|
|
|
|
|
|
|
|
|
Cash and cash equivalents
|
|
$ |
10,113 |
|
|
$ |
21,677 |
|
Total assets
|
|
|
1,253,408 |
|
|
|
1,261,994 |
|
Long-term debt and capital lease obligations, including current
maturities
|
|
|
608,607 |
|
|
|
508,607 |
|
Partners/ Stockholders equity
|
|
$ |
235,534 |
|
|
$ |
345,333 |
|
Financial Covenant Ratios(6):
|
|
|
|
|
|
|
|
|
Total leverage ratio
|
|
|
4.05 |
|
|
|
3.39 |
|
Senior leverage ratio
|
|
|
2.39 |
|
|
|
1.72 |
|
Fixed charge coverage ratio
|
|
|
1.64 |
|
|
|
1.70 |
|
|
|
(1) |
See note 1 to our combined financial statements with
respect to our fresh-start financial reporting. |
(2) |
Reflects an impairment of goodwill recorded in connection with
the adoption of SFAS No. 142. |
(3) |
Includes $26.3 million financed through capital leases. |
(4) |
EBITDA represents net income (loss) before interest expense,
net, income tax expense and depreciation and amortization
expenses. Adjusted EBITDA represents EBITDA adjusted to remove
the effect of the Laidlaw allocations of management fees and
compensation charges, insurance expenses, rebates and
reorganization costs, Onex management fees and certain
non-recurring items. Management routinely calculates EBITDA and
uses it to allocate resources. Management believes that EBITDA
is a useful measure to investors because it is commonly used as
an analytical indicator within the healthcare industry to
evaluate operational performance, leverage capacity and ability
to service debt. |
7
|
|
|
|
|
Adjusted EBITDA is used as a
measure for various financial covenants in our senior secured
credit facility, and we use adjusted EBITDA as a measure for
incentive compensation purposes. EBITDA and adjusted EBITDA
should not be considered in isolation or as an alternative to
net income, cash flows generated by operating, investing or
financing activities or other financial statement data presented
in the combined and consolidated financial statements as an
indicator of financial performance or liquidity. EBITDA and
adjusted EBITDA, as presented, may not be comparable to
similarly titled measures of other companies.
|
The following table reconciles EBITDA and EBITDA, as adjusted to
net income (loss):
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Predecessor (Pre-Acquisition) | |
|
|
|
|
|
| |
|
|
| |
|
|
|
|
|
(Pre-Laidlaw | |
|
|
|
|
|
|
|
|
Bankruptcy) | |
|
|
|
|
|
|
|
|
As Restated | |
|
|
(Post-Laidlaw Bankruptcy) | |
|
|
|
|
|
| |
|
|
| |
|
|
Successor | |
|
|
|
|
|
|
|
|
(Post-Acquisition) | |
|
|
|
|
|
|
|
|
|
|
|
|
| |
|
|
|
|
Nine | |
|
|
Three | |
|
|
|
Five Months | |
|
|
|
|
|
|
|
|
|
Months | |
|
|
Months | |
|
|
|
Ended | |
|
Eight Months | |
|
|
Eight Months | |
|
|
Year Ended | |
|
Ended | |
|
|
Ended | |
|
Year Ended | |
|
January 31, | |
|
Ended | |
|
|
Ended | |
|
|
August 31, | |
|
May 31, | |
|
|
August 31, | |
|
August 31, | |
|
| |
|
September 30, | |
|
|
September 30, | |
|
|
2002 | |
|
2003 | |
|
|
2003 | |
|
2004 | |
|
2004 | |
|
2005 | |
|
2004 | |
|
|
2005 | |
|
|
| |
|
| |
|
|
| |
|
| |
|
| |
|
| |
|
| |
|
|
| |
Combined/Consolidated Results:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Net income (loss)
|
|
$ |
(247,383 |
) |
|
$ |
(148,391 |
) |
|
|
$ |
(6,831 |
) |
|
$ |
37,349 |
|
|
$ |
15,026 |
|
|
$ |
9,482 |
|
|
$ |
24,570 |
|
|
|
$ |
14,002 |
|
Depreciation and amortization expenses
|
|
|
67,183 |
|
|
|
32,144 |
|
|
|
|
12,560 |
|
|
|
52,739 |
|
|
|
22,079 |
|
|
|
18,808 |
|
|
|
34,627 |
|
|
|
|
38,811 |
|
Interest expense
|
|
|
6,418 |
|
|
|
4,691 |
|
|
|
|
908 |
|
|
|
9,961 |
|
|
|
4,137 |
|
|
|
5,644 |
|
|
|
8,679 |
|
|
|
|
34,407 |
|
Interest and other income
|
|
|
(369 |
) |
|
|
(304 |
) |
|
|
|
(22 |
) |
|
|
(240 |
) |
|
|
(1,403 |
) |
|
|
(714 |
) |
|
|
(210 |
) |
|
|
|
(189 |
) |
Income tax expense
|
|
|
1,374 |
|
|
|
829 |
|
|
|
|
8,633 |
|
|
|
21,764 |
|
|
|
9,800 |
|
|
|
6,278 |
|
|
|
15,710 |
|
|
|
|
10,657 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
EBITDA(a)
|
|
$ |
(172,777 |
) |
|
$ |
(111,031 |
) |
|
|
$ |
15,248 |
|
|
$ |
121,573 |
|
|
$ |
49,639 |
|
|
|
39,498 |
|
|
|
83,376 |
|
|
|
|
97,688 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Laidlaw fees and compensation charges
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
19,857 |
|
|
|
10,095 |
|
|
|
|
|
|
Onex management fee
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
667 |
|
Transaction related costs
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
2,131 |
|
Non-cash charges
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
2,462 |
|
Restructuring charges
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
1,381 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
EBITDA, as adjusted
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
$ |
59,355 |
|
|
$ |
94,852 |
|
|
|
$ |
102,948 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
(a) |
EBITDA for periods presented includes Laidlaws allocation
to us of fees and compensation charges, insurance expenses and
rebates and reorganization costs. Laidlaws allocations to
us of fees and compensation charges and of reorganization costs
are based on allocations among all of Laidlaws business
units based on revenues, plus an additional amount allocated to
us in respect of a one-time compensation expense related to the
changes in the enterprise values of AMR and EmCare.
Laidlaws allocation to us of insurance expense and rebates
is based on an allocation of investment income of Laidlaws
captive insurance subsidiary among all of Laidlaws
business units based on revenues, and an allocation of claims
among Laidlaws business units based on each business
units claims experience. We do not believe that
Laidlaws allocation of these expenses and rebates are
predictive of expenses and rebates we expect to incur as a
stand-alone company in respect of management services or for
comparable stand-alone insurance costs. Laidlaws
allocation of these expenses and rebates for the historical
periods presented were as follows: |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Predecessor (Pre-Acquisition) | |
|
|
| |
|
|
| |
|
|
(Pre-Laidlaw | |
|
|
|
|
|
Bankruptcy) | |
|
|
(Post-Laidlaw Bankruptcy) | |
|
|
| |
|
|
| |
|
|
|
|
Nine | |
|
|
Three | |
|
|
|
|
|
|
|
|
Year | |
|
Months | |
|
|
Months | |
|
Year | |
|
Five Months Ended | |
|
Three Months | |
|
Eight Months | |
|
|
Ended | |
|
Ended | |
|
|
Ended | |
|
Ended | |
|
January 31, | |
|
Ended | |
|
Ended | |
|
|
August 31, | |
|
May 31, | |
|
|
August 31, | |
|
August 31, | |
|
| |
|
September 30, | |
|
September 30, | |
|
|
2002 | |
|
2003 | |
|
|
2003 | |
|
2004 | |
|
2004 | |
|
2005 | |
|
2004 | |
|
2004 | |
|
|
| |
|
| |
|
|
| |
|
| |
|
| |
|
| |
|
| |
|
| |
|
|
|
|
|
|
|
|
|
|
|
(unaudited) | |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
(unaudited) | |
|
|
(dollars in thousands) | |
Laidlaw insurance expense (rebate)(a)
|
|
$ |
(8,094 |
) |
|
$ |
3,058 |
|
|
|
$ |
11,522 |
|
|
$ |
(4,505 |
) |
|
$ |
|
|
|
$ |
|
|
|
$ |
|
|
|
$ |
|
|
Laidlaw fees and compensation charges
|
|
|
5,400 |
|
|
|
4,050 |
|
|
|
|
1,350 |
|
|
|
15,449 |
(b) |
|
|
6,436 |
|
|
|
19,857 |
(c) |
|
|
3,657 |
|
|
|
10,095 |
|
Laidlaw reorganization costs
|
|
|
8,761 |
|
|
|
3,650 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Total Laidlaw allocated expense
|
|
$ |
6,067 |
|
|
$ |
10,758 |
|
|
|
$ |
12,872 |
|
|
$ |
10,944 |
|
|
$ |
6,436 |
|
|
$ |
19,857 |
|
|
$ |
3,657 |
|
|
$ |
10,095 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
(a) |
Included in Insurance expense in our combined
statements of operations. |
|
|
(b) |
Includes compensation charges of $4.1 million. |
|
|
|
We estimate that the costs we will incur in respect of
management services and other costs as a stand-alone company
will total approximately $4.0 million a year. See note
(1) to the unaudited pro forma consolidated statement of
operations for the five months ended January 31, 2005
and the year ended August 31, 2004 in Unaudited Pro
Forma Consolidated Financial Data. We incurred
$1.9 million of such costs in the eight months ended
September 30, 2005, excluding costs related to our
acquisition of AMR and EmCare. |
|
|
|
|
(c) |
Includes compensation charges of $15.3 million. |
|
|
(5) |
Includes $46.4 million relating to the fresh-start
accounting adjustment and $(223.7) million relating to the
cumulative effect of a change in accounting principle. |
|
(6) |
Represents financial covenant coverages, calculated in
accordance with our senior secured credit facility. See
Managements Discussion and Analysis of Financial
Condition and Results of Operations Liquidity and
Capital Resources Debt Facilities for
information with respect to required coverages at
September 30, 2005 and the calculation of these ratios. |
8
RISK FACTORS
An investment in our class A common stock involves a high
degree of risk. You should carefully consider the factors
described below in addition to the other information set forth
in this prospectus before deciding whether to make an investment
in our class A common stock. Additional risks and
uncertainties not presently known to us or that we currently
believe to be immaterial may also materially and adversely
affect our business operations. Any of the following risks could
materially adversely affect our business, financial condition or
results of operations. In such case, you may lose all or part of
your original investment.
Risk Factors Related to our Capital Structure
The interests of our controlling stockholders may conflict
with your interests.
Following this offering, Onex Partners LP and other entities
affiliated with Onex Corporation, which we refer to together as
the Onex entities, will own all of our outstanding LP
exchangeable units, which are exchangeable at any time, at the
option of the holder, for our class B common stock. Our
class A common stock has one vote per share, while our
class B common stock has ten votes per share (reducing to
one vote per share under certain limited circumstances), on all
matters to be voted on by our stockholders. Prior to the
exchange for class B common stock, the holders of the LP
exchangeable units will be able to exercise the same voting
rights with respect to Emergency Medical Services as they would
have after the exchange through a share of class B special
voting stock. As a result, after this offering, the Onex
entities will control 96.6% of our combined voting power.
Accordingly, the Onex entities will exercise a controlling
influence over our business and affairs and will have the power
to determine all matters submitted to a vote of our
stockholders, including the election of directors, the removal
of directors and approval of significant corporate transactions
such as amendments to our certificate of incorporation, mergers
and the sale of all or substantially all of our assets. The Onex
entities could cause corporate actions to be taken even if the
interests of these entities conflict with the interests of our
other stockholders. This concentration of voting power could
have the effect of deterring or preventing a change in control
of Emergency Medical Services that might otherwise be beneficial
to our stockholders. Gerald W. Schwartz, the Chairman, President
and Chief Executive Officer of Onex Corporation, owns shares
representing a majority of the voting rights of the shares of
Onex Corporation. See Principal and Selling
Stockholders, Description of Capital Stock and
Limited Partnership Agreement of Emergency Medical
Services L.P.
Onex has the voting power to elect our entire board of
directors and to remove any director or our entire board without
cause.
Although our current board includes independent
directors, so long as the Onex entities control more than
50% of our combined voting power we are exempt from the NYSE
rule that requires that a board be comprised of a majority of
independent directors. Onex may have a controlling
influence over our board, as Onex has sufficient voting power to
elect the entire board, and our certificate of incorporation
permits stockholders to remove directors at any time with or
without cause.
As a holding company, our only material asset is our
equity interest in EMS L.P. and our only source of revenue is
distributions from EMS L.P. Because the Onex entities have the
voting power to control our board of directors, they could
influence us, as the general partner of EMS L.P., to take action
at the level of EMS L.P. that would benefit the Onex entities
and conflict with the interests of our class A
stockholders.
We are a holding company, and we will have no material assets
other than our direct ownership of an approximately 22% equity
interest in EMS L.P. EMS L.P. will also be our only source of
cash flow from operations. The Onex entities hold their equity
interest in us through LP exchangeable units of EMS L.P. As our
controlling stockholder, Onex could limit distributions to us
from EMS L.P., and could cause us to amend the EMS L.P.
partnership agreement in a manner that would be beneficial to
the Onex entities, as limited partners of EMS L.P., and
detrimental to our class A stockholders.
Any decrease in our distributions from EMS L.P. would have a
negative effect on our cash flow. In order to minimize this
conflict, the EMS L.P. partnership agreement requires that the
partnership reimburse
9
us for all of our expenses, including all employee costs and the
expenses we incur as a public company, and provides further that
no distributions may be made to the Onex entities, as the
holders of LP exchangeable units, unless we make pay an
economically equivalent dividend to all holders of our common
stock.
The EMS L.P. partnership agreement provides that amendments to
that agreement may only be proposed and authorized by us, as the
general partner. The Onex entities could seek to influence our
boards action with respect to any amendment and we, as the
general partner of EMS L.P., owe a fiduciary duty to the limited
partners of the partnership. Our board also owes a fiduciary
duty to our common stockholders. Because of the inherent
conflict of interest we face between our fiduciary duty to our
stockholders, including our class A stockholders, and the Onex
entities, as limited partners in EMS L.P., the EMS L.P.
partnership agreement provides that, if there is any conflict
between the interests of the limited partners and our common
stockholders, our board may, in the exercise of its business
judgment, cause us to act in the best interests of our
stockholders.
We are party to a management agreement with an affiliate
of Onex which permits us to increase substantially the fee we
pay to that affiliate.
The management agreement between our subsidiaries, AMR and
EmCare, and an Onex affiliate provides that the annual fee may
be increased from $1.0 million to $2.0 million, which
amount represents a significant percentage of our net income.
Such an increase would be detrimental to the interests of our
class A stockholders if the fee were disproportionate to the
benefit we derive from the services the Onex affiliate performs.
In order to minimize this potential conflict of interest, the
agreement requires that any increase in the fee be approved by a
majority of the members of the boards of AMR and EmCare who are
not affiliated with Onex. As long as the Onex entities control
more than 50% of our combined voting power, they may be able to
exercise a controlling influence over the election of the boards
of AMR and EmCare. See Certain Relationships and Related
Party Transactions Management Fee Agreement with
Onex Partners Manager LP.
Our substantial indebtedness could adversely affect our
financial condition and our ability to operate our
business.
We have a substantial amount of debt. At September 30,
2005, we had total debt of $608.6 million, including
$348.3 million of borrowings under the term loan portion of
our senior secured credit facility, $250.0 million of our
senior subordinated notes, $5.0 million of borrowings under
our revolving credit facility and $4.4 million of capital
lease obligations, and we had $27.3 million of letters of
credit outstanding. In addition, subject to restrictions in the
indenture governing our notes and the credit agreement governing
our senior secured credit facility, we may incur additional debt.
Our substantial debt could have important consequences to you,
including the following:
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it may be difficult for us to satisfy our obligations, including
debt service requirements under our outstanding debt, |
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our ability to obtain additional financing for working capital,
capital expenditures, debt service requirements or other general
corporate purposes may be impaired, |
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we must use a significant portion of our cash flow for payments
on our debt, which will reduce the funds available to us for
other purposes, |
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we are more vulnerable to economic downturns and adverse
industry conditions and our flexibility to plan for, or react
to, changes in our business or industry is more limited, |
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our ability to capitalize on business opportunities and to react
to competitive pressures, as compared to our competitors, may be
compromised due to our high level of debt, and |
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our ability to borrow additional funds or to refinance debt may
be limited. |
Furthermore, all of our debt under our senior secured credit
facility bears interest at variable rates. If these rates were
to increase significantly, our ability to borrow additional
funds may be reduced and the risks related to our substantial
debt would intensify.
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Servicing our debt will require a significant amount of
cash. Our ability to generate sufficient cash depends on
numerous factors beyond our control, and we may be unable to
generate sufficient cash flow to service our debt
obligations.
Our business may not generate sufficient cash flow from
operating activities. The cash we require to meet contractual
obligations in 2006, including our debt service, will total
approximately $89.7 million. Our ability to make payments
on and to refinance our debt and to fund planned capital
expenditures will depend on our ability to generate cash in the
future. To some extent, this is subject to general economic,
financial, competitive, legislative, regulatory and other
factors that are beyond our control. Lower net revenues, or
higher provision for uncollectibles, generally will reduce our
cash flow.
If we are unable to generate sufficient cash flow to service our
debt and meet our other commitments, we may need to refinance
all or a portion of our debt, sell material assets or operations
or raise additional debt or equity capital. We cannot assure you
that we could effect any of these actions on a timely basis, on
commercially reasonable terms or at all, or that these actions
would be sufficient to meet our capital requirements. In
addition, the terms of our existing or future debt agreements
may restrict us from effecting any of these alternatives.
Restrictive covenants in our senior secured credit
facility and the indenture governing our senior subordinated
notes may restrict our ability to pursue our business
strategies.
Our senior secured credit facility and the indenture governing
our senior subordinated notes limit our ability, among other
things, to:
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incur additional debt or issue certain preferred stock, |
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pay dividends or make distributions to our stockholders, |
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repurchase or redeem our capital, |
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make investments, |
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incur liens, |
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make capital expenditures, |
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enter into transactions with our stockholders and affiliates, |
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sell certain assets, |
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acquire the assets of, or merge or consolidate with, other
companies, and |
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incur restrictions on the ability of our subsidiaries to make
distributions or transfer assets to us. |
Our ability to comply with these covenants may be affected by
events beyond our control, and any material deviations from our
forecasts could require us to seek waivers or amendments of
covenants, alternative sources of financing or reductions in
expenditures. We cannot assure you that such waivers, amendments
or alternative financings could be obtained, or, if obtained,
would be on terms acceptable to us.
In addition, the credit agreement governing our senior secured
credit facility requires us to meet certain financial ratios and
restricts our ability to make capital expenditures or prepay
certain other debt. We may not be able to maintain these ratios,
and the restrictions could limit our ability to plan for or
react to market conditions or meet extraordinary capital needs
or otherwise restrict corporate activities.
If a breach of any covenant or restriction contained in our
financing agreements results in an event of default, those
lenders could discontinue lending, accelerate the related debt
(which would accelerate other debt) and declare all borrowings
outstanding thereunder to be due and payable. In addition, the
lenders could terminate any commitments they had made to supply
us with additional funds. In the event of an acceleration of our
debt, we may not have or be able to obtain sufficient funds to
make any accelerated debt payments.
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Our obligations under our senior secured credit facility
are secured by substantially all of our assets.
Our obligations under our senior secured credit facility are
secured by liens on substantially all of our assets, and the
guarantees of our subsidiaries under our senior secured credit
facility are secured by liens on substantially all of those
subsidiaries assets. If we become insolvent or are
liquidated, or if payment under our senior secured credit
facility or of other secured obligations are accelerated, the
lenders under our senior secured credit facility or the obligees
with respect to the other secured obligations will be entitled
to exercise the remedies available to a secured lender under
applicable law and the applicable agreements and instruments,
including the right to foreclose on all of our assets.
Accordingly, you could lose all or a part of your investment in
our common stock.
Risk Factors Related to Our Business
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We could be subject to lawsuits for which we are not fully
reserved. |
In recent years, physicians, hospitals and other participants in
the healthcare industry have become subject to an increasing
number of lawsuits alleging medical malpractice and related
legal theories such as negligent hiring, supervision and
credentialing. Similarly, ambulance transport services may
result in lawsuits concerning vehicle collisions and personal
injuries, patient care incidents and employee job-related
injuries. Some of these lawsuits may involve large claim amounts
and substantial defense costs.
EmCare procures professional liability insurance coverage for
most of its affiliated medical professionals and professional
and corporate entities. Beginning January 1, 2002, this
insurance coverage has been provided by affiliates of CNA
Insurance Company, which then reinsure the entire program,
primarily through EmCares wholly-owned subsidiary, EMCA
Insurance Company, Ltd., or EMCA. Workers compensation coverage
for EmCares employees and applicable affiliated medical
professionals is provided under a similar structure for the
period. From September 1, 2004 to the closing date of our
acquisition of AMR and EmCare, AMR obtained insurance coverage
for losses with respect to workers compensation, auto and
general liability claims through Laidlaws captive
insurance company. AMR currently has a self-insurance program
fronted by an unrelated third party. AMR retains the risk of
loss under this coverage. Under these insurance programs, we
establish reserves, using actuarial estimates, for all losses
covered under the policies. Moreover, in the normal course of
our business, we are involved in lawsuits, claims, audits and
investigations, including those arising out of our billing and
marketing practices, employment disputes, contractual claims and
other business disputes for which we may have no insurance
coverage, and which are not subject to actuarial estimates. The
outcome of these matters could have a material effect on our
results of operations in the period when we identify the matter,
and the ultimate outcome could have a material adverse effect on
our financial position or results of operations.
Our liability to pay for EmCares insurance program losses
is collateralized by funds held through EMCA and, to the extent
these losses exceed the collateral and assets of EMCA or the
limits of our insurance policies, will have to be funded by us.
Should our AMR losses with respect to such claims exceed the
collateral held by Laidlaw in connection with our self-insurance
program or the limits of our insurance policies, we will have to
fund such amounts. See Business American
Medical Response Insurance and
EmCare Insurance.
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The reserves we establish with respect to our losses
covered under our insurance programs are subject to inherent
uncertainties. |
In connection with our insurance programs, we establish reserves
for losses and related expenses, which represent estimates
involving actuarial and statistical projections, at a given
point in time, of our expectations of the ultimate resolution
and administration costs of losses we have incurred in respect
of our liability risks. Insurance reserves inherently are
subject to uncertainty. Our reserves are based on historical
claims, demographic factors, industry trends, severity and
exposure factors and other actuarial assumptions calculated by
an independent actuary firm. The independent actuary firm
performs studies of projected ultimate losses on an annual basis
and provides quarterly updates to those projections. We use
these actuarial estimates to determine appropriate reserves. Our
reserves could be significantly affected if current and future
occurrences
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differ from historical claim trends and expectations. While we
monitor claims closely when we estimate reserves, the complexity
of the claims and the wide range of potential outcomes may
hamper timely adjustments to the assumptions we use in these
estimates. Actual losses and related expenses may deviate,
individually and in the aggregate, from the reserve estimates
reflected in our financial statements. If we determine that our
estimated reserves are inadequate, we will be required to
increase reserves at the time of the determination, which would
result in a reduction in our net income in the period in which
the deficiency is determined. See Managements
Discussion and Analysis of Financial Condition and Results of
Operations Critical Accounting Policies
Claims Liability and Professional Liability Reserves and
note 12 of the notes to our combined financial statements
included elsewhere in this prospectus.
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Insurance coverage for some of our losses may be
inadequate and may be subject to the credit risk of commercial
insurance companies. |
Some of our insurance coverage, for periods prior to the
initiation of our self-insurance programs as well as portions of
our current insurance coverage, is through various third party
insurers. To the extent we hold policies to cover certain groups
of claims, but either did not obtain sufficient insurance
limits, did not buy an extended reporting period policy, where
applicable, or the issuing insurance company is no longer
viable, we may be responsible for losses attributable to such
claims. Furthermore, for our losses that are insured or
reinsured through commercial insurance companies, we are subject
to the credit risk of those insurance companies.
While we believe our commercial insurance company providers
currently are creditworthy, there can be no assurance that such
insurance companies will remain so in the future.
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We are subject to decreases in our revenue and profit
margin under our fee-for-service contracts, where we bear the
risk of changes in volume, payor mix and third party
reimbursement rates. |
In our fee-for-service arrangements, which generated
approximately 84% of our fiscal 2004 net revenue, we, or our
affiliated physicians, collect the fees for transports and
physician services. Under these arrangements, we assume the
financial risks related to changes in the mix of insured and
uninsured patients and patients covered by government-sponsored
healthcare programs, third party reimbursement rates and
transports and patient volume. Our revenue decreases if our
volume or reimbursement decreases, but our expenses do not
decrease proportionately. See Risk Factors
Related to Healthcare Regulation Changes in the
rates or methods of third party reimbursements may adversely
affect our revenue and operations. In addition,
fee-for-service contracts have less favorable cash flow
characteristics in the start-up phase than traditional flat-rate
contracts due to longer collection periods.
We collect a smaller portion of our fees for services rendered
to uninsured patients than for services rendered to insured
patients. Our credit risk related to services provided to
uninsured individuals is exacerbated because the law requires
communities to provide 911 emergency response services and
hospital emergency departments to treat all patients presenting
to the emergency department seeking care for an emergency
medical condition regardless of their ability to pay. We also
believe uninsured patients are more likely to seek care at
hospital emergency departments because they frequently do not
have a primary care physician with whom to consult.
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We may not be able to successfully recruit and retain
physicians and other healthcare professionals with the
qualifications and attributes desired by us and our
customers. |
Our ability to recruit and retain affiliated physicians and
other healthcare professionals significantly affects our
performance under our contracts. In the recent past, our
customer hospitals have increasingly demanded a greater degree
of specialized skills, training and experience in the healthcare
professionals providing services under their contracts with us.
This decreases the number of healthcare professionals who may be
permitted to staff our contracts. Moreover, because of the scope
of the geographic and demographic diversity of the hospitals and
other facilities with which we contract, we must recruit
healthcare professionals, and particularly physicians, to staff
a broad spectrum of contracts. We have had difficulty in the
past recruiting physicians to staff contracts in some regions of
the country and at some less economically advantaged hospitals.
Moreover, we compete with other entities to recruit and retain
qualified physicians and
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other healthcare professionals to deliver clinical services. Our
future success in retaining and winning new hospital contracts
depends on our ability to recruit and retain healthcare
professionals to maintain and expand our operations.
Our non-compete agreements and other restrictive
covenants involving physicians may not be enforceable.
We have contracts with physicians and professional corporations
in many states. Some of these contracts, as well as our
contracts with hospitals, include provisions preventing these
physicians and professional corporations from competing with us
both during and after the term of our relationship with them.
The law governing non-compete agreements and other forms of
restrictive covenants varies from state to state. Some states
are reluctant to strictly enforce non-compete agreements and
restrictive covenants applicable to physicians. There can be no
assurance that our non-compete agreements related to affiliated
physicians and professional corporations will not be
successfully challenged as unenforceable in certain states. In
such event, we would be unable to prevent former affiliated
physicians and professional corporations from competing with us,
potentially resulting in the loss of some of our hospital
contracts.
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We are required to make significant capital expenditures
for our ambulance services business in order to remain
competitive. |
Our capital expenditure requirements primarily relate to
maintaining and upgrading our vehicle fleet and medical
equipment to serve our customers and remain competitive. The
aging of our vehicle fleet requires us to make regular capital
expenditures to maintain our current level of service. Our
capital expenditures totaled $42.8 million and
$52.8 million in fiscal 2004 and fiscal 2003, respectively.
In addition, changing competitive conditions or the emergence of
any significant advances in medical technology could require us
to invest significant capital in additional equipment or
capacity in order to remain competitive. If we are unable to
fund any such investment or otherwise fail to invest in new
vehicles or medical equipment, our business, financial condition
or results of operations could be materially and adversely
affected.
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We depend on our senior management and may not be able to
retain those employees or recruit additional qualified
personnel. |
We depend on our senior management. The loss of services of any
of the members of our senior management could adversely affect
our business until a suitable replacement can be found. There
may be a limited number of persons with the requisite skills to
serve in these positions, and we cannot assure you that we would
be able to identify or employ such qualified personnel on
acceptable terms.
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We must perform on our own services that Laidlaw
previously performed for us, and we are subject to financial
reporting and other requirements for which our accounting and
other management systems and resources may not be
adequate. |
Laidlaw historically has provided various services to AMR and
EmCare, including income tax accounting, preparation of tax
returns, certain risk management, compliance and insurance
coverage services, cash management, certain benefit plan
administration and internal audit. Moreover, as subsidiaries of
a public company, AMR and EmCare have not themselves been
subject to the reporting and other requirements of the
Securities Exchange Act of 1934, or the Exchange Act. In
connection with this offering, we will become subject to
reporting and other obligations under the Exchange Act. We are
working with our independent legal, accounting and financial
advisors to identify those areas in which changes should be made
to our financial and management control systems to manage our
growth and our obligations as a public company. These areas
include corporate governance, corporate control, internal audit,
disclosure controls and procedures and financial reporting and
accounting systems. These reporting and other obligations will,
together with the impact of performing services previously
provided to us by Laidlaw, place significant demands on our
management, administrative and operational resources, including
accounting resources.
We anticipate that we will need to hire additional tax,
accounting and finance staff. We are reviewing the adequacy of
our systems, financial and management controls, and reporting
systems and procedures, and we
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intend to make any necessary changes. We believe these
replacement services will result in total annual stand-alone
selling, general and administrative, compensation and benefits
and insurance expense of approximately $4.0 million in
fiscal 2005, including a management fee we will pay to Onex. We
believe this represents our full incremental ordinary course
stand-alone expense, and compares to the pre-acquisition fees
and compensation charges of $15.4 million we paid Laidlaw
in fiscal 2004 and $19.9 million for the five months ended
January 31, 2005. In addition, we estimate that, in our
first year as a public company, we will incur costs of
approximately $1.0 million to implement the assessment of
controls and public reporting mandated by the Sarbanes-Oxley Act
of 2002. We cannot assure you that our estimate is accurate or
that our separation from Laidlaw will progress smoothly, either
of which could adversely impact our results. Although we have
not fully implemented our replacement services, our costs for
these services (including the Onex management fee but excluding
costs related to our acquisition of AMR and EmCare) totaled
$1.9 million in the eight months ended September 30,
2005. Moreover, our stand-alone expenses may increase. If we are
unable to upgrade our financial and management controls,
reporting systems and procedures in a timely and effective
fashion, we may not be able to satisfy our obligations as a
public company on a timely basis.
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Our revenue would be adversely affected if we lose
existing contracts. |
A significant portion of our growth historically has resulted
from increases in the number of emergency and non-emergency
transports, and the number of patient visits and fees for
services, we provide under existing contracts and the addition
of new contracts. Substantially all of our fiscal 2004 net
revenue was generated under contracts, including exclusive
contracts that accounted for approximately 86% of our fiscal
2004 net revenue. Our contracts with hospitals generally
have terms of three years and the term of our contracts with
communities to provide 911 services generally ranges from three
to five years. Most of our contracts are terminable by either of
the parties upon notice of as little as 30 days. Any of our
contracts may not be renewed or, if renewed, may contain terms
that are not as favorable to us as our current contracts. We
cannot assure you that we will be successful in retaining our
existing contracts or that any loss of contracts would not have
a material adverse effect on our business, financial condition
and results of operations.
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We may not accurately assess the costs we will incur under
new contracts. |
Our new contracts increasingly involve a competitive bidding
process. When we obtain new contracts, we must accurately assess
the costs we will incur in providing services in order to
realize adequate profit margins and otherwise meet our financial
and strategic objectives. Increasing pressures from healthcare
payors to restrict or reduce reimbursement rates at a time when
the costs of providing medical services continue to increase
make assessing the costs associated with the pricing of new
contracts, as well as maintenance of existing contracts, more
difficult. In addition, integrating new contracts, particularly
those in new geographic locations, could prove more costly, and
could require more management time, than we anticipate. Our
failure to accurately predict costs or to negotiate an adequate
profit margin could have a material adverse effect on our
business, financial condition and results of operations.
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The high level of competition in our segments of the
market for emergency medical services could adversely affect our
contract and revenue base. |
AMR. The market for providing ambulance transport
services to municipalities, other healthcare providers and third
party payors is highly competitive. In providing ambulance
transport services, we compete with governmental entities
(including cities and fire districts), hospitals, local and
volunteer private providers, and with several large national and
regional providers, such as Rural/ Metro Corporation, Southwest
Ambulance and Acadian Ambulance. In many communities, our most
important competitors are the local fire departments, which in
many cases have acted traditionally as the first response
providers during emergencies, and have been able to expand their
scope of services to include emergency ambulance transport and
do not wish to give up their franchises to a private competitor.
EmCare. The market for providing outsourced physician
staffing and related management services to hospitals and
clinics is highly competitive. Such competition could adversely
affect our ability to obtain new contracts, retain existing
contracts and increase or maintain profit margins. We compete
with both national
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and regional enterprises such as Team Health, Sterling
Healthcare, The Schumacher Group and National Emergency Services
Healthcare Group, some of which may have greater financial and
other resources available to them, greater access to physicians
and/or greater access to potential customers. We also compete
against local physician groups and self-operated hospital
emergency departments for satisfying staffing and scheduling
needs.
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Our business depends on numerous complex information
systems, and any failure to successfully maintain these systems
or implement new systems could materially harm our
operations. |
We had 3.7 million transports and 5.3 million patient
visits in fiscal 2004. We depend on complex, integrated
information systems and standardized procedures for operational
and financial information and our billing operations. We may not
have the necessary resources to enhance existing information
systems or implement new systems where necessary to handle our
volume and changing needs. Furthermore, we may experience
unanticipated delays, complications and expenses in
implementing, integrating and operating our systems, including
the integration of our AMR and EmCare systems. Any interruptions
in operations during periods of implementation would adversely
affect our ability to properly allocate resources and process
billing information in a timely manner, which could result in
customer dissatisfaction and delayed cash flow. We also use the
development and implementation of sophisticated and specialized
technology to differentiate our services from our competitors
and improve our profitability. The failure to successfully
implement and maintain operational, financial and billing
information systems could have an adverse effect on our ability
to obtain new business, retain existing business and maintain or
increase our profit margins.
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If we fail to implement our business strategy, our
financial performance and our growth could be materially and
adversely affected. |
Our future financial performance and success are dependent in
large part upon our ability to implement our business strategy
successfully. Our business strategy envisions several
initiatives, including increasing revenue from existing
customers, growing our customer base, pursuing select
acquisitions, implementing cost rationalization initiatives,
focusing on risk mitigation and utilizing technology to
differentiate our services and improve profitability. We may not
be able to implement our business strategy successfully or
achieve the anticipated benefits of our business plan. If we are
unable to do so, our long-term growth and profitability may be
adversely affected. Even if we are able to implement some or all
of the initiatives of our business plan successfully, our
operating results may not improve to the extent we anticipate,
or at all.
Implementation of our business strategy could also be affected
by a number of factors beyond our control, such as increased
competition, legal developments, government regulation, general
economic conditions or increased operating costs or expenses. In
addition, to the extent we have misjudged the nature and extent
of industry trends or our competition, we may have difficulty in
achieving our strategic objectives. Any failure to implement our
business strategy successfully may adversely affect our
business, financial condition and results of operations and thus
our ability to service our debt. In addition, we may decide to
alter or discontinue certain aspects of our business strategy at
any time.
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Our ability to obtain adequate bonding coverage, and
therefore maintain existing contracts and successfully bid on
new ones, could be adversely affected by our high
leverage. |
Our emergency ambulance transport service business is highly
dependent on our ability to obtain performance bond coverage
sufficient to meet bid requirements imposed by existing and
potential customers. In connection with the acquisition, Laidlaw
has agreed to provide to us any cash collateral required to
support the performance bonds in effect at the closing, and for
a three-year period to pay any bond premiums in excess of rates
in effect at the time of closing. We cannot assure you that we
will have access to adequate bonding capacity to meet new
contract requirements, or to obtain substitute performance bonds
for existing bonds at the end of the three-year period, or that
such bonding will be available on terms acceptable to us. If
adequate bonding is not available, or if the terms of the
bonding are too onerous, there would be a material adverse
effect on our business, financial condition and results of
operations.
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A successful challenge by tax authorities to our treatment
of certain physicians as independent contractors could require
us to pay past taxes and penalties. |
As of September 30, 2005, we contracted with approximately
1,200 physicians as independent contractors to fulfill our
contractual obligations to customers. Because we treat them as
independent contractors rather than as employees, we do not
(i) withhold federal or state income or other employment
related taxes from the compensation that we pay to them,
(ii) make federal or state unemployment tax or Federal
Insurance Contributions Act payments (except as described
below), (iii) provide workers compensation insurance with
respect to such affiliated physicians (except in states that
require us to do so even for independent contractors), or
(iv) allow them to participate in benefits and retirement
programs available to employed physicians. Our contracts with
our independent contractor physicians obligate these physicians
to pay these taxes and other costs. Whether these physicians are
properly classified as independent contractors depends upon the
facts and circumstances of our relationship with them. It is
possible that the nature of our relationship with these
physicians would support a challenge to our classification of
them. If such a challenge by federal or state taxing authorities
were successful, and the physicians at issue were instead
treated as employees, we could be adversely affected and liable
for past taxes and penalties to the extent that the physicians
did not fulfill their contractual obligations to pay those
taxes. Under current federal tax law, however, even if our
treatment were successfully challenged, if our current treatment
were found to be consistent with a long-standing practice of a
significant segment of our industry and we meet certain other
requirements, it is possible (but not certain) that our
treatment of the physicians would qualify under a safe
harbor and, consequently, we would be protected from the
imposition of past taxes and penalties. In the recent past,
however, there have been proposals to eliminate the safe harbor
and similar proposals could be made in the future.
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We may make acquisitions which could divert the attention
of management and which may not be integrated successfully into
our existing business. |
We may pursue acquisitions to increase our market penetration,
enter new geographic markets and expand the scope of services we
provide. We cannot assure you that we will identify suitable
acquisition candidates, that acquisitions will be completed on
acceptable terms or that we will be able to integrate
successfully the operations of any acquired business into our
existing business. The acquisitions could be of significant size
and involve operations in multiple jurisdictions. The
acquisition and integration of another business would divert
management attention from other business activities. This
diversion, together with other difficulties we may incur in
integrating an acquired business, could have a material adverse
effect on our business, financial condition and results of
operations. In addition, we may borrow money or issue capital
stock to finance acquisitions. Such borrowings might not be
available on terms as favorable to us as our current borrowing
terms and may increase our leverage, and the issuance of capital
stock could dilute the interests of our stockholders.
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If Laidlaw is unwilling or unable to satisfy any
indemnification claims made by us pursuant to the purchase
agreements relating to the acquisition of AMR and EmCare, we
will be forced to satisfy such claims ourselves. |
Laidlaw has agreed to indemnify us for certain claims or legal
actions brought against us arising out of the operations of AMR
and EmCare prior to the closing date of the acquisition. If we
make a claim against Laidlaw, and Laidlaw is unwilling or unable
to satisfy such claim, we would be required to satisfy the claim
ourselves and, as a result, our financial condition may be
adversely affected.
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Many of our employees are represented by labor unions and
any work stoppage could adversely affect our business. |
Approximately 50% of AMRs employees are represented by 42
collective bargaining agreements with 43 different union locals.
Fourteen of these collective bargaining agreements, representing
approximately 4,100 employees, are subject to renegotiation in
2006. Although we believe our relations with our employees
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are good, we cannot assure you that we will be able to negotiate
a satisfactory renewal of these collective bargaining agreements
or that our employee relations will remain stable.
Risk Factors Related to Healthcare Regulation
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We conduct business in a heavily regulated industry and if
we fail to comply with these laws and government regulations, we
could incur penalties or be required to make significant changes
to our operations. |
The healthcare industry is heavily regulated and closely
scrutinized by federal, state and local governments.
Comprehensive statutes and regulations govern the manner in
which we provide and bill for services, our contractual
relationships with our physicians and customers, our marketing
activities and other aspects of our operations. Failure to
comply with these laws can result in civil and criminal
penalties such as fines, damages and exclusion from the Medicare
and Medicaid programs. The risk of our being found in violation
of these laws and regulations is increased by the fact that many
of them have not been fully interpreted by the regulatory
authorities or the courts, and their provisions are sometimes
open to a variety of interpretations. Any action against us for
violation of these laws or regulations, even if we successfully
defend against it, could cause us to incur significant legal
expenses and divert our managements attention from the
operation of our business.
Our practitioners and our customers are also subject to ethical
guidelines and operating standards of professional and trade
associations and private accreditation agencies. Compliance with
these guidelines and standards is often required by our
contracts with our customers or to maintain our reputation.
The laws, regulations and standards governing the provision of
healthcare services may change significantly in the future. We
cannot assure you that any new or changed healthcare laws,
regulations or standards will not materially adversely affect
our business. We cannot assure you that a review of our business
by judicial, law enforcement, regulatory or accreditation
authorities will not result in a determination that could
adversely affect our operations.
We are subject to comprehensive and complex laws and rules
that govern the manner in which we bill and are paid for our
services by third party payors, and the failure to comply with
these rules, or allegations that we have failed to do so, can
result in civil or criminal sanctions, including exclusion from
federal and state healthcare programs.
Like most healthcare providers, the majority of our services are
paid for by private and governmental third party payors, such as
Medicare and Medicaid. These third party payors typically have
differing and complex billing and documentation requirements
that we must meet in order to receive payment for our services.
Reimbursement to us is typically conditioned on our providing
the correct procedure and diagnostic codes and properly
documenting the services themselves, including the level of
service provided, the medical necessity for the services, and
the identity of the practitioner who provided the service.
We must also comply with numerous other laws applicable to our
documentation and the claims we submit for payment, including
but not limited to (1) coordination of benefits
rules that dictate which payor we must bill first when a patient
has potential coverage from multiple payors;
(2) requirements that we obtain the signature of the
patient or patient representative, when possible, or document
why we are unable to do so, prior to submitting a claim;
(3) requirements that we make repayment to any payor which
pays us more than the amount to which we are entitled;
(4) requirements that we bill a hospital or nursing home,
rather than Medicare, for certain ambulance transports provided
to Medicare patients of such facilities;
(5) reassignment rules governing our ability to
bill and collect professional fees on behalf of our physicians;
(6) requirements that our electronic claims for payment be
submitted using certain standardized transaction codes and
formats; and (7) laws requiring us to handle all health and
financial information of our patients in a manner that complies
with specified security and privacy standards. See
Business Regulatory Matters
Medicare, Medicaid and Other Government Reimbursement
Programs.
Governmental and private third party payors and other
enforcement agencies carefully audit and monitor our compliance
with these and other applicable rules, and in some cases in the
past have found that we were not in compliance. We have received
in the past, and expect to receive in the future, repayment
demands from
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third party payors based on allegations that our services were
not medically necessary, were billed at an improper level, or
otherwise violated applicable billing requirements. See
Business American Medical Response
Legal Matters. Our failure to comply with the billing and
other rules applicable to us could result in non-payment for
services rendered or refunds of amounts previously paid for such
services. In addition, non-compliance with these rules may cause
us to incur civil and criminal penalties, including fines,
imprisonment and exclusion from government healthcare programs
such as Medicare and Medicaid, under a number of state and
federal laws. These laws include the federal False Claims Act,
the Health Insurance Portability and Accountability Act of 1996,
the federal Anti-Kickback Statute, the Balanced Budget Act of
1997 and other provisions of federal, state and local law.
In addition, from time to time we self-identify practices that
may have resulted in Medicare or Medicaid overpayments or other
regulatory issues. For example, we have previously identified
situations in which we may have inadvertently utilized incorrect
billing codes for some of the services we have billed to
government programs such as Medicare or Medicaid. In such cases,
it is our practice to disclose the issue to the affected
government programs and, if appropriate, to refund any resulting
overpayments. Although the government usually accepts such
disclosures and repayments without taking further enforcement
action, it is possible that such disclosures or repayments will
result in allegations by the government that we have violated
the False Claims Act or other laws, leading to investigations
and possibly civil or criminal enforcement actions. See
Regulatory Matters Corporate Compliance
Program and Corporate Integrity Obligations.
If our operations are found to be in violation of these or any
of the other laws which govern our activities, any resulting
penalties, damages, fines or other sanctions could adversely
affect our ability to operate our business and our financial
results. See Business Regulatory
Matters Federal False Claims Act and
Other Healthcare Fraud and Abuse Laws.
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Changes in the rates or methods of third party
reimbursements may adversely affect our revenue and
operations. |
We derive a majority of our revenue from direct billings to
patients and third party payors such as Medicare, Medicaid and
private health insurance companies. As a result, any changes in
the rates or methods of reimbursement for the services we
provide could have a significant adverse impact on our revenue
and financial results.
Government funding for healthcare programs is subject to
statutory and regulatory changes, administrative rulings,
interpretations of policy and determinations by intermediaries
and governmental funding restrictions, all of which could
materially impact program coverage and reimbursements for both
ambulance and physician services. In recent years, Congress has
consistently attempted to curb spending on Medicare, Medicaid
and other programs funded in whole or part by the federal
government. State and local governments have also attempted to
curb spending on those programs for which they are wholly or
partly responsible. This has resulted in cost containment
measures such as the imposition of new fee schedules that have
lowered reimbursement for some of our services and restricted
the rate of increase for others, and new utilization controls
that limit coverage of our services. For example, we estimate
that the impact of a national fee schedule promulgated in 2002,
as modified by subsequent legislation, resulted in a decrease in
AMRs net revenue for fiscal 2003 and fiscal 2004 of
approximately $20 million and $11 million,
respectively, will result in an increase in AMRs net
revenue of approximately $13 million in calendar 2005, and
will result in a decrease in AMRs net revenue of
approximately $17 million in 2006 and continuing decreases
thereafter to 2010. We currently expect that the Medicare fee
schedule update for physician services fees will provide for a
4.3% decrease to physician rates effective January 1, 2006,
which would result in a decrease in EmCares 2006 net
revenue of approximately $5.7 million. See
Business Regulatory Matters
Medicare, Medicaid and Other Government Reimbursement
Programs.
In addition, state and local government regulations or
administrative policies regulate ambulance rate structures in
some jurisdictions in which we conduct transport services. We
may be unable to receive ambulance service rate increases on a
timely basis where rates are regulated, or to establish or
maintain satisfactory rate structures where rates are not
regulated.
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We believe that regulatory trends in cost containment will
continue. We cannot assure you that we will be able to offset
reduced operating margins through cost reductions, increased
volume, the introduction of additional procedures or otherwise.
In addition, we cannot assure you that federal, state and local
governments will not impose reductions in the fee schedules or
rate regulations applicable to our services in the future. Any
such reductions could have a material adverse effect on our
business, financial condition or results of operations.
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If current or future laws or regulations force us to
restructure our arrangements with physicians, professional
corporations and hospitals, we may incur additional costs, lose
contracts and suffer a reduction in net revenue under existing
contracts, and we may need to refinance our debt or obtain debt
holder consent. |
A number of laws bear on our contractual relationships with our
physicians. There is a risk that state authorities in some
jurisdictions may find that these contractual relationships
violate laws prohibiting the corporate practice of medicine and
fee-splitting prohibitions. These laws prohibit the practice of
medicine by general business corporations and are intended to
prevent unlicensed persons or entities from interfering with or
inappropriately influencing the physicians professional
judgment. They may also prevent the sharing of professional
services income with non-professional or business interests.
From time to time, including recently, we have been involved in
litigation in which private litigants have raised these issues.
See Business Regulatory Matters
Fee-Splitting; Corporate Practice of Medicine.
In addition, the Medicare program generally prohibits the
reassignment of Medicare payments due to a physician or other
healthcare provider to any other person or entity unless the
billing arrangement between that physician or other healthcare
provider and the other person or entity falls within an
enumerated exception to the Medicare reassignment prohibition.
The Medicare Modernization Act amended the Medicare reassignment
statute as of December 8, 2003 and now permits our
independent contractor physicians to reassign their Medicare
receivables to us under certain circumstances. Because this
provision has only recently been implemented, it could be
interpreted in a manner adverse to us, which would negatively
impact our ability to bill for our physicians services.
Our physician contracts include contracts with individual
physicians and with physicians organized as separate legal
professional entities (e.g., professional medical
corporations). Antitrust laws may deem each such
physician/entity to be separate, both from EmCare and from each
other and, accordingly, each such physician/practice is subject
to a wide range of laws that prohibit anti-competitive conduct
between or among separate legal entities or individuals. A
review or action by regulatory authorities or the courts could
force us to terminate or modify our contractual relationships
with physicians and affiliated medical groups or revise them in
a manner that could be materially adverse to our business. See
Business Regulatory Matters
Antitrust Laws.
Various licensing and certification laws, regulations and
standards apply to us, our affiliated physicians and our
relationships with our affiliated physicians. Failure to comply
with these laws and regulations could result in our services
being found to be non-reimbursable or prior payments being
subject to recoupment, and can give rise to civil or criminal
penalties. We are pursuing steps we believe we must take to
retain or obtain all requisite licensure and operating
authorities. While we have made reasonable efforts to
substantially comply with federal, state and local licensing and
certification laws and regulations and standards as we interpret
them, we cannot assure you that agencies that administer these
programs will not find that we have failed to comply in some
material respects.
EmCares professional liability insurance program, under
which insurance is provided for most of our affiliated medical
professionals and professional and corporate entities, is
reinsured through our wholly-owned subsidiary, EMCA Insurance
Company, Ltd. The activities associated with the business of
insurance, and the companies involved in such activities, are
closely regulated. Failure to comply with the laws and
regulations can result in civil and criminal fines and penalties
and loss of licensure. While we have made reasonable efforts to
substantially comply with these laws and regulations, and
utilize licensed insurance professionals where necessary and
appropriate, we cannot assure you that we will not be found to
have violated these laws and regulations in some material
respects.
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Adverse judicial or administrative interpretations could result
in a finding that we are not in compliance with one or more of
these laws and rules that affect our relationships with our
physicians.
These laws and rules, and their interpretations, may also change
in the future. Any adverse interpretations or changes could
force us to restructure our relationships with physicians,
professional corporations or our hospital customers, or to
restructure our operations. This could cause our operating costs
to increase significantly. A restructuring could also result in
a loss of contracts or a reduction in revenue under existing
contracts. Moreover, if we are required to modify our structure
and organization to comply with these laws and rules, our
financing agreements may prohibit such modifications and require
us to obtain the consent of the holders of such debt or require
the refinancing of such debt.
Our contracts with healthcare facilities and marketing
practices are subject to the federal Anti-Kickback Statute, and
we are currently under investigation for alleged violations of
that statute.
We are subject to the federal Anti-Kickback Statute, which
prohibits the knowing and willful offer, payment, solicitation
or receipt of any form of remuneration in return
for, or to induce, the referral of business or ordering of
services paid for by Medicare or other federal programs.
Remuneration potentially includes discounts and
in-kind goods or services, as well as cash. Certain federal
courts have held that the Anti-Kickback Statute can be violated
if one purpose of a payment is to induce referrals.
Violations of the Anti-Kickback Statute can result in
imprisonment, civil or criminal fines or exclusion from Medicare
and other governmental programs.
In 1999, the Office of Inspector General of the Department of
Health and Human Services, or the OIG, issued an Advisory
Opinion indicating that discounts provided to health facilities
on the transports for which they are financially responsible
potentially violate the Anti-Kickback Statute when the ambulance
company also receives referrals of Medicare and other
government-funded transports from the facility. The OIG has
clarified that not all discounts violate the Anti-Kickback
Statute, but that the statute may be violated if part of the
purpose of the discount is to induce the referral of the
transports paid for by Medicare or other federal programs, and
the discount does not meet certain safe harbor
conditions. In the Advisory Opinion and subsequent
pronouncements, the OIG has provided guidance to ambulance
companies to help them avoid unlawful discounts. See
Business Regulatory Matters
Federal Anti-Kickback Statute.
Like other ambulance companies, we sometimes provide discounts
to our healthcare facility customers (nursing home and
hospital). Although we have attempted to comply with the
OIGs guidance on this issue, the government has alleged
that certain of our contractual discounts in effect in Texas,
principally in periods prior to 1999 and possibly through 2001,
violate the Anti-Kickback Statute. We are currently in
discussions with the OIG regarding these Texas allegations. Our
contracting practices in Oregon and possibly other jurisdictions
may also be under investigation. See Business
American Medical Response Legal Matters. If we
are found to have violated the Anti-Kickback Statute in these
jurisdictions, we may be subject to civil or criminal penalties,
including exclusion from the Medicare or Medicaid programs, or
may be required to enter into settlement agreements with the
government to avoid such sanctions. Typically, such settlement
agreements require substantial payments to the government in
exchange for the government to release its claims. Such a
settlement may also require us to enter into a Corporate
Integrity Agreement, or CIA. See Business
Regulatory Matters Corporate Compliance Program and
Corporate Integrity Obligations.
In addition to AMRs contracts with healthcare facilities,
other marketing practices or transactions entered into by AMR
and EmCare may implicate the Anti-Kickback Statute. Although we
have attempted to structure our past and current marketing
initiatives and business relationships to comply with the
Anti-Kickback Statute, we cannot assure you that the OIG or
other authorities will not find that our marketing practices and
relationships violate the statute.
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Changes in our ownership structure and operations require
us to comply with numerous notification and reapplication
requirements in order to maintain our licensure, certification
or other authority to operate, and failure to do so, or an
allegation that we have failed to do so, can result in payment
delays, forfeiture of payment or civil and criminal
penalties.
We and our affiliated physicians are subject to various federal,
state and local licensing and certification laws with which we
must comply in order to maintain authorization to provide, or
receive payment for, our services. For example, Medicare and
Medicaid require that we complete and periodically update
enrollment forms in order to obtain and maintain certification
to participate in programs. Compliance with these requirements
is complicated by the fact that they differ from jurisdiction to
jurisdiction, and in some cases are not uniformly applied or
interpreted even within the same jurisdiction. Failure to comply
with these requirements can lead not only to delays in payment
and refund requests, but in extreme cases can give rise to civil
or criminal penalties.
In certain jurisdictions, changes in our ownership structure
require pre-or post-notification to governmental licensing and
certification agencies, or agencies with which we have
contracts. Relevant laws in some jurisdictions may also require
re-application or re-enrollment and approval to maintain or
renew our licensure, certification, contracts or other operating
authority. For example, in connection with our acquisition of
AMR from Laidlaw, two of our subsidiaries were required to apply
for state and local ambulance operating authority in New York.
Similarly, the change in corporate structure and ownership in
connection with this offering may require us to give notice,
re-enroll or make other applications for authority to continue
operating in various jurisdictions.
If an agency requires us to complete the re-enrollment process
prior to submitting reimbursement requests, we may be delayed in
payment, receive refund requests or be subject to recoupment for
services we provide in the interim. The change in ownership
effected by our acquisition of AMR and EmCare from Laidlaw or
this offering may require us to re-enroll in one or more
jurisdictions, in which case reimbursement from the relevant
government program is likely to be deferred for several months.
This would affect our cash flow but would not affect our net
revenue. We do not expect the impact of this deferral to be
material to us unless several jurisdictions require us to
re-enroll.
While we have made reasonable efforts to substantially comply
with these requirements in connection with prior changes in our
operations and ownership structure, and will do so in connection
with this offering, we cannot assure you that the agencies that
administer these programs or have awarded us contracts will not
find that we have failed to comply in some material respects. A
finding of non-compliance and any resulting payment delays,
refund demands or other sanctions could have a material adverse
effect on our business, financial condition or results of
operations.
If we fail to comply with the terms of our settlement
agreements with the government, we could be subject to
additional litigation or other governmental actions which could
be harmful to our business.
In the last five years, we have entered into four settlement
agreements with the United States government. In June 2002, one
of our subsidiaries, AMR of Massachusetts, entered into a
settlement agreement to resolve a number of allegations,
including allegations related to billing and documentation
practices. In February 2003, another subsidiary, AMR of South
Dakota, entered into a settlement agreement to resolve
allegations that it incorrectly billed for transports performed
by other providers when an AMR paramedic accompanied the patient
during transport, and that it billed for certain non-emergency
transports using emergency codes. In July 2004, our
subsidiary, American Medical Response West, entered into a
settlement agreement in connection with billing matters related
to emergency transports and specialized services. In August
2004, AMR entered into a settlement agreement on behalf of a
subsidiary, Regional Emergency Services LP, or RES, to resolve
allegations of violations of the False Claims Act by RES and a
hospital system based on the absence of certificates of medical
necessity and other non-compliant billing practices. See
Business American Medical Response
Legal Matters.
As part of the settlements AMR of Massachusetts and
AMR West entered into with the government, we entered into
Corporate Integrity Agreements, or CIAs. Pursuant to these CIAs,
we are required to establish and maintain a compliance program
which includes, among other elements, the appointment of a
compliance
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officer and committee, claims review by an independent review
organization, and reporting of overpayments and other
reportable events. See Business
Regulatory Matters Corporate Compliance Program and
Corporate Integrity Obligations.
We cannot assure you that the CIAs or the compliance program we
initiated has prevented, or will prevent, any repetition of the
conduct or allegations that were the subject of these settlement
agreements, or that the government will not raise similar
allegations in other jurisdictions or for other periods of time.
If such allegations are raised, or if we fail to comply with the
terms of the CIAs, we may be subject to fines and other
contractual and regulatory remedies specified in the CIAs or by
applicable laws, including exclusion from the Medicare program
and other federal and state healthcare programs. Such actions
could have a material adverse effect on the conduct of our
business, our financial condition or our results of operations.
If we are unable to effectively adapt to changes in the
healthcare industry, our business may be harmed.
Political, economic and regulatory influences are subjecting the
healthcare industry in the United States to fundamental change.
We anticipate that Congress and state legislatures may continue
to review and assess alternative healthcare delivery and payment
systems and may in the future propose and adopt legislation
effecting fundamental changes in the healthcare delivery system.
We cannot assure you as to the ultimate content, timing or
effect of changes, nor is it possible at this time to estimate
the impact of potential legislation. Further, it is possible
that future legislation enacted by Congress or state
legislatures could adversely affect our business or could change
the operating environment of our customers. It is possible that
changes to the Medicare or other government program
reimbursements may serve as precedent to similar changes in
other payors reimbursement policies in a manner adverse to
us. Similarly, changes in private payor reimbursements could
lead to adverse changes in Medicare and other government payor
programs which could have a material adverse effect on our
business, financial condition or results of operations.
Risk Factors Related to this Offering
Prior to this offering, there has been no public market for our
class A common stock. An active trading market for our
class A common stock may not develop or be sustained after
this offering. The lack of a public market may impair the value
of your shares and your ability to sell your shares at any time
you wish to sell them.
Our stock price may be volatile and you may not be able to
sell your shares at or above the offering price.
The initial public offering price for our shares of class A
common stock will be determined by negotiations between the
representatives of the underwriters and us. This price may not
reflect the market price of our class A common stock
following this offering. You may be unable to resell the
class A common stock you buy at or above the initial public
offering price.
The stock markets in general have experienced extreme
volatility, often unrelated to the operating performance of
particular companies. Broad market fluctuations may adversely
affect the trading price of our class A common stock.
Price fluctuations in our class A common stock could result
from general market and economic conditions and a variety of
other factors, including:
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actual or anticipated fluctuations in our operating results, |
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changes in healthcare pricing or reimbursement policies, |
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our competitors announcements of significant contracts,
acquisitions or strategic investments, |
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changes in our growth rates or our competitors growth
rates, |
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the timing or results of regulatory submissions or actions with
respect to our business, |
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our inability to raise additional capital, |
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conditions of the healthcare industry or in the financial
markets or economic conditions in general, and |
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changes in stock market analyst recommendations regarding our
class A common stock, other comparable companies or the
healthcare industry generally. |
You will experience immediate and substantial dilution in
the net tangible book value of your class A common
stock.
Based on our actual book value, the value of the shares of
class A common stock you purchase in this offering
immediately will be less than the offering price you paid. This
reduction in the value of your equity is known as dilution. This
dilution occurs in large part because our initial investors paid
less than the initial public offering price when they purchased
their shares. If you purchase class A common stock in this
offering, you will incur immediate dilution of $16.19 per
share, based on an assumed initial public offering price of
$16.00 per share.
If a significant number of shares of our class A
common stock are sold into the market following this offering,
the market price of our class A common stock could
significantly decline, even if our business is doing
well.
Sales of a substantial number of shares of our class A
common stock in the public market after this offering could
adversely affect the prevailing market price of our class A
common stock.
Upon completion of this offering, we will have
8,948,325 shares of class A common stock,
142,545 shares of class B common stock and
32,107,500 LP exchangeable units outstanding. Of these
securities, the 7,800,000 shares of class A common
stock offered pursuant to this offering will be freely tradable
without restriction or further registration under federal
securities laws, except to the extent shares are purchased in
the offering by our affiliates. The 32,250,045 shares of
class B common stock outstanding or issuable on exchange of
the LP exchangeable units, as well as any class A
common stock held by our affiliates, as that term is defined in
the Securities Act of 1933, are restricted
securities under the Securities Act. Restricted securities
may not be sold in the public market unless the sale is
registered under the Securities Act or an exemption from
registration is available.
In connection with this offering, we, each of our directors and
executive officers and the Onex entities have entered into
lock-up agreements that prevent the sale of shares of our common
stock for up to 180 days after the date of this prospectus.
Following the expiration of the lock-up period, the Onex
entities will have the right, subject to certain conditions, to
require us to register the sale of these shares under the
federal securities laws. If this right is exercised, holders of
all shares subject to the registration rights agreement will be
entitled to participate in such registration. By exercising
their registration rights, and selling a large number of shares,
these holders could cause the prevailing market price of our
class A common stock to decline. Approximately 33,165,795
shares of our common stock will be subject to our registration
rights agreement upon completion of this offering. These shares
may be sold in the public market under Rule 144 after the
applicable holding period, subject to the restrictions and
limitations of that Rule. See Shares Eligible for Future
Sale and Description of Capital Stock
Registration Agreement.
Approximately 349,575 shares of our class A common
that we will issue in our formation transactions to employees,
affiliated physicians, physician assistants and nurse
practitioners will be eligible for sale in the public market
180 days after the date of this prospectus. See
Description of Capital Stock Equityholder
Agreements.
If a trading market develops for our class A common stock,
our employees, officers and directors may elect to sell their
shares of our class A common stock or exercise their stock
options in order to sell the stock underlying their options in
the market. Sales of a substantial number of shares of our
class A common stock in the public market after this
offering could depress the market price of our class A
common stock and impair our ability to raise capital through the
sale of additional equity securities.
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Our certificate of incorporation and our by-laws contain
provisions that could discourage another company from acquiring
us and may prevent attempts by our stockholders to replace or
remove our current management.
Provisions of our certificate of incorporation and our by-laws
may discourage, delay or prevent a merger or acquisition that
stockholders may consider favorable, including transactions in
which you might otherwise receive a premium for your shares. In
addition, these provisions may frustrate or prevent any attempts
by our stockholders to replace or remove our current management
by making it more difficult for stockholders to replace or
remove our current board of directors. These provisions include:
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providing for a classified board of directors with staggered
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providing for the class B special voting stock which will
be voted as directed by the Onex entities, |
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providing for multi-vote shares of common stock which, upon
exchange of LP exchangeable units, will be owned by the Onex
entities, |
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establishing advance notice requirements for nominations for
election to the board of directors or for proposing matters that
can be acted on by stockholders at stockholder meetings, and |
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the authority of the board of directors to issue, without
stockholder approval, up to 20,000,000 shares of preferred
stock with such terms as the board of directors may determine
and an additional 54,725,666 shares of class A common
stock. |
See Description of Capital Stock.
We are a controlled company within the meaning
of the New York Stock Exchange rules and, as a result, will
qualify for, and intend to rely on, exemptions from certain
corporate governance requirements.
Because the Onex entities will own more than 50% of our combined
voting power after the completion of this offering, we will be
deemed a controlled company under the rules of the
New York Stock Exchange, or the NYSE. As a result, we will
qualify for, and intend to rely upon, the controlled
company exception to the board of directors and committee
composition requirements under the rules of the NYSE. Pursuant
to this exception, we will be exempt from rules that would
otherwise require that our board of directors be comprised of a
majority of independent directors, and that our
compensation committee and corporate governance and nominating
committee be comprised solely of independent
directors (as defined under the rules of the NYSE), so
long as the Onex entities continue to own more than 50% of our
combined voting power. Upon completion of this offering, our
board of directors will be comprised of six persons, of which
one will be a representative from Onex and two will be current
executive officers and, therefore, will not be
independent. See Management
Composition of the Board of Directors after this Offering
and Committees of the Board of Directors.
We do not intend to pay cash dividends.
We do not intend to pay cash dividends on our common stock. We
currently intend to retain all available funds and any future
earnings for use in the operation and expansion of our business
and do not anticipate paying any cash dividends in the
foreseeable future. In addition, the terms of our current, as
well as any future, financing agreements may preclude us from
paying any dividends. As a result, capital appreciation, if any,
of our common stock will be your sole source of potential gain
for the foreseeable future.
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CAUTIONARY STATEMENTS REGARDING FORWARD-LOOKING STATEMENTS
This prospectus contains forward-looking statements.
Forward-looking statements give our current expectations or
forecasts of future events. Forward-looking statements generally
can be identified by the use of forward-looking terminology such
as may, will, expect,
intend, estimate,
anticipate, believe,
project, or continue, or other similar
words. These statements reflect managements current views
with respect to future events and are subject to risks and
uncertainties, both known and unknown. Our actual results may
vary materially from those anticipated in forward-looking
statements. We caution investors not to place undue reliance on
any forward-looking statements.
Important factors that could cause actual results to differ
materially from forward-looking statements include, but are not
limited to:
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the impact on our revenue of changes in transport volume, mix of
insured and uninsured patients, and third party reimbursement
rates, |
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the adequacy of our insurance coverage and insurance reserves, |
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potential penalties or changes to our operations if we fail to
comply with extensive and complex government regulation of our
industry, |
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our ability to recruit and retain qualified physicians and other
healthcare professionals, and enforce our non-compete agreements
with our physicians, |
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the effect of changes in rates or methods of third party
reimbursement, |
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our ability to generate cash flow to service our debt
obligations, |
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the cost of capital expenditures to maintain and upgrade our
vehicle fleet and medical equipment, |
|
|
|
the loss of services of one or more members of our senior
management team, |
|
|
|
the outcome of government investigations of certain of our
business practices, |
|
|
|
our ability to successfully restructure our operations to comply
with future changes in government regulation, |
|
|
|
our ability to perform services previously performed for us by
Laidlaw, |
|
|
|
the loss of existing contracts and the accuracy of our
assessment of costs under new contracts, |
|
|
|
the high level competition in our industry, |
|
|
|
our ability to maintain or implement complex information systems, |
|
|
|
our ability to implement our business strategy, |
|
|
|
our ability to obtain adequate bonding coverage, and |
|
|
|
our ability to successfully integrate strategic acquisitions. |
These factors are not exhaustive, and new factors may emerge or
changes to the foregoing factors may occur that could impact our
business. Except to the extent required by law, we undertake no
obligation to publicly update or revise any forward-looking
statements, whether as a result of new information, future
events or otherwise.
You should review carefully the sections captioned Risk
Factors and Managements Discussion and
Analysis of Financial Condition and Results of Operations
in this prospectus for a more complete discussion of these and
other factors that may affect our business. We note that the
safe harbor for forward-looking statements provided by the
Private Securities Litigation Reform Act of 1995 does not apply
to statements made in connection with an initial public offering.
26
FORMATION OF HOLDING COMPANY
Emergency Medical Services is a newly formed Delaware
corporation that is issuing class A common stock in this
offering. Immediately prior to the completion of this offering,
we intend to complete a reorganization. After giving effect to
the reorganization and the completion of this offering:
|
|
|
|
|
EMS L.P., currently our top-tier holding company, will become
our consolidated subsidiary, and |
|
|
|
we will own the general partner interests in EMS L.P., and will
continue to conduct our operations through AMR and EmCare, our
operating subsidiaries. |
Unless the context otherwise requires, this prospectus gives
effect to this reorganization.
We will have outstanding two classes of common stock and one
share of class B special voting stock, as follows:
|
|
|
|
|
8,948,325 shares of class A common stock, held by our
management and persons who purchase shares in this offering, |
|
|
|
142,545 shares of class B common stock, held by certain
former holders of interests in EMS L.P., and |
|
|
|
one share of class B special voting stock, held by Onex
Corporation as trustee for the holders of LP exchangeable units. |
EMS L.P. will have outstanding partnership units as follows:
|
|
|
|
|
32,107,500 LP exchangeable units, exchangeable on a one-for-one
basis for shares of our class B common stock, held by the
Onex entities, and |
|
|
|
860,570 other partnership units, including the general partner
interest, held by us. |
The shares sold in this offering will be our class A common
stock. The Onex entities ownership of the LP exchangeable
units will entitle them to acquire from us all of our
class B common stock other than the 142,545 shares
that will be outstanding upon completion of this offering. The
LP exchangeable units will be exchangeable at any time, at the
option of the holder, for shares of class B common stock on
a one-for-one basis, and the LP exchangeable units will be
substantially equivalent economically to class B common
stock.
Our shares of class A common stock and shares of
class B common stock will be identical except with respect
to voting rights and except that each share of class B
common stock may be converted into a share of class A
common stock at any time at the option of the holder. On every
matter properly submitted to stockholders for their vote, each
share of class A common stock will be entitled to one vote
per share and each share of class B common stock will be
entitled to ten votes per share, reducing to one vote per share
under certain limited circumstances. The one share of
class B special voting stock will be entitled to a number
of votes equal to the number of votes that could be cast if all
of the then outstanding LP exchangeable units were exchanged for
class B common stock. See Description of Capital
Stock Common Stock and LP
Exchangeable Units and Class B Special Voting Stock.
To effect the reorganization, we will take the following steps
immediately prior to the completion of this offering:
|
|
|
|
|
the holders of the capital stock of the sole general partner of
EMS L.P. will contribute that capital stock to us in exchange
for shares of class B common stock, the general partner will be
merged into us and we will become the general partner of EMS
L.P., |
|
|
|
the holders of class B units of EMS L.P. will contribute their
units to us in exchange for shares of our class A common stock,
and the holders of certain class A units of EMS L.P. will
contribute their units to us in exchange for shares of our class
B common stock, |
|
|
|
the class A units of EMS L.P. held by the Onex entities will
continue to be held by the Onex entities and will be designated
LP exchangeable units, and, |
27
|
|
|
|
|
we will issue one share of class B special voting stock to Onex
Corporation as trustee to hold for the benefit of the holders of
the LP exchangeable units. |
We have structured our reorganization in this manner to ensure
that our initial public offering will not result in a taxable
event for any of our equity holders. We are registering under
the Securities Act the class A common stock we are issuing
in our reorganization to holders of class B units of EMS
L.P. Accordingly, these shares will be freely transferable under
the Securities Act for holders who are not our affiliates. See
Shares Eligible for Future Sale.
The partnership interests of EMS L.P. we will purchase with the
net proceeds of this offering will be approximately 18.9% of the
total number of partnership units. This is the same percentage
as the class A common stock we are selling in this offering
bears to our total outstanding common stock, giving effect to
the exchange of all of the LP exchangeable units for
class B common stock. See Description of Capital
Stock Overview.
Immediately prior to this offering, our structure and ownership
is as follows:
|
|
* |
The stock of AMR and EmCare is held through 100% wholly-owned
subsidiaries. |
28
Upon completion of this offering, our structure and ownership
will be as follows:
|
|
|
|
* |
The stock of AMR and EmCare is held through 100% wholly-owned
subsidiaries. |
|
|
** |
The Onex entities will hold 30 shares of class B
common stock and will have the benefit of one share of
class B special voting stock. |
|
|
*** |
Holders have consent rights under certain limited circumstances
with respect to changes in the rights attributable to LP
exchangeable units. See Limited Partnership Agreement of
Emergency Medical Services L.P. Limited Consent
Rights. |
Following this offering, we will have the following securities
outstanding:
|
|
|
|
|
8,948,325 shares of class A common stock, |
|
|
|
142,545 shares of class B common stock, |
29
|
|
|
|
|
one share of class B special voting stock, and |
|
|
|
32,107,500 LP exchangeable units of EMS L.P. |
At any time at the option of the holder:
|
|
|
|
|
each LP exchangeable unit is exchangeable into one share of
class B common stock, and |
|
|
|
each share of class B common stock is convertible into one
share of class A common stock. |
Our securities are entitled to vote on all matters subject to a
vote of holders of common stock, voting together as a single
class, as follows:
|
|
|
|
|
class A common stock is entitled to one vote per share, |
|
|
|
class B common stock is entitled to ten votes per share
(reducing to one vote per share under certain limited
circumstances), and |
|
|
|
one share of class B special voting stock, held for the
benefit of the holders of LP exchangeable units, is entitled to
a number of votes equal to the number of votes that could be
cast if all the then outstanding LP exchangeable units were
exchanged for class B common stock. |
The holders of the LP exchangeable units may therefore
exercise voting rights with respect to Emergency Medical
Services as though they held the same number of shares of our
class B common stock.
30
USE OF PROCEEDS
We estimate that our net proceeds from the sale of
7,800,000 shares of class A common stock in this
offering will be approximately $111.6 million, based on an
assumed initial public offering price of $16.00 per share,
the midpoint of the range on the cover of this prospectus, and
after deducting underwriting discounts and commissions and
estimated offering expenses payable by us. We will not receive
any of the proceeds from the sale of shares by the selling
stockholders if the underwriters exercise their over-allotment
option.
We intend to use the net proceeds to purchase partnership
interests in our subsidiary, Emergency Medical Services L.P. In
turn, the partnership intends to use the net proceeds:
|
|
|
|
|
to repay $100.0 million of the $350.0 million
outstanding under the term loan portion of our senior secured
credit facility, and |
|
|
|
the balance for working capital, capital expenditures and other
general corporate purposes. |
On February 10, 2005, we entered into a $450.0 million
senior secured credit agreement, comprised of a
$100.0 million revolving credit facility and a
$350.0 million term loan. We borrowed the full amount of
the term loan and $20.2 million under the revolving credit
facility to fund our acquisition of AMR and EmCare, including
the payment of related fees and expenses, and we have used
balances outstanding from time to time under the revolving
credit facility for working capital purposes. As of
September 30, 2005, we had $5.0 million of borrowings
outstanding under the revolving credit facility and we had
approximately $67.7 million of availability under that
facility, net of outstanding letters of credit of $27.3 million.
Commitments under our revolving credit facility terminate on
February 10, 2010. We intend to repay $100.0 million
of the term loan with the proceeds of this offering. The term
loan and the revolving credit facility bear interest at variable
rates (5.98% at September 30, 2005). The revolving credit
facility matures on February 10, 2011 and the term loan
matures on February 10, 2012. Certain of the underwriters
of this offering or their affiliates are lenders under our
senior secured credit facility and, in that capacity, will
receive a portion of the net proceeds of this offering.
See Managements Discussion and Analysis of Financial
Condition and Results of Operations Liquidity and
Capital Resources Debt Facilities for
additional information regarding our outstanding debt.
See Formation of Holding Company for a description
of how we determined the percentage of the equity in
EMS L.P. we will purchase with the net proceeds of this
offering.
31
CAPITALIZATION
The following table sets forth as of September 30, 2005:
|
|
|
|
|
our consolidated capitalization on an actual basis, |
|
|
|
our consolidated capitalization on a pro forma basis to give
effect to our reorganization as a holding company and the
1.5-for-1 stock split to be effected immediately prior to this
offering, and |
|
|
|
our consolidated capitalization on a pro forma, as adjusted,
basis to give effect to the sale of 7,800,000 shares of
class A common stock by us in this offering at an assumed
initial public offering price of $16.00 per share, and the
application of those proceeds as described in Use of
Proceeds. |
You should read this table together with our unaudited
consolidated pro forma financial information included elsewhere
in this prospectus. For additional information regarding our
outstanding debt, see Managements Discussion and
Analysis of Financial Condition and Results of
Operations Liquidity and Capital
Resources Debt Facilities.
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
As of September 30, 2005 | |
|
|
| |
|
|
|
|
Pro Forma, | |
|
|
Actual | |
|
Pro Forma | |
|
as Adjusted | |
|
|
| |
|
| |
|
| |
|
|
(dollars in millions) | |
|
|
|
|
(unaudited) | |
|
|
Long-term debt, including current portion:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Revolving credit facility(1)
|
|
$ |
5.0 |
|
|
$ |
5.0 |
|
|
$ |
5.0 |
|
|
Term loan
|
|
|
348.3 |
|
|
|
348.3 |
|
|
|
248.3 |
|
|
Capital leases and other debt
|
|
|
5.3 |
|
|
|
5.3 |
|
|
|
5.3 |
|
|
|
|
|
|
|
|
|
|
|
|
|
Total senior debt
|
|
|
358.6 |
|
|
|
358.6 |
|
|
|
258.6 |
|
|
Senior subordinated notes
|
|
|
250.0 |
|
|
|
250.0 |
|
|
|
250.0 |
|
|
|
|
|
|
|
|
|
|
|
|
|
Total debt
|
|
$ |
608.6 |
|
|
$ |
608.6 |
|
|
$ |
508.6 |
|
Redeemable partnership equity
|
|
|
1.2 |
|
|
|
|
|
|
|
|
|
Partnership equity
|
|
|
222.2 |
|
|
|
|
|
|
|
|
|
Stockholders equity
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Preferred stock, $0.01 par value per share,
20,000,000 shares authorized pro forma; no shares issued
and outstanding
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Class A common stock, $0.01 par value per share,
100,000,000 shares authorized pro forma;
1,148,325 shares issued and outstanding pro forma;
8,498,325 shares issued and outstanding pro forma, as
adjusted
|
|
|
|
|
|
|
|
|
|
|
0.1 |
|
|
Class B common stock, $0.01 par value per share,
40,000,000 shares authorized pro forma; 142,545 shares
issued and outstanding pro forma and as adjusted
|
|
|
|
|
|
|
|
|
|
|
|
|
|
LP exchangeable units, 32,107,500 units issued and
outstanding pro forma and as adjusted
|
|
|
|
|
|
|
213.3 |
|
|
|
213.3 |
|
Additional paid-in capital
|
|
|
|
|
|
|
10.1 |
|
|
|
121.6 |
|
Retained earnings
|
|
|
14.0 |
|
|
|
14.0 |
|
|
|
11.0 |
|
Comprehensive loss
|
|
|
(.7 |
) |
|
|
(.7 |
) |
|
|
(.7 |
) |
|
|
|
|
|
|
|
|
|
|
|
|
Total equity
|
|
|
235.5 |
|
|
|
236.7 |
|
|
|
345.3 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Total capitalization
|
|
$ |
845.3 |
|
|
$ |
845.3 |
|
|
$ |
853.9 |
|
|
|
|
|
|
|
|
|
|
|
|
|
(1) |
The revolving credit facility provides for availability of
borrowings and issuances of letters of credit for up to
$100.0 million. At September 30, 2005,
$5.0 million of borrowings were outstanding under the
revolving credit facility, letters of credit outstanding were
$27.3 million and the maximum remaining available under the
facility was $67.7 million. |
32
DILUTION
If you invest in our class A common stock, your interest
will be diluted immediately to the extent of the difference
between the public offering price per share of our class A
common stock and the pro forma net tangible book value per share
of our common stock after this offering.
As of September 30, 2005, our net tangible book value,
determined on a historical basis as described below, was
$(117.8) million, or $(3.53) per share of class A
common stock and class B common stock (together, our common
stock). Net tangible book value represents the amount of our
total assets (excluding intangible assets), less our total
liabilities, divided, in the case of net tangible book value per
share, by the pro forma number of shares outstanding giving
effect to our reorganization into a holding company and the
1.5-for-1 stock split that we expect to effect in connection
with this offering.
After giving effect to our sale of 7,800,000 shares of
class A common stock in this offering, based on an assumed
initial public offering price of $16.00 per share, and
after deducting underwriting discounts and commissions and
estimated offering expenses payable by us, our adjusted pro
forma net tangible book value at September 30, 2005 would
have been approximately $(8.0) million, or $(0.19) per
share of our common stock. This represents an immediate increase
in pro forma net tangible book value of $3.34 per share to
our existing stockholders and an immediate net tangible book
value dilution of $16.19 per share to new investors
purchasing shares in this offering. The following table
illustrates this dilution:
|
|
|
|
|
|
|
|
|
|
Assumed initial public offering price per share
|
|
|
|
|
|
$ |
16.00 |
|
|
|
|
|
|
|
|
|
Net tangible book value per share at September 30, 2005
|
|
$ |
(3.53 |
) |
|
|
|
|
|
Increase in pro forma net tangible book value per share
attributable to new investors
|
|
|
3.34 |
|
|
|
|
|
|
|
|
|
|
|
|
Pro forma adjusted net tangible book value per share after this
offering
|
|
|
|
|
|
|
(0.19 |
) |
|
|
|
|
|
|
|
Dilution per share to new investors
|
|
|
|
|
|
$ |
16.19 |
|
|
|
|
|
|
|
|
The following table summarizes, as of September 30, 2005,
as adjusted to give effect to this offering, the differences
between the number of shares of our common stock purchased from
us, the total consideration paid to us and the average price per
share paid by our existing stockholders and by the new investors
purchasing common stock in this offering. The calculation is
based on an assumed initial public offering price of
$16.00 per share, before deducting underwriting discounts
and commissions and estimated offering expenses payable by us.
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Shares Purchased | |
|
Total Consideration | |
|
|
|
|
| |
|
| |
|
Average Price | |
|
|
Number | |
|
Percent | |
|
Amount | |
|
Percent | |
|
Per Share | |
|
|
| |
|
| |
|
| |
|
| |
|
| |
Existing stockholders
|
|
|
33,398,370 |
|
|
|
81.1 |
% |
|
$ |
222,655,800 |
|
|
|
64.1 |
% |
|
$ |
6.67 |
|
New investors
|
|
|
7,800,000 |
|
|
|
18.9 |
% |
|
$ |
124,800,000 |
|
|
|
35.9 |
% |
|
$ |
16.00 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Total
|
|
|
41,198,370 |
|
|
|
100 |
% |
|
$ |
347,455,800 |
|
|
|
100 |
% |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
If the underwriters exercise their over-allotment option in
full, our existing stockholders would own approximately 78.2% of
the total number of shares of our common stock outstanding after
this offering.
The preceding discussion and tables include the shares of our
class B common stock issuable on exchange of our
LP exchangeable units and exclude 3,509,219 shares of
our class A common stock issuable upon the exercise of
outstanding stock options at an exercise price of $6.67 per
share and 566,745 shares of our class A common stock
reserved for issuance under our equity option plan. To the
extent that all outstanding options are exercised, your
investment will be further diluted by $0.01 per share, and our
existing stockholders would own approximately 82.6% of the total
number of shares of our common stock outstanding after this
offering. In addition, we may choose to raise additional capital
due to market conditions or strategic considerations even if we
believe we have sufficient funds for our current or future
operating plans. To the extent additional capital is raised
through the sale of equity or convertible debt securities, the
issuance of these securities could result in further dilution to
our stockholders.
33
DIVIDEND POLICY
We currently intend to retain any future earnings to support our
operations and to fund the development and growth of our
business. In addition, the payment of dividends by us to holders
of our common stock is limited by our senior secured credit
facility. Our future dividend policy will depend on the
requirements of financing agreements to which we may be a party.
We do not intend to pay cash dividends on our common stock in
the foreseeable future. Any future determination to pay
dividends will be at the discretion of our board of directors
and will depend upon, among other factors, our results of
operations, financial condition, capital requirements and
contractual restrictions.
34
UNAUDITED PRO FORMA CONSOLIDATED FINANCIAL DATA
The following pro forma consolidated financial statements
present Emergency Medical Services financial position and
results of operations resulting from the acquisition, the sale
of 7,800,000 shares of class A common stock pursuant
to this offering and the application of the proceeds therefrom
as described in Use of Proceeds. AMR and EmCare
combined are the predecessor entity of Emergency Medical
Services for the periods prior to our acquisition of those
businesses.
The unaudited pro forma consolidated financial statements
include:
|
|
|
|
|
the pro forma consolidated balance sheet as of
September 30, 2005, assuming this offering occurred on
September 30, 2005 and the proceeds were applied as
described in Use of Proceeds, |
|
|
|
the pro forma consolidated statement of operations for the eight
months ended September 30, 2005, assuming this offering
occurred on February 1, 2005 and the proceeds were applied
as described in Use of Proceeds, |
|
|
|
the pro forma consolidated statement of operations for the five
months ended January 31, 2005, assuming the transactions
described below occurred as of September 1, 2004, and |
|
|
|
the pro forma consolidated statement of operations for the year
ended August 31, 2004, assuming the transactions described
below occurred as of September 1, 2003. |
The unaudited pro forma consolidated financial information is
presented for informational purposes only and does not purport
to represent our financial condition or our results of
operations had the acquisition and this offering occurred on or
as of the dates noted above or to project the results for any
future date or period. In the opinion of management, all
adjustments have been made that are necessary to present fairly
the unaudited pro forma consolidated financial information.
The unaudited pro forma consolidated financial statements for
periods prior to our acquisition of AMR and EmCare are based on
the historical combined financial statements of AMR and EmCare,
as predecessor to Emergency Medical Services, included elsewhere
in this prospectus, adjusted to give pro forma effect to the
following transactions, all of which are deemed to have occurred
concurrently:
|
|
|
|
|
our acquisition of AMR and EmCare, including: |
|
|
|
|
|
issuance of equity by Emergency Medical Services for aggregate
contributions of $219.2 million, |
|
|
|
our senior secured credit facility, consisting of: |
|
|
|
|
|
a revolving credit facility of $100.0 million, of which we
borrowed approximately $20.2 million at the closing date of
the acquisition and had outstanding $24.3 million of
letters of credit, and |
|
|
|
a term loan of $350.0 million, all of which was borrowed on
the closing date, |
|
|
|
|
|
the issuance and sale of $250.0 million in aggregate
principal amount of our senior subordinated notes, |
|
|
|
our purchase of all of the outstanding common stock of AMR and
EmCare, and |
|
|
|
the payment of related fees and expenses related to the
acquisition. |
The unaudited pro forma consolidated financial statements for
all periods are adjusted to give pro forma effect to the
following, which are deemed to have occurred concurrently:
|
|
|
|
|
our formation as a holding company, with EMS L.P. as a
subsidiary, the issuance of common stock to our equityholders
other than the Onex entities and the 1.5-for-1 stock
split, and |
|
|
|
the sale of the 7,800,000 shares of class A common
stock offered hereby by us and the application of the proceeds
therefrom as described in Use of Proceeds. |
The unaudited pro forma consolidated financial statements are
based on the estimates and assumptions set forth in the notes to
these statements that management believes are reasonable. These
estimates include an
35
allocation of fair value to identifiable intangible assets other
than goodwill, and the resulting excess of the purchase price
over the carrying value of the net assets acquired is recorded
as goodwill. The pro forma adjustments reflected in the
following financial statements are based on managements
preliminary assessment of the fair value of the tangible and
intangible assets we acquired and liabilities we assumed in our
acquisition of AMR and EmCare. The final purchase price
allocation will be performed when an independent appraisal of
certain assets acquired and liabilities assumed is finalized. We
expect that the final purchase price allocation may reflect
differences from our estimated amounts, as follows:
|
|
|
|
|
the fair value of our finite life contract intangible asset, |
|
|
|
the fair value adjustment for favorable or unfavorable leases, |
|
|
|
the fair value adjustment for property and equipment, |
|
|
|
changes in the excess purchase price allocated to goodwill, |
|
|
|
changes in the fair value of other liabilities assumed and
incurred as part of the acquisition, and |
|
|
|
changes in the value of net deferred tax assets carried over as
part of the acquisition, including the final determination of
the deductibility of amounts related to certain settlement
accruals. |
The unaudited pro forma consolidated financial statements should
be read in conjunction with our historical financial statements
and related notes and other financial information included
elsewhere in this prospectus, including Risk Factors
and Managements Discussion and Analysis of Financial
Condition and Results of Operations.
36
Emergency Medical Services Corporation
Unaudited Pro Forma Consolidated Balance Sheet
September 30, 2005
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Pro Forma Equity | |
|
|
|
|
|
|
Offering | |
|
Pro | |
|
|
Actual | |
|
Adjustments | |
|
Forma | |
|
|
| |
|
| |
|
| |
|
|
(dollars in thousands) | |
ASSETS |
Current assets:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Cash and cash equivalents
|
|
$ |
10,113 |
|
|
$ |
11,564 |
(1) |
|
$ |
21,677 |
|
|
Restricted cash and cash equivalents
|
|
|
11,949 |
|
|
|
|
|
|
|
11,949 |
|
|
Restricted marketable securities
|
|
|
2,165 |
|
|
|
|
|
|
|
2,165 |
|
|
Trade and other accounts receivable, net
|
|
|
369,766 |
|
|
|
|
|
|
|
369,766 |
|
|
Parts and supplies inventory
|
|
|
18,760 |
|
|
|
|
|
|
|
18,760 |
|
|
Other current assets
|
|
|
31,008 |
|
|
|
|
|
|
|
31,008 |
|
|
Current deferred tax assets
|
|
|
22,971 |
|
|
|
|
|
|
|
22,971 |
|
|
|
|
|
|
|
|
|
|
|
|
|
Total current assets
|
|
|
466,732 |
|
|
|
11,564 |
|
|
|
478,296 |
|
Non-current assets:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Property, plant and equipment, net
|
|
|
133,283 |
|
|
|
|
|
|
|
133,283 |
|
|
Intangible assets, net
|
|
|
81,363 |
|
|
|
|
|
|
|
81,363 |
|
|
Non-current deferred tax assets
|
|
|
117,488 |
|
|
|
|
|
|
|
117,488 |
|
|
Restricted long-term investments
|
|
|
73,304 |
|
|
|
|
|
|
|
73,304 |
|
|
Goodwill
|
|
|
271,987 |
|
|
|
|
|
|
|
271,987 |
|
|
Other long-term assets
|
|
|
109,251 |
|
|
|
(2,978 |
)(2) |
|
|
106,273 |
|
|
|
|
|
|
|
|
|
|
|
|
|
Total assets
|
|
$ |
1,253,408 |
|
|
$ |
8,586 |
|
|
$ |
1,261,994 |
|
|
|
|
|
|
|
|
|
|
|
|
LIABILITIES AND EQUITY |
Current liabilities:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Accounts payable
|
|
$ |
53,066 |
|
|
$ |
|
|
|
$ |
53,066 |
|
|
Accrued liabilities
|
|
|
199,849 |
|
|
|
|
|
|
|
199,849 |
|
|
Current portion of long-term debt
|
|
|
13,478 |
|
|
|
|
|
|
|
13,478 |
|
|
|
|
|
|
|
|
|
|
|
|
|
Total current liabilities
|
|
|
266,393 |
|
|
|
|
|
|
|
266,393 |
|
Long-term debt
|
|
|
595,129 |
|
|
|
(100,000 |
)(3) |
|
|
495,129 |
|
Other long-term liabilities
|
|
|
155,139 |
|
|
|
|
|
|
|
155,139 |
|
|
|
|
|
|
|
|
|
|
|
|
|
Total liabilities
|
|
|
1,016,661 |
|
|
|
(100,000 |
) |
|
|
916,661 |
|
|
|
|
|
|
|
|
|
|
|
Redeemable partnership equity
|
|
|
1,213 |
|
|
|
(1,213 |
)(4) |
|
|
|
|
Equity
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Partnership equity
|
|
|
222,178 |
|
|
|
(222,178 |
)(4) |
|
|
|
|
|
Class A common stock
|
|
|
|
|
|
|
90 |
(4) |
|
|
90 |
|
|
Class B common stock
|
|
|
|
|
|
|
1 |
(4) |
|
|
1 |
|
|
LP exchangeable units
|
|
|
|
|
|
|
213,311 |
(4) |
|
|
213,311 |
|
|
Additional paid-in capital
|
|
|
|
|
|
|
121,553 |
(4) |
|
|
121,553 |
|
|
Retained earnings
|
|
|
14,002 |
|
|
|
(2,978 |
)(2) |
|
|
11,024 |
|
|
Comprehensive income (loss)
|
|
|
(646 |
) |
|
|
|
|
|
|
(646 |
) |
|
|
|
|
|
|
|
|
|
|
|
|
Total equity
|
|
|
235,534 |
|
|
|
109,799 |
|
|
|
345,333 |
|
|
|
|
|
|
|
|
|
|
|
|
|
Total liabilities and equity
|
|
$ |
1,253,408 |
|
|
$ |
8,586 |
|
|
$ |
1,261,994 |
|
|
|
|
|
|
|
|
|
|
|
|
|
(1) |
To record cash receipts from the net proceeds of this offering
to be used for general corporate purposes. |
|
(2) |
To record the write-off of certain deferred financing costs
associated with the portion of our senior secured credit
facility we will pay down with the net proceeds of this
offering. We will expense these costs in our historical
post-offering consolidated statement of operations. |
|
(3) |
To record the pay-down of our senior secured credit facility
with the net proceeds of this offering. |
|
(4) |
To record (a) our formation as a holding company, with
EMS L.P. as a subsidiary, the (b) issuance of
class A common stock and class B common stock to
certain of our existing equityholders and the designation of the
remaining class A partnership units as LP exchangeable
units, exchangeable for our class B common stock and
(c) net proceeds of this offering. |
37
Emergency Medical Services Corporation
Unaudited Pro Forma Consolidated Statement of Operations
For the eight months ended September 30, 2005
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Pro Forma Equity | |
|
|
|
|
|
|
Offering | |
|
|
|
|
Consolidated | |
|
Adjustments | |
|
Pro Forma | |
|
|
| |
|
| |
|
| |
|
|
(dollars in thousands) | |
Net revenue
|
|
$ |
1,187,653 |
|
|
$ |
|
|
|
$ |
1,187,653 |
|
Compensation and benefits
|
|
|
822,595 |
|
|
|
|
|
|
|
822,595 |
|
Operating expenses
|
|
|
168,700 |
|
|
|
|
|
|
|
168,700 |
|
Insurance expense
|
|
|
60,382 |
|
|
|
|
|
|
|
60,382 |
|
Selling, general and administrative expenses
|
|
|
38,248 |
|
|
|
|
|
|
|
38,248 |
|
Depreciation and amortization expenses
|
|
|
38,811 |
|
|
|
|
|
|
|
38,811 |
|
|
|
|
|
|
|
|
|
|
|
Income from operations
|
|
|
58,917 |
|
|
|
|
|
|
|
58,917 |
|
Interest expense
|
|
|
(34,407 |
) |
|
|
4,512 |
(1) |
|
|
(29,895 |
) |
Realized loss on investments
|
|
|
(40 |
) |
|
|
|
|
|
|
(40 |
) |
Interest and other income
|
|
|
189 |
|
|
|
|
|
|
|
189 |
|
|
|
|
|
|
|
|
|
|
|
Income before income taxes
|
|
|
24,659 |
|
|
|
4,512 |
|
|
|
29,171 |
|
Income tax expense
|
|
|
(10,657 |
) |
|
|
(1,805 |
) (2) |
|
|
(12,462 |
) |
|
|
|
|
|
|
|
|
|
|
Net income
|
|
$ |
14,002 |
|
|
$ |
2,707 |
|
|
$ |
16,709 |
|
|
|
|
|
|
|
|
|
|
|
Net income per share:
|
|
|
|
|
|
|
|
|
|
|
|
|
Basic |
|
$ |
0.42 |
|
Diluted |
|
$ |
0.41 |
|
Weighted average shares basic |
|
|
40,163,066 |
(3) |
Weighted average shares diluted |
|
|
41,122,368 |
(3) |
|
|
(1) |
To record reduction of interest expense on our senior secured
credit facility as a result of the pay-down with net proceeds of
this offering and reduce amortization associated with the
write-down of deferred financing costs. |
|
(2) |
To adjust income tax expense to reflect the reduction of
interest expense, at an effective tax rate of 40%. |
|
(3) |
The pro forma weighted shares outstanding are based on the
actual equity transactions recorded in the eight-month period
ended September 30, 2005 and described elsewhere in this
prospectus. These actual equity transactions have been adjusted
to give effect to our reorganization as a holding company,
assume the exchange of all LP exchangeable units for
class B common stock, and include the 7.0 million
shares of common stock we will issue in this offering to
generate the $100 million of net proceeds we intend to use
to repay debt outstanding under our senior secured credit
facility. These weighted shares were used to calculate basic
earnings per share, and the number of diluted shares gives pro
forma effect to the options outstanding during the eight-month
period, using an assumed offering price of $16.00 per share. |
38
Emergency Medical Services Corporation
Unaudited Pro Forma Consolidated Statement of Operations
For the five months ended January 31, 2005
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
AMR and | |
|
Pro Forma | |
|
Pro Forma | |
|
|
|
|
EmCare | |
|
Acquisition | |
|
Equity Offering | |
|
|
|
|
Combined | |
|
Adjustments | |
|
Adjustments | |
|
Pro Forma | |
|
|
| |
|
| |
|
| |
|
| |
|
|
(dollars in thousands) | |
Net revenue
|
|
$ |
696,179 |
|
|
$ |
|
|
|
$ |
|
|
|
$ |
696,179 |
|
Compensation and benefits
|
|
|
481,305 |
|
|
|
|
|
|
|
|
|
|
|
481,305 |
|
Operating expenses
|
|
|
94,882 |
|
|
|
|
|
|
|
|
|
|
|
94,882 |
|
Insurance expense
|
|
|
39,002 |
|
|
|
|
|
|
|
|
|
|
|
39,002 |
|
Selling, general and administrative expenses
|
|
|
21,635 |
|
|
|
|
|
|
|
|
|
|
|
21,635 |
|
Laidlaw fees and compensation charges
|
|
|
19,857 |
|
|
|
|
|
|
|
|
|
|
|
19,857 |
(1) |
Depreciation and amortization expenses
|
|
|
18,808 |
|
|
|
4,424 |
(2) |
|
|
|
|
|
|
23,232 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Income (loss) from operations
|
|
|
20,690 |
|
|
|
(4,424 |
) |
|
|
|
|
|
|
16,266 |
|
Interest expense
|
|
|
(5,644 |
) |
|
|
5,254 |
(3) |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
(21,306 |
)(4)(5) |
|
|
3,141 |
(6) |
|
|
(18,555 |
) |
Interest and other income
|
|
|
714 |
|
|
|
|
|
|
|
|
|
|
|
714 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Income (loss) before income taxes
|
|
|
15,760 |
|
|
|
(20,476 |
) |
|
|
3,141 |
|
|
|
(1,575 |
) |
Income tax expense
|
|
|
(6,278 |
) |
|
|
8,157 |
(7) |
|
|
(1,250 |
)(7) |
|
|
629 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Net income (loss)
|
|
$ |
9,482 |
|
|
$ |
(12,319 |
) |
|
$ |
1,891 |
|
|
$ |
(946 |
) |
|
|
|
|
|
|
|
|
|
|
|
|
|
Net loss per share:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Basic |
|
$ |
(0.02 |
) |
Diluted |
|
$ |
(0.02 |
) |
Weighted average shares basic |
|
|
40,163,066 |
(8) |
Weighted average shares diluted |
|
|
41,122,368 |
(8) |
|
|
(1) |
Represents certain Laidlaw fees and compensation charges,
primarily relating to a compensation charge associated with the
increase in the enterprise values of AMR and EmCare. Our
estimated replacement costs for certain functions are not
recorded on the face of this pro forma statement of operations
because we do not have a contract for each element of these
costs. We will be required to replace certain functions and
costs previously provided to us by Laidlaw and which comprise
Laidlaw fees and compensation charges. Our estimate of these
costs on an annual basis ($1.67 million for a five-month
period) are: |
|
|
|
|
|
Compensation and benefits costs for personnel providing internal
audit and tax services
|
|
$ |
1,100 |
|
Directors and officers insurance
|
|
|
500 |
|
Selling, general and administrative expenses for external audit
fees, treasury services and other costs
|
|
|
1,400 |
|
Onex management fee
|
|
|
1,000 |
|
|
|
|
|
|
|
$ |
4,000 |
|
|
|
|
|
We incurred $1.9 million of such costs in the eight months
ended September 30, 2005, excluding costs related to our
acquisition of AMR and EmCare.
|
|
(2) |
AMR and EmCare combined amortization expense includes
amortization (over a 7-year period) of the finite life
intangible assets of $89.0 million based on the value of
identifiable intangible assets determined by an independent
valuation group. |
(3) |
To eliminate interest expense charged on the Laidlaw payable. |
(4) |
To record amortization on $18.1 million of deferred
financing costs associated with our acquisition-related
borrowings, utilizing a weighted average maturity of eight years
on an effective yield basis. |
(5) |
To record interest expense on our acquisition-related
borrowings, assuming a weighted average interest rate of 7.87%. |
(6) |
To record reduction of interest expense on our senior secured
credit facility as a result of the pay-down with net proceeds of
this offering. |
(7) |
To adjust income tax expense to reflect the adjustments
identified in notes (2) through (6), at an effective tax
rate of 40%. |
(8) |
The pro forma weighted shares outstanding are based on the
actual equity transactions recorded in the eight-month period
ended September 30, 2005 and described elsewhere in this
prospectus. These actual equity transactions have been adjusted
to give effect to our reorganization as a holding company,
assume the exchange of all LP exchangeable units for
class B common stock, and include the 7.0 million
shares of common stock we will issue in this offering to
generate the $100 million of net proceeds we intend to use
to repay debt outstanding under our senior secured credit
facility. These weighted shares were used to calculate basic
earnings per share, and the number of diluted shares gives pro
forma effect to the options outstanding during the eight-month
period, using an assumed offering price of $16.00 per share. |
39
Emergency Medical Services Corporation
Unaudited Pro Forma Consolidated Statement of Operations
For the year ended August 31, 2004
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
AMR and | |
|
Pro Forma | |
|
Pro Forma | |
|
|
|
|
EmCare | |
|
Acquisition | |
|
Equity Offering | |
|
|
|
|
Combined | |
|
Adjustments | |
|
Adjustments | |
|
Pro Forma | |
|
|
| |
|
| |
|
| |
|
| |
|
|
(dollars in thousands) | |
Net revenue
|
|
$ |
1,604,598 |
|
|
$ |
|
|
|
$ |
|
|
|
$ |
1,604,598 |
|
Compensation and benefits
|
|
|
1,117,890 |
|
|
|
|
|
|
|
|
|
|
|
1,117,890 |
|
Operating expenses
|
|
|
218,277 |
|
|
|
|
|
|
|
|
|
|
|
218,277 |
|
Insurance expense
|
|
|
80,255 |
|
|
|
|
|
|
|
|
|
|
|
80,255 |
|
Selling, general and administrative expenses
|
|
|
47,899 |
|
|
|
|
|
|
|
|
|
|
|
47,899 |
|
Laidlaw fees and compensation charges
|
|
|
15,449 |
|
|
|
|
|
|
|
|
|
|
|
15,449 |
(1) |
Depreciation and amortization expenses
|
|
|
52,739 |
|
|
|
3,130 |
(2) |
|
|
|
|
|
|
55,869 |
|
Restructuring charges
|
|
|
2,115 |
|
|
|
|
|
|
|
|
|
|
|
2,115 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Income (loss) from operations
|
|
|
69,974 |
|
|
|
(3,130 |
) |
|
|
|
|
|
|
66,844 |
|
Interest expense
|
|
|
(9,961 |
) |
|
|
6,373 |
(3) |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
(50,968 |
)(4)(5) |
|
|
7,505 |
(6) |
|
|
(47,051 |
) |
Realized loss on investments
|
|
|
(1,140 |
) |
|
|
|
|
|
|
|
|
|
|
(1,140 |
) |
Interest and other income
|
|
|
240 |
|
|
|
|
|
|
|
|
|
|
|
240 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Income (loss) before income taxes
|
|
|
59,113 |
|
|
|
(47,725 |
) |
|
|
7,505 |
|
|
|
18,893 |
|
Income tax expense
|
|
|
(21,764 |
) |
|
|
19,000 |
(7) |
|
|
(3,000 |
)(7) |
|
|
(5,764 |
) |
|
|
|
|
|
|
|
|
|
|
|
|
|
Net income (loss)
|
|
$ |
37,349 |
|
|
$ |
(28,725 |
) |
|
$ |
4,505 |
|
|
$ |
13,129 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Net income per share:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Basic
|
|
$ |
0.33 |
|
Diluted
|
|
$ |
0.32 |
|
Weighted average shares basic
|
|
|
40,163,066 |
(8) |
Weighted average shares diluted
|
|
|
41,122,368 |
(8) |
|
|
(1) |
Represents certain Laidlaw fees and compensation charges,
primarily relating to a compensation charge associated with the
increase in the enterprise values of AMR and EmCare. Our
estimated replacement costs for certain functions, are not
recorded on the face of this pro forma statement of operations
because we do not have a contract for each element of these
costs. We will be required to replace certain functions and
costs previously provided to us by Laidlaw and which comprise
Laidlaw fees and compensation charges. Our estimate of these
costs on an annual basis are: |
|
|
|
|
|
Compensation and benefits costs for personnel providing internal
audit and tax services
|
|
$ |
1,100 |
|
Directors and officers insurance
|
|
|
500 |
|
Selling, general and administrative expenses for external audit
fees, treasury services and other costs
|
|
|
1,400 |
|
Onex management fee
|
|
|
1,000 |
|
|
|
|
|
|
|
$ |
4,000 |
|
|
|
|
|
We incurred $1.9 million of such costs in the eight months
ended September 30, 2005, excluding costs related to our
acquisition of AMR and EmCare.
|
|
(2) |
AMR and EmCare combined amortization expense includes
amortization (over a 7-year period) of the finite life
intangible assets of $89.0 million based on the value of
identifiable intangible assets by an independent valuation group. |
(3) |
To eliminate interest expense charged on the Laidlaw payable. |
(4) |
To record amortization on $18.1 million of deferred
financing costs associated with our acquisition-related
borrowings, utilizing a weighted average maturity of eight years
on an effective yield basis. |
(5) |
To record interest expense on our acquisition-related
borrowings, assuming a weighted average interest rate of 7.87%. |
(6) |
To record reduction of interest expense on our senior secured
credit facility as a result of the pay-down with net proceeds of
this offering. |
(7) |
To adjust income tax expense to reflect the adjustments
identified in notes (2) through (6), at an effective tax
rate of 40%. |
(8) |
The pro forma weighted shares outstanding are based on the
actual equity transactions recorded in the eight-month period
ended September 30, 2005 and described elsewhere in this
prospectus. These actual equity transactions have been adjusted
to give effect to our reorganization as a holding company,
assume the exchange of all LP exchangeable units for
class B common stock, and include the 7.0 million
shares of common stock we will issue in this offering to
generate the $100 million of net proceeds we intend to
repay debt outstanding under our senior secured credit facility.
These weighted shares were used to calculate basic earnings per
share, and the number of diluted shares gives pro forma effect
to the options outstanding during the eight-month period, using
an assumed offering price of $16.00 per share. |
40
SELECTED COMBINED AND CONSOLIDATED FINANCIAL INFORMATION AND
OTHER DATA
The following table sets forth our selected combined or
consolidated financial data for each of the periods indicated.
Financial data for the year ended August 31, 2002
(Predecessor Pre-Laidlaw Bankruptcy), nine months
ended May 31, 2003 (Predecessor Pre-Laidlaw
Bankruptcy), as of and for the three months ended
August 31, 2003 (Predecessor Post-Laidlaw
bankruptcy), the year ended August 31, 2004
(Predecessor Post-Laidlaw Bankruptcy) and the five
months ended January 31, 2005 (Predecessor
Post-Laidlaw Bankruptcy) are derived from our audited combined
financial statements included in this prospectus. As a result of
a correction to AMRs method of calculating its accounts
receivable allowances, we determined that the allowances were
understated at various balance sheet dates. The audited combined
financial statements included in this prospectus are restated to
correct this error. There were no adjustments necessary to
income subsequent to May 31, 2003. Financial data as of and
for the five months ended January 31, 2004
(Predecessor Post-Laidlaw Bankruptcy) and the three
months and eight months ended September 30, 2004
(Predecessor Post-Laidlaw Bankruptcy) are derived
from our unaudited combined financial statements included in
this prospectus. Financial data as of and for the three months
and eight months ended September 30, 2005 are derived from
our unaudited consolidated financial statements. Interim results
are not necessarily indicative of the results to be expected for
the entire fiscal year. You should read the information
presented below in conjunction with Capitalization,
Managements Discussion and Analysis of Financial
Condition and Results of Operations and our combined and
consolidated financial statements and related notes contained
elsewhere in this prospectus.
The comparability of our selected historical financial data has
been affected by a number of significant events and
transactions. As we discuss more fully in
note 1 Fresh-Start Accounting of
the notes to our audited combined financial statements,
AMRs and EmCares former parent, Laidlaw, and certain
of its affiliates filed voluntary petitions for reorganization
under Chapter 11 of the U.S. Bankruptcy Code. Although
subsidiaries of Laidlaw, neither AMR nor EmCare was included in
the bankruptcy filing. Laidlaw emerged from bankruptcy
protection in June 2003. Laidlaw applied fresh-start accounting
as of June 1, 2003 to AMR and EmCare and pushed down to us
our share of the fresh-start accounting adjustments. As a result
of the fresh-start change in the basis of accounting for our
underlying assets and liabilities, our results of operations and
cash flows have been separated as pre-June 1, 2003 and
post-May 31, 2003.
Effective as of January 31, 2005, we acquired AMR and
EmCare from Laidlaw and, in connection with the acquisition, we
changed our fiscal year to December 31 from August 31. For all
periods prior to the acquisition, the AMR and EmCare businesses
formerly owned by Laidlaw are referred to as the
Predecessor. For all periods from and subsequent to
the acquisition, these businesses are referred to as the
Successor. As a result of the acquisition, we
include as a reporting period of the Predecessor our
pre-acquisition period ended January 31, 2005.
41
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Predecessor (Pre-Acquisition) | |
|
|
|
|
|
|
|
| |
|
|
|
|
|
|
|
Pre-Laidlaw Bankruptcy | |
|
|
|
|
|
|
|
|
As Restated | |
|
|
Post-Laidlaw Bankruptcy | |
|
|
Successor (Post-Acquisition) | |
|
|
| |
|
|
| |
|
|
| |
|
|
|
|
Nine | |
|
|
Three | |
|
|
|
|
|
|
|
|
|
|
|
|
|
Months | |
|
|
Months | |
|
|
|
Five Months Ended | |
|
Three Months | |
|
Eight Months | |
|
|
Three Months | |
|
Eight Months | |
|
|
Year Ended August 31, | |
|
Ended | |
|
|
Ended | |
|
Year Ended | |
|
January 31, | |
|
Ended | |
|
Ended | |
|
|
Ended | |
|
Ended | |
|
|
| |
|
May 31, | |
|
|
August 31, | |
|
August 31, | |
|
| |
|
September 30, | |
|
September 30, | |
|
|
September 30, | |
|
September 30, | |
|
|
2000(1) | |
|
2001(2) | |
|
2002 | |
|
2003 | |
|
|
2003 | |
|
2004 | |
|
2004 | |
|
2005 | |
|
2004 | |
|
2004 | |
|
|
2005 | |
|
2005 | |
|
|
| |
|
| |
|
| |
|
| |
|
|
| |
|
| |
|
| |
|
| |
|
| |
|
| |
|
|
| |
|
| |
|
|
(unaudited) | |
|
|
|
|
|
|
|
|
|
|
(unaudited) | |
|
|
|
(unaudited) | |
|
|
(unaudited) | |
|
|
(dollars in thousands) | |
Statement of Operations Data:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Net revenue
|
|
$ |
1,355,978 |
|
|
$ |
1,386,136 |
|
|
$ |
1,415,786 |
|
|
$ |
1,103,335 |
|
|
|
$ |
384,461 |
|
|
$ |
1,604,598 |
|
|
$ |
667,506 |
|
|
$ |
696,179 |
|
|
$ |
413,869 |
|
|
$ |
1,077,749 |
|
|
|
$ |
456,245 |
|
|
$ |
1,187,653 |
|
Compensation and benefits
|
|
|
980,731 |
|
|
|
976,330 |
|
|
|
960,590 |
|
|
|
757,183 |
|
|
|
|
264,604 |
|
|
|
1,117,890 |
|
|
|
461,923 |
|
|
|
481,305 |
|
|
|
286,628 |
|
|
|
751,238 |
|
|
|
|
319,292 |
|
|
|
822,595 |
|
Operating expenses
|
|
|
201,853 |
|
|
|
216,019 |
|
|
|
219,321 |
|
|
|
163,447 |
|
|
|
|
55,212 |
|
|
|
218,277 |
|
|
|
90,828 |
|
|
|
94,882 |
|
|
|
55,683 |
|
|
|
147,524 |
|
|
|
|
66,156 |
|
|
|
168,700 |
|
Insurance expense
|
|
|
78,079 |
|
|
|
117,374 |
|
|
|
66,479 |
|
|
|
69,576 |
|
|
|
|
34,671 |
|
|
|
80,255 |
|
|
|
36,664 |
|
|
|
39,002 |
|
|
|
18,404 |
|
|
|
51,674 |
|
|
|
|
21,048 |
|
|
|
60,382 |
|
Selling, general and administrative expenses
|
|
|
59,404 |
|
|
|
53,017 |
|
|
|
61,455 |
|
|
|
37,867 |
|
|
|
|
12,017 |
|
|
|
47,899 |
|
|
|
22,016 |
|
|
|
21,635 |
|
|
|
12,093 |
|
|
|
31,270 |
|
|
|
|
15,654 |
|
|
|
38,248 |
|
Laidlaw fees and compensation charges
|
|
|
7,320 |
|
|
|
7,260 |
|
|
|
5,400 |
|
|
|
4,050 |
|
|
|
|
1,350 |
|
|
|
15,449 |
|
|
|
6,436 |
|
|
|
19,857 |
|
|
|
3,657 |
|
|
|
10,095 |
|
|
|
|
|
|
|
|
|
|
Depreciation and amortization expense
|
|
|
99,957 |
|
|
|
66,286 |
|
|
|
67,183 |
|
|
|
32,144 |
|
|
|
|
12,560 |
|
|
|
52,739 |
|
|
|
22,079 |
|
|
|
18,808 |
|
|
|
12,669 |
|
|
|
34,627 |
|
|
|
|
14,843 |
|
|
|
38,811 |
|
Impairment losses
|
|
|
1,183,681 |
|
|
|
|
|
|
|
262,780 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Restructuring charges
|
|
|
1,826 |
|
|
|
|
|
|
|
3,777 |
|
|
|
1,288 |
|
|
|
|
1,449 |
|
|
|
2,115 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
1,381 |
|
|
|
|
|
|
|
|
|
|
Laidlaw reorganization charges
|
|
|
|
|
|
|
9,198 |
|
|
|
8,761 |
|
|
|
3,650 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Income (loss) from operations
|
|
|
(1,256,873 |
) |
|
|
(59,348 |
) |
|
|
(239,960 |
) |
|
|
34,130 |
|
|
|
|
2,598 |
|
|
|
69,974 |
|
|
|
27,560 |
|
|
|
20,690 |
|
|
|
24,555 |
|
|
|
49,940 |
|
|
|
|
19,252 |
|
|
|
58,917 |
|
Interest expense
|
|
|
(95,087 |
) |
|
|
(66,181 |
) |
|
|
(6,418 |
) |
|
|
(4,691 |
) |
|
|
|
(908 |
) |
|
|
(9,961 |
) |
|
|
(4,137 |
) |
|
|
(5,644 |
) |
|
|
(5,138 |
) |
|
|
(8,679 |
) |
|
|
|
(12,824 |
) |
|
|
(34,407 |
) |
Realized gain (loss) on investments
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
90 |
|
|
|
(1,140 |
) |
|
|
|
|
|
|
|
|
|
|
(1,140 |
) |
|
|
(1,191 |
) |
|
|
|
(34 |
) |
|
|
(40 |
) |
Interest and other income
|
|
|
86 |
|
|
|
222 |
|
|
|
369 |
|
|
|
304 |
|
|
|
|
22 |
|
|
|
240 |
|
|
|
1,403 |
|
|
|
714 |
|
|
|
162 |
|
|
|
210 |
|
|
|
|
91 |
|
|
|
189 |
|
Fresh-start accounting adjustments(3)
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
46,416 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Income (loss) before income taxes and cumulative effect of
change in accounting principle
|
|
|
(1,351,874 |
) |
|
|
(125,307 |
) |
|
|
(246,009 |
) |
|
|
76,159 |
|
|
|
|
1,802 |
|
|
|
59,113 |
|
|
|
24,826 |
|
|
|
15,760 |
|
|
|
18,439 |
|
|
|
40,280 |
|
|
|
|
6,485 |
|
|
|
24,659 |
|
Income tax expense
|
|
|
(54,639 |
) |
|
|
17,538 |
|
|
|
(1,374 |
) |
|
|
(829 |
) |
|
|
|
(8,633 |
) |
|
|
(21,764 |
) |
|
|
(9,800 |
) |
|
|
(6,278 |
) |
|
|
(7,191 |
) |
|
|
(15,710 |
) |
|
|
|
(3,479 |
) |
|
|
(10,657 |
) |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Income (loss) before cumulative effect of change in accounting
principle
|
|
|
(1,406,513 |
) |
|
|
(107,769 |
) |
|
|
(247,383 |
) |
|
|
75,330 |
|
|
|
|
(6,831 |
) |
|
|
37,349 |
|
|
|
15,026 |
|
|
|
9,482 |
|
|
|
11,248 |
|
|
|
24,570 |
|
|
|
|
3,006 |
|
|
|
14,002 |
|
Cumulative effect of a change in accounting principle
|
|
|
(5,288 |
) |
|
|
|
|
|
|
|
|
|
|
(223,721 |
)(4) |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Net income (loss)
|
|
$ |
(1,411,801 |
) |
|
$ |
(107,769 |
) |
|
$ |
(247,383 |
) |
|
$ |
(148,391 |
) |
|
|
$ |
(6,831 |
) |
|
$ |
37,349 |
|
|
$ |
15,026 |
|
|
$ |
9,482 |
|
|
$ |
11,248 |
|
|
$ |
24,570 |
|
|
|
$ |
3,006 |
|
|
$ |
14,002 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Other Financial Data:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Cash flows provided by (used in):
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Operating activities
|
|
$ |
30,133 |
|
|
$ |
28,044 |
|
|
$ |
156,544 |
|
|
$ |
58,769 |
|
|
|
$ |
30,009 |
|
|
$ |
127,679 |
|
|
$ |
18,627 |
|
|
$ |
15,966 |
|
|
|
|
|
|
$ |
99,961 |
|
|
|
|
|
|
|
$ |
108,462 |
|
|
Investing activities
|
|
|
(40,983 |
) |
|
|
(36,442 |
) |
|
|
(57,347 |
) |
|
|
(98,835 |
) |
|
|
|
(15,136 |
) |
|
|
(81,516 |
) |
|
|
(10,881 |
) |
|
|
(21,667 |
) |
|
|
|
|
|
|
(73,910 |
) |
|
|
|
|
|
|
|
(917,422 |
) |
|
Financing activities
|
|
|
22,402 |
|
|
|
11,376 |
|
|
|
(36,066 |
) |
|
|
(8,060 |
) |
|
|
|
(47,222 |
) |
|
|
(47,328 |
) |
|
|
(7,532 |
) |
|
|
10,856 |
|
|
|
|
|
|
|
(20,699 |
) |
|
|
|
|
|
|
|
804,442 |
|
Capital expenditures
|
|
$ |
37,698 |
|
|
$ |
39,347 |
|
|
$ |
57,438 |
(5) |
|
$ |
34,768 |
|
|
|
$ |
18,079 |
|
|
$ |
42,787 |
|
|
$ |
14,224 |
|
|
$ |
14,045 |
|
|
|
|
|
|
$ |
30,217 |
|
|
|
|
|
|
|
$ |
34,947 |
|
|
|
|
|
|
|
|
As of | |
|
|
September 30, 2005 | |
|
|
| |
|
|
(dollars in | |
|
|
thousands) | |
Balance Sheet Data:
|
|
|
|
|
Cash and cash equivalents
|
|
$ |
10,113 |
|
Total assets
|
|
|
1,253,408 |
|
Long-term debt and capital lease obligations, including current
maturities
|
|
|
608,607 |
|
Partners equity
|
|
$ |
235,534 |
|
|
|
(1) |
Represents the combination of the audited financial statements
of AMR and the unaudited financial statements of EmCare for the
year ended August 31, 2000. |
|
(2) |
Represents the combination of the audited financial statements
of AMR and EmCare for the year ended August 31, 2001. |
|
(3) |
See note 1 to our combined financial statements with
respect to our fresh-start financial reporting. |
|
(4) |
Reflects an impairment of goodwill recorded in connection with
the adoption of SFAS No. 142. |
|
(5) |
Includes $26.3 million financed through capital leases. |
42
MANAGEMENTS DISCUSSION AND ANALYSIS OF
FINANCIAL CONDITION AND RESULTS OF OPERATIONS
You should read the following discussion of our financial
condition and results of operations with the audited combined
financial statements, the notes to the audited combined
financial statements and the Selected Combined and
Consolidated Financial Information and Other Data
appearing elsewhere in this prospectus. The following covers
periods before the closing of the acquisition of AMR and EmCare.
Accordingly, the discussion and analysis of historical periods
do not reflect the impact the acquisition of AMR and EmCare will
have on us. In addition, this discussion contains
forward-looking statements and involves numerous risks and
uncertainties, including, but not limited to, those described in
the Risk Factors section of this prospectus. Our
results may differ materially from those anticipated in any
forward-looking statements.
Company Overview
We are a leading provider of emergency medical services in the
United States. We operate our business and market our services
under the AMR and EmCare brands. AMR is the leading provider of
ambulance transport services in the United States. EmCare is the
leading provider of outsourced emergency department staffing and
management services in the United States. Approximately 86% of
our fiscal 2004 net revenue was generated under exclusive
contracts. During fiscal 2004, we treated and transported
approximately 9 million patients in more than 2,050
communities nationwide. For the fiscal year ended
August 31, 2004, we generated net revenue of
$1.6 billion, of which AMR and EmCare represented
approximately 66% and 34%, respectively, and net income of
$37.3 million. Over the past two fiscal years, we increased
our net revenue and adjusted EBITDA organically at compound
annual growth rates, or CAGRs, of 6.5% and 13.5%, respectively.
American Medical Response
Over its 50 years of operating history, AMR has developed
the largest network of ambulance transport services in the
United States. AMR has an 8% share of the total ambulance
services market and a 21% share of the private provider
ambulance market. During fiscal 2004, AMR treated and
transported approximately 3.7 million patients in
34 states. AMR has approximately 2,855 contracts with
communities, government agencies, healthcare providers and
insurers to provide ambulance services. AMRs broad
geographic footprint enables us to contract on a national and
regional basis with managed care and insurance companies. AMR
has made significant investments in technology, customer service
plans, employee training and risk mitigation programs to deliver
a compelling value proposition to our customers, which we
believe has led to industry-leading contract retention rates.
For fiscal 2004, approximately 57% of AMRs net revenue was
generated from emergency 911 ambulance transport services.
Non-emergency ambulance transport services, including critical
care transfer, wheelchair transports and other interfacility
transports, or IFTs, accounted for 32% of AMRs net revenue
for the same period, with the balance generated from the
provision of training, dispatch centers and other services to
communities and public safety agencies. For fiscal 2004, AMR
generated net revenue of $1,054.8 million and net income of
$22.9 million.
EmCare
Over its 33 years of operating history, EmCare has become
the largest provider of outsourced emergency department staffing
and related management services to healthcare facilities. EmCare
has a 6% share of the total emergency department services market
and a 9% share of the outsourced emergency department services
market. In addition, EmCare has become one of the leading
providers of hospitalist services, with hospitalist-related net
revenue increasing from $7.2 million in fiscal 2001 to
$23.5 million in fiscal 2004. A hospitalist is a physician
who specializes in the care of acutely ill patients in an
in-patient setting. During fiscal 2004, EmCare had approximately
5.3 million patient visits in 38 states.
EmCare primarily provides emergency department staffing and
related management services to healthcare facilities. EmCare
recruits and hires or subcontracts with physicians and other
healthcare professionals, who
43
then provide professional services within the healthcare
facilities with which we contract. We also provide billing and
collection, risk management and other administrative services to
our healthcare professionals and to independent physicians.
EmCare has 333 contracts with hospitals and independent
physician groups to provide emergency department, hospitalist
and radiology staffing, and related management and other
administrative services. We believe that EmCares
successful physician recruitment and retention, high level of
customer service and advanced risk management programs have
resulted in high contract retention rates and continued growth
in new customers. For the year ended August 31, 2004,
EmCare generated net revenue of $549.8 million and net
income of $14.4 million.
Key Factors and Measures We Use to Evaluate Our Business
The key factors and measures we use to evaluate our business
focus on the number of patients we treat and transport and the
costs we incur to provide the necessary care and transportation
for each of our patients.
We evaluate our revenue net of provisions for contractual payor
discounts and provisions for uncompensated care. Medicaid,
Medicare and certain other payors receive discounts from our
standard charges, which we refer to as contractual discounts. In
addition, individuals we treat and transport may be personally
responsible for a deductible or co-pay under their third party
payor coverage, and most of our contracts require us to treat
and transport patients who have no insurance or other third
party payor coverage. Due to the uncertainty regarding
collectibility of charges associated with services we provide to
these patients, which we refer to as uncompensated care, our net
revenue recognition is based on expected cash collections. Our
net revenue is gross billings after provisions for contractual
discounts and estimated uncompensated care. Provisions for
contractual discounts and uncompensated care have increased
historically primarily as a result of increases in gross billing
rates. The table below summarizes our approximate payor mix as a
percentage of both net revenue and total transports and patient
visits for fiscal years 2003 and 2004.
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Percentage of | |
|
Percentage of Total | |
|
|
Net Revenue | |
|
Transports and Visits | |
|
|
Year Ended August 31, | |
|
Year Ended August 31, | |
|
|
| |
|
| |
|
|
2003 | |
|
2004 | |
|
2003 | |
|
2004 | |
|
|
| |
|
| |
|
| |
|
| |
Medicare
|
|
|
27.4 |
% |
|
|
27.3 |
% |
|
|
25.5 |
% |
|
|
25.8 |
% |
Medicaid
|
|
|
5.3 |
|
|
|
5.2 |
|
|
|
11.8 |
|
|
|
12.3 |
|
Commercial insurance and managed care
|
|
|
47.3 |
|
|
|
47.7 |
|
|
|
42.2 |
|
|
|
41.4 |
|
Self-pay
|
|
|
4.7 |
|
|
|
4.0 |
|
|
|
20.5 |
|
|
|
20.5 |
|
Subsidies and fees
|
|
|
15.3 |
|
|
|
15.8 |
|
|
|
0.0 |
|
|
|
0.0 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Total
|
|
|
100.0 |
% |
|
|
100.0 |
% |
|
|
100.0 |
% |
|
|
100.0 |
% |
|
|
|
|
|
|
|
|
|
|
|
|
|
In addition to continually monitoring our payor mix, we also
analyze the following key factors and measures in each of our
business segments:
AMR
Approximately 89% of AMRs fiscal 2004 net revenue was
transport revenue derived from the treatment and transportation
of patients based on billings to third party payors and
healthcare facilities. The balance of AMRs net revenue is
derived from direct billings to communities and government
agencies for the provision of training, dispatch center and
other services. AMRs measures for transport net revenue
include:
|
|
|
|
|
Transports. We utilize transport data, including the
number and types of transports, to evaluate net revenue and as
the basis by which we measure certain costs of the business. We
segregate transports into two main categories
ambulance transports (including emergency, as well as
non-emergency critical care and other interfacility transports)
and wheelchair transports due to the significant
differences in reimbursement and the associated costs of
providing ambulance and wheelchair transports. As a result of
these differences, in certain analyses we weight our transport
numbers according to category in an effort to better measure net
revenue and costs. |
44
|
|
|
|
|
Net revenue per transport. Net revenue per transport
reflects the expected net revenue for each transport based on
gross billings less all estimated provisions for contractual
discounts and uncompensated care. In order to better understand
the trends across business segments and in our transport rates,
we analyze our net revenue per transport based on weighted
transports to reflect the differences in our transportation mix. |
The change from period to period in the number of transports is
influenced by increases in transports in existing markets from
both new and existing facilities we serve for non-emergency
transports, and the effects of general community conditions for
emergency transports. The general community conditions may
include (1) the timing, location and severity of influenza,
allergens and other annually recurring viruses, (2) severe
weather that affects a regions health status and/or
infrastructure and (3) community-specific demographic
changes.
The costs we incur in our AMR business segment consist primarily
of compensation and benefits for ambulance crews and support
personnel, direct and indirect operating costs to provide
transportation services, and costs related to accident and
insurance claims. AMRs key cost measures include:
|
|
|
|
|
Unit hours and cost per unit hour. Our measurement of a
unit hour is based on a fully staffed ambulance or wheelchair
van for one operating hour. We use unit hours and cost per unit
hour to measure compensation-related costs and the efficiency of
our deployed resources. We monitor unit hours and cost per unit
hour on a combined basis, as well as on a segregated basis
between ambulance and wheelchair transports. |
|
|
|
Operating costs per transport. Operating costs per
transport is comprised of certain direct operating costs,
including vehicle operating costs, medical supplies and other
transport-related costs, but excluding compensation-related
costs. Monitoring operating costs per transport allows us to
better evaluate cost trends and operating practices of our
regional and local management teams. |
|
|
|
Accident and insurance claims. We monitor the number and
magnitude of all accident and insurance claims in order to
measure the effectiveness of our risk management programs.
Depending on the type of claim (workers compensation, auto,
general or professional liability), we monitor our performance
by utilizing various bases of measurement, such as net revenue,
miles driven, number of vehicles operated, compensation dollars,
and number of transports. |
Our recent operating costs have been adversely affected by
increasing fuel costs. Fuel costs represented approximately 9.8%
of our operating costs in fiscal 2004, increasing to 13.6% in
the three months ended September 30, 2005 as a result of
higher fuel costs. Further increases in fuel costs without
mitigation through fee and subsidy increases will continue to
adversely affect our operating costs.
We estimate that the impact of the Balanced Budget Act of 1997,
or BBA, ambulance service rate decreases, as modified by the
phase-in provisions of the Medicare Modernization Act, resulted
in a decrease in AMRs net revenue for fiscal 2003 and
fiscal 2004 of approximately $20 million and
$11 million, respectively, will result in an increase in
AMRs net revenue of approximately $13 million in
calendar 2005, and will result in a decrease in AMRs net
revenue of approximately $17 million in 2006 and continuing
decreases thereafter to 2010. Although we have been able to
substantially mitigate the phased-in reductions of the BBA
through additional fee and subsidy increases, we may not be able
to continue to do so.
We have focused our risk mitigation efforts on employee training
for proper patient handling techniques, development of clinical
and medical equipment protocols, driving safety, implementation
of technology to reduce auto incidents and other risk mitigation
processes which we believe has resulted in a reduction in the
frequency, severity and development of claims. We continue to
see positive trends in our claims costs but cannot assure you
that these trends will continue.
EmCare
Of EmCares fiscal 2004 net revenue, approximately 97% was
derived from our hospital contracts for emergency department
staffing, hospitalist and radiology services and other
management services. Of this revenue, approximately 75% was
generated from billings to third party payors for patient visits
and
45
approximately 25% was generated from billings to hospitals and
affiliated physician groups for professional services.
EmCares key net revenue measures are:
|
|
|
|
|
Number of contracts. This reflects the number of
contractual relationships we have for outsourced emergency
department staffing and related management services, hospitalist
services and other management services. We analyze the change in
our number of contracts from period to period based on net
new contracts, which is the difference between total new
contracts and contracts that have terminated. |
|
|
|
Revenue per patient visit. This reflects the expected net
revenue for each patient visit based on gross billings less all
estimated provisions for contractual discounts and uncompensated
care. Net revenue per patient visit also includes net revenue
from billings to third party payors and hospitals. |
The change from period to period in the number of patient visits
under our same store contracts is influenced by
general community conditions as well as hospital-specific
elements, many of which are beyond our direct control. The
general community conditions include (1) the timing,
location and severity of influenza, allergens and other annually
recurring viruses and (2) severe weather that affects a
regions health status and/or infrastructure.
Hospital-specific elements include the timing and extent of
facility renovations, hospital staffing issues and regulations
that affect patient flow through the hospital.
The costs incurred in our EmCare business segment consist
primarily of compensation and benefits for physicians and other
professional providers, professional liability costs, and
contract and other support costs. EmCares key cost
measures include:
|
|
|
|
|
Provider compensation per patient visit. Provider
compensation per patient visit includes all compensation and
benefit costs for all professional providers, including
physicians, physician assistants and nurse practitioners, during
each patient visit. Providers include all full-time, part-time
and independently contracted providers. Analyzing provider
compensation per patient visit enables us to monitor our most
significant cost in performing under our contracts. |
|
|
|
Professional liability costs. These costs include
provisions for estimated losses for actual claims, and claims
likely to be incurred in the period, within our self-insurance
limits based on our past loss experience, as well as actual
direct costs, including investigation and defense costs, claims
payments, reinsurance costs and other costs related to provider
professional liability. |
Medicare pays for all physicians services based upon a
national fee schedule. The rate formula may result in
significant yearly fluctuations which may be unrelated to
changes in the actual cost of providing physician services.
Initially, the physician fee schedule update for 2004 called for
a payment decrease of 4.5%. Subsequently, Congress authorized a
1.5% increase that negated the planned rate cuts, and also
provided a 1.5% rate increase for 2005. We currently expect that
the fee schedule will provide for a 4.3% decrease to physician
rates effective January 1, 2006, which would result in a
decrease in EmCares 2006 net revenue of approximately
$5.7 million.
We have developed extensive professional liability risk
mitigation processes, including risk assessments on medical
professionals and hospitals, extensive incident reporting and
tracking processes, clinical fail-safe programs, training and
education and other risk mitigation programs which we believe
have resulted in a continued reduction in the frequency,
severity and development of claims. We continue to see positive
trends in our claims costs but cannot assure you that these
trends will continue.
Hurricane Katrina and our Gulf Coast Operations
AMR provides ambulance services in Gulfport and Biloxi,
Mississippi and several other Gulf Coast communities. Although
our dispatch center was damaged by Hurricane Katrina and we had
damage to a small number of vehicles, we were able to maintain
communications through our use of back-up generators and other
emergency supplies. We have worked closely with FEMA and other
federal, state and local agencies and have deployed additional
ambulance transportation resources where they were most needed,
particularly in the coastal areas of Mississippi, Louisiana and
Alabama. We have deployed more than 100 additional ambulances
46
and nearly 300 paramedics, EMTs and other professionals to aid
the rescue effort in the Gulf Coast, including the deployment of
additional resources to aid in the transport of evacuees to
medical facilities in Texas. For the three months ended
September 30, 2005, we recognized revenue of
$4.6 million and expenses of $4.7 million in the
deployment of additional resources in connection with Hurricane
Katrina and other Gulf Coast storms.
EmCare operations were generally unaffected by Katrina, with
only one facility in the affected area. EmCare deployed
additional resources to assist those operations, and we have
experienced a volume increase in certain facilities in adjacent
states where evacuees were relocated.
We have been able to maintain our normal operations in areas
outside the Gulf Coast, notwithstanding our transfer of
resources to that area. We expect that, for the foreseeable
future, our AMR operations in Mississippi will continue to be
negatively affected by the aftermath of Hurricane Katrina, and
that we will continue to provide additional resources to assist
local recovery efforts throughout the region.
Results of Operations
As we discuss more fully in note 1
Fresh-Start Accounting of the notes to our audited
combined financial statements, AMRs and EmCares
former parent, Laidlaw, and certain of its affiliates filed
voluntary petitions for reorganization under Chapter 11 of
the U.S. Bankruptcy Code. Although subsidiaries of Laidlaw,
neither AMR nor EmCare was included in the bankruptcy filing.
Laidlaw emerged from bankruptcy protection in June 2003. Laidlaw
applied push-down accounting as of June 1, 2003 to AMR and
EmCare and allocated to us our share of the fresh-start
accounting adjustments. For financial statement purposes, for
periods prior to February 1, 2005, AMR and EmCare combined
are our Predecessor. As a result of the application of push-down
accounting and the fresh-start change in the basis of accounting
for our underlying assets and liabilities, our results of
operations and cash flows have been separated further as
pre-June 1, 2003 (referred to as the
Predecessor Pre-Laidlaw Bankruptcy) and
post-May 31, 2003 and pre-February 1, 2005 (referred
to as the Predecessor Post-Laidlaw Bankruptcy).
Effective as of January 31, 2005, we acquired EmCare and
AMR from Laidlaw and in connection with the acquisition we
changed our fiscal year to December 31 from August 31.
For all periods prior to the acquisition, the AMR and EmCare
businesses formerly owned by Laidlaw are referred to as the
Predecessor. For all periods subsequent to the
acquisition, the business is referred to as the
Successor. As a result of the acquisition, we
include as a reporting period of the Predecessor our
pre-acquisition period ended January 31, 2005.
We have made no comparisons for our financial results or cash
flows and other liquidity measures for the
Predecessor Post-Laidlaw Bankruptcys three
months ended August 31, 2003 or for the
Predecessor Post-Laidlaw Bankruptcys financial
results or cash flows and other liquidity measures for the nine
months ended May 31, 2003. As the length of these periods
is significantly different from the length of any corresponding
comparative periods, these results are not comparable in
absolute dollar terms.
However, to facilitate the identification of certain business
trends, we compare the financial results and cash flows for the
year ended August 31, 2004 for the Predecessor
Post-Laidlaw Bankruptcy to:
|
|
|
|
|
the combined financial results and cash flows for the year ended
August 31, 2003, which represents the financial results and
cash flows for the Predecessor Post-Laidlaw
Bankruptcy for the three months ended August 31, 2003 and
the financial results and cash flows for the
Predecessor Pre-Laidlaw Bankruptcy for the nine
months ended May 31, 2003, and |
|
|
|
our Predecessor Pre-Laidlaw Bankruptcys
financial results for the year ended August 31, 2002. |
The combined year ended August 31, 2003 presented below
does not comply with SOP 90-7, which calls for separate
reporting for the Predecessor Post-Laidlaw
Bankruptcy and the Predecessor Pre-Laidlaw
Bankruptcy. Additionally, for the reasons described in
note 1 and due to other non-recurring adjustments, the
Predecessor Pre-Laidlaw Bankruptcys financial
statements for the periods prior to Laidlaws emergence
47
from bankruptcy may not be comparable to our
Predecessor Post-Laidlaw Bankruptcys financial
statements and results of operations which are for periods after
Laidlaws emergence from bankruptcy. Investors should,
therefore, review this material with caution and should not rely
solely on the information concerning the Predecessor
Pre-Laidlaw Bankruptcy or the combined financial results for the
year ended August 31, 2003 as being indicative of our
future results or as providing an accurate comparison of
financial performance from period to period.
The following tables present, for the periods indicated,
information expressed as a percentage of net revenue. This
information has been derived from our audited combined
statements of operations, which include both our AMR and our
EmCare business segments, for the years ended August 31,
2002, 2003 and 2004 and the five months ended January 31,
2005, respectively, from our unaudited combined statements of
operations for the five months ended January 31, 2004 and
the three months and eight months ended September 30, 2004,
respectively, and from our unaudited consolidated statements of
operations for the three months and eight months ended
September 30, 2005.
48
Combined and Consolidated Results of Operations and as a
Percentage of Net Revenue
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Predecessor | |
|
|
|
|
|
|
|
| |
|
|
|
|
|
|
|
|
Successor | |
|
|
|
|
|
|
|
| |
|
|
Year Ended August 31, | |
|
|
|
|
|
|
|
|
|
| |
|
Five Months | |
|
Three Months | |
|
Eight Months | |
|
|
Three Months | |
|
Eight Months | |
|
|
|
|
|
|
Ended | |
|
Ended | |
|
Ended | |
|
|
Ended | |
|
Ended | |
|
|
As Restated | |
|
|
|
January 31, | |
|
September 30, | |
|
September 30, | |
|
|
September 30, | |
|
September 30, | |
|
|
| |
|
|
|
| |
|
| |
|
| |
|
|
| |
|
| |
|
|
2002 | |
|
2003 | |
|
2004 | |
|
2004 | |
|
2005 | |
|
2004 | |
|
2004 | |
|
|
2005 | |
|
2005 | |
|
|
| |
|
| |
|
| |
|
| |
|
| |
|
| |
|
| |
|
|
| |
|
| |
|
|
|
|
|
|
|
|
(unaudited) | |
|
|
|
(unaudited) | |
|
|
(unaudited) | |
Net revenue
|
|
$ |
1,415,786 |
|
|
$ |
1,487,796 |
|
|
$ |
1,604,598 |
|
|
$ |
667,506 |
|
|
$ |
696,179 |
|
|
$ |
413,869 |
|
|
$ |
1,077,749 |
|
|
|
$ |
456,245 |
|
|
$ |
1,187,653 |
|
Compensation and benefits
|
|
|
960,590 |
|
|
|
1,021,787 |
|
|
|
1,117,890 |
|
|
|
461,923 |
|
|
|
481,305 |
|
|
|
286,628 |
|
|
|
751,238 |
|
|
|
|
319,292 |
|
|
|
822,595 |
|
Operating expenses
|
|
|
219,321 |
|
|
|
218,659 |
|
|
|
218,277 |
|
|
|
90,828 |
|
|
|
94,882 |
|
|
|
55,863 |
|
|
|
147,524 |
|
|
|
|
66,156 |
|
|
|
168,700 |
|
Insurance expense
|
|
|
66,479 |
|
|
|
104,247 |
|
|
|
80,255 |
|
|
|
36,664 |
|
|
|
39,002 |
|
|
|
18,404 |
|
|
|
51,674 |
|
|
|
|
21,048 |
|
|
|
60,382 |
|
Selling, general and administrative expenses
|
|
|
61,455 |
|
|
|
49,884 |
|
|
|
47,899 |
|
|
|
22,016 |
|
|
|
21,635 |
|
|
|
12,093 |
|
|
|
31,270 |
|
|
|
|
15,654 |
|
|
|
38,248 |
|
Laidlaw fees and compensation charges(1)
|
|
|
5,400 |
|
|
|
5,400 |
|
|
|
15,449 |
|
|
|
6,436 |
|
|
|
19,857 |
|
|
|
3,657 |
|
|
|
10,095 |
|
|
|
|
|
|
|
|
|
|
Depreciation and amortization expenses
|
|
|
67,183 |
|
|
|
44,704 |
|
|
|
52,739 |
|
|
|
22,079 |
|
|
|
18,808 |
|
|
|
12,669 |
|
|
|
34,627 |
|
|
|
|
14,843 |
|
|
|
38,811 |
|
Impairment losses
|
|
|
262,780 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Restructuring charges
|
|
|
3,777 |
|
|
|
2,737 |
|
|
|
2,115 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
1,381 |
|
|
|
|
|
|
|
|
|
|
Laidlaw reorganization costs
|
|
|
8,761 |
|
|
|
3,650 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Income (loss) from operations
|
|
|
(239,960 |
) |
|
|
36,728 |
|
|
|
69,974 |
|
|
|
27,560 |
|
|
|
20,690 |
|
|
|
24,555 |
|
|
|
49,940 |
|
|
|
|
19,252 |
|
|
|
58,917 |
|
Interest expense
|
|
|
(6,418 |
) |
|
|
(5,599 |
) |
|
|
(9,961 |
) |
|
|
(4,137 |
) |
|
|
(5,644 |
) |
|
|
(5,138 |
) |
|
|
(8,679 |
) |
|
|
|
(12,824 |
) |
|
|
(34,407 |
) |
Realized gain (loss) on investments
|
|
|
|
|
|
|
90 |
|
|
|
(1,140 |
) |
|
|
|
|
|
|
|
|
|
|
(1,140 |
) |
|
|
(1,191 |
) |
|
|
|
(34 |
) |
|
|
(40 |
) |
Interest and other income
|
|
|
369 |
|
|
|
326 |
|
|
|
240 |
|
|
|
1,403 |
|
|
|
714 |
|
|
|
162 |
|
|
|
210 |
|
|
|
|
91 |
|
|
|
189 |
|
Fresh-start accounting adjustments
|
|
|
|
|
|
|
46,416 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Cumulative effect of a change in accounting principle
|
|
|
|
|
|
|
(223,721 |
) |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Income tax expense
|
|
|
(1,374 |
) |
|
|
(9,462 |
) |
|
|
(21,764 |
) |
|
|
(9,800 |
) |
|
|
(6,278 |
) |
|
|
(7,191 |
) |
|
|
(15,710 |
) |
|
|
|
(3,479 |
) |
|
|
(10,657 |
) |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Net income (loss)
|
|
$ |
(247,383 |
) |
|
$ |
(155,222 |
) |
|
$ |
37,349 |
|
|
$ |
15,026 |
|
|
$ |
9,482 |
|
|
$ |
11,248 |
|
|
$ |
24,570 |
|
|
|
$ |
3,006 |
|
|
$ |
14,002 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
(1) |
Amounts include specifically allocated compensation costs and
the Laidlaw fees and compensation charges allocated to AMR and
EmCare by Laidlaw pursuant to a formula based upon each
companys share of Laidlaws consolidated revenue. |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Predecessor | |
|
|
|
|
|
|
|
| |
|
|
|
|
|
|
|
|
Successor | |
|
|
|
|
|
|
|
| |
|
|
Year Ended August 31, | |
|
|
|
|
|
|
|
|
|
| |
|
Five Months | |
|
Three Months | |
|
Eight Months | |
|
|
Three Months | |
|
Eight Months | |
|
|
|
|
|
|
Ended | |
|
Ended | |
|
Ended | |
|
|
Ended | |
|
Ended | |
|
|
As Restated | |
|
|
|
January 31, | |
|
September 30, | |
|
September 30, | |
|
|
September 30, | |
|
September 30, | |
|
|
| |
|
|
|
| |
|
| |
|
| |
|
|
| |
|
| |
|
|
2002 | |
|
2003 | |
|
2004 | |
|
2004 | |
|
2005 | |
|
2004 | |
|
2004 | |
|
|
2005 | |
|
2005 | |
|
|
| |
|
| |
|
| |
|
| |
|
| |
|
| |
|
| |
|
|
| |
|
| |
|
|
|
|
|
|
|
|
(unaudited) | |
|
|
|
(unaudited) | |
|
|
(unaudited) | |
Net revenue
|
|
|
100.0 |
% |
|
|
100.0 |
% |
|
|
100.0 |
% |
|
|
100.0 |
% |
|
|
100.0 |
% |
|
|
100.0 |
% |
|
|
100.0 |
% |
|
|
|
100.0 |
% |
|
|
100.0 |
% |
Compensation and benefits
|
|
|
67.8 |
|
|
|
68.7 |
|
|
|
69.7 |
|
|
|
69.2 |
|
|
|
69.1 |
|
|
|
69.3 |
|
|
|
69.7 |
|
|
|
|
70.0 |
|
|
|
69.3 |
|
Operating expenses
|
|
|
15.5 |
|
|
|
14.7 |
|
|
|
13.6 |
|
|
|
13.6 |
|
|
|
13.6 |
|
|
|
13.5 |
|
|
|
13.7 |
|
|
|
|
14.5 |
|
|
|
14.2 |
|
Insurance expense
|
|
|
4.7 |
|
|
|
7.0 |
|
|
|
5.0 |
|
|
|
5.5 |
|
|
|
5.6 |
|
|
|
4.4 |
|
|
|
4.8 |
|
|
|
|
4.6 |
|
|
|
5.1 |
|
Selling, general and administrative expenses
|
|
|
4.3 |
|
|
|
3.4 |
|
|
|
3.0 |
|
|
|
3.3 |
|
|
|
3.1 |
|
|
|
2.9 |
|
|
|
2.9 |
|
|
|
|
3.4 |
|
|
|
3.2 |
|
Laidlaw fees and compensation charges(1)
|
|
|
0.4 |
|
|
|
0.4 |
|
|
|
1.0 |
|
|
|
1.0 |
|
|
|
2.9 |
|
|
|
0.9 |
|
|
|
0.9 |
|
|
|
|
0.0 |
|
|
|
0.0 |
|
Depreciation and amortization expense
|
|
|
4.7 |
|
|
|
3.0 |
|
|
|
3.3 |
|
|
|
3.3 |
|
|
|
2.7 |
|
|
|
3.1 |
|
|
|
3.2 |
|
|
|
|
3.3 |
|
|
|
3.3 |
|
Impairment losses
|
|
|
18.6 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
0.0 |
|
|
|
0.0 |
|
|
|
|
0.0 |
|
|
|
0.0 |
|
Restructuring charges
|
|
|
0.3 |
|
|
|
0.2 |
|
|
|
0.1 |
|
|
|
|
|
|
|
|
|
|
|
0.0 |
|
|
|
0.1 |
|
|
|
|
0.0 |
|
|
|
0.0 |
|
Laidlaw reorganization costs
|
|
|
0.6 |
|
|
|
0.2 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
0.0 |
|
|
|
0.0 |
|
|
|
|
0.0 |
|
|
|
0.0 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Income (loss) from operations
|
|
|
(16.9 |
)% |
|
|
2.5 |
% |
|
|
4.4 |
% |
|
|
4.1 |
% |
|
|
3.0 |
% |
|
|
5.9 |
% |
|
|
4.6 |
% |
|
|
|
4.2 |
% |
|
|
5.0 |
% |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
(1) |
Amounts include specifically allocated compensation costs and
the Laidlaw fees and compensation charges allocated to AMR and
EmCare by Laidlaw pursuant to a formula based upon each
companys share of Laidlaws consolidated revenue. |
49
AMR
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Predecessor | |
|
|
|
|
|
|
|
|
|
|
|
| |
|
|
|
|
|
|
|
|
|
|
|
Year Ended August 31, | |
|
|
|
Five Months Ended January 31, | |
|
|
|
|
Successor | |
|
|
| |
|
| |
|
| |
|
| |
|
|
| |
|
|
As Restated | |
|
|
|
|
|
|
|
|
|
|
|
| |
|
|
|
|
|
Three Months | |
|
|
|
Eight Months | |
|
|
|
|
Three Months | |
|
|
|
Eight Months | |
|
|
|
|
|
|
% of | |
|
|
|
% of | |
|
|
|
% of | |
|
|
|
% of | |
|
|
|
% of | |
|
Ended | |
|
% of | |
|
Ended | |
|
% of | |
|
|
Ended | |
|
% of | |
|
Ended | |
|
% of | |
|
|
|
|
Net | |
|
|
|
Net | |
|
|
|
Net | |
|
|
|
Net | |
|
|
|
Net | |
|
September 30, | |
|
Net | |
|
September 30, | |
|
Net | |
|
|
September 30, | |
|
Net | |
|
September 30, | |
|
Net | |
|
|
2002 | |
|
Revenue | |
|
2003 | |
|
Revenue | |
|
2004 | |
|
Revenue | |
|
2004 | |
|
Revenue | |
|
2005 | |
|
Revenue | |
|
2004 | |
|
Revenue | |
|
2004 | |
|
Revenue | |
|
|
2005 | |
|
Revenue | |
|
2005 | |
|
Revenue | |
|
|
| |
|
| |
|
| |
|
| |
|
| |
|
| |
|
| |
|
| |
|
| |
|
| |
|
| |
|
| |
|
| |
|
| |
|
|
| |
|
| |
|
| |
|
| |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
(unaudited) | |
|
(unaudited) | |
|
|
(unaudited) | |
|
|
(dollars in thousands) | |
Net revenue
|
|
$ |
984,451 |
|
|
|
100.0 |
% |
|
$ |
1,007,151 |
|
|
|
100.0 |
% |
|
$ |
1,054,800 |
|
|
|
100.0 |
% |
|
$ |
441,956 |
|
|
|
100.0 |
% |
|
$ |
455,059 |
|
|
|
100.0 |
% |
|
$ |
270,887 |
|
|
|
100.0 |
% |
|
$ |
705,181 |
|
|
|
100.0 |
% |
|
|
$ |
291,909 |
|
|
|
100.0 |
% |
|
$ |
761,712 |
|
|
|
100.0 |
% |
Compensation and benefits
|
|
|
627,818 |
|
|
|
63.8 |
|
|
|
647,255 |
|
|
|
64.3 |
|
|
|
687,221 |
|
|
|
65.2 |
|
|
|
287,736 |
|
|
|
65.1 |
|
|
|
289,733 |
|
|
|
63.7 |
|
|
|
174,792 |
|
|
|
64.5 |
|
|
|
457,661 |
|
|
|
64.9 |
|
|
|
|
190,112 |
|
|
|
65.1 |
|
|
|
486,455 |
|
|
|
63.9 |
|
Operating expenses
|
|
|
195,335 |
|
|
|
19.8 |
|
|
|
195,105 |
|
|
|
19.4 |
|
|
|
194,398 |
|
|
|
18.4 |
|
|
|
80,277 |
|
|
|
18.2 |
|
|
|
83,910 |
|
|
|
18.4 |
|
|
|
49,693 |
|
|
|
18.3 |
|
|
|
131,520 |
|
|
|
18.7 |
|
|
|
|
58,751 |
|
|
|
20.1 |
|
|
|
150,123 |
|
|
|
19.7 |
|
Insurance expense
|
|
|
36,079 |
|
|
|
3.7 |
|
|
|
67,409 |
|
|
|
6.7 |
|
|
|
44,272 |
|
|
|
4.2 |
|
|
|
20,297 |
|
|
|
4.6 |
|
|
|
22,437 |
|
|
|
4.9 |
|
|
|
11,612 |
|
|
|
4.3 |
|
|
|
28,785 |
|
|
|
4.1 |
|
|
|
|
9,431 |
|
|
|
3.2 |
|
|
|
30,368 |
|
|
|
4.0 |
|
Selling, general and administrative expenses
|
|
|
44,686 |
|
|
|
4.5 |
|
|
|
35,078 |
|
|
|
3.5 |
|
|
|
32,217 |
|
|
|
3.1 |
|
|
|
16,175 |
|
|
|
3.7 |
|
|
|
15,721 |
|
|
|
3.5 |
|
|
|
7,754 |
|
|
|
2.9 |
|
|
|
19,806 |
|
|
|
2.8 |
|
|
|
|
10,951 |
|
|
|
3.8 |
|
|
|
26,953 |
|
|
|
3.5 |
|
Laidlaw fees and compensation charges(1)
|
|
|
3,600 |
|
|
|
0.4 |
|
|
|
3,600 |
|
|
|
0.4 |
|
|
|
9,020 |
|
|
|
0.9 |
|
|
|
3,758 |
|
|
|
0.9 |
|
|
|
9,399 |
|
|
|
2.1 |
|
|
|
2,211 |
|
|
|
0.8 |
|
|
|
5,970 |
|
|
|
0.8 |
|
|
|
|
|
|
|
|
0.0 |
|
|
|
|
|
|
|
0.0 |
|
Depreciation and amortization expense
|
|
|
62,223 |
|
|
|
6.3 |
|
|
|
39,273 |
|
|
|
3.9 |
|
|
|
43,629 |
|
|
|
4.1 |
|
|
|
18,278 |
|
|
|
4.1 |
|
|
|
16,394 |
|
|
|
3.6 |
|
|
|
10,464 |
|
|
|
3.9 |
|
|
|
28,591 |
|
|
|
4.1 |
|
|
|
|
12,084 |
|
|
|
4.1 |
|
|
|
31,527 |
|
|
|
4.1 |
|
Impairment losses
|
|
|
262,780 |
|
|
|
26.7 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
0.0 |
|
|
|
|
|
|
|
0.0 |
|
|
|
|
|
|
|
|
0.0 |
|
|
|
|
|
|
|
0.0 |
|
Restructuring charges
|
|
|
3,777 |
|
|
|
0.4 |
|
|
|
2,737 |
|
|
|
0.3 |
|
|
|
2,115 |
|
|
|
0.2 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
0.0 |
|
|
|
1,381 |
|
|
|
0.2 |
|
|
|
|
|
|
|
|
0.0 |
|
|
|
|
|
|
|
0.0 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Income (loss) from operations
|
|
$ |
(251,847 |
) |
|
|
(25.6 |
)% |
|
$ |
16,694 |
|
|
|
1.7 |
% |
|
$ |
41,928 |
|
|
|
4.0 |
% |
|
$ |
15,435 |
|
|
|
3.5 |
% |
|
$ |
17,465 |
|
|
|
3.8 |
% |
|
$ |
14,361 |
|
|
|
5.3 |
% |
|
$ |
31,467 |
|
|
|
4.5 |
% |
|
|
$ |
10,580 |
|
|
|
3.6 |
% |
|
$ |
36,286 |
|
|
|
4.8 |
% |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
(1) |
Amounts include specifically allocated compensation costs and
the Laidlaw fees and compensation charges allocated to AMR by
Laidlaw pursuant to a formula based upon AMRs share of
Laidlaws consolidated revenue. |
EmCare
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Predecessor | |
|
|
|
|
|
|
|
|
|
|
|
| |
|
|
|
|
|
|
|
|
|
|
|
Year Ended August 31, | |
|
Five Months Ended January 31, | |
|
|
|
|
Successor | |
|
|
| |
|
| |
|
| |
|
|
| |
|
|
|
|
|
|
Three Months | |
|
|
|
Eight Months | |
|
|
|
|
Three Months | |
|
|
|
Eight Months | |
|
|
|
|
|
|
% of | |
|
|
|
% of | |
|
|
|
% of | |
|
|
|
% of | |
|
|
|
% of | |
|
Ended | |
|
% of | |
|
Ended | |
|
% of | |
|
|
Ended | |
|
% of | |
|
Ended | |
|
% of | |
|
|
|
|
Net | |
|
|
|
Net | |
|
|
|
Net | |
|
|
|
Net | |
|
|
|
Net | |
|
September 30, | |
|
Net | |
|
September 30, | |
|
Net | |
|
|
September 30, | |
|
Net | |
|
September 30, | |
|
Net | |
|
|
2002 | |
|
Revenue | |
|
2003 | |
|
Revenue | |
|
2004 | |
|
Revenue | |
|
2004 | |
|
Revenue | |
|
2005 | |
|
Revenue | |
|
2004 | |
|
Revenue | |
|
2004 | |
|
Revenue | |
|
|
2005 | |
|
Revenue | |
|
2005 | |
|
Revenue | |
|
|
| |
|
| |
|
| |
|
| |
|
| |
|
| |
|
| |
|
| |
|
| |
|
| |
|
| |
|
| |
|
| |
|
| |
|
|
| |
|
| |
|
| |
|
| |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
(unaudited) | |
|
(unaudited) | |
|
|
(unaudited) | |
|
|
(dollars in thousands) | |
Net revenue
|
|
$ |
431,335 |
|
|
|
100.0 |
% |
|
$ |
480,645 |
|
|
|
100.0 |
% |
|
$ |
549,798 |
|
|
|
100.0 |
% |
|
$ |
225,550 |
|
|
|
100.0 |
% |
|
$ |
241,120 |
|
|
|
100.0 |
% |
|
$ |
142,982 |
|
|
|
100.0 |
% |
|
$ |
372,568 |
|
|
|
100.0 |
% |
|
|
$ |
164,336 |
|
|
|
100.0 |
% |
|
$ |
425,941 |
|
|
|
100.0 |
% |
Compensation and benefits
|
|
|
332,772 |
|
|
|
77.1 |
|
|
|
374,532 |
|
|
|
77.9 |
|
|
|
430,669 |
|
|
|
78.3 |
|
|
|
174,187 |
|
|
|
77.2 |
|
|
|
191,572 |
|
|
|
79.5 |
|
|
|
111,836 |
|
|
|
78.2 |
|
|
|
293,577 |
|
|
|
78.8 |
|
|
|
|
129,180 |
|
|
|
78.6 |
|
|
|
336,140 |
|
|
|
78.9 |
|
Operating expenses
|
|
|
23,986 |
|
|
|
5.6 |
|
|
|
23,554 |
|
|
|
4.9 |
|
|
|
23,879 |
|
|
|
4.3 |
|
|
|
10,551 |
|
|
|
4.7 |
|
|
|
10,972 |
|
|
|
4.6 |
|
|
|
6,170 |
|
|
|
4.3 |
|
|
|
16,004 |
|
|
|
4.3 |
|
|
|
|
7,405 |
|
|
|
4.5 |
|
|
|
18,577 |
|
|
|
4.4 |
|
Insurance expense
|
|
|
30,400 |
|
|
|
7.0 |
|
|
|
36,838 |
|
|
|
7.7 |
|
|
|
35,983 |
|
|
|
6.5 |
|
|
|
16,367 |
|
|
|
7.3 |
|
|
|
16,565 |
|
|
|
6.9 |
|
|
|
6,792 |
|
|
|
4.8 |
|
|
|
22,889 |
|
|
|
6.1 |
|
|
|
|
11,617 |
|
|
|
7.1 |
|
|
|
30,014 |
|
|
|
7.0 |
|
Selling, general and administrative expenses
|
|
|
16,769 |
|
|
|
3.9 |
|
|
|
14,806 |
|
|
|
3.1 |
|
|
|
15,682 |
|
|
|
2.9 |
|
|
|
5,841 |
|
|
|
2.6 |
|
|
|
5,914 |
|
|
|
2.5 |
|
|
|
4,339 |
|
|
|
3.0 |
|
|
|
11,464 |
|
|
|
3.1 |
|
|
|
|
4,703 |
|
|
|
2.9 |
|
|
|
11,295 |
|
|
|
2.7 |
|
Laidlaw fees and compensation charges(1)
|
|
|
1,800 |
|
|
|
0.4 |
|
|
|
1,800 |
|
|
|
0.4 |
|
|
|
6,429 |
|
|
|
1.2 |
|
|
|
2,678 |
|
|
|
1.2 |
|
|
|
10,458 |
|
|
|
4.3 |
|
|
|
1,446 |
|
|
|
1.0 |
|
|
|
4,125 |
|
|
|
1.1 |
|
|
|
|
|
|
|
|
0.0 |
|
|
|
|
|
|
|
0.0 |
|
Depreciation and amortization expense
|
|
|
4,960 |
|
|
|
1.1 |
|
|
|
5,431 |
|
|
|
1.1 |
|
|
|
9,110 |
|
|
|
1.7 |
|
|
|
3,801 |
|
|
|
1.7 |
|
|
|
2,414 |
|
|
|
1.0 |
|
|
|
2,205 |
|
|
|
1.5 |
|
|
|
6,036 |
|
|
|
1.6 |
|
|
|
|
2,759 |
|
|
|
1.7 |
|
|
|
7,284 |
|
|
|
1.7 |
|
Laidlaw reorganization costs
|
|
|
8,761 |
|
|
|
2.0 |
|
|
|
3,650 |
|
|
|
0.8 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
0.0 |
|
|
|
|
|
|
|
0.0 |
|
|
|
|
|
|
|
|
0.0 |
|
|
|
|
|
|
|
0.0 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Income from operations
|
|
$ |
11,887 |
|
|
|
2.8 |
% |
|
$ |
20,034 |
|
|
|
4.2 |
% |
|
$ |
28,046 |
|
|
|
5.1 |
% |
|
$ |
12,125 |
|
|
|
5.4 |
% |
|
$ |
3,225 |
|
|
|
1.3 |
% |
|
$ |
10,194 |
|
|
|
7.1 |
% |
|
$ |
18,473 |
|
|
|
5.0 |
% |
|
|
$ |
8,672 |
|
|
|
5.3 |
% |
|
|
22,631 |
|
|
|
5.3 |
% |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
(1) |
Amounts include specifically allocated compensation costs and
the Laidlaw fees and compensation charges allocated to EmCare by
Laidlaw pursuant to a formula based upon EmCares share of
Laidlaws consolidated revenue. |
50
Eight months ended September 30, 2005 (Successor)
compared to the eight months ended September 30, 2004
(Predecessor)
For the eight months ended September 30, 2005 compared to the
same period in 2004, our net revenue grew 10.2%, with half of
this growth attributable to an increase in combined volumes at
our operating segments from increases in both existing markets
and the addition of net new contracts at each of AMR and EmCare.
The balance of the net revenue growth was generated by net
pricing increases due to contract and community rate increases
and Medicare increases.
Our income from operations increased 18.0% from period to
period, resulting in improved operating margins. The period to
period comparison is affected by increased fuel costs in 2005 of
$4.6 million, stock compensation charges of
$2.5 million in 2005, favorable insurance claims
development of $3.3 million recorded in 2004, and
$10.1 million of Laidlaw fees and compensation charges in
2004 offset by $4.0 million in 2005 for transaction-related
costs and services that were previously provided by Laidlaw.
Interest expense. Interest expense for the eight months
ended September 30, 2005 was $34.4 million compared to
$8.7 million for the eight months ended September 30,
2004. This $25.7 million increase relates to the debt we
incurred in connection with our acquisition of AMR and EmCare.
Income tax expense. Income tax expense for the eight
months ended September 30, 2005 was $10.7 million
compared to $15.7 million for the eight months ended
September 30, 2004. This $5.0 million decrease relates
primarily to the additional interest expense recorded during the
2005 period.
AMR
Net revenue. Net revenue for the eight months ended
September 30, 2005 was $761.7 million, an increase of
$56.5 million, or 8.0%, from $705.2 million for the
eight months ended September 30, 2004. The increase in net
revenue was due primarily to an increase in our net revenue per
weighted transport of approximately 7.4%. The increase in net
revenue per weighted transport was the result of rate increases
in several of our operating markets and Medicare rate increases
under the Medicare Modernization Act. In addition, we had a net
increase of approximately 11,600 weighted transports. We had an
increase in weighted transports of 82,900, or 4.4%, primarily as
a result of an increase in ambulance transports in existing
markets. This increase was offset by a decrease of approximately
71,300 weighted transports and $14.5 million in net revenue
for the eight months ended September 30, 2005 as a result
of exiting the Pinellas County, Florida market in September 2004.
Compensation and benefits. Compensation and benefits
costs for the eight months ended September 30, 2005 were
$486.5 million, or 63.9% of net revenue, compared to
$457.7 million, or 64.9% of net revenue, for the eight
months ended September 30, 2004. Total unit hours increased
period over period by approximately 105,000 due to the increase
in ambulance transport volume and deployment changes required as
part of several contract rate increases. In addition, ambulance
crew wages per ambulance unit hour increased by 5.4%, which
increased compensation costs by $13.6 million. The
ambulance crew wages per ambulance unit hour increase resulted
principally from annual salary increases. Benefits costs
increased $6.5 million due to increased health benefit
claim costs and health insurance premiums. The exit from the
Pinellas County, Florida market decreased ambulance unit hours
by 153,600 and compensation and benefits costs by
$11.2 million in 2005 compared to 2004.
Operating expenses. Operating expenses for the eight
months ended September 30, 2005 were $150.1 million,
or 19.7% of net revenue, compared to $131.5 million, or
18.7% of net revenue, for the eight months ended
September 30, 2004. Operating expenses per weighted
transport increased 13.5% in 2005 compared to the prior period.
The change is due primarily to additional fuel and vehicle
repair costs of approximately $6.3 million, an increase in
medical supply costs of $2.6 million and an increase in
external services costs of $3.7 million. Costs for medical
supplies and external services grew as a result of increased
ambulance transport volumes. An increase in professional fees of
$2.7 million was related primarily to audit fees and
consulting fees for valuations we incurred in connection with
our acquisition of AMR. Other operating costs, including
occupancy, telecommunications and other expenses, increased
$3.3 million, but remained relatively flat as a percentage
of net revenue compared to the prior period.
51
Insurance expense. Insurance expense for the eight months
ended September 30, 2005 was $30.4 million, or 4.0% of
net revenue, compared to $28.8 million, or 4.1% of net
revenue, for the same period in 2004.
Selling, general and administrative. Selling, general and
administrative expense for the eight months ended
September 30, 2005 was $27.0 million, or 3.5% of net
revenue, compared to $19.8 million, or 2.8% of net revenue,
for the eight months ended September 30, 2004. The eight
months ended September 30, 2004 included reductions in
expense resulting from a one-time reversal of an accrued
liability of $1.8 million and payroll tax refunds related
to prior periods of $2.0 million, and the 2005 period
included increased expense from $0.3 million of Onex
management fees and $0.5 million of additional employee
severance costs. The remaining increase in the 2005 period
related primarily to the Companys growth and strategic
initiatives.
Laidlaw fees and compensation charges. AMR did not incur
Laidlaw fees and compensation charges for the eight months ended
September 30, 2005 as it was no longer a subsidiary of
Laidlaw International, Inc. For the eight months ended
September 30, 2004, these fees and charges were
$6.0 million, or 0.8% of net revenue. Costs of
$1.0 million that we have incurred to date to replace the
services previously performed by Laidlaw are included in the
statement of operations for the eight months ended
September 30, 2005.
Restructuring charges. AMR did not incur restructuring
charges during the eight months ended September 30, 2005.
Restructuring charges of $1.4 million recorded during the
eight months ended September 30, 2004 relate to a reduction
in the number of operating regions. Oversight of the affected
operations was shifted to the remaining regional management
teams.
Depreciation and amortization. Depreciation and
amortization expense for the eight months ended
September 30, 2005 was $31.5 million, or 4.1% of net
revenue, compared to $28.6 million, or 4.1% of net revenue,
for the eight months ended September 30, 2004.
EmCare
Net revenue. Net revenue for the eight months ended
September 30, 2005 was $425.9 million, an increase of
$53.4 million, or 14.3%, from $372.6 million for the
eight months ended September 30, 2004. The increase was due
primarily to an increase in patient visits from net new hospital
contracts and net revenue increases in existing contracts.
Following September 30, 2004, we added 25 net new contracts
which accounted for a net revenue increase of $29.0 million
for the eight months ended September 30, 2005. Net revenue
increased $5.9 million as a result of 21 net new contract
additions in the eight months ended September 30, 2004. Net
revenue under our same store contracts (contracts in
existence for the entirety of both fiscal periods) increased
$18.5 million in the eight months ended September 30,
2005 due to a 4.8% increase in patient visits and a 0.9%
increase in net revenue per patient visit.
Compensation and benefits. Compensation and benefits
costs for the eight months ended September 30, 2005 were
$336.1 million, or 78.9% of net revenue, compared to
$293.6 million, or 78.8% of net revenue, for the eight
months ended September 30, 2004. Provider compensation and
benefits costs increased $24.6 million from net new
contract additions subsequent to January 31, 2004.
Same store provider compensation and benefits costs
increased $11.8 million primarily related to an increase in
patient visits.
Operating expenses. Operating expenses for the eight
months ended September 30, 2005 were $18.6 million, or
4.4% of net revenue, compared to $16.0 million, or 4.3% of
net revenue, for the eight months ended September 30, 2004.
Operating expenses increased due to net new contract additions
but remained consistent as a percentage of net revenue.
Insurance expense. Professional liability insurance
expense for the eight months ended September 30, 2005 was
$30.0 million, or 7.0% of net revenue, compared to
$22.9 million, or 6.1% of net revenue, for the eight months
ended September 30, 2004. The increase as a percent of net
revenue is due primarily to the impact of $3.3 million of
favorable claims development recorded in the 2004 period.
52
Selling, general and administrative. Selling, general and
administrative expense for the eight months ended
September 30, 2005 was $11.3 million, or 2.7% of net
revenue, compared to $11.5 million, or 3.1% of net revenue,
for the eight months ended September 30, 2004.
Laidlaw fees and compensation charges. EmCare did not
incur Laidlaw fees and compensation charges for the eight months
ended September 30, 2005 as it was no longer a subsidiary
of Laidlaw International, Inc. For the eight months ended
September 30, 2004, these fees and charges were
$4.1 million, or 1.1% of net revenue. Costs of
$0.9 million that we have incurred to date to replace the
services previously performed by Laidlaw are included in the
statement of operations for the eight months ended
September 30, 2005.
Depreciation and amortization. Depreciation and
amortization expense for the eight months ended
September 30, 2005 was $7.3 million, or 1.7% of net
revenue, compared to $6.0 million, or 1.6% of net revenue,
for the eight months ended September 30, 2004.
Three months ended September 30, 2005 (Successor)
compared to the three months ended September 30, 2004
(Predecessor)
For the three months ended September 30, 2005 compared to the
same period in 2004, our net revenue grew 10.2%, with half of
this growth attributable to an increase in combined volumes at
our operating segments from increases in both existing markets
and the addition of net new contracts at each of AMR and EmCare.
The balance of the net revenue growth was generated by net
pricing increases due to contract and community rate increases
and Medicare increases.
Our income from operations decreased 21.6% from period to period
due primarily to unusual items affecting the period to period
comparability. These items include increased fuel costs of
$2.5 million in 2005, stock compensation charges of
$2.2 million in 2005, favorable insurance claims
development of $5.4 million recorded in 2004 compared with
$3.0 million in 2005, health benefit reductions of
$1.4 million in 2004, and $3.7 million of Laidlaw fees
and compensation charges in 2004 offset by $1.7 million in
2005 for transaction-related costs and services that were
provided previously by Laidlaw.
Interest expense. Interest expense for the three months
ended September 30, 2005 was $12.8 million compared to
$5.1 million for the three months ended September 30,
2004. This $7.7 million increase relates to the debt we
incurred in connection with our acquisition of AMR and EmCare.
Income tax expense. Income tax expense for the three
months ended September 30, 2005 was $3.5 million
compared to $7.2 million for the three months ended
September 30, 2004. This $3.7 million decrease relates
primarily to the additional interest expense recorded during the
2005 period.
AMR
Net revenue. Net revenue for the three months ended
September 30, 2005 was $291.9 million, an increase of
$21.0 million, or 7.8%, from $270.9 million for the
three months ended September 30, 2004. The increase in net
revenue was due primarily to an increase in our net revenue per
weighted transport of approximately 7.6%. The increase in net
revenue per weighted transport was the result of rate increases
in several of our operating markets and Medicare rate increases
under the Medicare Modernization Act. In addition, we had a net
increase of approximately 800 weighted transports. We had an
increase in weighted transports of 27,600, or 3.9%, primarily as
a result of an increase in ambulance transports in existing
markets. This increase was offset by a decrease of approximately
26,800 weighted transports and $5.6 million in net revenue
for the three months ended September 30, 2005 as a result
of exiting the Pinellas County, Florida market in late September
2004.
Compensation and benefits. Compensation and benefits
costs for the three months ended September 30, 2005 were
$190.1 million, or 65.1% of net revenue, compared to
$174.8 million, or 64.5% of net revenue, for the three
months ended September 30, 2004. Total unit hours increased
period over period by approximately 85,200 due to the increase
in ambulance transport volume, deployment changes required as
part of several contract rate increases and deployment changes
to improve our inter-facility market share. In addition,
ambulance crew wages per ambulance unit hour increased by
approximately 5.4%, which increased compensation costs by
$5.5 million. The ambulance crew wages per ambulance unit
hour increase resulted
53
principally from annual salary increases. Benefits costs
increased $3.7 million due to rising costs of health
insurance premiums and increased health benefit claims and a
favorable adjustment of $1.4 million in 2004 for claims
experience. The exit from the Pinellas County, Florida market
decreased ambulance unit hours by 56,200 and compensation and
benefits costs by $4.5 million.
Operating expenses. Operating expenses for the three
months ended September 30, 2005 were $58.8 million, or
20.1% of net revenue, compared to $49.7 million, or 18.3%
of net revenue, for the three months ended September 30,
2004. Operating expenses per weighted transport increased 18.1%
in 2005 compared to the prior period. The change is due
primarily to additional fuel and vehicle repair costs of
approximately $3.2 million, and increases in medical
supplies, external services and professional fees of
$1.5 million, $1.8 million and $1.5 million,
respectively. External services increased due to contract
changes, increased ambulance transport volumes and professional
fees increased due to audit and consulting fees for valuations
we incurred in connection with our acquisition of AMR. Other
operating costs, including occupancy, telecommunications and
other expenses, increased $1.0 million, but remained
relatively flat as a percentage of net revenue compared to the
prior period.
Insurance expense. Insurance expense for the three months
ended September 30, 2005 was $9.4 million, or 3.2% of
net revenue, compared to $11.6 million, or 4.3% of net
revenue, for the same period in 2004. These quarters included
favorable reductions in ultimate claims costs of
$3.0 million and $2.2 million for the three months
ended September 30, 2005 and 2004, respectively.
Selling, general and administrative. Selling, general and
administrative expense for the three months ended
September 30, 2005 was $11.0 million, or 3.8% of net
revenue, compared to $7.8 million, or 2.9% of net revenue,
for the three months ended September 30, 2004. The three
months ended September 30, 2005 included Onex management
fees of $0.1 million, additional employee severance costs
of $0.3 million and donations totaling $0.3 million to
our employees impacted by the Gulf Coast storms. The remaining
increase related primarily to our growth and strategic
initiatives, which totaled $1.6 million.
Laidlaw fees and compensation charges. AMR did not incur
Laidlaw fees and compensation charges for the three months ended
September 30, 2005 as it was no longer a subsidiary of
Laidlaw International, Inc. For the three months ended
September 30, 2004, these fees and charges were
$2.2 million, or 0.8% of net revenue. Costs of
$0.4 million that we incurred to date to replace the
services previously performed by Laidlaw are included in the
statement of operations for the three months ended
September 30, 2005.
Depreciation and amortization. Depreciation and
amortization expense for the three months ended
September 30, 2005 was $12.1 million, or 4.1% of net
revenue, compared to $10.5 million, or 3.9% of net revenue,
for the three months ended September 30, 2004.
EmCare
Net revenue. Net revenue for the three months ended
September 30, 2005 was $164.3 million, an increase of
$21.3 million, or 14.9%, from $143.0 million for the
three months ended September 30, 2004. The increase was due
primarily to an increase in patient visits from net new hospital
contracts and net revenue increases in existing contracts.
Following September 30, 2004, we added 25 net new contracts
which accounted for a net revenue increase of $12.1 million
for the three months ended September 30, 2005. Net revenue
under our same store contracts (contracts in
existence for the entirety of both fiscal periods) increased
$9.3 million in the three months ended September 30,
2005 due to a 5.7% increase in patient visits and a 1.8%
increase in net revenue per patient visit.
Compensation and benefits. Compensation and benefits
costs for the three months ended September 30, 2005 were
$129.2 million, or 78.6% of net revenue, compared to
$111.8 million, or 78.2% of net revenue, for the three
months ended September 30, 2004. Provider compensation and
benefits costs increased $9.3 million from net new contract
additions subsequent to September 30, 2004. Same
store provider compensation and benefits costs increased
$6.6 million, related primarily to an increase in patient visits.
Operating expenses. Operating expenses for the three
months ended September 30, 2005 were $7.4 million, or
4.5% of net revenue, compared to $6.2 million, or 4.3% of
net revenue, for the three months ended September 30, 2004.
Operating expenses increased due to net new contract additions
but remained consistent as a percentage of net revenue.
54
Insurance expense. Professional liability insurance
expense for the three months ended September 30, 2005 was
$11.6 million, or 7.1% of net revenue, compared to
$6.8 million, or 4.8% of net revenue, for the three months
ended September 30, 2004. The increase as a percent of net
revenue is due primarily to the impact of $3.2 million of
favorable insurance claims development recorded in the 2004
period.
Selling, general and administrative. Selling, general and
administrative expense for the three months ended
September 30, 2005 was $4.7 million, or 2.9% of net
revenue, compared to $4.3 million, or 3.0% of net revenue,
for the three months ended September 30, 2004. The
$0.4 million increase in selling, general and
administrative expense is related to replacement costs
previously included in Laidlaw management fees and the increase
in net new contracts.
Laidlaw fees and compensation charges. EmCare did not
incur Laidlaw fees and compensation charges for the three months
ended September 30, 2005 as it was no longer a subsidiary
of Laidlaw International, Inc. For the three months ended
September 30, 2004, these fees and charges were
$1.4 million, or 1.0% of net revenue. Costs of
$0.4 million that we incurred to date to replace the
services previously performed by Laidlaw are included in the
statement of operations for the three months ended
September 30, 2005.
Depreciation and amortization. Depreciation and
amortization expense for the three months ended
September 30, 2005 was $2.8 million, or 1.7% of net
revenue, compared to $2.2 million, or 1.5% of net revenue,
for the three months ended September 30, 2004.
Five months ended January 31, 2005 (Successor)
compared to the five months ended January 31, 2004
(Predecessor)
Interest expense. Interest expense for the five months
ended January 31, 2005 was $5.6 million compared to
$4.1 million for the five months ended January 31,
2004. The $1.5 million difference relates to an increase in
the amount owed to Laidlaw during the five months ended
January 31, 2005 compared to the same period in 2004.
Income tax expense. Income tax expense for the five
months ended January 31, 2005 was $6.3 million
compared to $9.8 million for the five months ended
January 31, 2004. The $3.5 million decrease relates
primarily to additional interest expense and added costs
incurred by AMR and EmCare as a result of the acquisition.
AMR
Net revenue. Net revenue for the five months ended
January 31, 2005 was $455.1 million, an increase of
$13.1 million, or 3.0%, from $442.0 million for the
five months ended January 31, 2004. The increase in net
revenue was due primarily to an increase in our net revenue per
weighted transport of approximately 6%, offset by approximately
38,700 fewer weighted transports, including a 30,220 ambulance
transport decrease. The decrease in ambulance transports was due
primarily to exiting the Pinellas County, Florida market in late
September 2004, which accounted for a decrease of approximately
35,000 ambulance transports and $6.2 million in net revenue
for the five months ended January 31, 2005.
Compensation and benefits. Compensation and benefits
costs for the five months ended January 31, 2005 were
$289.7 million, or 63.7% of net revenue, compared to
$287.7 million, or 65.1% of net revenue, for the five
months ended January 31, 2004. Total unit hours decreased
period over period by 100,800 primarily as a result of the exit
from the Pinellas County, Florida market, which decreased
ambulance unit hours by 79,800 and compensation and benefits
costs by $5.3 million. The decrease in total unit hours was
offset by an increase in our ambulance crew wages per ambulance
unit hour of 6.6%, which increased compensation costs by
$10.1 million. The ambulance crew wages per ambulance unit
hour increase resulted principally from annual salary increases.
Benefits costs decreased $1.7 million due to our shift of
employees previously covered under premium-based health
insurance plans to self-insured health plans.
Operating expenses. Operating expenses for the five
months ended January 31, 2005 were $83.9 million, or
18.4% of net revenue, compared to $80.3 million, or 18.2%
of net revenue, for the five months ended January 31, 2004.
Operating expenses per weighted transport increased 7.9% in 2005
compared to the prior
55
period. This $3.6 million increase was due primarily to
higher fuel costs, which were 2.0% of net revenue for the five
months ended January 31, 2005, compared to 1.6% of net
revenue for the same period in 2004.
Insurance expense. Insurance expense for the five months
ended January 31, 2005 was $22.4 million, or 4.9% of
net revenue, compared to $20.3 million, or 4.6% of net
revenue, for the same period in 2004. This $2.1 million
decrease was primarily a result of improvements in ultimate
claims costs.
Selling, general and administrative. Selling, general and
administrative expense for the five months ended
January 31, 2005 was $15.7 million, or 3.5% of net
revenue, compared to $16.2 million, or 3.7% of net revenue,
for the five months ended January 31, 2004. The
$0.5 million decrease in selling, general and
administrative expense related primarily to deferred
compensation expense recorded as part of management incentive
programs that were implemented by Laidlaw during fiscal 2004 and
which were expensed as a component of Laidlaw fees and
compensation charges in 2005.
Laidlaw fees and compensation charges. Laidlaw fees and
compensation charges for the five months ended January 31,
2005 were $9.4 million, or 2.1% of net revenue, compared to
$3.8 million, or 0.9% of net revenue, for the five months
ended January 31, 2004. This $5.6 million increase was
primarily due to charges related to senior management incentive
plans expensed as part of the sale to Onex and additional
Laidlaw overhead costs allocated to AMR during the five months
ended January 31, 2005.
Depreciation and amortization. Depreciation and
amortization expense for the five months ended January 31,
2005 was $16.4 million, or 3.6% of net revenue, compared to
$18.3 million, or 4.1% of net revenue, for the five months
ended January 31, 2004. The $1.9 million decrease
resulted from the elimination of the contract intangible asset
recorded in fiscal 2003 as part of our fresh-start accounting
adjustments. As this asset was eliminated in the fourth quarter
of fiscal 2004, no amortization expense was recorded for this
intangible asset in the five months ended January 31, 2005.
EmCare
Net revenue. Net revenue for the five months ended
January 31, 2005 was $241.1 million, an increase of
$15.5 million, or 6.9%, from $225.6 million for the
five months ended January 31, 2004. The increase was due
primarily to an increase in patient visits from net new hospital
contracts and net revenue increases in existing contracts.
Following January 31, 2004, we added 33 net new
contracts which accounted for a net revenue increase of
$11.9 million for the five months ended January 31,
2005. Net revenue increased $2.6 million as a result of six
net new contract additions in the five months ended
January 31, 2004. Net revenue under our same
store contracts (contracts in existence for the entirety
of both fiscal periods) increased $1.1 million in the five
months ended January 31, 2005 due to a 1.4% decrease in
patient visits, offset by a 1.9% increase in net revenue per
patient visit.
Compensation and benefits. Compensation and benefits
costs for the five months ended January 31, 2005 were
$191.6 million, or 79.5% of net revenue, compared to
$174.2 million, or 77.2% of net revenue, for the five
months ended January 31, 2004. Provider compensation and
benefits costs increased $12.5 million from net new
contract additions subsequent to August 31, 2004.
Same store provider compensation and benefits
increased $3.6 million.
Operating expenses. Operating expenses for the five
months ended January 31, 2005 were $11.0 million, or
4.6% of net revenue, compared to $10.6 million, or 4.7% of
net revenue, for the five months ended January 31, 2004.
Operating expenses, as a percentage of net revenue, decreased
due to our leveraging of fixed billing and other fixed contract
costs.
Insurance expense. Professional liability insurance
expense for the five months ended January 31, 2005 was
$16.6 million, or 6.9% of net revenue, compared to
$16.4 million, or 7.3% of net revenue, for the five months
ended January 31, 2004. Insurance expense, as a percentage
of net revenue, decreased due to an improvement in expected
ultimate claims costs.
56
Selling, general and administrative. Selling, general and
administrative expense for the five months ended
January 31, 2005 was $5.9 million, or 2.5% of net
revenue, compared to $5.8 million, or 2.6% of net revenue,
for the five months ended January 31, 2004.
Laidlaw fees and compensation charges. Laidlaw fees and
compensation charges for the five months ended January 31,
2005 was $10.5 million, or 4.3% of net revenue, compared to
$2.7 million, or 1.2% of net revenue, for the five months
ended January 31, 2004. This $7.8 million increase was
primarily due to charges related to senior management incentive
plans expensed as part of the sale to Onex and additional
Laidlaw overhead costs allocated to EmCare during the five
months ended January 31, 2005.
Depreciation and amortization. Depreciation and
amortization expense for the five months ended January 31,
2005 was $2.4 million, or 1.0% of net revenue, compared to
$3.8 million, or 1.7% of net revenue, for the five months
ended January 31, 2004. The $1.4 million decrease was
the result of the elimination of the contract intangible asset
recorded in fiscal 2003 as part of our fresh-start accounting
adjustments. As this asset was eliminated in the fourth quarter
of fiscal 2004, no amortization expense was recorded for this
intangible asset in the five months ended January 31, 2005.
Year ended August 31, 2004 compared to the year ended
August 31, 2003
Interest expense. Interest expense for the year ended
August 31, 2004 was $10.0 million compared to
$5.6 million for the year ended August 31, 2003. The
increase is a result of Laidlaw suspending certain related party
interest charges during the Laidlaw bankruptcy in 2003.
Income tax expense. Income tax expense for the year ended
August 31, 2004 was $21.8 million compared to
$9.5 million for the year ended August 31, 2003. The
$12.3 million increase is a result of the release of full
valuation allowances on all deferred tax assets for the 2003
period in connection with Laidlaws exit from bankruptcy.
AMR
Net revenue. Net revenue for the year ended
August 31, 2004 was $1,054.8 million, an increase of
$47.6 million, or 4.7%, from $1,007.2 million for the
year ended August 31, 2003. The increase was due primarily
to an increase in weighted transports of 65,800, or 2.3%,
primarily as a result of an increase in ambulance transports in
existing markets, resulting in a net revenue increase of
$22.9 million. The balance of the increase resulted from
rate increases in several of our markets that offset Medicare
rate reductions in effect prior to the July 1, 2004
effective date of the Medicare Modernization Act, together
increasing our net revenue per weighted transport by 2.4%, or
$24.7 million.
Compensation and benefits. Compensation and benefits
costs for the year ended August 31, 2004 were
$687.2 million, or 65.2% of net revenue, compared to
$647.3 million, or 64.3%, for the year ended
August 31, 2003. The increase of $39.9 million
includes an increase in ambulance unit hours of 242,200, or
2.5%, associated with the increase in weighted transports,
totaling $8.9 million of compensation-related costs.
Ambulance salaries per unit hour increased 3.5%, or
$12.6 million. In fiscal 2004 we expanded our sales and
marketing team and our senior management, resulting in
$3.7 million of compensation and benefits costs. Our health
insurance costs and other employee benefits also increased year
over year by $11.0 million.
Operating expenses. Operating expenses for the year ended
August 31, 2004 were $194.4 million, or 18.4% of net
revenue, compared to $195.1 million, or 19.4% of net
revenue, for the year ended August 31, 2003. Operating
expenses per weighted transport decreased 2.6% from fiscal 2003
to fiscal 2004. These expenses decreased primarily as a result
of improvements in telecommunications contract rates, totaling
$0.6 million, and a reduction in medical supplies expense,
totaling $0.6 million, from improved purchasing contracts
and more efficient inventory management. These decreases were
offset in part by increases in vehicle operating costs, totaling
$0.6 million, resulting primarily from higher fuel costs
incurred in late fiscal 2004.
Insurance expense. Insurance expense for the year ended
August 31, 2004 was $44.3 million, or 4.2% of net
revenue, compared to $67.4 million, or 6.7% of net revenue,
for the year ended August 31, 2003. This
57
decrease of $23.1 million primarily relates to insurance
expense recorded in fiscal 2003 of $14.6 million resulting
from increases in actuarially-computed estimates of costs
required to settle prior years claims. In fiscal 2004, we
recorded a reduction of insurance expense of $4.5 million
due to favorable developments with respect to these claims. We
funded these claims through Laidlaws captive insurance
program. Excluding these adjustments, insurance expense
decreased $4.0 million from fiscal 2003 to fiscal 2004 as a
result of improvements in ultimate claims costs. Management
implemented a number of additional risk mitigation programs at
the beginning of fiscal 2003 that we believe positively impacted
claims costs in fiscal 2004.
Selling, general and administrative. Selling, general and
administrative expense for the year ended August 31, 2004
was $32.2 million, or 3.1% of net revenue, compared to
$35.1 million, or 3.5% of net revenue, for the year ended
August 31, 2003. This decrease of $2.9 million relates
primarily to a one-time expense reduction to eliminate a
contingent liability of $1.8 million.
Laidlaw fees and compensation charges. Laidlaw fees and
compensation charges for the year ended August 31, 2004
increased from $3.6 million, or 0.4% of net revenue, to
$9.0 million, or 0.9% of net revenue, from the year ended
August 31, 2003. The $5.4 million increase was due to
charges related to senior management incentive plans and
additional Laidlaw overhead costs allocated to AMR.
Depreciation and amortization. Depreciation and
amortization expense for the year ended August 31, 2004 was
$43.6 million, or 4.1% of net revenue, compared to
$39.3 million, or 3.9% of net revenue, for the year ended
August 31, 2003. The $4.3 million increase includes
$3.3 million attributable to amortization of a contract
intangible asset recorded as part of our fresh-start accounting
adjustments. The balance of the increase is related primarily to
vehicle acquisitions made in late fiscal 2003 and fiscal 2004.
Restructuring charges. Restructuring charges were
$2.1 million, or 0.2% of net revenue, for the year ended
August 31, 2004, a decrease from $2.7 million, or 0.3%
of net revenue, for the year ended August 31, 2003. Fiscal
2003 restructuring charges included severance-related costs for
several members of senior management who were replaced during
the year and costs incurred in restructuring and consolidating
our billing offices. In fiscal 2004, we reduced the number of
operating regions and shifted the oversight of the affected
operations to the remaining regional management teams.
EmCare
Net revenue. Net revenue for the year ended
August 31, 2004 was $549.8 million, an increase of
$69.2 million, or 14.4%, from $480.6 million for the
year ended August 31, 2003. The increase was due primarily
to an increase in patient visits from net new hospital contracts
and net revenue increases in existing contracts. During fiscal
2004, we added 35 net new contracts (58 new contracts,
including 50 new emergency department contracts and 8 new
hospitalist contracts, offset by 23 contract terminations), for
a net revenue increase of $21.6 million. Net revenue
increased $23.6 million as a result of the net impact of
contract additions and terminations in fiscal 2003. Same
store net revenue increased $24.0 million due to a
4.5% increase in patient visits and an increase of 1.1% in net
revenue per patient visit.
Compensation and benefits. Compensation and benefits
costs for the year ended August 31, 2004 were
$430.7 million, or 78.3% of net revenue, compared to
$374.5 million, or 77.9% of net revenue, for the year ended
August 31, 2003. Provider compensation and benefit costs
increased $32.7 million from net new contract additions in
fiscal 2003 and 2004. Same store contract
compensation and benefits costs increased $12.8 million, or
0.2% per patient visit, as a result of increased net revenue per
visit and an increase in volume of patient visits, as a number
of our contracts include productivity-based compensation plans.
Operating expenses. Operating expenses for the year ended
August 31, 2004 were $23.9 million, or 4.3% of net
revenue, compared to $23.6 million, or 4.9% of net revenue,
for the year ended August 31, 2003. Operating expenses
decreased as a percent of net revenue from 4.9% in fiscal 2003
to 4.3% in fiscal 2004 due to our leveraging of fixed billing
and other contract costs.
Insurance expense. Professional liability insurance
expense for the year ended August 31, 2004 was
$36.0 million, or 6.5% of net revenue, compared to
$36.8 million, or 7.7% of net revenue, for the year ended
August 31, 2003. The reduction as a percent of net revenue
represents a combination of improved investment
58
returns, changes in actuarial estimates of costs required to
settle prior years claims and a reduction in the estimate
of ultimate claims costs.
Selling, general and administrative. Selling, general and
administrative expense for the year ended August 31, 2004
was $15.7 million, or 2.9% of net revenue, compared to
$14.8 million, or 3.1% of net revenue, for the year ended
August 31, 2003. The $0.9 million increase in selling,
general and administrative expense includes $0.6 million of
deferred compensation expense recorded as part of management
incentive programs during fiscal 2004 that were terminated in
connection with the acquisition and additional support costs
required for net new contracts.
Laidlaw fees and compensation charges. Laidlaw fees and
compensation charges for the year ended August 31, 2004
were $6.4 million, or 1.2% of net revenue, compared to
$1.8 million, or 0.4% of net revenue, for the year ended
August 31, 2003. The increase was due to charges related to
senior management incentive plans and additional Laidlaw
overhead costs allocated to EmCare.
Depreciation and amortization. Depreciation and
amortization expense for the year ended August 31, 2004 was
$9.1 million, or 1.7% of net revenue, compared to
$5.4 million, or 1.1% of net revenue, for the year ended
August 31, 2003. The increase of $3.7 million was due
to amortization of a contract intangible asset recorded as part
of our fresh-start accounting adjustments.
Laidlaw reorganization costs. There were no allocated
reorganization costs in fiscal 2004. Laidlaw reorganization
costs for the year ended August 31, 2003 were
$3.7 million, or 0.8% of net revenue. These costs were
allocated to EmCare by Laidlaw and reflect costs borne by
Laidlaw during its Chapter 11 restructuring.
Year ended August 31, 2003 compared to the year ended
August 31, 2002
Interest expense. Interest expense for the year ended
August 31, 2003 was $5.6 million compared to
$6.4 million for the year ended August 31, 2002. The
decrease of $0.8 million is due to higher interest costs on
vehicle capital leases in fiscal 2002.
Income tax expense. Income tax expense for the year ended
August 31, 2003 was $9.5 million compared to
$1.4 million for the year ended August 31, 2002. The
$8.1 million increase is due to increased income from
operations during fiscal 2003.
AMR
Net revenue. Net revenue for the year ended
August 31, 2003 was $1,007.2 million, an increase of
$22.7 million, or 2.3%, from $984.5 million for the
same period in 2002. The increase for fiscal 2003 is due
primarily to rate increases we negotiated with several
communities and payors during fiscal 2003, partially in response
to Medicare rate reductions beginning in April 2002. Our rate
per weighted transport increased 2.9%, resulting in a
$28.4 million increase in net revenue. This increase was
offset, in part, by a decrease in weighted transports of 16,900,
or 0.6%, resulting in a $5.7 million decrease in net
revenue, due principally to fewer non-emergency transports.
Compensation and benefits. Compensation and benefits
costs for the year ended August 31, 2003 were
$647.3 million, or 64.3% of net revenue, compared to
$627.8 million, or 63.8% of net revenue, for the year ended
August 31, 2002. The $19.5 million increase relates
primarily to ambulance crew wage per unit hour increases of
approximately 2.9%, or $9.8 million, in addition to an
increase in unit hours of approximately 90,900, or 0.9%,
resulting in a $2.5 million increase. Benefits also
increased $3.6 million from period to period as a result of
rising health insurance premium costs.
Operating expenses. Operating expenses for the year ended
August 31, 2003 were $195.1 million, or 19.4% of net
revenue, compared to $195.3 million, or 19.8% of net
revenue, for the year ended August 31, 2002. Operating
expenses per weighted transport decreased 0.5% from fiscal 2002
to fiscal 2003. The $0.2 million decrease was a result of a
$3.1 million decrease in occupancy costs from consolidating
certain regional facilities and a $6.1 million decrease in
professional services from legal costs incurred in fiscal 2002
for compliance-related matters, offset in part by a
$6.5 million increase in external provider costs. The
59
increase in external provider costs resulted principally from a
significant expansion in our national and regional relationships
with managed care and insurance providers and the resulting
costs we incurred to subcontract certain transports to local
ambulance providers.
Insurance expense. Insurance expense for the year ended
August 31, 2003 was $67.4 million, or 6.7% of net
revenue, compared to $36.1 million, or 3.7% of net revenue,
for the year ended August 31, 2002. In fiscal 2003, we
recorded $14.6 million of expense related to reserve
adjustments resulting from increases in actuarially-computed
estimates of costs required to settle prior years claims.
We funded these claims through Laidlaws captive insurance
program. In fiscal 2002, we recorded a reduction of insurance
expense of $8.1 million related to the favorable
development of claims reserves on insurance liabilities prior to
fiscal 2002. Excluding these adjustments, the $8.6 million
increase in insurance expense related to increasing premium and
claims costs associated with our workers compensation, and auto,
general and professional liability programs.
Selling, general and administrative. Selling, general and
administrative expense for the year ended August 31, 2003
was $35.1 million, or 3.5% of net revenue, compared to
$44.7 million, or 4.5% of net revenue, for the year ended
August 31, 2002. The $9.6 million reduction in
selling, general and administrative expense from fiscal 2002 to
fiscal 2003 is the result of severance recorded in fiscal 2002
to replace certain members of management, totaling
$3.7 million, associated costs to close operations,
totaling $0.9 million, and compliance-related penalties of
approximately $1.9 million incurred in fiscal 2002. In
fiscal 2003, we recorded a one-time reduction of selling,
general and administrative expense relating to the release of
$1.2 million in accrued liabilities and a reduction to
expense related to payroll tax refunds of $0.6 million.
Depreciation and amortization. Depreciation and
amortization expense for the year ended August 31, 2003 was
$39.3 million, or 3.9% of net revenue, compared to
$62.2 million, or 6.3% of net revenue, for the year ended
August 31, 2002. The decrease of $22.9 million
includes $21.3 million attributable to the amortization of
goodwill. Beginning in fiscal 2003, this intangible asset was no
longer amortized, but evaluated annually for impairment under
applicable accounting guidance.
Impairment losses. In fiscal 2002, we recorded an
impairment charge of $262.8 million or 26.7% of net
revenue, on long-lived assets based on the evaluation at that
time that future operating cash flows would not be sufficient to
recover the carrying value of certain long-lived assets,
primarily goodwill.
Restructuring charges. Restructuring charges were
$2.7 million, or 0.3% of net revenue, in the year ended
August 31, 2003, a decrease from $3.8 million, or 0.4%
of net revenue, in the year ended August 31, 2002. Fiscal
2003 restructuring charges included severance-related costs for
several members of senior management who were replaced during
the year and costs incurred in restructuring and consolidating
our billing offices. In fiscal 2002, AMR reduced the number of
operating regions, exited certain facilities, and shifted the
oversight of the impacted operations to the remaining regional
management teams.
EmCare
Net revenue. Net revenue for the year ended
August 31, 2003 was $480.6 million, an increase of
$49.3 million, or 11.4%, from $431.3 million for the
year ended August 31, 2002. The increase was due primarily
to an increase in patient visits from net new hospital contracts
and net revenue increases in existing contracts. During fiscal
2003, we added 27 net new contracts (55 new contracts,
including 48 new emergency department contracts and 7 new
hospitalist contracts, offset by 28 contract terminations), for
a net revenue increase of $30.4 million. Net revenue
increased $3.9 million as a result of the net impact of
2002 contract additions and terminations. Same store
net revenue increased $15.0 million due to a 2.0% increase
in patient visits and a 1.8% increase in net revenue per patient
visit.
Compensation and benefits. Compensation and benefits
costs for the year ended August 31, 2003 were
$374.5 million, or 77.9% of net revenue, compared to
$332.8 million, or 77.1% of net revenue, for the year ended
August 31, 2002. Provider compensation and benefit costs
increased $26.4 million from net new contract additions in
fiscal 2003 and 2002. Same store contract
compensation and benefits costs increased
60
$11.0 million as a result of increased volume of patient
visits and increased net revenue per visit, as a number of our
contracts include productivity-based compensation plans.
Operating expenses. Operating expenses for the year ended
August 31, 2003 were $23.6 million, or 4.9% of net
revenue, compared to $24.0 million, or 5.6% of net revenue,
for the year ended August 31, 2002. Operating expenses
decreased as a percent of net revenue due to our leveraging of
fixed billing and other contract costs.
Insurance expense. Professional liability insurance
expense for the year ended August 31, 2003 was
$36.8 million, or 7.7% of net revenue, compared to
$30.4 million, or 7.0% of net revenue, for the year ended
August 31, 2002 due to an increase in expected ultimate
losses.
Selling, general and administrative. Selling, general and
administrative expense for the year ended August 31, 2003
was $14.8 million, or 3.1% of net revenue, compared to
$16.8 million, or 3.9% of net revenue, for the year ended
August 31, 2002. The $2.0 million decrease was a
result of reduced management contract costs, as contracted
management costs were converted to employee costs in fiscal 2003.
Depreciation and amortization. Depreciation and
amortization expense for the year ended August 31, 2003 was
$5.4 million, or 1.1% of net revenue, compared to
$5.0 million, or 1.1% of net revenue, for the year ended
August 31, 2002. The $0.4 million increase was due to
additional billing technology investments completed at the end
of fiscal 2002.
Laidlaw reorganization costs. Allocated reorganization
costs for the year ended August 31, 2003 were
$3.7 million, or 0.8% of net revenue, compared to
$8.8 million, or 2.0% of net revenue, for the year ended
August 31, 2002. These costs were allocated to EmCare by
Laidlaw and reflect costs borne by Laidlaw during its
Chapter 11 restructuring.
Liquidity and Capital Resources
Our primary sources of liquidity are cash flow provided by our
operating activities and, prior to the acquisition, related
party advances from Laidlaw. We are now using our revolving
senior secured credit facility, described below, to supplement
our cash flow provided by our operating activities. Our
liquidity needs are primarily to fund our working capital
requirements, capital expenditures related to the acquisition of
vehicles and medical equipment, technology-related assets and
insurance-related deposits.
For the eight months ended September 30, 2005 and 2004, we
generated cash flow from operating activities of
$108.5 million and $100.0 million, respectively. For
the eight months ended September 30, 2005, we had net
income of $14.0 million, compared to $24.6 million for
the same period in 2004. Operating cash flow from changes in
working capital for the eight months ended September 30,
2005 increased $23.8 million from the same period in 2004,
reflecting improved collections on accounts receivable, a
reduction in the amount of deposits required under our insurance
programs, an increase in accruals related to our growth and
accrued interest in the current period not incurred in the eight
months ended September 30, 2004.
Net cash used in investing activities was $917.4 million
for the eight months ended September 30, 2005, compared to
$73.9 million for the same period in 2004. The
$843.5 million increase was attributable principally to our
net cash outflow to fund the acquisition of AMR and EmCare.
For the eight months ended September 30, 2005, net cash
provided by financing activities was $804.4 million,
compared to net cash used in financing activities of
$20.7 million for the eight months ended September 30,
2004. The increase in net cash provided by financing activities
relates primarily to borrowings received from our senior secured
credit facility and senior subordinated notes. Net cash used in
financing activities included financing costs of
$20.1 million and repayments of debt, including capital
lease and senior secured credit facility obligations totaling
$25.8 million.
For the five months ended January 31, 2005 and 2004, we
generated cash flow from operating activities of
$16.0 million and $18.6 million, respectively.
Operating cash flow from changes in working capital for the five
months ended January 31, 2005 increased $8.9 million
from the same period in 2004, primarily reflecting improved
collections on accounts receivables.
61
Net cash used in investing activities was $21.7 million for
the five months ended January 31, 2005, compared to
$10.9 million for the same period in 2004. The
$10.8 million increase was attributable principally to our
net cash outflow to fund insurance-related deposits in our
EmCare business segment. The balance resulted primarily from the
purchase of new ambulance vehicles and certain medical equipment.
For the five months ended January 31, 2005, net cash
provided by financing activities was $10.9 million compared
to net cash used in financing activities of $7.5 million
for the five months ended January 31, 2004. Net cash used
in financing activities relates primarily to borrowings received
from Laidlaw and payments on our capital lease obligations.
During fiscal 2004, our operating activities generated
$127.7 million in cash flow compared to $88.8 million
in fiscal 2003, an increase of $38.9 million. Operating
cash flow from changes in working capital for fiscal 2004
increased $2.9 million compared to fiscal 2003. The balance
of the change in cash flow provided by operating activities was
attributable principally to an increase in net income, which
includes increases in depreciation and amortization expense and
changes in deferred taxes.
Net cash used in investing activities was $81.5 million and
$114.0 million during fiscal years 2004 and 2003,
respectively. In fiscal 2004, we spent $42.8 million on
property and equipment, of which $20.4 million related to
the acquisition of vehicles, and medical and communications
equipment, technology-related acquisition and leasehold
improvements accounted for $22.4 million. Our
$22.5 million net decrease in insurance-related deposits
and investments, which consist of restricted cash and cash
equivalents, short-term deposits, marketable securities and
long-term investments, resulted from a reduction in cash
outflows to fund certain insurance-related programs consistent
with improved claims development trends. This increase was
principally to support our increase in claims liabilities and
professional liability reserves. In fiscal 2003, we spent
$52.8 million on property and equipment, of which
$29.1 million was related to the acquisition of vehicles,
and medical and communications equipment, technology-related
acquisition and leasehold improvements accounted for
$23.8 million.
Net cash used in financing activities was $47.3 million and
$55.3 million during fiscal years 2004 and 2003,
respectively. In fiscal 2004, we made payments to Laidlaw of
$31.1 million and made mandatory debt repayments of
$8.7 million. Our bank overdrafts also decreased in fiscal
2004 by $4.5 million. In fiscal 2003, we made payments to
Laidlaw of $58.8 million and made mandatory debt repayments
of $8.2 million. Bank overdrafts also increased
$7.9 million during the year ended August 31, 2003.
Certain government programs, including Medicare and Medicaid
programs, require notice or re-enrollment when certain ownership
or corporate structure changes occur. In certain jurisdictions,
such changes require pre- or post-notification to governmental
licensing and certification agencies, or agencies with which we
have contracts. If the payor requires us to complete the
re-enrollment process prior to submitting reimbursement
requests, we may be delayed in payment, receive refund requests
or be subject to recoupment for services we provide in the
interim. For example, the change in ownership effected by our
acquisition of AMR required two of our subsidiaries to apply for
state and local ambulance operating authority in New York and
may require us to re-enroll in one or more jurisdictions. The
changes in our corporate structure and ownership in connection
with this offering or to meet certain state licensing
requirements may require us to give notice, re-enroll or make
other applications for authority to continue operating in
various jurisdictions. If we are required to re-enroll in a
jurisdiction, reimbursement from the relevant government program
is likely to be deferred for several months. This would affect
our cash flow but would not affect our net revenue. We do not
expect the impact of any such deferral to be material to us
unless several jurisdictions require us to re-enroll.
We expect to continue to fund the liquidity requirements of our
business principally with cash from operations and amounts
available under the revolving credit portion of our senior
secured credit facility. We have available to us, upon
compliance with customary conditions, $100.0 million under
the revolving credit facility, less borrowings and any letters
of credit outstanding. Outstanding borrowings at
September 30, 2005 were $5.0 million and letters of
credit at September 30, 2005 were $27.3 million.
62
The acquisition of AMR and EmCare resulted in a significant
increase in the level of our outstanding debt. We have a
$450.0 million senior secured credit facility bearing
interest at variable rates at specified margins above either the
agent banks alternate base rate or its LIBOR rate. The
senior secured credit facility consists of a
$100.0 million, six-year revolving credit facility and a
$350.0 million, seven-year term loan. We borrowed the full
amount of the term loan, and $20.2 million under the
revolving credit facility, on February 10, 2005 to fund the
acquisition of AMR and EmCare and pay related fees and expenses.
On February 10, 2005, we also issued $250.0 million
principal amount of 10% senior subordinated notes due 2015.
We used the net proceeds of this notes issuance to fund the
acquisition.
Our $350.0 million term loan initially carried interest at
the alternate base rate, plus a margin of 1.75%, or the LIBOR
rate, plus a margin of 2.75%. We refinanced this term loan on
March 29, 2005 for a term loan with identical terms except
that the margins were reduced by 0.25%. The term loan is subject
to quarterly amortization of principal (in quarterly
installments), with 1% of the aggregate principal payable in
each of the first six years, with the remaining balance due in
the final year. We intend to use $100.0 million of the
proceeds of this offering to prepay $100.0 million of the
term loan. Our $100.0 million revolving credit facility
initially bears interest at the alternate base rate, plus a
margin of 1.75%, or the LIBOR rate, plus a margin of 2.75%. At
September 30, 2005, we had repaid all but $5.0 million
of the outstanding balance of the revolving credit facility with
cash flow from operations. Under the terms of our senior secured
credit facility, our letters of credit outstanding reduce our
available borrowings under the revolving credit facility. At
September 30, 2005, our outstanding letters of credit
totaled $27.3 million, including $16.0 million to
support our self-insurance program and $8.3 million to
secure our performance under certain 911 emergency response
contracts.
We have a conditional right under our senior secured credit
facility to request new or existing lenders to provide up to an
additional $100 million of term debt (in $20 million
increments).
All amounts borrowed under our senior secured credit facility
are secured by, among other things:
|
|
|
|
|
substantially all present and future shares of the capital stock
of AMR HoldCo, Inc. and EmCare HoldCo, Inc., our wholly-owned
subsidiaries which are the co-borrowers, and each of their
present and future domestic subsidiaries and 65% of the capital
stock of controlled foreign corporations; |
|
|
|
substantially all present and future intercompany debt of the
co-borrowers and each guarantor; and |
|
|
|
substantially all of the present and future property and assets,
real and personal, of the co-borrowers and each guarantor. |
The agreements governing our senior secured credit facility
contains customary affirmative and negative covenants,
including, among other things, restrictions on indebtedness,
liens, mergers and consolidations, sales of assets, loans,
acquisitions, joint ventures, restricted payments, transactions
with affiliates, dividends and other payment restrictions
affecting subsidiaries, a change in control of the company and
other matters customarily restricted in such agreements. The
agreement governing our senior secured credit facility also
contains financial covenants, including a maximum total leverage
ratio (5.50 to 1.00 as of September 30, 2005), maximum
senior leverage ratio (3.25 to 1.00 as of September 30,
2005) and a minimum fixed charge coverage ratio (1.05 to 1.00 as
of September 30, 2005), all of which are based on adjusted
EBITDA, which is the amount of our income (loss) from operations
before depreciation and amortization expenses and other
specifically identified exclusions. These ratios are to be
calculated each quarter based on the financial data for the four
fiscal quarters then ending. Each financial covenant ratio
adjusts over time as set forth in our senior secured credit
facility. Our failure to meet any of these financial covenants
could be an event of default under our senior secured credit
facility.
63
The calculated ratios for the four fiscal quarters, or LTM,
ended September 30, 2005, and pro forma to give effect to
this offering and our use of proceeds as described in Use
of Proceeds, were as follows:
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|
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|
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|
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|
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|
As of September 30, 2005 | |
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| |
|
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Consolidated | |
|
|
|
Pro Forma | |
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| |
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| |
|
|
Total Leverage Ratio:
|
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|
|
|
|
|
|
|
|
|
|
|
|
|
Consolidated Indebtedness/
|
|
|
|
$ |
608,607 |
|
|
|
|
$ |
508,607 |
|
|
|
Adjusted LTM EBITDA(1)
|
|
÷ |
|
$ |
150,128 |
|
|
|
|
$ |
150,128 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
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|
|
|
|
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= 4.05 |
|
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× |
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= 3.39 |
|
|
× |
Senior Leverage Ratio:
|
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|
|
|
|
|
|
|
|
|
|
|
|
Senior Indebtedness/
|
|
|
|
$ |
358,607 |
|
|
|
|
$ |
258,607 |
|
|
|
Adjusted LTM EBITDA(1)
|
|
÷ |
|
$ |
150,128 |
|
|
|
|
$ |
150,128 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
= 2.39 |
|
|
× |
|
|
= 1.72 |
|
|
× |
Fixed Charge Coverage Ratio:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Fixed Charge Numerator(2)
|
|
|
|
$ |
103,336 |
|
|
|
|
$ |
103,336 |
|
|
|
Fixed Charge Denominator(3)
|
|
÷ |
|
$ |
63,097 |
|
|
|
|
$ |
60,686 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
= 1.64 |
|
|
× |
|
|
= 1.70 |
|
|
× |
|
|
(1) |
Adjusted LTM EBITDA is calculated as set forth in
our senior secured credit facility: our consolidated EBITDA for
the four fiscal quarters ended September 30, 2005, adding
back all management fees (totaling $19.8 million), and
other specifically identified exclusions. |
|
(2) |
The numerator for the fixed charge ratio is calculated as set
forth in our senior secured credit facility: Adjusted EBITDA,
less capital expenditures, for the four fiscal quarters ended
September 30, 2005. |
|
(3) |
The denominator for the fixed charge ratio is calculated as set
forth in our senior secured credit facility: the sum of our
consolidated interest expense, cash income taxes and principal
amount of all scheduled amortization payments on all
Indebtedness (as defined), including pro forma annual principal
payments on our senior secured credit facility, for the four
fiscal quarters ended September 30, 2005. |
We will not incur a prepayment penalty or any similar charges in
connection with our repayment of amounts outstanding under our
senior secured credit facility with proceeds from this offering.
Amounts repaid under the term loan will not be available for
future borrowing.
The indenture governing our senior subordinated notes contains a
number of covenants that, among other things, restrict our
ability and the ability of our subsidiaries, subject to certain
exceptions, to sell assets, incur additional debt or issue
preferred stock, repay other debt, pay dividends and
distributions or repurchase our capital stock, create liens on
assets, make investments, loans or advances, make certain
acquisitions, engage in mergers or consolidations and engage in
certain transactions with affiliates.
Quantitative and Qualitative Disclosures about Market Risk
As of September 30, 2005, we had $608.6 million of
debt, of which $353.3 million was variable rate debt under
our senior secured credit facility and the balance was fixed
rate debt, including the $250.0 million aggregate principal
amount of our senior subordinated notes. An increase or decrease
in interest rates will affect our interest costs. For
comparative purposes, for every 0.125% change in interest rates,
our interest costs on our senior secured credit facility will
change by approximately $0.44 million per year based on our
outstanding indebtedness at September 30, 2005.
Off-Balance Sheet Arrangements
We do not have any relationships with unconsolidated entities or
financial partnerships, such as entities often referred to as
structured finance or special purpose entities, established for
the purpose of facilitating off-balance sheet arrangements or
other contractually narrow or limited purposes. Accordingly, we
are not materially exposed to any financing, liquidity, market
or credit risk that could arise if we had engaged in such
relationships.
64
Tabular Disclosure of Contractual Obligations and Other
Commitments
The following tables reflect a summary of obligations and
commitments outstanding as of September 30, 2005, including
our borrowings under our senior secured credit facility and our
senior subordinated notes.
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Payments Due by Period | |
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| |
|
|
Less than | |
|
|
|
More than | |
|
|
|
|
1 Year | |
|
1-3 Years | |
|
3-5 Years | |
|
5 Years | |
|
Total | |
|
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| |
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| |
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| |
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| |
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| |
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(in thousands) | |
Contractual obligations:
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|
|
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|
|
|
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|
|
|
|
|
|
|
|
Long-term debt(1)
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|
$ |
157 |
|
|
$ |
271 |
|
|
$ |
221 |
|
|
$ |
319 |
|
|
$ |
968 |
|
Senior secured credit facility(2)
|
|
|
8,500 |
|
|
|
7,000 |
|
|
|
7,000 |
|
|
|
330,750 |
|
|
|
353,250 |
|
Capital lease obligations (principal)
|
|
|
4,389 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
4,389 |
|
Capital lease obligations (interest)
|
|
|
112 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
112 |
|
Senior subordinated notes
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
250,000 |
|
|
|
250,000 |
|
Interest on debt(3)
|
|
|
45,901 |
|
|
|
91,218 |
|
|
|
90,312 |
|
|
|
136,042 |
|
|
|
363,473 |
|
Operating lease obligations
|
|
|
24,876 |
|
|
|
33,708 |
|
|
|
14,527 |
|
|
|
11,886 |
|
|
|
84,997 |
|
Other contractual obligations(4)
|
|
|
5,793 |
|
|
|
3,982 |
|
|
|
3,363 |
|
|
|
243 |
|
|
|
13,381 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Subtotal
|
|
|
89,728 |
|
|
|
136,179 |
|
|
|
115,423 |
|
|
|
729,240 |
|
|
|
1,070,570 |
|
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|
|
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|
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|
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|
(1) |
Excludes capital lease obligations. |
|
(2) |
Excludes interest on our senior secured credit facility and
senior subordinated notes. |
|
(3) |
Interest on our floating rate debt was calculated for all years
using the effective rate as of September 30, 2005 of 5.98%. |
|
(4) |
Includes Onex management fees, dispatch fees and responder fees. |
|
|
|
|
|
|
|
|
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|
|
|
|
|
|
|
|
|
|
|
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|
Amount of Commitment Expiration Per Period | |
|
|
| |
|
|
Less than | |
|
|
|
More than | |
|
|
|
|
1 Year | |
|
1-3 Years | |
|
3-5 Years | |
|
5 Years | |
|
Total | |
|
|
| |
|
| |
|
| |
|
| |
|
| |
|
|
(in thousands) | |
Other commitments:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Guarantees of surety bonds
|
|
|
2,545 |
|
|
|
|
|
|
|
|
|
|
|
29,957 |
|
|
|
32,502 |
|
Letters of credit(1)
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
27,347 |
|
|
|
27,347 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Subtotal
|
|
|
2,545 |
|
|
|
|
|
|
|
|
|
|
|
57,304 |
|
|
|
59,849 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Total obligations and commitments
|
|
$ |
92,273 |
|
|
$ |
136,179 |
|
|
$ |
115,423 |
|
|
$ |
786,544 |
|
|
$ |
1,130,419 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
(1) |
Evergreen renewals are deemed to have expiration dates in excess
of 5 years. |
We have one capital lease relating to approximately 450
ambulances. The term of the lease extends to August 2007.
Critical Accounting Policies
The preparation of financial statements requires management to
make estimates and assumptions relating to the reporting of
results of operations, financial condition and related
disclosure of contingent assets and liabilities at the date of
the financial statements. Actual results may differ from those
estimates under different assumptions or conditions. The
following are our most critical accounting policies, which are
those that require managements most difficult, subjective
and complex judgments, requiring the need to make estimates
about the effect of matters that are inherently uncertain and
may change in subsequent periods.
Claims Liability and Professional Liability
Reserves
We are self-insured up to certain limits for costs associated
with workers compensation claims, automobile, professional
liability claims and general business liabilities. Reserves are
established for estimates of the loss that we will ultimately
incur on claims that have been reported but not paid and claims
that have
65
been incurred but not reported. These reserves are based upon
actuarial valuations that are prepared by our outside actuaries.
The actuarial valuations consider a number of factors, including
historical claim payment patterns and changes in case reserves,
the assumed rate of increase in healthcare costs and property
damage repairs. Historical experience and recent trends in the
historical experience are the most significant factors in the
determination of these reserves. We believe the use of actuarial
methods to account for these reserves provides a consistent and
effective way to measure these subjective accruals. However,
given the magnitude of the claims involved and the length of
time until the ultimate cost is known, the use of any estimation
technique in this area is inherently sensitive. Accordingly, our
recorded reserves could differ from our ultimate costs related
to these claims due to changes in our accident reporting, claims
payment and settlement practices or claims reserve practices, as
well as differences between assumed and future cost increases.
Trade and Other Accounts Receivable
Our internal billing operations have primary responsibility for
billing and collecting our accounts receivable. We utilize
various processes and procedures in our collection efforts
depending on the payor classification; these efforts include
monthly statements, written collection notices and telephonic
follow-up procedures for certain accounts. AMR writes off
amounts not collected through our internal collection efforts to
our uncompensated care allowance, and sends these receivables to
third party collection agencies for further follow-up collection
efforts. To simplify the recording of any third party collection
agency recoveries, EmCare classifies accounts sent to third
party collection agencies as delinquent and writes
them off completely against our uncompensated care allowance
when no further internal or external collection efforts will be
made. Accordingly, we record any subsequent collections through
third party collection efforts as a recovery, in the case of
AMR, and record it against our delinquent status
account, in the case of EmCare.
As we discuss further in our Revenue Recognition
policy below, we determine our allowances for contractual
discounts and uncompensated care based on sophisticated
information systems and financial models, including payor
reimbursement schedules, historical write-off experience and
other economic data. We record our patient-related accounts
receivable net of estimated allowances for contractual discounts
and uncompensated care in the period in which we perform our
services. We record gross fee-for-service revenue and related
receivables based upon established fee schedule prices. We
reduce our recorded revenue and receivables for estimated
discounts to patients covered by contractual insurance
arrangements, and reduce these further by our estimate of
uncollectible accounts. We estimate our allowances for
contractual discounts monthly utilizing our billing system
information, and we write off applicable allowances when we
receive net payments from third parties.
Our provision and allowance for uncompensated care is based
primarily on the historical collection and write-off activity of
our nearly 9 million annual patient encounters. We extract
this data from our billing systems regularly and use it to
compare our accounts receivable balances to estimated ultimate
collections. Our allowance for uncompensated care is related
principally to receivables we record for self-pay patients and
is not recorded on specific accounts due to the volume of
individual patient receivables and the thousands of commercial
and managed care contracts.
We also have other receivables related to facility and community
subsidies and contractual receivables for providing staffing to
communities for special events. We review these other
receivables periodically to determine our expected collections
and whether any allowances may be necessary. We write the
balance off after we have exhausted all collection efforts.
Revenue Recognition
A significant portion of our revenue is derived from Medicare,
Medicaid and private insurance payors that receive discounts
from our standard charges (referred to as contractual
provisions). Additionally, we are also subject to collection
risk for services provided to uninsured patients or for the
deductible or co-pay portion of services for insured patients
(referred to as uncompensated care). We record our healthcare
services revenue net of estimated provisions for the contractual
allowances and uncompensated care.
66
Healthcare reimbursement is complex and may involve lengthy
delays. Third party payors are continuing their efforts to
control expenditures for healthcare and may disallow, in whole
or in part, claims for reimbursement based on determinations
that certain amounts are not reimbursable under plan coverage,
were for services provided that were not determined medically
necessary, or insufficient supporting information was provided.
In addition, multiple payors with different requirements can be
involved with each claim.
Management utilizes sophisticated information systems and
financial models to estimate the provisions for contractual
allowances and uncompensated care. The estimate for contractual
allowances is determined on a payor-specific basis and is
predominantly based on prior collection experience, adjusted as
needed for known changes in reimbursement rates and recent
changes in payor mix and patient acuity factors. The estimate
for uncompensated care is based principally on historical
collection rates, write-off percentages and accounts receivable
agings. These estimates are analyzed continually and updated by
management by monitoring reimbursement rate trends from
governmental and private insurance payors, recent trends in
collections from self-pay patients, the ultimate cash collection
patterns from all payors, accounts receivable aging trends,
operating statistics and ratios, and the overall trends in
accounts receivable write-offs.
The evaluation of these factors, as well as the interpretation
of governmental regulations and private insurance contract
provisions, involves complex, subjective judgments. As a result
of the inherent complexity of these calculations, our actual
revenues and net income, and our accounts receivable, could vary
from the amounts reported.
Income Tax Valuation Allowance
We have significant net deferred tax assets resulting from net
operating losses, or NOLs, and interest deduction carryforwards
and other deductible temporary differences that will reduce
taxable income in future periods. Statement of Financial
Accounting Standards No. 109 Accounting for Income
Taxes requires that a valuation allowance be established
when it is more likely than not that all or a
portion of net deferred tax assets will not be realized. A
review of all available positive and negative evidence needs to
be considered, including expected reversals of significant
deductible temporary differences, a companys recent
financial performance, the market environment in which a company
operates, tax planning strategies and the length of the NOL and
interest deduction carryforward periods. Furthermore, the weight
given to the potential effect of negative and positive evidence
should be commensurate with the extent to which it can be
objectively verified. We routinely monitor the reliability of
our deferred tax assets. Changes in managements assessment
of recoverability could result in additions to the valuation
allowance, and such additions could be significant.
Contingencies
As discussed in note 10 Commitments and
Contingencies of notes to our combined financial statements,
management may not be able to make a reasonable estimate of
liabilities that result from the final resolution of certain
contingencies disclosed. Further assessments of the potential
liability will be made as additional information becomes
available. Management currently does not believe that these
matters will have a material adverse effect on our consolidated
financial position. It is possible, however, that results of
operations could be materially affected by changes in
managements assumptions relating to these matters or the
actual final resolution of these proceedings.
Intangible Assets
Definite life intangible assets are subject to impairment
reviews when evidence or triggering events suggest that an
impairment may have occurred. Should such triggering events
occur that cause us to review our definite life intangibles and
the fair value of our definite life intangible asset proves to
be less than our unamortized carrying amount, we would take a
charge to earnings for the decline. Should factors affecting the
value of our definite life intangibles change significantly,
such as declining contract retention rates or
67
reduced contractual cash flows, we may need to record an
impairment charge in amounts that are significant to our
financial statements.
Goodwill
Goodwill is not amortized and is required to be tested annually
for impairment, or more frequently if changes in circumstances,
such as an adverse change to our business environment, cause us
to believe that goodwill may be impaired. Goodwill is allocated
at the reporting unit level. If the fair value of the reporting
unit falls below the book value of the reporting unit at an
impairment assessment date, an impairment charge would be
recorded.
Should our business environment or other factors change, our
goodwill may become impaired and may result in charges to our
income statement that are material.
Restatement of Financial Statements
As described in the notes to our combined financial statements
included in this prospectus, we determined that, because of an
error in our reserving methodology, our accounts receivable
allowances were understated at various balance sheet dates prior
to and including the periods presented in those financial
statements. On August 2, 2005, we issued restated combined
financial statements for the referenced periods.
Our revised method of calculating our accounts receivable
allowances, which includes comparisons of subsequent cash
collections to net accounts receivable and subsequent write-offs
to accounts receivable allowances, demonstrated a shortfall of
accounts receivable allowances. Prior years analyses of
accounts receivable allowances did not include these comparisons
and certain elements were misapplied. In addition, we have made
other adjustments related to certain deferred rent and leasehold
amortization matters, principally to straight-line this
amortization, in accordance with generally accepted accounting
principles.
Controls over the application of accounting principles are
within the scope of internal controls. Management has concluded
that our internal controls were insufficient to provide
reasonable assurance that our accounting for accounts receivable
allowances and for deferred rent and leasehold amortization
would be in accordance with GAAP.
We corrected the deficiency in our internal controls over
financial reporting for accounts receivable allowances by
revising our method of calculating our accounts receivable
allowances. See Critical Accounting
Policies Trade and Other Accounts Receivable.
The errors relating to improper lease accounting resulted from
our incorrect interpretation of existing GAAP. To remediate this
deficiency, the individuals responsible for our financial
reporting have been made aware of the requirements of GAAP and
the SEC in this regard and we do not anticipate taking further
steps to address this matter.
See Risk Factors Risk Factors Related to Our
Business We must perform on our own services that
Laidlaw previously performed for us, and we are subject to
financial reporting and other requirements for which our
accounting and other management systems and resources may not be
adequate.
68
INDUSTRY
According to the Centers for Medicare and Medicaid Services, or
CMS, national healthcare spending increased 7.3% to $1.7
trillion in 2003, and increased 8.6% in 2002. This represents
faster growth than the overall economy, which grew 4.8% and 3.4%
during 2003 and 2002, respectively, as measured by the growth of
the gross domestic product.
Hospital care represents the largest individual segment of the
healthcare industry, accounting for an estimated 30.8% of total
healthcare spending in 2003. Hospital care expenditures
increased 5.1% to $511 billion in 2003. CMS estimates that
hospital care expenditures will increase to approximately
$934 billion by 2013, representing a compound annual growth
rate of 6.1% from 2003. The aging population and longer life
expectancy are increasing demand for healthcare services in the
United States, and hospitals are expected to be among the
principal beneficiaries.
Emergency Medical Services Industry
We operate in the ambulance and emergency department services
markets, two large and growing segments of the emergency medical
services market. By law, most communities are required to
provide emergency ambulance services and most hospitals are
required to provide emergency department services. Emergency
medical services are a core component of the range of care a
patient could potentially receive in the pre-hospital and
hospital-based settings. Accordingly, we believe that
expenditures for emergency medical services will continue to
correlate closely to growth in the U.S. hospital market.
Approximately 43% of all hospital admissions originated from the
emergency department in 2003, and a substantial portion of
patients enter the emergency department by way of ambulance
transport. We believe that the following key factors will
continue to drive growth in our emergency medical services
markets:
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Increase in outsourcing. Communities, government agencies
and healthcare facilities are under significant pressure both to
improve the quality and to reduce the cost of care. The
outsourcing of certain medical services has become a preferred
means to alleviate these pressures. |
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From 2000 to 2003, we believe outsourced emergency department
services increased from 55% to 65% of total emergency department
services. |
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From 1999 to 2003, the percentage of emergency medical
transportation services supplied by private ambulance providers
increased from 34% to 39% in the countrys largest
200 cities. |
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Favorable demographics. The growth and aging of the
population will be a significant demand driver for healthcare
services, and we believe it will result in an increase in
ambulance transports, emergency department visits and hospital
admissions. |
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The U.S. Census Bureau estimates that the number of
Americans over 65 will increase to 39 million by 2010 from
31 million in 1990. It is also expected that Americans over
the age of 65 will increase from one in eight Americans in 2000
to one in five by 2030. |
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A 2003 CDC Emergency Department Summary noted that patients aged
65 or over represent 38% of patients delivered to emergency
departments by ambulance. Emergency department visits for
persons aged 65 or over increased to 17.5 million in 2003,
a 26% increase from 1993. |
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Increased federal funding for disaster preparedness and other
federal programs. The United States government has increased
its focus on our nations ability to respond quickly and
effectively to emergencies, including both terrorist attacks and
natural disasters. Federal programs, such as Homeland Security,
FEMA and funding for services for undocumented aliens, have made
increased funding available which is aimed directly at emergency
services, including ambulance providers and emergency physician
services. |
Additional factors that may affect the emergency medical
services industry are described elsewhere in this prospectus.
See Risk Factors Risk Factors Related to
Healthcare Regulation and Business
Regulatory Matters.
69
We believe the ambulance services market represents annual
expenditures of approximately $12 billion. The ambulance
services market is highly fragmented, with more than 14,000
private, public and not-for-profit service providers accounting
for an estimated 36 million ambulance transports in 2004.
There are a limited number of regional ambulance providers and
we are one of only two national ambulance providers.
Ambulance services encompass both 911 emergency response and
non-emergency transport services, including critical care
transfers, wheelchair transports and other inter-facility
transports. Emergency response services include the dispatch of
ambulances equipped with life support equipment and staffed with
paramedics and/or emergency medical technicians, or EMTs, to
provide immediate medical care to injured or ill patients.
Non-emergency services utilize paramedics and EMTs to transport
patients between healthcare facilities or between facilities and
patient residences. Given demographic trends, we expect the
total number of ambulance transports to continue to grow at a
steady rate of 1% to 2% per year.
911 emergency response services are provided primarily under
long-term contracts with communities and government agencies. In
2003, approximately 39% of 911 ambulance services were provided
by private, for profit providers and 38% were provided by fire
departments, with the balance of 911 services being provided
principally by hospitals and city and county agencies.
Non-emergency services generally are provided pursuant to
non-exclusive contracts with healthcare facilities, managed care
and insurance companies. Usage tends to be controlled by the
facility discharge planners, nurses and physicians who are
responsible for requesting transport services. Non-emergency
services are provided primarily by private ambulance companies.
Quality of service, dependability and name recognition are
critical factors in winning non-emergency business.
Due to increased demand for effective use of technology,
cost-efficient services, improved patient outcomes and emergency
preparedness and response, we believe that the current trend by
communities and hospitals to outsource ambulance services will
contribute to growth for private providers. According to the
Journal of Emergency Medical Services, the percentage of
emergency medical transportation services delivered by private
ambulance providers in the nations 200 largest cities
increased from 34% in 1999 to 39% in 2003. Furthermore, we
expect private providers to benefit as hospitals continue to
outsource more of their ambulance services due to changes in
reimbursement rates and increased use of outpatient services.
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Emergency Department Services |
We believe the physician reimbursement component of the
emergency department services market represents annual
expenditures of approximately $10 billion. There are
approximately 4,700 hospitals in the United States that
operate emergency departments, of which approximately 67% of
these hospitals outsource their physician staffing and
management for this department. The market for outsourced
emergency department staffing and related management services is
highly fragmented, with more than 800 national, regional
and local providers. We believe we are one of only five national
providers.
Between 1993 and 2003, the total number of patient visits to
hospital emergency departments increased from 90.3 million
to 113.9 million, an increase of 26%. At the same time, the
number of hospital emergency departments declined 12%. As a
result, the average number of patient visits per hospital
emergency department increased substantially during that period.
We believe these trends are resulting in an increased focus by
hospitals on their emergency departments. As the per hospital
demand for emergency department visits continues to increase, we
believe that more hospitals will turn to well-established
providers, such as EmCare, which have a demonstrated track
record of improving productivity and efficiency while providing
high quality care.
70
BUSINESS
Company Overview
Emergency Medical Services Corporation is a leading provider of
emergency medical services in the United States. We operate our
business and market our services under the AMR and EmCare
brands. AMR is the leading provider of ambulance services in the
United States, based on net revenue and number of transports.
EmCare is the leading provider of outsourced emergency
department staffing and related management services in the
United States, based on number of contracts with hospitals and
affiliated physician groups. Approximately 86% of our fiscal
2004 net revenue was generated under exclusive contracts.
During fiscal 2004, we provided emergency medical services to
approximately 9 million patients in more than 2,000
communities nationwide. For the fiscal year ended
August 31, 2004, we generated net revenue of
$1.6 billion, of which AMR and EmCare represented 66% and
34%, respectively.
We offer a broad range of essential emergency medical services
through our two business segments:
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AMR |
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EmCare |
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Core Services: |
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Pre- and post-hospital medical transportation |
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Hospital-based medical care |
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Emergency (911) ambulance transports |
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Emergency department staffing and related management |
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Non-emergency ambulance |
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services |
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transports |
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Hospitalist services |
Customers:
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Communities |
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Hospitals |
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Government agencies |
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Independent physician groups |
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Healthcare facilities |
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Attending medical staff |
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Insurers |
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National Market Position:
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#1 provider of ambulance transports |
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#1 provider of outsourced emergency department
services |
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8% share of total ambulance market |
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6% share of emergency department services market |
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21% of private provider ambulance market |
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9% of outsourced emergency department services market |
Number of Contracts:
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At September 30, 2005
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155 911 contracts |
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333 hospital contracts |
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2,700 non-emergency transport contracts |
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Volume:
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For fiscal 2004
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3.7 million transports |
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5.3 million patient visits |
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Competitive Strengths
We believe the following competitive strengths position our
company to capitalize on the favorable trends occurring within
the healthcare industry and the emergency medical services
markets.
Leading, Established Provider of Emergency Medical
Services. We are a leading provider of emergency medical
services in the United States. AMR is the leading provider of
ambulance services, with net revenue approximately twice that of
our only national competitor. During fiscal 2004, AMR treated
and transported approximately 3.7 million patients in
34 states. AMR has made significant investments in
technology, which we believe enhances quality and reduces costs
for our customers. We believe that EmCare is the leading
provider of outsourced staffing and related management services
to emergency departments, with 32% more emergency department
staffing contracts than our principal national competitor.
EmCares 4,500 affiliated physicians provide services to
over 330 client hospitals in 39 states, including many of
the top 100 hospitals in the United States. Our client hospitals
range from high volume urban hospital emergency department to
lower volume
71
community facilities. EmCare is also one of the leading
providers of hospitalist services, based on number of hospital
contracts. We believe our track record of consistently meeting
or exceeding our customers service expectations, coupled
with our ability to leverage our infrastructure and technology
to drive increased productivity and efficiency, have contributed
to our ability to retain existing and win new contracts.
Significant Scale and Geographic Presence. We believe our
significant scale and broad geographic presence provide a
competitive advantage over local and regional providers in most
areas, including:
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Cost efficiencies and broad program offering. Our
investments in technology may be too costly for certain
providers to replicate, and provide us with several competitive
advantages, including: (i) operating cost efficiencies,
(ii) scalability and (iii) the capability to provide
broad, high quality service offerings to our customers at
competitive rates. In addition, our technology, including
electronic patient records, and our expertise in providing both
pre-hospital and hospital-based emergency care uniquely
positions us to respond to community demand for enhanced
coordination among their emergency service providers. |
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National contracting and preferred provider
relationships. We are able to enter into national and
regional contracts with managed care organizations and insurance
companies. We have an exclusive provider contract with Kaiser
Foundation Health Plan, one of the largest managed care
organizations, and we have preferred provider status with
several healthcare systems and many managed care organizations. |
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Ability to recruit and retain quality personnel. We are
able to recruit and retain clinical and support employees by
providing attractive compensation packages, comprehensive
training programs, risk mitigation strategies, career
development and greater breadth of job transferability. This
lowers our costs associated with employee turnover and increases
customer and patient satisfaction. |
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One of the keys to our success has been our ability to recruit
and retain high quality medical personnel. AMR has a competitive
advantage in recruiting quality medical personnel through our
in-house paramedic training institute, which we believe is the
largest in the United States. EmCare has developed proprietary
software that allows us to identify physicians, based on
multiple characteristics, matching the specific needs of our
customers. We provide continuing education to our affiliated
medical professionals through EMEDS, our in-house Emergency
Medical Education Systems. |
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We believe our 79% and 94% retention rates in fiscal 2004 for
full-time medical personnel at AMR and EmCare, respectively, are
among the highest in the emergency medical services segments in
which they compete. We believe that successfully recruiting and
retaining highly qualified clinicians and healthcare
professionals improves the overall experience and outcomes for
our customers and patients while significantly reducing our
operating costs. |
Long-Term Relationships with Existing Customers. We
believe our long-term, well-established relationships with
communities and healthcare facilities enhance our ability to
retain existing customers and win new contracts. AMR and EmCare
have maintained relationships with their ten largest customers
for an average of 34 and 12 years, respectively, and during
that time have continually demonstrated an ability to meet and
exceed contractual commitments. As a result, we believe we are
in an advantageous position at the time of contract renewal when
a community or hospital is faced with a decision whether to
retain its existing provider or explore other alternatives. We
believe our industry-leading contract retention rates during
fiscal 2004 reflect our ability to deliver on our service
commitments to our customers over extended time periods.
Strong Financial Performance. When we compete for new
business, one of the key factors our potential customers
evaluate is financial stability. As a result, we believe our
track record of strong financial performance provides us with a
competitive advantage over our competitors. We believe the
quality and breadth of our service offerings has allowed us to
increase our net revenue at a faster rate than the market for
emergency medical services. We believe our ability to
demonstrate consistently strong financial performance will
continue to differentiate our company and provide a competitive
advantage in winning new contracts and renewing existing
contracts.
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Focus on Risk Management. Our risk management initiatives
are enhanced by the use of our professional liability claims
database and comprehensive claims management. We analyze this
data to demonstrate claim trends on a national, hospital,
physician and procedure level, helping to manage and mitigate
risk exposure. AMRs risk/ safety program is aimed at
reducing worker injuries through training and improved
equipment, and increasing vehicle safety through the use of
technology. Over the last three years, our workers compensation,
auto, general and professional liability claims per 100,000
ambulance transports decreased 8.4% at AMR and our professional
liability claims per 100,000 emergency department visits
decreased 14.0% at EmCare.
Investment in Core Technologies. We utilize technology as
a means to enhance the quality, reduce the cost of our service
offerings, more effectively manage risk and improve our
profitability. For example:
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We believe AMR is the largest user of ambulance electronic
patient care records, or e-PCR. Our proprietary system enables
us to eliminate the use of manual patient records by replacing
them with electronic records, which we expect will reduce both
chart errors and costs. |
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AMR utilizes proprietary software, Millennium, to determine the
appropriate level of transportation services to be dispatched
and track response times and other data for hospitals. Our
initial implementation of these technologies has improved our
ability to capture revenue, decrease our billing costs and bid
more effectively for 911 contracts. |
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EmCare has developed proprietary physician recruitment software
that has enhanced our recruitment efficiency and improved our
physician retention rate. |
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At EmCare, we track risk exposure trends through what we believe
is one of the largest emergency department risk databases,
allowing us to assess, develop and implement targeted risk
intervention programs. |
Proven and Committed Management Team. We are led by an
experienced senior management team with an average of
21 years of experience in the healthcare industry. Our
Chairman and Chief Executive Officer, William Sanger, has over
30 years of experience within the healthcare services
industry, with leadership roles in multi-system hospitals,
ambulatory care facilities, post-acute service facilities,
physician management companies and insurance entities. Since
Mr. Sanger joined us in 2001, our senior management team
has been successful in growing the market share of our
businesses, managing changes in reimbursement policy, reducing
professional liability risk and improving the profitability of
our operations.
Business Strategy
We intend to leverage our competitive strengths to pursue our
business strategy:
Increase Revenue from Existing Customers. We believe our
long track record of delivering excellent service and quality
patient care, as well as the breadth of our services, creates
opportunities for us to increase revenue from our existing
customer base. We have established strategies aimed at assisting
communities and facilities to manage their cost of emergency
medical services. Some of our initiatives with existing
customers include:
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Implementing innovative productivity-enhancing programs |
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At EmCare, we have developed and implemented programs, such as
fast track and advanced triage protocols, to improve
throughput and wait times, thereby improving patient
satisfaction and reducing the number of patients who leave
without being seen. |
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At AMR, we have developed and implemented innovative programs to
improve our productivity through decreased drop and
on scene time. For example, we have recently
established transition units at several hospitals to hold and
monitor discharged patients awaiting transport, thereby
increasing our productivity while accelerating inpatient bed
availability and overall hospital throughput. |
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Continuing to broaden product and service offerings to our
customers |
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In 2002, we began marketing hospitalist services. Since that
time, our hospitalist services revenue increased at a compound
annual growth rate of 48.3% from $7.2 million to
$23.5 million in fiscal 2004. Approximately fifty percent
of our hospitalist contracts are with our emergency department
customers. |
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At certain facilities, AMR provides a dedicated on-site
non-emergency transport coordinator during times of peak demand
to increase efficiency and ensure appropriate utilization of all
medical transportation service levels. |
Grow Our Customer Base. We believe we have a unique
competency in the treatment, management and billing of episodic
and unscheduled care. We believe our long operating history,
significant scope and scale and leading market position provide
us with new and expanded opportunities to grow our customer
base. We will continue to generate new revenue and client growth
through:
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Targeted geographic sales and marketing programs, |
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Pursuing new outsourcing opportunities for emergency department,
hospitalist, radiology and ambulance services, |
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Expanding our public/private ambulance partnerships with local
fire departments, |
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Evaluating opportunities that leverage our core businesses,
including our communications center infrastructure, to manage
health-related transportation logistics. |
EmCare was awarded 52 new contracts with net revenue of
$79.0 million in 2003 and 58 new contracts with net revenue
of $79.4 million in 2004. AMR was awarded 109 new contracts
with net revenue of $17.1 million in 2003 and 60 new
contracts with net revenue of $12.2 million in 2004.
Pursue Select Acquisition Opportunities. The emergency
medical services industry is highly fragmented, with only a few
large national providers, and presents opportunities for
consolidation. We plan to pursue select acquisitions in our core
businesses, including acquisitions to enhance our presence in
existing markets and our entry into new geographic markets. We
will also explore the acquisition of complementary businesses,
such as radiology, hospitalist and managed transportation
services and seek opportunities to expand the scope of services
in which we can leverage our core competencies.
Utilize Technology to Differentiate Our Services and Improve
Operating Efficiencies. We intend to continue to invest in
technologies that broaden our services in the marketplace,
improve patient care, enhance our billing efficiencies and
increase our profitability. We believe that the complexities of
the healthcare industry and customer demand for broader, more
cost-effective service offerings will continue to benefit those
providers that remain at the forefront of technological
innovation. The following outlines certain technologies we
utilize:
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System Status Management (SSM): Enables AMR to use
current incident data to position our vehicles efficiently,
minimizing response time while maximizing asset utilization. We
currently utilize SSM in all communities in which we operate
under contracts to provide 911 emergency ambulance services. We
believe we are one of only a few ambulance services providers
that have begun to implement real-time SSM
technology. |
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Electronic patient care record (e-PCR): Where
implemented, allows AMR to capture billable revenue, decrease
our billing costs and optimize reimbursement. In addition, our
proprietary e-PCR enables us to shorten our billing cycle and
reduce risk by utilizing defined clinical and rules-based
protocols to capture patient information electronically. |
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Millennium software: Millennium, our proprietary
software, allows us greater flexibility in meeting our
customers needs. This rules-based software program
integrates medical protocol, managed care criteria and other
detailed data prescribed by our customers, enabling AMR to
efficiently dispatch appropriate transport and more effectively
track response time. |
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EmSource: EmSource, our proprietary physician recruitment
system, enables EmCare to more effectively recruit physicians
who meet the needs of our customers. The system consists of a
database of approximately 800,000 physicians that is updated
weekly to provide the most current physician contact available. |
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EmBillz: EmBillz, our proprietary coding, billing and
accounts receivable management system, enables EmCare to more
effectively process more than five million emergency department
visits each year. |
Continued Focus on Risk Management. Through our risk
management and quality assurance staffs, technology platform and
well-trained medical personnel, we will continue to conduct
aggressive risk management programs for loss prevention and
early intervention. We will continue to develop and utilize
clinical fail safes and use technology in our
ambulances to reduce vehicular incidents.
Implement Cost Rationalization Initiatives. We will
continue to rationalize our cost structure by aligning
compensation with productivity, developing risk management
initiatives that are focused on mitigating risk exposures, and
eliminating costs in our national and regional corporate support
structure. Since our acquisition of AMR and EmCare, we have
completed our preliminary analysis of certain of our support
areas, including accounting, legal, information services and
human resources, and have begun to implement initiatives to
increase productivity and achieve further economies of scale
across the company.
Company History
Effective January 31, 2005, an investor group led by Onex
Partners LP and Onex Corporation, and including members of our
management, purchased our operating subsidiaries AMR
and EmCare from Laidlaw International, Inc. Laidlaw
had acquired AMR and EmCare in 1997.
The purchase price for AMR and EmCare totaled
$828.8 million. We funded the purchase price and related
transaction costs with equity contributions of
$219.2 million, the issuance and sale of
$250.0 million principal amount of our senior subordinated
notes and borrowings under our senior secured credit facility,
including a term loan of $350.0 million and approximately
$20.2 million under our revolving credit facility. We
intend to use approximately $100.0 million of the net
proceeds from this offering to repay debt outstanding under our
senior secured credit facility.
Since completing our acquisition of AMR and EmCare, we have
operated through a holding company, EMS L.P., that is a limited
partnership. As described in Formation of Holding
Company, our new holding company will be a Delaware
corporation upon completion of this offering.
Business Segments
We operate our business and market our services under our two
business segments: AMR and EmCare. We provide ambulance
transport services in 34 states and the District of
Columbia and provide services to emergency department and
hospitalist programs in 39 states.
We believe that our operational structure enhances service
delivery and maintains favorable executive contact with key
contract decision-makers and community leaders. Each region
provides operational support and management of our local
business operating sites and facilities. Our regional management
is responsible for growing the business in the region,
overseeing key community and facility relationships, managing
labor and employee relations and providing regional support
activities to our operating sites.
We provide strategic planning, centralized financial support,
payroll administration, legal services, human resources,
coordinated marketing and purchasing efforts and risk management
through our National Resource Center. We also support our
operating sites with integrated information systems and
standardized procedures that enable us to efficiently manage the
billing and collections processes.
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The following is a detailed business description for our two
business segments.
American Medical
Response
American Medical Response, Inc., or AMR, is the leading provider
of ambulance services in the United States. AMR and our
predecessor companies have a long history in emergency medical
services, having provided services to some communities for more
than 50 years. We have an 8% share of the total ambulance
services market and a 21% share of the private provider
ambulance market. During fiscal 2004, AMR treated and
transported approximately 3.7 million patients in
34 states utilizing more than 4,200 vehicles that operated
out of more than 200 sites. AMR has approximately 2,855
contracts with communities, government agencies, healthcare
providers and insurers to provide ambulance transport services.
AMRs broad geographic footprint enables us to contract on
a national and regional basis with managed care and insurance
companies. AMR has made significant investments in technology,
customer service programs, employee training and risk mitigation
programs to deliver a compelling value proposition to our
customers, which has led to what we believe is our
industry-leading contract retention rate of 99% in fiscal year
2004 and significant new contract wins.
For fiscal 2004, approximately 57% of AMRs net revenue was
generated from emergency 911 ambulance services, which include
treating and stabilizing patients, transporting the patient to a
hospital or other healthcare facility and providing attendant
medical care en-route. Non-emergency ambulance services,
including critical care transfer, wheelchair transports and
other interfacility transports, accounted for 32% of AMRs
net revenue for the same period, with the balance generated from
the provision of training, dispatch centers and other services
to communities and public safety agencies. For the fiscal year
ended August 31, 2004, AMR generated net revenue of
$1.1 billion.
We have been instrumental in the development of protocols and
policies applicable to the emergency services industry. We
believe our key business competencies in communications and
logistics management and our partnerships with local fire
departments, which represented approximately 21% of AMRs
net revenue in fiscal 2004, enable us to operate profitably in
both large and small communities and position us to continue our
growth organically.
We provide substantially all of our ambulance services under our
AMR brand name. We operate under other names when required to do
so by local statute or contractual agreement.
Services
We provide a full range of emergency and non-emergency ambulance
transport and related services, which include:
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Emergency Response Services (911). We provide emergency
response services primarily under long-term exclusive contracts
with communities and hospitals. Our contracts typically
stipulate that we must respond to 911 calls in the designated
area within a specified response time. We utilize two types of
ambulance units Advanced Life Support, or ALS, units
and Basic Life Support, or BLS, units. ALS units, which are
staffed by two paramedics or one paramedic and an emergency
medical technician, or EMT, are equipped with high-acuity life
support equipment such as cardiac monitors, defibrillators and
oxygen delivery systems, and carry pharmaceutical and medical
supplies. BLS units are usually staffed by two EMTs and are
outfitted with medical supplies and equipment necessary to
administer first aid and basic medical treatment. The decision
to dispatch an ALS or BLS unit is determined by our contractual
requirements, as well as by the nature of the medical situation. |
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Under certain of our 911 emergency response contracts, we are
the first responder to an emergency scene. However, under most
of our 911 contracts, the local fire department is the first
responder. In these situations, the fire department typically
begins stabilization of the patient. Upon our arrival, we
continue stabilization through the provision of attendant
medical care and transport the patient to the closest
appropriate healthcare facility. In certain communities where
the fire department historically has been responsible for both
first response and emergency services, we seek to develop
public/private |
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partnerships with fire departments rather than compete with them
to provide the emergency service. These partnerships emphasize
collaboration with the fire departments and afford us the
opportunity to provide 911 emergency services in communities
that, for a variety of reasons, may not otherwise have
outsourced this service to a private provider. In most
instances, the provision of emergency services under our
partnerships closely resembles that of our most common 911
contracts described above. What differentiates the
public/private partnerships is the level of contractually
negotiated collaboration and coordination between AMR and the
fire department. As an example, in several of our public/private
partnerships, we utilize a fire department-employed paramedic
when we transport the patient and subsequently reimburse the
fire department for its employees time. These partnerships
benefit both parties they create a new revenue
source for the fire department while relieving it of the
complexities associated with the emergency transport business,
and they enable us to provide emergency response services in
communities that may not otherwise have outsourced this service.
In addition, the public/private partnerships lower our costs by
reducing the number of full-time paramedics we would otherwise
require. We estimate that these public/private partnerships
represented approximately 20% of AMRs net revenue in
fiscal 2004. |
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Non-Emergency Transport Services. With non-emergency
services, we provide transportation to patients requiring
ambulance or wheelchair transport with varying degrees of
medical care needs between healthcare facilities or between
healthcare facilities and their homes. Unlike emergency response
services, which typically are provided by communities or private
providers under exclusive or semi-exclusive contracts,
non-emergency transportation usually involves multiple contract
providers at a given facility, with one or more of the
competitors designated as the preferred provider.
Non-emergency transport business generally is awarded by a
healthcare facility, such as a hospital or nursing home, or a
healthcare payor, such as an HMO, managed care organization or
insurance company. |
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Non-emergency transport services include: (i) critical care
transport, (ii) wheelchair and stretcher-car transports,
and (iii) other inter-facility transports. |
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Critical care transports are provided to medically unstable
patients (such as cardiac patients and neonatal patients) who
require critical care while being transported between healthcare
facilities. Critical care services differ from ALS services in
that the ambulance may be equipped with additional medical
equipment and may be staffed by one of our medical specialists
or by an employee of a healthcare facility to attend to a
patients specific medical needs. |
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Wheelchair and stretcher-car transports are non-medical
transportation provided to handicapped and certain
non-ambulatory persons in some service areas. In providing this
service, we use vans that contain hydraulic wheelchair lifts or
ramps operated by drivers who generally are trained in
cardiopulmonary resuscitation, or CPR. |
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Other inter-facility transports, that require advanced or basic
levels of medical supervision during transfer, may be provided
when a home-bound patient requires examination or treatment at a
healthcare facility or when a hospital inpatient requires tests
or treatments (such as magnetic resonance imaging, or MRI,
testing, CAT scans, dialysis or chemotherapy treatment)
available at another facility. We use ALS or BLS ambulance units
to provide general ambulance services depending on the
patients needs. |
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Other Services. In addition to our 911 emergency and
non-emergency ambulance services, we provide the following
services: |
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Dispatch Services. Our dispatch centers manage our own
calls and, in certain communities, also manage dispatch centers
for public safety agencies, such as police and fire departments,
aeromedical transport programs and others. |
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Event Medical Services. We provide medical stand-by
support for concerts, athletic events, parades, conventions,
international conferences and VIP appearances in conjunction
with local and federal law enforcement and fire protection
agencies. We have contracts to provide stand-by support for
numerous sports franchises, such as the Oakland Raiders, Oakland
Athletics, Detroit |
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Lions and Los Angeles Dodgers, as well as for various NASCAR
events, Hollywood production studios and other specialty events. |
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Managed Transportation Services. Managed care
organizations and insurance companies contract with us to manage
various of their medical transportation-related needs, including
call-taking and scheduling, management of a network of
transportation providers and billing and reporting through our
e-PCR system. |
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Paramedic Training. We own and operate Northern
California Training Institute, or NCTI, the largest paramedic
training school in the United States and the only accredited
institution of its size, with over 500 graduates each year. |
Medical Personnel and Quality Assurance
Approximately 76% of our 18,500 employees have daily contact
with patients, including approximately 5,300 paramedics, 7,700
EMTs and 300 nurses. Paramedics and EMTs must be state-certified
to transport patients and perform emergency care services.
Certification as an EMT requires completion of a minimum of
140 hours of training in a program designated by the United
States Department of Transportation, such as those offered at
our training institute, NCTI. Once this program is completed,
state-certified EMTs are then eligible to participate in a
state-certified paramedic training program. The average
paramedic program involves over 1,000 hours of academic
training in advanced life support and assessment skills.
Local physician advisory boards develop medical protocols to be
followed by paramedics and EMTs in a service area. In addition,
instructions are conveyed on a case-by-case basis through direct
communications between the ambulance crew and hospital emergency
room physicians during the administration of advanced life
support procedures. Both paramedics and EMTs must complete
continuing education programs and, in some cases, state
supervised refresher training examinations to maintain their
certifications.
We maintain a commitment to provide high quality pre- and
post-hospital emergency medical care. In each location in which
we provide services, a medical director, who usually is a
physician associated with a hospital we serve, monitors
adherence to medical protocol and conducts periodic audits of
the care provided. In addition, we hold retrospective care
audits with our employees to evaluate compliance with medical
and performance standards.
Our commitment to quality is reflected in the fact that 15 of
our dispatch centers across the country are accredited by the
Commission on Accreditation of Ambulance Services, or CAAS,
representing 16% of the total CAAS accredited agencies. CAAS is
a joint program between the American Ambulance Association and
the American College of Emergency Physicians. The accreditation
process is voluntary and evaluates numerous qualitative factors
in the delivery of services. We believe communities and managed
care providers increasingly will consider accreditation as one
of the criteria in awarding contracts.
Billing and Collections
Our internal patient billing services, or PBS, offices located
across the United States invoice and collect for our services.
We receive payment from the following sources:
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the federal and state governments, primarily under the Medicare
and Medicaid programs, |
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health maintenance organizations, preferred provider
organizations and private insurers, |
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individual patients, and |
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community subsidies and fees. |
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Over the last three fiscal years, our self-pay revenue has
remained stable as a percentage of AMRs net revenue. The
table below presents the approximate percentages of AMRs
net revenue from the following sources:
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Percentage of AMR | |
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Net Revenue | |
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Year Ended | |
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August 31, | |
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2002 | |
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2003 | |
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2004 | |
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Medicare
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35 |
% |
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33 |
% |
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33 |
% |
Medicaid
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6 |
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6 |
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6 |
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Commercial insurance/managed care
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41 |
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44 |
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45 |
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Self-pay
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6 |
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6 |
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5 |
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Subsidies/fees
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12 |
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11 |
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11 |
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Total net revenue
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100 |
% |
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100 |
% |
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100 |
% |
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We have substantial experience in processing claims to third
party payors and employ a billing staff trained in third party
coverage and reimbursement procedures. Our integrated billing
and collection systems allow us to tailor the submission of
claims to Medicare, Medicaid and certain other third party
payors and has the capability to electronically submit claims to
the extent third party payors systems permit. This system
also provides for tracking of accounts receivable and status
pending payment. When collecting from individuals, we sometimes
use an automated dialer that pre-selects and dials accounts
based on their status within the billing and collection cycle,
which we believe improved our collection rate.
Companies in the ambulance services industry maintain
significant provisions for doubtful accounts compared to
companies in other industries. Collection of complete and
accurate patient billing information during an emergency service
call is sometimes difficult, and incomplete information hinders
post-service collection efforts. In addition, we cannot evaluate
the creditworthiness of patients requiring emergency transport
services. Our allowance for doubtful accounts generally is
higher for transports resulting from emergency ambulance calls
than for non-emergency ambulance requests. See Risk
Factors Risk Factors Related to Healthcare
Regulation Changes in the rates or methods of third
party reimbursements may adversely affect our revenue and
operations.
State licensing requirements, as well as contracts with
communities and healthcare facilities, typically require us to
provide ambulance services without regard to a patients
insurance coverage or ability to pay. As a result, we often
receive partial or no compensation for services provided to
patients who are not covered by Medicare, Medicaid or private
insurance. The anticipated level of uncompensated care and
uncollectible accounts is considered in negotiating a
government-paid subsidy to provide for uncompensated care, and
permitted rates under contracts with a community or government
agency.
A significant portion of our ambulance transport revenue is
derived from Medicare payments. The Balanced Budget Act of 1997,
or BBA, modified Medicare reimbursement rates for emergency
transportation with the introduction of a national fee schedule.
The BBA provided for a phase-in of the national fee schedule by
blending the new national fee schedule rates with ambulance
service suppliers pre-existing reasonable
charge reimbursement rates. The BBA provided for this
phase-in period to begin on April 1, 2002, with full
transition to the national fee schedule rates to be effective
January 1, 2006. In some regions, the national fee schedule
would have resulted in a decrease in Medicare reimbursement
rates of approximately 25% by the end of the phase-in period.
Partially in response to the dramatic decrease in rates dictated
by the BBA in some regions, the Medicare Modernization Act
established regional rates, certain of which are higher than the
BBAs national rates, and provided for the blending of the
regional and national rates until January 1, 2010. Other
rate provisions included in the Medicare Modernization Act
provide further temporary mitigation of the impact of the BBA
decreases, including a provision that provides for 1% to 2%
increases for blended rates for the period from January 1,
2004 through December 31, 2006. Because the Medicare
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Modernization Act relief is of limited duration, we will
continue to pursue strategies to offset the decreases mandated
by the BBA, including seeking fee and subsidy increases.
We estimate that the impact of the BBA rate decreases, as
modified by the provisions of the Medicare Modernization Act,
resulted in a decrease in AMRs net revenue for fiscal 2003
and fiscal 2004 of approximately $20 million and
$11 million, respectively. We have been able to
substantially mitigate the phase-in reductions of the BBA
through additional fee and subsidy increases. As a 911 emergency
response provider, we are uniquely positioned to offset changes
in reimbursement by requesting increases in the rates we are
permitted to charge for 911 services from the communities we
serve. In response, these communities often permit us to
increase rates for ambulance services from patients and their
third party payors in order to ensure the maintenance of
required community-wide 911 emergency response services. While
these rate increases do not result in higher payments from
Medicare and certain other public or private payors, overall
they increase our revenue.
See Regulatory Matters Medicare, Medicaid and
Other Government Program Reimbursement for additional
information on reimbursement from Medicare, Medicaid and other
government-sponsored programs.
Contracts
As of September 30, 2005, we had approximately 155
contracts with communities and government agencies to provide
911 emergency response services. Contracts with communities to
provide emergency transport services are typically exclusive,
three to five years in length and generally are obtained through
a competitive bidding process. In some instances where we are
the existing provider, communities elect to renegotiate existing
contracts rather than initiate new bidding processes. Our 911
contracts often contain options for earned extensions or
evergreen provisions. We have improved our contract retention
rate to 99% for fiscal 2004 compared to 81% in fiscal 2001. In
fiscal 2004, our top ten 911 contracts accounted for
approximately $243.3 million, or 23.1% of AMRs net
revenue. We have served these ten customers on a continual basis
for an average of 34 years.
Our 911 emergency response contracts typically specify maximum
fees we may charge and set forth minimum requirements, such as
response times, staffing levels, types of vehicles and
equipment, quality assurance and insurance coverage. Communities
and government agencies may also require us to provide a
performance bond or other assurances of financial
responsibility. The rates we are permitted to charge for
services under a contract for emergency ambulance services and
the amount of the subsidy, if any, we receive from a community
or government agency depend in large part on the nature of the
services we provide, payor mix and performance requirements.
We have approximately 2,700 contracts to provide non-emergency
ambulance services with hospitals, nursing homes and other
healthcare facilities that require a stable and reliable source
of medical transportation for their patients. These contracts
typically designate us as the preferred ambulance service
provider of non-emergency ambulance services to those facilities
and permit us to charge a base fee, mileage reimbursement, and
additional fees for the use of particular medical equipment and
supplies. We also provide a significant portion of our
non-emergency transports to facilities and organizations in
competitive markets without specific contracts.
Non-emergency transports often are provided to managed care or
insurance plan members who are stabilized at the closest
available hospital and are then moved to facilities within their
health plans network. We believe the increased prevalence
of managed care benefits larger ambulance service providers,
which can service a higher percentage of a managed care
providers members. This allows the managed care provider
to reduce its number of vendors, thus reducing administrative
costs and allowing it to negotiate more favorable rates with
healthcare facilities. Our scale and broad geographic footprint
enable us to contract on a national and regional basis with
managed care and insurance companies. We have multi-year
contracts with large healthcare networks and insurers including
Kaiser, Aetna, Healthnet, Cigna and SummaCare. None of these
customers represent revenue that amounts to 10% of our fiscal
2004 total net revenue.
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We believe that communities, government agencies, healthcare
facilities, managed care companies and insurers consider the
quality of care, historical response time performance and total
cost to be among the most important factors in awarding and
renewing contracts.
Dispatch and Communications
Dispatch centers control the deployment and dispatch of
ambulances in response to calls through the use of sophisticated
communications equipment 24 hours a day, seven days a week.
In many operating sites, we communicate with our vehicles over
dedicated radio frequencies licensed by the Federal
Communications Commission. In certain service areas with a large
volume of calls, we analyze data on traffic patterns,
demographics, usage frequency and similar factors with the aid
of System Status Management, or SSM technology, to help
determine optimal ambulance deployment and selection. In
addition to dispatching our own ambulances, we also provide and
staff 52 dispatch centers for communities where we are not an
ambulance service provider. Our dispatch centers are staffed by
EMTs and other experienced personnel who use local medical
protocols to analyze and triage a medical situation and
determine the best mode of transport.
Emergency Transport. Depending on the emergency medical
dispatch system used in a designated service area, the public
authority that receives 911 emergency medical calls either
dispatches our ambulances directly from the public control
center or communicates information regarding the location and
type of medical emergency to our control center which, in turn,
dispatches ambulances to the scene. While the ambulance is
en-route to the scene, the ambulance receives information
concerning the patients condition prior to the
ambulances arrival at the scene. Our communication systems
allow the ambulance crew to communicate directly with the
destination hospital to alert hospital medical personnel of the
arrival of the patient and the patients condition and to
receive instructions directly from emergency room personnel on
specific pre-hospital medical treatment. These systems also
facilitate close and direct coordination with other emergency
service providers, such as the appropriate police and fire
departments, that also may be responding to a call.
Non-Emergency Transport. Requests for non-emergency
transports typically are made by physicians, nurses, case
managers and hospital discharge coordinators who are interested
primarily in prompt ambulance arrival at the requested pick-up
time. We are also offering on-line, web-enabled transportation
ordering to certain facilities. We use our Millennium software
to track and manage requests for transportation services for
large healthcare facilities and managed care companies.
Management Information Systems
We support our regions with integrated information systems and
standardized procedures that enable us to efficiently manage the
billing and collections processes and financial support
functions. Our recently developed technology solutions provide
information for operations personnel, including real-time
operating statistics, tracking of strategic plan initiatives,
electronic purchasing and inventory management solutions.
We have three management information systems that we believe
have significantly enhanced our operations our e-PCR
technology, our Millennium call-taking system and our SSM
ambulance positioning system.
e-PCR. In those operating sites where we have implemented
it, our e-PCR technology, has enhanced the process of capturing
clinical patient data. The electronic record replaces the paper
patient care record and provides the paramedic with clinical
flowcharts to document each assessment and procedure performed.
The technology also integrates patient clinical and demographic
information with billing information, allowing the ambulance
crew to ensure that patient information is updated at the scene.
Billing information can be transmitted electronically while the
ambulance is en-route, thus reducing the billing cycle time and
the cost associated with the manual input of patient care record
information. Our initial implementation of this technology has
improved our ability to capture billable revenue and decrease
our billing costs. We currently employ e-PCR technology on
ruggedized laptops in eight of our operating sites and we plan
to implement it in three additional operating sites through
2006. This technology currently is available in operating sites
that
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accounted for approximately 10% of AMRs fiscal 2005
ambulance transports and approximately 13% of AMRs fiscal
2005 net transport revenue. Together with the operating sites to
be added in 2006, the e-PCR technology would have accounted for
12% of AMRs fiscal 2005 ambulance transports and 15% of
its fiscal 2005 net transport revenue. Our per unit e-PCR
capital costs continue to decline as hardware costs decline.
Millennium. Our proprietary Millennium system is a
call-taking application that tracks and manages requests for
transportation services for large healthcare facilities and
managed care companies. The system is designed to make certain
medical necessity and benefit level determinations prior to
transport. These determinations can be customized to fit an
individual customers needs. Customers call a single
toll-free telephone number and are routed to the appropriate AMR
call center. The telephone system is integrated into the
Millennium application, which gives the answering agent specific
call information, including customized greetings, patient
information and priority of the call. The system logic verifies
whether the transport is authorized by the health plan. If the
transport is determined to be appropriate, the system then
assigns a response time and level of service based on the
information obtained from the requestor. In fiscal 2004, we
utilized Millennium for approximately 217,000 transactions
resulting in 210,000 transports in the year. We have initiated a
campaign to promote the benefits of this system to other
potential customers.
SSM. Our SSM technology enables us to use historical data
on fleet usage patterns to predict where our emergency transport
services are likely to be required. SSM also creates a visual
display of current demand, allowing us to position our ambulance
units more effectively. This flexible deployment allows us to
improve response times and increase asset utilization.
Additionally, we have recently begun to implement
real-time SSM. This state-of-the-art SSM technology
will allow us to continuously position our ambulances in
optimized locations, thereby further improving response times
and maximizing asset utilization. We believe our ability to
continue deploying real-time SSM will further differentiate us
from our competitors in terms of both service quality and cost.
Sales and Marketing
Our 100-person sales and marketing team is comprised of two
distinct groups one focused primarily on contract
retention and the other on generating new sales. Many of our
sales and marketing employees are former paramedics or EMTs who
began their careers in the emergency transportation industry and
are therefore well-qualified to understand the needs of our
customers. Our sales force is incentivized through a
compensation package that includes base salary and significant
bonus potential based on achieving specified performance targets.
We continue to seek expansion in both the geographic markets we
serve and the scope of services we provide in existing markets.
Ownership of the local emergency response contract can be
advantageous to us when bidding for non-emergency business,
because our existing fleet of ambulances and dispatch centers
maintained for emergency response can also be used for
non-emergency business. For the same reason, our ownership of a
successful non-emergency business can be advantageous to us when
trying to unseat an incumbent emergency response operator or to
obtain a contract in a newly privatized market.
Risk Management
We are committed to the safety of our employees and the patients
and communities we serve. Our commitment is manifested in our
World Class Safety Program, which has gained distinction
with the National Safety Council and has served as a benchmark
for other companies. This program consists of two important
goals:
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To be the leader for safety in the emergency medical services
industry, and |
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To be recognized as a leader for safety among all industries. |
Our World Class Safety Program is built upon five important
components:
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Selecting highly qualified employees, |
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Providing exemplary safety policies and programs to control
losses, |
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Effective training and education programs, |
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Accountability of management and employees for safety of the
operation, and |
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Continuous review of new opportunities and existing programs for
improvement. |
We train and educate all new employees about our safety programs
including, among others, emergency vehicle operations, various
medical protocols, use of equipment and patient focused care and
advocacy. Our safety training also involves continuing education
programs and a monthly safety awareness campaign. We also work
directly with manufacturers to design equipment modifications
that enhance both patient and clinician safety.
Our safety and risk management team develops and executes
strategic planning initiatives focused on mitigating the factors
that drive losses in our operations. We aggressively investigate
and respond to all incidents we believe may result in a claim.
Operations supervisors submit documentation of such incidents to
the third party administrator handling the claim. We have a
dedicated liability unit with our third party administrator
which actively engages with our staff to gain valuable
information for closure of claims. Information from the claims
database is an important resource for identifying trends and
developing future safety initiatives.
We utilize an on-board monitoring system, RoadSafety, which
measures operator performance against our safe driving
standards. Our operations using RoadSafety have experienced
improved driving behaviors within 90 days of installation.
RoadSafety has been implemented in 49% of our vehicles in the
emergency response markets and is being expanded to 58% of our
emergency fleet in fiscal 2006. We expect to recover the average
cost per vehicle over a period of approximately 24 months
from installation due to reduced vehicle maintenance and repair
expenses.
We estimate that, in fiscal 2004, our costs for vehicle
collisions were 19% lower than in fiscal 2000 and our average
cost per vehicle claim was 37% lower than in fiscal 2000. Over
the same period, we estimate that we reduced patient care
incidents and employee injuries by 8% and 25%, respectively.
Competition
Our predominant competitors are fire departments, with 35% of
the ambulance transport services market. Firefighters have
traditionally acted as the first responders during emergencies,
and in many communities provide emergency medical care and
transport as well. In many communities we have established
public/private partnerships, in which we integrate our transport
services with the first responder services of the local fire
department. We believe these public/private partnerships provide
a model for us to collaborate, rather than compete, with fire
departments to increase the number of communities we serve.
Competition in the ambulance transport market is based primarily
on:
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pricing, |
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the ability to improve customer service, such as on-time
performance and efficient call intake, |
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the ability to recruit, train and motivate employees,
particularly ambulance crews who have direct contact with
patients and healthcare personnel, and |
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billing and reimbursement expertise. |
Our largest competitor, Rural/ Metro Corporation, is the only
other national provider of ambulance transport services and
generates less than half of AMRs net revenue. Our other
private provider competitors include Southwest Ambulance in
Arizona and New Mexico, Acadian Ambulance Service in Louisiana
and small, locally owned operators that principally serve the
inter-facility transport market.
Insurance
Workers Compensation, Auto and General Liability. For
periods prior to September 1, 2001, we are fully-insured
for our workers compensation, auto and general liability
programs through Laidlaws captive
83
insurance program. We have retained liability for the first
$1 million to $2 million of the loss under these
programs since September 1, 2001. Our self-insurance
program, fronted by ACE American Insurance Co. in fiscal 2002
and 2003 and funded through Laidlaws captive insurance
program in fiscal 2004 and 2005 to the date of our acquisition
of AMR and EmCare, covers the first $2 million of auto and
general liability claims per occurrence and the first
$1 million of workers compensation claims per occurrence.
From the date of the acquisition, our self-insurance program has
been fronted by ACE. Generally, our umbrella policies covering
claims that exceed our deductible levels have an annual cap of
approximately $100 million.
Professional Liability. For periods prior to
April 15, 2001, we are insured for our professional
liability claims through third party insurers. Since
April 15, 2001, we have a self-insured retention for our
professional liability coverage. The self-insured retention
covers the first $2 million for policy year ending
April 15, 2002, the first $5 million for policy years
ending April 15, 2003 and 2004 and the first
$5.5 million for the policy years ending April 15,
2005 and 2006. In addition, we have umbrella policies with third
party insurers covering claims exceeding these retention levels
with an aggregate cap of $10 million for each separate
policy period.
Property
Vehicle Fleet. We operate approximately 4,200 vehicles.
Of these, approximately 3,100 are ambulances, 600 are wheelchair
vans and 500 are support vehicles. We own approximately 89% of
our vehicles and lease the balance. We replace ambulances based
upon age and usage, but generally every eight to ten years. The
average age of our existing ambulance fleet is approximately
five years. We primarily use in-house maintenance services to
maintain our fleet. In those operations where our fleet is small
and quality external maintenance services that agree to maintain
our fleet in accordance with AMR standards are available, we
utilize these maintenance services. We are exploring ways to
decrease our overall capital expenditures for vehicles,
including major refurbishing and overhaul of our vehicles to
extend their useful life.
Facilities. We lease approximately 55,000 square
feet in an office building at 6200 S. Syracuse Way,
Greenwood Village, Colorado for the AMR and Emergency Medical
Services corporate headquarters. We also lease administrative
facilities and other facilities used principally for ambulance
basing, garaging and maintenance in those areas in which we
provide ambulance services. We own 14 facilities used
principally for administrative services and stationing for our
ambulances. We believe our present facilities are sufficient to
meet our current and projected needs, and that suitable space is
readily available should our need for space increase. Our leases
expire at various dates through 2014.
Environmental Matters
We are subject to federal, state and local laws and regulations
relating to the presence of hazardous materials and pollution
and the protection of the environment, including those governing
emissions to air, discharges to water, storage, treatment and
disposal of wastes, including medical waste, remediation of
contaminated sites, and protection of worker health and safety.
We believe our current operations are in substantial compliance
with all applicable environmental requirements and that we
maintain all material permits required to operate our business.
Certain environmental laws impose strict, and under certain
circumstances joint and several, liability for investigation and
remediation of the release of regulated substances into the
environment. Such liability can be imposed on current or former
owners or operators of contaminated sites, or on persons who
dispose or arrange for disposal of wastes at a contaminated
site. Releases have occurred at a few of the facilities we lease
as a result of historical practices of the owners or former
operators. Based on available information, we do not believe
that any known compliance obligations, releases or
investigations under environmental laws or regulations will have
a material adverse effect on our business, financial position
and results of operations. However, there can be no guarantee
that these releases or newly discovered information, more
stringent enforcement of or changes in environmental
requirements, or our inability to enforce available
indemnification agreements will not result in significant costs.
84
Employees
At September 30, 2005, we had approximately
18,500 employees, including approximately 5,300 paramedics,
7,700 EMTs, 300 nurses and 5,200 support
personnel. Approximately 50% of our employees are represented by
42 collective bargaining agreements with 43 different
union locals. Fourteen of these collective bargaining
agreements, representing approximately 4,100 employees, are
subject to renegotiation in 2006. We believe we have a good
relationship with our employees. We have reduced our employee
turnover to 19.9% in fiscal 2004, a 44.3% reduction since fiscal
2002. We have never experienced any union-related work stoppages.
Legal Matters
We are subject to litigation arising in the ordinary course of
our business, including litigation principally relating to
professional liability, auto accident and workers compensation
claims. There can be no assurance that our insurance coverage
will be adequate to cover all liabilities occurring out of such
claims. In the opinion of management, we are not engaged in any
legal proceedings that we expect will have a material adverse
effect on our business, financial condition, cash flows or
results of our operations other than as set forth below.
From time to time, in the ordinary course of business and like
others in the industry, we receive requests for information from
government agencies in connection with their regulatory or
investigational authority. Such requests can include subpoenas
or demand letters for documents to assist the government in
audits or investigations. We review such requests and notices
and take appropriate action. We have been subject to certain
requests for information and investigations in the past and
could be subject to such requests for information and
investigations in the future.
We are subject to the Medicare and Medicaid fraud and abuse
laws, which prohibit, among other things, any false claims, or
any bribe, kick-back, rebate or other remuneration, in cash or
in kind, in return for the referral of Medicare and Medicaid
patients. Violation of these prohibitions may result in civil
and criminal penalties and exclusion from participation in the
Medicare and Medicaid programs. We have implemented policies and
procedures that management believes will assure that we are in
substantial compliance with these laws, but we cannot assure you
that the government or a court will not find that some of our
business practices violate these laws.
On May 9, 2002, we received a subpoena from the Office of
Inspector General for the United States Department of Health and
Human Services, or OIG. The subpoena requested copies of
documents for the period from January 1993 through May 2002. The
subpoena required us to produce a broad range of documents
relating to contracts entered into by our affiliate, Regional
Emergency Services, or RES, in Texas, Georgia and Colorado. The
Department of Justice added inquiries involving contracts in
Texas to its other claims against RES and a hospital system
arising from a contract between RES and the hospital system in
Florida. These claims, including both Texas and Florida, were
settled by RES and the hospital system for approximately
$20.0 million, of which we were responsible for, and have
paid, $5.0 million. The government investigations in
Georgia and Colorado have not been resolved.
During the first quarter of fiscal 2004, we were advised by the
U.S. Department of Justice that it was investigating
certain business practices at AMR. The specific practices at
issue were (1) whether ambulance transports involving
Medicare eligible patients complied with the medical
necessity requirement imposed by Medicare regulations,
(2) whether patient signatures, when required, were
properly obtained from Medicare eligible patients, and
(3) whether discounts in violation of the federal
Anti-Kickback Statute were provided by AMR to hospitals and
nursing homes in exchange for referrals involving Medicare
eligible patients. This investigation has not yet been resolved.
In connection with the third issue, the government has alleged
that certain of our hospital and nursing home contracts in
effect in Texas, primarily certain contracts in effect in
periods prior to 1999, and possibly through 2001, contained
discounts in violation of the federal Anti-Kickback Statute. The
government recently has provided us with an analysis of the
investigation conducted in connection with this contract issue,
and invited us to respond. We are currently in discussions with
the government regarding these Texas allegations. The government
has proposed that we make a substantial payment to settle the
Texas matter, and has indicated that, in the absence of a
settlement, it will pursue further civil action in this matter.
The government may also be
85
investigating whether our contracts with health facilities in
Oregon and other jurisdictions violate the Anti-Kickback
Statute. Under the provisions of our purchase agreement for the
acquisition of AMR, we and Laidlaw International, Inc. share
responsibility for damages arising with respect to these
matters; we are responsible for 50% of the first
$10 million of damages and 10% of any damages in excess of
$10 million and up to and including $50 million. Based
upon our discussions with the government and our own analysis,
we believe we have adequately accrued for potential losses.
However, there can be no assurances as to the final resolution
of these investigations and any resulting proceedings.
On July 12, 2005, we received a letter and draft Audit
Report from the OIG requesting our response to its draft
findings that our Massachusetts subsidiary received
$1.9 million in overpayments from Medicare for services
performed between July 1, 2002 and December 31, 2002.
The draft findings state that some of these services did not
meet Medicare medical necessity and reimbursement requirements.
We disagree with the OIGs finding and are in the process
of responding to the draft Audit Report. If we are unsuccessful
in challenging the OIGs draft findings, and in any
administrative appeals to which we may be entitled following the
release of a final Audit Report, we may be required to make a
substantial repayment.
AMR and the City of Stockton, California are parties to
litigation regarding the terms and enforceability of a
memorandum of understanding and a related joint venture
agreement between the parties to present a joint bid in response
to a request for proposals to provide emergency ambulance
services in the County of San Joaquin, California. We were
unable to agree on the final terms of a joint bid. We are
seeking a judicial determination that these documents are
unenforceable and void, and Stockton has alleged breach of
contract. We have been awarded the San Joaquin contract. While
we are unable at this time to estimate the amount of potential
damages, we believe that Stockton may claim as damages a portion
of our profit on the contract or the profit Stockton might have
realized had the joint venture proceeded.
On December 14, 2005, a lawsuit, purporting to be a class
action, was commenced against AMR in Spokane, Washington. The
complaint alleges that the two identified plaintiffs were billed
for advanced life support services rather than basic life
support in violation of AMRs contract with the city of
Spokane, resulting in total overcharges for three transports of
$395. The complaint further alleges a potential group of over
30,000 patients transported since 1998, with possible
individual claims of $150 to $250, and seeks treble damages
under the state consumer protection act. AMR has not had
sufficient time to analyze the allegations in the complaint.
However, AMR recently reviewed its billing practices at the
request of the Spokane Fire Department, and is conducting a
further audit. Although there can be no assurances as to the
final outcome, at this time AMR does not believe that any
incorrect billings are material in amount.
EmCare
EmCare is the largest provider of outsourced emergency
department staffing and related management services to
healthcare facilities in the United States. EmCare has a 6%
share of the total emergency department services market and a 9%
share of the outsourced emergency department services market.
During fiscal 2004, EmCare had approximately 5.3 million
patient visits in 39 states. EmCare has 333 exclusive
contracts with hospitals and independent physician groups to
provide emergency department and hospitalist staffing,
management and other administrative services. We believe that
EmCares successful physician recruitment and retention,
high level of customer service and advanced risk management
programs have resulted in what we believe is our
industry-leading contract retention rate of 91% in fiscal 2004
and new contract wins.
EmCare primarily provides emergency department staffing and
related management services to healthcare facilities. We recruit
and hire or subcontract with physicians and other healthcare
professionals, who then provide professional services to the
hospitals with whom we contract. We also have practice support
agreements with independent physician groups and hospitals
pursuant to which we provide unbundled management services such
as billing and collection, recruiting, risk management and
certain other administrative services. For the fiscal year ended
August 31, 2004, EmCare generated net revenue of
$549.8 million.
In addition, we have become one of the leading providers of
hospitalist services. A hospitalist is a physician who
specializes in the care of acutely ill patients in an in-patient
setting. While we have provided limited hospitalist services for
the past 10 years, it is only in the last 18 months
that we have focused on
86
expanding this program. We have increased our hospitalist
programs from 8 contracts at August 31, 2003 to
24 contracts at September 30, 2005, increasing our net
revenue for this program from approximately $7.2 million in
fiscal 2001 to approximately $23.5 million, or
approximately 4% of EmCares net revenue, for fiscal 2004.
As of September 30, 2005, we independently contracted with
or employed approximately 170 hospitalist physicians.
EmCare was founded in Dallas, Texas in 1972. Initially we grew
by targeting larger hospitals in the Texas marketplace. We then
expanded our presence nationally, primarily through a series of
acquisitions in the 1990s. Throughout our history, EmCare has
enjoyed a strong reputation as a quality provider of emergency
department staffing and related management services.
The range of staffing and related management services we provide
includes:
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recruiting, scheduling and credentials coordination for clinical
professionals, |
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support services, such as payroll, insurance coverage,
continuing education services and management training, and |
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coding, billing and collection of fees for services provided by
medical professionals. |
We are a leading provider of outsourcing services to both market
segments, and have developed specific competencies and operating
groups to address the unique needs of each. In fiscal 2004, the
high volume and medium to low volume segments represented 88%
and 12%, respectively, of our emergency department net revenue.
Services
We provide a full range of outsourced physician staffing and
related management services for emergency department and
hospitalist programs, which include:
Contract Management. We utilize an integrated approach to
contract management that involves physicians, non-clinical
business experts, operational efficiency specialists and
hospital representatives. Together, the team works to improve
the quality and reduce the cost of care. We believe that our
approach fosters the culture that is necessary to operate
effectively in high stress emergency environments. An on-site
medical director is responsible for the day-to-day oversight of
the operation, including clinical quality, and works closely
with the hospitals management in developing strategic
initiatives and objectives. The regional director of operations,
which is a clinical position, provides systems analysis and
improvement plans. A quality manager develops site-specific
quality improvement programs, and practice improvement staff
focuses on chart documentation and physician utilization
patterns. The regional-based management staff provides support
for these efforts and ensures that each customers
expectations are identified, that service plans are developed
and executed to meet those expectations, and that the
companys and the customers financial objectives are
achieved.
Staffing. We provide a full range of staffing services to
meet the unique needs of each healthcare facility. Our dedicated
clinical teams include qualified, career-oriented physicians and
other healthcare professionals responsible for the delivery of
high quality, cost-effective care. These teams also rely on
managerial personnel, many of whom have clinical experience, who
oversee the administration and operations of the clinical area.
As a result of our staffing services, healthcare facilities can
focus their efforts on improving their core business of
providing healthcare services for their communities rather than
recruiting and managing physicians. Ensuring that each contract
is staffed with the appropriately qualified physicians and that
coverage is provided without any service deficiencies is
critical to the success of the contract. We believe that our
approach to recruiting, staffing and scheduling provides us with
a unique advantage in achieving these objectives.
Recruiting. Many healthcare facilities lack the resources
necessary to identify and attract specialized, career-oriented
physicians. We have committed significant resources to the
development of a proprietary national physician database that we
utilize in our recruiting programs across the country. Our
marketing and recruiting staff continuously updates our database
of more than 800,000 physicians with relevant data to allow
87
us to match potential physician candidates to specific openings
based upon personal preferences. This targeted recruiting method
increases the success and efficiency of our recruiters, and we
believe significantly increases our physician retention rates.
We actively recruit physicians through various media options
including telemarketing, direct mail, conventions, journal
advertising and our Internet site.
Scheduling. Our scheduling departments assist our medical
directors in scheduling physicians and other healthcare
professionals in accordance with the coverage model at each
facility. We provide 24-hour service to ensure that unscheduled
shift vacancies, due to situations such as physician illness and
personal emergencies, are filled with alternative coverage.
Payroll Administration and Benefits. We provide payroll
administration services for the physicians and other healthcare
professionals with whom we contract to provide services at
customer sites. Our clinical employees benefit significantly by
our ability to aggregate physicians to provide professional
liability coverage at lower rates than many hospitals or
physicians could negotiate on a stand-alone basis. Additionally,
healthcare facilities benefit from the elimination of the
overhead costs associated with the administration of payroll
and, where applicable, employee benefits.
Customer Satisfaction Programs. We design and implement
customized patient satisfaction programs for our hospital
customers. These programs are designed to improve patient
satisfaction through the use of communication, family inclusion
and hospitality techniques. These programs are delivered to the
clinical and non-clinical members of the hospital emergency
department.
Other Services. We provide a substantial portion of our
services to hospitals through our affiliate physician groups.
Because we have also identified situations in which hospitals
and physicians are interested in receiving stand-alone
management services such as billing and collection, scheduling,
recruitment and risk management, we often unbundle our services
to meet this need. Pursuant to these practice support
agreements, which generally will have a term of one to three
years, we provide these services to independent physician groups
and healthcare facilities. As of August 31, 2004, we had 19
practice support agreements which generated $5.6 million in
net revenue in fiscal 2004, a 33% increase over fiscal 2003. We
are working to commercialize our expertise in staffing and
billing and expect to enter into similar stand-alone practice
support agreements.
Operational Assessments. We undertake operational
assessments for our hospital customers that include
comprehensive reviews of critical operational matrices,
including turnaround times, triage systems, left without
being seens, throughput times and operating systems. These
assessments establish baseline values, develop and implement
process improvement programs, and then monitor the success of
the initiatives. This is an ongoing process that we continually
monitor and modify.
Practice Improvement. We provide ongoing comprehensive
documentation review and training for our affiliated physicians.
We review certain statistical indicators that allow us to
provide specific training to individual physicians regarding
documentation, and we tailor training for broader groups of
physicians as we see trends developing in documentation-related
areas. Our training focuses on the completeness of the medical
record or chart, specific payor requirements, and government
rules and regulations.
Risk Management
We utilize our risk management department, senior medical
leadership and on-site medical directors to conduct aggressive
risk management and quality assurance programs. We take a
proactive role in promoting early reporting, evaluation and
resolution of incidents that may evolve into claims. Our risk
management function is designed to mitigate risk associated with
the delivery of care and to prevent or minimize costs associated
with medical professional liability claims and includes:
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Incident Reporting Systems. We have established a
comprehensive support system for medical professionals. Our Risk
Management Hotline provides each physician with the ability to
discuss medical issues with a peer. In the event of a negative
patient outcome, the physician may discuss legal and medical
issues in anticipation of litigation directly with an EmCare
attorney experienced with medical malpractice issues. |
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Tracking and Trending Claims. We have an extensive claims
database developed from our experience in the emergency
department setting. From this database, we track multiple data
points on each professional liability claim. We utilize the
database to identify claim trends and risk factors so that we
can better target our risk management initiatives. Each year, we
target the medical conditions associated with our most frequent
professional liability claims, and provide detailed education to
assist our affiliated medical professionals in treating these
medical conditions. |
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Professional Risk Assessment. We conduct risk assessments
of our medical professionals. Typically, a risk assessment
includes a thorough review of professional liability claims
against the professional, assessment of issues raised by
hospital risk management and identification of areas where
additional education may be advantageous for the professional. |
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Hospital Risk Assessment. We conduct risk assessments of
potential hospital customers in conjunction with our sales and
contracting process. As part of the risk assessment, registered
nurses or physicians employed by us conduct a detailed analysis
of the hospitals operations affecting the emergency
department or hospitalist services, including the triage
procedures, on-call coverage, transfer procedures, nursing
staffing and related matters in an effort to address risk
factors contractually during negotiations with potential
customer hospitals. |
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Clinical Fail-Safe Programs. We review and identify key
risk areas which we believe may result in increased incidence of
patient injuries and resulting claims against us and our
affiliated medical professionals. We continue to develop
fail-safe clinical tools and make them available to
our affiliated physicians for use in conjunction with their
practice and to our customer hospitals for use as a part of
their peer review process. These fail-safe tools
assist physicians in identifying common patient attributes and
complaints that may identify the patient as being at high risk
for certain conditions (e.g., a heart attack). |
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Quality Improvement Programs. Our medical directors are
actively engaged in their respective hospitals quality
improvement committees and initiatives. In addition, we provide
tools that provide guidance to the medical directors on how to
conduct quality reviews of their physicians and help them track
their physicians medical practices. |
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Physician Education Programs. Our wholly owned
subsidiary, Emergency Medical Education Systems, Inc, or EMEDS,
conducts physician education through risk management and board
review conferences and on-line teaching modules. Our affiliated
medical professionals can access EMEDS to obtain valuable
medical information. Our internal continuing education services
are fully accredited by the Accreditation Council for Continuing
Medical Education. This allows us to grant our physicians and
nurses continuing education credits for internally developed
educational programs at a lower cost than if such credits were
earned through external programs. Our risk management department
also provides other forms of education, including articles in
the company newsletter that highlight current medical literature
on important emergency medicine topics. |
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Proactive Professional Liability Claims Handling. We
utilize a third party claims administrator to manage
professional liability claims against companies and medical
professionals covered under our insurance program. For each
case, detailed reports are reviewed to ensure proactively that
the defense is comprehensive and aggressive. Each professional
liability claim brought against an EmCare affiliated medical
professional or EmCare affiliated company is reviewed by
EmCares Claims Committee, consisting of physicians,
attorneys and company executives, before any resolution of the
claim. The Claims Committee periodically instructs EmCares
risk management department to undertake an analysis of
particular physicians or hospital locations associated with a
given claim. |
Billing and Collections
We receive payment for patient services from:
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the federal and state governments, primarily under the Medicare
and Medicaid programs, |
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health maintenance organizations, preferred provider
organizations and private insurers, |
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hospitals, and |
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individual patients. |
Over the last three fiscal years, our self-pay revenue has
remained stable as a percentage of EmCares net revenue.
The table below presents the approximate percentages of
EmCares net revenue from the following sources:
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Percentage of EmCares | |
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Net Revenue | |
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Year Ended August 31, | |
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2002 | |
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2003 | |
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2004 | |
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Medicare
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15 |
% |
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16 |
% |
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17 |
% |
Medicaid
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2 |
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3 |
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3 |
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Commercial insurance/managed care
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57 |
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54 |
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53 |
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Self-pay
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4 |
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3 |
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2 |
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Subsidies/fees
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22 |
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24 |
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25 |
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Total net revenue
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100 |
% |
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100 |
% |
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100 |
% |
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See Regulatory Matters Medicare,
Medicaid and Other Government Program Reimbursement for
additional information on reimbursement from Medicare, Medicaid
and other government-sponsored programs.
We code and bill for physician services through our wholly-owned
subsidiary, Reimbursement Technologies, Inc. We utilize
state-of-the-art document imaging and paperless workflow
processes to expedite the billing cycle and improve compliance
and customer service. Currently, at approximately 50% of our
customer locations, medical records and emergency department
logs are scanned and transmitted electronically to us. We are in
the process of transitioning additional customers to on-site
scanning. By providing these enhanced services, we believe we
increase the value of services we provide to our customers and
improve customer relations. Additionally, we believe these
comprehensive services differentiate us in sales situations and
improve the chance of being selected in competitive bidding
processes.
We do substantially all of the billing for our affiliated
physicians, and we have extensive experience in processing
claims to third party payors. We employ a billing staff of
approximately 640 employees who are trained in third party
coverage and reimbursement procedures. Our integrated billing
and collection system uses proprietary software to tailor the
submission of claims to Medicare, Medicaid and certain other
third party payors and has the capability to electronically
submit most claims to the third party payors systems. We
forward uncollected accounts electronically to two outside
collection agencies automatically, based on established
parameters. Each of these collection agencies have on-site
employees working at our in-house billing company to assist in
providing patients with quality customer service. Our
comprehensive billing and collection system allows us to have
full control of accounts receivable at each step of the process.
Contracts
We have contracts with (i) hospital customers to provide
professional staffing and related management services,
(ii) healthcare facilities and independent physician groups
to provide management services, and (iii) affiliated
physician groups and medical professionals to provide management
services and various benefits.
We deliver services to our hospital customers and their patients
through two principal types of contractual arrangements. EmCare
or a subsidiary frequently contracts directly with the hospital
to provide physician staffing and management services. In some
instances, a physician-owned professional corporation contracts
with the hospital to provide physician staffing and management
services, and the professional corporation, in turn, contracts
with us for a wide range of management and administrative
services, including billing, scheduling support, accounting and
other services. The professional corporation pays our management
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fee out of the fees it collects from patients, third party
payors and, in some cases, the hospital customer. Our physicians
and other healthcare professionals who provide services under
these hospital contracts do so pursuant to independent
contractor or employment agreements with us, or pursuant to
arrangements with the professional corporation that has a
management agreement with us. We refer to all of these
physicians as our affiliated physicians, and these physicians
and other individuals as our healthcare professionals.
Hospital and Practice Support Contracts. As of
September 30, 2005, EmCare provides services under 333
contracts. Typically, the agreements with the hospitals are
awarded on a competitive basis, and have an initial term of
three years with one-year automatic renewals and termination by
either party on specified notice. We have improved our contract
retention rate to 91% for fiscal 2004, up from 74% in fiscal
2001.
Our contracts with hospitals provide for one of three payment
models:
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we bill patients and third party payors directly for physician
fees, |
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we bill patients and third party payors directly for physician
fees, with the hospital paying us an additional pre-arranged fee
for our services, and |
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we bill the hospitals directly for the services of the
physicians. |
In all cases, the hospitals are responsible for billing and
collecting for non-physician-related services.
We have established long-term relationships with some of the
largest names in healthcare services, including Baylor Health
System, Community Health Systems, HCA, Quorum Healthcare, Tenet
Healthcare and Universal Health System. None of these customers
represent revenue that amounts to 10% of our fiscal 2004 total
net revenue. Our top ten hospital emergency department contracts
represent $68.3 million, or 12.4%, of EmCares fiscal
2004 net revenue. We have maintained our relationships with
these customers for an average of 12 years.
Affiliated Physician Group Contracts. In most states, we
contract directly with our hospital customers to provide
physician staffing and related management services. We, in turn,
contract with a professional corporation that is wholly-owned by
one or more physicians, which we refer to as an affiliated
physician group, or with independent contractor physicians. It
is these physicians who provide the medical professional
services. We then provide comprehensive management services to
the physicians. We typically provide professional liability and
workers compensation coverage to our affiliated physicians.
Certain states have laws that prohibit or restrict unlicensed
persons or business entities from practicing medicine. The laws
vary in scope and application from state to state. Some of these
states may prohibit us from contracting directly with hospitals
or physicians to provide professional medical services. In those
states, the affiliated physician groups contract with the
hospital, as well as all medical professionals. We provide
management services to the affiliated physician groups.
Medical Professional Contracts. We contract with medical
professionals as either independent contractors or employees to
provide services to our customers. The medical professionals
generally are paid an hourly rate for each hour of coverage, a
variable rate based upon productivity or contract margin, or a
combination of both a fixed hourly rate and a variable rate
component. We typically provide professional liability and
workers compensation coverage to our medical professionals.
The contracts with medical professionals typically have one-year
terms with automatic renewal clauses for additional one-year
terms. The contracts can be terminated with cause for various
reasons, and usually contain provisions allowing for termination
without cause by either party upon 90 days notice.
Agreements with physicians generally contain a non-compete or
non-solicitation provision and, in the case of medical
directors, a non-compete provision. The enforceability of these
provisions varies from state to state.
Management Information Systems
We have invested in scalable information systems and proprietary
software packages designed to allow us to grow efficiently and
to deliver and implement our best practice procedures
nationally, while retaining local
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and regional flexibility. We have developed and maintain
integrated systems to facilitate the exchange of information
between our regions and our customers.
Our customers, affiliated physicians and employees throughout
the country access a wide variety of information through our
custom portal, www.emcare.com. Designed as a forum to
deliver information and communicate with our various
constituencies, this website provides a unifying platform to
promote the growth in our business. It includes individualized
content, including physician schedules, rosters and performance
reports, all delivered securely to the intended individuals
through the use of a password.
We have developed and implemented the following proprietary
applications that we believe provides us with a competitive
advantage in billing and collections, and in recruiting,
credentialing, enrolling, scheduling and compensating healthcare
professionals.
EmSource is our system for our recruiting staff to source
physician candidates. The system consists of a database of
approximately 800,000 physicians that is updated weekly to
provide the most current physician contact information available.
EmTrac is our primary operations support system that
supports credentialing and scheduling. Information collected in
EmSource during the recruiting process populates
EmTrac, forms the basis for the credentialing module, and
is used to provide alerts on license and privilege expirations.
EmTrac is used by our schedulers to match physician
availability and preferences with the needs of the hospital
customer.
EmComp is our system for calculating physicians
gross pay and is an important tool supporting our compensation
strategy. Physicians are compensated by a wide variety of pay
plans ranging from simple hourly wages to fee for
service plans linked to productivity. EmComp has
been designed to support an unlimited variety of pay plans,
thereby giving EmCare a competitive advantage in physician
recruitment and retention. The system takes the actual hours
worked from EmTrac and the production data from
EmBillz, and applies the pay rules from the
physicians contract to calculate gross pay.
EmBillz is the coding, billing and accounts receivable
management system through which we process more than five
million emergency department visits each year. This proprietary
system supports the full collection process: from capturing the
emergency department patient logs, coding and issuing bills in
accordance with applicable federal and state regulations, and
payment follow-up and cash receipt posting.
Edison is a system that automates much of our physician
enrollment. To bill Medicare, Medicaid and some other third
party payors, each physician must have an approved provider
number for that payor. There are hundreds of unique forms from
the combination of states and payors. Edison facilitates
the completion of the forms, thereby relieving physicians of
significant administrative workload and enabling us to track
pending receivables and ensure timely completion.
Sales and Marketing
Contracts for outsourced emergency department and hospitalist
services are obtained through strategic marketing programs and
responses to requests for proposals. EmCares business
development team includes five Vice Presidents of Practice
Development located throughout the United States who are
responsible for developing sales and acquisition opportunities
for the operating group in his or her territory. A significant
portion of the compensation program for these sales
professionals is commission-based, with incentive compensation
based on the profitability of the contracts they sell and actual
contract performance in the first year. Leads for new hospital
customers are developed through our business development group,
which telemarkets the United States hospital industry. In
addition, leads are generated through our website, journal
advertising and a lead referral program. Each Vice President of
Practice Development is responsible for working with the
regional chief executive officer to structure and provide
customer proposals for new prospects in their respective regions.
Emergency medicine practices vary among healthcare facilities. A
healthcare facility request for proposal generally will include
demographic information of the facility department, a list of
services to be performed, the length of the contract, the
minimum qualifications of bidders, billing information,
selection criteria and
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the format to be followed in the bid. Prior to responding to a
request for proposal, EmCares senior management ensures
that the proposal is in line with certain financial parameters.
Senior management evaluates all aspects of each proposal,
including financial projections, staffing model, resource
requirements and competition, to determine how to best achieve
our business objectives and the customer goals.
Competition
The market for outsourced emergency department staffing and
related management services is highly fragmented, with more than
800 national, regional and local providers handling over
113 million patient visits in 2003. There are more than
4,700 hospitals in the United States with emergency
departments, of which approximately 67% currently outsource
physician services. Of these hospitals that outsource, we
believe approximately 50% contract with a local provider, 25%
contract with a regional provider and 25% contract with a
national provider.
Competition for outsourced physician and other healthcare
staffing and management service contracts is based primarily on:
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the ability to recruit and retain qualified physicians, |
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the ability to improve department productivity and patient
satisfaction while reducing overall costs, |
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the ability to integrate the emergency department with other
hospital departments and to provide value added services, |
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billing and reimbursement expertise, |
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a reputation for compliance with state and federal regulations, |
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the breadth of staffing and management services offered, and |
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financial stability, demonstrating an ability to pay providers
in a timely manner and provide professional liability insurance. |
Team Health is our largest competitor and has the second largest
share of the emergency department services market with an
approximately 4.4% share. The other national providers of
outsourced emergency department services are Sterling
Healthcare, National Emergency Service and the Schumacher Group,
which tend to focus on hospitals with lower to medium volume
emergency departments.
Insurance
Professional Liability Program. For the period
January 1, 2001 through December 31, 2004, our
professional liability insurance program provided claims made
insurance coverage with limits of $1 million per loss
event, with a $3 million annual per physician aggregate,
for all medical professionals for whom we have agreed to procure
coverage. Our subsidiaries and affiliated corporate entities are
provided with coverage of $1 million per loss event, but
share a $10 million annual corporate aggregate.
For the 2001 calendar year, Lexington Insurance Company provided
the majority of the professional liability insurance coverage,
subject to an aggregate policy limit of $10 million. We
also procured coverage on a regional basis under separate
policies of insurance during this period.
For the 2002, 2003 and 2004 calendar years, Columbia Casualty
Company and Continental Casualty Company, collectively referred
to as CCC, provided our professional liability insurance
coverage, covering all claims occurring and reported during
those calendar years. The CCC policies have a retroactive date
of January 1, 2001, thereby covering all claims occurring
during the 2001 calendar year but reported in the 2002, 2003 and
2004 calendar years. We also procured coverage on a regional
basis under separate policies of insurance during this period.
We are maintaining our calendar year 2004 professional liability
insurance program for calendar year 2005.
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Captive Insurance Arrangement. On December 10, 2001,
we formed EMCA Insurance Company, Ltd., or EMCA, as a wholly
owned subsidiary under the Companies Law of the Cayman Islands.
EMCA reinsures CCC for all losses associated with the CCC
insurance policies under the professional liability insurance
program, and provides collateral for the reinsurance arrangement
through a trust agreement.
Workers Compensation Program. For the period
September 1, 2002 through August 31, 2004, we procured
workers compensation insurance coverage for employees of EmCare
and affiliated physician groups through Continental Casualty
Company. Continental reinsures a portion of this workers
compensation exposure, on both a per claim and an aggregate
basis, with EMCA.
From September 1, 2004, EmCare has insured its workers
compensation exposure through The Travelers Indemnity Company,
which reinsures a portion of the exposure with EMCA.
Properties
We lease approximately 48,990 square feet in an office
building at 1717 Main Street, Dallas, Texas for our
corporate headquarters. We also lease 16 facilities to
house administrative, billing and other support functions for
our regional operations. We believe our present facilities are
sufficient to meet our current and projected needs, and that
suitable space is readily available should our need for space
increase. Our leases expire at various dates through 2014.
Employees
The following is an approximate break down of our affiliated
physicians, independent contractors and employees by job
classification as of September 30, 2005.
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Job Classification |
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Full-Time | |
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Part-Time | |
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Total | |
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Physicians*
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1,887 |
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714 |
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2,601 |
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Physician assistants
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162 |
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142 |
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304 |
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Nurse practitioners
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104 |
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94 |
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198 |
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Non-clinical employees
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1,076 |
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119 |
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1,195 |
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Total
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3,229 |
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1,069 |
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4,298 |
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* |
We have approximately 4,500 affiliated physicians. These figures
represent clinicians providing services at a particular time. |
We believe that our relations with our employees are good. None
of our physicians, physician assistants, nurse practitioners or
non-clinical employees are subject to any collective bargaining
agreement.
We offer our physicians substantial flexibility in terms of type
of facility, scheduling of work hours, benefit packages,
opportunities for relocation and career development. This
flexibility, combined with fewer administrative burdens,
improves physician retention rates and stabilizes our contract
base.
Legal Matters
We are subject to litigation arising in the ordinary course of
our business, including litigation principally relating to
professional liability claims. There can be no assurance that
our insurance coverage will be adequate to cover all liabilities
occurring out of such claims. In the opinion of management, we
are not engaged in any legal proceedings that we expect will
have a material adverse effect on our business, financial
condition, cash flows or results of our operations other than as
set forth below.
From time to time, in the ordinary course of business and like
others in the industry, we receive requests for information from
government agencies in connection with their regulatory or
investigational authority. Such requests can include subpoenas
or demand letters for documents to assist the government in
audits or investigations. We review such requests and notices
and take appropriate action. We have been subject to
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certain requests for information and investigations in the past
and could be subject to such requests for information and
investigations in the future.
Our healthcare businesses are subject to the Medicare and
Medicaid fraud and abuse laws, which prohibit, among other
things, any false claims, or any bribe, kick-back or rebate in
return for the referral of Medicare and Medicaid patients.
Violation of these prohibitions may result in civil and criminal
penalties and exclusion from participation in the Medicare and
Medicaid programs. We have implemented policies and procedures
that management believes will assure that we are in substantial
compliance with these laws.
EmCare has been named a defendant in two collective action
lawsuits brought by a number of nurse practitioners and
physician assistants under the Fair Labor Standards Act. The
plaintiffs are seeking to recover overtime pay for the hours
they worked in excess of 40 in a workweek and reclassification
as non-exempt employees. Certain of the plaintiffs brought a
related action under California state law. We have entered into
a settlement of the California state law claims.
Regulatory
Matters
As a participant in the healthcare industry, our operations and
relationships with healthcare providers such as hospitals, other
healthcare facilities and healthcare professionals are subject
to extensive and increasing regulation by numerous federal and
state government entities as well as local government agencies.
Specifically, but without limitation, we are subject to the
following laws and regulations.
Medicare, Medicaid and Other Government Reimbursement
Programs
We derive a significant portion of our revenue from services
rendered to beneficiaries of Medicare, Medicaid and other
government-sponsored healthcare programs. For fiscal 2004, we
received approximately 27.3% of our net revenue from Medicare
and 5.2% from Medicaid. To participate in these programs, we
must comply with stringent and often complex enrollment and
reimbursement requirements from the federal and state
governments. We are subject to governmental reviews and audits
of our bills and claims for reimbursement. Retroactive
adjustments to amounts previously reimbursed from these programs
can and do occur on a regular basis as a result of these reviews
and audits. In addition, these programs are subject to statutory
and regulatory changes, administrative rulings, interpretations
and determinations, all of which may materially increase or
decrease the payments we receive for our services as well as
affect the cost of providing services. In recent years, Congress
has consistently attempted to curb federal spending on such
programs.
Reimbursement to us typically is conditioned on our providing
the correct procedure and diagnosis codes and properly
documenting both the service itself and the medical necessity
for the service. Incorrect or incomplete documentation and
billing information, or the incorrect selection of codes for the
level of service provided, could result in non-payment for
services rendered or lead to allegations of billing fraud.
Moreover, third party payors may disallow, in whole or in part,
requests for reimbursement based on determinations that certain
amounts are not reimbursable, they were for services provided
that were not medically necessary, there was a lack of
sufficient supporting documentation, or for a number of other
reasons. Retroactive adjustments, recoupments or refund demands
may change amounts realized from third party payors. Additional
factors that could complicate our billing include:
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disputes between payors as to which party is responsible for
payment, |
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the difficulty of adherence to specific compliance requirements,
diagnosis coding and various other procedures mandated by the
government, and |
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failure to obtain proper physician credentialing and
documentation in order to bill governmental payors. |
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Due to the nature of our business and our participation in the
Medicare and Medicaid reimbursement programs, we are involved
from time to time in regulatory reviews, audits or
investigations by government agencies of matters such as
compliance with billing regulations and rules. We may be
required to repay these agencies if a finding is made that we
were incorrectly reimbursed, or we may lose eligibility for
certain programs in the event of certain types of
non-compliance. Delays and uncertainties in the reimbursement
process adversely affect our level of accounts receivable,
increase the overall cost of collection, and may adversely
affect our working capital and cause us to incur additional
borrowing costs. Unfavorable resolutions of pending or future
regulatory reviews or investigations, either individually or in
the aggregate, could have a material adverse effect on our
business, financial condition and results of operations.
We establish an allowance for discounts applicable to Medicare,
Medicaid and other third party payors and for doubtful accounts
based on credit risk applicable to certain types of payors,
historical trends, and other relevant information. We review our
allowance for doubtful accounts on an ongoing basis and may
increase or decrease such allowance from time to time, including
in those instances when we determine that the level of effort
and cost of collection of certain accounts receivable is
unacceptable.
We believe that regulatory trends in cost containment will
continue. We cannot assure you that we will be able to offset
reduced operating margins through cost reductions, increased
volume, the introduction of additional procedures or otherwise.
Ambulance Services Fee Schedule. In February 2002, the
Health Care Financing Administration, now renamed the Centers
for Medicare and Medicaid Services, issued the Medicare
Ambulance Fee Schedule Final Rule, or Final Rule, that
revised Medicare policy on the coverage of ambulance transport
services, effective April 1, 2002. The Final Rule was the
result of a mandate under the Balanced Budget Act of 1997, or
BBA, to establish a national fee schedule for payment of
ambulance transport services that would control increases in
expenditures under Part B of the Medicare program,
establish definitions for ambulance transport services that link
payments to the type of services furnished, consider appropriate
regional and operational differences and consider adjustments to
account for inflation, among other provisions.
The Final Rule provided for a five-year phase-in of a national
fee schedule, beginning April 1, 2002. Prior to that date,
Medicare used a charge-based reimbursement system for ambulance
transport services and reimbursed 80% of charges determined to
be reasonable, subject to the limits fixed for the particular
geographic area. The patient was responsible for co-pay amounts,
deductibles and the remaining balance of the transport cost, if
we did not accept the assigned reimbursement, and Medicare
required us to expend reasonable efforts to collect the balance.
In determining reasonable charges, Medicare considered and
applied the lowest of various charge factors, including the
actual charge, the customary charge, the prevailing charge in
the same locality, the amount of reimbursement for comparable
services, and the inflation-indexed charge limit.
On April 1, 2002, the Final Rule became effective. The
Final Rule categorizes seven levels of ground ambulance
services, ranging from basic life support to specialty care
transport, and two categories of air ambulance services. Ground
providers are paid based on a base rate conversion factor
multiplied by the number of relative value units assigned to
each level of transport, plus an additional amount for each mile
of patient transport. The base rate conversion factor for
services to Medicare patients is adjusted each year by the
Consumer Price Index. Additional adjustments to the base rate
conversion factor are included to recognize differences in
relative practice costs among geographic areas, and higher
transportation costs that may be incurred by ambulance providers
in rural areas with low population density. The Final Rule
requires ambulance providers to accept assignment on Medicare
claims, which means a provider must accept Medicares
allowed reimbursement rate as full payment. Medicare typically
reimburses 80% of that rate and the remaining 20% is collectible
from a secondary insurance or the patient. Originally, the Final
Rule called for a five-year phase-in period to allow providers
time to adjust to the new payment rates. The national fee
schedule was to be phased in at 20% increments each year, with
payments being made at 100% of the national fee schedule in 2006
and thereafter.
With the passage of the Medicare Prescription Drug Improvement
and Modernization Act of 2003, or the Medicare Modernization
Act, temporary modifications were made to the amounts payable
under the
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ambulance fee schedule in order to mitigate decreases in
reimbursement in some regions caused by the Final Rule. The
Medicare Modernization Act established regional fee schedules
based on historic costs in each region. Effective July 1,
2004, in those regions where the regional fee schedule exceeds
the national fee schedule, the regional fee schedule is blended
with the national fee schedule on a temporary basis, until 2010.
In addition to the regional fee schedule change, the Medicare
Modernization Act included other provisions for additional
reimbursement for ambulance transport services provided to
Medicare patients. Among other relief, the Medicare
Modernization Act provides for a 1% increase in reimbursement
for urban transports and a 2% increase for rural transports for
the remainder of the original phase-in period of the national
ambulance fee schedule, through 2006.
We estimate that the impact of the ambulance service rate
decreases under the national fee schedule, as modified by the
provisions of the Medicare Modernization Act, resulted in a
decrease in AMRs net revenue for fiscal 2003 and fiscal
2004 of approximately $20 million and $11 million,
respectively, will result in an increase in AMRs net
revenue of approximately $13 million in calendar 2005, and
will result in a decrease in AMRs net revenue of
approximately $17 million in 2006 and continuing decreases
thereafter to 2010. Although we have been able to substantially
mitigate the phased-in reductions of the fee schedule through
additional fee and subsidy increases, we cannot assure you that
we will be able to continue to do so, and the rate decreases
could have a material adverse effect on our results of
operations. We cannot predict whether Congress may make further
refinements and technical corrections to the law or pass a new
cost containment statute in a manner and in a form that could
adversely impact our business.
Local Ambulance Rate Regulation. State or local
government regulations or administrative policies regulate rate
structures in some states in which we provide ambulance
transport services. For example, in certain service areas in
which we are the exclusive provider of ambulance transport
services, the community sets the rates for emergency ambulance
services pursuant to an ordinance or master contract and may
also establish the rates for general ambulance services that we
are permitted to charge. We may be unable to receive ambulance
service rate increases on a timely basis where rates are
regulated or to establish or maintain satisfactory rate
structures where rates are not regulated.
Emergency Physician Services Fee Schedule. Medicare pays
for all physician services based upon a national fee schedule,
or Fee Schedule, which contains a list of uniform rates. The
payment rates under the Fee Schedule are determined based on:
(1) national uniform relative value units for the services
provided, (2) a geographic adjustment factor and (3) a
conversion factor. The Centers for Medicare and Medicaid
Services, or CMS, updates the conversion factor annually. The
Fee Schedule uses a target-setting formula system called the
Sustainable Growth Rate, or SGR, to update annually the
conversion factor. The SGR is a target rate of growth in
spending for physician services which is intended to control the
growth of Medicare expenditures for physicians services.
The Fee Schedule update is adjusted to reflect the comparison of
actual expenditures to target expenditures.
Because one of the factors for calculating the SGR system is
linked to the growth in the U.S. gross domestic product,
the SGR formula may result in a negative payment update if
growth in Medicare beneficiaries use of services exceeds
GDP growth. The SGR formula may result in significant yearly
fluctuations in Fee Schedule updates, which may be unrelated to
changes in the actual cost of providing physician services.
Unless Congress takes additional action in the future to modify
or reform the mechanism by which the physician fee schedule
conversion factor update is undertaken in the future,
significant reductions in Medicare reimbursement could occur,
and these reductions could have a material adverse effect on our
business, financial condition or results of operations. We
currently expect that the Medicare fee schedule update for
physician services fees will provide for a 4.3% decrease to
physician rates effective January 1, 2006, which would
result in a decrease in EmCares 2006 net revenue of
approximately $5.7 million.
Medicare Reassignment. The Medicare program prohibits the
reassignment of Medicare payments due to a physician or other
healthcare provider to any other person or entity unless the
billing arrangement between that physician or other healthcare
provider and the other person or entity falls within an
enumerated
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exception to the Medicare reassignment prohibition.
Historically, there was no exception that allowed us to receive
directly Medicare payments related to the services of
independent contractor physicians. However, the Medicare
Modernization Act amended the Medicare reassignment statute as
of December 8, 2003 and now permits our independent
contractor physicians to reassign their Medicare receivables to
us under certain circumstances. Because this provision has only
recently been implemented, it could be interpreted in a manner
adverse to us, which would negatively impact our ability to bill
for our physicians services.
Rules Applicable to Midlevel Practitioners. EmCare
utilizes physician assistants and nurse practitioners, sometimes
referred to collectively as midlevel practitioners,
to provide care under the supervision of our physicians. State
and federal laws require that such supervision be performed and
documented using specific procedures. For example, in some
states some or all of the midlevel practitioners chart
entries must be countersigned. Under applicable Medicare rules,
the midlevel practitioners services are reimbursed at a
rate equal to 85% of the physician fee schedule amount and we do
not bill separately for the supervising physicians
services. However, when a midlevel practitioner assists a
physician who is directly and personally involved in the
patients care, we often bill for the services of the
physician at the full physician fee schedule rates and do not
bill separately for the midlevel practitioners services.
We believe our billing and documentation practices related to
our use of midlevel practitioners comply with applicable state
and federal laws, but we cannot assure you that enforcement
authorities will not find that our practices violate such laws.
Ambulance Rates Payable by Medicare HMOs. One of the
changes made by ambulance fee schedule Final Rule was to require
ambulance providers to accept assignment from
Medicare and Medicare HMOs. Medicare HMOs are private insurance
companies which operate managed care plans that enroll Medicare
beneficiaries who elect to enroll in a plan in lieu of regular
Medicare coverage. When a provider accepts assignment, it agrees
to accept the rate established by Medicare as payment in full
for services covered by Medicare or the Medicare HMO and to
write off the balance of its charges. Prior to the
implementation of the Final Rule, ambulance providers were not
required to accept assignment and could obtain payment from
Medicare patients or Medicare HMOs for the providers full
charges, which typically are higher than the Medicare rate. When
the requirement to accept assignment became effective on
April 1, 2002, many Medicare HMOs continued to pay
ambulance providers their full charges, even though they could
have paid them the Medicare rate. Many Medicare HMOs
subsequently have taken the position that the amount paid to
such providers in excess of the Medicare rate constituted an
overpayment that must be refunded by the provider. We have
received such refund demands from some Medicare HMOs and, in
order to minimize litigation costs, have agreed to partial
repayment of amounts received from the plans in excess of the
Medicare rate. We have no reason to believe that additional HMOs
will make such demands, but we cannot assure you that there will
be no further demands.
The SNF Prospective Payment System. Under the Medicare
prospective payment system, or PPS, applicable to skilled
nursing facilities, or SNFs, SNFs are financially responsible
for some ancillary services, including certain ambulance
transports, or PPS transports, rendered to certain of their
Medicare patients. Ambulance companies must bill the SNF, rather
than Medicare, for PPS transports, but may bill Medicare for
other covered transports provided to the SNFs Medicare
patients. Ambulance companies are responsible for obtaining
sufficient information from the SNF to determine which
transports are PPS transports and which ones may be billed to
Medicare. The Office of Inspector General of the Department of
Health and Human Services, or the OIG, has issued two
industry-wide audit reports indicating that, in many cases, SNFs
do not provide, or ambulance companies and other ancillary
service providers do not obtain, sufficient information to make
this determination accurately. As a result, the OIG asserts that
some PPS transports that should have been billed by ambulance
providers to SNFs have been improperly billed to Medicare. The
OIG has recommended that Medicare recoup the amounts paid to
ancillary service providers, including ambulance companies, for
such services. Although we believe AMR currently has procedures
in place to correctly identify and bill for PPS transports, we
cannot assure you that AMR will not be subject to such
recoupments and other possible penalties.
Paramedic Intercepts. Medicare regulations permit
ambulance transport providers to subcontract with other
organizations for paramedic services. Generally, only the
transport provider may bill Medicare, and the
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paramedic services subcontractor must receive any payment to
which it is entitled from that provider. Based on these rules,
in some jurisdictions we have established paramedic
intercept arrangements in which we may provide paramedic
services to a municipal or volunteer transport provider. Our
subsidiary, AMR of South Dakota, previously entered into a
settlement agreement with the United States government arising
from allegations that we improperly billed Medicare for a small
number of transports for which we performed paramedic intercept
services, even though we were not the transport provider.
Although we believe AMR currently has procedures in place to
assure that we do not bill Medicare for paramedic intercept
services we provide, we cannot assure you that enforcement
agencies will not find that we have failed to comply with these
requirements.
Patient Signatures. Medicare regulations require that
providers obtain the signature of the patient or, if the patient
is unable to provide a signature, the signature of a
representative, prior to submitting a claim for payment from
Medicare. An exception exists for situations where it is not
reasonably possible to do so, provided that the reason for the
exception is clearly documented. This requirement historically
has been difficult for ambulance companies and other emergency
medical services providers to meet, because even when the
patient is competent, the exigency of the situation often makes
it impracticable to obtain a signature. Although we believe AMR
currently has procedures in place to assure that these signature
requirements are met, we cannot assure you that enforcement
agencies will not find that we have failed to comply with these
requirements.
Physician Certification Statements. Under applicable
Medicare rules, ambulance providers are required to obtain a
certification of medical necessity from the ordering physician
in order to bill Medicare for repetitive non-emergency
transports provided to patients with chronic conditions, such as
end-stage renal disease. For certain other non-emergency
transports, ambulance providers are required to attempt to
obtain a certification of medical necessity from a physician or
certain other practitioners. In the event the provider is not
able to obtain such certification within 21 days, it may
submit a claim for the transport if it can document reasonable
attempts to obtain the certification. Acceptable documentation
includes any U.S. postal document (e.g., signed
return receipt or Postal Service Proof of Service Form) showing
that the ordering practitioner was sent a request for the
certification. Although we believe AMR currently has procedures
in place to assure we are in compliance with these requirements,
we cannot assure you that enforcement agencies will not find
that we have failed to comply.
Coordination of Benefits Rules. When our services are
covered by multiple third party payors, such as a primary and a
secondary payor, financial responsibility must be allocated
among the multiple payors in a process known as
coordination of benefits, or COB. The rules
governing COB are complex, particularly when one of the payors
is Medicare or another government program. Under these rules, in
some cases Medicare or other government payors can be billed as
a secondary payor only after recourse to a primary
payor (e.g., a liability insurer) has been exhausted. In
some instances, multiple payors may reimburse us an amount
which, in the aggregate, exceeds the amount to which we are
entitled. In such cases, we are obligated to process a refund.
If we improperly bill Medicare or other government payors as the
primary payor when that program should be billed as the
secondary payor, or if we fail to process a refund when
required, we may be subject to civil or criminal penalties.
Although we believe we currently have procedures in place to
assure that we comply with applicable COB rules, and that we
process refunds when we receive overpayments, we cannot assure
you that payors or enforcement agencies will not find that we
have violated these requirements.
Consequences of Noncompliance. In the event any of our
billing and collection practices, including but not limited to
those described above, violate applicable laws such as those
described below, we could be subject to refund demands and
recoupments. If our violations are deemed to be willful, knowing
or reckless, we may be subject to civil and criminal penalties
under the False Claims Act or other statutes, including
exclusion from federal and state healthcare programs. To the
extent that the complexity associated with billing for our
services causes delays in our cash collections, we assume the
financial risk of increased carrying costs associated with the
aging of our accounts receivable as well as increased potential
for bad debts which could have a material adverse effect on our
revenue, provision for uncompensated care and cash flow.
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Federal False Claims Act
Both federal and state government agencies have continued civil
and criminal enforcement efforts as part of numerous ongoing
investigations of healthcare companies, and their executives and
managers. Although there are a number of civil and criminal
statutes that can be applied to healthcare providers, a
significant number of these investigations involve the federal
False Claims Act. These investigations can be initiated not only
by the government but also by a private party asserting direct
knowledge of fraud. These qui tam whistleblower
lawsuits may be initiated against any person or entity alleging
such person or entity has knowingly or recklessly presented, or
caused to be presented, a false or fraudulent request for
payment from the federal government, or has made a false
statement or used a false record to get a claim approved.
Penalties for False Claims Act violations include fines ranging
from $5,500 to $11,000 for each false claim, plus up to three
times the amount of damages sustained by the federal government.
A False Claims Act violation may provide the basis for exclusion
from the federally-funded healthcare programs. In addition, some
states have adopted similar insurance fraud, whistleblower and
false claims provisions.
The government and some courts have taken the position that
claims presented in violation of the various statutes, including
the federal Anti-Kickback Statute and the Stark Law, described
below, can be considered a violation of the federal False Claims
Act based on the contention that a provider impliedly certifies
compliance with all applicable laws, regulations and other rules
when submitting claims for reimbursement.
Federal Anti-Kickback Statute
We are subject to the federal Anti-Kickback Statute. The
Anti-Kickback Statute is broadly worded and prohibits the
knowing and willful offer, payment, solicitation or receipt of
any form of remuneration in return for, or to induce,
(1) the referral of a person covered by Medicare, Medicaid
or other governmental programs, (2) the furnishing or
arranging for the furnishing of items or services reimbursable
under Medicare, Medicaid or other governmental programs or
(3) the purchasing, leasing or ordering or arranging or
recommending purchasing, leasing or ordering of any item or
service reimbursable under Medicare, Medicaid or other
governmental programs. Certain federal courts have held that the
Anti-Kickback Statute can be violated if one purpose
of a payment is to induce referrals. Violations of the
Anti-Kickback Statute can result in exclusion from Medicare,
Medicaid or other governmental programs as well as civil and
criminal penalties, including fines of up to $50,000 per
violation and three times the amount of the unlawful
remuneration. Imposition of any of these remedies could have a
material adverse effect on our business, financial condition and
results of operations.
In addition to a few statutory exceptions, the OIG has published
safe harbor regulations that outline categories of activities
that are deemed protected from prosecution under the
Anti-Kickback Statute provided all applicable criteria are met.
The failure of a financial relationship to meet all of the
applicable safe harbor criteria does not necessarily mean that
the particular arrangement violates the Anti-Kickback Statute.
In order to obtain additional clarification on arrangements that
may not be subject to a statutory exception or may not satisfy
the criteria of a safe harbor, Congress established a process
under the Health Insurance Portability and Accountability Act of
1996 in which parties can seek an advisory opinion from the OIG.
We and others in the healthcare community have taken advantage
of the advisory opinion process, and a number of advisory
opinions have addressed issues that pertain to our various
operations, such as discounted ambulance services being provided
to skilled nursing facilities, patient co-payment
responsibilities, compensation methodologies under a management
services arrangement, and ambulance restocking arrangements. In
a number of these advisory opinions the government concluded
that such arrangements could be problematic if the requisite
intent were present. Although advisory opinions are binding only
on HHS and the requesting party or parties, when new advisory
opinions are issued, regardless of the requestor, we review them
and their application to our operations as part of our ongoing
corporate compliance program and endeavor to make appropriate
changes where we perceive the need to do so. See
Corporate Compliance Program and Corporate
Integrity Obligations.
Health facilities such as hospitals and nursing homes refer two
categories of ambulance transports to us and other ambulance
companies: (1) transports for which the facility must pay
the ambulance company, and
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(2) transports which the ambulance company can bill
directly to Medicare or other public or private payors. In
Advisory Opinion 99-2, which we requested, the OIG addressed the
issue of whether substantial contractual discounts provided to
nursing homes on the transports for which the nursing homes are
financially responsible may violate the Anti-Kickback Statute
when the ambulance company also receives referrals of Medicare
and other government-funded transports. The OIG opined that such
discounts implicate the Anti-Kickback Statute if even one
purpose of the discounts is to induce the referral of the
transports paid for by Medicare and other federal programs. The
OIG further indicated that a violation may exist even if there
is no contractual obligation on the part of the facility to
refer federally funded patients, and even if similar discounts
are provided by other ambulance companies in the same
marketplace. Following our receipt of this Advisory Opinion in
March of 1999, we took steps to bring our contracts with health
facilities into compliance with the OIGs views. However,
the government has alleged that certain of our contracts in
effect in Texas, principally in periods prior to the issuance of
the Advisory Opinion, and possibly through 2001, violated the
Anti-Kickback Statute. Our contracting practices in Oregon and
possibly other jurisdictions may also be under investigation.
See American Medical
Response Legal Matters. We cannot assure
you that the OIG or other authorities will not find that our
discounting practices in such other jurisdictions, or for other
periods of time, violate the Anti-Kickback Statute.
The OIG has also addressed potential violations of the
Anti-Kickback Statute (as well as other risk areas) in its
Compliance Program Guidance for Ambulance Suppliers. In addition
to discount arrangements with health facilities, the OIG notes
that arrangements between local governmental agencies that
control 911 patient referrals and ambulance companies which
receive such referrals may violate the Anti-Kickback Statute if
the ambulance companies provide inappropriate remuneration in
exchange for such referrals. Although we believe we have
structured our arrangements with local agencies in a manner
which complies with the Anti-Kickback Statute, we cannot assure
you that enforcement agencies will not find that some of those
arrangements violate that statute.
Fee-Splitting; Corporate Practice of Medicine
EmCare employs or contracts with physicians or physician-owned
professional corporations to deliver services to our hospital
customers and their patients. We frequently enter into
management services contracts with these physicians and
professional corporations pursuant to which we provide them with
billing, scheduling and a wide range of other services, and they
pay us for those services out of the fees they collect from
patients and third-party payors. These activities are subject to
various state laws that prohibit the practice of medicine by
corporations and are intended to prevent unlicensed persons from
interfering with or influencing the physicians
professional judgment and the sharing of professional services
income with non-professional or business interests. Activities
other than those directly related to the delivery of healthcare
may be considered an element of the practice of medicine in many
states. Under the corporate practice of medicine restrictions of
certain states, decisions and activities such as scheduling,
contracting, setting rates and the hiring and management of
non-clinical personnel may implicate the restrictions on
corporate practice of medicine. In such states, we maintain
long-term management contracts with affiliated physician groups,
which employ or contract with physicians to provide physician
services. We believe that we are in material compliance with
applicable state laws relating to the corporate practice of
medicine and fee-splitting. However, regulatory authorities or
other parties, including our affiliated physicians, may assert
that, despite these arrangements, we are engaged in the
corporate practice of medicine or that our contractual
arrangements with affiliated physician groups constitute
unlawful fee-splitting. In this event, we could be subject to
adverse judicial or administrative interpretations, to civil or
criminal penalties, our contracts could be found legally invalid
and unenforceable or we could be required to restructure our
contractual arrangements with our affiliated physician groups.
Federal Stark Law
We are also subject to a provision of the Social Security Act,
commonly known as the Stark Law. Where applicable,
this law prohibits a physician from referring Medicare patients
to an entity providing
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designated health services if the physician or a
member of such physicians immediate family has a
financial relationship with the entity, unless an
exception applies. The penalties for violating the Stark Law
include the denial of payment for services ordered in violation
of the statute, mandatory refunds of any sums paid for such
services and civil penalties of up to $15,000 for each
violation, and twice the dollar value of each such service and
possible exclusion from future participation in the
federally-funded healthcare programs. A person who engages in a
scheme to circumvent the Stark Laws prohibitions may be
fined up to $100,000 for each applicable arrangement or scheme.
Although we believe that we have structured our agreements with
physicians so as to not violate the Stark Law and related
regulations, a determination of liability under the Stark Law
could have an adverse effect on our business, financial
condition and results of operations.
Other Federal Healthcare Fraud and Abuse Laws
We are also subject to other federal healthcare fraud and abuse
laws. Under the Health Insurance Portability and Accountability
Act of 1996, there are two additional federal crimes that could
have an impact on our business: Healthcare Fraud and
False Statements Relating to Healthcare Matters. The
Healthcare Fraud statute prohibits knowingly and recklessly
executing a scheme or artifice to defraud any healthcare benefit
program, including private payors. A violation of this statute
is a felony and may result in fines, imprisonment and/or
exclusion from government-sponsored programs. The False
Statements Relating to Healthcare Matters statute prohibits
knowingly and willfully falsifying, concealing or covering up a
material fact by any trick, scheme or device or making any
materially false, fictitious or fraudulent statement in
connection with the delivery of or payment for healthcare
benefits, items or services. A violation of this statute is a
felony and may result in fines and/or imprisonment. This statute
could be used by the government to assert criminal liability if
a healthcare provider knowingly fails to refund an overpayment.
Another statute, commonly referred to as the Civil Monetary
Penalties Law, imposes civil administrative sanctions for, among
other violations, inappropriate billing of services to federally
funded healthcare programs, inappropriately reducing hospital
care lengths of stay for such patients, and employing or
contracting with individuals or entities who are excluded from
participation in federally funded healthcare programs.
Although we intend and endeavor to conduct our business in
compliance with all applicable fraud and abuse laws, we cannot
assure you that our arrangements or business practices will not
be subject to government scrutiny or be found to violate
applicable fraud and abuse laws.
Administrative Simplification Provisions of the Health
Insurance Portability and Accountability Act of 1996
The Administrative Simplification Provisions of the Health
Insurance Portability and Accountability Act of 1996, or HIPAA,
required the Department of Health and Human Services, or HHS, to
adopt standards to protect the privacy and security of
health-related information. All healthcare providers were
required to be compliant with the new federal privacy
requirements enacted by HHS no later than April 14, 2003.
We believe we have taken reasonable measures to comply with
these requirements.
The HIPAA privacy requirements contain detailed requirements
regarding the use and disclosure of individually identifiable
health information. Improper use or disclosure of identifiable
health information covered by the HIPAA privacy regulations can
result in the following civil and criminal penalties:
(1) civil money penalties for HIPAA privacy violations are
$100 per incident, to a maximum of $25,000, per person, per
year, per standard violated; (2) a person who knowingly and
in violation of the HIPAA privacy regulations obtains
individually identifiable health information or discloses such
information to another person may be fined up to $50,000 and
imprisoned up to one year, or both; (3) if the offense is
committed under false pretenses, the fine may be up to $100,000
and imprisonment for up to five years; and (4) if the
offense is done with the intent to sell, transfer or use
individually identifiable health information for commercial
advantage, personal gain or malicious harm, the fine may be up
to $250,000 and imprisonment for up to ten years.
102
In addition to enacting the foregoing privacy requirements, HHS
issued a final rule creating security requirements for
healthcare providers and other covered entities on
February 20, 2003. The final security rule requires covered
entities to meet specified standards by April 25, 2005. The
security standards contained in the final rule do not require
the use of specific technologies (e.g., no specific
hardware or software is required), but instead require
healthcare providers and other covered entities to comply with
certain minimum security procedures in order to protect data
integrity, confidentiality and availability. We believe we have
taken reasonable steps to comply with these standards.
HIPAA also required HHS to adopt national standards establishing
electronic transaction standards that all healthcare providers
must use when submitting or receiving certain healthcare
transactions electronically. Although these standards were to
become effective October 2002, Congress extended the compliance
deadline until October 2003 for organizations, such as ours,
that submitted a request for an extension. We believe we have
taken reasonable steps to comply with these standards.
Fair Debt Collection Practices Act
Some of our operations may be subject to compliance with certain
provisions of the Fair Debt Collection Practices Act and
comparable statutes in many states. Under the Fair Debt
Collection Practices Act, a third party collection company is
restricted in the methods it uses to contact consumer debtors
and elicit payments with respect to placed accounts.
Requirements under state collection agency statutes vary, with
most requiring compliance similar to that required under the
Fair Debt Collection Practices Act. We believe we are in
substantial compliance with the Fair Debt Collection Practices
Act and comparable state statutes where applicable.
State Fraud and Abuse Provisions
We are subject to state fraud and abuse statutes and
regulations. Most of the states in which we operate have adopted
a form of anti-kickback law, almost all of those states also
have adopted self-referral laws and some have adopted separate
false claims or insurance fraud provisions. The scope of these
laws and the interpretations of them vary from state to state
and are enforced by state courts and regulatory authorities,
each with broad discretion. Generally, state laws cover all
healthcare services and not just those covered under a
federally-funded healthcare program. A determination of
liability under such laws could result in fines and penalties
and restrictions on our ability to operate in these
jurisdictions.
Although we intend and endeavor to conduct our business in
compliance with all applicable fraud and abuse laws, we cannot
assure you that our arrangements or business practices will not
be subject to government scrutiny or be found to violate
applicable fraud and abuse laws.
Licensing, Certification, Accreditation and Related Laws and
Guidelines
In certain jurisdictions, changes in our ownership structure
require pre-or post-notification to governmental licensing and
certification agencies. Relevant laws and regulations may also
require re-application and approval to maintain or renew our
operating authorities or require formal application and approval
to continue providing services under certain government
contracts. For example, in connection with our acquisition of
AMR from Laidlaw, two of our subsidiaries were required to apply
for state and local ambulance operating authority in New York.
See Risk Factors Risk Factors Related to
Healthcare Regulation Changes in our ownership
structure and operations require us to comply with numerous
notification and reapplication requirements in order to maintain
our licensure, certification or other authority to operate, and
failure to do so, or an allegation that we have failed to do so,
can result in payment delays, forfeiture of payment or civil and
criminal penalties.
We and our affiliated physicians are subject to various federal,
state and local licensing and certification laws and regulations
and accreditation standards and other laws, relating to, among
other things, the adequacy of medical care, equipment, personnel
and operating policies and procedures. We are also subject to
periodic inspection by governmental and other authorities to
assure continued compliance with the various standards
103
necessary for licensing and accreditations. Failure to comply
with these laws and regulations could result in our services
being found to be non-reimbursable or prior payments being
subject to recoupment, and can give rise to civil or criminal
penalties. We are pursuing steps we believe we must take to
retain or obtain all requisite licensure and operating
authorities. While we have made reasonable efforts to
substantially comply with federal, state and local licensing and
certification laws and regulations and standards as we interpret
them, we cannot assure you that agencies that administer these
programs will not find that we have failed to comply in some
material respects.
Because we perform services at hospitals and other types of
healthcare facilities, we and our affiliated physicians may also
be subject to laws which are applicable to those entities. For
example, our operations are impacted by the Emergency Medical
Treatment and Active Labor Act of 1986, which prohibits
patient dumping by requiring hospitals and hospital
emergency departments and others to assess and stabilize any
patient presenting to the hospitals emergency department
or urgent care center requesting care for an emergency medical
condition, regardless of the patients ability to pay. Many
states in which we operate have similar state law provisions
concerning patient dumping. Violations of the Emergency Medical
Treatment and Active Labor Act of 1986 can result in civil
penalties and exclusion of the offending physician from the
Medicare and Medicaid programs.
In addition to the Emergency Medical Treatment and Active Labor
Act of 1986 and its state law equivalents, significant aspects
of our operations are affected by state and federal statutes and
regulations governing workplace health and safety, dispensing of
controlled substances and the disposal of medical waste. Changes
in ethical guidelines and operating standards of professional
and trade associations and private accreditation commissions
such as the American Medical Association and the Joint
Commission on Accreditation of Healthcare Organizations may also
affect our operations. We believe our operations as currently
conducted are in substantial compliance with these laws and
guidelines.
EmCares professional liability insurance program, under
which insurance is provided for most of our affiliated medical
professionals and professional and corporate entities, is
reinsured through our wholly-owned subsidiary, EMCA Insurance
Company, Ltd. The activities associated with the business of
insurance, and the companies involved in such activities, are
closely regulated. Failure to comply with applicable laws and
regulations can result in civil and criminal fines and penalties
and loss of licensure. While we have made reasonable efforts to
substantially comply with these laws and regulations, and
utilize licensed insurance professionals where necessary and
appropriate, we cannot assure you that we will not be found to
have violated these laws and regulations in some material
respects.
Antitrust Laws
Antitrust laws such as the Sherman Act and state counterparts
prohibit anticompetitive conduct by separate competitors, such
as price fixing or the division of markets. Our physician
contracts include contracts with individual physicians and with
physicians organized as separate legal professional entities
(e.g., professional medical corporations). Antitrust laws
may deem each such physician/entity to be separate, both from
EmCare and from each other and, accordingly, each such
physician/practice is subject to antitrust laws that prohibit
anti-competitive conduct between or among separate legal
entities or individuals. Although we believe we have structured
our physician contracts to substantially comply with these laws,
we cannot assure you that antitrust regulatory agencies or a
court would not find us to be non-compliant.
Corporate Compliance Program and Corporate Integrity
Obligations
We have developed a corporate compliance program in an effort to
monitor compliance with federal and state laws and regulations
applicable to healthcare entities, to ensure that we maintain
high standards of conduct in the operation of our business and
to implement policies and procedures so that employees act in
compliance with all applicable laws, regulations and company
policies. Our program also attempts to monitor compliance with
our Corporate Compliance Plan, which details our standards for:
(1) business ethics, (2) compliance with applicable
federal, state and local laws, and (3) business conduct. We
have an Ethics and
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Compliance Department whose focus is to prevent, detect and
mitigate regulatory risks. We attempt to accomplish this mission
through:
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providing guidance, education and proper controls based on the
regulatory risks associated with our business model and
strategic plan, |
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conducting internal audits and reviews to identify any improper
practices that may be occurring, |
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resolving regulatory matters, and |
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enhancing the ethical culture and leadership of the organization. |
The OIG has issued a series of Compliance Program Guidance
documents in which the OIG has set out the elements of an
effective compliance program. We believe our compliance program
has been structured appropriately in light of this guidance. The
primary compliance program components recommended by the OIG,
all of which we have attempted to implement, include:
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formal policies and written procedures, |
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designation of a Compliance Officer, |
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education and training programs, |
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internal monitoring and reviews, |
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responding appropriately to detected misconduct, |
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open lines of communication, and |
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discipline and accountability. |
Our corporate compliance program is based on the overall goal of
promoting a culture that encourages employees to conduct
activities with integrity, dignity and care for those we serve,
and in compliance with all applicable laws and policies.
Notwithstanding the foregoing, we audit compliance with our
compliance program on a sample basis. Although such an approach
reflects a reasonable and accepted approach in the industry, we
cannot assure you that our program will detect and rectify all
compliance issues in all markets and for all time periods.
As do other healthcare companies which operate effective
compliance programs, from time to time we identify practices
that may have resulted in Medicare or Medicaid overpayments or
other regulatory issues. For example, we have previously
identified situations in which we may have inadvertently
utilized incorrect billing codes for some of the services we
have billed to government programs such as Medicare or Medicaid.
In such cases, it is our practice to disclose the issue to the
affected government programs and, if appropriate, to refund any
resulting overpayments. The government usually accepts such
disclosures and repayments without taking further enforcement
action, and we generally expect that to be the case with respect
to our past and future disclosures and repayments. However, it
is possible that such disclosures or repayments will result in
allegations by the government that we have violated the False
Claims Act or other laws, leading to investigations and possibly
civil or criminal enforcement actions.
When the United States government settles a case involving
allegations of billing misconduct with a healthcare provider, it
typically requires the provider to enter into a Corporate
Integrity Agreement, or CIA, with the OIG. As a condition to
settlement of two government investigations, certain of our
operations are subject to CIAs with the OIG. As part of these
CIAs, AMR was required to establish and maintain a compliance
program that includes the following elements: (1) a
compliance officer and committee, (2) written standards
including a code of conduct and policies and procedures,
(3) general and specific training and education,
(4) claims review by an independent review organization,
(5) disclosure program for reporting of compliance issues
or questions, (6) screening and removal processes for
ineligible persons, (7) notification of
105
government investigations or legal proceedings and
(8) reporting of overpayments and other reportable
events.
If we fail or if we are accused of failing to comply with the
terms of the settlements, we may be subject to additional
litigation or other government actions, including being excluded
from participating in the Medicare program and other federal
healthcare programs.
See Risk Factors Risk Factors Related to
Healthcare Regulation for additional information related
to regulatory matters.
106
MANAGEMENT
Directors, Executive Officers and Key Employees
The following table sets forth information regarding our
directors and executive officers.
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Name |
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Age | |
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Position* |
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| |
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William A. Sanger
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55 |
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Director, Chairman and Chief Executive Officer |
Don S. Harvey
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48 |
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Director, President and Chief Operating Officer |
Randel G. Owen
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46 |
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Chief Financial Officer |
Dighton C. Packard, M.D.
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57 |
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Chief Medical Officer |
Todd G. Zimmerman
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40 |
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General Counsel |
Robert M. Le Blanc
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39 |
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Lead Director |
Steven B. Epstein
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62 |
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Director |
James T. Kelly
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59 |
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Director |
Michael L. Smith
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57 |
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Director |
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* |
Unless otherwise noted, the positions identified are the
positions held with the general partner of Emergency Medical
Services L.P. prior to this offering and with Emergency Medical
Services Corporation following this offering. |
William A. Sanger has been a director, chairman and Chief
Executive Officer of Emergency Medical Services Corporation
since February 10, 2005. Mr. Sanger was appointed
President of EmCare in 2001 and Chief Executive Officer of AMR
and EmCare in June 2002. Mr. Sanger is a co-founder of
BIDON Companies where he has been a Managing Partner since 1999.
Mr. Sanger served as President and Chief Executive Officer
of Cancer Treatment Centers of America, Inc. from 1997 to 2001.
From 1994 to 1997, Mr. Sanger was co-founder and Executive
Vice President of PhyMatrix Corp., then a publicly traded
diversified health services company. In addition,
Mr. Sanger was president and chief executive officer of
various other healthcare entities, including JFK Health Care
System. Mr. Sanger has an MBA from the Kellogg School of
Management at Northwestern University. Mr. Sanger has been
a leader in the healthcare industry for more than three decades.
Don S. Harvey has been President and Chief Operating
Officer of Emergency Medical Services Corporation since
February 10, 2005, and was elected a director of Emergency
Medical Services Corporation in July 2005. Mr. Harvey
joined EmCare as an executive officer in 2001 and was appointed
President in June 2002. Mr. Harvey is a co-founder of BIDON
Companies where he has been a Managing Partner since 1999. Prior
to that, he served as President of the Eastern Region of Cancer
Treatment Centers of America, Inc. from 1997 to 1999. Prior to
that, Mr. Harvey was an executive officer of PhyMatrix
Corp. and Executive Vice President of JFK Healthcare System.
Mr. Harvey is a director of several organizations,
including the emergency medicine industry trade association
EDPMA. Mr. Harvey has a Master of Science degree from Nova
Southeastern University. Mr. Harvey has more than
20 years of experience in healthcare services serving the
public, governmental and private markets.
Randel G. Owen has been Chief Financial Officer of
Emergency Medical Services Corporation since February 10,
2005. Mr. Owen was appointed Executive Vice President and
Chief Financial Officer of AMR in March 2003. He joined EmCare
in July 1999 and served as Executive Vice President and Chief
Financial Officer from June 2001 to March 2003. Before joining
EmCare, Mr. Owen was Vice President of Group Financial
Operations for PhyCor, Inc. in Nashville, Tennessee from 1995 to
1999. Mr. Owen has more than 20 years of financial
experience in the health care industry. Mr. Owen received
an accounting degree from Abilene Christian University.
Dighton C. Packard, M.D. has been Chief Medical
Officer of EmCare since 1990 and became Chief Medical Officer of
Emergency Medical Services Corporation in April 2005.
Dr. Packard is also the Chairman of the Department of
Emergency Medicine at Baylor University Medical Center in
Dallas, Texas and a member of the Board of Trustees for Baylor
University Medical Center and for Baylor Heart and Vascular
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Hospital. Dr. Packard has practiced emergency medicine for
more than 25 years. He received his BS from Baylor
University at Waco and his MD from the University of Texas
Medical School at San Antonio.
Todd G. Zimmerman has been General Counsel of Emergency
Medical Services Corporation since February 10, 2005.
Mr. Zimmerman was appointed General Counsel and Executive
Vice President of EmCare in July 2002 and of AMR in May 2004.
Mr. Zimmerman joined EmCare in October 1997 in connection
with EmCares acquisition of Spectrum Emergency Care, Inc.
where he served as Corporate Counsel. Prior to joining Spectrum
in 1997, Mr. Zimmerman worked in the private practice of
law for seven years, providing legal advice and support to
various large corporations. Mr. Zimmerman received his BS
in Business Administration from St. Louis University and
his J.D. from the University of Virginia School of Law.
Robert M. Le Blanc has served as Managing Director of
Onex Investment Corp., an affiliate of Onex Corporation, a
diversified industrial corporation, since 1999. Prior to joining
Onex in 1999, he was with Berkshire Hathaway for seven years.
From 1988 to 1992, Mr. Le Blanc held numerous positions
with GE Capital, with responsibility for corporate finance and
corporate strategy. Mr. Le Blanc serves as a Director of
Magellan Health Services, Inc., Res-Care, Inc., Center for
Diagnostic Imaging, Inc. and First Berkshire Hathaway Life.
Mr. Le Blanc became a director of Emergency Medical
Services Corporation in December 2004.
Steven B. Epstein became a director of Emergency Medical
Services Corporation in July 2005. Mr. Epstein is the
founder and senior healthcare partner of the law firm of Epstein
Becker & Green, P.C. Epstein Becker &
Green, P.C. generally is recognized as one of the
countrys leading healthcare law firms. Mr. Epstein
serves as a legal advisor to healthcare entities throughout the
U.S. Mr. Epstein received his B.A. from Tufts
University, where he serves on the Board of Trustees and the
Executive Committee, and his J.D. from Columbia Law School,
where he serves as Chairman of the Law Schools Board of
Visitors. In addition, Mr. Epstein serves as a director of
many healthcare companies and venture capital and private equity
firms, including HealthExtras, Inc. (a pharmacy benefit company).
James T. Kelly became a director of Emergency Medical
Services Corporation in July 2005. From 1986 to 1996,
Mr. Kelly served as President and Chief Executive Officer
of Lincare Holding Inc., and he served as Chairman of the Board
of Lincare from 1994 to 2000. Lincare is a publicly traded
company that provides respiratory care, infusion therapy and
medical equipment to patients in the home. Prior to joining
Lincare, Mr. Kelly was with Union Carbide Corporation for
19 years, where he served in various management positions.
Mr. Kelly also serves as a director of American Dental
Partners, Inc. (a provider of dental management services) and
HMS Holdings Corp. (a provider of consulting and business office
outsourcing and reimbursement services to healthcare providers).
Michael L. Smith became a director of Emergency Medical
Services Corporation in July 2005. Mr. Smith served as
Executive Vice President and Chief Financial and Accounting
Officer of Anthem, Inc. and its subsidiaries, Anthem Blue Cross
and Blue Shield, from 2001 until his retirement in January 2005.
Mr. Smith was Executive Vice President and Chief Financial
Officer of Anthem Insurance from 1999, and from 1996 to 1998 he
served as Chief Operating Officer and Chief Financial Officer of
American Health Network Inc., then a subsidiary of Anthem.
Mr. Smith was Chairman, President and Chief Executive
Officer of Mayflower Group, Inc. (a transportation company) from
1989 to 1995, and held various other management positions with
that company from 1974 to 1989. Mr. Smith also serves as a
director of First Indiana Corporation and its principal
subsidiary, First Indiana Bank, Finishmaster, Inc. (auto paint
distribution), InterMune, Inc. (a biopharmaceutical company) and
Kite Realty Group Trust (a retail property REIT). Mr. Smith
also serves as a member of the Board of Trustees of DePauw
University, a Trustee of the Indianapolis Museum of Art and a
Trustee of the Michigan Maritime Museum.
Key Employees
Steve Murphy has been appointed Senior Vice President of
Government and National Services for Emergency Medical Services
Corporation effective December 1, 2005. He has served in
that role with AMR since 2003. Prior to joining AMR in 1989,
Mr. Murphy was National Vice President of Government
Relations for CareLine Inc. and MedTrans, Inc., President and
Chief Operating Officer of Pruner Health Services, Inc. and
Chief Administrative Officer for Pruners Napa Ambulance
Service, Inc. Mr. Murphy has
108
been active in emergency medical services and the ambulance
industry for more than 30 years. He holds a Registered
Nursing Degree and has been certified as a Certified Emergency
Nurse and Mobile Intensive Care Nurse.
Kimberly Norman has been appointed Senior Vice President
of Human Resources of Emergency Medical Services Corporation
effective December 1, 2005. Ms. Norman joined
MedTrans, Inc. in June 1991 and joined AMR in 1997, when it
merged with MedTrans. She has held various human resource
positions for AMR, including Benefits Specialist, Manager of
Human Resources and Employee Development, and Regional and
National Vice President of Human Resources. Ms. Norman
received her B.B.M. from the University of Phoenix and a Human
Resource Management Certification from San Diego State
University.
Steve Ratton, Jr. has been Treasurer of Emergency
Medical Services Corporation since February 2005 and has been
appointed Senior Vice President effective December 1, 2005.
Mr. Ratton joined EmCare in April 2003 as Executive Vice
President and Chief Financial Officer. Prior to joining EmCare,
Mr. Ratton served as Treasurer for Radiologix, Inc. from
September 2001 to April 2003. Mr. Ratton was Vice President
of Finance for Matrix Rehabilitation, Inc. from August 2000 to
September 2001, and Director of Finance for PhyCor, Inc. from
April 1998 to August 2000. Mr. Ratton has more than
20 years of experience in the healthcare industry, in both
hospital and physician settings. Mr. Ratton has an
accounting degree from the University of Texas at El Paso.
William Tara has been appointed Senior Vice President and
Chief Information Officer of Emergency Medical Services
Corporation effective December 1, 2005. Mr. Tara
joined AMR as Chief Information Officer in February 2003. Before
joining AMR, Mr. Tara was Vice President and Chief
Information Officer for Teletech Holdings, Inc. from 1999 to
February 2003, responsible for global technology, including
software development, professional services and technology
operations in 13 countries supporting 30,000 employees.
Mr. Tara received his B.S. from the University of
California and a Masters Degree in Business from Cornell
University.
Joseph Taylor has been appointed Executive Vice President
of National Sales and Marketing of Emergency Medical Services
Corporation effective December 1, 2005. Mr. Taylor was
appointed Executive Vice President, National Sales and Marketing
of EmCare in 1997 and President of EmCare Physician Services in
2002. Prior to joining EmCare, Mr. Taylor served as
Executive Vice President for Spectrum Emergency Care, Inc.,
until the company was acquired by EmCare in October 1997.
Mr. Taylor has been in senior healthcare management and
emergency medicine operations for 13 years. Mr. Taylor
previously served as Regional Vice President and Vice President
Worldwide marketing for Unisys, a worldwide information systems
company. Mr. Taylor graduated cum laude with a B.S. in
Business Administration from the University of West Florida and
completed the Executive Corporate Management Program of the
Wharton School of Finance.
Except as described in this prospectus, there are no
arrangements or understandings between any member of the board
of directors or executive officer or any key employee and any
other person pursuant to which that person was elected or
appointed to his or her position.
Our board of directors has the power to appoint our executive
officers. Each executive officer will hold office for the term
determined by the board of directors and until such
persons successor is chosen or until such persons
death, resignation or removal.
Mr. Le Blanc is serving as our Lead Director. In that role,
his primary responsibility is to preside over periodic executive
sessions of our board of directors in which management directors
and other members of management do not participate, and he has
the authority to call meetings of the non-management directors.
The Lead Director also chairs certain portions of board
meetings, serves as liaison between the Chairman of the Board
and the non-management directors, and develops, together with
the Chairman, the agenda for board meetings. The Lead Director
will also perform other duties the board delegates from time to
time to assist the board in fulfilling its responsibilities.
There are no family relationships among any of our directors and
executive officers.
109
Composition of the Board of Directors after this Offering
Our certificate of incorporation, as in effect upon completion
of this offering, will provide for a classified board of
directors consisting of three staggered classes of directors, as
nearly equal in number as possible. At each annual meeting of
stockholders, a class of directors will be elected for a
three-year term to succeed the directors of the same class whose
terms are then expiring. The terms of the directors will expire
upon election and qualification of successor directors at the
annual meeting of stockholders to be held during the years 2006
for the Class I directors, 2007 for the Class II
directors and 2008 for the Class III directors.
Effective upon the closing of this offering, our board of
directors will consist of six members, classified as follows:
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our Class I directors will be Messrs. Le Blanc and
Sanger, |
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our Class II directors will be Messrs. Epstein and
Kelly, and |
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our Class III directors will be Messrs. Harvey and
Smith. |
Our by-laws, as in effect immediately prior to this offering,
will provide that the authorized number of directors, which will
be six at the time of this offering, may be changed by a
resolution adopted by at least a majority of our directors then
in office. Any additional directorships resulting from an
increase in the number of directors may only be filled by the
directors and will be distributed among the three classes so
that, as nearly as possible, each class will consist of
one-third of the directors. This classification of our board of
directors could have the effect of delaying or preventing
changes in control or changes in our management.
Following the consummation of this offering, we will be deemed
to be a controlled company under the rules of the
NYSE, and we will qualify for, and intend to rely upon, the
controlled company exception to the board of
directors and committee composition requirements under the rules
of the NYSE. Pursuant to this exception, we will be exempt from
the rules that would otherwise require that our board of
directors be comprised of a majority of independent
directors and that our executive compensation and
corporate governance and nominating committees be comprised
solely of independent directors, as defined under
the rules of the NYSE. The controlled company
exception does not modify the independence requirements for the
audit committee, and we intend to comply with the requirements
of the Sarbanes-Oxley Act of 2002 and the NYSE rules, which
require that our audit committee be comprised of independent
directors exclusively.
Upon the completion of this offering, our board will consist of
six directors, three of whom will qualify as
independent according to the rules and regulations
of the SEC and the New York Stock Exchange.
Committees of the Board of Directors
Prior to the completion of this offering, our board of directors
will have established an audit committee, a compensation
committee, a corporate governance and nominating committee and a
compliance committee. The composition, duties and
responsibilities of these committees are set forth below.
Committee members will hold office for a term of one year.
Audit Committee. The audit committee is responsible for
(1) selecting the independent auditor, (2) approving
the overall scope of the audit, (3) assisting the board of
directors in monitoring the integrity of our financial
statements, the independent accountants qualifications and
independence, the performance of the independent accountants and
our internal audit function and our compliance with legal and
regulatory requirements, (4) annually reviewing our
independent auditors report describing the auditing
firms internal quality-control procedures, and any
material issues raised by the most recent internal
quality-control review, or peer review, of the auditing firm,
(5) discussing the annual audited financial and quarterly
statements with management and the independent auditor,
(6) discussing earnings press releases, as well as
financial information and earnings guidance provided to analysts
and rating agencies, (7) discussing policies with respect
to risk assessment and risk management, (8) meeting
separately, periodically, with management, internal auditors and
the independent auditor, (9) reviewing with the independent
auditor any audit problems or difficulties and managements
response, (10) setting clear hiring policies for employees
or former employees of the independent auditors,
(11) handling such other matters that are specifically
delegated to the
110
audit committee by the board of directors from time to time and
(12) reporting regularly to the full board of directors.
Upon completion of this offering, our audit committee will
consist of Messrs. Epstein, Kelly and Smith, with
Mr. Smith serving as chairman of the committee. At our
first board meeting following this offering, our board of
directors will identify which of these persons is an audit
committee financial expert, as such term is defined in
Item 401(h) of Regulation S-K. Messrs. Kelly and
Smith have been determined to be independent. Although
Mr. Epstein has also been determined to be an independent
director under the NYSE rules, he is not independent
under the SEC rules applicable to our audit committee because we
recently engaged the law firm of which he is a partner to
perform legal services for us. Within one year of the date of
this prospectus, we will be required to appoint another director
who is independent under these SEC rules to replace
Mr. Epstein on the audit committee.
Compensation Committee. The compensation committee is
responsible for (1) reviewing key employee compensation
policies, plans and programs, (2) reviewing and approving
the compensation of our executive officers, (3) reviewing
and approving employment contracts and other similar
arrangements between us and our executive officers,
(4) reviewing and consulting with the chief executive
officer on the selection of officers and evaluation of executive
performance and other related matters, (5) administration
of stock plans and other incentive compensation plans and
(6) such other matters that are specifically delegated to
the compensation committee by the board of directors from time
to time.
Upon completion of this offering, our compensation committee
consists of Messrs. Kelly, Le Blanc and Smith, with
Mr. Kelly serving as chairman.
Corporate Governance and Nominating Committee. Our
corporate governance and nominating committees purpose
will be to assist our board of directors by identifying
individuals qualified to become members of our board consistent
with the criteria set by our board and to develop our corporate
governance principles. This committees responsibilities
will include: (1) evaluating the composition, size and
governance of our board of directors and its committees and
making recommendations regarding future planning and the
appointment of directors to our committees,
(2) establishing a policy for considering stockholder
nominees for election to our board of directors,
(3) recommending ways to enhance communications and
relations with our stockholders, (4) evaluating and
recommending candidates for election to our board of directors,
(5) overseeing our board of directors performance and
self-evaluation process and developing continuing education
programs for our directors, (6) reviewing our corporate
governance principles and providing recommendations to the board
of directors regarding possible changes, and (7) reviewing
and monitoring compliance with our code of ethics and our
insider trading policy.
Upon completion of this offering, all of our directors will be
members of our corporate governance and nominating committee.
Mr. Epstein will serve as chairman of the committee.
Compliance Committee. Our compliance committee is
responsible for overseeing our Corporate Compliance Program. The
committees responsibilities include oversight of our
processes for maintaining and monitoring compliance with federal
and state laws applicable to healthcare entities. The specific
functions overseen by the committee include our procedures for
(1) providing guidance and education to our workforce,
(2) performing compliance audits, (3) resolving
regulatory matters that come to our attention through our
compliance hotline, our audit activities or contacts from
government agencies and (4) enhancing the ethical culture
and leadership of our organization. Our compliance officers, who
supervise our Ethics and Compliance Department, will report
directly to the compliance committee and will meet with it on a
regular basis.
Upon completion of this offering, our compliance committee will
consist of Messrs. Epstein, Le Blanc and Smith, with Mr. Le
Blanc serving as chairman.
Other Committees. Our board of directors may establish
other committees as it deems necessary or appropriate from time
to time.
The compensation arrangements for our Chief Executive Officer
and each of our named executive officers were established
pursuant to the terms of the respective employment agreements
between us and each executive officer. The terms of the
employment agreements were established pursuant to arms-length
negotiations between a representative of Onex and each executive
officer.
111
None of our executive officers serves, and we anticipate that
none will serve, as a member of the board of directors or
compensation committee of any entity that has one or more
executive officers that serves on our board of directors or
compensation committee.
Following this offering, directors who are not our employees
will receive an annual cash payment of $35,000, payable
quarterly, $2,000 for each board meeting attended in person and
$1,000 for each board meeting attended via conference call, and
$1,000 and $500, respectively, for each committee meeting
attended in person or via conference call. The chair of the
audit committee and the compensation committee will receive an
additional $15,000 and $10,000, respectively. Consistent with
corporate policy, Mr. Le Blanc, as chairman of the
compliance committee, will receive no compensation for his
services to the company. When they were elected to the board, we
granted to each of Messrs. Epstein, Kelly and Smith an
option to purchase 3,750 shares of class A common
stock at an exercise price of $6.67 per share, with the
same vesting schedule as is applicable to our executive
officers. See Management Option Grants and
Stock Awards. All directors are reimbursed for their
out-of-pocket expenses incurred in connection with such services.
Executive Compensation
The following table sets forth the compensation of our chief
executive officer and the four other most highly compensated
executive officers during fiscal 2004. We refer to these
officers as our named executive officers.
Summary Compensation Table
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Annual Compensation | |
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Other Annual | |
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Long-Term | |
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All Other | |
Name and Principal Position(1) |
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Salary | |
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Bonus | |
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Compensation(2) | |
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Compensation Awards(3) | |
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Compensation(4) | |
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William A. Sanger
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2004 |
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$ |
571,411 |
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$ |
488,750 |
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$ |
9,957 |
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Chief Executive Officer of AMR and of EmCare |
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Don S. Harvey
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2004 |
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$ |
391,667 |
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$ |
337,500 |
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$ |
3,925 |
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President and Chief Operating Officer of EmCare |
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Randel G. Owen
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2004 |
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$ |
286,422 |
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$ |
117,500 |
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$ |
55,944(5 |
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$ |
35,245 |
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$ |
7,745 |
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Chief Financial Officer of AMR |
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Dighton C. Packard, M.D.
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2004 |
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$ |
211,467 |
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$ |
83,200 |
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$ |
21,333 |
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$ |
4,571 |
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Chief Medical Officer of EmCare |
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Todd G. Zimmerman
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2004 |
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$ |
201,955 |
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$ |
146,997 |
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$ |
11,594 |
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$ |
5,157 |
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General Counsel of EmCare |
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(1) |
Represents each persons principal position in fiscal 2004.
All of these individuals became executive officers of Emergency
Medical Services in connection with our acquisition of AMR and
EmCare. |
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(2) |
In accordance with the rules of the SEC, other annual
compensation disclosed in this table does not include various
perquisites and other personal benefits received by a named
executive officer that does not exceed the lesser of $50,000 or
10% of such officers total annual salary and bonus
disclosed in this table. |
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(3) |
Represents the vesting of restricted share awards granted to the
named executive officers by Laidlaw on November 24, 2004,
as follows: Mr. Owen 1,900 shares;
Dr. Packard 1,150 shares;
Mr. Zimmerman 625 shares. In connection
with our acquisition of AMR and EmCare, these awards terminated
and no further restricted shares will vest. |
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(4) |
Represents matching contributions to company 401(k) plans. |
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(5) |
Other annual compensation for Mr. Owen includes a
relocation allowance of $47,544. |
Substantially all of our salaried employees, including our named
executive officers, participate in our 401(k) savings plans. We
maintain three 401(k) plans for eligible AMR employees.
Employees may contribute a maximum of 40% of their compensation
up to a maximum of $13,000. We match the contribution up to a
112
maximum of 3% to 6% of the employees salary per year,
depending on the plan. Eligible EmCare employees may elect to
contribute 1% to 25% of their annual compensation and we match
50% of the first 6% of base compensation that an employee
contributes.
Prior to our acquisition of AMR and EmCare, our named executive
officers participated in the Laidlaw, Inc. U.S. Supplemental
Executive Retirement Arrangement, or SERP. The benefit amount
payable under the plan at age 65 is based upon an
employees final average earnings. The form of the benefit
would be an annuity, guaranteed for five years. Based on the
number of years of service and their respective salaries prior
to the acquisition, the following are the total estimated
accrued values of future benefits payable under the Laidlaw SERP
to the named executive officers on retirement, calculated at
August 31, 2004: Mr. Sanger $169,532;
Mr. Harvey $69,782; Mr. Owen
$141,190; Dr. Packard $169,030; and
Mr. Zimmerman $92,481. No additional benefits
will accrue under the SERP. See Certain Relationships and
Related Party Transactions Transactions with
Laidlaw Management Bonuses in Connection with Our
Acquisition of AMR and EmCare for information relating to
amounts paid by Laidlaw to the named executive officers in
connection with our acquisition of AMR and EmCare.
Option Grants and Stock Awards
There were no stock option grants or restricted stock awards to
the named executive officers in fiscal 2004.
The following table sets forth information regarding options
granted to each of our named executive officers in February 2005
in connection with our acquisition of AMR and EmCare. Potential
realizable value is based upon the assumed initial public
offering of $16.00 per share, and is net of the exercise
price of $6.67 per share. The potential realizable value
set forth in the last column of the table is calculated based on
the term of the option at the time of the grant, which is ten
years. The assumed 5% and 10% rates of appreciation comply with
the rules of the SEC and do not represent our estimate of future
stock price. Actual gains, if any, on stock option exercises
will be dependent on future performance of our class A
common stock. We have not granted any stock appreciation rights
to any of the named executive officers.
The exercise price of each option listed below is equal to the
price paid per share by our initial investors. Each option may
be exercised only upon the vesting of such options. One-half of
the options held by each named executive officer vest ratably
over a four-year period as of the one-year anniversaries of the
grant (the 6-month anniversaries, in the case of
Mr. Sanger), and one-half vest ratably over the same period
but are exercisable only if a specified performance target is
met. See Equity Plans Equity
Option Plan. The percentage of total options is based upon
options to purchase an aggregate of 3,509,219 shares of
class A common stock granted to employees in the eight
months ended September 30, 2005 under the equity option
plan we adopted in connection with the acquisition of AMR and
EmCare. The terms of all option grants described below give
effect to adjustments to our capitalization that will be made in
connection with this offering. See Equity
Plans Equity Option Plans.
Option Grants in Fiscal 2005
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of Stock Price Appreciation | |
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for Option Term | |
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Employees in | |
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Exercise | |
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Fiscal Year | |
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Price | |
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Expiration Date(1) | |
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5% | |
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10% | |
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William A. Sanger
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1,482,168 |
(2) |
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42.2 |
% |
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$ |
6.67 |
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February 10, 2015 |
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$ |
4,943,030.28 |
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$ |
9,886,060.56 |
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Don S. Harvey
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370,542 |
(3) |
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10.6 |
% |
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$ |
6.67 |
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February 10, 2015 |
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1,235,757.57 |
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2,471,515.14 |
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Randel G. Owen
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370,542 |
(3) |
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10.6 |
% |
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$ |
6.67 |
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February 10, 2015 |
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1,235,757.57 |
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2,471,515.14 |
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Todd G. Zimmerman
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148,217 |
(3) |
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4.2 |
% |
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$ |
6.67 |
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February 10, 2015 |
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494,303.70 |
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988,607.39 |
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Dighton C. Packard, M.D.
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48,750 |
(3) |
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1.4 |
% |
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$ |
6.67 |
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February 10, 2015 |
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162,581.25 |
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325,162.50 |
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(1) |
The options may expire earlier, upon termination of employment
or certain corporate events. See Equity
Plans Equity Option Plan. If the
employees employment is terminated prior to
February 10, 2015, his options will expire earlier as
follows: (a) upon the termination of employment if the
termination is for cause, (b) 30 days
after the termination of employment, or such other |
113
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date as determined by the
compensation committee, following termination by the employee
for good reason or by us without cause
or due to retirement, or (c) 90 days after termination
of employment due to death or disability. Vesting of the options
may accelerate, and all options will terminate if not exercised,
upon (i) a sale of our equity (other than a sale as part of
an initial public offering) whereby any person other than
existing equity holders as of the grant date acquire our voting
power to elect a majority of our board of directors or
(ii) a sale of all or substantially all of our assets.
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|
|
(2) |
The options vest ratably on the first eight six-month
anniversaries of the grant date, provided, that the
exercisability of one-half of the options is conditioned upon
meeting certain specified performance targets. See
Equity Plans Equity Option Plan. If
Mr. Sanger is terminated, the options will vest as
scheduled to the nearest six-month anniversary of the grant date. |
|
(3) |
The options vest ratably on the first four anniversaries of the
grant date, provided, that the exercisability of one-half of the
options is conditioned upon meeting certain specified
performance targets. See Equity Plans
Equity Option Plan. |
None of the named executive officers held any stock options
during the fiscal year ended August 31, 2004 and none of
them held unexercised stock options at that date.
Employment Agreements
We have entered into employment agreements with
Messrs. Sanger, Harvey, Owen and Zimmerman, each effective
February 10, 2005, and with Dr. Packard effective
April 19, 2005. Mr. Sangers employment agreement
has a five-year term and Mr. Harveys employment
agreement has a four-year term. The employment agreements of
Mr. Owen, Mr. Zimmerman and Dr. Packard have a
three-year, a two-year term and a one-year term, respectively,
and renew automatically for successive one-year terms unless
either party gives notice at least 90 days prior to the
expiration of the then current term. Each executive has the
right to terminate his agreement on 90 days notice,
in which event he will be subject to the non-compete provisions
described below, provided he receives specified severance
benefits. The employment agreements include provisions for the
payment of an annual base salary as well as the payment of a
bonus based upon the achievement of performance criteria
established by our board of directors or, in the case of
Dr. Packard, our Chief Executive Officer or President. The
target bonus percentage, expressed as a percentage of annual
salary, set forth in each agreement represents the bonus amount
payable to the executive if all of the performance criteria are
achieved. The annual base salary of Mr. Sanger is subject
to annual review and adjustment after the second anniversary of
the effectiveness of the agreement. The annual base salary of
Messrs. Harvey, Owen and Zimmerman are subject to annual
review and adjustment after the first anniversary of the
effectiveness of the agreements. Dr. Packards base
salary is subject to a $100,000 increase if he reduces his
clinical activities and increases the time he provides services
to us.
If we terminate a named executive officers employment
without cause or any of them leaves after a change of control
for one of several specified reasons, we have agreed to continue
the executives base salary and provide his benefits for a
period of 24 months from the date of termination for
Messrs. Sanger, Harvey and Owen, 18 months for
Mr. Zimmerman, and 12 months for Dr. Packard.
These agreements contain non-competition and non-solicitation
provisions pursuant to which the executive agrees not to compete
with AMR or EmCare or solicit or recruit our employees for a
period from the date of termination for 24 months in the
case of Mr. Sanger, Mr. Harvey, Mr. Owen and
Dr. Packard and 12 months in the case of
Mr. Zimmerman.
The annual base salary and target bonus for each named executive
officer is as follows:
|
|
|
|
|
|
|
|
|
|
|
|
|
Target | |
|
|
Annual | |
|
Bonus | |
Executive |
|
Base Salary | |
|
Percentage | |
|
|
| |
|
| |
William A. Sanger
|
|
$ |
850,000 |
|
|
|
100 |
% |
Don S. Harvey
|
|
$ |
500,000 |
|
|
|
75 |
% |
Randel G. Owen
|
|
$ |
350,000 |
|
|
|
50 |
% |
Todd G. Zimmerman
|
|
$ |
325,000 |
|
|
|
50 |
% |
Dighton C. Packard, M.D.
|
|
$ |
260,000 |
|
|
|
50 |
% |
Pursuant to their employment agreements, effective
February 10, 2005, we granted options to purchase our
class A common stock to each named executive officer. See
Option Grants and Stock Awards and
Equity Plans Equity Option
Plan. The option grant to each of these named executive
officers was conditioned upon his investment in our equity in an
amount as indicated in his respective employment agreement.
114
Our executive employment agreements with Messrs. Sanger,
Harvey, Owen and Zimmerman include indemnification provisions.
Under those agreements, we agree to indemnify each of these
individuals against claims arising out of events or occurrences
related to that individuals service as our agent or the
agent of any of our subsidiaries to the fullest extent legally
permitted. Under Delaware law, an officer may be indemnified,
except to the extent any claim arises from conduct that was not
in good faith or in a manner reasonably believed to be in, or
not opposed to, our best interest or, with respect to any
criminal action or proceedings, there was reasonable cause to
believe such conduct was unlawful.
Equity Plans
We adopted our equity option plan in connection with the
acquisition of AMR and EmCare. In the eight months ended
September 30, 2005, we have granted options to purchase
3,509,219 shares of class A common stock under the
plan and at September 30, 2005 we have an additional
566,745 shares reserved for future grants.
The compensation committee of our board of directors, or the
board itself if there is no committee, administers the equity
option plan.
The plan provides that if Emergency Medical Services undergoes a
reorganization, recapitalization or other change in its equity,
the compensation committee may make adjustments to the plan in
order to prevent dilution of outstanding options. In connection
with this offering, each option to purchase one partnership unit
at a price of $10.00 per unit will be adjusted to become
the right to purchase 1.5 shares of class A common
stock at a price of $6.67 per share, and the option terms
we refer to give effect to these adjustments.
The options to purchase 3,509,219 shares of class A
common stock we have granted under the plan through
September 30, 2005 are non-qualified options for federal
income tax purposes. These options have the following terms:
|
|
|
|
|
exercise price equal to $6.67 per share, being the equity
purchase price paid by the initial investors, |
|
|
|
vesting ratably on each of the first four anniversaries of the
effective February 10, 2005 grant date (the first eight
6-month anniversaries in the case of Mr. Sanger),
provided, that the exercisability of one-half of the
options granted to each employee is subject to the further
condition that Onex has realized a 15% internal rate of return,
as defined, or, on the fourth anniversary of the grant date, we
have achieved an aggregate EBITDA of not less than
$617.4 million, subject to certain adjustments, for the
four fiscal years ending December 31, 2008, |
|
|
|
each option expires on the tenth anniversary of the grant date
unless the employees employment is terminated earlier, in
which case the options will expire as follows: (i) upon the
termination of employment if the termination is for
cause, (ii) 30 days after the termination
of employment, or such other date as determined by the
compensation committee, following termination by the employee
for good reason or by us without cause
or due to retirement, or (iii) 90 days after
termination of employment due to death or disability, and |
|
|
|
upon (i) a sale of the equity of Emergency Medical Services
(other than a sale as part of this offering) whereby any person
other than existing equity holders as of the grant date acquire
voting power to elect a majority of our board of directors or
(ii) a sale of all or substantially all of our assets, all
options granted to each employee will accelerate (although still
subject to the performance target) and will terminate if not
exercised. |
All options and Emergency Medical Services equity held by our
senior management are governed by agreements which:
|
|
|
|
|
restrict transfer of their equity until the fifth anniversary of
purchase, and |
|
|
|
grant piggyback registration rights. |
115
See Description of Capital Stock Equityholder
Agreements and Registration
Agreement for a description of the transfer restrictions
and piggyback registration rights.
|
|
|
Management Investment and Equity Purchase Plan |
In connection with our acquisition of AMR and EmCare, our named
executive officers and other members of management purchased an
aggregate of 915,750 shares of class A common stock.
See Certain Relationships and Related Party
Transactions Issuance of Shares. Approximately
160 employees and affiliated physicians, physician
assistants and nurse practitioners purchased in the aggregate an
additional 232,575 shares of class A common stock
pursuant to our equity purchase plan. The 1,148,325 shares
held by these investors, including our named executive officers,
are governed by equityholders agreements. These agreements
contain restrictions on transfer of the equity. See
Description of Capital Stock Equityholder
Agreements.
116
PRINCIPAL AND SELLING STOCKHOLDERS
The following table shows information with respect to the
beneficial ownership of our common stock as of November 30,
2005, giving effect to our reorganization as a holding company,
including the exchange of limited partnership units for
class A common stock and class B common stock, the
assumed exchange of LP exchangeable units for our class B
common stock, the 1.5-for-1 stock split, and as adjusted to
reflect the sale of our class A common stock being offered
in this offering, by:
|
|
|
|
|
each person known by us to own beneficially 5% or more of our
class A or class B common stock, |
|
|
|
each of our directors, |
|
|
|
each of our named executive officers, and |
|
|
|
all of our directors and executive officers as a group. |
In addition, up to 1,170,000 LP exchangeable units owned by
the Onex entities may be exchanged for shares of our
class B common stock, converted into class A common
stock and sold if the underwriters exercise their over-allotment
option, as set forth in this section. No members of management,
and no other stockholder, is selling common stock as a part of
this offering.
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Before Offering | |
|
After Offering | |
|
|
| |
|
| |
|
|
Number of | |
|
Percentage | |
|
|
|
Percentage | |
|
|
|
|
Shares | |
|
of Class/All | |
|
Percentage | |
|
of Class/All | |
|
Percentage | |
|
|
Beneficially | |
|
Common | |
|
of Voting | |
|
Common | |
|
of Voting | |
Name of Beneficial Owner |
|
Owned(1)(2) | |
|
Stock | |
|
Power | |
|
Stock | |
|
Power | |
|
|
| |
|
| |
|
| |
|
| |
|
| |
Five Percent Stockholders
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Onex Corporation(3)
|
|
|
32,107,523 |
|
|
|
99.6%/ |
96.1% |
|
|
|
|
|
|
99.6%/ |
77.9% |
|
|
|
|
|
|
|
class B |
|
|
|
|
|
|
|
98.9% |
|
|
|
|
|
|
|
96.6% |
|
Onex Partners LP(4)
|
|
|
17,226,723 |
|
|
|
53.5%/ |
51.6% |
|
|
|
|
|
|
53.6%/ |
41.8% |
|
|
|
|
|
|
|
class B |
|
|
|
|
|
|
|
53.1% |
|
|
|
|
|
|
|
51.8% |
|
Onex Partners LLC(5)
|
|
|
11,106,924 |
|
|
|
34.4%/ |
33.3% |
|
|
|
|
|
|
34.4%/ |
27.0% |
|
|
|
|
|
|
|
class B |
|
|
|
|
|
|
|
34.2% |
|
|
|
|
|
|
|
33.4% |
|
Onex EMSC Co-Invest LP(6)
|
|
|
2,844,855 |
|
|
|
8.8%/ |
8.5% |
|
|
|
|
|
|
8.8%/ |
6.9% |
|
|
|
|
|
|
|
class B |
|
|
|
|
|
|
|
8.8% |
|
|
|
|
|
|
|
8.6% |
|
Directors and Executive Officers
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Robert M. Le Blanc(7)
|
|
|
56,107 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
class B |
|
|
|
*/ |
* |
|
|
* |
|
|
|
*/ |
* |
|
|
* |
|
Steven B. Epstein(8)
|
|
|
37,500 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
class A |
|
|
|
3.3%/ |
* |
|
|
* |
|
|
|
*/ |
* |
|
|
* |
|
James T. Kelly(8)
|
|
|
112,500 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
class A |
|
|
|
9.8%/ |
* |
|
|
* |
|
|
|
1.3%/ |
* |
|
|
* |
|
Michael L. Smith(8)
|
|
|
37,500 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
class A |
|
|
|
3.3%/ |
* |
|
|
* |
|
|
|
*/ |
* |
|
|
* |
|
William A. Sanger(8)
|
|
|
450,000 |
|
|
|
39.2%/ |
1.4% |
|
|
|
|
|
|
5.0%/ |
1.1% |
|
|
|
|
|
|
|
class A |
|
|
|
|
|
|
|
* |
|
|
|
|
|
|
|
* |
|
Don S. Harvey(8)
|
|
|
75,000 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
class A |
|
|
|
6.5%/ |
* |
|
|
* |
|
|
|
*/ |
* |
|
|
* |
|
Dighton C. Packard, M.D.(9)
|
|
|
33,750 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
class A |
|
|
|
2.9%/ |
* |
|
|
* |
|
|
|
*/ |
* |
|
|
* |
|
Randel G. Owen(8)
|
|
|
33,750 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
class A |
|
|
|
2.9%/ |
* |
|
|
* |
|
|
|
*/ |
* |
|
|
* |
|
Todd G. Zimmerman(8)
|
|
|
18,750 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
class A |
|
|
|
1.6%/ |
* |
|
|
* |
|
|
|
*/ |
* |
|
|
* |
|
All directors and executive officers as a group (9 persons)
|
|
|
56,107 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
class B |
|
|
|
*/ |
* |
|
|
* |
|
|
|
*/ |
* |
|
|
* |
|
|
|
|
798,750 |
|
|
|
69.6%/ |
2.4% |
|
|
* |
|
|
|
8.9%/ |
1.9% |
|
|
* |
|
|
|
|
class A |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
117
|
|
* |
Represents beneficial ownership of less than 1%. |
|
|
(1) |
The amounts and percentages of our common stock beneficially
owned are reported on the basis of regulations of the SEC
governing the determination of beneficial ownership of
securities. Under the rules of the SEC, a person is deemed to be
a beneficial owner of a security if that person has
or shares voting power, which includes the power to
vote or direct the voting of such security, or investment
power, which includes the power to dispose of or to direct
the disposition of such security. A person is also deemed to be
a beneficial owner of any securities of which that person has a
right to acquire beneficial ownership within 60 days,
including our common stock subject to an option that is
exercisable within 60 days. Under these rules, more than
one person may be deemed to be a beneficial owner of such
securities as to which such person has an economic interest.
None of the options granted under our equity option plan is
exercisable within 60 days. |
|
|
The LP exchangeable units are exchangeable on a one-for-one
basis for shares of class B common stock at any time at the
option of the holder. Accordingly, this table assumes the
exchange of all LP exchangeable units for class B common
stock. Until such exchange, the holders of the LP exchangeable
units have the benefit of the class B special voting stock
through which the holders may exercise voting rights as though
they held the same number of shares of class B common stock. |
|
(2) |
On each matter submitted to the stockholders for their vote, our
class A common stock is entitled to one vote per share, and
our class B common stock is entitled to ten votes per
share, reducing to one vote per share under certain limited
circumstances. Except as required by law, our class A and
class B common stock vote together on all matters submitted
to stockholders for their vote. |
|
(3) |
Includes the following: (i) 17,226,723 LP exchangeable
units held by Onex Partners LP; (ii) 11,106,924
LP exchangeable units held by Onex Partners LLC;
(iii) 2,844,855 LP exchangeable units held by Onex
EMSC Co-Invest LP; (iv) 639,649 LP exchangeable units
held by EMS Executive Investco LLC; (v) 289,349
LP exchangeable units held by Onex US Principals LP; and
(vi) 23 LP exchangeable units held by EMSC, Inc.
(formerly known as Emergency Medical Services Corporation). Onex
Corporation may be deemed to own beneficially the LP
exchangeable units held by (a) Onex Partners LP,
through Onex ownership of all of the common stock of Onex
Partners GP, Inc., the general partner of Onex
Partners GP LP, the general partner of Onex
Partners LP; (b) Onex Partners LLC, through
Onex ownership of all of the equity of Onex
Partners LLC; (c) Onex EMS Co-Invest LP, through
Onex ownership of all of the common stock of Onex
Partners GP, Inc., the general partner of Onex
Partners GP LP, the general partner of Onex EMSC
Co-Invest LP; (d) EMS Executive Investco LLC,
through Onex ownership of Onex American
Holdings II LLC which owns 33.33% of the voting power
of EMS Executive Investco LLC; and (e) Onex
US Principals LP through Onex ownership of all
of the equity of Onex American Holdings GP LLC, the
general partner of Onex US Principals LP. Onex
Corporation disclaims such beneficial ownership. |
|
|
In addition, prior to the formation of our holding company, Onex
Corporations subsidiary, Onex American
Holdings II LLC, owns 50% of the voting stock of
Emergency Medical Services Corporation, the general partner of
EMS L.P., and a 99.9% economic interest in EMSC, Inc. EMSC,
Inc. owns directly less than .001% of the equity interest of
EMS L.P. However, as its general partner, EMSC, Inc. may be
deemed to own beneficially all of the equity of the partnership.
The equity owned by EMSC, Inc. may be deemed beneficially owned
50% by Mr. Le Blanc and 50% by Onex American
Holdings II LLC and Onex Corporation.
Mr. Le Blanc disclaims such beneficial ownership. |
|
|
Mr. Gerald W. Schwartz, the Chairman, President and Chief
Executive Officer of Onex Corporation, owns shares representing
a majority of the voting rights of the shares of Onex
Corporation and as such may be deemed to own beneficially all of
the LP exchangeable units owned beneficially by Onex
Corporation. Mr. Schwartz disclaims such beneficial
ownership. The address for Onex Corporation is 161 Bay Street,
Toronto, ON M5J 2S1. |
|
(4) |
All of the LP exchangeable units owned by Onex Partners LP
may be deemed owned beneficially by each of Onex Partners GP LP,
Onex Partners GP, Inc. and Onex Corporation. The
address for Onex Partners LP is c/o Onex Investment
Corporation, 712 Fifth Avenue, New York, New York 10019. |
|
(5) |
All of the LP exchangeable units owned by Onex Partners LLC may
be deemed owned beneficially by Onex Corporation. The address
for Onex Partners LLC is 421 Leader Street, Marion, Ohio 43302. |
|
(6) |
All of the LP exchangeable units owned by Onex EMSC Co-Invest LP
may be deemed owned beneficially by each of Onex Partners GP LP,
Onex Partners GP, Inc. and Onex Corporation. The address for
Onex EMSC Co-Invest LP is c/o Onex Investment Corporation,
712 Fifth Avenue, New York, New York 10019. |
|
(7) |
Includes (i) 35,837 LP exchangeable units held by Onex
US Principals LP which may be deemed owned beneficially by
Mr. Le Blanc by reason of his pecuniary interest in
the LP exchangeable units owned by Onex US Principals LP,
(ii) 20,250 LP exchangeable units owned by Onex EMSC
Co-Invest LP which may be deemed to be owned beneficially by
Mr. Le Blanc by reason of his pecuniary interest in Onex
EMSC Co-Invest LP and (iii) 23 LP exchangeable units owned
by EMSC, Inc. Prior to our reorganization into a holding
company, Mr. Le Blanc owns 50% of the voting common stock
of EMSC, Inc. and a 0.01% economic interest in EMSC, Inc. See
note (3) with respect to EMSC, Inc.s equity interest
in EMS L.P., as to which Mr. Le Blanc disclaims
beneficial ownership. Mr. Le Blanc also disclaims
beneficial interest in the LP exchangeable units owned by Onex
US Principals LP and Onex EMSC Co-Invest LP. Mr. Le
Blancs address is c/o Onex Investment Corporation,
712 Fifth Avenue, New York, New York 10019. |
|
(8) |
The address of these stockholders is c/o Emergency Medical
Services Corporation, 6200 S. Syracuse Way, Suite 200,
Greenwood Village, Colorado 80111-4737. |
|
(9) |
The address of this stockholder is c/o EmCare Holdings Inc.,
1717 Main Street, Suite 5200, Dallas, Texas 75201. |
118
The following table sets forth information regarding the
ownership of shares of our common stock by the selling
stockholders, assuming the underwriters over-allotment
option is exercised in full:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Shares Beneficially Owned | |
|
|
Number of | |
|
After the Offering | |
|
|
Shares Offered | |
|
| |
|
|
in Over- | |
|
|
|
Percentage of | |
|
|
|
|
Allotment | |
|
|
|
Class/All | |
|
Percentage of | |
Name of Beneficial Owner |
|
Option | |
|
Number | |
|
Common Stock | |
|
Voting Power | |
|
|
| |
|
| |
|
| |
|
| |
Onex Partners LP
|
|
|
627,743 |
|
|
|
16,598,980 |
|
|
|
53.4%/ |
40.3% |
|
|
51.7 |
% |
Onex Partners LLC
|
|
|
404,737 |
|
|
|
10,702,187 |
|
|
|
34.4%/ |
26.0% |
|
|
33.4 |
% |
Onex EMSC Co-Invest LP
|
|
|
103,667 |
|
|
|
2,741,188 |
|
|
|
8.8%/ |
6.7% |
|
|
8.5 |
% |
Onex US Principals LP
|
|
|
10,544 |
|
|
|
278,805 |
|
|
|
*/ |
* |
|
|
* |
|
EMS Executive Investco LLC
|
|
|
23,309 |
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616,340 |
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2.0%/ |
1.5% |
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1.9 |
% |
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* |
Represents beneficial ownership of less than 1%. |
We have agreed to pay all the expenses of the selling
stockholders in connection with this offering other than
underwriting discounts and commissions. In the event the
underwriters over-allotment option is not exercised in
full, the number of shares to be sold by the selling
stockholders named above will be reduced proportionately.
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DESCRIPTION OF CAPITAL STOCK
The following description summarizes the material terms of our
capital stock and provisions of our restated certificate of
incorporation and restated by-laws as they will be in effect
upon completion of this offering. This description also
summarizes the principal agreements relating to the LP
exchangeable units. Because this is only a summary, it does not
contain all of the information that may be important to you. For
a complete description, you should refer to our restated
certificate of incorporation and restated by-laws, the
EMS L.P. limited partnership agreement and the voting and
exchange trust agreement referred to below, copies of which will
be filed as exhibits to the registration statement of which this
prospectus is a part, and to the applicable provisions of the
Delaware General Corporation Law, or the DGCL, and the Delaware
Revised Uniform Limited Partnership Act. References to our
certificate of incorporation and to our by-laws are references
to these documents, as restated.
Overview
At the time of this offering, our authorized capital stock will
consist of:
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100,000,000 shares of class A common stock, par value
$0.01 per share, |
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40,000,000 shares of class B common stock, par value
$0.01 per share, |
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one share of class B special voting stock, $0.01 par value,
and |
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20,000,000 shares of preferred stock, par value $0.01 per
share. |
Of the 100,000,000 authorized shares of class A common
stock, pursuant to this offering we are offering
7,800,000 shares and, subject to the underwriters
exercise of their over-allotment option in full, the selling
stockholders are offering 1,170,000 shares. On the closing
of this offering, if the underwriters over-allotment
option is not exercised, we and EMS L.P. will have outstanding
the following securities:
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8,948,325 shares of class A common stock, held by our
management and persons who purchase shares in this offering; |
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142,545 shares of class B common stock, held by
certain former holders of interests in EMS L.P.; |
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one share of class B special voting stock, held by Onex
Corporation as trustee for the holders of LP exchangeable units; |
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32,107,500 LP exchangeable units of EMS L.P., exchangeable on a
one-for-one basis for shares of class B common stock, held
by the Onex entities; and |
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860,570 other partnership units of EMS L.P., including the
general partner interest, held by us. |
If the underwriters over-allotment option is exercised in
full, the number of shares of class A common stock
outstanding will increase, and the number of LP exchangeable
units outstanding will decrease, by 1,170,000.
We refer to our class A common stock and our class B
common stock together as our common stock.
At any time at the option of the holder:
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each LP exchangeable unit is exchangeable into one share of
class B common stock, and |
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each share of class B common stock is convertible into one
share of class A common stock. |
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Our securities are entitled to vote on all matters subject to a
vote of holders of common stock, voting together as a single
class, as follows:
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class A common stock is entitled to one vote per share, |
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class B common stock is entitled to ten votes per share
(reducing to one vote per share under certain limited
circumstances), and |
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one share of class B special voting stock, held for the
benefit of the holders of LP exchangeable units, is entitled to
a number of votes equal to the number of votes that could be
cast if all the then outstanding LP exchangeable units were
exchanged for class B common stock. |
The holders of LP exchangeable units may therefore exercise
voting rights with respect to Emergency Medical Services as
though they held the same number of shares of our class B
common stock.
Our Controlling Stockholders
After this offering, the Onex entities will control 96.6% of our
combined voting power. Accordingly, the Onex entities will
exercise a controlling influence over our business and affairs
and will have the power to determine all matters submitted to a
vote of our stockholders, including the election of directors,
the removal of directors with or without cause, and approval of
significant corporate transactions such as amendments to our
certificate of incorporation, mergers and the sale of all or
substantially all of our assets. The Onex entities could cause
corporate actions to be taken even if the interests of these
entities conflict with the interests of our other stockholders.
This concentration of voting power could have the effect of
deterring or preventing a change in control of Emergency Medical
Services that might otherwise be beneficial to our stockholders.
The Onex entities will hold their equity interest in us through
their ownership of LP exchangeable units. Although the Onex
entities cannot directly vote to amend the EMS L.P. partnership
agreement or their distributions from the partnership, they
could influence the amendment of that agreement through their
indirect control of us, as the general partner of the
partnership.
Common Stock
The class A common stock and the class B common stock
will be identical in all respects, except with respect to voting
and except that each share of class B common stock is
convertible into one share of class A common stock at the
option of the holder. All of our existing common stock is, and
the shares of class A common stock being offered by us and
the selling stockholders, if any, in this offering will be, upon
payment therefor, validly issued, fully paid and non-assessable.
Voting Rights. Generally, on all matters on which the
holders of common stock are entitled to vote, the holders of the
class A common stock, the class B common stock and the
class B special voting stock vote together as a single
class. On all matters with respect to which the holders of our
common stock are entitled to vote, each outstanding share of
class A common stock is entitled to one vote, each
outstanding share of class B common stock is entitled to
ten votes and the one share of class B special voting stock
is entitled to a number of votes equal to the number of votes
that could be cast if all of the then outstanding LP
exchangeable units were exchanged for class B common stock.
If the Minimum Hold Condition is no longer satisfied, the number
of votes per share of class B common stock will be reduced
automatically to one vote per share. The Minimum Hold Condition
is satisfied so long as the aggregate of the numbers of
outstanding shares of class B common stock and LP
exchangeable units is at least 10% of the total number of shares
of common stock and LP exchangeable units outstanding.
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Class A Common Stock. In addition to the other
voting rights or power to which the holders of class A
common stock are entitled, holders of class A common stock are
entitled to vote as a separate class on approval of (i) any
alteration, repeal or amendment of our certificate of
incorporation which would adversely affect the powers,
preferences or rights of the holders of class A common
stock; and (ii) any merger or consolidation of our company
with any other entity if, as a result, shares of class B |
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common stock would be converted into or exchanged for, or
receive, any consideration that differs from that applicable to
the shares of class A common stock as a result of such
merger or consolidation, other than a difference limited to
preserving the relative voting power of the holders of the
class A common stock, the class B common stock and the
class B special voting stock. In respect of any matter as
to which the holders of the class A common stock are
entitled to a class vote, holders have one vote per share, and
the affirmative vote of the holders of a majority of the shares
of class A common stock outstanding is required for
approval. |
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Class B Common Stock and Class B Special Voting
Stock. In addition to the other voting rights or power to
which the holders of class B common stock and class B
special voting stock are entitled, holders of class B
common stock and class B special voting stock are entitled
to vote together as a single class on approval of (i) any
alteration, repeal or amendment of our certificate of
incorporation which would adversely affect the powers,
preferences or rights of the holders of class B common
stock or class B special voting stock; and (ii) any
merger or consolidation of our company with any other entity if,
as a result, (a) the class B special voting stock
would not remain outstanding or (b) shares of class B
common stock would be converted into or exchanged for, or
receive, any consideration that differs from that applicable to
the shares of class A common stock as a result of such
merger or consolidation, other than a difference limited to
preserving the relative voting power of the holders of the
class A common stock, the class B common stock and the
class B special voting stock. In respect of any matter as
to which the holders of the class B common stock and
class B special voting stock are entitled to a class vote,
holders of class B common stock have one vote per share and
the holder of the class B special voting stock will have
one vote for each LP exchangeable unit outstanding, and the
affirmative vote of the holders of a majority of the votes
entitled to be cast is required for approval. |
Dividend Rights. Subject to preferences that may apply to
shares of preferred stock outstanding at the time, holders of
our outstanding common stock are entitled to any dividend
declared by the board of directors out of funds legally
available for this purpose. No dividend can be declared on the
class A or class B common stock unless at the same
time an equal dividend is paid on each share of class A or
class B common stock, as the case may be. Dividends paid in
shares of our common stock must be paid, with respect to a
particular class of common stock, in shares of that class. We
will not pay dividends on our class B special voting stock.
The holders of the LP exchangeable units have the right to
receive distributions equivalent to, on a per share/per unit
basis, the dividends paid to the holders of the class A and
class B common stock. If a dividend with respect to our
common stock is paid in shares of common stock, the
corresponding distribution with respect to the
LP exchangeable units will be made in LP exchangeable
units.
Conversion Rights. The class A common stock is not
convertible. Each share of class B common stock may be
converted at any time at the option of the holder into one share
of class A common stock. The class B common stock will
be converted automatically into class A common stock upon a
transfer thereof to any person other than (i) Onex
Corporation, (ii) an affiliate of Onex, (iii) Gerald
W. Schwartz or an affiliate of Mr. Schwartz, (iv) Onex
Partners LP or (v) or another person or entity,
provided, that, in the case of this clause (v),
Onex, an affiliate of Onex, Mr. Schwartz or Onex Partners
LP has or shares voting power or investment
power, as those terms are defined in the rules of the SEC,
over the class B common stock held by that person or entity.
Preemptive or Similar Rights. Our common stock is not
entitled to preemptive or other similar rights to purchase any
of our securities.
Right to Receive Liquidation Distributions. Upon our
voluntary or involuntary liquidation, dissolution or winding up,
the holders of our common stock are entitled to receive pro rata
our assets which are legally available for distribution, after
payment of all debts and other liabilities and subject to the
rights of any holders of preferred stock then outstanding, and
subject to the rights of the holders of LP exchangeable units to
receive distributions of assets equivalent to, on a per
share/per unit basis, the distributions to the holders of
class A and class B common stock. We will not make any
distribution of assets with respect to the class B
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special voting stock upon our liquidation, dissolution or
winding up other than a distribution equal to its $0.01 par
value.
NYSE Listing. Our common stock has been accepted for
trading on the NYSE under the symbol EMS, subject to
official notice of issuance. The class B common stock, the
class B special voting stock and the LP exchangeable
units will not be listed on any securities exchange.
LP Exchangeable Units and Class B Special Voting
Stock
Each of the LP exchangeable units will be a security of EMS L.P.
that, taking into account the ancillary rights described in this
section, are substantially equivalent economically to a share of
class B common stock. The holders of LP exchangeable units
will have the following rights:
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the right to exchange those units, at the holders option,
for shares of class B common stock on a one-for-one basis, |
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the right to receive distributions, on a per unit basis, in
amounts (or property in the case of non-cash dividends), which
are the same as, or economically equivalent to, and which are
payable at the same time as, dividends declared on the
class B common stock (or dividends that would be required
to be declared if class B common stock were outstanding), |
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the right to vote, through the trustee holder of the
class B special voting stock, at all stockholder meetings
at which holders of the class B common stock or
class B special voting stock are entitled to vote, and |
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the right to participate on a pro rata basis with the
class B common stock in the distribution of assets of
Emergency Medical Services, upon specified events relating to
the voluntary or involuntary liquidation, dissolution, winding
up or other distribution of the assets through the mandatory
exchange of LP exchangeable units for shares of class B
common stock. |
On the closing of this offering, we will enter into a voting and
exchange trust agreement and issue one share of class B
special voting stock to Onex Corporation as trustee to be held
for the benefit of the holders of LP exchangeable units. By
furnishing instructions to the trustee, holders of the LP
exchangeable units will be able to exercise essentially the same
voting rights with respect to Emergency Medical Services as they
would have if they had exchanged their LP exchangeable units for
shares of our class B common stock.
In the EMS L.P. partnership agreement, we will agree to maintain
the economic equivalency of the LP exchangeable units and the
class B common stock by, among other things, not declaring
and paying dividends on the class A common stock or
class B common stock unless EMS L.P. is able to make,
and in fact makes, economically equivalent and contemporaneous
distributions on the LP exchangeable units in accordance with
the terms of those units. EMS L.P. may also make such unit
distributions or adjustments from time to time as necessary to
maintain the one-for-one economic equivalence between the
LP exchangeable units and shares of our class B common
stock. The LP exchangeable units do not carry any other right to
receive distributions from EMS L.P.
The partnership agreement provides that, in the event that a
tender offer, share exchange offer, issuer bid, take-over bid or
similar transaction for the purpose of acquiring the
class A common stock and/ or class B common stock is
proposed by us or is proposed to us or our stockholders and is
recommended by our board of directors, or is otherwise effected
or to be effected with the consent or approval of our board of
directors and the LP exchangeable units are not otherwise
exchanged for shares of class B common stock, then we will
use our reasonable efforts to enable and permit holders of LP
exchangeable units to participate in such an offer to the same
extent and on an economically equivalent basis as the holders of
our common stock. Without limiting the generality of the
foregoing, we will use its reasonable efforts to ensure that
holders of LP exchangeable units may participate in all such
offers without being required to exercise their right to
exchange their LP exchangeable units for class B common
stock or, if so required, to ensure that any
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such exchange shall be effective only upon, and shall be
conditional upon, the closing of the offer and only to the
extent necessary to tender or deposit under the offer. In the
event of the acquisition of Emergency Medical Services through a
merger or similar transaction, we will use our reasonable
efforts to permit holders of LP exchangeable units to
participate in such transaction to the same extent, and on an
economically equivalent basis, as the holders of our common
stock. Without limiting the generality of the foregoing, we will
use our reasonable efforts to ensure that the holders of LP
exchangeable units may participate in such transaction without
being required to exercise their right to exchange their LP
exchangeable units for class B common stock by effecting a
concurrent merger or similar transaction of EMS L.P. with the
acquiring entity.
The exchange rights of the LP exchangeable units are subject to
adjustment or modification in the event of a stock split,
combination or other change to our capital structure so as to
maintain the initial one-to-one relationship between the LP
exchangeable units and our class B common stock. We may
cause all of the outstanding LP exchangeable units to be
exchanged for one share of our class B common stock for
each LP exchangeable unit held at any time after
December 15, 2045 or if the number of LP exchangeable units
is less than 5% of the number of LP exchangeable units
outstanding at the closing of this offering (adjusted for
reorganizing, recapitalizing or other changes in equity).
The LP exchangeable units that will be outstanding on the
closing of this offering may not be resold or otherwise
transferred in the United States except to an Onex entity (or in
connection with a tender offer, share exchange offer, issuer
bid, take-over bid or similar transaction or merger as described
above) and then only pursuant to an effective registration
statement under the Securities Act or an exemption from
registration under the Securities Act.
Preferred Stock
Following this offering, our board of directors may, without
further action by our stockholders, from time to time, direct
the issuance of up to 20,000,000 million shares of
preferred stock in series and may, at the time of issuance,
determine the rights, preferences and limitations of each
series. Satisfaction of any dividend preferences of outstanding
shares of preferred stock would reduce the amount of funds
available for the payment of dividends on shares of our common
stock. Holders of shares of preferred stock may be entitled to
receive a preference payment in the event of our liquidation,
dissolution or winding-up before any payment is made to the
holders of shares of our common stock. Under specified
circumstances, the issuance of shares of preferred stock may
render more difficult or tend to discourage a merger, tender
offer or proxy contest, the assumption of control by a holder of
a large block of our securities or the removal of incumbent
management. Upon the affirmative vote of a majority of the total
number of directors then in office, the board of directors,
without stockholder approval, may issues shares of preferred
stock with voting and conversion rights which could adversely
affect the holders of shares of our common stock. Upon
consummation of this offering, there will be no shares of
preferred stock outstanding, and we have no present intention to
issue any shares of preferred stock.
Options
Following this offering, we will have outstanding under our
equity option plan options to purchase a total of approximately
3,509,219 shares of class A common stock with an
exercise price of $6.67 per share.
Anti-Takeover Effects of our Certificate of Incorporation and
By-Laws
Some provisions of our certificate of incorporation and our
by-laws contain provisions that are intended to enhance the
likelihood of continuity and stability in the composition of our
board of directors.
These provisions also may have the effect of delaying, deferring
or preventing a future takeover or change in control unless the
takeover or change in control is approved by our board of
directors.
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Class B Common Stock and Class B Special Voting
Stock |
The Onex entities ownership of the LP exchangeable units
entitles them to acquire from us substantially all of the
class B common stock which carries ten votes per share.
Through the class B special voting stock, the Onex entities
will exercise essentially the same voting rights with respect to
Emergency Medical Services as they would have if they had
exchanged their LP exchangeable units for our class B
common stock. Upon completion of this offering, Onex will own
beneficially 77.9% of our common stock and will control 96.6% of
the combined voting power of our outstanding common stock.
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Undesignated Preferred Stock |
The ability to authorize undesignated preferred stock makes it
possible for our board of directors to issue one or more series
of preferred stock with voting or other rights or preferences
that could impede the success of any attempt to change control
of us. These and other provisions may have the effect of
deferring hostile takeovers or delaying changes in control or
management of our company.
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Advance Notice Requirements for Stockholder Proposals and
Directors Nominations |
Our by-laws provide that stockholders seeking to bring business
before our annual meeting of stockholders, or to nominate
candidates for election as directors at our annual meeting, must
provide timely notice of their intent in writing. To be timely,
a stockholders notice must be delivered to, or mailed and
received at, our principal executive offices not less than
120 days prior to the first anniversary of the date of our
notice of annual meeting provided with respect to the previous
years annual meeting of stockholders; provided,
that if no annual meeting of stockholders was held in the
previous year or the date of the annual meeting of stockholders
has been changed to be more than 30 calendar days earlier than
such anniversary, notice by the stockholder, to be timely, must
be received a reasonable time before the solicitation is made.
These by-law provisions are not applicable to a holder of
class B common stock or class B special voting stock.
Our by-laws also specify certain requirements as to the form and
content of a stockholders notice. These provisions may
have the effect of precluding our stockholders from bringing
matters before a meeting or from making nominations for
directors if the proper procedures are not followed or may
discourage or defer a potential acquiror from conducting a
solicitation of proxies to elect our slated directors or
otherwise attempting to obtain control of the Company.
Our by-laws provide that, except as otherwise required by law,
special meetings of the stockholders may be called only by the
board of directors, our chief executive officer, our secretary
or the holders of our common stock having a majority of the
voting power of all our outstanding class A common stock,
class B common stock and class B special voting stock,
collectively. Stockholders are not otherwise permitted to call a
special meeting or to require the board of directors to call a
special meeting.
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Filling of Board Vacancies; Removal |
Our by-laws authorize only our board of directors to fill
vacancies created by resignation or removal and newly created
directorships. This may deter a stockholder from increasing the
size of our board and gaining control of our board of directors
by filling the resulting vacancies with its own nominees.
So long as the Minimum Hold Condition is satisfied, any director
or the entire board of directors may be removed, with or without
cause, by the holders of shares of class A common stock,
class B common stock and class B special voting stock,
voting together as a single class.
Our certificate of incorporation provides that our board is
classified into three classes of directors. The existence of a
staggered board could delay a successful tender offeror from
obtaining majority control of our
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board, and the prospect of such delay may deter a potential
offeror. Please see Management Composition of
the Board of Directors after this Offering for more
information regarding the staggered board.
Additional Certificate of Incorporation and By-Law
Provisions
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Stockholder Action by Written Consent |
Any action required or permitted to be taken at an annual or
special stockholders meeting may be taken without a
meeting, without prior notice and without a vote, if a consent
or consents in writing, setting forth the action so taken, shall
be signed by the holders of outstanding stock having not less
than the minimum number of votes that would be necessary to
authorize or take such action at a meeting at which all shares
entitled to vote thereon were present and voted. The action must
be evidenced by one or more written consents describing the
action taken, signed by the stockholders entitled to take action
without a meeting, and delivered to us in the manner prescribed
by the DGCL.
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Delaware Business Combination Statute |
We have elected not to be subject to Section 203 of the
DGCL, which generally prohibits a publicly held Delaware
corporation from engaging in various business
combination transactions with any interested
stockholder for a period of three years after the date of
the transaction in which the person became an interested
stockholder, unless the transaction is approved by the
board of directors before that person becomes an
interested stockholder or another exception is
available. A business combination includes mergers,
asset sales and other transactions resulting in a financial
benefit to a stockholder. An interested stockholder
is a person who, together with affiliates and associates, owns
(or within three years, did own) 15% or more of a
corporations voting stock. The statute is intended to
prohibit or delay the accomplishment of mergers or other
takeover or change in control attempts that do not receive the
prior approval of the board of directors. By virtue of our
decision to elect out of the statutes provisions, the
statute does not apply to us, but we could elect to be subject
to Section 203 in the future by amending our certificate of
incorporation.
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Amendments to our Certificate of Incorporation and
By-laws |
Except where our board of directors is permitted by law or by
our certificate of incorporation to act without any action by
our stockholders, provisions of our certificate of incorporation
may not be adopted, repealed, altered or amended, in whole or in
part, without the approval of a majority of the outstanding
stock entitled to vote thereon and a majority of the outstanding
stock of each class entitled to vote thereon as a class. The
holders of the outstanding shares of a particular class of our
capital stock are entitled to vote as a class upon any proposed
amendment of our certificate of incorporation that would alter
or change the relative powers, preferences or participating,
optional or other special rights of the shares of such class so
as to affect them adversely relative to the holders of any other
class. Our by-laws may be amended or repealed and new by-laws
may be adopted by a vote of the holders of a majority of the
voting power of our common stock or, except to the extent
relating to stockholders meetings and stockholder action by
written consent, by the board of directors. Any by-laws adopted
or amended by the board of directors may be amended or repealed
by the stockholders entitled to vote thereon.
Indemnification of Directors and Officers and Limitations on
Liability
Our certificate of incorporation and by-laws provide a right to
indemnification to the fullest extent permitted by law to any
person who was or is a party or is threatened to be made a party
to or is involved in any threatened, pending or completed
action, suit or proceeding, whether civil, criminal,
administrative or investigative and whether by or in our right
or otherwise, by reason of the fact that he or she, or a person
of whom he or she is the legal representative, is or was our
director or officer or is or was serving at our request as a
director or officer of another corporation or in a capacity with
comparable authority or responsibilities for any partnership,
joint venture, trust, employee benefit plan or other enterprise,
and that such person will be indemnified and held harmless by us
to the fullest extent authorized by, and subject to
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the conditions and procedures set forth in the DGCL, against all
judgments, fines, penalties, excise taxes, amounts paid in
settlement and costs, charges and expenses (including
attorneys fees, disbursements and other charges). Our
by-laws authorize us to take steps to ensure that all persons
entitled to the indemnification are properly indemnified,
including, if the board of directors so determines, purchasing
and maintaining insurance.
Our certificate of incorporation provides that none of the
directors shall be personally liable to us or our stockholders
for monetary damages for breach of fiduciary duty as a director,
except liability for:
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any breach of the directors duty of loyalty to us or our
stockholders, |
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acts or omissions not in good faith or which involve intentional
misconduct or a knowing violation of law, |
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the payment of unlawful dividends and unlawful repurchase or
redemption of our capital stock prohibited by the DGCL, and |
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any transaction from which the director derived any improper
personal benefits. |
The effect of this provision of our certificate of incorporation
is to eliminate our rights and the rights of our stockholders to
recover monetary damages against a director for breach of the
fiduciary duty of care as a director, including breaches
resulting from negligent or grossly negligent behavior, except
in the situations described above. This provision does not limit
or eliminate our rights or the rights of any stockholder to seek
non-monetary relief, such as an injunction or rescission in the
event of a breach of a directors duty of care.
Equityholder Agreements
We are a party to an investor equityholders agreement with the
Onex entities and certain of their affiliates, which we refer to
together as the Onex Investors, and certain other equityholders,
whom we refer to together as the Other Investors. The securities
subject to the agreement include the 32,107,500 LP exchangeable
units held by the Onex entities and the 915,750 shares of our
class A common stock and 142,545 shares of
class B common stock held by the Other Investors. Our Other
Investors include all of our named executive officers and our
directors who hold class A common stock. Under this
agreement, until the fifth anniversary of the closing of this
offering, an Other Investors right to sell common stock he
owns immediately prior to this offering, and any shares he
acquires upon the exercise of options he holds immediately prior
to this offering, is limited. An Other Investor may sell up to
12.5% of those shares in the first year following this offering,
increasing 12.5% each year up to a maximum of 50% of his shares
(or, if greater, the percentage of its shares sold by Onex
Partners), plus the number of shares required to pay any
income taxes on the exercise of options. The other substantive
provisions of the investor equityholders agreement will
terminate upon completion of this offering.
We are also a party to an equityholders agreement with the Onex
Investors and certain employee and affiliated physician
investors. Under this agreement, the employees and affiliated
physicians may not sell the class A common stock they will
receive in exchange for their EMS L.P. partnership units
for a period of 180 days after the date of this prospectus.
232,575 shares of our class A common stock are subject
to the equityholders agreement. Certain of these employees are
subject to the further limitations on resale that are applicable
to the Other Investors.
Registration Agreement
We are a party to a registration agreement with Onex Partners,
certain Onex affiliates and the Other Investors, including the
management investors. Following the completion of this offering,
stockholders holding 33,165,795 shares of our common stock
and LP exchangeable units will have the right, subject to
various conditions and limitations, to include their shares of
class A common stock in registration statements relating to
our securities. In addition, the Onex entities have the right,
beginning 180 days after the date of this prospectus, on
unlimited occasions, to demand that we register their shares of
our common stock under the Securities Act, subject to certain
limitations. If we propose to register any shares of our common
stock under the Securities Act either for our account or for the
account of any stockholders, the holders having piggyback
registration rights are entitled to receive notice of such
registration and include their shares of our common
127
stock in any such registration. These registration rights are
subject to certain conditions and limitations, including the
right of the underwriters of an offering to limit the number of
shares of common stock to be included in a registration. We
generally are required to bear all expenses of such
registrations.
Registration of any of the shares of our common stock held by
stockholders with registration rights would result in such
shares becoming freely tradable without restriction under the
Securities Act immediately upon the effectiveness of such
registration.
Holders who have the right to demand registration have agreed
not to exercise this right without the prior consent of Banc of
America Securities LLC and JPMorgan Securities Inc. for a period
of 180 days from the date of this prospectus.
Transfer Agent and Registrar
American Stock Transfer & Trust Company will serve as
our transfer agent and registrar for our class A common
stock. The transfer agents address is American Stock
Transfer & Trust Company, 59 Maiden Lane, New
York, New York 10038 and the telephone number is (800) 937-5449.
Listing
Our class A common stock has been accepted for listing on
the New York Stock Exchange, subject to official notice of
issuance, under the symbol EMS. The class B
common stock, class B special voting stock and
LP exchangeable units will not be listed on any securities
exchange.
128
LIMITED PARTNERSHIP AGREEMENT OF EMERGENCY MEDICAL SERVICES
L.P.
The following is a summary of the material provisions of the
EMS L.P. limited partnership agreement. We summarize the
following provisions of the partnership agreement under the
caption Description of Capital Stock LP
Exchangeable Units and Class B Special Voting Stock:
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distributions by the partnership, |
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the right of holders of LP exchangeable units to exchange their
units for class B common stock, and |
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the right of holders of LP exchangeable units to exercise
essentially the same voting rights with respect to Emergency
Medical Services as they would have if they had exchanged their
LP exchangeable units for shares of our class B common
stock. |
Overview
We will hold substantially all of our assets, including our
operating assets, through our approximately 22% direct equity
interest in EMS L.P. and EMS L.P.s indirect
ownership of the capital stock of AMR and EmCare. As a result,
we will be a holding company and our only source of
revenue and the only source of funding any
distributions to our holders of class A common
stock will be our ownership interest in
EMS L.P. and distributions from EMS L.P. pursuant to
the EMS L.P. partnership agreement. The Onex entities are
our controlling stockholders through their 96.6% voting power
represented by our class B special voting stock and will
also control us, indirectly, as the general partner of
EMS L.P. The Onex entities hold their interest in us
through their interest in LP exchangeable units, representing
approximately a 78% interest in the EMS L.P. partnership.
As described below, we control the operations of EMS L.P.,
and there are no general voting rights of the holders of LP
exchangeable units. The holders of the LP exchangeable rights
will exercise their voting interest and governance rights in us
through the one share of class B special voting stock. See
Description of Capital Stock LP Exchangeable
Units and Class B Special Voting Stock. All of the
holders of our common stock will exercise their rights in
EMS L.P. through us, as the general partner. Our
partnership interests in EMS L.P. and those of the Onex
entities (through the LP exchangeable units) are structured so
that all of our equity holders hold interests that are
economically equivalent and have the voting rights they would
hold through ownership of our common stock.
The partnership agreement grants no rights to the holders of the
LP exchangeable units to call meetings of the partnership, to
vote upon extraordinary transactions of Emergency Medical
Services (such as mergers, consolidations or the sale of
substantially all of our assets), to receive appraisal or
dissenters rights, to remove and replace us as the general
partner of the partnership, to compel the dissolution or
liquidation of the partnership or to propose or authorize any
amendment to the partnership agreement. As described under the
caption Limited Consent Rights, the
consent of each partner who would be adversely affected is
required for us to authorize certain amendments to the
partnership agreement or to change the form of our business
entity. As a result of these provisions, all of our equity
holders, including our class A common stockholders and the
Onex entities as the holders of LP exchangeable units, control
the EMS L.P. partnership, and any changes to the provisions of
the partnership agreement, through their voting rights in our
capital stock, including the common stock and the class B
special voting stock.
Purpose
The partnership agreement provides that EMS L.P. may engage
in any activities permitted under the applicable Delaware law.
The partnership agreement does not restrict our business
activities and does not require that we conduct all of our
business through EMS L.P.
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Partnership Interests
We will hold the general partner interest in EMS L.P. We will
also hold limited partner units that represent the same
percentage of the partnership as our outstanding common stock
bears to our total outstanding common stock, giving effect to
the exchange of all of the LP exchangeable units for
class B common stock.
The partnership interests of EMS L.P. represented by LP
exchangeable units are intended to be economically equivalent to
our class B common stock on a unit-for-share basis, and the
partnership interests we purchase in EMS L.P. upon a sale
of our common stock are intended to have the economic
equivalence of the number of shares of common stock we issue.
Accordingly, the partnership interests we purchase in
EMS L.P. on the sale of class A common stock in this
offering will be equal to the proportion the newly issued common
stock has to the total of our outstanding common stock, assuming
the exchange of all LP exchangeable units for class B
common stock. As a result, we will purchase an 18.9% interest in
EMS L.P. with the proceeds of this offering and, upon
completion of this offering, we will hold approximately 22% of
the equity interests in EMS L.P.
Management
EMS L.P. is organized as a Delaware limited partnership and
will be governed by the terms of the partnership agreement. The
partnership agreement provides that we, as sole general partner
of the partnership, will have sole and exclusive responsibility
for the management of the business and affairs of the
partnership. No limited partner may take part in the operation,
management or control of the business of the partnership by
virtue of being a holder of LP exchangeable units.
Conflicts of Interest and Fiduciary Duties
We hold all of our operating assets through EMS L.P. and
our cash flow from operations and our dividends to
our stockholders is dependent upon our receipt of
distributions from the partnership. The Onex entities hold their
equity interest in us through LP exchangeable units. Conflicts
of interest may arise in the future as a result of our role as
general partner of EMS L.P., and the fiduciary duties we
owe both to our stockholders and to the holders of LP
exchangeable units. We have tried to limit any conflict through
the provisions of the partnership agreement.
We are accountable both to our stockholders and to the LP
exchangeable unit holders as a fiduciary. Fiduciary duties owed
to our stockholders are prescribed by law. The Delaware law
provides that the fiduciary duties we owe to LP exchangeable
unit holders may be modified by the partnership agreement.
The partnership agreement has been structured to provide to LP
exchangeable unit holders the economic equivalency of a holder
of common stock. To clarify the nature of the fiduciary duty we
owe to the limited partners, the partnership agreement provides
that our duty to those holders will be construed as if
EMS L.P. were a corporation and the unit holders were
stockholders of that corporation. The partnership agreement also
provides that we will have no liability to EMS L.P. or the
limited partners as a result of any errors in judgment or any
act or omission so long as we carried out our duties in
good faith.
Moreover, fiduciary duties are generally considered to include
our obligation to act with loyalty. The duty of loyalty, in the
absence of a provision in the partnership agreement providing
otherwise, would generally prohibit us, as a general partner of
a Delaware limited partnership, from taking any action or
engaging in any transaction where a conflict of interest is
present. The limited partners of EMS L.P. have agreed that,
in the event of any conflict in the fiduciary duties owed by us
to our stockholders and by us, as general partner of the
partnership, to such limited partners, we may act in the best
interests of our stockholders including the holders
of our class A common stock without violating
fiduciary duties to such limited partners or being liable for
any resulting breach of our duties to the limited partners. See
also Exculpation and Indemnification of the
General Partner. We have not modified the fiduciary duty
we owe to our stockholders.
130
Transferability of Interests
The partnership agreement provides that we may not voluntarily
withdraw from the partnership, or transfer or assign our
interest in the partnership, except to an affiliate or, in
connection with a merger or similar transaction, to a successor.
The LP exchangeable unit holders may transfer their interests in
EMS L.P. to another limited partner, an affiliate or a
member of the Initial Investor Group, as defined in our
certificate of incorporation. Any transferee must agree to
become a party to the partnership agreement as a limited partner.
Additional Contributions
The partnership agreement provides that, in the event we issue
additional shares of capital stock, we will contribute to
EMS L.P. as an additional capital contribution any net
proceeds from such issuance in exchange for additional
partnership interests with preferences and rights corresponding
to the capital stock we issue.
Holders of LP exchangeable units are not obligated to make
additional capital contributions.
Distributions
The partnership agreement sets forth the manner in which
distributions will be made. See Description of Capital
Stock Common Stock Dividends and
LP Exchangeable Units and Class B Special
Voting Stock.
The distributions to holders of LP exchangeable units are
intended to provide to those holders the economic equivalency of
holders of class B common stock. The holders of the LP
exchangeable units have the right to receive from the
partnership distributions equivalent, on a per share/per unit
basis, to the dividends paid to the holders of the class A
and class B common stock, and no right to any other
distribution. In order to maintain the economic equivalence of
the LP exchangeable units and our common stock, any
distributions to us by EMS L.P. (other than as
reimbursement of our expenses) must be increased to reflect the
assumed amount of the taxes payable by us as a result of our
receipt of that distribution.
Limited Partner Exchange Rights
Pursuant to the partnership agreement, each LP exchangeable unit
may be exchanged at any time for one share of class B
common stock. See LP Exchangeable Units and
Class B Special Voting Stock.
Amendments of the Partnership Agreement
Amendments to the partnership agreement may be proposed and
authorized only by us, as general partner. There is no provision
in the partnership agreement for limited partners to propose or
authorize any amendment to the partnership agreement, and there
is no provision for any meetings of the partners.
Limited Consent Rights
We may not amend the partnership agreement without the consent
of each partner adversely affected if the amendment would:
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convert a limited partners interest into a general
partners interest, |
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modify the limited liability of a limited partner, or |
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alter the right to receive any distributions, or alter or modify
the provisions applicable to the LP exchangeable units. |
131
In addition, for us to merge or consolidate the partnership or
convert it into any other form of business entity, we require
the consent of any partner who would be adversely affected.
Rights of Limited Partners
As described above, the holders of LP exchangeable units have
specified distribution and exchange rights, and very limited
rights to consent or withhold consent to certain actions. These
holders are not permitted to propose an amendment to the
partnership agreement, call a meeting of partners or, generally,
vote with respect to any amendment to the partnership agreement.
In exercising our rights we have, as general partner, a
fiduciary duty both to the holders of our common stock and to
the limited partners of EMS L.P., including the holders of
the LP exchangeable units. The following is a summary of the
right of the holders of the LP exchangeable units to authorize
the matters specified:
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Issuance of additional units
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None. |
Amendment of partnership agreement
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None. Consent of each partner adversely affected required in
certain limited circumstances. See Limited
Consent Rights. |
Merger or sale of assets of Emergency Medical Services
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None. |
Removal of general partner
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None. |
Transfer of general partner interest
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None. |
Dissolution of partnership
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None. |
Reconstitution of partnership upon dissolution
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A majority of outstanding LP exchangeable units. |
Exculpation and Indemnification of the General Partner
The partnership agreement generally provides that we, as general
partner, will incur no liability to EMS L.P. or any limited
partner for losses sustained or liabilities incurred as a result
of errors in judgment or of any act or omission if we carried
out our duties in good faith.
The partnership agreement also provides for our indemnification
and indemnification of our directors, officers, employees and
agents from any loss, liability, damage, cost or expense
incurred by such person in connection with our business or
activities or those of EMS L.P., so long as the indemnitee
is not guilty of willful misconduct and was acting in good faith
within what the indemnitee reasonably believed to be the scope
of its authority for a purpose which it reasonably believed to
be not opposed to the interests of EMS L.P.
Merger, Sale or Other Disposition of Assets
The partnership agreement provides that, on a merger of
Emergency Medical Services, a disposition of substantially all
of our assets or a similar transaction, we will use our
reasonable efforts to permit holders of LP exchangeable units to
participate in such transaction to the same extent, and on an
economically equivalent basis, as the holders of our common
stock. The holders of LP exchangeable units have no voting
rights with respect to any such extraordinary transactions
except through their interest in the class B special voting
stock.
Reimbursement of Expenses; Management Agreement with an
Affiliate
The partnership agreement provides that we will not be
compensated for our services as general partner of EMS L.P.
However, we will be reimbursed for all expenses we incur,
including compensation of our employees and the costs and
expenses of being a public company. Under these circumstances,
no comparable distribution will be made to the limited partners
of EMS L.P.
132
We are party to a management agreement with an affiliate of Onex
Corporation, pursuant to which we pay an annual management fee
of $1.0 million. The agreement has an initial term of five
years. See Certain Relationships and Related Party
Transactions Management Agreement.
Liquidation or Dissolution
Upon our voluntary or involuntary liquidation, dissolution or
winding up, the holders of the LP exchangeable units are
entitled to receive distributions of assets equivalent to, on a
per share/per unit basis, the distributions to the holders of
class A and class B common stock, and to no other
distribution. We are entitled to receive the balance of the
distribution of assets for distribution to our stockholders.
See Description of Capital Stock Common
Stock Right to Receive Liquidation
Distributions.
Tax Matters
Pursuant to the partnership agreement, we will be the tax
matters partner of EMS L.P. and, as such, will have
authority to make tax elections under the Internal Revenue Code
on behalf of the partnership.
Term
The partnership will continue in full force and effect until
December 15, 2095 or until sooner dissolved pursuant to the
terms of the partnership agreement.
133
CERTAIN RELATIONSHIPS AND RELATED PARTY TRANSACTIONS
Since September 2001, we have not engaged in any transactions
valued in excess of $60,000 with any of our executive officers,
directors or holders of more than 5% of our outstanding voting
securities, other than the transactions described below.
Transactions with Laidlaw
Our Acquisition of AMR and EmCare
Pursuant to stock purchase agreements with Laidlaw
International, Inc. and a subsidiary of Laidlaw, on
February 10, 2005 we purchased all of the capital stock of
AMR and EmCare for an aggregate purchase price of
$815.8 million, subject to certain post-closing
adjustments. These adjustments included a decrease to reflect
debt assumed by us and an increase to reflect the increase in
the combined net worth of AMR and EmCare from August 31,
2004 through the date of closing, subject to the contractual
provision that the aggregate purchase price would not be more
than $835.8 million minus outstanding debt we
assumed. For purposes of these adjustments, the closing was
deemed to be effective as of the close of business on
January 31, 2005, and we had the benefit and the risks of
the businesses from that date. The aggregate purchase price we
paid was $826.6 million.
Pursuant to the stock purchase agreement, in March 2005 we
purchased an AMR subsidiary from Laidlaw for a purchase price of
approximately $2.2 million. This deferred purchase enabled
Laidlaw to prepay an outstanding debt obligation of the
subsidiary that was secured by the subsidiarys property.
The purchase price paid to Laidlaw at the closing of the
acquisition had been reduced by approximately $2.2 million.
Accordingly, the aggregate purchase price for the acquisition,
including this subsidiary, was $828.8 million.
The stock purchase agreements contain customary representations,
warranties and covenants. Pursuant to the stock purchase
agreements, we are indemnified by the seller (a subsidiary of
Laidlaw that directly owned AMR and EmCare) and Laidlaw, subject
to specified exceptions, for losses arising from:
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breaches by the seller of its representations, warranties,
covenants and agreements contained in the stock purchase
agreements, |
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damages relating to certain government investigations, and |
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tax liabilities for periods prior to closing. |
Claims for indemnification are subject to an aggregate
deductible equal to 1% of the aggregate purchase price and may
not exceed 15% of the aggregate purchase price (in each case,
without giving effect to any purchase price adjustment), each
subject to certain specified exceptions. Most claims for
indemnification must be made by the date that is 18 months
from the closing date; claims for environmental matters, taxes
and certain healthcare matters may be made for periods ranging
from three years to the applicable statute of limitations
(solely for certain tax matters), and certain representations,
such as those relating to corporate organization and ownership
of the capital stock of AMR and EmCare, do not expire.
Prior to the acquisition, Laidlaw provided various services to
AMR and EmCare, including income tax accounting, preparation of
tax returns, certain risk management/compliance/insurance
coverage services, cash management, certain benefit plan
administration and internal audit, and AMR and EmCare guaranteed
certain Laidlaw debt. See notes 10, 11 and 12 to the audited
combined financial statements included in this prospectus.
Management Bonuses in Connection with Our Acquisition of
AMR and EmCare
In connection with our acquisition of AMR and EmCare, Laidlaw
paid bonuses to Mr. Sanger and Mr. Harvey of
$12,691,032 and $2,270,002, respectively, pursuant to their
employment agreements. Each agreement set forth a formula to
determine the amount of bonus payable in connection with a sale
by Laidlaw of 50% or more of EmCare, in the case of
Mr. Harvey, and of 50% or more of AMR and/or EmCare, in the
case of Mr. Sanger. Also in connection with our acquisition
of AMR and EmCare, Laidlaw
134
paid Mr. Owen, Mr. Zimmerman and Dr. Packard
$200,363, $174,301 and $325,188, respectively, under
Laidlaws equity plan. Pursuant to that plan, in 2003,
units were granted to the named executive officers and other
members of senior management of AMR and EmCare. These units
vested in installments and were valued based upon the difference
between the initial value and the final value of AMR or EmCare,
as applicable. Participation in this plan by AMR and EmCare
management, including the named executive officers, terminated
upon the completion of our acquisition of AMR and EmCare.
Transition Services Agreement
In connection with our acquisition of AMR and EmCare, we entered
into a transition services agreement with Laidlaw. Pursuant to
this agreement:
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we agreed to hire a tax employee who would work for Laidlaw on a
consulting basis, until about December 31, 2005, to assist
in Laidlaws preparation of pre-closing period state and
federal tax returns relating to AMR and EmCare, |
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Laidlaw agreed to make its tax personnel available to us on a
consulting basis until December 31, 2005, and |
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Laidlaw agreed to lease certain Arlington, Texas office space to
us for 120 days at a lease price of $3,500 per month. |
We have paid Laidlaw for tax consulting services on a fixed
hourly rate. Laidlaw agreed to reimburse us for 120% of our tax
employees salary through June 30, 2005 and thereafter
for 75% of the 120% of salary, to pay the out-of-pocket expenses
related to the tax employees services to Laidlaw and to
pay 50% of any search firm fee with respect to the tax employee.
Laidlaw instead decided to utilize its own tax personnel to
complete the tax returns and we did not hire a tax employee for
this purpose. For the eight months ended September 30,
2005, we paid Laidlaw $19,515 under the transition services
agreement.
Performance Bond Arrangement
Certain of AMRs ambulance transport services contracts
require that AMR or its subsidiary post a surety or performance
bond. In the AMR stock purchase agreement, Laidlaw agrees to
continue to provide to us any cash required as collateral to
support the performance bonds in effect at January 31,
2005, and for a three-year period to pay any bond premiums in
excess of the rates in effect at the closing date. We have
agreed to indemnify Laidlaw for any claims against Laidlaw in
connection with these performance bonds. Under this agreement,
at September 30, 2005, Laidlaw continued to hold the
performance bond collateral amount of $14.8 million, which
represents 50% of the face amount of the performance bonds at
January 31, 2005. The cash collateral relating to each bond
will be delivered to us, or to a new surety for our benefit,
when Laidlaw is released from its indemnity obligations with
respect to the outstanding bond; until that release, Laidlaw and
we share equally investment income on the cash collateral.
Risk Financing Program
AMR is party to separate risk financing agreements with Laidlaw
for the period September 1, 1993 to August 31, 2001
and the period September 1, 2003 to the date of the closing
of our acquisition of AMR and EmCare. Pursuant to these
agreements, AMR had insured its workers compensation, auto and
general liability claims through Laidlaws captive
insurance company and participated in Laidlaws group
policies with respect to other types of coverage for occurrences
during the specific period of each agreement.
For the period September 1, 1993 to August 31, 2001,
we are fully-insured for AMRs workers compensation, auto
and general liability programs. We have no further payment
obligation to Laidlaw under that agreement, having previously
made all premium payments, and Laidlaw has agreed to bear the
cost of any claims relating to such claims for this period. For
the period September 1, 2003 to February 10, 2005, we
retain the risk of loss as to the first $2 million of auto
and general liability claims per occurrence and the first
$1 million of workers compensation claims per occurrence,
as a self-insurance program funded through Laidlaws
captive insurance program. AMR had collateral deposited with
Laidlaw totaling approximately
135
$42.2 million at February 10, 2005 and
$35.6 million at September 30, 2005. This collateral
is held in a trust fund owned by Laidlaw, and is applied by
Laidlaw to cover AMRs claims and related expenses. We are
responsible to Laidlaw for any claims costs in excess of the
collateral amount, and any excess collateral will be repaid to
us by Laidlaw. This self-insurance program for the period
September 1, 2003 to February 10, 2005 can be
terminated by either party on 60 days written notice.
See Business American Medical
Response Insurance.
Management Fee Agreement with Onex Partners Manager LP
We are party to a management agreement dated February 10,
2005 with Onex Partners Manager LP, or Onex Manager, a
wholly-owned subsidiary of Onex Corporation. In exchange for an
annual management fee of $1.0 million, Onex Manager
provides us with consulting and management advisory services in
the field of corporate finance and strategic planning and such
other management areas to which the parties agree. The annual
fee may be increased, to a maximum of $2.0 million, with
the approval of directors of each of AMR and EmCare who are not
affiliated with Onex. We also reimburse Onex Manager for
out-of-pocket expenses incurred in connection with the provision
of services pursuant to the agreement, and reimburse Onex
Manager for out-of-pocket expenses incurred in connection with
our acquisition of AMR and EmCare. The management agreement has
an initial term ending February 10, 2010, subject to
automatic one-year renewals, unless terminated by either party
by notice given at least 90 days prior to the scheduled
expiration date.
Issuance of Shares
The following table summarizes the purchases of our common stock
by our directors, executive officers and holders who
beneficially own more than 5% of our outstanding voting
securities. The information in this table, as to the type and
number of shares purchased, gives effect to the exchange of
EMS L.P. partnership units for our common stock to be
effected immediately prior to this offering and assumes the
exchange of all LP exchangeable units for our class B
common stock.
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Aggregate | |
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Number and | |
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Purchase | |
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Type of Shares | |
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Price | |
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Date of Purchase |
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5% Holders
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Onex Corporation
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32,107,523 class B |
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$ |
214,050,010 |
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February 10, 2005 |
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Onex Partners LP
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17,226,723 class B |
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$ |
114,844,820 |
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February 10, 2005 |
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Onex Partners LLC
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11,106,924 class B |
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$ |
74,046,160 |
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February 10, 2005 |
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Onex EMSC Co-Invest LP
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2,844,855 class B |
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$ |
18,965,700 |
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February 28, 2005 |
Executive Officers
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William A. Sanger
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450,000 class A |
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$ |
3,000,000 |
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February 10, 2005 |
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Don S. Harvey
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75,000 class A |
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$ |
500,000 |
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February 10, 2005 |
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Randel G. Owen
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33,750 class A |
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$ |
225,000 |
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February 10, 2005 |
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Dighton S. Packard, M.D.
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33,750 class A |
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$ |
225,000 |
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February 10, 2005 |
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Todd G. Zimmerman
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18,750 class A |
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$ |
125,000 |
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February 10, 2005 |
Non-Officer Directors
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Robert M. Le Blanc
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56,107 class B |
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$ |
373,981 |
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February 10, 2005 |
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Steven B. Epstein
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37,500 class A |
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$ |
250,000 |
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April 22, 2005 |
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James T. Kelly
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112,500 class A |
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$ |
750,000 |
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March 10, 2005 |
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Michael L. Smith
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37,500 class A |
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$ |
250,000 |
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June 30, 2005 |
Employment Agreements and Indemnification Agreements
We have an employment agreement and an option agreement with
Mr. Sanger, our Chairman and Chief Executive Officer, and
with certain of our other senior executives. For a description,
see Management Employment Agreements.
136
Pursuant to his employment agreement, Mr. Sanger leased
from us a personal residence we purchased when we asked him to
re-locate to Colorado. Mr. Sanger terminated the lease in
May 2005, at which time we sold the residence. As provided in
his employment agreement, in September 2005 we reimbursed
Mr. Sanger for the $463,000 he had spent on leasehold
improvements to the residence.
In November 1999, Texas EM-I Medical Services, P.A., a physician
group affiliated with EmCare, entered into an employment
agreement with Dighton C. Packard, M.D. Dr. Packards
employment agreement automatically renews for successive
two-year terms unless either party gives notice 180 days
prior to the expiration of the then current term.
Dr. Packard has the right to terminate his agreement upon
180 days notice, in which event he agrees to not
compete with Texas EM-I for 12 months following termination
of employment. Under the employment agreement, Dr. Packard
is to receive an annual base salary plus a bonus based on the
performance of the group under the agreements with Baylor
University Medical Center.
We have entered into indemnification agreements with each of our
directors, and our executive employment agreements include
indemnification provisions. Under those agreements, we agree to
indemnify each of these individuals against claims arising out
of events or occurrences related to that individuals
service as our agent or the agent of any of our subsidiaries to
the fullest extent legally permitted. See Description of
Capital Stock Indemnification of Directors and
Officers and Limitations on Liability.
Equityholder Agreements and Registration Agreement
On February 10, 2005, we entered into an investor
equityholders agreement and a registration rights agreement with
certain of our equityholders, including each of the named
executive officers. We are also party to an equityholders
agreement with certain of our employee, affiliated physician,
physician assistant and nurse practitioner equityholders. For a
descriptions of these agreements, see Description of
Capital Stock Equityholder Agreements and
Registration Agreement.
Consulting Agreement with BIDON Companies
On January 16, 2001, EmCare entered into a management
services agreement with BIDON, Inc., the stock of which is owned
by William A. Sanger, Don S. Harvey and a third partner.
Pursuant to the agreement, BIDON provided consulting and
management services to EmCare, including the services of
Messrs. Sanger and Harvey on a substantially full-time
basis. The agreement provided that BIDON was entitled to a
management fee and an incentive bonus, as well as a performance
fee payable upon a change in control of EmCare. The agreement
expired in March 31, 2003 and Messrs. Sanger and
Harvey entered into employment agreements with EmCare at that
time. Pursuant to the agreement, EmCare paid total fees and
bonuses to BIDON, including expense reimbursement, of
$2.6 million and $2.3 million in fiscal 2002 and
fiscal 2003, respectively.
Other Related Party Transactions and Business
Relationships
Assignment of Claim to Existing Equityholders
As we describe elsewhere in this prospectus, our historical
combined financial statements had reflected an understatement of
AMRs accounts receivable allowances, ranging from
$39 million to $50 million at various balance sheet
dates prior to our acquisition of AMR. We believe this
understatement gives rise to claims against Laidlaw and its
subsidiary, Laidlaw Medical Holdings, under the AMR stock
purchase agreement. All of the historical financial information
contained in this prospectus has been revised to reflect correct
accounts receivable allowances. We intend to assign this claim
against Laidlaw and the seller, and any related recovery we may
obtain, to the persons who hold our equity immediately prior to
this offering. Accordingly, persons who hold the class A
common stock we are offering pursuant to this prospectus will
not share in any such recovery.
Relationship with Law Firm
Steven B. Epstein, one of our directors, is a founding member
and the senior health law partner in the Washington, D.C. firm
of Epstein, Becker & Green, P.C., or EBG. EBG provided
healthcare-related legal services to Onex in connection with our
acquisition of AMR and EmCare, and we recently engaged EBG to
provide legal services to us.
137
MATERIAL U.S. FEDERAL INCOME TAX CONSIDERATIONS
The following summary describes certain material federal income
tax consequences arising from the purchase, ownership and
disposition of our class A common stock acquired in this
offering. This discussion does not cover all aspects of
U.S. federal income taxation that may be relevant to each
such holder due to the particular circumstances of such holder
or, except as expressly stated, address estate and gift tax
consequences, state, local or other tax consequences or
non-U.S. tax laws. This summary is based on the provisions
of the Internal Revenue Code of 1986, as amended (the
Code), final, temporary and proposed United States
Treasury regulations promulgated thereunder, and the
administrative and judicial interpretations thereof, all as in
effect as of the date of this prospectus and all of which are
subject to change, possibly with retroactive effect. In
particular, this summary does not address the considerations
that may be applicable to (a) particular classes of
taxpayers, including financial institutions, insurance
companies, small business investment companies, mutual funds,
partnerships or other pass-through entities or investors in such
entities, expatriates, broker-dealers and tax-exempt
organizations, (b) holders with a functional
currency other than the U.S. dollar or
(c) holders of 10% or more of the total combined voting
power of the Companys shares. This summary deals only with
the tax treatment of holders who own our common stock as
capital assets as defined in Section 1221 of
the Code.
THE SUMMARY OF U.S. FEDERAL INCOME TAX CONSIDERATIONS
SET FORTH BELOW IS FOR GENERAL INFORMATION ONLY AND DOES NOT
CONSTITUTE TAX ADVICE. ALL PROSPECTIVE PURCHASERS SHOULD CONSULT
THEIR OWN TAX ADVISORS AS TO THE PARTICULAR TAX CONSEQUENCES TO
THEM OF THE PURCHASE, OWNERSHIP, SALE OR OTHER DISPOSITION OF
SECURITIES INCLUDING THE EFFECTS OF APPLICABLE STATE, LOCAL,
NON-U.S. OR OTHER TAX LAWS, POSSIBLE CHANGES IN THE TAX
LAWS AND THE POSSIBLE APPLICABILITY OF INCOME TAX TREATIES.
As used herein, the term U.S. Holder means a
beneficial owner of our common stock that is for
U.S. federal income tax purposes:
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a U.S. citizen or individual resident in the United States, |
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a corporation, or other entity treated as a corporation created
or organized under the laws of the United States or any
political subdivision thereof, |
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an estate the income of which is subject to U.S. federal
income taxation regardless of its source, or |
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a trust (i) if a U.S. court can exercise primary
supervision over the administration of such trust and one or
more U.S. fiduciaries have the authority to control all of
the substantial interests of such trust or (ii) that has a
valid election in effect under applicable U.S. Treasury
regulations to be treated as a United States person. |
Except as provided below in the discussion of estate tax, the
term Non-U.S. Holder is a beneficial owner of
our common stock that is, for U.S. federal income tax
purposes, a nonresident alien individual or a corporation, trust
or estate that is not a U.S. Holder.
If a partnership, including any entity treated as a partnership
for U.S. federal income tax purposes, is a holder of our
common stock, the tax treatment of a partner in the partnership
will generally depend upon the status of the partner and the
activities of the partnership. If you are a partnership, or a
partner in such a partnership, you should consult your own tax
advisor regarding the tax consequences of the purchase,
ownership and disposition of our common stock.
Dividends
We do not anticipate paying cash dividends on our common stock
in the foreseeable future. See Dividend Policy. If
distributions are paid on shares of our common stock, such
distributions will constitute dividends for U.S. federal
income tax purposes to the extent paid from our current or
accumulated earnings
138
and profits, as determined under U.S. federal income tax
principles. If a distribution exceeds our current and
accumulated earnings and profits, it will constitute a return of
capital that is applied against and reduces, but not below zero,
a holders adjusted tax basis in our common stock. Any
remainder will constitute gain from the deemed sale of the
common stock. See Dispositions.
U.S. Holders. Any dividends payable by us will be
treated as U.S. source dividend income and will be eligible
for the dividends-received deduction generally allowed to
U.S. corporations under Section 243 of the Code
(subject to certain limitations and holding period requirements).
For taxable years ending on or before December 31, 2008,
certain qualified dividend income will be taxable to
a non-corporate U.S. Holder at the special reduced rate
normally applicable to capital gains (subject to certain
limitations). A U.S. Holder will be eligible for this
reduced rate only if it has held our common stock for more than
60 days during the 121-day period beginning 60 days
before the ex-dividend date.
Non-U.S. Holders. The dividends on our common stock
paid to a Non-U.S. Holder generally will be subject to
withholding of U.S. federal income tax at a 30% rate on the
gross amount of the dividend or such lower rate as may be
provided by an applicable income tax treaty. Dividends that are
effectively connected with a Non-U.S. Holders conduct
of a trade or business in the United States and, if a tax treaty
applies, attributable to a permanent establishment or fixed base
in the United States, known as U.S. trade or business
income, are generally not subject to the 30% withholding
tax if the Non-U.S. Holder files the appropriate
U.S. Internal Revenue Service form with the payor. However,
such U.S. trade or business income, net of specified
deductions and credits, generally is taxed at the same graduated
rates as applicable to U.S. persons. Any U.S. trade or
business income received by a Non-U.S. Holder that is a
corporation may also, under certain circumstances, be subject to
an additional branch profits tax at a 30% rate or
such lower rate as specified by an applicable income tax treaty.
A Non-U.S. Holder that claims the benefit of an applicable
income tax treaty generally will be required to satisfy
applicable certification and other requirements prior to the
distribution date. Non-U.S. Holders should consult their
tax advisors regarding their entitlement to benefits under a
relevant income tax treaty.
A Non-U.S. Holder that is eligible for a reduced rate of
U.S. federal withholding tax or other exclusion from
withholding under an income tax treaty but that did not timely
provide required certifications or other requirements, or that
has received a distribution subject to withholding in excess of
the amount properly treated as a dividend, may obtain a refund
or credit of any excess amounts withheld by timely filing an
appropriate claim for refund with the U.S. Internal Revenue
Service.
Dispositions
U.S. Holders. A U.S. Holder will recognize gain
or loss for U.S. federal income tax purposes upon the sale
or other disposition of our common stock in an amount equal to
the difference between the amount realized and the
U.S. Holders adjusted tax basis for such stock. Such
gain or loss will be capital gain or loss and will be long-term
capital gain or loss if the stock had been held for more than
one year. If the U.S. Holders holding period on the
date of the sale or exchange is one year or less, such gain or
loss will be short-term capital gain or loss. However, if a
U.S. Holder has received a dividend to which the special
reduced rate of tax, discussed above, applies, and which exceeds
10% of the U.S. Holders basis for the stock (taking
into account certain rules that aggregate dividends for this
purpose), any loss on sale or other disposition generally will
be a long-term capital loss to the extent of that dividend,
regardless of the U.S. Holders actual holding period.
Any gain or loss recognized on the sale or other disposition of
our common stock will generally be U.S. source income. Any
capital loss realized upon sale, exchange or other disposition
of our common stock is generally deductible only against capital
gains and not against ordinary income, except that in the case
of noncorporate taxpayers, a capital loss may be deductible to
the extent of capital gains plus ordinary income of up to $3,000.
139
A U.S. Holders tax basis for his, her or its shares
of our common stock will generally be the purchase price paid
therefor by such U.S. Holder (reduced by amounts of any
distributions, in excess of earnings and profits of the Company,
received by such U.S. Holder). The holding period of each
share of our common stock owned by a U.S. Holder will
commence on the day following the date of the
U.S. Holders purchase of such share and will include
the day on which the share is sold by such U.S. Holder.
Non-U.S. Holders. A Non-U.S. Holder generally
will not be subject to U.S. federal income tax (or
withholding thereof) on gain recognized on a disposition of our
common stock unless:
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the gain is U.S. trade or business income, in which case
such gain generally will be taxed in the same manner as gains of
U.S. persons, and such gains may also be subject to the
branch profits tax in the case of a corporate
Non-U.S. Holder; |
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the Non-U.S. Holder is an individual who is present in the
United States for more than 182 days in the taxable year of
the disposition and who meets certain other requirements, in
which case such holder generally will be subject to
U.S. federal income tax at a rate of 30% (or a reduced rate
under an applicable treaty) on the amount by which capital gains
allocable to U.S. sources (including gains from the sale,
exchange, retirement or other disposition of the common stock)
exceed capital losses allocable to U.S. sources; or |
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we are or have been a U.S. real property holding
corporation for U.S. federal income tax purposes at
any time during the shorter of the five-year period ending on
the date of disposition or the period that the
Non-U.S. Holder held our common stock (the applicable
period). |
Generally, a corporation is a U.S. real property
holding corporation if the fair market value of its
U.S. real property interests equals or exceeds
50% of the sum of the fair market value of its worldwide real
property interests plus its other assets used or held for use in
a trade or business. The tax relating to stock in a
U.S. real property holding corporation
generally will not apply to a Non-U.S. Holder whose
holdings, actual or constructive, at all times during the
applicable period, constituted 5% or less of our common stock,
provided that our common stock was regularly traded on an
established securities market. We believe we have never been,
are not currently and are not likely to become a U.S. real
property holding corporation for U.S. federal income tax
purposes in the future.
Information Reporting and Backup Withholding. We must
report annually to the U.S. Internal Revenue Service and to
each holder the amount of dividends paid to that holder and the
tax withheld with respect to those dividends. Copies of the
information returns reporting those dividends and the amount of
tax withheld may also be made available to the tax authorities
in the country in which a Non-U.S. Holder is a resident
under the provisions of an applicable income tax treaty.
Backup withholding, currently imposed at a rate of 28%, may
apply to payments of dividends paid by us. If you are a
U.S. Holder, backup withholding will apply if you fail to
provide an accurate taxpayer identification number or
certification of exempt status or fail to report all interest
and dividends required to be shown on your federal income tax
returns. Certain U.S. Holders (including, among others,
corporations) are not subject to backup withholding.
If you are a Non-U.S. Holder, backup withholding will apply
to dividend payments if you fail to provide us with the required
certification that you are not a U.S. person.
Payments of the proceeds from a disposition (including a
redemption) effected outside the United States by or through a
non-US. broker generally will not be subject to information
reporting or backup withholding. However, information reporting,
but generally not backup withholding, will apply to such a
payment if the broker has certain connections with the United
States unless the broker has documentary evidence in its records
that the beneficial owner of the disposed stock is a
Non-U.S. Holder and either specified conditions are met or
an exemption is otherwise established. Backup withholding and
information reporting will apply to dispositions made by or
through a U.S. office of any broker (U.S. or foreign).
140
Backup withholding is not an additional tax. Any amounts
withheld from a payment to you that result in an overpayment of
taxes generally will be refunded, or credited against your
U.S. federal income tax liability, if any, provided that
the required information is timely furnished to the
U.S. Internal Revenue Service.
Holders should consult their own tax advisors regarding
application of backup withholding in their particular
circumstance and the availability of, and procedure for
obtaining, an exemption from backup withholding under current
U.S. Treasury regulations.
Federal Estate Tax. Common stock owned or treated as
owned by an individual who is a Non-U.S. Holder (as specifically
defined for U.S. federal estate tax purposes) at the time
of death will be included in such individuals gross estate
for U.S. federal estate tax purposes, unless an applicable
treaty provides otherwise.
141
SHARES ELIGIBLE FOR FUTURE SALE
Prior to this offering, there has been no public market for our
class A common stock, and we cannot assure you that a
significant public market for our class A common stock will
develop or be sustained after this offering. Sales of
significant amounts of our class A common stock in the
public market after this offering, including shares of our
class A common stock issued upon exercise of outstanding
options or exchange of our LP exchangeable units for our
class B common stock and conversion into class A
common stock, or the perception that such sales could occur,
could adversely affect the prevailing market price of our
class A common stock and could impair our future ability to
raise capital through the sale of our equity securities.
Sale of Restricted Shares and Lock-Up Agreements
Upon completion of this offering, 8,948,325 shares of
class A common stock 142,545 shares of class B
common stock and 32,107,500 LP exchangeable units will be
outstanding, assuming no exercise of the underwriters
over-allotment option.
Of the 8,948,325 shares of class A common stock to be
outstanding upon completion of this offering,
7,800,000 shares of class A common stock offered
pursuant to this offering, or 8,970,000 shares if the
underwriters option is exercised in full, will be freely
tradable without restriction or further registration under
federal securities laws except to the extent shares of
class A common stock are purchased in this offering by our
affiliates, as that term is defined in Rule 144 under the
Securities Act.
Our issuance of 1,148,325 shares of our class A common
stock to holders of EMS L.P. partnership units in connection
with our formation as a holding company is registered by a
prospectus included with the registration statement filed for
this offering. Of these shares, 349,575 shares will be
issued to persons who are not our affiliates and will be freely
tradeable, subject to a contractual prohibition against the
transfer of these shares for a period of 180 days after the
date of this prospectus.
The remaining 798,750 shares of class A common stock
outstanding, which are held by our affiliates, the
142,545 shares of class B common stock and all of our
LP exchangeable units are restricted securities
under the Securities Act. These shares of class A common
stock, as well as the 32,250,045 shares of class A
common stock issuable on conversion of class B common
stock, are, or when issued on conversion will be, eligible for
public sale if registered under the Securities Act or sold in
accordance with Rule 144 of the Securities Act, subject to
the contractual provisions of our equityholders agreements. See
Description of Capital Stock Equityholder
Agreements. All of our common stock and
LP exchangeable units, held by our existing stockholders is
subject to market stand-off provisions that prohibit their sale
for a period of 180 days after the date of this prospectus.
In addition, Onex, our executive officers and directors and
certain of our other existing stockholders, who hold in the
aggregate 33,048,795 shares of our common stock (giving
effect to the exchange of the LP exchangeable units), are
subject to various lock-up agreements that prohibit the holders
from offering, selling, contracting to sell, granting an option
to purchase, making a short sale or otherwise disposing of any
shares of our common stock or any option to purchase shares of
our common stock or any securities exchangeable for or
convertible into shares of common stock for a period of
180 days after the date of this prospectus without the
prior written consent of Banc of America Securities LLC. Banc of
America Securities LLC, in its discretion and at any time
without notice, may release all or any portion of our common
stock held by our officers, directors and existing stockholders
subject to these lock-up agreements. Banc of America Securities
LLC has agreed with J.P. Morgan Securities Inc. that it
will not, without the consent of J.P. Morgan Securities
Inc., exercise its discretion to release all or any portion of
our common stock held by our officers, directors and existing
stockholders subject to these lock-up agreements.
As a result of the agreements described above, the registration
of our class A common stock issued in connection with our
formation as a holding company and the provisions of
Rule 144 of the Securities Act, 33,398,370 shares of
our class A common stock will be available for sale in the
public market as follows:
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349,575 shares will be eligible for sale beginning
180 days after the date of this prospectus subject to an
extension in certain circumstances as set forth in the section
entitled Underwriting Lock-up Agreements, |
142
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798,750 shares held by our executive officers and directors
will be eligible for sale under Rule 144 commencing
one-year from the date of this offering, or, if earlier, after
the shares are registered under the Securities Act, |
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142,545 shares issuable on conversion of our currently
outstanding class B common stock will be eligible for sale under
Rule 144 commencing one year from the date of such
conversion or, if earlier, after the resale is registered under
the Securities Act, and |
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32,107,500 shares will be eligible for sale under
Rule 144 one year from the date of the exchange of the LP
exchangeable units for class B common stock and the conversion
of the class B common stock for class A common stock or, if
earlier, after the exchange or the resale of the shares is
registered under the Securities Act. |
Rule 144
In general, Rule 144 allows a stockholder (or stockholders
where shares are aggregated) who has beneficially owned shares
of our class A common stock for at least one year and who
files a Form 144 with the SEC to sell within any
three-month period a number of those shares that does not exceed
the greater of:
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1% of the number of shares of our class A common stock then
outstanding, which will equal 89,483 shares immediately
after this offering, assuming no exercise of the
underwriters over-allotment option, or |
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the average weekly trading volume of our class A common
stock during the four calendar weeks preceding the filing of the
Form 144 with respect to such sale. |
Registration Rights
As described above in Description of Capital
Stock Registration Agreement, upon completion
of this offering, the holders of approximately
33,165,795 shares of our common stock will have the right,
subject to various conditions and limitations, to demand the
filing of, and include their shares in, registration statements
relating to our common stock, subject to the 180-day lock-up
arrangement described above. These registration rights of our
stockholders could impair the prevailing market price and impair
our ability to raise capital by depressing the price at which we
could sell our class A common stock.
Options
In addition to the 8,948,325 shares of class A common
stock outstanding immediately after this offering, as of the
date of this prospectus, there were outstanding options to
purchase 3,509,219 shares of our class A common stock.
None of these options are currently exercisable.
As soon as practicable after the completion of this offering, we
intend to file a registration statement on Form S-8 under
the Securities Act covering shares of our class A common
stock reserved for issuance under our equity option plan.
Accordingly, shares of our class A common stock registered
under such registration statement will be available for sale in
the open market upon exercise by the holders, subject to vesting
restrictions, Rule 144 limitations applicable to our
affiliates and the contractual lock-up and market stand-off
provisions described above.
143
UNDERWRITING
We and the selling stockholders are offering the shares of
class A common stock described in this prospectus through a
number of underwriters. Banc of America Securities LLC and
J.P. Morgan Securities Inc. are the representatives of the
underwriters. We and the selling stockholders have entered into
a firm commitment underwriting agreement with the
representatives. Subject to the terms and conditions of the
underwriting agreement, we and the selling stockholders have
agreed to sell to the underwriters, and each underwriter has
agreed to purchase from us and the selling stockholders, the
number of shares of class A common stock listed next to its
name in the following table:
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Underwriter |
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Number of Shares | |
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Banc of America Securities LLC
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J.P. Morgan Securities Inc.
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CIBC World Markets Corp.
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Credit Suisse First Boston LLC
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Goldman, Sachs & Co.
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Scotia Capital (USA) Inc.
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Utendahl Capital Group, LLC
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Total
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The underwriting agreement is subject to a number of terms and
conditions and provides that the underwriters must buy all of
the shares if they buy any of them. The underwriters will sell
the shares to the public when and if the underwriters buy the
shares from us and the selling stockholders.
The underwriters initially will offer the shares to the public
at the price specified on the cover page of this prospectus. The
underwriters may allow a concession of not more than
$ per
share to selected dealers. The underwriters may also allow, and
those dealers may re-allow, a concession of not more than
$ per
share to some other dealers. If all the shares are not sold at
the public offering price, the underwriters may change the
public offering price and the other selling terms. The
class A common stock is offered subject to a number of
conditions, including:
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receipt and acceptance of the class A common stock by the
underwriters; and |
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the underwriters right to reject orders in whole or in
part. |
Over-Allotment Option. The selling stockholders have
granted the underwriters an over-allotment option to buy up to
1,170,000 additional shares of our class A common stock at
the same price per share as they are paying for the shares shown
in the table above. These additional shares would cover sales of
shares by the underwriters which exceed the total number of
shares shown in the table above. The underwriters may exercise
this option at any time within 30 days after the date of
this prospectus. To the extent that the underwriters exercise
this option, each underwriter will purchase additional shares
from the selling stockholders in approximately the same
proportion as it purchased the shares shown in the table above.
If purchased, the additional shares will be sold by the
underwriters on the same terms as those on which the other
shares are sold. We will pay the expenses associated with the
exercise of this option.
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Discount and Commissions. The following table shows the
per share and total underwriting discounts and commissions to be
paid to the underwriters by us and the selling stockholders.
These amounts are shown assuming no exercise and full exercise
of the underwriters option to purchase additional shares.
We estimate that the expenses of the offering to be paid by us,
not including underwriting discounts and commissions, will be
approximately
$ million.
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Paid by the | |
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Paid by Us | |
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Selling Stockholders | |
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No Exercise | |
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Full Exercise | |
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No Exercise | |
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Full Exercise | |
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Per Share
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$ |
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$ |
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$ |
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$ |
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Total
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$ |
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$ |
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$ |
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$ |
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Listing. We have applied to include our class A
common stock for trading on the New York Stock Exchange under
the symbol EMS. In order to meet one of the
requirements for listing our class A common stock on the
New York Stock Exchange, the underwriters have undertaken to
sell 100 or more shares of our class A common stock to a
minimum of 2,000 beneficial holders.
Stabilization. In connection with this offering, the
underwriters may engage in activities that stabilize, maintain
or otherwise affect the price of our common stock, including:
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stabilizing transactions; |
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short sales; |
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syndicate covering transactions; |
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imposition of penalty bids; and |
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purchases to cover positions created by short sales. |
Stabilizing transactions consist of bids or purchases made for
the purpose of preventing or retarding a decline in the market
price of our class A common stock while this offering is in
progress. Stabilizing transactions may include making short
sales of our class A common stock, which involves the sale
by the underwriters of a greater number of shares of
class A common stock than they are required to purchase in
this offering, and purchasing shares of class A common
stock from the selling stockholders or on the open market to
cover positions created by short sales. Short sales may be
covered shorts, which are short positions in an
amount not greater than the underwriters over-allotment
option referred to above, or may be naked shorts,
which are short positions in excess of that amount. Syndicate
covering transactions involve purchases of our class A
common stock in the open market after the distribution has been
completed in order to cover syndicate short positions.
The underwriters may close out any covered short position either
by exercising their over-allotment option, in whole or in part,
or by purchasing shares in the open market. In making this
determination, the underwriters will consider, among other
things, the price of shares available for purchase in the open
market compared to the price at which the underwriters may
purchase shares through the over-allotment option.
A naked short position is more likely to be created if the
underwriters are concerned that there may be downward pressure
on the price of the class A common stock in the open market
that could adversely affect investors who purchased in this
offering. To the extent that the underwriters create a naked
short position, they will purchase shares in the open market to
cover the position.
The representatives also may impose a penalty bid on
underwriters and dealers participating in the offering. This
means that the representatives may reclaim from any syndicate
members or other dealers participating in the offering the
underwriting discount, commissions or selling concession on
shares sold by them and purchased by the representatives in
stabilizing or short covering transactions.
These activities may have the effect of raising or maintaining
the market price of our class A common stock or preventing
or retarding a decline in the market price of our class A
common stock. As a result of these activities, the price of our
class A common stock may be higher than the price that
otherwise might
145
exist in the open market. If the underwriters commence the
activities, they may discontinue them at any time. The
underwriters may carry out these transactions on the New York
Stock Exchange, in the over-the-counter market or otherwise.
Discretionary Accounts. The underwriters have informed us
that they will not make sales to accounts over which they
exercise discretionary authority without the prior written
specific approval of the customers.
IPO Pricing. Prior to this offering, there has been no
public market for our class A common stock. The initial
public offering price will be negotiated between us and the
representatives of the underwriters. Among the factors to be
considered in these negotiations are:
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the history of, and prospects for, our company and the industry
in which we compete; |
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our past and present financial performance; |
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our historical implicit stock prices, based on our February 2005
acquisition from Laidlaw and subsequent offerings of
unregistered shares; |
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an assessment of our management, our investments in technology
and risk management program; |
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the present state of our development, our scale and presence,
and our relationships with our customers; |
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the prospects for our future earnings and overall growth; |
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the prevailing conditions of the applicable United States
securities market at the time of this offering; |
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market valuations of publicly traded companies that we and the
representatives of the underwriters believe to be comparable to
us; and |
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other factors deemed relevant. |
Based upon the purchase price of our February 2005 acquisition
of AMR and EmCare, our implied stock price was $10.00 per
share. The implicit stock price with respect to the subsequent
issuances between February 10, 2005 and July 31, 2005,
and disclosed in Item 15 on pages II-2 and II-3 of the
registration statement of which this prospectus is a part, was
$10.00 per share. In determining the offering price with
respect to this initial public offering, the underwriters may
determine a price that is higher than these implicit prices per
share by considering a variety of factors, including those
listed above as well as the anticipated public trading market
for the shares, favorable developments in the industry, a more
effective capital and operating structure, and synergies that
have resulted from the common ownership and management of AMR
and EmCare.
The estimated initial public offering price range set forth on
the cover of this preliminary prospectus is subject to change as
a result of market conditions and other factors.
Qualified Independent Underwriter. Because we anticipate
that the underwriters or their affiliates will receive more than
10% of the net proceeds of this offering in connection with our
application of the net proceeds and, as described in
Conflicts/Affiliates below, under the Conduct Rules
of the NASD Manual the issuer may be deemed to be related to one
of the underwriters, Rules 2710(h)(1) and 2720(c) of the
Conduct Rules of the NASD Manual require the price to be no
higher than the price recommended by a qualified
independent underwriter which has participated in the
preparation of the registration statement and performed its
usual standard of due diligence in connection with that
preparation. In accordance with this requirement, Credit Suisse
First Boston LLC has assumed the responsibilities of acting as a
qualified independent underwriter and will recommend a price in
compliance with the requirements of Rule 2720 of the
Conduct Rules. Credit Suisse First Boston LLC will receive no
compensation for acting in this capacity; however, we have
agreed to indemnify Credit Suisse First Boston LLC for acting as
a qualified independent underwriter against specified
liabilities under the Securities Act.
Lock-up Agreements. We, our directors and our executive
officers have entered into lock-up agreements with the
underwriters. Our directors and executive officers own, in the
aggregate, 798,750 shares of our class A common stock.
Under these agreements, subject to exceptions, we may not issue
any new shares of
146
common stock, and those holders of stock and options may not,
directly or indirectly, offer, sell, contract to sell, pledge or
otherwise dispose of or hedge any common stock or securities
convertible into or exchangeable for shares of common stock, or
publicly announce the intention to do any of the foregoing,
without the prior written consent of Banc of America Securities
LLC and J.P. Morgan Securities Inc. for a period of
180 days from the date of this prospectus. This consent may
be given at any time without public notice. In addition, during
this 180-day period, we have agreed not to file any registration
statement for, and the Onex entities have agreed not to make any
demand for, or exercise any right of, the registration of, any
shares of common stock or any securities convertible into or
exercisable or exchangeable for common stock without the prior
written consent of Banc of America Securities LLC.
Notwithstanding the foregoing, if the 180th day after the
date of this prospectus occurs within 17 days following an
earnings release by us or the occurrence of material news or a
material event related to us, or if we intend to issue an
earnings release within 16 days following the
180th day, the 180-day period will be extended to the
18th day following such earnings release or the occurrence
of the material news or material event unless such extension is
waived by the underwriters.
Indemnification. We and the selling stockholders will
indemnify the underwriters against some liabilities, including
liabilities under the Securities Act. If we and the selling
stockholders are unable to provide this indemnification, we and
the selling stockholders will contribute to payments the
underwriters may be required to make in respect of those
liabilities.
Online Offering. A prospectus in electronic format may be
made available on the web sites maintained by one or more of the
underwriters participating in this offering. Other than the
prospectus in electronic format, the information on any such web
site, or accessible through any such web site, is not part of
the prospectus. The representatives may agree to allocate a
number of shares to underwriters for sale to their online
brokerage account holders. Internet distributions will be
allocated by the underwriters that will make internet
distributions on the same basis as other allocations. In
addition, shares may be sold by the underwriters to securities
dealers who resell shares to online brokerage account holders.
Conflicts/Affiliates. The underwriters and their
affiliates have provided, and may in the future provide, various
investment banking, commercial banking and other financial
services for us and our affiliates for which services they have
received, and may in the future receive, customary fees. Bank of
America, N.A., an affiliate of Banc of America Securities LLC,
is the administrative agent, collateral agent and a lender under
our senior secured credit facility. JPMorgan Chase Bank, N.A.,
an affiliate of J.P. Morgan Securities Inc., is the
syndication agent and a lender under our existing senior secured
credit facility. In addition, Banc of America Securities LLC and
J.P. Morgan Securities Inc. acted as joint book-running
managers in connection with the offering of our 10% senior
subordinated notes due 2015.
As described under Principal and Selling
Stockholders, Mr. Gerald W. Schwartz, the
Chairman, President and Chief Executive Officer of Onex
Corporation, owns shares representing a majority of the voting
rights of the shares of Onex Corporation and as such may be
deemed to own beneficially all of the LP exchangeable units
owned beneficially by Onex Corporation. Mr. Schwartz
disclaims such beneficial ownership. Mr. Schwartz is also a
member of the board of directors of The Bank of Nova Scotia, an
affiliate of Scotia Capital (USA) Inc., one of the underwriters
participating in this offering. As a result of this relationship
and as described in Qualified Independent
Underwriter above, this offering is being conducted in
accordance with Rule 2720 of the Conduct Rules.
Selling Restrictions. Each of the underwriters has
represented and agreed that:
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(a) it has not made or will not
make an offer of shares to the public in the United Kingdom
within the meaning of section 102B of the Financial
Services and Markets Act 2000 (as amended) (FSMA)
except to legal entities which are authorized or regulated to
operate in the financial markets or, if not so authorized or
regulated, whose corporate purpose is solely to invest in
securities or otherwise in circumstances which do not require
the publication by the company of a prospectus pursuant to the
Prospectus Rules of the Financial Services Authority
(FSA); |
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(b) it has only communicated or
caused to be communicated and will only communicate or cause to
be communicated an invitation or inducement to engage in
investment activity (within the meaning of |
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section 21 of FSMA) to persons who have professional
experience in matters relating to investments falling within
Article 19(5) of the Financial Services and Markets Act
2000 (Financial Promotion) Order 2005 or in circumstances in
which section 21 of FSMA does not apply to the
company; and |
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(c) it has complied with, and will
comply with all applicable provisions of FSMA with respect to
anything done by it in relation to the shares in, from or
otherwise involving the United Kingdom. |
In relation to each Member State of the European Economic Area
which has implemented the Prospectus Directive (each, a
Relevant Member State), each Underwriter has
represented and agreed that with effect from and including the
date on which the Prospectus Directive is implemented in that
Relevant Member State (the Relevant Implementation
Date) it has not made and will not make an offer of Shares
to the public in that Relevant Member State prior to the
publication of a prospectus in relation to the Shares which has
been approved by the competent authority in that Relevant Member
State or, where appropriate, approved in another Relevant Member
State and notified to the competent authority in that Relevant
Member State, all in accordance with the Prospectus Directive,
except that it may, with effect from and including the Relevant
Implementation Date, make an offer of Shares to the public in
that Relevant Member State at any time:
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(a) to legal entities which are
authorized or regulated to operate in the financial markets or,
if not so authorized or regulated, whose corporate purpose is
solely to invest in securities; |
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(b) to any legal entity which has
two or more of (1) an average of at least 250 employees
during the last financial year; (2) a total balance sheet
of more
than 43,000,000
and (3) an annual net turnover of more than
50,000,000,
as shown in its last annual or consolidated accounts; or |
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(c) in any other circumstances
which do not require the publication by the Issuer of a
prospectus pursuant to Article 3 of the Prospectus
Directive. |
For the purposes of this provision, the expression an
offer of Shares to the public in relation to any
Shares in any Relevant Member State means the communication in
any form and by any means of sufficient information on the terms
of the offer and the Shares to be offered so as to enable an
investor to decide to purchase or subscribe the Shares, as the
same may be varied in that Member State by any measure
implementing the Prospectus Directive in that Member State and
the expression Prospectus Directive means Directive
2003/71/ EC and includes any relevant implementing measure in
each Relevant Member State.
This offering is exempted from prospectus requirements in Norway
pursuant to the Norwegian Securities Trading Act. No prospectus
(including any amendment, supplement or replacement thereto) has
been prepared in connection with the offering of the
class A common stock that has been reviewed by the Oslo
Stock Exchange or the Norwegian Registry of Business
Enterprises, or by the competent authority of another State that
is a contracting party to the EEA agreement. This prospectus
shall not be released, distributed, published or reproduced, in
whole or in part, nor should its contents be disclosed by any
recipients to any other person.
This is not a prospectus and has not been prepared in accordance
with the prospectus requirements provided for in the Swedish
Financial Instruments Trading Act (lagen (1991:980) om handel
med finasiella instrument) nor any other Swedish enactment.
Neither the Swedish Financial Supervisory Authority nor any
other Swedish public body has examined, approved or registered
this document.
This prospectus has not been notified to or approved by the
Belgian Banking, Finance and Insurance Commission
(Commission bancaire, financiere et des
assurances/Commissie voor het Bank, Financie- en
Assurantiewezen) and is therefore transmitted on a purely
confidential basis. Accordingly, the class A common stock
may not be offered for sale, sold or marketed in Belgium by
means of a public offering under Belgian law. Any offer to sell
the class A common stock in Belgium will be permitted
exclusively to either:
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(i) persons who each subscribe for
a minimum
of 250,000, or |
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(ii) qualifying institutional
investors, acting for their own account, and listed in
Article 3, 2f of the Royal Decree of July 7,
1999. Qualifying institutional investors under Article 3,
2f of the Royal Decree are the following: |
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(1) |
the European Central Bank, certain Belgian sovereigns and public
institutions; |
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(2) |
licensed Belgian and foreign credit institutions; |
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(3) |
licensed Belgian and foreign investment firms; |
148
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(4) |
licensed Belgian and foreign collective investment schemes; |
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(5) |
licensed Belgian and foreign insurance companies, Belgian and
foreign reinsurance companies, and certain pensions funds; |
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(6) |
Belgian holding companies; |
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(7) |
authorized Belgian coordination centers; and |
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(8) |
Belgian and foreign companies listed on a Belgian or a foreign
regulated market with consolidated own funds of at least
425 million. |
No prospectus (including any amendment, supplement or
replacement thereto) has been prepared in connection with the
offering of the class A common stock that has been approved
by the Autorité des marchés financiers or by
the competent authority of another state that is a contracting
party to the Agreement on the European Economic Area that has
been recognized in France; no class A common stock has been
offered or sold and will be offered or sold, directly or
indirectly, to the public in France except to qualified
investors (investisseurs qualifiés) and/or to a
limited circle of investors (cercle restreint
dinvestisseurs) acting for their own account as
defined in article L. 411-2 of the French Code Monétaire
et Financier and applicable regulations thereunder; none of
this prospectus or any other materials related to the offering
or information contained therein relating to the class A
common stock has been released, issued or distributed to the
public in France except to qualified investors (investisseurs
qualifiés) and/or to a limited circle of investors
(cercle restreint dinvestisseurs) mentioned above;
and the direct or indirect resale to the public in France of any
class A common stock acquired by any qualified investors
(investisseurs qualifiés) and/or any investors
belonging to a limited circle of investors (cercle restreint
dinvestisseurs) may be made only as provided by
articles L. 412-1 and L. 621-8 of the French Code
Monétaire et Financier and applicable regulations
thereunder.
The class A common stock has not been and will not be
registered under the Securities and Exchange Law of Japan (the
Securities and Exchange Law) and each underwriter has agreed
that it will not offer or sell any securities, directly or
indirectly, in Japan or to, or for the benefit of, any resident
of Japan (which term as used herein means any person resident in
Japan, including any corporation or other entity organized under
the laws of Japan), or to others for re-offering or resale,
directly or indirectly, in Japan or to a resident of Japan,
except pursuant to an exemption from the registration
requirements of, and otherwise in compliance with, the
Securities and Exchange Law and any other applicable laws,
regulations and ministerial guidelines of Japan.
The class A common stock may not be offered or sold by
means of any document other than to persons whose ordinary
business is to buy or sell shares or debentures, whether as
principal or agent, or in circumstances which do not constitute
an offer to the public within the meaning of the Companies
Ordinance (Cap. 32) of Hong Kong, and no advertisement,
invitation or document relating to the class A common stock
may be issued, whether in Hong Kong or elsewhere, which is
directed at, or the contents of which are likely to be accessed
or read by, the public in Hong Kong (except if permitted to do
so under the securities laws of Hong Kong) other than with
respect to class A common stock which are or are intended
to be disposed of only to persons outside Hong Kong or only to
professional investors within the meaning of the
Securities and Futures Ordinance (Cap. 571) of Hong Kong and any
rules made thereunder.
This prospectus has not been registered as a prospectus with the
Monetary Authority of Singapore. Accordingly, this prospectus
and any other document or material in connection with the offer
or sale, or invitation or subscription or purchase, of the
class A common stock may not be circulated or distributed,
nor may the class A common stock be offered or sold, or be
made the subject of an invitation for subscription or purchase,
whether directly or indirectly, to persons in Singapore other
than under circumstances in which such offer, sale or invitation
does not constitute an offer or sale, or invitation for
subscription or purchase, of the class A common stock to
the public in Singapore.
149
LEGAL MATTERS
The validity of the shares of class A common stock offered
hereby and certain other legal matters will be passed upon for
us by Kaye Scholer LLP, New York, New York. Certain regulatory
matters will be passed upon for us by Foley & Lardner
LLP, San Diego, California. The validity of the shares of
class A common stock and certain other legal matters will
be passed upon for the underwriters by Cahill Gordon &
Reindel llp,
New York, New York.
EXPERTS
The balance sheet of Emergency Medical Services Corporation as
of November 10, 2005 end the combined financial statements
of American Medical Response, Inc. and its subsidiaries and
EmCare Holdings Inc. and its subsidiaries for the year ended
August 31, 2002 (Predecessor), the nine months ended
May 31, 2003 (Predecessor), and as of and for the three
months ended August 31, 2003, the year ended
August 31, 2004 and the five months ended January 31,
2005 included in this prospectus, have been so included in
reliance on the reports (which contain an explanatory paragraph
relating to the companies restatement of their combined
financial statements, as well as the parents emergence
from bankruptcy as described in Note 1) of
PricewaterhouseCoopers LLP, an independent registered public
accounting firm, given on the authority of said firm as experts
in auditing and accounting.
WHERE YOU CAN FIND MORE INFORMATION
We have filed a registration statement on Form S-1 with the
Securities and Exchange Commission under the Securities Act with
respect to the shares of class A common stock offered by
this prospectus. This prospectus, which constitutes a part of
the registration statement, does not contain all of the
information included in the registration statement or the
schedules, exhibits and amendments to the registration
statement. You should refer to the registration statement and
its exhibits and schedules for further information. Statements
made in this prospectus as to any of our contracts, agreements
or other documents referred to are not necessarily complete. In
each instance, if we have filed a copy of such contract,
agreement or other document as an exhibit to the registration
statement, you should read the exhibit for a more complete
understanding of the matter involved. Each statement regarding a
contract, agreement or other document is qualified in all
respects by reference to the actual document.
You may read and copy information omitted from this prospectus
but contained in the registration statement at the public
reference facilities maintained by the SEC at
100 F Street, N.E., Washington, DC 20549.
You may also request copies of all or any portion of such
material from the Public Reference Section of the SEC at 100 F
Street, N.E., Washington, DC 20549 at prescribed rates.
Please call the Securities and Exchange Commission at
1-800-SEC-0330 for further information on the operation of the
public reference rooms. In addition, materials filed
electronically with the SEC are available at the SECs
World Wide Web site at http://www.sec.gov.
Upon completion of this offering, we will become subject to the
information and periodic reporting requirements of the
Securities Exchange Act of 1934, and, in accordance therewith,
will file periodic reports, proxy statements and other
information with the SEC. Such periodic reports, proxy
statements and other information will be available for
inspection and copying at the public reference room and web site
of the SEC referred to above. We also intend to furnish our
stockholders with annual reports containing our financial
statements audited by an independent public accounting firm and
quarterly reports containing our unaudited financial
information. We maintain a web site at www.emsc.net. You
may access our annual report on Form 10-K, quarterly
reports on Form 10-Q, current reports on Form 8-K, and
amendments to those reports, filed or furnished pursuant to
section 13(a) or 15(d) of the Exchange Act with the SEC
free of charge at our web site as soon as reasonably practicable
after this material is electronically filed with, or furnished
to, the SEC. The reference to our web address does not
constitute incorporation by reference of the information
contained at that site.
150
AMERICAN MEDICAL RESPONSE, INC. & EMCARE HOLDINGS
INC.
INDEX TO COMBINED AND CONSOLIDATED FINANCIAL STATEMENTS
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Combined Financial Statements (as Restated) for the Five
Months Ended January 31, 2005, for the Year Ended
August 31, 2004, for the Three Months Ended August 31,
2003, for the Nine Months Ended May 31, 2003 (Predecessor)
for the Year Ended August 31, 2002 (Predecessor)
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Report of Independent Registered Public Accounting Firm
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F-2 |
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Combined Balance Sheets at January 31, 2005,
August 31, 2004 and 2003
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F-5 |
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Combined Statements of Operations and Comprehensive Income
(Loss) for the five months ended January 31, 2005, for the
year ended August 31, 2004, for the three months ended
August 31, 2003, for the nine months ended May 31,
2003 (Predecessor) and for the year ended August 31, 2002
(Predecessor)
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F-6 |
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Statements of Changes in Combined Equity for the five months
ended January 31, 2005, for the year ended August 31,
2004, for the three months ended August 31, 2003, for the
nine months ended May 31, 2003 (Predecessor) and for the
year ended August 31, 2002 (Predecessor)
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F-7 |
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Combined Statements of Cash Flows for the five months ended
January 31, 2005, for the year ended August 31, 2004,
for the three months ended August 31, 2003, for the nine
months ended May 31, 2003 (Predecessor) and for the year
ended August 31, 2002 (Predecessor)
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F-8 |
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Notes to Combined Financial Statements
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F-9 |
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Unaudited Consolidated/ Combined Financial Statements for the
Three Months and Eight Months Ended September 30, 2005 and
September 30, 2004
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Unaudited Consolidated Balance Sheet at September 30, 2005
and Combined Balance Sheet at January 31, 2005
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F-50 |
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Unaudited Consolidated/ Combined Statements of Operations and
Comprehensive Income for the three months and eight months ended
September 30, 2005 and 2004
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F-51 |
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Unaudited Consolidated/Combined Statements of Cash Flows for
eight months ended September 30, 2005 and 2004
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F-52 |
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Notes to Unaudited Consolidated/ Combined Financial Statements
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F-53 |
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EMERGENCY MEDICAL SERVICES CORPORATION
INDEX TO FINANCIAL STATEMENTS
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Financial Statements at November 10, 2005
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Report of Independent Registered Public Accounting Firm
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F-70 |
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Balance Sheet at November 10, 2005
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F-72 |
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Notes to Financial Statements
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F-73 |
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F-1
REPORT OF INDEPENDENT REGISTERED PUBLIC ACCOUNTING FIRM
To the Stockholders of American Medical Response, Inc.
and EmCare Holdings, Inc.:
In our opinion, the accompanying combined balance sheets
(successor basis) and the related combined statements of
operations and comprehensive income (loss) (successor basis),
changes in combined equity (successor basis) and cash flows
(successor basis) present fairly, in all material respects, the
financial position of American Medical Response, Inc. and its
subsidiaries (AMR) and EmCare Holdings, Inc. and its
subsidiaries (EmCare) (collectively, the
Company) as of January 31, 2005 and
August 31, 2004 and 2003 and the results of their
operations and changes in combined equity and cash flows for the
five-month period ended January 31, 2005, for the year
ended August 31, 2004 and for the three-month period ended
August 31, 2003, in conformity with accounting principles
generally accepted in the United States of America. These
combined financial statements are the responsibility of the AMR
and EmCare management; our responsibility is to express an
opinion on these financial statements based on our audits. We
conducted our audits of these statements in accordance with the
standards of the Public Company Accounting Oversight Board
(United States). Those standards require that we plan and
perform the audit to obtain reasonable assurance about whether
the financial statements are free of material misstatement. An
audit includes examining, on a test basis, evidence supporting
the amounts and disclosures in the financial statements,
assessing the accounting principles used and significant
estimates made by management, and evaluating the overall
financial statement presentation. We believe that our audits
provide a reasonable basis for our opinion.
As discussed in Note 1 to the combined financial
statements, AMR and EmCare are wholly-owned subsidiaries of
Laidlaw International, Inc., previously Laidlaw, Inc.
(Laidlaw). The United States Bankruptcy Court for
the Western District for New York confirmed Laidlaws Third
Amended Plan of Reorganization (the plan) on
February 27, 2003. Confirmation of the plan resulted in the
discharge of all claims against Laidlaw that arose on or before
June 28, 2001 and terminated all rights and interest of
equity security holders as provided for in the plan. The plan
was implemented in June 2003 and Laidlaw emerged from
bankruptcy. In connection with its emergence from bankruptcy,
Laidlaw adopted fresh-start accounting and recorded fresh-start
accounting adjustments in the separate financial statements of
AMR and EmCare on June 1, 2003. As a result, the
Companys post-emergence (successor basis) financial
statements reflect a different basis of accounting than its
pre-emergence (predecessor basis) financial statements.
As discussed in Note 1 to the combined financial
statements, the Company has restated its financial statements as
of August 31, 2004 and 2003.
PricewaterhouseCoopers LLP
Denver, Colorado
August 1, 2005, except as to the information disclosed in
Note 17, as to which the date is October 7, 2005
F-2
REPORT OF INDEPENDENT REGISTERED PUBLIC ACCOUNTING FIRM
To the Stockholders of American Medical Response, Inc.
and EmCare Holdings, Inc.:
In our opinion, the accompanying combined statements of
operations and comprehensive income (loss) (predecessor basis),
changes in combined equity (predecessor basis) and cash flows
(predecessor basis) present fairly, in all material respects,
the results of operations and changes in combined equity and
cash flows of American Medical Response, Inc. and its
subsidiaries (AMR) and EmCare Holdings, Inc. and its
subsidiaries (EmCare) (collectively, the
Company) for the nine-month period ended
May 31, 2003, and for the year ended August 31, 2002,
in conformity with accounting principles generally accepted in
the United States of America. These combined financial
statements are the responsibility of the AMR and EmCare
management; our responsibility is to express an opinion on these
financial statements based on our audits. We conducted our
audits of these statements in accordance with the standards of
the Public Company Accounting Oversight Board (United States).
Those standards require that we plan and perform the audit to
obtain reasonable assurance about whether the financial
statements are free of material misstatement. An audit includes
examining, on a test basis, evidence supporting the amounts and
disclosures in the financial statements, assessing the
accounting principles used and significant estimates made by
management, and evaluating the overall financial statement
presentation. We believe that our audits provide a reasonable
basis for our opinion.
As discussed in Note 1 to the combined financial
statements, AMR and EmCare are wholly-owned subsidiaries of
Laidlaw International, Inc., previously Laidlaw, Inc.
(Laidlaw). The United States Bankruptcy Court for
the Western District of New York confirmed Laidlaws Third
Amended Plan of Reorganization (the plan) on
February 27, 2003. Confirmation of the plan resulted in the
discharge of all claims against Laidlaw that arose on or before
June 28, 2001 and terminated all rights and interest of
equity security holders as provided for in the plan. The plan
was implemented in June 2003 and Laidlaw emerged from
bankruptcy. In connection with its emergence from bankruptcy,
Laidlaw adopted fresh-start accounting and recorded fresh-start
accounting adjustments in the separate financial statements of
AMR and EmCare on June 1, 2003. As a result, the
Companys post-emergence (successor basis) financial
statements reflect a different basis of accounting than its
pre-emergence (predecessor basis) financial statements.
As discussed in Note 2 to the combined financial
statements, on September 1, 2002, AMR and EmCare changed
their method of accounting for goodwill.
As discussed in Note 1 to the combined financial
statements, the Company has restated its financial statements
for the nine-month period ended May 31, 2003 and the year
ended August 31, 2002.
PricewaterhouseCoopers LLP
Denver, Colorado
January 14, 2005, except as to the restatement described in
Note 1, as to which the date is August 1, 2005 and as
to the information disclosed in Note 17, as to which the
date is October 7, 2005
F-3
American Medical Response, Inc.
& EmCare Holdings Inc.
(The Healthcare Transportation and Emergency Management
Services
Businesses of Laidlaw International, Inc.)
Combined Financial Statements
January 31, 2005 and August 31, 2004 and 2003 (as
restated)
F-4
American Medical Response, Inc. and EmCare Holdings Inc.
(The Healthcare Transportation and Emergency Management
Services
Businesses of Laidlaw International, Inc.)
Combined Balance Sheets
January 31, 2005, August 31, 2004 and 2003
(dollars in thousands)
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
As Restated | |
|
|
|
|
See Note 1 | |
|
|
|
|
| |
|
|
January 31, | |
|
August 31, | |
|
August 31, | |
|
|
2005 | |
|
2004 | |
|
2003 | |
|
|
| |
|
| |
|
| |
ASSETS |
Current assets:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Cash and cash equivalents
|
|
$ |
14,631 |
|
|
$ |
9,476 |
|
|
$ |
10,641 |
|
|
Restricted cash and cash equivalents
|
|
|
9,846 |
|
|
|
5,691 |
|
|
|
939 |
|
|
Restricted marketable securities
|
|
|
2,473 |
|
|
|
6,756 |
|
|
|
201 |
|
|
Trade and other accounts receivable, net
|
|
|
369,767 |
|
|
|
344,210 |
|
|
|
320,452 |
|
|
Parts and supplies inventory
|
|
|
18,499 |
|
|
|
18,577 |
|
|
|
17,444 |
|
|
Prepaids and other current assets
|
|
|
40,135 |
|
|
|
32,015 |
|
|
|
32,207 |
|
|
Current deferred tax assets
|
|
|
65,092 |
|
|
|
52,981 |
|
|
|
58,836 |
|
|
|
|
|
|
|
|
|
|
|
|
|
Current assets
|
|
|
520,443 |
|
|
|
469,706 |
|
|
|
440,720 |
|
|
|
|
|
|
|
|
|
|
|
Non-current assets:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Property, plant and equipment, net
|
|
|
128,766 |
|
|
|
132,685 |
|
|
|
133,546 |
|
|
Intangible assets, net
|
|
|
16,075 |
|
|
|
15,758 |
|
|
|
148,205 |
|
|
Non-current deferred tax assets
|
|
|
202,469 |
|
|
|
214,389 |
|
|
|
96,596 |
|
|
Restricted long-term investments
|
|
|
41,810 |
|
|
|
47,285 |
|
|
|
40,608 |
|
|
Other long-term assets
|
|
|
73,947 |
|
|
|
69,776 |
|
|
|
55,071 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Assets
|
|
$ |
983,510 |
|
|
$ |
949,599 |
|
|
$ |
914,746 |
|
|
|
|
|
|
|
|
|
|
|
|
LIABILITIES AND COMBINED EQUITY |
Current liabilities:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Accounts payable
|
|
$ |
55,818 |
|
|
$ |
50,915 |
|
|
$ |
50,182 |
|
|
Accrued liabilities
|
|
|
171,645 |
|
|
|
166,784 |
|
|
|
146,179 |
|
|
Current portion of long-term debt
|
|
|
5,846 |
|
|
|
7,565 |
|
|
|
8,270 |
|
|
|
|
|
|
|
|
|
|
|
|
|
Current liabilities
|
|
|
233,309 |
|
|
|
225,264 |
|
|
|
204,631 |
|
|
Long-term debt
|
|
|
5,651 |
|
|
|
7,915 |
|
|
|
15,787 |
|
|
Other long-term liabilities
|
|
|
146,273 |
|
|
|
142,580 |
|
|
|
133,789 |
|
|
|
|
|
|
|
|
|
|
|
|
|
Liabilities
|
|
|
385,233 |
|
|
|
375,759 |
|
|
|
354,207 |
|
|
|
|
|
|
|
|
|
|
|
Commitments and contingencies (notes 7, 9 and 10)
|
|
|
|
|
|
|
|
|
|
|
|
|
Laidlaw payable
|
|
|
202,042 |
|
|
|
186,778 |
|
|
|
22,416 |
|
Laidlaw investment
|
|
|
356,550 |
|
|
|
356,550 |
|
|
|
546,144 |
|
Retained earnings (deficit)
|
|
|
40,000 |
|
|
|
30,518 |
|
|
|
(6,831 |
) |
Comprehensive loss
|
|
|
(315 |
) |
|
|
(6 |
) |
|
|
(1,190 |
) |
|
|
|
|
|
|
|
|
|
|
|
|
Combined equity
|
|
|
598,277 |
|
|
|
573,840 |
|
|
|
560,539 |
|
|
|
|
|
|
|
|
|
|
|
|
|
Liabilities and combined equity
|
|
$ |
983,510 |
|
|
$ |
949,599 |
|
|
$ |
914,746 |
|
|
|
|
|
|
|
|
|
|
|
The accompanying notes are an integral part of these combined
financial statements.
F-5
American Medical Response, Inc. and EmCare Holdings Inc.
(The Healthcare Transportation and Emergency Management
Services
Businesses of Laidlaw International, Inc.)
Combined Statements of Operations and Comprehensive Income
(Loss)
For the Five Months Ended January 31, 2005, for the Year
Ended August 31, 2004, for the Three Months Ended
August 31, 2003, for the Nine Months Ended May 31,
2003 (Predecessor) and for the Year Ended August 31, 2002
(Predecessor)
(dollars in thousands)
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Predecessor as Restated | |
|
|
|
|
|
|
|
|
|
See note 1 | |
|
|
Five | |
|
|
|
Three | |
|
|
| |
|
|
Months | |
|
Year | |
|
Months | |
|
|
Nine Months | |
|
Year | |
|
|
Ended | |
|
Ended | |
|
Ended | |
|
|
Ended | |
|
Ended | |
|
|
January 31, | |
|
August 31, | |
|
August 31, | |
|
|
May 31, | |
|
August 31, | |
|
|
2005 | |
|
2004 | |
|
2003 | |
|
|
2003 | |
|
2002 | |
|
|
| |
|
| |
|
| |
|
|
| |
|
| |
Net revenue
|
|
$ |
696,179 |
|
|
$ |
1,604,598 |
|
|
$ |
384,461 |
|
|
|
$ |
1,103,335 |
|
|
$ |
1,415,786 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Compensation and benefits
|
|
|
481,305 |
|
|
|
1,117,890 |
|
|
|
264,604 |
|
|
|
|
757,183 |
|
|
|
960,590 |
|
Operating expenses
|
|
|
94,882 |
|
|
|
218,277 |
|
|
|
55,212 |
|
|
|
|
163,447 |
|
|
|
219,321 |
|
Insurance expense
|
|
|
39,002 |
|
|
|
80,255 |
|
|
|
34,671 |
|
|
|
|
69,576 |
|
|
|
66,479 |
|
Selling, general and administrative expenses
|
|
|
21,635 |
|
|
|
47,899 |
|
|
|
12,017 |
|
|
|
|
37,867 |
|
|
|
61,455 |
|
Laidlaw fees and compensation charges
|
|
|
19,857 |
|
|
|
15,449 |
|
|
|
1,350 |
|
|
|
|
4,050 |
|
|
|
5,400 |
|
Depreciation and amortization expense
|
|
|
18,808 |
|
|
|
52,739 |
|
|
|
12,560 |
|
|
|
|
32,144 |
|
|
|
67,183 |
|
Impairment losses
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
262,780 |
|
Restructuring charges
|
|
|
|
|
|
|
2,115 |
|
|
|
1,449 |
|
|
|
|
1,288 |
|
|
|
3,777 |
|
Laidlaw reorganization costs
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
3,650 |
|
|
|
8,761 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Income (loss) from operations
|
|
|
20,690 |
|
|
|
69,974 |
|
|
|
2,598 |
|
|
|
|
34,130 |
|
|
|
(239,960 |
) |
Interest expense
|
|
|
(5,644 |
) |
|
|
(9,961 |
) |
|
|
(908 |
) |
|
|
|
(4,691 |
) |
|
|
(6,418 |
) |
Realized gain (loss) on investments
|
|
|
|
|
|
|
(1,140 |
) |
|
|
90 |
|
|
|
|
|
|
|
|
|
|
Interest and other income
|
|
|
714 |
|
|
|
240 |
|
|
|
22 |
|
|
|
|
304 |
|
|
|
369 |
|
Fresh-start accounting adjustments
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
46,416 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Income (loss) before income taxes and cumulative effect of
change in accounting principle
|
|
|
15,760 |
|
|
|
59,113 |
|
|
|
1,802 |
|
|
|
|
76,159 |
|
|
|
(246,009 |
) |
Income tax expense
|
|
|
(6,278 |
) |
|
|
(21,764 |
) |
|
|
(8,633 |
) |
|
|
|
(829 |
) |
|
|
(1,374 |
) |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Income (loss) before cumulative effect of a change in accounting
principle
|
|
|
9,482 |
|
|
|
37,349 |
|
|
|
(6,831 |
) |
|
|
|
75,330 |
|
|
|
(247,383 |
) |
Cumulative effect of a change in accounting principle
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
(223,721 |
) |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Net income (loss)
|
|
|
9,482 |
|
|
|
37,349 |
|
|
|
(6,831 |
) |
|
|
|
(148,391 |
) |
|
|
(247,383 |
) |
Other comprehensive income (loss), net of tax
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Unrealized holding gains (losses) during the period
|
|
|
(309 |
) |
|
|
1,184 |
|
|
|
(1,190 |
) |
|
|
|
603 |
|
|
|
116 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Comprehensive income (loss)
|
|
$ |
9,173 |
|
|
$ |
38,533 |
|
|
$ |
(8,021 |
) |
|
|
$ |
(147,788 |
) |
|
$ |
(247,267 |
) |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
The accompanying notes are an integral part of these combined
financial statements.
F-6
American Medical Response, Inc. and EmCare Holdings Inc.
(The Healthcare Transportation and Emergency Management
Services
Businesses of Laidlaw International, Inc.)
Statements of Changes in Combined Equity
For the Five Months Ended January 31, 2005, for the Year
Ended August 31, 2004, for the Three Months Ended
August 31, 2003, for the Nine Months Ended May 31,
2003 (Predecessor) and for the Year Ended August 31, 2002
(Predecessor)
(dollars in thousands)
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Accumulated | |
|
|
|
|
|
|
|
|
Retained | |
|
Other | |
|
Total | |
|
|
Laidlaw | |
|
Laidlaw | |
|
Earnings | |
|
Comprehensive | |
|
Combined | |
|
|
Payable | |
|
Investment | |
|
(Deficit) | |
|
Income (Loss) | |
|
Equity | |
|
|
| |
|
| |
|
| |
|
| |
|
| |
Balances August 31, 2001 (Predecessor)
|
|
$ |
1,422,088 |
|
|
$ |
2,089,376 |
|
|
$ |
(2,437,836 |
) |
|
$ |
|
|
|
$ |
1,073,628 |
|
Prior period adjustment see note 1
|
|
|
|
|
|
|
|
|
|
|
(41,020 |
) |
|
|
|
|
|
|
(41,020 |
) |
Net loss
|
|
|
|
|
|
|
|
|
|
|
(247,383 |
) |
|
|
|
|
|
|
(247,383 |
) |
Payments made to Laidlaw, net
|
|
|
(24,823 |
) |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
(24,823 |
) |
Unrealized holding gains
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
116 |
|
|
|
116 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Balances August 31, 2002 (Predecessor) as
restated see note 1
|
|
|
1,397,265 |
|
|
|
2,089,376 |
|
|
|
(2,726,239 |
) |
|
|
116 |
|
|
|
760,518 |
|
Net loss
|
|
|
|
|
|
|
|
|
|
|
(148,391 |
) |
|
|
|
|
|
|
(148,391 |
) |
Payments made to Laidlaw, net
|
|
|
(83 |
) |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
(83 |
) |
Unrealized holding gains
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
603 |
|
|
|
603 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Balances May 31, 2003 (Predecessor) as restated
see note 1
|
|
$ |
1,397,182 |
|
|
$ |
2,089,376 |
|
|
$ |
(2,874,630 |
) |
|
$ |
719 |
|
|
$ |
612,647 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Fresh-start balances June 1, 2003 as restated
see note 1
|
|
$ |
66,503 |
|
|
$ |
546,144 |
|
|
$ |
|
|
|
$ |
|
|
|
$ |
612,647 |
|
Net loss
|
|
|
|
|
|
|
|
|
|
|
(6,831 |
) |
|
|
|
|
|
|
(6,831 |
) |
Payments made to Laidlaw, net
|
|
|
(44,087 |
) |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
(44,087 |
) |
Unrealized holding losses
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
(1,190 |
) |
|
|
(1,190 |
) |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Balances August 31, 2003, as restated see
note 1
|
|
|
22,416 |
|
|
|
546,144 |
|
|
|
(6,831 |
) |
|
|
(1,190 |
) |
|
|
560,539 |
|
Dividend to Laidlaw
|
|
|
200,000 |
|
|
|
(200,000 |
) |
|
|
|
|
|
|
|
|
|
|
|
|
Net income
|
|
|
|
|
|
|
|
|
|
|
37,349 |
|
|
|
|
|
|
|
37,349 |
|
Fresh-start adjustments (note 1)
|
|
|
|
|
|
|
10,406 |
|
|
|
|
|
|
|
|
|
|
|
10,406 |
|
Payments made to Laidlaw, net
|
|
|
(35,638 |
) |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
(35,638 |
) |
Unrealized holding gains
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
1,184 |
|
|
|
1,184 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Balances August 31, 2004 as restated see
note 1
|
|
|
186,778 |
|
|
|
356,550 |
|
|
|
30,518 |
|
|
|
(6 |
) |
|
|
573,840 |
|
Net income
|
|
|
|
|
|
|
|
|
|
|
9,482 |
|
|
|
|
|
|
|
9,482 |
|
Advances from Laidlaw, net
|
|
|
15,264 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
15,264 |
|
Unrealized holding losses
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
(309 |
) |
|
|
(309 |
) |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Balances January 31, 2005
|
|
$ |
202,042 |
|
|
$ |
356,550 |
|
|
$ |
40,000 |
|
|
$ |
(315 |
) |
|
$ |
598,277 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
The accompanying notes are an integral part of these combined
financial statements.
F-7
American Medical Response, Inc. and EmCare Holdings Inc.
(The Healthcare Transportation and Emergency Management
Services
Businesses of Laidlaw International, Inc.)
Combined Statements of Cash Flows
For the Five Months Ended January 31, 2005, for the Year
Ended August 31, 2004, for the Three Months Ended
August 31, 2003, for the Nine Months Ended May 31,
2003 (Predecessor)
and for the Year Ended August 31, 2002 (Predecessor)
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Predecessor as | |
|
|
|
|
|
|
|
|
|
restated | |
|
|
|
|
|
|
|
|
|
see note 1 | |
|
|
|
|
|
|
|
|
|
| |
|
|
Five Months | |
|
|
|
Three Months | |
|
|
Nine Months | |
|
|
|
|
Ended | |
|
Year Ended | |
|
Ended | |
|
|
Ended | |
|
Year Ended | |
|
|
January 31, | |
|
August 31, | |
|
August 31, | |
|
|
May 31, | |
|
August 31, | |
|
|
2005 | |
|
2004 | |
|
2003 | |
|
|
2003 | |
|
2002 | |
|
|
| |
|
| |
|
| |
|
|
| |
|
| |
|
|
(dollars in thousands) | |
|
|
(dollars in thousands) | |
Cash Flows from Operating Activities
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Net income (loss)
|
|
$ |
9,482 |
|
|
$ |
37,349 |
|
|
$ |
(6,831 |
) |
|
|
$ |
(148,391 |
) |
|
$ |
(247,383 |
) |
Adjustments to reconcile net income (loss) to net cash provided
by operating activities:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Depreciation and amortization
|
|
|
18,808 |
|
|
|
53,957 |
|
|
|
12,775 |
|
|
|
|
32,359 |
|
|
|
67,205 |
|
|
Loss (gain) on disposal of property, plant and equipment
|
|
|
145 |
|
|
|
(446 |
) |
|
|
(316 |
) |
|
|
|
(349 |
) |
|
|
(1,140 |
) |
|
Impairment charge
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
262,780 |
|
|
Cumulative effect of a change in accounting principle
(note 3)
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
223,721 |
|
|
|
|
|
|
Non-cash allocated expenses (income)
|
|
|
|
|
|
|
(4,505 |
) |
|
|
11,522 |
|
|
|
|
3,058 |
|
|
|
(8,094 |
) |
|
Restructuring charges
|
|
|
|
|
|
|
2,115 |
|
|
|
1,449 |
|
|
|
|
1,288 |
|
|
|
3,777 |
|
|
Notes payable discount
|
|
|
213 |
|
|
|
132 |
|
|
|
50 |
|
|
|
|
218 |
|
|
|
422 |
|
|
Loss (gain) on restricted investments
|
|
|
197 |
|
|
|
1,140 |
|
|
|
(90 |
) |
|
|
|
|
|
|
|
|
|
|
Deferred income taxes
|
|
|
6,278 |
|
|
|
21,899 |
|
|
|
(8,421 |
) |
|
|
|
|
|
|
|
|
|
|
Fresh-start accounting adjustments (note 1)
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
(46,416 |
) |
|
|
|
|
|
Changes in operating assets/liabilities (net of acquisitions):
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Trade and other accounts receivable
|
|
|
(26,057 |
) |
|
|
(23,764 |
) |
|
|
1,522 |
|
|
|
|
(14,049 |
) |
|
|
21,352 |
|
|
|
Parts and supplies inventory
|
|
|
78 |
|
|
|
(1,133 |
) |
|
|
(517 |
) |
|
|
|
233 |
|
|
|
(153 |
) |
|
|
Prepaids and other current assets
|
|
|
(269 |
) |
|
|
5,892 |
|
|
|
3,700 |
|
|
|
|
(12,257 |
) |
|
|
(10,345 |
) |
|
|
Accounts payable and accrued liabilities
|
|
|
3,046 |
|
|
|
17,322 |
|
|
|
3,553 |
|
|
|
|
(6,614 |
) |
|
|
22,350 |
|
|
|
Compliance and insurance accruals
|
|
|
4,045 |
|
|
|
20,402 |
|
|
|
12,520 |
|
|
|
|
31,312 |
|
|
|
46,575 |
|
|
|
Restructuring charges and acquisition accruals
|
|
|
|
|
|
|
(2,681 |
) |
|
|
(907 |
) |
|
|
|
(5,344 |
) |
|
|
(802 |
) |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Net cash provided by operating activities
|
|
|
15,966 |
|
|
|
127,679 |
|
|
|
30,009 |
|
|
|
|
58,769 |
|
|
|
156,544 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Cash Flows from Investing Activities
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Purchase of property, plant and equipment
|
|
|
(14,045 |
) |
|
|
(42,787 |
) |
|
|
(18,079 |
) |
|
|
|
(34,768 |
) |
|
|
(31,118 |
) |
Purchase of business
|
|
|
(1,200 |
) |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Proceeds from sale of business
|
|
|
1,300 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Proceeds from sale of property, plant and equipment
|
|
|
175 |
|
|
|
858 |
|
|
|
341 |
|
|
|
|
624 |
|
|
|
2,549 |
|
Purchase of restricted cash and investments
|
|
|
(31,257 |
) |
|
|
(64,357 |
) |
|
|
(11,287 |
) |
|
|
|
(66,266 |
) |
|
|
(50,946 |
) |
Proceeds from sale and maturity of restricted investments
|
|
|
35,960 |
|
|
|
46,389 |
|
|
|
12,530 |
|
|
|
|
36,748 |
|
|
|
32,215 |
|
Other investing activities
|
|
|
(79 |
) |
|
|
6,814 |
|
|
|
1,359 |
|
|
|
|
(35,173 |
) |
|
|
(10,047 |
) |
Increase in Laidlaw insurance deposits
|
|
|
(12,521 |
) |
|
|
(28,433 |
) |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Net cash used in investing activities
|
|
|
(21,667 |
) |
|
|
(81,516 |
) |
|
|
(15,136 |
) |
|
|
|
(98,835 |
) |
|
|
(57,347 |
) |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Cash Flows from Financing Activities
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Repayments of capital lease obligations and other debt
|
|
|
(3,992 |
) |
|
|
(8,709 |
) |
|
|
(1,851 |
) |
|
|
|
(6,338 |
) |
|
|
(17,817 |
) |
Increase (decrease) in bank overdrafts
|
|
|
5,866 |
|
|
|
(4,544 |
) |
|
|
8,675 |
|
|
|
|
(815 |
) |
|
|
(1,134 |
) |
Advances from (payments to) Laidlaw
|
|
|
8,982 |
|
|
|
(31,133 |
) |
|
|
(55,609 |
) |
|
|
|
(3,141 |
) |
|
|
(16,729 |
) |
Increase (decrease) in other non-current liabilities
|
|
|
|
|
|
|
(2,942 |
) |
|
|
1,563 |
|
|
|
|
2,234 |
|
|
|
(386 |
) |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Net cash provided by (used in) financing activities
|
|
|
10,856 |
|
|
|
(47,328 |
) |
|
|
(47,222 |
) |
|
|
|
(8,060 |
) |
|
|
(36,066 |
) |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Increase (decrease) in cash and cash equivalents
|
|
|
5,155 |
|
|
|
(1,165 |
) |
|
|
(32,349 |
) |
|
|
|
(48,126 |
) |
|
|
63,131 |
|
Cash and cash equivalents, beginning of period
|
|
|
9,476 |
|
|
|
10,641 |
|
|
|
42,990 |
|
|
|
|
91,116 |
|
|
|
27,985 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Cash and cash equivalents, end of period
|
|
$ |
14,631 |
|
|
$ |
9,476 |
|
|
$ |
10,641 |
|
|
|
$ |
42,990 |
|
|
$ |
91,116 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
The accompanying notes are an integral part of these combined
financial statements.
F-8
American Medical Response, Inc. & EmCare Holdings
Inc.
(The Healthcare Transportation and Emergency Management
Services
Businesses of Laidlaw International, Inc.)
Notes to Combined Financial Statements
(dollars in thousands)
Basis of Presentation of Financial Statements
These financial statements have been prepared in accordance with
accounting principles generally accepted in the United States of
America (GAAP) to reflect the combined financial
position, results of operations and cash flows of American
Medical Response, Inc. and its subsidiaries (AMR)
and EmCare Holdings Inc. and its subsidiaries
(EmCare) (combined or each individually, the
Company). These financial statements have been
prepared in connection with the definitive sale agreement
referred to in note 17 to reflect the businesses that were
purchased. AMR and EmCare are indirect, wholly owned
subsidiaries of Laidlaw International Inc., previously Laidlaw
Inc. (Laidlaw or the Parent). The
Company operates in two segments, AMR in the Healthcare
Transportation Service business and EmCare in the Emergency
Management Service business.
AMR operates in 34 states, providing a full range of
medical transportation services from basic patient transit to
the most advanced emergency care and pre-hospital assistance. In
addition, AMR operates emergency (911) call and response
services for large and small communities all across the United
States, offers medical staff for large entertainment venues like
stadiums and arenas, and provides telephone triage,
transportation dispatch and demand management services.
EmCare provides outsourced business services to hospitals
primarily for emergency departments, related urgent care centers
and for certain inpatient departments for 313 hospitals in
38 states. EmCare recruits physicians, gathers their
credentials, arranges contracts for their services, assists in
monitoring their performance and arranges their scheduling. In
addition, EmCare assists clients in such operational areas as
staff coordination, quality assurance, departmental
accreditation, billing, record-keeping, third-party payment
programs, and other administrative services.
Restatement
Accounts receivable allowance. The Company determined
that because of an error in its reserving methodology, its
accounts receivable allowances were understated at various
balance sheet dates prior to and including the periods presented
herein. As a result, AMR has recorded an adjustment of
$50 million to increase the accounts receivable allowance
as of May 31, 2003, of which $39 million reduces
previously reported retained earnings (deficit) as of
August 31, 2001. Adjustments were also required for the
nine-month period ended May 31, 2003 and the year ended
August 31, 2002, reflecting a reduction of net revenue and
a corresponding increase in accounts receivable allowances of
$8.0 million and $3.0 million, respectively. There
were no further adjustments necessary subsequent to May 31,
2003. In addition, the Company made other adjustments related to
certain deferred rent and leasehold amortization matters,
reducing previously reported retained earnings (deficit) as of
August 31, 2001 by $2.0 million and reducing earnings
for the nine-month period ended May 31, 2003 by
$0.1 million and for the year ended August 31, 2002 by
$0.2 million.
AMR adopted SFAS No. 142, Goodwill and Other
Intangible Assets (SFAS No. 142), on
September 1, 2002 and recorded a charge associated with a
change in accounting principle based on a fair value assessment
of goodwill. The impact of reducing the net accounts receivable
balance prior to the assessment reduced the charge necessary
upon adoption of SFAS No. 142 by $42 million.
Effective June 1, 2003, the Companys parent emerged
from bankruptcy and applied fresh-start accounting. The impact
of the correction made to the nine-month period ended
May 31, 2003 increased the fresh-start income adjustment by
$8.1 million.
F-9
American Medical Response, Inc. & EmCare Holdings
Inc.
(The Healthcare Transportation and Emergency Management
Services
Businesses of Laidlaw International, Inc.)
Notes to Combined Financial
Statements (Continued)
Also as a part of applying fresh-start accounting, the Company
adjusted its assets and liabilities to fair value. As a result
of the restatement which reduced net assets by
$52.3 million, as discussed above, the Company allocated
$52.3 million to goodwill at June 1, 2003 as the
reorganization value exceeded the fair value of the assets and
liabilities. See Chapter 11
Reorganization Laidlaw, below, for further
information.
As a result of these corrections, as of May 31, 2003,
deferred tax assets of $20.3 million have been recorded
with a corresponding full valuation allowance. In fiscal 2004,
AMR had reversed all of its valuation allowance, which reversal
now includes the valuation allowance referred to above. In
accordance with fresh-start accounting, the reversal of
valuation allowances first reduces intangible assets to zero,
and then any excess is credited to the Laidlaw investment in the
Statement of Changes in Combined Equity. As a result of the
increased goodwill of $52.3 million and the release of the
valuation allowance of $20.3 million discussed above, the
Company reduced its previously recorded credit to Laidlaw
investment by $32.0 million. See note 5 for further
information.
Following is a summary of the effects of these changes on the
Companys Combined Balance Sheet as of August 31, 2004
and 2003 and Combined Statements of Operations for the nine
months ended May 31, 2003 and for the fiscal year ended
August 31, 2002. Correcting for the error did not require
adjustment to total net cash flows provided by operating
activities, net cash flows used in investing activities, or net
cash flows provided by (used in) financing activities.
Combined Balance Sheets
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
As Previously | |
|
|
|
As | |
|
|
Reported | |
|
Adjustments | |
|
Restated | |
|
|
| |
|
| |
|
| |
August 31, 2004
|
|
|
|
|
|
|
|
|
|
|
|
|
Trade and other accounts receivable, net
|
|
$ |
394,210 |
|
|
$ |
(50,000 |
) |
|
$ |
344,210 |
|
Current deferred tax assets
|
|
|
33,935 |
|
|
|
19,046 |
|
|
|
52,981 |
|
Current assets
|
|
|
500,660 |
|
|
|
(30,954 |
) |
|
|
469,706 |
|
Property, plant & equipment
|
|
|
133,362 |
|
|
|
(677 |
) |
|
|
132,685 |
|
Non-current deferred tax assets
|
|
|
213,127 |
|
|
|
1,262 |
|
|
|
214,389 |
|
Assets
|
|
|
979,968 |
|
|
|
(30,369 |
) |
|
|
949,599 |
|
Other long-term liabilities
|
|
|
140,897 |
|
|
|
1,683 |
|
|
|
142,580 |
|
Liabilities
|
|
|
374,076 |
|
|
|
1,683 |
|
|
|
375,759 |
|
Laidlaw investment
|
|
|
388,602 |
|
|
|
(32,052 |
) |
|
|
356,550 |
|
Combined equity
|
|
|
605,892 |
|
|
|
(32,052 |
) |
|
|
573,840 |
|
Liabilities and combined equity
|
|
|
979,968 |
|
|
|
(30,369 |
) |
|
|
949,599 |
|
|
August 31, 2003
|
|
|
|
|
|
|
|
|
|
|
|
|
Trade and other accounts receivable, net
|
|
|
370,452 |
|
|
|
(50,000 |
) |
|
|
320,452 |
|
Current assets
|
|
|
490,720 |
|
|
|
(50,000 |
) |
|
|
440,720 |
|
Property, plant & equipment
|
|
|
134,223 |
|
|
|
(677 |
) |
|
|
133,546 |
|
Intangible assets, net
|
|
|
95,845 |
|
|
|
52,360 |
|
|
|
148,205 |
|
Assets
|
|
|
913,063 |
|
|
|
1,683 |
|
|
|
914,746 |
|
Other long-term liabilities
|
|
|
132,106 |
|
|
|
1,683 |
|
|
|
133,789 |
|
Liabilities
|
|
|
352,524 |
|
|
|
1,683 |
|
|
|
354,207 |
|
Liabilities and combined equity
|
|
$ |
913,063 |
|
|
$ |
1,683 |
|
|
$ |
914,746 |
|
F-10
American Medical Response, Inc. & EmCare Holdings
Inc.
(The Healthcare Transportation and Emergency Management
Services
Businesses of Laidlaw International, Inc.)
Notes to Combined Financial
Statements (Continued)
Combined Statements of Operations and Comprehensive Income
(Loss)
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
As Previously | |
|
|
|
As | |
|
|
Reported | |
|
Adjustments | |
|
Restated | |
|
|
| |
|
| |
|
| |
Nine months ended May 31, 2003 (predecessor)
|
|
|
|
|
|
|
|
|
|
|
|
|
Net revenue
|
|
$ |
1,111,335 |
|
|
$ |
(8,000 |
) |
|
$ |
1,103,335 |
|
Operating expenses
|
|
|
163,293 |
|
|
|
154 |
|
|
|
163,447 |
|
Depreciation and amortization expense
|
|
|
32,156 |
|
|
|
(12 |
) |
|
|
32,144 |
|
Income (loss) from operations
|
|
|
42,272 |
|
|
|
(8,142 |
) |
|
|
34,130 |
|
Fresh-start accounting adjustments
|
|
|
38,274 |
|
|
|
8,142 |
|
|
|
46,416 |
|
Cumulative effect of a change in accounting principle
|
|
|
(267,939 |
) |
|
|
44,218 |
|
|
|
(223,721 |
) |
Net income (loss)
|
|
|
(192,609 |
) |
|
|
44,218 |
|
|
|
(148,391 |
) |
Comprehensive income (loss)
|
|
|
(192,006 |
) |
|
|
44,218 |
|
|
|
(147,788 |
) |
Year ended August 31, 2002 (predecessor)
|
|
|
|
|
|
|
|
|
|
|
|
|
Net revenue
|
|
|
1,418,786 |
|
|
|
(3,000 |
) |
|
|
1,415,786 |
|
Operating expenses
|
|
|
219,121 |
|
|
|
200 |
|
|
|
219,321 |
|
Depreciation and amortization expense
|
|
|
67,185 |
|
|
|
(2 |
) |
|
|
67,183 |
|
Income (loss) from operations
|
|
|
(236,762 |
) |
|
|
(3,198 |
) |
|
|
(239,960 |
) |
Income (loss) before income taxes and cumulative effect of a
change in accounting principle
|
|
|
(242,811 |
) |
|
|
(3,198 |
) |
|
|
(246,009 |
) |
Income (loss) before cumulative effect of a change in accounting
principle
|
|
|
(244,185 |
) |
|
|
(3,198 |
) |
|
|
(247,383 |
) |
Net income (loss)
|
|
|
(244,185 |
) |
|
|
(3,198 |
) |
|
|
(247,383 |
) |
Comprehensive income (loss)
|
|
$ |
(244,069 |
) |
|
$ |
(3,198 |
) |
|
$ |
(247,267 |
) |
Chapter 11 Reorganization Laidlaw
On June 28, 2001, Laidlaw and certain of its affiliates
filed voluntary petitions for reorganization under
Chapter 11 of the Bankruptcy Code. During the pendency of
the Chapter 11 case, Laidlaw continued to operate its
businesses in accordance with the applicable provisions of the
Bankruptcy Code. Although subsidiaries of Laidlaw, neither AMR
nor EmCare filed for reorganization under Chapter 11 of the
Bankruptcy Code.
Laidlaw emerged from bankruptcy protection during fiscal 2003,
and on June 1, 2003 adopted Statement of
Position 90-7, Financial Reporting by Entities in
Reorganization Under the Bankruptcy Code (SOP 90-7),
applying fresh-start accounting to its balance sheet as of the
close of business on May 31, 2003. In accordance with the
principles of fresh-start accounting, Laidlaw determined the
reorganization value of its individual business units and
adjusted their assets and liabilities to estimated fair values
as of May 31, 2003. On May 31, 2003, Laidlaw applied
push-down accounting and allocated to the Company
its share of reorganization value aggregating
$939.9 million. Reorganization value, as defined in
SOP 90-7, is the amount that approximates the fair value of
the assets of an entity before considering liabilities. The
reorganization value allocated to the Company was based on the
consideration of factors such as the industries in which the
Company operates, the general economic conditions that impact
the health care industry, and application of certain valuation
methods, including a discounted cash flow analysis, an analysis
of comparable publicly traded company multiples and a comparable
acquisitions analysis. The net effect of all fresh-start
accounting
F-11
American Medical Response, Inc. & EmCare Holdings
Inc.
(The Healthcare Transportation and Emergency Management
Services
Businesses of Laidlaw International, Inc.)
Notes to Combined Financial
Statements (Continued)
adjustments pushed down to the Company resulted in additional
income of $46.4 million, which is reflected as an
adjustment to the financial results for the period from
September 1, 2002 through May 31, 2003.
As a result of the application of push-down accounting, the
Companys balance sheet as of the close of business
May 31, 2003 and financial statements for periods beginning
on June 1, 2003, referred to as Successor
Company, may not be comparable with its financial
statements for periods before June 1, 2003, referred to as
Predecessor Company because they are, in effect, those
reflecting the application of a new basis of accounting. The
balances below have been adjusted for the restatement described
above. As a result, trade receivables, property plant and
equipment, intangible assets and other long-term liabilities
changed by $(50) million, $(0.6) million,
$44.2 million and $1.6 million, respectively, in the
Predecessor and Successor columns. Retained earnings (deficit)
increased by $8.1 million in the Predecessor fair value
adjustment column and the adjustment to intangible fair value
decreased by $8.1 million. The effects of fresh-start
reporting on the Companys combined balance sheet as of the
close of business May 31, 2003 are as follows:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Restated | |
|
|
| |
|
|
Predecessor | |
|
Fair Value | |
|
Successor | |
|
|
Company | |
|
Adjustments | |
|
Company | |
|
|
| |
|
| |
|
| |
Assets
|
|
|
|
|
|
|
|
|
|
|
|
|
Current assets:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Cash and cash equivalents
|
|
$ |
42,990 |
|
|
$ |
|
|
|
$ |
42,990 |
|
|
Restricted cash and cash equivalents
|
|
|
1,154 |
|
|
|
|
|
|
|
1,154 |
|
|
Trade and other accounts receivable, net
|
|
|
321,974 |
|
|
|
|
|
|
|
321,974 |
|
|
Parts and supplies inventory
|
|
|
16,927 |
|
|
|
|
|
|
|
16,927 |
|
|
Other current assets
|
|
|
35,907 |
|
|
|
|
|
|
|
35,907 |
|
|
Current deferred tax assets
|
|
|
|
(c) |
|
|
72,493 |
|
|
|
72,493 |
|
|
|
|
|
|
|
|
|
|
|
|
|
Current assets
|
|
|
418,952 |
|
|
|
72,493 |
|
|
|
491,445 |
|
|
|
|
|
|
|
|
|
|
|
Property, plant, and equipment, net
|
|
|
130,212 |
(a) |
|
|
(4,683 |
) |
|
|
125,529 |
|
Intangible assets, net
|
|
|
230,222 |
(b) |
|
|
(79,843 |
) |
|
|
150,379 |
|
Non-current deferred tax assets
|
|
|
|
(c) |
|
|
73,918 |
|
|
|
73,918 |
|
Restricted long-term investments trust
|
|
|
43,764 |
|
|
|
|
|
|
|
43,764 |
|
Other long-term assets
|
|
|
56,596 |
|
|
|
|
|
|
|
56,596 |
|
|
|
|
|
|
|
|
|
|
|
|
|
Assets
|
|
$ |
879,746 |
|
|
$ |
61,885 |
|
|
$ |
941,631 |
|
|
|
|
|
|
|
|
|
|
|
F-12
American Medical Response, Inc. & EmCare Holdings
Inc.
(The Healthcare Transportation and Emergency Management
Services
Businesses of Laidlaw International, Inc.)
Notes to Combined Financial
Statements (Continued)
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Restated | |
|
|
| |
|
|
Predecessor | |
|
Fair Value | |
|
Successor | |
|
|
Company | |
|
Adjustments | |
|
Company | |
|
|
| |
|
| |
|
| |
|
Liabilities and Combined Equity
|
|
|
|
|
|
|
|
|
|
|
|
|
Current liabilities:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Accounts payable
|
|
$ |
40,156 |
|
|
$ |
|
|
|
$ |
40,156 |
|
|
Accrued liabilities
|
|
|
140,777 |
(d) |
|
|
1,000 |
|
|
|
141,777 |
|
|
Current portion of long-term debt
|
|
|
8,807 |
|
|
|
|
|
|
|
8,807 |
|
|
|
|
|
|
|
|
|
|
|
|
|
Current liabilities
|
|
|
189,740 |
|
|
|
1,000 |
|
|
|
190,740 |
|
Long-term debt
|
|
|
17,052 |
|
|
|
|
|
|
|
17,052 |
|
Other long-term liabilities
|
|
|
106,723 |
(e) |
|
|
14,469 |
|
|
|
121,192 |
|
|
|
|
|
|
|
|
|
|
|
|
|
Liabilities
|
|
|
313,515 |
|
|
|
15,469 |
|
|
|
328,984 |
|
|
|
|
|
|
|
|
|
|
|
Laidlaw payable
|
|
|
59,355 |
(f) |
|
|
7,148 |
|
|
|
66,503 |
|
Laidlaw investment
|
|
|
3,419,470 |
(f) |
|
|
(2,873,326 |
) |
|
|
546,144 |
|
Retained earnings (deficit)
|
|
|
(2,913,313 |
) (f) |
|
|
2,913,313 |
|
|
|
|
|
Comprehensive income
|
|
|
719 |
(f) |
|
|
(719 |
) |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Combined equity
|
|
|
566,231 |
|
|
|
46,416 |
|
|
|
612,647 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Liabilities and combined equity
|
|
$ |
879,746 |
|
|
$ |
61,885 |
|
|
$ |
941,631 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
(a) |
|
Adjusts property, plant and equipment to reflect the estimated
fair value of the assets based on independent appraisals. |
|
(b) |
|
Eliminates the Predecessor Companys historic goodwill,
records identifiable intangible assets at estimated fair value
based upon independent appraisals and records the remaining
reorganization value to goodwill. |
|
(c) |
|
Records the net deferred income tax assets of the Company. |
|
(d) |
|
Records the operating leases at their estimated fair value based
on independent valuations and the current borrowing rate of the
Company. |
|
(e) |
|
Adjusts the Companys insurance reserves to their estimated
fair value. |
|
(f) |
|
Reflects the elimination of the accumulated deficit and
comprehensive income and establishes the payable account to
Laidlaw. |
|
|
2. |
Summary of Significant Accounting Policies |
Combination
The combined financial statements include the accounts of the
Company or of the Predecessor Company consolidated with all of
their respective subsidiaries. All significant intracompany
transactions are eliminated.
Use of Estimates
The preparation of financial statements in accordance with GAAP
requires the Company to make estimates and assumptions that
affect reported amounts of assets, liabilities, revenue and
expenses, and disclosure of contingencies. Future events could
alter such estimates.
Cash and Cash Equivalents
Cash and cash equivalents are composed of highly liquid
investments with an original maturity of three months or less
and are recorded at market value.
At January 31, 2005 and August 31, 2004 and 2003, bank
overdrafts of $22.0 million, $16.1 million and
$20.6 million, respectively, were included in accounts
payable on the accompanying combined balance sheets.
F-13
American Medical Response, Inc. & EmCare Holdings
Inc.
(The Healthcare Transportation and Emergency Management
Services
Businesses of Laidlaw International, Inc.)
Notes to Combined Financial
Statements (Continued)
Restricted Cash and Cash Equivalents
Restricted cash and cash equivalents include short-term
investments that are part of the portfolio of the Companys
captive insurance arrangement. These investments are highly
liquid and have original maturities of three months or less.
These assets are used to support the current portion of claim
liabilities under the captive arrangement.
Restricted Marketable Securities
Marketable securities were pledged as collateral against the
Companys claim liabilities under the captive insurance
arrangement. Restricted marketable securities are
income-yielding securities that can be converted readily into
cash and include commercial paper, corporate and foreign notes
and bonds, and U.S. Treasury and agency obligations. Such
securities are stated at market value and are classified as
available-for-sale under Financial Accounting Standards Board
Statement of Financial Accounting Standards No. 115,
Accounting for Certain Investments in Debt and Equity
Securities (SFAS No. 115), with
unrealized gains and losses reported, net of tax, in other
comprehensive income as a component of combined equity.
Trade and Other Accounts Receivable, net
The Company determines its allowances based on payor
reimbursement schedules, historical write-off experience and
other economic data. The allowances for contractual discounts
and uncompensated care are reviewed monthly. Account balances
are charged off against the uncompensated care allowance when it
is probable the receivable will not be recovered. Write-offs to
the contractual allowance occur when payment is received. The
allowance for uncompensated care is related principally to
receivables recorded for self-pay patients.
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
August 31, | |
|
|
January 31, | |
|
| |
|
|
2005 | |
|
2004 | |
|
2003 | |
|
|
| |
|
| |
|
| |
Accounts receivable, net
|
|
|
|
|
|
|
|
|
|
|
|
|
AMR
|
|
$ |
229,798 |
|
|
$ |
210,177 |
|
|
$ |
196,473 |
|
EmCare
|
|
|
139,969 |
|
|
|
134,033 |
|
|
|
123,979 |
|
|
|
|
|
|
|
|
|
|
|
|
Total
|
|
$ |
369,767 |
|
|
$ |
344,210 |
|
|
$ |
320,452 |
|
|
|
|
|
|
|
|
|
|
|
Accounts receivable allowances
|
|
|
|
|
|
|
|
|
|
|
|
|
AMR
|
|
|
|
|
|
|
|
|
|
|
|
|
Allowance for contractual discounts
|
|
$ |
126,771 |
|
|
$ |
103,412 |
|
|
$ |
89,856 |
|
Allowance for uncompensated care |
|
|
124,699 |
|
|
|
111,766 |
|
|
|
104,833 |
|
|
|
|
|
|
|
|
|
|
|
|
Total
|
|
$ |
251,470 |
|
|
$ |
215,178 |
|
|
$ |
194,689 |
|
|
|
|
|
|
|
|
|
|
|
EmCare
|
|
|
|
|
|
|
|
|
|
|
|
|
Allowance for contractual discounts
|
|
$ |
188,092 |
|
|
$ |
168,060 |
|
|
$ |
168,912 |
|
Allowance for uncompensated care
|
|
|
556,605 |
|
|
|
499,512 |
|
|
|
382,757 |
|
|
|
|
|
|
|
|
|
|
|
|
Total
|
|
$ |
744,697 |
|
|
$ |
667,572 |
|
|
$ |
551,669 |
|
|
|
|
|
|
|
|
|
|
|
The increase in the allowances and provisions for contractual
discounts and uncompensated care is primarily a result of
increases in the Companys gross fee-for-service rate
schedules. These gross fee schedules, including any changes to
existing fee schedules, generally are negotiated with various
contracting entities, including municipalities and facilities.
Fee schedule increases are billed for all revenue sources and to
all payors under that specific contract; however, reimbursement
in the case of certain state and federal payors,
F-14
American Medical Response, Inc. & EmCare Holdings
Inc.
(The Healthcare Transportation and Emergency Management
Services
Businesses of Laidlaw International, Inc.)
Notes to Combined Financial
Statements (Continued)
including Medicare and Medicaid, will not change as a result of
the contract change. In certain cases, this results in a higher
level of contractual and uncompensated care provisions and
allowances, requiring a higher percentage of contractual
discount and uncompensated care provisions compared to gross
charges.
The allowance for uncompensated care at EmCare includes accounts
that have been sent to collection agencies and are listed as
delinquent within the billing system. These accounts are fully
reserved at each balance sheet date and total
$254.2 million, $218.6 million and $150.3 million
at January 31, 2005, August 31, 2004 and
August 31, 2003, respectively.
Parts and Supplies Inventory
Parts and supplies inventory is valued at cost, determined on a
first-in, first-out basis. Durable medical supplies, including
stretchers, oximeters and other miscellaneous items, are
capitalized as inventory and expensed as used.
Property, Plant and Equipment, net
Property, plant and equipment were reflected at their fair
values as of June 1, 2003. Additions to property, plant and
equipment subsequent to this date are recorded at cost.
Maintenance and repairs that do not extend the useful life of
the property are charged to expense as incurred. Gains and
losses from dispositions of property, plant and equipment are
recorded in the period incurred. Depreciation of property, plant
and equipment is provided substantially on a straight-line basis
over their estimated useful lives, which are as follows:
|
|
|
Buildings
|
|
35 to 40 years |
Leasehold improvements
|
|
Shorter of expected life or life of lease |
Vehicles
|
|
5 to 7 years |
Computer hardware and software
|
|
3 to 5 years |
Other
|
|
3 to 10 years |
Goodwill
The Predecessor Company adopted SFAS No. 142 on
September 1, 2002. SFAS No. 142 requires that any
goodwill recorded in connection with an acquisition consummated
on or after July 1, 2001 not be amortized, and instead
requiring a periodic assessment of recoverability utilizing a
fair value measurement. In connection with the adoption of this
standard, the Predecessor Company impaired $223.7 million
of restated goodwill, which is included in the accompanying
combined financial statements for the nine months ended
F-15
American Medical Response, Inc. & EmCare Holdings
Inc.
(The Healthcare Transportation and Emergency Management
Services
Businesses of Laidlaw International, Inc.)
Notes to Combined Financial
Statements (Continued)
May 31, 2003, as a cumulative effect of a change in
accounting principle. Recording this change had no tax-related
benefit or expense. Goodwill balances are as follows:
|
|
|
|
|
|
|
|
Restated | |
|
|
| |
Predecessor Company:
|
|
|
|
|
|
Balance on August 31, 2002
|
|
$ |
453,943 |
|
|
Impairment loss under SFAS No. 142, September 1,
2002
|
|
|
(223,721 |
) |
|
|
|
|
|
Balance on May 31, 2003
|
|
$ |
230,222 |
|
|
|
|
|
Successor Company:
|
|
|
|
|
|
Fresh-start adjustment
|
|
$ |
(177,862 |
) |
|
|
|
|
|
Balance on June 1, 2003 and August 31, 2003
|
|
|
52,360 |
|
|
Deferred tax valuation adjustment, August 31, 2004
|
|
|
(52,360 |
) |
|
|
|
|
|
Balance on August 31, 2004 and January 31, 2005
|
|
$ |
|
|
|
|
|
|
Had the change in the accounting policy for amortizing goodwill
been in effect in the prior year, the Predecessor Companys
income (loss) before cumulative effect of a change in accounting
principle for the year ended August 31, 2002 would have
been ($226.0) million compared to ($247.4) million as
originally recorded. There would have been no changes to the
results recorded for the five months ended January 31,
2005, the year ended August 31, 2004, the three months
ended August 31, 2003 or the Predecessor Company nine
months ended May 31, 2003.
Impairment of Long-lived Assets other than Goodwill and
Other Indefinite Lived Intangibles
Long-lived assets other than goodwill and other indefinite lived
intangibles are assessed for impairment whenever events or
changes in circumstances indicate that the carrying value may
not be recoverable. Important factors which could trigger
impairment review include significant underperformance relative
to historical or projected future operating results, significant
changes in the use of the acquired assets or the strategy for
the overall business, and significant negative industry or
economic trends. If indicators of impairment are present,
management evaluates the carrying value of long-lived assets
other than goodwill and other indefinite lived intangibles in
relation to the projection of future undiscounted cash flows of
the underlying business. Projected cash flows are based on
historical results adjusted to reflect managements best
estimate of future market and operating conditions, which may
differ from actual cash flows.
Contract Value
At January 31, 2005, August 31, 2004 and 2003, the
Companys contracts and customer relationships, recorded as
part of fresh-start push-down accounting, represent the
amortized fair value of such assets held by the Company at
June 1, 2003. Contract Assets are amortized on a
straight-line basis over the average length of the contracts and
the expected contract renewal period of 10 years. In
accordance with the provisions of fresh-start accounting, the
reversal of the income tax valuation allowance resulted in a
reduction in certain Contract Assets at August 31, 2004
(note 5).
Radio Frequencies
The radio frequency licenses, recorded as part of push-down
accounting and included in net intangible assets on the
accompanying combined balance sheet, total $4.0 million at
August 31, 2003 and are considered to be indefinite lived
intangible assets. As such, they are not amortized. The radio
frequency licenses are reviewed for impairment on an annual
basis. In accordance with the provisions of fresh-start
accounting, the
F-16
American Medical Response, Inc. & EmCare Holdings
Inc.
(The Healthcare Transportation and Emergency Management
Services
Businesses of Laidlaw International, Inc.)
Notes to Combined Financial
Statements (Continued)
reversal of the income tax valuation allowance resulted in the
radio frequency asset being reduced to zero at August 31,
2004 (note 5).
Restricted Long-Term Investments
Restricted long-term investments include investments that are
part of the portfolio of the Companys captive insurance
subsidiary. In accordance with SFAS No. 115,
the Company determines the classification of securities as
held-to-maturity or available-for-sale at the time of purchase
and re-evaluates such designation at each balance sheet date.
Securities are classified as held-to-maturity when the Company
has the positive intent and ability to hold securities to
maturity. Held-to-maturity securities are stated at cost,
adjusted for amortization of premiums and discounts to maturity.
Investments not classified as held-to-maturity are classified as
available-for-sale. Available-for-sale securities are carried at
fair value, with unrealized gains and losses reported as a
separate component of equity. The cost of securities sold is
based on the specific identification method. Restricted
long-term investments are available-for-sale.
These investments are used to support the Companys
self-insurance program. The investments are comprised
principally of government securities and investment grade debt
securities.
Other Long-Term Liabilities
Long-term portions of insurance reserves, acquisition-related
liabilities and other liabilities are classified as other
long-term liabilities.
Contractual Arrangements
EmCare structures its contractual arrangements for emergency
department management services in various ways. In most states,
a wholly-owned subsidiary of EmCare (EmCare
Subsidiary) contracts with hospitals to provide emergency
department management services. The EmCare Subsidiary enters
into an agreement (PA Management Agreement) with a
professional association or professional corporation
(PA), whereby the EmCare Subsidiary provides the PA
with management services, and the PA agrees to provide physician
services for the hospital contract. The PA employs physicians
directly or subcontracts with another entity for the physician
services. In certain states, the PA contracts directly with the
hospital, but provides physician services and obtains management
services in the same manner as described above. In all
arrangements, decisions regarding patient care are made
exclusively by the physicians. In consideration for these
services, the EmCare Subsidiary receives a monthly fee that may
be adjusted from time to time to reflect industry practice,
business conditions, and actual expenses for administrative
costs and uncollectible accounts. In most states, these fees
approximate the excess of the PAs revenues over its
expenses.
Each PA is wholly-owned by a physician who enters into a Stock
Transfer and Option Agreement with EmCare. This agreement gives
EmCare the right to replace the physician owner with another
physician in accordance with the terms of the agreement.
Historically, EmCare had determined that these management
contracts met Emerging Issues Task Force 97-2, Application of
FASB Statement No. 94 and APB Opinion No. 16 to
Physician Practice Entities, requirements for consolidation.
Upon adoption of FIN 46(R), Consolidation of Variable
Interest Entities, the Company concluded that these
management contracts resulted in a variable interest in the PAs
and that the Company is the primary beneficiary. Accordingly,
the consolidated financial statements of EmCare and these
combined financial statements include the accounts of EmCare and
its subsidiaries and the PAs. The financial statements of the
PAs are consolidated with EmCare and its subsidiaries because
EmCare has ultimate control over the assets and business
operations of the PAs as described above. Notwithstanding the
lack of technical
F-17
American Medical Response, Inc. & EmCare Holdings
Inc.
(The Healthcare Transportation and Emergency Management
Services
Businesses of Laidlaw International, Inc.)
Notes to Combined Financial
Statements (Continued)
majority ownership, consolidation of the PAs is necessary to
present fairly the financial position and results of operations
of EmCare because of the existence of a control relationship by
means other than record ownership of the PAs voting stock.
Control of a PA by EmCare is perpetual and other than temporary
because EmCare may replace the physician owner of the PA at any
time and thereby continue EmCares relationship with the PA.
Financial Instruments and Concentration of Credit
Risk
The Companys cash and cash equivalents, accounts
receivable, accounts payable, accrued liabilities (other than
current portion of self-insurance estimates), long-term debt and
long-term liabilities (other than self-insurance estimates)
constitute financial instruments. Based on managements
estimates, the carrying value of the Companys cash and
cash equivalents, accounts receivable, accounts payable, accrued
liabilities (other than current portion of self-insurance
estimates), long-term debt and long-term liabilities (other than
self-insurance estimates) approximates their fair value as of
January 31, 2005 and August 31, 2004 and 2003.
Concentration of credit risks in accounts receivable is limited,
due to the large number of customers comprising the
Companys customer base throughout the United States. A
significant component of the Companys revenue is derived
from Medicare and Medicaid. Given that these are government
programs, the credit risk for these customers is considered low.
The Company performs ongoing credit evaluations of its other
customers, but does not require collateral to support customer
accounts receivable. The Company establishes an allowance for
uncompensated care based on the credit risk applicable to
particular customers, historical trends and other relevant
information. For each of the periods presented, the Company
derived approximately 35% of its net revenue from Medicare and
Medicaid, 60% from insurance providers and contracted payors,
and 5% directly from patients.
Revenue Recognition
Revenue is recognized at the time of service and is recorded net
of provisions for contractual discounts and estimated
uncompensated care. Provisions for contractual discounts and
estimated uncompensated care by segment, as a percentage of
gross revenue, are as follows:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Predecessor | |
|
|
|
|
|
|
|
|
| |
|
|
Five Months | |
|
|
|
Three Months | |
|
Nine Months | |
|
|
|
|
Ended | |
|
Year Ended | |
|
Ended | |
|
Ended | |
|
Year Ended | |
|
|
January 31, | |
|
August 31, | |
|
August 31, | |
|
May 31, | |
|
August 31, | |
|
|
2005 | |
|
2004 | |
|
2003 | |
|
2003 | |
|
2002 | |
|
|
| |
|
| |
|
| |
|
| |
|
| |
AMR
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Gross revenue
|
|
|
100% |
|
|
|
100% |
|
|
|
100% |
|
|
|
100% |
|
|
|
100% |
|
Provision for contractual discounts
|
|
|
35% |
|
|
|
35% |
|
|
|
30% |
|
|
|
30% |
|
|
|
26% |
|
Provision for uncompensated care
|
|
|
14% |
|
|
|
14% |
|
|
|
16% |
|
|
|
15% |
|
|
|
16% |
|
EmCare
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Gross revenue
|
|
|
100% |
|
|
|
100% |
|
|
|
100% |
|
|
|
100% |
|
|
|
100% |
|
Provision for contractual discounts
|
|
|
42% |
|
|
|
41% |
|
|
|
40% |
|
|
|
40% |
|
|
|
38% |
|
Provision for uncompensated care
|
|
|
25% |
|
|
|
24% |
|
|
|
24% |
|
|
|
23% |
|
|
|
23% |
|
Total
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Gross revenue
|
|
|
100% |
|
|
|
100% |
|
|
|
100% |
|
|
|
100% |
|
|
|
100% |
|
Provision for contractual discounts
|
|
|
39% |
|
|
|
37% |
|
|
|
35% |
|
|
|
34% |
|
|
|
31% |
|
Provision for uncompensated care
|
|
|
19% |
|
|
|
18% |
|
|
|
19% |
|
|
|
18% |
|
|
|
19% |
|
Healthcare reimbursement is complex and may involve lengthy
delays. Third-party payors are continuing their efforts to
control expenditures for healthcare, including proposals to
revise reimbursement policies. The
F-18
American Medical Response, Inc. & EmCare Holdings
Inc.
(The Healthcare Transportation and Emergency Management
Services
Businesses of Laidlaw International, Inc.)
Notes to Combined Financial
Statements (Continued)
Company has from time to time experienced delays in
reimbursement from third-party payors. In addition, third-party
payors may disallow, in whole or in part, claims for
reimbursement based on determinations that certain amounts are
not reimbursable under plan coverage, determinations of medical
necessity, or the need for additional information. Laws and
regulations governing the Medicare and Medicaid programs are
very complex and subject to interpretation. As a result, there
is a reasonable possibility that recorded estimates will change
materially in the short-term. Retroactive adjustments may change
the amounts realized from third-party payors and are considered
in the recognition of revenue on an estimated basis in the
period the related services are rendered. Such amounts are
adjusted in future periods, as adjustments become known.
Subsidies and fees in connection with community contracts are
recognized ratably over the service period the payment covers.
The Company also provides services to patients who have no
insurance or other third-party payor coverage. In certain
circumstances, federal law requires providers to render services
to any patient who requires emergency care regardless of their
ability to pay.
Income Taxes
The Company accounts for income taxes under SFAS 109.
Deferred income taxes reflect the impact of temporary
differences between the reported amounts of assets and
liabilities for financial reporting purposes and such amounts as
measured by tax laws and regulations. The deferred tax assets
and liabilities represent the future tax return consequences of
those differences, which will either be taxable or deductible
when the assets and liabilities are recovered or settled. A
valuation allowance is provided for deferred tax assets when
management concludes it is more likely than not that some
portion of the deferred tax assets will not be recognized.
AMR and EmCare are included in the consolidated U.S. income
tax return with other Laidlaw U.S. subsidiaries. The tax
allocation agreement calculates tax liability on a separate
company basis and provides for reimbursement or payment for
utilization of carryovers among members of the group.
Consequently, AMR and EmCare only receive the benefits of net
operating loss and interest carryforwards to the extent utilized
in Laidlaws consolidated return. Costs related to income
taxes are included as payable to or receivable from Laidlaw.
Recent Accounting Pronouncements
In December 2004, the Financial Accounting Standards Board
(FASB) issued Statement No. 123 (revised 2004),
Share-Based Payment. This Statement is a
revision of FASB Statement No. 123, Accounting for
Stock-Based Compensation and is effective as of the
beginning of the first interim or annual reporting period that
begins after June 15, 2005. The Statement requires public
companies to measure the cost of employee services received in
exchange for an award of equity instruments based on the
grant-date fair value of the award. The Company anticipates that
the adoption of this Statement will not have a material impact
on its financial statements.
F-19
American Medical Response, Inc. & EmCare Holdings
Inc.
(The Healthcare Transportation and Emergency Management
Services
Businesses of Laidlaw International, Inc.)
Notes to Combined Financial
Statements (Continued)
|
|
3. |
Property, Plant and Equipment, net |
Property, plant and equipment, net consisted of the following at
January 31, 2005 and August 31, 2004 and 2003:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Restated | |
|
|
|
|
| |
|
|
2005 | |
|
2004 | |
|
2003 | |
|
|
| |
|
| |
|
| |
Land
|
|
$ |
2,079 |
|
|
$ |
2,079 |
|
|
$ |
2,079 |
|
Building and leasehold improvements
|
|
|
14,293 |
|
|
|
14,147 |
|
|
|
11,670 |
|
Vehicles
|
|
|
91,114 |
|
|
|
85,172 |
|
|
|
65,163 |
|
Computer hardware and software
|
|
|
42,006 |
|
|
|
35,585 |
|
|
|
29,290 |
|
Other
|
|
|
46,891 |
|
|
|
45,622 |
|
|
|
32,130 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
196,383 |
|
|
|
182,605 |
|
|
|
140,332 |
|
Less: accumulated depreciation
|
|
|
(67,617 |
) |
|
|
(49,920 |
) |
|
|
(6,786 |
) |
|
|
|
|
|
|
|
|
|
|
Property, plant and equipment, net
|
|
$ |
128,766 |
|
|
$ |
132,685 |
|
|
$ |
133,546 |
|
|
|
|
|
|
|
|
|
|
|
Vehicles include certain vehicles held under capital leases with
a net book value of $11.7 million, $13.9 million and
$19.0 million at January 31, 2005 and August 31,
2004 and 2003, respectively. Accumulated depreciation and
amortization at January 31, 2005 and August 31, 2004
and 2003 includes $8.4 million, $6.3 million and
$1.3 million, respectively, relating to such vehicles.
Depreciation expense was $18.0 million for the five months
ended January 31, 2005, $43.2 million for the year
ended August 31, 2004, $10.2 million for the three
months ended August 31, 2003, $32.2 million for the
nine months ended May 31, 2003 and $45.7 million for
the year ended August 31, 2002.
|
|
4. |
Intangible Assets, net |
Intangible assets, net consisted of the following at
January 31, 2005 and August 31, 2004 and 2003:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Restated | |
|
|
|
|
|
|
| |
|
|
2005 | |
|
2004 | |
|
2003 | |
|
|
| |
|
| |
|
| |
Goodwill
|
|
$ |
|
|
|
$ |
|
|
|
$ |
52,360 |
|
Contract value
|
|
|
22,544 |
|
|
|
22,106 |
|
|
|
94,177 |
|
Radio frequencies
|
|
|
|
|
|
|
|
|
|
|
4,000 |
|
Covenant not to compete
|
|
|
250 |
|
|
|
|
|
|
|
19 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
22,794 |
|
|
|
22,106 |
|
|
|
150,556 |
|
Less: accumulated amortization
|
|
|
(6,719 |
) |
|
|
(6,348 |
) |
|
|
(2,351 |
) |
|
|
|
|
|
|
|
|
|
|
Intangible assets, net
|
|
$ |
16,075 |
|
|
$ |
15,758 |
|
|
$ |
148,205 |
|
|
|
|
|
|
|
|
|
|
|
Amortization expense of intangible assets was $0.8 million
for the five months ended January 31, 2005,
$9.5 million for the year ended August 31, 2004 and
$2.4 million for the three months ended August 31,
2003, $0 for the nine months ended May 31, 2003 and
$21.4 million for the year ended August 31, 2002.
Covenants and the contract value are amortized over a life of
10 years. As a result of the reversal of the separate
company tax valuation allowance as of August 31, 2004 under
fresh-start accounting, AMR reduced its intangible assets to
zero and EmCare reduced its intangible assets to
$15.8 million. Estimated annual amortization over each of
the next five years is approximately $2.2 million.
F-20
American Medical Response, Inc. & EmCare Holdings
Inc.
(The Healthcare Transportation and Emergency Management
Services
Businesses of Laidlaw International, Inc.)
Notes to Combined Financial
Statements (Continued)
Deferred income taxes reflect the net tax effects of temporary
differences between the carrying amounts of assets and
liabilities for financial reporting purposes and the amounts
used for income tax purposes. Significant components of the
Companys deferred taxes were as follows at
January 31, 2005 and August 31, 2004 and 2003:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Restated | |
|
|
|
|
| |
|
|
2005 | |
|
2004 | |
|
2003 | |
|
|
| |
|
| |
|
| |
Deferred tax assets:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Accounts receivable
|
|
$ |
38,817 |
|
|
$ |
34,726 |
|
|
$ |
54,447 |
|
|
Accrued liabilities
|
|
|
58,508 |
|
|
|
56,803 |
|
|
|
62,120 |
|
|
Intangible assets
|
|
|
42,732 |
|
|
|
46,047 |
|
|
|
24,311 |
|
|
Interest carryforwards
|
|
|
84,590 |
|
|
|
85,188 |
|
|
|
84,474 |
|
|
Net operating loss carryforwards
|
|
|
54,565 |
|
|
|
55,055 |
|
|
|
94,576 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
279,212 |
|
|
|
277,819 |
|
|
|
319,928 |
|
Deferred tax liabilities:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Excess of tax over book depreciation
|
|
|
(11,651 |
) |
|
|
(10,449 |
) |
|
|
(8,544 |
) |
|
|
|
|
|
|
|
|
|
|
Net deferred tax assets
|
|
|
267,561 |
|
|
|
267,370 |
|
|
|
311,384 |
|
Valuation allowance
|
|
|
|
|
|
|
|
|
|
|
(155,952 |
) |
|
|
|
|
|
|
|
|
|
|
Net deferred tax assets
|
|
$ |
267,561 |
|
|
$ |
267,370 |
|
|
$ |
155,432 |
|
|
|
|
|
|
|
|
|
|
|
The Company has significant net deferred tax assets resulting
from net operating loss (NOL) and interest deduction
carryforwards and other deductible temporary differences that
will reduce taxable income in future periods.
SFAS No. 109 Accounting for Income
Taxes requires that a valuation allowance be
established when it is more likely than not that
all, or a portion, of net deferred tax assets will not be
realized. A review of all available positive and negative
evidence needs to be considered, including expected reversals of
significant deductible temporary differences, a companys
recent financial performance, the market environment in which a
company operates, tax planning strategies and the length of NOL
and interest deduction carryforward periods. Furthermore, the
weight given to the potential effect of negative and positive
evidence should be commensurate with the extent to which it can
be objectively verified.
At the fresh-start accounting date, May 31, 2003, the
Company recorded a valuation allowance of $156.0 million,
based on the criteria required under SFAS No. 109
discussed above. During fiscal 2004, write-offs of net operating
loss carryforwards and realization of other assets reduced the
valuation allowance by $48.2 million. As a result of the
Companys improved financial performance during fiscal
2004, management reduced the deferred tax valuation allowance by
an additional $107.8 million during the year ended
August 31, 2004. As required under fresh-start accounting,
this change also resulted in a reduction in intangible assets
and goodwill and an increase in Laidlaw equity of AMR.
The Company has interest carryovers of $222.6 million at
January 31, 2005 limited by Internal Revenue Code
Section 163(j) without expiration, and federal net
operating loss carryforwards of $143.7 million which expire
in the years 2005 to 2024. The interest carryovers and
$134.0 million of the net operating loss carryforwards are
subject to Laidlaws annual Section 382 limitation of
$58 million.
In connection with the sale described in note 18, the value
of deferred tax assets and liabilities will be adjusted.
F-21
American Medical Response, Inc. & EmCare Holdings
Inc.
(The Healthcare Transportation and Emergency Management
Services
Businesses of Laidlaw International, Inc.)
Notes to Combined Financial
Statements (Continued)
The components of income tax benefit (expense) were as follows:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Predecessor | |
|
|
|
|
|
|
|
|
| |
|
|
Five Months | |
|
Year | |
|
Three Months | |
|
Nine Months | |
|
Year | |
|
|
Ended | |
|
Ended | |
|
Ended | |
|
Ended | |
|
Ended | |
|
|
January 31, | |
|
August 31, | |
|
August 31, | |
|
May 31, | |
|
August 31, | |
|
|
2005 | |
|
2004 | |
|
2003 | |
|
2003 | |
|
2002 | |
|
|
| |
|
| |
|
| |
|
| |
|
| |
Current tax expense
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
State
|
|
$ |
|
|
|
$ |
559 |
|
|
$ |
(162 |
) |
|
$ |
829 |
|
|
$ |
1,374 |
|
Federal
|
|
|
|
|
|
|
(694 |
) |
|
|
17,216 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Total
|
|
|
|
|
|
|
(135 |
) |
|
|
17,054 |
|
|
|
829 |
|
|
|
1,374 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Deferred tax expense
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
State
|
|
|
762 |
|
|
|
2,496 |
|
|
|
(76 |
) |
|
|
|
|
|
|
|
|
Federal
|
|
|
5,516 |
|
|
|
19,403 |
|
|
|
(8,345 |
) |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Total
|
|
|
6,278 |
|
|
|
21,899 |
|
|
|
(8,421 |
) |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Total tax expense
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
State
|
|
|
762 |
|
|
|
3,055 |
|
|
|
(238 |
) |
|
|
829 |
|
|
|
1,374 |
|
Federal
|
|
|
5,516 |
|
|
|
18,709 |
|
|
|
8,871 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Total
|
|
$ |
6,278 |
|
|
$ |
21,764 |
|
|
$ |
8,633 |
|
|
$ |
829 |
|
|
$ |
1,374 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
A reconciliation of the provision (benefit) for income taxes at
the federal statutory rate compared to the Companys
effective tax rate is as follows:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
As Restated | |
|
|
|
|
|
|
|
|
Predecessor | |
|
|
|
|
|
|
|
|
| |
|
|
Five Months | |
|
Year | |
|
Three Months | |
|
Nine Months | |
|
Year | |
|
|
Ended | |
|
Ended | |
|
Ended | |
|
Ended | |
|
Ended | |
|
|
January 31, | |
|
August 31, | |
|
August 31, | |
|
May 31, | |
|
August 31, | |
|
|
2005 | |
|
2004 | |
|
2003 | |
|
2003 | |
|
2002 | |
|
|
| |
|
| |
|
| |
|
| |
|
| |
Income tax expense (benefit) at the statutory rate
|
|
$ |
5,516 |
|
|
$ |
20,690 |
|
|
$ |
631 |
|
|
$ |
26,656 |
|
|
$ |
(86,103 |
) |
Decrease(increase) in income taxes resulting from:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
State taxes, net of federal
|
|
|
495 |
|
|
|
1,986 |
|
|
|
(155 |
) |
|
|
539 |
|
|
|
893 |
|
|
Goodwill amortization/impairment
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
76,517 |
|
|
Fresh start accounting adjustments
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
(16,246 |
) |
|
|
|
|
|
Parent Company allocations
|
|
|
|
|
|
|
(1,577 |
) |
|
|
7,990 |
|
|
|
(2,826 |
) |
|
|
(40,377 |
) |
|
Change in valuation allowance
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
(7,607 |
) |
|
|
50,158 |
|
|
Other
|
|
|
267 |
|
|
|
665 |
|
|
|
167 |
|
|
|
313 |
|
|
|
286 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Provision for income taxes
|
|
$ |
6,278 |
|
|
$ |
21,764 |
|
|
$ |
8,633 |
|
|
$ |
829 |
|
|
$ |
1,374 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
F-22
American Medical Response, Inc. & EmCare Holdings
Inc.
(The Healthcare Transportation and Emergency Management
Services
Businesses of Laidlaw International, Inc.)
Notes to Combined Financial
Statements (Continued)
Accrued liabilities were as follows at January 31, 2005 and
August 31, 2004 and 2003:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
2005 | |
|
2004 | |
|
2003 | |
|
|
| |
|
| |
|
| |
Accrued wages and benefits
|
|
$ |
53,231 |
|
|
$ |
65,757 |
|
|
$ |
56,960 |
|
Accrued paid time off
|
|
|
20,141 |
|
|
|
19,828 |
|
|
|
16,896 |
|
Current portion of self-insurance reserve
|
|
|
41,283 |
|
|
|
36,384 |
|
|
|
28,206 |
|
Accrued restructuring
|
|
|
1,118 |
|
|
|
1,611 |
|
|
|
3,088 |
|
Current portion of compliance and legal
|
|
|
3,607 |
|
|
|
5,660 |
|
|
|
8,056 |
|
Accrued billing and collection fees
|
|
|
3,522 |
|
|
|
3,466 |
|
|
|
3,300 |
|
Accrued profit sharing
|
|
|
23,802 |
|
|
|
7,566 |
|
|
|
6,552 |
|
Other
|
|
|
24,941 |
|
|
|
26,512 |
|
|
|
23,121 |
|
|
|
|
|
|
|
|
|
|
|
Total accrued liabilities
|
|
$ |
171,645 |
|
|
$ |
166,784 |
|
|
$ |
146,179 |
|
|
|
|
|
|
|
|
|
|
|
Long-term debt consisted of the following at January 31,
2005 and August 31, 2004 and 2003:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
2005 | |
|
2004 | |
|
2003 | |
|
|
| |
|
| |
|
| |
Notes due at various dates from 2004 to 2022 with interest rates
from 6% to 10%
|
|
$ |
1,219 |
|
|
$ |
2,959 |
|
|
$ |
6,478 |
|
Mortgage loan due 2010 with an interest rate of 7%
|
|
|
2,168 |
|
|
|
2,190 |
|
|
|
2,242 |
|
Capital lease obligations due at various dates from 2006 to 2007
(note 10)
|
|
|
8,110 |
|
|
|
10,331 |
|
|
|
15,337 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
11,497 |
|
|
|
15,480 |
|
|
|
24,057 |
|
Less current portion
|
|
|
(5,846 |
) |
|
|
(7,565 |
) |
|
|
(8,270 |
) |
|
|
|
|
|
|
|
|
|
|
Total long-term debt
|
|
$ |
5,651 |
|
|
$ |
7,915 |
|
|
$ |
15,787 |
|
|
|
|
|
|
|
|
|
|
|
The aggregate amount of minimum payments (deposit refunds)
required on long-term debt in each of the years indicated is as
follows:
|
|
|
|
|
Year ending January 31, |
|
|
|
|
|
2006
|
|
$ |
5,846 |
|
2007
|
|
|
3,771 |
|
2008
|
|
|
(878 |
) |
2009
|
|
|
121 |
|
2010
|
|
|
108 |
|
Thereafter
|
|
|
2,529 |
|
|
|
|
|
|
|
$ |
11,497 |
|
|
|
|
|
F-23
American Medical Response, Inc. & EmCare Holdings
Inc.
(The Healthcare Transportation and Emergency Management
Services
Businesses of Laidlaw International, Inc.)
Notes to Combined Financial
Statements (Continued)
|
|
8. |
Restructuring Charges and Impairment Losses |
The activity in the accrued restructuring balance is as follows:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
2002 Plan | |
|
2003 Plan | |
|
2004 Plan | |
|
|
|
|
| |
|
| |
|
| |
|
|
|
|
Severance | |
|
Lease | |
|
Total | |
|
Severance | |
|
Severance | |
|
Total | |
|
|
| |
|
| |
|
| |
|
| |
|
| |
|
| |
Incurred
|
|
$ |
1,517 |
|
|
$ |
2,260 |
|
|
$ |
3,777 |
|
|
|
|
|
|
|
|
|
|
$ |
3,777 |
|
Paid
|
|
|
(456 |
) |
|
|
(149 |
) |
|
|
(605 |
) |
|
|
|
|
|
|
|
|
|
|
(605 |
) |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
August 31, 2002
|
|
|
1,061 |
|
|
|
2,111 |
|
|
|
3,172 |
|
|
|
|
|
|
|
|
|
|
|
3,172 |
|
Incurred April 2003
|
|
|
|
|
|
|
|
|
|
|
|
|
|
$ |
1,288 |
|
|
|
|
|
|
|
1,288 |
|
Incurred August 2003
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
1,449 |
|
|
|
|
|
|
|
1,449 |
|
Paid
|
|
|
(559 |
) |
|
|
(561 |
) |
|
|
(1,120 |
) |
|
|
(1,701 |
) |
|
|
|
|
|
|
(2,821 |
) |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
August 31, 2003
|
|
|
502 |
|
|
|
1,550 |
|
|
|
2,052 |
|
|
|
1,036 |
|
|
|
|
|
|
|
3,088 |
|
Incurred
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
$ |
2,115 |
|
|
|
2,115 |
|
Paid
|
|
|
(502 |
) |
|
|
(566 |
) |
|
|
(1,068 |
) |
|
|
(1,036 |
) |
|
|
(1,488 |
) |
|
|
(3,592 |
) |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
August 31, 2004
|
|
|
|
|
|
|
984 |
|
|
|
984 |
|
|
|
|
|
|
|
627 |
|
|
|
1,611 |
|
Incurred
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Paid
|
|
|
|
|
|
|
(238 |
) |
|
|
(238 |
) |
|
|
|
|
|
|
(255 |
) |
|
|
(493 |
) |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
January 31, 2005
|
|
$ |
|
|
|
$ |
746 |
|
|
$ |
746 |
|
|
$ |
|
|
|
$ |
372 |
|
|
$ |
1,118 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Restructuring Plans
During fiscal year 2004, AMR was re-aligned into three
geographic regions. The billing centers and operating units
within the four original AMR regions were shifted to create the
new structure and the administrative office of the former
South-Central region was closed. The functions previously
performed by this group were distributed to the remaining
regions. This restructuring plan is expected to be completed by
December 2005.
During fiscal year 2003, AMRs Northern Pacific Region
re-aligned the management structure of its operations. The first
phase occurred in April 2003 and the second and final phase
occurred in August 2003.
During fiscal year 2002, in an effort to eliminate the
differences in size among regions, AMR was re-aligned into four
geographic regions. The operating units within the five original
regions were shifted to create the new structure and the
administrative offices of the former South region and one
billing center were closed. National Products and Services was
also closed. The functions previously performed by this group
were distributed to the remaining regions and the corporate
office. This restructuring plan is expected to be completed by
December 2008.
2002 Impairment Losses
During fiscal year 2002, AMR incurred an impairment charge of
$262.8 million, including $254.9 goodwill impairment and
$7.9 million property, plant and equipment impairment. The
impairment losses resulted from the inability of AMR to recover
the carrying value of the long-lived assets from expected future
operating cash flows.
F-24
American Medical Response, Inc. & EmCare Holdings
Inc.
(The Healthcare Transportation and Emergency Management
Services
Businesses of Laidlaw International, Inc.)
Notes to Combined Financial
Statements (Continued)
|
|
9. |
Retirement Plans and Employee Benefits |
AMR maintains three 401(k) plans (the AMR Plans) for
its employees and employees of its subsidiaries who meet the
eligibility requirements set forth in the AMR Plans. Employees
may contribute a maximum of 40% of their compensation up to a
maximum of $13 (thousand). Generally 50% of the contribution is
matched by AMR up to a maximum of 3% to 6% of the
employees salary per year, depending on the plan.
AMRs contributions to the AMR Plans for the five months
ended January 31, 2005 were $3.7 million, the year
ended August 31, 2004 were $8.1 million, for the three
months ended August 31, 2003 were $1.9 million and for
the nine months ended May 31, 2003 were $5.7 million.
For the year ended August 31, 2002, AMRs
contributions to the AMR Plans were $6.9 million.
Contributions are included in operating expenses on the
accompanying combined statements of operations.
EmCare established the EmCare Holdings Inc. 401(k) Savings Plan
(the EmCare Plan) in 1994 to provide retirement
benefits to its employees. Employees may elect to participate in
the EmCare Plan at the beginning of each calendar quarter and
may contribute 1% to 25% of their annual compensation on a
tax-deferred basis subject to limits established by the Internal
Revenue Service. EmCare contributes 50% of the first 6% of base
compensation that a participant contributes to the EmCare Plan
during any calendar year. The EmCare Plan follows a calendar
year-end. Accordingly, EmCare makes its matching contributions
based on eligible employee contributions for each calendar year.
EmCare contributed $0.1 million to the EmCare Plan during
the five months ended January 31, 2005. During calendar
years 2004, 2003 and 2002, EmCare contributed $0.5 million,
$0.4 and $0.4 million, respectively, to the EmCare Plan.
In fiscal 2004, Laidlaw issued Value Appreciation Rights
(VAR) to various employees of AMR and EmCare. There
were no VARs issued prior to fiscal 2004. The VARs vest 100% on
the third anniversary of the date of the grant. The VARs
compensation is based on prescribed formulas that estimate
changes in the enterprise values of AMR and EmCare. The Company
recognizes compensation expense on a straight-line basis over
the vesting period with compensation expense of
$4.1 million for fiscal 2004. The Company recognized
$15.3 million of expense related to the VARs for the period
ended January 31, 2005 which is included in Laidlaw fees
and compensation charges. This expense related to the sale
transaction discussed in note 18 and was funded by Laidlaw
in accordance with the terms of the sale agreements. The VAR
program was terminated in connection with the sale of AMR and
EmCare in February 2005 and employees and executives will earn
no further rights.
|
|
10. |
Commitments and Contingencies |
Lease Commitments
The Company leases various facilities and equipment under
operating lease agreements. Rental expense incurred under these
leases was $12.4 million, $27.9 million,
$7.2 million and $23.2 million for the five months
ended January 31, 2005, the year ended August 31,
2004, the three months ended August 31, 2003 and the nine
months ended May 31, 2003, respectively, and was
$32.4 million in fiscal 2002.
In addition, the Company leases certain vehicles under capital
leases. Assets under capital lease are capitalized using
inherent interest rates at the inception of each lease. Capital
leases are collateralized by the leased vehicles.
F-25
American Medical Response, Inc. & EmCare Holdings
Inc.
(The Healthcare Transportation and Emergency Management
Services
Businesses of Laidlaw International, Inc.)
Notes to Combined Financial
Statements (Continued)
Future commitments under capital and operating leases for
vehicle, premises, equipment and other recurring commitments are
as follows (the balances below include fair value adjustments as
described in note 2):
|
|
|
|
|
|
|
|
|
|
|
|
|
Operating | |
|
|
Capital | |
|
Leases & | |
|
|
Leases | |
|
Other | |
|
|
| |
|
| |
Year ending January 31,
|
|
|
|
|
|
|
|
|
2006
|
|
$ |
6,000 |
|
|
$ |
27,289 |
|
2007
|
|
|
3,558 |
|
|
|
20,335 |
|
2008
|
|
|
(948 |
) |
|
|
16,242 |
|
2009
|
|
|
|
|
|
|
12,785 |
|
2010
|
|
|
|
|
|
|
8,810 |
|
Thereafter
|
|
|
|
|
|
|
20,659 |
|
|
|
|
|
|
|
|
|
|
|
8,610 |
|
|
$ |
106,120 |
|
|
|
|
|
|
|
|
Less imputed interest
|
|
|
(500 |
) |
|
|
|
|
|
|
|
|
|
|
|
Total capital lease obligations
|
|
|
8,110 |
|
|
|
|
|
Less current portion
|
|
|
(5,530 |
) |
|
|
|
|
|
|
|
|
|
|
|
Long-term capital lease obligations
|
|
$ |
2,580 |
|
|
|
|
|
|
|
|
|
|
|
|
Other commitments consisting of dispatch and responder fees
totaling $5,362, $1,133, $991, $989, $2,912 and $243 and Onex
management fees of $889, $1,000, $1,000, $1,000, $1,000 and $0
for the years ending January 31, 2006, 2007, 2008, 2009,
2010 and thereafter, respectively.
Services
The Company is subject to the Medicare and Medicaid fraud and
abuse laws which prohibit, among other things, any false claims,
or any bribe, kick-back or rebate in return for the referral of
Medicare and Medicaid patients. Violation of these prohibitions
may result in civil and criminal penalties and exclusion from
participation in the Medicare and Medicaid programs. Management
has implemented policies and procedures that management believes
will assure that the Company is in substantial compliance with
these laws. From time to time, we receive requests for
information from government agencies pursuant to their
regulatory or investigational authority. Such requests can
include subpoenas or demand letters for documents to assist the
government in audits or investigations. The Company is
cooperating with the government agencies conducting these
investigations and is providing requested information to the
government agencies. Other than the investigations described
below, management believes that the outcome of any of these
investigations would not have a material adverse effect on the
Company.
During the first quarter of fiscal 2004, AMR was advised by the
U.S. Department of Justice (DOJ) that it was
investigating certain of AMRs business practices. The
specific practices at issue were (1) whether ambulance
transports involving Medicare eligible patients complied with
the medical necessity requirement imposed by
Medicare regulations, (2) whether patient signatures, when
required, were properly obtained from Medicare eligible
patients, and (3) whether discounts in violation of the
federal Anti-Kickback Statute were provided by AMR in exchange
for referrals involving Medicare eligible patients. In
connection with the third issue, the government has alleged that
certain of AMRs hospital and nursing home contracts
in effect in Texas, primarily certain contracts in effect in
1996 and 1997, contained discounts in violation of the federal
Anti-Kickback Statute. The government recently has provided the
Company with an analysis of the
F-26
American Medical Response, Inc. & EmCare Holdings
Inc.
(The Healthcare Transportation and Emergency Management
Services
Businesses of Laidlaw International, Inc.)
Notes to Combined Financial
Statements (Continued)
investigation conducted in connection with this contract issue,
and invited the Company to respond. The Company is considering
the governments analysis and intends to provide its views,
as requested. The government may also be investigating whether
AMRs contracts with health facilities in Oregon and other
jurisdictions violate the Anti-Kickback Statute. At this time,
it is not possible to predict the ultimate conclusion of these
investigations, nor is it possible to estimate possible
financial exposure, if any, to the Company.
From August 1998 until August 2000, American Medical Response
West (AMR West), a subsidiary of AMR, received six
subpoenas duces tecum from the United States Attorneys
Office. These subpoenas related to billing matters for emergency
transports during the periods January 1, 1995 to
December 31, 1999. Pursuant to a settlement agreement with
the United States Attorneys Office, AMR West paid
$3.5 million in 2004 and entered into a five-year agreement
with the Department of Health and Human Services covering
various administrative processes and procedures. AMR reserved
for these matters in periods prior to the statements of
operations presented herein.
In June 1999, the DOJ began an investigation of the billing
processes of Regional Emergency Services L.P., or RES, a
subsidiary of AMR, and one of RES hospital clients.
The DOJ alleged violations by the companies of the False Claims
Act based on the absence of certificates of medical necessity
and other non-compliant billing practices from October 1992 to
May 2002. Pursuant to a settlement agreement to resolve these
allegations, including settlement of claims in Texas described
below, in April 2004 AMR paid $5.0 million of a total
$20.0 million settlement amount, with the balance paid by the
hospital. AMR reserved for these matters in periods prior to the
statements of operations presented herein.
On May 9, 2002, AMR received a subpoena duces tecum from
the Office of Inspector General for the United States Department
of Health and Human Services. The subpoena required AMR to
produce a broad range of documents relating to RES contracts in
Texas, Georgia and Colorado for the period from January 1993
through May 2002. The Texas claims were resolved pursuant to the
settlement agreement described above. The government
investigations in Georgia and Colorado are continuing; it is not
currently possible to estimate the financial exposure, if any,
to the Company.
On July 12, 2005, the Company received a letter and draft
Audit Report from the Office of Inspector General for the United
States Department of Health and Human Services, or OIG,
requesting the Companys response to its draft findings
that the Companys Massachusetts subsidiary received
$1.9 million in overpayments from Medicare for services
performed between July 1, 2002 and December 31, 2002.
The draft findings state that some of these services did not
meet Medicare medical necessity and reimbursement requirements.
The Company disagrees with the OIGs finding and is in the
process of responding to the draft Audit Report. If the Company
is unsuccessful in challenging the OIGs draft findings,
and in any administrative appeals to which the Company may be
entitled following the release of a final Audit Report, the
Company may be required to make a substantial repayment.
Letters of Credit
At January 31, 2005 and August 31, 2004 and 2003, AMR
had $23,297, $8,212 and $9,112, respectively, in outstanding
letters of credit. At January 31, 2005 and August 31,
2004 and 2003, Laidlaw also had issued letters of credit on
behalf of AMR for $1,000, $23,328 and $28,185, respectively.
Other Legal Matters
EmCare has been named as a defendant in two collective action
lawsuits brought by a number of nurse practitioners and
physician assistants under the federal Fair Labor Standards Act.
The plaintiffs are seeking to
F-27
American Medical Response, Inc. & EmCare Holdings
Inc.
(The Healthcare Transportation and Emergency Management
Services
Businesses of Laidlaw International, Inc.)
Notes to Combined Financial
Statements (Continued)
recover overtime pay for the hours they worked in excess of 40
in a workweek and reclassification as non-exempt employees.
Certain of the plaintiffs brought a related action under
California state law. EmCare has entered into a settlement of
the California state law claims for $1.5 million. EmCare
reserved the amount of this settlement in fiscal 2004 and it was
included as a component of selling, general and administrative
expenses.
Guarantees
Upon emergence from Chapter 11, Laidlaw established a new
senior secured credit facility (the Facility). The
Facility is guaranteed by Laidlaw and certain Laidlaw
subsidiaries, including AMR and EmCare. In addition, the
Facility is secured by the assets of Laidlaw and certain Laidlaw
subsidiaries, including AMR and EmCare, except for certain
assets of the Company contractually excluded from the
securitization. Under the terms of the Facility, Laidlaw is
required to meet certain financial covenants, including a fixed
charge coverage ratio, leverage ratio, interest coverage ratio,
net tangible asset ratio and maximum senior secured leverage
ratio, as well as certain non-financial covenants. As of
January 31, 2005, Laidlaw was in compliance with all
covenants and the outstanding balance under the Facility and
issued letters of credit aggregated $597.3 million.
As a result of emergence from Chapter 11, Laidlaw also
issued unsecured senior notes. These notes are also guaranteed
by Laidlaw and certain Laidlaw subsidiaries, including AMR and
EmCare. The outstanding balance under the notes at
January 31, 2005 aggregated $406 million.
In connection with the sale discussed in note 18, AMR and
EmCare have been released from these guarantees.
Income Tax Matters
The respective tax authorities, in the normal course, audit
previous tax filings. It is not possible at this time to predict
the final outcome of these audits or establish a reasonable
estimate of possible additional taxes owing, if any.
Allocation of Costs from Laidlaw
Laidlaw charges AMR and EmCare for the estimated cost of certain
functions that are managed by Laidlaw and can reasonably be
attributed directly to the operations of the Company. The
charges to the Company are based on managements estimate
of such services specifically used by the Company. Where
determinations based on specific usage alone have been
impracticable, other methods and criteria were used that Laidlaw
management believes are reasonable. Such allocations are not
intended to represent the costs that would be or would have been
incurred if the Company were an independent business.
The amount of Laidlaws combined equity and the Laidlaw
payable included in the balance sheet represents a net balance
as a result of various transactions between the Company and
Laidlaw. There are no terms of settlement associated with the
account balance. The balance is primarily the result of the
Companys participation in Laidlaws central cash
management program, wherein all the subsidiaries cash
receipts are remitted to Laidlaw and all cash disbursements are
funded by Laidlaw. Other transactions include certain direct
obligations administered by Laidlaw, as well as the
Companys share of the current portion of the Laidlaw
consolidated federal and state income tax liability and various
other administrative expenses allocated by Laidlaw. As a result,
obligations for these matters are not reflected on the
accompanying balance sheet.
F-28
American Medical Response, Inc. & EmCare Holdings
Inc.
(The Healthcare Transportation and Emergency Management
Services
Businesses of Laidlaw International, Inc.)
Notes to Combined Financial
Statements (Continued)
Self-insurance obligations and related deposits administered by
Laidlaw are reflected on the accompanying balance sheet.
Laidlaw charges or cost allocations included in the accompanying
combined statements of operations include the following:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Predecessor | |
|
|
|
|
|
|
|
|
|
| |
|
|
Five Months | |
|
Year | |
|
Three Months | |
|
|
Nine Months | |
|
Year | |
|
|
Ended | |
|
Ended | |
|
Ended | |
|
|
Ended | |
|
Ended | |
|
|
January 31, | |
|
August 31, | |
|
August 31, | |
|
|
May 31, | |
|
August 31, | |
|
|
2005 | |
|
2004 | |
|
2003 | |
|
|
2003 | |
|
2002 | |
|
|
| |
|
| |
|
| |
|
|
| |
|
| |
Allocated insurance expense (income)
|
|
$ |
|
|
|
$ |
(4,505 |
) |
|
$ |
11,522 |
|
|
|
$ |
3,058 |
|
|
$ |
(8,094 |
) |
Direct insurance expense
|
|
|
17,069 |
|
|
|
40,554 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Laidlaw fees and compensation charges
|
|
|
19,857 |
|
|
|
15,449 |
|
|
|
1,350 |
|
|
|
|
4,050 |
|
|
|
5,400 |
|
Reorganization costs
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
3,650 |
|
|
|
8,761 |
|
Interest
|
|
|
4,480 |
|
|
|
6,225 |
|
|
|
403 |
|
|
|
|
3,081 |
|
|
|
4,585 |
|
Included in insurance expense are allocations of charges and
credits made to AMR related to the operating costs and
investment activities of Laidlaws captive insurance
company. These allocations also include changes in actuarial
estimates of insurance reserves for fiscal year 2001 and prior
years claims estimates. For fiscal year 2002 and 2003, AMR
obtained insurance coverage from outside parties, rather than
through Laidlaw. In fiscal 2004, AMR returned to the Laidlaw
insurance program for workers compensation, auto and general
liability. EmCares participation in the Laidlaw insurance
program is limited to directors and officers, and general
liability insurance which is allocated as a component of Laidlaw
fees and compensation charges.
Management costs have been calculated using a formula based upon
the Companys share of Laidlaws consolidated revenue
and represent Laidlaws general and administrative costs
incurred for the benefit of the Company. Fiscal 2004 management
costs include $4.1 million of charges related to incentive
plans for management of the Company.
During the nine months ended May 31, 2003 and fiscal year
2002, Laidlaw charged the Company additional costs incurred by
Laidlaw as a result of its reorganization of $3.7 million
and $8.8 million, respectively.
Interest expense has been recorded by the Company based on an
average intercompany balance and applicable interest rates
(prime + 2%). During fiscal 2002 and for the nine months ended
May 31, 2003, Laidlaw, as a result of its bankruptcy,
suspended interest on purchase acquisition debt pushed down to
AMR.
On March 1, 2004, AMR declared a $200 million dividend
payable to Laidlaw. The dividend has been recorded as an
increase in the Laidlaw payable account on the balance sheet and
as a decrease to combined equity. There are no specific
repayment terms related to the Laidlaw payable account which has
been included as a component of equity on the accompanying
combined balance sheets and combined statements of changes in
equity.
At January 31, 2005, Laidlaw maintained deposits of
$16.4 million for collateral on behalf of AMR supporting
performance bonds held by a related party. AMRs interest
in the collateral is included in other long-term assets. As
described in note 12, Laidlaw also maintains
insurance-related deposits on behalf of AMR.
F-29
American Medical Response, Inc. & EmCare Holdings
Inc.
(The Healthcare Transportation and Emergency Management
Services
Businesses of Laidlaw International, Inc.)
Notes to Combined Financial
Statements (Continued)
The Company transfers surplus funds to Laidlaw as necessary and,
as described above, bears the cost of various allocated
expenses. The Companys operating results, cash flows and
financial position may significantly differ from those that
would have been achieved in the absence of the Companys
relationship with Laidlaw.
Insurance reserves are established for automobile, workers
compensation, general liability and professional liability
claims utilizing policies with both fully-insured and
self-insured components. This includes the use of an off-shore
captive insurance program through a wholly-owned subsidiary for
certain professional liability (malpractice) programs for
EmCare. In those instances where the Company has obtained
third-party insurance coverage, either directly through an
independent outside party or through participation in a Laidlaw
administered program, the Company normally retains liability for
the first $1 to $2 million of the loss. Insurance reserves
cover known claims and incidents within the level of Company
retention that may result in the assertion of additional claims,
as well as claims from unknown incidents that may be asserted
arising from activities through January 31, 2005.
The Company establishes reserves for claims based upon an
assessment of actual claims and claims incurred but not
reported. The reserves are established based on consultation
with third-party independent actuaries using actuarial
principles and assumptions that consider a number of factors,
including historical claim payment patterns (including legal
costs) and changes in case reserves and the assumed rate of
inflation in health care costs and property damage repairs. All
claims arising and not settled before June 1, 2003 were
recorded at estimated fair value as of the fresh-start date.
Claims, other than auto and general liability claims, that arose
after June 1, 2003 are discounted at a rate commensurate
with the interest rate on monetary assets that essentially are
risk free and have a maturity comparable to the underlying
liabilities. Auto and general liability claims that arose after
June 1, 2003 are not discounted. The table below summarizes
the non-health and welfare insurance reserves included in the
accompanying combined balance sheets.
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Accrued | |
|
Other Long-Term | |
|
Total | |
January 31, 2005 |
|
Liabilities | |
|
Liabilities | |
|
Liabilities | |
|
|
| |
|
| |
|
| |
Automobile
|
|
$ |
4,054 |
|
|
$ |
10,558 |
|
|
$ |
14,612 |
|
Workers compensation
|
|
|
11,554 |
|
|
|
34,636 |
|
|
|
46,190 |
|
General/ Professional liability
|
|
|
25,675 |
|
|
|
97,905 |
|
|
|
123,580 |
|
|
|
|
|
|
|
|
|
|
|
|
|
$ |
41,283 |
|
|
$ |
143,099 |
|
|
$ |
184,382 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Accrued | |
|
Other Long-Term | |
|
Total | |
August 31, 2004 |
|
Liabilities | |
|
Liabilities | |
|
Liabilities | |
|
|
| |
|
| |
|
| |
Automobile
|
|
$ |
4,007 |
|
|
$ |
8,887 |
|
|
$ |
12,894 |
|
Workers compensation
|
|
|
10,903 |
|
|
|
32,406 |
|
|
|
43,309 |
|
General/ Professional liability
|
|
|
21,474 |
|
|
|
96,887 |
|
|
|
118,361 |
|
|
|
|
|
|
|
|
|
|
|
|
|
$ |
36,384 |
|
|
$ |
138,180 |
|
|
$ |
174,564 |
|
|
|
|
|
|
|
|
|
|
|
F-30
American Medical Response, Inc. & EmCare Holdings
Inc.
(The Healthcare Transportation and Emergency Management
Services
Businesses of Laidlaw International, Inc.)
Notes to Combined Financial
Statements (Continued)
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Accrued | |
|
Other Long-term | |
|
Total | |
August 31, 2003 |
|
Liabilities | |
|
Liabilities | |
|
Liabilities | |
|
|
| |
|
| |
|
| |
Automobile
|
|
$ |
4,845 |
|
|
$ |
6,244 |
|
|
$ |
11,089 |
|
Workers compensation
|
|
|
10,152 |
|
|
|
23,870 |
|
|
|
34,022 |
|
General/ Professional liability
|
|
|
13,209 |
|
|
|
88,897 |
|
|
|
102,106 |
|
|
|
|
|
|
|
|
|
|
|
|
|
$ |
28,206 |
|
|
$ |
119,011 |
|
|
$ |
147,217 |
|
|
|
|
|
|
|
|
|
|
|
Certain insurance programs also require the Company to maintain
deposits with third-party insurers, trustees or with Laidlaw to
cover future claims costs and are included in other assets in
the combined balance sheets. Investments supporting insurance
programs are comprised principally of government securities and
investment grade securities and are presented as restricted
assets in the combined balance sheets. These investments are
designated as available-for-sale and reported at fair value.
Investment income/loss earned on these investments is reported
as a component of insurance expense in the combined statement of
operations. The following table summarizes these deposits and
restricted investments:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
January 31, | |
|
August 31, | |
|
August 31, | |
|
|
2005 | |
|
2004 | |
|
2003 | |
|
|
| |
|
| |
|
| |
Restricted cash and cash equivalents
|
|
$ |
9,846 |
|
|
$ |
5,691 |
|
|
$ |
939 |
|
Restricted marketable securities
|
|
|
2,473 |
|
|
|
6,756 |
|
|
|
201 |
|
Short-term deposits (included in other current assets)
|
|
|
8,044 |
|
|
|
9,889 |
|
|
|
14,997 |
|
Short-term deposits with Laidlaw (included in other current
assets)
|
|
|
11,541 |
|
|
|
5,700 |
|
|
|
|
|
Restricted long-term investments
|
|
|
41,810 |
|
|
|
47,285 |
|
|
|
40,608 |
|
Long-term deposits (included in other long-term assets)
|
|
|
20,006 |
|
|
|
23,708 |
|
|
|
28,626 |
|
Long-term deposits with Laidlaw (included in other long-term
assets)
|
|
|
29,413 |
|
|
|
22,733 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Total insurance deposits
|
|
$ |
123,133 |
|
|
$ |
121,762 |
|
|
$ |
85,371 |
|
|
|
|
|
|
|
|
|
|
|
Provisions for insurance expense included in the combined
statement of operations includes annual provisions determined in
consultation with Company actuaries, premiums paid to
third-party insurers net of retrospective policy adjustments,
interest accretion and earnings/loss on investments. Fiscal 2004
expense was reduced by a $3.8 million experience refund
received during the year.
F-31
American Medical Response, Inc. & EmCare Holdings
Inc.
(The Healthcare Transportation and Emergency Management
Services
Businesses of Laidlaw International, Inc.)
Notes to Combined Financial
Statements (Continued)
|
|
13. |
Supplemental Cash Flow Information |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Predecessor | |
|
|
|
|
Restated | |
|
|
|
|
| |
|
|
Five Months | |
|
Year | |
|
Three Months | |
|
|
Nine Months | |
|
Year | |
|
|
Ended | |
|
Ended | |
|
Ended | |
|
|
Ended | |
|
Ended | |
|
|
January 31, | |
|
August 31, | |
|
August 31, | |
|
|
May 31, | |
|
August 31, | |
|
|
2005 | |
|
2004 | |
|
2003 | |
|
|
2003 | |
|
2002 | |
|
|
| |
|
| |
|
| |
|
|
| |
|
| |
Cash paid during the period for interest
|
|
$ |
488 |
|
|
$ |
556 |
|
|
$ |
436 |
|
|
|
$ |
1,605 |
|
|
$ |
1,278 |
|
Finance and investing activities not requiring the use of cash:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Dividend to Laidlaw
|
|
|
|
|
|
|
200,000 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Acquisition of equipment through capital leases
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
26,320 |
|
|
Reduction of deferred tax asset valuation allowance through:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Reduction of ambulance service contracts and other intangibles
|
|
|
|
|
|
|
124,977 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Reduction of associated deferred tax asset
|
|
|
|
|
|
|
(27,606 |
) |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Laidlaw equity
|
|
$ |
|
|
|
$ |
10,406 |
|
|
$ |
|
|
|
|
$ |
|
|
|
$ |
|
|
The Company is organized around two separately managed business
units: healthcare transportation services and emergency
management services, which have been identified as operating
segments. The healthcare transportation services reportable
segment focuses on providing a full range of medical
transportation services from basic patient transit to the most
advanced emergency care and pre-hospital assistance. The
emergency management services reportable segment provides
outsourced business services to hospitals primarily for
emergency departments, urgent care centers and for certain
inpatient departments. The Chief Executive Officer has been
identified as the chief operating decision maker (CODM) for
purposes of SFAS No. 131 Disclosures about
Segments of an Enterprise and Related Information
(SFAS 131), as he assesses the performance of the business
units and decides how to allocate resources to the business
units. Pre-tax income from continuing operations before
interest, taxes and depreciation and amortization (Segment
EBITDA) is the measure of profit and loss that the CODM
uses to assess performance and make decisions. Pre-tax income
from continuing operations represents net revenue less direct
operating expenses incurred
F-32
American Medical Response, Inc. & EmCare Holdings
Inc.
(The Healthcare Transportation and Emergency Management
Services
Businesses of Laidlaw International, Inc.)
Notes to Combined Financial
Statements (Continued)
within the operating segments. The accounting policies for
reported segments are the same as for the Company as a whole
(see note 2).
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Predecessor Company | |
|
|
|
|
|
|
|
|
|
Restated | |
|
|
|
|
|
|
|
|
|
| |
|
|
Five Months | |
|
Year | |
|
Three Months | |
|
|
Nine Months | |
|
Year | |
|
|
Ended | |
|
Ended | |
|
Ended | |
|
|
Ended | |
|
Ended | |
|
|
January 31, | |
|
August 31, | |
|
August 31, | |
|
|
May 31, | |
|
August 31, | |
|
|
2005 | |
|
2004 | |
|
2003 | |
|
|
2003 | |
|
2002 | |
|
|
| |
|
| |
|
| |
|
|
| |
|
| |
Healthcare Transportation Services
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Revenue
|
|
$ |
455,059 |
|
|
$ |
1,054,800 |
|
|
$ |
255,807 |
|
|
|
$ |
751,344 |
|
|
$ |
984,451 |
|
Segment EBITDA
|
|
|
33,859 |
|
|
|
85,557 |
|
|
|
7,941 |
|
|
|
|
48,026 |
|
|
|
(189,624 |
)(1) |
Total identifiable assets
|
|
|
645,441 |
|
|
|
628,635 |
|
|
|
605,268 |
|
|
|
|
638,495 |
(2) |
|
|
894,943 |
|
Capital expenditures
|
|
|
12,054 |
|
|
|
38,573 |
|
|
|
17,581 |
|
|
|
|
30,888 |
|
|
|
26,670 |
|
Emergency Management Services
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Revenue
|
|
|
241,120 |
|
|
|
549,798 |
|
|
|
128,654 |
|
|
|
|
351,991 |
|
|
|
431,335 |
|
Segment EBITDA
|
|
|
5,639 |
|
|
|
37,156 |
|
|
|
7,217 |
|
|
|
|
18,248 |
|
|
|
16,847 |
|
Total identifiable assets
|
|
|
338,069 |
|
|
|
320,964 |
|
|
|
309,478 |
|
|
|
|
303,136 |
(2) |
|
|
163,132 |
|
Capital expenditures
|
|
|
1,991 |
|
|
|
4,214 |
|
|
|
498 |
|
|
|
|
3,880 |
|
|
|
4,448 |
|
Total
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Total revenue
|
|
|
696,179 |
|
|
|
1,604,598 |
|
|
|
384,461 |
|
|
|
|
1,103,335 |
|
|
|
1,415,786 |
|
Total segment EBITDA
|
|
|
39,498 |
|
|
|
122,713 |
|
|
|
15,158 |
|
|
|
|
66,274 |
|
|
|
(172,777 |
) |
Total identifiable assets
|
|
|
983,510 |
|
|
|
949,599 |
|
|
|
914,746 |
|
|
|
|
941,631 |
(2) |
|
|
1,058,075 |
|
Total capital expenditures
|
|
|
14,045 |
|
|
|
42,787 |
|
|
|
18,079 |
|
|
|
|
34,768 |
|
|
|
31,118 |
|
Reconciliation of EBITDA to Net Income (Loss)
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
EBITDA
|
|
|
39,498 |
|
|
|
122,713 |
|
|
|
15,158 |
|
|
|
|
66,274 |
|
|
|
(172,777 |
)(1) |
Depreciation and amortization expense
|
|
|
(18,808 |
) |
|
|
(52,739 |
) |
|
|
(12,560 |
) |
|
|
|
(32,144 |
) |
|
|
(67,183 |
) |
Interest expense
|
|
|
(5,644 |
) |
|
|
(9,961 |
) |
|
|
(908 |
) |
|
|
|
(4,691 |
) |
|
|
(6,418 |
) |
Realized gain (loss) on investments
|
|
|
|
|
|
|
(1,140 |
) |
|
|
90 |
|
|
|
|
|
|
|
|
|
|
Interest and other income
|
|
|
714 |
|
|
|
240 |
|
|
|
22 |
|
|
|
|
304 |
|
|
|
369 |
|
Fresh-start accounting adjustments
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
46,416 |
|
|
|
|
|
Income tax expense
|
|
|
(6,278 |
) |
|
|
(21,764 |
) |
|
|
(8,633 |
) |
|
|
|
(829 |
) |
|
|
(1,374 |
) |
Cumulative effect of a change in accounting principle
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
(223,721 |
) |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Net income (loss)
|
|
$ |
9,482 |
|
|
$ |
37,349 |
|
|
$ |
(6,831 |
) |
|
|
$ |
(148,391 |
) |
|
$ |
(247,383 |
) |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
(1) |
Includes an impairment loss of $262,780. |
|
(2) |
Total assets of the Company at June 1, 2003 after fair
value adjustments. |
F-33
American Medical Response, Inc. & EmCare Holdings
Inc.
(The Healthcare Transportation and Emergency Management
Services
Businesses of Laidlaw International, Inc.)
Notes to Combined Financial
Statements (Continued)
|
|
15. |
Valuation and Qualifying Accounts |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Total | |
|
Valuation | |
|
|
|
|
Allowance for | |
|
Allowance for | |
|
Accounts | |
|
Allowance for | |
|
|
|
|
Contractual | |
|
Uncompensated | |
|
Receivable | |
|
Deferred Tax | |
|
|
|
|
Discounts | |
|
Care | |
|
Allowances | |
|
Assets | |
|
Total | |
|
|
| |
|
| |
|
| |
|
| |
|
| |
Balance at August 31, 2001 (Predecessor)
restated
|
|
$ |
242,172 |
|
|
$ |
423,562 |
|
|
$ |
665,734 |
|
|
$ |
309,275 |
|
|
$ |
975,009 |
|
|
Additions
|
|
|
858,590 |
|
|
|
521,277 |
|
|
|
1,379,867 |
|
|
|
6,383 |
|
|
|
1,386,250 |
|
|
Reductions
|
|
|
(850,862 |
) |
|
|
(532,030 |
) |
|
|
(1,382,892 |
) |
|
|
(4,964 |
) |
|
|
(1,387,856 |
) |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Balance at August 31, 2002 (Predecessor)
restated
|
|
|
249,900 |
|
|
|
412,809 |
|
|
|
662,709 |
|
|
|
310,694 |
|
|
|
973,403 |
|
|
Additions
|
|
|
795,809 |
|
|
|
428,578 |
|
|
|
1,224,387 |
|
|
|
3,200 |
|
|
|
1,227,587 |
|
|
Reductions
|
|
|
(786,770 |
) |
|
|
(377,363 |
) |
|
|
(1,164,133 |
) |
|
|
(157,942 |
) |
|
|
(1,322,075 |
) |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Balance at May 31, 2003 (Predecessor) restated
|
|
$ |
258,939 |
|
|
$ |
464,024 |
|
|
$ |
722,963 |
|
|
$ |
155,952 |
|
|
$ |
878,915 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Fresh-start balance at June 1, 2003 restated
|
|
$ |
258,939 |
|
|
$ |
464,024 |
|
|
$ |
722,963 |
|
|
$ |
155,952 |
|
|
$ |
878,915 |
|
|
Additions
|
|
|
289,329 |
|
|
|
161,100 |
|
|
|
450,429 |
|
|
|
|
|
|
|
450,429 |
|
|
Reductions
|
|
|
(289,500 |
) |
|
|
(137,533 |
) |
|
|
(427,033 |
) |
|
|
|
|
|
|
(427,033 |
) |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Balance at August 31, 2003 restated
|
|
|
258,768 |
|
|
|
487,591 |
|
|
|
746,359 |
|
|
|
155,952 |
|
|
|
902,311 |
|
|
Additions
|
|
|
1,361,708 |
|
|
|
666,116 |
|
|
|
2,027,824 |
|
|
|
|
|
|
|
2,027,824 |
|
|
Reductions
|
|
|
(1,349,005 |
) |
|
|
(542,429 |
) |
|
|
(1,891,434 |
) |
|
|
(155,952 |
) |
|
|
(2,047,386 |
) |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Balance at August 31, 2004 restated
|
|
|
271,471 |
|
|
|
611,278 |
|
|
|
882,749 |
|
|
|
|
|
|
|
882,749 |
|
|
Additions
|
|
|
632,959 |
|
|
|
312,310 |
|
|
|
945,269 |
|
|
|
|
|
|
|
945,269 |
|
|
Reductions
|
|
|
(589,568 |
) |
|
|
(242,284 |
) |
|
|
(831,852 |
) |
|
|
|
|
|
|
(831,852 |
) |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Balance at January 31, 2005
|
|
$ |
314,862 |
|
|
$ |
681,304 |
|
|
$ |
996,166 |
|
|
$ |
|
|
|
$ |
996,166 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
16. |
Prior Period Results (unaudited) |
We have included below an unaudited combined statement of
operations and comprehensive income for the five months ended
January 31, 2004 and an unaudited combined statement of
cash flows for the five months ended January 31, 2004 for
comparison purposes only to the audited statements included
herein.
|
|
|
|
|
|
|
Five Months | |
|
|
Ended | |
|
|
January 31, | |
|
|
2004 | |
|
|
| |
|
|
(unaudited) | |
Combined Statement of Operations |
Net revenue
|
|
$ |
667,506 |
|
|
|
|
|
Compensation and benefits
|
|
|
461,923 |
|
Operating expenses
|
|
|
90,828 |
|
Insurance expense
|
|
|
36,664 |
|
Selling, general and administrative expenses
|
|
|
22,016 |
|
F-34
American Medical Response, Inc. & EmCare Holdings
Inc.
(The Healthcare Transportation and Emergency Management
Services
Businesses of Laidlaw International, Inc.)
Notes to Combined Financial
Statements (Continued)
|
|
|
|
|
|
|
|
|
|
Five Months | |
|
|
Ended | |
|
|
January 31, | |
|
|
2004 | |
|
|
| |
|
|
(unaudited) | |
Laidlaw fees and compensation charges
|
|
|
6,436 |
|
Depreciation and amortization expense
|
|
|
22,079 |
|
|
|
|
|
Income from operations
|
|
|
27,560 |
|
Interest expense
|
|
|
(4,137 |
) |
Interest and other income
|
|
|
1,403 |
|
|
|
|
|
Income before income taxes
|
|
|
24,826 |
|
Income tax expense
|
|
|
(9,800 |
) |
|
|
|
|
Net income
|
|
$ |
15,026 |
|
|
|
|
|
Combined Statement of Cash Flows |
Cash Flows from Operating Activities
|
|
|
|
|
Net income
|
|
$ |
15,026 |
|
Adjustments to reconcile net income to net cash provided by
operating activities:
|
|
|
|
|
|
Depreciation and amortization
|
|
|
22,079 |
|
|
Loss on disposal of property, plant and equipment
|
|
|
309 |
|
|
Deferred income taxes
|
|
|
9,320 |
|
|
Changes in operating assets/liabilities:
|
|
|
|
|
|
|
Trade and other accounts receivable
|
|
|
(33,822 |
) |
|
|
Other current assets
|
|
|
4,889 |
|
|
|
Accounts payable and accrued liabilities
|
|
|
827 |
|
|
|
|
|
|
|
|
Net cash provided by operating activities
|
|
|
18,627 |
|
|
|
|
|
Cash Flows from Investing Activities
|
|
|
|
|
Purchase of property, plant and equipment
|
|
|
(14,224 |
) |
Proceeds from sale of property, plant and equipment
|
|
|
84 |
|
Purchase of restricted cash and investments
|
|
|
(9,585 |
) |
Proceeds from sale of restricted investments
|
|
|
14,758 |
|
Net change in deposits and other assets
|
|
|
(1,914 |
) |
|
|
|
|
|
|
|
Net cash used in investing activities
|
|
|
(10,881 |
) |
|
|
|
|
Cash Flows from Financing Activities
|
|
|
|
|
Repayments of capital lease obligations and other debt
|
|
|
(3,784 |
) |
Increase in bank overdrafts
|
|
|
(3,216 |
) |
Payments made to Laidlaw
|
|
|
(2,215 |
) |
Increase in other non-current liabilities
|
|
|
1,683 |
|
|
|
|
|
|
|
|
Net cash used in financing activities
|
|
|
(7,532 |
) |
|
|
|
|
Increase in cash and cash equivalents
|
|
|
215 |
|
Cash and cash equivalents, beginning of period
|
|
|
10,641 |
|
|
|
|
|
Cash and cash equivalents, end of period
|
|
$ |
10,856 |
|
|
|
|
|
F-35
American Medical Response, Inc. & EmCare Holdings
Inc.
(The Healthcare Transportation and Emergency Management
Services
Businesses of Laidlaw International, Inc.)
Notes to Combined Financial
Statements (Continued)
Emergency Medical Services L.P. financed the acquisition of AMR
and EmCare, described in note 18 in part by issuing
$250.0 million principal amount of senior subordinated
notes and borrowing $370.2 million under its senior secured
credit facility. Its wholly-owned subsidiaries, AMR HoldCo, Inc.
and EmCare HoldCo, Inc., are the issuers of the senior
subordinated notes and the borrowers under the senior secured
credit facility. As part of the transaction, AMR and its
subsidiaries became wholly-owned subsidiaries of AMR HoldCo,
Inc. and EmCare and its subsidiaries became wholly-owned
subsidiaries of EmCare HoldCo, Inc. The senior subordinated
notes and the senior secured credit facility include a full,
unconditional and joint and several guarantee by all of the
Companys subsidiaries other than its captive insurance
subsidiary. All of the operating income and cash flow of EMS
L.P., AMR HoldCo, Inc. and EmCare HoldCo, Inc. is generated by
AMR, EmCare and their subsidiaries. As a result, funds necessary
to meet the debt service obligations under the senior secured
notes and senior secured credit facility described above are
provided by the distributions or advances from the subsidiary
companies, AMR and EmCare. Investments in subsidiary operating
companies are accounted for on the equity method. Accordingly,
entries necessary to consolidate the parent company, AMR HoldCo,
Inc., EmCare HoldCo, Inc. and all of their subsidiaries are
reflected in the Eliminations/ Adjustments column. Separate
complete financial statements of the issuers and subsidiary
guarantors would not provide additional material information
that would be useful in assessing the financial composition of
the issuers or the subsidiary guarantors. The condensed
combining financial statements for the parent company, the
issuers, the guarantors and the non-guarantor are as follows:
F-36
Combining Balance Sheet
As of January 31, 2005
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Issuer |
|
Issuer |
|
|
|
Subsidiary | |
|
|
|
|
|
|
|
|
AMR |
|
EmCare |
|
Subsidiary | |
|
Non- | |
|
Eliminations/ | |
|
|
|
|
Parent Co. |
|
HoldCo, Inc. |
|
HoldCo, Inc. |
|
Guarantors | |
|
guarantor | |
|
Adjustments | |
|
Total | |
|
|
|
|
|
|
|
|
| |
|
| |
|
| |
|
| |
Assets |
Current assets:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Cash and cash equivalents
|
|
$ |
|
|
|
$ |
|
|
|
$ |
|
|
|
$ |
4,778 |
|
|
$ |
9,853 |
|
|
$ |
|
|
|
$ |
14,631 |
|
|
Restricted cash and cash equivalents
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
9,846 |
|
|
|
|
|
|
|
9,846 |
|
|
Restricted marketable securities
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
2,473 |
|
|
|
|
|
|
|
2,473 |
|
|
Trade and other accounts receivable, net
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
359,945 |
|
|
|
43,339 |
|
|
|
(33,517 |
) |
|
|
369,767 |
|
|
Parts and supplies inventory
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
18,499 |
|
|
|
|
|
|
|
|
|
|
|
18,499 |
|
|
Other current assets
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
81,818 |
|
|
|
6,097 |
|
|
|
(47,780 |
) |
|
|
40,135 |
|
|
Current deferred tax assets
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
62,433 |
|
|
|
2,659 |
|
|
|
|
|
|
|
65,092 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Current assets
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
527,473 |
|
|
|
74,267 |
|
|
|
(81,297 |
) |
|
|
520,443 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Non-current assets:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Property, plant, and equipment, net
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
128,766 |
|
|
|
|
|
|
|
|
|
|
|
128,766 |
|
|
Intangible assets, net
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
16,075 |
|
|
|
|
|
|
|
|
|
|
|
16,075 |
|
|
Non-current deferred tax assets
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
203,391 |
|
|
|
(922 |
) |
|
|
|
|
|
|
202,469 |
|
|
Restricted long-term investments
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
41,810 |
|
|
|
|
|
|
|
41,810 |
|
|
Goodwill
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Other long-term assets
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
73,947 |
|
|
|
|
|
|
|
|
|
|
|
73,947 |
|
|
Investment and advances in subsidiaries
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
6,404 |
|
|
|
|
|
|
|
(6,404 |
) |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Assets
|
|
$ |
|
|
|
$ |
|
|
|
$ |
|
|
|
$ |
956,056 |
|
|
$ |
115,155 |
|
|
$ |
(87,701 |
) |
|
$ |
983,510 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Liabilities and Equity |
Current liabilities:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Accounts payable
|
|
$ |
|
|
|
$ |
|
|
|
$ |
|
|
|
$ |
82,167 |
|
|
$ |
5,186 |
|
|
$ |
(31,535 |
) |
|
$ |
55,818 |
|
|
Accrued liabilities
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
147,291 |
|
|
|
24,354 |
|
|
|
|
|
|
|
171,645 |
|
|
Current portion of long-term debt
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
5,846 |
|
|
|
|
|
|
|
|
|
|
|
5,846 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Current liabilities
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
235,304 |
|
|
|
29,540 |
|
|
|
(31,535 |
) |
|
|
233,309 |
|
Long-term debt
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
5,651 |
|
|
|
|
|
|
|
|
|
|
|
5,651 |
|
Other long-term liabilities
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
116,824 |
|
|
|
79,211 |
|
|
|
(49,762 |
) |
|
|
146,273 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Liabilities
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
357,779 |
|
|
|
108,751 |
|
|
|
(81,297 |
) |
|
|
385,233 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Laidlaw payable
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
202,042 |
|
|
|
|
|
|
|
|
|
|
|
202,042 |
|
Laidlaw investment
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
356,550 |
|
|
|
|
|
|
|
|
|
|
|
356,550 |
|
Common stock
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
30 |
|
|
|
(30 |
) |
|
|
|
|
Additional paid-in capital
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
5,054 |
|
|
|
(5,054 |
) |
|
|
|
|
Retained earnings
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
40,000 |
|
|
|
1,635 |
|
|
|
(1,635 |
) |
|
|
40,000 |
|
Comprehensive income (loss)
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
(315 |
) |
|
|
(315 |
) |
|
|
315 |
|
|
|
(315 |
) |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Equity
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
598,277 |
|
|
|
6,404 |
|
|
|
(6,404 |
) |
|
|
598,277 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Liabilities and Equity
|
|
$ |
|
|
|
$ |
|
|
|
$ |
|
|
|
$ |
956,056 |
|
|
$ |
115,155 |
|
|
$ |
(87,701 |
) |
|
$ |
983,510 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
F-37
Combining Balance Sheet
As of August 31, 2004
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Issuer |
|
Issuer |
|
|
|
Subsidiary | |
|
|
|
|
|
|
|
|
AMR |
|
EmCare |
|
Subsidiary | |
|
Non- | |
|
Eliminations/ | |
|
|
|
|
Parent Co. |
|
HoldCo, Inc. |
|
HoldCo, Inc. |
|
Guarantors | |
|
guarantor | |
|
Adjustments | |
|
Total | |
|
|
|
|
|
|
|
|
| |
|
| |
|
| |
|
| |
Assets |
Current assets:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Cash and cash equivalents
|
|
$ |
|
|
|
$ |
|
|
|
$ |
|
|
|
$ |
9,436 |
|
|
$ |
40 |
|
|
$ |
|
|
|
$ |
9,476 |
|
|
Restricted cash and cash equivalents
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
5,691 |
|
|
|
|
|
|
|
5,691 |
|
|
Restricted marketable securities
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
6,756 |
|
|
|
|
|
|
|
6,756 |
|
|
Trade and other accounts receivable, net
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
339,896 |
|
|
|
17,321 |
|
|
|
(13,007 |
) |
|
|
344,210 |
|
|
Parts and supplies inventory
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
18,577 |
|
|
|
|
|
|
|
|
|
|
|
18,577 |
|
|
Other current assets
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
45,254 |
|
|
|
1,820 |
|
|
|
(15,059 |
) |
|
|
32,015 |
|
|
Current deferred tax assets
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
50,322 |
|
|
|
2,659 |
|
|
|
|
|
|
|
52,981 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Current assets
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
463,485 |
|
|
|
34,287 |
|
|
|
(28,066 |
) |
|
|
469,706 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Non-current assets:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Property, plant, and equipment, net
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
132,685 |
|
|
|
|
|
|
|
|
|
|
|
132,685 |
|
|
Intangible assets, net
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
15,758 |
|
|
|
|
|
|
|
|
|
|
|
15,758 |
|
|
Non-current deferred tax assets
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
215,520 |
|
|
|
(1,131 |
) |
|
|
|
|
|
|
214,389 |
|
|
Restricted long-term investments
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
47,285 |
|
|
|
|
|
|
|
47,285 |
|
|
Other long-term assets
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
69,776 |
|
|
|
|
|
|
|
|
|
|
|
69,776 |
|
|
Investment and advances in subsidiaries
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
6,694 |
|
|
|
|
|
|
|
(6,694 |
) |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Assets
|
|
$ |
|
|
|
$ |
|
|
|
$ |
|
|
|
$ |
903,918 |
|
|
$ |
80,441 |
|
|
$ |
(34,760 |
) |
|
$ |
949,599 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Liabilities and Equity |
Current liabilities:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Accounts payable
|
|
$ |
|
|
|
$ |
|
|
|
$ |
|
|
|
$ |
59,631 |
|
|
$ |
1,129 |
|
|
$ |
(9,845 |
) |
|
$ |
50,915 |
|
|
Accrued liabilities
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
146,722 |
|
|
|
20,062 |
|
|
|
|
|
|
|
166,784 |
|
|
Current portion of long-term debt
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
7,565 |
|
|
|
|
|
|
|
|
|
|
|
7,565 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Current liabilities
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
213,918 |
|
|
|
21,191 |
|
|
|
(9,845 |
) |
|
|
225,264 |
|
Long-term debt
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
7,915 |
|
|
|
|
|
|
|
|
|
|
|
7,915 |
|
Other long-term liabilities
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
108,245 |
|
|
|
52,556 |
|
|
|
(18,221 |
) |
|
|
142,580 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Liabilities
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
330,078 |
|
|
|
73,747 |
|
|
|
(28,066 |
) |
|
|
375,759 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Laidlaw payable
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
186,778 |
|
|
|
|
|
|
|
|
|
|
|
186,778 |
|
Laidlaw investment
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
356,550 |
|
|
|
|
|
|
|
|
|
|
|
356,550 |
|
Common stock
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
30 |
|
|
|
(30 |
) |
|
|
|
|
Additional paid-in capital
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
5,035 |
|
|
|
(5,035 |
) |
|
|
|
|
Retained earnings
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
30,518 |
|
|
|
1,635 |
|
|
|
(1,635 |
) |
|
|
30,518 |
|
Comprehensive income (loss)
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
(6 |
) |
|
|
(6 |
) |
|
|
6 |
|
|
|
(6 |
) |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Equity
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
573,840 |
|
|
|
6,694 |
|
|
|
(6,694 |
) |
|
|
573,840 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Liabilities and Equity
|
|
$ |
|
|
|
$ |
|
|
|
$ |
|
|
|
$ |
903,918 |
|
|
$ |
80,441 |
|
|
$ |
(34,760 |
) |
|
$ |
949,599 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
F-38
Combining Balance Sheet
As of August 31, 2003
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Issuer |
|
Issuer |
|
|
|
Subsidiary | |
|
|
|
|
|
|
|
|
AMR |
|
EmCare |
|
Subsidiary | |
|
Non- | |
|
Eliminations/ | |
|
|
|
|
Parent Co. |
|
HoldCo, Inc. |
|
HoldCo, Inc. |
|
Guarantors | |
|
Guarantor | |
|
Adjustments | |
|
Total | |
|
|
|
|
|
|
|
|
| |
|
| |
|
| |
|
| |
Assets
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Current assets:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Cash and cash equivalents
|
|
$ |
|
|
|
$ |
|
|
|
$ |
|
|
|
$ |
10,604 |
|
|
$ |
37 |
|
|
$ |
|
|
|
$ |
10,641 |
|
|
Restricted cash and cash equivalents
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
939 |
|
|
|
|
|
|
|
939 |
|
|
Restricted marketable securities
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
201 |
|
|
|
|
|
|
|
201 |
|
|
Trade and other accounts receivable, net
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
316,395 |
|
|
|
4,057 |
|
|
|
|
|
|
|
320,452 |
|
|
Parts and supplies inventory
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
17,444 |
|
|
|
|
|
|
|
|
|
|
|
17,444 |
|
|
Other current assets
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
40,259 |
|
|
|
5,059 |
|
|
|
(13,111 |
) |
|
|
32,207 |
|
|
Current deferred tax assets
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
55,921 |
|
|
|
2,915 |
|
|
|
|
|
|
|
58,836 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Current assets
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
440,623 |
|
|
|
13,208 |
|
|
|
(13,111 |
) |
|
|
440,720 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Non-current assets:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Property, plant, and equipment, net
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
133,546 |
|
|
|
|
|
|
|
|
|
|
|
133,546 |
|
|
Intangible assets, net
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
148,205 |
|
|
|
|
|
|
|
|
|
|
|
148,205 |
|
|
Non-current deferred tax assets
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
96,596 |
|
|
|
|
|
|
|
|
|
|
|
96,596 |
|
|
Restricted long-term investments
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
40,608 |
|
|
|
|
|
|
|
40,608 |
|
|
Other long-term assets
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
55,071 |
|
|
|
|
|
|
|
|
|
|
|
55,071 |
|
|
Investment and advances in subsidiaries
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
3,859 |
|
|
|
|
|
|
|
(3,859 |
) |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Assets
|
|
$ |
|
|
|
$ |
|
|
|
$ |
|
|
|
$ |
877,900 |
|
|
$ |
53,816 |
|
|
$ |
(16,970 |
) |
|
$ |
914,746 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Liabilities and Equity
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Current liabilities:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Accounts payable
|
|
$ |
|
|
|
$ |
|
|
|
$ |
|
|
|
$ |
50,148 |
|
|
$ |
34 |
|
|
$ |
|
|
|
$ |
50,182 |
|
|
Accrued liabilities
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
146,772 |
|
|
|
9,529 |
|
|
|
(10,122 |
) |
|
|
146,179 |
|
|
Current portion of long-term debt
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
8,270 |
|
|
|
|
|
|
|
|
|
|
|
8,270 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Current liabilities
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
205,190 |
|
|
|
9,563 |
|
|
|
(10,122 |
) |
|
|
204,631 |
|
Long-term debt
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
15,787 |
|
|
|
|
|
|
|
|
|
|
|
15,787 |
|
Other long-term liabilities
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
96,384 |
|
|
|
40,394 |
|
|
|
(2,989 |
) |
|
|
133,789 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Liabilities
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
317,361 |
|
|
|
49,957 |
|
|
|
(13,111 |
) |
|
|
354,207 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Laidlaw payable
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
22,416 |
|
|
|
|
|
|
|
|
|
|
|
22,416 |
|
Laidlaw investment
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
546,144 |
|
|
|
|
|
|
|
|
|
|
|
546,144 |
|
Additional paid-in capital
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
5,049 |
|
|
|
(5,049 |
) |
|
|
|
|
Retained earnings
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
(6,831 |
) |
|
|
|
|
|
|
|
|
|
|
(6,831 |
) |
Comprehensive income (loss)
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
(1,190 |
) |
|
|
(1,190 |
) |
|
|
1,190 |
|
|
|
(1,190 |
) |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Equity
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
560,539 |
|
|
|
3,859 |
|
|
|
(3,859 |
) |
|
|
560,539 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Liabilities and Equity
|
|
$ |
|
|
|
$ |
|
|
|
$ |
|
|
|
$ |
877,900 |
|
|
$ |
53,816 |
|
|
$ |
(16,970 |
) |
|
$ |
914,746 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
F-39
Combining Statement of Operations
For the Five Months Ended January 31, 2005
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Issuer |
|
Issuer |
|
|
|
Subsidiary | |
|
|
|
|
|
|
|
|
AMR |
|
EmCare |
|
Subsidiary | |
|
Non- | |
|
Eliminations/ | |
|
|
|
|
Parent Co. |
|
HoldCo, Inc. |
|
HoldCo, Inc. |
|
Guarantors | |
|
Guarantor | |
|
Adjustments | |
|
Total | |
|
|
|
|
|
|
|
|
| |
|
| |
|
| |
|
| |
Net revenue
|
|
$ |
|
|
|
$ |
|
|
|
$ |
|
|
|
$ |
696,179 |
|
|
$ |
15,913 |
|
|
$ |
(15,913 |
) |
|
$ |
696,179 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Compensation and benefits
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
481,305 |
|
|
|
|
|
|
|
|
|
|
|
481,305 |
|
Operating expenses
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
94,882 |
|
|
|
|
|
|
|
|
|
|
|
94,882 |
|
Insurance expense
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
39,002 |
|
|
|
15,913 |
|
|
|
(15,913 |
) |
|
|
39,002 |
|
Selling, general and administrative expenses
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
21,635 |
|
|
|
|
|
|
|
|
|
|
|
21,635 |
|
Laidlaw fees and compensation charges
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
19,857 |
|
|
|
|
|
|
|
|
|
|
|
19,857 |
|
Depreciation and amortization expense
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
18,808 |
|
|
|
|
|
|
|
|
|
|
|
18,808 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Income from operations
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
20,690 |
|
|
|
|
|
|
|
|
|
|
|
20,690 |
|
Interest expense
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
(5,644 |
) |
|
|
|
|
|
|
|
|
|
|
(5,644 |
) |
Interest and other income
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
714 |
|
|
|
|
|
|
|
|
|
|
|
714 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Income before income taxes
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
15,760 |
|
|
|
|
|
|
|
|
|
|
|
15,760 |
|
Income tax expense
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
(6,278 |
) |
|
|
|
|
|
|
|
|
|
|
(6,278 |
) |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Net income
|
|
$ |
|
|
|
$ |
|
|
|
$ |
|
|
|
$ |
9,482 |
|
|
$ |
|
|
|
$ |
|
|
|
$ |
9,482 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Combining Statement of Operations
For the Year Ended August 31, 2004
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Issuer |
|
Issuer |
|
|
|
Subsidiary | |
|
|
|
|
|
|
|
|
AMR |
|
EmCare |
|
Subsidiary | |
|
Non- | |
|
Eliminations/ | |
|
|
|
|
Parent Co. |
|
HoldCo, Inc. |
|
HoldCo, Inc. |
|
Guarantors | |
|
Guarantor | |
|
Adjustments | |
|
Total | |
|
|
|
|
|
|
|
|
| |
|
| |
|
| |
|
| |
Net revenue
|
|
$ |
|
|
|
$ |
|
|
|
$ |
|
|
|
$ |
1,604,598 |
|
|
$ |
29,803 |
|
|
$ |
(29,803 |
) |
|
$ |
1,604,598 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Compensation and benefits
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
1,117,890 |
|
|
|
|
|
|
|
|
|
|
|
1,117,890 |
|
Operating expenses
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
218,277 |
|
|
|
|
|
|
|
|
|
|
|
218,277 |
|
Insurance expense
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
81,395 |
|
|
|
28,663 |
|
|
|
(29,803 |
) |
|
|
80,255 |
|
Selling, general and administrative expenses
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
47,899 |
|
|
|
|
|
|
|
|
|
|
|
47,899 |
|
Laidlaw fees and compensation charges
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
15,449 |
|
|
|
|
|
|
|
|
|
|
|
15,449 |
|
Depreciation and amortization expense
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
52,739 |
|
|
|
|
|
|
|
|
|
|
|
52,739 |
|
Restructuring charges
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
2,115 |
|
|
|
|
|
|
|
|
|
|
|
2,115 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Income from operations
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
68,834 |
|
|
|
1,140 |
|
|
|
|
|
|
|
69,974 |
|
Interest expense
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
(9,961 |
) |
|
|
|
|
|
|
|
|
|
|
(9,961 |
) |
Realized loss on investments
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
(1,140 |
) |
|
|
|
|
|
|
(1,140 |
) |
Interest and other income
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
240 |
|
|
|
|
|
|
|
|
|
|
|
240 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Income before income taxes
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
59,113 |
|
|
|
|
|
|
|
|
|
|
|
59,113 |
|
Income tax expense
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
(23,399 |
) |
|
|
1,635 |
|
|
|
|
|
|
|
(21,764 |
) |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Income before equity in earnings of subsidiary
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
35,714 |
|
|
|
1,635 |
|
|
|
|
|
|
|
37,349 |
|
Equity in earnings of subsidiary
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
1,635 |
|
|
|
|
|
|
|
(1,635 |
) |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Net income
|
|
$ |
|
|
|
$ |
|
|
|
$ |
|
|
|
$ |
37,349 |
|
|
$ |
1,635 |
|
|
$ |
(1,635 |
) |
|
$ |
37,349 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
F-40
Combining Statement of Operations
For the Three Months Ended August 31, 2003
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Issuer |
|
Issuer |
|
|
|
Subsidiary | |
|
|
|
|
|
|
|
|
AMR |
|
EmCare |
|
Subsidiary | |
|
Non- | |
|
Eliminations/ | |
|
|
|
|
Parent Co. |
|
HoldCo, Inc. |
|
HoldCo, Inc. |
|
Guarantors | |
|
Guarantor | |
|
Adjustments | |
|
Total | |
|
|
|
|
|
|
|
|
| |
|
| |
|
| |
|
| |
Net revenue
|
|
$ |
|
|
|
$ |
|
|
|
$ |
|
|
|
$ |
384,461 |
|
|
$ |
9,807 |
|
|
$ |
(9,807 |
) |
|
$ |
384,461 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Compensation and benefits
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
264,604 |
|
|
|
|
|
|
|
|
|
|
|
264,604 |
|
Operating expenses
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
55,212 |
|
|
|
|
|
|
|
|
|
|
|
55,212 |
|
Insurance expense
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
36,239 |
|
|
|
8,239 |
|
|
|
(9,807 |
) |
|
|
34,671 |
|
Selling, general and administrative expenses
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
12,017 |
|
|
|
|
|
|
|
|
|
|
|
12,017 |
|
Laidlaw fees and compensation charges
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
1,350 |
|
|
|
|
|
|
|
|
|
|
|
1,350 |
|
Depreciation and amortization expense
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
12,560 |
|
|
|
|
|
|
|
|
|
|
|
12,560 |
|
Restructuring charges
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
1,449 |
|
|
|
|
|
|
|
|
|
|
|
1,449 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Income from operations
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
1,030 |
|
|
|
1,568 |
|
|
|
|
|
|
|
2,598 |
|
Interest expense
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
(908 |
) |
|
|
|
|
|
|
|
|
|
|
(908 |
) |
Realized gain on investments
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
90 |
|
|
|
|
|
|
|
90 |
|
Interest and other income
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
22 |
|
|
|
|
|
|
|
|
|
|
|
22 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Income before income taxes
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
144 |
|
|
|
1,658 |
|
|
|
|
|
|
|
1,802 |
|
Income tax expense
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
(8,053 |
) |
|
|
(580 |
) |
|
|
|
|
|
|
(8,633 |
) |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Income (loss) before equity in earnings of subsidiary
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
(7,909 |
) |
|
|
1,078 |
|
|
|
|
|
|
|
(6,831 |
) |
Equity in earnings of subsidiary
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
1,078 |
|
|
|
|
|
|
|
(1,078 |
) |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Net income (loss)
|
|
$ |
|
|
|
$ |
|
|
|
$ |
|
|
|
$ |
(6,831 |
) |
|
$ |
1,078 |
|
|
$ |
(1,078 |
) |
|
$ |
(6,831 |
) |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Predecessor Company
Combining Statement of Operations
For the Nine Months Ended May 31, 2003
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Issuer |
|
Issuer |
|
|
|
|
|
|
|
|
|
|
|
|
AMR |
|
EmCare |
|
Subsidiary | |
|
Subsidiary | |
|
Eliminations/ | |
|
|
|
|
Parent Co. |
|
HoldCo, Inc. |
|
HoldCo, Inc. |
|
Guarantors | |
|
Non-guarantor | |
|
Adjustments | |
|
Total | |
|
|
|
|
|
|
|
|
| |
|
| |
|
| |
|
| |
Net revenue
|
|
$ |
|
|
|
$ |
|
|
|
$ |
|
|
|
$ |
1,103,335 |
|
|
$ |
16,640 |
|
|
$ |
(16,640 |
) |
|
$ |
1,103,335 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Compensation and benefits
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
757,183 |
|
|
|
|
|
|
|
|
|
|
|
757,183 |
|
Operating expenses
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
163,447 |
|
|
|
|
|
|
|
|
|
|
|
163,447 |
|
Insurance expense
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
69,576 |
|
|
|
16,640 |
|
|
|
(16,640 |
) |
|
|
69,576 |
|
Selling, general and administrative expenses
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
37,867 |
|
|
|
|
|
|
|
|
|
|
|
37,867 |
|
Laidlaw fees and compensation charges
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
4,050 |
|
|
|
|
|
|
|
|
|
|
|
4,050 |
|
Depreciation and amortization expense
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
32,144 |
|
|
|
|
|
|
|
|
|
|
|
32,144 |
|
Restructuring charges
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
1,288 |
|
|
|
|
|
|
|
|
|
|
|
1,288 |
|
Laidlaw reorganization costs
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
3,650 |
|
|
|
|
|
|
|
|
|
|
|
3,650 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Income from operations
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
34,130 |
|
|
|
|
|
|
|
|
|
|
|
34,130 |
|
Interest expense
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
(4,691 |
) |
|
|
|
|
|
|
|
|
|
|
(4,691 |
) |
Interest and other income
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
304 |
|
|
|
|
|
|
|
|
|
|
|
304 |
|
Fresh-start accounting adjustments
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
46,416 |
|
|
|
|
|
|
|
|
|
|
|
46,416 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Income before income taxes and cumulative effect of a change in
accounting principle
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
76,159 |
|
|
|
|
|
|
|
|
|
|
|
76,159 |
|
Income tax expense
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
(829 |
) |
|
|
|
|
|
|
|
|
|
|
(829 |
) |
|
Cumulative effect of a change in accounting principle
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
(223,721 |
) |
|
|
|
|
|
|
|
|
|
|
(223,721 |
) |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Net loss
|
|
$ |
|
|
|
$ |
|
|
|
$ |
|
|
|
$ |
(148,391 |
) |
|
$ |
|
|
|
$ |
|
|
|
$ |
(148,391 |
) |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
F-41
Predecessor Company
Combining Statement of Operations
For the Year Ended August 31, 2002
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Issuer |
|
Issuer |
|
|
|
|
|
|
|
|
|
|
|
|
AMR |
|
EmCare |
|
Subsidiary | |
|
Subsidiary | |
|
Eliminations/ | |
|
|
|
|
Parent Co. |
|
HoldCo, Inc. |
|
HoldCo, Inc. |
|
Guarantors | |
|
Non-guarantor | |
|
Adjustments | |
|
Total | |
|
|
|
|
|
|
|
|
| |
|
| |
|
| |
|
| |
Net revenue
|
|
$ |
|
|
|
$ |
|
|
|
$ |
|
|
|
$ |
1,415,786 |
|
|
$ |
12,004 |
|
|
$ |
(12,004 |
) |
|
$ |
1,415,786 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Compensation and benefits
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
960,590 |
|
|
|
|
|
|
|
|
|
|
|
960,590 |
|
Operating expenses
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
219,321 |
|
|
|
|
|
|
|
|
|
|
|
219,321 |
|
Insurance expense
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
66,479 |
|
|
|
12,004 |
|
|
|
(12,004 |
) |
|
|
66,479 |
|
Selling, general and administrative expenses
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
61,455 |
|
|
|
|
|
|
|
|
|
|
|
61,455 |
|
Laidlaw fees and compensation charges
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
5,400 |
|
|
|
|
|
|
|
|
|
|
|
5,400 |
|
Depreciation and amortization expense
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
67,183 |
|
|
|
|
|
|
|
|
|
|
|
67,183 |
|
Impairment losses
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
262,780 |
|
|
|
|
|
|
|
|
|
|
|
262,780 |
|
Restructuring charges
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
3,777 |
|
|
|
|
|
|
|
|
|
|
|
3,777 |
|
Laidlaw reorganization costs
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
8,761 |
|
|
|
|
|
|
|
|
|
|
|
8,761 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Loss from operations
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
(239,960 |
) |
|
|
|
|
|
|
|
|
|
|
(239,960 |
) |
Interest expense
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
(6,418 |
) |
|
|
|
|
|
|
|
|
|
|
(6,418 |
) |
Interest and other income
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
369 |
|
|
|
|
|
|
|
|
|
|
|
369 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Loss before income taxes
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
(246,009 |
) |
|
|
|
|
|
|
|
|
|
|
(246,009 |
) |
Income tax expense
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
(1,374 |
) |
|
|
|
|
|
|
|
|
|
|
(1,374 |
) |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Net loss
|
|
$ |
|
|
|
$ |
|
|
|
$ |
|
|
|
$ |
(247,383 |
) |
|
$ |
|
|
|
$ |
|
|
|
$ |
(247,383 |
) |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
F-42
Condensed Combining Statement of Cash Flows
For the Five Months ended January 31, 2005
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Issuer |
|
Issuer |
|
|
|
|
|
|
|
|
|
|
AMR |
|
EmCare |
|
Subsidiary | |
|
Subsidiary | |
|
|
|
|
Parent Co. |
|
HoldCo, Inc. |
|
HoldCo, Inc. |
|
Guarantors | |
|
Non-guarantors | |
|
Total | |
|
|
|
|
|
|
|
|
| |
|
| |
|
| |
Cash Flows from Operating Activities
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Net cash provided by operating activities
|
|
$ |
|
|
|
$ |
|
|
|
$ |
|
|
|
$ |
10,856 |
|
|
$ |
5,110 |
|
|
$ |
15,966 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Cash Flows from Investing Activities
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Purchase of property, plant and equipment
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
(14,045 |
) |
|
|
|
|
|
|
(14,045 |
) |
Purchase of business
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
(1,200 |
) |
|
|
|
|
|
|
(1,200 |
) |
Proceeds from sale of business
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
1,300 |
|
|
|
|
|
|
|
1,300 |
|
Proceeds from sale of property, plant and equipment
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
175 |
|
|
|
|
|
|
|
175 |
|
Purchase of restricted cash and investments
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
(31,257 |
) |
|
|
(31,257 |
) |
Proceeds from sale and maturity of restricted investments
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
35,960 |
|
|
|
35,960 |
|
Other investing activities
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
(79 |
) |
|
|
|
|
|
|
(79 |
) |
Increase in Laidlaw insurance deposits
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
(12,521 |
) |
|
|
|
|
|
|
(12,521 |
) |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Net cash (used in) provided by investing activities
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
(26,370 |
) |
|
|
4,703 |
|
|
|
(21,667 |
) |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Cash Flows from Financing Activities
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Repayments of capital lease obligations and other debt
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
(3,992 |
) |
|
|
|
|
|
|
(3,992 |
) |
Advances from Laidlaw
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
8,982 |
|
|
|
|
|
|
|
8,982 |
|
Increase in bank overdrafts
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
5,866 |
|
|
|
|
|
|
|
5,866 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Net cash provided by financing activities
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
10,856 |
|
|
|
|
|
|
|
10,856 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Change in cash and cash equivalents
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
(4,658 |
) |
|
|
9,813 |
|
|
|
5,155 |
|
Cash and cash equivalents, beginning of period
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
9,436 |
|
|
|
40 |
|
|
|
9,476 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Cash and cash equivalents, end of period
|
|
$ |
|
|
|
$ |
|
|
|
$ |
|
|
|
$ |
4,778 |
|
|
$ |
9,853 |
|
|
$ |
14,631 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
F-43
Condensed Combining Statement of Cash Flows
For the Year Ended August 31, 2004
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Issuer |
|
Issuer |
|
|
|
|
|
|
|
|
|
|
AMR |
|
EmCare |
|
Subsidiary | |
|
Subsidiary Non- | |
|
|
|
|
Parent Co. |
|
HoldCo, Inc. |
|
HoldCo, Inc. |
|
Guarantors | |
|
guarantors | |
|
Total | |
|
|
|
|
|
|
|
|
| |
|
| |
|
| |
Cash Flows from Operating Activities
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Net cash provided by operating activities
|
|
$ |
|
|
|
$ |
|
|
|
$ |
|
|
|
$ |
109,708 |
|
|
$ |
17,971 |
|
|
$ |
127,679 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Cash Flows from Investing Activities
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Purchase of property, plant and equipment
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
(42,787 |
) |
|
|
|
|
|
|
(42,787 |
) |
Proceeds from sale of property, plant and equipment
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
858 |
|
|
|
|
|
|
|
858 |
|
Purchase of restricted cash and investments
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
(64,357 |
) |
|
|
(64,357 |
) |
Proceeds from sale and maturity of restricted investments
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
46,389 |
|
|
|
46,389 |
|
Other investing activities
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
6,814 |
|
|
|
|
|
|
|
6,814 |
|
Increase in Laidlaw insurance deposits
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
(28,433 |
) |
|
|
|
|
|
|
(28,433 |
) |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Net cash used in investing activities
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
(63,548 |
) |
|
|
(17,968 |
) |
|
|
(81,516 |
) |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Cash Flows from Financing Activities
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Repayments of capital lease obligations and other debt
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
(8,709 |
) |
|
|
|
|
|
|
(8,709 |
) |
Payments to Laidlaw
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
(31,133 |
) |
|
|
|
|
|
|
(31,133 |
) |
Decrease in bank overdrafts
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
(4,544 |
) |
|
|
|
|
|
|
(4,544 |
) |
Decrease in other non-current liabilities
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
(2,942 |
) |
|
|
|
|
|
|
(2,942 |
) |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Net cash used in financing activities
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
(47,328 |
) |
|
|
|
|
|
|
(47,328 |
) |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Change in cash and cash equivalents
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
(1,168 |
) |
|
|
3 |
|
|
|
(1,165 |
) |
Cash and cash equivalents, beginning of period
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
10,604 |
|
|
|
37 |
|
|
|
10,641 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Cash and cash equivalents, end of period
|
|
$ |
|
|
|
$ |
|
|
|
$ |
|
|
|
$ |
9,436 |
|
|
$ |
40 |
|
|
$ |
9,476 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
F-44
Condensed Combining Statement of Cash Flows
For the Three Months Ended August 31, 2003
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Issuer |
|
Issuer |
|
|
|
|
|
|
|
|
|
|
AMR |
|
EmCare |
|
Subsidiary | |
|
Subsidiary Non- | |
|
|
|
|
Parent Co. |
|
HoldCo, Inc. |
|
HoldCo, Inc. |
|
Guarantors | |
|
guarantors | |
|
Total | |
|
|
|
|
|
|
|
|
| |
|
| |
|
| |
Cash Flows from Operating Activities
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Net cash provided by (used in) operating activities
|
|
$ |
|
|
|
$ |
|
|
|
$ |
|
|
|
$ |
31,268 |
|
|
$ |
(1,259 |
) |
|
$ |
30,009 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Cash Flows from Investing Activities
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Purchase of property, plant and equipment
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
(18,079 |
) |
|
|
|
|
|
|
(18,079 |
) |
Proceeds from sale of property, plant and equipment
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
341 |
|
|
|
|
|
|
|
341 |
|
Purchase of restricted cash and investments
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
(11,287 |
) |
|
|
(11,287 |
) |
Proceeds from sale and maturity of restricted investments
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
12,530 |
|
|
|
12,530 |
|
Other investing activities
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
1,359 |
|
|
|
|
|
|
|
1,359 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Net cash (used in) provided by investing activities
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
(16,379 |
) |
|
|
1,243 |
|
|
|
(15,136 |
) |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Cash Flows from Financing Activities
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Repayments of capital lease obligations and other debt
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
(1,851 |
) |
|
|
|
|
|
|
(1,851 |
) |
Payments to Laidlaw
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
(55,609 |
) |
|
|
|
|
|
|
(55,609 |
) |
Increase in bank overdrafts
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
8,675 |
|
|
|
|
|
|
|
8,675 |
|
Increase in other non-current liabilities
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
1,563 |
|
|
|
|
|
|
|
1,563 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Net cash used in financing activities
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
(47,222 |
) |
|
|
|
|
|
|
(47,222 |
) |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Change in cash and cash equivalents
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
(32,333 |
) |
|
|
(16 |
) |
|
|
(32,349 |
) |
Cash and cash equivalents, beginning of period
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
42,937 |
|
|
|
53 |
|
|
|
42,990 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Cash and cash equivalents, end of period
|
|
$ |
|
|
|
$ |
|
|
|
$ |
|
|
|
$ |
10,604 |
|
|
$ |
37 |
|
|
$ |
10,641 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
F-45
Predecessor Company
Condensed Combining Statement of Cash Flows
For the Nine Months Ended May 31, 2003
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Issuer |
|
Issuer |
|
|
|
Subsidiary | |
|
|
|
|
|
|
|
|
AMR |
|
EmCare |
|
Subsidiary | |
|
Non- | |
|
Eliminations/ | |
|
|
|
|
Parent Co. |
|
HoldCo, Inc. |
|
HoldCo, Inc. |
|
Guarantors | |
|
guarantors | |
|
Adjustments | |
|
Total | |
|
|
|
|
|
|
|
|
| |
|
| |
|
| |
|
| |
Cash Flows from Operating Activities
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Net cash provided by operating activities
|
|
$ |
|
|
|
$ |
|
|
|
$ |
|
|
|
$ |
34,398 |
|
|
$ |
24,371 |
|
|
$ |
|
|
|
$ |
58,769 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Cash Flows from Investing Activities
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Purchase of property, plant and equipment
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
(34,768 |
) |
|
|
|
|
|
|
|
|
|
|
(34,768 |
) |
Proceeds from sale of property, plant and equipment
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
624 |
|
|
|
|
|
|
|
|
|
|
|
624 |
|
Capital contribution
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
(2,721 |
) |
|
|
|
|
|
|
2,721 |
|
|
|
|
|
Purchase of restricted cash and investments
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
(2,400 |
) |
|
|
(63,866 |
) |
|
|
|
|
|
|
(66,266 |
) |
Proceeds from sale and maturity of restricted investments
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
36,748 |
|
|
|
|
|
|
|
36,748 |
|
Other investing activities
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
(35,173 |
) |
|
|
|
|
|
|
|
|
|
|
(35,173 |
) |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Net cash used in investing activities
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
(74,438 |
) |
|
|
(27,118 |
) |
|
|
2,721 |
|
|
|
(98,835 |
) |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Cash Flows from Financing Activities
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Repayments of capital lease obligations and other debt
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
(6,338 |
) |
|
|
|
|
|
|
|
|
|
|
(6,338 |
) |
Payments to Laidlaw
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
(3,141 |
) |
|
|
|
|
|
|
|
|
|
|
(3,141 |
) |
Decrease in bank overdrafts
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
(815 |
) |
|
|
|
|
|
|
|
|
|
|
(815 |
) |
Capital contribution
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
2,721 |
|
|
|
(2,721 |
) |
|
|
|
|
Increase in other non-current liabilities
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
2,234 |
|
|
|
|
|
|
|
|
|
|
|
2,234 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Net cash used in financing activities
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
(8,060 |
) |
|
|
2,721 |
|
|
|
(2,721 |
) |
|
|
(8,060 |
) |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Change in cash and cash equivalents
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
(48,100 |
) |
|
|
(26 |
) |
|
|
|
|
|
|
(48,126 |
) |
Cash and cash equivalents, beginning of period
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
91,037 |
|
|
|
79 |
|
|
|
|
|
|
|
91,116 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Cash and cash equivalents, end of period
|
|
$ |
|
|
|
$ |
|
|
|
$ |
|
|
|
$ |
42,937 |
|
|
$ |
53 |
|
|
$ |
|
|
|
$ |
42,990 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
F-46
Predecessor Company
Condensed Combining Statement of Cash Flows
For the Year Ended August 31, 2002
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Issuer |
|
Issuer |
|
|
|
Subsidiary | |
|
|
|
|
|
|
|
|
AMR |
|
EmCare |
|
Subsidiary | |
|
Non- | |
|
Eliminations/ | |
|
|
|
|
Parent Co. |
|
HoldCo, Inc. |
|
HoldCo, Inc. |
|
Guarantors | |
|
guarantors | |
|
Adjustments | |
|
Total | |
|
|
|
|
|
|
|
|
| |
|
| |
|
| |
|
| |
Cash Flows from Operating Activities
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Net cash provided by operating activities
|
|
$ |
|
|
|
$ |
|
|
|
$ |
|
|
|
$ |
140,296 |
|
|
$ |
16,248 |
|
|
$ |
|
|
|
$ |
156,544 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Cash Flows from Investing Activities
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Purchase of property, plant and equipment
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
(31,118 |
) |
|
|
|
|
|
|
|
|
|
|
(31,118 |
) |
Proceeds from sale of property, plant and equipment
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
2,549 |
|
|
|
|
|
|
|
|
|
|
|
2,549 |
|
Capital contribution
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
(1,150 |
) |
|
|
|
|
|
|
1,150 |
|
|
|
|
|
Purchase of restricted cash and investments
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
(1,412 |
) |
|
|
(49,534 |
) |
|
|
|
|
|
|
(50,946 |
) |
Proceeds from sale and maturity of restricted investments
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
32,215 |
|
|
|
|
|
|
|
32,215 |
|
Other investing activities
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
(10,047 |
) |
|
|
|
|
|
|
|
|
|
|
(10,047 |
) |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Net cash used in investing activities
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
(41,178 |
) |
|
|
(17,319 |
) |
|
|
1,150 |
|
|
|
(57,347 |
) |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Cash Flows from Financing Activities
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Repayments of capital lease obligations and other debt
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
(17,817 |
) |
|
|
|
|
|
|
|
|
|
|
(17,817 |
) |
Payments to Laidlaw
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
(16,729 |
) |
|
|
|
|
|
|
|
|
|
|
(16,729 |
) |
Decrease in bank overdrafts
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
(1,134 |
) |
|
|
|
|
|
|
|
|
|
|
(1,134 |
) |
Capital contributions
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
1,150 |
|
|
|
(1,150 |
) |
|
|
|
|
Decrease in other non-current liabilities
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
(386 |
) |
|
|
|
|
|
|
|
|
|
|
(386 |
) |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Net cash used in financing activities
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
(36,066 |
) |
|
|
1,150 |
|
|
|
(1,150 |
) |
|
|
(36,066 |
) |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Change in cash and cash equivalents
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
63,052 |
|
|
|
79 |
|
|
|
|
|
|
|
63,131 |
|
Cash and cash equivalents, beginning of period
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
27,985 |
|
|
|
|
|
|
|
|
|
|
|
27,985 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Cash and cash equivalents, end of period
|
|
$ |
|
|
|
$ |
|
|
|
$ |
|
|
|
$ |
91,037 |
|
|
$ |
79 |
|
|
$ |
|
|
|
$ |
91,116 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
F-47
On December 6, 2004, Laidlaw announced it had entered into
definitive agreements to sell 100% of the capital stock of AMR
and EmCare to Onex Partners LP, an affiliate of Onex
Corporation. Completion of the transaction occurred
February 10, 2005 with an effective date after the close of
business on January 31, 2005. Emergency Medical Services
L.P. was formed as the entity which ultimately acquired American
Medical Response, Inc. and EmCare Holdings Inc. from Laidlaw
International, Inc. The purchase price was $828.8 million,
subject to working capital and other purchase price adjustments.
|
|
19. |
Subsequent Events (unaudited) |
With respect to the DOJ investigation of certain of AMRs
business practices referred to in note 10
Services, a recent analysis provided by the government
indicates that it is investigating contracts in effect in
periods prior to 1999, and possibly through 2001. The Company is
considering the governments analysis and is in discussions
with the government regarding these Texas allegations. The
government has proposed that AMR make a substantial payment to
settle the Texas matter, and has indicated that, in the absence
of a settlement, it will pursue further civil action in this
matter. The government may also be investigating whether
AMRs contracts with its health facilities in Oregon and
other jurisdictions violate the Anti-Kickback Statute. Under the
provisions of the Companys purchase agreement for the
acquisition of AMR, the Company and Laidlaw International, Inc.
share responsibility for damages arising with respect to these
matters, with the Company responsible for 50% of the first
$10 million of damages and 10% of any damages in excess of
$10 million and up to and including $50 million. Based
upon its discussions with the government and its own analysis,
the Company believes it has adequately accrued for potential
losses in periods subsequent to the periods covered by the
combined financial statements included herein. However, there
can be no assurances as to the final resolution of these
investigations and any resulting proceedings.
On December 14, 2005, a lawsuit, purporting to be a class
action, was commenced against AMR in Spokane, Washington. The
complaint alleges that the two identified plaintiffs were billed
for advanced life support services rather than basic life
support in violation of AMRs contract with the city of
Spokane, resulting in total overcharges for three transports of
$395. The complaint further alleges a potential group of over
30,000 patients transported since 1998, with possible individual
claims of $150 to $250, and seeks treble damages under the state
consumer protection act. AMR has not had sufficient time to
analyze the allegations in the complaint. However, AMR recently
reviewed its billing practices at the request of the Spokane
Fire Department, and is conducting a further audit. Although
there can be no assurances as to the final outcome, at this time
AMR does not believe that any incorrect billings are material in
amount.
F-48
Emergency Medical Services L.P.
Consolidated/Combined Financial Statements
September 30, 2005
F-49
Emergency Medical Services L.P.
Balance Sheets
(in thousands)
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Unaudited | |
|
|
Predecessor | |
|
|
Consolidated | |
|
|
Combined | |
|
|
September 30, | |
|
|
January 31, | |
|
|
2005 | |
|
|
2005 | |
|
|
| |
|
|
| |
ASSETS
|
|
|
|
|
|
|
|
|
|
Current assets:
|
|
|
|
|
|
|
|
|
|
|
Cash and cash equivalents
|
|
$ |
10,113 |
|
|
|
$ |
14,631 |
|
|
Restricted cash and cash equivalents
|
|
|
11,949 |
|
|
|
|
9,846 |
|
|
Restricted marketable securities
|
|
|
2,165 |
|
|
|
|
2,473 |
|
|
Trade and other accounts receivable, net
|
|
|
369,766 |
|
|
|
|
369,767 |
|
|
Parts and supplies inventory
|
|
|
18,760 |
|
|
|
|
18,499 |
|
|
Other current assets
|
|
|
31,008 |
|
|
|
|
40,135 |
|
|
Current deferred tax assets
|
|
|
22,971 |
|
|
|
|
65,092 |
|
|
|
|
|
|
|
|
|
|
|
Current assets
|
|
|
466,732 |
|
|
|
|
520,443 |
|
|
|
|
|
|
|
|
|
Non-current assets:
|
|
|
|
|
|
|
|
|
|
|
Property, plant, and equipment, net
|
|
|
133,283 |
|
|
|
|
128,766 |
|
|
Intangible assets, net
|
|
|
81,363 |
|
|
|
|
16,075 |
|
|
Non-current deferred tax assets
|
|
|
117,488 |
|
|
|
|
202,469 |
|
|
Restricted long-term investments
|
|
|
73,304 |
|
|
|
|
41,810 |
|
|
Goodwill
|
|
|
271,987 |
|
|
|
|
|
|
|
Other long-term assets
|
|
|
109,251 |
|
|
|
|
73,947 |
|
|
|
|
|
|
|
|
|
|
|
|
Assets
|
|
$ |
1,253,408 |
|
|
|
$ |
983,510 |
|
|
|
|
|
|
|
|
|
|
|
LIABILITIES AND EQUITY
|
|
|
|
|
|
|
|
|
|
Current liabilities:
|
|
|
|
|
|
|
|
|
|
|
Accounts payable
|
|
$ |
53,066 |
|
|
|
$ |
55,818 |
|
|
Accrued liabilities
|
|
|
199,849 |
|
|
|
|
171,645 |
|
|
Current portion of long-term debt
|
|
|
13,478 |
|
|
|
|
5,846 |
|
|
|
|
|
|
|
|
|
|
|
Current liabilities
|
|
|
266,393 |
|
|
|
|
233,309 |
|
Long-term debt
|
|
|
595,129 |
|
|
|
|
5,651 |
|
Other long-term liabilities
|
|
|
155,139 |
|
|
|
|
146,273 |
|
|
|
|
|
|
|
|
|
|
|
|
Liabilities
|
|
|
1,016,661 |
|
|
|
|
385,233 |
|
|
|
|
|
|
|
|
|
Redeemable partnership equity
|
|
|
1,213 |
|
|
|
|
|
|
Laidlaw payable
|
|
|
|
|
|
|
|
202,042 |
|
Laidlaw investment
|
|
|
|
|
|
|
|
356,550 |
|
Partnership equity
|
|
|
222,178 |
|
|
|
|
|
|
Retained earnings
|
|
|
14,002 |
|
|
|
|
40,000 |
|
Comprehensive income (loss)
|
|
|
(646 |
) |
|
|
|
(315 |
) |
|
|
|
|
|
|
|
|
|
Equity
|
|
|
235,534 |
|
|
|
|
598,277 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Liabilities and equity
|
|
$ |
1,253,408 |
|
|
|
$ |
983,510 |
|
|
|
|
|
|
|
|
|
The accompanying notes are an integral part of these financial
statements.
F-50
Emergency Medical Services L.P.
Unaudited Statements of Operations and Comprehensive
Income
(in thousands, except per unit amounts)
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Consolidated | |
|
|
Combined | |
|
|
| |
|
|
| |
|
|
|
|
|
Predecessor | |
|
Predecessor | |
|
|
Eight Months | |
|
Three Months | |
|
|
Eight Months | |
|
Three Months | |
|
|
Ended | |
|
Ended | |
|
|
Ended | |
|
Ended | |
|
|
September 30, | |
|
September 30, | |
|
|
September 30, | |
|
September 30, | |
|
|
2005 | |
|
2005 | |
|
|
2004 | |
|
2004 | |
|
|
| |
|
| |
|
|
| |
|
| |
Net revenue
|
|
$ |
1,187,653 |
|
|
$ |
456,245 |
|
|
|
$ |
1,077,749 |
|
|
$ |
413,869 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Compensation and benefits
|
|
|
822,595 |
|
|
|
319,292 |
|
|
|
|
751,238 |
|
|
|
286,628 |
|
Operating expenses
|
|
|
168,700 |
|
|
|
66,156 |
|
|
|
|
147,524 |
|
|
|
55,863 |
|
Insurance expense
|
|
|
60,382 |
|
|
|
21,048 |
|
|
|
|
51,674 |
|
|
|
18,404 |
|
Selling, general and administrative expenses
|
|
|
38,248 |
|
|
|
15,654 |
|
|
|
|
31,270 |
|
|
|
12,093 |
|
Laidlaw fees and compensation charges
|
|
|
|
|
|
|
|
|
|
|
|
10,095 |
|
|
|
3,657 |
|
Depreciation and amortization expense
|
|
|
38,811 |
|
|
|
14,843 |
|
|
|
|
34,627 |
|
|
|
12,669 |
|
Restructuring charges
|
|
|
|
|
|
|
|
|
|
|
|
1,381 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Income from operations
|
|
|
58,917 |
|
|
|
19,252 |
|
|
|
|
49,940 |
|
|
|
24,555 |
|
Interest expense
|
|
|
(34,407 |
) |
|
|
(12,824 |
) |
|
|
|
(8,679 |
) |
|
|
(5,138 |
) |
Realized gain (loss) on investments
|
|
|
(40 |
) |
|
|
(34 |
) |
|
|
|
(1,191 |
) |
|
|
(1,140 |
) |
Interest and other income
|
|
|
189 |
|
|
|
91 |
|
|
|
|
210 |
|
|
|
162 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Income before income taxes
|
|
|
24,659 |
|
|
|
6,485 |
|
|
|
|
40,280 |
|
|
|
18,439 |
|
Income tax expense
|
|
|
(10,657 |
) |
|
|
(3,479 |
) |
|
|
|
(15,710 |
) |
|
|
(7,191 |
) |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Net income
|
|
|
14,002 |
|
|
|
3,006 |
|
|
|
|
24,570 |
|
|
|
11,248 |
|
Other comprehensive income, net of tax
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Unrealized holding gains (losses) during the period
|
|
|
(646 |
) |
|
|
(1,010 |
) |
|
|
|
364 |
|
|
|
364 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Comprehensive income
|
|
$ |
13,356 |
|
|
$ |
1,996 |
|
|
|
$ |
24,934 |
|
|
$ |
11,612 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
The accompanying notes are an integral part of these financial
statements.
F-51
Emergency Medical Services L.P.
Unaudited Statements of Cash Flows
(in thousands)
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Combined | |
|
|
|
|
|
| |
|
|
Consolidated | |
|
|
Predecessor | |
|
|
Eight Months | |
|
|
Eight Months | |
|
|
Ended | |
|
|
Ended | |
|
|
September 30, | |
|
|
September 30, | |
|
|
2005 | |
|
|
2004 | |
|
|
| |
|
|
| |
Cash Flows from Operating Activities
|
|
|
|
|
|
|
|
|
|
Net income
|
|
$ |
14,002 |
|
|
|
$ |
24,570 |
|
Adjustments to reconcile net income to net cash provided by
operating activities:
|
|
|
|
|
|
|
|
|
|
|
Depreciation and amortization
|
|
|
40,444 |
|
|
|
|
34,627 |
|
|
Gain on disposal of property, plant and equipment
|
|
|
(480 |
) |
|
|
|
(344 |
) |
|
Deferred income taxes
|
|
|
1,395 |
|
|
|
|
14,243 |
|
|
Stock compensation expense
|
|
|
2,462 |
|
|
|
|
|
|
|
Changes in operating assets/liabilities:
|
|
|
|
|
|
|
|
|
|
|
|
Trade and other accounts receivable
|
|
|
4,801 |
|
|
|
|
586 |
|
|
|
Other current assets
|
|
|
8,866 |
|
|
|
|
(1,047 |
) |
|
|
Accounts payable and accrued liabilities
|
|
|
36,972 |
|
|
|
|
27,326 |
|
|
|
|
|
|
|
|
|
|
|
|
Net cash provided by operating activities
|
|
|
108,462 |
|
|
|
|
99,961 |
|
|
|
|
|
|
|
|
|
Cash Flows from Investing Activities
|
|
|
|
|
|
|
|
|
|
EMS purchase of AMR and EmCare
|
|
|
(828,775 |
) |
|
|
|
|
|
Purchase of property, plant and equipment
|
|
|
(34,947 |
) |
|
|
|
(30,217 |
) |
Proceeds from sale of property, plant and equipment
|
|
|
565 |
|
|
|
|
773 |
|
Purchase of restricted cash and investments
|
|
|
(51,495 |
) |
|
|
|
(61,213 |
) |
Proceeds from sale and maturity of restricted investments
|
|
|
17,560 |
|
|
|
|
40,152 |
|
Net change in deposits and other assets
|
|
|
(20,330 |
) |
|
|
|
(23,405 |
) |
|
|
|
|
|
|
|
|
|
|
|
Net cash used in investing activities
|
|
|
(917,422 |
) |
|
|
|
(73,910 |
) |
|
|
|
|
|
|
|
|
Cash Flows from Financing Activities
|
|
|
|
|
|
|
|
|
|
Borrowings under new senior secured credit facility
|
|
|
350,000 |
|
|
|
|
|
|
Proceeds from issuance of senior subordinated notes
|
|
|
250,000 |
|
|
|
|
|
|
Borrowings under new revolving credit facility
|
|
|
25,200 |
|
|
|
|
|
|
Issuance of partnership equity
|
|
|
222,655 |
|
|
|
|
|
|
Financing costs
|
|
|
(20,122 |
) |
|
|
|
|
|
Repayments of capital lease obligations and other debt
|
|
|
(5,722 |
) |
|
|
|
(5,396 |
) |
Repayments of revolving credit facility
|
|
|
(20,200 |
) |
|
|
|
|
|
Increase (decrease) in bank overdrafts
|
|
|
997 |
|
|
|
|
4,290 |
|
Payments made to Laidlaw
|
|
|
|
|
|
|
|
(13,937 |
) |
Increase (decrease) in other non-current liabilities
|
|
|
1,634 |
|
|
|
|
(5,656 |
) |
|
|
|
|
|
|
|
|
|
|
|
Net cash provided by (used in) financing activities
|
|
|
804,442 |
|
|
|
|
(20,699 |
) |
|
|
|
|
|
|
|
|
Change in cash and cash equivalents
|
|
|
(4,518 |
) |
|
|
|
5,352 |
|
Cash and cash equivalents, beginning of period
|
|
|
14,631 |
|
|
|
|
10,856 |
|
|
|
|
|
|
|
|
|
Cash and cash equivalents, end of period
|
|
$ |
10,113 |
|
|
|
$ |
16,208 |
|
|
|
|
|
|
|
|
|
Cash paid for:
|
|
|
|
|
|
|
|
|
|
|
Interest
|
|
$ |
27,729 |
|
|
|
$ |
10,636 |
|
|
|
|
|
|
|
|
|
|
Taxes
|
|
$ |
9,550 |
|
|
|
$ |
|
|
|
|
|
|
|
|
|
|
The accompanying notes are an integral part of these financial
statements.
F-52
Emergency Medical Services L.P.
Notes to Unaudited Financial Statements
(dollars in thousands)
Basis of Presentation of Financial Statements
The accompanying unaudited, interim consolidated financial
statements of Emergency Medical Services L.P. (EMS
or the Company) reflect all adjustments of a normal,
recurring nature that are, in the opinion of management,
necessary for a fair presentation of results for these interim
periods but do not include all of the information and note
disclosures required by accounting principles generally accepted
in the United States (GAAP) for complete financial
statements. The results of operations for the eight months and
three months ended September 30, 2005 are not necessarily
indicative of the results that may be expected for the
eleven-month period ending December 31, 2005.
Emergency Medical Services L.P. acquired American Medical
Response, Inc. and EmCare Holdings Inc. from Laidlaw
International, Inc. on February 10, 2005 with an effective
transaction date after the close of business January 31,
2005. The purchase price was $828.8 million, subject to
working capital and other purchase adjustments. The Company
currently is completing its allocation of purchase price. To
finance the acquisition, we entered into a new $450 million
senior secured credit facility and issued senior subordinated
notes for gross proceeds of $250 million (see note 8).
We also issued approximately 22.1 million limited
partnership units for $221 million. For this reason, the
financial statements for periods prior to February 1, 2005
(Predecessor) may not be comparable to the financial
statements for periods from and including February 1, 2005.
The following table summarizes the estimated fair value of the
assets acquired and liabilities assumed at the date of
acquisition. The Company is in the process of obtaining
third-party valuations of certain intangible assets acquired and
liabilities assumed, and is evaluating the tax impact of certain
purchase accounting adjustments and the carryover of tax
attributes from the Predecessor; accordingly, the allocation of
the purchase price is subject to adjustment.
|
|
|
|
|
|
Current assets
|
|
$ |
483,957 |
|
Property, plant & equipment
|
|
|
128,766 |
|
Intangible assets
|
|
|
89,850 |
|
Goodwill
|
|
|
271,987 |
|
Other long-term assets
|
|
|
254,027 |
|
|
|
|
|
|
Total assets acquired
|
|
|
1,228,587 |
|
|
|
|
|
Current liabilities
|
|
|
245,144 |
|
Long-term debt
|
|
|
620,183 |
|
Other long-term liabilities
|
|
|
144,381 |
|
|
|
|
|
|
Total liabilities assumed
|
|
|
1,009,708 |
|
|
|
|
|
|
Net assets acquired
|
|
$ |
218,879 |
|
|
|
|
|
Intangible assets include $0.6 million of radio frequency
licenses, $0.3 million of covenants not to compete and
$89.0 million for customer relationships. Covenants not to
compete and customer relationships are subject to amortization
and have a weighted average useful life of approximately
7 years.
The $272.0 million of goodwill currently has been
preliminarily assigned to AMR and EmCare in the amounts of
$127.7 million and $144.3 million, respectively, based
on the sales agreements and valuations, and is not subject to
amortization. EmCare goodwill is deductible for tax purposes.
Pro forma net revenue, income from operations and net income for
the eight months ended September 30, 2004, when adjusted
for the acquisition described above, would be
$1,077.7 million, $45.8 million and $8.4 million,
respectively.
F-53
Emergency Medical Services L.P.
Notes to Unaudited Financial
Statements (Continued)
The Company is a party to a management agreement with a
wholly-owned subsidiary of Onex Corporation, its principal
equityholder. In exchange for an annual management fee of
$1.0 million, the Onex subsidiary provides us with
corporate finance and strategic planning consulting services.
For the eight months ended September 30, 2005, we expensed
$0.7 million in fees pursuant to this agreement.
The Predecessor companies had a fiscal year ending
August 31. EMS adopted a fiscal year end of
December 31. Accordingly, the financial statements
presented herein include the eight-month period beginning the
effective date of acquisition and ending September 30, 2005
and the three-month period ending September 30, 2005.
The preparation of financial statements in conformity with GAAP
requires management to make certain estimates and assumptions
that affect the amounts reported in the consolidated and
combined financial statements and accompanying notes. Actual
results may differ from those estimates. Estimates are used for,
but not limited to, the establishment of, allowances for
contractual discounts and uncompensated care, reserves for
insurance related liabilities, taxes and contingencies.
|
|
2. |
Summary of Significant Accounting Policies |
Consolidation
The unaudited consolidated financial statements include all
wholly-owned subsidiaries of EMS, including American Medical
Response, Inc. (AMR) and EmCare Holdings Inc.
(EmCare) and their respective subsidiaries.
Intercompany transactions and balances have been eliminated.
Combination
The unaudited combined financial statements for the eight months
and three months ended September 30, 2004 include the
accounts of AMR and EmCare (combined, the
Predecessor). AMR and EmCare were indirect,
wholly-owned subsidiaries of Laidlaw International, Inc.
(Laidlaw). All significant intracompany transactions
have been eliminated.
Trade and Accounts Receivable, Net and Net Revenue
The Company determines its allowances based on payor specific
schedules, historical write-off experience and other economic
data. The allowances for contractual discounts and uncompensated
care are reviewed monthly. Account balances are charged off
against the uncompensated care allowance when it is received.
The allowance for uncompensated care is related principally to
receivables recorded for self-pay patients.
F-54
Emergency Medical Services L.P.
Notes to Unaudited Financial
Statements (Continued)
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Predecessor | |
|
|
September 30, | |
|
January 31, | |
|
|
2005 | |
|
2005 | |
|
|
| |
|
| |
Accounts receivable, net
|
|
|
|
|
|
|
|
|
AMR
|
|
$ |
236,729 |
|
|
$ |
229,798 |
|
EmCare
|
|
|
133,037 |
|
|
|
139,969 |
|
|
|
|
|
|
|
|
|
Total
|
|
$ |
369,766 |
|
|
$ |
369,767 |
|
|
|
|
|
|
|
|
Accounts receivable allowances
|
|
|
|
|
|
|
|
|
AMR
|
|
|
|
|
|
|
|
|
Allowance for contractual discounts
|
|
$ |
121,453 |
|
|
$ |
126,771 |
|
Allowance for uncompensated care
|
|
|
122,906 |
|
|
|
124,699 |
|
|
|
|
|
|
|
|
|
Total
|
|
$ |
244,359 |
|
|
$ |
251,470 |
|
|
|
|
|
|
|
|
EmCare
|
|
|
|
|
|
|
|
|
Allowance for contractual discounts
|
|
$ |
197,542 |
|
|
$ |
188,092 |
|
Allowance for uncompensated care
|
|
|
653,181 |
|
|
|
556,605 |
|
|
|
|
|
|
|
|
|
Total
|
|
$ |
850,723 |
|
|
$ |
744,697 |
|
|
|
|
|
|
|
|
The allowance for uncompensated care at EmCare includes accounts
that have been sent to collection agencies and are listed as
delinquent within the billing system. These accounts are fully
reserved at each balance sheet date and total
$257.3 million and $254.2 million at
September 30, 2005 and January 31, 2005, respectively.
Provisions for contractual discounts and estimated uncompensated
care by segment, as a percentage of gross revenue, are as
follows:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Predecessor | |
|
|
|
|
|
|
| |
|
|
Eight Months | |
|
Three Months | |
|
Eight Months | |
|
Three Months | |
|
|
Ended | |
|
Ended | |
|
Ended | |
|
Ended | |
|
|
September 30, | |
|
September 30, | |
|
September 30, | |
|
September 30, | |
|
|
2005 | |
|
2005 | |
|
2004 | |
|
2004 | |
|
|
| |
|
| |
|
| |
|
| |
AMR
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Gross revenue
|
|
|
100 |
% |
|
|
100 |
% |
|
|
100 |
% |
|
|
100 |
% |
Provision for contractual discounts
|
|
|
37 |
% |
|
|
36 |
% |
|
|
35 |
% |
|
|
34 |
% |
Provision for uncompensated care
|
|
|
13 |
% |
|
|
14 |
% |
|
|
14 |
% |
|
|
15 |
% |
EmCare
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Gross revenue
|
|
|
100 |
% |
|
|
100 |
% |
|
|
100 |
% |
|
|
100 |
% |
Provision for contractual discounts
|
|
|
44 |
% |
|
|
44 |
% |
|
|
41 |
% |
|
|
41 |
% |
Provision for uncompensated care
|
|
|
26 |
% |
|
|
26 |
% |
|
|
25 |
% |
|
|
25 |
% |
Total
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Gross revenue
|
|
|
100 |
% |
|
|
100 |
% |
|
|
100 |
% |
|
|
100 |
% |
Provision for contractual discounts
|
|
|
40 |
% |
|
|
40 |
% |
|
|
38 |
% |
|
|
37 |
% |
Provision for uncompensated care
|
|
|
19 |
% |
|
|
20 |
% |
|
|
19 |
% |
|
|
19 |
% |
Redeemable Partnership Equity
The Company may be required to repurchase the limited
partnership interests of employee unitholders upon their
termination of employment as a result of death or disability;
the repurchase price is determined by
F-55
Emergency Medical Services L.P.
Notes to Unaudited Financial
Statements (Continued)
a formula based on the Companys earnings before interest,
taxes, depreciation and amortization for the period immediately
preceding termination.
Recent Accounting Pronouncements
In December 2004, the Financial Accounting Standards Board
(FASB) issued Statement No. 123 (revised
2004),Share-Based Payment. This Statement is
a revision of FASB Statement No. 123, Accounting
for Stock-Based Compensation and is effective for the
annual reporting periods that begin after June 15, 2005.
The Statement requires public companies to measure the cost of
employee services received in exchange for an award of equity
instruments based on the grant-date fair value of the award. The
Company currently is evaluating the impact that the adoption of
this Statement will have on its financial statements, including
the alternative transition methods.
|
|
3. |
Equity-based Compensation |
Under the Companys Equity Option Plan approved in February
2005, key employees have been granted options to purchase
partnership units of the Company. The options allow the grantee
to purchase partnership units at $10 per unit (subject to
appropriate adjustment upon a recapitalization or similar
event). The grants vest ratably over a period of 4 years
and, in addition, certain performance measures must be met for
50% of each grant to become exercisable. The Company has adopted
FASB Statement No. 123, Accounting for
Stock-Based Compensation. This Statement requires
companies to measure the cost of employee services received in
exchange for an award of equity instruments based on the
grant-date fair value of the award. The Company recorded a
charge of $0.7 million for the eight months ended
September 30, 2005 associated with the grant of these
options.
The Black-Scholes option pricing model was used to estimate fair
values as of the date of grant using 0% volatility, risk free
interest rates ranging from 3.61% to 3.88%, 0% dividend yield
and expected terms of 4 and 5 years.
The Company granted 2,339,479 options from the inception of
the plan through September 30, 2005.
The Company recorded a charge associated with partnership units
and certain options to purchase partnership units issued to
employees and officers of the Company which totaled
$1.8 million. This non-cash expense was recorded as a
component of compensation and benefits on the accompanying
statements of operations for the eight and three month periods
ended September 30, 2005.
F-56
Emergency Medical Services L.P.
Notes to Unaudited Financial
Statements (Continued)
Accrued liabilities were as follows at September 30, 2005
and January 31, 2005:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Predecessor | |
|
|
September 30, | |
|
|
January 31, | |
|
|
2005 | |
|
|
2005 | |
|
|
| |
|
|
| |
Accrued wages and benefits
|
|
$ |
51,288 |
|
|
|
$ |
53,231 |
|
Accrued paid time off
|
|
|
21,646 |
|
|
|
|
20,141 |
|
Current portion of self-insurance reserve
|
|
|
49,550 |
|
|
|
|
41,283 |
|
Accrued restructuring
|
|
|
325 |
|
|
|
|
1,118 |
|
Current portion of compliance and legal
|
|
|
14,783 |
|
|
|
|
3,607 |
|
Accrued billing and collection fees
|
|
|
4,081 |
|
|
|
|
3,522 |
|
Accrued incentive compensation
|
|
|
20,332 |
|
|
|
|
23,802 |
|
Accrued interest
|
|
|
5,545 |
|
|
|
|
|
|
Other
|
|
|
32,299 |
|
|
|
|
24,941 |
|
|
|
|
|
|
|
|
|
Total accrued liabilities
|
|
$ |
199,849 |
|
|
|
$ |
171,645 |
|
|
|
|
|
|
|
|
|
|
|
5. |
Commitments and Contingencies |
Services
The Company is subject to the Medicare and Medicaid fraud and
abuse laws which prohibit, among other things, any false claims,
or any bribe, kick-back or rebate in return for the referral of
Medicare and Medicaid patients. Violation of these prohibitions
may result in civil and criminal penalties and exclusion from
participation in the Medicare and Medicaid programs. Management
has implemented policies and procedures that management believes
will assure that the Company is in substantial compliance with
these laws. From time to time, we receive requests for
information from government agencies pursuant to their
regulatory or investigational authority. Such requests can
include subpoenas or demand letters for documents to assist the
government in audits or investigations. The Company is
cooperating with the government agencies conducting these
investigations and is providing requested information to the
government agencies. Other than the investigations described
below, management believes that the outcome of any of these
investigations would not have a material adverse effect on the
Company.
During the first quarter of fiscal 2004, AMR was advised by the
U.S. Department of Justice that it was investigating
certain of AMRs business practices. The specific practices
at issue are (1) whether ambulance transports involving
Medicare eligible patients complied with the medically
necessary requirement imposed by Medicare regulations,
(2) whether patient signatures, when required, were
properly obtained from Medicare eligible patients, and
(3) whether discounts in violation of the federal
Anti-Kickback Statute were provided by AMR in exchange for
referrals involving Medicare eligible patients. In connection
with the third issue, the government has alleged that certain of
our hospital and nursing home contracts in effect in Texas,
primarily certain contracts in effect in periods prior to 1999,
and possibly through 2001, contained discounts in violation of
the federal Anti-Kickback Statute. The government recently has
provided the Company with an analysis of the investigation
conducted in connection with this contract issue, and invited
the Company to respond. The Company is considering the
governments analysis and is in discussions with the
government regarding these Texas allegations. The government has
proposed that AMR make a substantial payment to settle the Texas
matter, and has indicated that, in the absence of a settlement,
it will pursue further civil action in this matter. The
government may also be investigating whether AMRs
contracts with its health facilities in Oregon and other
jurisdictions violate the Anti-Kickback Statute. Under the
provisions of the Companys purchase agreement for the
acquisition of AMR, the Company and Laidlaw International, Inc.
F-57
Emergency Medical Services L.P.
Notes to Unaudited Financial
Statements (Continued)
share responsibility for damages arising with respect to these
matters, with the Company responsible for 50% of the first $10
million of damages and 10% of any damages in excess of $10
million and up to and including $50 million. Based upon its
discussions with the government and its own analysis, the
Company believes it has adequately accrued for potential losses.
However, there can be no assurances as to the final resolution
of these investigations and any resulting proceedings.
On May 9, 2002, AMR received a subpoena duces tecum from
the Office of Inspector General for the United States Department
of Health and Human Services (HHS). The subpoena
requested copies of documents for the period from January 1993
through May 2002. The subpoena required AMR to produce a broad
range of documents relating to Regional Emergency Services
contracts in Texas, Georgia and Colorado. The claims in Texas
have been resolved. However, the government investigations in
Georgia and Colorado are continuing and it is not possible at
this time to estimate the financial exposure, if any, to the
Company.
EmCare has been named a defendant in a collective action lawsuit
brought by a number of nurse practitioners and physician
assistants under the federal Fair Labor Standards Act. The
plaintiffs are seeking to recover overtime pay for the hours
they worked in excess of 40 in a workweek and reclassification
as non-exempt employees. Certain of the plaintiffs brought a
related action under California state law. EmCare has entered
into a settlement of the California state law claims.
On July 12, 2005, the Company received a letter and draft
Audit Report from the Office of Inspector General for the United
States Department of Health and Human Services, or OIG,
requesting the Companys response to its draft findings
that the Companys Massachusetts subsidiary received
substantial overpayments from Medicare for services performed
between July 1, 2002 and December 31, 2002. The draft
findings state that some of these services did not meet Medicare
medical necessity and reimbursement requirements. The Company
disagrees with the OIGs finding and is in the process of
responding to the draft Audit Report. If the Company is
unsuccessful in challenging the OIGs draft findings, and
in any administrative appeals to which the Company may be
entitled following the release of a final Audit Report, the
Company may be required to make a substantial repayment.
AMR and the City of Stockton, California are parties to
litigation regarding the terms and enforceability of a
memorandum of understanding and a related joint venture
agreement between the parties to present a joint bid in response
to a request for proposals to provide emergency ambulance
services in the County of San Joaquin, California. The parties
were unable to agree on the final terms of a joint bid. AMR is
seeking a judicial determination that these contracts are
unenforceable and void, and Stockton has alleged breach of
contract and damages. AMR has been awarded the San Joaquin
contract. While the Company is unable at this time to estimate
the amount of potential damages, the Company believes that
Stockton may claim as damages a portion of AMRs profit on
the contract or the profit Stockton might have realized had the
joint venture proceeded.
On December 14, 2005, a lawsuit, purporting to be a class
action, was commenced against AMR in Spokane, Washington. The
complaint alleges that the two identified plaintiffs were billed
for advanced life support services rather than basic life
support in violation of AMRs contract with the city of
Spokane, resulting in total overcharges for three transports of
$395. The complaint further alleges a potential group of over
30,000 patients transported since 1998, with possible individual
claims of $150 to $250, and seeks treble damages under the state
consumer protection act. AMR has not had sufficient time to
analyze the allegations in the complaint. However, AMR recently
reviewed its billing practices at the request of the Spokane
Fire Department, and is conducting a further audit. Although
there can be no assurances as to the final outcome, at this time
AMR does not believe that any incorrect billings are material in
amount.
F-58
Emergency Medical Services L.P.
Notes to Unaudited Financial
Statements (Continued)
Income Tax Matters
The respective tax authorities, in the normal course, audit
previous tax filings. It is not possible at this time to predict
the final outcome of these audits or establish a reasonable
estimate of possible additional taxes owing, if any.
In connection with the acquisition of AMR and EmCare, a
section 338(h)(10) election was made for EmCare which
eliminated $85 million of deferred tax assets and
stepped-up EmCares tax basis to fair value. Differences
between book and tax depreciation and amortization for these
assets will create future deferred tax assets.
AMR HoldCo, Inc. and EmCare HoldCo, Inc. are commonly owned by a
partnership, Emergency Medical Services L.P., and therefore
are required to file two separate consolidated tax returns. The
disclosed tax amounts relate to the corporate income taxes of
these two corporate consolidated groups combined.
Insurance reserves are established for automobile, workers
compensation, general liability and professional liability
claims utilizing policies with both fully-insured and
self-insured components. This includes use of an off-shore
captive insurance program through a wholly-owned subsidiary for
certain professional liability (malpractice) programs for
EmCare. In those instances where the Company has obtained
third-party insurance coverage, either directly through an
independent outside party or through participation in a
Laidlaw-administered program, the Company normally retains
liability for the first $1 to $2 million of the loss.
Insurance reserves cover known claims and incidents within the
level of Company retention that may result in the assertion of
additional claims, as well as claims from unknown incidents that
may be asserted arising from activities through the balance
sheet dates.
The Company establishes reserves for claims based upon an
assessment of actual claims and claims incurred but not
reported. The reserves are established based on consultation
with third-party independent actuaries using actuarial
principles and assumptions that consider a number of factors,
including historical claim payment patterns (including legal
costs) and changes in case reserves and the assumed rate of
inflation in healthcare costs and property damage repairs.
Certain insurance programs also require the Company to maintain
deposits with third-party insurers, trustees or with Laidlaw to
cover future claims costs, and these deposits are included as
assets in the accompanying consolidated balance sheets.
Investments supporting insurance programs are comprised
principally of government securities and investment grade
securities and are presented as restricted assets in the
combined balance sheets. These investments are designated as
available-for-sale and reported at fair value. Investment
income/loss earned on these investments is reported as a
component of insurance expense in the consolidated/combined
statements of operations.
F-59
Emergency Medical Services L.P.
Notes to Unaudited Financial
Statements (Continued)
Operating segments are defined by SFAS No. 131,
Disclosures about Segments of an Enterprise and Related
Information, as components of an enterprise about which
separate financial information is available that is evaluated
regularly by the chief operating decision maker in deciding how
to allocate resources and in assessing performance. The
operating segments are managed separately because each operating
segment represents a strategic business unit providing
healthcare transportation services or emergency management
services.
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Predecessor | |
|
|
|
|
|
|
|
| |
|
|
Eight Months | |
|
Three Months | |
|
|
Eight Months | |
|
Three Months | |
|
|
Ended | |
|
Ended | |
|
|
Ended | |
|
Ended | |
|
|
September 30, | |
|
September 30, | |
|
|
September 30, | |
|
September 30, | |
|
|
2005 | |
|
2005 | |
|
|
2004 | |
|
2004 | |
|
|
| |
|
| |
|
|
| |
|
| |
Healthcare Transportation Services
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Net revenue
|
|
$ |
761,712 |
|
|
$ |
291,909 |
|
|
|
$ |
705,181 |
|
|
$ |
270,887 |
|
Segment EBITDA
|
|
|
67,813 |
|
|
|
22,664 |
|
|
|
|
60,058 |
|
|
|
24,825 |
|
Capital expenditures
|
|
|
31,612 |
|
|
|
13,307 |
|
|
|
|
27,257 |
|
|
|
12,506 |
|
Emergency Management Services
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Net revenue
|
|
|
425,941 |
|
|
|
164,336 |
|
|
|
|
372,568 |
|
|
|
142,982 |
|
Segment EBITDA
|
|
|
29,915 |
|
|
|
11,431 |
|
|
|
|
24,509 |
|
|
|
12,399 |
|
Capital expenditures
|
|
|
3,335 |
|
|
|
901 |
|
|
|
|
2,960 |
|
|
|
1,566 |
|
Total
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Net revenue
|
|
|
1,187,653 |
|
|
|
456,245 |
|
|
|
|
1,077,749 |
|
|
|
413,869 |
|
Segment EBITDA
|
|
|
97,728 |
|
|
|
34,095 |
|
|
|
|
84,567 |
|
|
|
37,224 |
|
Capital expenditures
|
|
|
34,947 |
|
|
|
14,208 |
|
|
|
|
30,217 |
|
|
|
14,072 |
|
Reconciliation of EBITDA to Net Income
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
EBITDA
|
|
|
97,728 |
|
|
|
34,095 |
|
|
|
|
84,567 |
|
|
|
37,224 |
|
Depreciation and amortization expense
|
|
|
(38,811 |
) |
|
|
(14,843 |
) |
|
|
|
(34,627 |
) |
|
|
(12,669 |
) |
Interest expense
|
|
|
(34,407 |
) |
|
|
(12,824 |
) |
|
|
|
(8,679 |
) |
|
|
(5,138 |
) |
Realized gain (loss) on investments
|
|
|
(40 |
) |
|
|
(34 |
) |
|
|
|
(1,191 |
) |
|
|
(1,140 |
) |
Interest and other income (loss)
|
|
|
189 |
|
|
|
91 |
|
|
|
|
210 |
|
|
|
162 |
|
Income tax expense
|
|
|
(10,657 |
) |
|
|
(3,479 |
) |
|
|
|
(15,710 |
) |
|
|
(7,191 |
) |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Net income
|
|
$ |
14,002 |
|
|
$ |
3,006 |
|
|
|
$ |
24,570 |
|
|
$ |
11,248 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
On February 10, 2005, the Company issued $250 million
of senior subordinated unsecured notes and executed a
$450 million senior secured credit facility agreement.
The senior subordinated notes have a fixed interest rate of 10%,
payable semi-annually, and mature in February 2015.
The senior secured credit facility consists of a
$350 million senior secured term loan and a
$100 million revolving credit facility commitment, each
collateralized by a pledge of 100% of the capital stock of the
Company and its direct and indirect domestic subsidiaries and
65% of the capital stock of any direct foreign subsidiaries, and
a security interest in substantially all tangible and intangible
assets of EMS and its subsidiaries. The term loan matures in
February 2012 and requires quarterly principal payments of $875
commencing May 2005. The revolving credit facility, which is
limited by outstanding letter of credit
F-60
Emergency Medical Services L.P.
Notes to Unaudited Financial
Statements (Continued)
obligations, requires principal and interest to be paid at
maturity in February 2011. The revolving credit facility is also
subject to an annual commitment fee of 0.5% on unused
commitments. Under the terms of the agreement, the Company may
select between various interest rate arrangements based on LIBOR
or the Prime Rate plus additional basis points within a range of
2.0% to 3.0%, determined by reference to a leverage ratio. At
September 30, 2005, $5.0 million of borrowings were
outstanding under the revolving credit facility, letters of
credit outstanding were $27.3 million, and the maximum
remaining available under the revolving credit facility was
$67.7 million.
The senior secured credit facility agreement contains various
customary operating and financial covenants. The more
restrictive of these covenants limit the Companys and its
subsidiaries ability to create liens on assets; make certain
investments, loans, guarantees or advances; incur additional
indebtedness or issue capital stock; engage in mergers,
acquisitions or consolidations; dispose of assets; pay
dividends, repurchase equity interests or make other restricted
payments; change the business conducted by the Company; engage
in transactions with affiliates; and repay certain indebtedness,
including the senior unsecured notes, or amend or otherwise
modify agreements governing the subordinated indebtedness. The
financial maintenance covenants establish a maximum leverage
ratio, a maximum senior leverage ratio, a minimum fixed charge
coverage ratio and an annual capital expenditure limit. The
Company is in compliance with its borrowing agreement covenants
as of September 30, 2005.
Following is a summary of the Companys borrowings as of
the respective balance sheet dates:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Predecessor | |
|
|
September 30, | |
|
|
January 31, | |
|
|
2005 | |
|
|
2005 | |
|
|
| |
|
|
| |
Senior subordinated notes due 2015
|
|
$ |
250,000 |
|
|
|
$ |
|
|
Senior secured term loan due 2012 (5.65% at September 30,
2005)
|
|
|
348,250 |
|
|
|
|
|
|
Revolving credit facility
|
|
|
5,000 |
|
|
|
|
|
|
Capital lease obligations
|
|
|
4,389 |
|
|
|
|
8,110 |
|
Notes due at various dates from 2005 to 2022 with interest rates
from 6% to 10%
|
|
|
968 |
|
|
|
|
3,387 |
|
|
|
|
|
|
|
|
|
Total long-term debt
|
|
|
608,607 |
|
|
|
|
11,497 |
|
Less current maturities
|
|
|
(13,478 |
) |
|
|
|
(5,846 |
) |
|
|
|
|
|
|
|
|
Long-term debt, less current maturities
|
|
$ |
595,129 |
|
|
|
$ |
5,651 |
|
|
|
|
|
|
|
|
|
The aggregate maturities of debt are as follows:
|
|
|
|
|
Twelve months ended September 30,
|
|
|
|
|
2006
|
|
$ |
13,478 |
|
2007
|
|
|
3,020 |
|
2008
|
|
|
3,624 |
|
2009
|
|
|
3,613 |
|
2010
|
|
|
3,608 |
|
Thereafter
|
|
|
581,264 |
|
|
|
|
|
|
|
$ |
608,607 |
|
|
|
|
|
F-61
Emergency Medical Services L.P.
Notes to Unaudited Financial
Statements (Continued)
Emergency Medical Services L.P. financed the acquisition of AMR
and EmCare in part by issuing $250.0 million principal
amount of senior subordinated notes and borrowing
$370.2 million under its senior secured credit facility.
Its wholly-owned subsidiaries, AMR HoldCo, Inc. and EmCare
HoldCo, Inc., are the issuers of the senior subordinated notes
and the borrowers under the senior secured credit facility. As
part of the transaction, AMR and its subsidiaries became
wholly-owned subsidiaries of AMR HoldCo, Inc. and EmCare and its
subsidiaries became wholly-owned subsidiaries of EmCare HoldCo,
Inc. The senior subordinated notes and the senior secured credit
facility include a full, unconditional and joint and several
guarantee by all of the Companys subsidiaries other than
its captive insurance subsidiary. All of the operating income
and cash flow of EMS L.P., AMR HoldCo, Inc. and EmCare HoldCo,
Inc. is generated by AMR, EmCare and their subsidiaries. As a
result, funds necessary to meet the debt service obligations
under the senior secured notes and senior secured credit
facility described above are provided by the distributions or
advances from the subsidiary companies, AMR and EmCare.
Investments in subsidiary operating companies are accounted for
on the equity method. Accordingly, entries necessary to
consolidate the parent company, AMR HoldCo, Inc., EmCare HoldCo,
Inc. and all of their subsidiaries are reflected in the
Eliminations/Adjustments column. Separate complete financial
statements of the issuers and subsidiary guarantors would not
provide additional material information that would be useful in
assessing the financial composition of the issuers or the
subsidiary guarantors. The condensed combining financial
statements for the parent company, the issuers, the guarantors
and the non-guarantor are as follows:
F-62
Consolidating Balance Sheet
As of September 30, 2005
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Issuer | |
|
Issuer | |
|
|
|
|
|
|
|
|
|
|
|
|
AMR | |
|
EmCare | |
|
Subsidiary | |
|
Subsidiary | |
|
Eliminations/ | |
|
|
|
|
Parent Co. | |
|
HoldCo, Inc. | |
|
HoldCo, Inc. | |
|
Guarantors | |
|
Non-guarantor | |
|
Adjustments | |
|
Total | |
|
|
| |
|
| |
|
| |
|
| |
|
| |
|
| |
|
| |
Assets |
Current assets:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Cash and cash equivalents
|
|
$ |
4,828 |
|
|
$ |
|
|
|
$ |
|
|
|
$ |
5,203 |
|
|
$ |
82 |
|
|
$ |
|
|
|
$ |
10,113 |
|
|
Restricted cash and cash equivalents
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
11,949 |
|
|
|
|
|
|
|
11,949 |
|
|
Restricted marketable securities
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
2,165 |
|
|
|
|
|
|
|
2,165 |
|
|
Trade and other accounts receivable, net
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
366,995 |
|
|
|
2,620 |
|
|
|
151 |
|
|
|
369,766 |
|
|
Parts and supplies inventory
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
18,760 |
|
|
|
|
|
|
|
|
|
|
|
18,760 |
|
|
Other current assets
|
|
|
325 |
|
|
|
|
|
|
|
|
|
|
|
41,459 |
|
|
|
1,986 |
|
|
|
(12,762 |
) |
|
|
31,008 |
|
|
Current deferred tax assets
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
20,312 |
|
|
|
2,659 |
|
|
|
|
|
|
|
22,971 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Current assets
|
|
|
5,153 |
|
|
|
|
|
|
|
|
|
|
|
452,729 |
|
|
|
21,461 |
|
|
|
(12,611 |
) |
|
|
466,732 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Non-current assets:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Property, plant, and equipment, net
|
|
|
329 |
|
|
|
|
|
|
|
|
|
|
|
132,954 |
|
|
|
|
|
|
|
|
|
|
|
133,283 |
|
|
Intercompany receivable
|
|
|
|
|
|
|
420,069 |
|
|
|
188,741 |
|
|
|
17,156 |
|
|
|
|
|
|
|
(625,966 |
) |
|
|
|
|
|
Intangible assets, net
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
81,363 |
|
|
|
|
|
|
|
|
|
|
|
81,363 |
|
|
Non-current deferred tax assets
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
118,619 |
|
|
|
(1,131 |
) |
|
|
|
|
|
|
117,488 |
|
|
Restricted long-term investments
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
73,304 |
|
|
|
|
|
|
|
73,304 |
|
|
Goodwill
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
271,529 |
|
|
|
458 |
|
|
|
|
|
|
|
271,987 |
|
|
Other long-term assets
|
|
|
|
|
|
|
11,838 |
|
|
|
5,318 |
|
|
|
92,095 |
|
|
|
|
|
|
|
|
|
|
|
109,251 |
|
|
Investment and advances in subsidiaries
|
|
|
236,747 |
|
|
|
160,515 |
|
|
|
76,218 |
|
|
|
6,074 |
|
|
|
|
|
|
|
(479,554 |
) |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Assets
|
|
$ |
242,229 |
|
|
$ |
592,422 |
|
|
$ |
270,277 |
|
|
$ |
1,172,519 |
|
|
$ |
94,092 |
|
|
$ |
(1,118,131 |
) |
|
$ |
1,253,408 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Liabilities and Equity |
Current liabilities:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Accounts payable
|
|
$ |
|
|
|
$ |
|
|
|
$ |
|
|
|
$ |
53,066 |
|
|
$ |
|
|
|
$ |
|
|
|
$ |
53,066 |
|
|
Accrued liabilities
|
|
|
|
|
|
|
3,826 |
|
|
|
1,720 |
|
|
|
161,037 |
|
|
|
33,266 |
|
|
|
|
|
|
|
199,849 |
|
|
Current portion of long-term debt
|
|
|
|
|
|
|
5,865 |
|
|
|
2,635 |
|
|
|
4,978 |
|
|
|
|
|
|
|
|
|
|
|
13,478 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Current liabilities
|
|
|
|
|
|
|
9,691 |
|
|
|
4,355 |
|
|
|
219,081 |
|
|
|
33,266 |
|
|
|
|
|
|
|
266,393 |
|
Long-term debt
|
|
|
|
|
|
|
410,378 |
|
|
|
184,372 |
|
|
|
379 |
|
|
|
|
|
|
|
|
|
|
|
595,129 |
|
Other long-term liabilities
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
112,998 |
|
|
|
54,752 |
|
|
|
(12,611 |
) |
|
|
155,139 |
|
Intercompany
|
|
|
5,482 |
|
|
|
11,838 |
|
|
|
5,318 |
|
|
|
603,328 |
|
|
|
|
|
|
|
(625,966 |
) |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Liabilities
|
|
|
5,482 |
|
|
|
431,907 |
|
|
|
194,045 |
|
|
|
935,786 |
|
|
|
88,018 |
|
|
|
(638,577 |
) |
|
|
1,016,661 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Redeemable partnership equity
|
|
|
1,213 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
1,213 |
|
Common stock
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
30 |
|
|
|
(30 |
) |
|
|
|
|
Additional paid-in capital
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
6,690 |
|
|
|
(6,690 |
) |
|
|
|
|
Partnership equity
|
|
|
222,178 |
|
|
|
153,722 |
|
|
|
69,669 |
|
|
|
223,391 |
|
|
|
|
|
|
|
(446,782 |
) |
|
|
222,178 |
|
Retained earnings
|
|
|
14,002 |
|
|
|
6,793 |
|
|
|
7,209 |
|
|
|
13,988 |
|
|
|
|
|
|
|
(27,990 |
) |
|
|
14,002 |
|
Comprehensive income (loss)
|
|
|
(646 |
) |
|
|
|
|
|
|
(646 |
) |
|
|
(646 |
) |
|
|
(646 |
) |
|
|
1,938 |
|
|
|
(646 |
) |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Equity
|
|
|
235,534 |
|
|
|
160,515 |
|
|
|
76,232 |
|
|
|
236,733 |
|
|
|
6,074 |
|
|
|
(479,554 |
) |
|
|
235,534 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Liabilities and Equity
|
|
$ |
242,229 |
|
|
$ |
592,422 |
|
|
$ |
270,277 |
|
|
$ |
1,172,519 |
|
|
$ |
94,092 |
|
|
$ |
(1,118,131 |
) |
|
$ |
1,253,408 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
F-63
Predecessor
Combining Balance Sheet
As of January 31, 2005
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Issuer |
|
Issuer |
|
|
|
|
|
|
|
|
|
|
|
|
AMR |
|
EmCare |
|
Subsidiary | |
|
Subsidiary | |
|
Eliminations/ | |
|
|
|
|
Parent Co. |
|
HoldCo, Inc. |
|
HoldCo, Inc. |
|
Guarantors | |
|
Non-guarantor | |
|
Adjustments | |
|
Total | |
|
|
|
|
|
|
|
|
| |
|
| |
|
| |
|
| |
Assets |
Current assets:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Cash and cash equivalents
|
|
$ |
|
|
|
$ |
|
|
|
$ |
|
|
|
$ |
4,778 |
|
|
$ |
9,853 |
|
|
$ |
|
|
|
$ |
14,631 |
|
|
Restricted cash and cash equivalents
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
9,846 |
|
|
|
|
|
|
|
9,846 |
|
|
Restricted marketable securities
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
2,473 |
|
|
|
|
|
|
|
2,473 |
|
|
Trade and other accounts receivable, net
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
359,945 |
|
|
|
43,339 |
|
|
|
(33,517 |
) |
|
|
369,767 |
|
|
Parts and supplies inventory
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
18,499 |
|
|
|
|
|
|
|
|
|
|
|
18,499 |
|
|
Other current assets
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
81,818 |
|
|
|
6,097 |
|
|
|
(47,780 |
) |
|
|
40,135 |
|
|
Current deferred tax assets
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
62,433 |
|
|
|
2,659 |
|
|
|
|
|
|
|
65,092 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Current assets
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
527,473 |
|
|
|
74,267 |
|
|
|
(81,297 |
) |
|
|
520,443 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Non-current assets:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Property, plant, and equipment, net
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
128,766 |
|
|
|
|
|
|
|
|
|
|
|
128,766 |
|
|
Intangible assets, net
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
16,075 |
|
|
|
|
|
|
|
|
|
|
|
16,075 |
|
|
Non-current deferred tax assets
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
203,391 |
|
|
|
(922 |
) |
|
|
|
|
|
|
202,469 |
|
|
Restricted long-term investments
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
41,810 |
|
|
|
|
|
|
|
41,810 |
|
|
Goodwill
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Other long-term assets
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
73,947 |
|
|
|
|
|
|
|
|
|
|
|
73,947 |
|
|
Investment and advances in subsidiaries
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
6,404 |
|
|
|
|
|
|
|
(6,404 |
) |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Assets
|
|
$ |
|
|
|
$ |
|
|
|
$ |
|
|
|
$ |
956,056 |
|
|
$ |
115,155 |
|
|
$ |
(87,701 |
) |
|
$ |
983,510 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Liabilities and Equity |
Current liabilities:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Accounts payable
|
|
$ |
|
|
|
$ |
|
|
|
$ |
|
|
|
$ |
82,167 |
|
|
$ |
5,186 |
|
|
$ |
(31,535 |
) |
|
$ |
55,818 |
|
|
Accrued liabilities
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
147,291 |
|
|
|
24,354 |
|
|
|
|
|
|
|
171,645 |
|
|
Current portion of long-term debt
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
5,846 |
|
|
|
|
|
|
|
|
|
|
|
5,846 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Current liabilities
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
235,304 |
|
|
|
29,540 |
|
|
|
(31,535 |
) |
|
|
233,309 |
|
Long-term debt
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
5,651 |
|
|
|
|
|
|
|
|
|
|
|
5,651 |
|
Other long-term liabilities
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
116,824 |
|
|
|
79,211 |
|
|
|
(49,762 |
) |
|
|
146,273 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Liabilities
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
357,779 |
|
|
|
108,751 |
|
|
|
(81,297 |
) |
|
|
385,233 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Laidlaw payable
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
202,042 |
|
|
|
|
|
|
|
|
|
|
|
202,042 |
|
Laidlaw investment
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
356,550 |
|
|
|
|
|
|
|
|
|
|
|
356,550 |
|
Common stock
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
30 |
|
|
|
(30 |
) |
|
|
|
|
Additional paid-in capital
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
5,054 |
|
|
|
(5,054 |
) |
|
|
|
|
Retained earnings
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
40,000 |
|
|
|
1,635 |
|
|
|
(1,635 |
) |
|
|
40,000 |
|
Comprehensive income (loss)
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
(315 |
) |
|
|
(315 |
) |
|
|
315 |
|
|
|
(315 |
) |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Equity
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
598,277 |
|
|
|
6,404 |
|
|
|
(6,404 |
) |
|
|
598,277 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Liabilities and Equity
|
|
$ |
|
|
|
$ |
|
|
|
$ |
|
|
|
$ |
956,056 |
|
|
$ |
115,155 |
|
|
$ |
(87,701 |
) |
|
$ |
983,510 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
F-64
Consolidating Statement of Operations
For the Eight Months Ended September 30, 2005
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Issuer | |
|
Issuer | |
|
|
|
Subsidiary | |
|
|
|
|
|
|
|
|
AMR | |
|
EmCare | |
|
Subsidiary | |
|
Non- | |
|
Eliminations/ | |
|
|
|
|
Parent Co. | |
|
HoldCo, Inc. | |
|
HoldCo, Inc. | |
|
Guarantors | |
|
guarantor | |
|
Adjustments | |
|
Total | |
|
|
| |
|
| |
|
| |
|
| |
|
| |
|
| |
|
| |
Net revenue
|
|
$ |
|
|
|
$ |
|
|
|
$ |
|
|
|
$ |
1,187,653 |
|
|
$ |
25,264 |
|
|
$ |
(25,264 |
) |
|
$ |
1,187,653 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Compensation and benefits
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
822,595 |
|
|
|
|
|
|
|
|
|
|
|
822,595 |
|
Operating expenses
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
168,700 |
|
|
|
|
|
|
|
|
|
|
|
168,700 |
|
Insurance expense
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
60,422 |
|
|
|
25,224 |
|
|
|
(25,264 |
) |
|
|
60,382 |
|
Selling, general and administrative expenses
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
38,248 |
|
|
|
|
|
|
|
|
|
|
|
38,248 |
|
Depreciation and amortization expense
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
38,811 |
|
|
|
|
|
|
|
|
|
|
|
38,811 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Income from operations
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
58,877 |
|
|
|
40 |
|
|
|
|
|
|
|
58,917 |
|
Interest expense
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
(34,407 |
) |
|
|
|
|
|
|
|
|
|
|
(34,407 |
) |
Realized loss on investments
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
(40 |
) |
|
|
|
|
|
|
(40 |
) |
Interest and other income
|
|
|
|
|
|
|
|
|
|
|
14 |
|
|
|
175 |
|
|
|
|
|
|
|
|
|
|
|
189 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Income before income taxes
|
|
|
|
|
|
|
|
|
|
|
14 |
|
|
|
24,645 |
|
|
|
|
|
|
|
|
|
|
|
24,659 |
|
Income tax expense
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
(10,657 |
) |
|
|
|
|
|
|
|
|
|
|
(10,657 |
) |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Income before equity in earnings of unconsolidated subsidiaries
|
|
|
|
|
|
|
|
|
|
|
14 |
|
|
|
13,988 |
|
|
|
|
|
|
|
|
|
|
|
14,002 |
|
Equity in earnings of unconsolidated subsidiaries
|
|
|
14,002 |
|
|
|
6,793 |
|
|
|
7,195 |
|
|
|
|
|
|
|
|
|
|
|
(27,990 |
) |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Net income
|
|
$ |
14,002 |
|
|
$ |
6,793 |
|
|
$ |
7,209 |
|
|
$ |
13,988 |
|
|
$ |
|
|
|
$ |
(27,990 |
) |
|
$ |
14,002 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
F-65
Predecessor Combining Statement of Operations
For the Eight Months Ended September 30, 2004
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Issuer |
|
Issuer |
|
|
|
Subsidiary | |
|
|
|
|
|
|
|
|
AMR |
|
EmCare |
|
Subsidiary | |
|
Non- | |
|
Eliminations/ | |
|
|
|
|
Parent Co. |
|
HoldCo, Inc. |
|
HoldCo, Inc. |
|
Guarantors | |
|
guarantor | |
|
Adjustments | |
|
Total | |
|
|
|
|
|
|
|
|
| |
|
| |
|
| |
|
| |
Net revenue
|
|
$ |
|
|
|
$ |
|
|
|
$ |
|
|
|
$ |
1,077,749 |
|
|
$ |
21,233 |
|
|
$ |
(21,233 |
) |
|
$ |
1,077,749 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Compensation and benefits
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
751,238 |
|
|
|
|
|
|
|
|
|
|
|
751,238 |
|
Operating expenses
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
147,524 |
|
|
|
|
|
|
|
|
|
|
|
147,524 |
|
Insurance expense
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
52,865 |
|
|
|
20,042 |
|
|
|
(21,233 |
) |
|
|
51,674 |
|
Selling, general and administrative expenses
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
31,270 |
|
|
|
|
|
|
|
|
|
|
|
31,270 |
|
Laidlaw fees and compensation charges
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
10,095 |
|
|
|
|
|
|
|
|
|
|
|
10,095 |
|
Depreciation and amortization expense
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
34,627 |
|
|
|
|
|
|
|
|
|
|
|
34,627 |
|
Restructuring charges
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
1,381 |
|
|
|
|
|
|
|
|
|
|
|
1,381 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Income from operations
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
48,749 |
|
|
|
1,191 |
|
|
|
|
|
|
|
49,940 |
|
Interest expense
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
(8,679 |
) |
|
|
|
|
|
|
|
|
|
|
(8,679 |
) |
Realized loss on investments
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
(1,191 |
) |
|
|
|
|
|
|
(1,191 |
) |
Interest and other income
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
210 |
|
|
|
|
|
|
|
|
|
|
|
210 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Income before income taxes
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
40,280 |
|
|
|
|
|
|
|
|
|
|
|
40,280 |
|
Income tax expense
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
(17,345 |
) |
|
|
1,635 |
|
|
|
|
|
|
|
(15,710 |
) |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Income before equity in earnings of subsidiary
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
22,935 |
|
|
|
1,635 |
|
|
|
|
|
|
|
24,570 |
|
Equity in earnings of subsidiary
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
1,635 |
|
|
|
|
|
|
|
(1,635 |
) |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Net income
|
|
$ |
|
|
|
$ |
|
|
|
$ |
|
|
|
$ |
24,570 |
|
|
$ |
1,635 |
|
|
$ |
(1,635 |
) |
|
$ |
24,570 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Consolidating Statement of Operations
For the Three Months Ended September 30, 2005
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Issuer | |
|
Issuer | |
|
|
|
Subsidiary | |
|
|
|
|
|
|
|
|
AMR | |
|
EmCare | |
|
Subsidiary | |
|
Non- | |
|
Eliminations/ | |
|
|
|
|
Parent Co. | |
|
HoldCo, Inc. | |
|
HoldCo, Inc. | |
|
Guarantors | |
|
guarantor | |
|
Adjustments | |
|
Total | |
|
|
| |
|
| |
|
| |
|
| |
|
| |
|
| |
|
| |
Net revenue
|
|
$ |
|
|
|
$ |
|
|
|
$ |
|
|
|
$ |
456,245 |
|
|
$ |
2,839 |
|
|
$ |
(2,839 |
) |
|
$ |
456,245 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Compensation and benefits
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
319,292 |
|
|
|
|
|
|
|
|
|
|
|
319,292 |
|
Operating expenses
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
66,156 |
|
|
|
|
|
|
|
|
|
|
|
66,156 |
|
Insurance expense
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
21,082 |
|
|
|
2,805 |
|
|
|
(2,839 |
) |
|
|
21,048 |
|
Selling, general and administrative expenses
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
15,654 |
|
|
|
|
|
|
|
|
|
|
|
15,654 |
|
Depreciation and amortization expense
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
14,843 |
|
|
|
|
|
|
|
|
|
|
|
14,843 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Income from operations
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
19,218 |
|
|
|
34 |
|
|
|
|
|
|
|
19,252 |
|
Interest expense
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
(12,824 |
) |
|
|
|
|
|
|
|
|
|
|
(12,824 |
) |
Realized gain on investments
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
(34 |
) |
|
|
|
|
|
|
(34 |
) |
Interest and other income
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
91 |
|
|
|
|
|
|
|
|
|
|
|
91 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Income before income taxes
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
6,485 |
|
|
|
|
|
|
|
|
|
|
|
6,485 |
|
Income tax expense
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
(3,479 |
) |
|
|
|
|
|
|
|
|
|
|
(3,479 |
) |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Income before equity in earnings of unconsolidated subsidiaries
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
3,006 |
|
|
|
|
|
|
|
|
|
|
|
3,006 |
|
Equity in earnings of unconsolidated subsidiaries
|
|
|
3,006 |
|
|
|
501 |
|
|
|
2,505 |
|
|
|
|
|
|
|
|
|
|
|
(6,012 |
) |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Net income
|
|
$ |
3,006 |
|
|
$ |
501 |
|
|
$ |
2,505 |
|
|
$ |
3,006 |
|
|
$ |
|
|
|
$ |
(6,012 |
) |
|
$ |
3,006 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
F-66
Predecessor
Combining Statement of Operations
For the Three Months Ended September 30, 2004
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Issuer |
|
Issuer |
|
|
|
Subsidiary | |
|
|
|
|
|
|
|
|
AMR |
|
EmCare |
|
Subsidiary | |
|
Non- | |
|
Eliminations/ | |
|
|
|
|
Parent Co. |
|
HoldCo, Inc. |
|
HoldCo, Inc. |
|
Guarantors | |
|
guarantor | |
|
Adjustments | |
|
Total | |
|
|
|
|
|
|
|
|
| |
|
| |
|
| |
|
| |
Net revenue
|
|
$ |
|
|
|
$ |
|
|
|
$ |
|
|
|
$ |
413,869 |
|
|
$ |
7,962 |
|
|
$ |
(7,962 |
) |
|
$ |
413,869 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Compensation and benefits
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
286,628 |
|
|
|
|
|
|
|
|
|
|
|
286,628 |
|
Operating expenses
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
55,863 |
|
|
|
|
|
|
|
|
|
|
|
55,863 |
|
Insurance expense
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
19,544 |
|
|
|
6,822 |
|
|
|
(7,962 |
) |
|
|
18,404 |
|
Selling, general and administrative expenses
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
12,093 |
|
|
|
|
|
|
|
|
|
|
|
12,093 |
|
Laidlaw fees and compensation charges
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
3,657 |
|
|
|
|
|
|
|
|
|
|
|
3,657 |
|
Depreciation and amortization expense
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
12,669 |
|
|
|
|
|
|
|
|
|
|
|
12,669 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Income from operations
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
23,415 |
|
|
|
1,140 |
|
|
|
|
|
|
|
24,555 |
|
Interest expense
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
(5,138 |
) |
|
|
|
|
|
|
|
|
|
|
(5,138 |
) |
Realized loss on investments
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
(1,140 |
) |
|
|
|
|
|
|
(1,140 |
) |
Interest and other income
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
162 |
|
|
|
|
|
|
|
|
|
|
|
162 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Income before income taxes
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
18,439 |
|
|
|
|
|
|
|
|
|
|
|
18,439 |
|
Income tax expense
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
(8,826 |
) |
|
|
1,635 |
|
|
|
|
|
|
|
(7,191 |
) |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Income before equity in earnings of subsidiary
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
9,613 |
|
|
|
1,635 |
|
|
|
|
|
|
|
11,248 |
|
Equity in earnings of subsidiary
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
1,635 |
|
|
|
|
|
|
|
(1,635 |
) |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Net income
|
|
$ |
|
|
|
$ |
|
|
|
$ |
|
|
|
$ |
11,248 |
|
|
$ |
1,635 |
|
|
$ |
(1,635 |
) |
|
$ |
11,248 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
F-67
Condensed Consolidating Statement of Cash Flows
For the Eight Months Ended September 30, 2005
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Issuer | |
|
Issuer | |
|
|
|
Subsidiary | |
|
|
|
|
|
|
AMR | |
|
EmCare | |
|
Subsidiary | |
|
Non- | |
|
|
|
|
Parent Co. | |
|
HoldCo Inc. | |
|
HoldCo Inc. | |
|
Guarantors | |
|
guarantors | |
|
Total | |
|
|
| |
|
| |
|
| |
|
| |
|
| |
|
| |
Cash Flows from Operating Activities
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Net cash provided by operating activities
|
|
$ |
|
|
|
$ |
|
|
|
$ |
14 |
|
|
$ |
84,284 |
|
|
$ |
24,164 |
|
|
$ |
108,462 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Cash Flows from Investing Activities
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
EMS purchase of AMR and EmCare
|
|
|
(828,775 |
) |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
(828,775 |
) |
Purchase of property, plant and equipment
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
(34,947 |
) |
|
|
|
|
|
|
(34,947 |
) |
Proceeds from sale of property, plant and equipment
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
565 |
|
|
|
|
|
|
|
565 |
|
Purchase of restricted cash and investments
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
(51,495 |
) |
|
|
(51,495 |
) |
Proceeds from sale and maturity of restricted investments
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
17,560 |
|
|
|
17,560 |
|
Net change in deposits and other assets
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
(20,330 |
) |
|
|
|
|
|
|
(20,330 |
) |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Net cash used in investing activities
|
|
|
(828,775 |
) |
|
|
|
|
|
|
|
|
|
|
(54,712 |
) |
|
|
(33,935 |
) |
|
|
(917,422 |
) |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Cash Flows from Financing Activities
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Borrowings under new senior secured credit facility
|
|
|
|
|
|
|
241,500 |
|
|
|
108,500 |
|
|
|
|
|
|
|
|
|
|
|
350,000 |
|
Proceeds from issuance of senior subordinated notes
|
|
|
|
|
|
|
172,500 |
|
|
|
77,500 |
|
|
|
|
|
|
|
|
|
|
|
250,000 |
|
Borrowings under new revolving credit facility
|
|
|
|
|
|
|
17,388 |
|
|
|
7,812 |
|
|
|
|
|
|
|
|
|
|
|
25,200 |
|
Issuance of partnership equity
|
|
|
222,655 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
222,655 |
|
Financing costs
|
|
|
(1,737 |
) |
|
|
(12,686 |
) |
|
|
(5,699 |
) |
|
|
|
|
|
|
|
|
|
|
(20,122 |
) |
Repayments of capital lease obligations and other debt
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
(5,722 |
) |
|
|
|
|
|
|
(5,722 |
) |
Repayments of revolving credit facility
|
|
|
|
|
|
|
(13,938 |
) |
|
|
(6,262 |
) |
|
|
|
|
|
|
|
|
|
|
(20,200 |
) |
Net intercompany borrowings (payments)
|
|
|
612,685 |
|
|
|
(404,764 |
) |
|
|
(181,865 |
) |
|
|
(26,056 |
) |
|
|
|
|
|
|
|
|
Increase (decrease) in bank overdrafts
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
997 |
|
|
|
|
|
|
|
997 |
|
Increase (decrease) in other non-current liabilities
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
1,634 |
|
|
|
|
|
|
|
1,634 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Net cash provided by (used in) financing activities
|
|
|
833,603 |
|
|
|
|
|
|
|
(14 |
) |
|
|
(29,147 |
) |
|
|
|
|
|
|
804,442 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Increase in cash and cash equivalents
|
|
|
4,828 |
|
|
|
|
|
|
|
|
|
|
|
425 |
|
|
|
(9,771 |
) |
|
|
(4,518 |
) |
Cash and cash equivalents, beginning of period
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
4,778 |
|
|
|
9,853 |
|
|
|
14,631 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Cash and cash equivalents, end of period
|
|
$ |
4,828 |
|
|
$ |
|
|
|
$ |
|
|
|
$ |
5,203 |
|
|
$ |
82 |
|
|
$ |
10,113 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
F-68
Predecessor
Condensed Combining Statement of Cash Flows
For the Eight Months Ended September 30, 2004
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Issuer |
|
Issuer |
|
|
|
Subsidiary | |
|
|
|
|
|
|
AMR |
|
EmCare |
|
Subsidiary | |
|
Non- | |
|
|
|
|
Parent Co. |
|
HoldCo, Inc. |
|
HoldCo, Inc. |
|
Guarantors | |
|
guarantors | |
|
Total | |
|
|
|
|
|
|
|
|
| |
|
| |
|
| |
Cash Flows from Operating Activities
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Net cash provided by operating activities
|
|
$ |
|
|
|
$ |
|
|
|
$ |
|
|
|
$ |
78,886 |
|
|
$ |
21,075 |
|
|
$ |
99,961 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Cash Flows from Investing Activities
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Purchase of property, plant and equipment
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
(30,217 |
) |
|
|
|
|
|
|
(30,217 |
) |
Proceeds from sale of property, plant and equipment
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
773 |
|
|
|
|
|
|
|
773 |
|
Purchase of restricted cash and investments
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
(61,213 |
) |
|
|
(61,213 |
) |
Proceeds from sale and maturity of restricted investments
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
40,152 |
|
|
|
40,152 |
|
Other investing activities
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
(23,405 |
) |
|
|
|
|
|
|
(23,405 |
) |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Net cash used in investing activities
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
(52,849 |
) |
|
|
(21,061 |
) |
|
|
(73,910 |
) |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Cash Flows from Financing Activities
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Repayments of capital lease obligations and other debt
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
(5,396 |
) |
|
|
|
|
|
|
(5,396 |
) |
Payments to Laidlaw
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
(13,937 |
) |
|
|
|
|
|
|
(13,937 |
) |
Change in other non-current liabilities
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
(5,656 |
) |
|
|
|
|
|
|
(5,656 |
) |
Decrease in bank overdrafts
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
4,290 |
|
|
|
|
|
|
|
4,290 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Net cash used in financing activities
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
(20,699 |
) |
|
|
|
|
|
|
(20,699 |
) |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Change in cash and cash equivalents
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
5,338 |
|
|
|
14 |
|
|
|
5,352 |
|
Cash and cash equivalents, beginning of period
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
10,830 |
|
|
|
26 |
|
|
|
10,856 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Cash and cash equivalents, end of period
|
|
$ |
|
|
|
$ |
|
|
|
$ |
|
|
|
$ |
16,168 |
|
|
$ |
40 |
|
|
$ |
16,208 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
10. |
Planned Public Offering |
On July 28, 2005, the board of directors of the general
partner of the Company authorized the filing of a registration
statement on Form S-1 in connection with a proposed initial
public offering of the Companys equity. The Company
currently anticipates that, in connection with a public
offering, it will effect a reorganization pursuant to which the
Company becomes a consolidated subsidiary of a newly-formed
Delaware corporation and that corporation, to be named Emergency
Medical Services Corporation, will issue common stock in the
offering.
In connection with the offering and the related reorganization,
the outstanding options described in note 3 will become
options to purchase shares of Emergency Medical Services
Corporations common stock; the number of shares subject to
each option and the exercise price will be determined based on
Emergency Medical Services Corporations capitalization and
the offering price per share of common stock.
F-69
REPORT OF INDEPENDENT REGISTERED PUBLIC ACCOUNTING FIRM
To the Stockholder of Emergency Medical Services Corporation
In our opinion, the accompanying balance sheet presents fairly,
in all material respects, the financial position of Emergency
Medical Services Corporation (the Company) as of
November 10, 2005 in accordance with accounting principles
generally accepted in the United States of America. This
financial statement is the responsibility of the Companys
management; our responsibility is to express an opinion on this
financial statement based on our audit. We conducted our audit
of this statement in accordance with the standards of the Public
Company Accounting Oversight Board (United States). Those
standards require that we plan and perform the audit to obtain
reasonable assurance about whether the balance sheet is free of
material misstatement. An audit includes examining, on a test
basis, evidence supporting the amounts and disclosures in the
balance sheet, assessing the accounting principles used and
significant estimates made by management, and evaluating the
overall balance sheet presentation. We believe that our audit of
the balance sheet provides a reasonable basis for our opinion.
PricewaterhouseCoopers LLP
Denver, Colorado
November 14, 2005
F-70
EMERGENCY MEDICAL SERVICES CORPORATION
FINANCIAL STATEMENT
November 10, 2005
F-71
EMERGENCY MEDICAL SERVICES CORPORATION
BALANCE SHEET
November 10, 2005
|
|
|
|
|
|
ASSETS
|
|
|
|
|
Cash
|
|
$ |
100 |
|
|
STOCKHOLDERS EQUITY
|
|
|
|
|
Stockholders equity:
|
|
|
|
|
|
Common stock, $.01 par value; 100 shares class B
authorized, 10 shares issued and outstanding; 100 shares
class A authorized, 0 shares issued and outstanding
|
|
$ |
0 |
|
Additional paid-in capital
|
|
|
100 |
|
|
|
|
|
Total stockholders equity
|
|
$ |
100 |
|
|
|
|
|
The accompanying notes are an integral part of this financial
statement
F-72
EMERGENCY MEDICAL SERVICES CORPORATION
NOTES TO FINANCIAL STATEMENTS
1. Description of Business
Emergency Medical Services Corporation (the Company)
is a Delaware corporation which was formed on November 1,
2005. Its capital was contributed on November 10, 2005 by
EMSC, Inc., the general partner of EMS L.P. The Companys
fiscal year-end is December 31.
2. Pending Transactions
(unaudited)
On July 28, 2005, the board of directors of the general
partner of Emergency Medical Services L.P.
(EMS L.P.), a related company, authorized the
filing of a registration statement on Form S-1 in connection
with a proposed initial public offering of the equity of the
Company. The Company currently anticipates that, in connection
with that public offering, EMS L.P. and the Company will effect
a reorganization pursuant to which EMS L.P. will become a
consolidated subsidiary of the Company and the Company will
issue common stock in the offering.
EMS L.P. acquired American Medical Response, Inc.
(AMR) and EmCare Holdings Inc. (EmCare)
from Laidlaw International, Inc. on February 10, 2005 with
an effective transaction date after the close of business
January 31, 2005. The purchase price was
$828.8 million, subject to working capital and other
purchase adjustments.
EMS L.P. currently is completing its allocation of purchase
price. To finance the acquisition, EMS L.P. entered into a new
$450 million senior secured credit facility and issued
senior subordinated notes for gross proceeds of
$250 million. EMS L.P. also issued approximately
22.1 million limited partnership units for
$221 million.
The following table summarizes the estimated fair value of the
assets acquired and liabilities assumed by EMS L.P. at the date
of acquisition. EMS L.P. is in the process of obtaining
third-party valuations of certain intangible assets acquired and
liabilities assumed, and is evaluating the tax impact of certain
purchase accounting adjustments and the carryover of tax
attributes from the predecessor companies; accordingly, the
allocation of the purchase price is subject to adjustment.
|
|
|
|
|
|
Current assets
|
|
$ |
483,957 |
|
Property, plant & equipment
|
|
|
128,766 |
|
Intangible assets
|
|
|
89,850 |
|
Goodwill
|
|
|
271,987 |
|
Other long-term assets
|
|
|
254,027 |
|
|
|
|
|
|
Total assets acquired
|
|
|
1,228,587 |
|
|
|
|
|
Current liabilities
|
|
|
245,144 |
|
Long-term debt
|
|
|
620,183 |
|
Other long-term liabilities
|
|
|
144,381 |
|
|
|
|
|
|
Total liabilities assumed
|
|
|
1,009,708 |
|
|
|
|
|
Net assets acquired
|
|
$ |
218,879 |
|
|
|
|
|
The $272.0 million of goodwill currently has been
preliminarily assigned to AMR and EmCare in the amounts of
$127.7 million and $144.3 million, respectively, based
on the sales agreements and valuations, and is not subject to
amortization. EmCare goodwill is deductible for tax purposes.
It is expected that the Company will contribute the net proceeds
from the proposed initial public offering to EMS L.P. to pay
down a portion of the senior secured credit borrowings described
above.
F-73
Our Reorganization and Capital Structure
In connection with the Companys proposed initial public
offering, the Company and EMS L.P. will take the following
steps immediately prior to the completion of the offering:
|
|
|
|
|
The Company will amend and restate its certificate of
incorporation, and its authorized capital stock will include
100,000,000 shares of class A common stock, $.01 par
value, 40,000,000 shares of class B common stock, $.01
par value, and one share of class B special voting stock,
$.01 par value. |
|
|
|
The holders of the capital stock of the sole general partner of
EMS L.P. will contribute that capital stock to the Company
in exchange for shares of class B common stock, the general
partner will be merged into the Company and the Company will
become the general partner of EMS L.P. |
|
|
|
The holders of class B units of EMS L.P. will
contribute their units to the Company in exchange for shares of
class A common stock, and the holders of certain
class A units of EMS L.P. will contribute their units
to the Company in exchange for shares of class B common
stock. |
|
|
|
The balance of the class A units of EMS L.P., which
are held by certain of the Companys affiliates, will
continue to be held by those persons and will be designated
LP exchangeable units. |
|
|
|
The Company will issue the one share of class B special
voting stock to Onex Corporation, as trustee, to hold for the
benefit of the holders of the LP exchangeable units. |
As a result of this reorganization, EMS L.P. will become a
subsidiary of the Company, and the Company will treat
EMS L.P. as a consolidated subsidiary for financial
reporting purposes. The Company will then have outstanding three
classes of capital stock: class A common stock,
class B common stock and class B special voting stock.
EMS L.P. will have outstanding LP exchangeable units,
held by certain affiliates of the Company, and other partnership
units held by the Company, as the general partner and as a
limited partner. At the completion of the offering, the LP
exchangeable units will represent approximately 78% of the
equity interests in EMS L.P. and the Company will hold
approximately 22% of the equity interests in EMS L.P. The
LP exchangeable units will be exchangeable at any time, at
the option of the holder, for shares of class B common
stock on a one-for-one basis.
The Companys shares of class A common stock and
class B common stock will be identical except with respect
to voting rights and except that each share of class B
common stock may be converted into a share of class A
common stock at any time at the option of the holder. On every
matter properly submitted to stockholders for their vote, each
share of class A common stock will be entitled to one vote
per share and each share of class B common stock will be
entitled to ten votes per share, reducing to one vote per share
under certain limited circumstances. The one share of
class B special voting stock will be entitled to a number
of votes equal to the number of votes that could be cast if all
of the then outstanding LP exchangeable units were
exchanged for class B common stock.
Each of the LP exchangeable units will be a security of
EMS L.P. that, taking into account the following ancillary
rights, are substantially equivalent economically to a share of
class B common stock:
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the right to exchange those units, at the holders option,
for shares of class B common stock on a one-for-one basis, |
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the right to receive distributions, on a per unit basis, in
amounts (or property in the case of non-cash dividends) which
are the same as, or economically equivalent to, and which are
payable at the same time as, dividends declared on the
class B common stock (or dividends that would be required
to be declared if class B common stock were outstanding), |
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the right to vote, through the trustee holder of the
class B special voting stock, at all stockholder meetings
at which holders of the class B common stock or
class B special voting stock are entitled to vote, and |
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the right to participate on a pro rata basis with the
class B common stock in the distribution of assets of the
Company, upon specified events relating to the voluntary or
involuntary liquidation, dissolution, |
F-74
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winding up or other distribution of the assets through the
mandatory exchange of LP exchangeable units for shares of
class B common stock. |
In the EMS L.P. partnership agreement, the Company has
agreed to maintain the economic equivalency of the
LP exchangeable units and the class B common stock,
and the holders of the LP exchangeable units have no
general voting rights. The LP exchangeable units, when
considered with the class B special voting stock, have the
same rights, privileges and characteristics of the
Companys class B common stock. The
LP exchangeable units are intended to be economically
equivalent to the class B common stock of the Company in
that the LP exchangeable units carry the right to vote (by
virtue of the class B special voting stock) with the
holders of class B common stock as if one class, and
entitle holders to receive distributions only if the equivalent
dividends are declared on the Companys class B common
stock. Accordingly, the Company will account for the
LP exchangeable units as if the LP exchangeable units
were shares of its common stock, including reporting the LP
exchangeable units in the equity section of the Companys
balance sheet and including the number of outstanding
LP exchangeable units in both its basic and diluted
earnings per share calculations.
F-75
emsc
emergency medical services corporation
www.emsc.net |
________________________________________________________________________________
7,800,000 Shares
Emergency Medical Services
Corporation
Class A Common
Stock
Prospectus
,
2005
Joint Book-Running
Managers
Banc of America Securities
LLC
JPMorgan
CIBC World Markets
Credit Suisse First
Boston
Goldman, Sachs &
Co.
Scotia Capital
Utendahl
Until ,
2005, all dealers that buy, sell or trade the class A
common stock may be required to deliver a prospectus, regardless
of whether they are participating in this offering. This is in
addition to the dealers obligation to deliver a prospectus
when acting as underwriters and with respect to their unsold
allotments or subscriptions.
To: Holders
of Class B Units of Emergency Medical Services L.P.
From: Emergency Medical
Services Corporation
Date: December 2,
2005
We enclose a preliminary prospectus, dated December 2,
2005, that relates to the class A common stock of Emergency
Medical Services Corporation we intend to issue in exchange for
the outstanding class B units of Emergency Medical Services
L.P.
We will issue the class A common stock at the same time we
complete our initial public offering. We expect to complete our
offering later this year. You will receive 1.5 shares of
class A common stock in exchange for every class B
unit you own. This exchange will occur automatically, and you
do not have to take any action to complete this exchange.
Our class A common stock has been accepted for listing on
the New York Stock Exchange, subject to official notice of
issuance, under the symbol EMS.
After this exchange, you will continue to be subject to the
Equityholders Agreement you entered into when you purchased your
class B units. You may not sell or otherwise transfer
your class A common stock for a period of 180 days
from the date we issue the final prospectus for the exchange,
and certain class B unit holders are subject to additional
restrictions. See Description of Capital Stock
Equityholders Agreement in the prospectus. Accordingly, if
we complete our initial public offering in late December, you
will not be able to sell or transfer your class A common
stock until late June 2006.
This information in
this prospectus in not complete and may be changed. We may not
sell these securities until the registration statement filed
with the Securities and Exchange Commission is effective. This
prospectus is not an offer to sell these securities and is not
soliciting an offer to buy these securities in any state where
the offer or sale is not
permitted.
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SUBJECT TO COMPLETION, DATED DECEMBER 2,
2005
Prospectus
1,148,325 Shares
EMERGENCY MEDICAL SERVICES CORPORATION
Class A Common Stock
Pursuant to the terms of the Emergency Medical Services L.P.
agreement of limited partnership, Emergency Medical Services
Corporation is issuing 1,148,325 shares of class A
common stock in exchange for class B units of Emergency
Medical Services L.P. We are issuing this class A common
stock in connection with our formation as a holding company and
concurrently with the completion of our initial public offering.
The exchange of class B units for class A common stock
will occur automatically, and you do not have to take any action
to complete the exchange.
You may not sell the class A common stock you receive in
this exchange for a period of 180 days after the date of
the final prospectus for this exchange and our initial public
offering.
For a description of our formation as a holding company and the
issuance of our class A common stock in exchange for
class B units, see Summary The
Exchange and Formation of Holding Company. We
will issue 1.5 shares of class A common stock in
exchange for every class B unit. No public market currently
exists for our class A common stock.
WE ARE NOT ASKING YOU FOR A PROXY AND
YOU ARE REQUESTED NOT TO SEND US A PROXY.
Our class A common stock has been accepted for listing on
the New York Stock Exchange under the symbol EMS,
subject to official notice of issuance.
Investing in our class A common stock involves a high
degree of risk. See Risk Factors beginning on
page 11.
Neither the Securities and Exchange Commission nor any state
securities commission has approved or disapproved of these
securities or determined if this prospectus is truthful or
complete. Any representation to the contrary is a criminal
offense.
,
2005
You should rely only on the information contained in this
prospectus. We have not authorized anyone to provide you with
different information. We are not issuing these securities in
any jurisdiction where the issuance is not permitted. You should
assume that the information in this prospectus is accurate on
the date on the front cover of this prospectus only. Our
business, financial condition, results of operations and
prospects may have changed since that date.
TABLE OF CONTENTS
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F-1 |
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INDUSTRY AND MARKET DATA
The market data and other statistical information used
throughout this prospectus are based on independent industry
publications, government publications, reports by market
research firms or other published independent sources. Some data
are also based on our good faith estimates, which are derived
from our review of internal surveys, as well as the independent
sources listed above. Although we believe these sources are
reliable, we have not independently verified the information.
None of the independent industry publications used in this
prospectus were prepared on our or our affiliates behalf
and none of the sources cited in this prospectus consented to
the inclusion of any data from its reports, nor have we sought
their consent.
i
SUMMARY
This summary highlights selected information contained
elsewhere in this prospectus and does not contain all of the
information you need to consider in making your investment
decision. This summary is qualified in its entirety by the more
detailed information and the combined and consolidated financial
statements and notes thereto appearing elsewhere in this
prospectus. You should read carefully this entire prospectus and
should consider, among other things, the matters set forth in
the section entitled Risk Factors before deciding
whether to invest in our common stock.
Company Overview
Emergency Medical Services Corporation is a leading provider of
emergency medical services in the United States. We operate our
business and market our services under the AMR and EmCare
brands. AMR is the leading provider of ambulance services in the
United States, based on net revenue and number of transports.
EmCare is the leading provider of outsourced emergency
department staffing and related management services in the
United States, based on number of contracts with hospitals and
affiliated physician groups. Approximately 86% of our fiscal
2004 net revenue was generated under exclusive contracts.
For the fiscal year ended August 31, 2004, we generated net
revenue of $1.6 billion, of which AMR and EmCare
represented approximately 66% and 34%, respectively, and net
income of $37.3 million.
AMR. Over its 50 years of operating history, AMR has
developed the largest network of ambulance services in the
United States. AMR has an 8% share of the total ambulance
services market and a 21% share of the private provider
ambulance market, with net revenue approximately twice that of
our only national competitor. During fiscal 2004, AMR treated
and transported approximately 3.7 million patients in
34 states. AMR has approximately 2,855 contracts with
communities, government agencies, healthcare providers and
insurers to provide ambulance transport services. For fiscal
2004, approximately 57% of AMRs net revenue was generated
from emergency 911 ambulance services, 32% from non-emergency
ambulance services and the balance generated from the provision
of training, dispatch centers and other services to communities
and public safety agencies.
EmCare. Over its 33 years of operating history,
EmCare has become the largest provider of outsourced emergency
department staffing and related management services to
healthcare facilities. EmCare has a 6% share of the total
emergency department services market and a 9% share of the
outsourced emergency department services market, and has 32%
more emergency department staffing contracts than our principal
national competitor. In addition, EmCare has become one of the
leading providers of hospitalist services, the staffing of
physicians that specialize in the care of acutely ill patients
in an inpatient setting. During fiscal 2004, EmCare had
approximately 5.3 million patient visits in 38 states.
We contract with our hospital customers and our healthcare
professionals directly and through our affiliated physician
groups and managed companies. Through its 4,500 affiliated
physicians and 333 exclusive contracts with hospitals and
independent physician groups, EmCare provides emergency
department, hospitalist and radiology staffing, management and
other administrative services.
We are issuing our class A common stock in this exchange.
After completion of this exchange and our concurrent initial
public offering, we will have no material assets other than
direct ownership of approximately 22.1% of the equity interest
in Emergency Medical Services L.P., or EMS L.P., the
Delaware limited partnership that holds all of the capital stock
of AMR and EmCare. Onex Corporation and its affiliates will hold
the remaining 77.9% of our equity through their ownership of LP
exchangeable units in EMS L.P. The Onex entities will
control 97.7% of our voting power through our class B
special voting stock. Our only source of cash flow from
operations is distributions from EMS L.P. pursuant to the
partnership agreement.
Emergency Medical Services Industry
We operate in the ambulance and emergency department services
markets, two large and growing segments of the emergency medical
services market. Most communities are required by law to provide
emergency ambulance services and most hospitals are required to
provide emergency department services. Approximately 43% of all
hospital admissions originated from the emergency department in
2003, and a substantial portion of patients enter the hospital
by way of ambulance transport. We believe that growth in our
emergency medical services markets will continue due to
increased outsourcing for these services driven by
1
increased outpatient services and emergency department visits,
coupled with the need for enhanced technology, changes in
reimbursement rates and increased federal funding for disaster
preparedness and response.
Ambulance services encompass both 911 emergency response and
non-emergency transport services. We believe the ambulance
services market represents annual expenditures of approximately
$12 billion. The ambulance services market is highly
fragmented, with more than 14,000 private, public and
not-for-profit service providers accounting for an estimated
36 million ambulance transports in 2004. Given demographic
trends, we expect the total number of ambulance transports to
continue to grow at a steady rate of 1% to 2% per year.
We believe the physician reimbursement component of the
emergency department services market represents annual
expenditures of approximately $10 billion. There are
approximately 4,700 hospitals in the United States that operate
emergency departments, of which approximately 67% outsource
their physician staffing and management for this department. The
market for outsourced emergency department staffing and related
management services is highly fragmented, with more than
800 national, regional and local providers.
Competitive Strengths
We believe the following competitive strengths position our
company to capitalize on the favorable trends occurring within
the healthcare industry and the emergency medical services
markets.
Significant Scale and Geographic Presence. We believe our
significant scale and broad geographic presence provide a
competitive advantage over local and regional providers through
our: (i) broad program offering and cost efficiencies
generated by our technology investment, which may be too costly
for certain providers to replicate; (ii) national
contracting and preferred provider relationships with managed
care organizations and healthcare systems; and
(iii) ability to recruit and retain quality personnel.
Long-Term Relationships with Existing Customers. We
believe our long-term, well-established relationships with
communities and healthcare facilities enhance our ability to
retain existing customers and win new contracts. AMR and EmCare
have maintained relationships with their ten largest customers
for an average of 34 and 12 years, respectively. We believe
our industry-leading contract retention rates reflect our
ability to deliver on our service commitments to our customers
over extended time periods.
Strong Financial Performance. One of the key factors our
potential customers evaluate is financial stability. We believe
our ability to demonstrate consistently strong financial
performance will continue to differentiate our company and
provide a competitive advantage in winning new contracts and
renewing existing contracts.
Focus on Risk Management. Our risk management initiatives
are enhanced by the use of our professional liability claims
database and comprehensive claims management at EmCare, and by
our risk/safety program at AMR. Over the last three years, our
workers compensation, auto, general and professional liability
claims per 100,000 ambulance transports decreased 8.4% at AMR
and our professional liability claims per 100,000 emergency
department visits decreased 14.0% at EmCare.
Investment in Core Technologies. AMR uses proprietary
technology to improve chart documentation, determine
transportation service levels and track response times and other
data for hospitals. EmCare uses proprietary physician
recruitment software to improve recruitment efficiency and
retention rates.
Proven and Committed Management Team. We are led by an
experienced senior management team with an average of
21 years of experience in the healthcare industry. Our
Chairman and Chief Executive Officer, William Sanger, has over
30 years of experience within the healthcare services
industry, with leadership roles in numerous areas of healthcare.
2
Business Strategy
We intend to leverage Emergency Medical Services
competitive strengths to pursue our business strategy:
Increase Revenue from Existing Customers. We believe our
long track record of delivering excellent service and innovative
programs for both communities and hospitals, coupled with our
breadth of services, creates opportunities for us to increase
revenue from our existing customer base.
Grow Our Customer Base. We believe we have a unique
competency in the treatment, management and billing of episodic
and unscheduled care. We will continue to pursue additional
outsourcing opportunities for ambulance transports and emergency
department, hospitalist and radiology services and expanding our
public/private ambulance partnerships with local fire
departments.
Pursue Select Acquisition Opportunities. We plan to
pursue select acquisitions in our core businesses, explore the
acquisition of complementary businesses and seek opportunities
to expand the scope of services in which we can leverage our
core competencies.
Utilize Technology to Differentiate Our Services and Improve
Operating Efficiencies. We intend to continue to invest in
technologies that broaden our services in the marketplace,
improve patient care, enhance our billing efficiencies and
increase our profitability.
Continued Focus on Risk Management. We will continue to
conduct aggressive risk management programs for loss prevention
and early intervention. We will continue to develop and utilize
clinical fail safes and use technology in our
ambulances to reduce vehicular incidents.
Implement Cost Rationalization Initiatives. We will
continue to rationalize our cost structure by aligning
compensation with productivity and eliminating costs in our
national and regional corporate support structure.
Company History
In February 2005, an investor group led by Onex Partners LP and
Onex Corporation, and including members of our management,
purchased our operating subsidiaries AMR and
EmCare from Laidlaw International, Inc. Laidlaw had
acquired AMR and EmCare in 1997.
The purchase price for AMR and EmCare totaled
$828.8 million. We funded the purchase price and related
transaction costs with equity contributions of
$219.2 million, the issuance and sale of
$250.0 million principal amount of our senior subordinated
notes and borrowings under our senior secured credit facility,
including a term loan of $350.0 million and approximately
$20.2 million under our revolving credit facility. We
intend to use approximately $100.0 million of the net
proceeds from this offering to repay debt outstanding under our
senior secured credit facility.
Since completing our acquisition of AMR and EmCare, we have
operated through a holding company, EMS L.P., that is a limited
partnership. As described in Formation of Holding
Company, our new holding company will be a Delaware
corporation upon completion of this offering. This prospectus
gives effect to our reorganization.
The class A common stock we are selling in our initial
public offering will represent approximately 18.9% of our equity
and 2.3% of our combined voting power. Following this offering,
our initial equity investors, including management and entities
affiliated with Onex Corporation, will continue to own
approximately 81.1% of our equity and 97.7% of our combined
voting power. The Onex entities will hold their equity in the
form of LP exchangeable units in EMS L.P., which are
exchangeable on a one-for-one basis for shares of our
class B common stock, and they will have the benefit of the
voting rights attributable to that class B common stock
through one share of class B special voting stock. See
Formation of Holding Company. Our class B
common stock has ten votes per share and our class A common
stock has one vote per share.
3
In exchange for an annual management fee of $1.0 million,
an affiliate of Onex Corporation provides us with corporate
finance and strategic planning consulting services. Our
management agreement has an initial term ending
February 10, 2010, subject to automatic one-year renewals
unless terminated by either party by notice given at least
90 days prior to the scheduled expiration date. The annual
fee may be increased to up to $2.0 million upon approval of
majority of the members of each of AMRs and EmCares
board of directors who are not affiliated with Onex. We have no
other arrangements by which Onex affiliates will receive
payments or compensation from us other than on an equivalent
basis to class A stockholders. See Certain
Relationships and Related Party Transactions
Management Fee Agreement with Onex Partners Manager LP.
Risk Factors
Investing in our class A common stock involves risks. You
should refer to the section entitled Risk Factors
for a discussion of certain risks you should consider in
connection with the exchange of class A common stock for
your class B units.
Executive Offices
Our principal executive offices are located at
6200 S. Syracuse Way, Suite 200, Greenwood
Village, Colorado 80111 and our telephone number at that address
is (303) 495-1200. Our website address is
www.emsc.net. The website addresses for our business
segments are www.amr.net and www.emcare.com.
Information contained on these websites is not part of this
prospectus and is not incorporated in this prospectus by
reference.
4
The Exchange
Background of this exchange
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Companies involved in this exchange |
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Emergency Medical Services Corporation, a newly formed Delaware
corporation, or EMSC. |
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Emergency Medical Services L.P., a Delaware limited partnership,
or EMS L.P. |
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The exchange |
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1.5 shares of class A common stock of EMSC for each
class B unit of EMS L.P. |
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Reasons for this exchange |
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We structured our reorganization, as described under
Formation of Holding Company, to ensure that our
initial public offering will not result in a taxable event for
any of our equity holders. We have authorized this exchange so
that our class B unitholders will hold common stock that is
listed on the New York Stock Exchange, and will be freely
transferable under the Securities Act for holders who are not
our affiliates, rather than limited partnership interests that
generally are not transferable. |
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Vote required for this exchange |
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There is no vote or consent required of the class B
unitholders. This exchange has been authorized by the general
partner and the class A unitholders of EMS L.P., as
permitted by the agreement of limited partnership of EMS L.P. |
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Restrictions on transfer of class A common stock issued in
this exchange |
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You may not sell the class A common stock you receive in
this exchange for a period of 180 days after the date of
the final prospectus for this exchange and our initial public
offering. See Description of Capital Stock
Equityholder Agreements. |
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Interests of certain persons in this exchange |
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The management and directors of EMSC will participate in this
exchange on the same terms as are applicable to all class B
unitholders. The Onex entities, which hold the EMS L.P.
class A units, will continue to hold their limited
partnership units; these units will be designated LP
exchangeable units, and will be exchangeable on a one-for-one
basis for shares of class B common stock of EMSC. The Onex
entities will also have the benefit of one share of class B
special voting stock. |
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When this exchange will occur |
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Concurrently with the completion of our initial public offering
of class A common stock. |
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Conditions to this exchange |
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The only condition to this exchange is the completion of our
initial public offering. |
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Appraisal or dissenters rights |
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In connection with this exchange, a holder of class B units
is not entitled to any appraisal or dissenters rights
under Delaware law. |
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Ownership of EMS L.P. before and after this exchange |
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The Onex entities own 96.1% of the equity and 100% of the voting
power of EMS L.P., and will own 77.9% of the equity and no
voting power of EMS L.P. after this exchange. |
5
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Ownership of EMSC after this
exchange |
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The class B unitholders and the public stockholders will
own, in the aggregate, 22.1% of the equity and 3.0% of the
voting power of EMSC after this exchange, and the Onex entities
will own 96.6% of the voting power of EMSC. See the diagram in
the section captioned Formation of Holding Company. |
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Accounting treatment |
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The reorganization, including this exchange, will be accounted
for on a carryover basis. |
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Federal income tax consequences |
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This exchange will be treated as a tax-free contribution of the
class B units to EMSC for federal income tax purposes, and
holders will not recognize gain or loss on this exchange. See
Material U.S. Income Tax Considerations Tax
Consequences of the Exchange. |
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Our capitalization after this exchange and our initial public
offering |
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Class A common stock issued by us in this exchange |
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1,148,325 shares |
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Class A common stock offered by us in our concurrent
initial public offering |
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7,800,000 shares |
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Class A common stock outstanding after this exchange and
our concurrent initial public offering |
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8,948,325 shares |
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Use of proceeds |
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We will not receive any cash proceeds from this exchange. The
units representing limited partnership interests in
EMS L.P. that we receive in exchange for shares of our
class A common stock being issued in this exchange will be
held by us. |
We are issuing the shares of class A common stock described
in this prospectus in exchange for all of the outstanding
class B units of EMS L.P. Holders of class B
units will receive 1.5 shares of our class A common
stock in exchange for each class B unit of EMS L.P.
they hold. See Plan of Distribution.
The number of shares of class A common stock being issued
in this exchange and our initial public offering represents
21.8% of our common stock outstanding and 3.0% of our combined
voting power. The number of shares of our common stock to be
outstanding after this exchange and our initial public offering
excludes the 32,107,500 shares of class B common stock
issuable on exchange of the LP exchangeable units and the
3,509,219 shares of class A common stock issuable upon
the exercise of options.
Following this exchange and our initial public offering, we will
have the following securities outstanding:
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8,948,325 shares of class A common stock, |
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142,545 shares of class B common stock, |
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one share of class B special voting stock, and |
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32,107,500 LP exchangeable units of EMS L.P. |
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At any time at the option of the holder:
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each LP exchangeable unit is exchangeable into one share of
class B common stock, and |
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each share of class B common stock is convertible into one
share of class A common stock. |
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6
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Our securities are entitled to vote on all matters subject to a
vote of holders of common stock, voting together as a single
class, as follows: |
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class A common stock is entitled to one vote per share, |
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class B common stock is entitled to ten votes per share
(reducing to one vote per share under certain limited
circumstances), and |
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one share of class B special voting stock, held for the
benefit of the holders of LP exchangeable units, is entitled to
a number of votes equal to the number of votes that could be
cast if all the then outstanding LP exchangeable units were
exchanged for class B common stock. |
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The holders of the LP exchangeable units may therefore exercise
voting rights with respect to Emergency Medical Services as
though they held the same number of shares of our class B
common stock.
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Except as otherwise indicated, all of the information presented
in this prospectus assumes the following: |
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our formation as a holding company named Emergency Medical
Services Corporation, as described under Formation of
Holding Company, |
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the anticipated 1.5-for-1 stock split based upon an assumed
initial public offering price of $16.00 per share, which is
the mid-point of the range set forth in the cover page of the
preliminary prospectus for our initial public offering, and |
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no exercise of the underwriters over-allotment option in
our initial public offering. |
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References in this prospectus to the offering,
our offering and this offering refer to
our initial public offering of class A common stock being
made concurrently with this exchange. This exchange will be
completed only if our initial public offering is completed.
7
Summary of Historical Combined, Consolidated and Pro Forma
Consolidated Financial Information and Other Data
The summary combined financial data of AMR and EmCare for the
year ended August 31, 2002 (Predecessor
Pre-Laidlaw Bankruptcy), the nine months ended May 31, 2003
(Predecessor Pre-Laidlaw Bankruptcy), and as of and
for the three months ended August 31, 2003
(Predecessor Post-Laidlaw Bankruptcy), the year
ended August 31, 2004 (Predecessor Post-Laidlaw
Bankruptcy) and the five months ended January 31, 2005
(Predecessor Post-Laidlaw Bankruptcy) are derived
from our audited combined historical financial statements
included in this prospectus. As a result of a correction to
AMRs method of calculating its accounts receivable
allowances, we determined that the allowances were understated
at various balance sheet dates. The audited combined financial
statements included in this prospectus are restated to correct
this error. There were no adjustments necessary to income
subsequent to May 31, 2003.
The summary combined historical financial data for the five
months ended January 31, 2004 (Predecessor
Post-Laidlaw Bankruptcy) and the three months and eight months
ended September 30, 2004 (Predecessor
Post-Laidlaw Bankruptcy) are derived from the unaudited combined
historical financial statements included in this prospectus. The
summary consolidated financial data for the three months and
eight months ended September 30, 2005 (Successor) are
derived from the unaudited consolidated historical financial
statements included elsewhere in this prospectus. The interim
financial statements include, in the opinion of management, all
adjustments, consisting of normal accruals, necessary for a fair
presentation of the information for those periods. The results
of operations for the interim periods may not be indicative of
results that may be expected for the full fiscal year.
The summary pro forma consolidated financial information and
other data for the year ended August 31, 2004, the five
months ended January 31, 2005 and the eight months ended
September 30, 2005 reflect the acquisition of AMR and
EmCare by Emergency Medical Services and the completion of this
offering, and should be read in conjunction with our unaudited
pro forma consolidated financial statements included elsewhere
in this prospectus which, with respect to statement of
operations data, give effect to the acquisition and this
offering as if they occurred as of September 1, 2003,
September 1, 2004 and February 1, 2005, respectively,
and with respect to balance sheet data, give effect to this
offering as if it occurred as of September 30, 2005. The
unaudited pro forma consolidated financial information is
presented for informational purposes only and does not purport
to represent what our results of operations would have been if
our acquisition of AMR and EmCare and this offering had occurred
as of the dates indicated or what such results will be for
future periods.
Effective as of January 31, 2005, we acquired AMR and
EmCare from Laidlaw and, in connection with the acquisition, we
changed our fiscal year to December 31 from August 31. For all
periods prior to the acquisition, the AMR and EmCare businesses
formerly owned by Laidlaw are referred to as the
Predecessor. For all periods from and subsequent to
the acquisition, these businesses are referred to as the
Successor. As a result of the acquisition, we
include as a reporting period of the Predecessor our
pre-acquisition period ended January 31, 2005.
You should read the summary information in conjunction with
Selected Combined and Consolidated Financial Information
and Other Data, Unaudited Pro Forma Consolidated
Financial Data, Managements Discussion and
Analysis of Financial Condition and Results of Operations
and the combined and consolidated financial statements and
related notes included in this prospectus.
8
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Predecessor (Pre-Acquisition) | |
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|
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| |
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| |
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(Pre-Laidlaw | |
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|
|
Bankruptcy) | |
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As Restated | |
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|
(Post-Laidlaw Bankruptcy) | |
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| |
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| |
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|
Successor (Post-Acquisition) | |
|
Unaudited Pro Forma | |
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Nine | |
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Three | |
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Months | |
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Months | |
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Five Months Ended | |
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Three Months | |
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Eight Months | |
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|
Three Months | |
|
Eight Months | |
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Five Months | |
|
Eight Months | |
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|
Year Ended | |
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Ended | |
|
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Ended | |
|
Year Ended | |
|
January 31, | |
|
Ended | |
|
Ended | |
|
|
Ended | |
|
Ended | |
|
Year Ended | |
|
Ended | |
|
Ended | |
|
|
August 31, | |
|
May 31, | |
|
|
August 31, | |
|
August 31, | |
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| |
|
September 30, | |
|
September 30, | |
|
|
September 30, | |
|
September 30, | |
|
August 31, | |
|
January 31, | |
|
September 30, | |
|
|
2002 | |
|
2003 | |
|
|
2003 | |
|
2004 | |
|
2004 | |
|
2005 | |
|
2004 | |
|
2004 | |
|
|
2005 | |
|
2005 | |
|
2004 | |
|
2005 | |
|
2005 | |
|
|
| |
|
| |
|
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| |
|
| |
|
| |
|
| |
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|
| |
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(unaudited) | |
|
|
|
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|
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|
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(unaudited) | |
|
|
(unaudited) | |
|
|
|
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|
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(dollars in thousands) | |
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Statement of Operations Data:
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|
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|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Net revenue
|
|
$ |
1,415,786 |
|
|
$ |
1,103,335 |
|
|
|
$ |
384,461 |
|
|
$ |
1,604,598 |
|
|
$ |
667,506 |
|
|
$ |
696,179 |
|
|
$ |
413,869 |
|
|
$ |
1,077,749 |
|
|
|
$ |
456,245 |
|
|
$ |
1,187,653 |
|
|
$ |
1,604,598 |
|
|
$ |
696,179 |
|
|
$ |
1,187,653 |
|
Compensation and benefits
|
|
|
960,590 |
|
|
|
757,183 |
|
|
|
|
264,604 |
|
|
|
1,117,890 |
|
|
|
461,923 |
|
|
|
481,305 |
|
|
|
286,628 |
|
|
|
751,238 |
|
|
|
|
319,292 |
|
|
|
822,595 |
|
|
|
1,117,890 |
|
|
|
481,305 |
|
|
|
822,595 |
|
Operating expenses
|
|
|
219,321 |
|
|
|
163,447 |
|
|
|
|
55,212 |
|
|
|
218,277 |
|
|
|
90,828 |
|
|
|
94,882 |
|
|
|
55,863 |
|
|
|
147,524 |
|
|
|
|
66,156 |
|
|
|
168,700 |
|
|
|
218,277 |
|
|
|
94,882 |
|
|
|
168,700 |
|
Insurance expense
|
|
|
66,479 |
|
|
|
69,576 |
|
|
|
|
34,671 |
|
|
|
80,255 |
|
|
|
36,664 |
|
|
|
39,002 |
|
|
|
18,404 |
|
|
|
51,674 |
|
|
|
|
21,048 |
|
|
|
60,382 |
|
|
|
80,255 |
|
|
|
39,002 |
|
|
|
60,382 |
|
Selling, general and administrative expenses
|
|
|
61,455 |
|
|
|
37,867 |
|
|
|
|
12,017 |
|
|
|
47,899 |
|
|
|
22,016 |
|
|
|
21,635 |
|
|
|
12,093 |
|
|
|
31,270 |
|
|
|
|
15,654 |
|
|
|
38,248 |
|
|
|
47,899 |
|
|
|
21,635 |
|
|
|
38,248 |
|
Laidlaw fees and compensation charges
|
|
|
5,400 |
|
|
|
4,050 |
|
|
|
|
1,350 |
|
|
|
15,449 |
|
|
|
6,436 |
|
|
|
19,857 |
|
|
|
3,657 |
|
|
|
10,095 |
|
|
|
|
|
|
|
|
|
|
|
|
15,449 |
|
|
|
19,857 |
|
|
|
|
|
Depreciation and amortization expenses
|
|
|
67,183 |
|
|
|
32,144 |
|
|
|
|
12,560 |
|
|
|
52,739 |
|
|
|
22,079 |
|
|
|
18,808 |
|
|
|
12,669 |
|
|
|
34,627 |
|
|
|
|
14,843 |
|
|
|
38,811 |
|
|
|
55,869 |
|
|
|
23,232 |
|
|
|
38,811 |
|
Impairment losses
|
|
|
262,780 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Restructuring charges
|
|
|
3,777 |
|
|
|
1,288 |
|
|
|
|
1,449 |
|
|
|
2,115 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
1,381 |
|
|
|
|
|
|
|
|
|
|
|
|
2,115 |
|
|
|
|
|
|
|
|
|
Laidlaw reorganization charges
|
|
|
8,761 |
|
|
|
3,650 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Income (loss) from operations
|
|
|
(239,960 |
) |
|
|
34,130 |
|
|
|
|
2,598 |
|
|
|
69,974 |
|
|
|
27,560 |
|
|
|
20,690 |
|
|
|
24,555 |
|
|
|
49,940 |
|
|
|
|
19,252 |
|
|
|
58,917 |
|
|
|
66,844 |
|
|
|
16,266 |
|
|
|
58,917 |
|
Interest expense
|
|
|
(6,418 |
) |
|
|
(4,691 |
) |
|
|
|
(908 |
) |
|
|
(9,961 |
) |
|
|
(4,137 |
) |
|
|
(5,644 |
) |
|
|
(5,138 |
) |
|
|
(8,679 |
) |
|
|
|
(12,824 |
) |
|
|
(34,407 |
) |
|
|
(47,051 |
) |
|
|
(18,555 |
) |
|
|
(29,895 |
) |
Realized gain (loss) on investments
|
|
|
|
|
|
|
|
|
|
|
|
90 |
|
|
|
(1,140 |
) |
|
|
|
|
|
|
|
|
|
|
(1,140 |
) |
|
|
(1,191 |
) |
|
|
|
(34 |
) |
|
|
(40 |
) |
|
|
(1,140 |
) |
|
|
|
|
|
|
(40 |
) |
Interest and other income
|
|
|
369 |
|
|
|
304 |
|
|
|
|
22 |
|
|
|
240 |
|
|
|
1,403 |
|
|
|
714 |
|
|
|
162 |
|
|
|
210 |
|
|
|
|
91 |
|
|
|
189 |
|
|
|
240 |
|
|
|
714 |
|
|
|
189 |
|
Fresh-start accounting adjustments(1)
|
|
|
|
|
|
|
46,416 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Income (loss) before income taxes and cumulative change in
accounting principle
|
|
|
(246,009 |
) |
|
|
76,159 |
|
|
|
|
1,802 |
|
|
|
59,113 |
|
|
|
24,826 |
|
|
|
15,760 |
|
|
|
18,439 |
|
|
|
40,280 |
|
|
|
|
6,485 |
|
|
|
24,659 |
|
|
|
18,893 |
|
|
|
(1,575 |
) |
|
|
29,171 |
|
Income tax expense
|
|
|
(1,374 |
) |
|
|
(829 |
) |
|
|
|
(8,633 |
) |
|
|
(21,764 |
) |
|
|
(9,800 |
) |
|
|
(6,278 |
) |
|
|
(7,191 |
) |
|
|
(15,710 |
) |
|
|
|
(3,479 |
) |
|
|
(10,657 |
) |
|
|
(5,764 |
) |
|
|
629 |
|
|
|
(12,462 |
) |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Income (loss) before cumulative effect of a change in accounting
principle
|
|
|
(247,383 |
) |
|
|
75,330 |
|
|
|
|
(6,831 |
) |
|
|
37,349 |
|
|
|
15,026 |
|
|
|
9,482 |
|
|
|
11,248 |
|
|
|
24,570 |
|
|
|
|
3,006 |
|
|
|
14,002 |
|
|
|
13,129 |
|
|
|
(946 |
) |
|
|
16,709 |
|
Cumulative effect of a change in accounting principle(2)
|
|
|
|
|
|
|
(223,721 |
) |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Net income (loss)
|
|
$ |
(247,383 |
) |
|
$ |
(148,391 |
) |
|
|
$ |
(6,831 |
) |
|
$ |
37,349 |
|
|
$ |
15,026 |
|
|
$ |
9,482 |
|
|
$ |
11,248 |
|
|
$ |
24,570 |
|
|
|
$ |
3,006 |
|
|
$ |
14,002 |
|
|
$ |
13,129 |
|
|
$ |
(946 |
) |
|
$ |
16,709 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Predecessor (Pre-Acquisition) | |
|
|
|
|
|
|
|
|
|
|
|
|
|
| |
|
|
| |
|
|
|
|
|
|
|
|
|
|
|
|
|
(Pre-Laidlaw | |
|
|
|
|
|
|
|
Successor | |
|
|
|
|
|
|
|
|
Bankruptcy) | |
|
|
|
|
|
|
|
(Post- | |
|
|
|
|
|
|
|
|
As Restated | |
|
|
(Post-Laidlaw Bankruptcy) | |
|
|
|
|
Acquisition) | |
|
|
|
|
|
|
|
|
| |
|
|
| |
|
|
|
|
| |
|
|
|
|
|
|
|
|
|
|
Nine | |
|
|
Three | |
|
|
|
|
|
|
|
|
|
|
Eight | |
|
|
|
|
|
|
|
|
Year | |
|
Months | |
|
|
Months | |
|
Year | |
|
Five Months Ended | |
|
|
|
Eight Months | |
|
|
|
|
Months | |
|
|
|
|
|
|
|
|
Ended | |
|
Ended | |
|
|
Ended | |
|
Ended | |
|
January 31, | |
|
|
|
Ended | |
|
|
|
|
Ended | |
|
|
|
|
|
|
|
|
August 31, | |
|
May 31, | |
|
|
August 31, | |
|
August 31, | |
|
| |
|
|
|
September 30, | |
|
|
|
|
September 30, | |
|
|
|
|
|
|
|
|
2002 | |
|
2003 | |
|
|
2003 | |
|
2004 | |
|
2004 | |
|
2005 | |
|
|
|
2004 | |
|
|
|
|
2005 | |
|
|
|
|
|
|
|
|
| |
|
| |
|
|
| |
|
| |
|
| |
|
| |
|
|
|
| |
|
|
|
|
| |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
(unaudited) | |
|
|
|
|
|
(unaudited) | |
|
|
|
|
(unaudited) | |
|
|
|
|
|
|
|
|
|
|
|
|
|
(dollars in thousands) | |
|
|
|
|
|
|
|
|
|
|
|
Other Financial Data:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Cash flow provided by (used in):
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Operating activities
|
|
$ |
156,544 |
|
|
$ |
58,769 |
|
|
|
$ |
30,009 |
|
|
$ |
127,679 |
|
|
$ |
18,627 |
|
|
$ |
15,966 |
|
|
|
|
|
|
$ |
99,961 |
|
|
|
|
|
|
|
$ |
108,462 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Investing activities
|
|
|
(57,347 |
) |
|
|
(98,835 |
) |
|
|
|
(15,136 |
) |
|
|
(81,516 |
) |
|
|
(10,881 |
) |
|
|
(21,667 |
) |
|
|
|
|
|
|
(73,910 |
) |
|
|
|
|
|
|
|
(917,422 |
) |
|
|
|
|
|
|
|
|
|
|
|
|
|
Financing activities
|
|
|
(36,066 |
) |
|
|
(8,060 |
) |
|
|
|
(47,222 |
) |
|
|
(47,328 |
) |
|
|
(7,532 |
) |
|
|
10,856 |
|
|
|
|
|
|
|
(20,699 |
) |
|
|
|
|
|
|
|
804,442 |
|
|
|
|
|
|
|
|
|
|
|
|
|
Capital expenditures
|
|
|
57,438 |
(3) |
|
|
34,768 |
|
|
|
|
18,079 |
|
|
|
42,787 |
|
|
|
14,224 |
|
|
|
14,045 |
|
|
|
|
|
|
|
(30,217 |
) |
|
|
|
|
|
|
|
34,947 |
|
|
|
|
|
|
|
|
|
|
|
|
|
EBITDA(4)
|
|
$ |
(172,777 |
) |
|
$ |
(111,031 |
)(5) |
|
|
$ |
15,428 |
|
|
$ |
121,753 |
|
|
$ |
49,639 |
|
|
|
39,498 |
|
|
|
|
|
|
|
83,376 |
|
|
|
|
|
|
|
|
97,688 |
|
|
|
|
|
|
|
|
|
|
|
|
|
EBITDA, as adjusted(4) |
|
$ |
59,355 |
|
|
|
|
|
|
$ |
94,852 |
|
|
|
|
|
|
|
$ |
102,948 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
As of September 30, 2005 | |
|
|
| |
|
|
Consolidated | |
|
Pro Forma | |
|
|
| |
|
| |
Balance Sheet Data:
|
|
|
|
|
|
|
|
|
Cash and cash equivalents
|
|
$ |
10,113 |
|
|
$ |
21,677 |
|
Total assets
|
|
|
1,253,408 |
|
|
|
1,261,994 |
|
Long-term debt and capital lease obligations, including current
maturities
|
|
|
608,607 |
|
|
|
508,607 |
|
Partners/ Stockholders equity
|
|
$ |
235,534 |
|
|
$ |
345,333 |
|
Financial Covenant Ratios(6):
|
|
|
|
|
|
|
|
|
Total leverage ratio
|
|
|
4.05 |
|
|
|
3.39 |
|
Senior leverage ratio
|
|
|
2.39 |
|
|
|
1.72 |
|
Fixed charge coverage ratio
|
|
|
1.64 |
|
|
|
1.70 |
|
|
|
(1) |
See note 1 to our combined financial statements with
respect to our fresh-start financial reporting. |
(2) |
Reflects an impairment of goodwill recorded in connection with
the adoption of SFAS No. 142. |
(3) |
Includes $26.3 million financed through capital leases. |
(4) |
EBITDA represents net income (loss) before interest expense,
net, income tax expense and depreciation and amortization
expenses. Adjusted EBITDA represents EBITDA adjusted to remove
the effect of the Laidlaw allocations of management fees and
compensation charges, insurance expenses, rebates and
reorganization costs, Onex management fees and certain
non-recurring items. Management routinely calculates EBITDA and
uses it to allocate resources. Management believes that EBITDA
is a useful measure to investors because it is commonly used as
an analytical indicator within the healthcare industry to
evaluate operational performance, leverage capacity and ability
to service debt. |
9
|
|
|
|
|
Adjusted EBITDA is used as a
measure for various financial covenants in our senior secured
credit facility, and we use adjusted EBITDA as a measure for
incentive compensation purposes. EBITDA and adjusted EBITDA
should not be considered in isolation or as an alternative to
net income, cash flows generated by operating, investing or
financing activities or other financial statement data presented
in the combined and consolidated financial statements as an
indicator of financial performance or liquidity. EBITDA and
adjusted EBITDA, as presented, may not be comparable to
similarly titled measures of other companies.
|
The following table reconciles EBITDA and EBITDA, as adjusted to
net income (loss):
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Predecessor (Pre-Acquisition) | |
|
|
|
|
|
| |
|
|
| |
|
|
|
|
|
(Pre-Laidlaw | |
|
|
|
|
|
|
|
|
Bankruptcy) | |
|
|
|
|
|
|
|
|
As Restated | |
|
|
(Post-Laidlaw Bankruptcy) | |
|
|
|
|
|
| |
|
|
| |
|
|
Successor | |
|
|
|
|
|
|
|
|
(Post-Acquisition) | |
|
|
|
|
|
|
|
|
|
|
|
|
| |
|
|
|
|
Nine | |
|
|
Three | |
|
|
|
Five Months | |
|
|
|
|
|
|
|
|
|
Months | |
|
|
Months | |
|
|
|
Ended | |
|
Eight Months | |
|
|
Eight Months | |
|
|
Year Ended | |
|
Ended | |
|
|
Ended | |
|
Year Ended | |
|
January 31, | |
|
Ended | |
|
|
Ended | |
|
|
August 31, | |
|
May 31, | |
|
|
August 31, | |
|
August 31, | |
|
| |
|
September 30, | |
|
|
September 30, | |
|
|
2002 | |
|
2003 | |
|
|
2003 | |
|
2004 | |
|
2004 | |
|
2005 | |
|
2004 | |
|
|
2005 | |
|
|
| |
|
| |
|
|
| |
|
| |
|
| |
|
| |
|
| |
|
|
| |
Combined/Consolidated Results:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Net income (loss)
|
|
$ |
(247,383 |
) |
|
$ |
(148,391 |
) |
|
|
$ |
(6,831 |
) |
|
$ |
37,349 |
|
|
$ |
15,026 |
|
|
$ |
9,482 |
|
|
$ |
24,570 |
|
|
|
$ |
14,002 |
|
Depreciation and amortization expenses
|
|
|
67,183 |
|
|
|
32,144 |
|
|
|
|
12,560 |
|
|
|
52,739 |
|
|
|
22,079 |
|
|
|
18,808 |
|
|
|
34,627 |
|
|
|
|
38,811 |
|
Interest expense
|
|
|
6,418 |
|
|
|
4,691 |
|
|
|
|
908 |
|
|
|
9,961 |
|
|
|
4,137 |
|
|
|
5,644 |
|
|
|
8,679 |
|
|
|
|
34,407 |
|
Interest and other income
|
|
|
(369 |
) |
|
|
(304 |
) |
|
|
|
(22 |
) |
|
|
(240 |
) |
|
|
(1,403 |
) |
|
|
(714 |
) |
|
|
(210 |
) |
|
|
|
(189 |
) |
Income tax expense
|
|
|
1,374 |
|
|
|
829 |
|
|
|
|
8,633 |
|
|
|
21,764 |
|
|
|
9,800 |
|
|
|
6,278 |
|
|
|
15,710 |
|
|
|
|
10,657 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
EBITDA(a)
|
|
$ |
(172,777 |
) |
|
$ |
(111,031 |
) |
|
|
$ |
15,248 |
|
|
$ |
121,573 |
|
|
$ |
49,639 |
|
|
|
39,498 |
|
|
|
83,376 |
|
|
|
|
97,688 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Laidlaw fees and compensation charges
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
19,857 |
|
|
|
10,095 |
|
|
|
|
|
|
Onex management fee
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
667 |
|
Transaction related costs
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
2,131 |
|
Non-cash charges
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
2,462 |
|
Restructuring charges
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
1,381 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
EBITDA, as adjusted
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
$ |
59,355 |
|
|
$ |
94,852 |
|
|
|
$ |
102,948 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
(a) |
EBITDA for periods presented includes Laidlaws allocation
to us of fees and compensation charges, insurance expenses and
rebates and reorganization costs. Laidlaws allocations to
us of fees and compensation charges and of reorganization costs
are based on allocations among all of Laidlaws business
units based on revenues, plus an additional amount allocated to
us in respect of a one-time compensation expense related to the
changes in the enterprise values of AMR and EmCare.
Laidlaws allocation to us of insurance expense and rebates
is based on an allocation of investment income of Laidlaws
captive insurance subsidiary among all of Laidlaws
business units based on revenues, and an allocation of claims
among Laidlaws business units based on each business
units claims experience. We do not believe that
Laidlaws allocation of these expenses and rebates are
predictive of expenses and rebates we expect to incur as a
stand-alone company in respect of management services or for
comparable stand-alone insurance costs. Laidlaws
allocation of these expenses and rebates for the historical
periods presented were as follows: |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Predecessor (Pre-Acquisition) | |
|
|
| |
|
|
| |
|
|
(Pre-Laidlaw | |
|
|
|
|
|
Bankruptcy) | |
|
|
(Post-Laidlaw Bankruptcy) | |
|
|
| |
|
|
| |
|
|
|
|
Nine | |
|
|
Three | |
|
|
|
|
|
|
|
|
Year | |
|
Months | |
|
|
Months | |
|
Year | |
|
Five Months Ended | |
|
Three Months | |
|
Eight Months | |
|
|
Ended | |
|
Ended | |
|
|
Ended | |
|
Ended | |
|
January 31, | |
|
Ended | |
|
Ended | |
|
|
August 31, | |
|
May 31, | |
|
|
August 31, | |
|
August 31, | |
|
| |
|
September 30, | |
|
September 30, | |
|
|
2002 | |
|
2003 | |
|
|
2003 | |
|
2004 | |
|
2004 | |
|
2005 | |
|
2004 | |
|
2004 | |
|
|
| |
|
| |
|
|
| |
|
| |
|
| |
|
| |
|
| |
|
| |
|
|
|
|
|
|
|
|
|
|
|
(unaudited) | |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
(unaudited) | |
|
|
(dollars in thousands) | |
Laidlaw insurance expense (rebate)(a)
|
|
$ |
(8,094 |
) |
|
$ |
3,058 |
|
|
|
$ |
11,522 |
|
|
$ |
(4,505 |
) |
|
$ |
|
|
|
$ |
|
|
|
$ |
|
|
|
$ |
|
|
Laidlaw fees and compensation charges
|
|
|
5,400 |
|
|
|
4,050 |
|
|
|
|
1,350 |
|
|
|
15,449 |
(b) |
|
|
6,436 |
|
|
|
19,857 |
(c) |
|
|
3,657 |
|
|
|
10,095 |
|
Laidlaw reorganization costs
|
|
|
8,761 |
|
|
|
3,650 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Total Laidlaw allocated expense
|
|
$ |
6,067 |
|
|
$ |
10,758 |
|
|
|
$ |
12,872 |
|
|
$ |
10,944 |
|
|
$ |
6,436 |
|
|
$ |
19,857 |
|
|
$ |
3,657 |
|
|
$ |
10,095 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
(a) |
Included in Insurance expense in our combined
statements of operations. |
|
|
(b) |
Includes compensation charges of $4.1 million. |
|
|
|
We estimate that the costs we will incur in respect of
management services and other costs as a stand-alone company
will total approximately $4.0 million a year. See note
(1) to the unaudited pro forma consolidated statement of
operations for the five months ended January 31, 2005
and the year ended August 31, 2004 in Unaudited Pro
Forma Consolidated Financial Data. We incurred
$1.9 million of such costs in the eight months ended
September 30, 2005, excluding costs related to our
acquisition of AMR and EmCare. |
|
|
|
|
(c) |
Includes compensation charges of $15.3 million. |
|
|
(5) |
Includes $46.4 million relating to the fresh-start
accounting adjustment and $(223.7) million relating to the
cumulative effect of a change in accounting principle. |
|
(6) |
Represents financial covenant coverages, calculated in
accordance with our senior secured credit facility. See
Managements Discussion and Analysis of Financial
Condition and Results of Operations Liquidity and
Capital Resources Debt Facilities for
information with respect to required coverages at
September 30, 2005 and the calculation of these ratios. |
10
RISK FACTORS
An investment in our class A common stock involves a high
degree of risk. You should carefully consider the factors
described below in addition to the other information set forth
in this prospectus. Additional risks and uncertainties not
presently known to us or that we currently believe to be
immaterial may also materially and adversely affect our business
operations. Any of the following risks could materially
adversely affect our business, financial condition or results of
operations. In such case, you may lose all or part of your
original investment.
Risk Factors Related to our Capital Structure
The interests of our controlling stockholders may conflict
with your interests.
Following this exchange and our offering, Onex Partners LP and
other entities affiliated with Onex Corporation, which we refer
to together as the Onex entities, will own all of our
outstanding LP exchangeable units, which are exchangeable at any
time, at the option of the holder, for our class B common
stock. Our class A common stock has one vote per share,
while our class B common stock has ten votes per share
(reducing to one vote per share under certain limited
circumstances), on all matters to be voted on by our
stockholders. Prior to the exchange for class B common
stock, the holders of the LP exchangeable units will be able to
exercise the same voting rights with respect to Emergency
Medical Services as they would have after the exchange through a
share of class B special voting stock. As a result, after
this exchange and our offering, the Onex entities will control
96.6% of our combined voting power. Accordingly, the Onex
entities will exercise a controlling influence over our business
and affairs and will have the power to determine all matters
submitted to a vote of our stockholders, including the election
of directors, the removal of directors and approval of
significant corporate transactions such as amendments to our
certificate of incorporation, mergers and the sale of all or
substantially all of our assets. The Onex entities could cause
corporate actions to be taken even if the interests of these
entities conflict with the interests of our other stockholders.
This concentration of voting power could have the effect of
deterring or preventing a change in control of Emergency Medical
Services that might otherwise be beneficial to our stockholders.
Gerald W. Schwartz, the Chairman, President and Chief Executive
Officer of Onex Corporation, owns shares representing a majority
of the voting rights of the shares of Onex Corporation. See
Principal and Selling Stockholders,
Description of Capital Stock and Limited
Partnership Agreement of Emergency Medical Services L.P.
Onex has the voting power to elect our entire board of
directors and to remove any director or our entire board without
cause.
Although our current board includes independent
directors, so long as the Onex entities control more than
50% of our combined voting power we are exempt from the NYSE
rule that requires that a board be comprised of a majority of
independent directors. Onex may have a controlling
influence over our board, as Onex has sufficient voting power to
elect the entire board, and our certificate of incorporation
permits stockholders to remove directors at any time with or
without cause.
As a holding company, our only material asset is our
equity interest in EMS L.P. and our only source of revenue is
distributions from EMS L.P. Because the Onex entities have the
voting power to control our board of directors, they could
influence us, as the general partner of EMS L.P., to take action
at the level of EMS L.P. that would benefit the Onex entities
and conflict with the interests of our class A
stockholders.
We are a holding company, and we will have no material assets
other than our direct ownership of an approximately 22% equity
interest in EMS L.P. EMS L.P. will also be our only source of
cash flow from operations. The Onex entities hold their equity
interest in us through LP exchangeable units of EMS L.P. As our
controlling stockholder, Onex could limit distributions to us
from EMS L.P., and could cause us to amend the EMS L.P.
partnership agreement in a manner that would be beneficial to
the Onex entities, as limited partners of EMS L.P., and
detrimental to our class A stockholders.
Any decrease in our distributions from EMS L.P. would have a
negative effect on our cash flow. In order to minimize this
conflict, the EMS L.P. partnership agreement requires that the
partnership reimburse
11
us for all of our expenses, including all employee costs and the
expenses we incur as a public company, and provides further that
no distributions may be made to the Onex entities, as the
holders of LP exchangeable units, unless we make pay an
economically equivalent dividend to all holders of our common
stock.
The EMS L.P. partnership agreement provides that amendments to
that agreement may only be proposed and authorized by us, as the
general partner. The Onex entities could seek to influence our
boards action with respect to any amendment and we, as the
general partner of EMS L.P., owe a fiduciary duty to the limited
partners of the partnership. Our board also owes a fiduciary
duty to our common stockholders. Because of the inherent
conflict of interest we face between our fiduciary duty to our
stockholders, including our class A stockholders, and the Onex
entities, as limited partners in EMS L.P., the EMS L.P.
partnership agreement provides that, if there is any conflict
between the interests of the limited partners and our common
stockholders, our board may, in the exercise of its business
judgment, cause us to act in the best interests of our
stockholders.
We are party to a management agreement with an affiliate
of Onex which permits us to increase substantially the fee we
pay to that affiliate.
The management agreement between our subsidiaries, AMR and
EmCare, and an Onex affiliate provides that the annual fee may
be increased from $1.0 million to $2.0 million, which
amount represents a significant percentage of our net income.
Such an increase would be detrimental to the interests of our
class A stockholders if the fee were disproportionate to the
benefit we derive from the services the Onex affiliate performs.
In order to minimize this potential conflict of interest, the
agreement requires that any increase in the fee be approved by a
majority of the members of the boards of AMR and EmCare who are
not affiliated with Onex. As long as the Onex entities control
more than 50% of our combined voting power, they may be able to
exercise a controlling influence over the election of the boards
of AMR and EmCare. See Certain Relationships and Related
Party Transactions Management Fee Agreement with
Onex Partners Manager LP.
Our substantial indebtedness could adversely affect our
financial condition and our ability to operate our
business.
We have a substantial amount of debt. At September 30,
2005, we had total debt of $608.6 million, including
$348.3 million of borrowings under the term loan portion of
our senior secured credit facility, $250.0 million of our
senior subordinated notes, $5.0 million of borrowings under
our revolving credit facility and $4.4 million of capital
lease obligations, and we had $27.3 million of letters of
credit outstanding. In addition, subject to restrictions in the
indenture governing our notes and the credit agreement governing
our senior secured credit facility, we may incur additional debt.
Our substantial debt could have important consequences to you,
including the following:
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it may be difficult for us to satisfy our obligations, including
debt service requirements under our outstanding debt, |
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our ability to obtain additional financing for working capital,
capital expenditures, debt service requirements or other general
corporate purposes may be impaired, |
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we must use a significant portion of our cash flow for payments
on our debt, which will reduce the funds available to us for
other purposes, |
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we are more vulnerable to economic downturns and adverse
industry conditions and our flexibility to plan for, or react
to, changes in our business or industry is more limited, |
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our ability to capitalize on business opportunities and to react
to competitive pressures, as compared to our competitors, may be
compromised due to our high level of debt, and |
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our ability to borrow additional funds or to refinance debt may
be limited. |
Furthermore, all of our debt under our senior secured credit
facility bears interest at variable rates. If these rates were
to increase significantly, our ability to borrow additional
funds may be reduced and the risks related to our substantial
debt would intensify.
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Servicing our debt will require a significant amount of
cash. Our ability to generate sufficient cash depends on
numerous factors beyond our control, and we may be unable to
generate sufficient cash flow to service our debt
obligations.
Our business may not generate sufficient cash flow from
operating activities. The cash we require to meet contractual
obligations in 2006, including our debt service, will total
approximately $89.7 million. Our ability to make payments
on and to refinance our debt and to fund planned capital
expenditures will depend on our ability to generate cash in the
future. To some extent, this is subject to general economic,
financial, competitive, legislative, regulatory and other
factors that are beyond our control. Lower net revenues, or
higher provision for uncollectibles, generally will reduce our
cash flow.
If we are unable to generate sufficient cash flow to service our
debt and meet our other commitments, we may need to refinance
all or a portion of our debt, sell material assets or operations
or raise additional debt or equity capital. We cannot assure you
that we could effect any of these actions on a timely basis, on
commercially reasonable terms or at all, or that these actions
would be sufficient to meet our capital requirements. In
addition, the terms of our existing or future debt agreements
may restrict us from effecting any of these alternatives.
Restrictive covenants in our senior secured credit
facility and the indenture governing our senior subordinated
notes may restrict our ability to pursue our business
strategies.
Our senior secured credit facility and the indenture governing
our senior subordinated notes limit our ability, among other
things, to:
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incur additional debt or issue certain preferred stock, |
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pay dividends or make distributions to our stockholders, |
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repurchase or redeem our capital, |
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make investments, |
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incur liens, |
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make capital expenditures, |
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enter into transactions with our stockholders and affiliates, |
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sell certain assets, |
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acquire the assets of, or merge or consolidate with, other
companies, and |
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incur restrictions on the ability of our subsidiaries to make
distributions or transfer assets to us. |
Our ability to comply with these covenants may be affected by
events beyond our control, and any material deviations from our
forecasts could require us to seek waivers or amendments of
covenants, alternative sources of financing or reductions in
expenditures. We cannot assure you that such waivers, amendments
or alternative financings could be obtained, or, if obtained,
would be on terms acceptable to us.
In addition, the credit agreement governing our senior secured
credit facility requires us to meet certain financial ratios and
restricts our ability to make capital expenditures or prepay
certain other debt. We may not be able to maintain these ratios,
and the restrictions could limit our ability to plan for or
react to market conditions or meet extraordinary capital needs
or otherwise restrict corporate activities.
If a breach of any covenant or restriction contained in our
financing agreements results in an event of default, those
lenders could discontinue lending, accelerate the related debt
(which would accelerate other debt) and declare all borrowings
outstanding thereunder to be due and payable. In addition, the
lenders could terminate any commitments they had made to supply
us with additional funds. In the event of an acceleration of our
debt, we may not have or be able to obtain sufficient funds to
make any accelerated debt payments.
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Our obligations under our senior secured credit facility
are secured by substantially all of our assets.
Our obligations under our senior secured credit facility are
secured by liens on substantially all of our assets, and the
guarantees of our subsidiaries under our senior secured credit
facility are secured by liens on substantially all of those
subsidiaries assets. If we become insolvent or are
liquidated, or if payment under our senior secured credit
facility or of other secured obligations are accelerated, the
lenders under our senior secured credit facility or the obligees
with respect to the other secured obligations will be entitled
to exercise the remedies available to a secured lender under
applicable law and the applicable agreements and instruments,
including the right to foreclose on all of our assets.
Accordingly, you could lose all or a part of your investment in
our common stock.
Risk Factors Related to Our Business
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We could be subject to lawsuits for which we are not fully
reserved. |
In recent years, physicians, hospitals and other participants in
the healthcare industry have become subject to an increasing
number of lawsuits alleging medical malpractice and related
legal theories such as negligent hiring, supervision and
credentialing. Similarly, ambulance transport services may
result in lawsuits concerning vehicle collisions and personal
injuries, patient care incidents and employee job-related
injuries. Some of these lawsuits may involve large claim amounts
and substantial defense costs.
EmCare procures professional liability insurance coverage for
most of its affiliated medical professionals and professional
and corporate entities. Beginning January 1, 2002, this
insurance coverage has been provided by affiliates of CNA
Insurance Company, which then reinsure the entire program,
primarily through EmCares wholly-owned subsidiary, EMCA
Insurance Company, Ltd., or EMCA. Workers compensation coverage
for EmCares employees and applicable affiliated medical
professionals is provided under a similar structure for the
period. From September 1, 2004 to the closing date of our
acquisition of AMR and EmCare, AMR obtained insurance coverage
for losses with respect to workers compensation, auto and
general liability claims through Laidlaws captive
insurance company. AMR currently has a self-insurance program
fronted by an unrelated third party. AMR retains the risk of
loss under this coverage. Under these insurance programs, we
establish reserves, using actuarial estimates, for all losses
covered under the policies. Moreover, in the normal course of
our business, we are involved in lawsuits, claims, audits and
investigations, including those arising out of our billing and
marketing practices, employment disputes, contractual claims and
other business disputes for which we may have no insurance
coverage, and which are not subject to actuarial estimates. The
outcome of these matters could have a material effect on our
results of operations in the period when we identify the matter,
and the ultimate outcome could have a material adverse effect on
our financial position or results of operations.
Our liability to pay for EmCares insurance program losses
is collateralized by funds held through EMCA and, to the extent
these losses exceed the collateral and assets of EMCA or the
limits of our insurance policies, will have to be funded by us.
Should our AMR losses with respect to such claims exceed the
collateral held by Laidlaw in connection with our self-insurance
program or the limits of our insurance policies, we will have to
fund such amounts. See Business American
Medical Response Insurance and
EmCare Insurance.
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The reserves we establish with respect to our losses
covered under our insurance programs are subject to inherent
uncertainties. |
In connection with our insurance programs, we establish reserves
for losses and related expenses, which represent estimates
involving actuarial and statistical projections, at a given
point in time, of our expectations of the ultimate resolution
and administration costs of losses we have incurred in respect
of our liability risks. Insurance reserves inherently are
subject to uncertainty. Our reserves are based on historical
claims, demographic factors, industry trends, severity and
exposure factors and other actuarial assumptions calculated by
an independent actuary firm. The independent actuary firm
performs studies of projected ultimate losses on an annual basis
and provides quarterly updates to those projections. We use
these actuarial estimates to determine appropriate reserves. Our
reserves could be significantly affected if current and future
occurrences
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differ from historical claim trends and expectations. While we
monitor claims closely when we estimate reserves, the complexity
of the claims and the wide range of potential outcomes may
hamper timely adjustments to the assumptions we use in these
estimates. Actual losses and related expenses may deviate,
individually and in the aggregate, from the reserve estimates
reflected in our financial statements. If we determine that our
estimated reserves are inadequate, we will be required to
increase reserves at the time of the determination, which would
result in a reduction in our net income in the period in which
the deficiency is determined. See Managements
Discussion and Analysis of Financial Condition and Results of
Operations Critical Accounting Policies
Claims Liability and Professional Liability Reserves and
note 12 of the notes to our combined financial statements
included elsewhere in this prospectus.
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Insurance coverage for some of our losses may be
inadequate and may be subject to the credit risk of commercial
insurance companies. |
Some of our insurance coverage, for periods prior to the
initiation of our self-insurance programs as well as portions of
our current insurance coverage, is through various third party
insurers. To the extent we hold policies to cover certain groups
of claims, but either did not obtain sufficient insurance
limits, did not buy an extended reporting period policy, where
applicable, or the issuing insurance company is no longer
viable, we may be responsible for losses attributable to such
claims. Furthermore, for our losses that are insured or
reinsured through commercial insurance companies, we are subject
to the credit risk of those insurance companies.
While we believe our commercial insurance company providers
currently are creditworthy, there can be no assurance that such
insurance companies will remain so in the future.
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We are subject to decreases in our revenue and profit
margin under our fee-for-service contracts, where we bear the
risk of changes in volume, payor mix and third party
reimbursement rates. |
In our fee-for-service arrangements, which generated
approximately 84% of our fiscal 2004 net revenue, we, or our
affiliated physicians, collect the fees for transports and
physician services. Under these arrangements, we assume the
financial risks related to changes in the mix of insured and
uninsured patients and patients covered by government-sponsored
healthcare programs, third party reimbursement rates and
transports and patient volume. Our revenue decreases if our
volume or reimbursement decreases, but our expenses do not
decrease proportionately. See Risk Factors
Related to Healthcare Regulation Changes in the
rates or methods of third party reimbursements may adversely
affect our revenue and operations. In addition,
fee-for-service contracts have less favorable cash flow
characteristics in the start-up phase than traditional flat-rate
contracts due to longer collection periods.
We collect a smaller portion of our fees for services rendered
to uninsured patients than for services rendered to insured
patients. Our credit risk related to services provided to
uninsured individuals is exacerbated because the law requires
communities to provide 911 emergency response services and
hospital emergency departments to treat all patients presenting
to the emergency department seeking care for an emergency
medical condition regardless of their ability to pay. We also
believe uninsured patients are more likely to seek care at
hospital emergency departments because they frequently do not
have a primary care physician with whom to consult.
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We may not be able to successfully recruit and retain
physicians and other healthcare professionals with the
qualifications and attributes desired by us and our
customers. |
Our ability to recruit and retain affiliated physicians and
other healthcare professionals significantly affects our
performance under our contracts. In the recent past, our
customer hospitals have increasingly demanded a greater degree
of specialized skills, training and experience in the healthcare
professionals providing services under their contracts with us.
This decreases the number of healthcare professionals who may be
permitted to staff our contracts. Moreover, because of the scope
of the geographic and demographic diversity of the hospitals and
other facilities with which we contract, we must recruit
healthcare professionals, and particularly physicians, to staff
a broad spectrum of contracts. We have had difficulty in the
past recruiting physicians to staff contracts in some regions of
the country and at some less economically advantaged hospitals.
Moreover, we compete with other entities to recruit and retain
qualified physicians and
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other healthcare professionals to deliver clinical services. Our
future success in retaining and winning new hospital contracts
depends on our ability to recruit and retain healthcare
professionals to maintain and expand our operations.
Our non-compete agreements and other restrictive
covenants involving physicians may not be enforceable.
We have contracts with physicians and professional corporations
in many states. Some of these contracts, as well as our
contracts with hospitals, include provisions preventing these
physicians and professional corporations from competing with us
both during and after the term of our relationship with them.
The law governing non-compete agreements and other forms of
restrictive covenants varies from state to state. Some states
are reluctant to strictly enforce non-compete agreements and
restrictive covenants applicable to physicians. There can be no
assurance that our non-compete agreements related to affiliated
physicians and professional corporations will not be
successfully challenged as unenforceable in certain states. In
such event, we would be unable to prevent former affiliated
physicians and professional corporations from competing with us,
potentially resulting in the loss of some of our hospital
contracts.
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We are required to make significant capital expenditures
for our ambulance services business in order to remain
competitive. |
Our capital expenditure requirements primarily relate to
maintaining and upgrading our vehicle fleet and medical
equipment to serve our customers and remain competitive. The
aging of our vehicle fleet requires us to make regular capital
expenditures to maintain our current level of service. Our
capital expenditures totaled $42.8 million and
$52.8 million in fiscal 2004 and fiscal 2003, respectively.
In addition, changing competitive conditions or the emergence of
any significant advances in medical technology could require us
to invest significant capital in additional equipment or
capacity in order to remain competitive. If we are unable to
fund any such investment or otherwise fail to invest in new
vehicles or medical equipment, our business, financial condition
or results of operations could be materially and adversely
affected.
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We depend on our senior management and may not be able to
retain those employees or recruit additional qualified
personnel. |
We depend on our senior management. The loss of services of any
of the members of our senior management could adversely affect
our business until a suitable replacement can be found. There
may be a limited number of persons with the requisite skills to
serve in these positions, and we cannot assure you that we would
be able to identify or employ such qualified personnel on
acceptable terms.
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We must perform on our own services that Laidlaw
previously performed for us, and we are subject to financial
reporting and other requirements for which our accounting and
other management systems and resources may not be
adequate. |
Laidlaw historically has provided various services to AMR and
EmCare, including income tax accounting, preparation of tax
returns, certain risk management, compliance and insurance
coverage services, cash management, certain benefit plan
administration and internal audit. Moreover, as subsidiaries of
a public company, AMR and EmCare have not themselves been
subject to the reporting and other requirements of the
Securities Exchange Act of 1934, or the Exchange Act. In
connection with this offering, we will become subject to
reporting and other obligations under the Exchange Act. We are
working with our independent legal, accounting and financial
advisors to identify those areas in which changes should be made
to our financial and management control systems to manage our
growth and our obligations as a public company. These areas
include corporate governance, corporate control, internal audit,
disclosure controls and procedures and financial reporting and
accounting systems. These reporting and other obligations will,
together with the impact of performing services previously
provided to us by Laidlaw, place significant demands on our
management, administrative and operational resources, including
accounting resources.
We anticipate that we will need to hire additional tax,
accounting and finance staff. We are reviewing the adequacy of
our systems, financial and management controls, and reporting
systems and procedures, and we
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intend to make any necessary changes. We believe these
replacement services will result in total annual stand-alone
selling, general and administrative, compensation and benefits
and insurance expense of approximately $4.0 million in
fiscal 2005, including a management fee we will pay to Onex. We
believe this represents our full incremental ordinary course
stand-alone expense, and compares to the pre-acquisition fees
and compensation charges of $15.4 million we paid Laidlaw
in fiscal 2004 and $19.9 million for the five months ended
January 31, 2005. In addition, we estimate that, in our
first year as a public company, we will incur costs of
approximately $1.0 million to implement the assessment of
controls and public reporting mandated by the Sarbanes-Oxley Act
of 2002. We cannot assure you that our estimate is accurate or
that our separation from Laidlaw will progress smoothly, either
of which could adversely impact our results. Although we have
not fully implemented our replacement services, our costs for
these services (including the Onex management fee but excluding
costs related to our acquisition of AMR and EmCare) totaled
$1.9 million in the eight months ended September 30,
2005. Moreover, our stand-alone expenses may increase. If we are
unable to upgrade our financial and management controls,
reporting systems and procedures in a timely and effective
fashion, we may not be able to satisfy our obligations as a
public company on a timely basis.
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Our revenue would be adversely affected if we lose
existing contracts. |
A significant portion of our growth historically has resulted
from increases in the number of emergency and non-emergency
transports, and the number of patient visits and fees for
services, we provide under existing contracts and the addition
of new contracts. Substantially all of our fiscal 2004 net
revenue was generated under contracts, including exclusive
contracts that accounted for approximately 86% of our fiscal
2004 net revenue. Our contracts with hospitals generally
have terms of three years and the term of our contracts with
communities to provide 911 services generally ranges from three
to five years. Most of our contracts are terminable by either of
the parties upon notice of as little as 30 days. Any of our
contracts may not be renewed or, if renewed, may contain terms
that are not as favorable to us as our current contracts. We
cannot assure you that we will be successful in retaining our
existing contracts or that any loss of contracts would not have
a material adverse effect on our business, financial condition
and results of operations.
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We may not accurately assess the costs we will incur under
new contracts. |
Our new contracts increasingly involve a competitive bidding
process. When we obtain new contracts, we must accurately assess
the costs we will incur in providing services in order to
realize adequate profit margins and otherwise meet our financial
and strategic objectives. Increasing pressures from healthcare
payors to restrict or reduce reimbursement rates at a time when
the costs of providing medical services continue to increase
make assessing the costs associated with the pricing of new
contracts, as well as maintenance of existing contracts, more
difficult. In addition, integrating new contracts, particularly
those in new geographic locations, could prove more costly, and
could require more management time, than we anticipate. Our
failure to accurately predict costs or to negotiate an adequate
profit margin could have a material adverse effect on our
business, financial condition and results of operations.
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The high level of competition in our segments of the
market for emergency medical services could adversely affect our
contract and revenue base. |
AMR. The market for providing ambulance transport
services to municipalities, other healthcare providers and third
party payors is highly competitive. In providing ambulance
transport services, we compete with governmental entities
(including cities and fire districts), hospitals, local and
volunteer private providers, and with several large national and
regional providers, such as Rural/ Metro Corporation, Southwest
Ambulance and Acadian Ambulance. In many communities, our most
important competitors are the local fire departments, which in
many cases have acted traditionally as the first response
providers during emergencies, and have been able to expand their
scope of services to include emergency ambulance transport and
do not wish to give up their franchises to a private competitor.
EmCare. The market for providing outsourced physician
staffing and related management services to hospitals and
clinics is highly competitive. Such competition could adversely
affect our ability to obtain new contracts, retain existing
contracts and increase or maintain profit margins. We compete
with both national
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and regional enterprises such as Team Health, Sterling
Healthcare, The Schumacher Group and National Emergency Services
Healthcare Group, some of which may have greater financial and
other resources available to them, greater access to physicians
and/or greater access to potential customers. We also compete
against local physician groups and self-operated hospital
emergency departments for satisfying staffing and scheduling
needs.
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Our business depends on numerous complex information
systems, and any failure to successfully maintain these systems
or implement new systems could materially harm our
operations. |
We had 3.7 million transports and 5.3 million patient
visits in fiscal 2004. We depend on complex, integrated
information systems and standardized procedures for operational
and financial information and our billing operations. We may not
have the necessary resources to enhance existing information
systems or implement new systems where necessary to handle our
volume and changing needs. Furthermore, we may experience
unanticipated delays, complications and expenses in
implementing, integrating and operating our systems, including
the integration of our AMR and EmCare systems. Any interruptions
in operations during periods of implementation would adversely
affect our ability to properly allocate resources and process
billing information in a timely manner, which could result in
customer dissatisfaction and delayed cash flow. We also use the
development and implementation of sophisticated and specialized
technology to differentiate our services from our competitors
and improve our profitability. The failure to successfully
implement and maintain operational, financial and billing
information systems could have an adverse effect on our ability
to obtain new business, retain existing business and maintain or
increase our profit margins.
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If we fail to implement our business strategy, our
financial performance and our growth could be materially and
adversely affected. |
Our future financial performance and success are dependent in
large part upon our ability to implement our business strategy
successfully. Our business strategy envisions several
initiatives, including increasing revenue from existing
customers, growing our customer base, pursuing select
acquisitions, implementing cost rationalization initiatives,
focusing on risk mitigation and utilizing technology to
differentiate our services and improve profitability. We may not
be able to implement our business strategy successfully or
achieve the anticipated benefits of our business plan. If we are
unable to do so, our long-term growth and profitability may be
adversely affected. Even if we are able to implement some or all
of the initiatives of our business plan successfully, our
operating results may not improve to the extent we anticipate,
or at all.
Implementation of our business strategy could also be affected
by a number of factors beyond our control, such as increased
competition, legal developments, government regulation, general
economic conditions or increased operating costs or expenses. In
addition, to the extent we have misjudged the nature and extent
of industry trends or our competition, we may have difficulty in
achieving our strategic objectives. Any failure to implement our
business strategy successfully may adversely affect our
business, financial condition and results of operations and thus
our ability to service our debt. In addition, we may decide to
alter or discontinue certain aspects of our business strategy at
any time.
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Our ability to obtain adequate bonding coverage, and
therefore maintain existing contracts and successfully bid on
new ones, could be adversely affected by our high
leverage. |
Our emergency ambulance transport service business is highly
dependent on our ability to obtain performance bond coverage
sufficient to meet bid requirements imposed by existing and
potential customers. In connection with the acquisition, Laidlaw
has agreed to provide to us any cash collateral required to
support the performance bonds in effect at the closing, and for
a three-year period to pay any bond premiums in excess of rates
in effect at the time of closing. We cannot assure you that we
will have access to adequate bonding capacity to meet new
contract requirements, or to obtain substitute performance bonds
for existing bonds at the end of the three-year period, or that
such bonding will be available on terms acceptable to us. If
adequate bonding is not available, or if the terms of the
bonding are too onerous, there would be a material adverse
effect on our business, financial condition and results of
operations.
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A successful challenge by tax authorities to our treatment
of certain physicians as independent contractors could require
us to pay past taxes and penalties. |
As of September 30, 2005, we contracted with approximately
1,200 physicians as independent contractors to fulfill our
contractual obligations to customers. Because we treat them as
independent contractors rather than as employees, we do not
(i) withhold federal or state income or other employment
related taxes from the compensation that we pay to them,
(ii) make federal or state unemployment tax or Federal
Insurance Contributions Act payments (except as described
below), (iii) provide workers compensation insurance with
respect to such affiliated physicians (except in states that
require us to do so even for independent contractors), or
(iv) allow them to participate in benefits and retirement
programs available to employed physicians. Our contracts with
our independent contractor physicians obligate these physicians
to pay these taxes and other costs. Whether these physicians are
properly classified as independent contractors depends upon the
facts and circumstances of our relationship with them. It is
possible that the nature of our relationship with these
physicians would support a challenge to our classification of
them. If such a challenge by federal or state taxing authorities
were successful, and the physicians at issue were instead
treated as employees, we could be adversely affected and liable
for past taxes and penalties to the extent that the physicians
did not fulfill their contractual obligations to pay those
taxes. Under current federal tax law, however, even if our
treatment were successfully challenged, if our current treatment
were found to be consistent with a long-standing practice of a
significant segment of our industry and we meet certain other
requirements, it is possible (but not certain) that our
treatment of the physicians would qualify under a safe
harbor and, consequently, we would be protected from the
imposition of past taxes and penalties. In the recent past,
however, there have been proposals to eliminate the safe harbor
and similar proposals could be made in the future.
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We may make acquisitions which could divert the attention
of management and which may not be integrated successfully into
our existing business. |
We may pursue acquisitions to increase our market penetration,
enter new geographic markets and expand the scope of services we
provide. We cannot assure you that we will identify suitable
acquisition candidates, that acquisitions will be completed on
acceptable terms or that we will be able to integrate
successfully the operations of any acquired business into our
existing business. The acquisitions could be of significant size
and involve operations in multiple jurisdictions. The
acquisition and integration of another business would divert
management attention from other business activities. This
diversion, together with other difficulties we may incur in
integrating an acquired business, could have a material adverse
effect on our business, financial condition and results of
operations. In addition, we may borrow money or issue capital
stock to finance acquisitions. Such borrowings might not be
available on terms as favorable to us as our current borrowing
terms and may increase our leverage, and the issuance of capital
stock could dilute the interests of our stockholders.
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If Laidlaw is unwilling or unable to satisfy any
indemnification claims made by us pursuant to the purchase
agreements relating to the acquisition of AMR and EmCare, we
will be forced to satisfy such claims ourselves. |
Laidlaw has agreed to indemnify us for certain claims or legal
actions brought against us arising out of the operations of AMR
and EmCare prior to the closing date of the acquisition. If we
make a claim against Laidlaw, and Laidlaw is unwilling or unable
to satisfy such claim, we would be required to satisfy the claim
ourselves and, as a result, our financial condition may be
adversely affected.
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Many of our employees are represented by labor unions and
any work stoppage could adversely affect our business. |
Approximately 50% of AMRs employees are represented by 42
collective bargaining agreements with 43 different union locals.
Fourteen of these collective bargaining agreements, representing
approximately 4,100 employees, are subject to renegotiation in
2006. Although we believe our relations with our employees
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are good, we cannot assure you that we will be able to negotiate
a satisfactory renewal of these collective bargaining agreements
or that our employee relations will remain stable.
Risk Factors Related to Healthcare Regulation
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We conduct business in a heavily regulated industry and if
we fail to comply with these laws and government regulations, we
could incur penalties or be required to make significant changes
to our operations. |
The healthcare industry is heavily regulated and closely
scrutinized by federal, state and local governments.
Comprehensive statutes and regulations govern the manner in
which we provide and bill for services, our contractual
relationships with our physicians and customers, our marketing
activities and other aspects of our operations. Failure to
comply with these laws can result in civil and criminal
penalties such as fines, damages and exclusion from the Medicare
and Medicaid programs. The risk of our being found in violation
of these laws and regulations is increased by the fact that many
of them have not been fully interpreted by the regulatory
authorities or the courts, and their provisions are sometimes
open to a variety of interpretations. Any action against us for
violation of these laws or regulations, even if we successfully
defend against it, could cause us to incur significant legal
expenses and divert our managements attention from the
operation of our business.
Our practitioners and our customers are also subject to ethical
guidelines and operating standards of professional and trade
associations and private accreditation agencies. Compliance with
these guidelines and standards is often required by our
contracts with our customers or to maintain our reputation.
The laws, regulations and standards governing the provision of
healthcare services may change significantly in the future. We
cannot assure you that any new or changed healthcare laws,
regulations or standards will not materially adversely affect
our business. We cannot assure you that a review of our business
by judicial, law enforcement, regulatory or accreditation
authorities will not result in a determination that could
adversely affect our operations.
We are subject to comprehensive and complex laws and rules
that govern the manner in which we bill and are paid for our
services by third party payors, and the failure to comply with
these rules, or allegations that we have failed to do so, can
result in civil or criminal sanctions, including exclusion from
federal and state healthcare programs.
Like most healthcare providers, the majority of our services are
paid for by private and governmental third party payors, such as
Medicare and Medicaid. These third party payors typically have
differing and complex billing and documentation requirements
that we must meet in order to receive payment for our services.
Reimbursement to us is typically conditioned on our providing
the correct procedure and diagnostic codes and properly
documenting the services themselves, including the level of
service provided, the medical necessity for the services, and
the identity of the practitioner who provided the service.
We must also comply with numerous other laws applicable to our
documentation and the claims we submit for payment, including
but not limited to (1) coordination of benefits
rules that dictate which payor we must bill first when a patient
has potential coverage from multiple payors;
(2) requirements that we obtain the signature of the
patient or patient representative, when possible, or document
why we are unable to do so, prior to submitting a claim;
(3) requirements that we make repayment to any payor which
pays us more than the amount to which we are entitled;
(4) requirements that we bill a hospital or nursing home,
rather than Medicare, for certain ambulance transports provided
to Medicare patients of such facilities;
(5) reassignment rules governing our ability to
bill and collect professional fees on behalf of our physicians;
(6) requirements that our electronic claims for payment be
submitted using certain standardized transaction codes and
formats; and (7) laws requiring us to handle all health and
financial information of our patients in a manner that complies
with specified security and privacy standards. See
Business Regulatory Matters
Medicare, Medicaid and Other Government Reimbursement
Programs.
Governmental and private third party payors and other
enforcement agencies carefully audit and monitor our compliance
with these and other applicable rules, and in some cases in the
past have found that we were not in compliance. We have received
in the past, and expect to receive in the future, repayment
demands from
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third party payors based on allegations that our services were
not medically necessary, were billed at an improper level, or
otherwise violated applicable billing requirements. See
Business American Medical Response
Legal Matters. Our failure to comply with the billing and
other rules applicable to us could result in non-payment for
services rendered or refunds of amounts previously paid for such
services. In addition, non-compliance with these rules may cause
us to incur civil and criminal penalties, including fines,
imprisonment and exclusion from government healthcare programs
such as Medicare and Medicaid, under a number of state and
federal laws. These laws include the federal False Claims Act,
the Health Insurance Portability and Accountability Act of 1996,
the federal Anti-Kickback Statute, the Balanced Budget Act of
1997 and other provisions of federal, state and local law.
In addition, from time to time we self-identify practices that
may have resulted in Medicare or Medicaid overpayments or other
regulatory issues. For example, we have previously identified
situations in which we may have inadvertently utilized incorrect
billing codes for some of the services we have billed to
government programs such as Medicare or Medicaid. In such cases,
it is our practice to disclose the issue to the affected
government programs and, if appropriate, to refund any resulting
overpayments. Although the government usually accepts such
disclosures and repayments without taking further enforcement
action, it is possible that such disclosures or repayments will
result in allegations by the government that we have violated
the False Claims Act or other laws, leading to investigations
and possibly civil or criminal enforcement actions. See
Regulatory Matters Corporate Compliance
Program and Corporate Integrity Obligations.
If our operations are found to be in violation of these or any
of the other laws which govern our activities, any resulting
penalties, damages, fines or other sanctions could adversely
affect our ability to operate our business and our financial
results. See Business Regulatory
Matters Federal False Claims Act and
Other Healthcare Fraud and Abuse Laws.
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Changes in the rates or methods of third party
reimbursements may adversely affect our revenue and
operations. |
We derive a majority of our revenue from direct billings to
patients and third party payors such as Medicare, Medicaid and
private health insurance companies. As a result, any changes in
the rates or methods of reimbursement for the services we
provide could have a significant adverse impact on our revenue
and financial results.
Government funding for healthcare programs is subject to
statutory and regulatory changes, administrative rulings,
interpretations of policy and determinations by intermediaries
and governmental funding restrictions, all of which could
materially impact program coverage and reimbursements for both
ambulance and physician services. In recent years, Congress has
consistently attempted to curb spending on Medicare, Medicaid
and other programs funded in whole or part by the federal
government. State and local governments have also attempted to
curb spending on those programs for which they are wholly or
partly responsible. This has resulted in cost containment
measures such as the imposition of new fee schedules that have
lowered reimbursement for some of our services and restricted
the rate of increase for others, and new utilization controls
that limit coverage of our services. For example, we estimate
that the impact of a national fee schedule promulgated in 2002,
as modified by subsequent legislation, resulted in a decrease in
AMRs net revenue for fiscal 2003 and fiscal 2004 of
approximately $20 million and $11 million,
respectively, will result in an increase in AMRs net
revenue of approximately $13 million in calendar 2005, and
will result in a decrease in AMRs net revenue of
approximately $17 million in 2006 and continuing decreases
thereafter to 2010. We currently expect that the Medicare fee
schedule update for physician services fees will provide for a
4.3% decrease to physician rates effective January 1, 2006,
which would result in a decrease in EmCares 2006 net
revenue of approximately $5.7 million. See
Business Regulatory Matters
Medicare, Medicaid and Other Government Reimbursement
Programs.
In addition, state and local government regulations or
administrative policies regulate ambulance rate structures in
some jurisdictions in which we conduct transport services. We
may be unable to receive ambulance service rate increases on a
timely basis where rates are regulated, or to establish or
maintain satisfactory rate structures where rates are not
regulated.
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We believe that regulatory trends in cost containment will
continue. We cannot assure you that we will be able to offset
reduced operating margins through cost reductions, increased
volume, the introduction of additional procedures or otherwise.
In addition, we cannot assure you that federal, state and local
governments will not impose reductions in the fee schedules or
rate regulations applicable to our services in the future. Any
such reductions could have a material adverse effect on our
business, financial condition or results of operations.
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If current or future laws or regulations force us to
restructure our arrangements with physicians, professional
corporations and hospitals, we may incur additional costs, lose
contracts and suffer a reduction in net revenue under existing
contracts, and we may need to refinance our debt or obtain debt
holder consent. |
A number of laws bear on our contractual relationships with our
physicians. There is a risk that state authorities in some
jurisdictions may find that these contractual relationships
violate laws prohibiting the corporate practice of medicine and
fee-splitting prohibitions. These laws prohibit the practice of
medicine by general business corporations and are intended to
prevent unlicensed persons or entities from interfering with or
inappropriately influencing the physicians professional
judgment. They may also prevent the sharing of professional
services income with non-professional or business interests.
From time to time, including recently, we have been involved in
litigation in which private litigants have raised these issues.
See Business Regulatory Matters
Fee-Splitting; Corporate Practice of Medicine.
In addition, the Medicare program generally prohibits the
reassignment of Medicare payments due to a physician or other
healthcare provider to any other person or entity unless the
billing arrangement between that physician or other healthcare
provider and the other person or entity falls within an
enumerated exception to the Medicare reassignment prohibition.
The Medicare Modernization Act amended the Medicare reassignment
statute as of December 8, 2003 and now permits our
independent contractor physicians to reassign their Medicare
receivables to us under certain circumstances. Because this
provision has only recently been implemented, it could be
interpreted in a manner adverse to us, which would negatively
impact our ability to bill for our physicians services.
Our physician contracts include contracts with individual
physicians and with physicians organized as separate legal
professional entities (e.g., professional medical
corporations). Antitrust laws may deem each such
physician/entity to be separate, both from EmCare and from each
other and, accordingly, each such physician/practice is subject
to a wide range of laws that prohibit anti-competitive conduct
between or among separate legal entities or individuals. A
review or action by regulatory authorities or the courts could
force us to terminate or modify our contractual relationships
with physicians and affiliated medical groups or revise them in
a manner that could be materially adverse to our business. See
Business Regulatory Matters
Antitrust Laws.
Various licensing and certification laws, regulations and
standards apply to us, our affiliated physicians and our
relationships with our affiliated physicians. Failure to comply
with these laws and regulations could result in our services
being found to be non-reimbursable or prior payments being
subject to recoupment, and can give rise to civil or criminal
penalties. We are pursuing steps we believe we must take to
retain or obtain all requisite licensure and operating
authorities. While we have made reasonable efforts to
substantially comply with federal, state and local licensing and
certification laws and regulations and standards as we interpret
them, we cannot assure you that agencies that administer these
programs will not find that we have failed to comply in some
material respects.
EmCares professional liability insurance program, under
which insurance is provided for most of our affiliated medical
professionals and professional and corporate entities, is
reinsured through our wholly-owned subsidiary, EMCA Insurance
Company, Ltd. The activities associated with the business of
insurance, and the companies involved in such activities, are
closely regulated. Failure to comply with the laws and
regulations can result in civil and criminal fines and penalties
and loss of licensure. While we have made reasonable efforts to
substantially comply with these laws and regulations, and
utilize licensed insurance professionals where necessary and
appropriate, we cannot assure you that we will not be found to
have violated these laws and regulations in some material
respects.
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Adverse judicial or administrative interpretations could result
in a finding that we are not in compliance with one or more of
these laws and rules that affect our relationships with our
physicians.
These laws and rules, and their interpretations, may also change
in the future. Any adverse interpretations or changes could
force us to restructure our relationships with physicians,
professional corporations or our hospital customers, or to
restructure our operations. This could cause our operating costs
to increase significantly. A restructuring could also result in
a loss of contracts or a reduction in revenue under existing
contracts. Moreover, if we are required to modify our structure
and organization to comply with these laws and rules, our
financing agreements may prohibit such modifications and require
us to obtain the consent of the holders of such debt or require
the refinancing of such debt.
Our contracts with healthcare facilities and marketing
practices are subject to the federal Anti-Kickback Statute, and
we are currently under investigation for alleged violations of
that statute.
We are subject to the federal Anti-Kickback Statute, which
prohibits the knowing and willful offer, payment, solicitation
or receipt of any form of remuneration in return
for, or to induce, the referral of business or ordering of
services paid for by Medicare or other federal programs.
Remuneration potentially includes discounts and
in-kind goods or services, as well as cash. Certain federal
courts have held that the Anti-Kickback Statute can be violated
if one purpose of a payment is to induce referrals.
Violations of the Anti-Kickback Statute can result in
imprisonment, civil or criminal fines or exclusion from Medicare
and other governmental programs.
In 1999, the Office of Inspector General of the Department of
Health and Human Services, or the OIG, issued an Advisory
Opinion indicating that discounts provided to health facilities
on the transports for which they are financially responsible
potentially violate the Anti-Kickback Statute when the ambulance
company also receives referrals of Medicare and other
government-funded transports from the facility. The OIG has
clarified that not all discounts violate the Anti-Kickback
Statute, but that the statute may be violated if part of the
purpose of the discount is to induce the referral of the
transports paid for by Medicare or other federal programs, and
the discount does not meet certain safe harbor
conditions. In the Advisory Opinion and subsequent
pronouncements, the OIG has provided guidance to ambulance
companies to help them avoid unlawful discounts. See
Business Regulatory Matters
Federal Anti-Kickback Statute.
Like other ambulance companies, we sometimes provide discounts
to our healthcare facility customers (nursing home and
hospital). Although we have attempted to comply with the
OIGs guidance on this issue, the government has alleged
that certain of our contractual discounts in effect in Texas,
principally in periods prior to 1999 and possibly through 2001,
violate the Anti-Kickback Statute. We are currently in
discussions with the OIG regarding these Texas allegations. Our
contracting practices in Oregon and possibly other jurisdictions
may also be under investigation. See Business
American Medical Response Legal Matters. If we
are found to have violated the Anti-Kickback Statute in these
jurisdictions, we may be subject to civil or criminal penalties,
including exclusion from the Medicare or Medicaid programs, or
may be required to enter into settlement agreements with the
government to avoid such sanctions. Typically, such settlement
agreements require substantial payments to the government in
exchange for the government to release its claims. Such a
settlement may also require us to enter into a Corporate
Integrity Agreement, or CIA. See Business
Regulatory Matters Corporate Compliance Program and
Corporate Integrity Obligations.
In addition to AMRs contracts with healthcare facilities,
other marketing practices or transactions entered into by AMR
and EmCare may implicate the Anti-Kickback Statute. Although we
have attempted to structure our past and current marketing
initiatives and business relationships to comply with the
Anti-Kickback Statute, we cannot assure you that the OIG or
other authorities will not find that our marketing practices and
relationships violate the statute.
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Changes in our ownership structure and operations require
us to comply with numerous notification and reapplication
requirements in order to maintain our licensure, certification
or other authority to operate, and failure to do so, or an
allegation that we have failed to do so, can result in payment
delays, forfeiture of payment or civil and criminal
penalties.
We and our affiliated physicians are subject to various federal,
state and local licensing and certification laws with which we
must comply in order to maintain authorization to provide, or
receive payment for, our services. For example, Medicare and
Medicaid require that we complete and periodically update
enrollment forms in order to obtain and maintain certification
to participate in programs. Compliance with these requirements
is complicated by the fact that they differ from jurisdiction to
jurisdiction, and in some cases are not uniformly applied or
interpreted even within the same jurisdiction. Failure to comply
with these requirements can lead not only to delays in payment
and refund requests, but in extreme cases can give rise to civil
or criminal penalties.
In certain jurisdictions, changes in our ownership structure
require pre-or post-notification to governmental licensing and
certification agencies, or agencies with which we have
contracts. Relevant laws in some jurisdictions may also require
re-application or re-enrollment and approval to maintain or
renew our licensure, certification, contracts or other operating
authority. For example, in connection with our acquisition of
AMR from Laidlaw, two of our subsidiaries were required to apply
for state and local ambulance operating authority in New York.
Similarly, the change in corporate structure and ownership in
connection with this offering may require us to give notice,
re-enroll or make other applications for authority to continue
operating in various jurisdictions.
If an agency requires us to complete the re-enrollment process
prior to submitting reimbursement requests, we may be delayed in
payment, receive refund requests or be subject to recoupment for
services we provide in the interim. The change in ownership
effected by our acquisition of AMR and EmCare from Laidlaw or
this offering may require us to re-enroll in one or more
jurisdictions, in which case reimbursement from the relevant
government program is likely to be deferred for several months.
This would affect our cash flow but would not affect our net
revenue. We do not expect the impact of this deferral to be
material to us unless several jurisdictions require us to
re-enroll.
While we have made reasonable efforts to substantially comply
with these requirements in connection with prior changes in our
operations and ownership structure, and will do so in connection
with this offering, we cannot assure you that the agencies that
administer these programs or have awarded us contracts will not
find that we have failed to comply in some material respects. A
finding of non-compliance and any resulting payment delays,
refund demands or other sanctions could have a material adverse
effect on our business, financial condition or results of
operations.
If we fail to comply with the terms of our settlement
agreements with the government, we could be subject to
additional litigation or other governmental actions which could
be harmful to our business.
In the last five years, we have entered into four settlement
agreements with the United States government. In June 2002, one
of our subsidiaries, AMR of Massachusetts, entered into a
settlement agreement to resolve a number of allegations,
including allegations related to billing and documentation
practices. In February 2003, another subsidiary, AMR of South
Dakota, entered into a settlement agreement to resolve
allegations that it incorrectly billed for transports performed
by other providers when an AMR paramedic accompanied the patient
during transport, and that it billed for certain non-emergency
transports using emergency codes. In July 2004, our
subsidiary, American Medical Response West, entered into a
settlement agreement in connection with billing matters related
to emergency transports and specialized services. In August
2004, AMR entered into a settlement agreement on behalf of a
subsidiary, Regional Emergency Services LP, or RES, to resolve
allegations of violations of the False Claims Act by RES and a
hospital system based on the absence of certificates of medical
necessity and other non-compliant billing practices. See
Business American Medical Response
Legal Matters.
As part of the settlements AMR of Massachusetts and
AMR West entered into with the government, we entered into
Corporate Integrity Agreements, or CIAs. Pursuant to these CIAs,
we are required to establish and maintain a compliance program
which includes, among other elements, the appointment of a
compliance
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officer and committee, claims review by an independent review
organization, and reporting of overpayments and other
reportable events. See Business
Regulatory Matters Corporate Compliance Program and
Corporate Integrity Obligations.
We cannot assure you that the CIAs or the compliance program we
initiated has prevented, or will prevent, any repetition of the
conduct or allegations that were the subject of these settlement
agreements, or that the government will not raise similar
allegations in other jurisdictions or for other periods of time.
If such allegations are raised, or if we fail to comply with the
terms of the CIAs, we may be subject to fines and other
contractual and regulatory remedies specified in the CIAs or by
applicable laws, including exclusion from the Medicare program
and other federal and state healthcare programs. Such actions
could have a material adverse effect on the conduct of our
business, our financial condition or our results of operations.
If we are unable to effectively adapt to changes in the
healthcare industry, our business may be harmed.
Political, economic and regulatory influences are subjecting the
healthcare industry in the United States to fundamental change.
We anticipate that Congress and state legislatures may continue
to review and assess alternative healthcare delivery and payment
systems and may in the future propose and adopt legislation
effecting fundamental changes in the healthcare delivery system.
We cannot assure you as to the ultimate content, timing or
effect of changes, nor is it possible at this time to estimate
the impact of potential legislation. Further, it is possible
that future legislation enacted by Congress or state
legislatures could adversely affect our business or could change
the operating environment of our customers. It is possible that
changes to the Medicare or other government program
reimbursements may serve as precedent to similar changes in
other payors reimbursement policies in a manner adverse to
us. Similarly, changes in private payor reimbursements could
lead to adverse changes in Medicare and other government payor
programs which could have a material adverse effect on our
business, financial condition or results of operations.
Risk Factors Related to this Exchange and Our Offering
Prior to this exchange and our offering, there has been no
public market for our class A common stock. An active
trading market for our class A common stock may not develop
or be sustained after our offering. The lack of a public market
may impair the value of your shares and your ability to sell
your shares at any time you wish to sell them.
Our stock price may be volatile and you may not be able to
sell your shares at or above the offering price.
The initial public offering price for our shares of class A
common stock will be determined by negotiations between the
representatives of the underwriters and us. This price may not
reflect the market price of our class A common stock
following our offering. You may be unable to resell the
class A common stock at or above the initial public
offering price. In addition, you may not sell the class A
common stock for a period of 180 days after the date of the
final prospectus for this exchange and our offering.
The stock markets in general have experienced extreme
volatility, often unrelated to the operating performance of
particular companies. Broad market fluctuations may adversely
affect the trading price of our class A common stock.
Price fluctuations in our class A common stock could result
from general market and economic conditions and a variety of
other factors, including:
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actual or anticipated fluctuations in our operating results, |
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changes in healthcare pricing or reimbursement policies, |
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our competitors announcements of significant contracts,
acquisitions or strategic investments, |
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changes in our growth rates or our competitors growth
rates, |
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the timing or results of regulatory submissions or actions with
respect to our business, |
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our inability to raise additional capital, |
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conditions of the healthcare industry or in the financial
markets or economic conditions in general, and |
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changes in stock market analyst recommendations regarding our
class A common stock, other comparable companies or the
healthcare industry generally. |
If a significant number of shares of our class A
common stock are sold into the market following our offering,
the market price of our class A common stock could
significantly decline, even if our business is doing
well.
Sales of a substantial number of shares of our class A
common stock in the public market after our offering could
adversely affect the prevailing market price of our class A
common stock.
Upon completion of our offering, we will have
8,948,325 shares of class A common stock,
142,545 shares of class B common stock and
32,107,500 LP exchangeable units outstanding. Of these
securities, the 7,800,000 shares of class A common
stock offered pursuant to our offering will be freely tradable
without restriction or further registration under federal
securities laws, except to the extent shares are purchased in
the offering by our affiliates. The 32,250,045 shares of
class B common stock outstanding or issuable on exchange of
the LP exchangeable units, as well as any class A
common stock held by our affiliates, as that term is defined in
the Securities Act of 1933, are restricted
securities under the Securities Act. Restricted securities
may not be sold in the public market unless the sale is
registered under the Securities Act or an exemption from
registration is available.
In connection with our offering, we, each of our directors and
executive officers and the Onex entities have entered into
lock-up agreements that prevent the sale of shares of our common
stock for up to 180 days after the date of this prospectus.
Following the expiration of the lock-up period, the Onex
entities will have the right, subject to certain conditions, to
require us to register the sale of these shares under the
federal securities laws. If this right is exercised, holders of
all shares subject to the registration rights agreement will be
entitled to participate in such registration. By exercising
their registration rights, and selling a large number of shares,
these holders could cause the prevailing market price of our
class A common stock to decline. Approximately 33,165,795
shares of our common stock will be subject to our registration
rights agreement upon completion of this offering. These shares
may be sold in the public market under Rule 144 after the
applicable holding period, subject to the restrictions and
limitations of that Rule. See Shares Eligible for Future
Sale and Description of Capital Stock
Registration Agreement.
Approximately 349,575 shares of our class A common
that we will issue in our formation transactions to employees,
affiliated physicians, physician assistants and nurse
practitioners will be eligible for sale in the public market
180 days after the date of this prospectus. See
Description of Capital Stock Equityholder
Agreements.
If a trading market develops for our class A common stock,
our employees, officers and directors may elect to sell their
shares of our class A common stock or exercise their stock
options in order to sell the stock underlying their options in
the market. Sales of a substantial number of shares of our
class A common stock in the public market after this
offering could depress the market price of our class A
common stock and impair our ability to raise capital through the
sale of additional equity securities.
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Our certificate of incorporation and our by-laws contain
provisions that could discourage another company from acquiring
us and may prevent attempts by our stockholders to replace or
remove our current management.
Provisions of our certificate of incorporation and our by-laws
may discourage, delay or prevent a merger or acquisition that
stockholders may consider favorable, including transactions in
which you might otherwise receive a premium for your shares. In
addition, these provisions may frustrate or prevent any attempts
by our stockholders to replace or remove our current management
by making it more difficult for stockholders to replace or
remove our current board of directors. These provisions include:
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providing for a classified board of directors with staggered
terms, |
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providing for the class B special voting stock which will
be voted as directed by the Onex entities, |
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providing for multi-vote shares of common stock which, upon
exchange of LP exchangeable units, will be owned by the Onex
entities, |
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establishing advance notice requirements for nominations for
election to the board of directors or for proposing matters that
can be acted on by stockholders at stockholder meetings, and |
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the authority of the board of directors to issue, without
stockholder approval, up to 20,000,000 shares of preferred
stock with such terms as the board of directors may determine
and an additional 54,725,666 shares of class A common
stock. |
See Description of Capital Stock.
We are a controlled company within the meaning
of the New York Stock Exchange rules and, as a result, will
qualify for, and intend to rely on, exemptions from certain
corporate governance requirements.
Because the Onex entities will own more than 50% of our combined
voting power after the completion of this offering, we will be
deemed a controlled company under the rules of the
New York Stock Exchange, or the NYSE. As a result, we will
qualify for, and intend to rely upon, the controlled
company exception to the board of directors and committee
composition requirements under the rules of the NYSE. Pursuant
to this exception, we will be exempt from rules that would
otherwise require that our board of directors be comprised of a
majority of independent directors, and that our
compensation committee and corporate governance and nominating
committee be comprised solely of independent
directors (as defined under the rules of the NYSE), so
long as the Onex entities continue to own more than 50% of our
combined voting power. Upon completion of this offering, our
board of directors will be comprised of six persons, of which
one will be a representative from Onex and two will be current
executive officers and, therefore, will not be
independent. See Management
Composition of the Board of Directors after this Offering
and Committees of the Board of Directors.
We do not intend to pay cash dividends.
We do not intend to pay cash dividends on our common stock. We
currently intend to retain all available funds and any future
earnings for use in the operation and expansion of our business
and do not anticipate paying any cash dividends in the
foreseeable future. In addition, the terms of our current, as
well as any future, financing agreements may preclude us from
paying any dividends. As a result, capital appreciation, if any,
of our common stock will be your sole source of potential gain
for the foreseeable future.
27
CAUTIONARY STATEMENTS REGARDING FORWARD-LOOKING STATEMENTS
This prospectus contains forward-looking statements.
Forward-looking statements give our current expectations or
forecasts of future events. Forward-looking statements generally
can be identified by the use of forward-looking terminology such
as may, will, expect,
intend, estimate,
anticipate, believe,
project, or continue, or other similar
words. These statements reflect managements current views
with respect to future events and are subject to risks and
uncertainties, both known and unknown. Our actual results may
vary materially from those anticipated in forward-looking
statements. We caution investors not to place undue reliance on
any forward-looking statements.
Important factors that could cause actual results to differ
materially from forward-looking statements include, but are not
limited to:
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|
the impact on our revenue of changes in transport volume, mix of
insured and uninsured patients, and third party reimbursement
rates, |
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|
the adequacy of our insurance coverage and insurance reserves, |
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|
potential penalties or changes to our operations if we fail to
comply with extensive and complex government regulation of our
industry, |
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|
our ability to recruit and retain qualified physicians and other
healthcare professionals, and enforce our non-compete agreements
with our physicians, |
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|
the effect of changes in rates or methods of third party
reimbursement, |
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|
our ability to generate cash flow to service our debt
obligations, |
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|
the cost of capital expenditures to maintain and upgrade our
vehicle fleet and medical equipment, |
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|
the loss of services of one or more members of our senior
management team, |
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|
the outcome of government investigations of certain of our
business practices, |
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|
our ability to successfully restructure our operations to comply
with future changes in government regulation, |
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|
our ability to perform services previously performed for us by
Laidlaw, |
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|
the loss of existing contracts and the accuracy of our
assessment of costs under new contracts, |
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|
the high level competition in our industry, |
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|
our ability to maintain or implement complex information systems, |
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|
our ability to implement our business strategy, |
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|
our ability to obtain adequate bonding coverage, and |
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|
our ability to successfully integrate strategic acquisitions. |
These factors are not exhaustive, and new factors may emerge or
changes to the foregoing factors may occur that could impact our
business. Except to the extent required by law, we undertake no
obligation to publicly update or revise any forward-looking
statements, whether as a result of new information, future
events or otherwise.
You should review carefully the sections captioned Risk
Factors and Managements Discussion and
Analysis of Financial Condition and Results of Operations
in this prospectus for a more complete discussion of these and
other factors that may affect our business. We note that the
safe harbor for forward-looking statements provided by the
Private Securities Litigation Reform Act of 1995 does not apply
to statements made in connection with an initial public offering.
28
FORMATION OF HOLDING COMPANY
Emergency Medical Services is a newly formed Delaware
corporation that is issuing class A common stock in this
exchange and our concurrent initial public offering. Immediately
prior to the completion of this exchange and our offering, we
intend to complete a reorganization. After giving effect to the
reorganization and the completion of this exchange and our
offering:
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|
|
|
|
EMS L.P., currently our top-tier holding company and the issuer
of the class B units, will become our consolidated
subsidiary, and |
|
|
|
we will own the general partner interests in EMS L.P., and will
continue to conduct our operations through AMR and EmCare, our
operating subsidiaries. |
Unless the context otherwise requires, this prospectus gives
effect to this reorganization.
We will have outstanding two classes of common stock and one
share of class B special voting stock, as follows:
|
|
|
|
|
8,948,325 shares of class A common stock, held by our
management and persons who purchase shares in our offering, and
including the 1,148,325 shares being issued in this
exchange, |
|
|
|
142,545 shares of class B common stock, held by certain
former holders of interests in EMS L.P., and |
|
|
|
one share of class B special voting stock, held by Onex
Corporation as trustee for the holders of LP exchangeable units. |
EMS L.P. will have outstanding partnership units as follows:
|
|
|
|
|
32,107,500 LP exchangeable units, exchangeable on a one-for-one
basis for shares of our class B common stock, held by the
Onex entities, and |
|
|
|
860,570 other partnership units, including the general partner
interest, held by us. |
The shares issued in this exchange and sold in our offering will
be our class A common stock. The Onex entities
ownership of the LP exchangeable units will entitle them to
acquire from us all of our class B common stock other than
the 142,545 shares that will be outstanding upon completion
of our offering. The LP exchangeable units will be exchangeable
at any time, at the option of the holder, for shares of
class B common stock on a one-for-one basis, and the LP
exchangeable units will be substantially equivalent economically
to class B common stock.
Our shares of class A common stock and shares of
class B common stock will be identical except with respect
to voting rights and except that each share of class B
common stock may be converted into a share of class A
common stock at any time at the option of the holder. On every
matter properly submitted to stockholders for their vote, each
share of class A common stock will be entitled to one vote
per share and each share of class B common stock will be
entitled to ten votes per share, reducing to one vote per share
under certain limited circumstances. The one share of
class B special voting stock will be entitled to a number
of votes equal to the number of votes that could be cast if all
of the then outstanding LP exchangeable units were exchanged for
class B common stock. See Description of Capital
Stock Common Stock and LP
Exchangeable Units and Class B Special Voting Stock.
Steps to Effect the Reorganization
To effect the reorganization, we will take the following steps
immediately prior to the completion of this exchange and our
concurrent initial public offering:
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|
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|
|
the holders of the capital stock of the sole general partner of
EMS L.P. will contribute that capital stock to us in exchange
for shares of class B common stock, the general partner will be
merged into us and we will become the general partner of EMS
L.P., |
29
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|
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|
|
the holders of class B units of EMS L.P. will contribute their
units to us in exchange for shares of our class A common stock,
and the holders of certain class A units of EMS L.P. will
contribute their units to us in exchange for shares of our class
B common stock, |
|
|
|
the class A units of EMS L.P. held by the Onex entities will
continue to be held by the Onex entities and will be designated
LP exchangeable units, and |
|
|
|
we will issue one share of class B special voting stock to Onex
Corporation as trustee to hold for the benefit of the holders of
the LP exchangeable units. |
We have structured our reorganization in this manner to ensure
that our initial public offering will not result in a taxable
event for any of our equity holders. We are registering under
the Securities Act the class A common stock we are issuing
in this exchange, as part of our reorganization, to holders of
class B units of EMS L.P. Accordingly, these shares will be
freely transferable under the Securities Act for holders who are
not our affiliates. See Shares Eligible for Future
Sale. However, all of the class A common stock we
issue in this exchange will be subject to contractual
restrictions on transfer. See Description of Capital
Stock Equityholder Agreements.
The partnership interests of EMS L.P. we will purchase with the
net proceeds of our offering will be approximately 18.9% of the
total number of partnership units. This is the same percentage
as the class A common stock we are selling in our offering
bears to our total outstanding common stock, giving effect to
the exchange of all of the LP exchangeable units for
class B common stock. See Description of Capital
Stock Overview.
The steps of the reorganization, including this exchange, are
set forth in an amendment to EMS L.P.s agreement of
limited partnership. Section 13.1 of the partnership
agreement provides that the agreement can be changed by consent
of the general partner and the holders of more than 50% of the
class A units. The Onex entities own 98% of the
class A units, and they have consented to the amendment
that will effect the reorganization. The holders of the
class B units have no voting rights under the EMS L.P.
partnership agreement. EMS L.P. is not required to, and has not
and will not, seek the consent of the holders of the
class B units to the reorganization, to the terms of the LP
exchangeable units or to this exchange. Copies of the
partnership agreement and the amendment are filed as exhibits to
the registration statement of which this prospectus forms a part
and the amendment is incorporated by reference into this
prospectus.
This exchange will occur automatically upon the completion of
our initial public offering, and the holders of the class B
units do not have the right to elect whether to exchange those
units for class A common stock. No appraisal or
dissenters rights are available under Delaware law or the
EMS L.P. partnership agreement to holders of class B
units in connection with this exchange.
Use of Proceeds from Our Initial Public Offering
We estimate that the net proceeds from our initial public
offering will be approximately $111.6 million, based on an
assumed initial public offering price of $16.00 per share,
the midpoint of the range on the cover of the preliminary
prospectus for the offering. We intend to contribute the net
proceeds to EMS L.P. in exchange for partnership interests and
EMS L.P., in turn, intends to use the net proceeds:
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|
to repay $100.0 million of the $350.0 million
outstanding under the term loan portion of our senior secured
credit facility, and |
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|
the balance for working capital, capital expenditures and other
general corporate purposes. |
See Managements Discussion and Analysis of Financial
Condition and Results of Operations Liquidity and
Capital Resources Debt Facilities for
additional information regarding our outstanding debt.
30
Immediately prior to this exchange and our initial public
offering, our structure and ownership is as follows:
|
|
* |
The stock of AMR and EmCare is held through 100% wholly-owned
subsidiaries. |
31
Upon completion of this exchange and our initial public
offering, our structure and ownership will be as follows:
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|
|
* |
The stock of AMR and EmCare is held through 100% wholly-owned
subsidiaries. |
|
|
** |
The Onex entities will hold 30 shares of class B
common stock and will have the benefit of one share of
class B special voting stock. |
|
|
*** |
Holders have consent rights under certain limited circumstances
with respect to changes in the rights attributable to LP
exchangeable units. See Limited Partnership Agreement of
Emergency Medical Services L.P. Limited Consent
Rights. |
Following this exchange and our initial public offering, we will
have the following securities outstanding:
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|
8,948,325 shares of class A common stock, |
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|
|
142,545 shares of class B common stock, |
32
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|
one share of class B special voting stock, and |
|
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|
32,107,500 LP exchangeable units of EMS L.P. |
At any time at the option of the holder:
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|
|
each LP exchangeable unit is exchangeable into one share of
class B common stock, and |
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|
|
each share of class B common stock is convertible into one
share of class A common stock. |
Our securities are entitled to vote on all matters subject to a
vote of holders of common stock, voting together as a single
class, as follows:
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|
|
|
class A common stock is entitled to one vote per share, |
|
|
|
class B common stock is entitled to ten votes per share
(reducing to one vote per share under certain limited
circumstances), and |
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|
|
one share of class B special voting stock, held for the
benefit of the holders of LP exchangeable units, is entitled to
a number of votes equal to the number of votes that could be
cast if all the then outstanding LP exchangeable units were
exchanged for class B common stock. |
The holders of the LP exchangeable units may therefore
exercise voting rights with respect to Emergency Medical
Services as though they held the same number of shares of our
class B common stock.
33
USE OF PROCEEDS
We will not receive any cash proceeds from the issuance of the
shares of class A common stock in this exchange. Instead,
we will receive .667 class B units representing limited
partnership interests in EMS L.P. for each share of
class A common stock we issue in this exchange. The units
representing limited partnership interests in EMS L.P. that
we receive in this exchange will be held by us.
34
CAPITALIZATION
The following table sets forth as of September 30, 2005:
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|
|
|
our consolidated capitalization on an actual basis, |
|
|
|
our consolidated capitalization on a pro forma basis to give
effect to our reorganization as a holding company and the
1.5-for-1 stock split to be effected immediately prior to this
offering, and |
|
|
|
our consolidated capitalization on a pro forma, as adjusted,
basis to give effect to the sale of 7,800,000 shares of
class A common stock by us in our offering at an assumed
initial public offering price of $16.00 per share, and the
application of those proceeds as described in Formation of
Holding Company Use of Proceeds from Our Initial
Public Offering. |
You should read this table together with our unaudited
consolidated pro forma financial information included elsewhere
in this prospectus. For additional information regarding our
outstanding debt, see Managements Discussion and
Analysis of Financial Condition and Results of
Operations Liquidity and Capital
Resources Debt Facilities.
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|
|
As of September 30, 2005 | |
|
|
| |
|
|
|
|
Pro Forma, | |
|
|
Actual | |
|
Pro Forma | |
|
as Adjusted | |
|
|
| |
|
| |
|
| |
|
|
(dollars in millions) | |
|
|
|
|
(unaudited) | |
|
|
Long-term debt, including current portion:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Revolving credit facility(1)
|
|
$ |
5.0 |
|
|
$ |
5.0 |
|
|
$ |
5.0 |
|
|
Term loan
|
|
|
348.3 |
|
|
|
348.3 |
|
|
|
248.3 |
|
|
Capital leases and other debt
|
|
|
5.3 |
|
|
|
5.3 |
|
|
|
5.3 |
|
|
|
|
|
|
|
|
|
|
|
|
|
Total senior debt
|
|
|
358.6 |
|
|
|
358.6 |
|
|
|
258.6 |
|
|
Senior subordinated notes
|
|
|
250.0 |
|
|
|
250.0 |
|
|
|
250.0 |
|
|
|
|
|
|
|
|
|
|
|
|
|
Total debt
|
|
$ |
608.6 |
|
|
$ |
608.6 |
|
|
$ |
508.6 |
|
Redeemable partnership equity
|
|
|
1.2 |
|
|
|
|
|
|
|
|
|
Partnership equity
|
|
|
222.2 |
|
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|
|
|
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|
Stockholders equity
|
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|
|
|
|
|
|
|
|
|
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|
Preferred stock, $0.01 par value per share,
20,000,000 shares authorized pro forma; no shares issued
and outstanding
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|
|
|
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|
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|
|
|
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|
|
Class A common stock, $0.01 par value per share,
100,000,000 shares authorized pro forma;
1,148,325 shares issued and outstanding pro forma;
8,498,325 shares issued and outstanding pro forma, as
adjusted
|
|
|
|
|
|
|
|
|
|
|
0.1 |
|
|
Class B common stock, $0.01 par value per share,
40,000,000 shares authorized pro forma; 142,545 shares
issued and outstanding pro forma and as adjusted
|
|
|
|
|
|
|
|
|
|
|
|
|
|
LP exchangeable units, 32,107,500 units issued and
outstanding pro forma and as adjusted
|
|
|
|
|
|
|
213.3 |
|
|
|
213.3 |
|
Additional paid-in capital
|
|
|
|
|
|
|
10.1 |
|
|
|
121.6 |
|
Retained earnings
|
|
|
14.0 |
|
|
|
14.0 |
|
|
|
11.0 |
|
Comprehensive loss
|
|
|
(.7 |
) |
|
|
(.7 |
) |
|
|
(.7 |
) |
|
|
|
|
|
|
|
|
|
|
|
|
Total equity
|
|
|
235.5 |
|
|
|
236.7 |
|
|
|
345.3 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Total capitalization
|
|
$ |
845.3 |
|
|
$ |
845.3 |
|
|
$ |
853.9 |
|
|
|
|
|
|
|
|
|
|
|
|
|
(1) |
The revolving credit facility provides for availability of
borrowings and issuances of letters of credit for up to
$100.0 million. At September 30, 2005,
$5.0 million of borrowings were outstanding under the
revolving credit facility, letters of credit outstanding were
$27.3 million and the maximum remaining available under the
facility was $67.7 million. |
35
DILUTION
For persons who invest in our class A common stock in our
initial public offering, their interest will be diluted
immediately to the extent of the difference between the public
offering price per share of our class A common stock and
the pro forma net tangible book value per share of our common
stock after our offering.
As of September 30, 2005, our net tangible book value,
determined on a historical basis as described below, was
$(117.8) million, or $(3.53) per share of class A
common stock and class B common stock (together, our common
stock). Net tangible book value represents the amount of our
total assets (excluding intangible assets), less our total
liabilities, divided, in the case of net tangible book value per
share, by the pro forma number of shares outstanding giving
effect to our reorganization into a holding company and the
1.5-for-1 stock split that we expect to effect in connection
with our offering.
After giving effect to our sale of 7,800,000 shares of
class A common stock in our offering, based on an assumed
initial public offering price of $16.00 per share, and
after deducting underwriting discounts and commissions and
estimated offering expenses payable by us, our adjusted pro
forma net tangible book value at September 30, 2005 would
have been approximately $(8.0) million, or $(0.19) per
share of our common stock. This represents an immediate increase
in pro forma net tangible book value of $3.34 per share to
our existing stockholders, including the persons who hold
class B units prior to this exchange, and an immediate net
tangible book value dilution of $16.19 per share to new
investors purchasing shares in our offering. The following table
illustrates this dilution:
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|
|
|
|
|
|
|
|
|
Assumed initial public offering price per share
|
|
|
|
|
|
$ |
16.00 |
|
|
|
|
|
|
|
|
|
Net tangible book value per share at September 30, 2005
|
|
$ |
(3.53 |
) |
|
|
|
|
|
Increase in pro forma net tangible book value per share
attributable to new investors
|
|
|
3.34 |
|
|
|
|
|
|
|
|
|
|
|
|
Pro forma adjusted net tangible book value per share after our
offering
|
|
|
|
|
|
|
(0.19 |
) |
|
|
|
|
|
|
|
Dilution per share to new investors
|
|
|
|
|
|
$ |
16.19 |
|
|
|
|
|
|
|
|
The following table summarizes, as of September 30, 2005,
as adjusted to give effect to our offering, the differences
between the number of shares of our common stock purchased from
us, the total consideration paid to us and the average price per
share paid by our existing stockholders and by the new investors
purchasing common stock in our offering. The calculation is
based on an assumed initial public offering price of
$16.00 per share, before deducting underwriting discounts
and commissions and estimated offering expenses payable by us.
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Shares Purchased | |
|
Total Consideration | |
|
|
|
|
| |
|
| |
|
Average Price | |
|
|
Number | |
|
Percent | |
|
Amount | |
|
Percent | |
|
Per Share | |
|
|
| |
|
| |
|
| |
|
| |
|
| |
Existing stockholders
|
|
|
33,398,370 |
|
|
|
81.1 |
% |
|
$ |
222,655,800 |
|
|
|
64.1 |
% |
|
$ |
6.67 |
|
New investors
|
|
|
7,800,000 |
|
|
|
18.9 |
% |
|
$ |
124,800,000 |
|
|
|
35.9 |
% |
|
$ |
16.00 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Total
|
|
|
41,198,370 |
|
|
|
100 |
% |
|
$ |
347,455,800 |
|
|
|
100 |
% |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
If the underwriters exercise their over-allotment option in
full, our existing stockholders would own approximately 78.2% of
the total number of shares of our common stock outstanding after
our offering.
The preceding discussion and tables include the shares of our
class B common stock issuable on exchange of our
LP exchangeable units and exclude 3,509,219 shares of
our class A common stock issuable upon the exercise of
outstanding stock options at an exercise price of $6.67 per
share and 566,745 shares of our class A common stock
reserved for issuance under our equity option plan. To the
extent that all outstanding options are exercised, the
investment of new investors will be further diluted by $0.01 per
share, and our existing stockholders would own approximately
82.6% of the total number of shares of our common stock
outstanding after our offering. In addition, we may choose to
raise additional capital due to market conditions or strategic
considerations even if we believe we have sufficient funds for
our current or future operating plans. To the extent additional
capital is raised through the sale of equity or convertible debt
securities, the issuance of these securities could result in
further dilution to our stockholders.
36
DIVIDEND POLICY
We currently intend to retain any future earnings to support our
operations and to fund the development and growth of our
business. In addition, the payment of dividends by us to holders
of our common stock is limited by our senior secured credit
facility. Our future dividend policy will depend on the
requirements of financing agreements to which we may be a party.
We do not intend to pay cash dividends on our common stock in
the foreseeable future. Any future determination to pay
dividends will be at the discretion of our board of directors
and will depend upon, among other factors, our results of
operations, financial condition, capital requirements and
contractual restrictions.
37
UNAUDITED PRO FORMA CONSOLIDATED FINANCIAL DATA
The following pro forma consolidated financial statements
present Emergency Medical Services financial position and
results of operations resulting from the acquisition, the sale
of 7,800,000 shares of class A common stock pursuant
to this offering and the application of the proceeds therefrom
as described in Formation of Holding Company
Use of Proceeds from Our Initial Public Offering. AMR and
EmCare combined are the predecessor entity of Emergency Medical
Services for the periods prior to our acquisition of those
businesses.
The unaudited pro forma consolidated financial statements
include:
|
|
|
|
|
the pro forma consolidated balance sheet as of
September 30, 2005, assuming this offering occurred on
September 30, 2005 and the proceeds were applied as
described in Formation of Holding Company Use
of Proceeds from Our Initial Public Offering, |
|
|
|
the pro forma consolidated statement of operations for the eight
months ended September 30, 2005, assuming this offering
occurred on February 1, 2005 and the proceeds were applied
as described in Formation of Holding Company
Use of Proceeds from Our Initial Public Offering, |
|
|
|
the pro forma consolidated statement of operations for the five
months ended January 31, 2005, assuming the transactions
described below occurred as of September 1, 2004, and |
|
|
|
the pro forma consolidated statement of operations for the year
ended August 31, 2004, assuming the transactions described
below occurred as of September 1, 2003. |
The unaudited pro forma consolidated financial information is
presented for informational purposes only and does not purport
to represent our financial condition or our results of
operations had the acquisition and our offering occurred on or
as of the dates noted above or to project the results for any
future date or period. In the opinion of management, all
adjustments have been made that are necessary to present fairly
the unaudited pro forma consolidated financial information.
The unaudited pro forma consolidated financial statements for
periods prior to our acquisition of AMR and EmCare are based on
the historical combined financial statements of AMR and EmCare,
as predecessor to Emergency Medical Services, included elsewhere
in this prospectus, adjusted to give pro forma effect to the
following transactions, all of which are deemed to have occurred
concurrently:
|
|
|
|
|
our acquisition of AMR and EmCare, including: |
|
|
|
|
|
issuance of equity by Emergency Medical Services for aggregate
contributions of $219.2 million, |
|
|
|
our senior secured credit facility, consisting of: |
|
|
|
|
|
a revolving credit facility of $100.0 million, of which we
borrowed approximately $20.2 million at the closing date of
the acquisition and had outstanding $24.3 million of
letters of credit, and |
|
|
|
a term loan of $350.0 million, all of which was borrowed on
the closing date, |
|
|
|
|
|
the issuance and sale of $250.0 million in aggregate
principal amount of our senior subordinated notes, |
|
|
|
our purchase of all of the outstanding common stock of AMR and
EmCare, and |
|
|
|
the payment of related fees and expenses related to the
acquisition. |
The unaudited pro forma consolidated financial statements for
all periods are adjusted to give pro forma effect to the
following, which are deemed to have occurred concurrently:
|
|
|
|
|
our formation as a holding company, with EMS L.P. as a
subsidiary, the issuance of common stock to our equityholders
other than the Onex entities and the 1.5-for-1 stock
split, and |
38
|
|
|
|
|
the sale of the 7,800,000 shares of class A common
stock offered by us in our initial public offering and the
application of the proceeds therefrom as described in
Formation of Holding Company Use of Proceeds
from Our Initial Public Offering. |
The unaudited pro forma consolidated financial statements are
based on the estimates and assumptions set forth in the notes to
these statements that management believes are reasonable. These
estimates include an allocation of fair value to identifiable
intangible assets other than goodwill, and the resulting excess
of the purchase price over the carrying value of the net assets
acquired is recorded as goodwill. The pro forma adjustments
reflected in the following financial statements are based on
managements preliminary assessment of the fair value of
the tangible and intangible assets we acquired and liabilities
we assumed in our acquisition of AMR and EmCare. The final
purchase price allocation will be performed when an independent
appraisal of certain assets acquired and liabilities assumed is
finalized. We expect that the final purchase price allocation
may reflect differences from our estimated amounts, as follows:
|
|
|
|
|
the fair value of our finite life contract intangible asset, |
|
|
|
the fair value adjustment for favorable or unfavorable leases, |
|
|
|
the fair value adjustment for property and equipment, |
|
|
|
changes in the excess purchase price allocated to goodwill, |
|
|
|
changes in the fair value of other liabilities assumed and
incurred as part of the acquisition, and |
|
|
|
changes in the value of net deferred tax assets carried over as
part of the acquisition, including the final determination of
the deductibility of amounts related to certain settlement
accruals. |
The unaudited pro forma consolidated financial statements should
be read in conjunction with our historical financial statements
and related notes and other financial information included
elsewhere in this prospectus, including Risk Factors
and Managements Discussion and Analysis of Financial
Condition and Results of Operations.
39
Emergency Medical Services Corporation
Unaudited Pro Forma Consolidated Balance Sheet
September 30, 2005
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Pro Forma Equity | |
|
|
|
|
|
|
Offering | |
|
Pro | |
|
|
Actual | |
|
Adjustments | |
|
Forma | |
|
|
| |
|
| |
|
| |
|
|
(dollars in thousands) | |
ASSETS |
Current assets:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Cash and cash equivalents
|
|
$ |
10,113 |
|
|
$ |
11,564 |
(1) |
|
$ |
21,677 |
|
|
Restricted cash and cash equivalents
|
|
|
11,949 |
|
|
|
|
|
|
|
11,949 |
|
|
Restricted marketable securities
|
|
|
2,165 |
|
|
|
|
|
|
|
2,165 |
|
|
Trade and other accounts receivable, net
|
|
|
369,766 |
|
|
|
|
|
|
|
369,766 |
|
|
Parts and supplies inventory
|
|
|
18,760 |
|
|
|
|
|
|
|
18,760 |
|
|
Other current assets
|
|
|
31,008 |
|
|
|
|
|
|
|
31,008 |
|
|
Current deferred tax assets
|
|
|
22,971 |
|
|
|
|
|
|
|
22,971 |
|
|
|
|
|
|
|
|
|
|
|
|
|
Total current assets
|
|
|
466,732 |
|
|
|
11,564 |
|
|
|
478,296 |
|
Non-current assets:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Property, plant and equipment, net
|
|
|
133,283 |
|
|
|
|
|
|
|
133,283 |
|
|
Intangible assets, net
|
|
|
81,363 |
|
|
|
|
|
|
|
81,363 |
|
|
Non-current deferred tax assets
|
|
|
117,488 |
|
|
|
|
|
|
|
117,488 |
|
|
Restricted long-term investments
|
|
|
73,304 |
|
|
|
|
|
|
|
73,304 |
|
|
Goodwill
|
|
|
271,987 |
|
|
|
|
|
|
|
271,987 |
|
|
Other long-term assets
|
|
|
109,251 |
|
|
|
(2,978 |
)(2) |
|
|
106,273 |
|
|
|
|
|
|
|
|
|
|
|
|
|
Total assets
|
|
$ |
1,253,408 |
|
|
$ |
8,586 |
|
|
$ |
1,261,994 |
|
|
|
|
|
|
|
|
|
|
|
|
LIABILITIES AND EQUITY |
Current liabilities:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Accounts payable
|
|
$ |
53,066 |
|
|
$ |
|
|
|
$ |
53,066 |
|
|
Accrued liabilities
|
|
|
199,849 |
|
|
|
|
|
|
|
199,849 |
|
|
Current portion of long-term debt
|
|
|
13,478 |
|
|
|
|
|
|
|
13,478 |
|
|
|
|
|
|
|
|
|
|
|
|
|
Total current liabilities
|
|
|
266,393 |
|
|
|
|
|
|
|
266,393 |
|
Long-term debt
|
|
|
595,129 |
|
|
|
(100,000 |
)(3) |
|
|
495,129 |
|
Other long-term liabilities
|
|
|
155,139 |
|
|
|
|
|
|
|
155,139 |
|
|
|
|
|
|
|
|
|
|
|
|
|
Total liabilities
|
|
|
1,016,661 |
|
|
|
(100,000 |
) |
|
|
916,661 |
|
|
|
|
|
|
|
|
|
|
|
Redeemable partnership equity
|
|
|
1,213 |
|
|
|
(1,213 |
)(4) |
|
|
|
|
Equity
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Partnership equity
|
|
|
222,178 |
|
|
|
(222,178 |
)(4) |
|
|
|
|
|
Class A common stock
|
|
|
|
|
|
|
90 |
(4) |
|
|
90 |
|
|
Class B common stock
|
|
|
|
|
|
|
1 |
(4) |
|
|
1 |
|
|
LP exchangeable units
|
|
|
|
|
|
|
213,311 |
(4) |
|
|
213,311 |
|
|
Additional paid-in capital
|
|
|
|
|
|
|
121,553 |
(4) |
|
|
121,553 |
|
|
Retained earnings
|
|
|
14,002 |
|
|
|
(2,978 |
)(2) |
|
|
11,024 |
|
|
Comprehensive income (loss)
|
|
|
(646 |
) |
|
|
|
|
|
|
(646 |
) |
|
|
|
|
|
|
|
|
|
|
|
|
Total equity
|
|
|
235,534 |
|
|
|
109,799 |
|
|
|
345,333 |
|
|
|
|
|
|
|
|
|
|
|
|
|
Total liabilities and equity
|
|
$ |
1,253,408 |
|
|
$ |
8,586 |
|
|
$ |
1,261,994 |
|
|
|
|
|
|
|
|
|
|
|
|
|
(1) |
To record cash receipts from the net proceeds of this offering
to be used for general corporate purposes. |
|
(2) |
To record the write-off of certain deferred financing costs
associated with the portion of our senior secured credit
facility we will pay down with the net proceeds of this
offering. We will expense these costs in our historical
post-offering consolidated statement of operations. |
|
(3) |
To record the pay-down of our senior secured credit facility
with the net proceeds of this offering. |
|
(4) |
To record (a) our formation as a holding company, with
EMS L.P. as a subsidiary, the (b) issuance of
class A common stock and class B common stock to
certain of our existing equityholders and the designation of the
remaining class A partnership units as LP exchangeable
units, exchangeable for our class B common stock and
(c) net proceeds of our offering. |
40
Emergency Medical Services Corporation
Unaudited Pro Forma Consolidated Statement of Operations
For the eight months ended September 30, 2005
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Pro Forma Equity | |
|
|
|
|
|
|
Offering | |
|
|
|
|
Consolidated | |
|
Adjustments | |
|
Pro Forma | |
|
|
| |
|
| |
|
| |
|
|
(dollars in thousands) | |
Net revenue
|
|
$ |
1,187,653 |
|
|
$ |
|
|
|
$ |
1,187,653 |
|
Compensation and benefits
|
|
|
822,595 |
|
|
|
|
|
|
|
822,595 |
|
Operating expenses
|
|
|
168,700 |
|
|
|
|
|
|
|
168,700 |
|
Insurance expense
|
|
|
60,382 |
|
|
|
|
|
|
|
60,382 |
|
Selling, general and administrative expenses
|
|
|
38,248 |
|
|
|
|
|
|
|
38,248 |
|
Depreciation and amortization expenses
|
|
|
38,811 |
|
|
|
|
|
|
|
38,811 |
|
|
|
|
|
|
|
|
|
|
|
Income from operations
|
|
|
58,917 |
|
|
|
|
|
|
|
58,917 |
|
Interest expense
|
|
|
(34,407 |
) |
|
|
4,512 |
(1) |
|
|
(29,895 |
) |
Realized loss on investments
|
|
|
(40 |
) |
|
|
|
|
|
|
(40 |
) |
Interest and other income
|
|
|
189 |
|
|
|
|
|
|
|
189 |
|
|
|
|
|
|
|
|
|
|
|
Income before income taxes
|
|
|
24,659 |
|
|
|
4,512 |
|
|
|
29,171 |
|
Income tax expense
|
|
|
(10,657 |
) |
|
|
(1,805 |
) (2) |
|
|
(12,462 |
) |
|
|
|
|
|
|
|
|
|
|
Net income
|
|
$ |
14,002 |
|
|
$ |
2,707 |
|
|
$ |
16,709 |
|
|
|
|
|
|
|
|
|
|
|
Net income per share:
|
|
|
|
|
|
|
|
|
|
|
|
|
Basic |
|
$ |
0.42 |
|
Diluted |
|
$ |
0.41 |
|
Weighted average shares basic |
|
|
40,163,066 |
(3) |
Weighted average shares diluted |
|
|
41,122,368 |
(3) |
|
|
(1) |
To record reduction of interest expense on our senior secured
credit facility as a result of the pay-down with net proceeds of
this offering and reduce amortization associated with the
write-down of deferred financing costs. |
|
(2) |
To adjust income tax expense to reflect the reduction of
interest expense, at an effective tax rate of 40%. |
|
(3) |
The pro forma weighted shares outstanding are based on the
actual equity transactions recorded in the eight-month period
ended September 30, 2005 and described elsewhere in this
prospectus. These actual equity transactions have been adjusted
to give effect to our reorganization as a holding company,
assume the exchange of all LP exchangeable units for
class B common stock, and include the 7.0 million
shares of common stock we will issue in our offering to generate
the $100 million of net proceeds we intend to use to repay
debt outstanding under our senior secured credit facility. These
weighted shares were used to calculate basic earnings per share,
and the number of diluted shares gives pro forma effect to the
options outstanding during the eight-month period, using an
assumed offering price of $16.00 per share. |
41
Emergency Medical Services Corporation
Unaudited Pro Forma Consolidated Statement of Operations
For the five months ended January 31, 2005
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
AMR and | |
|
Pro Forma | |
|
Pro Forma | |
|
|
|
|
EmCare | |
|
Acquisition | |
|
Equity Offering | |
|
|
|
|
Combined | |
|
Adjustments | |
|
Adjustments | |
|
Pro Forma | |
|
|
| |
|
| |
|
| |
|
| |
|
|
(dollars in thousands) | |
Net revenue
|
|
$ |
696,179 |
|
|
$ |
|
|
|
$ |
|
|
|
$ |
696,179 |
|
Compensation and benefits
|
|
|
481,305 |
|
|
|
|
|
|
|
|
|
|
|
481,305 |
|
Operating expenses
|
|
|
94,882 |
|
|
|
|
|
|
|
|
|
|
|
94,882 |
|
Insurance expense
|
|
|
39,002 |
|
|
|
|
|
|
|
|
|
|
|
39,002 |
|
Selling, general and administrative expenses
|
|
|
21,635 |
|
|
|
|
|
|
|
|
|
|
|
21,635 |
|
Laidlaw fees and compensation charges
|
|
|
19,857 |
|
|
|
|
|
|
|
|
|
|
|
19,857 |
(1) |
Depreciation and amortization expenses
|
|
|
18,808 |
|
|
|
4,424 |
(2) |
|
|
|
|
|
|
23,232 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Income (loss) from operations
|
|
|
20,690 |
|
|
|
(4,424 |
) |
|
|
|
|
|
|
16,266 |
|
Interest expense
|
|
|
(5,644 |
) |
|
|
5,254 |
(3) |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
(21,306 |
)(4)(5) |
|
|
3,141 |
(6) |
|
|
(18,555 |
) |
Interest and other income
|
|
|
714 |
|
|
|
|
|
|
|
|
|
|
|
714 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Income (loss) before income taxes
|
|
|
15,760 |
|
|
|
(20,476 |
) |
|
|
3,141 |
|
|
|
(1,575 |
) |
Income tax expense
|
|
|
(6,278 |
) |
|
|
8,157 |
(7) |
|
|
(1,250 |
)(7) |
|
|
629 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Net income (loss)
|
|
$ |
9,482 |
|
|
$ |
(12,319 |
) |
|
$ |
1,891 |
|
|
$ |
(946 |
) |
|
|
|
|
|
|
|
|
|
|
|
|
|
Net loss per share:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Basic |
|
$ |
(0.02 |
) |
Diluted |
|
$ |
(0.02 |
) |
Weighted average shares basic |
|
|
40,163,066 |
(8) |
Weighted average shares diluted |
|
|
41,122,368 |
(8) |
|
|
(1) |
Represents certain Laidlaw fees and compensation charges,
primarily relating to a compensation charge associated with the
increase in the enterprise values of AMR and EmCare. Our
estimated replacement costs for certain functions are not
recorded on the face of this pro forma statement of operations
because we do not have a contract for each element of these
costs. We will be required to replace certain functions and
costs previously provided to us by Laidlaw and which comprise
Laidlaw fees and compensation charges. Our estimate of these
costs on an annual basis ($1.67 million for a five-month
period) are: |
|
|
|
|
|
Compensation and benefits costs for personnel providing internal
audit and tax services
|
|
$ |
1,100 |
|
Directors and officers insurance
|
|
|
500 |
|
Selling, general and administrative expenses for external audit
fees, treasury services and other costs
|
|
|
1,400 |
|
Onex management fee
|
|
|
1,000 |
|
|
|
|
|
|
|
$ |
4,000 |
|
|
|
|
|
We incurred $1.9 million of such costs in the eight months
ended September 30, 2005, excluding costs related to our
acquisition of AMR and EmCare.
|
|
(2) |
AMR and EmCare combined amortization expense includes
amortization (over a 7-year period) of the finite life
intangible assets of $89.0 million based on the value of
identifiable intangible assets determined by an independent
valuation group. |
(3) |
To eliminate interest expense charged on the Laidlaw payable. |
(4) |
To record amortization on $18.1 million of deferred
financing costs associated with our acquisition-related
borrowings, utilizing a weighted average maturity of eight years
on an effective yield basis. |
(5) |
To record interest expense on our acquisition-related
borrowings, assuming a weighted average interest rate of 7.87%. |
(6) |
To record reduction of interest expense on our senior secured
credit facility as a result of the pay-down with net proceeds of
this offering. |
(7) |
To adjust income tax expense to reflect the adjustments
identified in notes (2) through (6), at an effective tax
rate of 40%. |
(8) |
The pro forma weighted shares outstanding are based on the
actual equity transactions recorded in the eight-month period
ended September 30, 2005 and described elsewhere in this
prospectus. These actual equity transactions have been adjusted
to give effect to our reorganization as a holding company,
assume the exchange of all LP exchangeable units for
class B common stock, and include the 7.0 million
shares of common stock we will issue in our offering to generate
the $100 million of net proceeds we intend to use to repay
debt outstanding under our senior secured credit facility. These
weighted shares were used to calculate basic earnings per share,
and the number of diluted shares gives pro forma effect to the
options outstanding during the eight-month period, using an
assumed offering price of $16.00 per share. |
42
Emergency Medical Services Corporation
Unaudited Pro Forma Consolidated Statement of Operations
For the year ended August 31, 2004
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
AMR and | |
|
Pro Forma | |
|
Pro Forma | |
|
|
|
|
EmCare | |
|
Acquisition | |
|
Equity Offering | |
|
|
|
|
Combined | |
|
Adjustments | |
|
Adjustments | |
|
Pro Forma | |
|
|
| |
|
| |
|
| |
|
| |
|
|
(dollars in thousands) | |
Net revenue
|
|
$ |
1,604,598 |
|
|
$ |
|
|
|
$ |
|
|
|
$ |
1,604,598 |
|
Compensation and benefits
|
|
|
1,117,890 |
|
|
|
|
|
|
|
|
|
|
|
1,117,890 |
|
Operating expenses
|
|
|
218,277 |
|
|
|
|
|
|
|
|
|
|
|
218,277 |
|
Insurance expense
|
|
|
80,255 |
|
|
|
|
|
|
|
|
|
|
|
80,255 |
|
Selling, general and administrative expenses
|
|
|
47,899 |
|
|
|
|
|
|
|
|
|
|
|
47,899 |
|
Laidlaw fees and compensation charges
|
|
|
15,449 |
|
|
|
|
|
|
|
|
|
|
|
15,449 |
(1) |
Depreciation and amortization expenses
|
|
|
52,739 |
|
|
|
3,130 |
(2) |
|
|
|
|
|
|
55,869 |
|
Restructuring charges
|
|
|
2,115 |
|
|
|
|
|
|
|
|
|
|
|
2,115 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Income (loss) from operations
|
|
|
69,974 |
|
|
|
(3,130 |
) |
|
|
|
|
|
|
66,844 |
|
Interest expense
|
|
|
(9,961 |
) |
|
|
6,373 |
(3) |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
(50,968 |
)(4)(5) |
|
|
7,505 |
(6) |
|
|
(47,051 |
) |
Realized loss on investments
|
|
|
(1,140 |
) |
|
|
|
|
|
|
|
|
|
|
(1,140 |
) |
Interest and other income
|
|
|
240 |
|
|
|
|
|
|
|
|
|
|
|
240 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Income (loss) before income taxes
|
|
|
59,113 |
|
|
|
(47,725 |
) |
|
|
7,505 |
|
|
|
18,893 |
|
Income tax expense
|
|
|
(21,764 |
) |
|
|
19,000 |
(7) |
|
|
(3,000 |
)(7) |
|
|
(5,764 |
) |
|
|
|
|
|
|
|
|
|
|
|
|
|
Net income (loss)
|
|
$ |
37,349 |
|
|
$ |
(28,725 |
) |
|
$ |
4,505 |
|
|
$ |
13,129 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Net income per share:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Basic
|
|
$ |
0.33 |
|
Diluted
|
|
$ |
0.32 |
|
Weighted average shares basic
|
|
|
40,163,066 |
(8) |
Weighted average shares diluted
|
|
|
41,122,368 |
(8) |
|
|
(1) |
Represents certain Laidlaw fees and compensation charges,
primarily relating to a compensation charge associated with the
increase in the enterprise values of AMR and EmCare. Our
estimated replacement costs for certain functions, are not
recorded on the face of this pro forma statement of operations
because we do not have a contract for each element of these
costs. We will be required to replace certain functions and
costs previously provided to us by Laidlaw and which comprise
Laidlaw fees and compensation charges. Our estimate of these
costs on an annual basis are: |
|
|
|
|
|
Compensation and benefits costs for personnel providing internal
audit and tax services
|
|
$ |
1,100 |
|
Directors and officers insurance
|
|
|
500 |
|
Selling, general and administrative expenses for external audit
fees, treasury services and other costs
|
|
|
1,400 |
|
Onex management fee
|
|
|
1,000 |
|
|
|
|
|
|
|
$ |
4,000 |
|
|
|
|
|
We incurred $1.9 million of such costs in the eight months
ended September 30, 2005, excluding costs related to our
acquisition of AMR and EmCare.
|
|
(2) |
AMR and EmCare combined amortization expense includes
amortization (over a 7-year period) of the finite life
intangible assets of $89.0 million based on the value of
identifiable intangible assets by an independent valuation group. |
(3) |
To eliminate interest expense charged on the Laidlaw payable. |
(4) |
To record amortization on $18.1 million of deferred
financing costs associated with our acquisition-related
borrowings, utilizing a weighted average maturity of eight years
on an effective yield basis. |
(5) |
To record interest expense on our acquisition-related
borrowings, assuming a weighted average interest rate of 7.87%. |
(6) |
To record reduction of interest expense on our senior secured
credit facility as a result of the pay-down with net proceeds of
this offering. |
(7) |
To adjust income tax expense to reflect the adjustments
identified in notes (2) through (6), at an effective tax
rate of 40%. |
(8) |
The pro forma weighted shares outstanding are based on the
actual equity transactions recorded in the eight-month period
ended September 30, 2005 and described elsewhere in this
prospectus. These actual equity transactions have been adjusted
to give effect to our reorganization as a holding company,
assume the exchange of all LP exchangeable units for
class B common stock, and include the 7.0 million
shares of common stock we will issue in our offering to generate
the $100 million of net proceeds we intend to repay debt
outstanding under our senior secured credit facility. These
weighted shares were used to calculate basic earnings per share,
and the number of diluted shares gives pro forma effect to the
options outstanding during the eight-month period, using an
assumed offering price of $16.00 per share. |
43
SELECTED COMBINED AND CONSOLIDATED FINANCIAL INFORMATION AND
OTHER DATA
The following table sets forth our selected combined or
consolidated financial data for each of the periods indicated.
Financial data for the year ended August 31, 2002
(Predecessor Pre-Laidlaw Bankruptcy), nine months
ended May 31, 2003 (Predecessor Pre-Laidlaw
Bankruptcy), as of and for the three months ended
August 31, 2003 (Predecessor Post-Laidlaw
bankruptcy), the year ended August 31, 2004
(Predecessor Post-Laidlaw Bankruptcy) and the five
months ended January 31, 2005 (Predecessor
Post-Laidlaw Bankruptcy) are derived from our audited combined
financial statements included in this prospectus. As a result of
a correction to AMRs method of calculating its accounts
receivable allowances, we determined that the allowances were
understated at various balance sheet dates. The audited combined
financial statements included in this prospectus are restated to
correct this error. There were no adjustments necessary to
income subsequent to May 31, 2003. Financial data as of and
for the five months ended January 31, 2004
(Predecessor Post-Laidlaw Bankruptcy) and the three
months and eight months ended September 30, 2004
(Predecessor Post-Laidlaw Bankruptcy) are derived
from our unaudited combined financial statements included in
this prospectus. Financial data as of and for the three months
and eight months ended September 30, 2005 are derived from
our unaudited consolidated financial statements. Interim results
are not necessarily indicative of the results to be expected for
the entire fiscal year. You should read the information
presented below in conjunction with Capitalization,
Managements Discussion and Analysis of Financial
Condition and Results of Operations and our combined and
consolidated financial statements and related notes contained
elsewhere in this prospectus.
The comparability of our selected historical financial data has
been affected by a number of significant events and
transactions. As we discuss more fully in
note 1 Fresh-Start Accounting of
the notes to our audited combined financial statements,
AMRs and EmCares former parent, Laidlaw, and certain
of its affiliates filed voluntary petitions for reorganization
under Chapter 11 of the U.S. Bankruptcy Code. Although
subsidiaries of Laidlaw, neither AMR nor EmCare was included in
the bankruptcy filing. Laidlaw emerged from bankruptcy
protection in June 2003. Laidlaw applied fresh-start accounting
as of June 1, 2003 to AMR and EmCare and pushed down to us
our share of the fresh-start accounting adjustments. As a result
of the fresh-start change in the basis of accounting for our
underlying assets and liabilities, our results of operations and
cash flows have been separated as pre-June 1, 2003 and
post-May 31, 2003.
Effective as of January 31, 2005, we acquired AMR and
EmCare from Laidlaw and, in connection with the acquisition, we
changed our fiscal year to December 31 from August 31. For all
periods prior to the acquisition, the AMR and EmCare businesses
formerly owned by Laidlaw are referred to as the
Predecessor. For all periods from and subsequent to
the acquisition, these businesses are referred to as the
Successor. As a result of the acquisition, we
include as a reporting period of the Predecessor our
pre-acquisition period ended January 31, 2005.
44
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Predecessor (Pre-Acquisition) | |
|
|
|
|
|
|
|
| |
|
|
|
|
|
|
|
Pre-Laidlaw Bankruptcy | |
|
|
|
|
|
|
|
|
As Restated | |
|
|
Post-Laidlaw Bankruptcy | |
|
|
Successor (Post-Acquisition) | |
|
|
| |
|
|
| |
|
|
| |
|
|
|
|
Nine | |
|
|
Three | |
|
|
|
|
|
|
|
|
|
|
|
|
|
Months | |
|
|
Months | |
|
|
|
Five Months Ended | |
|
Three Months | |
|
Eight Months | |
|
|
Three Months | |
|
Eight Months | |
|
|
Year Ended August 31, | |
|
Ended | |
|
|
Ended | |
|
Year Ended | |
|
January 31, | |
|
Ended | |
|
Ended | |
|
|
Ended | |
|
Ended | |
|
|
| |
|
May 31, | |
|
|
August 31, | |
|
August 31, | |
|
| |
|
September 30, | |
|
September 30, | |
|
|
September 30, | |
|
September 30, | |
|
|
2000(1) | |
|
2001(2) | |
|
2002 | |
|
2003 | |
|
|
2003 | |
|
2004 | |
|
2004 | |
|
2005 | |
|
2004 | |
|
2004 | |
|
|
2005 | |
|
2005 | |
|
|
| |
|
| |
|
| |
|
| |
|
|
| |
|
| |
|
| |
|
| |
|
| |
|
| |
|
|
| |
|
| |
|
|
(unaudited) | |
|
|
|
|
|
|
|
|
|
|
(unaudited) | |
|
|
|
(unaudited) | |
|
|
(unaudited) | |
|
|
(dollars in thousands) | |
Statement of Operations Data:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Net revenue
|
|
$ |
1,355,978 |
|
|
$ |
1,386,136 |
|
|
$ |
1,415,786 |
|
|
$ |
1,103,335 |
|
|
|
$ |
384,461 |
|
|
$ |
1,604,598 |
|
|
$ |
667,506 |
|
|
$ |
696,179 |
|
|
$ |
413,869 |
|
|
$ |
1,077,749 |
|
|
|
$ |
456,245 |
|
|
$ |
1,187,653 |
|
Compensation and benefits
|
|
|
980,731 |
|
|
|
976,330 |
|
|
|
960,590 |
|
|
|
757,183 |
|
|
|
|
264,604 |
|
|
|
1,117,890 |
|
|
|
461,923 |
|
|
|
481,305 |
|
|
|
286,628 |
|
|
|
751,238 |
|
|
|
|
319,292 |
|
|
|
822,595 |
|
Operating expenses
|
|
|
201,853 |
|
|
|
216,019 |
|
|
|
219,321 |
|
|
|
163,447 |
|
|
|
|
55,212 |
|
|
|
218,277 |
|
|
|
90,828 |
|
|
|
94,882 |
|
|
|
55,683 |
|
|
|
147,524 |
|
|
|
|
66,156 |
|
|
|
168,700 |
|
Insurance expense
|
|
|
78,079 |
|
|
|
117,374 |
|
|
|
66,479 |
|
|
|
69,576 |
|
|
|
|
34,671 |
|
|
|
80,255 |
|
|
|
36,664 |
|
|
|
39,002 |
|
|
|
18,404 |
|
|
|
51,674 |
|
|
|
|
21,048 |
|
|
|
60,382 |
|
Selling, general and administrative expenses
|
|
|
59,404 |
|
|
|
53,017 |
|
|
|
61,455 |
|
|
|
37,867 |
|
|
|
|
12,017 |
|
|
|
47,899 |
|
|
|
22,016 |
|
|
|
21,635 |
|
|
|
12,093 |
|
|
|
31,270 |
|
|
|
|
15,654 |
|
|
|
38,248 |
|
Laidlaw fees and compensation charges
|
|
|
7,320 |
|
|
|
7,260 |
|
|
|
5,400 |
|
|
|
4,050 |
|
|
|
|
1,350 |
|
|
|
15,449 |
|
|
|
6,436 |
|
|
|
19,857 |
|
|
|
3,657 |
|
|
|
10,095 |
|
|
|
|
|
|
|
|
|
|
Depreciation and amortization expense
|
|
|
99,957 |
|
|
|
66,286 |
|
|
|
67,183 |
|
|
|
32,144 |
|
|
|
|
12,560 |
|
|
|
52,739 |
|
|
|
22,079 |
|
|
|
18,808 |
|
|
|
12,669 |
|
|
|
34,627 |
|
|
|
|
14,843 |
|
|
|
38,811 |
|
Impairment losses
|
|
|
1,183,681 |
|
|
|
|
|
|
|
262,780 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Restructuring charges
|
|
|
1,826 |
|
|
|
|
|
|
|
3,777 |
|
|
|
1,288 |
|
|
|
|
1,449 |
|
|
|
2,115 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
1,381 |
|
|
|
|
|
|
|
|
|
|
Laidlaw reorganization charges
|
|
|
|
|
|
|
9,198 |
|
|
|
8,761 |
|
|
|
3,650 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Income (loss) from operations
|
|
|
(1,256,873 |
) |
|
|
(59,348 |
) |
|
|
(239,960 |
) |
|
|
34,130 |
|
|
|
|
2,598 |
|
|
|
69,974 |
|
|
|
27,560 |
|
|
|
20,690 |
|
|
|
24,555 |
|
|
|
49,940 |
|
|
|
|
19,252 |
|
|
|
58,917 |
|
Interest expense
|
|
|
(95,087 |
) |
|
|
(66,181 |
) |
|
|
(6,418 |
) |
|
|
(4,691 |
) |
|
|
|
(908 |
) |
|
|
(9,961 |
) |
|
|
(4,137 |
) |
|
|
(5,644 |
) |
|
|
(5,138 |
) |
|
|
(8,679 |
) |
|
|
|
(12,824 |
) |
|
|
(34,407 |
) |
Realized gain (loss) on investments
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
90 |
|
|
|
(1,140 |
) |
|
|
|
|
|
|
|
|
|
|
(1,140 |
) |
|
|
(1,191 |
) |
|
|
|
(34 |
) |
|
|
(40 |
) |
Interest and other income
|
|
|
86 |
|
|
|
222 |
|
|
|
369 |
|
|
|
304 |
|
|
|
|
22 |
|
|
|
240 |
|
|
|
1,403 |
|
|
|
714 |
|
|
|
162 |
|
|
|
210 |
|
|
|
|
91 |
|
|
|
189 |
|
Fresh-start accounting adjustments(3)
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
46,416 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Income (loss) before income taxes and cumulative effect of
change in accounting principle
|
|
|
(1,351,874 |
) |
|
|
(125,307 |
) |
|
|
(246,009 |
) |
|
|
76,159 |
|
|
|
|
1,802 |
|
|
|
59,113 |
|
|
|
24,826 |
|
|
|
15,760 |
|
|
|
18,439 |
|
|
|
40,280 |
|
|
|
|
6,485 |
|
|
|
24,659 |
|
Income tax expense
|
|
|
(54,639 |
) |
|
|
17,538 |
|
|
|
(1,374 |
) |
|
|
(829 |
) |
|
|
|
(8,633 |
) |
|
|
(21,764 |
) |
|
|
(9,800 |
) |
|
|
(6,278 |
) |
|
|
(7,191 |
) |
|
|
(15,710 |
) |
|
|
|
(3,479 |
) |
|
|
(10,657 |
) |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Income (loss) before cumulative effect of change in accounting
principle
|
|
|
(1,406,513 |
) |
|
|
(107,769 |
) |
|
|
(247,383 |
) |
|
|
75,330 |
|
|
|
|
(6,831 |
) |
|
|
37,349 |
|
|
|
15,026 |
|
|
|
9,482 |
|
|
|
11,248 |
|
|
|
24,570 |
|
|
|
|
3,006 |
|
|
|
14,002 |
|
Cumulative effect of a change in accounting principle
|
|
|
(5,288 |
) |
|
|
|
|
|
|
|
|
|
|
(223,721 |
)(4) |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Net income (loss)
|
|
$ |
(1,411,801 |
) |
|
$ |
(107,769 |
) |
|
$ |
(247,383 |
) |
|
$ |
(148,391 |
) |
|
|
$ |
(6,831 |
) |
|
$ |
37,349 |
|
|
$ |
15,026 |
|
|
$ |
9,482 |
|
|
$ |
11,248 |
|
|
$ |
24,570 |
|
|
|
$ |
3,006 |
|
|
$ |
14,002 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Other Financial Data:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Cash flows provided by (used in):
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Operating activities
|
|
$ |
30,133 |
|
|
$ |
28,044 |
|
|
$ |
156,544 |
|
|
$ |
58,769 |
|
|
|
$ |
30,009 |
|
|
$ |
127,679 |
|
|
$ |
18,627 |
|
|
$ |
15,966 |
|
|
|
|
|
|
$ |
99,961 |
|
|
|
|
|
|
|
$ |
108,462 |
|
|
Investing activities
|
|
|
(40,983 |
) |
|
|
(36,442 |
) |
|
|
(57,347 |
) |
|
|
(98,835 |
) |
|
|
|
(15,136 |
) |
|
|
(81,516 |
) |
|
|
(10,881 |
) |
|
|
(21,667 |
) |
|
|
|
|
|
|
(73,910 |
) |
|
|
|
|
|
|
|
(917,422 |
) |
|
Financing activities
|
|
|
22,402 |
|
|
|
11,376 |
|
|
|
(36,066 |
) |
|
|
(8,060 |
) |
|
|
|
(47,222 |
) |
|
|
(47,328 |
) |
|
|
(7,532 |
) |
|
|
10,856 |
|
|
|
|
|
|
|
(20,699 |
) |
|
|
|
|
|
|
|
804,442 |
|
Capital expenditures
|
|
$ |
37,698 |
|
|
$ |
39,347 |
|
|
$ |
57,438 |
(5) |
|
$ |
34,768 |
|
|
|
$ |
18,079 |
|
|
$ |
42,787 |
|
|
$ |
14,224 |
|
|
$ |
14,045 |
|
|
|
|
|
|
$ |
30,217 |
|
|
|
|
|
|
|
$ |
34,947 |
|
|
|
|
|
|
|
|
As of | |
|
|
September 30, 2005 | |
|
|
| |
|
|
(dollars in | |
|
|
thousands) | |
Balance Sheet Data:
|
|
|
|
|
Cash and cash equivalents
|
|
$ |
10,113 |
|
Total assets
|
|
|
1,253,408 |
|
Long-term debt and capital lease obligations, including current
maturities
|
|
|
608,607 |
|
Partners equity
|
|
$ |
235,534 |
|
|
|
(1) |
Represents the combination of the audited financial statements
of AMR and the unaudited financial statements of EmCare for the
year ended August 31, 2000. |
|
(2) |
Represents the combination of the audited financial statements
of AMR and EmCare for the year ended August 31, 2001. |
|
(3) |
See note 1 to our combined financial statements with
respect to our fresh-start financial reporting. |
|
(4) |
Reflects an impairment of goodwill recorded in connection with
the adoption of SFAS No. 142. |
|
(5) |
Includes $26.3 million financed through capital leases. |
45
MANAGEMENTS DISCUSSION AND ANALYSIS OF
FINANCIAL CONDITION AND RESULTS OF OPERATIONS
You should read the following discussion of our financial
condition and results of operations with the audited combined
financial statements, the notes to the audited combined
financial statements and the Selected Combined and
Consolidated Financial Information and Other Data
appearing elsewhere in this prospectus. The following covers
periods before the closing of the acquisition of AMR and EmCare.
Accordingly, the discussion and analysis of historical periods
do not reflect the impact the acquisition of AMR and EmCare will
have on us. In addition, this discussion contains
forward-looking statements and involves numerous risks and
uncertainties, including, but not limited to, those described in
the Risk Factors section of this prospectus. Our
results may differ materially from those anticipated in any
forward-looking statements.
Company Overview
We are a leading provider of emergency medical services in the
United States. We operate our business and market our services
under the AMR and EmCare brands. AMR is the leading provider of
ambulance transport services in the United States. EmCare is the
leading provider of outsourced emergency department staffing and
management services in the United States. Approximately 86% of
our fiscal 2004 net revenue was generated under exclusive
contracts. During fiscal 2004, we treated and transported
approximately 9 million patients in more than 2,050
communities nationwide. For the fiscal year ended
August 31, 2004, we generated net revenue of
$1.6 billion, of which AMR and EmCare represented
approximately 66% and 34%, respectively, and net income of
$37.3 million. Over the past two fiscal years, we increased
our net revenue and adjusted EBITDA organically at compound
annual growth rates, or CAGRs, of 6.5% and 13.5%, respectively.
American Medical Response
Over its 50 years of operating history, AMR has developed
the largest network of ambulance transport services in the
United States. AMR has an 8% share of the total ambulance
services market and a 21% share of the private provider
ambulance market. During fiscal 2004, AMR treated and
transported approximately 3.7 million patients in
34 states. AMR has approximately 2,855 contracts with
communities, government agencies, healthcare providers and
insurers to provide ambulance services. AMRs broad
geographic footprint enables us to contract on a national and
regional basis with managed care and insurance companies. AMR
has made significant investments in technology, customer service
plans, employee training and risk mitigation programs to deliver
a compelling value proposition to our customers, which we
believe has led to industry-leading contract retention rates.
For fiscal 2004, approximately 57% of AMRs net revenue was
generated from emergency 911 ambulance transport services.
Non-emergency ambulance transport services, including critical
care transfer, wheelchair transports and other interfacility
transports, or IFTs, accounted for 32% of AMRs net revenue
for the same period, with the balance generated from the
provision of training, dispatch centers and other services to
communities and public safety agencies. For fiscal 2004, AMR
generated net revenue of $1,054.8 million and net income of
$22.9 million.
EmCare
Over its 33 years of operating history, EmCare has become
the largest provider of outsourced emergency department staffing
and related management services to healthcare facilities. EmCare
has a 6% share of the total emergency department services market
and a 9% share of the outsourced emergency department services
market. In addition, EmCare has become one of the leading
providers of hospitalist services, with hospitalist-related net
revenue increasing from $7.2 million in fiscal 2001 to
$23.5 million in fiscal 2004. A hospitalist is a physician
who specializes in the care of acutely ill patients in an
in-patient setting. During fiscal 2004, EmCare had approximately
5.3 million patient visits in 38 states.
EmCare primarily provides emergency department staffing and
related management services to healthcare facilities. EmCare
recruits and hires or subcontracts with physicians and other
healthcare professionals, who
46
then provide professional services within the healthcare
facilities with which we contract. We also provide billing and
collection, risk management and other administrative services to
our healthcare professionals and to independent physicians.
EmCare has 333 contracts with hospitals and independent
physician groups to provide emergency department, hospitalist
and radiology staffing, and related management and other
administrative services. We believe that EmCares
successful physician recruitment and retention, high level of
customer service and advanced risk management programs have
resulted in high contract retention rates and continued growth
in new customers. For the year ended August 31, 2004,
EmCare generated net revenue of $549.8 million and net
income of $14.4 million.
Key Factors and Measures We Use to Evaluate Our Business
The key factors and measures we use to evaluate our business
focus on the number of patients we treat and transport and the
costs we incur to provide the necessary care and transportation
for each of our patients.
We evaluate our revenue net of provisions for contractual payor
discounts and provisions for uncompensated care. Medicaid,
Medicare and certain other payors receive discounts from our
standard charges, which we refer to as contractual discounts. In
addition, individuals we treat and transport may be personally
responsible for a deductible or co-pay under their third party
payor coverage, and most of our contracts require us to treat
and transport patients who have no insurance or other third
party payor coverage. Due to the uncertainty regarding
collectibility of charges associated with services we provide to
these patients, which we refer to as uncompensated care, our net
revenue recognition is based on expected cash collections. Our
net revenue is gross billings after provisions for contractual
discounts and estimated uncompensated care. Provisions for
contractual discounts and uncompensated care have increased
historically primarily as a result of increases in gross billing
rates. The table below summarizes our approximate payor mix as a
percentage of both net revenue and total transports and patient
visits for fiscal years 2003 and 2004.
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Percentage of | |
|
Percentage of Total | |
|
|
Net Revenue | |
|
Transports and Visits | |
|
|
Year Ended August 31, | |
|
Year Ended August 31, | |
|
|
| |
|
| |
|
|
2003 | |
|
2004 | |
|
2003 | |
|
2004 | |
|
|
| |
|
| |
|
| |
|
| |
Medicare
|
|
|
27.4 |
% |
|
|
27.3 |
% |
|
|
25.5 |
% |
|
|
25.8 |
% |
Medicaid
|
|
|
5.3 |
|
|
|
5.2 |
|
|
|
11.8 |
|
|
|
12.3 |
|
Commercial insurance and managed care
|
|
|
47.3 |
|
|
|
47.7 |
|
|
|
42.2 |
|
|
|
41.4 |
|
Self-pay
|
|
|
4.7 |
|
|
|
4.0 |
|
|
|
20.5 |
|
|
|
20.5 |
|
Subsidies and fees
|
|
|
15.3 |
|
|
|
15.8 |
|
|
|
0.0 |
|
|
|
0.0 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Total
|
|
|
100.0 |
% |
|
|
100.0 |
% |
|
|
100.0 |
% |
|
|
100.0 |
% |
|
|
|
|
|
|
|
|
|
|
|
|
|
In addition to continually monitoring our payor mix, we also
analyze the following key factors and measures in each of our
business segments:
AMR
Approximately 89% of AMRs fiscal 2004 net revenue was
transport revenue derived from the treatment and transportation
of patients based on billings to third party payors and
healthcare facilities. The balance of AMRs net revenue is
derived from direct billings to communities and government
agencies for the provision of training, dispatch center and
other services. AMRs measures for transport net revenue
include:
|
|
|
|
|
Transports. We utilize transport data, including the
number and types of transports, to evaluate net revenue and as
the basis by which we measure certain costs of the business. We
segregate transports into two main categories
ambulance transports (including emergency, as well as
non-emergency critical care and other interfacility transports)
and wheelchair transports due to the significant
differences in reimbursement and the associated costs of
providing ambulance and wheelchair transports. As a result of
these differences, in certain analyses we weight our transport
numbers according to category in an effort to better measure net
revenue and costs. |
47
|
|
|
|
|
Net revenue per transport. Net revenue per transport
reflects the expected net revenue for each transport based on
gross billings less all estimated provisions for contractual
discounts and uncompensated care. In order to better understand
the trends across business segments and in our transport rates,
we analyze our net revenue per transport based on weighted
transports to reflect the differences in our transportation mix. |
The change from period to period in the number of transports is
influenced by increases in transports in existing markets from
both new and existing facilities we serve for non-emergency
transports, and the effects of general community conditions for
emergency transports. The general community conditions may
include (1) the timing, location and severity of influenza,
allergens and other annually recurring viruses, (2) severe
weather that affects a regions health status and/or
infrastructure and (3) community-specific demographic
changes.
The costs we incur in our AMR business segment consist primarily
of compensation and benefits for ambulance crews and support
personnel, direct and indirect operating costs to provide
transportation services, and costs related to accident and
insurance claims. AMRs key cost measures include:
|
|
|
|
|
Unit hours and cost per unit hour. Our measurement of a
unit hour is based on a fully staffed ambulance or wheelchair
van for one operating hour. We use unit hours and cost per unit
hour to measure compensation-related costs and the efficiency of
our deployed resources. We monitor unit hours and cost per unit
hour on a combined basis, as well as on a segregated basis
between ambulance and wheelchair transports. |
|
|
|
Operating costs per transport. Operating costs per
transport is comprised of certain direct operating costs,
including vehicle operating costs, medical supplies and other
transport-related costs, but excluding compensation-related
costs. Monitoring operating costs per transport allows us to
better evaluate cost trends and operating practices of our
regional and local management teams. |
|
|
|
Accident and insurance claims. We monitor the number and
magnitude of all accident and insurance claims in order to
measure the effectiveness of our risk management programs.
Depending on the type of claim (workers compensation, auto,
general or professional liability), we monitor our performance
by utilizing various bases of measurement, such as net revenue,
miles driven, number of vehicles operated, compensation dollars,
and number of transports. |
Our recent operating costs have been adversely affected by
increasing fuel costs. Fuel costs represented approximately 9.8%
of our operating costs in fiscal 2004, increasing to 13.6% in
the three months ended September 30, 2005 as a result of
higher fuel costs. Further increases in fuel costs without
mitigation through fee and subsidy increases will continue to
adversely affect our operating costs.
We estimate that the impact of the Balanced Budget Act of 1997,
or BBA, ambulance service rate decreases, as modified by the
phase-in provisions of the Medicare Modernization Act, resulted
in a decrease in AMRs net revenue for fiscal 2003 and
fiscal 2004 of approximately $20 million and
$11 million, respectively, will result in an increase in
AMRs net revenue of approximately $13 million in
calendar 2005, and will result in a decrease in AMRs net
revenue of approximately $17 million in 2006 and continuing
decreases thereafter to 2010. Although we have been able to
substantially mitigate the phased-in reductions of the BBA
through additional fee and subsidy increases, we may not be able
to continue to do so.
We have focused our risk mitigation efforts on employee training
for proper patient handling techniques, development of clinical
and medical equipment protocols, driving safety, implementation
of technology to reduce auto incidents and other risk mitigation
processes which we believe has resulted in a reduction in the
frequency, severity and development of claims. We continue to
see positive trends in our claims costs but cannot assure you
that these trends will continue.
EmCare
Of EmCares fiscal 2004 net revenue, approximately 97% was
derived from our hospital contracts for emergency department
staffing, hospitalist and radiology services and other
management services. Of this revenue, approximately 75% was
generated from billings to third party payors for patient visits
and
48
approximately 25% was generated from billings to hospitals and
affiliated physician groups for professional services.
EmCares key net revenue measures are:
|
|
|
|
|
Number of contracts. This reflects the number of
contractual relationships we have for outsourced emergency
department staffing and related management services, hospitalist
services and other management services. We analyze the change in
our number of contracts from period to period based on net
new contracts, which is the difference between total new
contracts and contracts that have terminated. |
|
|
|
Revenue per patient visit. This reflects the expected net
revenue for each patient visit based on gross billings less all
estimated provisions for contractual discounts and uncompensated
care. Net revenue per patient visit also includes net revenue
from billings to third party payors and hospitals. |
The change from period to period in the number of patient visits
under our same store contracts is influenced by
general community conditions as well as hospital-specific
elements, many of which are beyond our direct control. The
general community conditions include (1) the timing,
location and severity of influenza, allergens and other annually
recurring viruses and (2) severe weather that affects a
regions health status and/or infrastructure.
Hospital-specific elements include the timing and extent of
facility renovations, hospital staffing issues and regulations
that affect patient flow through the hospital.
The costs incurred in our EmCare business segment consist
primarily of compensation and benefits for physicians and other
professional providers, professional liability costs, and
contract and other support costs. EmCares key cost
measures include:
|
|
|
|
|
Provider compensation per patient visit. Provider
compensation per patient visit includes all compensation and
benefit costs for all professional providers, including
physicians, physician assistants and nurse practitioners, during
each patient visit. Providers include all full-time, part-time
and independently contracted providers. Analyzing provider
compensation per patient visit enables us to monitor our most
significant cost in performing under our contracts. |
|
|
|
Professional liability costs. These costs include
provisions for estimated losses for actual claims, and claims
likely to be incurred in the period, within our self-insurance
limits based on our past loss experience, as well as actual
direct costs, including investigation and defense costs, claims
payments, reinsurance costs and other costs related to provider
professional liability. |
Medicare pays for all physicians services based upon a
national fee schedule. The rate formula may result in
significant yearly fluctuations which may be unrelated to
changes in the actual cost of providing physician services.
Initially, the physician fee schedule update for 2004 called for
a payment decrease of 4.5%. Subsequently, Congress authorized a
1.5% increase that negated the planned rate cuts, and also
provided a 1.5% rate increase for 2005. We currently expect that
the fee schedule will provide for a 4.3% decrease to physician
rates effective January 1, 2006, which would result in a
decrease in EmCares 2006 net revenue of approximately
$5.7 million.
We have developed extensive professional liability risk
mitigation processes, including risk assessments on medical
professionals and hospitals, extensive incident reporting and
tracking processes, clinical fail-safe programs, training and
education and other risk mitigation programs which we believe
have resulted in a continued reduction in the frequency,
severity and development of claims. We continue to see positive
trends in our claims costs but cannot assure you that these
trends will continue.
Hurricane Katrina and our Gulf Coast Operations
AMR provides ambulance services in Gulfport and Biloxi,
Mississippi and several other Gulf Coast communities. Although
our dispatch center was damaged by Hurricane Katrina and we had
damage to a small number of vehicles, we were able to maintain
communications through our use of back-up generators and other
emergency supplies. We have worked closely with FEMA and other
federal, state and local agencies and have deployed additional
ambulance transportation resources where they were most needed,
particularly in the coastal areas of Mississippi, Louisiana and
Alabama. We have deployed more than 100 additional ambulances
49
and nearly 300 paramedics, EMTs and other professionals to aid
the rescue effort in the Gulf Coast, including the deployment of
additional resources to aid in the transport of evacuees to
medical facilities in Texas. For the three months ended
September 30, 2005, we recognized revenue of
$4.6 million and expenses of $4.7 million in the
deployment of additional resources in connection with Hurricane
Katrina and other Gulf Coast storms.
EmCare operations were generally unaffected by Katrina, with
only one facility in the affected area. EmCare deployed
additional resources to assist those operations, and we have
experienced a volume increase in certain facilities in adjacent
states where evacuees were relocated.
We have been able to maintain our normal operations in areas
outside the Gulf Coast, notwithstanding our transfer of
resources to that area. We expect that, for the foreseeable
future, our AMR operations in Mississippi will continue to be
negatively affected by the aftermath of Hurricane Katrina, and
that we will continue to provide additional resources to assist
local recovery efforts throughout the region.
Results of Operations
As we discuss more fully in note 1
Fresh-Start Accounting of the notes to our audited
combined financial statements, AMRs and EmCares
former parent, Laidlaw, and certain of its affiliates filed
voluntary petitions for reorganization under Chapter 11 of
the U.S. Bankruptcy Code. Although subsidiaries of Laidlaw,
neither AMR nor EmCare was included in the bankruptcy filing.
Laidlaw emerged from bankruptcy protection in June 2003. Laidlaw
applied push-down accounting as of June 1, 2003 to AMR and
EmCare and allocated to us our share of the fresh-start
accounting adjustments. For financial statement purposes, for
periods prior to February 1, 2005, AMR and EmCare combined
are our Predecessor. As a result of the application of push-down
accounting and the fresh-start change in the basis of accounting
for our underlying assets and liabilities, our results of
operations and cash flows have been separated further as
pre-June 1, 2003 (referred to as the
Predecessor Pre-Laidlaw Bankruptcy) and
post-May 31, 2003 and pre-February 1, 2005 (referred
to as the Predecessor Post-Laidlaw Bankruptcy).
Effective as of January 31, 2005, we acquired EmCare and
AMR from Laidlaw and in connection with the acquisition we
changed our fiscal year to December 31 from August 31.
For all periods prior to the acquisition, the AMR and EmCare
businesses formerly owned by Laidlaw are referred to as the
Predecessor. For all periods subsequent to the
acquisition, the business is referred to as the
Successor. As a result of the acquisition, we
include as a reporting period of the Predecessor our
pre-acquisition period ended January 31, 2005.
We have made no comparisons for our financial results or cash
flows and other liquidity measures for the
Predecessor Post-Laidlaw Bankruptcys three
months ended August 31, 2003 or for the
Predecessor Post-Laidlaw Bankruptcys financial
results or cash flows and other liquidity measures for the nine
months ended May 31, 2003. As the length of these periods
is significantly different from the length of any corresponding
comparative periods, these results are not comparable in
absolute dollar terms.
However, to facilitate the identification of certain business
trends, we compare the financial results and cash flows for the
year ended August 31, 2004 for the Predecessor
Post-Laidlaw Bankruptcy to:
|
|
|
|
|
the combined financial results and cash flows for the year ended
August 31, 2003, which represents the financial results and
cash flows for the Predecessor Post-Laidlaw
Bankruptcy for the three months ended August 31, 2003 and
the financial results and cash flows for the
Predecessor Pre-Laidlaw Bankruptcy for the nine
months ended May 31, 2003, and |
|
|
|
our Predecessor Pre-Laidlaw Bankruptcys
financial results for the year ended August 31, 2002. |
The combined year ended August 31, 2003 presented below
does not comply with SOP 90-7, which calls for separate
reporting for the Predecessor Post-Laidlaw
Bankruptcy and the Predecessor Pre-Laidlaw
Bankruptcy. Additionally, for the reasons described in
note 1 and due to other non-recurring adjustments, the
Predecessor Pre-Laidlaw Bankruptcys financial
statements for the periods prior to Laidlaws emergence
50
from bankruptcy may not be comparable to our
Predecessor Post-Laidlaw Bankruptcys financial
statements and results of operations which are for periods after
Laidlaws emergence from bankruptcy. Investors should,
therefore, review this material with caution and should not rely
solely on the information concerning the Predecessor
Pre-Laidlaw Bankruptcy or the combined financial results for the
year ended August 31, 2003 as being indicative of our
future results or as providing an accurate comparison of
financial performance from period to period.
The following tables present, for the periods indicated,
information expressed as a percentage of net revenue. This
information has been derived from our audited combined
statements of operations, which include both our AMR and our
EmCare business segments, for the years ended August 31,
2002, 2003 and 2004 and the five months ended January 31,
2005, respectively, from our unaudited combined statements of
operations for the five months ended January 31, 2004 and
the three months and eight months ended September 30, 2004,
respectively, and from our unaudited consolidated statements of
operations for the three months and eight months ended
September 30, 2005.
51
Combined and Consolidated Results of Operations and as a
Percentage of Net Revenue
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Predecessor | |
|
|
|
|
|
|
|
| |
|
|
|
|
|
|
|
|
Successor | |
|
|
|
|
|
|
|
| |
|
|
Year Ended August 31, | |
|
|
|
|
|
|
|
|
|
| |
|
Five Months | |
|
Three Months | |
|
Eight Months | |
|
|
Three Months | |
|
Eight Months | |
|
|
|
|
|
|
Ended | |
|
Ended | |
|
Ended | |
|
|
Ended | |
|
Ended | |
|
|
As Restated | |
|
|
|
January 31, | |
|
September 30, | |
|
September 30, | |
|
|
September 30, | |
|
September 30, | |
|
|
| |
|
|
|
| |
|
| |
|
| |
|
|
| |
|
| |
|
|
2002 | |
|
2003 | |
|
2004 | |
|
2004 | |
|
2005 | |
|
2004 | |
|
2004 | |
|
|
2005 | |
|
2005 | |
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| |
|
| |
|
| |
|
| |
|
| |
|
| |
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| |
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| |
|
| |
|
|
|
|
|
|
|
|
(unaudited) | |
|
|
|
(unaudited) | |
|
|
(unaudited) | |
Net revenue
|
|
$ |
1,415,786 |
|
|
$ |
1,487,796 |
|
|
$ |
1,604,598 |
|
|
$ |
667,506 |
|
|
$ |
696,179 |
|
|
$ |
413,869 |
|
|
$ |
1,077,749 |
|
|
|
$ |
456,245 |
|
|
$ |
1,187,653 |
|
Compensation and benefits
|
|
|
960,590 |
|
|
|
1,021,787 |
|
|
|
1,117,890 |
|
|
|
461,923 |
|
|
|
481,305 |
|
|
|
286,628 |
|
|
|
751,238 |
|
|
|
|
319,292 |
|
|
|
822,595 |
|
Operating expenses
|
|
|
219,321 |
|
|
|
218,659 |
|
|
|
218,277 |
|
|
|
90,828 |
|
|
|
94,882 |
|
|
|
55,863 |
|
|
|
147,524 |
|
|
|
|
66,156 |
|
|
|
168,700 |
|
Insurance expense
|
|
|
66,479 |
|
|
|
104,247 |
|
|
|
80,255 |
|
|
|
36,664 |
|
|
|
39,002 |
|
|
|
18,404 |
|
|
|
51,674 |
|
|
|
|
21,048 |
|
|
|
60,382 |
|
Selling, general and administrative expenses
|
|
|
61,455 |
|
|
|
49,884 |
|
|
|
47,899 |
|
|
|
22,016 |
|
|
|
21,635 |
|
|
|
12,093 |
|
|
|
31,270 |
|
|
|
|
15,654 |
|
|
|
38,248 |
|
Laidlaw fees and compensation charges(1)
|
|
|
5,400 |
|
|
|
5,400 |
|
|
|
15,449 |
|
|
|
6,436 |
|
|
|
19,857 |
|
|
|
3,657 |
|
|
|
10,095 |
|
|
|
|
|
|
|
|
|
|
Depreciation and amortization expenses
|
|
|
67,183 |
|
|
|
44,704 |
|
|
|
52,739 |
|
|
|
22,079 |
|
|
|
18,808 |
|
|
|
12,669 |
|
|
|
34,627 |
|
|
|
|
14,843 |
|
|
|
38,811 |
|
Impairment losses
|
|
|
262,780 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Restructuring charges
|
|
|
3,777 |
|
|
|
2,737 |
|
|
|
2,115 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
1,381 |
|
|
|
|
|
|
|
|
|
|
Laidlaw reorganization costs
|
|
|
8,761 |
|
|
|
3,650 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Income (loss) from operations
|
|
|
(239,960 |
) |
|
|
36,728 |
|
|
|
69,974 |
|
|
|
27,560 |
|
|
|
20,690 |
|
|
|
24,555 |
|
|
|
49,940 |
|
|
|
|
19,252 |
|
|
|
58,917 |
|
Interest expense
|
|
|
(6,418 |
) |
|
|
(5,599 |
) |
|
|
(9,961 |
) |
|
|
(4,137 |
) |
|
|
(5,644 |
) |
|
|
(5,138 |
) |
|
|
(8,679 |
) |
|
|
|
(12,824 |
) |
|
|
(34,407 |
) |
Realized gain (loss) on investments
|
|
|
|
|
|
|
90 |
|
|
|
(1,140 |
) |
|
|
|
|
|
|
|
|
|
|
(1,140 |
) |
|
|
(1,191 |
) |
|
|
|
(34 |
) |
|
|
(40 |
) |
Interest and other income
|
|
|
369 |
|
|
|
326 |
|
|
|
240 |
|
|
|
1,403 |
|
|
|
714 |
|
|
|
162 |
|
|
|
210 |
|
|
|
|
91 |
|
|
|
189 |
|
Fresh-start accounting adjustments
|
|
|
|
|
|
|
46,416 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Cumulative effect of a change in accounting principle
|
|
|
|
|
|
|
(223,721 |
) |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Income tax expense
|
|
|
(1,374 |
) |
|
|
(9,462 |
) |
|
|
(21,764 |
) |
|
|
(9,800 |
) |
|
|
(6,278 |
) |
|
|
(7,191 |
) |
|
|
(15,710 |
) |
|
|
|
(3,479 |
) |
|
|
(10,657 |
) |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Net income (loss)
|
|
$ |
(247,383 |
) |
|
$ |
(155,222 |
) |
|
$ |
37,349 |
|
|
$ |
15,026 |
|
|
$ |
9,482 |
|
|
$ |
11,248 |
|
|
$ |
24,570 |
|
|
|
$ |
3,006 |
|
|
$ |
14,002 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
(1) |
Amounts include specifically allocated compensation costs and
the Laidlaw fees and compensation charges allocated to AMR and
EmCare by Laidlaw pursuant to a formula based upon each
companys share of Laidlaws consolidated revenue. |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Predecessor | |
|
|
|
|
|
|
|
| |
|
|
|
|
|
|
|
|
Successor | |
|
|
|
|
|
|
|
| |
|
|
Year Ended August 31, | |
|
|
|
|
|
|
|
|
|
| |
|
Five Months | |
|
Three Months | |
|
Eight Months | |
|
|
Three Months | |
|
Eight Months | |
|
|
|
|
|
|
Ended | |
|
Ended | |
|
Ended | |
|
|
Ended | |
|
Ended | |
|
|
As Restated | |
|
|
|
January 31, | |
|
September 30, | |
|
September 30, | |
|
|
September 30, | |
|
September 30, | |
|
|
| |
|
|
|
| |
|
| |
|
| |
|
|
| |
|
| |
|
|
2002 | |
|
2003 | |
|
2004 | |
|
2004 | |
|
2005 | |
|
2004 | |
|
2004 | |
|
|
2005 | |
|
2005 | |
|
|
| |
|
| |
|
| |
|
| |
|
| |
|
| |
|
| |
|
|
| |
|
| |
|
|
|
|
|
|
|
|
(unaudited) | |
|
|
|
(unaudited) | |
|
|
(unaudited) | |
Net revenue
|
|
|
100.0 |
% |
|
|
100.0 |
% |
|
|
100.0 |
% |
|
|
100.0 |
% |
|
|
100.0 |
% |
|
|
100.0 |
% |
|
|
100.0 |
% |
|
|
|
100.0 |
% |
|
|
100.0 |
% |
Compensation and benefits
|
|
|
67.8 |
|
|
|
68.7 |
|
|
|
69.7 |
|
|
|
69.2 |
|
|
|
69.1 |
|
|
|
69.3 |
|
|
|
69.7 |
|
|
|
|
70.0 |
|
|
|
69.3 |
|
Operating expenses
|
|
|
15.5 |
|
|
|
14.7 |
|
|
|
13.6 |
|
|
|
13.6 |
|
|
|
13.6 |
|
|
|
13.5 |
|
|
|
13.7 |
|
|
|
|
14.5 |
|
|
|
14.2 |
|
Insurance expense
|
|
|
4.7 |
|
|
|
7.0 |
|
|
|
5.0 |
|
|
|
5.5 |
|
|
|
5.6 |
|
|
|
4.4 |
|
|
|
4.8 |
|
|
|
|
4.6 |
|
|
|
5.1 |
|
Selling, general and administrative expenses
|
|
|
4.3 |
|
|
|
3.4 |
|
|
|
3.0 |
|
|
|
3.3 |
|
|
|
3.1 |
|
|
|
2.9 |
|
|
|
2.9 |
|
|
|
|
3.4 |
|
|
|
3.2 |
|
Laidlaw fees and compensation charges(1)
|
|
|
0.4 |
|
|
|
0.4 |
|
|
|
1.0 |
|
|
|
1.0 |
|
|
|
2.9 |
|
|
|
0.9 |
|
|
|
0.9 |
|
|
|
|
0.0 |
|
|
|
0.0 |
|
Depreciation and amortization expense
|
|
|
4.7 |
|
|
|
3.0 |
|
|
|
3.3 |
|
|
|
3.3 |
|
|
|
2.7 |
|
|
|
3.1 |
|
|
|
3.2 |
|
|
|
|
3.3 |
|
|
|
3.3 |
|
Impairment losses
|
|
|
18.6 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
0.0 |
|
|
|
0.0 |
|
|
|
|
0.0 |
|
|
|
0.0 |
|
Restructuring charges
|
|
|
0.3 |
|
|
|
0.2 |
|
|
|
0.1 |
|
|
|
|
|
|
|
|
|
|
|
0.0 |
|
|
|
0.1 |
|
|
|
|
0.0 |
|
|
|
0.0 |
|
Laidlaw reorganization costs
|
|
|
0.6 |
|
|
|
0.2 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
0.0 |
|
|
|
0.0 |
|
|
|
|
0.0 |
|
|
|
0.0 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Income (loss) from operations
|
|
|
(16.9 |
)% |
|
|
2.5 |
% |
|
|
4.4 |
% |
|
|
4.1 |
% |
|
|
3.0 |
% |
|
|
5.9 |
% |
|
|
4.6 |
% |
|
|
|
4.2 |
% |
|
|
5.0 |
% |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
(1) |
Amounts include specifically allocated compensation costs and
the Laidlaw fees and compensation charges allocated to AMR and
EmCare by Laidlaw pursuant to a formula based upon each
companys share of Laidlaws consolidated revenue. |
52
AMR
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Predecessor | |
|
|
|
|
|
|
|
|
|
|
|
| |
|
|
|
|
|
|
|
|
|
|
|
Year Ended August 31, | |
|
|
|
Five Months Ended January 31, | |
|
|
|
|
Successor | |
|
|
| |
|
| |
|
| |
|
| |
|
|
| |
|
|
As Restated | |
|
|
|
|
|
|
|
|
|
|
|
| |
|
|
|
|
|
Three Months | |
|
|
|
Eight Months | |
|
|
|
|
Three Months | |
|
|
|
Eight Months | |
|
|
|
|
|
|
% of | |
|
|
|
% of | |
|
|
|
% of | |
|
|
|
% of | |
|
|
|
% of | |
|
Ended | |
|
% of | |
|
Ended | |
|
% of | |
|
|
Ended | |
|
% of | |
|
Ended | |
|
% of | |
|
|
|
|
Net | |
|
|
|
Net | |
|
|
|
Net | |
|
|
|
Net | |
|
|
|
Net | |
|
September 30, | |
|
Net | |
|
September 30, | |
|
Net | |
|
|
September 30, | |
|
Net | |
|
September 30, | |
|
Net | |
|
|
2002 | |
|
Revenue | |
|
2003 | |
|
Revenue | |
|
2004 | |
|
Revenue | |
|
2004 | |
|
Revenue | |
|
2005 | |
|
Revenue | |
|
2004 | |
|
Revenue | |
|
2004 | |
|
Revenue | |
|
|
2005 | |
|
Revenue | |
|
2005 | |
|
Revenue | |
|
|
| |
|
| |
|
| |
|
| |
|
| |
|
| |
|
| |
|
| |
|
| |
|
| |
|
| |
|
| |
|
| |
|
| |
|
|
| |
|
| |
|
| |
|
| |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
(unaudited) | |
|
(unaudited) | |
|
|
(unaudited) | |
|
|
(dollars in thousands) | |
Net revenue
|
|
$ |
984,451 |
|
|
|
100.0 |
% |
|
$ |
1,007,151 |
|
|
|
100.0 |
% |
|
$ |
1,054,800 |
|
|
|
100.0 |
% |
|
$ |
441,956 |
|
|
|
100.0 |
% |
|
$ |
455,059 |
|
|
|
100.0 |
% |
|
$ |
270,887 |
|
|
|
100.0 |
% |
|
$ |
705,181 |
|
|
|
100.0 |
% |
|
|
$ |
291,909 |
|
|
|
100.0 |
% |
|
$ |
761,712 |
|
|
|
100.0 |
% |
Compensation and benefits
|
|
|
627,818 |
|
|
|
63.8 |
|
|
|
647,255 |
|
|
|
64.3 |
|
|
|
687,221 |
|
|
|
65.2 |
|
|
|
287,736 |
|
|
|
65.1 |
|
|
|
289,733 |
|
|
|
63.7 |
|
|
|
174,792 |
|
|
|
64.5 |
|
|
|
457,661 |
|
|
|
64.9 |
|
|
|
|
190,112 |
|
|
|
65.1 |
|
|
|
486,455 |
|
|
|
63.9 |
|
Operating expenses
|
|
|
195,335 |
|
|
|
19.8 |
|
|
|
195,105 |
|
|
|
19.4 |
|
|
|
194,398 |
|
|
|
18.4 |
|
|
|
80,277 |
|
|
|
18.2 |
|
|
|
83,910 |
|
|
|
18.4 |
|
|
|
49,693 |
|
|
|
18.3 |
|
|
|
131,520 |
|
|
|
18.7 |
|
|
|
|
58,751 |
|
|
|
20.1 |
|
|
|
150,123 |
|
|
|
19.7 |
|
Insurance expense
|
|
|
36,079 |
|
|
|
3.7 |
|
|
|
67,409 |
|
|
|
6.7 |
|
|
|
44,272 |
|
|
|
4.2 |
|
|
|
20,297 |
|
|
|
4.6 |
|
|
|
22,437 |
|
|
|
4.9 |
|
|
|
11,612 |
|
|
|
4.3 |
|
|
|
28,785 |
|
|
|
4.1 |
|
|
|
|
9,431 |
|
|
|
3.2 |
|
|
|
30,368 |
|
|
|
4.0 |
|
Selling, general and administrative expenses
|
|
|
44,686 |
|
|
|
4.5 |
|
|
|
35,078 |
|
|
|
3.5 |
|
|
|
32,217 |
|
|
|
3.1 |
|
|
|
16,175 |
|
|
|
3.7 |
|
|
|
15,721 |
|
|
|
3.5 |
|
|
|
7,754 |
|
|
|
2.9 |
|
|
|
19,806 |
|
|
|
2.8 |
|
|
|
|
10,951 |
|
|
|
3.8 |
|
|
|
26,953 |
|
|
|
3.5 |
|
Laidlaw fees and compensation charges(1)
|
|
|
3,600 |
|
|
|
0.4 |
|
|
|
3,600 |
|
|
|
0.4 |
|
|
|
9,020 |
|
|
|
0.9 |
|
|
|
3,758 |
|
|
|
0.9 |
|
|
|
9,399 |
|
|
|
2.1 |
|
|
|
2,211 |
|
|
|
0.8 |
|
|
|
5,970 |
|
|
|
0.8 |
|
|
|
|
|
|
|
|
0.0 |
|
|
|
|
|
|
|
0.0 |
|
Depreciation and amortization expense
|
|
|
62,223 |
|
|
|
6.3 |
|
|
|
39,273 |
|
|
|
3.9 |
|
|
|
43,629 |
|
|
|
4.1 |
|
|
|
18,278 |
|
|
|
4.1 |
|
|
|
16,394 |
|
|
|
3.6 |
|
|
|
10,464 |
|
|
|
3.9 |
|
|
|
28,591 |
|
|
|
4.1 |
|
|
|
|
12,084 |
|
|
|
4.1 |
|
|
|
31,527 |
|
|
|
4.1 |
|
Impairment losses
|
|
|
262,780 |
|
|
|
26.7 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
0.0 |
|
|
|
|
|
|
|
0.0 |
|
|
|
|
|
|
|
|
0.0 |
|
|
|
|
|
|
|
0.0 |
|
Restructuring charges
|
|
|
3,777 |
|
|
|
0.4 |
|
|
|
2,737 |
|
|
|
0.3 |
|
|
|
2,115 |
|
|
|
0.2 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
0.0 |
|
|
|
1,381 |
|
|
|
0.2 |
|
|
|
|
|
|
|
|
0.0 |
|
|
|
|
|
|
|
0.0 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Income (loss) from operations
|
|
$ |
(251,847 |
) |
|
|
(25.6 |
)% |
|
$ |
16,694 |
|
|
|
1.7 |
% |
|
$ |
41,928 |
|
|
|
4.0 |
% |
|
$ |
15,435 |
|
|
|
3.5 |
% |
|
$ |
17,465 |
|
|
|
3.8 |
% |
|
$ |
14,361 |
|
|
|
5.3 |
% |
|
$ |
31,467 |
|
|
|
4.5 |
% |
|
|
$ |
10,580 |
|
|
|
3.6 |
% |
|
$ |
36,286 |
|
|
|
4.8 |
% |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
(1) |
Amounts include specifically allocated compensation costs and
the Laidlaw fees and compensation charges allocated to AMR by
Laidlaw pursuant to a formula based upon AMRs share of
Laidlaws consolidated revenue. |
EmCare
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Predecessor | |
|
|
|
|
|
|
|
|
|
|
|
| |
|
|
|
|
|
|
|
|
|
|
|
Year Ended August 31, | |
|
Five Months Ended January 31, | |
|
|
|
|
Successor | |
|
|
| |
|
| |
|
| |
|
|
| |
|
|
|
|
|
|
Three Months | |
|
|
|
Eight Months | |
|
|
|
|
Three Months | |
|
|
|
Eight Months | |
|
|
|
|
|
|
% of | |
|
|
|
% of | |
|
|
|
% of | |
|
|
|
% of | |
|
|
|
% of | |
|
Ended | |
|
% of | |
|
Ended | |
|
% of | |
|
|
Ended | |
|
% of | |
|
Ended | |
|
% of | |
|
|
|
|
Net | |
|
|
|
Net | |
|
|
|
Net | |
|
|
|
Net | |
|
|
|
Net | |
|
September 30, | |
|
Net | |
|
September 30, | |
|
Net | |
|
|
September 30, | |
|
Net | |
|
September 30, | |
|
Net | |
|
|
2002 | |
|
Revenue | |
|
2003 | |
|
Revenue | |
|
2004 | |
|
Revenue | |
|
2004 | |
|
Revenue | |
|
2005 | |
|
Revenue | |
|
2004 | |
|
Revenue | |
|
2004 | |
|
Revenue | |
|
|
2005 | |
|
Revenue | |
|
2005 | |
|
Revenue | |
|
|
| |
|
| |
|
| |
|
| |
|
| |
|
| |
|
| |
|
| |
|
| |
|
| |
|
| |
|
| |
|
| |
|
| |
|
|
| |
|
| |
|
| |
|
| |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
(unaudited) | |
|
(unaudited) | |
|
|
(unaudited) | |
|
|
(dollars in thousands) | |
Net revenue
|
|
$ |
431,335 |
|
|
|
100.0 |
% |
|
$ |
480,645 |
|
|
|
100.0 |
% |
|
$ |
549,798 |
|
|
|
100.0 |
% |
|
$ |
225,550 |
|
|
|
100.0 |
% |
|
$ |
241,120 |
|
|
|
100.0 |
% |
|
$ |
142,982 |
|
|
|
100.0 |
% |
|
$ |
372,568 |
|
|
|
100.0 |
% |
|
|
$ |
164,336 |
|
|
|
100.0 |
% |
|
$ |
425,941 |
|
|
|
100.0 |
% |
Compensation and benefits
|
|
|
332,772 |
|
|
|
77.1 |
|
|
|
374,532 |
|
|
|
77.9 |
|
|
|
430,669 |
|
|
|
78.3 |
|
|
|
174,187 |
|
|
|
77.2 |
|
|
|
191,572 |
|
|
|
79.5 |
|
|
|
111,836 |
|
|
|
78.2 |
|
|
|
293,577 |
|
|
|
78.8 |
|
|
|
|
129,180 |
|
|
|
78.6 |
|
|
|
336,140 |
|
|
|
78.9 |
|
Operating expenses
|
|
|
23,986 |
|
|
|
5.6 |
|
|
|
23,554 |
|
|
|
4.9 |
|
|
|
23,879 |
|
|
|
4.3 |
|
|
|
10,551 |
|
|
|
4.7 |
|
|
|
10,972 |
|
|
|
4.6 |
|
|
|
6,170 |
|
|
|
4.3 |
|
|
|
16,004 |
|
|
|
4.3 |
|
|
|
|
7,405 |
|
|
|
4.5 |
|
|
|
18,577 |
|
|
|
4.4 |
|
Insurance expense
|
|
|
30,400 |
|
|
|
7.0 |
|
|
|
36,838 |
|
|
|
7.7 |
|
|
|
35,983 |
|
|
|
6.5 |
|
|
|
16,367 |
|
|
|
7.3 |
|
|
|
16,565 |
|
|
|
6.9 |
|
|
|
6,792 |
|
|
|
4.8 |
|
|
|
22,889 |
|
|
|
6.1 |
|
|
|
|
11,617 |
|
|
|
7.1 |
|
|
|
30,014 |
|
|
|
7.0 |
|
Selling, general and administrative expenses
|
|
|
16,769 |
|
|
|
3.9 |
|
|
|
14,806 |
|
|
|
3.1 |
|
|
|
15,682 |
|
|
|
2.9 |
|
|
|
5,841 |
|
|
|
2.6 |
|
|
|
5,914 |
|
|
|
2.5 |
|
|
|
4,339 |
|
|
|
3.0 |
|
|
|
11,464 |
|
|
|
3.1 |
|
|
|
|
4,703 |
|
|
|
2.9 |
|
|
|
11,295 |
|
|
|
2.7 |
|
Laidlaw fees and compensation charges(1)
|
|
|
1,800 |
|
|
|
0.4 |
|
|
|
1,800 |
|
|
|
0.4 |
|
|
|
6,429 |
|
|
|
1.2 |
|
|
|
2,678 |
|
|
|
1.2 |
|
|
|
10,458 |
|
|
|
4.3 |
|
|
|
1,446 |
|
|
|
1.0 |
|
|
|
4,125 |
|
|
|
1.1 |
|
|
|
|
|
|
|
|
0.0 |
|
|
|
|
|
|
|
0.0 |
|
Depreciation and amortization expense
|
|
|
4,960 |
|
|
|
1.1 |
|
|
|
5,431 |
|
|
|
1.1 |
|
|
|
9,110 |
|
|
|
1.7 |
|
|
|
3,801 |
|
|
|
1.7 |
|
|
|
2,414 |
|
|
|
1.0 |
|
|
|
2,205 |
|
|
|
1.5 |
|
|
|
6,036 |
|
|
|
1.6 |
|
|
|
|
2,759 |
|
|
|
1.7 |
|
|
|
7,284 |
|
|
|
1.7 |
|
Laidlaw reorganization costs
|
|
|
8,761 |
|
|
|
2.0 |
|
|
|
3,650 |
|
|
|
0.8 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
0.0 |
|
|
|
|
|
|
|
0.0 |
|
|
|
|
|
|
|
|
0.0 |
|
|
|
|
|
|
|
0.0 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Income from operations
|
|
$ |
11,887 |
|
|
|
2.8 |
% |
|
$ |
20,034 |
|
|
|
4.2 |
% |
|
$ |
28,046 |
|
|
|
5.1 |
% |
|
$ |
12,125 |
|
|
|
5.4 |
% |
|
$ |
3,225 |
|
|
|
1.3 |
% |
|
$ |
10,194 |
|
|
|
7.1 |
% |
|
$ |
18,473 |
|
|
|
5.0 |
% |
|
|
$ |
8,672 |
|
|
|
5.3 |
% |
|
|
22,631 |
|
|
|
5.3 |
% |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
(1) |
Amounts include specifically allocated compensation costs and
the Laidlaw fees and compensation charges allocated to EmCare by
Laidlaw pursuant to a formula based upon EmCares share of
Laidlaws consolidated revenue. |
53
Eight months ended September 30, 2005 (Successor)
compared to the eight months ended September 30, 2004
(Predecessor)
For the eight months ended September 30, 2005 compared to the
same period in 2004, our net revenue grew 10.2%, with half of
this growth attributable to an increase in combined volumes at
our operating segments from increases in both existing markets
and the addition of net new contracts at each of AMR and EmCare.
The balance of the net revenue growth was generated by net
pricing increases due to contract and community rate increases
and Medicare increases.
Our income from operations increased 18.0% from period to
period, resulting in improved operating margins. The period to
period comparison is affected by increased fuel costs in 2005 of
$4.6 million, stock compensation charges of
$2.5 million in 2005, favorable insurance claims
development of $3.3 million recorded in 2004, and
$10.1 million of Laidlaw fees and compensation charges in
2004 offset by $4.0 million in 2005 for transaction-related
costs and services that were previously provided by Laidlaw.
Interest expense. Interest expense for the eight months
ended September 30, 2005 was $34.4 million compared to
$8.7 million for the eight months ended September 30,
2004. This $25.7 million increase relates to the debt we
incurred in connection with our acquisition of AMR and EmCare.
Income tax expense. Income tax expense for the eight
months ended September 30, 2005 was $10.7 million
compared to $15.7 million for the eight months ended
September 30, 2004. This $5.0 million decrease relates
primarily to the additional interest expense recorded during the
2005 period.
AMR
Net revenue. Net revenue for the eight months ended
September 30, 2005 was $761.7 million, an increase of
$56.5 million, or 8.0%, from $705.2 million for the
eight months ended September 30, 2004. The increase in net
revenue was due primarily to an increase in our net revenue per
weighted transport of approximately 7.4%. The increase in net
revenue per weighted transport was the result of rate increases
in several of our operating markets and Medicare rate increases
under the Medicare Modernization Act. In addition, we had a net
increase of approximately 11,600 weighted transports. We had an
increase in weighted transports of 82,900, or 4.4%, primarily as
a result of an increase in ambulance transports in existing
markets. This increase was offset by a decrease of approximately
71,300 weighted transports and $14.5 million in net revenue
for the eight months ended September 30, 2005 as a result
of exiting the Pinellas County, Florida market in September 2004.
Compensation and benefits. Compensation and benefits
costs for the eight months ended September 30, 2005 were
$486.5 million, or 63.9% of net revenue, compared to
$457.7 million, or 64.9% of net revenue, for the eight
months ended September 30, 2004. Total unit hours increased
period over period by approximately 105,000 due to the increase
in ambulance transport volume and deployment changes required as
part of several contract rate increases. In addition, ambulance
crew wages per ambulance unit hour increased by 5.4%, which
increased compensation costs by $13.6 million. The
ambulance crew wages per ambulance unit hour increase resulted
principally from annual salary increases. Benefits costs
increased $6.5 million due to increased health benefit
claim costs and health insurance premiums. The exit from the
Pinellas County, Florida market decreased ambulance unit hours
by 153,600 and compensation and benefits costs by
$11.2 million in 2005 compared to 2004.
Operating expenses. Operating expenses for the eight
months ended September 30, 2005 were $150.1 million,
or 19.7% of net revenue, compared to $131.5 million, or
18.7% of net revenue, for the eight months ended
September 30, 2004. Operating expenses per weighted
transport increased 13.5% in 2005 compared to the prior period.
The change is due primarily to additional fuel and vehicle
repair costs of approximately $6.3 million, an increase in
medical supply costs of $2.6 million and an increase in
external services costs of $3.7 million. Costs for medical
supplies and external services grew as a result of increased
ambulance transport volumes. An increase in professional fees of
$2.7 million was related primarily to audit fees and
consulting fees for valuations we incurred in connection with
our acquisition of AMR. Other operating costs, including
occupancy, telecommunications and other expenses, increased
$3.3 million, but remained relatively flat as a percentage
of net revenue compared to the prior period.
54
Insurance expense. Insurance expense for the eight months
ended September 30, 2005 was $30.4 million, or 4.0% of
net revenue, compared to $28.8 million, or 4.1% of net
revenue, for the same period in 2004.
Selling, general and administrative. Selling, general and
administrative expense for the eight months ended
September 30, 2005 was $27.0 million, or 3.5% of net
revenue, compared to $19.8 million, or 2.8% of net revenue,
for the eight months ended September 30, 2004. The eight
months ended September 30, 2004 included reductions in
expense resulting from a one-time reversal of an accrued
liability of $1.8 million and payroll tax refunds related
to prior periods of $2.0 million, and the 2005 period
included increased expense from $0.3 million of Onex
management fees and $0.5 million of additional employee
severance costs. The remaining increase in the 2005 period
related primarily to the Companys growth and strategic
initiatives.
Laidlaw fees and compensation charges. AMR did not incur
Laidlaw fees and compensation charges for the eight months ended
September 30, 2005 as it was no longer a subsidiary of
Laidlaw International, Inc. For the eight months ended
September 30, 2004, these fees and charges were
$6.0 million, or 0.8% of net revenue. Costs of
$1.0 million that we have incurred to date to replace the
services previously performed by Laidlaw are included in the
statement of operations for the eight months ended
September 30, 2005.
Restructuring charges. AMR did not incur restructuring
charges during the eight months ended September 30, 2005.
Restructuring charges of $1.4 million recorded during the
eight months ended September 30, 2004 relate to a reduction
in the number of operating regions. Oversight of the affected
operations was shifted to the remaining regional management
teams.
Depreciation and amortization. Depreciation and
amortization expense for the eight months ended
September 30, 2005 was $31.5 million, or 4.1% of net
revenue, compared to $28.6 million, or 4.1% of net revenue,
for the eight months ended September 30, 2004.
EmCare
Net revenue. Net revenue for the eight months ended
September 30, 2005 was $425.9 million, an increase of
$53.4 million, or 14.3%, from $372.6 million for the
eight months ended September 30, 2004. The increase was due
primarily to an increase in patient visits from net new hospital
contracts and net revenue increases in existing contracts.
Following September 30, 2004, we added 25 net new contracts
which accounted for a net revenue increase of $29.0 million
for the eight months ended September 30, 2005. Net revenue
increased $5.9 million as a result of 21 net new contract
additions in the eight months ended September 30, 2004. Net
revenue under our same store contracts (contracts in
existence for the entirety of both fiscal periods) increased
$18.5 million in the eight months ended September 30,
2005 due to a 4.8% increase in patient visits and a 0.9%
increase in net revenue per patient visit.
Compensation and benefits. Compensation and benefits
costs for the eight months ended September 30, 2005 were
$336.1 million, or 78.9% of net revenue, compared to
$293.6 million, or 78.8% of net revenue, for the eight
months ended September 30, 2004. Provider compensation and
benefits costs increased $24.6 million from net new
contract additions subsequent to January 31, 2004.
Same store provider compensation and benefits costs
increased $11.8 million primarily related to an increase in
patient visits.
Operating expenses. Operating expenses for the eight
months ended September 30, 2005 were $18.6 million, or
4.4% of net revenue, compared to $16.0 million, or 4.3% of
net revenue, for the eight months ended September 30, 2004.
Operating expenses increased due to net new contract additions
but remained consistent as a percentage of net revenue.
Insurance expense. Professional liability insurance
expense for the eight months ended September 30, 2005 was
$30.0 million, or 7.0% of net revenue, compared to
$22.9 million, or 6.1% of net revenue, for the eight months
ended September 30, 2004. The increase as a percent of net
revenue is due primarily to the impact of $3.3 million of
favorable claims development recorded in the 2004 period.
55
Selling, general and administrative. Selling, general and
administrative expense for the eight months ended
September 30, 2005 was $11.3 million, or 2.7% of net
revenue, compared to $11.5 million, or 3.1% of net revenue,
for the eight months ended September 30, 2004.
Laidlaw fees and compensation charges. EmCare did not
incur Laidlaw fees and compensation charges for the eight months
ended September 30, 2005 as it was no longer a subsidiary
of Laidlaw International, Inc. For the eight months ended
September 30, 2004, these fees and charges were
$4.1 million, or 1.1% of net revenue. Costs of
$0.9 million that we have incurred to date to replace the
services previously performed by Laidlaw are included in the
statement of operations for the eight months ended
September 30, 2005.
Depreciation and amortization. Depreciation and
amortization expense for the eight months ended
September 30, 2005 was $7.3 million, or 1.7% of net
revenue, compared to $6.0 million, or 1.6% of net revenue,
for the eight months ended September 30, 2004.
Three months ended September 30, 2005 (Successor)
compared to the three months ended September 30, 2004
(Predecessor)
For the three months ended September 30, 2005 compared to the
same period in 2004, our net revenue grew 10.2%, with half of
this growth attributable to an increase in combined volumes at
our operating segments from increases in both existing markets
and the addition of net new contracts at each of AMR and EmCare.
The balance of the net revenue growth was generated by net
pricing increases due to contract and community rate increases
and Medicare increases.
Our income from operations decreased 21.6% from period to period
due primarily to unusual items affecting the period to period
comparability. These items include increased fuel costs of
$2.5 million in 2005, stock compensation charges of
$2.2 million in 2005, favorable insurance claims
development of $5.4 million recorded in 2004 compared with
$3.0 million in 2005, health benefit reductions of
$1.4 million in 2004, and $3.7 million of Laidlaw fees
and compensation charges in 2004 offset by $1.7 million in
2005 for transaction-related costs and services that were
provided previously by Laidlaw.
Interest expense. Interest expense for the three months
ended September 30, 2005 was $12.8 million compared to
$5.1 million for the three months ended September 30,
2004. This $7.7 million increase relates to the debt we
incurred in connection with our acquisition of AMR and EmCare.
Income tax expense. Income tax expense for the three
months ended September 30, 2005 was $3.5 million
compared to $7.2 million for the three months ended
September 30, 2004. This $3.7 million decrease relates
primarily to the additional interest expense recorded during the
2005 period.
AMR
Net revenue. Net revenue for the three months ended
September 30, 2005 was $291.9 million, an increase of
$21.0 million, or 7.8%, from $270.9 million for the
three months ended September 30, 2004. The increase in net
revenue was due primarily to an increase in our net revenue per
weighted transport of approximately 7.6%. The increase in net
revenue per weighted transport was the result of rate increases
in several of our operating markets and Medicare rate increases
under the Medicare Modernization Act. In addition, we had a net
increase of approximately 800 weighted transports. We had an
increase in weighted transports of 27,600, or 3.9%, primarily as
a result of an increase in ambulance transports in existing
markets. This increase was offset by a decrease of approximately
26,800 weighted transports and $5.6 million in net revenue
for the three months ended September 30, 2005 as a result
of exiting the Pinellas County, Florida market in late September
2004.
Compensation and benefits. Compensation and benefits
costs for the three months ended September 30, 2005 were
$190.1 million, or 65.1% of net revenue, compared to
$174.8 million, or 64.5% of net revenue, for the three
months ended September 30, 2004. Total unit hours increased
period over period by approximately 85,200 due to the increase
in ambulance transport volume, deployment changes required as
part of several contract rate increases and deployment changes
to improve our inter-facility market share. In addition,
ambulance crew wages per ambulance unit hour increased by
approximately 5.4%, which increased compensation costs by
$5.5 million. The ambulance crew wages per ambulance unit
hour increase resulted
56
principally from annual salary increases. Benefits costs
increased $3.7 million due to rising costs of health
insurance premiums and increased health benefit claims and a
favorable adjustment of $1.4 million in 2004 for claims
experience. The exit from the Pinellas County, Florida market
decreased ambulance unit hours by 56,200 and compensation and
benefits costs by $4.5 million.
Operating expenses. Operating expenses for the three
months ended September 30, 2005 were $58.8 million, or
20.1% of net revenue, compared to $49.7 million, or 18.3%
of net revenue, for the three months ended September 30,
2004. Operating expenses per weighted transport increased 18.1%
in 2005 compared to the prior period. The change is due
primarily to additional fuel and vehicle repair costs of
approximately $3.2 million, and increases in medical
supplies, external services and professional fees of
$1.5 million, $1.8 million and $1.5 million,
respectively. External services increased due to contract
changes, increased ambulance transport volumes and professional
fees increased due to audit and consulting fees for valuations
we incurred in connection with our acquisition of AMR. Other
operating costs, including occupancy, telecommunications and
other expenses, increased $1.0 million, but remained
relatively flat as a percentage of net revenue compared to the
prior period.
Insurance expense. Insurance expense for the three months
ended September 30, 2005 was $9.4 million, or 3.2% of
net revenue, compared to $11.6 million, or 4.3% of net
revenue, for the same period in 2004. These quarters included
favorable reductions in ultimate claims costs of
$3.0 million and $2.2 million for the three months
ended September 30, 2005 and 2004, respectively.
Selling, general and administrative. Selling, general and
administrative expense for the three months ended
September 30, 2005 was $11.0 million, or 3.8% of net
revenue, compared to $7.8 million, or 2.9% of net revenue,
for the three months ended September 30, 2004. The three
months ended September 30, 2005 included Onex management
fees of $0.1 million, additional employee severance costs
of $0.3 million and donations totaling $0.3 million to
our employees impacted by the Gulf Coast storms. The remaining
increase related primarily to our growth and strategic
initiatives, which totaled $1.6 million.
Laidlaw fees and compensation charges. AMR did not incur
Laidlaw fees and compensation charges for the three months ended
September 30, 2005 as it was no longer a subsidiary of
Laidlaw International, Inc. For the three months ended
September 30, 2004, these fees and charges were
$2.2 million, or 0.8% of net revenue. Costs of
$0.4 million that we incurred to date to replace the
services previously performed by Laidlaw are included in the
statement of operations for the three months ended
September 30, 2005.
Depreciation and amortization. Depreciation and
amortization expense for the three months ended
September 30, 2005 was $12.1 million, or 4.1% of net
revenue, compared to $10.5 million, or 3.9% of net revenue,
for the three months ended September 30, 2004.
EmCare
Net revenue. Net revenue for the three months ended
September 30, 2005 was $164.3 million, an increase of
$21.3 million, or 14.9%, from $143.0 million for the
three months ended September 30, 2004. The increase was due
primarily to an increase in patient visits from net new hospital
contracts and net revenue increases in existing contracts.
Following September 30, 2004, we added 25 net new contracts
which accounted for a net revenue increase of $12.1 million
for the three months ended September 30, 2005. Net revenue
under our same store contracts (contracts in
existence for the entirety of both fiscal periods) increased
$9.3 million in the three months ended September 30,
2005 due to a 5.7% increase in patient visits and a 1.8%
increase in net revenue per patient visit.
Compensation and benefits. Compensation and benefits
costs for the three months ended September 30, 2005 were
$129.2 million, or 78.6% of net revenue, compared to
$111.8 million, or 78.2% of net revenue, for the three
months ended September 30, 2004. Provider compensation and
benefits costs increased $9.3 million from net new contract
additions subsequent to September 30, 2004. Same
store provider compensation and benefits costs increased
$6.6 million, related primarily to an increase in patient visits.
Operating expenses. Operating expenses for the three
months ended September 30, 2005 were $7.4 million, or
4.5% of net revenue, compared to $6.2 million, or 4.3% of
net revenue, for the three months ended September 30, 2004.
Operating expenses increased due to net new contract additions
but remained consistent as a percentage of net revenue.
57
Insurance expense. Professional liability insurance
expense for the three months ended September 30, 2005 was
$11.6 million, or 7.1% of net revenue, compared to
$6.8 million, or 4.8% of net revenue, for the three months
ended September 30, 2004. The increase as a percent of net
revenue is due primarily to the impact of $3.2 million of
favorable insurance claims development recorded in the 2004
period.
Selling, general and administrative. Selling, general and
administrative expense for the three months ended
September 30, 2005 was $4.7 million, or 2.9% of net
revenue, compared to $4.3 million, or 3.0% of net revenue,
for the three months ended September 30, 2004. The
$0.4 million increase in selling, general and
administrative expense is related to replacement costs
previously included in Laidlaw management fees and the increase
in net new contracts.
Laidlaw fees and compensation charges. EmCare did not
incur Laidlaw fees and compensation charges for the three months
ended September 30, 2005 as it was no longer a subsidiary
of Laidlaw International, Inc. For the three months ended
September 30, 2004, these fees and charges were
$1.4 million, or 1.0% of net revenue. Costs of
$0.4 million that we incurred to date to replace the
services previously performed by Laidlaw are included in the
statement of operations for the three months ended
September 30, 2005.
Depreciation and amortization. Depreciation and
amortization expense for the three months ended
September 30, 2005 was $2.8 million, or 1.7% of net
revenue, compared to $2.2 million, or 1.5% of net revenue,
for the three months ended September 30, 2004.
Five months ended January 31, 2005 (Successor)
compared to the five months ended January 31, 2004
(Predecessor)
Interest expense. Interest expense for the five months
ended January 31, 2005 was $5.6 million compared to
$4.1 million for the five months ended January 31,
2004. The $1.5 million difference relates to an increase in
the amount owed to Laidlaw during the five months ended
January 31, 2005 compared to the same period in 2004.
Income tax expense. Income tax expense for the five
months ended January 31, 2005 was $6.3 million
compared to $9.8 million for the five months ended
January 31, 2004. The $3.5 million decrease relates
primarily to additional interest expense and added costs
incurred by AMR and EmCare as a result of the acquisition.
AMR
Net revenue. Net revenue for the five months ended
January 31, 2005 was $455.1 million, an increase of
$13.1 million, or 3.0%, from $442.0 million for the
five months ended January 31, 2004. The increase in net
revenue was due primarily to an increase in our net revenue per
weighted transport of approximately 6%, offset by approximately
38,700 fewer weighted transports, including a 30,220 ambulance
transport decrease. The decrease in ambulance transports was due
primarily to exiting the Pinellas County, Florida market in late
September 2004, which accounted for a decrease of approximately
35,000 ambulance transports and $6.2 million in net revenue
for the five months ended January 31, 2005.
Compensation and benefits. Compensation and benefits
costs for the five months ended January 31, 2005 were
$289.7 million, or 63.7% of net revenue, compared to
$287.7 million, or 65.1% of net revenue, for the five
months ended January 31, 2004. Total unit hours decreased
period over period by 100,800 primarily as a result of the exit
from the Pinellas County, Florida market, which decreased
ambulance unit hours by 79,800 and compensation and benefits
costs by $5.3 million. The decrease in total unit hours was
offset by an increase in our ambulance crew wages per ambulance
unit hour of 6.6%, which increased compensation costs by
$10.1 million. The ambulance crew wages per ambulance unit
hour increase resulted principally from annual salary increases.
Benefits costs decreased $1.7 million due to our shift of
employees previously covered under premium-based health
insurance plans to self-insured health plans.
Operating expenses. Operating expenses for the five
months ended January 31, 2005 were $83.9 million, or
18.4% of net revenue, compared to $80.3 million, or 18.2%
of net revenue, for the five months ended January 31, 2004.
Operating expenses per weighted transport increased 7.9% in 2005
compared to the prior
58
period. This $3.6 million increase was due primarily to
higher fuel costs, which were 2.0% of net revenue for the five
months ended January 31, 2005, compared to 1.6% of net
revenue for the same period in 2004.
Insurance expense. Insurance expense for the five months
ended January 31, 2005 was $22.4 million, or 4.9% of
net revenue, compared to $20.3 million, or 4.6% of net
revenue, for the same period in 2004. This $2.1 million
decrease was primarily a result of improvements in ultimate
claims costs.
Selling, general and administrative. Selling, general and
administrative expense for the five months ended
January 31, 2005 was $15.7 million, or 3.5% of net
revenue, compared to $16.2 million, or 3.7% of net revenue,
for the five months ended January 31, 2004. The
$0.5 million decrease in selling, general and
administrative expense related primarily to deferred
compensation expense recorded as part of management incentive
programs that were implemented by Laidlaw during fiscal 2004 and
which were expensed as a component of Laidlaw fees and
compensation charges in 2005.
Laidlaw fees and compensation charges. Laidlaw fees and
compensation charges for the five months ended January 31,
2005 were $9.4 million, or 2.1% of net revenue, compared to
$3.8 million, or 0.9% of net revenue, for the five months
ended January 31, 2004. This $5.6 million increase was
primarily due to charges related to senior management incentive
plans expensed as part of the sale to Onex and additional
Laidlaw overhead costs allocated to AMR during the five months
ended January 31, 2005.
Depreciation and amortization. Depreciation and
amortization expense for the five months ended January 31,
2005 was $16.4 million, or 3.6% of net revenue, compared to
$18.3 million, or 4.1% of net revenue, for the five months
ended January 31, 2004. The $1.9 million decrease
resulted from the elimination of the contract intangible asset
recorded in fiscal 2003 as part of our fresh-start accounting
adjustments. As this asset was eliminated in the fourth quarter
of fiscal 2004, no amortization expense was recorded for this
intangible asset in the five months ended January 31, 2005.
EmCare
Net revenue. Net revenue for the five months ended
January 31, 2005 was $241.1 million, an increase of
$15.5 million, or 6.9%, from $225.6 million for the
five months ended January 31, 2004. The increase was due
primarily to an increase in patient visits from net new hospital
contracts and net revenue increases in existing contracts.
Following January 31, 2004, we added 33 net new
contracts which accounted for a net revenue increase of
$11.9 million for the five months ended January 31,
2005. Net revenue increased $2.6 million as a result of six
net new contract additions in the five months ended
January 31, 2004. Net revenue under our same
store contracts (contracts in existence for the entirety
of both fiscal periods) increased $1.1 million in the five
months ended January 31, 2005 due to a 1.4% decrease in
patient visits, offset by a 1.9% increase in net revenue per
patient visit.
Compensation and benefits. Compensation and benefits
costs for the five months ended January 31, 2005 were
$191.6 million, or 79.5% of net revenue, compared to
$174.2 million, or 77.2% of net revenue, for the five
months ended January 31, 2004. Provider compensation and
benefits costs increased $12.5 million from net new
contract additions subsequent to August 31, 2004.
Same store provider compensation and benefits
increased $3.6 million.
Operating expenses. Operating expenses for the five
months ended January 31, 2005 were $11.0 million, or
4.6% of net revenue, compared to $10.6 million, or 4.7% of
net revenue, for the five months ended January 31, 2004.
Operating expenses, as a percentage of net revenue, decreased
due to our leveraging of fixed billing and other fixed contract
costs.
Insurance expense. Professional liability insurance
expense for the five months ended January 31, 2005 was
$16.6 million, or 6.9% of net revenue, compared to
$16.4 million, or 7.3% of net revenue, for the five months
ended January 31, 2004. Insurance expense, as a percentage
of net revenue, decreased due to an improvement in expected
ultimate claims costs.
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Selling, general and administrative. Selling, general and
administrative expense for the five months ended
January 31, 2005 was $5.9 million, or 2.5% of net
revenue, compared to $5.8 million, or 2.6% of net revenue,
for the five months ended January 31, 2004.
Laidlaw fees and compensation charges. Laidlaw fees and
compensation charges for the five months ended January 31,
2005 was $10.5 million, or 4.3% of net revenue, compared to
$2.7 million, or 1.2% of net revenue, for the five months
ended January 31, 2004. This $7.8 million increase was
primarily due to charges related to senior management incentive
plans expensed as part of the sale to Onex and additional
Laidlaw overhead costs allocated to EmCare during the five
months ended January 31, 2005.
Depreciation and amortization. Depreciation and
amortization expense for the five months ended January 31,
2005 was $2.4 million, or 1.0% of net revenue, compared to
$3.8 million, or 1.7% of net revenue, for the five months
ended January 31, 2004. The $1.4 million decrease was
the result of the elimination of the contract intangible asset
recorded in fiscal 2003 as part of our fresh-start accounting
adjustments. As this asset was eliminated in the fourth quarter
of fiscal 2004, no amortization expense was recorded for this
intangible asset in the five months ended January 31, 2005.
Year ended August 31, 2004 compared to the year ended
August 31, 2003
Interest expense. Interest expense for the year ended
August 31, 2004 was $10.0 million compared to
$5.6 million for the year ended August 31, 2003. The
increase is a result of Laidlaw suspending certain related party
interest charges during the Laidlaw bankruptcy in 2003.
Income tax expense. Income tax expense for the year ended
August 31, 2004 was $21.8 million compared to
$9.5 million for the year ended August 31, 2003. The
$12.3 million increase is a result of the release of full
valuation allowances on all deferred tax assets for the 2003
period in connection with Laidlaws exit from bankruptcy.
AMR
Net revenue. Net revenue for the year ended
August 31, 2004 was $1,054.8 million, an increase of
$47.6 million, or 4.7%, from $1,007.2 million for the
year ended August 31, 2003. The increase was due primarily
to an increase in weighted transports of 65,800, or 2.3%,
primarily as a result of an increase in ambulance transports in
existing markets, resulting in a net revenue increase of
$22.9 million. The balance of the increase resulted from
rate increases in several of our markets that offset Medicare
rate reductions in effect prior to the July 1, 2004
effective date of the Medicare Modernization Act, together
increasing our net revenue per weighted transport by 2.4%, or
$24.7 million.
Compensation and benefits. Compensation and benefits
costs for the year ended August 31, 2004 were
$687.2 million, or 65.2% of net revenue, compared to
$647.3 million, or 64.3%, for the year ended
August 31, 2003. The increase of $39.9 million
includes an increase in ambulance unit hours of 242,200, or
2.5%, associated with the increase in weighted transports,
totaling $8.9 million of compensation-related costs.
Ambulance salaries per unit hour increased 3.5%, or
$12.6 million. In fiscal 2004 we expanded our sales and
marketing team and our senior management, resulting in
$3.7 million of compensation and benefits costs. Our health
insurance costs and other employee benefits also increased year
over year by $11.0 million.
Operating expenses. Operating expenses for the year ended
August 31, 2004 were $194.4 million, or 18.4% of net
revenue, compared to $195.1 million, or 19.4% of net
revenue, for the year ended August 31, 2003. Operating
expenses per weighted transport decreased 2.6% from fiscal 2003
to fiscal 2004. These expenses decreased primarily as a result
of improvements in telecommunications contract rates, totaling
$0.6 million, and a reduction in medical supplies expense,
totaling $0.6 million, from improved purchasing contracts
and more efficient inventory management. These decreases were
offset in part by increases in vehicle operating costs, totaling
$0.6 million, resulting primarily from higher fuel costs
incurred in late fiscal 2004.
Insurance expense. Insurance expense for the year ended
August 31, 2004 was $44.3 million, or 4.2% of net
revenue, compared to $67.4 million, or 6.7% of net revenue,
for the year ended August 31, 2003. This
60
decrease of $23.1 million primarily relates to insurance
expense recorded in fiscal 2003 of $14.6 million resulting
from increases in actuarially-computed estimates of costs
required to settle prior years claims. In fiscal 2004, we
recorded a reduction of insurance expense of $4.5 million
due to favorable developments with respect to these claims. We
funded these claims through Laidlaws captive insurance
program. Excluding these adjustments, insurance expense
decreased $4.0 million from fiscal 2003 to fiscal 2004 as a
result of improvements in ultimate claims costs. Management
implemented a number of additional risk mitigation programs at
the beginning of fiscal 2003 that we believe positively impacted
claims costs in fiscal 2004.
Selling, general and administrative. Selling, general and
administrative expense for the year ended August 31, 2004
was $32.2 million, or 3.1% of net revenue, compared to
$35.1 million, or 3.5% of net revenue, for the year ended
August 31, 2003. This decrease of $2.9 million relates
primarily to a one-time expense reduction to eliminate a
contingent liability of $1.8 million.
Laidlaw fees and compensation charges. Laidlaw fees and
compensation charges for the year ended August 31, 2004
increased from $3.6 million, or 0.4% of net revenue, to
$9.0 million, or 0.9% of net revenue, from the year ended
August 31, 2003. The $5.4 million increase was due to
charges related to senior management incentive plans and
additional Laidlaw overhead costs allocated to AMR.
Depreciation and amortization. Depreciation and
amortization expense for the year ended August 31, 2004 was
$43.6 million, or 4.1% of net revenue, compared to
$39.3 million, or 3.9% of net revenue, for the year ended
August 31, 2003. The $4.3 million increase includes
$3.3 million attributable to amortization of a contract
intangible asset recorded as part of our fresh-start accounting
adjustments. The balance of the increase is related primarily to
vehicle acquisitions made in late fiscal 2003 and fiscal 2004.
Restructuring charges. Restructuring charges were
$2.1 million, or 0.2% of net revenue, for the year ended
August 31, 2004, a decrease from $2.7 million, or 0.3%
of net revenue, for the year ended August 31, 2003. Fiscal
2003 restructuring charges included severance-related costs for
several members of senior management who were replaced during
the year and costs incurred in restructuring and consolidating
our billing offices. In fiscal 2004, we reduced the number of
operating regions and shifted the oversight of the affected
operations to the remaining regional management teams.
EmCare
Net revenue. Net revenue for the year ended
August 31, 2004 was $549.8 million, an increase of
$69.2 million, or 14.4%, from $480.6 million for the
year ended August 31, 2003. The increase was due primarily
to an increase in patient visits from net new hospital contracts
and net revenue increases in existing contracts. During fiscal
2004, we added 35 net new contracts (58 new contracts,
including 50 new emergency department contracts and 8 new
hospitalist contracts, offset by 23 contract terminations), for
a net revenue increase of $21.6 million. Net revenue
increased $23.6 million as a result of the net impact of
contract additions and terminations in fiscal 2003. Same
store net revenue increased $24.0 million due to a
4.5% increase in patient visits and an increase of 1.1% in net
revenue per patient visit.
Compensation and benefits. Compensation and benefits
costs for the year ended August 31, 2004 were
$430.7 million, or 78.3% of net revenue, compared to
$374.5 million, or 77.9% of net revenue, for the year ended
August 31, 2003. Provider compensation and benefit costs
increased $32.7 million from net new contract additions in
fiscal 2003 and 2004. Same store contract
compensation and benefits costs increased $12.8 million, or
0.2% per patient visit, as a result of increased net revenue per
visit and an increase in volume of patient visits, as a number
of our contracts include productivity-based compensation plans.
Operating expenses. Operating expenses for the year ended
August 31, 2004 were $23.9 million, or 4.3% of net
revenue, compared to $23.6 million, or 4.9% of net revenue,
for the year ended August 31, 2003. Operating expenses
decreased as a percent of net revenue from 4.9% in fiscal 2003
to 4.3% in fiscal 2004 due to our leveraging of fixed billing
and other contract costs.
Insurance expense. Professional liability insurance
expense for the year ended August 31, 2004 was
$36.0 million, or 6.5% of net revenue, compared to
$36.8 million, or 7.7% of net revenue, for the year ended
August 31, 2003. The reduction as a percent of net revenue
represents a combination of improved investment
61
returns, changes in actuarial estimates of costs required to
settle prior years claims and a reduction in the estimate
of ultimate claims costs.
Selling, general and administrative. Selling, general and
administrative expense for the year ended August 31, 2004
was $15.7 million, or 2.9% of net revenue, compared to
$14.8 million, or 3.1% of net revenue, for the year ended
August 31, 2003. The $0.9 million increase in selling,
general and administrative expense includes $0.6 million of
deferred compensation expense recorded as part of management
incentive programs during fiscal 2004 that were terminated in
connection with the acquisition and additional support costs
required for net new contracts.
Laidlaw fees and compensation charges. Laidlaw fees and
compensation charges for the year ended August 31, 2004
were $6.4 million, or 1.2% of net revenue, compared to
$1.8 million, or 0.4% of net revenue, for the year ended
August 31, 2003. The increase was due to charges related to
senior management incentive plans and additional Laidlaw
overhead costs allocated to EmCare.
Depreciation and amortization. Depreciation and
amortization expense for the year ended August 31, 2004 was
$9.1 million, or 1.7% of net revenue, compared to
$5.4 million, or 1.1% of net revenue, for the year ended
August 31, 2003. The increase of $3.7 million was due
to amortization of a contract intangible asset recorded as part
of our fresh-start accounting adjustments.
Laidlaw reorganization costs. There were no allocated
reorganization costs in fiscal 2004. Laidlaw reorganization
costs for the year ended August 31, 2003 were
$3.7 million, or 0.8% of net revenue. These costs were
allocated to EmCare by Laidlaw and reflect costs borne by
Laidlaw during its Chapter 11 restructuring.
Year ended August 31, 2003 compared to the year ended
August 31, 2002
Interest expense. Interest expense for the year ended
August 31, 2003 was $5.6 million compared to
$6.4 million for the year ended August 31, 2002. The
decrease of $0.8 million is due to higher interest costs on
vehicle capital leases in fiscal 2002.
Income tax expense. Income tax expense for the year ended
August 31, 2003 was $9.5 million compared to
$1.4 million for the year ended August 31, 2002. The
$8.1 million increase is due to increased income from
operations during fiscal 2003.
AMR
Net revenue. Net revenue for the year ended
August 31, 2003 was $1,007.2 million, an increase of
$22.7 million, or 2.3%, from $984.5 million for the
same period in 2002. The increase for fiscal 2003 is due
primarily to rate increases we negotiated with several
communities and payors during fiscal 2003, partially in response
to Medicare rate reductions beginning in April 2002. Our rate
per weighted transport increased 2.9%, resulting in a
$28.4 million increase in net revenue. This increase was
offset, in part, by a decrease in weighted transports of 16,900,
or 0.6%, resulting in a $5.7 million decrease in net
revenue, due principally to fewer non-emergency transports.
Compensation and benefits. Compensation and benefits
costs for the year ended August 31, 2003 were
$647.3 million, or 64.3% of net revenue, compared to
$627.8 million, or 63.8% of net revenue, for the year ended
August 31, 2002. The $19.5 million increase relates
primarily to ambulance crew wage per unit hour increases of
approximately 2.9%, or $9.8 million, in addition to an
increase in unit hours of approximately 90,900, or 0.9%,
resulting in a $2.5 million increase. Benefits also
increased $3.6 million from period to period as a result of
rising health insurance premium costs.
Operating expenses. Operating expenses for the year ended
August 31, 2003 were $195.1 million, or 19.4% of net
revenue, compared to $195.3 million, or 19.8% of net
revenue, for the year ended August 31, 2002. Operating
expenses per weighted transport decreased 0.5% from fiscal 2002
to fiscal 2003. The $0.2 million decrease was a result of a
$3.1 million decrease in occupancy costs from consolidating
certain regional facilities and a $6.1 million decrease in
professional services from legal costs incurred in fiscal 2002
for compliance-related matters, offset in part by a
$6.5 million increase in external provider costs. The
62
increase in external provider costs resulted principally from a
significant expansion in our national and regional relationships
with managed care and insurance providers and the resulting
costs we incurred to subcontract certain transports to local
ambulance providers.
Insurance expense. Insurance expense for the year ended
August 31, 2003 was $67.4 million, or 6.7% of net
revenue, compared to $36.1 million, or 3.7% of net revenue,
for the year ended August 31, 2002. In fiscal 2003, we
recorded $14.6 million of expense related to reserve
adjustments resulting from increases in actuarially-computed
estimates of costs required to settle prior years claims.
We funded these claims through Laidlaws captive insurance
program. In fiscal 2002, we recorded a reduction of insurance
expense of $8.1 million related to the favorable
development of claims reserves on insurance liabilities prior to
fiscal 2002. Excluding these adjustments, the $8.6 million
increase in insurance expense related to increasing premium and
claims costs associated with our workers compensation, and auto,
general and professional liability programs.
Selling, general and administrative. Selling, general and
administrative expense for the year ended August 31, 2003
was $35.1 million, or 3.5% of net revenue, compared to
$44.7 million, or 4.5% of net revenue, for the year ended
August 31, 2002. The $9.6 million reduction in
selling, general and administrative expense from fiscal 2002 to
fiscal 2003 is the result of severance recorded in fiscal 2002
to replace certain members of management, totaling
$3.7 million, associated costs to close operations,
totaling $0.9 million, and compliance-related penalties of
approximately $1.9 million incurred in fiscal 2002. In
fiscal 2003, we recorded a one-time reduction of selling,
general and administrative expense relating to the release of
$1.2 million in accrued liabilities and a reduction to
expense related to payroll tax refunds of $0.6 million.
Depreciation and amortization. Depreciation and
amortization expense for the year ended August 31, 2003 was
$39.3 million, or 3.9% of net revenue, compared to
$62.2 million, or 6.3% of net revenue, for the year ended
August 31, 2002. The decrease of $22.9 million
includes $21.3 million attributable to the amortization of
goodwill. Beginning in fiscal 2003, this intangible asset was no
longer amortized, but evaluated annually for impairment under
applicable accounting guidance.
Impairment losses. In fiscal 2002, we recorded an
impairment charge of $262.8 million or 26.7% of net
revenue, on long-lived assets based on the evaluation at that
time that future operating cash flows would not be sufficient to
recover the carrying value of certain long-lived assets,
primarily goodwill.
Restructuring charges. Restructuring charges were
$2.7 million, or 0.3% of net revenue, in the year ended
August 31, 2003, a decrease from $3.8 million, or 0.4%
of net revenue, in the year ended August 31, 2002. Fiscal
2003 restructuring charges included severance-related costs for
several members of senior management who were replaced during
the year and costs incurred in restructuring and consolidating
our billing offices. In fiscal 2002, AMR reduced the number of
operating regions, exited certain facilities, and shifted the
oversight of the impacted operations to the remaining regional
management teams.
EmCare
Net revenue. Net revenue for the year ended
August 31, 2003 was $480.6 million, an increase of
$49.3 million, or 11.4%, from $431.3 million for the
year ended August 31, 2002. The increase was due primarily
to an increase in patient visits from net new hospital contracts
and net revenue increases in existing contracts. During fiscal
2003, we added 27 net new contracts (55 new contracts,
including 48 new emergency department contracts and 7 new
hospitalist contracts, offset by 28 contract terminations), for
a net revenue increase of $30.4 million. Net revenue
increased $3.9 million as a result of the net impact of
2002 contract additions and terminations. Same store
net revenue increased $15.0 million due to a 2.0% increase
in patient visits and a 1.8% increase in net revenue per patient
visit.
Compensation and benefits. Compensation and benefits
costs for the year ended August 31, 2003 were
$374.5 million, or 77.9% of net revenue, compared to
$332.8 million, or 77.1% of net revenue, for the year ended
August 31, 2002. Provider compensation and benefit costs
increased $26.4 million from net new contract additions in
fiscal 2003 and 2002. Same store contract
compensation and benefits costs increased
63
$11.0 million as a result of increased volume of patient
visits and increased net revenue per visit, as a number of our
contracts include productivity-based compensation plans.
Operating expenses. Operating expenses for the year ended
August 31, 2003 were $23.6 million, or 4.9% of net
revenue, compared to $24.0 million, or 5.6% of net revenue,
for the year ended August 31, 2002. Operating expenses
decreased as a percent of net revenue due to our leveraging of
fixed billing and other contract costs.
Insurance expense. Professional liability insurance
expense for the year ended August 31, 2003 was
$36.8 million, or 7.7% of net revenue, compared to
$30.4 million, or 7.0% of net revenue, for the year ended
August 31, 2002 due to an increase in expected ultimate
losses.
Selling, general and administrative. Selling, general and
administrative expense for the year ended August 31, 2003
was $14.8 million, or 3.1% of net revenue, compared to
$16.8 million, or 3.9% of net revenue, for the year ended
August 31, 2002. The $2.0 million decrease was a
result of reduced management contract costs, as contracted
management costs were converted to employee costs in fiscal 2003.
Depreciation and amortization. Depreciation and
amortization expense for the year ended August 31, 2003 was
$5.4 million, or 1.1% of net revenue, compared to
$5.0 million, or 1.1% of net revenue, for the year ended
August 31, 2002. The $0.4 million increase was due to
additional billing technology investments completed at the end
of fiscal 2002.
Laidlaw reorganization costs. Allocated reorganization
costs for the year ended August 31, 2003 were
$3.7 million, or 0.8% of net revenue, compared to
$8.8 million, or 2.0% of net revenue, for the year ended
August 31, 2002. These costs were allocated to EmCare by
Laidlaw and reflect costs borne by Laidlaw during its
Chapter 11 restructuring.
Liquidity and Capital Resources
Our primary sources of liquidity are cash flow provided by our
operating activities and, prior to the acquisition, related
party advances from Laidlaw. We are now using our revolving
senior secured credit facility, described below, to supplement
our cash flow provided by our operating activities. Our
liquidity needs are primarily to fund our working capital
requirements, capital expenditures related to the acquisition of
vehicles and medical equipment, technology-related assets and
insurance-related deposits.
For the eight months ended September 30, 2005 and 2004, we
generated cash flow from operating activities of
$108.5 million and $100.0 million, respectively. For
the eight months ended September 30, 2005, we had net
income of $14.0 million, compared to $24.6 million for
the same period in 2004. Operating cash flow from changes in
working capital for the eight months ended September 30,
2005 increased $23.8 million from the same period in 2004,
reflecting improved collections on accounts receivable, a
reduction in the amount of deposits required under our insurance
programs, an increase in accruals related to our growth and
accrued interest in the current period not incurred in the eight
months ended September 30, 2004.
Net cash used in investing activities was $917.4 million
for the eight months ended September 30, 2005, compared to
$73.9 million for the same period in 2004. The
$843.5 million increase was attributable principally to our
net cash outflow to fund the acquisition of AMR and EmCare.
For the eight months ended September 30, 2005, net cash
provided by financing activities was $804.4 million,
compared to net cash used in financing activities of
$20.7 million for the eight months ended September 30,
2004. The increase in net cash provided by financing activities
relates primarily to borrowings received from our senior secured
credit facility and senior subordinated notes. Net cash used in
financing activities included financing costs of
$20.1 million and repayments of debt, including capital
lease and senior secured credit facility obligations totaling
$25.8 million.
For the five months ended January 31, 2005 and 2004, we
generated cash flow from operating activities of
$16.0 million and $18.6 million, respectively.
Operating cash flow from changes in working capital for the five
months ended January 31, 2005 increased $8.9 million
from the same period in 2004, primarily reflecting improved
collections on accounts receivables.
64
Net cash used in investing activities was $21.7 million for
the five months ended January 31, 2005, compared to
$10.9 million for the same period in 2004. The
$10.8 million increase was attributable principally to our
net cash outflow to fund insurance-related deposits in our
EmCare business segment. The balance resulted primarily from the
purchase of new ambulance vehicles and certain medical equipment.
For the five months ended January 31, 2005, net cash
provided by financing activities was $10.9 million compared
to net cash used in financing activities of $7.5 million
for the five months ended January 31, 2004. Net cash used
in financing activities relates primarily to borrowings received
from Laidlaw and payments on our capital lease obligations.
During fiscal 2004, our operating activities generated
$127.7 million in cash flow compared to $88.8 million
in fiscal 2003, an increase of $38.9 million. Operating
cash flow from changes in working capital for fiscal 2004
increased $2.9 million compared to fiscal 2003. The balance
of the change in cash flow provided by operating activities was
attributable principally to an increase in net income, which
includes increases in depreciation and amortization expense and
changes in deferred taxes.
Net cash used in investing activities was $81.5 million and
$114.0 million during fiscal years 2004 and 2003,
respectively. In fiscal 2004, we spent $42.8 million on
property and equipment, of which $20.4 million related to
the acquisition of vehicles, and medical and communications
equipment, technology-related acquisition and leasehold
improvements accounted for $22.4 million. Our
$22.5 million net decrease in insurance-related deposits
and investments, which consist of restricted cash and cash
equivalents, short-term deposits, marketable securities and
long-term investments, resulted from a reduction in cash
outflows to fund certain insurance-related programs consistent
with improved claims development trends. This increase was
principally to support our increase in claims liabilities and
professional liability reserves. In fiscal 2003, we spent
$52.8 million on property and equipment, of which
$29.1 million was related to the acquisition of vehicles,
and medical and communications equipment, technology-related
acquisition and leasehold improvements accounted for
$23.8 million.
Net cash used in financing activities was $47.3 million and
$55.3 million during fiscal years 2004 and 2003,
respectively. In fiscal 2004, we made payments to Laidlaw of
$31.1 million and made mandatory debt repayments of
$8.7 million. Our bank overdrafts also decreased in fiscal
2004 by $4.5 million. In fiscal 2003, we made payments to
Laidlaw of $58.8 million and made mandatory debt repayments
of $8.2 million. Bank overdrafts also increased
$7.9 million during the year ended August 31, 2003.
Certain government programs, including Medicare and Medicaid
programs, require notice or re-enrollment when certain ownership
or corporate structure changes occur. In certain jurisdictions,
such changes require pre- or post-notification to governmental
licensing and certification agencies, or agencies with which we
have contracts. If the payor requires us to complete the
re-enrollment process prior to submitting reimbursement
requests, we may be delayed in payment, receive refund requests
or be subject to recoupment for services we provide in the
interim. For example, the change in ownership effected by our
acquisition of AMR required two of our subsidiaries to apply for
state and local ambulance operating authority in New York and
may require us to re-enroll in one or more jurisdictions. The
changes in our corporate structure and ownership in connection
with this offering or to meet certain state licensing
requirements may require us to give notice, re-enroll or make
other applications for authority to continue operating in
various jurisdictions. If we are required to re-enroll in a
jurisdiction, reimbursement from the relevant government program
is likely to be deferred for several months. This would affect
our cash flow but would not affect our net revenue. We do not
expect the impact of any such deferral to be material to us
unless several jurisdictions require us to re-enroll.
We expect to continue to fund the liquidity requirements of our
business principally with cash from operations and amounts
available under the revolving credit portion of our senior
secured credit facility. We have available to us, upon
compliance with customary conditions, $100.0 million under
the revolving credit facility, less borrowings and any letters
of credit outstanding. Outstanding borrowings at
September 30, 2005 were $5.0 million and letters of
credit at September 30, 2005 were $27.3 million.
65
The acquisition of AMR and EmCare resulted in a significant
increase in the level of our outstanding debt. We have a
$450.0 million senior secured credit facility bearing
interest at variable rates at specified margins above either the
agent banks alternate base rate or its LIBOR rate. The
senior secured credit facility consists of a
$100.0 million, six-year revolving credit facility and a
$350.0 million, seven-year term loan. We borrowed the full
amount of the term loan, and $20.2 million under the
revolving credit facility, on February 10, 2005 to fund the
acquisition of AMR and EmCare and pay related fees and expenses.
On February 10, 2005, we also issued $250.0 million
principal amount of 10% senior subordinated notes due 2015.
We used the net proceeds of this notes issuance to fund the
acquisition.
Our $350.0 million term loan initially carried interest at
the alternate base rate, plus a margin of 1.75%, or the LIBOR
rate, plus a margin of 2.75%. We refinanced this term loan on
March 29, 2005 for a term loan with identical terms except
that the margins were reduced by 0.25%. The term loan is subject
to quarterly amortization of principal (in quarterly
installments), with 1% of the aggregate principal payable in
each of the first six years, with the remaining balance due in
the final year. We intend to use $100.0 million of the
proceeds of this offering to prepay $100.0 million of the
term loan. Our $100.0 million revolving credit facility
initially bears interest at the alternate base rate, plus a
margin of 1.75%, or the LIBOR rate, plus a margin of 2.75%. At
September 30, 2005, we had repaid all but $5.0 million
of the outstanding balance of the revolving credit facility with
cash flow from operations. Under the terms of our senior secured
credit facility, our letters of credit outstanding reduce our
available borrowings under the revolving credit facility. At
September 30, 2005, our outstanding letters of credit
totaled $27.3 million, including $16.0 million to
support our self-insurance program and $8.3 million to
secure our performance under certain 911 emergency response
contracts.
We have a conditional right under our senior secured credit
facility to request new or existing lenders to provide up to an
additional $100 million of term debt (in $20 million
increments).
All amounts borrowed under our senior secured credit facility
are secured by, among other things:
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substantially all present and future shares of the capital stock
of AMR HoldCo, Inc. and EmCare HoldCo, Inc., our wholly-owned
subsidiaries which are the co-borrowers, and each of their
present and future domestic subsidiaries and 65% of the capital
stock of controlled foreign corporations; |
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substantially all present and future intercompany debt of the
co-borrowers and each guarantor; and |
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substantially all of the present and future property and assets,
real and personal, of the co-borrowers and each guarantor. |
The agreements governing our senior secured credit facility
contains customary affirmative and negative covenants,
including, among other things, restrictions on indebtedness,
liens, mergers and consolidations, sales of assets, loans,
acquisitions, joint ventures, restricted payments, transactions
with affiliates, dividends and other payment restrictions
affecting subsidiaries, a change in control of the company and
other matters customarily restricted in such agreements. The
agreement governing our senior secured credit facility also
contains financial covenants, including a maximum total leverage
ratio (5.50 to 1.00 as of September 30, 2005), maximum
senior leverage ratio (3.25 to 1.00 as of September 30,
2005) and a minimum fixed charge coverage ratio (1.05 to 1.00 as
of September 30, 2005), all of which are based on adjusted
EBITDA, which is the amount of our income (loss) from operations
before depreciation and amortization expenses and other
specifically identified exclusions. These ratios are to be
calculated each quarter based on the financial data for the four
fiscal quarters then ending. Each financial covenant ratio
adjusts over time as set forth in our senior secured credit
facility. Our failure to meet any of these financial covenants
could be an event of default under our senior secured credit
facility.
66
The calculated ratios for the four fiscal quarters, or LTM,
ended September 30, 2005, and pro forma to give effect to
this offering and our use of proceeds as described in Use
of Proceeds, were as follows:
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As of September 30, 2005 | |
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Consolidated | |
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Pro Forma | |
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Total Leverage Ratio:
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Consolidated Indebtedness/
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$ |
608,607 |
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$ |
508,607 |
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Adjusted LTM EBITDA(1)
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÷ |
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$ |
150,128 |
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$ |
150,128 |
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= 4.05 |
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× |
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= 3.39 |
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× |
Senior Leverage Ratio:
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Senior Indebtedness/
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$ |
358,607 |
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$ |
258,607 |
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Adjusted LTM EBITDA(1)
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÷ |
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$ |
150,128 |
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$ |
150,128 |
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= 2.39 |
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× |
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= 1.72 |
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× |
Fixed Charge Coverage Ratio:
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Fixed Charge Numerator(2)
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$ |
103,336 |
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$ |
103,336 |
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Fixed Charge Denominator(3)
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÷ |
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$ |
63,097 |
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$ |
60,686 |
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= 1.64 |
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× |
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= 1.70 |
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× |
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(1) |
Adjusted LTM EBITDA is calculated as set forth in
our senior secured credit facility: our consolidated EBITDA for
the four fiscal quarters ended September 30, 2005, adding
back all management fees (totaling $19.8 million), and
other specifically identified exclusions. |
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(2) |
The numerator for the fixed charge ratio is calculated as set
forth in our senior secured credit facility: Adjusted EBITDA,
less capital expenditures, for the four fiscal quarters ended
September 30, 2005. |
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(3) |
The denominator for the fixed charge ratio is calculated as set
forth in our senior secured credit facility: the sum of our
consolidated interest expense, cash income taxes and principal
amount of all scheduled amortization payments on all
Indebtedness (as defined), including pro forma annual principal
payments on our senior secured credit facility, for the four
fiscal quarters ended September 30, 2005. |
We will not incur a prepayment penalty or any similar charges in
connection with our repayment of amounts outstanding under our
senior secured credit facility with proceeds from this offering.
Amounts repaid under the term loan will not be available for
future borrowing.
The indenture governing our senior subordinated notes contains a
number of covenants that, among other things, restrict our
ability and the ability of our subsidiaries, subject to certain
exceptions, to sell assets, incur additional debt or issue
preferred stock, repay other debt, pay dividends and
distributions or repurchase our capital stock, create liens on
assets, make investments, loans or advances, make certain
acquisitions, engage in mergers or consolidations and engage in
certain transactions with affiliates.
Quantitative and Qualitative Disclosures about Market Risk
As of September 30, 2005, we had $608.6 million of
debt, of which $353.3 million was variable rate debt under
our senior secured credit facility and the balance was fixed
rate debt, including the $250.0 million aggregate principal
amount of our senior subordinated notes. An increase or decrease
in interest rates will affect our interest costs. For
comparative purposes, for every 0.125% change in interest rates,
our interest costs on our senior secured credit facility will
change by approximately $0.44 million per year based on our
outstanding indebtedness at September 30, 2005.
Off-Balance Sheet Arrangements
We do not have any relationships with unconsolidated entities or
financial partnerships, such as entities often referred to as
structured finance or special purpose entities, established for
the purpose of facilitating off-balance sheet arrangements or
other contractually narrow or limited purposes. Accordingly, we
are not materially exposed to any financing, liquidity, market
or credit risk that could arise if we had engaged in such
relationships.
67
Tabular Disclosure of Contractual Obligations and Other
Commitments
The following tables reflect a summary of obligations and
commitments outstanding as of September 30, 2005, including
our borrowings under our senior secured credit facility and our
senior subordinated notes.
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Payments Due by Period | |
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Less than | |
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More than | |
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1 Year | |
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1-3 Years | |
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3-5 Years | |
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5 Years | |
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Total | |
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(in thousands) | |
Contractual obligations:
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Long-term debt(1)
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$ |
157 |
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$ |
271 |
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$ |
221 |
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$ |
319 |
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$ |
968 |
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Senior secured credit facility(2)
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8,500 |
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7,000 |
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7,000 |
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330,750 |
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353,250 |
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Capital lease obligations (principal)
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4,389 |
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4,389 |
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Capital lease obligations (interest)
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112 |
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112 |
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Senior subordinated notes
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250,000 |
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250,000 |
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Interest on debt(3)
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45,901 |
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91,218 |
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90,312 |
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136,042 |
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363,473 |
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Operating lease obligations
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24,876 |
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33,708 |
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14,527 |
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11,886 |
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84,997 |
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Other contractual obligations(4)
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5,793 |
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3,982 |
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3,363 |
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243 |
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13,381 |
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Subtotal
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89,728 |
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136,179 |
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115,423 |
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729,240 |
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1,070,570 |
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(1) |
Excludes capital lease obligations. |
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(2) |
Excludes interest on our senior secured credit facility and
senior subordinated notes. |
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(3) |
Interest on our floating rate debt was calculated for all years
using the effective rate as of September 30, 2005 of 5.98%. |
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(4) |
Includes Onex management fees, dispatch fees and responder fees. |
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Amount of Commitment Expiration Per Period | |
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Less than | |
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More than | |
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1 Year | |
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1-3 Years | |
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3-5 Years | |
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5 Years | |
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Total | |
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(in thousands) | |
Other commitments:
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Guarantees of surety bonds
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2,545 |
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29,957 |
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32,502 |
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Letters of credit(1)
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|
|
|
|
|
|
27,347 |
|
|
|
27,347 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Subtotal
|
|
|
2,545 |
|
|
|
|
|
|
|
|
|
|
|
57,304 |
|
|
|
59,849 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Total obligations and commitments
|
|
$ |
92,273 |
|
|
$ |
136,179 |
|
|
$ |
115,423 |
|
|
$ |
786,544 |
|
|
$ |
1,130,419 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
(1) |
Evergreen renewals are deemed to have expiration dates in excess
of 5 years. |
We have one capital lease relating to approximately 450
ambulances. The term of the lease extends to August 2007.
Critical Accounting Policies
The preparation of financial statements requires management to
make estimates and assumptions relating to the reporting of
results of operations, financial condition and related
disclosure of contingent assets and liabilities at the date of
the financial statements. Actual results may differ from those
estimates under different assumptions or conditions. The
following are our most critical accounting policies, which are
those that require managements most difficult, subjective
and complex judgments, requiring the need to make estimates
about the effect of matters that are inherently uncertain and
may change in subsequent periods.
Claims Liability and Professional Liability
Reserves
We are self-insured up to certain limits for costs associated
with workers compensation claims, automobile, professional
liability claims and general business liabilities. Reserves are
established for estimates of the loss that we will ultimately
incur on claims that have been reported but not paid and claims
that have
68
been incurred but not reported. These reserves are based upon
actuarial valuations that are prepared by our outside actuaries.
The actuarial valuations consider a number of factors, including
historical claim payment patterns and changes in case reserves,
the assumed rate of increase in healthcare costs and property
damage repairs. Historical experience and recent trends in the
historical experience are the most significant factors in the
determination of these reserves. We believe the use of actuarial
methods to account for these reserves provides a consistent and
effective way to measure these subjective accruals. However,
given the magnitude of the claims involved and the length of
time until the ultimate cost is known, the use of any estimation
technique in this area is inherently sensitive. Accordingly, our
recorded reserves could differ from our ultimate costs related
to these claims due to changes in our accident reporting, claims
payment and settlement practices or claims reserve practices, as
well as differences between assumed and future cost increases.
Trade and Other Accounts Receivable
Our internal billing operations have primary responsibility for
billing and collecting our accounts receivable. We utilize
various processes and procedures in our collection efforts
depending on the payor classification; these efforts include
monthly statements, written collection notices and telephonic
follow-up procedures for certain accounts. AMR writes off
amounts not collected through our internal collection efforts to
our uncompensated care allowance, and sends these receivables to
third party collection agencies for further follow-up collection
efforts. To simplify the recording of any third party collection
agency recoveries, EmCare classifies accounts sent to third
party collection agencies as delinquent and writes
them off completely against our uncompensated care allowance
when no further internal or external collection efforts will be
made. Accordingly, we record any subsequent collections through
third party collection efforts as a recovery, in the case of
AMR, and record it against our delinquent status
account, in the case of EmCare.
As we discuss further in our Revenue Recognition
policy below, we determine our allowances for contractual
discounts and uncompensated care based on sophisticated
information systems and financial models, including payor
reimbursement schedules, historical write-off experience and
other economic data. We record our patient-related accounts
receivable net of estimated allowances for contractual discounts
and uncompensated care in the period in which we perform our
services. We record gross fee-for-service revenue and related
receivables based upon established fee schedule prices. We
reduce our recorded revenue and receivables for estimated
discounts to patients covered by contractual insurance
arrangements, and reduce these further by our estimate of
uncollectible accounts. We estimate our allowances for
contractual discounts monthly utilizing our billing system
information, and we write off applicable allowances when we
receive net payments from third parties.
Our provision and allowance for uncompensated care is based
primarily on the historical collection and write-off activity of
our nearly 9 million annual patient encounters. We extract
this data from our billing systems regularly and use it to
compare our accounts receivable balances to estimated ultimate
collections. Our allowance for uncompensated care is related
principally to receivables we record for self-pay patients and
is not recorded on specific accounts due to the volume of
individual patient receivables and the thousands of commercial
and managed care contracts.
We also have other receivables related to facility and community
subsidies and contractual receivables for providing staffing to
communities for special events. We review these other
receivables periodically to determine our expected collections
and whether any allowances may be necessary. We write the
balance off after we have exhausted all collection efforts.
Revenue Recognition
A significant portion of our revenue is derived from Medicare,
Medicaid and private insurance payors that receive discounts
from our standard charges (referred to as contractual
provisions). Additionally, we are also subject to collection
risk for services provided to uninsured patients or for the
deductible or co-pay portion of services for insured patients
(referred to as uncompensated care). We record our healthcare
services revenue net of estimated provisions for the contractual
allowances and uncompensated care.
69
Healthcare reimbursement is complex and may involve lengthy
delays. Third party payors are continuing their efforts to
control expenditures for healthcare and may disallow, in whole
or in part, claims for reimbursement based on determinations
that certain amounts are not reimbursable under plan coverage,
were for services provided that were not determined medically
necessary, or insufficient supporting information was provided.
In addition, multiple payors with different requirements can be
involved with each claim.
Management utilizes sophisticated information systems and
financial models to estimate the provisions for contractual
allowances and uncompensated care. The estimate for contractual
allowances is determined on a payor-specific basis and is
predominantly based on prior collection experience, adjusted as
needed for known changes in reimbursement rates and recent
changes in payor mix and patient acuity factors. The estimate
for uncompensated care is based principally on historical
collection rates, write-off percentages and accounts receivable
agings. These estimates are analyzed continually and updated by
management by monitoring reimbursement rate trends from
governmental and private insurance payors, recent trends in
collections from self-pay patients, the ultimate cash collection
patterns from all payors, accounts receivable aging trends,
operating statistics and ratios, and the overall trends in
accounts receivable write-offs.
The evaluation of these factors, as well as the interpretation
of governmental regulations and private insurance contract
provisions, involves complex, subjective judgments. As a result
of the inherent complexity of these calculations, our actual
revenues and net income, and our accounts receivable, could vary
from the amounts reported.
Income Tax Valuation Allowance
We have significant net deferred tax assets resulting from net
operating losses, or NOLs, and interest deduction carryforwards
and other deductible temporary differences that will reduce
taxable income in future periods. Statement of Financial
Accounting Standards No. 109 Accounting for Income
Taxes requires that a valuation allowance be established
when it is more likely than not that all or a
portion of net deferred tax assets will not be realized. A
review of all available positive and negative evidence needs to
be considered, including expected reversals of significant
deductible temporary differences, a companys recent
financial performance, the market environment in which a company
operates, tax planning strategies and the length of the NOL and
interest deduction carryforward periods. Furthermore, the weight
given to the potential effect of negative and positive evidence
should be commensurate with the extent to which it can be
objectively verified. We routinely monitor the reliability of
our deferred tax assets. Changes in managements assessment
of recoverability could result in additions to the valuation
allowance, and such additions could be significant.
Contingencies
As discussed in note 10 Commitments and
Contingencies of notes to our combined financial statements,
management may not be able to make a reasonable estimate of
liabilities that result from the final resolution of certain
contingencies disclosed. Further assessments of the potential
liability will be made as additional information becomes
available. Management currently does not believe that these
matters will have a material adverse effect on our consolidated
financial position. It is possible, however, that results of
operations could be materially affected by changes in
managements assumptions relating to these matters or the
actual final resolution of these proceedings.
Intangible Assets
Definite life intangible assets are subject to impairment
reviews when evidence or triggering events suggest that an
impairment may have occurred. Should such triggering events
occur that cause us to review our definite life intangibles and
the fair value of our definite life intangible asset proves to
be less than our unamortized carrying amount, we would take a
charge to earnings for the decline. Should factors affecting the
value of our definite life intangibles change significantly,
such as declining contract retention rates or
70
reduced contractual cash flows, we may need to record an
impairment charge in amounts that are significant to our
financial statements.
Goodwill
Goodwill is not amortized and is required to be tested annually
for impairment, or more frequently if changes in circumstances,
such as an adverse change to our business environment, cause us
to believe that goodwill may be impaired. Goodwill is allocated
at the reporting unit level. If the fair value of the reporting
unit falls below the book value of the reporting unit at an
impairment assessment date, an impairment charge would be
recorded.
Should our business environment or other factors change, our
goodwill may become impaired and may result in charges to our
income statement that are material.
Restatement of Financial Statements
As described in the notes to our combined financial statements
included in this prospectus, we determined that, because of an
error in our reserving methodology, our accounts receivable
allowances were understated at various balance sheet dates prior
to and including the periods presented in those financial
statements. On August 2, 2005, we issued restated combined
financial statements for the referenced periods.
Our revised method of calculating our accounts receivable
allowances, which includes comparisons of subsequent cash
collections to net accounts receivable and subsequent write-offs
to accounts receivable allowances, demonstrated a shortfall of
accounts receivable allowances. Prior years analyses of
accounts receivable allowances did not include these comparisons
and certain elements were misapplied. In addition, we have made
other adjustments related to certain deferred rent and leasehold
amortization matters, principally to straight-line this
amortization, in accordance with generally accepted accounting
principles.
Controls over the application of accounting principles are
within the scope of internal controls. Management has concluded
that our internal controls were insufficient to provide
reasonable assurance that our accounting for accounts receivable
allowances and for deferred rent and leasehold amortization
would be in accordance with GAAP.
We corrected the deficiency in our internal controls over
financial reporting for accounts receivable allowances by
revising our method of calculating our accounts receivable
allowances. See Critical Accounting
Policies Trade and Other Accounts Receivable.
The errors relating to improper lease accounting resulted from
our incorrect interpretation of existing GAAP. To remediate this
deficiency, the individuals responsible for our financial
reporting have been made aware of the requirements of GAAP and
the SEC in this regard and we do not anticipate taking further
steps to address this matter.
See Risk Factors Risk Factors Related to Our
Business We must perform on our own services that
Laidlaw previously performed for us, and we are subject to
financial reporting and other requirements for which our
accounting and other management systems and resources may not be
adequate.
71
INDUSTRY
According to the Centers for Medicare and Medicaid Services, or
CMS, national healthcare spending increased 7.3% to $1.7
trillion in 2003, and increased 8.6% in 2002. This represents
faster growth than the overall economy, which grew 4.8% and 3.4%
during 2003 and 2002, respectively, as measured by the growth of
the gross domestic product.
Hospital care represents the largest individual segment of the
healthcare industry, accounting for an estimated 30.8% of total
healthcare spending in 2003. Hospital care expenditures
increased 5.1% to $511 billion in 2003. CMS estimates that
hospital care expenditures will increase to approximately
$934 billion by 2013, representing a compound annual growth
rate of 6.1% from 2003. The aging population and longer life
expectancy are increasing demand for healthcare services in the
United States, and hospitals are expected to be among the
principal beneficiaries.
Emergency Medical Services Industry
We operate in the ambulance and emergency department services
markets, two large and growing segments of the emergency medical
services market. By law, most communities are required to
provide emergency ambulance services and most hospitals are
required to provide emergency department services. Emergency
medical services are a core component of the range of care a
patient could potentially receive in the pre-hospital and
hospital-based settings. Accordingly, we believe that
expenditures for emergency medical services will continue to
correlate closely to growth in the U.S. hospital market.
Approximately 43% of all hospital admissions originated from the
emergency department in 2003, and a substantial portion of
patients enter the emergency department by way of ambulance
transport. We believe that the following key factors will
continue to drive growth in our emergency medical services
markets:
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|
|
|
|
Increase in outsourcing. Communities, government agencies
and healthcare facilities are under significant pressure both to
improve the quality and to reduce the cost of care. The
outsourcing of certain medical services has become a preferred
means to alleviate these pressures. |
|
|
|
|
|
From 2000 to 2003, we believe outsourced emergency department
services increased from 55% to 65% of total emergency department
services. |
|
|
|
From 1999 to 2003, the percentage of emergency medical
transportation services supplied by private ambulance providers
increased from 34% to 39% in the countrys largest
200 cities. |
|
|
|
|
|
Favorable demographics. The growth and aging of the
population will be a significant demand driver for healthcare
services, and we believe it will result in an increase in
ambulance transports, emergency department visits and hospital
admissions. |
|
|
|
|
|
The U.S. Census Bureau estimates that the number of
Americans over 65 will increase to 39 million by 2010 from
31 million in 1990. It is also expected that Americans over
the age of 65 will increase from one in eight Americans in 2000
to one in five by 2030. |
|
|
|
A 2003 CDC Emergency Department Summary noted that patients aged
65 or over represent 38% of patients delivered to emergency
departments by ambulance. Emergency department visits for
persons aged 65 or over increased to 17.5 million in 2003,
a 26% increase from 1993. |
|
|
|
|
|
Increased federal funding for disaster preparedness and other
federal programs. The United States government has increased
its focus on our nations ability to respond quickly and
effectively to emergencies, including both terrorist attacks and
natural disasters. Federal programs, such as Homeland Security,
FEMA and funding for services for undocumented aliens, have made
increased funding available which is aimed directly at emergency
services, including ambulance providers and emergency physician
services. |
Additional factors that may affect the emergency medical
services industry are described elsewhere in this prospectus.
See Risk Factors Risk Factors Related to
Healthcare Regulation and Business
Regulatory Matters.
72
We believe the ambulance services market represents annual
expenditures of approximately $12 billion. The ambulance
services market is highly fragmented, with more than 14,000
private, public and not-for-profit service providers accounting
for an estimated 36 million ambulance transports in 2004.
There are a limited number of regional ambulance providers and
we are one of only two national ambulance providers.
Ambulance services encompass both 911 emergency response and
non-emergency transport services, including critical care
transfers, wheelchair transports and other inter-facility
transports. Emergency response services include the dispatch of
ambulances equipped with life support equipment and staffed with
paramedics and/or emergency medical technicians, or EMTs, to
provide immediate medical care to injured or ill patients.
Non-emergency services utilize paramedics and EMTs to transport
patients between healthcare facilities or between facilities and
patient residences. Given demographic trends, we expect the
total number of ambulance transports to continue to grow at a
steady rate of 1% to 2% per year.
911 emergency response services are provided primarily under
long-term contracts with communities and government agencies. In
2003, approximately 39% of 911 ambulance services were provided
by private, for profit providers and 38% were provided by fire
departments, with the balance of 911 services being provided
principally by hospitals and city and county agencies.
Non-emergency services generally are provided pursuant to
non-exclusive contracts with healthcare facilities, managed care
and insurance companies. Usage tends to be controlled by the
facility discharge planners, nurses and physicians who are
responsible for requesting transport services. Non-emergency
services are provided primarily by private ambulance companies.
Quality of service, dependability and name recognition are
critical factors in winning non-emergency business.
Due to increased demand for effective use of technology,
cost-efficient services, improved patient outcomes and emergency
preparedness and response, we believe that the current trend by
communities and hospitals to outsource ambulance services will
contribute to growth for private providers. According to the
Journal of Emergency Medical Services, the percentage of
emergency medical transportation services delivered by private
ambulance providers in the nations 200 largest cities
increased from 34% in 1999 to 39% in 2003. Furthermore, we
expect private providers to benefit as hospitals continue to
outsource more of their ambulance services due to changes in
reimbursement rates and increased use of outpatient services.
|
|
|
Emergency Department Services |
We believe the physician reimbursement component of the
emergency department services market represents annual
expenditures of approximately $10 billion. There are
approximately 4,700 hospitals in the United States that
operate emergency departments, of which approximately 67% of
these hospitals outsource their physician staffing and
management for this department. The market for outsourced
emergency department staffing and related management services is
highly fragmented, with more than 800 national, regional
and local providers. We believe we are one of only five national
providers.
Between 1993 and 2003, the total number of patient visits to
hospital emergency departments increased from 90.3 million
to 113.9 million, an increase of 26%. At the same time, the
number of hospital emergency departments declined 12%. As a
result, the average number of patient visits per hospital
emergency department increased substantially during that period.
We believe these trends are resulting in an increased focus by
hospitals on their emergency departments. As the per hospital
demand for emergency department visits continues to increase, we
believe that more hospitals will turn to well-established
providers, such as EmCare, which have a demonstrated track
record of improving productivity and efficiency while providing
high quality care.
73
BUSINESS
Company Overview
Emergency Medical Services Corporation is a leading provider of
emergency medical services in the United States. We operate our
business and market our services under the AMR and EmCare
brands. AMR is the leading provider of ambulance services in the
United States, based on net revenue and number of transports.
EmCare is the leading provider of outsourced emergency
department staffing and related management services in the
United States, based on number of contracts with hospitals and
affiliated physician groups. Approximately 86% of our fiscal
2004 net revenue was generated under exclusive contracts.
During fiscal 2004, we provided emergency medical services to
approximately 9 million patients in more than 2,000
communities nationwide. For the fiscal year ended
August 31, 2004, we generated net revenue of
$1.6 billion, of which AMR and EmCare represented 66% and
34%, respectively.
We offer a broad range of essential emergency medical services
through our two business segments:
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|
AMR |
|
EmCare |
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|
Core Services: |
|
Pre- and post-hospital medical transportation |
|
Hospital-based medical care |
|
|
Emergency (911) ambulance transports |
|
Emergency department staffing and related management |
|
|
Non-emergency ambulance |
|
services |
|
|
transports |
|
Hospitalist services |
Customers:
|
|
Communities |
|
Hospitals |
|
|
Government agencies |
|
Independent physician groups |
|
|
Healthcare facilities |
|
Attending medical staff |
|
|
Insurers |
|
|
National Market Position:
|
|
#1 provider of ambulance transports |
|
#1 provider of outsourced emergency department
services |
|
|
8% share of total ambulance market |
|
6% share of emergency department services market |
|
|
21% of private provider ambulance market |
|
9% of outsourced emergency department services market |
Number of Contracts:
|
|
|
|
|
|
At September 30, 2005
|
|
155 911 contracts |
|
333 hospital contracts |
|
|
2,700 non-emergency transport contracts |
|
|
Volume:
|
|
|
|
|
|
For fiscal 2004
|
|
3.7 million transports |
|
5.3 million patient visits |
|
Competitive Strengths
We believe the following competitive strengths position our
company to capitalize on the favorable trends occurring within
the healthcare industry and the emergency medical services
markets.
Leading, Established Provider of Emergency Medical
Services. We are a leading provider of emergency medical
services in the United States. AMR is the leading provider of
ambulance services, with net revenue approximately twice that of
our only national competitor. During fiscal 2004, AMR treated
and transported approximately 3.7 million patients in
34 states. AMR has made significant investments in
technology, which we believe enhances quality and reduces costs
for our customers. We believe that EmCare is the leading
provider of outsourced staffing and related management services
to emergency departments, with 32% more emergency department
staffing contracts than our principal national competitor.
EmCares 4,500 affiliated physicians provide services to
over 330 client hospitals in 39 states, including many of
the top 100 hospitals in the United States. Our client hospitals
range from high volume urban hospital emergency department to
lower volume
74
community facilities. EmCare is also one of the leading
providers of hospitalist services, based on number of hospital
contracts. We believe our track record of consistently meeting
or exceeding our customers service expectations, coupled
with our ability to leverage our infrastructure and technology
to drive increased productivity and efficiency, have contributed
to our ability to retain existing and win new contracts.
Significant Scale and Geographic Presence. We believe our
significant scale and broad geographic presence provide a
competitive advantage over local and regional providers in most
areas, including:
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|
Cost efficiencies and broad program offering. Our
investments in technology may be too costly for certain
providers to replicate, and provide us with several competitive
advantages, including: (i) operating cost efficiencies,
(ii) scalability and (iii) the capability to provide
broad, high quality service offerings to our customers at
competitive rates. In addition, our technology, including
electronic patient records, and our expertise in providing both
pre-hospital and hospital-based emergency care uniquely
positions us to respond to community demand for enhanced
coordination among their emergency service providers. |
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|
|
National contracting and preferred provider
relationships. We are able to enter into national and
regional contracts with managed care organizations and insurance
companies. We have an exclusive provider contract with Kaiser
Foundation Health Plan, one of the largest managed care
organizations, and we have preferred provider status with
several healthcare systems and many managed care organizations. |
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|
|
Ability to recruit and retain quality personnel. We are
able to recruit and retain clinical and support employees by
providing attractive compensation packages, comprehensive
training programs, risk mitigation strategies, career
development and greater breadth of job transferability. This
lowers our costs associated with employee turnover and increases
customer and patient satisfaction. |
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|
One of the keys to our success has been our ability to recruit
and retain high quality medical personnel. AMR has a competitive
advantage in recruiting quality medical personnel through our
in-house paramedic training institute, which we believe is the
largest in the United States. EmCare has developed proprietary
software that allows us to identify physicians, based on
multiple characteristics, matching the specific needs of our
customers. We provide continuing education to our affiliated
medical professionals through EMEDS, our in-house Emergency
Medical Education Systems. |
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|
We believe our 79% and 94% retention rates in fiscal 2004 for
full-time medical personnel at AMR and EmCare, respectively, are
among the highest in the emergency medical services segments in
which they compete. We believe that successfully recruiting and
retaining highly qualified clinicians and healthcare
professionals improves the overall experience and outcomes for
our customers and patients while significantly reducing our
operating costs. |
Long-Term Relationships with Existing Customers. We
believe our long-term, well-established relationships with
communities and healthcare facilities enhance our ability to
retain existing customers and win new contracts. AMR and EmCare
have maintained relationships with their ten largest customers
for an average of 34 and 12 years, respectively, and during
that time have continually demonstrated an ability to meet and
exceed contractual commitments. As a result, we believe we are
in an advantageous position at the time of contract renewal when
a community or hospital is faced with a decision whether to
retain its existing provider or explore other alternatives. We
believe our industry-leading contract retention rates during
fiscal 2004 reflect our ability to deliver on our service
commitments to our customers over extended time periods.
Strong Financial Performance. When we compete for new
business, one of the key factors our potential customers
evaluate is financial stability. As a result, we believe our
track record of strong financial performance provides us with a
competitive advantage over our competitors. We believe the
quality and breadth of our service offerings has allowed us to
increase our net revenue at a faster rate than the market for
emergency medical services. We believe our ability to
demonstrate consistently strong financial performance will
continue to differentiate our company and provide a competitive
advantage in winning new contracts and renewing existing
contracts.
75
Focus on Risk Management. Our risk management initiatives
are enhanced by the use of our professional liability claims
database and comprehensive claims management. We analyze this
data to demonstrate claim trends on a national, hospital,
physician and procedure level, helping to manage and mitigate
risk exposure. AMRs risk/ safety program is aimed at
reducing worker injuries through training and improved
equipment, and increasing vehicle safety through the use of
technology. Over the last three years, our workers compensation,
auto, general and professional liability claims per 100,000
ambulance transports decreased 8.4% at AMR and our professional
liability claims per 100,000 emergency department visits
decreased 14.0% at EmCare.
Investment in Core Technologies. We utilize technology as
a means to enhance the quality, reduce the cost of our service
offerings, more effectively manage risk and improve our
profitability. For example:
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We believe AMR is the largest user of ambulance electronic
patient care records, or e-PCR. Our proprietary system enables
us to eliminate the use of manual patient records by replacing
them with electronic records, which we expect will reduce both
chart errors and costs. |
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|
AMR utilizes proprietary software, Millennium, to determine the
appropriate level of transportation services to be dispatched
and track response times and other data for hospitals. Our
initial implementation of these technologies has improved our
ability to capture revenue, decrease our billing costs and bid
more effectively for 911 contracts. |
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|
EmCare has developed proprietary physician recruitment software
that has enhanced our recruitment efficiency and improved our
physician retention rate. |
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|
At EmCare, we track risk exposure trends through what we believe
is one of the largest emergency department risk databases,
allowing us to assess, develop and implement targeted risk
intervention programs. |
Proven and Committed Management Team. We are led by an
experienced senior management team with an average of
21 years of experience in the healthcare industry. Our
Chairman and Chief Executive Officer, William Sanger, has over
30 years of experience within the healthcare services
industry, with leadership roles in multi-system hospitals,
ambulatory care facilities, post-acute service facilities,
physician management companies and insurance entities. Since
Mr. Sanger joined us in 2001, our senior management team
has been successful in growing the market share of our
businesses, managing changes in reimbursement policy, reducing
professional liability risk and improving the profitability of
our operations.
Business Strategy
We intend to leverage our competitive strengths to pursue our
business strategy:
Increase Revenue from Existing Customers. We believe our
long track record of delivering excellent service and quality
patient care, as well as the breadth of our services, creates
opportunities for us to increase revenue from our existing
customer base. We have established strategies aimed at assisting
communities and facilities to manage their cost of emergency
medical services. Some of our initiatives with existing
customers include:
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Implementing innovative productivity-enhancing programs |
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At EmCare, we have developed and implemented programs, such as
fast track and advanced triage protocols, to improve
throughput and wait times, thereby improving patient
satisfaction and reducing the number of patients who leave
without being seen. |
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|
At AMR, we have developed and implemented innovative programs to
improve our productivity through decreased drop and
on scene time. For example, we have recently
established transition units at several hospitals to hold and
monitor discharged patients awaiting transport, thereby
increasing our productivity while accelerating inpatient bed
availability and overall hospital throughput. |
76
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Continuing to broaden product and service offerings to our
customers |
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In 2002, we began marketing hospitalist services. Since that
time, our hospitalist services revenue increased at a compound
annual growth rate of 48.3% from $7.2 million to
$23.5 million in fiscal 2004. Approximately fifty percent
of our hospitalist contracts are with our emergency department
customers. |
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At certain facilities, AMR provides a dedicated on-site
non-emergency transport coordinator during times of peak demand
to increase efficiency and ensure appropriate utilization of all
medical transportation service levels. |
Grow Our Customer Base. We believe we have a unique
competency in the treatment, management and billing of episodic
and unscheduled care. We believe our long operating history,
significant scope and scale and leading market position provide
us with new and expanded opportunities to grow our customer
base. We will continue to generate new revenue and client growth
through:
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Targeted geographic sales and marketing programs, |
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Pursuing new outsourcing opportunities for emergency department,
hospitalist, radiology and ambulance services, |
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Expanding our public/private ambulance partnerships with local
fire departments, |
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Evaluating opportunities that leverage our core businesses,
including our communications center infrastructure, to manage
health-related transportation logistics. |
EmCare was awarded 52 new contracts with net revenue of
$79.0 million in 2003 and 58 new contracts with net revenue
of $79.4 million in 2004. AMR was awarded 109 new contracts
with net revenue of $17.1 million in 2003 and 60 new
contracts with net revenue of $12.2 million in 2004.
Pursue Select Acquisition Opportunities. The emergency
medical services industry is highly fragmented, with only a few
large national providers, and presents opportunities for
consolidation. We plan to pursue select acquisitions in our core
businesses, including acquisitions to enhance our presence in
existing markets and our entry into new geographic markets. We
will also explore the acquisition of complementary businesses,
such as radiology, hospitalist and managed transportation
services and seek opportunities to expand the scope of services
in which we can leverage our core competencies.
Utilize Technology to Differentiate Our Services and Improve
Operating Efficiencies. We intend to continue to invest in
technologies that broaden our services in the marketplace,
improve patient care, enhance our billing efficiencies and
increase our profitability. We believe that the complexities of
the healthcare industry and customer demand for broader, more
cost-effective service offerings will continue to benefit those
providers that remain at the forefront of technological
innovation. The following outlines certain technologies we
utilize:
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System Status Management (SSM): Enables AMR to use
current incident data to position our vehicles efficiently,
minimizing response time while maximizing asset utilization. We
currently utilize SSM in all communities in which we operate
under contracts to provide 911 emergency ambulance services. We
believe we are one of only a few ambulance services providers
that have begun to implement real-time SSM
technology. |
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Electronic patient care record (e-PCR): Where
implemented, allows AMR to capture billable revenue, decrease
our billing costs and optimize reimbursement. In addition, our
proprietary e-PCR enables us to shorten our billing cycle and
reduce risk by utilizing defined clinical and rules-based
protocols to capture patient information electronically. |
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Millennium software: Millennium, our proprietary
software, allows us greater flexibility in meeting our
customers needs. This rules-based software program
integrates medical protocol, managed care criteria and other
detailed data prescribed by our customers, enabling AMR to
efficiently dispatch appropriate transport and more effectively
track response time. |
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EmSource: EmSource, our proprietary physician recruitment
system, enables EmCare to more effectively recruit physicians
who meet the needs of our customers. The system consists of a
database of approximately 800,000 physicians that is updated
weekly to provide the most current physician contact available. |
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EmBillz: EmBillz, our proprietary coding, billing and
accounts receivable management system, enables EmCare to more
effectively process more than five million emergency department
visits each year. |
Continued Focus on Risk Management. Through our risk
management and quality assurance staffs, technology platform and
well-trained medical personnel, we will continue to conduct
aggressive risk management programs for loss prevention and
early intervention. We will continue to develop and utilize
clinical fail safes and use technology in our
ambulances to reduce vehicular incidents.
Implement Cost Rationalization Initiatives. We will
continue to rationalize our cost structure by aligning
compensation with productivity, developing risk management
initiatives that are focused on mitigating risk exposures, and
eliminating costs in our national and regional corporate support
structure. Since our acquisition of AMR and EmCare, we have
completed our preliminary analysis of certain of our support
areas, including accounting, legal, information services and
human resources, and have begun to implement initiatives to
increase productivity and achieve further economies of scale
across the company.
Company History
Effective January 31, 2005, an investor group led by Onex
Partners LP and Onex Corporation, and including members of our
management, purchased our operating subsidiaries AMR
and EmCare from Laidlaw International, Inc. Laidlaw
had acquired AMR and EmCare in 1997.
The purchase price for AMR and EmCare totaled
$828.8 million. We funded the purchase price and related
transaction costs with equity contributions of
$219.2 million, the issuance and sale of
$250.0 million principal amount of our senior subordinated
notes and borrowings under our senior secured credit facility,
including a term loan of $350.0 million and approximately
$20.2 million under our revolving credit facility. We
intend to use approximately $100.0 million of the net
proceeds from this offering to repay debt outstanding under our
senior secured credit facility.
Since completing our acquisition of AMR and EmCare, we have
operated through a holding company, EMS L.P., that is a limited
partnership. As described in Formation of Holding
Company, our new holding company will be a Delaware
corporation upon completion of this offering.
Business Segments
We operate our business and market our services under our two
business segments: AMR and EmCare. We provide ambulance
transport services in 34 states and the District of
Columbia and provide services to emergency department and
hospitalist programs in 39 states.
We believe that our operational structure enhances service
delivery and maintains favorable executive contact with key
contract decision-makers and community leaders. Each region
provides operational support and management of our local
business operating sites and facilities. Our regional management
is responsible for growing the business in the region,
overseeing key community and facility relationships, managing
labor and employee relations and providing regional support
activities to our operating sites.
We provide strategic planning, centralized financial support,
payroll administration, legal services, human resources,
coordinated marketing and purchasing efforts and risk management
through our National Resource Center. We also support our
operating sites with integrated information systems and
standardized procedures that enable us to efficiently manage the
billing and collections processes.
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The following is a detailed business description for our two
business segments.
American Medical
Response
American Medical Response, Inc., or AMR, is the leading provider
of ambulance services in the United States. AMR and our
predecessor companies have a long history in emergency medical
services, having provided services to some communities for more
than 50 years. We have an 8% share of the total ambulance
services market and a 21% share of the private provider
ambulance market. During fiscal 2004, AMR treated and
transported approximately 3.7 million patients in
34 states utilizing more than 4,200 vehicles that operated
out of more than 200 sites. AMR has approximately 2,855
contracts with communities, government agencies, healthcare
providers and insurers to provide ambulance transport services.
AMRs broad geographic footprint enables us to contract on
a national and regional basis with managed care and insurance
companies. AMR has made significant investments in technology,
customer service programs, employee training and risk mitigation
programs to deliver a compelling value proposition to our
customers, which has led to what we believe is our
industry-leading contract retention rate of 99% in fiscal year
2004 and significant new contract wins.
For fiscal 2004, approximately 57% of AMRs net revenue was
generated from emergency 911 ambulance services, which include
treating and stabilizing patients, transporting the patient to a
hospital or other healthcare facility and providing attendant
medical care en-route. Non-emergency ambulance services,
including critical care transfer, wheelchair transports and
other interfacility transports, accounted for 32% of AMRs
net revenue for the same period, with the balance generated from
the provision of training, dispatch centers and other services
to communities and public safety agencies. For the fiscal year
ended August 31, 2004, AMR generated net revenue of
$1.1 billion.
We have been instrumental in the development of protocols and
policies applicable to the emergency services industry. We
believe our key business competencies in communications and
logistics management and our partnerships with local fire
departments, which represented approximately 21% of AMRs
net revenue in fiscal 2004, enable us to operate profitably in
both large and small communities and position us to continue our
growth organically.
We provide substantially all of our ambulance services under our
AMR brand name. We operate under other names when required to do
so by local statute or contractual agreement.
Services
We provide a full range of emergency and non-emergency ambulance
transport and related services, which include:
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Emergency Response Services (911). We provide emergency
response services primarily under long-term exclusive contracts
with communities and hospitals. Our contracts typically
stipulate that we must respond to 911 calls in the designated
area within a specified response time. We utilize two types of
ambulance units Advanced Life Support, or ALS, units
and Basic Life Support, or BLS, units. ALS units, which are
staffed by two paramedics or one paramedic and an emergency
medical technician, or EMT, are equipped with high-acuity life
support equipment such as cardiac monitors, defibrillators and
oxygen delivery systems, and carry pharmaceutical and medical
supplies. BLS units are usually staffed by two EMTs and are
outfitted with medical supplies and equipment necessary to
administer first aid and basic medical treatment. The decision
to dispatch an ALS or BLS unit is determined by our contractual
requirements, as well as by the nature of the medical situation. |
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Under certain of our 911 emergency response contracts, we are
the first responder to an emergency scene. However, under most
of our 911 contracts, the local fire department is the first
responder. In these situations, the fire department typically
begins stabilization of the patient. Upon our arrival, we
continue stabilization through the provision of attendant
medical care and transport the patient to the closest
appropriate healthcare facility. In certain communities where
the fire department historically has been responsible for both
first response and emergency services, we seek to develop
public/private |
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partnerships with fire departments rather than compete with them
to provide the emergency service. These partnerships emphasize
collaboration with the fire departments and afford us the
opportunity to provide 911 emergency services in communities
that, for a variety of reasons, may not otherwise have
outsourced this service to a private provider. In most
instances, the provision of emergency services under our
partnerships closely resembles that of our most common 911
contracts described above. What differentiates the
public/private partnerships is the level of contractually
negotiated collaboration and coordination between AMR and the
fire department. As an example, in several of our public/private
partnerships, we utilize a fire department-employed paramedic
when we transport the patient and subsequently reimburse the
fire department for its employees time. These partnerships
benefit both parties they create a new revenue
source for the fire department while relieving it of the
complexities associated with the emergency transport business,
and they enable us to provide emergency response services in
communities that may not otherwise have outsourced this service.
In addition, the public/private partnerships lower our costs by
reducing the number of full-time paramedics we would otherwise
require. We estimate that these public/private partnerships
represented approximately 20% of AMRs net revenue in
fiscal 2004. |
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Non-Emergency Transport Services. With non-emergency
services, we provide transportation to patients requiring
ambulance or wheelchair transport with varying degrees of
medical care needs between healthcare facilities or between
healthcare facilities and their homes. Unlike emergency response
services, which typically are provided by communities or private
providers under exclusive or semi-exclusive contracts,
non-emergency transportation usually involves multiple contract
providers at a given facility, with one or more of the
competitors designated as the preferred provider.
Non-emergency transport business generally is awarded by a
healthcare facility, such as a hospital or nursing home, or a
healthcare payor, such as an HMO, managed care organization or
insurance company. |
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Non-emergency transport services include: (i) critical care
transport, (ii) wheelchair and stretcher-car transports,
and (iii) other inter-facility transports. |
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Critical care transports are provided to medically unstable
patients (such as cardiac patients and neonatal patients) who
require critical care while being transported between healthcare
facilities. Critical care services differ from ALS services in
that the ambulance may be equipped with additional medical
equipment and may be staffed by one of our medical specialists
or by an employee of a healthcare facility to attend to a
patients specific medical needs. |
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Wheelchair and stretcher-car transports are non-medical
transportation provided to handicapped and certain
non-ambulatory persons in some service areas. In providing this
service, we use vans that contain hydraulic wheelchair lifts or
ramps operated by drivers who generally are trained in
cardiopulmonary resuscitation, or CPR. |
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Other inter-facility transports, that require advanced or basic
levels of medical supervision during transfer, may be provided
when a home-bound patient requires examination or treatment at a
healthcare facility or when a hospital inpatient requires tests
or treatments (such as magnetic resonance imaging, or MRI,
testing, CAT scans, dialysis or chemotherapy treatment)
available at another facility. We use ALS or BLS ambulance units
to provide general ambulance services depending on the
patients needs. |
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Other Services. In addition to our 911 emergency and
non-emergency ambulance services, we provide the following
services: |
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Dispatch Services. Our dispatch centers manage our own
calls and, in certain communities, also manage dispatch centers
for public safety agencies, such as police and fire departments,
aeromedical transport programs and others. |
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Event Medical Services. We provide medical stand-by
support for concerts, athletic events, parades, conventions,
international conferences and VIP appearances in conjunction
with local and federal law enforcement and fire protection
agencies. We have contracts to provide stand-by support for
numerous sports franchises, such as the Oakland Raiders, Oakland
Athletics, Detroit |
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Lions and Los Angeles Dodgers, as well as for various NASCAR
events, Hollywood production studios and other specialty events. |
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Managed Transportation Services. Managed care
organizations and insurance companies contract with us to manage
various of their medical transportation-related needs, including
call-taking and scheduling, management of a network of
transportation providers and billing and reporting through our
e-PCR system. |
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Paramedic Training. We own and operate Northern
California Training Institute, or NCTI, the largest paramedic
training school in the United States and the only accredited
institution of its size, with over 500 graduates each year. |
Medical Personnel and Quality Assurance
Approximately 76% of our 18,500 employees have daily contact
with patients, including approximately 5,300 paramedics, 7,700
EMTs and 300 nurses. Paramedics and EMTs must be state-certified
to transport patients and perform emergency care services.
Certification as an EMT requires completion of a minimum of
140 hours of training in a program designated by the United
States Department of Transportation, such as those offered at
our training institute, NCTI. Once this program is completed,
state-certified EMTs are then eligible to participate in a
state-certified paramedic training program. The average
paramedic program involves over 1,000 hours of academic
training in advanced life support and assessment skills.
Local physician advisory boards develop medical protocols to be
followed by paramedics and EMTs in a service area. In addition,
instructions are conveyed on a case-by-case basis through direct
communications between the ambulance crew and hospital emergency
room physicians during the administration of advanced life
support procedures. Both paramedics and EMTs must complete
continuing education programs and, in some cases, state
supervised refresher training examinations to maintain their
certifications.
We maintain a commitment to provide high quality pre- and
post-hospital emergency medical care. In each location in which
we provide services, a medical director, who usually is a
physician associated with a hospital we serve, monitors
adherence to medical protocol and conducts periodic audits of
the care provided. In addition, we hold retrospective care
audits with our employees to evaluate compliance with medical
and performance standards.
Our commitment to quality is reflected in the fact that 15 of
our dispatch centers across the country are accredited by the
Commission on Accreditation of Ambulance Services, or CAAS,
representing 16% of the total CAAS accredited agencies. CAAS is
a joint program between the American Ambulance Association and
the American College of Emergency Physicians. The accreditation
process is voluntary and evaluates numerous qualitative factors
in the delivery of services. We believe communities and managed
care providers increasingly will consider accreditation as one
of the criteria in awarding contracts.
Billing and Collections
Our internal patient billing services, or PBS, offices located
across the United States invoice and collect for our services.
We receive payment from the following sources:
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the federal and state governments, primarily under the Medicare
and Medicaid programs, |
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health maintenance organizations, preferred provider
organizations and private insurers, |
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individual patients, and |
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community subsidies and fees. |
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Over the last three fiscal years, our self-pay revenue has
remained stable as a percentage of AMRs net revenue. The
table below presents the approximate percentages of AMRs
net revenue from the following sources:
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Percentage of AMR | |
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Net Revenue | |
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Year Ended | |
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August 31, | |
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2002 | |
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2003 | |
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2004 | |
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Medicare
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35 |
% |
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33 |
% |
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33 |
% |
Medicaid
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6 |
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6 |
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6 |
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Commercial insurance/managed care
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41 |
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44 |
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45 |
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Self-pay
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6 |
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6 |
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5 |
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Subsidies/fees
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12 |
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11 |
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11 |
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Total net revenue
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100 |
% |
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100 |
% |
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100 |
% |
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We have substantial experience in processing claims to third
party payors and employ a billing staff trained in third party
coverage and reimbursement procedures. Our integrated billing
and collection systems allow us to tailor the submission of
claims to Medicare, Medicaid and certain other third party
payors and has the capability to electronically submit claims to
the extent third party payors systems permit. This system
also provides for tracking of accounts receivable and status
pending payment. When collecting from individuals, we sometimes
use an automated dialer that pre-selects and dials accounts
based on their status within the billing and collection cycle,
which we believe improved our collection rate.
Companies in the ambulance services industry maintain
significant provisions for doubtful accounts compared to
companies in other industries. Collection of complete and
accurate patient billing information during an emergency service
call is sometimes difficult, and incomplete information hinders
post-service collection efforts. In addition, we cannot evaluate
the creditworthiness of patients requiring emergency transport
services. Our allowance for doubtful accounts generally is
higher for transports resulting from emergency ambulance calls
than for non-emergency ambulance requests. See Risk
Factors Risk Factors Related to Healthcare
Regulation Changes in the rates or methods of third
party reimbursements may adversely affect our revenue and
operations.
State licensing requirements, as well as contracts with
communities and healthcare facilities, typically require us to
provide ambulance services without regard to a patients
insurance coverage or ability to pay. As a result, we often
receive partial or no compensation for services provided to
patients who are not covered by Medicare, Medicaid or private
insurance. The anticipated level of uncompensated care and
uncollectible accounts is considered in negotiating a
government-paid subsidy to provide for uncompensated care, and
permitted rates under contracts with a community or government
agency.
A significant portion of our ambulance transport revenue is
derived from Medicare payments. The Balanced Budget Act of 1997,
or BBA, modified Medicare reimbursement rates for emergency
transportation with the introduction of a national fee schedule.
The BBA provided for a phase-in of the national fee schedule by
blending the new national fee schedule rates with ambulance
service suppliers pre-existing reasonable
charge reimbursement rates. The BBA provided for this
phase-in period to begin on April 1, 2002, with full
transition to the national fee schedule rates to be effective
January 1, 2006. In some regions, the national fee schedule
would have resulted in a decrease in Medicare reimbursement
rates of approximately 25% by the end of the phase-in period.
Partially in response to the dramatic decrease in rates dictated
by the BBA in some regions, the Medicare Modernization Act
established regional rates, certain of which are higher than the
BBAs national rates, and provided for the blending of the
regional and national rates until January 1, 2010. Other
rate provisions included in the Medicare Modernization Act
provide further temporary mitigation of the impact of the BBA
decreases, including a provision that provides for 1% to 2%
increases for blended rates for the period from January 1,
2004 through December 31, 2006. Because the Medicare
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Modernization Act relief is of limited duration, we will
continue to pursue strategies to offset the decreases mandated
by the BBA, including seeking fee and subsidy increases.
We estimate that the impact of the BBA rate decreases, as
modified by the provisions of the Medicare Modernization Act,
resulted in a decrease in AMRs net revenue for fiscal 2003
and fiscal 2004 of approximately $20 million and
$11 million, respectively. We have been able to
substantially mitigate the phase-in reductions of the BBA
through additional fee and subsidy increases. As a 911 emergency
response provider, we are uniquely positioned to offset changes
in reimbursement by requesting increases in the rates we are
permitted to charge for 911 services from the communities we
serve. In response, these communities often permit us to
increase rates for ambulance services from patients and their
third party payors in order to ensure the maintenance of
required community-wide 911 emergency response services. While
these rate increases do not result in higher payments from
Medicare and certain other public or private payors, overall
they increase our revenue.
See Regulatory Matters Medicare, Medicaid and
Other Government Program Reimbursement for additional
information on reimbursement from Medicare, Medicaid and other
government-sponsored programs.
Contracts
As of September 30, 2005, we had approximately 155
contracts with communities and government agencies to provide
911 emergency response services. Contracts with communities to
provide emergency transport services are typically exclusive,
three to five years in length and generally are obtained through
a competitive bidding process. In some instances where we are
the existing provider, communities elect to renegotiate existing
contracts rather than initiate new bidding processes. Our 911
contracts often contain options for earned extensions or
evergreen provisions. We have improved our contract retention
rate to 99% for fiscal 2004 compared to 81% in fiscal 2001. In
fiscal 2004, our top ten 911 contracts accounted for
approximately $243.3 million, or 23.1% of AMRs net
revenue. We have served these ten customers on a continual basis
for an average of 34 years.
Our 911 emergency response contracts typically specify maximum
fees we may charge and set forth minimum requirements, such as
response times, staffing levels, types of vehicles and
equipment, quality assurance and insurance coverage. Communities
and government agencies may also require us to provide a
performance bond or other assurances of financial
responsibility. The rates we are permitted to charge for
services under a contract for emergency ambulance services and
the amount of the subsidy, if any, we receive from a community
or government agency depend in large part on the nature of the
services we provide, payor mix and performance requirements.
We have approximately 2,700 contracts to provide non-emergency
ambulance services with hospitals, nursing homes and other
healthcare facilities that require a stable and reliable source
of medical transportation for their patients. These contracts
typically designate us as the preferred ambulance service
provider of non-emergency ambulance services to those facilities
and permit us to charge a base fee, mileage reimbursement, and
additional fees for the use of particular medical equipment and
supplies. We also provide a significant portion of our
non-emergency transports to facilities and organizations in
competitive markets without specific contracts.
Non-emergency transports often are provided to managed care or
insurance plan members who are stabilized at the closest
available hospital and are then moved to facilities within their
health plans network. We believe the increased prevalence
of managed care benefits larger ambulance service providers,
which can service a higher percentage of a managed care
providers members. This allows the managed care provider
to reduce its number of vendors, thus reducing administrative
costs and allowing it to negotiate more favorable rates with
healthcare facilities. Our scale and broad geographic footprint
enable us to contract on a national and regional basis with
managed care and insurance companies. We have multi-year
contracts with large healthcare networks and insurers including
Kaiser, Aetna, Healthnet, Cigna and SummaCare. None of these
customers represent revenue that amounts to 10% of our fiscal
2004 total net revenue.
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We believe that communities, government agencies, healthcare
facilities, managed care companies and insurers consider the
quality of care, historical response time performance and total
cost to be among the most important factors in awarding and
renewing contracts.
Dispatch and Communications
Dispatch centers control the deployment and dispatch of
ambulances in response to calls through the use of sophisticated
communications equipment 24 hours a day, seven days a week.
In many operating sites, we communicate with our vehicles over
dedicated radio frequencies licensed by the Federal
Communications Commission. In certain service areas with a large
volume of calls, we analyze data on traffic patterns,
demographics, usage frequency and similar factors with the aid
of System Status Management, or SSM technology, to help
determine optimal ambulance deployment and selection. In
addition to dispatching our own ambulances, we also provide and
staff 52 dispatch centers for communities where we are not an
ambulance service provider. Our dispatch centers are staffed by
EMTs and other experienced personnel who use local medical
protocols to analyze and triage a medical situation and
determine the best mode of transport.
Emergency Transport. Depending on the emergency medical
dispatch system used in a designated service area, the public
authority that receives 911 emergency medical calls either
dispatches our ambulances directly from the public control
center or communicates information regarding the location and
type of medical emergency to our control center which, in turn,
dispatches ambulances to the scene. While the ambulance is
en-route to the scene, the ambulance receives information
concerning the patients condition prior to the
ambulances arrival at the scene. Our communication systems
allow the ambulance crew to communicate directly with the
destination hospital to alert hospital medical personnel of the
arrival of the patient and the patients condition and to
receive instructions directly from emergency room personnel on
specific pre-hospital medical treatment. These systems also
facilitate close and direct coordination with other emergency
service providers, such as the appropriate police and fire
departments, that also may be responding to a call.
Non-Emergency Transport. Requests for non-emergency
transports typically are made by physicians, nurses, case
managers and hospital discharge coordinators who are interested
primarily in prompt ambulance arrival at the requested pick-up
time. We are also offering on-line, web-enabled transportation
ordering to certain facilities. We use our Millennium software
to track and manage requests for transportation services for
large healthcare facilities and managed care companies.
Management Information Systems
We support our regions with integrated information systems and
standardized procedures that enable us to efficiently manage the
billing and collections processes and financial support
functions. Our recently developed technology solutions provide
information for operations personnel, including real-time
operating statistics, tracking of strategic plan initiatives,
electronic purchasing and inventory management solutions.
We have three management information systems that we believe
have significantly enhanced our operations our e-PCR
technology, our Millennium call-taking system and our SSM
ambulance positioning system.
e-PCR. In those operating sites where we have implemented
it, our e-PCR technology, has enhanced the process of capturing
clinical patient data. The electronic record replaces the paper
patient care record and provides the paramedic with clinical
flowcharts to document each assessment and procedure performed.
The technology also integrates patient clinical and demographic
information with billing information, allowing the ambulance
crew to ensure that patient information is updated at the scene.
Billing information can be transmitted electronically while the
ambulance is en-route, thus reducing the billing cycle time and
the cost associated with the manual input of patient care record
information. Our initial implementation of this technology has
improved our ability to capture billable revenue and decrease
our billing costs. We currently employ e-PCR technology on
ruggedized laptops in eight of our operating sites and we plan
to implement it in three additional operating sites through
2006. This technology currently is available in operating sites
that
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accounted for approximately 10% of AMRs fiscal 2005
ambulance transports and approximately 13% of AMRs fiscal
2005 net transport revenue. Together with the operating sites to
be added in 2006, the e-PCR technology would have accounted for
12% of AMRs fiscal 2005 ambulance transports and 15% of
its fiscal 2005 net transport revenue. Our per unit e-PCR
capital costs continue to decline as hardware costs decline.
Millennium. Our proprietary Millennium system is a
call-taking application that tracks and manages requests for
transportation services for large healthcare facilities and
managed care companies. The system is designed to make certain
medical necessity and benefit level determinations prior to
transport. These determinations can be customized to fit an
individual customers needs. Customers call a single
toll-free telephone number and are routed to the appropriate AMR
call center. The telephone system is integrated into the
Millennium application, which gives the answering agent specific
call information, including customized greetings, patient
information and priority of the call. The system logic verifies
whether the transport is authorized by the health plan. If the
transport is determined to be appropriate, the system then
assigns a response time and level of service based on the
information obtained from the requestor. In fiscal 2004, we
utilized Millennium for approximately 217,000 transactions
resulting in 210,000 transports in the year. We have initiated a
campaign to promote the benefits of this system to other
potential customers.
SSM. Our SSM technology enables us to use historical data
on fleet usage patterns to predict where our emergency transport
services are likely to be required. SSM also creates a visual
display of current demand, allowing us to position our ambulance
units more effectively. This flexible deployment allows us to
improve response times and increase asset utilization.
Additionally, we have recently begun to implement
real-time SSM. This state-of-the-art SSM technology
will allow us to continuously position our ambulances in
optimized locations, thereby further improving response times
and maximizing asset utilization. We believe our ability to
continue deploying real-time SSM will further differentiate us
from our competitors in terms of both service quality and cost.
Sales and Marketing
Our 100-person sales and marketing team is comprised of two
distinct groups one focused primarily on contract
retention and the other on generating new sales. Many of our
sales and marketing employees are former paramedics or EMTs who
began their careers in the emergency transportation industry and
are therefore well-qualified to understand the needs of our
customers. Our sales force is incentivized through a
compensation package that includes base salary and significant
bonus potential based on achieving specified performance targets.
We continue to seek expansion in both the geographic markets we
serve and the scope of services we provide in existing markets.
Ownership of the local emergency response contract can be
advantageous to us when bidding for non-emergency business,
because our existing fleet of ambulances and dispatch centers
maintained for emergency response can also be used for
non-emergency business. For the same reason, our ownership of a
successful non-emergency business can be advantageous to us when
trying to unseat an incumbent emergency response operator or to
obtain a contract in a newly privatized market.
Risk Management
We are committed to the safety of our employees and the patients
and communities we serve. Our commitment is manifested in our
World Class Safety Program, which has gained distinction
with the National Safety Council and has served as a benchmark
for other companies. This program consists of two important
goals:
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To be the leader for safety in the emergency medical services
industry, and |
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To be recognized as a leader for safety among all industries. |
Our World Class Safety Program is built upon five important
components:
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Selecting highly qualified employees, |
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Providing exemplary safety policies and programs to control
losses, |
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Effective training and education programs, |
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Accountability of management and employees for safety of the
operation, and |
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Continuous review of new opportunities and existing programs for
improvement. |
We train and educate all new employees about our safety programs
including, among others, emergency vehicle operations, various
medical protocols, use of equipment and patient focused care and
advocacy. Our safety training also involves continuing education
programs and a monthly safety awareness campaign. We also work
directly with manufacturers to design equipment modifications
that enhance both patient and clinician safety.
Our safety and risk management team develops and executes
strategic planning initiatives focused on mitigating the factors
that drive losses in our operations. We aggressively investigate
and respond to all incidents we believe may result in a claim.
Operations supervisors submit documentation of such incidents to
the third party administrator handling the claim. We have a
dedicated liability unit with our third party administrator
which actively engages with our staff to gain valuable
information for closure of claims. Information from the claims
database is an important resource for identifying trends and
developing future safety initiatives.
We utilize an on-board monitoring system, RoadSafety, which
measures operator performance against our safe driving
standards. Our operations using RoadSafety have experienced
improved driving behaviors within 90 days of installation.
RoadSafety has been implemented in 49% of our vehicles in the
emergency response markets and is being expanded to 58% of our
emergency fleet in fiscal 2006. We expect to recover the average
cost per vehicle over a period of approximately 24 months
from installation due to reduced vehicle maintenance and repair
expenses.
We estimate that, in fiscal 2004, our costs for vehicle
collisions were 19% lower than in fiscal 2000 and our average
cost per vehicle claim was 37% lower than in fiscal 2000. Over
the same period, we estimate that we reduced patient care
incidents and employee injuries by 8% and 25%, respectively.
Competition
Our predominant competitors are fire departments, with 35% of
the ambulance transport services market. Firefighters have
traditionally acted as the first responders during emergencies,
and in many communities provide emergency medical care and
transport as well. In many communities we have established
public/private partnerships, in which we integrate our transport
services with the first responder services of the local fire
department. We believe these public/private partnerships provide
a model for us to collaborate, rather than compete, with fire
departments to increase the number of communities we serve.
Competition in the ambulance transport market is based primarily
on:
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pricing, |
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the ability to improve customer service, such as on-time
performance and efficient call intake, |
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the ability to recruit, train and motivate employees,
particularly ambulance crews who have direct contact with
patients and healthcare personnel, and |
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billing and reimbursement expertise. |
Our largest competitor, Rural/ Metro Corporation, is the only
other national provider of ambulance transport services and
generates less than half of AMRs net revenue. Our other
private provider competitors include Southwest Ambulance in
Arizona and New Mexico, Acadian Ambulance Service in Louisiana
and small, locally owned operators that principally serve the
inter-facility transport market.
Insurance
Workers Compensation, Auto and General Liability. For
periods prior to September 1, 2001, we are fully-insured
for our workers compensation, auto and general liability
programs through Laidlaws captive
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insurance program. We have retained liability for the first
$1 million to $2 million of the loss under these
programs since September 1, 2001. Our self-insurance
program, fronted by ACE American Insurance Co. in fiscal 2002
and 2003 and funded through Laidlaws captive insurance
program in fiscal 2004 and 2005 to the date of our acquisition
of AMR and EmCare, covers the first $2 million of auto and
general liability claims per occurrence and the first
$1 million of workers compensation claims per occurrence.
From the date of the acquisition, our self-insurance program has
been fronted by ACE. Generally, our umbrella policies covering
claims that exceed our deductible levels have an annual cap of
approximately $100 million.
Professional Liability. For periods prior to
April 15, 2001, we are insured for our professional
liability claims through third party insurers. Since
April 15, 2001, we have a self-insured retention for our
professional liability coverage. The self-insured retention
covers the first $2 million for policy year ending
April 15, 2002, the first $5 million for policy years
ending April 15, 2003 and 2004 and the first
$5.5 million for the policy years ending April 15,
2005 and 2006. In addition, we have umbrella policies with third
party insurers covering claims exceeding these retention levels
with an aggregate cap of $10 million for each separate
policy period.
Property
Vehicle Fleet. We operate approximately 4,200 vehicles.
Of these, approximately 3,100 are ambulances, 600 are wheelchair
vans and 500 are support vehicles. We own approximately 89% of
our vehicles and lease the balance. We replace ambulances based
upon age and usage, but generally every eight to ten years. The
average age of our existing ambulance fleet is approximately
five years. We primarily use in-house maintenance services to
maintain our fleet. In those operations where our fleet is small
and quality external maintenance services that agree to maintain
our fleet in accordance with AMR standards are available, we
utilize these maintenance services. We are exploring ways to
decrease our overall capital expenditures for vehicles,
including major refurbishing and overhaul of our vehicles to
extend their useful life.
Facilities. We lease approximately 55,000 square
feet in an office building at 6200 S. Syracuse Way,
Greenwood Village, Colorado for the AMR and Emergency Medical
Services corporate headquarters. We also lease administrative
facilities and other facilities used principally for ambulance
basing, garaging and maintenance in those areas in which we
provide ambulance services. We own 14 facilities used
principally for administrative services and stationing for our
ambulances. We believe our present facilities are sufficient to
meet our current and projected needs, and that suitable space is
readily available should our need for space increase. Our leases
expire at various dates through 2014.
Environmental Matters
We are subject to federal, state and local laws and regulations
relating to the presence of hazardous materials and pollution
and the protection of the environment, including those governing
emissions to air, discharges to water, storage, treatment and
disposal of wastes, including medical waste, remediation of
contaminated sites, and protection of worker health and safety.
We believe our current operations are in substantial compliance
with all applicable environmental requirements and that we
maintain all material permits required to operate our business.
Certain environmental laws impose strict, and under certain
circumstances joint and several, liability for investigation and
remediation of the release of regulated substances into the
environment. Such liability can be imposed on current or former
owners or operators of contaminated sites, or on persons who
dispose or arrange for disposal of wastes at a contaminated
site. Releases have occurred at a few of the facilities we lease
as a result of historical practices of the owners or former
operators. Based on available information, we do not believe
that any known compliance obligations, releases or
investigations under environmental laws or regulations will have
a material adverse effect on our business, financial position
and results of operations. However, there can be no guarantee
that these releases or newly discovered information, more
stringent enforcement of or changes in environmental
requirements, or our inability to enforce available
indemnification agreements will not result in significant costs.
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Employees
At September 30, 2005, we had approximately
18,500 employees, including approximately 5,300 paramedics,
7,700 EMTs, 300 nurses and 5,200 support
personnel. Approximately 50% of our employees are represented by
42 collective bargaining agreements with 43 different
union locals. Fourteen of these collective bargaining
agreements, representing approximately 4,100 employees, are
subject to renegotiation in 2006. We believe we have a good
relationship with our employees. We have reduced our employee
turnover to 19.9% in fiscal 2004, a 44.3% reduction since fiscal
2002. We have never experienced any union-related work stoppages.
Legal Matters
We are subject to litigation arising in the ordinary course of
our business, including litigation principally relating to
professional liability, auto accident and workers compensation
claims. There can be no assurance that our insurance coverage
will be adequate to cover all liabilities occurring out of such
claims. In the opinion of management, we are not engaged in any
legal proceedings that we expect will have a material adverse
effect on our business, financial condition, cash flows or
results of our operations other than as set forth below.
From time to time, in the ordinary course of business and like
others in the industry, we receive requests for information from
government agencies in connection with their regulatory or
investigational authority. Such requests can include subpoenas
or demand letters for documents to assist the government in
audits or investigations. We review such requests and notices
and take appropriate action. We have been subject to certain
requests for information and investigations in the past and
could be subject to such requests for information and
investigations in the future.
We are subject to the Medicare and Medicaid fraud and abuse
laws, which prohibit, among other things, any false claims, or
any bribe, kick-back, rebate or other remuneration, in cash or
in kind, in return for the referral of Medicare and Medicaid
patients. Violation of these prohibitions may result in civil
and criminal penalties and exclusion from participation in the
Medicare and Medicaid programs. We have implemented policies and
procedures that management believes will assure that we are in
substantial compliance with these laws, but we cannot assure you
that the government or a court will not find that some of our
business practices violate these laws.
On May 9, 2002, we received a subpoena from the Office of
Inspector General for the United States Department of Health and
Human Services, or OIG. The subpoena requested copies of
documents for the period from January 1993 through May 2002. The
subpoena required us to produce a broad range of documents
relating to contracts entered into by our affiliate, Regional
Emergency Services, or RES, in Texas, Georgia and Colorado. The
Department of Justice added inquiries involving contracts in
Texas to its other claims against RES and a hospital system
arising from a contract between RES and the hospital system in
Florida. These claims, including both Texas and Florida, were
settled by RES and the hospital system for approximately
$20.0 million, of which we were responsible for, and have
paid, $5.0 million. The government investigations in
Georgia and Colorado have not been resolved.
During the first quarter of fiscal 2004, we were advised by the
U.S. Department of Justice that it was investigating
certain business practices at AMR. The specific practices at
issue were (1) whether ambulance transports involving
Medicare eligible patients complied with the medical
necessity requirement imposed by Medicare regulations,
(2) whether patient signatures, when required, were
properly obtained from Medicare eligible patients, and
(3) whether discounts in violation of the federal
Anti-Kickback Statute were provided by AMR to hospitals and
nursing homes in exchange for referrals involving Medicare
eligible patients. This investigation has not yet been resolved.
In connection with the third issue, the government has alleged
that certain of our hospital and nursing home contracts in
effect in Texas, primarily certain contracts in effect in
periods prior to 1999, and possibly through 2001, contained
discounts in violation of the federal Anti-Kickback Statute. The
government recently has provided us with an analysis of the
investigation conducted in connection with this contract issue,
and invited us to respond. We are currently in discussions with
the government regarding these Texas allegations. The government
has proposed that we make a substantial payment to settle the
Texas matter, and has indicated that, in the absence of a
settlement, it will pursue further civil action in this matter.
The government may also be
88
investigating whether our contracts with health facilities in
Oregon and other jurisdictions violate the Anti-Kickback
Statute. Under the provisions of our purchase agreement for the
acquisition of AMR, we and Laidlaw International, Inc. share
responsibility for damages arising with respect to these
matters; we are responsible for 50% of the first
$10 million of damages and 10% of any damages in excess of
$10 million and up to and including $50 million. Based
upon our discussions with the government and our own analysis,
we believe we have adequately accrued for potential losses.
However, there can be no assurances as to the final resolution
of these investigations and any resulting proceedings.
On July 12, 2005, we received a letter and draft Audit
Report from the OIG requesting our response to its draft
findings that our Massachusetts subsidiary received
$1.9 million in overpayments from Medicare for services
performed between July 1, 2002 and December 31, 2002.
The draft findings state that some of these services did not
meet Medicare medical necessity and reimbursement requirements.
We disagree with the OIGs finding and are in the process
of responding to the draft Audit Report. If we are unsuccessful
in challenging the OIGs draft findings, and in any
administrative appeals to which we may be entitled following the
release of a final Audit Report, we may be required to make a
substantial repayment.
AMR and the City of Stockton, California are parties to
litigation regarding the terms and enforceability of a
memorandum of understanding and a related joint venture
agreement between the parties to present a joint bid in response
to a request for proposals to provide emergency ambulance
services in the County of San Joaquin, California. We were
unable to agree on the final terms of a joint bid. We are
seeking a judicial determination that these documents are
unenforceable and void, and Stockton has alleged breach of
contract. We have been awarded the San Joaquin contract. While
we are unable at this time to estimate the amount of potential
damages, we believe that Stockton may claim as damages a portion
of our profit on the contract or the profit Stockton might have
realized had the joint venture proceeded.
On December 14, 2005, a lawsuit, purporting to be a class
action, was commenced against AMR in Spokane, Washington. The
complaint alleges that the two identified plaintiffs were billed
for advanced life support services rather than basic life
support in violation of AMRs contract with the city of
Spokane, resulting in total overcharges for three transports of
$395. The complaint further alleges a potential group of over
30,000 patients transported since 1998, with possible
individual claims of $150 to $250, and seeks treble damages
under the state consumer protection act. AMR has not had
sufficient time to analyze the allegations in the complaint.
However, AMR recently reviewed its billing practices at the
request of the Spokane Fire Department, and is conducting a
further audit. Although there can be no assurances as to the
final outcome, at this time AMR does not believe that any
incorrect billings are material in amount.
EmCare
EmCare is the largest provider of outsourced emergency
department staffing and related management services to
healthcare facilities in the United States. EmCare has a 6%
share of the total emergency department services market and a 9%
share of the outsourced emergency department services market.
During fiscal 2004, EmCare had approximately 5.3 million
patient visits in 39 states. EmCare has 333 exclusive
contracts with hospitals and independent physician groups to
provide emergency department and hospitalist staffing,
management and other administrative services. We believe that
EmCares successful physician recruitment and retention,
high level of customer service and advanced risk management
programs have resulted in what we believe is our
industry-leading contract retention rate of 91% in fiscal 2004
and new contract wins.
EmCare primarily provides emergency department staffing and
related management services to healthcare facilities. We recruit
and hire or subcontract with physicians and other healthcare
professionals, who then provide professional services to the
hospitals with whom we contract. We also have practice support
agreements with independent physician groups and hospitals
pursuant to which we provide unbundled management services such
as billing and collection, recruiting, risk management and
certain other administrative services. For the fiscal year ended
August 31, 2004, EmCare generated net revenue of
$549.8 million.
In addition, we have become one of the leading providers of
hospitalist services. A hospitalist is a physician who
specializes in the care of acutely ill patients in an in-patient
setting. While we have provided limited hospitalist services for
the past 10 years, it is only in the last 18 months
that we have focused on
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expanding this program. We have increased our hospitalist
programs from 8 contracts at August 31, 2003 to
24 contracts at September 30, 2005, increasing our net
revenue for this program from approximately $7.2 million in
fiscal 2001 to approximately $23.5 million, or
approximately 4% of EmCares net revenue, for fiscal 2004.
As of September 30, 2005, we independently contracted with
or employed approximately 170 hospitalist physicians.
EmCare was founded in Dallas, Texas in 1972. Initially we grew
by targeting larger hospitals in the Texas marketplace. We then
expanded our presence nationally, primarily through a series of
acquisitions in the 1990s. Throughout our history, EmCare has
enjoyed a strong reputation as a quality provider of emergency
department staffing and related management services.
The range of staffing and related management services we provide
includes:
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recruiting, scheduling and credentials coordination for clinical
professionals, |
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support services, such as payroll, insurance coverage,
continuing education services and management training, and |
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coding, billing and collection of fees for services provided by
medical professionals. |
We are a leading provider of outsourcing services to both market
segments, and have developed specific competencies and operating
groups to address the unique needs of each. In fiscal 2004, the
high volume and medium to low volume segments represented 88%
and 12%, respectively, of our emergency department net revenue.
Services
We provide a full range of outsourced physician staffing and
related management services for emergency department and
hospitalist programs, which include:
Contract Management. We utilize an integrated approach to
contract management that involves physicians, non-clinical
business experts, operational efficiency specialists and
hospital representatives. Together, the team works to improve
the quality and reduce the cost of care. We believe that our
approach fosters the culture that is necessary to operate
effectively in high stress emergency environments. An on-site
medical director is responsible for the day-to-day oversight of
the operation, including clinical quality, and works closely
with the hospitals management in developing strategic
initiatives and objectives. The regional director of operations,
which is a clinical position, provides systems analysis and
improvement plans. A quality manager develops site-specific
quality improvement programs, and practice improvement staff
focuses on chart documentation and physician utilization
patterns. The regional-based management staff provides support
for these efforts and ensures that each customers
expectations are identified, that service plans are developed
and executed to meet those expectations, and that the
companys and the customers financial objectives are
achieved.
Staffing. We provide a full range of staffing services to
meet the unique needs of each healthcare facility. Our dedicated
clinical teams include qualified, career-oriented physicians and
other healthcare professionals responsible for the delivery of
high quality, cost-effective care. These teams also rely on
managerial personnel, many of whom have clinical experience, who
oversee the administration and operations of the clinical area.
As a result of our staffing services, healthcare facilities can
focus their efforts on improving their core business of
providing healthcare services for their communities rather than
recruiting and managing physicians. Ensuring that each contract
is staffed with the appropriately qualified physicians and that
coverage is provided without any service deficiencies is
critical to the success of the contract. We believe that our
approach to recruiting, staffing and scheduling provides us with
a unique advantage in achieving these objectives.
Recruiting. Many healthcare facilities lack the resources
necessary to identify and attract specialized, career-oriented
physicians. We have committed significant resources to the
development of a proprietary national physician database that we
utilize in our recruiting programs across the country. Our
marketing and recruiting staff continuously updates our database
of more than 800,000 physicians with relevant data to allow
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us to match potential physician candidates to specific openings
based upon personal preferences. This targeted recruiting method
increases the success and efficiency of our recruiters, and we
believe significantly increases our physician retention rates.
We actively recruit physicians through various media options
including telemarketing, direct mail, conventions, journal
advertising and our Internet site.
Scheduling. Our scheduling departments assist our medical
directors in scheduling physicians and other healthcare
professionals in accordance with the coverage model at each
facility. We provide 24-hour service to ensure that unscheduled
shift vacancies, due to situations such as physician illness and
personal emergencies, are filled with alternative coverage.
Payroll Administration and Benefits. We provide payroll
administration services for the physicians and other healthcare
professionals with whom we contract to provide services at
customer sites. Our clinical employees benefit significantly by
our ability to aggregate physicians to provide professional
liability coverage at lower rates than many hospitals or
physicians could negotiate on a stand-alone basis. Additionally,
healthcare facilities benefit from the elimination of the
overhead costs associated with the administration of payroll
and, where applicable, employee benefits.
Customer Satisfaction Programs. We design and implement
customized patient satisfaction programs for our hospital
customers. These programs are designed to improve patient
satisfaction through the use of communication, family inclusion
and hospitality techniques. These programs are delivered to the
clinical and non-clinical members of the hospital emergency
department.
Other Services. We provide a substantial portion of our
services to hospitals through our affiliate physician groups.
Because we have also identified situations in which hospitals
and physicians are interested in receiving stand-alone
management services such as billing and collection, scheduling,
recruitment and risk management, we often unbundle our services
to meet this need. Pursuant to these practice support
agreements, which generally will have a term of one to three
years, we provide these services to independent physician groups
and healthcare facilities. As of August 31, 2004, we had 19
practice support agreements which generated $5.6 million in
net revenue in fiscal 2004, a 33% increase over fiscal 2003. We
are working to commercialize our expertise in staffing and
billing and expect to enter into similar stand-alone practice
support agreements.
Operational Assessments. We undertake operational
assessments for our hospital customers that include
comprehensive reviews of critical operational matrices,
including turnaround times, triage systems, left without
being seens, throughput times and operating systems. These
assessments establish baseline values, develop and implement
process improvement programs, and then monitor the success of
the initiatives. This is an ongoing process that we continually
monitor and modify.
Practice Improvement. We provide ongoing comprehensive
documentation review and training for our affiliated physicians.
We review certain statistical indicators that allow us to
provide specific training to individual physicians regarding
documentation, and we tailor training for broader groups of
physicians as we see trends developing in documentation-related
areas. Our training focuses on the completeness of the medical
record or chart, specific payor requirements, and government
rules and regulations.
Risk Management
We utilize our risk management department, senior medical
leadership and on-site medical directors to conduct aggressive
risk management and quality assurance programs. We take a
proactive role in promoting early reporting, evaluation and
resolution of incidents that may evolve into claims. Our risk
management function is designed to mitigate risk associated with
the delivery of care and to prevent or minimize costs associated
with medical professional liability claims and includes:
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Incident Reporting Systems. We have established a
comprehensive support system for medical professionals. Our Risk
Management Hotline provides each physician with the ability to
discuss medical issues with a peer. In the event of a negative
patient outcome, the physician may discuss legal and medical
issues in anticipation of litigation directly with an EmCare
attorney experienced with medical malpractice issues. |
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Tracking and Trending Claims. We have an extensive claims
database developed from our experience in the emergency
department setting. From this database, we track multiple data
points on each professional liability claim. We utilize the
database to identify claim trends and risk factors so that we
can better target our risk management initiatives. Each year, we
target the medical conditions associated with our most frequent
professional liability claims, and provide detailed education to
assist our affiliated medical professionals in treating these
medical conditions. |
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Professional Risk Assessment. We conduct risk assessments
of our medical professionals. Typically, a risk assessment
includes a thorough review of professional liability claims
against the professional, assessment of issues raised by
hospital risk management and identification of areas where
additional education may be advantageous for the professional. |
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Hospital Risk Assessment. We conduct risk assessments of
potential hospital customers in conjunction with our sales and
contracting process. As part of the risk assessment, registered
nurses or physicians employed by us conduct a detailed analysis
of the hospitals operations affecting the emergency
department or hospitalist services, including the triage
procedures, on-call coverage, transfer procedures, nursing
staffing and related matters in an effort to address risk
factors contractually during negotiations with potential
customer hospitals. |
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Clinical Fail-Safe Programs. We review and identify key
risk areas which we believe may result in increased incidence of
patient injuries and resulting claims against us and our
affiliated medical professionals. We continue to develop
fail-safe clinical tools and make them available to
our affiliated physicians for use in conjunction with their
practice and to our customer hospitals for use as a part of
their peer review process. These fail-safe tools
assist physicians in identifying common patient attributes and
complaints that may identify the patient as being at high risk
for certain conditions (e.g., a heart attack). |
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Quality Improvement Programs. Our medical directors are
actively engaged in their respective hospitals quality
improvement committees and initiatives. In addition, we provide
tools that provide guidance to the medical directors on how to
conduct quality reviews of their physicians and help them track
their physicians medical practices. |
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Physician Education Programs. Our wholly owned
subsidiary, Emergency Medical Education Systems, Inc, or EMEDS,
conducts physician education through risk management and board
review conferences and on-line teaching modules. Our affiliated
medical professionals can access EMEDS to obtain valuable
medical information. Our internal continuing education services
are fully accredited by the Accreditation Council for Continuing
Medical Education. This allows us to grant our physicians and
nurses continuing education credits for internally developed
educational programs at a lower cost than if such credits were
earned through external programs. Our risk management department
also provides other forms of education, including articles in
the company newsletter that highlight current medical literature
on important emergency medicine topics. |
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Proactive Professional Liability Claims Handling. We
utilize a third party claims administrator to manage
professional liability claims against companies and medical
professionals covered under our insurance program. For each
case, detailed reports are reviewed to ensure proactively that
the defense is comprehensive and aggressive. Each professional
liability claim brought against an EmCare affiliated medical
professional or EmCare affiliated company is reviewed by
EmCares Claims Committee, consisting of physicians,
attorneys and company executives, before any resolution of the
claim. The Claims Committee periodically instructs EmCares
risk management department to undertake an analysis of
particular physicians or hospital locations associated with a
given claim. |
Billing and Collections
We receive payment for patient services from:
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the federal and state governments, primarily under the Medicare
and Medicaid programs, |
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health maintenance organizations, preferred provider
organizations and private insurers, |
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hospitals, and |
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individual patients. |
Over the last three fiscal years, our self-pay revenue has
remained stable as a percentage of EmCares net revenue.
The table below presents the approximate percentages of
EmCares net revenue from the following sources:
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Percentage of EmCares | |
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Net Revenue | |
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Year Ended August 31, | |
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2002 | |
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2003 | |
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2004 | |
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Medicare
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15 |
% |
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16 |
% |
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17 |
% |
Medicaid
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2 |
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3 |
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3 |
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Commercial insurance/managed care
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57 |
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54 |
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53 |
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Self-pay
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4 |
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3 |
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2 |
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Subsidies/fees
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22 |
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24 |
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25 |
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Total net revenue
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100 |
% |
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100 |
% |
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100 |
% |
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See Regulatory Matters Medicare,
Medicaid and Other Government Program Reimbursement for
additional information on reimbursement from Medicare, Medicaid
and other government-sponsored programs.
We code and bill for physician services through our wholly-owned
subsidiary, Reimbursement Technologies, Inc. We utilize
state-of-the-art document imaging and paperless workflow
processes to expedite the billing cycle and improve compliance
and customer service. Currently, at approximately 50% of our
customer locations, medical records and emergency department
logs are scanned and transmitted electronically to us. We are in
the process of transitioning additional customers to on-site
scanning. By providing these enhanced services, we believe we
increase the value of services we provide to our customers and
improve customer relations. Additionally, we believe these
comprehensive services differentiate us in sales situations and
improve the chance of being selected in competitive bidding
processes.
We do substantially all of the billing for our affiliated
physicians, and we have extensive experience in processing
claims to third party payors. We employ a billing staff of
approximately 640 employees who are trained in third party
coverage and reimbursement procedures. Our integrated billing
and collection system uses proprietary software to tailor the
submission of claims to Medicare, Medicaid and certain other
third party payors and has the capability to electronically
submit most claims to the third party payors systems. We
forward uncollected accounts electronically to two outside
collection agencies automatically, based on established
parameters. Each of these collection agencies have on-site
employees working at our in-house billing company to assist in
providing patients with quality customer service. Our
comprehensive billing and collection system allows us to have
full control of accounts receivable at each step of the process.
Contracts
We have contracts with (i) hospital customers to provide
professional staffing and related management services,
(ii) healthcare facilities and independent physician groups
to provide management services, and (iii) affiliated
physician groups and medical professionals to provide management
services and various benefits.
We deliver services to our hospital customers and their patients
through two principal types of contractual arrangements. EmCare
or a subsidiary frequently contracts directly with the hospital
to provide physician staffing and management services. In some
instances, a physician-owned professional corporation contracts
with the hospital to provide physician staffing and management
services, and the professional corporation, in turn, contracts
with us for a wide range of management and administrative
services, including billing, scheduling support, accounting and
other services. The professional corporation pays our management
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fee out of the fees it collects from patients, third party
payors and, in some cases, the hospital customer. Our physicians
and other healthcare professionals who provide services under
these hospital contracts do so pursuant to independent
contractor or employment agreements with us, or pursuant to
arrangements with the professional corporation that has a
management agreement with us. We refer to all of these
physicians as our affiliated physicians, and these physicians
and other individuals as our healthcare professionals.
Hospital and Practice Support Contracts. As of
September 30, 2005, EmCare provides services under 333
contracts. Typically, the agreements with the hospitals are
awarded on a competitive basis, and have an initial term of
three years with one-year automatic renewals and termination by
either party on specified notice. We have improved our contract
retention rate to 91% for fiscal 2004, up from 74% in fiscal
2001.
Our contracts with hospitals provide for one of three payment
models:
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we bill patients and third party payors directly for physician
fees, |
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we bill patients and third party payors directly for physician
fees, with the hospital paying us an additional pre-arranged fee
for our services, and |
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we bill the hospitals directly for the services of the
physicians. |
In all cases, the hospitals are responsible for billing and
collecting for non-physician-related services.
We have established long-term relationships with some of the
largest names in healthcare services, including Baylor Health
System, Community Health Systems, HCA, Quorum Healthcare, Tenet
Healthcare and Universal Health System. None of these customers
represent revenue that amounts to 10% of our fiscal 2004 total
net revenue. Our top ten hospital emergency department contracts
represent $68.3 million, or 12.4%, of EmCares fiscal
2004 net revenue. We have maintained our relationships with
these customers for an average of 12 years.
Affiliated Physician Group Contracts. In most states, we
contract directly with our hospital customers to provide
physician staffing and related management services. We, in turn,
contract with a professional corporation that is wholly-owned by
one or more physicians, which we refer to as an affiliated
physician group, or with independent contractor physicians. It
is these physicians who provide the medical professional
services. We then provide comprehensive management services to
the physicians. We typically provide professional liability and
workers compensation coverage to our affiliated physicians.
Certain states have laws that prohibit or restrict unlicensed
persons or business entities from practicing medicine. The laws
vary in scope and application from state to state. Some of these
states may prohibit us from contracting directly with hospitals
or physicians to provide professional medical services. In those
states, the affiliated physician groups contract with the
hospital, as well as all medical professionals. We provide
management services to the affiliated physician groups.
Medical Professional Contracts. We contract with medical
professionals as either independent contractors or employees to
provide services to our customers. The medical professionals
generally are paid an hourly rate for each hour of coverage, a
variable rate based upon productivity or contract margin, or a
combination of both a fixed hourly rate and a variable rate
component. We typically provide professional liability and
workers compensation coverage to our medical professionals.
The contracts with medical professionals typically have one-year
terms with automatic renewal clauses for additional one-year
terms. The contracts can be terminated with cause for various
reasons, and usually contain provisions allowing for termination
without cause by either party upon 90 days notice.
Agreements with physicians generally contain a non-compete or
non-solicitation provision and, in the case of medical
directors, a non-compete provision. The enforceability of these
provisions varies from state to state.
Management Information Systems
We have invested in scalable information systems and proprietary
software packages designed to allow us to grow efficiently and
to deliver and implement our best practice procedures
nationally, while retaining local
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and regional flexibility. We have developed and maintain
integrated systems to facilitate the exchange of information
between our regions and our customers.
Our customers, affiliated physicians and employees throughout
the country access a wide variety of information through our
custom portal, www.emcare.com. Designed as a forum to
deliver information and communicate with our various
constituencies, this website provides a unifying platform to
promote the growth in our business. It includes individualized
content, including physician schedules, rosters and performance
reports, all delivered securely to the intended individuals
through the use of a password.
We have developed and implemented the following proprietary
applications that we believe provides us with a competitive
advantage in billing and collections, and in recruiting,
credentialing, enrolling, scheduling and compensating healthcare
professionals.
EmSource is our system for our recruiting staff to source
physician candidates. The system consists of a database of
approximately 800,000 physicians that is updated weekly to
provide the most current physician contact information available.
EmTrac is our primary operations support system that
supports credentialing and scheduling. Information collected in
EmSource during the recruiting process populates
EmTrac, forms the basis for the credentialing module, and
is used to provide alerts on license and privilege expirations.
EmTrac is used by our schedulers to match physician
availability and preferences with the needs of the hospital
customer.
EmComp is our system for calculating physicians
gross pay and is an important tool supporting our compensation
strategy. Physicians are compensated by a wide variety of pay
plans ranging from simple hourly wages to fee for
service plans linked to productivity. EmComp has
been designed to support an unlimited variety of pay plans,
thereby giving EmCare a competitive advantage in physician
recruitment and retention. The system takes the actual hours
worked from EmTrac and the production data from
EmBillz, and applies the pay rules from the
physicians contract to calculate gross pay.
EmBillz is the coding, billing and accounts receivable
management system through which we process more than five
million emergency department visits each year. This proprietary
system supports the full collection process: from capturing the
emergency department patient logs, coding and issuing bills in
accordance with applicable federal and state regulations, and
payment follow-up and cash receipt posting.
Edison is a system that automates much of our physician
enrollment. To bill Medicare, Medicaid and some other third
party payors, each physician must have an approved provider
number for that payor. There are hundreds of unique forms from
the combination of states and payors. Edison facilitates
the completion of the forms, thereby relieving physicians of
significant administrative workload and enabling us to track
pending receivables and ensure timely completion.
Sales and Marketing
Contracts for outsourced emergency department and hospitalist
services are obtained through strategic marketing programs and
responses to requests for proposals. EmCares business
development team includes five Vice Presidents of Practice
Development located throughout the United States who are
responsible for developing sales and acquisition opportunities
for the operating group in his or her territory. A significant
portion of the compensation program for these sales
professionals is commission-based, with incentive compensation
based on the profitability of the contracts they sell and actual
contract performance in the first year. Leads for new hospital
customers are developed through our business development group,
which telemarkets the United States hospital industry. In
addition, leads are generated through our website, journal
advertising and a lead referral program. Each Vice President of
Practice Development is responsible for working with the
regional chief executive officer to structure and provide
customer proposals for new prospects in their respective regions.
Emergency medicine practices vary among healthcare facilities. A
healthcare facility request for proposal generally will include
demographic information of the facility department, a list of
services to be performed, the length of the contract, the
minimum qualifications of bidders, billing information,
selection criteria and
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the format to be followed in the bid. Prior to responding to a
request for proposal, EmCares senior management ensures
that the proposal is in line with certain financial parameters.
Senior management evaluates all aspects of each proposal,
including financial projections, staffing model, resource
requirements and competition, to determine how to best achieve
our business objectives and the customer goals.
Competition
The market for outsourced emergency department staffing and
related management services is highly fragmented, with more than
800 national, regional and local providers handling over
113 million patient visits in 2003. There are more than
4,700 hospitals in the United States with emergency
departments, of which approximately 67% currently outsource
physician services. Of these hospitals that outsource, we
believe approximately 50% contract with a local provider, 25%
contract with a regional provider and 25% contract with a
national provider.
Competition for outsourced physician and other healthcare
staffing and management service contracts is based primarily on:
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the ability to recruit and retain qualified physicians, |
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the ability to improve department productivity and patient
satisfaction while reducing overall costs, |
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the ability to integrate the emergency department with other
hospital departments and to provide value added services, |
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billing and reimbursement expertise, |
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a reputation for compliance with state and federal regulations, |
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the breadth of staffing and management services offered, and |
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financial stability, demonstrating an ability to pay providers
in a timely manner and provide professional liability insurance. |
Team Health is our largest competitor and has the second largest
share of the emergency department services market with an
approximately 4.4% share. The other national providers of
outsourced emergency department services are Sterling
Healthcare, National Emergency Service and the Schumacher Group,
which tend to focus on hospitals with lower to medium volume
emergency departments.
Insurance
Professional Liability Program. For the period
January 1, 2001 through December 31, 2004, our
professional liability insurance program provided claims made
insurance coverage with limits of $1 million per loss
event, with a $3 million annual per physician aggregate,
for all medical professionals for whom we have agreed to procure
coverage. Our subsidiaries and affiliated corporate entities are
provided with coverage of $1 million per loss event, but
share a $10 million annual corporate aggregate.
For the 2001 calendar year, Lexington Insurance Company provided
the majority of the professional liability insurance coverage,
subject to an aggregate policy limit of $10 million. We
also procured coverage on a regional basis under separate
policies of insurance during this period.
For the 2002, 2003 and 2004 calendar years, Columbia Casualty
Company and Continental Casualty Company, collectively referred
to as CCC, provided our professional liability insurance
coverage, covering all claims occurring and reported during
those calendar years. The CCC policies have a retroactive date
of January 1, 2001, thereby covering all claims occurring
during the 2001 calendar year but reported in the 2002, 2003 and
2004 calendar years. We also procured coverage on a regional
basis under separate policies of insurance during this period.
We are maintaining our calendar year 2004 professional liability
insurance program for calendar year 2005.
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Captive Insurance Arrangement. On December 10, 2001,
we formed EMCA Insurance Company, Ltd., or EMCA, as a wholly
owned subsidiary under the Companies Law of the Cayman Islands.
EMCA reinsures CCC for all losses associated with the CCC
insurance policies under the professional liability insurance
program, and provides collateral for the reinsurance arrangement
through a trust agreement.
Workers Compensation Program. For the period
September 1, 2002 through August 31, 2004, we procured
workers compensation insurance coverage for employees of EmCare
and affiliated physician groups through Continental Casualty
Company. Continental reinsures a portion of this workers
compensation exposure, on both a per claim and an aggregate
basis, with EMCA.
From September 1, 2004, EmCare has insured its workers
compensation exposure through The Travelers Indemnity Company,
which reinsures a portion of the exposure with EMCA.
Properties
We lease approximately 48,990 square feet in an office
building at 1717 Main Street, Dallas, Texas for our
corporate headquarters. We also lease 16 facilities to
house administrative, billing and other support functions for
our regional operations. We believe our present facilities are
sufficient to meet our current and projected needs, and that
suitable space is readily available should our need for space
increase. Our leases expire at various dates through 2014.
Employees
The following is an approximate break down of our affiliated
physicians, independent contractors and employees by job
classification as of September 30, 2005.
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Job Classification |
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Full-Time | |
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Part-Time | |
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Total | |
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Physicians*
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1,887 |
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714 |
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2,601 |
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Physician assistants
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162 |
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142 |
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304 |
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Nurse practitioners
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104 |
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94 |
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198 |
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Non-clinical employees
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1,076 |
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119 |
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1,195 |
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Total
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3,229 |
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1,069 |
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4,298 |
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* |
We have approximately 4,500 affiliated physicians. These figures
represent clinicians providing services at a particular time. |
We believe that our relations with our employees are good. None
of our physicians, physician assistants, nurse practitioners or
non-clinical employees are subject to any collective bargaining
agreement.
We offer our physicians substantial flexibility in terms of type
of facility, scheduling of work hours, benefit packages,
opportunities for relocation and career development. This
flexibility, combined with fewer administrative burdens,
improves physician retention rates and stabilizes our contract
base.
Legal Matters
We are subject to litigation arising in the ordinary course of
our business, including litigation principally relating to
professional liability claims. There can be no assurance that
our insurance coverage will be adequate to cover all liabilities
occurring out of such claims. In the opinion of management, we
are not engaged in any legal proceedings that we expect will
have a material adverse effect on our business, financial
condition, cash flows or results of our operations other than as
set forth below.
From time to time, in the ordinary course of business and like
others in the industry, we receive requests for information from
government agencies in connection with their regulatory or
investigational authority. Such requests can include subpoenas
or demand letters for documents to assist the government in
audits or investigations. We review such requests and notices
and take appropriate action. We have been subject to
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certain requests for information and investigations in the past
and could be subject to such requests for information and
investigations in the future.
Our healthcare businesses are subject to the Medicare and
Medicaid fraud and abuse laws, which prohibit, among other
things, any false claims, or any bribe, kick-back or rebate in
return for the referral of Medicare and Medicaid patients.
Violation of these prohibitions may result in civil and criminal
penalties and exclusion from participation in the Medicare and
Medicaid programs. We have implemented policies and procedures
that management believes will assure that we are in substantial
compliance with these laws.
EmCare has been named a defendant in two collective action
lawsuits brought by a number of nurse practitioners and
physician assistants under the Fair Labor Standards Act. The
plaintiffs are seeking to recover overtime pay for the hours
they worked in excess of 40 in a workweek and reclassification
as non-exempt employees. Certain of the plaintiffs brought a
related action under California state law. We have entered into
a settlement of the California state law claims.
Regulatory
Matters
As a participant in the healthcare industry, our operations and
relationships with healthcare providers such as hospitals, other
healthcare facilities and healthcare professionals are subject
to extensive and increasing regulation by numerous federal and
state government entities as well as local government agencies.
Specifically, but without limitation, we are subject to the
following laws and regulations.
Medicare, Medicaid and Other Government Reimbursement
Programs
We derive a significant portion of our revenue from services
rendered to beneficiaries of Medicare, Medicaid and other
government-sponsored healthcare programs. For fiscal 2004, we
received approximately 27.3% of our net revenue from Medicare
and 5.2% from Medicaid. To participate in these programs, we
must comply with stringent and often complex enrollment and
reimbursement requirements from the federal and state
governments. We are subject to governmental reviews and audits
of our bills and claims for reimbursement. Retroactive
adjustments to amounts previously reimbursed from these programs
can and do occur on a regular basis as a result of these reviews
and audits. In addition, these programs are subject to statutory
and regulatory changes, administrative rulings, interpretations
and determinations, all of which may materially increase or
decrease the payments we receive for our services as well as
affect the cost of providing services. In recent years, Congress
has consistently attempted to curb federal spending on such
programs.
Reimbursement to us typically is conditioned on our providing
the correct procedure and diagnosis codes and properly
documenting both the service itself and the medical necessity
for the service. Incorrect or incomplete documentation and
billing information, or the incorrect selection of codes for the
level of service provided, could result in non-payment for
services rendered or lead to allegations of billing fraud.
Moreover, third party payors may disallow, in whole or in part,
requests for reimbursement based on determinations that certain
amounts are not reimbursable, they were for services provided
that were not medically necessary, there was a lack of
sufficient supporting documentation, or for a number of other
reasons. Retroactive adjustments, recoupments or refund demands
may change amounts realized from third party payors. Additional
factors that could complicate our billing include:
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disputes between payors as to which party is responsible for
payment, |
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the difficulty of adherence to specific compliance requirements,
diagnosis coding and various other procedures mandated by the
government, and |
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failure to obtain proper physician credentialing and
documentation in order to bill governmental payors. |
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Due to the nature of our business and our participation in the
Medicare and Medicaid reimbursement programs, we are involved
from time to time in regulatory reviews, audits or
investigations by government agencies of matters such as
compliance with billing regulations and rules. We may be
required to repay these agencies if a finding is made that we
were incorrectly reimbursed, or we may lose eligibility for
certain programs in the event of certain types of
non-compliance. Delays and uncertainties in the reimbursement
process adversely affect our level of accounts receivable,
increase the overall cost of collection, and may adversely
affect our working capital and cause us to incur additional
borrowing costs. Unfavorable resolutions of pending or future
regulatory reviews or investigations, either individually or in
the aggregate, could have a material adverse effect on our
business, financial condition and results of operations.
We establish an allowance for discounts applicable to Medicare,
Medicaid and other third party payors and for doubtful accounts
based on credit risk applicable to certain types of payors,
historical trends, and other relevant information. We review our
allowance for doubtful accounts on an ongoing basis and may
increase or decrease such allowance from time to time, including
in those instances when we determine that the level of effort
and cost of collection of certain accounts receivable is
unacceptable.
We believe that regulatory trends in cost containment will
continue. We cannot assure you that we will be able to offset
reduced operating margins through cost reductions, increased
volume, the introduction of additional procedures or otherwise.
Ambulance Services Fee Schedule. In February 2002, the
Health Care Financing Administration, now renamed the Centers
for Medicare and Medicaid Services, issued the Medicare
Ambulance Fee Schedule Final Rule, or Final Rule, that
revised Medicare policy on the coverage of ambulance transport
services, effective April 1, 2002. The Final Rule was the
result of a mandate under the Balanced Budget Act of 1997, or
BBA, to establish a national fee schedule for payment of
ambulance transport services that would control increases in
expenditures under Part B of the Medicare program,
establish definitions for ambulance transport services that link
payments to the type of services furnished, consider appropriate
regional and operational differences and consider adjustments to
account for inflation, among other provisions.
The Final Rule provided for a five-year phase-in of a national
fee schedule, beginning April 1, 2002. Prior to that date,
Medicare used a charge-based reimbursement system for ambulance
transport services and reimbursed 80% of charges determined to
be reasonable, subject to the limits fixed for the particular
geographic area. The patient was responsible for co-pay amounts,
deductibles and the remaining balance of the transport cost, if
we did not accept the assigned reimbursement, and Medicare
required us to expend reasonable efforts to collect the balance.
In determining reasonable charges, Medicare considered and
applied the lowest of various charge factors, including the
actual charge, the customary charge, the prevailing charge in
the same locality, the amount of reimbursement for comparable
services, and the inflation-indexed charge limit.
On April 1, 2002, the Final Rule became effective. The
Final Rule categorizes seven levels of ground ambulance
services, ranging from basic life support to specialty care
transport, and two categories of air ambulance services. Ground
providers are paid based on a base rate conversion factor
multiplied by the number of relative value units assigned to
each level of transport, plus an additional amount for each mile
of patient transport. The base rate conversion factor for
services to Medicare patients is adjusted each year by the
Consumer Price Index. Additional adjustments to the base rate
conversion factor are included to recognize differences in
relative practice costs among geographic areas, and higher
transportation costs that may be incurred by ambulance providers
in rural areas with low population density. The Final Rule
requires ambulance providers to accept assignment on Medicare
claims, which means a provider must accept Medicares
allowed reimbursement rate as full payment. Medicare typically
reimburses 80% of that rate and the remaining 20% is collectible
from a secondary insurance or the patient. Originally, the Final
Rule called for a five-year phase-in period to allow providers
time to adjust to the new payment rates. The national fee
schedule was to be phased in at 20% increments each year, with
payments being made at 100% of the national fee schedule in 2006
and thereafter.
With the passage of the Medicare Prescription Drug Improvement
and Modernization Act of 2003, or the Medicare Modernization
Act, temporary modifications were made to the amounts payable
under the
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ambulance fee schedule in order to mitigate decreases in
reimbursement in some regions caused by the Final Rule. The
Medicare Modernization Act established regional fee schedules
based on historic costs in each region. Effective July 1,
2004, in those regions where the regional fee schedule exceeds
the national fee schedule, the regional fee schedule is blended
with the national fee schedule on a temporary basis, until 2010.
In addition to the regional fee schedule change, the Medicare
Modernization Act included other provisions for additional
reimbursement for ambulance transport services provided to
Medicare patients. Among other relief, the Medicare
Modernization Act provides for a 1% increase in reimbursement
for urban transports and a 2% increase for rural transports for
the remainder of the original phase-in period of the national
ambulance fee schedule, through 2006.
We estimate that the impact of the ambulance service rate
decreases under the national fee schedule, as modified by the
provisions of the Medicare Modernization Act, resulted in a
decrease in AMRs net revenue for fiscal 2003 and fiscal
2004 of approximately $20 million and $11 million,
respectively, will result in an increase in AMRs net
revenue of approximately $13 million in calendar 2005, and
will result in a decrease in AMRs net revenue of
approximately $17 million in 2006 and continuing decreases
thereafter to 2010. Although we have been able to substantially
mitigate the phased-in reductions of the fee schedule through
additional fee and subsidy increases, we cannot assure you that
we will be able to continue to do so, and the rate decreases
could have a material adverse effect on our results of
operations. We cannot predict whether Congress may make further
refinements and technical corrections to the law or pass a new
cost containment statute in a manner and in a form that could
adversely impact our business.
Local Ambulance Rate Regulation. State or local
government regulations or administrative policies regulate rate
structures in some states in which we provide ambulance
transport services. For example, in certain service areas in
which we are the exclusive provider of ambulance transport
services, the community sets the rates for emergency ambulance
services pursuant to an ordinance or master contract and may
also establish the rates for general ambulance services that we
are permitted to charge. We may be unable to receive ambulance
service rate increases on a timely basis where rates are
regulated or to establish or maintain satisfactory rate
structures where rates are not regulated.
Emergency Physician Services Fee Schedule. Medicare pays
for all physician services based upon a national fee schedule,
or Fee Schedule, which contains a list of uniform rates. The
payment rates under the Fee Schedule are determined based on:
(1) national uniform relative value units for the services
provided, (2) a geographic adjustment factor and (3) a
conversion factor. The Centers for Medicare and Medicaid
Services, or CMS, updates the conversion factor annually. The
Fee Schedule uses a target-setting formula system called the
Sustainable Growth Rate, or SGR, to update annually the
conversion factor. The SGR is a target rate of growth in
spending for physician services which is intended to control the
growth of Medicare expenditures for physicians services.
The Fee Schedule update is adjusted to reflect the comparison of
actual expenditures to target expenditures.
Because one of the factors for calculating the SGR system is
linked to the growth in the U.S. gross domestic product,
the SGR formula may result in a negative payment update if
growth in Medicare beneficiaries use of services exceeds
GDP growth. The SGR formula may result in significant yearly
fluctuations in Fee Schedule updates, which may be unrelated to
changes in the actual cost of providing physician services.
Unless Congress takes additional action in the future to modify
or reform the mechanism by which the physician fee schedule
conversion factor update is undertaken in the future,
significant reductions in Medicare reimbursement could occur,
and these reductions could have a material adverse effect on our
business, financial condition or results of operations. We
currently expect that the Medicare fee schedule update for
physician services fees will provide for a 4.3% decrease to
physician rates effective January 1, 2006, which would
result in a decrease in EmCares 2006 net revenue of
approximately $5.7 million.
Medicare Reassignment. The Medicare program prohibits the
reassignment of Medicare payments due to a physician or other
healthcare provider to any other person or entity unless the
billing arrangement between that physician or other healthcare
provider and the other person or entity falls within an
enumerated
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exception to the Medicare reassignment prohibition.
Historically, there was no exception that allowed us to receive
directly Medicare payments related to the services of
independent contractor physicians. However, the Medicare
Modernization Act amended the Medicare reassignment statute as
of December 8, 2003 and now permits our independent
contractor physicians to reassign their Medicare receivables to
us under certain circumstances. Because this provision has only
recently been implemented, it could be interpreted in a manner
adverse to us, which would negatively impact our ability to bill
for our physicians services.
Rules Applicable to Midlevel Practitioners. EmCare
utilizes physician assistants and nurse practitioners, sometimes
referred to collectively as midlevel practitioners,
to provide care under the supervision of our physicians. State
and federal laws require that such supervision be performed and
documented using specific procedures. For example, in some
states some or all of the midlevel practitioners chart
entries must be countersigned. Under applicable Medicare rules,
the midlevel practitioners services are reimbursed at a
rate equal to 85% of the physician fee schedule amount and we do
not bill separately for the supervising physicians
services. However, when a midlevel practitioner assists a
physician who is directly and personally involved in the
patients care, we often bill for the services of the
physician at the full physician fee schedule rates and do not
bill separately for the midlevel practitioners services.
We believe our billing and documentation practices related to
our use of midlevel practitioners comply with applicable state
and federal laws, but we cannot assure you that enforcement
authorities will not find that our practices violate such laws.
Ambulance Rates Payable by Medicare HMOs. One of the
changes made by ambulance fee schedule Final Rule was to require
ambulance providers to accept assignment from
Medicare and Medicare HMOs. Medicare HMOs are private insurance
companies which operate managed care plans that enroll Medicare
beneficiaries who elect to enroll in a plan in lieu of regular
Medicare coverage. When a provider accepts assignment, it agrees
to accept the rate established by Medicare as payment in full
for services covered by Medicare or the Medicare HMO and to
write off the balance of its charges. Prior to the
implementation of the Final Rule, ambulance providers were not
required to accept assignment and could obtain payment from
Medicare patients or Medicare HMOs for the providers full
charges, which typically are higher than the Medicare rate. When
the requirement to accept assignment became effective on
April 1, 2002, many Medicare HMOs continued to pay
ambulance providers their full charges, even though they could
have paid them the Medicare rate. Many Medicare HMOs
subsequently have taken the position that the amount paid to
such providers in excess of the Medicare rate constituted an
overpayment that must be refunded by the provider. We have
received such refund demands from some Medicare HMOs and, in
order to minimize litigation costs, have agreed to partial
repayment of amounts received from the plans in excess of the
Medicare rate. We have no reason to believe that additional HMOs
will make such demands, but we cannot assure you that there will
be no further demands.
The SNF Prospective Payment System. Under the Medicare
prospective payment system, or PPS, applicable to skilled
nursing facilities, or SNFs, SNFs are financially responsible
for some ancillary services, including certain ambulance
transports, or PPS transports, rendered to certain of their
Medicare patients. Ambulance companies must bill the SNF, rather
than Medicare, for PPS transports, but may bill Medicare for
other covered transports provided to the SNFs Medicare
patients. Ambulance companies are responsible for obtaining
sufficient information from the SNF to determine which
transports are PPS transports and which ones may be billed to
Medicare. The Office of Inspector General of the Department of
Health and Human Services, or the OIG, has issued two
industry-wide audit reports indicating that, in many cases, SNFs
do not provide, or ambulance companies and other ancillary
service providers do not obtain, sufficient information to make
this determination accurately. As a result, the OIG asserts that
some PPS transports that should have been billed by ambulance
providers to SNFs have been improperly billed to Medicare. The
OIG has recommended that Medicare recoup the amounts paid to
ancillary service providers, including ambulance companies, for
such services. Although we believe AMR currently has procedures
in place to correctly identify and bill for PPS transports, we
cannot assure you that AMR will not be subject to such
recoupments and other possible penalties.
Paramedic Intercepts. Medicare regulations permit
ambulance transport providers to subcontract with other
organizations for paramedic services. Generally, only the
transport provider may bill Medicare, and the
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paramedic services subcontractor must receive any payment to
which it is entitled from that provider. Based on these rules,
in some jurisdictions we have established paramedic
intercept arrangements in which we may provide paramedic
services to a municipal or volunteer transport provider. Our
subsidiary, AMR of South Dakota, previously entered into a
settlement agreement with the United States government arising
from allegations that we improperly billed Medicare for a small
number of transports for which we performed paramedic intercept
services, even though we were not the transport provider.
Although we believe AMR currently has procedures in place to
assure that we do not bill Medicare for paramedic intercept
services we provide, we cannot assure you that enforcement
agencies will not find that we have failed to comply with these
requirements.
Patient Signatures. Medicare regulations require that
providers obtain the signature of the patient or, if the patient
is unable to provide a signature, the signature of a
representative, prior to submitting a claim for payment from
Medicare. An exception exists for situations where it is not
reasonably possible to do so, provided that the reason for the
exception is clearly documented. This requirement historically
has been difficult for ambulance companies and other emergency
medical services providers to meet, because even when the
patient is competent, the exigency of the situation often makes
it impracticable to obtain a signature. Although we believe AMR
currently has procedures in place to assure that these signature
requirements are met, we cannot assure you that enforcement
agencies will not find that we have failed to comply with these
requirements.
Physician Certification Statements. Under applicable
Medicare rules, ambulance providers are required to obtain a
certification of medical necessity from the ordering physician
in order to bill Medicare for repetitive non-emergency
transports provided to patients with chronic conditions, such as
end-stage renal disease. For certain other non-emergency
transports, ambulance providers are required to attempt to
obtain a certification of medical necessity from a physician or
certain other practitioners. In the event the provider is not
able to obtain such certification within 21 days, it may
submit a claim for the transport if it can document reasonable
attempts to obtain the certification. Acceptable documentation
includes any U.S. postal document (e.g., signed
return receipt or Postal Service Proof of Service Form) showing
that the ordering practitioner was sent a request for the
certification. Although we believe AMR currently has procedures
in place to assure we are in compliance with these requirements,
we cannot assure you that enforcement agencies will not find
that we have failed to comply.
Coordination of Benefits Rules. When our services are
covered by multiple third party payors, such as a primary and a
secondary payor, financial responsibility must be allocated
among the multiple payors in a process known as
coordination of benefits, or COB. The rules
governing COB are complex, particularly when one of the payors
is Medicare or another government program. Under these rules, in
some cases Medicare or other government payors can be billed as
a secondary payor only after recourse to a primary
payor (e.g., a liability insurer) has been exhausted. In
some instances, multiple payors may reimburse us an amount
which, in the aggregate, exceeds the amount to which we are
entitled. In such cases, we are obligated to process a refund.
If we improperly bill Medicare or other government payors as the
primary payor when that program should be billed as the
secondary payor, or if we fail to process a refund when
required, we may be subject to civil or criminal penalties.
Although we believe we currently have procedures in place to
assure that we comply with applicable COB rules, and that we
process refunds when we receive overpayments, we cannot assure
you that payors or enforcement agencies will not find that we
have violated these requirements.
Consequences of Noncompliance. In the event any of our
billing and collection practices, including but not limited to
those described above, violate applicable laws such as those
described below, we could be subject to refund demands and
recoupments. If our violations are deemed to be willful, knowing
or reckless, we may be subject to civil and criminal penalties
under the False Claims Act or other statutes, including
exclusion from federal and state healthcare programs. To the
extent that the complexity associated with billing for our
services causes delays in our cash collections, we assume the
financial risk of increased carrying costs associated with the
aging of our accounts receivable as well as increased potential
for bad debts which could have a material adverse effect on our
revenue, provision for uncompensated care and cash flow.
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Federal False Claims Act
Both federal and state government agencies have continued civil
and criminal enforcement efforts as part of numerous ongoing
investigations of healthcare companies, and their executives and
managers. Although there are a number of civil and criminal
statutes that can be applied to healthcare providers, a
significant number of these investigations involve the federal
False Claims Act. These investigations can be initiated not only
by the government but also by a private party asserting direct
knowledge of fraud. These qui tam whistleblower
lawsuits may be initiated against any person or entity alleging
such person or entity has knowingly or recklessly presented, or
caused to be presented, a false or fraudulent request for
payment from the federal government, or has made a false
statement or used a false record to get a claim approved.
Penalties for False Claims Act violations include fines ranging
from $5,500 to $11,000 for each false claim, plus up to three
times the amount of damages sustained by the federal government.
A False Claims Act violation may provide the basis for exclusion
from the federally-funded healthcare programs. In addition, some
states have adopted similar insurance fraud, whistleblower and
false claims provisions.
The government and some courts have taken the position that
claims presented in violation of the various statutes, including
the federal Anti-Kickback Statute and the Stark Law, described
below, can be considered a violation of the federal False Claims
Act based on the contention that a provider impliedly certifies
compliance with all applicable laws, regulations and other rules
when submitting claims for reimbursement.
Federal Anti-Kickback Statute
We are subject to the federal Anti-Kickback Statute. The
Anti-Kickback Statute is broadly worded and prohibits the
knowing and willful offer, payment, solicitation or receipt of
any form of remuneration in return for, or to induce,
(1) the referral of a person covered by Medicare, Medicaid
or other governmental programs, (2) the furnishing or
arranging for the furnishing of items or services reimbursable
under Medicare, Medicaid or other governmental programs or
(3) the purchasing, leasing or ordering or arranging or
recommending purchasing, leasing or ordering of any item or
service reimbursable under Medicare, Medicaid or other
governmental programs. Certain federal courts have held that the
Anti-Kickback Statute can be violated if one purpose
of a payment is to induce referrals. Violations of the
Anti-Kickback Statute can result in exclusion from Medicare,
Medicaid or other governmental programs as well as civil and
criminal penalties, including fines of up to $50,000 per
violation and three times the amount of the unlawful
remuneration. Imposition of any of these remedies could have a
material adverse effect on our business, financial condition and
results of operations.
In addition to a few statutory exceptions, the OIG has published
safe harbor regulations that outline categories of activities
that are deemed protected from prosecution under the
Anti-Kickback Statute provided all applicable criteria are met.
The failure of a financial relationship to meet all of the
applicable safe harbor criteria does not necessarily mean that
the particular arrangement violates the Anti-Kickback Statute.
In order to obtain additional clarification on arrangements that
may not be subject to a statutory exception or may not satisfy
the criteria of a safe harbor, Congress established a process
under the Health Insurance Portability and Accountability Act of
1996 in which parties can seek an advisory opinion from the OIG.
We and others in the healthcare community have taken advantage
of the advisory opinion process, and a number of advisory
opinions have addressed issues that pertain to our various
operations, such as discounted ambulance services being provided
to skilled nursing facilities, patient co-payment
responsibilities, compensation methodologies under a management
services arrangement, and ambulance restocking arrangements. In
a number of these advisory opinions the government concluded
that such arrangements could be problematic if the requisite
intent were present. Although advisory opinions are binding only
on HHS and the requesting party or parties, when new advisory
opinions are issued, regardless of the requestor, we review them
and their application to our operations as part of our ongoing
corporate compliance program and endeavor to make appropriate
changes where we perceive the need to do so. See
Corporate Compliance Program and Corporate
Integrity Obligations.
Health facilities such as hospitals and nursing homes refer two
categories of ambulance transports to us and other ambulance
companies: (1) transports for which the facility must pay
the ambulance company, and
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(2) transports which the ambulance company can bill
directly to Medicare or other public or private payors. In
Advisory Opinion 99-2, which we requested, the OIG addressed the
issue of whether substantial contractual discounts provided to
nursing homes on the transports for which the nursing homes are
financially responsible may violate the Anti-Kickback Statute
when the ambulance company also receives referrals of Medicare
and other government-funded transports. The OIG opined that such
discounts implicate the Anti-Kickback Statute if even one
purpose of the discounts is to induce the referral of the
transports paid for by Medicare and other federal programs. The
OIG further indicated that a violation may exist even if there
is no contractual obligation on the part of the facility to
refer federally funded patients, and even if similar discounts
are provided by other ambulance companies in the same
marketplace. Following our receipt of this Advisory Opinion in
March of 1999, we took steps to bring our contracts with health
facilities into compliance with the OIGs views. However,
the government has alleged that certain of our contracts in
effect in Texas, principally in periods prior to the issuance of
the Advisory Opinion, and possibly through 2001, violated the
Anti-Kickback Statute. Our contracting practices in Oregon and
possibly other jurisdictions may also be under investigation.
See American Medical
Response Legal Matters. We cannot assure
you that the OIG or other authorities will not find that our
discounting practices in such other jurisdictions, or for other
periods of time, violate the Anti-Kickback Statute.
The OIG has also addressed potential violations of the
Anti-Kickback Statute (as well as other risk areas) in its
Compliance Program Guidance for Ambulance Suppliers. In addition
to discount arrangements with health facilities, the OIG notes
that arrangements between local governmental agencies that
control 911 patient referrals and ambulance companies which
receive such referrals may violate the Anti-Kickback Statute if
the ambulance companies provide inappropriate remuneration in
exchange for such referrals. Although we believe we have
structured our arrangements with local agencies in a manner
which complies with the Anti-Kickback Statute, we cannot assure
you that enforcement agencies will not find that some of those
arrangements violate that statute.
Fee-Splitting; Corporate Practice of Medicine
EmCare employs or contracts with physicians or physician-owned
professional corporations to deliver services to our hospital
customers and their patients. We frequently enter into
management services contracts with these physicians and
professional corporations pursuant to which we provide them with
billing, scheduling and a wide range of other services, and they
pay us for those services out of the fees they collect from
patients and third-party payors. These activities are subject to
various state laws that prohibit the practice of medicine by
corporations and are intended to prevent unlicensed persons from
interfering with or influencing the physicians
professional judgment and the sharing of professional services
income with non-professional or business interests. Activities
other than those directly related to the delivery of healthcare
may be considered an element of the practice of medicine in many
states. Under the corporate practice of medicine restrictions of
certain states, decisions and activities such as scheduling,
contracting, setting rates and the hiring and management of
non-clinical personnel may implicate the restrictions on
corporate practice of medicine. In such states, we maintain
long-term management contracts with affiliated physician groups,
which employ or contract with physicians to provide physician
services. We believe that we are in material compliance with
applicable state laws relating to the corporate practice of
medicine and fee-splitting. However, regulatory authorities or
other parties, including our affiliated physicians, may assert
that, despite these arrangements, we are engaged in the
corporate practice of medicine or that our contractual
arrangements with affiliated physician groups constitute
unlawful fee-splitting. In this event, we could be subject to
adverse judicial or administrative interpretations, to civil or
criminal penalties, our contracts could be found legally invalid
and unenforceable or we could be required to restructure our
contractual arrangements with our affiliated physician groups.
Federal Stark Law
We are also subject to a provision of the Social Security Act,
commonly known as the Stark Law. Where applicable,
this law prohibits a physician from referring Medicare patients
to an entity providing
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designated health services if the physician or a
member of such physicians immediate family has a
financial relationship with the entity, unless an
exception applies. The penalties for violating the Stark Law
include the denial of payment for services ordered in violation
of the statute, mandatory refunds of any sums paid for such
services and civil penalties of up to $15,000 for each
violation, and twice the dollar value of each such service and
possible exclusion from future participation in the
federally-funded healthcare programs. A person who engages in a
scheme to circumvent the Stark Laws prohibitions may be
fined up to $100,000 for each applicable arrangement or scheme.
Although we believe that we have structured our agreements with
physicians so as to not violate the Stark Law and related
regulations, a determination of liability under the Stark Law
could have an adverse effect on our business, financial
condition and results of operations.
Other Federal Healthcare Fraud and Abuse Laws
We are also subject to other federal healthcare fraud and abuse
laws. Under the Health Insurance Portability and Accountability
Act of 1996, there are two additional federal crimes that could
have an impact on our business: Healthcare Fraud and
False Statements Relating to Healthcare Matters. The
Healthcare Fraud statute prohibits knowingly and recklessly
executing a scheme or artifice to defraud any healthcare benefit
program, including private payors. A violation of this statute
is a felony and may result in fines, imprisonment and/or
exclusion from government-sponsored programs. The False
Statements Relating to Healthcare Matters statute prohibits
knowingly and willfully falsifying, concealing or covering up a
material fact by any trick, scheme or device or making any
materially false, fictitious or fraudulent statement in
connection with the delivery of or payment for healthcare
benefits, items or services. A violation of this statute is a
felony and may result in fines and/or imprisonment. This statute
could be used by the government to assert criminal liability if
a healthcare provider knowingly fails to refund an overpayment.
Another statute, commonly referred to as the Civil Monetary
Penalties Law, imposes civil administrative sanctions for, among
other violations, inappropriate billing of services to federally
funded healthcare programs, inappropriately reducing hospital
care lengths of stay for such patients, and employing or
contracting with individuals or entities who are excluded from
participation in federally funded healthcare programs.
Although we intend and endeavor to conduct our business in
compliance with all applicable fraud and abuse laws, we cannot
assure you that our arrangements or business practices will not
be subject to government scrutiny or be found to violate
applicable fraud and abuse laws.
Administrative Simplification Provisions of the Health
Insurance Portability and Accountability Act of 1996
The Administrative Simplification Provisions of the Health
Insurance Portability and Accountability Act of 1996, or HIPAA,
required the Department of Health and Human Services, or HHS, to
adopt standards to protect the privacy and security of
health-related information. All healthcare providers were
required to be compliant with the new federal privacy
requirements enacted by HHS no later than April 14, 2003.
We believe we have taken reasonable measures to comply with
these requirements.
The HIPAA privacy requirements contain detailed requirements
regarding the use and disclosure of individually identifiable
health information. Improper use or disclosure of identifiable
health information covered by the HIPAA privacy regulations can
result in the following civil and criminal penalties:
(1) civil money penalties for HIPAA privacy violations are
$100 per incident, to a maximum of $25,000, per person, per
year, per standard violated; (2) a person who knowingly and
in violation of the HIPAA privacy regulations obtains
individually identifiable health information or discloses such
information to another person may be fined up to $50,000 and
imprisoned up to one year, or both; (3) if the offense is
committed under false pretenses, the fine may be up to $100,000
and imprisonment for up to five years; and (4) if the
offense is done with the intent to sell, transfer or use
individually identifiable health information for commercial
advantage, personal gain or malicious harm, the fine may be up
to $250,000 and imprisonment for up to ten years.
105
In addition to enacting the foregoing privacy requirements, HHS
issued a final rule creating security requirements for
healthcare providers and other covered entities on
February 20, 2003. The final security rule requires covered
entities to meet specified standards by April 25, 2005. The
security standards contained in the final rule do not require
the use of specific technologies (e.g., no specific
hardware or software is required), but instead require
healthcare providers and other covered entities to comply with
certain minimum security procedures in order to protect data
integrity, confidentiality and availability. We believe we have
taken reasonable steps to comply with these standards.
HIPAA also required HHS to adopt national standards establishing
electronic transaction standards that all healthcare providers
must use when submitting or receiving certain healthcare
transactions electronically. Although these standards were to
become effective October 2002, Congress extended the compliance
deadline until October 2003 for organizations, such as ours,
that submitted a request for an extension. We believe we have
taken reasonable steps to comply with these standards.
Fair Debt Collection Practices Act
Some of our operations may be subject to compliance with certain
provisions of the Fair Debt Collection Practices Act and
comparable statutes in many states. Under the Fair Debt
Collection Practices Act, a third party collection company is
restricted in the methods it uses to contact consumer debtors
and elicit payments with respect to placed accounts.
Requirements under state collection agency statutes vary, with
most requiring compliance similar to that required under the
Fair Debt Collection Practices Act. We believe we are in
substantial compliance with the Fair Debt Collection Practices
Act and comparable state statutes where applicable.
State Fraud and Abuse Provisions
We are subject to state fraud and abuse statutes and
regulations. Most of the states in which we operate have adopted
a form of anti-kickback law, almost all of those states also
have adopted self-referral laws and some have adopted separate
false claims or insurance fraud provisions. The scope of these
laws and the interpretations of them vary from state to state
and are enforced by state courts and regulatory authorities,
each with broad discretion. Generally, state laws cover all
healthcare services and not just those covered under a
federally-funded healthcare program. A determination of
liability under such laws could result in fines and penalties
and restrictions on our ability to operate in these
jurisdictions.
Although we intend and endeavor to conduct our business in
compliance with all applicable fraud and abuse laws, we cannot
assure you that our arrangements or business practices will not
be subject to government scrutiny or be found to violate
applicable fraud and abuse laws.
Licensing, Certification, Accreditation and Related Laws and
Guidelines
In certain jurisdictions, changes in our ownership structure
require pre-or post-notification to governmental licensing and
certification agencies. Relevant laws and regulations may also
require re-application and approval to maintain or renew our
operating authorities or require formal application and approval
to continue providing services under certain government
contracts. For example, in connection with our acquisition of
AMR from Laidlaw, two of our subsidiaries were required to apply
for state and local ambulance operating authority in New York.
See Risk Factors Risk Factors Related to
Healthcare Regulation Changes in our ownership
structure and operations require us to comply with numerous
notification and reapplication requirements in order to maintain
our licensure, certification or other authority to operate, and
failure to do so, or an allegation that we have failed to do so,
can result in payment delays, forfeiture of payment or civil and
criminal penalties.
We and our affiliated physicians are subject to various federal,
state and local licensing and certification laws and regulations
and accreditation standards and other laws, relating to, among
other things, the adequacy of medical care, equipment, personnel
and operating policies and procedures. We are also subject to
periodic inspection by governmental and other authorities to
assure continued compliance with the various standards
106
necessary for licensing and accreditations. Failure to comply
with these laws and regulations could result in our services
being found to be non-reimbursable or prior payments being
subject to recoupment, and can give rise to civil or criminal
penalties. We are pursuing steps we believe we must take to
retain or obtain all requisite licensure and operating
authorities. While we have made reasonable efforts to
substantially comply with federal, state and local licensing and
certification laws and regulations and standards as we interpret
them, we cannot assure you that agencies that administer these
programs will not find that we have failed to comply in some
material respects.
Because we perform services at hospitals and other types of
healthcare facilities, we and our affiliated physicians may also
be subject to laws which are applicable to those entities. For
example, our operations are impacted by the Emergency Medical
Treatment and Active Labor Act of 1986, which prohibits
patient dumping by requiring hospitals and hospital
emergency departments and others to assess and stabilize any
patient presenting to the hospitals emergency department
or urgent care center requesting care for an emergency medical
condition, regardless of the patients ability to pay. Many
states in which we operate have similar state law provisions
concerning patient dumping. Violations of the Emergency Medical
Treatment and Active Labor Act of 1986 can result in civil
penalties and exclusion of the offending physician from the
Medicare and Medicaid programs.
In addition to the Emergency Medical Treatment and Active Labor
Act of 1986 and its state law equivalents, significant aspects
of our operations are affected by state and federal statutes and
regulations governing workplace health and safety, dispensing of
controlled substances and the disposal of medical waste. Changes
in ethical guidelines and operating standards of professional
and trade associations and private accreditation commissions
such as the American Medical Association and the Joint
Commission on Accreditation of Healthcare Organizations may also
affect our operations. We believe our operations as currently
conducted are in substantial compliance with these laws and
guidelines.
EmCares professional liability insurance program, under
which insurance is provided for most of our affiliated medical
professionals and professional and corporate entities, is
reinsured through our wholly-owned subsidiary, EMCA Insurance
Company, Ltd. The activities associated with the business of
insurance, and the companies involved in such activities, are
closely regulated. Failure to comply with applicable laws and
regulations can result in civil and criminal fines and penalties
and loss of licensure. While we have made reasonable efforts to
substantially comply with these laws and regulations, and
utilize licensed insurance professionals where necessary and
appropriate, we cannot assure you that we will not be found to
have violated these laws and regulations in some material
respects.
Antitrust Laws
Antitrust laws such as the Sherman Act and state counterparts
prohibit anticompetitive conduct by separate competitors, such
as price fixing or the division of markets. Our physician
contracts include contracts with individual physicians and with
physicians organized as separate legal professional entities
(e.g., professional medical corporations). Antitrust laws
may deem each such physician/entity to be separate, both from
EmCare and from each other and, accordingly, each such
physician/practice is subject to antitrust laws that prohibit
anti-competitive conduct between or among separate legal
entities or individuals. Although we believe we have structured
our physician contracts to substantially comply with these laws,
we cannot assure you that antitrust regulatory agencies or a
court would not find us to be non-compliant.
Corporate Compliance Program and Corporate Integrity
Obligations
We have developed a corporate compliance program in an effort to
monitor compliance with federal and state laws and regulations
applicable to healthcare entities, to ensure that we maintain
high standards of conduct in the operation of our business and
to implement policies and procedures so that employees act in
compliance with all applicable laws, regulations and company
policies. Our program also attempts to monitor compliance with
our Corporate Compliance Plan, which details our standards for:
(1) business ethics, (2) compliance with applicable
federal, state and local laws, and (3) business conduct. We
have an Ethics and
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Compliance Department whose focus is to prevent, detect and
mitigate regulatory risks. We attempt to accomplish this mission
through:
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providing guidance, education and proper controls based on the
regulatory risks associated with our business model and
strategic plan, |
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conducting internal audits and reviews to identify any improper
practices that may be occurring, |
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resolving regulatory matters, and |
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enhancing the ethical culture and leadership of the organization. |
The OIG has issued a series of Compliance Program Guidance
documents in which the OIG has set out the elements of an
effective compliance program. We believe our compliance program
has been structured appropriately in light of this guidance. The
primary compliance program components recommended by the OIG,
all of which we have attempted to implement, include:
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formal policies and written procedures, |
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designation of a Compliance Officer, |
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education and training programs, |
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internal monitoring and reviews, |
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responding appropriately to detected misconduct, |
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open lines of communication, and |
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discipline and accountability. |
Our corporate compliance program is based on the overall goal of
promoting a culture that encourages employees to conduct
activities with integrity, dignity and care for those we serve,
and in compliance with all applicable laws and policies.
Notwithstanding the foregoing, we audit compliance with our
compliance program on a sample basis. Although such an approach
reflects a reasonable and accepted approach in the industry, we
cannot assure you that our program will detect and rectify all
compliance issues in all markets and for all time periods.
As do other healthcare companies which operate effective
compliance programs, from time to time we identify practices
that may have resulted in Medicare or Medicaid overpayments or
other regulatory issues. For example, we have previously
identified situations in which we may have inadvertently
utilized incorrect billing codes for some of the services we
have billed to government programs such as Medicare or Medicaid.
In such cases, it is our practice to disclose the issue to the
affected government programs and, if appropriate, to refund any
resulting overpayments. The government usually accepts such
disclosures and repayments without taking further enforcement
action, and we generally expect that to be the case with respect
to our past and future disclosures and repayments. However, it
is possible that such disclosures or repayments will result in
allegations by the government that we have violated the False
Claims Act or other laws, leading to investigations and possibly
civil or criminal enforcement actions.
When the United States government settles a case involving
allegations of billing misconduct with a healthcare provider, it
typically requires the provider to enter into a Corporate
Integrity Agreement, or CIA, with the OIG. As a condition to
settlement of two government investigations, certain of our
operations are subject to CIAs with the OIG. As part of these
CIAs, AMR was required to establish and maintain a compliance
program that includes the following elements: (1) a
compliance officer and committee, (2) written standards
including a code of conduct and policies and procedures,
(3) general and specific training and education,
(4) claims review by an independent review organization,
(5) disclosure program for reporting of compliance issues
or questions, (6) screening and removal processes for
ineligible persons, (7) notification of
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government investigations or legal proceedings and
(8) reporting of overpayments and other reportable
events.
If we fail or if we are accused of failing to comply with the
terms of the settlements, we may be subject to additional
litigation or other government actions, including being excluded
from participating in the Medicare program and other federal
healthcare programs.
See Risk Factors Risk Factors Related to
Healthcare Regulation for additional information related
to regulatory matters.
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MANAGEMENT
Directors, Executive Officers and Key Employees
The following table sets forth information regarding our
directors and executive officers.
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Name |
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Age | |
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Position* |
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William A. Sanger
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55 |
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Director, Chairman and Chief Executive Officer |
Don S. Harvey
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48 |
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Director, President and Chief Operating Officer |
Randel G. Owen
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46 |
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Chief Financial Officer |
Dighton C. Packard, M.D.
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57 |
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Chief Medical Officer |
Todd G. Zimmerman
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40 |
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General Counsel |
Robert M. Le Blanc
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39 |
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Lead Director |
Steven B. Epstein
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62 |
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Director |
James T. Kelly
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59 |
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Director |
Michael L. Smith
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57 |
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Director |
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* |
Unless otherwise noted, the positions identified are the
positions held with the general partner of Emergency Medical
Services L.P. prior to this offering and with Emergency Medical
Services Corporation following this offering. |
William A. Sanger has been a director, chairman and Chief
Executive Officer of Emergency Medical Services Corporation
since February 10, 2005. Mr. Sanger was appointed
President of EmCare in 2001 and Chief Executive Officer of AMR
and EmCare in June 2002. Mr. Sanger is a co-founder of
BIDON Companies where he has been a Managing Partner since 1999.
Mr. Sanger served as President and Chief Executive Officer
of Cancer Treatment Centers of America, Inc. from 1997 to 2001.
From 1994 to 1997, Mr. Sanger was co-founder and Executive
Vice President of PhyMatrix Corp., then a publicly traded
diversified health services company. In addition,
Mr. Sanger was president and chief executive officer of
various other healthcare entities, including JFK Health Care
System. Mr. Sanger has an MBA from the Kellogg School of
Management at Northwestern University. Mr. Sanger has been
a leader in the healthcare industry for more than three decades.
Don S. Harvey has been President and Chief Operating
Officer of Emergency Medical Services Corporation since
February 10, 2005, and was elected a director of Emergency
Medical Services Corporation in July 2005. Mr. Harvey
joined EmCare as an executive officer in 2001 and was appointed
President in June 2002. Mr. Harvey is a co-founder of BIDON
Companies where he has been a Managing Partner since 1999. Prior
to that, he served as President of the Eastern Region of Cancer
Treatment Centers of America, Inc. from 1997 to 1999. Prior to
that, Mr. Harvey was an executive officer of PhyMatrix
Corp. and Executive Vice President of JFK Healthcare System.
Mr. Harvey is a director of several organizations,
including the emergency medicine industry trade association
EDPMA. Mr. Harvey has a Master of Science degree from Nova
Southeastern University. Mr. Harvey has more than
20 years of experience in healthcare services serving the
public, governmental and private markets.
Randel G. Owen has been Chief Financial Officer of
Emergency Medical Services Corporation since February 10,
2005. Mr. Owen was appointed Executive Vice President and
Chief Financial Officer of AMR in March 2003. He joined EmCare
in July 1999 and served as Executive Vice President and Chief
Financial Officer from June 2001 to March 2003. Before joining
EmCare, Mr. Owen was Vice President of Group Financial
Operations for PhyCor, Inc. in Nashville, Tennessee from 1995 to
1999. Mr. Owen has more than 20 years of financial
experience in the health care industry. Mr. Owen received
an accounting degree from Abilene Christian University.
Dighton C. Packard, M.D. has been Chief Medical
Officer of EmCare since 1990 and became Chief Medical Officer of
Emergency Medical Services Corporation in April 2005.
Dr. Packard is also the Chairman of the Department of
Emergency Medicine at Baylor University Medical Center in
Dallas, Texas and a member of the Board of Trustees for Baylor
University Medical Center and for Baylor Heart and Vascular
110
Hospital. Dr. Packard has practiced emergency medicine for
more than 25 years. He received his BS from Baylor
University at Waco and his MD from the University of Texas
Medical School at San Antonio.
Todd G. Zimmerman has been General Counsel of Emergency
Medical Services Corporation since February 10, 2005.
Mr. Zimmerman was appointed General Counsel and Executive
Vice President of EmCare in July 2002 and of AMR in May 2004.
Mr. Zimmerman joined EmCare in October 1997 in connection
with EmCares acquisition of Spectrum Emergency Care, Inc.
where he served as Corporate Counsel. Prior to joining Spectrum
in 1997, Mr. Zimmerman worked in the private practice of
law for seven years, providing legal advice and support to
various large corporations. Mr. Zimmerman received his BS
in Business Administration from St. Louis University and
his J.D. from the University of Virginia School of Law.
Robert M. Le Blanc has served as Managing Director of
Onex Investment Corp., an affiliate of Onex Corporation, a
diversified industrial corporation, since 1999. Prior to joining
Onex in 1999, he was with Berkshire Hathaway for seven years.
From 1988 to 1992, Mr. Le Blanc held numerous positions
with GE Capital, with responsibility for corporate finance and
corporate strategy. Mr. Le Blanc serves as a Director of
Magellan Health Services, Inc., Res-Care, Inc., Center for
Diagnostic Imaging, Inc. and First Berkshire Hathaway Life.
Mr. Le Blanc became a director of Emergency Medical
Services Corporation in December 2004.
Steven B. Epstein became a director of Emergency Medical
Services Corporation in July 2005. Mr. Epstein is the
founder and senior healthcare partner of the law firm of Epstein
Becker & Green, P.C. Epstein Becker &
Green, P.C. generally is recognized as one of the
countrys leading healthcare law firms. Mr. Epstein
serves as a legal advisor to healthcare entities throughout the
U.S. Mr. Epstein received his B.A. from Tufts
University, where he serves on the Board of Trustees and the
Executive Committee, and his J.D. from Columbia Law School,
where he serves as Chairman of the Law Schools Board of
Visitors. In addition, Mr. Epstein serves as a director of
many healthcare companies and venture capital and private equity
firms, including HealthExtras, Inc. (a pharmacy benefit company).
James T. Kelly became a director of Emergency Medical
Services Corporation in July 2005. From 1986 to 1996,
Mr. Kelly served as President and Chief Executive Officer
of Lincare Holding Inc., and he served as Chairman of the Board
of Lincare from 1994 to 2000. Lincare is a publicly traded
company that provides respiratory care, infusion therapy and
medical equipment to patients in the home. Prior to joining
Lincare, Mr. Kelly was with Union Carbide Corporation for
19 years, where he served in various management positions.
Mr. Kelly also serves as a director of American Dental
Partners, Inc. (a provider of dental management services) and
HMS Holdings Corp. (a provider of consulting and business office
outsourcing and reimbursement services to healthcare providers).
Michael L. Smith became a director of Emergency Medical
Services Corporation in July 2005. Mr. Smith served as
Executive Vice President and Chief Financial and Accounting
Officer of Anthem, Inc. and its subsidiaries, Anthem Blue Cross
and Blue Shield, from 2001 until his retirement in January 2005.
Mr. Smith was Executive Vice President and Chief Financial
Officer of Anthem Insurance from 1999, and from 1996 to 1998 he
served as Chief Operating Officer and Chief Financial Officer of
American Health Network Inc., then a subsidiary of Anthem.
Mr. Smith was Chairman, President and Chief Executive
Officer of Mayflower Group, Inc. (a transportation company) from
1989 to 1995, and held various other management positions with
that company from 1974 to 1989. Mr. Smith also serves as a
director of First Indiana Corporation and its principal
subsidiary, First Indiana Bank, Finishmaster, Inc. (auto paint
distribution), InterMune, Inc. (a biopharmaceutical company) and
Kite Realty Group Trust (a retail property REIT). Mr. Smith
also serves as a member of the Board of Trustees of DePauw
University, a Trustee of the Indianapolis Museum of Art and a
Trustee of the Michigan Maritime Museum.
Key Employees
Steve Murphy has been appointed Senior Vice President of
Government and National Services for Emergency Medical Services
Corporation effective December 1, 2005. He has served in
that role with AMR since 2003. Prior to joining AMR in 1989,
Mr. Murphy was National Vice President of Government
Relations for CareLine Inc. and MedTrans, Inc., President and
Chief Operating Officer of Pruner Health Services, Inc. and
Chief Administrative Officer for Pruners Napa Ambulance
Service, Inc. Mr. Murphy has
111
been active in emergency medical services and the ambulance
industry for more than 30 years. He holds a Registered
Nursing Degree and has been certified as a Certified Emergency
Nurse and Mobile Intensive Care Nurse.
Kimberly Norman has been appointed Senior Vice President
of Human Resources of Emergency Medical Services Corporation
effective December 1, 2005. Ms. Norman joined
MedTrans, Inc. in June 1991 and joined AMR in 1997, when it
merged with MedTrans. She has held various human resource
positions for AMR, including Benefits Specialist, Manager of
Human Resources and Employee Development, and Regional and
National Vice President of Human Resources. Ms. Norman
received her B.B.M. from the University of Phoenix and a Human
Resource Management Certification from San Diego State
University.
Steve Ratton, Jr. has been Treasurer of Emergency
Medical Services Corporation since February 2005 and has been
appointed Senior Vice President effective December 1, 2005.
Mr. Ratton joined EmCare in April 2003 as Executive Vice
President and Chief Financial Officer. Prior to joining EmCare,
Mr. Ratton served as Treasurer for Radiologix, Inc. from
September 2001 to April 2003. Mr. Ratton was Vice President
of Finance for Matrix Rehabilitation, Inc. from August 2000 to
September 2001, and Director of Finance for PhyCor, Inc. from
April 1998 to August 2000. Mr. Ratton has more than
20 years of experience in the healthcare industry, in both
hospital and physician settings. Mr. Ratton has an
accounting degree from the University of Texas at El Paso.
William Tara has been appointed Senior Vice President and
Chief Information Officer of Emergency Medical Services
Corporation effective December 1, 2005. Mr. Tara
joined AMR as Chief Information Officer in February 2003. Before
joining AMR, Mr. Tara was Vice President and Chief
Information Officer for Teletech Holdings, Inc. from 1999 to
February 2003, responsible for global technology, including
software development, professional services and technology
operations in 13 countries supporting 30,000 employees.
Mr. Tara received his B.S. from the University of
California and a Masters Degree in Business from Cornell
University.
Joseph Taylor has been appointed Executive Vice President
of National Sales and Marketing of Emergency Medical Services
Corporation effective December 1, 2005. Mr. Taylor was
appointed Executive Vice President, National Sales and Marketing
of EmCare in 1997 and President of EmCare Physician Services in
2002. Prior to joining EmCare, Mr. Taylor served as
Executive Vice President for Spectrum Emergency Care, Inc.,
until the company was acquired by EmCare in October 1997.
Mr. Taylor has been in senior healthcare management and
emergency medicine operations for 13 years. Mr. Taylor
previously served as Regional Vice President and Vice President
Worldwide marketing for Unisys, a worldwide information systems
company. Mr. Taylor graduated cum laude with a B.S. in
Business Administration from the University of West Florida and
completed the Executive Corporate Management Program of the
Wharton School of Finance.
Except as described in this prospectus, there are no
arrangements or understandings between any member of the board
of directors or executive officer or any key employee and any
other person pursuant to which that person was elected or
appointed to his or her position.
Our board of directors has the power to appoint our executive
officers. Each executive officer will hold office for the term
determined by the board of directors and until such
persons successor is chosen or until such persons
death, resignation or removal.
Mr. Le Blanc is serving as our Lead Director. In that role,
his primary responsibility is to preside over periodic executive
sessions of our board of directors in which management directors
and other members of management do not participate, and he has
the authority to call meetings of the non-management directors.
The Lead Director also chairs certain portions of board
meetings, serves as liaison between the Chairman of the Board
and the non-management directors, and develops, together with
the Chairman, the agenda for board meetings. The Lead Director
will also perform other duties the board delegates from time to
time to assist the board in fulfilling its responsibilities.
There are no family relationships among any of our directors and
executive officers.
112
Composition of the Board of Directors after this Offering
Our certificate of incorporation, as in effect upon completion
of this offering, will provide for a classified board of
directors consisting of three staggered classes of directors, as
nearly equal in number as possible. At each annual meeting of
stockholders, a class of directors will be elected for a
three-year term to succeed the directors of the same class whose
terms are then expiring. The terms of the directors will expire
upon election and qualification of successor directors at the
annual meeting of stockholders to be held during the years 2006
for the Class I directors, 2007 for the Class II
directors and 2008 for the Class III directors.
Effective upon the closing of this offering, our board of
directors will consist of six members, classified as follows:
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our Class I directors will be Messrs. Le Blanc and
Sanger, |
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our Class II directors will be Messrs. Epstein and
Kelly, and |
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our Class III directors will be Messrs. Harvey and
Smith. |
Our by-laws, as in effect immediately prior to this offering,
will provide that the authorized number of directors, which will
be six at the time of this offering, may be changed by a
resolution adopted by at least a majority of our directors then
in office. Any additional directorships resulting from an
increase in the number of directors may only be filled by the
directors and will be distributed among the three classes so
that, as nearly as possible, each class will consist of
one-third of the directors. This classification of our board of
directors could have the effect of delaying or preventing
changes in control or changes in our management.
Following the consummation of this offering, we will be deemed
to be a controlled company under the rules of the
NYSE, and we will qualify for, and intend to rely upon, the
controlled company exception to the board of
directors and committee composition requirements under the rules
of the NYSE. Pursuant to this exception, we will be exempt from
the rules that would otherwise require that our board of
directors be comprised of a majority of independent
directors and that our executive compensation and
corporate governance and nominating committees be comprised
solely of independent directors, as defined under
the rules of the NYSE. The controlled company
exception does not modify the independence requirements for the
audit committee, and we intend to comply with the requirements
of the Sarbanes-Oxley Act of 2002 and the NYSE rules, which
require that our audit committee be comprised of independent
directors exclusively.
Upon the completion of this offering, our board will consist of
six directors, three of whom will qualify as
independent according to the rules and regulations
of the SEC and the New York Stock Exchange.
Committees of the Board of Directors
Prior to the completion of this offering, our board of directors
will have established an audit committee, a compensation
committee, a corporate governance and nominating committee and a
compliance committee. The composition, duties and
responsibilities of these committees are set forth below.
Committee members will hold office for a term of one year.
Audit Committee. The audit committee is responsible for
(1) selecting the independent auditor, (2) approving
the overall scope of the audit, (3) assisting the board of
directors in monitoring the integrity of our financial
statements, the independent accountants qualifications and
independence, the performance of the independent accountants and
our internal audit function and our compliance with legal and
regulatory requirements, (4) annually reviewing our
independent auditors report describing the auditing
firms internal quality-control procedures, and any
material issues raised by the most recent internal
quality-control review, or peer review, of the auditing firm,
(5) discussing the annual audited financial and quarterly
statements with management and the independent auditor,
(6) discussing earnings press releases, as well as
financial information and earnings guidance provided to analysts
and rating agencies, (7) discussing policies with respect
to risk assessment and risk management, (8) meeting
separately, periodically, with management, internal auditors and
the independent auditor, (9) reviewing with the independent
auditor any audit problems or difficulties and managements
response, (10) setting clear hiring policies for employees
or former employees of the independent auditors,
(11) handling such other matters that are specifically
delegated to the
113
audit committee by the board of directors from time to time and
(12) reporting regularly to the full board of directors.
Upon completion of this offering, our audit committee will
consist of Messrs. Epstein, Kelly and Smith, with
Mr. Smith serving as chairman of the committee. At our
first board meeting following this offering, our board of
directors will identify which of these persons is an audit
committee financial expert, as such term is defined in
Item 401(h) of Regulation S-K. Messrs. Kelly and
Smith have been determined to be independent. Although
Mr. Epstein has also been determined to be an independent
director under the NYSE rules, he is not independent
under the SEC rules applicable to our audit committee because we
recently engaged the law firm of which he is a partner to
perform legal services for us. Within one year of the date of
this prospectus, we will be required to appoint another director
who is independent under these SEC rules to replace
Mr. Epstein on the audit committee.
Compensation Committee. The compensation committee is
responsible for (1) reviewing key employee compensation
policies, plans and programs, (2) reviewing and approving
the compensation of our executive officers, (3) reviewing
and approving employment contracts and other similar
arrangements between us and our executive officers,
(4) reviewing and consulting with the chief executive
officer on the selection of officers and evaluation of executive
performance and other related matters, (5) administration
of stock plans and other incentive compensation plans and
(6) such other matters that are specifically delegated to
the compensation committee by the board of directors from time
to time.
Upon completion of this offering, our compensation committee
consists of Messrs. Kelly, Le Blanc and Smith, with
Mr. Kelly serving as chairman.
Corporate Governance and Nominating Committee. Our
corporate governance and nominating committees purpose
will be to assist our board of directors by identifying
individuals qualified to become members of our board consistent
with the criteria set by our board and to develop our corporate
governance principles. This committees responsibilities
will include: (1) evaluating the composition, size and
governance of our board of directors and its committees and
making recommendations regarding future planning and the
appointment of directors to our committees,
(2) establishing a policy for considering stockholder
nominees for election to our board of directors,
(3) recommending ways to enhance communications and
relations with our stockholders, (4) evaluating and
recommending candidates for election to our board of directors,
(5) overseeing our board of directors performance and
self-evaluation process and developing continuing education
programs for our directors, (6) reviewing our corporate
governance principles and providing recommendations to the board
of directors regarding possible changes, and (7) reviewing
and monitoring compliance with our code of ethics and our
insider trading policy.
Upon completion of this offering, all of our directors will be
members of our corporate governance and nominating committee.
Mr. Epstein will serve as chairman of the committee.
Compliance Committee. Our compliance committee is
responsible for overseeing our Corporate Compliance Program. The
committees responsibilities include oversight of our
processes for maintaining and monitoring compliance with federal
and state laws applicable to healthcare entities. The specific
functions overseen by the committee include our procedures for
(1) providing guidance and education to our workforce,
(2) performing compliance audits, (3) resolving
regulatory matters that come to our attention through our
compliance hotline, our audit activities or contacts from
government agencies and (4) enhancing the ethical culture
and leadership of our organization. Our compliance officers, who
supervise our Ethics and Compliance Department, will report
directly to the compliance committee and will meet with it on a
regular basis.
Upon completion of this offering, our compliance committee will
consist of Messrs. Epstein, Le Blanc and Smith, with Mr. Le
Blanc serving as chairman.
Other Committees. Our board of directors may establish
other committees as it deems necessary or appropriate from time
to time.
The compensation arrangements for our Chief Executive Officer
and each of our named executive officers were established
pursuant to the terms of the respective employment agreements
between us and each executive officer. The terms of the
employment agreements were established pursuant to arms-length
negotiations between a representative of Onex and each executive
officer.
114
None of our executive officers serves, and we anticipate that
none will serve, as a member of the board of directors or
compensation committee of any entity that has one or more
executive officers that serves on our board of directors or
compensation committee.
Following this offering, directors who are not our employees
will receive an annual cash payment of $35,000, payable
quarterly, $2,000 for each board meeting attended in person and
$1,000 for each board meeting attended via conference call, and
$1,000 and $500, respectively, for each committee meeting
attended in person or via conference call. The chair of the
audit committee and the compensation committee will receive an
additional $15,000 and $10,000, respectively. Consistent with
corporate policy, Mr. Le Blanc, as chairman of the
compliance committee, will receive no compensation for his
services to the company. When they were elected to the board, we
granted to each of Messrs. Epstein, Kelly and Smith an
option to purchase 3,750 shares of class A common
stock at an exercise price of $6.67 per share, with the
same vesting schedule as is applicable to our executive
officers. See Management Option Grants and
Stock Awards. All directors are reimbursed for their
out-of-pocket expenses incurred in connection with such services.
Executive Compensation
The following table sets forth the compensation of our chief
executive officer and the four other most highly compensated
executive officers during fiscal 2004. We refer to these
officers as our named executive officers.
Summary Compensation Table
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Annual Compensation | |
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Other Annual | |
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Long-Term | |
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All Other | |
Name and Principal Position(1) |
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Year | |
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Salary | |
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Bonus | |
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Compensation(2) | |
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Compensation Awards(3) | |
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Compensation(4) | |
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William A. Sanger
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2004 |
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$ |
571,411 |
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$ |
488,750 |
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$ |
9,957 |
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Chief Executive Officer of AMR and of EmCare |
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Don S. Harvey
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2004 |
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$ |
391,667 |
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$ |
337,500 |
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$ |
3,925 |
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President and Chief Operating Officer of EmCare |
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Randel G. Owen
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2004 |
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$ |
286,422 |
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$ |
117,500 |
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$ |
55,944(5 |
) |
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$ |
35,245 |
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$ |
7,745 |
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Chief Financial Officer of AMR |
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Dighton C. Packard, M.D.
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2004 |
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$ |
211,467 |
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$ |
83,200 |
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$ |
21,333 |
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$ |
4,571 |
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Chief Medical Officer of EmCare |
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Todd G. Zimmerman
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2004 |
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$ |
201,955 |
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$ |
146,997 |
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$ |
11,594 |
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$ |
5,157 |
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General Counsel of EmCare |
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(1) |
Represents each persons principal position in fiscal 2004.
All of these individuals became executive officers of Emergency
Medical Services in connection with our acquisition of AMR and
EmCare. |
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(2) |
In accordance with the rules of the SEC, other annual
compensation disclosed in this table does not include various
perquisites and other personal benefits received by a named
executive officer that does not exceed the lesser of $50,000 or
10% of such officers total annual salary and bonus
disclosed in this table. |
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(3) |
Represents the vesting of restricted share awards granted to the
named executive officers by Laidlaw on November 24, 2004,
as follows: Mr. Owen 1,900 shares;
Dr. Packard 1,150 shares;
Mr. Zimmerman 625 shares. In connection
with our acquisition of AMR and EmCare, these awards terminated
and no further restricted shares will vest. |
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(4) |
Represents matching contributions to company 401(k) plans. |
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(5) |
Other annual compensation for Mr. Owen includes a
relocation allowance of $47,544. |
Substantially all of our salaried employees, including our named
executive officers, participate in our 401(k) savings plans. We
maintain three 401(k) plans for eligible AMR employees.
Employees may contribute a maximum of 40% of their compensation
up to a maximum of $13,000. We match the contribution up to a
115
maximum of 3% to 6% of the employees salary per year,
depending on the plan. Eligible EmCare employees may elect to
contribute 1% to 25% of their annual compensation and we match
50% of the first 6% of base compensation that an employee
contributes.
Prior to our acquisition of AMR and EmCare, our named executive
officers participated in the Laidlaw, Inc. U.S. Supplemental
Executive Retirement Arrangement, or SERP. The benefit amount
payable under the plan at age 65 is based upon an
employees final average earnings. The form of the benefit
would be an annuity, guaranteed for five years. Based on the
number of years of service and their respective salaries prior
to the acquisition, the following are the total estimated
accrued values of future benefits payable under the Laidlaw SERP
to the named executive officers on retirement, calculated at
August 31, 2004: Mr. Sanger $169,532;
Mr. Harvey $69,782; Mr. Owen
$141,190; Dr. Packard $169,030; and
Mr. Zimmerman $92,481. No additional benefits
will accrue under the SERP. See Certain Relationships and
Related Party Transactions Transactions with
Laidlaw Management Bonuses in Connection with Our
Acquisition of AMR and EmCare for information relating to
amounts paid by Laidlaw to the named executive officers in
connection with our acquisition of AMR and EmCare.
Option Grants and Stock Awards
There were no stock option grants or restricted stock awards to
the named executive officers in fiscal 2004.
The following table sets forth information regarding options
granted to each of our named executive officers in February 2005
in connection with our acquisition of AMR and EmCare. Potential
realizable value is based upon the assumed initial public
offering of $16.00 per share, and is net of the exercise
price of $6.67 per share. The potential realizable value
set forth in the last column of the table is calculated based on
the term of the option at the time of the grant, which is ten
years. The assumed 5% and 10% rates of appreciation comply with
the rules of the SEC and do not represent our estimate of future
stock price. Actual gains, if any, on stock option exercises
will be dependent on future performance of our class A
common stock. We have not granted any stock appreciation rights
to any of the named executive officers.
The exercise price of each option listed below is equal to the
price paid per share by our initial investors. Each option may
be exercised only upon the vesting of such options. One-half of
the options held by each named executive officer vest ratably
over a four-year period as of the one-year anniversaries of the
grant (the 6-month anniversaries, in the case of
Mr. Sanger), and one-half vest ratably over the same period
but are exercisable only if a specified performance target is
met. See Equity Plans Equity
Option Plan. The percentage of total options is based upon
options to purchase an aggregate of 3,509,219 shares of
class A common stock granted to employees in the eight
months ended September 30, 2005 under the equity option
plan we adopted in connection with the acquisition of AMR and
EmCare. The terms of all option grants described below give
effect to adjustments to our capitalization that will be made in
connection with this offering. See Equity
Plans Equity Option Plans.
Option Grants in Fiscal 2005
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Individual Grants | |
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Potential Realizable Value of | |
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Options | |
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of Stock Price Appreciation | |
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Underlying | |
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Granted to | |
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for Option Term | |
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Employees in | |
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Exercise | |
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Granted(1) | |
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Fiscal Year | |
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Price | |
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Expiration Date(1) | |
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5% | |
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10% | |
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William A. Sanger
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1,482,168 |
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42.2 |
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$ |
6.67 |
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|
|
February 10, 2015 |
|
|
$ |
4,943,030.28 |
|
|
$ |
9,886,060.56 |
|
Don S. Harvey
|
|
|
370,542 |
(3) |
|
|
10.6 |
% |
|
$ |
6.67 |
|
|
|
February 10, 2015 |
|
|
|
1,235,757.57 |
|
|
|
2,471,515.14 |
|
Randel G. Owen
|
|
|
370,542 |
(3) |
|
|
10.6 |
% |
|
$ |
6.67 |
|
|
|
February 10, 2015 |
|
|
|
1,235,757.57 |
|
|
|
2,471,515.14 |
|
Todd G. Zimmerman
|
|
|
148,217 |
(3) |
|
|
4.2 |
% |
|
$ |
6.67 |
|
|
|
February 10, 2015 |
|
|
|
494,303.70 |
|
|
|
988,607.39 |
|
Dighton C. Packard, M.D.
|
|
|
48,750 |
(3) |
|
|
1.4 |
% |
|
$ |
6.67 |
|
|
|
February 10, 2015 |
|
|
|
162,581.25 |
|
|
|
325,162.50 |
|
|
|
(1) |
The options may expire earlier, upon termination of employment
or certain corporate events. See Equity
Plans Equity Option Plan. If the
employees employment is terminated prior to
February 10, 2015, his options will expire earlier as
follows: (a) upon the termination of employment if the
termination is for cause, (b) 30 days
after the termination of employment, or such other |
116
|
|
|
date as determined by the
compensation committee, following termination by the employee
for good reason or by us without cause
or due to retirement, or (c) 90 days after termination
of employment due to death or disability. Vesting of the options
may accelerate, and all options will terminate if not exercised,
upon (i) a sale of our equity (other than a sale as part of
an initial public offering) whereby any person other than
existing equity holders as of the grant date acquire our voting
power to elect a majority of our board of directors or
(ii) a sale of all or substantially all of our assets.
|
|
(2) |
The options vest ratably on the
first eight six-month anniversaries of the grant date,
provided, that the exercisability of one-half of the
options is conditioned upon meeting certain specified
performance targets. See Equity Plans
Equity Option Plan. If Mr. Sanger is terminated, the
options will vest as scheduled to the nearest six-month
anniversary of the grant date.
|
|
(3) |
The options vest ratably on the
first four anniversaries of the grant date, provided, that the
exercisability of one-half of the options is conditioned upon
meeting certain specified performance targets. See
Equity Plans Equity Option Plan.
|
None of the named executive officers held any stock options
during the fiscal year ended August 31, 2004 and none of
them held unexercised stock options at that date.
Employment Agreements
We have entered into employment agreements with
Messrs. Sanger, Harvey, Owen and Zimmerman, each effective
February 10, 2005, and with Dr. Packard effective
April 19, 2005. Mr. Sangers employment agreement
has a five-year term and Mr. Harveys employment
agreement has a four-year term. The employment agreements of
Mr. Owen, Mr. Zimmerman and Dr. Packard have a
three-year, a two-year term and a one-year term, respectively,
and renew automatically for successive one-year terms unless
either party gives notice at least 90 days prior to the
expiration of the then current term. Each executive has the
right to terminate his agreement on 90 days notice,
in which event he will be subject to the non-compete provisions
described below, provided he receives specified severance
benefits. The employment agreements include provisions for the
payment of an annual base salary as well as the payment of a
bonus based upon the achievement of performance criteria
established by our board of directors or, in the case of
Dr. Packard, our Chief Executive Officer or President. The
target bonus percentage, expressed as a percentage of annual
salary, set forth in each agreement represents the bonus amount
payable to the executive if all of the performance criteria are
achieved. The annual base salary of Mr. Sanger is subject
to annual review and adjustment after the second anniversary of
the effectiveness of the agreement. The annual base salary of
Messrs. Harvey, Owen and Zimmerman are subject to annual
review and adjustment after the first anniversary of the
effectiveness of the agreements. Dr. Packards base
salary is subject to a $100,000 increase if he reduces his
clinical activities and increases the time he provides services
to us.
If we terminate a named executive officers employment
without cause or any of them leaves after a change of control
for one of several specified reasons, we have agreed to continue
the executives base salary and provide his benefits for a
period of 24 months from the date of termination for
Messrs. Sanger, Harvey and Owen, 18 months for
Mr. Zimmerman, and 12 months for Dr. Packard.
These agreements contain non-competition and non-solicitation
provisions pursuant to which the executive agrees not to compete
with AMR or EmCare or solicit or recruit our employees for a
period from the date of termination for 24 months in the
case of Mr. Sanger, Mr. Harvey, Mr. Owen and
Dr. Packard and 12 months in the case of
Mr. Zimmerman.
The annual base salary and target bonus for each named executive
officer is as follows:
|
|
|
|
|
|
|
|
|
|
|
|
|
Target | |
|
|
Annual | |
|
Bonus | |
Executive |
|
Base Salary | |
|
Percentage | |
|
|
| |
|
| |
William A. Sanger
|
|
$ |
850,000 |
|
|
|
100 |
% |
Don S. Harvey
|
|
$ |
500,000 |
|
|
|
75 |
% |
Randel G. Owen
|
|
$ |
350,000 |
|
|
|
50 |
% |
Todd G. Zimmerman
|
|
$ |
325,000 |
|
|
|
50 |
% |
Dighton C. Packard, M.D.
|
|
$ |
260,000 |
|
|
|
50 |
% |
Pursuant to their employment agreements, effective
February 10, 2005, we granted options to purchase our
class A common stock to each named executive officer. See
Option Grants and Stock Awards and
Equity Plans Equity Option
Plan. The option grant to each of these named executive
officers was conditioned upon his investment in our equity in an
amount as indicated in his respective employment agreement.
117
Our executive employment agreements with Messrs. Sanger,
Harvey, Owen and Zimmerman include indemnification provisions.
Under those agreements, we agree to indemnify each of these
individuals against claims arising out of events or occurrences
related to that individuals service as our agent or the
agent of any of our subsidiaries to the fullest extent legally
permitted. Under Delaware law, an officer may be indemnified,
except to the extent any claim arises from conduct that was not
in good faith or in a manner reasonably believed to be in, or
not opposed to, our best interest or, with respect to any
criminal action or proceedings, there was reasonable cause to
believe such conduct was unlawful.
Equity Plans
We adopted our equity option plan in connection with the
acquisition of AMR and EmCare. In the eight months ended
September 30, 2005, we have granted options to purchase
3,509,219 shares of class A common stock under the
plan and at September 30, 2005 we have an additional
566,745 shares reserved for future grants.
The compensation committee of our board of directors, or the
board itself if there is no committee, administers the equity
option plan.
The plan provides that if Emergency Medical Services undergoes a
reorganization, recapitalization or other change in its equity,
the compensation committee may make adjustments to the plan in
order to prevent dilution of outstanding options. In connection
with this offering, each option to purchase one partnership unit
at a price of $10.00 per unit will be adjusted to become
the right to purchase 1.5 shares of class A common
stock at a price of $6.67 per share, and the option terms
we refer to give effect to these adjustments.
The options to purchase 3,509,219 shares of class A
common stock we have granted under the plan through
September 30, 2005 are non-qualified options for federal
income tax purposes. These options have the following terms:
|
|
|
|
|
exercise price equal to $6.67 per share, being the equity
purchase price paid by the initial investors, |
|
|
|
vesting ratably on each of the first four anniversaries of the
effective February 10, 2005 grant date (the first eight
6-month anniversaries in the case of Mr. Sanger),
provided, that the exercisability of one-half of the
options granted to each employee is subject to the further
condition that Onex has realized a 15% internal rate of return,
as defined, or, on the fourth anniversary of the grant date, we
have achieved an aggregate EBITDA of not less than
$617.4 million, subject to certain adjustments, for the
four fiscal years ending December 31, 2008, |
|
|
|
each option expires on the tenth anniversary of the grant date
unless the employees employment is terminated earlier, in
which case the options will expire as follows: (i) upon the
termination of employment if the termination is for
cause, (ii) 30 days after the termination
of employment, or such other date as determined by the
compensation committee, following termination by the employee
for good reason or by us without cause
or due to retirement, or (iii) 90 days after
termination of employment due to death or disability, and |
|
|
|
upon (i) a sale of the equity of Emergency Medical Services
(other than a sale as part of this offering) whereby any person
other than existing equity holders as of the grant date acquire
voting power to elect a majority of our board of directors or
(ii) a sale of all or substantially all of our assets, all
options granted to each employee will accelerate (although still
subject to the performance target) and will terminate if not
exercised. |
All options and Emergency Medical Services equity held by our
senior management are governed by agreements which:
|
|
|
|
|
restrict transfer of their equity until the fifth anniversary of
purchase, and |
|
|
|
grant piggyback registration rights. |
118
See Description of Capital Stock Equityholder
Agreements and Registration
Agreement for a description of the transfer restrictions
and piggyback registration rights.
|
|
|
Management Investment and Equity Purchase Plan |
In connection with our acquisition of AMR and EmCare, our named
executive officers and other members of management purchased an
aggregate of 915,750 shares of class A common stock.
See Certain Relationships and Related Party
Transactions Issuance of Shares. Approximately
160 employees and affiliated physicians, physician
assistants and nurse practitioners purchased in the aggregate an
additional 232,575 shares of class A common stock
pursuant to our equity purchase plan. The 1,148,325 shares
held by these investors, including our named executive officers,
are governed by equityholders agreements. These agreements
contain restrictions on transfer of the equity. See
Description of Capital Stock Equityholder
Agreements.
119
PRINCIPAL AND SELLING STOCKHOLDERS
The following table shows information with respect to the
beneficial ownership of our common stock as of November 30,
2005, giving effect to our reorganization as a holding company,
including the exchange of limited partnership units for
class A common stock and class B common stock, the
assumed exchange of LP exchangeable units for our class B
common stock, the 1.5-for-1 stock split, and as adjusted to
reflect the sale of our class A common stock being offered
in this offering, by:
|
|
|
|
|
each person known by us to own beneficially 5% or more of our
class A or class B common stock, |
|
|
|
each of our directors, |
|
|
|
each of our named executive officers, and |
|
|
|
all of our directors and executive officers as a group. |
In addition, up to 1,170,000 LP exchangeable units owned by
the Onex entities may be exchanged for shares of our
class B common stock, converted into class A common
stock and sold if the underwriters exercise their over-allotment
option, as set forth in this section. No members of management,
and no other stockholder, is selling common stock as a part of
this offering.
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Before Offering | |
|
After Offering | |
|
|
| |
|
| |
|
|
Number of | |
|
Percentage | |
|
|
|
Percentage | |
|
|
|
|
Shares | |
|
of Class/All | |
|
Percentage | |
|
of Class/All | |
|
Percentage | |
|
|
Beneficially | |
|
Common | |
|
of Voting | |
|
Common | |
|
of Voting | |
Name of Beneficial Owner |
|
Owned(1)(2) | |
|
Stock | |
|
Power | |
|
Stock | |
|
Power | |
|
|
| |
|
| |
|
| |
|
| |
|
| |
Five Percent Stockholders
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Onex Corporation(3)
|
|
|
32,107,523 |
|
|
|
99.6%/ |
96.1% |
|
|
|
|
|
|
99.6%/ |
77.9% |
|
|
|
|
|
|
|
class B |
|
|
|
|
|
|
|
98.9% |
|
|
|
|
|
|
|
96.6% |
|
Onex Partners LP(4)
|
|
|
17,226,723 |
|
|
|
53.5%/ |
51.6% |
|
|
|
|
|
|
53.6%/ |
41.8% |
|
|
|
|
|
|
|
class B |
|
|
|
|
|
|
|
53.1% |
|
|
|
|
|
|
|
51.8% |
|
Onex Partners LLC(5)
|
|
|
11,106,924 |
|
|
|
34.4%/ |
33.3% |
|
|
|
|
|
|
34.4%/ |
27.0% |
|
|
|
|
|
|
|
class B |
|
|
|
|
|
|
|
34.2% |
|
|
|
|
|
|
|
33.4% |
|
Onex EMSC Co-Invest LP(6)
|
|
|
2,844,855 |
|
|
|
8.8%/ |
8.5% |
|
|
|
|
|
|
8.8%/ |
6.9% |
|
|
|
|
|
|
|
class B |
|
|
|
|
|
|
|
8.8% |
|
|
|
|
|
|
|
8.6% |
|
Directors and Executive Officers
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Robert M. Le Blanc(7)
|
|
|
56,107 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
class B |
|
|
|
*/ |
* |
|
|
* |
|
|
|
*/ |
* |
|
|
* |
|
Steven B. Epstein(8)
|
|
|
37,500 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
class A |
|
|
|
3.3%/ |
* |
|
|
* |
|
|
|
*/ |
* |
|
|
* |
|
James T. Kelly(8)
|
|
|
112,500 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
class A |
|
|
|
9.8%/ |
* |
|
|
* |
|
|
|
1.3%/ |
* |
|
|
* |
|
Michael L. Smith(8)
|
|
|
37,500 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
class A |
|
|
|
3.3%/ |
* |
|
|
* |
|
|
|
*/ |
* |
|
|
* |
|
William A. Sanger(8)
|
|
|
450,000 |
|
|
|
39.2%/ |
1.4% |
|
|
|
|
|
|
5.0%/ |
1.1% |
|
|
|
|
|
|
|
class A |
|
|
|
|
|
|
|
* |
|
|
|
|
|
|
|
* |
|
Don S. Harvey(8)
|
|
|
75,000 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
class A |
|
|
|
6.5%/ |
* |
|
|
* |
|
|
|
*/ |
* |
|
|
* |
|
Dighton C. Packard, M.D.(9)
|
|
|
33,750 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
class A |
|
|
|
2.9%/ |
* |
|
|
* |
|
|
|
*/ |
* |
|
|
* |
|
Randel G. Owen(8)
|
|
|
33,750 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
class A |
|
|
|
2.9%/ |
* |
|
|
* |
|
|
|
*/ |
* |
|
|
* |
|
Todd G. Zimmerman(8)
|
|
|
18,750 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
class A |
|
|
|
1.6%/ |
* |
|
|
* |
|
|
|
*/ |
* |
|
|
* |
|
All directors and executive officers as a group (9 persons)
|
|
|
56,107 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
class B |
|
|
|
*/ |
* |
|
|
* |
|
|
|
*/ |
* |
|
|
* |
|
|
|
|
798,750 |
|
|
|
69.6%/ |
2.4% |
|
|
* |
|
|
|
8.9%/ |
1.9% |
|
|
* |
|
|
|
|
class A |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
120
|
|
* |
Represents beneficial ownership of less than 1%. |
|
|
(1) |
The amounts and percentages of our common stock beneficially
owned are reported on the basis of regulations of the SEC
governing the determination of beneficial ownership of
securities. Under the rules of the SEC, a person is deemed to be
a beneficial owner of a security if that person has
or shares voting power, which includes the power to
vote or direct the voting of such security, or investment
power, which includes the power to dispose of or to direct
the disposition of such security. A person is also deemed to be
a beneficial owner of any securities of which that person has a
right to acquire beneficial ownership within 60 days,
including our common stock subject to an option that is
exercisable within 60 days. Under these rules, more than
one person may be deemed to be a beneficial owner of such
securities as to which such person has an economic interest.
None of the options granted under our equity option plan is
exercisable within 60 days. |
|
|
The LP exchangeable units are exchangeable on a one-for-one
basis for shares of class B common stock at any time at the
option of the holder. Accordingly, this table assumes the
exchange of all LP exchangeable units for class B common
stock. Until such exchange, the holders of the LP exchangeable
units have the benefit of the class B special voting stock
through which the holders may exercise voting rights as though
they held the same number of shares of class B common stock. |
|
(2) |
On each matter submitted to the stockholders for their vote, our
class A common stock is entitled to one vote per share, and
our class B common stock is entitled to ten votes per
share, reducing to one vote per share under certain limited
circumstances. Except as required by law, our class A and
class B common stock vote together on all matters submitted
to stockholders for their vote. |
|
(3) |
Includes the following: (i) 17,226,723 LP exchangeable
units held by Onex Partners LP; (ii) 11,106,924
LP exchangeable units held by Onex Partners LLC;
(iii) 2,844,855 LP exchangeable units held by Onex
EMSC Co-Invest LP; (iv) 639,649 LP exchangeable units
held by EMS Executive Investco LLC; (v) 289,349
LP exchangeable units held by Onex US Principals LP; and
(vi) 23 LP exchangeable units held by EMSC, Inc.
(formerly known as Emergency Medical Services Corporation). Onex
Corporation may be deemed to own beneficially the LP
exchangeable units held by (a) Onex Partners LP,
through Onex ownership of all of the common stock of Onex
Partners GP, Inc., the general partner of Onex
Partners GP LP, the general partner of Onex
Partners LP; (b) Onex Partners LLC, through
Onex ownership of all of the equity of Onex
Partners LLC; (c) Onex EMS Co-Invest LP, through
Onex ownership of all of the common stock of Onex
Partners GP, Inc., the general partner of Onex
Partners GP LP, the general partner of Onex EMSC
Co-Invest LP; (d) EMS Executive Investco LLC,
through Onex ownership of Onex American
Holdings II LLC which owns 33.33% of the voting power
of EMS Executive Investco LLC; and (e) Onex
US Principals LP through Onex ownership of all
of the equity of Onex American Holdings GP LLC, the
general partner of Onex US Principals LP. Onex
Corporation disclaims such beneficial ownership. |
|
|
In addition, prior to the formation of our holding company, Onex
Corporations subsidiary, Onex American
Holdings II LLC, owns 50% of the voting stock of
Emergency Medical Services Corporation, the general partner of
EMS L.P., and a 99.9% economic interest in EMSC, Inc. EMSC,
Inc. owns directly less than .001% of the equity interest of
EMS L.P. However, as its general partner, EMSC, Inc. may be
deemed to own beneficially all of the equity of the partnership.
The equity owned by EMSC, Inc. may be deemed beneficially owned
50% by Mr. Le Blanc and 50% by Onex American
Holdings II LLC and Onex Corporation.
Mr. Le Blanc disclaims such beneficial ownership. |
|
|
Mr. Gerald W. Schwartz, the Chairman, President and Chief
Executive Officer of Onex Corporation, owns shares representing
a majority of the voting rights of the shares of Onex
Corporation and as such may be deemed to own beneficially all of
the LP exchangeable units owned beneficially by Onex
Corporation. Mr. Schwartz disclaims such beneficial
ownership. The address for Onex Corporation is 161 Bay Street,
Toronto, ON M5J 2S1. |
|
(4) |
All of the LP exchangeable units owned by Onex Partners LP
may be deemed owned beneficially by each of Onex Partners GP LP,
Onex Partners GP, Inc. and Onex Corporation. The
address for Onex Partners LP is c/o Onex Investment
Corporation, 712 Fifth Avenue, New York, New York 10019. |
|
(5) |
All of the LP exchangeable units owned by Onex Partners LLC may
be deemed owned beneficially by Onex Corporation. The address
for Onex Partners LLC is 421 Leader Street, Marion, Ohio 43302. |
|
(6) |
All of the LP exchangeable units owned by Onex EMSC Co-Invest LP
may be deemed owned beneficially by each of Onex Partners GP LP,
Onex Partners GP, Inc. and Onex Corporation. The address for
Onex EMSC Co-Invest LP is c/o Onex Investment Corporation,
712 Fifth Avenue, New York, New York 10019. |
|
(7) |
Includes (i) 35,837 LP exchangeable units held by Onex
US Principals LP which may be deemed owned beneficially by
Mr. Le Blanc by reason of his pecuniary interest in
the LP exchangeable units owned by Onex US Principals LP,
(ii) 20,250 LP exchangeable units owned by Onex EMSC
Co-Invest LP which may be deemed to be owned beneficially by
Mr. Le Blanc by reason of his pecuniary interest in Onex
EMSC Co-Invest LP and (iii) 23 LP exchangeable units owned
by EMSC, Inc. Prior to our reorganization into a holding
company, Mr. Le Blanc owns 50% of the voting common stock
of EMSC, Inc. and a 0.01% economic interest in EMSC, Inc. See
note (3) with respect to EMSC, Inc.s equity interest
in EMS L.P., as to which Mr. Le Blanc disclaims
beneficial ownership. Mr. Le Blanc also disclaims
beneficial interest in the LP exchangeable units owned by Onex
US Principals LP and Onex EMSC Co-Invest LP. Mr. Le
Blancs address is c/o Onex Investment Corporation,
712 Fifth Avenue, New York, New York 10019. |
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(8) |
The address of these stockholders is c/o Emergency Medical
Services Corporation, 6200 S. Syracuse Way, Suite 200,
Greenwood Village, Colorado 80111-4737. |
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(9) |
The address of this stockholder is c/o EmCare Holdings Inc.,
1717 Main Street, Suite 5200, Dallas, Texas 75201. |
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The following table sets forth information regarding the
ownership of shares of our common stock by the selling
stockholders, assuming the underwriters over-allotment
option is exercised in full:
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Shares Beneficially Owned | |
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Number of | |
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After the Offering | |
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Shares Offered | |
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in Over- | |
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Percentage of | |
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Allotment | |
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Class/All | |
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Percentage of | |
Name of Beneficial Owner |
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Option | |
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Number | |
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Common Stock | |
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Voting Power | |
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| |
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| |
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| |
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| |
Onex Partners LP
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627,743 |
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16,598,980 |
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53.4%/ |
40.3% |
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51.7 |
% |
Onex Partners LLC
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404,737 |
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10,702,187 |
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34.4%/ |
26.0% |
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33.4 |
% |
Onex EMSC Co-Invest LP
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103,667 |
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2,741,188 |
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8.8%/ |
6.7% |
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8.5 |
% |
Onex US Principals LP
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10,544 |
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278,805 |
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*/ |
* |
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* |
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EMS Executive Investco LLC
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23,309 |
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616,340 |
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2.0%/ |
1.5% |
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1.9 |
% |
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* |
Represents beneficial ownership of less than 1%. |
We have agreed to pay all the expenses of the selling
stockholders in connection with our public offering other than
underwriting discounts and commissions. In the event the
underwriters over-allotment option is not exercised in
full, the number of shares to be sold by the selling
stockholders named above will be reduced proportionately.
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DESCRIPTION OF CAPITAL STOCK
The following description summarizes the material terms of our
capital stock and provisions of our restated certificate of
incorporation and restated by-laws as they will be in effect
upon completion of this exchange and our offering. This
description also summarizes the principal agreements relating to
the LP exchangeable units. Because this is only a summary, it
does not contain all of the information that may be important to
you. For a complete description, you should refer to our
restated certificate of incorporation and restated by-laws, the
EMS L.P. limited partnership agreement, as amended and
restated, and the voting and exchange trust agreement referred
to below, copies of which will be filed as exhibits to the
registration statement of which this prospectus is a part, and
to the applicable provisions of the Delaware General Corporation
Law, or the DGCL, and the Delaware Revised Uniform Limited
Partnership Act. References to our certificate of incorporation,
to our by-laws and to the EMS L.P. limited partnership agreement
are references to these documents, as restated.
Overview
At the time of our offering, our authorized capital stock will
consist of:
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100,000,000 shares of class A common stock, par value
$0.01 per share, |
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40,000,000 shares of class B common stock, par value
$0.01 per share, |
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one share of class B special voting stock, $0.01 par value,
and |
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20,000,000 shares of preferred stock, par value $0.01 per
share. |
Of the 100,000,000 authorized shares of class A common
stock, pursuant to our offering we are offering
7,800,000 shares and, subject to the underwriters
exercise of their over-allotment option in full, the selling
stockholders are offering 1,170,000 shares. On the closing
of our offering, if the underwriters over-allotment option
is not exercised, we and EMS L.P. will have outstanding the
following securities:
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8,948,325 shares of class A common stock, held by our
management, employees and persons who purchase shares in our
offering; |
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142,545 shares of class B common stock, held by
certain former holders of interests in EMS L.P.; |
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one share of class B special voting stock, held by Onex
Corporation as trustee for the holders of LP exchangeable units; |
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32,107,500 LP exchangeable units of EMS L.P., exchangeable on a
one-for-one basis for shares of class B common stock, held
by the Onex entities; and |
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860,570 other partnership units of EMS L.P., including the
general partner interest, held by us. |
If the underwriters over-allotment option is exercised in
full, the number of shares of class A common stock
outstanding will increase, and the number of LP exchangeable
units outstanding will decrease, by 1,170,000.
We refer to our class A common stock and our class B
common stock together as our common stock.
At any time at the option of the holder:
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each LP exchangeable unit is exchangeable into one share of
class B common stock, and |
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each share of class B common stock is convertible into one
share of class A common stock. |
123
Our securities are entitled to vote on all matters subject to a
vote of holders of common stock, voting together as a single
class, as follows:
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class A common stock is entitled to one vote per share, |
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class B common stock is entitled to ten votes per share
(reducing to one vote per share under certain limited
circumstances), and |
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one share of class B special voting stock, held for the
benefit of the holders of LP exchangeable units, is entitled to
a number of votes equal to the number of votes that could be
cast if all the then outstanding LP exchangeable units were
exchanged for class B common stock. |
The holders of LP exchangeable units may therefore exercise
voting rights with respect to Emergency Medical Services as
though they held the same number of shares of our class B
common stock.
Our Controlling Stockholders
After this offering, the Onex entities will control 96.6% of our
combined voting power. Accordingly, the Onex entities will
exercise a controlling influence over our business and affairs
and will have the power to determine all matters submitted to a
vote of our stockholders, including the election of directors,
the removal of directors with or without cause, and approval of
significant corporate transactions such as amendments to our
certificate of incorporation, mergers and the sale of all or
substantially all of our assets. The Onex entities could cause
corporate actions to be taken even if the interests of these
entities conflict with the interests of our other stockholders.
This concentration of voting power could have the effect of
deterring or preventing a change in control of Emergency Medical
Services that might otherwise be beneficial to our stockholders.
The Onex entities will hold their equity interest in us through
their ownership of LP exchangeable units. Although the Onex
entities cannot directly vote to amend the EMS L.P. partnership
agreement or their distributions from the partnership, they
could influence the amendment of that agreement through their
indirect control of us, as the general partner of the
partnership.
Common Stock
The class A common stock and the class B common stock
will be identical in all respects, except with respect to voting
and except that each share of class B common stock is
convertible into one share of class A common stock at the
option of the holder. All of our existing common stock is, and
the shares of class A common stock being offered by us and
the selling stockholders, if any, in this offering will be, upon
payment therefor, validly issued, fully paid and non-assessable.
Voting Rights. Generally, on all matters on which the
holders of common stock are entitled to vote, the holders of the
class A common stock, the class B common stock and the
class B special voting stock vote together as a single
class. On all matters with respect to which the holders of our
common stock are entitled to vote, each outstanding share of
class A common stock is entitled to one vote, each
outstanding share of class B common stock is entitled to
ten votes and the one share of class B special voting stock
is entitled to a number of votes equal to the number of votes
that could be cast if all of the then outstanding LP
exchangeable units were exchanged for class B common stock.
If the Minimum Hold Condition is no longer satisfied, the number
of votes per share of class B common stock will be reduced
automatically to one vote per share. The Minimum Hold Condition
is satisfied so long as the aggregate of the numbers of
outstanding shares of class B common stock and LP
exchangeable units is at least 10% of the total number of shares
of common stock and LP exchangeable units outstanding.
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Class A Common Stock. In addition to the other
voting rights or power to which the holders of class A
common stock are entitled, holders of class A common stock are
entitled to vote as a separate class on approval of (i) any
alteration, repeal or amendment of our certificate of
incorporation which would adversely affect the powers,
preferences or rights of the holders of class A common
stock; and (ii) any merger or consolidation of our company
with any other entity if, as a result, shares of class B |
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common stock would be converted into or exchanged for, or
receive, any consideration that differs from that applicable to
the shares of class A common stock as a result of such
merger or consolidation, other than a difference limited to
preserving the relative voting power of the holders of the
class A common stock, the class B common stock and the
class B special voting stock. In respect of any matter as
to which the holders of the class A common stock are
entitled to a class vote, holders have one vote per share, and
the affirmative vote of the holders of a majority of the shares
of class A common stock outstanding is required for
approval. |
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Class B Common Stock and Class B Special Voting
Stock. In addition to the other voting rights or power to
which the holders of class B common stock and class B
special voting stock are entitled, holders of class B
common stock and class B special voting stock are entitled
to vote together as a single class on approval of (i) any
alteration, repeal or amendment of our certificate of
incorporation which would adversely affect the powers,
preferences or rights of the holders of class B common
stock or class B special voting stock; and (ii) any
merger or consolidation of our company with any other entity if,
as a result, (a) the class B special voting stock
would not remain outstanding or (b) shares of class B
common stock would be converted into or exchanged for, or
receive, any consideration that differs from that applicable to
the shares of class A common stock as a result of such
merger or consolidation, other than a difference limited to
preserving the relative voting power of the holders of the
class A common stock, the class B common stock and the
class B special voting stock. In respect of any matter as
to which the holders of the class B common stock and
class B special voting stock are entitled to a class vote,
holders of class B common stock have one vote per share and
the holder of the class B special voting stock will have
one vote for each LP exchangeable unit outstanding, and the
affirmative vote of the holders of a majority of the votes
entitled to be cast is required for approval. |
Dividend Rights. Subject to preferences that may apply to
shares of preferred stock outstanding at the time, holders of
our outstanding common stock are entitled to any dividend
declared by the board of directors out of funds legally
available for this purpose. No dividend can be declared on the
class A or class B common stock unless at the same
time an equal dividend is paid on each share of class A or
class B common stock, as the case may be. Dividends paid in
shares of our common stock must be paid, with respect to a
particular class of common stock, in shares of that class. We
will not pay dividends on our class B special voting stock.
The holders of the LP exchangeable units have the right to
receive distributions equivalent to, on a per share/per unit
basis, the dividends paid to the holders of the class A and
class B common stock. If a dividend with respect to our
common stock is paid in shares of common stock, the
corresponding distribution with respect to the
LP exchangeable units will be made in LP exchangeable
units.
Conversion Rights. The class A common stock is not
convertible. Each share of class B common stock may be
converted at any time at the option of the holder into one share
of class A common stock. The class B common stock will
be converted automatically into class A common stock upon a
transfer thereof to any person other than (i) Onex
Corporation, (ii) an affiliate of Onex, (iii) Gerald
W. Schwartz or an affiliate of Mr. Schwartz, (iv) Onex
Partners LP or (v) or another person or entity,
provided, that, in the case of this clause (v),
Onex, an affiliate of Onex, Mr. Schwartz or Onex Partners
LP has or shares voting power or investment
power, as those terms are defined in the rules of the SEC,
over the class B common stock held by that person or entity.
Preemptive or Similar Rights. Our common stock is not
entitled to preemptive or other similar rights to purchase any
of our securities.
Right to Receive Liquidation Distributions. Upon our
voluntary or involuntary liquidation, dissolution or winding up,
the holders of our common stock are entitled to receive pro rata
our assets which are legally available for distribution, after
payment of all debts and other liabilities and subject to the
rights of any holders of preferred stock then outstanding, and
subject to the rights of the holders of LP exchangeable units to
receive distributions of assets equivalent to, on a per
share/per unit basis, the distributions to the holders of
class A and class B common stock. We will not make any
distribution of assets with respect to the class B
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special voting stock upon our liquidation, dissolution or
winding up other than a distribution equal to its $0.01 par
value.
NYSE Listing. Our class A common stock has been
accepted for trading on the NYSE under the symbol
EMS, subject to official notice of issuance. The
class B common stock, the class B special voting stock
and the LP exchangeable units will not be listed on any
securities exchange.
LP Exchangeable Units and Class B Special Voting
Stock
Each of the LP exchangeable units will be a security of EMS L.P.
that, taking into account the ancillary rights described in this
section, are substantially equivalent economically to a share of
class B common stock. The holders of LP exchangeable units
will have the following rights:
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the right to exchange those units, at the holders option,
for shares of class B common stock on a one-for-one basis, |
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the right to receive distributions, on a per unit basis, in
amounts (or property in the case of non-cash dividends), which
are the same as, or economically equivalent to, and which are
payable at the same time as, dividends declared on the
class B common stock (or dividends that would be required
to be declared if class B common stock were outstanding), |
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the right to vote, through the trustee holder of the
class B special voting stock, at all stockholder meetings
at which holders of the class B common stock or
class B special voting stock are entitled to vote, and |
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the right to participate on a pro rata basis with the
class B common stock in the distribution of assets of
Emergency Medical Services, upon specified events relating to
the voluntary or involuntary liquidation, dissolution, winding
up or other distribution of the assets through the mandatory
exchange of LP exchangeable units for shares of class B
common stock. |
On the closing of this offering, we will enter into a voting and
exchange trust agreement and issue one share of class B
special voting stock to Onex Corporation as trustee to be held
for the benefit of the holders of LP exchangeable units. By
furnishing instructions to the trustee, holders of the LP
exchangeable units will be able to exercise essentially the same
voting rights with respect to Emergency Medical Services as they
would have if they had exchanged their LP exchangeable units for
shares of our class B common stock.
In the EMS L.P. partnership agreement, we will agree to maintain
the economic equivalency of the LP exchangeable units and the
class B common stock by, among other things, not declaring
and paying dividends on the class A common stock or
class B common stock unless EMS L.P. is able to make,
and in fact makes, economically equivalent and contemporaneous
distributions on the LP exchangeable units in accordance with
the terms of those units. EMS L.P. may also make such unit
distributions or adjustments from time to time as necessary to
maintain the one-for-one economic equivalence between the
LP exchangeable units and shares of our class B common
stock. The LP exchangeable units do not carry any other right to
receive distributions from EMS L.P.
The partnership agreement provides that, in the event that a
tender offer, share exchange offer, issuer bid, take-over bid or
similar transaction for the purpose of acquiring the
class A common stock and/ or class B common stock is
proposed by us or is proposed to us or our stockholders and is
recommended by our board of directors, or is otherwise effected
or to be effected with the consent or approval of our board of
directors and the LP exchangeable units are not otherwise
exchanged for shares of class B common stock, then we will
use our reasonable efforts to enable and permit holders of LP
exchangeable units to participate in such an offer to the same
extent and on an economically equivalent basis as the holders of
our common stock. Without limiting the generality of the
foregoing, we will use its reasonable efforts to ensure that
holders of LP exchangeable units may participate in all such
offers without being required to exercise their right to
exchange their LP exchangeable units for class B common
stock or, if so required, to ensure that any
126
such exchange shall be effective only upon, and shall be
conditional upon, the closing of the offer and only to the
extent necessary to tender or deposit under the offer. In the
event of the acquisition of Emergency Medical Services through a
merger or similar transaction, we will use our reasonable
efforts to permit holders of LP exchangeable units to
participate in such transaction to the same extent, and on an
economically equivalent basis, as the holders of our common
stock. Without limiting the generality of the foregoing, we will
use our reasonable efforts to ensure that the holders of LP
exchangeable units may participate in such transaction without
being required to exercise their right to exchange their LP
exchangeable units for class B common stock by effecting a
concurrent merger or similar transaction of EMS L.P. with the
acquiring entity.
The exchange rights of the LP exchangeable units are subject to
adjustment or modification in the event of a stock split,
combination or other change to our capital structure so as to
maintain the initial one-to-one relationship between the LP
exchangeable units and our class B common stock. We may
cause all of the outstanding LP exchangeable units to be
exchanged for one share of our class B common stock for
each LP exchangeable unit held at any time after
December 15, 2045 or if the number of LP exchangeable units
is less than 5% of the number of LP exchangeable units
outstanding at the closing of this offering (adjusted for
reorganizing, recapitalizing or other changes in equity).
The LP exchangeable units that will be outstanding on the
closing of this offering may not be resold or otherwise
transferred in the United States except to an Onex entity (or in
connection with a tender offer, share exchange offer, issuer
bid, take-over bid or similar transaction or merger as described
above) and then only pursuant to an effective registration
statement under the Securities Act or an exemption from
registration under the Securities Act.
Preferred Stock
Following this offering, our board of directors may, without
further action by our stockholders, from time to time, direct
the issuance of up to 20,000,000 million shares of
preferred stock in series and may, at the time of issuance,
determine the rights, preferences and limitations of each
series. Satisfaction of any dividend preferences of outstanding
shares of preferred stock would reduce the amount of funds
available for the payment of dividends on shares of our common
stock. Holders of shares of preferred stock may be entitled to
receive a preference payment in the event of our liquidation,
dissolution or winding-up before any payment is made to the
holders of shares of our common stock. Under specified
circumstances, the issuance of shares of preferred stock may
render more difficult or tend to discourage a merger, tender
offer or proxy contest, the assumption of control by a holder of
a large block of our securities or the removal of incumbent
management. Upon the affirmative vote of a majority of the total
number of directors then in office, the board of directors,
without stockholder approval, may issues shares of preferred
stock with voting and conversion rights which could adversely
affect the holders of shares of our common stock. Upon
consummation of this offering, there will be no shares of
preferred stock outstanding, and we have no present intention to
issue any shares of preferred stock.
Options
Following this offering, we will have outstanding under our
equity option plan options to purchase a total of approximately
3,509,219 shares of class A common stock with an
exercise price of $6.67 per share.
Anti-Takeover Effects of our Certificate of Incorporation and
By-Laws
Some provisions of our certificate of incorporation and our
by-laws contain provisions that are intended to enhance the
likelihood of continuity and stability in the composition of our
board of directors.
These provisions also may have the effect of delaying, deferring
or preventing a future takeover or change in control unless the
takeover or change in control is approved by our board of
directors.
127
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Class B Common Stock and Class B Special Voting
Stock |
The Onex entities ownership of the LP exchangeable units
entitles them to acquire from us substantially all of the
class B common stock which carries ten votes per share.
Through the class B special voting stock, the Onex entities
will exercise essentially the same voting rights with respect to
Emergency Medical Services as they would have if they had
exchanged their LP exchangeable units for our class B
common stock. Upon completion of this offering, Onex will own
beneficially 77.9% of our common stock and will control 96.6% of
the combined voting power of our outstanding common stock.
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Undesignated Preferred Stock |
The ability to authorize undesignated preferred stock makes it
possible for our board of directors to issue one or more series
of preferred stock with voting or other rights or preferences
that could impede the success of any attempt to change control
of us. These and other provisions may have the effect of
deferring hostile takeovers or delaying changes in control or
management of our company.
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Advance Notice Requirements for Stockholder Proposals and
Directors Nominations |
Our by-laws provide that stockholders seeking to bring business
before our annual meeting of stockholders, or to nominate
candidates for election as directors at our annual meeting, must
provide timely notice of their intent in writing. To be timely,
a stockholders notice must be delivered to, or mailed and
received at, our principal executive offices not less than
120 days prior to the first anniversary of the date of our
notice of annual meeting provided with respect to the previous
years annual meeting of stockholders; provided,
that if no annual meeting of stockholders was held in the
previous year or the date of the annual meeting of stockholders
has been changed to be more than 30 calendar days earlier than
such anniversary, notice by the stockholder, to be timely, must
be received a reasonable time before the solicitation is made.
These by-law provisions are not applicable to a holder of
class B common stock or class B special voting stock.
Our by-laws also specify certain requirements as to the form and
content of a stockholders notice. These provisions may
have the effect of precluding our stockholders from bringing
matters before a meeting or from making nominations for
directors if the proper procedures are not followed or may
discourage or defer a potential acquiror from conducting a
solicitation of proxies to elect our slated directors or
otherwise attempting to obtain control of the Company.
Our by-laws provide that, except as otherwise required by law,
special meetings of the stockholders may be called only by the
board of directors, our chief executive officer, our secretary
or the holders of our common stock having a majority of the
voting power of all our outstanding class A common stock,
class B common stock and class B special voting stock,
collectively. Stockholders are not otherwise permitted to call a
special meeting or to require the board of directors to call a
special meeting.
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Filling of Board Vacancies; Removal |
Our by-laws authorize only our board of directors to fill
vacancies created by resignation or removal and newly created
directorships. This may deter a stockholder from increasing the
size of our board and gaining control of our board of directors
by filling the resulting vacancies with its own nominees.
So long as the Minimum Hold Condition is satisfied, any director
or the entire board of directors may be removed, with or without
cause, by the holders of shares of class A common stock,
class B common stock and class B special voting stock,
voting together as a single class.
Our certificate of incorporation provides that our board is
classified into three classes of directors. The existence of a
staggered board could delay a successful tender offeror from
obtaining majority control of our
128
board, and the prospect of such delay may deter a potential
offeror. Please see Management Composition of
the Board of Directors after this Offering for more
information regarding the staggered board.
Additional Certificate of Incorporation and By-Law
Provisions
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Stockholder Action by Written Consent |
Any action required or permitted to be taken at an annual or
special stockholders meeting may be taken without a
meeting, without prior notice and without a vote, if a consent
or consents in writing, setting forth the action so taken, shall
be signed by the holders of outstanding stock having not less
than the minimum number of votes that would be necessary to
authorize or take such action at a meeting at which all shares
entitled to vote thereon were present and voted. The action must
be evidenced by one or more written consents describing the
action taken, signed by the stockholders entitled to take action
without a meeting, and delivered to us in the manner prescribed
by the DGCL.
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Delaware Business Combination Statute |
We have elected not to be subject to Section 203 of the
DGCL, which generally prohibits a publicly held Delaware
corporation from engaging in various business
combination transactions with any interested
stockholder for a period of three years after the date of
the transaction in which the person became an interested
stockholder, unless the transaction is approved by the
board of directors before that person becomes an
interested stockholder or another exception is
available. A business combination includes mergers,
asset sales and other transactions resulting in a financial
benefit to a stockholder. An interested stockholder
is a person who, together with affiliates and associates, owns
(or within three years, did own) 15% or more of a
corporations voting stock. The statute is intended to
prohibit or delay the accomplishment of mergers or other
takeover or change in control attempts that do not receive the
prior approval of the board of directors. By virtue of our
decision to elect out of the statutes provisions, the
statute does not apply to us, but we could elect to be subject
to Section 203 in the future by amending our certificate of
incorporation.
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Amendments to our Certificate of Incorporation and
By-laws |
Except where our board of directors is permitted by law or by
our certificate of incorporation to act without any action by
our stockholders, provisions of our certificate of incorporation
may not be adopted, repealed, altered or amended, in whole or in
part, without the approval of a majority of the outstanding
stock entitled to vote thereon and a majority of the outstanding
stock of each class entitled to vote thereon as a class. The
holders of the outstanding shares of a particular class of our
capital stock are entitled to vote as a class upon any proposed
amendment of our certificate of incorporation that would alter
or change the relative powers, preferences or participating,
optional or other special rights of the shares of such class so
as to affect them adversely relative to the holders of any other
class. Our by-laws may be amended or repealed and new by-laws
may be adopted by a vote of the holders of a majority of the
voting power of our common stock or, except to the extent
relating to stockholders meetings and stockholder action by
written consent, by the board of directors. Any by-laws adopted
or amended by the board of directors may be amended or repealed
by the stockholders entitled to vote thereon.
Indemnification of Directors and Officers and Limitations on
Liability
Our certificate of incorporation and by-laws provide a right to
indemnification to the fullest extent permitted by law to any
person who was or is a party or is threatened to be made a party
to or is involved in any threatened, pending or completed
action, suit or proceeding, whether civil, criminal,
administrative or investigative and whether by or in our right
or otherwise, by reason of the fact that he or she, or a person
of whom he or she is the legal representative, is or was our
director or officer or is or was serving at our request as a
director or officer of another corporation or in a capacity with
comparable authority or responsibilities for any partnership,
joint venture, trust, employee benefit plan or other enterprise,
and that such person will be indemnified and held harmless by us
to the fullest extent authorized by, and subject to
129
the conditions and procedures set forth in the DGCL, against all
judgments, fines, penalties, excise taxes, amounts paid in
settlement and costs, charges and expenses (including
attorneys fees, disbursements and other charges). Our
by-laws authorize us to take steps to ensure that all persons
entitled to the indemnification are properly indemnified,
including, if the board of directors so determines, purchasing
and maintaining insurance.
Our certificate of incorporation provides that none of the
directors shall be personally liable to us or our stockholders
for monetary damages for breach of fiduciary duty as a director,
except liability for:
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any breach of the directors duty of loyalty to us or our
stockholders, |
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acts or omissions not in good faith or which involve intentional
misconduct or a knowing violation of law, |
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the payment of unlawful dividends and unlawful repurchase or
redemption of our capital stock prohibited by the DGCL, and |
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any transaction from which the director derived any improper
personal benefits. |
The effect of this provision of our certificate of incorporation
is to eliminate our rights and the rights of our stockholders to
recover monetary damages against a director for breach of the
fiduciary duty of care as a director, including breaches
resulting from negligent or grossly negligent behavior, except
in the situations described above. This provision does not limit
or eliminate our rights or the rights of any stockholder to seek
non-monetary relief, such as an injunction or rescission in the
event of a breach of a directors duty of care.
Equityholder Agreements
We are a party to an investor equityholders agreement with the
Onex entities and certain of their affiliates, which we refer to
together as the Onex Investors, and certain other equityholders,
whom we refer to together as the Other Investors. The securities
subject to the agreement include the 32,107,500 LP exchangeable
units held by the Onex entities and the 915,750 shares of our
class A common stock and 142,545 shares of
class B common stock held by the Other Investors. Our Other
Investors include all of our named executive officers and our
directors who hold class A common stock. Under this
agreement, until the fifth anniversary of the closing of this
offering, an Other Investors right to sell common stock he
owns immediately prior to this offering, and any shares he
acquires upon the exercise of options he holds immediately prior
to this offering, is limited. An Other Investor may sell up to
12.5% of those shares in the first year following this offering,
increasing 12.5% each year up to a maximum of 50% of his shares
(or, if greater, the percentage of its shares sold by Onex
Partners), plus the number of shares required to pay any
income taxes on the exercise of options. The other substantive
provisions of the investor equityholders agreement will
terminate upon completion of this offering.
We are also a party to an equityholders agreement with the Onex
Investors and certain employee and affiliated physician
investors who hold the class B units subject to this
exchange. Under this agreement, the employees and affiliated
physicians may not sell the class A common stock they will
receive in exchange for their EMS L.P. partnership units
for a period of 180 days after the date of the final
prospectus for this exchange and our initial public offering.
The 232,575 shares of our class A common stock issued
in this exchange are subject to the equityholders agreement.
Certain of these employees are subject to the further
limitations on resale that are applicable to the Other Investors.
Registration Agreement
We are a party to a registration agreement with Onex Partners,
certain Onex affiliates and the Other Investors, including the
management investors. Following the completion of this offering,
stockholders holding 33,165,795 shares of our common stock
and LP exchangeable units will have the right, subject to
various conditions and limitations, to include their shares of
class A common stock in registration statements relating to
our securities. In addition, the Onex entities have the right,
beginning 180 days after the date of this prospectus, on
unlimited occasions, to demand that we register their shares of
our common stock under the Securities Act, subject to certain
limitations. If we propose to register any shares of our common
stock under the Securities Act either for our account or for the
account of any stockholders, the holders having piggyback
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registration rights are entitled to receive notice of such
registration and include their shares of our common stock in any
such registration. These registration rights are subject to
certain conditions and limitations, including the right of the
underwriters of an offering to limit the number of shares of
common stock to be included in a registration. We generally are
required to bear all expenses of such registrations.
Registration of any of the shares of our common stock held by
stockholders with registration rights would result in such
shares becoming freely tradable without restriction under the
Securities Act immediately upon the effectiveness of such
registration.
Holders who have the right to demand registration have agreed
not to exercise this right without the prior consent of Banc of
America Securities LLC and JPMorgan Securities Inc. for a period
of 180 days from the date of this prospectus.
Transfer Agent and Registrar
American Stock Transfer & Trust Company will serve as
our transfer agent and registrar for our class A common
stock. The transfer agents address is American Stock
Transfer & Trust Company, 59 Maiden Lane, New
York, New York 10038 and the telephone number is (800) 937-5449.
Listing
Our class A common stock has been accepted for listing on
the New York Stock Exchange, subject to official notice of
issuance, under the symbol EMS. The class B
common stock, class B special voting stock and
LP exchangeable units will not be listed on any securities
exchange.
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LIMITED PARTNERSHIP AGREEMENT OF EMERGENCY MEDICAL SERVICES
L.P.
The following is a summary of the material provisions of the
EMS L.P. limited partnership agreement, as that agreement
will be in effect upon completion of this exchange and our
initial public offering. We summarize the following provisions
of the partnership agreement under the caption Description
of Capital Stock LP Exchangeable Units and
Class B Special Voting Stock:
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distributions by the partnership, |
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the right of holders of LP exchangeable units to exchange their
units for class B common stock, and |
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the right of holders of LP exchangeable units to exercise
essentially the same voting rights with respect to Emergency
Medical Services as they would have if they had exchanged their
LP exchangeable units for shares of our class B common
stock. |
Overview
We will hold substantially all of our assets, including our
operating assets, through our approximately 22% direct equity
interest in EMS L.P. and EMS L.P.s indirect
ownership of the capital stock of AMR and EmCare. As a result,
we will be a holding company and our only source of
revenue and the only source of funding any
distributions to our holders of class A common
stock will be our ownership interest in
EMS L.P. and distributions from EMS L.P. pursuant to
the EMS L.P. partnership agreement. The Onex entities are
our controlling stockholders through their 96.6% voting power
represented by our class B special voting stock and will
also control us, indirectly, as the general partner of
EMS L.P. The Onex entities hold their interest in us
through their interest in LP exchangeable units, representing
approximately a 78% interest in the EMS L.P. partnership.
As described below, we control the operations of EMS L.P.,
and there are no general voting rights of the holders of LP
exchangeable units. The holders of the LP exchangeable rights
will exercise their voting interest and governance rights in us
through the one share of class B special voting stock. See
Description of Capital Stock LP Exchangeable
Units and Class B Special Voting Stock. All of the
holders of our common stock will exercise their rights in
EMS L.P. through us, as the general partner. Our
partnership interests in EMS L.P. and those of the Onex
entities (through the LP exchangeable units) are structured so
that all of our equity holders hold interests that are
economically equivalent and have the voting rights they would
hold through ownership of our common stock.
The partnership agreement grants no rights to the holders of the
LP exchangeable units to call meetings of the partnership, to
vote upon extraordinary transactions of Emergency Medical
Services (such as mergers, consolidations or the sale of
substantially all of our assets), to receive appraisal or
dissenters rights, to remove and replace us as the general
partner of the partnership, to compel the dissolution or
liquidation of the partnership or to propose or authorize any
amendment to the partnership agreement. As described under the
caption Limited Consent Rights, the
consent of each partner who would be adversely affected is
required for us to authorize certain amendments to the
partnership agreement or to change the form of our business
entity. As a result of these provisions, all of our equity
holders, including our class A common stockholders and the
Onex entities as the holders of LP exchangeable units, control
the EMS L.P. partnership, and any changes to the provisions of
the partnership agreement, through their voting rights in our
capital stock, including the common stock and the class B
special voting stock.
Purpose
The partnership agreement provides that EMS L.P. may engage
in any activities permitted under the applicable Delaware law.
The partnership agreement does not restrict our business
activities and does not require that we conduct all of our
business through EMS L.P.
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Partnership Interests
We will hold the general partner interest in EMS L.P. We will
also hold limited partner units that represent the same
percentage of the partnership as our outstanding common stock
bears to our total outstanding common stock, giving effect to
the exchange of all of the LP exchangeable units for
class B common stock.
The partnership interests of EMS L.P. represented by LP
exchangeable units are intended to be economically equivalent to
our class B common stock on a unit-for-share basis, and the
partnership interests we purchase in EMS L.P. upon a sale
of our common stock are intended to have the economic
equivalence of the number of shares of common stock we issue.
Accordingly, the partnership interests we purchase in
EMS L.P. on the sale of class A common stock in this
offering will be equal to the proportion the newly issued common
stock has to the total of our outstanding common stock, assuming
the exchange of all LP exchangeable units for class B
common stock. As a result, we will purchase an 18.9% interest in
EMS L.P. with the proceeds of this offering and, upon
completion of this offering, we will hold approximately 22% of
the equity interests in EMS L.P.
Management
EMS L.P. is organized as a Delaware limited partnership and
will be governed by the terms of the partnership agreement. The
partnership agreement provides that we, as sole general partner
of the partnership, will have sole and exclusive responsibility
for the management of the business and affairs of the
partnership. No limited partner may take part in the operation,
management or control of the business of the partnership by
virtue of being a holder of LP exchangeable units.
Conflicts of Interest and Fiduciary Duties
We hold all of our operating assets through EMS L.P. and
our cash flow from operations and our dividends to
our stockholders is dependent upon our receipt of
distributions from the partnership. The Onex entities hold their
equity interest in us through LP exchangeable units. Conflicts
of interest may arise in the future as a result of our role as
general partner of EMS L.P., and the fiduciary duties we
owe both to our stockholders and to the holders of LP
exchangeable units. We have tried to limit any conflict through
the provisions of the partnership agreement.
We are accountable both to our stockholders and to the LP
exchangeable unit holders as a fiduciary. Fiduciary duties owed
to our stockholders are prescribed by law. The Delaware law
provides that the fiduciary duties we owe to LP exchangeable
unit holders may be modified by the partnership agreement.
The partnership agreement has been structured to provide to LP
exchangeable unit holders the economic equivalency of a holder
of common stock. To clarify the nature of the fiduciary duty we
owe to the limited partners, the partnership agreement provides
that our duty to those holders will be construed as if
EMS L.P. were a corporation and the unit holders were
stockholders of that corporation. The partnership agreement also
provides that we will have no liability to EMS L.P. or the
limited partners as a result of any errors in judgment or any
act or omission so long as we carried out our duties in
good faith.
Moreover, fiduciary duties are generally considered to include
our obligation to act with loyalty. The duty of loyalty, in the
absence of a provision in the partnership agreement providing
otherwise, would generally prohibit us, as a general partner of
a Delaware limited partnership, from taking any action or
engaging in any transaction where a conflict of interest is
present. The limited partners of EMS L.P. have agreed that,
in the event of any conflict in the fiduciary duties owed by us
to our stockholders and by us, as general partner of the
partnership, to such limited partners, we may act in the best
interests of our stockholders including the holders
of our class A common stock without violating
fiduciary duties to such limited partners or being liable for
any resulting breach of our duties to the limited partners. See
also Exculpation and Indemnification of the
General Partner. We have not modified the fiduciary duty
we owe to our stockholders.
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Transferability of Interests
The partnership agreement provides that we may not voluntarily
withdraw from the partnership, or transfer or assign our
interest in the partnership, except to an affiliate or, in
connection with a merger or similar transaction, to a successor.
The LP exchangeable unit holders may transfer their interests in
EMS L.P. to another limited partner, an affiliate or a
member of the Initial Investor Group, as defined in our
certificate of incorporation. Any transferee must agree to
become a party to the partnership agreement as a limited partner.
Additional Contributions
The partnership agreement provides that, in the event we issue
additional shares of capital stock, we will contribute to
EMS L.P. as an additional capital contribution any net
proceeds from such issuance in exchange for additional
partnership interests with preferences and rights corresponding
to the capital stock we issue.
Holders of LP exchangeable units are not obligated to make
additional capital contributions.
Distributions
The partnership agreement sets forth the manner in which
distributions will be made. See Description of Capital
Stock Common Stock Dividends and
LP Exchangeable Units and Class B Special
Voting Stock.
The distributions to holders of LP exchangeable units are
intended to provide to those holders the economic equivalency of
holders of class B common stock. The holders of the LP
exchangeable units have the right to receive from the
partnership distributions equivalent, on a per share/per unit
basis, to the dividends paid to the holders of the class A
and class B common stock, and no right to any other
distribution. In order to maintain the economic equivalence of
the LP exchangeable units and our common stock, any
distributions to us by EMS L.P. (other than as
reimbursement of our expenses) must be increased to reflect the
assumed amount of the taxes payable by us as a result of our
receipt of that distribution.
Limited Partner Exchange Rights
Pursuant to the partnership agreement, each LP exchangeable unit
may be exchanged at any time for one share of class B
common stock. See LP Exchangeable Units and
Class B Special Voting Stock.
Amendments of the Partnership Agreement
Amendments to the partnership agreement may be proposed and
authorized only by us, as general partner. There is no provision
in the partnership agreement for limited partners to propose or
authorize any amendment to the partnership agreement, and there
is no provision for any meetings of the partners.
Limited Consent Rights
We may not amend the partnership agreement without the consent
of each partner adversely affected if the amendment would:
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convert a limited partners interest into a general
partners interest, |
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modify the limited liability of a limited partner, or |
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alter the right to receive any distributions, or alter or modify
the provisions applicable to the LP exchangeable units. |
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In addition, for us to merge or consolidate the partnership or
convert it into any other form of business entity, we require
the consent of any partner who would be adversely affected.
Rights of Limited Partners
As described above, the holders of LP exchangeable units have
specified distribution and exchange rights, and very limited
rights to consent or withhold consent to certain actions. These
holders are not permitted to propose an amendment to the
partnership agreement, call a meeting of partners or, generally,
vote with respect to any amendment to the partnership agreement.
In exercising our rights we have, as general partner, a
fiduciary duty both to the holders of our common stock and to
the limited partners of EMS L.P., including the holders of
the LP exchangeable units. The following is a summary of the
right of the holders of the LP exchangeable units to authorize
the matters specified:
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Issuance of additional units
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None. |
Amendment of partnership agreement
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None. Consent of each partner adversely affected required in
certain limited circumstances. See Limited
Consent Rights. |
Merger or sale of assets of Emergency Medical Services
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None. |
Removal of general partner
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None. |
Transfer of general partner interest
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None. |
Dissolution of partnership
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None. |
Reconstitution of partnership upon dissolution
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A majority of outstanding LP exchangeable units. |
Exculpation and Indemnification of the General Partner
The partnership agreement generally provides that we, as general
partner, will incur no liability to EMS L.P. or any limited
partner for losses sustained or liabilities incurred as a result
of errors in judgment or of any act or omission if we carried
out our duties in good faith.
The partnership agreement also provides for our indemnification
and indemnification of our directors, officers, employees and
agents from any loss, liability, damage, cost or expense
incurred by such person in connection with our business or
activities or those of EMS L.P., so long as the indemnitee
is not guilty of willful misconduct and was acting in good faith
within what the indemnitee reasonably believed to be the scope
of its authority for a purpose which it reasonably believed to
be not opposed to the interests of EMS L.P.
Merger, Sale or Other Disposition of Assets
The partnership agreement provides that, on a merger of
Emergency Medical Services, a disposition of substantially all
of our assets or a similar transaction, we will use our
reasonable efforts to permit holders of LP exchangeable units to
participate in such transaction to the same extent, and on an
economically equivalent basis, as the holders of our common
stock. The holders of LP exchangeable units have no voting
rights with respect to any such extraordinary transactions
except through their interest in the class B special voting
stock.
Reimbursement of Expenses; Management Agreement with an
Affiliate
The partnership agreement provides that we will not be
compensated for our services as general partner of EMS L.P.
However, we will be reimbursed for all expenses we incur,
including compensation of our employees and the costs and
expenses of being a public company. Under these circumstances,
no comparable distribution will be made to the limited partners
of EMS L.P.
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We are party to a management agreement with an affiliate of Onex
Corporation, pursuant to which we pay an annual management fee
of $1.0 million. The agreement has an initial term of five
years. See Certain Relationships and Related Party
Transactions Management Agreement.
Liquidation or Dissolution
Upon our voluntary or involuntary liquidation, dissolution or
winding up, the holders of the LP exchangeable units are
entitled to receive distributions of assets equivalent to, on a
per share/per unit basis, the distributions to the holders of
class A and class B common stock, and to no other
distribution. We are entitled to receive the balance of the
distribution of assets for distribution to our stockholders.
See Description of Capital Stock Common
Stock Right to Receive Liquidation
Distributions.
Tax Matters
Pursuant to the partnership agreement, we will be the tax
matters partner of EMS L.P. and, as such, will have
authority to make tax elections under the Internal Revenue Code
on behalf of the partnership.
Term
The partnership will continue in full force and effect until
December 15, 2095 or until sooner dissolved pursuant to the
terms of the partnership agreement.
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COMPARISON OF RIGHTS OF EMS L.P. CLASS B UNITHOLDERS AND
EMSC CLASS A STOCKHOLDERS
At the effective time of this exchange, the EMS L.P.
class B unitholders will automatically, and without any
action on the part of the class B unitholders, become EMSC
class A stockholders.
The rights of the class B unitholders are governed by the
Agreement of Limited Partnership of Emergency Medical Services
L.P., or the Partnership Agreement, a copy of which is included
as an exhibit to the registration statement of which this
prospectus is a part, and by the Delaware Revised Uniform
Limited Partnership Act. Delaware law allows partnerships great
flexibility to agree, by contract, on the provisions that govern
the partnership. Accordingly, the rights of the class B
unitholders are principally those set forth in the Partnership
Agreement. The Partnership Agreement will be amended and
restated at the effective time of this exchange. This section
describes the Partnership Agreement applicable to the holders of
class B units, as the Partnership Agreement is currently in
effect.
The rights of the class A stockholders of EMSC are governed
by the Amended and Restated Certificate of Incorporation and the
Amended and Restated By-laws of EMSC, copies of which are
included as exhibits to the registration statement of which this
prospectus is a part, and by the Delaware General Corporation
Law. Delaware law contains a statutory framework for the rights
of a stockholder which may be supplemented or, in some
instances, modified by the corporations certificate of
incorporation and by-laws.
The following are summaries of the material differences between
the rights of EMS L.P. class B unitholders and EMSC
class A stockholders. This is not a complete statement of
the provisions affecting, and the differences between, the
rights of class B unitholders and class A
stockholders. This summary is qualified by reference to the
complete text of the Partnership Agreement and the EMSC charter
documents. For information as to how you can obtain copies of
these documents, please see Where You Can Find More
Information.
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Emergency Medical |
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EMS L.P. |
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Services Corporation |
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Management Control
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The conduct and control of the business and affairs of EMS L.P.
is vested solely in its general partner, EMSC, Inc. |
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EMSC is managed by its board of directors. See
Management. |
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Authorized Equity
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The general partner is authorized to issue additional
class B units of the partnership. |
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The board of directors of EMSC is authorized to issue up
to shares
of class A common
stock, shares
of class B common stock
and shares
of preferred stock. See Description of Capital Stock. |
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Distributions/Dividends
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The general partner may make distributions at the times and in
the amounts determined by the general partner in its sole
discretion.
All distributions are to be made to the partners in accordance
with their respective percentage interests. |
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Delaware law provides that dividends may be paid by a Delaware
corporation either out of (1) surplus or (2) in case
there is no surplus, out of its net profits for the fiscal year
in which the dividend is declared and/or the preceding fiscal
year, except when the capital is diminished to an amount less
than the aggregate amount of capital represented by |
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Emergency Medical |
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EMS L.P. |
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issued and outstanding stock having a preference on the
distribution of assets. |
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Our certificate of incorporation provides that no dividend can
be paid on the class A or class B common stock unless
at the same time an equal dividend is paid on the class A
or class B common stock, as the case may be. See
Dividend Policy and Description of Capital
Stock. |
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Voting Rights
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Holders of the class B units have no voting rights. |
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Holders of the class A common stock are entitled to one
vote per share on all matters on which holders of common stock
of EMSC are entitled to vote. |
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Generally, the holders of our class A common stock,
class B common stock and class B special voting
stock will vote together as a single class. At the completion of
our offering, the class A stockholders will hold 3.0% of
our combined voting power. |
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Holders of class A common stock shall be entitled to vote
as a separate class, in addition to any other vote of
stockholders that may be required, on approval of (i) any
alteration, repeal or amendment of the certificate of
incorporation which would adversely affect the powers,
preferences or rights of the holders of class A common
stock, and (ii) any merger or consolidation of EMSC with
any other entity if, as a result, shares of class B common
stock would be converted into or exchanged for, or receive, any
consideration that differs from that applicable to the shares of
class A common stock as a result of such merger or
consolidation, other than a difference limited to preserving the
relative voting power of the holders of class A common
stock and class B common stock. In |
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Emergency Medical |
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EMS L.P. |
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respect of any of the foregoing matters as to which the holders
of the class A common stock shall be entitled to a class
vote, holders shall have one vote per share and the affirmative
vote of the holders of a majority of the shares of class A
common stock shall be required for approval. See
Description of Capital Stock. |
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Amendment of Governing Documents
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The Partnership Agreement may be amended by the authorization of
general partner and the holders of more than 50% of the
class A units. Holders of class B units are not
entitled to vote on amendments to the Partnership Agreement. |
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Generally, Delaware law provides that a corporation may amend
its certificate of incorporation if (1) its board of
directors has adopted a resolution setting forth the proposed
amendment and declared its advisability, and (2) the
amendment is adopted by the affirmative votes of a majority of
the outstanding shares entitled to vote on the amendment and a
majority of the outstanding stock of each class entitled to vote
on the amendment as a class. Except as described under
Voting Rights, holders of class A common stock
will vote together with holders of class B common stock and
the class B special voting stock on any amendment to our
certificate of incorporation. |
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The by-laws of EMSC may be amended by the affirmative vote of a
majority of the board of directors or by the affirmative vote of
the holders of a majority of the voting power of the outstanding
shares of common stock. See Description of Capital
Stock. |
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Transfer of Units/Shares
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Holders of class B units may not transfer their units
without the prior written consent of the general partner. |
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At any time after the 180th day following our initial
public offering and this exchange, holders of class A
common stock other than our affiliates may freely transfer their
class A common stock, subject in certain limited cases to
contractual restrictions. See Management
Equityholders Agreements and Shares Eligible for
Future Sale. |
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Appraisal or Dissenters Rights
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Holders of the class B units have no appraisal or
dissenters rights in connection with any partnership
transaction. |
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Delaware law provides that in certain transactions, a holder of
any class or series of capital stock has the right, in specified
circumstances, to dissent from a merger or consolidation by
demanding payment in cash for the stockholders shares
equal to the fair value of those shares, as determined by the
Delaware Chancery Court in an action timely brought by the
corporation or a dissenting stockholder. However, no appraisal
rights are available for shares of any class or series that are
listed on a national security exchange, such as the New York
Stock Exchange, or held of record by more than
2,000 stockholders, unless the agreement of merger or
consolidation requires the holders to accept for their shares
anything other than certain specified consideration. |
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Number of Directors
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EMS L.P. is managed directly by its general partner and has
no board of directors. |
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The EMSC by-laws provide that the number of directors will be
determined by resolution of the board of directors, adopted by
the affirmative vote of a majority of the board of directors. |
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Upon completion of this exchange, our board will consist of six
directors. The composition of the board of directors at the
effective time of our initial public offering and this exchange
is described in Management Composition of Our
Board of Directors after this Offering. |
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Appointment and Removal of General Partner/Directors
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There is no provision in the Partnership Agreement for the
removal of the general partner. Upon the withdrawal of the
general partner, a new general partner may be appointed by the
affirmative vote of a majority of the holders of class A
units. |
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Directors may be nominated by the Corporate Governance and
Nominating Committee of the board of directors and appointed
upon the affirmative vote of a majority of the board. See
Description of Capital Stock Filling of Board
Vacancies; Removal. |
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Under Delaware law, directors may be removed with cause by
holders of a majority of the shares entitled |
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Emergency Medical |
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EMS L.P. |
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to vote at an election of directors. Our certificate of
incorporation provides that, so long as the Minimum Hold
Condition is satisfied, any director or the entire board of
directors may also be removed without cause by holders of a
majority of the shares entitled to vote at an election of
directors. |
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Notice of Partner/Stockholder Meeting
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Holders of class B units are not entitled to notice of, or
to attend, any meeting of the partners. |
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Written notice of meetings of stockholders and, in the case of a
special meeting, of the general nature of the business to be
transacted at the meeting, must be given to each stockholder at
least 10 days before the date of the meeting. |
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Fiduciary Duties of the General Partner/Directors
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The Partnership Agreement provides that the general partner has
a fiduciary duty to the limited partners and shall exercise its
power and authority only in such manner as is consistent with
such duty. |
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Under Delaware law, directors of a corporation have fiduciary
obligations to the corporation and its stockholders. These
fiduciary obligations require the directors to act in accordance
with the so-called duties of due care and
loyalty. Under Delaware law, the duty of care
requires that the directors act in good faith, in an informed
and deliberative manner and they inform themselves, prior to
making a business decision, of all material information
reasonably available to them. The duty of loyalty requires a
director to act in good faith in a manner reasonably believed to
be in the best interests of the corporation and its stockholders
and not in their own interests. |
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Indemnification of the General Partner/Directors
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The Partnership Agreement provides that EMS L.P. will indemnify
the general partner, its agents, officers, employees and
directors, and hold them harmless against, any loss, liability
or damage, cost or expense sustained as a result of any act or
omission concerning the partnership or the general partner,
provided that the indemnitee was acting in good faith
within what the indemnitee reasonably believed to be the |
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Delaware law provides that a corporation may indemnify its
present and former directors, officers, employees and agents, as
well as any individual serving with another corporation in that
capacity at the corporations request, against expenses
(including attorneys fees) judgments, fines and amounts
paid in settlement of actions, if the individual acted in good
faith and in a manner reasonably believed to |
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Emergency Medical |
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EMS L.P. |
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Services Corporation |
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scope of its or his authority for a purpose it or he reasonably
believed to be not opposed to the interests of EMS L.P. |
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be in, or not opposed to, the best interests of the corporation
and, in a criminal proceeding, the individual had no reasonable
cause to believe the individuals conduct was unlawful. |
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The EMSC certificate of incorporation and by-laws provide that
EMSC will indemnify its directors to the fullest extent allowed
under Delaware law. In addition, EMSC has entered into
indemnification agreements with each of its directors. See
Description of Capital Stock Indemnification
of Directors and Officers and Limitations on Liability and
Certain Relationships and Related Party
Transactions Indemnification Agreements. |
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The EMSC certificate of incorporation provides that, except to
the extent prohibited by Delaware law, no director shall be
personally liable to EMSC or its stockholders for monetary
damages for any breach of fiduciary duty as a director. |
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Anti-Takeover Provisions
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Pursuant to the transfer restrictions in the Partnership
Agreement, the general partner may withhold its consent to the
transfer of any units. |
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EMSC has expressly elected in its certificate of incorporation
not to be governed by provisions of Delaware law that prohibit,
in certain circumstances, a business combination between the
corporation and an interested stockholder (generally
a person owning or controlling more than 15% of the outstanding
voting stock) within three years of the stockholders becoming an
interested stockholder absent compliance with the
approval requirements of the provisions or other specified
exceptions. See Description of Capital Stock
Anti-Takeover Effects of Our Certificate of Incorporation and
By-Laws. |
142
CERTAIN RELATIONSHIPS AND RELATED PARTY TRANSACTIONS
Since September 2001, we have not engaged in any transactions
valued in excess of $60,000 with any of our executive officers,
directors or holders of more than 5% of our outstanding voting
securities, other than the transactions described below.
Transactions with Laidlaw
Our Acquisition of AMR and EmCare
Pursuant to stock purchase agreements with Laidlaw
International, Inc. and a subsidiary of Laidlaw, on
February 10, 2005 we purchased all of the capital stock of
AMR and EmCare for an aggregate purchase price of
$815.8 million, subject to certain post-closing
adjustments. These adjustments included a decrease to reflect
debt assumed by us and an increase to reflect the increase in
the combined net worth of AMR and EmCare from August 31,
2004 through the date of closing, subject to the contractual
provision that the aggregate purchase price would not be more
than $835.8 million minus outstanding debt we
assumed. For purposes of these adjustments, the closing was
deemed to be effective as of the close of business on
January 31, 2005, and we had the benefit and the risks of
the businesses from that date. The aggregate purchase price we
paid was $826.6 million.
Pursuant to the stock purchase agreement, in March 2005 we
purchased an AMR subsidiary from Laidlaw for a purchase price of
approximately $2.2 million. This deferred purchase enabled
Laidlaw to prepay an outstanding debt obligation of the
subsidiary that was secured by the subsidiarys property.
The purchase price paid to Laidlaw at the closing of the
acquisition had been reduced by approximately $2.2 million.
Accordingly, the aggregate purchase price for the acquisition,
including this subsidiary, was $828.8 million.
The stock purchase agreements contain customary representations,
warranties and covenants. Pursuant to the stock purchase
agreements, we are indemnified by the seller (a subsidiary of
Laidlaw that directly owned AMR and EmCare) and Laidlaw, subject
to specified exceptions, for losses arising from:
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breaches by the seller of its representations, warranties,
covenants and agreements contained in the stock purchase
agreements, |
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damages relating to certain government investigations, and |
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tax liabilities for periods prior to closing. |
Claims for indemnification are subject to an aggregate
deductible equal to 1% of the aggregate purchase price and may
not exceed 15% of the aggregate purchase price (in each case,
without giving effect to any purchase price adjustment), each
subject to certain specified exceptions. Most claims for
indemnification must be made by the date that is 18 months
from the closing date; claims for environmental matters, taxes
and certain healthcare matters may be made for periods ranging
from three years to the applicable statute of limitations
(solely for certain tax matters), and certain representations,
such as those relating to corporate organization and ownership
of the capital stock of AMR and EmCare, do not expire.
Prior to the acquisition, Laidlaw provided various services to
AMR and EmCare, including income tax accounting, preparation of
tax returns, certain risk management/compliance/insurance
coverage services, cash management, certain benefit plan
administration and internal audit, and AMR and EmCare guaranteed
certain Laidlaw debt. See notes 10, 11 and 12 to the audited
combined financial statements included in this prospectus.
Management Bonuses in Connection with Our Acquisition of
AMR and EmCare
In connection with our acquisition of AMR and EmCare, Laidlaw
paid bonuses to Mr. Sanger and Mr. Harvey of
$12,691,032 and $2,270,002, respectively, pursuant to their
employment agreements. Each agreement set forth a formula to
determine the amount of bonus payable in connection with a sale
by Laidlaw of 50% or more of EmCare, in the case of
Mr. Harvey, and of 50% or more of AMR and/or EmCare, in the
case of Mr. Sanger. Also in connection with our acquisition
of AMR and EmCare, Laidlaw
143
paid Mr. Owen, Mr. Zimmerman and Dr. Packard
$200,363, $174,301 and $325,188, respectively, under
Laidlaws equity plan. Pursuant to that plan, in 2003,
units were granted to the named executive officers and other
members of senior management of AMR and EmCare. These units
vested in installments and were valued based upon the difference
between the initial value and the final value of AMR or EmCare,
as applicable. Participation in this plan by AMR and EmCare
management, including the named executive officers, terminated
upon the completion of our acquisition of AMR and EmCare.
Transition Services Agreement
In connection with our acquisition of AMR and EmCare, we entered
into a transition services agreement with Laidlaw. Pursuant to
this agreement:
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we agreed to hire a tax employee who would work for Laidlaw on a
consulting basis, until about December 31, 2005, to assist
in Laidlaws preparation of pre-closing period state and
federal tax returns relating to AMR and EmCare, |
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Laidlaw agreed to make its tax personnel available to us on a
consulting basis until December 31, 2005, and |
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Laidlaw agreed to lease certain Arlington, Texas office space to
us for 120 days at a lease price of $3,500 per month. |
We have paid Laidlaw for tax consulting services on a fixed
hourly rate. Laidlaw agreed to reimburse us for 120% of our tax
employees salary through June 30, 2005 and thereafter
for 75% of the 120% of salary, to pay the out-of-pocket expenses
related to the tax employees services to Laidlaw and to
pay 50% of any search firm fee with respect to the tax employee.
Laidlaw instead decided to utilize its own tax personnel to
complete the tax returns and we did not hire a tax employee for
this purpose. For the eight months ended September 30,
2005, we paid Laidlaw $19,515 under the transition services
agreement.
Performance Bond Arrangement
Certain of AMRs ambulance transport services contracts
require that AMR or its subsidiary post a surety or performance
bond. In the AMR stock purchase agreement, Laidlaw agrees to
continue to provide to us any cash required as collateral to
support the performance bonds in effect at January 31,
2005, and for a three-year period to pay any bond premiums in
excess of the rates in effect at the closing date. We have
agreed to indemnify Laidlaw for any claims against Laidlaw in
connection with these performance bonds. Under this agreement,
at September 30, 2005, Laidlaw continued to hold the
performance bond collateral amount of $14.8 million, which
represents 50% of the face amount of the performance bonds at
January 31, 2005. The cash collateral relating to each bond
will be delivered to us, or to a new surety for our benefit,
when Laidlaw is released from its indemnity obligations with
respect to the outstanding bond; until that release, Laidlaw and
we share equally investment income on the cash collateral.
Risk Financing Program
AMR is party to separate risk financing agreements with Laidlaw
for the period September 1, 1993 to August 31, 2001
and the period September 1, 2003 to the date of the closing
of our acquisition of AMR and EmCare. Pursuant to these
agreements, AMR had insured its workers compensation, auto and
general liability claims through Laidlaws captive
insurance company and participated in Laidlaws group
policies with respect to other types of coverage for occurrences
during the specific period of each agreement.
For the period September 1, 1993 to August 31, 2001,
we are fully-insured for AMRs workers compensation, auto
and general liability programs. We have no further payment
obligation to Laidlaw under that agreement, having previously
made all premium payments, and Laidlaw has agreed to bear the
cost of any claims relating to such claims for this period. For
the period September 1, 2003 to February 10, 2005, we
retain the risk of loss as to the first $2 million of auto
and general liability claims per occurrence and the first
$1 million of workers compensation claims per occurrence,
as a self-insurance program funded through Laidlaws
captive insurance program. AMR had collateral deposited with
Laidlaw totaling approximately
144
$42.2 million at February 10, 2005 and
$35.6 million at September 30, 2005. This collateral
is held in a trust fund owned by Laidlaw, and is applied by
Laidlaw to cover AMRs claims and related expenses. We are
responsible to Laidlaw for any claims costs in excess of the
collateral amount, and any excess collateral will be repaid to
us by Laidlaw. This self-insurance program for the period
September 1, 2003 to February 10, 2005 can be
terminated by either party on 60 days written notice.
See Business American Medical
Response Insurance.
Management Fee Agreement with Onex Partners Manager LP
We are party to a management agreement dated February 10,
2005 with Onex Partners Manager LP, or Onex Manager, a
wholly-owned subsidiary of Onex Corporation. In exchange for an
annual management fee of $1.0 million, Onex Manager
provides us with consulting and management advisory services in
the field of corporate finance and strategic planning and such
other management areas to which the parties agree. The annual
fee may be increased, to a maximum of $2.0 million, with
the approval of directors of each of AMR and EmCare who are not
affiliated with Onex. We also reimburse Onex Manager for
out-of-pocket expenses incurred in connection with the provision
of services pursuant to the agreement, and reimburse Onex
Manager for out-of-pocket expenses incurred in connection with
our acquisition of AMR and EmCare. The management agreement has
an initial term ending February 10, 2010, subject to
automatic one-year renewals, unless terminated by either party
by notice given at least 90 days prior to the scheduled
expiration date.
Issuance of Shares
The following table summarizes the purchases of our common stock
by our directors, executive officers and holders who
beneficially own more than 5% of our outstanding voting
securities. The information in this table, as to the type and
number of shares purchased, gives effect to the exchange of
EMS L.P. partnership units for our common stock to be
effected immediately prior to this offering and assumes the
exchange of all LP exchangeable units for our class B
common stock.
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Date of Purchase |
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5% Holders
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Onex Corporation
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32,107,523 class B |
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$ |
214,050,010 |
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February 10, 2005 |
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Onex Partners LP
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17,226,723 class B |
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$ |
114,844,820 |
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February 10, 2005 |
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Onex Partners LLC
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11,106,924 class B |
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$ |
74,046,160 |
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February 10, 2005 |
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Onex EMSC Co-Invest LP
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2,844,855 class B |
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$ |
18,965,700 |
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February 28, 2005 |
Executive Officers
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William A. Sanger
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450,000 class A |
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3,000,000 |
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February 10, 2005 |
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Don S. Harvey
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75,000 class A |
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$ |
500,000 |
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February 10, 2005 |
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Randel G. Owen
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33,750 class A |
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$ |
225,000 |
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February 10, 2005 |
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Dighton S. Packard, M.D.
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33,750 class A |
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$ |
225,000 |
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February 10, 2005 |
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Todd G. Zimmerman
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18,750 class A |
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$ |
125,000 |
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February 10, 2005 |
Non-Officer Directors
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Robert M. Le Blanc
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56,107 class B |
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$ |
373,981 |
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February 10, 2005 |
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Steven B. Epstein
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37,500 class A |
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$ |
250,000 |
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April 22, 2005 |
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James T. Kelly
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112,500 class A |
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$ |
750,000 |
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March 10, 2005 |
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Michael L. Smith
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37,500 class A |
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$ |
250,000 |
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June 30, 2005 |
Employment Agreements and Indemnification Agreements
We have an employment agreement and an option agreement with
Mr. Sanger, our Chairman and Chief Executive Officer, and
with certain of our other senior executives. For a description,
see Management Employment Agreements.
145
Pursuant to his employment agreement, Mr. Sanger leased
from us a personal residence we purchased when we asked him to
re-locate to Colorado. Mr. Sanger terminated the lease in
May 2005, at which time we sold the residence. As provided in
his employment agreement, in September 2005 we reimbursed
Mr. Sanger for the $463,000 he had spent on leasehold
improvements to the residence.
In November 1999, Texas EM-I Medical Services, P.A., a physician
group affiliated with EmCare, entered into an employment
agreement with Dighton C. Packard, M.D. Dr. Packards
employment agreement automatically renews for successive
two-year terms unless either party gives notice 180 days
prior to the expiration of the then current term.
Dr. Packard has the right to terminate his agreement upon
180 days notice, in which event he agrees to not
compete with Texas EM-I for 12 months following termination
of employment. Under the employment agreement, Dr. Packard
is to receive an annual base salary plus a bonus based on the
performance of the group under the agreements with Baylor
University Medical Center.
We have entered into indemnification agreements with each of our
directors, and our executive employment agreements include
indemnification provisions. Under those agreements, we agree to
indemnify each of these individuals against claims arising out
of events or occurrences related to that individuals
service as our agent or the agent of any of our subsidiaries to
the fullest extent legally permitted. See Description of
Capital Stock Indemnification of Directors and
Officers and Limitations on Liability.
Equityholder Agreements and Registration Agreement
On February 10, 2005, we entered into an investor
equityholders agreement and a registration rights agreement with
certain of our equityholders, including each of the named
executive officers. We are also party to an equityholders
agreement with certain of our employee, affiliated physician,
physician assistant and nurse practitioner equityholders. For a
descriptions of these agreements, see Description of
Capital Stock Equityholder Agreements and
Registration Agreement.
Consulting Agreement with BIDON Companies
On January 16, 2001, EmCare entered into a management
services agreement with BIDON, Inc., the stock of which is owned
by William A. Sanger, Don S. Harvey and a third partner.
Pursuant to the agreement, BIDON provided consulting and
management services to EmCare, including the services of
Messrs. Sanger and Harvey on a substantially full-time
basis. The agreement provided that BIDON was entitled to a
management fee and an incentive bonus, as well as a performance
fee payable upon a change in control of EmCare. The agreement
expired in March 31, 2003 and Messrs. Sanger and
Harvey entered into employment agreements with EmCare at that
time. Pursuant to the agreement, EmCare paid total fees and
bonuses to BIDON, including expense reimbursement, of
$2.6 million and $2.3 million in fiscal 2002 and
fiscal 2003, respectively.
Other Related Party Transactions and Business
Relationships
Assignment of Claim to Existing Equityholders
As we describe elsewhere in this prospectus, our historical
combined financial statements had reflected an understatement of
AMRs accounts receivable allowances, ranging from
$39 million to $50 million at various balance sheet
dates prior to our acquisition of AMR. We believe this
understatement gives rise to claims against Laidlaw and its
subsidiary, Laidlaw Medical Holdings, under the AMR stock
purchase agreement. All of the historical financial information
contained in this prospectus has been revised to reflect correct
accounts receivable allowances. We intend to assign this claim
against Laidlaw and the seller, and any related recovery we may
obtain, to the persons who hold our equity immediately prior to
this offering. Accordingly, persons who hold the class A
common stock we are offering pursuant to this prospectus will
not share in any such recovery.
Relationship with Law Firm
Steven B. Epstein, one of our directors, is a founding member
and the senior health law partner in the Washington, D.C. firm
of Epstein, Becker & Green, P.C., or EBG. EBG provided
healthcare-related legal services to Onex in connection with our
acquisition of AMR and EmCare, and we recently engaged EBG to
provide legal services to us.
146
MATERIAL U.S. FEDERAL INCOME TAX CONSIDERATIONS
The following summary describes certain material federal income
tax consequences arising from the purchase, ownership and
disposition of our class A common stock acquired in this
offering. This discussion does not cover all aspects of
U.S. federal income taxation that may be relevant to each
such holder due to the particular circumstances of such holder
or, except as expressly stated, address estate and gift tax
consequences, state, local or other tax consequences or
non-U.S. tax laws. This summary is based on the provisions
of the Internal Revenue Code of 1986, as amended (the
Code), final, temporary and proposed United States
Treasury regulations promulgated thereunder, and the
administrative and judicial interpretations thereof, all as in
effect as of the date of this prospectus and all of which are
subject to change, possibly with retroactive effect. In
particular, this summary does not address the considerations
that may be applicable to (a) particular classes of
taxpayers, including financial institutions, insurance
companies, small business investment companies, mutual funds,
partnerships or other pass-through entities or investors in such
entities, expatriates, broker-dealers and tax-exempt
organizations, (b) holders with a functional
currency other than the U.S. dollar or
(c) holders of 10% or more of the total combined voting
power of the Companys shares. This summary deals only with
the tax treatment of holders who own our common stock as
capital assets as defined in Section 1221 of
the Code.
THE SUMMARY OF U.S. FEDERAL INCOME TAX CONSIDERATIONS
SET FORTH BELOW IS FOR GENERAL INFORMATION ONLY AND DOES NOT
CONSTITUTE TAX ADVICE. ALL PROSPECTIVE PURCHASERS SHOULD CONSULT
THEIR OWN TAX ADVISORS AS TO THE PARTICULAR TAX CONSEQUENCES TO
THEM OF THE PURCHASE, OWNERSHIP, SALE OR OTHER DISPOSITION OF
SECURITIES INCLUDING THE EFFECTS OF APPLICABLE STATE, LOCAL,
NON-U.S. OR OTHER TAX LAWS, POSSIBLE CHANGES IN THE TAX
LAWS AND THE POSSIBLE APPLICABILITY OF INCOME TAX TREATIES.
As used herein, the term U.S. Holder means a
beneficial owner of our common stock that is for
U.S. federal income tax purposes:
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a U.S. citizen or individual resident in the United States, |
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a corporation, or other entity treated as a corporation created
or organized under the laws of the United States or any
political subdivision thereof, |
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an estate the income of which is subject to U.S. federal
income taxation regardless of its source, or |
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a trust (i) if a U.S. court can exercise primary
supervision over the administration of such trust and one or
more U.S. fiduciaries have the authority to control all of
the substantial interests of such trust or (ii) that has a
valid election in effect under applicable U.S. Treasury
regulations to be treated as a United States person. |
Except as provided below in the discussion of estate tax, the
term Non-U.S. Holder is a beneficial owner of
our common stock that is, for U.S. federal income tax
purposes, a nonresident alien individual or a corporation, trust
or estate that is not a U.S. Holder.
If a partnership, including any entity treated as a partnership
for U.S. federal income tax purposes, is a holder of our
common stock, the tax treatment of a partner in the partnership
will generally depend upon the status of the partner and the
activities of the partnership. If you are a partnership, or a
partner in such a partnership, you should consult your own tax
advisor regarding the tax consequences of the purchase,
ownership and disposition of our common stock.
Dividends
We do not anticipate paying cash dividends on our common stock
in the foreseeable future. See Dividend Policy. If
distributions are paid on shares of our common stock, such
distributions will constitute dividends for U.S. federal
income tax purposes to the extent paid from our current or
accumulated earnings
147
and profits, as determined under U.S. federal income tax
principles. If a distribution exceeds our current and
accumulated earnings and profits, it will constitute a return of
capital that is applied against and reduces, but not below zero,
a holders adjusted tax basis in our common stock. Any
remainder will constitute gain from the deemed sale of the
common stock. See Dispositions.
U.S. Holders. Any dividends payable by us will be
treated as U.S. source dividend income and will be eligible
for the dividends-received deduction generally allowed to
U.S. corporations under Section 243 of the Code
(subject to certain limitations and holding period requirements).
For taxable years ending on or before December 31, 2008,
certain qualified dividend income will be taxable to
a non-corporate U.S. Holder at the special reduced rate
normally applicable to capital gains (subject to certain
limitations). A U.S. Holder will be eligible for this
reduced rate only if it has held our common stock for more than
60 days during the 121-day period beginning 60 days
before the ex-dividend date.
Non-U.S. Holders. The dividends on our common stock
paid to a Non-U.S. Holder generally will be subject to
withholding of U.S. federal income tax at a 30% rate on the
gross amount of the dividend or such lower rate as may be
provided by an applicable income tax treaty. Dividends that are
effectively connected with a Non-U.S. Holders conduct
of a trade or business in the United States and, if a tax treaty
applies, attributable to a permanent establishment or fixed base
in the United States, known as U.S. trade or business
income, are generally not subject to the 30% withholding
tax if the Non-U.S. Holder files the appropriate
U.S. Internal Revenue Service form with the payor. However,
such U.S. trade or business income, net of specified
deductions and credits, generally is taxed at the same graduated
rates as applicable to U.S. persons. Any U.S. trade or
business income received by a Non-U.S. Holder that is a
corporation may also, under certain circumstances, be subject to
an additional branch profits tax at a 30% rate or
such lower rate as specified by an applicable income tax treaty.
A Non-U.S. Holder that claims the benefit of an applicable
income tax treaty generally will be required to satisfy
applicable certification and other requirements prior to the
distribution date. Non-U.S. Holders should consult their
tax advisors regarding their entitlement to benefits under a
relevant income tax treaty.
A Non-U.S. Holder that is eligible for a reduced rate of
U.S. federal withholding tax or other exclusion from
withholding under an income tax treaty but that did not timely
provide required certifications or other requirements, or that
has received a distribution subject to withholding in excess of
the amount properly treated as a dividend, may obtain a refund
or credit of any excess amounts withheld by timely filing an
appropriate claim for refund with the U.S. Internal Revenue
Service.
Dispositions
U.S. Holders. A U.S. Holder will recognize gain
or loss for U.S. federal income tax purposes upon the sale
or other disposition of our common stock in an amount equal to
the difference between the amount realized and the
U.S. Holders adjusted tax basis for such stock. Such
gain or loss will be capital gain or loss and will be long-term
capital gain or loss if the stock had been held for more than
one year. If the U.S. Holders holding period on the
date of the sale or exchange is one year or less, such gain or
loss will be short-term capital gain or loss. However, if a
U.S. Holder has received a dividend to which the special
reduced rate of tax, discussed above, applies, and which exceeds
10% of the U.S. Holders basis for the stock (taking
into account certain rules that aggregate dividends for this
purpose), any loss on sale or other disposition generally will
be a long-term capital loss to the extent of that dividend,
regardless of the U.S. Holders actual holding period.
Any gain or loss recognized on the sale or other disposition of
our common stock will generally be U.S. source income. Any
capital loss realized upon sale, exchange or other disposition
of our common stock is generally deductible only against capital
gains and not against ordinary income, except that in the case
of noncorporate taxpayers, a capital loss may be deductible to
the extent of capital gains plus ordinary income of up to $3,000.
148
A U.S. Holders tax basis for his, her or its shares
of our common stock will generally be the purchase price paid
therefor by such U.S. Holder (reduced by amounts of any
distributions, in excess of earnings and profits of the Company,
received by such U.S. Holder). The holding period of each
share of our common stock owned by a U.S. Holder will
commence on the day following the date of the
U.S. Holders purchase of such share and will include
the day on which the share is sold by such U.S. Holder.
Non-U.S. Holders. A Non-U.S. Holder generally
will not be subject to U.S. federal income tax (or
withholding thereof) on gain recognized on a disposition of our
common stock unless:
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the gain is U.S. trade or business income, in which case
such gain generally will be taxed in the same manner as gains of
U.S. persons, and such gains may also be subject to the
branch profits tax in the case of a corporate
Non-U.S. Holder; |
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the Non-U.S. Holder is an individual who is present in the
United States for more than 182 days in the taxable year of
the disposition and who meets certain other requirements, in
which case such holder generally will be subject to
U.S. federal income tax at a rate of 30% (or a reduced rate
under an applicable treaty) on the amount by which capital gains
allocable to U.S. sources (including gains from the sale,
exchange, retirement or other disposition of the common stock)
exceed capital losses allocable to U.S. sources; or |
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we are or have been a U.S. real property holding
corporation for U.S. federal income tax purposes at
any time during the shorter of the five-year period ending on
the date of disposition or the period that the
Non-U.S. Holder held our common stock (the applicable
period). |
Generally, a corporation is a U.S. real property
holding corporation if the fair market value of its
U.S. real property interests equals or exceeds
50% of the sum of the fair market value of its worldwide real
property interests plus its other assets used or held for use in
a trade or business. The tax relating to stock in a
U.S. real property holding corporation
generally will not apply to a Non-U.S. Holder whose
holdings, actual or constructive, at all times during the
applicable period, constituted 5% or less of our common stock,
provided that our common stock was regularly traded on an
established securities market. We believe we have never been,
are not currently and are not likely to become a U.S. real
property holding corporation for U.S. federal income tax
purposes in the future.
Information Reporting and Backup Withholding. We must
report annually to the U.S. Internal Revenue Service and to
each holder the amount of dividends paid to that holder and the
tax withheld with respect to those dividends. Copies of the
information returns reporting those dividends and the amount of
tax withheld may also be made available to the tax authorities
in the country in which a Non-U.S. Holder is a resident
under the provisions of an applicable income tax treaty.
Backup withholding, currently imposed at a rate of 28%, may
apply to payments of dividends paid by us. If you are a
U.S. Holder, backup withholding will apply if you fail to
provide an accurate taxpayer identification number or
certification of exempt status or fail to report all interest
and dividends required to be shown on your federal income tax
returns. Certain U.S. Holders (including, among others,
corporations) are not subject to backup withholding.
If you are a Non-U.S. Holder, backup withholding will apply
to dividend payments if you fail to provide us with the required
certification that you are not a U.S. person.
Payments of the proceeds from a disposition (including a
redemption) effected outside the United States by or through a
non-US. broker generally will not be subject to information
reporting or backup withholding. However, information reporting,
but generally not backup withholding, will apply to such a
payment if the broker has certain connections with the United
States unless the broker has documentary evidence in its records
that the beneficial owner of the disposed stock is a
Non-U.S. Holder and either specified conditions are met or
an exemption is otherwise established. Backup withholding and
information reporting will apply to dispositions made by or
through a U.S. office of any broker (U.S. or foreign).
149
Backup withholding is not an additional tax. Any amounts
withheld from a payment to you that result in an overpayment of
taxes generally will be refunded, or credited against your
U.S. federal income tax liability, if any, provided that
the required information is timely furnished to the
U.S. Internal Revenue Service.
Holders should consult their own tax advisors regarding
application of backup withholding in their particular
circumstance and the availability of, and procedure for
obtaining, an exemption from backup withholding under current
U.S. Treasury regulations.
Federal Estate Tax. Common stock owned or treated as
owned by an individual who is a Non-U.S. Holder (as specifically
defined for U.S. federal estate tax purposes) at the time
of death will be included in such individuals gross estate
for U.S. federal estate tax purposes, unless an applicable
treaty provides otherwise.
Tax Consequences of the Exchange
Holders of the class B units of EMS L.P. will not
recognize gain or loss for federal income tax purposes on the
exchange of those units for class A common stock of EMSC.
Their basis for the shares of class A common stock that
they receive in that exchange will equal their basis for their
class B units immediately before the exchange.
EMS L.P.s tax basis for its shares of stock of
AMR HoldCo and EmCare HoldCo will be unaffected by the
exchange. EMSCs tax basis for the class B units of
EMS L.P. that EMSC receives in the exchange will equal the
exchanging holders tax basis for such units immediately
before the exchange.
150
SHARES ELIGIBLE FOR FUTURE SALE
Prior to our offering, there has been no public market for our
class A common stock, and we cannot assure you that a
significant public market for our class A common stock will
develop or be sustained after this offering. Sales of
significant amounts of our class A common stock in the
public market after this offering, including shares of our
class A common stock issued upon exercise of outstanding
options or exchange of our LP exchangeable units for our
class B common stock and conversion into class A
common stock, or the perception that such sales could occur,
could adversely affect the prevailing market price of our
class A common stock and could impair our future ability to
raise capital through the sale of our equity securities.
Sale of Restricted Shares and Lock-Up Agreements
Upon completion of this exchange and our offering,
8,948,325 shares of class A common stock
142,545 shares of class B common stock and 32,107,500
LP exchangeable units will be outstanding, assuming no
exercise of the underwriters over-allotment option.
Of the 8,948,325 shares of class A common stock to be
outstanding upon completion of our offering,
7,800,000 shares of class A common stock offered
pursuant to our offering, or 8,970,000 shares if the
underwriters option is exercised in full, will be freely
tradable without restriction or further registration under
federal securities laws except to the extent shares of
class A common stock are purchased in our offering by our
affiliates, as that term is defined in Rule 144 under the
Securities Act.
Our issuance of 1,148,325 shares of our class A common
stock to holders of EMS L.P. partnership units in connection
with our formation as a holding company is registered by this
prospectus included with the registration statement filed for
our initial public offering. Of these shares,
349,575 shares will be issued to persons who are not our
affiliates and will be freely tradeable, subject to a
contractual prohibition against the transfer of these shares for
a period of 180 days after the date of the final prospectus
for this exchange and our offering.
The remaining 798,750 shares of class A common stock
outstanding, which are held by our affiliates, the
142,545 shares of class B common stock and all of our
LP exchangeable units are restricted securities
under the Securities Act. These shares of class A common
stock, as well as the 32,250,045 shares of class A
common stock issuable on conversion of class B common
stock, are, or when issued on conversion will be, eligible for
public sale if registered under the Securities Act or sold in
accordance with Rule 144 of the Securities Act, subject to
the contractual provisions of our equityholders agreements. See
Description of Capital Stock Equityholder
Agreements. All of our common stock and
LP exchangeable units, held by our existing stockholders is
subject to market stand-off provisions that prohibit their sale
for a period of 180 days after the date of our final
prospectus. In addition, Onex, our executive officers and
directors and certain of our other existing stockholders, who
hold in the aggregate 33,048,795 shares of our common stock
(giving effect to the exchange of the LP exchangeable
units), are subject to various lock-up agreements that prohibit
the holders from offering, selling, contracting to sell,
granting an option to purchase, making a short sale or otherwise
disposing of any shares of our common stock or any option to
purchase shares of our common stock or any securities
exchangeable for or convertible into shares of common stock for
a period of 180 days after the date of our final prospectus
without the prior written consent of Banc of America Securities
LLC. Banc of America Securities LLC, in its discretion and at
any time without notice, may release all or any portion of our
common stock held by our officers, directors and existing
stockholders subject to these lock-up agreements. Banc of
America Securities LLC has agreed with J.P. Morgan
Securities Inc. that it will not, without the consent of
J.P. Morgan Securities Inc., exercise its discretion to
release all or any portion of our common stock held by our
officers, directors and existing stockholders subject to these
lock-up agreements.
151
As a result of the agreements described above, the registration
of our class A common stock issued in connection with our
formation as a holding company and the provisions of
Rule 144 of the Securities Act, 33,398,370 shares of
our class A common stock will be available for sale in the
public market as follows:
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349,575 shares will be eligible for sale beginning
180 days after the date of the final prospectus for this
exchange and our offering subject to an extension in certain
circumstances as set forth in the section entitled
Underwriting Lock-up Agreements, |
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798,750 shares held by our executive officers and directors
will be eligible for sale under Rule 144 commencing
one-year from the date of this offering, or, if earlier, after
the shares are registered under the Securities Act, |
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142,545 shares issuable on conversion of our currently
outstanding class B common stock will be eligible for sale under
Rule 144 commencing one year from the date of such
conversion or, if earlier, after the resale is registered under
the Securities Act, and |
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32,107,500 shares will be eligible for sale under
Rule 144 one year from the date of the exchange of the LP
exchangeable units for class B common stock and the conversion
of the class B common stock for class A common stock or, if
earlier, after the exchange or the resale of the shares is
registered under the Securities Act. |
Rule 144
In general, Rule 144 allows a stockholder (or stockholders
where shares are aggregated) who has beneficially owned shares
of our class A common stock for at least one year and who
files a Form 144 with the SEC to sell within any
three-month period a number of those shares that does not exceed
the greater of:
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1% of the number of shares of our class A common stock then
outstanding, which will equal 89,483 shares immediately
after this offering, assuming no exercise of the
underwriters over-allotment option, or |
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the average weekly trading volume of our class A common
stock during the four calendar weeks preceding the filing of the
Form 144 with respect to such sale. |
Registration Rights
As described above in Description of Capital
Stock Registration Agreement, upon completion
of this offering, the holders of approximately
33,165,795 shares of our common stock will have the right,
subject to various conditions and limitations, to demand the
filing of, and include their shares in, registration statements
relating to our common stock, subject to the 180-day lock-up
arrangement described above. These registration rights of our
stockholders could impair the prevailing market price and impair
our ability to raise capital by depressing the price at which we
could sell our class A common stock.
Options
In addition to the 8,948,325 shares of class A common
stock outstanding immediately after this offering, as of the
date of this prospectus, there were outstanding options to
purchase 3,509,219 shares of our class A common stock.
None of these options are currently exercisable.
As soon as practicable after the completion of this offering, we
intend to file a registration statement on Form S-8 under
the Securities Act covering shares of our class A common
stock reserved for issuance under our equity option plan.
Accordingly, shares of our class A common stock registered
under such registration statement will be available for sale in
the open market upon exercise by the holders, subject to vesting
restrictions, Rule 144 limitations applicable to our
affiliates and the contractual lock-up and market stand-off
provisions described above.
152
PLAN OF DISTRIBUTION
We are issuing the shares of class A common stock described
in this prospectus in exchange for class B units of
EMS L.P. as part of our formation as the holding company of
EMS L.P. See Formation of Holding Company.
Pursuant to the EMS L.P. agreement of limited partnership,
all of the outstanding class B units of EMS L.P. are
being contributed by the holders to Emergency Medical Services
in exchange for shares of our class A common stock. In
consideration of their contribution of class B units to us,
holders of the class B units will receive 1.5 shares
of our class A common stock in exchange for each
class B unit of EMS L.P. they hold.
All of the shares of class A common stock we are issuing in
this exchange are subject to the provisions of an equityholders
agreement among EMS L.P. and certain of its equityholders.
The class A common stock will be freely tradable, subject
to the prohibition in the equityholders agreement on the
transfer of these shares for a period of 180 days after the
date of the final prospectus for this exchange and our initial
public offering, and further restrictions applicable to certain
holders. In addition, the 798,750 shares of our
class A common stock received by our affiliates in this
exchange are subject to resale restrictions under the Securities
Act and under agreements with the underwriters of our initial
public offering.
We will not receive any cash proceeds from this exchange. The
units representing limited partnership interests in
EMS L.P. that we receive in exchange for shares of our
class A common stock will be held by us.
We are effecting this exchange concurrently with the completion
of our initial public offering of our class A common stock.
We will pay the expenses of this exchange, which we estimate to
be approximately $200,000.
153
LEGAL MATTERS
The validity of the shares of class A common stock offered
hereby and certain other legal matters will be passed upon for
us by Kaye Scholer LLP, New York, New York. Certain regulatory
matters will be passed upon for us by Foley & Lardner
LLP, San Diego, California.
EXPERTS
The balance sheet of Emergency Medical Services Corporation as
of November 10, 2005 end the combined financial statements
of American Medical Response, Inc. and its subsidiaries and
EmCare Holdings Inc. and its subsidiaries for the year ended
August 31, 2002 (Predecessor), the nine months ended
May 31, 2003 (Predecessor), and as of and for the three
months ended August 31, 2003, the year ended
August 31, 2004 and the five months ended January 31,
2005 included in this prospectus, have been so included in
reliance on the reports (which contain an explanatory paragraph
relating to the companies restatement of their combined
financial statements, as well as the parents emergence
from bankruptcy as described in Note 1) of
PricewaterhouseCoopers LLP, an independent registered public
accounting firm, given on the authority of said firm as experts
in auditing and accounting.
WHERE YOU CAN FIND MORE INFORMATION
We have filed a registration statement on Form S-1 with the
Securities and Exchange Commission under the Securities Act with
respect to the shares of class A common stock offered by
this prospectus. This prospectus, which constitutes a part of
the registration statement, does not contain all of the
information included in the registration statement or the
schedules, exhibits and amendments to the registration
statement. You should refer to the registration statement and
its exhibits and schedules for further information. Statements
made in this prospectus as to any of our contracts, agreements
or other documents referred to are not necessarily complete. In
each instance, if we have filed a copy of such contract,
agreement or other document as an exhibit to the registration
statement, you should read the exhibit for a more complete
understanding of the matter involved. Each statement regarding a
contract, agreement or other document is qualified in all
respects by reference to the actual document.
You may read and copy information omitted from this prospectus
but contained in the registration statement at the public
reference facilities maintained by the SEC at
100 F Street, N.E., Washington, DC 20549.
You may also request copies of all or any portion of such
material from the Public Reference Section of the SEC at 100 F
Street, N.E., Washington, DC 20549 at prescribed rates.
Please call the Securities and Exchange Commission at
1-800-SEC-0330 for further information on the operation of the
public reference rooms. In addition, materials filed
electronically with the SEC are available at the SECs
World Wide Web site at http://www.sec.gov.
Upon completion of this exchange, we will become subject to the
information and periodic reporting requirements of the
Securities Exchange Act of 1934, and, in accordance therewith,
will file periodic reports, proxy statements and other
information with the SEC. Such periodic reports, proxy
statements and other information will be available for
inspection and copying at the public reference room and web site
of the SEC referred to above. We also intend to furnish our
stockholders with annual reports containing our financial
statements audited by an independent public accounting firm and
quarterly reports containing our unaudited financial
information. We maintain a web site at www.emsc.net. You
may access our annual report on Form 10-K, quarterly
reports on Form 10-Q, current reports on Form 8-K, and
amendments to those reports, filed or furnished pursuant to
section 13(a) or 15(d) of the Exchange Act with the SEC
free of charge at our web site as soon as reasonably practicable
after this material is electronically filed with, or furnished
to, the SEC. The reference to our web address does not
constitute incorporation by reference of the information
contained at that site.
154
AMERICAN MEDICAL RESPONSE, INC. & EMCARE HOLDINGS
INC.
INDEX TO COMBINED AND CONSOLIDATED FINANCIAL STATEMENTS
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Page | |
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Combined Financial Statements (as Restated) for the Five
Months Ended January 31, 2005, for the Year Ended
August 31, 2004, for the Three Months Ended August 31,
2003, for the Nine Months Ended May 31, 2003 (Predecessor)
for the Year Ended August 31, 2002 (Predecessor)
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Report of Independent Registered Public Accounting Firm
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F-2 |
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Combined Balance Sheets at January 31, 2005,
August 31, 2004 and 2003
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F-5 |
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Combined Statements of Operations and Comprehensive Income
(Loss) for the five months ended January 31, 2005, for the
year ended August 31, 2004, for the three months ended
August 31, 2003, for the nine months ended May 31,
2003 (Predecessor) and for the year ended August 31, 2002
(Predecessor)
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F-6 |
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Statements of Changes in Combined Equity for the five months
ended January 31, 2005, for the year ended August 31,
2004, for the three months ended August 31, 2003, for the
nine months ended May 31, 2003 (Predecessor) and for the
year ended August 31, 2002 (Predecessor)
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F-7 |
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Combined Statements of Cash Flows for the five months ended
January 31, 2005, for the year ended August 31, 2004,
for the three months ended August 31, 2003, for the nine
months ended May 31, 2003 (Predecessor) and for the year
ended August 31, 2002 (Predecessor)
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F-8 |
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Notes to Combined Financial Statements
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F-9 |
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Unaudited Consolidated/ Combined Financial Statements for the
Three Months and Eight Months Ended September 30, 2005 and
September 30, 2004
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Unaudited Consolidated Balance Sheet at September 30, 2005
and Combined Balance Sheet at January 31, 2005
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F-50 |
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Unaudited Consolidated/ Combined Statements of Operations and
Comprehensive Income for the three months and eight months ended
September 30, 2005 and 2004
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F-51 |
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Unaudited Consolidated/Combined Statements of Cash Flows for
eight months ended September 30, 2005 and 2004
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F-52 |
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Notes to Unaudited Consolidated/ Combined Financial Statements
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F-53 |
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EMERGENCY MEDICAL SERVICES CORPORATION
INDEX TO FINANCIAL STATEMENTS
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Financial Statements at November 10, 2005
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Report of Independent Registered Public Accounting Firm
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F-70 |
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Balance Sheet at November 10, 2005
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F-72 |
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Notes to Financial Statements
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F-73 |
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F-1
REPORT OF INDEPENDENT REGISTERED PUBLIC ACCOUNTING FIRM
To the Stockholders of American Medical Response, Inc.
and EmCare Holdings, Inc.:
In our opinion, the accompanying combined balance sheets
(successor basis) and the related combined statements of
operations and comprehensive income (loss) (successor basis),
changes in combined equity (successor basis) and cash flows
(successor basis) present fairly, in all material respects, the
financial position of American Medical Response, Inc. and its
subsidiaries (AMR) and EmCare Holdings, Inc. and its
subsidiaries (EmCare) (collectively, the
Company) as of January 31, 2005 and
August 31, 2004 and 2003 and the results of their
operations and changes in combined equity and cash flows for the
five-month period ended January 31, 2005, for the year
ended August 31, 2004 and for the three-month period ended
August 31, 2003, in conformity with accounting principles
generally accepted in the United States of America. These
combined financial statements are the responsibility of the AMR
and EmCare management; our responsibility is to express an
opinion on these financial statements based on our audits. We
conducted our audits of these statements in accordance with the
standards of the Public Company Accounting Oversight Board
(United States). Those standards require that we plan and
perform the audit to obtain reasonable assurance about whether
the financial statements are free of material misstatement. An
audit includes examining, on a test basis, evidence supporting
the amounts and disclosures in the financial statements,
assessing the accounting principles used and significant
estimates made by management, and evaluating the overall
financial statement presentation. We believe that our audits
provide a reasonable basis for our opinion.
As discussed in Note 1 to the combined financial
statements, AMR and EmCare are wholly-owned subsidiaries of
Laidlaw International, Inc., previously Laidlaw, Inc.
(Laidlaw). The United States Bankruptcy Court for
the Western District for New York confirmed Laidlaws Third
Amended Plan of Reorganization (the plan) on
February 27, 2003. Confirmation of the plan resulted in the
discharge of all claims against Laidlaw that arose on or before
June 28, 2001 and terminated all rights and interest of
equity security holders as provided for in the plan. The plan
was implemented in June 2003 and Laidlaw emerged from
bankruptcy. In connection with its emergence from bankruptcy,
Laidlaw adopted fresh-start accounting and recorded fresh-start
accounting adjustments in the separate financial statements of
AMR and EmCare on June 1, 2003. As a result, the
Companys post-emergence (successor basis) financial
statements reflect a different basis of accounting than its
pre-emergence (predecessor basis) financial statements.
As discussed in Note 1 to the combined financial
statements, the Company has restated its financial statements as
of August 31, 2004 and 2003.
PricewaterhouseCoopers LLP
Denver, Colorado
August 1, 2005, except as to the information disclosed in
Note 17, as to which the date is October 7, 2005
F-2
REPORT OF INDEPENDENT REGISTERED PUBLIC ACCOUNTING FIRM
To the Stockholders of American Medical Response, Inc.
and EmCare Holdings, Inc.:
In our opinion, the accompanying combined statements of
operations and comprehensive income (loss) (predecessor basis),
changes in combined equity (predecessor basis) and cash flows
(predecessor basis) present fairly, in all material respects,
the results of operations and changes in combined equity and
cash flows of American Medical Response, Inc. and its
subsidiaries (AMR) and EmCare Holdings, Inc. and its
subsidiaries (EmCare) (collectively, the
Company) for the nine-month period ended
May 31, 2003, and for the year ended August 31, 2002,
in conformity with accounting principles generally accepted in
the United States of America. These combined financial
statements are the responsibility of the AMR and EmCare
management; our responsibility is to express an opinion on these
financial statements based on our audits. We conducted our
audits of these statements in accordance with the standards of
the Public Company Accounting Oversight Board (United States).
Those standards require that we plan and perform the audit to
obtain reasonable assurance about whether the financial
statements are free of material misstatement. An audit includes
examining, on a test basis, evidence supporting the amounts and
disclosures in the financial statements, assessing the
accounting principles used and significant estimates made by
management, and evaluating the overall financial statement
presentation. We believe that our audits provide a reasonable
basis for our opinion.
As discussed in Note 1 to the combined financial
statements, AMR and EmCare are wholly-owned subsidiaries of
Laidlaw International, Inc., previously Laidlaw, Inc.
(Laidlaw). The United States Bankruptcy Court for
the Western District of New York confirmed Laidlaws Third
Amended Plan of Reorganization (the plan) on
February 27, 2003. Confirmation of the plan resulted in the
discharge of all claims against Laidlaw that arose on or before
June 28, 2001 and terminated all rights and interest of
equity security holders as provided for in the plan. The plan
was implemented in June 2003 and Laidlaw emerged from
bankruptcy. In connection with its emergence from bankruptcy,
Laidlaw adopted fresh-start accounting and recorded fresh-start
accounting adjustments in the separate financial statements of
AMR and EmCare on June 1, 2003. As a result, the
Companys post-emergence (successor basis) financial
statements reflect a different basis of accounting than its
pre-emergence (predecessor basis) financial statements.
As discussed in Note 2 to the combined financial
statements, on September 1, 2002, AMR and EmCare changed
their method of accounting for goodwill.
As discussed in Note 1 to the combined financial
statements, the Company has restated its financial statements
for the nine-month period ended May 31, 2003 and the year
ended August 31, 2002.
PricewaterhouseCoopers LLP
Denver, Colorado
January 14, 2005, except as to the restatement described in
Note 1, as to which the date is August 1, 2005 and as
to the information disclosed in Note 17, as to which the
date is October 7, 2005
F-3
American Medical Response, Inc.
& EmCare Holdings Inc.
(The Healthcare Transportation and Emergency Management
Services
Businesses of Laidlaw International, Inc.)
Combined Financial Statements
January 31, 2005 and August 31, 2004 and 2003 (as
restated)
F-4
American Medical Response, Inc. and EmCare Holdings Inc.
(The Healthcare Transportation and Emergency Management
Services
Businesses of Laidlaw International, Inc.)
Combined Balance Sheets
January 31, 2005, August 31, 2004 and 2003
(dollars in thousands)
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As Restated | |
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See Note 1 | |
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January 31, | |
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August 31, | |
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August 31, | |
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2005 | |
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2004 | |
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2003 | |
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ASSETS |
Current assets:
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Cash and cash equivalents
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$ |
14,631 |
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$ |
9,476 |
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$ |
10,641 |
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Restricted cash and cash equivalents
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|
9,846 |
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5,691 |
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|
939 |
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Restricted marketable securities
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|
2,473 |
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|
6,756 |
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|
|
201 |
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|
Trade and other accounts receivable, net
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|
369,767 |
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|
|
344,210 |
|
|
|
320,452 |
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Parts and supplies inventory
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|
18,499 |
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|
|
18,577 |
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|
17,444 |
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Prepaids and other current assets
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|
40,135 |
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|
|
32,015 |
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|
32,207 |
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Current deferred tax assets
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|
65,092 |
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|
52,981 |
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58,836 |
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Current assets
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520,443 |
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469,706 |
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440,720 |
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Non-current assets:
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Property, plant and equipment, net
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128,766 |
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132,685 |
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133,546 |
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Intangible assets, net
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16,075 |
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|
|
15,758 |
|
|
|
148,205 |
|
|
Non-current deferred tax assets
|
|
|
202,469 |
|
|
|
214,389 |
|
|
|
96,596 |
|
|
Restricted long-term investments
|
|
|
41,810 |
|
|
|
47,285 |
|
|
|
40,608 |
|
|
Other long-term assets
|
|
|
73,947 |
|
|
|
69,776 |
|
|
|
55,071 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Assets
|
|
$ |
983,510 |
|
|
$ |
949,599 |
|
|
$ |
914,746 |
|
|
|
|
|
|
|
|
|
|
|
|
LIABILITIES AND COMBINED EQUITY |
Current liabilities:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Accounts payable
|
|
$ |
55,818 |
|
|
$ |
50,915 |
|
|
$ |
50,182 |
|
|
Accrued liabilities
|
|
|
171,645 |
|
|
|
166,784 |
|
|
|
146,179 |
|
|
Current portion of long-term debt
|
|
|
5,846 |
|
|
|
7,565 |
|
|
|
8,270 |
|
|
|
|
|
|
|
|
|
|
|
|
|
Current liabilities
|
|
|
233,309 |
|
|
|
225,264 |
|
|
|
204,631 |
|
|
Long-term debt
|
|
|
5,651 |
|
|
|
7,915 |
|
|
|
15,787 |
|
|
Other long-term liabilities
|
|
|
146,273 |
|
|
|
142,580 |
|
|
|
133,789 |
|
|
|
|
|
|
|
|
|
|
|
|
|
Liabilities
|
|
|
385,233 |
|
|
|
375,759 |
|
|
|
354,207 |
|
|
|
|
|
|
|
|
|
|
|
Commitments and contingencies (notes 7, 9 and 10)
|
|
|
|
|
|
|
|
|
|
|
|
|
Laidlaw payable
|
|
|
202,042 |
|
|
|
186,778 |
|
|
|
22,416 |
|
Laidlaw investment
|
|
|
356,550 |
|
|
|
356,550 |
|
|
|
546,144 |
|
Retained earnings (deficit)
|
|
|
40,000 |
|
|
|
30,518 |
|
|
|
(6,831 |
) |
Comprehensive loss
|
|
|
(315 |
) |
|
|
(6 |
) |
|
|
(1,190 |
) |
|
|
|
|
|
|
|
|
|
|
|
|
Combined equity
|
|
|
598,277 |
|
|
|
573,840 |
|
|
|
560,539 |
|
|
|
|
|
|
|
|
|
|
|
|
|
Liabilities and combined equity
|
|
$ |
983,510 |
|
|
$ |
949,599 |
|
|
$ |
914,746 |
|
|
|
|
|
|
|
|
|
|
|
The accompanying notes are an integral part of these combined
financial statements.
F-5
American Medical Response, Inc. and EmCare Holdings Inc.
(The Healthcare Transportation and Emergency Management
Services
Businesses of Laidlaw International, Inc.)
Combined Statements of Operations and Comprehensive Income
(Loss)
For the Five Months Ended January 31, 2005, for the Year
Ended August 31, 2004, for the Three Months Ended
August 31, 2003, for the Nine Months Ended May 31,
2003 (Predecessor) and for the Year Ended August 31, 2002
(Predecessor)
(dollars in thousands)
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Predecessor as Restated | |
|
|
|
|
|
|
|
|
|
See note 1 | |
|
|
Five | |
|
|
|
Three | |
|
|
| |
|
|
Months | |
|
Year | |
|
Months | |
|
|
Nine Months | |
|
Year | |
|
|
Ended | |
|
Ended | |
|
Ended | |
|
|
Ended | |
|
Ended | |
|
|
January 31, | |
|
August 31, | |
|
August 31, | |
|
|
May 31, | |
|
August 31, | |
|
|
2005 | |
|
2004 | |
|
2003 | |
|
|
2003 | |
|
2002 | |
|
|
| |
|
| |
|
| |
|
|
| |
|
| |
Net revenue
|
|
$ |
696,179 |
|
|
$ |
1,604,598 |
|
|
$ |
384,461 |
|
|
|
$ |
1,103,335 |
|
|
$ |
1,415,786 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Compensation and benefits
|
|
|
481,305 |
|
|
|
1,117,890 |
|
|
|
264,604 |
|
|
|
|
757,183 |
|
|
|
960,590 |
|
Operating expenses
|
|
|
94,882 |
|
|
|
218,277 |
|
|
|
55,212 |
|
|
|
|
163,447 |
|
|
|
219,321 |
|
Insurance expense
|
|
|
39,002 |
|
|
|
80,255 |
|
|
|
34,671 |
|
|
|
|
69,576 |
|
|
|
66,479 |
|
Selling, general and administrative expenses
|
|
|
21,635 |
|
|
|
47,899 |
|
|
|
12,017 |
|
|
|
|
37,867 |
|
|
|
61,455 |
|
Laidlaw fees and compensation charges
|
|
|
19,857 |
|
|
|
15,449 |
|
|
|
1,350 |
|
|
|
|
4,050 |
|
|
|
5,400 |
|
Depreciation and amortization expense
|
|
|
18,808 |
|
|
|
52,739 |
|
|
|
12,560 |
|
|
|
|
32,144 |
|
|
|
67,183 |
|
Impairment losses
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
262,780 |
|
Restructuring charges
|
|
|
|
|
|
|
2,115 |
|
|
|
1,449 |
|
|
|
|
1,288 |
|
|
|
3,777 |
|
Laidlaw reorganization costs
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
3,650 |
|
|
|
8,761 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Income (loss) from operations
|
|
|
20,690 |
|
|
|
69,974 |
|
|
|
2,598 |
|
|
|
|
34,130 |
|
|
|
(239,960 |
) |
Interest expense
|
|
|
(5,644 |
) |
|
|
(9,961 |
) |
|
|
(908 |
) |
|
|
|
(4,691 |
) |
|
|
(6,418 |
) |
Realized gain (loss) on investments
|
|
|
|
|
|
|
(1,140 |
) |
|
|
90 |
|
|
|
|
|
|
|
|
|
|
Interest and other income
|
|
|
714 |
|
|
|
240 |
|
|
|
22 |
|
|
|
|
304 |
|
|
|
369 |
|
Fresh-start accounting adjustments
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
46,416 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Income (loss) before income taxes and cumulative effect of
change in accounting principle
|
|
|
15,760 |
|
|
|
59,113 |
|
|
|
1,802 |
|
|
|
|
76,159 |
|
|
|
(246,009 |
) |
Income tax expense
|
|
|
(6,278 |
) |
|
|
(21,764 |
) |
|
|
(8,633 |
) |
|
|
|
(829 |
) |
|
|
(1,374 |
) |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Income (loss) before cumulative effect of a change in accounting
principle
|
|
|
9,482 |
|
|
|
37,349 |
|
|
|
(6,831 |
) |
|
|
|
75,330 |
|
|
|
(247,383 |
) |
Cumulative effect of a change in accounting principle
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
(223,721 |
) |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Net income (loss)
|
|
|
9,482 |
|
|
|
37,349 |
|
|
|
(6,831 |
) |
|
|
|
(148,391 |
) |
|
|
(247,383 |
) |
Other comprehensive income (loss), net of tax
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Unrealized holding gains (losses) during the period
|
|
|
(309 |
) |
|
|
1,184 |
|
|
|
(1,190 |
) |
|
|
|
603 |
|
|
|
116 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Comprehensive income (loss)
|
|
$ |
9,173 |
|
|
$ |
38,533 |
|
|
$ |
(8,021 |
) |
|
|
$ |
(147,788 |
) |
|
$ |
(247,267 |
) |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
The accompanying notes are an integral part of these combined
financial statements.
F-6
American Medical Response, Inc. and EmCare Holdings Inc.
(The Healthcare Transportation and Emergency Management
Services
Businesses of Laidlaw International, Inc.)
Statements of Changes in Combined Equity
For the Five Months Ended January 31, 2005, for the Year
Ended August 31, 2004, for the Three Months Ended
August 31, 2003, for the Nine Months Ended May 31,
2003 (Predecessor) and for the Year Ended August 31, 2002
(Predecessor)
(dollars in thousands)
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Accumulated | |
|
|
|
|
|
|
|
|
Retained | |
|
Other | |
|
Total | |
|
|
Laidlaw | |
|
Laidlaw | |
|
Earnings | |
|
Comprehensive | |
|
Combined | |
|
|
Payable | |
|
Investment | |
|
(Deficit) | |
|
Income (Loss) | |
|
Equity | |
|
|
| |
|
| |
|
| |
|
| |
|
| |
Balances August 31, 2001 (Predecessor)
|
|
$ |
1,422,088 |
|
|
$ |
2,089,376 |
|
|
$ |
(2,437,836 |
) |
|
$ |
|
|
|
$ |
1,073,628 |
|
Prior period adjustment see note 1
|
|
|
|
|
|
|
|
|
|
|
(41,020 |
) |
|
|
|
|
|
|
(41,020 |
) |
Net loss
|
|
|
|
|
|
|
|
|
|
|
(247,383 |
) |
|
|
|
|
|
|
(247,383 |
) |
Payments made to Laidlaw, net
|
|
|
(24,823 |
) |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
(24,823 |
) |
Unrealized holding gains
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
116 |
|
|
|
116 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Balances August 31, 2002 (Predecessor) as
restated see note 1
|
|
|
1,397,265 |
|
|
|
2,089,376 |
|
|
|
(2,726,239 |
) |
|
|
116 |
|
|
|
760,518 |
|
Net loss
|
|
|
|
|
|
|
|
|
|
|
(148,391 |
) |
|
|
|
|
|
|
(148,391 |
) |
Payments made to Laidlaw, net
|
|
|
(83 |
) |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
(83 |
) |
Unrealized holding gains
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
603 |
|
|
|
603 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Balances May 31, 2003 (Predecessor) as restated
see note 1
|
|
$ |
1,397,182 |
|
|
$ |
2,089,376 |
|
|
$ |
(2,874,630 |
) |
|
$ |
719 |
|
|
$ |
612,647 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Fresh-start balances June 1, 2003 as restated
see note 1
|
|
$ |
66,503 |
|
|
$ |
546,144 |
|
|
$ |
|
|
|
$ |
|
|
|
$ |
612,647 |
|
Net loss
|
|
|
|
|
|
|
|
|
|
|
(6,831 |
) |
|
|
|
|
|
|
(6,831 |
) |
Payments made to Laidlaw, net
|
|
|
(44,087 |
) |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
(44,087 |
) |
Unrealized holding losses
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
(1,190 |
) |
|
|
(1,190 |
) |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Balances August 31, 2003, as restated see
note 1
|
|
|
22,416 |
|
|
|
546,144 |
|
|
|
(6,831 |
) |
|
|
(1,190 |
) |
|
|
560,539 |
|
Dividend to Laidlaw
|
|
|
200,000 |
|
|
|
(200,000 |
) |
|
|
|
|
|
|
|
|
|
|
|
|
Net income
|
|
|
|
|
|
|
|
|
|
|
37,349 |
|
|
|
|
|
|
|
37,349 |
|
Fresh-start adjustments (note 1)
|
|
|
|
|
|
|
10,406 |
|
|
|
|
|
|
|
|
|
|
|
10,406 |
|
Payments made to Laidlaw, net
|
|
|
(35,638 |
) |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
(35,638 |
) |
Unrealized holding gains
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
1,184 |
|
|
|
1,184 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Balances August 31, 2004 as restated see
note 1
|
|
|
186,778 |
|
|
|
356,550 |
|
|
|
30,518 |
|
|
|
(6 |
) |
|
|
573,840 |
|
Net income
|
|
|
|
|
|
|
|
|
|
|
9,482 |
|
|
|
|
|
|
|
9,482 |
|
Advances from Laidlaw, net
|
|
|
15,264 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
15,264 |
|
Unrealized holding losses
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
(309 |
) |
|
|
(309 |
) |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Balances January 31, 2005
|
|
$ |
202,042 |
|
|
$ |
356,550 |
|
|
$ |
40,000 |
|
|
$ |
(315 |
) |
|
$ |
598,277 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
The accompanying notes are an integral part of these combined
financial statements.
F-7
American Medical Response, Inc. and EmCare Holdings Inc.
(The Healthcare Transportation and Emergency Management
Services
Businesses of Laidlaw International, Inc.)
Combined Statements of Cash Flows
For the Five Months Ended January 31, 2005, for the Year
Ended August 31, 2004, for the Three Months Ended
August 31, 2003, for the Nine Months Ended May 31,
2003 (Predecessor)
and for the Year Ended August 31, 2002 (Predecessor)
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Predecessor as | |
|
|
|
|
|
|
|
|
|
restated | |
|
|
|
|
|
|
|
|
|
see note 1 | |
|
|
|
|
|
|
|
|
|
| |
|
|
Five Months | |
|
|
|
Three Months | |
|
|
Nine Months | |
|
|
|
|
Ended | |
|
Year Ended | |
|
Ended | |
|
|
Ended | |
|
Year Ended | |
|
|
January 31, | |
|
August 31, | |
|
August 31, | |
|
|
May 31, | |
|
August 31, | |
|
|
2005 | |
|
2004 | |
|
2003 | |
|
|
2003 | |
|
2002 | |
|
|
| |
|
| |
|
| |
|
|
| |
|
| |
|
|
(dollars in thousands) | |
|
|
(dollars in thousands) | |
Cash Flows from Operating Activities
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Net income (loss)
|
|
$ |
9,482 |
|
|
$ |
37,349 |
|
|
$ |
(6,831 |
) |
|
|
$ |
(148,391 |
) |
|
$ |
(247,383 |
) |
Adjustments to reconcile net income (loss) to net cash provided
by operating activities:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Depreciation and amortization
|
|
|
18,808 |
|
|
|
53,957 |
|
|
|
12,775 |
|
|
|
|
32,359 |
|
|
|
67,205 |
|
|
Loss (gain) on disposal of property, plant and equipment
|
|
|
145 |
|
|
|
(446 |
) |
|
|
(316 |
) |
|
|
|
(349 |
) |
|
|
(1,140 |
) |
|
Impairment charge
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
262,780 |
|
|
Cumulative effect of a change in accounting principle
(note 3)
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
223,721 |
|
|
|
|
|
|
Non-cash allocated expenses (income)
|
|
|
|
|
|
|
(4,505 |
) |
|
|
11,522 |
|
|
|
|
3,058 |
|
|
|
(8,094 |
) |
|
Restructuring charges
|
|
|
|
|
|
|
2,115 |
|
|
|
1,449 |
|
|
|
|
1,288 |
|
|
|
3,777 |
|
|
Notes payable discount
|
|
|
213 |
|
|
|
132 |
|
|
|
50 |
|
|
|
|
218 |
|
|
|
422 |
|
|
Loss (gain) on restricted investments
|
|
|
197 |
|
|
|
1,140 |
|
|
|
(90 |
) |
|
|
|
|
|
|
|
|
|
|
Deferred income taxes
|
|
|
6,278 |
|
|
|
21,899 |
|
|
|
(8,421 |
) |
|
|
|
|
|
|
|
|
|
|
Fresh-start accounting adjustments (note 1)
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
(46,416 |
) |
|
|
|
|
|
Changes in operating assets/liabilities (net of acquisitions):
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Trade and other accounts receivable
|
|
|
(26,057 |
) |
|
|
(23,764 |
) |
|
|
1,522 |
|
|
|
|
(14,049 |
) |
|
|
21,352 |
|
|
|
Parts and supplies inventory
|
|
|
78 |
|
|
|
(1,133 |
) |
|
|
(517 |
) |
|
|
|
233 |
|
|
|
(153 |
) |
|
|
Prepaids and other current assets
|
|
|
(269 |
) |
|
|
5,892 |
|
|
|
3,700 |
|
|
|
|
(12,257 |
) |
|
|
(10,345 |
) |
|
|
Accounts payable and accrued liabilities
|
|
|
3,046 |
|
|
|
17,322 |
|
|
|
3,553 |
|
|
|
|
(6,614 |
) |
|
|
22,350 |
|
|
|
Compliance and insurance accruals
|
|
|
4,045 |
|
|
|
20,402 |
|
|
|
12,520 |
|
|
|
|
31,312 |
|
|
|
46,575 |
|
|
|
Restructuring charges and acquisition accruals
|
|
|
|
|
|
|
(2,681 |
) |
|
|
(907 |
) |
|
|
|
(5,344 |
) |
|
|
(802 |
) |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Net cash provided by operating activities
|
|
|
15,966 |
|
|
|
127,679 |
|
|
|
30,009 |
|
|
|
|
58,769 |
|
|
|
156,544 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Cash Flows from Investing Activities
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Purchase of property, plant and equipment
|
|
|
(14,045 |
) |
|
|
(42,787 |
) |
|
|
(18,079 |
) |
|
|
|
(34,768 |
) |
|
|
(31,118 |
) |
Purchase of business
|
|
|
(1,200 |
) |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Proceeds from sale of business
|
|
|
1,300 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Proceeds from sale of property, plant and equipment
|
|
|
175 |
|
|
|
858 |
|
|
|
341 |
|
|
|
|
624 |
|
|
|
2,549 |
|
Purchase of restricted cash and investments
|
|
|
(31,257 |
) |
|
|
(64,357 |
) |
|
|
(11,287 |
) |
|
|
|
(66,266 |
) |
|
|
(50,946 |
) |
Proceeds from sale and maturity of restricted investments
|
|
|
35,960 |
|
|
|
46,389 |
|
|
|
12,530 |
|
|
|
|
36,748 |
|
|
|
32,215 |
|
Other investing activities
|
|
|
(79 |
) |
|
|
6,814 |
|
|
|
1,359 |
|
|
|
|
(35,173 |
) |
|
|
(10,047 |
) |
Increase in Laidlaw insurance deposits
|
|
|
(12,521 |
) |
|
|
(28,433 |
) |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Net cash used in investing activities
|
|
|
(21,667 |
) |
|
|
(81,516 |
) |
|
|
(15,136 |
) |
|
|
|
(98,835 |
) |
|
|
(57,347 |
) |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Cash Flows from Financing Activities
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Repayments of capital lease obligations and other debt
|
|
|
(3,992 |
) |
|
|
(8,709 |
) |
|
|
(1,851 |
) |
|
|
|
(6,338 |
) |
|
|
(17,817 |
) |
Increase (decrease) in bank overdrafts
|
|
|
5,866 |
|
|
|
(4,544 |
) |
|
|
8,675 |
|
|
|
|
(815 |
) |
|
|
(1,134 |
) |
Advances from (payments to) Laidlaw
|
|
|
8,982 |
|
|
|
(31,133 |
) |
|
|
(55,609 |
) |
|
|
|
(3,141 |
) |
|
|
(16,729 |
) |
Increase (decrease) in other non-current liabilities
|
|
|
|
|
|
|
(2,942 |
) |
|
|
1,563 |
|
|
|
|
2,234 |
|
|
|
(386 |
) |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Net cash provided by (used in) financing activities
|
|
|
10,856 |
|
|
|
(47,328 |
) |
|
|
(47,222 |
) |
|
|
|
(8,060 |
) |
|
|
(36,066 |
) |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Increase (decrease) in cash and cash equivalents
|
|
|
5,155 |
|
|
|
(1,165 |
) |
|
|
(32,349 |
) |
|
|
|
(48,126 |
) |
|
|
63,131 |
|
Cash and cash equivalents, beginning of period
|
|
|
9,476 |
|
|
|
10,641 |
|
|
|
42,990 |
|
|
|
|
91,116 |
|
|
|
27,985 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Cash and cash equivalents, end of period
|
|
$ |
14,631 |
|
|
$ |
9,476 |
|
|
$ |
10,641 |
|
|
|
$ |
42,990 |
|
|
$ |
91,116 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
The accompanying notes are an integral part of these combined
financial statements.
F-8
American Medical Response, Inc. & EmCare Holdings
Inc.
(The Healthcare Transportation and Emergency Management
Services
Businesses of Laidlaw International, Inc.)
Notes to Combined Financial Statements
(dollars in thousands)
Basis of Presentation of Financial Statements
These financial statements have been prepared in accordance with
accounting principles generally accepted in the United States of
America (GAAP) to reflect the combined financial
position, results of operations and cash flows of American
Medical Response, Inc. and its subsidiaries (AMR)
and EmCare Holdings Inc. and its subsidiaries
(EmCare) (combined or each individually, the
Company). These financial statements have been
prepared in connection with the definitive sale agreement
referred to in note 17 to reflect the businesses that were
purchased. AMR and EmCare are indirect, wholly owned
subsidiaries of Laidlaw International Inc., previously Laidlaw
Inc. (Laidlaw or the Parent). The
Company operates in two segments, AMR in the Healthcare
Transportation Service business and EmCare in the Emergency
Management Service business.
AMR operates in 34 states, providing a full range of
medical transportation services from basic patient transit to
the most advanced emergency care and pre-hospital assistance. In
addition, AMR operates emergency (911) call and response
services for large and small communities all across the United
States, offers medical staff for large entertainment venues like
stadiums and arenas, and provides telephone triage,
transportation dispatch and demand management services.
EmCare provides outsourced business services to hospitals
primarily for emergency departments, related urgent care centers
and for certain inpatient departments for 313 hospitals in
38 states. EmCare recruits physicians, gathers their
credentials, arranges contracts for their services, assists in
monitoring their performance and arranges their scheduling. In
addition, EmCare assists clients in such operational areas as
staff coordination, quality assurance, departmental
accreditation, billing, record-keeping, third-party payment
programs, and other administrative services.
Restatement
Accounts receivable allowance. The Company determined
that because of an error in its reserving methodology, its
accounts receivable allowances were understated at various
balance sheet dates prior to and including the periods presented
herein. As a result, AMR has recorded an adjustment of
$50 million to increase the accounts receivable allowance
as of May 31, 2003, of which $39 million reduces
previously reported retained earnings (deficit) as of
August 31, 2001. Adjustments were also required for the
nine-month period ended May 31, 2003 and the year ended
August 31, 2002, reflecting a reduction of net revenue and
a corresponding increase in accounts receivable allowances of
$8.0 million and $3.0 million, respectively. There
were no further adjustments necessary subsequent to May 31,
2003. In addition, the Company made other adjustments related to
certain deferred rent and leasehold amortization matters,
reducing previously reported retained earnings (deficit) as of
August 31, 2001 by $2.0 million and reducing earnings
for the nine-month period ended May 31, 2003 by
$0.1 million and for the year ended August 31, 2002 by
$0.2 million.
AMR adopted SFAS No. 142, Goodwill and Other
Intangible Assets (SFAS No. 142), on
September 1, 2002 and recorded a charge associated with a
change in accounting principle based on a fair value assessment
of goodwill. The impact of reducing the net accounts receivable
balance prior to the assessment reduced the charge necessary
upon adoption of SFAS No. 142 by $42 million.
Effective June 1, 2003, the Companys parent emerged
from bankruptcy and applied fresh-start accounting. The impact
of the correction made to the nine-month period ended
May 31, 2003 increased the fresh-start income adjustment by
$8.1 million.
F-9
American Medical Response, Inc. & EmCare Holdings
Inc.
(The Healthcare Transportation and Emergency Management
Services
Businesses of Laidlaw International, Inc.)
Notes to Combined Financial
Statements (Continued)
Also as a part of applying fresh-start accounting, the Company
adjusted its assets and liabilities to fair value. As a result
of the restatement which reduced net assets by
$52.3 million, as discussed above, the Company allocated
$52.3 million to goodwill at June 1, 2003 as the
reorganization value exceeded the fair value of the assets and
liabilities. See Chapter 11
Reorganization Laidlaw, below, for further
information.
As a result of these corrections, as of May 31, 2003,
deferred tax assets of $20.3 million have been recorded
with a corresponding full valuation allowance. In fiscal 2004,
AMR had reversed all of its valuation allowance, which reversal
now includes the valuation allowance referred to above. In
accordance with fresh-start accounting, the reversal of
valuation allowances first reduces intangible assets to zero,
and then any excess is credited to the Laidlaw investment in the
Statement of Changes in Combined Equity. As a result of the
increased goodwill of $52.3 million and the release of the
valuation allowance of $20.3 million discussed above, the
Company reduced its previously recorded credit to Laidlaw
investment by $32.0 million. See note 5 for further
information.
Following is a summary of the effects of these changes on the
Companys Combined Balance Sheet as of August 31, 2004
and 2003 and Combined Statements of Operations for the nine
months ended May 31, 2003 and for the fiscal year ended
August 31, 2002. Correcting for the error did not require
adjustment to total net cash flows provided by operating
activities, net cash flows used in investing activities, or net
cash flows provided by (used in) financing activities.
Combined Balance Sheets
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
As Previously | |
|
|
|
As | |
|
|
Reported | |
|
Adjustments | |
|
Restated | |
|
|
| |
|
| |
|
| |
August 31, 2004
|
|
|
|
|
|
|
|
|
|
|
|
|
Trade and other accounts receivable, net
|
|
$ |
394,210 |
|
|
$ |
(50,000 |
) |
|
$ |
344,210 |
|
Current deferred tax assets
|
|
|
33,935 |
|
|
|
19,046 |
|
|
|
52,981 |
|
Current assets
|
|
|
500,660 |
|
|
|
(30,954 |
) |
|
|
469,706 |
|
Property, plant & equipment
|
|
|
133,362 |
|
|
|
(677 |
) |
|
|
132,685 |
|
Non-current deferred tax assets
|
|
|
213,127 |
|
|
|
1,262 |
|
|
|
214,389 |
|
Assets
|
|
|
979,968 |
|
|
|
(30,369 |
) |
|
|
949,599 |
|
Other long-term liabilities
|
|
|
140,897 |
|
|
|
1,683 |
|
|
|
142,580 |
|
Liabilities
|
|
|
374,076 |
|
|
|
1,683 |
|
|
|
375,759 |
|
Laidlaw investment
|
|
|
388,602 |
|
|
|
(32,052 |
) |
|
|
356,550 |
|
Combined equity
|
|
|
605,892 |
|
|
|
(32,052 |
) |
|
|
573,840 |
|
Liabilities and combined equity
|
|
|
979,968 |
|
|
|
(30,369 |
) |
|
|
949,599 |
|
|
August 31, 2003
|
|
|
|
|
|
|
|
|
|
|
|
|
Trade and other accounts receivable, net
|
|
|
370,452 |
|
|
|
(50,000 |
) |
|
|
320,452 |
|
Current assets
|
|
|
490,720 |
|
|
|
(50,000 |
) |
|
|
440,720 |
|
Property, plant & equipment
|
|
|
134,223 |
|
|
|
(677 |
) |
|
|
133,546 |
|
Intangible assets, net
|
|
|
95,845 |
|
|
|
52,360 |
|
|
|
148,205 |
|
Assets
|
|
|
913,063 |
|
|
|
1,683 |
|
|
|
914,746 |
|
Other long-term liabilities
|
|
|
132,106 |
|
|
|
1,683 |
|
|
|
133,789 |
|
Liabilities
|
|
|
352,524 |
|
|
|
1,683 |
|
|
|
354,207 |
|
Liabilities and combined equity
|
|
$ |
913,063 |
|
|
$ |
1,683 |
|
|
$ |
914,746 |
|
F-10
American Medical Response, Inc. & EmCare Holdings
Inc.
(The Healthcare Transportation and Emergency Management
Services
Businesses of Laidlaw International, Inc.)
Notes to Combined Financial
Statements (Continued)
Combined Statements of Operations and Comprehensive Income
(Loss)
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
As Previously | |
|
|
|
As | |
|
|
Reported | |
|
Adjustments | |
|
Restated | |
|
|
| |
|
| |
|
| |
Nine months ended May 31, 2003 (predecessor)
|
|
|
|
|
|
|
|
|
|
|
|
|
Net revenue
|
|
$ |
1,111,335 |
|
|
$ |
(8,000 |
) |
|
$ |
1,103,335 |
|
Operating expenses
|
|
|
163,293 |
|
|
|
154 |
|
|
|
163,447 |
|
Depreciation and amortization expense
|
|
|
32,156 |
|
|
|
(12 |
) |
|
|
32,144 |
|
Income (loss) from operations
|
|
|
42,272 |
|
|
|
(8,142 |
) |
|
|
34,130 |
|
Fresh-start accounting adjustments
|
|
|
38,274 |
|
|
|
8,142 |
|
|
|
46,416 |
|
Cumulative effect of a change in accounting principle
|
|
|
(267,939 |
) |
|
|
44,218 |
|
|
|
(223,721 |
) |
Net income (loss)
|
|
|
(192,609 |
) |
|
|
44,218 |
|
|
|
(148,391 |
) |
Comprehensive income (loss)
|
|
|
(192,006 |
) |
|
|
44,218 |
|
|
|
(147,788 |
) |
Year ended August 31, 2002 (predecessor)
|
|
|
|
|
|
|
|
|
|
|
|
|
Net revenue
|
|
|
1,418,786 |
|
|
|
(3,000 |
) |
|
|
1,415,786 |
|
Operating expenses
|
|
|
219,121 |
|
|
|
200 |
|
|
|
219,321 |
|
Depreciation and amortization expense
|
|
|
67,185 |
|
|
|
(2 |
) |
|
|
67,183 |
|
Income (loss) from operations
|
|
|
(236,762 |
) |
|
|
(3,198 |
) |
|
|
(239,960 |
) |
Income (loss) before income taxes and cumulative effect of a
change in accounting principle
|
|
|
(242,811 |
) |
|
|
(3,198 |
) |
|
|
(246,009 |
) |
Income (loss) before cumulative effect of a change in accounting
principle
|
|
|
(244,185 |
) |
|
|
(3,198 |
) |
|
|
(247,383 |
) |
Net income (loss)
|
|
|
(244,185 |
) |
|
|
(3,198 |
) |
|
|
(247,383 |
) |
Comprehensive income (loss)
|
|
$ |
(244,069 |
) |
|
$ |
(3,198 |
) |
|
$ |
(247,267 |
) |
Chapter 11 Reorganization Laidlaw
On June 28, 2001, Laidlaw and certain of its affiliates
filed voluntary petitions for reorganization under
Chapter 11 of the Bankruptcy Code. During the pendency of
the Chapter 11 case, Laidlaw continued to operate its
businesses in accordance with the applicable provisions of the
Bankruptcy Code. Although subsidiaries of Laidlaw, neither AMR
nor EmCare filed for reorganization under Chapter 11 of the
Bankruptcy Code.
Laidlaw emerged from bankruptcy protection during fiscal 2003,
and on June 1, 2003 adopted Statement of
Position 90-7, Financial Reporting by Entities in
Reorganization Under the Bankruptcy Code (SOP 90-7),
applying fresh-start accounting to its balance sheet as of the
close of business on May 31, 2003. In accordance with the
principles of fresh-start accounting, Laidlaw determined the
reorganization value of its individual business units and
adjusted their assets and liabilities to estimated fair values
as of May 31, 2003. On May 31, 2003, Laidlaw applied
push-down accounting and allocated to the Company
its share of reorganization value aggregating
$939.9 million. Reorganization value, as defined in
SOP 90-7, is the amount that approximates the fair value of
the assets of an entity before considering liabilities. The
reorganization value allocated to the Company was based on the
consideration of factors such as the industries in which the
Company operates, the general economic conditions that impact
the health care industry, and application of certain valuation
methods, including a discounted cash flow analysis, an analysis
of comparable publicly traded company multiples and a comparable
acquisitions analysis. The net effect of all fresh-start
accounting
F-11
American Medical Response, Inc. & EmCare Holdings
Inc.
(The Healthcare Transportation and Emergency Management
Services
Businesses of Laidlaw International, Inc.)
Notes to Combined Financial
Statements (Continued)
adjustments pushed down to the Company resulted in additional
income of $46.4 million, which is reflected as an
adjustment to the financial results for the period from
September 1, 2002 through May 31, 2003.
As a result of the application of push-down accounting, the
Companys balance sheet as of the close of business
May 31, 2003 and financial statements for periods beginning
on June 1, 2003, referred to as Successor
Company, may not be comparable with its financial
statements for periods before June 1, 2003, referred to as
Predecessor Company because they are, in effect, those
reflecting the application of a new basis of accounting. The
balances below have been adjusted for the restatement described
above. As a result, trade receivables, property plant and
equipment, intangible assets and other long-term liabilities
changed by $(50) million, $(0.6) million,
$44.2 million and $1.6 million, respectively, in the
Predecessor and Successor columns. Retained earnings (deficit)
increased by $8.1 million in the Predecessor fair value
adjustment column and the adjustment to intangible fair value
decreased by $8.1 million. The effects of fresh-start
reporting on the Companys combined balance sheet as of the
close of business May 31, 2003 are as follows:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Restated | |
|
|
| |
|
|
Predecessor | |
|
Fair Value | |
|
Successor | |
|
|
Company | |
|
Adjustments | |
|
Company | |
|
|
| |
|
| |
|
| |
Assets
|
|
|
|
|
|
|
|
|
|
|
|
|
Current assets:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Cash and cash equivalents
|
|
$ |
42,990 |
|
|
$ |
|
|
|
$ |
42,990 |
|
|
Restricted cash and cash equivalents
|
|
|
1,154 |
|
|
|
|
|
|
|
1,154 |
|
|
Trade and other accounts receivable, net
|
|
|
321,974 |
|
|
|
|
|
|
|
321,974 |
|
|
Parts and supplies inventory
|
|
|
16,927 |
|
|
|
|
|
|
|
16,927 |
|
|
Other current assets
|
|
|
35,907 |
|
|
|
|
|
|
|
35,907 |
|
|
Current deferred tax assets
|
|
|
|
(c) |
|
|
72,493 |
|
|
|
72,493 |
|
|
|
|
|
|
|
|
|
|
|
|
|
Current assets
|
|
|
418,952 |
|
|
|
72,493 |
|
|
|
491,445 |
|
|
|
|
|
|
|
|
|
|
|
Property, plant, and equipment, net
|
|
|
130,212 |
(a) |
|
|
(4,683 |
) |
|
|
125,529 |
|
Intangible assets, net
|
|
|
230,222 |
(b) |
|
|
(79,843 |
) |
|
|
150,379 |
|
Non-current deferred tax assets
|
|
|
|
(c) |
|
|
73,918 |
|
|
|
73,918 |
|
Restricted long-term investments trust
|
|
|
43,764 |
|
|
|
|
|
|
|
43,764 |
|
Other long-term assets
|
|
|
56,596 |
|
|
|
|
|
|
|
56,596 |
|
|
|
|
|
|
|
|
|
|
|
|
|
Assets
|
|
$ |
879,746 |
|
|
$ |
61,885 |
|
|
$ |
941,631 |
|
|
|
|
|
|
|
|
|
|
|
F-12
American Medical Response, Inc. & EmCare Holdings
Inc.
(The Healthcare Transportation and Emergency Management
Services
Businesses of Laidlaw International, Inc.)
Notes to Combined Financial
Statements (Continued)
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Restated | |
|
|
| |
|
|
Predecessor | |
|
Fair Value | |
|
Successor | |
|
|
Company | |
|
Adjustments | |
|
Company | |
|
|
| |
|
| |
|
| |
|
Liabilities and Combined Equity
|
|
|
|
|
|
|
|
|
|
|
|
|
Current liabilities:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Accounts payable
|
|
$ |
40,156 |
|
|
$ |
|
|
|
$ |
40,156 |
|
|
Accrued liabilities
|
|
|
140,777 |
(d) |
|
|
1,000 |
|
|
|
141,777 |
|
|
Current portion of long-term debt
|
|
|
8,807 |
|
|
|
|
|
|
|
8,807 |
|
|
|
|
|
|
|
|
|
|
|
|
|
Current liabilities
|
|
|
189,740 |
|
|
|
1,000 |
|
|
|
190,740 |
|
Long-term debt
|
|
|
17,052 |
|
|
|
|
|
|
|
17,052 |
|
Other long-term liabilities
|
|
|
106,723 |
(e) |
|
|
14,469 |
|
|
|
121,192 |
|
|
|
|
|
|
|
|
|
|
|
|
|
Liabilities
|
|
|
313,515 |
|
|
|
15,469 |
|
|
|
328,984 |
|
|
|
|
|
|
|
|
|
|
|
Laidlaw payable
|
|
|
59,355 |
(f) |
|
|
7,148 |
|
|
|
66,503 |
|
Laidlaw investment
|
|
|
3,419,470 |
(f) |
|
|
(2,873,326 |
) |
|
|
546,144 |
|
Retained earnings (deficit)
|
|
|
(2,913,313 |
) (f) |
|
|
2,913,313 |
|
|
|
|
|
Comprehensive income
|
|
|
719 |
(f) |
|
|
(719 |
) |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Combined equity
|
|
|
566,231 |
|
|
|
46,416 |
|
|
|
612,647 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Liabilities and combined equity
|
|
$ |
879,746 |
|
|
$ |
61,885 |
|
|
$ |
941,631 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
(a) |
|
Adjusts property, plant and equipment to reflect the estimated
fair value of the assets based on independent appraisals. |
|
(b) |
|
Eliminates the Predecessor Companys historic goodwill,
records identifiable intangible assets at estimated fair value
based upon independent appraisals and records the remaining
reorganization value to goodwill. |
|
(c) |
|
Records the net deferred income tax assets of the Company. |
|
(d) |
|
Records the operating leases at their estimated fair value based
on independent valuations and the current borrowing rate of the
Company. |
|
(e) |
|
Adjusts the Companys insurance reserves to their estimated
fair value. |
|
(f) |
|
Reflects the elimination of the accumulated deficit and
comprehensive income and establishes the payable account to
Laidlaw. |
|
|
2. |
Summary of Significant Accounting Policies |
Combination
The combined financial statements include the accounts of the
Company or of the Predecessor Company consolidated with all of
their respective subsidiaries. All significant intracompany
transactions are eliminated.
Use of Estimates
The preparation of financial statements in accordance with GAAP
requires the Company to make estimates and assumptions that
affect reported amounts of assets, liabilities, revenue and
expenses, and disclosure of contingencies. Future events could
alter such estimates.
Cash and Cash Equivalents
Cash and cash equivalents are composed of highly liquid
investments with an original maturity of three months or less
and are recorded at market value.
At January 31, 2005 and August 31, 2004 and 2003, bank
overdrafts of $22.0 million, $16.1 million and
$20.6 million, respectively, were included in accounts
payable on the accompanying combined balance sheets.
F-13
American Medical Response, Inc. & EmCare Holdings
Inc.
(The Healthcare Transportation and Emergency Management
Services
Businesses of Laidlaw International, Inc.)
Notes to Combined Financial
Statements (Continued)
Restricted Cash and Cash Equivalents
Restricted cash and cash equivalents include short-term
investments that are part of the portfolio of the Companys
captive insurance arrangement. These investments are highly
liquid and have original maturities of three months or less.
These assets are used to support the current portion of claim
liabilities under the captive arrangement.
Restricted Marketable Securities
Marketable securities were pledged as collateral against the
Companys claim liabilities under the captive insurance
arrangement. Restricted marketable securities are
income-yielding securities that can be converted readily into
cash and include commercial paper, corporate and foreign notes
and bonds, and U.S. Treasury and agency obligations. Such
securities are stated at market value and are classified as
available-for-sale under Financial Accounting Standards Board
Statement of Financial Accounting Standards No. 115,
Accounting for Certain Investments in Debt and Equity
Securities (SFAS No. 115), with
unrealized gains and losses reported, net of tax, in other
comprehensive income as a component of combined equity.
Trade and Other Accounts Receivable, net
The Company determines its allowances based on payor
reimbursement schedules, historical write-off experience and
other economic data. The allowances for contractual discounts
and uncompensated care are reviewed monthly. Account balances
are charged off against the uncompensated care allowance when it
is probable the receivable will not be recovered. Write-offs to
the contractual allowance occur when payment is received. The
allowance for uncompensated care is related principally to
receivables recorded for self-pay patients.
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
August 31, | |
|
|
January 31, | |
|
| |
|
|
2005 | |
|
2004 | |
|
2003 | |
|
|
| |
|
| |
|
| |
Accounts receivable, net
|
|
|
|
|
|
|
|
|
|
|
|
|
AMR
|
|
$ |
229,798 |
|
|
$ |
210,177 |
|
|
$ |
196,473 |
|
EmCare
|
|
|
139,969 |
|
|
|
134,033 |
|
|
|
123,979 |
|
|
|
|
|
|
|
|
|
|
|
|
Total
|
|
$ |
369,767 |
|
|
$ |
344,210 |
|
|
$ |
320,452 |
|
|
|
|
|
|
|
|
|
|
|
Accounts receivable allowances
|
|
|
|
|
|
|
|
|
|
|
|
|
AMR
|
|
|
|
|
|
|
|
|
|
|
|
|
Allowance for contractual discounts
|
|
$ |
126,771 |
|
|
$ |
103,412 |
|
|
$ |
89,856 |
|
Allowance for uncompensated care |
|
|
124,699 |
|
|
|
111,766 |
|
|
|
104,833 |
|
|
|
|
|
|
|
|
|
|
|
|
Total
|
|
$ |
251,470 |
|
|
$ |
215,178 |
|
|
$ |
194,689 |
|
|
|
|
|
|
|
|
|
|
|
EmCare
|
|
|
|
|
|
|
|
|
|
|
|
|
Allowance for contractual discounts
|
|
$ |
188,092 |
|
|
$ |
168,060 |
|
|
$ |
168,912 |
|
Allowance for uncompensated care
|
|
|
556,605 |
|
|
|
499,512 |
|
|
|
382,757 |
|
|
|
|
|
|
|
|
|
|
|
|
Total
|
|
$ |
744,697 |
|
|
$ |
667,572 |
|
|
$ |
551,669 |
|
|
|
|
|
|
|
|
|
|
|
The increase in the allowances and provisions for contractual
discounts and uncompensated care is primarily a result of
increases in the Companys gross fee-for-service rate
schedules. These gross fee schedules, including any changes to
existing fee schedules, generally are negotiated with various
contracting entities, including municipalities and facilities.
Fee schedule increases are billed for all revenue sources and to
all payors under that specific contract; however, reimbursement
in the case of certain state and federal payors,
F-14
American Medical Response, Inc. & EmCare Holdings
Inc.
(The Healthcare Transportation and Emergency Management
Services
Businesses of Laidlaw International, Inc.)
Notes to Combined Financial
Statements (Continued)
including Medicare and Medicaid, will not change as a result of
the contract change. In certain cases, this results in a higher
level of contractual and uncompensated care provisions and
allowances, requiring a higher percentage of contractual
discount and uncompensated care provisions compared to gross
charges.
The allowance for uncompensated care at EmCare includes accounts
that have been sent to collection agencies and are listed as
delinquent within the billing system. These accounts are fully
reserved at each balance sheet date and total
$254.2 million, $218.6 million and $150.3 million
at January 31, 2005, August 31, 2004 and
August 31, 2003, respectively.
Parts and Supplies Inventory
Parts and supplies inventory is valued at cost, determined on a
first-in, first-out basis. Durable medical supplies, including
stretchers, oximeters and other miscellaneous items, are
capitalized as inventory and expensed as used.
Property, Plant and Equipment, net
Property, plant and equipment were reflected at their fair
values as of June 1, 2003. Additions to property, plant and
equipment subsequent to this date are recorded at cost.
Maintenance and repairs that do not extend the useful life of
the property are charged to expense as incurred. Gains and
losses from dispositions of property, plant and equipment are
recorded in the period incurred. Depreciation of property, plant
and equipment is provided substantially on a straight-line basis
over their estimated useful lives, which are as follows:
|
|
|
Buildings
|
|
35 to 40 years |
Leasehold improvements
|
|
Shorter of expected life or life of lease |
Vehicles
|
|
5 to 7 years |
Computer hardware and software
|
|
3 to 5 years |
Other
|
|
3 to 10 years |
Goodwill
The Predecessor Company adopted SFAS No. 142 on
September 1, 2002. SFAS No. 142 requires that any
goodwill recorded in connection with an acquisition consummated
on or after July 1, 2001 not be amortized, and instead
requiring a periodic assessment of recoverability utilizing a
fair value measurement. In connection with the adoption of this
standard, the Predecessor Company impaired $223.7 million
of restated goodwill, which is included in the accompanying
combined financial statements for the nine months ended
F-15
American Medical Response, Inc. & EmCare Holdings
Inc.
(The Healthcare Transportation and Emergency Management
Services
Businesses of Laidlaw International, Inc.)
Notes to Combined Financial
Statements (Continued)
May 31, 2003, as a cumulative effect of a change in
accounting principle. Recording this change had no tax-related
benefit or expense. Goodwill balances are as follows:
|
|
|
|
|
|
|
|
Restated | |
|
|
| |
Predecessor Company:
|
|
|
|
|
|
Balance on August 31, 2002
|
|
$ |
453,943 |
|
|
Impairment loss under SFAS No. 142, September 1,
2002
|
|
|
(223,721 |
) |
|
|
|
|
|
Balance on May 31, 2003
|
|
$ |
230,222 |
|
|
|
|
|
Successor Company:
|
|
|
|
|
|
Fresh-start adjustment
|
|
$ |
(177,862 |
) |
|
|
|
|
|
Balance on June 1, 2003 and August 31, 2003
|
|
|
52,360 |
|
|
Deferred tax valuation adjustment, August 31, 2004
|
|
|
(52,360 |
) |
|
|
|
|
|
Balance on August 31, 2004 and January 31, 2005
|
|
$ |
|
|
|
|
|
|
Had the change in the accounting policy for amortizing goodwill
been in effect in the prior year, the Predecessor Companys
income (loss) before cumulative effect of a change in accounting
principle for the year ended August 31, 2002 would have
been ($226.0) million compared to ($247.4) million as
originally recorded. There would have been no changes to the
results recorded for the five months ended January 31,
2005, the year ended August 31, 2004, the three months
ended August 31, 2003 or the Predecessor Company nine
months ended May 31, 2003.
Impairment of Long-lived Assets other than Goodwill and
Other Indefinite Lived Intangibles
Long-lived assets other than goodwill and other indefinite lived
intangibles are assessed for impairment whenever events or
changes in circumstances indicate that the carrying value may
not be recoverable. Important factors which could trigger
impairment review include significant underperformance relative
to historical or projected future operating results, significant
changes in the use of the acquired assets or the strategy for
the overall business, and significant negative industry or
economic trends. If indicators of impairment are present,
management evaluates the carrying value of long-lived assets
other than goodwill and other indefinite lived intangibles in
relation to the projection of future undiscounted cash flows of
the underlying business. Projected cash flows are based on
historical results adjusted to reflect managements best
estimate of future market and operating conditions, which may
differ from actual cash flows.
Contract Value
At January 31, 2005, August 31, 2004 and 2003, the
Companys contracts and customer relationships, recorded as
part of fresh-start push-down accounting, represent the
amortized fair value of such assets held by the Company at
June 1, 2003. Contract Assets are amortized on a
straight-line basis over the average length of the contracts and
the expected contract renewal period of 10 years. In
accordance with the provisions of fresh-start accounting, the
reversal of the income tax valuation allowance resulted in a
reduction in certain Contract Assets at August 31, 2004
(note 5).
Radio Frequencies
The radio frequency licenses, recorded as part of push-down
accounting and included in net intangible assets on the
accompanying combined balance sheet, total $4.0 million at
August 31, 2003 and are considered to be indefinite lived
intangible assets. As such, they are not amortized. The radio
frequency licenses are reviewed for impairment on an annual
basis. In accordance with the provisions of fresh-start
accounting, the
F-16
American Medical Response, Inc. & EmCare Holdings
Inc.
(The Healthcare Transportation and Emergency Management
Services
Businesses of Laidlaw International, Inc.)
Notes to Combined Financial
Statements (Continued)
reversal of the income tax valuation allowance resulted in the
radio frequency asset being reduced to zero at August 31,
2004 (note 5).
Restricted Long-Term Investments
Restricted long-term investments include investments that are
part of the portfolio of the Companys captive insurance
subsidiary. In accordance with SFAS No. 115,
the Company determines the classification of securities as
held-to-maturity or available-for-sale at the time of purchase
and re-evaluates such designation at each balance sheet date.
Securities are classified as held-to-maturity when the Company
has the positive intent and ability to hold securities to
maturity. Held-to-maturity securities are stated at cost,
adjusted for amortization of premiums and discounts to maturity.
Investments not classified as held-to-maturity are classified as
available-for-sale. Available-for-sale securities are carried at
fair value, with unrealized gains and losses reported as a
separate component of equity. The cost of securities sold is
based on the specific identification method. Restricted
long-term investments are available-for-sale.
These investments are used to support the Companys
self-insurance program. The investments are comprised
principally of government securities and investment grade debt
securities.
Other Long-Term Liabilities
Long-term portions of insurance reserves, acquisition-related
liabilities and other liabilities are classified as other
long-term liabilities.
Contractual Arrangements
EmCare structures its contractual arrangements for emergency
department management services in various ways. In most states,
a wholly-owned subsidiary of EmCare (EmCare
Subsidiary) contracts with hospitals to provide emergency
department management services. The EmCare Subsidiary enters
into an agreement (PA Management Agreement) with a
professional association or professional corporation
(PA), whereby the EmCare Subsidiary provides the PA
with management services, and the PA agrees to provide physician
services for the hospital contract. The PA employs physicians
directly or subcontracts with another entity for the physician
services. In certain states, the PA contracts directly with the
hospital, but provides physician services and obtains management
services in the same manner as described above. In all
arrangements, decisions regarding patient care are made
exclusively by the physicians. In consideration for these
services, the EmCare Subsidiary receives a monthly fee that may
be adjusted from time to time to reflect industry practice,
business conditions, and actual expenses for administrative
costs and uncollectible accounts. In most states, these fees
approximate the excess of the PAs revenues over its
expenses.
Each PA is wholly-owned by a physician who enters into a Stock
Transfer and Option Agreement with EmCare. This agreement gives
EmCare the right to replace the physician owner with another
physician in accordance with the terms of the agreement.
Historically, EmCare had determined that these management
contracts met Emerging Issues Task Force 97-2, Application of
FASB Statement No. 94 and APB Opinion No. 16 to
Physician Practice Entities, requirements for consolidation.
Upon adoption of FIN 46(R), Consolidation of Variable
Interest Entities, the Company concluded that these
management contracts resulted in a variable interest in the PAs
and that the Company is the primary beneficiary. Accordingly,
the consolidated financial statements of EmCare and these
combined financial statements include the accounts of EmCare and
its subsidiaries and the PAs. The financial statements of the
PAs are consolidated with EmCare and its subsidiaries because
EmCare has ultimate control over the assets and business
operations of the PAs as described above. Notwithstanding the
lack of technical
F-17
American Medical Response, Inc. & EmCare Holdings
Inc.
(The Healthcare Transportation and Emergency Management
Services
Businesses of Laidlaw International, Inc.)
Notes to Combined Financial
Statements (Continued)
majority ownership, consolidation of the PAs is necessary to
present fairly the financial position and results of operations
of EmCare because of the existence of a control relationship by
means other than record ownership of the PAs voting stock.
Control of a PA by EmCare is perpetual and other than temporary
because EmCare may replace the physician owner of the PA at any
time and thereby continue EmCares relationship with the PA.
Financial Instruments and Concentration of Credit
Risk
The Companys cash and cash equivalents, accounts
receivable, accounts payable, accrued liabilities (other than
current portion of self-insurance estimates), long-term debt and
long-term liabilities (other than self-insurance estimates)
constitute financial instruments. Based on managements
estimates, the carrying value of the Companys cash and
cash equivalents, accounts receivable, accounts payable, accrued
liabilities (other than current portion of self-insurance
estimates), long-term debt and long-term liabilities (other than
self-insurance estimates) approximates their fair value as of
January 31, 2005 and August 31, 2004 and 2003.
Concentration of credit risks in accounts receivable is limited,
due to the large number of customers comprising the
Companys customer base throughout the United States. A
significant component of the Companys revenue is derived
from Medicare and Medicaid. Given that these are government
programs, the credit risk for these customers is considered low.
The Company performs ongoing credit evaluations of its other
customers, but does not require collateral to support customer
accounts receivable. The Company establishes an allowance for
uncompensated care based on the credit risk applicable to
particular customers, historical trends and other relevant
information. For each of the periods presented, the Company
derived approximately 35% of its net revenue from Medicare and
Medicaid, 60% from insurance providers and contracted payors,
and 5% directly from patients.
Revenue Recognition
Revenue is recognized at the time of service and is recorded net
of provisions for contractual discounts and estimated
uncompensated care. Provisions for contractual discounts and
estimated uncompensated care by segment, as a percentage of
gross revenue, are as follows:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Predecessor | |
|
|
|
|
|
|
|
|
| |
|
|
Five Months | |
|
|
|
Three Months | |
|
Nine Months | |
|
|
|
|
Ended | |
|
Year Ended | |
|
Ended | |
|
Ended | |
|
Year Ended | |
|
|
January 31, | |
|
August 31, | |
|
August 31, | |
|
May 31, | |
|
August 31, | |
|
|
2005 | |
|
2004 | |
|
2003 | |
|
2003 | |
|
2002 | |
|
|
| |
|
| |
|
| |
|
| |
|
| |
AMR
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Gross revenue
|
|
|
100% |
|
|
|
100% |
|
|
|
100% |
|
|
|
100% |
|
|
|
100% |
|
Provision for contractual discounts
|
|
|
35% |
|
|
|
35% |
|
|
|
30% |
|
|
|
30% |
|
|
|
26% |
|
Provision for uncompensated care
|
|
|
14% |
|
|
|
14% |
|
|
|
16% |
|
|
|
15% |
|
|
|
16% |
|
EmCare
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Gross revenue
|
|
|
100% |
|
|
|
100% |
|
|
|
100% |
|
|
|
100% |
|
|
|
100% |
|
Provision for contractual discounts
|
|
|
42% |
|
|
|
41% |
|
|
|
40% |
|
|
|
40% |
|
|
|
38% |
|
Provision for uncompensated care
|
|
|
25% |
|
|
|
24% |
|
|
|
24% |
|
|
|
23% |
|
|
|
23% |
|
Total
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Gross revenue
|
|
|
100% |
|
|
|
100% |
|
|
|
100% |
|
|
|
100% |
|
|
|
100% |
|
Provision for contractual discounts
|
|
|
39% |
|
|
|
37% |
|
|
|
35% |
|
|
|
34% |
|
|
|
31% |
|
Provision for uncompensated care
|
|
|
19% |
|
|
|
18% |
|
|
|
19% |
|
|
|
18% |
|
|
|
19% |
|
Healthcare reimbursement is complex and may involve lengthy
delays. Third-party payors are continuing their efforts to
control expenditures for healthcare, including proposals to
revise reimbursement policies. The
F-18
American Medical Response, Inc. & EmCare Holdings
Inc.
(The Healthcare Transportation and Emergency Management
Services
Businesses of Laidlaw International, Inc.)
Notes to Combined Financial
Statements (Continued)
Company has from time to time experienced delays in
reimbursement from third-party payors. In addition, third-party
payors may disallow, in whole or in part, claims for
reimbursement based on determinations that certain amounts are
not reimbursable under plan coverage, determinations of medical
necessity, or the need for additional information. Laws and
regulations governing the Medicare and Medicaid programs are
very complex and subject to interpretation. As a result, there
is a reasonable possibility that recorded estimates will change
materially in the short-term. Retroactive adjustments may change
the amounts realized from third-party payors and are considered
in the recognition of revenue on an estimated basis in the
period the related services are rendered. Such amounts are
adjusted in future periods, as adjustments become known.
Subsidies and fees in connection with community contracts are
recognized ratably over the service period the payment covers.
The Company also provides services to patients who have no
insurance or other third-party payor coverage. In certain
circumstances, federal law requires providers to render services
to any patient who requires emergency care regardless of their
ability to pay.
Income Taxes
The Company accounts for income taxes under SFAS 109.
Deferred income taxes reflect the impact of temporary
differences between the reported amounts of assets and
liabilities for financial reporting purposes and such amounts as
measured by tax laws and regulations. The deferred tax assets
and liabilities represent the future tax return consequences of
those differences, which will either be taxable or deductible
when the assets and liabilities are recovered or settled. A
valuation allowance is provided for deferred tax assets when
management concludes it is more likely than not that some
portion of the deferred tax assets will not be recognized.
AMR and EmCare are included in the consolidated U.S. income
tax return with other Laidlaw U.S. subsidiaries. The tax
allocation agreement calculates tax liability on a separate
company basis and provides for reimbursement or payment for
utilization of carryovers among members of the group.
Consequently, AMR and EmCare only receive the benefits of net
operating loss and interest carryforwards to the extent utilized
in Laidlaws consolidated return. Costs related to income
taxes are included as payable to or receivable from Laidlaw.
Recent Accounting Pronouncements
In December 2004, the Financial Accounting Standards Board
(FASB) issued Statement No. 123 (revised 2004),
Share-Based Payment. This Statement is a
revision of FASB Statement No. 123, Accounting for
Stock-Based Compensation and is effective as of the
beginning of the first interim or annual reporting period that
begins after June 15, 2005. The Statement requires public
companies to measure the cost of employee services received in
exchange for an award of equity instruments based on the
grant-date fair value of the award. The Company anticipates that
the adoption of this Statement will not have a material impact
on its financial statements.
F-19
American Medical Response, Inc. & EmCare Holdings
Inc.
(The Healthcare Transportation and Emergency Management
Services
Businesses of Laidlaw International, Inc.)
Notes to Combined Financial
Statements (Continued)
|
|
3. |
Property, Plant and Equipment, net |
Property, plant and equipment, net consisted of the following at
January 31, 2005 and August 31, 2004 and 2003:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Restated | |
|
|
|
|
| |
|
|
2005 | |
|
2004 | |
|
2003 | |
|
|
| |
|
| |
|
| |
Land
|
|
$ |
2,079 |
|
|
$ |
2,079 |
|
|
$ |
2,079 |
|
Building and leasehold improvements
|
|
|
14,293 |
|
|
|
14,147 |
|
|
|
11,670 |
|
Vehicles
|
|
|
91,114 |
|
|
|
85,172 |
|
|
|
65,163 |
|
Computer hardware and software
|
|
|
42,006 |
|
|
|
35,585 |
|
|
|
29,290 |
|
Other
|
|
|
46,891 |
|
|
|
45,622 |
|
|
|
32,130 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
196,383 |
|
|
|
182,605 |
|
|
|
140,332 |
|
Less: accumulated depreciation
|
|
|
(67,617 |
) |
|
|
(49,920 |
) |
|
|
(6,786 |
) |
|
|
|
|
|
|
|
|
|
|
Property, plant and equipment, net
|
|
$ |
128,766 |
|
|
$ |
132,685 |
|
|
$ |
133,546 |
|
|
|
|
|
|
|
|
|
|
|
Vehicles include certain vehicles held under capital leases with
a net book value of $11.7 million, $13.9 million and
$19.0 million at January 31, 2005 and August 31,
2004 and 2003, respectively. Accumulated depreciation and
amortization at January 31, 2005 and August 31, 2004
and 2003 includes $8.4 million, $6.3 million and
$1.3 million, respectively, relating to such vehicles.
Depreciation expense was $18.0 million for the five months
ended January 31, 2005, $43.2 million for the year
ended August 31, 2004, $10.2 million for the three
months ended August 31, 2003, $32.2 million for the
nine months ended May 31, 2003 and $45.7 million for
the year ended August 31, 2002.
|
|
4. |
Intangible Assets, net |
Intangible assets, net consisted of the following at
January 31, 2005 and August 31, 2004 and 2003:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Restated | |
|
|
|
|
|
|
| |
|
|
2005 | |
|
2004 | |
|
2003 | |
|
|
| |
|
| |
|
| |
Goodwill
|
|
$ |
|
|
|
$ |
|
|
|
$ |
52,360 |
|
Contract value
|
|
|
22,544 |
|
|
|
22,106 |
|
|
|
94,177 |
|
Radio frequencies
|
|
|
|
|
|
|
|
|
|
|
4,000 |
|
Covenant not to compete
|
|
|
250 |
|
|
|
|
|
|
|
19 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
22,794 |
|
|
|
22,106 |
|
|
|
150,556 |
|
Less: accumulated amortization
|
|
|
(6,719 |
) |
|
|
(6,348 |
) |
|
|
(2,351 |
) |
|
|
|
|
|
|
|
|
|
|
Intangible assets, net
|
|
$ |
16,075 |
|
|
$ |
15,758 |
|
|
$ |
148,205 |
|
|
|
|
|
|
|
|
|
|
|
Amortization expense of intangible assets was $0.8 million
for the five months ended January 31, 2005,
$9.5 million for the year ended August 31, 2004 and
$2.4 million for the three months ended August 31,
2003, $0 for the nine months ended May 31, 2003 and
$21.4 million for the year ended August 31, 2002.
Covenants and the contract value are amortized over a life of
10 years. As a result of the reversal of the separate
company tax valuation allowance as of August 31, 2004 under
fresh-start accounting, AMR reduced its intangible assets to
zero and EmCare reduced its intangible assets to
$15.8 million. Estimated annual amortization over each of
the next five years is approximately $2.2 million.
F-20
American Medical Response, Inc. & EmCare Holdings
Inc.
(The Healthcare Transportation and Emergency Management
Services
Businesses of Laidlaw International, Inc.)
Notes to Combined Financial
Statements (Continued)
Deferred income taxes reflect the net tax effects of temporary
differences between the carrying amounts of assets and
liabilities for financial reporting purposes and the amounts
used for income tax purposes. Significant components of the
Companys deferred taxes were as follows at
January 31, 2005 and August 31, 2004 and 2003:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Restated | |
|
|
|
|
| |
|
|
2005 | |
|
2004 | |
|
2003 | |
|
|
| |
|
| |
|
| |
Deferred tax assets:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Accounts receivable
|
|
$ |
38,817 |
|
|
$ |
34,726 |
|
|
$ |
54,447 |
|
|
Accrued liabilities
|
|
|
58,508 |
|
|
|
56,803 |
|
|
|
62,120 |
|
|
Intangible assets
|
|
|
42,732 |
|
|
|
46,047 |
|
|
|
24,311 |
|
|
Interest carryforwards
|
|
|
84,590 |
|
|
|
85,188 |
|
|
|
84,474 |
|
|
Net operating loss carryforwards
|
|
|
54,565 |
|
|
|
55,055 |
|
|
|
94,576 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
279,212 |
|
|
|
277,819 |
|
|
|
319,928 |
|
Deferred tax liabilities:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Excess of tax over book depreciation
|
|
|
(11,651 |
) |
|
|
(10,449 |
) |
|
|
(8,544 |
) |
|
|
|
|
|
|
|
|
|
|
Net deferred tax assets
|
|
|
267,561 |
|
|
|
267,370 |
|
|
|
311,384 |
|
Valuation allowance
|
|
|
|
|
|
|
|
|
|
|
(155,952 |
) |
|
|
|
|
|
|
|
|
|
|
Net deferred tax assets
|
|
$ |
267,561 |
|
|
$ |
267,370 |
|
|
$ |
155,432 |
|
|
|
|
|
|
|
|
|
|
|
The Company has significant net deferred tax assets resulting
from net operating loss (NOL) and interest deduction
carryforwards and other deductible temporary differences that
will reduce taxable income in future periods.
SFAS No. 109 Accounting for Income
Taxes requires that a valuation allowance be
established when it is more likely than not that
all, or a portion, of net deferred tax assets will not be
realized. A review of all available positive and negative
evidence needs to be considered, including expected reversals of
significant deductible temporary differences, a companys
recent financial performance, the market environment in which a
company operates, tax planning strategies and the length of NOL
and interest deduction carryforward periods. Furthermore, the
weight given to the potential effect of negative and positive
evidence should be commensurate with the extent to which it can
be objectively verified.
At the fresh-start accounting date, May 31, 2003, the
Company recorded a valuation allowance of $156.0 million,
based on the criteria required under SFAS No. 109
discussed above. During fiscal 2004, write-offs of net operating
loss carryforwards and realization of other assets reduced the
valuation allowance by $48.2 million. As a result of the
Companys improved financial performance during fiscal
2004, management reduced the deferred tax valuation allowance by
an additional $107.8 million during the year ended
August 31, 2004. As required under fresh-start accounting,
this change also resulted in a reduction in intangible assets
and goodwill and an increase in Laidlaw equity of AMR.
The Company has interest carryovers of $222.6 million at
January 31, 2005 limited by Internal Revenue Code
Section 163(j) without expiration, and federal net
operating loss carryforwards of $143.7 million which expire
in the years 2005 to 2024. The interest carryovers and
$134.0 million of the net operating loss carryforwards are
subject to Laidlaws annual Section 382 limitation of
$58 million.
In connection with the sale described in note 18, the value
of deferred tax assets and liabilities will be adjusted.
F-21
American Medical Response, Inc. & EmCare Holdings
Inc.
(The Healthcare Transportation and Emergency Management
Services
Businesses of Laidlaw International, Inc.)
Notes to Combined Financial
Statements (Continued)
The components of income tax benefit (expense) were as follows:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Predecessor | |
|
|
|
|
|
|
|
|
| |
|
|
Five Months | |
|
Year | |
|
Three Months | |
|
Nine Months | |
|
Year | |
|
|
Ended | |
|
Ended | |
|
Ended | |
|
Ended | |
|
Ended | |
|
|
January 31, | |
|
August 31, | |
|
August 31, | |
|
May 31, | |
|
August 31, | |
|
|
2005 | |
|
2004 | |
|
2003 | |
|
2003 | |
|
2002 | |
|
|
| |
|
| |
|
| |
|
| |
|
| |
Current tax expense
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
State
|
|
$ |
|
|
|
$ |
559 |
|
|
$ |
(162 |
) |
|
$ |
829 |
|
|
$ |
1,374 |
|
Federal
|
|
|
|
|
|
|
(694 |
) |
|
|
17,216 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Total
|
|
|
|
|
|
|
(135 |
) |
|
|
17,054 |
|
|
|
829 |
|
|
|
1,374 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Deferred tax expense
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
State
|
|
|
762 |
|
|
|
2,496 |
|
|
|
(76 |
) |
|
|
|
|
|
|
|
|
Federal
|
|
|
5,516 |
|
|
|
19,403 |
|
|
|
(8,345 |
) |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Total
|
|
|
6,278 |
|
|
|
21,899 |
|
|
|
(8,421 |
) |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Total tax expense
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
State
|
|
|
762 |
|
|
|
3,055 |
|
|
|
(238 |
) |
|
|
829 |
|
|
|
1,374 |
|
Federal
|
|
|
5,516 |
|
|
|
18,709 |
|
|
|
8,871 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Total
|
|
$ |
6,278 |
|
|
$ |
21,764 |
|
|
$ |
8,633 |
|
|
$ |
829 |
|
|
$ |
1,374 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
A reconciliation of the provision (benefit) for income taxes at
the federal statutory rate compared to the Companys
effective tax rate is as follows:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
As Restated | |
|
|
|
|
|
|
|
|
Predecessor | |
|
|
|
|
|
|
|
|
| |
|
|
Five Months | |
|
Year | |
|
Three Months | |
|
Nine Months | |
|
Year | |
|
|
Ended | |
|
Ended | |
|
Ended | |
|
Ended | |
|
Ended | |
|
|
January 31, | |
|
August 31, | |
|
August 31, | |
|
May 31, | |
|
August 31, | |
|
|
2005 | |
|
2004 | |
|
2003 | |
|
2003 | |
|
2002 | |
|
|
| |
|
| |
|
| |
|
| |
|
| |
Income tax expense (benefit) at the statutory rate
|
|
$ |
5,516 |
|
|
$ |
20,690 |
|
|
$ |
631 |
|
|
$ |
26,656 |
|
|
$ |
(86,103 |
) |
Decrease(increase) in income taxes resulting from:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
State taxes, net of federal
|
|
|
495 |
|
|
|
1,986 |
|
|
|
(155 |
) |
|
|
539 |
|
|
|
893 |
|
|
Goodwill amortization/impairment
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
76,517 |
|
|
Fresh start accounting adjustments
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
(16,246 |
) |
|
|
|
|
|
Parent Company allocations
|
|
|
|
|
|
|
(1,577 |
) |
|
|
7,990 |
|
|
|
(2,826 |
) |
|
|
(40,377 |
) |
|
Change in valuation allowance
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
(7,607 |
) |
|
|
50,158 |
|
|
Other
|
|
|
267 |
|
|
|
665 |
|
|
|
167 |
|
|
|
313 |
|
|
|
286 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Provision for income taxes
|
|
$ |
6,278 |
|
|
$ |
21,764 |
|
|
$ |
8,633 |
|
|
$ |
829 |
|
|
$ |
1,374 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
F-22
American Medical Response, Inc. & EmCare Holdings
Inc.
(The Healthcare Transportation and Emergency Management
Services
Businesses of Laidlaw International, Inc.)
Notes to Combined Financial
Statements (Continued)
Accrued liabilities were as follows at January 31, 2005 and
August 31, 2004 and 2003:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
2005 | |
|
2004 | |
|
2003 | |
|
|
| |
|
| |
|
| |
Accrued wages and benefits
|
|
$ |
53,231 |
|
|
$ |
65,757 |
|
|
$ |
56,960 |
|
Accrued paid time off
|
|
|
20,141 |
|
|
|
19,828 |
|
|
|
16,896 |
|
Current portion of self-insurance reserve
|
|
|
41,283 |
|
|
|
36,384 |
|
|
|
28,206 |
|
Accrued restructuring
|
|
|
1,118 |
|
|
|
1,611 |
|
|
|
3,088 |
|
Current portion of compliance and legal
|
|
|
3,607 |
|
|
|
5,660 |
|
|
|
8,056 |
|
Accrued billing and collection fees
|
|
|
3,522 |
|
|
|
3,466 |
|
|
|
3,300 |
|
Accrued profit sharing
|
|
|
23,802 |
|
|
|
7,566 |
|
|
|
6,552 |
|
Other
|
|
|
24,941 |
|
|
|
26,512 |
|
|
|
23,121 |
|
|
|
|
|
|
|
|
|
|
|
Total accrued liabilities
|
|
$ |
171,645 |
|
|
$ |
166,784 |
|
|
$ |
146,179 |
|
|
|
|
|
|
|
|
|
|
|
Long-term debt consisted of the following at January 31,
2005 and August 31, 2004 and 2003:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
2005 | |
|
2004 | |
|
2003 | |
|
|
| |
|
| |
|
| |
Notes due at various dates from 2004 to 2022 with interest rates
from 6% to 10%
|
|
$ |
1,219 |
|
|
$ |
2,959 |
|
|
$ |
6,478 |
|
Mortgage loan due 2010 with an interest rate of 7%
|
|
|
2,168 |
|
|
|
2,190 |
|
|
|
2,242 |
|
Capital lease obligations due at various dates from 2006 to 2007
(note 10)
|
|
|
8,110 |
|
|
|
10,331 |
|
|
|
15,337 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
11,497 |
|
|
|
15,480 |
|
|
|
24,057 |
|
Less current portion
|
|
|
(5,846 |
) |
|
|
(7,565 |
) |
|
|
(8,270 |
) |
|
|
|
|
|
|
|
|
|
|
Total long-term debt
|
|
$ |
5,651 |
|
|
$ |
7,915 |
|
|
$ |
15,787 |
|
|
|
|
|
|
|
|
|
|
|
The aggregate amount of minimum payments (deposit refunds)
required on long-term debt in each of the years indicated is as
follows:
|
|
|
|
|
Year ending January 31, |
|
|
|
|
|
2006
|
|
$ |
5,846 |
|
2007
|
|
|
3,771 |
|
2008
|
|
|
(878 |
) |
2009
|
|
|
121 |
|
2010
|
|
|
108 |
|
Thereafter
|
|
|
2,529 |
|
|
|
|
|
|
|
$ |
11,497 |
|
|
|
|
|
F-23
American Medical Response, Inc. & EmCare Holdings
Inc.
(The Healthcare Transportation and Emergency Management
Services
Businesses of Laidlaw International, Inc.)
Notes to Combined Financial
Statements (Continued)
|
|
8. |
Restructuring Charges and Impairment Losses |
The activity in the accrued restructuring balance is as follows:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
2002 Plan | |
|
2003 Plan | |
|
2004 Plan | |
|
|
|
|
| |
|
| |
|
| |
|
|
|
|
Severance | |
|
Lease | |
|
Total | |
|
Severance | |
|
Severance | |
|
Total | |
|
|
| |
|
| |
|
| |
|
| |
|
| |
|
| |
Incurred
|
|
$ |
1,517 |
|
|
$ |
2,260 |
|
|
$ |
3,777 |
|
|
|
|
|
|
|
|
|
|
$ |
3,777 |
|
Paid
|
|
|
(456 |
) |
|
|
(149 |
) |
|
|
(605 |
) |
|
|
|
|
|
|
|
|
|
|
(605 |
) |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
August 31, 2002
|
|
|
1,061 |
|
|
|
2,111 |
|
|
|
3,172 |
|
|
|
|
|
|
|
|
|
|
|
3,172 |
|
Incurred April 2003
|
|
|
|
|
|
|
|
|
|
|
|
|
|
$ |
1,288 |
|
|
|
|
|
|
|
1,288 |
|
Incurred August 2003
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
1,449 |
|
|
|
|
|
|
|
1,449 |
|
Paid
|
|
|
(559 |
) |
|
|
(561 |
) |
|
|
(1,120 |
) |
|
|
(1,701 |
) |
|
|
|
|
|
|
(2,821 |
) |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
August 31, 2003
|
|
|
502 |
|
|
|
1,550 |
|
|
|
2,052 |
|
|
|
1,036 |
|
|
|
|
|
|
|
3,088 |
|
Incurred
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
$ |
2,115 |
|
|
|
2,115 |
|
Paid
|
|
|
(502 |
) |
|
|
(566 |
) |
|
|
(1,068 |
) |
|
|
(1,036 |
) |
|
|
(1,488 |
) |
|
|
(3,592 |
) |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
August 31, 2004
|
|
|
|
|
|
|
984 |
|
|
|
984 |
|
|
|
|
|
|
|
627 |
|
|
|
1,611 |
|
Incurred
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Paid
|
|
|
|
|
|
|
(238 |
) |
|
|
(238 |
) |
|
|
|
|
|
|
(255 |
) |
|
|
(493 |
) |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
January 31, 2005
|
|
$ |
|
|
|
$ |
746 |
|
|
$ |
746 |
|
|
$ |
|
|
|
$ |
372 |
|
|
$ |
1,118 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Restructuring Plans
During fiscal year 2004, AMR was re-aligned into three
geographic regions. The billing centers and operating units
within the four original AMR regions were shifted to create the
new structure and the administrative office of the former
South-Central region was closed. The functions previously
performed by this group were distributed to the remaining
regions. This restructuring plan is expected to be completed by
December 2005.
During fiscal year 2003, AMRs Northern Pacific Region
re-aligned the management structure of its operations. The first
phase occurred in April 2003 and the second and final phase
occurred in August 2003.
During fiscal year 2002, in an effort to eliminate the
differences in size among regions, AMR was re-aligned into four
geographic regions. The operating units within the five original
regions were shifted to create the new structure and the
administrative offices of the former South region and one
billing center were closed. National Products and Services was
also closed. The functions previously performed by this group
were distributed to the remaining regions and the corporate
office. This restructuring plan is expected to be completed by
December 2008.
2002 Impairment Losses
During fiscal year 2002, AMR incurred an impairment charge of
$262.8 million, including $254.9 goodwill impairment and
$7.9 million property, plant and equipment impairment. The
impairment losses resulted from the inability of AMR to recover
the carrying value of the long-lived assets from expected future
operating cash flows.
F-24
American Medical Response, Inc. & EmCare Holdings
Inc.
(The Healthcare Transportation and Emergency Management
Services
Businesses of Laidlaw International, Inc.)
Notes to Combined Financial
Statements (Continued)
|
|
9. |
Retirement Plans and Employee Benefits |
AMR maintains three 401(k) plans (the AMR Plans) for
its employees and employees of its subsidiaries who meet the
eligibility requirements set forth in the AMR Plans. Employees
may contribute a maximum of 40% of their compensation up to a
maximum of $13 (thousand). Generally 50% of the contribution is
matched by AMR up to a maximum of 3% to 6% of the
employees salary per year, depending on the plan.
AMRs contributions to the AMR Plans for the five months
ended January 31, 2005 were $3.7 million, the year
ended August 31, 2004 were $8.1 million, for the three
months ended August 31, 2003 were $1.9 million and for
the nine months ended May 31, 2003 were $5.7 million.
For the year ended August 31, 2002, AMRs
contributions to the AMR Plans were $6.9 million.
Contributions are included in operating expenses on the
accompanying combined statements of operations.
EmCare established the EmCare Holdings Inc. 401(k) Savings Plan
(the EmCare Plan) in 1994 to provide retirement
benefits to its employees. Employees may elect to participate in
the EmCare Plan at the beginning of each calendar quarter and
may contribute 1% to 25% of their annual compensation on a
tax-deferred basis subject to limits established by the Internal
Revenue Service. EmCare contributes 50% of the first 6% of base
compensation that a participant contributes to the EmCare Plan
during any calendar year. The EmCare Plan follows a calendar
year-end. Accordingly, EmCare makes its matching contributions
based on eligible employee contributions for each calendar year.
EmCare contributed $0.1 million to the EmCare Plan during
the five months ended January 31, 2005. During calendar
years 2004, 2003 and 2002, EmCare contributed $0.5 million,
$0.4 and $0.4 million, respectively, to the EmCare Plan.
In fiscal 2004, Laidlaw issued Value Appreciation Rights
(VAR) to various employees of AMR and EmCare. There
were no VARs issued prior to fiscal 2004. The VARs vest 100% on
the third anniversary of the date of the grant. The VARs
compensation is based on prescribed formulas that estimate
changes in the enterprise values of AMR and EmCare. The Company
recognizes compensation expense on a straight-line basis over
the vesting period with compensation expense of
$4.1 million for fiscal 2004. The Company recognized
$15.3 million of expense related to the VARs for the period
ended January 31, 2005 which is included in Laidlaw fees
and compensation charges. This expense related to the sale
transaction discussed in note 18 and was funded by Laidlaw
in accordance with the terms of the sale agreements. The VAR
program was terminated in connection with the sale of AMR and
EmCare in February 2005 and employees and executives will earn
no further rights.
|
|
10. |
Commitments and Contingencies |
Lease Commitments
The Company leases various facilities and equipment under
operating lease agreements. Rental expense incurred under these
leases was $12.4 million, $27.9 million,
$7.2 million and $23.2 million for the five months
ended January 31, 2005, the year ended August 31,
2004, the three months ended August 31, 2003 and the nine
months ended May 31, 2003, respectively, and was
$32.4 million in fiscal 2002.
In addition, the Company leases certain vehicles under capital
leases. Assets under capital lease are capitalized using
inherent interest rates at the inception of each lease. Capital
leases are collateralized by the leased vehicles.
F-25
American Medical Response, Inc. & EmCare Holdings
Inc.
(The Healthcare Transportation and Emergency Management
Services
Businesses of Laidlaw International, Inc.)
Notes to Combined Financial
Statements (Continued)
Future commitments under capital and operating leases for
vehicle, premises, equipment and other recurring commitments are
as follows (the balances below include fair value adjustments as
described in note 2):
|
|
|
|
|
|
|
|
|
|
|
|
|
Operating | |
|
|
Capital | |
|
Leases & | |
|
|
Leases | |
|
Other | |
|
|
| |
|
| |
Year ending January 31,
|
|
|
|
|
|
|
|
|
2006
|
|
$ |
6,000 |
|
|
$ |
27,289 |
|
2007
|
|
|
3,558 |
|
|
|
20,335 |
|
2008
|
|
|
(948 |
) |
|
|
16,242 |
|
2009
|
|
|
|
|
|
|
12,785 |
|
2010
|
|
|
|
|
|
|
8,810 |
|
Thereafter
|
|
|
|
|
|
|
20,659 |
|
|
|
|
|
|
|
|
|
|
|
8,610 |
|
|
$ |
106,120 |
|
|
|
|
|
|
|
|
Less imputed interest
|
|
|
(500 |
) |
|
|
|
|
|
|
|
|
|
|
|
Total capital lease obligations
|
|
|
8,110 |
|
|
|
|
|
Less current portion
|
|
|
(5,530 |
) |
|
|
|
|
|
|
|
|
|
|
|
Long-term capital lease obligations
|
|
$ |
2,580 |
|
|
|
|
|
|
|
|
|
|
|
|
Other commitments consisting of dispatch and responder fees
totaling $5,362, $1,133, $991, $989, $2,912 and $243 and Onex
management fees of $889, $1,000, $1,000, $1,000, $1,000 and $0
for the years ending January 31, 2006, 2007, 2008, 2009,
2010 and thereafter, respectively.
Services
The Company is subject to the Medicare and Medicaid fraud and
abuse laws which prohibit, among other things, any false claims,
or any bribe, kick-back or rebate in return for the referral of
Medicare and Medicaid patients. Violation of these prohibitions
may result in civil and criminal penalties and exclusion from
participation in the Medicare and Medicaid programs. Management
has implemented policies and procedures that management believes
will assure that the Company is in substantial compliance with
these laws. From time to time, we receive requests for
information from government agencies pursuant to their
regulatory or investigational authority. Such requests can
include subpoenas or demand letters for documents to assist the
government in audits or investigations. The Company is
cooperating with the government agencies conducting these
investigations and is providing requested information to the
government agencies. Other than the investigations described
below, management believes that the outcome of any of these
investigations would not have a material adverse effect on the
Company.
During the first quarter of fiscal 2004, AMR was advised by the
U.S. Department of Justice (DOJ) that it was
investigating certain of AMRs business practices. The
specific practices at issue were (1) whether ambulance
transports involving Medicare eligible patients complied with
the medical necessity requirement imposed by
Medicare regulations, (2) whether patient signatures, when
required, were properly obtained from Medicare eligible
patients, and (3) whether discounts in violation of the
federal Anti-Kickback Statute were provided by AMR in exchange
for referrals involving Medicare eligible patients. In
connection with the third issue, the government has alleged that
certain of AMRs hospital and nursing home contracts
in effect in Texas, primarily certain contracts in effect in
1996 and 1997, contained discounts in violation of the federal
Anti-Kickback Statute. The government recently has provided the
Company with an analysis of the
F-26
American Medical Response, Inc. & EmCare Holdings
Inc.
(The Healthcare Transportation and Emergency Management
Services
Businesses of Laidlaw International, Inc.)
Notes to Combined Financial
Statements (Continued)
investigation conducted in connection with this contract issue,
and invited the Company to respond. The Company is considering
the governments analysis and intends to provide its views,
as requested. The government may also be investigating whether
AMRs contracts with health facilities in Oregon and other
jurisdictions violate the Anti-Kickback Statute. At this time,
it is not possible to predict the ultimate conclusion of these
investigations, nor is it possible to estimate possible
financial exposure, if any, to the Company.
From August 1998 until August 2000, American Medical Response
West (AMR West), a subsidiary of AMR, received six
subpoenas duces tecum from the United States Attorneys
Office. These subpoenas related to billing matters for emergency
transports during the periods January 1, 1995 to
December 31, 1999. Pursuant to a settlement agreement with
the United States Attorneys Office, AMR West paid
$3.5 million in 2004 and entered into a five-year agreement
with the Department of Health and Human Services covering
various administrative processes and procedures. AMR reserved
for these matters in periods prior to the statements of
operations presented herein.
In June 1999, the DOJ began an investigation of the billing
processes of Regional Emergency Services L.P., or RES, a
subsidiary of AMR, and one of RES hospital clients.
The DOJ alleged violations by the companies of the False Claims
Act based on the absence of certificates of medical necessity
and other non-compliant billing practices from October 1992 to
May 2002. Pursuant to a settlement agreement to resolve these
allegations, including settlement of claims in Texas described
below, in April 2004 AMR paid $5.0 million of a total
$20.0 million settlement amount, with the balance paid by the
hospital. AMR reserved for these matters in periods prior to the
statements of operations presented herein.
On May 9, 2002, AMR received a subpoena duces tecum from
the Office of Inspector General for the United States Department
of Health and Human Services. The subpoena required AMR to
produce a broad range of documents relating to RES contracts in
Texas, Georgia and Colorado for the period from January 1993
through May 2002. The Texas claims were resolved pursuant to the
settlement agreement described above. The government
investigations in Georgia and Colorado are continuing; it is not
currently possible to estimate the financial exposure, if any,
to the Company.
On July 12, 2005, the Company received a letter and draft
Audit Report from the Office of Inspector General for the United
States Department of Health and Human Services, or OIG,
requesting the Companys response to its draft findings
that the Companys Massachusetts subsidiary received
$1.9 million in overpayments from Medicare for services
performed between July 1, 2002 and December 31, 2002.
The draft findings state that some of these services did not
meet Medicare medical necessity and reimbursement requirements.
The Company disagrees with the OIGs finding and is in the
process of responding to the draft Audit Report. If the Company
is unsuccessful in challenging the OIGs draft findings,
and in any administrative appeals to which the Company may be
entitled following the release of a final Audit Report, the
Company may be required to make a substantial repayment.
Letters of Credit
At January 31, 2005 and August 31, 2004 and 2003, AMR
had $23,297, $8,212 and $9,112, respectively, in outstanding
letters of credit. At January 31, 2005 and August 31,
2004 and 2003, Laidlaw also had issued letters of credit on
behalf of AMR for $1,000, $23,328 and $28,185, respectively.
Other Legal Matters
EmCare has been named as a defendant in two collective action
lawsuits brought by a number of nurse practitioners and
physician assistants under the federal Fair Labor Standards Act.
The plaintiffs are seeking to
F-27
American Medical Response, Inc. & EmCare Holdings
Inc.
(The Healthcare Transportation and Emergency Management
Services
Businesses of Laidlaw International, Inc.)
Notes to Combined Financial
Statements (Continued)
recover overtime pay for the hours they worked in excess of 40
in a workweek and reclassification as non-exempt employees.
Certain of the plaintiffs brought a related action under
California state law. EmCare has entered into a settlement of
the California state law claims for $1.5 million. EmCare
reserved the amount of this settlement in fiscal 2004 and it was
included as a component of selling, general and administrative
expenses.
Guarantees
Upon emergence from Chapter 11, Laidlaw established a new
senior secured credit facility (the Facility). The
Facility is guaranteed by Laidlaw and certain Laidlaw
subsidiaries, including AMR and EmCare. In addition, the
Facility is secured by the assets of Laidlaw and certain Laidlaw
subsidiaries, including AMR and EmCare, except for certain
assets of the Company contractually excluded from the
securitization. Under the terms of the Facility, Laidlaw is
required to meet certain financial covenants, including a fixed
charge coverage ratio, leverage ratio, interest coverage ratio,
net tangible asset ratio and maximum senior secured leverage
ratio, as well as certain non-financial covenants. As of
January 31, 2005, Laidlaw was in compliance with all
covenants and the outstanding balance under the Facility and
issued letters of credit aggregated $597.3 million.
As a result of emergence from Chapter 11, Laidlaw also
issued unsecured senior notes. These notes are also guaranteed
by Laidlaw and certain Laidlaw subsidiaries, including AMR and
EmCare. The outstanding balance under the notes at
January 31, 2005 aggregated $406 million.
In connection with the sale discussed in note 18, AMR and
EmCare have been released from these guarantees.
Income Tax Matters
The respective tax authorities, in the normal course, audit
previous tax filings. It is not possible at this time to predict
the final outcome of these audits or establish a reasonable
estimate of possible additional taxes owing, if any.
Allocation of Costs from Laidlaw
Laidlaw charges AMR and EmCare for the estimated cost of certain
functions that are managed by Laidlaw and can reasonably be
attributed directly to the operations of the Company. The
charges to the Company are based on managements estimate
of such services specifically used by the Company. Where
determinations based on specific usage alone have been
impracticable, other methods and criteria were used that Laidlaw
management believes are reasonable. Such allocations are not
intended to represent the costs that would be or would have been
incurred if the Company were an independent business.
The amount of Laidlaws combined equity and the Laidlaw
payable included in the balance sheet represents a net balance
as a result of various transactions between the Company and
Laidlaw. There are no terms of settlement associated with the
account balance. The balance is primarily the result of the
Companys participation in Laidlaws central cash
management program, wherein all the subsidiaries cash
receipts are remitted to Laidlaw and all cash disbursements are
funded by Laidlaw. Other transactions include certain direct
obligations administered by Laidlaw, as well as the
Companys share of the current portion of the Laidlaw
consolidated federal and state income tax liability and various
other administrative expenses allocated by Laidlaw. As a result,
obligations for these matters are not reflected on the
accompanying balance sheet.
F-28
American Medical Response, Inc. & EmCare Holdings
Inc.
(The Healthcare Transportation and Emergency Management
Services
Businesses of Laidlaw International, Inc.)
Notes to Combined Financial
Statements (Continued)
Self-insurance obligations and related deposits administered by
Laidlaw are reflected on the accompanying balance sheet.
Laidlaw charges or cost allocations included in the accompanying
combined statements of operations include the following:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Predecessor | |
|
|
|
|
|
|
|
|
|
| |
|
|
Five Months | |
|
Year | |
|
Three Months | |
|
|
Nine Months | |
|
Year | |
|
|
Ended | |
|
Ended | |
|
Ended | |
|
|
Ended | |
|
Ended | |
|
|
January 31, | |
|
August 31, | |
|
August 31, | |
|
|
May 31, | |
|
August 31, | |
|
|
2005 | |
|
2004 | |
|
2003 | |
|
|
2003 | |
|
2002 | |
|
|
| |
|
| |
|
| |
|
|
| |
|
| |
Allocated insurance expense (income)
|
|
$ |
|
|
|
$ |
(4,505 |
) |
|
$ |
11,522 |
|
|
|
$ |
3,058 |
|
|
$ |
(8,094 |
) |
Direct insurance expense
|
|
|
17,069 |
|
|
|
40,554 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Laidlaw fees and compensation charges
|
|
|
19,857 |
|
|
|
15,449 |
|
|
|
1,350 |
|
|
|
|
4,050 |
|
|
|
5,400 |
|
Reorganization costs
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
3,650 |
|
|
|
8,761 |
|
Interest
|
|
|
4,480 |
|
|
|
6,225 |
|
|
|
403 |
|
|
|
|
3,081 |
|
|
|
4,585 |
|
Included in insurance expense are allocations of charges and
credits made to AMR related to the operating costs and
investment activities of Laidlaws captive insurance
company. These allocations also include changes in actuarial
estimates of insurance reserves for fiscal year 2001 and prior
years claims estimates. For fiscal year 2002 and 2003, AMR
obtained insurance coverage from outside parties, rather than
through Laidlaw. In fiscal 2004, AMR returned to the Laidlaw
insurance program for workers compensation, auto and general
liability. EmCares participation in the Laidlaw insurance
program is limited to directors and officers, and general
liability insurance which is allocated as a component of Laidlaw
fees and compensation charges.
Management costs have been calculated using a formula based upon
the Companys share of Laidlaws consolidated revenue
and represent Laidlaws general and administrative costs
incurred for the benefit of the Company. Fiscal 2004 management
costs include $4.1 million of charges related to incentive
plans for management of the Company.
During the nine months ended May 31, 2003 and fiscal year
2002, Laidlaw charged the Company additional costs incurred by
Laidlaw as a result of its reorganization of $3.7 million
and $8.8 million, respectively.
Interest expense has been recorded by the Company based on an
average intercompany balance and applicable interest rates
(prime + 2%). During fiscal 2002 and for the nine months ended
May 31, 2003, Laidlaw, as a result of its bankruptcy,
suspended interest on purchase acquisition debt pushed down to
AMR.
On March 1, 2004, AMR declared a $200 million dividend
payable to Laidlaw. The dividend has been recorded as an
increase in the Laidlaw payable account on the balance sheet and
as a decrease to combined equity. There are no specific
repayment terms related to the Laidlaw payable account which has
been included as a component of equity on the accompanying
combined balance sheets and combined statements of changes in
equity.
At January 31, 2005, Laidlaw maintained deposits of
$16.4 million for collateral on behalf of AMR supporting
performance bonds held by a related party. AMRs interest
in the collateral is included in other long-term assets. As
described in note 12, Laidlaw also maintains
insurance-related deposits on behalf of AMR.
F-29
American Medical Response, Inc. & EmCare Holdings
Inc.
(The Healthcare Transportation and Emergency Management
Services
Businesses of Laidlaw International, Inc.)
Notes to Combined Financial
Statements (Continued)
The Company transfers surplus funds to Laidlaw as necessary and,
as described above, bears the cost of various allocated
expenses. The Companys operating results, cash flows and
financial position may significantly differ from those that
would have been achieved in the absence of the Companys
relationship with Laidlaw.
Insurance reserves are established for automobile, workers
compensation, general liability and professional liability
claims utilizing policies with both fully-insured and
self-insured components. This includes the use of an off-shore
captive insurance program through a wholly-owned subsidiary for
certain professional liability (malpractice) programs for
EmCare. In those instances where the Company has obtained
third-party insurance coverage, either directly through an
independent outside party or through participation in a Laidlaw
administered program, the Company normally retains liability for
the first $1 to $2 million of the loss. Insurance reserves
cover known claims and incidents within the level of Company
retention that may result in the assertion of additional claims,
as well as claims from unknown incidents that may be asserted
arising from activities through January 31, 2005.
The Company establishes reserves for claims based upon an
assessment of actual claims and claims incurred but not
reported. The reserves are established based on consultation
with third-party independent actuaries using actuarial
principles and assumptions that consider a number of factors,
including historical claim payment patterns (including legal
costs) and changes in case reserves and the assumed rate of
inflation in health care costs and property damage repairs. All
claims arising and not settled before June 1, 2003 were
recorded at estimated fair value as of the fresh-start date.
Claims, other than auto and general liability claims, that arose
after June 1, 2003 are discounted at a rate commensurate
with the interest rate on monetary assets that essentially are
risk free and have a maturity comparable to the underlying
liabilities. Auto and general liability claims that arose after
June 1, 2003 are not discounted. The table below summarizes
the non-health and welfare insurance reserves included in the
accompanying combined balance sheets.
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Accrued | |
|
Other Long-Term | |
|
Total | |
January 31, 2005 |
|
Liabilities | |
|
Liabilities | |
|
Liabilities | |
|
|
| |
|
| |
|
| |
Automobile
|
|
$ |
4,054 |
|
|
$ |
10,558 |
|
|
$ |
14,612 |
|
Workers compensation
|
|
|
11,554 |
|
|
|
34,636 |
|
|
|
46,190 |
|
General/ Professional liability
|
|
|
25,675 |
|
|
|
97,905 |
|
|
|
123,580 |
|
|
|
|
|
|
|
|
|
|
|
|
|
$ |
41,283 |
|
|
$ |
143,099 |
|
|
$ |
184,382 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Accrued | |
|
Other Long-Term | |
|
Total | |
August 31, 2004 |
|
Liabilities | |
|
Liabilities | |
|
Liabilities | |
|
|
| |
|
| |
|
| |
Automobile
|
|
$ |
4,007 |
|
|
$ |
8,887 |
|
|
$ |
12,894 |
|
Workers compensation
|
|
|
10,903 |
|
|
|
32,406 |
|
|
|
43,309 |
|
General/ Professional liability
|
|
|
21,474 |
|
|
|
96,887 |
|
|
|
118,361 |
|
|
|
|
|
|
|
|
|
|
|
|
|
$ |
36,384 |
|
|
$ |
138,180 |
|
|
$ |
174,564 |
|
|
|
|
|
|
|
|
|
|
|
F-30
American Medical Response, Inc. & EmCare Holdings
Inc.
(The Healthcare Transportation and Emergency Management
Services
Businesses of Laidlaw International, Inc.)
Notes to Combined Financial
Statements (Continued)
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Accrued | |
|
Other Long-term | |
|
Total | |
August 31, 2003 |
|
Liabilities | |
|
Liabilities | |
|
Liabilities | |
|
|
| |
|
| |
|
| |
Automobile
|
|
$ |
4,845 |
|
|
$ |
6,244 |
|
|
$ |
11,089 |
|
Workers compensation
|
|
|
10,152 |
|
|
|
23,870 |
|
|
|
34,022 |
|
General/ Professional liability
|
|
|
13,209 |
|
|
|
88,897 |
|
|
|
102,106 |
|
|
|
|
|
|
|
|
|
|
|
|
|
$ |
28,206 |
|
|
$ |
119,011 |
|
|
$ |
147,217 |
|
|
|
|
|
|
|
|
|
|
|
Certain insurance programs also require the Company to maintain
deposits with third-party insurers, trustees or with Laidlaw to
cover future claims costs and are included in other assets in
the combined balance sheets. Investments supporting insurance
programs are comprised principally of government securities and
investment grade securities and are presented as restricted
assets in the combined balance sheets. These investments are
designated as available-for-sale and reported at fair value.
Investment income/loss earned on these investments is reported
as a component of insurance expense in the combined statement of
operations. The following table summarizes these deposits and
restricted investments:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
January 31, | |
|
August 31, | |
|
August 31, | |
|
|
2005 | |
|
2004 | |
|
2003 | |
|
|
| |
|
| |
|
| |
Restricted cash and cash equivalents
|
|
$ |
9,846 |
|
|
$ |
5,691 |
|
|
$ |
939 |
|
Restricted marketable securities
|
|
|
2,473 |
|
|
|
6,756 |
|
|
|
201 |
|
Short-term deposits (included in other current assets)
|
|
|
8,044 |
|
|
|
9,889 |
|
|
|
14,997 |
|
Short-term deposits with Laidlaw (included in other current
assets)
|
|
|
11,541 |
|
|
|
5,700 |
|
|
|
|
|
Restricted long-term investments
|
|
|
41,810 |
|
|
|
47,285 |
|
|
|
40,608 |
|
Long-term deposits (included in other long-term assets)
|
|
|
20,006 |
|
|
|
23,708 |
|
|
|
28,626 |
|
Long-term deposits with Laidlaw (included in other long-term
assets)
|
|
|
29,413 |
|
|
|
22,733 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Total insurance deposits
|
|
$ |
123,133 |
|
|
$ |
121,762 |
|
|
$ |
85,371 |
|
|
|
|
|
|
|
|
|
|
|
Provisions for insurance expense included in the combined
statement of operations includes annual provisions determined in
consultation with Company actuaries, premiums paid to
third-party insurers net of retrospective policy adjustments,
interest accretion and earnings/loss on investments. Fiscal 2004
expense was reduced by a $3.8 million experience refund
received during the year.
F-31
American Medical Response, Inc. & EmCare Holdings
Inc.
(The Healthcare Transportation and Emergency Management
Services
Businesses of Laidlaw International, Inc.)
Notes to Combined Financial
Statements (Continued)
|
|
13. |
Supplemental Cash Flow Information |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Predecessor | |
|
|
|
|
Restated | |
|
|
|
|
| |
|
|
Five Months | |
|
Year | |
|
Three Months | |
|
|
Nine Months | |
|
Year | |
|
|
Ended | |
|
Ended | |
|
Ended | |
|
|
Ended | |
|
Ended | |
|
|
January 31, | |
|
August 31, | |
|
August 31, | |
|
|
May 31, | |
|
August 31, | |
|
|
2005 | |
|
2004 | |
|
2003 | |
|
|
2003 | |
|
2002 | |
|
|
| |
|
| |
|
| |
|
|
| |
|
| |
Cash paid during the period for interest
|
|
$ |
488 |
|
|
$ |
556 |
|
|
$ |
436 |
|
|
|
$ |
1,605 |
|
|
$ |
1,278 |
|
Finance and investing activities not requiring the use of cash:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Dividend to Laidlaw
|
|
|
|
|
|
|
200,000 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Acquisition of equipment through capital leases
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
26,320 |
|
|
Reduction of deferred tax asset valuation allowance through:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Reduction of ambulance service contracts and other intangibles
|
|
|
|
|
|
|
124,977 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Reduction of associated deferred tax asset
|
|
|
|
|
|
|
(27,606 |
) |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Laidlaw equity
|
|
$ |
|
|
|
$ |
10,406 |
|
|
$ |
|
|
|
|
$ |
|
|
|
$ |
|
|
The Company is organized around two separately managed business
units: healthcare transportation services and emergency
management services, which have been identified as operating
segments. The healthcare transportation services reportable
segment focuses on providing a full range of medical
transportation services from basic patient transit to the most
advanced emergency care and pre-hospital assistance. The
emergency management services reportable segment provides
outsourced business services to hospitals primarily for
emergency departments, urgent care centers and for certain
inpatient departments. The Chief Executive Officer has been
identified as the chief operating decision maker (CODM) for
purposes of SFAS No. 131 Disclosures about
Segments of an Enterprise and Related Information
(SFAS 131), as he assesses the performance of the business
units and decides how to allocate resources to the business
units. Pre-tax income from continuing operations before
interest, taxes and depreciation and amortization (Segment
EBITDA) is the measure of profit and loss that the CODM
uses to assess performance and make decisions. Pre-tax income
from continuing operations represents net revenue less direct
operating expenses incurred
F-32
American Medical Response, Inc. & EmCare Holdings
Inc.
(The Healthcare Transportation and Emergency Management
Services
Businesses of Laidlaw International, Inc.)
Notes to Combined Financial
Statements (Continued)
within the operating segments. The accounting policies for
reported segments are the same as for the Company as a whole
(see note 2).
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Predecessor Company | |
|
|
|
|
|
|
|
|
|
Restated | |
|
|
|
|
|
|
|
|
|
| |
|
|
Five Months | |
|
Year | |
|
Three Months | |
|
|
Nine Months | |
|
Year | |
|
|
Ended | |
|
Ended | |
|
Ended | |
|
|
Ended | |
|
Ended | |
|
|
January 31, | |
|
August 31, | |
|
August 31, | |
|
|
May 31, | |
|
August 31, | |
|
|
2005 | |
|
2004 | |
|
2003 | |
|
|
2003 | |
|
2002 | |
|
|
| |
|
| |
|
| |
|
|
| |
|
| |
Healthcare Transportation Services
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Revenue
|
|
$ |
455,059 |
|
|
$ |
1,054,800 |
|
|
$ |
255,807 |
|
|
|
$ |
751,344 |
|
|
$ |
984,451 |
|
Segment EBITDA
|
|
|
33,859 |
|
|
|
85,557 |
|
|
|
7,941 |
|
|
|
|
48,026 |
|
|
|
(189,624 |
)(1) |
Total identifiable assets
|
|
|
645,441 |
|
|
|
628,635 |
|
|
|
605,268 |
|
|
|
|
638,495 |
(2) |
|
|
894,943 |
|
Capital expenditures
|
|
|
12,054 |
|
|
|
38,573 |
|
|
|
17,581 |
|
|
|
|
30,888 |
|
|
|
26,670 |
|
Emergency Management Services
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Revenue
|
|
|
241,120 |
|
|
|
549,798 |
|
|
|
128,654 |
|
|
|
|
351,991 |
|
|
|
431,335 |
|
Segment EBITDA
|
|
|
5,639 |
|
|
|
37,156 |
|
|
|
7,217 |
|
|
|
|
18,248 |
|
|
|
16,847 |
|
Total identifiable assets
|
|
|
338,069 |
|
|
|
320,964 |
|
|
|
309,478 |
|
|
|
|
303,136 |
(2) |
|
|
163,132 |
|
Capital expenditures
|
|
|
1,991 |
|
|
|
4,214 |
|
|
|
498 |
|
|
|
|
3,880 |
|
|
|
4,448 |
|
Total
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Total revenue
|
|
|
696,179 |
|
|
|
1,604,598 |
|
|
|
384,461 |
|
|
|
|
1,103,335 |
|
|
|
1,415,786 |
|
Total segment EBITDA
|
|
|
39,498 |
|
|
|
122,713 |
|
|
|
15,158 |
|
|
|
|
66,274 |
|
|
|
(172,777 |
) |
Total identifiable assets
|
|
|
983,510 |
|
|
|
949,599 |
|
|
|
914,746 |
|
|
|
|
941,631 |
(2) |
|
|
1,058,075 |
|
Total capital expenditures
|
|
|
14,045 |
|
|
|
42,787 |
|
|
|
18,079 |
|
|
|
|
34,768 |
|
|
|
31,118 |
|
Reconciliation of EBITDA to Net Income (Loss)
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
EBITDA
|
|
|
39,498 |
|
|
|
122,713 |
|
|
|
15,158 |
|
|
|
|
66,274 |
|
|
|
(172,777 |
)(1) |
Depreciation and amortization expense
|
|
|
(18,808 |
) |
|
|
(52,739 |
) |
|
|
(12,560 |
) |
|
|
|
(32,144 |
) |
|
|
(67,183 |
) |
Interest expense
|
|
|
(5,644 |
) |
|
|
(9,961 |
) |
|
|
(908 |
) |
|
|
|
(4,691 |
) |
|
|
(6,418 |
) |
Realized gain (loss) on investments
|
|
|
|
|
|
|
(1,140 |
) |
|
|
90 |
|
|
|
|
|
|
|
|
|
|
Interest and other income
|
|
|
714 |
|
|
|
240 |
|
|
|
22 |
|
|
|
|
304 |
|
|
|
369 |
|
Fresh-start accounting adjustments
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
46,416 |
|
|
|
|
|
Income tax expense
|
|
|
(6,278 |
) |
|
|
(21,764 |
) |
|
|
(8,633 |
) |
|
|
|
(829 |
) |
|
|
(1,374 |
) |
Cumulative effect of a change in accounting principle
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
(223,721 |
) |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Net income (loss)
|
|
$ |
9,482 |
|
|
$ |
37,349 |
|
|
$ |
(6,831 |
) |
|
|
$ |
(148,391 |
) |
|
$ |
(247,383 |
) |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
(1) |
Includes an impairment loss of $262,780. |
|
(2) |
Total assets of the Company at June 1, 2003 after fair
value adjustments. |
F-33
American Medical Response, Inc. & EmCare Holdings
Inc.
(The Healthcare Transportation and Emergency Management
Services
Businesses of Laidlaw International, Inc.)
Notes to Combined Financial
Statements (Continued)
|
|
15. |
Valuation and Qualifying Accounts |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Total | |
|
Valuation | |
|
|
|
|
Allowance for | |
|
Allowance for | |
|
Accounts | |
|
Allowance for | |
|
|
|
|
Contractual | |
|
Uncompensated | |
|
Receivable | |
|
Deferred Tax | |
|
|
|
|
Discounts | |
|
Care | |
|
Allowances | |
|
Assets | |
|
Total | |
|
|
| |
|
| |
|
| |
|
| |
|
| |
Balance at August 31, 2001 (Predecessor)
restated
|
|
$ |
242,172 |
|
|
$ |
423,562 |
|
|
$ |
665,734 |
|
|
$ |
309,275 |
|
|
$ |
975,009 |
|
|
Additions
|
|
|
858,590 |
|
|
|
521,277 |
|
|
|
1,379,867 |
|
|
|
6,383 |
|
|
|
1,386,250 |
|
|
Reductions
|
|
|
(850,862 |
) |
|
|
(532,030 |
) |
|
|
(1,382,892 |
) |
|
|
(4,964 |
) |
|
|
(1,387,856 |
) |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Balance at August 31, 2002 (Predecessor)
restated
|
|
|
249,900 |
|
|
|
412,809 |
|
|
|
662,709 |
|
|
|
310,694 |
|
|
|
973,403 |
|
|
Additions
|
|
|
795,809 |
|
|
|
428,578 |
|
|
|
1,224,387 |
|
|
|
3,200 |
|
|
|
1,227,587 |
|
|
Reductions
|
|
|
(786,770 |
) |
|
|
(377,363 |
) |
|
|
(1,164,133 |
) |
|
|
(157,942 |
) |
|
|
(1,322,075 |
) |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Balance at May 31, 2003 (Predecessor) restated
|
|
$ |
258,939 |
|
|
$ |
464,024 |
|
|
$ |
722,963 |
|
|
$ |
155,952 |
|
|
$ |
878,915 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Fresh-start balance at June 1, 2003 restated
|
|
$ |
258,939 |
|
|
$ |
464,024 |
|
|
$ |
722,963 |
|
|
$ |
155,952 |
|
|
$ |
878,915 |
|
|
Additions
|
|
|
289,329 |
|
|
|
161,100 |
|
|
|
450,429 |
|
|
|
|
|
|
|
450,429 |
|
|
Reductions
|
|
|
(289,500 |
) |
|
|
(137,533 |
) |
|
|
(427,033 |
) |
|
|
|
|
|
|
(427,033 |
) |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Balance at August 31, 2003 restated
|
|
|
258,768 |
|
|
|
487,591 |
|
|
|
746,359 |
|
|
|
155,952 |
|
|
|
902,311 |
|
|
Additions
|
|
|
1,361,708 |
|
|
|
666,116 |
|
|
|
2,027,824 |
|
|
|
|
|
|
|
2,027,824 |
|
|
Reductions
|
|
|
(1,349,005 |
) |
|
|
(542,429 |
) |
|
|
(1,891,434 |
) |
|
|
(155,952 |
) |
|
|
(2,047,386 |
) |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Balance at August 31, 2004 restated
|
|
|
271,471 |
|
|
|
611,278 |
|
|
|
882,749 |
|
|
|
|
|
|
|
882,749 |
|
|
Additions
|
|
|
632,959 |
|
|
|
312,310 |
|
|
|
945,269 |
|
|
|
|
|
|
|
945,269 |
|
|
Reductions
|
|
|
(589,568 |
) |
|
|
(242,284 |
) |
|
|
(831,852 |
) |
|
|
|
|
|
|
(831,852 |
) |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Balance at January 31, 2005
|
|
$ |
314,862 |
|
|
$ |
681,304 |
|
|
$ |
996,166 |
|
|
$ |
|
|
|
$ |
996,166 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
16. |
Prior Period Results (unaudited) |
We have included below an unaudited combined statement of
operations and comprehensive income for the five months ended
January 31, 2004 and an unaudited combined statement of
cash flows for the five months ended January 31, 2004 for
comparison purposes only to the audited statements included
herein.
|
|
|
|
|
|
|
Five Months | |
|
|
Ended | |
|
|
January 31, | |
|
|
2004 | |
|
|
| |
|
|
(unaudited) | |
Combined Statement of Operations |
Net revenue
|
|
$ |
667,506 |
|
|
|
|
|
Compensation and benefits
|
|
|
461,923 |
|
Operating expenses
|
|
|
90,828 |
|
Insurance expense
|
|
|
36,664 |
|
Selling, general and administrative expenses
|
|
|
22,016 |
|
F-34
American Medical Response, Inc. & EmCare Holdings
Inc.
(The Healthcare Transportation and Emergency Management
Services
Businesses of Laidlaw International, Inc.)
Notes to Combined Financial
Statements (Continued)
|
|
|
|
|
|
|
|
|
|
Five Months | |
|
|
Ended | |
|
|
January 31, | |
|
|
2004 | |
|
|
| |
|
|
(unaudited) | |
Laidlaw fees and compensation charges
|
|
|
6,436 |
|
Depreciation and amortization expense
|
|
|
22,079 |
|
|
|
|
|
Income from operations
|
|
|
27,560 |
|
Interest expense
|
|
|
(4,137 |
) |
Interest and other income
|
|
|
1,403 |
|
|
|
|
|
Income before income taxes
|
|
|
24,826 |
|
Income tax expense
|
|
|
(9,800 |
) |
|
|
|
|
Net income
|
|
$ |
15,026 |
|
|
|
|
|
Combined Statement of Cash Flows |
Cash Flows from Operating Activities
|
|
|
|
|
Net income
|
|
$ |
15,026 |
|
Adjustments to reconcile net income to net cash provided by
operating activities:
|
|
|
|
|
|
Depreciation and amortization
|
|
|
22,079 |
|
|
Loss on disposal of property, plant and equipment
|
|
|
309 |
|
|
Deferred income taxes
|
|
|
9,320 |
|
|
Changes in operating assets/liabilities:
|
|
|
|
|
|
|
Trade and other accounts receivable
|
|
|
(33,822 |
) |
|
|
Other current assets
|
|
|
4,889 |
|
|
|
Accounts payable and accrued liabilities
|
|
|
827 |
|
|
|
|
|
|
|
|
Net cash provided by operating activities
|
|
|
18,627 |
|
|
|
|
|
Cash Flows from Investing Activities
|
|
|
|
|
Purchase of property, plant and equipment
|
|
|
(14,224 |
) |
Proceeds from sale of property, plant and equipment
|
|
|
84 |
|
Purchase of restricted cash and investments
|
|
|
(9,585 |
) |
Proceeds from sale of restricted investments
|
|
|
14,758 |
|
Net change in deposits and other assets
|
|
|
(1,914 |
) |
|
|
|
|
|
|
|
Net cash used in investing activities
|
|
|
(10,881 |
) |
|
|
|
|
Cash Flows from Financing Activities
|
|
|
|
|
Repayments of capital lease obligations and other debt
|
|
|
(3,784 |
) |
Increase in bank overdrafts
|
|
|
(3,216 |
) |
Payments made to Laidlaw
|
|
|
(2,215 |
) |
Increase in other non-current liabilities
|
|
|
1,683 |
|
|
|
|
|
|
|
|
Net cash used in financing activities
|
|
|
(7,532 |
) |
|
|
|
|
Increase in cash and cash equivalents
|
|
|
215 |
|
Cash and cash equivalents, beginning of period
|
|
|
10,641 |
|
|
|
|
|
Cash and cash equivalents, end of period
|
|
$ |
10,856 |
|
|
|
|
|
F-35
American Medical Response, Inc. & EmCare Holdings
Inc.
(The Healthcare Transportation and Emergency Management
Services
Businesses of Laidlaw International, Inc.)
Notes to Combined Financial
Statements (Continued)
Emergency Medical Services L.P. financed the acquisition of AMR
and EmCare, described in note 18 in part by issuing
$250.0 million principal amount of senior subordinated
notes and borrowing $370.2 million under its senior secured
credit facility. Its wholly-owned subsidiaries, AMR HoldCo, Inc.
and EmCare HoldCo, Inc., are the issuers of the senior
subordinated notes and the borrowers under the senior secured
credit facility. As part of the transaction, AMR and its
subsidiaries became wholly-owned subsidiaries of AMR HoldCo,
Inc. and EmCare and its subsidiaries became wholly-owned
subsidiaries of EmCare HoldCo, Inc. The senior subordinated
notes and the senior secured credit facility include a full,
unconditional and joint and several guarantee by all of the
Companys subsidiaries other than its captive insurance
subsidiary. All of the operating income and cash flow of EMS
L.P., AMR HoldCo, Inc. and EmCare HoldCo, Inc. is generated by
AMR, EmCare and their subsidiaries. As a result, funds necessary
to meet the debt service obligations under the senior secured
notes and senior secured credit facility described above are
provided by the distributions or advances from the subsidiary
companies, AMR and EmCare. Investments in subsidiary operating
companies are accounted for on the equity method. Accordingly,
entries necessary to consolidate the parent company, AMR HoldCo,
Inc., EmCare HoldCo, Inc. and all of their subsidiaries are
reflected in the Eliminations/ Adjustments column. Separate
complete financial statements of the issuers and subsidiary
guarantors would not provide additional material information
that would be useful in assessing the financial composition of
the issuers or the subsidiary guarantors. The condensed
combining financial statements for the parent company, the
issuers, the guarantors and the non-guarantor are as follows:
F-36
Combining Balance Sheet
As of January 31, 2005
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Issuer |
|
Issuer |
|
|
|
Subsidiary | |
|
|
|
|
|
|
|
|
AMR |
|
EmCare |
|
Subsidiary | |
|
Non- | |
|
Eliminations/ | |
|
|
|
|
Parent Co. |
|
HoldCo, Inc. |
|
HoldCo, Inc. |
|
Guarantors | |
|
guarantor | |
|
Adjustments | |
|
Total | |
|
|
|
|
|
|
|
|
| |
|
| |
|
| |
|
| |
Assets |
Current assets:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Cash and cash equivalents
|
|
$ |
|
|
|
$ |
|
|
|
$ |
|
|
|
$ |
4,778 |
|
|
$ |
9,853 |
|
|
$ |
|
|
|
$ |
14,631 |
|
|
Restricted cash and cash equivalents
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
9,846 |
|
|
|
|
|
|
|
9,846 |
|
|
Restricted marketable securities
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
2,473 |
|
|
|
|
|
|
|
2,473 |
|
|
Trade and other accounts receivable, net
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
359,945 |
|
|
|
43,339 |
|
|
|
(33,517 |
) |
|
|
369,767 |
|
|
Parts and supplies inventory
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
18,499 |
|
|
|
|
|
|
|
|
|
|
|
18,499 |
|
|
Other current assets
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
81,818 |
|
|
|
6,097 |
|
|
|
(47,780 |
) |
|
|
40,135 |
|
|
Current deferred tax assets
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
62,433 |
|
|
|
2,659 |
|
|
|
|
|
|
|
65,092 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Current assets
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
527,473 |
|
|
|
74,267 |
|
|
|
(81,297 |
) |
|
|
520,443 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Non-current assets:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Property, plant, and equipment, net
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
128,766 |
|
|
|
|
|
|
|
|
|
|
|
128,766 |
|
|
Intangible assets, net
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
16,075 |
|
|
|
|
|
|
|
|
|
|
|
16,075 |
|
|
Non-current deferred tax assets
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
203,391 |
|
|
|
(922 |
) |
|
|
|
|
|
|
202,469 |
|
|
Restricted long-term investments
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
41,810 |
|
|
|
|
|
|
|
41,810 |
|
|
Goodwill
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Other long-term assets
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
73,947 |
|
|
|
|
|
|
|
|
|
|
|
73,947 |
|
|
Investment and advances in subsidiaries
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
6,404 |
|
|
|
|
|
|
|
(6,404 |
) |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Assets
|
|
$ |
|
|
|
$ |
|
|
|
$ |
|
|
|
$ |
956,056 |
|
|
$ |
115,155 |
|
|
$ |
(87,701 |
) |
|
$ |
983,510 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Liabilities and Equity |
Current liabilities:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Accounts payable
|
|
$ |
|
|
|
$ |
|
|
|
$ |
|
|
|
$ |
82,167 |
|
|
$ |
5,186 |
|
|
$ |
(31,535 |
) |
|
$ |
55,818 |
|
|
Accrued liabilities
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
147,291 |
|
|
|
24,354 |
|
|
|
|
|
|
|
171,645 |
|
|
Current portion of long-term debt
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
5,846 |
|
|
|
|
|
|
|
|
|
|
|
5,846 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Current liabilities
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
235,304 |
|
|
|
29,540 |
|
|
|
(31,535 |
) |
|
|
233,309 |
|
Long-term debt
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
5,651 |
|
|
|
|
|
|
|
|
|
|
|
5,651 |
|
Other long-term liabilities
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
116,824 |
|
|
|
79,211 |
|
|
|
(49,762 |
) |
|
|
146,273 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Liabilities
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
357,779 |
|
|
|
108,751 |
|
|
|
(81,297 |
) |
|
|
385,233 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Laidlaw payable
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
202,042 |
|
|
|
|
|
|
|
|
|
|
|
202,042 |
|
Laidlaw investment
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
356,550 |
|
|
|
|
|
|
|
|
|
|
|
356,550 |
|
Common stock
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
30 |
|
|
|
(30 |
) |
|
|
|
|
Additional paid-in capital
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
5,054 |
|
|
|
(5,054 |
) |
|
|
|
|
Retained earnings
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
40,000 |
|
|
|
1,635 |
|
|
|
(1,635 |
) |
|
|
40,000 |
|
Comprehensive income (loss)
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
(315 |
) |
|
|
(315 |
) |
|
|
315 |
|
|
|
(315 |
) |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Equity
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
598,277 |
|
|
|
6,404 |
|
|
|
(6,404 |
) |
|
|
598,277 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Liabilities and Equity
|
|
$ |
|
|
|
$ |
|
|
|
$ |
|
|
|
$ |
956,056 |
|
|
$ |
115,155 |
|
|
$ |
(87,701 |
) |
|
$ |
983,510 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
F-37
Combining Balance Sheet
As of August 31, 2004
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Issuer |
|
Issuer |
|
|
|
Subsidiary | |
|
|
|
|
|
|
|
|
AMR |
|
EmCare |
|
Subsidiary | |
|
Non- | |
|
Eliminations/ | |
|
|
|
|
Parent Co. |
|
HoldCo, Inc. |
|
HoldCo, Inc. |
|
Guarantors | |
|
guarantor | |
|
Adjustments | |
|
Total | |
|
|
|
|
|
|
|
|
| |
|
| |
|
| |
|
| |
Assets |
Current assets:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Cash and cash equivalents
|
|
$ |
|
|
|
$ |
|
|
|
$ |
|
|
|
$ |
9,436 |
|
|
$ |
40 |
|
|
$ |
|
|
|
$ |
9,476 |
|
|
Restricted cash and cash equivalents
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
5,691 |
|
|
|
|
|
|
|
5,691 |
|
|
Restricted marketable securities
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
6,756 |
|
|
|
|
|
|
|
6,756 |
|
|
Trade and other accounts receivable, net
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
339,896 |
|
|
|
17,321 |
|
|
|
(13,007 |
) |
|
|
344,210 |
|
|
Parts and supplies inventory
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
18,577 |
|
|
|
|
|
|
|
|
|
|
|
18,577 |
|
|
Other current assets
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
45,254 |
|
|
|
1,820 |
|
|
|
(15,059 |
) |
|
|
32,015 |
|
|
Current deferred tax assets
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
50,322 |
|
|
|
2,659 |
|
|
|
|
|
|
|
52,981 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Current assets
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
463,485 |
|
|
|
34,287 |
|
|
|
(28,066 |
) |
|
|
469,706 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Non-current assets:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Property, plant, and equipment, net
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
132,685 |
|
|
|
|
|
|
|
|
|
|
|
132,685 |
|
|
Intangible assets, net
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
15,758 |
|
|
|
|
|
|
|
|
|
|
|
15,758 |
|
|
Non-current deferred tax assets
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
215,520 |
|
|
|
(1,131 |
) |
|
|
|
|
|
|
214,389 |
|
|
Restricted long-term investments
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
47,285 |
|
|
|
|
|
|
|
47,285 |
|
|
Other long-term assets
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
69,776 |
|
|
|
|
|
|
|
|
|
|
|
69,776 |
|
|
Investment and advances in subsidiaries
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
6,694 |
|
|
|
|
|
|
|
(6,694 |
) |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Assets
|
|
$ |
|
|
|
$ |
|
|
|
$ |
|
|
|
$ |
903,918 |
|
|
$ |
80,441 |
|
|
$ |
(34,760 |
) |
|
$ |
949,599 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Liabilities and Equity |
Current liabilities:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Accounts payable
|
|
$ |
|
|
|
$ |
|
|
|
$ |
|
|
|
$ |
59,631 |
|
|
$ |
1,129 |
|
|
$ |
(9,845 |
) |
|
$ |
50,915 |
|
|
Accrued liabilities
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
146,722 |
|
|
|
20,062 |
|
|
|
|
|
|
|
166,784 |
|
|
Current portion of long-term debt
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
7,565 |
|
|
|
|
|
|
|
|
|
|
|
7,565 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Current liabilities
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
213,918 |
|
|
|
21,191 |
|
|
|
(9,845 |
) |
|
|
225,264 |
|
Long-term debt
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
7,915 |
|
|
|
|
|
|
|
|
|
|
|
7,915 |
|
Other long-term liabilities
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
108,245 |
|
|
|
52,556 |
|
|
|
(18,221 |
) |
|
|
142,580 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Liabilities
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
330,078 |
|
|
|
73,747 |
|
|
|
(28,066 |
) |
|
|
375,759 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Laidlaw payable
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
186,778 |
|
|
|
|
|
|
|
|
|
|
|
186,778 |
|
Laidlaw investment
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
356,550 |
|
|
|
|
|
|
|
|
|
|
|
356,550 |
|
Common stock
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
30 |
|
|
|
(30 |
) |
|
|
|
|
Additional paid-in capital
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
5,035 |
|
|
|
(5,035 |
) |
|
|
|
|
Retained earnings
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
30,518 |
|
|
|
1,635 |
|
|
|
(1,635 |
) |
|
|
30,518 |
|
Comprehensive income (loss)
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
(6 |
) |
|
|
(6 |
) |
|
|
6 |
|
|
|
(6 |
) |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Equity
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
573,840 |
|
|
|
6,694 |
|
|
|
(6,694 |
) |
|
|
573,840 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Liabilities and Equity
|
|
$ |
|
|
|
$ |
|
|
|
$ |
|
|
|
$ |
903,918 |
|
|
$ |
80,441 |
|
|
$ |
(34,760 |
) |
|
$ |
949,599 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
F-38
Combining Balance Sheet
As of August 31, 2003
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Issuer |
|
Issuer |
|
|
|
Subsidiary | |
|
|
|
|
|
|
|
|
AMR |
|
EmCare |
|
Subsidiary | |
|
Non- | |
|
Eliminations/ | |
|
|
|
|
Parent Co. |
|
HoldCo, Inc. |
|
HoldCo, Inc. |
|
Guarantors | |
|
Guarantor | |
|
Adjustments | |
|
Total | |
|
|
|
|
|
|
|
|
| |
|
| |
|
| |
|
| |
Assets
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Current assets:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Cash and cash equivalents
|
|
$ |
|
|
|
$ |
|
|
|
$ |
|
|
|
$ |
10,604 |
|
|
$ |
37 |
|
|
$ |
|
|
|
$ |
10,641 |
|
|
Restricted cash and cash equivalents
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
939 |
|
|
|
|
|
|
|
939 |
|
|
Restricted marketable securities
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
201 |
|
|
|
|
|
|
|
201 |
|
|
Trade and other accounts receivable, net
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
316,395 |
|
|
|
4,057 |
|
|
|
|
|
|
|
320,452 |
|
|
Parts and supplies inventory
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
17,444 |
|
|
|
|
|
|
|
|
|
|
|
17,444 |
|
|
Other current assets
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
40,259 |
|
|
|
5,059 |
|
|
|
(13,111 |
) |
|
|
32,207 |
|
|
Current deferred tax assets
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
55,921 |
|
|
|
2,915 |
|
|
|
|
|
|
|
58,836 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Current assets
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
440,623 |
|
|
|
13,208 |
|
|
|
(13,111 |
) |
|
|
440,720 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Non-current assets:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Property, plant, and equipment, net
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
133,546 |
|
|
|
|
|
|
|
|
|
|
|
133,546 |
|
|
Intangible assets, net
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
148,205 |
|
|
|
|
|
|
|
|
|
|
|
148,205 |
|
|
Non-current deferred tax assets
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
96,596 |
|
|
|
|
|
|
|
|
|
|
|
96,596 |
|
|
Restricted long-term investments
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
40,608 |
|
|
|
|
|
|
|
40,608 |
|
|
Other long-term assets
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
55,071 |
|
|
|
|
|
|
|
|
|
|
|
55,071 |
|
|
Investment and advances in subsidiaries
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
3,859 |
|
|
|
|
|
|
|
(3,859 |
) |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Assets
|
|
$ |
|
|
|
$ |
|
|
|
$ |
|
|
|
$ |
877,900 |
|
|
$ |
53,816 |
|
|
$ |
(16,970 |
) |
|
$ |
914,746 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Liabilities and Equity
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Current liabilities:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Accounts payable
|
|
$ |
|
|
|
$ |
|
|
|
$ |
|
|
|
$ |
50,148 |
|
|
$ |
34 |
|
|
$ |
|
|
|
$ |
50,182 |
|
|
Accrued liabilities
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
146,772 |
|
|
|
9,529 |
|
|
|
(10,122 |
) |
|
|
146,179 |
|
|
Current portion of long-term debt
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
8,270 |
|
|
|
|
|
|
|
|
|
|
|
8,270 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Current liabilities
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
205,190 |
|
|
|
9,563 |
|
|
|
(10,122 |
) |
|
|
204,631 |
|
Long-term debt
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
15,787 |
|
|
|
|
|
|
|
|
|
|
|
15,787 |
|
Other long-term liabilities
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
96,384 |
|
|
|
40,394 |
|
|
|
(2,989 |
) |
|
|
133,789 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Liabilities
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
317,361 |
|
|
|
49,957 |
|
|
|
(13,111 |
) |
|
|
354,207 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Laidlaw payable
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
22,416 |
|
|
|
|
|
|
|
|
|
|
|
22,416 |
|
Laidlaw investment
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
546,144 |
|
|
|
|
|
|
|
|
|
|
|
546,144 |
|
Additional paid-in capital
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
5,049 |
|
|
|
(5,049 |
) |
|
|
|
|
Retained earnings
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
(6,831 |
) |
|
|
|
|
|
|
|
|
|
|
(6,831 |
) |
Comprehensive income (loss)
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
(1,190 |
) |
|
|
(1,190 |
) |
|
|
1,190 |
|
|
|
(1,190 |
) |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Equity
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
560,539 |
|
|
|
3,859 |
|
|
|
(3,859 |
) |
|
|
560,539 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Liabilities and Equity
|
|
$ |
|
|
|
$ |
|
|
|
$ |
|
|
|
$ |
877,900 |
|
|
$ |
53,816 |
|
|
$ |
(16,970 |
) |
|
$ |
914,746 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
F-39
Combining Statement of Operations
For the Five Months Ended January 31, 2005
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Issuer |
|
Issuer |
|
|
|
Subsidiary | |
|
|
|
|
|
|
|
|
AMR |
|
EmCare |
|
Subsidiary | |
|
Non- | |
|
Eliminations/ | |
|
|
|
|
Parent Co. |
|
HoldCo, Inc. |
|
HoldCo, Inc. |
|
Guarantors | |
|
Guarantor | |
|
Adjustments | |
|
Total | |
|
|
|
|
|
|
|
|
| |
|
| |
|
| |
|
| |
Net revenue
|
|
$ |
|
|
|
$ |
|
|
|
$ |
|
|
|
$ |
696,179 |
|
|
$ |
15,913 |
|
|
$ |
(15,913 |
) |
|
$ |
696,179 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Compensation and benefits
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
481,305 |
|
|
|
|
|
|
|
|
|
|
|
481,305 |
|
Operating expenses
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
94,882 |
|
|
|
|
|
|
|
|
|
|
|
94,882 |
|
Insurance expense
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
39,002 |
|
|
|
15,913 |
|
|
|
(15,913 |
) |
|
|
39,002 |
|
Selling, general and administrative expenses
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
21,635 |
|
|
|
|
|
|
|
|
|
|
|
21,635 |
|
Laidlaw fees and compensation charges
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
19,857 |
|
|
|
|
|
|
|
|
|
|
|
19,857 |
|
Depreciation and amortization expense
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
18,808 |
|
|
|
|
|
|
|
|
|
|
|
18,808 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Income from operations
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
20,690 |
|
|
|
|
|
|
|
|
|
|
|
20,690 |
|
Interest expense
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
(5,644 |
) |
|
|
|
|
|
|
|
|
|
|
(5,644 |
) |
Interest and other income
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
714 |
|
|
|
|
|
|
|
|
|
|
|
714 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Income before income taxes
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
15,760 |
|
|
|
|
|
|
|
|
|
|
|
15,760 |
|
Income tax expense
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
(6,278 |
) |
|
|
|
|
|
|
|
|
|
|
(6,278 |
) |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Net income
|
|
$ |
|
|
|
$ |
|
|
|
$ |
|
|
|
$ |
9,482 |
|
|
$ |
|
|
|
$ |
|
|
|
$ |
9,482 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Combining Statement of Operations
For the Year Ended August 31, 2004
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Issuer |
|
Issuer |
|
|
|
Subsidiary | |
|
|
|
|
|
|
|
|
AMR |
|
EmCare |
|
Subsidiary | |
|
Non- | |
|
Eliminations/ | |
|
|
|
|
Parent Co. |
|
HoldCo, Inc. |
|
HoldCo, Inc. |
|
Guarantors | |
|
Guarantor | |
|
Adjustments | |
|
Total | |
|
|
|
|
|
|
|
|
| |
|
| |
|
| |
|
| |
Net revenue
|
|
$ |
|
|
|
$ |
|
|
|
$ |
|
|
|
$ |
1,604,598 |
|
|
$ |
29,803 |
|
|
$ |
(29,803 |
) |
|
$ |
1,604,598 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Compensation and benefits
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
1,117,890 |
|
|
|
|
|
|
|
|
|
|
|
1,117,890 |
|
Operating expenses
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
218,277 |
|
|
|
|
|
|
|
|
|
|
|
218,277 |
|
Insurance expense
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
81,395 |
|
|
|
28,663 |
|
|
|
(29,803 |
) |
|
|
80,255 |
|
Selling, general and administrative expenses
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
47,899 |
|
|
|
|
|
|
|
|
|
|
|
47,899 |
|
Laidlaw fees and compensation charges
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
15,449 |
|
|
|
|
|
|
|
|
|
|
|
15,449 |
|
Depreciation and amortization expense
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
52,739 |
|
|
|
|
|
|
|
|
|
|
|
52,739 |
|
Restructuring charges
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
2,115 |
|
|
|
|
|
|
|
|
|
|
|
2,115 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Income from operations
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
68,834 |
|
|
|
1,140 |
|
|
|
|
|
|
|
69,974 |
|
Interest expense
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
(9,961 |
) |
|
|
|
|
|
|
|
|
|
|
(9,961 |
) |
Realized loss on investments
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
(1,140 |
) |
|
|
|
|
|
|
(1,140 |
) |
Interest and other income
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
240 |
|
|
|
|
|
|
|
|
|
|
|
240 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Income before income taxes
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
59,113 |
|
|
|
|
|
|
|
|
|
|
|
59,113 |
|
Income tax expense
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
(23,399 |
) |
|
|
1,635 |
|
|
|
|
|
|
|
(21,764 |
) |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Income before equity in earnings of subsidiary
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
35,714 |
|
|
|
1,635 |
|
|
|
|
|
|
|
37,349 |
|
Equity in earnings of subsidiary
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
1,635 |
|
|
|
|
|
|
|
(1,635 |
) |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Net income
|
|
$ |
|
|
|
$ |
|
|
|
$ |
|
|
|
$ |
37,349 |
|
|
$ |
1,635 |
|
|
$ |
(1,635 |
) |
|
$ |
37,349 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
F-40
Combining Statement of Operations
For the Three Months Ended August 31, 2003
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Issuer |
|
Issuer |
|
|
|
Subsidiary | |
|
|
|
|
|
|
|
|
AMR |
|
EmCare |
|
Subsidiary | |
|
Non- | |
|
Eliminations/ | |
|
|
|
|
Parent Co. |
|
HoldCo, Inc. |
|
HoldCo, Inc. |
|
Guarantors | |
|
Guarantor | |
|
Adjustments | |
|
Total | |
|
|
|
|
|
|
|
|
| |
|
| |
|
| |
|
| |
Net revenue
|
|
$ |
|
|
|
$ |
|
|
|
$ |
|
|
|
$ |
384,461 |
|
|
$ |
9,807 |
|
|
$ |
(9,807 |
) |
|
$ |
384,461 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Compensation and benefits
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
264,604 |
|
|
|
|
|
|
|
|
|
|
|
264,604 |
|
Operating expenses
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
55,212 |
|
|
|
|
|
|
|
|
|
|
|
55,212 |
|
Insurance expense
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
36,239 |
|
|
|
8,239 |
|
|
|
(9,807 |
) |
|
|
34,671 |
|
Selling, general and administrative expenses
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
12,017 |
|
|
|
|
|
|
|
|
|
|
|
12,017 |
|
Laidlaw fees and compensation charges
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
1,350 |
|
|
|
|
|
|
|
|
|
|
|
1,350 |
|
Depreciation and amortization expense
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
12,560 |
|
|
|
|
|
|
|
|
|
|
|
12,560 |
|
Restructuring charges
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
1,449 |
|
|
|
|
|
|
|
|
|
|
|
1,449 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Income from operations
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
1,030 |
|
|
|
1,568 |
|
|
|
|
|
|
|
2,598 |
|
Interest expense
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
(908 |
) |
|
|
|
|
|
|
|
|
|
|
(908 |
) |
Realized gain on investments
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
90 |
|
|
|
|
|
|
|
90 |
|
Interest and other income
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
22 |
|
|
|
|
|
|
|
|
|
|
|
22 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Income before income taxes
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
144 |
|
|
|
1,658 |
|
|
|
|
|
|
|
1,802 |
|
Income tax expense
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
(8,053 |
) |
|
|
(580 |
) |
|
|
|
|
|
|
(8,633 |
) |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Income (loss) before equity in earnings of subsidiary
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
(7,909 |
) |
|
|
1,078 |
|
|
|
|
|
|
|
(6,831 |
) |
Equity in earnings of subsidiary
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
1,078 |
|
|
|
|
|
|
|
(1,078 |
) |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Net income (loss)
|
|
$ |
|
|
|
$ |
|
|
|
$ |
|
|
|
$ |
(6,831 |
) |
|
$ |
1,078 |
|
|
$ |
(1,078 |
) |
|
$ |
(6,831 |
) |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Predecessor Company
Combining Statement of Operations
For the Nine Months Ended May 31, 2003
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Issuer |
|
Issuer |
|
|
|
|
|
|
|
|
|
|
|
|
AMR |
|
EmCare |
|
Subsidiary | |
|
Subsidiary | |
|
Eliminations/ | |
|
|
|
|
Parent Co. |
|
HoldCo, Inc. |
|
HoldCo, Inc. |
|
Guarantors | |
|
Non-guarantor | |
|
Adjustments | |
|
Total | |
|
|
|
|
|
|
|
|
| |
|
| |
|
| |
|
| |
Net revenue
|
|
$ |
|
|
|
$ |
|
|
|
$ |
|
|
|
$ |
1,103,335 |
|
|
$ |
16,640 |
|
|
$ |
(16,640 |
) |
|
$ |
1,103,335 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Compensation and benefits
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
757,183 |
|
|
|
|
|
|
|
|
|
|
|
757,183 |
|
Operating expenses
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
163,447 |
|
|
|
|
|
|
|
|
|
|
|
163,447 |
|
Insurance expense
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
69,576 |
|
|
|
16,640 |
|
|
|
(16,640 |
) |
|
|
69,576 |
|
Selling, general and administrative expenses
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
37,867 |
|
|
|
|
|
|
|
|
|
|
|
37,867 |
|
Laidlaw fees and compensation charges
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
4,050 |
|
|
|
|
|
|
|
|
|
|
|
4,050 |
|
Depreciation and amortization expense
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
32,144 |
|
|
|
|
|
|
|
|
|
|
|
32,144 |
|
Restructuring charges
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
1,288 |
|
|
|
|
|
|
|
|
|
|
|
1,288 |
|
Laidlaw reorganization costs
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
3,650 |
|
|
|
|
|
|
|
|
|
|
|
3,650 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Income from operations
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
34,130 |
|
|
|
|
|
|
|
|
|
|
|
34,130 |
|
Interest expense
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
(4,691 |
) |
|
|
|
|
|
|
|
|
|
|
(4,691 |
) |
Interest and other income
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
304 |
|
|
|
|
|
|
|
|
|
|
|
304 |
|
Fresh-start accounting adjustments
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
46,416 |
|
|
|
|
|
|
|
|
|
|
|
46,416 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Income before income taxes and cumulative effect of a change in
accounting principle
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
76,159 |
|
|
|
|
|
|
|
|
|
|
|
76,159 |
|
Income tax expense
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
(829 |
) |
|
|
|
|
|
|
|
|
|
|
(829 |
) |
|
Cumulative effect of a change in accounting principle
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
(223,721 |
) |
|
|
|
|
|
|
|
|
|
|
(223,721 |
) |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Net loss
|
|
$ |
|
|
|
$ |
|
|
|
$ |
|
|
|
$ |
(148,391 |
) |
|
$ |
|
|
|
$ |
|
|
|
$ |
(148,391 |
) |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
F-41
Predecessor Company
Combining Statement of Operations
For the Year Ended August 31, 2002
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Issuer |
|
Issuer |
|
|
|
|
|
|
|
|
|
|
|
|
AMR |
|
EmCare |
|
Subsidiary | |
|
Subsidiary | |
|
Eliminations/ | |
|
|
|
|
Parent Co. |
|
HoldCo, Inc. |
|
HoldCo, Inc. |
|
Guarantors | |
|
Non-guarantor | |
|
Adjustments | |
|
Total | |
|
|
|
|
|
|
|
|
| |
|
| |
|
| |
|
| |
Net revenue
|
|
$ |
|
|
|
$ |
|
|
|
$ |
|
|
|
$ |
1,415,786 |
|
|
$ |
12,004 |
|
|
$ |
(12,004 |
) |
|
$ |
1,415,786 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Compensation and benefits
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
960,590 |
|
|
|
|
|
|
|
|
|
|
|
960,590 |
|
Operating expenses
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
219,321 |
|
|
|
|
|
|
|
|
|
|
|
219,321 |
|
Insurance expense
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
66,479 |
|
|
|
12,004 |
|
|
|
(12,004 |
) |
|
|
66,479 |
|
Selling, general and administrative expenses
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
61,455 |
|
|
|
|
|
|
|
|
|
|
|
61,455 |
|
Laidlaw fees and compensation charges
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
5,400 |
|
|
|
|
|
|
|
|
|
|
|
5,400 |
|
Depreciation and amortization expense
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
67,183 |
|
|
|
|
|
|
|
|
|
|
|
67,183 |
|
Impairment losses
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
262,780 |
|
|
|
|
|
|
|
|
|
|
|
262,780 |
|
Restructuring charges
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
3,777 |
|
|
|
|
|
|
|
|
|
|
|
3,777 |
|
Laidlaw reorganization costs
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
8,761 |
|
|
|
|
|
|
|
|
|
|
|
8,761 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Loss from operations
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
(239,960 |
) |
|
|
|
|
|
|
|
|
|
|
(239,960 |
) |
Interest expense
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
(6,418 |
) |
|
|
|
|
|
|
|
|
|
|
(6,418 |
) |
Interest and other income
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
369 |
|
|
|
|
|
|
|
|
|
|
|
369 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Loss before income taxes
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
(246,009 |
) |
|
|
|
|
|
|
|
|
|
|
(246,009 |
) |
Income tax expense
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
(1,374 |
) |
|
|
|
|
|
|
|
|
|
|
(1,374 |
) |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Net loss
|
|
$ |
|
|
|
$ |
|
|
|
$ |
|
|
|
$ |
(247,383 |
) |
|
$ |
|
|
|
$ |
|
|
|
$ |
(247,383 |
) |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
F-42
Condensed Combining Statement of Cash Flows
For the Five Months ended January 31, 2005
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Issuer |
|
Issuer |
|
|
|
|
|
|
|
|
|
|
AMR |
|
EmCare |
|
Subsidiary | |
|
Subsidiary | |
|
|
|
|
Parent Co. |
|
HoldCo, Inc. |
|
HoldCo, Inc. |
|
Guarantors | |
|
Non-guarantors | |
|
Total | |
|
|
|
|
|
|
|
|
| |
|
| |
|
| |
Cash Flows from Operating Activities
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Net cash provided by operating activities
|
|
$ |
|
|
|
$ |
|
|
|
$ |
|
|
|
$ |
10,856 |
|
|
$ |
5,110 |
|
|
$ |
15,966 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Cash Flows from Investing Activities
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Purchase of property, plant and equipment
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
(14,045 |
) |
|
|
|
|
|
|
(14,045 |
) |
Purchase of business
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
(1,200 |
) |
|
|
|
|
|
|
(1,200 |
) |
Proceeds from sale of business
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
1,300 |
|
|
|
|
|
|
|
1,300 |
|
Proceeds from sale of property, plant and equipment
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
175 |
|
|
|
|
|
|
|
175 |
|
Purchase of restricted cash and investments
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
(31,257 |
) |
|
|
(31,257 |
) |
Proceeds from sale and maturity of restricted investments
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
35,960 |
|
|
|
35,960 |
|
Other investing activities
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
(79 |
) |
|
|
|
|
|
|
(79 |
) |
Increase in Laidlaw insurance deposits
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
(12,521 |
) |
|
|
|
|
|
|
(12,521 |
) |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Net cash (used in) provided by investing activities
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
(26,370 |
) |
|
|
4,703 |
|
|
|
(21,667 |
) |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Cash Flows from Financing Activities
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Repayments of capital lease obligations and other debt
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
(3,992 |
) |
|
|
|
|
|
|
(3,992 |
) |
Advances from Laidlaw
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
8,982 |
|
|
|
|
|
|
|
8,982 |
|
Increase in bank overdrafts
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
5,866 |
|
|
|
|
|
|
|
5,866 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Net cash provided by financing activities
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
10,856 |
|
|
|
|
|
|
|
10,856 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Change in cash and cash equivalents
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
(4,658 |
) |
|
|
9,813 |
|
|
|
5,155 |
|
Cash and cash equivalents, beginning of period
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
9,436 |
|
|
|
40 |
|
|
|
9,476 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Cash and cash equivalents, end of period
|
|
$ |
|
|
|
$ |
|
|
|
$ |
|
|
|
$ |
4,778 |
|
|
$ |
9,853 |
|
|
$ |
14,631 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
F-43
Condensed Combining Statement of Cash Flows
For the Year Ended August 31, 2004
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Issuer |
|
Issuer |
|
|
|
|
|
|
|
|
|
|
AMR |
|
EmCare |
|
Subsidiary | |
|
Subsidiary Non- | |
|
|
|
|
Parent Co. |
|
HoldCo, Inc. |
|
HoldCo, Inc. |
|
Guarantors | |
|
guarantors | |
|
Total | |
|
|
|
|
|
|
|
|
| |
|
| |
|
| |
Cash Flows from Operating Activities
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Net cash provided by operating activities
|
|
$ |
|
|
|
$ |
|
|
|
$ |
|
|
|
$ |
109,708 |
|
|
$ |
17,971 |
|
|
$ |
127,679 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Cash Flows from Investing Activities
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Purchase of property, plant and equipment
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
(42,787 |
) |
|
|
|
|
|
|
(42,787 |
) |
Proceeds from sale of property, plant and equipment
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
858 |
|
|
|
|
|
|
|
858 |
|
Purchase of restricted cash and investments
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
(64,357 |
) |
|
|
(64,357 |
) |
Proceeds from sale and maturity of restricted investments
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
46,389 |
|
|
|
46,389 |
|
Other investing activities
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
6,814 |
|
|
|
|
|
|
|
6,814 |
|
Increase in Laidlaw insurance deposits
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
(28,433 |
) |
|
|
|
|
|
|
(28,433 |
) |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Net cash used in investing activities
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
(63,548 |
) |
|
|
(17,968 |
) |
|
|
(81,516 |
) |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Cash Flows from Financing Activities
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Repayments of capital lease obligations and other debt
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
(8,709 |
) |
|
|
|
|
|
|
(8,709 |
) |
Payments to Laidlaw
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
(31,133 |
) |
|
|
|
|
|
|
(31,133 |
) |
Decrease in bank overdrafts
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
(4,544 |
) |
|
|
|
|
|
|
(4,544 |
) |
Decrease in other non-current liabilities
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
(2,942 |
) |
|
|
|
|
|
|
(2,942 |
) |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Net cash used in financing activities
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
(47,328 |
) |
|
|
|
|
|
|
(47,328 |
) |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Change in cash and cash equivalents
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
(1,168 |
) |
|
|
3 |
|
|
|
(1,165 |
) |
Cash and cash equivalents, beginning of period
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
10,604 |
|
|
|
37 |
|
|
|
10,641 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Cash and cash equivalents, end of period
|
|
$ |
|
|
|
$ |
|
|
|
$ |
|
|
|
$ |
9,436 |
|
|
$ |
40 |
|
|
$ |
9,476 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
F-44
Condensed Combining Statement of Cash Flows
For the Three Months Ended August 31, 2003
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Issuer |
|
Issuer |
|
|
|
|
|
|
|
|
|
|
AMR |
|
EmCare |
|
Subsidiary | |
|
Subsidiary Non- | |
|
|
|
|
Parent Co. |
|
HoldCo, Inc. |
|
HoldCo, Inc. |
|
Guarantors | |
|
guarantors | |
|
Total | |
|
|
|
|
|
|
|
|
| |
|
| |
|
| |
Cash Flows from Operating Activities
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Net cash provided by (used in) operating activities
|
|
$ |
|
|
|
$ |
|
|
|
$ |
|
|
|
$ |
31,268 |
|
|
$ |
(1,259 |
) |
|
$ |
30,009 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Cash Flows from Investing Activities
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Purchase of property, plant and equipment
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
(18,079 |
) |
|
|
|
|
|
|
(18,079 |
) |
Proceeds from sale of property, plant and equipment
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
341 |
|
|
|
|
|
|
|
341 |
|
Purchase of restricted cash and investments
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
(11,287 |
) |
|
|
(11,287 |
) |
Proceeds from sale and maturity of restricted investments
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
12,530 |
|
|
|
12,530 |
|
Other investing activities
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
1,359 |
|
|
|
|
|
|
|
1,359 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Net cash (used in) provided by investing activities
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
(16,379 |
) |
|
|
1,243 |
|
|
|
(15,136 |
) |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Cash Flows from Financing Activities
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Repayments of capital lease obligations and other debt
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
(1,851 |
) |
|
|
|
|
|
|
(1,851 |
) |
Payments to Laidlaw
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
(55,609 |
) |
|
|
|
|
|
|
(55,609 |
) |
Increase in bank overdrafts
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
8,675 |
|
|
|
|
|
|
|
8,675 |
|
Increase in other non-current liabilities
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
1,563 |
|
|
|
|
|
|
|
1,563 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Net cash used in financing activities
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
(47,222 |
) |
|
|
|
|
|
|
(47,222 |
) |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Change in cash and cash equivalents
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
(32,333 |
) |
|
|
(16 |
) |
|
|
(32,349 |
) |
Cash and cash equivalents, beginning of period
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
42,937 |
|
|
|
53 |
|
|
|
42,990 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Cash and cash equivalents, end of period
|
|
$ |
|
|
|
$ |
|
|
|
$ |
|
|
|
$ |
10,604 |
|
|
$ |
37 |
|
|
$ |
10,641 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
F-45
Predecessor Company
Condensed Combining Statement of Cash Flows
For the Nine Months Ended May 31, 2003
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Issuer |
|
Issuer |
|
|
|
Subsidiary | |
|
|
|
|
|
|
|
|
AMR |
|
EmCare |
|
Subsidiary | |
|
Non- | |
|
Eliminations/ | |
|
|
|
|
Parent Co. |
|
HoldCo, Inc. |
|
HoldCo, Inc. |
|
Guarantors | |
|
guarantors | |
|
Adjustments | |
|
Total | |
|
|
|
|
|
|
|
|
| |
|
| |
|
| |
|
| |
Cash Flows from Operating Activities
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Net cash provided by operating activities
|
|
$ |
|
|
|
$ |
|
|
|
$ |
|
|
|
$ |
34,398 |
|
|
$ |
24,371 |
|
|
$ |
|
|
|
$ |
58,769 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Cash Flows from Investing Activities
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Purchase of property, plant and equipment
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
(34,768 |
) |
|
|
|
|
|
|
|
|
|
|
(34,768 |
) |
Proceeds from sale of property, plant and equipment
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
624 |
|
|
|
|
|
|
|
|
|
|
|
624 |
|
Capital contribution
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
(2,721 |
) |
|
|
|
|
|
|
2,721 |
|
|
|
|
|
Purchase of restricted cash and investments
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
(2,400 |
) |
|
|
(63,866 |
) |
|
|
|
|
|
|
(66,266 |
) |
Proceeds from sale and maturity of restricted investments
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
36,748 |
|
|
|
|
|
|
|
36,748 |
|
Other investing activities
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
(35,173 |
) |
|
|
|
|
|
|
|
|
|
|
(35,173 |
) |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Net cash used in investing activities
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
(74,438 |
) |
|
|
(27,118 |
) |
|
|
2,721 |
|
|
|
(98,835 |
) |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Cash Flows from Financing Activities
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Repayments of capital lease obligations and other debt
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
(6,338 |
) |
|
|
|
|
|
|
|
|
|
|
(6,338 |
) |
Payments to Laidlaw
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
(3,141 |
) |
|
|
|
|
|
|
|
|
|
|
(3,141 |
) |
Decrease in bank overdrafts
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
(815 |
) |
|
|
|
|
|
|
|
|
|
|
(815 |
) |
Capital contribution
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
2,721 |
|
|
|
(2,721 |
) |
|
|
|
|
Increase in other non-current liabilities
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
2,234 |
|
|
|
|
|
|
|
|
|
|
|
2,234 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Net cash used in financing activities
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
(8,060 |
) |
|
|
2,721 |
|
|
|
(2,721 |
) |
|
|
(8,060 |
) |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Change in cash and cash equivalents
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
(48,100 |
) |
|
|
(26 |
) |
|
|
|
|
|
|
(48,126 |
) |
Cash and cash equivalents, beginning of period
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
91,037 |
|
|
|
79 |
|
|
|
|
|
|
|
91,116 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Cash and cash equivalents, end of period
|
|
$ |
|
|
|
$ |
|
|
|
$ |
|
|
|
$ |
42,937 |
|
|
$ |
53 |
|
|
$ |
|
|
|
$ |
42,990 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
F-46
Predecessor Company
Condensed Combining Statement of Cash Flows
For the Year Ended August 31, 2002
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Issuer |
|
Issuer |
|
|
|
Subsidiary | |
|
|
|
|
|
|
|
|
AMR |
|
EmCare |
|
Subsidiary | |
|
Non- | |
|
Eliminations/ | |
|
|
|
|
Parent Co. |
|
HoldCo, Inc. |
|
HoldCo, Inc. |
|
Guarantors | |
|
guarantors | |
|
Adjustments | |
|
Total | |
|
|
|
|
|
|
|
|
| |
|
| |
|
| |
|
| |
Cash Flows from Operating Activities
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Net cash provided by operating activities
|
|
$ |
|
|
|
$ |
|
|
|
$ |
|
|
|
$ |
140,296 |
|
|
$ |
16,248 |
|
|
$ |
|
|
|
$ |
156,544 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Cash Flows from Investing Activities
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Purchase of property, plant and equipment
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
(31,118 |
) |
|
|
|
|
|
|
|
|
|
|
(31,118 |
) |
Proceeds from sale of property, plant and equipment
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
2,549 |
|
|
|
|
|
|
|
|
|
|
|
2,549 |
|
Capital contribution
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
(1,150 |
) |
|
|
|
|
|
|
1,150 |
|
|
|
|
|
Purchase of restricted cash and investments
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
(1,412 |
) |
|
|
(49,534 |
) |
|
|
|
|
|
|
(50,946 |
) |
Proceeds from sale and maturity of restricted investments
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
32,215 |
|
|
|
|
|
|
|
32,215 |
|
Other investing activities
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
(10,047 |
) |
|
|
|
|
|
|
|
|
|
|
(10,047 |
) |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Net cash used in investing activities
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
(41,178 |
) |
|
|
(17,319 |
) |
|
|
1,150 |
|
|
|
(57,347 |
) |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Cash Flows from Financing Activities
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Repayments of capital lease obligations and other debt
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
(17,817 |
) |
|
|
|
|
|
|
|
|
|
|
(17,817 |
) |
Payments to Laidlaw
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
(16,729 |
) |
|
|
|
|
|
|
|
|
|
|
(16,729 |
) |
Decrease in bank overdrafts
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
(1,134 |
) |
|
|
|
|
|
|
|
|
|
|
(1,134 |
) |
Capital contributions
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
1,150 |
|
|
|
(1,150 |
) |
|
|
|
|
Decrease in other non-current liabilities
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
(386 |
) |
|
|
|
|
|
|
|
|
|
|
(386 |
) |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Net cash used in financing activities
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
(36,066 |
) |
|
|
1,150 |
|
|
|
(1,150 |
) |
|
|
(36,066 |
) |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Change in cash and cash equivalents
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
63,052 |
|
|
|
79 |
|
|
|
|
|
|
|
63,131 |
|
Cash and cash equivalents, beginning of period
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
27,985 |
|
|
|
|
|
|
|
|
|
|
|
27,985 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Cash and cash equivalents, end of period
|
|
$ |
|
|
|
$ |
|
|
|
$ |
|
|
|
$ |
91,037 |
|
|
$ |
79 |
|
|
$ |
|
|
|
$ |
91,116 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
F-47
On December 6, 2004, Laidlaw announced it had entered into
definitive agreements to sell 100% of the capital stock of AMR
and EmCare to Onex Partners LP, an affiliate of Onex
Corporation. Completion of the transaction occurred
February 10, 2005 with an effective date after the close of
business on January 31, 2005. Emergency Medical Services
L.P. was formed as the entity which ultimately acquired American
Medical Response, Inc. and EmCare Holdings Inc. from Laidlaw
International, Inc. The purchase price was $828.8 million,
subject to working capital and other purchase price adjustments.
|
|
19. |
Subsequent Events (unaudited) |
With respect to the DOJ investigation of certain of AMRs
business practices referred to in note 10
Services, a recent analysis provided by the government
indicates that it is investigating contracts in effect in
periods prior to 1999, and possibly through 2001. The Company is
considering the governments analysis and is in discussions
with the government regarding these Texas allegations. The
government has proposed that AMR make a substantial payment to
settle the Texas matter, and has indicated that, in the absence
of a settlement, it will pursue further civil action in this
matter. The government may also be investigating whether
AMRs contracts with its health facilities in Oregon and
other jurisdictions violate the Anti-Kickback Statute. Under the
provisions of the Companys purchase agreement for the
acquisition of AMR, the Company and Laidlaw International, Inc.
share responsibility for damages arising with respect to these
matters, with the Company responsible for 50% of the first
$10 million of damages and 10% of any damages in excess of
$10 million and up to and including $50 million. Based
upon its discussions with the government and its own analysis,
the Company believes it has adequately accrued for potential
losses in periods subsequent to the periods covered by the
combined financial statements included herein. However, there
can be no assurances as to the final resolution of these
investigations and any resulting proceedings.
On December 14, 2005, a lawsuit, purporting to be a class
action, was commenced against AMR in Spokane, Washington. The
complaint alleges that the two identified plaintiffs were billed
for advanced life support services rather than basic life
support in violation of AMRs contract with the city of
Spokane, resulting in total overcharges for three transports of
$395. The complaint further alleges a potential group of over
30,000 patients transported since 1998, with possible individual
claims of $150 to $250, and seeks treble damages under the state
consumer protection act. AMR has not had sufficient time to
analyze the allegations in the complaint. However, AMR recently
reviewed its billing practices at the request of the Spokane
Fire Department, and is conducting a further audit. Although
there can be no assurances as to the final outcome, at this time
AMR does not believe that any incorrect billings are material in
amount.
F-48
Emergency Medical Services L.P.
Consolidated/Combined Financial Statements
September 30, 2005
F-49
Emergency Medical Services L.P.
Balance Sheets
(in thousands)
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Unaudited | |
|
|
Predecessor | |
|
|
Consolidated | |
|
|
Combined | |
|
|
September 30, | |
|
|
January 31, | |
|
|
2005 | |
|
|
2005 | |
|
|
| |
|
|
| |
ASSETS
|
|
|
|
|
|
|
|
|
|
Current assets:
|
|
|
|
|
|
|
|
|
|
|
Cash and cash equivalents
|
|
$ |
10,113 |
|
|
|
$ |
14,631 |
|
|
Restricted cash and cash equivalents
|
|
|
11,949 |
|
|
|
|
9,846 |
|
|
Restricted marketable securities
|
|
|
2,165 |
|
|
|
|
2,473 |
|
|
Trade and other accounts receivable, net
|
|
|
369,766 |
|
|
|
|
369,767 |
|
|
Parts and supplies inventory
|
|
|
18,760 |
|
|
|
|
18,499 |
|
|
Other current assets
|
|
|
31,008 |
|
|
|
|
40,135 |
|
|
Current deferred tax assets
|
|
|
22,971 |
|
|
|
|
65,092 |
|
|
|
|
|
|
|
|
|
|
|
Current assets
|
|
|
466,732 |
|
|
|
|
520,443 |
|
|
|
|
|
|
|
|
|
Non-current assets:
|
|
|
|
|
|
|
|
|
|
|
Property, plant, and equipment, net
|
|
|
133,283 |
|
|
|
|
128,766 |
|
|
Intangible assets, net
|
|
|
81,363 |
|
|
|
|
16,075 |
|
|
Non-current deferred tax assets
|
|
|
117,488 |
|
|
|
|
202,469 |
|
|
Restricted long-term investments
|
|
|
73,304 |
|
|
|
|
41,810 |
|
|
Goodwill
|
|
|
271,987 |
|
|
|
|
|
|
|
Other long-term assets
|
|
|
109,251 |
|
|
|
|
73,947 |
|
|
|
|
|
|
|
|
|
|
|
|
Assets
|
|
$ |
1,253,408 |
|
|
|
$ |
983,510 |
|
|
|
|
|
|
|
|
|
|
|
LIABILITIES AND EQUITY
|
|
|
|
|
|
|
|
|
|
Current liabilities:
|
|
|
|
|
|
|
|
|
|
|
Accounts payable
|
|
$ |
53,066 |
|
|
|
$ |
55,818 |
|
|
Accrued liabilities
|
|
|
199,849 |
|
|
|
|
171,645 |
|
|
Current portion of long-term debt
|
|
|
13,478 |
|
|
|
|
5,846 |
|
|
|
|
|
|
|
|
|
|
|
Current liabilities
|
|
|
266,393 |
|
|
|
|
233,309 |
|
Long-term debt
|
|
|
595,129 |
|
|
|
|
5,651 |
|
Other long-term liabilities
|
|
|
155,139 |
|
|
|
|
146,273 |
|
|
|
|
|
|
|
|
|
|
|
|
Liabilities
|
|
|
1,016,661 |
|
|
|
|
385,233 |
|
|
|
|
|
|
|
|
|
Redeemable partnership equity
|
|
|
1,213 |
|
|
|
|
|
|
Laidlaw payable
|
|
|
|
|
|
|
|
202,042 |
|
Laidlaw investment
|
|
|
|
|
|
|
|
356,550 |
|
Partnership equity
|
|
|
222,178 |
|
|
|
|
|
|
Retained earnings
|
|
|
14,002 |
|
|
|
|
40,000 |
|
Comprehensive income (loss)
|
|
|
(646 |
) |
|
|
|
(315 |
) |
|
|
|
|
|
|
|
|
|
Equity
|
|
|
235,534 |
|
|
|
|
598,277 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Liabilities and equity
|
|
$ |
1,253,408 |
|
|
|
$ |
983,510 |
|
|
|
|
|
|
|
|
|
The accompanying notes are an integral part of these financial
statements.
F-50
Emergency Medical Services L.P.
Unaudited Statements of Operations and Comprehensive
Income
(in thousands, except per unit amounts)
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Consolidated | |
|
|
Combined | |
|
|
| |
|
|
| |
|
|
|
|
|
Predecessor | |
|
Predecessor | |
|
|
Eight Months | |
|
Three Months | |
|
|
Eight Months | |
|
Three Months | |
|
|
Ended | |
|
Ended | |
|
|
Ended | |
|
Ended | |
|
|
September 30, | |
|
September 30, | |
|
|
September 30, | |
|
September 30, | |
|
|
2005 | |
|
2005 | |
|
|
2004 | |
|
2004 | |
|
|
| |
|
| |
|
|
| |
|
| |
Net revenue
|
|
$ |
1,187,653 |
|
|
$ |
456,245 |
|
|
|
$ |
1,077,749 |
|
|
$ |
413,869 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Compensation and benefits
|
|
|
822,595 |
|
|
|
319,292 |
|
|
|
|
751,238 |
|
|
|
286,628 |
|
Operating expenses
|
|
|
168,700 |
|
|
|
66,156 |
|
|
|
|
147,524 |
|
|
|
55,863 |
|
Insurance expense
|
|
|
60,382 |
|
|
|
21,048 |
|
|
|
|
51,674 |
|
|
|
18,404 |
|
Selling, general and administrative expenses
|
|
|
38,248 |
|
|
|
15,654 |
|
|
|
|
31,270 |
|
|
|
12,093 |
|
Laidlaw fees and compensation charges
|
|
|
|
|
|
|
|
|
|
|
|
10,095 |
|
|
|
3,657 |
|
Depreciation and amortization expense
|
|
|
38,811 |
|
|
|
14,843 |
|
|
|
|
34,627 |
|
|
|
12,669 |
|
Restructuring charges
|
|
|
|
|
|
|
|
|
|
|
|
1,381 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Income from operations
|
|
|
58,917 |
|
|
|
19,252 |
|
|
|
|
49,940 |
|
|
|
24,555 |
|
Interest expense
|
|
|
(34,407 |
) |
|
|
(12,824 |
) |
|
|
|
(8,679 |
) |
|
|
(5,138 |
) |
Realized gain (loss) on investments
|
|
|
(40 |
) |
|
|
(34 |
) |
|
|
|
(1,191 |
) |
|
|
(1,140 |
) |
Interest and other income
|
|
|
189 |
|
|
|
91 |
|
|
|
|
210 |
|
|
|
162 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Income before income taxes
|
|
|
24,659 |
|
|
|
6,485 |
|
|
|
|
40,280 |
|
|
|
18,439 |
|
Income tax expense
|
|
|
(10,657 |
) |
|
|
(3,479 |
) |
|
|
|
(15,710 |
) |
|
|
(7,191 |
) |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Net income
|
|
|
14,002 |
|
|
|
3,006 |
|
|
|
|
24,570 |
|
|
|
11,248 |
|
Other comprehensive income, net of tax
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Unrealized holding gains (losses) during the period
|
|
|
(646 |
) |
|
|
(1,010 |
) |
|
|
|
364 |
|
|
|
364 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Comprehensive income
|
|
$ |
13,356 |
|
|
$ |
1,996 |
|
|
|
$ |
24,934 |
|
|
$ |
11,612 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
The accompanying notes are an integral part of these financial
statements.
F-51
Emergency Medical Services L.P.
Unaudited Statements of Cash Flows
(in thousands)
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Combined | |
|
|
|
|
|
| |
|
|
Consolidated | |
|
|
Predecessor | |
|
|
Eight Months | |
|
|
Eight Months | |
|
|
Ended | |
|
|
Ended | |
|
|
September 30, | |
|
|
September 30, | |
|
|
2005 | |
|
|
2004 | |
|
|
| |
|
|
| |
Cash Flows from Operating Activities
|
|
|
|
|
|
|
|
|
|
Net income
|
|
$ |
14,002 |
|
|
|
$ |
24,570 |
|
Adjustments to reconcile net income to net cash provided by
operating activities:
|
|
|
|
|
|
|
|
|
|
|
Depreciation and amortization
|
|
|
40,444 |
|
|
|
|
34,627 |
|
|
Gain on disposal of property, plant and equipment
|
|
|
(480 |
) |
|
|
|
(344 |
) |
|
Deferred income taxes
|
|
|
1,395 |
|
|
|
|
14,243 |
|
|
Stock compensation expense
|
|
|
2,462 |
|
|
|
|
|
|
|
Changes in operating assets/liabilities:
|
|
|
|
|
|
|
|
|
|
|
|
Trade and other accounts receivable
|
|
|
4,801 |
|
|
|
|
586 |
|
|
|
Other current assets
|
|
|
8,866 |
|
|
|
|
(1,047 |
) |
|
|
Accounts payable and accrued liabilities
|
|
|
36,972 |
|
|
|
|
27,326 |
|
|
|
|
|
|
|
|
|
|
|
|
Net cash provided by operating activities
|
|
|
108,462 |
|
|
|
|
99,961 |
|
|
|
|
|
|
|
|
|
Cash Flows from Investing Activities
|
|
|
|
|
|
|
|
|
|
EMS purchase of AMR and EmCare
|
|
|
(828,775 |
) |
|
|
|
|
|
Purchase of property, plant and equipment
|
|
|
(34,947 |
) |
|
|
|
(30,217 |
) |
Proceeds from sale of property, plant and equipment
|
|
|
565 |
|
|
|
|
773 |
|
Purchase of restricted cash and investments
|
|
|
(51,495 |
) |
|
|
|
(61,213 |
) |
Proceeds from sale and maturity of restricted investments
|
|
|
17,560 |
|
|
|
|
40,152 |
|
Net change in deposits and other assets
|
|
|
(20,330 |
) |
|
|
|
(23,405 |
) |
|
|
|
|
|
|
|
|
|
|
|
Net cash used in investing activities
|
|
|
(917,422 |
) |
|
|
|
(73,910 |
) |
|
|
|
|
|
|
|
|
Cash Flows from Financing Activities
|
|
|
|
|
|
|
|
|
|
Borrowings under new senior secured credit facility
|
|
|
350,000 |
|
|
|
|
|
|
Proceeds from issuance of senior subordinated notes
|
|
|
250,000 |
|
|
|
|
|
|
Borrowings under new revolving credit facility
|
|
|
25,200 |
|
|
|
|
|
|
Issuance of partnership equity
|
|
|
222,655 |
|
|
|
|
|
|
Financing costs
|
|
|
(20,122 |
) |
|
|
|
|
|
Repayments of capital lease obligations and other debt
|
|
|
(5,722 |
) |
|
|
|
(5,396 |
) |
Repayments of revolving credit facility
|
|
|
(20,200 |
) |
|
|
|
|
|
Increase (decrease) in bank overdrafts
|
|
|
997 |
|
|
|
|
4,290 |
|
Payments made to Laidlaw
|
|
|
|
|
|
|
|
(13,937 |
) |
Increase (decrease) in other non-current liabilities
|
|
|
1,634 |
|
|
|
|
(5,656 |
) |
|
|
|
|
|
|
|
|
|
|
|
Net cash provided by (used in) financing activities
|
|
|
804,442 |
|
|
|
|
(20,699 |
) |
|
|
|
|
|
|
|
|
Change in cash and cash equivalents
|
|
|
(4,518 |
) |
|
|
|
5,352 |
|
Cash and cash equivalents, beginning of period
|
|
|
14,631 |
|
|
|
|
10,856 |
|
|
|
|
|
|
|
|
|
Cash and cash equivalents, end of period
|
|
$ |
10,113 |
|
|
|
$ |
16,208 |
|
|
|
|
|
|
|
|
|
Cash paid for:
|
|
|
|
|
|
|
|
|
|
|
Interest
|
|
$ |
27,729 |
|
|
|
$ |
10,636 |
|
|
|
|
|
|
|
|
|
|
Taxes
|
|
$ |
9,550 |
|
|
|
$ |
|
|
|
|
|
|
|
|
|
|
The accompanying notes are an integral part of these financial
statements.
F-52
Emergency Medical Services L.P.
Notes to Unaudited Financial Statements
(dollars in thousands)
Basis of Presentation of Financial Statements
The accompanying unaudited, interim consolidated financial
statements of Emergency Medical Services L.P. (EMS
or the Company) reflect all adjustments of a normal,
recurring nature that are, in the opinion of management,
necessary for a fair presentation of results for these interim
periods but do not include all of the information and note
disclosures required by accounting principles generally accepted
in the United States (GAAP) for complete financial
statements. The results of operations for the eight months and
three months ended September 30, 2005 are not necessarily
indicative of the results that may be expected for the
eleven-month period ending December 31, 2005.
Emergency Medical Services L.P. acquired American Medical
Response, Inc. and EmCare Holdings Inc. from Laidlaw
International, Inc. on February 10, 2005 with an effective
transaction date after the close of business January 31,
2005. The purchase price was $828.8 million, subject to
working capital and other purchase adjustments. The Company
currently is completing its allocation of purchase price. To
finance the acquisition, we entered into a new $450 million
senior secured credit facility and issued senior subordinated
notes for gross proceeds of $250 million (see note 8).
We also issued approximately 22.1 million limited
partnership units for $221 million. For this reason, the
financial statements for periods prior to February 1, 2005
(Predecessor) may not be comparable to the financial
statements for periods from and including February 1, 2005.
The following table summarizes the estimated fair value of the
assets acquired and liabilities assumed at the date of
acquisition. The Company is in the process of obtaining
third-party valuations of certain intangible assets acquired and
liabilities assumed, and is evaluating the tax impact of certain
purchase accounting adjustments and the carryover of tax
attributes from the Predecessor; accordingly, the allocation of
the purchase price is subject to adjustment.
|
|
|
|
|
|
Current assets
|
|
$ |
483,957 |
|
Property, plant & equipment
|
|
|
128,766 |
|
Intangible assets
|
|
|
89,850 |
|
Goodwill
|
|
|
271,987 |
|
Other long-term assets
|
|
|
254,027 |
|
|
|
|
|
|
Total assets acquired
|
|
|
1,228,587 |
|
|
|
|
|
Current liabilities
|
|
|
245,144 |
|
Long-term debt
|
|
|
620,183 |
|
Other long-term liabilities
|
|
|
144,381 |
|
|
|
|
|
|
Total liabilities assumed
|
|
|
1,009,708 |
|
|
|
|
|
|
Net assets acquired
|
|
$ |
218,879 |
|
|
|
|
|
Intangible assets include $0.6 million of radio frequency
licenses, $0.3 million of covenants not to compete and
$89.0 million for customer relationships. Covenants not to
compete and customer relationships are subject to amortization
and have a weighted average useful life of approximately
7 years.
The $272.0 million of goodwill currently has been
preliminarily assigned to AMR and EmCare in the amounts of
$127.7 million and $144.3 million, respectively, based
on the sales agreements and valuations, and is not subject to
amortization. EmCare goodwill is deductible for tax purposes.
Pro forma net revenue, income from operations and net income for
the eight months ended September 30, 2004, when adjusted
for the acquisition described above, would be
$1,077.7 million, $45.8 million and $8.4 million,
respectively.
F-53
Emergency Medical Services L.P.
Notes to Unaudited Financial
Statements (Continued)
The Company is a party to a management agreement with a
wholly-owned subsidiary of Onex Corporation, its principal
equityholder. In exchange for an annual management fee of
$1.0 million, the Onex subsidiary provides us with
corporate finance and strategic planning consulting services.
For the eight months ended September 30, 2005, we expensed
$0.7 million in fees pursuant to this agreement.
The Predecessor companies had a fiscal year ending
August 31. EMS adopted a fiscal year end of
December 31. Accordingly, the financial statements
presented herein include the eight-month period beginning the
effective date of acquisition and ending September 30, 2005
and the three-month period ending September 30, 2005.
The preparation of financial statements in conformity with GAAP
requires management to make certain estimates and assumptions
that affect the amounts reported in the consolidated and
combined financial statements and accompanying notes. Actual
results may differ from those estimates. Estimates are used for,
but not limited to, the establishment of, allowances for
contractual discounts and uncompensated care, reserves for
insurance related liabilities, taxes and contingencies.
|
|
2. |
Summary of Significant Accounting Policies |
Consolidation
The unaudited consolidated financial statements include all
wholly-owned subsidiaries of EMS, including American Medical
Response, Inc. (AMR) and EmCare Holdings Inc.
(EmCare) and their respective subsidiaries.
Intercompany transactions and balances have been eliminated.
Combination
The unaudited combined financial statements for the eight months
and three months ended September 30, 2004 include the
accounts of AMR and EmCare (combined, the
Predecessor). AMR and EmCare were indirect,
wholly-owned subsidiaries of Laidlaw International, Inc.
(Laidlaw). All significant intracompany transactions
have been eliminated.
Trade and Accounts Receivable, Net and Net Revenue
The Company determines its allowances based on payor specific
schedules, historical write-off experience and other economic
data. The allowances for contractual discounts and uncompensated
care are reviewed monthly. Account balances are charged off
against the uncompensated care allowance when it is received.
The allowance for uncompensated care is related principally to
receivables recorded for self-pay patients.
F-54
Emergency Medical Services L.P.
Notes to Unaudited Financial
Statements (Continued)
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Predecessor | |
|
|
September 30, | |
|
January 31, | |
|
|
2005 | |
|
2005 | |
|
|
| |
|
| |
Accounts receivable, net
|
|
|
|
|
|
|
|
|
AMR
|
|
$ |
236,729 |
|
|
$ |
229,798 |
|
EmCare
|
|
|
133,037 |
|
|
|
139,969 |
|
|
|
|
|
|
|
|
|
Total
|
|
$ |
369,766 |
|
|
$ |
369,767 |
|
|
|
|
|
|
|
|
Accounts receivable allowances
|
|
|
|
|
|
|
|
|
AMR
|
|
|
|
|
|
|
|
|
Allowance for contractual discounts
|
|
$ |
121,453 |
|
|
$ |
126,771 |
|
Allowance for uncompensated care
|
|
|
122,906 |
|
|
|
124,699 |
|
|
|
|
|
|
|
|
|
Total
|
|
$ |
244,359 |
|
|
$ |
251,470 |
|
|
|
|
|
|
|
|
EmCare
|
|
|
|
|
|
|
|
|
Allowance for contractual discounts
|
|
$ |
197,542 |
|
|
$ |
188,092 |
|
Allowance for uncompensated care
|
|
|
653,181 |
|
|
|
556,605 |
|
|
|
|
|
|
|
|
|
Total
|
|
$ |
850,723 |
|
|
$ |
744,697 |
|
|
|
|
|
|
|
|
The allowance for uncompensated care at EmCare includes accounts
that have been sent to collection agencies and are listed as
delinquent within the billing system. These accounts are fully
reserved at each balance sheet date and total
$257.3 million and $254.2 million at
September 30, 2005 and January 31, 2005, respectively.
Provisions for contractual discounts and estimated uncompensated
care by segment, as a percentage of gross revenue, are as
follows:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Predecessor | |
|
|
|
|
|
|
| |
|
|
Eight Months | |
|
Three Months | |
|
Eight Months | |
|
Three Months | |
|
|
Ended | |
|
Ended | |
|
Ended | |
|
Ended | |
|
|
September 30, | |
|
September 30, | |
|
September 30, | |
|
September 30, | |
|
|
2005 | |
|
2005 | |
|
2004 | |
|
2004 | |
|
|
| |
|
| |
|
| |
|
| |
AMR
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Gross revenue
|
|
|
100 |
% |
|
|
100 |
% |
|
|
100 |
% |
|
|
100 |
% |
Provision for contractual discounts
|
|
|
37 |
% |
|
|
36 |
% |
|
|
35 |
% |
|
|
34 |
% |
Provision for uncompensated care
|
|
|
13 |
% |
|
|
14 |
% |
|
|
14 |
% |
|
|
15 |
% |
EmCare
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Gross revenue
|
|
|
100 |
% |
|
|
100 |
% |
|
|
100 |
% |
|
|
100 |
% |
Provision for contractual discounts
|
|
|
44 |
% |
|
|
44 |
% |
|
|
41 |
% |
|
|
41 |
% |
Provision for uncompensated care
|
|
|
26 |
% |
|
|
26 |
% |
|
|
25 |
% |
|
|
25 |
% |
Total
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Gross revenue
|
|
|
100 |
% |
|
|
100 |
% |
|
|
100 |
% |
|
|
100 |
% |
Provision for contractual discounts
|
|
|
40 |
% |
|
|
40 |
% |
|
|
38 |
% |
|
|
37 |
% |
Provision for uncompensated care
|
|
|
19 |
% |
|
|
20 |
% |
|
|
19 |
% |
|
|
19 |
% |
Redeemable Partnership Equity
The Company may be required to repurchase the limited
partnership interests of employee unitholders upon their
termination of employment as a result of death or disability;
the repurchase price is determined by
F-55
Emergency Medical Services L.P.
Notes to Unaudited Financial
Statements (Continued)
a formula based on the Companys earnings before interest,
taxes, depreciation and amortization for the period immediately
preceding termination.
Recent Accounting Pronouncements
In December 2004, the Financial Accounting Standards Board
(FASB) issued Statement No. 123 (revised
2004),Share-Based Payment. This Statement is
a revision of FASB Statement No. 123, Accounting
for Stock-Based Compensation and is effective for the
annual reporting periods that begin after June 15, 2005.
The Statement requires public companies to measure the cost of
employee services received in exchange for an award of equity
instruments based on the grant-date fair value of the award. The
Company currently is evaluating the impact that the adoption of
this Statement will have on its financial statements, including
the alternative transition methods.
|
|
3. |
Equity-based Compensation |
Under the Companys Equity Option Plan approved in February
2005, key employees have been granted options to purchase
partnership units of the Company. The options allow the grantee
to purchase partnership units at $10 per unit (subject to
appropriate adjustment upon a recapitalization or similar
event). The grants vest ratably over a period of 4 years
and, in addition, certain performance measures must be met for
50% of each grant to become exercisable. The Company has adopted
FASB Statement No. 123, Accounting for
Stock-Based Compensation. This Statement requires
companies to measure the cost of employee services received in
exchange for an award of equity instruments based on the
grant-date fair value of the award. The Company recorded a
charge of $0.7 million for the eight months ended
September 30, 2005 associated with the grant of these
options.
The Black-Scholes option pricing model was used to estimate fair
values as of the date of grant using 0% volatility, risk free
interest rates ranging from 3.61% to 3.88%, 0% dividend yield
and expected terms of 4 and 5 years.
The Company granted 2,339,479 options from the inception of
the plan through September 30, 2005.
The Company recorded a charge associated with partnership units
and certain options to purchase partnership units issued to
employees and officers of the Company which totaled
$1.8 million. This non-cash expense was recorded as a
component of compensation and benefits on the accompanying
statements of operations for the eight and three month periods
ended September 30, 2005.
F-56
Emergency Medical Services L.P.
Notes to Unaudited Financial
Statements (Continued)
Accrued liabilities were as follows at September 30, 2005
and January 31, 2005:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Predecessor | |
|
|
September 30, | |
|
|
January 31, | |
|
|
2005 | |
|
|
2005 | |
|
|
| |
|
|
| |
Accrued wages and benefits
|
|
$ |
51,288 |
|
|
|
$ |
53,231 |
|
Accrued paid time off
|
|
|
21,646 |
|
|
|
|
20,141 |
|
Current portion of self-insurance reserve
|
|
|
49,550 |
|
|
|
|
41,283 |
|
Accrued restructuring
|
|
|
325 |
|
|
|
|
1,118 |
|
Current portion of compliance and legal
|
|
|
14,783 |
|
|
|
|
3,607 |
|
Accrued billing and collection fees
|
|
|
4,081 |
|
|
|
|
3,522 |
|
Accrued incentive compensation
|
|
|
20,332 |
|
|
|
|
23,802 |
|
Accrued interest
|
|
|
5,545 |
|
|
|
|
|
|
Other
|
|
|
32,299 |
|
|
|
|
24,941 |
|
|
|
|
|
|
|
|
|
Total accrued liabilities
|
|
$ |
199,849 |
|
|
|
$ |
171,645 |
|
|
|
|
|
|
|
|
|
|
|
5. |
Commitments and Contingencies |
Services
The Company is subject to the Medicare and Medicaid fraud and
abuse laws which prohibit, among other things, any false claims,
or any bribe, kick-back or rebate in return for the referral of
Medicare and Medicaid patients. Violation of these prohibitions
may result in civil and criminal penalties and exclusion from
participation in the Medicare and Medicaid programs. Management
has implemented policies and procedures that management believes
will assure that the Company is in substantial compliance with
these laws. From time to time, we receive requests for
information from government agencies pursuant to their
regulatory or investigational authority. Such requests can
include subpoenas or demand letters for documents to assist the
government in audits or investigations. The Company is
cooperating with the government agencies conducting these
investigations and is providing requested information to the
government agencies. Other than the investigations described
below, management believes that the outcome of any of these
investigations would not have a material adverse effect on the
Company.
During the first quarter of fiscal 2004, AMR was advised by the
U.S. Department of Justice that it was investigating
certain of AMRs business practices. The specific practices
at issue are (1) whether ambulance transports involving
Medicare eligible patients complied with the medically
necessary requirement imposed by Medicare regulations,
(2) whether patient signatures, when required, were
properly obtained from Medicare eligible patients, and
(3) whether discounts in violation of the federal
Anti-Kickback Statute were provided by AMR in exchange for
referrals involving Medicare eligible patients. In connection
with the third issue, the government has alleged that certain of
our hospital and nursing home contracts in effect in Texas,
primarily certain contracts in effect in periods prior to 1999,
and possibly through 2001, contained discounts in violation of
the federal Anti-Kickback Statute. The government recently has
provided the Company with an analysis of the investigation
conducted in connection with this contract issue, and invited
the Company to respond. The Company is considering the
governments analysis and is in discussions with the
government regarding these Texas allegations. The government has
proposed that AMR make a substantial payment to settle the Texas
matter, and has indicated that, in the absence of a settlement,
it will pursue further civil action in this matter. The
government may also be investigating whether AMRs
contracts with its health facilities in Oregon and other
jurisdictions violate the Anti-Kickback Statute. Under the
provisions of the Companys purchase agreement for the
acquisition of AMR, the Company and Laidlaw International, Inc.
F-57
Emergency Medical Services L.P.
Notes to Unaudited Financial
Statements (Continued)
share responsibility for damages arising with respect to these
matters, with the Company responsible for 50% of the first $10
million of damages and 10% of any damages in excess of $10
million and up to and including $50 million. Based upon its
discussions with the government and its own analysis, the
Company believes it has adequately accrued for potential losses.
However, there can be no assurances as to the final resolution
of these investigations and any resulting proceedings.
On May 9, 2002, AMR received a subpoena duces tecum from
the Office of Inspector General for the United States Department
of Health and Human Services (HHS). The subpoena
requested copies of documents for the period from January 1993
through May 2002. The subpoena required AMR to produce a broad
range of documents relating to Regional Emergency Services
contracts in Texas, Georgia and Colorado. The claims in Texas
have been resolved. However, the government investigations in
Georgia and Colorado are continuing and it is not possible at
this time to estimate the financial exposure, if any, to the
Company.
EmCare has been named a defendant in a collective action lawsuit
brought by a number of nurse practitioners and physician
assistants under the federal Fair Labor Standards Act. The
plaintiffs are seeking to recover overtime pay for the hours
they worked in excess of 40 in a workweek and reclassification
as non-exempt employees. Certain of the plaintiffs brought a
related action under California state law. EmCare has entered
into a settlement of the California state law claims.
On July 12, 2005, the Company received a letter and draft
Audit Report from the Office of Inspector General for the United
States Department of Health and Human Services, or OIG,
requesting the Companys response to its draft findings
that the Companys Massachusetts subsidiary received
substantial overpayments from Medicare for services performed
between July 1, 2002 and December 31, 2002. The draft
findings state that some of these services did not meet Medicare
medical necessity and reimbursement requirements. The Company
disagrees with the OIGs finding and is in the process of
responding to the draft Audit Report. If the Company is
unsuccessful in challenging the OIGs draft findings, and
in any administrative appeals to which the Company may be
entitled following the release of a final Audit Report, the
Company may be required to make a substantial repayment.
AMR and the City of Stockton, California are parties to
litigation regarding the terms and enforceability of a
memorandum of understanding and a related joint venture
agreement between the parties to present a joint bid in response
to a request for proposals to provide emergency ambulance
services in the County of San Joaquin, California. The parties
were unable to agree on the final terms of a joint bid. AMR is
seeking a judicial determination that these contracts are
unenforceable and void, and Stockton has alleged breach of
contract and damages. AMR has been awarded the San Joaquin
contract. While the Company is unable at this time to estimate
the amount of potential damages, the Company believes that
Stockton may claim as damages a portion of AMRs profit on
the contract or the profit Stockton might have realized had the
joint venture proceeded.
On December 14, 2005, a lawsuit, purporting to be a class
action, was commenced against AMR in Spokane, Washington. This
complaint alleges that the two identified plaintiffs were billed
for advanced life support services rather than basic life
support in violation of AMRs contract with the city of
Spokane, resulting in total overcharges for three transports of
$395. The complaint further alleges a potential group of over
30,000 patients transported since 1998, with possible individual
claims of $150 to $250, and seeks treble damages under the state
consumer protection act. AMR has not had sufficient time to
analyze the allegations in the complaint. However, AMR recently
reviewed its billing practices at the request of the Spokane
Fire Department, and is conducting a further audit. Although
there can be no assurance as to the final outcome, at this time
AMR does not believe that any incorrect billings are material in
amount.
F-58
Emergency Medical Services L.P.
Notes to Unaudited Financial
Statements (Continued)
Income Tax Matters
The respective tax authorities, in the normal course, audit
previous tax filings. It is not possible at this time to predict
the final outcome of these audits or establish a reasonable
estimate of possible additional taxes owing, if any.
In connection with the acquisition of AMR and EmCare, a
section 338(h)(10) election was made for EmCare which
eliminated $85 million of deferred tax assets and
stepped-up EmCares tax basis to fair value. Differences
between book and tax depreciation and amortization for these
assets will create future deferred tax assets.
AMR HoldCo, Inc. and EmCare HoldCo, Inc. are commonly owned by a
partnership, Emergency Medical Services L.P., and therefore
are required to file two separate consolidated tax returns. The
disclosed tax amounts relate to the corporate income taxes of
these two corporate consolidated groups combined.
Insurance reserves are established for automobile, workers
compensation, general liability and professional liability
claims utilizing policies with both fully-insured and
self-insured components. This includes use of an off-shore
captive insurance program through a wholly-owned subsidiary for
certain professional liability (malpractice) programs for
EmCare. In those instances where the Company has obtained
third-party insurance coverage, either directly through an
independent outside party or through participation in a
Laidlaw-administered program, the Company normally retains
liability for the first $1 to $2 million of the loss.
Insurance reserves cover known claims and incidents within the
level of Company retention that may result in the assertion of
additional claims, as well as claims from unknown incidents that
may be asserted arising from activities through the balance
sheet dates.
The Company establishes reserves for claims based upon an
assessment of actual claims and claims incurred but not
reported. The reserves are established based on consultation
with third-party independent actuaries using actuarial
principles and assumptions that consider a number of factors,
including historical claim payment patterns (including legal
costs) and changes in case reserves and the assumed rate of
inflation in healthcare costs and property damage repairs.
Certain insurance programs also require the Company to maintain
deposits with third-party insurers, trustees or with Laidlaw to
cover future claims costs, and these deposits are included as
assets in the accompanying consolidated balance sheets.
Investments supporting insurance programs are comprised
principally of government securities and investment grade
securities and are presented as restricted assets in the
combined balance sheets. These investments are designated as
available-for-sale and reported at fair value. Investment
income/loss earned on these investments is reported as a
component of insurance expense in the consolidated/combined
statements of operations.
F-59
Emergency Medical Services L.P.
Notes to Unaudited Financial
Statements (Continued)
Operating segments are defined by SFAS No. 131,
Disclosures about Segments of an Enterprise and Related
Information, as components of an enterprise about which
separate financial information is available that is evaluated
regularly by the chief operating decision maker in deciding how
to allocate resources and in assessing performance. The
operating segments are managed separately because each operating
segment represents a strategic business unit providing
healthcare transportation services or emergency management
services.
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Predecessor | |
|
|
|
|
|
|
|
| |
|
|
Eight Months | |
|
Three Months | |
|
|
Eight Months | |
|
Three Months | |
|
|
Ended | |
|
Ended | |
|
|
Ended | |
|
Ended | |
|
|
September 30, | |
|
September 30, | |
|
|
September 30, | |
|
September 30, | |
|
|
2005 | |
|
2005 | |
|
|
2004 | |
|
2004 | |
|
|
| |
|
| |
|
|
| |
|
| |
Healthcare Transportation Services
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Net revenue
|
|
$ |
761,712 |
|
|
$ |
291,909 |
|
|
|
$ |
705,181 |
|
|
$ |
270,887 |
|
Segment EBITDA
|
|
|
67,813 |
|
|
|
22,664 |
|
|
|
|
60,058 |
|
|
|
24,825 |
|
Capital expenditures
|
|
|
31,612 |
|
|
|
13,307 |
|
|
|
|
27,257 |
|
|
|
12,506 |
|
Emergency Management Services
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Net revenue
|
|
|
425,941 |
|
|
|
164,336 |
|
|
|
|
372,568 |
|
|
|
142,982 |
|
Segment EBITDA
|
|
|
29,915 |
|
|
|
11,431 |
|
|
|
|
24,509 |
|
|
|
12,399 |
|
Capital expenditures
|
|
|
3,335 |
|
|
|
901 |
|
|
|
|
2,960 |
|
|
|
1,566 |
|
Total
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Net revenue
|
|
|
1,187,653 |
|
|
|
456,245 |
|
|
|
|
1,077,749 |
|
|
|
413,869 |
|
Segment EBITDA
|
|
|
97,728 |
|
|
|
34,095 |
|
|
|
|
84,567 |
|
|
|
37,224 |
|
Capital expenditures
|
|
|
34,947 |
|
|
|
14,208 |
|
|
|
|
30,217 |
|
|
|
14,072 |
|
Reconciliation of EBITDA to Net Income
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
EBITDA
|
|
|
97,728 |
|
|
|
34,095 |
|
|
|
|
84,567 |
|
|
|
37,224 |
|
Depreciation and amortization expense
|
|
|
(38,811 |
) |
|
|
(14,843 |
) |
|
|
|
(34,627 |
) |
|
|
(12,669 |
) |
Interest expense
|
|
|
(34,407 |
) |
|
|
(12,824 |
) |
|
|
|
(8,679 |
) |
|
|
(5,138 |
) |
Realized gain (loss) on investments
|
|
|
(40 |
) |
|
|
(34 |
) |
|
|
|
(1,191 |
) |
|
|
(1,140 |
) |
Interest and other income (loss)
|
|
|
189 |
|
|
|
91 |
|
|
|
|
210 |
|
|
|
162 |
|
Income tax expense
|
|
|
(10,657 |
) |
|
|
(3,479 |
) |
|
|
|
(15,710 |
) |
|
|
(7,191 |
) |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Net income
|
|
$ |
14,002 |
|
|
$ |
3,006 |
|
|
|
$ |
24,570 |
|
|
$ |
11,248 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
On February 10, 2005, the Company issued $250 million
of senior subordinated unsecured notes and executed a
$450 million senior secured credit facility agreement.
The senior subordinated notes have a fixed interest rate of 10%,
payable semi-annually, and mature in February 2015.
The senior secured credit facility consists of a
$350 million senior secured term loan and a
$100 million revolving credit facility commitment, each
collateralized by a pledge of 100% of the capital stock of the
Company and its direct and indirect domestic subsidiaries and
65% of the capital stock of any direct foreign subsidiaries, and
a security interest in substantially all tangible and intangible
assets of EMS and its subsidiaries. The term loan matures in
February 2012 and requires quarterly principal payments of $875
commencing May 2005. The revolving credit facility, which is
limited by outstanding letter of credit
F-60
Emergency Medical Services L.P.
Notes to Unaudited Financial
Statements (Continued)
obligations, requires principal and interest to be paid at
maturity in February 2011. The revolving credit facility is also
subject to an annual commitment fee of 0.5% on unused
commitments. Under the terms of the agreement, the Company may
select between various interest rate arrangements based on LIBOR
or the Prime Rate plus additional basis points within a range of
2.0% to 3.0%, determined by reference to a leverage ratio. At
September 30, 2005, $5.0 million of borrowings were
outstanding under the revolving credit facility, letters of
credit outstanding were $27.3 million, and the maximum
remaining available under the revolving credit facility was
$67.7 million.
The senior secured credit facility agreement contains various
customary operating and financial covenants. The more
restrictive of these covenants limit the Companys and its
subsidiaries ability to create liens on assets; make certain
investments, loans, guarantees or advances; incur additional
indebtedness or issue capital stock; engage in mergers,
acquisitions or consolidations; dispose of assets; pay
dividends, repurchase equity interests or make other restricted
payments; change the business conducted by the Company; engage
in transactions with affiliates; and repay certain indebtedness,
including the senior unsecured notes, or amend or otherwise
modify agreements governing the subordinated indebtedness. The
financial maintenance covenants establish a maximum leverage
ratio, a maximum senior leverage ratio, a minimum fixed charge
coverage ratio and an annual capital expenditure limit. The
Company is in compliance with its borrowing agreement covenants
as of September 30, 2005.
Following is a summary of the Companys borrowings as of
the respective balance sheet dates:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Predecessor | |
|
|
September 30, | |
|
|
January 31, | |
|
|
2005 | |
|
|
2005 | |
|
|
| |
|
|
| |
Senior subordinated notes due 2015
|
|
$ |
250,000 |
|
|
|
$ |
|
|
Senior secured term loan due 2012 (5.65% at September 30,
2005)
|
|
|
348,250 |
|
|
|
|
|
|
Revolving credit facility
|
|
|
5,000 |
|
|
|
|
|
|
Capital lease obligations
|
|
|
4,389 |
|
|
|
|
8,110 |
|
Notes due at various dates from 2005 to 2022 with interest rates
from 6% to 10%
|
|
|
968 |
|
|
|
|
3,387 |
|
|
|
|
|
|
|
|
|
Total long-term debt
|
|
|
608,607 |
|
|
|
|
11,497 |
|
Less current maturities
|
|
|
(13,478 |
) |
|
|
|
(5,846 |
) |
|
|
|
|
|
|
|
|
Long-term debt, less current maturities
|
|
$ |
595,129 |
|
|
|
$ |
5,651 |
|
|
|
|
|
|
|
|
|
The aggregate maturities of debt are as follows:
|
|
|
|
|
Twelve months ended September 30,
|
|
|
|
|
2006
|
|
$ |
13,478 |
|
2007
|
|
|
3,020 |
|
2008
|
|
|
3,624 |
|
2009
|
|
|
3,613 |
|
2010
|
|
|
3,608 |
|
Thereafter
|
|
|
581,264 |
|
|
|
|
|
|
|
$ |
608,607 |
|
|
|
|
|
F-61
Emergency Medical Services L.P.
Notes to Unaudited Financial
Statements (Continued)
Emergency Medical Services L.P. financed the acquisition of AMR
and EmCare in part by issuing $250.0 million principal
amount of senior subordinated notes and borrowing
$370.2 million under its senior secured credit facility.
Its wholly-owned subsidiaries, AMR HoldCo, Inc. and EmCare
HoldCo, Inc., are the issuers of the senior subordinated notes
and the borrowers under the senior secured credit facility. As
part of the transaction, AMR and its subsidiaries became
wholly-owned subsidiaries of AMR HoldCo, Inc. and EmCare and its
subsidiaries became wholly-owned subsidiaries of EmCare HoldCo,
Inc. The senior subordinated notes and the senior secured credit
facility include a full, unconditional and joint and several
guarantee by all of the Companys subsidiaries other than
its captive insurance subsidiary. All of the operating income
and cash flow of EMS L.P., AMR HoldCo, Inc. and EmCare HoldCo,
Inc. is generated by AMR, EmCare and their subsidiaries. As a
result, funds necessary to meet the debt service obligations
under the senior secured notes and senior secured credit
facility described above are provided by the distributions or
advances from the subsidiary companies, AMR and EmCare.
Investments in subsidiary operating companies are accounted for
on the equity method. Accordingly, entries necessary to
consolidate the parent company, AMR HoldCo, Inc., EmCare HoldCo,
Inc. and all of their subsidiaries are reflected in the
Eliminations/Adjustments column. Separate complete financial
statements of the issuers and subsidiary guarantors would not
provide additional material information that would be useful in
assessing the financial composition of the issuers or the
subsidiary guarantors. The condensed combining financial
statements for the parent company, the issuers, the guarantors
and the non-guarantor are as follows:
F-62
Consolidating Balance Sheet
As of September 30, 2005
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Issuer | |
|
Issuer | |
|
|
|
|
|
|
|
|
|
|
|
|
AMR | |
|
EmCare | |
|
Subsidiary | |
|
Subsidiary | |
|
Eliminations/ | |
|
|
|
|
Parent Co. | |
|
HoldCo, Inc. | |
|
HoldCo, Inc. | |
|
Guarantors | |
|
Non-guarantor | |
|
Adjustments | |
|
Total | |
|
|
| |
|
| |
|
| |
|
| |
|
| |
|
| |
|
| |
Assets |
Current assets:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Cash and cash equivalents
|
|
$ |
4,828 |
|
|
$ |
|
|
|
$ |
|
|
|
$ |
5,203 |
|
|
$ |
82 |
|
|
$ |
|
|
|
$ |
10,113 |
|
|
Restricted cash and cash equivalents
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
11,949 |
|
|
|
|
|
|
|
11,949 |
|
|
Restricted marketable securities
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
2,165 |
|
|
|
|
|
|
|
2,165 |
|
|
Trade and other accounts receivable, net
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
366,995 |
|
|
|
2,620 |
|
|
|
151 |
|
|
|
369,766 |
|
|
Parts and supplies inventory
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
18,760 |
|
|
|
|
|
|
|
|
|
|
|
18,760 |
|
|
Other current assets
|
|
|
325 |
|
|
|
|
|
|
|
|
|
|
|
41,459 |
|
|
|
1,986 |
|
|
|
(12,762 |
) |
|
|
31,008 |
|
|
Current deferred tax assets
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
20,312 |
|
|
|
2,659 |
|
|
|
|
|
|
|
22,971 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Current assets
|
|
|
5,153 |
|
|
|
|
|
|
|
|
|
|
|
452,729 |
|
|
|
21,461 |
|
|
|
(12,611 |
) |
|
|
466,732 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Non-current assets:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Property, plant, and equipment, net
|
|
|
329 |
|
|
|
|
|
|
|
|
|
|
|
132,954 |
|
|
|
|
|
|
|
|
|
|
|
133,283 |
|
|
Intercompany receivable
|
|
|
|
|
|
|
420,069 |
|
|
|
188,741 |
|
|
|
17,156 |
|
|
|
|
|
|
|
(625,966 |
) |
|
|
|
|
|
Intangible assets, net
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
81,363 |
|
|
|
|
|
|
|
|
|
|
|
81,363 |
|
|
Non-current deferred tax assets
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
118,619 |
|
|
|
(1,131 |
) |
|
|
|
|
|
|
117,488 |
|
|
Restricted long-term investments
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
73,304 |
|
|
|
|
|
|
|
73,304 |
|
|
Goodwill
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
271,529 |
|
|
|
458 |
|
|
|
|
|
|
|
271,987 |
|
|
Other long-term assets
|
|
|
|
|
|
|
11,838 |
|
|
|
5,318 |
|
|
|
92,095 |
|
|
|
|
|
|
|
|
|
|
|
109,251 |
|
|
Investment and advances in subsidiaries
|
|
|
236,747 |
|
|
|
160,515 |
|
|
|
76,218 |
|
|
|
6,074 |
|
|
|
|
|
|
|
(479,554 |
) |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Assets
|
|
$ |
242,229 |
|
|
$ |
592,422 |
|
|
$ |
270,277 |
|
|
$ |
1,172,519 |
|
|
$ |
94,092 |
|
|
$ |
(1,118,131 |
) |
|
$ |
1,253,408 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Liabilities and Equity |
Current liabilities:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Accounts payable
|
|
$ |
|
|
|
$ |
|
|
|
$ |
|
|
|
$ |
53,066 |
|
|
$ |
|
|
|
$ |
|
|
|
$ |
53,066 |
|
|
Accrued liabilities
|
|
|
|
|
|
|
3,826 |
|
|
|
1,720 |
|
|
|
161,037 |
|
|
|
33,266 |
|
|
|
|
|
|
|
199,849 |
|
|
Current portion of long-term debt
|
|
|
|
|
|
|
5,865 |
|
|
|
2,635 |
|
|
|
4,978 |
|
|
|
|
|
|
|
|
|
|
|
13,478 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Current liabilities
|
|
|
|
|
|
|
9,691 |
|
|
|
4,355 |
|
|
|
219,081 |
|
|
|
33,266 |
|
|
|
|
|
|
|
266,393 |
|
Long-term debt
|
|
|
|
|
|
|
410,378 |
|
|
|
184,372 |
|
|
|
379 |
|
|
|
|
|
|
|
|
|
|
|
595,129 |
|
Other long-term liabilities
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
112,998 |
|
|
|
54,752 |
|
|
|
(12,611 |
) |
|
|
155,139 |
|
Intercompany
|
|
|
5,482 |
|
|
|
11,838 |
|
|
|
5,318 |
|
|
|
603,328 |
|
|
|
|
|
|
|
(625,966 |
) |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Liabilities
|
|
|
5,482 |
|
|
|
431,907 |
|
|
|
194,045 |
|
|
|
935,786 |
|
|
|
88,018 |
|
|
|
(638,577 |
) |
|
|
1,016,661 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Redeemable partnership equity
|
|
|
1,213 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
1,213 |
|
Common stock
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
30 |
|
|
|
(30 |
) |
|
|
|
|
Additional paid-in capital
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
6,690 |
|
|
|
(6,690 |
) |
|
|
|
|
Partnership equity
|
|
|
222,178 |
|
|
|
153,722 |
|
|
|
69,669 |
|
|
|
223,391 |
|
|
|
|
|
|
|
(446,782 |
) |
|
|
222,178 |
|
Retained earnings
|
|
|
14,002 |
|
|
|
6,793 |
|
|
|
7,209 |
|
|
|
13,988 |
|
|
|
|
|
|
|
(27,990 |
) |
|
|
14,002 |
|
Comprehensive income (loss)
|
|
|
(646 |
) |
|
|
|
|
|
|
(646 |
) |
|
|
(646 |
) |
|
|
(646 |
) |
|
|
1,938 |
|
|
|
(646 |
) |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Equity
|
|
|
235,534 |
|
|
|
160,515 |
|
|
|
76,232 |
|
|
|
236,733 |
|
|
|
6,074 |
|
|
|
(479,554 |
) |
|
|
235,534 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Liabilities and Equity
|
|
$ |
242,229 |
|
|
$ |
592,422 |
|
|
$ |
270,277 |
|
|
$ |
1,172,519 |
|
|
$ |
94,092 |
|
|
$ |
(1,118,131 |
) |
|
$ |
1,253,408 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
F-63
Predecessor
Combining Balance Sheet
As of January 31, 2005
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Issuer |
|
Issuer |
|
|
|
|
|
|
|
|
|
|
|
|
AMR |
|
EmCare |
|
Subsidiary | |
|
Subsidiary | |
|
Eliminations/ | |
|
|
|
|
Parent Co. |
|
HoldCo, Inc. |
|
HoldCo, Inc. |
|
Guarantors | |
|
Non-guarantor | |
|
Adjustments | |
|
Total | |
|
|
|
|
|
|
|
|
| |
|
| |
|
| |
|
| |
Assets |
Current assets:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Cash and cash equivalents
|
|
$ |
|
|
|
$ |
|
|
|
$ |
|
|
|
$ |
4,778 |
|
|
$ |
9,853 |
|
|
$ |
|
|
|
$ |
14,631 |
|
|
Restricted cash and cash equivalents
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
9,846 |
|
|
|
|
|
|
|
9,846 |
|
|
Restricted marketable securities
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
2,473 |
|
|
|
|
|
|
|
2,473 |
|
|
Trade and other accounts receivable, net
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
359,945 |
|
|
|
43,339 |
|
|
|
(33,517 |
) |
|
|
369,767 |
|
|
Parts and supplies inventory
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
18,499 |
|
|
|
|
|
|
|
|
|
|
|
18,499 |
|
|
Other current assets
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
81,818 |
|
|
|
6,097 |
|
|
|
(47,780 |
) |
|
|
40,135 |
|
|
Current deferred tax assets
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
62,433 |
|
|
|
2,659 |
|
|
|
|
|
|
|
65,092 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Current assets
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
527,473 |
|
|
|
74,267 |
|
|
|
(81,297 |
) |
|
|
520,443 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Non-current assets:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Property, plant, and equipment, net
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
128,766 |
|
|
|
|
|
|
|
|
|
|
|
128,766 |
|
|
Intangible assets, net
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
16,075 |
|
|
|
|
|
|
|
|
|
|
|
16,075 |
|
|
Non-current deferred tax assets
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
203,391 |
|
|
|
(922 |
) |
|
|
|
|
|
|
202,469 |
|
|
Restricted long-term investments
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
41,810 |
|
|
|
|
|
|
|
41,810 |
|
|
Goodwill
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Other long-term assets
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
73,947 |
|
|
|
|
|
|
|
|
|
|
|
73,947 |
|
|
Investment and advances in subsidiaries
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
6,404 |
|
|
|
|
|
|
|
(6,404 |
) |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Assets
|
|
$ |
|
|
|
$ |
|
|
|
$ |
|
|
|
$ |
956,056 |
|
|
$ |
115,155 |
|
|
$ |
(87,701 |
) |
|
$ |
983,510 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Liabilities and Equity |
Current liabilities:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Accounts payable
|
|
$ |
|
|
|
$ |
|
|
|
$ |
|
|
|
$ |
82,167 |
|
|
$ |
5,186 |
|
|
$ |
(31,535 |
) |
|
$ |
55,818 |
|
|
Accrued liabilities
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
147,291 |
|
|
|
24,354 |
|
|
|
|
|
|
|
171,645 |
|
|
Current portion of long-term debt
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
5,846 |
|
|
|
|
|
|
|
|
|
|
|
5,846 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Current liabilities
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
235,304 |
|
|
|
29,540 |
|
|
|
(31,535 |
) |
|
|
233,309 |
|
Long-term debt
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
5,651 |
|
|
|
|
|
|
|
|
|
|
|
5,651 |
|
Other long-term liabilities
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
116,824 |
|
|
|
79,211 |
|
|
|
(49,762 |
) |
|
|
146,273 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Liabilities
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
357,779 |
|
|
|
108,751 |
|
|
|
(81,297 |
) |
|
|
385,233 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Laidlaw payable
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
202,042 |
|
|
|
|
|
|
|
|
|
|
|
202,042 |
|
Laidlaw investment
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
356,550 |
|
|
|
|
|
|
|
|
|
|
|
356,550 |
|
Common stock
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
30 |
|
|
|
(30 |
) |
|
|
|
|
Additional paid-in capital
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
5,054 |
|
|
|
(5,054 |
) |
|
|
|
|
Retained earnings
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
40,000 |
|
|
|
1,635 |
|
|
|
(1,635 |
) |
|
|
40,000 |
|
Comprehensive income (loss)
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
(315 |
) |
|
|
(315 |
) |
|
|
315 |
|
|
|
(315 |
) |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Equity
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
598,277 |
|
|
|
6,404 |
|
|
|
(6,404 |
) |
|
|
598,277 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Liabilities and Equity
|
|
$ |
|
|
|
$ |
|
|
|
$ |
|
|
|
$ |
956,056 |
|
|
$ |
115,155 |
|
|
$ |
(87,701 |
) |
|
$ |
983,510 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
F-64
Consolidating Statement of Operations
For the Eight Months Ended September 30, 2005
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Issuer | |
|
Issuer | |
|
|
|
Subsidiary | |
|
|
|
|
|
|
|
|
AMR | |
|
EmCare | |
|
Subsidiary | |
|
Non- | |
|
Eliminations/ | |
|
|
|
|
Parent Co. | |
|
HoldCo, Inc. | |
|
HoldCo, Inc. | |
|
Guarantors | |
|
guarantor | |
|
Adjustments | |
|
Total | |
|
|
| |
|
| |
|
| |
|
| |
|
| |
|
| |
|
| |
Net revenue
|
|
$ |
|
|
|
$ |
|
|
|
$ |
|
|
|
$ |
1,187,653 |
|
|
$ |
25,264 |
|
|
$ |
(25,264 |
) |
|
$ |
1,187,653 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Compensation and benefits
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
822,595 |
|
|
|
|
|
|
|
|
|
|
|
822,595 |
|
Operating expenses
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
168,700 |
|
|
|
|
|
|
|
|
|
|
|
168,700 |
|
Insurance expense
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
60,422 |
|
|
|
25,224 |
|
|
|
(25,264 |
) |
|
|
60,382 |
|
Selling, general and administrative expenses
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
38,248 |
|
|
|
|
|
|
|
|
|
|
|
38,248 |
|
Depreciation and amortization expense
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
38,811 |
|
|
|
|
|
|
|
|
|
|
|
38,811 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Income from operations
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
58,877 |
|
|
|
40 |
|
|
|
|
|
|
|
58,917 |
|
Interest expense
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
(34,407 |
) |
|
|
|
|
|
|
|
|
|
|
(34,407 |
) |
Realized loss on investments
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
(40 |
) |
|
|
|
|
|
|
(40 |
) |
Interest and other income
|
|
|
|
|
|
|
|
|
|
|
14 |
|
|
|
175 |
|
|
|
|
|
|
|
|
|
|
|
189 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Income before income taxes
|
|
|
|
|
|
|
|
|
|
|
14 |
|
|
|
24,645 |
|
|
|
|
|
|
|
|
|
|
|
24,659 |
|
Income tax expense
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
(10,657 |
) |
|
|
|
|
|
|
|
|
|
|
(10,657 |
) |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Income before equity in earnings of unconsolidated subsidiaries
|
|
|
|
|
|
|
|
|
|
|
14 |
|
|
|
13,988 |
|
|
|
|
|
|
|
|
|
|
|
14,002 |
|
Equity in earnings of unconsolidated subsidiaries
|
|
|
14,002 |
|
|
|
6,793 |
|
|
|
7,195 |
|
|
|
|
|
|
|
|
|
|
|
(27,990 |
) |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Net income
|
|
$ |
14,002 |
|
|
$ |
6,793 |
|
|
$ |
7,209 |
|
|
$ |
13,988 |
|
|
$ |
|
|
|
$ |
(27,990 |
) |
|
$ |
14,002 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
F-65
Predecessor Combining Statement of Operations
For the Eight Months Ended September 30, 2004
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Issuer |
|
Issuer |
|
|
|
Subsidiary | |
|
|
|
|
|
|
|
|
AMR |
|
EmCare |
|
Subsidiary | |
|
Non- | |
|
Eliminations/ | |
|
|
|
|
Parent Co. |
|
HoldCo, Inc. |
|
HoldCo, Inc. |
|
Guarantors | |
|
guarantor | |
|
Adjustments | |
|
Total | |
|
|
|
|
|
|
|
|
| |
|
| |
|
| |
|
| |
Net revenue
|
|
$ |
|
|
|
$ |
|
|
|
$ |
|
|
|
$ |
1,077,749 |
|
|
$ |
21,233 |
|
|
$ |
(21,233 |
) |
|
$ |
1,077,749 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Compensation and benefits
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
751,238 |
|
|
|
|
|
|
|
|
|
|
|
751,238 |
|
Operating expenses
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
147,524 |
|
|
|
|
|
|
|
|
|
|
|
147,524 |
|
Insurance expense
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
52,865 |
|
|
|
20,042 |
|
|
|
(21,233 |
) |
|
|
51,674 |
|
Selling, general and administrative expenses
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
31,270 |
|
|
|
|
|
|
|
|
|
|
|
31,270 |
|
Laidlaw fees and compensation charges
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
10,095 |
|
|
|
|
|
|
|
|
|
|
|
10,095 |
|
Depreciation and amortization expense
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
34,627 |
|
|
|
|
|
|
|
|
|
|
|
34,627 |
|
Restructuring charges
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
1,381 |
|
|
|
|
|
|
|
|
|
|
|
1,381 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Income from operations
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
48,749 |
|
|
|
1,191 |
|
|
|
|
|
|
|
49,940 |
|
Interest expense
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
(8,679 |
) |
|
|
|
|
|
|
|
|
|
|
(8,679 |
) |
Realized loss on investments
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
(1,191 |
) |
|
|
|
|
|
|
(1,191 |
) |
Interest and other income
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
210 |
|
|
|
|
|
|
|
|
|
|
|
210 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Income before income taxes
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
40,280 |
|
|
|
|
|
|
|
|
|
|
|
40,280 |
|
Income tax expense
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
(17,345 |
) |
|
|
1,635 |
|
|
|
|
|
|
|
(15,710 |
) |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Income before equity in earnings of subsidiary
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
22,935 |
|
|
|
1,635 |
|
|
|
|
|
|
|
24,570 |
|
Equity in earnings of subsidiary
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
1,635 |
|
|
|
|
|
|
|
(1,635 |
) |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Net income
|
|
$ |
|
|
|
$ |
|
|
|
$ |
|
|
|
$ |
24,570 |
|
|
$ |
1,635 |
|
|
$ |
(1,635 |
) |
|
$ |
24,570 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Consolidating Statement of Operations
For the Three Months Ended September 30, 2005
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Issuer | |
|
Issuer | |
|
|
|
Subsidiary | |
|
|
|
|
|
|
|
|
AMR | |
|
EmCare | |
|
Subsidiary | |
|
Non- | |
|
Eliminations/ | |
|
|
|
|
Parent Co. | |
|
HoldCo, Inc. | |
|
HoldCo, Inc. | |
|
Guarantors | |
|
guarantor | |
|
Adjustments | |
|
Total | |
|
|
| |
|
| |
|
| |
|
| |
|
| |
|
| |
|
| |
Net revenue
|
|
$ |
|
|
|
$ |
|
|
|
$ |
|
|
|
$ |
456,245 |
|
|
$ |
2,839 |
|
|
$ |
(2,839 |
) |
|
$ |
456,245 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Compensation and benefits
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
319,292 |
|
|
|
|
|
|
|
|
|
|
|
319,292 |
|
Operating expenses
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
66,156 |
|
|
|
|
|
|
|
|
|
|
|
66,156 |
|
Insurance expense
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
21,082 |
|
|
|
2,805 |
|
|
|
(2,839 |
) |
|
|
21,048 |
|
Selling, general and administrative expenses
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
15,654 |
|
|
|
|
|
|
|
|
|
|
|
15,654 |
|
Depreciation and amortization expense
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
14,843 |
|
|
|
|
|
|
|
|
|
|
|
14,843 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Income from operations
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
19,218 |
|
|
|
34 |
|
|
|
|
|
|
|
19,252 |
|
Interest expense
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
(12,824 |
) |
|
|
|
|
|
|
|
|
|
|
(12,824 |
) |
Realized gain on investments
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
(34 |
) |
|
|
|
|
|
|
(34 |
) |
Interest and other income
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
91 |
|
|
|
|
|
|
|
|
|
|
|
91 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Income before income taxes
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
6,485 |
|
|
|
|
|
|
|
|
|
|
|
6,485 |
|
Income tax expense
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
(3,479 |
) |
|
|
|
|
|
|
|
|
|
|
(3,479 |
) |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Income before equity in earnings of unconsolidated subsidiaries
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
3,006 |
|
|
|
|
|
|
|
|
|
|
|
3,006 |
|
Equity in earnings of unconsolidated subsidiaries
|
|
|
3,006 |
|
|
|
501 |
|
|
|
2,505 |
|
|
|
|
|
|
|
|
|
|
|
(6,012 |
) |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Net income
|
|
$ |
3,006 |
|
|
$ |
501 |
|
|
$ |
2,505 |
|
|
$ |
3,006 |
|
|
$ |
|
|
|
$ |
(6,012 |
) |
|
$ |
3,006 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
F-66
Predecessor
Combining Statement of Operations
For the Three Months Ended September 30, 2004
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Issuer |
|
Issuer |
|
|
|
Subsidiary | |
|
|
|
|
|
|
|
|
AMR |
|
EmCare |
|
Subsidiary | |
|
Non- | |
|
Eliminations/ | |
|
|
|
|
Parent Co. |
|
HoldCo, Inc. |
|
HoldCo, Inc. |
|
Guarantors | |
|
guarantor | |
|
Adjustments | |
|
Total | |
|
|
|
|
|
|
|
|
| |
|
| |
|
| |
|
| |
Net revenue
|
|
$ |
|
|
|
$ |
|
|
|
$ |
|
|
|
$ |
413,869 |
|
|
$ |
7,962 |
|
|
$ |
(7,962 |
) |
|
$ |
413,869 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Compensation and benefits
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
286,628 |
|
|
|
|
|
|
|
|
|
|
|
286,628 |
|
Operating expenses
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
55,863 |
|
|
|
|
|
|
|
|
|
|
|
55,863 |
|
Insurance expense
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
19,544 |
|
|
|
6,822 |
|
|
|
(7,962 |
) |
|
|
18,404 |
|
Selling, general and administrative expenses
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
12,093 |
|
|
|
|
|
|
|
|
|
|
|
12,093 |
|
Laidlaw fees and compensation charges
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
3,657 |
|
|
|
|
|
|
|
|
|
|
|
3,657 |
|
Depreciation and amortization expense
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
12,669 |
|
|
|
|
|
|
|
|
|
|
|
12,669 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Income from operations
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
23,415 |
|
|
|
1,140 |
|
|
|
|
|
|
|
24,555 |
|
Interest expense
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
(5,138 |
) |
|
|
|
|
|
|
|
|
|
|
(5,138 |
) |
Realized loss on investments
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
(1,140 |
) |
|
|
|
|
|
|
(1,140 |
) |
Interest and other income
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
162 |
|
|
|
|
|
|
|
|
|
|
|
162 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Income before income taxes
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
18,439 |
|
|
|
|
|
|
|
|
|
|
|
18,439 |
|
Income tax expense
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
(8,826 |
) |
|
|
1,635 |
|
|
|
|
|
|
|
(7,191 |
) |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Income before equity in earnings of subsidiary
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
9,613 |
|
|
|
1,635 |
|
|
|
|
|
|
|
11,248 |
|
Equity in earnings of subsidiary
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
1,635 |
|
|
|
|
|
|
|
(1,635 |
) |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Net income
|
|
$ |
|
|
|
$ |
|
|
|
$ |
|
|
|
$ |
11,248 |
|
|
$ |
1,635 |
|
|
$ |
(1,635 |
) |
|
$ |
11,248 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
F-67
Condensed Consolidating Statement of Cash Flows
For the Eight Months Ended September 30, 2005
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Issuer | |
|
Issuer | |
|
|
|
Subsidiary | |
|
|
|
|
|
|
AMR | |
|
EmCare | |
|
Subsidiary | |
|
Non- | |
|
|
|
|
Parent Co. | |
|
HoldCo Inc. | |
|
HoldCo Inc. | |
|
Guarantors | |
|
guarantors | |
|
Total | |
|
|
| |
|
| |
|
| |
|
| |
|
| |
|
| |
Cash Flows from Operating Activities
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Net cash provided by operating activities
|
|
$ |
|
|
|
$ |
|
|
|
$ |
14 |
|
|
$ |
84,284 |
|
|
$ |
24,164 |
|
|
$ |
108,462 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Cash Flows from Investing Activities
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
EMS purchase of AMR and EmCare
|
|
|
(828,775 |
) |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
(828,775 |
) |
Purchase of property, plant and equipment
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
(34,947 |
) |
|
|
|
|
|
|
(34,947 |
) |
Proceeds from sale of property, plant and equipment
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
565 |
|
|
|
|
|
|
|
565 |
|
Purchase of restricted cash and investments
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
(51,495 |
) |
|
|
(51,495 |
) |
Proceeds from sale and maturity of restricted investments
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
17,560 |
|
|
|
17,560 |
|
Net change in deposits and other assets
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
(20,330 |
) |
|
|
|
|
|
|
(20,330 |
) |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Net cash used in investing activities
|
|
|
(828,775 |
) |
|
|
|
|
|
|
|
|
|
|
(54,712 |
) |
|
|
(33,935 |
) |
|
|
(917,422 |
) |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Cash Flows from Financing Activities
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Borrowings under new senior secured credit facility
|
|
|
|
|
|
|
241,500 |
|
|
|
108,500 |
|
|
|
|
|
|
|
|
|
|
|
350,000 |
|
Proceeds from issuance of senior subordinated notes
|
|
|
|
|
|
|
172,500 |
|
|
|
77,500 |
|
|
|
|
|
|
|
|
|
|
|
250,000 |
|
Borrowings under new revolving credit facility
|
|
|
|
|
|
|
17,388 |
|
|
|
7,812 |
|
|
|
|
|
|
|
|
|
|
|
25,200 |
|
Issuance of partnership equity
|
|
|
222,655 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
222,655 |
|
Financing costs
|
|
|
(1,737 |
) |
|
|
(12,686 |
) |
|
|
(5,699 |
) |
|
|
|
|
|
|
|
|
|
|
(20,122 |
) |
Repayments of capital lease obligations and other debt
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
(5,722 |
) |
|
|
|
|
|
|
(5,722 |
) |
Repayments of revolving credit facility
|
|
|
|
|
|
|
(13,938 |
) |
|
|
(6,262 |
) |
|
|
|
|
|
|
|
|
|
|
(20,200 |
) |
Net intercompany borrowings (payments)
|
|
|
612,685 |
|
|
|
(404,764 |
) |
|
|
(181,865 |
) |
|
|
(26,056 |
) |
|
|
|
|
|
|
|
|
Increase (decrease) in bank overdrafts
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
997 |
|
|
|
|
|
|
|
997 |
|
Increase (decrease) in other non-current liabilities
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
1,634 |
|
|
|
|
|
|
|
1,634 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Net cash provided by (used in) financing activities
|
|
|
833,603 |
|
|
|
|
|
|
|
(14 |
) |
|
|
(29,147 |
) |
|
|
|
|
|
|
804,442 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Increase in cash and cash equivalents
|
|
|
4,828 |
|
|
|
|
|
|
|
|
|
|
|
425 |
|
|
|
(9,771 |
) |
|
|
(4,518 |
) |
Cash and cash equivalents, beginning of period
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
4,778 |
|
|
|
9,853 |
|
|
|
14,631 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Cash and cash equivalents, end of period
|
|
$ |
4,828 |
|
|
$ |
|
|
|
$ |
|
|
|
$ |
5,203 |
|
|
$ |
82 |
|
|
$ |
10,113 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
F-68
Predecessor
Condensed Combining Statement of Cash Flows
For the Eight Months Ended September 30, 2004
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Issuer |
|
Issuer |
|
|
|
Subsidiary | |
|
|
|
|
|
|
AMR |
|
EmCare |
|
Subsidiary | |
|
Non- | |
|
|
|
|
Parent Co. |
|
HoldCo, Inc. |
|
HoldCo, Inc. |
|
Guarantors | |
|
guarantors | |
|
Total | |
|
|
|
|
|
|
|
|
| |
|
| |
|
| |
Cash Flows from Operating Activities
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Net cash provided by operating activities
|
|
$ |
|
|
|
$ |
|
|
|
$ |
|
|
|
$ |
78,886 |
|
|
$ |
21,075 |
|
|
$ |
99,961 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Cash Flows from Investing Activities
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Purchase of property, plant and equipment
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
(30,217 |
) |
|
|
|
|
|
|
(30,217 |
) |
Proceeds from sale of property, plant and equipment
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
773 |
|
|
|
|
|
|
|
773 |
|
Purchase of restricted cash and investments
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
(61,213 |
) |
|
|
(61,213 |
) |
Proceeds from sale and maturity of restricted investments
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
40,152 |
|
|
|
40,152 |
|
Other investing activities
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
(23,405 |
) |
|
|
|
|
|
|
(23,405 |
) |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Net cash used in investing activities
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
(52,849 |
) |
|
|
(21,061 |
) |
|
|
(73,910 |
) |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Cash Flows from Financing Activities
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Repayments of capital lease obligations and other debt
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
(5,396 |
) |
|
|
|
|
|
|
(5,396 |
) |
Payments to Laidlaw
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
(13,937 |
) |
|
|
|
|
|
|
(13,937 |
) |
Change in other non-current liabilities
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
(5,656 |
) |
|
|
|
|
|
|
(5,656 |
) |
Decrease in bank overdrafts
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
4,290 |
|
|
|
|
|
|
|
4,290 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Net cash used in financing activities
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
(20,699 |
) |
|
|
|
|
|
|
(20,699 |
) |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Change in cash and cash equivalents
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
5,338 |
|
|
|
14 |
|
|
|
5,352 |
|
Cash and cash equivalents, beginning of period
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
10,830 |
|
|
|
26 |
|
|
|
10,856 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Cash and cash equivalents, end of period
|
|
$ |
|
|
|
$ |
|
|
|
$ |
|
|
|
$ |
16,168 |
|
|
$ |
40 |
|
|
$ |
16,208 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
10. |
Planned Public Offering |
On July 28, 2005, the board of directors of the general
partner of the Company authorized the filing of a registration
statement on Form S-1 in connection with a proposed initial
public offering of the Companys equity. The Company
currently anticipates that, in connection with a public
offering, it will effect a reorganization pursuant to which the
Company becomes a consolidated subsidiary of a newly-formed
Delaware corporation and that corporation, to be named Emergency
Medical Services Corporation, will issue common stock in the
offering.
In connection with the offering and the related reorganization,
the outstanding options described in note 3 will become
options to purchase shares of Emergency Medical Services
Corporations common stock; the number of shares subject to
each option and the exercise price will be determined based on
Emergency Medical Services Corporations capitalization and
the offering price per share of common stock.
F-69
REPORT OF INDEPENDENT REGISTERED PUBLIC ACCOUNTING FIRM
To the Stockholder of Emergency Medical Services Corporation
In our opinion, the accompanying balance sheet presents fairly,
in all material respects, the financial position of Emergency
Medical Services Corporation (the Company) as of
November 10, 2005 in accordance with accounting principles
generally accepted in the United States of America. This
financial statement is the responsibility of the Companys
management; our responsibility is to express an opinion on this
financial statement based on our audit. We conducted our audit
of this statement in accordance with the standards of the Public
Company Accounting Oversight Board (United States). Those
standards require that we plan and perform the audit to obtain
reasonable assurance about whether the balance sheet is free of
material misstatement. An audit includes examining, on a test
basis, evidence supporting the amounts and disclosures in the
balance sheet, assessing the accounting principles used and
significant estimates made by management, and evaluating the
overall balance sheet presentation. We believe that our audit of
the balance sheet provides a reasonable basis for our opinion.
PricewaterhouseCoopers LLP
Denver, Colorado
November 14, 2005
F-70
EMERGENCY MEDICAL SERVICES CORPORATION
FINANCIAL STATEMENT
November 10, 2005
F-71
EMERGENCY MEDICAL SERVICES CORPORATION
BALANCE SHEET
November 10, 2005
|
|
|
|
|
|
ASSETS
|
|
|
|
|
Cash
|
|
$ |
100 |
|
|
STOCKHOLDERS EQUITY
|
|
|
|
|
Stockholders equity:
|
|
|
|
|
|
Common stock, $.01 par value; 100 shares class B
authorized, 10 shares issued and outstanding; 100 shares
class A authorized, 0 shares issued and outstanding
|
|
$ |
0 |
|
Additional paid-in capital
|
|
|
100 |
|
|
|
|
|
Total stockholders equity
|
|
$ |
100 |
|
|
|
|
|
The accompanying notes are an integral part of this financial
statement
F-72
EMERGENCY MEDICAL SERVICES CORPORATION
NOTES TO FINANCIAL STATEMENTS
1. Description of Business
Emergency Medical Services Corporation (the Company)
is a Delaware corporation which was formed on November 1,
2005. Its capital was contributed on November 10, 2005 by
EMSC, Inc., the general partner of EMS L.P. The Companys
fiscal year-end is December 31.
2. Pending Transactions
(unaudited)
On July 28, 2005, the board of directors of the general
partner of Emergency Medical Services L.P.
(EMS L.P.), a related company, authorized the
filing of a registration statement on Form S-1 in connection
with a proposed initial public offering of the equity of the
Company. The Company currently anticipates that, in connection
with that public offering, EMS L.P. and the Company will effect
a reorganization pursuant to which EMS L.P. will become a
consolidated subsidiary of the Company and the Company will
issue common stock in the offering.
EMS L.P. acquired American Medical Response, Inc.
(AMR) and EmCare Holdings Inc. (EmCare)
from Laidlaw International, Inc. on February 10, 2005 with
an effective transaction date after the close of business
January 31, 2005. The purchase price was
$828.8 million, subject to working capital and other
purchase adjustments.
EMS L.P. currently is completing its allocation of purchase
price. To finance the acquisition, EMS L.P. entered into a new
$450 million senior secured credit facility and issued
senior subordinated notes for gross proceeds of
$250 million. EMS L.P. also issued approximately
22.1 million limited partnership units for
$221 million.
The following table summarizes the estimated fair value of the
assets acquired and liabilities assumed by EMS L.P. at the date
of acquisition. EMS L.P. is in the process of obtaining
third-party valuations of certain intangible assets acquired and
liabilities assumed, and is evaluating the tax impact of certain
purchase accounting adjustments and the carryover of tax
attributes from the predecessor companies; accordingly, the
allocation of the purchase price is subject to adjustment.
|
|
|
|
|
|
Current assets
|
|
$ |
483,957 |
|
Property, plant & equipment
|
|
|
128,766 |
|
Intangible assets
|
|
|
89,850 |
|
Goodwill
|
|
|
271,987 |
|
Other long-term assets
|
|
|
254,027 |
|
|
|
|
|
|
Total assets acquired
|
|
|
1,228,587 |
|
|
|
|
|
Current liabilities
|
|
|
245,144 |
|
Long-term debt
|
|
|
620,183 |
|
Other long-term liabilities
|
|
|
144,381 |
|
|
|
|
|
|
Total liabilities assumed
|
|
|
1,009,708 |
|
|
|
|
|
Net assets acquired
|
|
$ |
218,879 |
|
|
|
|
|
The $272.0 million of goodwill currently has been
preliminarily assigned to AMR and EmCare in the amounts of
$127.7 million and $144.3 million, respectively, based
on the sales agreements and valuations, and is not subject to
amortization. EmCare goodwill is deductible for tax purposes.
It is expected that the Company will contribute the net proceeds
from the proposed initial public offering to EMS L.P. to pay
down a portion of the senior secured credit borrowings described
above.
F-73
Our Reorganization and Capital Structure
In connection with the Companys proposed initial public
offering, the Company and EMS L.P. will take the following
steps immediately prior to the completion of the offering:
|
|
|
|
|
The Company will amend and restate its certificate of
incorporation, and its authorized capital stock will include
100,000,000 shares of class A common stock, $.01 par
value, 40,000,000 shares of class B common stock, $.01
par value, and one share of class B special voting stock,
$.01 par value. |
|
|
|
The holders of the capital stock of the sole general partner of
EMS L.P. will contribute that capital stock to the Company
in exchange for shares of class B common stock, the general
partner will be merged into the Company and the Company will
become the general partner of EMS L.P. |
|
|
|
The holders of class B units of EMS L.P. will
contribute their units to the Company in exchange for shares of
class A common stock, and the holders of certain
class A units of EMS L.P. will contribute their units
to the Company in exchange for shares of class B common
stock. |
|
|
|
The balance of the class A units of EMS L.P., which
are held by certain of the Companys affiliates, will
continue to be held by those persons and will be designated
LP exchangeable units. |
|
|
|
The Company will issue the one share of class B special
voting stock to Onex Corporation, as trustee, to hold for the
benefit of the holders of the LP exchangeable units. |
As a result of this reorganization, EMS L.P. will become a
subsidiary of the Company, and the Company will treat
EMS L.P. as a consolidated subsidiary for financial
reporting purposes. The Company will then have outstanding three
classes of capital stock: class A common stock,
class B common stock and class B special voting stock.
EMS L.P. will have outstanding LP exchangeable units,
held by certain affiliates of the Company, and other partnership
units held by the Company, as the general partner and as a
limited partner. At the completion of the offering, the LP
exchangeable units will represent approximately 78% of the
equity interests in EMS L.P. and the Company will hold
approximately 22% of the equity interests in EMS L.P. The
LP exchangeable units will be exchangeable at any time, at
the option of the holder, for shares of class B common
stock on a one-for-one basis.
The Companys shares of class A common stock and
class B common stock will be identical except with respect
to voting rights and except that each share of class B
common stock may be converted into a share of class A
common stock at any time at the option of the holder. On every
matter properly submitted to stockholders for their vote, each
share of class A common stock will be entitled to one vote
per share and each share of class B common stock will be
entitled to ten votes per share, reducing to one vote per share
under certain limited circumstances. The one share of
class B special voting stock will be entitled to a number
of votes equal to the number of votes that could be cast if all
of the then outstanding LP exchangeable units were
exchanged for class B common stock.
Each of the LP exchangeable units will be a security of
EMS L.P. that, taking into account the following ancillary
rights, are substantially equivalent economically to a share of
class B common stock:
|
|
|
|
|
the right to exchange those units, at the holders option,
for shares of class B common stock on a one-for-one basis, |
|
|
|
the right to receive distributions, on a per unit basis, in
amounts (or property in the case of non-cash dividends) which
are the same as, or economically equivalent to, and which are
payable at the same time as, dividends declared on the
class B common stock (or dividends that would be required
to be declared if class B common stock were outstanding), |
|
|
|
the right to vote, through the trustee holder of the
class B special voting stock, at all stockholder meetings
at which holders of the class B common stock or
class B special voting stock are entitled to vote, and |
|
|
|
the right to participate on a pro rata basis with the
class B common stock in the distribution of assets of the
Company, upon specified events relating to the voluntary or
involuntary liquidation, dissolution, |
F-74
|
|
|
|
|
winding up or other distribution of the assets through the
mandatory exchange of LP exchangeable units for shares of
class B common stock. |
In the EMS L.P. partnership agreement, the Company has
agreed to maintain the economic equivalency of the
LP exchangeable units and the class B common stock,
and the holders of the LP exchangeable units have no
general voting rights. The LP exchangeable units, when
considered with the class B special voting stock, have the
same rights, privileges and characteristics of the
Companys class B common stock. The
LP exchangeable units are intended to be economically
equivalent to the class B common stock of the Company in
that the LP exchangeable units carry the right to vote (by
virtue of the class B special voting stock) with the
holders of class B common stock as if one class, and
entitle holders to receive distributions only if the equivalent
dividends are declared on the Companys class B common
stock. Accordingly, the Company will account for the
LP exchangeable units as if the LP exchangeable units
were shares of its common stock, including reporting the LP
exchangeable units in the equity section of the Companys
balance sheet and including the number of outstanding
LP exchangeable units in both its basic and diluted
earnings per share calculations.
F-75
1,148,325 Shares
Emergency Medical Services
Corporation
Class A Common
Stock
Prospectus
, 2005
Until ,
2005, all dealers that buy, sell or trade the class A
common stock may be required to deliver a prospectus, regardless
of whether they are participating in this offering. This is in
addition to the dealers obligation to deliver a prospectus
when acting as underwriters and with respect to their unsold
allotments or subscriptions.
PART II
Information Not Required in Prospectus
|
|
Item 13. |
Other Expenses of Issuance and Distribution |
The following table shows the costs and expenses, other than
underwriting discounts and commissions, payable in connection
with the sale and distribution of the class A common stock
being registered. All of these expenses will be paid by us. All
amounts except the SEC registration fee, the NASD filing fee and
the NYSE fee are estimated.
|
|
|
|
|
|
Securities and Exchange Commission registration fee
|
|
$ |
21,239 |
|
NASD filing fee
|
|
|
18,544 |
|
NYSE listing fee
|
|
|
150,000 |
|
Blue Sky fees and expenses (including attorneys fees and
expenses)
|
|
|
5,000 |
|
Accounting fees and expenses
|
|
|
875,000 |
|
Legal fees and expenses
|
|
|
1,250,000 |
|
Printing costs
|
|
|
650,000 |
|
Transfer agent and registrar fees
|
|
|
5,000 |
|
Miscellaneous fees and expenses
|
|
|
1,500,000 |
|
|
|
|
|
|
Total
|
|
$ |
4,474,783 |
|
|
|
* |
To be provided by amendment |
|
|
Item 14. |
Indemnification of Directors and Officers |
We will be incorporated under the laws of the State of Delaware.
Under Section 145 of the Delaware General Corporation Law,
the DGCL, a corporation may indemnify its directors, officers,
employees and agents and its former directors, officers,
employees and agents and those who serve, at the
corporations request, in such capacities with another
enterprise, against expenses, including attorneys fees, as
well as judgments, fines and settlements in nonderivative
lawsuits, actually and reasonably incurred in connection with
the defense of any action, suit or proceeding in which they or
any of them were or are made parties or are threatened to be
made parties by reason of their serving or having served in such
capacity. The DGCL provides, however, that such person must have
acted in good faith and in a manner such person reasonably
believed to be in, or not opposed to, the best interests of the
corporation and, in the case of a criminal action, such person
must have had no reasonable cause to believe his or her conduct
was unlawful. In addition, the DGCL does not permit
indemnification in an action or suit by or in the right of the
corporation, where such person has been adjudged liable to the
corporation, unless, and only to the extent that, a court
determines that such person fairly and reasonably is entitled to
indemnity for costs the court deems proper in light of liability
adjudication. Indemnity is mandatory to the extent a claim,
issue or matter has been successfully defended.
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Certificate of Incorporation and By-Laws |
Our certificate of incorporation will provide that none of our
directors shall be personally liable for breach of fiduciary
duty as a director. Any repeal or modification of that provision
shall not adversely affect any right or protection, or any
limitation of the liability of, any of our directors existing
at, or arising out of facts or incidents occurring prior to, the
effective date of such repeal or modification. Both our
certificate of incorporation and our by-laws will provide for
the indemnification of our directors and officers to the fullest
extent permitted by the DGCL.
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Indemnification Agreements |
Additionally, we have entered into indemnification agreements
with certain of our directors and officers which may, in certain
cases, be broader than the specific indemnification provisions
contained under current
II-1
applicable law. The indemnification agreements may require us,
among other things, to indemnify such officers and directors
against certain liabilities that may arise by reason of their
status or service as directors, officers or employees of the
company and to advance the expenses incurred by such parties as
a result of any threatened claims or proceedings brought against
them as to which they could be indemnified.
Our directors and officers are covered by insurance policies
maintained by us against certain liabilities for actions taken
in their capacities as such, including liabilities under the
Securities Act of 1933, or the Securities Act. Insofar as
indemnification for liabilities arising under the Securities Act
may be permitted to directors, officers and controlling persons
of the registrant pursuant to the foregoing provisions, or
otherwise, the registrant has been advised that in the opinion
of the Securities and Exchange Commission such indemnification
is against public policy as expressed in the Securities Act and
is, therefore, unenforceable. In the event that a claim for
indemnification against such liabilities (other than the payment
by the registrant of expenses incurred or paid by a director,
officer or controlling person of the registrant in the
successful defense of any action, suit or proceeding) is
asserted by such director, officer or controlling person in
connection with the securities being registered, the registrant
will, unless in the opinion of its counsel the matter has been
settled by controlling precedent, submit to a court of
appropriate jurisdiction the question whether such
indemnification by it is against public policy as expressed in
the Securities Act and will be governed by the final
adjudication of such issue.
Underwriting Agreement
The Underwriting Agreement (to be filed as Exhibit 1.1 to
the Registration Statement) provides for the indemnification of
our directors and officers in certain circumstances against
certain liabilities, including liabilities arising under the
Securities Act.
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Item 15. |
Recent Sales of Unregistered Securities |
On February 10, 2005, we issued 21,500,020 class A
units representing limited partnership interests of Emergency
Medical Services L.P. at a purchase price of $10.00 per
unit to seven accredited investors in reliance upon the
exemption provided by Rule 506 of the Securities Act.
On February 10, 2005, we issued 485,500 class B units
representing limited partnership interests of Emergency Medical
Services L.P. at a purchase price of $10.00 per unit to the
following members of senior management in the amounts set forth
opposite their names, in reliance upon the exemption provided by
Rule 506 of the Securities Act:
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Russell H. Harris, M.D.
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10,000 |
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Don S. Harvey
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50,000 |
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Angel L. Iscovich
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10,000 |
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Terry R. Meadows
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5,000 |
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Louis K. Meyer
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10,000 |
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David Mintz
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7,500 |
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James L. Murphy
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7,500 |
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Randel G. Owen
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22,500 |
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Dighton Packard
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22,500 |
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Steve W. Ratton, Jr.
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10,000 |
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William A. Sanger
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300,000 |
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Joseph Taylor
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13,000 |
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Douglas P. Webster
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5,000 |
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Todd Zimmerman
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12,500 |
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Effective as of February 10, 2005, we granted to members of
senior management options to purchase an aggregate of 2,289,979
class B units representing limited partnership interests of
Emergency Medical Services L.P., in reliance upon the
exemption provided by Rule 506 of the Securities Act. See
Management Equity Plans Equity
Option Plan.
II-2
On February 10, 2005, our subsidiaries, AMR Holdco, Inc.
and EmCare Holdco, Inc., sold $250,000,000 principal amount of
10% senior subordinated notes due 2005 to Banc of America
Securities LLC and JP Morgan Securities Inc., as the
initial purchasers, at a purchase price of $975.00 per $1,000
principal amount, in reliance upon the exemption provided by
Section 4(2) of the Securities Act and Rule 144A
promulgated under the Securities Act.
On March 10, 2005, we issued 75,000 class B units
representing limited partnership interests of Emergency Medical
Services L.P. at a purchase price of $10.00 per unit to James T.
Kelly, one of our directors, in reliance upon the exemption
provided by Rule 506 of the Securities Act.
On April 22, 2005, we issued 25,000 class B units
representing limited partnership membership interests of
Emergency Medical Services L.P. at a purchase price of $10.00
per unit to Steven B. Epstein, one of our directors, in reliance
upon the exemption provided by Rule 506 of the Securities
Act.
On June 10, 2005, we issued 25,000 class B units
representing limited partnership interests of Emergency Medical
Services L.P. at a purchase price of $10.00 per unit to Michael
L. Smith, one of our directors, in reliance upon the exemption
provided by Rule 506 of the Securities Act.
In July 2005, we granted to certain members of our board of
directors and senior management options to purchase an aggregate
of 49,500 class B units representing limited partnership
units of Emergency Medical Services L.P., in reliance upon the
exemption provided by Rule 506 of the Securities Act. See
Management Equity Plans Equity
Option Plan.
In July 2005, we issued 134,050 class B units
representing limited partnership interests of Emergency Medical
Services L.P. at a purchase price of $10.00 per unit to
employees of our subsidiaries pursuant to our equity purchase
plan in reliance upon the exemption provided by Rule 701
the Securities Act. The issuance of these units to employees in
certain states is subject to our making regulatory filings
and/or our receipt of regulatory approval.
In July 2005, we issued 21,000 class B units
representing limited partnership interests of Emergency Medical
Services L.P. at a purchase price of $10.00 per unit to
affiliated physicians, physician assistants and nurse
practitioners pursuant to our equity purchase plan in reliance
upon the exemption provided by Rule 506 the Securities Act.
On the effective date of this offering, we will issue shares of
our class B common stock to two accredited investors in
exchange for their 95,000 class A units representing
limited partnership interests of Emergency Medical Services
L.P., in reliance upon the exemption provided by Rule 506
of the Securities Act.
II-3
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Item 16. |
Exhibits and Financial Data Schedules |
(A) Exhibits
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1 |
.1 |
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Form of Underwriting Agreement |
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1 |
.2 |
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Form of Lock-Up Agreement |
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2 |
.1 |
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Stock Purchase Agreement, dated as of December 6, 2004, by
and among Laidlaw International, Inc., Laidlaw Medical Holdings,
Inc. and Emergency Medical Services Corporation* |
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2 |
.2 |
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Amendment to Stock Purchase Agreement, dated February 10,
2005, by and among Laidlaw International, Inc., Laidlaw
Medical Holdings, Inc. and Emergency Medical Services
Corporation* |
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2 |
.3 |
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Stock Purchase Agreement, dated as of December 6, 2004, by
and among Laidlaw International, Inc., Laidlaw Medical Holdings,
Inc. and Emergency Medical Services Corporation* |
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2 |
.4 |
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Amendment to Stock Purchase Agreement, dated as of
February 10, 2005, by and among Laidlaw International,
Inc., Laidlaw Medical Holdings, Inc. and Emergency Medical
Services Corporation* |
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2 |
.5 |
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Letter, dated March 25, 2005, to AMR HoldCo, Inc. from
Laidlaw Medical Holdings, Inc.* |
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3 |
.1 |
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Form of Amended and Restated Certificate of Incorporation of
Emergency Medical Services Corporation* |
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3 |
.2 |
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Form of Amended and Restated By-Laws of Emergency Medical
Services Corporation* |
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3 |
.3 |
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Certificate of Formation of Emergency Medical Services L.P.* |
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3 |
.4 |
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Agreement of Limited Partnership of Emergency Medical Services
L.P., dated February 10, 2005, by and among Emergency
Medical Services Corporation and the persons listed on
Schedule A thereto* |
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3 |
.4.1 |
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Amendment to Agreement of Limited Partnership, dated
November 27, 2005, by and among Emergency Medical Services
L.P. and the other signatories thereto.* |
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3 |
.4.2 |
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Form of Amendment to Agreement of Limited Partnership, dated
December , 2005 by and among EMSC, Inc. and the
persons listed on Schedule A thereto* |
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3 |
.5 |
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Form of Amended and Restated Agreement of Limited Partnership of
Emergency Medical Services L.P., dated
December , 2005, by and among EMSC, Inc. and
the persons listed on Schedule A thereto* |
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4 |
.1 |
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Form of Class A Common Stock Certificate* |
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4 |
.2 |
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Form of Class B Common Stock Certificate* |
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4 |
.3 |
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Investor Equityholders Agreement, dated February 10, 2005,
by and among Emergency Medical Services L.P., Onex
Partners LP and the equityholders listed on the signature
pages thereto* |
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4 |
.4 |
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Equityholders Agreement, dated as of February 10, 2005, by
and among Emergency Medical Services L.P., Onex
Partners LP and the equityholders listed on the signature
pages thereto* |
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4 |
.5 |
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Registration Agreement, dated February 10, 2005, by and
among Emergency Medical Services L.P. and the persons
listed on Schedule A thereto and amendment thereto* |
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4 |
.6 |
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Indenture, dated February 10, 2005, by and among AMR
HoldCo, Inc., EmCare HoldCo, Inc., the guarantors named therein
and U.S. Bank Trust National Association, as trustee* |
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4 |
.7 |
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Supplemental Indenture, dated April 15, 2005, by and among
AMR Brockton L.L.C., AMR HoldCo, Inc., EmCare HoldCo, Inc., the
guarantors named therein and U.S. Bank Trust National
Association, as trustee* |
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4 |
.8 |
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Supplemental Indenture No. 2, effective as of
September 30, 2005, by and among Global Medical Response,
Inc., AMR HoldCo, Inc., EmCare HoldCo, Inc., the guarantors
named therein and U.S. Bank Trust National Association, as
trustee* |
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4 |
.9 |
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Registration Rights Agreement, dated as of February 10,
2005, by and among AMR HoldCo, Inc., EmCare HoldCo, Inc., the
guarantors named therein, Banc of America Securities LLC and
J.P. Morgan Securities Inc.* |
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4 |
.10 |
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Form of Voting and Exchange Trust Agreement among Emergency
Medical Services Corporation, Emergency Medical Services L.P.
and Onex Corporation* |
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4 |
.11 |
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Form of Indemnification Agreement* |
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5 |
.1 |
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Opinion of Kaye Scholer LLP with respect to legality of
securities being registered |
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8 |
.1 |
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Opinion of Kaye Scholer LLP with respect to tax matters* |
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10 |
.1 |
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Employment Agreement, dated December 6, 2004, between
William A. Sanger and Emergency Medical Services Corporation* |
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10 |
.2 |
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Employment Agreement, dated as of February 10, 2005,
between Don S. Harvey and Emergency Medical Services L.P., and
assignment to Emergency Medical Services Corporation* |
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10 |
.3 |
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Employment Agreement, dated as of February 10, 2005,
between Randel G. Owen and Emergency Medical Services L.P., and
assignment to Emergency Medical Services Corporation* |
II-4
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10 |
.4 |
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Employment Agreement, dated as of February 10, 2005,
between Todd Zimmerman and Emergency Medical Services L.P., and
assignment to Emergency Medical Services Corporation* |
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10 |
.5 |
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Employment Agreement, dated as of April 19, 2005, by and
between Emergency Medical Services L.P. and Dighton Packard,
M.D., and assignment to Emergency Medical Services Corporation.* |
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10 |
.6 |
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Emergency Medical Services L.P. Equity Option Plan* |
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10 |
.7 |
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Emergency Medical Services L.P. Equity Purchase Plan* |
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10 |
.8 |
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Management Agreement, dated February 10, 2005, by and among
Onex Partners Manager LP, AMR HoldCo, Inc. and EmCare HoldCo,
Inc.* |
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10 |
.9 |
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Purchase Agreement, dated January 27, 2005, among AMR
HoldCo, Inc., EmCare HoldCo, Inc., the Registrant, the
guarantors party thereto, Banc of America LLC Securities and
J.P. Morgan Securities Inc.* |
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10 |
.10 |
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Credit Agreement, dated as of February 10, 2005, among AMR
HoldCo, Inc., EmCare HoldCo, Inc., Emergency Medical Services
L.P., the guarantors party thereto, Bank of America, N.A. and
the other lenders party thereto* |
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10 |
.11 |
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Amendment No. 1, dated March 29, 2005, among AMR
HoldCo, Inc., EmCare HoldCo, Emergency Medical Services L.P.,
the guarantors and the lenders party thereto, to the Credit
Agreement dated as of February 10, 2005, among AMR HoldCo,
Inc., EmCare HoldCo, Inc., Emergency Medical Services L.P., the
guarantors party thereto, Bank of America, N.A. and the other
lenders party thereto* |
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10 |
.12 |
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Security Agreement, dated as of February 10, 2005, made by
AMR HoldCo, Inc., EmCare HoldCo., Inc., the guarantors party
thereto, in favor of Bank of America, N.A.* |
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10 |
.13 |
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Form of Assignment, dates as of December ,
2005, by and among Emergency Medical Services Corporation,
AMR HoldCo, Inc. and ClaimCo LP |
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21 |
.1 |
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Subsidiaries of Emergency Medical Services L.P.* |
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23 |
.1 |
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Consent of PricewaterhouseCoopers LLP |
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23 |
.2 |
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Consent of Kaye Scholer LLP (included in Exhibit 5.1)* |
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24 |
.1 |
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Powers of Attorney of the directors of Emergency Medical
Services L.P. (included in the signature page to the
registration statement)* |
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24 |
.2 |
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Powers of Attorney of the directors of Emergency Medical
Services Corporation (included in the signature page to the
registration statement)* |
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* |
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Previously filed |
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** |
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To be filed by amendment |
(B) Financial Data Schedule
The undersigned registrant hereby undertakes as specified in the
underwriting agreement to provide to the underwriters at closing
certificates in such denominations and registered in such names
as required by the underwriters to permit prompt delivery to
each purchaser.
Insofar as indemnification for liabilities arising under the
Securities Act may be permitted to directors, officers and
controlling persons of the registrant pursuant to the foregoing
provisions, or otherwise, the registrant has been advised that
in the opinion of the Securities and Exchange Commission such
indemnification is against public policy as expressed in the
Securities Act and is, therefore, unenforceable. In the event
that a claim for indemnification against such liabilities (other
than the payment by the registrant of expenses incurred or paid
by a director, officer or controlling person of the registrant
in the successful defense of any action, suit or proceeding) is
asserted by such director, officer or controlling person in
connection with the securities being registered, the registrant
will, unless in the opinion of its counsel the matter has been
settled by controlling precedent, submit to a court of
appropriate jurisdiction the question whether such
indemnification by it is against public policy as expressed in
the Securities Act and will be governed by the final
adjudication of such issue.
The undersigned registrant hereby undertakes that:
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(1) For purposes of determining any
liability under the Securities Act, the information omitted from
the form of prospectus filed as part of this registration
statement in reliance upon Rule 430A and contained in a
form of prospectus filed by the registrant pursuant to
Rule 424(b)(1) or (4) or 497(h) |
II-5
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under the Securities Act shall be deemed to be part of this
registration statement as of the time it was declared effective. |
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(2) For the purpose of determining
any liability under the Securities Act, each post-effective
amendment that contains a form of prospectus shall be deemed to
be a new registration statement relating to the securities
offered therein, and the offering of such securities at that
time shall be deemed to be the initial bona fide offering
thereof. |
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(3) For the purpose of determining
liability of the registrants under the Securities Act of 1933 to
any purchaser in the initial distribution of the securities, in
a primary offering of securities of the undersigned registrants
pursuant to this registration statement, regardless of the
underwriting method used to sell the securities to the
purchaser, if the securities are offered or sold to such
purchaser by means of any of the following communications, the
undersigned registrants will be a seller to the purchaser and
will be considered to offer or sell such securities to such
purchaser: |
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(i) Any preliminary prospectus or prospectus of the
undersigned registrants relating to the offering required to be
filed pursuant to Rule 424; |
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(ii) Any free writing prospectus relating to the offering
prepared by or on behalf of the undersigned registrants or used
or referred to by the undersigned registrants; |
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(iii) The portion of any other free writing prospectus
relating to the offering containing material information about
the undersigned registrants or their securities provided by or
on behalf of the undersigned registrants; and |
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(iv) Any other communication that is an offer in the
offering made by the undersigned registrants to the purchaser. |
II-6
SIGNATURES
Pursuant to the requirements of the Securities Act, Emergency
Medical Services L.P. has duly caused this amendment
no. 6 to its registration statement to be signed on its
behalf by the undersigned, thereunto duly authorized, in
Greenwood Village, State of Colorado, on December 15, 2005.
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EMERGENCY MEDICAL SERVICES L.P. |
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By: |
EMSC, Inc.,
its General Partner |
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By: |
/s/ William A. Sanger
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William A. Sanger |
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Chief Executive Officer |
Pursuant to the requirements of the Securities Act, this
Amendment No. 6 to Registration Statement on Form S-1
has been signed by the following persons in the capacities
indicated for EMSC, Inc., as general partner of Emergency
Medical Services L.P., and on the date indicated.
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Signature |
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Title |
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Date |
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/s/ William A. Sanger
William
A. Sanger |
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Chairman, Chief Executive Officer and Director (Principal
Executive Officer) |
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December 14, 2005 |
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/s/ Randel G. Owen
Randel
G. Owen |
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Chief Financial Officer (Principal Financial and Accounting
Officer) |
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December 14, 2005 |
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*
Robert
M. Le Blanc |
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Director |
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December 14, 2005 |
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*
Steven
B. Epstein |
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Director |
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December 14, 2005 |
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*
Don
S. Harvey |
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Director |
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December 14, 2005 |
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*
James
T. Kelly |
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Director |
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December 14, 2005 |
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*
Michael
L. Smith |
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Director |
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December 14, 2005 |
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* By: |
/s/ William A. Sanger
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Name: William A. Sanger
Attorney-in-Fact
II-7
SIGNATURES
Pursuant to the requirements of the Securities Act, Emergency
Medical Services Corporation has duly caused this amendment
no. 6 to its registration statement to be signed on its
behalf by the undersigned, thereunto duly authorized, in
Greenwood Village, State of Colorado, on December 15, 2005.
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EMERGENCY MEDICAL SERVICES
CORPORATION |
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By: |
/s/ William A. Sanger
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William A. Sanger |
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Chief Executive Officer |
Pursuant to the requirements of the Securities Act, this
Amendment No. 6 to Registration Statement on Form S-1
has been signed by the following persons in the capacities
indicated for Emergency Medical Services Corporation and on the
date indicated.
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Signature |
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Title |
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Date |
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/s/ William A. Sanger
William
A. Sanger |
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Chairman, Chief Executive Officer and Director
(Principal Executive Officer) |
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December 14, 2005 |
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/s/ Randel G. Owen
Randel
G. Owen |
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Chief Financial Officer
(Principal Financial and
Accounting Officer) |
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December 14, 2005 |
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*
Robert
M. Le Blanc |
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Director |
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December 14, 2005 |
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*By: |
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/s/ William A. Sanger
Name: William
A. Sanger
Attorney-in-Fact |
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II-8