Emergency Medical Services Corporation (NYSE: EMS) (EMSC or the
Company) today announces results for the fourth quarter and year
ended December 31, 2009.
William A. Sanger, Chairman and Chief Executive Officer, said,
“EMSC had another banner year in 2009. In more than 13 million
patient encounters, our clinicians provided care with an emphasis
on quality, safety, compassion and dignity. We produced strong
organic growth, won a significant number of new contracts, and
enhanced our market position with targeted acquisitions. We believe
the actions taken in 2009 position us well for the opportunities in
2010 and beyond.”
Results of Operations for the Fourth Quarter 2009
For the quarter ended December 31, 2009, EMSC generated net
revenue of $654.3 million, an increase of 10.2% compared to
the same period last year.
EMSC generated net income of $33.3 million, or $0.75 per diluted
share, for the fourth quarter of 2009, compared to net income of
$20.9 million, or $0.48 per diluted share, in the fourth quarter of
2008. Adjusted EBITDA was $71.2 million, an increase of 18.3%
compared to the same quarter last year. This increase is
attributable primarily to the impact of increased volume from net
new contracts, increased revenue from existing contracts, a
decrease in selling, general and administrative expenses as a
percentage of net revenue and lower fuel costs offset by increased
compensation and insurance expense. Net income and diluted earnings
per share were also positively impacted by a reduction in tax
expense of approximately $3.5 million, or $0.08 per diluted share,
primarily related to the release of accruals for previous tax
positions. A description of the non-GAAP measures, Adjusted EBITDA
and Free Cash Flow, and a reconciliation of non-GAAP to GAAP
financial measures are included in this news release.
Cash provided by operating activities was $62.8 million in the
fourth quarter of 2009, compared to $81.0 million for the same
quarter last year. Working capital changes in the fourth quarter of
2008 were significantly impacted by the FEMA hurricane deployment.
During the fourth quarter of 2009, accounts receivable decreased
$10.3 million and changes in other assets and liabilities increased
cash by $26.7 million related to the timing of insurance and tax
payments.
Free cash flow was $52.0 million in the fourth quarter of 2009.
This figure does not include a $17.4 million cash flow benefit
related to tax deductions for stock-based compensation. Free cash
flow of $63.9 million in the fourth quarter of 2008 included
significant net collections associated with our FEMA
deployment.
Net cash used in investing activities was $85.0 million for the
quarter ended December 31, 2009, compared to $44.6 million for the
same period in 2008. Acquisition related funding was $74.2 million
in the fourth quarter 2009 compared to $27.5 million in the same
period last year.
For the quarter ended December 31, 2009, net cash provided by
financing activities was $24.0 million and includes the exercise of
stock options and the cash flow benefit related to tax deductions
for stock-based compensation. Net cash used in financing activities
of $26.0 million for the fourth quarter of 2008 included
unscheduled payments of approximately $20.0 million on our senior
secured credit facility. At December 31, 2009, there were no
amounts outstanding under our revolving credit facility.
Results of Operations for the Year Ended December 31,
2009
EMSC’s net revenue was $2.57 billion for the year ended December
31, 2009, an increase of 6.6% compared to last year, or an 11.6%
increase excluding the 2008 impact of the FEMA hurricane
deployment.
EMSC’s net income for the year ended December 31, 2009 was
$115.2 million, or $2.64 per diluted share, compared to net income
of $84.8 million, or $1.97 per diluted share, an increase of 34.3%
over last year. Adjusted EBITDA was $282.0 million, an increase of
15.8% compared to last year. The increase in earnings is
attributable primarily to the net impact of increased volume from
net new contracts, increased revenue on existing contracts, a
decrease in compensation and benefits expenses as a percentage of
net revenue and lower fuel costs, partially offset by higher
insurance expense in 2009 and the favorable impact of the FEMA
hurricane deployment in 2008.
Cash provided by operating activities for the year ended
December 31, 2009 was $272.6 million compared to $211.5 million in
2008. The increase in operating cash flow relates primarily to an
increase in net income, further reductions in DSO, and changes in
other assets and liabilities. Accounts receivable decreased $18.7
million for the year ended December 31, 2009, primarily due to a
decrease in DSO of 10 days during the year. Changes in other assets
and liabilities increased cash by $42.7 million during the year
ended December 31, 2009, primarily attributable to the timing of
compensation related payments and deferred income taxes. Working
capital changes for the year ended December 31, 2008 were
significantly impacted by the FEMA hurricane deployment. Free cash
flow was $231.5 million for the year ended December 31, 2009, an
increase of $39.2 million over the year ended December 31,
2008.
Net cash used in investing activities was $116.6 million for the
year ended December 31, 2009 compared to $74.9 million in 2008. The
increase relates primarily to an increase in acquisition and net
capital expenditures. Acquisitions totaled $75.6 million during the
year ended December 31, 2009 compared to $55.8 million during 2008.
Net capital expenditures were $44.6 million for the year ended
December 31, 2009 compared to $31.7 million for the same period in
2008.
For the year ended December 31, 2009, net cash provided by
financing activities was $30.8 million and includes the exercise of
stock options and the cash flow benefit related to tax deductions
for stock-based compensation. Net cash used in financing activities
of $19.3 million for the year ended December 31, 2008 included
unscheduled payments of approximately $20.0 million on our senior
secured 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 facility-based physician services segment.
American Medical Response (AMR)
Comparisons of AMR’s results for the quarter and year ended
December 31, 2009 to the same periods last year are significantly
impacted by our FEMA hurricane deployment during 2008.
Notwithstanding the difficulty in comparing the 2009 to the 2008
periods, performance in our core business improved in 2009.
For the quarter ended December 31, 2009, AMR generated net
revenue of $331.1 million, an increase of 2.0% compared to the
fourth quarter last year, or a 4.0% increase excluding the fourth
quarter 2008 impact of the FEMA hurricane deployment. The increase
in net revenue was from an improvement in revenue per transport and
growth in our managed transportation business, offset by lower
transports primarily from our exit of underperforming markets.
Adjusted EBITDA was $26.6 million, a decrease of 6.4% compared
to the same quarter last year. The decrease in Adjusted EBITDA is
attributable primarily to the favorable impact of the FEMA
hurricane deployment in the fourth quarter of 2008. Adjusted EBITDA
in 2009 was positively impacted by revenue growth coupled with
improvements in our resource utilization and lower fuel costs.
Insurance costs were higher in the quarter by $3.5 million
primarily due to a benefit recorded in the fourth quarter of 2008
for current year reserves. Income from operations was $14.0
million, a decrease of 0.3% compared to the same quarter in
2008.
For the year ended December 31, 2009, AMR’s net revenue was
$1.34 billion, a decrease of 4.1% compared to last year, or a 3.8%
increase excluding the 2008 FEMA hurricane deployment revenue.
Adjusted EBITDA was $124.7 million, a decrease of 4.0% compared to
last year, which was positively affected by the 2008 FEMA hurricane
deployment. Insurance expense for the year ended December 31, 2009
included an unfavorable prior period adjustment of $1.1 million
compared to a favorable prior period adjustment of $4.4 million in
2008. Income from operations was $73.5 million, an increase of 1.8%
compared to 2008.
EmCare
For the quarter ended December 31, 2009, EmCare generated net
revenue of $321.2 million, an increase of 20.2% compared to the
same quarter last year. The increase in revenue is attributable
primarily to the addition of 74 net new contracts since September
30, 2008 (of which 23 were a part of our Pinnacle transaction in
December 2009) and revenue increases at existing contracts.
Adjusted EBITDA was $44.6 million for the quarter compared to
$31.8 million last year, an increase of 40.3%. The increase in
Adjusted EBITDA was driven primarily by the net impact of revenue
and volume increases in addition to a decrease in operating,
insurance and selling general and administrative expenses as a
percentage of net revenue. Income from operations was $40.4
million, an increase of 47.9% over the same period in 2008.
For the year ended December 31, 2009, EmCare’s net revenue was
$1.23 billion, an increase of 21.6% compared to last year. Adjusted
EBITDA was $157.3 million compared to $113.7 million, an increase
of 38.4% compared to last year. Insurance expense in the year ended
December 31, 2009 included unfavorable prior period adjustments of
$3.4 million compared to unfavorable prior period adjustments of
$0.3 million last year. Income from operations was $139.6 million,
an increase of 45.5% over 2008.
Guidance
The Company announces guidance for the fiscal year ending
December 31, 2010. The Company expects diluted earnings per share
to be between $3.00 and $3.10, and Adjusted EBITDA to be between
$313.0 million and $320.0 million for the year. Guidance for 2010
includes expected stock compensation expense of $7.0 million, but
does not include future acquisitions or any expected impact from
debt refinancing options the Company is considering.
Conference Call
EMSC management will host a conference call and live audio
webcast on Thursday, February 11, 2010, at 11:00 a.m. EST, 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
facility-based physician services segment. AMR is the leading
provider of ambulance services in the United States. EmCare is a
leading provider of outsourced physician services to healthcare
facilities. In 2009, EMSC provided services in 13.0 million patient
encounters in more than 2,200 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; the impact of potential changes in the healthcare
industry generally resulting from legislation currently under
consideration; our ability to recruit and retain qualified
physicians and other healthcare professionals, and enforce our
non-compete agreements with our physicians; our ability to generate
cash flow to service our debt obligations; the cost of capital
expenditures to maintain and upgrade our vehicle fleet and medical
equipment; 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 successfully
restructure our operations to comply with future changes in
government regulation; the loss of existing contracts and the
accuracy of our assessment of costs under new contracts; the high
level of competition in our industry; our ability to maintain or
implement complex information systems; our ability to implement our
business strategy; our ability to successfully integrate strategic
acquisitions; and our ability to comply with the terms of our
settlement agreements with the government.
Non-GAAP Financial Measures Description and
Reconciliation
This press release includes presentations of Adjusted EBITDA,
which is defined as net income before equity in earnings 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 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
(unaudited; in thousands, except shares, per share data and
other information) Quarter ended December 31,
Year ended December 31, 2009 2008 2009
2008 Net revenue $ 654,316 $ 593,671 $
2,569,685 $ 2,409,864 Compensation and benefits
463,992 415,818 1,796,779 1,637,425 Operating expenses 81,973
81,345 334,328 383,359 Insurance expense 21,904 18,581 97,610
82,221 Selling, general and administrative expenses 16,295 19,037
63,481 69,658 Depreciation and amortization expense 15,693
16,824 64,351 68,980
Income from operations 54,459 42,066 213,136 168,221
Interest income from restricted assets 1,048 1,294 4,516 6,407
Interest expense (10,247 ) (10,700 ) (40,996 ) (42,087 ) Realized
gain (loss) on investments 75 (289 ) 2,105 2,722 Interest and other
income 374 958 1,816 2,055 Loss on early debt extinguishment
- (241 ) - (241 )
Income before income taxes and
equity in earnings of unconsolidated subsidiary
45,709 33,088 180,577 137,077 Income tax expense (12,541 ) (12,360
) (65,685 ) (52,530 ) Equity in earnings of unconsolidated
subsidiary 103 148 347
300 Net income $ 33,271 $ 20,876 $
115,239 $ 84,847 Basic earnings per
common share $ 0.77 $ 0.50 $ 2.71 $ 2.04 Diluted earnings per
common share $ 0.75 $ 0.48 $ 2.64 $ 1.97 Weighted average common
shares outstanding, basic 43,106,582 41,826,415 42,552,716
41,652,783 Weighted average common shares outstanding, diluted
44,280,705 43,344,507 43,623,800 43,130,782
Other
Information EmCare patient encounters 2,626,560 2,078,030
9,753,211 8,061,851 EmCare weighted patient encounters (1)
2,300,799 1,849,415 8,607,527 7,306,249 AMR ambulance transports
699,735 717,969 2,876,976 2,938,814 AMR weighted transports (2)
706,760 727,460 2,906,899 2,982,153
(1) EmCare weighted encounters
include a weighting of Radiology and Anesthesia encounters due to
the differences in reimbursement for these services.
(2) AMR weighted transports include a weighting of wheelchair
transports due to the differences in reimbursement for these
services.
EMERGENCY MEDICAL SERVICES
CORPORATION Reconciliation of Adjusted EBITDA to Net
Income (unaudited; in thousands) Quarter ended
December 31, Year ended December 31, 2009
2008 2009 2008 Adjusted EBITDA $ 71,200
$ 60,184 $ 282,003 $ 243,608 Depreciation and amortization expense
(15,693 ) (16,824 ) (64,351 ) (68,980 ) Interest income from
restricted assets (1,048 ) (1,294 ) (4,516 )
(6,407 ) Income from operations 54,459 42,066 213,136
168,221 Interest income from restricted assets 1,048 1,294 4,516
6,407 Interest expense (10,247 ) (10,700 ) (40,996 ) (42,087 )
Realized gain (loss) on investments 75 (289 ) 2,105 2,722 Interest
and other income 374 958 1,816 2,055 Loss on early debt
extinguishment - (241 ) -
(241 )
Income before income taxes and
equity in earnings of unconsolidated subsidiary
45,709 33,088 180,577 137,077 Income tax expense (12,541 ) (12,360
) (65,685 ) (52,530 ) Equity in earnings of unconsolidated
subsidiary 103 148 347
300 Net income $ 33,271 $ 20,876 $
115,239 $ 84,847
EMERGENCY
MEDICAL SERVICES CORPORATION Reconciliation of Adjusted
EBITDA to Net Cash Provided by Operating Activities
(unaudited; in thousands) Quarter ended December
31, Year ended December 31, 2009 2008
2009 2008 Adjusted EBITDA $ 71,200 $ 60,184 $
282,003 $ 243,608 Interest paid (9,741 ) (10,175 ) (39,165 )
(39,983 ) Change in accounts receivable 10,294 82,117 18,742 27,618
Change in other operating assets/liabilities 26,675 (44,579 )
42,675 (15,353 ) Equity based compensation 1,104 635 3,979 2,476
Excess tax benefits from stock-based compensation (17,448 ) -
(17,448 ) - Other (19,332 ) (7,151 ) (18,233 )
(6,909 ) Net cash provided by operating activities $ 62,752
$ 81,031 $ 272,553 $ 211,457
EMERGENCY MEDICAL SERVICES CORPORATION
Reconciliation of Segment Adjusted EBITDA to Income from
Operations (unaudited; in thousands) Quarter
ended December 31, Year ended December 31, 2009
2008 2009 2008 AMR Adjusted EBITDA $
26,558 $ 28,375 $ 124,709 $ 129,933 Depreciation and amortization
expense (12,043 ) (13,131 ) (49,190 ) (55,082 ) Interest income
from restricted assets (495 ) (521 ) (1,980 )
(2,590 ) Income from operations 14,020
14,723 73,539 72,261
EmCare Adjusted EBITDA 44,642 31,809 157,294 113,675
Depreciation and amortization expense (3,650 ) (3,693 ) (15,161 )
(13,898 ) Interest income from restricted assets (553 )
(773 ) (2,536 ) (3,817 ) Income from
operations 40,439 27,343 139,597
95,960
Total Adjusted EBITDA
71,200 60,184 282,003 243,608 Depreciation and amortization expense
(15,693 ) (16,824 ) (64,351 ) (68,980 ) Interest income from
restricted assets (1,048 ) (1,294 ) (4,516 )
(6,407 ) Income from operations $ 54,459 $ 42,066
$ 213,136 $ 168,221
EMERGENCY MEDICAL SERVICES CORPORATION Condensed
Consolidated Balance Sheets (in thousands)
December 31, 2009 2008 (Unaudited)
(Audited) Assets Current assets: Cash and cash
equivalents $ 332,888 $ 146,173 Trade and other accounts
receivable, net 459,088 472,501 Other current assets 73,241
196,500
Total current assets
865,217 815,174 Non-current assets: Property, plant and equipment,
net 125,855 124,869 Goodwill and other intangible assets, net
484,605 422,154 Other long-term assets 179,030
179,022 Total assets $ 1,654,707 $ 1,541,219
Liabilities
and Equity Current liabilities $ 349,139 $ 320,141 Long-term
debt 449,254 453,600 Insurance reserves and other long-term
liabilities 170,227 228,439 Total liabilities 968,620
1,002,180 Total equity 686,087 539,039 Total
liabilities and equity $ 1,654,707 $ 1,541,219
EMERGENCY MEDICAL SERVICES CORPORATION Condensed
Consolidated Statements of Cash Flows (unaudited; in
thousands) Quarter ended December 31, Year
ended December 31, 2009 2008 2009
2008 Cash Flows from Operating Activities Net income
$ 33,271 $ 20,876 $ 115,239 $ 84,847 Adjustments to reconcile net
income to net cash provided by operating activities: Depreciation,
amortization, deferred taxes and other (7,488 ) 22,617 95,897
114,345 Changes in operating assets/liabilities, net of
acquisitions: Trade and other accounts receivable 10,294 82,117
18,742 27,618 Insurance accruals (671 ) 855 6,362 (4,478 ) Other
assets and liabilities 27,346 (45,434 )
36,313 (10,875 ) Net cash provided (used in) by
operating activities 62,752 81,031
272,553 211,457
Cash Flows
from Investing Activities Purchases of property, plant and
equipment, net (11,048 ) (10,273 ) (44,608 ) (31,680 ) Acquisition
of businesses, net of cash received (74,238 ) (27,500 ) (75,612 )
(55,825 ) Net change in insurance collateral 342 (6,539 ) 4,411
9,444 Other investing activities (11 ) (276 )
(820 ) 3,116 Net cash used in investing activities
(84,955 ) (44,588 ) (116,629 ) (74,945
)
Cash Flows from Financing Activities EMSC issuance
of class A common stock 3,355 503 10,515 2,423 Excess tax benefits
from stock-based compensation 17,448 - 17,448 - Borrowings under
revolving credit facility - - - 14,000 Repayments of capital lease
obligations and other debt (1,283 ) (21,224 ) (5,109 ) (39,230 )
Increase in bank overdrafts 4,466 (5,231 )
7,937 3,554 Net cash provided by (used
in) financing activities 23,986 (25,952 )
30,791 (19,253 ) Change in cash and
cash equivalents 1,783 10,491 186,715 117,259 Cash and cash
equivalents, beginning of period 331,105
135,682 146,173 28,914 Cash and
cash equivalents, end of period $ 332,888 $ 146,173 $
332,888 $ 146,173 Free cash flow $ 52,035 $
63,943 $ 231,536 $ 192,337
EMERGENCY MEDICAL SERVICES
CORPORATION Reconciliation of Free Cash Flow to Net Cash
Provided by Operating Activities (unaudited; in
thousands) Quarter ended December
31, Year ended December 31, 2009 2008
2009 2008 Free cash flow $ 52,035 $ 63,943 $
231,536 $ 192,337 Purchase of property, plant and equipment, net
11,048 10,273 44,608 31,680 Net change in insurance collateral (342
) 6,539 (4,411 ) (9,444 ) Other investing activities 11
276 820 (3,116 ) Net cash
provided by operating activities $ 62,752 $ 81,031 $ 272,553
$ 211,457
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