UNITED STATES SECURITIES AND
EXCHANGE COMMISSION
Washington, DC 20549
Form 10-K
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(Mark One)
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ANNUAL REPORT PURSUANT TO SECTION 13 OR 15(d) OF THE
SECURITIES EXCHANGE ACT OF 1934
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For the fiscal year ended
September 30, 2008
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or
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TRANSITION REPORT PURSUANT TO SECTION 13 OR 15(d) OF THE
SECURITIES EXCHANGE ACT OF 1934
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Commission File Number
000-33009
MedCath Corporation
(Exact name of registrant as
specified in its charter)
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Delaware
(State or other jurisdiction
of
incorporation or organization)
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56-2248952
(I.R.S. Employer
Identification No.)
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10720
Sikes Place
Charlotte, North Carolina 28277
(Address of principal executive
offices, including zip code)
(704) 708-6600
(Registrants telephone
number, including area code)
Securities registered pursuant to Section 12(b) of the
Act:
None
Securities registered pursuant to Section 12(g) of the
Act:
Common Stock, $0.01 par value
Indicate by check mark whether the registrant is a well-known
seasoned issuer, as defined in Rule 405 of the Securities
Act. Yes
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No
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Indicate by check mark if the registrant is not required to file
reports pursuant to Section 13 or 15(d) of the Securities
Exchange Act of
1934. Yes
o
No
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Indicate by check mark whether the registrant: (1) has
filed all reports required to be filed by Section 13 or
15(d) of the Securities Exchange Act of 1934 during the
preceding 12 months (or for such shorter period that the
registrant was required to file such reports), and (2) has
been subject to such filing requirements for the past
90 days. Yes
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No
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Indicate by check mark if disclosure of delinquent filers
pursuant to Item 405 of
Regulation S-K
is not contained herein, and will not be contained, to the best
of registrants knowledge, in definitive proxy or
information statements incorporated by reference in
Part III of this
Form 10-K
or any amendment to this
Form 10-K.
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Indicate by check mark whether the registrant is a large
accelerated filer, an accelerated filer, a non-accelerated
filer, or a smaller reporting company. See the definitions of
large accelerated filer, accelerated
filer and smaller reporting company in
Rule 12b-2
of the Exchange Act. (Check one):
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Large
accelerated
filer
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Accelerated
filer
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Non-accelerated
filer
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Smaller
reporting
company
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(Do not check if a smaller reporting company)
Indicate by check mark whether the registrant is a shell company
(as defined in
Rule 12b-2
of the Exchange
Act). Yes
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No
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As of December 11, 2008 there were 19,598,693 shares of the
Registrants Common Stock outstanding. The aggregate market
value of the Registrants common stock held by
non-affiliates as of March 31, 2008 was approximately
$287.2 million (computed by reference to the closing sales
price of such stock on the Nasdaq Global
Market
®
on such date).
DOCUMENTS
INCORPORATED BY REFERENCE
Portions of the Registrants proxy statement for its annual
meeting of stockholders to be held on March 4, 2009 are
incorporated by reference into Part III of this Report.
MEDCATH
CORPORATION
FORM 10-K
TABLE OF CONTENTS
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FORWARD-LOOKING
STATEMENTS
Some of the statements and matters discussed in this report and
in exhibits to this report constitute forward-looking
statements. Words such as expects,
anticipates, approximates,
believes, estimates, intends
and hopes and variations of such words and similar
expressions are intended to identify such forward-looking
statements. We have based these statements on our current
expectations and projections about future events. These
forward-looking statements are not guarantees of future
performance and are subject to risks and uncertainties that
could cause actual results to differ materially from those
projected in these statements. The forward-looking statements
contained in this report include, among others, statements about
the following:
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the impact of federal and state healthcare reform initiatives,
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changes in Medicare and Medicaid reimbursement levels,
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unanticipated delays in achieving expected operating results at
our newer hospitals,
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difficulties in executing our strategy,
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our relationships with physicians who use our facilities,
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competition from other healthcare providers,
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our ability to attract and retain nurses and other qualified
personnel to provide quality services to patients in our
facilities,
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our information systems,
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existing governmental regulations and changes in, or failure to
comply with, governmental regulations,
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liabilities and other claims asserted against us,
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changes in medical devices or other technologies, and
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market-specific or general economic downturns.
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Although these statements are made in good faith based upon
assumptions our management believes are reasonable on the date
they are made, we cannot assure you that we will achieve our
goals. In light of these risks, uncertainties and assumptions,
the forward-looking events discussed in this report and its
exhibits might not occur. Our forward-looking statements speak
only as of the date of this report or the date they were
otherwise made. Other than as may be required by federal
securities laws to disclose material developments related to
previously disclosed information, we undertake no obligation to
publicly update or revise any forward-looking statements,
whether as a result of new information, future events or
otherwise. We urge you to review carefully all of the
information in this report and the discussion of risk factors
before making an investment decision with respect to our debt
and equity securities.
Unless otherwise noted, the following references in this report
will have the meanings below:
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the terms the Company, MedCath,
we, us and our refer to
MedCath Corporation and its consolidated subsidiaries; and
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references to fiscal years are to our fiscal years ending
September 30. For example, fiscal 2008 refers
to our fiscal year ended September 30, 2008.
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A copy of this report, including exhibits, is available on the
internet site of the Securities and Exchange Commission at
http://www.sec.gov
or through our website at
http://www.medcath.com
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ii
PART I
Overview
We were incorporated in Delaware in 2001 as a healthcare
provider and are focused primarily on providing high acuity
services, including the diagnosis and treatment of
cardiovascular disease. We own and operate hospitals in
partnership with physicians whom we believe have established
reputations for clinical excellence. We opened our first
hospital in 1996 and currently have ownership interests in and
operate nine hospitals, including seven in which we own a
majority interest. Each of our majority-owned hospitals is a
freestanding, licensed general acute care hospital that provides
a wide range of health services with a focus on cardiovascular
care. Each of our hospitals has a
24-hour
emergency room staffed by emergency department physicians. The
hospitals in which we have ownership interests have a total of
676 licensed beds and are located in predominantly high growth
markets in seven states: Arizona, Arkansas, California,
Louisiana, New Mexico, South Dakota, and Texas. We are currently
in the process of developing a new acute care hospital in
Kingman, Arizona which we expect to open in late 2009 or early
2010. This hospital is designed to accommodate a total of 106
licensed beds and will initially open with 70 licensed beds. We
expanded our patient beds by 28 licensed beds at Arkansas Heart
Hospital earlier this year and just completed a 60 bed
addition at TexSAn Heart Hospital (TexSAn) in August 2008. We
are expanding our licensed beds by 80 at Louisiana Medical
Center and Heart Hospital with remaining capacity for an
additional 40 beds at that hospital. We expect this 79 licensed
bed expansion to open in 2009. We also have plans to expand our
Bakersfield Heart Hospital by 72 inpatient beds and 16 emergency
department beds that will diversify the services offered by the
hospital. The expansion is subject to the approval of
Californias Office of Statewide Health Planning and
Development (OSHPD).
In addition to our hospitals, we currently own
and/or
manage 20 cardiac diagnostic and therapeutic facilities. Eight
of these facilities are located at hospitals operated by other
parties. These facilities offer invasive diagnostic and, in some
cases, therapeutic procedures. The remaining seven facilities
are not located at hospitals and offer only diagnostic
procedures. We refer to our diagnostics division as
MedCath Partners. For financial data and other
information of this and other segments of our business see
Note 19 to our consolidated financial statements in
Item 8 of this report for financial information by segment.
We believe our facilities provide superior clinical outcomes,
which, together with our ability to provide management
capabilities and capital resources, positions us to expand upon
our relationships with physicians and community hospitals to
increase our presence in existing and new markets. Specifically,
we plan to increase our revenue and income from operations
through a combination of:
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improved operating performance at our existing facilities;
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increased capacity and expanded scope of services provided at
certain of our existing hospitals;
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the development of new relationships with physicians in certain
of our existing markets;
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the establishment of new ventures with physicians in new
markets; and
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selective evaluation of acquisitions of specialty and general
acute care facilities.
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We are subject to the informational requirements of the
Securities Exchange Act of 1934 (the Exchange Act) and
therefore, we file reports, proxy statements and other
information with the Securities and Exchange Commission (SEC).
Such reports may be read and copied at the Public Reference Room
of the SEC at 100 F Street NE, Washington, D.C.
20549. Information on the operation of the Public Reference Room
may be obtained by calling the SEC at (800) SEC-0330. In
addition, the SEC maintains an Internet site (www.sec.gov) that
contains reports, proxy and information statements and other
information regarding issuers that file electronically.
We maintain an Internet website at
www.medcath.com
that
investors and interested parties can access and obtain copies,
free-of-charge, of all reports, proxy and information statements
and other information that the Company submits to the SEC as
soon as reasonably practicable after we electronically submit
such material to the SEC. This information includes copies of
our proxy statements, annual reports on
Form 10-K,
quarterly reports on
1
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.
Investors and interested parties can also submit electronic
requests for information directly to the Company at the
following
e-mail
address:
ir@medcath.com.
Alternatively, communications
can be mailed to the attention of Investor Relations
at the Companys executive offices.
Information on our website is not incorporated into this
Form 10-K
or our other securities filings and is not a part of them.
Our
Strengths
Leading Local Market Positions in Growing
Markets.
We believe all of our seven
majority-owned hospitals that have been open for at least three
years are ranked number one or two in the local market based on
procedures performed in our core business diagnosis-related
group (DRG), based on data reported by Solucient, a leading
source of healthcare business information, based on 2007
Medicare Provider Analysis and Review (MedPar) data.
Historically, 80% to 95% of patients treated in our hospitals
reside in markets where the population of those 55 years
and older, the primary recipients of cardiac care services, is
anticipated to increase on average by 13.7%, from 2008 to 2012,
versus the national average of 16.1%, according to
U.S. census data.
Efficient Quality Care Delivery Model.
Our
hospitals have innovative facility designs and operating
characteristics that we believe enhance the quality of patient
care and service and improve physician and staff productivity.
The innovative characteristics of our hospital designs include:
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fully-equipped patient rooms capable of providing the majority
of services needed during a patients entire length of stay;
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centrally located inpatient ancillary services that reduce the
amount of transportation patients must endure; and
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focus on resource allocation and care management through the use
of protocols for more consistent and predictable outcomes and
expenses.
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We believe our care delivery model leads to a high level of
patient satisfaction and quality care. We selected NRC Picker to
administer our inpatient satisfaction surveys beginning
January 1, 2006. We have performed well when compared to
the NRC Picker Comparative Group. For the most recent available
calendar year, 2007, our hospitals had an overall satisfaction
rating of 82.7% compared to 59.6% for the NRC Picker Comparative
Group. Our most recently reported overall satisfaction rating
for the second quarter of 2008 has increased to 84.1% compared
to 59.8% for the comparative group.
Proven Ability to Partner with Physicians.
We
partner with physicians and share capital commitments in all of
our hospitals and many of our cardiac diagnostic and therapeutic
facilities. Physicians practicing at our hospitals participate
in shared governance where decisions are made on a wide range of
strategic and operational matters, such as development of
clinical care protocols, patient procedure scheduling,
development of hospital formularies, selection of vendors for
high-cost supplies and devices, review of annual operating
budgets and significant capital expenditures. The opportunity to
have a role in how our hospitals are managed empowers physicians
and encourages them to share new ideas, concepts and practices.
We attribute our success in partnering with physicians to our
ability to develop and effectively manage facilities in a manner
that promotes physician productivity, satisfaction and
professional success while enhancing the quality and efficiency
of patient care services that we provide.
Established Relationships with Community Hospital
Systems.
We have management and partnership
arrangements with community hospital systems for cardiac
diagnostic and therapeutic facilities, and in certain of our
hospitals. We attribute our success in establishing
relationships with community hospital systems to our proven
ability to work effectively with physicians and deliver quality
health care. As community hospital systems seek to enhance their
networks for patient access and reputation for providing quality
health care and physician relationships, we believe they will
continue to seek alliances and partnerships with other entities
in order to accomplish these goals. This partnership approach
provides benefits to us in the form of further sharing of
capital
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commitments and enhanced access to managed care relationships.
Because of our experience in focused care, quality outcomes and
partnering with physicians, we believe we offer expertise that
differentiates us in the provider community.
Strong Management Team.
Our management team
has extensive experience and relationships in the healthcare
industry. Our president and chief executive officer, O. Edwin
French, was appointed to this position in February 2006 and has
over 40 years of experience in the healthcare industry,
most recently serving as president of the Acute Care Hospital
Division for Universal Health Services. On June 23, 2008
Jeffrey L. Hinton was named executive vice president and chief
financial officer. Mr. Hinton has extensive and diverse
financial leadership and experience in healthcare that we
believe will be beneficial as we look to expand our services in
existing and new markets.
Our
Strategy
Key components of our strategy include:
Improve Operating Performance at Our Existing
Facilities.
In markets where we have
well-established hospitals and cardiac diagnostic and
therapeutic facilities, we intend to continue to focus on
strengthening management processes and systems in an effort to
improve operating performance. We will seek to:
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improve labor efficiencies by staffing to patient volumes and
clinical needs;
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proactively manage the delivery of health care to achieve
appropriate and efficient lengths of stay through the
application of technology, medicines, and other resources which
have a positive impact on the quality and cost of health care;
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control supplies expense through more favorable group purchasing
arrangements and inventory management;
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focus efforts on the management of bad debt through improvement
in our registration process and upfront collections as well as
continued refinement of our business office operations after
discharge;
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consolidate the purchased services contracts for all of our
facilities to achieve better pricing; and
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improve the systems related to patient registration, billing,
collections and managed care contracting to improve revenue
cycle management.
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Increase Patient Capacity and Expand Services at Existing
Hospitals.
We intend to invest in our facilities
to build out existing capacity and broaden the scope of services
provided based on the needs of the communities we serve. We
believe demand exists in certain of our existing markets to
support the expansion of certain of our existing facilities. We
believe capital investments to expand capacity in our existing
facilities represents an attractive return on invested capital
and enables us to better leverage our existing fixed asset base.
We expect execution of this strategy will increase patient
volume, improve operating efficiency and better utilize fixed
operating costs while maintaining our quality of care.
Furthermore, to increase occupancy and utilization at our
hospitals, we intend to expand the scope of procedures performed
in certain of our facilities. While we continue to operate some
of our facilities with a primary focus on serving the unique
needs of patients suffering from cardiovascular disease, we
believe we will be able to expand our quality of care service
offerings and improve the performance of our facilities by
utilizing our expertise in partnering with physicians and
operating hospitals and by broadening our services to include
other high acuity surgical and medical services.
Develop New Relationships with Physicians in Our Existing
Markets.
We intend to develop new relationships
with physicians to strengthen our competitive position in
certain of our existing markets. We believe that our
relationships with physicians who have a reputation for clinical
excellence gives us important insights into the operation and
management of our facilities and provides further motivation to
provide quality, cost-effective healthcare. Further, as we
strengthen our market position, we believe we will improve our
ability to develop favorable managed care relationships with,
and market the quality of our services to, the communities we
serve. We believe this focus on the provision of quality
healthcare will increase patient volume.
3
Pursue Growth Opportunities in New Markets with Physicians
and Community Hospital Systems.
We will pursue
growth opportunities in new markets by partnering with
physicians and community hospital systems. These opportunities
are expected to continue our historic focus on providing
inpatient and outpatient cardiovascular care while also
broadening our services to include other high acuity surgical
and medical services. Community hospital systems often have
limited access to the resources needed to invest in certain
services, including cardiology. We believe that as a result of
these limitations, our record of success in providing quality
cardiovascular care, partnering with physicians and community
hospital systems, and providing capital resources interests many
other physicians and community hospital systems in partnering
with us to provide cardiovascular care services
and/or
other
surgical and medical services. We announced plans to develop a
106 licensed bed general acute care hospital in Kingman,
Arizona, which we expect to initially open with 70 licensed beds
in late 2009 or early 2010.
Selectively Evaluate Acquisitions and
Dispositions.
We may selectively evaluate
acquisitions of specialty and general acute care facilities in
attractive markets throughout the United States and we will
potentially consider acquisitions of facilities where we believe
we can improve clinical outcomes and operating performance. We
also may consider opportunistic dispositions of hospitals or
other facilities where a motivated buyer emerges or the facility
does not meet our overall growth or financial return objectives.
We will employ a disciplined approach to evaluating and
qualifying acquisition and disposition opportunities.
Our
Hospitals
We currently have ownership interests in and operate nine
hospitals and have one hospital under development. The following
table identifies key characteristics of these hospitals.
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MedCath
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Licensed
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Cath
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Operating
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Hospital
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Location
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Ownership
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Opening Date
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Beds
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Labs
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Rooms
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Arkansas Heart Hospital
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Little Rock, AR
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70.3
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March 1997
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112
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6
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3
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Arizona Heart Hospital
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Phoenix, AZ
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70.6
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June 1998
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59
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3
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4
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Heart Hospital of Austin
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Austin, TX
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70.9
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January 1999
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58
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6
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4
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Bakersfield Heart Hospital(3)
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Bakersfield, CA
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53.3
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October 1999
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47
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Heart Hospital of New Mexico
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Albuquerque, NM
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75.0
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October 1999
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55
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4
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3
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Avera Heart Hospital of South Dakota(1)
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Sioux Falls, SD
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33.3
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March 2001
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55
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3
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3
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Harlingen Medical Center(1)
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Harlingen, TX
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35.6
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October 2002
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112
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2
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10
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Louisiana Medical Center and Heart Hospital(2)
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St. Tammany Parish, LA
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89.2
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February 2003
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58
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4
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Texsan Heart Hospital
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San Antonio, TX
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69.0
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January 2004
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120
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4
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4
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Hualapai Mountain Medical Center(4)
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Kingman, AZ
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79.2
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%
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Fiscal 2009/2010
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70
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(5)
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2
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4
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(1)
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Avera Heart Hospital of South Dakota and Harlingen Medical
Center are the only hospitals in which we do not have a majority
ownership interest as of September 30, 2008. We use the
equity method of accounting for these hospitals, which means
that we include in our consolidated statements of income only a
percentage of the hospitals reported net income (loss) for
each reporting period. Harlingen Medical Center was consolidated
prior to July 2007 and is included in the consolidated
statements of income for the year ended September 30, 2006
and for the first three quarters of fiscal 2007 as a
consolidated hospital.
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(2)
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We are currently expanding Louisiana Medical Center and Heart
Hospital by 79 licensed general acute care beds with additional
capacity for 40 licensed beds. After expansion, the hospital
will contain capacity for 177 private rooms.
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(3)
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We have plans to expand Bakersfield Heart Hospital by 72
licensed inpatient beds and 16 licensed emergency department
beds. After expansion, the hospital will contain capacity for
119 beds. The expansion is subject to approval by
Californias OSHPD.
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(4)
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This hospital is under development and is expected to initially
open with 70 licensed beds in late 2009 or early 2010.
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(5)
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Hualapai Mountain Medical Center is designed to accommodate 106
licensed inpatient beds, but will initially open with 70
licensed beds.
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4
Before designing and constructing our first hospital, we
consulted with our physician partners to analyze the operations,
facilities and work flow of existing hospitals and found what we
believed to be many inefficiencies in the way cardiovascular
care was provided in existing hospitals. Based upon this
analysis and our physician partners input, we designed a
hospital that we believed would enhance physician and staff
productivity and allow for the provision of patient-focused
care. Using subsequent operating experience and further input
from physicians at our other hospitals, we have refined our
basic hospital layout to enable us to combine site selection,
facility size and layout, staff and equipment to deliver quality
high acuity care and will continue to do so at our existing
facilities.
The innovative characteristics of our hospitals include:
Universal Patient Rooms.
Our large,
single-patient rooms enable our staff to provide all levels of
care required for our patients during their entire hospital
stay, including critical care, telemetry and post-surgical care.
Each room is equipped as an intensive care unit, which enables
us to keep a patient in the same room throughout their recovery.
This approach differs from the general acute care hospital model
of moving patients, potentially several times, as they recover
from surgical procedures.
Centrally Located Inpatient Services.
We have
centrally located all services required for inpatients,
including radiology, laboratory, pharmacy and respiratory
therapy, in close proximity to the patient rooms, which are
usually all located on a single floor in the hospital. This
arrangement reduces scheduling conflicts and patient waiting
time. Additionally, this eliminates the need for costly
transportation staff to move patients from floor to floor and
department to department.
Strategically Placed Nursing Stations.
Unlike
traditional hospitals with large central nursing stations, which
serve as many as 30 patients, we have corner configuration
nursing stations on our patient floors where each station serves
six to eight patients and is located in close proximity to the
patient rooms. This design provides for excellent visual
monitoring of patients, allows for flexibility in staffing to
accommodate the required levels of care, shortens travel
distances for nurses, allows for fast response to patient calls
and offers proximity to the nursing station for family members.
Efficient Workflow.
We have designed and
constructed our various procedure areas in close proximity to
each other allowing for both patient safety and efficient staff
workflow. For example, our cardiac catheterization laboratories
are located in close proximity to our operating rooms,
outpatient services are located immediately next to procedure
areas and emergency services are located off the staff work
corridor leading directly to the diagnostic and treatment areas.
Additional Capacity for Critical Cardiac
Procedures.
We design and construct our hospitals
with more operating rooms and cardiac catheterization
laboratories than we believe are available in the cardiovascular
program of a typical general acute care hospital and we believe
this increases physician productivity and patient satisfaction.
This feature of our hospitals ensures that the physicians
practicing in our hospitals will experience fewer conflicts in
scheduling procedures for their patients. In addition, all of
our operating rooms are designed primarily for cardiovascular
procedures, which enable them to be used more efficiently by
physicians and staff.
Diagnostic
and Therapeutic Facilities
We have participated in the development of or have acquired
interests in, and provide management services to, facilities
where physicians diagnose and treat cardiovascular disease and
manage hospital-based cardiac catheterization laboratories. We
also own and operate mobile cardiac catheterization laboratories
serving hospital networks and maintain a number of mobile and
modular cardiac catheterization laboratories that we lease on a
short-term basis. These diagnostic and therapeutic facilities
and mobile cardiac catheterization laboratories are equipped to
allow the physicians using them to employ a range of diagnostic
and treatment options for patients suffering from cardiovascular
disease.
5
Managed Diagnostic and Therapeutic
Facilities.
Currently we own
and/or
manage the operations of 20 cardiac diagnostic and
therapeutic facilities. The following table provides information
about these facilities.
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MedCath
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Termination
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Management
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or Next
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MedCath
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Commencement
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Renewal
|
|
Facility/Entity
|
|
Location
|
|
Ownership
|
|
|
Date(3)
|
|
|
Date
|
|
|
Joint Ventures:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Greensboro Heart Center, LLC
|
|
Greensboro, NC
|
|
|
51
|
%
|
|
|
2001
|
|
|
|
July 2031
|
|
Center for Cardiac Sleep Medicine, LLC(1)
|
|
Lacombe, LA
|
|
|
51
|
%
|
|
|
2004
|
|
|
|
Dec. 2013
|
|
Blue Ridge Cardiology Services, LLC(1)
|
|
Morganton, NC
|
|
|
50
|
%
|
|
|
2004
|
|
|
|
Dec. 2014
|
|
Central New Jersey Heart Services, LLC(1)
|
|
Trenton, NJ
|
|
|
15
|
%
|
|
|
2007
|
|
|
|
Mar 2017
|
|
Coastal Carolina Heart, LLC(1)
|
|
Wilmington, NC
|
|
|
9
|
%
|
|
|
2007
|
|
|
|
July 2010
|
|
Southwest Arizona Heart and Vascular, LLC(1)
|
|
Yuma, AZ
|
|
|
27
|
%
|
|
|
2008
|
|
|
|
Dec 2068
|
|
Tri-County Heart Services
|
|
Edison, NJ
|
|
|
33
|
%
|
|
|
2008
|
|
|
|
Jan 2018
|
|
Wilmington Heart Services, LLC(1)
|
|
Wilmington, DE
|
|
|
15
|
%
|
|
|
2007
|
|
|
|
July 2017
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Managed Ventures:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Cardiac Testing Centers, PA
|
|
Springfield, NJ
|
|
|
100
|
%(2)
|
|
|
1992
|
|
|
|
Dec. 2008
|
|
Sun City Cardiac Center, Inc.(1)
|
|
Sun City, AZ
|
|
|
60
|
%(2)
|
|
|
1992
|
|
|
|
Oct. 2032
|
|
Heart Institute of Northern Arizona, LLC(1)
|
|
Kingman, AZ
|
|
|
100
|
%(2)
|
|
|
1994
|
|
|
|
Sept 2009
|
|
Falmouth Hospital(1)
|
|
Falmouth, MA
|
|
|
100
|
%(2)
|
|
|
2002
|
|
|
|
May 2009
|
|
Johnston Memorial Hospital
|
|
Smithfield, NC
|
|
|
100
|
%(2)
|
|
|
2002
|
|
|
|
Sept 2009
|
|
Watauga Medical Center(1)
|
|
Boone, NC
|
|
|
100
|
%(2)
|
|
|
2003
|
|
|
|
June 2009
|
|
Margaret R. Pardee Memorial Hospital(1)
|
|
Hendersonville, NC
|
|
|
100
|
%(2)
|
|
|
2004
|
|
|
|
Mar 2009
|
|
Duke Health Raleigh Hospital(1)
|
|
Raleigh, NC
|
|
|
100
|
%(2)
|
|
|
2006
|
|
|
|
Dec. 2012
|
|
Caldwell Cardiology Services
|
|
Lenoir, NC
|
|
|
100
|
%(2)
|
|
|
2006
|
|
|
|
Mar. 2012
|
|
Southern Virginia Regional Medical Center(1)
|
|
Emporia, VA
|
|
|
100
|
%(2)
|
|
|
2006
|
|
|
|
Mar 2009
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Professional Services Agreements:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Greater Philadelphia Cardiology Assoc., Inc.
|
|
Philadelphia, PA
|
|
|
100
|
%(2)
|
|
|
2002
|
|
|
|
June 2012
|
|
VNC Sleep(1)
|
|
Annandale, VA
|
|
|
100
|
%(2)
|
|
|
2004
|
|
|
|
Sept. 2009
|
|
|
|
|
(1)
|
|
Our management agreement with each of these facilities includes
an option for us to extend the initial term at increments
ranging from one to 10 years, through an aggregate of up to
an additional 40 years for some of the facilities.
|
|
(2)
|
|
The ownership interest refers to our ownership in the entities
that have entered into, and provided services to, the facilities
under a management services agreement or professional service
agreement with us.
|
|
(3)
|
|
Calendar year.
|
Except when the requirements of applicable law require us to
modify our services, our management services generally include
providing all non-physician personnel required to deliver
patient care and the administrative, management and support
functions required in the operation of the facility. The
physicians who supervise or perform diagnostic and therapeutic
procedures at these facilities have complete control over the
delivery of cardiovascular healthcare services. The management
agreements for each of these centers generally have an extended
initial term and several renewal options ranging from one to
10 years each. The physicians and hospitals with which we
have contracts to operate these centers may terminate the
agreements under certain circumstances. We may terminate most of
these agreements for cause or upon the occurrence of specified
material adverse changes in the business of the facilities. We
intend to develop with hospitals and physician groups, or
acquire contracts to manage, additional diagnostic and
therapeutic facilities in the future.
Interim Mobile Catheterization Labs.
We
maintain a rental fleet of mobile and modular cardiac
catheterization laboratories. We lease these laboratories on a
short-term basis to hospitals while they are either adding
capacity to their existing facilities or replacing or upgrading
their equipment. We also lease these laboratories to
6
hospitals that experience a higher demand for cardiac
catheterization procedures during a particular season of the
year and choose not to expand their own facilities to meet peak
period demand. Our rental and modular laboratories are
manufactured by leading original equipment manufacturers and
have advanced technology and enable cardiologists to perform
both diagnostic and interventional therapeutic procedures. Each
of our rental units is generally in service for an average of
nine months of the year. These units enable us to be responsive
to immediate demand and create flexibility in our operations.
Major
Procedures Performed at Our Facilities
The following is a brief description of the major cardiovascular
procedures physicians perform at our hospitals and other
facilities.
Invasive
Procedures
Cardiac catheterization:
percutaneous
intravascular insertion of a catheter into any chamber of the
heart or great vessels for diagnosis, assessment of
abnormalities, interventional treatment and evaluation of the
effects of pathology on the heart and great vessels.
Percutaneous cardiac intervention,
including the
following:
|
|
|
|
|
Atherectomy:
a technique using a cutting
device to remove plaque from an artery. This technique can be
used for coronary and non-coronary arteries.
|
|
|
|
Angioplasty:
a method of treating narrowing of
a vessel using a balloon catheter to dilate the narrowed vessel.
If the procedure is performed on a coronary vessel, it is
commonly referred to as a percutaneous transluminal coronary
angioplasty, or PTCA.
|
|
|
|
Percutaneous balloon angioplasty:
the
insertion of one or more balloons across a stenotic heart valve.
|
|
|
|
Stent:
a small expandable wire tube, usually
stainless steel, with a self-expanding mesh introduced into an
artery. It is used to prevent lumen closure or restenosis.
Stents can be placed in coronary arteries as well as renal,
aortic and other peripheral arteries. A drug-eluting stent is
coated with a drug that is intended to prevent the stent from
reclogging with scar tissue after a procedure.
|
|
|
|
Brachytherapy:
a radiation therapy using
implants of radioactive material placed inside a coronary stent
with restenosis.
|
Electrophysiology study:
a diagnostic study of
the electrical system of the heart. Procedures include the
following:
|
|
|
|
|
Cardiac ablation:
removal of a part, pathway
or function of the heart by surgery, chemical destruction,
electrocautery or radio frequency.
|
|
|
|
Pacemaker implant:
an electrical device that
can substitute for a defective natural pacemaker and control the
beating of the heart by a series of rhythmic electrical
discharges.
|
|
|
|
Automatic Internal Cardiac
Defibrillator:
cardioverter implanted in patients
at high risk for sudden death from ventricular arrhythmias.
|
|
|
|
Cardiac assist devices:
a mechanical device
placed inside of a persons chest where it helps the heart
pump oxygen rich blood throughout the body.
|
Coronary artery bypass graft surgery:
a
surgical establishment of a shunt that permits blood to travel
from the aorta to a branch of the coronary artery at a point
past the obstruction.
Valve Replacement Surgery:
an open-heart
surgical procedure involving the replacement of valves that
regulate the flow of blood between chambers in the heart, which
have become narrowed or ineffective due to the
build-up
of
calcium or scar tissue or the presence of some other physical
damage.
7
Non-Invasive
Procedures
Cardiac magnetic resonance imaging:
a test
using a powerful magnet to produce highly detailed, accurate and
reproducible images of the heart and surrounding structures as
well as the blood vessels in the body without the need for
contrast agents.
Echocardiogram with color flow doppler, or ultrasound
test:
a test which produces real time images of
the interior of the heart muscle and valves, which are used to
accurately evaluate heart valve and muscle problems and measure
heart muscle damage.
Nuclear treadmill exercise test or nuclear
angiogram:
a test which involves the injection of
a low level radioactive tracer isotope into the patients
bloodstream during exercise on a motorized treadmill, which is
frequently used to screen patients who may need cardiac
catheterization and to evaluate the results in patients who have
undergone angioplasty or cardiac surgery.
Standard treadmill exercise test:
a test which
involves a patient exercising on a motorized treadmill while the
electrical activity of the patients heart is measured,
which is frequently used to screen for heart disease.
Ultrafast computerized tomography:
a test
which can detect the buildup of calcified plaque in coronary
arteries before the patient experiences any symptoms.
Employees
As of September 30, 2008, we employed 3,147 persons,
including 2,311 full-time and 836 part-time employees.
None of our employees is a party to a collective bargaining
agreement and we consider our relationships with our employees
to be good. There currently is a nationwide shortage of nurses
and other medical support personnel, which makes recruiting and
retaining these employees difficult. We believe we offer our
employees competitive wages and benefits and offer a
professional work environment that we believe helps us recruit
and retain the staff we need to operate our hospitals and other
facilities.
Our hospitals are staffed by licensed physicians who have been
admitted to the medical staffs of individual hospitals. Any
licensed physician not just our physician
partners may apply to be admitted to the medical
staff of any of our hospitals, but admission to the staff must
be approved by the hospitals medical staff and governing
board in accordance with established credentialing criteria.
Environmental
Matters
We are subject to various federal, state and local laws and
regulations governing the use, storage, discharge and disposal
of hazardous materials, including medical waste products. We
believe that all of our facilities and practices comply with
these laws and regulations and we do not anticipate that any of
these laws will have a material adverse effect on our
operations. We cannot predict, however, whether environmental
issues may arise in the future.
Insurance
Like most health care providers, we are subject to claims and
legal actions in the ordinary course of business. To cover these
claims, we maintain professional malpractice liability insurance
and general liability insurance in amounts and with deductibles
and levels of self-insured retention that we believe are
sufficient for our operations. We also maintain umbrella
liability coverage to cover claims not covered by our
professional malpractice liability or general liability
insurance policies. See
Managements Discussion
and Analysis of Financial Condition and Results of
Operations Critical Accounting Policies
General and Professional Liability Risk.
We can offer no assurances that our professional liability and
general liability insurance, nor our recorded reserves for
self-insured retention, will cover all claims against us or
continue to be available at reasonable costs for us to maintain
adequate levels of insurance in the future.
8
Competition
In executing our business strategy, we compete primarily with
other cardiovascular care providers, principally for-profit and
not-for-profit general acute care hospitals. We also compete
with other companies pursuing strategies similar to ours, and
with not-for-profit general acute care hospitals that may elect
to develop a hospital. In most of our markets we compete for
market share of cardiovascular procedures with two to three
hospitals. Some of the hospitals that compete with our hospitals
are owned by governmental agencies or not-for-profit
corporations supported by endowments and charitable
contributions and can finance capital expenditures and
operations on a tax-exempt basis. Some of our competitors are
larger and are more established than we are and, have greater
geographic coverage, offer a wider range of services or have
more capital or other resources than we do. If our competitors
are able to finance capital improvements, recruit physicians,
expand services or obtain favorable managed care contracts at
their facilities, we may experience a decline in market share.
In operating our hospitals, particularly in performing
outpatient procedures, we compete with free-standing diagnostic
and therapeutic facilities located in the same markets.
Reimbursement
Medicare.
Medicare is a federal program that
provides hospital and medical insurance benefits to persons
age 65 and over, some disabled persons and persons with
end-stage renal disease. Under the Medicare program, we are paid
for certain inpatient and outpatient services performed by our
hospitals and also for services provided at our diagnostic and
therapeutic facilities.
Medicare payments for inpatient acute services are generally
made pursuant to a prospective payment system (PPS). Under this
system, hospitals are paid a prospectively determined fixed
amount for each hospital discharge based on the patients
diagnosis. Specifically, each discharge is assigned to a
diagnosis-related group (DRG). Based upon the patients
condition and treatment during the relevant inpatient stay, each
DRG is assigned a fixed payment rate that is prospectively set
using national average costs per case for treating a patient for
a particular diagnosis. The DRG rates are adjusted by an update
factor each federal fiscal year, which begins on October 1.
The update factor is determined, in part, by the projected
increase in the cost of goods and services that are purchased by
hospitals, referred to as the market basket index. DRG payments
do not consider the actual costs incurred by a hospital in
providing a particular inpatient service; however, such payments
are adjusted by a predetermined geographic adjustment factor
assigned to the geographic area in which the hospital is located.
While hospitals generally do not receive direct payments in
addition to a DRG payment, hospitals may qualify for an outlier
payment when the relevant patients treatment costs are
extraordinarily high and exceed a specified threshold. Outlier
payments, which were established by Congress as part of the DRG
prospective payment system, are additional payments made to
hospitals for treating patients who are costlier to treat than
the average patient. In general, a hospital receives outlier
payments when its costs, as determined by using gross charges
adjusted by the hospitals cost-to-charge ratio, exceed a
certain threshold established annually by the Centers for
Medicare and Medicaid Services (CMS). Outlier payments are
currently subject to multiple factors including but not limited
to: (1) the hospitals estimated operating costs based
on its historical ratio of costs to gross charges; (2) the
patients case acuity; (3) the CMS established
threshold; and, (4) the hospitals geographic
location. CMS is required by law to limit total outlier payments
to between five and six percent of total DRG payments. CMS
periodically changes the threshold in order to bring expected
outlier payments within the mandated limit. An increase to the
cost threshold reduces total outlier payments by
(1) reducing the number of cases that qualify for outlier
payments and (2) reducing the dollar amount hospitals
receive for those cases that qualify. CMS historically has used
a hospitals most recently settled cost report to set the
hospitals cost-to-charge ratios. Those cost reports are
typically two to three years old.
On August 22, 2007, CMS issued its final inpatient hospital
prospective payment system rule for fiscal year 2008, which
began October 1, 2007. The final rule continues major DRG
reforms designed to improve the accuracy of hospital payments.
As introduced in the fiscal year 2007 final rule, CMS will
continue to use hospital costs rather than charges to set
payment rates. For fiscal year 2008, hospitals were paid based
upon a blend of 1/3 charge-based weights and 2/3 hospital
cost-based weights for DRGs. Additionally, CMS adopted its
proposal to restructure the current 538 DRGs to 745 MS-DRGs
(severity-adjusted DRGs) to better recognize severity of patient
illness. These MS-DRGs are being phased in over a two-year
period.
9
CMS published the inpatient prospective payment system rule
(IPPS) for 2009 on August 19, 2008. In addition to
provisions which relate to inpatient PPS payments, the 2009 IPPS
final rule also contained provisions related to the Emergency
Medical Treatment and Active Labor Act (EMTALA) and the Stark
Law, which will be discussed under the applicable EMTALA and
Stark sections of this document. CMS also expanded the list of
codes of hospital-acquired conditions for which CMS will not pay
as secondary diagnoses unless the condition was present on
admission. Due to the late enactment of the Medicare
Improvements for Patient and Providers Act (MIPPA), CMS was
unable to publish final rates in the 2009 IPPS final rule.
Outpatient services are also subject to a prospective payment
system. Services provided at our freestanding diagnostic
facilities are typically reimbursed on the basis of the
physician fee schedule, which is revised periodically, and bases
payment on various factors including resource-based practice
expense relative value units and geographic practice cost
indices.
Future legislation may modify Medicare reimbursement for
inpatient and outpatient services provided at our hospitals or
services provided at our diagnostic and therapeutic facilities,
but we are not able to predict the method or amount of any such
reimbursement changes or the effect that such changes will have
on us.
Medicaid.
Medicaid is a health insurance
program for low-income individuals, which is funded jointly by
the federal and individual state governments and administered
locally by each state. Most state Medicaid payments for
hospitals are made under a prospective payment system or under
programs that negotiate payment levels with individual
hospitals. Medicaid reimbursement is often less than a
hospitals cost of services. States periodically consider
significantly reducing Medicaid funding, while at the same time
in some cases expanding Medicaid benefits. This could adversely
affect future levels of Medicaid payments received by our
hospitals. We are unable to predict what impact, if any, future
Medicaid managed care systems might have on our operations.
The Medicare and Medicaid programs are subject to statutory and
regulatory changes, retroactive and prospective rate
adjustments, administrative rulings, court decisions, executive
orders and freezes and funding reductions, all of which may
adversely affect our business. There can be no assurance that
payments for hospital services and cardiac diagnostic and other
procedures under the Medicare and Medicaid programs will
continue to be based on current methodologies or remain
comparable to present levels. In this regard, we may be subject
to rate reductions as a result of federal budgetary or other
legislation related to the Medicare and Medicaid programs. In
addition, various state Medicaid programs periodically
experience budgetary shortfalls, which may result in Medicaid
payment reductions and delays in payment to us.
Utilization Review.
Federal law contains
numerous provisions designed to ensure that services rendered by
hospitals to Medicare and Medicaid patients meet professionally
recognized standards and are medically necessary and that claims
for reimbursement are properly filed. These provisions include a
requirement that a sampling of admissions of Medicare and
Medicaid patients be reviewed by quality improvement
organizations that analyze the appropriateness of Medicare and
Medicaid patient admissions and discharges, quality of care
provided, validity of DRG classifications and appropriateness of
cases of extraordinary length of stay or cost. Quality
improvement organizations may deny payment for services
provided, assess fines and recommend to the Department of Health
and Human Services (HHS) that a provider not in substantial
compliance with the standards of the quality improvement
organization be excluded from participation in the Medicare
program. Most non-governmental managed care organizations also
require utilization review.
Annual Cost Reports.
Hospitals participating
in the Medicare and some Medicaid programs, whether paid on a
reasonable cost basis or under a prospective payment system, are
required to meet certain financial reporting requirements.
Federal and, where applicable, state regulations require
submission of annual cost reports identifying medical costs and
expenses associated with the services provided by each hospital
to Medicare beneficiaries and Medicaid recipients.
Annual cost reports required under the Medicare and some
Medicaid programs are subject to routine governmental audits.
These audits may result in adjustments to the amounts ultimately
determined to be due to us under these reimbursement programs
and result in a recoupment of monies paid. Finalization of these
audits and determination of amounts earned under these programs
often takes several years. Providers can appeal any final
determination made in connection with an audit.
10
Program Adjustments.
The Medicare, Medicaid
and other federal health care programs are subject to statutory
and regulatory changes, administrative rulings, interpretations
and determinations, and requirements for utilization review and
new governmental funding restrictions, all of which may
materially increase or decrease program payments as well as
affect the cost of providing services and the timing of payment
to facilities. The final determination of amounts earned under
the programs often requires many years, because of audits by the
program representatives, providers rights of appeal and
the application of numerous technical reimbursement provisions.
We believe that we have made adequate provision for such
adjustments. Until final adjustment, however, previously
determined allowances could become either inadequate or more
than ultimately required.
Managed Care.
The percentage of admissions and
net revenue attributable at our hospitals and other facilities
to managed care plans has increased as a result of pressures to
control the cost of healthcare services. We expect that the
trend toward increasing percentages related to managed care
plans will continue in the future. Generally, we receive lower
payments from managed care plans than from traditional
commercial/indemnity insurers; however, as part of our business
strategy, we intend to take steps to improve our managed care
position.
Commercial Insurance.
Our hospitals provide
services to individuals covered by private healthcare insurance.
Private insurance carriers pay our hospitals or in some cases
reimburse their policyholders based upon the hospitals
established charges and the coverage provided in the insurance
policy. Commercial insurers are trying to limit the costs of
hospital services by negotiating discounts, and including the
use of prospective payment systems, which would reduce payments
by commercial insurers to our hospitals. Reductions in payments
for services provided by our hospitals to individuals covered by
commercial insurers could adversely affect us. We cannot predict
whether or how payment by third party payors for the services
provided by all hospitals and other facilities may change.
Modifications in methodology or reductions in payment could
adversely affect us.
Regulation
Overview.
The healthcare industry is required
to comply with extensive government regulation at the federal,
state and local levels. Under these laws and regulations,
hospitals must meet requirements to be licensed under state law
and be certified to participate in government programs,
including the Medicare and Medicaid programs. These requirements
relate to matters such as the adequacy of medical care,
equipment, personnel, operating policies and procedures,
emergency medical care, maintenance of records, relationships
with physicians, cost reporting and claim submission,
rate-setting, compliance with building codes and environmental
protection. There are also extensive government regulations that
apply to our owned and managed diagnostic facilities and the
physician practices that we manage. If we fail to comply with
applicable laws and regulations, we could be subject to criminal
penalties and civil sanctions and our hospitals and other
facilities could lose their licenses and their ability to
participate in the Medicare, Medicaid and other federal and
state health care programs. In addition, government laws and
regulations, or the interpretation of such laws and regulations,
may change. If that happens, we may have to make changes in our
facilities, equipment, personnel, services or business
structures so that our hospitals and other healthcare facilities
remain qualified to participate in these programs. We believe
that our hospitals and other health care facilities are in
substantial compliance with current federal, state, and local
regulations and standards.
The
Medicare Modernization Act and Other Healthcare Reform
Initiatives
The Medicare Prescription Drug Improvement and Modernization Act
of 2003 (the Medicare Modernization Act) made significant
changes to the Medicare program, particularly with respect to
the coverage of prescription drugs. These modifications also
include provisions affecting Medicare coverage and reimbursement
to general acute care hospitals, as well as other types of
providers.
The healthcare industry continues to attract much legislative
interest and public attention. In recent years, an increasing
number of legislative proposals have been introduced or proposed
in Congress and in some state legislatures that, like the
Medicare Modernization Act, would effect major changes in the
healthcare system. Proposals that have been considered include
changes in Medicare, Medicaid, and other state and federal
programs, cost controls on hospitals and mandatory health
insurance coverage for employees. We cannot predict the course
of future healthcare legislation or other changes in the
administration or interpretation of governmental healthcare
programs and the effect that any legislation, interpretation, or
change may have on us.
11
Licensure
and Certification
Licensure and Accreditation.
Our hospitals are
subject to state and local licensing requirements. In order to
verify compliance with these requirements, our hospitals are
subject to periodic inspection by state and local authorities.
All of our majority-owned hospitals are licensed as general
acute care hospitals under applicable state law. In addition,
our hospitals are accredited by The Joint Commission, a
nationwide commission which establishes standards relating to
physical plant, administration, quality of patient care and
operation of hospital medical staffs.
Certification.
In order to participate in the
Medicare and Medicaid programs, each provider must meet
applicable regulations of the HHS and similar state entities
relating to, among other things, the type of facility,
equipment, personnel, standards of medical care and compliance
with applicable federal, state and local laws. As part of such
participation requirements and effective October 1, 2007,
all physician-owned hospitals are required to provide written
notice to patients that the hospital is physician-owned.
Additionally, as part of a patient safety measure, all
Medicare-participating hospitals must provide written notice to
patients if a doctor is not present in the hospital
24 hours per day, 7 days a week. All our hospitals and
our freestanding diagnostic and therapeutic facilities are
certified to participate or are enrolled in the Medicare and
Medicaid programs. Changes to the enrollment and billing
requirements for independent diagnostic testing facilities
(IDTFs) that were included in the 2009 Medicare Physician Fee
Schedule final rule (the 2009 MPFS final rule) may require that
mobile cardiac catheterization laboratories we own and operate
be enrolled in Medicare as effective January 1, 2009 and we
are currently preparing to comply with this requirement. In
addition, the 2009 MPFS final rule requires that with the
exception of mobile entities providing services under
arrangement with hospitals, that mobile entities providing
diagnostic services must bill directly to Medicare. This change
may require restructuring of some of our current mobile cardiac
catheterization laboratory arrangements.
Emergency Medical Treatment and Active Labor
Act.
The Emergency Medical Treatment and Active
Labor Act impose requirements as to the care that must be
provided to anyone who seeks care at facilities providing
emergency medical services. In addition, CMS has issued final
regulations clarifying those areas within a hospital system that
must provide emergency treatment, procedures to meet on-call
requirements, as well as other requirements under EMTALA. CMS
clarified the requirements related to the availability of on
call physicians and obligations of recipient hospitals with
specialized capabilities in the 2009 IPPS Final Rule. Sanctions
for failing to fulfill these requirements include exclusion from
participation in the Medicare and Medicaid programs and civil
monetary penalties. In addition, the law creates private civil
remedies that enable an individual who suffers personal harm as
a direct result of a violation of the law to sue the offending
hospital for damages and equitable relief. A hospital that
suffers a financial loss as a direct result of another
participating hospitals violation of the law also has a
similar right. Although we believe that our emergency care
practices are in compliance with the law and applicable
regulations, we cannot assure you that governmental officials
responsible for enforcing the law or others will not assert that
we are in violation of these laws nor what obligations may be
imposed by regulations to be issued in the future.
Certificate of Need Laws.
In some states, the
construction of new facilities, the acquisition of existing
facilities or the addition of new beds or services may be
subject to review by state regulatory agencies under a
certificate of need program. These laws generally require
appropriate state agency determination of public need and
approval prior to the addition of beds or services. Currently,
we do not operate any hospitals in states that have adopted
certificate of need laws. However, these laws may limit our
ability to acquire or develop new facilities in states that have
such laws. We operate diagnostic facilities in some states with
certificate of need laws and we believe they are operated in
compliance with applicable requirements or are exempt from such
requirements. However, we cannot assure you that government
officials will agree with our interpretation of these laws.
Professional Licensure.
Healthcare
professionals who perform services at our hospitals and
diagnostic and therapeutic facilities are required to be
individually licensed or certified under applicable state law.
Our facilities are required to have by-laws relating to the
credentialing process, or otherwise document appropriate medical
staff credentialing. We take steps to ensure that our employees
and agents and physicians on each hospitals medical staff
have all necessary licenses and certifications, and we believe
that the medical staff members, as well as our employees and
agents comply with all applicable state licensure laws as well
as any hospital by-laws applicable to credentialing activities.
However, we cannot assure you that government officials will
agree with our position.
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Corporate Practice of Medicine and
Fee-Splitting.
Some states have laws that
prohibit unlicensed persons or business entities, including
corporations, from employing physicians. Some states also have
adopted laws that prohibit physician ownership in health care
facilities or otherwise restrict direct or indirect payments or
fee-splitting arrangements between physicians and unlicensed
persons or business entities. Possible sanctions for violations
of these restrictions include loss of a physicians
license, civil and criminal penalties, and rescission of the
business arrangements. These laws vary from state to state, are
often vague, and in most states have seldom been interpreted by
the courts or regulatory agencies. We have attempted to
structure our arrangements with healthcare providers to comply
with the relevant state law. However, we cannot assure you that
governmental officials charged with responsibility for enforcing
these laws will not assert that we, or the transactions in which
we are involved, are in violation of these laws. These laws may
also be interpreted by the courts in a manner inconsistent with
our interpretations.
Fraud
and Abuse Laws
Overview.
Various federal and state laws
govern financial and other arrangements among healthcare
providers and prohibit the submission of false or fraudulent
claims to the Medicare, Medicaid and other government healthcare
programs. Penalties for violation of these laws include civil
and criminal fines, imprisonment and exclusion from
participation in federal and state healthcare programs. The
Health Insurance Portability and Accountability Act of 1996
(HIPAA) broadened the scope of certain fraud and abuse laws by
adding several civil and criminal statutes that apply to all
healthcare services, whether or not they are reimbursed under a
federal healthcare program. Among other things, HIPAA
established civil monetary penalties for certain conduct,
including upcoding and billing for medically unnecessary goods
or services. In addition, the federal False Claims Act allows an
individual to bring a lawsuit on behalf of the government, in
what are known as qui tam or whistleblower actions, alleging
false Medicare or Medicaid claims or other violations of the
statute. The use of these private enforcement actions against
healthcare providers has increased dramatically in the recent
past, in part because the individual filing the initial
complaint may be entitled to share in a portion of any
settlement or judgment.
Anti-Kickback Statute.
The federal
anti-kickback statute prohibits providers of healthcare and
others from soliciting, receiving, offering, or paying, directly
or indirectly, any type of remuneration in connection with the
referral of patients covered by the federal healthcare programs.
Violations of the anti-kickback statute may be punished by a
criminal fine of up to $25,000 or imprisonment for each
violation, civil fines of up to $50,000, damages of up to three
times the total dollar amount involved, and exclusion from
federal healthcare programs, including Medicare and Medicaid.
As authorized by Congress, the Office of Inspector General of
the Department of HHS (OIG) has published safe harbor
regulations that describe activities and business relationships
that are deemed protected from prosecution under the
anti-kickback statute. However, the failure of a particular
activity to comply with the safe harbor regulations does not
mean that the activity violates the anti-kickback statute. There
are safe harbors for various types of arrangements, including
those for personal services and management contracts and others
for investment interests, such as stock ownership in companies
with more than $50 million in undepreciated net tangible
assets related to healthcare items and services. This publicly
traded company safe harbor contains additional criteria,
including that the stock must be obtained on terms and at a
price equally available to the public when trading on a
registered securities exchange.
The OIG is primarily responsible for enforcing the anti-kickback
statute and generally for identifying fraud and abuse activities
affecting government programs. In order to fulfill its duties,
the OIG performs audits and investigations. In addition, the
agency provides guidance to healthcare providers by issuing
Special Fraud Alerts and Bulletins that identify types of
activities that could violate the anti-kickback statute and
other fraud and abuse laws. The OIG has identified the following
arrangements with physicians as potential violations of the
statute:
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payment of any incentive by the hospital each time a physician
refers a patient to the hospital,
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use of free or significantly discounted office space or
equipment for physicians,
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provision of free or significantly discounted billing, nursing,
or other staff services,
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free training for a physicians office staff including
management and laboratory techniques,
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guarantees which provide that if the physicians income
fails to reach a predetermined level, the hospital will pay any
portion of the remainder,
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low-interest or interest-free loans, or loans which may be
forgiven if a physician refers patients to the hospital,
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payment of the costs of a physicians travel and expenses
for conferences,
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payment of services which require few, if any, substantive
duties by the physician, or payment for services in excess of
the fair market value of the services rendered, or
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purchasing goods or services from physicians at prices in excess
of their fair market value.
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We have a variety of financial relationships with physicians who
refer patients to our hospitals and our other facilities.
Physicians own interests in each of our hospitals and some of
our cardiac catheterization laboratories. Physicians may also
own MedCath Corporation common stock. We also have contracts
with physicians providing for a variety of financial
arrangements, including leases, management agreements,
independent contractor agreements, right of first refusal
agreements, medical director and professional service
agreements. Although we believe that our arrangements with
physicians have been structured to comply with the current law
and available interpretations, some of our arrangements do not
expressly meet the requirements for safe harbor protection. We
cannot assure you that regulatory authorities will not determine
that these arrangements violate the
anti-kickback
statute or other applicable laws. Also, most of the states in
which we operate have adopted
anti-kickback
laws, some of which apply more broadly to all payors, not just
to federal health care programs. Many of these state laws do not
have safe harbor regulations comparable to the federal
anti-kickback law and have only rarely been interpreted by the
courts or other government agencies. If our arrangements were
found to violate any of these anti-kickback laws we could be
subject to criminal and civil penalties
and/or
possible exclusion from participating in Medicare, Medicaid, or
other governmental healthcare programs.
Physician Self-Referral Law.
Section 1877
of the Social Security Act, commonly known as the Stark Law,
prohibits physicians from referring Medicare and Medicaid
patients for certain designated health services to entities in
which they or any of their immediate family members have a
direct or indirect ownership or compensation arrangement unless
an exception applies. The initial Stark Law applied only to
referrals of clinical laboratory services. The statute was
expanded in Stark II to apply to ten additional
designated health services, including inpatient and
outpatient hospital services, and some radiology services.
Sanctions for violating the Stark Law include civil monetary
penalties, including up to $15,000 for each improper claim and
$100,000 for any circumvention scheme, and exclusion from the
Medicare or Medicaid programs. There are various ownership and
compensation arrangement exceptions to the self-referral
prohibition, including an exception for a physicians
ownership in an entire hospital as opposed to an
ownership interest in a hospital department if the
physician is authorized to perform services at the hospital.
This exception is commonly referred to as the whole
hospital exception. There is also an exception for
ownership of publicly traded securities in a company that has
stockholder equity exceeding $75 million at the end of its
most recent fiscal year or on average during the three previous
fiscal years, as long as the physician acquired the securities
on terms generally available to the public and the securities
are traded on one of the major exchanges. Additionally, there is
an exception for certain indirect ownership and compensation
arrangements. Exceptions are also provided for many of the
customary financial arrangements between physicians and
providers, including employment contracts, personal service
arrangements, isolated financial transactions, payments by
physicians, leases, and recruitment agreements, as long as these
arrangements meet certain conditions.
As discussed, there are various ownership and compensation
arrangement exceptions to the Stark Law. In addressing the whole
hospital exception, the Stark regulations specifically reiterate
the statutory requirements for the exception. Additionally, the
exception requires that the hospital qualify as a
hospital under the Medicare program. The Stark Law
and the Stark Regulations may also apply to certain compensation
arrangements between hospitals and physicians.
The Deficit Reduction Act of 2005 (DRA) required the Secretary
of HHS to develop a plan addressing several issues concerning
physician investment in specialty hospitals. In August 2006, HHS
submitted its required final report to Congress addressing:
(1) proportionality of investment return; (2) bona
fide investment; (3) annual
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disclosure of investment; (4) provision of care to Medicaid
beneficiaries; (5) charity care; and (6) appropriate
enforcement. The report reaffirms HHS intention to
implement reforms to increase Medicare payment accuracy in the
hospital inpatient prospective and ambulatory surgical center
payment systems. HHS also has implemented certain
gainsharing demonstrations are required by the DRA
and other value-based payment approaches designed to align
physician and hospital incentives while achieving measurable
improvements in quality to care. In addition, HHS now requires
transparency in hospital financial arrangements with physicians.
Currently, all hospitals are required to provide HHS information
concerning physician investment and compensation arrangements
that potentially implicate the physician self-referral statute,
and to disclose to patients whether they have physician
investors. Hospitals that do not comply in a timely manner with
this new disclosure requirement may face civil penalties of
$10,000 per day that they are in violation. HHS also announced
its position that non-proportional returns on investments and
non-bona fide investments may violate the physician
self-referral statute and are suspect under the anti-kickback
statute. Other components of the plan include providing further
guidance concerning what is expected of hospitals that do not
have emergency departments under EMTALA and changes in the
Medicare enrollment form to identify specialty hospitals.
Issuance of the strategic plan coincided with the sunset of a
DRA provision suspending enrollment of new specialty hospitals
into the Medicare program.
In July 2007 as part of proposed revisions to the Medicare
physician fee scheduled for fiscal year 2008, CMS proposed
certain additional changes to the Stark Law. In particular, the
proposed rule would revise the Stark Law exception for space and
equipment rentals. In instances where a physician leases space
or equipment to an entity who accepts patients referred by that
physician, the CMS proposal would no longer allow
unit-of-service or per click payments for such
leases. Additionally, the proposed rule would no longer treat
under arrangements between hospitals and
physician-owned entities as compensation instead of ownership
relationships. CMS finalized these proposed changes to the Stark
Law in the 2009 IPPS final rule published on August 19.
2008. These changes are effective October 1, 2009.
Specifically, the 2009 IPPS final rule limits the ability of
hospitals to enter into under arrangements with physicians and
physician-owned entities and thus, physician-owned joint venture
entities deemed to be performing DHS will have to
comply with one of the more limited Stark Law
ownership exceptions, rather than the previously
acceptable Stark Law compensation exceptions. In
addition, the 2009 IPPS final rule finalized the prohibition on
per unit compensation in space and equipment lease transactions.
We will be restructuring any of our space and equipment lease
transactions that include per unit or per use compensation prior
to October 1, 2009 and we are currently evaluating the
impact of these changes on our arrangements with community
hospitals.
There have been few enforcement actions taken and relatively few
cases interpreting the Stark Law to date, although one case
struck down an aspect of the Stark regulations relating to the
Stark Laws applicability to certain types of services. As
a result, there is little indication as to how courts will
interpret and apply the Stark Law; however, enforcement is
expected to increase. We believe we have structured our
financial arrangements with physicians to comply with the
statutory exceptions included in the Stark Law and the Stark
regulations. In particular, we believe that our physician
ownership arrangements meet the whole hospital exception. In
addition, we expect to meet the exception for publicly traded
securities or indirect compensation arrangements, as
appropriate. The freestanding diagnostic and other facilities
that we own do not furnish any designated health services as
defined under the Stark Law, and thus referrals to them are not
subject to the Stark Laws prohibitions. Similarly, our
consulting and management services to physician group practices
are not subject to the Stark Laws prohibitions.
Possible amendments to the Stark Law, including any modification
or revocation of the whole hospital exception upon which we rely
in establishing many of our relationships with physicians, could
require us to change or adversely impact the manner in which we
establish relationships with physicians to develop and operate a
facility, as well as our other business relationships such as
joint ventures and physician practice management arrangements.
We note that legislation has been introduced in Congress
recently and in the past seeking to limit or restrict the whole
hospital exception. There can be no assurance that future
legislation will not seek to modify, limit, restrict, or revoke
the whole hospital exception. There also can be no assurance the
CMS will not promulgate additional regulations under the Stark
Law that may change or adversely impact our arrangements with
referring physicians.
Moreover, as noted above, states in which we operate also have
physician self-referral laws, which may prohibit certain
physician referrals or require certain disclosures. Some of
these state laws would apply regardless of the source of payment
for care. These statutes typically provide criminal and civil
penalties as well as loss of
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licensure and may have broader prohibitions than the Stark Law
or more limited exceptions. While there is little precedent for
the interpretation or enforcement of these state laws, we
believe we have structured our financial relationships with
physicians and others to comply with applicable state laws. In
addition, existing state self-referral laws may be amended. We
cannot predict whether new state self-referral laws or
amendments to existing laws will be enacted or, once enacted,
their effect on us, and we have not researched pending
legislation in all the states in which our hospitals are located.
Civil Monetary Penalties.
The Social Security
Act contains provisions imposing civil monetary penalties for
various fraudulent
and/or
abusive practices, including, among others, hospitals which
knowingly make payments to a physician as an inducement to
reduce or limit medically necessary care or services provided to
Medicare or Medicaid beneficiaries. In July 1999, the OIG issued
a Special Advisory Bulletin on gainsharing arrangements. The
bulletin warns that clinical joint ventures between hospitals
and physicians may implicate these provisions as well as the
anti-kickback statute, and specifically refers to specialty
hospitals, which are marketed to physicians in a position to
refer patients to the hospital, and structured to take advantage
of the whole hospital exception. Hospitals specializing in
heart, orthopedic, and maternity care are mentioned, and the
bulletin states that these hospitals may induce
investor-physicians to reduce services to patients through
participation in profits generated by cost savings, in violation
of a civil monetary penalty provision. Despite this initial
broad interpretation of this civil monetary penalty law, since
2005 the OIG has issued nine advisory opinions which declined to
sanction a particular gainsharing arrangement under this civil
monetary penalty provision, or the anti-kickback statute,
because of the specific circumstances and safeguards built into
the arrangement. We believe that the ownership distributions
paid to physicians by our hospitals do not constitute payments
made to physicians under gainsharing arrangements. We cannot
assure you, however, that government officials will agree with
our interpretation of applicable law.
False Claims Prohibitions.
False claims are
prohibited by various federal criminal and civil statutes. In
addition, the federal False Claims Act prohibits the submission
of false or fraudulent claims to the Medicare, Medicaid, and
other government healthcare programs. Penalties for violation of
the False Claims Act include substantial civil and criminal
fines, including treble damages, imprisonment, and exclusion
from participation in federal health care programs. In addition,
the False Claims Act allows an individual to bring lawsuits on
behalf of the government, in what are known as qui tam or
whistleblower actions, alleging false Medicare or Medicaid
claims or other violations of the statute.
A number of states, including states in which we operate, have
adopted their own false claims provisions as well as their own
whistleblower provisions whereby a private party may file a
civil lawsuit in state court. In fact, the DRA contains
provisions which create incentives for states to enact
anti-fraud legislation modeled after the federal False Claims
Act.
Healthcare
Industry Investigations
The federal government, private insurers and various state
enforcement agencies have increased their scrutiny of
providers business arrangements and claims in an effort to
identify and prosecute fraudulent and abusive practices. There
are ongoing federal and state investigations in the healthcare
industry regarding multiple issues including cost reporting,
billing and charge-setting practices, unnecessary utilization,
physician recruitment practices, physician ownership of
healthcare providers and joint ventures with hospitals. Certain
of these investigations have targeted hospitals and physicians.
We have substantial Medicare, Medicaid and other governmental
billings, which could result in heightened scrutiny of our
operations. We continue to monitor these and all other aspects
of our business and have developed a compliance program to
assist us in gaining comfort that our business practices are
consistent with both legal requirements and current industry
standards. However, because the federal and state fraud and
abuse laws are complex and constantly evolving, we cannot assure
you that government investigations will not result in
interpretations that are inconsistent with industry practices,
including ours. Evolving interpretations of current, or the
adoption of new federal or state laws or regulations could
affect many of the arrangements entered into by each of our
hospitals. In public statements surrounding current
investigations, governmental authorities have taken positions on
a number of issues, including some for which little official
interpretation previously has been available, that appear to be
inconsistent with practices that have been common within the
industry and that previously have not been challenged in this
manner. In some instances, government
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investigations that in the past have been conducted under the
civil provisions of federal law may now be conducted as criminal
investigations.
A number of healthcare investigations are national initiatives
in which federal agencies target an entire segment of the
healthcare industry. One example involved the federal
governments initiative regarding hospitals improper
requests for separate payments for services rendered to a
patient on an outpatient basis within three days prior to the
patients admission to the hospital, where reimbursement
for such services is included as part of the reimbursement for
services furnished during an inpatient stay. The government
targeted all hospital providers to ensure conformity with this
reimbursement rule. Further, the federal government continues to
investigate Medicare overpayments to prospective payment system
hospitals that incorrectly report transfers of patients to other
prospective payment system hospitals as discharges. Law
enforcement authorities, including the OIG and the United States
Department of Justice, are also increasing scrutiny of various
types of arrangements between healthcare providers and potential
referral sources, including so-called contractual joint
ventures, to ensure that the arrangements are not designed as a
mechanism to exchange remuneration for patient care referrals
and business opportunities. Investigators have also demonstrated
a willingness to look behind the formalities of a business
transaction to determine the underlying purpose of payments
between healthcare providers and potential referral sources.
Recently, the OIG has also begun to investigate certain
hospitals with a particularly high proportion of Medicare
reimbursement resulting from outlier payments. The OIGs
workplan has indicated its intention to review hospital
privileging activities within the context of Medicare conditions
of participation.
It is possible that governmental or regulatory authorities could
initiate investigations on these or other subjects at our
facilities and such investigations could result in significant
costs in responding to such investigations and penalties to us,
as well as adverse publicity, declines in the value of our
equity and debt securities and lawsuits brought by holders of
those securities. It is also possible that our executives,
managers and hospital board members, many of whom have worked at
other healthcare companies that are or may become the subject of
federal and state investigations and private litigation, could
be included in governmental investigations or named as
defendants in private litigation. The positions taken by
authorities in any investigations of us, our executives,
managers, hospital board members or other healthcare providers,
and the liabilities or penalties that may be imposed could have
a material adverse effect on our business, financial condition
and results of operations.
Clinical
Trials at Hospitals
Our hospitals serve as research sites for physician clinical
trials sponsored by pharmaceutical and device manufacturers and
therefore may perform services on patients enrolled in those
studies, including implantation of experimental devices. Only
physicians who are members of the medical staff of the hospital
may participate in such studies at the hospital. All trials are
approved by an Institutional Review Board (IRB), which has the
responsibility to review and monitor each study pursuant to
applicable law and regulations. Such clinical trials are subject
to numerous regulatory requirements.
The industry standard for conducting preclinical testing is
embodied in the investigational new drug regulations
administered by the federal Food and Drug Administration (the
FDA). Research conducted at institutions supported by funds from
the National Institutes of Health must also comply with multiple
project assurance agreements and with regulations and guidelines
governing the conduct of clinical research that are administered
by the National Institutes of Health, the HHS Office of Research
Integrity, and the Office of Human Research Protection. Research
funded by the National Institutes of Health must also comply
with the federal financial reporting and record keeping
requirements incorporated into any grant contract awarded. The
requirements for facilities engaging in clinical trials are set
forth in the code of federal regulations and published
guidelines. Regulations related to good clinical practices and
investigational new drugs have been mandated by the FDA and have
been adopted by similar regulatory authorities in other
countries. These regulations contain requirements for research,
sponsors, investigators, IRBs, and personnel engaged in the
conduct of studies to which these regulations apply. The
regulations require that written protocols and standard
operating procedures are followed during the conduct of studies
and for the recording, reporting, and retention of study data
and records. CMS also imposes certain requirements for billing
of services provided in connection with clinical trials.
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The FDA and other regulatory authorities require that study
results and data submitted to such authorities are based on
studies conducted in accordance with the provisions related to
good clinical practices and investigational new drugs. These
provisions include:
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complying with specific regulations governing the selection of
qualified investigators,
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obtaining specific written commitments from the investigators,
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disclosure of financial conflicts-of-interest,
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verifying that patient informed consent is obtained,
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instructing investigators to maintain records and reports,
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verifying drug or device safety and efficacy, and
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permitting appropriate governmental authorities access to data
for their review.
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Records for clinical studies must be maintained for specific
periods for inspection by the FDA or other authorities during
audits. Non-compliance with the good clinical practices or
investigational new drug requirements can result in the
disqualification of data collected during the clinical trial. It
may also lead to debarment of an investigator or institution or
False Claims Act allegations if fraud or substantial
non-compliance is detected, and subject a hospital to a
recoupment of payments for services that are not covered by
federal health care programs. Finally, non-compliance could lead
to revocation or non-renewal of government research grants.
Failure to comply with new or revised applicable federal, state,
and international clinical trial laws existing laws and
regulations could subject us and physician investigators to loss
of the right to conduct research, civil fines, criminal
penalties, and other enforcement actions.
Finally, the Administrative Simplification Subtitle of HIPAA and
related privacy and security regulations also require healthcare
entities engaged in clinical research to maintain the privacy of
patient identifiable medical information. See
Privacy and Security Requirements.
We have implemented policies in an attempt to comply with
these rules as they apply to clinical research, including
procedures to obtain all required patient authorizations.
However, there is little or no guidance available as to how
these rules will be enforced.
Privacy
and Security Requirements
HIPAA requires the use of uniform electronic data transmission
standards for healthcare claims and payment transactions
submitted or received electronically. These provisions are
intended to encourage electronic commerce in the healthcare
industry. HHS has adopted final regulations establishing
electronic data transmission standards that all healthcare
providers must use when submitting or receiving certain
healthcare transactions electronically. We believe we have
complied in all material respects with these electronic data
transmission standards.
HHS has also adopted final regulations containing privacy
standards as required by HIPAA. The privacy regulations
extensively regulate the use and disclosure of individually
identifiable health-related information. We have taken measures
to comply with the final privacy regulations, but since there is
little guidance about how these regulations will be enforced by
the government, we cannot predict whether the government will
agree that our healthcare facilities are in compliance.
HHS has adopted final regulations regarding security standards.
These security regulations require healthcare providers to
implement organizational and technical practices to protect the
security of electronically maintained or transmitted
health-related information. We believe we have complied in all
material respects with these security standards.
Violations of the Administrative Simplification Provisions of
HIPAA could result in civil penalties of up to $25,000 per type
of violation in each calendar year and criminal penalties of up
to $250,000 per violation. In addition, our facilities continue
to remain subject to state laws that may be more restrictive
than the regulations issued under HIPAA. These statutes vary by
state and could impose additional penalties.
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Compliance
Program
The OIG has issued guidelines to promote voluntarily developed
and implemented compliance programs for the healthcare industry.
In response to these guidelines, we adopted a code of ethics,
designated compliance officers at the parent company level and
individual hospitals, established a toll-free compliance line,
which permits anonymous reporting, implemented various
compliance training programs, and developed a process for
screening all employees through applicable federal and state
databases.
We have established a reporting system, auditing and monitoring
programs, and a disciplinary system to enforce the code of
ethics, and other compliance policies. Auditing and monitoring
activities include claims preparation and submission, and cover
numerous issues such as coding, billing, cost reporting, and
financial arrangements with physicians and other referral
sources. These areas are also the focus of training programs.
Our policy is to require our officers and all employees to
participate in compliance training programs. The board of
directors has established a compliance committee, which oversees
implementation of the compliance program.
The committee consists of three outside directors, and is
chaired by Galen Powers, a former chief counsel for the Health
Care Financing Administration (now known as CMS), where he was
responsible for providing legal advice on federal healthcare
programs, particularly Medicare and Medicaid. The compliance
committee of the board meets at least quarterly.
Joan McCanless, the Chief Clinical and Compliance Officer
reports to the chief executive officer for day-to-day compliance
matters and at least quarterly to the compliance committee of
the board. The corporate compliance officer is a senior vice
president, and has a background in nursing and hospital
administration. Each hospital has its own compliance committee
and compliance officer that reports to its governing board. The
compliance committee of the board of directors assesses each
hospitals compliance program at least annually. The
corporate compliance officer annually assesses the hospitals for
compliance reviews, provides an audit guide to the hospitals to
evaluate compliance with our policies and procedures and serves
on the compliance committee of each hospital.
The objective of the program is to ensure that our operations at
all levels are conducted in compliance with applicable federal
and state laws regarding both public and private healthcare
programs.
You should carefully consider and evaluate all of the
information included in this report, including the risk factors
set forth below before making an investment decision with
respect to our securities. The following is not an exhaustive
discussion of all of the risks facing our company. Additional
risks not presently known to us or that we currently deem
immaterial may impair our business operations and results of
operations.
If the
anti-kickback, physician self-referral or other fraud and abuse
laws are modified, interpreted differently or if other
regulatory restrictions become effective, we could incur
significant civil or criminal penalties and loss of
reimbursement or be required to revise or restructure aspects of
our business arrangements.
The federal anti-kickback statute prohibits the offer, payment,
solicitation or receipt of any form of remuneration in return
for referring items or services payable by Medicare, Medicaid or
any other federal healthcare program. The anti-kickback statute
also prohibits any form of remuneration in return for
purchasing, leasing or ordering or arranging for or recommending
the purchasing, leasing or ordering of items or services payable
by these programs. The anti-kickback statute is very broad in
scope and many of its provisions have not been uniformly or
definitively interpreted by existing case law, regulations or
advisory opinions.
Violations of the anti-kickback statute may result in
substantial civil or criminal penalties, including criminal
fines of up to $25,000 for each violation or imprisonment and
civil penalties of up to $50,000 for each violation, plus three
times the amount claimed and exclusion from participation in the
Medicare, Medicaid and other federal healthcare reimbursement
programs. Any exclusion of our hospitals or diagnostic and
therapeutic facilities from these programs would result in
significant reductions in revenue and would have a material
adverse effect on our business.
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The requirements of the physician self-referral statute, or
Stark Law, are very complex and while federal regulations have
been issued to implement all of its provisions, proper
interpretation and application of the statute remains
challenging. The Stark Law prohibits a physician who has a
financial relationship with an entity from referring
Medicare or Medicaid patients to that entity for certain
designated health services. A financial
relationship includes a direct or indirect ownership or
investment interest in the entity, and a compensation
arrangement between the physician and the entity. Designated
health services include some radiology services and inpatient
and outpatient services.
There are various ownership and compensation arrangement
exceptions to this self-referral prohibition. Our hospitals rely
upon the whole hospital exception to allow referrals from
physician investors. Under this ownership exception, physicians
may make referrals to a hospital in which he or she has an
ownership interest if (1) the physician is authorized to
perform services at the hospital and (2) the ownership
interest is in the entire hospital, as opposed to a department
or a subdivision of the hospital. Another exception for
ownership of publicly traded securities permits physicians who
own shares of our common stock to make referrals to our
hospitals, provided our stockholders equity exceeded
$75.0 million at the end of our most recent fiscal year or
on average during the three previous fiscal years. This
exception applies if, prior to the time the physician makes a
referral for a designated health service to a hospital, the
physician acquired the securities on terms generally available
to the public and the securities are traded on one of the major
exchanges.
In July 2007 as part of proposed revisions to the Medicare
physician fee scheduled for fiscal year 2008, CMS proposed
certain additional changes to the Stark Law. In particular, the
proposed rule would revise the Stark Law exception for space and
equipment rentals. In instances where a physician leases space
or equipment to an entity who accepts patients referred by that
physician, the CMS proposal would no longer allow
unit-of-service or per click payments for such
leases. Additionally, the proposed rule would no longer treat
under arrangements between hospitals and
physician-owned entities as compensation instead of ownership
relationships. Specifically, the proposal would revise the
definition of entity under the Stark Law to include
not only the entity billing for the service but also the entity
that has performed the designated health service CMS finalized
these proposed changes to the Stark Law in the 2009 IPPS final
rule published on August 19, 2008. These changes are
effective October 1, 2009. Specifically, the 2009 IPPS
final rule limits the ability of hospitals to enter into under
arrangements with physicians and physician-owned entities and
thus, physician-owned joint venture entities deemed to be
performing Designated Health Services (DHS) will
have to comply with one of the more limited Stark Law
ownership exceptions, rather than the previously
acceptable Stark Law compensation exceptions. In
addition, the 2009 IPPS final rule finalized the prohibition on
per unit compensation in space and equipment lease transactions.
We will be restructuring any of our space and equipment lease
transactions that include per unit or per use compensation prior
to October 1, 2009 and we are currently evaluating the
impact of these changes on our arrangements with community
hospitals. The arrangements between MedCath Partners and certain
community hospitals could be materially and adversely affected
if we are unable to successfully execute such a restructuring.
Possible amendments to the Stark Law, including any modification
or revocation of the whole hospital exception upon which we rely
in establishing many of our relationships with physicians, could
require us to change or adversely impact the manner in which we
establish relationships with physicians to develop and operate a
facility, as well as our other business relationships such as
joint ventures and physician practice management arrangements.
We note that legislation has been introduced in Congress
recently and in the past seeking to limit or restrict the whole
hospital exception. There can be no assurance that future
legislation will not seek to modify, limit, restrict, or revoke
the whole hospital exception. There also can be no assurance the
CMS will not promulgate additional regulations under the Stark
Law that may change or adversely impact our arrangements with
referring physicians.
Reductions
or changes in reimbursement from government or third-party
payors could adversely impact our operating
results.
Historically, Congress and some state legislatures have, from
time to time, proposed significant changes in the healthcare
system. Many of these changes have resulted in limitations on,
and in some cases, significant reductions in the levels of,
payments to healthcare providers for services under many
government reimbursement programs. Recent budget proposals, if
enacted in their current form, would freeze
and/or
reduce reimbursement for inpatient and outpatient hospital
services. The Medicare hospital inpatient prospective payment
system is evaluated on an
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annual basis. On August 22, 2007, CMS issued its final
inpatient hospital prospective payment system rule for fiscal
year 2008, which begins October 1, 2007. The final rule
continues major DRG reforms designed to improve the accuracy of
hospital payments. As introduced in the fiscal year 2007 final
rule, CMS will continue to use hospital costs rather than
charges to set payment rates. For fiscal year 2008, hospitals
will be paid based upon a blend of 1/3 charge-based weights and
2/3 hospital cost-based weights for DRGs. Additionally, CMS
adopted its proposal to restructure the current 538 DRGs to 745
MS-DRGs (severity-adjusted DRGs) to better recognize severity of
patient illness. These MS-DRGs will be phased in over a two-year
period. Effective fiscal year 2009, CMS has identified eight
conditions that will not be paid at a higher rate unless they
were present on admission, including three serious preventable
events deemed never events. CMS published the
inpatient prospective payment system rule for 2009 on
August 19, 2008. Due to the late enactment of the Medicare
Improvements for Patient and Providers Act (MIPPA), CMS did not
publish the final wage indices and payment rates for the 2009
IPPS final rule until October 2008.
During the fiscal years ended September 30, 2008 and 2007,
we derived 43.1% and 45.9%, respectively, of our net revenue
from the Medicare and Medicaid programs. Changes in laws or
regulations governing the Medicare and Medicaid programs or
changes in the manner in which government agencies interpret
them could materially and adversely affect our operating results
or financial position.
Our relationships with third-party payors are generally governed
by negotiated agreements or out of network arrangements. These
agreements set forth the amounts we are entitled to receive for
our services. Third-party payors have undertaken
cost-containment initiatives during the past several years,
including different payment methods, monitoring healthcare
expenditures and anti-fraud initiatives, that have made these
relationships more difficult to establish and less profitable to
maintain. We could be adversely affected in some of the markets
where we operate if we are unable to establish favorable
agreements with third-party payors or satisfactory out of
network arrangements.
If we
fail to comply with the extensive laws and government
regulations applicable to us, we could suffer penalties or be
required to make significant changes to our
operations.
We are required to comply with extensive and complex laws and
regulations at the federal, state and local government levels.
These laws and regulations relate to, among other things:
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licensure, certification and accreditation,
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billing, coverage and reimbursement for supplies and services,
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relationships with physicians and other referral sources,
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adequacy and quality of medical care,
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quality of medical equipment and services,
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qualifications of medical and support personnel,
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confidentiality, maintenance and security issues associated with
medical records,
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the screening, stabilization and transfer of patients who have
emergency medical conditions,
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building codes,
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environmental protection,
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clinical research,
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operating policies and procedures, and
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addition of facilities and services.
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Many of these laws and regulations are expansive, and we do not
always have the benefit of significant regulatory or judicial
interpretation of them. In the future, different interpretations
or enforcement of these laws and regulations could subject our
current or past practices to allegations of impropriety or
illegality or could require us
21
to make changes in our facilities, equipment, personnel,
services, capital expenditure programs, operating procedures,
and contractual arrangements.
If we fail to comply with applicable laws and regulations, we
could be subjected to liabilities, including:
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criminal penalties,
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civil penalties, including monetary penalties and the loss of
our licenses to operate one or more of our facilities, and
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exclusion of one or more of our facilities from participation in
the Medicare, Medicaid and other federal and state healthcare
programs.
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A number of initiatives have been proposed during the past
several years to reform various aspects of the healthcare system
at the federal level and in the states in which we operate.
Current or future legislative initiatives, government
regulations or other government actions may have a material
adverse effect on us.
Companies
within the healthcare industry continue to be the subject of
federal and state investigations.
Both federal and state government agencies as well as private
payors have heightened and coordinated civil and criminal
enforcement efforts as part of numerous ongoing investigations
of healthcare organizations including hospital companies. Like
others in the healthcare industry, we receive requests for
information from these governmental agencies in connection with
their regulatory or investigative authority which, if determined
adversely to us, could have a material adverse effect on our
financial condition or our results of operations.
In addition, the Office of Inspector General and the
U.S. Department of Justice have, from time to time,
undertaken national enforcement initiatives that focus on
specific billing practices or other suspected areas of abuse.
Moreover, healthcare providers are subject to civil and criminal
false claims laws, including the federal False Claims Act, which
allows private parties to bring what are called whistleblower
lawsuits against private companies doing business with or
receiving reimbursement under government programs. These are
sometimes referred to as qui tam lawsuits.
Because qui tam lawsuits are filed under seal, we could be named
in one or more such lawsuits of which we are not aware or which
cannot be disclosed until the court lifts the seal from the
case. Defendants determined to be liable under the False Claims
Act may be required to pay three times the actual damages
sustained by the government, plus mandatory civil penalties of
between $5,500 and $11,000 for each separate false claim.
Typically, each fraudulent bill submitted by a provider is
considered a separate false claim, and thus the penalties under
a false claim case may be substantial. Liability arises when an
entity knowingly submits a false claim for reimbursement to a
federal health care program. In some cases, whistleblowers or
the federal government have taken the position that providers
who allegedly have violated other statutes, such as the
anti-kickback statute or the Stark Law, have thereby submitted
false claims under the False Claims Act. Thus, it is possible
that we have liability exposure under the False Claims Act.
Some states have adopted similar state whistleblower and false
claims provisions. Publicity associated with the substantial
amounts paid by other healthcare providers to settle these
lawsuits may encourage current and former employees of ours and
other healthcare providers to seek to bring more whistleblower
lawsuits. Some of our activities could become the subject of
governmental investigations or inquiries. Any such
investigations of us, our executives or managers could result in
significant liabilities or penalties to us, as well as adverse
publicity.
In October 2007, we reached an agreement with the DOJ and the
United States Attorneys Office in Phoenix, Arizona
regarding clinical trials at the Arizona Heart Hospital, one of
the nine hospitals in which we own an interest. The settlement
concerns Medicare claims submitted between June 1998 and October
2002 for physician services involving the implantation of
certain endoluminal graft devices (utilized to treat aneurysms)
that had not received final marketing approval from the FDA, and
allegedly were either implanted without an approved
investigational device exception (IDE) or were implanted outside
of the approved IDE protocol. The DOJ allegations did not
involve patient care and related solely to whether the
procedures were properly reimbursable by Medicare. The parties
reached a settlement of the allegations to avoid the delay,
uncertainty, inconvenience, and expense of protracted
litigation. Further, the hospital denies engagement in any
wrongdoing or illegal conduct, and the settlement agreement does
not contain any admission of liability. As disclosed in previous
filings, the hospital agreed to pay approximately
$5.8 million to settle and obtain a release from any civil
or administrative monetary
22
claims related to the DOJs investigation. Additionally,
the hospital has entered into a five-year corporate integrity
agreement with the OIG under which the hospital will continue to
maintain its existing corporate compliance program and which
relates to clinical trials conducted at the hospital. The
$5.8 million was paid to the United States in November 2007.
If
laws governing the corporate practice of medicine change, we may
be required to restructure some of our
relationships.
The laws of various states in which we operate or may operate in
the future do not permit business corporations to practice
medicine, exercise control over physicians who practice medicine
or engage in various business practices, such as fee-splitting
with physicians. The interpretation and enforcement of these
laws vary significantly from state to state. We are not required
to obtain a license to practice medicine in any jurisdiction in
which we own or operate a hospital or other facility because our
facilities are not engaged in the practice of medicine. The
physicians who use our facilities to provide care to their
patients are individually licensed to practice medicine. In most
instances, the physicians and physician group practices are not
affiliated with us other than through the physicians
ownership interests in the facility and through the service and
lease agreements we have with some of these physicians. Should
the interpretation, enforcement or laws of the states in which
we operate or may operate change, we cannot assure you that such
changes would not require us to restructure some of our
physician relationships.
If
government laws or regulations change or the enforcement or
interpretation of them change, we may be obligated to purchase
some or all of the ownership interests of the physicians
associated with us.
Changes in government regulation or changes in the enforcement
or interpretation of existing laws or regulations could obligate
us to purchase at the then fair market value some or all of the
ownership interests of the physicians who have invested in the
ventures that own and operate our hospitals and other healthcare
businesses. Regulatory changes that could create this obligation
include changes that:
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make illegal the referral of Medicare or other patients to our
hospitals and other healthcare businesses by physicians
affiliated with us,
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create the substantial likelihood that cash distributions from
the hospitals and other healthcare businesses to our physician
partners will be illegal, or
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make illegal the ownership by our physician partners of their
interests in the hospitals and other healthcare businesses.
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From time to time, we may voluntarily seek to increase our
ownership interest in one or more of our hospitals and other
healthcare businesses, in accordance with any applicable
limitations. We may seek to use shares of our common stock to
purchase physicians ownership interests instead of cash.
If the use of our stock is not permitted or attractive to us or
our physician partners, we may use cash or promissory notes to
purchase the physicians ownership interests. Our existing
capital resources may not be sufficient for the acquisition or
the use of cash may limit our ability to use our capital
resources elsewhere, limiting our growth and impairing our
operations. The creation of these obligations and the possible
adverse effect on our affiliation with these physicians could
have a material adverse effect on us.
We may
have fiduciary duties to our partners that may prevent us from
acting solely in our best interests.
We hold our ownership interests in hospitals and other
healthcare businesses through ventures organized as limited
liability companies or limited partnerships. As general partner,
manager or owner of the majority interest in these entities, we
may have special legal responsibilities, known as fiduciary
duties, to our partners who own an interest in a particular
entity. Our fiduciary duties include not only a duty of care and
a duty of full disclosure but also a duty to act in good faith
at all times as manager or general partner of the limited
liability company or limited partnership. This duty of good
faith includes primarily an obligation to act in the best
interest of each business, without being influenced by any
conflict of interest we may have as a result of our own business
interests.
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We also have a duty to operate our business for the benefit of
our stockholders. As a result, we may encounter conflicts
between our fiduciary duties to our partners in our hospitals
and other healthcare businesses, and our responsibility to our
stockholders. For example, we have entered into management
agreements to provide management services to our hospitals in
exchange for a fee. Disputes may arise with our partners as to
the nature of the services to be provided or the amount of the
fee to be paid. In these cases, as manager or general partner we
may be obligated to exercise reasonable, good faith judgment to
resolve the disputes and may not be free to act solely in our
own best interests or the interests of our stockholders. We
cannot assure you that any dispute between us and our partners
with respect to a particular business decision or regarding the
interpretation of the provisions of the hospital operating
agreement will be resolved or that, as a result of our fiduciary
duties, any dispute resolution will be on terms favorable or
satisfactory to us.
Material
decisions regarding the operations of our facilities require
consent of our physician and community hospital partners, and we
may be unable as a result to take actions that we believe are in
our best interest.
The physician and community hospital partners in our healthcare
businesses participate in material strategic and operating
decisions we make for these facilities. They may do so through
their representatives on the governing board of the subsidiary
that owns the facility or a requirement in the governing
documents that we obtain the consent of their representatives
before taking specified material actions. We generally must
obtain the consent of our physician and other hospital partners
or their representatives before making any material amendments
to the operating or partnership agreement for the venture or
admitting additional members or partners. Although they have not
done so to date, these rights to approve material decisions
could in the future limit our ability to take actions that we
believe are in our best interest and the best interest of the
venture. We may not be able to resolve favorably, or at all, any
dispute regarding material decisions with our physician or other
hospital partners.
We may
experience difficulties in executing our growth
strategy.
Our growth strategy depends on our ability to identify
attractive markets in which to expand existing facilities and
establish new business ventures. We may have difficulty in
identifying potential markets that satisfy our criteria for
expansion or developing a new facility or for entering into
other business arrangements. Identifying physician and community
hospital partners and negotiating and implementing the terms of
an agreement with them can be a lengthy and complex process. As
a result, we may not be able to develop new business ventures at
the rate we currently anticipate. Our growth strategy also
involves the expansion of several of our hospitals. The success
of these expansions is dependant on increased regional support
in each respective market. If the market conditions in these
regions deteriorate, these expansion costs may not be
recoverable.
Our growth strategy will also increase demands on our
management, operational and financial information systems and
other resources. To accommodate our growth, we will need to
continue to implement operational and financial information
systems and controls, and expand, train, manage and motivate our
employees. Our personnel, information systems, procedures or
controls may not adequately support our operations in the
future. Failure to recruit and retain strong management,
implement operational and financial information systems and
controls, or expand, train, manage or motivate our workforce,
could lead to delays in developing and achieving expected
operating results for new facilities.
Unfavorable
or unexpected results at one of our hospitals or in one of our
markets could significantly impact our consolidated operating
results.
Each of our individual hospitals comprise a significant portion
of our operating results and a majority of our hospitals are
located in the southwestern United States. Any material change
in the current demographic, economic, competitive or regulatory
conditions in this region, a particular market in which one of
our other hospitals operates or the United States in general
could adversely affect our operating results. In particular, if
economic conditions deteriorate in one or more of these markets,
we may experience a shift in payor mix arising from
patients loss of or changes in employer-provided health
insurance resulting in higher co-payments and deductibles or an
increased number of uninsured patients.
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Growth
of self-pay patients and a deterioration in the collectability
of these accounts could adversely affect our results of
operations.
We have experienced growth in our self-pay patients, which
includes situations in which each patient is responsible for the
entire bill, as well as cases where deductibles are due from
insured patients after insurance pays. We may have greater
amounts of uninsured receivables in the future and if the
collectability of those uninsured receivables deteriorates,
increases in our allowance for doubtful accounts may be
required, which could materially adversely impact our operating
results and financial condition.
Our
hospitals and other facilities face competition for patients
from other healthcare companies.
The healthcare industry is highly competitive. Our facilities
face competition for patients from other providers in our
markets. In most of our markets we compete for market share of
cardiovascular and other healthcare procedures that are the
focus of our facilities with two to three providers. Some of
these providers are part of large for-profit or not-for-profit
hospital systems with greater financial resources than we have
available to us and have been operating in the markets they
serve for many years. Some of the hospitals that we compete
against in certain of our markets and elsewhere have attempted
to use their market position and managed care networks to
influence physicians not to enter into or to abandon joint
ventures that own facilities such as ours by, for example,
revoking the admission privileges of our physician partners at
the competing hospital. These practices of economic
credentialing appear to be on the increase. Although these
practices have not been successful to date in either preventing
us from developing new ventures with physicians or causing us to
lose existing investors, the future inability to attract new
investors or loss of a significant number of our physician
partners in one or more of our existing ventures could have a
material adverse effect on our business and operating results.
We
depend on our relationships with the physicians who use our
facilities.
Our business depends upon the efforts and success of the
physicians who provide healthcare services at our facilities and
the strength of our relationships with these physicians. We
generally do not employ any practicing physicians at any of our
hospitals or other facilities. Each member of the medical staffs
at our hospitals may also serve on the medical staffs of, and
practice at, hospitals not owned by us.
At each of our hospitals, our business could be adversely
affected if a significant number of key physicians or a group of
physicians:
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terminated their relationship with, or reduced their use of, our
facilities,
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failed to maintain the quality of care provided or to otherwise
adhere to the legal professional standards or the legal
requirements to obtain privileges at our hospitals or other
facilities,
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suffered any damage to their reputation,
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exited the market entirely, or
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experienced financial issues within their medical practice or
other major changes in its composition or leadership.
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Based upon our managements general knowledge of the
operations of our hospitals, we believe that, consistent with
most hospitals in our industry, a significant portion of the
patient admissions at most of our hospitals are attributable to
approximately 10% of the total number of physicians on the
hospitals medical staff. Historically, the medical staff
at each hospital ranges from approximately 160 to 400 physicians
depending upon the size of the hospital and the number of
practicing physicians in the market. If we fail to maintain our
relationships with the physicians in this group at a particular
hospital, many of whom are investors in our hospitals, the
revenues of that hospital would be reduced. None of the
physicians practicing at our hospitals has a legal commitment,
or any other obligation or arrangement that requires the
physician to refer patients to any of our hospitals or other
facilities.
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A
shortage of qualified nurses could affect our ability to grow
and deliver quality, cost-effective care services.
We depend on qualified nurses to provide quality service to
patients in our facilities. There is currently a shortage of
qualified nurses in the markets where we operate our facilities.
This shortage of qualified nurses and the more stressful working
conditions it creates for those remaining in the profession are
increasingly viewed as a threat to patient safety and may
trigger the adoption of state and federal laws and regulations
intended to reduce that risk. For example, some states have
adopted or are considering legislation that would prohibit
forced overtime for nurses
and/or
establish mandatory staffing level requirements. Growing numbers
of nurses are also joining unions that threaten and sometimes
call work stoppages.
Historically, we have employed between approximately 100 and 265
nurses at each of our hospitals and between one and 10 at each
of our diagnostic and therapeutic facilities. When we need to
hire a replacement member of our nursing staff, it can several
weeks to recruit for the position. We estimate the cost of
recruiting and training a replacement nurse to range from
$63,000 to $77,000.
In response to the shortage of qualified nurses, we have
increased and are likely to have to continue to increase our
wages and benefits to recruit and retain nurses or to engage
expensive contract nurses until we hire permanent staff nurses.
We may not be able to increase the rates we charge to offset
increased costs. The shortage of qualified nurses has in the
past and may in the future delay our ability to achieve our
operational goals at a hospital by limiting the number of
patient beds available during the
start-up
phase of the hospital. The shortage of nurses also makes it
difficult for us in some markets to reduce personnel expense at
our facilities by implementing a reduction in the size of the
nursing staff during periods of reduced patient admissions and
procedure volumes.
We
rely heavily on our information systems and if our access to
this technology is impaired or interrupted, or if such
technology does not perform as warranted by the vendor, our
business could be harmed and we may not comply with applicable
laws and regulations.
Increasingly, our business depends in large part upon our
ability to store, retrieve, process and manage substantial
amounts of information. To achieve our strategic objectives and
to remain in compliance with various regulations, we must
continue to develop and enhance our information systems. This
may require the acquisition of equipment and third-party
software. Our inability to implement and utilize, in a
cost-effective manner, information systems that provide the
capabilities necessary for us to operate effectively, or any
interruption or loss of our information processing capabilities,
for any reason including if such systems do not perform
appropriately, could harm our business, results of operations or
financial condition.
Uninsured
risks from legal actions related to professional liability could
adversely affect our cash flow and operating
results.
In recent years, physicians, hospitals, diagnostic centers and
other healthcare providers have become subject, in the normal
course of business, to an increasing number of legal actions
alleging negligence in performing services, negligence in
allowing unqualified physicians to perform services or other
legal theories as a basis for liability. Many of these actions
involve large monetary claims and significant defense costs. We
may be subject to such legal actions even though a particular
physician at one of our hospitals or other facilities is not our
employee and the governing documents for the medical staffs of
each of our hospitals require physicians who provide services,
or conduct procedures, at our hospitals to meet all licensing
and specialty credentialing requirements and to maintain their
own professional liability insurance.
We have established a reserve for malpractice claims based on
actuarial estimates using our historical experience with
malpractice claims and assumptions about future events. Due to
the considerable variability that is inherent in such estimates,
including such factors as changes in medical costs and changes
in actual experience, there is a reasonable possibility that the
recorded estimates will change by a material amount in the near
term. Also, there can be no assurance that the ultimate
liability we experience under our self-insured retention for
medical malpractice claims will not exceed our estimates. It is
also possible that such claims could exceed the scope of
coverage, or that coverage could be denied.
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Our
results of operations may be adversely affected from time to
time by changes in treatment practice and new medical
technologies.
One major element of our business model is to focus on the
treatment of patients suffering from cardiovascular disease. Our
commitment and that of our physician partners to treating
cardiovascular disease often requires us to purchase newly
approved pharmaceuticals and devices that have been developed by
pharmaceutical and device manufacturers to treat cardiovascular
disease. At times, these new technologies receive required
regulatory approval and become widely available to the
healthcare market prior to becoming eligible for reimbursement
by government and other payors. In addition, the clinical
application of existing technologies may expand, resulting in
their increased utilization. We cannot predict when new
technologies will be available to the marketplace, the rate of
acceptance of the new technologies by physicians who practice at
our facilities, and when or if, government and third-party
payors will provide adequate reimbursement to compensate us for
all or some of the additional cost required to purchase new
technologies. As such, our results of operations may be
adversely affected from time to time by the additional,
unreimbursed cost of these new technologies.
For example, the utilization of automatic implantable
cardioverter defibrillators (AICDs) has increased due to their
clinical efficacy in treating certain types of cardiovascular
disease. AICDs are high-cost cardiac devices that cost often
exceeds the related reimbursement. We are unable to determine if
the reimbursement for these procedures will increase to a level
necessary to consistently reimburse us for the cost of the
devices.
In addition, advances in alternative cardiovascular treatments
or in cardiovascular disease prevention techniques could reduce
demand or eliminate the need for some of the services provided
at our facilities, which could adversely affect our results of
operations. Further, certain technologies may require
significant capital investments or render existing capital
obsolete which may adversely impact our cash flows or operations.
California
state law may impact our operations.
As noted, Bakersfield Heart Hospital is one of the nine
hospitals in which we have an ownership interest. The hospital
is located in Bakersfield, California and is subject to recent
California legislation. Originally enacted in 2006 and amended
effective January 1, 2008, California hospitals licensed as
general acute care hospitals are subject to certain hospital
fair pricing provisions. Each such hospital must have written
policies for charity care and discount payment policies, clearly
stated eligibility criteria and procedures for these policies, a
description of the review process, and written policies for debt
collection practices and procedures. On January 1, 2008 and
at least every other year thereafter, hospitals are required to
submit this information to the state which then makes this
information available to the public. Failure to comply with
these provisions may result in suspension or termination of a
hospitals license and is subject to a $100 per day penalty
for failure to submit require information to the state.
Additionally, effective January 1, 2009, California
licensed general acute hospitals are subject to increased
administrative penalties associated with survey deficiencies
impacting the health or safety of a patient. Deficiencies
constituting immediate jeopardy to the health or safety of a
patient are subject to graduated penalties of up to a maximum
$100,000 per violation (up from a maximum of $25,000 per
violation). Deficiencies not constituting immediate jeopardy to
the health or safety of a patient are subject to penalties up to
a maximum of $25,000 per violation (up from a maximum
of $17,500 per violation).
Additionally, hospitals are required to prevent the unlawful or
unauthorized access, use, or disclosure of a patients
medical information. Penalties for violation of this provisions
are up to $25,000 per patient, and a maximum of $17,500 for each
subsequent access, use, or disclosure of the patients
medical information.
We believe we are or will be in compliance with this new
California provisions, but there can be no assurance that
applicable regulatory agencies or individuals may challenge that
assertion.
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Item 1B.
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Unresolved
Staff Comments
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None.
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Our executive offices are located in Charlotte, North Carolina
in approximately 32,580 square feet of leased commercial
office space.
Each of the ventures we have formed to develop a hospital owns
the land and buildings of the hospital, with the exception of
the land underlying the Heart Hospital of Austin and the land
and building at Harlingen Medical Center, which are leased. Each
hospital has pledged its interest in the land and hospital
building to secure the long-term debt incurred to develop the
hospital, and substantially all the equipment located at these
hospitals is pledged as collateral to secure long-term debt.
Each entity formed to own and operate a diagnostic and
therapeutic facility leases its facility.
|
|
Item 3.
|
Legal
Proceedings
|
We are involved in various litigation and proceedings in the
ordinary course of our business. We do not believe, based on our
experience with past litigation, and taking into account our
applicable insurance coverage and the expectations of counsel
with respect to the amount of our potential liability, the
outcome of any such litigation, individually or in the
aggregate, will have a material adverse effect upon our
business, financial condition or results of operations.
|
|
Item 4.
|
Submission
of Matters to a Vote of Security Holders
|
No matters were submitted to a vote of security holders during
the fourth quarter of 2008.
28
PART II
|
|
Item 5.
|
Market
for Registrants Common Equity, Related Stockholder Matters
and Issuer Purchases of Equity Securities
|
Our common stock trades on the Nasdaq Global
Market
®
under the symbol MDTH. At December 11, 2008,
there were 19,598,693 shares of common stock outstanding,
the sale price of our common stock per share was $9.32, and
there were 42 holders of record. The following table sets forth,
for the periods indicated, the high and low sale prices per
share of our common stock as reported by the Nasdaq Global
Market
®
:
|
|
|
|
|
|
|
|
|
Year Ended September 30, 2008
|
|
High
|
|
|
Low
|
|
|
First Quarter
|
|
$
|
29.98
|
|
|
$
|
21.40
|
|
Second Quarter
|
|
|
27.00
|
|
|
|
18.02
|
|
Third Quarter
|
|
|
23.07
|
|
|
|
16.09
|
|
Fourth Quarter
|
|
|
22.69
|
|
|
|
16.97
|
|
|
|
|
|
|
|
|
|
|
Year Ended September 30, 2007
|
|
High
|
|
|
Low
|
|
|
First Quarter
|
|
$
|
31.10
|
|
|
$
|
22.75
|
|
Second Quarter
|
|
|
31.09
|
|
|
|
25.62
|
|
Third Quarter
|
|
|
34.61
|
|
|
|
27.41
|
|
Fourth Quarter
|
|
|
34.29
|
|
|
|
23.95
|
|
We have not declared or paid any cash dividends on our common
stock and do not anticipate paying cash dividends on our common
stock for the foreseeable future. The terms of our credit
agreements and the indenture governing our senior notes also
restrict our ability to pay and the amount of any cash dividends
or other distributions to our stockholders. Under the terms of
our credit agreement, we may only pay dividends if there is no
default or event of default and we are in compliance with the
restricted payment covenant and the financial ratio covenant
after giving effect to the dividend. See Note 9 to our
consolidated financial statements contained elsewhere in this
report. We anticipate that we will retain all earnings, if any,
to develop and expand our business. See
Managements Discussion and Analysis of Financial
Condition and Results of Operations Liquidity and
Capital Resources.
Payment of dividends in the future
will be at the discretion of our board of directors and will
depend upon our financial condition and operating results.
During August 2007, our board of directors approved a stock
repurchase program of up to $59.0 million. The purchases
will be made from time to time in the open market or in
privately negotiated transactions in accordance with applicable
federal and state securities laws and regulations. The extent to
which we repurchase common shares and the timing of such
repurchases will depend upon stock price, general economic and
market conditions and other corporate considerations. The
repurchase program may be discontinued at any time. Subsequent
to the approval of the stock repurchase program, the Company has
repurchased 1,885,461 shares of common stock at a total
cost of $44.4 million, with a remaining $14.6 million
available to be repurchased under the approved stock repurchase
program.
No shares were repurchased during the fourth quarter of fiscal
2008.
29
The following graph illustrates, for the period from
September 30, 2003 through September 30, 2008, the
cumulative total shareholder return of $100 invested (assuming
that all dividends, if any, were reinvested) in (1) our
common stock, (2) the NASDAQ Composite Stock Index and
(3) the S&P Health Care Facilities Index.
The comparisons in this table are required by the rules of the
Securities and Exchange Commission and, therefore, are not
intended to forecast or be indicative of possible future
performance of our common stock.
COMPARISON
OF 5 YEAR CUMULATIVE TOTAL RETURN*
Among MedCath Corporation, The NASDAQ Composite Index
And The S&P Health Care Facilities Index
|
|
*
|
$100 invested on 9/30/03 in stock & index-including
reinvestment of dividends. Fiscal year ending September 30.
|
Copyright
©
2008 S&P, a division of The McGraw-Hill Companies Inc. All
rights reserved.
30
|
|
Item 6.
|
Selected
Financial Data
|
The selected consolidated financial data have been derived from
our audited consolidated financial statements. The selected
consolidated financial data should be read in conjunction with
Managements Discussion and Analysis of Financial
Condition and Results of Operations
and our
consolidated financial statements and related notes, appearing
elsewhere in this report.
The following table sets forth our selected consolidated
financial data as of and for the years ended September 30,
2008, 2007, 2006, 2005 and 2004.
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Year Ended September 30,
|
|
|
|
2008
|
|
|
2007
|
|
|
2006
|
|
|
2005
|
|
|
2004
|
|
|
Consolidated Statement of Operations Data:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
(in thousands, except per share data)
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Net revenue
|
|
$
|
613,955
|
|
|
$
|
660,603
|
|
|
$
|
644,417
|
|
|
$
|
605,323
|
|
|
$
|
549,399
|
|
Impairment of long-lived assets and goodwill
|
|
$
|
|
|
|
$
|
|
|
|
$
|
458
|
|
|
$
|
2,662
|
|
|
$
|
6,425
|
|
Income from continuing operations before minority interest,
income taxes and discontinued operations
|
|
$
|
40,383
|
|
|
$
|
41,071
|
|
|
$
|
21,478
|
|
|
$
|
18,295
|
|
|
$
|
6,844
|
|
Income (loss) from continuing operations
|
|
$
|
14,320
|
|
|
$
|
15,251
|
|
|
$
|
3,858
|
|
|
$
|
2,693
|
|
|
$
|
(1,730
|
)
|
Income (loss) from discontinued operations
|
|
$
|
6,670
|
|
|
$
|
(3,724
|
)
|
|
$
|
8,718
|
|
|
$
|
6,098
|
|
|
$
|
(1,893
|
)
|
Net income (loss)
|
|
$
|
20,990
|
|
|
$
|
11,527
|
|
|
$
|
12,576
|
|
|
$
|
8,791
|
|
|
$
|
(3,623
|
)
|
Earnings (loss) from continuing operations per share, basic
|
|
$
|
0.72
|
|
|
$
|
0.73
|
|
|
$
|
0.21
|
|
|
$
|
0.15
|
|
|
$
|
(0.10
|
)
|
Earnings (loss) from continuing operations per share, diluted
|
|
$
|
0.71
|
|
|
$
|
0.71
|
|
|
$
|
0.20
|
|
|
$
|
0.14
|
|
|
$
|
(0.10
|
)
|
Earnings (loss) per share, basic
|
|
$
|
1.05
|
|
|
$
|
0.56
|
|
|
$
|
0.67
|
|
|
$
|
0.48
|
|
|
$
|
(0.20
|
)
|
Earnings (loss) per share, diluted
|
|
$
|
1.04
|
|
|
$
|
0.54
|
|
|
$
|
0.64
|
|
|
$
|
0.45
|
|
|
$
|
(0.20
|
)
|
Weighted average number of shares, basic(a)
|
|
|
19,996
|
|
|
|
20,872
|
|
|
|
18,656
|
|
|
|
18,286
|
|
|
|
17,984
|
|
Weighted average number of shares, diluted(a)
|
|
|
20,069
|
|
|
|
21,511
|
|
|
|
19,555
|
|
|
|
19,470
|
|
|
|
17,984
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Balance Sheet and Cash Flow Data:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
(in thousands)
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Total assets
|
|
$
|
653,456
|
|
|
$
|
678,567
|
|
|
$
|
785,849
|
|
|
$
|
763,205
|
|
|
$
|
754,236
|
|
Total long-term obligations
|
|
$
|
121,989
|
|
|
$
|
148,484
|
|
|
$
|
286,928
|
|
|
$
|
297,526
|
|
|
$
|
358,977
|
|
Net cash provided by operating activities
|
|
$
|
52,008
|
|
|
$
|
58,225
|
|
|
$
|
65,634
|
|
|
$
|
61,247
|
|
|
$
|
62,546
|
|
Net cash provided by (used in) investing activities
|
|
$
|
(5,805
|
)
|
|
$
|
(28,591
|
)
|
|
$
|
10,064
|
|
|
$
|
22,802
|
|
|
$
|
(65,430
|
)
|
Net cash used in financing activities
|
|
$
|
(78,028
|
)
|
|
$
|
(80,116
|
)
|
|
$
|
(22,165
|
)
|
|
$
|
(12,645
|
)
|
|
$
|
(19,434
|
)
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Selected Operating Data (consolidated)(b):
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Number of hospitals
|
|
|
7
|
|
|
|
7
|
|
|
|
8
|
|
|
|
8
|
|
|
|
8
|
|
Licensed beds(c)
|
|
|
509
|
|
|
|
421
|
|
|
|
533
|
|
|
|
533
|
|
|
|
533
|
|
Staffed and available beds(d)
|
|
|
464
|
|
|
|
404
|
|
|
|
516
|
|
|
|
499
|
|
|
|
469
|
|
Admissions(e)
|
|
|
29,360
|
|
|
|
35,373
|
|
|
|
37,901
|
|
|
|
36,274
|
|
|
|
34,147
|
|
Adjusted admissions(f)
|
|
|
40,971
|
|
|
|
48,306
|
|
|
|
49,622
|
|
|
|
47,234
|
|
|
|
42,956
|
|
Patient days(g)
|
|
|
107,353
|
|
|
|
120,556
|
|
|
|
124,358
|
|
|
|
126,240
|
|
|
|
118,691
|
|
Adjusted patient days(h)
|
|
|
150,559
|
|
|
|
164,131
|
|
|
|
162,813
|
|
|
|
163,420
|
|
|
|
148,907
|
|
Average length of stay(i)
|
|
|
3.66
|
|
|
|
3.41
|
|
|
|
3.28
|
|
|
|
3.48
|
|
|
|
3.48
|
|
Occupancy(j)
|
|
|
63.4
|
%
|
|
|
81.8
|
%
|
|
|
66.0
|
%
|
|
|
69.3
|
%
|
|
|
69.3
|
%
|
Inpatient catheterization procedures(k)
|
|
|
15,979
|
|
|
|
17,925
|
|
|
|
19,072
|
|
|
|
18,595
|
|
|
|
17,438
|
|
Inpatient surgical procedures(l)
|
|
|
8,383
|
|
|
|
9,481
|
|
|
|
9,973
|
|
|
|
9,936
|
|
|
|
9,057
|
|
Hospital net revenue
|
|
$
|
565,787
|
|
|
$
|
607,551
|
|
|
$
|
586,941
|
|
|
$
|
549,313
|
|
|
$
|
490,631
|
|
|
|
|
(a)
|
|
See Note 14 to the consolidated financial statements
included elsewhere in this report.
|
|
(b)
|
|
Selected operating data includes consolidated hospitals in
operation as of the end of the period reported in continuing
operations but does not include hospitals which were accounted
for using the equity method or as discontinued operations in our
consolidated financial statements. During the fourth quarter of
fiscal 2007, Harlingen Medical Center ceased to be a
consolidated subsidiary due to the sale of a portion of the
hospital.
|
31
|
|
|
(c)
|
|
Licensed beds represent the number of beds for which the
appropriate state agency licenses a facility regardless of
whether the beds are actually available for patient use.
|
|
(d)
|
|
Staffed and available beds represent the number of beds that are
readily available for patient use at the end of the period.
|
|
(e)
|
|
Admissions represent the number of patients admitted for
inpatient treatment.
|
|
(f)
|
|
Adjusted admissions is a general measure of combined inpatient
and outpatient volume. We computed adjusted admissions by
dividing gross patient revenue by gross inpatient revenue and
then multiplying the quotient by admissions.
|
|
(g)
|
|
Patient days represent the total number of days of care provided
to inpatients.
|
|
(h)
|
|
Adjusted patient days is a general measure of combined inpatient
and outpatient volume. We computed adjusted patient days by
dividing gross patient revenue by gross inpatient revenue and
then multiplying the quotient by patient days.
|
|
(i)
|
|
Average length of stay (days) represents the average number of
days inpatients stay in our hospitals.
|
|
(j)
|
|
We computed occupancy by dividing patient days by the number of
days in the period and then dividing the quotient by the number
of staffed and available beds.
|
|
(k)
|
|
Inpatients with a catheterization procedure represent the number
of inpatients with a procedure performed in one of the
hospitals catheterization labs during the period.
|
|
(l)
|
|
Inpatient surgical procedures represent the number of surgical
procedures performed on inpatients during the period.
|
|
|
Item 7.
|
Managements
Discussion and Analysis of Financial Condition and Results of
Operations
|
The following discussion and analysis of our financial
condition and results of operations should be read in
conjunction with the consolidated financial statements and
related notes included elsewhere in this report.
Overview
We are a healthcare provider focused primarily on providing high
acuity services, predominantly the diagnosis and treatment of
cardiovascular disease. We own and operate hospitals in
partnership with physicians whom we believe have established
reputations for clinical excellence. We also have partnerships
with community hospital systems, and we manage the
cardiovascular program of various hospitals operated by other
parties. We opened our first hospital in 1996 and currently have
ownership interests in and operate nine hospitals, including
seven in which we own a majority interest. Each of our
majority-owned hospitals is a freestanding, licensed general
acute care hospital that provides a wide range of health
services with a focus on cardiovascular care. Each of our
hospitals has a twenty-four hour emergency room staffed by
emergency department physicians. The hospitals in which we have
ownership interests have a total of 676 licensed beds and are
located predominately in high growth markets in seven states:
Arizona, Arkansas, California, Louisiana, New Mexico, South
Dakota, and Texas. We are currently in the process of developing
a new hospital in Kingman, Arizona. We expect this hospital to
open in late 2009 or early 2010. This hospital is designed to
accommodate a total of 106 licensed beds and will initially open
with 70 licensed beds. We expanded our patient beds by 28
licensed beds at Arkansas Heart Hospital earlier this year and
just completed a 60 bed addition at TexSAn Heart Hospital in
August 2008. We are expanding our licensed beds by 79 at
Louisiana Medical Center and Heart Hospital with remaining
capacity for an additional 40 beds at that hospital. This
expansion is expected to open in 2009. We also have plans to
expand our Bakersfield Heart Hospital by 72 inpatient beds and
16 emergency department beds that will diversify the services
offered by the hospital.
In addition to our hospitals, we currently own
and/or
manage 15 cardiac diagnostic and therapeutic facilities. Eight
of these facilities are located at hospitals operated by other
parties. These facilities offer invasive diagnostic and, in some
cases, therapeutic procedures. The remaining seven facilities
are not located at hospitals and offer only diagnostic
procedures.
We believe our facilities provide superior clinical outcomes,
which, together with our ability to provide management
capabilities and capital resources, positions us to expand upon
our relationships with physicians and community hospitals to
increase our presence in existing and new markets.
32
Basis of Consolidation.
We have included in
our consolidated financial statements hospitals and cardiac
diagnostic and therapeutic facilities over which we exercise
substantive control, including all entities in which we own more
than a 50% interest, as well as variable interest entities in
which we are the primary beneficiary. We have used the equity
method of accounting for entities, including variable interest
entities, in which we hold less than a 50% interest and over
which we do not exercise substantive control, and are not the
primary beneficiary. Accordingly, for all periods presented, one
of the hospitals in which we hold a minority interest, Avera
Heart Hospital of South Dakota, is excluded from the net revenue
and operating results of our consolidated company and our
consolidated hospital division. During the fourth quarter of
fiscal 2007, we sold a portion of our equity interest in
Harlingen Medical Center; therefore, beginning in July 2007, we
began excluding this hospital from net revenue and operating
results of our consolidated company and our consolidated
hospital division. Similarly, a number of our diagnostic and
therapeutic facilities are excluded from the net revenue and
operating results of our consolidated company and our
consolidated MedCath Partners division. Our minority interest in
the results of operations for the periods discussed for these
entities is recognized as part of the equity in net earnings of
unconsolidated affiliates in our statements of income in
accordance with the equity method of accounting.
We sold our equity interests in Tucson Heart Hospital in 2006
and we sold our equity interests in Heart Hospital of Lafayette
and the net assets of Dayton Heart Hospital in 2008.
Accordingly, for all periods presented, the results of
operations for these hospitals have been excluded from
continuing operations and are reported in income (loss) from
discontinued operations, net of taxes.
Same Facility Hospitals.
Our policy is to
include, on a same facility basis, only those facilities that
were open and operational during the full current and prior
fiscal year comparable periods. For example, on a same facility
basis for our consolidated hospital division for the fiscal year
ended September 30, 2007, we exclude the results of
operations of Harlingen Medical Center, which, during the fourth
quarter of fiscal 2007 and the entire fiscal 2008, ceased to be
a consolidated subsidiary due to the sale of a portion of the
hospital.
Revenue Sources by Division.
The largest
percentage of our net revenue is attributable to our hospital
division. The following table sets forth the percentage
contribution of each of our consolidating divisions to
consolidated net revenue in the periods indicated below.
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Year Ended September 30,
|
|
Division
|
|
2008
|
|
|
2007
|
|
|
2006
|
|
|
Hospital
|
|
|
92.6
|
%
|
|
|
92.3
|
%
|
|
|
91.6
|
%
|
MedCath Partners
|
|
|
7.0
|
%
|
|
|
7.3
|
%
|
|
|
8.0
|
%
|
Corporate and other
|
|
|
0.4
|
%
|
|
|
0.4
|
%
|
|
|
0.4
|
%
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Net Revenue
|
|
|
100.0
|
%
|
|
|
100.0
|
%
|
|
|
100.0
|
%
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Revenue Sources by Payor.
We receive payments
for our services rendered to patients from the Medicare and
Medicaid programs, commercial insurers, health maintenance
organizations, and our patients directly. Generally, our net
revenue is determined by a number of factors, including the
payor mix, the number and nature of procedures performed and the
rate of payment for the procedures. Since cardiovascular disease
disproportionately affects those age 55 and older, the
proportion of net revenue we derive from the Medicare program is
higher than that of most general acute care hospitals. The
following table sets forth the percentage of consolidated net
revenue we earned by category of payor in each of our last three
fiscal years.
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Year Ended September 30,
|
|
Payor
|
|
2008
|
|
|
2007
|
|
|
2006
|
|
|
Medicare
|
|
|
38.7
|
%
|
|
|
41.3
|
%
|
|
|
44.1
|
%
|
Medicaid
|
|
|
4.4
|
%
|
|
|
4.6
|
%
|
|
|
5.0
|
%
|
Commercial and other, including self-pay
|
|
|
56.9
|
%
|
|
|
54.1
|
%
|
|
|
50.9
|
%
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Total consolidated net revenue
|
|
|
100.0
|
%
|
|
|
100.0
|
%
|
|
|
100.0
|
%
|
|
|
|
|
|
|
|
|
|
|
|
|
|
A significant portion of our net revenue is derived from federal
and state governmental healthcare programs, including Medicare
and Medicaid, and we expect the net revenue that we receive from
the Medicare program as a
33
percentage of total consolidated net revenue will remain
significant in future periods. Our payor mix may fluctuate in
future periods due to changes in reimbursement, market and
industry trends with self-pay patients and other similar factors.
The Medicare and Medicaid programs are subject to statutory and
regulatory changes, retroactive and prospective rate
adjustments, administrative rulings, court decisions, executive
orders and freezes and funding reductions, all of which may
significantly affect our business. In addition, reimbursement is
generally subject to adjustment following audit by third party
payors, including the fiscal intermediaries who administer the
Medicare program for Centers for Medicare and Medicaid Services
(CMS). Final determination of amounts due providers under the
Medicare program often takes several years because of such
audits, as well as resulting provider appeals and the
application of technical reimbursement provisions. We believe
that adequate provision has been made for any adjustments that
might result from these programs; however, due to the complexity
of laws and regulations governing the Medicare and Medicaid
programs, the manner in which they are interpreted and the other
complexities involved in estimating our net revenue, there is a
possibility that recorded estimates will change by a material
amount in the near term. See
Business
Reimbursement
and
Regulation.
Critical
Accounting Policies and Estimates
General.
The discussion and analysis of our
financial condition and results of operations are based on our
audited consolidated financial statements, which have been
prepared in accordance with accounting principles generally
accepted in the United States of America. The preparation of
these consolidated financial statements requires us to make
estimates and assumptions that affect the reported amounts of
assets and liabilities, revenues and expenses, and related
disclosure of contingent assets and liabilities at the date of
our consolidated financial statements. We base our estimates on
historical experience and on various other assumptions that we
believe to be reasonable under the circumstances, the results of
which form the basis for making judgments about the carrying
values of assets and liabilities that are not readily apparent
from other sources. We evaluate our estimates and assumptions on
a regular basis and make changes as experience develops or new
information becomes known. Actual results may differ from these
estimates under different assumptions or conditions.
We define critical accounting policies as those that
(1) involve significant judgments and uncertainties,
(2) require estimates that are more difficult for
management to determine and (3) have the potential to
result in materially different results under different
assumptions and conditions. We believe that our critical
accounting policies are those described below. For a detailed
discussion of the application of these and other accounting
policies, see Note 2 to the consolidated financial
statements included elsewhere in this report.
Revenue Recognition.
Amounts we receive for
treatment of patients covered by governmental programs such as
Medicare and Medicaid and other third-party payors such as
commercial insurers, health maintenance organizations and
preferred provider organizations are generally less than our
established billing rates. Payment arrangements with third-party
payors may include prospectively determined rates per discharge
or per visit, a discount from established charges, per diem
payments, reimbursed costs (subject to limits)
and/or
other
similar contractual arrangements. As a result, net revenue for
services rendered to patients is reported at the estimated net
realizable amounts as services are rendered. We account for the
difference between the estimated realizable rates under the
reimbursement program and the standard billing rates as
contractual adjustments.
The majority of our contractual adjustments are system-generated
at the time of billing based on either government fee schedules
or fee schedules contained in our managed care agreements with
various insurance plans. Portions of our contractual adjustments
are performed manually and these adjustments primarily relate to
patients that have insurance plans with whom our hospitals do
not have contracts containing discounted fee schedules, also
referred to as non-contracted payors and patients that have
secondary insurance plans following adjudication by the primary
payor. Estimates of contractual adjustments are made on a
payor-specific basis and based on the best information available
regarding our interpretation of the applicable laws, regulations
and contract terms. While subsequent adjustments to the
systematic contractual allowances can arise due to denials,
short payments deemed immaterial for continued collection effort
and a variety of other reasons, such amounts have not
historically been significant.
34
We continually review the contractual estimation process to
consider and incorporate updates to the laws and regulations and
any changes in the contractual terms of our programs. Final
settlements under some of these programs are subject to
adjustment based on administrative review and audit by third
parties, which can take several years to determine. From a
procedural standpoint, for government payors, primarily
Medicare, we recognize estimated settlements in our consolidated
financial statements based on filed cost reports. We
subsequently adjust those settlements as we obtain new
information from audits or reviews by the fiscal intermediary
and, if the result of the fiscal intermediary audit or review
impacts other unsettled and open cost reports, then we recognize
the impact of those adjustments. We estimate current year
settlements based on models designed to approximate our cost
report filings and revise our estimates in February of each year
upon completion of the actual cost report and tentative
settlement. Due to the complexity of laws and regulations
governing the Medicare and Medicaid programs, the manner in
which they are interpreted, and the other complexities involved
in estimating our net revenue, there is a reasonable possibility
that recorded estimates will change by a material amount in the
near term.
We provide care to patients who meet certain criteria under our
charity care policy without charge or at amounts less than our
established rates. Because we do not pursue collection of
amounts determined to qualify as charity care, they are not
reported as net revenue.
Our managed diagnostic and therapeutic facilities and mobile
cardiac catheterization laboratories operate under various
contracts where management fee revenue is recognized under
fixed-rate and percentage-of-income arrangements as services are
rendered. In addition, certain diagnostic and therapeutic
facilities and mobile cardiac catheterization laboratories
recognize additional revenue under cost reimbursement and
equipment lease arrangements. Net revenue from our owned
diagnostic and therapeutic facilities and mobile cardiac
catheterization laboratories is reported at the estimated net
realizable amounts due from patients, third party payors, and
others as services are rendered, including estimated retroactive
adjustments under reimbursement agreements with third-party
payors.
Allowance for Doubtful Accounts.
Accounts
receivable primarily consist of amounts due from third-party
payors and patients in our hospital division. The remainder of
our accounts receivable principally consist of amounts due from
billings to hospitals for various cardiovascular care services
performed in our MedCath Partners division and amounts due under
consulting and management contracts. To provide for accounts
receivable that could become uncollectible in the future, we
establish an allowance for doubtful accounts to reduce the
carrying value of such receivables to their estimated net
realizable value. We estimate this allowance based on such
factors as payor mix, aging and the historical collection
experience and write-offs of our respective hospitals and other
business units. Adverse changes in business office operations,
payor mix, economic conditions or trends in federal and state
governmental health care reimbursement could affect our
collection of accounts receivable.
When possible, we will attempt to collect co-payments from
patients prior to admission for inpatient services as a part of
the pre-registration and registration processes. If
unsuccessful, we will also attempt to reach a mutually
agreed-upon
payment arrangement at that time. To the extent possible, the
estimated amount of the patients financial responsibility
is determined based on the services to be performed, the
patients applicable co-payment amount or percentage and
any identified remaining deductible and co-insurance
percentages. If payment arrangements are not provided upon
admission or only a partial payment is obtained, we will attempt
to collect any estimated remaining patient balance upon
discharge. We also comply with the requirements under applicable
law concerning collection of Medicare co-payments and
deductibles. Patients who come to our hospitals for outpatient
services are expected to make payment or adequate financial
arrangements before receiving services. Patients who come to the
emergency room are screened and stabilized to the extent of the
hospitals capability for any emergency medical condition
in accordance with applicable laws, rules and other regulations
in order that financial arrangements do not delay such
screening, stabilization, and appropriate disposition.
General and Professional Liability Risk.
For
the past three fiscal years we carried a one-year claims-made
policy providing coverage for medical malpractice claim amounts
of retained liability per claim, subject to an additional
amounts of retained liability per claim and an aggregate for
claims reported if deemed necessary. In June 2008, we entered
into a new one-year claims-made policy providing coverage for
medical malpractice claim amounts in excess of $2.0 million
of retained liability per claim.
35
Because of our self-insured retention levels, we are required to
recognize an estimated expense/ liability for the amount of our
retained liability applicable to each malpractice claim. As of
September 30, 2008 and September 30, 2007, the total
estimated liability for our self-insured retention on medical
malpractice claims, including an estimated amount for incurred
but not reported claims, was approximately $4.6 million and
$4.1 million, respectively, which is included in other
accrued liabilities on our consolidated balance sheets. We
maintain this reserve based on actuarial estimates prepared by
an independent third party, who bases the estimates on our
historical experience with claims and assumptions about future
events.
In addition to reserves for medical malpractice, we also
maintain reserves for our self-insured workmans
compensation, healthcare and dental coverage. As of
September 30, 2008 and September 30, 2007, our total
estimated reserve for self-insured liabilities on employee
health and dental claims was $3.2 million, which is
included in current liabilities in our consolidated balance
sheets. We maintain this reserve based on our historical
experience with claims. We maintained commercial stop loss
coverage for our health and dental insurance program of $150,000
per plan participant through June 30, 2008, at which time
the commercial stop loss coverage per plan participant increased
$25,000 to $175,000.
We continually review our estimates for self-insured liabilities
and record adjustments as experience develops or new information
becomes known. The changes to the estimated liabilities are
included in current operating results. Due to the considerable
variability that is inherent in such estimates, including such
factors as changes in medical costs and changes in actual
experience, there is a reasonable possibility that the recorded
estimates will change by a material amount in the near term.
Also, there can be no assurance that the ultimate liability will
not exceed our estimates.
Goodwill and Intangible Assets.
Goodwill
represents acquisition costs in excess of the fair value of net
identifiable tangible and intangible assets of businesses
purchased. Other intangible assets primarily consist of the
value of management contracts. With the exception of goodwill,
intangible assets are being amortized over periods ranging from
11 to 29 years. In accordance with Statement of Financial
Accounting Standards (SFAS) No. 142,
Goodwill and Other
Intangible Assets
(SFAS No. 142), we evaluate
goodwill annually on September 30 for impairment, or earlier if
indicators of potential impairment exist. The determination of
whether or not goodwill has become impaired involves a
significant level of judgment in the assumptions underlying the
approach used to determine the value of our reporting units.
Changes in our strategy
and/or
market conditions could significantly impact these judgments and
require adjustments to recorded amounts of intangible assets.
For the years ended September 30, 2008, 2007 and 2006, we
analyzed goodwill for impairment. The results of our analysis
indicated that our goodwill was not impaired and no additional
impairment was required in fiscal 2008, 2007 or 2006 for our
continuing operations. The goodwill calculation for fiscal 2008
excluded Dayton Heart Hospital, which is reported as a
discontinued operation. A separate goodwill impairment test
related to this hospital was performed and $4.6 million of
goodwill was allocated to this hospital and was written off as
part of the net gain on the sale of the hospital during the
third quarter of fiscal 2008. The goodwill calculation for
fiscal 2007 excluded Heart Hospital of Lafayette, which is
reported as a discontinued operation. A separate goodwill
impairment test related to this hospital was performed and it
was determined that goodwill impairment for this hospital did
exist. Accordingly, we recorded an impairment charge of
approximately $2.8 million during the first quarter of
fiscal 2007. The impairment charge is included as a component of
income (loss) from discontinued operations in the statement of
operations for the fiscal year ended September 30, 2007.
During the year ended September 30, 2008 the Company
purchased additional equity interests in the Heart Hospital of
New Mexico and TexSAn Heart Hospital resulting in an increase to
goodwill of $1.3 million and $0.7 million,
respectively.
Long-Lived Assets.
In accordance with
SFAS No. 144,
Accounting for the Impairment or
Disposal of Long-Lived Assets
(SFAS No. 144),
long-lived assets, other than goodwill, are evaluated for
impairment when events or changes in business circumstances
indicate that the carrying amount of the assets may not be fully
recoverable. An impairment loss would be recognized when
estimated undiscounted future cash flows expected to result from
the use of an asset and its eventual disposition are less than
its carrying amount. The determination of whether or not
long-lived assets have become impaired involves a significant
level of judgment in the assumptions underlying the approach
used to determine the estimated future cash flows expected to
result from the use of those assets. Changes
36
in our strategy, assumptions
and/or
market conditions could significantly impact these judgments and
require adjustments to recorded amounts of long-lived assets.
During the year ended September 30, 2006, the operating
performance of one of our facilities, Heart Hospital of
Lafayette, was significantly below expectations. Following the
consideration of the performance of the hospital as well as
other strategic alternatives for the hospital, we decided to
seek to dispose of the Heart Hospital of Lafayette. Accordingly,
the hospital is classified as a discontinued operation in the
accompanying financial statements. We evaluated the carrying
value of our interest in the hospital at September 30,
2006, to ensure it was equal to or greater than the fair market
value to determine whether or not impairment existed. Based upon
this evaluation it was determined that our investment in Heart
Hospital of Lafayette was not impaired and recorded no
impairment charge for the year ended September 30, 2006
related to this asset. During the year ended September 30,
2007 our impairment evaluation resulted in total impairment
charges of $4.8 million, which are included in income
(loss) from discontinued operations, net of taxes. During the
first quarter of fiscal 2008, we completed the disposition of
Heart Hospital of Lafayette.
Also during the year ended September 30, 2006, we
discontinued the implementation of certain nurse staffing
software and as a result, a $0.5 million impairment charge
was recognized to write-off the costs incurred to date on such
software.
Earnings Allocated to Minority
Interests.
Earnings allocated to minority
interests represent the allocation of profits and losses to
minority owners in our consolidated subsidiaries. Because our
hospitals are owned as joint ventures, each hospitals
earnings and losses are generally allocated for accounting
purposes to us and our physician and community hospital partners
on a pro-rata basis in accordance with the respective ownership
percentages in the hospital. If, however, the cumulative net
losses of a hospital exceed its initial capitalization and
committed capital obligations of our partners, then we are
required, in accordance with accounting principles generally
accepted in the United States of America, to recognize a
disproportionately higher share, up to 100%, of the
hospitals losses, instead of the smaller pro-rata share of
the losses that normally would be allocated to us based upon our
percentage ownership. The disproportionate allocation to us of a
hospitals losses would reduce our consolidated net income
in that reporting period. When the same hospital has earnings in
a subsequent period, a disproportionately higher share, up to
100%, of the hospitals earnings will be allocated to us to
the extent we have previously recognized a disproportionate
share of that hospitals losses. The disproportionate
allocation to us of a hospitals earnings would increase
our consolidated net income in that reporting period.
The determination of disproportionate losses to be allocated is
based on the specific terms of each hospitals operating
agreement, including each partners contributed capital,
obligation to contribute additional capital to provide working
capital loans, or to guarantee the outstanding obligations of
the hospital. During each of our fiscal years 2008, 2007 and
2006, our disproportionate recognition of earnings and losses in
our hospitals had a net positive/(negative) impact of
$0.6 million, $(0.2) million, and $(2.0) million,
respectively, on our reported income from continuing operations
before income taxes and discontinued operations.
We expect our earnings allocated to minority interests to
fluctuate in future periods as we either recognize
disproportionate losses
and/or
recoveries thereof through disproportionate profits of our
hospitals. As of September 30, 2008, we have no cumulative
disproportionate loss allocations. We could also be required to
recognize disproportionate losses at our other hospitals not
currently in a disproportionate allocation position depending on
their results of operations in future periods.
Accounting for Gains on Capital Transactions of
Subsidiary.
A gain on the issuance of units in
one of our subsidiaries, Harlingen Medical Center, LLC (HMC), is
reflected in our consolidated balance sheets for fiscal 2007 as
a component of stockholders equity, in accordance with the
provisions of Staff Accounting Bulletin Topic 5H
(SAB Topic 5H). The gain resulted from the difference
between the carrying amount of our investment in HMC prior to
the issuance of units and our equity investment immediately
following the issuance of units. We determined that recognition
of the gain as a component of equity was appropriate since HMC
has historically experienced net operating losses and due to
uncertainty surrounding future transactions that may involve
further dilution of our equity interest in HMC. Future issuances
of units to third parties will further dilute our ownership
percentage and may give rise to additional gains or losses based
on the offering price in comparison to the carrying value of our
investment.
37
Income Taxes.
Income taxes are computed on the
pretax income based on current tax law. Deferred income taxes
are recognized for the expected future tax consequences or
benefits of differences between the tax bases of assets or
liabilities and their carrying amounts in the consolidated
financial statements. A valuation allowance is provided for
deferred tax assets if it is more likely than not that these
items will either expire before we are able to realize their
benefit or their future deductibility is uncertain.
Developing the provision for income taxes requires significant
judgment and expertise in federal and state income tax laws,
regulations and strategies, including the determination of
deferred tax assets and liabilities and, if necessary, any
valuation allowances that may be required for deferred tax
assets. Our judgments and tax strategies are subject to audit by
various taxing authorities. While we believe we have provided
adequately for our income tax liabilities in our consolidated
financial statements, adverse determinations by these taxing
authorities could have a material adverse effect on our
consolidated financial condition and results of operations.
Share-Based Compensation
On October 1,
2005, the Company adopted
SFAS No. 123-R
(revised 2004),
Share-Based Payment
(SFAS No. 123-R),
which requires the measurement and recognition of compensation
expense for all share-based payment awards made to employees and
directors based on estimated fair values.
SFAS No. 123-R
requires companies to estimate the fair value of share-based
payment awards on the date of grant using an option-pricing
model and to expense the value of the portion of the award that
is ultimately expected to vest over the requisite service period
in the Companys statement of operations. Prior to the
adoption of
SFAS No. 123-R,
the Company accounted for stock options issued to employees and
directors using the intrinsic value method in accordance with
Accounting Principles Board (APB) Opinion No. 25,
Accounting for Stock Issued to Employees
(APB
No. 25), as permitted under SFAS No. 123,
Accounting for Stock-Based Compensation
(SFAS No. 123), and provided pro forma net income
and pro forma earnings per share disclosures for stock option
grants made as if the fair value method of measuring
compensation cost for stock options granted had been applied.
Under the intrinsic value method, no share-based compensation
expense was recognized for options granted with an exercise
price equal to the fair value of the underlying stock at the
grant date.
In September 2005, the compensation committee of the board of
directors approved a plan to accelerate the vesting of
substantially all unvested stock options previously awarded to
employees with the condition that the optionee enter into a sale
restriction agreement which provides that if the optionee
exercises a stock option prior to its originally scheduled
vesting date while employed by the Company, the optionee will be
prohibited from selling the share of stock acquired upon
exercise of the option until the date the option would have
become vested had it not been accelerated. All new stock options
granted since September 30, 2005 have immediate vesting
with the same sale restriction. As a result, share-based
compensation is recorded on the option grant date.
The Company adopted
SFAS No. 123-R
using the modified prospective transition method, which requires
the application of the accounting standard as of October 1,
2005, the first day of the Companys fiscal year 2006. The
Companys financial statements as of and for the years
ended September 30, 2008, 2007 and 2006 reflect the impact
of
SFAS No. 123-R.
On November 10, 2005, the FASB issued Staff Position
No. 123-R-3,
Transition Election Related to Accounting for the Tax Effects
of Share-Based Payment Awards
(Staff Position
No. 123-R-3),
which provides a simplified alternative method to calculate the
pool of excess income tax benefits upon the adoption of
SFAS No. 123-R.
The Company has elected to follow the provisions of Staff
Position
No. 123-R-3.
As required under
SFAS No. 123-R
in calculating the share-based compensation expense for the
years ended September 30, 2008, 2007 and 2006 the fair
value of each option grant was estimated on the date of grant.
The Company used the Black-Scholes option pricing model with the
range of weighted-average assumptions used for option grants
noted in the following table. The expected life of the stock
options represents the period of time that options granted are
expected to be outstanding and the range given below results
from certain groups of employees exhibiting different behavior
with respect to the options granted to them and has been
determined based on an annual analysis of historical and
expected exercise and cancellation behavior. The risk-free
interest rate is based on the US Treasury yield curve in effect
on the date of the grant. The expected volatility is based on
the historical volatilities of the Companys common stock
and the common stock of comparable publicly traded companies.
38
Results
of Operations
Fiscal
Year 2008 Compared to Fiscal Year 2007
Statement of Operations Data.
The following
table presents our results of operations in dollars and as a
percentage of net revenue:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Year Ended September 30,
|
|
|
|
|
|
|
|
|
|
|
|
|
% of Net
|
|
|
|
|
|
|
|
|
|
Increase/Decrease
|
|
|
Revenue
|
|
|
|
2008
|
|
|
2007
|
|
|
$
|
|
|
%
|
|
|
2008
|
|
|
2007
|
|
|
Net revenue
|
|
$
|
613,955
|
|
|
$
|
660,603
|
|
|
$
|
(46,648
|
)
|
|
|
(7.1
|
)%
|
|
|
100.0
|
%
|
|
|
100.0
|
%
|
Operating expenses:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Personnel expense
|
|
|
201,685
|
|
|
|
209,501
|
|
|
|
(7,816
|
)
|
|
|
(3.7
|
)%
|
|
|
32.9
|
%
|
|
|
31.7
|
%
|
Medical supplies expense
|
|
|
170,801
|
|
|
|
176,615
|
|
|
|
(5,814
|
)
|
|
|
(3.3
|
)%
|
|
|
27.8
|
%
|
|
|
26.7
|
%
|
Bad debt expense
|
|
|
43,691
|
|
|
|
51,360
|
|
|
|
(7,669
|
)
|
|
|
(14.9
|
)%
|
|
|
7.1
|
%
|
|
|
7.8
|
%
|
Other operating expenses
|
|
|
121,174
|
|
|
|
129,770
|
|
|
|
(8,596
|
)
|
|
|
(6.6
|
)%
|
|
|
19.8
|
%
|
|
|
19.7
|
%
|
Pre-opening expenses
|
|
|
786
|
|
|
|
555
|
|
|
|
231
|
|
|
|
41.6
|
%
|
|
|
0.1
|
%
|
|
|
0.1
|
%
|
Depreciation
|
|
|
30,261
|
|
|
|
31,236
|
|
|
|
(975
|
)
|
|
|
(3.1
|
)%
|
|
|
4.9
|
%
|
|
|
4.7
|
%
|
Amortization
|
|
|
560
|
|
|
|
631
|
|
|
|
(71
|
)
|
|
|
(11.3
|
)%
|
|
|
0.1
|
%
|
|
|
0.1
|
%
|
Loss on disposal of property, equipment and other assets
|
|
|
248
|
|
|
|
1,447
|
|
|
|
(1,199
|
)
|
|
|
82.9
|
%
|
|
|
0.1
|
%
|
|
|
0.2
|
%
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Income from operations
|
|
|
44,749
|
|
|
|
59,488
|
|
|
|
(14,739
|
)
|
|
|
(24.8
|
)%
|
|
|
7.2
|
%
|
|
|
9.0
|
%
|
Other income (expenses):
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Interest expense
|
|
|
(14,300
|
)
|
|
|
(22,068
|
)
|
|
|
7,768
|
|
|
|
35.2
|
%
|
|
|
(2.3
|
)%
|
|
|
(3.3
|
)%
|
Loss on early extinguishment of debt
|
|
|
|
|
|
|
(9,931
|
)
|
|
|
9,931
|
|
|
|
100.0
|
%
|
|
|
|
|
|
|
(1.5
|
)%
|
Interest and other income, net
|
|
|
2,043
|
|
|
|
7,843
|
|
|
|
(5,800
|
)
|
|
|
(74.0
|
)%
|
|
|
0.3
|
%
|
|
|
1.1
|
%
|
Equity in net earnings of unconsolidated affiliates
|
|
|
7,891
|
|
|
|
5,739
|
|
|
|
2,152
|
|
|
|
37.5
|
%
|
|
|
1.3
|
%
|
|
|
0.9
|
%
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Income from continuing operations before minority interest,
income taxes and discontinued operations
|
|
|
40,383
|
|
|
|
41,071
|
|
|
|
(688
|
)
|
|
|
(1.7
|
)%
|
|
|
6.5
|
%
|
|
|
6.2
|
%
|
Minority interest share of earnings of consolidated subsidiaries
|
|
|
(15,476
|
)
|
|
|
(13,917
|
)
|
|
|
(1,559
|
)
|
|
|
(11.2
|
)%
|
|
|
(2.5
|
)%
|
|
|
(2.1
|
)%
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Income from continuing operations before income taxes and
discontinued operations
|
|
|
24,907
|
|
|
|
27,154
|
|
|
|
(2,247
|
)
|
|
|
(8.3
|
)%
|
|
|
4.0
|
%
|
|
|
4.1
|
%
|
Income tax expense
|
|
|
10,587
|
|
|
|
11,903
|
|
|
|
(1,316
|
)
|
|
|
(11.1
|
)%
|
|
|
1.7
|
%
|
|
|
1.8
|
%
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Income from continuing operations
|
|
|
14,320
|
|
|
|
15,251
|
|
|
|
(931
|
)
|
|
|
(6.1
|
)%
|
|
|
2.3
|
%
|
|
|
2.3
|
%
|
Income (loss) from discontinued operations, net of taxes
|
|
|
6,670
|
|
|
|
(3,724
|
)
|
|
|
10,394
|
|
|
|
279.1
|
%
|
|
|
1.1
|
%
|
|
|
(0.6
|
)%
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Net income
|
|
$
|
20,990
|
|
|
$
|
11,527
|
|
|
$
|
9,463
|
|
|
|
82.1
|
%
|
|
|
3.4
|
%
|
|
|
1.7
|
%
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
During the fourth quarter of fiscal 2007, we completed a
recapitalization of Harlingen Medical Center. As part of the
recapitalization, our ownership in Harlingen Medical Center was
reduced from a majority ownership of 51.0% to a minority
ownership of 35.6%. Due to this change in ownership, we began
accounting for Harlingen Medical Center as an equity investment
at the beginning of the fiscal quarter ended September 30,
2007 as opposed to including Harlingen Medical Center in our
consolidated results of operations. As such, our fiscal year
2008 and our fourth quarter of fiscal 2007 consolidated results
exclude the financials results of Harlingen Medical Center. The
following management discussion and analysis focuses on same
facility results of operations and, therefore, excludes
Harlingen Medical Center from the results of both fiscal 2008
and fiscal 2007 when appropriate.
39
Net revenue.
Net revenue decreased 7.1% to
$614.0 million for our fiscal year ended September 30,
2008 from $660.6 million for our fiscal year ended
September 30, 2007. Of this $46.6 million decrease in
net revenue, our hospitals generated a $41.4 million
decrease, our MedCath Partners division generated a
$5.4 million decrease, our cardiology consulting and
management operations generated a $0.3 million increase,
and our corporate and other division generated a
$0.1 million decrease.
On a same facility basis our hospital net revenue increased
$14.4 million, or 2.4% from the prior fiscal year.
We have experienced a shift in inpatient to outpatient
procedures during fiscal 2008. On a same facility basis our
admissions were down 1.8% for the 2008 fiscal year compared to
the 2007 fiscal year, however our adjusted admissions, which
take into consideration outpatient visits, increased 3.8% as a
result of the shift from inpatient to outpatient procedures.
Outpatient net revenue increased from 24.9% of total same
facility hospital net revenue for fiscal 2007 to 30.8% for
fiscal 2008. During fiscal 2008 we experienced an increase in
net revenues of 66% and 67% from outpatient drug-eluting stents
and bare metal stents, respectively, when compared to fiscal
2007. Net revenue from inpatient drug-eluting stents and bare
metal stents were down 4.8% and 6.9%, respectively, on a same
facility basis in fiscal 2008 compared to fiscal 2007.
Our net revenue has been negatively impacted by an overall
increase in deductions for uncompensated care. We commonly refer
to these deductions as charity care. Charity care was
$14.4 million for fiscal 2008 compared to $4.9 million
for fiscal 2007. Charity care is recorded for patients that meet
certain federal poverty guidelines. The number of patients that
qualified for charity care increased during fiscal 2008 compared
to fiscal 2007.
During fiscal 2007, we recognized net negative contractual
adjustments to our net revenue of $0.7 million related to
the filing of our 2006 Medicare cost reports as well as other
Medicare and Medicaid settlement adjustments. Further, the
fiscal year ended September 30, 2007 was negatively
impacted as a result of recording a $5.8 million reduction
in net revenue for a portion of certain federal healthcare
billings reimbursed in prior years. See Note 12
Contingencies and Commitments
of our consolidated
financial statements. In contrast, we recognized negative
contractual adjustments to our net revenue of $2.0 million
during fiscal 2008 related to our Medicare cost reports and
other Medicare and Medicaid settlement adjustments for prior
fiscal periods.
Personnel expense.
Personnel expense decreased
3.7% to $201.7 million for fiscal 2008 from
$209.5 million for fiscal 2007. As a percentage of net
revenue, personnel expense increased to 32.9% from 31.7% for the
comparable periods.
On a same facility basis, personnel expense increased to 32.9%
of net revenue for the fiscal year ended September 30, 2008
from 31.7% for the fiscal year ended September 30, 2007.
This increase is mainly due to cost of living wage adjustments
made during the first quarter of fiscal 2008 and an increase in
labor costs due to the continued demand for nurses and other
technicians in several of our markets.
On October 1, 2005, we adopted
SFAS No. 123-R
(revised 2004),
Share-Based Payment
, which requires the
measurement and recognition of compensation expense for all
share-based payment awards made to employees and directors based
on estimated fair values. Using this methodology and since all
options are immediately vested, we recognized share-based
compensation of $5.0 million and $4.3 million for the
fiscal year ended September 2008 and 2007, respectively.
Medical supplies expense.
Medical supplies
expense decreased 3.3% to $170.8 million for fiscal 2008
from $176.6 million for fiscal 2007.
Medical supplies expense on a same facility basis decreased to
27.8% of net revenue for the fiscal year ending
September 30, 2008 compared to 27.9% for fiscal year ending
September 30, 2007. Medical supplies expense as a
percentage of adjusted admission has remained flat on a same
facility basis year over year.
Bad debt expense.
Bad debt expense decreased
14.9% to $43.7 million for fiscal 2008 from
$51.4 million for fiscal 2007. Same facility bad debt
expense increased 12.8% to $43.7 million for fiscal 2008
compared to $38.7 million for fiscal 2007. Same facility
bad debt expense also increased to 7.1% of net revenue for the
fiscal year ending September 30, 2008 compared to 6.5% for
the fiscal year ended September 30, 2007 due to a decrease
in payments and write-offs as a percentage of patient billings.
We have experienced an unfavorable trend regarding the
collection of the portion of the amount due from patients after
insurance and a decrease in the number of patients that qualify
for Medicaid.
40
Other operating expenses.
Other operating
expenses decreased 6.6% to $121.2 million for fiscal 2008
from $129.8 million for fiscal 2007. Same facility other
operating expenses increased 4.0% to $121.2 million for
fiscal 2008 compared to $116.6 million for fiscal 2007. We
continue to see an increase in contract services due to the
growth in volume at several of our facilities as well as
increased maintenance costs at our hospitals as machinery
warranties have expired at several of our facilities.
Pre-opening expenses.
We incurred
approximately $0.8 million and $0.6 million in
pre-opening expenses during fiscal 2008 and 2007. Pre-opening
expenses represent costs specifically related to projects under
development, primarily new hospitals. As of September 30,
2008 and 2007, we have one hospital under development, Hualapai
Medical Center in Kingman, Arizona. The amount of pre-opening
expenses, if any, we incur in future periods will depend on the
nature, timing and size of our development activities.
Depreciation.
Depreciation decreased 3.1% to
$30.3 million for the fiscal year ended September 30,
2008 as compared to $31.2 million for the fiscal year ended
September 30, 2007.
On a same facility basis, depreciation increased 10.5% to
$30.3 million for fiscal 2008 compared to
$27.4 million for fiscal 2007. The depreciation increase is
a result of the expansion and the investment in support software
at several of our facilities.
Loss (gain) on disposal of property, equipment and other
assets.
We incurred a loss on the disposal of
property, equipment and other assets of $1.5 million in
fiscal 2007 compared to a loss of $0.2 million in fiscal
2008. The 2007 loss was higher as a result of assets that were
disposed and replaced with improved technology to ensure the
highest state of the art care for our patients. The loss for
fiscal 2008 is also due to the replacement of aged assets offset
by a $0.2 gain on the sale of equipment by one of our managed
ventures.
Interest expense.
Interest expense decreased
35.2% to $14.3 million for fiscal 2008 compared to
$22.1 million for fiscal 2007. This $7.8 million
decrease in interest expense is primarily attributable to the
overall reduction in our outstanding debt as we repurchased
approximately $36.2 million of our senior notes, repaid
$21.2 million of our REIT loan at one of our facilities,
repaid $11.1 million of our equipment loan at another of
our facilities, and repaid $39.9 million of our senior
secured credit facility during the fiscal year ended
September 30, 2007.
Loss on early extinguishment of debt.
Loss on
early extinguishment of debt for fiscal 2007 was
$9.9 million for fiscal 2007. During the fiscal year ended
September 30, 2007, this loss consisted of a
$3.5 million repurchase premium and the write off of
approximately $1.0 million of deferred loan acquisition
costs related to the prepayment of a portion of our senior notes
in December 2006. We also wrote off $0.5 million in
deferred loan acquisition costs during fiscal 2007 related to
the prepayment of $39.9 million of our senior secured
credit facility. Further, upon early repayment of
$11.1 million of our equipment loan at one of our
facilities, we expensed approximately $0.2 million of
deferred loan acquisition costs, and as part of the Harlingen
Medical Center recapitalization transaction, we incurred a
$3.5 million repurchase premium and expensed approximately
$1.2 million of deferred loan acquisition costs. There was
no loss on early extinguishment of debt for fiscal 2008.
Interest and other income, net.
Interest and
other income, net decreased 74.0% to $2.0 million for
fiscal 2008 compared to $7.8 million for fiscal 2007. The
decrease is a result of the decrease in cash and the decrease in
interest earned on cash balances during fiscal 2008.
Equity in net earnings of unconsolidated
affiliates.
Equity in net earnings of
unconsolidated affiliates increased to $7.9 million in
fiscal 2008 from $5.7 million in fiscal 2007. The increase
is attributable to growth in earnings for our unconsolidated
affiliates related to our Hospital Division of $0.7 million
and an increase in earnings for several new ventures in our
MedCath Partners division. Equity in net earnings of
unconsolidated affiliates related to our MedCath Partners
division was $0.3 million for fiscal 2007 compared to
$2.2 million for fiscal 2008.
Minority interest share of earnings of consolidated
subsidiaries.
Minority interest share of earnings
of consolidated subsidiaries decreased $1.6 million in
fiscal 2008 compared to fiscal 2007. Our minority interest share
of earnings can fluctuate as a result of our disproportionate
share accounting for our partnership interests. Our partnership
operating agreements may call for the recognition of losses or
profits at amounts that are disproportionate to our partnership
interest.
Income tax expense.
Income tax expense was
$10.6 million for fiscal 2008 compared to
$11.9 million for fiscal 2007, which represented an
effective tax rate of approximately 42.5% and 43.8%,
respectively. The decrease in the effective tax rate is due to
the reduced impact of one-time permanent adjustments to derive
taxable income.
41
Income (loss) from discontinued operations, net of
taxes.
Income from discontinued operations, net
of taxes, reflects the results of Dayton Heart Hospital and the
Heart Hospital of Lafayette for fiscal 2007 and fiscal 2008. Net
income from discontinued operations was $6.7 million for
fiscal 2008 compared to a loss of $3.7 million for fiscal
2007. In accordance with SFAS No. 144, the Company
evaluated the carrying value of the long-lived assets related to
Heart Hospital of Lafayette during fiscal 2007 and determined
that the carrying value was in excess of the fair value.
Accordingly, an impairment charge of $4.1 million was
recorded in accordance with SFAS No. 144 during the
first quarter of fiscal 2007. The $4.1 million impairment
charge was offset by net income related to Dayton Heart Hospital
for fiscal 2007. Income from discontinued operations, net of
taxes, for fiscal 2008 includes the gain recorded as a result of
the sale of certain assets of Dayton Heart Hospital offset by
operating losses of Dayton Heart Hospital prior to the sale.
Fiscal
Year 2007 Compared to Fiscal Year 2006
Statement of Operations Data.
The following
table presents our results of operations in dollars and as a
percentage of net revenue:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Year Ended September 30,
|
|
|
|
|
|
|
|
|
|
|
|
|
% of Net
|
|
|
|
|
|
|
|
|
|
Increase/Decrease
|
|
|
Revenue
|
|
|
|
2007
|
|
|
2006
|
|
|
$
|
|
|
%
|
|
|
2007
|
|
|
2006
|
|
|
Net revenue
|
|
$
|
660,603
|
|
|
$
|
644,417
|
|
|
$
|
16,186
|
|
|
|
2.5
|
%
|
|
|
100.0
|
%
|
|
|
100.0
|
%
|
Operating expenses:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Personnel expense
|
|
|
209,501
|
|
|
|
208,530
|
|
|
|
971
|
|
|
|
0.5
|
%
|
|
|
31.7
|
%
|
|
|
32.3
|
%
|
Medical supplies expense
|
|
|
176,615
|
|
|
|
177,852
|
|
|
|
(1,237
|
)
|
|
|
(0.7
|
)%
|
|
|
26.7
|
%
|
|
|
27.6
|
%
|
Bad debt expense
|
|
|
51,360
|
|
|
|
54,051
|
|
|
|
(2,691
|
)
|
|
|
(5.0
|
)%
|
|
|
7.8
|
%
|
|
|
8.4
|
%
|
Other operating expenses
|
|
|
129,770
|
|
|
|
128,475
|
|
|
|
1,295
|
|
|
|
1.0
|
%
|
|
|
19.7
|
%
|
|
|
19.9
|
%
|
Pre-opening expenses
|
|
|
555
|
|
|
|
|
|
|
|
555
|
|
|
|
100.0
|
%
|
|
|
0.1
|
%
|
|
|
|
|
Depreciation
|
|
|
31,236
|
|
|
|
32,624
|
|
|
|
(1,388
|
)
|
|
|
(4.3
|
)%
|
|
|
4.7
|
%
|
|
|
5.1
|
%
|
Amortization
|
|
|
631
|
|
|
|
1,008
|
|
|
|
(377
|
)
|
|
|
(37.4
|
)%
|
|
|
0.1
|
%
|
|
|
0.2
|
%
|
Loss (gain) on disposal of property, equipment and other assets
|
|
|
1,447
|
|
|
|
(158
|
)
|
|
|
1,605
|
|
|
|
1015.8
|
%
|
|
|
0.2
|
%
|
|
|
|
|
Impairment of long-lived assets
|
|
|
|
|
|
|
458
|
|
|
|
(458
|
)
|
|
|
(100.0
|
)%
|
|
|
|
|
|
|
0.1
|
%
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Income from operations
|
|
|
59,488
|
|
|
|
41,577
|
|
|
|
17,911
|
|
|
|
43.1
|
%
|
|
|
9.0
|
%
|
|
|
6.4
|
%
|
Other income (expenses):
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Interest expense
|
|
|
(22,068
|
)
|
|
|
(32,742
|
)
|
|
|
10,674
|
|
|
|
32.6
|
%
|
|
|
(3.3
|
)%
|
|
|
(5.1
|
)%
|
Loss on early extinguishment of debt
|
|
|
(9,931
|
)
|
|
|
|
|
|
|
(9,931
|
)
|
|
|
(100.0
|
)%
|
|
|
(1.5
|
)%
|
|
|
|
|
Interest and other income, net
|
|
|
7,843
|
|
|
|
7,724
|
|
|
|
119
|
|
|
|
1.5
|
%
|
|
|
1.1
|
%
|
|
|
1.2
|
%
|
Equity in net earnings of unconsolidated affiliates
|
|
|
5,739
|
|
|
|
4,919
|
|
|
|
820
|
|
|
|
16.7
|
%
|
|
|
0.9
|
%
|
|
|
0.8
|
%
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Income from continuing operations before minority interest,
income taxes and discontinued operations
|
|
|
41,071
|
|
|
|
21,478
|
|
|
|
19,593
|
|
|
|
91.2
|
%
|
|
|
6.2
|
%
|
|
|
3.3
|
%
|
Minority interest share of earnings of consolidated subsidiaries
|
|
|
(13,917
|
)
|
|
|
(14,080
|
)
|
|
|
163
|
|
|
|
1.2
|
%
|
|
|
(2.1
|
)%
|
|
|
(2.2
|
)%
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Income from continuing operations before income taxes and
discontinued operations
|
|
|
27,154
|
|
|
|
7,398
|
|
|
|
19,756
|
|
|
|
267.0
|
%
|
|
|
4.1
|
%
|
|
|
1.1
|
%
|
Income tax expense
|
|
|
11,903
|
|
|
|
3,540
|
|
|
|
8,363
|
|
|
|
236.2
|
%
|
|
|
1.8
|
%
|
|
|
0.5
|
%
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Income from continuing operations
|
|
|
15,251
|
|
|
|
3,858
|
|
|
|
11,393
|
|
|
|
295.3
|
%
|
|
|
2.3
|
%
|
|
|
0.6
|
%
|
Income (loss) from discontinued operations, net of taxes
|
|
|
(3,724
|
)
|
|
|
8,718
|
|
|
|
(12,442
|
)
|
|
|
(142.7
|
)%
|
|
|
(0.6
|
)%
|
|
|
1.4
|
%
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Net income
|
|
$
|
11,527
|
|
|
$
|
12,576
|
|
|
|
(1,049
|
)
|
|
|
(8.3
|
)%
|
|
|
1.7
|
%
|
|
|
2.0
|
%
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
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|
42
During the fourth quarter of fiscal 2007, we completed a
recapitalization of Harlingen Medical Center. As part of the
recapitalization, our ownership in Harlingen Medical Center was
reduced from a majority ownership of 51.0% to a minority
ownership of 36.0%. Due to this change in ownership, we began
accounting for Harlingen Medical Center as an equity investment
at the beginning of the fiscal quarter ended September 30,
2007 as opposed to including Harlingen Medical Center in our
consolidated results of operations. As such, our fourth quarter
of fiscal 2007 consolidated results exclude the financials
results of Harlingen Medical Center. The following management
discussion and analysis focuses on same facility fluctuations
which excludes Harlingen Medical Center from the results of both
fiscal 2007 and fiscal 2006 when appropriate.
Net revenue.
Net revenue increased 2.5% to
$660.6 million for our fiscal year ended September 30,
2007 from $644.4 million for our fiscal year ended
September 30, 2006. Of this $16.2 million increase in
net revenue, our hospitals generated a $19.5 million
increase, which was partially offset by a $2.9 million
decrease in our MedCath Partners division, a $0.3 million
decrease in our cardiology consulting and management operations
and a $0.1 million decrease in our corporate and other
division.
On a same facility basis, excluding HMC from the results of both
fiscal 2007 and fiscal 2006, our hospital net revenue increased
$23.3 million, or 4.0% from the prior year.
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|
|
Same facility adjusted admissions increased 2.1% and revenue per
adjusted admissions increased 3.2% for the fiscal year ended
September 30, 2007 as compared to the fiscal year ended
September 30, 2006.
|
|
|
|
We have focused a significant amount of time and resources on
the improvement of our clinical documentation process, both on
an inpatient and outpatient basis. This focus has helped improve
our reimbursement on a per adjusted admissions basis in both
areas.
|
|
|
|
We have successfully renegotiated a number of managed care
contracts during the course of this fiscal year, which has led
to higher net revenue per admission.
|
Also contributing to the increase in net revenue over the prior
fiscal year, during the second quarter of fiscal 2007, we
recognized contractual adjustments to our net revenue of
($0.7) million for continued operations and
$2.2 million for discontinued operations related to the
filing of our 2006 Medicare cost reports as well as other
Medicare and Medicaid settlement adjustments. By contrast, we
recognized adjustments impacting our net revenue by
$1.1 million for continued operations and
($0.3) million for discontinued operations for prior period
cost reports for fiscal 2006.
Further, the fiscal year ended September 30, 2007 was
negatively impacted as a result of recording a $5.8 million
reduction in net revenue for a portion of certain federal
healthcare billings reimbursed in prior years. See Note 12
Contingencies and Commitments
.
Personnel expense.
Personnel expense increased
0.5% to $209.5 million for fiscal 2007 from
$208.5 million for fiscal 2006. As a percentage of net
revenue, personnel expense decreased to 31.7% from 32.3% for the
comparable periods. The $1.0 million increase in personnel
expense was primarily due to a $13.5 million increase for
our same facility hospital division offset by an
$8.9 million reduction in share-based compensation.
On October 1, 2005, we adopted
SFAS No. 123-R
(revised 2004),
Share-Based Payment
, which requires the
measurement and recognition of compensation expense for all
share-based payment awards made to employees and directors based
on estimated fair values. Using this methodology and since all
options are immediately vested, we recognized share-based
compensation of $4.3 million and $13.2 million for the
fiscal year ended September 2007 and 2006, respectively. Due to
the appointment of a new president and chief executive officer
as well as a new chief operating officer, the issuance of stock
options during fiscal 2006 was above normal historical activity.
For our same facility hospitals, on an adjusted patient day
basis, personnel expense decreased by 2.8% to $1,374 per
adjusted patient day for the fiscal year ended
September 30, 2007 from $1,413 per adjusted patient day for
the comparable period in the prior year. Further, excluding the
share-based compensation and the consolidated results of
Harlingen Medical Center, as a percentage of net revenue,
personnel expense increased to 31.0% for the fiscal year ended
September 30, 2007 from 29.9% for the fiscal year ended
September 30, 2006. This increase is mainly due to cost of
living wage adjustments made during the first quarter of fiscal
2007.
43
Medical supplies expense.
Medical supplies
expense decreased 0.7% to $176.6 million for fiscal 2007
from $177.9 million for fiscal 2006. Further, same facility
hospital medical supplies expense per adjusted patient day
decreased 5.1% to $1,210 for fiscal 2007 as compared to $1,275
for fiscal 2006, reflecting the decrease in overall supplies
volume as well as the shift in procedural mix from drug eluting
stents to bare metal stents. Also, our supply chain initiatives
helped us experience price reductions during the fiscal year as
we experienced a decline in our most costly medical devices.
Bad debt expense.
Bad debt expense decreased
5.0% to $51.4 million for fiscal 2007 from
$54.1 million for fiscal 2006. On a same facility basis,
bad debt expense decreased 5.7% to $38.7 million for fiscal
2007 compared to $41.1 million for fiscal 2006. We have
experienced reductions in bad debt expense due to our continued
initiatives to improve our registration process to more timely
and accurately identify patients eligible for third party
benefits and to improve processes surrounding our billing and
collection procedures.
Other operating expenses.
Other operating
expenses increased 1.0% to $129.8 million for fiscal 2007
from $128.5 million for fiscal 2006. Same facility other
operating expenses increased 3.4% from $112.7 million for
fiscal 2006 compared to $116.6 million for fiscal 2007.
During fiscal 2007, we have experienced an increase in contract
services due to the growth in volume at several of our
facilities as well as increased maintenance costs at our
hospitals as machinery warranties have expired at several of our
facilities.
Pre-opening expenses.
We incurred
approximately $0.6 million in pre-opening expenses during
fiscal 2007 while there were no pre-opening expenses incurred in
fiscal 2006. Pre-opening expenses represent costs specifically
related to projects under development, primarily new hospitals.
As of September 30, 2007, we have one hospital under
development, Hualapai Medical Center in Kingman, Arizona. The
amount of pre-opening expenses, if any, we incur in future
periods will depend on the nature, timing and size of our
development activities.
Depreciation.
Depreciation decreased 4.3% to
$31.2 million for the fiscal year ended September 30,
2007 as compared to $32.6 million for the fiscal year ended
September 30, 2006. Excluding Harlingen Medical Center,
which we began accounting for as an equity investment during the
fourth quarter of fiscal 2007, depreciation remained relatively
flat at $27.4 million for fiscal 2007 compared to
$27.6 million for fiscal 2006.
Loss (gain) on disposal of property, equipment and other
assets.
We incurred a gain on the disposal of
property, equipment and other assets of $0.1 million in
fiscal 2006 compared to a loss of $1.5 million in fiscal
2007. The current year loss is a result of several assets that
were disposed and replaced with improved technology to ensure
the highest state of the art care for our patients.
Impairment of long-lived assets.
Impairment of
long-lived assets was $0.5 million in fiscal 2006. During
fiscal 2006, management decided to discontinue the
implementation of certain nurse staffing software and as a
result, a $0.5 million impairment charge was recognized to
write-off the costs incurred to date on such software. During
fiscal 2007, no such impairment was recorded. See
Critical Accounting Policies Long-Lived
Assets.
Interest expense.
Interest expense decreased
32.6% to $22.1 million for fiscal 2007 compared to
$32.7 million for fiscal 2006. This $10.6 million
decrease in interest expense is primarily attributable to the
overall reduction in our outstanding debt as we repurchased
approximately $36.2 million of our senior notes, repaid
$21.2 million of our REIT loan at one of our facilities,
repaid $11.1 million of our equipment loan at another of
our facilities, and repaid $39.9 million of our senior
secured credit facility during the fiscal year ended
September 30, 2007.
Loss on early extinguishment of debt.
Loss on
early extinguishment of debt was $9.9 million for fiscal
2007 while we did not incur any for fiscal 2006. During the
fiscal year ended September 30, 2007, this loss consisted
of a $3.5 million repurchase premium and the write off of
approximately $1.0 million of deferred loan acquisition
costs related to the prepayment of a portion of our senior notes
in December 2006. We also wrote off $0.5 million in
deferred loan acquisition costs during fiscal 2007 related to
the prepayment of $39.9 million of our senior secured
credit facility. Further, upon early repayment of
$11.1 million of our equipment loan at one of our
facilities, we expensed approximately $0.2 million of
deferred loan acquisition costs, and as part of the Harlingen
Medical Center recapitalization transaction, we incurred a
$3.5 million repurchase premium and expensed approximately
$1.2 million of deferred loan acquisition costs.
44
Interest and other income, net.
Interest and
other income, net remained relatively flat at $7.8 million
for fiscal 2007 as compared to $7.7 million for fiscal
2006. During the fiscal year ended September 30, 2006, we
received $2.0 million as a part of a settlement agreement
related to a lawsuit. The proceeds received from the settlement
were offset in part by $0.6 million of legal fees incurred
related to the settlement. Excluding this net receipt of
$1.4 million, interest and other income, net, increased
$1.5 million from fiscal 2006 to fiscal 2007. This increase
is due to higher interest earned on available cash and cash
equivalents during the comparable periods, as well as higher
rates of return on our short-term investments.
Equity in net earnings of unconsolidated
affiliates.
Equity in net earnings of
unconsolidated affiliates increased to $5.7 million in
fiscal 2007 from $4.9 million in fiscal 2006. The increase
is attributable to growth in earnings at one of the hospitals in
which we hold less than a 50% interest, as well as growth in
earnings in various diagnostic ventures in which we hold less
than a 50% interest.
Minority interest share of earnings of consolidated
subsidiaries.
Minority interest share of earnings
of consolidated subsidiaries decreased $0.2 million in
fiscal 2007 compared to fiscal 2006. Our minority interest share
of earnings can fluctuate as a result of our disproportionate
share accounting for our partnership interests. Our partnership
operating agreements may call for the recognition of losses or
profits at amounts that are disproportionate to our partnership
interest.
Income tax expense.
Income tax expense was
$11.9 million for fiscal 2007 compared to $3.5 million
for fiscal 2006, which represented an effective tax rate of
approximately 43.8% and 47.9%, respectively. The overall
increase in the effective rate is the result of several items
that are not deductible for tax such as the exercise of
incentive stock options and penalties incurred on contingencies.
Income (loss) from discontinued operations, net of
taxes.
Income (loss) from discontinued
operations, net of taxes, reflects the results of Dayton Heart
Hospital, Heart Hospital of Lafayette and Tucson Heart Hospital
for fiscal 2006 and fiscal 2007. Net loss from discontinued
operations was ($3.7) million for fiscal 2007 compared to
net income of $8.7 million for fiscal 2006. In accordance
with SFAS No. 144, the Company evaluated the carrying
value of the long-lived assets related to Heart Hospital of
Lafayette during fiscal 2007 and determined that the carrying
value was in excess of the fair value. Accordingly, an
impairment charge of $4.1 million was recorded in
accordance with SFAS No. 144 during the first quarter
of fiscal 2007. The $4.1 million impairment charge was
offset by net income related to Dayton Heart Hospital for fiscal
2007.
45
Selected
Quarterly Results of Operations
The following table sets forth quarterly consolidated operating
results for each of our last five quarters. We have prepared
this information on a basis consistent with our audited
consolidated financial statements and included all adjustments
that we consider necessary for a fair presentation of the data.
These quarterly results are not necessarily indicative of future
results of operations. This information should be read in
conjunction with our consolidated financial statements and
related notes included elsewhere in this report.
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|
|
|
|
|
|
|
|
|
|
Three Months Ended
|
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|
|
September 30,
|
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|
June 30,
|
|
|
March 31,
|
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|
December 31,
|
|
|
September 30,
|
|
|
|
2008
|
|
|
2008
|
|
|
2008
|
|
|
2007
|
|
|
2007
|
|
|
|
|
|
|
|
|
|
(In thousands)
|
|
|
|
|
|
|
|
|
Statement of Operations Data:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Net revenue
|
|
$
|
150,921
|
|
|
$
|
157,086
|
|
|
$
|
157,098
|
|
|
$
|
148,850
|
|
|
$
|
145,084
|
|
Income from operations
|
|
|
5,157
|
|
|
|
14,051
|
|
|
|
15,385
|
|
|
|
10,156
|
|
|
|
14,405
|
|
Equity in net earnings of unconsolidated affiliates
|
|
|
1,049
|
|
|
|
2,636
|
|
|
|
2,181
|
|
|
|
2,025
|
|
|
|
(2,922
|
)
|
Minority interest share of earnings of consolidated subsidiaries
|
|
|
(1,617
|
)
|
|
|
(4,293
|
)
|
|
|
(5,114
|
)
|
|
|
(4,452
|
)
|
|
|
(4,437
|
)
|
Income from continuing operations
|
|
|
377
|
|
|
|
5,348
|
|
|
|
5,977
|
|
|
|
2,618
|
|
|
|
2,454
|
|
Income (loss) from discontinued operations
|
|
|
92
|
|
|
|
6,424
|
|
|
|
(292
|
)
|
|
|
446
|
|
|
|
(1,546
|
)
|
Net income
|
|
$
|
469
|
|
|
$
|
11,772
|
|
|
$
|
5,685
|
|
|
$
|
3,064
|
|
|
$
|
908
|
|
Earnings (loss) per share, basic Continuing operations
|
|
$
|
0.02
|
|
|
$
|
0.27
|
|
|
$
|
0.30
|
|
|
$
|
0.13
|
|
|
$
|
0.12
|
|
Discontinued operations
|
|
|
0.00
|
|
|
|
0.33
|
|
|
|
(0.01
|
)
|
|
$
|
0.01
|
|
|
|
(0.06
|
)
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Earnings (loss) per share, basic
|
|
$
|
0.02
|
|
|
$
|
0.60
|
|
|
$
|
0.29
|
|
|
$
|
0.14
|
|
|
$
|
0.06
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Earnings (loss) per share, diluted Continuing operations
|
|
$
|
0.02
|
|
|
$
|
0.27
|
|
|
$
|
0.30
|
|
|
$
|
0.12
|
|
|
$
|
0.13
|
|
Discontinued operations
|
|
|
0.00
|
|
|
|
0.33
|
|
|
|
(0.01
|
)
|
|
$
|
0.01
|
|
|
|
(0.06
|
)
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Earnings (loss) per share, diluted
|
|
$
|
0.02
|
|
|
$
|
0.60
|
|
|
$
|
0.29
|
|
|
$
|
0.13
|
|
|
$
|
0.07
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Weighted average number of shares, basic
|
|
|
19,590
|
|
|
|
19,524
|
|
|
|
19,841
|
|
|
|
21,028
|
|
|
|
21,202
|
|
Dilutive effect of stock options and restricted stock
|
|
|
65
|
|
|
|
107
|
|
|
|
121
|
|
|
|
263
|
|
|
|
579
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Weighted average number of shares, diluted
|
|
|
19,655
|
|
|
|
19,631
|
|
|
|
19,962
|
|
|
|
21,291
|
|
|
|
21,781
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Cash Flow Data:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Net cash provided by operating activities
|
|
$
|
14,526
|
|
|
$
|
17,895
|
|
|
$
|
18,766
|
|
|
$
|
821
|
|
|
$
|
14,327
|
|
Net cash provided by (used in) investing activities
|
|
$
|
(34,729
|
)
|
|
$
|
41,037
|
|
|
$
|
(22,170
|
)
|
|
$
|
10,057
|
|
|
$
|
(11,251
|
)
|
Net cash provided by (used in) financing activities
|
|
$
|
(5,494
|
)
|
|
$
|
(10,040
|
)
|
|
$
|
(25,630
|
)
|
|
$
|
(36,864
|
)
|
|
$
|
(833
|
)
|
Our results of operations historically have fluctuated on a
quarterly basis and can be expected to continue to be subject to
quarterly fluctuations. Cardiovascular procedures can often be
scheduled ahead of time, permitting some patients to choose to
undergo the procedure at a time and location of their
preference. Some of the types of trends that we have experienced
in the past and may experience again in the future include:
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|
|
|
|
the markets where some of our hospitals are located are
susceptible to seasonal population changes with part-time
residents living in the area only during certain months of the
year;
|
|
|
|
patients choosing to schedule procedures around significant
dates, such as holidays; and
|
46
|
|
|
|
|
physicians in the market where a hospital is located schedule
vacation from their practice during the summer months of the
year, around holidays and for various professional meetings held
throughout the world during the year.
|
To the extent these types of events occur in the future, as in
the past, we expect they will affect the quarterly results of
operations of our hospitals.
Liquidity
and Capital Resources
Working Capital and Cash Flow Activities.
Our
consolidated working capital was $115.1 million at
September 30, 2008 and $179.0 million at
September 30, 2007. The decrease of $63.9 million in
working capital primarily resulted from cash outflows for
capital expenditures as a result of our hospital expansions, the
repurchase of common stock under our stock repurchase program,
and the payment of federal and state income taxes offset by cash
flows from operations.
At September 30, 2008 $3.2 million of cash was
restricted and held in escrow as required by the city of
Kingman, Arizona in conjunction with the Companys
development of the Hualapai Mountain Medical Center. The
escrowed funds are released upon our completion of common
infrastructure construction projects affecting the city of
Kingman. We anticipate the completion of the related projects
and release of escrowed funds during fiscal 2009 or early 2010.
During the second quarter of fiscal 2007, we were informed by
one of our Medicare fiscal intermediaries that outlier payments
received prior to January 1, 2004 would not be disputed;
therefore, we reversed a reserve of $2.2 million that was
originally recorded to account for outlier payments that had
been received in 2003. At September 30, 2008, we continued
to carry a reserve of $9.1 million for outlier payments
received in 2004.
The cash provided by operating activities from continuing
operations was $49.0 million and $61.0 million for the
years ending September 30, 2008 and 2007, respectively. The
$12.0 million decrease is primarily attributed to the
payment of federal and state income taxes during the year ended
September 30, 2008, offset by cash flows from operations.
Our investing activities from continuing operations used net
cash of $82.0 million for fiscal 2008 compared to net cash
used of $31.8 million for fiscal 2007. Net cash used by
investing activities for the year ended September 30, 2008
and 2007 was primarily capital expenditures for the development
of our hospital in Kingman, Arizona and expansion projects at
two of our existing hospitals.
Our financing activities from continuing operations used net
cash of $64.2 million during fiscal 2008 compared to net
cash used of $77.4 million during fiscal 2007. The
$64.2 million of net cash used for financing activities for
the year ended September 30, 2008 is primarily a result of
distributions to minority partners and the repurchase of common
stock under our repurchase program. The $77.4 million of
net cash used for financing activities for the year ended
September 30, 2007 is primarily a result of distributions
to minority partners and the repayment of long-term debt and
obligations under capital leases, including a payment of
$39.9 million to pay off our senior secured credit
facility, a payment of $21.2 million to pay off one of our
facilitys REIT loans, which matured in December 2006, and
a payment of $11.1 million to pay off the equipment loan at
another of our facilities. Further, during fiscal 2007, we
completed a secondary public offering in which we sold an
additional 1.7 million shares of common stock. The proceeds
from this offering were used to prepay $36.2 million of our
senior notes.
Lease Transaction with HMC Realty.
During July
2007, Harlingen Medical Center transferred real property with a
net book value of approximately $34.3 million (fair value
of $57.8 million) to a newly formed wholly-owned limited
liability subsidiary, HMC Realty, LLC (HMC Realty), in exchange
for HMC Realtys assumption of related party and third
party debt of approximately $57.8 million. Subsequently,
Harlingen Medical Center entered into a lease agreement with HMC
Realty whereby Harlingen Medical Center will lease the real
property from HMC Realty for approximately $5.5 million
annually for 25 years. Subsequent to the transfer of assets
and debt, HMC Realty received capital contributions as described
below, and Harlingen Medical Center canceled its membership in
HMC Realty. The $57.8 million debt assumed by HMC Realty
consisted of $2.9 million owed to Valley Baptist Health
System (Valley Baptist), $11.3 million owed to us for
working capital loans, and the assumption of
47
$43.5 million in real estate debt with a third party. We
converted $9.6 million of the working capital loan with HMC
Realty into a 36% interest in HMC Realty.
Recapitalization of Harlingen Medical
Center.
During fiscal 2006, Harlingen Medical
Center entered into two $10.0 million convertible notes
with Valley Baptist. The first note could have been voluntarily
converted by the health system into a 13.2% ownership interest
in Harlingen Medical Center after the third anniversary date of
issuance, or it could have been automatically converted into an
ownership interest in Harlingen Medical Center upon the
achievement of specified financial targets contained in the debt
agreement, up until the third anniversary date of the agreement
or the fourth anniversary date of the agreement, if extended by
Harlingen Medical Center. The second note was convertible into
the same ownership interest percentage as the first note at the
discretion of the health system after the conversion of the
first note. The potential ownership interest in Harlingen
Medical Center by the health system was capped at 49%. The notes
accrued interest at 5% per annum up until the third anniversary
date, after which time the interest rate would have been
increased to 8% if the notes had not been converted.
Interest payments were due quarterly. In accordance with the
provisions of
EITF 99-1,
Accounting for Debt Convertible into the Stock of a
Consolidated Subsidiary
,
EITF 00-19,
Accounting for Derivative Financial Instruments Indexed to,
and Potentially Settled in, a Companys Own Stock
, and
EITF 01-6,
The Meaning of Indexed to a Companys Own Stock
,
the convertible notes were accounted for as convertible debt in
the accompanying consolidated balance sheets and the embedded
conversion option in the convertible notes were not accounted
for as a separate derivative.
During July 2007, we elected, along with the original physician
investors and Valley Baptist, to allow early conversion of the
Valley Baptist notes into an equity interest in Harlingen
Medical Center (the Recapitalization). Valley
Baptist converted $17.1 million of the convertible notes
into a 32.1% equity interest in Harlingen Medical Center. The
remaining $2.9 million was converted into a membership
interest in HMC Realty. Prior to the Recapitalization, Harlingen
Medical Center had approximately $12.5 million in working
capital debt outstanding with us. As a result of the
Recapitalization, we converted $1.2 million of the debt
into additional capital in Harlingen Medical Center, converted
$9.5 million into a membership interest of HMC Realty, and
were repaid the remaining balance of the working capital note.
As a result of the transactions described above, we now own a
36% interest in Harlingen Medical Center, and a 36% interest in
HMC Realty. In addition, Valley Baptist holds a 32% interest in
Harlingen Medical Center and a 19% interest in HMC Realty, and
the remaining ownership interests in both entities are held by
unrelated physician investor groups.
Prior to the Recapitalization, we consolidated Harlingen Medical
Center. As a result of the Recapitalization, our interest in
Harlingen Medical Center was diluted from 51.0% to 36.0%
effective for the fourth quarter of fiscal year 2007. We
recorded the gain resulting from the change in ownership
interest in accordance with SAB Topic 5H. The gain resulted
from the difference between the carrying amount of our
investment in Harlingen Medical Center prior to the issuance of
units and our equity investment immediately following the
issuance of units. We determined that recognition of the gain as
a capital transaction was appropriate because Harlingen Medical
Center had historically experienced net losses, and because of
uncertainty regarding the possible future occurrence of
transactions that may involve further dilution of our equity
interest in Harlingen Medical Center. Future issuances of units
to third parties, if any, will further dilute our ownership
percentage and may give rise to additional gains or losses based
on the offering price in comparison to the carrying value of our
investment.
Capital Expenditures.
Expenditures, including
accrued but unpaid amounts, for property and equipment for
fiscal years 2008 and 2007 were $85.0 million and
$36.4 million, respectively. Cash paid for property and
equipment was $67.0 million and $36.4 million for
fiscal years 2008 and 2007, respectively. For the year ended
September 30, 2008, we continued the development of our
hospital in Kingman, Arizona and the expansion projects at two
of our existing hospitals, which began during the year ended
September 30, 2007. Anticipated remaining costs to complete
our current expansion projects are estimated to be
$60.0 million. The amount of capital expenditures we incur
in future periods will depend largely on the type and size of
strategic investments we make in future periods.
48
Obligations, Commitments and Availability of
Financing.
As described more fully in the notes
to our consolidated financial statements included elsewhere in
this report, we had certain cash obligations at
September 30, 2008, which are due as follows (in thousands):
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Payments Due by Fiscal Year
|
|
|
|
2009
|
|
|
2010
|
|
|
2011
|
|
|
2012
|
|
|
2013
|
|
|
Thereafter
|
|
|
Total
|
|
|
Long-term debt
|
|
$
|
30,748
|
|
|
$
|
11,711
|
|
|
$
|
16,827
|
|
|
$
|
52,514
|
|
|
$
|
|
|
|
$
|
34,576
|
|
|
$
|
146,376
|
|
Obligations under capital leases
|
|
|
1,172
|
|
|
|
708
|
|
|
|
679
|
|
|
|
493
|
|
|
|
207
|
|
|
|
|
|
|
|
3,259
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Total debt
|
|
|
31,920
|
|
|
|
12,419
|
|
|
|
17,506
|
|
|
|
53,007
|
|
|
|
207
|
|
|
|
34,576
|
|
|
|
149,635
|
|
Other long-term obligations(1)
|
|
|
3,936
|
|
|
|
2,228
|
|
|
|
558
|
|
|
|
14
|
|
|
|
|
|
|
|
|
|
|
|
6,736
|
|
Interest on indebtedness
|
|
|
17,186
|
|
|
|
9,722
|
|
|
|
8,248
|
|
|
|
3,025
|
|
|
|
3,019
|
|
|
|
6,752
|
|
|
|
47,952
|
|
Operating leases
|
|
|
2,075
|
|
|
|
1,211
|
|
|
|
571
|
|
|
|
427
|
|
|
|
375
|
|
|
|
410
|
|
|
|
5,069
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Total(2)
|
|
$
|
55,117
|
|
|
$
|
25,580
|
|
|
$
|
26,883
|
|
|
$
|
56,473
|
|
|
$
|
3,601
|
|
|
$
|
41,738
|
|
|
$
|
209,392
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
(1)
|
|
Other long-term obligations contain revenue guarantees related
to contracts for physician services or to physician recruiting
arrangements.
|
|
(2)
|
|
In addition, we have $1.2 million in unrecognized tax
benefits.
|
During the fourth quarter of fiscal 2004, we completed our
offering of $150.0 million in aggregate principal amount of
9 7 / 8% senior notes. During November 2008, we
amended and restated our senior credit facility. The amended
credit facility provides for a three-year term loan facility in
the amount of $75.0 million (Term Loan) and a
revolving credit facility in the amount of $85.0 million
(Revolver), which includes a $25.0 million
sub-limit for the issuance of stand-by and commercial letters of
credit and a $10.0 million sub-limit for swing-line loans.
The aggregate amount available under the amended credit facility
may be increased by an amount up to $50.0 million.
Borrowings under the amended credit facility, excluding
swing-line loans, bear interest per annum at a rate equal to the
sum of LIBOR plus the applicable margin or the alternate base
rate plus the applicable margin.
The amended credit facility continues to be guaranteed jointly
and severally by us and certain of our existing and future,
direct and indirect, subsidiaries and continues to be secured by
a first priority perfected security interest in all of the
capital stock or other ownership interests owned by us and our
subsidiary guarantors in each of their subsidiaries, and,
subject to certain exceptions in the credit facility all other
present and future assets and properties of the MedCath and the
subsidiary guarantors and all the intercompany notes.
The amended credit facility requires compliance with certain
financial covenants including a consolidated senior secured
leverage ratio test, a consolidated fixed charge coverage ratio
test and a consolidated total leverage ratio test. The amended
credit facility also contains customary restrictions on, among
other things, our and our subsidiaries ability to incur
liens; engage in mergers, consolidations and sales of assets;
incur debt; declare dividends; redeem stock and repurchase,
redeem
and/or
repay
other debt; make loans, advances and investments and
acquisitions; and entering into transactions with affiliates.
The amended credit facility contains events of default,
including cross-defaults to certain indebtedness, change of
control events and events of default customary for syndicated
commercial credit facilities. Upon the occurrence of an event of
default, we could be required to immediately repay all
outstanding amounts under the amended credit facility.
We are required to make mandatory prepayments of principal in
specified amounts upon the occurrence of certain events
identified in the amended credit facility and are permitted to
make voluntary prepayments of principal under the amended credit
facility. The Term Loan is subject to amortization of principal
in quarterly installments commencing on March 31, 2010. The
maturity date of the Term Loan and Revolver is November 10,
2011.
The Company will use the proceeds of the $75.0 million Term
Loan, along with cash on hand, to repurchase all of the
Companys $102.0 million outstanding
9
7
/
8
% senior
notes, plus pay the notes repurchase premium of
49
approximately $5.0 million. In addition to the repurchase
premium, the Company will incur approximately $2.0 million
in expense in its first quarter of fiscal 2009, ending
December 31, 2008, related to the write-off of previously
incurred financing cost.
At September 30, 2008, we had $149.6 million of
outstanding debt, $31.9 million of which was classified as
current. The $27.0 million of the senior notes are
classified as current as of September 30, 2008 as we have
secured long term financing, as discussed above, for the
remaining $75.0 million. Of the outstanding debt,
$102.0 million was outstanding under our
9
7
/
8
% senior
notes and $47.2 million was outstanding to lenders to our
hospitals. The remaining $0.4 million of debt was
outstanding to lenders for MedCath Partners diagnostic
services under capital leases and other miscellaneous
indebtedness. No amounts were outstanding to lenders under our
current $100.0 million revolving credit facility at
September 30, 2008. At the same date, however, we had
letters of credit outstanding of $1.7 million, which
reduced our availability under this facility to
$98.3 million.
During the first quarter of fiscal 2007, we sold
1.7 million shares of common stock to the public. The
$39.7 million in net proceeds from this offering were used
to repurchase approximately $36.2 million of our
outstanding senior notes and to pay approximately
$3.5 million of associated premiums and expenses associated
with the note repurchase.
Covenants related to our long-term debt restrict the payment of
dividends and require the maintenance of specific financial
ratios and amounts and periodic financial reporting. At
September 30, 2007, we were in violation of a financial
covenant under an equipment loan to Heart Hospital of Lafayette.
Heart Hospital of Lafayette is classified as a discontinued
operation. Accordingly, the total outstanding balance of this
loan has been included in current liabilities of discontinued
operations on the consolidated balance sheet as of
September 30, 2007. The equipment loan was subsequently
paid as part of the sale of the Heart Hospital of Lafayette. See
Note 3 to our consolidated financial statements. We were in
compliance with all other covenants in the instruments governing
our outstanding debt at September 30, 2008.
At September 30, 2008, we guaranteed either all or a
portion of the obligations of our subsidiary hospitals for
equipment and other notes payable. We provide these guarantees
in accordance with the related hospital operating agreements,
and we receive a fee for providing these guarantees from the
hospitals or the physician investors.
We also guarantee approximately 30% of certain equipment debt of
Avera Heart Hospital of South Dakota, a hospital in which we own
a minority interest at September 30, 2008, and therefore do
not consolidate the hospitals results of operations and
financial position. We provide this guarantee in exchange for a
fee from the hospital. At September 30, 2008, Avera Heart
Hospital of South Dakota was in compliance with all covenants in
the instruments governing its debt. Equipment debt guaranteed by
us was immaterial at September 30, 2008.
See Note 9 to the consolidated financial statements
included elsewhere in this report for additional discussion of
the terms, covenants and repayment schedule surrounding our debt.
We believe that internally generated cash flows and available
borrowings under our amended credit facility will be sufficient
to finance our business plan, capital expenditures and our
working capital requirements for the next 12 to 18 months.
Intercompany Financing Arrangements.
We
provide secured real estate, equipment and working capital
financings to our majority-owned hospitals. The aggregate amount
of the intercompany real estate, equipment and working capital
and other loans outstanding as of September 30, 2008 was
$253.6 million.
Each intercompany real estate loan is separately documented and
secured with a lien on the borrowing hospitals real
estate, building and equipment and certain other assets. Each
intercompany real estate loan typically matures in 2 to
10 years and accrues interest at variable rates based on
LIBOR plus an applicable margin or a fixed rate similar to terms
commercially available.
Each intercompany equipment loan is separately documented and
secured with a lien on the borrowing hospitals equipment
and certain other assets. Amounts borrowed under the
intercompany equipment loans are payable in monthly installments
of principal and interest over terms that range from 5 to
7 years. The intercompany
50
equipment loans accrue interest at fixed rates ranging from
6.58% to 8.58% or variable rates based on LIBOR plus an
applicable margin. The weighted average interest rate for the
intercompany equipment loans at September 30, 2008 was
8.05%.
We typically receive a fee from the minority partners in the
subsidiary hospitals as consideration for providing these
intercompany real estate and equipment loans.
We also use intercompany financing arrangements to provide cash
support to individual hospitals for their working capital and
other corporate needs. We provide these working capital loans
pursuant to the terms of the operating agreements between our
physician and hospital investor partners and us at each of our
hospitals. These intercompany loans are evidenced by promissory
notes that establish borrowing limits and provide for a market
rate of interest to be paid to us on outstanding balances. These
intercompany loans are subordinate to each hospitals
mortgage and equipment debt outstanding, but are senior to our
equity interests and our partners equity interests in the
hospital venture and are secured, subject to the prior rights of
the senior lenders, in each instance by a pledge of certain of
the borrowing hospitals assets. Also as part of our
intercompany financing and cash management structure, we sweep
cash from individual hospitals as amounts are available in
excess of the individual hospitals working capital needs.
These funds are advanced pursuant to cash management agreements
with the individual hospital that establish the terms of the
advances and provide for a rate of interest to be paid
consistent with the market rate earned by us on the investment
of its funds. These cash advances are due back to the individual
hospital on demand and are subordinate to our equity investment
in the hospital venture. As of September 30, 2008 and
September 30, 2007, we held $19.8 million and
$33.0 million, respectively, of intercompany working
capital and other notes and related accrued interest, net of
advances from our hospitals.
Because these intercompany notes receivable and related interest
income are eliminated with the corresponding notes payable and
interest expense at our consolidating hospitals in the process
of preparing our consolidated financial statements in accordance
with accounting principles generally accepted in the United
States of America, the amounts outstanding under these notes do
not appear in our consolidated financial statements or
accompanying notes. Information about the aggregate amount of
these notes outstanding from time to time may be helpful,
however, in understanding the amount of our total investment in
our hospitals. In addition, we believe investors and others will
benefit from a greater understanding of the significance of the
priority rights we have under these intercompany notes
receivable to distributions of cash by our hospitals as funds
are generated from future operations, a potential sale of a
hospital, or other sources. Because these notes receivable are
senior to the equity interests of MedCath and our partners in
each hospital, in the event of a sale of a hospital, the
hospital would be required first to pay to us any balance
outstanding under its intercompany notes prior to distributing
any of the net proceeds of the sale to any of the
hospitals equity investors as a return on their investment
based on their pro-rata ownership interests. Also, appropriate
payments to us to amortize principal balances outstanding and to
pay interest due under these notes are generally made to us from
a hospitals available cash flows prior to any pro-rata
distributions of a hospitals earnings to the equity
investors in the hospitals.
Off-Balance Sheet Arrangements.
The
Companys off-balance sheet arrangements consist of
guarantees of consolidated and unconsolidated subsidiary
equipment loans and operating leases that are reflected in the
table above and as discussed in Notes 9 and 12,
respectively, in the consolidated financial statements.
Reimbursement,
Legislative and Regulatory Changes
Legislative and regulatory action has resulted in continuing
changes in reimbursement under the Medicare and Medicaid
programs that will continue to limit payments we receive under
these programs. Within the statutory framework of the Medicare
and Medicaid programs, there are substantial areas subject to
legislative and regulatory changes, administrative rulings,
interpretations, and discretion which may further affect
payments made under those programs, and the federal and state
governments may, in the future, reduce the funds available under
those programs or require more stringent utilization and quality
reviews of our hospitals or require other changes in our
operations. Additionally, there may be a continued rise in
managed care programs and future restructuring of the financing
and delivery of healthcare in the United States. These events
could have an adverse effect on our future financial results.
See
Item 1A: Risk Factors Reductions or
changes in reimbursement from government or third-party payors
could adversely impact our operating results
.
51
Inflation
The healthcare industry is labor intensive. Wages and other
expenses increase during periods of inflation and when labor
shortages, such as the growing nationwide shortage of qualified
nurses, occur in the marketplace. In addition, suppliers pass
along rising costs to us in the form of higher prices. We have
implemented cost control measures, including our case and
resource management program, to curb increases in operating
costs and expenses. We have, to date, offset increases in
operating costs by increasing reimbursement for services and
expanding services. However, we cannot predict our ability to
cover, or offset, future cost increases.
|
|
Item 7A.
|
Quantitative
and Qualitative Disclosures About Market Risk
|
We maintain a policy for managing risk related to exposure to
variability in interest rates, commodity prices, and other
relevant market rates and prices which includes considering
entering into derivative instruments (freestanding derivatives),
or contracts or instruments containing features or terms that
behave in a manner similar to derivative instruments (embedded
derivatives) in order to mitigate our risks. In addition, we may
be required to hedge some or all of our market risk exposure,
especially to interest rates, by creditors who provide debt
funding to us. Currently one of our hospitals in which we have a
minority interest and account for under the equity method
entered into an interest rate swap during fiscal 2006 for
purposes of hedging variable interest payments on long term debt
outstanding for that hospital. The interest rate swap is
accounted for as a cash flow hedge by the hospital whereby
changes in the fair value of the interest rate swap flow through
comprehensive income of the hospital. Potential losses of
earnings and cash flows due to the market risk of the
aforementioned interest rate swap are immaterial. As of
September 30, 2008, our indebtedness accrued interest based
on fixed rates.
52
|
|
Item 8.
|
Financial
Statements and Supplementary Data
|
INDEX TO
FINANCIAL STATEMENTS
MEDCATH
CORPORATION AND SUBSIDIARIES
|
|
|
|
|
|
|
Page
|
|
|
|
|
54
|
|
CONSOLIDATED FINANCIAL STATEMENTS:
|
|
|
|
|
|
|
|
55
|
|
|
|
|
56
|
|
|
|
|
57
|
|
|
|
|
58
|
|
|
|
|
59
|
|
HEART
HOSPITAL OF SOUTH DAKOTA, LLC
|
|
|
|
|
|
|
Page
|
|
|
|
|
96
|
|
FINANCIAL STATEMENTS:
|
|
|
|
|
|
|
|
97
|
|
|
|
|
98
|
|
|
|
|
99
|
|
|
|
|
100
|
|
|
|
|
101
|
|
53
REPORT OF
INDEPENDENT REGISTERED PUBLIC ACCOUNTING FIRM
To the Board of Directors and Stockholders of
MedCath Corporation
Charlotte, North Carolina
We have audited the accompanying consolidated balance sheets of
MedCath Corporation and subsidiaries (the Company)
as of September 30, 2008 and 2007, and the related
consolidated statements of income, stockholders equity,
and cash flows for each of the three years in the period ended
September 30, 2008. These financial statements are the
responsibility of the Companys management. Our
responsibility is to express an opinion on these financial
statements based on our audits.
We conducted our audits 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. An audit also includes assessing the
accounting principles used and significant estimates made by
management, as well as evaluating the overall financial
statement presentation. We believe that our audits provide a
reasonable basis for our opinion.
In our opinion, such consolidated financial statements present
fairly, in all material respects, the financial position of the
Company at September 30, 2008 and 2007, and the results of
its operations and its cash flows for each of the three years in
the period ended September 30, 2008, in conformity with
accounting principles generally accepted in the United States of
America.
We have also audited, in accordance with the standards of the
Public Company Accounting Oversight Board (United States), the
Companys internal control over financial reporting as of
September 30, 2008, based on the criteria established in
Internal Control Integrated Framework
issued
by the Committee of Sponsoring Organizations of the Treadway
Commission and our report dated December 15, 2008 expressed
an unqualified opinion on the Companys internal control
over financial reporting.
DELOITTE & TOUCHE LLP
Charlotte, North Carolina
December 15, 2008
54
MEDCATH
CORPORATION
CONSOLIDATED
BALANCE SHEETS
(In thousands, except per share data)
|
|
|
|
|
|
|
|
|
|
|
September 30,
|
|
|
|
2008
|
|
|
2007
|
|
|
Current assets:
|
|
|
|
|
|
|
|
|
Cash and cash equivalents
|
|
$
|
94,174
|
|
|
$
|
140,276
|
|
Restricted cash
|
|
|
3,154
|
|
|
|
|
|
Accounts receivable, net
|
|
|
84,791
|
|
|
|
85,943
|
|
Income tax receivable, net
|
|
|
3,091
|
|
|
|
|
|
Medical supplies
|
|
|
16,070
|
|
|
|
13,928
|
|
Deferred income tax assets
|
|
|
9,769
|
|
|
|
12,389
|
|
Prepaid expenses and other current assets
|
|
|
9,893
|
|
|
|
6,197
|
|
Current assets of discontinued operations
|
|
|
18,834
|
|
|
|
22,832
|
|
|
|
|
|
|
|
|
|
|
Total current assets
|
|
|
239,776
|
|
|
|
281,565
|
|
Property and equipment, net
|
|
|
323,780
|
|
|
|
270,663
|
|
Investments in affiliates
|
|
|
15,285
|
|
|
|
5,718
|
|
Goodwill
|
|
|
60,174
|
|
|
|
62,740
|
|
Other intangible assets, net
|
|
|
6,063
|
|
|
|
6,448
|
|
Other assets
|
|
|
8,378
|
|
|
|
6,531
|
|
Long-term assets of discontinued operations
|
|
|
|
|
|
|
44,902
|
|
|
|
|
|
|
|
|
|
|
Total assets
|
|
$
|
653,456
|
|
|
$
|
678,567
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Current liabilities:
|
|
|
|
|
|
|
|
|
Accounts payable
|
|
$
|
41,739
|
|
|
$
|
30,933
|
|
Income tax payable
|
|
|
|
|
|
|
10,552
|
|
Accrued compensation and benefits
|
|
|
16,885
|
|
|
|
18,567
|
|
Other accrued liabilities
|
|
|
24,134
|
|
|
|
13,421
|
|
Current portion of long-term debt and obligations under capital
leases
|
|
|
31,920
|
|
|
|
4,089
|
|
Current liabilities of discontinued operations
|
|
|
9,994
|
|
|
|
24,962
|
|
|
|
|
|
|
|
|
|
|
Total current liabilities
|
|
|
124,672
|
|
|
|
102,524
|
|
Long-term debt
|
|
|
115,628
|
|
|
|
146,398
|
|
Obligations under capital leases
|
|
|
2,087
|
|
|
|
1,793
|
|
Deferred income tax liabilities
|
|
|
12,352
|
|
|
|
12,018
|
|
Other long-term obligations
|
|
|
4,454
|
|
|
|
460
|
|
Long-term liabilities of discontinued operations
|
|
|
|
|
|
|
13
|
|
|
|
|
|
|
|
|
|
|
Total liabilities
|
|
|
259,193
|
|
|
|
263,206
|
|
|
|
|
|
|
|
|
|
|
Commitments and contingencies
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Minority interest in equity of consolidated subsidiaries
|
|
|
24,667
|
|
|
|
29,737
|
|
|
|
|
|
|
|
|
|
|
Stockholders equity:
|
|
|
|
|
|
|
|
|
Preferred stock, $0.01 par value, 10,000,000 shares
authorized; none issued
|
|
|
|
|
|
|
|
|
Common stock, $0.01 par value, 50,000,000 shares
authorized; 21,553,054 issued and 19,598,693 outstanding at
September 30, 2008 21,271,144 issued and 21,202,244
outstanding at September 30, 2007
|
|
|
216
|
|
|
|
213
|
|
Paid-in capital
|
|
|
455,494
|
|
|
|
447,688
|
|
Accumulated deficit
|
|
|
(41,138
|
)
|
|
|
(61,821
|
)
|
Accumulated other comprehensive loss
|
|
|
(179
|
)
|
|
|
(62
|
)
|
Treasury stock, at cost; 1,954,361 shares at
September 30, 2008 and 68,900 shares at
September 30, 2007
|
|
|
(44,797
|
)
|
|
|
(394
|
)
|
|
|
|
|
|
|
|
|
|
Total stockholders equity
|
|
|
369,596
|
|
|
|
385,624
|
|
|
|
|
|
|
|
|
|
|
Total liabilities and stockholders equity
|
|
$
|
653,456
|
|
|
$
|
678,567
|
|
|
|
|
|
|
|
|
|
|
See notes to consolidated financial statements.
55
MEDCATH
CORPORATION
CONSOLIDATED
STATEMENTS OF INCOME
(In thousands, except per share data)
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Year Ended September 30,
|
|
|
|
2008
|
|
|
2007
|
|
|
2006
|
|
|
Net revenue
|
|
$
|
613,955
|
|
|
$
|
660,603
|
|
|
$
|
644,417
|
|
Operating expenses:
|
|
|
|
|
|
|
|
|
|
|
|
|
Personnel expense
|
|
|
201,685
|
|
|
|
209,501
|
|
|
|
208,530
|
|
Medical supplies expense
|
|
|
170,801
|
|
|
|
176,615
|
|
|
|
177,852
|
|
Bad debt expense
|
|
|
43,691
|
|
|
|
51,360
|
|
|
|
54,051
|
|
Other operating expenses
|
|
|
121,174
|
|
|
|
129,770
|
|
|
|
128,475
|
|
Pre-opening expenses
|
|
|
786
|
|
|
|
555
|
|
|
|
|
|
Depreciation
|
|
|
30,261
|
|
|
|
31,236
|
|
|
|
32,624
|
|
Amortization
|
|
|
560
|
|
|
|
631
|
|
|
|
1,008
|
|
Loss (gain) on disposal of property, equipment and other assets
|
|
|
248
|
|
|
|
1,447
|
|
|
|
(158
|
)
|
Impairment of long-lived assets
|
|
|
|
|
|
|
|
|
|
|
458
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Total operating expenses
|
|
|
569,206
|
|
|
|
601,115
|
|
|
|
602,840
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Income from operations
|
|
|
44,749
|
|
|
|
59,488
|
|
|
|
41,577
|
|
Other income (expenses):
|
|
|
|
|
|
|
|
|
|
|
|
|
Interest expense
|
|
|
(14,300
|
)
|
|
|
(22,068
|
)
|
|
|
(32,742
|
)
|
Loss on early extinguishment of debt
|
|
|
|
|
|
|
(9,931
|
)
|
|
|
|
|
Interest and other income
|
|
|
2,043
|
|
|
|
7,843
|
|
|
|
7,724
|
|
Equity in net earnings of unconsolidated affiliates
|
|
|
7,891
|
|
|
|
5,739
|
|
|
|
4,919
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Total other expenses, net
|
|
|
(4,366
|
)
|
|
|
(18,417
|
)
|
|
|
(20,099
|
)
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Income from continuing operations before minority interest,
incomes taxes and discontinued operations
|
|
|
40,383
|
|
|
|
41,071
|
|
|
|
21,478
|
|
Minority interest share of earnings of consolidated subsidiaries
|
|
|
(15,476
|
)
|
|
|
(13,917
|
)
|
|
|
(14,080
|
)
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Income from continuing operations before income taxes and
discontinued operations
|
|
|
24,907
|
|
|
|
27,154
|
|
|
|
7,398
|
|
Income tax expense
|
|
|
10,587
|
|
|
|
11,903
|
|
|
|
3,540
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Income from continuing operations
|
|
|
14,320
|
|
|
|
15,251
|
|
|
|
3,858
|
|
Income (loss) from discontinued operations, net of taxes
|
|
|
6,670
|
|
|
|
(3,724
|
)
|
|
|
8,718
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Net income
|
|
$
|
20,990
|
|
|
$
|
11,527
|
|
|
$
|
12,576
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Earnings per share, basic
|
|
|
|
|
|
|
|
|
|
|
|
|
Continuing operations
|
|
$
|
0.72
|
|
|
$
|
0.73
|
|
|
$
|
0.21
|
|
Discontinued operations
|
|
|
0.33
|
|
|
|
(0.17
|
)
|
|
|
0.46
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Earnings per share, basic
|
|
$
|
1.05
|
|
|
$
|
0.56
|
|
|
$
|
0.67
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Earnings per share, diluted
|
|
|
|
|
|
|
|
|
|
|
|
|
Continuing operations
|
|
$
|
0.71
|
|
|
$
|
0.71
|
|
|
$
|
0.20
|
|
Discontinued operations
|
|
|
0.33
|
|
|
|
(0.17
|
)
|
|
|
0.44
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Earnings per share, diluted
|
|
$
|
1.04
|
|
|
$
|
0.54
|
|
|
$
|
0.64
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Weighted average number of shares, basic
|
|
|
19,996
|
|
|
|
20,872
|
|
|
|
18,656
|
|
Dilutive effect of stock options and restricted stock
|
|
|
73
|
|
|
|
639
|
|
|
|
899
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Weighted average number of shares, diluted
|
|
|
20,069
|
|
|
|
21,511
|
|
|
|
19,555
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
See notes to consolidated financial statements.
56
MEDCATH
CORPORATION
CONSOLIDATED
STATEMENTS OF STOCKHOLDERS EQUITY
(In thousands)
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Accumulated
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Other
|
|
|
|
|
|
|
|
|
|
|
|
|
Common Stock
|
|
|
Paid-in
|
|
|
Accumulated
|
|
|
Comprehensive
|
|
|
Treasury Stock
|
|
|
|
|
|
|
Shares
|
|
|
Par Value
|
|
|
Capital
|
|
|
Deficit
|
|
|
Income (Loss)
|
|
|
Shares
|
|
|
Amount
|
|
|
Total
|
|
|
Balance, September 30, 2005
|
|
|
18,563
|
|
|
$
|
186
|
|
|
$
|
368,849
|
|
|
$
|
(85,924
|
)
|
|
$
|
24
|
|
|
|
69
|
|
|
$
|
(394
|
)
|
|
$
|
282,741
|
|
Exercise of stock options, including income tax benefit
|
|
|
597
|
|
|
|
6
|
|
|
|
9,190
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
9,196
|
|
Share-based compensation expense
|
|
|
|
|
|
|
|
|
|
|
13,222
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
13,222
|
|
Comprehensive income:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Net income
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
12,576
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
12,576
|
|
Change in fair value of interest rate swaps, net of income tax
benefit(*)
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
(75
|
)
|
|
|
|
|
|
|
|
|
|
|
(75
|
)
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Total comprehensive income
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
12,501
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Balance, September 30, 2006
|
|
|
19,160
|
|
|
|
192
|
|
|
|
391,261
|
|
|
|
(73,348
|
)
|
|
|
(51
|
)
|
|
|
69
|
|
|
|
(394
|
)
|
|
|
317,660
|
|
Exercise of stock options, including income tax benefit
|
|
|
411
|
|
|
|
4
|
|
|
|
7,879
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
7,883
|
|
Secondary public offering
|
|
|
1,700
|
|
|
|
17
|
|
|
|
39,641
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
39,658
|
|
Share-based compensation expense
|
|
|
|
|
|
|
|
|
|
|
4,338
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
4,338
|
|
Gain on capital transaction of subsidiary, net of tax
|
|
|
|
|
|
|
|
|
|
|
4,569
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
4,569
|
|
Comprehensive income:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Net income
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
11,527
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
11,527
|
|
Change in fair value of interest rate swaps, net of income tax
benefit(*)
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
(11
|
)
|
|
|
|
|
|
|
|
|
|
|
(11
|
)
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Total comprehensive income
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
11,516
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Balance, September 30, 2007
|
|
|
21,271
|
|
|
|
213
|
|
|
|
447,688
|
|
|
|
(61,821
|
)
|
|
|
(62
|
)
|
|
|
69
|
|
|
|
(394
|
)
|
|
|
385,624
|
|
Cumulative impact of change in accounting principle
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
(307
|
)
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
(307
|
)
|
Exercise of stock options, including income tax benefit
|
|
|
282
|
|
|
|
3
|
|
|
|
4,741
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
4,744
|
|
Share buyback
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
1,885
|
|
|
|
(44,403
|
)
|
|
|
(44,403
|
)
|
Share-based compensation expense
|
|
|
|
|
|
|
|
|
|
|
4,978
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
4,978
|
|
Tax impact of cancellation of stock options
|
|
|
|
|
|
|
|
|
|
|
(1,913
|
)
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
(1,913
|
)
|
Comprehensive income:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Net income
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
20,990
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
20,990
|
|
Change in fair value of interest rate swaps, net of income tax
benefit(*)
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
(117
|
)
|
|
|
|
|
|
|
|
|
|
|
(117
|
)
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Total comprehensive income
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
20,873
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Balance, September 30, 2008
|
|
|
21,553
|
|
|
$
|
216
|
|
|
$
|
455,494
|
|
|
$
|
(41,138
|
)
|
|
$
|
(179
|
)
|
|
|
1,954
|
|
|
$
|
(44,797
|
)
|
|
$
|
369,596
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
(*)
|
|
Tax benefits were $77, $7, and $50
for the years ended September 30, 2008, 2007 and 2006,
respectively.
|
See notes to consolidated financial statements.
57
MEDCATH
CORPORATION
CONSOLIDATED
STATEMENTS OF CASH FLOWS
(In thousands)
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Year Ended September 30,
|
|
|
|
2008
|
|
|
2007
|
|
|
2006
|
|
|
Net income
|
|
$
|
20,990
|
|
|
$
|
11,527
|
|
|
$
|
12,576
|
|
Adjustments to reconcile net income to net cash provided by
operating activities:
|
|
|
|
|
|
|
|
|
|
|
|
|
(Income) loss from discontinued operations, net of taxes
|
|
|
(6,670
|
)
|
|
|
3,724
|
|
|
|
(8,718
|
)
|
Bad debt expense
|
|
|
43,691
|
|
|
|
51,360
|
|
|
|
54,051
|
|
Depreciation
|
|
|
30,261
|
|
|
|
31,236
|
|
|
|
32,624
|
|
Amortization
|
|
|
560
|
|
|
|
631
|
|
|
|
1,008
|
|
Excess income tax benefit on exercised stock options
|
|
|
(608
|
)
|
|
|
(2,080
|
)
|
|
|
(2,697
|
)
|
Loss (gain) on disposal of property, equipment and other assets
|
|
|
248
|
|
|
|
1,447
|
|
|
|
(158
|
)
|
Share-based compensation expense
|
|
|
4,978
|
|
|
|
4,338
|
|
|
|
13,222
|
|
Impairment of long-lived assets
|
|
|
|
|
|
|
|
|
|
|
458
|
|
Amortization of loan acquisition costs
|
|
|
879
|
|
|
|
3,858
|
|
|
|
2,907
|
|
Equity in earnings of unconsolidated affiliates, net of
dividends received
|
|
|
(224
|
)
|
|
|
(2,458
|
)
|
|
|
(2,071
|
)
|
Minority interest share of earnings of consolidated subsidiaries
|
|
|
15,476
|
|
|
|
13,917
|
|
|
|
14,080
|
|
Change in fair value of interest rate swaps
|
|
|
|
|
|
|
|
|
|
|
(75
|
)
|
Deferred income taxes
|
|
|
3,032
|
|
|
|
(6,037
|
)
|
|
|
7,217
|
|
Change in assets and liabilities that relate to operations:
|
|
|
|
|
|
|
|
|
|
|
|
|
Accounts receivable
|
|
|
(42,539
|
)
|
|
|
(55,356
|
)
|
|
|
(67,780
|
)
|
Medical supplies
|
|
|
(2,142
|
)
|
|
|
736
|
|
|
|
(1,093
|
)
|
Prepaids and other assets
|
|
|
955
|
|
|
|
1,164
|
|
|
|
369
|
|
Accounts payable and accrued liabilities
|
|
|
(19,839
|
)
|
|
|
2,955
|
|
|
|
4,192
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Net cash provided by operating activities of continuing
operations
|
|
|
49,048
|
|
|
|
60,962
|
|
|
|
60,112
|
|
Net cash provided by (used in) operating activities of
discontinued operations
|
|
|
2,960
|
|
|
|
(2,737
|
)
|
|
|
5,522
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Net cash provided by operating activities
|
|
|
52,008
|
|
|
|
58,225
|
|
|
|
65,634
|
|
Investing activities:
|
|
|
|
|
|
|
|
|
|
|
|
|
Purchases of property and equipment
|
|
|
(66,659
|
)
|
|
|
(36,364
|
)
|
|
|
(27,246
|
)
|
Proceeds from sale of property and equipment
|
|
|
1,009
|
|
|
|
4,541
|
|
|
|
2,116
|
|
Restricted funds held in escrow
|
|
|
(3,154
|
)
|
|
|
|
|
|
|
|
|
Investment in affiliates
|
|
|
(9,530
|
)
|
|
|
|
|
|
|
|
|
Purchase of equity interest
|
|
|
(3,694
|
)
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Net cash used in investing activities of continuing operations
|
|
|
(82,028
|
)
|
|
|
(31,823
|
)
|
|
|
(25,130
|
)
|
Net cash provided by investing activities of discontinued
operations
|
|
|
76,223
|
|
|
|
3,232
|
|
|
|
35,194
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Net cash provided by (used in) investing activities
|
|
|
(5,805
|
)
|
|
|
(28,591
|
)
|
|
|
10,064
|
|
Financing activities:
|
|
|
|
|
|
|
|
|
|
|
|
|
Proceeds from issuance of long-term debt
|
|
|
|
|
|
|
|
|
|
|
60,000
|
|
Repayments of long-term debt
|
|
|
(2,879
|
)
|
|
|
(112,969
|
)
|
|
|
(75,033
|
)
|
Repayments of obligations under capital leases
|
|
|
(1,348
|
)
|
|
|
(1,808
|
)
|
|
|
(1,937
|
)
|
Payments of loan acquisition costs
|
|
|
|
|
|
|
|
|
|
|
(1,879
|
)
|
Investments by minority partners
|
|
|
|
|
|
|
2,688
|
|
|
|
|
|
Distributions to minority partners
|
|
|
(20,514
|
)
|
|
|
(12,861
|
)
|
|
|
(13,233
|
)
|
Proceeds from exercised stock options
|
|
|
4,317
|
|
|
|
5,803
|
|
|
|
6,499
|
|
Proceeds from issuance of common stock
|
|
|
|
|
|
|
39,658
|
|
|
|
|
|
Purchase of treasury shares
|
|
|
(44,403
|
)
|
|
|
|
|
|
|
|
|
Excess income tax benefit on exercised stock options
|
|
|
608
|
|
|
|
2,080
|
|
|
|
2,697
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Net cash used in financing activities of continuing operations
|
|
|
(64,219
|
)
|
|
|
(77,409
|
)
|
|
|
(22,886
|
)
|
Net cash (used in) provided by financing activities of
discontinued operations
|
|
|
(13,809
|
)
|
|
|
(2,707
|
)
|
|
|
721
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Net cash used in financing activities
|
|
|
(78,028
|
)
|
|
|
(80,116
|
)
|
|
|
(22,165
|
)
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Net increase (decrease) in cash and cash equivalents
|
|
|
(31,825
|
)
|
|
|
(50,482
|
)
|
|
|
53,533
|
|
Cash and cash equivalents:
|
|
|
|
|
|
|
|
|
|
|
|
|
Beginning of year
|
|
|
143,893
|
|
|
|
194,375
|
|
|
|
140,842
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
End of year
|
|
$
|
112,068
|
|
|
$
|
143,893
|
|
|
$
|
194,375
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Cash and cash equivalents of continuing operations
|
|
|
94,174
|
|
|
|
140,276
|
|
|
|
193,497
|
|
Cash and cash equivalents of discontinued operations
|
|
|
17,894
|
|
|
|
3,617
|
|
|
|
878
|
|
See notes to consolidated financial statements.
58
MEDCATH
CORPORATION
(All
tables in thousands, except per share amounts)
|
|
1.
|
Business
and Organization
|
MedCath Corporation (the Company) primarily focuses on providing
high acuity services, including the diagnosis and treatment of
cardiovascular disease. The Company owns and operates hospitals
in partnership with physicians, most of whom are cardiologists
and cardiovascular surgeons. While each of the Companys
majority-owned hospitals (collectively, the hospital division)
is licensed as a general acute care hospital, the Company
focuses on serving the unique needs of patients suffering from
cardiovascular disease. As of September 30, 2008, the
Company owned and operated nine hospitals, together with its
partners or members, who own an equity interest in the hospitals
where they practice. The Companys existing hospitals had a
total of 676 licensed beds, of which 629 were staffed and
available, and were located in seven states: Arizona, Arkansas,
California, Louisiana, New Mexico, South Dakota and Texas.
The Company is currently in the process of developing a new
hospital located in Kingman, Arizona which it expects to open in
late 2009 or early 2010.
See Note 3
Discontinued Operations
for
details concerning the Companys sale of its equity
interest in Tucson Heart Hospital and Heart Hospital of
Lafayette and certain net assets of Dayton Heart Hospital.
Unless specifically indicated otherwise, all amounts and
percentages presented in these notes are exclusive of the
Companys discontinued operations.
The Company accounts for all but two of its owned and operated
hospitals as consolidated subsidiaries. The Company owns a
minority interest in Avera Heart Hospital of South Dakota and
Harlingen Medical Center as of September 30, 2008 and is
not the primary beneficiary under the revised version of
Financial Accounting Standards Board (FASB) Interpretation
No. 46,
Consolidation of Variable Interest Entities, an
interpretation of ARB No. 51
(FIN No. 46-R).
Therefore, the Company is unable to consolidate the
hospitals results of operations and financial position,
but rather is required to account for its minority ownership
interest in these hospitals as an equity investment. Harlingen
Medical Center was a consolidated entity for the fiscal year
ended September 30, 2006 and for the first three quarters
of fiscal 2007. In July 2007, the Company sold a portion of its
equity interest in Harlingen Medical Center; therefore, the
Company no longer is its primary beneficiary and accounts for
its minority ownership interest in the hospital as an equity
investment.
In addition to its hospitals, the Company provides
cardiovascular care services in diagnostic and therapeutic
facilities in various locations and through mobile cardiac
catheterization laboratories (the MedCath Partners division).
The Company also provides consulting and management services
tailored primarily to cardiologists and cardiovascular surgeons,
which is included in the corporate and other division.
|
|
2.
|
Summary
of Significant Accounting Policies and Estimates
|
Basis of Consolidation
The consolidated
financial statements include the accounts of the Company and its
subsidiaries that are wholly and majority owned
and/or
over
which it exercises substantive control, including variable
interest entities in which the Company is the primary
beneficiary. All intercompany accounts and transactions have
been eliminated in consolidation. The Company uses the equity
method of accounting in accordance with Accounting Principles
Board Opinion No. 18,
The Equity Method of Accounting
for Investments in Common Stock
for entities, including
variable interest entities, in which the Company holds less than
a 50% interest, has significant influence but does not have
control, and is not the primary beneficiary.
Reclassifications
In accordance with
Statement of Financial Accounting Standards (SFAS) No. 144,
Accounting for the Impairment or Disposal of Long-Lived
Assets
(SFAS No. 144), the Company has classified
the results of operations, the assets and liabilities of the
hospitals held for sale, as well as the impacts from the
collections and payments of the remaining assets and liabilities
associated with the hospitals divested, as discontinued
operations for all periods presented. During fiscal 2006, the
Company completed the sale of its equity interest in Tucson
Heart Hospital and decided to seek to dispose of its interest in
Heart Hospital of Lafayette and entered into a confidentiality
and exclusivity agreement with a potential buyer, therefore
classifying the hospital
59
MEDCATH
CORPORATION
NOTES TO
CONSOLIDATED FINANCIAL
STATEMENTS (Continued)
as held for sale. The sale of Heart Hospital of Lafayette was
completed during the first quarter of fiscal 2008. During May
2008, the Company sold certain assets of Dayton Heart Hospital
pursuant to a definitive agreement entered into during the first
quarter of 2008. In accordance with the provisions of
SFAS No. 144, the results of operations of these
hospitals for the years ended September 30, 2008, 2007 and
2006 are reported as discontinued operations for all periods
presented. Many of the provisions of SFAS No. 144
involve judgment in determining whether a hospital will be
reported as continuing or discontinued operations. Such
judgments include whether a hospital will be sold, the period
required to complete the disposition and the likelihood of
changes to a plan for sale. If in future periods the Company
determines that a hospital should be either reclassified from
continuing operations to discontinued operations or from
discontinued operations to continuing operations, previously
reported consolidated statements of income are reclassified in
order to reflect the current classification.
Use of Estimates
The preparation of financial
statements in conformity with accounting principles generally
accepted in the United States of America requires management to
make estimates and assumptions that affect reported amounts of
assets and liabilities, revenues and expenses and related
disclosures of contingent assets and liabilities in the
consolidated financial statements and accompanying notes. There
is a reasonable possibility that actual results may vary
significantly from those estimates.
Fair Value of Financial Instruments
The
Company considers the carrying amounts of significant classes of
financial instruments on the consolidated balance sheets,
including cash and cash equivalents, accounts receivable, net,
accounts payable, income taxes payable, accrued liabilities,
variable rate long-term debt, obligations under capital leases,
and other long-term obligations to be reasonable estimates of
fair value due either to their length to maturity or the
existence of variable interest rates underlying such financial
instruments that approximate prevailing market rates at
September 30, 2008 and 2007. The estimated fair value of
long-term debt, including the current portion, at
September 30, 2008 is approximately $152.8 million as
compared to a carrying value of approximately
$146.4 million. At September 30, 2007, the estimated
fair value of long-term debt, including the current portion, was
approximately $177.0 million as compared to a carrying
value of approximately $149.3 million. Fair value of the
Companys fixed rate debt was estimated using discounted
cash flow analyses, based on the Companys current
incremental borrowing rates for similar types of arrangements
and market information. The fair value of the Companys
variable rate debt was determined to approximate its carrying
value, due to the underlying variable interest rates.
Concentrations of Credit Risk
Financial
instruments that potentially subject the Company to
concentrations of credit risk are primarily cash and cash
equivalents and accounts receivable. Cash and cash equivalents
are maintained with several large financial institutions. At
times deposits held with financial institutions exceed the
insurance provided by the Federal Deposit Insurance Corporation.
The Company has not experienced any losses on its deposits of
cash and cash equivalents.
The Company grants credit without collateral to its patients,
most of whom are insured under payment arrangements with third
party payors, including Medicare, Medicaid and commercial
insurance carriers. The Company has not experienced significant
losses related to receivables from individual patients or groups
of patients in any particular industry or geographic area.
Accounts receivable of the Hospital Division represents 89.4%
and 91.0% of total accounts receivable for the Company as of
September 30, 2008 and 2007, respectively. The following
table summarizes the percentage of gross accounts receivable
from all payors for the Hospital Division at September 30:
|
|
|
|
|
|
|
|
|
|
|
2008
|
|
|
2007
|
|
|
Medicare and Medicaid
|
|
|
28
|
%
|
|
|
30
|
%
|
Commercial
|
|
|
23
|
%
|
|
|
24
|
%
|
Other, including self-pay
|
|
|
49
|
%
|
|
|
46
|
%
|
|
|
|
|
|
|
|
|
|
|
|
|
100
|
%
|
|
|
100
|
%
|
|
|
|
|
|
|
|
|
|
60
MEDCATH
CORPORATION
NOTES TO
CONSOLIDATED FINANCIAL
STATEMENTS (Continued)
Cash and Cash Equivalents
The Company
considers currency on hand, demand deposits, and all highly
liquid investments with an original maturity of three months or
less at the date of purchase to be cash and cash equivalents.
Restricted Cash
At September 30, 2008
the Company had $3.2 million of restricted cash held in
escrow as required by the city of Kingman, Arizona in
conjunction with the Companys development of the Hualapai
Mountain Medical Center. The escrowed funds are released upon
the Companys completion of common infrastructure
construction projects affecting the city of Kingman. The Company
anticipates the completion of the related projects and release
of escrowed funds during the year ended September 30. 2009.
Allowance for Doubtful Accounts
Accounts
receivable primarily consist of amounts due from third-party
payors and patients in the Companys hospital division. The
remainder of the Companys accounts receivable principally
consist of amounts due from billings to hospitals for various
cardiovascular care services performed in its MedCath Partners
division and amounts due under consulting and management
contracts. To provide for accounts receivable that could become
uncollectible in the future, the Company establishes an
allowance for doubtful accounts to reduce the carrying value of
such receivables to their estimated net realizable value. The
Company estimates this allowance based on such factors as payor
mix, aging and the historical collection experience and
write-offs of its respective hospitals and other business units.
Medical Supplies
Medical supplies consist
primarily of supplies necessary for diagnostics, catheterization
and surgical procedures and general patient care and are stated
at the lower of
first-in,
first-out (FIFO) cost or market.
Property and Equipment
Property and equipment
are recorded at cost and are depreciated principally on a
straight-line basis over the estimated useful lives of the
assets, which generally range from 25 to 40 years for
buildings and improvements, 25 years for land improvements,
and from 3 to 10 years for equipment, furniture and
software. Repairs and maintenance costs are charged to operating
expense while betterments are capitalized as additions to the
related assets. Retirements, sales, and disposals are recorded
by removing the related cost and accumulated depreciation with
any resulting gain or loss reflected in income from operations.
Amortization of property and equipment recorded under capital
leases is included in depreciation expense. Interest expense
incurred in connection with the construction of hospitals is
capitalized as part of the cost of the building until the
facility is operational, at which time depreciation begins using
the straight-line method over the estimated useful life of the
building. The Company capitalized interest of $1.3 million
and $0.2 million, respectively, during the years ended
September 30, 2008 and 2007. The Company did not capitalize
any interest during the year ended September 30, 2006.
Goodwill and Intangible Assets
Goodwill
represents acquisition costs in excess of the fair value of net
identifiable tangible and intangible assets of businesses
purchased. All of the Companys goodwill is recorded within
the Hospital Division segment, see Note 19. Other
intangible assets primarily consist of the value of management
contracts. With the exception of goodwill, intangible assets are
being amortized over periods ranging from 11 to 29 years.
In accordance with SFAS No. 142,
Goodwill and Other
Intangible Assets
(SFAS No. 142), the Company
evaluates goodwill annually on September 30 for impairment, or
earlier if indicators of potential impairment exist. The
determination of whether or not goodwill has become impaired
involves a significant level of judgment in the assumptions
underlying the approach used to determine the value of the
Companys reporting unit. Changes in the Companys
strategy, assumptions
and/or
market conditions could significantly impact these judgments and
require adjustments to recorded amounts of intangible assets.
The Company recorded a goodwill impairment charge of
approximately $2.8 million during the year ended
September 30, 2007 related to Heart Hospital of Lafayette,
which is reported as a discontinued operation. The impairment
charge is included as a component of income (loss) from
discontinued operations in the statement of operations for the
year ended September 30, 2007. During the year ended
September 30, 2008, $4.6 million of goodwill was
written off as part of the gain resulting from the disposition
of the Dayton Heart Hospital which is included within income
(loss) from discontinued operations, see Note 3 for
additional discussion of this transaction.
61
MEDCATH
CORPORATION
NOTES TO
CONSOLIDATED FINANCIAL
STATEMENTS (Continued)
During the year ended September 30, 2008 the Company
purchased additional equity interests in the Heart Hospital of
New Mexico and TexSAn Heart Hospital (TexSAn) resulting in an
increase to goodwill of $1.3 million and $0.7 million,
respectively, see Note 5.
Other Assets
Other assets primarily consist
of loan acquisition costs, prepaid rent under a long-term
operating lease for land at one of the Companys hospitals
and intangible assets associated with physician related revenue
guarantees. See Note 12 for further discussion of these
guarantees. Loan acquisition costs (Loan Costs) are costs
associated with obtaining long-term financing. Loan Costs, net
of accumulated amortization, were $2.1 million and
$3.0 million as of September 30, 2008 and 2007,
respectively. Loan Costs are being amortized using the
straight-line method, which approximates the effective interest
method, as a component of interest expense over the life of the
related debt. Amortization expense recognized for Loan Costs
totaled $0.9 million, $1.2 million, and
$2.9 million for the years ended September 30, 2008,
2007 and 2006, respectively. Prepaid rent is being amortized
using the straight-line method over the lease term, which
extends through December 11, 2065. The Company recognizes
the amortization of prepaid rent as a component of other
operating expense.
Long-Lived Assets
In accordance with
SFAS No. 144 (SFAS No. 144),
Accounting
for the Impairment or Disposal of Long-Lived Assets
, are
evaluated for impairment when events or changes in business
circumstances indicate that the carrying amount of the assets
may not be fully recoverable. An impairment loss would be
recognized when estimated undiscounted future cash flows
expected to result from the use of an asset and its eventual
disposition are less than its carrying amount. The determination
of whether or not long-lived assets have become impaired
involves a significant level of judgment in the assumptions
underlying the approach used to determine the estimated future
cash flows expected to result from the use of those assets.
Changes in the Companys strategy, assumptions
and/or
market conditions could significantly impact these judgments and
require adjustments to recorded amounts of long-lived assets.
During the year ended September 30, 2006, the operating
performance of one of the Companys facilities, Heart
Hospital of Lafayette, was significantly below expectations. The
performance of the hospital as well as other strategic
initiatives were considered when management made the decision to
seek to dispose of the Heart Hospital of Lafayette, which is
classified as a discontinued operation in the accompanying
financial statements (see Note 3). At September 30,
2006, management believed the net carrying value of the
discontinued assets as of September 30, 2007 would be
realizable; however, ultimate realization of the discontinued
assets could not be assured. During the year ended
September 30, 2007, the Company re-evaluated the
discontinued assets and $4.8 million in impairment charges
in accordance with SFAS No. 144 (in addition to the
$2.8 million goodwill impairment recorded in accordance
with SFAS No. 142 discussed above) were recorded and
are included in income (loss) from discontinued operations, net
of taxes in the Companys statement of operations for
fiscal 2007.
Also during the year ended September 30, 2006, management
decided to discontinue the implementation of certain nurse
staffing software and as a result, a $0.5 million
impairment charge was recognized to write-off the costs incurred
to date on such software.
Other Long-Term Obligations
Other long-term
obligations consist of physician revenue guarantees and other
long term contracts. See Note 12 for further discussion of
the physician guarantees.
Market Risk Policy
The Companys policy
for managing risk related to its exposure to variability in
interest rates, commodity prices, and other relevant market
rates and prices includes consideration of entering into
derivative instruments (freestanding derivatives), or contracts
or instruments containing features or terms that behave in a
manner similar to derivative instruments (embedded derivatives)
in order to mitigate its risks. In addition, the Company may be
required to hedge some or all of its market risk exposure,
especially to interest rates, by creditors who provide debt
funding to the Company. The Company recognizes all derivatives
as either assets or liabilities on the balance sheets and
measures those instruments at fair value in accordance with
SFAS No. 133,
Accounting for Derivative Instruments
and Hedging Activities
, as amended by
SFAS No. 138,
Accounting for
62
MEDCATH
CORPORATION
NOTES TO
CONSOLIDATED FINANCIAL
STATEMENTS (Continued)
Certain Derivative Instruments and Certain Hedging Activities
(an Amendment of FASB Statement No. 133)
, and as
amended by SFAS No. 149,
Amendment of Statement 133
on Derivative Instruments and Hedging Activities.
Comprehensive Income
Comprehensive income is
the change in equity of a business enterprise during a period
from transactions and other events and circumstances from
non-owner sources.
Revenue Recognition
Amounts the Company
receives for treatment of patients covered by governmental
programs such as Medicare and Medicaid and other third-party
payors such as commercial insurers, health maintenance
organizations and preferred provider organizations are generally
less than established billing rates. Payment arrangements with
third-party payors may include prospectively determined rates
per discharge or per visit, a discount from established charges,
per diem payments, reimbursed costs (subject to limits)
and/or
other
similar contractual arrangements. As a result, net revenue for
services rendered to patients is reported at the estimated net
realizable amounts as services are rendered. The Company
accounts for the differences between the estimated realizable
rates under the reimbursement program and the standard billing
rates as contractual adjustments.
The majority of the Companys contractual adjustments are
system-generated at the time of billing based on either
government fee schedules or fee schedules contained in managed
care agreements with various insurance plans. Portions of the
Companys contractual adjustments are performed manually
and these adjustments primarily relate to patients that have
insurance plans with whom the Companys hospitals do not
have contracts containing discounted fee schedules, also
referred to as non-contracted payors, and patients that have
secondary insurance plans following adjudication by the primary
payor. Estimates of contractual adjustments are made on a
payor-specific basis and based on the best information available
regarding the Companys interpretation of the applicable
laws, regulations and contract terms. While subsequent
adjustments to the systematic contractual allowances can arise
due to denials, short payments deemed immaterial for continued
collection effort and a variety of other reasons, such amounts
have not historically been significant.
The Company continually reviews the contractual estimation
process to consider and incorporate updates to the laws and
regulations and any changes in the contractual terms of its
programs. Final settlements under some of these programs are
subject to adjustment based on audit by third parties, which can
take several years to determine. From a procedural standpoint,
for governmental payors, primarily Medicare, the Company
recognizes estimated settlements in its consolidated financial
statements based on filed cost reports. The Company subsequently
adjusts those settlements as new information is obtained from
audits or reviews by the fiscal intermediary and, if the result
of the fiscal intermediary audit or review impacts other
unsettled and open cost reports, the Company recognizes the
impact of those adjustments. As such, the Company recognized
adjustments that increased/(decreased) net revenue by
($2.0) million, ($0.7) million and $1.1 million
for continuing operations and $0.4 million,
$2.2 million and ($0.3) million for discontinued
operations in the years ended September 30, 2008, 2007 and
2006, respectively.
A significant portion of the Companys net revenue is
derived from federal and state governmental healthcare programs,
including Medicare and Medicaid, which, combined, accounted for
43.1%, 45.9% and 49.1% of the Companys net revenue during
the years ended September 30, 2008, 2007 and 2006,
respectively. Medicare payments for inpatient acute services and
certain outpatient services are generally made pursuant to a
prospective payment system. Under this system, hospitals are
paid a prospectively-determined fixed amount for each hospital
discharge based on the patients diagnosis. Specifically,
each discharge is assigned to a diagnosis-related group (DRG).
Based upon the patients condition and treatment during the
relevant inpatient stay, each DRG is assigned a fixed payment
rate that is prospectively set using national average costs per
case for treating a patient for a particular diagnosis. The DRG
rates are adjusted by an update factor each federal fiscal year,
which begins on October 1. The update factor is determined,
in part, by the projected increase in the cost of goods and
services that are purchased by hospitals, referred to as the
market basket index. DRG payments do not consider the actual
costs incurred by a hospital in providing a particular inpatient
service; however, DRG payments are adjusted by a predetermined
adjustment factor assigned to the geographic area in which the
hospital is located.
63
MEDCATH
CORPORATION
NOTES TO
CONSOLIDATED FINANCIAL
STATEMENTS (Continued)
While hospitals generally do not receive direct payment in
addition to a DRG payment, hospitals may qualify for additional
capital-related cost reimbursement and outlier payments from
Medicare under specific circumstances. In addition, some
hospitals with high levels of low income patients qualify for
Medicare Disproportionate Share Hosptial (DSH)
reimbursement as an add on to DRG payments. Medicare payments
for most outpatient services are based on prospective payments
using ambulatory payment classifications (APCs).
Other outpatient services, including outpatient clinical
laboratory, are reimbursed through a variety of fee schedules.
The Company is reimbursed for DSH payments and cost-reimbursable
items at tentative rates, with final settlement determined after
submission of annual cost reports by the Company and audits
thereof by the Medicare fiscal intermediary.
Medicaid payments for inpatient and outpatient services are
based upon methodologies specific to the state in which
hospitals are located and are made at prospectively determined
amounts, such as DRGs; reasonable costs or charges; or fee
schedule. Depending upon the state in which hospitals are
located, Medicaid payments may be made at tentative rates with
final settlement determined after submission of annual cost
reports by the hospitals and audits or reviews thereof by the
states Medicaid agencies.
The Companys managed diagnostic and therapeutic facilities
and mobile cardiac catheterization laboratories operate under
various contracts where management fee revenue is recognized
under fixed-rate and percentage-of-income arrangements as
services are rendered. In addition, certain diagnostic and
therapeutic facilities and mobile cardiac catheterization
laboratories recognize additional revenue under cost
reimbursement and equipment lease arrangements. Net revenue from
the Companys owned diagnostic and therapeutic facilities
and mobile cardiac catheterization laboratories is reported at
the estimated net realizable amounts due from patients,
third-party payors, and others as services are rendered,
including estimated retroactive adjustments under reimbursement
agreements with third-party payors.
Segment Reporting.
SFAS No. 131,
Disclosures About Segments of an Enterprise and Related
Information
(SFAS No. 131),
establishes standards for a public company to report financial
and descriptive information about its reportable operating
segments in annual and interim financial reports. Operating
segments are components of an enterprise about which separate
financial information is available and evaluated regularly by
the chief operating decision maker in deciding how to allocate
resources and evaluate performance. Two or more operating
segments may be aggregated into a single reportable segment
provided aggregation is consistent with the objective and basic
principles of SFAS No. 131, if the segments have
similar economic characteristics, and the segments are
considered similar under criteria provided by
SFAS No. 131. There is no aggregation within the
Companys reportable segments. SFAS No. 131 also
establishes standards and related disclosures about the way the
operating segments were determined, including products and
services, geographic areas and major customers, differences
between the measurements used in reporting segment information
and those used in the general-purpose financial statements, and
changes in the measurement of segment amounts from period to
period. The description of the Companys reportable
segments, consistent with how business results are reported
internally to management and the disclosure of segment
information in accordance with SFAS No. 131 is
discussed in Note 19,
Advertising
Advertising costs are expensed as
incurred. During the years ended September 30, 2008, 2007
and 2006, the Company incurred approximately $3.9 million,
$3.6 million and $3.7 million of advertising expenses,
respectively.
Pre-opening Expenses
Pre-opening expenses
consist of operating expenses incurred during the development of
a new venture and prior to its opening for business. Such costs
specifically relate to ventures under development and are
expensed as incurred. The Company incurred approximately
$0.8 million and $0.6 million, respectively, of
pre-opening expenses during the years ended September 30,
2008 and 2007. The Company did not incur any pre-opening
expenses during the year ended September 30, 2006.
Interest and other income
Interest and other
income is predominantly comprised of interest income. Interest
income recorded in the consolidated statements of income was
$2.0 million, $7.6 million, and $6.3 million for
the years ended September 30, 2008, 2007, and 2006,
respectively.
64
MEDCATH
CORPORATION
NOTES TO
CONSOLIDATED FINANCIAL
STATEMENTS (Continued)
Income Taxes
Income taxes are computed on the
pretax income based on current tax law. Deferred income taxes
are recognized for the expected future tax consequences or
benefits of differences between the tax bases of assets or
liabilities and their carrying amounts in the consolidated
financial statements. A valuation allowance is provided for
deferred tax assets if it is more likely than not that these
items will either expire before the Company is able to realize
their benefit or that future deductibility is uncertain.
Members and Partners Share of Hospitals Net
Income and Loss
Each of the Companys
consolidated hospitals is organized as a limited liability
company or limited partnership, with one of the Companys
wholly-owned subsidiaries serving as the manager or general
partner and holding from 53.3% to 89.2% of the ownership
interest in the entity. In most cases, physician partners or
members own the remaining ownership interests as members or
limited partners. In some instances, the Company may organize a
hospital with a community hospital investing as an additional
partner or member. In those instances, the Company may hold a
minority interest in the hospital with the community hospital
and physician partners owning the remaining interests also as
minority partners. In such instances, the hospital is generally
accounted for under the equity method of accounting. Profits and
losses of hospitals accounted for under either the consolidated
or equity methods are generally allocated to their owners based
on their respective ownership percentages. If the cumulative
losses of a hospital exceed its initial capitalization and
committed capital obligations of the partners or members, the
Company will recognize a disproportionate share of the
hospitals losses that otherwise would be allocated to all
of its owners on a pro rata basis in accordance with accounting
principles generally accepted in the United States. In such
cases, the Company will recognize a disproportionate share of
the hospitals future profits to the extent the Company has
previously recognized a disproportionate share of the
hospitals losses.
Share-Based Compensation
On October 1,
2005, the Company adopted
SFAS No. 123-R
(revised 2004),
Share-Based Payment
(SFAS No. 123-R),
which requires the measurement and recognition of compensation
expense for all share-based payment awards made to employees and
directors based on estimated fair values.
SFAS No. 123-R
requires companies to estimate the fair value of share-based
payment awards on the date of grant using an option-pricing
model and to expense the value of the portion of the award that
is ultimately expected to vest over the requisite service period
in the Companys statement of operations.
In September 2005, the compensation committee of the board of
directors approved a plan to accelerate the vesting of
substantially all unvested stock options previously awarded to
employees with the condition that the optionee enter into a sale
restriction agreement which provides that if the optionee
exercises a stock option prior to its originally scheduled
vesting date while employed by the Company, the optionee will be
prohibited from selling the share of stock acquired upon
exercise of the option until the date the option would have
become vested had it not been accelerated. All new stock options
granted since September 30, 2005 have immediate vesting
with the same sale restriction. As a result, share-based
compensation is recorded on the option grant date.
The Company adopted
SFAS No. 123-R
using the modified prospective transition method, which requires
the application of the accounting standard as of October 1,
2005, the first day of the Companys fiscal year 2006. The
Companys financial statements as of and for the years
ended September 30, 2008, 2007 and 2006 reflect the impact
of
SFAS No. 123-R.
On November 10, 2005, the FASB issued Staff Position
No. 123-R-3,
Transition Election Related to Accounting for the Tax Effects
of Share-Based Payment Awards
(Staff Position
No. 123-R-3),
which provides a simplified alternative method to calculate the
pool of excess income tax benefits upon the adoption of
SFAS No. 123-R.
The Company has elected to follow the provisions of Staff
Position
No. 123-R-3.
As required under
SFAS No. 123-R
in calculating the share-based compensation expense for the
years ended September 30, 2008, 2007 and 2006 the fair
value of each option grant was estimated on the date of grant.
The Company used the Black-Scholes option pricing model with the
range of weighted-average assumptions used for option grants
noted in the following table. The expected life of the stock
options represents the period of time that options granted are
expected to be outstanding and the range given below results
from certain groups of employees
65
MEDCATH
CORPORATION
NOTES TO
CONSOLIDATED FINANCIAL
STATEMENTS (Continued)
exhibiting different behavior with respect to the options
granted to them and has been determined based on an annual
analysis of historical and expected exercise and cancellation
behavior. The risk-free interest rate is based on the US
Treasury yield curve in effect on the date of the grant. The
expected volatility is based on the historical volatilities of
the Companys common stock and the common stock of
comparable publicly traded companies.
|
|
|
|
|
|
|
|
|
Year Ended September 30,
|
|
|
2008
|
|
2007
|
|
2006
|
|
Expected life
|
|
5-8 years
|
|
5-8 years
|
|
6-8 years
|
Risk- free interest rate
|
|
2.34-4.56%
|
|
4.12-5.17%
|
|
4.26-5.20%
|
Expected volatility
|
|
33-41%
|
|
37-43%
|
|
39-44%
|
Accounting for Gains on Capital Transactions of
Subsidiary.
In accordance with Staff Accounting
Bulletin Topic 5H (SAB Topic 5H), the Company has
adopted an accounting policy of recording non-operating gains in
the Companys consolidated statement of income upon the
dilution of ownership interests that occurs when ownership
interests of subsidiaries are issued to third party investors,
if the gain recognition criteria of SAB Topic 5H are met.
If such criteria are not met, then such gains will be recorded
directly to equity as a capital transaction. A gain on the
issuance of units in one of the Companys formerly
consolidated subsidiaries, Harlingen Medical Center, LLC (the
Partnership), is reflected in the Companys consolidated
balance sheets for fiscal 2007 as a capital transaction, in
accordance with the provisions of SAB Topic 5H, see
Note 5 for further discussion of this transaction.
New Accounting Pronouncements
In July 2006,
the FASB issued Interpretation No. 48,
Accounting for
Uncertainty in Income Taxes
(FIN No. 48).
FIN No. 48 prescribes detailed guidance for the
financial statement recognition, measurement and disclosure of
uncertain tax positions recognized in an enterprises
financial statements in accordance with FASB Statement
No. 109,
Accounting for Income Taxes
(FAS No. 109). Tax positions must meet a
more-likely-than-not recognition threshold at the effective date
to be recognized upon the adoption of FIN No. 48 and
in subsequent periods. FIN No. 48 is effective for
fiscal years beginning after December 15, 2006 and the
provisions of FIN No. 48 have been applied to all tax
positions accounted for under FAS No. 109 upon
adoption as of the beginning of the year ended
September 30, 2008. The cumulative effect of applying the
provisions of FIN No. 48 was $0.3 million,
reported as an adjustment to the opening balance of the
Companys accumulated deficit.
In September 2006, the FASB issued Statement of Financial
Accounting Standards No. 157,
Fair Value Measurements
(SFAS No. 157). SFAS No. 157, which
defines fair value, establishes a framework for measuring fair
value in GAAP, and expands disclosures about fair value
measurements. SFAS No. 157 does not require any new
fair value measurements. The application of
SFAS No. 157 may change the Companys current
practice for measuring fair values under other accounting
pronouncements that require fair value measurements.
SFAS No. 157 is effective for fiscal years beginning
after November 15, 2007, fiscal 2009 for the Company. The
Company is in the process of determining the effect that the
adoption of SFAS No. 157 will have on its consolidated
financial statements.
In February 2007, the FASB issued Statement of Financial
Accounting Standards No. 159, The
Fair Value Option for
Financial Assets and Financial Liabilities
(SFAS No. 159). SFAS No. 159 provides
companies with an option to report selected financial assets and
financial liabilities at fair value. Unrealized gains and losses
on items for which the fair value option has been elected are
reported in earnings at each subsequent reporting date.
SFAS No. 159 is effective for fiscal years beginning
after November 15, 2007, fiscal 2009 for the Company and
will have no impact on amounts presented for periods prior to
the effective date. The Company does not currently have any
financial assets or financial liabilities for which the
provisions of SFAS No. 159 have been elected. However,
in the future, the Company may elect to measure certain
financial instruments at fair value in accordance with this
standard.
In December 2007, the FASB issued SFAS No. 141(R),
Business Combinations
(SFAS 141(R)).
SFAS 141(R) replaces SFAS 141
Business Combinations
and addresses the recognition and accounting for
identifiable assets
66
MEDCATH
CORPORATION
NOTES TO
CONSOLIDATED FINANCIAL
STATEMENTS (Continued)
acquired, liabilities assumed, and noncontrolling interests in
business combinations. This standard will require more assets
and liabilities to be recorded at fair value and will require
expense recognition (rather than capitalization) of certain
pre-acquisition costs. This standard also will require any
adjustments to acquired deferred tax assets and liabilities
occurring after the related allocation period to be made through
earnings. Furthermore, this standard requires this treatment of
acquired deferred tax assets and liabilities also be applied to
acquisitions occurring prior to the effective date of this
standard. SFAS 141(R) is effective for fiscal years
beginning after December 15, 2008, fiscal 2010 for the
Company and is required to be adopted prospectively with no
early adoption permitted. The Company expects SFAS 141R
will have an impact on accounting for business combinations, but
the effect will be dependent upon any potential future
acquisitions.
In December 2007, the FASB issued SFAS No. 160.
Noncontrolling Interests in Consolidated Financial
Statements-an Amendment of ARB No. 51
(SFAS 160).
SFAS 160 establishes accounting and reporting standards
pertaining to ownership interests in subsidiaries held by
parties other than the parent, the amount of net income
attributable to the parent and to the noncontrolling interest,
changes in a parents ownership interest, and the valuation
of any retained noncontrolling equity investment when a
subsidiary is deconsolidated. This statement also establishes
disclosure requirements that clearly identify and distinguish
between the interests of the parent and the interests of the
noncontrolling owners. SFAS 160 is effective for fiscal
years beginning on or after December 15, 2008, fiscal 2010
for the Company. The Company is evaluating the potential impact
the adoption of SFAS 160 will have on its consolidated
financial statements.
In March 2008, the FASB issued SFAS No. 161
Disclosures about Derivative Instruments and Hedging
Activities an amendment of FASB Statement
No. 133 (SFAS 161). SFAS 161 changes the
disclosure requirements for derivative instruments and hedging
activities. Entities are required to provide enhanced
disclosures about how and why an entity uses derivative
instruments, how derivative instruments and related hedged items
are accounted for under SFAS 133 Accounting for
Derivative Instruments and Hedging Activities and its
related interpretations, and how derivative instruments and
related hedged items affect an entitys financial position,
financial performance, and cash flows. SFAS 161 is
effective for fiscal years and interim periods beginning after
November 15, 2008, the second quarter of fiscal 2009 for
the Company. The Company is evaluating the potential impact the
adoption of SFAS 161 will have on its consolidated
financial statements.
In April 2008, the FASB issued FASB Staff Position (FSP)
FAS 142-3
Determination of the Useful Life of an Intangible Asset
(FSP
FAS 142-3),
which amends the list of factors an entity should consider in
developing renewal or extension assumptions used in determining
the useful life of recognized intangible assets under Statements
of Financial Accounting Standards (SFAS) No. 142
Goodwill and Other Intangible Assets
. The new guidance
applies to intangible assets that are acquired individually or
with a group of other assets and intangible assets acquired in
both business combinations and asset acquisitions. FSP
FAS 142-3
is effective for financial statements issued for fiscal years
beginning after December 15, 2008 and interim periods
within those fiscal years, fiscal 2010 for the Company. The
impact of FSP
FAS 142-3
will be dependent upon any potential future acquisitions.
In June 2008, Emerging Issues Task Force (EITF) Issue
No. 08-3
Accounting by Lessees for Maintenance Deposits Under Lease
Arrangements
(EITF 08-3)
was ratified by the FASB. The EITF reached a consensus that all
nonrefundable maintenance deposits that are contractually and
substantively related to maintenance of the leased asset are
accounted for as deposit assets. The lessees deposit asset
is expensed or capitalized as part of a fixed asset (depending
on the lessees maintenance accounting policy) when the
underlying maintenance is performed. When the lessee determines
that it is less than probable that an amount on deposit will be
returned to the lessee (and thus no longer meets the definition
of an asset), the lessee must recognize an additional expense
for that amount.
EITF 08-3
is effective for fiscal years beginning after December 15,
2008, fiscal 2010 for the Company, and must be applied by
recognizing the cumulative effect of the change in accounting
principle in the opening balance of retained earnings as of the
beginning of the fiscal year in which this consensus is
initially applied. The Company is evaluating the potential
impact the adoption of
EITF 08-3
will have on its consolidated financial statements.
67
MEDCATH
CORPORATION
NOTES TO
CONSOLIDATED FINANCIAL
STATEMENTS (Continued)
|
|
3.
|
Discontinued
Operations
|
During May 2008, the Company sold certain net assets of Dayton
Heart Hospital (DHH) to Good Samaritan Hospital for
$47.5 million pursuant to a definitive agreement entered
into during the year ended September 30, 2008. The total
gain recognized, net of tax, was $3.4 million and is
included in income (loss) from discontinued operations on the
consolidated statement of operations for the year ended
September 30, 2008.
In accordance with the terms of the sale, DHH and Good Samaritan
Hospital entered into an indemnification agreement for a period
of eighteen months from the date of the sale. DHH agreed to
indemnify Good Samaritan Hospital from certain exposures arising
subsequent to the date of sale, including environmental exposure
and exposure resulting from the breach of representations or
warranties made in accordance with the sale. The maximum
exposure associated with the indemnity agreement is
$10 million. The estimated fair value of this
indemnification is not material. Additionally, as a condition to
the sale and as part of the indemnification agreement, the
Company has entered into a non-compete agreement for a period of
five years from the date of the sale. The Company was paid
$5.0 million under the non-compete agreement which resulted
in the Company recording $3.1 million, net of tax, as part
of income (loss) from discontinued operations in the
consolidated statement of operations for the year ended
September 30, 2008.
As of September 30, 2008 and 2007 the Company had reserved
$9.1 million and $8.5 million, respectively, for
Medicare outlier payments received by DHH during the year ended
September 30, 2004, which are included in current
liabilities of discontinued operations in the consolidated
balance sheets.
During September 2006, the Company decided to seek to dispose of
its interest in Heart Hospital of Lafayette (HHLf) and entered
into a confidentiality and exclusivity agreement with a
potential buyer. In accordance with SFAS No. 144, it
was determined that the carrying value of HHLf was in excess of
fair value at December 31, 2007. Accordingly, an impairment
charge of $4.1 million was recorded and is included in the
income (loss) from discontinued operations in the consolidated
statement of operations for the fiscal year 2007. The sale of
HHLf was completed during the year ended September 30,
2008, resulting in an immaterial loss recorded as part of income
(loss) from discontinued operations for the year ended
September 30, 2008.
At September 30, 2007 and 2006, the Company was in
violation of a financial covenant under an equipment loan to
HHLf, which is guaranteed by MedCath. The total outstanding
balance of this loan was included in current liabilities of
discontinued operations on the consolidated balance sheet as of
September 30, 2007.
On August 31, 2006, the Company completed the divestiture
of its entire equity interest in Tucson Heart Hospital (THH) to
Carondelet Health Network. Pursuant to the terms of the
transaction, Carondelet Health Network acquired MedCaths
59% ownership interest in THH and the hospital repaid all
secured debt owed to MedCath. Total proceeds received by MedCath
were $40.7 million resulting in a gain of
$7.8 million, net of tax, recorded in income (loss) from
discontinued operations for the year ended September 30,
2006.
The results of operations of DHH, HHLf and THH excluding
intercompany interest expense and intercompany gain as a result
of the sales, are as follows:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Year Ended September 30,
|
|
|
|
2008
|
|
|
2007
|
|
|
2006
|
|
|
Net revenue
|
|
$
|
39,396
|
|
|
$
|
93,251
|
|
|
$
|
146,392
|
|
Income (loss) before income taxes
|
|
$
|
13,088
|
|
|
$
|
(115
|
)
|
|
|
14,106
|
|
Income tax expense
|
|
|
6,418
|
|
|
|
3,609
|
|
|
|
5,388
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Net income (loss)
|
|
$
|
6,670
|
|
|
$
|
(3,724
|
)
|
|
$
|
8,718
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
68
MEDCATH
CORPORATION
NOTES TO
CONSOLIDATED FINANCIAL
STATEMENTS (Continued)
The principal balance sheet items of DHH and HHLf including
allocated goodwill and excluding intercompany debt, are as
follows:
|
|
|
|
|
|
|
|
|
|
|
Year Ended September 30,
|
|
|
|
2008
|
|
|
2007
|
|
|
Cash and cash equivalents
|
|
$
|
17,894
|
|
|
$
|
3,617
|
|
Accounts receivable, net
|
|
|
940
|
|
|
|
15,217
|
|
Other current assets
|
|
|
|
|
|
|
3,998
|
|
|
|
|
|
|
|
|
|
|
Current assets of discontinued operations
|
|
$
|
18,834
|
|
|
$
|
22,832
|
|
|
|
|
|
|
|
|
|
|
Property and equipment, net
|
|
$
|
|
|
|
$
|
44,506
|
|
Investments in affiliates
|
|
|
|
|
|
|
240
|
|
Other assets
|
|
|
|
|
|
|
156
|
|
|
|
|
|
|
|
|
|
|
Long-term assets of discontinued operations
|
|
$
|
|
|
|
$
|
44,902
|
|
|
|
|
|
|
|
|
|
|
Accounts payable
|
|
$
|
9,370
|
|
|
$
|
12,951
|
|
Accrued liabilities
|
|
|
624
|
|
|
|
3,798
|
|
Current portion of long-term debt and obligations under capital
leases
|
|
|
|
|
|
|
8,213
|
|
|
|
|
|
|
|
|
|
|
Current liabilities of discontinued operations
|
|
$
|
9,994
|
|
|
$
|
24,962
|
|
|
|
|
|
|
|
|
|
|
Obligations under capital leases
|
|
$
|
|
|
|
$
|
13
|
|
|
|
|
|
|
|
|
|
|
Long-term liabilities of discontinued operations
|
|
$
|
|
|
|
$
|
13
|
|
|
|
|
|
|
|
|
|
|
|
|
4.
|
Goodwill
and Other Intangible Assets
|
The results of the annual goodwill impairment analysis performed
during September 2008, 2007 and 2006 indicated that no
impairment was required during the years ended
September 30, 2008, 2007 and 2006, respectively for
continuing operations.
As of September 30, 2008 and 2007, the Companys other
intangible assets, net, included the following:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
September 30, 2008
|
|
|
September 30, 2007
|
|
|
|
Gross
|
|
|
|
|
|
Gross
|
|
|
|
|
|
|
Carrying
|
|
|
Accumulated
|
|
|
Carrying
|
|
|
Accumulated
|
|
|
|
Amount
|
|
|
Amortization
|
|
|
Amount
|
|
|
Amortization
|
|
|
Management contracts
|
|
$
|
19,084
|
|
|
$
|
(13,462
|
)
|
|
$
|
19,084
|
|
|
$
|
(12,985
|
)
|
Other
|
|
|
655
|
|
|
|
(214
|
)
|
|
|
480
|
|
|
|
(131
|
)
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Total
|
|
$
|
19,739
|
|
|
$
|
(13,676
|
)
|
|
$
|
19,564
|
|
|
$
|
(13,116
|
)
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Amortization expense recognized for the management contracts and
other intangible assets totaled $0.6 million,
$0.6 million and $1.0 million for the years ended
September 30, 2008, 2007 and 2006, respectively.
69
MEDCATH
CORPORATION
NOTES TO
CONSOLIDATED FINANCIAL
STATEMENTS (Continued)
The estimated aggregate amortization expense for each of the
five fiscal years succeeding the Companys most recent
fiscal year ended September 30, 2008 is as follows:
|
|
|
|
|
|
|
Estimated Amortization
|
|
Fiscal Year
|
|
Expense
|
|
|
2009
|
|
$
|
477
|
|
2010
|
|
|
477
|
|
2011
|
|
|
477
|
|
2012
|
|
|
477
|
|
2013
|
|
|
477
|
|
|
|
5.
|
Business
Combinations and Hospital Development
|
New Hospital Development
In August 2007, the
Company announced a venture to construct a new
106 inpatient bed capacity general acute care hospital,
Hualapai Mountain Medical Center, which will be located in
Kingman, Arizona. The hospital is accounted for as a
consolidated subsidiary since the Company, through its
wholly-owned subsidiary, owns 79.2% of the interest in the
venture with physician partners owning the remaining 20.8%.
Further, the Company exercises substantive control over the
hospital. Construction of Hualapai Mountain Medical Center began
during fiscal year 2007 and is anticipated to be completed in
late fiscal 2009 or early fiscal 2010.
In May 2007, the Company and its physician partners announced a
120 bed general acute care expansion of its hospital located in
St. Tammany Parish, Louisiana. Construction is expected to be
completed during fiscal 2009, with 80 patient rooms being
completed initially and capacity for 40 patient rooms being
available for future growth. To recognize its expanded service
capabilities, the hospital, which opened in February 2003, has
been renamed the Louisiana Medical Center and Heart Hospital.
In April 2007, the Company and its physician partners announced
the expansion of Arkansas Heart Hospital, located in Little
Rock, Arkansas. The expansion converted shelled space into 28
inpatient beds, added a 130 space parking garage to the campus
and support the renovation of the hospitals annex building
to accommodate non-clinical services.
In June 2008, the Company and its physician partners announced
the expansion of Bakersfield Heart Hospital, which is subject to
the approval of Californias Office of Statewide Health
Planning and Development. The expansion will include the
addition of 72 inpatient beds to the hospitals existing 47
inpatient beds and expansion of the hospitals emergency
department by 16 beds. The expansion will allow Bakersfield
Heart Hospital to expand its current services, which include
cardiac, vascular, GI (gastrointestinal), general surgery and
internal medicine. Upon completion of the expansion Bakersfield
Heart Hospital anticipates providing new surgical services in
joint replacement, gynecological, ENT and bariatric.
Lease Transaction with HMC Realty.
During July
2007, Harlingen Medical Center (HMC) transferred real property
with a net book value of approximately $34.3 million (fair
value of $57.8 million) to a newly formed wholly-owned
limited liability subsidiary, HMC Realty, LLC (HMC Realty), in
exchange for HMC Realtys assumption of related party and
third party debt of approximately $57.8 million.
Subsequently, HMC entered into a lease agreement with HMC Realty
whereby HMC will lease the real property from HMC Realty for
approximately $5.5 million annually for 25 years.
Subsequent to the transfer of assets and debt, HMC Realty
received capital contributions as described below, and HMC
canceled its membership in HMC Realty. The $57.8 million
debt assumed by HMC Realty consisted of $2.9 million owed
to Valley Baptist Health System (Valley Baptist),
$11.3 million owed to the Company for working capital
loans, and the assumption of $43.5 million in real estate
debt with a third party. The Company converted $9.6 million
of the working capital loan with HMC Realty into a 36% interest
in HMC Realty.
70
MEDCATH
CORPORATION
NOTES TO
CONSOLIDATED FINANCIAL
STATEMENTS (Continued)
Recapitalization of Harlingen Medical
Center.
During the year ended September 30,
2006, HMC entered into two $10.0 million convertible notes
with Valley Baptist. The first note could have been voluntarily
converted by the health system into a 13.2% ownership interest
in HMC after the third anniversary date of issuance, or it could
have been automatically converted into an ownership interest in
HMC upon the achievement of specified financial targets
contained in the debt agreement, up until the third anniversary
date of the agreement or the fourth anniversary date of the
agreement, if extended by HMC. The second note was convertible
into the same ownership interest percentage as the first note at
the discretion of the health system after the conversion of the
first note. The potential ownership interest in HMC by the
health system was capped at 49%. The notes accrued interest at
5% per annum up until the third anniversary date, after
which time the interest rate would have been increased to 8% if
the notes had not been converted.
During July 2007, the Company elected, along with the original
physician investors and Valley Baptist, to allow early
conversion of the Valley Baptist notes into an equity interest
in HMC (the Recapitalization). Valley Baptist converted
$17.1 million of the convertible notes into a 32.1% equity
interest in HMC. The remaining $2.9 million was converted
into a membership interest in HMC Realty. Prior to the
Recapitalization, Harlingen Medical Center had approximately
$12.5 million in working capital debt outstanding with the
Company. As a result of the Recapitalization, the Company
converted $1.2 million of the debt into additional capital
in HMC, converted $9.6 million into a membership interest
of HMC Realty, and was repaid the remaining balance of the
working capital note. As a result of the transactions described
above, the Company now owns a 36% interest in HMC, and a 36%
interest in HMC Realty. In addition, Valley Baptist holds a 32%
interest in Harlingen Medical Center and a 19% interest in HMC
Realty, and the remaining ownership interests in both entities
are held by unrelated physician investor groups.
Prior to the Recapitalization, the Company consolidated HMC. As
a result of the Recapitalization, the Companys interest in
HMC was diluted from 51.0% to 36.0% effective for the fourth
quarter of fiscal year 2007. The Company recorded the gain
resulting from the change in ownership interest in accordance
with SAB Topic 5H. The gain resulted from the difference
between the carrying amount of the Companys investment in
HMC prior to the issuance of units and the Companys equity
investment immediately following the issuance of units. The
Company determined that recognition of the gain as a capital
transaction was appropriate because HMC had historically
experienced net losses, and because of uncertainty regarding the
possible future occurrence of transactions that may involve
further dilution of the Companys equity interest in HMC.
Future issuances of units to third parties, if any, will further
dilute the Companys ownership percentage and may give rise
to additional gains or losses based on the offering price in
comparison to the carrying value of the Companys
investment.
Purchase of Additional Interests in Hospitals
During June 2008 the Company acquired an additional 14.29%
ownership interest in the TexSAn by converting $9.5 million
of intercompany debt to equity. Additionally, during September
2008 the Company purchased an additional 3.676% ownership
interest in TexSAn for $1.2 million.
During July 2008 the Company purchased an additional 3% interest
in the Heart Hospital of New Mexico for $2.5 million.
Diagnostic and Therapeutic Facilities
Development
During April 2008 the Company paid
$8.5 million to acquire a 27.4% interest in Southwest
Arizona Heart and Vascular LLC a joint venture with the Heart
Lung Vascular Center of Yuma. The joint venture provides cardiac
catheterization lab services to Yuma Regional Medical Center in
Arizona.
During February 2008 the Company paid $1.0 million to
acquire a 33.33% interest in a joint venture with Solaris Health
Systems LLC and individual physician members to manage two
cardiac catheterization laboratories located in New Jersey.
During the year ended September 30, 2007, the Company
entered into three non-consolidating joint ventures of which the
Company owns between 9.2% and 15%.
71
MEDCATH
CORPORATION
NOTES TO
CONSOLIDATED FINANCIAL
STATEMENTS (Continued)
During the year ended September 30, 2006, the Company
entered into a business alliance with a medical center in
Illinois. Under this agreement, the Company receives fees
related to the management of the hospitals existing
cardiovascular program.
Additionally throughout the year ended September 30, 2006,
the Company opened five managed ventures throughout the United
States. The Company owns 100% of these centers.
Accounts receivable, net, consist of the following:
|
|
|
|
|
|
|
|
|
|
|
September 30,
|
|
|
|
2008
|
|
|
2007
|
|
|
Receivables, principally from patients and third-party payors
|
|
$
|
131,915
|
|
|
$
|
120,806
|
|
Receivables, principally from billings to hospitals for various
cardiovascular procedures
|
|
|
3,524
|
|
|
|
4,630
|
|
Amounts due under management contracts
|
|
|
3,745
|
|
|
|
1,763
|
|
Other
|
|
|
3,463
|
|
|
|
4,058
|
|
|
|
|
|
|
|
|
|
|
|
|
|
142,647
|
|
|
|
131,257
|
|
Less allowance for doubtful accounts
|
|
|
(57,856
|
)
|
|
|
(45,314
|
)
|
|
|
|
|
|
|
|
|
|
Accounts receivable, net
|
|
$
|
84,791
|
|
|
$
|
85,943
|
|
|
|
|
|
|
|
|
|
|
Activity for the allowance for doubtful accounts is as follows:
|
|
|
|
|
|
|
|
|
|
|
Year Ended September 30,
|
|
|
|
2008
|
|
|
2007
|
|
|
Balance, beginning of year
|
|
$
|
45,314
|
|
|
$
|
27,718
|
|
Bad debt expense
|
|
|
43,691
|
|
|
|
51,360
|
|
Write-offs, net of recoveries
|
|
|
(31,149
|
)
|
|
|
(33,764
|
)
|
|
|
|
|
|
|
|
|
|
Balance, end of year
|
|
$
|
57,856
|
|
|
$
|
45,314
|
|
|
|
|
|
|
|
|
|
|
|
|
7.
|
Property
and Equipment
|
Property and equipment, net, consists of the following:
|
|
|
|
|
|
|
|
|
|
|
September 30,
|
|
|
|
2008
|
|
|
2007
|
|
|
Land
|
|
$
|
26,457
|
|
|
$
|
24,746
|
|
Buildings
|
|
|
224,807
|
|
|
|
206,041
|
|
Equipment
|
|
|
245,999
|
|
|
|
230,077
|
|
Construction in progress
|
|
|
41,533
|
|
|
|
9,941
|
|
|
|
|
|
|
|
|
|
|
Total, at cost
|
|
|
538,796
|
|
|
|
470,805
|
|
Less accumulated depreciation
|
|
|
(215,016
|
)
|
|
|
(200,142
|
)
|
|
|
|
|
|
|
|
|
|
Property and equipment, net
|
|
$
|
323,780
|
|
|
$
|
270,663
|
|
|
|
|
|
|
|
|
|
|
Substantially all of the Companys property and equipment
is either pledged as collateral for various long-term
obligations or assigned to lenders under the senior secured
credit facility as intercompany collateral liens, see
Note 9.
72
MEDCATH
CORPORATION
NOTES TO
CONSOLIDATED FINANCIAL
STATEMENTS (Continued)
|
|
8.
|
Investments
in Affiliates
|
The Companys determination of the appropriate
consolidation method to follow with respect to investments in
affiliates is based on the amount of control it has and the
ownership level in the underlying entity. Investments in
entities that the Company does not control, but over whose
operations the Company has the ability to exercise significant
influence (including investments where we have less than 20%
ownership), are accounted for under the equity method. The
Company also considers FAS Interpretation No. 46,
Consolidation of Variable Interest Entities (as amended)
(FIN 46R) to determine if the Company is the primary
beneficiary of (and therefore should consolidate) any entity
whose operations the Company does not control. At
September 30, 2008, all of the Companys investments
in unconsolidated affiliates are accounted for using the equity
method.
Variable
Interest Entities
During the year ended September 30, 2007 the Companys
interest in HMC was diluted from 51.0% to 36.0%, see Note 5
for further discussion of this transaction. Prior to the fourth
quarter of fiscal 2007 the Company consolidated the results of
HMC. Upon dilution, the Company began accounting for HMC as an
equity investment as the Company determined that HMC was a
variable interest entity as defined by FIN 46(R) and was
not the primary beneficiary. HMC is an acute care hospital
facility in which the Company acts as manager of the facility
and provides support services as necessary.
Investments in unconsolidated affiliates accounted for under the
equity method consist of the following:
|
|
|
|
|
|
|
|
|
|
|
Year Ended September 30,
|
|
|
|
2008
|
|
|
2007
|
|
|
Avera Heart Hospital of South Dakota
|
|
$
|
9,888
|
|
|
$
|
8,856
|
|
Harlingen Medical Center
|
|
|
6,635
|
|
|
|
7,105
|
|
HMC Realty, LLC
|
|
|
(11,686
|
)
|
|
|
(11,371
|
)
|
Southwest Arizona Heart and Vascular, LLC
|
|
|
8,766
|
|
|
|
|
|
Other
|
|
|
1,682
|
|
|
|
1,128
|
|
|
|
|
|
|
|
|
|
|
|
|
$
|
15,285
|
|
|
$
|
5,718
|
|
|
|
|
|
|
|
|
|
|
The Companys ownership percentage for each investment
accounted for under the equity method is presented in the table
below:
|
|
|
|
|
Investee
|
|
Ownership
|
|
|
Blue Ridge Cardiology Services, LLC(a)(c)
|
|
|
50.0
|
%
|
Austin Development Holding, Inc.(a)
|
|
|
49.0
|
%
|
HMC Realty LLC(b)
|
|
|
36.1
|
%
|
Harlingen Medical Center(b)
|
|
|
35.6
|
%
|
Tri-County Heart New Jersey LLC(a)(c)
|
|
|
33.3
|
%
|
Avera Heart Hospital of South Dakota(b)
|
|
|
33.3
|
%
|
Southwest Arizona Heart and Vascular, LLC(c)
|
|
|
27.4
|
%
|
Wilmington Heart Services, LLC(a)(c)
|
|
|
15.0
|
%
|
Central New Jersey Heart Services, LLC(a)(c)
|
|
|
15.0
|
%
|
Coastal Carolina Heart, LLC(a)(c)
|
|
|
9.2
|
%
|
Austin MOB Inc.(a)
|
|
|
1.0
|
%
|
|
|
|
(a)
|
|
Included in Other
|
|
(b)
|
|
Included in the Hospital Division
|
|
(c)
|
|
Included in MedCath Partners
Division
|
73
MEDCATH
CORPORATION
NOTES TO
CONSOLIDATED FINANCIAL
STATEMENTS (Continued)
Accumulated deficit includes $10.3 million,
$8.1 million, and $6.4 million of undistributed
earnings from unconsolidated affiliates accounted for under the
equity method for the years ended September 30, 2008, 2007
and 2006, respectively. Distributions received from
unconsolidated affiliates accounted for under the equity method
were $7.7 million, $3.3 million and $2.8 million
during the years ended September 30, 2008, 2007 and 2006,
respectively.
The following tables represents summarized combined financial
information of the Companys unconsolidated affiliates
accounted for under the equity method
|
|
|
|
|
|
|
|
|
|
|
Year Ended
|
|
|
|
September 30,
|
|
|
|
2008
|
|
|
2007
|
|
|
Net revenue
|
|
$
|
215,707
|
|
|
$
|
97,182
|
|
Income from operations
|
|
$
|
43,053
|
|
|
$
|
19,497
|
|
Net income
|
|
$
|
34,005
|
|
|
$
|
12,822
|
|
|
|
|
|
|
|
|
|
|
|
|
September 30,
|
|
|
|
2008
|
|
|
2007
|
|
|
Current assets
|
|
$
|
69,766
|
|
|
$
|
57,802
|
|
Long-term assets
|
|
$
|
153,479
|
|
|
$
|
87,626
|
|
Current liabilities
|
|
$
|
28,430
|
|
|
$
|
23,065
|
|
Long-term liabilities
|
|
$
|
123,215
|
|
|
$
|
65,573
|
|
Long-term debt consists of the following:
|
|
|
|
|
|
|
|
|
|
|
September 30,
|
|
|
|
2008
|
|
|
2007
|
|
|
Senior Notes
|
|
$
|
101,961
|
|
|
$
|
101,961
|
|
Notes payable to various lenders
|
|
|
44,415
|
|
|
|
47,294
|
|
|
|
|
|
|
|
|
|
|
|
|
|
146,376
|
|
|
|
149,255
|
|
Less current portion
|
|
|
(30,748
|
)
|
|
|
(2,857
|
)
|
|
|
|
|
|
|
|
|
|
Long-term debt
|
|
$
|
115,628
|
|
|
$
|
146,398
|
|
|
|
|
|
|
|
|
|
|
Senior Notes
During the year ended
September 30, 2004, the Companys wholly-owned
subsidiary, MedCath Holdings Corp. (the Issuer), completed an
offering of $150.0 million in aggregate principal amount of
9 7 / 8% senior notes (the Senior Notes). The
proceeds, net of fees, of $145.5 million were used to repay
a significant portion of the Companys then outstanding
debt and obligations under capital leases. The Senior Notes,
which mature on July 15, 2012, pay interest semi-annually,
in arrears, on January 15 and July 15 of each year. The Senior
Notes are redeemable, in whole or in part, at any time on or
after July 15, 2008 at a designated redemption amount, plus
accrued and unpaid interest and liquidated damages, if any, to
the applicable redemption date. The Company could redeem up to
35% of the aggregate principal amount of the Senior Notes on or
before July 15, 2007 with the net cash proceeds from
certain equity offerings. In event of a change in control in the
Company or the Issuer, the Company must offer to purchase the
Senior Notes at a purchase price of 101% of the aggregate
principal amount, plus accrued and unpaid interest and
liquidated damages, if any, to the date of redemption.
The Senior Notes are general unsecured unsubordinated
obligations of the Issuer and are fully and unconditionally
guaranteed, jointly and severally, by MedCath Corporation (the
Parent) and all wholly owned existing and future domestic
subsidiaries of the Issuer (the Guarantors). The guarantees are
general unsecured unsubordinated obligations of the Guarantors.
74
MEDCATH
CORPORATION
NOTES TO
CONSOLIDATED FINANCIAL
STATEMENTS (Continued)
The Senior Notes include covenants that restrict, among other
things, the Companys and its subsidiaries ability to
make restricted payments, declare or pay dividends, incur
additional indebtedness or issue preferred stock, incur liens,
merge, consolidate or sell all or substantially all of the
assets, engage in certain transactions with affiliates, enter
into various transactions with affiliates, enter into sale and
leaseback transactions or engage in any business other than a
related business.
In connection with the sale of the assets of The Heart Hospital
of Milwaukee and as stipulated by the indenture governing the
Senior Notes, during the year ended September 30, 2006, the
Company offered to repurchase up to $30.3 million of Senior
Notes. The tender offer for the notes expired during the fiscal
year and the Company accepted for purchase and paid for
$11.9 million principal amount of Senior Notes tendered
prior to the expiration of the tender offer. Accordingly, the
Company expensed $0.4 million of deferred loan acquisition
costs related to this prepayment. This expense is reported as a
loss on early extinguishment of debt in the Companys
consolidated statement of operations for the year ended
September 30, 2006.
During fiscal 2007, the Company repurchased $36.2 million
of its outstanding Senior Notes using the proceeds from the
Companys secondary public offering which was declared
effective by the Securities and Exchange Commission on
November 6, 2006. The Company incurred a repurchase premium
of $3.5 million and approximately $1.0 million of
deferred loan acquisition costs were written off in connection
with the repurchase. These costs are reported as a loss on early
extinguishment of debt in the Companys statement of
operations for the year ended September 30, 2007.
Senior Secured Credit Facility
Concurrent
with the offering of the Senior Notes, the Issuer entered into a
$200.0 million senior secured credit facility (the Senior
Secured Credit Facility) with a syndicate of banks and other
institutional lenders. The Senior Secured Credit Facility
provides for a seven-year term loan facility (the Term Loan) in
the amount of $100.0 million and a five-year senior secured
revolving credit facility (Revolving Facility) in the amount of
$100.0 million, which includes a $25.0 million
sub-limit for the issuance of stand-by and commercial letters of
credit and a $10.0 million sub-limit for swing-line loans,
and is collateralized by patient accounts receivable and certain
other assets of the Company. There were no borrowings under the
Revolving Facility at September 30, 2008; however, the
Company has letters of credit outstanding of $1.7 million,
which reduces availability under the Revolving Facility to
$98.3 million as of September 30, 2008.
Borrowings under the Senior Secured Credit Facility, excluding
swing-line loans, bear interest per annum at a rate equal to the
sum of LIBOR plus the applicable margin or the alternate base
rate plus the applicable margin. The applicable margin is
different for the Revolving Facility and the Term Loan and
varies for the Revolving Facility depending on the
Companys financial performance. swing-line borrowings
under the Revolving Facility bear interest at the alternate base
rate which is defined as the greater of the Bank of America,
N.A. prime rate or the federal funds rate plus 0.5%. The Issuer
is required to pay quarterly, in arrears, a 0.5% per annum
commitment fee equal to the unused commitments under the Senior
Secured Credit Facility. The Issuer is also required to pay
quarterly, in arrears, a fee on the stated amount of each issued
and outstanding letter of credit ranging from 200 to
300 basis points depending upon the Companys
financial performance.
The Senior Secured Credit Facility is guaranteed, jointly and
severally, by the Parent and all wholly owned existing and
future direct and indirect domestic subsidiaries of the Issuer
and is secured by a first priority perfected security interest
in all of the capital stock or other ownership interests owned
by the Issuer in each of its subsidiaries, all other present and
future assets and properties of the Parent, the Issuer and the
subsidiary guarantors and all the intercompany notes.
The Senior Secured Credit Facility requires compliance with
certain financial covenants including a senior secured leverage
ratio test, a fixed charge coverage ratio test, a tangible net
worth test and a total leverage ratio test. The Senior Secured
Credit Facility also contains customary restrictions on, among
other things, the Companys ability and its
subsidiaries ability to incur liens; engage in mergers,
consolidations and sales of assets; incur debt;
75
MEDCATH
CORPORATION
NOTES TO
CONSOLIDATED FINANCIAL
STATEMENTS (Continued)
declare dividends, redeem stock and repurchase, redeem
and/or
repay
other debt; make loans, advances and investments and
acquisitions; make capital expenditures; and transactions with
affiliates.
The Issuer is required to make mandatory prepayments of
principal in specified amounts upon the occurrence of excess
cash flows and other certain events, as defined by the Senior
Secured Credit Facility, and is permitted to make voluntary
prepayments of principal under the Senior Secured Credit
Facility. The Term Loan is subject to amortization of principal
in quarterly installments of $250,000 for each of the first five
years, with the remaining balance payable in the final two years.
During the year ended September 30, 2006, the Company made
a voluntary prepayment of $58.0 million on the outstanding
balance of the Term Loan. Accordingly, the Company expensed
approximately $1.0 million of deferred loan acquisition
costs related to this prepayment. This expense is reported as a
loss on early extinguishment of debt in the Companys
statement of operations for the year ended September 30,
2006. Further, the amortization of principal was revised to
quarterly installments of $102,000 for the remaining first five
years, with the remaining balance payable in the final two years.
During January 2007, the Company paid off its outstanding
$39.9 million Term Loan under the Senior Secured Credit
Facility. In connection with the early repayment, the Company
wrote off approximately $0.5 million in deferred loan
acquisition costs. These costs are reported as a loss on early
extinguishment of debt in the Companys consolidated
statement of operations for the year ended September 30,
2007.
During November 2008, the Company amended and restated the
Senior Secured Credit Facility (the Amended Credit Facility).
The Amended Credit Facility provides for a three-year term loan
facility in the amount of $75.0 million (the Amended Term
Loan) and a revolving credit facility in the amount of
$85.0 million (Revolver), which includes a
$25.0 million sub-limit for the issuance of stand-by and
commercial letters of credit and a $10.0 million sub-limit
for swing-line loans. The aggregate amount available under the
Amended Credit Facility may be increased by an amount up to
$50.0 million. Borrowings under the Amended Credit
Facility, excluding swing-line loans, bear interest per annum at
a rate equal to the sum of LIBOR plus the applicable margin or
the alternate base rate plus the applicable margin.
The Amended Credit Facility continues to be guaranteed jointly
and severally by the Company and certain of Companys
existing and future, direct and indirect, subsidiaries and
continues to be secured by a first priority perfected security
interest in all of the capital stock or other ownership
interests owned by the Company and subsidiary guarantors in each
of their subsidiaries, and, subject to certain exceptions in the
credit facility all other present and future assets and
properties of the Company and the subsidiary guarantors and all
the intercompany notes.
The Amended Credit Facility requires compliance with certain
financial covenants including a consolidated senior secured
leverage ratio test, a consolidated fixed charge coverage ratio
test and a consolidated total leverage ratio test. The Amended
Credit Facility also contains customary restrictions on, among
other things, our and our subsidiaries ability to incur
liens; engage in mergers, consolidations and sales of assets;
incur debt; declare dividends; redeem stock and repurchase,
redeem
and/or
repay
other debt; make loans, advances and investments and
acquisitions; and entering into transactions with affiliates.
The Amended Credit Facility contains events of default,
including cross-defaults to certain indebtedness, change of
control events and events of default customary for syndicated
commercial credit facilities. Upon the occurrence of an event of
default, the Company could be required to immediately repay all
outstanding amounts under the amended credit facility.
The Company is required to make mandatory prepayments of
principal in specified amounts upon the occurrence of certain
events identified in the Amended Credit Facility and are
permitted to make voluntary prepayments of principal under the
Amended Credit Facility. The Amended Term Loan is subject to
amortization of
76
MEDCATH
CORPORATION
NOTES TO
CONSOLIDATED FINANCIAL
STATEMENTS (Continued)
principal in quarterly installments commencing on March 31,
2010. The maturity date of the Amended Term Loan and Revolver is
November 10, 2011.
Real Estate Investment Trust (REIT) Loans
As
of September 30, 2006, the Companys REIT Loan balance
included the outstanding indebtedness of two hospitals. The
interest rates on the outstanding REIT Loans were based on a
rate index tied to U.S. Treasury Notes plus a margin that
was determined on the completion date of the hospital, and
subsequently increased per year by 20 basis points. The
principal and interest on the REIT Loans were payable monthly
over seven-year terms from the completion date of the hospital
using extended period amortization schedules and included
balloon payments at the end of the terms. One of the REIT Loans
was due in full in October 2006 and therefore, the outstanding
balance was included in the current portion of long-term debt
and obligations under capital leases as of September 30,
2006. Borrowings under this REIT Loan were collateralized by a
pledge of the Companys interest in the related
hospitals property, equipment and certain other assets.
During the first quarter of fiscal 2007, this loan, in the
amount of $21.2 million, was repaid in full. The other REIT
Loan, which was previously scheduled to mature during the second
quarter of fiscal 2006, was refinanced in February 2006. Under
the terms of the new financing, the loan requires monthly,
interest-only payments for ten years, at which time the loan is
due in full. The interest rate on this loan is 8
1 / 2%. Borrowings under this REIT Loan are
collateralized by a pledge of the Companys interest in the
related hospitals property, equipment and certain other
assets.
As of September 30, 2006, in accordance with the
hospitals operating agreement and as required by the
lender, the Company guaranteed 100% of the obligation of one of
its subsidiary hospitals for the bank mortgage loan made under
its REIT Loan. As of September 30, 2007, the outstanding
REIT Loan was not guaranteed by the Company. The Company
received a fee during fiscal 2006 from the minority partners in
the subsidiary hospital as consideration for providing a
guarantee in excess of the Companys ownership percentage
in the subsidiary hospital, see Note 17. The guarantee
expired concurrent with the terms of the related real estate
loan and required the Company to perform under the guarantee in
the event of the subsidiary hospitals failing to perform
under the related loan. The total amount of the real estate debt
was secured by the subsidiary hospitals underlying real
estate, which was financed with the proceeds from the debt.
At September 30, 2008, the total amount of the REIT loan
was $35.3 million. Because the Company consolidates the
subsidiary hospitals results of operations and financial
position, both the assets and the accompanying liabilities are
included in the assets and long-term debt on the Companys
consolidated balance sheets.
Convertible Notes
During fiscal 2006, HMC
entered into two $10.0 million convertible notes with a
third-party health system, Valley Baptist. The first note could
be voluntarily converted by the health system into a 13.2%
ownership interest in HMC after the third anniversary date or it
will automatically be converted into an ownership interest in
HMC upon the achievement of specified financial targets of the
agreement, up until the third anniversary date of the agreement
or the fourth anniversary date of the agreement, if extended by
HMC. The second note was convertible into the same ownership
interest percentage as the first note at the discretion of the
health system after the conversion of the first note. The
potential ownership interest in HMC by the health system was
capped at 49%. The notes accrued interest at 5% up until the
third anniversary date, after which time the interest rate
increased to 8% if the notes have not been converted. Interest
payments were due quarterly. In accordance with the provisions
of
EITF 99-1,
Accounting for Debt Convertible into the Stock of a
Consolidated Subsidiary
,
EITF 00-19,
Accounting for Derivative Financial Instruments Indexed to,
and Potentially Settled in, a Companys Own Stock
, and
EITF 01-6,
The Meaning of Indexed to a Companys Own Stock
, the
convertible notes were accounted for as convertible debt in the
accompanying consolidated balance sheet and the embedded
conversion option in the convertible notes had not been
accounted for as a separate derivative as of September 30,
2006.
During July 2007, the Company elected, along with the original
physician investors and Valley Baptist, to allow early
conversion of the notes into an equity interest in HMC. Valley
Baptist converted $17.1 million of the convertible loans
into a 32.1% equity interest in HMC. The remaining
$2.9 million was conveyed to HMC Realty as payment of the
real property as a result of the sales-leaseback transaction
discussed above. See Note 5 for further discussion of the
Recapitalization transaction.
77
MEDCATH
CORPORATION
NOTES TO
CONSOLIDATED FINANCIAL
STATEMENTS (Continued)
Mortgage Loan
During the year ended
September 30, 2006 HMC entered into a $40.0 million,
ten year mortgage loan with a third-party lender. The loan
required quarterly, interest-only payments until the maturity
date. The interest rate on the loan was 8 3 / 4%. The
loan was secured by substantially all the assets of HMC and was
subject to certain financial and other restrictive covenants. In
addition, the Company guaranteed $10.0 million of the loan
balance. The Company received a fee from the minority partners
at HMC as consideration for providing a guarantee in excess of
the Companys ownership percentage in HMC, see
Note 17. The guarantee expired concurrent with the terms of
the related loan and required the Company to perform under the
guarantee in the event of HMCs failure to perform under
the related loan.
Notes Payable to Various Lenders
The Company
acquired substantially all of the medical and other equipment
for its hospitals and certain diagnostic and therapeutic
facilities and mobile cardiac catheterization laboratories under
installment notes payable to equipment lenders collateralized by
the related equipment. In addition, two facilities in the
MedCath Partners division financed leasehold improvements
through notes payable collateralized by the leasehold
improvements. Amounts borrowed under these notes are payable in
monthly installments of principal and interest over a
7 year term with a fixed interest rate at 7.16%. The
Company has guaranteed certain of its subsidiary hospitals
equipment loans. The Company receives a fee from the minority
partners in the subsidiary hospitals as consideration for
providing guarantees in excess of the Companys ownership
percentage in the subsidiary hospitals, see Note 17. These
guarantees expire concurrent with the terms of the related
equipment loans and would require the Company to perform under
the guarantee in the event of the subsidiaries failure to
perform under the related loan.
During March 2007, the Company paid off $11.1 million of
equipment debt outstanding at one of its hospitals. Due to the
early prepayment, the Company wrote off approximately
$0.1 million of deferred loan acquisition costs and
incurred approximately $0.1 million in early prepayment
fees. These costs are reported as a loss on early extinguishment
of debt in the consolidated statement of operations for the year
ended September 30, 2007.
At September 30, 2008, the total amount of notes payable to
various lenders was approximately $9.1 million, of which
$5.5 million was guaranteed by the Company. Because the
Company consolidates the subsidiary hospitals results of
operations and financial position, both the assets and the
accompanying liabilities are included in the assets and
long-term debt on the Companys consolidated balance
sheets. These notes payable contain various covenants and
restrictions including the maintenance of specific financial
ratios and amounts and payment of dividends.
Debt Covenants
At September 30, 2007,
the Company was in violation of a financial covenant under an
equipment loan to Heart Hospital of Lafayette, which is
guaranteed by MedCath. Heart Hospital of Lafayette is classified
as a discontinued operation. Accordingly, the total outstanding
balance of this loan has been included in current liabilities of
discontinued operations on the Companys consolidated
balance sheet as of September 30, 2007. The Company was in
compliance with all covenants in the instruments governing its
outstanding debt as of September 30, 2008.
Guarantees of Unconsolidated Affiliates
Debt
The Company has guaranteed approximately
30% of certain equipment debt of one of the affiliate hospitals
in which the Company has a minority ownership interest and
therefore does not consolidate the hospitals results of
operations and financial position. The Company provides this
guarantee in exchange for a fee from that affiliate hospital,
see Note 17. At September 30, 2008, the affiliate
hospital was in compliance with all covenants in the instruments
governing its debt. Equipment debt guaranteed by the Company was
immaterial at September 30, 2008. This guarantee expires
concurrent with the terms of the related equipment loans and
would require the Company to perform under the guarantee in the
event of the affiliate hospitals failure to perform under
the related loans. The total amount of this affiliate
hospitals debt is secured by the hospitals
underlying equipment, which was financed with the proceeds from
the debt. Because the Company does not consolidate the affiliate
hospitals results of operations or financial position,
neither the assets nor the accompanying liabilities are included
in the assets or liabilities on the Companys consolidated
balance sheets.
78
MEDCATH
CORPORATION
NOTES TO
CONSOLIDATED FINANCIAL
STATEMENTS (Continued)
Interest Rate Swaps
During the year ended
September 30, 2006 one of the hospitals in which the
Company has a minority interest and consequently accounts for
under the equity method, entered into an interest rate swap for
purposes of hedging variable interest payments on long term debt
outstanding for that hospital. The interest rate swap is
accounted for as a cash flow hedge by the hospital whereby
changes in the fair value of the interest rate swap flow through
comprehensive income of the hospital. The Company recorded its
proportionate share of comprehensive income within
stockholders equity in the consolidated balance sheets
based on the Companys ownership interest in that hospital.
Future Maturities
Presented below are the
future maturities of long-term debt at September 30, 2008,
inclusive of payments under the Amended Credit Facility,
discussed above.
|
|
|
|
|
|
|
Debt
|
|
Fiscal Year
|
|
Maturity
|
|
|
2009
|
|
$
|
30,748
|
|
2010
|
|
|
11,711
|
|
2011
|
|
|
16,827
|
|
2012
|
|
|
52,514
|
|
2013
|
|
|
|
|
Thereafter
|
|
|
34,576
|
|
|
|
|
|
|
|
|
$
|
146,376
|
|
|
|
|
|
|
|
|
10.
|
Obligations
Under Capital Leases
|
The Company currently leases several diagnostic and therapeutic
facilities, mobile catheterization laboratories, office space,
computer software and hardware, equipment and certain vehicles
under capital leases expiring through fiscal year 2013. Some of
these leases contain provisions for annual rental adjustments
based on increases in the consumer price index, renewal options,
and options to purchase during the lease terms. Amortization of
the capitalized amounts is included in depreciation expense.
Total assets under capital leases (net of accumulated
depreciation of approximately $4.6 million and
$6.7 million) at September 30, 2008 and 2007,
respectively, are approximately $3.7 million and
$3.6 million, respectively, and are included in property
and equipment on the consolidated balance sheets. Lease payments
during the years ended September 30, 2008, 2007, and 2006
were $1.5 million, $1.8 million and $2.7 million,
respectively, and include interest of approximately
$0.2 million, $0.2 million, and $0.3 million,
respectively.
Future minimum lease payments at September 30, 2008 are as
follows:
|
|
|
|
|
|
|
Minimum
|
|
Fiscal Year
|
|
Lease Payment
|
|
|
2009
|
|
$
|
1,285
|
|
2010
|
|
|
796
|
|
2011
|
|
|
734
|
|
2012
|
|
|
517
|
|
2013
|
|
|
216
|
|
|
|
|
|
|
Total future minimum lease payments
|
|
|
3,548
|
|
Less amounts representing interest
|
|
|
(289
|
)
|
|
|
|
|
|
Present value of net minimum lease payments
|
|
|
3,259
|
|
Less current portion
|
|
|
(1,172
|
)
|
|
|
|
|
|
|
|
$
|
2,087
|
|
|
|
|
|
|
79
MEDCATH
CORPORATION
NOTES TO
CONSOLIDATED FINANCIAL
STATEMENTS (Continued)
|
|
11.
|
Liability
Insurance Coverage
|
During June 2006, the Company entered into a new one-year
claims-made policy providing coverage for medical malpractice
claim amounts in excess of $2.0 million of retained
liability per claim. The Company also purchased additional
insurance to reduce the retained liability per claim to $250,000
for the MedCath Partners division. During June 2007, the Company
entered into a new one-year claims-made policy providing
coverage for medical malpractice claim amounts in excess of
$3.0 million of retained liability per claim. The Company
also purchased additional insurance to reduce the retained
liability per claim to $250,000 for the MedCath Partners
division. During June 2008, the Company entered into a new
one-year claims-made policy providing coverage for medical
malpractice claim amounts in excess of $2.0 million of
retained liability per claim. The Company also purchased
additional insurance to reduce the retained liability per claim
to $250,000 for the MedCath Partners division.
Because of the Companys self-insured retention levels, the
Company is required to recognize an estimated expense/liability
for the amount of retained liability applicable to each
malpractice claim. As of September 30, 2008 and
September 30, 2007, the total estimated liability for the
Companys self-insured retention on medical malpractice
claims, including an estimated amount for incurred but not
reported claims, was approximately $4.6 million and
$4.1 million, respectively, which is included in other
accrued liabilities in the consolidated balance sheets. The
Company maintains this reserve based on actuarial estimates
using the Companys historical experience with claims and
assumptions about future events. Due to the considerable
variability that is inherent in such estimates, including such
factors as changes in medical costs and changes in actual
experience, there is a reasonable possibility that the recorded
estimates will change by a material amount in the near term.
Also, there can be no assurance that the ultimate liability will
not exceed the Companys estimates.
In addition to reserves for medical malpractice, the Company
also maintains reserves for self-insured workmans
compensation, healthcare and dental coverage. The total
estimated reserve for self-insured liabilities for
workmans compensation, employee health and dental claims
was $3.2 million as of September 30, 2008 and
September 30, 2007 which is included in other accrued
liabilities in the consolidated balance sheets. The Company
maintains this reserve based on historical experience with
claims. The Company maintained commercial stop loss coverage for
health and dental insurance program of $150,000 per plan
participant through June 30, 2008, at which time the
commercial stop loss coverage per plan participant increased
$25,000 to $175,000.
|
|
12.
|
Commitments
and Contingencies
|
Operating Leases
The Company currently leases
several cardiac diagnostic and therapeutic facilities, mobile
catheterization laboratories, office space, computer software
and hardware equipment, certain vehicles and land under
noncancelable operating leases expiring through fiscal year
2017. Total rent expense under noncancelable rental commitments
was approximately $2.6 million, $2.3 million and
$2.8 million for the years ended September 30, 2008,
2007 and 2006, respectively, and is included in other operating
expenses in the accompanying consolidated statements of income.
The approximate future minimum rental commitments under
noncancelable operating leases as of September 30, 2008 are
as follows:
|
|
|
|
|
|
|
Rental
|
|
Fiscal Year
|
|
Commitment
|
|
|
2009
|
|
$
|
2,075
|
|
2010
|
|
|
1,211
|
|
2011
|
|
|
571
|
|
2012
|
|
|
427
|
|
2013
|
|
|
375
|
|
Thereafter
|
|
|
410
|
|
|
|
|
|
|
|
|
$
|
5,069
|
|
|
|
|
|
|
80
MEDCATH
CORPORATION
NOTES TO
CONSOLIDATED FINANCIAL
STATEMENTS (Continued)
Contingencies
Laws and regulations governing
the Medicare and Medicaid programs are complex, subject to
interpretation and may be modified. The Company believes that it
is in compliance with such laws and regulations. However,
compliance with such laws and regulations can be subject to
future government review and interpretation as well as
significant regulatory action including substantial fines and
criminal penalties, as well as repayment of previously billed
and collected revenue from patient services and exclusion from
the Medicare and Medicaid programs.
The Company is involved in various claims and legal actions in
the ordinary course of business, including malpractice claims
arising from services provided to patients that have been
asserted by various claimants and additional claims that may be
asserted for known incidents through September 30, 2008.
These claims and legal actions are in various stages, and some
may ultimately be brought to trial. Moreover, additional claims
arising from services provided to patients in the past and other
legal actions may be asserted in the future. The Company is
protecting its interests in all such claims and actions and does
not expect the ultimate resolution of these matters to have a
material adverse impact on the Companys consolidated
financial position, results of operations or cash flows.
A joint venture in our Partners Division provides cardiac care
services to a hospital pursuant to a management and services
agreement. The joint venture and the hospital disagreed
regarding the interpretation of certain provisions in the
management and services agreement. During August 2008 the two
parties reached an agreement as to settlement, resulting in the
Company recording a liability of $0.7 million which is
included within accrued liabilities in the consolidated balance
sheet at September 30, 2008. During November 2008 the
entire settlement amount was paid by the Company.
The U.S. Department of Justice, or DOJ, conducted an
investigation of a clinical trial conducted at one of our
hospitals. The investigation concerned alleged improper federal
healthcare program billings from
1998-2002
because certain endoluminal graft devices were implanted either
without an approved investigational device exception or outside
of the approved protocol. The DOJ reached a settlement under the
False Claims Act with the medical practice whose physicians
conducted the clinical trial. The hospital entered into an
agreement with the DOJ under which it paid $5.8 million to
the United States to settle, and obtain a release from any
federal civil false claims related to DOJs investigation.
The settlement and release cover both the hospital and the
physician who conducted the clinical trial, and does not include
any finding of wrong doing or any admission of liability. The
Company recorded a $5.8 million reduction in net revenue
for the year ended September 30, 2007, to establish a
reserve for repayment of a portion of Medicare reimbursement
related to hospital inpatient services provided to patients from
1998-2002
in
accordance with SFAS No. 5,
Accounting for
Contingences
. The $5.8 million settlement was paid to
the United States in November 2007.
Commitments
On November 10, 2005, the
FASB issued Interpretation
No. 45-3,
Application of FASB Interpretation No. 45 to Minimum
Revenue Guarantees Granted to a Business or Its Owners
(FIN No. 45-3).
FIN No. 45-3
amends FIN No. 45,
Guarantors Accounting and
Disclosure Requirements for Guarantees, Including Indirect
Guarantees of Indebtedness of Others
, to expand the scope
to include guarantees granted to a business, such as a
physicians practice, or its owner(s), guaranteeing that
the revenue of the business for a specified period will be at
least a specified amount. Under
FIN No. 45-3,
the accounting requirements of FIN No. 45 are
effective for any new revenue guarantees issued or modified on
or after January 1, 2006 and the disclosure of all revenue
guarantees, regardless of whether they were recognized under
FIN No. 45, is required for all interim and annual
periods beginning after January 1, 2006. Some of the
Companys hospitals provide guarantees to certain physician
groups for funds required to operate and maintain services for
the benefit of the hospitals patients including emergency
care and anesthesiology services, among other services. These
guarantees extend for the duration of the underlying service
agreements. The maximum potential future payments that the
Company could be required to make under these guarantees was
approximately $7.3 million through July 2011 as of
September 30, 2008. At September 30, 2008 the Company
has recorded a liability of $6.2 million for the fair value
of these guarantees, of which $3.7 million is in other
accrued liabilities and $2.5 million is in other long term
obligations. Additionally, the Company has recorded an asset of
$6.1 million representing the futures services to be
provided by the physicians, of which $3.6 million is in
prepaid expenses and other current assets and $2.5 million
is in other assets.
81
MEDCATH
CORPORATION
NOTES TO
CONSOLIDATED FINANCIAL
STATEMENTS (Continued)
The components of income tax expense (benefit) are as follows:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Year Ended September 30,
|
|
|
|
2008
|
|
|
2007
|
|
|
2006
|
|
|
Current tax expense (benefit):
|
|
|
|
|
|
|
|
|
|
|
|
|
Federal
|
|
$
|
5,680
|
|
|
$
|
17,861
|
|
|
$
|
(2,376
|
)
|
State
|
|
|
3,300
|
|
|
|
3,461
|
|
|
|
1,502
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Total current tax expense (benefit)
|
|
|
8,980
|
|
|
|
21,322
|
|
|
|
(874
|
)
|
Deferred tax expense (benefit):
|
|
|
|
|
|
|
|
|
|
|
|
|
Federal
|
|
|
2,365
|
|
|
|
(7,864
|
)
|
|
|
5,859
|
|
State
|
|
|
(758
|
)
|
|
|
(1,555
|
)
|
|
|
(1,445
|
)
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Total deferred tax expense (benefit)
|
|
|
1,607
|
|
|
|
(9,419
|
)
|
|
|
4,414
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Total income tax expense
|
|
$
|
10,587
|
|
|
$
|
11,903
|
|
|
$
|
3,540
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
The components of net deferred taxes are as follows:
|
|
|
|
|
|
|
|
|
|
|
Year Ended
|
|
|
|
September 30,
|
|
|
|
2008
|
|
|
2007
|
|
|
Deferred tax liabilities:
|
|
|
|
|
|
|
|
|
Property and equipment
|
|
$
|
20,227
|
|
|
$
|
24,569
|
|
Equity investments
|
|
|
1,844
|
|
|
|
1,533
|
|
Management contracts
|
|
|
1,225
|
|
|
|
1,016
|
|
Gain on sale of partnership units
|
|
|
2,461
|
|
|
|
2,461
|
|
Other
|
|
|
253
|
|
|
|
1,077
|
|
|
|
|
|
|
|
|
|
|
Total deferred tax liabilities
|
|
|
26,010
|
|
|
|
30,656
|
|
|
|
|
|
|
|
|
|
|
Deferred tax assets:
|
|
|
|
|
|
|
|
|
Net operating and economic loss carryforward
|
|
|
4,356
|
|
|
|
4,252
|
|
Basis difference in investment in subsidiaries
|
|
|
4,636
|
|
|
|
6,748
|
|
Allowances for doubtful accounts and other reserves
|
|
|
6,946
|
|
|
|
9,172
|
|
Accrued liabilities
|
|
|
2,924
|
|
|
|
3,152
|
|
Intangibles
|
|
|
100
|
|
|
|
267
|
|
Share-based compensation expense
|
|
|
6,081
|
|
|
|
7,333
|
|
Impairment of assets
|
|
|
|
|
|
|
1,486
|
|
Other
|
|
|
547
|
|
|
|
1,427
|
|
|
|
|
|
|
|
|
|
|
Total deferred tax assets
|
|
|
25,590
|
|
|
|
33,837
|
|
Valuation allowance
|
|
|
(2,163
|
)
|
|
|
(2,810
|
)
|
|
|
|
|
|
|
|
|
|
Net deferred tax asset (liability)
|
|
$
|
(2,583
|
)
|
|
$
|
371
|
|
|
|
|
|
|
|
|
|
|
As of September 30, 2008 and 2007, the Company had recorded
a valuation allowance of $2.2 million and
$2.8 million, respectively, primarily related to state net
operating loss carryforwards. The valuation allowance decreased
by approximately $0.6 million during the year ended
September 30, 2008 due to current year income incurred in
certain states.
82
MEDCATH
CORPORATION
NOTES TO
CONSOLIDATED FINANCIAL
STATEMENTS (Continued)
The Company has state net operating loss carryforwards of
approximately $108.2 million that began to expire in 2008.
The differences between the U.S. federal statutory tax rate
and the effective rate are as follows.
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
2008
|
|
|
2007
|
|
|
2006
|
|
|
Statutory federal income tax rate
|
|
|
35.0
|
%
|
|
|
35.0
|
%
|
|
|
35.0
|
%
|
State income taxes, net of federal effect
|
|
|
4.2
|
%
|
|
|
7.2
|
%
|
|
|
7.1
|
%
|
Share-based compensation expense
|
|
|
1.5
|
%
|
|
|
1.7
|
%
|
|
|
2.1
|
%
|
Penalties
|
|
|
|
|
|
|
1.1
|
%
|
|
|
|
|
Other non-deductible expenses and adjustments
|
|
|
1.8
|
%
|
|
|
(1.2
|
)%
|
|
|
3.7
|
%
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Effective income tax rate
|
|
|
42.5
|
%
|
|
|
43.8
|
%
|
|
|
47.9
|
%
|
In June 2006, the FASB issued FASB Interpretation No. 48,
Accounting for Uncertainty in Income Taxes an
interpretation of FASB Statement No. 109
(FIN 48). FIN 48 establishes a single
model to address accounting for uncertain tax positions.
FIN 48 clarifies the accounting for income taxes by
prescribing a minimum recognition threshold a tax position is
required to meet before being recognized in the financial
statements. FIN 48 also provides guidance on derecognition,
measurement, classification, interest and penalties, accounting
in interim periods, disclosure and transition.
The Company adopted Financial Accounting Standards Board (FASB)
Interpretation (FIN) No. 48, Accounting for
Uncertainty in Income Taxes, effective October 1,
2007. As a result of the implementation, the Company recognized
a $0.3 million net increase to the reserves for uncertain
tax positions. This increase was accounted for as a cumulative
effect adjustment and recognized as a reduction in beginning
retained earnings in the consolidated balance sheet. Including
the cumulative effect adjustment, the Company had approximately
$2.4 million of unrecognized tax benefits as of
October 1, 2007 and $1.2 million as of
September 30, 2008. Of the balance at September 30,
2008, $0.5 million represented the amount of unrecognized
tax benefits that, if recognized, would favorably impact the
effective income tax rate in any future periods. It is expected
that the amount of unrecognized tax benefits will change in the
next twelve months; however the Company does not expect the
change to have a significant impact on the results of operations
or the financial position of the Company.
The Company includes interest related to tax issues as part of
interest expense in the consolidated financial statements. The
Company records applicable penalties, if any, related to tax
issues within the income tax provision. The Company had
$0.2 million and $0.4 million accrued for interest as
of October 1, 2007 and September 30, 2008,
respectively. The interest impact for the unrecognized tax
liabilities was $0.2 million to the consolidated financial
results for fiscal 2008. There were no penalties recorded for
the unrecognized tax benefits.
Following is a reconciliation of the Companys unrecognized
tax benefits:
|
|
|
|
|
Balance at October 1, 2007
|
|
$
|
2,424
|
|
Additions based on tax positions related to the current year
|
|
|
|
|
Additions based on tax positions of prior years
|
|
|
640
|
|
Settlements
|
|
|
|
|
Reductions for positions of prior years
|
|
|
(1,830
|
)
|
|
|
|
|
|
Balance at September 30, 2008
|
|
$
|
1,234
|
|
|
|
|
|
|
Due to the utilization of all federal net operating losses in
the past three years, the Company may be subject to examination
by the Internal Revenue Service (IRS) back to September 30,
2000. In addition, the Company files income tax returns in
multiple states and local jurisdictions. Generally, the Company
is subject to state and local
83
MEDCATH
CORPORATION
NOTES TO
CONSOLIDATED FINANCIAL
STATEMENTS (Continued)
audits going back to years ended September 30, 2004;
however, due to existing net operating loss carryforwards, the
IRS can audit back to September 30, 1998 and
September 30, 1999 in a few significant states.
In the ordinary course of the Companys business there are
transactions where the ultimate tax determination is uncertain.
The Company believes that is has adequately provided for income
tax issues not yet resolved with federal, state and local tax
authorities. If an ultimate tax assessment exceeds the
Companys estimate of tax liabilities, an additional charge
to expense would result.
The calculation of diluted earnings (loss) per share considers
the potential dilutive effect of options to purchase 1,776,837,
1,727,112, and 2,070,472 shares of common stock at prices
ranging from $9.95 to $33.05, which were outstanding at
September 30, 2008, 2007 and 2006, respectively, as well as
123,982 and 193,982 shares of restricted stock which were
outstanding at September 30, 2008 and 2007, respectively.
Of the outstanding stock options, 947,000, 135,000, and 208,500
options have not been included in the calculation of diluted
earnings (loss) per share at September 30, 2008, 2007 and
2006, respectively, because the options were anti-dilutive.
|
|
15.
|
Stock
Compensation Plans
|
On July 28, 1998, the Companys board of directors
adopted a stock option plan (the 1998 Stock Option Plan) under
which it may grant incentive stock options and nonqualified
stock options to officers and other key employees. Under the
1998 Stock Option Plan, the board of directors may grant option
awards and determine the option exercise period, the option
exercise price, and other such conditions and restrictions on
the grant or exercise of the option as it deems appropriate. The
1998 Stock Option Plan provides that the option exercise price
may not be less than the fair value of the common stock as of
the date of grant and that the options may not be exercised more
than ten years after the date of grant. Options that have been
granted during the years ended September 30, 2008, 2007 and
2006 were granted at an option exercise price equal to or
greater than fair market value of the underlying stock at the
date of the grant and become exercisable on grading and fixed
vesting schedules ranging from 4 to 8 years subject to
certain performance acceleration features. As further discussed
in Note 2, effective September 30, 2005, the
compensation committee of the board of directors approved a plan
to accelerate the vesting of substantially all unvested stock
options previously awarded to employees, subject to a
Restriction Agreement. At September 30, 2008, the maximum
number of shares of common stock, which can be issued through
awards granted under the 1998 Option Plan is 3,000,000, of which
754,637 are outstanding as of September 30, 2008. Per the
1998 Stock Option Plan agreement options may no longer be
granted as of July 31, 2008.
On July 23, 2000, the Company adopted an outside
directors stock option plan (the Directors Plan)
under which nonqualified stock options may be granted to
non-employee directors. Under the Directors Plan, grants
of 2,000 options were granted to each new director upon becoming
a member of the board of directors and grants of 2,000 options
were made to each continuing director on October 1, 1999
(the first day of the fiscal year ended September 30,
2000). Effective September 15, 2000, the Directors
Plan was amended to increase the number of options granted for
future awards from 2,000 to 3,500. Further, effective
September 30, 2007, the Directors Plan was amended to
increase the number of options granted for future awards from
3,500 to 8,000. All options granted under the Directors
Plan through September 30, 2008 have been granted at an
exercise price equal to or greater than the fair market value of
the underlying stock at the date of the grant. Options are
exercisable immediately upon the date of grant and expire ten
years from the date of grant. Effective March 5, 2008, the
Directors Plan was amended to increase the maximum number
of common stock shares which can be issued under the
Directors Plan by 300,000. The maximum number of shares of
common stock which can be issued through awards granted under
the Directors Plan is 550,000, of which 206,000 are
outstanding as of September 30, 2008.
Effective October 1, 2005, the Company adopted the MedCath
Corporation 2006 Stock Option and Award Plan (the Stock Plan),
which provides for the issuance of stock options, restricted
stock and restricted stock units to employees of the Company.
The Stock Plan is administered by the compensation committee of
the board of
84
MEDCATH
CORPORATION
NOTES TO
CONSOLIDATED FINANCIAL
STATEMENTS (Continued)
directors, who has the authority to select the employees
eligible to receive awards. This committee also has the
authority under the Stock Plan to determine the types of awards,
select the terms and conditions attached to all awards, and,
subject to the limitation on individual awards in the Stock
Plan, determine the number of shares to be awarded. At
September 30, 2008, the maximum number of shares of common
stock which can be issued through awards granted under the Stock
Plan is 1,750,000 of which 940,182 are outstanding as of
September 30, 2008.
Stock options granted to employees under the Stock Plan have an
exercise price per share that represents the fair market value
of the common stock of the Company on the respective dates that
the options are granted. The options expire ten years from the
grant date, are fully vested as of the date of grant, and are
exercisable at any time. Subsequent to the exercise of stock
options, the shares of stock acquired upon exercise may be
subject to certain sale restrictions depending on the
optionees employment status and length of time the options
were held prior to exercise.
Activity for the Companys stock compensation plans during
the years ended September 30, 2008, 2007 and 2006 was as
follows:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Weighted-
|
|
|
|
Number of
|
|
|
Average
|
|
|
|
Options
|
|
|
Exercise Price
|
|
|
Outstanding options, September 30, 2005
|
|
|
2,409,618
|
|
|
$
|
13.50
|
|
Granted
|
|
|
1,070,500
|
|
|
|
20.98
|
|
Exercised
|
|
|
(597,363
|
)
|
|
|
11.72
|
|
Cancelled
|
|
|
(380,283
|
)
|
|
|
12.79
|
|
Forfeited
|
|
|
(432,000
|
)
|
|
|
9.72
|
|
|
|
|
|
|
|
|
|
|
Outstanding options, September 30, 2006
|
|
|
2,070,472
|
|
|
$
|
18.80
|
|
Granted
|
|
|
243,000
|
|
|
|
29.22
|
|
Exercised
|
|
|
(411,146
|
)
|
|
|
14.03
|
|
Cancelled
|
|
|
(175,214
|
)
|
|
|
22.95
|
|
|
|
|
|
|
|
|
|
|
Outstanding options, September 30, 2007
|
|
|
1,727,112
|
|
|
$
|
19.11
|
|
Granted
|
|
|
480,000
|
|
|
|
24.51
|
|
Exercised
|
|
|
(269,996
|
)
|
|
|
15.99
|
|
Cancelled
|
|
|
(160,279
|
)
|
|
|
26.93
|
|
|
|
|
|
|
|
|
|
|
Outstanding options, September 30, 2008
|
|
|
1,776,837
|
|
|
$
|
22.15
|
|
|
|
|
|
|
|
|
|
|
85
MEDCATH
CORPORATION
NOTES TO
CONSOLIDATED FINANCIAL
STATEMENTS (Continued)
The following table summarizes information for options
outstanding and exercisable at September 30, 2008:
|
|
|
|
|
|
|
|
|
|
|
|
|
Options Outstanding and Exercisable
|
|
|
|
Number of
|
|
|
|
|
|
|
|
|
|
Options
|
|
|
Weighted-
|
|
|
Weighted-
|
|
|
|
Outstanding
|
|
|
Average
|
|
|
Average
|
|
Range of
|
|
and
|
|
|
Remaining
|
|
|
Exercise
|
|
Prices
|
|
Exercisable
|
|
|
Life (years)
|
|
|
Price
|
|
|
9.95 - 15.80
|
|
|
157,137
|
|
|
|
6.00
|
|
|
$
|
13.55
|
|
15.91 - 18.26
|
|
|
99,200
|
|
|
|
6.95
|
|
|
|
16.27
|
|
19.00 - 20.07
|
|
|
173,000
|
|
|
|
7.34
|
|
|
|
19.28
|
|
20.56 - 21.49
|
|
|
526,000
|
|
|
|
7.50
|
|
|
|
21.45
|
|
21.66 - 22.50
|
|
|
338,000
|
|
|
|
7.62
|
|
|
|
22.42
|
|
23.25 - 27.71
|
|
|
317,500
|
|
|
|
8.64
|
|
|
|
26.41
|
|
27.80 - 30.24
|
|
|
91,000
|
|
|
|
8.37
|
|
|
|
29.29
|
|
30.35 - 33.05
|
|
|
75,000
|
|
|
|
8.51
|
|
|
|
31.55
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
$ 9.95 - 33.05
|
|
|
1,776,837
|
|
|
|
7.62
|
|
|
$
|
22.15
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Under
SFAS No. 123-R,
share-based compensation expense recognized for the fiscal years
ended September 30, 2008, 2007 and 2006 was
$5.0 million, $4.3 million and $13.2 million,
respectively. The associated tax benefits related to the
compensation expense recognized for fiscal 2008, 2007 and 2006
was $2.0 million, $1.9 million and $6.3 million,
respectively. The compensation expense recognized represents the
compensation related to restricted stock awards over the vesting
period, as well as the value of all stock options issued during
the period as all such options vest immediately. The
weighted-average grant-date fair value of options granted during
the fiscal years ended September 30, 2008, 2007 and 2006
was $10.53, $12.80 and $11.55, respectively. The total intrinsic
value of options exercised during fiscal 2008 and 2007 was
$1.4 million and $5.5 million, respectively and the
total intrinsic value of options outstanding at
September 30, 2008 was $(7.5) million.
During the year ended September 30, 2006, the Company
granted to employees 270,836 shares of restricted stock
units, which vest at various dates through March 2009. The
compensation expense, which represents the fair value of the
stock measured at the market price at the date of grant, less
estimated forfeitures, is recognized on a straight-line basis
over the vesting period. Unamortized compensation expense
related to restricted stock units amounted to $0.3 million,
$1.8 million and $3.5 million at September 30,
2008, 2007 and 2006, respectively.
Activity for the Companys restricted stock units issued
under the Stock Plan during the years ended September 30,
2008, 2007 and 2006 was as follows:
|
|
|
|
|
|
|
|
|
|
|
Number of
|
|
|
Weighted-
|
|
|
|
Restricted
|
|
|
Average
|
|
|
|
Stock Units
|
|
|
Exercise Price
|
|
|
Outstanding restricted stock units, September 30, 2005
|
|
|
|
|
|
$
|
|
|
Granted
|
|
|
270,836
|
|
|
|
19.94
|
|
Cancelled
|
|
|
(54,001
|
)
|
|
|
20.50
|
|
|
|
|
|
|
|
|
|
|
Outstanding restricted stock units, September 30, 2006
|
|
|
216,835
|
|
|
$
|
19.80
|
|
Cancelled
|
|
|
(22,853
|
)
|
|
|
20.50
|
|
|
|
|
|
|
|
|
|
|
Outstanding restricted stock units, September 30, 2007
|
|
|
193,982
|
|
|
$
|
19.72
|
|
Exercised
|
|
|
(21,448
|
)
|
|
|
20.50
|
|
Cancelled
|
|
|
(48,552
|
)
|
|
|
20.50
|
|
|
|
|
|
|
|
|
|
|
Outstanding restricted stock units, September 30, 2008
|
|
|
123,982
|
|
|
$
|
19.28
|
|
|
|
|
|
|
|
|
|
|
86
MEDCATH
CORPORATION
NOTES TO
CONSOLIDATED FINANCIAL
STATEMENTS (Continued)
|
|
16.
|
Employee
Benefit Plan
|
The Company has a defined contribution retirement savings plan
(the 401(k) Plan) which covers all employees. The 401(k) Plan
allows employees to contribute from 1% to 50% of their annual
compensation on a pre-tax basis. The Company, at its discretion,
may make an annual contribution of up to 40% of an
employees pretax contribution, up to a maximum of 6% of
compensation. This annual contribution percentage was increased
to 40% for the year ended September 30, 2008 from 30% for
the year ended September 30, 2007. The Companys
contributions to the 401(k) Plan for the years ended
September 30, 2008, 2007 and 2006 were approximately
$2.3 million, $1.7 million and $1.3 million,
respectively.
|
|
17.
|
Related
Party Transactions
|
During the years ended September 30, 2007 and 2006 the
Company incurred $0.1 million in insurance and related risk
management fees to its principal stockholders and their
affiliates. No amounts were incurred in insurance and related
risk management fees to its principal stockholders and their
affiliates during the year ended September 30, 2008. In
addition, $0.1 million was paid to a director for
consulting fees during the year ended September 30, 2006.
No consulting fees were paid to any directors during the years
ended September 30, 2008 and 2007.
As compensation for the Companys guarantee of certain
unconsolidated affiliate hospitals long term debt, the Company
receives a debt guarantee fee; see Note 9 for further
discussion. Debt guarantee fees recorded in net revenues in the
consolidated statement of operations were $0.4 million,
$0.5 million and $0.7 million for the years ended
September 30, 2008, 2007 and 2006, respectively.
Additionally the Company receives a management fee from
unconsolidated affiliates. Management fees recorded within net
revenues in the consolidated statement of operations were
$6.0 million, $3.6 million, and $3.0 million for
the years ended September 30, 2008, 2007 and 2006,
respectively.
At September 30, 2008 and 2007 the Company had
$1.9 million and $2.6 million of outstanding fees
recorded within prepaid expenses and other current assets in the
consolidated balance sheets primarily related to management,
insurance and legal fees charged to unconsolidated affiliates,
see Note 8 for further discussion regarding unconsolidated
affiliates of the Company.
87
MEDCATH
CORPORATION
NOTES TO
CONSOLIDATED FINANCIAL
STATEMENTS (Continued)
|
|
18.
|
Summary
of Quarterly Financial Data (Unaudited)
|
Summarized quarterly financial results were as follows:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Year Ended September 30, 2008
|
|
|
|
First
|
|
|
Second
|
|
|
Third
|
|
|
Fourth
|
|
|
|
Quarter
|
|
|
Quarter
|
|
|
Quarter
|
|
|
Quarter
|
|
|
Net revenue
|
|
$
|
148,850
|
|
|
$
|
157,098
|
|
|
$
|
157,086
|
|
|
$
|
150,921
|
|
Operating expenses
|
|
|
138,694
|
|
|
|
141,713
|
|
|
|
143,035
|
|
|
|
145,764
|
|
Income from operations
|
|
|
10,156
|
|
|
|
15,385
|
|
|
|
14,051
|
|
|
|
5,157
|
|
Income from continuing operations
|
|
|
2,618
|
|
|
|
5,977
|
|
|
|
5,348
|
|
|
|
377
|
|
Income (loss) from discontinued operations
|
|
|
446
|
|
|
|
(292
|
)
|
|
|
6,424
|
|
|
|
92
|
|
Net income
|
|
$
|
3,064
|
|
|
$
|
5,685
|
|
|
$
|
11,772
|
|
|
$
|
469
|
|
Earnings per share, basic
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Continuing operations
|
|
$
|
0.13
|
|
|
$
|
0.30
|
|
|
$
|
0.27
|
|
|
$
|
0.02
|
|
Discontinued operations
|
|
|
0.01
|
|
|
|
(0.01
|
)
|
|
|
0.33
|
|
|
|
0.00
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Earnings per share, basic
|
|
$
|
0.14
|
|
|
$
|
0.29
|
|
|
$
|
0.60
|
|
|
$
|
0.02
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Earnings per share, diluted
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Continuing operations
|
|
$
|
0.12
|
|
|
$
|
0.30
|
|
|
$
|
0.27
|
|
|
$
|
0.02
|
|
Discontinued operations
|
|
|
0.01
|
|
|
|
(0.01
|
)
|
|
|
0.33
|
|
|
|
0.00
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Earnings per share, diluted
|
|
$
|
0.13
|
|
|
$
|
0.29
|
|
|
$
|
0.60
|
|
|
$
|
0.02
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Weighted average number of shares, basic
|
|
|
21,028
|
|
|
|
19,841
|
|
|
|
19,524
|
|
|
|
19,590
|
|
Dilutive effect of stock options and restricted stock
|
|
|
263
|
|
|
|
121
|
|
|
|
107
|
|
|
|
65
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Weighted average number of shares, diluted
|
|
|
21,291
|
|
|
|
19,962
|
|
|
|
19,631
|
|
|
|
19,655
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Year Ended September 30, 2007
|
|
|
|
First
|
|
|
Second
|
|
|
Third
|
|
|
Fourth
|
|
|
|
Quarter
|
|
|
Quarter
|
|
|
Quarter
|
|
|
Quarter
|
|
|
Net revenue
|
|
$
|
160,387
|
|
|
$
|
176,640
|
|
|
$
|
178,492
|
|
|
$
|
145,084
|
|
Operating expenses
|
|
|
150,904
|
|
|
|
161,071
|
|
|
|
158,461
|
|
|
|
130,679
|
|
Income from operations
|
|
|
9,483
|
|
|
|
15,569
|
|
|
|
20,031
|
|
|
|
14,405
|
|
Income (loss) from continuing operations
|
|
|
(361
|
)
|
|
|
4,729
|
|
|
|
8,429
|
|
|
|
2,454
|
|
Income (loss) from discontinued operations
|
|
|
(4,535
|
)
|
|
|
1,521
|
|
|
|
836
|
|
|
|
(1,546
|
)
|
Net income (loss)
|
|
$
|
(4,896
|
)
|
|
$
|
6,250
|
|
|
$
|
9,265
|
|
|
$
|
908
|
|
Earnings (loss) per share, basic
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Continuing operations
|
|
$
|
(0.02
|
)
|
|
$
|
0.23
|
|
|
$
|
0.40
|
|
|
$
|
0.12
|
|
Discontinued operations
|
|
$
|
(0.22
|
)
|
|
$
|
0.07
|
|
|
|
0.04
|
|
|
|
(0.06
|
)
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Earnings (loss) per share, basic
|
|
$
|
(0.24
|
)
|
|
$
|
0.30
|
|
|
$
|
0.44
|
|
|
$
|
0.06
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Earnings (loss) per share, diluted
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Continuing operations
|
|
$
|
(0.02
|
)
|
|
$
|
0.22
|
|
|
$
|
0.38
|
|
|
$
|
0.13
|
|
Discontinued operations
|
|
$
|
(0.22
|
)
|
|
$
|
0.07
|
|
|
|
0.04
|
|
|
|
(0.06
|
)
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Earnings (loss) per share, diluted
|
|
$
|
(0.24
|
)
|
|
$
|
0.29
|
|
|
$
|
0.42
|
|
|
$
|
0.07
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Weighted average number of shares, basic
|
|
|
20,121
|
|
|
|
21,019
|
|
|
|
21,144
|
|
|
|
21,202
|
|
Dilutive effect of stock options and restricted stock
|
|
|
|
|
|
|
625
|
|
|
|
682
|
|
|
|
579
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Weighted average number of shares, diluted
|
|
|
20,121
|
|
|
|
21,644
|
|
|
|
21,826
|
|
|
|
21,781
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
88
MEDCATH
CORPORATION
NOTES TO
CONSOLIDATED FINANCIAL
STATEMENTS (Continued)
|
|
19.
|
Reportable
Segment Information
|
The Companys reportable segments consist of the Hospital
Division and the MedCath Partners Division. The Hospital
Division consists of freestanding, licensed general acute care
hospitals that provide a wide range of health services with a
focus on cardiovascular care. MedCath Partners Division consists
of cardiac diagnostic and therapeutic facilities that are either
freestanding or located within unrelated hospitals. MedCath
Partners Division provides management services to facilities or
operates facilities directly on a contracted basis.
There is no aggregation of operating segments within each
reportable segment. The Company believes these reportable
business segments properly align the various operations of the
Company with how the chief operating decision maker views the
business. The Companys chief operating decision maker
regularly reviews financial information about each of these
reportable business segments in deciding how to allocate
resources and evaluate performance.
Financial information concerning the Companys operations
by each of the reportable segments as of and for the years ended
September 30 are as follows:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Year Ended September 30,
|
|
|
|
2008
|
|
|
2007
|
|
|
2006
|
|
|
Net revenue:
|
|
|
|
|
|
|
|
|
|
|
|
|
Hospital Division
|
|
$
|
568,625
|
|
|
$
|
610,008
|
|
|
$
|
590,423
|
|
MedCath Partners Division
|
|
|
42,929
|
|
|
|
48,337
|
|
|
|
51,269
|
|
Corporate and other
|
|
|
2,401
|
|
|
|
2,258
|
|
|
|
2,725
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Consolidated totals
|
|
$
|
613,955
|
|
|
$
|
660,603
|
|
|
$
|
644,417
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Income (loss) from operations:
|
|
|
|
|
|
|
|
|
|
|
|
|
Hospital Division
|
|
$
|
68,726
|
|
|
$
|
64,132
|
|
|
$
|
56,644
|
|
MedCath Partners Division
|
|
|
5,928
|
|
|
|
8,634
|
|
|
|
9,843
|
|
Corporate and other
|
|
|
(29,905
|
)
|
|
|
(13,278
|
)
|
|
|
(24,910
|
)
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Consolidated totals
|
|
$
|
44,749
|
|
|
$
|
59,488
|
|
|
$
|
41,577
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Depreciation and amortization:
|
|
|
|
|
|
|
|
|
|
|
|
|
Hospital Division
|
|
$
|
25,232
|
|
|
$
|
25,703
|
|
|
$
|
27,019
|
|
MedCath Partners Division
|
|
|
4,816
|
|
|
|
5,677
|
|
|
|
5,884
|
|
Corporate and other
|
|
|
773
|
|
|
|
487
|
|
|
|
729
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Consolidated totals
|
|
$
|
30,821
|
|
|
$
|
31,867
|
|
|
$
|
33,632
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Interest expense (income) including intercompany, net:
|
|
|
|
|
|
|
|
|
|
|
|
|
Hospital Division
|
|
$
|
19,955
|
|
|
$
|
29,408
|
|
|
$
|
34,296
|
|
MedCath Partners Division
|
|
|
(18
|
)
|
|
|
(67
|
)
|
|
|
40
|
|
Corporate and other
|
|
|
(7,589
|
)
|
|
|
(14,898
|
)
|
|
|
(7,862
|
)
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Consolidated totals
|
|
$
|
12,348
|
|
|
$
|
14,443
|
|
|
$
|
26,474
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Capital expenditures:
|
|
|
|
|
|
|
|
|
|
|
|
|
Hospital Division
|
|
$
|
78,862
|
|
|
$
|
31,340
|
|
|
$
|
15,464
|
|
MedCath Partners Division
|
|
|
1,890
|
|
|
|
855
|
|
|
|
8,759
|
|
Corporate and other
|
|
|
3,891
|
|
|
|
4,182
|
|
|
|
2,957
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Consolidated totals
|
|
$
|
84,643
|
|
|
$
|
36,377
|
|
|
$
|
27,180
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
September 30,
|
|
|
|
2008
|
|
|
2007
|
|
|
Aggregate identifiable assets:
|
|
|
|
|
|
|
|
|
Hospital Division
|
|
$
|
546,665
|
|
|
$
|
542,827
|
|
MedCath Partners Division
|
|
|
38,719
|
|
|
|
34,021
|
|
Corporate and other
|
|
|
68,072
|
|
|
|
101,719
|
|
|
|
|
|
|
|
|
|
|
Consolidated totals
|
|
$
|
653,456
|
|
|
$
|
678,567
|
|
|
|
|
|
|
|
|
|
|
89
MEDCATH
CORPORATION
NOTES TO
CONSOLIDATED FINANCIAL
STATEMENTS (Continued)
Substantially all of the Companys net revenue in its
hospital division and MedCath Partners division is derived
directly or indirectly from patient services. The amounts
presented for corporate and other primarily include management
and consulting fees, general overhead and administrative
expenses, financing activities, certain cash and cash
equivalents, prepaid expenses, other assets and operations of
the business not subject to separate segment reporting.
|
|
20.
|
Guarantor/Non-Guarantor
Financial Statements
|
The following tables present the condensed consolidated
financial information for each of the Parent, the Issuer, the
Guarantors and the subsidiaries of the Issuer that are not
Guarantors (the Non-Guarantors), together with consolidating
eliminations, as of and for the periods indicated.
MEDCATH
CORPORATION
CONDENSED
CONSOLIDATING BALANCE SHEET
September 30,
2008
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Non-
|
|
|
|
|
|
|
|
|
|
Parent
|
|
|
Issuer
|
|
|
Guarantors
|
|
|
Guarantors
|
|
|
Eliminations
|
|
|
MedCath
|
|
|
Current assets:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Cash and cash equivalents
|
|
$
|
|
|
|
$
|
|
|
|
$
|
43,164
|
|
|
$
|
51,010
|
|
|
$
|
|
|
|
$
|
94,174
|
|
Accounts receivable, net
|
|
|
|
|
|
|
|
|
|
|
5,490
|
|
|
|
79,301
|
|
|
|
|
|
|
|
84,791
|
|
Other current assets
|
|
|
|
|
|
|
|
|
|
|
34,488
|
|
|
|
20,625
|
|
|
|
(13,136
|
)
|
|
|
41,977
|
|
Current assets of discontinued operations
|
|
|
|
|
|
|
|
|
|
|
159
|
|
|
|
18,834
|
|
|
|
(159
|
)
|
|
|
18,834
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Total current assets
|
|
|
|
|
|
|
|
|
|
|
83,301
|
|
|
|
169,770
|
|
|
|
(13,295
|
)
|
|
|
239,776
|
|
Property and equipment, net
|
|
|
|
|
|
|
|
|
|
|
18,028
|
|
|
|
305,752
|
|
|
|
|
|
|
|
323,780
|
|
Investments in subsidiaries
|
|
|
369,596
|
|
|
|
369,596
|
|
|
|
76,385
|
|
|
|
(62
|
)
|
|
|
(815,515
|
)
|
|
|
|
|
Goodwill
|
|
|
|
|
|
|
|
|
|
|
60,174
|
|
|
|
|
|
|
|
|
|
|
|
60,174
|
|
Intercompany notes receivable
|
|
|
|
|
|
|
|
|
|
|
234,025
|
|
|
|
|
|
|
|
(234,025
|
)
|
|
|
|
|
Other long-term assets
|
|
|
|
|
|
|
|
|
|
|
23,230
|
|
|
|
6,496
|
|
|
|
|
|
|
|
29,726
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Total assets
|
|
$
|
369,596
|
|
|
$
|
369,596
|
|
|
$
|
495,143
|
|
|
$
|
481,956
|
|
|
$
|
(1,062,835
|
)
|
|
$
|
653,456
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Current liabilities:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Accounts payable
|
|
$
|
|
|
|
$
|
|
|
|
$
|
460
|
|
|
$
|
41,279
|
|
|
$
|
|
|
|
$
|
41,739
|
|
Accrued compensation and benefits
|
|
|
|
|
|
|
|
|
|
|
4,579
|
|
|
|
12,306
|
|
|
|
|
|
|
|
16,885
|
|
Other current liabilities
|
|
|
|
|
|
|
|
|
|
|
5,094
|
|
|
|
32,176
|
|
|
|
(13,136
|
)
|
|
|
24,134
|
|
Current portion of long-term debt and obligations under capital
leases
|
|
|
|
|
|
|
|
|
|
|
27,261
|
|
|
|
4,659
|
|
|
|
|
|
|
|
31,920
|
|
Current liabilities of discontinued operations
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
10,153
|
|
|
|
(159
|
)
|
|
|
9,994
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Total current liabilities
|
|
|
|
|
|
|
|
|
|
|
37,394
|
|
|
|
100,573
|
|
|
|
(13,295
|
)
|
|
|
124,672
|
|
Long-term debt
|
|
|
|
|
|
|
|
|
|
|
74,991
|
|
|
|
40,637
|
|
|
|
|
|
|
|
115,628
|
|
Obligations under capital leases
|
|
|
|
|
|
|
|
|
|
|
47
|
|
|
|
2,040
|
|
|
|
|
|
|
|
2,087
|
|
Intercompany notes payable
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
234,025
|
|
|
|
(234,025
|
)
|
|
|
|
|
Deferred income tax liabilities
|
|
|
|
|
|
|
|
|
|
|
12,352
|
|
|
|
|
|
|
|
|
|
|
|
12,352
|
|
Other long-term obligations
|
|
|
|
|
|
|
|
|
|
|
763
|
|
|
|
3,691
|
|
|
|
|
|
|
|
4,454
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Total liabilities
|
|
|
|
|
|
|
|
|
|
|
125,547
|
|
|
|
380,966
|
|
|
|
(247,320
|
)
|
|
|
259,193
|
|
Minority interest in equity of consolidated subsidiaries
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
24,667
|
|
|
|
24,667
|
|
Total stockholders equity
|
|
|
369,596
|
|
|
|
369,596
|
|
|
|
369,596
|
|
|
|
100,990
|
|
|
|
(840,182
|
)
|
|
|
369,596
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Total liabilities and stockholders equity
|
|
$
|
369,596
|
|
|
$
|
369,596
|
|
|
$
|
495,143
|
|
|
$
|
481,956
|
|
|
$
|
(1,062,835
|
)
|
|
$
|
653,456
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
90
MEDCATH
CORPORATION
NOTES TO
CONSOLIDATED FINANCIAL
STATEMENTS (Continued)
MEDCATH
CORPORATION
CONDENSED
CONSOLIDATING BALANCE SHEET
September 30,
2007
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Non-
|
|
|
|
|
|
|
|
|
|
Parent
|
|
|
Issuer
|
|
|
Guarantors
|
|
|
Guarantors
|
|
|
Eliminations
|
|
|
MedCath
|
|
|
Current assets:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Cash and cash equivalents
|
|
$
|
|
|
|
$
|
|
|
|
$
|
80,044
|
|
|
$
|
60,232
|
|
|
$
|
|
|
|
$
|
140,276
|
|
Accounts receivable, net
|
|
|
|
|
|
|
|
|
|
|
5,372
|
|
|
|
80,571
|
|
|
|
|
|
|
|
85,943
|
|
Other current assets
|
|
|
|
|
|
|
|
|
|
|
23,529
|
|
|
|
15,804
|
|
|
|
(6,819
|
)
|
|
|
32,514
|
|
Current assets of discontinued operations
|
|
|
|
|
|
|
|
|
|
|
14,470
|
|
|
|
21,810
|
|
|
|
(13,448
|
)
|
|
|
22,832
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Total current assets
|
|
|
|
|
|
|
|
|
|
|
123,415
|
|
|
|
178,417
|
|
|
|
(20,267
|
)
|
|
|
281,565
|
|
Property and equipment, net
|
|
|
|
|
|
|
|
|
|
|
17,434
|
|
|
|
253,229
|
|
|
|
|
|
|
|
270,663
|
|
Investments in subsidiaries
|
|
|
385,624
|
|
|
|
385,624
|
|
|
|
64,167
|
|
|
|
(62
|
)
|
|
|
(835,353
|
)
|
|
|
|
|
Goodwill
|
|
|
|
|
|
|
|
|
|
|
62,740
|
|
|
|
|
|
|
|
|
|
|
|
62,740
|
|
Intercompany notes receivable
|
|
|
|
|
|
|
|
|
|
|
205,478
|
|
|
|
|
|
|
|
(205,478
|
)
|
|
|
|
|
Other long-term assets
|
|
|
|
|
|
|
|
|
|
|
15,045
|
|
|
|
3,652
|
|
|
|
|
|
|
|
18,697
|
|
Long-term assets of discontinued operations
|
|
|
|
|
|
|
|
|
|
|
34,470
|
|
|
|
44,902
|
|
|
|
(34,470
|
)
|
|
|
44,902
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Total assets
|
|
$
|
385,624
|
|
|
$
|
385,624
|
|
|
$
|
522,749
|
|
|
$
|
480,138
|
|
|
$
|
(1,095,568
|
)
|
|
$
|
678,567
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Current liabilities:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Accounts payable
|
|
$
|
|
|
|
$
|
|
|
|
$
|
1,087
|
|
|
$
|
29,846
|
|
|
$
|
|
|
|
$
|
30,933
|
|
Income tax payable
|
|
|
|
|
|
|
|
|
|
|
10,552
|
|
|
|
|
|
|
|
|
|
|
|
10,552
|
|
Accrued compensation and benefits
|
|
|
|
|
|
|
|
|
|
|
6,617
|
|
|
|
11,950
|
|
|
|
|
|
|
|
18,567
|
|
Other current liabilities
|
|
|
|
|
|
|
|
|
|
|
4,077
|
|
|
|
16,141
|
|
|
|
(6,797
|
)
|
|
|
13,421
|
|
Current portion of long-term debt and obligations under capital
leases
|
|
|
|
|
|
|
|
|
|
|
473
|
|
|
|
3,616
|
|
|
|
|
|
|
|
4,089
|
|
Current liabilities of discontinued operations
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
38,432
|
|
|
|
(13,470
|
)
|
|
|
24,962
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Total current liabilities
|
|
|
|
|
|
|
|
|
|
|
22,806
|
|
|
|
99,985
|
|
|
|
(20,267
|
)
|
|
|
102,524
|
|
Long-term debt
|
|
|
|
|
|
|
|
|
|
|
101,904
|
|
|
|
44,494
|
|
|
|
|
|
|
|
146,398
|
|
Obligations under capital leases
|
|
|
|
|
|
|
|
|
|
|
397
|
|
|
|
1,396
|
|
|
|
|
|
|
|
1,793
|
|
Intercompany notes payable
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
205,478
|
|
|
|
(205,478
|
)
|
|
|
|
|
Deferred income tax liabilities
|
|
|
|
|
|
|
|
|
|
|
12,018
|
|
|
|
|
|
|
|
|
|
|
|
12,018
|
|
Other long-term obligations
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
460
|
|
|
|
|
|
|
|
460
|
|
Long-term liabilities of discontinued operations
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
34,483
|
|
|
|
(34,470
|
)
|
|
|
13
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Total liabilities
|
|
|
|
|
|
|
|
|
|
|
137,125
|
|
|
|
386,296
|
|
|
|
(260,215
|
)
|
|
|
263,206
|
|
Minority interest in equity of consolidated subsidiaries
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
29,737
|
|
|
|
29,737
|
|
Total stockholders equity
|
|
|
385,624
|
|
|
|
385,624
|
|
|
|
385,624
|
|
|
|
93,842
|
|
|
|
(865,090
|
)
|
|
|
385,624
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Total liabilities and stockholders equity
|
|
$
|
385,624
|
|
|
$
|
385,624
|
|
|
$
|
522,749
|
|
|
$
|
480,138
|
|
|
$
|
(1,095,568
|
)
|
|
$
|
678,567
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
91
MEDCATH
CORPORATION
NOTES TO
CONSOLIDATED FINANCIAL
STATEMENTS (Continued)
MEDCATH
CORPORATION
CONDENSED
CONSOLIDATING STATEMENTS OF INCOME
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Year Ended September 30, 2008
|
|
|
|
|
|
|
|
|
|
|
|
|
Non-
|
|
|
|
|
|
|
|
|
|
Parent
|
|
|
Issuer
|
|
|
Guarantors
|
|
|
Guarantors
|
|
|
Eliminations
|
|
|
MedCath
|
|
|
Net revenue
|
|
$
|
|
|
|
$
|
|
|
|
$
|
29,350
|
|
|
$
|
591,656
|
|
|
$
|
(7,051
|
)
|
|
$
|
613,955
|
|
Total operating expenses
|
|
|
|
|
|
|
|
|
|
|
62,300
|
|
|
|
513,957
|
|
|
|
(7,051
|
)
|
|
|
569,206
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Income (loss) from operations
|
|
|
|
|
|
|
|
|
|
|
(32,950
|
)
|
|
|
77,699
|
|
|
|
|
|
|
|
44,749
|
|
Interest expense
|
|
|
|
|
|
|
|
|
|
|
(10,266
|
)
|
|
|
(4,034
|
)
|
|
|
|
|
|
|
(14,300
|
)
|
Interest and other income (expense), net
|
|
|
|
|
|
|
|
|
|
|
17,852
|
|
|
|
(15,809
|
)
|
|
|
|
|
|
|
2,043
|
|
Equity in net earnings of unconsolidated affiliates
|
|
|
20,990
|
|
|
|
20,990
|
|
|
|
57,586
|
|
|
|
|
|
|
|
(91,675
|
)
|
|
|
7,891
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Income from continuing operations before minority interest,
income taxes and discontinued operations
|
|
|
20,990
|
|
|
|
20,990
|
|
|
|
32,222
|
|
|
|
57,856
|
|
|
|
(91,675
|
)
|
|
|
40,383
|
|
Minority interest share of earnings of consolidated subsidiaries
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
(15,476
|
)
|
|
|
(15,476
|
)
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Income from continuing operations before income taxes and
discontinued operations
|
|
|
20,990
|
|
|
|
20,990
|
|
|
|
32,222
|
|
|
|
57,856
|
|
|
|
(107,151
|
)
|
|
|
24,907
|
|
Income tax expense
|
|
|
|
|
|
|
|
|
|
|
10,043
|
|
|
|
544
|
|
|
|
|
|
|
|
10,587
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Income from continuing operations
|
|
|
20,990
|
|
|
|
20,990
|
|
|
|
22,179
|
|
|
|
57,312
|
|
|
|
(107,151
|
)
|
|
|
14,320
|
|
Income (loss) from discontinued operations, net of taxes
|
|
|
|
|
|
|
|
|
|
|
(1,189
|
)
|
|
|
7,859
|
|
|
|
|
|
|
|
6,670
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Net income
|
|
$
|
20,990
|
|
|
$
|
20,990
|
|
|
$
|
20,990
|
|
|
$
|
65,171
|
|
|
$
|
(107,151
|
)
|
|
$
|
20,990
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Year Ended September 30, 2007
|
|
|
|
|
|
|
|
|
|
|
|
|
Non-
|
|
|
|
|
|
|
|
|
|
Parent
|
|
|
Issuer
|
|
|
Guarantors
|
|
|
Guarantors
|
|
|
Eliminations
|
|
|
MedCath
|
|
|
Net revenue
|
|
$
|
|
|
|
$
|
|
|
|
$
|
29,841
|
|
|
$
|
637,295
|
|
|
$
|
(6,533
|
)
|
|
$
|
660,603
|
|
Total operating expenses
|
|
|
|
|
|
|
|
|
|
|
45,970
|
|
|
|
561,678
|
|
|
|
(6,533
|
)
|
|
|
601,115
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Income (loss) from operations
|
|
|
|
|
|
|
|
|
|
|
(16,129
|
)
|
|
|
75,617
|
|
|
|
|
|
|
|
59,488
|
|
Interest expense
|
|
|
|
|
|
|
|
|
|
|
(13,420
|
)
|
|
|
(8,648
|
)
|
|
|
|
|
|
|
(22,068
|
)
|
Loss on early extinguishment of debt
|
|
|
|
|
|
|
|
|
|
|
(9,781
|
)
|
|
|
(150
|
)
|
|
|
|
|
|
|
(9,931
|
)
|
Interest and other income (expense), net
|
|
|
|
|
|
|
|
|
|
|
28,400
|
|
|
|
(20,557
|
)
|
|
|
|
|
|
|
7,843
|
|
Equity in net earnings of unconsolidated affiliates
|
|
|
11,527
|
|
|
|
11,527
|
|
|
|
34,629
|
|
|
|
|
|
|
|
(51,944
|
)
|
|
|
5,739
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Income from continuing operations before minority interest,
income taxes and discontinued operations
|
|
|
11,527
|
|
|
|
11,527
|
|
|
|
23,699
|
|
|
|
46,262
|
|
|
|
(51,944
|
)
|
|
|
41,071
|
|
Minority interest share of earnings of consolidated subsidiaries
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
(13,917
|
)
|
|
|
(13,917
|
)
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Income from continuing operations before income taxes and
discontinued operations
|
|
|
11,527
|
|
|
|
11,527
|
|
|
|
23,699
|
|
|
|
46,262
|
|
|
|
(65,861
|
)
|
|
|
27,154
|
|
Income tax expense
|
|
|
|
|
|
|
|
|
|
|
11,903
|
|
|
|
|
|
|
|
|
|
|
|
11,903
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Income from continuing operations
|
|
|
11,527
|
|
|
|
11,527
|
|
|
|
11,796
|
|
|
|
46,262
|
|
|
|
(65,861
|
)
|
|
|
15,251
|
|
Loss from discontinued operations, net of taxes
|
|
|
|
|
|
|
|
|
|
|
(269
|
)
|
|
|
(3,455
|
)
|
|
|
|
|
|
|
(3,724
|
)
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Net income
|
|
$
|
11,527
|
|
|
$
|
11,527
|
|
|
$
|
11,527
|
|
|
$
|
42,807
|
|
|
$
|
(65,861
|
)
|
|
$
|
11,527
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
92
MEDCATH
CORPORATION
NOTES TO
CONSOLIDATED FINANCIAL
STATEMENTS (Continued)
MEDCATH
CORPORATION
CONDENSED
CONSOLIDATING STATEMENTS OF INCOME
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Year Ended September 30, 2006
|
|
|
|
|
|
|
|
|
|
|
|
|
Non-
|
|
|
|
|
|
|
|
|
|
Parent
|
|
|
Issuer
|
|
|
Guarantors
|
|
|
Guarantors
|
|
|
Eliminations
|
|
|
MedCath
|
|
|
Net revenue
|
|
$
|
|
|
|
$
|
|
|
|
$
|
30,047
|
|
|
$
|
621,286
|
|
|
$
|
(6,916
|
)
|
|
$
|
644,417
|
|
Total operating expenses
|
|
|
|
|
|
|
|
|
|
|
58,609
|
|
|
|
551,147
|
|
|
|
(6,916
|
)
|
|
|
602,840
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Income (loss) from operations
|
|
|
|
|
|
|
|
|
|
|
(28,562
|
)
|
|
|
70,139
|
|
|
|
|
|
|
|
41,577
|
|
Interest expense
|
|
|
|
|
|
|
|
|
|
|
(21,221
|
)
|
|
|
(11,521
|
)
|
|
|
|
|
|
|
(32,742
|
)
|
Interest and other income (expense), net
|
|
|
|
|
|
|
|
|
|
|
30,357
|
|
|
|
(22,633
|
)
|
|
|
|
|
|
|
7,724
|
|
Equity in net earnings of unconsolidated affiliates
|
|
|
12,576
|
|
|
|
12,576
|
|
|
|
41,333
|
|
|
|
|
|
|
|
(61,566
|
)
|
|
|
4,919
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Income from continuing operations before minority interest,
income taxes and discontinued operations
|
|
|
12,576
|
|
|
|
12,576
|
|
|
|
21,907
|
|
|
|
35,985
|
|
|
|
(61,566
|
)
|
|
|
21,478
|
|
Minority interest share of earnings of consolidated subsidiaries
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
(14,080
|
)
|
|
|
(14,080
|
)
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Income from continuing operations before income taxes and
discontinued operations
|
|
|
12,576
|
|
|
|
12,576
|
|
|
|
21,907
|
|
|
|
35,985
|
|
|
|
(75,646
|
)
|
|
|
7,398
|
|
Income tax expense
|
|
|
|
|
|
|
|
|
|
|
3,540
|
|
|
|
|
|
|
|
|
|
|
|
3,540
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Income from continuing operations
|
|
|
12,576
|
|
|
|
12,576
|
|
|
|
18,367
|
|
|
|
35,985
|
|
|
|
(75,646
|
)
|
|
|
3,858
|
|
Income (loss) from discontinued operations, net of taxes
|
|
|
|
|
|
|
|
|
|
|
(5,791
|
)
|
|
|
14,509
|
|
|
|
|
|
|
|
8,718
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Net income
|
|
$
|
12,576
|
|
|
$
|
12,576
|
|
|
$
|
12,576
|
|
|
$
|
50,494
|
|
|
$
|
(75,646
|
)
|
|
$
|
12,576
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
MEDCATH
CORPORATION
CONDENSED
CONSOLIDATING STATEMENTS OF CASH FLOWS
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Year Ended September 30, 2008
|
|
|
|
|
|
|
|
|
|
Non-
|
|
|
|
|
|
|
|
|
|
Parent
|
|
|
Guarantors
|
|
|
Guarantors
|
|
|
Eliminations
|
|
|
MedCath
|
|
|
Net cash (used in) provided by operating activities
|
|
$
|
|
|
|
$
|
57,657
|
|
|
$
|
(32,829
|
)
|
|
$
|
27,180
|
|
|
$
|
52,008
|
|
Net cash (used in) provided by investing activities
|
|
|
|
|
|
|
(54,586
|
)
|
|
|
13,759
|
|
|
|
35,002
|
|
|
|
(5,805
|
)
|
Net cash provided by (used in) financing activities
|
|
|
|
|
|
|
(39,952
|
)
|
|
|
24,126
|
|
|
|
(62,202
|
)
|
|
|
(78,028
|
)
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
(Decrease) increase in cash and cash equivalents
|
|
|
|
|
|
|
(36,881
|
)
|
|
|
5,056
|
|
|
|
|
|
|
|
(31,825
|
)
|
Cash and cash equivalents:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Beginning of period
|
|
|
|
|
|
|
80,044
|
|
|
|
63,849
|
|
|
|
|
|
|
|
143,893
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
End of period
|
|
$
|
|
|
|
$
|
43,163
|
|
|
$
|
68,905
|
|
|
$
|
|
|
|
$
|
112,068
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
93
MEDCATH
CORPORATION
NOTES TO
CONSOLIDATED FINANCIAL
STATEMENTS (Continued)
MEDCATH
CORPORATION
CONDENSED
CONSOLIDATING STATEMENTS OF CASH FLOWS
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Year Ended September 30, 2007
|
|
|
|
|
|
|
|
|
|
Non-
|
|
|
|
|
|
|
|
|
|
Parent
|
|
|
Guarantors
|
|
|
Guarantors
|
|
|
Eliminations
|
|
|
MedCath
|
|
|
Net cash provided by (used in) operating activities
|
|
$
|
|
|
|
$
|
(13,958
|
)
|
|
$
|
72,183
|
|
|
$
|
|
|
|
$
|
58,225
|
|
Net cash provided by (used in) investing activities
|
|
|
(7,883
|
)
|
|
|
(29,539
|
)
|
|
|
948
|
|
|
|
7,883
|
|
|
|
(28,591
|
)
|
Net cash provided by (used in) financing activities
|
|
|
7,883
|
|
|
|
(54,431
|
)
|
|
|
(25,685
|
)
|
|
|
(7,883
|
)
|
|
|
(80,116
|
)
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Decrease in cash and cash equivalents
|
|
|
|
|
|
|
(97,928
|
)
|
|
|
47,446
|
|
|
|
|
|
|
|
(50,482
|
)
|
Cash and cash equivalents:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Beginning of year
|
|
|
|
|
|
|
177,972
|
|
|
|
16,403
|
|
|
|
|
|
|
|
194,375
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
End of year
|
|
$
|
|
|
|
$
|
80,044
|
|
|
$
|
63,849
|
|
|
$
|
|
|
|
$
|
143,893
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Year Ended September 30, 2006
|
|
|
|
|
|
|
|
|
|
Non-
|
|
|
|
|
|
|
|
|
|
Parent
|
|
|
Guarantors
|
|
|
Guarantors
|
|
|
Eliminations
|
|
|
MedCath
|
|
|
Net cash provided by operating activities
|
|
$
|
|
|
|
$
|
6,539
|
|
|
$
|
59,095
|
|
|
$
|
|
|
|
$
|
65,634
|
|
Net cash provided by (used in) investing activities
|
|
|
(9,196
|
)
|
|
|
56,191
|
|
|
|
(20,373
|
)
|
|
|
(16,558
|
)
|
|
|
10,064
|
|
Net cash provided by (used in) financing activities
|
|
|
9,196
|
|
|
|
(7,587
|
)
|
|
|
(40,332
|
)
|
|
|
16,558
|
|
|
|
(22,165
|
)
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Increase in cash and cash equivalents
|
|
|
|
|
|
|
55,143
|
|
|
|
(1,610
|
)
|
|
|
|
|
|
|
53,533
|
|
Cash and cash equivalents:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Beginning of year
|
|
|
|
|
|
|
122,829
|
|
|
|
18,013
|
|
|
|
|
|
|
|
140,842
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
End of year
|
|
$
|
|
|
|
$
|
177,972
|
|
|
$
|
16,403
|
|
|
$
|
|
|
|
$
|
194,375
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
During the year ended September 30, 2007, the board of
directors approved a stock repurchase program of up to
$59.0 million. During the year ended September 30,
2008 1,885,461 million shares of common stock, with a total
cost of $44.4 million, have been repurchased by the Company
under this program.
94
MEDCATH
CORPORATION
NOTES TO
CONSOLIDATED FINANCIAL
STATEMENTS (Continued)
|
|
22.
|
Supplemental
Cash Flow Disclosures
|
Supplemental disclosures of cash flow information for the years
ended September 30, 2008, 2007 and 2006 are presented below.
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Year Ended September 30,
|
|
|
|
2008
|
|
|
2007
|
|
|
2006
|
|
|
Supplemental disclosure of cash flow information:
|
|
|
|
|
|
|
|
|
|
|
|
|
Interest paid
|
|
$
|
14,725
|
|
|
$
|
23,065
|
|
|
$
|
30,494
|
|
Income taxes paid
|
|
$
|
26,777
|
|
|
$
|
10,927
|
|
|
$
|
2,550
|
|
Supplemental schedule of noncash investing and financing
activities:
|
|
|
|
|
|
|
|
|
|
|
|
|
Capital expenditures financed by capital leases
|
|
$
|
1,582
|
|
|
$
|
1,645
|
|
|
$
|
|
|
Accrued capital expenditures
|
|
$
|
15,185
|
|
|
$
|
|
|
|
$
|
|
|
Subsidiary stock issued in exchange for services at fair market
value
|
|
$
|
|
|
|
$
|
240
|
|
|
$
|
|
|
During November 2008 the Company amended the Senior Secured
Credit Facility, see Note 9 for further discussion of this
transaction.
During December 2008 the Senior Notes were paid in full,
including a repurchase premium of $5.0 million, with the
Amended Term Loan and available cash.
95
INDEPENDENT
AUDITORS REPORT
To Heart Hospital of South Dakota, LLC:
We have audited the accompanying balance sheets of Heart
Hospital of South Dakota, LLC (the Company) as of
September 30, 2008 and 2007, and the related statements of
income, members capital, and cash flows for each of the
three years in the period ended September 30, 2008. These
financial statements are the responsibility of the
Companys management. Our responsibility is to express an
opinion on these financial statements based on our audits.
We conducted our audits in accordance with auditing standards
generally accepted in the United States of America. Those
standards require that we plan and perform the audit to obtain
reasonable assurance about whether the financial statements are
free of material misstatement. An audit includes consideration
of internal control over financial reporting as a basis for
designing audit procedures that are appropriate in the
circumstances, but not for the purpose of expressing an opinion
on the effectiveness of the Companys internal control over
financial reporting. Accordingly, we express no such opinion. An
audit also 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, as well as evaluating
the overall financial statement presentation. We believe that
our audits provide a reasonable basis for our opinion.
In our opinion, such financial statements present fairly, in all
material respects, the financial position of the Company as of
September 30, 2008 and 2007, and the results of its
operations and its cash flows for each of the three years in the
period ended September 30, 2008, in conformity with
accounting principles generally accepted in the United States of
America.
DELOITTE & TOUCHE LLP
December 15, 2008
96
HEART
HOSPITAL OF SOUTH DAKOTA, LLC
BALANCE
SHEETS
(In
thousands)
|
|
|
|
|
|
|
|
|
|
|
September 30,
|
|
|
|
2008
|
|
|
2007
|
|
|
Current assets:
|
|
|
|
|
|
|
|
|
Cash
|
|
$
|
16,542
|
|
|
$
|
14,159
|
|
Accounts receivable, net
|
|
|
7,081
|
|
|
|
7,208
|
|
Medical supplies
|
|
|
1,202
|
|
|
|
1,112
|
|
Prepaid expenses and other current assets
|
|
|
1,323
|
|
|
|
362
|
|
|
|
|
|
|
|
|
|
|
Total current assets
|
|
|
26,148
|
|
|
|
22,841
|
|
Property and equipment, net
|
|
|
33,360
|
|
|
|
32,745
|
|
Other assets
|
|
|
1,426
|
|
|
|
427
|
|
|
|
|
|
|
|
|
|
|
Total assets
|
|
$
|
60,934
|
|
|
$
|
56,013
|
|
|
|
|
|
|
|
|
|
|
Current liabilities:
|
|
|
|
|
|
|
|
|
Accounts payable
|
|
$
|
2,946
|
|
|
$
|
2,601
|
|
Accrued compensation and benefits
|
|
|
2,871
|
|
|
|
2,431
|
|
Accrued property taxes
|
|
|
697
|
|
|
|
732
|
|
Other accrued liabilities
|
|
|
1,162
|
|
|
|
109
|
|
Current portion of long-term debt
|
|
|
1,739
|
|
|
|
2,272
|
|
|
|
|
|
|
|
|
|
|
Total current liabilities
|
|
|
9,415
|
|
|
|
8,145
|
|
Long-term debt
|
|
|
19,967
|
|
|
|
21,019
|
|
Other long-term obligations
|
|
|
1,888
|
|
|
|
282
|
|
|
|
|
|
|
|
|
|
|
Total liabilities
|
|
|
31,270
|
|
|
|
29,446
|
|
Members capital
|
|
|
29,664
|
|
|
|
26,567
|
|
|
|
|
|
|
|
|
|
|
Total liabilities and members capital
|
|
$
|
60,934
|
|
|
$
|
56,013
|
|
|
|
|
|
|
|
|
|
|
See notes to financial statements.
97
HEART
HOSPITAL OF SOUTH DAKOTA, LLC
STATEMENTS
OF INCOME
(In thousands)
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Year Ended September 30,
|
|
|
|
2008
|
|
|
2007
|
|
|
2006
|
|
|
Net revenue
|
|
$
|
67,041
|
|
|
$
|
66,342
|
|
|
$
|
61,345
|
|
Operating expenses:
|
|
|
|
|
|
|
|
|
|
|
|
|
Personnel expense
|
|
|
22,308
|
|
|
|
21,246
|
|
|
|
19,372
|
|
Medical supplies expense
|
|
|
14,627
|
|
|
|
15,917
|
|
|
|
14,367
|
|
Bad debt expense
|
|
|
1,036
|
|
|
|
1,721
|
|
|
|
939
|
|
Other operating expenses
|
|
|
9,365
|
|
|
|
9,979
|
|
|
|
9,333
|
|
Depreciation
|
|
|
2,139
|
|
|
|
1,915
|
|
|
|
2,504
|
|
Loss on disposal of property, equipment and other assets
|
|
|
140
|
|
|
|
33
|
|
|
|
8
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Total operating expenses
|
|
|
49,615
|
|
|
|
50,811
|
|
|
|
46,523
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Income from operations
|
|
|
17,426
|
|
|
|
15,531
|
|
|
|
14,822
|
|
Other income (expenses):
|
|
|
|
|
|
|
|
|
|
|
|
|
Interest expense
|
|
|
(1,441
|
)
|
|
|
(1,711
|
)
|
|
|
(1,845
|
)
|
Interest and other income, net
|
|
|
453
|
|
|
|
617
|
|
|
|
501
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Total other expenses, net
|
|
|
(988
|
)
|
|
|
(1,094
|
)
|
|
|
(1,344
|
)
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Net income
|
|
$
|
16,438
|
|
|
$
|
14,437
|
|
|
$
|
13,478
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
See notes to financial statements.
98
HEART
HOSPITAL OF SOUTH DAKOTA, LLC
STATEMENTS
OF MEMBERS CAPITAL
(In thousands)
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Accumulated Other
|
|
|
|
|
|
|
Sioux Falls
|
|
|
|
|
|
|
|
|
Comprehensive Income (Loss)
|
|
|
|
|
|
|
Hospital
|
|
|
North Central
|
|
|
|
|
|
Sioux Falls
|
|
|
North Central
|
|
|
|
|
|
|
|
|
|
Management,
|
|
|
Heart Institute
|
|
|
Avera
|
|
|
Hospital
|
|
|
Heart Institute
|
|
|
Avera
|
|
|
|
|
|
|
Inc.
|
|
|
Holdings, PLLC
|
|
|
McKennan
|
|
|
Management, Inc.
|
|
|
Holdings, PLLC
|
|
|
McKennan
|
|
|
Total
|
|
|
Balance, September 30, 2005
|
|
$
|
5,591
|
|
|
$
|
5,590
|
|
|
$
|
5,591
|
|
|
$
|
50
|
|
|
$
|
50
|
|
|
$
|
50
|
|
|
$
|
16,922
|
|
Distributions to members
|
|
|
(2,648
|
)
|
|
|
(2,647
|
)
|
|
|
(2,647
|
)
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
(7,942
|
)
|
Comprehensive income:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Net income
|
|
|
4,493
|
|
|
|
4,493
|
|
|
|
4,492
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
13,478
|
|
Change in fair value of interest rate swap
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
(124
|
)
|
|
|
(124
|
)
|
|
|
(124
|
)
|
|
|
(372
|
)
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Total comprehensive income
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
13,106
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Balance, September 30, 2006
|
|
$
|
7,436
|
|
|
$
|
7,436
|
|
|
$
|
7,436
|
|
|
$
|
(74
|
)
|
|
$
|
(74
|
)
|
|
$
|
(74
|
)
|
|
$
|
22,086
|
|
Distributions to members
|
|
|
(3,299
|
)
|
|
|
(3,299
|
)
|
|
|
(3,298
|
)
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
(9,896
|
)
|
Comprehensive income:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Net income
|
|
|
4,813
|
|
|
|
4,812
|
|
|
|
4,812
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
14,437
|
|
Change in fair value of interest rate swap
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
(20
|
)
|
|
|
(20
|
)
|
|
|
(20
|
)
|
|
|
(60
|
)
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Total comprehensive income
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
14,377
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Balance, September 30, 2007
|
|
$
|
8,950
|
|
|
$
|
8,949
|
|
|
$
|
8,950
|
|
|
$
|
(94
|
)
|
|
$
|
(94
|
)
|
|
$
|
(94
|
)
|
|
$
|
26,567
|
|
Distributions to members
|
|
|
(4,254
|
)
|
|
|
(4,253
|
)
|
|
|
(4,253
|
)
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
(12,760
|
)
|
Comprehensive income:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Net income
|
|
|
5,480
|
|
|
|
5,479
|
|
|
|
5,479
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
16,438
|
|
Change in fair value of interest rate swap
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
(194
|
)
|
|
|
(194
|
)
|
|
|
(193
|
)
|
|
|
(581
|
)
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Total comprehensive income
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
15,857
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Balance, September 30, 2008
|
|
$
|
10,176
|
|
|
$
|
10,175
|
|
|
$
|
10,176
|
|
|
$
|
(288
|
)
|
|
$
|
(288
|
)
|
|
$
|
(287
|
)
|
|
$
|
29,664
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
See notes to financial statements.
99
HEART
HOSPITAL OF SOUTH DAKOTA, LLC
STATEMENTS
OF CASH FLOWS
(In thousands)
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Year Ended September 30,
|
|
|
|
2008
|
|
|
2007
|
|
|
2006
|
|
|
Net income
|
|
$
|
16,438
|
|
|
$
|
14,437
|
|
|
$
|
13,478
|
|
Adjustments to reconcile net income to net cash
provided by operating activities:
|
|
|
|
|
|
|
|
|
|
|
|
|
Bad debt expense
|
|
|
1,036
|
|
|
|
1,721
|
|
|
|
939
|
|
Depreciation
|
|
|
2,139
|
|
|
|
1,915
|
|
|
|
2,504
|
|
Amortization of loan acquisition costs
|
|
|
39
|
|
|
|
38
|
|
|
|
66
|
|
Loss on disposal of property, equipment and other assets
|
|
|
140
|
|
|
|
33
|
|
|
|
8
|
|
Change in assets and liabilities that relate to operations:
|
|
|
|
|
|
|
|
|
|
|
|
|
Accounts receivable
|
|
|
(909
|
)
|
|
|
(1,706
|
)
|
|
|
(1,938
|
)
|
Medical supplies
|
|
|
(90
|
)
|
|
|
218
|
|
|
|
(143
|
)
|
Prepaid expenses and other assets
|
|
|
(87
|
)
|
|
|
(71
|
)
|
|
|
10
|
|
Accounts payable and accrued liabilities
|
|
|
117
|
|
|
|
1,055
|
|
|
|
(456
|
)
|
Due to affiliates
|
|
|
|
|
|
|
40
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Net cash provided by operating activities
|
|
|
18,823
|
|
|
|
17,680
|
|
|
|
14,468
|
|
Investing activities:
|
|
|
|
|
|
|
|
|
|
|
|
|
Purchases of property and equipment
|
|
|
(2,112
|
)
|
|
|
(1,240
|
)
|
|
|
(1,291
|
)
|
Proceeds from sale of property and equipment
|
|
|
18
|
|
|
|
(7
|
)
|
|
|
1
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Net cash used in investing activities
|
|
|
(2,094
|
)
|
|
|
(1,247
|
)
|
|
|
(1,290
|
)
|
Financing activities:
|
|
|
|
|
|
|
|
|
|
|
|
|
Proceeds from issuance of long-term debt
|
|
|
|
|
|
|
347
|
|
|
|
|
|
Repayments of long-term debt
|
|
|
(1,586
|
)
|
|
|
(3,057
|
)
|
|
|
(4,770
|
)
|
Payments of loan acquisition costs
|
|
|
|
|
|
|
|
|
|
|
(64
|
)
|
Distributions to members
|
|
|
(12,760
|
)
|
|
|
(9,896
|
)
|
|
|
(7,942
|
)
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Net cash used in financing activities
|
|
|
(14,346
|
)
|
|
|
(12,606
|
)
|
|
|
(12,776
|
)
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Net increase in cash
|
|
|
2,383
|
|
|
|
3,827
|
|
|
|
402
|
|
Cash:
|
|
|
|
|
|
|
|
|
|
|
|
|
Beginning of year
|
|
|
14,159
|
|
|
|
10,332
|
|
|
|
9,930
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
End of year
|
|
$
|
16,542
|
|
|
$
|
14,159
|
|
|
$
|
10,332
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Supplemental cash flow disclosures:
|
|
|
|
|
|
|
|
|
|
|
|
|
Interest paid
|
|
$
|
1,441
|
|
|
$
|
1,677
|
|
|
$
|
1,775
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
See notes to financial statements.
100
HEART
HOSPITAL OF SOUTH DAKOTA, LLC
NOTES TO
FINANCIAL STATEMENTS
(All
tables in thousands)
Heart Hospital of South Dakota, LLC, doing business as Avera
Heart Hospital of South Dakota, (the Company) is a North
Carolina limited liability company that was formed on
June 18, 1999 to develop, own, and operate an acute-care
hospital located in South Dakota, specializing in all aspects of
cardiology and cardiovascular surgery. The hospital commenced
operations on March 20, 2001. At September 30, 2008
and 2007, Sioux Falls Hospital Management, Inc., North Central
Heart Institute Holdings, PLLC, and Avera McKennan each held a
33
1
/
3
%
interest in the Company.
Sioux Falls Hospital Management, Inc., an indirectly wholly
owned subsidiary of MedCath Corporation (MedCath), acts as the
managing member in accordance with the Companys operating
agreement. The Company will cease to exist on December 31,
2060, unless the members elect earlier dissolution. The
termination date may be extended for up to an additional
40 years in five-year increments at the election of the
Companys board of directors.
|
|
2.
|
Summary
of Significant Accounting Policies
|
Use of Estimates
The preparation of financial
statements in conformity with accounting principles generally
accepted in the United States of America requires management to
make estimates and assumptions that affect the reported amounts
of assets and liabilities, revenues and expenses, and related
disclosures of contingent assets and liabilities in the
financial statements and accompanying notes. There is a
reasonable possibility that actual results may vary
significantly from those estimates.
Fair Value of Financial Instruments
The
Company considers the carrying amounts of significant classes of
financial instruments on the balance sheets, including cash,
accounts receivable, net, accounts payable, accrued liabilities
and long-term debt to be reasonable estimates of fair value due
either to their length to maturity or the existence of variable
interest rates underlying such financial instruments that
approximate prevailing market rates at September 30, 2008
and 2007. The Company has no financial instruments on the
balance sheets for which the carrying amounts and estimated fair
values differed significantly at September 30, 2008 and
2007.
Cash
Cash consists of currency on hand and
demand deposits with financial institutions.
Concentrations of Credit Risk
The Company
grants credit without collateral to its patients, most of whom
are insured under payment arrangements with third-party payors,
including Medicare, Medicaid, and commercial insurance carriers.
The following table summarizes the percentage of gross accounts
receivable from all payors at September 30:
|
|
|
|
|
|
|
|
|
|
|
2008
|
|
|
2007
|
|
|
Medicare and Medicaid
|
|
|
57
|
%
|
|
|
43
|
%
|
Commercial
|
|
|
28
|
%
|
|
|
35
|
%
|
Other, including self-pay
|
|
|
15
|
%
|
|
|
22
|
%
|
|
|
|
|
|
|
|
|
|
|
|
|
100
|
%
|
|
|
100
|
%
|
|
|
|
|
|
|
|
|
|
Allowance for Doubtful Accounts
Accounts
receivable primarily consist of amounts due from third-party
payors and patients. To provide for accounts receivable that
could become uncollectible in the future, the Company
establishes an allowance for doubtful accounts to reduce the
carrying value of such receivables to their estimated net
realizable value. The Company estimates this allowance based on
such factors as payor mix, aging and its historical collection
experience and write-offs.
Medical Supplies
Medical supplies consist
primarily of supplies necessary for diagnostics, catheterization
and surgical procedures and general patient care and are stated
at the lower of
first-in,
first-out (FIFO) cost or market.
101
HEART
HOSPITAL OF SOUTH DAKOTA, LLC
NOTES TO
FINANCIAL STATEMENTS (Continued)
Property and Equipment
Property and equipment
are recorded at cost and depreciated principally on a
straight-line basis over the estimated useful lives of the
assets, which generally range from 25 to 40 years for
buildings and improvements, 25 years for land improvements,
and from 3 to 10 years for equipment and software. Repairs
and maintenance costs are charged to operating expense while
betterments are capitalized as additions to the related assets.
Retirements, sales and disposals of assets are recorded by
removing the related cost and accumulated depreciation with any
resulting gain or loss reflected in income from operations.
Long-Lived Assets
Long-lived assets are
evaluated for impairment when events or changes in business
circumstances indicate that the carrying amount of the assets
may not be fully recoverable. An impairment loss would be
recognized when estimated undiscounted future cash flows
expected to result from the use of these assets and their
eventual disposition are less than their carrying amount. The
determination of whether or not long-lived assets have become
impaired involves a significant level of judgment in the
assumptions underlying the approach used to determine the
estimated future cash flows expected to result from the use of
those assets.
Changes in the Companys strategy, assumptions
and/or
market conditions could significantly impact these judgments and
require adjustments to recorded amounts of long-lived assets. No
impairment charges of long-lived assets were necessary for the
years ended September 30, 2008, 2007 and 2006.
Other Assets
Other assets primarily consist
of loan acquisition costs (Loan Costs), which are costs
associated with obtaining long-term financing. Loan Costs, net
of accumulated amortization, were $273,000 and $311,000 as of
September 30, 2008 and 2007, respectively. Loan Costs are
being amortized using the straight-line method, which
approximates the effective interest method, as a component of
interest expense over the life of the related debt. Amortization
expense recognized for Loan Costs totaled approximately $39,000,
$38,000 and $66,000 for the years ended September 30, 2008,
2007 and 2006, respectively.
Revenue Recognition
Amounts the Company
receives for treatment of patients covered by governmental
programs such as Medicare and Medicaid and other third-party
payors such as commercial insurers, health maintenance
organizations and preferred provider organizations are generally
less than established billing rates. Payment arrangements with
third-party payors may include prospectively determined rates
per discharge or per visit, a discount from established charges,
per diem payments, reimbursed costs (subject to limits)
and/or
other
similar contractual arrangements. As a result, net revenue for
services rendered to patients is reported at the estimated net
realizable amounts as services are rendered. The Company
accounts for the differences between the estimated realizable
rates under the reimbursement program and the standard billing
rates as contractual adjustments.
The majority of the Companys contractual adjustments are
system-generated at the time of billing based on either
government fee schedules or fee schedules contained in managed
care agreements with various insurance plans. Portions of the
Companys contractual adjustments are performed manually
and these adjustments primarily relate to patients that have
insurance plans with whom the Company does not have contracts
containing discounted fee schedules, also referred to as
non-contracted payors, patients that have secondary insurance
plans following adjudication by the primary payor, uninsured
self-pay patients and charity care patients. Estimates of
contractual adjustments are made on a payor-specific basis and
based on the best information available regarding the
Companys interpretation of the applicable laws,
regulations and contract terms. While subsequent adjustments to
the systematic contractual allowances can arise due to denials,
short payments deemed immaterial for continued collection effort
and a variety of other reasons, such amounts have not
historically been significant.
The Company continually reviews the contractual estimation
process to consider and incorporate updates to the laws and
regulations and any changes in the contractual terms of its
programs. Final settlements under some of these programs are
subject to adjustment based on audit by third parties, which can
take several years to determine. From a procedural standpoint,
the Company subsequently adjusts those settlements as new
information is obtained from audits or review by the fiscal
intermediary, and, if the result of the of the fiscal
intermediary audit or review impacts other unsettled and open
costs reports, then the Company recognizes the impact of those
adjustments.
102
HEART
HOSPITAL OF SOUTH DAKOTA, LLC
NOTES TO
FINANCIAL STATEMENTS (Continued)
A significant portion of the Companys net revenue is
derived from federal and state governmental healthcare programs,
including Medicare and Medicaid, which, combined, accounted for
53%, respectively, of the Companys net revenue during each
of the years ended September 30, 2008, 2007 and 2006.
Medicare payments for inpatient acute services and certain
outpatient services are generally made pursuant to a prospective
payment system. Under this system, a hospital is paid a
prospectively-determined fixed amount for each hospital
discharge based on the patients diagnosis. Specifically,
each discharge is assigned to a Medicare severity
diagnosis-related group
(MS-DRG).
Based upon the patients condition and treatment during the
relevant inpatient stay, each MS-DRG is assigned a fixed payment
rate that is prospectively set using national average costs per
case for treating a patient for a particular diagnosis. The
MS-DRG rates are adjusted by an update factor each federal
fiscal year, which begins on October 1. The update factor
is determined, in part, by the projected increase in the cost of
goods and services that are purchased by hospitals, referred to
as the market basket index. MS-DRG payments do not consider the
actual costs incurred by a hospital in providing a particular
inpatient service; however, MS-DRG payments are adjusted by a
predetermined adjustment factor assigned to the geographic area
in which the hospital is located.
While hospitals generally do not receive direct payment in
addition to a MS-DRG payment, hospitals may qualify for
additional capital-related cost reimbursement and outlier
payments from Medicare under specific circumstances. Medicare
payments for non-acute services, certain outpatient services,
medical equipment, and education costs are made based on a cost
reimbursement methodology and are under transition to various
methodologies involving prospectively determined rates. The
Company is reimbursed for cost-reimbursable items at a tentative
rate with final settlement determined after submission of annual
cost reports by the Company and audits thereof by the Medicare
fiscal intermediary. Medicaid payments for inpatient and
outpatient services are made at prospectively determined amounts
and cost based reimbursement, respectively.
The Company provides care to patients who meet certain criteria
under its charity care policy without charge or at amounts less
than its established rates. Because the Company does not pursue
collection of amounts determined to qualify as charity care,
they are not reported as net revenue.
Advertising
Advertising costs are expensed as
incurred. During the years ended September 30, 2008, 2007
and 2006, the Company incurred approximately $317,000, $597,000
and $544,000, respectively, of advertising expenses.
Income Taxes
The Company has elected to be
treated as a limited liability company for federal and state
income tax purposes. As such, all taxable income or loss of the
Company is included in the income tax returns of the respective
members. Accordingly, no provision has been made for federal or
state income taxes in the accompanying financial statements.
Members Share of Net Income and Loss
In
accordance with the membership agreement, net income and loss
are first allocated to the members based on their respective
ownership percentages. If the cumulative losses of the Company
exceed its initial capitalization and committed capital
obligations of its members, Sioux Falls Hospital Management,
Inc., the Companys managing member, in accordance with
accounting principles generally accepted in the United States of
America, will recognize a disproportionate share of the
Companys losses that otherwise would be allocated to all
of its members on a pro rata basis. In such cases, Sioux Falls
Hospital Management, Inc. will recognize a disproportionate
share of the Companys future profits to the extent it has
previously recognized a disproportionate share of the
Companys losses.
Market Risk
The Companys policy for
managing risk related to its exposure to variability in interest
rates, commodity prices, and other relevant market rates and
prices includes consideration of entering into derivative
instruments (freestanding derivatives), or contracts or
instruments containing features or terms that behave in a manner
similar to derivative instruments (embedded derivatives) in
order to mitigate its risks. In addition, the Company may be
required to hedge some or all of its market risk exposure,
especially to interest rates, by creditors who provide debt
funding to the Company. The Company recognizes all derivatives
as either assets or liabilities in the balance sheets and
measures those instruments at fair value in accordance with
Statement of Financial
103
HEART
HOSPITAL OF SOUTH DAKOTA, LLC
NOTES TO
FINANCIAL STATEMENTS (Continued)
Accounting Standards (SFAS) No. 133,
Accounting for
Derivative Instruments and Hedging Activities
, as amended by
SFAS No. 138,
Accounting for Certain Derivative
Instruments and Certain Hedging Activities
(
an Amendment
of FASB Statement No. 133)
and as amended by
SFAS No. 149,
Amendment of Statement 133 on
Derivative Instruments and Hedging Activities.
Accounts receivable, net, at September 30 is as follows:
|
|
|
|
|
|
|
|
|
|
|
2008
|
|
|
2007
|
|
|
Receivables, principally from patients and third-party payors
|
|
$
|
7,720
|
|
|
$
|
8,230
|
|
Other receivables
|
|
|
125
|
|
|
|
160
|
|
|
|
|
|
|
|
|
|
|
|
|
|
7,845
|
|
|
|
8,390
|
|
Allowance for doubtful accounts
|
|
|
(764
|
)
|
|
|
(1,182
|
)
|
|
|
|
|
|
|
|
|
|
Accounts receivable, net
|
|
$
|
7,081
|
|
|
$
|
7,208
|
|
|
|
|
|
|
|
|
|
|
Activity for the allowance for doubtful accounts for the years
ended September 30 is as follows:
|
|
|
|
|
|
|
|
|
|
|
2008
|
|
|
2007
|
|
|
Balance, beginning of year
|
|
$
|
1,182
|
|
|
$
|
786
|
|
Bad debt expense
|
|
|
1,036
|
|
|
|
1,721
|
|
Write-offs, net of recoveries
|
|
|
(1,454
|
)
|
|
|
(1,325
|
)
|
|
|
|
|
|
|
|
|
|
Balance, end of year
|
|
$
|
764
|
|
|
$
|
1,182
|
|
|
|
|
|
|
|
|
|
|
|
|
4.
|
Property
and Equipment
|
Property and equipment, net, at September 30 is as follows:
|
|
|
|
|
|
|
|
|
|
|
2008
|
|
|
2007
|
|
|
Land and improvements
|
|
$
|
1,327
|
|
|
$
|
1,327
|
|
Buildings and improvements
|
|
|
31,642
|
|
|
|
31,642
|
|
Equipment and software
|
|
|
21,541
|
|
|
|
18,871
|
|
Construction in progress
|
|
|
20
|
|
|
|
343
|
|
|
|
|
|
|
|
|
|
|
|
|
|
54,530
|
|
|
|
52,183
|
|
Less accumulated depreciation
|
|
|
(21,170
|
)
|
|
|
(19,438
|
)
|
|
|
|
|
|
|
|
|
|
|
|
$
|
33,360
|
|
|
$
|
32,745
|
|
|
|
|
|
|
|
|
|
|
104
HEART
HOSPITAL OF SOUTH DAKOTA, LLC
NOTES TO
FINANCIAL STATEMENTS (Continued)
Long-term debt at September 30 is as follows:
|
|
|
|
|
|
|
|
|
|
|
2008
|
|
|
2007
|
|
|
Bank mortgage loan
|
|
$
|
20,706
|
|
|
$
|
22,212
|
|
Installment notes payable to equipment lenders
|
|
|
22
|
|
|
|
731
|
|
Equipment loan
|
|
|
978
|
|
|
|
348
|
|
|
|
|
|
|
|
|
|
|
|
|
|
21,706
|
|
|
|
23,291
|
|
Less current portion
|
|
|
(1,739
|
)
|
|
|
(2,272
|
)
|
|
|
|
|
|
|
|
|
|
|
|
$
|
19,967
|
|
|
$
|
21,019
|
|
|
|
|
|
|
|
|
|
|
Bank Mortgage Loan
The Company financed its
building and land through a bank mortgage loan dated
June 29, 2000. Under the terms of the loan, interest-only
payments were due through June 2002, which represented the first
24 months following the closing of the loan. Thereupon, the
loan converted to a term loan with principal and interest
payments due monthly, based on a
240-month
amortization schedule with interest determined using the LIBOR
rate plus an applicable margin of 2.75%. The loan was originally
scheduled to mature on July 10, 2003 but was amended to
extend the maturity date to September 30, 2008. During
February 2006, this loan was refinanced and extended through
December 2015 with an interest rate of the LIBOR rate plus an
applicable margin of 1.25%. At September 30, 2008 and 2007,
the interest rate on this loan was 3.74% and 6.97%,
respectively. Until the date of refinancing, MedCath and Avera
McKennan guaranteed 50% of the outstanding balance of the bank
mortgage loan.
At September 30, 2005, the Company had four interest rate
swaps, which qualified as cash flow hedges, outstanding for a
total notional amount of approximately 80% of the bank mortgage
loans outstanding balance. Two of the swaps effectively
fixed LIBOR at 4.18% (4.18% Swaps) for approximately 60% of the
bank mortgage loans outstanding balance. The remaining two
swaps effectively fixed LIBOR at 3.46% (3.46% Swaps) for
approximately 20% of the bank mortgage loans outstanding
balance. The Company terminated the 4.18% Swaps and the 3.46%
Swaps during the year ended September 30, 2006 and entered
into a new interest rate swap (the Swap), which qualifies as a
cash flow hedge and which effectively fixes LIBOR at 5.21% for
approximately 80% of the bank mortgage loans outstanding
balance. At both September 30, 2008 and 2007, the
Companys effective interest rate on the notional amount of
the Swap is 6.46%. During fiscal 2008 and 2007, the Company
recognized interest expense based upon the fixed interest rates
provided under the swap, while the change in the fair value of
the swap is recorded as other comprehensive income (loss) and as
an adjustment to the derivative liability in the balance sheets.
The derivative liability is $863,000 and $282,000 at
September 30, 2008 and 2007, respectively, and is included
in other long-term obligations on the balance sheets. Future
changes in the fair value of the Swap will be recorded based
upon the variability in the market interest rates until maturity
in December 2015.
The bank mortgage loan agreement contains certain restrictive
covenants, which require the maintenance of specific financial
ratios and amounts. The Company is in compliance with these
restrictive covenants at September 30, 2008.
Notes Payable to Equipment Lenders
The
Company acquired substantially all of its equipment under
installment notes payable to equipment lenders collateralized by
the related equipment, which has a net book value of
approximately $2.0 million and $1.3 million at
September 30, 2008 and 2007, respectively. During January
2008, the Company entered into an additional $785,000 note with
an equipment lender, collateralized by the related equipment.
Amounts borrowed under these notes are payable in monthly
installments of principal and interest over five-year and
eight-year terms. The notes have annual fixed rates of interest
ranging from 5.0% to 8.8%. MedCath and Avera McKennan have each
guaranteed 30% of $22,000 of the installment notes payable to
equipment lenders as of September 30, 2008.
105
HEART
HOSPITAL OF SOUTH DAKOTA, LLC
NOTES TO
FINANCIAL STATEMENTS (Continued)
The Company also had a $2.5 million working capital line of
credit that was provided by the real estate lender, and was
subject to the interest rate, covenants, guarantee and
collateral of the real estate loan which was scheduled to expire
in June 2006 but during fiscal 2006 was extended to December
2008. No amounts were outstanding under this line of credit at
September 30, 2008 or 2007.
Future maturities of long-term debt, as of September 30,
2008, are as follows:
|
|
|
|
|
Fiscal Year:
|
|
|
|
|
2009
|
|
$
|
1,739
|
|
2010
|
|
|
1,729
|
|
2011
|
|
|
1,742
|
|
2012
|
|
|
1,755
|
|
2013
|
|
|
1,571
|
|
Thereafter
|
|
|
13,170
|
|
|
|
|
|
|
|
|
$
|
21,706
|
|
|
|
|
|
|
|
|
6.
|
Commitments
and Contingencies
|
Operating Leases
The Company leases certain
equipment under noncancelable operating leases. The total rent
expense under operating leases was approximately $43,000,
$100,000 and $100,000, respectively, during the years ended
September 30, 2008, 2007 and 2006 and is included in other
operating expenses. There were no future minimum payments on
noncancelable operating leases as of September 30, 2008.
Commitments
The Company provides guarantees
to certain non-investor physician groups for funds required to
operate and maintain services for the benefit of the
hospitals patients. These guarantees extend for the
duration of the underlying service agreements and the maximum
potential future payments that the Company could be required to
make under these guarantees was approximately $4.4 million
through March 2011 as of September 30, 2008. At
September 30, 2008, the Company has recorded a liability of
$1,910,000 for the fair value of these guarantees, of which
$952,000 is in other accrued liabilities and $958,000 is in
other long term obligations. Additionally, the Company has
recorded an asset of $1,910,000 representing the future services
to be provided by the physicians, of which $952,000 is in
prepaid expenses and other current assets and $958,000 is in
other assets.
Contingencies
Laws and regulations governing
the Medicare and Medicaid programs are complex, subject to
interpretation and may be modified. The Company believes that it
is in compliance with such laws and regulations and it is not
aware of any investigations involving allegations of potential
wrongdoing. However, compliance with such laws and regulations
can be subject to future government review and interpretation as
well as significant regulatory action, including substantial
fines and criminal penalties, as well as repayment of previously
billed and collected revenue from patient services and exclusion
from the Medicare and Medicaid programs. Medicare and Medicaid
cost reports have been audited by the fiscal intermediary
through September 30, 2006 and September 30, 2004,
respectively.
The Company is involved in various claims and legal actions in
the ordinary course of business. Moreover, claims arising from
services provided to patients in the past and other legal
actions may be asserted in the future. The Company is protecting
its interests in all such claims and actions.
Management does not believe, taking into account the applicable
liability insurance coverage and the expectations of counsel
with respect to the amount of potential liability, the outcome
of any such claims and litigation, individually or in the
aggregate, will have a materially adverse effect on the
Companys financial position or results of operations.
106
HEART
HOSPITAL OF SOUTH DAKOTA, LLC
NOTES TO
FINANCIAL STATEMENTS (Continued)
|
|
7.
|
Related-Party
Transactions
|
MedCath provides working capital to the Company under a
revolving credit note with a maximum borrowing limit of
$12.0 million. The loan is collateralized by the
Companys accounts receivable from patient services. There
are no amounts outstanding under the working capital loan as of
September 30, 2008 and 2007. No interest was paid in fiscal
2008, 2007 or 2006 because the working capital loan was paid off
monthly.
MedCath and Avera McKennan received debt guarantee fees for
their guarantee of 50% of the Companys outstanding bank
mortgage loan until the loan was refinanced in February 2006. In
addition, at September 30, 2008, 2007 and 2006 MedCath and
Avera McKennan each guarantee 30% of $22,000, $731,000 and
$2,300,000, respectively, of the Companys outstanding
equipment debt. The total amount of such debt guarantee fees are
approximately $2,000 each, for the year ended September 30,
2007 and $23,000 each, for the year ended September 30,
2006 and are immaterial for the year ended September 30,
2008. No amounts are due as of September 30, 2008 or 2007.
MedCath allocated corporate expenses to the Company for costs in
the following categories, which are included in operating
expenses in the statements of income, during the years ended
September 30:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
2008
|
|
|
2007
|
|
|
2006
|
|
|
Management fees
|
|
$
|
1,349
|
|
|
$
|
1,296
|
|
|
$
|
1,236
|
|
Hospital employee group insurance
|
|
|
4,621
|
|
|
|
4,130
|
|
|
|
3,656
|
|
Other
|
|
|
81
|
|
|
|
28
|
|
|
|
72
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
$
|
6,051
|
|
|
$
|
5,454
|
|
|
$
|
4,964
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
The other category above consists primarily of support services
provided by MedCath and consolidated purchased services paid for
by MedCath for which it receives reimbursement at cost in lieu
of the Companys incurring these services directly. Support
services include but are not limited to training, treasury, and
development. Consolidated purchased services include, but are
not limited to insurance coverage, professional services,
software maintenance and licenses purchased by MedCath under its
consolidated purchasing programs and agreements with third-party
vendors for the direct benefit of the Company. At
September 30, 2008 and 2007, approximately $30,000 and
$38,000, respectively, are outstanding for these corporate
allocated expenses and are included in other accrued liabilities.
The Company pays Avera McKennan and North Central Heart
Institute Holdings, PLLC for various services, including labor,
supplies and equipment purchases. The amounts paid during the
years ended September 30, were as follows:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
2008
|
|
|
2007
|
|
|
2006
|
|
|
Avera McKennan
|
|
$
|
999
|
|
|
$
|
1,018
|
|
|
$
|
931
|
|
North Central Heart Institute Holdings
|
|
|
546
|
|
|
|
779
|
|
|
|
791
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Total
|
|
$
|
1,545
|
|
|
$
|
1,797
|
|
|
$
|
1,722
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
The Company participates in MedCaths defined contribution
retirement savings plan (the 401(k) Plan), which covers all
employees. The 401(k) Plan allows eligible employees to
contribute from 1% to 50% of their annual compensation on a
pretax basis. The Company, at its discretion, may make an annual
contribution of up to 40% of an employees pretax
contribution, up to a maximum of 6% of compensation. This annual
contribution percentage was increased to 40% for fiscal 2008
from 30% for fiscal 2007. The Companys contributions to
the 401(k) Plan were approximately $325,000, $231,000 and
$176,000 during the years ended September 30, 2008, 2007
and 2006, respectively.
107
|
|
Item 9.
|
Changes
in and Disagreements With Accountants on Accounting and
Financial Disclosure.
|
None.
|
|
Item 9A.
|
Controls
and Procedures.
|
The President and Chief Executive Officer and the Executive Vice
President and Chief Financial Officer of the Company (its
principal executive officer and principal financial officer,
respectively) have concluded, based on their evaluation of the
Companys disclosure controls and procedures as of the end
of the fiscal year covered by this Annual Report on
Form 10-K,
that the Companys disclosure controls and procedures were
effective as of the end of the fiscal year covered by this
report to ensure that information required to be disclosed by
the Company in the reports filed or submitted by it under the
Securities Exchange Act of 1934, as amended (the Exchange Act),
is recorded, processed, summarized and reported within the time
periods specified in the SECs rules and forms, and include
controls and procedures designed to ensure that information
required to be disclosed by the Company in the reports that it
files under the Exchange Act is accumulated and communicated to
the Companys management, including the Chief Executive
Officer and Chief Financial Officer, as appropriate to allow
timely decisions regarding required disclosure.
No change in the Companys internal control over financial
reporting was made during the most recent fiscal quarter covered
by this report that materially affected, or is reasonably likely
to materially affect, the Companys internal control over
financial reporting.
Managements Report on Internal Control Over Financial
Reporting.
The Companys management is responsible for establishing
and maintaining adequate internal control over financial
reporting for the Company (as defined in Securities Exchange Act
Rule 13a-15(f)).
The Companys internal control system was designed to
provide reasonable assurance to the Companys management
and board of directors regarding the preparation and fair
presentation of published financial statements.
All internal control systems, no matter how well designed, have
inherent limitations. Therefore, even those systems determined
to be effective can provide only reasonable assurance with
respect to financial statement preparation and presentation and
the reliability of financial reporting. Moreover, projections of
any evaluation of effectiveness to future periods are subject to
the risk that controls may become inadequate because of changes
in conditions, or that the degree of compliance with the
policies or procedures may deteriorate.
The Companys management assessed the effectiveness of the
Companys internal control over financial reporting as of
September 30, 2008. In making this assessment, we used the
criteria set forth by the Committee of Sponsoring Organizations
of the Treadway Commission. Based on our assessment, the
Companys internal control over financial reporting was
effective as of September 30, 2008 based on those criteria.
Deloitte & Touche LLP, an independent registered
public accounting firm, which audited the consolidated financial
statements included in this Annual Report on
Form 10-K,
has issued an attestation report on our internal control over
financial reporting, which is included below.
108
REPORT OF
INDEPENDENT REGISTERED PUBLIC ACCOUNTING FIRM
To the Board of Directors and Stockholders of
MedCath Corporation
Charlotte, North Carolina
We have audited the internal control over financial reporting of
MedCath Corporation and subsidiaries (the Company)
as of September 30, 2008, based on criteria established in
Internal Control Integrated Framework
issued
by the Committee of Sponsoring Organizations of the Treadway
Commission. The Companys management is responsible for
maintaining effective internal control over financial reporting
and for its assessment of the effectiveness of internal control
over financial reporting, included in the accompanying
Managements Report on Internal Control Over Financial
Reporting. Our responsibility is to express an opinion on the
Companys internal control over financial reporting based
on our audit.
We conducted our audit 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 effective internal control
over financial reporting was maintained in all material
respects. Our audit included obtaining an understanding of
internal control over financial reporting, assessing the risk
that a material weakness exists, testing and evaluating the
design and operating effectiveness of internal control based on
the assessed risk, and performing such other procedures as we
considered necessary in the circumstances. We believe that our
audit provides a reasonable basis for our opinion.
A companys internal control over financial reporting is a
process designed by, or under the supervision of, the
companys principal executive and principal financial
officers, or persons performing similar functions, and effected
by the companys board of directors, management, and other
personnel to provide reasonable assurance regarding the
reliability of financial reporting and the preparation of
financial statements for external purposes in accordance with
generally accepted accounting principles. A companys
internal control over financial reporting includes those
policies and procedures that (1) pertain to the maintenance
of records that, in reasonable detail, accurately and fairly
reflect the transactions and dispositions of the assets of the
company; (2) provide reasonable assurance that transactions
are recorded as necessary to permit preparation of financial
statements in accordance with generally accepted accounting
principles, and that receipts and expenditures of the company
are being made only in accordance with authorizations of
management and directors of the company; and (3) provide
reasonable assurance regarding prevention or timely detection of
unauthorized acquisition, use, or disposition of the
companys assets that could have a material effect on the
financial statements.
Because of the inherent limitations of internal control over
financial reporting, including the possibility of collusion or
improper management override of controls, material misstatements
due to error or fraud may not be prevented or detected on a
timely basis. Also, projections of any evaluation of the
effectiveness of the internal control over financial reporting
to future periods are subject to the risk that the controls may
become inadequate because of changes in conditions, or that the
degree of compliance with the policies or procedures may
deteriorate.
In our opinion, the Company maintained, in all material
respects, effective internal control over financial reporting as
of September 30, 2008, based on the criteria established in
Internal Control Integrated Framework
issued
by the Committee of Sponsoring Organizations of the Treadway
Commission.
We have also audited, in accordance with the standards of the
Public Company Accounting Oversight Board (United States), the
consolidated balance sheet of the Company as of
September 30, 2008 and the related consolidated statements
of income, stockholders equity, and cash flows for the
year then ended and our report dated December 15, 2008
expressed an unqualified opinion on those financial statements.
DELOITTE & TOUCHE LLP
Charlotte, North Carolina
December 15, 2008
109
|
|
Item 9B.
|
Other
Information
|
None.
110
PART III
|
|
Item 10.
|
Directors
and Executive Officers of the Registrant
|
The information required by this Item with respect to directors
is incorporated by reference to information provided under the
headings Election of Directors, Corporate
Governance, Other Matters-Section 16(a)
Beneficial Ownership Compliance, Accounting and
Audit Matters-Audit Committee Financial Expert,
Executive Compensation and Other Information, and
elsewhere in the Companys proxy statement to be filed with
the Commission on or before January 28, 2009 in connection
with the Annual Meeting of Stockholders of the Company scheduled
to be held on March 4, 2009 (the 2009 Proxy Statement).
|
|
Item 11.
|
Executive
Compensation.
|
The information required by this Item is incorporated by
reference to information provided under the headings
Executive Compensation and Other Information and
Corporate Governance-Compensation of Directors and
elsewhere in the 2009 Proxy Statement.
|
|
Item 12.
|
Security
Ownership of Certain Beneficial Owners and Management and
Related Stockholder Matters.
|
The information required by this Item is incorporated by
reference to information provided under the headings
Security Ownership of Certain Beneficial Owners and
Management and Executive Compensation and Other
Information-Equity Compensation Plan Information and
elsewhere in the 2009 Proxy Statement.
|
|
Item 13.
|
Certain
Relationships and Related Transactions.
|
The information required by this Item is incorporated by
reference to information provided under the heading
Certain Transactions and elsewhere in the 2009 Proxy
Statement.
|
|
Item 14.
|
Principal
Accounting Fees and Services.
|
The information required by this Item is incorporated by
reference to information provided under the heading
Accounting and Audit Matters and elsewhere in the
2009 Proxy Statement.
PART IV
|
|
Item 15.
|
Exhibits,
Financial Statement Schedules.
|
(a)(1) The financial statements as listed in the Index under
Part II, Item 8, are filed as part of this report.
(2)
Financial Statement Schedules.
All
schedules have been omitted because they are not required, are
not applicable or the information is included in the selected
consolidated financial data or notes to consolidated financial
statements appearing elsewhere in this report.
(3) The following list of exhibits includes both exhibits
submitted with this report and those incorporated by reference
to other filings:
|
|
|
|
|
|
|
Exhibit
|
|
|
|
|
No.
|
|
|
|
Description
|
|
|
3
|
.1
|
|
|
|
Amended and Restated Certificate of Incorporation of MedCath
Corporation(1)
|
|
3
|
.2
|
|
|
|
Bylaws of MedCath Corporation(1)
|
|
4
|
.1
|
|
|
|
Specimen common stock certificate(1)
|
|
4
|
.2
|
|
|
|
Stockholders Agreement dated as of July 31, 1998 by
and among MedCath Holdings, Inc., MedCath 1998 LLC, Welsh,
Carson, Anderson & Stowe VII, L.P. and the several
other stockholders (the Stockholders Agreement)(1)
|
|
4
|
.3
|
|
|
|
First Amendment to Stockholders agreement dated as of
June 1, 2001 by and among MedCath Holdings, Inc., the KKR
Fund and the WCAS Stockholders(1)
|
111
|
|
|
|
|
|
|
Exhibit
|
|
|
|
|
No.
|
|
|
|
Description
|
|
|
4
|
.4
|
|
|
|
Registration Rights Agreement dated as of July 31, 1998 by
and among MedCath Holdings, Inc., MedCath 1998 LLC, Welsh,
Carson, Anderson & Stowe VII, L.P., WCAS Healthcare
Partners, L.P. And the several stockholders parties thereto (the
Registration Rights Agreement)(1)
|
|
4
|
.5
|
|
|
|
First Amendment to Registration Rights Agreement dated as of
June 1, 2001 by and among MedCath Holdings, Inc. and the
persons listed in Schedule I attached hereto(1)
|
|
4
|
.6
|
|
|
|
Form of
9
7
/
8
% Senior
Note due 2012(12)
|
|
4
|
.7
|
|
|
|
Indenture dated as of July 7, 2004 among MedCath Holdings
Corp., as issuer (the Issuer), MedCath Corporation and the
subsidiaries of the Issuer named therein, as guarantors (the
Guarantors), and U.S. Bank National Association, as trustee (the
Trustee), relating to the
9
7
/
8
% Senior
Notes due 2012(12)
|
|
4
|
.8
|
|
|
|
Amended and Restated Credit Agreement, dated as of
November 10, 2008, among MedCath Corporation, as a parent
guarantor, MedCath Holdings Corp., as the borrower, certain of
the subsidiaries of MedCath Corporation party thereto from time
to time, as subsidiary guarantors, Bank of America, N.A., as
administrative agent, swing line lender and letter of credit
issuer, and each of the lenders party thereto from time to
time.(20)
|
|
4
|
.9
|
|
|
|
Collateral Agreement, dated as of July 7, 2004, by and
among MedCath Corporation, MedCath Holdings Corp., the
Subsidiary Guarantors, as identified on the signature pages
thereto and any Additional Grantor (as defined therein) who may
become party to the Collateral Agreement, in favor of Bank of
America, N.A., as administrative agent for the ratable benefit
of the banks and other financial institutions from time to time
parties to the Credit Agreement, dated as of July 7, 2004,
by and among the MedCath Corporation, MedCath Holdings Corp. and
the lenders party thereto(12)
|
|
10
|
.1
|
|
|
|
Operating Agreement of the Little Rock Company dated as of
July 11, 1995 by and among MedCath of Arkansas, Inc. and
several other parties thereto (the Little Rock Operating
Agreement)(1)(6)
|
|
10
|
.2
|
|
|
|
First Amendment to the Little Rock Operating Agreement dated as
of September 21, 1995(1)(6)
|
|
10
|
.3
|
|
|
|
Amendment to Little Rock Operating Agreement effective as of
January 20, 2000(1)(6)
|
|
10
|
.4
|
|
|
|
Amendment to Little Rock Operating Agreement dated as of
April 25, 2001(1)
|
|
10
|
.5
|
|
|
|
Operating Agreement of Arizona Heart Hospital, LLC entered into
as of January 6, 1997 (the Arizona Heart Hospital Operating
Agreement)(1)(6)
|
|
10
|
.6
|
|
|
|
Amendment to Arizona Heart Hospital Operating Agreement
effective as of February 23, 2000(1)(6)
|
|
10
|
.7
|
|
|
|
Amendment to Operating Agreement of Arizona Heart Hospital, LLC
dated as of April 25, 2001(1)
|
|
10
|
.8
|
|
|
|
Agreement of Limited Partnership of Heart Hospital IV, L.P. as
amended by the First, Second, Third and Fourth Amendments
thereto entered into as of February 22, 1996 (the Austin
Limited Partnership Agreement)(1)(6)
|
|
10
|
.9
|
|
|
|
Fifth Amendment to the Austin Limited Partnership Agreement
effective as of December 31, 1997(1)(6)
|
|
10
|
.10
|
|
|
|
Amendment to Austin Limited Partnership Agreement effective as
of July 31, 2000(1)(6)
|
|
10
|
.11
|
|
|
|
Amendment to Austin Limited Partnership Agreement dated as of
March 30, 2001(1)
|
|
10
|
.12
|
|
|
|
Amendment to Austin Limited Partnership Agreement dated as of
May 3, 2001(1)
|
|
10
|
.13
|
|
|
|
Guaranty made as of November 11, 1997 by MedCath
Incorporated in favor of HCPI Mortgage Corp(1)
|
|
10
|
.14
|
|
|
|
Operating Agreement of Heart Hospital of BK, LLC amended and
restated as of September 26, 2001(the Bakersfield Operating
Agreement)(2)(6)
|
|
10
|
.15
|
|
|
|
Second Amendment to Bakersfield Operating Agreement effective as
of December 1, 1999(1)(6)
|
|
10
|
.16
|
|
|
|
Amended and Restated Operating Agreement of effective as of
September 6, 2002 of Heart Hospital of DTO, LLC (the Dayton
Operating Agreement)(10)(6)
|
|
10
|
.17
|
|
|
|
Amendment to New Mexico Operating Agreement and Management
Services Agreement) effective as of October 1, 1998(1)(6)
|
|
10
|
.18
|
|
|
|
Amended and Restated Operating Agreement of Heart Hospital of
New Mexico, LLC.(3)(6)
|
|
10
|
.19
|
|
|
|
Guaranty made as of September 24, 1998 by MedCath
Incorporated, St. Joseph Healthcare System, SWCA, LLC and NMHI,
LLC in favor of Health Care Property Investors, Inc(1)
|
112
|
|
|
|
|
|
|
Exhibit
|
|
|
|
|
No.
|
|
|
|
Description
|
|
|
10
|
.20
|
|
|
|
Amended and Restated Guaranty made as of October 1, 2001 by
MedCath Incorporated, St. Joseph Healthcare System, SWCA, LLC
and NMHI, LLC in favor of Health Care Property Investors, Inc.(3)
|
|
10
|
.21
|
|
|
|
Termination and Release dated October 1, 2000 by and among
Heart Hospital of DTO, LLC, DTO Management, Inc., Franciscan
Health Systems of the Ohio Valley, Inc. and ProWellness Health
Management Systems, Inc(1)(6)
|
|
10
|
.22
|
|
|
|
Operating Agreement of Heart Hospital of South Dakota, LLC
effective as of June 8, 1999 Sioux Falls Hospital
Management, Inc. and North Central Heart Institute Holdings,
PLLC (the Sioux Falls Operating Agreement)(1)(6)
|
|
10
|
.23
|
|
|
|
First Amendment to Sioux Falls Operating Agreement of Heart
Hospital of South Dakota, LLC effective as of July 31,
1999(1)(6)
|
|
10
|
.24
|
|
|
|
Limited Partnership Agreement of Harlingen Medical Center LP
effective as of June 1, 1999 by and between Harlingen
Hospital Management, Inc. and the several partners thereto(1)(6)
|
|
10
|
.25
|
|
|
|
Operating Agreement of Louisiana Heart Hospital, LLC effective
as of December 1, 2000 by and among Louisiana Hospital
Management, Inc. and the several parties thereto (Louisiana
Operating Agreement)(1)(6)
|
|
10
|
.26
|
|
|
|
Amendment to Louisiana Operating Agreement effective as of
December 1, 2000(1)(6)
|
|
10
|
.27
|
|
|
|
Second Amendment to Louisiana Operating Agreement effective as
of December 1, 2000(1)(6)
|
|
10
|
.28
|
|
|
|
Limited Partnership Agreement of San Antonio Heart
Hospital, L.P. effective as of September 17, 2001(2)(6)
|
|
10
|
.29
|
|
|
|
1998 Stock Option Plan for Key Employees of MedCath Holdings,
Inc. and Subsidiaries(1)
|
|
10
|
.30
|
|
|
|
Outside Directors Stock Option Plan(1)
|
|
10
|
.31
|
|
|
|
Amended and Restated Directors Option Plan(4)
|
|
10
|
.32
|
|
|
|
Form of Heart Hospital Management Services Agreement(1)
|
|
10
|
.33
|
|
|
|
Engagement Letter dated October 30, 2003 between MedCath
Corporation and Sokolov, Sokolov, Burgess(13)
|
|
10
|
.34
|
|
|
|
Addendum to Engagement Letter dated as of February 5, 2004
between MedCath Corporation and Sokolov, Sokolov, Burgess(13)
|
|
10
|
.35
|
|
|
|
Engagement Letter dated February 17, 2004 between MedCath
Corporation, Arizona Heart Hospital, Arizona Heart Institute and
Sokolov, Sokolov, Burgess(13)
|
|
10
|
.36
|
|
|
|
Agreement for Purchase and Sale, dated November 4, 2004(14)
|
|
10
|
.37
|
|
|
|
Amended and Restated Employment Agreement dated
September 30, 2005 by and between MedCath Corporation and
John T. Casey(15)
|
|
10
|
.38
|
|
|
|
Employment Agreement dated June 23, 2008 by and between
MedCath Corporation and Jeffrey L. Hinton(21)
|
|
10
|
.39
|
|
|
|
Amended and Restated Employment Agreement dated
September 30, 2005 by and between MedCath Corporation and
Joan McCanless(15)
|
|
10
|
.40
|
|
|
|
Sample Agreement to Accelerate Vesting of Stock Options and
Restrict Sale of Related Stock Effective September 30,
2005(15)
|
|
10
|
.41
|
|
|
|
Consulting Services Agreement dated October 27, 2005 by and
between MedCath Corporation and French Healthcare Consulting,
Inc.(15)
|
|
10
|
.42
|
|
|
|
Separation and Release Agreement effective November 25,
2005 by and between MedCath Corporation and Charles R. Slaton(15)
|
|
10
|
.43
|
|
|
|
Guaranty made as of December 28, 2005 by MedCath
Corporation and Harlingen Medical Center Limited Partnership in
favor of HCPI Mortgage Corp.(16)
|
|
10
|
.44
|
|
|
|
Employment agreement dated February 21, 2006, by and
between MedCath Corporation and O. Edwin French(17)
|
|
10
|
.45
|
|
|
|
MedCath Corporation 2006 Stock Option and Award Plan effective
March 1, 2006
|
113
|
|
|
|
|
|
|
Exhibit
|
|
|
|
|
No.
|
|
|
|
Description
|
|
|
10
|
.46
|
|
|
|
Consulting agreement effective August 4, 2006 by and
between MedCath Incorporated and SSB Solutions(18)
|
|
10
|
.47
|
|
|
|
Resignation letter of John T. Casey dated August 16, 2006
|
|
10
|
.48
|
|
|
|
First Amendment to the September 30, 2005 Amended and
Restated Employment Agreement by and between MedCath Corporation
and James E. Harris dated September 1, 2006
|
|
10
|
.49
|
|
|
|
First Amendment to the September 30, 2005 Amended and
Restated Employment Agreement by and between MedCath Corporation
and Thomas K. Hearn dated September 1, 2006
|
|
10
|
.50
|
|
|
|
First Amendment to the September 30, 2005 Amended and
Restated Employment Agreement by and between MedCath Corporation
and Joan McCanless dated September 1, 2006
|
|
10
|
.51
|
|
|
|
First Amendment to the February 21, 2006 Employment
Agreement by and between MedCath Corporation and O. Edwin French
dated September 1, 2006
|
|
10
|
.52
|
|
|
|
LLC Interest Purchase Agreement, dated as of August 14,
2006, by and among Carondelet Health Network, an Arizona
non-profit corporation, Southern Arizona Heart, Inc., a North
Carolina corporation, and MedCath Incorporated, a North Carolina
corporation(19)
|
|
10
|
.53
|
|
|
|
Operating Agreement of HMC Management Company, LLC, effective as
of June 29, 2007(6)
|
|
10
|
.54
|
|
|
|
Amended and Restated Operating Agreement of Coastal Carolina
Heart, LLC, effective as of July 1, 2007(6)
|
|
10
|
.55
|
|
|
|
Amended and Restated Limited Partnership Agreement of Harlingen
Medical Center, Limited Partnership, effective as of
July 10, 2007(6)
|
|
10
|
.56
|
|
|
|
Amended and Restated Operating Agreement of HMC Realty, LLC,
effective as of July 10, 2007(6)
|
|
10
|
.57
|
|
|
|
Amendment to Amended and Restated Outside Directors Stock
Option Plan(22)
|
|
10
|
.58
|
|
|
|
Asset Purchase Agreement By and Between Heart Hospital of DTO,
LLC and Good Samaritan Hospital(22)
|
|
12
|
.0
|
|
|
|
Ratio of earnings to fixed charges
|
|
21
|
.1
|
|
|
|
List of Subsidiaries
|
|
23
|
.1
|
|
|
|
Consent of Deloitte & Touche LLP, Independent
Registered Public Accounting Firm
|
|
23
|
.2
|
|
|
|
Consent of Deloitte & Touche LLP, Independent Auditors
|
|
31
|
.1
|
|
|
|
Certification of Chief Executive Officer pursuant to
Section 302 of the Sarbanes-Oxley Act of 2002
|
|
31
|
.2
|
|
|
|
Certification of Chief Financial Officer pursuant to
Section 302 of the Sarbanes-Oxley Act of 2002
|
|
32
|
.1
|
|
|
|
Certification of Chief Executive Officer pursuant to
Section 906 of the Sarbanes-Oxley Act of 2002
|
|
32
|
.2
|
|
|
|
Certification of Chief Financial Officer pursuant to
Section 906 of the Sarbanes-Oxley Act of 2002
|
|
|
|
(1)
|
|
Incorporated by reference from the Companys Registration
Statement on
Form S-1
(File
no. 333-60278).
|
|
(2)
|
|
Incorporated by reference from the Companys Annual Report
on
Form 10-K
for the fiscal year ended September 30, 2001.
|
|
(3)
|
|
Incorporated by reference from the Companys Quarterly
Report on
Form 10-Q
for the quarter ended December 31, 2001.
|
|
(4)
|
|
Incorporated by reference from the Companys Quarterly
Report on
Form 10-Q
for the quarter ended March 31, 2002.
|
|
(5)
|
|
Incorporated by reference from the Companys Quarterly
Report on
Form 10-Q
for the quarter ended June 30, 2002.
|
|
(6)
|
|
Certain portions of these exhibits have been omitted pursuant to
a request for confidential treatment filed with the Commission.
|
|
(7)
|
|
Incorporated by reference from the Companys Quarterly
Report on
Form 10-Q
for the quarter ended December 31, 2002.
|
|
(8)
|
|
Incorporated by reference from the Companys Quarterly
Report on
Form 10-Q
for the quarter ended March 31, 2003.
|
114
|
|
|
(9)
|
|
Incorporated by reference from the Companys Quarterly
Report on
Form 10-Q
for the quarter ended June 30, 2003.
|
|
(10)
|
|
Incorporated by reference from the Companys Annual Report
on
Form 10-K
for the fiscal year ended September 30, 2003.
|
|
(11)
|
|
Incorporated by reference from the Companys Quarterly
Report on
Form 10-Q
for the quarter ended December 31, 2003.
|
|
(12)
|
|
Incorporated by reference from the Companys Registration
Statement on
Form S-4
(File
No. 333-119170).
|
|
(13)
|
|
Incorporated by reference from the Companys Annual Report
on
Form 10-K
for the year ended September 30, 2004.
|
|
(14)
|
|
Incorporated by reference from the Companys Quarterly
Report on
Form 10-Q
for the quarter ended December 31, 2004.
|
|
(15)
|
|
Incorporated by reference from the Companys Annual Report
on
Form 10-K
for the year ended September 30, 2005.
|
|
(16)
|
|
Incorporated by reference from the Companys Quarterly
Report on
Form 10-Q
for the quarter ended December 31, 2005.
|
|
(17)
|
|
Incorporated by reference from the Companys Quarterly
Report on
Form 10-Q
for the quarter ended March 31, 2006.
|
|
(18)
|
|
Incorporated by reference from the Companys Quarterly
Report on
Form 10-Q
for the quarter ended June 30, 2006.
|
|
(19)
|
|
Incorporated by reference from the Companys Current Report
on
Form 8-K
filed September 7, 2006.
|
|
(20)
|
|
Incorporated by reference from the Companys Current Report
on
Form 8-K
filed November 14, 2008.
|
|
(21)
|
|
Incorporated by reference from the Companys Current Report
on
Form 8-K
filed June 25, 2008.
|
|
(22)
|
|
Incorporated by reference from the Companys Quarterly
Report on
Form 10-Q/A
for the quarter ended March 31, 2008.
|
115
SIGNATURES
Pursuant to the requirements of Section 13 or 15(d) of the
Securities Exchange Act of 1934, the registrant has duly caused
this report to be signed on its behalf by the undersigned,
thereunto duly authorized.
Medcath Corporation
O. Edwin French
President, Chief Executive Officer
(principal executive officer)
Pursuant to the requirements of the Securities Exchange Act of
1934, this report has been signed below by the following persons
on behalf of the registrant and in the capacities and on the
dates indicated.
|
|
|
|
|
|
|
Name
|
|
Title
|
|
Date
|
|
|
|
|
|
|
/s/
O.
Edwin French
O.
Edwin French
|
|
President and Chief Executive Officer (principal executive
officer)
|
|
December 15, 2008
|
|
|
|
|
|
/s/
Jeffrey
L. Hinton
Jeffrey
L. Hinton
|
|
Executive Vice President and
Chief Financial Officer
(principal financial officer)
|
|
December 15, 2008
|
|
|
|
|
|
/s/
Lora
Ramsey
Lora
Ramsey
|
|
Vice President Controller
(principal accounting officer)
|
|
December 15, 2008
|
|
|
|
|
|
/s/
Pamela
G. Bailey
Pamela
G. Bailey
|
|
Director
|
|
December 15, 2008
|
|
|
|
|
|
/s/
Edward
R. Casas
Edward
R. Casas
|
|
Director
|
|
December 15, 2008
|
|
|
|
|
|
/s/
Woodrin
Grossman
Woodrin
Grossman
|
|
Director
|
|
December 15, 2008
|
|
|
|
|
|
/s/
Robert
S. McCoy, Jr.
Robert
S. McCoy, Jr.
|
|
Director
|
|
December 15, 2008
|
|
|
|
|
|
/s/
John
B. McKinnon
John
B. McKinnon
|
|
Director
|
|
December 15, 2008
|
|
|
|
|
|
/s/
Galen
D. Powers
Galen
D. Powers
|
|
Director
|
|
December 15, 2008
|
|
|
|
|
|
/s/
Paul
B. Queally
Paul
B. Queally
|
|
Director
|
|
December 15, 2008
|
|
|
|
|
|
/s/
Jacque
J. Sokolov, MD
Jacque
J. Sokolov, MD
|
|
Director
|
|
December 15, 2008
|
|
|
|
|
|
/s/
John
T. Casey
John
T. Casey
|
|
Director
|
|
December 15, 2008
|
116
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