The following discussion highlights the principal factors that have affected our
financial condition and results of operations, as well as our liquidity and
capital resources, for the periods described. This discussion should be read in
conjunction with the unaudited Consolidated Financial Statements and the notes
thereto included in this Quarterly Report. In addition, reference is made to our
audited consolidated financial statements and notes thereto and related
Management's Discussion and Analysis of Financial Condition and Results of
Operations included in our Annual Report on Form 10-K for the fiscal year ended
December 31, 2022, filed with the Securities and Exchange Commission on February
17, 2023 (the "2022 Form 10-K"). As used in this Quarterly Report, the terms
"Pediatrix", the "Company", "we", "us" and "our" refer to the parent company,
Pediatrix Medical Group, Inc., a Florida corporation, and the consolidated
subsidiaries through which its businesses are actually conducted (collectively,
"PMG"), together with PMG's affiliated business corporations or professional
associations, professional corporations, limited liability companies and
partnerships ("affiliated professional contractors"). Certain subsidiaries of
PMG have contracts with our affiliated professional contractors, which are
separate legal entities that provide physician services in certain states. We
ceased providing services in Puerto Rico on December 31, 2022. The following
discussion contains forward-looking statements. Please see the Company's 2022
Form 10-K, including Item 1A, Risk Factors, for a discussion of the
uncertainties, risks and assumptions associated with these forward-looking
statements. In addition, please see "Caution Concerning Forward-Looking
Statements" below.
Company Name Change
On July 1, 2022, effective after the close of the market, we changed our
corporate name from "Mednax, Inc." to "Pediatrix Medical Group, Inc." signifying
our return to our core focus in caring for women, babies and children. Our
common stock continues to trade on the New York Stock Exchange under the ticker
symbol "MD."
Overview
Pediatrix is a leading provider of physician services including newborn,
maternal-fetal, pediatric cardiology and other pediatric subspecialty care. Our
national network is comprised of affiliated physicians who provide clinical care
in 37 states. We ceased providing services in Puerto Rico on December 31, 2022.
Our affiliated physicians provide neonatal clinical care, primarily within
hospital-based neonatal intensive care units ("NICUs"), to babies born
prematurely or with medical complications; and maternal-fetal and obstetrical
medical care to expectant mothers experiencing complicated pregnancies,
primarily in areas where our affiliated neonatal physicians practice. Our
network also includes other pediatric subspecialists, including those who
provide pediatric intensive care, pediatric cardiology care, hospital-based
pediatric care, pediatric surgical care, pediatric ear, nose and throat,
pediatric ophthalmology, pediatric urology services and pediatric primary and
urgent care.
General Economic Conditions and Other Factors
Our operations and performance depend significantly on economic conditions.
During the three months ended March 31, 2023, the percentage of our patient
service revenue being reimbursed under government-sponsored healthcare programs
("GHC Programs") increased as compared to the three months ended March 31, 2022.
We could experience additional shifts toward GHC Programs if changes occur in
economic behaviors or population demographics within geographic locations in
which we provide services, including an increase in unemployment and
underemployment as well as losses of commercial health insurance or if there are
additional impacts from COVID-19 or its variants. Payments received from GHC
Programs are substantially less for equivalent services than payments received
from commercial insurance payors. In addition, costs of managed care premiums
and patient responsibility amounts continue to rise, and accordingly, we may
experience lower net revenue resulting from increased bad debt due to patients'
inability to pay for certain services.
"Surprise" Billing Legislation
In late 2020, Congress enacted legislation intended to protect patients from
"surprise" medical bills when services are furnished by providers who are not in
network with the patient's insurer (the "No Surprises Act" or the "NSA").
Effective January 1, 2022, if the patient's insurance plan is subject to the
NSA, providers are not permitted to send patients an unexpected or "surprise"
medical bill that arises from out-of-network emergency care provided at an
out-of-network facility or at in-network facilities by out-of-network providers
and out-of-network nonemergency care provided at in-network facilities without
the patient's informed consent. Many states have legislation on this topic and
will continue to modify and review their laws pertaining to surprise billing.
Under the NSA, patients are only required to pay the in-network cost-sharing
amount, which has been determined through an established regulatory formula and
will count toward the patient's health plan deductible and out-of-pocket
cost-sharing limits. Providers will generally not be permitted to balance bill
patients beyond this cost-sharing amount. An out-of-network provider will only
be permitted to bill a patient more than the in-network cost-sharing amount for
care if the provider gives the patient notice of the provider's network status
and delivers to the patient or their health plan an estimate of charges within
certain specified timeframes, and obtains the patient's written consent prior to
the delivery of care. Providers that violate these surprise billing prohibitions
may be subject to state enforcement action or federal civil monetary penalties.
Also under the NSA, out of network providers will be paid an amount determined
by the patient's insurer for services rendered in the emergency care setting; if
a provider is not satisfied with the amount paid for the services, the provider
can pursue recourse through an independent dispute resolution ("IDR") process.
These IDR results will bind both the provider and payor for a 90-day period. In
August 2022, the United States Department of Health and Human Services,
Department of Labor and Department of Treasury (the "Departments") issued their
final rule and corresponding guidance implementing certain portions of the IDR
process under the NSA. The Departments plan to publish additional rules and
guidance in the coming months and years. Certain IDR-related provisions of the
NSA are being challenged in courts by
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provider groups, and the result of this litigation may alter portions of the
law. Accordingly, we cannot predict how these IDR results will compare to the
rates that our affiliated physicians customarily receive for their services.
These measures could limit the amount we can charge and recover for services we
furnish where we have not contracted with the patient's insurer, and therefore
could have a material adverse effect on our business, financial condition,
results of operations, cash flows and the trading price of our securities.
Moreover, these measures could affect our ability to contract with certain
payors and under historically similar terms and may cause, and the prospect of
these changes may have caused, payors to terminate their contracts with us and
our affiliated practices, further affecting our business, financial condition,
results of operations, cash flows and the trading price of our securities.
Healthcare Reform
The Patient Protection and Affordable Care Act (the "ACA") contains a number of
provisions that have affected us and, absent amendment or repeal, may continue
to affect us over the next several years. These provisions include the
establishment of health insurance exchanges to facilitate the purchase of
qualified health plans, expanded Medicaid eligibility, subsidized insurance
premiums and additional requirements and incentives for businesses to provide
healthcare benefits. Other provisions have expanded the scope and reach of the
Federal Civil False Claims Act and other healthcare fraud and abuse laws.
Moreover, we could be affected by potential changes to various aspects of the
ACA, including changes to subsidies, healthcare insurance marketplaces and
Medicaid expansion.
Despite the ACA going into effect over a decade ago, continuous legal and
Congressional challenges to the law's provisions and persisting uncertainty with
respect to the scope and effect of certain provisions have made compliance
costly. In 2017, Congress unsuccessfully sought to replace substantial parts of
the ACA with different mechanisms for facilitating insurance coverage in the
commercial and Medicaid markets. Congress may again attempt to enact substantial
or target changes to the ACA in the future. Additionally, Centers for Medicare &
Medicaid Services ("CMS") has administratively revised a number of provisions
and may seek to advance additional significant changes through regulation,
guidance and enforcement in the future.
At the end of 2017, Congress repealed the part of the ACA that required most
individuals to purchase and maintain health insurance or face a tax penalty,
known as the individual mandate. In light of these changes, in December 2018, a
federal district court in Texas declared that key portions of the ACA were
inconsistent with the U.S. Constitution and that the entire ACA is invalid as a
result. Several states appealed this decision, and in December 2019, a federal
court of appeals upheld the district court's conclusion that part of the ACA is
unconstitutional but remanded for further evaluation whether in light of this
defect the entire ACA must be invalidated. Democratic attorneys general and the
House appealed the Fifth Circuit's decision to the United States Supreme Court.
On June 17, 2021, the United States Supreme Court in California et al. v. Texas
et al. dismissed this judicial challenge to the ACA brought by several states
and sided with supporters of the ACA in a way that left the law in effect in its
current form. Another potentially existential challenge to the ACA is advancing
in federal courts. In Braidwood Management v. Becerra, the plaintiffs argue that
the law's requirement that insurance cover certain preventive services is
unconstitutional. In September 2022, a federal district court in Texas ruled in
favor of the plaintiffs, finding, among other things, that the requirement that
self-funded plans and insurers cover certain preventive services violates the
plaintiffs' rights under the Religious Freedom Restoration Act. The case is
likely to be appealed and may ultimately be resolved by the United States
Supreme Court. If the case succeeds, millions of Americans could lose access to
preventive care guaranteed by the ACA or be forced to pay out of pocket for
these services. Notwithstanding the Supreme Court's ruling, we cannot say for
certain whether there will be future challenges to the ACA or what impact, if
any, such challenges may have on our business. Changes resulting from these
proceedings could have a material impact on our business.
In late 2020 and early 2021, the results of the federal and state elections
changed which persons and parties occupy the Office of the President of the
United States and the U.S. Senate and many states' governors and legislatures.
In late 2022, the results of the federal elections changed which party controls
the U.S. House of Representatives. The current Administration may propose
sweeping changes to the U.S. healthcare system, including expanding
government-funded health insurance options, additional Medicaid expansion or
replacing current healthcare financing mechanisms with systems that would be
entirely administered by the federal government. Any legislative or
administrative change to the current healthcare financing system could have a
material adverse effect on our financial condition, results of operations, cash
flows and the trading price of our securities.
In addition to the potential impacts to the ACA, there could be changes to other
GHC Programs, such as a change to the structure of Medicaid or Medicaid payment
rates set forth under state law. Historically, Congress and the Administration
have sought to convert Medicaid into a block grant or to institute per capita
spending caps, among other things. These changes, if implemented, could
eliminate the guarantee that everyone who is eligible and applies for benefits
would receive them and could potentially give states new authority to restrict
eligibility, cut benefits and make it more difficult for people to enroll.
Additionally, several states are considering and pursuing changes to their
Medicaid programs, such as requiring recipients to engage in employment or
education activities as a condition of eligibility for most adults, disenrolling
recipients for failure to pay a premium, or adjusting premium amounts based on
income. Many states have recently shifted a majority or all of their Medicaid
program beneficiaries into Managed Medicaid Plans. Managed Medicaid Plans have
some flexibility to set rates for providers, but many states require minimum
provider rates in their contracts with such plans. In July of each year, CMS
releases the annual Medicaid Managed Care Rate Development Guide which provides
federal baseline rules for setting reimbursement rates in managed care plans. We
could be affected by lower reimbursement rates in some of all of the Managed
Medicaid Plans with which we participate. We could also be materially impacted
if we are dropped from the provider network in one or more of the Managed
Medicaid Plans with which we currently participate.
We cannot predict with any assurance the ultimate effect of these laws and
resulting changes to payments under GHC Programs, nor can we provide any
assurance that they will not have a material adverse effect on our business,
financial condition, results of operations, cash flows and the trading price of
our securities. Further, any fiscal tightening impacting GHC Programs or changes
to the structure of any GHC Programs could have a material adverse effect on our
financial condition, results of operations, cash flows and the trading price of
our securities.
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Medicaid Expansion
The ACA also allows states to expand their Medicaid programs through federal
payments that fund most of the cost of increasing the Medicaid eligibility
income limit from a state's historic eligibility levels to 133% of the federal
poverty level. To date, 39 states and the District of Columbia have expanded
Medicaid eligibility to cover this additional low-income patient population, and
other states are considering expansion. All of the states in which we operate,
however, already cover children in the first year of life and pregnant women if
their household income is at or below 133% of the federal poverty level.
Recently, Democrats in Congress have sought to expand Medicaid or Medicaid-like
coverage in states that have not yet expanded Medicaid. They also have sought to
reduce payments to certain hospitals in some of these states. Additionally, as
noted above, Congress is currently considering altering the terms and state
remuneration for Medicaid expansion pursuant to the ACA. Should any of these
changes take effect, we cannot predict with any assurance the ultimate effect to
reimbursements for our services.
Coronavirus Pandemic ("COVID-19")
COVID-19 has had an impact on the demand for medical services provided by our
affiliated clinicians. Beginning in mid-March 2020 and continuing throughout the
second quarter of 2020, our operating results were significantly impacted by
COVID-19, but volumes began to normalize in mid-2020 and substantially recovered
throughout 2020 with no material impacts from COVID-19 or its variants since
that time. However, due to the continued uncertainties surrounding the timeline
of and impacts from COVID-19 and with multiple variant strains still
circulating, we are unable to predict the ultimate impact on our business,
financial condition, results of operations, cash flows and the trading price of
our securities at this time.
CARES Act
On March 27, 2020, the Coronavirus Aid, Relief, and Economic Security Act
("CARES Act") was signed into law. The CARES Act is a relief package intended to
assist many aspects of the American economy, including providing financial aid
to the healthcare industry to reimburse healthcare providers for lost revenue
and expenses attributable to COVID-19. The Department of Health and Human
Services is administering this program, and our affiliated physician practices
within continuing operations recognized an aggregate of $10.4 million of CARES
Act relief within miscellaneous revenue during the three months ended March 31,
2022.
Non-GAAP Measures
In our analysis of our results of operations, we use certain non-GAAP financial
measures. We report adjusted earnings before interest, taxes and depreciation
and amortization ("Adjusted EBITDA") from continuing operations, which is
defined as income (loss) from continuing operations before interest, income
taxes, depreciation and amortization, and transformational and restructuring
related expenses. We also report adjusted earnings per share ("Adjusted EPS")
from continuing operations which consists of diluted income (loss) from
continuing operations per common and common equivalent share adjusted for
amortization expense, stock-based compensation expense, transformational and
restructuring related expenses and any impacts from discrete tax events. For the
three months ended March 31, 2022, both Adjusted EBITDA and Adjusted EPS are
being further adjusted to exclude the impacts from the loss on the early
extinguishment of debt.
We believe these measures, in addition to income from continuing operations, net
income and diluted net income from continuing operations per common and common
equivalent share, provide investors with useful supplemental information to
compare and understand our underlying business trends and performance across
reporting periods on a consistent basis. These measures should be considered a
supplement to, and not a substitute for, financial performance measures
determined in accordance with GAAP. In addition, since these non-GAAP measures
are not determined in accordance with GAAP, they are susceptible to varying
calculations and may not be comparable to other similarly titled measures of
other companies.
For a reconciliation of each of Adjusted EBITDA from continuing operations and
Adjusted EPS from continuing operations to the most directly comparable GAAP
measures for the three months ended March 31, 2023 and 2022, refer to the tables
below (in thousands, except per share data).
Three Months Ended
March 31,
2023 2022
Income (loss) from continuing operations attributable
to Pediatrix Medical Group, Inc.
$ 14,206 $ (20,941 )
Interest expense 10,390 11,818
Loss on early extinguishment of debt - 57,016
Income tax provision (benefit) 6,506 (7,401 )
Depreciation and amortization expense 8,953 8,769
Transformational and restructuring related expenses - 1,421
Adjusted EBITDA from continuing operations
attributable to Pediatrix Medical Group, Inc. $ 40,055 $ 50,682
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Three Months Ended
March 31,
2023 2022
Weighted average diluted shares
outstanding 82,318 85,405
Income (loss) from continuing operations
and diluted income from
continuing operations per share
attributable to Pediatrix Medical Group,
Inc. $ 14,206 $ 0.17 $ (20,941 ) $ (0.25 )
Adjustments (1):
Amortization (net of tax of $499 and
$541) 1,496 0.02 1,621 0.02
Stock-based compensation (net of tax of
$752 and $1,109) 2,257 0.03 3,326 0.04
Transformational and restructuring
expenses (net of tax of $355) - - 1,066 0.01
Loss on early extinguishment of debt
(net of tax of $14,254) - - 42,762 0.50
Net impact from discrete tax events 720 0.01 492 0.01
Adjusted income and diluted EPS from
continuing operations
attributable to Pediatrix Medical
Group, Inc. $ 18,679 $ 0.23 $ 28,326 $ 0.33
(1)
A blended tax rate of 25% was used to calculate the tax effects of the
adjustments for the three months ended March 31, 2023 and 2022.
Results of Operations
Three Months Ended March 31, 2023 as Compared to Three Months Ended March 31,
2022
Our net revenue attributable to continuing operations was $491.0 million for the
three months ended March 31, 2023, as compared to $482.2 million for the same
period in 2022. The increase in revenue of $8.8 million, or 1.8%, was primarily
attributable to an increase in same-unit revenue, partially offset by a decrease
in revenue from net acquisitions. Same units are those units at which we
provided services for the entire current period and the entire comparable
period. Same-unit net revenue increased by $9.4 million, or 2.0%. The increase
in same-unit net revenue was comprised of an increase of $7.4 million, or 1.6%,
related to patient service volumes and $2.0 million, or 0.4%, from net
reimbursement-related factors. The increase in revenue from patient service
volumes was related to increases in maternal-fetal medicine and other pediatric
subspecialty services, partially offset by a modest decline in neonatology. The
net increase in revenue related to net reimbursement-related factors was
primarily due to an increase in revenue resulting from improved cash collections
in revenue cycle management, partially offset by decreases in revenue from CARES
Act relief and an increase in the percentage of our patients being enrolled in
GHC programs.
Practice salaries and benefits attributable to continuing operations increased
$19.0 million, or 5.6%, to $362.2 million for the three months ended March 31,
2023, as compared to $343.2 million for the same period in 2022. Of the $19.0
million increase, $17.2 million was related to salaries, driven by increases in
clinical compensation at our existing units, and $1.8 million was related to
benefits and incentive compensation, due to increased benefits costs as a result
of increased salaries expense, partially offset by lower incentive compensation
expense.
Practice supplies and other operating expenses attributable to continuing
operations increased $2.2 million, or 7.8%, to $30.7 million for the three
months ended March 31, 2023, as compared to $28.5 million for the same period in
2022. The increase was primarily attributable to practice supply, rent and other
costs related to our existing units, including an increase in medical supplies
and other miscellaneous expenses as compared to the prior year period.
General and administrative expenses attributable to continuing operations
primarily include all billing and collection functions and all other salaries,
benefits, supplies and operating expenses not specifically related to the
day-to-day operations of our affiliated physician practices and services.
General and administrative expenses were $59.1 million for the three months
ended March 31, 2023, as compared to $61.3 million for the same period in 2022.
The net decrease of $2.2 million was primarily related to salaries and benefit
cost reductions from net staffing reductions and decreases in other expenses
including travel and insurance. General and administrative expenses as a
percentage of net revenue was 12.0% for the three months ended March 31, 2023,
as compared to 12.7% for the same period in 2022.
Transformational and restructuring related expenses attributable to continuing
operations were $1.4 million for three months ended March 31, 2022 and primarily
related to position eliminations.
Depreciation and amortization expense attributable to continuing operations was
$9.0 million for the three months ended March 31, 2023, as compared to $8.8
million for the same period in 2022. The net increase of $0.2 million was
primarily related to an increase in depreciation expense at our existing units
for information technology and other equipment.
Income from operations attributable to continuing operations decreased $9.1
million, or 23.2%, to $30.0 million for the three months ended March 31, 2023,
as compared to $39.1 million for the same period in 2022. Our operating margin
was 6.1% for the three months ended March 31, 2023, as compared to 8.1% for the
same period in 2022. The decrease in our operating margin was primarily due to a
decrease in CARES Act relief and net unfavorable impacts in our same-unit
results driven by higher operating expenses, partially offset by same-unit
revenue increases and lower general and administrative expenses. Excluding
transformation and restructuring related expenses for the three months ended
March 31, 2022, our income from operations attributable to continuing operations
was $40.5 million and our operating margin was 8.4% for such period. We believe
excluding the impacts from the transformational and restructuring related
activity provides a more comparable view of our operating income and operating
margin from continuing operations.
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Total non-operating expenses attributable to continuing operations were $9.3
million for the three months ended March 31, 2023, as compared to $67.5 million
for the same period in 2022. The net decrease in non-operating expenses was
primarily related to a decrease of $57.0 million in loss on early extinguishment
of debt from the redemption of our 6.25% senior unsecured notes due 2027 (the
"2027 Notes") in February 2022.
Our effective income tax rate attributable to continuing operations ("tax rate")
was 31.4% for the three months ended March 31, 2023 as compared to 26.1% for the
three months ended March 31, 2022. The first quarter 2023 and 2022 tax rates
include discrete tax expenses of $0.7 million and $0.5 million, respectively.
After excluding discrete tax impacts during the three months ended March 31,
2023 and 2022, our tax rate was 27.9% for both periods. We believe excluding
discrete tax impacts provides a more comparable view of our tax rate.
Net income attributable to Pediatrix Medical Group, Inc. was $14.2 million for
the three months ended March 31, 2023, as compared to loss of $21.2 million for
the same period in 2022. Adjusted EBITDA from continuing operations attributable
to Pediatrix Medical Group, Inc. was $40.1 million for the three months ended
March 31, 2023, as compared to $50.7 million for the same period in 2022. The
decrease in our Adjusted EBITDA was primarily due to a decrease in CARES Act
relief and net unfavorable impacts in our same-unit results, primarily from
higher operating expenses.
Diluted net income from continuing operations per common and common equivalent
share attributable to Pediatrix Medical Group, Inc. was $0.17 on weighted
average shares outstanding of 82.3 million for the three months ended March 31,
2023, as compared to loss from continuing operations of $0.25 per common and
common equivalent share on weighted average shares outstanding of 85.4 million
for the same period in 2022. Adjusted EPS from continuing operations was $0.23
for the three months ended March 31, 2023, as compared to $0.33 for the same
period in 2022. The decrease in weighted average shares outstanding resulted
from the share repurchases completed during 2022.
Liquidity and Capital Resources
As of March 31, 2023, we had $6.1 million of cash and cash equivalents
attributable to continuing operations as compared to $9.8 million at December
31, 2022. Additionally, we had working capital attributable to continuing
operations of $124.4 million at March 31, 2023, an increase of $123.4 million
from working capital of $1.0 million at December 31, 2022. The net increase in
working capital is primarily due to net borrowings on our line of credit.
Cash Flows from Continuing Operations
Cash (used in) provided from operating, investing and financing activities from
continuing operations is summarized as follows (in thousands):
Three Months Ended
March 31,
2023 2022
Operating activities $ (100,644 ) $ (89,931 )
Investing activities (11,350 ) (26,273 )
Financing activities 108,567 (256,457 )
Operating Activities from Continuing Operations
During the three months ended March 31, 2023, our net cash used in operating
activities for continuing operations was $100.6 million, compared to $89.9
million for the same period in 2022. The net increase in cash used of $11.0
million was primarily due to decreases in cash outflow from income taxes,
prepaid expenses and other current assets and other liabilities, partially
offset by increases in cash flow from accounts receivable and higher earnings.
During the three months ended March 31, 2023, cash flow from accounts receivable
for continuing operations increased by $21.3 million, as compared to a decrease
of $20.2 million for the same period in 2022. The increase in cash flow from
accounts receivable for the three months ended March 31, 2023 as compared to the
prior year period was primarily due to improved cash collections at existing
units.
Days sales outstanding ("DSO") is one of the key factors that we use to evaluate
the condition of our accounts receivable and the related allowances for
contractual adjustments and uncollectibles. DSO reflects the timeliness of cash
collections on billed revenue and the level of reserves on outstanding accounts
receivable. Our DSO for continuing operations was 51.1 days at March 31, 2023 as
compared to 53.1 days at December 31, 2022 and 59.2 days at March 31, 2022. The
improvement in our DSO was primarily related to improved cash collections at our
existing units.
Investing Activities from Continuing Operations
During the three months ended March 31, 2023, our net cash used in investing
activities for continuing operations of $11.4 million consisted primarily of
capital expenditures of $7.0 million and net purchases of investments of $2.7
million.
Financing Activities from Continuing Operations
During the three months ended March 31, 2023, our net cash provided by financing
activities for continuing operations of $108.6 million primarily consisted of
net borrowings on our Revolving Credit Line (as defined below) of $110.0
million.
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Liquidity
On February 11, 2022, we issued $400.0 million of 5.375% unsecured senior notes
due 2030 (the "2030 Notes"). We used the net proceeds from the issuance of the
2030 Notes, together with $100.0 million drawn under our Revolving Credit Line
(as defined below), $250.0 million of Term A Loan and approximately $308.0
million of cash on hand, to redeem (the "Redemption") the 2027 Notes, which had
an outstanding principal balance of $1.0 billion, and to pay costs, fees and
expenses associated with the Redemption and the Credit Agreement Amendment (as
defined below).
Also in connection with the Redemption, we amended and restated the Credit
Agreement (the "Credit Agreement"), and such amendment and restatement (the
"Credit Agreement Amendment"), concurrently with the issuance of the 2030 Notes.
The Credit Agreement, as amended by the Credit Agreement Amendment (the "Amended
Credit Agreement"), among other things, (i) refinanced the prior unsecured
revolving credit facility with a $450.0 million unsecured revolving credit
facility, including a $37.5 million sub-facility for the issuance of letters of
credit (the "Revolving Credit Line"), and a new $250.0 million term A loan
facility ("Term A Loan") and (ii) removed JPMorgan Chase Bank, N.A., as the
administrative agent under the Credit Agreement and appointed Bank of America,
N.A. as the administrative agent for the lenders under the Amended Credit
Agreement.
The Amended Credit Agreement matures on February 11, 2027 and is guaranteed on
an unsecured basis by substantially all of our subsidiaries and affiliated
professional contractors. At our option, borrowings under the Amended Credit
Agreement bear interest at (i) the Alternate Base Rate (defined as the highest
of (a) the prime rate as announced by Bank of America, N.A., (b) the Federal
Funds Rate plus 0.50% and (c) Term Secured Overnight Financing Rate ("SOFR") for
an interest period of one month plus 1.00% with a 1.00% floor) plus an
applicable margin rate of 0.50% for the first two fiscal quarters after the date
of the Credit Agreement Amendment, and thereafter at an applicable margin rate
ranging from 0.125% to 0.750% based on our consolidated net leverage ratio or
(ii) Term SOFR rate (calculated as the Secured Overnight Financing Rate
published on the applicable Reuters screen page plus a spread adjustment of
0.10%, 0.15% or 0.25% depending on if we select a one-month, three-month or
six-month interest period, respectively, for the applicable loan with a 0%
floor), plus an applicable margin rate of 1.50% for the first two full fiscal
quarters after the date of the Credit Agreement Amendment, and thereafter at an
applicable margin rate ranging from 1.125% to 1.750% based on our consolidated
net leverage ratio. The Amended Credit Agreement also provides for other
customary fees and charges, including an unused commitment fee with respect to
the Revolving Credit Line ranging from 0.150% to 0.200% of the unused lending
commitments under the Revolving Credit Line, based on our consolidated net
leverage ratio.
The Amended Credit Agreement contains customary covenants and restrictions,
including covenants that require us to maintain a minimum interest coverage
ratio, a maximum consolidated total consolidated net leverage ratio and to
comply with laws, and restrictions on the ability to pay dividends, incur
indebtedness or liens and make certain other distributions subject to baskets
and exceptions, in each case, as specified therein. Failure to comply with these
covenants would constitute an event of default under the Amended Credit
Agreement, notwithstanding the ability of the company to meet its debt service
obligations. The Amended Credit Agreement includes various customary remedies
for the lenders following an event of default, including the acceleration of
repayment of outstanding amounts under the Amended Credit Agreement. In
addition, we may increase the principal amount of the Revolving Credit Line or
incur additional term loans under the Amended Credit Agreement in an aggregate
principal amount such that on a pro forma basis after giving effect to such
increase or additional term loans, we are in compliance with the financial
covenants, subject to the satisfaction of specified conditions and additional
caps in the event that the Amended Credit Agreement is secured.
At March 31, 2023, we had an outstanding principal balance on the Amended Credit
Agreement of $351.5 million, composed of $237.5 million under the Term A Loan
and $114.0 million under the Revolving Credit Line. We had $336.0 million
available on the Amended Credit Agreement at March 31, 2023.
At March 31, 2023, we had an outstanding principal balance of $400.0 million on
the 2030 Notes. Our obligations under the 2030 Notes are guaranteed on an
unsecured senior basis by the same subsidiaries and affiliated professional
contractors that guarantee our Amended Credit Agreement. Interest on the 2030
Notes accrues at the rate of 5.375% per annum, or $21.5 million, and is payable
semi-annually in arrears on February 15 and August 15, beginning on August 15,
2022.
The indenture under which the 2030 Notes are issued, among other things, limits
our ability to (1) incur liens and (2) enter into sale and lease-back
transactions, and also limits our ability to merge or dispose of all or
substantially all of our assets, in all cases, subject to a number of customary
exceptions. Although we are not required to make mandatory redemption or sinking
fund payments with respect to the 2030 Notes, upon the occurrence of a change in
control, we may be required to repurchase the 2030 Notes at a purchase price
equal to 101% of the aggregate principal amount of the 2030 Notes repurchased
plus accrued and unpaid interest.
At March 31, 2023, we believe we were in compliance, in all material respects,
with the financial covenants and other restrictions applicable to us under the
Amended Credit Agreement and the 2030 Notes. We believe we will be in compliance
with these covenants throughout 2023.
We maintain professional liability insurance policies with third-party insurers,
subject to self-insured retention, exclusions and other restrictions. We
self-insure our liabilities to pay self-insured retention amounts under our
professional liability insurance coverage through a wholly owned captive
insurance subsidiary. We record liabilities for self-insured amounts and claims
incurred but not reported based on an actuarial valuation using historical loss
information, claim emergence patterns and various actuarial assumptions. Our
total liability related to professional liability risks at March 31, 2023 was
$295.0 million, of which $26.1 million is classified as a current liability
within accounts payable and accrued expenses in the Consolidated Balance Sheet.
In addition, there is a corresponding insurance receivable of $50.1 million
recorded as a component of other assets for certain professional liability
claims that are covered by insurance policies.
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We anticipate that funds generated from operations, together with our current
cash on hand and funds available under our Amended Credit Agreement, will be
sufficient to finance our working capital requirements, fund anticipated
acquisitions and capital expenditures, fund expenses, if any, related to our
transformational and restructuring activities, fund our share repurchase
programs and meet our contractual obligations for at least the next 12 months
from the date of issuance of this Quarterly Report on Form 10-Q.
Caution Concerning Forward-Looking Statements
Certain information included or incorporated by reference in this Quarterly
Report may be deemed to be "forward-looking statements" within the meaning of
the Private Securities Litigation Reform Act of 1995, Section 27A of the
Securities Act of 1933, as amended, and Section 21E of the Securities Exchange
Act of 1934, as amended (the "Exchange Act"). Forward-looking statements may
include, but are not limited to, statements relating to our objectives, plans
and strategies, and all statements, other than statements of historical facts,
that address activities, events or developments that we intend, expect, project,
believe or anticipate will or may occur in the future are forward-looking
statements. These statements are often characterized by terminology such as
"believe," "hope," "may," "anticipate," "should," "intend," "plan," "will,"
"expect," "estimate," "project," "positioned," "strategy" and similar
expressions, and are based on assumptions and assessments made by our management
in light of their experience and their perception of historical trends, current
conditions, expected future developments and other factors they believe to be
appropriate. Any forward-looking statements in this Quarterly Report are made as
of the date hereof, and we undertake no duty to update or revise any such
statements, whether as a result of new information, future events or otherwise.
Forward-looking statements are not guarantees of future performance and are
subject to risks and uncertainties. Important factors that could cause actual
results, developments and business decisions to differ materially from
forward-looking statements are described in the 2022 Form 10-K, including the
section entitled "Risk Factors."
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