Companies:
10,652
total market cap:
$142.360 T
Sign In
๐บ๐ธ
EN
English
$ USD
โฌ
EUR
๐ช๐บ
โน
INR
๐ฎ๐ณ
ยฃ
GBP
๐ฌ๐ง
$
CAD
๐จ๐ฆ
$
AUD
๐ฆ๐บ
$
NZD
๐ณ๐ฟ
$
HKD
๐ญ๐ฐ
$
SGD
๐ธ๐ฌ
Global ranking
Ranking by countries
America
๐บ๐ธ United States
๐จ๐ฆ Canada
๐ฒ๐ฝ Mexico
๐ง๐ท Brazil
๐จ๐ฑ Chile
Europe
๐ช๐บ European Union
๐ฉ๐ช Germany
๐ฌ๐ง United Kingdom
๐ซ๐ท France
๐ช๐ธ Spain
๐ณ๐ฑ Netherlands
๐ธ๐ช Sweden
๐ฎ๐น Italy
๐จ๐ญ Switzerland
๐ต๐ฑ Poland
๐ซ๐ฎ Finland
Asia
๐จ๐ณ China
๐ฏ๐ต Japan
๐ฐ๐ท South Korea
๐ญ๐ฐ Hong Kong
๐ธ๐ฌ Singapore
๐ฎ๐ฉ Indonesia
๐ฎ๐ณ India
๐ฒ๐พ Malaysia
๐น๐ผ Taiwan
๐น๐ญ Thailand
๐ป๐ณ Vietnam
Others
๐ฆ๐บ Australia
๐ณ๐ฟ New Zealand
๐ฎ๐ฑ Israel
๐ธ๐ฆ Saudi Arabia
๐น๐ท Turkey
๐ท๐บ Russia
๐ฟ๐ฆ South Africa
>> All Countries
Ranking by categories
๐ All assets by Market Cap
๐ Automakers
โ๏ธ Airlines
๐ซ Airports
โ๏ธ Aircraft manufacturers
๐ฆ Banks
๐จ Hotels
๐ Pharmaceuticals
๐ E-Commerce
โ๏ธ Healthcare
๐ฆ Courier services
๐ฐ Media/Press
๐ท Alcoholic beverages
๐ฅค Beverages
๐ Clothing
โ๏ธ Mining
๐ Railways
๐ฆ Insurance
๐ Real estate
โ Ports
๐ผ Professional services
๐ด Food
๐ Restaurant chains
โ๐ป Software
๐ Semiconductors
๐ฌ Tobacco
๐ณ Financial services
๐ข Oil&Gas
๐ Electricity
๐งช Chemicals
๐ฐ Investment
๐ก Telecommunication
๐๏ธ Retail
๐ฅ๏ธ Internet
๐ Construction
๐ฎ Video Game
๐ป Tech
๐ฆพ AI
>> All Categories
ETFs
๐ All ETFs
๐๏ธ Bond ETFs
๏ผ Dividend ETFs
โฟ Bitcoin ETFs
โข Ethereum ETFs
๐ช Crypto Currency ETFs
๐ฅ Gold ETFs & ETCs
๐ฅ Silver ETFs & ETCs
๐ข๏ธ Oil ETFs & ETCs
๐ฝ Commodities ETFs & ETNs
๐ Emerging Markets ETFs
๐ Small-Cap ETFs
๐ Low volatility ETFs
๐ Inverse/Bear ETFs
โฌ๏ธ Leveraged ETFs
๐ Global/World ETFs
๐บ๐ธ USA ETFs
๐บ๐ธ S&P 500 ETFs
๐บ๐ธ Dow Jones ETFs
๐ช๐บ Europe ETFs
๐จ๐ณ China ETFs
๐ฏ๐ต Japan ETFs
๐ฎ๐ณ India ETFs
๐ฌ๐ง UK ETFs
๐ฉ๐ช Germany ETFs
๐ซ๐ท France ETFs
โ๏ธ Mining ETFs
โ๏ธ Gold Mining ETFs
โ๏ธ Silver Mining ETFs
๐งฌ Biotech ETFs
๐ฉโ๐ป Tech ETFs
๐ Real Estate ETFs
โ๏ธ Healthcare ETFs
โก Energy ETFs
๐ Renewable Energy ETFs
๐ก๏ธ Insurance ETFs
๐ฐ Water ETFs
๐ด Food & Beverage ETFs
๐ฑ Socially Responsible ETFs
๐ฃ๏ธ Infrastructure ETFs
๐ก Innovation ETFs
๐ Semiconductors ETFs
๐ Aerospace & Defense ETFs
๐ Cybersecurity ETFs
๐ฆพ Artificial Intelligence ETFs
Watchlist
Account
DaVita
DVA
#2124
Rank
$9.64 B
Marketcap
๐บ๐ธ
United States
Country
$144.27
Share price
3.58%
Change (1 day)
-16.97%
Change (1 year)
โ๏ธ Healthcare
Categories
DaVita Inc.
is an American company providing dialysis services for patients with chronic and acute kidney failure.
Market cap
Revenue
Earnings
Price history
P/E ratio
P/S ratio
More
Price history
P/E ratio
P/S ratio
P/B ratio
Operating margin
EPS
Stock Splits
Shares outstanding
Fails to deliver
Cost to borrow
Total assets
Total liabilities
Total debt
Cash on Hand
Net Assets
Annual Reports (10-K)
DaVita
Quarterly Reports (10-Q)
Submitted on 2001-11-13
DaVita - 10-Q quarterly report FY
Text size:
Small
Medium
Large
UNITED STATES
SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
FORM 10-Q
For the Quarter Ended September 30, 2001
QUARTERLY REPORT PURSUANT TO SECTION 13 OR 15(d) OF THE
SECURITIES EXCHANGE ACT OF 1934
Commission File Number: 1-4034
DAVITA INC.
(Former name: Total Renal Care Holdings, Inc.)
21250 Hawthorne Blvd., Suite 800
Torrance, California 90503-5517
Telephone # (310) 792-2600
Delaware
51-0354549
(State of incorporation)
(I.R.S. employer identification no.)
The Registrant 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 and has been subject to such filing requirements for the past 90 days.
As of November 1, 2001, there were 84,599,565 shares of the Registrants common stock (par value $0.001) issued and outstanding.
DAVITA INC.
INDEX
Page No.
PART I. FINANCIAL INFORMATION
Ite
m 1.
Condensed Consolidated Financial Statements:
Consolidated Balance Sheets as of September 30, 2001 and December 31, 2000
1
Consolidated Statements of Income and Comprehensive Income for the three and nine
months ended September 30, 2001 and September 30, 2000
2
Consolidated Statements of Cash Flows for the nine months ended September 30, 2001 and
September 30, 2000
3
Notes to Condensed Consolidated Financial Statements
4
Ite
m 2.
Managements Discussion and Analysis of Financial Condition and Results of Operations
11
Ite
m 3.
Quantitative and Qualitative Disclosures About Market Risk
14
Risk Factors
15
PART II. OTHER INFORMATION
Ite
m 1.
Legal Proceedings
19
Ite
m 6.
Exhibits and Reports on Form 8-K
19
Signatures
20
Note:Items
2, 3, 4, and 5 of Part II are omitted because they are not applicable.
i
DAVITA INC.
CONSOLIDATED BALANCE SHEETS
(unaudited)
(dollars in thousands, except per share data)
September 30,
2001
December 31,
2000
A S S E T S
Ca
sh and cash equivalents
$ 45,255
$ 31,207
Ac
counts receivable, less allowance of $48,757 and $61,619
318,035
290,412
Inv
entories
33,173
20,641
Oth
er current assets
7,852
10,293
Inc
ome taxes receivable
2,830
De
ferred income taxes
51,789
42,492
To
tal current assets
456,104
397,875
Pro
perty and equipment, net
246,031
236,659
Int
angible assets, net
943,558
921,623
Inv
estments in third-party dialysis businesses
5,093
34,194
Oth
er long-term assets
2,307
1,979
De
ferred income taxes
4,302
$1,653,093
$1,596,632
L I A B I L I T I E S A N D S H A R E H O L D E R S E Q U I T Y
Ac
counts payable
$ 80,325
$ 74,882
Oth
er current liabilities
121,666
102,563
Ac
crued compensation and benefits
85,732
70,406
Cu
rrent portion of long-term debt
6,432
1,676
Inc
ome taxes payable
19,485
To
tal current liabilities
313,640
249,527
Lo
ng-term debt
813,977
974,006
Oth
er long-term liabilities
5,212
4,855
De
ferred income taxes
21,509
Mi
nority interests
21,121
18,876
Sh
areholders equity:
Pre
ferred stock ($0.001 par value; 5,000,000 shares authorized; none
issued or outstanding)
Co
mmon stock ($0.001 par value, 195,000,000 shares authorized;
84,577,090 and 82,135,634 shares issued and outstanding)
85
82
Ad
ditional paid-in capital
456,593
430,676
No
tes receivable from shareholders
(83
)
Tre
asury stock, at cost (126,000 shares)
(2,494
)
Re
tained earnings (deficit)
23,450
(81,307
)
To
tal shareholders equity
477,634
349,368
$1,653,093
$1,596,632
See notes to condensed consolidated financial statements.
1
DAVITA INC.
CONSOLIDATED STATEMENTS OF INCOME AND COMPREHENSIVE INCOME
(unaudited)
(dollars in thousands, except per share data)
Three months ended
September 30,
Nine months ended
September 30,
2001
2000
2001
2000
Ne
t operating revenues
$434,239
$362,535
$1,221,096
$1,113,556
Op
erating expenses:
Dia
lysis centers and labs
277,252
248,734
809,771
775,746
Ge
neral and administrative
31,150
29,920
95,380
93,460
De
preciation and amortization
26,281
26,927
79,053
84,315
Pro
vision for uncollectible accounts
2,689
7,048
(5,874
)
32,555
Im
pairment and valuation adjustments
4,414
To
tal operating expenses
337,372
312,629
978,330
990,490
Op
erating income
96,867
49,906
242,766
123,066
Oth
er income (loss), net
1,856
1,418
4,324
(9,171
)
De
bt expense
18,319
26,370
56,758
94,017
Mi
nority interests in income of consolidated subsidiaries
(2,126
)
(1,147
)
(6,852
)
(3,168
)
Inc
ome before income taxes and extraordinary item
78,278
23,807
183,480
16,710
Inc
ome tax expense
34,000
10,657
79,700
15,068
Inc
ome before extraordinary item
44,278
13,150
103,780
1,642
Ex
traordinary gain (loss) related to early extinguishment of
debt, net of tax of $(652) in 2001 and $2,222 in 2000,
respectively
(3,490
)
977
(3,490
)
Ne
t income (loss)
$ 44,278
$ 9,660
$ 104,757
$ (1,848
)
Ea
rnings (loss) per common sharebasic:
Inc
ome before extraordinary item
$ 0.52
$ 0.16
$ 1.25
$ 0.02
Ex
traordinary gain (loss), net of tax
(0.04
)
0.01
(0.04
)
Ne
t income (loss)
$ 0.52
$ 0.12
$ 1.26
$ (0.02
)
Ea
rnings (loss) per common shareassuming dilution:
Inc
ome before extraordinary item
$ 0.47
$ 0.16
$ 1.15
$ 0.02
Ex
traordinary gain (loss), net of tax
(0.04
)
0.01
(0.04
)
Ne
t income (loss)
$ 0.47
$ 0.12
$ 1.16
$ (0.02
)
Co
mprehensive income:
Ne
t income (loss)
$ 44,278
$ 9,660
$ 104,757
$ (1,848
)
Fo
reign currency translation
4,718
Co
mprehensive income
$ 44,278
$ 9,660
$ 104,757
$ 2,870
See notes to condensed consolidated financial statements.
2
DAVITA INC.
CONSOLIDATED STATEMENTS OF CASH FLOWS
(unaudited)
(dollars in thousands)
Nine months ended
September 30,
2001
2000
Ca
sh flows from operating activities:
Ne
t income (loss)
$ 104,757
$ (1,848
)
Ad
justments to reconcile net income to cash provided by operating activities:
De
preciation and amortization
79,053
84,315
Im
pairment and valuation losses
4,414
Lo
ss (gain) on divestitures
528
(2,107
)
De
ferred income taxes
16,514
(2,603
)
No
n-cash debt expense
1,823
2,482
Sto
ck option expense and tax benefits
12,864
1,319
Eq
uity investment losses (income)
(2,666
)
1,447
Fo
reign currency translation loss
4,718
Mi
nority interests in income of consolidated subsidiaries
6,852
3,168
Ex
traordinary (gain) loss
(977
)
3,490
Ch
anges in operating assets and liabilities, net of acquisitions and divestitures:
Ac
counts receivable
(21,647
)
37,731
Inv
entories
(11,847
)
(7,683
)
Oth
er current assets
4,026
8,861
Oth
er long-term assets
(53
)
2,290
Ac
counts payable
1,789
(33,644
)
Ac
crued compensation and benefits
14,896
20,521
Oth
er current liabilities
19,072
13,011
Inc
ome taxes
21,563
53,187
Oth
er long-term liabilities
357
1,713
Ne
t cash provided by operating activities
246,904
194,782
Ca
sh flows from investing activities:
Ad
ditions of property and equipment, net
(30,180
)
(32,023
)
Ac
quisitions and divestitures, net
(66,588
)
147,639
Inv
estments in affiliates, net
24,533
(1,824
)
Int
angible assets
(11
)
(162
)
Ne
t cash provided by (used in) investing activities
(72,246
)
113,630
Ca
sh flows from financing activities:
Bo
rrowings
1,541,890
1,657,604
Pay
ments on long-term debt
(1,697,941
)
(2,027,548
)
De
ferred financing costs
(10,018
)
(3,079
)
Ne
t proceeds from issuance of common stock
13,139
856
Dis
tributions to minority interests
(5,186
)
(5,652
)
Pu
rchase of treasury shares
(2,494
)
Ne
t cash used in financing activities
(160,610
)
(377,819
)
Ne
t increase in cash
14,048
(69,407
)
Ca
sh and cash equivalents at beginning of period
31,207
107,981
Ca
sh and cash equivalents at end of period
$ 45,255
$ 38,574
See notes to condensed consolidated financial statements
3
DAVITA INC.
NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS
(unaudited)
(dollars in thousands, except per share data)
Unless otherwise indicated in this Form 10-Q, the Company, we, us, our and similar terms refer to DaVita Inc. and its subsidiaries.
1. Condensed consolidated interim financial statements
The condensed consolidated interim financial statements included in this report have been prepared by the Company without audit. In the opinion of management, all adjustments necessary for a fair presentation are reflected in these interim financial statements. These adjustments are of a normal and recurring nature. The results of operations for the periods ended September 30, 2001 are not necessarily indicative of the operating results for the full year. The interim financial statements should be read in conjunction with the audited consolidated financial statements and notes thereto included in the Companys 2000 Form 10-K as amended by Form 10-K/A. Certain reclassifications have been made to prior periods to conform with current reporting.
2. Changes in estimates and recoveries
Net operating revenues for the three months ended September 30, 2001 include $22 million of cash settlements and collections in excess of our prior estimates for 2000 net revenue. The provisions for uncollectible accounts for the three and nine months ended September 30, 2001 include cash recoveries of $5.2 million and $30.1 million, respectively, associated with aged accounts receivable that had been reserved in 1999. Cash recoveries associated with prior years services have resulted from continued improvements in the Companys billing and collecting operations. Although the Company continues to pursue collection of aged accounts, the Company cannot predict the timing or amount of future incremental recoveries or settlements.
3. Earnings per share calculation
The reconciliation of the numerators and denominators used to calculate earnings per common share for the periods presented is as follows (shares in 000s):
Three months ended
September 30,
Nine months ended
September 30,
2001
2000
2001
2000
Ba
sic:
Ne
t income (loss)
$ 44,278
$ 9,660
$104,757
$ (1,848
)
We
ighted average number of shares outstanding during the period
84,354
81,673
83,411
81,502
Re
duction in shares in connection with notes receivable from employees
(24
)
(33
)
We
ighted average number of shares outstanding for earnings per
sharebasic
84,354
81,649
83,411
81,469
Ea
rnings (loss) per sharebasic
$ 0.52
$ 0.12
$ 1.26
$ (0.02
)
As
suming dilution:
Ne
t income (loss)
$ 44,278
$ 9,660
$104,757
$ (1,848
)
De
bt expense, net of tax, resulting from dilutive effect of convertible debt
4,862
14,587
Ne
t income (loss)assuming dilution
$ 49,140
$ 9,660
$119,344
$ (1,848
)
We
ighted average number of shares outstanding for earnings per
sharebasic
84,354
81,649
83,411
81,469
Inc
remental shares from stock option plans
4,278
2,198
4,352
1,095
Inc
remental shares from convertible debt
15,394
15,394
We
ighted average outstanding and incremental shares for earnings per
shareassuming dilution
104,026
83,847
103,157
82,564
Ea
rnings (loss) per shareassuming dilution
$ 0.47
$ 0.12
$ 1.16
$ (0.02
)
4
For the three and nine months ended September 30, 2001, the calculation of earnings per share assuming dilution includes conversion of both the 5
5
/
8
% convertible subordinated notes and the 7% convertible subordinated notes. For the three and nine months ended September 30, 2000, both the 7% convertible subordinated notes and the 5
5
/
8
% convertible subordinated notes were anti-dilutive and therefore not included in the computation of earnings per share assuming dilution.
Shares associated with stock options that have exercise prices greater than the average market price of shares outstanding during the period, which were not included in the computation of earnings per share assuming dilution because they were anti-dilutive, are as follows:
Three months ended
September 30,
Nine months ended
September 30,
2001
2000
2001
2000
Sh
ares associated with stock options not included in computation
(shares in 000s)
474
9,158
1,483
10,987
Ex
ercise price range of shares not included in computation:
Lo
w
$20.59
$ 6.81
$18.45
$ 4.99
Hig
h
$33.00
$35.50
$33.00
$ 35.50
4. Debt transactions
In April 2001 the Company completed the issuance of $225,000 9¼% Senior Subordinated Notes in a private offering. The Notes mature on April 15, 2011 and will be callable by the Company on or after April 15, 2006. Net proceeds of $219,375 from the offering were used to pay down amounts outstanding under the Companys then-existing senior credit facilities. In August 2001 these notes were exchanged for a series of notes with identical terms that had been registered under the Securities Act of 1933.
In May 2001 the Company completed a refinancing of its existing senior credit facilities. Proceeds from this refinancing were used to pay down all outstanding amounts under the then-existing senior credit facilities. The new credit facilities consist of two term loans and a $150,000 undrawn revolving credit facility.
As a result of these transactions, the write-off of deferred financing costs and accelerated recognition of deferred swap liquidation gains associated with the refinanced debt are reported as a net extraordinary gain of $977 for the nine months ended September 30, 2001.
Long-term debt was comprised of the following:
September 30,
2001
December 31,
2000
Sen
ior secured credit facilities
$114,000
$498,800
Sen
ior subordinated notes, 9¼%, due 2011
225,000
Co
nvertible subordinated notes, 7%, due 2009
345,000
345,000
Co
nvertible subordinated notes, 5
5
/
8
%, due 2006
125,000
125,000
Ac
quisition obligations and other notes payable
5,453
829
Ca
pital lease obligations
5,956
6,053
820,409
975,682
Le
ss current portion
(6,432
)
(1,676
)
$813,977
$974,006
5
Scheduled maturities of long-term debt at September 30, 2001 were as follows:
200
1
655
200
2
8,565
200
3
10,856
200
4
10,365
200
5
10,242
200
6
206,788
Th
ereafter
572,938
5. Contingencies
Health care provider revenues may be subject to adjustment as a result of (1) examination by government agencies or contractors, for which the resolution of any matters raised may take extended periods of time to finalize; (2) differing interpretations of government regulations by different fiscal intermediaries; (3) differing opinions regarding a patients medical diagnosis or the medical necessity of services provided; and (4) retroactive applications or interpretations of governmental requirements.
The Companys Florida-based laboratory subsidiary is the subject of a third-party carrier review of its Medicare reimbursement claims. The carrier has issued formal overpayment determinations in the amount of $5,600 for the review period from January 1995 to April 1996, and $15,000 for the review period from May 1996 to March 1998. The carrier has suspended all payments of Medicare claims from this laboratory since May 1998. The carrier has also determined that $16,100 of the suspended claims for the review period from April 1998 to August 1999 and $11,600 of the suspended claims for the review period from August 1999 to May 2000 were not properly supported by the prescribing physicians medical justification. The carrier has alleged that 99% of the tests the laboratory performed during the review period from January 1995 to April 1996, 96% of the tests performed in the period from May 1996 to March 1998, 70% of the tests performed in the period from April 1998 to August 1999, and 72% of the tests performed in the period from August 1999 to May 2000 were not properly supported by the prescribing physicians medical justification. The Company has received minimal responses from the carrier to its repeated requests for clarification and information regarding the continuing payment suspension.
The Company is disputing the overpayment determinations and has provided supporting documentation of its claims. The Company has initiated the process of a formal review of each of the carriers determinations. The first step in this formal review process is a hearing before a hearing officer at the carrier. The hearing regarding the initial review period from January 1995 to April 1996 was held in July 1999. In January 2000 the hearing officer issued a decision upholding the overpayment determination of $5,600. The hearing regarding the second review period from May 1996 to March 1998 was held in April 2000. In July 2000 the hearing officer issued a decision upholding $14,200, or substantially all of the overpayment determination. The Company has filed appeals of both decisions to a federal administrative law judge, who has consolidated the two appeals at the Companys request. The Company has provided additional information to the administrative law judge. A hearing with the administrative law judge has not yet been scheduled.
In addition to the formal appeal process with a federal administrative law judge, beginning in the third quarter of 1999 we sought a meeting with the Department of Justice, or DOJ, to begin a process to resolve this matter. The carrier had previously informed the local office of the DOJ and the Department of Health and Human Services of this matter, and we had provided requested information to the DOJ. The Company met with the DOJ in February 2001 at which time the DOJ requested additional information, which the Company has provided.
Timing of the final resolution of this matter is highly uncertain, and beyond the Companys control or influence. Beginning in the third quarter of 2000, the Company stopped recognizing Medicare revenue from this
6
laboratory until the uncertainties regarding both the timing of resolution and the ultimate revenue valuations are at least substantially eliminated. The amount of potential Medicare revenue not accrued beginning in the third quarter of 2000 was approximately $4,000 per quarter. We estimate that the potential cash exposure as of September 30, 2001 is not more than $10,000 based on the carriers overpayment findings noted above. If this matter is resolved in a manner adverse to the Company, the government could impose additional fines and penalties, which could be substantial.
In February 2001, the Civil Division of the United States Attorneys Office for the Eastern District of Pennsylvania contacted the Company and requested its cooperation in a review of some of the Companys historical practices, including billing and other operating procedures and our financial relationships with physicians. The Civil Division has requested that the Company provide a wide range of information responding to the areas of review. The Civil Division has not initiated any legal process or served any subpoena on the Company. The Civil Division has indicated that it is not making any allegation of wrongdoing at this time and that no criminal action against the Company or any individual is contemplated. The Company is cooperating in this review. The inquiry appears to be at an early stage. As it proceeds, the Civil Division could expand its areas of concern. If a court determines there has been wrongdoing, the penalties under applicable statutes could be substantial.
In addition to the foregoing, DaVita is subject to claims and suits in the ordinary course of business. Management believes that the ultimate resolution of these additional matters, whether the underlying claims are covered by insurance or not, will not have a material adverse effect on the Companys financial condition, results of operations or cash flows.
6. Recent accounting pronouncements
In July 2001 the Financial Accounting Standards Board (FASB) issued Statement of Financial Accounting Standards (SFAS) No. 142,
Goodwill and Other Intangible Assets
which will be effective January 1, 2002. Under SFAS 142, amortization of goodwill and other indefinite-lived intangible assets, including any such intangibles recorded in past business combinations, will be discontinued beginning January 1, 2002. In addition, goodwill and other indefinite-lived intangible assets recorded as a result of business combinations completed during the six-month period ending December 31, 2001 will not be amortized. Under the new standard, goodwill and other indefinite-lived intangible assets will be written down with a goodwill impairment charge against current earnings whenever the recorded values exceed their fair values. The Company is currently reviewing the provisions of SFAS 142 and assessing the impact of its adoption.
In October 2001 the FASB issued SFAS 144,
Accounting for Impairment or Disposal of Long-Lived Assets.
SFAS 144 supercedes SFAS 121,
Accounting for the Impairment of Long-Lived Assets and for Long-Lived Assets to be Disposed Of.
SFAS 144 also extends discontinued operations treatment, previously applied only to operating segments to be disposed of, to all separately accountable components of an entity. The Company is currently reviewing the provisions of SFAS 144 and assessing the impact of its adoption, which will be effective January 1, 2002.
7. Condensed consolidating financial statements
The following information is presented as required under the Securities and Exchange Commissions Financial Reporting Release No. 55 in connection with the Companys publicly traded debt. The operating and investing activities of the separate legal entities included in the consolidated financial statements are fully interdependent and integrated. Revenues and operating expenses of the separate legal entities include
7
intercompany charges for management and other services. Other income (loss) for the nine months ended September 30, 2001 includes intercompany interest charges in accordance with the intercompany debt agreements in effect at September 30, 2001.
The $125,000 5
5
/
8
% Convertible Subordinated Notes due 2006, issued by the wholly-owned subsidiary Renal Treatment Centers, Inc., or RTC, are guaranteed by DaVita Inc. The $225,000 9¼% Senior Subordinated Notes issued in April 2001 by DaVita Inc. are guaranteed by all of its wholly-owned domestic subsidiaries. Non-wholly-owned subsidiaries, joint ventures and partnerships are not guarantors of either obligation.
Condensed Consolidating Balance Sheets
Wholly-owned
subsidiaries
Non-participating
subsidiaries
Consolidating
adjustments
DaVita
Inc.
RTC
All
others
Consolidated
As
of September 30, 2001
Ca
sh and cash equivalents
$ 35,168
$ 10
$ 10,077
$ 45,255
Ac
counts receivable, net
101,333
191,344
$ 25,358
318,035
Oth
er current assets
2,228
16,591
71,842
2,153
92,814
To
tal current assets
37,396
117,934
273,263
27,511
456,104
Pro
perty and equipment, net
10,543
55,113
157,064
23,311
246,031
Inv
estments in subsidiaries
276,916
$ (276,916
)
Re
ceivables from subsidiaries
838,598
(838,598
)
Int
angible assets, net
23,993
282,148
522,515
114,902
943,558
Oth
er assets
3,537
1,300
2,519
44
7,400
To
tal assets
$1,190,983
$456,495
$955,361
$165,768
$(1,115,514
)
$1,653,093
Cu
rrent liabilities
29,228
8,635
271,155
4,622
313,640
Pay
ables to subsidiaries/parent
125,163
688,333
25,102
(838,598
)
Lo
ng-term liabilities
684,121
125,134
26,519
4,924
840,698
Mi
nority interests
21,121
21,121
Sh
areholders equity
477,634
197,563
(30,646
)
131,120
(298,037
)
477,634
To
tal liabilities and shareholders equity
$1,190,983
$456,495
$955,361
$165,768
$(1,115,514
)
$1,653,093
As
of December 31, 2000
Ca
sh and cash equivalents
$ 16,553
$ 1,871
$ 12,783
$ 31,207
Ac
counts receivable, net
83,313
180,263
$ 26,836
290,412
Oth
er current assets
2,014
15,967
55,947
2,328
76,256
To
tal current assets
18,567
101,151
248,993
29,164
397,875
Pro
perty and equipment, net
5,377
61,686
146,959
22,637
236,659
Inv
estments in subsidiaries
199,079
$ (199,079
)
Re
ceivables from subsidiaries
938,183
(938,183
)
Int
angible assets, net
9,548
299,813
493,946
118,316
921,623
Oth
er assets
37,692
2,146
593
44
40,475
To
tal assets
$1,208,446
$464,796
$890,491
$170,161
$(1,137,262
)
$1,596,632
Cu
rrent liabilities
15,278
23,996
206,275
3,978
249,527
Pay
ables to subsidiaries/parent
146,877
746,892
44,414
(938,183
)
Lo
ng-term liabilities
843,800
125,000
5,311
4,750
978,861
Mi
nority interests
18,876
18,876
Sh
areholders equity
349,368
168,923
(67,987
)
117,019
(217,955
)
349,368
To
tal liabilities and shareholders equity
$1,208,446
$464,796
$890,491
$170,161
$(1,137,262
)
$1,596,632
8
Condensed Consolidating Statements of Income
Wholly-owned
subsidiaries
Non-
participating
subsidiaries
Consolidating
adjustments
DaVita Inc.
RTC
All
others
Consolidated
Fo
r the nine months ended September 30, 2001
Ne
t operating revenues
$ 89,141
$375,726
$704,823
$136,561
$(85,155
)
$1,221,096
Op
erating expenses
45,024
320,220
594,421
103,820
(85,155
)
978,330
Op
erating income
44,117
55,506
110,402
32,741
242,766
Oth
er income (loss), net
74,445
(70,121
)
4,324
De
bt expense
51,779
5,172
(4,057
)
3,864
56,758
Mi
nority interests
(6,852
)
(6,852
)
Inc
ome taxes
28,984
21,694
29,022
79,700
Eq
uity earnings in consolidated subsidiaries
65,981
22,025
(88,006
)
Ex
traordinary gain
977
977
Ne
t income
$104,757
$ 28,640
$ 37,341
$ 28,877
$(94,858
)
$ 104,757
Fo
r the nine months ended September 30, 2000
Ne
t operating revenues
$ 89,557
$373,954
$616,475
$116,883
$(83,313
)
$1,113,556
Op
erating expenses
25,887
352,903
597,535
97,478
(83,313
)
990,490
Op
erating income
63,670
21,051
18,940
19,405
123,066
Oth
er income (loss), net
(9,103
)
(1,373
)
1,305
(9,171
)
De
bt expense
87,814
5,869
(5,927
)
6,261
94,017
Mi
nority interests
(3,168
)
(3,168
)
Inc
ome taxes
(13,631
)
6,688
22,115
(104
)
15,068
Eq
uity earnings in consolidated subsidiaries
21,258
11,385
(32,643
)
Ex
traordinary loss
(3,490
)
(3,490
)
Ne
t income (loss)
$ (1,848
)
$ 8,494
$ 12,764
$ 14,553
$(35,811
)
$ (1,848
)
9
Condensed Consolidating Statements of Cash Flows
Wholly-owned
subsidiaries
Non-
participating
subsidiaries
Consolidating
adjustments
DaVita
Inc.
RTC
All
others
Consolidated
Nin
e months ended September 30, 2001
Ca
sh flows from operating activities:
Ne
t income
$104,757
$ 28,640
$37,341
$28,877
$(94,858
)
$104,757
Ch
anges in operating and intercompany assets
and liabilities and non cash items included
in net income
79,438
(25,501
)
12,652
(19,300
)
94,858
142,147
Ne
t cash provided by operating activities
184,195
3,139
49,993
9,577
246,904
Ca
sh flows from investing activities:
Pu
rchases of property and equipment, net
(6,407
)
(5,134
)
(14,027
)
(4,612
)
(30,180
)
Ac
quisitions and divestitures, net
(66,588
)
(66,588
)
Oth
er items
24,497
25
24,522
Ne
t cash used in investing activities
(6,407
)
(5,134
)
(56,118
)
(4,587
)
(72,246
)
Ca
sh flows from financing activities:
Lo
ng-term debt
(159,800
)
134
3,419
196
(156,051
)
Oth
er items
627
(5,186
)
(4,559
)
Ne
t cash provided by (used in) financing
activities
(159,173
)
134
3,419
(4,990
)
(160,610
)
Ne
t increase (decrease) in cash
18,615
(1,861
)
(2,706
)
14,048
Ca
sh at the beginning of the period
16,553
1,871
12,783
31,207
Ca
sh at the end of the period
$ 35,168
$ 10
$10,077
$
$
$ 45,255
Nin
e months ended September 30, 2000
Ca
sh flows from operating activities:
Ne
t income (loss)
$ (1,848
)
$ 8,494
$12,764
$14,553
$(35,811
)
$ (1,848
)
Ch
anges in operating and intercompany assets
and liabilities and non cash items included
in net income (loss)
298,354
(109,966
)
(15,912
)
(11,657
)
35,811
196,630
Ne
t cash provided by (used in) operating
activities
296,506
(101,472
)
(3,148
)
2,896
194,782
Ca
sh flows from investing activities:
Pu
rchases of property and equipment, net
(942
)
(5,549
)
(23,062
)
(2,470
)
(32,023
)
Ac
quisitions and divestitures, net
105,342
42,297
147,639
Oth
er items
(342
)
(1,644
)
(1,986
)
Ne
t cash provided by (used in) investing
activities
(1,284
)
99,793
17,591
(2,470
)
113,630
Ca
sh flows from financing activities:
Lo
ng-term debt
(358,195
)
(11,323
)
(426
)
(369,944
)
Oth
er items
(2,223
)
(5,652
)
(7,875
)
Ne
t cash used in financing activities
(360,418
)
(16,975
)
(426
)
(377,819
)
Ne
t decrease in cash
(65,196
)
(1,679
)
(2,532
)
(69,407
)
Ca
sh at the beginning of the period
90,544
4,118
13,319
107,981
Ca
sh at the end of the period
$ 25,348
$ 2,439
$10,787
$
$
$ 38,574
10
Item 2. Managements Discussion and Analysis of Financial Condition and Results of Operations.
Forward-looking statements
This Form 10-Q contains statements that are forward-looking statements within the meaning of the federal securities laws, including statements about our expectations, beliefs, intentions or strategies for the future. These statements involve known and unknown risks and uncertainties, including risks resulting from the regulatory environment in which we operate, economic and market conditions, competitive activities, other business conditions, accounting estimates, and the risk factors set forth in this Form 10-Q. These risks, among others, include those relating to possible reductions in private and government reimbursement rates, the concentration of profits generated from PPO and private indemnity patients and from ancillary services including the administration of pharmaceuticals, the ongoing payment suspension and review of the Companys Florida laboratory subsidiary by its Medicare carrier and the Department of Justice, the ongoing review by the Civil Division of the US Attorneys Office for the Eastern District of Pennsylvania and the Companys ability to maintain contracts with physician medical directors. Our actual results may differ materially from results anticipated in our forward-looking statements. We base our forward-looking statements on information currently available to us, and we have no current intention to update these statements, whether as a result of changes in underlying factors, new information, future events or other developments.
Results of operations
Continental U.S. and non-continental U.S. operating revenues and operating expenses were as follows (dollars in millions):
Quarter ended
September 30,
2001
June 30,
2001
September 30,
2000
Re
venues:
Co
ntinental U.S.
$430
99
%
$397
99
%
$359
99
%
No
n-continental U.S.
4
1
%
4
1
%
4
1
%
434
100
%
401
100
%
363
100
%
Op
erating expenses:
Co
ntinental U.S.
333
99
%
326
99
%
309
99
%
No
n-continental U.S.
4
1
%
4
1
%
4
1
%
337
100
%
330
100
%
313
100
%
Co
nsolidated operating income.
$ 97
$ 71
$ 50
11
The Companys divestiture of its dialysis operations outside the continental United States was substantially completed during the second quarter of 2000, reducing the number of dialysis centers that we operate outside the continental United States from 84 to 2 by the end of 2000. Because all operations outside the continental United States have been divested with the exception of the pending completion of the sale of the centers in Puerto Rico, the non-continental U.S. operating results are excluded from the revenue and cost trends discussed below.
Continental U.S. Operations
(dollars in millions, except per treatment data)
Quarter ended
September 30,
2001
June 30,
2001
September 30,
2000
Ne
t operating revenues:
Cu
rrent period services
$ 408
100
%
$ 397
100
%
$ 359
100
%
Pri
or period services
$ 22
Op
erating expenses:
Dia
lysis centers and labs
274
67
%
269
68
%
246
69
%
Ge
neral and administrative
31
8
%
32
8
%
30
8
%
De
preciation and amortization
26
6
%
26
7
%
26
7
%
Pro
vision for uncollectible accounts
2
1
%
(1
)
7
2
%
333
82
%
326
82
%
309
86
%
Op
erating income before impairment losses
$ 97
$ 71
$ 50
Dia
lysis treatments (000s)
1,432
1,409
1,348
Av
erage dialysis revenue per treatment
$ 280
$ 276
$ 260
Net operating revenues for the continental U.S. operations (excluding revenue associated with prior period services) were $408 million for the third quarter of 2001, approximately 14% higher than in the third quarter of 2000. Approximately 8% was due to higher average revenue per treatment and approximately 6% was due to the increase in the number of treatments. The average dialysis revenue per treatment (excluding lab and pharmacy revenues and management fee income) was $280 for the third quarter of 2001, compared with $260 for the same period of 2000. The increase in the average revenue per treatment was principally attributable to improvements in revenue capture, billing and collecting operations, and payor contracting, and an increase in the Medicare composite reimbursement rate. Other operating revenues were approximately $7 million in the third quarter of 2001, or approximately $1 million lower than in the third quarter of 2000, primarily due to lower management fee income resulting from our acquisitions of previously managed dialysis centers.
Third quarter 2001 current period services net operating revenues were 2.9% higher than in the second quarter of 2001. The number of treatments increased by 1.6% in the third quarter. Net dialysis revenue per treatment increased approximately $4 from the second quarter of 2001 to the third quarter of 2001, attributable to the same factors noted above. Same center growth was 4.1% in the third quarter of 2001 as measured against the same quarter in the prior year.
Net operating revenues for the three months ended September 30, 2001 include $22 million of cash settlements and collections in excess of our prior estimates for 2000 net revenue. These cash recoveries associated with prior years services have resulted from continued improvements in the Companys billing and collecting operations. Although the Company continues to pursue collection of aged accounts, the Company cannot predict the timing or amount of further incremental recoveries or settlements.
Center operating expenses were approximately 67% of operating revenues for continental U.S. operations in the third quarter of 2001, compared with 68% in the second quarter of 2001 and 69% in the third quarter of 2000. On a per-treatment basis, third quarter 2001 center operating expenses were approximately $1 higher than in the prior quarter, and averaged approximately $9 per treatment higher than in the third quarter of 2000. The higher average cost per treatment was primarily attributable to higher labor and drug costs, which were more than offset by the increases in revenue per treatment.
12
General and administrative expenses were approximately 8% of operating revenues for continental U.S. operations in the third quarter of 2001, consistent with recent quarters. We expect general and administrative expenses to increase over the next several quarters as we continue to add administrative staff and implement major new systems and operating processes.
The provision for uncollectible accounts for the third quarter of 2001 is net of cash recoveries of $5.2 million associated with aged accounts receivables reserved in 1999, compared with cash recoveries of $8.9 million in the prior quarter. Before considering these cash recoveries, the provisions for uncollectible accounts receivable were approximately 2% of operating revenues.
Debt expense of $18 million for the third quarter of 2001 was approximately $8 million lower than the same period of 2000 due to lower effective interest rates and reduced debt balances.
At this time, we expect fourth quarter normal operating earnings before depreciation, amortization, debt expense and income taxes to meet or exceed our third quarter level of approximately $96 million. However, because of a) additional significant investments in our infrastructure, clinical education and operating and information systems, b) ongoing cost pressures, and c) pharmaceutical contribution risks, our current projections for the year 2002 are for normal operating earnings before depreciation, amortization, debt expense and income taxes to be in the range of $350 to $380 million. Our underlying assumptions involve significant risks and uncertainties, and actual results may vary significantly from these current projections. Other factors that could contribute to operating results being outside that range include reinstatement of Medicare lab billings (see Note 5, Contingencies to the consolidated financial statements), significant changes in our patient/payor mix and revenue reimbursement rates, significant changes in operating performance and billing procedures, changes in applicable laws and regulations or their interpretation, and acquisitions beyond the level currently projected. Additional risks and uncertainties are described elsewhere in this Form 10-Q. We cannot predict the amounts or timing of additional cash settlements and recoveries associated with prior years services, and we do not include such amounts in our trend analysis for normal operating earnings or our projections for next years earnings.
Liquidity and capital resources
Cash flow from operations during the nine months of 2001 amounted to $247 million and net reductions in long-term debt totaled $156 million. The positive cash flow included $218 million from earnings adjusted for non-cash items. Non-operating cash outflows included acquisitions of dialysis centers for $67 million (before offsets of $25 million related to reductions in investments in third-party dialysis businesses) and $30 million in capital asset expenditures.
During the second quarter of 2001 we issued $225 million of 9¼% Senior Subordinated Notes and completed a refinancing of our senior credit facilities. The net proceeds were used to pay down amounts outstanding under our then-existing senior credit facilities. The new senior credit facilities consist of two term loans and a $150 million undrawn revolving credit facility. Debt, net of cash, amounted to $775 million at September 30, 2001, down $90 million from the end of the previous quarter, June 30, 2001, and down $169 million from the beginning of the year.
Continental U.S. accounts receivable at September 30, 2001 amounted to $309 million, an increase of $18 million during the quarter. This balance represented approximately 71 days of net revenue. This was 3 days higher than the previous quarter primarily because of delayed collections following the terrorist attacks on September 11, 2001. The continental U.S. accounts receivable balance as of December 31, 2000 represented 73 days of net revenue.
We plan to substantially increase capital expenditures over the next year, including significant investment expenditures for information technology projects and for new dialysis centers, relocations and expansions. At this time we expect to open at least 12 to 18 new dialysis centers during 2002. Additionally, we are targeting a
13
minimum of $25 to $50 million for acquisitions during 2002, but the actual level and timing of acquisitions will depend upon the specific opportunities that arise. Of the 21 centers acquired during the first nine months of 2001, we previously managed 18 of the centers. Eight centers were acquired during the third quarter, five of which we had previously managed.
New accounting pronouncements
In July 2001 the Financial Accounting Standards Board (FASB) issued Statement of Financial Accounting Standards (SFAS) No. 142,
Goodwill and Other Intangible Assets
which will be effective January 1, 2002. Under SFAS 142, amortization of goodwill and other indefinite-lived intangible assets, including any such intangibles recorded in past business combinations, will be discontinued beginning January 1, 2002. In addition, goodwill and other indefinite-lived intangible assets recorded as a result of business combinations completed during the six-month period ending December 31, 2001 will not be amortized. Under the new standard, goodwill and other indefinite-lived intangible assets will be written down with a goodwill impairment charge against current earnings whenever the recorded values exceed their fair values. We are currently reviewing the provisions of SFAS 142 and assessing the impact of its adoption.
In October 2001 the FASB issued SFAS 144,
Accounting for Impairment or Disposal of Long-Lived Assets
. SFAS 144 supercedes SFAS 121,
Accounting for the Impairment of Long-Lived Assets and for Long-Lived Assets to be Disposed Of
. SFAS 144 also extends discontinued operations treatment, previously applied only to operating segments to be disposed of, to all separately accountable components of an entity. The Company is currently reviewing the provisions of SFAS 144 and assessing the impact of its adoption, which will be effective January 1, 2002.
Item 3. Quantitative and Qualitative Disclosures About Market Risk.
Interest rate sensitivity
The table below provides information about our financial instruments that are sensitive to changes in interest rates.
Expected maturity date
Fair
value
Average
interest
rate
2001
2002
2003
2004
2005
2006
Thereafter
Total
(dollars in millions)
Lo
ng-term debt
Fix
ed rate
$125
$570
$695
$692
7.48
%
Va
riable rate
$1
$9
$11
$10
$10
81
3
125
125
7.02
%
Exchange rate sensitivity
We are currently not exposed to any foreign currency exchange rate risk.
14
RISK FACTORS
This Form 10-Q contains statements that are forward-looking statements within the meaning of the federal securities laws, including statements about our expectations, beliefs, intentions or strategies for the future. These forward-looking statements include statements regarding our expectations for treatment growth rates, revenue per treatment, expense growth, levels of the provision for uncollectible accounts receivable, earnings before depreciation and amortization, debt expense and taxes, and capital expenditures. We base our forward-looking statements on information currently available to us, and we do not intend to update these statements, whether as a result of changes in underlying factors, new information, future events or other developments.
These statements involve known and unknown risks and uncertainties, including risks resulting from economic and market conditions, the regulatory environment in which we operate, competitive activities and other business conditions. Our actual results may differ materially from results anticipated in these forward-looking statements. Important factors that could cause actual results to differ materially from the forward-looking statements include those set forth below. The risks discussed below are not the only ones facing our business.
If the percentage of our patients paying at or near our list prices declines, then our revenues, cash flows and net income would be substantially reduced.
Approximately 41% of our continental U.S. dialysis revenues in 1999 and 42% in both 2000 and the first nine months of 2001 were generated from patients who had private payors as the primary payor. A minority of these patients have insurance policies that reimburse us at or near our list prices, which are significantly higher than Medicare rates. The majority of these patients have insurance policies that reimburse us at rates that are below our list prices but, in most cases, higher than Medicare rates. We believe that pressure from private payors to decrease the rates at which they pay us may increase. If the percentage of patients who have insurance that pays us at or near our list prices decreases significantly, it would have a material adverse effect on our revenues, cash flows and net income.
If we are unable to renegotiate material contracts with managed care plans on acceptable terms, we may experience a decline in same center growth.
We have contracts with some large managed care plans that include unfavorable terms. Although we are attempting to renegotiate the terms of these contracts, we cannot predict whether we will reach agreement on new terms or whether we will renew these contracts. As a result, we may lose numerous patients of these managed care plans and experience a decline in our same center growth, which will negatively impact our revenues.
Future declines, or the lack of further increases, in Medicare reimbursement rates would reduce our net income and cash flows.
Approximately 54% of our continental U.S. dialysis revenues in 1999 and 53% in both 2000 and the first nine months of 2001 were generated from patients who had Medicare as their primary payor. The Medicare ESRD program reimburses us for dialysis and ancillary services at fixed rates. Unlike many other Medicare programs, the Medicare ESRD program does not provide for periodic inflation increases in reimbursement rates. These rates have declined over 70% in real dollars since 1972. Congress recently enacted two separate increases of 1.2% to the Medicare composite reimbursement rate for dialysis effective January 1, 2000 and January 1, 2001. An additional 1.2% increase became effective April 1, 2001, plus an adjustment factor designed to provide the benefits of the increase as if it had become effective on January 1, 2001. These were the first increases in the composite rate since 1991 and are significantly less than the cumulative rate of inflation since 1991. In addition, the Medicare Payment Advisory Commission has recommended to Congress that there be no increase in the composite rate for 2002. Increases in operating costs that are subject to inflation, such as labor and supply costs, have occurred and are expected to continue to occur without a compensating increase in reimbursement rates. We cannot predict the nature or extent of future rate changes, if any. To the extent these rates are not adjusted to keep pace with inflation, our net income and cash flows would be adversely affected.
15
Future changes in the structure of, and reimbursement rates under, the Medicare ESRD program could substantially reduce our operating earnings and cash flows.
In legislation enacted in December 2000, Congress mandated government studies on whether:
The Medicare composite rate for dialysis should be modified to include an annual inflation increasestudy due July 2002;
The Medicare composite rate for dialysis should be modified to include additional services, such as laboratory and other diagnostic tests and the administration of EPO and other pharmaceuticals, in the composite ratestudy due July 2002; and
Reimbursement for many outpatient prescription drugs that we administer to dialysis patients should be reduced from the current rate of 95% of the average wholesale price. (This study has been completed and the resulting recommendations exclude dialysis drugs at this time. Congress has yet to act, however, on the recommendations in this study.)
If Medicare began to include in its composite reimbursement rate any ancillary services that it currently reimburses separately, our revenue would decrease to the extent there was not a corresponding increase in that composite rate. In particular, Medicare revenue from EPO was approximately 13% of our net revenue in 1999, 2000 and the first nine months of 2001. If EPO were included in the composite rate, and if the composite rate were not increased sufficiently, our operating earnings and cash flows could decrease substantially. Reductions in current reimbursement rates for EPO or other outpatient prescription drugs would also reduce our operating earnings and cash flows.
If a significant number of physicians were to cease referring patients to our dialysis centers, whether due to regulatory or other reasons, our revenue and earnings would decline.
If a significant number of physicians stop referring patients to our centers, it could have a material adverse effect on our revenue and earnings. Many physicians prefer to have their patients treated at centers where they or other members of their practice supervise the overall care provided as medical directors of the centers. As a result, the primary referral source for our centers is typically the physician or physician group providing medical director services to the center. If a medical director agreement terminates, whether before or at the end of its term, it may negatively impact the former medical directors decision to treat his or her patients at our centers.
Our medical director contracts are for fixed periods, generally five to ten years. Medical directors have no obligation to extend their agreements with us. As of September 30, 2001, the agreements with medical directors at 52 centers required renewal on or before December 31, 2002. This includes agreements with terms expiring on or before December 31, 2002 and those with automatic renewal terms that will expire on or before December 31, 2002 if we or the medical director elect not to renew the agreement.
We also may take actions to restructure existing relationships or take positions in negotiating extensions of relationships in order to assure compliance with anti-kickback and similar laws. These actions could negatively impact physicians decisions to extend their medical director agreements with us. For example, we have recalled stock options and we require monthly statements from our medical directors certifying that they have performed their contractual obligations. To our knowledge, we are the only major dialysis provider to have done this. In addition, if the terms of an existing agreement were found to violate applicable laws, we may not be successful in restructuring the relationship, which could lead to the early termination of the agreement.
If the current shortage of skilled clinical personnel or our high level of personnel turnover continues, we may experience disruptions in our business operations and increases in operating expenses.
We are experiencing increased labor costs and difficulties in hiring nurses due to a nationwide shortage of skilled clinical personnel. This shortage limits our ability to expand our operations. We also have a high personnel turnover rate in our dialysis centers and central billing offices. Turnover has been the highest among
16
our reuse technicians, patient care technicians and unit secretaries. Recent efforts to reduce this turnover may not succeed. If we are not successful, or if we are unable to hire skilled clinical personnel when needed, our operations and our same center growth will be negatively impacted.
Adverse developments with respect to EPO could materially reduce our net income and cash flows and affect our ability to care for our patients.
Amgen is the sole supplier of EPO and may unilaterally decide to increase its price for EPO. For example, Amgen unilaterally increased its base price for EPO by 3.9% in both 2000 and 2001. We expect Amgen to continue to increase its base price from time to time. Also, we cannot predict whether we will continue to receive the same discount structure for EPO that we currently receive, or whether we will continue to achieve the same levels of discounts within that structure as we have historically achieved. In addition, Amgen is developing a new product, NESP, that may replace EPO or reduce its use. We cannot predict if or when NESP will be introduced to the U.S. dialysis market, nor what its cost and reimbursement structure will be. Increases in the cost of EPO and the introduction of NESP could have a material adverse effect on our net income and cash flows.
Changes in clinical practices and reimbursement rates or rules for EPO and other drugs could substantially reduce our revenue and earnings.
The administration of EPO and other drugs accounted for approximately 32% of our net operating revenue in 1999, 35% in 2000 and 38% in the first nine months of 2001. Changes in physician practice patterns and accepted clinical practices, changes in private and governmental reimbursement rates and rules, the introduction of new drugs and the conversion to alternate types of administration, for example from intravenous administration to subcutaneous or oral administration, that may also result in lower or less frequent dosages, could reduce our revenues and earnings from the administration of EPO and other drugs.
If we fail to adhere to all of the complex government regulations that apply to our business, we could suffer severe consequences that would substantially reduce our revenue and earnings.
Our dialysis operations are subject to extensive federal, state and local government regulations, including Medicare and Medicaid reimbursement rules and regulations and federal and state anti-kickback laws. The regulatory scrutiny of healthcare providers, including dialysis providers, has increased significantly in recent years. For the fiscal year ended September 30, 2000, the DOJ announced total recoveries of $840 million from healthcare civil fraud cases, including a $486 million settlement with one of our competitors as a result of an Office of Inspector General, or OIG, and DOJ investigation into some of its business practices. In addition, the frequency and intensity of Medicare certification surveys and inspections of dialysis centers has increased markedly over the last year, consistent with recommendations of the OIG.
We endeavor to comply with all of the requirements for receiving Medicare and Medicaid reimbursement and to structure all of our relationships with referring physicians to comply with the anti-kickback laws; however, the laws and regulations in this area are complex and subject to varying interpretations. In addition, our historic dependence on manual processes that vary widely across our network of dialysis centers exposes us to greater risk of errors in billing and other business processes.
If any of our operations are found to violate these or other government regulations, we could suffer severe consequences, including:
Mandated practice changes that significantly increase operating expenses;
Suspension of payments from government reimbursement programs;
Refunds of amounts received in violation of law or applicable reimbursement program requirements;
17
Loss of required government certifications or exclusion from government reimbursement programs, such as the Medicare ESRD program and Medicaid programs;
Loss of licenses required to operate healthcare facilities in some of the states in which we operate; and
Fines or monetary penalties for anti-kickback law violations, submission of false claims or other failures to meet reimbursement program requirements.
The pending federal review of some of our historical practices and third-party carrier review of our laboratory subsidiary could result in substantial penalties against us.
We are voluntarily cooperating with the Civil Division of the United States Attorneys Office for the Eastern District of Pennsylvania in a review of some of our historical practices, including billing and other operating procedures and our financial relationships with physicians. In addition, our Florida-based laboratory subsidiary is the subject of a third-party carrier review of claims it has submitted for Medicare reimbursement. All further Medicare payments to this laboratory were suspended in May 1998, and the DOJ is also reviewing the situation. We are unable to determine when these matters will be resolved, whether any additional areas of inquiry will be opened or any outcome of these matters, financial or otherwise. Any negative findings could result in substantial financial penalties against us and exclusion from future participation in the Medicare and Medicaid programs.
Our rollout of new information technology systems will significantly disrupt our billing and collection activity, may not work as planned and could have a negative impact on our results of operations and financial condition.
We intend to roll out new information technology systems and new processes in each of our dialysis centers over the next few years. It is likely that this rollout will disrupt our billing and collection activity and may cause other disruptions to our business operations, which may negatively impact our cash flows. Also, the new information systems may not work as planned or improve our billing and collection processes. If they do not, we may have to spend substantial amounts to enhance or replace these systems.
Provisions in our charter documents and compensation programs we have adopted may deter a change of control that our stockholders would otherwise determine to be in their best interests.
Our charter documents include provisions which may deter hostile takeovers, delay or prevent changes of control or changes in our management, or limit the ability of our stockholders to approve transactions that they may otherwise determine to be in their best interests. These include provisions prohibiting our stockholders from acting by written consent, requiring 60 days' advance notice of stockholder proposals or nominations to our Board of Directors and granting our board of directors the authority to issue up to five million shares of preferred stock and to determine the rights and preferences of the preferred stock without the need for further stockholder approval.
In addition, most of our outstanding employee stock options include a provision accelerating the vesting of the options in the event of a change of control. We have also adopted a change of control protection program for our employees who do not have a significant number of stock options, which provides for cash bonuses to the employees in the event of a change of control. Based on the shares of our common stock outstanding and the market price of our stock on September 30, 2001, these cash bonuses would total approximately $60 million. These compensation programs may affect the price an acquirer would be willing to pay.
We may, in the future, adopt other measures that may have the effect of delaying, deferring or preventing an unsolicited takeover, even if such a change of control were at a premium price or favored by a majority of unaffiliated stockholders. Furthermore, we may adopt some of these measures without any further vote or action by our stockholders.
18
PART II
OTHER INFORMATION
Item 1.
Legal Proceedings.
The information in Note 5 of the Notes to Condensed Consolidated Financial Statements in Part I, Item 1 of this report is incorporated by this reference in response to this item.
Items 2, 3, 4, and 5 are not applicable.
Item 6.
Exhibits and Reports on Form 8-K.
(a)
Exhibits:
12.1 Ratio of earnings to fixed charges.
ü
(b)
Reports on Form 8-K
None.
ü
Filed herewith
19
SIGNATURE
Pursuant to the requirements of the Securities Exchange Act of 1934, the Registrant has duly caused this report to be signed on its behalf by the undersigned thereunto duly authorized.
D
AVITA
I
NC
.
/
S
/ G
ARY
W. B
EIL
By:
Gary W. Beil
Vice President and Controller*
Da
te: November 13, 2001
*
Mr. Beil has signed both on behalf of the Registrant as a duly authorized officer and as the Registrants chief accounting officer.
20
INDEX TO EXHIBITS
Exhibit
Number
Description
12.1
Ra
tio of earnings to fixed charges.
ü
ü
Filed herewith.
21