American Renal Associates Holdings, Inc. (NYSE: ARA) (“ARA” or
the “Company”), a leading provider of outpatient dialysis services,
today announced financial and operating results for the first
quarter ended March 31, 2017.
Certain metrics, including those expressed on an adjusted basis,
are Non-GAAP financial measures (See “Use of Non-GAAP Financial
Measures” and the reconciliation tables further below).
First Quarter 2017 Highlights (all percentage changes
compare Q1 2017 to Q1 2016 unless noted):
- Net patient service operating revenues
increased 3% to $177.0 million;
- Net (loss) income attributable to
American Renal Associates Holdings, Inc. was $(1.3) million or
$(0.40) per share as compared to $3.8 million or $0.16 per share in
Q1 2016;
- Adjusted EBITDA less noncontrolling
interests (“Adjusted EBITDA-NCI”) was $21.4 million as compared to
$27.2 million in Q1 2016;
- Adjusted net income attributable to
American Renal Associates Holdings, Inc. was $1.9 million or $0.06
per share for the first quarter of 2017;
- Total dialysis treatments increased
10.1%, of which 9.2% was non-acquired growth;
- As of March 31, 2017, the Company
operated 217 outpatient dialysis centers serving approximately
14,700 patients.
Joseph (Joe) Carlucci, Chairman and Chief Executive Officer,
said, “We made considerable progress with our operational
initiatives during the first quarter of 2017, and this progress is
a testament to the collective effort within our organization and
the strength of our operating model. I believe the actions we’ve
taken should put our Company in a stronger position during the
remainder of 2017 to manage against the headwinds associated with
the previously-disclosed ACA impact. First quarter 2017 financial
results were largely consistent with our internal plan. As
discussed below, we are establishing financial guidance for 2017,
and our 2017 Outlook assumes that our quarterly results should
improve sequentially as our operational initiatives take further
hold.”
“ARA’s dedicated staff remains focused on our Company’s first
priority - delivering the highest quality patient care. To that
end, I am proud of ARA’s performance in the most recent In-Center
Hemodialysis Consumer Assessment of Health Care Providers and
Systems (ICH-CAHPS) survey data, which shows that ARA patients have
significantly higher satisfaction rates with their dialysis
facility (15% higher), with the staff of their dialysis facility
(11% higher), and with the nephrologist at their dialysis facility
(11% higher) as compared to industry averages. The most recent
ICH-CAHPS survey was administered by a third party for the period
October 2016 through January 2017.”
“Our differentiated partnership model allows us to deliver high
quality dialysis care in an integrated and coordinated manner with
our physician partners. During the first quarter of 2017, we opened
three new de novo clinics and ended the period with a pipeline of
32 signed clinics at March 31, 2017. Our pipeline continues to be
strong and reflects the growing acceptance of our operating
philosophy within the nephrology community,” continued
Carlucci.
Financial and operating highlights include:
Revenue: Net patient service operating revenues for the
first quarter of 2017 were $177.0 million, an increase of 2.8% as
compared to $172.1 million for the prior-year period due to
treatment growth and offset by adverse changes in payor mix,
primarily related to a decrease in patients covered by Affordable
Care Act-compliant individual marketplace plans (both on-exchange
and off-exchange) ("ACA Plans").
Treatment Volume: Total dialysis treatments for the first
quarter of 2017 were 531,220 representing an increase of 10.1% over
the first quarter of 2016. Non-acquired treatment growth was 9.2%
and acquired treatment growth was 0.9% for the first quarter of
2017.
Center Activity: As of March 31, 2017, the Company
provided services at 217 outpatient dialysis centers serving 14,735
patients. During the first quarter of 2017, we opened three de novo
centers. As of March 31, 2017, we had 32 signed de novo clinics
scheduled to open in the future.
Net income, Net income attributable to noncontrolling
interests, Net (loss) income attributable to American Renal
Associates Holdings, Inc., Adjusted EBITDA and Adjusted EBITDA less
noncontrolling interests:
(Unaudited) Three Months
EndedMarch 31, Increase (Decrease) (in
thousands, except per share amounts) 2017 2016
Amount
PercentageChange*
Net income $ 12,902 $ 22,557 $ (9,655 ) (42.8 )% Net income
attributable to noncontrolling interests (14,153 ) (18,801 ) 4,648
(24.7 )% Net (loss) income attributable to American Renal
Associates Holdings, Inc. (1,251 ) 3,756 (5,007 )
NM
Non-GAAP financial measures**: Adjusted EBITDA $ 35,568 $
46,020 $ (10,452 ) (22.7 )% Adjusted EBITDA less noncontrolling
interests $ 21,415 $ 27,219 $ (5,804 ) (21.3 )%
__________________________
* NM – Not Meaningful** See reconciliation of Non-GAAP Financial
Measures.
Operating Expenses: Patient care costs for the first
quarter of 2017 were $120.3 million or 68.0% (or 67.0% excluding
the Modification Expense described below) of net patient service
operating revenues as compared to $105.5 million or 61.3% of net
patient service operating revenues in the prior-year period.
General and administrative expenses were $31.2 million
or 17.6% (or 13.5% excluding the Modification Expense
described below) of net patient service operating revenues as
compared to $21.5 million or 12.5% of net patient service operating
revenues in the prior-year period. Patient care costs and general
and administrative expenses for the first quarter of 2017 include
$1.7 million and $7.4 million, respectively, of stock-based
compensation related to modification of options at the time of the
Company’s initial public offering (the “Modification Expense”).
Cash Flow: Cash provided by operating activities for the
first quarter of 2017 was $16.5 million as compared to $36.6
million in the prior-year period. Adjusted cash provided (used) by
operating activities less distributions to noncontrolling interests
(see reconciliation of Non-GAAP Financial Measures) for the first
quarter of 2017 was ($2.5) million as compared to $15.2 million in
the prior-year period. Total capital expenditures for the first
quarter of 2017 were $6.4 million as compared to $16.4 million in
the prior-year period.
Balance Sheet: At March 31, 2017 the Company’s
balance sheet included consolidated cash of $84.0 million and
consolidated debt of $565.9 million, including the current portion
of long-term debt. Excluding clinic-level debt not guaranteed by
ARA and clinic-level cash not owned by ARA, Adjusted owned net debt
(see reconciliation of Non-GAAP Financial Measures) was $447.4
million at March 31, 2017, as compared to $438.1 million at
December 31, 2016. Adjusted owned net debt to last twelve months
Adjusted EBITDA less NCI leverage ratio was 3.8x at March 31,
2017. As of March 31, 2017, net patient accounts receivable
was $77.5 million and DSO for the period was 39 days as compared to
40 days for the three months ended March 31, 2016.
2017 Outlook for Adjusted EBITDA less NCI:
The Company expects 2017 Adjusted EBITDA less NCI to be in a
range of $100 million and $106 million. The 2017 Outlook reflects
the previously announced estimated decline of approximately $25
million related to reductions from Affordable Care Act-compliant
individual marketplace plans (both on-exchange and off-exchange)
(“ACA Plans”), as compared to 2016, for patients who also received
charitable premium assistance. The estimated $25 million decline
from 2016 Adjusted EBITDA less NCI takes ARA’s weighted average
dialysis facility ownership into account.
The Company’s 2017 Adjusted EBITDA less NCI Outlook excludes
severance costs, certain legal costs, and other future potential
costs, which could include potential closure and consolidation
costs, to the extent they occur during 2017.
We are not providing a quantitative reconciliation of our
Non-GAAP outlook to the corresponding GAAP information because the
GAAP measures that we exclude from our Non-GAAP outlook are not
available without unreasonable effort on a forward-looking basis
due to their unpredictability, high variability, complexity and low
visibility. These excluded GAAP measures include noncontrolling
interests, interest expense, income taxes, and other charges. We
expect the variability of these charges to have a potentially
unpredictable, and potentially significant, impact on our future
GAAP financial results.
Please see the “Forward-Looking Statements” section of this
release for a discussion of certain risks to our outlook.
Conference Call
American Renal Associates Holdings, Inc. will hold a conference
call to discuss this release on Wednesday, May 10, 2017, at 9:00
a.m. Eastern time. Investors will have the opportunity to listen to
the conference call by dialing (877) 407-8029, or for international
callers (201) 689-8029, or may listen over the Internet by going to
the Investor Relations section at www.ir.americanrenal.com. For
those who cannot listen to the live broadcast, a replay will be
available and can be accessed by dialing (877) 660-6853, or for
international callers (201) 612-7415. The conference ID for the
live call and the replay is 13660571.
About American Renal Associates
American Renal Associates Holdings, Inc. (NYSE: ARA) is a
leading provider of outpatient dialysis services in the United
States. As of March 31, 2017, ARA operated 217 dialysis clinic
locations in 25 states and the District of Columbia serving
approximately 14,700 patients with end stage renal disease. ARA
operates exclusively through a physician joint venture model, in
which it partners with approximately 380 local nephrologists to
develop, own and operate dialysis clinics. ARA’s Core Values
emphasize taking good care of patients, providing physicians with
clinical autonomy and operational support, hiring and retaining the
best possible staff and providing best practices management
services. For more information about American Renal Associates,
visit www.americanrenal.com.
Forward-Looking Statements
This press release contains forward-looking statements within
the meaning of Section 27A of the Securities Act of 1933, as
amended, and Section 21E of the Securities Exchange Act of 1934, as
amended. These statements, which have been included in reliance of
the “safe harbor” provisions of the Private Securities Litigation
Reform Act of 1995, involve risks and uncertainties and assumptions
relating to our operations, financial condition, business,
prospects, growth strategy and liquidity, which may cause our
actual results to differ materially from those projected by such
forward-looking statements, and the Company cannot give assurances
that such statements will prove to be correct. You can identify
forward-looking statements because they do not relate strictly to
historical or current facts. These statements may include words
such as “aim,” “anticipate,” “believe,” “estimate,” “expect,”
“forecast,” “outlook,” “potential,” “project,” “projection,”
“plan,” “intend,” “seek,” “may,” “could,” “would,” “will,”
“should,” “can,” “can have,” “likely,” the negatives thereof and
other words and terms of similar meaning in connection with any
discussion of the timing or nature of future operating or financial
performance or other events.
The forward-looking statements appear in a number of places
throughout this press release and include statements regarding our
intentions, beliefs or current expectations concerning, among other
things, our results of operations, financial condition, liquidity,
prospects, growth, strategies and the industry in which we operate.
All forward-looking statements are subject to risks and
uncertainties, including but not limited to those risks and
uncertainties described in “Risk Factors” and “Special Note
Regarding Forward-Looking Statements” in our Annual Report on Form
10-K for the year ended December 31, 2016 to be filed with the SEC
that may cause actual results to differ materially from those that
we expected.
Some of the factors that could cause actual results to differ
materially from those expressed or implied by the forward-looking
statements include, among others, the following:
- decline in the number of patients with
commercial insurance, including as a result of changes to the
healthcare exchanges or changes in regulations or enforcement of
regulations regarding the healthcare exchanges and challenges from
commercial payors or any regulatory changes leading to changes in
the ability of patients with commercial insurance coverage to
receive charitable premium support;
- decline in commercial payor
reimbursement rates;
- the ultimate resolution of the Centers
for Medicare and Medicaid Services (“CMS”) Interim Final Rule
published December 14, 2016 related to dialysis facilities
Conditions for Coverage (CMS 3337-IFC);
- reduction of government-based payor
reimbursement rates or insufficient rate increases or adjustments
that do not cover all of our operating costs;
- our ability to successfully develop de
novo clinics, acquire existing clinics and attract new physician
partners;
- our ability to compete effectively in
the dialysis services industry;
- the performance of our joint venture
subsidiaries and their ability to make distributions to us;
- changes to the Medicare ESRD program
that could affect reimbursement rates and evaluation criteria, as
well as changes in Medicaid or other non-Medicare government
programs or payment rates, including the ESRD PPS final rule for
2017 issued on October 28, 2016;
- federal or state healthcare laws that
could adversely affect us;
- our ability to comply with all of the
complex federal, state and local government regulations that apply
to our business, including those in connection with federal and
state anti-kickback laws and state laws prohibiting the corporate
practice of medicine or fee-splitting;
- heightened federal and state
investigations and enforcement efforts;
- the impact of the litigation by
affiliates of UnitedHealth Group, Inc., the Department of Justice
inquiry, securities litigation and related matters;
- changes in the availability and cost of
erythropoietin-stimulating agents (“ESAs”) and other
pharmaceuticals used in our business;
- development of new technologies that
could decrease the need for dialysis services or decrease our
in-center patient population;
- our ability to timely and accurately
bill for our services and meet payor billing requirements;
- claims and losses relating to
malpractice, professional liability and other matters; the
sufficiency of our insurance coverage for those claims and rising
insurances costs; and any negative publicity or reputational damage
arising from such matters;
- loss of any members of our senior
management;
- damage to our reputation or our brand
and our ability to maintain brand recognition;
- our ability to maintain relationships
with our medical directors and renew our medical director
agreements;
- shortages of qualified skilled clinical
personnel, or higher than normal turnover rates;
- competition and consolidation in the
dialysis services industry;
- deteriorations in economic conditions,
particularly in states where we operate a large number of clinics,
or disruptions in the financial markets;
- the participation of our physician
partners in material strategic and operating decisions and our
ability to favorably resolve any disputes;
- our ability to honor obligations under
the joint venture operating agreements with our physician partners
were they to exercise certain put rights and other rights;
- unauthorized disclosure of personally
identifiable, protected health or other sensitive or confidential
information;
- our ability to meet our obligations and
comply with restrictions under our substantial level of
indebtedness; and
- the ability of our principal
stockholder, whose interests may conflict with yours, to strongly
influence or effectively control our corporate decisions.
The forward-looking statements made in this press release are
made only as of the date of the hereof. Except as required by law,
we undertake no obligation to update any forward-looking statement,
whether as a result of new information or otherwise. More
information about potential factors that could affect our business
and financial results is included in our filings with the SEC.
Use of Non-GAAP Financial Measures
In addition to the results prepared in accordance with generally
accepted accounting principles in the United States (“GAAP”)
provided throughout this press release, the Company has presented
the following Non-GAAP financial measures: EBITDA, Adjusted EBITDA,
Adjusted EBITDA less noncontrolling interests (NCI), Adjusted net
income (loss) attributable to American Renal Associates Holdings,
Inc., Adjusted cash provided (used) by operating activities and
Adjusted owned net debt, which exclude various items detailed in
the attached “Reconciliation of Non-GAAP Financial Measures”.
These Non-GAAP financial measures are not intended to replace
financial performance measures determined in accordance with GAAP.
Rather, they are presented as supplemental measures of the
Company's performance that management believes may enhance the
evaluation of the Company's ongoing operating results. Please see
“Reconciliation of Non-GAAP Financial Measures” for additional
reasons for why these measures are provided.
American Renal Associates Holdings,
Inc. and Subsidiaries
Consolidated Statements of
Operations
(Unaudited)
(dollars in thousands except per share
amounts)
Three Months Ended March 31, 2017
2016 Patient service operating revenues $ 178,632 $ 173,554
Provision for uncollectible accounts (1,607 ) (1,423 ) Net patient
service operating revenues 177,025 172,131 Operating expenses:
Patient care costs 120,301 105,455 General and administrative
31,244 21,499 Transaction-related costs — 24 Depreciation and
amortization 9,074 7,677 Certain legal matters 3,936 —
Total operating expenses 164,555 134,655
Operating income 12,470 37,476 Interest expense, net (7,609 )
(12,258 ) Income tax receivable agreement income 4,517 —
Income before income taxes 9,378 25,218 Income tax (benefit)
expense (3,524 ) 2,661 Net income 12,902 22,557 Less: Net
income attributable to noncontrolling interests (14,153 ) (18,801 )
Net (loss) income attributable to American
Renal Associates Holdings, Inc.
$ (1,251 ) $ 3,756 (Loss) earnings per share: Basic $
(0.40 ) $ 0.17 Diluted (0.40 ) 0.16 Weighted-average number of
common shares outstanding Basic 30,907,482 22,213,967 Diluted
30,907,482 22,785,670
American Renal Associates Holdings,
Inc. and Subsidiaries
Consolidated Balance Sheets
(dollars in thousands except per share
data)
March 31, 2017 December 31, 2016
Assets (Unaudited) Cash $ 84,003 $ 100,916 Accounts
receivable, less allowance for doubtful accounts of $9,227 and
$8,726, respectively 77,495 81,127 Inventories 4,648 4,676 Prepaid
expenses and other current assets 18,217 18,498 Income tax
receivable 9,415 5,163 Total current assets 193,778
210,380 Property and equipment, net of accumulated depreciation of
$129,540 and $121,242, respectively 167,338 170,118 Intangible
assets, net of accumulated depreciation of $23,005 and $23,489,
respectively 25,681 25,626 Other long-term assets 7,472 6,753
Goodwill 573,147 573,147 Total assets $ 967,416
$ 986,024
Liabilities and Equity Accounts
payable $ 24,605 $ 31,127 Accrued compensation and benefits 26,092
29,103 Accrued expenses and other current liabilities 45,075 45,286
Current portion of long-term debt 45,559 48,274 Total
current liabilities 141,331 153,790 Long-term debt, less current
portion 520,364 522,058 Income tax receivable agreement payable
16,683 21,200 Other long-term liabilities 12,826 11,670 Deferred
tax liabilities 1,522 1,278
Total liabilities
692,726 709,996 Commitments and contingencies (Note 14 and Note 15)
Noncontrolling interests subject to put provisions 132,465 130,365
Equity:
Preferred stock, $0.01 par value;
1,000,000 shares authorized; none issued
Common stock, $0.01 par value; 300,000,000 shares authorized;
31,143,998 and 30,894,962 issued and outstanding at March 31, 2017
and December 31, 2016, respectively 184 184 Additional paid-in
capital 93,596 95,062 Receivable from noncontrolling interests (747
) (544 ) Accumulated deficit (129,897 ) (128,646 ) Accumulated
other comprehensive loss, net of tax (744 ) (100 ) Total American
Renal Associates Holdings, Inc. deficit (37,608 ) (34,044 )
Noncontrolling interests not subject to put provisions 179,833
179,707 Total equity 142,225 145,663
Total liabilities and equity $ 967,416 $ 986,024
American Renal Associates Holdings,
Inc. and Subsidiaries
Consolidated Statements of Cash
Flows
(Unaudited)
(dollars in thousands)
Three Months EndedMarch 31,
Operating activities 2017 2016 Net
income $ 12,902 $ 22,557 Adjustments to reconcile net income to
cash provided by operating activities: Depreciation and
amortization 9,074 7,677 Amortization of discounts, fees and
deferred financing costs 530 797 Stock-based compensation 10,088
386 Premium paid for interest rate cap agreements (1,186 ) —
Deferred taxes 673 67 Income tax receivable agreement income (4,517
) — Non-cash charge related to interest rate swap 173 623 Non-cash
rent charges 289 512 Loss on disposal of assets 57 — Change in
operating assets and liabilities, net of acquisitions: Accounts
receivable 3,632 1,088 Inventories 28 (1,224 ) Prepaid expenses and
other current assets (3,870 ) (152 ) Other assets (63 ) (18 )
Accounts payable (6,522 ) 1,286 Accrued compensation and benefits
(3,011 ) (1,008 ) Accrued expenses and other liabilities (1,755 )
3,985 Cash provided by operating activities 16,522 36,576
Investing activities Purchases of property, equipment and
intangible assets (6,406 ) (16,396 ) Cash used in investing
activities (6,406 ) (16,396 )
Financing activities Proceeds
from term loans, net of deferred financing costs 4,881 12,282
Payments on long-term debt (9,689 ) (7,462 ) Dividends and dividend
equivalents paid (271 ) — Proceeds from exercise of stock options
30 — Payments of deferred offering costs — (467 ) Distributions to
noncontrolling interests (19,044 ) (21,440 ) Contributions from
noncontrolling interests 1,710 1,884 Purchases of noncontrolling
interests (4,546 ) — Cash used in financing activities
(26,929 ) (15,203 )
(Decrease) increase in cash (16,813 )
4,977 Cash and restricted cash at beginning of period 100,916
90,988 Cash and restricted cash at end of period $
84,103 $ 95,965
Supplemental Disclosure of
Cash Flow Information Cash paid for income taxes $ 127 $ 193
Cash paid for interest 6,832 10,581
Supplemental
Disclosure of Non-Cash Financing Activities Accrued offering
expense — 680 Liability for accrued dividend equivalent payments
1,563 —
American Renal Associates Holdings,
Inc. and Subsidiaries
Unaudited Supplemental Business
Metrics
(dollars in thousands except per
treatment amounts)
Three Months Ended Dialysis Clinic
Activity: March 31, 2017 December 31, 2016
March 31, 2016 Number of clinics (as of end of
period)
217 214 194 Number of de novo clinics
opened (during period)
3 7 2 Signed clinics
(as of end of period)
32 33 35 Patients and
Treatment Volume: Patients (as of end of period)
14,735
14,590
13,420
Treatments 531,220 530,346 482,666 Number of treatment days 77 79
78 Treatments per day 6,899 6,713 6,188
Sources of treatment
growth (year over year % change): Non-acquired growth 9.2 %
10.3 % 14.4 % Acquired growth 0.9 % 1.1 % 0.5 % Total treatment
growth 10.1 % 11.4 % 14.9 %
Revenue: Patient service
operating revenues $ 178,632 $ 200,980 $ 173,554 Patient service
operating revenues per treatment $ 336 $ 379 $ 360 Net patient
service operating revenues $ 177,025 $ 199,114 $ 172,131
Expenses: Patient care costs (1) Amount $ 118,582 $ 119,221
$ 105,455 As a % of net patient service operating revenues 67.0 %
59.9 % 61.3 % Per treatment $ 223
$
225
$ 218 General and administrative expenses (2) Amount $ 23,859 $
24,235 $ 21,499 As a % of net patient service operating revenues
13.5 % 12.2 % 12.5 % Per treatment $ 45 $ 46 $ 45 Provision for
uncollectible accounts Amount $ 1,607 $ 1,866 $ 1,423 As a % of net
patient service operating revenues 0.9 % 0.9 % 0.8 % Per treatment
$ 3 $ 4 $ 3
Accounts receivable DSO (days) 39 37 40
Adjusted EBITDA* Adjusted EBITDA including noncontrolling
interests $ 35,568 $ 55,880 $ 46,020 Adjusted EBITDA - NCI $ 21,415
$ 32,201 $ 27,219
Clinical (quarterly averages): Dialysis
adequacy - % of patients with Kt/V > 1.2 99 % 98 % 98 % Vascular
access - % catheter in use > 90 days 11 % 10 % 11 %
____________________________________
* See reconciliation of Non-GAAP Financial Measures.
(1) Excludes $1.7 million and $1.9 million of stock-based
compensation related to modification of options at the time of the
Company’s IPO during the three months ended March 31, 2017 and
December 31, 2016, respectively.
(2) Excludes $7.4 million and $13.4 million of stock-based
compensation related to modification of options at the time of the
Company’s IPO during the three months ended March 31, 2017 and
December 31, 2016 respectively. The three months ended December 31,
2016 also exclude $1.7 million of executive severance costs and
$1.5 million of stock compensation primarily related to the
departure of our chief operating officer.
American Renal Associates Holdings,
Inc. and Subsidiaries
Net (Loss) Income per Share
Reconciliation
(Unaudited)
(dollars in thousands except per share
data)
Three Months EndedMarch
31,
2017 2016 Basic Net (loss) income
attributable to American Renal Associates Holdings, Inc. $ (1,251 )
$ 3,756 Change in the difference between the estimated fair values
of contractual noncontrolling interest put provisions and estimated
fair values for accounting purposes of the related noncontrolling
interests (11,083 ) — Net (loss) income attributable to American
Renal Associates Holdings, Inc. for basic earnings per share
calculation $ (12,334 ) $ 3,756 Weighted-average common shares
outstanding 30,907,482
22,213,967
(Loss) earnings per share, basic $ (0.40 ) $ 0.17
Diluted
Net (loss) income attributable to American Renal Associates
Holdings, Inc. $ (1,251 ) $ 3,756 Change in the difference between
the estimated fair values of contractual noncontrolling interest
put provisions and estimated fair values for accounting purposes of
the related noncontrolling interests (11,083 ) — Net (loss) income
attributable to American Renal Associates Holdings, Inc. for
diluted earnings per share calculation $ (12,334 ) $ 3,756
Weighted-average common shares outstanding, basic 30,907,482
22,213,967 Weighted-average effect of dilutive securities: Effect
of assumed exercise of stock options — 571,703
Weighted-average common shares outstanding, diluted 30,907,482
22,785,670 (Loss) earnings per share, diluted $ (0.40 ) $
0.16 Outstanding options excluded as impact would be anti-dilutive
1,315,091 116,937
American Renal Associates Holdings, Inc. and
SubsidiariesReconciliation of Non-GAAP Financial
Measures:(Unaudited)(dollars in thousands)
We use Adjusted EBITDA and Adjusted EBITDA-NCI to track our
performance. “Adjusted EBITDA” is defined as net income before
income taxes, interest expense, net, depreciation and amortization,
as adjusted for stock-based compensation, loss on early
extinguishment of debt, transaction-related costs, certain legal
matters costs, executive severance costs, income tax receivable
agreement income and expense and management fees. “Adjusted
EBITDA-NCI” is defined as Adjusted EBITDA less net income
attributable to noncontrolling interests. We believe Adjusted
EBITDA and Adjusted EBITDA-NCI provide information useful for
evaluating our business and a further understanding of the
Company's results of operations from management's perspective. We
believe Adjusted EBITDA is helpful in highlighting trends because
Adjusted EBITDA excludes the results of actions that are outside
the operational control of management, but can differ significantly
from company to company depending on long-term strategic decisions
regarding capital structure, the tax jurisdictions in which
companies operate and capital investments. We believe Adjusted
EBITDA-NCI is helpful in highlighting the amount of Adjusted EBITDA
that is available to us after reflecting the interests of our joint
venture partners. Adjusted EBITDA and Adjusted EBITDA-NCI are not
measures of operating performance computed in accordance with GAAP
and should not be considered as a substitute for operating income,
net income, cash flows from operations, or other statement of
operations or cash flow data prepared in conformity with GAAP, or
as measures of profitability or liquidity. In addition, Adjusted
EBITDA and Adjusted EBITDA-NCI may not be comparable to similarly
titled measures of other companies. Adjusted EBITDA and Adjusted
EBITDA-NCI may not be indicative of historical operating results,
and we do not mean for these items to be predictive of future
results of operations or cash flows. Adjusted EBITDA and Adjusted
EBITDA-NCI have limitations as analytical tools, and you should
not consider these items in isolation, or as substitutes for
an analysis of our results as reported under GAAP. Some of these
limitations are that Adjusted EBITDA and Adjusted EBITDA-NCI:
- do not include stock-based compensation
expense;
- do not include transaction-related
costs;
- do not include depreciation and
amortization—because construction and operation of our dialysis
clinics requires significant capital expenditures, depreciation and
amortization are a necessary element of our costs and ability to
generate profits;
- do not include interest expense—as we
have borrowed money for general corporate purposes, interest
expense is a necessary element of our costs and ability to generate
profits and cash flows;
- do not include income tax receivable
agreement income;
- do not include loss on early
extinguishment of debt;
- do not include costs related to certain
legal matters;
- beginning with the quarter ended
December 31, 2016, do not include executive severance costs;
- do not include management fee;
- do not include certain income tax
payments that represent a reduction in cash available to us;
and
- do not reflect changes in, or cash
requirements for, our working capital needs.
In addition, Adjusted EBITDA is not adjusted for the portion of
earnings that we distribute to our joint venture partners.
You should not consider Adjusted EBITDA and Adjusted EBITDA-NCI
as alternatives to income from operations or net income, determined
in accordance with GAAP, as an indicator of our operating
performance, or as alternatives to cash provided by operating
activities, determined in accordance with GAAP, as an indicator of
cash flows or as a measure of liquidity. This presentation of
Adjusted EBITDA and Adjusted EBITDA-NCI may not be directly
comparable to similarly titled measures of other companies, since
not all companies use identical calculations.
We use Adjusted net income attributable to American Renal
Associates Holdings, Inc. because it is a useful measure to
evaluate our performance by excluding the impact of certain items
that we believe are not related to our normal business operations
and/or are a result of changes in our liabilities from period to
period. See the notes to the tables below for further explanation
of the exclusion of certain items. By excluding these items, we
believe Adjusted net income allows us and investors to evaluate our
net income on a more consistent basis. “Adjusted net income
attributable to American Renal Associates Holdings, Inc.” is
defined as Net income (loss) attributable to American Renal
Associates Holdings, Inc. plus or minus, as applicable, income
tax receivable agreement income/expense, accounting changes in
fair value of non-controlling interest puts, certain legal matter
costs, and share-based compensation due to option modifications and
other transactions at the time of the Company’s initial public
offering, net of taxes. We use Adjusted weighted average number of
diluted shares to calculate Adjusted net income attributable to
American Renal Associates Holdings, Inc. per share. Adjusted
weighted average number of diluted shares outstanding is calculated
using the treasury method as if certain unvested in-the-money
options subject to a contingency are treated as being vested to
provide investors with a calculation of the fully-diluted number of
shares assuming certain pre-IPO options vest.
We use Adjusted cash provided (used) by operating activities
less distributions to NCI because it is a useful measure to
evaluate the cash flow that is available to the Company for
investment in property, plant and equipment, debt service, growth
and other general corporate purposes. “Adjusted cash provided
(used) by operating activities less distributions to noncontrolling
interests” is defined as cash provided by operating activities plus
transaction-related expenses less distributions to noncontrolling
interests.
We use Adjusted owned net debt because it is a useful metric to
evaluate the Company’s share of interests in the cash on our
consolidated balance sheet and the debt of the Company. “Adjusted
owned net debt” is defined as Debt (other than clinic-level debt)
plus Clinic-level debt guaranteed by our wholly owned subsidiaries
of American Renal Associates Holdings, Inc. less Cash (other than
clinic-level cash) less the Company’s pro rata interest in
Clinic-level cash. “Owned Net Leverage” is defined as the ratio of
Owned Net Debt to our trailing twelve months Adjusted EBITDA less
NCI.
The following table presents the reconciliation from net income
to Adjusted EBITDA and Adjusted EBITDA-NCI for the periods
indicated:
(Unaudited)
Reconciliation of Net income to Adjusted
EBITDA
Three Months EndedMarch
31,
LTM (1) as ofMarch
31,2017
2017 2016 Net income $ 12,902 $ 22,557
$ 78,550 Interest expense, net 7,609 12,258 31,284 Income tax
(benefit) expense (3,524 ) 2,661 (6,938 ) Depreciation and
amortization 9,074 7,677 35,259 Transaction-related costs — 24
2,215 Loss on early extinguishment of debt — — 4,708 Income tax
receivable agreement income (4,517 ) — (5,803 ) Certain legal
matters (2) 3,936 — 10,715 Executive severance costs (3) — — 1,650
Stock-based compensation 10,088 386 50,000 Management fee —
457 80 Adjusted EBITDA (including noncontrolling
interests) $ 35,568 $ 46,020 $ 201,720 Less: Net income
attributable to noncontrolling interests (14,153 ) (18,801 )
(83,942 ) Adjusted EBITDA-NCI $ 21,415 $ 27,219 $
117,778
__________________________________
(1) Last twelve months (“LTM”) is the period beginning April 1,
2016 through March 31, 2017.
(2) Certain legal matters costs include professional fees and
other expenses associated with the Company’s handling of, and
response to, the UnitedHealth litigation, the SEC inquiry, the CMS
request for information, the securities litigation, and the
Company’s internal review and analysis of factual and legal issues
relating to the aforementioned matters as described in our Form
10-Q for the period ended March 31, 2017. We have excluded
these costs because they represent unusual fees and expenses that
are not related to the usual operation of our business.
(3) Represents executive severance costs primarily related to
the departure of our chief operating officer.
The following table presents the reconciliation from Net loss
attributable to American Renal Associates Holdings, Inc. to
Adjusted net income attributable to American Renal Associates
Holdings, Inc. for the period indicated:
(dollars in thousands except per share
data)
Reconciliation of Net Loss Attributable
to American Renal Associates Holdings, Inc. to Adjusted Net Income
Attributable to American Renal Associates Holdings, Inc.:
(Unaudited)
Three MonthsEnded
March31, 2017
Net loss attributable to American Renal Associates Holdings, Inc. $
(1,251 )
Change in the difference between the
estimated fair values of contractual noncontrolling interest put
provisions and estimated fair values for accounting purposes of the
related noncontrolling interests (1)
(11,083 ) Net loss attributable to American Renal Associates
Holdings, Inc. for basic earnings per share calculation $ (12,334 )
Adjustments:
Share-based compensation due to option
modification and IPO transactions (2)
9,105
Certain legal matters (3)
3,936 Total pre-tax adjustments $ 13,041 Tax effect 5,408
Income tax receivable agreement income (4,517 )
Change in the difference between the
estimated fair values of contractual noncontrolling interest put
provisions and estimated fair values for accounting purposes of the
related noncontrolling interests (1)
(11,083 ) Total adjustments, net $ 14,199 Adjusted net income
attributable to American Renal Associates Holdings, Inc. $ 1,865
Basic shares outstanding 30,907,482 Adjusted effect of
dilutive stock options (4) 2,957,928 Adjusted weighted
average number of diluted shares used to compute adjusted net
income attributable to American Renal Associates Holdings, Inc. per
share (4) 33,865,410
Adjusted net income attributable to
American Renal Associates Holdings, Inc. per share $ 0.06
_______________________________
(1) Changes in fair values of contractual noncontrolling
interest put provisions are related to certain put rights that may
be accelerated as a result of the IPO.
(2) Share-based compensation due to option modification and
other transactions at the time of the IPO which will be expensed
within 12 months after the IPO have been excluded since they arose
based on transactions that are not expected to occur in the
future.
(3) Certain legal matters costs include professional fees and
other expenses associated with the Company’s handling of, and
response to, the UnitedHealth litigation, the SEC inquiry, the CMS
request for information, the securities litigation, and the
Company’s internal review and analysis of factual and legal issues
relating to the aforementioned matters as described in our Form
10-Q for the period ended March 31, 2017. We have excluded
these costs because they represent unusual fees and expenses that
are not related to the usual operation of our business.
(4) Adjusted weighted average number of diluted shares
outstanding calculated using the treasury method as if 2.5 million
shares related to unvested in-the-money options subject to a
contingency are vested.
American Renal Associates Holdings,
Inc. and Subsidiaries
Unaudited Supplemental Cash
Flow
(dollars in thousands)
Three Months EndedMarch
31,
2017 2016 Cash provided by operating
activities $ 16,522 $ 36,576 Plus: Transaction-related costs
(1) — 24
Adjusted cash provided by operating
activities $ 16,522 $ 36,600 Distributions to noncontrolling
interests (19,044 ) (21,440 )
Adjusted cash (used) provided by
operating activities less distributions to NCI $ (2,522 ) $
15,160
Capital expenditure breakdown: Routine and
maintenance capital expenditures $ 1,918 $ 2,858 Development
capital expenditures 4,488 13,538
Total capital
expenditures $ 6,406 $ 16,396
American Renal Associates Holdings,
Inc. and Subsidiaries
Unaudited Supplemental Leverage
Statistics
(dollars in thousands)
As of March 31, 2017 Total ARA ARA
"Owned" Cash (other than clinic-level cash) $ 19,644
$
19,644
Clinic-level cash 64,359
33,422
Total cash $ 84,003 $ 53,066 Debt (other than clinic-level
debt) $ 435,561 $ 435,561 Clinic-level debt 134,292
68,847
Unamortized debt discounts and fees (3,930 )
(3,930
) Total debt $ 565,923 $ 500,478
Adjusted owned net debt (total
debt - total cash) $ 447,412
Adjusted EBITDA less NCI,
LTM $ 117,778
Leverage ratio (2) 3.8x
_________________________
(1) Transaction-related costs due to the IPO and debt
refinancing, including accounting, valuation, legal and other
consulting and professional fees.
(2) Leverage ratio calculated as follows: Adjusted owned net
debt divided by Adjusted EBITDA less NCI, last twelve months.
View source
version on businesswire.com: http://www.businesswire.com/news/home/20170509006668/en/
American Renal Associates Holdings, Inc.Darren Lehrich,
978-922-3080 x134SVP Strategy & Investor
Relationsdlehrich@americanrenal.com
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