e10vq
UNITED STATES SECURITIES AND
EXCHANGE COMMISSION
Washington, D.C.
20549
Form 10-Q
QUARTERLY REPORT PURSUANT TO
SECTION 13 OR 15(d)
OF THE SECURITIES EXCHANGE ACT
OF 1934
For the quarterly period ended June 30, 2009
Commission file number
001-15925
COMMUNITY HEALTH SYSTEMS,
INC.
(Exact name of registrant as
specified in its charter)
|
|
|
Delaware
|
|
13-3893191
|
(State or other jurisdiction
of
incorporation or organization)
|
|
(I.R.S. Employer
Identification Number)
|
|
|
|
4000 Meridian Boulevard
Franklin, Tennessee
(Address of principal
executive offices)
|
|
37067
(Zip
Code)
|
(Registrants telephone number)
615-465-7000
Indicate by check mark whether the Registrant (1) has filed
all reports required to be filed by Section 13 or 15(d) of
the Securities Exchange Act of 1934 during the preceding
12 months (or for such shorter period that the registrant
was required to file such reports), and (2) has been
subject to such filing requirements for the past
90 days. Yes þ No o
Indicate by check mark whether the registrant has 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
(§ 232.405 of this chapter) during the preceding
12 months (or for such shorter period that the registrant
was required to submit and post such
files). Yes o No o
Indicate by check mark whether the registrant is a large
accelerated filer, an accelerated filer, a non-accelerated
filer, or a smaller reporting company. See the definitions of
large accelerated filer, accelerated
filer and smaller reporting company in Rule
12b-2 of the
Exchange Act. (Check one):
|
|
|
|
Large
accelerated
filer þ
|
Accelerated
filer o
|
Non-accelerated
filer o
|
Smaller
reporting
company o
|
(Do not check if a smaller reporting company)
Indicated by check mark whether the registrant is a shell
company (as defined in
Rule 126-2
of the Exchange
Act). Yes o No þ
As of July 20, 2009, there were outstanding
92,728,693 shares of the Registrants Common Stock,
$0.01 par value.
Community
Health Systems, Inc.
Form 10-Q
For the Three and Six Months Ended June 30, 2009
1
PART I
FINANCIAL INFORMATION
|
|
Item 1.
|
Financial
Statements
|
|
|
|
|
|
|
|
|
|
|
|
June 30,
|
|
|
December 31,
|
|
|
|
2009
|
|
|
2008
|
|
|
ASSETS
|
Current assets
|
|
|
|
|
|
|
|
|
Cash and cash equivalents
|
|
$
|
268,825
|
|
|
$
|
220,655
|
|
Patient accounts receivable, net of allowance for doubtful
accounts of $1,274,698 and $1,111,131 at June 30, 2009 and
December 31, 2008, respectively
|
|
|
1,657,923
|
|
|
|
1,625,470
|
|
Supplies
|
|
|
286,594
|
|
|
|
275,696
|
|
Prepaid income taxes
|
|
|
|
|
|
|
92,710
|
|
Deferred income taxes
|
|
|
91,875
|
|
|
|
91,875
|
|
Prepaid expenses and taxes
|
|
|
94,598
|
|
|
|
73,792
|
|
Other current assets
|
|
|
199,616
|
|
|
|
224,852
|
|
|
|
|
|
|
|
|
|
|
Total current assets
|
|
|
2,599,431
|
|
|
|
2,605,050
|
|
|
|
|
|
|
|
|
|
|
Property and equipment
|
|
|
7,505,415
|
|
|
|
7,110,357
|
|
Less accumulated depreciation and amortization
|
|
|
(1,429,270
|
)
|
|
|
(1,215,952
|
)
|
|
|
|
|
|
|
|
|
|
Property and equipment, net
|
|
|
6,076,145
|
|
|
|
5,894,405
|
|
|
|
|
|
|
|
|
|
|
Goodwill
|
|
|
4,187,968
|
|
|
|
4,166,091
|
|
|
|
|
|
|
|
|
|
|
Other assets, net
|
|
|
1,008,478
|
|
|
|
1,152,708
|
|
|
|
|
|
|
|
|
|
|
Total assets
|
|
$
|
13,872,022
|
|
|
$
|
13,818,254
|
|
|
|
|
|
|
|
|
|
|
|
LIABILITIES AND EQUITY
|
Current liabilities
|
|
|
|
|
|
|
|
|
Current maturities of long-term debt
|
|
$
|
56,734
|
|
|
$
|
33,904
|
|
Accounts payable
|
|
|
505,966
|
|
|
|
532,595
|
|
Current income taxes payable
|
|
|
25,920
|
|
|
|
|
|
Deferred income taxes
|
|
|
6,740
|
|
|
|
6,740
|
|
Accrued interest
|
|
|
143,581
|
|
|
|
153,234
|
|
Accrued liabilities
|
|
|
721,313
|
|
|
|
782,944
|
|
|
|
|
|
|
|
|
|
|
Total current liabilities
|
|
|
1,460,254
|
|
|
|
1,509,417
|
|
|
|
|
|
|
|
|
|
|
Long-term debt
|
|
|
8,883,810
|
|
|
|
8,938,185
|
|
|
|
|
|
|
|
|
|
|
Deferred income taxes
|
|
|
461,098
|
|
|
|
460,793
|
|
|
|
|
|
|
|
|
|
|
Other long-term liabilities
|
|
|
825,473
|
|
|
|
888,557
|
|
|
|
|
|
|
|
|
|
|
Total liabilities
|
|
|
11,630,635
|
|
|
|
11,796,952
|
|
|
|
|
|
|
|
|
|
|
Redeemable noncontrolling interests in equity of consolidated
subsidiaries
|
|
|
323,994
|
|
|
|
320,171
|
|
|
|
|
|
|
|
|
|
|
EQUITY
|
|
|
|
|
|
|
|
|
Community Health Systems, Inc. stockholders equity
|
|
|
|
|
|
|
|
|
Preferred stock, $.01 par value per share,
100,000,000 shares authorized; none issued
|
|
|
|
|
|
|
|
|
Common stock, $.01 par value per share,
300,000,000 shares authorized; 93,702,225 shares
issued and 92,726,676 shares outstanding at June 30,
2009, and 92,483,166 shares issued and
91,507,617 shares outstanding at December 31, 2008
|
|
|
937
|
|
|
|
925
|
|
Additional paid-in capital
|
|
|
1,168,125
|
|
|
|
1,151,119
|
|
Treasury stock, at cost, 975,549 shares at June 30,
2009 and December 31, 2008
|
|
|
(6,678
|
)
|
|
|
(6,678
|
)
|
Accumulated other comprehensive loss
|
|
|
(220,565
|
)
|
|
|
(295,575
|
)
|
Retained earnings
|
|
|
894,599
|
|
|
|
776,249
|
|
|
|
|
|
|
|
|
|
|
Total Community Health Systems, Inc. stockholders equity
|
|
|
1,836,418
|
|
|
|
1,626,040
|
|
Noncontrolling interests in equity of consolidated
subsidiaries
|
|
|
80,975
|
|
|
|
75,091
|
|
|
|
|
|
|
|
|
|
|
Total equity
|
|
|
1,917,393
|
|
|
|
1,701,131
|
|
|
|
|
|
|
|
|
|
|
Total liabilities and equity
|
|
$
|
13,872,022
|
|
|
$
|
13,818,254
|
|
|
|
|
|
|
|
|
|
|
See accompanying notes to the condensed consolidated financial
statements.
2
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Three Months Ended
|
|
|
Six Months Ended
|
|
|
|
June 30,
|
|
|
June 30,
|
|
|
|
2009
|
|
|
2008
|
|
|
2009
|
|
|
2008
|
|
|
Net operating revenues
|
|
$
|
3,016,961
|
|
|
$
|
2,673,153
|
|
|
$
|
5,929,710
|
|
|
$
|
5,383,508
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Operating costs and expenses:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Salaries and benefits
|
|
|
1,201,680
|
|
|
|
1,078,165
|
|
|
|
2,375,120
|
|
|
|
2,165,250
|
|
Provision for bad debts
|
|
|
362,462
|
|
|
|
285,593
|
|
|
|
700,230
|
|
|
|
577,666
|
|
Supplies
|
|
|
419,956
|
|
|
|
375,324
|
|
|
|
825,593
|
|
|
|
759,307
|
|
Other operating expenses
|
|
|
567,813
|
|
|
|
523,828
|
|
|
|
1,112,790
|
|
|
|
1,049,394
|
|
Rent
|
|
|
61,200
|
|
|
|
58,254
|
|
|
|
121,528
|
|
|
|
117,331
|
|
Depreciation and amortization
|
|
|
142,447
|
|
|
|
123,544
|
|
|
|
278,008
|
|
|
|
244,850
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Total operating costs and expenses
|
|
|
2,755,558
|
|
|
|
2,444,708
|
|
|
|
5,413,269
|
|
|
|
4,913,798
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Income from operations
|
|
|
261,403
|
|
|
|
228,445
|
|
|
|
516,441
|
|
|
|
469,710
|
|
Interest expense, net
|
|
|
161,473
|
|
|
|
153,361
|
|
|
|
325,386
|
|
|
|
318,063
|
|
Loss (gain) from early extinguishment of debt
|
|
|
6
|
|
|
|
|
|
|
|
(2,406
|
)
|
|
|
1,328
|
|
Equity in earnings of unconsolidated affiliates
|
|
|
(11,783
|
)
|
|
|
(10,499
|
)
|
|
|
(24,700
|
)
|
|
|
(23,383
|
)
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Income from continuing operations before income taxes
|
|
|
111,707
|
|
|
|
85,583
|
|
|
|
218,161
|
|
|
|
173,702
|
|
Provision for income taxes
|
|
|
37,209
|
|
|
|
30,190
|
|
|
|
72,843
|
|
|
|
61,054
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Income from continuing operations
|
|
|
74,498
|
|
|
|
55,393
|
|
|
|
145,318
|
|
|
|
112,648
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Discontinued operations, net of taxes:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
(Loss) income from operations of hospitals sold and hospitals
held for sale
|
|
|
(508
|
)
|
|
|
(240
|
)
|
|
|
1,977
|
|
|
|
1,624
|
|
(Loss) gain on sale of hospitals, net
|
|
|
|
|
|
|
(9
|
)
|
|
|
(405
|
)
|
|
|
9,608
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
(Loss) income from discontinued operations
|
|
|
(508
|
)
|
|
|
(249
|
)
|
|
|
1,572
|
|
|
|
11,232
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Net income
|
|
|
73,990
|
|
|
|
55,144
|
|
|
|
146,890
|
|
|
|
123,880
|
|
Less: Net income attributable to noncontrolling interests
|
|
|
14,555
|
|
|
|
7,251
|
|
|
|
28,540
|
|
|
|
15,860
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Net income attributable to Community Health Systems, Inc.
|
|
$
|
59,435
|
|
|
$
|
47,893
|
|
|
$
|
118,350
|
|
|
$
|
108,020
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Income from continuing operations attributable to Community
Health Systems, Inc. common stockholders per share(1):
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Basic
|
|
$
|
0.66
|
|
|
$
|
0.51
|
|
|
$
|
1.30
|
|
|
$
|
1.03
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Diluted
|
|
$
|
0.66
|
|
|
$
|
0.50
|
|
|
$
|
1.29
|
|
|
$
|
1.02
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Discontinued operations attributable to Community Health
Systems, Inc. common stockholders per share(1):
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Basic
|
|
$
|
(0.01
|
)
|
|
$
|
|
|
|
$
|
0.01
|
|
|
$
|
0.12
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Diluted
|
|
$
|
(0.01
|
)
|
|
$
|
|
|
|
$
|
0.01
|
|
|
$
|
0.12
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Net income attributable to Community Health Systems, Inc.
common stockholders per share(1):
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Basic
|
|
$
|
0.66
|
|
|
$
|
0.51
|
|
|
$
|
1.31
|
|
|
$
|
1.15
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Diluted
|
|
$
|
0.65
|
|
|
$
|
0.50
|
|
|
$
|
1.31
|
|
|
$
|
1.14
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Weighted-average number of shares outstanding:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Basic
|
|
|
90,358,583
|
|
|
|
94,192,295
|
|
|
|
90,169,735
|
|
|
|
94,017,435
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Diluted
|
|
|
91,071,147
|
|
|
|
95,513,127
|
|
|
|
90,666,009
|
|
|
|
95,127,523
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
(1) |
|
Total per share amounts may not add due to rounding. |
See accompanying notes to the condensed consolidated financial
statements.
3
|
|
|
|
|
|
|
|
|
|
|
Six Months Ended
|
|
|
|
June 30,
|
|
|
|
2009
|
|
|
2008
|
|
|
Cash flows from operating activities
|
|
|
|
|
|
|
|
|
Net income attributable to Community Health Systems, Inc.
|
|
$
|
118,350
|
|
|
$
|
108,020
|
|
Plus: Net income attributable to noncontrolling interests
|
|
|
28,540
|
|
|
|
15,860
|
|
|
|
|
|
|
|
|
|
|
Net income
|
|
|
146,890
|
|
|
|
123,880
|
|
Adjustments to reconcile net income to net cash provided by
operating activities:
|
|
|
|
|
|
|
|
|
Depreciation and amortization
|
|
|
278,340
|
|
|
|
244,850
|
|
Stock-based compensation expense
|
|
|
24,805
|
|
|
|
26,681
|
|
Loss (gain) on sale of hospitals and partnership interest, net
|
|
|
405
|
|
|
|
(13,211
|
)
|
Excess tax benefits relating to stock-based compensation
|
|
|
3,389
|
|
|
|
947
|
|
(Gain) loss on early extinguishment of debt
|
|
|
(2,406
|
)
|
|
|
1,328
|
|
Other non-cash expenses, net
|
|
|
(6,472
|
)
|
|
|
2,041
|
|
Changes in operating assets and liabilities, net of effects of
acquisitions and divestitures:
|
|
|
|
|
|
|
|
|
Patient accounts receivable
|
|
|
8,937
|
|
|
|
(74,786
|
)
|
Supplies, prepaid expenses and other current assets
|
|
|
5,198
|
|
|
|
13,570
|
|
Accounts payable, accrued liabilities and income taxes
|
|
|
72,042
|
|
|
|
83,869
|
|
Other
|
|
|
13,279
|
|
|
|
7,614
|
|
|
|
|
|
|
|
|
|
|
Net cash provided by operating activities
|
|
|
544,407
|
|
|
|
416,783
|
|
|
|
|
|
|
|
|
|
|
Cash flows from investing activities
|
|
|
|
|
|
|
|
|
Acquisitions of facilities and other related equipment
|
|
|
(210,904
|
)
|
|
|
(6,646
|
)
|
Purchases of property and equipment
|
|
|
(267,275
|
)
|
|
|
(275,605
|
)
|
Proceeds from disposition of hospitals and other ancillary
operations
|
|
|
89,909
|
|
|
|
365,913
|
|
Proceeds from sale of property and equipment
|
|
|
355
|
|
|
|
12,889
|
|
Increase in other non-operating assets
|
|
|
(74,506
|
)
|
|
|
(144,380
|
)
|
|
|
|
|
|
|
|
|
|
Net cash used in investing activities
|
|
|
(462,421
|
)
|
|
|
(47,829
|
)
|
|
|
|
|
|
|
|
|
|
Cash flows from financing activities
|
|
|
|
|
|
|
|
|
Proceeds from exercise of stock options
|
|
|
3,445
|
|
|
|
1,357
|
|
Excess tax benefits relating to stock-based compensation
|
|
|
(3,389
|
)
|
|
|
(947
|
)
|
Deferred financing costs
|
|
|
(207
|
)
|
|
|
(2,444
|
)
|
Stock buy-back
|
|
|
|
|
|
|
(10,194
|
)
|
Proceeds from noncontrolling investors in joint ventures
|
|
|
26,314
|
|
|
|
11,214
|
|
Redemption of noncontrolling investments in joint ventures
|
|
|
(1,631
|
)
|
|
|
(53,485
|
)
|
Distributions to noncontrolling investors in joint ventures
|
|
|
(22,166
|
)
|
|
|
(14,916
|
)
|
Borrowings under credit agreement
|
|
|
200,000
|
|
|
|
22,657
|
|
Repayments of long-term indebtedness
|
|
|
(236,182
|
)
|
|
|
(190,998
|
)
|
|
|
|
|
|
|
|
|
|
Net cash used in financing activities
|
|
|
(33,816
|
)
|
|
|
(237,756
|
)
|
|
|
|
|
|
|
|
|
|
Net change in cash and cash equivalents
|
|
|
48,170
|
|
|
|
131,198
|
|
Cash and cash equivalents at beginning of period
|
|
|
220,655
|
|
|
|
132,874
|
|
|
|
|
|
|
|
|
|
|
Cash and cash equivalents at end of period
|
|
$
|
268,825
|
|
|
$
|
264,072
|
|
|
|
|
|
|
|
|
|
|
See accompanying notes to the condensed consolidated financial
statements.
4
COMMUNITY
HEALTH SYSTEMS, INC. AND SUBSIDIARIES
NOTES TO
CONDENSED CONSOLIDATED FINANCIAL STATEMENTS
(UNAUDITED)
The unaudited condensed consolidated financial statements of
Community Health Systems, Inc. and its subsidiaries (the
Company) as of June 30, 2009 and
December 31, 2008 and for the three-month and six-month
periods ended June 30, 2009 and June 30, 2008, have
been prepared in accordance with accounting principles generally
accepted in the United States of America
(U.S. GAAP). In the opinion of management, such
information contains all adjustments, consisting only of normal
recurring adjustments, necessary for a fair presentation of the
results for such periods. All intercompany transactions and
balances have been eliminated. The results of operations for the
three and six months ended June 30, 2009, are not
necessarily indicative of the results to be expected for the
full fiscal year ending December 31, 2009. Certain
information and disclosures normally included in the notes to
consolidated financial statements have been condensed or omitted
as permitted by the rules and regulations of the Securities and
Exchange Commission (SEC). The Company believes the
disclosures are 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, 2008, contained in the Companys
Annual Report on
Form 10-K.
On January 1, 2009, the Company adopted Statement of
Financial Accounting Standards (SFAS) No. 160,
Noncontrolling Interests in Consolidated Financial
Statements an Amendment of ARB No. 51
(SFAS No. 160), which addresses the
accounting and reporting framework for noncontrolling ownership
interests in consolidated subsidiaries of the parent.
SFAS No. 160 also establishes disclosure requirements
that clearly identify and distinguish between the interests of
the parent company and the interests of the noncontrolling
owners. This standard requires that minority interests be
renamed noncontrolling interests and that noncontrolling
ownership interests be presented separately within equity in the
condensed consolidated financial statements. Revenues, expenses
and income from continuing operations from
less-than-wholly-owned
subsidiaries are presented on the condensed consolidated
statements of income at the consolidated amounts, with a
consolidated net income measure that presents separately the
amounts attributable to both the controlling and noncontrolling
interests for all periods presented. Noncontrolling ownership
interests that are redeemable or may become redeemable at a
fixed or determinable price at the option of the holder or upon
the occurrence of an event outside of the control of the company
continue to be presented in mezzanine equity in accordance with
Emerging Issues Task Force Topic D-98, Classification and
Measurement of Redeemable Securities.
SFAS No. 160 requires retrospective adoption of the
presentation and disclosure requirements for all periods
presented. Therefore, the condensed consolidated financial
statements as of December 31, 2008 and for the three and
six months ended June 30, 2008 reflect the provisions of
SFAS No. 160 as if it was effective for those periods.
Other than these changes in financial statement presentation,
the adoption of SFAS No. 160 did not have a material
impact on the condensed consolidated financial statements.
During the three months ended June 30, 2009, the Company
decided to retain a hospital and related businesses previously
classified as held for sale. Results of operations for all
periods presented have been restated to include this retained
hospital and related businesses, which previously were reported
as discontinued operations. The condensed consolidated balance
sheets for each of the periods presented have been restated to
include assets and liabilities previously reported as held for
sale.
Throughout these notes to the condensed consolidated financial
statements, Community Health Systems, Inc., the parent company,
and its consolidated subsidiaries are referred to on a
collective basis as the Company. This drafting style
is not meant to indicate that the publicly-traded parent company
or any subsidiary of the parent company owns or operates any
asset, business, or property. The hospitals, operations and
businesses described in this filing are owned and operated, and
management services provided, by distinct and indirect
subsidiaries of Community Health Systems, Inc. References to the
Company may include one or more of its subsidiaries.
5
COMMUNITY
HEALTH SYSTEMS, INC. AND SUBSIDIARIES
NOTES TO
CONDENSED CONSOLIDATED FINANCIAL
STATEMENTS (Continued)
|
|
2.
|
ACCOUNTING
FOR STOCK-BASED COMPENSATION
|
Stock-based compensation awards are granted under the Community
Health Systems, Inc. Amended and Restated 2000 Stock Option and
Award Plan (the 2000 Plan) and the Community Health
Systems, Inc. 2009 Stock Option and Award Plan (the 2009
Plan).
The 2000 Plan allows for the grant of incentive stock options
intended to qualify under Section 422 of the Internal
Revenue Code (IRC), as well as stock options which
do not so qualify, stock appreciation rights, restricted stock,
performance units and performance shares, phantom stock awards
and share awards. Persons eligible to receive grants under the
2000 Plan include the Companys directors, officers,
employees and consultants. To date, all options granted under
the 2000 Plan have been nonqualified stock options
for tax purposes. Generally, vesting of these granted options
occurs in one-third increments on each of the first three
anniversaries of the award date. Options granted prior to 2005
have a 10 year contractual term, options granted in 2005
through 2007 have an eight year contractual term and options
granted in 2008 and 2009 have a 10 year contractual term.
The exercise price of all options granted under the 2000 Plan is
equal to the fair value of the Companys common stock on
the option grant date. As of June 30, 2009,
3,790,273 shares of unissued common stock were reserved for
future grants under the 2000 Plan.
The 2009 Plan, which was adopted as of March 24, 2009 and
approved by stockholders on May 19, 2009, provides for the
grant of incentive stock options intended to qualify under
Section 422 of the IRC and for the grant of stock options
which do not so qualify, stock appreciation rights, restricted
stock, restricted stock units, performance-based shares or units
and other share awards. Persons eligible to receive grants under
the 2009 Plan include the Companys directors, officers,
employees and consultants. The duration of any option granted
under the 2009 Plan will be determined by the Companys
compensation committee. Generally, however, no option may be
exercised more than 10 years from the date of grant,
provided that the compensation committee may provide that a
stock option may, upon the death of the grantee, be exercised
for up to one year following the date of death even if such
period extends beyond 10 years. As of June 30, 2009,
no grants had been made under the 2009 Plan, with
3,500,000 shares of unissued common stock remaining
reserved for future grants.
The following table reflects the impact of total compensation
expense related to stock-based equity plans under
SFAS No. 123(R) on the reported operating results for
the respective periods (in thousands, except per share data):
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Three Months Ended
|
|
|
Six Months Ended
|
|
|
|
June 30,
|
|
|
June 30,
|
|
|
|
2009
|
|
|
2008
|
|
|
2009
|
|
|
2008
|
|
|
Effect on income from continuing operations before income taxes
|
|
$
|
(12,519
|
)
|
|
$
|
(13,435
|
)
|
|
$
|
(24,805
|
)
|
|
$
|
(26,681
|
)
|
Effect on net income
|
|
$
|
(7,605
|
)
|
|
$
|
(8,162
|
)
|
|
$
|
(15,069
|
)
|
|
$
|
(16,209
|
)
|
Effect on net income attributable to Community Health Systems,
Inc. common stockholders per share-diluted
|
|
$
|
(0.08
|
)
|
|
$
|
(0.09
|
)
|
|
$
|
(0.17
|
)
|
|
$
|
(0.17
|
)
|
At June 30, 2009, $58.6 million of unrecognized
stock-based compensation expense was expected to be recognized
over a weighted-average period of 23 months. Of that
amount, $19.7 million related to outstanding unvested stock
options expected to be recognized over a weighted-average period
of 20 months and $38.9 million related to outstanding
unvested restricted stock and phantom shares expected to be
recognized over a weighted-average period of 24 months.
6
COMMUNITY
HEALTH SYSTEMS, INC. AND SUBSIDIARIES
NOTES TO
CONDENSED CONSOLIDATED FINANCIAL
STATEMENTS (Continued)
The fair value of stock options was estimated using the Black
Scholes option pricing model with the following weighted-average
assumptions during the three and six months ended June 30,
2009 and 2008:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Three Months Ended
|
|
|
Six Months Ended
|
|
|
|
June 30,
|
|
|
June 30,
|
|
|
|
2009
|
|
|
2008
|
|
|
2009
|
|
|
2008
|
|
|
Expected volatility
|
|
|
44.0
|
%
|
|
|
24.5
|
%
|
|
|
40.2
|
%
|
|
|
24.1
|
%
|
Expected dividends
|
|
|
0
|
|
|
|
0
|
|
|
|
0
|
|
|
|
0
|
|
Expected term
|
|
|
4 years
|
|
|
|
4 years
|
|
|
|
4 years
|
|
|
|
4 years
|
|
Risk-free interest rate
|
|
|
1.75
|
%
|
|
|
2.80
|
%
|
|
|
1.63
|
%
|
|
|
2.59
|
%
|
In determining expected return, the Company examined
concentrations of option holdings and historical patterns of
option exercises and forfeitures, as well as forward looking
factors, in an effort to determine if there were any discernable
employee populations. From this analysis, the Company identified
two employee populations, one consisting primarily of certain
senior executives and the other consisting of all other
recipients.
The expected volatility rate was estimated based on historical
volatility. In determining expected volatility, the Company also
reviewed the market-based implied volatility of actively traded
options of its common stock and determined that historical
volatility did not differ significantly from the implied
volatility.
The expected life computation is based on historical exercise
and cancellation patterns and forward-looking factors, where
present, for each population identified. The risk-free interest
rate is based on the U.S. Treasury yield curve in effect at
the time of the grant. The pre-vesting forfeiture rate is based
on historical rates and forward-looking factors for each
population identified. The Company adjusts the estimated
forfeiture rate to its actual experience.
Options outstanding and exercisable under the 2000 Plan as of
June 30, 2009, and changes during the three and six months
then ended were as follows (in thousands, except share and per
share data):
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Weighted-
|
|
|
|
|
|
|
|
|
|
|
|
|
Average
|
|
|
Aggregate
|
|
|
|
|
|
|
Weighted-
|
|
|
Remaining
|
|
|
Intrinsic
|
|
|
|
|
|
|
Average
|
|
|
Contractual
|
|
|
Value as of
|
|
|
|
|
|
|
Exercise
|
|
|
Term
|
|
|
June 30,
|
|
|
|
Shares
|
|
|
Price
|
|
|
(in Years)
|
|
|
2009
|
|
|
Outstanding at December 31, 2008
|
|
|
8,764,084
|
|
|
$
|
30.97
|
|
|
|
|
|
|
|
|
|
Granted
|
|
|
1,160,000
|
|
|
|
18.18
|
|
|
|
|
|
|
|
|
|
Exercised
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Forfeited and cancelled
|
|
|
(63,165
|
)
|
|
|
31.78
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Outstanding at March 31, 2009
|
|
|
9,860,919
|
|
|
|
29.45
|
|
|
|
|
|
|
|
|
|
Granted
|
|
|
31,000
|
|
|
|
25.27
|
|
|
|
|
|
|
|
|
|
Exercised
|
|
|
(267,400
|
)
|
|
|
13.07
|
|
|
|
|
|
|
|
|
|
Forfeited and cancelled
|
|
|
(170,277
|
)
|
|
|
30.52
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Outstanding at June 30, 2009
|
|
|
9,454,242
|
|
|
$
|
29.88
|
|
|
|
5.6 years
|
|
|
$
|
19,906
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Exercisable at June 30, 2009
|
|
|
5,819,817
|
|
|
$
|
29.49
|
|
|
|
4.9 years
|
|
|
$
|
11,407
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
The weighted-average grant date fair value of stock options
granted during the six months ended June 30, 2009 and 2008,
was $6.14 and $7.64, respectively. The aggregate intrinsic value
(the number of
in-the-money
stock options multiplied by the difference between the
Companys closing stock price on the last trading day of
the reporting period ($25.25) and the exercise price of the
respective stock options) in the table above represents the
amount that would have been received by the option holders had
all option holders exercised their options on
7
COMMUNITY
HEALTH SYSTEMS, INC. AND SUBSIDIARIES
NOTES TO
CONDENSED CONSOLIDATED FINANCIAL
STATEMENTS (Continued)
June 30, 2009. This amount changes based on the market
value of the Companys common stock. The aggregate
intrinsic value of options exercised during the three months
ended June 30, 2009 and 2008 was $3.5 million and
$0.3 million, respectively, and the aggregate intrinsic
value of options exercised during the six months ended
June 30, 2009 and 2008 was $3.5 million and
$0.4 million, respectively. The aggregate intrinsic value
of options vested and expected to vest approximates that of the
outstanding options.
The Company has also awarded restricted stock under the 2000
Plan to its directors and employees of certain subsidiaries. The
restrictions on these shares generally lapse in one-third
increments on each of the first three anniversaries of the award
date, except for restricted stock granted on July 25, 2007,
for which restrictions lapse equally on the first two
anniversaries of the award date. Certain of the restricted stock
awards granted to the Companys senior executives contain a
performance objective that must be met in addition to any
vesting requirements. If the performance objective is not
attained, the awards will be forfeited in their entirety. Once
the performance objective has been attained, restrictions will
lapse in one-third increments on each of the first three
anniversaries of the award date with the exception of the
July 25, 2007 restricted stock awards, which have no
additional time vesting restrictions once the performance
restrictions are met. Notwithstanding the above-mentioned
performance objectives and vesting requirements, the
restrictions will lapse earlier in the event of death,
disability or termination of employment by the Company for any
reason other than for cause of the holder of the restricted
stock, or change in control of the Company. Restricted stock
awards subject to performance standards are not considered
outstanding for purposes of determining earnings per share until
the performance objectives have been satisfied.
Restricted stock outstanding under the 2000 Plan as of
June 30, 2009, and changes during the three and six months
then ended were as follows:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Weighted-Average
|
|
|
|
Shares
|
|
|
Grant Date Fair Value
|
|
|
Unvested at December 31, 2008
|
|
|
1,684,207
|
|
|
$
|
35.57
|
|
Granted
|
|
|
1,156,000
|
|
|
|
18.18
|
|
Vested
|
|
|
(621,312
|
)
|
|
|
35.68
|
|
Forfeited
|
|
|
(5,667
|
)
|
|
|
33.52
|
|
|
|
|
|
|
|
|
|
|
Unvested at March 31, 2009
|
|
|
2,213,228
|
|
|
|
26.46
|
|
Granted
|
|
|
19,151
|
|
|
|
25.27
|
|
Vested
|
|
|
(6,498
|
)
|
|
|
36.82
|
|
Forfeited
|
|
|
(3,335
|
)
|
|
|
35.11
|
|
|
|
|
|
|
|
|
|
|
Unvested at June 30, 2009
|
|
|
2,222,546
|
|
|
$
|
26.40
|
|
|
|
|
|
|
|
|
|
|
On February 25, 2009, each of the Companys outside
directors received a grant of shares of phantom stock under the
2000 Plan equal in value to $130,000 divided by the closing
price of the Companys common stock on that date ($18.18),
or 7,151 shares per director (a total of 42,906 shares
of phantom stock). Vesting of these shares of phantom stock
occurs in one-third increments on each of the first three
anniversaries of the award date. As of June 30, 2009, there
were 42,906 shares of phantom stock unvested at a
weighted-average grant date fair value of $18.18. No shares of
phantom stock were vested or canceled during the six months
ended June 30, 2009. Pursuant to a March 24, 2009
amendment to the 2000 Plan, future grants of this type will be
denominated as restricted stock unit awards.
8
COMMUNITY
HEALTH SYSTEMS, INC. AND SUBSIDIARIES
NOTES TO
CONDENSED CONSOLIDATED FINANCIAL
STATEMENTS (Continued)
Under the Directors Fees Deferral Plan, the Companys
outside directors may elect to receive share equivalent units in
lieu of cash for their directors fees. These units are
held in the plan until the director electing to receive the
share equivalent units retires or otherwise terminates
his/her
directorship with the Company. Share equivalent units are
converted to shares of common stock of the Company at the time
of distribution. The following table represents the amount of
directors fees which were deferred and the equivalent
units into which they converted for each of the respective
periods (in thousands, except units):
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Six Months Ended
|
|
|
|
Three Months Ended June 30,
|
|
|
June 30,
|
|
|
|
2009
|
|
|
2008
|
|
|
2009
|
|
|
2008
|
|
|
Directors fees earned and deferred into plan
|
|
$
|
20
|
|
|
$
|
17
|
|
|
$
|
40
|
|
|
$
|
58
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Equivalent units
|
|
|
792.079
|
|
|
|
515.464
|
|
|
|
2,095.860
|
|
|
|
1,733.069
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
At June 30, 2009, there was a total of
18,914.862 units deferred in the plan with an aggregate
fair value of $0.5 million, based on the closing market
price of the Companys common stock on the last trading day
of the reporting period of $25.25.
The majority of the Companys operating costs and expenses
are cost of revenue items. Operating costs that
could be classified as general and administrative by the Company
would include the Companys corporate office costs, which
were $43.7 million and $43.0 million for the three
months ended June 30, 2009 and 2008, respectively, and
$82.9 million and $81.1 million for the six months
ended June 30, 2009 and 2008, respectively. Included in
these amounts is stock-based compensation expense of
$12.5 million and $13.4 million for the three months
ended June 30, 2009 and 2008, respectively, and
$24.8 million and $26.7 million for the six months
ended June 30, 2009 and 2008, respectively.
The preparation of financial statements in conformity with
U.S. GAAP requires management to make estimates and
assumptions that affect the amounts reported in the condensed
consolidated financial statements. Actual results could differ
from these estimates under different assumptions or conditions.
|
|
5.
|
ACQUISITIONS
AND DIVESTITURES
|
In December 2007, the Financial Accounting Standards Board (the
FASB) issued SFAS No. 141(R),
Business Combinations
(SFAS No. 141(R)).
SFAS No. 141(R) replaces SFAS No. 141 and
addresses the recognition and accounting for identifiable assets
acquired, liabilities assumed, and noncontrolling interests in
business combinations. This standard requires more assets and
liabilities to be recorded at fair value and requires expense
recognition (rather than capitalization) of certain
pre-acquisition costs. This standard also requires any
adjustments to acquired deferred tax assets and liabilities
occurring after the related allocation period to be made through
earnings. Furthermore, this standard requires this treatment of
acquired deferred tax assets and liabilities be applied to
acquisitions occurring prior to the effective date of this
standard. SFAS No. 141(R) is effective for fiscal
years beginning after December 15, 2008 and is required to
be adopted prospectively. SFAS No. 141(R) was adopted
by the Company on January 1, 2009. Approximately
$2.0 million and $3.0 million of acquisition costs
related to prospective acquisitions were expensed during the
three and six months ended June 30, 2009, respectively,
from the adoption of SFAS No. 141(R). The impact of
SFAS No. 141(R) on the Companys consolidated
results of operations or consolidated financial position in
future periods will be largely dependent on the number of
acquisitions pursued by the Company; however, it is not
anticipated at this time that such impact will be material.
9
COMMUNITY
HEALTH SYSTEMS, INC. AND SUBSIDIARIES
NOTES TO
CONDENSED CONSOLIDATED FINANCIAL
STATEMENTS (Continued)
Triad
Acquisition
On July 25, 2007, the Company completed its acquisition of
Triad Hospitals, Inc. (Triad). Triad owned and
operated 50 hospitals with 49 hospitals located in
17 states in non-urban and middle market communities and
one hospital located in the Republic of Ireland. As of
June 30, 2009, eight of the hospitals acquired from Triad
have been sold. As a result of its acquisition of Triad, the
Company also provides management and consulting services on a
contract basis to independent hospitals, through its subsidiary,
Quorum Health Resources, LLC. The Company acquired Triad for
approximately $6.857 billion, including the assumption of
$1.686 billion of existing indebtedness.
In connection with the consummation of the acquisition of Triad,
the Companys wholly-owned subsidiary CHS/Community Health
Systems, Inc. (CHS) obtained $7.215 billion of
senior secured financing under a new credit facility (the
Credit Facility) and issued $3.021 billion
aggregate principal amount of 8.875% senior notes due 2015
(the Notes). The Company used the net proceeds of
$3.000 billion from the Notes offering and the net proceeds
of $6.065 billion of term loans under the Credit Facility
to acquire the outstanding shares of Triad, to refinance certain
of Triads indebtedness and the Companys
indebtedness, to complete certain related transactions, to pay
certain costs and expenses of the transactions and for general
corporate uses. This Credit Facility also provides an additional
$750 million revolving credit facility and had a
$400 million delayed draw term loan facility for future
acquisitions, working capital and general corporate purposes. As
of December 31, 2007, the $400 million delayed draw
term loan was reduced to $300 million at the request of the
Company. As of December 31, 2008, $100 million of the
delayed draw term loan had been drawn by the Company, reducing
the delayed draw term loan availability to $200 million at
that date. In January 2009, the Company drew down the remaining
$200 million of the delayed draw term loan.
The total cost of the Triad acquisition has been allocated to
the assets acquired and liabilities assumed based upon their
respective fair values in accordance with
SFAS No. 141. The purchase price represented a premium
over the fair value of the net tangible and identifiable
intangible assets acquired for reasons such as:
|
|
|
|
|
strategically, Triad had operations in five states in which the
Company previously had no operations;
|
|
|
|
the combined company has smaller concentrations of credit risk
through greater geographic diversification;
|
|
|
|
many support functions were centralized; and
|
|
|
|
duplicate corporate functions were eliminated.
|
The allocation process required the analysis of acquired fixed
assets, contracts, contractual commitments, and legal
contingencies to identify and record the fair value of all
assets acquired and liabilities assumed. The Company completed
the allocation of the total cost of the Triad acquisition in the
third quarter of 2008 and has made a final analysis and
adjustment as of December 31, 2008 to deferred tax accounts
based on the final cost allocation, resulting in approximately
$2.781 billion of goodwill being recorded with respect to
the Triad acquisition.
Other
Acquisitions
Effective June 1, 2009, one or more subsidiaries of the
Company acquired from Akron General Medical Center all of its
joint venture interest in Massillon Community Health System,
LLC, which indirectly owns and operates Affinity Medical Center
of Massillon, Ohio. The purchase price for this noncontrolling
equity interest was $1.1 million in cash. Affinity Medical
Center is now wholly-owned by these subsidiaries of the Company.
Effective April 30, 2009, one or more subsidiaries of the
Company acquired Wyoming Valley Health Care System in
Wilkes-Barre, Pennsylvania. This health care system includes
Wilkes-Barre General Hospital, a 392-bed, full-service acute
care hospital located in Wilkes-Barre, and First Hospital
Wyoming Valley, a behavioral health facility located in
Kingston, Pennsylvania, as well as other outpatient and
ancillary services. The total consideration for fixed assets and
working capital of Wyoming Valley Health Care System was
approximately $178.1 million, of
10
COMMUNITY
HEALTH SYSTEMS, INC. AND SUBSIDIARIES
NOTES TO
CONDENSED CONSOLIDATED FINANCIAL
STATEMENTS (Continued)
which $153.6 million was paid in cash, net of
$14.2 million of cash in acquired bank accounts, and
$24.5 million was assumed in liabilities. This acquisition
transaction was accounted for using the purchase method of
accounting. This preliminary allocation of the purchase price
has been determined by the Company based upon available
information and the allocation is subject to settling amounts
related to purchased working capital and final appraisals of
tangible and intangible assets. Adjustments to the purchase
price allocation are not expected to be material.
Effective April 1, 2009, one or more subsidiaries of the
Company acquired from Share Foundation the remaining 50% equity
interest in MCSA L.L.C., an entity in which one or more
subsidiaries of the Company previously had a 50% noncontrolling
interest, which was not consolidated, and for which it provided
certain management services. This acquisition resulted in these
subsidiaries of the Company owning 100% equity interest in that
entity. MCSA L.L.C. owns and operates Medical Center of South
Arkansas (166 licensed beds) in El Dorado, Arkansas. The
purchase price was $26.0 million in cash. As of the
acquisition date, one or more subsidiaries of the Company had a
liability to MCSA L.L.C. of $14.1 million, as a result of a
cash management agreement previously entered into with the
hospital. Upon completion of the acquisition, this liability was
eliminated in consolidation.
Effective February 1, 2009, one or more subsidiaries of the
Company completed the acquisition of Siloam Springs Memorial
Hospital (74 licensed beds), located in Siloam Springs,
Arkansas, from the City of Siloam Springs. The total
consideration for this hospital consisted of approximately
$1.1 million of assumed liabilities. As required by a lease
agreement entered into as part of this acquisition, a subsidiary
of the Company deposited $1.6 million of cash in an escrow
account and agreed to build a replacement facility at this
location, with construction required to commence by February
2011 and be completed by February 2013. If the construction of
the replacement facility is not completed within the agreed time
frame, the escrow balance will be remitted to the City of Siloam
Springs.
Effective November 14, 2008, one or more subsidiaries of
the Company acquired from Willamette Community Health Solutions
all of its joint venture interest in MWMC Holdings, LLC, which
indirectly owns a controlling interest in and operates
McKenzie-Willamette Medical Center of Springfield, Oregon. This
acquisition resulted from a put right held by Willamette
Community Health Solutions in connection with the 2003
transaction establishing the joint venture. The purchase price
for this noncontrolling interest was $22.7 million in cash.
Physicians affiliated with Oregon Healthcare Resources, Inc.
continue to own a noncontrolling interest in the hospital, with
the balance owned by these subsidiaries of the Company.
Effective October 1, 2008, one or more subsidiaries of the
Company completed the acquisition of Deaconess Medical Center
(388 licensed beds) and Valley Hospital and Medical Center (123
licensed beds) both located in Spokane, Washington, from Empire
Health Services. The total consideration for these two hospitals
was approximately $185.8 million, of which
$149.2 million was paid in cash and $36.6 million was
assumed in liabilities. Based upon the Companys
preliminary purchase price allocation relating to this
acquisition as of June 30, 2009, no goodwill has been
recorded. The acquisition transaction was accounted for using
the purchase method of accounting. This preliminary allocation
of the purchase price has been determined by the Company based
upon available information and the allocation is subject to
settling amounts related to purchased working capital and final
appraisals of tangible and intangible assets. Adjustments to the
purchase price allocation are not expected to be material.
Effective June 30, 2008, one or more subsidiaries of the
Company acquired the remaining 35% equity interest in Affinity
Health Systems, LLC, which indirectly owns and operates Trinity
Medical Center (560 licensed beds) in Birmingham, Alabama, from
Baptist Health Systems, Inc. of Birmingham, Alabama
(Baptist), giving these subsidiaries 100% ownership
of that facility. The purchase price for this noncontrolling
interest was $51.5 million in cash and the cancellation of
a promissory note issued by Baptist to Affinity Health Systems,
LLC in the original principal amount of $32.8 million.
11
COMMUNITY
HEALTH SYSTEMS, INC. AND SUBSIDIARIES
NOTES TO
CONDENSED CONSOLIDATED FINANCIAL
STATEMENTS (Continued)
Discontinued
Operations
Effective March 31, 2009, the Company, through its
subsidiaries Triad-Denton Hospital LLC and
Triad-Denton
Hospital LP, completed the settlement of pending litigation
which resulted in the sale of its ownership interest in a
partnership, which owned and operated Presbyterian Hospital of
Denton (255 licensed beds) in Denton, Texas, to Texas Health
Resources for $103.0 million in cash. Also included as part
of the settlement, these subsidiaries of the Company transferred
certain hospital related assets.
Effective March 1, 2008, one or more subsidiaries of the
Company sold Woodland Medical Center (100 licensed beds)
located in Cullman, Alabama; Parkway Medical Center (108
licensed beds) located in Decatur, Alabama; Hartselle Medical
Center (150 licensed beds) located in Hartselle, Alabama;
Jacksonville Medical Center (89 licensed beds) located in
Jacksonville, Alabama; National Park Medical Center (166
licensed beds) located in Hot Springs, Arkansas;
St. Marys Regional Medical Center (170 licensed beds)
located in Russellville, Arkansas; Mineral Area Regional Medical
Center (135 licensed beds) located in Farmington, Missouri;
Willamette Valley Medical Center (80 licensed beds) located in
McMinnville, Oregon; and White County Community Hospital
(60 licensed beds) located in Sparta, Tennessee, to Capella
Healthcare, Inc., headquartered in Franklin, Tennessee. The
proceeds from this sale were $315.0 million in cash.
Effective February 21, 2008, one or more subsidiaries of
the Company sold THI Ireland Holdings Limited, a private limited
company incorporated in the Republic of Ireland, which leased
and managed the operations of Beacon Medical Center (122
licensed beds) located in Dublin, Ireland, to Beacon Medical
Group Limited, headquartered in Dublin, Ireland. The proceeds
from this sale were $1.5 million in cash.
Effective February 1, 2008, one or more subsidiaries of the
Company sold Russell County Medical Center (78 licensed
beds) located in Lebanon, Virginia to Mountain States Health
Alliance, headquartered in Johnson City, Tennessee. The proceeds
from this sale were $48.6 million in cash.
In connection with the above actions and in accordance with
SFAS No. 144, Accounting for the Impairment or
Disposal of Long-Lived Assets, the Company has classified
the results of operations of the above mentioned hospitals as
discontinued operations in the accompanying condensed
consolidated statements of income.
Net operating revenues and income (loss) on discontinued
operations for the respective periods are as follows (in
thousands):
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Three Months Ended June 30,
|
|
|
Six Months Ended June 30,
|
|
|
|
2009
|
|
|
2008
|
|
|
2009
|
|
|
2008
|
|
|
Net operating revenues
|
|
$
|
85
|
|
|
$
|
35,932
|
|
|
$
|
42,113
|
|
|
$
|
159,764
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
(Loss) income from operations of hospitals sold and hospitals
held for sale before income taxes
|
|
|
(807
|
)
|
|
|
(850
|
)
|
|
|
3,024
|
|
|
|
2,578
|
|
(Loss) gain on sale of hospitals, net
|
|
|
|
|
|
|
(9
|
)
|
|
|
(644
|
)
|
|
|
17,715
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Income from discontinued operations, before taxes
|
|
|
(807
|
)
|
|
|
(859
|
)
|
|
|
2,380
|
|
|
|
20,293
|
|
Income tax (benefit) expense
|
|
|
(299
|
)
|
|
|
(610
|
)
|
|
|
808
|
|
|
|
9,061
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
(Loss) income from discontinued operations, net of tax
|
|
$
|
(508
|
)
|
|
$
|
(249
|
)
|
|
$
|
1,572
|
|
|
$
|
11,232
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Interest expense and loss on early extinguishment of debt was
allocated to discontinued operations based on sale proceeds
available for debt repayment.
During the three months ended June 30, 2009, the Company
decided to retain a hospital and related businesses previously
classified as held for sale. Results of operations for all
periods presented have been restated to include this retained
hospital and related businesses, which were previously reported
as discontinued operations. The
12
COMMUNITY
HEALTH SYSTEMS, INC. AND SUBSIDIARIES
NOTES TO
CONDENSED CONSOLIDATED FINANCIAL
STATEMENTS (Continued)
condensed consolidated balance sheets for each of the periods
presented have been restated to include assets and liabilities
previously reported as held for sale.
The Company adopted the provisions of FASB Interpretation
No. 48, Accounting for Uncertainty in Income
Taxes (FIN 48), on January 1, 2007.
The total amount of unrecognized benefit that would affect the
effective tax rate, if recognized, was approximately
$13.6 million as of June 30, 2009. It is the
Companys policy to recognize interest and penalties
accrued related to unrecognized benefits in its condensed
consolidated statements of income as income tax expense. During
the six months ended June 30, 2009, the Company decreased
liabilities by approximately $0.1 million and recorded
$0.5 million in interest and penalties related to prior
state income tax returns through its income tax provision from
continuing operations, which are included in its FIN 48
liability at June 30, 2009. A total of approximately
$1.8 million of interest and penalties is included in the
amount of FIN 48 liability at June 30, 2009.
The Company believes that it is reasonably possible that
approximately $4.1 million of its current unrecognized tax
benefit may be recognized within the next twelve months as a
result of a lapse of the statute of limitations and settlements
with taxing authorities.
The Company, or one of its subsidiaries, files income tax
returns in the U.S. federal jurisdiction and various state
jurisdictions. The Company has extended the federal statute of
limitations for Triad for the tax periods ended
December 31, 1999, December 31, 2000, April 30,
2001, June 30, 2001, December 31, 2001,
December 31, 2002 and December 31, 2003. The Company
is currently under examination by the IRS of the federal tax
return of Triad for the tax periods ended December 31,
2004, December 31, 2005, December 31, 2006 and
July 25, 2007. The Company believes the results of this
examination will not be material to its consolidated results of
operations or consolidated financial position. With few
exceptions, the Company is no longer subject to state income tax
examinations for years prior to 2004.
Prior to the adoption of SFAS No. 160 on
January 1, 2009, income attributable to noncontrolling
interests was deducted from earnings before arriving at income
from continuing operations. With the adoption of
SFAS No. 160, the income attributable to
noncontrolling interests has been reclassified below net income
and therefore is no longer deducted in arriving at income from
continuing operations. However, the provision for income taxes
does not change because those subsidiaries with noncontrolling
interests attribute their taxable income to their respective
investors. Accordingly, the Company will not pay tax on the
income attributable to the noncontrolling interests. As a result
of separately reporting income that is taxed to others, the
Companys effective tax rate on continuing operations
before income taxes, as reported on the face of the financial
statements is 33.3% and 35.3% for the three months ended
June 30, 2009 and 2008, respectively, and 33.4% and 35.1%
for the six months ended June 30, 2009 and 2008,
respectively. However, the actual effective tax rate that is
attributable to the Companys share of income from
continuing operations before income taxes (income from
continuing operations before income taxes, as presented on the
face of the statement of income, less income from continuing
operations attributable to noncontrolling interests of
$14.6 million and $7.4 million for the three months
ended June 30, 2009 and 2008, respectively, and
$28.2 million and $15.6 million for the six months
ended June 30, 2009 and 2008, respectively) is 38.3% for
the three and six months ended June 30, 2009 and 38.6% for
the three and six months ended June 30, 2008.
Cash paid for income taxes, net of refunds received, resulted in
net cash paid of $61.6 million for the three months ended
June 30, 2009 and a net cash refund of $46.5 million
for the three months ended June 30, 2008. Cash paid for
income taxes, net of refunds received, resulted in a net cash
refund of $0.7 million and $49.3 million for the six
months ended June 30, 2009 and 2008, respectively.
13
COMMUNITY
HEALTH SYSTEMS, INC. AND SUBSIDIARIES
NOTES TO
CONDENSED CONSOLIDATED FINANCIAL
STATEMENTS (Continued)
|
|
7.
|
GOODWILL
AND OTHER INTANGIBLE ASSETS
|
The changes in the carrying amount of goodwill for the six
months ended June 30, 2009, are as follows
(in thousands):
|
|
|
|
|
Balance as of December 31, 2008
|
|
$
|
4,166,091
|
|
Goodwill acquired as part of acquisitions during 2009
|
|
|
18,514
|
|
Consideration adjustments and finalization of purchase price
allocation adjustments for prior years acquisitions
|
|
|
3,363
|
|
|
|
|
|
|
Balance as of June 30, 2009
|
|
$
|
4,187,968
|
|
|
|
|
|
|
SFAS No. 142 requires that goodwill be allocated to
each identified reporting unit, which is defined as an operating
segment or one level below the operating segment (referred to as
a component of the entity). Management has determined that the
Companys operating segments meet the criteria to be
classified as reporting units. At June 30, 2009, the
hospital operations reporting unit, the home care agencies
reporting unit, and the hospital management services reporting
unit had $4.120 billion, $34.2 million and
$33.3 million, respectively, of goodwill.
SFAS No. 142 requires goodwill to be evaluated for
impairment at the same time every year and when an event occurs
or circumstances change that, more likely than not, reduce the
fair value of the reporting unit below its carrying value.
SFAS No. 142 requires a two-step method for
determining goodwill impairment. Step one is to compare the fair
value of the reporting unit with the units carrying
amount, including goodwill. If this test indicates the fair
value is less than the carrying value, then step two is required
to compare the implied fair value of the reporting units
goodwill with the carrying value of the reporting units
goodwill. The Company has selected September 30th as
its annual testing date. The Company performed its annual
goodwill evaluation as required by SFAS No. 142 as of
September 30, 2008. No impairment was indicated by this
evaluation.
The Company estimates the fair value of the related reporting
units using both a discounted cash flow model, as well as an
EBITDA multiple model. These models are both based on the
Companys best estimate of future revenues and operating
costs and are reconciled to the Companys consolidated
market capitalization. The cash flow forecasts are adjusted by
an appropriate discount rate based on the Companys
weighted-average cost of capital. Historically, the
Companys valuation models did not fully capture the fair
value of the Companys business as a whole, as they did not
consider the increased consideration a potential acquirer would
be required to pay, in the form of a control premium, in order
to gain sufficient ownership to set policies, direct operations
and control management decisions. However, because the
Companys models have indicated value significantly in
excess of the carrying amount of assets in the Companys
reporting units, the additional value from a control premium was
not a determining factor in the outcome of step one of the
Companys impairment assessment.
The gross carrying amount of the Companys other intangible
assets subject to amortization was $77.2 million at
June 30, 2009 and $68.6 million at December 31,
2008, and the net carrying amount was $54.0 million at
June 30, 2009 and $54.1 million at December 31,
2008. The carrying amount of the Companys other intangible
assets not subject to amortization was $34.6 million and
$35.2 million at June 30, 2009 and December 31,
2008, respectively. Other intangible assets are included in
other assets, net on the Companys condensed consolidated
balance sheets. Substantially all of the Companys
intangible assets are contract-based intangible assets related
to operating licenses, management contracts, or non-compete
agreements entered into in connection with prior acquisitions.
The weighted-average amortization period for the intangible
assets subject to amortization is approximately nine years.
There are no expected residual values related to these
intangible assets. Amortization expense on these intangible
assets during the three months ended June 30, 2009 and 2008
was $3.6 million and $0.8 million, respectively, and
$6.9 million and $3.2 million for the six months ended
June 30, 2009 and 2008, respectively. Amortization expense
on intangible assets is estimated to be $7.5 million for
the remainder of 2009, $12.5 million in 2010,
$6.4 million in 2011, $4.8 million in 2012,
$4.3 million in 2013, and $18.6 million in 2014 and
thereafter.
14
COMMUNITY
HEALTH SYSTEMS, INC. AND SUBSIDIARIES
NOTES TO
CONDENSED CONSOLIDATED FINANCIAL
STATEMENTS (Continued)
The following table sets forth the components of the numerator
and denominator for the computation of basic and diluted
earnings per share for income from continuing operations,
discontinued operations and net income attributable to Community
Health Systems, Inc. common stockholders (in thousands, except
share data):
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Three Months Ended
|
|
|
Six Months Ended
|
|
|
|
June 30,
|
|
|
June 30,
|
|
|
|
2009
|
|
|
2008
|
|
|
2009
|
|
|
2008
|
|
|
Numerator for basic and diluted earnings per share:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Income from continuing operations, net of tax
|
|
$
|
74,498
|
|
|
$
|
55,393
|
|
|
$
|
145,318
|
|
|
$
|
112,648
|
|
Less: Income from continuing operations attributable to
noncontrolling interests, net of taxes
|
|
|
14,555
|
|
|
|
7,447
|
|
|
|
28,185
|
|
|
|
15,602
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Income from continuing operations attributable to Community
Health Systems, Inc. common stockholders basic and
diluted
|
|
$
|
59,943
|
|
|
$
|
47,946
|
|
|
$
|
117,133
|
|
|
$
|
97,046
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
(Loss) income from discontinued operations, net of tax
|
|
$
|
(508
|
)
|
|
$
|
(249
|
)
|
|
$
|
1,572
|
|
|
$
|
11,232
|
|
Less: Income (loss) from discontinued operations attributable to
noncontrolling interests, net of taxes
|
|
|
|
|
|
|
(196
|
)
|
|
|
355
|
|
|
|
258
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
(Loss) income from discontinued operations attributable to
Community Health Systems, Inc. common stockholders
basic and diluted
|
|
$
|
(508
|
)
|
|
$
|
(53
|
)
|
|
$
|
1,217
|
|
|
$
|
10,974
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Denominator:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Weighted-average number of shares outstanding basic
|
|
|
90,358,583
|
|
|
|
94,192,295
|
|
|
|
90,169,735
|
|
|
|
94,017,435
|
|
Effect of dilutive securities:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Restricted stock awards
|
|
|
534,525
|
|
|
|
399,975
|
|
|
|
387,851
|
|
|
|
238,715
|
|
Employee options
|
|
|
168,802
|
|
|
|
920,857
|
|
|
|
103,805
|
|
|
|
871,373
|
|
Other equity based awards
|
|
|
9,237
|
|
|
|
|
|
|
|
4,618
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Weighted-average number of shares outstanding diluted
|
|
|
91,071,147
|
|
|
|
95,513,127
|
|
|
|
90,666,009
|
|
|
|
95,127,523
|
|
Dilutive securities outstanding not included in the computation
of earnings per share because their effect is antidilutive:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Employee options
|
|
|
6,008,843
|
|
|
|
3,540,068
|
|
|
|
7,766,781
|
|
|
|
3,950,600
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Authorized capital shares of the Company include
400,000,000 shares of capital stock consisting of
300,000,000 shares of common stock and
100,000,000 shares of preferred stock. Each of the
aforementioned classes of capital stock has a par value of $0.01
per share. Shares of preferred stock, none of which were
outstanding as of June 30, 2009, may be issued in one or
more series having such rights, preferences and other provisions
as determined by the Board of Directors without approval by the
holders of common stock.
15
COMMUNITY
HEALTH SYSTEMS, INC. AND SUBSIDIARIES
NOTES TO
CONDENSED CONSOLIDATED FINANCIAL
STATEMENTS (Continued)
On December 13, 2006, the Company commenced an open market
repurchase program for up to 5,000,000 shares of the
Companys common stock, not to exceed $200 million in
repurchases. This program will conclude at the earlier of three
years or when the maximum number of shares has been repurchased.
During the year ended December 31, 2008, the Company
repurchased 4,786,609 shares, which is the cumulative
number of shares that have been repurchased under this program,
at a weighted-average price of $18.80 per share. During the six
months ended June 30, 2009, the Company did not repurchase
any shares under this program.
The following schedule presents the reconciliation of the
carrying amount of total equity, equity attributable to the
Company, and equity attributable to the noncontrolling interests
as if the provisions of SFAS No. 160 were adopted on
the first day of the six-month period ended June 30, 2009
(in thousands):
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Community Health Systems, Inc. Stockholders
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Accumulated
|
|
|
|
|
|
|
|
|
|
|
|
|
Redeemable
|
|
|
|
|
|
|
Additional
|
|
|
|
|
|
Other
|
|
|
|
|
|
|
|
|
Total
|
|
|
|
Noncontrolling
|
|
|
|
Common
|
|
|
Paid-in
|
|
|
Treasury
|
|
|
Comprehensive
|
|
|
Retained
|
|
|
Noncontrolling
|
|
|
Stockholders
|
|
|
|
Interests
|
|
|
|
Stock
|
|
|
Capital
|
|
|
Stock
|
|
|
Income (Loss)
|
|
|
Earnings
|
|
|
Interests
|
|
|
Equity
|
|
Balance, December 31, 2008
(as previously reported)
|
|
$
|
|
|
|
|
$
|
925
|
|
|
$
|
1,197,944
|
|
|
$
|
(6,678
|
)
|
|
$
|
(295,575
|
)
|
|
$
|
776,249
|
|
|
$
|
|
|
|
$
|
1,672,865
|
|
January 1, 2009 adjustment to noncontrolling interests from
adoption of SFAS No. 160
|
|
|
320,171
|
|
|
|
|
|
|
|
|
(46,825
|
)
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
75,091
|
|
|
|
28,266
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Balance, December 31, 2008
(as adjusted)
|
|
|
320,171
|
|
|
|
|
925
|
|
|
|
1,151,119
|
|
|
|
(6,678
|
)
|
|
|
(295,575
|
)
|
|
|
776,249
|
|
|
|
75,091
|
|
|
|
1,701,131
|
|
Comprehensive income (loss):
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Net income
|
|
|
20,119
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
118,350
|
|
|
|
8,421
|
|
|
|
126,771
|
|
Net change in fair value of interest rate swaps
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
74,049
|
|
|
|
|
|
|
|
|
|
|
|
74,049
|
|
Net change in fair value of available for sale securities (loss)
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
(449
|
)
|
|
|
|
|
|
|
|
|
|
|
(449
|
)
|
Adjustment to pension liability
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
1,410
|
|
|
|
|
|
|
|
|
|
|
|
1,410
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Total comprehensive income
|
|
|
20,119
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
75,010
|
|
|
|
118,350
|
|
|
|
8,421
|
|
|
|
201,781
|
|
Net distributions to noncontrolling interests
|
|
|
(2,060
|
)
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
(3,147
|
)
|
|
|
(3,147
|
)
|
Purchase of subsidiary shares from noncontrolling interests
|
|
|
(140
|
)
|
|
|
|
|
|
|
|
3,345
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
610
|
|
|
|
3,955
|
|
Sale of less than wholly-owned subsidiaries
|
|
|
(21,691
|
)
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Adjustment to redemption value of redeemable noncontrolling
interests
|
|
|
7,595
|
|
|
|
|
|
|
|
|
(7,595
|
)
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
(7,595
|
)
|
Issuance of common stock in connection with the exercise of
stock options
|
|
|
|
|
|
|
|
3
|
|
|
|
3,445
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
3,448
|
|
Cancellation of restricted stock for tax withholdings on vested
shares
|
|
|
|
|
|
|
|
(2
|
)
|
|
|
(3,605
|
)
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
(3,607
|
)
|
Tax benefit from exercise of options
|
|
|
|
|
|
|
|
|
|
|
|
(3,389
|
)
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
(3,389
|
)
|
Share-based compensation
|
|
|
|
|
|
|
|
11
|
|
|
|
24,805
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
24,816
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Balance, June 30, 2009
|
|
$
|
323,994
|
|
|
|
$
|
937
|
|
|
$
|
1,168,125
|
|
|
$
|
(6,678
|
)
|
|
$
|
(220,565
|
)
|
|
$
|
894,599
|
|
|
$
|
80,975
|
|
|
$
|
1,917,393
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
16
COMMUNITY
HEALTH SYSTEMS, INC. AND SUBSIDIARIES
NOTES TO
CONDENSED CONSOLIDATED FINANCIAL
STATEMENTS (Continued)
The following schedule discloses the effects of changes in the
Companys ownership interest in its less than wholly-owned
subsidiaries on Community Health Systems, Inc.
stockholders equity:
|
|
|
|
|
|
|
Six Months Ended
|
|
|
|
June 30, 2009
|
|
|
Net income attributable to Community Health Systems, Inc.
|
|
$
|
118,350
|
|
Transfers from the noncontrolling interests:
|
|
|
|
|
Increase in Community Health Systems, Inc. paid-in capital for
purchase of subsidiary partnership interests
|
|
|
3,345
|
|
|
|
|
|
|
Net transfers from the noncontrolling interests
|
|
|
3,345
|
|
|
|
|
|
|
Change from net income attributable to Community Health Systems,
Inc. and transfers (to) from noncontrolling interests
|
|
$
|
121,695
|
|
|
|
|
|
|
The following table presents the components of comprehensive
income, net of related taxes. The net change in fair value of
interest rate swap agreements is a function of the spread
between the fixed interest rate of each swap and the underlying
variable interest rate under the Credit Facility, the change in
fair value of available for sale securities is the unrealized
gain (losses) on the related investments and the amortization of
unrecognized pension cost components is the amortization of
prior service costs and credits and actuarial gains and losses
(in thousands):
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Three Months Ended
|
|
|
Six Months Ended
|
|
|
|
June 30,
|
|
|
June 30,
|
|
|
|
2009
|
|
|
2008
|
|
|
2009
|
|
|
2008
|
|
|
Net income
|
|
$
|
73,990
|
|
|
$
|
55,144
|
|
|
$
|
146,890
|
|
|
$
|
123,880
|
|
Net change in fair value of interest rate swaps
|
|
|
61,139
|
|
|
|
109,368
|
|
|
|
74,049
|
|
|
|
4,814
|
|
Net change in fair value of available for sale securities
|
|
|
801
|
|
|
|
(105
|
)
|
|
|
(449
|
)
|
|
|
(858
|
)
|
Amortization of unrecognized pension components
|
|
|
970
|
|
|
|
880
|
|
|
|
1,410
|
|
|
|
(112
|
)
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Comprehensive income
|
|
|
136,900
|
|
|
|
165,287
|
|
|
|
221,900
|
|
|
|
127,724
|
|
Less: Comprehensive income attributable to noncontrolling
interests
|
|
|
14,555
|
|
|
|
7,251
|
|
|
|
28,540
|
|
|
|
15,860
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Comprehensive income attributable to Community Health Systems,
Inc.
|
|
$
|
122,345
|
|
|
$
|
158,036
|
|
|
$
|
193,360
|
|
|
$
|
111,864
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
The net change in fair value of the interest rate swaps, the net
change in fair value of available for sale securities and
amortization of unrecognized pension cost components are
included in accumulated other comprehensive loss on the
accompanying condensed consolidated balance sheets.
As of June 30, 2009, the Company owned equity interests of
27.5% in four hospitals in Las Vegas, Nevada, and 26.1% in one
hospital in Las Vegas, Nevada, in which Universal Health
Systems, Inc. owns the majority interest, and an equity interest
of 38.0% in three hospitals in Macon, Georgia in which HCA, Inc.
owns the majority interest. Effective April 1, 2009, one or
more subsidiaries of the Company acquired from Share Foundation
the remaining 50% equity interest in MCSA L.L.C., an entity in
which one or more subsidiaries of the Company previously had a
50% noncontrolling interest and for which it provided certain
management services. This acquisition resulted in these
subsidiaries of the Company owning 100% equity interest in that
entity. MCSA L.L.C. owns and operates
17
COMMUNITY
HEALTH SYSTEMS, INC. AND SUBSIDIARIES
NOTES TO
CONDENSED CONSOLIDATED FINANCIAL
STATEMENTS (Continued)
Medical Center of South Arkansas in El Dorado, Arkansas. The
results of operations for MCSA L.L.C. were included in the
consolidated financial statements effective April 1, 2009.
Summarized combined financial information for the three and six
months ended June 30, 2009 and 2008, for these
unconsolidated entities in which the Company owns an equity
interest is as follows (in thousands):
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Three Months Ended June 30,
|
|
|
Six Months Ended June 30,
|
|
|
|
2009
|
|
|
2008
|
|
|
2009
|
|
|
2008
|
|
|
Revenues
|
|
$
|
348,684
|
|
|
$
|
359,695
|
|
|
$
|
724,382
|
|
|
$
|
723,362
|
|
Operating costs and expenses
|
|
|
309,129
|
|
|
|
322,151
|
|
|
|
633,802
|
|
|
|
641,914
|
|
Net income
|
|
|
39,541
|
|
|
|
37,578
|
|
|
|
90,580
|
|
|
|
88,277
|
|
The summarized financial information for the three and six
months ended June 30, 2009 and 2008 was derived from the
unaudited financial information provided to the Company by those
unconsolidated entities.
The Companys investment in all of its unconsolidated
affiliates is $424.8 million and $421.6 million at
June 30, 2009 and December 31, 2008, respectively, and
is included in other assets in the accompanying condensed
consolidated balance sheets. Included in the Companys
results of operations is the Companys equity in pre-tax
earnings from all of its investments in unconsolidated
affiliates, which was $11.8 million and $10.5 million
for the three months ended June 30, 2009 and 2008,
respectively, and $24.7 million and $23.4 million for
the six months ended June 30, 2009 and 2008, respectively.
Credit
Facility and Notes
On July 25, 2007, CHS entered into the Credit Facility with
a syndicate of financial institutions led by Credit Suisse, as
administrative agent and collateral agent. The Credit Facility
consisted of a $6.065 billion funded term loan facility
with a maturity of seven years, a $400 million delayed draw
term loan facility with a maturity of seven years and a
$750 million revolving credit facility with a maturity of
nine years. As of December 31, 2007, the $400 million
delayed draw term loan facility had been reduced to
$300 million at the request of CHS. During the fourth
quarter of 2008, $100 million of the delayed draw term loan
was drawn by CHS, reducing the delayed draw term loan
availability to $200 million at December 31, 2008. In
January 2009, CHS drew down the remaining $200 million of
the delayed draw term loan. The revolving credit facility also
includes a subfacility for letters of credit and a swingline
subfacility. In connection with the consummation of the
acquisition of Triad, CHS used a portion of the net proceeds
from its Credit Facility and the Notes offering to repay its
outstanding debt under the previously outstanding credit
facility, the 6.50% senior subordinated notes due 2012 and
certain of Triads existing indebtedness. During the third
quarter of 2007, the Company recorded a pre-tax write-off of
approximately $13.9 million in deferred loan costs relative
to the early extinguishment of the debt under the previously
outstanding credit facility and incurred tender and solicitation
fees of approximately $13.4 million on the early repayment
of the Companys $300 million aggregate principal
amount of 6.50% senior subordinated notes due 2012 through
a cash tender offer and consent solicitation.
The Credit Facility requires quarterly amortization payments of
each term loan facility equal to 0.25% of the outstanding amount
of the term loans, if any, with the outstanding principal
balance payable on July 25, 2014.
The term loan facility must be prepaid in an amount equal to
(1) 100% of the net cash proceeds of certain asset sales
and dispositions by the Company and its subsidiaries, subject to
certain exceptions and reinvestment rights, (2) 100% of the
net cash proceeds of issuances of certain debt obligations or
receivables based financing by the Company and its subsidiaries,
subject to certain exceptions, and (3) 50%, subject to
reduction to a lower percentage based on the Companys
leverage ratio (as defined in the Credit Facility generally as
the ratio of total debt on the date of determination to the
Companys EBITDA, as defined, for the four quarters most
recently ended prior to such
18
COMMUNITY
HEALTH SYSTEMS, INC. AND SUBSIDIARIES
NOTES TO
CONDENSED CONSOLIDATED FINANCIAL
STATEMENTS (Continued)
date), of excess cash flow (as defined) for any year, commencing
in 2008, subject to certain exceptions. Voluntary prepayments
and commitment reductions are permitted in whole or in part,
without any premium or penalty, subject to minimum prepayment or
reduction requirements.
The obligor under the Credit Facility is CHS. All of the
obligations under the Credit Facility are unconditionally
guaranteed by the Company and certain existing and subsequently
acquired or organized domestic subsidiaries. All obligations
under the Credit Facility and the related guarantees are secured
by a perfected first priority lien or security interest in
substantially all of the assets of the Company, CHS and each
subsidiary guarantor, including equity interests held by the
Company, CHS or any subsidiary guarantor, but excluding, among
others, the equity interests of non-significant subsidiaries,
syndication subsidiaries, securitization subsidiaries and joint
venture subsidiaries.
The loans under the Credit Facility bear interest on the
outstanding unpaid principal amount at a rate equal to an
applicable percentage plus, at CHSs option, either
(a) an Alternate Base Rate (as defined) determined by
reference to the greater of (1) the Prime Rate (as defined)
announced by Credit Suisse or (2) the Federal Funds
Effective Rate (as defined) plus one-half of 1.0%, or (b) a
reserve adjusted London interbank offered rate for dollars
(Eurodollar Rate) (as defined). The applicable percentage for
term loans is 1.25% for Alternate Base Rate loans and 2.25% for
Eurodollar rate loans. The applicable percentage for revolving
loans is initially 1.25% for Alternate Base Rate revolving loans
and 2.25% for Eurodollar revolving loans, in each case subject
to reduction based on the Companys leverage ratio. Loans
under the swingline subfacility bear interest at the rate
applicable to Alternate Base Rate loans under the revolving
credit facility.
CHS has agreed to pay letter of credit fees equal to the
applicable percentage then in effect with respect to Eurodollar
rate loans under the revolving credit facility times the maximum
aggregate amount available to be drawn under all letters of
credit outstanding under the subfacility for letters of credit.
The issuer of any letter of credit issued under the subfacility
for letters of credit will also receive a customary fronting fee
and other customary processing charges. CHS is initially
obligated to pay commitment fees of 0.50% per annum (subject to
reduction based upon the Companys leverage ratio) on the
unused portion of the revolving credit facility. For purposes of
this calculation, swingline loans are not treated as usage of
the revolving credit facility. With respect to the delayed draw
term loan facility, CHS was also obligated to pay commitment
fees of 0.50% per annum for the first nine months after the
closing of the Credit Facility, 0.75% per annum for the next
three months after such nine-month period and thereafter, 1.0%
per annum. In each case, the commitment fee was paid on the
unused amount of the delayed draw term loan facility. After the
draw down of the remaining $200 million of the delayed draw
term loan in January 2009, CHS no longer pays commitment fees
for the delayed draw term loan facility. CHS paid arrangement
fees on the closing of the Credit Facility and pays an annual
administrative agent fee.
The Credit Facility contains customary representations and
warranties, subject to limitations and exceptions, and customary
covenants restricting, subject to certain exceptions, the
Companys and its subsidiaries ability to, among
other things (1) declare dividends, make distributions or
redeem or repurchase capital stock, (2) prepay, redeem or
repurchase other debt, (3) incur liens or grant negative
pledges, (4) make loans and investments and enter into
acquisitions and joint ventures, (5) incur additional
indebtedness or provide certain guarantees, (6) make
capital expenditures, (7) engage in mergers, acquisitions
and asset sales, (8) conduct transactions with affiliates,
(9) alter the nature of the Companys businesses,
(10) grant certain guarantees with respect to physician
practices, (11) engage in sale and leaseback transactions
or (12) change the Companys fiscal year. The Company
is also required to comply with specified financial covenants
(consisting of a leverage ratio and an interest coverage ratio)
and various affirmative covenants.
Events of default under the Credit Facility include, but are not
limited to, (1) CHSs failure to pay principal,
interest, fees or other amounts under the credit agreement when
due (taking into account any applicable grace period),
(2) any representation or warranty proving to have been
materially incorrect when made, (3) covenant defaults
subject, with respect to certain covenants, to a grace period,
(4) bankruptcy events, (5) a cross default to certain
other debt, (6) certain undischarged judgments (not paid
within an applicable grace period), (7) a change of
19
COMMUNITY
HEALTH SYSTEMS, INC. AND SUBSIDIARIES
NOTES TO
CONDENSED CONSOLIDATED FINANCIAL
STATEMENTS (Continued)
control, (8) certain ERISA-related defaults and
(9) the invalidity or impairment of specified security
interests, guarantees or subordination provisions in favor of
the administrative agent or lenders under the Credit Facility.
The Notes were issued by CHS in connection with the Triad
acquisition in the principal amount of $3.021 billion.
These Notes will mature on July 15, 2015. The Notes bear
interest at the rate of 8.875% per annum, payable semiannually
in arrears on January 15 and July 15, commencing
January 15, 2008. Interest on the Notes accrues from the
date of original issuance. Interest is calculated on the basis
of 360-day
year comprised of twelve
30-day
months.
Except as set forth below, CHS is not entitled to redeem the
Notes prior to July 15, 2011.
On and after July 15, 2011, CHS is entitled, at its option,
to redeem all or a portion of the Notes upon not less than 30
nor more than 60 days notice, at the redemption prices
(expressed as a percentage of principal amount on the redemption
date), plus accrued and unpaid interest, if any, to the
redemption date (subject to the right of holders of record on
the relevant record date to receive interest due on the relevant
interest payment date), if redeemed during the
12-month
period commencing on July 15 of the years set forth below:
|
|
|
|
|
Period
|
|
Redemption Price
|
|
|
2011
|
|
|
104.438
|
%
|
2012
|
|
|
102.219
|
%
|
2013 and thereafter
|
|
|
100.000
|
%
|
In addition, any time prior to July 15, 2010, CHS is
entitled, at its option, on one or more occasions to redeem the
Notes (which include additional Notes (the Additional
Notes), if any which may be issued from time to time under
the indenture under which the Notes were issued) in an aggregate
principal amount not to exceed 35% of the aggregate principal
amount of the Notes (which includes Additional Notes, if any)
originally issued at a redemption price (expressed as a
percentage of principal amount) of 108.875%, plus accrued and
unpaid interest to the redemption date, with the Net Cash
Proceeds (as defined) from one or more Public Equity Offerings
(as defined) (provided that if the Public Equity Offering is an
offering by the Company, a portion of the Net Cash Proceeds
thereof equal to the amount required to redeem any such Notes is
contributed to the equity capital of CHS); provided, however,
that:
1) at least 65% of such aggregate principal amount of Notes
originally issued remains outstanding immediately after the
occurrence of each such redemption (other than the Notes held,
directly or indirectly, by the Company or its
subsidiaries); and
2) each such redemption occurs within 90 days after
the date of the related Public Equity Offering.
CHS is entitled, at its option, to redeem the Notes, in whole or
in part, at any time prior to July 15, 2011, upon not less
than 30 or more than 60 days notice, at a redemption price
equal to 100% of the principal amount of Notes redeemed plus the
Application Premium (as defined), and accrued and unpaid
interest, if any, as of the applicable redemption date.
Pursuant to a registration rights agreement entered into at the
time of the issuance of the Notes, as a result of an exchange
offer made by CHS, substantially all of the Notes issued in July
2007 were exchanged in November 2007 for new notes (the
Exchange Notes) having terms substantially identical
in all material respects to the Notes (except that the Exchange
Notes were issued under a registration statement pursuant to the
Securities Act of 1933, as amended). References to the Notes
shall also be deemed to include Exchange Notes unless the
context provides otherwise.
During the three months ended June 30, 2009, the Company
repurchased on the open market and cancelled $61.0 million
of principal amount of the Notes. This resulted in a net gain
from early extinguishment of debt of $0.3 million with an
after-tax impact of $0.2 million. During the six months
ended June 30, 2009, the Company
20
COMMUNITY
HEALTH SYSTEMS, INC. AND SUBSIDIARIES
NOTES TO
CONDENSED CONSOLIDATED FINANCIAL
STATEMENTS (Continued)
repurchased on the open market and cancelled $121.5 million
of principal amount of the Notes. This resulted in a net gain
from early extinguishment of debt of $2.7 million with an
after-tax impact of $1.7 million.
On April 2, 2009, the Company paid down $110.4 million
of its term loans under the Credit Facility. Of this amount,
$85.0 million was paid down as required under the terms of
the Credit Facility with the net proceeds received from the sale
of the ownership interest in the partnership that owned and
operated Presbyterian Hospital of Denton. This resulted in a
loss from early extinguishment of debt of $1.1 million with
an after-tax impact of $0.7 million recorded in
discontinued operations for both the three and six months ended
June 30, 2009. The remaining $25.4 million was paid on
the term loans as required under the terms of the Credit
Facility with the net proceeds received from the sale of various
other assets. This resulted in a loss from early extinguishment
of debt of $0.3 million with an after-tax impact of
$0.2 million recorded in continuing operations for both the
three and six months ended June 30, 2009.
As of June 30, 2009, the availability for additional
borrowings under the Credit Facility was $750 million
pursuant to the revolving credit facility, of which
$89.2 million was set aside for outstanding letters of
credit. CHS also has the ability to add up to $300 million
of borrowing capacity from receivable transactions (including
securitizations) under the Credit Facility, which has not yet
been accessed. CHS also has the ability to amend the Credit
Facility to provide for one or more tranches of term loans in an
aggregate principal amount of $600 million, which CHS has
not yet accessed. As of June 30, 2009, the weighted-average
interest rate under the Credit Facility, excluding swaps, was
3.2%.
Cash paid for interest, net of interest income, was
$102.1 million and $97.4 million during the three
months ended June 30, 2009 and 2008, respectively, and
$335.0 million and $326.4 million during the six
months ended June 30, 2009 and 2008, respectively.
|
|
13.
|
FAIR
VALUE OF FINANCIAL INSTRUMENTS
|
The fair value of financial instruments has been estimated by
the Company using available market information as of
June 30, 2009 and December 31, 2008, and valuation
methodologies considered appropriate. The estimates presented
are not necessarily indicative of amounts the Company could
realize in a current market exchange (in thousands):
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
June 30, 2009
|
|
|
December 31, 2008
|
|
|
|
Carrying
|
|
|
Estimated Fair
|
|
|
Carrying
|
|
|
Estimated Fair
|
|
|
|
Amount
|
|
|
Value
|
|
|
Amount
|
|
|
Value
|
|
|
Assets:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Cash and cash equivalents
|
|
$
|
268,825
|
|
|
$
|
268,825
|
|
|
$
|
220,655
|
|
|
$
|
220,655
|
|
Available-for-sale
securities
|
|
|
6,959
|
|
|
|
6,959
|
|
|
|
6,325
|
|
|
|
6,325
|
|
Trading securities
|
|
|
21,654
|
|
|
|
21,654
|
|
|
|
24,325
|
|
|
|
24,325
|
|
Liabilities:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Credit facilities
|
|
|
6,054,715
|
|
|
|
5,449,224
|
|
|
|
5,965,866
|
|
|
|
4,653,375
|
|
Tax-exempt bonds
|
|
|
8,000
|
|
|
|
8,000
|
|
|
|
8,000
|
|
|
|
8,000
|
|
Senior notes
|
|
|
2,789,331
|
|
|
|
2,740,518
|
|
|
|
2,910,831
|
|
|
|
2,677,965
|
|
Other debt
|
|
|
42,769
|
|
|
|
42,769
|
|
|
|
41,663
|
|
|
|
41,663
|
|
Cash and cash equivalents. The carrying amount
approximates fair value due to the short-term maturity of these
instruments (less than three months).
Available-for-sale
securities. Estimated fair value is based on
closing price as quoted in public markets.
Trading securities. Estimated fair value is
based on closing price as quoted in public markets.
21
COMMUNITY
HEALTH SYSTEMS, INC. AND SUBSIDIARIES
NOTES TO
CONDENSED CONSOLIDATED FINANCIAL
STATEMENTS (Continued)
Credit facilities. Estimated fair value is
based on information from the Companys bankers regarding
relevant pricing for trading activity among the Companys
lending institutions.
Tax-exempt bonds. The carrying amount
approximates fair value as a result of the weekly interest rate
reset feature of these publicly-traded instruments.
Senior notes. Estimated fair value is based on
the average bid and ask price as quoted by the bank who served
as underwriter in the sale of these notes.
Other debt. The carrying amount of all other
debt approximates fair value due to the nature of these
obligations.
Interest Rate Swaps. The fair value of
interest rate swap agreements is the amount at which they could
be settled, based on estimates calculated by the Company using a
discounted cash flow analysis based on observable market inputs
and validated by comparison to estimates obtained from the
counterparty. The Company has designated the interest rate swaps
as cash flow hedge instruments whose recorded value included in
other long-term liabilities in the consolidated balance sheet
approximates fair market value.
The Company assesses the effectiveness of its hedge instruments
on a quarterly basis. For the three months ended June 30,
2009 and 2008, the Company completed an assessment of the cash
flow hedge instruments and determined the hedges to be highly
effective. The Company has also determined that the ineffective
portion of the hedges do not have a material effect on the
Companys consolidated financial position, operations or
cash flows. The counterparties to the interest rate swap
agreements expose the Company to credit risk in the event of
non-performance. However, at June 30, 2009, since all but
one of the swap agreements entered into by the Company were in
net liability positions so that the Company would be required to
make the net settlement payments to the counterparties, the
Company does not anticipate non-performance by those
counterparties. The Company does not hold or issue derivative
financial instruments for trading purposes.
22
COMMUNITY
HEALTH SYSTEMS, INC. AND SUBSIDIARIES
NOTES TO
CONDENSED CONSOLIDATED FINANCIAL
STATEMENTS (Continued)
Interest rate swaps consisted of the following at June 30,
2009:
|
|
|
|
|
|
|
|
|
|
|
Notional
|
|
|
|
|
|
|
|
|
Amount
|
|
Fixed Interest
|
|
Termination
|
|
Fair Value
|
Swap #
|
|
(in 000s)
|
|
Rate
|
|
Date
|
|
(in 000s)
|
|
1
|
|
$704,000
|
|
0.4250%
|
|
August 28, 2009
|
|
$ (147)(1)
|
2
|
|
100,000
|
|
4.3375%
|
|
November 30, 2009
|
|
(1,725)
|
3
|
|
200,000
|
|
2.8800%
|
|
September 17, 2010
|
|
(3,397)
|
4
|
|
100,000
|
|
4.9360%
|
|
October 4, 2010
|
|
(4,435)
|
5
|
|
100,000
|
|
4.7090%
|
|
January 24, 2011
|
|
(5,059)
|
6
|
|
300,000
|
|
5.1140%
|
|
August 8, 2011
|
|
(22,170)
|
7
|
|
100,000
|
|
4.7185%
|
|
August 19, 2011
|
|
(6,746)
|
8
|
|
100,000
|
|
4.7040%
|
|
August 19, 2011
|
|
(6,590)
|
9
|
|
100,000
|
|
4.6250%
|
|
August 19, 2011
|
|
(6,544)
|
10
|
|
200,000
|
|
4.9300%
|
|
August 30, 2011
|
|
(14,235)
|
11
|
|
200,000
|
|
3.0920%
|
|
September 18, 2011
|
|
(6,442)
|
12
|
|
100,000
|
|
3.0230%
|
|
October 23, 2011
|
|
(3,064)
|
13
|
|
200,000
|
|
4.4815%
|
|
October 26, 2011
|
|
(12,729)
|
14
|
|
200,000
|
|
4.0840%
|
|
December 3, 2011
|
|
(11,097)
|
15
|
|
100,000
|
|
3.8470%
|
|
January 4, 2012
|
|
(5,026)
|
16
|
|
100,000
|
|
3.8510%
|
|
January 4, 2012
|
|
(5,036)
|
17
|
|
100,000
|
|
3.8560%
|
|
January 4, 2012
|
|
(5,048)
|
18
|
|
200,000
|
|
3.7260%
|
|
January 8, 2012
|
|
(9,470)
|
19
|
|
200,000
|
|
3.5065%
|
|
January 16, 2012
|
|
(8,399)
|
20
|
|
250,000
|
|
5.0185%
|
|
May 30, 2012
|
|
(20,874)
|
21
|
|
150,000
|
|
5.0250%
|
|
May 30, 2012
|
|
(12,597)
|
22
|
|
200,000
|
|
4.6845%
|
|
September 11, 2012
|
|
(15,307)
|
23
|
|
100,000
|
|
3.3520%
|
|
October 23, 2012
|
|
(3,563)
|
24
|
|
125,000
|
|
4.3745%
|
|
November 23, 2012
|
|
(8,486)
|
25
|
|
75,000
|
|
4.3800%
|
|
November 23, 2012
|
|
(5,129)
|
26
|
|
150,000
|
|
5.0200%
|
|
November 30, 2012
|
|
(13,386)
|
27
|
|
100,000
|
|
5.0230%
|
|
May 30, 2013
|
|
(9,290)
|
28
|
|
300,000
|
|
5.2420%
|
|
August 6, 2013
|
|
(31,538)
|
29
|
|
100,000
|
|
5.0380%
|
|
August 30, 2013
|
|
(9,517)
|
30
|
|
50,000
|
|
3.5860%
|
|
October 23, 2013
|
|
(1,879)
|
31
|
|
50,000
|
|
3.5240%
|
|
October 23, 2013
|
|
(1,754)
|
32
|
|
100,000
|
|
5.0500%
|
|
November 30, 2013
|
|
(9,742)
|
33
|
|
200,000
|
|
2.0700%
|
|
December 19, 2013
|
|
6,241
|
34
|
|
100,000
|
|
5.2310%
|
|
July 25, 2014
|
|
(10,895)
|
35
|
|
100,000
|
|
5.2310%
|
|
July 25, 2014
|
|
(10,895)
|
36
|
|
200,000
|
|
5.1600%
|
|
July 25, 2014
|
|
(21,120)
|
37
|
|
75,000
|
|
5.0405%
|
|
July 25, 2014
|
|
(7,498)
|
38
|
|
125,000
|
|
5.0215%
|
|
July 25, 2014
|
|
(12,384)
|
|
|
|
(1) |
|
This interest rate swap is a
90-day swap
for which we pay a monthly fixed rate of 0.4250% and receive
one-month LIBOR rates payable on $704 million of term loans
under the Credit Facility. As with each of these swap
agreements, the variable interest rate received matches the
variable interest rate paid for the revolving credit and term
loans under the Credit Facility. The Company continues to pay a
margin of 225 basis points for the revolving credit and
term loans under the Credit Facility. |
23
COMMUNITY
HEALTH SYSTEMS, INC. AND SUBSIDIARIES
NOTES TO
CONDENSED CONSOLIDATED FINANCIAL
STATEMENTS (Continued)
In September 2006, the FASB issued SFAS No. 157,
Fair Value Measurements
(SFAS No. 157), which defines fair value,
provides a framework for measuring fair value, and expands
disclosures required for fair value measurements.
SFAS No. 157 applies to other accounting
pronouncements that require fair value measurement; it does not
require any new fair value measurements. SFAS No. 157
was effective for fiscal years beginning after November 15,
2007, and was adopted by the Company as of January 1, 2008.
The adoption of this statement has not had a material effect on
the Companys consolidated results of operations or
consolidated financial position.
In February 2008, the FASB issued FASB Staff Position
No. 157-2,
Effective Date of FASB Statement No. 157,
(FSP 157-2).
FSP 157-2
deferred the effective date of the provisions of
SFAS No. 157 for all non-financial assets and
non-financial liabilities to fiscal years beginning after
November 15, 2008, and was adopted by the Company as of
January 1, 2009. The adoption of this statement has not had
a material effect on the Companys consolidated results of
operations or consolidated financial position.
Fair
Value Hierarchy
SFAS No. 157 emphasizes that fair value is a
market-based measurement, not an entity-specific measurement.
Therefore, a fair value measurement should be determined based
on the assumptions that market participants would use in pricing
the asset or liability. As a basis for considering market
participant assumptions in fair value measurements,
SFAS No. 157 establishes a fair value hierarchy that
distinguishes between market participant assumptions based on
market data obtained from sources independent of the reporting
entity (observable inputs that are classified within
Levels 1 and 2 of the hierarchy) and the reporting
entitys own assumption about market participant
assumptions (unobservable inputs classified within Level 3
of the hierarchy).
SFAS No. 157 classifies the inputs used to measure
fair value into the following hierarchy:
Level 1: Quoted market prices in active
markets for identical assets or liabilities.
Level 2: Observable market-based inputs
or unobservable inputs that are corroborated by market data.
Level 3: Unobservable inputs that are
supported by little or no market activity and are significant to
the fair value of the assets or liabilities. Level 3
includes values determined using pricing models, discounted cash
flow methodologies, or similar techniques reflecting the
Companys own assumptions.
In instances where the determination of the fair value hierarchy
measurement is based on inputs from different levels of the fair
value hierarchy, the level in the fair value hierarchy within
which the entire fair value measurement falls is based on the
lowest level input that is significant to the fair value
measurement in its entirety. The Companys assessment of
the significance of a particular input to the fair value
measurement in its entirety requires judgment of factors
specific to the asset or liability.
The following table sets forth, by level within the fair value
hierarchy, the financial assets and liabilities recorded at fair
value on a recurring basis as of June 30, 2009 (in
thousands):
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
June 30,
|
|
|
|
|
|
|
|
|
|
|
|
|
2009
|
|
|
Level 1
|
|
|
Level 2
|
|
|
Level 3
|
|
|
Available-for-sale
securities
|
|
$
|
6,959
|
|
|
$
|
6,959
|
|
|
$
|
|
|
|
$
|
|
|
Trading securities
|
|
|
21,654
|
|
|
|
21,654
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Total assets
|
|
$
|
28,613
|
|
|
$
|
28,613
|
|
|
$
|
|
|
|
$
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Fair value of interest rate swap agreements
|
|
$
|
319,432
|
|
|
$
|
|
|
|
$
|
319,432
|
|
|
$
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Total liabilities
|
|
$
|
319,432
|
|
|
$
|
|
|
|
$
|
319,432
|
|
|
$
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
24
COMMUNITY
HEALTH SYSTEMS, INC. AND SUBSIDIARIES
NOTES TO
CONDENSED CONSOLIDATED FINANCIAL
STATEMENTS (Continued)
Available-for-sale
securities and trading securities classified as Level 1 are
measured using quoted market prices.
The valuation of the Companys interest rate swap
agreements is determined using market valuation techniques,
including discounted cash flow analysis on the expected cash
flows of each agreement. This analysis reflects the contractual
terms of the agreement, including the period to maturity, and
uses observable market-based inputs, including forward interest
rate curves. The fair values of interest rate swap agreements
are determined by netting the discounted future fixed cash
payments (or receipts) and the discounted expected variable cash
receipts (or payments). The variable cash receipts (or payments)
are based on the expectation of future interest rates based on
observable market forward interest rate curves and the notional
amount being hedged.
To comply with the provisions of SFAS No. 157, the
Company incorporates credit valuation adjustments (CVAs) to
appropriately reflect both its own nonperformance or credit risk
and the respective counterpartys nonperformance or credit
risk in the fair value measurements. In adjusting the fair value
of its interest rate swap agreements for the effect of
nonperformance risk, the Company has considered the impact of
any netting features included in the agreements. The CVA on the
Companys interest rate swap agreements at June 30,
2009 resulted in a decrease in the fair value of the related
liability of $40.5 million and an after-tax adjustment of
$25.9 million to other comprehensive income.
The majority of the inputs used to value its interest rate swap
agreements, including the forward interest rate curves and
market perceptions of the Companys credit risk used in the
CVAs, are observable inputs available to a market participant.
As a result, the Company has determined that the interest rate
swap valuations are classified in Level 2 of the fair value
hierarchy.
The contractual obligation liability recorded during the year
ended December 31, 2008, represented the fair value of a
put option assumed in connection with a business combination
using unobservable inputs and assumptions available to the
Company. The contractual obligation represented by this
liability was settled during the three months ended
March 31, 2009, as a result of the sale of ownership
interest in the partnership that owned Presbyterian Hospital of
Denton. The following table presents a reconciliation of the
beginning and ending balance of the contractual obligation
liability (in thousands):
|
|
|
|
|
|
|
Contractual
|
|
|
|
Obligation
|
|
|
|
Liability
|
|
|
Balance at January 1, 2009
|
|
$
|
48,985
|
|
Settlement of contractual obligation liability
|
|
|
(48,985
|
)
|
|
|
|
|
|
Balance at June 30, 2009
|
|
$
|
|
|
|
|
|
|
|
|
|
15.
|
DERIVATIVE
INSTRUMENTS
|
In March 2008, the FASB issued SFAS No. 161,
Disclosures about Derivative Instruments and Hedging
Activities (SFAS No. 161).
SFAS No. 161 expands the disclosure requirements for
derivative instruments and for hedging activities in order to
provide additional understanding of how an entity uses
derivative instruments and how they are accounted for and
reported in an entitys financial statements. The new
disclosure requirements for SFAS No. 161 are effective
for fiscal years beginning after November 15, 2008, and
were adopted by the Company on January 1, 2009. The
adoption of this statement has not had a material effect on the
Companys consolidated results of operations or
consolidated financial position.
The Company is exposed to certain risks relating to its ongoing
business operations. The primary risk managed by using
derivative instruments is interest rate risk. Interest rate
swaps are entered into to manage interest rate risk associated
with the term loans in the Credit Facility.
SFAS No. 133 requires companies to recognize all
derivative instruments as either assets or liabilities at fair
value in the consolidated statement of financial position. In
25
COMMUNITY
HEALTH SYSTEMS, INC. AND SUBSIDIARIES
NOTES TO
CONDENSED CONSOLIDATED FINANCIAL
STATEMENTS (Continued)
accordance with SFAS No. 133, the Company designates
interest rate swaps as cash flow hedges. For derivative
instruments that are designated and qualify as cash flow hedges,
the effective portion of the gain or loss on the derivative is
reported as a component of other comprehensive income and
reclassified into earnings in the same period or periods during
which the hedged transactions affects earnings. Gains and losses
on the derivative representing either hedge ineffectiveness or
hedge components excluded from the assessment of effectiveness
are recognized in current earnings.
The Companys derivative instruments had no effect on the
Companys consolidated results of operations for the three
and six months ended June 30, 2009 and 2008.
The fair values of derivative instruments in the condensed
consolidated balance sheets as of June 30, 2009 and
December 31, 2008 were as follows (in thousands):
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Asset Derivatives
|
|
|
Liability Derivatives
|
|
|
June 30, 2009
|
|
December 31, 2008
|
|
|
June 30, 2009
|
|
December 31, 2008
|
|
|
Balance
|
|
|
|
Balance
|
|
|
|
|
Balance
|
|
|
|
Balance
|
|
|
|
|
Sheet
|
|
|
|
Sheet
|
|
|
|
|
Sheet
|
|
|
|
Sheet
|
|
|
|
|
Location
|
|
Fair Value
|
|
Location
|
|
Fair Value
|
|
|
Location
|
|
Fair Value
|
|
Location
|
|
Fair Value
|
Derivatives designated as hedging instruments under Statement 133
|
|
Other
assets,
net
|
|
$
|
|
|
|
Other
assets,
net
|
|
$
|
|
|
|
|
Other
long-term
liabilities
|
|
$
|
319,432
|
|
|
Other
long-term
liabilities
|
|
$
|
435,134
|
|
The Company operates in three distinct operating segments,
represented by hospital operations (which includes its general
acute care hospitals and related healthcare entities that
provide inpatient and outpatient health care services), home
care agency operations (which provide in-home outpatient care),
and hospital management services (which provides executive
management and consulting services to non-affiliated acute care
hospitals). Only the hospital operations segment meets the
criteria in SFAS No. 131, Disclosure about
Segments of an Enterprise and Related Information
(SFAS No. 131), as a separate reportable
segment. The financial information for the home care agencies
and management services segments do not meet the quantitative
thresholds defined in SFAS No. 131 and are combined
into the corporate and all other reportable segment.
The distribution between reportable segments of the
Companys revenues and income from continuing operations
before income taxes is summarized in the following tables (in
thousands):
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Three Months Ended
|
|
|
Six Months Ended
|
|
|
|
June 30,
|
|
|
June 30,
|
|
|
|
2009
|
|
|
2008
|
|
|
2009
|
|
|
2008
|
|
|
Revenues:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Hospital operations
|
|
$
|
2,946,985
|
|
|
$
|
2,611,869
|
|
|
$
|
5,798,032
|
|
|
$
|
5,260,539
|
|
Corporate and all other
|
|
|
69,976
|
|
|
|
61,284
|
|
|
|
131,678
|
|
|
|
122,969
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
$
|
3,016,961
|
|
|
$
|
2,673,153
|
|
|
$
|
5,929,710
|
|
|
$
|
5,383,508
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Income from continuing operations before income taxes:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Hospital operations
|
|
$
|
147,786
|
|
|
$
|
123,515
|
|
|
$
|
287,847
|
|
|
$
|
245,935
|
|
Corporate and all other
|
|
|
(36,079
|
)
|
|
|
(37,932
|
)
|
|
|
(69,686
|
)
|
|
|
(72,233
|
)
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
$
|
111,707
|
|
|
$
|
85,583
|
|
|
$
|
218,161
|
|
|
$
|
173,702
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
26
COMMUNITY
HEALTH SYSTEMS, INC. AND SUBSIDIARIES
NOTES TO
CONDENSED CONSOLIDATED FINANCIAL
STATEMENTS (Continued)
The Company is a party to various legal proceedings incidental
to its business. In the opinion of management, any ultimate
liability with respect to these actions will not have a material
adverse effect on the Companys consolidated financial
position, cash flows or results of operations.
In a letter dated October 4, 2007, the Civil Division of
the Department of Justice notified the Company that, as a result
of an investigation into the way in which different state
Medicaid programs apply to the federal government for matching
or supplemental funds that are ultimately used to pay for a
small portion of the services provided to Medicaid and indigent
patients, it believes the Company and three of its New Mexico
hospitals have caused the State of New Mexico to submit improper
claims for federal funds in violation of the Federal False
Claims Act. This investigation has culminated in the federal
governments intervention in a qui tam lawsuit styled
U.S. ex rel. Baker vs. Community Health Systems, Inc.
The federal government filed its complaint in intervention
on June 30, 2009. The relator filed a second amended
complaint on July 1, 2009. The Companys responses are
due within 60 days. The Company is vigorously defending
this action.
SFAS No. 165 Subsequent Events
(SFAS No. 165) establishes general
standards of accounting for and disclosure of events that occur
after the balance sheet date but before financial statements are
issued or are available to be issued. In particular, this
Statement sets forth: (1) the period after the balance
sheet date during which management of a reporting entity should
evaluate events or transactions that may occur for potential
recognition or disclosure in the financial statements,
(2) the circumstances under which an entity should
recognize events or transactions occurring after the balance
sheet date in its financial statements and (3) the
disclosures that an entity should make about events or
transactions that occurred after the balance sheet date.
SFAS No. 165 is effective for interim or annual
financial periods ending after June 15, 2009. This standard
does not result in significant changes in the subsequent events
that are reported either through recognition or disclosure in
the consolidated financial statements. In accordance with
SFAS No. 165, the Company evaluated all material
events occurring subsequent to the balance sheet date through
July 31, 2009, the date the consolidated financial
statements were issued, for events requiring disclosure or
recognition in the consolidated financial statements.
|
|
19.
|
FASB
ACCOUNTING STANDARDS CODIFICATION
|
SFAS No. 168 The FASB Accounting Standards
Codification and the Hierarchy of Generally Accepted Accounting
Principles a replacement of FASB Statement
No. 162 (SFAS No. 168) is
effective for financial statements issued for interim and annual
periods ending after September 15, 2009. The FASB
Accounting Standards Codification (Codification)
will become the source of authoritative U.S. GAAP
recognized by the FASB to be applied by nongovernmental
entities. Rules and interpretive releases of the SEC under
authority of federal securities laws are also sources of
authoritative U.S. GAAP for SEC registrants. On the
effective date of this Statement, the Codification will
supersede all then-existing non-SEC accounting and reporting
standards. All other non-grandfathered non-SEC accounting
literature not included in the Codification will become
non-authoritative. The issuance of SFAS No. 168 and
the Codification do not change current U.S. GAAP and will
not have an impact on the Companys consolidated results of
operations or consolidated financial position.
|
|
20.
|
SUPPLEMENTAL
CONDENSED CONSOLIDATING FINANCIAL INFORMATION
|
In connection with the consummation of the Triad acquisition,
CHS obtained $7.215 billion of senior secured financing
under the Credit Facility and issued the Notes in the aggregate
principal amount of $3.021 billion. The Notes are senior
unsecured obligations of CHS and are guaranteed on a senior
basis by the Company and by certain of existing and subsequently
acquired or organized 100% owned domestic subsidiaries.
27
COMMUNITY
HEALTH SYSTEMS, INC. AND SUBSIDIARIES
NOTES TO
CONDENSED CONSOLIDATED FINANCIAL
STATEMENTS (Continued)
The Notes are fully and unconditionally guaranteed on a joint
and several basis. The following condensed consolidating
financial statements present Community Health Systems, Inc. (as
parent guarantor), CHS (as the issuer), the subsidiary
guarantors, the subsidiary non-guarantors and eliminations.
These condensed consolidating financial statements have been
prepared and presented in accordance with SEC
Regulation S-X
Rule 3-10
Financial Statements of Guarantors and Issuers of
Guaranteed Securities Registered or Being Registered.
The accounting policies used in the preparation of this
financial information are consistent with those elsewhere in the
consolidated financial statements of the Company, except as
noted below:
|
|
|
|
|
Intercompany receivables and payables are presented gross in the
supplemental consolidating balance sheets.
|
|
|
|
Cash flows from intercompany transactions are presented in cash
flows from financing activities, as changes in intercompany
balances with affiliates, net.
|
|
|
|
Income tax expense is allocated from the parent guarantor to the
income producing operations (other guarantors and
non-guarantors) and the issuer through stockholders
equity. As this approach represents an allocation, the income
tax expense allocation is considered non-cash for statement of
cash flow purposes.
|
|
|
|
Interest expense, net has been presented to reflect net interest
expense and interest income from outstanding long-term debt and
intercompany balances.
|
The Companys intercompany activity consists primarily of
daily cash transfers for purposes of cash management, the
allocation of certain expenses and expenditures paid for by the
parent on behalf of its subsidiaries, and the push down of
investment in its subsidiaries. The Companys subsidiaries
generally do not purchase services from one another and
therefore the intercompany transactions do not represent revenue
generating transactions. All intercompany transactions eliminate
in consolidation.
28
COMMUNITY
HEALTH SYSTEMS, INC. AND SUBSIDIARIES
NOTES TO
CONDENSED CONSOLIDATED FINANCIAL
STATEMENTS (Continued)
Condensed
Consolidating Balance Sheet
June 30, 2009
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Parent
|
|
|
|
|
|
Other
|
|
|
Non-
|
|
|
|
|
|
|
|
|
|
Guarantor
|
|
|
Issuer
|
|
|
Guarantors
|
|
|
Guarantors
|
|
|
Eliminations
|
|
|
Consolidated
|
|
|
|
(In thousands, except share data)
|
|
|
ASSETS
|
Current assets:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Cash and cash equivalents
|
|
$
|
|
|
|
$
|
|
|
|
$
|
173,773
|
|
|
$
|
95,052
|
|
|
$
|
|
|
|
$
|
268,825
|
|
Patient accounts receivable, net of allowance for doubtful
accounts
|
|
|
|
|
|
|
|
|
|
|
1,035,917
|
|
|
|
622,006
|
|
|
|
|
|
|
|
1,657,923
|
|
Supplies
|
|
|
|
|
|
|
|
|
|
|
180,048
|
|
|
|
106,546
|
|
|
|
|
|
|
|
286,594
|
|
Deferred income taxes
|
|
|
91,875
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
91,875
|
|
Prepaid expenses and taxes
|
|
|
|
|
|
|
24
|
|
|
|
70,791
|
|
|
|
23,783
|
|
|
|
|
|
|
|
94,598
|
|
Other current assets
|
|
|
|
|
|
|
20
|
|
|
|
107,452
|
|
|
|
92,144
|
|
|
|
|
|
|
|
199,616
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Total current assets
|
|
|
91,875
|
|
|
|
44
|
|
|
|
1,567,981
|
|
|
|
939,531
|
|
|
|
|
|
|
|
2,599,431
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Intercompany receivable
|
|
|
938,577
|
|
|
|
9,375,765
|
|
|
|
8,398,180
|
|
|
|
2,753,282
|
|
|
|
(21,465,804
|
)
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Property and equipment, net
|
|
|
|
|
|
|
|
|
|
|
3,886,085
|
|
|
|
2,190,060
|
|
|
|
|
|
|
|
6,076,145
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Goodwill
|
|
|
|
|
|
|
|
|
|
|
2,423,680
|
|
|
|
1,764,288
|
|
|
|
|
|
|
|
4,187,968
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Other assets, net of accumulated amortization
|
|
|
|
|
|
|
155,262
|
|
|
|
347,233
|
|
|
|
505,983
|
|
|
|
|
|
|
|
1,008,478
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Net investment in subsidiaries
|
|
|
1,324,759
|
|
|
|
5,274,168
|
|
|
|
3,295,169
|
|
|
|
|
|
|
|
(9,894,096
|
)
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Total assets
|
|
$
|
2,355,211
|
|
|
$
|
14,805,239
|
|
|
$
|
19,918,328
|
|
|
$
|
8,153,144
|
|
|
$
|
(31,359,900
|
)
|
|
$
|
13,872,022
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
LIABILITIES AND EQUITY
|
Current liabilities:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Current maturities of long-term debt
|
|
$
|
|
|
|
$
|
32,603
|
|
|
$
|
21,094
|
|
|
$
|
3,037
|
|
|
$
|
|
|
|
$
|
56,734
|
|
Accounts payable
|
|
|
19
|
|
|
|
|
|
|
|
341,821
|
|
|
|
164,126
|
|
|
|
|
|
|
|
505,966
|
|
Current income taxes payable
|
|
|
25,920
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
25,920
|
|
Deferred income taxes
|
|
|
6,740
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
6,740
|
|
Interest payable (receivable)
|
|
|
|
|
|
|
144,656
|
|
|
|
1,134
|
|
|
|
(2,209
|
)
|
|
|
|
|
|
|
143,581
|
|
Accrued liabilities
|
|
|
8,283
|
|
|
|
8,712
|
|
|
|
487,320
|
|
|
|
216,998
|
|
|
|
|
|
|
|
721,313
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Total current liabilities
|
|
|
40,962
|
|
|
|
185,971
|
|
|
|
851,369
|
|
|
|
381,952
|
|
|
|
|
|
|
|
1,460,254
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Long-term debt
|
|
|
|
|
|
|
8,812,201
|
|
|
|
29,571
|
|
|
|
42,038
|
|
|
|
|
|
|
|
8,883,810
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Intercompany payable
|
|
|
|
|
|
|
4,173,569
|
|
|
|
17,121,462
|
|
|
|
7,067,616
|
|
|
|
(28,362,647
|
)
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Deferred income taxes
|
|
|
461,098
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
461,098
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Other long-term liabilities
|
|
|
16,733
|
|
|
|
319,432
|
|
|
|
271,108
|
|
|
|
218,200
|
|
|
|
|
|
|
|
825,473
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Total liabilities
|
|
|
518,793
|
|
|
|
13,491,173
|
|
|
|
18,273,510
|
|
|
|
7,709,806
|
|
|
|
(28,362,647
|
)
|
|
|
11,630,635
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Redeemable noncontrolling interests in equity of consolidated
subsidiaries
|
|
|
|
|
|
|
|
|
|
|
31,302
|
|
|
|
292,692
|
|
|
|
|
|
|
|
323,994
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Equity:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Community Health Systems, Inc. stockholders equity:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Preferred stock
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Common stock
|
|
|
937
|
|
|
|
|
|
|
|
1
|
|
|
|
2
|
|
|
|
(3
|
)
|
|
|
937
|
|
Additional paid-in capital
|
|
|
1,168,125
|
|
|
|
589,298
|
|
|
|
625,783
|
|
|
|
26,753
|
|
|
|
(1,241,834
|
)
|
|
|
1,168,125
|
|
Treasury stock, at cost
|
|
|
(6,678
|
)
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
(6,678
|
)
|
Accumulated other comprehensive loss
|
|
|
(220,565
|
)
|
|
|
(220,565
|
)
|
|
|
(16,129
|
)
|
|
|
|
|
|
|
236,694
|
|
|
|
(220,565
|
)
|
Retained earnings
|
|
|
894,599
|
|
|
|
945,333
|
|
|
|
1,003,861
|
|
|
|
42,916
|
|
|
|
(1,992,110
|
)
|
|
|
894,599
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Total Community Health Systems, Inc. stockholders equity
|
|
|
1,836,418
|
|
|
|
1,314,066
|
|
|
|
1,613,516
|
|
|
|
69,671
|
|
|
|
(2,997,253
|
)
|
|
|
1,836,418
|
|
Noncontrolling interests in equity of consolidated subsidiaries
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
80,975
|
|
|
|
|
|
|
|
80,975
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Total equity
|
|
|
1,836,418
|
|
|
|
1,314,066
|
|
|
|
1,613,516
|
|
|
|
150,646
|
|
|
|
(2,997,253
|
)
|
|
|
1,917,393
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Total liabilities and equity
|
|
$
|
2,355,211
|
|
|
$
|
14,805,239
|
|
|
$
|
19,918,328
|
|
|
$
|
8,153,144
|
|
|
$
|
(31,359,900
|
)
|
|
$
|
13,872,022
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
29
COMMUNITY
HEALTH SYSTEMS, INC. AND SUBSIDIARIES
NOTES TO
CONDENSED CONSOLIDATED FINANCIAL
STATEMENTS (Continued)
Condensed
Consolidating Balance Sheet
December 31, 2008
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Parent
|
|
|
|
|
|
Other
|
|
|
Non-
|
|
|
|
|
|
|
|
|
|
Guarantor
|
|
|
Issuer
|
|
|
Guarantors
|
|
|
Guarantors
|
|
|
Eliminations
|
|
|
Consolidated
|
|
|
|
(In thousands)
|
|
|
ASSETS
|
Current assets:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Cash and cash equivalents
|
|
$
|
|
|
|
$
|
|
|
|
$
|
155,018
|
|
|
$
|
65,637
|
|
|
$
|
|
|
|
$
|
220,655
|
|
Patient accounts receivable, net of allowance for doubtful
accounts
|
|
|
|
|
|
|
|
|
|
|
1,024,402
|
|
|
|
601,068
|
|
|
|
|
|
|
|
1,625,470
|
|
Supplies
|
|
|
|
|
|
|
|
|
|
|
170,417
|
|
|
|
105,279
|
|
|
|
|
|
|
|
275,696
|
|
Deferred income taxes
|
|
|
91,875
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
91,875
|
|
Prepaid expenses and taxes
|
|
|
92,710
|
|
|
|
111
|
|
|
|
66,559
|
|
|
|
7,122
|
|
|
|
|
|
|
|
166,502
|
|
Other current assets
|
|
|
|
|
|
|
85
|
|
|
|
131,661
|
|
|
|
93,106
|
|
|
|
|
|
|
|
224,852
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Total current assets
|
|
|
184,585
|
|
|
|
196
|
|
|
|
1,548,057
|
|
|
|
872,212
|
|
|
|
|
|
|
|
2,605,050
|
|
Intercompany receivable
|
|
|
1,026,905
|
|
|
|
9,325,281
|
|
|
|
5,207,453
|
|
|
|
3,402,559
|
|
|
|
(18,962,198
|
)
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Property and equipment, net
|
|
|
|
|
|
|
|
|
|
|
3,658,095
|
|
|
|
2,236,310
|
|
|
|
|
|
|
|
5,894,405
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Goodwill
|
|
|
|
|
|
|
|
|
|
|
2,404,082
|
|
|
|
1,762,009
|
|
|
|
|
|
|
|
4,166,091
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Other assets, net of accumulated amortization
|
|
|
|
|
|
|
171,396
|
|
|
|
330,132
|
|
|
|
651,180
|
|
|
|
|
|
|
|
1,152,708
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Net investment in subsidiaries
|
|
|
1,109,833
|
|
|
|
4,459,037
|
|
|
|
3,330,368
|
|
|
|
|
|
|
|
(8,899,238
|
)
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Total assets
|
|
$
|
2,321,323
|
|
|
$
|
13,955,910
|
|
|
$
|
16,478,187
|
|
|
$
|
8,924,270
|
|
|
$
|
(27,861,436
|
)
|
|
$
|
13,818,254
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
LIABILITIES AND EQUITY
|
Current liabilities:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Current maturities of long-term debt
|
|
$
|
|
|
|
$
|
12,066
|
|
|
$
|
7,653
|
|
|
$
|
14,185
|
|
|
$
|
|
|
|
$
|
33,904
|
|
Accounts payable
|
|
|
70
|
|
|
|
|
|
|
|
376,273
|
|
|
|
156,252
|
|
|
|
|
|
|
|
532,595
|
|
Current income taxes payable
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Deferred income taxes
|
|
|
6,740
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
6,740
|
|
Interest payable (receivable)
|
|
|
|
|
|
|
152,070
|
|
|
|
2,263
|
|
|
|
(1,099
|
)
|
|
|
|
|
|
|
153,234
|
|
Accrued liabilities
|
|
|
8,869
|
|
|
|
567
|
|
|
|
471,764
|
|
|
|
301,744
|
|
|
|
|
|
|
|
782,944
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Total current liabilities
|
|
|
15,679
|
|
|
|
164,703
|
|
|
|
857,953
|
|
|
|
471,082
|
|
|
|
|
|
|
|
1,509,417
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Long-term debt
|
|
|
|
|
|
|
8,865,390
|
|
|
|
34,958
|
|
|
|
37,837
|
|
|
|
|
|
|
|
8,938,185
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Intercompany payable
|
|
|
200,600
|
|
|
|
3,369,977
|
|
|
|
13,832,783
|
|
|
|
7,832,161
|
|
|
|
(25,235,521
|
)
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Deferred income taxes
|
|
|
460,793
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
460,793
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Other long-term liabilities
|
|
|
18,211
|
|
|
|
435,134
|
|
|
|
218,306
|
|
|
|
216,906
|
|
|
|
|
|
|
|
888,557
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Total liabilities
|
|
|
695,283
|
|
|
|
12,835,204
|
|
|
|
14,944,000
|
|
|
|
8,557,986
|
|
|
|
(25,235,521
|
)
|
|
|
11,796,952
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Redeemable noncontrolling interests in equity of consolidated
subsidiaries
|
|
|
|
|
|
|
|
|
|
|
51,602
|
|
|
|
268,569
|
|
|
|
|
|
|
|
320,171
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Equity:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Community Health Systems, Inc. stockholders equity:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Preferred stock
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Common stock
|
|
|
925
|
|
|
|
|
|
|
|
1
|
|
|
|
2
|
|
|
|
(3
|
)
|
|
|
925
|
|
Additional paid-in capital
|
|
|
1,151,119
|
|
|
|
545,268
|
|
|
|
577,375
|
|
|
|
8,709
|
|
|
|
(1,131,352
|
)
|
|
|
1,151,119
|
|
Treasury stock, at cost
|
|
|
(6,678
|
)
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
(6,678
|
)
|
Accumulated other comprehensive loss
|
|
|
(295,575
|
)
|
|
|
(295,575
|
)
|
|
|
(17,090
|
)
|
|
|
|
|
|
|
312,665
|
|
|
|
(295,575
|
)
|
Retained earnings
|
|
|
776,249
|
|
|
|
871,013
|
|
|
|
922,299
|
|
|
|
13,913
|
|
|
|
(1,807,225
|
)
|
|
|
776,249
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Total Community Health Systems, Inc. stockholders equity
|
|
|
1,626,040
|
|
|
|
1,120,706
|
|
|
|
1,482,585
|
|
|
|
22,624
|
|
|
|
(2,625,915
|
)
|
|
|
1,626,040
|
|
Noncontrolling interests in equity of consolidated subsidiaries
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
75,091
|
|
|
|
|
|
|
|
75,091
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Total equity
|
|
|
1,626,040
|
|
|
|
1,120,706
|
|
|
|
1,482,585
|
|
|
|
97,715
|
|
|
|
(2,625,915
|
)
|
|
|
1,701,131
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Total liabilities and equity
|
|
$
|
2,321,323
|
|
|
$
|
13,955,910
|
|
|
$
|
16,478,187
|
|
|
$
|
8,924,270
|
|
|
$
|
(27,861,436
|
)
|
|
$
|
13,818,254
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
30
COMMUNITY
HEALTH SYSTEMS, INC. AND SUBSIDIARIES
NOTES TO
CONDENSED CONSOLIDATED FINANCIAL
STATEMENTS (Continued)
Condensed
Consolidating Statement of Income
Three Months Ended June 30, 2009
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Parent
|
|
|
|
|
|
Other
|
|
|
Non-
|
|
|
|
|
|
|
|
|
|
Guarantor
|
|
|
Issuer
|
|
|
Guarantors
|
|
|
Guarantors
|
|
|
Eliminations
|
|
|
Consolidated
|
|
|
|
(In thousands)
|
|
|
Net operating revenues
|
|
$
|
|
|
|
$
|
|
|
|
$
|
1,872,775
|
|
|
$
|
1,144,186
|
|
|
$
|
|
|
|
$
|
3,016,961
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Operating costs and expenses:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Salaries and benefits
|
|
|
|
|
|
|
|
|
|
|
722,366
|
|
|
|
479,314
|
|
|
|
|
|
|
|
1,201,680
|
|
Provision for bad debts
|
|
|
|
|
|
|
|
|
|
|
237,169
|
|
|
|
125,293
|
|
|
|
|
|
|
|
362,462
|
|
Supplies
|
|
|
|
|
|
|
|
|
|
|
257,235
|
|
|
|
162,721
|
|
|
|
|
|
|
|
419,956
|
|
Other operating expenses
|
|
|
|
|
|
|
|
|
|
|
331,921
|
|
|
|
235,892
|
|
|
|
|
|
|
|
567,813
|
|
Rent
|
|
|
|
|
|
|
|
|
|
|
32,818
|
|
|
|
28,382
|
|
|
|
|
|
|
|
61,200
|
|
Depreciation and amortization
|
|
|
|
|
|
|
|
|
|
|
89,392
|
|
|
|
53,055
|
|
|
|
|
|
|
|
142,447
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Total operating costs and expenses
|
|
|
|
|
|
|
|
|
|
|
1,670,901
|
|
|
|
1,084,657
|
|
|
|
|
|
|
|
2,755,558
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Income from operations
|
|
|
|
|
|
|
|
|
|
|
201,874
|
|
|
|
59,529
|
|
|
|
|
|
|
|
261,403
|
|
Interest expense, net
|
|
|
|
|
|
|
31,196
|
|
|
|
124,537
|
|
|
|
5,740
|
|
|
|
|
|
|
|
161,473
|
|
Loss (gain) from early extinguishment of debt
|
|
|
|
|
|
|
6
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
6
|
|
Equity in earnings of unconsolidated affiliates
|
|
|
(59,435
|
)
|
|
|
(68,908
|
)
|
|
|
(36,911
|
)
|
|
|
|
|
|
|
153,471
|
|
|
|
(11,783
|
)
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Income from continuing operations before income taxes
|
|
|
59,435
|
|
|
|
37,706
|
|
|
|
114,248
|
|
|
|
53,789
|
|
|
|
(153,471
|
)
|
|
|
111,707
|
|
Provision for (benefit from) income taxes
|
|
|
|
|
|
|
(21,729
|
)
|
|
|
43,348
|
|
|
|
15,590
|
|
|
|
|
|
|
|
37,209
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Income from continuing operations
|
|
|
59,435
|
|
|
|
59,435
|
|
|
|
70,900
|
|
|
|
38,199
|
|
|
|
(153,471
|
)
|
|
|
74,498
|
|
Discontinued operations, net of taxes:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
(Loss) income from operations of hospitals sold and held for sale
|
|
|
|
|
|
|
|
|
|
|
(7
|
)
|
|
|
(501
|
)
|
|
|
|
|
|
|
(508
|
)
|
(Loss) gain on sale of hospitals, net
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
(Loss) income from discontinued operations
|
|
|
|
|
|
|
|
|
|
|
(7
|
)
|
|
|
(501
|
)
|
|
|
|
|
|
|
(508
|
)
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Net income
|
|
|
59,435
|
|
|
|
59,435
|
|
|
|
70,893
|
|
|
|
37,698
|
|
|
|
(153,471
|
)
|
|
|
73,990
|
|
Less: Net income attributable to noncontrolling interests
|
|
|
|
|
|
|
|
|
|
|
1,362
|
|
|
|
13,193
|
|
|
|
|
|
|
|
14,555
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Net income attributable to Community Health Systems, Inc.
|
|
$
|
59,435
|
|
|
$
|
59,435
|
|
|
$
|
69,531
|
|
|
$
|
24,505
|
|
|
$
|
(153,471
|
)
|
|
$
|
59,435
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
31
COMMUNITY
HEALTH SYSTEMS, INC. AND SUBSIDIARIES
NOTES TO
CONDENSED CONSOLIDATED FINANCIAL
STATEMENTS (Continued)
Condensed
Consolidating Statement of Income
Three Months Ended June 30, 2008
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Parent
|
|
|
|
|
|
Other
|
|
|
Non-
|
|
|
|
|
|
|
|
|
|
Guarantor
|
|
|
Issuer
|
|
|
Guarantors
|
|
|
Guarantors
|
|
|
Eliminations
|
|
|
Consolidated
|
|
|
|
(In thousands)
|
|
|
Net operating revenues
|
|
$
|
|
|
|
$
|
|
|
|
$
|
1,625,112
|
|
|
$
|
1,048,041
|
|
|
$
|
|
|
|
$
|
2,673,153
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Operating costs and expenses:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Salaries and benefits
|
|
|
|
|
|
|
|
|
|
|
614,094
|
|
|
|
464,071
|
|
|
|
|
|
|
|
1,078,165
|
|
Provision for bad debts
|
|
|
|
|
|
|
|
|
|
|
182,401
|
|
|
|
103,192
|
|
|
|
|
|
|
|
285,593
|
|
Supplies
|
|
|
|
|
|
|
|
|
|
|
221,305
|
|
|
|
154,019
|
|
|
|
|
|
|
|
375,324
|
|
Other operating expenses
|
|
|
|
|
|
|
|
|
|
|
306,556
|
|
|
|
217,272
|
|
|
|
|
|
|
|
523,828
|
|
Rent
|
|
|
|
|
|
|
|
|
|
|
32,485
|
|
|
|
25,769
|
|
|
|
|
|
|
|
58,254
|
|
Depreciation and amortization
|
|
|
|
|
|
|
|
|
|
|
76,189
|
|
|
|
47,355
|
|
|
|
|
|
|
|
123,544
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Total operating costs and expenses
|
|
|
|
|
|
|
|
|
|
|
1,433,030
|
|
|
|
1,011,678
|
|
|
|
|
|
|
|
2,444,708
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Income from operations
|
|
|
|
|
|
|
|
|
|
|
192,082
|
|
|
|
36,363
|
|
|
|
|
|
|
|
228,445
|
|
Interest expense, net
|
|
|
|
|
|
|
14,598
|
|
|
|
132,578
|
|
|
|
6,185
|
|
|
|
|
|
|
|
153,361
|
|
Loss (gain) from early extinguishment of debt
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Equity in earnings of unconsolidated affiliates
|
|
|
(47,893
|
)
|
|
|
(51,796
|
)
|
|
|
(24,096
|
)
|
|
|
|
|
|
|
113,286
|
|
|
|
(10,499
|
)
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Income from continuing operations before income taxes
|
|
|
47,893
|
|
|
|
37,198
|
|
|
|
83,600
|
|
|
|
30,178
|
|
|
|
(113,286
|
)
|
|
|
85,583
|
|
Provision for (benefit from) income taxes
|
|
|
|
|
|
|
(10,695
|
)
|
|
|
32,109
|
|
|
|
8,776
|
|
|
|
|
|
|
|
30,190
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Income from continuing operations
|
|
|
47,893
|
|
|
|
47,893
|
|
|
|
51,491
|
|
|
|
21,402
|
|
|
|
(113,286
|
)
|
|
|
55,393
|
|
Discontinued operations, net of taxes:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
(Loss) income from operations of hospitals sold and held for sale
|
|
|
|
|
|
|
|
|
|
|
820
|
|
|
|
(1,060
|
)
|
|
|
|
|
|
|
(240
|
)
|
(Loss) gain on sale of hospitals, net
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
(9
|
)
|
|
|
|
|
|
|
(9
|
)
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
(Loss) income from discontinued operations
|
|
|
|
|
|
|
|
|
|
|
820
|
|
|
|
(1,069
|
)
|
|
|
|
|
|
|
(249
|
)
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Net income
|
|
|
47,893
|
|
|
|
47,893
|
|
|
|
52,311
|
|
|
|
20,333
|
|
|
|
(113,286
|
)
|
|
|
55,144
|
|
Less: Net income attributable to noncontrolling interests
|
|
|
|
|
|
|
|
|
|
|
(129
|
)
|
|
|
7,380
|
|
|
|
|
|
|
|
7,251
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Net income attributable to Community Health Systems, Inc.
|
|
$
|
47,893
|
|
|
$
|
47,893
|
|
|
$
|
52,440
|
|
|
$
|
12,953
|
|
|
$
|
(113,286
|
)
|
|
$
|
47,893
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
32
COMMUNITY
HEALTH SYSTEMS, INC. AND SUBSIDIARIES
NOTES TO
CONDENSED CONSOLIDATED FINANCIAL
STATEMENTS (Continued)
Condensed
Consolidating Statement of Income
Six Months Ended June 30, 2009
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Parent
|
|
|
|
|
|
Other
|
|
|
Non-
|
|
|
|
|
|
|
|
|
|
Guarantor
|
|
|
Issuer
|
|
|
Guarantors
|
|
|
Guarantors
|
|
|
Eliminations
|
|
|
Consolidated
|
|
|
|
(In thousands)
|
|
|
Net operating revenues
|
|
$
|
|
|
|
$
|
|
|
|
$
|
3,666,028
|
|
|
$
|
2,263,682
|
|
|
$
|
|
|
|
$
|
5,929,710
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Operating costs and expenses:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Salaries and benefits
|
|
|
|
|
|
|
|
|
|
|
1,418,148
|
|
|
|
956,972
|
|
|
|
|
|
|
|
2,375,120
|
|
Provision for bad debts
|
|
|
|
|
|
|
|
|
|
|
462,779
|
|
|
|
237,451
|
|
|
|
|
|
|
|
700,230
|
|
Supplies
|
|
|
|
|
|
|
|
|
|
|
499,985
|
|
|
|
325,608
|
|
|
|
|
|
|
|
825,593
|
|
Other operating expenses
|
|
|
|
|
|
|
|
|
|
|
640,015
|
|
|
|
472,775
|
|
|
|
|
|
|
|
1,112,790
|
|
Rent
|
|
|
|
|
|
|
|
|
|
|
64,960
|
|
|
|
56,568
|
|
|
|
|
|
|
|
121,528
|
|
Depreciation and amortization
|
|
|
|
|
|
|
|
|
|
|
174,695
|
|
|
|
103,313
|
|
|
|
|
|
|
|
278,008
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Total operating costs and expenses
|
|
|
|
|
|
|
|
|
|
|
3,260,582
|
|
|
|
2,152,687
|
|
|
|
|
|
|
|
5,413,269
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Income from operations
|
|
|
|
|
|
|
|
|
|
|
405,446
|
|
|
|
110,995
|
|
|
|
|
|
|
|
516,441
|
|
Interest expense, net
|
|
|
|
|
|
|
49,113
|
|
|
|
263,163
|
|
|
|
13,110
|
|
|
|
|
|
|
|
325,386
|
|
Loss (gain) from early extinguishment of debt
|
|
|
|
|
|
|
(2,406
|
)
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
(2,406
|
)
|
Equity in earnings of unconsolidated affiliates
|
|
|
(118,350
|
)
|
|
|
(128,532
|
)
|
|
|
(73,184
|
)
|
|
|
|
|
|
|
295,366
|
|
|
|
(24,700
|
)
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Income from continuing operations before income taxes
|
|
|
118,350
|
|
|
|
81,825
|
|
|
|
215,467
|
|
|
|
97,885
|
|
|
|
(295,366
|
)
|
|
|
218,161
|
|
Provision for (benefit from) income taxes
|
|
|
|
|
|
|
(36,525
|
)
|
|
|
81,156
|
|
|
|
28,212
|
|
|
|
|
|
|
|
72,843
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Income from continuing operations
|
|
|
118,350
|
|
|
|
118,350
|
|
|
|
134,311
|
|
|
|
69,673
|
|
|
|
(295,366
|
)
|
|
|
145,318
|
|
Discontinued operations, net of taxes:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
(Loss) income from operations of hospitals sold and held for sale
|
|
|
|
|
|
|
|
|
|
|
(218
|
)
|
|
|
2,195
|
|
|
|
|
|
|
|
1,977
|
|
(Loss) gain on sale of hospitals, net
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
(405
|
)
|
|
|
|
|
|
|
(405
|
)
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
(Loss) income from discontinued operations
|
|
|
|
|
|
|
|
|
|
|
(218
|
)
|
|
|
1,790
|
|
|
|
|
|
|
|
1,572
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Net income
|
|
|
118,350
|
|
|
|
118,350
|
|
|
|
134,093
|
|
|
|
71,463
|
|
|
|
(295,366
|
)
|
|
|
146,890
|
|
Less: Net income attributable to noncontrolling interests
|
|
|
|
|
|
|
|
|
|
|
4,124
|
|
|
|
24,416
|
|
|
|
|
|
|
|
28,540
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Net income attributable to Community Health Systems, Inc.
|
|
$
|
118,350
|
|
|
$
|
118,350
|
|
|
$
|
129,969
|
|
|
$
|
47,047
|
|
|
$
|
(295,366
|
)
|
|
$
|
118,350
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
33
COMMUNITY
HEALTH SYSTEMS, INC. AND SUBSIDIARIES
NOTES TO
CONDENSED CONSOLIDATED FINANCIAL
STATEMENTS (Continued)
Condensed
Consolidating Statement of Income
Six Months Ended June 30, 2008
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Parent
|
|
|
|
|
|
Other
|
|
|
Non-
|
|
|
|
|
|
|
|
|
|
Guarantor
|
|
|
Issuer
|
|
|
Guarantors
|
|
|
Guarantors
|
|
|
Eliminations
|
|
|
Consolidated
|
|
|
|
(In thousands)
|
|
|
Net operating revenues
|
|
$
|
|
|
|
$
|
|
|
|
$
|
3,262,125
|
|
|
$
|
2,121,383
|
|
|
$
|
|
|
|
$
|
5,383,508
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Operating costs and expenses:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Salaries and benefits
|
|
|
|
|
|
|
|
|
|
|
1,241,128
|
|
|
|
924,122
|
|
|
|
|
|
|
|
2,165,250
|
|
Provision for bad debts
|
|
|
|
|
|
|
|
|
|
|
376,307
|
|
|
|
201,359
|
|
|
|
|
|
|
|
577,666
|
|
Supplies
|
|
|
|
|
|
|
|
|
|
|
442,623
|
|
|
|
316,684
|
|
|
|
|
|
|
|
759,307
|
|
Other operating expenses
|
|
|
|
|
|
|
|
|
|
|
614,346
|
|
|
|
435,048
|
|
|
|
|
|
|
|
1,049,394
|
|
Rent
|
|
|
|
|
|
|
|
|
|
|
63,851
|
|
|
|
53,480
|
|
|
|
|
|
|
|
117,331
|
|
Depreciation and amortization
|
|
|
|
|
|
|
|
|
|
|
152,455
|
|
|
|
92,395
|
|
|
|
|
|
|
|
244,850
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Total operating costs and expenses
|
|
|
|
|
|
|
|
|
|
|
2,890,710
|
|
|
|
2,023,088
|
|
|
|
|
|
|
|
4,913,798
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Income from operations
|
|
|
|
|
|
|
|
|
|
|
371,415
|
|
|
|
98,295
|
|
|
|
|
|
|
|
469,710
|
|
Interest expense, net
|
|
|
|
|
|
|
27,522
|
|
|
|
270,062
|
|
|
|
20,479
|
|
|
|
|
|
|
|
318,063
|
|
Loss (gain) from early extinguishment of debt
|
|
|
|
|
|
|
1,328
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
1,328
|
|
Equity in earnings of unconsolidated affiliates
|
|
|
(108,020
|
)
|
|
|
(107,428
|
)
|
|
|
(72,077
|
)
|
|
|
|
|
|
|
264,142
|
|
|
|
(23,383
|
)
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Income from continuing operations before income taxes
|
|
|
108,020
|
|
|
|
78,578
|
|
|
|
173,430
|
|
|
|
77,816
|
|
|
|
(264,142
|
)
|
|
|
173,702
|
|
Provision for (benefit from) income taxes
|
|
|
|
|
|
|
(29,442
|
)
|
|
|
67,133
|
|
|
|
23,363
|
|
|
|
|
|
|
|
61,054
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Income from continuing operations
|
|
|
108,020
|
|
|
|
108,020
|
|
|
|
106,297
|
|
|
|
54,453
|
|
|
|
(264,142
|
)
|
|
|
112,648
|
|
Discontinued operations, net of taxes:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
(Loss) income from operations of hospitals sold and held for sale
|
|
|
|
|
|
|
|
|
|
|
268
|
|
|
|
1,356
|
|
|
|
|
|
|
|
1,624
|
|
(Loss) gain on sale of hospitals, net
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
9,608
|
|
|
|
|
|
|
|
9,608
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
(Loss) income from discontinued operations
|
|
|
|
|
|
|
|
|
|
|
268
|
|
|
|
10,964
|
|
|
|
|
|
|
|
11,232
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Net income
|
|
|
108,020
|
|
|
|
108,020
|
|
|
|
106,565
|
|
|
|
65,417
|
|
|
|
(264,142
|
)
|
|
|
123,880
|
|
Less: Net income attributable to noncontrolling interests
|
|
|
|
|
|
|
|
|
|
|
(1,270
|
)
|
|
|
17,130
|
|
|
|
|
|
|
|
15,860
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Net income attributable to Community Health Systems, Inc.
|
|
$
|
108,020
|
|
|
$
|
108,020
|
|
|
$
|
107,835
|
|
|
$
|
48,287
|
|
|
$
|
(264,142
|
)
|
|
$
|
108,020
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
34
COMMUNITY
HEALTH SYSTEMS, INC. AND SUBSIDIARIES
NOTES TO
CONDENSED CONSOLIDATED FINANCIAL
STATEMENTS (Continued)
Condensed
Consolidating Statement of Cash Flows
Six Months Ended June 30, 2009
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Parent
|
|
|
|
|
|
Other
|
|
|
Non-
|
|
|
|
|
|
|
|
|
|
Guarantor
|
|
|
Issuer
|
|
|
Guarantors
|
|
|
Guarantors
|
|
|
Eliminations
|
|
|
Consolidated
|
|
|
|
(In thousands)
|
|
|
Cash flows from operating activities:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Net cash provided by (used in) operating activities
|
|
$
|
(1,269
|
)
|
|
$
|
(11,605
|
)
|
|
$
|
400,905
|
|
|
$
|
156,376
|
|
|
$
|
|
|
|
$
|
544,407
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Cash flows from investing activities:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Acquisitions of facilities and other related equipment
|
|
|
|
|
|
|
|
|
|
|
(198,326
|
)
|
|
|
(12,578
|
)
|
|
|
|
|
|
|
(210,904
|
)
|
Purchases of property and equipment
|
|
|
|
|
|
|
|
|
|
|
(205,505
|
)
|
|
|
(61,770
|
)
|
|
|
|
|
|
|
(267,275
|
)
|
Proceeds from disposition of hospitals and other ancillary
operations
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
89,909
|
|
|
|
|
|
|
|
89,909
|
|
Proceeds from sale of property and equipment
|
|
|
|
|
|
|
|
|
|
|
102
|
|
|
|
253
|
|
|
|
|
|
|
|
355
|
|
Increase in other non-operating assets
|
|
|
|
|
|
|
(18,381
|
)
|
|
|
(47,989
|
)
|
|
|
(8,136
|
)
|
|
|
|
|
|
|
(74,506
|
)
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Net cash (used in) provided by investing activities
|
|
|
|
|
|
|
(18,381
|
)
|
|
|
(451,718
|
)
|
|
|
7,678
|
|
|
|
|
|
|
|
(462,421
|
)
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Cash flows from financing activities:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Proceeds from exercise of stock options
|
|
|
3,445
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
3,445
|
|
Excess tax benefits relating to stock-based compensation
|
|
|
(3,389
|
)
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
(3,389
|
)
|
Deferred financing costs
|
|
|
|
|
|
|
(207
|
)
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
(207
|
)
|
Stock buy-back
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Proceeds from noncontrolling investors in joint ventures
|
|
|
|
|
|
|
|
|
|
|
326
|
|
|
|
25,988
|
|
|
|
|
|
|
|
26,314
|
|
Redemption of noncontrolling investments in joint ventures
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
(1,631
|
)
|
|
|
|
|
|
|
(1,631
|
)
|
Distributions to noncontrolling investors in joint ventures
|
|
|
|
|
|
|
|
|
|
|
(4,205
|
)
|
|
|
(17,961
|
)
|
|
|
|
|
|
|
(22,166
|
)
|
Changes in intercompany balances with affiliates, net
|
|
|
1,213
|
|
|
|
61,381
|
|
|
|
74,334
|
|
|
|
(136,928
|
)
|
|
|
|
|
|
|
|
|
Borrowings under credit agreement
|
|
|
|
|
|
|
200,000
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
200,000
|
|
Repayments of long-term indebtedness
|
|
|
|
|
|
|
(231,188
|
)
|
|
|
(887
|
)
|
|
|
(4,107
|
)
|
|
|
|
|
|
|
(236,182
|
)
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Net cash (used in) provided by financing activities
|
|
|
1,269
|
|
|
|
29,986
|
|
|
|
69,568
|
|
|
|
(134,639
|
)
|
|
|
|
|
|
|
(33,816
|
)
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Net change in cash and cash equivalents
|
|
|
|
|
|
|
|
|
|
|
18,755
|
|
|
|
29,415
|
|
|
|
|
|
|
|
48,170
|
|
Cash and cash equivalents at beginning of period
|
|
|
|
|
|
|
|
|
|
|
155,018
|
|
|
|
65,637
|
|
|
|
|
|
|
|
220,655
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Cash and cash equivalents at end of period
|
|
$
|
|
|
|
$
|
|
|
|
$
|
173,773
|
|
|
$
|
95,052
|
|
|
$
|
|
|
|
$
|
268,825
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
35
COMMUNITY
HEALTH SYSTEMS, INC. AND SUBSIDIARIES
NOTES TO
CONDENSED CONSOLIDATED FINANCIAL
STATEMENTS (Continued)
Condensed
Consolidating Statement of Cash Flows
Six Months Ended June 30, 2008
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Parent
|
|
|
|
|
|
Other
|
|
|
Non-
|
|
|
|
|
|
|
|
|
|
Guarantor
|
|
|
Issuer
|
|
|
Guarantors
|
|
|
Guarantors
|
|
|
Eliminations
|
|
|
Consolidated
|
|
|
|
(In thousands)
|
|
|
Cash flows from operating activities:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Net cash provided by (used in) operating activities
|
|
$
|
61,067
|
|
|
$
|
(31,359
|
)
|
|
$
|
406,999
|
|
|
$
|
(19,924
|
)
|
|
$
|
|
|
|
$
|
416,783
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Cash flows from investing activities:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Acquisitions of facilities and other related equipment
|
|
|
|
|
|
|
|
|
|
|
(6,464
|
)
|
|
|
(182
|
)
|
|
|
|
|
|
|
(6,646
|
)
|
Purchases of property and equipment
|
|
|
|
|
|
|
|
|
|
|
(189,971
|
)
|
|
|
(85,634
|
)
|
|
|
|
|
|
|
(275,605
|
)
|
Proceeds from disposition of hospitals and other ancillary
operations
|
|
|
|
|
|
|
|
|
|
|
10,693
|
|
|
|
355,220
|
|
|
|
|
|
|
|
365,913
|
|
Proceeds from sale of property and equipment
|
|
|
|
|
|
|
|
|
|
|
1,094
|
|
|
|
11,795
|
|
|
|
|
|
|
|
12,889
|
|
Increase in other non-operating assets
|
|
|
|
|
|
|
|
|
|
|
(114,592
|
)
|
|
|
(29,788
|
)
|
|
|
|
|
|
|
(144,380
|
)
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Net cash (used in) provided by investing activities
|
|
|
|
|
|
|
|
|
|
|
(299,240
|
)
|
|
|
251,411
|
|
|
|
|
|
|
|
(47,829
|
)
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Cash flows from financing activities:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Proceeds from exercise of stock options
|
|
|
1,357
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
1,357
|
|
Excess tax benefits relating to stock-based compensation
|
|
|
(947
|
)
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
(947
|
)
|
Deferred financing costs
|
|
|
|
|
|
|
(2,444
|
)
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
(2,444
|
)
|
Stock buy-back
|
|
|
(10,194
|
)
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
(10,194
|
)
|
Proceeds from noncontrolling investors in joint ventures
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
11,214
|
|
|
|
|
|
|
|
11,214
|
|
Redemption of noncontrolling investments in joint ventures
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
(53,485
|
)
|
|
|
|
|
|
|
(53,485
|
)
|
Distributions to noncontrolling investors in joint ventures
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
(14,916
|
)
|
|
|
|
|
|
|
(14,916
|
)
|
Changes in intercompany balances with affiliates, net
|
|
|
(51,283
|
)
|
|
|
195,597
|
|
|
|
60,797
|
|
|
|
(205,111
|
)
|
|
|
|
|
|
|
|
|
Borrowings under credit agreement
|
|
|
|
|
|
|
25,000
|
|
|
|
44,818
|
|
|
|
(47,161
|
)
|
|
|
|
|
|
|
22,657
|
|
Repayments of long-term indebtedness
|
|
|
|
|
|
|
(186,794
|
)
|
|
|
(68,321
|
)
|
|
|
64,117
|
|
|
|
|
|
|
|
(190,998
|
)
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Net cash (used in) provided by financing activities
|
|
|
(61,067
|
)
|
|
|
31,359
|
|
|
|
37,294
|
|
|
|
(245,342
|
)
|
|
|
|
|
|
|
(237,756
|
)
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Net change in cash and cash equivalents
|
|
|
|
|
|
|
|
|
|
|
145,053
|
|
|
|
(13,855
|
)
|
|
|
|
|
|
|
131,198
|
|
Cash and cash equivalents at beginning of period
|
|
|
|
|
|
|
|
|
|
|
114,853
|
|
|
|
18,021
|
|
|
|
|
|
|
|
132,874
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Cash and cash equivalents at end of period
|
|
$
|
|
|
|
$
|
|
|
|
$
|
259,906
|
|
|
$
|
4,166
|
|
|
$
|
|
|
|
$
|
264,072
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
36
|
|
Item 2.
|
Managements
Discussion and Analysis of Financial Condition and Results of
Operations
|
You should read this discussion together with our unaudited
condensed consolidated financial statements and accompanying
notes included herein.
Throughout this Quarterly Report on
Form 10-Q,
Community Health Systems, Inc., the parent company, and its
consolidated subsidiaries are referred to on a collective basis
using words like we, our, us
and the Company. This drafting style is not meant to
indicate that the publicly-traded parent company or any
subsidiary of the parent company owns or operates any asset,
business, or property. The hospitals, operations and businesses
described in this filing are owned and operated, and management
services provided, by distinct and indirect subsidiaries of
Community Health Systems, Inc. References to the Company may
include one or more of its subsidiaries.
Executive
Overview
We are the largest publicly traded operator of hospitals in the
United States in terms of number of facilities and net operating
revenues. We provide healthcare services through these hospitals
that we own and operate in non-urban and selected urban markets.
We generate revenue primarily by providing a broad range of
general hospital healthcare services to patients in the
communities in which we are located. We currently have 122
general acute care hospitals. In addition, we own and operate
home care agencies, located primarily in markets where we also
operate a hospital, and through our wholly-owned subsidiary,
Quorum Health Resources, LLC, or QHR, we provide management and
consulting services to non-affiliated general acute care
hospitals located throughout the United States. We are paid for
our services by governmental agencies, private insurers and
directly by the patients we serve.
During the three months ended June 30, 2009, we continued
to navigate the uncertainties of the global and domestic
economies. Unemployment continues to increase, credit markets
remained tightened and there remained a low level of liquidity
in many financial markets. Consequently, as previously
disclosed, we are continuing to take a cautious approach to our
acquisition strategy in this uncertain economic environment.
During the three months ended June 30, 2009, we acquired
the remaining 50% interest in a hospital in El Dorado, Arkansas,
in which we previously were a joint venture partner, but did not
consolidate its operations, and we completed the previously
announced acquisition of a health care system in Wilkes Barre,
Pennsylvania.
Despite these uncertainties in the economy, our net operating
revenue for the three months ended June 30, 2009 increased
to $3.017 billion, as compared to $2.673 billion for
the three months ended June 30, 2008. Income from
continuing operations, before noncontrolling interests, for the
three months ended June 30, 2009 increased 34.5% over the
three months ended June 30, 2008. This increase in income
from continuing operations during the three months ended
June 30, 2009, as compared to the three months ended
June 30, 2008, is due primarily to an increase in surgeries
performed at our hospitals, strong outpatient growth, the
realization of synergies from our acquisition of Triad
Hospitals, Inc., or Triad, and the recognition of cost savings
from our ability to effectively control costs. Total admissions
for the three months ended June 30, 2009 increased 5.8%
compared to the three months ended June 30, 2008. This
increase in admissions was due primarily to our recent
acquisitions.
Our net operating revenue for the six months ended June 30,
2009 increased to $5.930 billion, as compared to
$5.384 billion for the six months ended June 30, 2008.
Income from continuing operations, before noncontrolling
interests, for the six months ended June 30, 2009 increased
29.0% over the six months ended June 30, 2008. This
increase in income from continuing operations during the six
months ended June 30, 2009, as compared to the six months
ended June 30, 2008 is due primarily to an increase in
surgeries performed at our hospitals, strong outpatient growth,
the realization of synergies from the Triad acquisition, and the
recognition of cost savings from our ability to effectively
control costs. Total admissions for the six months ended
June 30, 2009 increased 1.7% compared to the six months
ended June 30, 2008. This increase in admissions was due
primarily to our recent acquisitions.
Self-pay revenues represented approximately 10.8% and 10.7% of
our net operating revenues for the three months ended
June 30, 2009 and 2008, respectively, and 11.2% and 10.8%
of our net operating revenues for the six months ended
June 30, 2009 and 2008, respectively. The value of charity
care services relative to total net operating revenues increased
to 3.9% and 3.8% for the three and six months ended
June 30, 2009, respectively, compared to 3.8% and 3.7% for
the three and six months ended June 30, 2008, respectively.
Uninsured and underinsured patients continue to be an
industry-wide issue, and we anticipate this trend will continue
into the foreseeable future.
37
As a result of our current levels of cash, available borrowing
capacity, long-term outlook on our debt repayments and our
continued projection of our ability to generate cash flows, we
do not anticipate a significant impact on our ability to invest
the necessary capital in our business over the next twelve
months and into the foreseeable future. We believe there
continues to be ample opportunity for growth in substantially
all of our markets by decreasing the need for patients to travel
outside their communities for health care services. Furthermore,
we continue to benefit from synergies from the acquisition of
Triad and will continue to strive to improve operating
efficiencies and procedures in order to improve our
profitability at all of our hospitals.
During the three months ended June 30, 2009, we decided to
retain a hospital and related businesses previously classified
as held for sale. Results of operations for all periods
presented have been restated to include this retained hospital
and related businesses, which previously were reported as
discontinued operations. The condensed consolidated balance
sheets for each of the periods presented have been restated to
include assets and liabilities previously reported as held for
sale.
Sources
of Consolidated Net Operating Revenue
The following table presents the approximate percentages of net
operating revenue derived from Medicare, Medicaid, managed care,
self-pay and other sources for the periods indicated. The data
for the periods presented are not strictly comparable due to the
significant effect that hospital acquisitions have had on these
statistics.
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Three Months Ended
|
|
|
Six Months Ended
|
|
|
|
June 30,
|
|
|
June 30,
|
|
|
|
2009
|
|
|
2008
|
|
|
2009
|
|
|
2008
|
|
|
Medicare
|
|
|
27.2
|
%
|
|
|
27.6
|
%
|
|
|
27.5
|
%
|
|
|
28.1
|
%
|
Medicaid
|
|
|
9.0
|
%
|
|
|
8.7
|
%
|
|
|
8.7
|
%
|
|
|
8.5
|
%
|
Managed Care and other third party payors
|
|
|
53.0
|
%
|
|
|
53.0
|
%
|
|
|
52.6
|
%
|
|
|
52.6
|
%
|
Self-pay
|
|
|
10.8
|
%
|
|
|
10.7
|
%
|
|
|
11.2
|
%
|
|
|
10.8
|
%
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Total
|
|
|
100.0
|
%
|
|
|
100.0
|
%
|
|
|
100.0
|
%
|
|
|
100.0
|
%
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
As shown above, we receive a substantial portion of our revenue
from the Medicare and Medicaid programs. Included in Managed
Care and other third party payors is net operating revenue from
insurance companies with which we have insurance provider
contracts, Managed Care Medicare, insurance companies for which
we do not have insurance provider contracts, workers
compensation carriers, and non-patient service revenue, such as
rental income and cafeteria sales.
Net operating revenues include amounts estimated by management
to be reimbursable by Medicare and Medicaid under prospective
payment systems and provisions of cost-based reimbursement and
other payment methods. In addition, we are reimbursed by
non-governmental payors using a variety of payment
methodologies. Amounts we receive for treatment of patients
covered by these programs are generally less than the standard
billing rates. We account for the differences between the
estimated program reimbursement rates and the standard billing
rates as contractual allowance adjustments, which we deduct from
gross revenues to arrive at net operating revenues. Final
settlements under some of these programs are subject to
adjustment based on administrative review and audit by third
parties. We account for adjustments to previous program
reimbursement estimates as contractual allowance adjustments and
report them in the periods that such adjustments become known.
Contractual allowance adjustments related to final settlements
and previous program reimbursement estimates impacted net
operating revenues and net income by an insignificant amount in
each of the three-month and six-month periods ended
June 30, 2009 and 2008. In the future, we expect the
percentage of revenues received from the Medicare program to
increase due to the general aging of the population.
The payment rates under the Medicare program for inpatient acute
care services are based on a prospective payment system,
depending upon the diagnosis of a patients condition.
These rates are indexed for inflation annually, although
increases have historically been less than actual inflation.
Reductions in the rate of increase in Medicare reimbursement may
cause our net operating revenue growth to decline.
38
In addition, specified managed care programs, insurance
companies, and employers are actively negotiating the amounts
paid to hospitals. The trend toward increased enrollment in
managed care may adversely affect our net operating revenue
growth.
Results
of Operations
Our hospitals offer a variety of services involving a broad
range of inpatient and outpatient medical and surgical services.
These include orthopedics, cardiology, occupational medicine,
diagnostic services, emergency services, rehabilitation
treatment, home health and skilled nursing. The strongest demand
for hospital services generally occurs during January through
April and the weakest demand for these services occurs during
the summer months. Accordingly, eliminating the effect of new
acquisitions, our net operating revenues and earnings are
historically highest during the first quarter and lowest during
the third quarter.
The following tables summarize, for the periods indicated,
selected operating data.
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Three Months Ended
|
|
|
Six Months Ended
|
|
|
|
June 30,
|
|
|
June 30,
|
|
|
|
2009
|
|
|
2008
|
|
|
2009
|
|
|
2008
|
|
|
|
(Expressed as a percentage
|
|
|
|
of net operating revenues)
|
|
|
Consolidated(a)
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Net operating revenues
|
|
|
100.0
|
%
|
|
|
100.0
|
%
|
|
|
100.0
|
%
|
|
|
100.0
|
%
|
Operating expenses(b)
|
|
|
(86.6
|
)
|
|
|
(86.8
|
)
|
|
|
(86.6
|
)
|
|
|
(86.7
|
)
|
Depreciation and amortization
|
|
|
(4.7
|
)
|
|
|
(4.7
|
)
|
|
|
(4.7
|
)
|
|
|
(4.6
|
)
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Income from operations
|
|
|
8.7
|
|
|
|
8.5
|
|
|
|
8.7
|
|
|
|
8.7
|
|
Interest expense, net
|
|
|
(5.4
|
)
|
|
|
(5.7
|
)
|
|
|
(5.4
|
)
|
|
|
(5.9
|
)
|
Gain from early extinguishment of debt
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Equity in earnings of unconsolidated affiliates
|
|
|
0.4
|
|
|
|
0.4
|
|
|
|
0.4
|
|
|
|
0.4
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Income from continuing operations before income taxes
|
|
|
3.7
|
|
|
|
3.2
|
|
|
|
3.7
|
|
|
|
3.2
|
|
Provision for income taxes
|
|
|
(1.2
|
)
|
|
|
(1.1
|
)
|
|
|
(1.2
|
)
|
|
|
(1.1
|
)
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Income from continuing operations
|
|
|
2.5
|
|
|
|
2.1
|
|
|
|
2.5
|
|
|
|
2.1
|
|
Income from discontinued operations, net of tax
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
0.2
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Net income
|
|
|
2.5
|
|
|
|
2.1
|
|
|
|
2.5
|
|
|
|
2.3
|
|
Less: Net income attributable to noncontrolling interests
|
|
|
(0.5
|
)
|
|
|
(0.3
|
)
|
|
|
(0.5
|
)
|
|
|
(0.3
|
)
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Net income attributable to Community Health Systems, Inc.
|
|
|
2.0
|
%
|
|
|
1.8
|
%
|
|
|
2.0
|
%
|
|
|
2.0
|
%
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Three Months Ended
|
|
|
Six Months Ended
|
|
|
|
June 30, 2009
|
|
|
June 30, 2009
|
|
|
Percentage increase (decrease) from same period prior year(a):
|
|
|
|
|
|
|
|
|
Net operating revenues
|
|
|
12.9
|
%
|
|
|
10.1
|
%
|
Admissions
|
|
|
5.8
|
|
|
|
1.7
|
|
Adjusted admissions(c)
|
|
|
7.7
|
|
|
|
3.8
|
|
Average length of stay
|
|
|
|
|
|
|
|
|
Net income attributable to Community Health Systems, Inc.(d)
|
|
|
24.1
|
|
|
|
9.6
|
|
Same-store percentage increase from same period prior year(a)(e):
|
|
|
|
|
|
|
|
|
Net operating revenues
|
|
|
6.7
|
%
|
|
|
5.5
|
%
|
Admissions
|
|
|
(0.4
|
)
|
|
|
(2.7
|
)
|
Adjusted admissions(c)
|
|
|
1.7
|
|
|
|
(0.4
|
)
|
39
|
|
|
(a) |
|
Pursuant to Statement of Financial Accounting Standards, or
SFAS, No. 144, Accounting for the Impairment or
Disposal of Long-Lived Assets, or SFAS No. 144,
we have restated our prior period financial statements and
statistical results to reflect discontinued operations. |
|
(b) |
|
Operating expenses include salaries and benefits, provision for
bad debts, supplies, rent and other operating expenses. |
|
(c) |
|
Adjusted admissions is a general measure of combined inpatient
and outpatient volume. We computed adjusted admissions by
multiplying admissions by gross patient revenues and then
dividing that number by gross inpatient revenues. |
|
(d) |
|
Includes income or loss from discontinued operations. |
|
(e) |
|
Includes acquired hospitals to the extent we operated them in
both years. |
Three
months Ended June 30, 2009 Compared to Three months Ended
June 30, 2008
Net operating revenues increased $344 million to
$3.017 billion for the three months ended June 30,
2009, from $2.673 billion for the three months ended
June 30, 2008. Growth from hospitals owned throughout both
periods contributed $178 million of that increase and
$166 million was contributed by hospitals acquired in 2009
and 2008. On a same-store basis, this represents an increase in
net revenue of 6.7%. The increase from hospitals that we owned
throughout both periods was primarily attributable to higher
acuity level of services provided and outpatient growth, along
with rate increases and favorable payor mix.
On a consolidated basis, inpatient admissions increased by 5.8%
and adjusted admissions increased by 7.7%. On a same-store
basis, admissions decreased by 0.4% during the three months
ended June 30, 2009. This decrease in admissions was due
primarily to the impact of closing certain unprofitable services
during the three months ended June 30, 2009.
Operating expenses, excluding depreciation and amortization, as
a percentage of net operating revenues, decreased to 86.6% for
the three months ended June 30, 2009, compared to 86.8% for
the three months ended June 30, 2008. Salaries and
benefits, as a percentage of net operating revenues, decreased
0.5% to 39.8% for the three months ended June 30, 2009,
compared to 40.3% for the three months ended June 30, 2008.
Provision for bad debts, as a percentage of net operating
revenues, increased 1.3% to 12.0% for the three months ended
June 30, 2009, compared to 10.7% for the three months ended
June 30, 2008. This increase primarily represents an
increase in self-pay revenues over the comparable period of 2008
due to increased charges and the impact of current economic
conditions on individuals ability to pay. Supplies, as a
percentage of net operating revenues, decreased 0.1% to 13.9%
for the three months ended June 30, 2009, as compared to
14.0% for the three months ended June 30, 2008. Rent and
other operating expenses, as a percentage of net operating
revenues, decreased 0.9% to 20.9% for the three months ended
June 30, 2009, as compared to 21.8% for the three months
ended June 30, 2008. This decrease is due primarily to
reductions in contract labor. Equity in earnings of
unconsolidated affiliates, as a percentage of net operating
revenues, remained consistent at 0.4% for each of the
three-month periods ended June 30, 2009 and 2008.
Depreciation and amortization remained consistent at 4.7% of net
operating revenues for each of the three-month periods ended
June 30, 2009 and 2008.
Interest expense, net, increased by $8.1 million from
$153.4 million for the three months ended June 30,
2008 to $161.5 million for the three months ended
June 30, 2009. An increase in our average outstanding debt
during the three months ended June 30, 2009, compared to
the three months ended June 30, 2008, accounted for
$1.6 million of this increase, while an increase in
interest rates during the three months ended June 30, 2009,
compared to June 30, 2008, accounted for $3.4 million.
The remaining increase in interest expense of $3.1 million
is the result of decreased capitalized interest due to fewer
major construction projects during the three months ended
June 30, 2009, compared to the three months ended
June 30, 2008.
The net results of the above mentioned changes resulted in
income from continuing operations before income taxes increasing
$26.1 million from $85.6 million for the three months
ended June 30, 2008 to $111.7 million for the three
months ended June 30, 2009.
40
Provision for income taxes increased from $30.2 million for
the three months ended June 30, 2008 to $37.2 million
for the three months ended June 30, 2009, due primarily to
an increase in taxable income in the comparable period resulting
from the decrease in operating expenses as a percentage of net
operating revenues.
Income from continuing operations as a percentage of net
operating revenue increased from 2.1% for the three months ended
June 30, 2008 to 2.5% for the three months ended
June 30, 2009. Net income as a percentage of net operating
revenue increased from 2.1% for the three months ended
June 30, 2008 to 2.5% for the three months ended
June 30, 2009. The increase in income from continuing
operations as a percentage of net operating revenue is primarily
a result of the net decreases in operating expenses, as
discussed above.
Net income attributable to noncontrolling interests as a
percentage of net operating revenue was 0.5% for the three
months ended June 30, 2009, compared to 0.3% for the three
months ended June 30, 2008. This increase is due primarily
to additional syndications entered into after the second quarter
of 2008.
Net income attributable to Community Health Systems, Inc. was
$59.4 million for the three months ended June 30,
2009, compared to $47.9 million for the three months ended
June 30, 2008, representing an increase of 24.1%. The
increase in net income is reflective of the impact of the
revenue growth and net decrease in expenses discussed above.
Six
months Ended June 30, 2009 Compared to Six months Ended
June 30, 2008
Net operating revenues increased $546 million to
$5.930 billion for the six months ended June 30, 2009,
from $5.384 billion for the six months ended June 30,
2008. Growth from hospitals owned throughout both periods
contributed $293 million of that increase and
$253 million was contributed by hospitals acquired in 2009
and 2008. On a same-store basis, this represents an increase in
net revenue of 5.5%. The increase from hospitals that we owned
throughout both periods was primarily attributable to higher
acuity level of services provided and outpatient growth, along
with rate increases and favorable payor mix. These improvements
were partially offset by the strong flu and respiratory season
during the six months ended June 30, 2008 and the extra day
from the leap year in 2008, both of which were non-recurring
events in 2009.
On a consolidated basis, inpatient admissions increased by 1.7%
and adjusted admissions increased by 3.8%. On a same-store
basis, admissions decreased by 2.7% during the six months ended
June 30, 2009. This decrease in admissions was due
primarily to the strong flu and respiratory season during the
six months ended June 30, 2008, which did not recur during
2009, the 2008 period having one additional day because it was a
leap year, and the impact of closing certain unprofitable
services.
Operating expenses, excluding depreciation and amortization, as
a percentage of net operating revenues, decreased to 86.6% for
the six months ended June 30, 2009, compared to 86.7% for
the six months ended June 30, 2008. Salaries and benefits,
as a percentage of net operating revenues, decreased 0.1% to
40.1% for the six months ended June 30, 2009, compared to
40.2% for the six months ended June 30, 2008. Provision for
bad debts, as a percentage of net operating revenues, increased
1.1% to 11.8% for the six months ended June 30, 2009,
compared to 10.7% for the six months ended June 30, 2008.
This increase primarily represents an increase in self-pay
revenues over the comparable period of 2008 due to increased
charges and the impact of current economic conditions on
individuals ability to pay. Supplies, as a percentage of
net operating revenues, decreased 0.2% to 13.9% for the six
months ended June 30, 2009, as compared to 14.1% for the
six months ended June 30, 2008. This decrease is primarily
the result of improvements from greater utilization of and
improved pricing under our purchasing program. Rent and other
operating expenses, as a percentage of net operating revenues,
decreased 0.9% to 20.8% for the six months ended June 30,
2009, as compared to 21.7% for the six months ended
June 30, 2008. This decrease is due primarily to reductions
in contract labor. Equity in earnings of unconsolidated
affiliates, as a percentage of net operating revenues, remained
consistent at 0.4% for each of the six-month periods ended
June 30, 2009 and 2008.
Depreciation and amortization increased from 4.6% of net
operating revenues for the six months ended June 30, 2008
to 4.7% of net operating revenues for the six months ended
June 30, 2009. The increase in depreciation and
amortization as a percentage of net operating revenue is
primarily due to the opening of three replacement hospitals in
the second and third quarters of 2008.
41
Interest expense, net, increased by $7.3 million from
$318.1 million for the six months ended June 30, 2008
to $325.4 million for the six months ended June 30,
2009. An increase in our average outstanding debt during the six
months ended June 30, 2009, compared to the six months
ended June 30, 2008, accounted for $2.0 million of the
increase in interest expense, while an increase in interest
rates during the six months ended June 30, 2009, compared
to June 30, 2008, accounted for $1.0 million. In
addition, $6.1 million of the increase in interest expense
is the result of decreased capitalized interest due to fewer
major construction projects during the six months ended
June 30, 2009, compared to the six months ended
June 30, 2008. These increases were offset by an additional
$1.8 million of interest expense in 2008, which was not
incurred in 2009, since 2008 was a leap year.
The net results of the above mentioned changes resulted in
income from continuing operations before income taxes increasing
$44.5 million from $173.7 million for the six months
ended June 30, 2008 to $218.2 million for the six
months ended June 30, 2009.
Provision for income taxes increased from $61.1 million for
the six months ended June 30, 2008 to $72.8 million
for the six months ended June 30, 2009, due primarily to an
increase in taxable income in the comparable period resulting
from both the gain on early extinguishment of debt, as well as
the decrease in operating expenses as a percentage of net
operating revenues.
Income from continuing operations as a percentage of net
operating revenue increased from 2.1% for the six months ended
June 30, 2008 to 2.5% for the six months ended
June 30, 2009. Net income as a percentage of net operating
revenue increased from 2.3% for the six months ended
June 30, 2008 to 2.5% for the six months ended
June 30, 2009. The increase in income from continuing
operations as a percentage of net operating revenue is primarily
a result of the net decreases in operating expenses, as
discussed above.
Net income attributable to noncontrolling interests as a
percentage of net operating revenue was 0.5% for the six months
ended June 30, 2009, compared to 0.3% for the six months
ended June 30, 2008. This increase is due primarily to
additional syndications entered into after the first quarter of
2008.
Net income attributable to Community Health Systems, Inc. was
$118.4 million for the six months ended June 30, 2009,
compared to $108.0 million for the six months ended
June 30, 2008, representing an increase of 9.6%, as net
income for the six months ended June 30, 2008 included a
gain of $9.6 million from the sale of hospitals during that
period.
Liquidity
and Capital Resources
Net cash provided by operating activities increased
$127.6 million, from $416.8 million for the six months
ended June 30, 2008 to $544.4 million for the six
months ended June 30, 2009. The increase in cash flows, in
comparison to the prior year period, is from an increase in net
income of $23.0 million, increases in non-cash expenses of
$35.4 million, consisting primarily of depreciation and an
increase in cash flows from the change in accounts receivable of
$83.7 million. These increases were offset by decreases in
cash flows from net changes in supplies, prepaid expenses and
other current assets of $8.4 million and accounts payable,
accrued liabilities and income taxes and other of
$6.1 million.
The cash used in investing activities was $462.4 million
for the six months ended June 30, 2009, compared to
$47.8 million for the six months ended June 30, 2008.
The increase in cash used in investing activities, in comparison
to the prior year period, is from an increase in acquisitions of
facilities and other related equipment of $204.3 million, a
reduction in the amount of proceeds from the disposition of
hospitals and other ancillary operations of $276.0 million
due to the sale of one hospital in 2009 versus the sale of 11
hospitals in 2008, a reduction in the amount of the proceeds
from sale of property and equipment of $12.5 million, a net
decrease in other non-operating assets of $69.9 million,
and a reduction in the amount of purchases of property and
equipment of $8.3 million.
The cash used in financing activities was $237.8 million
for the six months ended June 30, 2008, compared to
$33.8 million for the six months ended June 30, 2009.
This change is primarily due to an increase in borrowing under
our Credit Facility.
42
Capital
Expenditures
Cash expenditures related to purchases of facilities were
$210.9 million for the six months ended June 30, 2009,
compared to $6.6 million for the six months ended
June 30, 2008. These expenditures during the six months
ended June 30, 2009 include the purchase of two hospitals,
a controlling equity interest in another hospital, surgery
centers, and physician practices and the settlement of working
capital items from a prior year acquisition. The expenditures
during the six months ended June 30, 2008 were for the
acquisition of ten physician practices and a clinic.
Excluding the cost to construct replacement hospitals, our
capital expenditures for the six months ended June 30, 2009
totaled $265.6 million, compared to $172.2 million for
the six months ended June 30, 2008. These capital
expenditures related primarily to the purchase of additional
equipment and minor renovations. Costs to construct replacement
hospitals for the six months ended June 30, 2009 totaled
$1.7 million, compared to $103.4 million for the six
months ended June 30, 2008. At June 30, 2009, there
are no replacement hospitals currently under construction. In
2008, the Company completed construction of and opened three
replacement hospitals, accounting for the higher costs incurred
during the six months ended June 30, 2008. Pursuant to
hospital purchase agreements in effect as of June 30, 2009,
where required certificate of need approval has been obtained,
we are required to build replacement hospitals in Valparaiso,
Indiana by April 2011 and in Siloam Springs, Arkansas by
February 2013. Also as required by an amendment to a lease
agreement entered into in 2005, we agreed to build a replacement
hospital at Barstow Community Hospital in Barstow, California.
Estimated construction costs, including equipment costs, are
approximately $304.0 million for these three replacement
hospitals. In addition, in October 2008, after the purchase of
the minority owners interest in our Birmingham, Alabama
facility, we initiated the purchase of an alternate site for a
replacement hospital rather than the one previously selected by
Triad. The new site includes a partially constructed hospital
structure, for which we are currently assessing completion
costs, to be used for relocating the existing Birmingham
facility. This project is subject to the approval of a
certificate of need. Upon receiving the certificate of need, and
after resolution of any legal opposition, we will undertake
completion of the unfinished facility.
Capital
Resources
Net working capital was $1.139 billion at June 30,
2009, compared to $1.096 billion at December 31, 2008.
The $43.5 million increase was primarily attributable to an
increase in working capital attributable to the acquisition of
Siloam Springs Memorial Hospital, Wyoming Valley Health Care
System and a controlling equity interest in MCSA L.L.C., an
increase in cash as a result of cash flows from operations, an
increase in prepaid expenses and a decrease in accounts payable
and accrued liabilities offset by a decrease in prepaid taxes.
In connection with the consummation of the Triad acquisition in
July 2007, we obtained $7.215 billion of senior secured
financing under a Credit Facility with a syndicate of financial
institutions led by Credit Suisse, as administrative agent and
collateral agent. The Credit Facility consisted of a
$6.065 billion funded term loan facility with a maturity of
seven years, a $300 million delayed draw term loan facility
(reduced from $400 million) with a maturity of seven years
and a $750 million revolving credit facility with a
maturity of nine years. During the fourth quarter of 2008,
$100 million of the delayed draw term loan was drawn down
by us reducing the delayed draw term loan availability to
$200 million at December 31, 2008. In January 2009, we
drew down the remaining $200 million of the delayed draw
term loan. The revolving credit facility also includes a
subfacility for letters of credit and a swingline subfacility.
The Credit Facility requires us to make quarterly amortization
payments of each term loan facility equal to 0.25% of the
initial outstanding amount of the term loans, if any, with the
outstanding principal balance of each term loan facility payable
on July 25, 2014.
The term loan facility must be prepaid in an amount equal to
(1) 100% of the net cash proceeds of certain asset sales
and dispositions by us and our subsidiaries, subject to certain
exceptions and reinvestment rights, (2) 100% of the net
cash proceeds of issuances of certain debt obligations or
receivables based financing by us and our subsidiaries, subject
to certain exceptions, and (3) 50%, subject to reduction to
a lower percentage based on our leverage ratio (as defined in
the Credit Facility generally as the ratio of total debt on the
date of determination to our EBITDA, as defined, for the four
quarters most recently ended prior to such date), of excess cash
flow (as defined) for any year, commencing in 2008, subject to
certain exceptions. Voluntary prepayments and commitment
43
reductions are permitted in whole or in part, without premium or
penalty, subject to minimum prepayment or reduction requirements.
The obligor under the Credit Facility is CHS/Community Health
Systems, Inc., or CHS, a wholly-owned subsidiary of Community
Health Systems, Inc. All of our obligations under the Credit
Facility are unconditionally guaranteed by Community Health
Systems, Inc. and certain existing and subsequently acquired or
organized domestic subsidiaries. All obligations under the
Credit Facility and the related guarantees are secured by a
perfected first priority lien or security interest in
substantially all of the assets of Community Health Systems,
Inc., CHS and each subsidiary guarantor, including equity
interests held by us or any subsidiary guarantor, but excluding,
among others, the equity interests of non-significant
subsidiaries, syndication subsidiaries, securitization
subsidiaries and joint venture subsidiaries.
The loans under the Credit Facility bear interest on the
outstanding unpaid principal amount at a rate equal to an
applicable percentage plus, at our option, either (a) an
Alternate Base Rate (as defined) determined by reference to the
greater of (1) the Prime Rate (as defined) announced by
Credit Suisse or (2) the Federal Funds Effective Rate (as
defined) plus 0.5%, or (b) a reserve adjusted London
interbank offered rate for dollars (Eurodollar rate) (as
defined). The applicable percentage for term loans is 1.25% for
Alternate Base Rate loans and 2.25% for Eurodollar rate loans.
The applicable percentage for revolving loans was initially
1.25% for Alternate Base Rate revolving loans and 2.25% for
Eurodollar revolving loans, in each case subject to reduction
based on our leverage ratio. Loans under the swingline
subfacility bear interest at the rate applicable to Alternate
Base Rate loans under the revolving credit facility.
We have agreed to pay letter of credit fees equal to the
applicable percentage then in effect with respect to Eurodollar
rate loans under the revolving credit facility times the maximum
aggregate amount available to be drawn under all letters of
credit outstanding under the subfacility for letters of credit.
The issuer of any letter of credit issued under the subfacility
for letters of credit will also receive a customary fronting fee
and other customary processing charges. We were initially
obligated to pay commitment fees of 0.50% per annum (subject to
reduction based upon on our leverage ratio), on the unused
portion of the revolving credit facility. For purposes of this
calculation, swingline loans are not treated as usage of the
revolving credit facility. With respect to the delayed draw term
loan facility, we were also obligated to pay commitment fees of
0.50% per annum for the first nine months after the close of the
Credit Facility, 0.75% per annum for the next three months after
such nine-month period and thereafter 1.0% per annum. In each
case, the commitment fee was based on the unused amount of the
delayed draw term loan facility. After the draw down of the
remaining $200 million of the delayed draw term loan in
January 2009, we no longer pay commitment fees for the delayed
draw term loan facility. We also paid arrangement fees on the
closing of the Credit Facility and pay an annual administrative
agent fee.
The Credit Facility contains customary representations and
warranties, subject to limitations and exceptions, and customary
covenants restricting our and our subsidiaries ability to,
among other things and subject to various exceptions,
(1) declare dividends, make distributions or redeem or
repurchase capital stock, (2) prepay, redeem or repurchase
other debt, (3) incur liens or grant negative pledges,
(4) make loans and investments and enter into acquisitions
and joint ventures, (5) incur additional indebtedness or
provide certain guarantees, (6) make capital expenditures,
(7) engage in mergers, acquisitions and asset sales,
(8) conduct transactions with affiliates, (9) alter
the nature of our businesses, (10) grant certain guarantees
with respect to physician practices, (11) engage in sale
and leaseback transactions or (12) change our fiscal year.
We and our subsidiaries are also required to comply with
specified financial covenants (consisting of a leverage ratio
and an interest coverage ratio) and various affirmative
covenants.
Events of default under the Credit Facility include, but are not
limited to, (1) our failure to pay principal, interest,
fees or other amounts under the credit agreement when due
(taking into account any applicable grace period), (2) any
representation or warranty proving to have been materially
incorrect when made, (3) covenant defaults subject, with
respect to certain covenants, to a grace period,
(4) bankruptcy events, (5) a cross default to certain
other debt, (6) certain undischarged judgments (not paid
within an applicable grace period), (7) a change of
control, (8) certain ERISA-related defaults and
(9) the invalidity or impairment of specified security
interests, guarantees or subordination provisions in favor of
the administrative agent or lenders under the Credit Facility.
44
As of June 30, 2009, there was approximately
$750 million of available borrowing capacity under our
Credit Facility, of which $89.2 million was set aside for
outstanding letters of credit.
During the three months ended June 30, 2009, the Company
repurchased on the open market and cancelled $61.0 million
of principal amount of the Notes. This resulted in a net gain
from early extinguishment of debt of $0.3 million with an
after-tax impact of $0.2 million. During the six months
ended June 30, 2009, we repurchased on the open market and
cancelled $121.5 million of principal amount of the Notes.
This resulted in a net gain from early extinguishment of debt of
$2.7 million with an after-tax impact of $1.7 million.
On April 2, 2009, the Company paid down $110.4 million
of its term loans under the Credit Facility. Of this amount,
$85.0 million was paid down as required under the terms of
the Credit Facility with the net proceeds received from the sale
of the ownership interest in the partnership that owned and
operated Presbyterian Hospital of Denton. This resulted in a
loss from early extinguishment of debt of $1.1 million with
an after-tax impact of $0.7 million recorded in
discontinued operations for both the three and six months ended
June 30, 2009. The remaining $25.4 million was paid on
the term loans as required under the terms of the Credit
Facility with the net proceeds received from the sale of various
other assets. This resulted in a loss from early extinguishment
of debt of $0.3 million with an after-tax impact of
$0.2 million recorded in continuing operations for the
three and six months ended June 30, 2009.
As of June 30, 2009, we are currently a party to the
following interest rate swap agreements to limit the effect of
changes in interest rates on a portion of our long-term
borrowings. On each of these swaps, we received a variable rate
of interest based on the three-month London Inter-Bank Offer
Rate, or LIBOR, in exchange for the payment by us of a fixed
rate of interest. We currently pay, on a quarterly basis, a
margin above LIBOR of 225 basis points for revolving credit
and term loans under the Credit Facility.
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Notional
|
|
|
|
|
|
|
|
|
Amount
|
|
Fixed Interest
|
|
Termination
|
|
Fair Value
|
Swap #
|
|
(in 000s)
|
|
Rate
|
|
Date
|
|
(in 000s)
|
|
1
|
|
|
$704,000
|
|
|
0.4250%
|
|
August 28, 2009
|
|
$
|
(147
|
) (1)
|
2
|
|
|
100,000
|
|
|
4.3375%
|
|
November 30, 2009
|
|
|
(1,725
|
)
|
3
|
|
|
200,000
|
|
|
2.8800%
|
|
September 17, 2010
|
|
|
(3,397
|
)
|
4
|
|
|
100,000
|
|
|
4.9360%
|
|
October 4, 2010
|
|
|
(4,435
|
)
|
5
|
|
|
100,000
|
|
|
4.7090%
|
|
January 24, 2011
|
|
|
(5,059
|
)
|
6
|
|
|
300,000
|
|
|
5.1140%
|
|
August 8, 2011
|
|
|
(22,170
|
)
|
7
|
|
|
100,000
|
|
|
4.7185%
|
|
August 19, 2011
|
|
|
(6,746
|
)
|
8
|
|
|
100,000
|
|
|
4.7040%
|
|
August 19, 2011
|
|
|
(6,590
|
)
|
9
|
|
|
100,000
|
|
|
4.6250%
|
|
August 19, 2011
|
|
|
(6,544
|
)
|
10
|
|
|
200,000
|
|
|
4.9300%
|
|
August 30, 2011
|
|
|
(14,235
|
)
|
11
|
|
|
200,000
|
|
|
3.0920%
|
|
September 18, 2011
|
|
|
(6,442
|
)
|
12
|
|
|
100,000
|
|
|
3.0230%
|
|
October 23, 2011
|
|
|
(3,064
|
)
|
13
|
|
|
200,000
|
|
|
4.4815%
|
|
October 26, 2011
|
|
|
(12,729
|
)
|
14
|
|
|
200,000
|
|
|
4.0840%
|
|
December 3, 2011
|
|
|
(11,097
|
)
|
15
|
|
|
100,000
|
|
|
3.8470%
|
|
January 4, 2012
|
|
|
(5,026
|
)
|
16
|
|
|
100,000
|
|
|
3.8510%
|
|
January 4, 2012
|
|
|
(5,036
|
)
|
17
|
|
|
100,000
|
|
|
3.8560%
|
|
January 4, 2012
|
|
|
(5,048
|
)
|
18
|
|
|
200,000
|
|
|
3.7260%
|
|
January 8, 2012
|
|
|
(9,470
|
)
|
19
|
|
|
200,000
|
|
|
3.5065%
|
|
January 16, 2012
|
|
|
(8,399
|
)
|
20
|
|
|
250,000
|
|
|
5.0185%
|
|
May 30, 2012
|
|
|
(20,874
|
)
|
21
|
|
|
150,000
|
|
|
5.0250%
|
|
May 30, 2012
|
|
|
(12,597
|
)
|
22
|
|
|
200,000
|
|
|
4.6845%
|
|
September 11, 2012
|
|
|
(15,307
|
)
|
23
|
|
|
100,000
|
|
|
3.3520%
|
|
October 23, 2012
|
|
|
(3,563
|
)
|
24
|
|
|
125,000
|
|
|
4.3745%
|
|
November 23, 2012
|
|
|
(8,486
|
)
|
45
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Notional
|
|
|
|
|
|
|
|
|
Amount
|
|
Fixed Interest
|
|
Termination
|
|
Fair Value
|
Swap #
|
|
(in 000s)
|
|
Rate
|
|
Date
|
|
(in 000s)
|
|
25
|
|
|
75,000
|
|
|
4.3800%
|
|
November 23, 2012
|
|
|
(5,129
|
)
|
26
|
|
|
150,000
|
|
|
5.0200%
|
|
November 30, 2012
|
|
|
(13,386
|
)
|
27
|
|
|
100,000
|
|
|
5.0230%
|
|
May 30, 2013
|
|
|
(9,290
|
)
|
28
|
|
|
300,000
|
|
|
5.2420%
|
|
August 6, 2013
|
|
|
(31,538
|
)
|
29
|
|
|
100,000
|
|
|
5.0380%
|
|
August 30, 2013
|
|
|
(9,517
|
)
|
30
|
|
|
50,000
|
|
|
3.5860%
|
|
October 23, 2013
|
|
|
(1,879
|
)
|
31
|
|
|
50,000
|
|
|
3.5240%
|
|
October 23, 2013
|
|
|
(1,754
|
)
|
32
|
|
|
100,000
|
|
|
5.0500%
|
|
November 30, 2013
|
|
|
(9,742
|
)
|
33
|
|
|
200,000
|
|
|
2.0700%
|
|
December 19, 2013
|
|
|
6,241
|
|
34
|
|
|
100,000
|
|
|
5.2310%
|
|
July 25, 2014
|
|
|
(10,895
|
)
|
35
|
|
|
100,000
|
|
|
5.2310%
|
|
July 25, 2014
|
|
|
(10,895
|
)
|
36
|
|
|
200,000
|
|
|
5.1600%
|
|
July 25, 2014
|
|
|
(21,120
|
)
|
37
|
|
|
75,000
|
|
|
5.0405%
|
|
July 25, 2014
|
|
|
(7,498
|
)
|
38
|
|
|
125,000
|
|
|
5.0215%
|
|
July 25, 2014
|
|
|
(12,384
|
)
|
|
|
|
(1) |
|
This interest rate swap is a
90-day swap
for which we pay a monthly fixed rate of 0.4250% and receive
one-month LIBOR rates payable on $704 million of term loans
under the Credit Facility. As with each of these swap
agreements, the variable interest rate received matches the
variable interest rate paid for the revolving credit and term
loans under the Credit Facility. We continue to pay a margin of
225 basis points for the revolving credit and term loans
under the Credit Facility. |
The Credit Facility
and/or the
Notes contain various covenants that limit our ability to take
certain actions including, among other things, our ability to:
|
|
|
|
|
incur, assume or guarantee additional indebtedness;
|
|
|
|
issue redeemable stock and preferred stock;
|
|
|
|
repurchase capital stock;
|
|
|
|
make restricted payments, including paying dividends and making
investments;
|
|
|
|
redeem debt that is junior in right of payment to the notes;
|
|
|
|
create liens without securing the notes;
|
|
|
|
sell or otherwise dispose of assets, including capital stock of
subsidiaries;
|
|
|
|
enter into agreements that restrict dividends from subsidiaries;
|
|
|
|
merge, consolidate, sell or otherwise dispose of substantial
portions of our assets;
|
|
|
|
enter into transactions with affiliates; and
|
|
|
|
guarantee certain obligations.
|
In addition, our Credit Facility contains restrictive covenants
and requires us to maintain specified financial ratios and
satisfy other financial condition tests. Our ability to meet
these restricted covenants and financial ratios and tests can be
affected by events beyond our control, and we cannot assure you
that we will meet those tests. A breach of any of these
covenants could result in a default under our Credit Facility
and/or the
Notes. Upon the occurrence of an event of default under our
Credit Facility or the Notes, all amounts outstanding under our
Credit Facility and the Notes may become due and payable and all
commitments under the Credit Facility to extend further credit
may be terminated.
46
We believe that internally generated cash flows, availability
for additional borrowings under our Credit Facility of a
$750 million revolving credit facility, and our ability to
add up to $300 million of borrowing capacity from
receivable transactions (including securitizations) will be
sufficient to finance acquisitions, capital expenditures and
working capital requirements through the next 12 months. We
believe these same sources of cash flows, borrowings under our
credit agreement and, despite the current conditions in the
financial and capital markets resulting from the global credit
and liquidity issues, access to bank credit and capital markets
will be available to us beyond the next 12 months and into
the foreseeable future.
On December 22, 2008, we filed a universal automatic shelf
registration statement on
Form S-3ASR
that will permit us, from time to time, in one or more public
offerings, to offer debt securities, common stock, preferred
stock, warrants, depositary shares, or any combination of such
securities. The shelf registration statement will also permit
our subsidiary, CHS, to offer debt securities that would be
guaranteed by us, from time to time in one or more public
offerings. The terms of any such future offerings would be
established at the time of the offering.
The following table shows the ratio of earnings to fixed charges
for the six months ended June 30, 2009:
|
|
|
|
|
|
|
Six Months
|
|
|
|
Ended
|
|
|
|
June 30, 2009
|
|
|
Ratio of earnings to fixed charges(1)
|
|
|
1.53x
|
|
|
|
|
|
|
|
|
|
(1) |
|
There are no shares of preferred stock outstanding. |
Off-balance
Sheet Arrangements
Our consolidated operating results for the six months ended
June 30, 2009 and 2008, included $143.3 million and
$139.0 million, respectively, of net operating revenue and
$10.6 million and $7.4 million, respectively, of
income from operations generated from six hospitals operated by
us under operating lease arrangements. In accordance with
accounting principles generally accepted in the United States of
America, or U.S. GAAP, the respective assets and the future
lease obligations under these arrangements are not recorded on
our condensed consolidated balance sheet. Lease payments under
these arrangements are included in rent expense when paid and
totaled approximately $8.3 million for the six months ended
June 30, 2009, compared to $8.2 million for the six
months ended June 30, 2008. The current terms of these
operating leases expire between June 2010 and December 2019, not
including lease extension options. If we allow these leases to
expire, we would no longer generate revenue nor incur expenses
from these hospitals.
In the past, we have utilized operating leases as a financing
tool for obtaining the operations of specified hospitals without
acquiring, through ownership, the related assets of the hospital
and without a significant outlay of cash at the front end of the
lease. We utilize the same management and operating strategies
to improve operations at those hospitals held under operating
leases as we do at those hospitals that we own. We have not
entered into any operating leases for hospital operations since
December 2000.
Joint
Ventures
We have sold noncontrolling interests in certain of our
subsidiaries or acquired subsidiaries with existing
noncontrolling interest ownership positions. As of June 30,
2009, we have hospitals owned by physician joint ventures in 23
of the markets we serve, with ownership interests ranging from
less than 1% to 40%, including one hospital that also had a
non-profit entity as a partner. In addition, three other
hospitals had non-profit entities as partners. Redeemable
noncontrolling interests in equity of consolidated subsidiaries
was $324.0 million and $320.2 million as of
June 30, 2009 and December 31, 2008, respectively, and
noncontrolling interests in equity of consolidated subsidiaries
was $81.0 million and $75.1 million as of
June 30, 2009 and December 31, 2008, respectively, and
the amount of net income attributable to noncontrolling
interests was $14.6 million and $7.3 million for the
three months ended June 30, 2009 and 2008, respectively,
and $28.5 million and $15.9 million for the six months
ended June 30, 2009 and 2008, respectively.
47
Reimbursement,
Legislative and Regulatory Changes
Legislative and regulatory action has resulted in continuing
change in the Medicare and Medicaid reimbursement programs which
will continue to limit payment increases under these programs
and in some cases implement payment decreases. Within the
statutory framework of the Medicare and Medicaid programs, there
are substantial areas subject to administrative rulings,
interpretations, and discretion which may further affect
payments made under those programs, and the federal and state
governments might, in the future, reduce the funds available
under those programs or require more stringent utilization and
quality reviews of hospital facilities. Additionally, there may
be a continued rise in managed care programs and future
restructuring of the financing and delivery of healthcare in the
United States. These events could cause our future financial
results to decline.
Inflation
The healthcare industry is labor intensive. Wages and other
expenses increase during periods of inflation and when labor
shortages occur in the marketplace. In addition, our suppliers
pass along rising costs to us in the form of higher prices. We
have implemented cost control measures, including our case and
resource management program, to curb increases in operating
costs and expenses. We have generally offset increases in
operating costs by increasing reimbursement for services,
expanding services and reducing costs in other areas. However,
we cannot predict our ability to cover or offset future cost
increases.
Critical
Accounting Policies
The discussion and analysis of our financial condition and
results of operations are based upon our condensed consolidated
financial statements, which have been prepared in accordance
with U.S. GAAP. The preparation of these financial
statements requires us to make estimates and judgments that
affect the reported amount of assets and liabilities, revenues
and expenses, and related disclosure of contingent assets and
liabilities at the date of our condensed consolidated financial
statements. Actual results may differ from these estimates under
different assumptions or conditions.
Critical accounting policies are defined as those that are
reflective of significant judgments and uncertainties, and
potentially result in materially different results under
different assumptions and conditions. We believe that our
critical accounting policies are limited to those described
below.
Third
Party Reimbursement
Net operating revenues include amounts estimated by management
to be reimbursable by Medicare and Medicaid under prospective
payment systems and provisions of cost-reimbursement and other
payment methods. In addition, we are reimbursed by
non-governmental payors using a variety of payment
methodologies. Amounts we receive for treatment of patients
covered by these programs are generally less than the standard
billing rates. Contractual allowances are automatically
calculated and recorded through our internally developed
automated contractual allowance system. Within this
automated system, actual Medicare DRG data and payors
historical paid claims data are utilized to calculate the
contractual allowances. This data is automatically updated on a
monthly basis. All hospital contractual allowance calculations
are subjected to monthly review by management to ensure
reasonableness and accuracy. We account for the differences
between the estimated program reimbursement rates and the
standard billing rates as contractual allowance adjustments,
which we deduct from gross revenues to arrive at net operating
revenues. The process of estimating contractual allowances
requires us to estimate the amount expected to be received based
on government programs and payor contract provisions. The key
assumption in this process is the estimated contractual
reimbursement percentage, which is based on payor classification
and historical paid claims data. Due to the complexities
involved in these estimates, actual payments we receive could be
different from the amounts we estimate and record. If the actual
contractual reimbursement percentage under government programs
and managed care contracts differed by 1% from our estimated
reimbursement percentage, net income for the six months ended
June 30, 2009 would have changed by approximately
$25.8 million, and net accounts receivable would have
changed by $42.0 million. Final settlements under some of
these programs are subject to adjustment based on administrative
review and audit by third parties. We account for adjustments to
previous program reimbursement estimates as contractual
allowance adjustments and report them in the periods that
48
such adjustments become known. Contractual allowance adjustments
related to final settlements and previous program reimbursement
estimates impacted net operating revenues and net income by an
insignificant amount in each of the three-month and six-month
periods ended June 30, 2009 and 2008.
Allowance
for Doubtful Accounts
Substantially all of our accounts receivable are related to
providing healthcare services to our hospitals patients.
Collection of these accounts receivable is our primary source of
cash and is critical to our operating performance. Our primary
collection risks relate to uninsured patients and outstanding
patient balances for which the primary insurance payor has paid
some but not all of the outstanding balance, with the remaining
outstanding balance (generally deductibles and co-payments) owed
by the patient. At the point of service, for patients required
to make a co-payment, we generally collect less than 15% of the
related revenue. For all procedures scheduled in advance, our
policy is to verify insurance coverage prior to the date of the
procedure. Insurance coverage is not verified in advance of
procedures for walk-in and emergency room patients.
We estimate the allowance for doubtful accounts by reserving a
percentage of all self-pay accounts receivable without regard to
aging category, based on collection history, adjusted for
expected recoveries and, if present, anticipated changes in
trends. For all other payor categories we reserve 100% of all
accounts aging over 365 days from the date of discharge.
The percentage used to reserve for all self-pay accounts is
based on our collection history. We believe that we collect
substantially all of our third-party insured receivables, which
include receivables from governmental agencies.
Collections are impacted by the economic ability of patients to
pay and the effectiveness of our collection efforts. Significant
changes in payor mix, business office operations, economic
conditions or trends in federal and state governmental
healthcare coverage could affect our collection of accounts
receivable. The process of estimating the allowance for doubtful
accounts requires us to estimate the collectability of self-pay
accounts receivable, which is primarily based on our collection
history, adjusted for expected recoveries and, if available,
anticipated changes in collection trends. Significant change in
payor mix, business office operations, economic conditions,
trends in federal and state governmental healthcare coverage or
other third party payors could affect our estimates of accounts
receivable collectability. If the actual collection percentage
differed by 1% from our estimated collection percentage as a
result of a change in expected recoveries, net income for the
six months ended June 30, 2009 would have changed by
$13.4 million, and net accounts receivable would have
changed by $21.7 million. We also continually review our
overall reserve adequacy by monitoring historical cash
collections as a percentage of trailing net revenue less
provision for bad debts, as well as by analyzing current period
net revenue and admissions by payor classification, aged
accounts receivable by payor, days revenue outstanding, and the
impact of recent acquisitions and dispositions.
Our policy is to write-off gross accounts receivable if the
balance is under $10.00 or when such amounts are placed with
outside collection agencies. We believe this policy accurately
reflects our ongoing collection efforts and is consistent with
industry practices. We had approximately $1.4 billion at
June 30, 2009 and $1.5 billion December 31, 2008,
being pursued by various outside collection agencies. We expect
to collect less than 3%, net of estimated collection fees, of
the amounts being pursued by outside collection agencies. As
these amounts have been written-off, they are not included in
our gross accounts receivable or our allowance for doubtful
accounts. Collections on amounts previously written-off are
recognized as a reduction to bad debt expense when received.
However, we take into consideration estimated collections of
these future amounts written-off in evaluating the
reasonableness of our allowance for doubtful accounts.
All of the following information is derived from our hospitals,
excluding clinics, unless otherwise noted.
Patient accounts receivable from our hospitals represent
approximately 95% of our total consolidated accounts receivable.
Days revenue outstanding was 50 days at June 30, 2009
and 53 days at December 31, 2008. Our target range for
days revenue outstanding is 52 to 58 days.
49
Total gross accounts receivable (prior to allowance for
contractual adjustments and doubtful accounts) was approximately
$6.083 billion as of June 30, 2009 and approximately
$5.458 billion as of December 31, 2008.
The approximate percentage of total gross accounts receivable
(prior to allowances for contractual adjustments and doubtful
accounts) summarized by payor category is as follows:
|
|
|
|
|
|
|
|
|
|
|
As of
|
|
|
|
June 30,
|
|
|
December 31,
|
|
|
|
2009
|
|
|
2008
|
|
|
Insured receivables
|
|
|
65.4
|
%
|
|
|
67.0
|
%
|
Self-pay receivables
|
|
|
34.6
|
%
|
|
|
33.0
|
%
|
|
|
|
|
|
|
|
|
|
Total
|
|
|
100.0
|
%
|
|
|
100.0
|
%
|
|
|
|
|
|
|
|
|
|
For the hospital segment, the combined total of the allowance
for doubtful accounts and related allowances for other self-pay
discounts and contractuals, as a percentage of gross self-pay
receivables, was approximately 81% at June 30, 2009 and 80%
at December 31, 2008. If the receivables that have been
written-off but where collections are still being pursued by
outside collection agencies, were included in both the
allowances and gross self-pay receivables specified above, the
percentage of combined allowances to total self-pay receivables
would have been approximately 88% at June 30, 2009 and
December 31, 2008.
Goodwill
and Other Intangibles
Goodwill represents the excess of cost over the fair value of
net assets acquired. Goodwill arising from business combinations
is accounted for under the provisions of
SFAS No. 141(R) Business Combinations and
SFAS No. 142, Goodwill and Other Intangible
Assets and is not amortized. SFAS No. 142
requires goodwill to be evaluated for impairment at the same
time every year and when an event occurs or circumstances change
that, more likely than not, reduce the fair value of the
reporting unit below its carrying value. SFAS No. 142
requires a two-step method for determining goodwill impairment.
Step one is to compare the fair value of the reporting unit with
the units carrying amount, including goodwill. If this
test indicates the fair value is less than the carrying value,
then step two is required to compare the implied fair value of
the reporting units goodwill with the carrying value of
the reporting units goodwill. We have selected
September 30th as our annual testing date.
We estimate the fair value of the related reporting units using
both a discounted cash flow model as well as an EBITDA multiple
model. These models are both based on our best estimate of
future revenues and operating costs and are reconciled to our
consolidated market capitalization. The cash flow forecasts are
adjusted by an appropriate discount rate based on our weighted
average cost of capital. Historically our valuation models did
not fully capture the fair value of our business as a whole, as
they did not consider the increased consideration a potential
acquirer would be required to pay, in the form of a control
premium, in order to gain sufficient ownership to set policies,
direct operations and control management decisions. However,
because our models have indicated value significantly in excess
of the carrying amount of assets in our reporting units, the
additional value from a control premium was not a determining
factor in the outcome of step one of our impairment assessment.
Impairment
or Disposal of Long-Lived Assets
In accordance with SFAS No. 144, whenever events or
changes in circumstances indicate that the carrying values of
certain long-lived assets may be impaired, we project the
undiscounted cash flows expected to be generated by these
assets. If the projections indicate that the reported amounts
are not expected to be recovered, such amounts are reduced to
their estimated fair value based on a quoted market price, if
available, or an estimate based on valuation techniques
available in the circumstances.
Professional
Liability Insurance Claims
As part of our business of owning and operating hospitals, we
are subject to legal actions alleging liability on our part. We
accrue for losses resulting from such liability claims, as well
as loss adjustment expenses that are out-of-pocket and directly
related to such liability claims. These direct out-of-pocket
expenses include fees of outside counsel and experts. We do not
accrue for costs that are part of our corporate overhead, such
as the costs of our in-
50
house legal and risk management departments. The losses
resulting from professional liability claims primarily consist
of estimates for known claims, as well as estimates for incurred
but not reported claims. The estimates are based on specific
claim facts, our historical claim reporting and payment
patterns, the nature and level of our hospital operations, and
actuarially determined projections. The actuarially determined
projections are based on our actual claim data, including
historic reporting and payment patterns which have been gathered
over an approximate
20-year
period. As discussed below, since we purchase excess insurance
on a claims-made basis that transfers risk to third party
insurers, the liability we accrue does not include an amount for
the losses covered by our excess insurance. Since we believe
that the amount and timing of our future claims payments are
reliably determinable, we discount the amount we accrue for
losses resulting from professional liability claims using the
risk-free interest rate corresponding to the timing of our
expected payments.
The net present value of the projected payments was discounted
using a weighted-average risk-free rate of 2.6% and 4.1% in 2008
and 2007, respectively. This liability is adjusted for new
claims information in the period such information becomes known
to us. Professional malpractice expense includes the losses
resulting from professional liability claims and loss adjustment
expense, as well as paid excess insurance premiums, and is
presented within other operating expenses in the accompanying
consolidated statements of income.
Our processes for obtaining and analyzing claims and incident
data are standardized across all of our hospitals and have been
consistent for many years. We monitor the outcomes of the
medical care services that we provide and for each reported
claim, we obtain various information concerning the facts and
circumstances related to that claim. In addition, we routinely
monitor current key statistics and volume indicators in our
assessment of utilizing historical trends. The average lag
period between claim occurrence and payment of a final
settlement is between 4 and 5 years, although the facts and
circumstances of individual claims could result in the timing of
such payments being different from this average. Since claims
are paid promptly after settlement with the claimant is reached,
settled claims generally represent less than 1.0% of the total
liability at the end of any period.
For purposes of estimating our individual claim accruals, we
utilize specific claim information, including the nature of the
claim, the expected claim amount, the year in which the claim
occurred and the laws of the jurisdiction in which the claim
occurred. Once the case accruals for known claims are
determined, information is stratified by loss layers and
retentions, accident years, reported years, geography, and
claims relating to the acquired Triad hospitals versus claims
relating to our other hospitals. Several actuarial methods are
used against this data to produce estimates of ultimate paid
losses and reserves for incurred but not reported claims. Each
of these methods uses our company-specific historical claims
data and other information. This company-specific data includes
information regarding our business, including historical paid
losses and loss adjustment expenses, historical and current case
loss reserves, actual and projected hospital statistical data, a
variety of hospital census information, employed physician
information, professional liability retentions for each policy
year, geographic information and other data.
Based on these analyses, we determine our estimate of the
professional liability claims. The determination of
managements estimate, including the preparation of the
reserve analysis that supports such estimate, involves
subjective judgment of the management. Changes in reserving data
or the trends and factors that influence reserving data may
signal fundamental shifts in our future claim development
patterns or may simply reflect single-period anomalies. Even if
a change reflects a fundamental shift, the full extent of the
change may not become evident until years later. Moreover, since
our methods and models use different types of data and we select
our liability from the results of all of these methods, we
typically cannot quantify the precise impact of such factors on
our estimates of the liability. Due to our standardized and
consistent processes for handling claims and the long history
and depth of our company-specific data, our methodologies have
produced reliably determinable estimates of ultimate paid losses.
We are primarily self-insured for these claims; however, we
obtain excess insurance that transfers the risk of loss to a
third-party insurer for claims in excess of our self-insured
retentions. Our excess insurance is underwritten on a
claims-made basis. For claims reported prior to June 1,
2002, substantially all of our professional and general
liability risks were subject to a $0.5 million per
occurrence self-insured retention and for claims reported from
June 1, 2002 through June 1, 2003, these self-insured
retentions were $2.0 million per occurrence. Substantially
all claims reported after June 1, 2003 and before
June 1, 2005 are self-insured up to $4 million per
claim. Substantially
51
all claims reported on or after June 1, 2005 are
self-insured up to $5 million per claim. Management on
occasion has selectively increased the insured risk at certain
hospitals based upon insurance pricing and other factors and may
continue that practice in the future. Excess insurance for all
hospitals has been purchased through commercial insurance
companies and generally covers us for liabilities in excess of
the self-insured retentions and up to $100 million per
occurrence for claims reported on or after June 1, 2003 and
up to $150 million per occurrence for claims occurred and
reported after January 1, 2008.
Effective January 1, 2008, the former Triad Hospitals are
insured on a claims-made basis as described above and through
commercial insurance companies as described above for
substantially all claims occurring on or after January 1,
2002 and reported on or after January 1, 2008.
Substantially all losses for the former Triad hospitals in
periods prior to May 1999 were insured through a wholly-owned
insurance subsidiary of HCA, Inc., or HCA, Triads owner
prior to that time, and excess loss policies maintained by HCA.
HCA has agreed to indemnify the former Triad hospitals in
respect of claims covered by such insurance policies arising
prior to May 1999. After May 1999 through December 31,
2006, the former Triad hospitals obtained insurance coverage on
a claims incurred basis from HCAs wholly-owned insurance
subsidiary with excess coverage obtained from other carriers
that is subject to certain deductibles. Effective for claims
incurred after December 31, 2006, Triad began insuring its
claims from $1 million to $5 million through its
wholly-owned captive insurance company, replacing the coverage
provided by HCA. Substantially all claims occurring during 2007
were self-insured up to $10 million per claim.
There have been no significant changes in our estimate of the
reserve for professional liability claims during the three and
six months ended June 30, 2009.
Income
Taxes
We must make estimates in recording provision for income taxes,
including determination of deferred tax assets and deferred tax
liabilities and any valuation allowances that might be required
against the deferred tax assets. We believe that future income
will enable us to realize these deferred tax assets, subject to
the valuation allowance we have established.
On January 1, 2007, we adopted the provisions of FASB
Interpretation No. 48, Accounting for Uncertainty in
Income Taxes. The total amount of unrecognized benefit
that would affect the effective tax rate, if recognized, was
approximately $13.6 million as of June 30, 2009. It is
our policy to recognize interest and penalties accrued related
to unrecognized benefits in our condensed consolidated
statements of income as income tax expense. During the six
months ended June 30, 2009, we decreased liabilities by
approximately $0.1 million and recorded $0.5 million
in interest and penalties related to prior state income tax
returns through our income tax provision from continuing
operations, which are included in our FASB Interpretation
No. 48 liability at June 30, 2009. A total of
approximately $1.8 million of interest and penalties is
included in the amount of FASB Interpretation No. 48
liability at June 30, 2009.
We believe it is reasonably possible that approximately
$4.1 million of our current unrecognized tax benefit may be
recognized within the next twelve months as a result of a lapse
of the statute of limitations and settlements with taxing
authorities.
We, or one of our subsidiaries, file income tax returns in the
U.S. federal jurisdiction and various state jurisdictions.
We have extended the federal statute of limitations for Triad
for the tax periods ended December 31, 1999,
December 31, 2000, April 30, 2001, June 30, 2001,
December 31, 2001, December 31, 2002 and
December 31, 2003. We are currently under examination by
the IRS of the federal tax return of Triad for the tax periods
ended December 31, 2004, December 31, 2005,
December 31, 2006 and July 25, 2007. We believe the
results of this examination will not be material to our
consolidated results of operations or consolidated financial
position. With few exceptions, we are no longer subject to state
income tax examinations for years prior to 2004.
Prior to the adoption of SFAS No. 160,
Noncontrolling Interests in Consolidated Financials
Statements an Amendment of ARB No. 51, or
SFAS No. 160, on January 1, 2009, income
attributable to noncontrolling interests was deducted from
earnings before arriving at income from continuing operations.
With the adoption of SFAS No. 160, the income
attributable to noncontrolling interests has been reclassified
below net income and therefore is no longer deducted in arriving
at income from continuing operations. However, the provision for
52
income taxes does not change because those subsidiaries with
noncontrolling interests attribute their taxable income to their
respective investors. Accordingly, we will not pay tax on the
income attributable to the noncontrolling interests. As a result
of separately reporting income that is taxed to others, our
effective tax rate on continuing operations before income taxes,
as reported on the face of the financial statements is 33.3% and
35.3% for the three months ended June 30, 2009 and 2008,
respectively, and 33.4% and 35.1% for the six months ended
June 30, 2009 and 2008, respectively. However, the actual
effective tax rate that is attributable to the Companys
share of income from continuing operations before income taxes
(income from continuing operations before income taxes, as
presented on the face of the statement of income, less income
from continuing operations attributable to noncontrolling
interests of $14.6 million and $7.4 million for the
three months ended June 30, 2009 and 2008, respectively,
and $28.2 million and $15.6 million for the six months
ended June 30, 2009 and 2008, respectively) is 38.3% for
the three and six months ended June 30, 2009 and 38.6% for
the three and six months ended June 30, 2008.
Recent
Accounting Pronouncements
In December 2007, the FASB issued SFAS No. 141(R),
Business Combinations, or SFAS No. 141(R).
SFAS No. 141(R) replaces SFAS No. 141 and
addresses the recognition and accounting for identifiable assets
acquired, liabilities assumed, and noncontrolling interests in
business combinations. This standard requires more assets and
liabilities to be recorded at fair value and requires expense
recognition (rather than capitalization) of certain
pre-acquisition costs. This standard also requires any
adjustments to acquired deferred tax assets and liabilities
occurring after the related allocation period to be made through
earnings. Furthermore, this standard requires this treatment of
acquired deferred tax assets and liabilities also be applied to
acquisitions occurring prior to the effective date of this
standard. SFAS No. 141(R) is effective for fiscal
years beginning after December 15, 2008 and is required to
be adopted prospectively with no early adoption permitted. We
adopted SFAS No. 141(R) on January 1, 2009.
Approximately $2.0 million and $3.0 million of
acquisition costs related to prospective acquisitions were
expensed during the three and six months ended June 30,
2009, respectively, from the adoption of
SFAS No. 141(R). The impact of
SFAS No. 141(R) on our consolidated results of
operations and consolidated financial position in future periods
will be largely dependent on the number of acquisitions we
pursue; however, we do not anticipate at this time that such
impact will be material.
SFAS No. 160 addresses the accounting and reporting
framework for noncontrolling ownership interests in consolidated
subsidiaries of the parent. SFAS No. 160 also
establishes disclosure requirements that clearly identify and
distinguish between the interests of the parent company and the
interests of the noncontrolling owners. These disclosure
requirements require that minority interests be renamed
noncontrolling interests and that noncontrolling ownership
interests be presented separately within equity in the
consolidated financial statements. Revenues, expenses and income
from continuing operations from less-than-wholly-owned
subsidiaries are presented on the condensed consolidated
statements of income at the consolidated amounts, with a
consolidated net income measure that presents separately the
amounts attributable to both the controlling and noncontrolling
interests for all periods presented. Noncontrolling ownership
interests that are redeemable or may become redeemable at a
fixed or determinable price at the option of the holder or upon
the occurrence of an event outside of the control of the company
continue to be presented in mezzanine equity in accordance with
Emerging Issues Task Force Topic D-98, Classification and
Measurement of Redeemable Securities.
SFAS No. 160 requires retrospective adoption of the
presentation and disclosure requirements for all periods
presented. Therefore, the condensed consolidated financial
statements as of December 31, 2008 and for the three and
six months ended June 30, 2008 reflect the provisions of
SFAS No. 160 as if it was effective for those periods.
Other than these changes in financial statement presentation,
the adoption of SFAS No. 160 did not have a material
impact on the condensed consolidated financial statements.
In March 2008, the FASB issued SFAS No. 161,
Disclosures about Derivative Instruments and Hedging
Activities, or SFAS No. 161.
SFAS No. 161 expands the disclosure requirements for
derivative instruments and for hedging activities in order to
provide additional understanding of how an entity uses
derivative instruments and how they are accounted for and
reported in an entitys financial statements. The new
disclosure requirements for SFAS No. 161 are effective
for fiscal years beginning after November 15, 2008, and was
adopted by us on January 1, 2009. The adoption of this
statement has not had a material effect on our consolidated
results of operations or consolidated financial position.
53
SFAS No. 165 Subsequent Events, or
SFAS No. 165, establishes general standards of
accounting for and disclosure of events that occur after the
balance sheet date but before financial statements are issued or
are available to be issued. In particular, this Statement sets
forth: (1) the period after the balance sheet date during
which management of a reporting entity should evaluate events or
transactions that may occur for potential recognition or
disclosure in the financial statements, (2) the
circumstances under which an entity should recognize events or
transactions occurring after the balance sheet date in its
financial statements and (3) the disclosures that an entity
should make about events or transactions that occurred after the
balance sheet date. SFAS No. 165 is effective for
interim or annual financial periods ending after June 15,
2009. This standard does not result in significant changes in
the subsequent events that are reported either through
recognition or disclosure in the consolidated financial
statements. In accordance with SFAS No. 165, the
Company evaluated all material events occurring subsequent to
the balance sheet date through July 31, 2009, the date the
consolidated financial statements were issued, for events
requiring disclosure or recognition in the consolidated
financial statements.
SFAS No. 168 The FASB Accounting Standards
Codification and the Hierarchy of Generally Accepted Accounting
Principles a replacement of FASB Statement
No. 162, or SFAS No. 168, is effective for
financial statements issued for interim and annual periods
ending after September 15, 2009. The FASB Accounting
Standards Codification, or Codification, will become the source
of authoritative U.S. GAAP recognized by the FASB to be
applied by nongovernmental entities. Rules and interpretive
releases of the Securities and Exchange Commission, or SEC,
under authority of federal securities laws are also sources of
authoritative U.S. GAAP for SEC registrants. On the
effective date of this Statement, the Codification will
supersede all then-existing non-SEC accounting and reporting
standards. All other non-grandfathered non-SEC accounting
literature not included in the Codification will become
non-authoritative. The issuance of SFAS No. 168 and
the Codification do not change current U.S. GAAP and will
not have an impact on our consolidated results of operations or
consolidated financial position.
FORWARD-LOOKING
STATEMENTS
Some of the matters discussed in this report include
forward-looking statements. Statements that are predictive in
nature, that depend upon or refer to future events or conditions
or that include words such as expects,
anticipates, intends, plans,
believes, estimates, thinks,
and similar expressions are forward-looking statements. These
statements involve known and unknown risks, uncertainties, and
other factors that may cause our actual results and performance
to be materially different from any future results or
performance expressed or implied by these forward-looking
statements. These factors include, but are not limited to, the
following:
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general economic and business conditions, both nationally and in
the regions in which we operate;
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legislative proposals for healthcare reform and universal access
to healthcare coverage;
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risks associated with our substantial indebtedness, leverage,
and debt service obligations;
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demographic changes;
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changes in, or the failure to comply with, governmental
regulations;
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potential adverse impact of known and unknown government
investigations and Federal and State False Claims Act litigation;
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our ability, where appropriate, to enter into and maintain
managed care provider arrangements and the terms of these
arrangements;
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changes in, or the failure to comply with, managed care
contracts could result in disputes and changes in reimbursement
that could be applied retroactively;
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changes in inpatient or outpatient Medicare and Medicaid payment
levels;
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increases in the amount and risk of collectability of patient
accounts receivable;
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increases in wages as a result of inflation or competition for
highly technical positions and rising supply costs due to market
pressure from pharmaceutical companies and new product releases;
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liabilities and other claims asserted against us, including
self-insured malpractice claims;
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competition;
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our ability to attract and retain, without significant
employment costs, qualified personnel, key management,
physicians, nurses and other health care workers;
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trends toward treatment of patients in less acute or specialty
healthcare settings, including ambulatory surgery centers or
specialty hospitals;
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changes in medical or other technology;
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changes in U.S. GAAP;
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the availability and terms of capital to fund additional
acquisitions or replacement facilities;
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our ability to successfully acquire additional hospitals and
complete the sale of hospitals held for sale;
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our ability to successfully integrate any acquired hospitals or
to recognize expected synergies from such acquisitions;
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our ability to obtain adequate levels of general and
professional liability insurance; and
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timeliness of reimbursement payments received under government
programs.
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Although we believe that these statements are based upon
reasonable assumptions, we can give no assurance that our goals
will be achieved. Given these uncertainties, prospective
investors are cautioned not to place undue reliance on these
forward-looking statements. These forward-looking statements are
made as of the date of this filing. We assume no obligation to
update or revise them or provide reasons why actual results may
differ.
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Item 3.
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Quantitative
and Qualitative Disclosures about Market Risk
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We are exposed to interest rate changes, primarily as a result
of our senior secured credit facility which bears interest based
on floating rates. In order to manage the volatility relating to
the market risk, we entered into interest rate swap agreements
described under the heading Liquidity and Capital
Resources in Item 2. We do not anticipate any
material changes in our primary market risk exposures in 2009.
We utilize risk management procedures and controls in executing
derivative financial instrument transactions. We do not execute
transactions or hold derivative financial instruments for
trading purposes. Derivative financial instruments related to
interest rate sensitivity of debt obligations are used with the
goal of mitigating a portion of the exposure when it is cost
effective to do so.
A 1% change in interest rates on variable rate debt in excess of
that amount covered by interest rate swaps would have resulted
in interest expense fluctuating approximately $0.1 million
and $3.5 million for the three months ended June 30,
2009 and 2008, respectively, and $1.4 million and
$7.3 million for the six months ended June 30, 2009
and 2008, respectively.
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Item 4.
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Controls
and Procedures
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Our Chief Executive Officer and Chief Financial Officer, with
the participation of other members of management, have evaluated
the effectiveness of our disclosure controls and procedures (as
defined in Rules 13a 15(e) and 15d
15(e) under the Securities and Exchange Act of 1934, as
amended), as of the end of the period covered by this report.
Based on such evaluations, our Chief Executive Officer and Chief
Financial Officer concluded that, as of such date, our
disclosure controls and procedures were effective (at the
reasonable assurance level) to ensure that the information
required to be included in this report has been recorded,
processed, summarized and reported within the time periods
specified in the Commissions rules and forms and to ensure
that the information required to be included in this report was
accumulated and communicated to management, including our Chief
Executive Officer and Chief Financial Officer, to allow timely
decisions regarding required disclosure.
There have been no changes in our internal control over
financial reporting during the quarter ended June 30, 2009,
that have materially affected or are reasonably likely to
materially affect our internal control over financial reporting.
55
PART II
OTHER INFORMATION
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Item 1.
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Legal
Proceedings
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From time to time, we receive various inquiries or subpoenas
from state regulators, fiscal intermediaries, the Centers for
Medicare and Medicaid Services and the Department of Justice
regarding various Medicare and Medicaid issues. In addition, we
are subject to other claims and lawsuits arising in the ordinary
course of our business. We are not aware of any pending or
threatened litigation that is not covered by insurance policies
or reserved for in our financial statements or which we believe
would have a material adverse impact on us; however, some
pending or threatened proceedings against us may involve
potentially substantial amounts as well as the possibility of
civil, criminal, or administrative fines, penalties, or other
sanctions, which could be material. Settlements of suits
involving Medicare and Medicaid issues routinely require both
monetary payments as well as corporate integrity agreements.
Additionally, qui tam or whistleblower actions
initiated under the civil False Claims Act may be pending but
placed under seal by the court to comply with the False Claims
Acts requirements for filing such suits.
Community
Health Systems, Inc. Legal Proceedings
In May 1999, we were served with a complaint in U.S. ex
rel. Bledsoe v. Community Health Systems, Inc.,
subsequently moved to the Middle District of Tennessee, Case
No. 2-00-0083.
This qui tam action sought treble damages and penalties under
the False Claims Act against us. The Department of Justice did
not intervene in this action. The allegations in the amended
complaint were extremely general, but involved Medicare billing
at our White County Community Hospital in Sparta, Tennessee. By
order entered on September 19, 2001, the U.S. District
Court granted our motion for judgment on the pleadings and
dismissed the case, with prejudice. The qui tam whistleblower
(also referred to as a relator) appealed the
district courts ruling to the U.S. Court of Appeals
for the Sixth Circuit. On September 10, 2003, the Sixth
Circuit Court of Appeals rendered its decision in this case,
affirming in part and reversing in part the district
courts decision to dismiss the case with prejudice. The
court affirmed the lower courts dismissal of certain of
plaintiffs claims on the grounds that his allegations had
been previously publicly disclosed. In addition, the appeals
court agreed that, as to all other allegations, the relator had
failed to include enough information to meet the special
pleading requirements for fraud under the False Claims Act and
the Federal Rules of Civil Procedure. However, the case was
returned to the district court to allow the relator another
opportunity to amend his complaint in an attempt to plead his
fraud allegations with particularity. In May 2004, the relator
in U.S. ex rel. Bledsoe filed an amended complaint alleging
fraud involving Medicare billing at White County Community
Hospital. We then filed a renewed motion to dismiss the amended
complaint. On January 6, 2005, the District Court dismissed
with prejudice the bulk of the relators allegations. The
only remaining allegations involve a small number of charges
from 1997 and 1998 at White County. After further motion
practice between the relator and the United States Government
regarding the relators right to participate in a previous
settlement with the Company, the District Court again dismissed
all claims in the case on December 13, 2005. On
January 9, 2006, the relator filed a notice of appeal to
the U.S. Court of Appeals for the Sixth Circuit and on
September 6, 2007, the Court of Appeals issued its opinion
affirming in part, reversing in part (and in doing so,
reinstating a number of the allegations claimed by the relator),
and remanding the case to the District Court for further
proceedings. The relator filed a motion for rehearing. That
motion for rehearing was denied. The relator amended his
complaint to conform to the decision of the Court of Appeals and
we filed an answer. A case management conference was held
August 18, 2008. The parties have exchanged initial written
discovery. Relator has filed a pleading stating Relator
Sean Bledsoe has a potentially fatal brain tumor that has
severely affected Relators long-term and short-term
memory... The court has now ordered that all discovery be
stayed until Relator and wife are deposed. We will continue to
vigorously defend this case.
In August 2004, we were served a complaint in Arleana Lawrence
and Robert Hollins v. Lakeview Community Hospital and
Community Health Systems, Inc. (now styled Arleana Lawrence and
Lisa Nichols vs. Eufaula Community Hospital, Community Health
Systems, Inc., South Baldwin Regional Medical Center and
Community Health Systems Professional Services Corporation) in
the Circuit Court of Barbour County, Alabama (Eufaula Division).
This alleged class action was brought by the plaintiffs on
behalf of themselves and as the representatives of similarly
situated uninsured individuals who were treated at our Lakeview
Hospital or any of our other Alabama
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hospitals. The plaintiffs allege that uninsured patients who do
not qualify for Medicaid, Medicare or charity care are charged
unreasonably high rates for services and materials and that we
use unconscionable methods to collect bills. The plaintiffs seek
restitution of overpayment, compensatory and other allowable
damages and injunctive relief. In October 2005, the complaint
was amended to eliminate one of the named plaintiffs and to add
our management company subsidiary as a defendant. In November
2005, the complaint was again amended to add another plaintiff,
Lisa Nichols and another defendant, our hospital in Foley,
Alabama, South Baldwin Regional Medical Center. After a hearing
held on June 13, 2007, on October 29, 2007 the Circuit
Court ruled in favor of the plaintiffs class action
certification request. On summary judgment, the Circuit Court
dismissed the case against Community Health Systems, Inc. only.
All other parties remain. We disagree with the certification
ruling and pursued our automatic right of appeal to the Alabama
Supreme Court. Briefs have now been filed and oral argument
requested but not yet scheduled. We are vigorously defending
this case.
On March 3, 2005, we were served with a complaint in Sheri
Rix v. Heartland Regional Medical Center and Health Care
Systems, Inc. in the Circuit Court of Williamson County,
Illinois. This alleged class action was brought by the plaintiff
on behalf of herself and as the representative of similarly
situated uninsured individuals who were treated at our Heartland
Regional Medical Center. The plaintiff alleges that uninsured
patients who do not qualify for Medicaid, Medicare or charity
care are charged unreasonably high rates for services and
materials and that we use unconscionable methods to collect
bills. The plaintiff seeks recovery for breach of contract and
the covenant of good faith and fair dealing, violation of the
Illinois Consumer Fraud and Deceptive Practices Act, restitution
of overpayment, and for unjust enrichment. The plaintiff class
seeks compensatory and other damages and equitable relief. The
Circuit Court Judge granted our motion to dismiss the case, but
allowed the plaintiff to re-plead her case. The plaintiff
elected to appeal the Circuit Courts decision in lieu of
amending her case. Oral argument was heard on this case on
January 9, 2008. On June 16, 2008, the Appellate Court
upheld the dismissal of the consumer fraud claim but reversed
dismissal of the contract claim. We filed a Petition for Leave
of Appeal to the Illinois Supreme Court which was denied. The
case has now been remanded and on March 10, 2009, we filed
a motion for summary judgment. We are vigorously defending this
case.
On February 10, 2006, we received a letter from the Civil
Division of the Department of Justice requesting documents in an
investigation it was conducting involving the Company. The
inquiry related to the way in which different state Medicaid
programs apply to the federal government for matching or
supplemental funds that are ultimately used to pay for a small
portion of the services provided to Medicaid and indigent
patients. These programs are referred to by different names,
including intergovernmental payments, upper
payment limit programs, and Medicaid
disproportionate share hospital payments. The February
2006 letter focused on our hospitals in three states: Arkansas,
New Mexico, and South Carolina. On August 31, 2006, we
received a follow up letter from the Department of Justice
requesting additional documents relating to the programs in New
Mexico and the payments to the Companys three hospitals in
that state. Through the beginning of 2009, we provided the
Department of Justice with requested documents, met with them on
numerous occasions, and otherwise cooperated in its
investigation. During the course of the investigation, the Civil
Division notified us that it believed that we and these three
New Mexico hospitals caused the State of New Mexico to submit
improper claims for federal funds, in violation of the Federal
False Claims Act. At one point, the Civil Division calculated
that the three hospitals received ineligible federal
participation payments from August 2000 to June 2006 of
approximately $27.5 million and said that if it proceeded
to trial, it would seek treble damages plus an appropriate
penalty for each of the violations of the Federal False Claims
Act. This investigation has culminated in the federal
governments intervention in a qui tam lawsuit styled
U.S. ex rel. Baker vs. Community Health Systems, Inc.,
pending in the United States District Court for the District of
New Mexico. The federal government filed its complaint in
intervention on June 30, 2009. The relator filed a second
amended complaint on July 1, 2009. Our responses are due
within 60 days. We are vigorously defending this action.
On June 12, 2008, two of our hospitals received letters
from the U.S. Attorneys Office for the Western
District of New York requesting documents in an investigation it
was conducting into billing practices with respect to
kyphoplasty procedures performed during the period
January 1, 2002, through June 9, 2008. On
September 16, 2008, one of our hospitals in South Carolina
also received an inquiry. Kyphoplasty is a surgical spine
procedure that returns a compromised vertebrae (either from
trauma or osteoporotic disease process) to its previous height,
reducing or eliminating severe pain. We have been informed that
similar investigations have been initiated at
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unaffiliated facilities in Alabama, South Carolina, Indiana and
other states. We believe that this investigation is related to a
recent qui tam settlement between the same
U.S. Attorneys office and the manufacturer and
distributor of the Kyphon product, which is used in performing
the kyphoplasty procedure. We are cooperating with the
investigation by collecting and producing material responsive to
the requests. At this early stage, we do not have sufficient
information to determine whether our hospitals have engaged in
inappropriate billing for kyphoplasty procedures. We are
continuing to evaluate and discuss this matter with the federal
government.
Triad
Hospitals, Inc. Legal Proceedings
Triad, and its subsidiary, Quorum Health Resources, Inc. are
defendants in a qui tam case styled U.S. ex rel. Whitten
vs. Quorum Health Resources, Inc. et al., which is pending in
the Southern District of Georgia, Brunswick Division. Whitten, a
long-term employee of a two hospital system in Brunswick and
Camden, Georgia sued both his employer and Quorum Health
Resources, Inc. and its predecessors, which had managed the
facility from 1989 through September 2000; upon his termination
of employment, Whitten signed a release and was paid $124,000.
Whittens original qui tam complaint was filed under seal
in November 2002 and the case was unsealed in 2004. Whitten
alleges various charging and billing infractions, including
charging for routine equipment supplies and services not
separately billable, billing for observation services that were
not medically necessary or for which there was no physician
order, billing labor and delivery patients for durable medical
equipment that was not separately billable, inappropriate
preparation of patients histories and physicals, billing
for cardiac rehabilitation services without physician
supervision, performing outpatient dialysis without Medicare
certification, and performing mental health services without the
proper staff assignments. In October 2005, the district court
granted Quorums motion for summary judgment on the grounds
that his claims were precluded under his severance agreement
with the hospital, without reaching two other arguments made by
Quorum, which included that a prior settlement agreement between
the hospital and the federal government precluded the claims
brought by Whitten as well as the doctrine of prior public
disclosure. On appeal to the 11th Circuit Court of Appeals,
the court reversed the findings of the district court regarding
the severance agreement, but remanded the case to the district
court for findings on Quorums other two defenses. Limited
discovery has been conducted and renewed motions by Quorum to
dismiss the action and to stay further discovery were filed in
September 2007. On August 5, 2008, our motion to dismiss
was denied. At the conclusion of discovery, a motion for summary
judgment was filed on February 13, 2009, and set for a
hearing on June 5, 2009. Our motion for summary judgment
was granted on July 1, 2009. On July 7, 2009, the
relator filed a notice of appeal.
In a case styled U.S. ex rel. Bartlett vs. Quorum Health
Resources, Inc., et al., pending in the Western District of
Pennsylvania, Johnstown Division, the relator alleges in his
second amended complaint, filed in January 2006 (the first
amended complaint having been dismissed), that Quorum conspired
with an unaffiliated hospital to pay an illegal remuneration in
violation of the anti-kickback statute and the Stark laws, thus
causing false claims to be filed. A renewed motion to dismiss
that was filed in March 2006 asserting that the second amended
complaint did not cure the defects contained in the first
amended complaint. In September 2006, the hospital and one of
the other defendants affiliated with the hospital filed for
protection under Chapter 11 of the federal bankruptcy code,
which imposed an automatic stay on proceedings in the case.
Relators entered into a settlement agreement with the hospital,
subject to confirmation of the hospitals reorganization
plan. The District Court conducted a status conference on
January 30, 2009 and later convened another conference on
March 30, 2009 and heard arguments on whether to proceed
with a motion to dismiss, but did not make a ruling. We believe
that this case is without merit and should the stay be lifted,
will continue to vigorously defend it.
There have been no material changes with regard to risk factors
previously disclosed in our most recent annual report on
Form 10-K.
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Item 2.
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Unregistered
Sales of Equity Securities and Use of Proceeds
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We have not paid any cash dividends since our inception, and do
not anticipate the payment of cash dividends in the foreseeable
future. As of June 30, 2009, our Credit Facility limits our
ability to pay dividends
and/or
repurchase stock to an amount not to exceed $400 million in
the aggregate (but not in excess of $200 million unless
58
we receive confirmation from Moodys and S&P that
dividends or repurchases would not result in a downgrade,
qualification or withdrawal of the then corporate credit
rating). The indenture governing our Notes also limits our
ability to pay dividends
and/or
repurchase stock in an amount higher than permitted by our
Credit Facility.
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Item 3.
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Defaults
Upon Senior Securities
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None
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Item 4.
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Submission
of Matters to a Vote of Security Holders
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(a) The annual meeting of the stockholders of Community
Health Systems, Inc., was held in New York, New York on
May 19, 2009, for the purpose of voting on the proposals
described below.
(b) Proxies for the meeting were solicited pursuant to
Section 14(a) of the Securities and Exchange Act of 1934
and there was no solicitation in opposition to the Governance
and Nominating Committees nominees for directors. All of
the Governance and Nominating Committees nominees for
directors were elected as set forth in clause (c) below. In
addition, the terms of office as a director of W. Larry Cash,
John A. Fry, William N. Jennings, Harvey Klein, M.D. and H.
Mitchell Watson, Jr. continued after the meeting.
(c) Five proposals were submitted to a vote of stockholders
as follows:
(1) The stockholders approved the election of the following
persons as directors of the Company:
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Name
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For
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Withheld
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Abstain
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Broker Non-Votes
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John A. Clerico
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81,685,129
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3,785,165
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179,342
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James S. Ely III
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84,609,379
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867,715
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172,542
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Julia B. North
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81,576,018
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3,917,250
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156,368
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Wayne T. Smith
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82,117,132
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3,372,938
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159,566
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(2)
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The stockholders approved the Community Health Systems, Inc.
2000 Stock Option and Award Plan, amended and restated as of
March 24, 2009:
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For
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Withheld
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Abstain
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Broker Non-Votes
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47,515,852
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34,996,479
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140,638
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2,996,667
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(3)
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The stockholders approved the Community Health Systems, Inc.
2004 Employee Performance Incentive Plan, amended and restated
as of March 24, 2009:
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For
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Withheld
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Abstain
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Broker Non-Votes
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81,672,105
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3,841,262
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136,269
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(4)
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The stockholders approved the Community Health Systems, Inc.
2009 Stock Option and Award Plan, adopted as of March 24,
2009:
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For
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Withheld
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Abstain
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Broker Non-Votes
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73,443,413
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9,069,247
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140,311
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2,996,665
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(5)
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The Board of Directors appointment of Deloitte &
Touche, LLP, as the Companys independent accountants for
2009 was ratified by the affirmative votes of stockholders:
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For
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Withheld
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Abstain
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Broker Non-Votes
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85,403,051
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73,678
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172,907
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Item 5.
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Other
Information
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None
59
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No.
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Description
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4
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.1
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Seventh Supplemental Indenture relating to CHS/Community Health
Systems, Inc.s
87/8% Senior
Notes due 2015, dated as of June 30, 2009, by and among
CHS/Community Health Systems, Inc., the guarantors party thereto
and U.S. Bank National Association
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4
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.2
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Release of Certain Guarantors relating to CHS/Community Health
Systems, Inc.s
87/8% Senior
Notes due 2015, dated as of June 30, 2009, by and among
CHS/Community Health Systems, Inc., the guarantors party thereto
and U.S. Bank National Association
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10
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.1
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Credit Agreement, dated as of July 25, 2007, by and among
CHS/Community Health Systems, Inc., Community Health Systems,
Inc., the lender parties thereto and Credit Suisse, as
Administrative Agent and Collateral Agent, Credit Suisse
Securities (USA) LLC and Wachovia Capital Markets, LLC as Joint
Bookrunner and Co-Lead Arrangers, Wachovia Bank, N.A. as
Syndication Agent, JPMorgan Chase Bank and Merrill Lynch Capital
Corporation as Co-Documentation Agents
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10
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.2
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Guarantee and Collateral Agreement, dated as of July 25, 2007,
by and among CHS/Community Health Systems, Inc., Community
Health Systems, Inc., the Subsidiaries from time to time party
thereto and Credit Suisse, as collateral agent
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10
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.3
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Community Health Systems, Inc. 2004 Employee Performance
Incentive Plan, as amended and restated on March 24, 2009
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10
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.4
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Community Health Systems, Inc. 2000 Stock Option and Award Plan,
as amended and restated on March 24, 2009
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10
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.5
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Community Health Systems, Inc. 2009 Stock Option and Award Plan,
effective as of March 24, 2009
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12
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Computation of Ratio of Earnings to Fixed Charges
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31
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.1
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Certification of Chief Executive Officer pursuant to Section 302
of the Sarbanes-Oxley Act of 2002
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31
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.2
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Certification of Chief Financial Officer pursuant to Section 302
of the Sarbanes-Oxley Act of 2002
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32
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.1
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Certification of Chief Executive Officer pursuant to
18 U.S.C. Section 1350, adopted pursuant to Section 906 of
the Sarbanes-Oxley Act of 2002
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32
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.2
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Certification of Chief Financial Officer pursuant to
18 U.S.C. Section 1350, adopted pursuant to Section 906 of
the Sarbanes-Oxley Act of 2002
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Indicates a management contract or compensatory plan or
arrangement. |
60
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.
COMMUNITY HEALTH SYSTEMS, INC.
(Registrant)
Wayne T. Smith
Chairman of the Board,
President and Chief Executive Officer
(principal executive officer)
W. Larry Cash
Executive Vice President, Chief Financial
Officer and Director
(principal financial officer)
T. Mark Buford
Vice President and Chief Accounting Officer
(principal accounting officer)
Date: July 31, 2009
61
Index to
Exhibits
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No.
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Description
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4
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.1
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|
Seventh Supplemental Indenture relating to CHS/Community Health
Systems, Inc.s
87/8% Senior
Notes due 2015, dated as of June 30, 2009, by and among
CHS/Community Health Systems, Inc., the guarantors party thereto
and U.S. Bank National Association
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4
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.2
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Release of Certain Guarantors relating to CHS/Community Health
Systems, Inc.s
87/8% Senior
Notes due 2015, dated as of June 30, 2009, by and among
CHS/Community Health Systems, Inc., the guarantors party thereto
and U.S. Bank National Association
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10
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.1
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Credit Agreement, dated as of July 25, 2007, by and among
CHS/Community Health Systems, Inc., Community Health Systems,
Inc., the lender parties thereto and Credit Suisse, as
Administrative Agent and Collateral Agent, Credit Suisse
Securities (USA) LLC and Wachovia Capital Markets, LLC as Joint
Bookrunner and Co-Lead Arrangers, Wachovia Bank, N.A. as
Syndication Agent, JPMorgan Chase Bank and Merrill Lynch Capital
Corporation as Co-Documentation Agents
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10
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.2
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Guarantee and Collateral Agreement, dated as of July 25, 2007,
by and among CHS/Community Health Systems, Inc., Community
Health Systems, Inc., the Subsidiaries from time to time party
thereto and Credit Suisse, as collateral agent
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10
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.3
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Community Health Systems, Inc. 2004 Employee Performance
Incentive Plan, as amended and restated on March 24, 2009
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10
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.4
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Community Health Systems, Inc. 2000 Stock Option and Award Plan,
as amended and restated on March 24, 2009
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10
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.5
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Community Health Systems, Inc. 2009 Stock Option and Award Plan,
effective as of March 24, 2009
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12
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Computation of Ratio of Earnings to Fixed Charges
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31
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.1
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Certification of Chief Executive Officer pursuant to Section 302
of the Sarbanes-Oxley Act of 2002
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31
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.2
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Certification of Chief Financial Officer pursuant to Section 302
of the Sarbanes-Oxley Act of 2002
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32
|
.1
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Certification of Chief Executive Officer pursuant to
18 U.S.C. Section 1350, adopted pursuant to
Section 906 of the Sarbanes-Oxley Act of 2002
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32
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.2
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Certification of Chief Financial Officer pursuant to
18 U.S.C. Section 1350, adopted pursuant to
Section 906 of the Sarbanes-Oxley Act of 2002
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Indicates a management contract or compensatory plan or
arrangement. |
62