EMS Emergency Medical Services Corp

Emergency Medical Services Corporation (NYSE:EMS) (EMSC or the Company) today announces results for the first quarter ended March 31, 2009.

William A. Sanger, Chairman and Chief Executive Officer, said, �EMSC performed well in the midst of difficult economic times. Our revenue and earnings growth was driven by the addition of new contracts, including those under our national agreements, and improved resource utilization. We are encouraged by the continued demand for our services and believe we are well positioned to capitalize on these opportunities.�

Results of Operations for the First Quarter 2009

For the quarter ended March 31, 2009, EMSC generated net revenue of $613.0�million, an increase of 8.3% compared to the same quarter last year. Adjusted EBITDA was $65.5 million, an increase of 20.5% compared to the quarter ended March 31, 2008. A reconciliation of non-GAAP to GAAP financial measures is included in this news release.

EMSC generated net income of $24.1 million, or $0.56 per diluted share, for the first quarter of 2009, compared to net income of $17.0 million, or $0.40 per diluted share, in the first quarter of last year, an increase of 41.4%. The increase in earnings is attributable primarily to the net impact of increased volume from net new contracts and acquisitions, higher rates on existing contracts, lower fuel costs, and improvement in compensation and benefits expenses as a percentage of net revenue.

Free cash flow was $47.4 million in the first quarter of 2009 compared to ($2.5) million in the same quarter last year. Cash provided by operating activities was $41.9 million in the first quarter of 2009, compared to cash used in operating activities of $2.8 million for the same quarter last year. Accounts payable and accrued liabilities decreased $8.5 million in the first quarter of 2009 compared to a $13.4 million decrease in the same period last year. Accounts receivable increased $2.6 million during the first quarter of 2009 compared to $26.3 million in the first quarter of 2008. EMSC�s Days Sales Outstanding (DSO) decreased 4 days in the first quarter of 2009.

Net cash provided by investing activities was $5.5 million for the quarter ended March 31, 2009, compared to cash used in investing activities of $13.0 million for the same period in 2008. The quarter was positively impacted by a decrease in insurance collateral of $13.3 million, offset by the purchase of fixed assets of $7.2 million. The first quarter of 2008 included acquisition funding of $13.3 million.

For the quarter ended March 31, 2009, net cash provided by financing activities was $0.6 million compared to $3.0 million for the same quarter last year. At March 31, 2009, there were no amounts outstanding under our revolving credit facility.

Segment Results

EMSC operates two business segments: American Medical Response, Inc. (AMR), the Company�s healthcare transportation services segment, and EmCare Holdings Inc. (EmCare), the Company�s outsourced hospital-based physician services segment.

AMR

For the quarter ended March 31, 2009, AMR generated net revenue of $336.4 million, an increase of 3.1% compared to the same quarter last year. The increase in net revenue was from an improvement in revenue per transport, growth in managed transportation and other businesses, offset by lower transports primarily as a result of a mild flu season during the quarter. Adjusted EBITDA was $33.9 million, an increase of 19.3% compared to the same quarter last year. The increase in Adjusted EBITDA is attributable primarily to the net impact of revenue growth, improved management of compensation expense and lower fuel costs.

EmCare

For the quarter ended March 31, 2009, EmCare generated net revenue of $276.6 million, an increase of 15.5% compared to the same quarter last year. The increase in revenue is attributable primarily to the addition of 86 net new contracts since December 31, 2007 (of which 45 were a part of our acquisition of Clinical Partners in August 2008 with related management fee revenue of $2.0 million during the quarter) and revenue increases at existing contracts. Adjusted EBITDA was $31.7 million for the quarter compared to $26.0 million last year, an increase of 21.7%. The increase in Adjusted EBITDA is driven primarily by revenue increases and by a reduction of compensation and benefits expenses as a percentage of net revenue.

Conference Call

EMSC management will host a conference call and live audio webcast on Tuesday, May 5, 2009, at 11:00 a.m. EDT, to discuss the Company�s financial results. A 30-day online replay will be available approximately one hour following the conclusion of the live broadcast. A link to the live broadcast and online replay is available on the Investor Relations section of the Company�s website at www.emsc.net.

About Emergency Medical Services Corporation

Emergency Medical Services Corporation (EMSC) is a leading provider of emergency medical services in the United States. EMSC operates two business segments: American Medical Response, Inc. (AMR), the Company�s healthcare transportation services segment, and EmCare Holdings Inc. (EmCare), the Company�s outsourced hospital-based physician services segment. AMR is the leading provider of ambulance services in the United States. EmCare is a leading provider of outsourced emergency department and hospital-based physician services. In 2008, EMSC provided services to 11.4 million patients in nearly 2,100 communities nationwide. EMSC is headquartered in Greenwood Village, Colorado. For additional information visit www.emsc.net.

Forward-Looking Statements

Certain statements and information herein may be deemed to be "forward-looking statements" within the meaning of the Federal Private Securities Litigation Reform Act of 1995. 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. Any forward-looking statements herein are made as of the date of this press release, and EMSC undertakes no duty to update or revise any such statements. 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 EMSC's filings with the SEC from time to time, including in the section entitled �Risk Factors� in the Company�s most recent Annual Report on Form 10-K and subsequent periodic reports. Among the factors that could cause future results to differ materially from those provided in this press release are: the impact on our revenue of changes in transport volume, mix of insured and uninsured patients, and third party reimbursement rates and methods; the adequacy of our insurance coverage and insurance reserves; potential penalties or changes to our operations if we fail to comply with extensive and complex government regulation of our industry, both as it exists now and as it may change in the future; our ability to recruit and retain qualified physicians and other healthcare professionals, and enforce our non-compete agreements with our physicians; the loss of one or more members of our senior management team; the outcome of government investigations of certain of our business practices; our ability to generate cash flow to service our debt obligations and fund the cost of capital expenditures to maintain and upgrade our vehicle fleet and medical equipment; and the loss of existing contracts and the accuracy of our assessment of costs under new contracts.

Non-GAAP Financial Measures Reconciliation

This press release includes presentations of Adjusted EBITDA, which is defined as net income before equity in earnings (loss) of unconsolidated subsidiary, income tax expense, interest and other income, realized gain on investments, interest expense, and depreciation and amortization. It also includes presentations of free cash flow, which is defined as cash flow from operations adjusted for cash used in or provided by non-acquisition related investment activities. Adjusted EBITDA and free cash flow are commonly used by management and investors as performance measures and liquidity indicators. Adjusted EBITDA and free cash flow are not considered measures of financial performance under U.S. generally accepted accounting principles (GAAP), and the items excluded therefrom are significant components in understanding and assessing our financial performance. Adjusted EBITDA and free cash flow should not be considered in isolation or as an alternative to GAAP measures such as net income, cash flows provided by or used in operating, investing or financing activities or other financial statement data presented in our consolidated financial statements as an indicator of financial performance or liquidity. Reconciliations of non-GAAP financial measures are provided in this news release. Reconciliation for the forward-looking Adjusted EBITDA projections presented herein is not being provided due to the number of variables in the projected Adjusted EBITDA range. Since Adjusted EBITDA and free cash flow are not measures determined in accordance with GAAP and are susceptible to varying calculations, these measures, as presented, may not be comparable to other similarly titled measures of other companies.

EMERGENCY MEDICAL SERVICES CORPORATION Consolidated Statements of Operations and Other Information Including a Reconciliation of Income from Operations to Adjusted EBITDA1 (unaudited; in thousands, except shares, per share data and other information) � � � Quarter ended March 31, � 2009 � � 2008 � � Net revenue $ 613,022 � $ 565,786 � Compensation and benefits 426,534 394,351 Operating expenses 84,672 83,223 Insurance expense 22,504 20,963 Selling, general and administrative expenses 15,036 14,592 Depreciation and amortization expense � 16,768 � � 17,717 � Income from operations 47,508 34,940 Interest income from restricted assets 1,266 1,755 Interest expense (10,190 ) (9,916 ) Realized gain on investments 639 672 Interest and other income � 517 � � 302 �

Income before income taxes and equity in earnings of unconsolidated subsidiary

39,740 27,753 Income tax expense (15,726 ) (10,684 ) Equity in earnings (loss) of unconsolidated subsidiary � 57 � � (50 ) Net income $ 24,071 � $ 17,019 � � � Basic earnings per common share $ 0.57 $ 0.41 Diluted earnings per common share $ 0.56 $ 0.40 Weighted average common shares outstanding, basic 41,924,218 41,570,412 Weighted average common shares outstanding, diluted 43,094,597 43,083,642 � Other Information EmCare patient encounters 2,182,132 1,965,514 EmCare weighted patient encounters (2) 1,941,186 1,787,885 AMR ambulance transports 726,608 751,640 AMR weighted transports 734,630 763,514 � � Reconciliation of income from operations to Adjusted EBITDA Income from operations $ 47,508 $ 34,940 Depreciation and amortization expense 16,768 17,717 Interest income from restricted assets � 1,266 � � 1,755 � Adjusted EBITDA $ 65,542 � $ 54,412 � � � (1) These statements provide a reconciliation of income from operations to Adjusted EBITDA; and a reconciliation of income from operations to net income.

(2) EmCare weighted encounters include a weighting of Radiology reads due to the differences in reimbursement for these services.

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EMERGENCY MEDICAL SERVICES CORPORATION Reconciliation of Adjusted EBITDA to Net Cash Flows Provided by (Used in) Operating Activities (unaudited; in thousands) � � � Quarter ended March 31, � 2009 � � 2008 � � Adjusted EBITDA $ 65,542 $ 54,412 Interest paid (9,877 ) (9,337 ) Change in accounts receivable (2,625 ) (26,308 ) Change in other operating assets/liabilities (12,483 ) (22,740 ) Equity based compensation 650 562 Other � 735 � � 633 � Net cash provided by (used in) operating activities $ 41,942 � $ (2,778 ) � EMERGENCY MEDICAL SERVICES CORPORATION Reconciliation of Segment Income from Operations to Adjusted EBITDA (unaudited; in thousands) � � � � Quarter ended March 31, 2009 2008 AMR Income from operations $ 20,627 $ 13,330 Depreciation and amortization expense 12,706 14,386 Interest income from restricted assets � 555 � 682 Adjusted EBITDA � 33,888 � 28,398 � EmCare Income from operations 26,881 21,610 Depreciation and amortization expense 4,062 3,331 Interest income from restricted assets � 711 � 1,073 Adjusted EBITDA � 31,654 � 26,014 � Total Income from operations 47,508 34,940 Depreciation and amortization expense 16,768 17,717 Interest income from restricted assets � 1,266 � 1,755 Adjusted EBITDA $ 65,542 $ 54,412 � EMERGENCY MEDICAL SERVICES CORPORATION Condensed Consolidated Balance Sheets (in thousands) � � � � March 31, December 31, 2009 2008 (Unaudited) (Audited) Assets Current assets: Cash and cash equivalents $ 194,148 $ 146,173 Trade and other accounts receivable, net 475,126 472,501 Other current assets � 193,962 � 196,500 Total current assets 863,236 815,174 Non-current assets: Property, plant and equipment, net 119,641 124,869 Goodwill and other intangible assets, net 417,803 422,154 Other long-term assets � 159,875 � 179,022 Total assets $ 1,560,555 $ 1,541,219 � Liabilities and Equity Current liabilities $ 310,405 $ 320,141 Long-term debt 452,803 453,600 Insurance reserves and other long-term liabilities � 231,121 � 228,439 Total liabilities 994,329 1,002,180 Total equity � 566,226 � 539,039 Total liabilities and equity $ 1,560,555 $ 1,541,219 � EMERGENCY MEDICAL SERVICES CORPORATION Condensed Consolidated Statements of Cash Flows (unaudited; in thousands) � Quarter ended March 31, � 2009 � � 2008 � Cash Flows from Operating Activities Net income $ 24,071 $ 17,019 Adjustments to reconcile net income to net cash provided by (used in) operating activities: Depreciation, amortization, deferred taxes and other 32,979 29,251 Changes in operating assets/liabilities, net of acquisitions: Trade and other accounts receivable (2,625 ) (26,308 ) Insurance accruals 3,877 (3,399 ) Other assets and liabilities � (16,360 ) � (19,341 ) Net cash provided by (used in) operating activities � 41,942 � � (2,778 ) � Cash Flows from Investing Activities Purchases of property, plant and equipment, net (7,186 ) (2,464 ) Acquisition of businesses, net of cash received - (13,278 ) Net change in insurance collateral 13,310 2,125 Other investing activities � (670 ) � 653 � Net cash provided by (used in) investing activities � 5,454 � � (12,964 ) � Cash Flows from Financing Activities EMSC issuance of class A common stock 898 12 Borrowings under revolving credit facility - 14,000 Repayments of capital lease obligations and other debt (1,159 ) (15,151 ) Increase in bank overdrafts � 840 � � 4,122 � Net cash provided by financing activities � 579 � � 2,983 � � Change in cash and cash equivalents 47,975 (12,759 ) Cash and cash equivalents, beginning of period � 146,173 � � 28,914 � Cash and cash equivalents, end of period $ 194,148 � $ 16,155 � � Free cash flow $ 47,396 $ (2,464 ) � � Reconciliation of free cash flow to net cash provided by (used in) operating activities Free cash flow $ 47,396 $ (2,464 ) Purchase of property, plant and equipment, net 7,186 2,464 Net change in insurance collateral (13,310 ) (2,125 ) Other investing activities � 670 � � (653 ) Net cash provided by (used in) operating activities $ 41,942 � $ (2,778 )