Select Medical Holdings Corporation Announces Results For Its Fourth Quarter and Year Ended December 31, 2019

Select Medical Holdings Corporation announced results for its fourth quarter and year ended December 31, 2019.

MECHANICSBURG, Pa., Feb. 20, 2020 /PRNewswire/ -- Select Medical Holdings Corporation ("Select Medical") (NYSE: SEM) today announced results for its fourth quarter and year ended December 31, 2019.

For the fourth quarter ended December 31, 2019, net operating revenues increased 8.7% to $1,374.6 million, compared to $1,264.7 million for the same quarter, prior year. Income from operations increased 27.3% to $112.4 million for the fourth quarter ended December 31, 2019, compared to $88.3 million for the same quarter, prior year. Net income increased 46.9% to $43.7 million for the fourth quarter ended December 31, 2019, compared to $29.7 million for the same quarter, prior year. For the fourth quarter ended December 31, 2019, net income included pre-tax losses on early retirement of debt of $19.4 million. For the fourth quarter ended December 31, 2018, net income included pre-tax losses on early retirement of debt of $3.9 million. Adjusted EBITDA increased 16.9% to $171.9 million for the fourth quarter ended December 31, 2019, compared to $147.1 million for the same quarter, prior year. Earnings per common share increased to $0.24 on a fully diluted basis for the fourth quarter ended December 31, 2019, compared to $0.18 for the same quarter, prior year. Adjusted earnings per common share was $0.31 on a fully diluted basis for the fourth quarter ended December 31, 2019, compared to $0.20 for the same quarter, prior year. Adjusted earnings per common share excludes the losses on early retirement of debt and their related tax effects for both the fourth quarters ended December 31, 2019 and 2018. The definition of Adjusted EBITDA and a reconciliation of net income to Adjusted EBITDA are presented in table IX of this release. A reconciliation of earnings per common share to adjusted earnings per common share is presented in table X of this release.

For the year ended December 31, 2019, net operating revenues increased 7.3% to $5,453.9 million, compared to $5,081.3 million for the prior year. Income from operations increased 13.1% to $471.9 million for the year ended December 31, 2019, compared to $417.3 million for the prior year. Net income increased 13.6% to $201.0 million for the year ended December 31, 2019, compared to $176.9 million for the prior year. For the year ended December 31, 2019, net income included pre-tax losses on early retirement of debt of $38.1 million and a pre-tax gain on sale of businesses of $6.5 million. For the year ended December 31, 2018, net income included pre-tax losses on early retirement of debt of $14.2 million, pre-tax gains on sales of businesses of $9.0 million, and pre-tax U.S. HealthWorks acquisition costs of $2.9 million. Adjusted EBITDA increased 10.2% to $710.9 million for the year ended December 31, 2019, compared to $645.2 million for the prior year. Earnings per common share increased to $1.10 on a fully diluted basis for the year ended December 31, 2019, compared to $1.02 for the prior year. Adjusted earnings per common share was $1.24 on a fully diluted basis for the year ended December 31, 2019, compared to $1.03 for the prior year. Adjusted earnings per common share excludes the losses on early retirement of debt and related costs and gain on sale of businesses and their related tax effects for the year ended December 31, 2019. Adjusted earnings per common share excludes the losses on early retirement of debt, gains on sales of businesses, U.S. HealthWorks acquisition costs, and their related tax effects for the year ended December 31, 2018. The definition of Adjusted EBITDA and a reconciliation of net income to Adjusted EBITDA are presented in table IX of this release. A reconciliation of earnings per common share to adjusted earnings per common share is presented in table X of this release.

Company Overview

Select Medical is one of the largest operators of critical illness recovery hospitals, rehabilitation hospitals, outpatient rehabilitation clinics, and occupational health centers in the United States based on the number of facilities. Select Medical's reportable segments include the critical illness recovery hospital segment, the rehabilitation hospital segment, the outpatient rehabilitation segment, and the Concentra segment. As of December 31, 2019, Select Medical operated 101 critical illness recovery hospitals in 28 states, 29 rehabilitation hospitals in 12 states, and 1,740 outpatient rehabilitation clinics in 37 states and the District of Columbia. Select Medical's joint venture subsidiary Concentra operated 521 occupational health centers in 41 states. Concentra also provides contract services at employer worksites and Department of Veterans Affairs community-based outpatient clinics. At December 31, 2019, Select Medical had operations in 47 states and the District of Columbia. Information about Select Medical is available at www.selectmedical.com.

Critical Illness Recovery Hospital Segment

For the fourth quarter ended December 31, 2019, net operating revenues for the critical illness recovery hospital segment increased 6.7% to $454.9 million, compared to $426.3 million for the same quarter, prior year. Adjusted EBITDA for the critical illness recovery hospital segment increased 8.0% to $60.5 million for the fourth quarter ended December 31, 2019, compared to $56.0 million for the same quarter, prior year. The Adjusted EBITDA margin for the critical illness recovery hospital segment was 13.3% for the fourth quarter ended December 31, 2019, compared to 13.1% for the same quarter, prior year. Certain critical illness recovery hospital key statistics are presented in table VII of this release for both the fourth quarters ended December 31, 2019 and 2018.

For the year ended December 31, 2019, net operating revenues for the critical illness recovery hospital segment increased 4.7% to $1,836.5 million, compared to $1,753.6 million for the prior year. Adjusted EBITDA for the critical illness recovery hospital segment increased 4.9% to $254.9 million for the year ended December 31, 2019, compared to $243.0 million for the prior year. The Adjusted EBITDA margin for the critical illness recovery hospital segment was 13.9% for both the years ended December 31, 2019 and 2018. Certain critical illness recovery hospital key statistics are presented in table VIII of this release for both the years ended December 31, 2019 and 2018.

Rehabilitation Hospital Segment

For the fourth quarter ended December 31, 2019, net operating revenues for the rehabilitation hospital segment increased 20.9% to $182.7 million, compared to $151.1 million for the same quarter, prior year. Adjusted EBITDA for the rehabilitation hospital segment increased 51.4% to $43.3 million for the fourth quarter ended December 31, 2019, compared to $28.6 million for the same quarter, prior year. The Adjusted EBITDA margin for the rehabilitation hospital segment was 23.7% for the fourth quarter ended December 31, 2019, compared to 18.9% for the same quarter, prior year. For the fourth quarter ended December 31, 2018, the Adjusted EBITDA results for the rehabilitation hospital segment include start-up losses of approximately $0.9 million. Certain rehabilitation hospital key statistics are presented in table VII of this release for both the fourth quarters ended December 31, 2019 and 2018.

For the year ended December 31, 2019, net operating revenues for the rehabilitation hospital segment increased 14.9% to $671.0 million, compared to $583.7 million for the prior year. Adjusted EBITDA for the rehabilitation hospital segment increased 24.7% to $135.9 million for the year ended December 31, 2019, compared to $108.9 million for the prior year. The Adjusted EBITDA margin for the rehabilitation hospital segment was 20.2% for the year ended December 31, 2019, compared to 18.7% for the prior year. The Adjusted EBITDA results for the rehabilitation hospital segment include start-up losses of approximately $8.8 million for the year ended December 31, 2019, compared to approximately $4.7 million for the prior year. Certain rehabilitation hospital key statistics are presented in table VIII of this release for both the years ended December 31, 2019 and 2018.

Outpatient Rehabilitation Segment

For the fourth quarter ended December 31, 2019, net operating revenues for the outpatient rehabilitation segment increased 7.7% to $271.9 million, compared to $252.4 million for the same quarter, prior year. Adjusted EBITDA for the outpatient rehabilitation segment increased 14.9% to $40.2 million for the fourth quarter ended December 31, 2019, compared to $35.0 million for the same quarter, prior year. The Adjusted EBITDA margin for the outpatient rehabilitation segment was 14.8% for the fourth quarter ended December 31, 2019, compared to 13.9% for the same quarter, prior year. Certain outpatient rehabilitation key statistics are presented in table VII of this release for both the fourth quarters ended December 31, 2019 and 2018.

For the year ended December 31, 2019, net operating revenues for the outpatient rehabilitation segment increased 5.0% to $1,046.0 million, compared to $995.8 million for the prior year. Adjusted EBITDA for the outpatient rehabilitation segment increased 6.9% to $151.8 million for the year ended December 31, 2019, compared to $142.0 million for the prior year. The Adjusted EBITDA margin for the outpatient rehabilitation segment was 14.5% for the year ended December 31, 2019, compared to 14.3% for the prior year. Certain outpatient rehabilitation key statistics are presented in table VIII of this release for both the years ended December 31, 2019 and 2018.

Concentra Segment

The financial results for the Concentra segment include U.S. HealthWorks beginning February 1, 2018.

For the fourth quarter ended December 31, 2019, net operating revenues for the Concentra segment increased 3.4% to $397.1 million, compared to $384.3 million for the same quarter, prior year. Adjusted EBITDA for the Concentra segment increased 6.8% to $56.5 million for the fourth quarter ended December 31, 2019, compared to $52.9 million for the same quarter, prior year. The Adjusted EBITDA margin for the Concentra segment was 14.2% for the fourth quarter ended December 31, 2019, compared to 13.8% for the same quarter, prior year. Certain Concentra key statistics are presented in table VII of this release for both the fourth quarters ended December 31, 2019 and 2018.

For the year ended December 31, 2019, net operating revenues for the Concentra segment increased 4.6% to $1,628.8 million, compared to $1,557.7 million for the prior year. Adjusted EBITDA for the Concentra segment increased 9.7% to $276.5 million for the year ended December 31, 2019, compared to $252.0 million for the prior year. The Adjusted EBITDA margin for the Concentra segment was 17.0% for the year ended December 31, 2019, compared to 16.2% for the prior year. Certain Concentra key statistics are presented in table VIII of this release for both the years ended December 31, 2019 and 2018.

Stock Repurchase Program

The board of directors of Select Medical has authorized a common stock repurchase program to repurchase up to $500.0 million worth of shares of its common stock. The program has been extended until December 31, 2020, and will remain in effect until then, unless further extended or earlier terminated by the board of directors. Stock repurchases under this program may be made in the open market or through privately negotiated transactions, and at times and in such amounts as Select Medical deems appropriate. Select Medical funds this program with cash on hand and borrowings under its revolving credit facility.

During the year ended December 31, 2019, Select Medical repurchased 2,165,221 shares at a cost of approximately $33.2 million, or $15.32 per share, which includes transaction costs. Since the inception of the program through December 31, 2019, Select Medical has repurchased 38,089,349 shares at a cost of approximately $347.9 million, or $9.13 per share, which includes transaction costs.

Financing Transactions

On December 10, 2019, Select Medical issued and sold $675.0 million aggregate principal amount of 6.250% senior notes, due August 15, 2026, as additional notes under the indenture dated August 1, 2019, pursuant to which it previously issued $550.0 million of 6.250% senior notes due 2026. The additional senior notes were issued at 106.00% of the aggregate principal amount.

On December 10, 2019, Select Medical entered into Amendment No. 4 to its senior secured credit agreement. Among other things, Amendment No. 4 provided for an additional $615.0 million in term loans that, along with the existing term loans, have a maturity date of March 6, 2025.

Select Medical used a portion of the net proceeds from the incremental term loans, together with a portion of the net proceeds of the 6.250% additional senior notes, to make a first lien term loan in the aggregate principal amount of approximately $1,240.3 million to Concentra Inc., pursuant to an intercompany loan agreement. Concentra Inc. used the proceeds from the intercompany loan to repay in full the first lien term loan outstanding under Concentra Inc.'s first lien credit agreement. Concentra Inc. continues to have availability of up to $100.0 million under its existing revolving credit facility.

Purchase of Concentra Interest

On January 1, 2020, Select Medical, Welsh, Carson, Anderson & Stowe XII, L.P. ("WCAS"), and Dignity Health Holding Corporation ("DHHC") entered into an agreement pursuant to which Select Medical acquired approximately 17.2% of the outstanding membership interests of Concentra Group Holdings Parent, LLC ("Concentra Parent") on a fully diluted basis from WCAS, DHHC, and other equity holders of Concentra Parent for approximately $338.4 million. On February 1, 2020, Select Medical, WCAS and DHHC entered into an agreement pursuant to which Select Medical acquired an additional 1.4% of the outstanding membership interests of Concentra Parent on a fully diluted basis from WCAS, DHHC, and other equity holders of Concentra Parent for approximately $27.8 million.

These purchases were in lieu of, and considered to be, the exercise of the first put right provided to certain equity holders under the terms of the Amended and Restated Limited Liability Company Agreement of Concentra Parent, dated as of February 1, 2018. Following these purchases, Select Medical owns approximately 66.6% of the outstanding membership interests of Concentra Parent on a fully diluted basis and approximately 68.8% of the outstanding voting membership interests of Concentra Parent.

Business Outlook

Select Medical reaffirms its 2020 business outlook, provided most recently in its January 27, 2020 press release, for net operating revenues, Adjusted EBITDA and fully diluted earnings per common share. Select Medical continues to expect consolidated net operating revenues for the full year 2020 to be in the range of $5.575 billion to $5.675 billion. Select Medical continues to expect Adjusted EBITDA for the full year 2020 to be in the range of $725.0 million to $760.0 million. Select Medical continues to expect fully diluted earnings per common share for the full year 2020 to be in the range of $1.27 to $1.46.

Conference Call

Select Medical will host a conference call regarding its results for the fourth quarter and full year ended December 31, 2019, as well as its business outlook, on Friday, February 21, 2020, at 9:00am ET. The domestic dial in number for the call is 1-866-440-2669. The international dial in number is 1-409-220-9844. The conference ID for the call is 8644656. The conference call will be webcast simultaneously and can be accessed at Select Medical Holdings Corporation's website www.selectmedicalholdings.com.

For those unable to participate in the conference call, a replay will be available until 12:00pm ET, February 28, 2020. The replay number is 1-855-859-2056 (domestic) or 1-404-537-3406 (international). The conference ID for the replay will be 8644656. The replay can also be accessed at Select Medical Holdings Corporation's website, www.selectmedicalholdings.com.

* * * * *

Certain statements contained herein that are not descriptions of historical facts are "forward-looking" statements (as such term is defined in the Private Securities Litigation Reform Act of 1995). Because such statements include risks and uncertainties, actual results may differ materially from those expressed or implied by such forward-looking statements due to factors including the following:

  • changes in government reimbursement for our services and/or new payment policies may result in a reduction in net operating revenues, an increase in costs, and a reduction in profitability;
  • the failure of our Medicare-certified long term care hospitals or inpatient rehabilitation facilities to maintain their Medicare certifications may cause our net operating revenues and profitability to decline;
  • the failure of our Medicare-certified long term care hospitals and inpatient rehabilitation facilities operated as "hospitals within hospitals" to qualify as hospitals separate from their host hospitals may cause our net operating revenues and profitability to decline;
  • a government investigation or assertion that we have violated applicable regulations may result in sanctions or reputational harm and increased costs;
  • acquisitions or joint ventures may prove difficult or unsuccessful, use significant resources or expose us to unforeseen liabilities;
  • our plans and expectations related to our acquisitions and our ability to realize anticipated synergies;
  • private third-party payors for our services may adopt payment policies that could limit our future net operating revenues and profitability;
  • the failure to maintain established relationships with the physicians in the areas we serve could reduce our net operating revenues and profitability;
  • shortages in qualified nurses, therapists, physicians, or other licensed providers could increase our operating costs significantly or limit our ability to staff our facilities;
  • competition may limit our ability to grow and result in a decrease in our net operating revenues and profitability;
  • the loss of key members of our management team could significantly disrupt our operations;
  • the effect of claims asserted against us could subject us to substantial uninsured liabilities;
  • a security breach of our or our third-party vendors' information technology systems may subject us to potential legal and reputational harm and may result in a violation of the Health Insurance Portability and Accountability Act of 1996 or the Health Information Technology for Economic and Clinical Health Act; and
  • other factors discussed from time to time in our filings with the Securities and Exchange Commission (the "SEC"), including factors discussed under the heading "Risk Factors" of the annual report on Form 10-K for the year ended December 31, 2019.

Except as required by applicable law, including the securities laws of the United States and the rules and regulations of the SEC, we are under no obligation to publicly update or revise any forward-looking statements, whether as a result of any new information, future events, or otherwise. You should not place undue reliance on our forward-looking statements. Although we believe that the expectations reflected in forward-looking statements are reasonable, we cannot guarantee future results or performance.

Investor inquiries:

Joel T. Veit
Senior Vice President and Treasurer
717-972-1100
ir@selectmedical.com

SOURCE: Select Medical Holdings Corporation

I. Condensed Consolidated Statements of Operations
For the Three Months Ended December 31, 2018 and 2019
(In thousands, except per share amounts, unaudited)

   

2018

 

2019

 

% Change

Net operating revenues

 

$

1,264,683

   

$

1,374,584

   

8.7

%

             

Costs and expenses:

           

Cost of services

 

1,093,450

   

1,175,649

   

7.5

 

General and administrative

 

30,317

   

34,062

   

12.4

 

Depreciation and amortization

 

52,633

   

52,504

   

(0.2)

 
             

Income from operations

 

88,283

   

112,369

   

27.3

 
             

Loss on early retirement of debt

 

(3,900)

   

(19,440)

   

N/M

 

Equity in earnings of unconsolidated subsidiaries

 

6,991

   

6,279

   

(10.2)

 

Interest expense

 

(50,502)

   

(43,959)

   

(13.0)

 
             

Income before income taxes

 

40,872

   

55,249

   

35.2

 
             

Income tax expense

 

11,150

   

11,578

   

3.8

 
             

Net income

 

29,722

   

43,671

   

46.9

 
             

Less: Net income attributable to non-controlling interests

 

5,049

   

11,604

   

129.8

 
             

Net income attributable to Select Medical

 

$

24,673

   

$

32,067

   

30.0

%

             

Diluted earnings per common share:(1)

 

$

0.18

   

$

0.24

     

_______________________________________________________________________________

(1)

Refer to table III for calculation of earnings per common share.

   

N/M

Not meaningful

II. Condensed Consolidated Statements of Operations
For the Years Ended December 31, 2018 and 2019
(In thousands, except per share amounts, unaudited)

   

2018

 

2019

 

% Change

Net operating revenues

 

$

5,081,258

   

$

5,453,922

   

7.3

%

             

Costs and expenses:

           

Cost of services

 

4,341,056

   

4,641,002

   

6.9

 

General and administrative

 

121,268

   

128,463

   

5.9

 

Depreciation and amortization

 

201,655

   

212,576

   

5.4

 
             

Income from operations

 

417,279

   

471,881

   

13.1

 
             

Loss on early retirement of debt

 

(14,155)

   

(38,083)

   

N/M

 

Equity in earnings of unconsolidated subsidiaries

 

21,905

   

24,989

   

14.1

 

Gain on sale of businesses

 

9,016

   

6,532

   

N/M

 

Interest expense

 

(198,493)

   

(200,570)

   

1.0

 
             

Income before income taxes

 

235,552

   

264,749

   

12.4

 
             

Income tax expense

 

58,610

   

63,718

   

8.7

 
             

Net income

 

176,942

   

201,031

   

13.6

 
             

Less: Net income attributable to non-controlling interests

 

39,102

   

52,582

   

34.5

 
             

Net income attributable to Select Medical

 

$

137,840

   

$

148,449

   

7.7

 
             

Diluted earnings per common share:(1)

 

$

1.02

   

$

1.10

     

_______________________________________________________________________________

(1)

Refer to table III for calculation of earnings per common share.

   

N/M

Not meaningful

III. Earnings per Share
For the Three Months and Years Ended December 31, 2018 and 2019
(In thousands, except per share amounts, unaudited)

Select Medical's capital structure includes common stock and unvested restricted stock awards. To compute earnings per share ("EPS"), Select Medical applies the two-class method because its unvested restricted stock awards are participating securities which are entitled to participate equally with its common stock in undistributed earnings.

The following table sets forth the net income attributable to Select Medical, its common shares outstanding, and its participating securities outstanding for the three months and years ended December 31, 2018 and 2019:

   

Diluted EPS

 
   

Three Months Ended
December 31,

 

Years Ended
December 31,

 
   

2018

 

2019

 

2018

 

2019

 

Net income

 

$

29,722

   

$

43,671

   

$

176,942

   

$

201,031

   

Less: net income attributable to non-controlling interests

 

5,049

   

11,604

   

39,102

   

52,582

   

Net income attributable to Select Medical

 

24,673

   

32,067

   

137,840

   

148,449

   

Less: net income attributable to participating securities

 

817

   

1,101

   

4,548

   

4,994

   

Net income attributable to common shares

 

$

23,856

   

$

30,966

   

$

133,292

   

$

143,455

   

The following tables set forth the computation of EPS under the two-class method for the three months and years ended December 31, 2018 and 2019:

   

Three Months Ended December 31,

   

2018

   

2019

   

Net Income
Allocation

 

Shares(1)

 

Diluted EPS

   

Net Income
Allocation

 

Shares(1)

 

Diluted EPS

Common shares

 

$

23,856

   

130,820

   

$

0.18

     

$

30,966

   

129,676

   

$

0.24

 

Participating securities

 

817

   

4,480

   

$

0.18

     

1,101

   

4,610

   

$

0.24

 

Total

 

$

24,673

             

$

32,067

         
   

Years Ended December 31,

   

2018

   

2019

   

Net Income
Allocation

 

Shares(1)

 

Diluted EPS

   

Net Income
Allocation

 

Shares(1)

 

Diluted EPS

Common shares

 

$

133,292

   

130,256

   

$

1.02

     

$

143,455

   

130,276

   

$

1.10

 

Participating securities

 

4,548

   

4,444

   

$

1.02

     

4,994

   

4,535

   

$

1.10

 

Total

 

$

137,840

             

$

148,449

         

_______________________________________________________________________________

(1)

Represents the weighted average share count outstanding during the period.

IV. Condensed Consolidated Balance Sheets
(In thousands, unaudited)

   

December 31,

   

2018

 

2019

Assets

       

Current Assets:

       

Cash

 

$

175,178

   

$

335,882

 

Accounts receivable

 

706,676

   

762,677

 

Other current assets

 

110,670

   

114,433

 

Total Current Assets

 

992,524

   

1,212,992

 

Operating lease right-of-use assets

 

   

1,003,986

 

Property and equipment, net

 

979,810

   

998,406

 

Goodwill

 

3,320,726

   

3,391,955

 

Identifiable intangible assets, net

 

437,693

   

409,068

 

Other assets

 

233,512

   

323,881

 

Total Assets

 

$

5,964,265

   

$

7,340,288

 

Liabilities and Equity

       

Current Liabilities:

       

Payables and accruals

 

$

661,321

   

$

681,163

 

Current operating lease liabilities

 

   

207,950

 

Current portion of long-term debt and notes payable

 

43,865

   

25,167

 

Total Current Liabilities

 

705,186

   

914,280

 

Non-current operating lease liabilities

 

   

852,897

 

Long-term debt, net of current portion

 

3,249,516

   

3,419,943

 

Non-current deferred tax liability

 

153,895

   

148,258

 

Other non-current liabilities

 

158,940

   

101,334

 

Total Liabilities

 

4,267,537

   

5,436,712

 

Redeemable non-controlling interests

 

780,488

   

974,541

 

Total equity

 

916,240

   

929,035

 

Total Liabilities and Equity

 

$

5,964,265

   

$

7,340,288

 

V. Condensed Consolidated Statements of Cash Flows
For the Three Months Ended December 31, 2018 and 2019
(In thousands, unaudited)

   

2018

 

2019

Operating activities

       

Net income

 

$

29,722

   

$

43,671

 

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

       

Distributions from unconsolidated subsidiaries

 

4,987

   

6,613

 

Depreciation and amortization

 

52,633

   

52,504

 

Provision for bad debts

 

270

   

694

 

Equity in earnings of unconsolidated subsidiaries

 

(6,991)

   

(6,279)

 

Loss on extinguishment of debt

 

2,515

   

11,970

 

Gain on sale of assets and businesses

 

(39)

   

28

 

Stock compensation expense

 

6,151

   

7,020

 

Amortization of debt discount, premium and issuance costs

 

3,267

   

2,097

 

Deferred income taxes

 

9,309

   

(188)

 

Changes in operating assets and liabilities, net of effects of business combinations:

       

Accounts receivable

 

31,080

   

35,434

 

Other current assets

 

6,122

   

1,757

 

Other assets

 

3,029

   

4,863

 

Accounts payable and accrued expenses

 

(28,838)

   

18,358

 

Net cash provided by operating activities

 

113,217

   

178,542

 

Investing activities

       

Business combinations, net of cash acquired

 

(3,876)

   

(7,436)

 

Purchases of property and equipment

 

(46,242)

   

(33,170)

 

Investment in businesses

 

(546)

   

(5,422)

 

Proceeds from sale of assets and businesses

 

69

   

9

 

Net cash used in investing activities

 

(50,595)

   

(46,019)

 

Financing activities

       

Borrowings on revolving facilities

 

175,000

   

 

Payments on revolving facilities

 

(220,000)

   

 

Proceeds from term loans

 

   

614,423

 

Payments on term loans

 

(2,875)

   

(1,243,086)

 

Proceeds from 6.250% senior notes

 

   

705,811

 

Revolving facility debt issuance costs

 

(387)

   

 

Borrowings of other debt

 

12,084

   

4,943

 

Principal payments on other debt

 

(7,271)

   

(7,976)

 

Repurchase of common stock

 

(1,197)

   

(1,222)

 

Proceeds from exercise of stock options

 

89

   

92

 

Increase in overdrafts

 

1,792

   

 

Proceeds from issuance of non-controlling interests

 

   

159

 

Distributions to and purchases of non-controlling interests

 

(5,092)

   

(5,748)

 

Net cash provided by (used in) financing activities

 

(47,857)

   

67,396

 

Net increase in cash and cash equivalents

 

14,765

   

199,919

 

Cash and cash equivalents at beginning of period

 

160,413

   

135,963

 

Cash and cash equivalents at end of period

 

$

175,178

   

$

335,882

 

Supplemental information

       

Cash paid for interest

 

$

59,028

   

$

33,902

 

Cash paid for taxes

 

$

7,693

   

$

12,120

 

VI. Condensed Consolidated Statements of Cash Flows
For the Years Ended December 31, 2018 and 2019
(In thousands, unaudited)

   

2018

 

2019

Operating activities

       

Net income

 

$

176,942

   

$

201,031

 

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

       

Distributions from unconsolidated subsidiaries

 

15,721

   

20,222

 

Depreciation and amortization

 

201,655

   

212,576

 

Provision for bad debts

 

(103)

   

3,038

 

Equity in earnings of unconsolidated subsidiaries

 

(21,905)

   

(24,989)

 

Loss on extinguishment of debt

 

2,999

   

22,130

 

Gain on sale of assets and businesses

 

(9,168)

   

(6,321)

 

Stock compensation expense

 

23,326

   

26,451

 

Amortization of debt discount, premium and issuance costs

 

13,112

   

11,566

 

Deferred income taxes

 

7,217

   

(7,435)

 

Changes in operating assets and liabilities, net of effects of business combinations:

       

Accounts receivable

 

54,575

   

(57,991)

 

Other current assets

 

(4,152)

   

(4,259)

 

Other assets

 

7,857

   

6,122

 

Accounts payable and accrued expenses

 

26,118

   

43,041

 

Net cash provided by operating activities

 

494,194

   

445,182

 

Investing activities

       

Business combinations, net of cash acquired

 

(523,134)

   

(93,705)

 

Purchases of property and equipment

 

(167,281)

   

(157,126)

 

Investment in businesses

 

(13,482)

   

(66,090)

 

Proceeds from sale of assets and businesses

 

6,760

   

192

 

Net cash used in investing activities

 

(697,137)

   

(316,729)

 

Financing activities

       

Borrowings on revolving facilities

 

595,000

   

700,000

 

Payments on revolving facilities

 

(805,000)

   

(720,000)

 

Proceeds from term loans

 

779,823

   

1,208,106

 

Payments on term loans

 

(11,500)

   

(1,618,170)

 

Proceeds from 6.250% senior notes

 

   

1,244,987

 

Payment on 6.375% senior notes

 

   

(710,000)

 

Revolving facility debt issuance costs

 

(1,639)

   

(310)

 

Borrowings of other debt

 

42,218

   

24,225

 

Principal payments on other debt

 

(25,242)

   

(30,604)

 

Repurchase of common stock

 

(6,837)

   

(38,531)

 

Proceeds from exercise of stock options

 

1,722

   

964

 

Decrease in overdrafts

 

(4,380)

   

(25,083)

 

Proceeds from issuance of non-controlling interests

 

2,926

   

18,447

 

Distributions to and purchases of non-controlling interests

 

(311,519)

   

(21,780)

 

Net cash provided by financing activities

 

255,572

   

32,251

 

Net increase in cash and cash equivalents

 

52,629

   

160,704

 

Cash and cash equivalents at beginning of period

 

122,549

   

175,178

 

Cash and cash equivalents at end of period

 

$

175,178

   

$

335,882

 

Supplemental information

       

Cash paid for interest

 

$

193,406

   

$

182,992

 

Cash paid for taxes

 

$

48,153

   

$

70,592

 

Non-cash equity exchange for acquisition of U.S. HealthWorks

 

$

238,000

   

$

 

VII. Key Statistics
For the Three Months Ended December 31, 2018 and 2019

(unaudited)

   

2018(e)

 

2019

 

% Change

Critical Illness Recovery Hospital

           

Number of hospitals – end of period(a)

 

96

   

101

     

Net operating revenues (,000)

 

$

426,348

   

$

454,949

   

6.7

%

Number of patient days(b)

 

246,505

   

259,283

   

5.2

%

Number of admissions(b)

 

8,869

   

9,095

   

2.5

%

Net revenue per patient day(b)(c)

 

$

1,717

   

$

1,742

   

1.5

%

Adjusted EBITDA (,000)

 

$

56,026

   

$

60,485

   

8.0

%

Adjusted EBITDA margin

 

13.1

%

 

13.3

%

   

Rehabilitation Hospital

           

Number of hospitals – end of period(a)

 

26

   

29

     

Net operating revenues (,000)

 

$

151,070

   

$

182,670

   

20.9

%

Number of patient days(b)

 

81,931

   

94,236

   

15.0

%

Number of admissions(b)

 

5,594

   

6,636

   

18.6

%

Net revenue per patient day(b)(c)

 

$

1,610

   

$

1,739

   

8.0

%

Adjusted EBITDA (,000)

 

$

28,613

   

$

43,312

   

51.4

%

Adjusted EBITDA margin

 

18.9

%

 

23.7

%

   

Outpatient Rehabilitation

           

Number of clinics – end of period(a)

 

1,662

   

1,740

     

Net operating revenues (,000)

 

$

252,415

   

$

271,885

   

7.7

%

Number of visits(b)

 

2,104,436

   

2,256,966

   

7.2

%

Revenue per visit(b)(d)

 

$

103

   

$

104

   

1.0

%

Adjusted EBITDA (,000)

 

$

35,002

   

$

40,216

   

14.9

%

Adjusted EBITDA margin

 

13.9

%

 

14.8

%

   

Concentra

           

Number of centers – end of period(b)

 

524

   

521

     

Net operating revenues (,000)

 

$

384,253

   

$

397,145

   

3.4

%

Number of visits(b)

 

2,821,928

   

2,903,266

   

2.9

%

Revenue per visit(b)(d)

 

$

124

   

$

122

   

(1.6)

%

Adjusted EBITDA (,000)

 

$

52,858

   

$

56,458

   

6.8

%

Adjusted EBITDA margin

 

13.8

%

 

14.2

%

   

_______________________________________________________________________________

(a)

Includes managed locations.

   

(b)

Excludes managed locations. For purposes of our Concentra segment, onsite clinics and community-based outpatient clinics are excluded.

   

(c)

Net revenue per patient day is calculated by dividing direct patient service revenues by the total number of patient days.

   

(d)

Net revenue per visit is calculated by dividing direct patient service revenue by the total number of visits. For purposes of this computation for our outpatient rehabilitation segment, direct patient service revenue does not include managed clinics. For purposes of this computation for our Concentra segment, direct patient service revenue does not include onsite clinics and community-based outpatient clinics.

   

(e)

For the three months ended December 31, 2018, the financial results of our reportable segments have been changed to remove the net operating revenues and expenses associated with employee leasing services provided to our non-consolidating subsidiaries. These results are now reported as part of our other activities. Select Medical leases employees at cost to these non-consolidating subsidiaries.

VIII. Key Statistics
For the Years Ended December 31, 2018 and 2019

(unaudited)

   

2018(e)

 

2019

 

% Change

Critical Illness Recovery Hospital

           

Number of hospitals – end of period(a)

 

96

   

101

     

Net operating revenues (,000)

 

$

1,753,584

   

$

1,836,518

   

4.7

%

Number of patient days(b)

 

1,012,368

   

1,038,361

   

2.6

%

Number of admissions(b)

 

36,474

   

36,774

   

0.8

%

Net revenue per patient day(b)(c)

 

$

1,716

   

$

1,753

   

2.2

%

Adjusted EBITDA (,000)

 

$

243,015

   

$

254,868

   

4.9

%

Adjusted EBITDA margin

 

13.9

%

 

13.9

%

   

Rehabilitation Hospital

           

Number of hospitals – end of period(a)

 

26

   

29

     

Net operating revenues (,000)

 

$

583,745

   

$

670,971

   

14.9

%

Number of patient days(b)

 

315,468

   

353,031

   

11.9

%

Number of admissions(b)

 

21,813

   

24,889

   

14.1

%

Net revenue per patient day(b)(c)

 

$

1,606

   

$

1,685

   

4.9

%

Adjusted EBITDA (,000)

 

$

108,927

   

$

135,857

   

24.7

%

Adjusted EBITDA margin

 

18.7

%

 

20.2

%

   

Outpatient Rehabilitation

           

Number of clinics – end of period(a)

 

1,662

   

1,740

     

Net operating revenues (,000)

 

$

995,794

   

$

1,046,011

   

5.0

%

Number of visits(b)

 

8,356,018

   

8,719,282

   

4.3

%

Revenue per visit(b)(d)

 

$

103

   

$

103

   

0.0

%

Adjusted EBITDA (,000)

 

$

142,005

   

$

151,831

   

6.9

%

Adjusted EBITDA margin

 

14.3

%

 

14.5

%

   

Concentra

           

Number of centers – end of period(b)

 

524

   

521

     

Net operating revenues (,000)

 

$

1,557,673

   

$

1,628,817

   

4.6

%

Number of visits(b)

 

11,426,940

   

12,068,865

   

5.6

%

Revenue per visit(b)(d)

 

$

124

   

$

122

   

(1.6)

%

Adjusted EBITDA (,000)

 

$

251,977

   

$

276,482

   

9.7

%

Adjusted EBITDA margin

 

16.2

%

 

17.0

%

   

_______________________________________________________________________________

(a)

Includes managed locations.

   

(b)

Excludes managed locations. For purposes of our Concentra segment, onsite clinics and community-based outpatient clinics are excluded.

   

(c)

Net revenue per patient day is calculated by dividing direct patient service revenues by the total number of patient days.

   

(d)

Net revenue per visit is calculated by dividing direct patient service revenue by the total number of visits. For purposes of this computation for our outpatient rehabilitation segment, direct patient service revenue does not include managed clinics. For purposes of this computation for our Concentra segment, direct patient service revenue does not include onsite clinics and community-based outpatient clinics.

   

(e)

For the year ended December 31, 2018, the financial results of our reportable segments have been changed to remove the net operating revenues and expenses associated with employee leasing services provided to our non-consolidating subsidiaries. These results are now reported as part of our other activities. Select Medical leases employees at cost to these non-consolidating subsidiaries.

IX. Net Income to Adjusted EBITDA Reconciliation
For the Three Months and Years Ended December 31, 2018 and 2019
(In thousands, unaudited)

The presentation of Adjusted EBITDA is important to investors because Adjusted EBITDA is commonly used as an analytical indicator of performance by investors within the healthcare industry. Adjusted EBITDA is used to evaluate financial performance and determine resource allocation for each of Select Medical's operating segments. Adjusted EBITDA is not a measure of financial performance under generally accepted accounting principles ("GAAP"). Items excluded from Adjusted EBITDA are significant components in understanding and assessing financial performance. Adjusted EBITDA should not be considered in isolation or as an alternative to, or substitute for, net income, income from operations, cash flows generated by operations, investing or financing activities, or other financial statement data presented in the consolidated financial statements as indicators of financial performance or liquidity. Because Adjusted EBITDA is not a measurement determined in accordance with GAAP and is thus susceptible to varying definitions, Adjusted EBITDA as presented may not be comparable to other similarly titled measures of other companies.

The following table reconciles net income to Adjusted EBITDA for Select Medical. Adjusted EBITDA is used by Select Medical to report its segment performance. Adjusted EBITDA is defined as earnings excluding interest, income taxes, depreciation and amortization, gain (loss) on early retirement of debt, stock compensation expense, acquisition costs associated with U.S. HealthWorks, gain (loss) on sale of businesses, and equity in earnings (losses) of unconsolidated subsidiaries.

 

Three Months Ended
December 31,

 

Years Ended

December 31,

 

2018

 

2019

 

2018

 

2019

Net income

$

29,722

   

$

43,671

   

$

176,942

   

$

201,031

 

Income tax expense

11,150

   

11,578

   

58,610

   

63,718

 

Interest expense

50,502

   

43,959

   

198,493

   

200,570

 

Gain on sale of businesses

   

   

(9,016)

   

(6,532)

 

Equity in earnings of unconsolidated subsidiaries

(6,991)

   

(6,279)

   

(21,905)

   

(24,989)

 

Loss on early retirement of debt

3,900

   

19,440

   

14,155

   

38,083

 

Income from operations

88,283

   

112,369

   

417,279

   

471,881

 

Stock compensation expense:

             

Included in general and administrative

4,884

   

5,485

   

17,604

   

20,334

 

Included in cost of services

1,267

   

1,535

   

5,722

   

6,117

 

Depreciation and amortization

52,633

   

52,504

   

201,655

   

212,576

 

U.S. HealthWorks acquisition costs

   

   

2,895

   

 

Adjusted EBITDA

$

147,067

   

$

171,893

   

$

645,155

   

$

710,908

 
               

Critical illness recovery hospital

$

56,026

   

$

60,485

   

$

243,015

   

$

254,868

 

Rehabilitation hospital

28,613

   

43,312

   

108,927

   

135,857

 

Outpatient rehabilitation

35,002

   

40,216

   

142,005

   

151,831

 

Concentra

52,858

   

56,458

   

251,977

   

276,482

 

Other(a)

(25,432)

   

(28,578)

   

(100,769)

   

(108,130)

 

Adjusted EBITDA

$

147,067

   

$

171,893

   

$

645,155

   

$

710,908

 

_______________________________________________________________________________

(a)

Other primarily includes general and administrative costs.

X. Reconciliation of Earnings per Common Share to Adjusted Earnings per Common Share
For the Three Months and Years Ended December 31, 2018 and 2019
(In thousands, except per share amounts, unaudited)

Adjusted net income attributable to common shares and adjusted earnings per common share are not measures of financial performance under GAAP. Items excluded from adjusted net income attributable to common shares and adjusted earnings per common share are significant components in understanding and assessing financial performance. Select Medical believes that the presentation of adjusted net income attributable to common shares and adjusted earnings per common share are important to investors because they are reflective of the financial performance of our ongoing operations and provide better comparability of our results of operations between periods. Adjusted net income attributable to common shares and adjusted earnings per common share should not be considered in isolation or as alternatives to, or substitutes for, net income, cash flows generated by operations, investing or financing activities, or other financial statement data presented in the consolidated financial statements as indicators of financial performance or liquidity. Because adjusted net income attributable to common shares and adjusted earnings per common share are not measurements determined in accordance with GAAP and are thus susceptible to varying calculations, adjusted net income attributable to common shares and adjusted earnings per common share as presented may not be comparable to other similarly titled measures of other companies.

The following tables reconcile net income attributable to common shares and earnings per common share on a fully diluted basis to adjusted net income attributable to common shares and adjusted earnings per common share on a fully diluted basis.

 

Three Months Ended December 31,

 

2018

 

Per Share(a)

 

2019

 

Per Share(a)

Net income attributable to common shares(a)

$

23,856

   

$

0.18

   

$

30,966

   

$

0.24

 

Adjustments:(b)

             

Loss on early retirement of debt

2,284

   

0.02

   

9,505

   

0.07

 

Adjusted net income attributable to common shares

$

26,140

   

$

0.20

   

$

40,471

   

$

0.31

 
 
 
 

Years Ended December 31,

 

2018

 

Per Share(a)

 

2019

 

Per Share(a)

Net income attributable to common shares(a)

$

133,292

   

$

1.02

   

$

143,455

   

$

1.10

 

Adjustments:(b)

             

Loss on early retirement of debt and related costs(c)

6,674

   

0.05

   

22,286

   

0.17

 

Gain on sale of businesses

(6,432)

   

(0.05)

   

(4,543)

   

(0.03)

 

U.S. HealthWorks acquisition costs

1,002

   

0.01

   

   

 

Adjusted net income attributable to common shares

$

134,536

   

$

1.03

   

$

161,198

   

$

1.24

 

_______________________________________________________________________________

(a)

Net income attributable to common shares and earnings per common share are calculated based on the diluted weighted average common shares outstanding, as presented in table III.

   

(b)

Adjustments to net income attributable to common shares include estimated income tax and non-controlling interest impacts and are calculated based on the diluted weighted average common shares outstanding.

 

The estimated income tax impact, which is determined using tax rates based on the nature of the adjustment and the jurisdiction in which the adjustment occurred, includes both current and deferred income tax expense or benefits. For the three months ended December 31, 2018 and 2019, the adjustments to net income attributable to common shares include estimated income tax benefits of approximately $1.0 million and $5.2 million, respectively. For the years ended December 31, 2018 and 2019, the adjustments to net income attributable to common shares include estimated net income tax benefits of approximately $2.1 million and $9.2 million, respectively.

   

(c)

Select Medical redeemed its $710.0 million 6.375% senior notes on August 30, 2019 and issued and sold $550.0 million 6.250% senior notes on August 1, 2019. As a result, Select Medical recognized interest expense on both the 6.250% senior notes and the 6.375% senior notes during August 2019. The adjustment to net income attributable to common shares for the loss on early retirement of debt and related costs includes the interest expense recognized on the 6.375% senior notes during August 2019 and its related tax effects.

XI. Net Income to Adjusted EBITDA Reconciliation
Business Outlook for the Year Ending December 31, 2020
(In millions, unaudited)

The following is a reconciliation of full year 2020 Adjusted EBITDA expectations as computed at the low and high points of the range to the closest comparable GAAP financial measure. Refer to table IX for the definition of Adjusted EBITDA and a discussion of Select Medical's use of Adjusted EBITDA in evaluating financial performance. Each item presented in the below table is an estimation of full year 2020 expectations.

 

Range

Non-GAAP Measure Reconciliation

Low

 

High

Net income attributable to Select Medical

$

171

   

$

197

 

Net income attributable to non-controlling interests

72

   

72

 

Net income

243

   

269

 

Income tax expense

81

   

90

 

Interest expense

188

   

188

 

Equity in earnings of unconsolidated subsidiaries

(29)

   

(29)

 

Income from operations

483

   

518

 

Stock compensation expense

30

   

30

 

Depreciation and amortization

212

   

212

 

Adjusted EBITDA

$

725

   

$

760

 

Cision View original content:http://www.prnewswire.com/news-releases/select-medical-holdings-corporation-announces-results-for-its-fourth-quarter-and-year-ended-december-31-2019-301008705.html

SOURCE Select Medical Holdings Corporation


Company Codes: NYSE:SEM

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