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| USMD > SEC Filings for USMD > Form 10-Q on 14-Aug-2012 | All Recent SEC Filings |
14-Aug-2012
Quarterly Report
This Quarterly Report on Form 10-Q contains, and from time to time management may make, statements that may constitute "forward-looking statements" within the meaning of the safe harbor provisions of the Private Securities Litigation Reform Act of 1995. Forward-looking statements are not historical facts but instead represent management's current expectations regarding future events, many of which, by their nature, are inherently uncertain and outside its control. The forward-looking statements contained in this Quarterly Report are based on information as of the date of this Quarterly Report. Many of these forward-looking statements relate to future industry trends, actions, future performance or results of current and anticipated initiatives and the outcome of contingencies and other uncertainties that may have a significant impact on Holdings' business, future operating results and liquidity. Whenever possible, Holdings identifies these statements by using words such as "anticipate," "believe," "estimate," "continue," "intend," "expect," "plan," "forecast," "project" and similar expressions, for future-tense or conditional constructions ("will," "may," "should," "could," etc.). Holdings cautions you that these statements are only predictions and are not guarantees of future performance. These forward-looking statements and Holdings actual results, developments and business are subject to certain risks and uncertainties that could cause actual results and events to differ materially from those anticipated by these statements. By identifying these statements for you in this manner, we are alerting you to the possibility that our actual results may differ, possibly materially, from the anticipated results indicated in these forward-looking statements. Holdings assumes no obligation to update or revise any forward-looking statements, whether as a result of new information or future events, except as required by law. Many factors that could cause actual results to differ from those in the forward-looking statements including, among others, those discussed under "Risk Factors," in Holdings' Form S-4 registration statement and those described elsewhere in this Quarterly Report on Form 10-Q and from time to time in Holdings' future reports filed with the Securities and Exchange Commission.
Executive Overview
Holdings is a Delaware corporation formed on May 7, 2010 to facilitate the business combination of USMD, UANT and Ventures. On August 19, 2010, Holdings, USMD, Ventures and UANT entered into the Original Contribution Agreement pursuant to which the entities would combine into a single integrated health services company. Immediately prior to the Contribution, a subsidiary of Ventures would merge with and into UANT, resulting in UANT's becoming a wholly-owned subsidiary of Ventures, and certain of the USMD shareholders would contribute all or a portion of their shares of USMD common stock to Ventures in exchange for partnership interests in Ventures. When the contribution is consummated, Ventures would contribute all of its assets, which would include its equity interests in USMD and UANT, and the remaining USMD shareholders would contribute their USMD shares, to Holdings in exchange for shares of Holdings common stock. Holdings described the Contribution in its Registration Statement on Form S-4 filed with the SEC on December 23, 2010 (File No. 333-171386) and declared effective by the SEC on July 25, 2011. On August 23, 2011, the shareholders of USMD and the partners of Ventures voted on and approved the Original Contribution Agreement.
On December 1, 2011, Ventures and Holdings entered into a merger agreement with MCNT, and on December 15, 2011, Ventures and Holdings entered into a merger agreement with Impel. These merger agreements provide that subsidiaries of Ventures will merge with and into each of MCNT and Impel, with MCNT and Impel surviving as wholly-owned subsidiaries of Ventures. As a result of these merger agreements, on February 9, 2012, Holdings, USMD, UANT and Ventures executed the Amendment to reflect, among other changes, that Ventures will contribute to Holdings, in addition to its equity interests in USMD and UANT, its equity interests in MCNT and Impel as part of the Contribution. On May 21, 2012, Ventures, Holdings, MCNT and Impel executed a corresponding amendment to the merger agreements. On May 29, 2012, USMD, Ventures, MCNT and Impel voted on and approved the Amendment. Holdings expects the Contribution to close during the third quarter of 2012.
Through June 30, 2012, Holdings had no operations or cash flows except for the expenses associated with a share-based payment, periodic reporting to the SEC and in preparation for the Contribution and the new post-Contribution organization. Holdings' only assets, liabilities and equity are related to these items. As such, except for certain forward-looking discussions, Holdings has not presented significant discussions of its results of operations or liquidity and capital resources.
Holdings will operate the businesses that are currently owned and operated by USMD, UANT, Ventures, MCNT and Impel. The growth and success of Holdings in the near term largely depends on Holdings' ability to:
• consummate the Contribution;
• increase the number of patients served by its subsidiaries and the health care providers it manages;
• successfully open new facilities or expand existing facilities;
• successfully integrate its acquired and/or managed facilities into existing operations; and
• maintain productive relationships with physician and hospital partners.
In addition, Holdings intends to vertically expand its business in the North Texas service area by developing or acquiring complementary physician group practices and ancillary healthcare service providers. Holdings plans to horizontally expand its business in other strategic service areas by developing strategic alliances with large integrated practices and expanding the medical service lines of those medical groups in those service areas. Holdings believes that the opportunity to execute its business combination with USMD, UANT, Ventures, MCNT and Impel and to develop or acquire targeted physician group practices and ancillary healthcare service providers will place it in a position to achieve its goal of becoming a national integrated health services company.
Key Development
• On February 9, 2012, Holdings, USMD, UANT and Ventures entered into the Amendment to reflect, among other changes, that Ventures will contribute to Holdings, in addition to its equity interests in USMD and UANT, its equity interests in MCNT and Impel as part of the Contribution. On May 21, 2012, Ventures, Holdings, MCNT and Impel executed a corresponding amendment to the merger agreements. On May 29, 2012, USMD, Ventures, MCNT and Impel voted on and approved the Amendment.
Results of Operations
As of June 30, 2012 and for the three and six month periods ending June 30, 2012 and 2011, Holdings had no operations or revenues. Expenses were limited to activity associated with the issuance of restricted common shares, expenses associated with the preparation and filing of periodic reports with the SEC and expenses in preparation for the Contribution and the new post-Contribution organization. MCNT, UANT and USMD, the entity that will be the accounting acquirer in the event the Contribution is consummated, are paying the majority of those expenses, and Holdings records related party payables to these entities for those expenses.
Liquidity and Capital Resources
As of June 30, 2012 and for the three and six month periods ending June 30, 2012 and 2011, Holdings had no net cash flows.
In the event the Contribution is consummated, Holdings expects to utilize cash flows from the operations of its subsidiaries to fund operations and meet principal and interest payment obligations. Holdings is currently negotiating a corporate credit agreement to provide term loan facilities and a revolving line of credit facility for the purpose of refinancing existing indebtedness at acquired subsidiaries and to finance working capital needs in the ordinary course of business. The credit facilities are expected to be secured by certain assets and equity interest of Holdings and will have terms ranging between six months and five years. Part of Holdings' overall business strategy is to make strategic acquisitions of complementary healthcare facilities and physician practice groups and Holdings' may rely heavily on financing in order to fulfill this strategy. To the extent Holdings is unable to secure the necessary acquisition financing, it may be hampered or delayed in its ability to acquire such entities and, thus, may be unable to fulfill timely its acquisition strategy. Holdings currently has no commitments for capital expenditures.
If the Contribution is completed, Holdings has agreed to pay for the reasonable and documented out of pocket costs and expenses of MCNT and Impel incurred in connection with the Contribution in an aggregate amount not to exceed $500,000. Such costs shall include without limitation fees paid by MCNT and Impel to attorneys and valuation, financial and investment banking advisors. Holdings has been advised that the maximum amount of such reimbursable aggregate expenses has been exceeded by MCNT and Impel.
Supplemental USMD Management's Discussion and Analysis of Financial Condition and Results of Operations
Holdings is presenting supplemental management's discussion and analysis of financial condition and results of operations of USMD (the "USMD MD&A"), the predecessor entity that will be considered the accounting acquirer in the event the Contribution is consummated. Following is the USMD MD&A for the three and six month interim periods ended June 30, 2012 and 2011.
Executive Overview
USMD provides finance, revenue cycle, centralized business office, clinical, operational and business development services, or a selection of these management services, to healthcare providers. USMD owns and operates three healthcare management companies - USMD Hospital Division, USMD CTC Division and USMD Lithotripsy Division - formed principally to establish, invest in, operate and/or manage acute-care hospitals, cancer treatment centers and lithotripsy service providers. USMD's revenues are comprised of management, operational and clinical services revenue received from contracts with certain health care providers and the revenue of consolidated lithotripsy entities. In addition, USMD generates income from equity in income of nonconsolidated affiliates that results from the allocation to USMD of its proportionate share of income of its nonconsolidated affiliates.
USMD Hospital Division is a healthcare management services company that has beneficial partnership interests of 5% and 20% in hospital partnerships located in Arlington and Fort Worth, Texas, respectively. USMD Hospital Division owns 100% of the general partners of both of these partnerships and manages their hospital operations pursuant to long-term contractual management agreements.
USMD Arlington owns and operates an acute care hospital that has 34 inpatient licensed beds. Its surgery unit is comprised of 18 day surgery beds, two procedure rooms and nine operating rooms. The hospital performs inpatient and outpatient surgeries in a variety of specialties that include urology, neurosurgery, general surgery, gynecology, podiatry, plastic surgery, pain management and orthopedics. Other services include an in-house laboratory, diagnostic radiology, computed tomography, magnetic resonance imaging, nuclear medicine and ultrasound. The hospital also has an emergency department. A wholly-owned subsidiary of USMD Hospital Division is the general partner of USMD Arlington.
USMD Fort Worth owns and operates an acute care hospital that opened in March 2008 and has six operating rooms and eight licensed inpatient beds. The hospital performs inpatient and outpatient surgeries in a variety of specialties that include urology, ENT, general surgery, gynecology, podiatry, plastic surgery, oral surgery and orthopedics. Other services include an in-house laboratory, diagnostic radiology, computed tomography scans and ultrasound. A wholly-owned subsidiary of USMD Hospital Division is the general partner of USMD Fort Worth.
USMD CTC Division is a healthcare management services company formed to develop, invest in, operate and/or manage cancer treatment centers providing radiotherapy solutions to advance cancer care. As of June 30, 2012, USMD CTC Division had six contractual agreements under which USMD CTC Division provided management services to nine operational cancer treatment centers located in Texas, Florida, Missouri and Arizona. USMD CTC Division also has an equity method investment in a cancer treatment center in Monterrey, Mexico, and is actively pursuing investment and management contracts with radiation treatment centers.
USMD Lithotripsy Division is a healthcare management services partnership formed to establish, invest in or acquire, operate and/or manage joint venture entities that provide lithotripsy services to hospitals, ambulatory surgery centers, and/or physician offices. As of June 30, 2012, USMD Lithotripsy Division provided management services to 23 lithotripsy service providers, either pursuant to a management agreement or as a result of its role as general partner or managing member of such providers. In addition, USMD Lithotripsy Division owns equity interests in substantially all of these lithotripsy service providers. The lithotripsy service providers are primarily located in the South Central United States. The balance sheets and results of operations of the entities for which USMD served as the general partner are included in USMD's consolidated financial statements.
Sources of Revenue
USMD Hospital Division primarily generates revenue from management services provided by USMD Hospital Division to USMD Arlington and USMD Fort Worth. Management fees are based on a percentage of each hospital's adjusted net patient revenues, i.e., net patient service revenues and medical office building base rent minus bad debt expense. Hospital net patient service revenue depends on a variety of factors, such as surgical case volume, the case mix or intensity of utilization of services and the mix of third-party payer sources. USMD Hospital Division provides the hospitals with management, information technology and revenue cycle staff, and the hospitals pay USMD Hospital Division for the labor costs associated with staffing these functions. Billings for these services are included in management services revenue.
USMD CTC Division primarily earns revenue through the provision of broad-based management and clinical (physics) services to cancer treatment centers. In addition, USMD CTC Division recognizes revenue that represents payment for certain operating expenses such as operations and revenue cycle staffing. Billings for these services are included in management services revenue.
USMD Lithotripsy Division primarily generates revenue through the provision of lithotripsy services to hospitals in nine states by its consolidated entities. USMD typically provides these lithotripsy services to its hospital, ambulatory surgery center and physician office clients based on contracted fee-for-service arrangements. USMD Lithotripsy Division also recognizes revenue that represents payment for certain operating expenses such as operations staffing and revenue cycle staffing and accounting services.
Key Developments
• On December 31, 2011, the partnership for a managed lithotripsy entity expired. On January 1, 2012, USMD entered into a new partnership agreement with this entity. Terms of the new agreement for this entity necessitate consolidation accounting and beginning January 1, 2012, USMD consolidates the entity's balance sheet and results of operations.
• On June 19, 2012, USMD submitted a private placement memorandom to certain investors offering shares of common stock of USMD at a purchase price of $2.80 per share. The maximum number of shares available under the offering is 350,000. As of August 6, 2012, USMD had received and accepted subscriptions from 103 investors for the 350,000 shares available under this offering. Proceeds totaling $980,000 were received by USMD subsequent to June 30, 2012. The shares have not been registered or qualified under the Securities Act of 1933, as amended , or the securities laws of any state or other jurisdiction. The offering is intended to provide additional working capital for USMD and to increase the number of record holders of USMD common stock.
Key Drivers and Challenges
• Given the current contracted managed care reimbursement rates at USMD Arlington and USMD Fort Worth, USMD believes the management fee revenue it receives is sufficient to fund its working capital and routine capital expenditure requirements with cash flow from operations. USMD's debt capacity is currently constrained by its ability to service additional debt and the tight credit markets. See further discussion in the "Liquidity and Capital Resources" section of the USMD MD&A.
• As the ongoing economic climate has increased the number of underinsured patients, and as the prevalence of high deductible insurance plans has increased, USMD anticipates that a higher percentage of revenues of USMD Arlington and USMD Fort Worth will be comprised of the patients' share of cost. This shift in payer mix may have an unfavorable impact on hospital collection rates, which could have an unfavorable impact on USMD's revenue-based management fees.
Supplemental Results of Operations for USMD
Three Months Ended June 30, 2012 Compared to Three Months Ended June 30, 2011
The following table summarizes USMD's results of operations for the periods
indicated and is used in the discussions that follow (in thousands):
Three Months Ended June 30, Three Months Variance
2012 2011 2012 vs. 2011
Amount Ratio Amount Ratio Amount Ratio
Revenues:
Management services revenue $ 5,687 49.5 % $ 5,792 50.8 % $ (105 ) -1.8 %
Lithotripsy revenue 5,795 50.5 % 5,603 49.2 % 192 3.4 %
Net operating revenue 11,482 100.0 % 11,395 100.0 % 87 0.8 %
Operating expenses:
Salaries, wages and employee
benefits 5,245 45.7 % 4,923 43.2 % 322 6.5 %
Medical supplies and services
expense 94 0.8 % 132 1.2 % (38 ) -28.8 %
Provision for doubtful accounts 36 0.3 % (13 ) -0.1 % 49 -376.9 %
Other operating expenses 2,141 18.6 % 2,666 23.4 % (525 ) -19.7 %
Depreciation and amortization 272 2.4 % 233 2.0 % 39 16.7 %
7,788 67.8 % 7,941 69.7 % (153 ) -1.9 %
Income from operations 3,694 32.2 % 3,454 30.3 % 240 6.9 %
Other income (expense), net 371 3.2 % 248 2.2 % 123 49.6 %
Income before provision for income
taxes 4,065 35.4 % 3,702 32.5 % 363 9.8 %
Provision for income taxes (233 ) -2.0 % (279 ) -2.4 % 46 -16.5 %
Net income 3,832 33.4 % 3,423 30.0 % 409 11.9 %
Less: net income attributable to
noncontrolling interests (3,262 ) -28.4 % (3,363 ) -29.5 % 101 -3.0 %
Net income attributable to USMD $ 570 5.0 % $ 60 0.5 % $ 510 850.0 %
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Revenues
Net operating revenue increased 0.8% to $11.5 million for the three months ended June 30, 2012, from $11.4 million for the same period in 2011, due to a 1.8% decrease in management services revenue offset by a 3.4% increase in lithotripsy revenue.
Management services revenue includes revenue earned through the provision of management and staffing services to USMD's managed entities and decreased 1.8% to $5.7 million for the three months ended June 30, 2012 from $5.8 million for the same period in 2011. USMD Hospital Division management services revenue increased $0.1 million as a result of higher acuity case mix and volume at the two managed hospitals as well as inflation adjustments to the reimbursable management costs associated with the two managed hospitals. USMD Lithotripsy Division management services revenue remained flat while the USMD CTC Division management services revenue decreased $0.2 million. The decrease in the USMD CTC Division occurred due to the termination of management agreements with two existing cancer treatment centers during the second and third quarter of 2011 partially offset by the opening of one cancer treatment center in the fourth quarter of 2011. CTC case counts have declined 4.9% for the three months ended June 30, 2012 compared to the same period in 2011.
Lithotripsy revenue consists of revenue of the consolidated lithotripsy entities, which increased 3.4%, to $5.8 million for the three months ended June 30, 2012, from $5.6 million for the same period in 2011. This increase in revenue coincides with the lithotripsy entity case count increase of 3.6% as compared to the same period in 2011.
Operating Expenses
Salaries, wages and employee benefits as a percentage of revenue increased to 45.7% for the three months ended June 30, 2012 from 43.2% for the same period in 2011. The $0.3 million increase is primarily due to a $0.1 million increase in contracted labor costs and benefits accrued in the USMD Hospital Division as well as an increase of $0.3 million in share-based compensation expense, 2012 variable bonuses accrued and staffing expense increase related to the expansion of centralized financial reporting staff and other departments at the corporate offices. These increases are offset by a $0.1 million decrease in the USMD CTC Division.
Other operating expenses consist primarily of professional fees, purchased services, facilities expense, travel expense and other expense. Other operating expenses decreased $0.5 million to $2.1 million for the three months ended June 30, 2012 primarily due to a $0.8 million decrease in professional fees and purchased services related to the filing of the Registration Statement on Form S-4 in 2011. This was offset by a $0.2 million increase in travel and other expenses and a $0.1 million increase in facilities expenses across the USMD Lithotripsy Division.
Other Income (Expense)
Other income increased $0.1 million to $0.4 million for the three months ended June 30, 2012, compared to the same period in 2011. The variance is primarily due to a $0.1 million partial recovery of an investment previously written off by the USMD CTC Division.
The income tax provision decreased $0.1 million to $0.2 million for the three months ended June 30, 2012, from $0.3 million for the same period in 2011. USMD's effective tax rates were 5.7% and 7.5% for the three months ended June 30, 2012 and 2011, respectively. The decrease is primarily due to the impact of net income attributable to noncontrolling interest.
Net income attributable to noncontrolling interests decreased $0.1 million to $3.3 million for the three months ended June 30, 2012, from $3.4 million for the same period in 2011, due to a decline in net income of the consolidated lithotripsy entities .
Six Months Ended June 30, 2012 Compared to Six Months Ended June 30, 2011
The following table summarizes USMD's results of operations for the periods
indicated and is used in the discussions that follow (in thousands):
Six Months Ended June 30, Six Months Variance
2012 2011 2012 vs. 2011
Amount Ratio Amount Ratio Amount Ratio
Revenues:
Management services revenue $ 11,707 51.6 % $ 11,704 52.5 % $ 3 0.0 %
Lithotripsy revenue 11,000 48.4 % 10,571 47.5 % 429 4.1 %
Net operating revenue 22,707 100.0 % 22,275 100.0 % 432 1.9 %
Operating expenses:
Salaries, wages and employee benefits 10,721 47.2 % 9,689 43.5 % 1,032 10.7 %
Medical supplies and services expense 196 0.9 % 200 0.9 % (4 ) -2.0 %
Provision for doubtful accounts 72 0.3 % 29 0.1 % 43 148.3 %
Other operating expenses 4,201 18.5 % 4,445 20.0 % (244 ) -5.5 %
Depreciation and amortization 537 2.4 % 510 2.3 % 27 5.3 %
15,727 69.3 % 14,873 66.8 % 854 5.7 %
Income from operations 6,980 30.7 % 7,402 33.2 % (422 ) -5.7 %
Other income (expense), net 482 2.1 % 518 2.3 % (36 ) -6.9 %
Income before provision for income
taxes 7,462 32.9 % 7,920 35.6 % (458 ) -5.8 %
Provision for income taxes (521 ) -2.3 % (824 ) -3.7 % 303 -36.8 %
Net income 6,941 30.6 % 7,096 31.9 % (155 ) -2.2 %
Less: net income attributable to
noncontrolling interests (5,988 ) -26.4 % (6,324 ) -28.4 % 336 -5.3 %
Net income attributable to USMD $ 953 4.2 % $ 772 3.5 % $ 181 23.4 %
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Revenues
Net operating revenue increased 1.9% to $22.7 million for the six months ended June 30, 2012, as compared to the same period in 2011, due to an increase in lithotripsy revenue while management services revenue remained flat.
Lithotripsy revenue consists of revenue of the consolidated lithotripsy entities, which increased 4.1%, or $0.4 million, to $11.0 million for the six months ended June 30, 2012 from $10.6 million for the same period in 2011. This increase in revenue coincides with the lithotripsy entity case count increase of 3.9% as compared to the same period in 2011.
Operating Expenses
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