- MORE -
- MORE -
- MORE -
Three Months Ended | Year Ended | |||||||||||||||
December 31, | December 31, | |||||||||||||||
2010 | 2009 | 2010 | 2009 | |||||||||||||
Net operating revenues (g) |
$ | 3,402,699 | $ | 3,091,146 | $ | 12,986,500 | $ | 12,107,613 | ||||||||
Adjusted EBITDA (c) |
$ | 452,317 | $ | 434,421 | $ | 1,770,199 | $ | 1,671,397 | ||||||||
Income from continuing operations (d)(e)(f)(g)(h) |
$ | 92,249 | $ | 84,126 | $ | 348,441 | $ | 304,805 | ||||||||
Net income attributable to Community Health Systems, Inc. |
$ | 69,510 | $ | 65,088 | $ | 279,983 | $ | 243,150 | ||||||||
Basic earnings per share attributable to Community |
||||||||||||||||
Health Systems, Inc. common stockholders: |
||||||||||||||||
Continuing operations |
$ | 0.77 | $ | 0.71 | $ | 3.05 | $ | 2.67 | ||||||||
Discontinued operations |
| | | 0.01 | ||||||||||||
Net income |
$ | 0.77 | $ | 0.71 | $ | 3.05 | $ | 2.68 | ||||||||
Diluted earnings per share attributable to Community |
||||||||||||||||
Health Systems, Inc. common stockholders (j): |
||||||||||||||||
Continuing operations |
$ | 0.76 | $ | 0.70 | $ | 3.01 | $ | 2.64 | ||||||||
Discontinued operations |
| | | 0.01 | ||||||||||||
Net income |
$ | 0.76 | $ | 0.70 | $ | 3.01 | $ | 2.66 | ||||||||
Weighted-average number of shares outstanding (i): |
||||||||||||||||
Basic |
90,422 | 91,178 | 91,719 | 90,615 | ||||||||||||
Diluted |
91,779 | 92,699 | 92,946 | 91,517 | ||||||||||||
Net cash provided by operating activities |
$ | 290,354 | $ | 175,669 | $ | 1,188,730 | $ | 1,076,429 |
- MORE -
Three Months Ended December 31, | ||||||||||||||||
2010 | 2009 | |||||||||||||||
% of Net | % of Net | |||||||||||||||
Operating | Operating | |||||||||||||||
Amount | Revenues | Amount | Revenues | |||||||||||||
Net operating revenues (g) |
$ | 3,402,699 | 100.0 | % | $ | 3,091,146 | 100.0 | % | ||||||||
Operating costs and expenses: |
||||||||||||||||
Salaries and benefits |
1,383,989 | 40.7 | % | 1,228,063 | 39.7 | % | ||||||||||
Provision for bad debts |
425,915 | 12.5 | % | 381,720 | 12.3 | % | ||||||||||
Supplies |
458,962 | 13.5 | % | 431,780 | 14.0 | % | ||||||||||
Other operating expenses |
628,443 | 18.5 | % | 557,061 | 18.1 | % | ||||||||||
Rent |
65,405 | 1.9 | % | 62,921 | 2.0 | % | ||||||||||
Depreciation and amortization |
157,660 | 4.6 | % | 144,645 | 4.7 | % | ||||||||||
Total operating costs and expenses (g) |
3,120,374 | 91.7 | % | 2,806,190 | 90.8 | % | ||||||||||
Income from operations (f) |
282,325 | 8.3 | % | 284,956 | 9.2 | % | ||||||||||
Interest expense, net |
165,618 | 4.9 | % | 161,755 | 5.2 | % | ||||||||||
Equity in earnings of unconsolidated affiliates |
(12,332 | ) | -0.4 | % | (4,820 | ) | -0.2 | % | ||||||||
Impairment of long-lived and other assets |
| 0.0 | % | 12,477 | 0.5 | % | ||||||||||
Income from
continuing operations before income taxes |
129,039 | 3.8 | % | 115,544 | 3.7 | % | ||||||||||
Provision for income taxes |
36,790 | 1.1 | % | 31,418 | 1.0 | % | ||||||||||
Income from continuing operations (f)(g)(h) |
92,249 | 2.7 | % | 84,126 | 2.7 | % | ||||||||||
Income from discontinued operations |
| 0.0 | % | | 0.0 | % | ||||||||||
Net income |
92,249 | 2.7 | % | 84,126 | 2.7 | % | ||||||||||
Less: Net income attributable to noncontrolling interests |
22,739 | 0.7 | % | 19,038 | 0.6 | % | ||||||||||
Net income attributable to Community Health Systems, Inc. |
$ | 69,510 | 2.0 | % | $ | 65,088 | 2.1 | % | ||||||||
Basic earnings per share attributable to Community |
||||||||||||||||
Health Systems, Inc. common stockholders: |
||||||||||||||||
Continuing operations |
$ | 0.77 | $ | 0.71 | ||||||||||||
Discontinued operations |
| | ||||||||||||||
Net income |
$ | 0.77 | $ | 0.71 | ||||||||||||
Diluted earnings per share attributable to Community |
||||||||||||||||
Health Systems, Inc. common stockholders: |
||||||||||||||||
Continuing operations |
$ | 0.76 | $ | 0.70 | ||||||||||||
Discontinued operations |
| | ||||||||||||||
Net income |
$ | 0.76 | $ | 0.70 | ||||||||||||
Weighted-average number of shares outstanding (i): |
||||||||||||||||
Basic |
90,422 | 91,178 | ||||||||||||||
Diluted |
91,779 | 92,699 | ||||||||||||||
- MORE -
Year Ended December 31, | ||||||||||||||||
2010 | 2009 | |||||||||||||||
% of Net | % of Net | |||||||||||||||
Amount | Operating Revenues | Amount | Operating Revenues | |||||||||||||
Net operating revenues (g) |
$ | 12,986,500 | 100.0 | % | $ | 12,107,613 | 100.0 | % | ||||||||
Operating costs and expenses: |
||||||||||||||||
Salaries and benefits |
5,237,971 | 40.3 | % | 4,842,330 | 40.0 | % | ||||||||||
Provision for bad debts |
1,588,516 | 12.2 | % | 1,460,307 | 12.1 | % | ||||||||||
Supplies |
1,771,129 | 13.6 | % | 1,685,493 | 13.9 | % | ||||||||||
Other operating expenses |
2,406,596 | 18.6 | % | 2,237,475 | 18.5 | % | ||||||||||
Rent |
257,521 | 2.0 | % | 247,132 | 2.0 | % | ||||||||||
Depreciation and amortization |
609,839 | 4.7 | % | 566,211 | 4.7 | % | ||||||||||
Total operating costs and expenses (g) |
11,871,572 | 91.4 | % | 11,038,948 | 91.2 | % | ||||||||||
Income from operations (f) |
1,114,928 | 8.6 | % | 1,068,665 | 8.8 | % | ||||||||||
Interest expense, net |
651,926 | 5.0 | % | 648,964 | 5.4 | % | ||||||||||
Gain from early extinguishment of debt |
| 0.0 | % | (2,385 | ) | 0.0 | % | |||||||||
Equity in earnings of unconsolidated affiliates |
(45,432 | ) | -0.3 | % | (36,521 | ) | -0.3 | % | ||||||||
Impairment of long-lived and other assets |
| 0.0 | % | 12,477 | 0.0 | % | ||||||||||
Income from continuing operations
before income taxes |
508,434 | 3.9 | % | 446,130 | 3.7 | % | ||||||||||
Provision for income taxes |
159,993 | 1.2 | % | 141,325 | 1.2 | % | ||||||||||
Income from continuing operations (d)(e)(f)(g)(h) |
348,441 | 2.7 | % | 304,805 | 2.5 | % | ||||||||||
Discontinued operations, net of taxes (b): |
||||||||||||||||
Income from operations of hospitals sold and hospitals
held for sale (e) |
| 0.0 | % | 1,977 | 0.0 | % | ||||||||||
Loss on sale of hospitals, net |
| 0.0 | % | (405 | ) | 0.0 | % | |||||||||
Income from discontinued operations |
| 0.0 | % | 1,572 | 0.0 | % | ||||||||||
Net income |
348,441 | 2.7 | % | 306,377 | 2.5 | % | ||||||||||
Less: Net income attributable to noncontrolling interests |
68,458 | 0.5 | % | 63,227 | 0.5 | % | ||||||||||
Net income attributable to Community Health Systems, Inc. |
$ | 279,983 | 2.2 | % | $ | 243,150 | 2.0 | % | ||||||||
Basic earnings per share attributable to Community
Health Systems, Inc. common stockholders (j): |
||||||||||||||||
Continuing operations |
$ | 3.05 | $ | 2.67 | ||||||||||||
Discontinued operations |
| 0.01 | ||||||||||||||
Net income |
$ | 3.05 | $ | 2.68 | ||||||||||||
Diluted earnings per share attributable to Community
Health Systems, Inc. common stockholders (j): |
||||||||||||||||
Continuing operations |
$ | 3.01 | $ | 2.64 | ||||||||||||
Discontinued operations |
| 0.01 | ||||||||||||||
Net income |
$ | 3.01 | $ | 2.66 | ||||||||||||
Weighted-average number of shares
outstanding (i): |
||||||||||||||||
Basic |
91,719 | 90,615 | ||||||||||||||
Diluted |
92,946 | 91,517 | ||||||||||||||
For the Three Months Ended December 31, | ||||||||||||||||||||||||
Consolidated | Same-Store | |||||||||||||||||||||||
2010 | 2009 | % Change | 2010 | 2009 | % Change | |||||||||||||||||||
Number of hospitals (at end of period) (k) |
130 | 125 | 125 | 125 | ||||||||||||||||||||
Licensed beds (at end of period) |
19,372 | 18,140 | 18,273 | 18,140 | ||||||||||||||||||||
Beds in service (at end of period) |
16,622 | 15,897 | 15,914 | 15,897 | ||||||||||||||||||||
Admissions |
175,112 | 171,648 | 2.0 | % | 166,789 | 171,648 | -2.8 | % | ||||||||||||||||
Adjusted admissions |
333,466 | 317,175 | 5.1 | % | 317,004 | 317,175 | -0.1 | % | ||||||||||||||||
Patient days |
751,416 | 733,571 | 715,252 | 733,571 | ||||||||||||||||||||
Average length of stay (days) |
4.3 | 4.3 | 4.3 | 4.3 | ||||||||||||||||||||
Occupancy rate (average beds in service) |
49.2 | % | 50.1 | % | 48.9 | % | 50.1 | % | ||||||||||||||||
Net operating revenues (g) |
$ | 3,402,699 | $ | 3,091,146 | 10.1 | % | $ | 3,242,078 | $ | 3,090,785 | 4.9 | % | ||||||||||||
Net inpatient revenues as a % of
total net operating revenues |
48.8 | % | 50.4 | % | 49.0 | % | 50.4 | % | ||||||||||||||||
Net outpatient revenues as a % of
total net operating revenues |
48.8 | % | 47.3 | % | 48.7 | % | 47.3 | % | ||||||||||||||||
Income from operations (f) |
$ | 282,325 | $ | 284,956 | -0.9 | % | $ | 296,209 | $ | 288,730 | 2.6 | % | ||||||||||||
Income from operations as a
% of net operating revenues |
8.3 | % | 9.2 | % | 9.1 | % | 9.3 | % | ||||||||||||||||
Depreciation and amortization |
$ | 157,660 | $ | 144,645 | $ | 153,313 | $ | 144,642 | ||||||||||||||||
Equity in earnings of unconsolidated affiliates |
$ | (12,332 | ) | $ | (4,820 | ) | $ | (12,332 | ) | $ | (4,820 | ) | ||||||||||||
Liquidity Data: |
||||||||||||||||||||||||
Adjusted EBITDA (c) |
$ | 452,317 | $ | 434,421 | 4.1 | % | ||||||||||||||||||
Adjusted EBITDA as a % of net
operating revenues |
13.3 | % | 14.1 | % | ||||||||||||||||||||
Net cash provided by operating activities |
$ | 290,354 | $ | 175,669 | ||||||||||||||||||||
Net cash provided by operating activities as
a % of net operating revenues |
8.5 | % | 5.7 | % |
For The Year Ended December 31, | ||||||||||||||||||||||||
Consolidated | Same-Store | |||||||||||||||||||||||
2010 | 2009 | % Change | 2010 | 2009 | % Change | |||||||||||||||||||
Number of hospitals (at end of period) (k) |
130 | 125 | 125 | 125 | ||||||||||||||||||||
Licensed beds (at end of period) |
19,372 | 18,140 | 18,273 | 18,140 | ||||||||||||||||||||
Beds in service (at end of period) |
16,622 | 15,897 | 15,914 | 15,897 | ||||||||||||||||||||
Admissions |
693,382 | 692,569 | 0.1 | % | 675,086 | 692,569 | -2.5 | % | ||||||||||||||||
Adjusted admissions |
1,308,334 | 1,275,888 | 2.5 | % | 1,269,467 | 1,275,888 | -0.5 | % | ||||||||||||||||
Patient days |
2,948,876 | 2,937,194 | 2,858,532 | 2,937,194 | ||||||||||||||||||||
Average length of stay (days) |
4.3 | 4.2 | 4.2 | 4.2 | ||||||||||||||||||||
Occupancy rate (average beds in service) |
50.0 | % | 51.3 | % | 49.8 | % | 51.3 | % | ||||||||||||||||
Net operating revenues (g) |
$ | 12,986,500 | $ | 12,107,613 | 7.3 | % | $ | 12,582,406 | $ | 12,105,938 | 3.9 | % | ||||||||||||
Net inpatient revenues as a % of
total net operating revenues |
48.9 | % | 50.1 | % | 49.3 | % | 50.1 | % | ||||||||||||||||
Net outpatient revenues as a % of
total net operating revenues |
48.9 | % | 47.6 | % | 48.6 | % | 47.6 | % | ||||||||||||||||
Income from operations (f) |
$ | 1,114,928 | $ | 1,068,665 | 4.3 | % | $ | 1,139,501 | $ | 1,083,805 | 5.1 | % | ||||||||||||
Income from operations as a
% of net operating revenues |
8.6 | % | 8.8 | % | 9.1 | % | 9.0 | % | ||||||||||||||||
Depreciation and amortization |
$ | 609,839 | $ | 566,211 | $ | 595,482 | $ | 566,219 | ||||||||||||||||
Equity in earnings of unconsolidated
affiliates |
$ | (45,432 | ) | $ | (36,521 | ) | $ | (45,220 | ) | $ | (36,409 | ) | ||||||||||||
Liquidity Data: |
||||||||||||||||||||||||
Adjusted EBITDA (c) |
$ | 1,770,199 | $ | 1,671,397 | 5.9 | % | ||||||||||||||||||
Adjusted EBITDA as a % of net
operating revenues |
13.6 | % | 13.8 | % | ||||||||||||||||||||
Net cash provided by operating activities |
$ | 1,188,730 | $ | 1,076,429 | ||||||||||||||||||||
Net cash provided by operating activities as
a % of net operating revenues |
9.2 | % | 8.9 | % |
December 31, | ||||||||
2010 | 2009 | |||||||
ASSETS |
||||||||
Current assets |
||||||||
Cash and cash equivalents |
$ | 299,169 | $ | 344,541 | ||||
Patient accounts receivable, net of allowance
for doubtful accounts of $1,639,198
and $1,417,188 at December 31, 2010 and
December 31, 2009, respectively |
1,714,542 | 1,617,903 | ||||||
Supplies |
329,114 | 302,609 | ||||||
Prepaid income taxes |
118,464 | 45,414 | ||||||
Deferred income taxes |
115,819 | 80,714 | ||||||
Prepaid expenses and taxes |
100,754 | 89,475 | ||||||
Other current assets |
193,331 | 194,339 | ||||||
Total current assets |
2,871,193 | 2,674,995 | ||||||
Property and equipment |
8,564,212 | 7,787,256 | ||||||
Less accumulated depreciation and amortization |
(2,106,746 | ) | (1,655,010 | ) | ||||
Property and equipment, net |
6,457,466 | 6,132,246 | ||||||
Goodwill |
4,199,905 | 4,157,927 | ||||||
Other assets, net |
1,169,559 | 1,056,304 | ||||||
Total assets |
$ | 14,698,123 | $ | 14,021,472 | ||||
LIABILITIES |
||||||||
Current liabilities |
||||||||
Current maturities of long-term debt |
$ | 63,139 | $ | 66,470 | ||||
Accounts payable |
526,338 | 428,565 | ||||||
Deferred income taxes |
8,882 | 28,397 | ||||||
Accrued interest |
146,415 | 145,201 | ||||||
Accrued liabilities |
897,266 | 789,163 | ||||||
Total current liabilities |
1,642,040 | 1,457,796 | ||||||
Long-term debt |
8,808,382 | 8,844,638 | ||||||
Deferred income taxes |
608,177 | 475,812 | ||||||
Other long-term liabilities |
1,001,675 | 858,952 | ||||||
Total liabilities |
12,060,274 | 11,637,198 | ||||||
Redeemable noncontrolling interests in equity of consolidated subsidiaries |
387,472 | 368,857 | ||||||
EQUITY |
||||||||
Community Health Systems, Inc. stockholders equity |
||||||||
Preferred stock, $.01 par value per share, 100,000,000 shares authorized;
none issued |
||||||||
Common stock, $.01 par value per share, 300,000,000 shares authorized; |
| | ||||||
93,644,862 shares issued and 92,669,313 shares outstanding
at December 31, 2010, and 94,013,537 shares issued and 93,037,988 shares
outstanding at December 31, 2009 |
936 | 940 | ||||||
Additional paid-in capital |
1,126,751 | 1,158,359 | ||||||
Treasury stock, at cost, 975,549 shares at December 31, 2010 and
December 31, 2009 |
(6,678 | ) | (6,678 | ) | ||||
Accumulated other comprehensive loss |
(230,927 | ) | (221,385 | ) | ||||
Retained earnings |
1,299,382 | 1,019,399 | ||||||
Total Community Health Systems, Inc. stockholders equity |
2,189,464 | 1,950,635 | ||||||
Noncontrolling interests in equity of consolidated subsidiaries |
60,913 | 64,782 | ||||||
Total equity |
2,250,377 | 2,015,417 | ||||||
Total liabilities and equity |
$ | 14,698,123 | $ | 14,021,472 | ||||
Year Ended | ||||||||
December 31, | ||||||||
2010 | 2009 | |||||||
Cash flows from operating activities |
||||||||
Net income |
$ | 348,441 | $ | 306,377 | ||||
Adjustments
to reconcile net income to net cash provided by operating activities: |
||||||||
Depreciation and amortization |
609,839 | 566,543 | ||||||
Deferred income taxes |
97,370 | 34,268 | ||||||
Stock-based compensation expense |
38,779 | 44,501 | ||||||
Loss on sale of hospitals and partnership interest, net |
| 405 | ||||||
(Excess tax benefit) income tax payable increase relating to stock-based compensation |
(10,219 | ) | 3,472 | |||||
Gain on early extinguishment of debt |
| (2,385 | ) | |||||
Impairment of long-lived and other assets |
| 12,477 | ||||||
Other non-cash expenses, net |
12,503 | 22,870 | ||||||
Changes in operating assets and liabilities, net of effects of acquisitions
and divestitures: |
||||||||
Patient accounts receivable |
(27,049 | ) | 58,390 | |||||
Supplies, prepaid expenses and other current assets |
(39,904 | ) | (34,535 | ) | ||||
Accounts payable, accrued liabilities and income taxes |
161,952 | 86,098 | ||||||
Other |
(2,982 | ) | (22,052 | ) | ||||
Net cash provided by operating activities |
1,188,730 | 1,076,429 | ||||||
Cash flows from investing activities |
||||||||
Acquisitions of facilities and other related equipment |
(248,251 | ) | (263,773 | ) | ||||
Purchases of property and equipment |
(667,378 | ) | (576,888 | ) | ||||
Proceeds from disposition of hospitals and other ancillary operations |
| 89,514 | ||||||
Proceeds from sale of property and equipment |
8,401 | 4,019 | ||||||
Increase in other non-operating assets |
(137,082 | ) | (120,054 | ) | ||||
Net cash used in investing activities |
(1,044,310 | ) | (867,182 | ) | ||||
Cash flows from financing activities |
||||||||
Proceeds from exercise of stock options |
56,916 | 12,759 | ||||||
Excess tax benefit (income tax payable increase) relating to stock-based compensation |
10,219 | (3,472 | ) | |||||
Deferred financing costs |
(13,260 | ) | (82 | ) | ||||
Stock buy-back |
(113,961 | ) | | |||||
Proceeds from noncontrolling investors in joint ventures |
7,201 | 29,838 | ||||||
Redemption of noncontrolling investments in joint ventures |
(7,318 | ) | (7,268 | ) | ||||
Distributions to noncontrolling investors in joint ventures |
(68,113 | ) | (58,963 | ) | ||||
Borrowings under credit agreement |
| 200,000 | ||||||
Repayments of long-term indebtedness |
(61,476 | ) | (258,173 | ) | ||||
Net cash used in financing activities |
(189,792 | ) | (85,361 | ) | ||||
Net change in cash and cash equivalents |
(45,372 | ) | 123,886 | |||||
Cash and cash equivalents at beginning of period |
344,541 | 220,655 | ||||||
Cash and cash equivalents at end of period |
$ | 299,169 | $ | 344,541 | ||||
(a) | The following table provides information needed to calculate income per share which is adjusted for noncontrolling interests (in thousands). |
Three Months Ended | Year Ended | |||||||||||||||
December 31, | December 31, | |||||||||||||||
2010 | 2009 | 2010 | 2009 | |||||||||||||
Income from continuing operations attributable to Community
Health Systems, Inc. common stockholders: |
||||||||||||||||
Income from continuing operations, net of taxes |
$ | 92,249 | $ | 84,126 | $ | 348,441 | $ | 304,805 | ||||||||
Less: Income from continuing operations attributable to
noncontrolling interests, net of taxes |
22,739 | 19,038 | 68,458 | 62,872 | ||||||||||||
Income from continuing operations attributable to Community
Health Systems, Inc. common stockholders basic and diluted |
$ | 69,510 | $ | 65,088 | $ | 279,983 | $ | 241,933 | ||||||||
Income from discontinued operations attributable to Community
Health Systems, Inc. common stockholders: |
||||||||||||||||
Income from discontinued operations, net of taxes |
$ | | $ | | $ | | $ | 1,572 | ||||||||
Less: Income from discontinued operations attributable to
noncontrolling interests, net of taxes |
| | | 355 | ||||||||||||
Income from discontinued operations attributable to Community
Health Systems, Inc. common stockholders basic and diluted |
$ | | $ | | $ | | $ | 1,217 | ||||||||
(b) | Continuing operating results exclude discontinued operations for the year ended December 31, 2009. |
(c) | EBITDA consists of net income attributable to Community Health Systems, Inc. before interest, income taxes, and depreciation and amortization. Adjusted EBITDA is EBITDA adjusted to exclude discontinued operations, gain/loss from early extinguishment of debt and net income attributable to noncontrolling interests. The Company has from time to time sold noncontrolling interests in certain of its subsidiaries or acquired subsidiaries with existing noncontrolling interest ownership positions. The Company believes that it is useful to present adjusted EBITDA because it excludes the portion of EBITDA attributable to these third-party interests and clarifies for investors the Companys portion of EBITDA generated by continuing operations. The Company uses adjusted EBITDA as a measure of liquidity. The Company has included this measure because it believes it provides investors with additional information about the Companys ability to incur and service debt and make capital expenditures. Adjusted EBITDA is the basis for a key component in the determination of the Companys compliance with some of the covenants under the Companys senior secured credit facility, as well as to determine the interest rate and commitment fee payable under the senior secured credit facility. |
Adjusted EBITDA is not a measurement of financial performance or liquidity under U.S. GAAP. It should not be considered in isolation or as a substitute for net income, operating income, cash flows from operating, investing or financing activities, or any other measure calculated in accordance with U.S. GAAP. The items excluded from adjusted EBITDA are significant components in understanding and evaluating financial performance and liquidity. This calculation of adjusted EBITDA may not be comparable to similarly titled measures reported by other companies. |
The following table reconciles adjusted EBITDA, as defined, to net cash provided by operating activities as derived directly from the condensed consolidated financial statements (in thousands): |
Three Months Ended | Year Ended | |||||||||||||||
December 31, | December 31, | |||||||||||||||
2010 | 2009 | 2010 | 2009 | |||||||||||||
Adjusted EBITDA |
$ | 452,317 | $ | 434,421 | $ | 1,770,199 | $ | 1,671,397 | ||||||||
Interest expense, net |
(165,618 | ) | (161,755 | ) | (651,926 | ) | (648,964 | ) | ||||||||
Provision for income taxes |
(36,790 | ) | (31,418 | ) | (159,993 | ) | (141,325 | ) | ||||||||
Income from operations of hospitals sold
and hospitals held for sale, net of taxes |
| | | 1,977 | ||||||||||||
Other non-cash expenses, net |
110,406 | 53,036 | 138,433 | 105,443 | ||||||||||||
Net changes in operating assets and liabilities,
net of effects of acquisitions |
(69,961 | ) | (118,615 | ) | 92,017 | 87,901 | ||||||||||
Net cash provided by operating activities |
$ | 290,354 | $ | 175,669 | $ | 1,188,730 | $ | 1,076,429 | ||||||||
(d) | Included in income from continuing operations for the year ended December 31, 2009, is a gain from early extinguishment of debt of $2.4 million with an after-tax impact of $1.5 million related to the repurchases on the open market and cancellation of $126.5 million of Senior Notes and the early payment of $110.4 million of term loans under the Companys Credit Facility. | |
(e) | Included in discontinued operations for the year ended December 31, 2009, is Presbyterian Hospital of Denton (255 licensed beds) located in Denton, Texas, which was conveyed to the noncontrolling partner on March 31, 2009. | |
(f) | Included in income from operations and income from continuing operations for the three months and year ended December 31, 2010, are the following non-same-store charges: |
| Pre-tax charges of $4.5 million and $8.8 million, respectively, related to acquisition costs; and | ||
| Pre-tax charges of $1.7 million and $6.7 million, respectively, for system conversion costs. |
(g) | Total consolidated net operating revenues and operating costs and expenses for the three months and year ended December 31, 2010, includes net revenues of approximately $2.9 million and $20.0 million, respectively, and total operating costs and expenses of approximately $1.3 million and $8.8 million, respectively, relating to the California Department of Healths enacted California Hospital Fee Program, which had been anticipated in 2010. These amounts represent the eighteen month retroactive impact of the program from its inception date through December 31, 2010. The State of California Department of Health Care Services issued a letter to the California Hospital Association stating that all necessary approvals for the California Hospital Fee Program were received during 2010, which is consistent with the Companys revenue and expense recognition. |
(h) | Income from continuing operations for the three months and year ended December 31, 2009, reflects the impact on earnings from the following recorded in the year ended December 31, 2009: |
Year Ended | ||||||||
December 31, 2009 | ||||||||
After-Tax Gain | ||||||||
(Loss) Impact | Gain (Loss) | |||||||
(In Millions) | Impact Per Share | |||||||
Impairment of long-lived and other assets |
$ | (7,757 | ) | $ | (0.08 | ) | ||
Recognized anticipated tax benefit from
adjustment and revaluation of deferred tax
accounts |
2,996 | 0.03 | ||||||
Combined Impact for 4th Quarter 2009 |
$ | (4,761 | ) | $ | (0.05 | ) |
(i) | The following table sets forth components reconciling the basic weighted-average number of shares to the diluted weighted-average number of shares (in thousands): |
Three Months Ended | Year Ended | |||||||||||||||
December 31, | December 31, | |||||||||||||||
2010 | 2009 | 2010 | 2009 | |||||||||||||
Weighted-average number of shares
outstanding basic |
90,422 | 91,178 | 91,719 | 90,615 | ||||||||||||
Add effect of dilutive securities: |
||||||||||||||||
Stock awards and options |
1,357 | 1,521 | 1,227 | 902 | ||||||||||||
Weighted-average number of shares
outstanding diluted |
91,779 | 92,699 | 92,946 | 91,517 | ||||||||||||
(j) | Total per share amounts may not add due to rounding. | |
(k) | Total number of hospitals (at end of period) for the three months and year ended December 31, 2010 and 2009 includes 4 and 3 stand-along psych or rehab hospitals, respectively. |
Updated 2011 | ||||||||||||
Projection | ||||||||||||
Range | ||||||||||||
Net operating revenues (in millions) |
$ | 13,900 | to | $ | 14,200 | |||||||
Adjusted EBITDA (in millions) |
$ | 1,850 | to | $ | 1,875 | |||||||
Income from continuing operations per share diluted |
$ | 3.15 | to | $ | 3.35 | |||||||
Same hospital annual admissions/adjusted admissions growth |
-1.0 | % | to | 1.0 | % | |||||||
Weighted-average diluted shares (in millions) |
92 | to | 93 | |||||||||
Acquisitions of new hospitals |
2 | to | 3 | |||||||||
Income from continuing operations per share diluted
1st Quarter ending March 31, 2011 |
$ | 0.77 | to | $ | 0.80 |
| The assumed acquisition of new hospitals for 2011 does not currently include the proposed Tenet acquisition. |
| Projected 2011 same hospital annual admissions/adjusted admissions growth does not take into account service closures and other unusual events. |
| Expressed as a percent of net operating revenues, the provision for bad debts is projected to be approximately 12.4% to 12.7% for 2011. These percentages may vary depending on changes in payor mix. |
| Expressed as a percent of net operating revenues, depreciation and amortization is projected to be approximately 4.7% to 4.8% for 2011; however, this is a fixed cost and the percentages may vary as revenue varies. Excludes possible impact of any future fair-value adjustments to investments and hospital fixed asset impairments. |
| 2011 projection assumes an estimate of $0.03 to $0.06 per share (diluted) of acquisition costs that are required to be expensed. This projection excludes the estimated acquisition expense related to the proposed Tenet acquisition. |
| For the purpose of providing interest expense guidance, the Company assumes that the borrowing rate under the Companys $7.2 billion Senior Secured Credit Facility for 2011 will remain relatively stable with the rates existing currently, particularly since the Company is a party to interest rate swap agreements (with original maturities of at least two years) resulting in total fixed debt including swaps being 93% of total debt. These swap agreements limit the effect of changes in interest rates. Based on these assumptions, expressed as a percentage of net operating revenues, interest expense is projected to be approximately 4.7% to 4.9% of net revenue guidance for 2011; however, these percentages will vary as revenue and interest rates vary. The 2011 projections do not assume any changes to the financing terms of the Senior Secured Credit Facility or any new financing arrangements, which have not been previously announced. | |
| On September 15, 2010, the Company adopted a new open market repurchase program for up to four million shares of the Companys common stock, not to exceed $100 million in purchases. The new repurchase program will conclude at the earliest of three years, when the maximum number of shares has been repurchased or when the maximum dollar amount has been reached. Through February 24, 2011, approximately 451,000 shares with a value of approximately $13.9 million were purchased and retired under this repurchase plan. |
| Expressed as a percentage of net operating revenues, equity in earnings of unconsolidated affiliates is projected to be approximately 0.3% to 0.4% for 2011. |
| Expressed as a percentage of net operating revenues, net income attributable to noncontrolling interests is projected to be approximately 0.5% to 0.6% for 2011. |
| Expressed as a percentage of income from continuing operations before income taxes, provision for income tax is projected to be approximately 31.0% to 33.0% for 2011. |
| Capital expenditures are projected as follows (in millions): |
2011 | ||||||||||||
Guidance | ||||||||||||
Total |
$ | 750 | to | $ | 850 |
| Regarding meaningful use certified electronic health records incentive payments, no significant benefit is currently projected for 2011. This will be updated as the year progresses. | |
| Net cash provided by operating activities are projected as follows (in millions): |
2011 | ||||||||||||
Guidance | ||||||||||||
Total |
$ | 1,150 | to | $ | 1,250 |
| The Companys guidance does not take into account resolution of certain pending government investigations and lawsuits. |
| general economic and business conditions, both nationally and in the regions in which we operate; | ||
| implementation and effect of potential and recently-adopted federal and state healthcare legislation; | ||
| risks associated with our substantial indebtedness, leverage, and debt service obligations; | ||
| demographic changes; | ||
| changes in, or the failure to comply with, governmental regulations; | ||
| potential adverse impact of known and unknown government investigations, audits, and Federal and State False Claims Act litigation; | ||
| our ability, where appropriate, to enter into and maintain managed care provider arrangements and the terms of these arrangements; | ||
| changes in, or the failure to comply with, managed care provider contracts could result in disputes and changes in reimbursement that could be applied retroactively; | ||
| changes in inpatient or outpatient Medicare and Medicaid payment levels; | ||
| increases in the amount and risk of collectability of patient accounts receivable; | ||
| increases in wages as a result of inflation or competition for highly technical positions and rising supply costs due to market pressure from pharmaceutical companies and new product releases; | ||
| liabilities and other claims asserted against us, including self-insured malpractice claims; | ||
| competition; | ||
| our ability to attract and retain, without significant employment costs, qualified personnel, key management, physicians, nurses and other health care workers; | ||
| trends toward treatment of patients in less acute or specialty healthcare settings, including ambulatory surgery centers or specialty hospitals; | ||
| changes in medical or other technology; | ||
| changes in U.S. generally accepted accounting principles; | ||
| the availability and terms of capital to fund additional acquisitions or replacement facilities; | ||
| our ability to successfully acquire additional hospitals; | ||
| our ability to successfully integrate any acquired hospitals or to recognize expected synergies from such acquisitions; | ||
| our ability to obtain adequate levels of general and professional liability insurance; | ||
| timeliness of reimbursement payments received under government programs; and | ||
| the other risk factors set forth in our public filings with the Securities and Exchange Commission. |