Table of Contents

 

 

 

UNITED STATES

SECURITIES AND EXCHANGE COMMISSION

Washington, D.C. 20549

 

FORM 10-Q

 

(Mark One)

 

x

Quarterly Report Pursuant to Section 13 or 15(d) of the Securities Exchange Act of 1934

 

For the Quarterly Period Ended June 30, 2012

 

o

Transition report pursuant to Section 13 or 15(d) of the Securities Exchange Act of 1934

 

For the Transition Period From                       to                      .

 

Commission File Numbers:  001 – 34465 and 001 – 31441

 

SELECT MEDICAL HOLDINGS CORPORATION

 

SELECT MEDICAL CORPORATION

(Exact name of Registrants as specified in their charters)

 

Delaware

Delaware
(State or other jurisdiction of
incorporation or organization)

 

20-1764048

23-2872718
(I.R.S. employer identification
number)

 

4714 Gettysburg Road, P.O. Box 2034, Mechanicsburg, Pennsylvania 17055

(Address of principal executive offices and zip code)

 

(717) 972-1100

(Registrants’ telephone number, including area code)

 

Indicate by check mark whether the Registrants (1) have 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 periods as the Registrants were required to file such reports), and (2) have been subject to such filing requirements for the past 90 days.  YES  x  NO  o

 

Indicate by check mark whether the Registrants have submitted electronically and posted on its corporate Web site, if any, every Interactive Data File required to be submitted and posted pursuant to Rule 405 of Regulation S-T during the preceding 12 months (or for such shorter period that the Registrants were required to submit and post such files).  YES  x  NO  o

 

Indicate by check mark whether the Registrants are large accelerated filers, accelerated filers, non-accelerated filers, or smaller reporting companies.  See definitions of “large accelerated filer,” “accelerated filer” and “smaller reporting company” in Rule 12b-2 of the Exchange Act.

 

Large accelerated filer  o

 

Accelerated filer  x

 

 

 

Non-accelerated filer  o

 

Smaller reporting company  o

 

Indicate by check mark whether the Registrants are shell companies (as defined in Rule 12b-2 of the Exchange Act).  YES  o  NO  x

 

As of July 31, 2012, Select Medical Holdings Corporation had outstanding 139,866,719 shares of common stock.

 

This Form 10-Q is a combined quarterly report being filed separately by two Registrants: Select Medical Holdings Corporation and Select Medical Corporation.  Unless the context indicates otherwise, any reference in this report to “Holdings” refers to Select Medical Holdings Corporation and any reference to “Select” refers to Select Medical Corporation, the wholly-owned operating subsidiary of Holdings.  References to the “Company,” “we,” “us,” and “our” refer collectively to Select Medical Holdings Corporation and Select Medical Corporation.

 

 

 



Table of Contents

 

TABLE OF CONTENTS

 

PART I

FINANCIAL INFORMATION

 

 

 

 

ITEM 1.

CONSOLIDATED FINANCIAL STATEMENTS

 

 

 

 

 

Consolidated balance sheets

3

 

 

 

 

Consolidated statements of operations

4

 

 

 

 

Consolidated statements of changes in stockholders’ equity and income

6

 

 

 

 

Consolidated statements of cash flows

7

 

 

 

 

Notes to consolidated financial statements

8

 

 

 

ITEM 2.

MANAGEMENT’S DISCUSSION AND ANALYSIS OF FINANCIAL CONDITION AND RESULTS OF OPERATIONS

27

 

 

 

ITEM 3.

QUANTITATIVE AND QUALITATIVE DISCLOSURES ABOUT MARKET RISK

52

 

 

 

ITEM 4.

CONTROLS AND PROCEDURES

52

 

 

 

PART II

OTHER INFORMATION

52

 

 

 

ITEM 1.

LEGAL PROCEEDINGS

52

 

 

 

ITEM 1A.

RISK FACTORS

54

 

 

 

ITEM 2.

UNREGISTERED SALES OF EQUITY SECURITIES AND USE OF PROCEEDS

54

 

 

 

ITEM 3.

DEFAULTS UPON SENIOR SECURITIES

54

 

 

 

ITEM 4.

MINE SAFETY DISCLOSURES

54

 

 

 

ITEM 5.

OTHER INFORMATION

54

 

 

 

ITEM 6.

EXHIBITS

55

 

 

 

SIGNATURES

 

 

2



Table of Contents

 

Consolidated Balance Sheets

(unaudited)

(in thousands, except share and per share amounts)

 

 

 

Select Medical Holdings Corporation

 

Select Medical Corporation

 

 

 

December 31,

 

June 30,

 

December 31,

 

June 30,

 

 

 

2011

 

2012

 

2011

 

2012

 

 

 

 

 

 

 

 

 

 

 

ASSETS

 

 

 

 

 

 

 

 

 

Current Assets:

 

 

 

 

 

 

 

 

 

Cash and cash equivalents

 

$

12,043

 

$

21,520

 

$

12,043

 

$

21,520

 

Accounts receivable, net of allowance for doubtful accounts of $47,469 and $44,783 in 2011 and 2012, respectively

 

413,743

 

423,859

 

413,743

 

423,859

 

Current deferred tax asset

 

18,305

 

15,533

 

18,305

 

15,533

 

Prepaid income taxes

 

9,497

 

4,061

 

9,497

 

4,061

 

Other current assets

 

29,822

 

31,383

 

29,822

 

31,383

 

Total Current Assets

 

483,410

 

496,356

 

483,410

 

496,356

 

 

 

 

 

 

 

 

 

 

 

Property and equipment, net

 

510,028

 

492,781

 

510,028

 

492,781

 

Goodwill

 

1,631,716

 

1,631,461

 

1,631,716

 

1,631,461

 

Other identifiable intangibles

 

72,123

 

71,783

 

72,123

 

71,783

 

Assets held for sale

 

2,742

 

2,742

 

2,742

 

2,742

 

Other assets

 

72,128

 

84,514

 

70,719

 

83,291

 

 

 

 

 

 

 

 

 

 

 

Total Assets

 

$

2,772,147

 

$

2,779,637

 

$

2,770,738

 

$

2,778,414

 

 

 

 

 

 

 

 

 

 

 

LIABILITIES AND EQUITY

 

 

 

 

 

 

 

 

 

Current Liabilities:

 

 

 

 

 

 

 

 

 

Bank overdrafts

 

$

16,609

 

$

20,348

 

$

16,609

 

$

20,348

 

Current portion of long-term debt and notes payable

 

10,848

 

11,785

 

10,848

 

11,785

 

Accounts payable

 

95,618

 

90,132

 

95,618

 

90,132

 

Accrued payroll

 

82,888

 

73,712

 

82,888

 

73,712

 

Accrued vacation

 

51,250

 

56,208

 

51,250

 

56,208

 

Accrued interest

 

15,096

 

26,945

 

11,980

 

23,746

 

Accrued restructuring

 

5,027

 

3,038

 

5,027

 

3,038

 

Accrued other

 

101,076

 

99,583

 

106,316

 

104,823

 

Due to third party payors

 

5,526

 

7,264

 

5,526

 

7,264

 

Total Current Liabilities

 

383,938

 

389,015

 

386,062

 

391,056

 

 

 

 

 

 

 

 

 

 

 

Long-term debt, net of current portion

 

1,385,950

 

1,342,134

 

1,218,650

 

1,174,834

 

Non-current deferred tax liability

 

82,028

 

82,911

 

82,028

 

82,911

 

Other non-current liabilities

 

64,905

 

68,649

 

64,905

 

68,649

 

 

 

 

 

 

 

 

 

 

 

Total Liabilities

 

1,916,821

 

1,882,709

 

1,751,645

 

1,717,450

 

 

 

 

 

 

 

 

 

 

 

Stockholders’ Equity:

 

 

 

 

 

 

 

 

 

Common stock of Holdings, $0.001 par value, 700,000,000 shares authorized, 145,268,190 shares and 139,863,119 shares issued and outstanding in 2011 and 2012, respectively

 

145

 

140

 

 

 

Common stock of Select, $0.01 par value, 100 shares issued and outstanding

 

 

 

0

 

0

 

Capital in excess of par

 

493,828

 

469,410

 

848,844

 

853,506

 

Retained earnings

 

328,882

 

393,961

 

137,778

 

174,041

 

Total Select Medical Holdings Corporation and Select Medical Corporation Stockholders’ Equity

 

822,855

 

863,511

 

986,622

 

1,027,547

 

Non-controlling interest

 

32,471

 

33,417

 

32,471

 

33,417

 

Total Equity

 

855,326

 

896,928

 

1,019,093

 

1,060,964

 

 

 

 

 

 

 

 

 

 

 

Total Liabilities and Equity

 

$

2,772,147

 

$

2,779,637

 

$

2,770,738

 

$

2,778,414

 

 

The accompanying notes are an integral part of these consolidated financial statements.

 

3



Table of Contents

 

Consolidated Statements of Operations

(unaudited)

(in thousands, except per share amounts)

 

 

 

Select Medical Holdings Corporation

 

Select Medical Corporation

 

 

 

For the Three Months Ended June 30,

 

For the Three Months Ended June 30,

 

 

 

2011

 

2012

 

2011

 

2012

 

 

 

 

 

 

 

 

 

 

 

Net operating revenues

 

$

698,749

 

$

750,193

 

$

698,749

 

$

750,193

 

 

 

 

 

 

 

 

 

 

 

Costs and expenses:

 

 

 

 

 

 

 

 

 

Cost of services

 

569,666

 

612,669

 

569,666

 

612,669

 

General and administrative

 

16,115

 

18,554

 

16,115

 

18,554

 

Bad debt expense

 

13,943

 

10,029

 

13,943

 

10,029

 

Depreciation and amortization

 

17,999

 

15,428

 

17,999

 

15,428

 

Total costs and expenses

 

617,723

 

656,680

 

617,723

 

656,680

 

 

 

 

 

 

 

 

 

 

 

Income from operations

 

81,026

 

93,513

 

81,026

 

93,513

 

 

 

 

 

 

 

 

 

 

 

Other income and expense:

 

 

 

 

 

 

 

 

 

Loss on early retirement of debt

 

(31,018

)

 

(20,385

)

 

Equity in earnings (losses) of unconsolidated subsidiaries

 

(251

)

2,752

 

(251

)

2,752

 

Interest income

 

111

 

 

111

 

 

Interest expense

 

(25,296

)

(23,798

)

(19,694

)

(20,957

)

 

 

 

 

 

 

 

 

 

 

Income before income taxes

 

24,572

 

72,467

 

40,807

 

75,308

 

 

 

 

 

 

 

 

 

 

 

Income tax expense

 

10,915

 

27,651

 

16,597

 

28,646

 

 

 

 

 

 

 

 

 

 

 

Net income

 

13,657

 

44,816

 

24,210

 

46,662

 

 

 

 

 

 

 

 

 

 

 

Less: Net income attributable to non-controlling interests

 

1,938

 

1,644

 

1,938

 

1,644

 

 

 

 

 

 

 

 

 

 

 

Net income attributable to Select Medical Holdings Corporation and Select Medical Corporation

 

$

11,719

 

$

43,172

 

$

22,272

 

$

45,018

 

 

 

 

 

 

 

 

 

 

 

Income per common share:

 

 

 

 

 

 

 

 

 

Basic

 

$

0.08

 

$

0.31

 

 

 

 

 

Diluted

 

$

0.08

 

$

0.31

 

 

 

 

 

 

The accompanying notes are an integral part of these consolidated financial statements.

 

4



Table of Contents

 

Consolidated Statements of Operations

(unaudited)

(in thousands, except per share amounts)

 

 

 

Select Medical Holdings Corporation

 

Select Medical Corporation

 

 

 

For the Six Months Ended June 30,

 

For the Six Months Ended June 30,

 

 

 

2011

 

2012

 

2011

 

2012

 

 

 

 

 

 

 

 

 

 

 

Net operating revenues

 

$

1,391,935

 

$

1,494,214

 

$

1,391,935

 

$

1,494,214

 

 

 

 

 

 

 

 

 

 

 

Costs and expenses:

 

 

 

 

 

 

 

 

 

Cost of services

 

1,127,082

 

1,224,288

 

1,127,082

 

1,224,288

 

General and administrative

 

32,681

 

32,778

 

32,681

 

32,778

 

Bad debt expense

 

28,293

 

20,404

 

28,293

 

20,404

 

Depreciation and amortization

 

35,221

 

31,627

 

35,221

 

31,627

 

Total costs and expenses

 

1,223,277

 

1,309,097

 

1,223,277

 

1,309,097

 

 

 

 

 

 

 

 

 

 

 

Income from operations

 

168,658

 

185,117

 

168,658

 

185,117

 

 

 

 

 

 

 

 

 

 

 

Other income and expense:

 

 

 

 

 

 

 

 

 

Loss on early retirement of debt

 

(31,018

)

 

(20,385

)

 

Equity in earnings (losses) of unconsolidated subsidiaries

 

(324

)

5,217

 

(324

)

5,217

 

Interest income

 

167

 

 

167

 

 

Interest expense

 

(50,960

)

(47,720

)

(38,356

)

(42,207

)

 

 

 

 

 

 

 

 

 

 

Income before income taxes

 

86,523

 

142,614

 

109,760

 

148,127

 

 

 

 

 

 

 

 

 

 

 

Income tax expense

 

37,479

 

55,226

 

45,611

 

57,156

 

 

 

 

 

 

 

 

 

 

 

Net income

 

49,044

 

87,388

 

64,149

 

90,971

 

 

 

 

 

 

 

 

 

 

 

Less: Net income attributable to non-controlling interests

 

3,653

 

2,674

 

3,653

 

2,674

 

 

 

 

 

 

 

 

 

 

 

Net income attributable to Select Medical Holdings Corporation and Select Medical Corporation

 

$

45,391

 

$

84,714

 

$

60,496

 

$

88,297

 

 

 

 

 

 

 

 

 

 

 

Income per common share:

 

 

 

 

 

 

 

 

 

Basic

 

$

0.29

 

$

0.60

 

 

 

 

 

Diluted

 

$

0.29

 

$

0.59

 

 

 

 

 

 

The accompanying notes are an integral part of these consolidated financial statements.

 

5



Table of Contents

 

Select Medical Holdings Corporation

Consolidated Statement of Changes in Equity and Income

(unaudited)

(in thousands)

 

 

 

 

 

Select Medical Holdings Corporation Stockholders

 

 

 

 

 

Total

 

Common
Stock Issued

 

Common
Stock Par
Value

 

Capital in
Excess of Par

 

Retained
Earnings

 

Non-controlling
Interests

 

Balance at December 31, 2011

 

$

855,326

 

145,268

 

$

145

 

$

493,828

 

$

328,882

 

$

32,471

 

Net income

 

87,388

 

 

 

 

 

 

 

84,714

 

2,674

 

Issuance and vesting of restricted stock

 

1,998

 

194

 

0

 

1,998

 

 

 

 

 

Exercise of stock options

 

547

 

127

 

0

 

547

 

 

 

 

 

Stock option expense

 

601

 

 

 

 

 

601

 

 

 

 

 

Repurchase of common shares

 

(46,790

)

(5,726

)

(5

)

(27,150

)

(19,635

)

 

 

Distributions to non-controlling interests

 

(1,681

)

 

 

 

 

 

 

 

 

(1,681

)

Other

 

(461

)

 

 

 

 

(414

)

 

 

(47

)

Balance at June 30, 2012

 

$

896,928

 

139,863

 

$

140

 

$

469,410

 

$

393,961

 

$

33,417

 

 

Select Medical Corporation

Consolidated Statement of Changes in Equity and Income

(unaudited)

(in thousands)

 

 

 

 

 

Select Medical Corporation Stockholders

 

 

 

 

 

Total

 

Common
Stock Issued

 

Common
Stock Par
Value

 

Capital in
Excess of Par

 

Retained
Earnings

 

Non-controlling
Interests

 

Balance at December 31, 2011

 

$

1,019,093

 

0

 

$

0

 

$

848,844

 

$

137,778

 

$

32,471

 

Net income

 

90,971

 

 

 

 

 

 

 

88,297

 

2,674

 

Federal tax benefit of losses contributed by Holdings

 

1,930

 

 

 

 

 

1,930

 

 

 

 

 

Additional investment by Holdings

 

547

 

 

 

 

 

547

 

 

 

 

 

Dividends declared and paid to Holdings

 

(52,034

)

 

 

 

 

 

 

(52,034

)

 

 

Distributions to non-controlling interests

 

(1,681

)

 

 

 

 

 

 

 

 

(1,681

)

Other

 

(461

)

 

 

 

 

(414

)

 

 

(47

)

Contribution related to restricted stock awards and stock option issuances by Holdings

 

2,599

 

 

 

 

 

2,599

 

 

 

 

 

Balance at June 30, 2012

 

$

1,060,964

 

0

 

$

0

 

$

853,506

 

$

174,041

 

$

33,417

 

 

The accompanying notes are an integral part of these consolidated financial statements.

 

6



Table of Contents

 

Consolidated Statements of Cash Flows

(unaudited)

(in thousands)

 

 

 

Select Medical Holdings Corporation

 

Select Medical Corporation

 

 

 

For the Six Months Ended June 30,

 

For the Six Months Ended June 30,

 

 

 

2011

 

2012

 

2011

 

2012

 

 

 

 

 

 

 

 

 

 

 

Operating activities

 

 

 

 

 

 

 

 

 

Net income

 

$

49,044

 

$

87,388

 

$

64,149

 

$

90,971

 

Adjustments to reconcile net income to net cash provided by operating activities:

 

 

 

 

 

 

 

 

 

Depreciation and amortization

 

35,221

 

31,627

 

35,221

 

31,627

 

Provision for bad debts

 

28,293

 

20,404

 

28,293

 

20,404

 

Loss on early retirement of debt

 

31,018

 

 

20,385

 

 

Gain from disposal or sale of assets

 

(5,201

)

(3,604

)

(5,201

)

(3,604

)

Non-cash stock compensation expense

 

1,780

 

2,599

 

1,780

 

2,599

 

Amortization of debt discount

 

962

 

622

 

103

 

622

 

Changes in operating assets and liabilities, net of effects from acquisition of businesses:

 

 

 

 

 

 

 

 

 

Accounts receivable

 

(81,240

)

(30,520

)

(81,240

)

(30,520

)

Other current assets

 

(1,511

)

(1,612

)

(1,511

)

(1,612

)

Other assets

 

2,724

 

(653

)

2,469

 

(839

)

Accounts payable

 

8,107

 

(5,486

)

8,107

 

(5,486

)

Due to third-party payors

 

(464

)

1,738

 

(464

)

1,738

 

Accrued expenses

 

6,775

 

6,423

 

13,008

 

6,340

 

Income and deferred taxes

 

8,019

 

9,879

 

16,151

 

11,809

 

Net cash provided by operating activities

 

83,527

 

118,805

 

101,250

 

124,049

 

 

 

 

 

 

 

 

 

 

 

Investing activities

 

 

 

 

 

 

 

 

 

Purchases of property and equipment

 

(23,696

)

(27,934

)

(23,696

)

(27,934

)

Proceeds from sale of assets

 

7,879

 

16,511

 

7,879

 

16,511

 

Investment in business

 

(13,514

)

(10,014

)

(13,514

)

(10,014

)

Acquisition of businesses, net of cash acquired

 

1,921

 

(206

)

1,921

 

(206

)

Net cash used in investing activities

 

(27,410

)

(21,643

)

(27,410

)

(21,643

)

 

 

 

 

 

 

 

 

 

 

Financing activities

 

 

 

 

 

 

 

 

 

Borrowings on revolving credit facilities

 

435,000

 

340,000

 

435,000

 

340,000

 

Payments on revolving credit facilities

 

(395,000

)

(380,000

)

(395,000

)

(380,000

)

Borrowings on 2011 credit facility term loan, net of discount

 

841,500

 

 

841,500

 

 

Payments on 2011 credit facility term loan

 

 

(4,250

)

 

(4,250

)

Payments on 2005 credit facility term loans, net of call premium

 

(484,633

)

 

(484,633

)

 

Repurchase of 10% senior subordinated notes

 

(150,000

)

 

 

 

Repurchase of 7 5/8% senior subordinated notes, net of tender premium

 

(273,941

)

 

(273,941

)

 

Borrowings of other debt

 

5,496

 

5,835

 

5,496

 

5,835

 

Principal payments on other debt

 

(3,480

)

(5,085

)

(3,480

)

(5,085

)

Debt issuance costs

 

(18,556

)

 

(18,556

)

 

Dividends paid to Holdings

 

 

 

(171,008

)

(52,034

)

Repurchase of common stock

 

(3,285

)

(46,790

)

 

 

Proceeds from issuance of common stock

 

169

 

547

 

 

 

Equity investment by Holdings

 

 

 

169

 

547

 

Proceeds from bank overdrafts

 

2,102

 

3,739

 

2,102

 

3,739

 

Distributions to non-controlling interests

 

(2,270

)

(1,681

)

(2,270

)

(1,681

)

Net cash used in financing activities

 

(46,898

)

(87,685

)

(64,621

)

(92,929

)

 

 

 

 

 

 

 

 

 

 

Net increase in cash and cash equivalents

 

9,219

 

9,477

 

9,219

 

9,477

 

 

 

 

 

 

 

 

 

 

 

Cash and cash equivalents at beginning of period

 

4,365

 

12,043

 

4,365

 

12,043

 

Cash and cash equivalents at end of period

 

$

13,584

 

$

21,520

 

$

13,584

 

$

21,520

 

 

 

 

 

 

 

 

 

 

 

Supplemental Cash Flow Information

 

 

 

 

 

 

 

 

 

Cash paid for interest

 

$

59,289

 

$

32,378

 

$

41,572

 

$

27,136

 

Cash paid for taxes

 

$

29,435

 

$

45,344

 

$

29,435

 

$

45,344

 

 

The accompanying notes are an integral part of these consolidated financial statements.

 

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Table of Contents

 

SELECT MEDICAL HOLDINGS CORPORATION AND SELECT MEDICAL CORPORATION

 

NOTES TO CONSOLIDATED FINANCIAL STATEMENTS (UNAUDITED)

 

1.              Basis of Presentation

 

Select Medical Corporation (“Select”) was formed in December 1996 and commenced operations during February 1997 upon the completion of its first acquisition. Select Medical Holdings Corporation (“Holdings”) was formed in October 2004 for the purpose of affecting a leveraged buyout of Select, which was a publicly traded entity.  On February 24, 2005, Select merged with a subsidiary of Holdings, which resulted in Select becoming a wholly-owned subsidiary of Holdings (the “Merger”). On September 30, 2009 Holdings completed its initial public offering of common stock.  Generally accepted accounting principles (“GAAP”) require that any amounts recorded or incurred (such as goodwill and compensation expense) by the parent as a result of the Merger or for the benefit of the subsidiary be “pushed down” and recorded in Select’s consolidated financial statements. Holdings and Select and their subsidiaries are collectively referred to as the “Company.” The consolidated financial statements of Holdings include the accounts of its wholly-owned subsidiary Select. Holdings conducts substantially all of its business through Select and its subsidiaries.

 

The unaudited condensed consolidated financial statements of the Company as of June 30, 2012 and for the three and six month periods ended June 30, 2011 and 2012 have been prepared in accordance with GAAP.  In the opinion of management, such information contains all adjustments, which are normal and recurring in nature, necessary for a fair statement of the financial position, results of operations and cash flow for such periods.  All significant intercompany transactions and balances have been eliminated.  The results of operations for the three and six months ended June 30, 2012 are not necessarily indicative of the results to be expected for the full fiscal year ending December 31, 2012.

 

Certain information and disclosures normally included in the notes to consolidated financial statements have been condensed or omitted consistent with the rules and regulations of the Securities and Exchange Commission (the “SEC”), although the Company believes the disclosure is adequate to make the information presented not misleading.  The accompanying unaudited condensed consolidated financial statements should be read in conjunction with the consolidated financial statements and notes thereto for the year ended December 31, 2011 contained in the Company’s Annual Report on Form 10-K filed with the Securities and Exchange Commission on March 2, 2012.

 

2.              Accounting Policies

 

Use of Estimates

 

The preparation of financial statements in conformity with GAAP requires management to make estimates and assumptions that affect the reported amounts of assets and liabilities and disclosure of contingent assets and liabilities at the date of the financial statements and reported amounts of revenues and expenses during the reporting period. Actual results could differ materially from those estimates.

 

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Recent Accounting Pronouncements

 

In June 2011, the Financial Accounting Standards Board (“FASB”) issued Accounting Standards Update (“ASU”) 2011-05, “Comprehensive Income (Topic 220) — Presentation of Comprehensive Income” (“Update 2011-05”) that improves the comparability, consistency and transparency of financial reporting and increases the prominence of items reported in other comprehensive income by eliminating the option to present components of other comprehensive income as part of the statement of changes in stockholders’ equity. Update 2011-05 requires that all non-owner changes in stockholders’ equity be presented either in a single continuous statement of comprehensive income or in two separate but consecutive statements. Under either method, adjustments must be displayed for items that are reclassified from other comprehensive income (“OCI”) to net income, in both net income and OCI. Update 2011-05 does not change the current option for presenting components of OCI gross or net of the effect of income taxes, provided that such tax effects are presented in the statement in which OCI is presented or disclosed in the notes to the financial statements. Additionally, Update 2011-05 does not affect the calculation or reporting of earnings per share. Update 2011-05 was effective for fiscal years, and interim periods within those years, beginning after December 15, 2011 and is to be applied retrospectively. The Company adopted Update 2011-05 on January 1, 2012.  Update 2011-05 had no effect on the Company’s presentation of other comprehensive income for the three and six months ended June 30, 2011 and 2012 because the Company did not have any items of other comprehensive income during these periods.

 

3.  Intangible Assets

 

The Company’s intangible assets consist of the following:

 

 

 

As of June 30, 2012

 

 

 

Gross Carrying
Amount

 

Accumulated
Amortization

 

 

 

(in thousands)

 

Amortized intangible assets:

 

 

 

 

 

Non-compete agreements

 

$

25,909

 

$

(25,909

)

 

 

 

 

 

 

Indefinite-lived intangible assets:

 

 

 

 

 

Goodwill

 

$

1,631,461

 

 

 

Trademarks

 

57,709

 

 

 

Certificates of need

 

11,914

 

 

 

Accreditations

 

2,160

 

 

 

Total

 

$

1,703,244

 

 

 

 

The Company’s accreditations and trademarks have renewal terms. The costs to renew these intangibles are expensed as incurred. At June 30, 2012, the accreditations and trademarks have a weighted average time until next renewal of approximately 1.5 years and 8.0 years, respectively.

 

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Amortization expense for the Company’s intangible assets with finite lives follows:

 

 

 

Three Months Ended June 30,

 

Six Months Ended June 30,

 

 

 

2011

 

2012

 

2011

 

2012

 

 

 

(in thousands)

 

(in thousands)

 

Amortization expense

 

$

327

 

$

85

 

$

653

 

$

340

 

 

Amortization expense for the Company’s intangible assets primarily relates to the amortization of the value associated with the non-compete agreement entered into in connection with the acquisition of the outpatient rehabilitation division of HealthSouth Corporation. The useful life of the outpatient rehabilitation division of HealthSouth Corporation’s non-compete was five years.

 

The changes in the carrying amount of goodwill for the Company’s reportable segments for the six months ended June 30, 2012 are as follows:

 

 

 

Specialty
Hospitals

 

Outpatient
Rehabilitation

 

Total

 

 

 

(in thousands)

 

Balance as of December 31, 2011

 

$

1,333,553

 

$

298,163

 

$

1,631,716

 

Other

 

(333

)

 

(333

)

Goodwill acquired during the period

 

 

78

 

78

 

Balance as of June 30, 2012

 

$

1,333,220

 

$

298,241

 

$

1,631,461

 

 

4.  Restructuring Reserves

 

In connection with the acquisition of substantially all of the outpatient rehabilitation division of HealthSouth Corporation, the Company recorded an estimated liability of $18.7 million in 2007 for business restructuring which was accounted for as additional purchase price. This reserve primarily included costs associated with workforce reductions and lease termination costs in accordance with the Company’s restructuring plan.

 

In connection with the acquisition of all the issued and outstanding equity securities of Regency Hospital Company, L.L.C. (“Regency”), an operator of long term acute care hospitals, the Company recorded an estimated liability of $4.3 million in 2010 for business restructuring related to lease termination costs.

 

The following summarizes the Company’s restructuring activity:

 

 

 

Lease Termination
Costs

 

 

 

(in thousands)

 

Balance as of December 31, 2011

 

$

5,027

 

Amounts paid in 2012

 

(845

)

Accretion expense

 

157

 

Revision of estimate

 

(1,301

)

Balance as of June 30, 2012

 

$

3,038

 

 

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The Company expects to pay out the remaining lease termination costs through 2014 for the acquisition of the outpatient rehabilitation division of HealthSouth Corporation and through 2015 for the Regency acquisition.

 

5.  Fair Value

 

Financial instruments include cash and cash equivalents, notes payable and long-term debt.  The carrying amount of cash and cash equivalents approximates fair value because of the short-term maturity of these instruments.

 

The carrying value of Select’s senior secured credit facility was $878.0 million and $834.3 million at December 31, 2011 and June 30, 2012, respectively.  The fair value of Select’s senior secured credit facility was $823.3 million and $815.6 million at December 31, 2011 and June 30, 2012, respectively.  The fair value of Select’s senior secured credit facility was based on quoted market prices for this debt in the syndicated loan market.

 

The carrying value of Select’s 7 5/8% senior subordinated notes was $345.0 million at both December 31, 2011 and June 30, 2012.  The fair value of Select’s 7 5/8% senior subordinated notes was $326.4 million and $346.3 million at December 31, 2011 and June 30, 2012, respectively.  The fair value of this registered debt was based on quoted market prices.

 

The carrying value of Holdings’ senior floating rate notes was $167.3 million at both December 31, 2011 and June 30, 2012.  The fair value of Holdings’ senior floating rate notes was $143.9 million and $160.6 million at December 31, 2011 and June 30, 2012, respectively.  The fair value of this registered debt was based on quoted market prices.

 

The Company considers the inputs in the valuation process of its debt instruments to be Level 2 in the fair value hierarchy.  Level 2 in the fair value hierarchy is defined as inputs other than quoted prices that are observable for the asset or liability, either directly or indirectly.  These include quoted prices for similar assets or liabilities in active markets and quoted prices for identical or similar assets or liabilities in markets that are not active.

 

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6.  Segment Information

 

The Company’s reportable segments consist of (i) specialty hospitals and (ii) outpatient rehabilitation. All other represents amounts associated with corporate activities and non-healthcare related services. The outpatient rehabilitation reportable segment has two operating segments: outpatient rehabilitation clinics and contract therapy. These operating segments are aggregated for reporting purposes as they have common economic characteristics and provide a similar service to a similar patient base. The accounting policies of the segments are the same as those described in the summary of significant accounting policies. The Company evaluates performance of the segments based on Adjusted EBITDA. Adjusted EBITDA is defined as net income before interest, income taxes, depreciation and amortization, gain (loss) on early retirement of debt, stock compensation expense, equity in earnings (losses) of unconsolidated subsidiaries and other income (expense).

 

The following tables summarize selected financial data for the Company’s reportable segments for the three and six months ended June 30, 2011 and 2012.  The segment results of Holdings are identical to those of Select with the exception of total assets:

 

 

 

Three Months Ended June 30, 2011

 

 

 

Specialty
Hospitals

 

Outpatient
Rehabilitation

 

All Other

 

Total

 

 

 

(in thousands)

 

 

 

 

 

 

 

 

 

 

 

Net operating revenue

 

$

520,261

 

$

178,473

 

$

15

 

$

698,749

 

Adjusted EBITDA

 

91,081

 

24,467

 

(15,623

)

99,925

 

Total assets:

 

 

 

 

 

 

 

 

 

Select Medical Corporation

 

2,202,994

 

471,175

 

112,264

 

2,786,433

 

Select Medical Holdings Corporation

 

2,202,994

 

471,175

 

113,853

 

2,788,022

 

Capital expenditures

 

6,130

 

2,801

 

1,845

 

10,776

 

 

 

 

 

 

 

 

 

 

 

 

 

Three Months Ended June 30, 2012

 

 

 

Specialty
Hospitals

 

Outpatient
Rehabilitation

 

All
Other

 

Total

 

 

 

(in thousands)

 

 

 

 

 

 

 

 

 

 

 

Net operating revenue

 

$

557,130

 

$

193,050

 

$

13

 

$

750,193

 

Adjusted EBITDA

 

102,166

 

25,837

 

(17,724

)

110,279

 

Total assets:

 

 

 

 

 

 

 

 

 

Select Medical Corporation

 

2,184,743

 

437,591

 

156,080

 

2,778,414

 

Select Medical Holdings Corporation

 

2,184,743

 

437,591

 

157,303

 

2,779,637

 

Capital expenditures

 

12,631

 

2,922

 

630

 

16,183

 

 

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Table of Contents

 

 

 

Six Months Ended June 30, 2011

 

 

 

Specialty
Hospitals

 

Outpatient
Rehabilitation

 

All Other

 

Total

 

 

 

(in thousands)

 

 

 

 

 

 

 

 

 

 

 

Net operating revenue

 

$

1,040,185

 

$

351,664

 

$

86

 

$

1,391,935

 

Adjusted EBITDA

 

191,434

 

45,873

 

(31,648

)

205,659

 

Total assets:

 

 

 

 

 

 

 

 

 

Select Medical Corporation

 

2,202,994

 

471,175

 

112,264

 

2,786,433

 

Select Medical Holdings Corporation

 

2,202,994

 

471,175

 

113,853

 

2,788,022

 

Capital expenditures

 

16,617

 

4,982

 

2,097

 

23,696

 

 

 

 

Six Months Ended June 30, 2012

 

 

 

Specialty
Hospitals

 

Outpatient
Rehabilitation

 

All Other

 

Total

 

 

 

(in thousands)

 

 

 

 

 

 

 

 

 

 

 

Net operating revenue

 

$

1,110,168

 

$

383,949

 

$

97

 

$

1,494,214

 

Adjusted EBITDA

 

202,120

 

48,315

 

(31,092

)

219,343

 

Total assets:

 

 

 

 

 

 

 

 

 

Select Medical Corporation

 

2,184,743

 

437,591

 

156,080

 

2,778,414

 

Select Medical Holdings Corporation

 

2,184,743

 

437,591

 

157,303

 

2,779,637

 

Capital expenditures

 

19,682

 

6,713

 

1,539

 

27,934

 

 

A reconciliation of Adjusted EBITDA to income before income taxes is as follows:

 

 

 

Three Months Ended June 30, 2011

 

 

 

(in thousands)

 

 

 

Specialty
Hospitals

 

Outpatient
Rehabilitation

 

All Other

 

 

 

 

 

Adjusted EBITDA

 

$

91,081

 

$

24,467

 

$

(15,623

)

 

 

 

 

Depreciation and amortization

 

(13,047

)

(4,227

)

(725

)

 

 

 

 

Stock compensation expense

 

 

 

(900

)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Select
Medical
Holdings
Corporation

 

Select
Medical
Corporation

 

Income (loss) from operations

 

$

78,034

 

$

20,240

 

$

(17,248

)

$

81,026

 

$

81,026

 

Loss on early retirement of debt

 

 

 

 

 

 

 

(31,018

)

(20,385

)

Equity in losses of unconsolidated subsidiaries

 

 

 

 

 

 

 

(251

)

(251

)

Interest expense, net

 

 

 

 

 

 

 

(25,185

)

(19,583

)

 

 

 

 

 

 

 

 

 

 

 

 

Income before income taxes

 

 

 

 

 

 

 

$

24,572

 

$

40,807

 

 

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Table of Contents

 

 

 

Three Months Ended June 30, 2012

 

 

 

(in thousands)

 

 

 

Specialty
Hospitals

 

Outpatient
Rehabilitation

 

All Other

 

 

 

 

 

Adjusted EBITDA

 

$

102,166

 

$

25,837

 

$

(17,724

)

 

 

 

 

Depreciation and amortization

 

(11,479

)

(3,232

)

(717

)

 

 

 

 

Stock compensation expense

 

 

 

(1,338

)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Select
Medical
Holdings
Corporation

 

Select
Medical
Corporation

 

Income (loss) from operations

 

$

90,687

 

$

22,605

 

$

(19,779

)

$

93,513

 

$

93,513

 

Equity in earnings of unconsolidated subsidiaries

 

 

 

 

 

 

 

2,752

 

2,752

 

Interest expense, net

 

 

 

 

 

 

 

(23,798

)

(20,957

)

 

 

 

 

 

 

 

 

 

 

 

 

Income before income taxes

 

 

 

 

 

 

 

$

72,467

 

$

75,308

 

 

 

 

Six Months Ended June 30, 2011

 

 

 

(in thousands)

 

 

 

Specialty
Hospitals

 

Outpatient
Rehabilitation

 

All Other

 

 

 

 

 

Adjusted EBITDA

 

$

191,434

 

$

45,873

 

$

(31,648

)

 

 

 

 

Depreciation and amortization

 

(25,093

)

(8,686

)

(1,442

)

 

 

 

 

Stock compensation expense

 

 

 

(1,780

)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Select
Medical
Holdings
Corporation

 

Select
Medical
Corporation

 

Income (loss) from operations

 

$

166,341

 

$

37,187

 

$

(34,870

)

$

168,658

 

$

168,658

 

Loss on early retirement of debt

 

 

 

 

 

 

 

(31,018

)

(20,385

)

Equity in losses of unconsolidated subsidiaries

 

 

 

 

 

 

 

(324

)

(324

)

Interest expense, net

 

 

 

 

 

 

 

(50,793

)

(38,189

)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Income before income taxes

 

 

 

 

 

 

 

$

86,523

 

$

109,760

 

 

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Table of Contents

 

 

 

Six Months Ended June 30, 2012

 

 

 

(in thousands)

 

 

 

Specialty
Hospitals

 

Outpatient
Rehabilitation

 

All Other

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Adjusted EBITDA

 

$

202,120

 

$

48,315

 

$

(31,092

)

 

 

 

 

Depreciation and amortization

 

(23,322

)

(6,882

)

(1,423

)

 

 

 

 

Stock compensation expense

 

 

 

(2,599

)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Select
Medical
Holdings
Corporation

 

Select
Medical
Corporation

 

Income (loss) from operations

 

$

178,798

 

$

41,433

 

$

(35,114

)

$

185,117

 

$

185,117

 

Equity in earnings of unconsolidated subsidiaries

 

 

 

 

 

 

 

5,217

 

5,217

 

Interest expense, net

 

 

 

 

 

 

 

(47,720

)

(42,207

)

 

 

 

 

 

 

 

 

 

 

 

 

Income before income taxes

 

 

 

 

 

 

 

$

142,614

 

$

148,127

 

 

7.  Income per Common Share

 

The Company applies the two-class method for calculating and presenting income per common share. The two-class method is an earnings allocation formula that determines earnings per share for each class of stock participation rights in undistributed earnings. Effective January 1, 2009 the Financial Accounting Standards Board (“FASB”) clarified that share based payment awards that have not yet vested meet the definition of a participating security provided the right to receive the dividend is non-forfeitable and non-contingent. Participating securities are defined as securities that participate in dividends with common stock according to a predetermined formula. These participating securities should be included in the computation of basic earnings per share under the two class method. Based upon the clarification made by FASB, the Company concluded that its non-vested restricted stock awards meet the definition of a participating security and should be included in the Company’s computation of basic earnings per share.

 

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The following table sets forth for the periods indicated the calculation of net income per share in the Company’s consolidated statement of operations and the differences between basic weighted average shares outstanding and diluted weighted average shares outstanding used to compute basic and diluted earnings per share, respectively:

 

 

 

For the Three Months

 

For the Six Months

 

 

 

Ended June 30,

 

Ended June, 30

 

 

 

2011

 

2012

 

2011

 

2012

 

 

 

(in thousands, except per share data)

 

Numerator:

 

 

 

 

 

 

 

 

 

Net income attributable to Select Medical Holdings Corporation

 

$

11,719

 

$

43,172

 

$

45,391

 

$

84,714

 

Less: Earnings allocated to unvested restricted stockholders

 

125

 

707

 

486

 

1,338

 

Net income available to common stockholders

 

$

11,594

 

$

42,465

 

$

44,905

 

$

83,376

 

 

 

 

 

 

 

 

 

 

 

Denominator:

 

 

 

 

 

 

 

 

 

Weighted average shares – basic

 

152,603

 

138,456

 

152,720

 

139,941

 

Effect of dilutive securities:

 

 

 

 

 

 

 

 

 

Stock options

 

278

 

229

 

231

 

221

 

Weighted average shares – diluted

 

152,881

 

138,685

 

152,951

 

140,162

 

 

 

 

 

 

 

 

 

 

 

Basic income per common share

 

$

0.08

 

$

0.31

 

$

0.29

 

$

0.60

 

Diluted income per common share

 

$

0.08

 

$

0.31

 

$

0.29

 

$

0.59

 

 

 

 

 

 

 

 

 

 

 

 

The following share amounts are shown here for informational and comparative purposes only since their inclusion would be anti-dilutive:

 

 

 

For the Three Months
Ended June 30,

 

For the Six Months
Ended June 30,

 

 

 

2011

 

2012

 

2011

 

2012

 

 

 

(in thousands)

 

Stock options

 

1,691

 

1,684

 

2,400

 

1,699

 

 

8. Commitments and Contingencies

 

Litigation

 

The Company is a party to various legal actions, proceedings and claims (some of which are not insured), and regulatory and other governmental audits and investigations in the ordinary course of its business. The Company cannot predict the ultimate outcome of pending litigation, proceedings and regulatory and other governmental audits and investigations. These matters could potentially subject the Company to sanctions, damages, recoupments, fines and other penalties. The Department of Justice, Centers for Medicare & Medicaid Services (“CMS”) or other federal and state enforcement and regulatory agencies may conduct additional investigations related to the Company’s businesses in the future that may, either individually or in the

 

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Table of Contents

 

aggregate, have a material adverse effect on the Company’s business, financial position, results of operations and liquidity.

 

To address claims arising out of the operations of the Company’s specialty hospitals and outpatient rehabilitation facilities, the Company maintains professional malpractice liability insurance and general liability insurance, subject to self-insured retention of $2.0 million per medical incident for professional liability claims and $2.0 million per occurrence for general liability claims. The Company also maintains umbrella liability insurance covering claims which, due to their nature or amount, are not covered by or not fully covered by the Company’s other insurance policies. These insurance policies also do not generally cover punitive damages and are subject to various deductibles and policy limits. Significant legal actions, as well as the cost and possible lack of available insurance, could subject the Company to substantial uninsured liabilities. In the Company’s opinion, the outcome of these actions, individually or in the aggregate, will not have a material adverse effect on its financial position, results of operations, or cash flows.

 

Healthcare providers are subject to lawsuits under the qui tam provisions of the federal False Claims Act. Qui tam lawsuits typically remain under seal (hence, usually unknown to the defendant) for some time while the government decides whether or not to intervene on behalf of a private qui tam plaintiff (known as a relator) and take the lead in the litigation. These lawsuits can involve significant monetary damages and penalties and award bounties to private plaintiffs who successfully bring the suits. The Company has been a defendant in these cases in the past, and may be named as a defendant in similar cases from time to time in the future.

 

During April 2012, the Company’s long term acute care hospital in Evansville, Indiana (“SSH - Evansville”) received two subpoenas from the Office of Attorney General for the State of Indiana. One subpoena demanded certain patient medical records of SSH - Evansville. The second subpoena demanded reports and documents related to SSH - Evansville for various periods beginning in 2006, including certain financial, statistical, billing and quality reports; certain policies and procedures, joint venture board meeting minutes, and documents related to certain complaints and internal investigations. SSH — Evansville subsequently received a Request for Information or Assistance from the Office of Inspector General of the U.S. Department of Health and Human Services (Indianapolis, Indiana Field Office) covering the period beginning in 2007 seeking substantially the same records demanded by the Indiana Attorney General’s Office, additional patient medical records of SSH - Evansville and additional documents and information of SSH - Evansville, including documents concerning SSH - Evansville’s relationships with its joint venture partner and seven other identified persons and entities. During May 2012, the Evansville (Indiana) Police Department executed a search warrant at SSH - Evansville purporting to seek evidence pertaining to the crime of theft. At the Company’s request, the Vanderburgh (Indiana) Superior Court ordered the release of the probable cause affidavit supporting that search warrant. According to the affidavit, confidential informants, some of whom are purportedly current or former employees of SSH-Evansville, alleged, among other things, that a physician on the medical staff at SSH-Evansville improperly manipulated patient diagnoses to raise the diagnosis related group (DRG) and lengths-of-stay to enhance reimbursement and, on one occasion, discontinued treatments to a patient based on financial motivation and without regard to the patient’s end of life instructions resulting in the patient’s death, and that a second physician on the medical staff at SSH-Evansville performed bronchoscopes that were medically unnecessary and resulted in at least two patient deaths. The affidavit also makes allegations that imply that the Company may not have provided complete or accurate documents called for in the Indiana Attorney General’s Office subpoenas which were received during April 2012. In August 2012, the Company received a subpoena from the Office of Inspector General of the U.S. Department of Health and Human Services (Chicago Regional Office) demanding additional documents covering the period beginning in March 2007 relating to the Company and SSH - Evansville, including contracts with SSH - Evansville’s joint venture partner, contracts and other documents relating to financial relationships with physicians practicing at SSH - Evansville, records of payments to and hours worked by physicians practicing at SSH - Evansville, documents relating to actual or expected physician referrals and admissions to SSH - Evansville, documents relating to billing for services furnished by the Company’s long term acute care hospitals (“LTCHs”), such as government program guidance and staff training materials, information relating to case manager duties and responsibilities at the Company’s LTCHs, reports on patient admissions, discharges, DRG, length-of-stay and transfers at SSH - Evansville, and documents relating to criteria used by the Company or SSH - Evansville for patient admissions, discharges and eligibility for service.  The Company has produced and will continue to produce documents in response to, and intends to fully cooperate with, these governmental investigations. At this time, the Company is unable to predict the timing and outcome of this matter.

 

17



Table of Contents

 

Construction Commitments

 

At June 30, 2012, the Company had outstanding commitments under construction contracts related to new construction, improvements and renovations at the Company’s long term acute care properties and inpatient rehabilitation facilities totaling approximately $9.3 million.

 

9.              Financial Information for Subsidiary Guarantors and Non-Guarantor Subsidiaries under Select’s 7 5/8% Senior Subordinated Notes

 

Select’s 7 5/8% senior subordinated notes are fully and unconditionally guaranteed, except for customary limitations, on a senior subordinated basis by all of Select’s wholly-owned subsidiaries (the “Subsidiary Guarantors”). Certain of Select’s subsidiaries did not guarantee the 7 5/8% senior subordinated notes (the “Non-Guarantor Subsidiaries”).

 

Select conducts a significant portion of its business through its subsidiaries. Presented below is condensed consolidating financial information for Select, the Subsidiary Guarantors and the Non-Guarantor Subsidiaries at December 31, 2011 and June 30, 2012 and for the three and six months ended June 30, 2011 and 2012.

 

The equity method has been used by Select with respect to investments in subsidiaries. The equity method has been used by Subsidiary Guarantors with respect to investments in Non-Guarantor Subsidiaries. Separate financial statements for Subsidiary Guarantors are not presented.

 

18



Table of Contents

 

 

 

Select Medical Corporation

 

 

 

Condensed Consolidating Balance Sheet

 

 

 

June 30, 2012

 

 

 

(unaudited)

 

 

 

Select Medical
Corporation (Parent
Company Only)

 

Subsidiary
Guarantors

 

Non-Guarantor
Subsidiaries

 

Eliminations

 

Consolidated

 

 

 

(in thousands)

 

Assets

 

 

 

 

 

 

 

 

 

 

 

Current Assets:

 

 

 

 

 

 

 

 

 

 

 

Cash and cash equivalents

 

$

18,100

 

$

2,798

 

$

622

 

$

 

$

21,520

 

Accounts receivable, net

 

 

367,585

 

56,274

 

 

423,859

 

Current deferred tax asset

 

8,774

 

3,262

 

3,497

 

 

15,533

 

Prepaid income taxes

 

4,061

 

 

 

 

4,061

 

Other current assets

 

7,654

 

20,339

 

3,390

 

 

31,383

 

Total Current Assets

 

38,589

 

393,984

 

63,783

 

 

496,356

 

 

 

 

 

 

 

 

 

 

 

 

 

Property and equipment, net

 

14,754

 

422,031

 

55,996

 

 

492,781

 

Investment in affiliates

 

2,861,419

 

78,736

 

 

(2,940,155

)(a)(b)

 

Goodwill

 

 

1,631,461

 

 

 

1,631,461

 

Other identifiable intangibles

 

 

71,783

 

 

 

71,783

 

Assets held for sale

 

2,742

 

 

 

 

2,742

 

Other assets

 

24,335

 

58,224

 

732

 

 

83,291

 

 

 

 

 

 

 

 

 

 

 

 

 

Total Assets

 

$

2,941,839

 

$

2,656,219

 

$

120,511

 

$

(2,940,155

)

$

2,778,414

 

 

 

 

 

 

 

 

 

 

 

 

 

Liabilities and Equity

 

 

 

 

 

 

 

 

 

 

 

Current Liabilities:

 

 

 

 

 

 

 

 

 

 

 

Bank overdrafts

 

$

20,348

 

$

 

$

 

$

 

$

20,348

 

Current portion of long-term debt and notes payable

 

10,236

 

370

 

1,179

 

 

11,785

 

Accounts payable

 

6,679

 

72,709

 

10,744

 

 

90,132

 

Intercompany accounts

 

1,036,057

 

(944,178

)

(91,879

)

 

 

Accrued payroll

 

13

 

73,528

 

171

 

 

73,712

 

Accrued vacation

 

4,319

 

44,964

 

6,925

 

 

56,208

 

Accrued interest

 

22,920

 

826

 

 

 

23,746

 

Accrued restructuring

 

 

3,038

 

 

 

3,038

 

Accrued other

 

45,069

 

52,856

 

6,898

 

 

104,823

 

Due to third party payors

 

 

4,106

 

3,158

 

 

7,264

 

Total Current Liabilities

 

1,145,641

 

(691,781

)

(62,804

)

 

391,056

 

 

 

 

 

 

 

 

 

 

 

 

 

Long-term debt, net of current portion

 

723,251

 

392,423

 

59,160

 

 

1,174,834

 

Non-current deferred tax liability

 

(3,960

)

78,164

 

8,707

 

 

82,911

 

Other non-current liabilities

 

49,360

 

18,909

 

380

 

 

68,649

 

 

 

 

 

 

 

 

 

 

 

 

 

Total Liabilities

 

1,914,292

 

(202,285

)

5,443

 

 

1,717,450

 

 

 

 

 

 

 

 

 

 

 

 

 

Stockholder’s Equity:

 

 

 

 

 

 

 

 

 

 

 

Common stock

 

0

 

 

 

 

0

 

Capital in excess of par

 

853,506

 

 

 

 

853,506

 

Retained earnings

 

174,041

 

724,340

 

22,366

 

(746,706

)(b)

174,041

 

Subsidiary investment

 

 

2,134,164

 

59,285

 

(2,193,449

)(a)

 

Total Select Medical Corporation Stockholder’s Equity

 

1,027,547

 

2,858,504

 

81,651

 

(2,940,155

)

1,027,547

 

 

 

 

 

 

 

 

 

 

 

 

 

Non-controlling interest

 

 

 

33,417

 

 

33,417

 

Total Equity

 

1,027,547

 

2,858,504

 

115,068

 

(2,940,155

)

1,060,964

 

 

 

 

 

 

 

 

 

 

 

 

 

Total Liabilities and Equity

 

$

2,941,839

 

$

2,656,219

 

$

120,511

 

$

(2,940,155

)

$

2,778,414

 

 


(a)  Elimination of investments in consolidated subsidiaries.

(b)  Elimination of investments in consolidated subsidiaries’ earnings.

 

19



Table of Contents

 

 

 

Select Medical Corporation

 

 

 

Condensed Consolidating Statement of Operations

 

 

 

For the Three Months Ended June 30, 2012

 

 

 

(unaudited)

 

 

 

Select Medical
Corporation (Parent
Company Only)

 

Subsidiary
Guarantors

 

Non-
Guarantor
Subsidiaries

 

Eliminations

 

Consolidated

 

 

 

(in thousands)

 

Net operating revenues

 

$

13

 

$

649,628

 

$

100,552

 

$

 

$

750,193

 

 

 

 

 

 

 

 

 

 

 

 

 

Costs and expenses:

 

 

 

 

 

 

 

 

 

 

 

Cost of services

 

521

 

527,479

 

84,669

 

 

612,669

 

General and administrative

 

19,345

 

(791

)

 

 

18,554

 

Bad debt expense

 

 

8,832

 

1,197

 

 

10,029

 

Depreciation and amortization

 

718

 

12,410

 

2,300

 

 

15,428

 

Total costs and expenses

 

20,584

 

547,930

 

88,166

 

 

656,680

 

 

 

 

 

 

 

 

 

 

 

 

 

Income (loss) from operations

 

(20,571

)

101,698

 

12,386

 

 

93,513

 

 

 

 

 

 

 

 

 

 

 

 

 

Other income and expense:

 

 

 

 

 

 

 

 

 

 

 

Intercompany interest and royalty fees

 

(763

)

754

 

9

 

 

 

Intercompany management fees

 

27,755

 

(23,159

)

(4,596

)

 

 

Equity in earnings of unconsolidated subsidiaries

 

 

2,739

 

13

 

 

2,752

 

Interest expense

 

(13,173

)

(6,712

)

(1,072

)

 

(20,957

)

 

 

 

 

 

 

 

 

 

 

 

 

Income (loss) from operations before income taxes

 

(6,752

)

75,320

 

6,740

 

 

75,308

 

 

 

 

 

 

 

 

 

 

 

 

 

Income tax expense

 

2,211

 

26,377

 

58

 

 

28,646

 

Equity in earnings of subsidiaries

 

53,981

 

5,612

 

 

(59,593

)(a)

 

 

 

 

 

 

 

 

 

 

 

 

 

Net income

 

45,018

 

54,555

 

6,682

 

(59,593

)

46,662

 

 

 

 

 

 

 

 

 

 

 

 

 

Less: Net income attributable to non-controlling interests

 

 

 

1,644

 

 

1,644

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Net income attributable to Select Medical Corporation

 

$

45,018

 

$

54,555

 

$

5,038

 

$

(59,593

)

$

45,018

 

 


(a) Elimination of equity in earnings of subsidiaries.

 

20



Table of Contents

 

 

 

Select Medical Corporation

 

 

 

Condensed Consolidating Statement of Operations

 

 

 

For the Six Months Ended June 30, 2012

 

 

 

(unaudited)

 

 

 

Select Medical
Corporation (Parent
Company Only)

 

Subsidiary
Guarantors

 

Non-
Guarantor
Subsidiaries

 

Eliminations

 

Consolidated

 

 

 

(in thousands)

 

Net operating revenues

 

$

97

 

$

1,293,953

 

$

200,164

 

$

 

$

1,494,214

 

 

 

 

 

 

 

 

 

 

 

 

 

Costs and expenses:

 

 

 

 

 

 

 

 

 

 

 

Cost of services

 

1,010

 

1,052,944

 

170,334

 

 

1,224,288

 

General and administrative

 

33,455

 

(677

)

 

 

32,778

 

Bad debt expense

 

 

17,674

 

2,730

 

 

20,404

 

Depreciation and amortization

 

1,423

 

25,580

 

4,624

 

 

31,627

 

Total costs and expenses

 

35,888

 

1,095,521

 

177,688

 

 

1,309,097

 

 

 

 

 

 

 

 

 

 

 

 

 

Income (loss) from operations

 

(35,791

)

198,432

 

22,476

 

 

185,117

 

 

 

 

 

 

 

 

 

 

 

 

 

Other income and expense:

 

 

 

 

 

 

 

 

 

 

 

Intercompany interest and royalty fees

 

(1,556

)

1,539

 

17

 

 

 

Intercompany management fees

 

57,129

 

(48,242

)

(8,887

)

 

 

Equity in earnings of unconsolidated subsidiaries

 

 

5,194

 

23

 

 

5,217

 

Interest expense

 

(26,147

)

(13,910

)

(2,150

)

 

(42,207

)

 

 

 

 

 

 

 

 

 

 

 

 

Income (loss) from operations before income taxes

 

(6,365

)

143,013

 

11,479

 

 

148,127

 

 

 

 

 

 

 

 

 

 

 

 

 

Income tax expense

 

1,976

 

54,904

 

276

 

 

57,156

 

Equity in earnings of subsidiaries

 

96,638

 

9,111

 

 

(105,749

)(a)

 

 

 

 

 

 

 

 

 

 

 

 

 

Net income

 

88,297

 

97,220

 

11,203

 

(105,749

)

90,971

 

 

 

 

 

 

 

 

 

 

 

 

 

Less: Net income attributable to non-controlling interests

 

 

 

2,674

 

 

2,674

 

 

 

 

 

 

 

 

 

 

 

 

 

Net income attributable to Select Medical Corporation

 

$

88,297

 

$

97,220

 

$

8,529

 

$

(105,749

)

$

88,297

 

 


(a) Elimination of equity in earnings of subsidiaries.

 

21



Table of Contents

 

 

 

Select Medical Corporation

 

 

 

Condensed Consolidating Statement of Cash Flows

 

 

 

For the Six Months Ended June 30, 2012

 

 

 

(unaudited)

 

 

 

Select Medical
Corporation
(Parent Company
Only)

 

Subsidiary
Guarantors

 

Non-
Guarantor
Subsidiaries

 

Eliminations

 

Consolidated

 

 

 

(in thousands)

 

Operating activities

 

 

 

 

 

 

 

 

 

 

 

Net income

 

$

88,297

 

$

97,220

 

$

11,203

 

$

(105,749

)(a)

$

90,971

 

Adjustments to reconcile net income to net cash provided by operating activities:

 

 

 

 

 

 

 

 

 

 

 

Depreciation and amortization

 

1,423

 

25,580

 

4,624

 

 

31,627

 

Provision for bad debts

 

 

17,674

 

2,730

 

 

20,404

 

Loss (gain) from disposal of assets

 

 

(3,606

)

2

 

 

(3,604

)

Non-cash stock compensation expense

 

2,599

 

 

 

 

2,599

 

Amortization of debt discount

 

622

 

 

 

 

622

 

Changes in operating assets and liabilities, net of effects from acquisition of businesses:

 

 

 

 

 

 

 

 

 

 

 

Equity in earnings of subsidiaries

 

(96,638

)

(9,111

)

 

105,749

(a)

 

Intercompany

 

46,380

 

(40,086

)

(6,294

)

 

 

Accounts receivable

 

 

(15,938

)

(14,582

)

 

(30,520

)

Other current assets

 

(1,314

)

(983

)

685

 

 

(1,612

)

Other assets

 

4,051

 

(5,011

)

121

 

 

(839

)

Accounts payable

 

(674

)

(3,498

)

(1,314

)

 

(5,486

)

Due to third-party payors

 

 

(9,527

)

11,265

 

 

1,738

 

Accrued expenses

 

8,717

 

(2,587

)

210

 

 

6,340

 

Income and deferred taxes

 

11,809

 

 

 

 

11,809

 

Net cash provided by operating activities

 

65,272

 

50,127

 

8,650

 

 

124,049

 

 

 

 

 

 

 

 

 

 

 

 

 

Investing activities

 

 

 

 

 

 

 

 

 

 

 

Purchases of property and equipment

 

(1,536

)

(20,684

)

(5,714

)

 

(27,934

)

Proceeds from sale of assets

 

 

16,511

 

 

 

16,511

 

Investment in businesses

 

 

(10,014

)

 

 

(10,014

)

Acquisition of businesses, net of cash acquired

 

 

(206

)

 

 

(206

)

Net cash used in investing activities

 

(1,536

)

(14,393

)

(5,714

)

 

(21,643

)

 

 

 

 

 

 

 

 

 

 

 

 

Financing activities

 

 

 

 

 

 

 

 

 

 

 

Borrowings on revolving credit facility

 

340,000

 

 

 

 

340,000

 

Payments on revolving credit facility

 

(380,000

)

 

 

 

(380,000

)

Payments on 2011 credit facility term loan

 

(4,250

)

 

 

 

(4,250

)

Borrowings of other debt

 

5,557

 

 

278

 

 

5,835

 

Principal payments on other debt

 

(4,179

)

(220

)

(686

)

 

(5,085

)

Dividends paid to Holdings

 

(52,034

)

 

 

 

(52,034

)

Equity investment by Holdings

 

547

 

 

 

 

547

 

Proceeds from bank overdrafts

 

3,739

 

 

 

 

3,739

 

Intercompany debt reallocation

 

33,557

 

(32,716

)

(841

)

 

 

Distributions to non-controlling interests

 

 

 

(1,681

)

 

(1,681

)

Net cash used in financing activities

 

(57,063

)

(32,936

)

(2,930

)

 

(92,929

)

 

 

 

 

 

 

 

 

 

 

 

 

Net increase in cash and cash equivalents

 

6,673

 

2,798

 

6

 

 

9,477

 

 

 

 

 

 

 

 

 

 

 

 

 

Cash and cash equivalents at beginning of period

 

11,427

 

 

616

 

 

12,043

 

Cash and cash equivalents at end of period

 

$

18,100

 

$

2,798

 

$

622

 

$

 

$

21,520

 

 


(a)  Elimination of equity in earnings of consolidated subsidiaries.

 

22



Table of Contents

 

 

 

Select Medical Corporation

 

 

 

Condensed Consolidating Balance Sheet

 

 

 

December 31, 2011

 

 

 

(unaudited)

 

 

 

Select Medical
Corporation (Parent
Company Only)

 

Subsidiary
Guarantors

 

Non-Guarantor
Subsidiaries

 

Eliminations

 

Consolidated

 

 

 

(in thousands)

 

Assets

 

 

 

 

 

 

 

 

 

 

 

Current Assets:

 

 

 

 

 

 

 

 

 

 

 

Cash and cash equivalents

 

$

11,427

 

$

 

$

616

 

$

 

$

12,043

 

Accounts receivable, net

 

 

369,321

 

44,422

 

 

413,743

 

Current deferred tax asset

 

11,415

 

3,221

 

3,669

 

 

18,305

 

Prepaid income taxes

 

9,497

 

 

 

 

9,497

 

Other current assets

 

6,340

 

19,407

 

4,075

 

 

29,822

 

Total Current Assets

 

38,679

 

391,949

 

52,782

 

 

483,410

 

 

 

 

 

 

 

 

 

 

 

 

 

Property and equipment, net

 

14,641

 

440,736

 

54,651

 

 

510,028

 

Investment in affiliates

 

2,751,776

 

83,772

 

 

(2,835,548

)(a)(b)

 

Goodwill

 

 

1,631,716

 

 

 

1,631,716

 

Other identifiable intangibles

 

 

72,123

 

 

 

72,123

 

Assets held for sale

 

2,742

 

 

 

 

2,742

 

Other assets

 

28,386

 

41,480

 

853

 

 

70,719

 

 

 

 

 

 

 

 

 

 

 

 

 

Total Assets

 

$

2,836,224

 

$

2,661,776

 

$

108,286

 

$

(2,835,548

)

$

2,770,738

 

 

 

 

 

 

 

 

 

 

 

 

 

Liabilities and Equity

 

 

 

 

 

 

 

 

 

 

 

Current Liabilities:

 

 

 

 

 

 

 

 

 

 

 

Bank overdrafts

 

$

16,609

 

$

 

$

 

$

 

$

16,609

 

Current portion of long-term debt and notes payable

 

8,853

 

390

 

1,605

 

 

10,848

 

Accounts payable

 

7,353

 

76,207

 

12,058

 

 

95,618

 

Intercompany accounts

 

975,809

 

(880,537

)

(95,272

)

 

 

Accrued payroll

 

229

 

82,518

 

141

 

 

82,888

 

Accrued vacation

 

3,703

 

41,305

 

6,242

 

 

51,250

 

Accrued interest

 

11,843

 

137

 

 

 

11,980

 

Accrued restructuring

 

 

5,027

 

 

 

5,027

 

Accrued other

 

47,829

 

51,086

 

7,401

 

 

106,316

 

Due to third party payors

 

 

13,633

 

(8,107

)

 

5,526

 

Total Current Liabilities

 

1,072,228

 

(610,234

)

(75,932

)

 

386,062

 

 

 

 

 

 

 

 

 

 

 

 

 

Long-term debt, net of current portion

 

733,328

 

425,315

 

60,007

 

 

1,218,650

 

Non-current deferred tax liability

 

(2,509

)

75,750

 

8,787

 

 

82,028

 

Other non-current liabilities

 

46,555

 

17,970

 

380

 

 

64,905

 

 

 

 

 

 

 

 

 

 

 

 

 

Total Liabilities

 

1,849,602

 

(91,199

)

(6,758

)

 

1,751,645

 

 

 

 

 

 

 

 

 

 

 

 

 

Stockholder’s Equity:

 

 

 

 

 

 

 

 

 

 

 

Common stock

 

0

 

 

 

 

0

 

Capital in excess of par

 

848,844

 

 

 

 

848,844

 

Retained earnings

 

137,778

 

627,120

 

23,154

 

(650,274

)(b)

137,778

 

Subsidiary investment

 

 

2,125,855

 

59,419

 

(2,185,274

)(a)

 

Total Select Medical Corporation Stockholder’s Equity

 

986,622

 

2,752,975

 

82,573

 

(2,835,548

)

986,622

 

 

 

 

 

 

 

 

 

 

 

 

 

Non-controlling interest

 

 

 

32,471

 

 

32,471

 

Total Equity

 

986,622

 

2,752,975

 

115,044

 

(2,835,548

)

1,019,093

 

 

 

 

 

 

 

 

 

 

 

 

 

Total Liabilities and Equity

 

$

2,836,224

 

$

2,661,776

 

$

108,286

 

$

(2,835,548

)

$

2,770,738

 

 


(a)  Elimination of investments in consolidated subsidiaries.

(b)  Elimination of investments in consolidated subsidiaries’ earnings.

 

23



Table of Contents

 

 

 

Select Medical Corporation

 

 

 

Condensed Consolidating Statement of Operations

 

 

 

For the Three Months Ended June 30, 2011

 

 

 

(unaudited)

 

 

 

Select Medical
Corporation (Parent
Company Only)

 

Subsidiary
Guarantors

 

Non-
Guarantor
Subsidiaries

 

Eliminations

 

Consolidated

 

 

 

(in thousands)

 

Net operating revenues

 

$

15

 

$

605,562

 

$

93,172

 

$

 

$

698,749

 

 

 

 

 

 

 

 

 

 

 

 

 

Costs and expenses:

 

 

 

 

 

 

 

 

 

 

 

Cost of services

 

194

 

493,059

 

76,413

 

 

569,666

 

General and administrative

 

16,039

 

76

 

 

 

16,115

 

Bad debt expense

 

 

11,908

 

2,035

 

 

13,943

 

Depreciation and amortization

 

654

 

15,099

 

2,246

 

 

17,999

 

Total costs and expenses

 

16,887

 

520,142

 

80,694

 

 

617,723

 

 

 

 

 

 

 

 

 

 

 

 

 

Income (loss) from operations

 

(16,872

)

85,420

 

12,478

 

 

81,026

 

 

 

 

 

 

 

 

 

 

 

 

 

Other income and expense:

 

 

 

 

 

 

 

 

 

 

 

Intercompany interest and royalty fees

 

(1,000

)

994

 

6

 

 

 

Intercompany management fees

 

44,391

 

(39,901

)

(4,490

)

 

 

Loss on early retirement of debt

 

(20,385

)

 

 

 

(20,385

)

Equity in earnings (losses) of unconsolidated subsidiaries

 

 

(260

)

9

 

 

(251

)

Interest income

 

34

 

77

 

 

 

111

 

Interest expense

 

(9,011

)

(9,370

)

(1,313

)

 

(19,694

)

 

 

 

 

 

 

 

 

 

 

 

 

Income (loss) from operations before income taxes

 

(2,843

)

36,960

 

6,690

 

 

40,807

 

 

 

 

 

 

 

 

 

 

 

 

 

Income tax expense

 

362

 

16,224

 

11

 

 

16,597

 

Equity in earnings of subsidiaries

 

25,477

 

4,784

 

 

(30,261

)(a)

 

 

 

 

 

 

 

 

 

 

 

 

 

Net income

 

22,272

 

25,520

 

6,679

 

(30,261

)

24,210

 

 

 

 

 

 

 

 

 

 

 

 

 

Less: Net income attributable to non-controlling interests

 

 

 

1,938

 

 

1,938

 

 

 

 

 

 

 

 

 

 

 

 

 

Net income attributable to Select Medical Corporation

 

$

22,272

 

$

25,520

 

$

4,741

 

$

(30,261

)

$

22,272

 

 


(a) Elimination of equity in earnings of subsidiaries.

 

24



Table of Contents

 

 

 

Select Medical Corporation

 

 

 

Condensed Consolidating Statement of Operations

 

 

 

For the Six Months Ended June 30, 2011

 

 

 

(unaudited)

 

 

 

Select Medical
Corporation (Parent
Company Only)

 

Subsidiary
Guarantors

 

Non-
Guarantor
Subsidiaries

 

Eliminations

 

Consolidated

 

 

 

(in thousands)

 

Net operating revenues

 

$

86

 

$

1,205,815

 

$

186,034

 

$

 

$

1,391,935

 

 

 

 

 

 

 

 

 

 

 

 

 

Costs and expenses:

 

 

 

 

 

 

 

 

 

 

 

Cost of services

 

832

 

974,281

 

151,969

 

 

1,127,082

 

General and administrative

 

32,494

 

187

 

 

 

32,681

 

Bad debt expense

 

 

24,909

 

3,384

 

 

28,293

 

Depreciation and amortization

 

1,300

 

29,455

 

4,466

 

 

35,221

 

Total costs and expenses

 

34,626

 

1,028,832

 

159,819

 

 

1,223,277

 

 

 

 

 

 

 

 

 

 

 

 

 

Income (loss) from operations

 

(34,540

)

176,983

 

26,215

 

 

168,658

 

 

 

 

 

 

 

 

 

 

 

 

 

Other income and expense:

 

 

 

 

 

 

 

 

 

 

 

Intercompany interest and royalty fees

 

(1,995

)

1,980

 

15

 

 

 

Intercompany management fees

 

67,863

 

(59,131

)

(8,732

)

 

 

Loss on early retirement of debt

 

(20,385

)

 

 

 

(20,385

)

Equity in earnings (losses) of unconsolidated subsidiaries

 

 

(348

)

24

 

 

(324

)

Interest income

 

65

 

101

 

1

 

 

167

 

Interest expense

 

(16,376

)

(19,319

)

(2,661

)

 

(38,356

)

 

 

 

 

 

 

 

 

 

 

 

 

Income (loss) from operations before income taxes

 

(5,368

)

100,266

 

14,862

 

 

109,760

 

 

 

 

 

 

 

 

 

 

 

 

 

Income tax expense

 

1,288

 

44,044

 

279

 

 

45,611

 

Equity in earnings of subsidiaries

 

67,152

 

10,581

 

 

(77,733

)(a)

 

 

 

 

 

 

 

 

 

 

 

 

 

Net income

 

60,496

 

66,803

 

14,583

 

(77,733

)

64,149

 

 

 

 

 

 

 

 

 

 

 

 

 

Less: Net income attributable to non-controlling interests

 

 

 

3,653

 

 

3,653

 

 

 

 

 

 

 

 

 

 

 

 

 

Net income attributable to Select Medical Corporation

 

$

60,496

 

$

66,803

 

$

10,930

 

$

(77,733

)

$

60,496

 

 


(a) Elimination of equity in earnings of subsidiaries.

 

25



Table of Contents

 

 

 

Select Medical Corporation

 

 

 

Condensed Consolidating Statement of Cash Flows

 

 

 

For the Six Months Ended June 30, 2011

 

 

 

(unaudited)

 

 

 

Select Medical
Corporation
(Parent Company
Only)

 

Subsidiary
Guarantors

 

Non-
Guarantor
Subsidiaries

 

Eliminations

 

Consolidated

 

 

 

(in thousands)

 

Operating activities

 

 

 

 

 

 

 

 

 

 

 

Net income

 

$

60,496

 

$

66,803

 

$

14,583

 

$

(77,733

)(a)

$

64,149

 

Adjustments to reconcile net income to net cash provided by operating activities:

 

 

 

 

 

 

 

 

 

 

 

Depreciation and amortization

 

1,300

 

29,455

 

4,466

 

 

35,221

 

Provision for bad debts

 

 

24,909

 

3,384

 

 

28,293

 

Loss on early retirement of debt

 

20,385

 

 

 

 

20,385

 

Loss (gain) from disposal of assets

 

10

 

(5,225

)

14

 

 

(5,201

)

Non-cash stock compensation expense

 

1,780

 

 

 

 

1,780

 

Amortization of debt discount

 

103

 

 

 

 

103

 

Changes in operating assets and liabilities, net of effects from acquisition of businesses:

 

 

 

 

 

 

 

 

 

 

 

Equity in earnings of subsidiaries

 

(67,152

)

(10,581

)

 

77,733

(a)

 

Intercompany

 

53,735

 

(46,683

)

(7,052

)

 

 

Accounts receivable

 

 

(73,715

)

(7,525

)

 

(81,240

)

Other current assets

 

(2,096

)

245

 

340

 

 

(1,511

)

Other assets

 

(4,203

)

6,564

 

108

 

 

2,469

 

Accounts payable

 

2,758

 

4,531

 

818

 

 

8,107

 

Due to third-party payors

 

 

6,599

 

(7,063

)

 

(464

)

Accrued expenses

 

9,410

 

4,606

 

(1,008

)

 

13,008

 

Income and deferred taxes

 

16,151

 

 

 

 

16,151

 

Net cash provided by operating activities

 

92,677

 

7,508

 

1,065

 

 

101,250

 

 

 

 

 

 

 

 

 

 

 

 

 

Investing activities

 

 

 

 

 

 

 

 

 

 

 

Purchases of property and equipment

 

(1,178

)

(18,898

)

(3,620

)

 

(23,696

)

Investment in business

 

 

(13,514

)

 

 

(13,514

)

Acquisition of businesses, net of cash acquired

 

 

1,921

 

 

 

1,921

 

Proceeds from sale of assets

 

 

7,879

 

 

 

7,879

 

Net cash used in investing activities

 

(1,178

)

(22,612

)

(3,620

)

 

(27,410

)

 

 

 

 

 

 

 

 

 

 

 

 

Financing activities

 

 

 

 

 

 

 

 

 

 

 

Borrowings on revolving credit facilities

 

435,000

 

 

 

 

435,000

 

Payments on revolving credit facilities

 

(395,000

)

 

 

 

(395,000

)

Borrowings on 2011 credit facility term loan, net of discount

 

841,500

 

 

 

 

841,500

 

Payments on 2005 credit facility term loans, net of call premium

 

(484,633

)

 

 

 

(484,633

)

Repurchase of 7 5/8% senior subordinated notes, net of tender premium

 

(273,941

)

 

 

 

(273,941

)

Borrowings of other debt

 

5,496

 

 

 

 

5,496

 

Principal payments on other debt

 

(2,581

)

(899

)

 

 

(3,480

)

Debt issuance costs

 

(18,556

)

 

 

 

(18,556

)

Proceeds from bank overdrafts

 

2,102

 

 

 

 

2,102

 

Equity investment by Holdings

 

169

 

 

 

 

169

 

Dividends paid to Holdings

 

(171,008

)

 

 

 

(171,008

)

Intercompany debt reallocation

 

(20,061

)

15,372

 

4,689

 

 

 

Distributions to non-controlling interests

 

 

 

(2,270

)

 

(2,270

)

Net cash provided by (used in) financing activities

 

(81,513

)

14,473

 

2,419

 

 

(64,621

)

 

 

 

 

 

 

 

 

 

 

 

 

Net increase (decrease) in cash and cash equivalents

 

9,986

 

(631

)

(136

)

 

9,219

 

 

 

 

 

 

 

 

 

 

 

 

 

Cash and cash equivalents at beginning of period

 

149

 

3,567

 

649

 

 

4,365

 

Cash and cash equivalents at end of period

 

$

10,135

 

$

2,936

 

$

513

 

$

 

$

13,584

 

 


(a)  Elimination of equity in earnings of consolidated subsidiaries.

 

26



Table of Contents

 

ITEM 2.                             MANAGEMENT’S DISCUSSION AND ANALYSIS OF FINANCIAL CONDITION AND RESULTS OF OPERATIONS

 

You should read this discussion together with our unaudited consolidated financial statements and accompanying notes.

 

Forward-Looking Statements

 

This report on Form 10-Q contains forward-looking statements within the meaning of the federal securities laws.  Statements that are not historical facts, including statements about our beliefs and expectations, are forward-looking statements.  Forward-looking statements include statements preceded by, followed by or that include the words “may,” “could,” “would,” “should,” “believe,” “expect,” “anticipate,” “plan,” “target,” “estimate,” “project,” “intend” and similar expressions.  These statements include, among others, statements regarding our expected business outlook, anticipated financial and operating results, our business strategy and means to implement our strategy, our objectives, the amount and timing of capital expenditures, the likelihood of our success in expanding our business, financing plans, budgets, working capital needs and sources of liquidity.

 

Forward-looking statements are only predictions and are not guarantees of performance.  These statements are based on our management’s beliefs and assumptions, which in turn are based on currently available information. Important assumptions relating to the forward-looking statements include, among others, assumptions regarding our services, the expansion of our services, competitive conditions and general economic conditions. These assumptions could prove inaccurate. Forward-looking statements also involve known and unknown risks and uncertainties, which could cause actual results to differ materially from those contained in any forward-looking statement. Many of these factors are beyond our ability to control or predict. Such factors include, but are not limited to, the following:

 

·                  additional changes in government reimbursement for our services, including changes that will result from the expiration of the moratorium for long term acute care hospitals established by the Medicare, Medicaid, and SCHIP Extension Act of 2007, the American Recovery and Reinvestment Act, and the Patient Protection and Affordable Care Act may result in a reduction in net operating revenues, an increase in costs and a reduction in profitability;

 

·                  the failure of our specialty hospitals to maintain their Medicare certifications may cause our net operating revenues and profitability to decline;

 

·                  the failure of our facilities operated as “hospitals within hospitals” to qualify as hospitals separate from their host hospitals may cause our net operating revenues and profitability to decline;

 

·                  a government investigation or assertion that we have violated applicable regulations may result in sanctions or reputational harm and increased costs;

 

·                  acquisitions or joint ventures may prove difficult or unsuccessful, use significant resources or expose us to unforeseen liabilities;

 

·                  private third-party payors for our services may undertake future cost containment initiatives that limit our future net operating revenues and profitability;

 

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Table of Contents

 

·                  the failure to maintain established relationships with the physicians in the areas we serve could reduce our net operating revenues and profitability;

 

·                  shortages in qualified nurses or therapists could increase our operating costs significantly;

 

·                  competition may limit our ability to grow and result in a decrease in our net operating revenues and profitability;

 

·                  the loss of key members of our management team could significantly disrupt our operations;

 

·                  the effect of claims asserted against us could subject us to substantial uninsured liabilities; and

 

·                  other factors discussed from time to time in our filings with the Securities and Exchange Commission (the “SEC”), including factors discussed under the heading “Risk Factors” for the year ended December 31, 2011 contained in our annual report on Form 10-K filed with the SEC on March 2, 2012.

 

Except as required by applicable law, including the securities laws of the United States and the rules and regulations of the SEC, we are under no obligation to publicly update or revise any forward-looking statements, whether as a result of any new information, future events or otherwise.  You should not place undue reliance on our forward-looking statements.  Although we believe that the expectations reflected in forward-looking statements are reasonable, we cannot guarantee future results or performance.

 

Investors should also be aware that while we do, from time to time, communicate with securities analysts, it is against our policy to disclose to securities analysts any material non-public information or other confidential commercial information.  Accordingly, stockholders should not assume that we agree with any statement or report issued by any securities analyst irrespective of the content of the statement or report.  Thus, to the extent that reports issued by securities analysts contain any projections, forecasts or opinions, such reports are not the responsibility of the Company.

 

Overview

 

We believe that we are one of the largest operators of both specialty hospitals and outpatient rehabilitation clinics in the United States based on number of facilities.  As of June 30, 2012, we operated 111 long term acute care hospitals and 12 acute medical rehabilitation hospitals in 28 states, and 956 outpatient rehabilitation clinics in 32 states and the District of Columbia. We also provide medical rehabilitation services on a contracted basis to nursing homes, hospitals, assisted living and senior care centers, schools and work sites.  We began operations in 1997 under the leadership of our current management team.  As of June 30, 2012 we had operations in 44 states and the District of Columbia.

 

We manage our Company through two business segments, our specialty hospital segment and our outpatient rehabilitation segment.  We had net operating revenues of $1,494.2 million for the six months ended June 30, 2012.  Of this total, we earned approximately 74% of our net operating revenues from our specialty hospitals and approximately 26% from our outpatient rehabilitation business.  Our specialty hospital segment consists of hospitals designed to serve the needs of long term stay acute patients and hospitals designed to serve patients that require intensive medical rehabilitation care.  Patients are typically admitted to our specialty hospitals from general acute care hospitals.  These patients have specialized needs, and serious and often complex medical conditions such as respiratory failure, neuromuscular disorders, traumatic brain and spinal cord injuries, strokes,

 

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Table of Contents

 

non-healing wounds, cardiac disorders, renal disorders and cancer.  Our outpatient rehabilitation segment consists of clinics and contract services that provide physical, occupational and speech rehabilitation services.  Our outpatient rehabilitation patients are typically diagnosed with musculoskeletal impairments that restrict their ability to perform normal activities of daily living.

 

Significant 2012 Events

 

Stock Repurchase Program

 

On February 22, 2012, the Company’s board of directors authorized an increase of $100.0 million in the capacity of its common stock repurchase program from $150.0 million to $250.0 million.  The program will remain in effect until March 31, 2013, unless extended by the board of directors.  Stock repurchases under this program may be made in the open market or through privately negotiated transactions, and at times and in such amounts as the Company deems appropriate.  The timing of purchases of stock will be based upon market conditions and other factors.  The Company is funding this program with cash on hand or borrowings under its revolving credit facility.  The Company repurchased 2,522,090 shares at a cost of $21.1 million and 5,725,782 shares at a cost of $46.8 million, which includes transaction costs, during the three months ended June 30, 2012 and the six months ended June 30, 2012, respectively.  Since the inception of the program through June 30, 2012, the Company has repurchased 22,490,389 shares at a cost of $163.6 million, or $7.28 per share, which includes transaction costs.

 

Summary Financial Results

 

Second Quarter Ended June 30, 2012

 

For the three months ended June 30, 2012, our net operating revenues increased $51.4 million or 7.4% to $750.2 million compared to $698.7 million for the three months ended June 30, 2011.  Our specialty hospital revenues increased $36.9 million or 7.1% and our outpatient rehabilitation revenues increased $14.6 million or 8.2%.  We had income from operations for the three months ended June 30, 2012 of $93.5 million compared to $81.0 million for the three months ended June 30, 2011.  We had net income attributable to Holdings’ for the three months ended June 30, 2012 of $43.2 million compared to $11.7 million for the three months ended June 30, 2011.  Our Adjusted EBITDA for the three months ended June 30, 2012 was $110.3 million compared to $99.9 million for the three months ended June 30, 2011.  See the section entitled “Results of Operations” for a reconciliation of net income to Adjusted EBITDA.  The increase in our income from operations and Adjusted EBITDA is principally due to increases in operating performance in our specialty hospital segment. We were able to increase our specialty hospital income from operations $12.7 million or 16.2% and our specialty hospital Adjusted EBITDA $11.1 million or 12.2% for the three months ended June 30, 2012 from the same period prior year.  These increases principally occurred in our Regency hospitals that were acquired in 2010.

 

Net income attributable to Holdings’ increased $31.5 million to $43.2 million for the three months ended June 30, 2012 compared to $11.7 million for the three months ended June 30, 2011.  The increase resulted primarily from an increase in our income from operations described above, increases in our equity in earnings of unconsolidated subsidiaries principally related to our investment in our joint venture with the Baylor Health Care System that was formed on April 1, 2011 (“Baylor JV”) and a reduction in our interest expense.  We also incurred a loss on early retirement of debt related to the refinancing completed June 1, 2011 that reduced our net income in the three months ended June 30, 2011.

 

For the six months ended June 30, 2012, our net operating revenues increased 7.3% to $1,494.2 million compared to $1,391.9 million for the six months ended June 30, 2011.  Our specialty hospital revenues

 

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increased $70.0 million or 6.7% and our outpatient rehabilitation revenues increased $32.3 million or 9.2%.  We had income from operations for the six months ended June 30, 2012 of $185.1 million compared to $168.7 million for the six months ended June 30, 2011.  We had net income attributable to Holdings’ for the six months ended June 30, 2012 of $84.7 million compared to $45.4 million for the six months ended June 30, 2011.  Our Adjusted EBITDA for the six months ended June 30, 2012 was $219.3 million compared to $205.7 million for the six months ended June 30, 2011.  See the section entitled “Results of Operations” for a reconciliation of net income to Adjusted EBITDA.  The increases in our income from operations and Adjusted EBITDA is principally due to increases in our operating performance of our specialty hospital segment. We were able to increase our specialty hospital income from operations $12.5 million or 7.5% and our specialty hospital Adjusted EBITDA $10.7 million or 5.6% for the six months ended June 30, 2012 as compared to the six months ended June 30, 2011.  These increases principally occurred in our Regency hospitals that were acquired in 2010.

 

Net income attributable to Holdings’ increased $39.3 million to $84.7 million for the six months ended June 30, 2012 compared to $45.4 million for the six months ended June 30, 2011. The increase resulted primarily from an increase in our income from operations described above, increases in our equity in earnings of unconsolidated subsidiaries principally related to our Baylor JV, and a reduction of interest expense.  We also incurred a loss on early retirement of debt related to the refinancing completed June 1, 2011 that reduced our net income in the six months ended June 30, 2011.

 

Cash flow from operations provided $118.8 million of cash for the six months ended June 30, 2012 for Holdings and $124.0 million of cash for the six months ended June 30, 2012 for Select.  The difference in cash flow from operations between Holdings and Select primarily relates to interest payments on Holdings’ senior floating rate notes.

 

Regulatory Changes

 

In the past few years, there have been significant regulatory changes that have affected our net operating revenues and, in some cases, caused us to change our operating models and strategies.  The following is a discussion of recent regulatory changes that are affecting our results of operations in 2012 or may have an affect on our future results of operations.  Our Annual Report on Form 10-K for the year ended December 31, 2011 filed with the Securities and Exchange Commission (“SEC”) on March 2, 2012 contains a more detailed discussion of the regulations that affect our business in Part I — Business — Government Regulations, and the information below should be read in connection with that more detailed discussion.

 

Healthcare Reform Legislation

 

Federal agencies, including the Centers for Medicare & Medicaid Services (“CMS”), continue to implement provisions of the Patient Protection and Affordable Care Act (“PPACA”).  The PPACA expands access to health insurance through subsidies, coverage mandates and other insurance market reforms.  In addition, PPACA makes dramatic changes to the Medicare and Medicaid programs by adopting numerous initiatives addressing, among other things, reductions in healthcare spending, patient safety incentives and protections against fraud and abuse of federal healthcare programs.  The PPACA adopts significant changes to the Medicare program that are particularly relevant to long term acute care hospitals (“LTCHs”), inpatient rehabilitation facilities (“IRFs”) and outpatient rehabilitation services.  As part of healthcare reform legislation, President Obama also signed the “Health Care and Education Affordability Reconciliation Act of 2010,” which made some limited but important changes to the PPACA.

 

A number of states attorneys general and other parties filed legal challenges to the PPACA seeking to block its implementation on constitutional grounds.  On June 28, 2012 the U.S. Supreme Court upheld the PPACA finding that the individual health insurance mandate does not violate the Constitution because it may be viewed

 

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as a permissible tax on individuals who do not obtain health insurance.  The only provision of the law that the Court invalidated is a Medicaid provision that threatened states with the loss of existing Medicaid funding if they decline to comply with the PPACA’s Medicaid coverage extension.  Federal and state agencies are expected to continue to implement provisions of the PPACA following the Court’s decision.

 

We have included in our Annual Report on Form 10-K for the year ended December 31, 2011 a discussion of the PPACA provisions that affect our business, as well as regulatory initiatives adopted by CMS in response to particular provisions of the PPACA.

 

Budget Control Act of 2011

 

Beginning in January 2013, the Budget Control Act of 2011 will automatically reduce federal spending by approximately $1.2 trillion split evenly between domestic and defense spending.  Payments to Medicare providers are subject to these automatic spending reductions, subject to a 2% cap.  Unless further legislation is enacted, we believe this will generally result in a 2% reduction to Medicare payments, beginning in January 2013.

 

Medicare Payment of Long Term Acute Care Hospitals during Fiscal Year 2012

 

On August 18, 2011, CMS published the policies and payment rates for LTCH-PPS for fiscal year 2012 (affecting discharges and cost reporting periods beginning on or after October 1, 2011 through September 30, 2012).  The standard federal rate for fiscal year 2012 is $40,222, an increase from the fiscal year 2011 standard federal rate of $39,600.  The final rule establishes a fixed-loss amount for high cost outlier cases for fiscal year 2012 of $17,931, which is a decrease from the fixed-loss amount in the 2011 fiscal year of $18,785.

 

The labor-related share of the LTCH-PPS standard federal rate is adjusted annually to account for geographic differences in area wage levels by applying the applicable LTCH-PPS wage index.  CMS adopted a decrease in the labor-related share from 75.271% to 70.199% under the LTCH-PPS for fiscal year 2012.

 

In addition, CMS applied an area wage level budget neutrality factor to the standard federal rate to make annual changes to the area wage level adjustment budget neutral.  Previously, there was no statutory or regulatory requirement that these adjustments to the area wage level be made in a budget neutral manner.  The final rule creates a regulatory requirement that any adjustments or updates to the area wage level adjustment be made in a budget neutral manner such that estimated aggregate LTCH-PPS payments are not affected.

 

An LTCH must have an average inpatient length of stay for Medicare patients (including both Medicare covered and non-covered days) of greater than 25 days.  In the preamble to the final rule for fiscal year 2012, CMS clarified its policy on the calculation of the average length of stay by specifying that all data on all Medicare inpatient days, including Medicare Advantage days, must be included in the average length of stay calculation effective for cost reporting periods beginning on or after January 1, 2012.

 

Medicare Payment of Long Term Acute Care Hospitals during Fiscal Year 2013

 

On August 1, 2012, CMS published the final rule updating the policies and payment rates for LTCH-PPS for fiscal year 2013 (affecting discharges and cost reporting periods beginning on or after October 1, 2012 through September 30, 2013).  Two different standard federal rates apply during fiscal year 2013.  The standard federal rate for discharges on or after October 1, 2012 and before December 29, 2012 is set at $40,916, an increase from $40,222 applicable during fiscal year 2012. The standard federal rate for discharges on or after December 29, 2012 and the remainder of fiscal year 2013 is set at $40,398. The increase through December 28, 2012

 

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is based on a market basket increase of 2.6% less a productivity adjustment of 0.7% and less an additional reduction of 0.1% mandated by the PPACA. The market basket increase for the period of December 29, 2012 through the remainder of fiscal 2013 is further reduced by a portion of the one-time budget neutrality adjustment, as discussed below.  The fixed loss amount for high cost outlier cases is set at $15,408, a decrease from the fixed loss amount in the 2012 fiscal year of $17,931.

 

Very Short Stay Outlier Policy

 

CMS established a different payment methodology for Medicare patients with a length of stay less than or equal to five-sixths of the geometric average length of stay for that particular MS-LTC-DRG, referred to as a short stay outlier, or “SSO.” The SSO rule was further revised adding a category referred to as a “very short stay outlier” for discharges occurring after July 1, 2007. For cases with a length of stay that is equal to or less than one standard deviation from the geometric average length of stay for the same MS-DRG under IPPS, referred to as the so-called “IPPS comparable threshold,” the rule lowers the LTCH payment to a rate based on the general acute care hospital IPPS per diem. SSO cases with covered lengths of stay that exceed the IPPS comparable threshold would continue to be paid under the SSO payment policy. The SCHIP Extension Act, as amended by the PPACA, prevented CMS from applying the very short-stay outlier policy before December 29, 2012. Under existing regulations Medicare payments for very short-stay cases will be generally lowered to a rate based on the general acute care hospital IPPS per diem beginning with discharges on or after December 29, 2012.

 

25 Percent Rule

 

The 25 Percent Rule is a downward payment adjustment that applies to Medicare patients discharged from LTCHs who were admitted from a co-located hospital or a non-co-located hospital and caused the LTCH to exceed the applicable percentage thresholds of discharged Medicare patients. The SCHIP Extension Act as amended by the American Recovery and Reinvestment Act, or “ARRA,” and the PPACA limited the full application of the Medicare percentage threshold and, in some cases, postponed application of the percentage threshold until cost reporting periods beginning on or after July 1, 2012 or October 1, 2012.

 

In the update to the Medicare policies and payment rates for fiscal year 2013, CMS adopted through regulations a one-year extension of relief granted by the SCHIP Extension Act from the full application of Medicare admission thresholds. As a result, full implementation of the Medicare admission thresholds will not go into effect until cost reporting periods beginning on or after October 1, 2013, except for certain LTCHs with cost reporting periods that begin between July 1, 2012 and September 30, 2012. Specifically, those freestanding facilities, grandfathered HIHs and grandfathered satellites with cost reporting periods beginning on or after July 1, 2012 and before October 1, 2012 are subject to a modified 25 Percent Rule for discharges occurring in a three month period between July 1,2012 and September 30, 2012.

 

In the preamble to the proposed update to the Medicare policies and payment rates for fiscal year 2013, CMS indicates that “within the near future” it may recommend revisions to the payment policies addressing MedPAC’s recommendations for the development of patient-level and facility-level criteria.  CMS also indicates that these recommendations may render unnecessary the existing payment reductions for Medicare patients admitted from a general acute care hospital in excess of the applicable admission thresholds.

 

One-Time Budget Neutrality Adjustment

 

Congress required that the LTCH-PPS payment rates maintain budget neutrality during the first year of the prospective payment system with total expenditures that would have been made under the previous reasonable cost-based payment system. The LTCH-PPS regulations give CMS the ability to make a one-time adjustment to

 

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the standard federal rate to correct any “significant difference between actual payments and estimated payments for the first year” of LTCH-PPS. The SCHIP Extension Act, as amended by the PPACA, precluded CMS from implementing the one-time prospective adjustment to the LTCH standard federal rate before December 29, 2012.

 

In the update to the Medicare policies and payment rates for fiscal year 2013, CMS adopted a one-time budget neutrality adjustment that results in a permanent negative adjustment of 3.75% to the LTCH base rate.  CMS is implementing the adjustment over a three-year period by applying a factor of 0.98734 to the standard federal rate in fiscal years 2013, 2014 and 2015, except that the adjustment would not apply to payments for discharges occurring on or after October 1, 2012 through December 28, 2012.

 

Medicare Market Basket Adjustments for Long Term Acute Care Hospitals

 

In the update to the Medicare policies and payment rates for fiscal year 2013, CMS adopted for the first time an LTCH-specific market basket based entirely on Medicare cost report data from LTCHs.  The LTCH-specific market basket replaces the rehabilitation, psychiatric and long-term care hospital market basket previously used to determine the annual update to the LTCH-PPS.  For fiscal year 2013 CMS adopted an LTCH-specific market basket update of 1.8% based on an estimate of the LTCH-specific market basket update of 2.6% less a productivity adjustment of 0.7% and less an additional reduction of 0.1% mandated by the PPACA and as further adjusted by the one-time budget neutrality adjustment described above.

 

The PPACA institutes a market basket payment adjustment for LTCHs.  For fiscal years 2012 and 2013, the reduction is 0.1%.  For fiscal year 2014, the reduction is 0.3%.  For fiscal years 2015 and 2016, the reduction is 0.2%.  For fiscal years 2017 through fiscal year 2019, the reduction is 0.75%.

 

Medicare Payment of Inpatient Rehabilitation Facilities during Fiscal Year 2012

 

On August 5, 2011, CMS published the policies and payment rates for IRF-PPS for fiscal year 2012 (affecting discharges and cost reporting periods beginning on or after October 1, 2011 through September 30, 2012). The standard payment conversion factor for discharges for fiscal year 2012 is $14,076, an increase from the fiscal year 2011 standard payment conversion factor of $13,860.  CMS initially decreased the outlier threshold amount for fiscal year 2012 to $10,660 from $11,410 for fiscal year 2011.  In a notice published September 26, 2011, CMS corrected its calculation of the outlier threshold amount for fiscal year 2012 to $10,713.

 

Medicare Payment of Inpatient Rehabilitation Facilities during Fiscal Year 2013

 

On July 30, 2012, CMS published the policies and payment rates for IRF-PPS for fiscal year 2013 (affecting discharges and cost reporting periods beginning on or after October 1, 2012 through September 30, 2013).  The standard payment conversion factor for discharges for fiscal year 2013 is $14,343, an increase from the fiscal year 2012 standard payment conversion factor of $14,076.  The standard payment conversion factor for fiscal year 2013 includes a market basket payment reduction adjustment for IRFs as mandated by the PPACA.  The outlier

 

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threshold amount for fiscal year 2013 is set at $10,466, a decrease from the outlier threshold amount in the 2012 fiscal year of $10,713.

 

Medicare Market Basket Adjustments for Inpatient Rehabilitation Facilities

 

The PPACA instituted a market basket payment reduction adjustment for IRFs.  For fiscal years 2012 and 2013, the reduction is 0.1%.  For fiscal year 2014, the reduction is 0.3%.  For fiscal years 2015 and 2016, the reduction is 0.2%.  For fiscal years 2017 - 2019, the reduction is 0.75%.

 

Medicare Payment of Outpatient Rehabilitation Services

 

Medicare Physician Fee Schedule Sustainable Growth Rate Update

 

The Medicare program reimburses outpatient rehabilitation providers based on the Medicare physician fee schedule.  The Medicare physician fee schedule rates are automatically updated annually based on the sustainable growth rate (“SGR”) formula contained in legislation.  The SGR formula has resulted in automatic reductions in rates in every year since 2002; however, for each year through 2012 CMS or Congress has taken action to prevent the SGR formula reductions.  The Middle Class Tax Relief and Job Creation Act of 2012 froze Medicare physician fee schedule rates at 2011 levels through December 31, 2012, temporarily averting a scheduled 27.4% cut as a result of the SGR formula that would have taken effect on March 1, 2012.  In the proposed 2013 Medicare physician fee schedule rule, CMS has estimated a 27.0% reduction in the Medicare physician fee schedule payment rates beginning on January 1, 2013, unless Congress again takes legislative action to prevent the SGR formula reductions from going into effect.  This reduction would be in addition to any sequestration being enacted which would cut all of Medicare by 2%.  If the 27.0% SGR and 2% sequestration cuts are averted by Congress, the projected impact of other changes in the proposed 2013 Medicare physician fee schedule rule on outpatient physical therapy services in aggregate would be a 3% increase in 2013.  This positive change is primarily due to the phase in of the final year of the 4-year transition to the new practice expense relative value units based on data from the Physician Practice Information Survey.

 

On October 6, 2011, MedPAC recommended that Congress repeal and replace the statutory SGR formula.  The MedPAC proposal, which would require Congressional approval, would freeze current Medicare physician fee schedule rates for primary care services for 10 years, while other services would be subject to annual payment reductions of 5.9% for 3 years, followed by a freeze on payments for the next seven years. MedPAC offered a list of options for Congress to consider if it decides to offset SGR repeal costs (estimated at about $200 billion over 10 years) within the Medicare program.

 

In addition to the SGR proposal, MedPAC recommended that Congress direct CMS to collect data on provider service volume and work time to establish more accurate relative value unit payment rates and to identify and reduce overpriced fee schedule services.  Similarly, the PPACA requires CMS to identify and review potentially misvalued codes and make appropriate adjustments to the relative values of those services identified as being misvalued.  In the final update to the Medicare physician fee schedule for calendar year 2012, CMS identified several CPT codes used by physical therapists as codes they will review.

 

Therapy Caps

 

Beginning on January 1, 1999, the Balanced Budget Act of 1997 subjected certain outpatient therapy providers reimbursed under the Medicare physician fee schedule to annual limits for therapy expenses.  Effective January 1, 2012, the annual limit on outpatient therapy services is $1,880 for combined physical and speech language pathology services and $1,880 for occupational therapy services.  The per beneficiary caps were $1,870 for calendar year 2011.  The annual limits for therapy expenses do not apply to services furnished and billed by outpatient hospital departments.  However, beginning no later than October 1, 2012 and expiring on December 31, 2012, the Middle Class Tax Relief and Job Creation Act of 2012 will apply the annual limits on therapy expenses to hospital outpatient department settings.  The application of annual limits to hospital outpatient department settings will sunset at the end of 2012 unless extended by Congress. We operated 956

 

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outpatient rehabilitation clinics at June 30, 2012, of which 135 are provider-based outpatient rehabilitation clinics operated as departments of the inpatient rehabilitation hospitals.

 

In the Deficit Reduction Act of 2005, Congress implemented an exceptions process to the annual limit for therapy expenses.  Under this process, a Medicare enrollee (or person acting on behalf of the Medicare enrollee) is able to request an exception from the therapy caps if the provision of therapy services was deemed to be medically necessary.  Therapy cap exceptions have been available automatically for certain conditions and on a case-by-case basis upon submission of documentation of medical necessity.  The Middle Class Tax Relief and Job Creation Act of 2012 extended the exceptions process for outpatient therapy caps through December 31, 2012.  Unless Congress extends the exceptions process, the therapy caps will apply to all outpatient therapy services beginning January 1, 2013, except those services furnished and billed by outpatient hospital departments.

 

The Middle Class Tax Relief and Job Creation Act of 2012 made several changes to the exceptions process to the annual limit for therapy expenses.  For any claim above the annual limit, the claim must contain a modifier, such as the KX modifier, indicating that the services are medically necessary and justified by appropriate documentation in the medical record.  Effective October 1, 2012, all claims exceeding $3,700 will be subject to a manual medical review process.  The $3,700 threshold will be applied separately to the combined physical therapy/speech therapy cap and the occupational therapy cap.  Effective October 1, 2012, all therapy claims, whether above or below the annual limit, must include the national provider identifier (NPI) of the physician responsible for certifying and periodically reviewing the plan of care.

 

In the proposed 2013 Medicare physician fee schedule rule, CMS will implement a claims-based data collection process to gather additional data on patient function during the course of therapy in order to better understand patient conditions and outcomes.  All practice settings that provide outpatient therapy services must include this data on the claim form.  Beginning on January 1, 2013,  therapists will be required to report new codes and modifiers on the claim form that reflect a patient’s functional limitations and goals at initial evaluation, periodically throughout care, and at discharge.  For claims submitted after July 1, 2013, CMS proposes to return claims as unpaid if the required data is not included in the claim.

 

Several government agencies are expected to release reports on aspects of the Medicare payment system for therapy services.  In the final 2011 Medicare physician fee schedule rule, CMS indicated the agency is evaluating alternative payment methodologies that would provide appropriate payment for medically necessary and effective therapy services furnished to Medicare beneficiaries based on patient needs rather than the current therapy caps.  The Middle Class Tax Relief and Job Creation Act of 2012 directs the MedPAC to submit a report to Congress by June 15, 2013 making recommendations on how to reform the payment system to better reflect acuity, condition, and the therapy needs of the patient.  The MedPAC report is to include an examination of private sector initiatives related to therapy benefits.  In addition, the GAO is directed to issue a report no later than May 1, 2013 regarding implementation of the manual medical review process instituted by the Middle Class Tax Relief and Job Creation Act of 2012.  The report must detail the number of beneficiaries subject to the process, the number of reviews conducted, and the outcome of the reviews.

 

Multiple Procedure Payment Reduction

 

CMS adopted a multiple procedure payment reduction for therapy services in the final update to the Medicare physician fee schedule for calendar year 2011.  Under the policy, the Medicare program pays 100% of the practice expense component of the therapy procedure or unit of service with the highest relative value unit and then reduces the payment for the practice expense component by 20% in office and other non-institutional

 

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settings and 25% in institutional settings for the second and subsequent therapy procedures or units of service furnished during the same day for the same patient, regardless of whether those therapy services are furnished in separate sessions.  This multiple procedure payment reduction policy became effective January 1, 2011 and applies to all outpatient therapy services paid under Medicare Part B.  Furthermore, the multiple procedure payment reduction policy applies across all therapy disciplines — occupational therapy, physical therapy and speech language pathology.  Our outpatient rehabilitation therapy services are primarily offered in institutional settings and, as such, are subject to the applicable 25% payment reduction in the practice expense component for the second and subsequent therapy services furnished by us to the same patient on the same day.  In the 2012 Medicare physician fee schedule rule, CMS indicated that over the next year it will continue to review whether specific CPT codes billed under the fee schedule are overvalued or undervalued, including certain specific CPT codes used by physical therapists.

 

Medicare Quality Reporting Program for LTCHs and IRFs

 

The PPACA requires that CMS establish new quality data reporting programs for LTCHs and IRFs by fiscal year 2014.  CMS has adopted a quality data reporting program requiring LTCHs to submit data from three quality measures in order to receive the full payment update in fiscal year 2014, including measures related to (1) catheter-associated urinary tract infections, (2) central line catheter-associated blood stream infection, and (3) pressure ulcers that are new or have worsened.  In addition to the foregoing measures, CMS has adopted the following quality measures for LTCH reporting beginning in fiscal year 2016: (1) percent of nursing home residents who were assessed and appropriately given the seasonal influenza vaccine, and (2) influenza vaccination coverage among healthcare personnel.  CMS adopted a quality data reporting program requiring IRFs to submit data from two quality measures in order to receive the full payment update in fiscal year 2014, including measures related to (1) catheter-associated urinary tract infections and (2) pressure ulcers that are new or have worsened.  Under the PPACA and CMS regulations, if an LTCH or IRF fails to report on the selected quality measures, its reimbursement will be reduced by 2.0% of the annual market basket update.  The reduction can result in payment rates less than the prior year.  However, the reduction will not carry over into the subsequent fiscal years.

 

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Operating Statistics

 

The following tables set forth operating statistics for our specialty hospitals and our outpatient rehabilitation clinics for each of the periods presented. The data in the tables reflect the changes in the number of specialty hospitals and outpatient rehabilitation clinics we operate that resulted from acquisitions, start-up activities, closures and sales. The operating statistics reflect data for the period of time these operations were managed by us.

 

 

 

Three Months Ended 
June 30,

 

Six Months Ended 
June 30,

 

 

 

2011

 

2012

 

2011

 

2012

 

Specialty hospital data(1):

 

 

 

 

 

 

 

 

 

Number of hospitals owned - start of period

 

116

 

117

 

116

 

115

 

Number of hospitals acquired

 

 

 

1

 

1

 

Number of hospital start-ups

 

 

 

 

1

 

Number of hospitals closed/sold

 

(1

)

 

(2

)

 

Number of hospitals owned - end of period

 

115

 

117

 

115

 

117

 

Number of hospitals managed - end of period

 

4

 

6

 

4

 

6

 

Total number of hospitals (all) - end of period

 

119

 

123

 

119

 

123

 

Long term acute care hospitals

 

110

 

111

 

110

 

111

 

Rehabilitation hospitals

 

9

 

12

 

9

 

12

 

Available licensed beds (2)

 

5,135

 

5,205

 

5,135

 

5,205

 

Admissions (2)

 

13,556

 

13,872

 

27,366

 

27,927

 

Patient days (2)

 

327,001

 

336,016

 

660,857

 

679,037

 

Average length of stay (days) (2)

 

24

 

24

 

24

 

24

 

Net revenue per patient day (2)(3)

 

$

1,505

 

$

1,554

 

$

1,510

 

$

1,539

 

Occupancy rate (2)

 

70

%

71

%

71

%

72

%

Percent patient days - Medicare (2)

 

64

%

64

%

64

%

65

%

 

 

 

 

 

 

 

 

 

 

Outpatient rehabilitation data:

 

 

 

 

 

 

 

 

 

Number of clinics owned - start of period

 

874

 

848

 

875

 

850

 

Number of clinic start-ups

 

7

 

10

 

15

 

18

 

Number of clinics closed/sold

 

(32

)

(6

)

(41

)

(16

)

Number of clinics owned - end of period

 

849

 

852

 

849

 

852

 

Number of clinics managed - end of period

 

103

 

104

 

103

 

104

 

Total number of clinics (all) - end of period

 

952

 

956

 

952

 

956

 

Number of visits (2)

 

1,143,854

 

1,166,550

 

2,282,554

 

2,318,759

 

Net revenue per visit (2)(4)

 

$

102

 

$

102

 

$

102

 

$

103

 

 


(1)  Specialty hospitals consist of long term acute care hospitals and inpatient rehabilitation facilities.

(2)  Data excludes specialty hospitals and outpatient clinics managed by the Company.

(3)  Net revenue per patient day is calculated by dividing specialty hospital direct patient service revenues by the total number of patient days.

(4)  Net revenue per visit is calculated by dividing outpatient rehabilitation clinic revenue by the total number of visits. For purposes of this computation, outpatient rehabilitation clinic revenue does not include contract services revenue.

 

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Results of Operations

 

The following table outlines, for the periods indicated, selected operating data as a percentage of net operating revenues:

 

 

 

Select Medical Holdings 
Corporation

 

Select Medical Corporation

 

 

 

Three Months
Ended June 30,

 

Three Months
Ended June 30,

 

 

 

2011

 

2012

 

2011

 

2012

 

Net operating revenues

 

100.0

%

100.0

%

100.0

%

100.0

%

Cost of services(1)

 

81.5

 

81.7

 

81.5

 

81.7

 

General and administrative

 

2.3

 

2.5

 

2.3

 

2.5

 

Bad debt expense

 

2.0

 

1.3

 

2.0

 

1.3

 

Depreciation and amortization

 

2.6

 

2.0

 

2.6

 

2.0

 

Income from operations

 

11.6

 

12.5

 

11.6

 

12.5

 

Loss on early retirement of debt

 

(4.4

)

 

(2.9

)

 

Equity in earnings (losses) of unconsolidated subsidiaries

 

(0.0

)

0.3

 

(0.0

)

0.3

 

Interest expense, net

 

(3.6

)

(3.1

)

(2.8

)

(2.8

)

Income before income taxes

 

3.6

 

9.7

 

5.9

 

10.0

 

Income tax expense

 

1.6

 

3.7

 

2.4

 

3.8

 

Net income

 

2.0

 

6.0

 

3.5

 

6.2

 

Net income attributable to non-controlling interest

 

0.3

 

0.2

 

0.3

 

0.2

 

Net income attributable to Holdings and Select

 

1.7

%

5.8

%

3.2

%

6.0

%

 

 

 

Select Medical Holdings
Corporation

 

Select Medical Corporation

 

 

 

Six Months
Ended June 30,

 

Six Months
Ended June 30,

 

 

 

2011

 

2012

 

2011

 

2012

 

Net operating revenues

 

100.0

%

100.0

%

100.0

%

100.0

%

Cost of services(1)

 

81.0

 

81.9

 

81.0

 

81.9

 

General and administrative

 

2.4

 

2.2

 

2.4

 

2.2

 

Bad debt expense

 

2.0

 

1.4

 

2.0

 

1.4

 

Depreciation and amortization

 

2.5

 

2.1

 

2.5

 

2.1

 

Income from operations

 

12.1

 

12.4

 

12.1

 

12.4

 

Loss on early retirement of debt

 

(2.2

)

 

(1.5

)

 

Equity in earnings (losses) of unconsolidated subsidiaries

 

(0.0

)

0.3

 

(0.0

)

0.3

 

Interest expense, net

 

(3.7

)

(3.2

)

(2.7

)

(2.8

)

Income before income taxes

 

6.2

 

9.5

 

7.9

 

9.9

 

Income tax expense

 

2.7

 

3.7

 

3.3

 

3.8

 

Net income

 

3.5

 

5.8

 

4.6

 

6.1

 

Net income attributable to non-controlling interest

 

0.3

 

0.2

 

0.3

 

0.2

 

Net income attributable to Holdings and Select

 

3.2

%

5.6

%

4.3

%

5.9

%

 

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The following tables summarize selected financial data by business segment, for the periods indicated:

 

 

 

Select Medical Holdings Corporation

 

Select Medical Corporation

 

 

 

Three Months Ended June 30,

 

Three Months Ended June 30,

 

 

 

2011

 

2012

 


Change

 

2011

 

2012

 

%
Change

 

 

 

(in thousands)

 

 

 

(in thousands)

 

 

 

Net operating revenues:

 

 

 

 

 

 

 

 

 

 

 

 

 

Specialty hospitals

 

$

520,261

 

$

557,130

 

7.1

%

$

520,261

 

$

557,130

 

7.1

%

Outpatient rehabilitation

 

178,473

 

193,050

 

8.2

 

178,473

 

193,050

 

8.2

 

Other(2)

 

15

 

13

 

(13.3

)

15

 

13

 

(13.3

)

Total company

 

$

698,749

 

$

750,193

 

7.4

%

$

698,749

 

$

750,193

 

7.4

%

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Income (loss) from operations:

 

 

 

 

 

 

 

 

 

 

 

 

 

Specialty hospitals

 

$

78,034

 

$

90,687

 

16.2

%

$

78,034

 

$

90,687

 

16.2

%

Outpatient rehabilitation

 

20,240

 

22,605

 

11.7

 

20,240

 

22,605

 

11.7

 

Other(2)

 

(17,248

)

(19,779

)

(14.7

)

(17,248

)

(19,779

)

(14.7

)

Total company

 

$

81,026

 

$

93,513

 

15.4

%

$

81,026

 

$

93,513

 

15.4

%

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Adjusted EBITDA:(3)

 

 

 

 

 

 

 

 

 

 

 

 

 

Specialty hospitals

 

$

91,081

 

$

102,166

 

12.2

%

$

91,081

 

$

102,166

 

12.2

%

Outpatient rehabilitation

 

24,467

 

25,837

 

5.6

 

24,467

 

25,837

 

5.6

 

Other(2)

 

(15,623

)

(17,724

)

(13.4

)

(15,623

)

(17,724

)

(13.4

)

Total company

 

$

99,925

 

$

110,279

 

10.4

%

$

99,925

 

$

110,279

 

10.4

%

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Adjusted EBITDA margins:(3)

 

 

 

 

 

 

 

 

 

 

 

 

 

Specialty hospitals

 

17.5

%

18.3

%

 

 

17.5

%

18.3

%

 

 

Outpatient rehabilitation

 

13.7

 

13.4

 

 

 

13.7

 

13.4

 

 

 

Other(2)

 

N/M

 

N/M

 

 

 

N/M

 

N/M

 

 

 

Total company

 

14.3

%

14.7

%

 

 

14.3

%

14.7

%

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Total assets:

 

 

 

 

 

 

 

 

 

 

 

 

 

Specialty hospitals

 

$

2,202,994

 

$

2,184,743

 

 

 

$

2,202,994

 

$

2,184,743

 

 

 

Outpatient rehabilitation

 

471,175

 

437,591

 

 

 

471,175

 

437,591

 

 

 

Other(2)

 

113,853

 

157,303

 

 

 

112,264

 

156,080

 

 

 

Total company

 

$

2,788,022

 

$

2,779,637

 

 

 

$

2,786,433

 

$

2,778,414

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Purchases of property and equipment:

 

 

 

 

 

 

 

 

 

 

 

 

 

Specialty hospitals

 

$

6,130

 

$

12,631

 

 

 

$

6,130

 

$

12,631

 

 

 

Outpatient rehabilitation

 

2,801

 

2,922

 

 

 

2,801

 

2,922

 

 

 

Other(2)

 

1,845

 

630

 

 

 

1,845

 

630

 

 

 

Total company

 

$

10,776

 

$

16,183

 

 

 

$

10,776

 

$

16,183

 

 

 

 

39



Table of Contents

 

 

 

Select Medical Holdings Corporation

 

Select Medical Corporation

 

 

 

Six Months Ended June 30,

 

Six Months Ended June 30,

 

 

 

2011

 

2012

 


Change

 

2011

 

2012

 

%
Change

 

 

 

(in thousands)

 

 

 

(in thousands)

 

 

 

Net operating revenues:

 

 

 

 

 

 

 

 

 

 

 

 

 

Specialty hospitals

 

$

1,040,185

 

$

1,110,168

 

6.7

%

$

1,040,185

 

$

1,110,168

 

6.7

%

Outpatient rehabilitation

 

351,664

 

383,949

 

9.2

 

351,664

 

383,949

 

9.2

 

Other(2)

 

86

 

97

 

12.8

 

86

 

97

 

12.8

 

Total company

 

$

1,391,935

 

$

1,494,214

 

7.3

%

$

1,391,935

 

$

1,494,214

 

7.3

%

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Income (loss) from operations:

 

 

 

 

 

 

 

 

 

 

 

 

 

Specialty hospitals

 

$

166,341

 

$

178,798

 

7.5

%

$

166,341

 

$

178,798

 

7.5

%

Outpatient rehabilitation

 

37,187

 

41,433

 

11.4

 

37,187

 

41,433

 

11.4

 

Other(2)

 

(34,870

)

(35,114

)

(0.7

)

(34,870

)

(35,114

)

(0.7

)

Total company

 

$

168,658

 

$

185,117

 

9.8

%

$

168,658

 

$

185,117

 

9.8

%

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Adjusted EBITDA:(3)

 

 

 

 

 

 

 

 

 

 

 

 

 

Specialty hospitals

 

$

191,434

 

$

202,120

 

5.6

%

$

191,434

 

$

202,120

 

5.6

%

Outpatient rehabilitation

 

45,873

 

48,315

 

5.3

 

45,873

 

48,315

 

5.3

 

Other(2)

 

(31,648

)

(31,092

)

1.8

 

(31,648

)

(31,092

)

1.8

 

Total company

 

$

205,659

 

$

219,343

 

6.7

%

$

205,659

 

$

219,343

 

6.7

%

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Adjusted EBITDA margins:(3)

 

 

 

 

 

 

 

 

 

 

 

 

 

Specialty hospitals

 

18.4

%

18.2

%

 

 

18.4

%

18.2

%

 

 

Outpatient rehabilitation

 

13.0

 

12.6

 

 

 

13.0

 

12.6

 

 

 

Other(2)

 

N/M

 

N/M

 

 

 

N/M

 

N/M

 

 

 

Total company

 

14.8

%

14.7

%

 

 

14.8

%

14.7

%

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Total assets:

 

 

 

 

 

 

 

 

 

 

 

 

 

Specialty hospitals

 

$

2,202,994

 

$

2,184,743

 

 

 

$

2,202,994

 

$

2,184,743

 

 

 

Outpatient rehabilitation

 

471,175

 

437,591

 

 

 

471,175

 

437,591

 

 

 

Other(2)

 

113,853

 

157,303

 

 

 

112,264

 

156,080

 

 

 

Total company

 

$

2,788,022

 

$

2,779,637

 

 

 

$

2,786,433

 

$

2,778,414

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Purchases of property and equipment:

 

 

 

 

 

 

 

 

 

 

 

 

 

Specialty hospitals

 

$

16,617

 

$

19,682

 

 

 

$

16,617

 

$

19,682

 

 

 

Outpatient rehabilitation

 

4,982

 

6,713

 

 

 

4,982

 

6,713

 

 

 

Other(2)

 

2,097

 

1,539

 

 

 

2,097

 

1,539

 

 

 

Total company

 

$

23,696

 

$

27,934

 

 

 

$

23,696

 

$

27,934

 

 

 

 

40



Table of Contents

 


N/M — Not Meaningful.

 

(1)         Cost of services includes salaries, wages and benefits, operating supplies, lease and rent expense and other operating costs.

 

(2)         Other includes our general and administrative services and non-healthcare services.

 

(3)         We define Adjusted EBITDA as net income before interest, income taxes, depreciation and amortization, stock compensation expense, equity in earnings (losses) of unconsolidated subsidiaries, gain (loss) on early retirement of debt and other income (expense). We believe that the presentation of Adjusted EBITDA is important to investors because Adjusted EBITDA is commonly used as an analytical indicator of performance by investors within the healthcare industry. Adjusted EBITDA is used by management to evaluate financial performance and determine resource allocation for each of our operating units. Adjusted EBITDA is not a measure of financial performance under generally accepted accounting principles. Items excluded from Adjusted EBITDA are significant components in understanding and assessing financial performance. Adjusted EBITDA should not be considered in isolation or as an alternative to, or substitute for, net income, cash flows generated by operations, investing or financing activities, or other financial statement data presented in the consolidated financial statements as indicators of financial performance or liquidity. Because Adjusted EBITDA is not a measurement determined in accordance with generally accepted accounting principles and is thus susceptible to varying calculations, Adjusted EBITDA as presented may not be comparable to other similarly titled measures of other companies.

 

Following is a reconciliation of net income to Adjusted EBITDA as utilized by us in reporting our segment performance:

 

 

 

Select Medical Holdings 
Corporation

 

Select Medical Corporation

 

 

 

Three Months Ended June 30,

 

Three Months Ended June 30,

 

 

 

2011

 

2012

 

2011

 

2012

 

 

 

(in thousands)

 

(in thousands)

 

Net income

 

$

13,657

 

$

44,816

 

$

24,210

 

$

46,662

 

Income tax expense

 

10,915

 

27,651

 

16,597

 

28,646

 

Interest expense, net of interest income

 

25,185

 

23,798

 

19,583

 

20,957

 

Loss on early retirement of debt

 

31,018

 

 

20,385

 

 

Equity in (earnings) losses of unconsolidated subsidiaries

 

251

 

(2,752

)

251

 

(2,752

)

Stock compensation expense:

 

 

 

 

 

 

 

 

 

Included in general and administrative

 

478

 

817

 

478

 

817

 

Included in cost of services

 

422

 

521

 

422

 

521

 

Depreciation and amortization

 

17,999

 

15,428

 

17,999

 

15,428

 

Adjusted EBITDA

 

$

99,925

 

$

110,279

 

$

99,925

 

$

110,279

 

 

 

 

Select Medical Holdings 
Corporation

 

Select Medical Corporation

 

 

 

Six Months Ended June 30,

 

Six Months Ended June 30,

 

 

 

2011

 

2012

 

2011

 

2012

 

 

 

(in thousands)

 

(in thousands)

 

Net income

 

$

49,044

 

$

87,388

 

$

64,149

 

$

90,971

 

Income tax expense

 

37,479

 

55,226

 

45,611

 

57,156

 

Interest expense, net of interest income

 

50,793

 

47,720

 

38,189

 

42,207

 

Loss on early retirement of debt

 

31,018

 

 

20,385

 

 

Equity in (earnings) losses of unconsolidated subsidiaries

 

324

 

(5,217

)

324

 

(5,217

)

Stock compensation expense:

 

 

 

 

 

 

 

 

 

Included in general and administrative

 

948

 

1,589

 

948

 

1,589

 

Included in cost of services

 

832

 

1,010

 

832

 

1,010

 

Depreciation and amortization

 

35,221

 

31,627

 

35,221

 

31,627

 

Adjusted EBITDA

 

$

205,659

 

$

219,343

 

$

205,659

 

$

219,343

 

 

41



Table of Contents

 

Three Months Ended June 30, 2012 Compared to Three Months Ended June 30, 2011

 

In the following discussion, we address the results of operations of Select and Holdings.  With the exception of loss on early retirement of debt, interest expense and income taxes, the results of operations of Holdings are identical to those of Select.  Therefore, the discussion related to net operating revenues, operating expenses, Adjusted EBITDA, income from operations, equity in earnings (losses) of unconsolidated subsidiaries and non-controlling interest is identical for Holdings and Select.

 

Net Operating Revenues

 

Our net operating revenues increased by 7.4% to $750.2 million for the three months ended June 30, 2012 compared to $698.7 million for the three months ended June 30, 2011.

 

Specialty Hospitals.  Our specialty hospital net operating revenues increased 7.1% to $557.1 million for the three months ended June 30, 2012 compared to $520.3 million for the three months ended June 30, 2011.  The growth in net operating revenue primarily resulted from increases in patient volumes, increases in non-Medicare rates and revenues that are generated from contracted labor services provided to the Baylor JV.  Our patient days increased 2.8% to 336,016 days for the three months ended June 30, 2012 compared to the three months ended June 30, 2011 resulting from equal increases in both Medicare and non-Medicare patient days.  Our specialty hospital occupancy increased to 71% for the three months ended June 30, 2012 compared to 70% for the three months ended June 30, 2011.  Our average net revenue per patient day was $1,554 for the three months ended June 30, 2012 compared to $1,505 for the three months ended June 30, 2011.  The increase in our net revenue per patient day was principally due to increases in our average non-Medicare net revenue per patient day, resulting principally from Medicaid bonus payments we received during the quarter.

 

Outpatient Rehabilitation.  Our outpatient rehabilitation net operating revenues increased 8.2% to $193.1 million for the three months ended June 30, 2012 compared to $178.5 million for the three months ended June 30, 2011.  The net operating revenues generated by our outpatient rehabilitation clinics for the three months ended June 30, 2012 increased 2.9% to $142.8 million for the three months ended June 30, 2012 compared to $138.7 million for the three months ended June 30, 2011.  The increase was related to volume growth in our owned outpatient clinics and revenues we generated from contracted labor services provided to the Baylor JV.  The number of patient visits in our owned outpatient rehabilitation clinics increased 2.0% for the three months ended June 30, 2012 to 1,166,550 visits compared to 1,143,854 visits for the three months ended June 30, 2011.  Net revenue per visit in our clinics was $102 for both the three months ended June 30, 2012 and 2011.  Our contract services business increased net operating revenues by 26.6% to $50.3 million for the three months ended June 30, 2012 compared to $39.8 million for the three months ended June 30, 2011, which primarily resulted from the addition of new contracts in the fourth quarter of 2011.

 

Operating Expenses

 

Our operating expenses include our cost of services, general and administrative expense and bad debt expense.  Our operating expenses increased 6.9% to $641.3 million for the three months ended June 30, 2012 compared to $599.7 million for the three months ended June 30, 2011.  As a percentage of our net operating revenues, our operating expenses were 85.5% for the three months ended June 30, 2012 compared to 85.8% for the three months ended June 30, 2011.  Our cost of services, a major component of which is labor expense, were $612.7 million or 81.7% of net operating revenue for the three months ended June 30, 2012 compared to $569.7 million or 81.5% of net operating revenue for the three months ended June 30, 2011.  The increase in cost of

 

42



Table of Contents

 

services as a percentage of net operating revenue resulted primarily from increased relative labor costs in our outpatient rehabilitation segment.  This increase in relative labor costs for the three months ended June 30, 2012 resulted from increased labor costs associated with the Baylor JV services agreement,  increased staffing in our rehabilitation clinics, and lower productivity in our contract services business.  Facility rent expense, which is a component of cost of services, was $31.3 million for three months ended June 30, 2012 compared to $29.6 million for the three months ended June 30, 2011.  General and administrative expenses were 2.5% of net operating revenue or $18.6 million for the three months ended June 30, 2012 compared to 2.3% of net operating revenue or $16.1 million for the three months ended June 30, 2011.  The increase in our general and administrative expenses resulted from increased administrative costs principally related to executive compensation and the write-off of costs related to a withdrawn financing transaction.  Our bad debt expense was $10.0 million or 1.3% of net operating revenues for the three months ended June 30, 2012 compared to $13.9 million or 2.0% of net operating revenues for the three months ended June 30, 2011.  The decline in our bad debt expense was attributed to our favorable collections experience of accounts receivable in both our operating segments for the three months ended June 30, 2012 as compared to the three months ended June 30, 2011.

 

Adjusted EBITDA

 

Specialty Hospitals.  Our Adjusted EBITDA for our specialty hospitals increased 12.2% to $102.2 million for the three months ended June 30, 2012 compared to $91.1 million for the three months ended June 30, 2011.  Our Adjusted EBITDA margins for the segment increased to 18.3% for the three months ended June 30, 2012 from 17.5% for the three months ended June 30, 2011.  The increase in the Adjusted EBITDA for our specialty hospitals was primarily the result of operating improvements in the Regency hospitals we acquired in 2010, lower bad debt expense and the Medicaid bonus payments we received during the quarter.

 

Outpatient Rehabilitation.  Our Adjusted EBITDA for our outpatient rehabilitation segment increased 5.6% to $25.8 million for the three months ended June 30, 2012 compared to $24.5 million for the three months ended June 30, 2011.  Our Adjusted EBITDA margins for the segment decreased to 13.4% for the three months ended June 30, 2012 from 13.7% for the three months ended June 30, 2011.  The Adjusted EBITDA in our outpatient rehabilitation clinics increased by $0.8 million to $21.6 million and our Adjusted EBITDA margins increased to 15.1% from 15.0% for the three months ended June 30, 2012 compared to the three months ended June 30, 2011.  The increase in our Adjusted EBITDA in our rehabilitation clinics was principally due to increased volumes and a reduction of bad debt expense, offset in part by increases in labor costs. The Adjusted EBITDA in our contract services business increased by $0.6 million to $4.3 million and the Adjusted EBITDA margins declined to 8.5% from 9.2% for the three months ended June 30, 2012 compared to the three months ended June 30, 2011.  The decline in Adjusted EBITDA margins in our contract services business was principally due to increased relative labor costs associated with lower productivity related to new business.

 

Other.  The Adjusted EBITDA loss was $17.7 million for the three months ended June 30, 2012 compared to an Adjusted EBITDA loss of $15.6 million for the three months ended June 30, 2011 and is primarily related to higher general and administrative expenses, as described under “Operating Expenses.”

 

Income from Operations

 

For the three months ended June 30, 2012 we had income from operations of $93.5 million compared to $81.0 million for the three months ended June 30, 2011.  The increase in our income from operations resulted principally from increases in our operating performance of our specialty hospital segment, a reduction in bad debt expense and a reduction in depreciation and amortization expense, offset in part by an increase in general and administrative expenses.

 

43



Table of Contents

 

Loss on Early Retirement of Debt

 

Select Medical Corporation.  On June 1, 2011 we refinanced our senior secured credit facility which now consists of an $850.0 million term loan facility and a $300.0 million revolving facility.  A portion of the proceeds from this transaction were used to repay $266.5 million of Select’s 7 5/8% senior subordinated notes.  We recognized a loss on early retirement of debt of $20.4 million for the three months ended June 30, 2011 which included the write-off of unamortized deferred financing costs and tender premiums.

 

Select Medical Holdings Corporation.  On June 1, 2011 we refinanced our senior secured credit facility which now consists of an $850.0 million term loan facility and a $300.0 million revolving facility.  A portion of the proceeds from this transaction were used to repurchase and retire $266.5 million of Select’s 7 5/8% senior subordinated notes and $150.0 million to repurchase and retire our 10% senior subordinated notes.  As a result of this debt repayment, we recognized a loss on early retirement of debt of $31.0 million for the three months ended June 30, 2011, which included the write-off of unamortized deferred financing costs, tender premiums and original issue discount.

 

Equity in Earnings (Losses) of Unconsolidated Subsidiaries

 

For the three months ended June 30, 2012 we had equity in earnings of unconsolidated subsidiaries of $2.8 million compared to equity in losses of unconsolidated subsidiaries of $0.3 million for the three months ended June 30, 2011.  The increase in our equity in earnings of unconsolidated subsidiaries resulted principally from an increase in the contribution from the Baylor JV.

 

Interest Expense

 

Select Medical Corporation.  Interest expense was $21.0 million for the three months ended June 30, 2012 compared to $19.7 million for the three months ended June 30, 2011.  The increase in interest expense resulted primarily from the refinancing of $150.0 million of Holdings’ debt, for which Select was not previously obligated, through indebtedness incurred by Select under the new senior secured credit facility on June 1, 2011.

 

Select Medical Holdings Corporation.  Interest expense was $23.8 million for the three months ended June 30, 2012 compared to $25.3 million for the three months ended June 30, 2011.  The decrease in interest expense resulted primarily from the lower interest rates on the portions of the debt that were refinanced on June 1, 2011 and reduced borrowings for the three months ended June 30, 2012 compared to the three months ended June 30, 2011.

 

Income Taxes

 

Select Medical Corporation. We recorded income tax expense of $28.6 million for the three months ended June 30, 2012. The expense represented an effective tax rate of 38.0%.  We recorded income tax expense of $16.6 million for the three months ended June 30, 2011. The expense represented an effective tax rate of 40.7%.  Select Medical Corporation is part of the consolidated federal tax return for Select Medical Holdings Corporation.  We allocate income taxes between Select and Holdings for purposes of financial statement presentation.  Because Holdings is a passive investment company incorporated in Delaware, it does not incur any state income tax expense or benefit on its specific income or loss and, as such, receives a tax allocation equal to the federal statutory rate of 35% on its specific income or loss.  Based upon the relative size of Holdings’ income or loss, this can cause the effective tax rate for Select to differ from the effective tax rate for the consolidated company.

 

44



Table of Contents

 

Select Medical Holdings Corporation.  We recorded income tax expense of $27.7 million for the three months ended June 30, 2012. The expense represented an effective tax rate of 38.2%.  We recorded income tax expense of $10.9 million for the three months ended June 30, 2011. The expense represented an effective tax rate of 44.4%.  The decline in our effective tax rate is primarily a consequence of the 2011 rate having been impacted by a tax gain associated with a hospital exchange that occurred in 2011, a reduction in the provision for uncertain tax positions and a lower effective state tax rate.

 

Non-Controlling Interests

 

Non-controlling interests in consolidated earnings were $1.6 million for the three months ended June 30, 2012 and $1.9 million for the three months ended June 30, 2011.

 

Six Months Ended June 30, 2012 Compared to Six Months Ended June 30, 2011

 

In the following discussion, we address the results of operations of Select and Holdings.  With the exception of loss on early retirement of debt, interest expense, and income taxes, the results of operations of Holdings are identical to those of Select.  Therefore, the discussion related to net operating revenues, operating expenses, Adjusted EBITDA, income from operations, equity in earnings (losses) of unconsolidated subsidiaries and non-controlling interest is identical for Holdings and Select.

 

Net Operating Revenues

 

Our net operating revenues increased by 7.3% to $1,494.2 million for the six months ended June 30, 2012 compared to $1,391.9 million for the six months ended June 30, 2011.

 

Specialty Hospitals.  Our specialty hospital net operating revenues increased by 6.7% to $1,110.2 million for the six months ended June 30, 2012 compared to $1,040.2 million for the six months ended June 30, 2011.  The growth in net operating revenue primarily resulted from increases in Medicare patient volumes, increases in non-Medicare rates and revenues that are generated from contracted labor services provided to the Baylor JV.  Our patient days increased 2.8% to 679,037 days for the six months ended June 30, 2012 primarily as a result of an increase in Medicare patient days.  Our specialty hospital occupancy increased to 72% for the six months ended June 30, 2012 compared to 71% for the six months ended June 30, 2011.  Our average net revenue per patient day was $1,539 for the six months ended June 30, 2012 compared to $1,510 for the six months ended June 30, 2011.  The increase in our net revenue per patient day was principally due to increases in our average non-Medicare net revenue per patient day, resulting principally from Medicaid bonus payments we received during the six months ended June 30, 2012.

 

Outpatient Rehabilitation.  Our outpatient rehabilitation net operating revenues increased 9.2% to $383.9 million for the six months ended June 30, 2012 compared to $351.7 million for the six months ended June 30, 2011.  The net operating revenues generated by our outpatient rehabilitation clinics for the six months ended June 30, 2012 increased 4.0% to $283.6 million compared to $272.7 million for the six months ended June 30, 2011.  The increase was primarily related to revenues we generated from contracted labor services provided to the Baylor JV and volume growth in our owned outpatient clinics.  The number of patient visits in our owned outpatient rehabilitation clinics increased 1.6% for the six months ended June 30, 2012 to 2,318,759 visits compared to 2,282,554 visits for the six months ended June 30, 2011.  Net revenue per visit in our clinics was $103 for the six months ended June 30, 2012 compared to $102 for the six months ended June 30, 2011.  Our contract services business increased net operating revenues 27.1% to $100.4 million compared to $79.0 million for the six months ended June 30, 2011, which primarily resulted from the addition of new contracts in the fourth quarter of 2011.

 

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Operating Expenses

 

Our operating expenses include our cost of services, general and administrative expense and bad debt expense.  Our operating expenses increased by 7.5% to $1,277.5 million for the six months ended June 30, 2012 compared to $1,188.1 million for the six months ended June 30, 2011.  As a percentage of our net operating revenues, our operating expenses were 85.5% for the six months ended June 30, 2012 compared to 85.4% for the six months ended June 30, 2011.  Our cost of services, a major component of which is labor expense, were $1,224.3 million or 81.9% of net operating revenue for the six months ended June 30, 2012 compared to $1,127.1 million or 81.0% of net operating revenue for the six months ended June 30, 2011.  The increase in cost of services as a percentage of net operating revenue resulted primarily from increased relative labor costs in both our specialty hospital and our outpatient rehabilitation segments.  Our specialty hospitals experienced an increase in relative labor costs due to the labor costs associated with the Baylor JV services agreement and increased staffing costs during six months ended June 30, 2012 compared to the six months ended June 30, 2011.  Our outpatient rehabilitation segment experienced an increase in relative labor costs associated with the Baylor JV services agreement and lower productivity in our contract services business.  Facility rent expense, which is a component of cost of services, was $61.7 million for the six months ended June 30, 2012 compared to $59.6 million for the six months ended June 30, 2011.  General and administrative expenses were 2.2% of net operating revenue or $32.8 million for the six months ended June 30, 2012 compared to 2.4% of net operating revenue or $32.7 million for the six months ended June 30, 2011.  This small increase in general and administrative expense resulted from the increases we experienced in the second quarter of 2012 and discussed above under “Three Months Ended June 30, 2012 compared to Three Months Ended June 30, 2012 — Operating Expenses” offset by the gain on the sale of a building that occurred during our first quarter ended March 31, 2012.  Our bad debt expense was $20.4 million or 1.4% of net operating revenues for the six months ended June 30, 2012 compared to $28.3 million or 2.0% for the six months ended June 30, 2011.  The decline in our bad debt expense was attributed to our favorable collections experience of accounts receivable in both our operating segments for the six months ended June 30, 2012 as compared to the six months ended June 30, 2011.

 

Adjusted EBITDA

 

Specialty Hospitals.   Our Adjusted EBITDA for our specialty hospitals increased by 5.6% to $202.1 million for the six months ended June 30, 2012 compared to $191.4 million for the six months ended June 30, 2011.  Our Adjusted EBITDA margins for the segment decreased to 18.2% for the six months ended June 30, 2012 from 18.4% for the six months ended June 30, 2011.  The increase in the Adjusted EBITDA for our specialty hospitals was primarily the result of increases in our net operating revenues discussed above under “Net Operating Revenues” and a reduction in bad debt expense discussed above under “Operating Expenses.”  The decrease in the Adjusted EBITDA margin is due to negative margin effect of the Baylor JV services agreement and higher relative labor costs in our hospitals.

 

Outpatient Rehabilitation.   Our Adjusted EBITDA for our outpatient rehabilitation segment increased 5.3% to $48.3 million for the six months ended June 30, 2012 compared to $45.9 million for the six months ended June 30, 2011.  Our Adjusted EBITDA margins decreased to 12.6% for the six months ended June 30, 2012 from 13.0% for the six months ended June 30, 2011.  The Adjusted EBITDA in our outpatient rehabilitation clinics increased by $1.4 million to $40.3 million for the six months ended June 30, 2012 compared to $38.9 million for the six months ended June 30, 2011.  Our Adjusted EBITDA margins for our outpatient rehabilitation clinics decreased to 14.2% for the six months ended June 30, 2012 from 14.3% for the six months ended June 30, 2011.  The decline in our Adjusted EBITDA margin in our rehabilitation clinics was principally due to increased relative labor costs associated with the Baylor JV services agreement.  The Adjusted EBITDA

 

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in our contract services business increased by $1.0 million to $8.0 million for the six months ended June 30, 2012 compared to $7.0 million for the six months ended June 30, 2011.  The Adjusted EBITDA margins for our contract services business declined to 8.0% for the six months ended June 30, 2012 compared to 8.9% for the six months ended June 30, 2011.  The decline in Adjusted EBITDA margins was principally due to increased labor costs associated with new business and lower productivity resulting from regulatory changes that became effective on October 1, 2011.

 

Other.  The Adjusted EBITDA loss was $31.1 million for the six months ended June 30, 2012 compared to an Adjusted EBITDA loss of $31.6 million for the six months ended June 30, 2011.  The reduction in loss is primarily related to the recognition of a gain on the sale of a building that occurred during our first quarter ended March 31, 2012, offset by higher general and administrative costs in the six months ended June 30, 2012 compared to the six months ended June 30, 2011.

 

Income from Operations

 

For the six months ended June 30, 2012 we had income from operations of $185.1 million compared to $168.7 million for the six months ended June 30, 2011.  The increase in our income from operations resulted principally from increases in our operating performance of our specialty hospital segment, reductions in bad debt expense and a reduction of our depreciation and amortization expenses.

 

Loss on Early Retirement of Debt

 

Select Medical Corporation.  On June 1, 2011, we refinanced our senior secured credit facility which now consists of an $850.0 million term loan facility and a $300.0 million revolving facility.  A portion of the proceeds from this transaction were used to repay $266.5 million of Select’s 7 5/8% senior subordinated notes.  We recognized a loss on early retirement of debt of $20.4 million for the six months ended June 30, 2011 which included the write-off of unamortized deferred financing costs and tender premiums.

 

Select Medical Holdings Corporation.  On June 1, 2011, we refinanced our senior secured credit facility which now consists of an $850.0 million term loan facility and a $300.0 million revolving facility.  A portion of the proceeds from this transaction were used to repurchase and retire $266.5 million of Select’s 7 5/8% senior subordinated notes and $150.0 million to repurchase and retire our 10% senior subordinated notes.  As a result of this debt repayment, we recognized a loss on early retirement of debt of $31.0 million for the six months ended June 30, 2011, which included the write-off of unamortized deferred financing costs, tender premiums and original issue discount.

 

Equity in Earnings (Losses) of Unconsolidated Subsidiaries

 

For the six months ended June 30, 2012, we had equity in earnings of unconsolidated subsidiaries of $5.2 million compared to equity in losses of unconsolidated subsidiaries of $0.3 million for the six months ended June 30, 2011.  The increase in our equity in earnings of unconsolidated subsidiaries resulted principally from an increase in the contribution from the Baylor JV.

 

Interest Expense

 

Select Medical Corporation.  Interest expense was $42.2 million for the six months ended June 30, 2012 compared to $38.4 million for the six months ended June 30, 2011.  The increase in interest expense resulted primarily from the refinancing of $150.0 million of Holdings’ debt, for which Select was not previously obligated, through indebtedness incurred by Select under the new senior secured credit facility on June 1, 2011.

 

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Select Medical Holdings CorporationInterest expense was $47.7 million for the six months ended June 30, 2012 compared to $51.0 million for the six months ended June 30, 2011.  The decrease in interest expense resulted primarily from the lower interest rates on the portions of the debt that were refinanced on June 1, 2011 and reduced borrowings for the six months ended June 30, 2012 compared to the six months ended June 30, 2011.

 

Income Taxes

 

Select Medical Corporation.  We recorded income tax expense of $57.2 million for the six months ended June 30, 2012. The expense represented an effective tax rate of 38.6%.  We recorded income tax expense of $45.6 million for the six months ended June 30, 2011. The expense represented an effective tax rate of 41.6%.  Select Medical Corporation is part of the consolidated federal tax return for Select Medical Holdings Corporation.  We allocate income taxes between Select and Holdings for purposes of financial statement presentation.  Because Holdings is a passive investment company incorporated in Delaware, it does not incur any state income tax expense or benefit on its specific income or loss and, as such, receives a tax allocation equal to the federal statutory rate of 35% on its specific income or loss.  Based upon the relative size of Holdings’ income or loss, this can cause the effective tax rate for Select to differ from the effective tax rate for the consolidated company.

 

Select Medical Holdings Corporation.  We recorded income tax expense of $55.2 million for the six months ended June 30, 2012. The expense represented an effective tax rate of 38.7%.  We recorded income tax expense of $37.5 million for the six months ended June 30, 2011. The expense represented an effective tax rate of 43.3%.  The decline in our effective tax rate is primarily a consequence of the 2011 rate having been impacted by a tax gain associated with a hospital exchange that occurred in 2011, a reduction in the provision for uncertain tax positions and a lower effective state tax rate.

 

Non-Controlling Interests

 

Non-controlling interests in consolidated earnings were $2.7 million for the six months ended June 30, 2012 and $3.7 million for the six months ended June 30, 2011.

 

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Liquidity and Capital Resources

 

Cash Flows for the Six Months Ended June 30, 2012 and Six Months Ended June 30, 2011

 

 

 

Select Medical Holdings
Corporation

 

Select Medical Corporation

 

 

 

Six Months
Ended June 30,

 

Six Months
Ended June 30,

 

 

 

2011

 

2012

 

2011

 

2012

 

 

 

(in thousands)

 

(in thousands)

 

 

 

 

 

 

 

 

 

 

 

Cash flows provided by operating activities

 

$

83,527

 

$

118,805

 

$

101,250

 

$

124,049

 

Cash flows used in investing activities

 

(27,410

)

(21,643

)

(27,410

)

(21,643

)

Cash flows used in financing activities

 

(46,898

)

(87,685

)

(64,621

)

(92,929

)

Net increase in cash and cash equivalents

 

9,219

 

9,477

 

9,219

 

9,477

 

Cash and cash equivalents at beginning of period

 

4,365

 

12,043

 

4,365

 

12,043

 

Cash and cash equivalents at end of period

 

$

13,584

 

$

21,520

 

$

13,584

 

$

21,520

 

 

Operating activities for Holdings provided $118.8 million and for Select provided $124.0 million of cash flows for the six months ended June 30, 2012; and for Holdings provided $83.5 million and for Select provided $101.3 million of cash flows for the six months ended June 30, 2011. The operating cash flows of Select exceeded the operating cash flows of Holdings by $5.2 million for the six months ended June 30, 2012 and by $17.7 million for the six months ended June 30, 2011.  The difference relates to interest payments on Holdings’ indebtedness.

 

Our days sales outstanding were 51 days at June 30, 2012 compared to 53 days at June 30, 2011 and 53 days at December 31, 2011.  The decrease in days sales outstanding between December 31, 2011 and June 30, 2012 is primarily related to the timing of the periodic interim payments we receive from Medicare for the services provided at our specialty hospitals.

 

Investing activities used $21.6 million of cash flow for the six months ended June 30, 2012.  The principal use of cash included $27.9 million related to the purchase of property and equipment and $10.0 million related primarily to an additional investment in the Baylor JV.  This use of cash was offset by $16.5 million in proceeds related to the sale of a building.  Investing activities used $27.4 million of cash flow for the six months ended June 30, 2011.  The principal use of cash included $23.7 million related to the purchase of property and equipment and $13.5 million related to the purchase of the Baylor JV partnership units and working capital advances, offset by proceeds from the sale of assets of $7.9 million which was primarily related to the sale of a building we acquired in connection with the acquisition of Regency and $2.0 million from acquisition activities that includes the resolution of the  Regency net working capital settlement with the seller.

 

Financing activities for Select used $92.9 million of cash flow for the six months ended June 30, 2012.  The primary uses of cash related to net payments under our senior secured credit facility of $44.3 million, dividends paid to Holdings to fund interest payments and stock repurchases of $52.0 million and distributions to non-controlling interests of $1.7 million.  These uses were offset by net borrowings of other debt of $0.8 million, proceeds of $0.5 million from the issuance of common stock and proceeds from bank overdrafts of $3.7 million.  Financing activities for Select used $64.6 million of cash flow for the six months ended June 30, 2011.  The primary use of cash related to dividends paid to Holdings of $171.0 million to fund interest payments and the repurchase of all $150.0 million principal amount of Holdings 10% senior subordinated notes, $18.6 million of

 

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debt issuance costs and $2.3 million in distributions to non-controlling interests offset by net borrowings of debt of $124.9 million and $2.1 million in proceeds from bank overdrafts.

 

The difference in cash flows provided by financing activities of Holdings compared to Select of $5.2 million for the six months ended June 30, 2012 and $17.7 million for the six months ended June 30, 2011 related to dividends paid by Select to Holdings to service Holdings’ interest obligations related to indebtedness.

 

Capital Resources

 

Select Medical Corporation.  Select had net working capital of $105.3 million at June 30, 2012 compared to a net working capital of $97.3 million at December 31, 2011.

 

Select Medical Holdings Corporation.  Holdings had net working capital of $107.3 million at June 30, 2012 compared to a net working capital of $99.5 million at December 31, 2011.

 

At June 30, 2012, we had outstanding borrowings of $834.3 million (net of unamortized original issue discount of $7.2 million) under the term loan and no outstanding borrowings under the revolving loan portions of our senior secured credit facilities. Also, as of June 30, 2012, we had $265.8 million of availability under our revolving loan facility (after giving effect to $34.2 million of outstanding letters of credit).

 

The applicable margin percentage for borrowings under our term loan is (1) 2.75% for alternate base rate loans and (2) 3.75% for adjusted LIBO rate loans. The adjusted LIBO rate at no time shall be less than 1.75% when used in reference to borrowings under our term loan. The applicable margin percentage for borrowings under our revolving loan is subject to change based upon the ratio of Select’s leverage ratio (as defined in the credit agreement). The applicable margin percentage for revolving loans is currently (1) 2.50% for alternate base rate loans and (2) 3.50% for adjusted LIBO rate loans. The applicable margin percentage for revolving loans will decrease to (1) 2.25% for alternate base rate loans and (2) 3.25% for adjusted LIBO rate loans upon the delivery of our Form 10-Q to JP Morgan Chase Bank, N.A., as administrative agent to our senior secured credit facility.

 

Our senior secured credit facility requires Select to maintain certain leverage ratios (as defined in our senior secured credit facility). For the four consecutive fiscal quarters ended June 30, 2012, Select was required to maintain its leverage ratio (its ratio of total indebtedness to consolidated EBITDA) at less than 5.25 to 1.00. Select’s leverage ratio was 2.97 to 1.00 as of June 30, 2012.

 

Holdings has authorized a program to repurchase up to $250.0 million worth of shares of our common stock.  The program will remain in effect until March 31, 2013, unless extended by the board of directors. During the six months ended June 30, 2012, Holdings has repurchased 5,725,782 shares at a cost of $46.8 million and since the inception of the program has repurchased 22,490,389 shares under the program at a cost of $163.6 million, which includes related transaction costs. We anticipate funding this program through available operating cash flow and borrowings under our senior secured credit facility.

 

We may from time to time seek to retire or purchase our outstanding debt through cash purchases and/or exchanges for equity securities, in open market purchases, privately negotiated transactions, tender offers or otherwise.  Such repurchases or exchanges, if any, may be funded from operating cash flows or other sources and will depend on prevailing market conditions, our liquidity requirements, contractual restrictions and other factors.  The amounts involved may be material.

 

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We believe our internally generated cash flows and borrowing capacity under our senior secured credit facility will be sufficient to finance operations over the next twelve months.

 

As a result of the SCHIP Extension Act as amended by PPACA, which prohibits the establishment and classification of new LTCHs or satellites during the five calendar years commencing on December 29, 2007, we have stopped all new LTCH development.  However, we continue to evaluate opportunities to develop new joint venture relationships with significant health systems, and from time to time we may also develop new inpatient rehabilitation hospitals. We also intend to open new outpatient rehabilitation clinics in local areas that we currently serve where we can benefit from existing referral relationships and brand awareness to produce incremental growth.  In addition to our development activities, we may grow our network of specialty hospitals through opportunistic acquisitions.

 

Recent Accounting Pronouncements

 

In June 2011, the FASB issued ASU 2011-05, “Comprehensive Income (Topic 220) — Presentation of Comprehensive Income” (“Update 2011-05”) that improves the comparability, consistency and transparency of financial reporting and increases the prominence of items reported in other comprehensive income by eliminating the option to present components of other comprehensive income as part of the statement of changes in stockholders’ equity. Update 2011-05 requires that all non-owner changes in stockholders’ equity be presented either in a single continuous statement of comprehensive income or in two separate but consecutive statements. Under either method, adjustments must be displayed for items that are reclassified from other comprehensive income (“OCI”) to net income, in both net income and OCI. Update 2011-05 does not change the current option for presenting components of OCI gross or net of the effect of income taxes, provided that such tax effects are presented in the statement in which OCI is presented or disclosed in the notes to the financial statements. Additionally, Update 2011-05 does not affect the calculation or reporting of earnings per share. Update 2011-05 was effective for fiscal years, and interim periods within those years, beginning after December 15, 2011 and is to be applied retrospectively. We adopted Update 2011-05 on January 1, 2012.  Update 2011-05 had no effect on our presentation of other comprehensive income for the three months ended June 30, 2011 and 2012 because we did not have any items of other comprehensive income during these periods.

 

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ITEM 3.        QUANTITATIVE AND QUALITATIVE DISCLOSURES ABOUT MARKET RISK

 

Quantitative and Qualitative Disclosures About Market Risk

 

We are subject to interest rate risk in connection with our long-term indebtedness.  Our principal interest rate exposure relates to the loans outstanding under Select’s senior secured credit facility and Holdings’ senior floating rate notes. As of June 30, 2012, we had $841.5 million (excluding unamortized original issue discount) in term loans outstanding under our senior secured credit facility and $167.3 million in senior floating rate notes outstanding, which bear interest at variable rates. Each eighth point change in interest rates on the variable rate portion of our long-term indebtedness would result in a $1.3 million annual change in interest expense on our term loans.  However, because the variable interest rate for our $841.5 million in term loans is subject to an Adjusted LIBO Rate floor of 1.75% until the Adjusted LIBO Rate exceeds 1.75%, our interest rate on this indebtedness is effectively fixed at 5.50%.

 

ITEM 4.        CONTROLS AND PROCEDURES

 

Evaluation of Disclosure Controls and Procedures

 

We carried out an evaluation, under the supervision and with the participation of our principal executive officer and principal financial officer, of the effectiveness of the design and operation of our disclosure controls and procedures (as defined in Rule 13a-15(e) of the Securities Exchange Act of 1934) as of the end of the period covered in this report. Based on this evaluation, our principal executive officer and principal financial officer concluded that our disclosure controls and procedures, including the accumulation and communication of disclosure to our principal executive officer and principal financial officer as appropriate to allow timely decisions regarding disclosure, are effective as of June 30, 2012 to provide reasonable assurance that material information required to be included in our periodic SEC reports is recorded, processed, summarized and reported within the time periods specified in the relevant SEC rules and forms.

 

Changes in Internal Control Over Financial Reporting

 

There was no change in our internal control over financial reporting (as defined in Rule 13a-15(f) of the Securities Exchange Act of 1934) identified in connection with the evaluation required by Rule 13a-15(d) of the Securities Exchange Act of 1934 that occurred during the second quarter ended June 30, 2012 that has materially affected, or is reasonably likely to materially affect, our internal control over financial reporting.

 

Inherent Limitations on Effectiveness of Controls

 

It should be noted that any system of controls, however well designed and operated, can provide only reasonable, and not absolute, assurance that the objectives of the system will be met.  In addition, the design of any control system is based in part upon certain assumptions about the likelihood of future events.  Because of these and other inherent limitations of control systems, there is only reasonable assurance that our controls will succeed in achieving their goals under all potential future conditions.

 

PART II         OTHER INFORMATION

 

ITEM 1.          LEGAL PROCEEDINGS

 

The Company is a party to various legal actions, proceedings and claims (some of which are not insured), and regulatory and other governmental audits and investigations in the ordinary course of its business. The

 

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Company cannot predict the ultimate outcome of pending litigation, proceedings and regulatory and other governmental audits and investigations. These matters could potentially subject the Company to sanctions, damages, recoupments, fines and other penalties. The Department of Justice, CMS or other federal and state enforcement and regulatory agencies may conduct additional investigations related to the Company’s businesses in the future that may, either individually or in the aggregate, have a material adverse effect on the Company’s business, financial position, results of operations and liquidity.

 

To cover claims arising out of the operations of the Company’s specialty hospitals and outpatient rehabilitation facilities, the Company maintains professional malpractice liability insurance and general liability insurance, subject to self-insured retention of $2.0 million per medical incident for professional liability claims and $2.0 million per occurrence for general liability claims. The Company also maintains umbrella liability insurance covering claims which, due to their nature or amount, are not covered by or not fully covered by the Company’s other insurance policies. These insurance policies also do not generally cover punitive damages and are subject to various deductibles and policy limits. Significant legal actions, as well as the cost and possible lack of available insurance, could subject the Company to substantial uninsured liabilities. In the Company’s opinion, the outcome of these actions, individually or in the aggregate, will not have a material adverse effect on its financial position, results of operations, or cash flows.

 

Healthcare providers are subject to lawsuits under the qui tam provisions of the federal False Claims Act. Qui tam lawsuits typically remain under seal (hence, usually unknown to the defendant) for some time while the government decides whether or not to intervene on behalf of a private qui tam plaintiff (known as a relator) and take the lead in the litigation. These lawsuits can involve significant monetary damages and penalties and award bounties to private plaintiffs who successfully bring the suits. The Company has been a defendant in these cases in the past, and may be named as a defendant in similar cases from time to time in the future.

 

During April 2012, the Company’s long term acute care hospital in Evansville, Indiana (“SSH - Evansville”) received two subpoenas from the Office of Attorney General for the State of Indiana. One subpoena demanded certain patient medical records of SSH - Evansville. The second subpoena demanded reports and documents related to SSH - Evansville for various periods beginning in 2006, including certain financial, statistical, billing and quality reports; certain policies and procedures, joint venture board meeting minutes, and documents related to certain complaints and internal investigations. SSH - Evansville subsequently received a Request for Information or Assistance from the Office of Inspector General of the U.S. Department of Health and Human Services (Indianapolis, Indiana Field Office) covering the period beginning in 2007 seeking substantially the same records demanded by the Indiana Attorney General’s Office, additional patient medical records of SSH - Evansville and additional documents and information of SSH - Evansville, including documents concerning SSH - Evansville’s relationships with its joint venture partner and seven other identified persons and entities. During May 2012, the Evansville (Indiana) Police Department executed a search warrant at SSH - Evansville purporting to seek evidence pertaining to the crime of theft. At the Company’s request, the Vanderburgh (Indiana) Superior Court ordered the release of the probable cause affidavit supporting that search warrant. According to the affidavit, confidential informants, some of whom are purportedly current or former employees of SSH-Evansville, alleged, among other things, that a physician on the medical staff at SSH-Evansville improperly manipulated patient diagnoses to raise the diagnosis related group (DRG) and lengths-of-stay to enhance reimbursement and, on one occasion, discontinued treatments to a patient based on financial motivation and without regard to the patient’s end of life instructions resulting in the patient’s death, and that a second physician on the medical staff at SSH-Evansville  performed bronchoscopes that were medically unnecessary and resulted in at least two patient deaths. The affidavit also makes allegations that imply that the Company may not have provided complete or accurate documents called for in the Indiana Attorney General’s Office subpoenas which were received during April 2012. In August 2012, the Company received a subpoena from the Office of Inspector General of the U.S. Department of Health and Human Services (Chicago Regional Office) demanding additional documents covering the period beginning in March 2007 relating to the Company and SSH - Evansville, including contracts with SSH - Evansville’s joint venture partner, contracts and other documents relating to financial relationships with physicians practicing at SSH - Evansville, records of payments to and hours worked by physicians practicing at SSH - Evansville, documents relating to actual or expected physician referrals and admissions to SSH - Evansville, documents relating to billing for services furnished by the Company’s LTCHs, such as government program guidance and staff training materials, information relating to case manager duties and responsibilities at the Company’s LTCHs, reports on patient admissions, discharges, DRG, length-of-stay and transfers at SSH - Evansville, and documents relating to criteria used by the Company or SSH - Evansville for patient admissions, discharges and eligibility for service. The Company has produced and will continue to

 

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produce documents in response to, and intends to fully cooperate with, these governmental investigations. At this time, the Company is unable to predict the timing and outcome of this matter.

 

ITEM 1A.                    RISK FACTORS.

 

There have been no material changes from our risk factors as previously reported in our Annual Report on Form 10-K for the year ended December 31, 2011.

 

ITEM 2.          UNREGISTERED SALES OF EQUITY SECURITIES AND USE OF PROCEEDS

 

Purchases of Equity Securities by the Issuer

 

In November 2010, our board of directors authorized a stock repurchase program pursuant to which we may purchase up to $100.0 million worth of our common stock.  On August 3, 2011, our board of directors authorized an increase of $50.0 million in the capacity of our common stock repurchase program, from $100.0 million to $150.0 million and on February 22, 2012 increased the capacity by an additional $100.0 million to $250.0 million.  The other terms of the plan remain unchanged.  Stock repurchases under this program may be made in the open market or through privately negotiated transactions, and at times and in such amounts as the Company deems appropriate.  The program will remain in effect until March 31, 2013, unless extended by our board of directors.  During the three months ended June 30, 2012, we purchased a total of 2,522,090 shares of our common stock at an average purchase price of $8.33.

 

The following table sets forth the monthly purchases made under this program during the three months ended June 30, 2012:

 

Period

 

Total
Number
of Shares
Purchased

 

Average
Price
Paid Per
Share

 

Total
Number of
Shares
Purchased
as Part of
Publicly
Announced
Plans or
Programs

 

Approximate
Dollar Value of
Shares that
May Yet Be
Purchased
Under the
Plans or
Programs

 

April 1, 2012 to April 30, 2012

 

1,101,471

 

$

7.59

 

1,101,471

 

$

99,029,913

 

May 1, 2012 to May 31, 2012

 

961,631

 

$

8.76

 

961,631

 

$

90,582,480

 

June 1, 2012 to June 30, 2012

 

458,988

 

$

9.19

 

458,988

 

$

86,354,165

 

Second Quarter 2012

 

2,522,090

 

$

8.33

 

2,522,090

 

$

86,354,165

 

 

ITEM 3.          DEFAULTS UPON SENIOR SECURITIES

 

Not applicable.

 

ITEM 4.          MINE SAFETY DISCLOSURES

 

Not applicable.

 

ITEM 5.          OTHER INFORMATION

 

None.

 

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ITEM 6.          EXHIBITS

 

The exhibits to this report are listed in the Exhibit Index appearing on page 56 hereof.

 

SIGNATURES

 

Pursuant to the requirements 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.

 

 

 

SELECT MEDICAL CORPORATION

 

 

 

 

 

 

 

 

By:

/s/  Martin F. Jackson

 

 

 

      Martin F. Jackson

 

 

 

Executive Vice President and Chief Financial Officer

 

 

 

(Duly Authorized Officer)

 

 

 

 

 

 

By:

/s/  Scott A. Romberger

 

 

 

      Scott A. Romberger

 

 

 

Senior Vice President, Chief Accounting Officer and Controller

 

 

 

(Principal Accounting Officer)

 

 

 

 

Dated: August 7, 2012

 

 

 

 

 

 

 

 

 

SELECT MEDICAL HOLDINGS CORPORATION

 

 

 

 

 

 

 

 

 

 

By:

/s/  Martin F. Jackson

 

 

 

      Martin F. Jackson

 

 

 

Executive Vice President and Chief Financial Officer

 

 

 

(Duly Authorized Officer)

 

 

 

 

 

 

By:

/s/  Scott A. Romberger

 

 

 

      Scott A. Romberger

 

 

 

Senior Vice President, Chief Accounting Officer and Controller

 

 

 

(Principal Accounting Officer)

 

 

 

 

Dated: August 7, 2012

 

 

 

 

55



Table of Contents

 

EXHIBIT INDEX

 

Exhibit

 

Description

 

 

 

31.1

 

Certification of Chief Executive Officer pursuant to Section 302 of the Sarbanes-Oxley Act of 2002.

31.2

 

Certification of Executive Vice President and Chief Financial Officer pursuant to Section 302 of the Sarbanes-Oxley Act of 2002.

32.1

 

Certification of Chief Executive Officer, and Executive Vice President and Chief Financial Officer pursuant to 18 U.S.C. Section 1350 as adopted pursuant to Section 906 of the Sarbanes-Oxley Act of 2002.

101

 

The following financial information from the Registrant’s Quarterly Report on Form 10-Q for the quarter ended June 30, 2012 formatted in XBRL (eXtensible Business Reporting Language): (i) Consolidated Statements of Operations for the three and six months ended June 30, 2012 and 2011, (ii) Consolidated Balance Sheets as of June 30, 2012 and December 31, 2011, (iii) Consolidated Statements of Cash Flows for the six months ended June 30, 2012 and 2011, (iv) Consolidated Statements of Changes in Equity and Income for the six months ended June 30, 2012 and (v) Notes to Consolidated Financial Statements.*

 


*  XBRL information is furnished and not filed herewith, is not part of a registration statement or prospectus for purposes of section 11 or 12 of the Securities Act of 1933, is deemed not filed for purposes of section 18 of the Securities Exchange Act of 1934, and otherwise is not subject to liability under these sections.

 

56