XFRA:UHS Universal Health Services Inc Class B Quarterly Report 10-Q Filing - 3/31/2012

Effective Date 3/31/2012

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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 March 31, 2012

OR

 

¨ TRANSITION REPORT PURSUANT TO SECTION 13 OR 15(d) OF THE SECURITIES EXCHANGE ACT OF 1934

For the transition period from             to             

Commission file number 1-10765

 

 

UNIVERSAL HEALTH SERVICES, INC.

(Exact name of registrant as specified in its charter)

 

 

 

DELAWARE   23-2077891

(State or other jurisdiction of

incorporation or organization)

 

(I.R.S. Employer

Identification No.)

UNIVERSAL CORPORATE CENTER

367 SOUTH GULPH ROAD

KING OF PRUSSIA, PENNSYLVANIA 19406

(Address of principal executive offices) (Zip Code)

Registrant’s telephone number, including area code (610) 768-3300

 

 

Indicate by check mark whether the registrant: (1) has filed all reports required to be filed by Section 13 or 15(d) of the Securities Exchange Act of 1934 during the preceding 12 months (or for such shorter period that the registrant was required to file such reports), and (2) has been subject to such filing requirements for the past 90 days.    Yes  x    No  ¨

Indicate by check mark whether the registrant has submitted electronically and posted on its corporate website, if any, every Interactive Data File required to be submitted and posted pursuant to Rule 405 of Regulation S-T (232.405 of this chapter) during the preceding 12 months (or for such shorter period that the registrant was required to submit and post such files).    Yes  x    No  ¨

Indicate by check mark whether the registrant is a large accelerated filer, an accelerated filer, a non-accelerated filer, or a smaller reporting company. See the definitions of “large accelerated filer,” “accelerated filer” and “smaller reporting company” in Rule 12b-2 of the Exchange Act.

 

Large accelerated filer   x    Accelerated filer   ¨
Non-accelerated filer   ¨    Smaller reporting company   ¨

Indicate by check mark whether the registrant is a shell company (as defined in Rule 12b-2 of the Exchange Act).    Yes  ¨    No  x

Indicate the number of shares outstanding of each of the issuer’s classes of common stock, as of the latest practicable date. Common shares outstanding, as of April 30, 2012:

 

Class A

     6,625,708   

Class B

     89,499,771   

Class C

     664,000   

Class D

     32,388   

 

 

 


Table of Contents

UNIVERSAL HEALTH SERVICES, INC.

INDEX

 

     PAGE NO.  

PART I. FINANCIAL INFORMATION

  

Item 1. Financial Statements

  

Condensed Consolidated Statements of Income – Three Months Ended March 31, 2012 and 2011

     3   

Condensed Consolidated Statements of Comprehensive Income – Three Months Ended March  31, 2012 and 2011

     4   

Condensed Consolidated Balance Sheets – March 31, 2012 and December 31, 2011

     5   

Condensed Consolidated Statements of Cash Flows – Three Months Ended March 31, 2012 and 2011

     6   

Notes to Condensed Consolidated Financial Statements

     7   

Item 2. Management’s Discussion and Analysis of Financial Condition and Results of Operations

     23   

Item 3. Quantitative and Qualitative Disclosures About Market Risk

     41   

Item 4. Controls and Procedures

     41   

PART II. Other Information

     42   

Item 1. Legal Proceedings

     42   

Item 1A. Risk Factors

     44   

Item 2. Unregistered Sales of Equity Securities and Use of Proceeds

     44   

Item 6. Exhibits

     44   

Signatures

     46   

EXHIBIT INDEX

     47   

In this Report on Form 10-Q for the quarterly period ended March 31, 2012, “we,” “us,” “our” and the “Company” refer to Universal Health Services, Inc. and its subsidiaries. UHS is a registered trademark of UHS of Delaware, Inc., the management company for, and a wholly-owned subsidiary of Universal Health Services, Inc. Universal Health Services, Inc. is a holding company and operates through its subsidiaries including its management company, UHS of Delaware, Inc. All healthcare and management operations are conducted by subsidiaries of Universal Health Services, Inc. To the extent any reference to “UHS” or “UHS facilities” in this report including letters, narratives or other forms contained herein relates to our healthcare or management operations it is referring to Universal Health Services, Inc.’s subsidiaries including UHS of Delaware, Inc. Further, the terms “we,” “us,” “our” or the “Company” in such context similarly refer to the operations of Universal Health Services Inc.’s subsidiaries including UHS of Delaware, Inc. Any reference to employees or employment contained herein refers to employment with or employees of the subsidiaries of Universal Health Services, Inc. including UHS of Delaware, Inc.

 

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PART I. FINANCIAL INFORMATION

UNIVERSAL HEALTH SERVICES, INC. AND SUBSIDIARIES

CONDENSED CONSOLIDATED STATEMENTS OF INCOME

(amounts in thousands, except per share amounts)

(unaudited)

 

     Three months ended  
     March 31,  
     2012      2011  

Net revenues before provision for doubtful accounts

   $ 1,977,003       $ 1,910,528   

Less: Provision for doubtful accounts

     151,714         153,116   
  

 

 

    

 

 

 

Net revenues

     1,825,289         1,757,412   

Operating charges:

     

Salaries, wages and benefits

     889,506         845,864   

Other operating expenses

     359,541         349,446   

Supplies expense

     209,532         207,170   

Depreciation and amortization

     73,820         71,351   

Lease and rental expense

     23,862         23,168   
  

 

 

    

 

 

 
     1,556,261         1,496,999   
  

 

 

    

 

 

 

Income from operations

     269,028         260,413   

Interest expense, net

     46,710         56,417   
  

 

 

    

 

 

 

Income before income taxes

     222,318         203,996   

Provision for income taxes

     79,748         74,009   
  

 

 

    

 

 

 

Net income

     142,570         129,987   

Less: Income attributable to noncontrolling interests

     13,963         15,794   
  

 

 

    

 

 

 

Net income attributable to UHS

   $ 128,607       $ 114,193   
  

 

 

    

 

 

 

Basic earnings per share attributable to UHS

   $ 1.33       $ 1.17   
  

 

 

    

 

 

 

Diluted earnings per share attributable to UHS

   $ 1.31       $ 1.15   
  

 

 

    

 

 

 

Weighted average number of common shares - basic

     96,593         97,381   

Add: Other share equivalents

     1,198         1,487   
  

 

 

    

 

 

 

Weighted average number of common shares and equivalents - diluted

     97,791         98,868   
  

 

 

    

 

 

 

The accompanying notes are an integral part of these consolidated financial statements.

 

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UNIVERSAL HEALTH SERVICES, INC. AND SUBSIDIARIES

CONDENSED CONSOLIDATED STATEMENTS OF COMPREHENSIVE INCOME

(amounts in thousands, unaudited)

 

     Three months ended  
     March 31,  
     2012     2011  

Net income

   $ 142,570      $ 129,987   

Other comprehensive income (loss):

    

Unrealized derivative gains on cash flow hedges

     1,615        2,307   

Amortization of terminated hedge

     (84     (84
  

 

 

   

 

 

 

Other comprehensive income before tax

     1,531        2,223   

Income tax expense related to items of other comprehensive income

     582        860   
  

 

 

   

 

 

 

Total other comprehensive income, net of tax

     949        1,363   
  

 

 

   

 

 

 

Comprehensive income

     143,519        131,350   

Less: Comprehensive income attributable to noncontrolling interests

     13,963        15,794   
  

 

 

   

 

 

 

Comprehensive income attributable to UHS

   $ 129,556      $ 115,556   
  

 

 

   

 

 

 

The accompanying notes are an integral part of these consolidated financial statements.

 

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UNIVERSAL HEALTH SERVICES, INC. AND SUBSIDIARIES

CONDENSED CONSOLIDATED BALANCE SHEETS

(amounts in thousands, unaudited)

 

     March 31,     December 31,  
     2012     2011  

Assets

    

Current assets:

    

Cash and cash equivalents

   $ 41,999      $ 41,229   

Accounts receivable, net

     1,116,634        969,802   

Supplies

     96,974        96,775   

Other current assets

     91,622        99,859   

Deferred income taxes

     115,916        108,324   

Current assets held for sale

     0        48,916   
  

 

 

   

 

 

 

Total current assets

     1,463,145        1,364,905   
  

 

 

   

 

 

 

Property and equipment

     5,185,774        5,106,160   

Less: accumulated depreciation

     (1,881,538     (1,818,180
  

 

 

   

 

 

 
     3,304,236        3,287,980   
  

 

 

   

 

 

 

Other assets:

    

Goodwill

     2,629,765        2,627,602   

Deferred charges

     105,870        111,780   

Other

     280,265        272,978   
  

 

 

   

 

 

 
   $ 7,783,281      $ 7,665,245   
  

 

 

   

 

 

 

Liabilities and Stockholders’ Equity

    

Current liabilities:

    

Current maturities of long-term debt

   $ 2,512      $ 2,479   

Accounts payable and accrued liabilities

     814,173        832,125   

Current liabilities held for sale

     0        2,329   

Federal and state taxes

     75,305        0   
  

 

 

   

 

 

 

Total current liabilities

     891,990        836,933   
  

 

 

   

 

 

 

Other noncurrent liabilities

     403,071        401,908   

Long-term debt

     3,581,844        3,651,428   

Deferred income taxes

     198,645        209,592   

Redeemable noncontrolling interests

     228,928        218,266   

UHS common stockholders’ equity

     2,427,312        2,296,352   

Noncontrolling interest

     51,491        50,766   
  

 

 

   

 

 

 

Total equity

     2,478,803        2,347,118   
  

 

 

   

 

 

 
   $ 7,783,281      $ 7,665,245   
  

 

 

   

 

 

 

The accompanying notes are an integral part of these consolidated financial statements.

 

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UNIVERSAL HEALTH SERVICES, INC. AND SUBSIDIARIES

CONDENSED CONSOLIDATED STATEMENTS OF CASH FLOWS

(amounts in thousands, unaudited)

 

     Three months  
     ended March 31,  
     2012     2011  

Cash Flows from Operating Activities:

    

Net income

   $ 142,570      $ 129,987   

Adjustments to reconcile net income to net cash provided by operating activities:

    

Depreciation & amortization

     73,820        71,526   

Stock-based compensation expense

     5,486        3,954   

Changes in assets & liabilities, net of effects from acquisitions and dispositions:

    

Accounts receivable

     (146,670     (103,919

Accrued interest

     13,280        12,875   

Accrued and deferred income taxes

     75,471        68,994   

Other working capital accounts

     (48,074     (27,056

Other assets and deferred charges

     7,120        6,777   

Other

     (2,082     11,208   

Accrued insurance expense, net of commercial premiums paid

     24,581        23,744   

Payments made in settlement of self-insurance claims

     (18,279     (14,913
  

 

 

   

 

 

 

Net cash provided by operating activities

     127,223        183,177   
  

 

 

   

 

 

 

Cash Flows from Investing Activities:

    

Property and equipment additions, net of disposals

     (92,563     (56,558

Proceeds received from sale of assets and businesses

     53,461        991   

Costs incurred for purchase and implementation of electronic health records application

     (14,501     (8,145

Return of deposit on terminated purchase agreement

     6,500        0   
  

 

 

   

 

 

 

Net cash used in investing activities

     (47,103     (63,712
  

 

 

   

 

 

 

Cash Flows from Financing Activities:

    

Reduction of long-term debt

     (70,942     (136,403

Additional borrowings

     0        73,500   

Financing costs

     0        (23,140

Repurchase of common shares

     (2,017     (3,170

Dividends paid

     (4,832     (4,876

Issuance of common stock

     1,016        1,251   

Profit distributions to noncontrolling interests

     (2,575     (4,025
  

 

 

   

 

 

 

Net cash used in financing activities

     (79,350     (96,863
  

 

 

   

 

 

 

Increase in cash and cash equivalents

     770        22,602   

Cash and cash equivalents, beginning of period

     41,229        29,474   
  

 

 

   

 

 

 

Cash and cash equivalents, end of period

   $ 41,999      $ 52,076   
  

 

 

   

 

 

 

Supplemental Disclosures of Cash Flow Information:

    

Interest paid

   $ 25,945      $ 37,130   
  

 

 

   

 

 

 

Income taxes paid, net of refunds

   $ 3,419      $ 4,527   
  

 

 

   

 

 

 

The accompanying notes are an integral part of these consolidated financial statements.

 

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UNIVERSAL HEALTH SERVICES, INC. AND SUBSIDIARIES

NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS

(1) General

This Report on Form 10-Q is for the quarterly period ended March 31, 2012. In this Quarterly Report, “we,” “us,” “our” and the “Company” refer to Universal Health Services, Inc. and its subsidiaries.

The condensed consolidated financial statements include the accounts of our majority-owned subsidiaries and partnerships and limited liability companies controlled by us, or our subsidiaries, as managing general partner or managing member. The condensed consolidated financial statements included herein have been prepared by us, without audit, pursuant to the rules and regulations of the Securities and Exchange Commission (“SEC”) and reflect all normal and recurring adjustments which, in our opinion, are necessary to fairly state results for the interim periods. Certain information and footnote disclosures normally included in financial statements prepared in accordance with accounting principles generally accepted in the United States of America have been condensed or omitted pursuant to such rules and regulations, although we believe that the accompanying disclosures are adequate to make the information presented not misleading. It is suggested that these condensed consolidated financial statements be read in conjunction with the consolidated financial statements, significant accounting policies and the notes thereto included in our Annual Report on Form 10-K for the year ended December 31, 2011.

(2) Relationship with Universal Health Realty Income Trust and Related Party Transactions

Relationship with Universal Health Realty Income Trust:

At March 31, 2012, we held approximately 6.2% of the outstanding shares of Universal Health Realty Income Trust (the “Trust”). We serve as Advisor to the Trust under an annually renewable advisory agreement pursuant to the terms of which we conduct the Trust’s day-to-day affairs, provide administrative services and present investment opportunities. In addition, certain of our officers and directors are also officers and/or directors of the Trust. Management believes that it has the ability to exercise significant influence over the Trust, therefore we account for our investment in the Trust using the equity method of accounting. We earned an advisory fee from the Trust, which is included in net revenues in the accompanying condensed consolidated statements of income, of $515,000 and $471,000 during the three-month periods ended March 31, 2012 and 2011, respectively. Our pre-tax share of income from the Trust was $300,000 for each of the three-month periods ended March 31, 2012 and 2011. The carrying value of this investment was $9.8 million and $9.9 million at March 31, 2012 and December 31, 2011, respectively, and is included in other assets in the accompanying condensed consolidated balance sheets. The market value of this investment, based on the closing price of the Trust’s stock on the respective dates, was $31.2 million at March 31, 2012 and $30.7 million at December 31, 2011.

Total rent expense under the operating leases on the hospital facilities with the Trust was $4.1 million during each of the three-month periods ended March 31, 2012 and 2011. In addition, certain of our subsidiaries are tenants in several medical office buildings owned by limited liability companies in which the Trust holds either 100% ownership interests or non-controlling majority ownership interests.

The table below details the renewal options and terms for each of our four hospital facilities leased from the Trust, giving effect to the above-mentioned renewals:

 

Hospital Name

   Type of Facility    Annual
Minimum
Rent
     End of Lease Term    Renewal
Term
(years)
 

McAllen Medical Center

   Acute Care    $ 5,485,000       December, 2016      15 (a) 

Wellington Regional Medical Center

   Acute Care    $ 3,030,000       December, 2016      15 (b) 

Southwest Healthcare System, Inland Valley Campus

   Acute Care    $ 2,648,000       December, 2016      15 (b) 

The Bridgeway

   Behavioral Health    $ 930,000       December, 2014      10 (c) 

 

(a) We have three 5-year renewal options at existing lease rates (through 2031).
(b) We have one 5-year renewal option at existing lease rates (through 2021) and two 5-year renewal options at fair market value lease rates (2022 through 2031).
(c) We have two 5-year renewal options at fair market value lease rates (2015 through 2024).

Other Related Party Transactions:

In December, 2010, our Board of Directors approved the Company’s entering into supplemental life insurance plans and agreements on the lives of our chief executive officer and his wife. As a result of these agreements, based on actuarial tables and other assumptions, during the life expectancies of the insureds, we would pay approximately $25 million in premiums and certain trusts, owned by our chief executive officer, would pay approximately $8 million in premiums. Based on the projected premiums mentioned above, and assuming the policies remain in effect until the death of the insureds, we will be entitled to receive death benefit proceeds of no less than $33 million representing the $25 million of aggregate premiums paid by us as well as the $8 million of aggregate premiums paid by the trusts. These agreements did not have a material effect on our consolidated financial statements or results of operations during 2011 or the first quarter of 2012.

A member of our Board of Directors and member of the Executive Committee is Of Counsel to the law firm used by us as our principal outside counsel. This Board member is also the trustee of certain trusts for the benefit of our Chief Executive Officer (“CEO”) and his family. This law firm also provides personal legal services to our CEO.

 

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(3) Other Noncurrent liabilities and Redeemable/Noncontrolling Interests

Other noncurrent liabilities include the long-term portion of our professional and general liability, workers’ compensation reserves, pension liability, and interest rate swaps.

Outside owners hold noncontrolling, minority ownership interests of: (i) approximately 28% in our five acute care facilities located in Las Vegas, Nevada; (ii) 20% in an acute care facility located in Washington, D.C.; (iii) approximately 11% in an acute care facility located in Laredo, Texas, and; (iv) 20% in a behavioral health care facility located in Philadelphia, Pennsylvania. The redeemable noncontrolling interest balances of $229 million and $218 million as of March 31, 2012 and December 31, 2011, respectively, and the noncontrolling interest balances of $51 million at both March 31, 2012 and December 31, 2011, consist primarily of the third-party ownership interests in these hospitals.

In connection with the five acute care facilities located in Las Vegas, Nevada, the minority ownership interests of which are reflected as redeemable noncontrolling interests on our Consolidated Balance Sheet, the outside owners have certain “put rights”, that are currently exercisable, that if exercised, require us to purchase the minority member’s interests at fair market value. The put rights are exercisable upon the occurrence of: (i) certain specified financial conditions falling below established thresholds; (ii) breach of the management contract by the managing member (a subsidiary of ours), or; (iii) if the minority member’s ownership percentage is reduced to less than certain thresholds. In connection with the behavioral health care facility located in Philadelphia, Pennsylvania, the minority ownership interest of which is also reflected as redeemable noncontrolling interests on our Consolidated Balance Sheet, the outside owner has a “put option” to put its entire ownership interest to us at any time. If exercised, the put option requires us to purchase the minority member’s interest at fair market value. As of March 31, 2012, we believe the fair market value of the minority ownership interests in these facilities approximates the book value of the redeemable noncontrolling interests.

(4) Long-term debt and cash flow hedges

Debt:

On November 15, 2010, we entered into a credit agreement (the “Credit Agreement”) with various financial institutions. The Credit Agreement is a senior secured facility which provided an initial aggregate commitment amount of $3.45 billion, comprised of a new $800 million revolving credit facility, a $1.05 billion Term Loan A facility and a $1.6 billion Term Loan B facility. Prior to the effectiveness of the Credit Agreement Amendment in March, 2011 (as discussed below), we prepaid the principal amount and permanently reduced the Term Loan B commitment by $125 million. During the first quarter of 2012, we made scheduled principal payments of $35 million on the Term Loan A and $13 million on the Term Loan B. The revolving credit facility and the Term Loan A mature on November 15, 2015 and the Term Loan B matures on November 15, 2016. The revolving credit facility includes a $125 million sub-limit for letters of credit. The Credit Agreement is secured by substantially all of the assets of the Company and our material subsidiaries and guaranteed by our material subsidiaries.

On March 15, 2011, we entered into a first amendment to the Credit Agreement (the “Amendment”) which became effective immediately and provides, among other things, for a reduction in the interest rates payable in connection with borrowings under the Credit Agreement. Upon the effectiveness of the Amendment, borrowings under the Credit Agreement bear interest at the ABR rate which is defined as the rate per annum equal to, at our election (1) the greatest of (a) the lender’s prime rate, (b) the weighted average of the federal funds rate, plus 0.5% and (c) one month Eurodollar rate plus 1%, in each case, plus an applicable margin based upon our consolidated leverage ratio at the end of each quarter ranging from 0.50% to 1.25% for revolving credit and Term Loan A borrowings and 1.75% to 2.00% for Term Loan B borrowings or (2) the one, two, three or six month Eurodollar rate (at our election), plus an applicable margin based upon our consolidated leverage ratio at the end of each quarter ranging from 1.50% to 2.25% for revolving credit and Term Loan A borrowings and ranging from 2.75% to 3.00% for Term Loan B borrowings. The current applicable margins are 0.75% for ABR-based loans, 1.75% for Eurodollar-based loans under the revolving credit and Term Loan A facilities and 2.75% under the Term Loan B facility. Upon the effectiveness of the Amendment, the minimum Eurodollar rate for the Term Loan B facility was reduced from 1.50% to 1.00%. In connection with the Amendment, we paid a fee of 1.00% of the amounts outstanding under the Term Loan B in accordance with the terms of the Credit Agreement.

In October, 2010, we amended our accounts receivable securitization program (“Securitization”) with a group of conduit lenders and liquidity banks. We increased the size of the Securitization to $240 million (the “Commitments”), from $200 million, and extended the maturity date to October 25, 2013. Substantially all of the patient-related accounts receivable of our acute care hospitals (“Receivables”) serve as collateral for the outstanding borrowings. The interest rate on the borrowings is based on the commercial paper rate plus a spread of 0.475% and there is a facility fee of 0.375% required on 102% on the Commitments. We have accounted for this Securitization as borrowings. We maintain effective control over the Receivables since, pursuant to the terms of the Securitization, the Receivables are sold from certain of our subsidiaries to special purpose entities that are wholly-owned by us. The Receivables, however, are owned by the special purpose entities, can be used only to satisfy the debts of the wholly-owned special purpose entities, and thus are not available to us except through our ownership interest in the special purpose entities. The wholly-owned special purpose entities use the Receivables to collateralize the loans obtained from the group of third-party conduit lenders and liquidity banks. The group of third-party conduit lenders and liquidity banks do not have recourse

 

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to us beyond the assets of the wholly-owned special purpose entities that securitize the loans. At March 31, 2012, we had $240 million of outstanding borrowings and no additional capacity pursuant to the terms of our accounts receivable securitization program.

As of March 31, 2012, we had $9 million outstanding borrowings under a short-term, on-demand credit facility. Outstanding borrowings pursuant to this facility are classified as long-term debt on our Consolidated Balance Sheet since we have the intent and ability to refinance through available borrowings under the terms of our Credit Agreement.

As of March 31, 2012, we had an aggregate of $509 million of available borrowing capacity pursuant to the terms of our Credit Agreement and Securitization, net of $219 million of outstanding borrowings, $63 million of outstanding letters of credit and $9 million of outstanding borrowings under a short-term, on-demand credit facility.

On September 29, 2010, we issued $250 million of 7.00% senior unsecured notes (the “Unsecured Notes”) which are scheduled to mature on October 1, 2018. The Unsecured Notes were registered in April, 2011. Interest on the Unsecured Notes is payable semiannually in arrears on April 1st and October 1st of each year. The Unsecured Notes can be redeemed in whole at anytime subject to a make-whole call at treasury rate plus 50 basis points prior to October 1, 2014. They are also redeemable in whole or in part at a price of: (i) 103.5% on or after October 1, 2014; (ii) 101.75% on or after October 1, 2015, and; (iii) 100% on or after October 1, 2016. These Unsecured Notes are guaranteed by a group of subsidiaries (each of which is a 100% directly owned subsidiary of Universal Health Services, Inc.) which fully and unconditionally guarantee the Unsecured Notes on a joint and several basis, subject to certain customary automatic release provisions.

On June 30, 2006, we issued $250 million of senior notes which have a 7.125% coupon rate and mature on June 30, 2016 (the “7.125% Notes”). Interest on the 7.125% Notes is payable semiannually in arrears on June 30th and December 30th of each year. In June, 2008, we issued an additional $150 million of 7.125% Notes which formed a single series with the original 7.125% Notes issued in June, 2006. Other than their date of issuance and initial price to the public, the terms of the 7.125% Notes issued in June, 2008 are identical to and trade interchangeably with, the 7.125% Notes which were originally issued in June, 2006.

In connection with the entering into of the Credit Agreement on November 15, 2010, and in accordance with the Indenture dated January 20, 2000 governing the rights of our existing notes, we entered into a supplemental indenture pursuant to which our 7.125% Notes (due in 2015) were equally and ratably secured with the lenders under the Credit Agreement with respect to the collateral for so long as the lenders under the Credit Agreement are so secured.

Our Credit Agreement includes a material adverse change clause that must be represented at each draw. The Credit Agreement contains covenants that include a limitation on sales of assets, mergers, change of ownership, liens and indebtedness, transactions with affiliates and dividends; and requires compliance with financial covenants including maximum leverage and minimum interest coverage ratios. We are in compliance with all required covenants as of March 31, 2012.

The carrying amount and fair value of our debt was $3.58 billion and $3.65 billion at March 31, 2012, respectively. The fair value of our debt was computed based upon quotes received from financial institutions and we consider these to be “level 2” in the fair value hierarchy as outlined in the authoritative guidance for disclosures in connection with debt instruments.

Cash Flow Hedges:

We manage our ratio of fixed to floating rate debt with the objective of achieving a mix that management believes is appropriate. To manage this risk in a cost-effective manner, we, from time to time, enter into interest rate swap agreements in which we agree to exchange various combinations of fixed and/or variable interest rates based on agreed upon notional amounts. We account for our derivative and hedging activities using the Financial Accounting Standard Board’s (“FASB”) guidance which requires all derivative instruments, including certain derivative instruments embedded in other contracts, to be carried at fair value on the balance sheet. For derivative transactions designated as hedges, we formally document all relationships between the hedging instrument and the related hedged item, as well as its risk-management objective and strategy for undertaking each hedge transaction.

Derivative instruments designated in a hedge relationship to mitigate exposure to variability in expected future cash flows, or other types of forecasted transactions, are considered cash flow hedges. Cash flow hedges are accounted for by recording the fair value of the derivative instrument on the balance sheet as either an asset or liability, with a corresponding amount recorded in accumulated other comprehensive income (“AOCI”) within stockholders’ equity. Amounts are reclassified from AOCI to the income statement in the period or periods in which the hedged transaction affects earnings. We use interest rate derivatives in our cash flow hedge transactions. Such derivatives are designed to be highly effective in offsetting changes in the cash flows related to the hedged liability. For derivative instruments designated as cash flow hedges, the ineffective portion of the changes in expected cash flows of the hedged item are recognized currently in the income statement.

For hedge transactions that do not qualify for the short-cut method, at the hedge’s inception and on a regular basis thereafter, a formal assessment is performed to determine whether changes in the fair values or cash flows of the derivative instruments have been highly effective in offsetting changes in cash flows of the hedged items and whether they are expected to be highly effective in the future.

The fair value of interest rate swap agreements approximates the amount at which they could be settled, based on estimates obtained from the counterparties. We assess the effectiveness and consideration of nonperformance risk of our hedge instruments on a quarterly basis. We performed periodic assessments of the cash flow hedge instruments during 2011 and the first quarter of 2012 and determined the hedges to be highly effective. We also determined that no

 

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portion of the hedges is ineffective and therefore there was no material effect on our consolidated financial position, operations or cash flows. The counterparties to the interest rate swap agreements expose us to credit risk in the event of nonperformance. We do not anticipate nonperformance by our counterparties. At March 31, 2012, each swap agreement entered into by us was in a net liability position which would require us to make the net settlement payments to the counterparties. We do not hold or issue derivative financial instruments for trading purposes.

During the first quarter of 2011, we entered into a forward starting interest rate cap on a total notional amount of $450 million from December, 2011 to December, 2012 reducing to $400 million from December, 2012 to December, 2013 whereby we paid a premium of $740,000 in exchange for the counterparty agreeing to pay the difference between 7.00% and three-month LIBOR if the three-month LIBOR rate rises above 7.00% during the term of the cap. If the three-month LIBOR does not reach 7.00% during the term of the cap, no payment is made to us.

We also entered into six forward starting interest rate swaps in the first quarter of 2011 whereby we pay a fixed rate on a total notional amount of $425 million and receive three-month LIBOR. Three of these swaps with a total notional amount of $225 million became effective in March, 2011 and will mature in May, 2015. The average fixed rate payable on these swaps is 1.91%. The three remaining interest rate swaps with total notional amounts of $100 million, $25 million and $75 million became effective in December, 2011 and have fixed rates of 2.50%, 1.96% and 1.32%, and maturity dates in December, 2014, December, 2013 and December, 2012, respectively.

During the fourth quarter of 2010, we entered into four forward starting interest rate swaps whereby we pay a fixed rate on a total notional amount of $600 million and receive three-month LIBOR. Each of the four swaps became effective in December, 2011 and will mature in May, 2015. The average fixed rate payable on these swaps is 2.38%.

During the fourth quarter of 2007, we entered into an interest rate swap whereby we pay a fixed rate on a total notional principal amount of $75 million and receive three-month LIBOR. The fixed rate payable is 4.76% and it matures in October, 2012.

We measure our interest rate swaps at fair value on a recurring basis. The fair value of our interest rate swaps is based primarily on quotes from banks. We consider those inputs to be “level 2” in the fair value hierarchy as outlined in the authoritative guidance for disclosures in connection with derivative instruments and hedging activities. The fair value of our interest rate swaps was a liability of $46 million at March 31, 2012, of which $2 million is included in other current liabilities and $44 million is included in other noncurrent liabilities on the accompanying balance sheet.

(5) Commitments and Contingencies

Professional and General Liability Claims and Property Insurance

Professional and General Liability

Effective January 1, 2008, most of our subsidiaries became self-insured for professional and general liability exposure up to $10 million per occurrence. Prior to our acquisition of Psychiatric Solutions, Inc. (“PSI”) in November, 2010, our subsidiaries purchased several excess policies through commercial insurance carriers which provide for coverage in excess of $10 million up to $200 million per occurrence and in the aggregate. However, we are liable for 10% of the claims paid pursuant to the commercially insured coverage in excess of $10 million up to $60 million per occurrence and in the aggregate.

Prior to our acquisition in November, 2010, the PSI subsidiaries were commercially insured for professional and general liability insurance claims in excess of a $3 million self-insured retention to a limit of $75 million. PSI utilized its captive insurance company and that captive insurance company remains in place after our acquisition of PSI to manage the self-insured retention for all former PSI subsidiaries for claims incurred prior to January 1, 2011. The captive insurance company also continues to manage the applicable self-insured retention for all professional and general liability claims, regardless of date incurred, for the former PSI subsidiaries located in Florida and Puerto Rico.

Since our acquisition of PSI on November 15, 2010, the former PSI subsidiaries are self-insured for professional and general liability exposure up to $3 million per occurrence and our legacy subsidiaries (which are not former PSI subsidiaries) are self-insured for professional and general liability exposure up to $10 million per occurrence. Effective November, 2010, our subsidiaries (including the former PSI subsidiaries) were provided with several excess policies through commercial insurance carriers which provide for coverage in excess of the applicable per occurrence self-insured retention (either $3 million or $10 million) up to $200 million per occurrence and in the aggregate. We remain liable for 10% of the claims paid pursuant to the commercially insured coverage in excess of $10 million up to $60 million per occurrence and in the aggregate.

Our estimated liability for self-insured professional and general liability claims is based on a number of factors including, among other things, the number of asserted claims and reported incidents, estimates of losses for these claims based on recent and historical settlement amounts, estimates of incurred but not reported claims based on historical experience, and estimates of amounts recoverable under our commercial insurance policies. While we continuously monitor these factors, our ultimate liability for professional and general liability claims could change materially from our current estimates due to inherent uncertainties involved in making this estimate. Given our significant self-insured

 

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exposure for professional and general liability claims, there can be no assurance that a sharp increase in the number and/or severity of claims asserted against us will not have a material adverse effect on our future results of operations.

As of March 31, 2012 and December 31, 2011, the total accrual for our professional and general liability claims, including the estimated claims related to the facilities acquired from PSI, was $297 million and $292 million, respectively, of which $60 million is included in current liabilities as of each date.

Property Insurance

We have commercial property insurance policies covering catastrophic losses, including windstorm damage, up to a $1 billion policy limit per occurrence, subject to a $250,000 deductible. Losses resulting from named windstorms are subject to deductibles between 3% and 5% of the declared total insurable value of the property. In addition, we have commercial property insurance policies covering catastrophic losses resulting from earthquake and flood damage, each subject to aggregated loss limits (as opposed to per occurrence losses). Our earthquake limit is $250 million, subject to a deductible of $250,000, except for facilities located within documented fault zones. Earthquake losses that affect facilities located in fault zones within the United States are subject to a $100 million limit and will have applied deductibles ranging from 1% to 5% of the declared total insurable value of the property. The earthquake limit in Puerto Rico is $25 million. Flood losses have either a $250,000 or $500,000 deductible, based upon the location of the facility.

Our property insurance coverage is scheduled for renewal on June 1, 2012. Due to an increase in property losses experienced nationwide in recent years, the cost of commercial property insurance has increased. As a result, catastrophic coverage for earthquake and flood has been limited to annual aggregate losses (as opposed to per occurrence losses). Given these insurance market conditions, there can be no assurance that a continuation of these unfavorable trends, or a sharp increase in uninsured property losses sustained by us, will not have a material adverse effect on our future results of operations.

Other

We entered into an agreement in April, 2012 with the United States Department of Health and Human Services, the Secretary of Health and Human Services, and the Centers for Medicare and Medicaid Services (referred to collectively as “HHS”) that is expected to result in an aggregate cash payment to us of approximately $36 million, the majority of which we expect to receive on or about June 30, 2012. After reductions for estimated related expenses and the portion attributable to third-party non-controlling ownership interests, this settlement favorably impacted our pre-tax consolidated financial results during the three-month period ended March 31, 2012 by approximately $30 million. This agreement was part of an industry-wide settlement with HHS related to litigation that was pending for several years contending that acute care hospitals in the U.S. were underpaid from the Medicare inpatient prospective payment system during a number of prior years. The underpayments resulted from calculations related to rural floor budget neutrality adjustments that were implemented in connection with the Balanced Budget Act of 1997.

As of March 31, 2012 and December 31, 2011, our accounts receivable includes approximately $73 million and $54 million, respectively, due from Illinois. Collection of these receivables continues to be delayed due to state budgetary and funding pressures. Approximately $50 million as of March 31, 2012, and $41 million as of December 31, 2011, of the receivables due from Illinois have been outstanding in excess of 60 days, as of each respective date, and a large portion will likely remain outstanding for the foreseeable future. Since we expect to eventually collect all amounts due to us, no related reserves have been established in our consolidated financial statements. However, we can provide no assurance that we will eventually collect all amounts due to us from Illinois. Failure to ultimately collect all outstanding amounts due from Illinois would have an adverse impact on our future consolidated results of operations and cash flows.

As of March 31, 2012, we were party to certain off balance sheet arrangements consisting of standby letters of credit and surety bonds which totaled $83 million consisting of: (i) $66 million related to our self-insurance programs, and; (ii) $17 million of other debt and public utility guarantees.

Legal Proceedings

We are subject to claims and suits in the ordinary course of business, including those arising from care and treatment afforded by our hospitals and are party to litigation, as outlined below.

U.S. v. Marion and UHS:

In November, 2009, the United States Department of Justice (“DOJ”) and the Virginia Attorney General intervened in a qui tam case that had been filed by former employees of Marion Youth Center under seal in 2007 against Universal Health Services, Inc. (“UHS”), and Keystone Marion, LLC (“Marion”) and Keystone Education and Youth Services, LLC (“Keystone”). The intervention by the DOJ followed the issuance of a series of subpoenas from the Office of the Inspector General for the Department of Health and Human Services seeking documents related to the treatment of Medicaid beneficiaries at Marion. The amended complaint filed by the DOJ and Virginia Attorney General alleged causes of action pursuant to the federal and state false claims acts and the Virginia fraud statute. The former employees filed a separate amended complaint alleging employment and retaliation claims as well as false claim act violations. During the third quarter of 2011, we reached agreements in principle to settle all of the claims. During the first quarter of 2012, the settlement agreements were finalized. We had previously established a reserve in connection with this matter, which did not have a material impact on our financial statements. Settlement payments were made in April, 2012.

Martin v. UHS of Delaware:

UHS of Delaware, Inc., a wholly-owned subsidiary of ours, has been named as defendants in a state False Claim Act case in Sacramento County Superior Court. Plaintiffs are a former student and employees of the Elmira School who claim that the UHS schools in California unlawfully retained public education funding from the state of California for the operation of these schools but failed to meet state requirements pertaining to the operation of non-public schools. We deny liability and intend to defend this case vigorously. We have established a reserve in connection with this matter which did not have a material impact on our consolidated financial statements.

 

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Department of Justice ICD Investigation:

In September, 2010, we, along with many other companies in the healthcare industry, received a letter from the United States Department of Justice (“DOJ”) advising of a False Claim Act investigation being conducted in connection with the implantation of implantable cardioverter defibrillators (“ICDs”) from 2003 to the present at several of our acute care facilities. The DOJ alleges that ICDs were implanted and billed by our facilities in contravention of a National Claims Determination regarding these devices. We have established a reserve in connection with this matter which did not have a material impact on our consolidated financial statements.

Two Rivers Psychiatric Hospital:

In April, 2011, the Centers for Medicare and Medicaid Services (“CMS”) issued notice of its decision terminating Two Rivers Psychiatric Hospital (“Two Rivers”) in Kansas City, Missouri from participation in the Medicare and Medicaid program. The termination notice was issued as a result of surveys conducted which allegedly found Two Rivers to be out of compliance with the conditions of participation required for participation in the Medicare program and for Two Rivers’ alleged failure to alleviate an “immediate jeopardy” situation. Two Rivers filed an administrative appeal with the U.S. Department of Health and Human Services, Departmental Appeal Board, Civil Remedies Division, seeking review and reversal of that decision. In addition, Two Rivers filed a complaint in the U.S. District Court for the Western District of Missouri seeking a temporary restraining order and preliminary injunction against CMS rescinding the termination action. Later in April, 2011, the District Court issued a temporary restraining order abating the termination action pending a preliminary injunction hearing or an agreement with CMS. In May, 2011, Two Rivers and CMS entered into a settlement agreement which resulted in the rescission of the termination notice and actions by CMS. Pursuant to the terms of the agreement, Two Rivers was required to submit an acceptable plan of correction relative to the immediate jeopardy citation and engage independent experts in various disciplines to analyze and develop implementation plans for Two Rivers to meet the applicable Medicare conditions of participation. Both of these actions have occurred. Pursuant to the agreement, CMS conducted an initial survey of Two Rivers in April 2012 to determine if the Medicare conditions of participation, which formed the basis of the termination action in April 2011, have been met. In late April, 2012, CMS advised Two Rivers that it has successfully passed this initial survey. Pursuant to the terms of the agreement, a second survey will be conducted either late 2012 or early 2013 to further confirm that Two Rivers is in compliance with all Medicare/Medicaid Conditions of Participation. During the term of this agreement, Two Rivers remains eligible to receive reimbursements for services rendered to Medicare and Medicaid beneficiaries. Two Rivers remains fully committed to providing high-quality healthcare to their patients and the community it serves. We therefore intend to work expeditiously and collaboratively with CMS in an effort to resolve these matters. We can provide no assurance that Two Rivers will not ultimately lose its Medicare certification. The operating results of Two Rivers did not have a material impact on our consolidated results of operations or financial condition for the three-month period ended March 31, 2012 or the year ended December 31, 2011.

Matters Relating to PSI:

The following matters pertain to PSI or former PSI facilities (owned by subsidiaries of Psychiatric Solutions, Inc.) for which we have assumed the defense as a result of our acquisition of PSI which was completed in November, 2010:

Garden City Employees’ Retirement System v. PSI:

This is a purported shareholder class action lawsuit filed in the United States District Court for the Middle District of Tennessee against PSI and the former directors in 2009 alleging violations of federal securities laws. We intend to defend the case vigorously. Should we be deemed liable in this matter, we believe we would be entitled to commercial insurance recoveries for amounts paid by us, subject to certain limitations and deductibles. Included in our consolidated balance sheets as of March 31, 2012 and December 31, 2011, is an estimated reserve (current liability) and corresponding commercial insurance recovery (current asset) which did not have a material impact on our financial statements. Although we believe the commercial insurance recoveries are adequate to satisfy potential liability in this matter, we can provide no assurance that the ultimate liability will not exceed the commercial insurance recoveries which would make us liable for the excess.

Department of Justice Investigation of Sierra Vista:

In 2009, Sierra Vista Hospital in Sacramento, California learned of an investigation by the U.S. Department of Justice (“DOJ”) relating to Medicare services provided by the facility. The DOJ ultimately notified the facility that with respect to partial hospitalization and outpatient services, the DOJ believed that the medical record documentation did not adequately support the claims submitted for reimbursement by Medicare. We reached a settlement with the DOJ which was finalized during the second quarter of 2012. As part of that agreement, the facility will be subject to a corporate integrity agreement. The reserve established in connection with this matter did not have a material impact on our consolidated financial statements.

Department of Justice Investigation of Friends Hospital:

In October, 2010, Friends Hospital in Philadelphia, Pennsylvania, received a subpoena from the DOJ requesting certain documents from the facility. The requested documents have been collected and provided to the DOJ for review and examination. Another subpoena was issued to the facility in July 2011 requesting additional documents, a portion of which have been collected and delivered to the DOJ, pursuant to their request. At present,

 

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we are uncertain as to the focus, scope or extent of the investigation, liability of the facility and/or potential financial exposure, if any, in connection with this matter.

Department of Justice Investigation of Riveredge Hospital:

In 2008, Riveredge Hospital in Chicago, Illinois received a subpoena from the DOJ requesting certain information from the facility. Additional requests for documents were also received from the DOJ in 2009 and 2010. The requested documents have been provided to the DOJ and we continue to cooperate with the DOJ with respect to this investigation. At present, we are uncertain as to the focus, scope or extent of the investigation, liability of the facility and/or potential financial exposure, if any, in connection with this matter.

Virginia Department of Medical Assistance Services Recoupment Claims:

The Virginia Department of Medical Assistance Services (“DMAS”) has conducted audits at seven former PSI Residential Treatment Centers operated in the Commonwealth of Virginia to confirm compliance with provider rules under the state’s Medicaid Provider Services Manual (“Manual”). As a result of those audits, DMAS claims the facilities failed to comply with the requirements of the Manual and has requested repayment of Medicaid payments to those facilities. PSI had previously filed appeals to repayment demands at each facility which are currently pending. The aggregate refund of Medicaid payments made to those facilities, as requested by DMAS, and the corresponding reserve established on our consolidated balance sheet, was not material to our consolidated financial position or results of operations.

General:

The healthcare industry is subject to numerous laws and regulations which include, among other things, matters such as government healthcare participation requirements, various licensure, certifications, and accreditations, reimbursement for patient services, and Medicare and Medicaid fraud and abuse. Government action has increased with respect to investigations and/or allegations concerning possible violations of fraud and abuse and false claims statutes and/or regulations by healthcare providers. Currently, and from time to time, some of our facilities are subjected to inquiries and/or actions and receive notices of potential non-compliance of laws and regulations from various federal and state agencies. Providers that are found to have violated these laws and regulations may be excluded from participating in government healthcare programs, subjected to potential licensure, certification, and/or accreditation revocation, subjected to fines or penalties or required to repay amounts received from the government for previously billed patient services. We monitor all aspects of our business and have developed a comprehensive ethics and compliance program that is designed to meet or exceed applicable federal guidelines and industry standards. Because the law in this area is complex and constantly evolving, governmental investigation or litigation may result in interpretations that are inconsistent with industry practices, including ours. Although we believe our policies, procedures and practices comply with governmental regulations, there is no assurance that we will not be faced with sanctions, fines or penalties in connection with such inquiries or actions, including with respect to the investigations and other matters discussed herein. Even if we were to ultimately prevail, such inquiries and/or actions could have a material adverse effect on us.

The outcome of any current or future litigation or governmental or internal investigations, including the matters described above, cannot be accurately predicted, nor can we predict any resulting penalties, fines or other sanctions that may be imposed at the discretion of federal or state regulatory authorities. We record accruals for such contingencies to the extent that we conclude it is probable that a liability has been incurred and the amount of the loss can be reasonably estimated. No estimate of the possible loss or range of loss in excess of amounts accrued, if any, can be made at this time regarding the matters specifically described above because the inherently unpredictable nature of legal proceedings may be exacerbated by various factors, including, but not limited to: (i) the damages sought in the proceedings are unsubstantiated or indeterminate; (ii) discovery is not complete; (iii) the proceeding is in its early stages; (iv) the matters present legal uncertainties; (v) there are significant facts in dispute; (vi) there are a large number of parties, or; (vii) there is a wide range of potential outcomes. It is possible that the outcome of these matters could have a material adverse impact on our future results of operations, financial position, cash flows and, potentially, our reputation.

In addition, various suits and claims arising against us in the ordinary course of business are pending. In the opinion of management, the outcome of such claims and litigation will not materially affect our consolidated financial position or results of operations.

(6) Segment Reporting

Our reportable operating segments consist of acute care hospital services and behavioral health care services. The “Other” segment column below includes centralized services including information services, purchasing, reimbursement, accounting, taxation, legal, advertising, design and construction and patient accounting as well as the operating results for our other operating entities including outpatient surgery and radiation centers. The chief operating decision making group for our acute care hospital services and behavioral health care services is comprised of the Chief Executive Officer, the President and the Presidents of each operating segment. The Presidents of each operating segment also manage the profitability of each respective segment’s various facilities. The operating segments are managed separately because each operating segment represents a business unit that offers different types of healthcare services or operates in different healthcare environments. The accounting policies of the operating segments are the same as those described in the summary of significant accounting policies included in our Annual Report on Form 10-K for the year ended December 31, 2011. The corporate overhead allocations, as reflected below, are utilized for internal reporting purposes and are comprised of each period’s projected corporate-level operating expenses (excluding

 

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interest expense). The overhead expenses are captured and allocated directly to each segment, to the extent possible, with the non-directly allocated overhead expenses allocated based upon each segment’s respective percentage of total facility-based operating expenses.

 

     Three months ended March 31, 2012  
     Acute Care     Behavioral              
     Hospital     Health           Total  
     Services     Services     Other     Consolidated  
     (Amounts in thousands)  

Gross inpatient revenues

   $ 3,349,035      $ 1,422,085        —        $ 4,771,120   

Gross outpatient revenues

   $ 1,598,517      $ 161,258      $ 12,270      $ 1,772,045   

Total net revenues

   $ 954,232      $ 864,873      $ 6,184      $ 1,825,289   

Income/(loss) before allocation of corporate overhead and income taxes

   $ 129,848      $ 202,496      ($ 110,026   $ 222,318   

Allocation of corporate overhead

   ($ 40,743   ($ 21,061   $ 61,804        0   

Income/(loss) after allocation of corporate overhead and before income taxes

   $ 89,105      $ 181,435      ($ 48,222   $ 222,318   

Total assets as of 3/31/12

   $ 2,946,334      $ 4,425,079      $ 411,868      $ 7,783,281   

 

     Three months ended March 31, 2011  
     Acute Care     Behavioral              
     Hospital     Health           Total  
     Services     Services     Other     Consolidated  
     (Amounts in thousands)  

Gross inpatient revenues

   $ 3,222,247      $ 1,391,201        —        $ 4,613,448   

Gross outpatient revenues

   $ 1,370,118      $ 149,595      $ 12,869      $ 1,532,582   

Total net revenues

   $ 922,542      $ 828,948      $ 5,922      $ 1,757,412   

Income/(loss) before allocation of corporate overhead and income taxes

   $ 126,984      $ 185,779      ($ 108,767   $ 203,996   

Allocation of corporate overhead

   ($ 32,806   ($ 15,725   $ 48,531        0   

Income/(loss) after allocation of corporate overhead and before income taxes

   $ 94,178      $ 170,054      ($ 60,236   $ 203,996   

Total assets as of 3/31/11

   $ 2,802,225      $ 4,390,677      $ 420,172      $ 7,613,074   

(7) Earnings Per Share Data (“EPS”) and Stock Based Compensation

Basic earnings per share are based on the weighted average number of common shares outstanding during the period. Diluted earnings per share are based on the weighted average number of common shares outstanding during the period adjusted to give effect to common stock equivalents.

The following table sets forth the computation of basic and diluted earnings per share for the periods indicated (in thousands, except per share data):

 

     Three months ended
March 31,
 
     2012     2011  

Basic and Diluted:

    

Net income attributable to UHS

   $ 128,607      $ 114,193   

Less: Net income attributable to unvested restricted share grants

     (168     (149
  

 

 

   

 

 

 

 

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     Three months ended
March 31,
 
     2012      2011  

Net income attributable to UHS – basic and diluted

   $ 128,439       $ 114,044   
  

 

 

    

 

 

 

Weighted average number of common shares - basic

     96,593         97,381   

Net effect of dilutive stock options and grants based on the treasury stock method

     1,198         1,487   
  

 

 

    

 

 

 

Weighted average number of common shares and equivalents - diluted

     97,791         98,868   
  

 

 

    

 

 

 

Earnings per basic share attributable to UHS:

   $ 1.33       $ 1.17   
  

 

 

    

 

 

 

Earnings per diluted share attributable to UHS:

   $ 1.31       $ 1.15   
  

 

 

    

 

 

 

The “Net effect of dilutive stock options and grants based on the treasury stock method”, for all periods presented above, excludes certain outstanding stock options applicable to each period since the effect would have been anti-dilutive. The excluded weighted-average stock options totaled 2.7 million for the three months ended March 31, 2012. There were no significant anti-dilutive stock options during the three months ended March 31, 2011. All classes of our common stock have the same dividend rights.

Stock-Based Compensation: During the three-month periods ended March 31, 2012 and 2011, compensation cost of $4.9 million ($3.0 million after-tax) and $3.5 million ($2.1 million after-tax), respectively, was recognized related to outstanding stock options. In addition, during the three-month periods ended March 31, 2012 and 2011, compensation cost of approximately $577,000 ($359,000 after-tax) and $451,000 ($277,000 after-tax), respectively, was recognized related to restricted stock. As of March 31, 2012 there was $50.5 million of unrecognized compensation cost related to unvested options and restricted stock which is expected to be recognized over the remaining weighted average vesting period of 3.1 years. There were 2,902,950 stock options granted (net of cancellations) during the first three months of 2012 with a weighted-average grant date fair value of $10.72 per share. There were 54,127 restricted stock shares granted during the first three months of 2012, with a weighted-average grant date fair value of $36.95 per share.

(8) Dispositions and acquisitions

Subsequent to March 31, 2012:

 

   

We executed a definitive agreement to sell Auburn Regional Medical Center, a 213-bed acute care hospital located in Auburn, Washington, for total cash proceeds of approximately $98 million including estimated working capital. The transaction, which is subject to customary regulatory approvals, is expected to occur by the end of the third quarter of 2012. We expect to realize a substantial gain on the divestiture of this hospital which will be recorded in our consolidated financial statements upon closing of the transaction.

 

   

As a result of the seller’s inability to obtain the removal of the deed restriction on its hospital, we provided the seller with a notice of termination of the previously executed purchase agreement in connection with our planned acquisition of the Knapp Medical Center located in Weslaco, Texas.

Three-month period ended March 31, 2012:

There were no acquisitions during the first quarter of 2012.

During the first three months of 2012, we received aggregate cash proceeds of approximately $53 million for the divestiture of: (i) the Hospital San Juan Capestrano, a 108-bed behavioral health care facility located in Rio Piedras, Puerto Rico, that was sold in January, 2012 pursuant to our agreement with the Federal Trade Commission in connection with our acquisition of Psychiatric Solutions, Inc., and; (ii) the real property of a previously closed behavioral health care facility. The pre-tax net gain on these divestitures did not have a material impact on our consolidated results of operations during the first quarter of 2012.

Three-month period ended March 31, 2011:

There were no acquisitions during the first quarter of 2011.

During the first quarter of 2011, we sold the real property of a closed acute care hospital for net cash proceeds of approximately $1 million. This transaction did not have a material impact on our consolidated financial statements or results of operations.

 

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(9) Dividends

We declared and paid dividends of $4.8 million, or $.05 per share, during the first quarter of 2012 and $4.9 million, or $.05 per share, during the first quarter of 2011.

(10) Pension Plan

The following table shows the components of net periodic pension cost for our defined benefit pension plan as of March 31, 2012 and 2011 (amounts in thousands):

 

    

Three months ended

March 31,

 
     2012     2011  

Service cost

   $ 286      $ 334   

Interest cost

     1,165        1,452   

Expected return on assets

     (1,540     (1,509

Recognized actuarial loss

     1,055        744   
  

 

 

   

 

 

 

Net periodic pension cost

   $ 966      $ 1,021   
  

 

 

   

 

 

 

During the three months ended March 31, 2012, we made contributions totaling $7.1 million to our pension plan.

(11) Income Taxes

As of January 1, 2012, our unrecognized tax benefits were approximately $7 million. The amount, if recognized, that would affect the effective tax rate is approximately $5 million. During the quarter ended March 31, 2012, changes to the estimated liabilities for uncertain tax positions (including accrued interest) relating to tax positions taken during prior and current periods did not have a material impact on our financial statements.

We recognize accrued interest and penalties associated with uncertain tax positions as part of the tax provision. As of March 31, 2012, we have approximately $1 million of accrued interest and penalties. The U.S. federal statute of limitations remains open for the 2008 and subsequent years. Foreign and U.S. state and local jurisdictions have statutes of limitations generally ranging from 3 to 4 years. The statute of limitations on certain jurisdictions could expire within the next twelve months.

We operate in multiple jurisdictions with varying tax laws. We are subject to audits by any of these taxing authorities. Our tax returns have been examined by the Internal Revenue Service (“IRS”) through the year ended December 31, 2006. We believe that adequate accruals have been provided for federal, foreign and state taxes.

(12) Supplemental Condensed Consolidating Financial Information

Certain of our senior notes are guaranteed by a group of subsidiaries (the “Guarantors”). The Guarantors, each of which is a 100% directly owned subsidiary of Universal Health Services, Inc., fully and unconditionally guarantee the senior notes on a joint and several basis, subject to certain customary release provisions.

The following financial statements present condensed consolidating financial data for (i) Universal Health Services, Inc. (on a parent company only basis), (ii) the combined Guarantors, (iii) the combined non guarantor subsidiaries (all other subsidiaries), (iv) an elimination column for adjustments to arrive at the information for the parent company, Guarantors, and non guarantors on a consolidated basis, and (v) the parent company and our subsidiaries on a consolidated basis.

Investments in subsidiaries are accounted for by the parent company and the Guarantors using the equity method for this presentation. Results of operations of subsidiaries are therefore classified in the parent company’s and Guarantors’ investment in subsidiaries accounts. The elimination entries set forth in the following condensed consolidating financial statements eliminate distributed and undistributed income of subsidiaries, investments in subsidiaries, and intercompany balances and transactions between the parent, Guarantors, and non guarantors.

 

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UNIVERSAL HEALTH SERVICES, INC. AND SUBSIDIARIES

CONDENSED CONSOLIDATING STATEMENTS OF INCOME

FOR THE THREE MONTHS ENDED MARCH 31, 2012

(amounts in thousands)

 

                             Total  
                 Non     Consolidating     Consolidated  
     Parent     Guarantors     Guarantors     Adjustments     Amounts  

Net revenues before provision for doubtful accounts

   $ 0      $ 1,363,923      $ 619,406      $ (6,326   $ 1,977,003   

Less: Provision for doubtful accounts

     0        92,490        59,224        0        151,714   
  

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

Net revenues

     0        1,271,433        560,182        (6,326     1,825,289   
  

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

Operating charges:

          

Salaries, wages and benefits

     0        636,208        253,298        0        889,506   

Other operating expenses

     0        242,048        123,724        (6,231     359,541   

Supplies expense

     0        132,128        77,404        0        209,532   

Depreciation and amortization

     0        53,135        20,685        0        73,820   

Lease and rental expense

     0        15,132        8,825        (95     23,862   
  

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 
     0        1,078,651        483,936        (6,326     1,556,261   
  

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

Income from operations

     0        192,782        76,246        0        269,028   

Interest expense

     45,154        787        769        0        46,710   

Interest (income) expense, affiliate

     0        22,782        (22,782     0        0   

Equity in net income of consolidated affiliates

     (156,478     (41,077     0        197,555        0   
  

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

Income before income taxes

     111,324        210,290        98,259        (197,555     222,318   

Provision for income taxes

     (17,283     74,108        22,923        0        79,748   
  

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

Net income

     128,607        136,182        75,336        (197,555     142,570   

Less: Income attributable to noncontrolling interests

     0        0        13,963        0        13,963   
  

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

Net income attributable to UHS

   $ 128,607      $ 136,182      $ 61,373      $ (197,555   $ 128,607   
  

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

 

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UNIVERSAL HEALTH SERVICES, INC. AND SUBSIDIARIES

CONDENSED CONSOLIDATING STATEMENTS OF INCOME

FOR THE THREE MONTHS ENDED MARCH 31, 2011

(amounts in thousands)

 

                             Total  
                 Non     Consolidating     Consolidated  
     Parent     Guarantors     Guarantors     Adjustments     Amounts  

Net revenues before provision for doubtful accounts

   $ 0      $ 1,320,128      $ 596,707      $ (6,307   $ 1,910,528   

Less: Provision for doubtful accounts

     0        94,375        58,741        0        153,116   
  

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

Net revenues

     0        1,225,753        537,966        (6,307     1,757,412   
  

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

Operating charges:

          

Salaries, wages and benefits

     0        608,308        237,556        0        845,864   

Other operating expenses

     0        241,077        114,581        (6,212     349,446   

Supplies expense

     0        131,595        75,575        0        207,170   

Depreciation and amortization

     0        52,390        18,961        0        71,351   

Lease and rental expense

     0        15,981        7,282        (95     23,168   
  

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 
     0        1,049,351        453,955        (6,307     1,496,999   
  

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

Income from operations

     0        176,402        84,011        0        260,413   

Interest expense, net

     54,870        793        754        0        56,417   

Interest (income) expense, affiliate

     0        15,904        (15,904     0        0   

Equity in net income of consolidated affiliates

     (147,608     (50,202     0        197,810        0   
  

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

Income before income taxes

     92,738        209,907        99,161        (197,810     203,996   

Provision for income taxes

     (21,455     74,961        20,503        0        74,009   
  

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

Net income

     114,193        134,946        78,658        (197,810     129,987   

Less: Income attributable to noncontrolling interests

     0        0        15,794        0        15,794   
  

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

Net income attributable to UHS

   $ 114,193      $ 134,946      $ 62,864      $ (197,810   $ 114,193   
  

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

 

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UNIVERSAL HEALTH SERVICES, INC. AND SUBSIDIARIES

CONDENSED CONSOLIDATING STATEMENTS OF COMPREHENSIVE INCOME

FOR THE THREE MONTHS ENDED MARCH 31, 2012

(amounts in thousands)

 

                               Total  
                  Non      Consolidating     Consolidated  
     Parent     Guarantors      Guarantors      Adjustments     Amounts  

Net income

   $ 128,607      $ 136,182       $ 75,336       $ (197,555   $ 142,570   

Other comprehensive income (loss):

            

Unrealized derivative gains on cash flow hedges

     1,615        0         0         0        1,615   

Amortization of terminated hedge

     (84     0         0         0        (84
  

 

 

   

 

 

    

 

 

    

 

 

   

 

 

 

Other comprehensive income before tax

     1,531        0         0         0        1,531   

Income tax expense related to items of other comprehensive income

     582        0         0         0        582   
  

 

 

   

 

 

    

 

 

    

 

 

   

 

 

 

Total other comprehensive income, net of tax

     949        0         0         0        949   
  

 

 

   

 

 

    

 

 

    

 

 

   

 

 

 

Comprehensive income

     129,556        136,182         75,336         (197,555     143,519   

Less: Comprehensive income attributable to noncontrolling interests

     0        0         13,963         0        13,963   
  

 

 

   

 

 

    

 

 

    

 

 

   

 

 

 

Comprehensive income attributable to UHS

   $ 129,556      $ 136,182       $ 61,373       $ (197,555   $ 129,556   
  

 

 

   

 

 

    

 

 

    

 

 

   

 

 

 

 

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Table of Contents

UNIVERSAL HEALTH SERVICES, INC. AND SUBSIDIARIES

CONDENSED CONSOLIDATING STATEMENTS OF COMPREHENSIVE INCOME

FOR THE THREE MONTHS ENDED MARCH 31, 2011

(amounts in thousands)

 

                               Total  
                  Non      Consolidating     Consolidated  
     Parent     Guarantors      Guarantors      Adjustments     Amounts  

Net income

   $ 114,193      $ 134,946       $ 78,658       $ (197,810   $ 129,987   

Other comprehensive income (loss):

            

Unrealized derivative gains on cash flow hedges

     2,307        0         0         0        2,307   

Amortization of terminated hedge

     (84     0         0         0        (84
  

 

 

   

 

 

    

 

 

    

 

 

   

 

 

 

Other comprehensive income before tax

     2,223        0         0         0        2,223   

Income tax expense related to items of other comprehensive income

     860        0         0         0        860   
  

 

 

   

 

 

    

 

 

    

 

 

   

 

 

 

Total other comprehensive income, net of tax

     1,363        0         0         0        1,363   
  

 

 

   

 

 

    

 

 

    

 

 

   

 

 

 

Comprehensive income

     115,556        134,946         78,658         (197,810     131,350   

Less: Comprehensive income attributable to noncontrolling interests

     0        0         15,794         0        15,794   
  

 

 

   

 

 

    

 

 

    

 

 

   

 

 

 

Comprehensive income attributable to UHS

   $ 115,556      $ 134,946       $ 62,864       $ (197,810   $ 115,556   
  

 

 

   

 

 

    

 

 

    

 

 

   

 

 

 

 

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UNIVERSAL HEALTH SERVICES, INC. AND SUBSIDIARIES

CONDENSED CONSOLIDATING BALANCE SHEET

AS OF MARCH 31, 2012

(amounts in thousands)

 

                              Total  
                  Non     Consolidating     Consolidated  
     Parent      Guarantors     Guarantors     Adjustments     Amounts  

Assets

           

Current assets:

           

Cash and cash equivalents

   $ 0       $ 33,417      $ 8,582      $ 0      $ 41,999   

Accounts receivable, net

     2,090         781,738        332,806        0        1,116,634   

Supplies

     0         59,023        37,951        0        96,974   

Other current assets

     2,330         78,068        11,224        0        91,622   

Deferred income taxes

     74,700         41,216        322        (322     115,916   
  

 

 

    

 

 

   

 

 

   

 

 

   

 

 

 

Total current assets

     79,120         993,462        390,885        (322     1,463,145   
  

 

 

    

 

 

   

 

 

   

 

 

   

 

 

 

Investments in subsidiaries

     5,370,051         1,222,926        0        (6,592,977     0   

Intercompany receivable

     687,617         0        82,614        (770,231     0   

Intercompany note receivable

     0         0        1,148,839        (1,148,839     0   

Property and equipment

     0         3,717,908        1,467,866        0        5,185,774   

Less: accumulated depreciation

     0         (1,229,753     (651,785     0        (1,881,538
  

 

 

    

 

 

   

 

 

   

 

 

   

 

 

 
     0         2,488,155        816,081        0        3,304,236   
  

 

 

    

 

 

   

 

 

   

 

 

   

 

 

 

Other assets:

           

Goodwill

     820         2,134,593        494,352        0        2,629,765   

Deferred charges

     97,570         6,001        2,299        0        105,870   

Other

     9,906         232,457        37,902        0        280,265   
  

 

 

    

 

 

   

 

 

   

 

 

   

 

 

 
   $ 6,245,084       $ 7,077,594      $ 2,972,972      $ (8,512,369   $ 7,783,281   
  

 

 

    

 

 

   

 

 

   

 

 

   

 

 

 

Liabilities and Stockholders’ Equity

           

Current liabilities:

           

Current maturities of long-term debt

   $ 0       $ 1,084      $ 1,428      $ 0      $ 2,512   

Accounts payable and accrued liabilities

     25,963         604,046        184,164        0        814,173   

Federal and state taxes

     74,459         226        620        0        75,305   
  

 

 

    

 

 

   

 

 

   

 

 

   

 

 

 

Total current liabilities

     100,422         605,356        186,212        0        891,990   
  

 

 

    

 

 

   

 

 

   

 

 

   

 

 

 

Intercompany payable

     0         770,231        0        (770,231     0   

Other noncurrent liabilities

     49,863         247,280        105,928        0        403,071   

Long-term debt

     3,526,521         3,360        51,963        0        3,581,844   

Intercompany note payable

     0         1,148,839        0        (1,148,839     0   

Deferred income taxes

     140,966         58,001        0        (322     198,645   

Redeemable noncontrolling interests

     0         0        228,928        0        228,928   

UHS common stockholders’ equity

     2,427,312         4,244,527        2,348,450        (6,592,977     2,427,312   

Noncontrolling interest

     0         0        51,491        0        51,491   
  

 

 

    

 

 

   

 

 

   

 

 

   

 

 

 

Total equity

     2,427,312         4,244,527        2,399,941        (6,592,977     2,478,803   
  

 

 

    

 

 

   

 

 

   

 

 

   

 

 

 
   $ 6,245,084       $ 7,077,594      $ 2,972,972      $ (8,512,369   $ 7,783,281   
  

 

 

    

 

 

   

 

 

   

 

 

   

 

 

 

 

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UNIVERSAL HEALTH SERVICES, INC. AND SUBSIDIARIES

CONDENSED CONSOLIDATING BALANCE SHEET

AS OF DECEMBER 31, 2011

(amounts in thousands)

 

                              Total  
                  Non     Consolidating     Consolidated  
     Parent      Guarantors     Guarantors     Adjustments     Amounts  

Assets

           

Current assets:

           

Cash and cash equivalents

   $ 0       $ 33,221      $ 8,008      $ 0      $ 41,229   

Accounts receivable, net

     8,891         663,593        297,318        0        969,802   

Supplies

     0         59,467        37,308        0        96,775   

Other current assets

     33,057         56,864        9,938        0        99,859   

Deferred income taxes

     67,189         41,755        322        (942     108,324   

Current assets held for sale

     0         48,916        0        0        48,916   
  

 

 

    

 

 

   

 

 

   

 

 

   

 

 

 

Total current assets

     109,137         903,816        352,894        (942     1,364,905   
  

 

 

    

 

 

   

 

 

   

 

 

   

 

 

 

Investments in subsidiaries

     5,213,573         1,181,849        0        (6,395,422     0   

Intercompany receivable

     669,112         0        74,155        (743,267     0   

Intercompany note receivable

     0         0        1,148,839        (1,148,839     0   

Property and equipment

     0         3,650,025        1,456,135        0        5,106,160   

Less: accumulated depreciation

     0         (1,184,283     (633,897     0        (1,818,180
  

 

 

    

 

 

   

 

 

   

 

 

   

 

 

 
     0         2,465,742        822,238        0        3,287,980   
  

 

 

    

 

 

   

 

 

   

 

 

   

 

 

 

Other assets:

           

Goodwill

     820         2,132,103        494,679        0        2,627,602   

Deferred charges

     103,434         5,972        2,374        0        111,780   

Other

     10,412         241,107        21,459        0        272,978   
  

 

 

    

 

 

   

 

 

   

 

 

   

 

 

 
   $ 6,106,488       $ 6,930,589      $ 2,916,638      $ (8,288,470   $ 7,665,245   
  

 

 

    

 

 

   

 

 

   

 

 

   

 

 

 

Liabilities and Stockholders’ Equity

           

Current liabilities:

           

Current maturities of long-term debt

   $ 0       $ 1,133      $ 1,346      $ 0      $ 2,479   

Accounts payable and accrued liabilities

     14,201         616,026        201,898        0        832,125   

Current liabilities held for sale

     0         2,329        0        0        2,329   

Federal and state taxes

     0         0        620        (620     0   
  

 

 

    

 

 

   

 

 

   

 

 

   

 

 

 

Total current liabilities

     14,201         619,488        203,864        (620     836,933   
  

 

 

    

 

 

   

 

 

   

 

 

   

 

 

 

Intercompany payable

     0         743,267        0        (743,267     0   

Other noncurrent liabilities

     49,840         249,033        103,035        0        401,908   

Long-term debt

     3,594,182         3,616        53,630        0        3,651,428   

Intercompany note payable

     0         1,148,839        0        (1,148,839     0   

Deferred income taxes

     151,913         58,001        0        (322     209,592   

Redeemable noncontrolling interests

     0         0        218,266        0        218,266   

UHS common stockholders’ equity

     2,296,352         4,108,345        2,287,077        (6,395,422     2,296,352   

Noncontrolling interest

     0         0        50,766        0        50,766   
  

 

 

    

 

 

   

 

 

   

 

 

   

 

 

 

Total equity

     2,296,352         4,108,345        2,337,843        (6,395,422     2,347,118   
  

 

 

    

 

 

   

 

 

   

 

 

   

 

 

 
   $ 6,106,488       $ 6,930,589      $ 2,916,638      $ (8,288,470   $ 7,665,245   
  

 

 

    

 

 

   

 

 

   

 

 

   

 

 

 

 

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UNIVERSAL HEALTH SERVICES, INC. AND SUBSIDIARIES

CONDENSED CONSOLIDATING STATEMENTS OF CASH FLOWS

FOR THE THREE MONTHS ENDED MARCH 31, 2012

(amounts in thousands)

 

                              Total  
                 Non     Consolidating      Consolidated  
     Parent     Guarantors     Guarantors     Adjustments      Amounts  

Net cash provided by operating activities

   $ 93,390      $ 10,893      $ 22,940      $ 0       $ 127,223   
  

 

 

   

 

 

   

 

 

   

 

 

    

 

 

 

Cash Flows from Investing Activities:

           

Property and equipment additions, net of disposals

     0        (79,339     (13,224     0         (92,563

Proceeds received from sale of assets and businesses

     0        49,984        3,477        0         53,461   

Costs incurred for purchase and development of electronic health records application

     0        (14,501     0        0         (14,501

Return of deposit on terminated purchase agreement

     0        6,500        0        0         6,500   
  

 

 

   

 

 

   

 

 

   

 

 

    

 

 

 

Net cash used in investing activities

     0        (37,356     (9,747     0         (47,103
  

 

 

   

 

 

   

 

 

   

 

 

    

 

 

 

Cash Flows from Financing Activities:

           

Reduction of long-term debt

     (69,052     (305     (1,585     0         (70,942

Repurchase of common shares

     (2,017     0        0        0         (2,017

Dividends paid

     (4,832     0        0        0         (4,832

Issuance of common stock

     1,016        0        0        0         1,016   

Profit distributions to noncontrolling interests

     0        0        (2,575     0         (2,575

Changes in intercompany balances with affiliates, net

     (18,505     26,964        (8,459     0         0   
  

 

 

   

 

 

   

 

 

   

 

 

    

 

 

 

Net cash (used in) provided by financing activities

     (93,390     26,659        (12,619     0         (79,350
  

 

 

   

 

 

   

 

 

   

 

 

    

 

 

 

Increase (decrease) in cash and cash equivalents

     0        196        574        0         770   

Cash and cash equivalents, beginning of period

     0        33,221        8,008        0         41,229   
  

 

 

   

 

 

   

 

 

   

 

 

    

 

 

 

Cash and cash equivalents, end of period

   $ 0      $ 33,417      $ 8,582      $ 0       $ 41,999   
  

 

 

   

 

 

   

 

 

   

 

 

    

 

 

 

 

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UNIVERSAL HEALTH SERVICES, INC. AND SUBSIDIARIES

CONDENSED CONSOLIDATING STATEMENTS OF CASH FLOWS

FOR THE THREE MONTHS ENDED MARCH 31, 2011

(amounts in thousands)

 

                              Total  
                 Non     Consolidating      Consolidated  
     Parent     Guarantors     Guarantors     Adjustments      Amounts  

Net cash provided by operating activities

   $ 59,016      $ 109,876      $ 14,285      $ 0       $ 183,177   

Cash Flows from Investing Activities:

           

Property and equipment additions, net of disposals

     0        (41,016     (15,542     0         (56,558

Proceeds received from sale of assets and businesses

     0        991        0        0         991   

Costs incurred for purchase and development of electronic health records application

     0        (8,145     0        0         (8,145
  

 

 

   

 

 

   

 

 

   

 

 

    

 

 

 

Net cash used in investing activities

     0        (48,170     (15,542     0         (63,712
  

 

 

   

 

 

   

 

 

   

 

 

    

 

 

 

Cash Flows from Financing Activities:

           

Reduction of long-term debt

     (135,334     (396     (673     0         (136,403

Additional borrowings

     73,500        0        0        0         73,500   

Financing costs

     (23,140     0        0        0         (23,140

Repurchase of common shares

     (3,170     0        0        0         (3,170

Dividends paid

     (4,876     0        0        0         (4,876

Issuance of common stock

     1,251        0        0        0         1,251   

Profit distributions to noncontrolling interests

     0        0        (4,025     0         (4,025

Changes in intercompany balances with affiliates, net

     32,753        (37,292     4,539           0   
  

 

 

   

 

 

   

 

 

   

 

 

    

 

 

 

Net cash (used in) provided by financing activities

     (59,016     (37,688     (159     0         (96,863
  

 

 

   

 

 

   

 

 

   

 

 

    

 

 

 

Increase (decrease) in cash and cash equivalents

     0        24,018        (1,416     0         22,602   

Cash and cash equivalents, beginning of period

     0        21,385        8,089        0         29,474   
  

 

 

   

 

 

   

 

 

   

 

 

    

 

 

 

Cash and cash equivalents, end of period

   $ 0      $ 45,403      $ 6,673      $ 0       $ 52,076   
  

 

 

   

 

 

   

 

 

   

 

 

    

 

 

 

(13) Recent Accounting Standards

Presentation and Disclosure of Patient Service Revenue, Provision for Bad Debts, and the Allowance for Doubtful Accounts for Certain Health Care Entities: During the first quarter of 2012, we adopted the Financial Accounting Standards Board’s Accounting Standards Update (“ASU”) No. 2011-07, “Health Care Entities (Topic 954): Presentation and Disclosure of Patient Service Revenue, Provision for Bad Debts, and the Allowance for Doubtful Accounts for Certain Health Care Entities,” which required certain health care entities to change the presentation in their statement of operations by reclassifying the provision for bad debts associated with patient service revenue from an operating expense to a deduction from patient service revenue (net of contractual allowances and discounts). As a result, the provision for doubtful accounts for our acute care and behavioral health care facilities is reflected as a deduction from net revenues in the accompanying consolidated statements of income for the three-month periods ended March 31, 2012 and 2011. The adoption of this standard had no impact on our financial position or overall results of operations.

Presentation of Comprehensive Income: In June 2011, the FASB amended its guidance governing the presentation of comprehensive income. The amended guidance eliminates the option to report other comprehensive income and its components in the statement of changes in equity. Under the new guidance, an entity can elect to present items of net income and other comprehensive income in one continuous statement referred to as the statement of comprehensive income or in two separate, but consecutive, statements. While the options for presenting other comprehensive income change under the guidance, other portions of the current guidance will not change. For public entities, these changes are effective for fiscal years, and interim periods within those years, beginning after December 15, 2011. The adoption of this standard did not have an impact on our consolidated financial position or results of operations.

 

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Item 2. Management’s Discussion and Analysis of Financial Condition and Results of Operations

Overview

Our principal business is owning and operating, through our subsidiaries, acute care hospitals, behavioral health centers, surgical hospitals, ambulatory surgery centers and radiation oncology centers. As of March 31, 2012, we owned and/or operated 25 acute care hospitals and 196 behavioral health centers located in 36 states, Washington, D.C., Puerto Rico and the U.S. Virgin Islands. As part of our ambulatory treatment centers division, we manage and/or own outright or in partnerships with physicians, 6 surgical hospitals and surgery and radiation oncology centers located in 4 states and Puerto Rico.

During the first quarter of 2012, we adopted the Financial Accounting Standards Board’s Accounting Standards Update (“ASU”) No. 2011-07, “Health Care Entities (Topic 954): Presentation and Disclosure of Patient Service Revenue, Provision for Bad Debts, and the Allowance for Doubtful Accounts for Certain Health Care Entities,” which required certain health care entities to change the presentation in their statement of operations by reclassifying the provision for bad debts associated with patient service revenue from an operating expense to a deduction from patient service revenue (net of contractual allowances and discounts). As a result, the provision for doubtful accounts for our acute care and behavioral health care facilities is reflected as a deduction from net revenues in the accompanying consolidated statements of income for the three-month periods ended March 31, 2012 and 2011. The adoption of this standard had no impact on our financial position or overall results of operations.

Net revenues from our acute care hospitals, surgical hospitals, surgery centers and radiation oncology centers accounted for 53% of our consolidated net revenues during each of the three-month periods ended March 31, 2012 and 2011. Net revenues from our behavioral health care facilities accounted for 47% of our consolidated net revenues during each of the three-month periods ended March 31, 2012 and 2011.

Services provided by our hospitals include general and specialty surgery, internal medicine, obstetrics, emergency room care, radiology, oncology, diagnostic care, coronary care, pediatric services, pharmacy services and/or behavioral health services. We provide capital resources as well as a variety of management services to our facilities, including central purchasing, information services, finance and control systems, facilities planning, physician recruitment services, administrative personnel management, marketing and public relations.

Forward-Looking Statements and Risk Factors

You should carefully review the information contained in this Quarterly Report, and should particularly consider any risk factors that we set forth in this Quarterly Report and in other reports or documents that we file from time to time with the Securities and Exchange Commission (the “SEC”). In this Quarterly Report, we state our beliefs of future events and of our future financial performance. This Quarterly Report contains “forward-looking statements” that reflect our current estimates, expectations and projections about our future results, performance, prospects and opportunities. Forward-looking statements include, among other things, the information concerning our possible future results of operations, business and growth strategies, financing plans, expectations that regulatory developments or other matters will not have a material adverse effect on our business or financial condition, our competitive position and the effects of competition, the projected growth of the industry in which we operate, and the benefits and synergies to be obtained from our completed and any future acquisitions, and statements of our goals and objectives, and other similar expressions concerning matters that are not historical facts. Words such as “may,” “will,” “should,” “could,” “would,” “predicts,” “potential,” “continue,” “expects,” “anticipates,” “future,” “intends,” “plans,” “believes,” “estimates,” “appears,” “projects” and similar expressions, as well as statements in future tense, identify forward-looking statements. In evaluating those statements, you should specifically consider various factors, including the risks related to healthcare industry trends and those detailed in our filings with the SEC including those set forth herein and in our Annual Report on Form 10-K for the year ended December 31, 2011 in Item 1A Risk Factors and in Item 7 Management’s Discussion and Analysis of Financial Condition and Results of Operations – Forward Looking Statements and Risk Factors. Those factors may cause our actual results to differ materially from any of our forward-looking statements.

Forward-looking statements should not be read as a guarantee of future performance or results, and will not necessarily be accurate indications of the times at, or by which, such performance or results will be achieved. Forward-looking information is based on information available at the time and/or our good faith belief with respect to future events, and is subject to risks and uncertainties that could cause actual performance or results to differ materially from those expressed in the statements. Such factors include, among other things, the following:

 

   

our ability to comply with the existing laws and government regulations, and/or changes in laws and government regulations;

 

   

an increasing number of legislative initiatives have recently been passed into law that may result in major changes in the health care delivery system on a national or state level. No assurances can be given that the implementation of these new laws will not have a material adverse effect on our business, financial condition or results of operations;

 

   

possible unfavorable changes in the levels and terms of reimbursement for our charges by third party payors or government programs, including Medicare or Medicaid;

 

   

an increase in the number of uninsured and self-pay patients treated at our acute care facilities that unfavorably impacts our ability to satisfactorily and timely collect our self-pay patient accounts;

 

   

our ability to enter into managed care provider agreements on acceptable terms and the ability of our competitors to do the same, including contracts with United/Sierra Healthcare in Las Vegas, Nevada;

 

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the outcome of known and unknown litigation, government investigations, false claim act allegations, and liabilities and other claims asserted against us, including matters as disclosed in Item 1. Legal Proceedings;

 

   

the potential unfavorable impact on our business of deterioration in national, regional and local economic and business conditions, including a continuation or worsening of unfavorable credit market conditions;

 

   

competition from other healthcare providers (including physician owned facilities) in certain markets, including McAllen/Edinburg, Texas, the site of one of our largest acute care facilities and Riverside County, California;

 

   

technological and pharmaceutical improvements that increase the cost of providing, or reduce the demand for healthcare;

 

   

our ability to attract and retain qualified personnel, nurses, physicians and other healthcare professionals and the impact on our labor expenses resulting from a shortage of nurses and other healthcare professionals;

 

   

demographic changes;

 

   

our acquisition of PSI which has substantially increased our level of indebtedness which could, among other things, adversely affect our ability to raise additional capital to fund operations, limit our ability to react to changes in the economy or our industry and could potentially prevent us from meeting our obligations under the agreements related to our indebtedness;

 

   

our ability to successfully integrate and improve our recent acquisitions and the availability of suitable acquisitions and divestiture opportunities;

 

   

we receive Medicaid revenues in excess of $100 million annually from each of Texas, Pennsylvania, Virginia, Illinois and Washington, D.C., making us particularly sensitive to reductions in Medicaid and other state based revenue programs (which have been implemented in various forms with respect to our areas of operation in the respective 2012 state fiscal years) as well as regulatory, economic, environmental and competitive changes in those states. In the states in which we operate, based upon the state budgets for the 2012 fiscal year (which generally began at various times during the second half of 2011), we estimate that, on a blended basis, our aggregate Medicaid rates have been reduced by approximately 3% to 4% (or approximately $45 million to $55 million annually) from the average rates in effect during the states’ 2011 fiscal years (which generally ended during the third quarter of 2011). Our consolidated results of operations for the year ended December 31, 2011 and the three-month period ended March 31, 2012 include the pro rata portion of these Medicaid rate reductions. We can provide no assurance that further reductions to Medicaid revenues (which have been proposed in certain states for fiscal year 2013), particularly in the above-mentioned states, will not have a material adverse effect on our future results of operations;

 

   

our ability to continue to obtain capital on acceptable terms, including borrowed funds, to fund the future growth of our business;

 

   

some of our acute care facilities continue to experience decreasing inpatient admission trends;

 

   

our financial statements reflect large amounts due from various commercial and private payors and there can be no assurance that failure of the payors to remit amounts due to us will not have a material adverse effect on our future results of operations;

 

   

the Department of Health and Human Services (“HHS”) published final regulations in July, 2010 implementing the health information technology (“HIT”) provisions of the American Recovery and Reinvestment Act (referred to as the “HITECH Act”). The final regulation defines the “meaningful use” of Electronic Health Records (“EHR”) and establishes the requirements for the Medicare and Medicaid EHR payment incentive programs. The implementation period for these new Medicare and Medicaid incentive payments started in federal fiscal year 2011 and can end as late as 2016 for Medicare and 2021 for the state Medicaid programs. Our acute care hospitals may qualify for these EHR incentive payments upon implementation of the EHR application assuming they meet the “meaningful use criteria”. Certain of our acute care hospitals implemented an EHR application in 2011 and we plan to continue the implementation at each of our acute care hospitals, on a facility-by-facility basis, during 2012 and 2013. However, there can be no assurance that we (our acute care hospitals) will ultimately qualify for these incentive payments and, should we qualify, we are unable to quantify the amount of incentive payments we may receive since the amounts are dependent upon various factors including the implementation timing at each hospital. Should we qualify for incentive payments, there may be timing differences in the recognition of the revenues and expenses recorded in connection with the implementation of the EHR application which may cause material period-to-period changes in our future results of operations. Hospitals that do not qualify as a meaningful user of EHR by 2015 are subject to a reduced market basket update to the inpatient prospective payment system (“IPPS”) standardized amount in 2015 and each subsequent fiscal year. Although we believe that our acute care hospitals will be in compliance with the EHR standards by 2015, there can be no assurance that all of our facilities will be in compliance and therefore not subject to the penalty provision of the HITECH Act;

 

   

in August, 2011, the Budget Control Act of 2011 (the “2011 Act”) was enacted into law. The 2011 Act imposed annual spending limits for most federal agencies and programs aimed at reducing budget deficits by $917 billion between 2012 and 2021, according to a report released by the Congressional Budget Office. Among its other provisions, the law established a bipartisan Congressional committee, known as the Joint Select Committee on Deficit Reduction (the “Joint Committee”), which was tasked with making recommendations aimed at reducing future federal budget deficits by an additional $1.5 trillion over 10 years. The Joint Committee was unable to reach an agreement by the November 23, 2011 deadline and, as a result, across-the-board cuts to discretionary, national defense and Medicare spending were implemented which, if triggered, would result in Medicare payment

 

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reductions of up to 2% per fiscal year with a uniform percentage reduction across all Medicare programs starting in 2013. We cannot predict whether Congress will attempt to suspend or restructure the automatic budget cuts or what other deficit reduction initiatives may be proposed by Congress;

 

   

the ability to obtain adequate levels of general and professional liability insurance on current terms;

 

   

changes in our business strategies or development plans;

 

   

fluctuations in the value of our common stock, and;

 

   

other factors referenced herein or in our other filings with the Securities and Exchange Commission.

Given these uncertainties, risks and assumptions, as outlined above, you are cautioned not to place undue reliance on such forward-looking statements. Our actual results and financial condition could differ materially from those expressed in, or implied by, the forward-looking statements. Forward-looking statements speak only as of the date the statements are made. We assume no obligation to publicly update any forward-looking statements to reflect actual results, changes in assumptions or changes in other factors affecting forward-looking information, except as may be required by law. All forward-looking statements attributable to us or persons acting on our behalf are expressly qualified in their entirety by this cautionary statement.

Critical Accounting Policies and Estimates

The preparation of financial statements in conformity with U.S. generally accepted accounting principles requires us to make estimates and assumptions that affect the amounts reported in our consolidated financial statements and accompanying notes. We consider our critical accounting policies to be those that require us to make significant judgments and estimates when we prepare our consolidated financial statements. For a summary of our significant accounting policies, please see Note 1 to the Consolidated Financial Statements as included in our Annual Report on Form 10-K for the year ended December 31, 2011.

Revenue recognition: We record revenues and related receivables for health care services at the time the services are provided. Medicare and Medicaid revenues represented 39% and 41% of our net patient revenues during the three-month periods ended March 31, 2012 and 2011, respectively. Revenues from managed care entities, including health maintenance organizations and managed Medicare and Medicaid programs, accounted for 48% and 46% of our net patient revenues during the three-month periods ended March 31, 2012 and 2011, respectively.

Provision for Doubtful Accounts: On a consolidated basis, we monitor our total self-pay receivables to ensure that the total allowance for doubtful accounts provides adequate coverage based on historical collection experience. Our accounts receivable are recorded net of allowance for doubtful accounts of $268 million at March 31, 2012 and $253 million at December 31, 2011.

Our accounts receivable includes $73 million as of March 31, 2012 and $54 million as of December 31, 2011 due from Illinois, the collection of which continues to be delayed due to budgetary and funding pressures experienced by the state. Although approximately $50 million of the receivables due from Illinois as of March 31, 2012 have been outstanding in excess of 60 days, and a large portion will likely remain outstanding for the foreseeable future, we expect to eventually collect all amounts due to us and therefore no related reserves have been established in our consolidated financial statements. However, we can provide no assurance that we will eventually collect all amounts due to us from Illinois. Failure to ultimately collect all outstanding amounts due from Illinois would have an adverse impact on our future consolidated results of operations and cash flows.

Recent Accounting Standards: For a summary of accounting standards, please see Note 13 to the Consolidated Financial Statements, as included herein.

Results of Operations

Three-month periods ended March 31, 2012 and 2011:

The following table summarizes our results of operations and is used in the discussion below for the three-month periods ended March 31, 2012 and 2011 (dollar amounts in thousands):

 

00000,000,000 00000,000,000 00000,000,000 00000,000,000
     Three months ended     Three months ended  
     March 31, 2012     March 31, 2011  
            % of Net            % of Net  
     Amount      Revenues     Amount      Revenues  

Net revenues before provision for doubtful accounts

   $ 1,977,003         $ 1,910,528      

Less: Provision for doubtful accounts

     151,714           153,116      
  

 

 

    

 

 

   

 

 

    

 

 

 

Net revenues

     1,825,289         100.0     1,757,412         100.0

Operating charges:

          

Salaries, wages and benefits

     889,506         48.7     845,864         48.1

Other operating expenses

     359,541         19.7     349,446         19.9

Supplies expense

     209,532         11.5     207,170         11.8

Depreciation and amortization

     73,820         4.0     71,351         4.1

Lease and rental expense

     23,862         1.3     23,168         1.3
  

 

 

    

 

 

   

 

 

    

 

 

 

Subtotal-operating expenses

     1,556,261         85.3     1,496,999         85.2
  

 

 

    

 

 

   

 

 

    

 

 

 

Income from operations

     269,028         14.7     260,413         14.8

Interest expense, net

     46,710         2.6     56,417         3.2
  

 

 

    

 

 

   

 

 

    

 

 

 

Income before income taxes

     222,318         12.2     203,996         11.6

Provision for income taxes

     79,748         4.4     74,009         4.2
  

 

 

    

 

 

   

 

 

    

 

 

 

Net income

     142,570         7.8     129,987         7.4

Less: Income attributable to noncontrolling interests

     13,963         0.8     15,794         0.9
  

 

 

    

 

 

   

 

 

    

 

 

 

Net income attributable to UHS

   $ 128,607         7.0   $ 114,193         6.5
  

 

 

    

 

 

   

 

 

    

 

 

 

 

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Net revenues increased 4% or $68 million to $1.83 billion during the three-month period ended March 31, 2012 as compared to $1.76 billion during the comparable quarter of the prior year. The increase was attributable to:

 

   

a $50 million or 3% increase in net revenues generated at our acute care hospitals and behavioral health care facilities owned during both periods (which we refer to as “same facility”);

 

   

$36 million of revenues resulting from an agreement, which was part of an industry-wide settlement related to underpayments of Medicare inpatient prospective payments during a number of prior years, entered into with the United States Department of Health and Human Services, the Secretary of Health and Human Services, and the Centers for Medicare and Medicaid Services, and;

 

   

$18 million of other combined net decreases in revenues resulting primarily from the divestiture of a behavioral health care facility in January, 2012 (San Juan Capestrano) and temporary closure of a behavioral health care facility that was closed during the third quarter of 2011 from flood damage (the facility re-opened in March, 2012).

Income before income taxes (before deduction for income attributable to noncontrolling interests) increased $18 million to $222 million during the three-month period ended March 31, 2012 as compared to $204 million during the comparable quarter of the prior year. Included in our income before income taxes during the first quarter of 2012, as compared to the comparable prior year quarter, was the following:

 

  a. a decrease of $19 million at our acute care facilities as discussed below in Acute Care Hospital Services, excluding impact of the items mentioned in c., and e. below;

 

  b. an increase of $10 million at our behavioral health care facilities, as discussed below in Behavioral Health Services, excluding the impact of the items mentioned in d. below;

 

  c. an increase of $33 million (net of related expenses) resulting from an agreement, which was part of an industry-wide settlement related to underpayments of Medicare inpatient prospective payments during a number of prior years, entered into with the United States Department of Health and Human Services, the Secretary of Health and Human Services, and the Centers for Medicare and Medicaid Services;

 

  d. an increase of $7 million representing the 2011 portion of the net Medicaid supplemental reimbursements earned pursuant to the Oklahoma Supplemental Hospital Offset Payment Program (“SHOPP”) which is expected to provide annual aggregate net reimbursements of $14 million to our facilities located in the state during the state’s fiscal years of 2012 and 2013, retroactive to July 1, 2011;

 

  e. an aggregate decrease of $11 million resulting from: (i) the revised Supplemental Security Income ratios utilized for calculating Medicare disproportionate share hospital reimbursements for federal fiscal years 2006 through 2009 ($7 million unfavorable impact), and; (ii) the write-off of receivables related to revenues recorded during 2011 at two of our acute care hospitals located in Florida resulting from reductions in certain county reimbursements due to reductions in federal matching Inter-Governmental Transfer funds ($4 million unfavorable impact);

 

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  f. an increase of $10 million due to a decrease in interest expense resulting primarily from a decrease in our average effective interest rate (due primarily to an amendment to our credit agreement in March of 2011 which, among other things, provided for reductions in the rates payable for borrowings outstanding under our Term Loan A, Term Loan B and revolving credit facility) and average borrowings outstanding, and;

 

  g. $12 million of other combined net decreases including increased corporate overhead expenses.

Net income attributable to UHS increased $14 million to $129 million during the three-month period ended March 31, 2012 as compared to $114 million during the comparable prior year quarter. The increase during the first quarter of 2012, as compared to the comparable prior year quarter, consisted of:

 

   

an increase of $18 million in income before income taxes, as discussed above;

 

   

an increase of $2 million resulting from a decrease in income attributable to noncontrolling interests, and;

 

   

a decrease of $6 million resulting from an increase in the provision for income taxes resulting primarily from the income tax provision recorded on the $20 million increase in pre-tax income ($18 million increase in income before income taxes and the $2 million increase in income due to a decrease in the income attributable to noncontrolling interests).

Acute Care Hospital Services

Same Facility Basis Acute Care Hospitals

We believe that providing our results on a “Same Facility” basis, which includes the operating results for facilities owned in both the current year and prior year periods, is helpful to our investors as a measure of our operating performance. Our “Same Facility” results also neutralize the effect of items that are non-operational in nature including items such as, but not limited to, gains on sales of assets and businesses, impacts of settlements, legal judgments and lawsuits and other amounts that may be reflected in the current or prior year financial statements that relate to prior periods.

The following table summarizes the results of operations for our acute care facilities, on a same facility and all acute care basis, and is used in the discussion below for the three-month periods ended March 31, 2012 and 2011 (dollar amounts in thousands):

 

     Three months ended
March 31, 2012
    Three months ended
March 31, 2011
 
     Amount      % of Net
Revenues
    Amount      % of Net
Revenues
 

Net revenues before provision for doubtful accounts

   $ 1,058,134         $ 1,054,293      

Less: Provision for doubtful accounts

     128,455           131,751      
  

 

 

    

 

 

   

 

 

    

 

 

 

Net revenues

     929,679         100.0     922,542         100.0

Operating charges:

          

Salaries, wages and benefits

     407,825         43.9     391,960         42.5

Other operating expenses

     185,648         20.0     179,571         19.5

Supplies expense

     163,200         17.6     161,702         17.5

Depreciation and amortization

     49,183         5.3     47,784         5.2

Lease and rental expense

     14,752         1.6     13,535         1.5
  

 

 

    

 

 

   

 

 

    

 

 

 

Subtotal-operating expenses

     820,608         88.3     794,552         86.1
  

 

 

    

 

 

   

 

 

    

 

 

 

Income from operations

     109,071         11.7     127,990         13.9

Interest expense, net

     1,178         0.1     1,006         0.1
  

 

 

    

 

 

   

 

 

    

 

 

 

Income before income taxes

     107,893         11.6     126,984         13.8
  

 

 

    

 

 

   

 

 

    

 

 

 

During the three-month period ended March 31, 2012, as compared to the comparable prior year quarter, net revenues at our acute care hospitals increased $7 million or 1%. Income before income taxes (and before income attributable to noncontrolling interests) decreased $19 million or 15% to $108 million or 11.6% of net revenues during the first quarter of 2012 as compared to $127 million or 13.8% of net revenues during the comparable prior year quarter.

During the three-month period ended March 31, 2012, as compared to the comparable prior year quarter, inpatient admissions to our acute care facilities decreased 2.0% and adjusted admissions (adjusted for outpatient activity) increased 1.6%. Patient days at these facilities

 

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decreased 2.6% during the first quarter of 2012 and adjusted patient days increased 1.0% during the three-month period ended March 31, 2012 as compared to the comparable prior year quarter. The average length of inpatient stay at these facilities was 4.5 days during each of the three-month periods ended March 31, 2012 and 2011, respectively. The occupancy rate, based on the average available beds at these facilities, was 57% and 60% during the three-month periods ended March 31, 2012 and 2011, respectively. During the three-month period ended March 31, 2012, net revenue per adjusted admission decreased 0.8% and net revenue per adjusted patient day decreased 0.2%, as compared to the comparable quarter of the prior year.

The decreases in income from operations and net revenue per adjusted admission and adjusted patient day experienced at our acute care hospitals during the three-month period ended March 31, 2012, as compared to the comparable quarter of the prior year, were largely due to difficult comparisons to the prior year quarter when our acute care net revenues were favorably impacted by positive changes in payor mix and acuity of patients treated at our hospitals and a stabilization of uninsured patient volumes.

Charity care and uninsured discounts:

A significant portion of the patients treated throughout our portfolio of acute care hospitals are uninsured patients which, in part, has resulted from an increase in the number of patients who are employed but do not have health insurance or who have policies with relatively high deductibles. We provide care to patients who meet certain financial or economic criteria without charge or at amounts substantially less than our established rates. Because we do not pursue collection of amounts that qualify as charity care, they are not reported in net revenues or in accounts receivable, net. Our acute care hospitals provided charity care and uninsured discounts, based on charges at established rates, amounting to $315 million and $223 million during three-month periods ended March 31, 2012 and 2011, respectively.

The estimated costs of providing the charity services was $52 million and $39 million during the three-month periods ended March 31, 2012 and 2011, respectively. The estimated costs were based on a calculation which multiplied the percentage of operating expenses for our acute care hospitals to gross charges for those hospitals by the above-mentioned gross charity care and uninsured discount amounts. The percentage of cost to gross charges is calculated based on the total operating expenses for our acute care facilities divided by gross patient service revenue for those facilities. An increase in the level of uninsured patients to our facilities and the resulting adverse trends in the provision for doubtful accounts and charity care provided could have a material unfavorable impact on our future operating results.

All Acute Care Hospitals

The following table summarizes the results of operations for our acute care hospitals for the three-month periods ended March 31, 2012 and 2011. Included in the financial results below for the three-month period ended March 31, 2012, in addition to our acute care hospitals’, same facility basis financial results as discussed above, were the following items. There were no such adjustments required to our same facility acute care results for the three-month period ended March 31, 2011.

 

   

$36 million of net revenues and $3 million of related operating expenses resulting from an agreement, which was part of an industry-wide settlement related to underpayments of Medicare inpatient prospective payments during a number of prior years, entered into with the United States Department of Health and Human Services, the Secretary of Health and Human Services, and the Centers for Medicare and Medicaid Services, and;

 

   

(i) a $7 million reduction to net revenues resulting from the revised Supplemental Security Income ratios utilized for calculating Medicare disproportionate share hospital reimbursements for federal fiscal years 2006 through 2009, and; (ii) a $4 million reduction to net revenues resulting from the write-off of receivables related to revenues recorded during 2011 at two of our acute care hospitals located in Florida resulting from reductions in certain county reimbursements due to reductions in federal matching Inter-Governmental Transfer funds.

 

     Three months ended
March 31, 2012
    Three months ended
March 31, 2011
 
     Amount      % of Net
Revenues
    Amount      % of Net
Revenues
 

Net revenues before provision for doubtful accounts

   $ 1,082,687         $ 1,054,293      

Less: Provision for doubtful accounts

     128,455           131,751      
  

 

 

    

 

 

   

 

 

    

 

 

 

Net revenues

     954,232         100.0     922,542         100.0

Operating charges:

          

Salaries, wages and benefits

     407,825         42.7     391,960         42.5

 

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Other operating expenses

     188,246         19.7     179,571         19.5

Supplies expense

     163,200         17.1     161,702         17.5

Depreciation and amortization

     49,183         5.2     47,784         5.2

Lease and rental expense

     14,752         1.5     13,535         1.5
  

 

 

    

 

 

   

 

 

    

 

 

 

Subtotal-operating expenses

     823,206         86.3     794,552         86.1
  

 

 

    

 

 

   

 

 

    

 

 

 

Income from operations

     131,026         13.7     127,990         13.9

Interest expense, net

     1,178         0.1     1,006         0.1
  

 

 

    

 

 

   

 

 

    

 

 

 

Income before income taxes

     129,848         13.6     126,984         13.8
  

 

 

    

 

 

   

 

 

    

 

 

 

Behavioral Health Services

The following table summarizes the results of operations for our behavioral health care facilities, on a same facility basis, and is used in the discussion below for the three-month periods ended March 31, 2012 and 2011 (dollar amounts in thousands):

Same Facility – Behavioral Health

 

     Three months ended
March 31, 2012
    Three months ended
March 31, 2011
 
     Amount      % of Net
Revenues
    Amount      % of Net
Revenues
 

Net revenues before provision for doubtful accounts

   $ 877,839         $ 832,929      

Less: Provision for doubtful accounts

     23,035           21,013      
  

 

 

    

 

 

   

 

 

    

 

 

 

Net revenues

     854,804         100.0     811,916         100.0

Operating charges:

          

Salaries, wages and benefits

     428,523         50.1     409,268         50.4

Other operating expenses

     152,406         17.8     144,410         17.8

Supplies expense

     44,600         5.2     43,018         5.3

Depreciation and amortization

     22,636         2.6     21,000         2.6

Lease and rental expense

     8,387         1.0     8,180         1.0
  

 

 

    

 

 

   

 

 

    

 

 

 

Subtotal-operating expenses

     656,552         76.8     625,876         77.1
  

 

 

    

 

 

   

 

 

    

 

 

 

Income from operations

     198,252         23.2     186,040         22.9

Interest expense, net

     377         0.1     531         0.1
  

 

 

    

 

 

   

 

 

    

 

 

 

Income before income taxes

     197,875         23.1     185,509         22.8
  

 

 

    

 

 

   

 

 

    

 

 

 

On a same facility basis, during the first quarter of 2012, as compared to the first quarter of 2011, net revenues at our behavioral health care facilities increased 5% or $43 million to $855 million from $812 million. Income before income taxes increased $12 million or 7% to $198 million or 23.1% of net revenues during the three-month period ended March 31, 2012, as compared to $186 million or 22.8% of net revenues during the comparable prior year quarter.

On a same facility basis, inpatient admissions and adjusted admissions (adjusted for outpatient activity) to our behavioral health facilities increased 8.6% and 9.2%, respectively, during the three-month period ended March 31, 2012 as compared to the comparable quarter of the prior year. Patient days and adjusted patient days increased 2.3% and 2.8%, respectively, during the three-month period ended March 31, 2012 as compared to the comparable prior year quarter. The average length of inpatient stay at these facilities was 13.7 days and 14.6 days during the three-month periods ended March 31, 2012 and 2011, respectively. The occupancy rate, based on the average available beds at these facilities, was 76% and 75% during the three-month periods ended March 31, 2012 and 2011, respectively. During the three-month period ended March 31, 2012, net revenue per adjusted admission decreased 3.6% and net revenue per adjusted patient day increased 2.4%, as compared to the comparable quarter of the prior year.

All Behavioral Health Care Facilities

 

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The following table summarizes the results of operations for our behavioral health care facilities for the three-month periods ended March 31, 2012 and 2011. Included in the financial results below for the three-month period ended March 31, 2012, in addition to our behavioral health care facilities’ same facility basis financial results as discussed above, were the following items:

 

   

$7 million of net revenues recorded during the three-month period ended March 31, 2012 representing the 2011 portion of the net Medicaid supplemental reimbursements earned pursuant to the Oklahoma Supplemental Hospital Offset Payment Program (“SHOPP”) which is expected to provide annual aggregate net reimbursements of $14 million to our facilities located in the state during the state’s fiscal years of 2012 and 2013, retroactive to July 1, 2011, and;

 

   

The operating results of San Juan Capestrano that was divested in January, 2012, and a behavioral health care facility that was temporarily closed beginning in the third quarter of 2011 from flood damage (the facility re-opened in March, 2012).

 

     Three months ended
March 31, 2012
    Three months ended
March 31, 2011
 
     Amount      % of Net
Revenues
    Amount      % of Net
Revenues
 

Net revenues before provision for doubtful accounts

   $ 888,177         $ 850,308      

Less: Provision for doubtful accounts

     23,304           21,360      
  

 

 

    

 

 

   

 

 

    

 

 

 

Net revenues

     864,873         100.0     828,948         100.0

Operating charges:

          

Salaries, wages and benefits

     434,083         50.2     419,065         50.6

Other operating expenses

     151,433         17.5     149,409         18.0

Supplies expense

     44,953         5.2     44,090         5.3

Depreciation and amortization

     22,972         2.7     21,443         2.6

Lease and rental expense

     8,559         1.0     8,609         1.0
  

 

 

    

 

 

   

 

 

    

 

 

 

Subtotal-operating expenses

     662,000         76.5     642,616         77.5
  

 

 

    

 

 

   

 

 

    

 

 

 

Income from operations

     202,873         23.5     186,332         22.5

Interest expense, net

     377         0.1     553         0.1
  

 

 

    

 

 

   

 

 

    

 

 

 

Income before income taxes

     202,496         23.4     185,779         22.4
  

 

 

    

 

 

   

 

 

    

 

 

 

During the first quarter of 2012, as compared to the comparable prior year quarter, net revenues at our behavioral health care facilities increased 4% or $36 million. Income before income taxes increased $17 million or 9% to $202 million or 23.4% of net revenues during the first quarter of 2012, as compared to $186 million or 22.4% of net revenues during the first quarter of 2011. The increases in net revenues and income before income taxes were primarily attributable to the same facility basis increases, as discussed above.

Sources of Revenue

Overview: We receive payments for services rendered from private insurers, including managed care plans, the federal government under the Medicare program, state governments under their respective Medicaid programs and directly from patients.

The following tables show the approximate percentages of net patient revenue during the past three years (excludes sources of revenues for all periods presented for divested facilities which are reflected as discontinued operations in our Consolidated Financial Statements) for: (i) our Acute Care and Behavioral Health Care Facilities Combined; (ii) our Acute Care Facilities, and; (iii) our Behavioral Health Care Facilities. Net patient revenue is defined as revenue from all sources after deducting contractual allowances and discounts from established billing rates, which we derived from various sources of payment for the years indicated.

The following table shows the approximate percentages of net patient revenue for the three month period ended March 31, 2012 and 2011 presented: (i) on a combined basis for both our acute care and behavioral health facilities; (ii) for our acute care facilities only, and; (iii) for our behavioral health facilities only:

 

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Acute Care and Behavioral Health Facilities Combined    Percentage of Net Patient
Revenues
 
     Three Months Ended
March 31,
 
     2012     2011  

Third Party Payors:

    

Medicare

     24     24

Medicaid

     15     17

Managed Care (HMO and PPOs)

     48     46

Other Sources

     13     13
  

 

 

   

 

 

 

Total

     100     100
  

 

 

   

 

 

 

 

Acute Care Facilities    Percentage of Net Patient
Revenues
 
     Three Months Ended
March 31,
 
     2012     2011  

Third Party Payors:

    

Medicare

     29     30

Medicaid

     7     9

Managed Care (HMO and PPOs)

     55     51

Other Sources

     9     10
  

 

 

   

 

 

 

Total

     100     100
  

 

 

   

 

 

 

 

Behavioral Health Facilities    Percentage of Net Patient
Revenues
 
     Three Months Ended
March 31,
 
     2012     2011  

Third Party Payors:

    

Medicare

     18     17

Medicaid

     24     26

Managed Care (HMO and PPOs)

     40     39

Other Sources

     18     18
  

 

 

   

 

 

 

Total

     100     100
  

 

 

   

 

 

 

Medicare: Medicare is a federal program that provides certain hospital and medical insurance benefits to persons aged 65 and over, some disabled persons and persons with end-stage renal disease. All of our acute care hospitals and many of our behavioral health centers are certified as providers of Medicare services by the appropriate governmental authorities. Amounts received under the Medicare program are generally significantly less than a hospital’s customary charges for services provided. Since a substantial portion of our revenues will come from patients under the Medicare program, our ability to operate our business successfully in the future will depend in large measure on our ability to adapt to changes in this program.

Under the Medicare program, for inpatient services, our general acute care hospitals receive reimbursement under the inpatient prospective payment system (“IPPS”). Under the IPPS, hospitals are paid a predetermined fixed payment amount for each hospital discharge. The fixed payment amount is based upon each patient’s Medicare severity diagnosis related group (“MS-DRG”). Every MS-DRG is assigned a payment rate based upon the estimated intensity of hospital resources necessary to treat the average patient with that particular diagnosis. The MS-DRG payment rates are based upon historical national average costs and do not consider the actual costs incurred by a hospital in providing care. This MS-DRG assignment also affects the predetermined capital rate paid with each MS-DRG. The MS-DRG and capital payment rates are adjusted annually by the predetermined geographic adjustment factor for the geographic region in which a particular hospital is located and are weighted based upon a statistically normal distribution of severity. While we generally will not receive payment from Medicare for inpatient services, other than the MS-DRG payment, a hospital may qualify for an “outlier” payment if a particular patient’s treatment costs are extraordinarily high and exceed a specified threshold.

MS-DRG rates are adjusted by an update factor each federal fiscal year, which begins on October 1. The index used to adjust the MS-DRG rates, known as the “hospital market basket index,” gives consideration to the inflation experienced by hospitals in purchasing goods and

 

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services. Generally, however, the percentage increases in the MS-DRG payments have been lower than the projected increase in the cost of goods and services purchased by hospitals.

In July, 2010, CMS published its final IPPS 2011 payment rule which provided for a 2.6% market basket increase to the base Medicare MS-DRG blended rate. When statutorily mandated budget neutrality factors and annual geographic wage index updates and the documenting and coding adjustments were considered, our overall decrease from the federal fiscal year 2011 rule was 1.1%. In addition, as outlined in the Sources of Revenues and Health Care Reform discussion below, CMS was also required by federal law to reduce the update factor by 0.25% in federal fiscal year 2011.

In August, 2011, CMS published its final IPPS 2012 payment rule which provided for a 3.0% market basket increase to the base Medicare MS-DRG blended rate. When statutorily mandated budget neutrality factors, annual geographic wage index updates, documenting and coding adjustments and Health Care Reform productivity adjustments are considered, we estimate our overall increase from the final federal fiscal year 2012 rule will approximate 0.6%. CMS also includes a 2.0% market basket reduction related to prior year documentation and coding adjustments as well as a 1.1% increase related to the correction of a prior year wage index budget neutrality adjustment. In addition, as outlined in the Sources of Revenues and Health Care Reform discussion below, CMS was also required by federal law to reduce the update factor by 0.10% in federal fiscal year 2012. The projected impact from this IPPS rule noted above reflects all of the adjustments described in this paragraph.

In April, 2012, CMS published its proposed IPPS 2013 payment rule which provided for a 3.0% market basket increase to the base Medicare MS-DRG blended rate. When statutorily mandated budget neutrality factors, annual geographic wage index updates, documenting and coding adjustments and Health Care Reform mandated adjustments are considered, we estimate our overall increase from the proposed federal fiscal year 2013 rule will approximate 0.8%. The projected impact from this IPPS proposed rule noted above reflects all of the adjustments described in this paragraph.

In September, 2007, the “TMA, Abstinence Education, and QI Programs Extension Act of 2007” legislation took effect and scaled back cuts in hospital reimbursement that CMS was set to impose. In federal fiscal years 2010 to 2012, the new law requires CMS to make adjustments to the Medicare standardized amounts in these years to reflect the removal of actual aggregate payment increases or decreases for documentation and coding adjustments that occurred during federal fiscal years 2008 and 2009 as compared to the initial CMS estimates. In federal fiscal year 2010, CMS made its initial statutory mandated adjustment under this legislation and will continue to do so in subsequent fiscal years to ensure the implementation of MS-DRGs was budget neutral among all affected hospitals. In July, 2010, the IPPS 2011 proposed payment rule applied a 2.9% reduction to the 2011 market basket update and indicated another 2.9% reduction would also be applied in 2012 for documenting and coding. In this same rule, CMS indicated a remaining documenting and coding adjustment of 3.9% reduction is still required to be made to future IPPS updates. In the 2012 IPPS final rule, CMS offset 2.0% of this remaining reduction and has proposed to offset the remaining 1.9% in the IPPS 2013 payment rule described above.

On January 1, 2005, CMS implemented a new Psychiatric Prospective Payment System (“Psych PPS”) for inpatient services furnished by psychiatric hospitals under the Medicare program. This system replaced the cost-based reimbursement guidelines with a per diem Psych PPS with adjustments to account for certain facility and patient characteristics. The Psych PPS also contained provisions for outlier payments and an adjustment to a psychiatric hospital’s base payment if it maintains a full-service emergency department. According to the April, 2010 CMS notice, the market basket increase was 2.4% for the period of July 1, 2010 through June 30, 2011. In April, 2011 CMS published its final Psych PPS rule for the fifteen month period July 1, 2011 to September 30, 2012. The market basket increase for this time period is scheduled to be 2.95%, which includes a 0.25% reduction required by the federal Health Care Reform legislation enacted in 2010.

In November 2010, CMS published its annual final Medicare Outpatient Prospective Payment System (“OPPS”) rule for 2011. The final market basket increase to the OPPS base rate is 2.46%. In addition, as outlined in the Sources of Revenues and Health Care Reform discussion below, CMS is also required by federal law to reduce the update factor by 0.25% in federal fiscal year 2011. When other statutorily required adjustments and hospital patient service mix are considered, the overall Medicare OPPS payment increase for 2011 is estimated to be 3.2%.

In November, 2011, CMS published its annual final Medicare OPPS rule for 2012. The market basket increase to the OPPS base rate is 3.0%. In addition, as outlined in the Sources of Revenues and Health Care Reform discussion below, CMS is also required by federal law to reduce the update factor by 0.1% in federal fiscal year 2012 and to reduce the annual update by a productivity adjustment which is 1.1%. In the final rule, CMS is also implementing a significant decrease in the 2012 Medicare rates for both hospital-based and community mental health center (CMHC) partial hospitalization programs. When other statutorily required adjustments, hospital patient service mix and the aforementioned partial hospitalization rates are considered, our overall Medicare OPPS payment decrease for 2012 is estimated to be 0.7%. Excluding the behavioral health division partial hospitalization rate impact, our Medicare OPPS payment increase for 2012 is estimated to be 2.1%.

In August, 2011, the Budget Control Act of 2011 (the “2011 Act”) was enacted into law. Included in this law are the imposition of annual spending limits for most federal agencies and programs aimed at reducing budget deficits by $917 billion between 2012 and 2021, according to a report released by the Congressional Budget Office. Among its other provisions, the law established a bipartisan Congressional committee, known as the Joint Committee, which was responsible for developing recommendations aimed at reducing future federal budget deficits by an additional $1.5 trillion over 10 years. The Joint Committee was unable to reach an agreement by the November 23, 2011

 

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deadline and, as a result, across-the-board cuts to discretionary, national defense and Medicare spending were implemented which, if triggered, would result in Medicare payment reductions of up to 2% per fiscal year with a uniform percentage reduction across all Medicare programs starting in 2013. We cannot predict whether Congress will attempt to suspend or restructure the automatic budget cuts or what other deficit reduction initiatives may be proposed by Congress.

We entered into an agreement in April, 2012 with the United States Department of Health and Human Services, the Secretary of Health and Human Services, and the Centers for Medicare and Medicaid Services (referred to collectively as “HHS”) that is expected to result in an aggregate cash payment to us of approximately $36 million, the majority of which we expect to receive on or about June 30, 2012. After reductions for estimated related expenses and the portion attributable to third-party non-controlling ownership interests, this settlement favorably impacted our pre-tax consolidated financial results during the three-month period ended March 31, 2012 by approximately $30 million. This agreement was part of an industry-wide settlement with HHS related to litigation that was pending for several years contending that acute care hospitals in the U.S. were underpaid from the Medicare inpatient prospective payment system during a number of prior years. The underpayments resulted from calculations related to rural floor budget neutrality adjustments that were implemented in connection with the Balanced Budget Act of 1997.

During March, 2012, CMS issued new Supplemental Security Income (“SSI”) ratios utilized for calculating Medicare Disproportionate Share Hospital reimbursements (“Medicare DSH”) for federal fiscal years 2006 through 2009. As a result of these new SSI ratios, acute care hospitals are required to recalculate their Medicare DSH for the affected years and record adjustments for differences in estimated reimbursements. In addition, two of our acute care hospitals located in Florida were notified that the respective counties in which they operate were no longer funding the hospitals with certain reimbursements resulting from reductions in federal matching Inter-Governmental Transfer funds. As a result of the unfavorable adjustments required from the revised SSI ratios, and the write-off of receivables from certain counties located in Florida, our pre-tax consolidated financial results during the three-month period ended March 31, 2012 were unfavorably impacted by an aggregate of approximately $8 million (net of the portion attributable to third-party non-controlling ownership interests).

HITECH Act: In July 2010, the Department of Health and Human Services (“HHS”) published final regulations implementing the health information technology (“HIT”) provisions of the American Recovery and Reinvestment Act (referred to as the “HITECH Act”). The final regulation defines the “meaningful use” of Electronic Health Records (“EHR”) and establishes the requirements for the Medicare and Medicaid EHR payment incentive programs. The final rule established an initial set of standards and certification criteria. The implementation period for these new Medicare and Medicaid incentive payments started in federal fiscal year 2011 and can end as late as 2016 for Medicare and 2021 for the state Medicaid programs. State Medicaid program participation in this federally funded incentive program is voluntary but we expect that all of the states in which our eligible hospitals operate will ultimately choose to participate. Our acute care hospitals may qualify for these EHR incentive payments upon implementation of the EHR application assuming they meet the “meaningful use criteria”. The government’s ultimate goal is to promote more effective (quality) and efficient healthcare delivery through the use of technology to reduce the total cost of healthcare for all Americans and utilizing the cost savings to expand access to the healthcare system.

Our acute care facilities have begun implementing an EHR application, on a facility-by-facility basis, beginning in 2011. The implementation is scheduled to be completed in 2013. However, there can be no assurance that we will ultimately qualify for these incentive payments and, should we qualify, the amount of incentive payments received is dependent upon various factors including the implementation timing at each facility. Should we qualify for incentive payments, there may be timing differences in the recognition of the revenues and expenses recorded in connection with the implementation of the EHR application which may cause material period-to-period changes in our future results of operations.

There are no EHR-related revenues included in our consolidated results of operations for the three-month periods ended March 31, 2012 and 2011. Although we received an aggregate of approximately $17 million of state Medicaid, EHR incentive payments as of March 31, 2012, these payments have been reflected as deferred revenue on our consolidated balance sheet as of that date (included in other current liabilities). These payments will be recorded as revenue in our consolidated statements of income in the periods in which the applicable hospitals are deemed to have met the meaningful use criteria. Also, if our hospitals meet the meaningful use criteria, we may become entitled to additional Medicaid incentive payments in future periods. Hospitals that do not qualify as a meaningful user of EHR by 2015 are subject to a reduced market basket update to the IPPS standardized amount in 2015 and each subsequent fiscal year. Although we believe that our acute care hospitals will be in compliance with the EHR standards by 2015, there can be no assurance that all of our facilities will be in compliance and therefore not subject to the penalty provision of the HITECH Act. Although our results of operations for the three-month periods ended March 31, 2012 and 2011 include certain EHR-related expenses, the amounts did not have a material impact on our consolidated financial results.

Medicaid: Medicaid is a joint federal-state funded health care benefit program that is administered by the states to provide benefits to qualifying individuals who are unable to afford care. Most state Medicaid payments are made under a PPS-like system, or under programs that negotiate payment levels with individual hospitals. Amounts received under the Medicaid program are generally significantly less than a hospital’s customary charges for services provided. In addition to revenues received pursuant to the Medicare program, we receive a large portion of our revenues either directly from Medicaid programs or from managed care companies managing Medicaid. All of our acute care hospitals and most of our behavioral health centers are certified as providers of Medicaid services by the appropriate governmental authorities.

 

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We receive Medicaid revenues in excess of $100 million annually from each of Texas, Pennsylvania, Virginia, Illinois and Washington, D.C., making us particularly sensitive to reductions in Medicaid and other state based revenue programs (which have been implemented in various forms with respect to our areas of operation in the respective 2012 state fiscal years) as well as regulatory, economic, environmental and competitive changes in those states. In the states in which we operate, based upon the state budgets for the 2012 fiscal year (which generally began at various times during the second half of 2011), we estimate that, on a blended basis, our aggregate Medicaid rates have been reduced by approximately 3% to 4% (or approximately $45 million to $55 million annually) from the average rates in effect during the states’ 2011 fiscal years (which generally ended during the third quarter of 2011). Our consolidated results of operations for the three months ended March 31, 2012 include the pro rata portion of these Medicaid rate reductions. We can provide no assurance that further reductions to Medicaid revenues (which have been proposed in certain states for fiscal year 2013), particularly in the above-mentioned states, will not have a material adverse effect on our future results of operations.

Certain of our acute care hospitals located in various counties of Texas (Hildalgo, Maverick, Potter and Webb) participate in CMS-approved private Medicaid supplemental payment (“UPL”) programs. These hospitals also have affiliation agreements with third-party hospitals to provide free hospital and physician care to qualifying indigent residents of these counties. Our hospitals receive both UPL payments from the Medicaid program and indigent care payments from third-party, affiliated hospitals. The UPL payments are contingent on the county or hospital district making an Inter-Governmental Transfer (“IGT”) to the state Medicaid program while the indigent care payment is contingent on a transfer of funds from the applicable affiliated hospitals. We received $7 million and $10 million during the three-month periods ended March 31, 2012 and 2011, respectively, of aggregate, net UPL and affiliated hospital indigent care payments. For state fiscal year 2012, Texas Medicaid will operate under a CMS-approved Section 1115 five-year Medicaid waiver demonstration program. During the first five years of this program, the Texas Health and Human Services Commission (“THHSC”) will transition away from UPL payments to new waiver incentive payment programs. During the first year of transition, which commenced on October 1, 2011, THHSC will make payments to Medicaid UPL recipient providers that received payments during the state’s prior fiscal year. During transition years two through five, THHSC will make incentive payments under the program after certain qualifying criteria are met by hospitals. If the applicable hospital district or county makes IGTs consistent with 2011 levels, we believe we would be entitled to aggregate net payments pursuant to these programs of approximately $18 million during the remaining nine months of 2012.

We incur health-care related taxes (“Provider Taxes”) imposed by states in the form of a licensing fee, assessment or other mandatory payment which are related to: (i) healthcare items or services; (ii) the provision of, or the authority to provide, the health care items of services, or; (iii) the payment for the health care items or services. Such Provider Taxes are subject to various federal regulations that limit the scope and amount of the taxes that can be levied by states in order to secure federal matching dollars as part of their respective state Medicaid programs. We derive a related Medicaid reimbursement benefit from assessed Provider Taxes in the form of Medicaid claims based payment increases and/or lump sum Medicaid supplemental payments. We earned an aggregate net benefit of approximately $5 million during each of the three-month periods ended March 31, 2012 and 2011 from Medicaid supplemental payments, after assessed Provider Taxes were considered (exclusive of our hospitals located in Oklahoma, as discussed below). Excluding Oklahoma, we estimate that our aggregate net benefit from these Provider Tax programs will approximate $16 million during the remaining nine months of 2012. The aggregate net benefit is earned from multiple states and therefore no particular state’s portion is individually material to our consolidated financial statements. However, Provider Taxes are governed by both federal and state laws and are subject to future legislative changes that, if reduced from current rates in several states, could have a material adverse impact on our consolidated future results of operations.

In January, 2012, the state of Oklahoma was granted federal approval by the Centers for Medicare and Medicaid Services (“CMS”) for the Supplemental Hospital Offset Payment Program (“SHOPP”) which grants the Oklahoma Health Care Authority the authority to assess a 2.5% fee on certain Oklahoma hospitals and to make Medicaid supplemental payments to hospitals through December 31, 2014, retroactive to July 1, 2011. The state finalized the initial supplemental payment program amounts in March, 2012. Pursuant to the terms and conditions of the SHOPP program during the state’s fiscal years of 2012 and 2013, we estimate that we are entitled to annual net reimbursements of approximately $14 million, retroactive to July 1, 2011. Our pre-tax consolidated financial results for the three-month period ended March 31, 2012 were favorably impacted by approximately $11 million consisting of revenues related to the SHOPP program covering the period of July 1, 2011 through March 31, 2012.

In California, a Medicaid state plan amendment (“SPA”) was submitted to CMS by the state requesting and extension of a prior provider tax and related Medicaid supplemental payment program retroactive to July 1, 2011 through December 31, 2013. In Indiana, a similar Medicaid SPA was submitted to CMS by the state requesting retroactive approval of the program to July 1, 2011 with the program operating through June 30, 2013. If these SPAs are approved by CMS, we estimate that we may be entitled to net annual reimbursement which would have a favorable impact on our future results of operations.

In July, 2011 in accordance with the state 2012-2013 General Appropriations Act (the “Act”), the Texas Health and Human Services Commission (“THHSC”) published a proposed rule that changes the reimbursement methodology for inpatient services by establishing a statewide base standard dollar amount (“SDA”) rate along with certain hospital specific SDA rate adjustments for geographic location, trauma level designation and teaching hospital status. The new SDA payment methodology became effective September 1, 2011. Similarly, THHSC also incorporated changes in conformance with the Act which results in reductions to various categories of Medicaid hospital outpatient services. The expected reduction to our annual Medicaid inpatient reimbursement resulting from the proposed inpatient SDA payment methodology has been factored into the fiscal year 2012 Medicaid reductions (3% to 4%), as mentioned above.

 

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Managed Care: A significant portion of our net patient revenues are generated from managed care companies, which include health maintenance organizations, preferred provider organizations and managed Medicare (referred to as Medicare Part C or Medicare Advantage) and Medicaid programs. In general, we expect the percentage of our business from managed care programs to continue to grow. The consequent growth in managed care networks and the resulting impact of these networks on the operating results of our facilities vary among the markets in which we operate. Typically, we receive lower payments per patient from managed care payors than we do from traditional indemnity insurers, however, during the past few years we have secured price increases from many of our commercial payors including managed care companies.

Commercial Insurance: Our hospitals also provide services to individuals covered by private health care insurance. Private insurance carriers typically make direct payments to hospitals or, in some cases, reimburse their policy holders, based upon the particular hospital’s established charges and the particular coverage provided in the insurance policy. Private insurance reimbursement varies among payors and states and is generally based on contracts negotiated between the hospital and the payor.

Commercial insurers are continuing efforts to limit the payments for hospital services by adopting discounted payment mechanisms, including predetermined payment or DRG-based payment systems, for more inpatient and outpatient services. To the extent that such efforts are successful and reduce the insurers’ reimbursement to hospitals and the costs of providing services to their beneficiaries, such reduced levels of reimbursement may have a negative impact on the operating results of our hospitals.

Other Sources: Our hospitals provide services to individuals that do not have any form of health care coverage. Such patients are evaluated, at the time of service or shortly thereafter, for their ability to pay based upon federal and state poverty guidelines, qualifications for Medicaid or other state assistance programs, as well as our local hospitals’ indigent and charity care policy. Patients without health care coverage who do not qualify for Medicaid or indigent care write-offs are offered substantial discounts in an effort to settle their outstanding account balances.

State Medicaid Disproportionate Share Hospital Payments: Hospitals that have an unusually large number of low-income patients (i.e., those with a Medicaid utilization rate of at least one standard deviation above the mean Medicaid utilization, or having a low income patient utilization rate exceeding 25%) are eligible to receive a disproportionate share hospital (“DSH”) adjustment. Congress established a national limit on DSH adjustments. Although this legislation and the resulting state broad-based provider taxes have affected the payments we receive under the Medicaid program, to date the net impact has not been materially adverse.

Upon meeting certain conditions and serving a disproportionately high share of Texas’ and South Carolina’s low income patients, five of our facilities located in Texas and one facility located in South Carolina received additional reimbursement from each state’s DSH fund. The Texas and South Carolina programs have been renewed for each state’s 2012 fiscal years (covering the period of October 1, 2011 through September 30, 2012 for each state). In connection with these DSH programs, included in our financial results was an aggregate of $10 million and $12 million during the three-month periods ended March 31, 2012 and 2011, respectively.

In April, 2012, the THHSC published a proposed rule that would change the Texas Medicaid Disproportionate Share Hospital (“Texas Medicaid DSH”) methodology, which, if implemented, could reduce reimbursements to us effective July 1, 2012. Although we can provide no assurance as to the ultimate outcome of this rule, or its ultimate impact on our consolidated financial results, if this proposed rule is implemented as currently drafted, our future Texas Medicaid DSH reimbursements could be reduced by approximately $16 million annually, beginning July 1, 2012. As of March 31, 2012, we have approximately $20 million of receivables recorded in connection with Texas Medicaid DSH reimbursements covering the period of October, 2011 through March, 2012, $8 million of which was paid to us in April, 2012. Although at this time we expect to fully collect the remainder of the Texas Medicaid DSH receivables, as previously disclosed, since receipt of the Texas Medicaid DSH reimbursements is contingent on certain public hospitals in Texas making Inter-Governmental Transfers to the state, we can provide no assurance that we will ultimately collect all of the estimated amounts due to us.

Assuming that the South Carolina DSH program is renewed for the state’s 2013 fiscal year at amounts similar to the 2012 fiscal year program, and assuming the Texas DSH program is renewed for the state’s 2013 fiscal year at an reduced annual rate as contemplated in the above-mentioned proposed rule (resulting in a $16 million annual reduction effective July 1, 2012), we estimate our aggregate reimbursements pursuant to these programs to be approximately $28 million during the remaining nine months of 2012. Failure to renew these DSH programs beyond their scheduled termination dates, failure of the public hospitals to provide the necessary IGTs for the states’ share of the DSH programs, failure of our hospitals that currently receive DSH payments to qualify for future DSH funds under these programs, or reductions in reimbursements, could have a material adverse effect on our future results of operations.

Sources of Revenues and Health Care Reform: Given increasing budget deficits, the federal government and many states are currently considering additional ways to limit increases in levels of Medicare and Medicaid funding, which could also adversely affect future payments received by our hospitals. In addition, the uncertainty and fiscal pressures placed upon the federal government as a result of, among other things, the War on Terrorism, economic recovery stimulus packages, responses to natural disasters, the expansion of a Medicare drug benefit and the federal budget deficit in general may affect the availability of federal funds to provide additional relief in the future. We are unable to predict the effect of future policy changes on our operations.

In March, 2010, the Health Care and Education Reconciliation Act of 2010 (H.R. 4872, P.L. 111-152), (the “Reconciliation Act”) and the Patient Protection and Affordable Care Act (P.L. 111-148), (the “Affordable Care Act”), were enacted into law and created significant

 

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changes to health insurance coverage for U.S. citizens as well as material revisions to the federal Medicare and state Medicaid programs. Medicare, Medicaid and other health care industry changes which are scheduled to be implemented at various times during this decade are noted below.

Immediate Medicare Reductions:

The Reconciliation Act reduced the market basket update for inpatient and outpatient hospitals and inpatient behavioral health facilities by 0.25% in each of 2010 and 2011 and by 0.10% in 2012 and 2013. Further, the Affordable Care Act implemented certain reforms to Medicare Advantage payments, effective in 2011.

Future Medicare Reductions:

Future changes to the Medicare program include:

 

   

A Medicare shared savings program (effective 2012)

 

   

A hospital readmissions reduction program (effective 2012)

 

   

A national pilot program on payment bundling (effective 2013)

 

   

A value-based purchasing program for hospitals (effective 2012)

 

   

Reduction to Medicare disproportionate share hospital (“DSH”) payments (effective 2014)

Medicaid Revisions:

 

   

Expanded Medicaid eligibility and related special federal payments (effective 2014)

 

   

Reduction to Medicaid DSH (effective 2014)

Health Insurance Revisions:

 

   

Large employer insurance reforms (effective 2014)

 

   

Individual insurance mandate and related federal subsidies (effective 2014)

 

   

Federally mandated insurance coverage reforms (2010 and forward)

Although the above-mentioned Medicare market basket reductions implemented in 2010 did not have a material impact on our results of operations to date, we are unable to estimate the future impact of the other legislative changes as outlined above.

In addition to statutory and regulatory changes to the Medicare and each of the state Medicaid programs, our operations and reimbursement may be affected by administrative rulings, new or novel interpretations and determinations of existing laws and regulations, post-payment audits, requirements for utilization review and new governmental funding restrictions, all of which may materially increase or decrease program payments as well as affect the cost of providing services and the timing of payments to our facilities. The final determination of amounts we receive under the Medicare and Medicaid programs often takes many years, because of audits by the program representatives, providers’ rights of appeal and the application of numerous technical reimbursement provisions. We believe that we have made adequate provisions for such potential adjustments. Nevertheless, until final adjustments are made, certain issues remain unresolved and previously determined allowances could become either inadequate or more than ultimately required.

Finally, we expect continued third-party efforts to aggressively manage reimbursement levels and cost controls. Reductions in reimbursement amounts received from third-party payors could have a material adverse effect on our financial position and our results of operations.

Other Operating Results

The combined net revenues and income before income taxes generated at our surgical hospitals, ambulatory surgery centers and radiation oncology centers was not material to our results of operations during each of the three month periods ended March 31, 2012 and 2011.

Interest Expense:

Interest expense was $47 million and $56 million during the three-month periods ended March 31, 2012 and 2011, respectively. Below is a schedule of our interest expense for the three month periods ended March 31, 2012 and 2011 (amounts in thousands):

 

     Three Months
Ended
March 31,
2012
     Three Months
Ended
March 31,
2011
 

Revolving credit & demand notes

   $ 1,640       $ 2,169   

$200 million, 6.75% Senior Notes due 2011 (a.)

     —           3,378   

$400 million, 7.125% Senior Notes due 2016 (b.)

     7,124         7,124   

 

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     Three Months
Ended
March 31,
2012
    Three Months
Ended
March 31,
2011
 

$250 million, 7.00% Senior Notes due 2018

     4,375        4,375   

Term loan facility A

     5,794        8,756   

Term loan facility B

     14,113        20,371   

Accounts receivable securitization program

     687        665   
  

 

 

   

 

 

 

Subtotal-revolving credit, demand notes, Senior Notes, term loan facilities and accounts receivable securitization program

     33,733        46,838   

Interest rate swap expense, net

     5,158        1,405   

Amortization of financing fees

     7,277        6,545   

Other combined interest expense

     1,576        1,673   

Capitalized interest on major construction and other projects

     (1,005     —     

Interest income

     (29     (44
  

 

 

   

 

 

 

Interest expense, net

   $ 46,710      $ 56,417   
  

 

 

   

 

 

 

 

(a.) The $200 million, 6.75% Senior Notes matured and were paid in full on November 15, 2011 utilizing borrowings pursuant to our revolving credit agreement.
(b.) In June, 2008, we issued an additional $150 million of senior notes (the “Notes”) which formed a single series with the original $250 million of Notes issued in June, 2006 (see Note 4—Long Term Debt). Other than their date of issuance and initial price to the public, the terms of the Notes issued in June, 2008 are identical to, and trade interchangeably with, the Notes which were originally issued in June, 2006. The proceeds from this issuance were used to repay outstanding borrowings.

Interest expense decreased $10 million during the three-month period ended March 31, 2012, as compared to the comparable quarter of 2011. The decreased interest expense was due primarily to decreases in our average effective interest rate (due primarily to an amendment to our credit agreement in March of 2011 which, among other things, provided for reductions in the rates payable for borrowings outstanding under our Term Loan A, Term Loan B and revolving credit facility) and average borrowings outstanding.

Discontinued Operations

In connection with the receipt of antitrust clearance from the Federal Trade Commission (“FTC”) in connection with our acquisition of PSI in November, 2010, we agreed to divest three former PSI facilities as well as one of our legacy behavioral health facilities in Puerto Rico. Pursuant to the terms of our agreement with the FTC, we divested:

 

   

in July, 2011, the Meadowood Behavioral Health System, a 58-bed facility located in New Castle, Delaware;

 

   

in December, 2011, the Montevista Hospital (101-bed) and Red Rock Hospital (21-bed), both of which are located in Las Vegas, Nevada, and;

 

   

in January, 2012, the Hospital San Juan Capestrano, a 108-bed facility located in Rio Piedras, Puerto Rico.

The operating results for the three former PSI facilities located in Delaware and Nevada are reflected as discontinued operations during the first quarter of 2011. Since the aggregate income from discontinued operations before income tax expense for these facilities is not material to our consolidated financial statements, it is included as a reduction to other operating expenses. The aggregate pre-tax net gain on the divestiture of San Juan Capestrano in January, 2012 did not have a material impact on our consolidated results of operations during the first quarter of 2012. Assets and liabilities for the Hospital San Juan Capestrano were reflected as “held for sale” on our Consolidated Balance Sheet as of December 31, 2011.

The following table shows the results of operations for the former PSI facilities located in Delaware and Nevada, on a combined basis, which were reflected as discontinued operations during the first quarter of 2011 (amounts in thousands):

 

     Three Months Ended
March 31, 2011
 

Net revenues

   $ 10,260   

Income from discontinued operations, before income tax expense

     2,331   

Income tax expense

     (899
  

 

 

 

Income from discontinued operations, net of income tax expense

   $ 1,432   
  

 

 

 

 

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Provision for Income Taxes and Effective Tax Rates:

The effective tax rates, as calculated by dividing the provision for income taxes by income before income taxes, were as follows for the three-month periods ended March 31, 2012 and 2011 (dollar amounts in thousands):

 

     Three Months Ended
March 31,
 
     2012     2011  

Provision for income taxes

   $ 79,748      $ 74,009   

Income before income taxes

     222,318        203,996   
  

 

 

   

 

 

 

Effective tax rate

     35.9     36.3
  

 

 

   

 

 

 

Outside owners hold various noncontrolling, minority ownership interests in seven of our acute care facilities and one behavioral health care facility. Each of these facilities are owned and operated by limited liability companies (“LLC”) or limited partnerships (“LP”). As a result, since there is no income tax liability incurred at the LLC/LP level (since it passes through to the members/partners), the net income attributable to noncontrolling interests does not include any income tax provision/benefit. When computing the provision for income taxes, as reflected on our consolidated statements of income, the net income attributable to noncontrolling interests is deducted from income before income taxes since it represents the third-party members’/partners’ share of the income generated by the joint-venture entities. In addition to providing the effective tax rates, as indicated above (as calculated from dividing the provision for income taxes by the income before income taxes as reflected on the consolidated statements of income), we believe it is helpful to our investors that we also provide our effective tax rate as calculated after giving effect to the portion of our pre-tax income that is attributable to the third-party members/partners.

The effective tax rates, as calculated by dividing the provision for income taxes by the difference in income before income taxes, minus net income attributable to noncontrolling interests, were as follows for each of the three-month periods ended March 31, 2012 and 2011 (dollar amounts in thousands):

 

     Three Months Ended
March 31,
 
     2012     2011  

Provision for income taxes

   $ 79,748      $ 74,009   

Income before income taxes

     222,318        203,996   

Less: Net income attributable to noncontrolling interests

     (13,963     (15,794
  

 

 

   

 

 

 

Income before income taxes, less net income attributable to noncontrolling interests

     208,355        188,202   
  

 

 

   

 

 

 

Effective tax rate

     38.3     39.3
  

 

 

   

 

 

 

The decrease in the effective tax rates during the three-month period ended March 31, 2012, as compared to the comparable prior year quarter, was primarily attributable to a decrease in our blended effective state income tax rate.