Table of contents
UNITED STATES
SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
FORM 10-Q
(Mark One)
☒
QUARTERLY REPORT PURSUANT TO SECTION 13 OR 15(d) OF THE SECURITIES EXCHANGE ACT OF 1934
For the quarterly period ended March 31, 2019
or
☐
TRANSITION REPORT PURSUANT TO SECTION 13 OR 15(d) OF THE SECURITIES EXCHANGE ACT OF 1934
For the transition period from to
Commission File Number: 001-35331
ACADIA HEALTHCARE COMPANY, INC.
(Exact name of registrant as specified in its charter)
Delaware
45-2492228
(State or other jurisdiction of
incorporation or organization)
(I.R.S. Employer
Identification No.)
6100 Tower Circle, Suite 1000
Franklin, Tennessee 37067
(Address, including zip code, of registrant’s principal executive offices)
(615) 861-6000
(Registrant’s telephone number, including area code)
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 ☒ No ☐
Indicate by check mark whether the registrant has submitted electronically every Interactive Data File required to be submitted 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 such files). Yes ☒ No ☐
Indicate by check mark whether the registrant is a large accelerated filer, an accelerated filer, a non-accelerated filer, a smaller reporting company or an emerging growth company. See the definitions of “large accelerated filer,” “accelerated filer,” “smaller reporting company” and “emerging growth company” in Rule 12b-2 of the Exchange Act.
Large accelerated filer
Accelerated filer
Non-accelerated filer
Smaller reporting company
Emerging growth company
If an emerging growth company, indicate by check mark if the registrant has elected not to use the extended transition period for complying with any new or revised financial accounting standards provided pursuant to Section 13(a) of the Exchange Act. ☐
Indicate by check mark whether the registrant is a shell company (as defined in Rule 12b-2 of the Exchange Act). Yes ☐ No ☒
At May 1, 2019, there were 88,701,225 shares of the registrant’s common stock outstanding.
Title of each class
Trading Symbol
Name of each exchange on which registered
Common Stock, $.01 par value
ACHC
NASDAQ Global Select Market
QUARTERLY REPORT ON FORM 10-Q
TABLE OF CONTENTS
PART I – FINANCIAL INFORMATION
Item 1.
Financial Statements
1
Condensed Consolidated Balance Sheets (Unaudited)
Condensed Consolidated Statements of Income (Unaudited)
2
Condensed Consolidated Statements of Comprehensive Income (Unaudited)
3
Condensed Consolidated Statement of Equity (Unaudited)
4
Condensed Consolidated Statements of Cash Flows (Unaudited)
5
Notes to Condensed Consolidated Financial Statements (Unaudited)
6
Item 2.
Management’s Discussion and Analysis of Financial Condition and Results of Operations
29
Item 3.
Quantitative and Qualitative Disclosures About Market Risk
38
Item 4.
Controls and Procedures
39
PART II – OTHER INFORMATION
Legal Proceedings
40
Item 1A.
Risk Factors
Unregistered Sales of Equity Securities and Use of Proceeds
41
Item 6.
Exhibits
42
SIGNATURES
43
Acadia Healthcare Company, Inc.
Condensed Consolidated Balance Sheets
(Unaudited)
March 31,
2019
December 31,
2018
(In thousands, except share and per
share amounts)
ASSETS
Current assets:
Cash and cash equivalents
$
43,684
50,510
Accounts receivable, net
331,851
318,087
Other current assets
76,979
81,820
Total current assets
452,514
450,417
Property and equipment, net
3,173,052
3,107,766
Goodwill
2,441,999
2,396,412
Intangible assets, net
89,796
88,990
Deferred tax assets
3,436
3,468
Derivative instrument assets
46,304
60,524
Operating lease right-of-use assets
506,787
—
Other assets
71,629
64,927
Total assets
6,785,517
6,172,504
LIABILITIES AND EQUITY
Current liabilities:
Current portion of long-term debt
36,503
34,112
Accounts payable
116,666
117,740
Accrued salaries and benefits
108,546
113,299
Current portion of operating lease liabilities
27,984
Other accrued liabilities
134,972
151,226
Total current liabilities
424,671
416,377
Long-term debt
3,221,709
3,159,375
Deferred tax liabilities
76,922
80,372
Operating lease liabilities
504,753
Other liabilities
122,188
154,267
Total liabilities
4,350,243
3,810,391
Redeemable noncontrolling interests
31,931
28,806
Equity:
Preferred stock, $0.01 par value; 10,000,000 shares authorized, no shares issued
Common stock, $0.01 par value; 180,000,000 shares authorized; 87,593,730
and 87,444,473 issued and outstanding at March 31, 2019 and December 31, 2018,
respectively
876
874
Additional paid-in capital
2,546,759
2,541,987
Accumulated other comprehensive loss
(426,586
)
(462,377
Retained earnings
282,294
252,823
Total equity
2,403,343
2,333,307
Total liabilities and equity
See accompanying notes.
Condensed Consolidated Statements of Income
Three Months Ended
(In thousands, except per share amounts)
Revenue
760,617
742,241
Salaries, wages and benefits (including equity-based compensation expense of $6,101
and $6,919, respectively)
429,579
411,528
Professional fees
57,007
54,018
Supplies
29,957
29,364
Rents and leases
20,307
20,288
Other operating expenses
93,865
88,231
Depreciation and amortization
40,580
39,773
Interest expense, net
48,130
45,243
Debt extinguishment costs
940
Transaction-related expenses
4,321
4,768
Total expenses
723,746
694,153
Income before income taxes
36,871
48,088
Provision for (benefit from) income taxes
7,360
(2,786
Net income
29,511
50,874
Net income attributable to noncontrolling interests
(40
(55
Net income attributable to Acadia Healthcare Company, Inc.
29,471
50,819
Earnings per share attributable to Acadia Healthcare Company, Inc. stockholders:
Basic
0.34
0.58
Diluted
Weighted-average shares outstanding:
87,505
87,121
87,694
87,294
Condensed Consolidated Statements of Comprehensive Income
(In thousands)
Other comprehensive income:
Foreign currency translation gain
44,481
92,780
Loss on derivative instruments, net of tax of $(3.5) million and $(7.3) million, respectively
(8,690
(20,053
Other comprehensive income
35,791
72,727
Comprehensive income
65,302
123,601
Comprehensive income attributable to noncontrolling interests
Comprehensive income attributable to Acadia Healthcare Company, Inc.
65,262
123,546
Condensed Consolidated Statement of Equity
Common Stock
Additional
Paid-in
Accumulated
Other
Comprehensive
Retained
Shares
Amount
Capital
Loss
Earnings
Total
Balance at December 31, 2017
87,060
871
2,517,545
(374,118
428,573
2,572,871
Common stock issued under stock incentive plans
228
94
96
Common stock withheld for minimum statutory
taxes
(2,126
Equity-based compensation expense
6,919
313
Net income attributable to Acadia Healthcare
Company, Inc.
Balance at March 31, 2018
87,288
873
2,522,745
(301,391
479,392
2,701,619
128
(232
7,129
Other comprehensive loss
(114,492
58,836
Balance at June 30, 2018
87,330
2,530,083
(415,883
538,228
2,653,301
33
19
20
(158
5,225
(24,579
208
46,232
Balance at September 30, 2018
87,363
2,535,377
(440,462
584,460
2,680,249
81
130
(1,265
2,728
(21,915
5,017
Net loss attributable to Acadia Healthcare
(331,637
Balance at December 31, 2018
87,444
149
291
293
(1,620
6,101
Balance at March 31, 2019
87,593
Condensed Consolidated Statements of Cash Flows
Operating activities:
Adjustments to reconcile net income to net cash provided by continuing operating
activities:
Amortization of debt issuance costs
2,888
2,525
Deferred income taxes
(666
1,897
2,187
1,043
Change in operating assets and liabilities:
(11,980
(18,793
(5,875
(13,216
295
(1,268
Accounts payable and other accrued liabilities
(15,701
(3,368
(5,849
4,802
2,182
509
Net cash provided by continuing operating activities
43,673
72,637
Net cash used in discontinued operating activities
(287
Net cash provided by operating activities
72,350
Investing activities:
Cash paid for acquisitions, net of cash acquired
(40,400
Cash paid for capital expenditures
(69,248
(70,327
Cash paid for real estate acquisitions
(1,066
(4,293
613
(4,066
Net cash used in investing activities
(110,101
(78,686
Financing activities:
Borrowings on revolving credit facility
71,573
Principal payments on long-term debt
(8,246
Common stock withheld for minimum statutory taxes, net
(1,327
(2,030
(3,497
(2,704
Net cash provided by (used in) financing activities
58,503
(4,734
Effect of exchange rate changes on cash
1,099
1,588
Net decrease in cash and cash equivalents
(6,826
(9,482
Cash and cash equivalents at beginning of the period
67,290
Cash and cash equivalents at end of the period
57,808
Effect of acquisitions:
Assets acquired, excluding cash
44,028
Liabilities assumed
(3,628
40,400
Notes to Condensed Consolidated Financial Statements
March 31, 2019
1.
Description of Business and Basis of Presentation
Description of Business
Acadia Healthcare Company, Inc. (the “Company”) develops and operates inpatient psychiatric facilities, residential treatment centers, group homes, substance abuse facilities and facilities providing outpatient behavioral healthcare services to serve the behavioral health and recovery needs of communities throughout the United States (“U.S.”), the United Kingdom (“U.K.”) and Puerto Rico. At March 31, 2019, the Company operated 593 behavioral healthcare facilities with approximately 18,100 beds in 40 states, the U.K. and Puerto Rico.
Basis of Presentation
The business of the Company is conducted through limited liability companies, partnerships and C-corporations. The Company’s consolidated financial statements include the accounts of the Company and all subsidiaries controlled by the Company through its’ direct or indirect ownership of majority interests and exclusive rights granted to the Company as the controlling member of an entity. All intercompany accounts and transactions have been eliminated in consolidation.
The accompanying consolidated financial statements have been prepared in accordance with U.S. generally accepted accounting principles (“GAAP”) for interim financial information. Accordingly, they do not include all of the information and notes required by GAAP for complete financial statements. In the opinion of management, all adjustments (consisting of normal recurring accruals) considered necessary for fair presentation of our financial position and results of operations have been included. The Company’s fiscal year ends on December 31 and interim results are not necessarily indicative of results for a full year or any other interim period. The condensed consolidated balance sheet at December 31, 2018 has been derived from the audited financial statements as of that date. The information contained in these condensed consolidated financial statements should be read in conjunction with the Company’s consolidated financial statements and notes thereto for the fiscal year ended December 31, 2018 included in the Company’s Annual Report on Form 10-K filed with the Securities and Exchange Commission (the “SEC”) on March 1, 2019. The preparation of financial statements in conformity with GAAP requires management to make estimates and assumptions that affect the amounts reported in the consolidated financial statements and accompanying notes. Actual results could differ from those estimates.
Certain reclassifications have been made to prior years to conform to the current year presentation.
2.
Recently Issued Accounting Standards
In August 2018, the Financial Accounting Standards Board (“FASB”) issued Accounting Standard Update (“ASU”) ASU 2018-15, “Intangibles—Goodwill and Other—Internal-Use Software (Subtopic 350-40): Customer’s Accounting for Implementation Costs Incurred in a Cloud Computing Arrangement That Is a Service Contract” (“ASU 2018-15”). ASU 2018-15 requires a customer in a cloud computing arrangement that is a service contract to follow the internal-use software guidance in ASC 350-402 to determine which implementation costs to capitalize as assets. ASU 2018-15 is effective for fiscal years, and interim periods within those years, beginning after December 15, 2019. Early adoption is permitted. Management is evaluating the impact of ASU 2018-15 on the Company’s consolidated financial statements.
In August 2017, FASB issued ASU 2017-12, “Derivatives and Hedging (Topic 815): Targeted Improvements to Accounting for Hedging Activities” (“ASU 2017-12”). ASU 2017-12 amends the hedge accounting model to enable entities to better portray the economics of their risk management activities in the financial statements and simplifies the application of hedge accounting in certain situations. ASU 2017-12 is effective for fiscal years, and interim periods within those years, beginning after December 15, 2018. Early adoption is permitted. The Company adopted ASU 2017-02 on January 1, 2019. There is no significant impact on the Company’s consolidated financial statements.
In March 2016, the FASB issued ASU 2016-02, “Leases” (“ASU 2016-02”). ASU 2016-02’s core principle is to increase transparency and comparability among organizations by recognizing lease assets and liabilities on the balance sheet and disclosing key information. ASU 2016-02 is effective for fiscal years, and interim periods within those years, beginning after December 15, 2018. ASU 2016-02 requires application either retrospectively to each prior reporting period presented in the financial statements or retrospectively at the beginning of the period of adoption. The Company adopted ASU 2016-02 retrospectively at the beginning of the
period of adoption. Prior periods have not been adjusted. On January 1, 2019, the Company recorded right-of-use assets and lease liabilities of $509.8 million and $536.7 million, respectively, as described in Note 8 – Leases.
3.
Revenue is primarily derived from services rendered to patients for inpatient psychiatric and substance abuse care, outpatient psychiatric care and residential treatment. The services provided by the Company have no fixed duration and can be terminated by the patient or the facility at any time, and therefore, each treatment is its own stand-alone contract.
As our performance obligations relate to contracts with a duration of one year or less, the Company elected the optional exemption in Accounting Standards Codification (“ASC”) ASC 606-10-50-14(a). Therefore, the Company is not required to disclose the transaction price for the remaining performance obligations at the end of the reporting period or when the Company expects to recognize the revenue. The Company has minimal unsatisfied performance obligations at the end of the reporting period as our patients typically are under no obligation to remain admitted in our facilities.
The Company disaggregates revenue from contracts with customers by service type and by payor within each of the Company’s segments.
U.S. Facilities
The Company’s facilities in the United States (the “U.S. Facilities”) and services provided by the U.S. Facilities can generally be classified into the following categories: acute inpatient psychiatric facilities; specialty treatment facilities; residential treatment centers; and outpatient community-based facilities.
Acute inpatient psychiatric facilities. Acute inpatient psychiatric facilities provide a high level of care in order to stabilize patients that are either a threat to themselves or to others. The acute setting provides 24-hour observation, daily intervention and monitoring by psychiatrists.
Specialty treatment facilities. Specialty treatment facilities include residential recovery facilities, eating disorder facilities and comprehensive treatment centers. The Company provides a comprehensive continuum of care for adults with addictive disorders and co-occurring mental disorders. Inpatient, including detoxification and rehabilitation, partial hospitalization and outpatient treatment programs give patients access to the least restrictive level of care.
Residential treatment centers. Residential treatment centers treat patients with behavioral disorders in a non-hospital setting, including outdoor programs. The facilities balance therapy activities with social, academic and other activities.
Outpatient community-based facilities. Outpatient community-based programs are designed to provide therapeutic treatment to children and adolescents who have a clinically-defined emotional, psychiatric or chemical dependency disorder while enabling the youth to remain at home and within their community.
The table below presents total U.S. revenue attributed to each category (in thousands):
Three Months Ended March 31,
Acute inpatient psychiatric facilities
216,597
195,891
Specialty treatment facilities
193,035
184,535
Residential treatment centers
73,224
71,557
Outpatient community-based facilities
5,104
10,422
487,960
462,405
The Company receives payments from the following sources for services rendered in our U.S. Facilities: (i) state governments under their respective Medicaid and other programs; (ii) commercial insurers; (iii) the federal government under the Medicare program administered by the Centers for Medicare and Medicaid Services (“CMS”); and (iv) individual patients and clients.
7
The Company determines the transaction price based on established billing rates reduced by contractual adjustments provided to third-party payors, discounts provided to uninsured patients and implicit price concessions. Contractual adjustments and discounts are based on contractual agreements, discount policies and historical experience. Implicit price concessions are based on historical collection experience. Most of our U.S. Facilities have contracts containing variable consideration. However, it is unlikely a significant reversal of revenue will occur when the uncertainty is resolved, and therefore, the Company has included the variable consideration in the estimated transaction price. Subsequent changes resulting from a patient’s ability to pay are recorded as bad debt expense, which is included as a component of other operating expenses in the condensed consolidating statements of income. Bad debt expense for the three months ended March 31, 2019 and 2018 was not significant.
The following table presents revenue by payor type and as a percentage of revenue in our U.S. Facilities (in thousands):
%
Commercial
139,427
28.6
137,619
29.8
Medicare
72,616
14.9
67,214
14.5
Medicaid
239,191
49.0
213,336
46.1
Self-Pay
31,732
6.5
36,907
8.0
4,994
1.0
7,329
1.6
100.0
U.K. Facilities
The Company’s facilities located in the United Kingdom (the “U.K. Facilities”) and services provided by the U.K. Facilities can generally be classified into the following categories: healthcare facilities, education and children’s services, adult care facilities and elderly care facilities.
Healthcare facilities. Healthcare facilities provide psychiatric treatment and nursing for sufferers of mental disorders, including for patients whose risk of harm to others and risk of escape from hospitals cannot be managed safely within other mental health settings. In order to manage the risks involved with treating patients, the facility is managed through the application of a range of security measures depending on the level of dependency and risk exhibited by the patient.
Education and children’s services. Education and children’s services provide specialist education for children and young people with special educational needs, including autism, Asperger’s Syndrome, social, emotional and mental health, and specific learning difficulties, such as dyslexia. The division also offers standalone children’s homes for children that require 52-week residential care to support complex and challenging behavior and fostering services.
Adult care facilities. Adult care focuses on care of individuals with a variety of learning difficulties, mental health illnesses and adult autism spectrum disorders. It also includes long-term, short-term and respite nursing care to high-dependency elderly individuals who are physically frail or suffering from dementia. Care is provided in a number of settings, including in residential care homes and through supported living.
The table below presents total U.K. revenue attributed to each category (in thousands):
Healthcare facilities
151,708
154,615
Education and Children’s Services
46,122
48,085
Adult Care facilities
74,827
77,136
272,657
279,836
On an annual basis, the Company receives payments from approximately 500 public funded sources in the U.K. (including the National Health Service (“NHS”), Clinical Commissioning Groups (“CCGs”) and local authorities in England, Scotland and Wales) and individual patients and clients. The Company determines the transaction price based on established billing rates by payor and is reduced by implicit price concessions. Implicit price concessions are insignificant in the U.K. Facilities.
8
The following table presents revenue by payor type and as a percentage of revenue in our U.K. Facilities (in thousands):
U.K. public funded sources
245,413
90.0
253,294
90.5
26,814
9.8
25,068
9.0
430
0.2
1,474
0.5
The Company’s contract liabilities primarily consist of unearned revenue in our U.K. Facilities due to the timing of payments received mainly in our education and children’s services and healthcare facilities. Contract liabilities are included in other accrued liabilities on the condensed consolidated balance sheets. A summary of the activity in unearned revenue in the U.K. Facilities is as follows (in thousands):
31,239
Payments received
48,216
Revenue recognized
(39,736
480
40,199
4.
Earnings Per Share
The following table sets forth the computation of basic and diluted earnings per share for the three months ended March 31, 2019 and 2018 (in thousands, except per share amounts):
Numerator:
Denominator:
Weighted average shares outstanding for basic
earnings per share
Effect of dilutive instruments
189
173
Shares used in computing diluted earnings per
common share
Earnings per share attributable to Acadia Healthcare
Company, Inc. stockholders:
Approximately 2.6 million and 2.0 million shares of common stock issuable upon exercise of outstanding stock option awards were excluded from the calculation of diluted earnings per share for the three months ended March 31, 2019 and 2018, respectively, because their effect would have been anti-dilutive.
5.
Acquisitions
The Company’s strategy is to acquire and develop behavioral healthcare facilities and improve operating results within its facilities and its other behavioral healthcare operations.
On February 15, 2019, the Company completed the acquisition of Whittier Pavilion (“Whittier”), an inpatient psychiatric facility with 71 beds located in Haverhill, Massachusetts, for cash consideration of approximately $17.9 million. Also on February 15, 2019, the Company completed the acquisition of Mission Treatment (“Mission Treatment”) for cash consideration of approximately $22.5
9
million and a working capital settlement. Mission Treatment operated nine comprehensive treatment centers in California, Nevada, Arizona and Oklahoma.
Transaction-related expenses represent costs primarily related to our acquisitions, termination, restructuring and closure costs. Transaction-related expenses compromised the following cost for the three months ended March 31, 2019 and 2018 (in thousands):
Termination, restructuring and closure costs
3,525
3,392
Legal, accounting and other
796
1,376
6.
Property and Equipment
Property and equipment consisted of the following at March 31, 2019 and December 31, 2018 (in thousands):
December 31, 2018
Land
451,157
430,771
Building and improvements
2,565,195
2,423,594
Equipment
456,369
444,538
Construction in progress
216,075
294,848
3,688,796
3,593,751
Less: accumulated depreciation
(515,744
(485,985
During the three months ended March 31, 2019, the Company closed a 168-bed residential treatment center in Albuquerque, New Mexico. The Company is currently evaluating options for the future use of this property. Additionally, the Company has recorded assets held for sale of $21.1 million and $17.0 million within other assets on the condensed consolidated balance sheets at March 31, 2019 and December 31, 2018, respectively.
7.
Other Intangible Assets
Other identifiable intangible assets and related accumulated amortization consisted of the following at March 31, 2019 and December 31, 2018 (in thousands):
Gross Carrying Amount
Accumulated Amortization
Intangible assets subject to amortization:
Contract intangible assets
2,100
(2,100
Non-compete agreements
1,147
(1,147
3,247
(3,247
Intangible assets not subject to amortization:
Licenses and accreditations
12,259
12,343
Trade names
60,572
60,109
Certificates of need
16,965
16,538
93,043
92,237
All the Company’s definite-lived intangible assets are fully amortized. The Company’s licenses and accreditations, trade names and certificate of need intangible assets have indefinite lives and are, therefore, not subject to amortization.
10
8.
Leases
The Company’s lease portfolio primarily consists of finance and operating real estate leases integral for facility operations. The original terms of the leases typically range from five to 30 years with optional renewal periods. A minimal portion of the Company’s lease portfolio consists of non-real estate leases, including copiers and equipment, which generally have lease terms of one to three years and have insignificant lease obligations.
In March 2016, the FASB issued ASU 2016-02. ASU 2016-02’s core principle is to increase transparency and comparability among organizations by recognizing lease assets and liabilities on the balance sheet and disclosing key information. The Company adopted ASU 2016-02 retrospectively at the beginning of the period of adoption. Prior periods have not been adjusted.
The Company has elected the package of practical expedients offered in the transition guidance which allows management not to reassess lease identification, lease classification and initial direct costs. The Company also elected the accounting policy practical expedients by class of underlying asset to: (i) combine associated lease and non-lease components into a single lease component; and (ii) exclude recording short-term leases as right-of-use assets and liabilities on the condensed consolidated balance sheets. Non-lease components, which are not significant overall, are combined with lease components.
On January 1, 2019, the Company recorded right-of-use assets and lease liabilities on the condensed consolidated balance sheet of $509.8 million and $536.7 million, respectively, for non-cancelable real estate operating leases with original lease terms in excess of one year. Finance leases remained on the condensed consolidating balance sheets as required by previous accounting guidance. The Company reviews service agreements for embedded leases and records right-of-use assets and liabilities as necessary.
Operating lease liabilities were recorded as the present value of remaining lease payments not yet paid for the lease term discounted using the incremental borrowing rate associated with each lease. Operating lease right-of-use assets represent operating lease liabilities adjusted for prepayments, accrued lease payments, lease incentives and initial direct costs. Certain of the Company’s leases include renewal or termination options. Calculation of operating lease right-of-use assets and liabilities include the initial lease term unless it is reasonably certain a renewal or termination option will be exercised. Variable components of lease payments fluctuating with a future index or rate, as well as those related to common area maintenance costs, are not included in determining lease payments and are expensed as incurred. Most of the Company’s leases do not contain implicit borrowing rates, and therefore, incremental borrowing rates were calculated based on information available at the later of the lease commencement date or January 1, 2019. Incremental borrowing rates reflect the Company’s estimated interest rates for collateralized borrowings over similar lease terms.
Lease Position
At March 31, 2019, the Company recorded the following on the condensed consolidated balance sheet (in thousands):
Right-of-Use Assets
Balance Sheet Classification
Finance lease right-of-use assets
45,547
552,334
Lease Liabilities
Current:
Finance lease liabilities
7,210
Noncurrent:
44,445
584,392
11
Weighted-average remaining lease terms and discount rates at March 31, 2019 were as follows:
Weighted-average remaining lease term (in years):
Finance
7.4
Operating
19.9
Weighted-average discount rate:
6.4
Lease Costs
The Company recorded the following lease costs for the three months ended March 31, 2019 (in thousands):
Finance lease costs:
Depreciation of leased assets
1,123
Interest of lease liabilities
997
Total finance lease costs
2,120
Operating lease costs
16,529
Variable lease costs
886
Short term lease costs
1,447
Other lease costs
1,445
Total rents and leases
Total lease costs
22,427
Undiscounted cash flows for finance and operating leases recorded on the condensed consolidated balance sheet were as follows at March 31, 2019 (in thousands):
Finance Leases
Operating Leases
For the nine months ending December 31, 2019
6,078
46,252
2020
6,785
58,573
2021
34,922
55,048
2022
1,984
50,272
2023
1,007
46,774
Thereafter
26,096
723,393
Total minimum lease payments
76,872
980,312
Less: amount of lease payments representing interest
25,217
447,575
Present value of future minimum lease payments
51,655
532,737
Less: Current portion of lease liabilities
Noncurrent lease liabilities
12
Supplemental data for the three months ended March 31, 2019 was as follows (in thousands):
Cash paid for amounts included in the measurement of lease liabilities:
Operating cash flows for operating leases
15,809
Operating cash flows for finance leases
Financing cash flows for finance leases
846
Right-of-use assets obtained in exchange for lease obligations:
Operating leases
3,662
Finance leases
1,027
9.
Long-Term Debt
Long-term debt consisted of the following (in thousands):
Amended and Restated Senior Credit Facility:
Senior Secured Term A Loans
361,000
365,750
Senior Secured Term B Loans
1,369,416
1,372,912
Senior Secured Revolving Line of Credit
6.125% Senior Notes due 2021
150,000
5.125% Senior Notes due 2022
300,000
5.625% Senior Notes due 2023
650,000
6.500% Senior Notes due 2024
390,000
Other long-term debt
5,676
5,953
Less: unamortized debt issuance costs, discount and
premium
(39,453
(41,128
3,258,212
3,193,487
Less: current portion
(36,503
(34,112
Amended and Restated Senior Credit Facility
The Company entered into a senior secured credit facility (the “Senior Secured Credit Facility”) on April 1, 2011. On December 31, 2012, the Company entered into an Amended and Restated Credit Agreement (the “Amended and Restated Credit Agreement”) which amended and restated the Senior Secured Credit Facility (the “Amended and Restated Senior Credit Facility”). The Company has amended the Amended and Restated Credit Agreement from time to time as described in the Company’s prior filings with the SEC.
On March 22, 2018, the Company entered into a Second Repricing Facilities Amendment (the “Second Repricing Facilities Amendment”) to the Amended and Restated Credit Agreement. The Second Repricing Facilities Amendment (i) replaced the Term Loan B Facility Tranche B-1 (the “Tranche B-1 Facility”) and the Term Loan B Facility Tranche B-2 (the “Tranche B-2 Facility”) with a new Term Loan B facility Tranche B-3 (the “Tranche B-3 Facility”) and a new Term Loan B facility Tranche B-4 (the “Tranche B-4 Facility”), respectively, and (ii) reduced the Applicable Rate from 2.75% to 2.50% in the case of Eurodollar Rate loans and reduced the Applicable Rate from 1.75% to 1.50% in the case of Base Rate Loans.
On March 29, 2018, the Company entered into a Third Repricing Facilities Amendment to the Amended and Restated Credit Agreement (the “Third Repricing Facilities Amendment”, and together with the Second Repricing Facilities Amendment, the “Repricing Facilities Amendments”). The Third Repricing Facilities Amendment replaced the existing revolving credit facility and Term Loan A facility (“TLA Facility”) with a new revolving credit facility and TLA Facility, respectively. The Company’s line of credit on its revolving credit facility remains at $500.0 million and the Third Repricing Facility Amendment reduced the size of the TLA Facility from $400.0 million to $380.0 million to reflect the then current outstanding principal. The Third Repricing Facilities Amendment reduced the Applicable Rate by 25 basis points for the revolving credit facility and the TLA Facility by amending the
13
definition of “Applicable Rate.”
In connection with the Repricing Facilities Amendments, the Company recorded a debt extinguishment charge of $0.9 million, including the discount and write-off of deferred financing costs, which was recorded in debt extinguishment costs in the condensed consolidated statements of income.
On February 6, 2019, the Company entered into the Eleventh Amendment (the “Eleventh Amendment”) to the Amended and Restated Credit Agreement. The Eleventh Amendment, among other things, amended the definition of “Consolidated EBITDA” to remove the cap on non-cash charges, losses and expenses related to the impairment of goodwill, which in turn provided increased flexibility to the Company in terms of the Company’s financial covenants.
On February 27, 2019, the Company entered into the Twelfth Amendment (the “Twelfth Amendment”) to the Amended and Restated Credit Agreement. The Twelfth Amendment, among other things, modified certain definitions, including “Consolidated EBITDA”, and increased our permitted Maximum Consolidated Leverage Ratio, thereby providing increased flexibility to the Company in terms of the Company’s financial covenants.
The Company had $414.7 million of availability under the revolving line of credit and had standby letters of credit outstanding of $13.7 million related to security for the payment of claims required by its workers’ compensation insurance program at March 31, 2019. Borrowings under the revolving line of credit are subject to customary conditions precedent to borrowing. The Amended and Restated Credit Agreement requires quarterly term loan principal repayments of our TLA Facility of $4.8 million for June 30, 2019 to December 31, 2019, $7.1 million for March 31, 2020 to December 31, 2020, and $9.5 million for March 31, 2021 to September 30, 2021, with the remaining principal balance of the TLA Facility due on the maturity date of November 30, 2021. The Company is required to repay the Tranche B-3 Facility in equal quarterly installments of $1.2 million on the last business day of each March, June, September and December, with the outstanding principal balance of the Tranche B-3 Facility due on February 11, 2022. The Company is required to repay the Tranche B-4 Facility in equal quarterly installments of approximately $2.3 million on the last business day of each March, June, September and December, with the outstanding principal balance of the Tranche B-4 Facility due on February 16, 2023. On April 17, 2018, the Company made an additional payment of $15.0 million, including $5.1 million on the Tranche B-3 Facility and $9.9 million on the Tranche B-4 Facility.
Borrowings under the Amended and Restated Senior Credit Facility are guaranteed by each of the Company’s wholly-owned domestic subsidiaries (other than certain excluded subsidiaries) and are secured by a lien on substantially all of the assets of the Company and such subsidiaries. Borrowings with respect to the TLA Facility and the Company’s revolving credit facility (collectively, “Pro Rata Facilities”) under the Amended and Restated Credit Agreement bear interest at a rate tied to Acadia’s Consolidated Leverage Ratio (defined as consolidated funded debt net of up to $50.0 million of unrestricted and unencumbered cash to consolidated EBITDA, in each case as defined in the Amended and Restated Credit Agreement). The Applicable Rate (as defined in the Amended and Restated Credit Agreement) for the Pro Rata Facilities was 2.50% for Eurodollar Rate Loans (as defined in the Amended and Restated Credit Agreement) and 1.50% for Base Rate Loans (as defined in the Amended and Restated Credit Agreement) at March 31, 2019. Eurodollar Rate Loans with respect to the Pro Rata Facilities bear interest at the Applicable Rate plus the Eurodollar Rate (as defined in the Amended and Restated Credit Agreement) (based upon the LIBOR Rate (as defined in the Amended and Restated Credit Agreement) prior to commencement of the interest rate period). Base Rate Loans with respect to the Pro Rata Facilities bear interest at the Applicable Rate plus the highest of (i) the federal funds rate plus 0.50%, (ii) the prime rate and (iii) the Eurodollar Rate plus 1.00%. At March 31, 2019, the Pro Rata Facilities bore interest at a rate of LIBOR plus 2.50%. In addition, the Company is required to pay a commitment fee on undrawn amounts under the revolving line of credit.
The Amended and Restated Credit Agreement requires the Company and its subsidiaries to comply with customary affirmative, negative and financial covenants, including a fixed charge coverage ratio, consolidated leverage ratio and senior secured leverage ratio. The Company may be required to pay all of its indebtedness immediately if it defaults on any of the numerous financial or other restrictive covenants contained in any of its material debt agreements. At March 31, 2019, the Company was in compliance with such covenants.
Senior Notes
On March 12, 2013, the Company issued $150.0 million of 6.125% Senior Notes due 2021 (the “6.125% Senior Notes”). The 6.125% Senior Notes mature on March 15, 2021 and bear interest at a rate of 6.125% per annum, payable semi-annually in arrears on March 15 and September 15 of each year.
14
On July 1, 2014, the Company issued $300.0 million of 5.125% Senior Notes due 2022 (the “5.125% Senior Notes”). The 5.125% Senior Notes mature on July 1, 2022 and bear interest at a rate of 5.125% per annum, payable semi-annually in arrears on January 1 and July 1 of each year.
On February 11, 2015, the Company issued $375.0 million of 5.625% Senior Notes due 2023 (the “5.625% Senior Notes”). On September 21, 2015, the Company issued $275.0 million of additional 5.625% Senior Notes. The additional notes formed a single class of debt securities with the 5.625% Senior Notes issued in February 2015. Giving effect to this issuance, the Company has outstanding an aggregate of $650.0 million of 5.625% Senior Notes. The 5.625% Senior Notes mature on February 15, 2023 and bear interest at a rate of 5.625% per annum, payable semi-annually in arrears on February 15 and August 15 of each year.
On February 16, 2016, the Company issued $390.0 million of 6.500% Senior Notes due 2024 (the “6.500% Senior Notes”). The 6.500% Senior Notes mature on March 1, 2024 and bear interest at a rate of 6.500% per annum, payable semi-annually in arrears on March 1 and September 1 of each year, beginning on September 1, 2016.
The indentures governing the 6.125% Senior Notes, 5.125% Senior Notes, 5.625% Senior Notes and 6.500% Senior Notes (together, the “Senior Notes”) contain covenants that, among other things, limit the Company’s ability and the ability of its restricted subsidiaries to: (i) pay dividends, redeem stock or make other distributions or investments; (ii) incur additional debt or issue certain preferred stock; (iii) transfer or sell assets; (iv) engage in certain transactions with affiliates; (v) create restrictions on dividends or other payments by the restricted subsidiaries; (vi) merge, consolidate or sell substantially all of the Company’s assets; and (vii) create liens on assets.
The Senior Notes issued by the Company are guaranteed by each of the Company’s subsidiaries that guarantee the Company’s obligations under the Amended and Restated Senior Credit Facility. The guarantees are full and unconditional and joint and several.
The Company may redeem the Senior Notes at its option, in whole or part, at the dates and amounts set forth in the indentures.
10.
Equity-Based Compensation
Equity Incentive Plans
The Company issues stock-based awards, including stock options, restricted stock and restricted stock units, to certain officers, employees and non-employee directors under the Acadia Healthcare Company, Inc. Incentive Compensation Plan (the “Equity Incentive Plan”). At March 31, 2019, a maximum of 8,200,000 shares of the Company’s common stock were authorized for issuance as stock options, restricted stock and restricted stock units or other share-based compensation under the Equity Incentive Plan, of which 2,737,250 were available for future grant. Stock options may be granted for terms of up to ten years. The Company recognizes expense on all share-based awards on a straight-line basis over the requisite service period of the entire award. Grants to employees generally vest in annual increments of 25% each year, commencing one year after the date of grant. The exercise prices of stock options are equal to the most recent closing price of the Company’s common stock on the most recent trading date prior to the date of grant.
The Company recognized $6.1 million and $6.9 million in equity-based compensation expense for the three months ended March 31, 2019 and 2018, respectively. At March 31, 2019, there was $40.9 million of unrecognized compensation expense related to unvested options, restricted stock and restricted stock units, which is expected to be recognized over the remaining weighted average vesting period of 1.4 years.
At March 31, 2019, there were no warrants outstanding and exercisable. The Company recognized a deferred income tax benefit of $1.6 million and $1.9 million for the three months ended March 31, 2019 and 2018, respectively, related to equity-based compensation expense.
15
Stock Options
Stock option activity during 2018 and 2019 was as follows (aggregate intrinsic value in thousands):
Number
of
Options
Weighted
Average
Exercise Price
Remaining
Contractual
Term (in years)
Aggregate
Intrinsic
Value
Options outstanding at January 1, 2018
974,566
47.89
7.46
3,802
Options granted
374,700
37.54
9.21
246
Options exercised
(20,989
17.83
N/A
383
Options cancelled
(128,737
50.83
Options outstanding at December 31, 2018
1,199,540
44.64
7.26
2,717
566,800
28.25
9.94
45
(18,315
15.96
225
(118,707
42.43
Options outstanding at March 31, 2019
1,629,318
39.39
8.14
762
Options exercisable at December 31, 2018
534,164
44.98
5.73
2,386
Options exercisable at March 31, 2019
611,099
46.73
6.29
717
Fair values are estimated using the Black-Scholes option pricing model. The following table summarizes the grant-date fair value of options and the assumptions used to develop the fair value estimates for options granted during the three months ended March 31, 2019 and year ended December 31, 2018:
Weighted average grant-date fair value of options
10.45
13.67
Risk-free interest rate
2.4
2.2
Expected volatility
37
Expected life (in years)
5.0
5.1
The Company’s estimate of expected volatility for stock options is based upon the volatility of our stock price over the expected life of the award. The risk-free interest rate is the approximate yield on U. S. Treasury Strips having a life equal to the expected option life on the date of grant. The expected life is an estimate of the number of years an option will be held before it is exercised.
Other Stock-Based Awards
Restricted stock activity during 2018 and 2019 was as follows:
Number of
Grant-Date
Fair Value
Unvested at January 1, 2018
809,868
50.19
Granted
480,137
36.84
Cancelled
(88,989
47.57
Vested
(395,959
50.41
Unvested at December 31, 2018
805,057
42.40
540,342
27.85
(53,673
43.42
(190,356
47.10
Unvested at March 31, 2019
1,101,370
34.40
16
Restricted stock unit activity during 2018 and 2019 was as follows:
Units
360,909
50.04
285,358
42.26
(89,173
55.44
(72,983
49.64
484,111
44.52
(175,661
47.97
308,450
42.55
Restricted stock awards are time-based vesting awards that vest over a period of three or four years and are subject to continuing service of the employee or non-employee director over the ratable vesting periods. The fair values of the restricted stock awards were determined based on the closing price of the Company’s common stock on the trading date immediately prior to the grant date.
Restricted stock units are granted to employees and are subject to Company performance compared to pre-established targets and, in the case of the 2018 awards, Company performance compared to peers. In addition to Company performance, these performance-based restricted stock units are subject to the continuing service of the employee during the two- or three-year period covered by the awards. The performance condition for the restricted stock units is based on the Company’s achievement of annually established targets for diluted earnings per share. Additionally, the number of shares issuable pursuant to restricted stock units granted during 2018 is subject to adjustment based on the Company’s three-year annualized total stockholder return relative to a peer group consisting of S&P 1500 companies within the Healthcare Providers & Services 6 digit GICS industry group and selected other companies deemed to be peers. The number of shares issuable at the end of the applicable vesting period of restricted stock units ranges from 0% to 200% of the targeted units based on the Company’s actual performance compared to the targets and, for 2018 awards, performance compared to peers.
The fair values of restricted stock units were determined based on the closing price of the Company’s common stock on the trading date immediately prior to the grant date for units subject to performance conditions, or at its Monte-Carlo simulation value for units subject to market conditions.
11.
Income Taxes
The provision for (benefit from) income taxes for the three months ended March 31, 2019 and 2018 reflects effective tax rates of 20.0% and (5.8)%, respectively. The increase in the effective tax rate for the three months ended March 31, 2019 was primarily attributable to the application of Public Law 115-97, informally referred to as the Tax Cuts and Jobs Act (the “Tax Act”). The Company recorded a discrete benefit of $10.5 million during the three months ended March 31, 2018 related to a change in the Company’s provisional amount recorded at December 31, 2017.
12.
Derivatives
The Company entered into foreign currency forward contracts during the three months ended March 31, 2019 and 2018 in connection with certain transfers of cash between the U.S. and U.K. under the Company’s cash management and foreign currency risk management programs. Foreign currency forward contracts limit the economic risk of changes in the exchange rate between U.S. Dollars (“USD”) and British Pounds (“GBP”) associated with cash transfers.
In May 2016, the Company entered into multiple cross currency swap agreements with an aggregate notional amount of $650.0 million to manage foreign currency risk by effectively converting a portion of its fixed-rate USD-denominated senior notes, including the semi-annual interest payments thereunder, to fixed-rate GBP-denominated debt of £449.3 million. During the term of the swap agreements, the Company will receive semi-annual interest payments in USD from the counterparties at fixed interest rates, and the Company will make semi-annual interest payments in GBP to the counterparties at fixed interest rates. The interest payments under the cross-currency swap agreements result in £24.7 million of annual cash flows from the Company’s U.K. business being converted to $35.8 million (at a 1.45 exchange rate).
17
The Company has designated the cross currency swap agreements and forward contracts entered into during 2018 and the three months ended March 31, 2019 as qualifying hedging instruments and is accounting for these as net investment hedges. The fair value of these derivatives at March 31, 2019 and December 31, 2018 of $46.3 million and $60.5 million, respectively, are recorded as derivative instrument assets on the condensed consolidated balance sheets. The gains and losses resulting from fair value adjustments to the cross currency swap agreements are recorded in accumulated other comprehensive loss as the swaps are effective in hedging the designated risk. Cash flows related to the cross currency swap derivatives are included in operating activities in the condensed consolidated statements of cash flows.
13.
Fair Value Measurements
The carrying amounts reported for cash and cash equivalents, accounts receivable, other current assets, accounts payable and other current liabilities approximate fair value because of the short-term maturity of these instruments.
The carrying amounts and fair values of the Company’s Amended and Restated Senior Credit Facility, 6.125% Senior Notes, 5.125% Senior Notes, 5.625% Senior Notes, 6.500% Senior Notes, other long-term debt and derivative instruments at March 31, 2019 and December 31, 2018 were as follows (in thousands):
Carrying Amount
1,779,357
1,715,338
1,779,537
148,803
148,657
147,542
297,147
296,946
297,890
283,583
643,651
643,289
647,674
609,516
383,577
383,304
394,125
369,888
5,677
The Company’s Amended and Restated Senior Credit Facility, 6.125% Senior Notes, 5.125% Senior Notes, 5.625% Senior Notes, 6.500% Senior Notes and other long-term debt were categorized as Level 2 in the GAAP fair value hierarchy. Fair values were based on trading activity among the Company’s lenders and the average bid and ask price as determined using published rates.
The fair values of the derivative instruments were categorized as Level 2 in the GAAP fair value hierarchy and were based on observable market inputs including applicable exchange rates and interest rates.
14.
Commitments and Contingencies
Professional and General Liability
A portion of the Company’s professional liability risks are insured through a wholly-owned insurance subsidiary. The Company is self-insured for professional liability claims up to $3.0 million per claim and has obtained reinsurance coverage from a third party to cover claims in excess of the retention limit. The reinsurance policy has a coverage limit of $75.0 million in the aggregate. The Company’s reinsurance receivables are recognized consistent with the related liabilities and include known claims and any incurred but not reported claims that are covered by current insurance policies in place.
The Company is, from time to time, subject to various claims, lawsuits, governmental investigations and regulatory actions, including claims for damages for personal injuries, medical malpractice, overpayments, breach of contract, securities law violations, tort and employment related claims. In these actions, plaintiffs request a variety of damages, including, in some instances, punitive and other types of damages that may not be covered by insurance. In addition, healthcare companies are subject to numerous investigations by various governmental agencies. Certain of the Company’s individual facilities have received, and from time to time, other facilities may receive, subpoenas, civil investigative demands, audit requests and other inquiries from, and may be subject to investigation by, federal and state agencies. These investigations can result in repayment obligations, and violations of the False Claims Act can result in substantial monetary penalties and fines, the imposition of a corporate integrity agreement and exclusion from participation in governmental health programs. In addition, the federal False Claims Act permits private parties to bring qui tam, or
18
“whistleblower,” suits against companies that submit false claims for payments to, or improperly retain overpayments from, the government. Some states have adopted similar state whistleblower and false claims provisions.
On April 1, 2019, a consolidated complaint was filed against the Company and certain former and current officers in the lawsuit styled St. Clair County Employees’ Retirement System v. Acadia Healthcare Company, Inc., et al., Case No. 3:19-cv-00988, which is pending in the United States District Court for the Middle District of Tennessee. The complaint purports to be brought on behalf of a class consisting of all persons (other than defendants) who purchased securities of the Company between April 30, 2014 and November 15, 2018, and alleges that defendants violated Sections 10(b) and 20(a) of the Securities Exchange Act of 1934 (the “Exchange Act”) and Rule 10b-5 promulgated thereunder. At this time, we are not able to quantify any potential liability in connection with this litigation because the case is in its early stages.
On February 21, 2019, a purported stockholder filed a related derivative action on behalf of the Company against certain former and current officers and directors in the lawsuit styled Davydov v. Joey A. Jacobs, et al., Case No. 3:19-cv-00167, which is pending in the United States District Court for the Middle District of Tennessee. The complaint alleges claims for violations of Section 10(b) and 14(a) of the Exchange Act, breach of fiduciary duty, waste of corporate assets, and unjust enrichment. On April 15, 2019, the Court entered an order staying the case pending a ruling on the motion to dismiss that will be filed in the St. Clair County v. Acadia Healthcare case described above. At this time, we are not able to quantify any potential liability in connection with this litigation because the case is in its early stages.
During the third quarter of 2018, the U.S. Attorney’s Office for the Southern District of West Virginia served subpoenas on seven of our comprehensive treatment centers located in West Virginia requesting various documents from January 2012 to present. The U.S. Attorney’s Office has advised us that the civil aspect of the investigation is a False Claims Act investigation focused on claims submitted by the centers for certain lab services. The Company is cooperating fully with the government’s investigation and established a reserve of $19.0 million during the fourth quarter of 2018 relating to the Company’s billing for lab services in West Virginia. In connection with the investigation, we expect to enter into a corporate integrity agreement with the Office of Inspector General imposing customary compliance obligations on our subsidiary, CRC Health. Changes in the reserve may be required in future periods as discussions with the government continue and additional information becomes available.
In the fall of 2017, the Office of Inspector General issued subpoenas to three of the Company’s facilities requesting certain documents from January 2013 to the date of the subpoenas. The U.S. Attorney’s Office for the Middle District of Florida issued a civil investigative demand to one of the Company’s facilities in December 2017 requesting certain documents from November 2012 to the date of the demand. In April 2019, the Office of Inspector General issued subpoenas relating to six additional facilities requesting certain documents and information from January 2013 to the date of the subpoenas. The government’s investigation of each of these facilities is focused on claims not eligible for payment because of alleged violations of certain regulatory requirements relating to, among other things, medical necessity, admission eligibility, discharge decisions, length of stay and patient care issues. The Company is cooperating with the government’s investigation but is not able to quantify any potential liability in connection with these investigations.
On January 15, 2019, the Company paid $3.1 million in connection with a class action lawsuit filed in 2011 on behalf of the shareholders of PHC, Inc. d/b/a Pioneer Behavioral Health (“PHC”) related to the merger of the Company with PHC.
15.
Noncontrolling Interests
Noncontrolling interests in the consolidated financial statements represents the portion of equity held by noncontrolling partners in the Company’s non-wholly owned subsidiaries. At March 31, 2019, the Company operated five facilities and owns between 60% and 85% of the equity interests, and noncontrolling partners own the remaining equity interests. The initial value of the noncontrolling interests is based on the fair value of contributions, and the Company consolidates the operations of each facility based on its equity ownership and its control of the entity. The noncontrolling interests are reflected as redeemable noncontrolling interests on the condensed consolidated balance sheets based on put rights that could require the Company to purchase the noncontrolling interests upon the occurrence of a change in control.
The components of redeemable noncontrolling interests are as follows (in thousands):
Acquisition of redeemable noncontrolling interests
3,085
16.
Other Current Assets
Other current assets consisted of the following (in thousands):
Prepaid expenses
20,807
30,802
Other receivables
20,245
19,205
Cost report receivable
10,752
10,340
Workers’ compensation deposits – current portion
10,000
Inventory
6,115
5,055
Income taxes receivable
5,119
2,380
Insurance receivable – current portion
2,049
1,892
1,989
17.
Other Accrued Liabilities
Other accrued liabilities consisted of the following (in thousands):
Unearned income
40,862
32,154
Accrued expenses
40,235
44,938
Accrued legal settlements
17,075
22,076
Accrued interest
11,917
32,838
445
Income taxes payable
6,053
3,041
Insurance liability – current portion
4,956
Accrued property taxes
4,641
4,136
2,023
6,642
18.
Segment Information
The Company operates in one line of business, which is operating acute inpatient psychiatric facilities, specialty treatment facilities, residential treatment centers and facilities providing outpatient behavioral healthcare services. As management reviews the operating results of its U.S. Facilities and its U.K. Facilities separately to assess performance and make decisions, the Company’s operating segments include our U.S. Facilities and U.K. Facilities. At March 31, 2019, the U.S. Facilities segment included 223 behavioral healthcare facilities with approximately 9,300 beds in 40 states and Puerto Rico, and the U.K. Facilities segment included 370 behavioral healthcare facilities with approximately 8,800 beds in the U.K.
The following tables set forth the financial information by operating segment, including a reconciliation of Segment EBITDA to income before income taxes (in thousands):
Revenue:
Corporate and Other
Segment EBITDA (1):
119,008
117,124
40,056
51,152
(23,061
(22,545
136,003
145,731
Segment EBITDA (1)
Less:
(6,101
(6,919
(4,321
(4,768
(940
(48,130
(45,243
(40,580
(39,773
Corporate
and Other
Consolidated
Goodwill:
Balance at January 1, 2019
2,044,837
351,575
Increase from 2019 acquisitions
34,523
Increase from contribution of redeemable noncontrolling interests
7,979
2,082,445
359,554
Assets (2):
3,950,684
3,779,040
2,633,347
2,175,809
201,486
217,655
21
(1)
Segment EBITDA is defined as income before provision for income taxes, equity-based compensation expense, transaction-related expenses, debt extinguishment costs, interest expense and depreciation and amortization. The Company uses Segment EBITDA as an analytical indicator to measure the performance of the Company’s segments and to develop strategic objectives and operating plans for those segments. Segment EBITDA is commonly used as an analytical indicator within the health care industry, and also serves as a measure of leverage capacity and debt service ability. Segment EBITDA should not be considered as a measure of financial performance under GAAP, and the items excluded from Segment EBITDA are significant components in understanding and assessing financial performance. Because Segment EBITDA is not a measurement determined in accordance with GAAP and is thus susceptible to varying calculations, Segment EBITDA, as presented, may not be comparable to other similarly titled measures of other companies.
(2)
Assets include property and equipment for the U.S. Facilities of $1.4 billion, U.K. Facilities of $1.7 billion and corporate and other of $42.9 million at March 31, 2019. Assets include property and equipment for the U.S. Facilities of $1.4 billion, U.K. Facilities of $1.7 billion and corporate and other of $44.9 million at December 31, 2018.
19.
Accumulated Other Comprehensive Loss
The components of accumulated other comprehensive loss are as follows (in thousands):
Foreign Currency
Translation
Adjustments
Change in Fair
Value of
Derivative
Instruments
Pension Plan
(504,528
43,966
(1,815
Foreign currency translation gain (loss)
44,522
(41
Loss on derivative instruments, net of tax of $(3.5)
million
(460,006
35,276
(1,856
20.
Financial Information for the Company and Its Subsidiaries
The Company conducts substantially all of its business through its subsidiaries. The 6.125% Senior Notes, 5.125% Senior Notes, 5.625% Senior Notes and 6.500% Senior Notes are jointly and severally guaranteed on an unsecured senior basis by all of the Company’s subsidiaries that guarantee the Company’s obligations under the Amended and Restated Senior Credit Facility. Presented below is condensed consolidating financial information for the Company and its subsidiaries at March 31, 2019 and December 31, 2018, and for the three months ended March 31, 2019 and 2018. The information segregates the parent company (Acadia Healthcare Company, Inc.), the combined wholly-owned subsidiary guarantors, the combined non-guarantor subsidiaries and eliminations.
22
Condensed Consolidating Balance Sheets
Parent
Combined
Subsidiary
Guarantors
Non-
Consolidating
Amounts
17,843
25,841
268,956
62,895
55,472
21,507
342,271
110,243
1,263,982
1,909,070
1,989,900
452,099
57,994
31,802
2,094
(2,094
Investment in subsidiaries
5,340,603
(5,340,603
98,419
408,368
284,470
58,157
9,755
(280,753
5,673,471
3,810,723
2,924,773
(5,623,450
80,486
36,180
77,320
31,226
17,040
10,944
11,916
35,492
87,564
48,419
210,338
165,914
280,753
28,636
50,380
78,042
426,711
102,787
19,401
3,270,128
419,803
943,159
(282,847
3,390,920
1,949,683
23
32,471
18,039
248,218
69,869
60,160
21,660
340,849
109,568
1,219,803
1,887,963
1,936,057
460,355
56,611
32,379
Deferred tax assets – noncurrent
1,841
(1,841
Derivative instruments
5,190,771
(5,190,771
306,495
52,824
9,548
(303,940
5,559,631
3,606,144
2,503,281
(5,496,552
79,463
38,277
84,150
29,149
32,837
42,062
76,327
66,949
205,675
143,753
303,940
Deferred tax liabilities – noncurrent
31,874
50,339
107,866
46,401
3,226,324
345,415
544,433
(305,781
3,260,729
1,930,042
24
Condensed Consolidating Statement of Comprehensive Income (Loss)
Three Months Ended March 31, 2019
459,818
300,799
Salaries, wages and benefits
254,942
168,536
25,368
31,639
19,384
10,573
8,403
11,904
59,390
34,475
19,605
20,975
19,578
23,018
5,534
3,218
1,103
25,679
413,328
284,739
(Loss) income before income taxes
(25,679
46,490
16,060
Equity in earnings of subsidiaries
48,157
(48,157
(Benefit from) provision for income taxes
(7,033
17,065
(2,672
Net income (loss)
29,425
18,732
Net income (loss) attributable to Acadia
Healthcare Company, Inc.
18,692
Loss on derivative instruments
Other comprehensive (loss) income
Comprehensive income (loss) attributable to Acadia Healthcare Company, Inc.
20,821
63,173
25
Three Months Ended March 31, 2018
435,625
306,616
239,052
165,557
24,271
29,747
18,712
10,652
8,239
12,049
56,170
32,061
18,172
21,601
14,617
23,584
7,042
4,009
759
22,476
392,209
279,468
(22,476
43,416
27,148
67,598
(67,598
(5,752
(123
3,089
43,539
24,059
Net loss attributable to noncontrolling interests
24,004
Other comprehensive (loss) income:
30,821
116,784
26
Condensed Consolidating Statement of Cash Flows
Adjustments to reconcile net income (loss)
to net cash (used in) provided by continuing
operating activities:
(254
(678
266
1,993
253
(59
(15,693
3,713
(5,484
(391
2,665
(353
648
(2,665
(7,100
(8,601
(7,872
3,317
(1,135
Net cash (used in) provided by operating activities
(5,253
15,420
36,171
(45,231
(24,017
521
92
(86,176
(23,925
(2,375
(442
(680
Cash (used in) provided by intercompany activity
(54,372
56,570
(2,198
Net provided by (used in) in financing activities
5,253
56,128
(5,543
Net (decrease) increase in cash and cash equivalents
(14,628
7,802
27
Adjustments to reconcile net income (loss) to
net cash provided by (used in) continuing
2,626
(101
942
1,104
(149
794
315
(66
(21,049
2,256
(7,980
(5,236
4,432
(1,305
(4,432
(11,417
8,049
5,208
(406
1,204
(695
Net cash provided by (used in) continuing operating
activities
(71
27,791
49,349
Net cash provided by (used in) operating activities
27,504
(40,879
(29,448
(4,799
733
(49,971
(28,715
(169
(4,263
(1,742
(962
Cash provided by (used in) intercompany activity
3,843
1,950
(5,793
Net (used in) provided by in financing activities
71
819
(10,056
Net increase (decrease) in cash and cash equivalents
(21,648
12,166
46,860
20,430
25,212
32,596
21. Subsequent Events
On April 1, 2019, the Company completed the acquisition of Bradford Recovery Center (“Bradford”), a specialty treatment facility with 46 beds located in Millerton, Pennsylvania for cash consideration of approximately $4.5 million.
28
Management’s Discussion and Analysis of Financial Condition and Results of Operations.
This Quarterly Report on Form 10-Q contains “forward-looking statements” within the meaning of the Private Securities Litigation Reform Act of 1995. Forward-looking statements include any statements that address future results or occurrences. In some cases you can identify forward-looking statements by terminology such as “may,” “might,” “will,” “would,” “should,” “could” or the negative thereof. Generally, the words “anticipate,” “believe,” “continue,” “expect,” “intend,” “estimate,” “project,” “plan” and similar expressions identify forward-looking statements. In particular, statements about our expectations, beliefs, plans, objectives, assumptions or future events or performance contained are forward-looking statements.
We have based these forward-looking statements on our current expectations, assumptions, estimates and projections. While we believe these expectations, assumptions, estimates and projections are reasonable, such forward-looking statements are only predictions and involve known and unknown risks, uncertainties and other factors, many of which are outside of our control, which could cause our actual results, performance or achievements to differ materially from any results, performance or achievements expressed or implied by such forward-looking statements. These risks, uncertainties and other factors include, but are not limited to:
•
our significant indebtedness, our ability to meet our debt obligations, and our ability to incur substantially more debt;
difficulties in successfully integrating the operations of acquired facilities or realizing the potential benefits and synergies of our acquisitions and joint ventures;
our ability to implement our business strategies in the U.S. and the U.K. and adapt to the regulatory and business environment in the U.K.;
potential difficulties operating our business in light of political and economic instability in the U.K. and globally relating to the U.K.’s departure from the European Union;
the impact of fluctuations in foreign exchange rates, including the devaluations of the GBP relative to the USD;
the impact of payments received from the government and third-party payors on our revenue and results of operations including the significant dependence of our U.K. facilities on payments received from the NHS;
our ability to recruit and retain quality psychiatrists and other physicians, nurses, counselors and other medical support personnel;
the impact of competition for staffing on our labor costs and profitability;
the impact of increases to our labor costs in the U.S. and the U.K.;
the occurrence of patient incidents, which could result in negative media coverage, adversely affect the price of our securities and result in incremental regulatory burdens and governmental investigations;
our future cash flow and earnings;
our restrictive covenants, which may restrict our business and financing activities;
our ability to make payments on our financing arrangements;
the impact of the economic and employment conditions in the U.S. and the U.K. on our business and future results of operations;
compliance with laws and government regulations;
the impact of claims brought against us or our facilities including claims for damages for personal injuries, medical malpractice, overpayments, breach of contract, securities law violations, tort and employee related claims;
the impact of governmental investigations, regulatory actions and whistleblower lawsuits;
the impact of healthcare reform in the U.S. and abroad, including the potential repeal, replacement or modification of the Patient Protection and Affordable Care Act;
the impact of adverse weather conditions, including the effects of hurricanes;
the impact of our highly competitive industry on patient volumes;
our dependence on key management personnel, key executives and local facility management personnel;
our acquisition, joint venture and de novo strategies, which expose us to a variety of operational and financial risks, as well as legal and regulatory risks;
the impact of state efforts to regulate the construction or expansion of healthcare facilities on our ability to operate and expand our operations;
our potential inability to extend leases at expiration;
the impact of controls designed to reduce inpatient services on our revenue;
the impact of different interpretations of accounting principles on our results of operations or financial condition;
the impact of environmental, health and safety laws and regulations, especially in locations where we have concentrated operations;
the impact of an increase in uninsured and underinsured patients or the deterioration in the collectability of the accounts of such patients on our results of operations;
the risk of a cyber-security incident and any resulting violation of laws and regulations regarding information privacy or other negative impact;
the impact of laws and regulations relating to privacy and security of patient health information and standards for electronic transactions;
our ability to cultivate and maintain relationships with referral sources;
the impact of a change in the mix of our U.S. and U.K. earnings, adverse changes in our effective tax rate and adverse developments in tax laws generally;
changes in interpretations, assumptions and expectations regarding the Tax Act, including additional guidance that may be issued by federal and state taxing authorities;
failure to maintain effective internal control over financial reporting;
the impact of fluctuations in our operating results, quarter to quarter earnings and other factors on the price of our securities;
the impact of the trend for insurance companies and managed care organizations to enter into sole source contracts on our ability to obtain patients;
the impact of value-based purchasing programs on our revenue; and
those risks and uncertainties described from time to time in our filings with the SEC.
Given these risks and uncertainties, you are cautioned not to place undue reliance on such forward-looking statements. These risks and uncertainties may cause our actual future results to be materially different than those expressed in our forward-looking statements. These forward-looking statements are made only as of the date of this Quarterly Report on Form 10-Q. We do not undertake and specifically decline any obligation to update any such statements or to publicly announce the results of any revisions to any such statements to reflect future events or developments.
Overview
Our business strategy is to acquire and develop behavioral healthcare facilities and improve our operating results within our facilities and our other behavioral healthcare operations. We strive to improve the operating results of our facilities by providing high-quality services, expanding referral networks and marketing initiatives while meeting the increased demand for behavioral healthcare services through expansion of our current locations as well as developing new services within existing locations. At March 31, 2019, we operated 593 behavioral healthcare facilities with approximately 18,100 beds in 40 states, the U.K. and Puerto Rico. During the three months ended March 31, 2019, we acquired 10 facilities and added 260 beds (exclusive of acquisitions), including 100 added to existing facilities and 160 added through the opening of two de novo facilities. For the year ending December 31, 2019, we expect to add approximately 700 total beds exclusive of acquisitions.
We are the leading publicly traded pure-play provider of behavioral healthcare services, with operations in the U.S. and the U.K. Management believes that we are positioned as a leading platform in a highly fragmented industry under the direction of an experienced management team that has significant industry expertise. Management expects to take advantage of several strategies that are more accessible as a result of our increased size and geographic scale, including continuing a national marketing strategy to attract new patients and referral sources, increasing our volume of out-of-state referrals, providing a broader range of services to new and existing patients and clients and selectively pursuing opportunities to expand our facility and bed count in the U.S and U.K. though acquisitions, joint ventures and bed additions in existing facilities.
30
On April 1, 2019, the Company completed the acquisition of Bradford, a specialty treatment facility with 46 beds located in Millerton, Pennsylvania for cash consideration of approximately $4.5 million.
On February 15, 2019, the Company completed the acquisition of Whittier, an inpatient psychiatric facility with 71 beds located in Haverhill, Massachusetts, for cash consideration of approximately $17.9 million. Also on February 15, 2019, the Company completed the acquisition of Mission Treatment for cash consideration of approximately $22.5 million and a working capital settlement. Mission Treatment operated nine comprehensive treatment centers in California, Nevada, Arizona and Oklahoma.
Results of Operations
The following table illustrates our consolidated results of operations for the respective periods shown (dollars in thousands):
56.5
55.4
7.5
7.3
3.9
4.0
2.7
12.3
11.9
5.3
5.4
Interest expense
6.3
6.1
0.0
0.1
0.6
95.1
93.5
4.9
-0.4
6.9
Net income attributable to noncontrolling interest
Segments
At March 31, 2019, the U.S. Facilities segment included 223 behavioral healthcare facilities with approximately 9,300 beds in 40 states and Puerto Rico, and the U.K. Facilities segment included 370 behavioral healthcare facilities with approximately 8,800 beds in the U.K.
The following table sets forth percent changes in same facility operating data for our U.S. Facilities for the three months ended March 31, 2019 compared to the same period in 2018:
U.S. Same Facility Results (a)
Revenue growth
6.1%
Patient days growth
4.3%
Admissions growth
6.8%
Average length of stay change (b)
-2.3%
Revenue per patient day growth
1.7%
EBITDA margin change (c)
0 bps
(a)
Results for the period presented include facilities we have operated more than one year and exclude certain closed services.
(b)
Average length of stay is defined as patient days divided by admissions.
(c) Segment EBITDA is defined as income before provision for income taxes, equity-based compensation expense, transaction-related expenses, debt extinguishment costs, interest expense and depreciation and amortization. Management uses Segment EBITDA as an analytical indicator to
31
measure the performance of our segments and to develop strategic objectives and operating plans for those segments. Segment EBITDA is commonly used as an analytical indicator within the health care industry, and also serves as a measure of leverage capacity and debt service ability. Segment EBITDA should not be considered as a measure of financial performance under GAAP, and the items excluded from Segment EBITDA are significant components in understanding and assessing financial performance. Because Segment EBITDA is not a measurement determined in accordance with GAAP and is thus susceptible to varying calculations, Segment EBITDA, as presented, may not be comparable to other similarly titled measures of other companies.
The following table sets forth percent changes in same facility operating data for our U.K. Facilities for the three months ended March 31, 2019 compared to the same period in 2018:
U.K. Same Facility Results (a,c)
4.7%
0.9%
-2.1%
3.1%
3.7%
EBITDA margin change (d,e)
-430 bps
Results for the period presented include facilities we have operated more than one year and exclude the elderly care division and certain closed services.
(c)
Revenue and revenue per patient day for the three months ended March 31, 2018 is adjusted to reflect the foreign currency exchange rate for the comparable periods of 2018 in order to eliminate the effect of changes in the exchange rate.
(d)
See definition of Segment EBITDA in U.S. Same Facility Results table above.
(e)
U.K. EBITDA margin was affected by lower census and higher operating expenses including labor in particular.
Three months ended March 31, 2019 compared to the three months ended March 31, 2018
Revenue. Revenue increased $18.4 million, or 2.5%, to $760.6 million for the three months ended March 31, 2019 from $742.2 million for the three months ended March 31, 2018 resulting from same facility revenue growth of 5.6% and offset by the decrease in the exchange rate between USD and GBP of $17.9 million. During the three months ended March 31, 2019, we generated $488.0 million of revenue, or 64.2% of our total revenue, from our U.S. Facilities and $272.7 million of revenue, or 35.8% of our total revenue, from our U.K. Facilities. During the three months ended March 31, 2018, we generated $462.4 million of revenue, or 62.3% of our total revenue, from our U.S. Facilities and $279.8 million of revenue, or 37.7% of our total revenue, from our U.K. Facilities.
U.S. same facility revenue increased by $27.4 million, or 6.1%, for the three months ended March 31, 2019 compared to the three months ended March 31, 2018, resulting from same facility growth in patient days of 4.3% and an increase in same facility revenue per day of 1.7%. U.K. same facility revenue increased by $11.1 million, or 4.7%, for the three months ended March 31, 2019 compared to the three months ended March 31, 2018, resulting from same facility growth in patient days of 0.9% and an increase in same facility revenue per day of 3.7%. Consistent with the same facility patient day growth in 2018, the growth in same facility patient days for the three months ended March 31, 2019 compared to the three months ended March 31, 2018, resulted from the addition of beds to our existing facilities and ongoing demand for our services.
Salaries, wages and benefits. Salaries, wages and benefits (“SWB”) expense was $429.6 million for the three months ended March 31, 2019 compared to $411.5 million for the three months ended March 31, 2018, an increase of $18.1 million. SWB expense included $6.1 million and $6.9 million of equity-based compensation expense for the three months ended March 31, 2019 and 2018, respectively. Excluding equity-based compensation expense, SWB expense was $423.5 million, or 55.7% of revenue, for the three months ended March 31, 2019, compared to $404.6 million, or 54.5% of revenue, for the three months ended March 31, 2018. Same facility SWB expense was $379.2 million for the three months ended March 31, 2019, or 52.4% of revenue, compared to $352.7 million for the three months ended March 31, 2018, or 51.5% of revenue.
Professional fees. Professional fees were $57.0 million for the three months ended March 31, 2019, or 7.5% of revenue, compared to $54.0 million for the three months ended March 31, 2018, or 7.3% of revenue. The $3.0 million increase was primarily attributable to higher contract labor costs in our U.K. Facilities. Contract labor costs in our U.K. Facilities were higher primarily due
32
to the ongoing nursing and clinical labor shortage and our dependence on higher cost agency labor. Same facility professional fees were $49.2 million for the three months ended March 31, 2019, or 6.8% of revenue, compared to $44.3 million, for the three months ended March 31, 2018, or 6.5% of revenue.
Supplies. Supplies expense was $30.0 million for the three months ended March 31, 2019, or 3.9% of revenue, compared to $29.4 million for the three months ended March 31, 2018, or 4.0% of revenue. Same facility supplies expense was $27.8 million for the three months ended March 31, 2019, or 3.8% of revenue, compared to $26.6 million for the three months ended March 31, 2018, or 3.9% of revenue.
Rents and leases. Rents and leases were $20.3 million for both the three months ended March 31, 2019 and 2018, or 2.7% of revenue. Same facility rents and leases were $16.4 million for the three months ended March 31, 2019, or 2.3% of revenue, compared to $15.6 million for the three months ended March 31, 2018, or 2.3% of revenue.
Other operating expenses. Other operating expenses consisted primarily of purchased services, utilities, insurance, travel and repairs and maintenance expenses. Other operating expenses were $93.9 million for the three months ended March 31, 2019, or 12.3% of revenue, compared to $88.2 million for the three months ended March 31, 2018, or 11.9% of revenue. Same facility other operating expenses were $86.6 million for the three months ended March 31, 2019, or 12.0% of revenue, compared to $80.2 million for the three months ended March 31, 2018, or 11.7% of revenue.
Depreciation and amortization. Depreciation and amortization expense was $40.6 million for the three months ended March 31, 2019, or 5.3% of revenue, compared to $39.8 million for the three months ended March 31, 2018, or 5.4% of revenue.
Interest expense. Interest expense was $48.1 million for the three months ended March 31, 2019 compared to $45.2 million for the three months ended March 31, 2018. The increase in interest expense was primarily a result of higher interest rates applicable to our variable-rate debt slightly offset by the lower interest rates as a result of the Repricing Facilities to the Amended and Restated Credit Agreement.
Debt extinguishment costs. Debt extinguishment costs for the three months ended March 31, 2018 represent $0.6 million of cash charges and $0.3 million of non-cash charges recorded in connection with the Repricing Facilities Amendments to the Amended and Restated Credit Agreement.
Transaction-related expenses. Transaction-related expenses were $4.3 million for the three months ended March 31, 2019 compared to $4.8 million for the three months ended March 31, 2018. Transaction-related expenses represent costs incurred in the respective periods primarily related to our acquisitions, termination, restructuring and closure costs, as summarized below (in thousands):
Provision for (benefit from) income taxes. For the three months ended March 31, 2019, the provision for income taxes was $7.4 million, reflecting an effective tax rate of 20.0%, compared to the benefit from income taxes of $(2.8) million, reflecting an effective tax rate of (5.8)%, for the three months ended March 31, 2018. The increase in the effective tax rate for the three months ended March 31, 2019 was primarily attributable to the application of the Tax Act. The Company recorded a discrete benefit of $10.5 million during the three months ended March 31, 2018 related to the change in the Company’s provisional amount recorded at December 31, 2017.
Our revenue is primarily derived from services rendered to patients for inpatient psychiatric and substance abuse care, outpatient psychiatric care and adolescent residential treatment. We receive payments from the following sources for services rendered in our facilities: (i) state governments under their respective Medicaid and other programs; (ii) commercial insurers; (iii) the federal government under the Medicare program administered by CMS; (iv) publicly funded sources in the U.K. (including the NHS, CCGs and local authorities in England, Scotland and Wales) and (v) individual patients and clients. We determine the transaction price based on established billing rates reduced by contractual adjustments provided to third-party payors, discounts provided to uninsured
patients and implicit price concessions. Contractual adjustments and discounts are based on contractual agreements, discount policies and historical experience. Implicit price concessions are based on historical collection experience.
The following table presents revenue by payor type and as a percentage of revenue in our U.S. Facilities for the three months ended March 31, 2019 and 2018 (dollars in thousands):
The following table presents revenue by payor type and as a percentage of revenue in our U.K. Facilities for the three months ended March 31, 2019 and 2018 (dollars in thousands):
The following tables present a summary of our aging of accounts receivable at March 31, 2019 and December 31, 2018:
Current
30-90
90-150
>150
16.7
29.6
10.8
1.1
14.0
23.2
2.6
6.8
38.9
3.0
-0.1
8.1
1.9
1.4
7.8
0.3
58.3
18.5
16.3
14.8
29.1
1.8
0.9
13.1
22.4
3.4
39.6
6.0
8.4
1.7
3.2
0.4
55.2
18.9
8.6
17.3
34
Liquidity and Capital Resources
Cash provided by continuing operating activities for the three months ended March 31, 2019 was $43.7 million compared to $72.6 million for the three months ended March 31, 2018. The decrease in cash provided by continuing operating activities was primarily attributable to the decline in earnings in our U.K. Facilities and changes in salaries, wages and benefits accruals. Days sales outstanding were 39 days at both March 31, 2019 and December 31, 2018, respectively. At March 31, 2019 and December 31, 2018, we had working capital of $27.8 million and $34.0 million, respectively.
Cash used in investing activities for the three months ended March 31, 2019 was $110.1 million compared to $78.7 million for the three months ended March 31, 2018. Cash used in investing activities for the three months ended March 31, 2019 primarily consisted of cash paid for acquisitions of $40.4 million, $69.2 million of cash paid for capital expenditures and $1.1 million of cash paid for real estate. Cash paid for capital expenditures for the three months ended March 31, 2019 consisted of $18.5 million of routine capital expenditures and $50.7 million of expansion capital expenditures. We define expansion capital expenditures as those that increase the capacity of our facilities or otherwise enhance revenue. Routine or maintenance capital expenditures were 2.4% of revenue for the three months ended March 31, 2019. Cash used in investing activities for the three months ended March 31, 2018 primarily consisted of $70.3 million of cash paid for capital expenditures and $4.3 million of cash paid for real estate. Cash paid for capital expenditures for the three months ended March 31, 2018 consisted of $18.1 million of cash paid for routine capital expenditures and $52.2 million of expansion capital expenditures.
Cash provided by financing activities for the three months ended March 31, 2019 was $58.5 million compared to cash used in financing activities of $4.7 million for the three months ended March 31, 2018. Cash provided by financing activities for the three months ended March 31, 2019 consisted of borrowings on revolving credit facility of $71.6 million offset by principal payments of long-term debt of $8.2 million, common stock withheld for minimum statutory taxes of $1.3 million and other of $3.5 million. Cash used in financing activities for the three months ended March 31, 2018 primarily consisted of common stock withheld for minimum statutory taxes of $2.0 million and other of $2.7 million.
We had total available cash and cash equivalents of $43.7 million and $50.5 million at March 31, 2019 and December 31, 2018, respectively, of which approximately $25.8 million and $18.0 million was held by our foreign subsidiaries, respectively. Our strategic plan does not require the repatriation of foreign cash in order to fund our operations in the U.S., and it is our current intention to permanently reinvest our foreign cash and cash equivalents outside of the U.S.
We entered into the Senior Secured Credit Facility on April 1, 2011. On December 31, 2012, we entered into the Amended and Restated Credit Agreement which amended and restated the Senior Secured Credit Facility. We have amended the Amended and Restated Credit Agreement from time to time as described in our prior filings with the SEC.
On March 22, 2018, we entered into a Second Repricing Facilities Amendment to the Amended and Restated Credit Agreement. The Second Repricing Facilities Amendment (i) replaced the Tranche B-1 Facility and the Tranche B-2 Facility with a new Tranche B-3 Facility and a new Tranche B-4 Facility, respectively, and (ii) reduced the Applicable Rate from 2.75% to 2.50% in the case of Eurodollar Rate loans and reduced the Applicable Rate from 1.75% to 1.50% in the case of Base Rate Loans.
On March 29, 2018, we entered into a Third Repricing Facilities Amendment to the Amended and Restated Credit Agreement. The Third Repricing Facilities Amendment replaced the existing revolving credit facility and TLA Facility with a new revolving credit facility and TLA Facility, respectively. Our line of credit on the revolving credit facility remains at $500.0 million and the Third Repricing Facility Amendment reduced the size of the TLA Facility from $400.0 million to $380.0 million to reflect the then current outstanding principal. The Third Repricing Facilities Amendment reduced the Applicable Rate for the revolving credit facility and the TLA Facility by amending the definition of “Applicable Rate” and replacing the rate table therein with the table set forth below.
In connection with the Repricing Facilities Amendments, we recorded a debt extinguishment charge of $0.9 million, including the discount and write-off of deferred financing costs, which was recorded in debt extinguishment costs in the condensed consolidated statements of income.
On February 6, 2019, we entered into the Eleventh Amendment to the Amended and Restated Credit Agreement. The Eleventh Amendment, among other things, amended the definition of “Consolidated EBITDA” to remove the cap on non-cash charges, losses and expenses related to the impairment of goodwill, which in turn provided increased flexibility to us in terms of our financial covenants.
35
On February 27, 2019, we entered into the Twelfth Amendment to the Amended and Restated Credit Agreement. The Twelfth Amendment, among other things, modified certain definitions, including “Consolidated EBITDA”, and increased our permitted Maximum Consolidated Leverage Ratio, thereby providing increased flexibility to us in terms of our financial covenants.
We had $414.7 million of availability under the revolving line of credit and had standby letters of credit outstanding of $13.7 million related to security for the payment of claims required by our workers’ compensation insurance program at March 31, 2019. Borrowings under the revolving line of credit are subject to customary conditions precedent to borrowing. The Amended and Restated Credit Agreement requires quarterly term loan principal repayments of our TLA Facility of $4.8 million for June 30, 2019 to December 31, 2019, $7.1 million for March 31, 2020 to December 31, 2020, and $9.5 million for March 31, 2021 to September 30, 2021, with the remaining principal balance of the TLA Facility due on the maturity date of November 30, 2021. We are required to repay the Tranche B-3 Facility in equal quarterly installments of $1.2 million on the last business day of each March, June, September and December, with the outstanding principal balance of the Tranche B-3 Facility due on February 11, 2022. We are required to repay the Tranche B-4 Facility in equal quarterly installments of approximately $2.3 million on the last business day of each March, June, September and December, with the outstanding principal balance of the Tranche B-4 Facility due on February 16, 2023. On April 17, 2018, we made an additional payment of $15.0 million, including $5.1 million on the Tranche B-3 Facility and $9.9 million on the Tranche B-4 Facility.
Borrowings under the Amended and Restated Credit Agreement are guaranteed by each of our wholly-owned domestic subsidiaries (other than certain excluded subsidiaries) and are secured by a lien on substantially all of the Company and such subsidiaries’ assets. Borrowings with respect to the TLA Facility and our revolving credit facility (collectively, “Pro Rata Facilities”) under the Amended and Restated Credit Agreement bear interest at a rate tied to our Consolidated Leverage Ratio (defined as consolidated funded debt net of up to $50.0 million of unrestricted and unencumbered cash to consolidated EBITDA, in each case as defined in the Amended and Restated Credit Agreement). The Applicable Rate (as defined in the Amended and Restated Credit Agreement) for the Pro Rata Facilities was 2.50% for Eurodollar Rate Loans (as defined in the Amended and Restated Credit Agreement) and 1.50% for Base Rate Loans (as defined in the Amended and Restated Credit Agreement) at March 31, 2019. Eurodollar Rate Loans with respect to the Pro Rata Facilities bear interest at the Applicable Rate plus the Eurodollar Rate (as defined in the Amended and Restated Credit Agreement) (based upon the LIBOR Rate (as defined in the Amended and Restated Credit Agreement) prior to commencement of the interest rate period). Base Rate Loans with respect to the Pro Rata Facilities bear interest at the Applicable Rate plus the highest of (i) the federal funds rate plus 0.50%, (ii) the prime rate and (iii) the Eurodollar Rate plus 1.0%. At March 31, 2019, the Pro Rata Facilities bore interest at a rate of LIBOR plus 2.50%. In addition, we are required to pay a commitment fee on undrawn amounts under our revolving credit facility.
The interest rates and the unused line fee on unused commitments related to the Pro Rata Facilities are based upon the following pricing tiers:
Pricing Tier
Consolidated Leverage Ratio
Eurodollar Rate
Loans
Base Rate
Commitment
Fee
< 3.50:1.0
1.50
0.50
0.20
>3.50:1.0 but < 4.00:1.0
1.75
0.75
0.25
>4.00:1.0 but < 4.50:1.0
2.00
1.00
0.30
>4.50:1.0 but < 5.25:1.0
2.25
1.25
0.35
>5.25:1.0
2.50
0.40
Eurodollar Rate Loans with respect to the Tranche B-3 Facility bear interest at the Tranche B-3 Facility Applicable Rate (as defined below) plus the Eurodollar Rate (subject to a floor of 0.75% and based upon the LIBOR Rate prior to commencement of the interest rate period). Base Rate Loans bear interest at the Tranche B-3 Facility Applicable Rate plus the highest of (i) the federal funds rate plus 0.50%, (ii) the prime rate and (iii) the Eurodollar Rate plus 1.0%. As used herein, the term “Tranche B-3 Facility Applicable Rate” means, with respect to Eurodollar Rate Loans, 2.50%, and with respect to Base Rate Loans, 1.50%. The Tranche B-4 Facility bears interest as follows: Eurodollar Rate Loans bear interest at the Applicable Rate (as defined in the Amended and Restated Credit Agreement) plus the Eurodollar Rate (subject to a floor of 0.75% and based upon the LIBOR Rate prior to commencement of the interest rate period) and Base Rate Loans bear interest at the Applicable Rate plus the highest of (i) the federal funds rate plus 0.50%, (ii) the prime rate and (iii) the Eurodollar Rate plus 1.0%. As used herein, the term “Applicable Rate” means, with respect to Eurodollar Rate Loans, 2.50%, and with respect to Base Rate Loans, 1.50%.
The lenders who provided the Tranche B-3 Facility and Tranche B-4 Facility are not entitled to benefit from our maintenance of its financial covenants under the Amended and Restated Credit Agreement. Accordingly, if we fail to maintain its financial covenants, such failure shall not constitute an event of default under the Amended and Restated Credit Agreement with respect to the Tranche B-
36
3 Facility or Tranche B-4 Facility until and unless the Amended and Restated Senior Credit Facility is accelerated or the commitment of the lenders to make further loans is terminated.
The Amended and Restated Credit Agreement requires us and our subsidiaries to comply with customary affirmative, negative and financial covenants, including a fixed charge coverage ratio, consolidated leverage ratio and consolidated senior secured leverage ratio. We may be required to pay all of our indebtedness immediately if we default on any of the numerous financial or other restrictive covenants contained in any of our material debt agreements. Set forth below is a brief description of such covenants, all of which are subject to customary exceptions, materiality thresholds and qualifications:
a)
the affirmative covenants include the following: (i) delivery of financial statements and other customary financial information; (ii) notices of events of default and other material events; (iii) maintenance of existence, ability to conduct business, properties, insurance and books and records; (iv) payment of taxes; (v) lender inspection rights; (vi) compliance with laws; (vii) use of proceeds; (viii) further assurances; and (ix) additional collateral and guarantor requirements.
b)
the negative covenants include limitations on the following: (i) liens; (ii) debt (including guaranties); (iii) investments; (iv) fundamental changes (including mergers, consolidations and liquidations); (v) dispositions; (vi) sale leasebacks; (vii) affiliate transactions; (viii) burdensome agreements; (ix) restricted payments; (x) use of proceeds; (xi) ownership of subsidiaries; (xii) changes to line of business; (xiii) changes to organizational documents, legal name, state of formation, form of entity and fiscal year; (xiv) prepayment or redemption of certain senior unsecured debt; and (xv) amendments to certain material agreements. We are generally not permitted to issue dividends or distributions other than with respect to the following: (w) certain tax distributions; (x) the repurchase of equity held by employees, officers or directors upon the occurrence of death, disability or termination subject to cap of $500,000 in any fiscal year and compliance with certain other conditions; (y) in the form of capital stock; and (z) scheduled payments of deferred purchase price, working capital adjustments and similar payments pursuant to the merger agreement or any permitted acquisition.
c)
The financial covenants include maintenance of the following:
the fixed charge coverage ratio may not be less than 1.25:1.00 as of the end of any fiscal quarter;
the total leverage ratio may not be greater than the following levels as of the end of each fiscal quarter listed below:
March 31
June 30
September 30
December 31
6.25x
6.00x
5.75x
5.50x
5.25x
5.00x
the secured leverage ratio may not be greater than 3.50x as of the end of each fiscal quarter.
At March 31, 2019, we were in compliance with all of the above covenants.
6.125% Senior Notes Due 2021
On March 12, 2013, we issued $150.0 million of 6.125% Senior Notes due 2021. The 6.125% Senior Notes mature on March 15, 2021 and bear interest at a rate of 6.125% per annum, payable semi-annually in arrears on March 15 and September 15 of each year.
On July 1, 2014, we issued $300.0 million of 5.125% Senior Notes due 2022. The 5.125% Senior Notes mature on July 1, 2022 and bear interest at a rate of 5.125% per annum, payable semi-annually in arrears on January 1 and July 1 of each year.
On February 11, 2015, we issued $375.0 million of 5.625% Senior Notes due 2023. On September 21, 2015, we issued $275.0 million of additional 5.625% Senior Notes. The additional notes formed a single class of debt securities with the 5.625% Senior Notes issued in February 2015. Giving effect to this issuance, we have outstanding an aggregate of $650.0 million of 5.625% Senior Notes. The 5.625% Senior Notes mature on February 15, 2023 and bear interest at a rate of 5.625% per annum, payable semi-annually in arrears on February 15 and August 15 of each year.
On February 16, 2016, we issued $390.0 million of 6.500% Senior Notes due 2024. The 6.500% Senior Notes mature on March 1, 2024 and bear interest at a rate of 6.500% per annum, payable semi-annually in arrears on March 1 and September 1 of each year, beginning on September 1, 2016.
The indentures governing the Senior Notes contain covenants that, among other things, limit our ability and the ability of its restricted subsidiaries to: (i) pay dividends, redeem stock or make other distributions or investments; (ii) incur additional debt or issue certain preferred stock; (iii) transfer or sell assets; (iv) engage in certain transactions with affiliates; (v) create restrictions on dividends or other payments by the restricted subsidiaries; (vi) merge, consolidate or sell substantially all of our assets; and (vii) create liens on assets.
The Senior Notes issued by us are guaranteed by each of our subsidiaries that guarantee our obligations under the Amended and Restated Senior Credit Facility. The guarantees are full and unconditional and joint and several.
We may redeem the Senior Notes at its option, in whole or part, at the dates and amounts set forth in the indentures.
Contractual Obligations
The following table presents a summary of contractual obligations at March 31, 2019 (dollars in thousands):
Payments Due by Period
Less Than
1 Year
1-3 Years
3-5 Years
More Than
5 Years
Long-term debt (a)
211,704
1,374,837
2,349,099
3,935,640
Operating lease liabilities (b)
61,078
111,516
95,580
712,138
7,879
40,527
2,619
25,847
Total obligations and commitments
280,661
1,526,880
2,447,298
737,985
4,992,824
Amounts include required principal and interest payments. The projected interest payments reflect the interest rates in place on our variable-rate debt at March 31, 2019.
Amounts exclude variable components of lease payments.
Off-Balance Sheet Arrangements
At March 31, 2019, we had standby letters of credit outstanding of $13.7 million related to security for the payment of claims as required by our workers’ compensation insurance program.
Interest Rate Risk
Our interest expense is sensitive to changes in market interest rates. Our long-term debt outstanding at March 31, 2019 was composed of $1.5 billion of fixed-rate debt and $1.8 billion of variable-rate debt with interest based on LIBOR plus an applicable margin. A hypothetical 10% increase in interest rates (which would equate to a 0.49% higher rate on our variable rate debt) would decrease our net income and cash flows by $5.9 million on an annual basis based upon our borrowing level at March 31, 2019.
LIBOR and certain other interest “benchmarks” may be subject to regulatory guidance and/or reform that could cause interest rates under our current or future debt agreements to perform differently than in the past or cause other unanticipated consequences. The U.K.’s Financial Conduct Authority, which regulates LIBOR, has announced that it intends to stop encouraging or requiring banks to submit rates for the calculation of LIBOR rates after 2021, and it is unclear if LIBOR will cease to exist or if new methods of calculating LIBOR will evolve. If LIBOR ceases to exist or if the methods of calculating LIBOR change from their current form, interest rates on our current or future debt obligations may be adversely affected.
Foreign Currency Risk
The functional currency for our U.K. facilities is the British pound or GBP. Our revenue and earnings are sensitive to changes in the GBP to USD exchange rate from the translation of our earnings into USD at exchange rates that may fluctuate. Based upon the
level of our U.K. operations relative to the Company as a whole, a hypothetical 10% change in the exchange rate (which would equate to an increase or decrease in the exchange rate of 0.13) would cause a change in our net income of $7.7 million on an annual basis.
In May 2016, we entered into multiple cross currency swap agreements with an aggregate notional amount of $650.0 million to manage foreign currency exchange risk by effectively converting a portion of our fixed-rate USD denominated senior notes, including the semi-annual interest payments thereunder, to fixed-rate, GBP-denominated debt of £449.3 million. The cross currency swap agreements limit the impact of changes in the exchange rate on our cash flows and leverage.
Evaluation of Disclosure Controls and Procedures
As of the end of the period covered by this report, our management conducted an evaluation, with the participation of our chief executive officer and chief financial officer, of the effectiveness of our disclosure controls and procedures (as defined in Rules 13a-15(e) and 15d-15(e) under the Exchange Act). Based on this evaluation, our chief executive officer and chief financial officer have concluded that our disclosure controls and procedures are effective to ensure that information required to be disclosed by us in the reports that we file or submit under the Exchange Act is recorded, processed, summarized and reported within the time periods specified in the SEC’s rules and forms and that such information is accumulated and communicated to management, including our chief executive officer and chief financial officer, as appropriate to allow timely decisions regarding required disclosure.
Changes in Internal Control Over Financial Reporting
The Company adopted the new lease accounting guidance in ASU 2016-02 on January 1, 2019 and began using new lease accounting software. The implementation of the new lease accounting standard and lease accounting software included additions to our internal controls, policies and procedures. There have been no other changes in our internal control over financial reporting during the three months ended March 31, 2019 that have materially affected or are reasonably likely to materially affect our internal control over financial reporting.
We are, from time to time, subject to various claims, lawsuits, governmental investigations and regulatory actions, including claims for damages for personal injuries, medical malpractice, overpayments, breach of contract, securities law violations, tort and employment related claims. In these actions, plaintiffs request a variety of damages, including, in some instances, punitive and other types of damages that may not be covered by insurance. In addition, healthcare companies are subject to numerous investigations by various governmental agencies. Certain of our individual facilities have received, and from time to time, other facilities may receive, subpoenas, civil investigative demands, audit requests and other inquiries from, and may be subject to investigation by, federal and state agencies. These investigations can result in repayment obligations, and violations of the False Claims Act can result in substantial monetary penalties and fines, the imposition of a corporate integrity agreement and exclusion from participation in governmental health programs. In addition, the federal False Claims Act permits private parties to bring qui tam, or “whistleblower,” suits against companies that submit false claims for payments to, or improperly retain overpayments from, the government. Some states have adopted similar state whistleblower and false claims provisions.
On April 1, 2019, a consolidated complaint was filed against the Company and certain former and current officers in the lawsuit styled St. Clair County Employees’ Retirement System v. Acadia Healthcare Company, Inc., et al., Case No. 3:19-cv-00988, which is pending in the United States District Court for the Middle District of Tennessee. The complaint purports to be brought on behalf of a class consisting of all persons (other than defendants) who purchased securities of the Company between April 30, 2014 and November 15, 2018, and alleges that defendants violated Sections 10(b) and 20(a) of the Exchange Act and Rule 10b-5 promulgated thereunder. At this time, we are not able to quantify any potential liability in connection with this litigation because the case is in its early stages.
During the third quarter of 2018, the U.S. Attorney’s Office for the Southern District of West Virginia served subpoenas on seven of our comprehensive treatment centers located in West Virginia requesting various documents from January 2012 to the date of the subpoena. The U.S. Attorney’s Office has advised us that the civil aspect of the investigation is a False Claims Act investigation focused on claims submitted by the centers for certain lab services. We are cooperating fully with the government’s investigation and established a reserve of $19.0 million during the fourth quarter of 2018 relating to our billing for lab services in West Virginia. In connection with the investigation, we expect to enter into a corporate integrity agreement with the Office of Inspector General imposing customary compliance obligations on our subsidiary, CRC Health. At this time, we cannot predict the potential liability, and changes in the reserve may be required in future periods as discussions with the government continue and additional information becomes available.
In the fall of 2017, Office of Inspector General issued subpoenas to three of our facilities requesting certain documents from January 2013 to the date of the subpoenas. The U.S. Attorney’s Office for the Middle District of Florida issued a civil investigative demand to one of our facilities in December 2017 requesting certain documents from November 2012 to the date of the demand. In April 2019, the Office of Inspector General issued subpoenas relating to six additional facilities requesting certain documents and information from January 2013 to the date of the subpoenas. The government’s investigation of each of these facilities is focused on claims not eligible for payment because of alleged violations of certain regulatory requirements relating to, among other things, medical necessity, admission eligibility, discharge decisions, length of stay and patient care issues. We are cooperating with the government’s investigation but are not able to quantify any potential liability in connection with these investigations.
In addition to the other information set forth in this report, an investor should carefully consider the factors discussed in Part I, “Item 1A. Risk Factors” in the Company’s Annual Report on Form 10-K for the year ended December 31, 2018. The risks, as described in in the Company’s Annual Report on Form 10-K for the year ended December 31, 2018, are not the only risks facing the Company. Additional risks and uncertainties not currently known to management or that management currently deems immaterial also may materially, adversely affect the Company’s business, financial condition, operating results or cash flows.
During the three months ended March 31, 2019, the Company withheld shares of Company common stock to satisfy employee minimum statutory tax withholding obligations payable upon the vesting of restricted stock, as follows:
Period
Total Number
of Shares
Purchased
Average Price
Paid per Share
Total Number of Shares Purchased as Part of Publicly Announced Plans or Programs
Maximum Number
of Shares that
May Yet Be
Purchased Under
the Plans
or Programs
January 1 – January 31
7,193
25.71
February 1 – February 28
38,811
27.30
March 1 – March 31
13,410
29.99
59,414
Exhibit No.
Exhibit Description
3.1
Amended and Restated Certificate of Incorporation, as amended. (1)
Amended and Restated Bylaws of the Company, as amended. (1)
10.1
Eleventh Amendment, dated February 6, 2019, to the Credit Agreement. (2)
10.2
Twelfth Amendment, dated February 27, 2019, to the Credit Agreement. (2)
31.1*
Certification of the Chief Executive Officer of the Company pursuant to Rule 13a-14(a) of the Securities Exchange Act of 1934, as amended, as Adopted Pursuant to Section 302 of the Sarbanes-Oxley Act of 2002.
31.2*
Certification of the Chief Financial Officer of the Company pursuant to Rule 13a-14(a) of the Securities Exchange Act of 1934, as amended, as Adopted Pursuant to Section 302 of the Sarbanes-Oxley Act of 2002.
32*
Certification of Chief Executive Officer and Chief Financial Officer of the Company pursuant to 18 U.S.C. Section 1350, as Adopted Pursuant to Section 906 of the Sarbanes-Oxley Act of 2002.
101.INS**
XBRL Instance Document - The instance document does not appear in the interactive data file because its XBRL tags are embedded within the inline XBRL document.
101.SCH**
XBRL Taxonomy Extension Schema Document.
101.CAL**
XBRL Taxonomy Calculation Linkbase Document.
101.DEF**
XBRL Taxonomy Extension Definition Linkbase Document.
101.LAB**
XBRL Taxonomy Labels Linkbase Document.
101.PRE**
XBRL Taxonomy Presentation Linkbase Document.
Incorporated by reference to exhibits filed with the Company’s Current Report on Form 8-K filed May 25, 2017 (File No. 001-35331).
Incorporated by reference to exhibits filed with the Company’s Annual Report on Form 10-K for the year ended December 31, 2018 (File No. 001-35331).
*
Filed herewith.
** The XBRL related information in Exhibit 101 to this quarterly report on Form 10-Q shall not be deemed “filed” for purposes of Section 18 of the Securities Exchange Act of 1934, as amended, or otherwise subject to liability of that section and shall not be incorporated by reference into any filing or other document pursuant to the Securities Act of 1933, as amended, except as shall be expressly set forth by specific reference in such filing or document.
Pursuant to the requirements of the Securities Act of 1934, the registrant has duly caused this report to be signed on its behalf by the undersigned thereunto duly authorized.
By:
/s/ David M. Duckworth
David M. Duckworth
Chief Financial Officer
Dated: May 1, 2019