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| ASGR > SEC Filings for ASGR > Form 10-Q on 29-Oct-2009 | All Recent SEC Filings |
29-Oct-2009
Quarterly Report
• whether or not government agencies continue to privatize correctional healthcare services;
• risks arising from governmental budgetary pressures and funding;
• the possible effect of adverse publicity on the Company's business;
• increased competition for new contracts and renewals of existing contracts;
• risks arising from the possibility that the Company may be unable to collect accounts receivable or that accounts receivable collection may be delayed;
• the Company's ability to limit its exposure for inmate medical costs, catastrophic illnesses, injuries or medical malpractice claims in excess of amounts covered under contracts or insurance coverage;
• the Company's ability to maintain and continually develop information technology and clinical systems;
• the outcome or adverse development of pending litigation, including professional liability litigation;
• the Company's determination whether to continue the payment of quarterly cash dividends, and if so, at the current amount;
• the Company's determination whether to repurchase shares under its stock repurchase program;
• the Company's dependence on key management and clinical personnel;
• risks arising from potential weaknesses or deficiencies in the Company's internal control over financial reporting;
• risks associated with the possibility that the Company may be unable to satisfy covenants under its credit facility;
• the risk that government or municipal entities (including the Company's government and municipal customers) may bring enforcement actions against, seek additional refunds from, or impose penalties on, the Company or its subsidiaries as a result of the matters investigated by the Audit Committee in prior years or the previous restatement of the Company's financial results;
• the Company's ability to expand its products beyond its traditional correctional health client base; and
• risks arising from shareholder litigation.
In addition to the factors referenced above and the other cautionary
statements discussed in this report, you should also consider the risks included
in Item 1A, "Risk Factors" contained in this Form 10-Q and Item 1A, "Risk
Factors" contained in the Company's Annual Report on Form 10-K for the year
ended December 31, 2008 and in other documents that the Company files from time
to time with the Securities and Exchange Commission. Because these risk factors
could cause actual results or outcomes to differ materially from those expressed
or implied in any forward-looking statements made by the Company or on the
Company's behalf, stockholders should not place undue reliance on any
forward-looking statements. Further, any forward-looking statement speaks only
as of the date on which it is made, and the Company undertakes no obligation to
update any forward-looking statement to reflect events or circumstances after
the date on which the statement is made or to reflect the occurrence of
unanticipated events. New factors emerge from time to time, and it is not
possible for the Company to predict which factors will arise. In addition, the
Company cannot assess the impact of each factor on its business or the extent to
which any factor, or combination of factors, may cause actual results to differ
materially from those contained in or implied by any forward-looking statements.
Critical Accounting Policies And Estimates
General
The Company's discussion and analysis of its financial condition and results
of operations are based upon its condensed consolidated financial statements,
which have been prepared in accordance with United States generally accepted
accounting principles. The preparation of these financial statements requires
the Company to make estimates and judgments that affect the reported amounts of
assets, liabilities, revenues and expenses, and related disclosure of contingent
assets and liabilities. On an on-going basis, the Company evaluates its
estimates, including, but not limited to, those related to:
• revenue (net of contractual allowances) and cost recognition (including
the estimated cost of off-site medical claims);
• cash and cash equivalents;
• allowance for doubtful accounts;
• loss contracts;
• professional and general liability self-insurance retention;
• other self-funded insurance reserves;
• legal contingencies;
• impairment of intangible assets and goodwill;
• amortizable life of contract intangibles;
• income taxes; and
• share-based compensation.
The Company bases its estimates on historical experience and on various other
assumptions that are believed to be reasonable under the circumstances, the
results of which form the basis for making judgments about the carrying values
of assets and liabilities that are not readily apparent from other sources.
Actual results may differ from these estimates under different assumptions or
conditions.
The Company believes the following critical accounting policies are affected
by its more significant judgments and estimates used in the preparation of its
condensed consolidated financial statements.
Revenue and Cost Recognition
The Company's contracts to provide healthcare services to correctional
institutions are principally fixed price contracts with revenue adjustments for
census fluctuations and risk sharing arrangements, such as stop-loss provisions
and aggregate limits for off-site or pharmaceutical costs. Such contracts
typically have a term of one to three years with subsequent renewal options and
generally may be terminated by either party without cause upon proper notice.
Revenues earned under contracts with correctional institutions are recognized in
the period that services are rendered. Cash received in advance for future
services is recorded as deferred revenue and recognized as income when the
service is performed.
Revenues are calculated based on the specific contract terms and fall into
one of three general categories: fixed fee, population based, or cost plus a
fee.
For fixed fee contracts, revenues are recorded based on fixed monthly amounts
established in the service contract irrespective of inmate population. Revenues
for population-based contracts are calculated either on a fixed fee that is
subsequently adjusted using a per diem rate for variances in the inmate
population from predetermined population levels or by a per diem rate multiplied
by the average inmate population for the period of service. For cost plus a fee
contracts, revenues are calculated based on actual expenses incurred during the
service period plus a contractual fee.
Generally, the Company's contracts will also include additional provisions
which mitigate a portion of the Company's risk related to cost increases.
Off-site utilization risk is mitigated in the majority of the Company's
contracts through aggregate pools or caps for off-site expenses, stop-loss
provisions, cost plus a fee arrangements or, in some cases, the entire exclusion
of certain or all off-site service costs. Pharmacy expense risk is similarly
mitigated in certain of the Company's contracts. Typically, under the terms of
such provisions, the Company's revenue under the contract increases to offset
increases in specified cost categories such as off-site expenses or
pharmaceutical costs. For contracts that include such provisions, the Company
recognizes the additional revenues due from clients based on its estimates of
applicable contract to date costs incurred as compared to the corresponding pro
rata contractual limit for such costs. Because such provisions typically specify
how often such additional revenue may be invoiced and require all such
additional revenue to be ultimately settled based on actual expenses, the
additional revenues are initially recorded as unbilled receivables until the
time period for billing has been met and actual costs are known. Any differences
between the Company's estimates of incurred costs and the actual costs are
recorded in the period in which such differences become known along with the
corresponding adjustment to the amount of recorded additional revenues.
Under all contracts, the Company records revenues net of any estimated
contractual allowances for potential adjustments resulting from a failure to
meet performance or staffing related criteria. If necessary, the Company revises
its estimates for such adjustments in future periods when the actual amount of
the adjustment is determined.
The table below illustrates these revenue categories as a percentage of total
revenues from continuing operations for the nine months ended September 30, 2009
and 2008.
Percentage of Revenue from
Continuing Operations
For the Nine Months For the Nine Months
Contract Category Ended Sept. 30, 2009 Ended Sept. 30, 2008
Fixed Fee 13.1 % 15.1 %
Population Based 63.1 % 58.6 %
Cost Plus a Fee 23.8 % 26.3 %
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Contracts under the population based and fixed fee categories generally have
similar margins which are higher than margins for contracts under the cost plus
a fee category. Cost plus a fee contracts generally have lower margins but with
much less potential for variability due to the limited risk involved. The
Company's profitability under each of the three general contract categories
discussed above varies based on the level of risk assumed under the contract
terms with the most potential for variability being in contracts under the
population based or fixed fee categories which do not contain the risk
mitigating provisions related to off-site utilization described above.
Healthcare expenses include the compensation of physicians, nurses and other
healthcare professionals and related benefits and all other direct costs of
providing and/or administering the managed care, including the costs associated
with services provided and/or administered by off-site medical providers, the
costs of professional and general liability insurance and other self-funded
insurance reserves discussed more fully below. Many of the Company's contracts
require the Company's customers to reimburse the Company for all treatment costs
or, in some cases, only treatment costs related to certain catastrophic events,
and/or for specific disease diagnoses illnesses. Certain of the Company's
contracts do not contain such limits. The Company attempts to compensate for the
increased financial risk when pricing contracts that do not contain individual,
catastrophic or specific disease diagnosis-related limits. However, the
occurrence of severe individual cases, specific disease diagnoses illnesses or a
catastrophic event in a facility governed by a contract without such limitations
could render the contract unprofitable and could have a material adverse effect
on the Company's operations. For certain of its contracts that do not contain
catastrophic protection, the Company maintains stop loss insurance from an
unaffiliated insurer with respect to, among other things, inpatient and
outpatient hospital expenses (as defined in the policy) for amounts in excess of
$375,000 per inmate up to an annual cap of $1.0 million per inmate. Amounts
reimbursable per claim under the policy are further limited to the lessor of 60%
of billed charges, the amount paid or the contracted amounts in situations where
the Company has negotiated rates with the applicable providers.
The cost of healthcare services provided, administered or contracted for are
recognized in the period in which they are provided and/or administered based in
part on estimates, including an accrual for estimated unbilled medical services
rendered through the balance sheet date. The Company estimates the accrual for
unbilled medical services using actual utilization data including
hospitalization, one-day surgeries, physician visits and emergency room and
ambulance visits and their corresponding costs, which are estimated using the
average historical cost of such services. Additionally, the Company's
utilization management personnel perform a monthly review of inpatient hospital
stays in order to identify any stays which would have a cost in excess of the
historical average rates. Once identified, reserves for such stays are
determined which take into consideration the specific facts of the stay. An
actuarial analysis is also prepared at least quarterly as an additional tool to
be considered by management in evaluating the adequacy of the Company's total
accrual related to contracts which have sufficient claims payment history. The
analysis takes into account historical claims experience (including the average
historical costs and billing lag time for such services) and other actuarial
data.
Actual payments and future reserve requirements will differ from the
Company's current estimates. The differences could be material if significant
fluctuations occur in the healthcare cost structure or the Company's future
claims experience. Changes in estimates of claims resulting from such
fluctuations and differences between actuarial estimates and actual claims
payments are recognized in the period in which the estimates are changed or the
payments are made.
Cash and Cash Equivalents
Cash and cash equivalents include cash on hand, demand deposits, money market
funds and investments which can be liquidated within three months or less when
purchased. Due to the short term nature of these instruments, the carrying
amounts approximate fair value.
Allowance for Doubtful Accounts
Accounts receivable are stated at estimated net realizable value. The Company
recognizes allowances for doubtful accounts based on a variety of factors,
including the length of time receivables are past due, significant one-time
events, contractual rights, client funding and/or political pressures,
discussions with clients and historical experience. If circumstances change,
estimates of the recoverability of receivables would be further adjusted and
such adjustments could have a material adverse effect on the Company's results
of operations in the period in which they are recorded.
Unbilled accounts receivable generally represent additional revenue earned
under shared-risk contracting models that remain unbilled at each balance sheet
date, due to provisions within the contracts governing the timing for billing
such amounts.
The Company and its clients will, from time to time, have disputes over
amounts billed under the Company's contracts. The Company records a reserve for
contractual allowances in circumstances where it concludes that a loss from such
disputes is probable.
As discussed more fully in Part II - Item 1. "Legal Proceedings," PHS is
currently involved in two lawsuits with its former client, Baltimore County,
Maryland (the "County"); one of the two lawsuits involves the County's lack of
payment for services rendered. PHS has approximately $1.7 million of receivables
due from the County, primarily related to services rendered between April 1,
2006 and September 14, 2006, the date the Company's relationship with the County
was terminated. The County has refused to pay PHS for these amounts and
therefore, on October 27, 2006, PHS filed suit against the County in the Circuit
Court for Baltimore County, Maryland seeking collection of the outstanding
receivables balance, damages for breach of contract, quantum meruit, and unjust
enrichment as well as prejudgment interest. PHS believes, in the case of this
lawsuit, that it has a valid and meritorious cause of action and, as a result,
has concluded that the outstanding receivables, which represent services
performed under the relationship between the parties, are probable of
collection. Although PHS believes it has valid contractual and legal arguments,
an adverse result in this lawsuit could have a negative impact on the results of
this matter and/or PHS' ability to collect the outstanding receivables amount.
These receivables are classified as other noncurrent assets in the Company's
condensed consolidated balance sheet.
Changes in circumstances related to the matter discussed above involving the
County, or any other receivables, could result in a change in the allowance for
doubtful accounts or the estimate of contractual adjustments in future periods.
Such change, if it were to occur, could have a material adverse affect on the
Company's results of operations and financial position in the period in which
the change occurs.
Loss Contracts
On a quarterly basis, the Company performs a review of its portfolio of
contracts for the purpose of identifying potential loss contracts and developing
a loss contract reserve for succeeding periods if any loss contracts are
identified. The Company accrues losses under its fixed price contracts when it
is probable that a loss has been incurred and the amount of the loss can be
reasonably estimated. The Company performs this loss accrual analysis on a
specific contract basis taking into consideration such factors as the Company's
ability to terminate the contract, future contractual revenue, projected future
healthcare and maintenance costs, projected future stop-loss insurance
recoveries and the contract's specific terms related to future revenue increases
as compared to increased healthcare costs. The projected future healthcare and
maintenance costs are estimated based on historical trends and management's
estimate of future cost increases. These estimates are subject to the same
adverse fluctuations and future claims experience as previously noted.
In the course of performing its reviews in future periods, the Company might
identify contracts which have become loss contracts due to a change in
circumstances. Circumstances that might change and result in the identification
of a contract as a loss contract in a future period include interpretations
regarding contract termination or expiration provisions, unanticipated adverse
changes in the healthcare cost structure, inmate population or the utilization
of outside medical services in a contract, where such changes are not offset by
increased healthcare revenues. Should a contract be identified as a loss
contract in a future period, the Company would record, in the period in which
such identification is made, a reserve for the estimated future losses that
would be incurred under the contract. The identification of a loss contract in
the future could have a material adverse effect on the Company's results of
operations in the period in which the reserve is recorded.
There are no loss contracts identified as of September 30, 2009.
Professional and General Liability Self-Insurance Retention
As a healthcare provider, the Company's business occasionally results in
actions for negligence and other causes of action related to its provision of
healthcare services with the attendant risk of substantial damage awards, or
court ordered non-monetary relief such as, changes in operating practices or
procedures, which may lead to the potential for substantial increases in the
Company's operating expenses. The most significant source of potential
liability in this regard is the risk of suits brought by inmates alleging
negligent healthcare services, deliberate indifference to their medical needs or
the lack of timely or adequate healthcare services. The Company may also be
liable, as employer, for the negligence of healthcare professionals it employs
or healthcare professionals with whom it contracts. The Company's contracts
generally provide for the Company to indemnify the governmental agency for
losses incurred related to healthcare provided by the Company and its agents.
To mitigate a portion of this risk, the Company maintains a primary
professional liability insurance program, principally on a claims-made basis.
For 2002 through 2006 and 2008 through 2009 with respect to the majority of its
patients, the Company purchased commercial insurance coverage, but is
effectively self-insured due to the terms of the coverage which include
adjustable premiums. For 2002 through 2006 and 2008 through 2009, the Company is
covered by separate policies each of which contains a premium that is
retroactively adjusted, with adjustment based on actual losses. The Company's
ultimate premium for its 2002 through 2006 and 2008 through 2009 policies will
depend on the final incurred losses related to each of these separate policy
periods. For 2007, the Company is insured through claims made policies subject
to per event and aggregate coverage limits. Any amounts ultimately incurred
above these coverage limits would be the responsibility of the Company.
Management establishes reserves for the estimated losses that will be incurred
under these insurance policies after taking into consideration the Company's
professional liability claims department and external counsel evaluations of the
merits of the individual claims, analysis of claim history, actuarial analysis
and coverage limits where applicable. Any adjustments resulting from the review
are reflected in current earnings.
Given the fact that many claims are not brought during the year of
occurrence, in addition to its reserves for known claims, the Company maintains
a reserve for incurred but not reported claims. The reserve for incurred but not
reported claims is recorded on an undiscounted basis. The Company's estimates of
this reserve are supported by various analyses, including an actuarial analysis,
which is performed on a quarterly basis.
At September 30, 2009, the Company's reserves for both known as well as
incurred but not reported claims totaled $27.8 million. Reserves for medical
malpractice claims fluctuate because the number of claims and the severity of
the underlying incidents change from one period to the next. Reserves for
medical malpractice claims can also fluctuate as a result of court decisions or
as new facts become available. Furthermore, payments with respect to previously
estimated liabilities frequently differ from the estimated liability. Changes in
estimates of losses resulting from such fluctuations and differences between
management's established reserves and actual loss payments are recognized by an
adjustment to the reserve for medical malpractice claims in the period in which
the estimates are changed or payments are made. For the nine months ended
September 30, 2009 and 2008, the Company recorded increases of approximately
$5.6 million and $2.1 million, respectively, related to its prior year known
claims reserves as a result of adverse developments. The reserves can also be
affected by changes in the financial health of the third-party insurance
carriers used by the Company. If a third party insurance carrier fails to meet
its contractual obligations under the agreement with the Company, the Company
would then be responsible for such obligations. Such changes could have a
material adverse effect on the Company's financial position and its results of
operations in the period in which the changes occur.
Other Self-Funded Insurance Reserves
At September 30, 2009, the Company has approximately $8.7 million in accrued
liabilities for employee health and workers' compensation claims. Approximately
$7.3 million of this amount is related to workers' compensation claims, of which
approximately $3.3 million is included within the noncurrent portion of accrued
expenses as it is not expected to be paid within a year. The Company is
essentially self-insured for employee health and workers' compensation claims
subject to certain individual case stop loss levels. As such, its insurance
expense is largely dependent on claims experience and the ability to control
claims. The Company accrues the estimated liability for employee health
insurance based on its history of claims experience and estimated time lag
between the incident date and the date of actual claim payment. The Company
accrues the estimated liability for workers' compensation claims based on
evaluations of the merits of the individual claims and analysis of claims
history. These estimated liabilities are recorded on an undiscounted basis. An
actuarial analysis is prepared at least annually as an additional tool to be
considered by management in evaluating the adequacy of the Company's reserve for
workers' compensation claims. These estimates of self-funded insurance reserves
could change in the future based on changes in the factors discussed above. Any
adjustments resulting from such changes in estimates are reflected in current
earnings.
Legal Contingencies
In addition to professional and general liability claims, the Company is also
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