American Renal Associates Holdings, Inc. Announces Third Quarter 2019 Results
November 5, 2019BEVERLY, Mass.–(BUSINESS WIRE)–American Renal Associates Holdings, Inc. (NYSE: ARA) (the “Company”), a leading kidney care and dialysis provider focused on partnering with local nephrologists, today announced financial and operating results for the third quarter ended September 30, 2019.
Certain metrics, including those expressed on an adjusted basis, are Non-GAAP financial measures (See “Use of Non-GAAP Financial Measures” and the reconciliation tables further below).
Third Quarter 2019 Highlights (all percentage changes compare Q3 2019 to Q3 2018 unless noted):
- Patient service operating revenues increased 2.8% to $211.4 million;
- Net income attributable to American Renal Associates Holdings, Inc. was $4.8 million as compared to a net loss of $0.7 million in Q3 2018;
- Adjusted EBITDA less noncontrolling interests (“Adjusted EBITDA-NCI”) was $26.5 million as compared to $23.3 million in Q3 2018;
- Adjusted net income attributable to American Renal Associates Holdings, Inc. was $11.2 million, or $0.33 per share, for Q3 2019;
- Total dialysis treatments increased 8.1%, of which 5.8% was non-acquired growth. Normalized total treatment growth was 7.9%, and normalized non-acquired treatment growth was 5.7%; and
- As of September 30, 2019, the Company operated 244 outpatient dialysis clinics serving more than 17,100 patients.
Joseph (Joe) Carlucci, Chairman and Chief Executive Officer, said, “Our third quarter 2019 results were consistent with our internal expectations. We remain pleased with our treatment growth performance this year, which demonstrates that more patients continue to choose ARA to receive high quality care. During the third quarter of 2019, we also continued to make progress with our operating expense initiatives, and we believe our payor contracting efforts during the past year yielded further stability with our commercial payor treatment mix. We are also encouraged by our cash flow performance, which allowed us to reduce our aggregate borrowings by more than $18 million during the third quarter of 2019 and improve our leverage ratio by 0.3x as compared to June 30, 2019.”
Carlucci added, “In light of our third quarter 2019 performance and outlook for the fourth quarter of 2019, we are increasing and tightening our guidance range for 2019 Adjusted EBITDA-NCI. We remain focused on improving our operating efficiency and strengthening the balance sheet, while thoughtfully balancing the growth and development opportunities that remain ahead of us.”
Financial and operating highlights include:
Revenue: Patient service operating revenues for the third quarter of 2019 were $211.4 million, an increase of 2.8% as compared to $205.7 million for the prior-year period, which was primarily due to an increase of 8.1% in the number of dialysis treatments, partially offset by adverse changes in commercial treatment rates.
Treatment Volume: Total dialysis treatments for the third quarter of 2019 were 625,684, representing an increase of 8.1% over the third quarter of 2018. Non-acquired treatment growth was 5.8%, and acquired treatment growth was 2.3% for the third quarter of 2019. Normalized total treatment growth was 7.9%, and non-acquired treatment growth was 5.7% as compared to Q3 2018.
Clinic Activity: As of September 30, 2019, the Company provided services at 244 outpatient dialysis clinics serving 17,159 patients. During the third quarter of 2019, we opened one de novo clinic and divested two clinics.
Net income, Net income attributable to noncontrolling interests, Net income attributable to American Renal Associates Holdings, Inc., Adjusted EBITDA and Adjusted EBITDA-NCI:
|
|
|
(Unaudited) |
|
|
|
|
|||||||||
|
|
|
Three Months Ended |
|
Increase (Decrease) |
|||||||||||
|
(in thousands) |
|
2019 |
|
2018 |
|
Amount |
|
Percentage |
|||||||
|
Net income |
|
$ |
17,027 |
|
|
$ |
12,512 |
|
|
$ |
4,515 |
|
|
36.1 |
% |
|
Net income attributable to noncontrolling interests |
|
(12,250 |
) |
|
(13,246 |
) |
|
$ |
996 |
|
|
7.5 |
% |
||
|
Net income (loss) attributable to American Renal Associates Holdings, Inc. |
|
$ |
4,777 |
|
|
$ |
(734 |
) |
|
$ |
5,511 |
|
|
NM* |
|
|
Non-GAAP financial measures**: |
|
|
|
|
|
|
|
|
|||||||
|
Adjusted EBITDA |
|
$ |
38,705 |
|
|
$ |
36,496 |
|
|
$ |
2,209 |
|
|
6.1 |
% |
|
Adjusted EBITDA-NCI |
|
$ |
26,455 |
|
|
$ |
23,250 |
|
|
$ |
3,205 |
|
|
13.8 |
% |
|
|
|
(Unaudited) |
|
|
|
|
|||||||||
|
|
|
Nine Months Ended |
|
Increase (Decrease) |
|||||||||||
|
(in thousands) |
|
2019 |
|
2018 |
|
Amount |
|
Percentage |
|||||||
|
Net income |
|
$ |
17,022 |
|
|
$ |
11,293 |
|
|
$ |
5,729 |
|
|
50.7 |
% |
|
Net income attributable to noncontrolling interests |
|
(30,902 |
) |
|
(39,488 |
) |
|
$ |
8,586 |
|
|
21.7 |
% |
||
|
Net loss attributable to American Renal Associates Holdings, Inc. |
|
$ |
(13,880 |
) |
|
$ |
(28,195 |
) |
|
$ |
14,315 |
|
|
NM* |
|
|
Non-GAAP financial measures**: |
|
|
|
|
|
|
|
|
|||||||
|
Adjusted EBITDA |
|
$ |
95,537 |
|
|
$ |
104,800 |
|
|
$ |
(9,263 |
) |
|
(8.8 |
)% |
|
Adjusted EBITDA-NCI |
|
$ |
64,635 |
|
|
$ |
65,312 |
|
|
$ |
(677 |
) |
|
(1.0 |
)% |
* Not Meaningful
** See “Reconciliation of Non-GAAP Financial Measures.”
Operating Expenses: Patient care costs for the third quarter of 2019 were $154.6 million, or 73.1% of patient service operating revenues, as compared to $145.9 million, or 70.9% of patient service operating revenues, in the prior-year period. General and administrative expenses were $18.8 million, or 8.9% of patient service operating revenues, as compared to $24.6 million, or 12.0% of patient service operating revenues, in the prior-year period.
Patient care costs for the nine months ended September 30, 2019 were $455.8 million, or 73.9% of patient service operating revenues, as compared to $421.5 million, or 70.5% of patient service operating revenues, in the prior-year period. General and administrative expenses during the nine months ended September 30, 2019 were $68.3 million, or 11.1% of patient service operating revenues, as compared to $76.1 million, or 12.7% of patient service operating revenues, in the prior-year period.
Cash Flow: Cash provided by operating activities for the third quarter of 2019 was $27.4 million as compared to $25.4 million in the prior-year period. Adjusted cash provided by operating activities less distributions to noncontrolling interests (see “Reconciliation of Non-GAAP Financial Measures”) for the third quarter of 2019 was $8.7 million as compared to $4.5 million in the prior-year period. Total capital expenditures for the third quarter of 2019 were $3.7 million, compared to $10.7 million in the prior-year period. Capital expenditures for the three months ended September 30, 2019 included $2.9 million for expansions and new clinic development and $0.8 million for other capital expenditures.
Cash provided by operating activities for the nine months ended September 30, 2019 was $35.1 million as compared to $83.9 million in the prior-year period. Adjusted cash provided by operating activities less distributions to noncontrolling interests (see “Reconciliation of Non-GAAP Financial Measures”) for the nine months ended September 30, 2019 was $(5.1) million as compared to $29.6 million in the prior-year period. Total capital expenditures for the nine months ended September 30, 2019 were $17.9 million as compared to $29.1 million in the prior-year period. Capital expenditures for the nine months ended September 30, 2019 included $14.0 million for expansions and new clinic development and $3.9 million for other capital expenditures.
Balance Sheet: At September 30, 2019, the Company’s balance sheet included consolidated cash of $60.2 million and consolidated debt of $593.4 million, including the current portion of long-term debt. Excluding clinic-level debt not guaranteed by the Company and clinic-level cash not owned by the Company, Adjusted owned net debt (see “Reconciliation of Non-GAAP Financial Measures”) was $497.4 million at September 30, 2019, as compared to $470.9 million at December 31, 2018. Adjusted owned net debt to last twelve months Adjusted EBITDA-NCI leverage ratio was 5.6x at September 30, 2019, an improvement of 0.3x from June 30, 2019. As of September 30, 2019, net patient accounts receivable was $103.4 million, and days sales outstanding (“DSO”) for the period was 45 days as compared to 46 days as of June 30, 2019.
Outlook for Adjusted EBITDA-NCI:
The Company now expects 2019 Adjusted EBITDA-NCI to be in a range of $87 million and $89 million as compared to the previous range of $85 million and $88 million.
The Company is reaffirming its preliminary outlook for 2020 Adjusted EBITDA-NCI to be in a range of $90 million and $95 million. The Company expects its leverage ratio (defined below) to improve by between 0.3x and 0.6x by year-end 2020 as compared to 5.6x at September 30, 2019.
The Company is not providing a quantitative reconciliation of our Non-GAAP outlook to the corresponding GAAP information because the GAAP measures that we exclude from our Non-GAAP outlook are not available without unreasonable effort on a forward-looking basis due to their unpredictability, high variability, complexity and low visibility. These excluded GAAP measures include noncontrolling interests, interest expense, income taxes, certain legal and other matters, and other charges. We expect the variability of these charges to have a potentially unpredictable, and potentially significant, impact on our future GAAP financial results.
Please see the “Forward-Looking Statements” section of this release for a discussion of certain risks to our outlook.
Conference Call
American Renal Associates Holdings, Inc. will hold a conference call to discuss this release on Wednesday, November 6, 2019, at 9:00 a.m. Eastern time. Investors will have the opportunity to listen to the conference call by dialing (877) 407-8029, or for international callers (201) 689-8029, or may listen over the Internet by going to the Investor Relations section at www.ir.americanrenal.com. For those who cannot listen to the live broadcast, a replay will be available and can be accessed by dialing (877) 660-6853, or for international callers (201) 612-7415. The conference ID for the live call and the replay is 13683474.
About American Renal Associates
American Renal Associates (“ARA”) is a leading provider of outpatient dialysis services in the United States. As of September 30, 2019, ARA operated 244 dialysis clinic locations in 27 states and the District of Columbia serving more than 17,100 patients with end stage renal disease. ARA operates principally through a physician partnership model, in which it partners with approximately 400 local nephrologists to develop, own and operate dialysis clinics. ARA’s Core Values emphasize taking good care of patients, providing physicians with clinical autonomy and operational support, hiring and retaining the best possible staff and providing comprehensive management services. For more information about American Renal Associates, visit www.americanrenal.com.
Forward-Looking Statements
Statements in this press release that are “forward-looking statements” within the meaning of the Private Securities Litigation Reform Act of 1995, including statements regarding our outlook for Adjusted EBITDA-NCI, are based upon currently available information, operating plans and projections about future events and trends. Terminology such as “anticipate,” “believe,” “contemplate,” “estimate,” “expect,” “forecast,” “intend,” “may,” “objective,” “outlook,” “plan,” “potential,” “project,” “seek,” “should,” “strategy,” “target” or “will” or variations of such words or similar expressions are intended to identify forward-looking statements, although not all forward-looking statements contain such terms.
Forward-looking statements inherently involve risks and uncertainties that could cause actual results to differ materially from those predicted in such forward-looking statements. Such risks and uncertainties include, among others, the effect of the restatement of our previously issued financial results and the related securities and derivative litigation and related matters; our ability to remediate material weaknesses in our internal controls over financial reporting; continuing decline in the number of patients with commercial insurance, including as a result of changes to the healthcare exchanges or changes in regulations or enforcement of regulations regarding the healthcare exchanges and challenges from commercial payors or any regulatory or other changes leading to changes in the ability of patients with commercial insurance coverage to receive charitable premium support; decline in commercial payor reimbursement rates; the ultimate resolution of the Centers for Medicare and Medicaid Services Interim Final Rule published December 14, 2016 related to dialysis facilities Conditions for Coverage (CMS 3337-IFC), including an issuance of a different but related Final Rule; reduction of government-based payor reimbursement rates or insufficient rate increases or adjustments that do not cover all of our operating costs; our ability to successfully develop de novo clinics, acquire existing clinics and attract new nephrologist partners; our ability to compete effectively in the dialysis services industry; the performance of our joint venture subsidiaries and their ability to make distributions to us; changes to the Medicare end-stage renal disease (“ESRD”) program that could affect reimbursement rates and evaluation criteria, as well as changes in Medicaid or other non-Medicare government programs or payment rates, including the ESRD prospective payment rate system final rule for 2020 issued October 31, 2019; federal or state healthcare laws that could adversely affect us; our ability to comply with all of the complex federal, state and local government regulations that apply to our business, including those in connection with federal and state anti-kickback laws and state laws prohibiting the corporate practice of medicine or fee-splitting; heightened federal and state investigations and enforcement efforts; the impact of the SEC investigation; changes in the availability and cost of erythropoietin-stimulating agents and other pharmaceuticals used in our business; changes in the reimbursement rates of the calcimimetics pharmaceutical class reimbursed under the Medicare Transitional Drug Add-on Payment Adjustment; development of new technologies or government regulation that could decrease the need for dialysis services or decrease our in-center patient population; our ability to timely and accurately bill for our services and meet payor billing requirements; claims and losses relating to malpractice, professional liability and other matters; the sufficiency of our insurance coverage for those claims and rising insurances costs; and negative publicity or reputational damage arising from such matters; loss of any members of our senior management; damage to our reputation or our brand and our ability to maintain brand recognition; our ability to maintain relationships with our medical directors and renew our medical director agreements; shortages of qualified skilled clinical personnel, or higher than normal turnover rates; competition and consolidation in the dialysis services industry; deterioration in economic conditions, particularly in states where we operate a large number of clinics, or disruptions in the financial markets; the participation of our physician partners in material strategic and operating decisions and our ability to favorably resolve any disputes; our ability to honor obligations under the joint venture operating agreements with our physician partners were they to exercise certain put rights and other rights; unauthorized disclosure of personally identifiable, protected health or other sensitive or confidential information; our ability to meet our obligations and comply with restrictions under our substantial level of indebtedness; and the ability of our principal stockholder, whose interests may conflict with yours, to strongly influence or effectively control our corporate decisions.
For additional information and other factors that could cause ARA’s actual results to materially differ from those set forth herein, please see ARA’s filings with the SEC. Investors are cautioned not to place undue reliance on any such forward-looking statements, which speak only as of the date they are made. ARA undertakes no obligation to update any forward-looking statement, whether as a result of new information, future events or otherwise.
Use of Non-GAAP Financial Measures
In addition to the results prepared in accordance with generally accepted accounting principles in the United States (“GAAP”) provided throughout this press release, the Company has presented the following Non-GAAP financial measures: Adjusted EBITDA, Adjusted EBITDA less noncontrolling interests, Adjusted net income attributable to American Renal Associates Holdings, Inc., Adjusted cash provided by operating activities and Adjusted owned net debt, which exclude various items detailed in the attached “Reconciliation of Non-GAAP Financial Measures.”
These Non-GAAP financial measures are not intended to replace financial performance and liquidity measures determined in accordance with GAAP. Rather, they are presented as supplemental measures of the Company’s performance and liquidity that management believes may enhance the evaluation of the Company’s ongoing operating results. Please see “Reconciliation of Non-GAAP Financial Measures” for additional reasons why these measures are provided.
|
American Renal Associates Holdings, Inc. and Subsidiaries Consolidated Statements of Operations (Unaudited) (dollars in thousands, except for share data) |
||||||||||||||||
|
|
|
Three Months Ended September 30, |
|
Nine Months Ended September 30, |
||||||||||||
|
|
|
2019 |
|
2018 |
|
2019 |
|
2018 |
||||||||
|
Patient service operating revenues |
|
$ |
211,429 |
|
|
$ |
205,719 |
|
|
$ |
616,443 |
|
|
$ |
597,970 |
|
|
Operating expenses: |
|
|
|
|
|
|
|
|
||||||||
|
Patient care costs |
|
154,588 |
|
|
145,939 |
|
|
455,785 |
|
|
421,484 |
|
||||
|
General and administrative |
|
18,783 |
|
|
24,619 |
|
|
68,309 |
|
|
76,120 |
|
||||
|
Transaction-related costs |
|
— |
|
|
— |
|
|
— |
|
|
856 |
|
||||
|
Depreciation and amortization |
|
10,220 |
|
|
10,023 |
|
|
30,585 |
|
|
29,460 |
|
||||
|
Certain legal and other matters |
|
9,634 |
|
|
1,028 |
|
|
23,306 |
|
|
37,677 |
|
||||
|
Total operating expenses |
|
193,225 |
|
|
181,609 |
|
|
577,985 |
|
|
565,597 |
|
||||
|
Operating income |
|
18,204 |
|
|
24,110 |
|
|
38,458 |
|
|
32,373 |
|
||||
|
Interest expense, net |
|
(12,242 |
) |
|
(8,242 |
) |
|
(32,533 |
) |
|
(23,835 |
) |
||||
|
Change in fair value of income tax receivable agreement |
|
(30 |
) |
|
(3,480 |
) |
|
1,348 |
|
|
(2,765 |
) |
||||
|
Income before income taxes |
|
5,932 |
|
|
12,388 |
|
|
7,273 |
|
|
5,773 |
|
||||
|
Income tax benefit |
|
(11,095 |
) |
|
(124 |
) |
|
(9,749 |
) |
|
(5,520 |
) |
||||
|
Net income |
|
17,027 |
|
|
12,512 |
|
|
17,022 |
|
|
11,293 |
|
||||
|
Less: Net income attributable to noncontrolling interests |
|
(12,250 |
) |
|
(13,246 |
) |
|
(30,902 |
) |
|
(39,488 |
) |
||||
|
Net income (loss) attributable to American Renal Associates Holdings, Inc. |
|
4,777 |
|
|
(734 |
) |
|
(13,880 |
) |
|
(28,195 |
) |
||||
|
Less: Change in the difference between the redemption value and estimated fair value for accounting purposes of the related noncontrolling interests |
|
(1,161 |
) |
|
(580 |
) |
|
(877 |
) |
|
(1,331 |
) |
||||
|
Net income (loss) attributable to common shareholders |
|
$ |
3,616 |
|
|
$ |
(1,314 |
) |
|
$ |
(14,757 |
) |
|
$ |
(29,526 |
) |
|
|
|
|
|
|
|
|
|
|
||||||||
|
Earnings (loss) per share: |
|
|
|
|
|
|
|
|
||||||||
|
Basic |
|
$ |
0.11 |
|
|
$ |
(0.04 |
) |
|
$ |
(0.46 |
) |
|
$ |
(0.93 |
) |
|
Diluted |
|
$ |
0.11 |
|
|
$ |
(0.04 |
) |
|
$ |
(0.46 |
) |
|
$ |
(0.93 |
) |
|
Weighted-average number of common shares outstanding: |
|
|
|
|
|
|
|
|
||||||||
|
Basic |
|
32,281,818 |
|
|
32,005,544 |
|
|
32,248,791 |
|
|
31,912,934 |
|
||||
|
Diluted |
|
33,618,723 |
|
|
32,005,544 |
|
|
32,248,791 |
|
|
31,912,934 |
|
||||
|
American Renal Associates Holdings, Inc. and Subsidiaries Consolidated Balance Sheets (dollars in thousands, except for share data) |
||||||||
|
|
|
September 30, 2019 |
|
December 31, 2018 |
||||
|
Assets |
|
(Unaudited) |
|
|
||||
|
Cash |
|
$ |
60,190 |
|
|
$ |
55,200 |
|
|
Accounts receivable, less allowance for doubtful accounts of $1,458 and $3,270, respectively |
|
103,358 |
|
|
99,526 |
|
||
|
Inventories |
|
7,997 |
|
|
11,433 |
|
||
|
Prepaid expenses and other current assets |
|
27,026 |
|
|
28,127 |
|
||
|
Income tax receivable |
|
572 |
|
|
— |
|
||
|
Current assets held for sale |
|
13,292 |
|
|
577 |
|
||
|
Total current assets |
|
212,435 |
|
|
194,863 |
|
||
|
Property and equipment, net of accumulated depreciation of $215,549 and $199,703, respectively |
|
156,210 |
|
|
180,268 |
|
||
|
Operating lease right-of-use assets |
|
139,456 |
|
|
— |
|
||
|
Intangible assets, net of accumulated amortization of $24,872 and $24,206, respectively |
|
24,695 |
|
|
24,628 |
|
||
|
Other long-term assets |
|
9,067 |
|
|
14,745 |
|
||
|
Goodwill |
|
576,082 |
|
|
571,339 |
|
||
|
Total assets |
|
$ |
1,117,945 |
|
|
$ |
985,843 |
|
|
Liabilities and Equity |
|
|
|
|
||||
|
Accounts payable |
|
$ |
58,054 |
|
|
$ |
59,082 |
|
|
Accrued compensation and benefits |
|
37,642 |
|
|
34,587 |
|
||
|
Accrued expenses and other current liabilities |
|
51,914 |
|
|
61,116 |
|
||
|
Current portion of long-term debt |
|
41,430 |
|
|
42,855 |
|
||
|
Current portion of operating lease liabilities |
|
22,222 |
|
|
— |
|
||
|
Total current liabilities |
|
211,262 |
|
|
197,640 |
|
||
|
Long-term debt, less current portion |
|
551,999 |
|
|
517,511 |
|
||
|
Long-term operating lease liabilities, less current portion |
|
129,460 |
|
|
— |
|
||
|
Income tax receivable agreement payable |
|
1,719 |
|
|
3,700 |
|
||
|
Other long-term liabilities |
|
6,036 |
|
|
24,813 |
|
||
|
Deferred tax liabilities |
|
8,374 |
|
|
3,169 |
|
||
|
Total liabilities |
|
908,850 |
|
|
746,833 |
|
||
|
Commitments and contingencies |
|
|
|
|
||||
|
Noncontrolling interests subject to put provisions |
|
124,418 |
|
|
129,099 |
|
||
|
Equity |
|
|
|
|
||||
|
Preferred stock, $0.01 par value; 1,000,000 shares authorized; none issued |
|
|
|
|
||||
|
Common stock, $0.01 par value; 300,000,000 shares authorized; 32,559,776 and 32,603,846 issued and outstanding at September 30, 2019 and December 31, 2018, respectively |
|
197 |
|
|
196 |
|
||
|
Additional paid-in capital |
|
104,671 |
|
|
105,715 |
|
||
|
Receivable from noncontrolling interests |
|
(498 |
) |
|
(506 |
) |
||
|
Accumulated deficit |
|
(178,331 |
) |
|
(164,451 |
) |
||
|
Accumulated other comprehensive (loss) income, net of tax |
|
(1,801 |
) |
|
76 |
|
||
|
Total American Renal Associates Holdings, Inc. deficit |
|
(75,762 |
) |
|
(58,970 |
) |
||
|
Noncontrolling interests not subject to put provisions |
|
160,439 |
|
|
168,881 |
|
||
|
Total equity |
|
84,677 |
|
|
109,911 |
|
||
|
Total liabilities and equity |
$ |
1,117,945 |
$ |
985,843 |
||||
|
American Renal Associates Holdings, Inc. and Subsidiaries Consolidated Statements of Cash Flows (Unaudited) (dollars in thousands) |
||||||||||||||||
|
|
|
Three Months Ended |
|
Nine Months Ended |
||||||||||||
|
Operating activities |
|
2019 |
|
2018 |
|
2019 |
|
2018 |
||||||||
|
Net income |
|
$ |
17,027 |
|
|
$ |
12,512 |
|
|
$ |
17,022 |
|
|
$ |
11,293 |
|
|
Adjustments to reconcile net income to cash provided by operating activities: |
|
|
|
|
|
|
|
|
||||||||
|
Depreciation and amortization |
|
10,220 |
|
|
10,023 |
|
|
30,585 |
|
|
29,460 |
|
||||
|
Amortization of discounts, fees and deferred financing costs |
|
873 |
|
|
395 |
|
|
2,078 |
|
|
1,384 |
|
||||
|
Stock-based compensation |
|
979 |
|
|
1,247 |
|
|
3,230 |
|
|
4,174 |
|
||||
|
Deferred taxes |
|
5,630 |
|
|
(147 |
) |
|
5,492 |
|
|
(5,884 |
) |
||||
|
Change in fair value of income tax receivable agreement |
|
30 |
|
|
3,480 |
|
|
(1,348 |
) |
|
2,765 |
|
||||
|
Non-cash charge related to derivative agreements |
|
1,193 |
|
|
13 |
|
|
4 |
|
|
18 |
|
||||
|
Non-cash rent charges |
|
— |
|
|
239 |
|
|
— |
|
|
400 |
|
||||
|
(Gain) loss on sale of assets |
|
(286 |
) |
|
99 |
|
|
(681 |
) |
|
81 |
|
||||
|
Change in operating assets and liabilities, net of acquisitions: |
|
|
|
|
|
|
|
|
||||||||
|
Accounts receivable |
|
4,189 |
|
|
6,212 |
|
|
(3,832 |
) |
|
13,965 |
|
||||
|
Inventories |
|
(487 |
) |
|
154 |
|
|
3,533 |
|
|
(1,716 |
) |
||||
|
Prepaid expenses and other current assets |
|
2,908 |
|
|
923 |
|
|
(213 |
) |
|
7,261 |
|
||||
|
Other assets |
|
5,907 |
|
|
1,442 |
|
|
4,632 |
|
|
(7,291 |
) |
||||
|
Right-of-use assets and operating lease liabilities |
|
(902 |
) |
|
— |
|
|
(2,420 |
) |
|
— |
|
||||
|
Accounts payable |
|
406 |
|
|
1,174 |
|
|
(1,028 |
) |
|
20,602 |
|
||||
|
Accrued compensation and benefits |
|
2,815 |
|
|
3,777 |
|
|
3,055 |
|
|
5,673 |
|
||||
|
Accrued expenses and other liabilities |
|
(23,147 |
) |
|
(16,151 |
) |
|
(25,006 |
) |
|
1,686 |
|
||||
|
Cash provided by operating activities |
|
27,355 |
|
|
25,392 |
|
|
35,103 |
|
|
83,871 |
|
||||
|
Investing activities |
|
|
|
|
|
|
|
|
||||||||
|
Purchases of property, equipment and intangible assets |
|
(3,736 |
) |
|
(10,656 |
) |
|
(17,905 |
) |
|
(29,074 |
) |
||||
|
Proceeds from sale of clinics |
|
3,000 |
|
|
2 |
|
|
6,300 |
|
|
2,502 |
|
||||
|
Cash paid for acquisitions |
|
— |
|
|
— |
|
|
(6,590 |
) |
|
— |
|
||||
|
Cash used in investing activities |
|
(736 |
) |
|
(10,654 |
) |
|
(18,195 |
) |
|
(26,572 |
) |
||||
|
Financing activities |
|
|
|
|
|
|
|
|
||||||||
|
Proceeds from term loans, net of deferred financing costs |
|
(164 |
) |
|
23,630 |
|
|
73,387 |
|
|
52,576 |
|
||||
|
Payments on long-term debt |
|
(17,914 |
) |
|
(26,705 |
) |
|
(40,983 |
) |
|
(59,903 |
) |
||||
|
Dividends and dividend equivalents paid |
|
(19 |
) |
|
(42 |
) |
|
(44 |
) |
|
(320 |
) |
||||
|
Proceeds from exercise of stock options |
|
(14 |
) |
|
761 |
|
|
53 |
|
|
1,157 |
|
||||
|
Repurchase of vested restricted stock awards withheld on net share settlement |
|
(24 |
) |
|
(54 |
) |
|
(362 |
) |
|
(421 |
) |
||||
|
Distributions to noncontrolling interests |
|
(18,620 |
) |
|
(20,942 |
) |
|
(40,249 |
) |
|
(55,131 |
) |
||||
|
Contributions from noncontrolling interests |
|
749 |
|
|
1,125 |
|
|
4,684 |
|
|
3,645 |
|
||||
|
Purchases of noncontrolling interests |
|
(509 |
) |
|
(128 |
) |
|
(8,504 |
) |
|
(8,729 |
) |
||||
|
Proceeds from sales of additional noncontrolling interests |
|
— |
|
|
86 |
|
|
— |
|
|
178 |
|
||||
|
Cash used in financing activities |
|
(36,515 |
) |
|
(22,269 |
) |
|
(12,018 |
) |
|
(66,948 |
) |
||||
|
|
|
|
|
|
|
|
|
|
||||||||
|
(Decrease) increase in cash and restricted cash |
|
(9,896 |
) |
|
(7,531 |
) |
|
4,890 |
|
|
(9,649 |
) |
||||
|
Cash and restricted cash at beginning of period |
|
70,086 |
|
|
69,493 |
|
|
55,300 |
|
|
71,611 |
|
||||
|
Cash and restricted cash at end of period |
|
$ |
60,190 |
|
|
$ |
61,962 |
|
|
$ |
60,190 |
|
|
$ |
61,962 |
|
|
|
|
|
|
|
|
|
|
|
||||||||
|
Supplemental Disclosure of Cash Flow Information |
|
|
|
|
|
|
|
|
||||||||
|
Cash paid for income taxes |
|
$ |
832 |
|
|
$ |
627 |
|
|
$ |
1,005 |
|
|
$ |
2,152 |
|
|
Cash paid for interest |
|
10,128 |
|
|
9,556 |
|
|
25,420 |
|
|
22,221 |
|
||||
Contacts
Investor Contact:
Darren Lehrich
Telephone: (978)-522-6063; Email: [email protected]