Table of Contents
UNITED STATES
SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
FORM 10-Q
(Mark One)
x Quarterly Report Pursuant to Section 13 or 15(d) of the Securities Exchange Act of 1934
For the Quarterly Period Ended June 30, 2013
o Transition report pursuant to Section 13 or 15(d) of the Securities Exchange Act of 1934
For the Transition Period From to .
Commission File Number: 001 – 34465
SELECT MEDICAL HOLDINGS CORPORATION
(Exact name of Registrant as specified in its charter)
Delaware
20-1764048
(State or other jurisdiction of incorporation or organization)
(I.R.S. employer identification number)
4714 Gettysburg Road, P.O. Box 2034, Mechanicsburg, Pennsylvania 17055
(Address of principal executive offices and zip code)
(717) 972-1100
(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 periods as the Registrant was required to file such reports), and (2) has been subject to such filing requirements for the past 90 days. YES x NO o
Indicate by check mark whether the Registrant has submitted electronically and posted on its corporate Web site, if any, every Interactive Data File required to be submitted and posted pursuant to Rule 405 of Regulation S-T during the preceding 12 months (or for such shorter period that the Registrant was required to submit and post such files). YES x NO o
Indicate by check mark whether the Registrant is a large accelerated filer, accelerated filer, non-accelerated filer, or smaller reporting company. See definitions of “large accelerated filer,” “accelerated filer” and “smaller reporting company” in Rule 12b-2 of the Exchange Act.
Large accelerated filer o Accelerated filer x Non-accelerated filer o
Smaller reporting company o
Indicate by check mark whether the Registrant is a shell company (as defined in Rule 12b-2 of the Exchange Act). YES o NO x
As of July 31, 2013, the Company had outstanding 139,625,565 shares of common stock.
Unless the context indicates otherwise, any reference in this report to “Holdings” refers to Select Medical Holdings Corporation and any reference to “Select” refers to Select Medical Corporation, the wholly-owned operating subsidiary of Holdings. References to the “Company,” “we,” “us,” and “our” refer collectively to Select Medical Holdings Corporation and Select Medical Corporation.
TABLE OF CONTENTS
PART I
FINANCIAL INFORMATION
3
ITEM 1.
CONSOLIDATED FINANCIAL STATEMENTS
Consolidated balance sheets
Consolidated statements of operations
4
Consolidated statements of changes in equity and income
6
Consolidated statements of cash flows
7
Notes to consolidated financial statements
8
ITEM 2.
MANAGEMENT’S DISCUSSION AND ANALYSIS OF FINANCIAL CONDITION AND RESULTS OF OPERATIONS
28
ITEM 3.
QUANTITATIVE AND QUALITATIVE DISCLOSURES ABOUT MARKET RISK
54
ITEM 4.
CONTROLS AND PROCEDURES
PART II
OTHER INFORMATION
55
LEGAL PROCEEDINGS
ITEM 1A.
RISK FACTORS
56
UNREGISTERED SALES OF EQUITY SECURITIES AND USE OF PROCEEDS
DEFAULTS UPON SENIOR SECURITIES
MINE SAFETY DISCLOSURES
ITEM 5.
ITEM 6.
EXHIBITS
57
SIGNATURES
2
PART I FINANCIAL INFORMATION
ITEM 1. CONSOLIDATED FINANCIAL STATEMENTS
Consolidated Balance Sheets
(unaudited)
(in thousands, except share and per share amounts)
Select Medical Holdings Corporation
Select Medical Corporation
December 31,
June 30,
2012
2013
ASSETS
Current Assets:
Cash and cash equivalents
$
40,144
8,768
Accounts receivable, net of allowance for doubtful accounts of $41,854 and $43,066 at 2012 and 2013, respectively
359,929
427,191
Current deferred tax asset
17,877
14,850
Prepaid income taxes
3,895
12,219
Other current assets
31,818
38,077
Total Current Assets
453,663
501,105
Property and equipment, net
501,552
498,808
Goodwill
1,640,534
1,641,796
Other identifiable intangibles
71,745
71,713
Other assets
93,867
131,633
92,819
Total Assets
2,761,361
2,845,055
2,760,313
LIABILITIES AND EQUITY
Current Liabilities:
Bank overdrafts
17,836
19,461
Current portion of long-term debt and notes payable
11,646
13,230
Accounts payable
89,547
86,914
Accrued payroll
88,586
76,289
Accrued vacation
55,714
60,304
Accrued interest
22,016
9,057
18,759
Accrued other
102,040
94,127
107,280
Due to third party payors
1,078
6,295
Total Current Liabilities
388,463
365,677
390,446
Long-term debt, net of current portion
1,458,597
1,517,728
1,291,297
Non-current deferred tax liability
89,510
89,676
Other non-current liabilities
68,502
70,647
Total Liabilities
2,005,072
2,043,728
1,839,755
Redeemable non-controlling interests
10,811
12,520
Stockholders’ Equity:
Common stock of Holdings, $0.001 par value, 700,000,000 shares authorized, 140,589,256 shares and 139,625,565 shares issued and outstanding at 2012 and 2013, respectively
141
140
—
Common stock of Select, $0.01 par value, 100 shares issued and outstanding
0
Capital in excess of par
473,697
470,809
859,839
864,557
Retained earnings (accumulated deficit)
243,210
287,350
21,478
(106,258
)
Total Select Medical Holdings Corporation and Select Medical Corporation Stockholders’ Equity
717,048
758,299
881,317
Non-controlling interest
28,430
30,508
Total Equity
745,478
788,807
909,747
Total Liabilities and Equity
The accompanying notes are an integral part of these consolidated financial statements.
Consolidated Statements of Operations
(in thousands, except per share amounts)
For the Three Months Ended June 30,
Net operating revenues
750,193
756,673
Costs and expenses:
Cost of services
612,669
625,730
General and administrative
18,554
17,927
Bad debt expense
10,029
8,846
Depreciation and amortization
15,428
15,907
Total costs and expenses
656,680
668,410
Income from operations
93,513
88,263
Other income and expense:
Loss on early retirement of debt
(17,280
Equity in earnings of unconsolidated subsidiaries
2,752
568
Interest expense
(23,798
(21,904
(20,957
Income before income taxes
72,467
49,647
75,308
Income tax expense
27,651
19,769
28,646
Net income
44,816
29,878
46,662
Less: Net income attributable to non-controlling interests
1,644
2,098
Net income attributable to Select Medical Holdings Corporation and Select Medical Corporation
43,172
27,780
45,018
Income per common share:
Basic
0.31
0.20
Diluted
For the Six Months Ended June 30,
1,494,214
1,506,628
1,224,288
1,250,634
32,778
35,325
20,404
18,167
31,627
31,709
1,309,097
1,335,835
185,117
170,793
(18,747
(17,788
5,217
1,626
(47,720
(45,362
(42,207
(42,952
142,614
108,310
148,127
111,679
55,226
41,630
57,156
42,809
87,388
66,680
90,971
68,870
2,674
4,482
84,714
62,198
88,297
64,388
0.60
0.44
0.59
5
Consolidated Statements of Changes in Equity and Income
(in thousands)
Select Medical Holdings Corporation Stockholders
Comprehensive Income
Total
Common Stock Issued
Common Stock Par Value
Capital in Excess of Par
Retained Earnings
Non-controlling Interests
Balance at December 31, 2012
140,589
64,812
2,614
Net income - attributable to redeemable non-controlling interests
1,868
Total comprehensive income
Dividends paid to common stockholders
(13,963
Issuance and vesting of restricted stock
3,076
152
Stock option expense
461
Repurchase of common shares
(9,983
(1,115
(1
(6,425
(3,557
Acquisitions of non-controlling interests
261
Distributions to non-controlling interests
(797
Redeemable non-controlling interests redemption value adjustment
(538
Balance at June 30, 2013
139,626
Select Medical Corporation Stockholders
Retained Earnings (accumulated deficit)
67,002
Federal tax benefit of losses contributed by Holdings
1,181
Net change in dividends payable to Holdings
5,239
Dividends declared and paid to Holdings
(196,825
Contribution related to restricted stock awards and stock option issuances by Holdings
3,537
Distributions to non-controlling intersts
Consolidated Statements of Cash Flows
Operating activities
Adjustments to reconcile net income to net cash provided by operating activities:
Provision for bad debts
(5,217
(1,626
18,747
17,788
Loss (gain) from disposal or sale of assets
(3,604
81
Non-cash stock compensation expense
2,599
Amortization of debt discount and issuance costs
3,511
4,588
3,325
4,499
Changes in operating assets and liabilities, net of effects from acquisition of businesses:
Accounts receivable
(30,520
(83,832
(1,612
(5,894
1,675
144
(5,486
(2,665
Due to third-party payors
1,738
Accrued expenses
6,423
(28,203
6,340
(24,945
Income and deferred taxes
9,879
(4,627
11,809
(3,448
Net cash provided by operating activities
118,805
22,023
124,049
27,602
Investing activities
Purchases of property and equipment
(27,934
(27,962
Proceeds from sale of assets
16,511
Investment in businesses, net of distributions
(10,014
(28,716
Acquisition of businesses, net of cash acquired
(206
(171
Net cash used in investing activities
(21,643
(56,849
Financing activities
Borrowings on revolving credit facility
340,000
455,000
Payments on revolving credit facility
(380,000
(480,000
Borrowings on credit facility term loans, net of discount
298,500
Payments on credit facility term loans
(4,250
(592,615
Issuance of 6.375% senior notes
600,000
Repurchase of senior floating rate notes
(167,300
Repurchase of 7 5/8% senior subordinated notes
(70,000
Borrowings of other debt
5,835
6,909
Principal payments on other debt
(5,085
(4,673
Debt issuance costs
(18,583
Dividends paid to Holdings
(52,034
Repurchase of common stock
(46,790
Proceeds from issuance of common stock
547
Equity investment by Holdings
Proceeds from bank overdrafts
3,739
1,625
(1,681
(1,467
Net cash provided by (used in) financing activities
(87,685
3,450
(92,929
(2,129
Net increase (decrease) in cash and cash equivalents
9,477
(31,376
Cash and cash equivalents at beginning of period
12,043
Cash and cash equivalents at end of period
21,520
Supplemental Cash Flow Information
Cash paid for interest
32,378
53,914
27,136
48,335
Cash paid for taxes
45,344
46,832
SELECT MEDICAL HOLDINGS CORPORATION AND SELECT MEDICAL CORPORATION
NOTES TO CONSOLIDATED FINANCIAL STATEMENTS (UNAUDITED)
1. Basis of Presentation
The unaudited consolidated financial statements of Select Medical Holdings Corporation (“Holdings”) and Select Medical Corporation (“Select”) as of June 30, 2013 and for the three and six month periods ended June 30, 2012 and 2013 have been prepared in accordance with generally accepted accounting principles (“GAAP”). In the opinion of management, such information contains all adjustments, which are normal and recurring in nature, necessary for a fair statement of the financial position, results of operations and cash flow for such periods. All significant intercompany transactions and balances have been eliminated. The results of operations for the three and six months ended June 30, 2013 are not necessarily indicative of the results to be expected for the full fiscal year ending December 31, 2013. Holdings and Select and their subsidiaries are collectively referred to as the “Company.” The consolidated financial statements of Holdings include the accounts of its wholly-owned subsidiary Select. Holdings conducts substantially all of its business through Select and its subsidiaries.
Certain information and disclosures normally included in the notes to consolidated financial statements have been condensed or omitted consistent with the rules and regulations of the Securities and Exchange Commission (the “SEC”), although the Company believes the disclosure is adequate to make the information presented not misleading. The accompanying unaudited condensed consolidated financial statements should be read in conjunction with the consolidated financial statements and notes thereto for the year ended December 31, 2012 contained in the Company’s Annual Report on Form 10-K filed with the Securities and Exchange Commission on February 26, 2013.
2. Accounting Policies
Use of Estimates
The preparation of financial statements in conformity with GAAP requires management to make estimates and assumptions that affect the reported amounts of assets and liabilities and disclosure of contingent assets and liabilities at the date of the financial statements and reported amounts of revenues and expenses during the reporting period. Actual results could differ materially from those estimates.
3. Intangible Assets
The gross carrying amounts of the Company’s indefinite-lived intangible assets consist of the following:
December 31, 2012
June 30, 2013
Trademarks
57,709
Certificates of need
11,914
11,921
Accreditations
2,122
2,083
1,712,279
1,713,509
The Company’s accreditations and trademarks have renewal terms. The costs to renew these intangibles are expensed as incurred. At June 30, 2013, the accreditations and trademarks have a weighted average time until next renewal of approximately 1.5 years and 7.0 years, respectively.
The changes in the carrying amount of goodwill for the Company’s reportable segments for the six months ended June 30, 2013 are as follows:
Specialty Hospitals
Outpatient Rehabilitation
Balance as of December 31, 2012
1,333,220
307,314
Goodwill acquired during the period
1,395
Purchase price adjustment
(133
Balance as of June 30, 2013
1,334,615
307,181
4. Indebtedness
The components of long-term debt and notes payable are as follows:
Holdings
7 5/8% senior subordinated notes
70,000
6.375% senior notes
Senior secured credit facilities:
Revolving loan
130,000
105,000
Term loans (1)
1,096,641
811,060
Senior floating rate notes
167,300
Other
6,302
14,898
Total debt
1,470,243
1,530,958
Less: current maturities
Total long-term debt
Select
1,302,943
9
(1) Presented net of unamortized discounts of $14.2 million and $7.2 million at December 31, 2012 and June 30, 2013, respectively.
On February 20, 2013, Select entered into an additional credit extension amendment to its senior secured credit facilities providing for a $300.0 million additional term loan tranche, (the “series B term loan”) to Select. Select used the borrowings under the series B term loan to redeem all of its outstanding 7 5/8% senior subordinated notes due 2015 on March 22, 2013, to finance Holdings’ redemption of all of its senior floating rate notes due 2015 on March 22, 2013 and to repay a portion of the balance outstanding under Select’s revolving credit facility.
The Company recognized a loss on early retirement of debt of $1.5 million during the three months ended March 31, 2013 for unamortized debt issuance costs, approximately $0.5 million associated with Select’s 7 5/8% senior subordinated notes due 2015 and approximately $1.0 million associated with Holdings’ senior floating rate notes due 2015.
Borrowings under the series B term loan bear interest at a rate equal to Adjusted LIBO plus 3.25%, or Alternate Base Rate plus 2.25%. The series B term loan amortizes in equal quarterly installments on the last day of each March, June, September and December in aggregate annual amounts equal to $3.0 million. The balance of the series B term loan is payable on February 20, 2016.
At the time of issuing the series B term loan, Select had additional term loan tranches outstanding including an $850.0 million term loan tranche issued on June 1, 2011 (the “original term loan”) and a $275.0 million incremental term loan tranche issued August 13, 2012 (the “series A term loan”). Both the original term loan and series A term loan tranches were issued at a discount and amortize in equal quarterly installments on the last day of each March, June, September and December. The balance of both the original term loan and series A term loan are payable on June 1, 2018.
On May 28, 2013, Select issued and sold $600.0 million aggregate principal amount of its 6.375% senior notes due 2021. The senior notes are senior unsecured obligations of Select and are fully and unconditionally guaranteed by all of Select’s wholly owned subsidiaries. On May 28, 2013, Select used the proceeds of the senior notes to pay a portion of the amounts outstanding on the original term loan and the series A term loan, and to pay related fees and expenses. Select recognized a loss on early retirement of debt of $17.3 million in the three months ended June 30, 2013 in connection with the repayment of a portion of its term loans and amendment of the existing senior secured credit facility, which included the write-off of unamortized debt issuance costs.
Interest on the senior notes accrues at the rate of 6.375% per annum and is payable semi-annually in cash in arrears on June 1 and December 1 of each year, commencing on December 1, 2013. The senior notes are Select’s senior unsecured obligations and rank equally in right of payment with all of its other existing and future senior unsecured indebtedness and senior in right of payment to all of its existing and future subordinated indebtedness. The senior notes are guaranteed, jointly and severally, by Select’s direct or indirect existing and future domestic restricted subsidiaries other than certain non-guarantor subsidiaries.
Select may redeem some or all of the senior notes prior to June 1, 2016 by paying a “make-whole” premium. Select may redeem some or all of the senior notes on or after June 1, 2016 at specified redemption prices. In addition, prior to June 1, 2016, Select may redeem up to 35% of the senior notes with the net proceeds of certain equity offerings at a price of 106.375% plus accrued and unpaid interest, if any. Select is obligated to offer to repurchase the senior notes at a price of 101% of their principal amount plus accrued and
10
unpaid interest, if any, as a result of certain change of control events. These restrictions and prohibitions are subject to certain qualifications and exceptions.
The Indenture relating to the senior notes contains covenants that, among other things, limit Select’s ability and the ability of certain of its subsidiaries to (i) grant liens on its assets, (ii) make dividend payments, other distributions or other restricted payments, (iii) incur restrictions on the ability of Select’s restricted subsidiaries to pay dividends or make other payments, (iv) enter into sale and leaseback transactions, (v) merge, consolidate, transfer or dispose of substantially all of their assets, (vi) incur additional indebtedness, (vii) make investments, (viii) sell assets, including capital stock of subsidiaries, (ix) use the proceeds from sales of assets, including capital stock of restricted subsidiaries, and (x) enter into transactions with affiliates. In addition, the Indenture requires, among other things, Select to provide financial and current reports to holders of the senior notes or file such reports electronically with the U.S. Securities and Exchange Commission (the “SEC”). These covenants are subject to a number of exceptions, limitations and qualifications set forth in the Indenture.
In connection with the issuance of the senior notes, Select entered into a registration rights agreement on May 28, 2013 with certain guarantors of the notes named therein and J.P. Morgan Securities LLC, on behalf of itself and the other initial purchasers named therein (the “Registration Rights Agreement”). Pursuant to the Registration Rights Agreement, Select has agreed to file an exchange offer registration statement to exchange the senior notes for substantially identical notes registered under the Securities Act unless the exchange offer is not permitted by applicable law or the policy of the SEC. Select has also agreed to file a shelf registration statement to cover resales of notes under certain circumstances. Select has agreed to file the exchange offer registration statement with the SEC within 150 days of the issue date of the senior notes and use commercially reasonable efforts to have the exchange offer registration statement declared effective within 240 days of the issue date and to complete the exchange offer with respect to the senior notes within 30 days of effectiveness. In addition, Select agreed to use commercially reasonable efforts to file the shelf registration statement on or prior to the later of (i) 120 days after a filing obligation arises and (ii) 270 days after the issue date, and to use commercially reasonable efforts to cause such shelf registration statement to be declared effective by the SEC on or prior to 210 days after such filing. If Select fails to satisfy its registration obligations under the Registration Rights Agreement, it will be required to pay additional interest to the holders of the senior notes under certain circumstances.
On June 3, 2013, Select amended its existing senior secured credit facilities in order to:
· extend the maturity date on $293.3 million of its $300.0 million revolving credit facility from June 1, 2016 to March 1, 2018;
· convert the remaining original term loan and series A term loan to a series C term loan and lower the interest rate payable on the series C term loan from Adjusted LIBO plus 3.75%, or Alternate Base Rate plus 2.75%, to Adjusted LIBO plus 3.00%, or Alternate Base Rate plus 2.00%, and amend the provision of the series C term loan from providing that Adjusted LIBO will at no time be less than 1.75% to providing that Adjusted LIBO will at no time be less than 1.00%; and
· amend the restrictive covenants governing the senior secured credit facilities in order to allow for unlimited restricted payments so long as there is no event of default under the senior secured credit facilities and the total pro forma ratio of total indebtedness to Consolidated EBITDA (as defined in our senior secured credit facilities) is less than or equal to 2.75 to 1.00.
11
Maturities of Long-Term Debt and Notes Payable
Maturities of the Company’s long-term debt for the period from July 1, 2013 through December 31, 2013 and the years after 2013 are approximately as follows and are presented net of the discounts on the senior secured credit facility term loans (in thousands):
July 1, 2013 – December 31, 2013
8,252
2014
9,742
2015
10,536
2016
296,134
2017
4,075
2018 and beyond
1,202,219
5. Fair Value
Financial instruments include cash and cash equivalents, notes payable and long-term debt. The carrying amount of cash and cash equivalents approximates fair value because of the short-term maturity of these instruments.
The carrying value of Select’s senior secured credit facility was $1,226.6 million and $916.1 million at December 31, 2012 and June 30, 2013, respectively. The fair value of Select’s senior secured credit facility was $1,216.2 million and $907.8 million at December 31, 2012 and June 30, 2013, respectively. The fair value of Select’s senior secured credit facility was based on quoted market prices for this debt in the syndicated loan market.
The carrying value of Select’s 6.375% senior notes was $600.0 million at June 30, 2013. The fair value of Select’s 6.375% senior notes was $570.0 million June 30, 2013. The fair value of this debt was based on quoted market prices.
The Company considers the inputs in the valuation process of its senior secured credit facility and 6.375% senior notes to be Level 2 in the fair value hierarchy. Level 2 in the fair value hierarchy is defined as inputs that are observable for the asset or liability, either directly or indirectly which includes quoted prices for identical assets or liabilities in markets that are not active.
6. Segment Information
The Company’s reportable segments consist of (i) specialty hospitals and (ii) outpatient rehabilitation. Other activities include the Company’s corporate services and certain other non-consolidating joint ventures and minority investments in other healthcare related businesses. The outpatient rehabilitation reportable segment has two operating segments: outpatient rehabilitation clinics and contract therapy. These operating segments are aggregated for reporting purposes as they have common economic characteristics and provide a similar service to a similar patient base. The accounting policies of the segments are the same as those described in the summary of significant accounting policies. The Company evaluates performance of the segments based on Adjusted EBITDA. Adjusted EBITDA is defined as net income before interest, income taxes, depreciation and amortization, gain (loss) on early retirement of debt, stock compensation expense, equity in earnings (losses) of unconsolidated subsidiaries and other income (expense).
12
The following tables summarize selected financial data for the Company’s reportable segments. The segment results of Holdings are identical to those of Select with the exception of total assets:
Three Months Ended June 30, 2012
Specialty
Outpatient
Hospitals
Rehabilitation
557,130
193,050
13
Adjusted EBITDA
102,166
25,837
(17,724
110,279
Total assets:
2,184,743
437,591
156,080
2,778,414
157,303
2,779,637
Capital expenditures
12,631
2,922
630
16,183
Three Months Ended June 30, 2013
559,386
197,080
207
96,393
26,054
(16,489
105,958
2,229,458
445,411
170,186
10,203
2,999
761
13,963
Six Months Ended June 30, 2012
1,110,168
383,949
97
202,120
48,315
(31,092
219,343
19,682
6,713
1,539
27,934
Six Months Ended June 30, 2013
1,117,137
389,181
310
189,740
48,887
(32,588
206,039
21,100
5,844
1,018
27,962
A reconciliation of Adjusted EBITDA to income before income taxes is as follows:
(11,479
(3,232
(717
Stock compensation expense
(1,338
Income (loss) from operations
90,687
22,605
(19,779
14
(11,932
(3,001
(974
(1,788
84,461
23,053
(19,251
(23,322
(6,882
(1,423
(2,599
178,798
41,433
(35,114
15
(23,794
(5,970
(1,945
(3,537
165,946
42,917
(38,070
7. Income per Common Share
The Company applies the two-class method for calculating and presenting income per common share. The two-class method is an earnings allocation formula that determines earnings per share for each class of stock participation rights in undistributed earnings. The following table sets forth for the periods indicated the calculation of income per common share in the Company’s consolidated statement of operations and the differences between basic weighted average shares outstanding and diluted weighted average shares outstanding used to compute basic and diluted income per common share, respectively:
Numerator:
Net income attributable to Select Medical Holdings Corporation
Less: Earnings allocated to unvested restricted stockholders
707
593
1,338
1,304
Net income available to common stockholders
42,465
27,187
83,376
60,894
Denominator:
Weighted average shares — basic
138,456
136,609
139,941
136,997
Effect of dilutive securities:
Stock options
229
134
221
168
Weighted average shares — diluted
138,685
136,743
140,162
137,165
Basic income per common share
Diluted income per common share
16
The following share amounts are shown here for informational and comparative purposes only since their inclusion would be anti-dilutive:
1,684
2,165
1,699
1,554
8. Commitments and Contingencies
Litigation
The Company is a party to various legal actions, proceedings and claims (some of which are not insured), and regulatory and other governmental audits and investigations in the ordinary course of its business. The Company cannot predict the ultimate outcome of pending litigation, proceedings and regulatory and other governmental audits and investigations. These matters could potentially subject the Company to sanctions, damages, recoupments, fines and other penalties. The Department of Justice, Centers for Medicare & Medicaid Services (“CMS”) or other federal and state enforcement and regulatory agencies may conduct additional investigations related to the Company’s businesses in the future that may, either individually or in the aggregate, have a material adverse effect on the Company’s business, financial position, results of operations and liquidity.
To address claims arising out of the operations of the Company’s specialty hospitals and outpatient rehabilitation facilities, the Company maintains professional malpractice liability insurance and general liability insurance, subject to self-insured retention of $2.0 million per medical incident for professional liability claims and $2.0 million per occurrence for general liability claims. The Company also maintains umbrella liability insurance covering claims which, due to their nature or amount, are not covered by or not fully covered by the Company’s other insurance policies. These insurance policies also do not generally cover punitive damages and are subject to various deductibles and policy limits. Significant legal actions, as well as the cost and possible lack of available insurance, could subject the Company to substantial uninsured liabilities. In the Company’s opinion, the outcome of these actions, individually or in the aggregate, will not have a material adverse effect on its financial position, results of operations, or cash flows.
Healthcare providers are subject to lawsuits under the qui tam provisions of the federal False Claims Act. Qui tam lawsuits typically remain under seal (hence, usually unknown to the defendant) for some time while the government decides whether or not to intervene on behalf of a private qui tam plaintiff (known as a relator) and take the lead in the litigation. These lawsuits can involve significant monetary damages and penalties and award bounties to private plaintiffs who successfully bring the suits. The Company has been a defendant in these cases in the past, and may be named as a defendant in similar cases from time to time in the future.
On January 8, 2013, a federal magistrate judge unsealed an Amended Complaint in United States of America and the State of Indiana, ex rel. Doe I, Doe II and Doe III v. Select Medical Corporation, Select Specialty Hospital-Evansville, Evansville Physician Investment Corporation, Dr. Richard Sloan and Dr. Jeffrey Selby. The Amended Complaint, which was served on the Company on February 15, 2013, is a civil action filed under seal on September 28, 2012 in the United States District Court for the Southern District of Indiana by private plaintiff-relators on behalf of the United States and the state of Indiana under the federal False Claims Act and Indiana False Claims and Whistleblower Protection Act. Although the Amended Complaint identifies
17
the relators by fictitious pseudonyms, on March 28, 2013, the relators filed a Notice identifying themselves as the former CEO at the Company’s long term acute care hospital in Evansville, Indiana (“SSH-Evansville”) and two former case managers at SSH-Evansville. The named defendants include the Company, SSH-Evansville, and two physicians who have practiced at SSH-Evansville. On March 26, 2013, the defendants, relators and the United States filed a joint motion seeking a stay of the proceedings, in which the United States notified the court that its investigation has not been completed and therefore it is not yet able to decide whether or not to intervene, and on March 29, 2013, the magistrate judge granted the motion and stayed all deadlines in the case for 90 days. On June 26, 2013, the United States filed a motion seeking to extend such stay of the proceedings for an additional 90 days, and on June 27, 2013, the defendants each filed a notice of consent to the requested stay.
The Amended Complaint alleges that the defendants manipulated the length of stay of patients at SSH-Evansville in order to maximize reimbursement under the Medicare prospective payment system applicable to long term acute care hospitals. It also alleges that the defendants manipulated the discharge of patients to other facilities and the timing of readmissions from those facilities in order to enable SSH-Evansville to receive two separate Medicare payments and causing the other facility to submit claims for unnecessary services. The Amended Complaint discusses the federal Stark Law and Anti-Kickback Statute and implies that the behavior of physicians referring to or providing services at SSH-Evansville was based on their financial interests. The Amended Complaint further alleges that Dr. Selby, a pulmonologist formerly on the medical staff of SSH-Evansville, performed unnecessary bronchoscopies at the hospital with the knowledge of the Company, and that Dr. Sloan, the Chief Medical Officer and an attending physician at SSH-Evansville, falsely coded the diagnoses of Medicare patients in order to increase SSH-Evansville’s reimbursement. Moreover, the Amended Complaint alleges that the practices at SSH-Evansville involved corporate policies of the Company used to maximize profit at all Select long term acute care hospitals. The Amended Complaint alleges that, through these acts, the defendants have violated the federal False Claims Act and Indiana False Claims and Whistleblower Protection Act and are liable for unspecified treble damages and penalties.
As previously disclosed, beginning in April 2012, the Company and SSH-Evansville have received various subpoenas and demands for documents relating to SSH-Evansville, including a request for information and subpoenas from the Office of Inspector General of the U.S. Department of Health and Human Services and subpoenas from the Office of Attorney General for the State of Indiana, and the Evansville (Indiana) Police Department has executed a search warrant at SSH-Evansville. The Company has produced and will continue to produce documents in response to, and intends to fully cooperate with, these governmental investigations. At this time, the Company is unable to predict the timing and outcome of this matter.
Construction Commitments
At June 30, 2013, the Company had outstanding commitments under construction contracts related to new construction, improvements and renovations at the Company’s long term acute care properties and inpatient rehabilitation facilities totaling approximately $18.3 million.
18
9. Subsequent Event
On August 7, 2013, Holdings’ board of directors declared a quarterly cash dividend of $0.10 per share. The dividend will be payable on or about August 30, 2013 to stockholders of record as of the close of business on August 20, 2013.
10. Financial Information for Subsidiary Guarantors and Non-Guarantor Subsidiaries under Select’s 6.375% Senior Notes
Select’s 6.375% senior notes are fully and unconditionally guaranteed, except for customary limitations, on a senior basis by all of Select’s wholly-owned subsidiaries (the “Subsidiary Guarantors”) which is defined as a subsidiary where Select or a subsidiary of Select holds all of the outstanding ownership interests. Certain of Select’s subsidiaries did not guarantee the 6.375% senior notes (the “Non-Guarantor Subsidiaries”).
Select conducts a significant portion of its business through its subsidiaries. Presented below is condensed consolidating financial information for Select, the Subsidiary Guarantors and the Non-Guarantor Subsidiaries at December 31, 2012 and June 30, 2013 and for the three and six months ended June 30, 2012 and 2013.
The equity method has been used by Select with respect to investments in subsidiaries. The equity method has been used by Subsidiary Guarantors with respect to investments in Non-Guarantor Subsidiaries. Separate financial statements for Subsidiary Guarantors are not presented.
19
Consolidating Balance Sheet
Select Medical Corporation (Parent Company Only)
Subsidiary Guarantors
Non-Guarantor Subsidiaries
Eliminations
Consolidated
Assets
5,053
2,501
1,214
Accounts receivable, net
363,430
63,761
8,844
1,701
4,305
Intercompany receivables
995,840
106,493
(1,102,333
)(a)
7,910
25,425
4,742
34,026
1,388,897
180,515
15,417
424,392
58,999
Investment in affiliates
3,001,006
87,070
(3,088,076
)(b) (c)
Non-current deferred tax asset
7,129
(7,129
)(d)
34,220
96,805
608
3,091,798
3,710,673
240,122
(4,197,538
Liabilities and Equity
9,050
2,195
1,985
6,531
68,785
11,598
Intercompany payables
1,102,333
573
75,542
174
4,634
47,909
7,761
7,927
1,130
48,367
36,500
9,260
2,745
3,550
1,198,876
234,806
34,328
1,085,867
367,718
64,143
87,637
9,168
48,756
21,688
203
2,333,499
711,849
107,842
(1,109,462
Stockholder’s Equity:
Common stock
861,889
25,223
(887,112
)(c)
Subsidiary investment
2,136,935
64,029
(2,200,964
)(b)
Total Select Medical Corporation Stockholder’s Equity
2,998,824
89,252
Non-controlling interests
119,760
(a) Elimination of intercompany.
(b) Elimination of investments in consolidated subsidiaries.
(c) Elimination of investments in consolidated subsidiaries’ earnings.
(d) Reclass of non-current deferred tax asset to report net non-current deferred tax liability in consolidation.
20
Consolidating Statement of Operations
For the Three Months Ended June 30, 2013
Non- Guarantor Subsidiaries
652,745
103,721
557
537,048
88,125
17,853
74
7,099
1,747
975
12,522
2,410
19,385
556,743
92,282
(19,178
96,002
11,439
Intercompany interest and royalty fees
(361
355
Intercompany management fees
62,247
(57,217
(5,030
546
22
(15,427
(5,447
(1,030
Income from operations before income taxes
10,001
34,239
5,407
6,555
13,018
196
Equity in earnings of subsidiaries
24,334
3,439
(27,773
24,660
5,211
Net income attributable to Select Medical Corporation
3,113
(a) Elimination of equity in earnings of subsidiaries.
21
For the Six Months Ended June 30, 2013
1,296,182
210,136
1,110
1,073,295
176,229
35,219
106
14,922
3,245
1,945
25,025
4,739
38,274
1,113,348
184,213
(37,964
182,834
25,923
(755
741
81,976
(72,619
(9,357
1,571
(30,153
(10,769
(2,030
Income (loss) from operations before income taxes
(4,684
101,758
14,605
1,912
40,682
215
70,984
10,121
(81,105
71,197
14,390
9,908
Consolidating Statement of Cash Flows
Adjustments to reconcile net income to net cash provided by (used in) operating activities:
Equity in earnings of unconsolidated subsidiaires
(1,571
(55
Loss from disposal or sale of assets
(70,984
(10,121
81,105
(a)
(70,357
(13,475
(2,310
(5,405
1,821
(5,540
5,600
84
1,857
(3,460
(1,062
4,390
827
(19,539
(6,586
1,180
Net cash provided by (used in) operating activities
(7,807
23,708
11,701
(1,071
(23,802
(3,089
(52,689
5,826
1,083
(4,057
(223
(393
Intercompany
(20,010
27,971
(7,961
(21,139
27,748
(8,738
Net decrease in cash and cash equivalents
(30,017
(1,233
(126
35,070
3,734
1,340
(a) Elimination of equity in earnings of consolidated subsidiaries.
23
308,043
53,531
(1,645
12,383
1,060
4,434
1,021,479
102,694
(1,124,173
19,655
6,563
56,948
1,353,971
168,562
(1,125,818
16,344
425,677
59,531
2,930,022
82,475
(3,012,497
)(c) (d)
5,107
(5,107
)(e)
28,680
63,447
692
3,037,101
3,637,849
228,785
(4,143,422
8,916
1,059
1,671
4,674
72,213
12,660
1,124,173
186
88,096
304
4,249
44,508
6,957
17,955
804
58,650
39,876
8,754
2,723
1,236,639
246,556
33,069
872,671
358,104
60,522
85,287
9,330
46,474
20,275
1,753
2,155,784
710,222
104,674
(1,130,925
Retained earnings
790,692
21,197
(811,889
63,673
(2,200,608
2,927,627
84,870
113,300
(a) Reclass portion of due to third party payor to accounts receivable net in consolidation.
(b) Elimination of intercompany.
(c) Elimination of investments in consolidated subsidiaries.
(d) Elimination of investments in consolidated subsidiaries’ earnings.
(e) Reclass of non-current deferred tax asset to report net non-current deferred tax liability in consolidation.
24
For the Three Months Ended June 30, 2012
649,628
100,552
521
527,479
84,669
19,345
(791
8,832
1,197
718
12,410
2,300
20,584
547,930
88,166
(20,571
101,698
12,386
(763
754
27,755
(23,159
(4,596
2,739
(13,173
(6,712
(1,072
(6,752
75,320
6,740
2,211
26,377
58
53,981
5,612
(59,593
54,555
6,682
5,038
25
For the Six Months Ended June 30, 2012
1,293,953
200,164
1,010
1,052,944
170,334
33,455
(677
17,674
2,730
1,423
25,580
4,624
35,888
1,095,521
177,688
(35,791
198,432
22,476
(1,556
57,129
(48,242
(8,887
5,194
(26,147
(13,910
(2,150
(6,365
143,013
11,479
1,976
54,904
276
96,638
9,111
(105,749
97,220
11,203
8,529
26
(5,194
(23
Loss (gain) from disposal of assets
(3,606
(96,638
(9,111
105,749
(15,938
(14,582
(1,314
(983
685
1,348
183
(674
(3,498
(9,527
11,265
8,717
(2,587
210
18,892
90,213
14,944
(1,536
(20,684
(5,714
(14,393
5,557
278
(4,179
(220
(686
79,937
(72,802
(7,135
Net cash used in financing activities
(10,683
(73,022
(9,224
Net increase in cash and cash equivalents
6,673
2,798
11,427
616
18,100
622
27
ITEM 2. MANAGEMENT’S DISCUSSION AND ANALYSIS OF FINANCIAL CONDITION AND RESULTS OF OPERATIONS
You should read this discussion together with our unaudited consolidated financial statements and accompanying notes.
Forward-Looking Statements
This report on Form 10-Q contains forward-looking statements within the meaning of the federal securities laws. Statements that are not historical facts, including statements about our beliefs and expectations, are forward-looking statements. Forward-looking statements include statements preceded by, followed by or that include the words “may,” “could,” “would,” “should,” “believe,” “expect,” “anticipate,” “plan,” “target,” “estimate,” “project,” “intend” and similar expressions. These statements include, among others, statements regarding our expected business outlook, anticipated financial and operating results, our business strategy and means to implement our strategy, our objectives, the amount and timing of capital expenditures, the likelihood of our success in expanding our business, financing plans, budgets, working capital needs and sources of liquidity.
Forward-looking statements are only predictions and are not guarantees of performance. These statements are based on our management’s beliefs and assumptions, which in turn are based on currently available information. Important assumptions relating to the forward-looking statements include, among others, assumptions regarding our services, the expansion of our services, competitive conditions and general economic conditions. These assumptions could prove inaccurate. Forward-looking statements also involve known and unknown risks and uncertainties, which could cause actual results to differ materially from those contained in any forward-looking statement. Many of these factors are beyond our ability to control or predict. Such factors include, but are not limited to, the following:
· changes in government reimbursement for our services due to the implementation of healthcare reform legislation, deficit reduction measures, and/or new payment policies (including, for example, the expiration of the moratorium on the 25-percent payment adjustment threshold that would reduce our Medicare payments for those patients admitted to a long-term acute care hospital from a referring hospital in excess of the percentage threshold) may result in a reduction in net operating revenues, an increase in costs and a reduction in profitability;
· the impact of the Budget Control Act of 2011 which, as amended by the American Taxpayer Relief Act of 2012, has resulted in a 2% reduction to Medicare payments for services furnished on or after April 1, 2013 and will continue unless further legislation is enacted;
· the failure of our specialty hospitals to maintain their Medicare certifications may cause our net operating revenues and profitability to decline;
· the failure of our facilities operated as “hospitals within hospitals” to qualify as hospitals separate from their host hospitals may cause our net operating revenues and profitability to decline;
· a government investigation or assertion that we have violated applicable regulations may result in sanctions or reputational harm and increased costs;
· acquisitions or joint ventures may prove difficult or unsuccessful, use significant resources or expose us to unforeseen liabilities;
· private third-party payors for our services may undertake future cost containment initiatives that limit our future net operating revenues and profitability;
· the failure to maintain established relationships with the physicians in the areas we serve could reduce our net operating revenues and profitability;
· shortages in qualified nurses or therapists could increase our operating costs significantly;
· competition may limit our ability to grow and result in a decrease in our net operating revenues and profitability;
· the loss of key members of our management team could significantly disrupt our operations;
· the effect of claims asserted against us could subject us to substantial uninsured liabilities; and
· other factors discussed from time to time in our filings with the Securities and Exchange Commission (the “SEC”), including factors discussed under the heading “Risk Factors” for the year ended December 31, 2012 contained in our annual report on Form 10-K filed with the SEC on February 26, 2013 and our quarterly report on Form 10-Q for the three months ended March 31, 2013, filed with the SEC on May 2, 2013.
Except as required by applicable law, including the securities laws of the United States and the rules and regulations of the SEC, we are under no obligation to publicly update or revise any forward-looking statements, whether as a result of any new information, future events or otherwise. You should not place undue reliance on our forward-looking statements. Although we believe that the expectations reflected in forward-looking statements are reasonable, we cannot guarantee future results or performance.
Investors should also be aware that while we do, from time to time, communicate with securities analysts, it is against our policy to disclose to security analysts any material non-public information or other confidential commercial information. Accordingly, stockholders should not assume that we agree with any statement or report issued by any security analyst irrespective of the content of the statement or report. Thus, to the extent that reports issued by securities analysts contain any projections, forecasts or opinions, such reports are not the responsibility of the Company.
Overview
We believe that we are one of the largest operators of both specialty hospitals and outpatient rehabilitation clinics in the United States based on number of facilities. As of June 30, 2013, we operated 109 long term acute care hospitals and 14 acute medical rehabilitation hospitals in 28 states, and 988 outpatient rehabilitation clinics in 32 states and the District of Columbia. We also provide medical rehabilitation services on a contracted basis to nursing homes, hospitals, assisted living and senior care centers, schools and work sites. We began operations in 1997 under the leadership of our current management team. As of June 30, 2013 we had operations in 44 states and the District of Columbia.
We manage our Company through two business segments, our specialty hospital segment and our outpatient rehabilitation segment. We had net operating revenues of $1,506.6 million for the six months ended June 30, 2013. Of this total, we earned approximately 74% of our net operating revenues from our specialty hospitals and approximately 26% from our outpatient rehabilitation business. Our specialty hospital segment consists of hospitals designed to serve the needs of long term stay acute patients and hospitals designed to serve patients that require intensive medical rehabilitation care. Patients are typically admitted to our specialty hospitals from general acute care hospitals. These patients have specialized needs, and serious and often complex medical conditions such as respiratory failure, neuromuscular disorders, traumatic brain and spinal cord injuries, strokes, non-healing wounds, cardiac disorders, renal disorders and cancer. Our outpatient rehabilitation segment consists of clinics and contract services that provide physical, occupational and speech rehabilitation services. Our outpatient rehabilitation patients are typically diagnosed with musculoskeletal impairments that restrict their ability to perform normal activities of daily living.
29
Significant 2013 Events
Refinancing Activities
Three and Six Months Ended June 30, 2013
On February 20, 2013, Select entered into an additional credit extension amendment to its senior secured credit facilities providing for a $300.0 million additional term loan tranche, (the “series B term loan”) to Select. Select used the borrowings under the series B term loan to redeem all of its outstanding 7 5/8% senior subordinated notes due 2015 on March 22, 2013, to finance Holdings’ redemption of all of its senior floating rate notes due 2015 on March 22, 2013 and to repay a portion of the balance outstanding under Select’s revolving credit facility. Holdings and Select recognized a loss on early retirement of debt of $1.5 million and $0.5 million, respectively, in the three months ended March 31, 2013 related to this refinancing.
On May 28, 2013, Select issued and sold $600.0 million aggregate principal amount of its 6.375% senior notes due 2021. The senior notes are senior unsecured obligations of Select and are fully and unconditionally guaranteed by all of Select’s wholly owned subsidiaries. On May 28, 2013, Select used the proceeds of the senior notes to pay a portion of the amounts outstanding on the original term loan and the series A term loan and to pay related fees and expenses. Select recognized a loss on early retirement of debt of $17.3 million in the three months ended June 30, 2013 in connection with the repayment of a portion of its term loans and amendment of the existing senior secured credit facility, which included the write-off of unamortized debt issuance costs.
Stock Repurchase Program
Holdings’ board of directors has authorized a common stock repurchase program to repurchase up to $350.0 million worth of shares of its common stock. The program will remain in effect until March 31, 2014, unless extended by the board of directors. Stock repurchases under this program may be made in the open market or through privately negotiated transactions, and at times and in such amounts as Holdings deems appropriate. Holdings is funding this program with cash on hand and borrowings under its revolving credit facility. For the three months ended June 30, 2013 Holdings did not repurchase common stock. Holdings repurchased 1,115,691 shares at a cost of approximately $10.0 million, an average cost per share of $8.95, which includes transaction costs, during the six months ended June 30, 2013. Since the inception of the program through June 30, 2013, Holdings has repurchased 23,606,080 shares at a cost of approximately $173.6 million, or $7.36 per share, which includes transaction costs.
30
Budget Control Act of 2011
On April 1, 2013 a federally mandated 2% reduction to Medicare payments was implemented resulting in reductions to our net operating revenues and income from operations of approximately $9.5 million, of which approximately $9.1 million was related to our specialty hospitals and $0.4 million was related to outpatient rehabilitation, in the three months ended June 30, 2013. See the section titled “Regulatory Changes” — “Budget Control Act of 2011” for a discussion of this regulatory change.
American Taxpayer Relief Act of 2012
On April 1, 2013 the multiple procedure payment reduction (“MPPR Reduction”) for therapy services was increased to 50% resulting in reductions to our net operating revenues and income from operations of approximately $1.7 million in the three months ended June 30, 2013. See the section titled “Multiple Procedure Payment Reduction” for a discussion of this regulatory change.
Summary Financial Results
For the three months ended June 30, 2013, our net operating revenues increased 0.9% to $756.7 million compared to $750.2 million for the three months ended June 30, 2012. This increase in net operating revenues resulted principally from increases that occurred within our outpatient rehabilitation segment. We had income from operations for the three months ended June 30, 2013 of $88.3 million compared to $93.5 million for the three months ended June 30, 2012. Our Adjusted EBITDA for the three months ended June 30, 2013 was $106.0 million, compared to $110.3 million for the three months ended June 30, 2012 and our Adjusted EBITDA margin was 14.0% for the three months ended June 30, 2013 compared to 14.7% for the three months ended June 30, 2012. See the section entitled “Results of Operations” for a reconciliation of net income to Adjusted EBITDA. The decrease in our income from operations, Adjusted EBITDA and Adjusted EBITDA margin is principally due to the 2% reduction in Medicare payments implemented April 1, 2013 as part of the automatic reductions in federal spending mandated under the Budget Control Act of 2011 and the MPPR Reduction.
Net income attributable to Holdings was $27.8 million for the three months ended June 30, 2013 compared to $43.2 million for the three months ended June 30, 2012. The decrease in net income resulted principally from a decrease in our income from operations described above and a loss on early retirement of debt.
For the six months ended June 30, 2013, our net operating revenues increased 0.8% to $1,506.6 million compared to $1,494.2 million for the six months ended June 30, 2012. We experienced increases in net operating revenues in both our specialty hospital and outpatient rehabilitation segments. We had income from operations for the six months ended June 30, 2013 of $170.8 million compared to $185.1 million for the six months ended June 30, 2012. Our Adjusted EBITDA for the six months ended June 30, 2013 was $206.0 million, compared to $219.3 million for the six months ended June 30, 2012 and our Adjusted EBITDA margin was 13.7% for the six months ended June 30, 2013 compared to 14.7% for the six months ended June 30, 2012. See the section entitled “Results of Operations” for a reconciliation of net income to Adjusted EBITDA. The decrease in our income from operations, Adjusted EBITDA and Adjusted EBITDA margin is principally due to the 2% reduction in Medicare payments implemented April 1, 2013 as part of the automatic reductions in federal spending mandated under the Budget Control Act of 2011 and the MPPR Reduction, and increases in our operating expenses.
Net income attributable to Holdings’ was $62.2 million for the six months ended June 30, 2013 compared to $84.7 million for the six months ended June 30, 2012. The decrease in net income resulted from a decrease in our income from operations described above, a loss on early retirement of debt, and a decrease in our equity in earnings of unconsolidated subsidiaries, offset in part by a reduction in our effective income tax rate.
31
Cash flow from operations provided $22.0 million of cash for the six months ended June 30, 2013 for Holdings and $27.6 million of cash for the six months ended June 30, 2013 for Select. The difference in cash flow from operations between Holdings and Select primarily relates to interest payments on Holdings senior floating rate notes.
Regulatory Changes
In the past few years, there have been significant regulatory changes that have affected our net operating revenues and, in some cases, caused us to change our operating models and strategies. The following is a discussion of recent regulatory changes that are affecting our results of operations in 2013 or may have an affect on our future results of operations. Our Annual Report on Form 10-K for the year ended December 31, 2012 filed with the Securities and Exchange Commission (“SEC”) on February 26, 2013 contains a more detailed discussion of the regulations that affect our business in Part I — Business — Government Regulations, and the information below should be read in connection with that more detailed discussion.
The Budget Control Act of 2011, enacted on August 2, 2011, increased the federal debt ceiling in connection with deficit reductions over the next ten years. The Budget Control Act of 2011 requires automatic reductions in federal spending by approximately $1.2 trillion split evenly between domestic and defense spending. Payments to Medicare providers are subject to these automatic spending reductions, subject to a 2% cap, which are expected to reduce Medicare payments by more than $9.5 billion in fiscal year 2013 and $123 billion over the period of fiscal years 2013 to 2021. On April 1, 2013, a 2% reduction to Medicare payments was implemented. For the three months ended June 30, 2013, this reduction has reduced our net operating revenues and income from operation by approximately $9.5 million. We have estimated that this reduction will reduce our net operating revenues and income from operations by approximately $16.0 million to $17.0 million for the remainder of 2013.
Medicare Payment of Long Term Acute Care Hospital Services (“LTCH-PPS”)
Medicare Payment of Long Term Acute Care Hospitals during Fiscal Year 2013
On August 1, 2012, CMS published the final rule updating the policies and payment rates for LTCH-PPS for fiscal year 2013 (affecting discharges and cost reporting periods beginning on or after October 1, 2012 through September 30, 2013). Two different standard federal rates apply during fiscal year 2013. The standard federal rate for discharges on or after October 1, 2012 and through December 28, 2012 was set at $40,916 and the standard federal rate for discharges on or after December 29, 2012 for the remainder of fiscal year 2013 is $40,398 both of which are an increase from the fiscal year 2012 standard federal rate of $40,222. The update to the standard federal rate for fiscal year 2013 through December 28, 2012 included a market basket increase of 2.6%, less a productivity adjustment of 0.7% and less an additional reduction of 0.1% mandated by the Patient Protection and Affordable Care Act (“PPACA”). The standard federal rate for the period of December 29, 2012 through the remainder of fiscal 2013 is further reduced by a portion of the one-time budget neutrality adjustment of 1.266%, as discussed below. The final rule established a fixed-loss amount for high cost outlier cases for fiscal year 2013 of $15,408, which is a decrease from the fixed-loss amount in the 2012 fiscal year of $17,931.
32
Medicare Payment of Long Term Acute Care Hospitals during Fiscal Year 2014
On August 1, 2013, CMS released an advanced copy of the final rule updating the policies and payment rates for LTCH-PPS for fiscal year 2014 (affecting discharges and cost reporting periods beginning on or after October 1, 2013 through September 30, 2014). The standard federal rate was set at $40,607, an increase from the standard federal rate applicable during the period from December 29, 2012 through September 30, 2013 of $40,398. The update to the standard federal rate for fiscal year 2014 includes a market basket increase of 2.5%, less a productivity adjustment of 0.5%, less a reduction of 0.3% mandated by the PPACA, and less a budget neutrality adjustment of 1.266%, as discussed below. The fixed-loss amount for high cost outlier cases was set at $13,314, which is a decrease from the fixed-loss amount in the 2013 fiscal year of $15,408.
Short Stay Outlier Policy
CMS established a different payment methodology for Medicare patients with a length of stay less than or equal to five-sixths of the geometric average length of stay for that particular MS-LTC-DRG, referred to as a short stay outlier, or “SSO.” The SSO rule was further revised adding a category referred to as a “very short stay outlier” for discharges occurring on or after December 29, 2012. For cases with a length of stay that is equal to or less than one standard deviation from the geometric average length of stay for the same MS-DRG under IPPS, referred to as the so-called “IPPS comparable threshold,” the rule lowers the LTCH payment to a rate based on the general acute care hospital IPPS per diem. SSO cases with covered lengths of stay that exceed the IPPS comparable threshold continue to be paid under the SSO payment policy.
25 Percent Rule
The 25 Percent Rule is a downward payment adjustment that applies to Medicare patients discharged from LTCHs who were admitted from a co-located hospital or a non-co-located hospital and caused the LTCH to exceed the applicable percentage thresholds for discharged Medicare patients. The SCHIP Extension Act of 2007 as amended by the American Recovery and Reinvestment Act and the PPACA has limited the application of the 25 Percent Rule. CMS adopted through regulations an additional one-year extension of relief from the full application of Medicare admission thresholds. As a result, full implementation of the Medicare admission thresholds will not go into effect until cost reporting periods beginning on or after October 1, 2013. After the expiration of the extension, our LTCHs will be subject to a downward payment adjustment for any Medicare patients who were admitted from a co-located or a non-co-located hospital and that exceed the applicable percentage threshold of all Medicare patients discharged from the LTCH during the cost reporting period.
In the preamble to the proposed update to the Medicare policies and payment rates for fiscal year 2014, CMS seeks public comments on adoption of a payment adjustment based on whether a particular case qualifies as chronically critically ill/medically complex (“CCI/MC”). CMS is considering a change to the LTCH-PPS payment policies that would limit full LTCH-PPS payment to those patients meeting the definition of CCI/MC while they were in an IPPS hospital inpatient setting and subsequently directly admitted to an LTCH. Payment for non-CCI/MC patients would be made at an “IPPS comparable amount,” that is, an amount comparable to what would have been paid under the IPPS calculated as a per diem rate with total payments capped at the full IPPS MS-DRG payment rate. We cannot predict whether CMS will adopt the CCI/MC patient-level criteria in the future or, if adopted, how such criteria would affect the application of the 25 Percent Rule to our LTCHs.
33
One-Time Budget Neutrality Adjustment
The regulations governing LTCH-PPS authorizes CMS to make a one-time adjustment to the standard federal rate to correct any “significant difference between actual payments and estimated payments for the first year” of LTCH-PPS. In the update to the Medicare policies and payment rates for fiscal year 2013, CMS adopted a one-time budget neutrality adjustment that results in a permanent negative adjustment of 3.75% to the LTCH base rate. CMS is implementing the adjustment over a three-year period by applying a factor of 0.98734 to the standard federal rate in fiscal years 2013, 2014 and 2015, except that the adjustment did not apply to payments for discharges occurring on or after October 1, 2012 through December 28, 2012.
Medicare Market Basket Adjustments for Long Term Acute Care Hospitals
The PPACA instituted a market basket payment adjustment to LTCHs. In fiscal year 2014, the market basket update will be reduced by 0.3%. Fiscal years 2015 and 2016 the market basket update will be reduced by 0.2%. Finally, in fiscal years 2017-2019, the market basket update will be reduced by 0.75%. The PPACA specifically allows these market basket reductions to result in less than a 0% payment update and payment rates that are less than the prior year.
Medicare Payment of Inpatient Rehabilitation Facility Services (“IRF-PPS”)
Medicare Payment of Inpatient Rehabilitation Facilities during Fiscal Year 2013
On July 30, 2012, CMS published the policies and payment rates for IRF-PPS for fiscal year 2013 (affecting discharges and cost reporting periods beginning on or after October 1, 2012 through September 30, 2013). The standard payment conversion factor for discharges for fiscal year 2013 is $14,343, which is an increase from the fiscal year 2012 standard payment conversion factor of $14,076. The update to the standard payment conversion factor for fiscal year 2013 includes a market basket increase of 2.7%, less a productivity adjustment of 0.7%, less an additional reduction of 0.1% as mandated by the PPACA. CMS decreased the outlier threshold amount for fiscal year 2013 to $10,466 from $10,713 established in the final rule for fiscal year 2012.
Medicare Payment of Inpatient Rehabilitation Facilities during Fiscal Year 2014
On July 31, 2013, CMS released an advanced copy of the final rule updating policies and payment rates for IRF-PPS for fiscal year 2014 (affecting discharges and cost reporting periods beginning on or after October 1, 2013 through September 30, 2014). The standard payment conversion factor for discharges for fiscal year 2014 is $14,846, which is an increase from the fiscal year 2013 standard payment conversion factor of $14,343. The update to the standard payment conversion factor for fiscal year 2014 includes a market basket increase of 2.6%, less a productivity adjustment of 0.5%, less an additional reduction of 0.3% as mandated by the PPACA. CMS decreased the outlier threshold amount for fiscal year 2014 to $9,272 from $10,466 established in the final rule for fiscal year 2013.
Classification Criteria for Inpatient Rehabilitation Facilities
In order to be excluded from the hospital inpatient PPS and be paid at the higher IRF-PPS rates, an inpatient hospital must demonstrate that at least 60 percent of its patients meet the criteria specified in the regulations, including the need for intensive inpatient rehabilitation services for one or more of the 13 listed conditions, representing a presumptive need for intensive inpatient rehabilitation. Compliance is demonstrated through either medical review or the “presumptive” method, in which a patient’s diagnosis codes are compared to a “presumptive compliance” list.
34
CMS has announced that it will remove a number of diagnosis codes from the presumptive compliance list. According to CMS, these conditions do not demonstrate the need for intensive inpatient rehabilitation services in the absence of additional facts that would have to be pulled from a patient’s medical record. As a result, beginning on or after October 1, 2014, a number of diagnosis codes previously on the presumptive compliance list will be removed, including diagnosis codes in the following categories: non specific diagnosis codes, arthritis diagnosis codes, unilateral upper extremity amputations diagnosis, some congenital anomalies diagnosis codes, other miscellaneous diagnosis codes.
Medicare Market Basket Adjustments for Inpatient Rehabilitation Facilities
The PPACA instituted a market basket payment adjustment for IRFs. For fiscal year 2014, the reduction is 0.3%. For fiscal years 2015 and 2016, the reduction is 0.2%. For fiscal years 2017 - 2019, the reduction is 0.75%. The PPACA specifically allows these market basket reductions to result in less than a 0% payment update and payment rates that are less than the prior year.
Medicare Payment of Outpatient Rehabilitation Services
Medicare Physician Fee Schedule and Sustainable Growth Rate Update
The Medicare program reimburses outpatient rehabilitation providers based on the Medicare physician fee schedule. The Medicare physician fee schedule rates are automatically updated annually based on a formula, called the sustainable growth rate (“SGR”) formula, contained in legislation. The SGR formula has resulted in automatic reductions in rates in every year since 2002; however, for each year through 2013 CMS or Congress has taken action to prevent the SGR formula reductions. The American Taxpayer Relief Act of 2012 froze Medicare physician fee schedule rates at 2012 levels through December 31, 2013, averting a scheduled 26.5% cut as a result of the SGR formula that would have taken effect on January 1, 2013. On March 5, 2013, CMS estimated a 24.4% reduction in the Medicare physician fee schedule payment rates for calendar year 2014, unless Congress again takes legislative action to prevent the SGR formula reductions from going into effect. If the 24.4% reduction is averted by Congress, the projected impact of the proposed 2014 Medicare physician fee schedule rule on outpatient physical therapy services would be a positive 1% in aggregate for calendar year 2014. However, the amount of payment for each service would vary depending on CPT codes billed and the geographic practice cost indices adjustments among localities.
Therapy Caps
Beginning on January 1, 1999, the Balanced Budget Act of 1997 subjected certain outpatient therapy providers reimbursed under the Medicare physician fee schedule to annual limits for therapy expenses. Effective January 1, 2013, the annual limit on outpatient therapy services is $1,900 for combined physical and speech language pathology services and $1,900 for occupational therapy services. The per beneficiary caps were $1,880 for calendar year 2012. It is anticipated that in calendar year 2014 the therapy cap will be the 2013 rate increased by the percentage increase in the Medicare Economic Index. The Middle Class Tax Relief and Job Creation Act of 2012 extended the annual limits on therapy expenses to hospital outpatient departments for dates of service on or after October 1, 2012. The application of annual limits to hospital outpatient department settings will sunset at the end of 2013 unless Congress takes further action to extend it.
In the Deficit Reduction Act of 2005, Congress implemented an exceptions process to the annual limit for therapy expenses. Under this process, a Medicare enrollee (or person acting on behalf of the Medicare enrollee) is able to request an exception from the therapy caps if the provision of therapy services was deemed to be medically necessary. Therapy cap exceptions have been available automatically for certain conditions and on a case-by-case basis upon submission of documentation of medical necessity. The American Taxpayer Relief Act of 2012 extends the exceptions process for outpatient therapy caps through December 31, 2013. Unless Congress extends the exceptions process, the therapy caps will apply to all outpatient therapy services
35
beginning January 1, 2014, except those services furnished and billed by outpatient hospital departments, as noted above.
The Middle Class Tax Relief and Job Creation Act of 2012 made several changes to the exceptions process to the annual limit for therapy expenses. For any claim above the annual limit, the claim must contain a modifier indicating that the services are medically necessary and justified by appropriate documentation in the medical record. Effective October 1, 2012, all claims exceeding $3,700 are subject to a manual medical review process. The $3,700 threshold is applied separately to the combined physical therapy/speech therapy cap and the occupational therapy cap. The American Taxpayer Relief Act of 2012 extends through December 31, 2013 the requirement that Medicare perform manual medical review of therapy services when an exception is requested for cases in which the beneficiary has reached a specified dollar aggregate threshold, including therapy services furnished in hospital outpatient departments. Effective October 1, 2012, all therapy claims, whether above or below the annual limit, must include the national provider identifier (NPI) of the physician responsible for certifying and periodically reviewing the plan of care. As of January 1, 2013, CMS implemented a claims based data collection strategy that is designed to assist in reforming the Medicare payment system for outpatient therapy. Effective January 1, 2013, all therapy claims must include additional codes and modifiers providing information about the beneficiary’s functional status at the outset of the therapy episode of care, specified points during treatment, and at the time of discharge. After July 1, 2013, claims submitted without the appropriate codes and modifiers will be returned unpaid.
Multiple Procedure Payment Reduction
CMS adopted a multiple procedure payment reduction for therapy services in the final update to the Medicare physician fee schedule for calendar year 2011. This multiple procedure payment reduction policy became effective January 1, 2011 and applies to all outpatient therapy services paid under Medicare Part B. Furthermore, the multiple procedure payment reduction policy applies across all therapy disciplines — occupational therapy, physical therapy and speech-language pathology. Under the policy, the Medicare program pays 100% of the practice expense component of the therapy procedure or unit of service with the highest Relative Value Unit, and then reduces the payment for the practice expense component for the second and subsequent therapy procedures or units of service furnished during the same day for the same patient, regardless of whether those therapy services are furnished in separate sessions. In 2011 and 2012, the second and subsequent therapy service furnished during the same day for the same patient was reduced by 20% in office and other non-institutional settings and by 25% in institutional settings. The American Taxpayer Relief Act of 2012 increases the payment reduction in either setting to 50% effective April 1, 2013 for all outpatient therapy services. Our outpatient rehabilitation therapy services are primarily offered in institutional settings and, as such, are subject to the applicable 25% payment reduction in the practice expense component for the second and subsequent therapy services furnished by us to the same patient on the same day until April 1, 2013 when the payment reduction was increased to 50%.
36
Operating Statistics
The following tables set forth operating statistics for our specialty hospitals and our outpatient rehabilitation clinics for each of the periods presented. The data in the tables reflect the changes in the number of specialty hospitals and outpatient rehabilitation clinics we operate that resulted from acquisitions, start-up activities, closures and sales. The operating statistics reflect data for the period of time these operations were managed by us.
Three Months Ended June 30,
Six Months Ended June 30,
Specialty hospital data(1):
Number of hospitals owned - start of period
117
116
115
Number of hospitals acquired
1
Number of hospital start-ups
Number of hospitals closed/sold
Number of hospitals owned - end of period
Number of hospitals managed - end of period
Total number of hospitals (all) - end of period
123
Long term acute care hospitals
111
109
Rehabilitation hospitals
Available licensed beds (2)
5,205
5,181
Admissions (2)
13,872
14,106
27,927
Patient days (2)
336,016
341,655
679,037
681,037
Average length of stay (days) (2)
Net revenue per patient day (2)(3)
1,532
1,538
Occupancy rate (2)
71
%
73
72
Percent patient days - Medicare (2)
64
65
Outpatient rehabilitation data:
Number of clinics owned - start of period
848
871
850
867
Number of clinic start-ups
Number of clinics closed/sold
(6
(16
Number of clinics owned - end of period
852
872
Number of clinics managed - end of period
104
Total number of clinics (all) - end of period
956
988
Number of visits (2)
1,166,550
1,217,598
2,318,759
2,380,221
Net revenue per visit (2)(4)
102
103
(1) Specialty hospitals consist of long term acute care hospitals and inpatient rehabilitation facilities.
(2) Data excludes specialty hospitals and outpatient clinics managed by the Company.
(3) Net revenue per patient day is calculated by dividing specialty hospital direct patient service revenues by the total number of patient days.
(4) Net revenue per visit is calculated by dividing outpatient rehabilitation clinic direct patient service revenue by the total number of visits. For purposes of this computation, outpatient rehabilitation direct patient service clinic revenue does not include contract services revenue.
37
Results of Operations
The following table outlines, for the periods indicated, selected operating data as a percentage of net operating revenues:
100.0
Cost of services(1)
81.7
82.7
2.5
2.3
1.3
1.2
2.0
2.1
12.5
11.7
(2.3
0.3
0.1
(3.1
(2.9
(2.8
9.7
6.6
10.0
3.7
2.6
3.8
6.0
4.0
6.2
Net income attributable to non-controlling interests
0.2
Net income attributable to Holdings and Select
5.8
81.9
83.0
2.2
2.4
1.4
12.4
11.3
(1.2
(3.2
(3.0
9.5
7.2
9.9
7.4
2.8
4.4
6.1
4.6
5.6
4.1
5.9
4.3
38
The following tables summarize selected financial data by business segment, for the periods indicated:
% Change
Net operating revenues:
Specialty hospitals
0.4
Outpatient rehabilitation
Other(2)
N/M
Total company
0.9
Income (loss) from operations:
(6.9
)%
2.7
(5.6
Adjusted EBITDA:(3)
(5.7
0.8
7.0
(3.9
Adjusted EBITDA margins:(3)
18.3
17.2
13.4
13.2
14.7
14.0
Purchases of property and equipment:
39
0.6
(7.2
3.6
(8.4
(7.7
(6.1
(4.8
18.2
17.0
12.6
13.7
N/M — Not Meaningful.
(1) Cost of services includes salaries, wages and benefits, operating supplies, lease and rent expense and other operating costs.
(2) Other includes our corporate services and certain other non-consolidating joint ventures and minority investments in other healthcare related businesses.
40
(3) We define Adjusted EBITDA as net income before interest, income taxes, depreciation and amortization, gain (loss) on early retirement of debt, stock compensation expense, equity in earnings (losses) of unconsolidated subsidiaries, and other income (expense). We believe that the presentation of Adjusted EBITDA is important to investors because Adjusted EBITDA is commonly used as an analytical indicator of performance by investors within the healthcare industry. Adjusted EBITDA is used by management to evaluate financial performance and determine resource allocation for each of our operating units. Adjusted EBITDA is not a measure of financial performance under generally accepted accounting principles. Items excluded from Adjusted EBITDA are significant components in understanding and assessing financial performance. Adjusted EBITDA should not be considered in isolation or as an alternative to, or substitute for, net income, cash flows generated by operations, investing or financing activities, or other financial statement data presented in the consolidated financial statements as indicators of financial performance or liquidity. Because Adjusted EBITDA is not a measurement determined in accordance with generally accepted accounting principles and is thus susceptible to varying calculations, Adjusted EBITDA as presented may not be comparable to other similarly titled measures of other companies.
Following is a reconciliation of net income to Adjusted EBITDA as utilized by us in reporting our segment performance:
23,798
21,904
20,957
17,280
(2,752
(568
Stock compensation expense:
Included in general and administrative
817
1,231
Included in cost of services
47,720
45,362
42,207
42,952
1,589
2,427
41
Three Months Ended June 30, 2013 Compared to Three Months Ended June 30, 2012
In the following discussion, we address the results of operations of Select and Holdings. With the exception of interest expense and income taxes for certain periods, the results of operations of Holdings are identical to those of Select. Therefore, the discussion related to net operating revenues, operating expenses, Adjusted EBITDA, income from operations, loss on early retirement of debt, equity in earnings of unconsolidated subsidiaries and non-controlling interest is identical for Holdings and Select.
Net Operating Revenues
Our net operating revenues increased by 0.9% to $756.7 million for the three months ended June 30, 2013 compared to $750.2 million for the three months ended June 30, 2012.
Specialty Hospitals. Our specialty hospital net operating revenues increased by 0.4% to $559.4 million for the three months ended June 30, 2013 compared to $557.1 million for the three months ended June 30, 2012. The growth in net operating revenue resulted from increases in our patient volume, almost all of which was offset by a 2% reduction in our Medicare payments as part of the automatic reductions in federal spending under the Budget Control Act of 2011. The reductions in our Medicare net operating revenue due to the Budget Control Act of 2011 were $9.1 million for the three months ended June 30, 2013. Our patient days increased 1.7% to 341,655 days for the three months ended June 30, 2013 as compared to the three months ended June 30, 2012. Our occupancy percentage was 73% for the three months ended June 30, 2013 compared to 71% for the three months ended June 30, 2012. Our average net revenue per patient day fell to $1,532 for the three months ended June 30, 2013 compared to $1,554 for the three months ended June 30, 2012, principally as a result of decreases resulting from the automatic reduction of our Medicare payments mandated by the Budget Control Act of 2011.
Outpatient Rehabilitation. Our outpatient rehabilitation segment net operating revenues increased 2.1% to $197.1 million for the three months ended June 30, 2013 compared to $193.1 million for the three months ended June 30, 2012, more than offsetting reductions in net operating revenues of $0.4 million due to the automatic reduction of our Medicare payments mandated by the Budget Control Act of 2011 and the $1.7 million impact of the MPPR Reduction. The net operating revenues generated by our outpatient rehabilitation clinics for the three months ended June 30, 2013 increased 5.5% compared to the three months ended June 30, 2012. The increase was related to growth in both our number of visits and our net revenue per visit. The number of visits in our owned outpatient rehabilitation clinics increased 4.4% for the three months ended June 30, 2013 to 1,217,598 visits compared to 1,166,550 visits for the three months ended June 30, 2012. Net revenue per visit in our owned outpatient rehabilitation clinics increased 1.0% to $103 for the three months ended June 30, 2013 compared to $102 for the three months ended June 30, 2012. Our contract services business experienced a decrease in net operating revenues of $3.9 million compared to the three months ended June 30, 2012, which principally resulted from the termination of contracts.
Operating Expenses
Our operating expenses include our cost of services, general and administrative expense and bad debt expense. Our operating expenses increased by $11.2 million to $652.5 million for the three months ended June 30, 2013 compared to $641.3 million for the three months ended June 30, 2012 and resulted principally from increased patient volumes in our specialty hospitals and outpatient clinics. As a percentage of our net operating revenues, our operating expenses were 86.2% for the three months ended June 30, 2013 compared to 85.5% for the three months ended June 30, 2012. Our cost of services, a major component of which is labor expense, were $625.7 million or 82.7% of net operating revenue for the three months ended June 30, 2013 compared to $612.7 million or 81.7% of net operating revenue for the three months ended June 30, 2012. Our increase in cost of services as a percentage of net operating revenue for the three months ended June 30, 2013 was principally from the loss of net operating revenues associated with the 2% reduction in our Medicare payments as part of the automatic reductions in federal spending mandated under the Budget Control Act of 2011 and the MPPR Reduction discussed above
42
under “Net Operating Revenues” with no offsetting reduction in costs. Facility rent expense, which is a component of cost of services, was $30.9 million for the three months ended June 30, 2013 compared to $31.3 million for the three months ended June 30, 2012. General and administrative expenses were 2.3% of net operating revenue or $17.9 million for the three months ended June 30, 2013 compared to 2.5% of net operating revenue or $18.6 million for the three months ended June 30, 2012. Our general and administrative expenses decreased principally due to a reduction in executive compensation expenses. Our bad debt expense was $8.8 million or 1.2% of net operating revenues for the three months ended June 30, 2013 compared to $10.0 million or 1.3% of net operating revenues for the three months ended March 31, 2012.
Specialty Hospitals. Adjusted EBITDA for our specialty hospitals decreased 5.7% to $96.4 million for the three months ended June 30, 2013 compared to $102.2 million for the three months ended June 30, 2012. Our Adjusted EBITDA margins for the segment decreased to 17.2% for the three months ended June 30, 2013 from 18.3% for the three months ended June 30, 2012. The decrease in Adjusted EBITDA for our specialty hospitals was primarily the result of the 2% reduction in our Medicare payments as part of the automatic reductions in federal spending mandated under the Budget Control Act of 2011 as discussed above under “Net Operating Revenues” which reductions were accompanied by no offsetting reduction in costs.
Outpatient Rehabilitation. Our Adjusted EBITDA for our outpatient rehabilitation segment increased 0.8% to $26.1 million for the three months ended June 30, 2013 compared to $25.8 million for the three months ended June 30, 2012, more than offsetting reductions in net operating revenues of $0.4 million due to the automatic reduction of our Medicare payments mandated by the Budget Control Act of 2011 and the $1.7 million impact of the MPPR Reduction. Our Adjusted EBITDA margins for the outpatient rehabilitation segment decreased to 13.2% for the three months ended June 30, 2013 from 13.4% for the three months ended June 30, 2012. The increase in the Adjusted EBITDA for our outpatient rehabilitation segment is principally due to the growth in net operating revenues of our outpatient rehabilitation clinics discussed above under “Net Operating Revenues.” The Adjusted EBITDA in our outpatient rehabilitation clinics increased by $1.2 million for the three months ended June 30, 2013 compared to the three months ended June 30, 2012. Our Adjusted EBITDA margins for our outpatient rehabilitation clinics were 15.1% for both the three months ended June 30, 2013 and 2012. The Adjusted EBITDA in our contract services business decreased by $0.9 million for the three months ended June 30, 2013 compared to the three months ended June 30, 2012. The Adjusted EBITDA margins for our contract services business declined to 7.1% for the three months ended June 30, 2013 from 8.5% for the three months ended June 30, 2012.
Other. The Adjusted EBITDA loss was $16.5 million for the three months ended June 30, 2013 compared to an Adjusted EBITDA loss of $17.7 million for the three months ended June 30, 2012, principally due to decreases in executive compensation expenses as discussed above under “Operating Expenses.”
Income from Operations
For the three months ended June 30, 2013 we had income from operations of $88.3 million compared to $93.5 million for the three months ended June 30, 2012. The decrease in our income from operations resulted principally from the 2% reduction in our Medicare payments as part of the automatic reductions in federal spending mandated under the Budget Control Act of 2011 and the MPPR Reduction as discussed above under “Net Operating Revenues,” which reductions were accompanied by no offsetting reduction in costs.
43
Loss on Early Retirement of Debt
On May 28, 2013, we repaid a portion of our original term loan and series A term loan of our senior secured credit facility. We recognized a loss of $17.3 million for the three months ended June 30, 2013, which included unamortized debt issuance costs, unamortized original issue discount, and certain debt issuance costs associated with refinancing activities during the three months ended June 30, 2013.
Equity in Earnings of Unconsolidated Subsidiaries
For the three months ended June 30, 2013, we had equity in earnings of unconsolidated subsidiaries of $0.6 million compared to equity in earnings of unconsolidated subsidiaries of $2.8 million for the three months ended June 30, 2012. The decrease in our equity in earnings of unconsolidated subsidiaries resulted principally from losses incurred by start-up companies where we own a minority interest.
Interest Expense
Select Medical Corporation. Interest expense was $21.9 million for the three months ended June 30, 2013 compared to $21.0 million for the three months ended June 30, 2012. The increase in interest expense was principally due to increased borrowings at Select that were used to refinance debt held by Holdings in both the third quarter of 2012 and the first quarter of 2013.
Select Medical Holdings Corporation. Interest expense was $21.9 million for the three months ended June 30, 2013 compared to $23.8 million for the three months ended June 30, 2012. The decrease in interest expense was principally due to lower interest rates on the portions of the debt that we refinanced in both the third quarter of 2012 and the first quarter of 2013.
Income Taxes
Select Medical Corporation. We recorded income tax expense of $19.8 million for the three months ended June 30, 2013. The expense represented an effective tax rate of 39.8%. We recorded income tax expense of $28.6 million for the three months ended June 30, 2012. The expense represented an effective tax rate of 38.0%. Select Medical Corporation is part of the consolidated federal tax return for Select Medical Holdings Corporation. We allocate income taxes between Select and Holdings for purposes of financial statement presentation. Because Holdings is a passive investment company incorporated in Delaware, it does not incur any state income tax expense or benefit on its specific income or loss and, as such, receives a tax allocation equal to the federal statutory rate of 35% on its specific income or loss. Based upon the relative size of Holdings’ income or loss, this can cause the effective tax rate for Select to differ from the effective tax rate for the consolidated company.
Select Medical Holdings Corporation. We recorded income tax expense of $19.8 million for the three months ended June 30, 2013, which represented an effective tax rate of 39.8%. We recorded income tax expense of $27.7 million for the three months ended June 30, 2012, which represented an effective tax rate of 38.2%. The increase in our effective tax rate has resulted from increases in our state taxes relative to our income. We experienced a higher proportion of income in higher state income tax rate jurisdictions for the three months ended June 30, 2013 compared to the three months ended June 30, 2012. In addition, income tax expense was reduced in the three months ended June 30, 2012 from the usage of state net operating losses.
44
Non-Controlling Interests
Non-controlling interests in consolidated earnings were $2.1 million for the three months ended June 30, 2013 and $1.6 million for the three months ended June 30, 2012.
Six Months Ended June 30, 2013 Compared to Six Months Ended June 30, 2012
In the following discussion, we address the results of operations of Select and Holdings. With the exception of the loss on early retirement of debt, interest expense and income taxes for certain periods, the results of operations of Holdings are identical to those of Select. Therefore, the discussion related to net operating revenues, operating expenses, Adjusted EBITDA, income from operations, equity in earnings of unconsolidated subsidiaries and non-controlling interest is identical for Holdings and Select.
Our net operating revenues increased by 0.8% to $1,506.6 million for the six months ended June 30, 2013 compared to $1,494.2 million for the six months ended June 30, 2012.
Specialty Hospitals. Our specialty hospital net operating revenues increased by 0.6% to $1,117.1 million for the six months ended June 30, 2013 compared to $1,110.2 million for the six months ended June 30, 2012. The growth in net operating revenue primarily resulted from increases in our patient volume, increases in our non-Medicare reimbursement rates and increases in revenues that are generated from contracted labor services provided to our joint venture with Baylor Health Care System (the “Baylor JV”). These increases were offset in part by a 2% reduction in our Medicare payments as part of the automatic reductions in federal spending under the Budget Control Act of 2011. The reductions in our Medicare net operating revenue due to the Budget Control Act of 2011 were $9.1 million for the six months ended June 30, 2013. Our patient days increased 0.3% to 681,037 days for the six months ended June 30, 2013 as compared to the six months ended June 30, 2012. Our occupancy percentage was 73% for the six months ended June 30, 2013 compared to 72% for the six months ended June 30, 2012. Our average net revenue per patient day decreased to $1,538 for the six months ended June 30, 2013 compared to $1,539 for the six months ended June 30, 2012 and this decrease principally resulted from decreases in our average Medicare net revenue per patient day as a result of the 2% reduction in our Medicare payments as part of the automatic reductions in federal spending mandated under the Budget Control Act of 2011 offset in part by increases in our non-Medicare reimbursement rates.
Outpatient Rehabilitation. Our outpatient rehabilitation segment net operating revenues increased 1.4% to $389.2 million for the six months ended June 30, 2013 compared to $383.9 million for the six months ended June 30, 2012, more than offsetting reductions in net operating revenues of $0.4 million due to the automatic reduction of our Medicare payments mandated by the Budget Control Act of 2011 and the $1.7 million impact of the MPPR Reduction. The net operating revenues generated by our outpatient rehabilitation clinics for the six months ended June 30, 2013 increased 4.3% compared to the six months ended June 30, 2012. The increase was related to growth in both our number of visits and net revenue per visit. The number of visits in our owned outpatient rehabilitation clinics increased 2.7% for the six months ended June 30, 2013 to 2,380,221 visits compared to 2,318,759 visits for the six months ended June 30, 2012. Net revenue per visit in our owned outpatient rehabilitation clinics increased 1.0% to $104 for the six months ended June 30, 2013 compared to $103 for the six months ended June 30, 2012. Our contract services business experienced a decrease in net operating revenues of approximately $6.9 million compared to the six months ended June 30, 2012, which principally resulted from the termination of contracts.
45
Our operating expenses include our cost of services, general and administrative expense and bad debt expense. Our operating expenses increased by $26.6 million to $1,304.1 million for the six months ended June 30, 2013 compared to $1,277.5 million for the six months ended June 30, 2012, principally due to increases in our specialty hospital segment. As a percentage of our net operating revenues, our operating expenses were 86.6% for the six months ended June 30, 2013 compared to 85.5% for the six months ended June 30, 2012. Our cost of services, a major component of which is labor expense, were $1,250.6 million or 83.0% of net operating revenue for the six months ended June 30, 2013 compared to $1,224.3 million or 81.9% of net operating revenue for the six months ended June 30, 2012. The principal cause of the increase in cost of services as a percentage of net operating revenues resulted from inflationary increases in labor costs in our specialty hospitals and the loss of net operating revenues associated with the 2% reduction in our Medicare payments as part of the automatic reductions in federal spending mandated under the Budget Control Act of 2011 and the MPPR Reduction discussed above under “Net Operating Revenues” with no offsetting reduction in costs. Facility rent expense, which is a component of cost of services, was $61.3 million for the six months ended June 30, 2013 compared to $61.7 million for the six months ended June 30, 2012. General and administrative expenses were 2.4% of net operating revenue or $35.3 million for the six months ended June 30, 2013 compared to 2.2% of net operating revenue or $32.8 million for the six months ended June 30, 2012. Our general and administrative expenses for the six months ended June 30, 2012 were favorably impacted by a gain on the sale of a building; excluding this gain, general and administrative expenses for the six months ended June 30, 2012 would have been 2.4% of net operating revenue. Our bad debt expense was $18.2 million or 1.2% of net operating revenues for the six months ended June 30, 2013 compared to $20.4 million or 1.4% of net operating revenues for the six months ended June 30, 2012.
Specialty Hospitals. Adjusted EBITDA for our specialty hospitals decreased 6.1% to $189.7 million for the six months ended June 30, 2013 compared to $202.1 million for the six months ended June 30, 2012. Our Adjusted EBITDA margins for the segment decreased to 17.0% for the six months ended June 30, 2013 from 18.2% for the six months ended June 30, 2012. The decrease in Adjusted EBITDA for our specialty hospitals was primarily the result of the 2% reduction in our Medicare payments as part of the automatic reductions in federal spending mandated under the Budget Control Act of 2011 as discussed above under “Net Operating Revenues,” which reductions were accompanied by no offsetting reduction in costs, and increases in our operating expenses discussed above under “Operating Expenses.”
Outpatient Rehabilitation. Our Adjusted EBITDA for our outpatient rehabilitation segment increased 1.2% to $48.9 million for the six months ended June 30, 2013 compared to $48.3 million for the six months ended June 30, 2012, more than offsetting reductions in net operating revenues of $0.4 million due to the automatic reduction of our Medicare payments mandated by the Budget Control Act of 2011 and the $1.7 million impact of the MPPR Reduction. Our Adjusted EBITDA margin for the outpatient rehabilitation segment was 12.6% for both the six months ended June 30, 2013 and 2012. The increase in the Adjusted EBITDA for our outpatient rehabilitation segment is principally due to growth in net operating revenues of our outpatient rehabilitation clinics discussed above under “Net Operating Revenues.” The Adjusted EBITDA in our outpatient rehabilitation clinics increased by $1.8 million for the six months ended June 30, 2013 compared to the six months ended June 30, 2012. Our Adjusted EBITDA margins for our outpatient rehabilitation clinics was 14.2% for both the six months ended June 30, 2013 and 2012. The Adjusted EBITDA in our contract services business decreased by $1.2 million for the six months ended June 30, 2013 compared to the six months ended June 30, 2012. The Adjusted EBITDA margins for our contract services business declined to 7.3% for the six months ended June 30, 2013 from 8.0% for the six months ended June 30, 2012.
Other. The Adjusted EBITDA loss was $32.6 million for the six months ended June 30, 2013 compared to an Adjusted EBITDA loss of $31.1 million for the six months ended June 30, 2012. The lower Adjusted EBITDA loss for the six months ended June 30, 2012 is primarily attributable to the gain on the sale of a building during the same period last year, as described under “Operating Expenses.”
46
For the six months ended June 30, 2013 we had income from operations of $170.8 million compared to $185.1 million for the six months ended June 30, 2012. The decrease in our income from operations resulted principally from the 2% reduction in our Medicare payments as part of the automatic reductions in federal spending mandated under the Budget Control Act of 2011 and the MPPR Reduction, as discussed above under “Net Operating Revenues,” and increases in labor costs in our specialty hospitals as discussed above under “Operating Expenses.”
Select Medical Corporation. On March 22, 2013 we redeemed all of Select’s outstanding 7 5/8% senior subordinated notes due 2015. We recognized a loss on early retirement of debt of $0.5 million in the first quarter 2013 for the unamortized debt issuance costs associated with the redeemed debt.
On May 28, 2013, we repaid a portion of our original term loan and series A term loan of our senior secured credit facility and on June 3, 2013 we amended our existing senior secured credit facility. We recognized a loss on early retirement of debt of $17.3 million in the second quarter 2013, which included unamortized debt issuance costs, unamortized original issue discount, and certain debt issuance costs associated with refinancing activities.
Select Medical Holdings Corporation. On March 22, 2013 we redeemed all of Select’s outstanding 7 5/8% senior subordinated notes due 2015, and redeemed all of our senior floating rate notes due 2015. We recognized a loss on early retirement of debt of $1.5 million in the first quarter 2013 for the unamortized debt issuance costs associated with the redeemed debt.
On May 28, 2013, we repaid a portion of our original term loan and series A term loan of our senior secured credit facility and on June 3, 2013 we amended our existing senior secured credit facility. We recognized a loss of $17.3 million in the second quarter 2013, which included unamortized debt issuance costs, unamortized original issue discount, and certain debt issuance costs associated with refinancing activities.
For the six months ended June 30, 2013, we had equity in earnings of unconsolidated subsidiaries of $1.6 million compared to equity in earnings of unconsolidated subsidiaries of $5.2 million for the six months ended June 30, 2012. The decrease in our equity in earnings of unconsolidated subsidiaries resulted from decreases in earnings contributed from the Baylor JV and losses incurred by start-up companies where we own a minority interest.
Select Medical Corporation. Interest expense was $43.0 million for the six months ended June 30, 2013 compared to $42.2 million for the six months ended June 30, 2012. The increase in interest expense was principally due to increased borrowings that were used to refinance debt held by Holdings in both the third quarter of 2012 and the first quarter of 2013.
47
Select Medical Holdings Corporation. Interest expense was $45.4 million for the six months ended June 30, 2013 compared to $47.7 million for the six months ended June 30, 2012. The decrease in interest expense was principally due to lower interest rates on the portions of the debt that we refinanced in both the third quarter of 2012 and the first quarter of 2013.
Select Medical Corporation. We recorded income tax expense of $42.8 million for the six months ended June 30, 2013. The expense represented an effective tax rate of 38.3%. We recorded income tax expense of $57.2 million for the six months ended June 30, 2012. The expense represented an effective tax rate of 38.6%. Select Medical Corporation is part of the consolidated federal tax return for Select Medical Holdings Corporation. We allocate income taxes between Select and Holdings for purposes of financial statement presentation. Because Holdings is a passive investment company incorporated in Delaware, it does not incur any state income tax expense or benefit on its specific income or loss and, as such, receives a tax allocation equal to the federal statutory rate of 35% on its specific income or loss. Based upon the relative size of Holdings’ income or loss, this can cause the effective tax rate for Select to differ from the effective tax rate for the consolidated company.
Select Medical Holdings Corporation. We recorded income tax expense of $41.6 million for the six months ended June 30, 2013, which represented an effective tax rate of 38.4%. We recorded income tax expense of $55.2 million for the six months ended June 30, 2012, which represented an effective tax rate of 38.7%. The decline in our effective tax rate has resulted from an increase in earnings of our consolidated subsidiaries taxed as pass-through entities where we only record income taxes on our share of the income, offset in part by an increase in our state effective tax rates that has resulted from a higher proportion of our income being generated in states with higher tax rates.
Non-controlling interests in consolidated earnings were $4.5 million for the six months ended June 30, 2013 and $2.7 million for the six months ended June 30, 2012.
48
Liquidity and Capital Resources
Cash Flows for the Six Months Ended June 30, 2013 and Six Months Ended June 30, 2012
Cash flows provided by operating activities
Cash flows used in investing activities
Cash flows provided by (used in) financing activities
Operating activities for Holdings provided $22.0 million and for Select provided $27.6 million of cash flows for the six months ended June 30, 2013. Operating activities for Holdings provided $118.8 million and for Select provided $124.0 million of cash flows for the six months ended June 30, 2012. The operating cash flows of Select exceeded the operating cash flows of Holdings by $5.6 million for the six months ended June 30, 2013 and by $5.2 million for the six months ended June 30, 2012. The difference relates to interest payments on Holdings’ indebtedness. The decline in operating cash flows for both Holdings and Select in the six months ended June 30, 2013 compared to the six months ended June 30, 2012 is due to the timing of the periodic interim payments we receive from Medicare for the services provided at our specialty hospitals and an acceleration in the payment of accrued interest resulting from our debt refinancings.
Our days sales outstanding were 51 days at June 30, 2013 compared to 51 days at June 30, 2012 and 45 days at December 31, 2012. The increase in days sales outstanding between December 31, 2012 and June 30, 2013 is primarily related to the timing of the periodic interim payments we receive from Medicare for the services provided at our specialty hospitals.
Investing activities used $56.8 million of cash flow for the six months ended June 30, 2013. The principal use of cash included $28.0 million related to the purchase of property and equipment and $28.7 million related principally to investments in unconsolidated businesses. Investing activities used $21.6 million of cash flow for the six months ended June 30, 2012. The principal use of cash included $27.9 million related to the purchase of property and equipment and $10.0 million related primarily to an additional investment in the Baylor JV. This use of cash was offset by $16.5 million in proceeds related to the sale of a building.
Financing activities for Select used $2.1 million of cash flow for the six months ended June 30, 2013. The primary source of cash related to $600.0 million of proceeds from Select’s 6.375% senior notes on May 28, 2013. The proceeds of the senior notes were used to repay $587.0 million of Select’s senior secured credit facility term loans and fund certain transaction costs amounting to $14.4 million. In addition, cash of $298.5 million was provided through the issuance of senior secured credit facility term loans which was used to pay dividends to Holdings to fund the redemption of $167.3 million principal amount of Holdings senior floating rate notes, repurchase $70.0 million of Selects’ 7 5/8% senior subordinated notes and pay $4.2 million of transaction costs related to the financing transactions completed during the first quarter ended March 31, 2013. In addition, during the six months ended June 30, 2013 Select paid dividends to Holdings to fund $14.0 million
49
of dividends paid to common stockholders, $10.0 million to fund Holding’s repurchase of common stock and $5.6 million to fund interest payments on Holdings debt. Select also made net repayments on the revolving portion of the credit facility of $25.0 million, paid $5.6 million for credit facility term loan principal maturities and received net proceeds from other debt of $2.2 million. Select had proceeds of $1.6 million from bank overdrafts and used $1.5 million to make distributions to non-controlling interests. Financing activities for Select used $92.9 million of cash flow for the six months ended June 30, 2012. The primary uses of cash related to net payments under our senior secured credit facility of $44.3 million, dividends paid to Holdings to fund interest payments and stock repurchases of $52.0 million and distributions to non-controlling interests of $1.7 million. These uses were offset by net borrowings of other debt of $0.8 million, proceeds of $0.5 million from the issuance of common stock and proceeds from bank overdrafts of $3.7 million.
The difference in cash flows provided by financing activities of Holdings compared to Select of $5.6 million for the six months ended June 30, 2013 and $5.2 million for the six months ended June 30, 2012 related to dividends paid by Select to Holdings to service Holdings’ interest obligations related to its indebtedness.
Capital Resources
Select Medical Corporation. Select had net working capital of $135.4 million at June 30, 2013 compared to net working capital of $63.2 million at December 31, 2012. The increase in net working capital is primarily due to increases in accounts receivable.
Select Medical Holdings Corporation. Holdings had net working capital of $135.4 million at June 30, 2013 compared to net working capital of $65.2 million at December 31, 2012. The increase in net working capital is primarily due to increases in accounts receivable.
At the time of issuing the series B term loan, Select had additional term loan tranches including an $850.0 million term loan tranche issued on June 1, 2011 (the “original term loan”) and a $275.0 million incremental term loan tranche issued August 13, 2012 (the “series A term loan”). Both the original term loan and series A term loan tranches were issued at a discount and amortize in equal quarterly installments on the last day of each March, June, September and December. The balance of both the original term loan and series A term loan are payable on June 1, 2018.
50
Select may redeem some or all of the senior notes prior to June 1, 2016 by paying a “make-whole” premium. Select may redeem some or all of the senior notes on or after June 1, 2016 at specified redemption prices. In addition, prior to June 1, 2016, Select may redeem up to 35% of the senior notes with the net proceeds of certain equity offerings at a price of 106.375% plus accrued and unpaid interest, if any. Select is obligated to offer to repurchase the senior notes at a price of 101% of their principal amount plus accrued and unpaid interest, if any, as a result of certain change of control events. These restrictions and prohibitions are subject to certain qualifications and exceptions.
In connection with the issuance of the senior notes, Select entered into a registration rights agreement on May 28, 2013 with certain guarantors of the notes named therein and J.P. Morgan Securities LLC, on behalf of itself and the other initial purchasers named therein (the “Registration Rights Agreement”). Pursuant to the Registration Rights Agreement, Select has agreed to file an exchange offer registration statement to exchange the senior notes for substantially identical notes registered under the Securities Act unless the exchange offer is not permitted by applicable law or the policy of the SEC. Select has also agreed to file a shelf registration statement to cover resales of notes under certain circumstances. Select has agreed to file the exchange offer registration statement with the SEC within 150 days of the issue date of the senior notes and use commercially reasonable efforts to have the exchange offer registration statement declared effective within 240 days of the issue date and to complete the exchange offer with respect to the senior notes within 30 days of effectiveness. In addition, Select agreed to use commercially reasonable efforts to file the shelf registration statement on or prior to the later of (i) 120 days after a filing obligation arises and (ii) 270 days after the issue date, and to use commercially reasonable efforts to cause such shelf registration statement to be declared effective by the SEC on or prior to 210 days after such filing. If Select fails to satisfy its registration obligations under the
51
Registration Rights Agreement, it will be required to pay additional interest to the holders of the senior notes under certain circumstances.
At June 30, 2013, we had outstanding borrowings of $811.1 million (net of unamortized original issue discounts of $7.2 million) under the term loans and borrowings of $105.0 million (excluding letters of credit) under the revolving loan portion of our senior secured credit facilities. We had $153.1 million of availability under our revolving loan facility (after giving effect to $41.9 million of outstanding letters of credit) at June 30, 2013.
The applicable margin percentage for borrowings under our revolving loan is subject to change based upon the ratio of Select’s leverage ratio (as defined in our senior secured credit facility). The applicable interest rate for revolving loans as of June 30, 2013 was (1) Alternate Base plus 2.75% for alternate base rate loans and (2) LIBO plus 3.75% for adjusted LIBO rate loans.
Our senior secured credit facility requires Select to maintain certain leverage ratios (as defined in our senior secured credit facility). For the four consecutive fiscal quarters ended June 30, 2013, Select was required to maintain its leverage ratio (its ratio of total indebtedness to consolidated EBITDA) at less than 4.50 to 1.00. Select’s leverage ratio was 3.93 to 1.00 as of June 30, 2013.
We may from time to time seek to retire or purchase our outstanding debt through cash purchases and/or exchanges for equity securities, in open market purchases, privately negotiated transactions, tender offers or otherwise. Such repurchases or exchanges, if any, may be funded from operating cash flows or other sources and will depend on prevailing market conditions, our liquidity requirements, contractual restrictions and other factors. The amounts involved may be material.
52
Holdings’ board of directors has authorized a common stock repurchase program to repurchase up to $350.0 million worth of shares of its common stock. The program will remain in effect until March 31, 2014, unless extended by the board of directors. Stock repurchases under this program may be made in the open market or through privately negotiated transactions, and at times and in such amounts as Holdings deems appropriate. Holdings is funding this program with cash on hand and borrowings under its revolving credit facility. During the six months ended June 30, 2013, Holdings repurchased 1,115,691 shares at a cost of approximately $10.0 million, an average cost per share of $8.95, which includes transaction costs. Since the inception of the program through June 30, 2013, Holdings has repurchased 23,606,080 shares at a cost of approximately $173.6 million, or $7.36 per share, which includes transaction costs.
We believe our internally generated cash flows and borrowing capacity under our senior secured credit facility will be sufficient to finance operations over the next twelve months.
We routinely pursue opportunities to develop new joint venture relationships with significant health systems, and from time to time we may also develop new inpatient rehabilitation hospitals. With the expiration on December 28, 2012 of the moratorium on new LTCHs and new LTCH beds, we are evaluating the addition of new LTCH beds at certain of our hospitals. We also intend to open new outpatient rehabilitation clinics in local areas that we currently serve where we can benefit from existing referral relationships and brand awareness to produce incremental growth. In addition to our development activities, we may grow our network of specialty hospitals through opportunistic acquisitions.
Dividend
Effects of inflation and changing prices
We derive a substantial portion of our revenues from the Medicare program. We have been, and could be in the future, affected by the continuing efforts of governmental and private third party payors to contain healthcare costs by limiting or reducing reimbursement payments.
Additionally, reimbursement payments under governmental and private third party payor programs may not increase to sufficiently cover increasing costs. Medicare reimbursement in long term acute care hospitals and inpatient rehabilitation facilities are subject to fixed payments under the Medicare prospective payment systems. In accordance with Medicare laws, CMS makes annual adjustments to Medicare payments under what is commonly known as a “market basket update.” Generally, these rates are adjusted for inflation. However, these adjustments may not reflect the actual increase in the costs of providing healthcare services and may be reduced by CMS for other adjustments.
The healthcare industry is labor intensive and the Company’s largest expenses are labor related costs. Wages and other expenses increase during periods of inflation and when labor shortages occur in the marketplace. While we believe the current economic climate may help to moderate wage increases in the near term, there can be no guarantee we will not experience increases in the cost of labor, as the need for clinical healthcare professionals is expected to grow. In addition, suppliers pass along rising costs to us in the form of higher prices. We have little or no ability to pass on these increased costs associated with providing services due to federal laws that establish fixed reimbursement rates.
53
ITEM 3. QUANTITATIVE AND QUALITATIVE DISCLOSURES ABOUT MARKET RISK
Quantitative and Qualitative Disclosures About Market Risk
We are subject to interest rate risk in connection with our long-term indebtedness. Our principal interest rate exposure relates to the loans outstanding under our senior secured credit facility. As of June 30, 2013, we had $818.3 million (excluding unamortized original issue discount) in term loans outstanding under our senior secured credit facility and $105.0 million in revolving loans outstanding under our senior secured credit facility, which bear interest at variable rates. Each eighth point change in interest rates on the variable rate portion of our long-term indebtedness would result in a $1.2 million annual change in interest expense. However, because the variable interest rate for an aggregate $519.8 million in series C term loan is subject to an Adjusted LIBO Rate floor of 1.00% until the Adjusted LIBO Rate exceeds 1.00%, our interest rate on this indebtedness is effectively fixed at 4.00%.
ITEM 4. CONTROLS AND PROCEDURES
Evaluation of Disclosure Controls and Procedures
We carried out an evaluation, under the supervision and with the participation of our principal executive officer and principal financial officer, of the effectiveness of the design and operation of our disclosure controls and procedures (as defined in Rule 13a-15(e) of the Securities Exchange Act of 1934) as of the end of the period covered in this report. Based on this evaluation, our principal executive officer and principal financial officer concluded that our disclosure controls and procedures, including the accumulation and communication of disclosure to our principal executive officer and principal financial officer as appropriate to allow timely decisions regarding disclosure, are effective as of June 30, 2013 to provide reasonable assurance that material information required to be included in our periodic SEC reports is recorded, processed, summarized and reported within the time periods specified in the relevant SEC rules and forms.
Changes in Internal Control Over Financial Reporting
There was no change in our internal control over financial reporting (as defined in Rule 13a-15(f) of the Securities Exchange Act of 1934) identified in connection with the evaluation required by Rule 13a-15(d) of the Securities Exchange Act of 1934 that occurred during the first quarter ended June 30, 2013 that has materially affected, or is reasonably likely to materially affect, our internal control over financial reporting.
Inherent Limitations on Effectiveness of Controls
It should be noted that any system of controls, however well designed and operated, can provide only reasonable, and not absolute, assurance that the objectives of the system will be met. In addition, the design of any control system is based in part upon certain assumptions about the likelihood of future events. Because of these and other inherent limitations of control systems, there is only reasonable assurance that our controls will succeed in achieving their goals under all potential future conditions.
PART II OTHER INFORMATION
ITEM 1. LEGAL PROCEEDINGS
On January 8, 2013, a federal magistrate judge unsealed an Amended Complaint in United States of America and the State of Indiana, ex rel. Doe I, Doe II and Doe III v. Select Medical Corporation, Select Specialty Hospital-Evansville, Evansville Physician Investment Corporation, Dr. Richard Sloan and Dr. Jeffrey Selby. The Amended Complaint, which was served on the Company on February 15, 2013, is a civil action filed under seal on September 28, 2012 in the United States District Court for the Southern District of Indiana by private plaintiff-relators on behalf of the United States and the state of Indiana under the federal False Claims Act and Indiana False Claims and Whistleblower Protection Act. Although the Amended Complaint identifies the relators by fictitious pseudonyms, on March 28, 2013, the relators filed a Notice identifying themselves as the former CEO at the Company’s long term acute care hospital in Evansville, Indiana (“SSH-Evansville”) and two former case managers at SSH-Evansville. The named defendants include the Company, SSH-Evansville, and two physicians who have practiced at SSH-Evansville. On March 26, 2013, the defendants, relators and the United States filed a joint motion seeking a stay of the proceedings, in which the United States notified the court that its investigation has not been completed and therefore it is not yet able to decide whether or not to intervene, and on March 29, 2013, the magistrate judge granted the motion and stayed all deadlines in the case
for 90 days. On June 26, 2013, the United States filed a motion seeking to extend such stay of the proceedings for an additional 90 days, and on June 27, 2013, the defendants each filed a notice of consent to the requested stay.
ITEM 1A. RISK FACTORS
There have been no material changes from our risk factors as previously reported in our Annual Report on Form 10-K for the year ended December 31, 2012 and our Quarterly Report on Form 10-Q for the three months ended March 31, 2013.
ITEM 2. UNREGISTERED SALES OF EQUITY SECURITIES AND USE OF PROCEEDS
None.
ITEM 3. DEFAULTS UPON SENIOR SECURITIES
Not applicable.
ITEM 4. MINE SAFETY DISCLOSURES
ITEM 5. OTHER INFORMATION
ITEM 6. EXHIBITS
The exhibits to this report are listed in the Exhibit Index appearing on page 59 hereof.
Pursuant to the requirements of the Securities Exchange Act of 1934, the Registrant has duly caused this Report to be signed on its behalf by the undersigned, thereunto duly authorized.
By:
/s/ Martin F. Jackson
Martin F. Jackson
Executive Vice President and Chief Financial Officer
(Duly Authorized Officer)
/s/ Scott A. Romberger
Scott A. Romberger
Senior Vice President, Chief Accounting Officer and Controller
(Principal Accounting Officer)
Dated: August 8, 2013
EXHIBIT INDEX
Exhibit
Description
1.1
Purchase Agreement, dated May 13, 2013, by and among Select Medical Corporation, the initial purchasers named therein and the Guarantors (as defined therein), incorporated herein by reference to Exhibit 1.1 of the Current Report on Form 8-K of Select Medical Holdings Corporation filed on May 14, 2013. (Reg. No. 001-34465)
Indenture, dated as of May 28, 2013, by and among the Company, the guarantors named therein and U.S. Bank National Association, as trustee, incorporated herein by reference to Exhibit 4.1 of the Current Report on Form 8-K of Select Medical Holdings Corporation filed on May 28, 2013. (Reg. No. 001-34465)
4.2
Forms of 6.375% Senior Notes due 2021, incorporated herein by reference to Exhibit 4.2 of the Current Report on Form 8-K of Select Medical Holdings Corporation filed on May 28, 2013. (Reg. No. 001-34465)
Registration Rights Agreement, dated May 28, 2013, by and among the Company, the guarantors named therein and J.P. Morgan Securities LLC, on behalf of itself and the other initial purchasers named therein, incorporated herein by reference to Exhibit 4.3 of the Current Report on Form 8-K of Select Medical Holdings Corporation filed on May 28, 2013. (Reg. No. 001-34465)
10.1
Amendment No. 10 to Employment Agreement, by and between Select Medical Corporation and Patricia A. Rice, dated June 28, 2013, incorporated herein by reference to Exhibit 4.3 of the Current Report on Form 8-K of Select Medical Holdings Corporation filed on July 2, 2013. (Reg. No. 001-34465)
10.2
Amendment No. 4 to the Credit Agreement, dated as of June 3, 2013, among Select Medical Holdings Corporation, Select Medical Corporation and JPMorgan Chase Bank, N.A.
31.1
Certification of Chief Executive Officer pursuant to Section 302 of the Sarbanes-Oxley Act of 2002.
31.2
Certification of Executive Vice President and Chief Financial Officer pursuant to Section 302 of the Sarbanes-Oxley Act of 2002.
32.1
Certification of Chief Executive Officer, and Executive Vice President and Chief Financial Officer pursuant to 18 U.S.C. Section 1350 as adopted pursuant to Section 906 of the Sarbanes-Oxley Act of 2002.
101
The following financial information from the Registrant’s Quarterly Report on Form 10-Q for the quarter ended June 30, 2013 formatted in XBRL (eXtensible Business Reporting Language): (i) Consolidated Statements of Operations for the three and six months ended June 30, 2013 and 2012, (ii) Consolidated Balance Sheets as June 30, 2013 and December 31, 2012, (iii) Consolidated Statements of Cash Flows for the six months ended June 30, 2013 and 2012, (iv) Consolidated Statements of Changes in Equity and Income for the six months ended June 30, 2013 and (v) Notes to Consolidated Financial Statements.*
* XBRL information is furnished and not filed herewith, is not part of a registration statement or prospectus for purposes of section 11 or 12 of the Securities Act of 1933, is deemed not filed for purposes of section 18 of the Securities Exchange Act of 1934, and otherwise is not subject to liability under these sections.
59