We could not find any results for:
Make sure your spelling is correct or try broadening your search.
Share Name | Share Symbol | Market | Type |
---|---|---|---|
Tenet Healthcare Corporation New | NYSE:THC | NYSE | Common Stock |
Price Change | % Change | Share Price | High Price | Low Price | Open Price | Shares Traded | Last Trade | |
---|---|---|---|---|---|---|---|---|
-1.23 | -0.99% | 122.84 | 124.60 | 121.165 | 123.32 | 1,541,032 | 22:30:00 |
|
☒
|
Quarterly report pursuant to Section 13 or 15(d) of the Securities Exchange Act of 1934 for the quarterly period ended June 30, 2017
|
☐
|
Transition report pursuant to Section 13 or 15(d) of the Securities Exchange Act of 1934 for the transition period from to
|
Nevada
(State of Incorporation)
|
95-2557091
(IRS Employer Identification No.)
|
Large accelerated filer ☒
|
Accelerated filer ☐
|
Non-accelerated filer ☐
|
|
|
|
Smaller reporting company ☐
|
|
Emerging growth company ☐
|
|
|
Page
|
|||
|
||||
|
|
|
||
|
||||
|
|
|
||
|
||||
|
|
|
||
|
||||
|
|
|
||
|
|
|
||
|
|
|
||
|
|
|
||
|
||||
|
|
|
||
|
|
|
||
|
|
|
||
|
|
|
|
|
June 30,
|
|
December 31,
|
||||
|
|
2017
|
|
2016
|
||||
ASSETS
|
|
|
|
|
||||
Current assets:
|
|
|
|
|
||||
Cash and cash equivalents
|
|
$
|
475
|
|
|
$
|
716
|
|
Accounts receivable, less allowance for doubtful accounts
($966 at June 30, 2017 and $1,031 at December 31, 2016) |
|
2,706
|
|
|
2,897
|
|
||
Inventories of supplies, at cost
|
|
316
|
|
|
326
|
|
||
Income tax receivable
|
|
7
|
|
|
4
|
|
||
Assets held for sale
|
|
705
|
|
|
29
|
|
||
Other current assets
|
|
1,173
|
|
|
1,285
|
|
||
Total current assets
|
|
5,382
|
|
|
5,257
|
|
||
Investments and other assets
|
|
1,238
|
|
|
1,250
|
|
||
Deferred income taxes
|
|
1,020
|
|
|
871
|
|
||
Property and equipment, at cost, less accumulated depreciation and amortization
($4,826 at June 30, 2017 and $4,974 at December 31, 2016) |
|
7,738
|
|
|
8,053
|
|
||
Goodwill
|
|
7,157
|
|
|
7,425
|
|
||
Other intangible assets, at cost, less accumulated amortization
($839 at June 30, 2017 and $772 at December 31, 2016) |
|
1,806
|
|
|
1,845
|
|
||
Total assets
|
|
$
|
24,341
|
|
|
$
|
24,701
|
|
LIABILITIES AND EQUITY
|
|
|
|
|
||||
Current liabilities:
|
|
|
|
|
||||
Current portion of long-term debt
|
|
$
|
143
|
|
|
$
|
191
|
|
Accounts payable
|
|
1,086
|
|
|
1,329
|
|
||
Accrued compensation and benefits
|
|
749
|
|
|
872
|
|
||
Professional and general liability reserves
|
|
208
|
|
|
181
|
|
||
Accrued interest payable
|
|
238
|
|
|
210
|
|
||
Liabilities held for sale
|
|
51
|
|
|
9
|
|
||
Accrued legal settlement costs
|
|
1
|
|
|
8
|
|
||
Other current liabilities
|
|
1,861
|
|
|
1,234
|
|
||
Total current liabilities
|
|
4,337
|
|
|
4,034
|
|
||
Long-term debt, net of current portion
|
|
15,012
|
|
|
15,064
|
|
||
Professional and general liability reserves
|
|
644
|
|
|
613
|
|
||
Defined benefit plan obligations
|
|
618
|
|
|
626
|
|
||
Deferred income taxes
|
|
296
|
|
|
279
|
|
||
Other long-term liabilities
|
|
598
|
|
|
610
|
|
||
Total liabilities
|
|
21,505
|
|
|
21,226
|
|
||
Commitments and contingencies
|
|
|
|
|
|
|
||
Redeemable noncontrolling interests in equity of consolidated subsidiaries
|
|
1,781
|
|
|
2,393
|
|
||
Equity:
|
|
|
|
|
||||
Shareholders’ equity:
|
|
|
|
|
||||
Common stock, $0.05 par value; authorized 262,500,000 shares; 149,127,794 shares
issued at June 30, 2017 and 148,106,249 shares issued at December 31, 2016 |
|
7
|
|
|
7
|
|
||
Additional paid-in capital
|
|
4,819
|
|
|
4,827
|
|
||
Accumulated other comprehensive loss
|
|
(242
|
)
|
|
(258
|
)
|
||
Accumulated deficit
|
|
(1,794
|
)
|
|
(1,742
|
)
|
||
Common stock in treasury, at cost, 48,417,575 shares at June 30, 2017 and
48,420,650 shares at December 31, 2016 |
|
(2,417
|
)
|
|
(2,417
|
)
|
||
Total shareholders’ equity
|
|
373
|
|
|
417
|
|
||
Noncontrolling interests
|
|
682
|
|
|
665
|
|
||
Total equity
|
|
1,055
|
|
|
1,082
|
|
||
Total liabilities and equity
|
|
$
|
24,341
|
|
|
$
|
24,701
|
|
|
|
Three Months Ended June 30,
|
|
Six Months Ended June 30,
|
||||||||||||
|
|
2017
|
|
2016
|
|
2017
|
|
2016
|
||||||||
Net operating revenues:
|
|
|
|
|
|
|
|
|
||||||||
Net operating revenues before provision for doubtful accounts
|
|
$
|
5,173
|
|
|
$
|
5,220
|
|
|
$
|
10,369
|
|
|
$
|
10,640
|
|
Less: Provision for doubtful accounts
|
|
371
|
|
|
352
|
|
|
754
|
|
|
728
|
|
||||
Net operating revenues
|
|
4,802
|
|
|
4,868
|
|
|
9,615
|
|
|
9,912
|
|
||||
Equity in earnings of unconsolidated affiliates
|
|
28
|
|
|
30
|
|
|
57
|
|
|
54
|
|
||||
Operating expenses:
|
|
|
|
|
|
|
|
|
||||||||
Salaries, wages and benefits
|
|
2,346
|
|
|
2,309
|
|
|
4,726
|
|
|
4,704
|
|
||||
Supplies
|
|
780
|
|
|
773
|
|
|
1,545
|
|
|
1,584
|
|
||||
Other operating expenses, net
|
|
1,159
|
|
|
1,213
|
|
|
2,346
|
|
|
2,455
|
|
||||
Electronic health record incentives
|
|
(6
|
)
|
|
(21
|
)
|
|
(7
|
)
|
|
(21
|
)
|
||||
Depreciation and amortization
|
|
222
|
|
|
215
|
|
|
443
|
|
|
427
|
|
||||
Impairment and restructuring charges, and acquisition-related costs
|
|
41
|
|
|
22
|
|
|
74
|
|
|
50
|
|
||||
Litigation and investigation costs
|
|
1
|
|
|
114
|
|
|
6
|
|
|
287
|
|
||||
Gains on sales, consolidation and deconsolidation of facilities
|
|
(23
|
)
|
|
(1
|
)
|
|
(38
|
)
|
|
(148
|
)
|
||||
Operating income
|
|
310
|
|
|
274
|
|
|
577
|
|
|
628
|
|
||||
Interest expense
|
|
(260
|
)
|
|
(244
|
)
|
|
(518
|
)
|
|
(487
|
)
|
||||
Other non-operating expense, net
|
|
(5
|
)
|
|
(5
|
)
|
|
(10
|
)
|
|
(11
|
)
|
||||
Loss from early extinguishment of debt
|
|
(26
|
)
|
|
—
|
|
|
(26
|
)
|
|
—
|
|
||||
Net income from continuing operations, before income taxes
|
|
19
|
|
|
25
|
|
|
23
|
|
|
130
|
|
||||
Income tax benefit (expense)
|
|
12
|
|
|
16
|
|
|
45
|
|
|
(51
|
)
|
||||
Net income from continuing operations, before discontinued operations
|
|
31
|
|
|
41
|
|
|
68
|
|
|
79
|
|
||||
Discontinued operations:
|
|
|
|
|
|
|
|
|
||||||||
Income (loss) from operations
|
|
2
|
|
|
(2
|
)
|
|
—
|
|
|
(7
|
)
|
||||
Income tax benefit (expense)
|
|
(1
|
)
|
|
—
|
|
|
—
|
|
|
1
|
|
||||
Net income (loss) from discontinued operations
|
|
1
|
|
|
(2
|
)
|
|
—
|
|
|
(6
|
)
|
||||
Net income
|
|
32
|
|
|
39
|
|
|
68
|
|
|
73
|
|
||||
Less: Net income attributable to noncontrolling interests
|
|
87
|
|
|
85
|
|
|
176
|
|
|
178
|
|
||||
Net loss attributable to Tenet Healthcare Corporation common
shareholders |
|
$
|
(55
|
)
|
|
$
|
(46
|
)
|
|
$
|
(108
|
)
|
|
$
|
(105
|
)
|
Amounts attributable to Tenet Healthcare Corporation common shareholders
|
|
|
|
|
|
|
|
|
||||||||
Net loss from continuing operations, net of tax
|
|
$
|
(56
|
)
|
|
$
|
(44
|
)
|
|
$
|
(108
|
)
|
|
$
|
(99
|
)
|
Net income (loss) from discontinued operations, net of tax
|
|
1
|
|
|
(2
|
)
|
|
—
|
|
|
(6
|
)
|
||||
Net loss attributable to Tenet Healthcare Corporation common
shareholders |
|
$
|
(55
|
)
|
|
$
|
(46
|
)
|
|
$
|
(108
|
)
|
|
$
|
(105
|
)
|
Earnings (loss) per share available (attributable) to Tenet Healthcare Corporation common shareholders:
|
|
|
|
|
|
|
|
|
||||||||
Basic
|
|
|
|
|
|
|
|
|
||||||||
Continuing operations
|
|
$
|
(0.56
|
)
|
|
$
|
(0.44
|
)
|
|
$
|
(1.08
|
)
|
|
$
|
(1.00
|
)
|
Discontinued operations
|
|
0.01
|
|
|
(0.02
|
)
|
|
—
|
|
|
(0.06
|
)
|
||||
|
|
$
|
(0.55
|
)
|
|
$
|
(0.46
|
)
|
|
$
|
(1.08
|
)
|
|
$
|
(1.06
|
)
|
Diluted
|
|
|
|
|
|
|
|
|
||||||||
Continuing operations
|
|
$
|
(0.56
|
)
|
|
$
|
(0.44
|
)
|
|
$
|
(1.08
|
)
|
|
$
|
(1.00
|
)
|
Discontinued operations
|
|
0.01
|
|
|
(0.02
|
)
|
|
—
|
|
|
(0.06
|
)
|
||||
|
|
$
|
(0.55
|
)
|
|
$
|
(0.46
|
)
|
|
$
|
(1.08
|
)
|
|
$
|
(1.06
|
)
|
Weighted average shares and dilutive securities outstanding (in thousands):
|
|
|
|
|
|
|
|
|
||||||||
Basic
|
|
100,612
|
|
|
99,341
|
|
|
100,306
|
|
|
99,054
|
|
||||
Diluted
|
|
100,612
|
|
|
99,341
|
|
|
100,306
|
|
|
99,054
|
|
|
|
Three Months Ended June 30,
|
|
Six Months Ended June 30,
|
||||||||||||
|
|
2017
|
|
2016
|
|
2017
|
|
2016
|
||||||||
Net income
|
|
$
|
32
|
|
|
$
|
39
|
|
|
$
|
68
|
|
|
$
|
73
|
|
Other comprehensive income:
|
|
|
|
|
|
|
|
|
||||||||
Amortization of net actuarial loss included in other non-operating expense, net
|
|
4
|
|
|
3
|
|
|
8
|
|
|
3
|
|
||||
Unrealized gains (losses) on securities held as available-for-sale
|
|
1
|
|
|
(2
|
)
|
|
3
|
|
|
1
|
|
||||
Foreign currency translation adjustments
|
|
6
|
|
|
(43
|
)
|
|
9
|
|
|
(41
|
)
|
||||
Other comprehensive income (loss) before income taxes
|
|
11
|
|
|
(42
|
)
|
|
20
|
|
|
(37
|
)
|
||||
Income tax benefit (expense) related to items of other comprehensive income (loss)
|
|
2
|
|
|
(1
|
)
|
|
(4
|
)
|
|
(2
|
)
|
||||
Total other comprehensive income (loss), net of tax
|
|
13
|
|
|
(43
|
)
|
|
16
|
|
|
(39
|
)
|
||||
Comprehensive net income (loss)
|
|
45
|
|
|
(4
|
)
|
|
84
|
|
|
34
|
|
||||
Less: Comprehensive income attributable to noncontrolling interests
|
|
87
|
|
|
85
|
|
|
176
|
|
|
178
|
|
||||
Comprehensive loss attributable to Tenet Healthcare Corporation common shareholders
|
|
$
|
(42
|
)
|
|
$
|
(89
|
)
|
|
$
|
(92
|
)
|
|
$
|
(144
|
)
|
|
|
Six Months Ended
June 30, |
||||||
|
|
2017
|
|
2016
|
||||
Net income
|
|
$
|
68
|
|
|
$
|
73
|
|
Adjustments to reconcile net income to net cash provided by operating activities:
|
|
|
|
|
||||
Depreciation and amortization
|
|
443
|
|
|
427
|
|
||
Provision for doubtful accounts
|
|
754
|
|
|
728
|
|
||
Deferred income tax expense (benefit)
|
|
(81
|
)
|
|
37
|
|
||
Stock-based compensation expense
|
|
29
|
|
|
35
|
|
||
Impairment and restructuring charges, and acquisition-related costs
|
|
74
|
|
|
50
|
|
||
Litigation and investigation costs
|
|
6
|
|
|
287
|
|
||
Gains on sales, consolidation and deconsolidation of facilities
|
|
(38
|
)
|
|
(148
|
)
|
||
Loss from early extinguishment of debt
|
|
26
|
|
|
—
|
|
||
Equity in earnings of unconsolidated affiliates, net of distributions received
|
|
4
|
|
|
10
|
|
||
Amortization of debt discount and debt issuance costs
|
|
22
|
|
|
21
|
|
||
Pre-tax loss from discontinued operations
|
|
—
|
|
|
7
|
|
||
Other items, net
|
|
(25
|
)
|
|
(2
|
)
|
||
Changes in cash from operating assets and liabilities:
|
|
|
|
|
|
|
||
Accounts receivable
|
|
(673
|
)
|
|
(725
|
)
|
||
Inventories and other current assets
|
|
160
|
|
|
(30
|
)
|
||
Income taxes
|
|
(7
|
)
|
|
(17
|
)
|
||
Accounts payable, accrued expenses and other current liabilities
|
|
(345
|
)
|
|
(106
|
)
|
||
Other long-term liabilities
|
|
48
|
|
|
34
|
|
||
Payments for restructuring charges, acquisition-related costs, and litigation costs and settlements
|
|
(62
|
)
|
|
(99
|
)
|
||
Net cash used in operating activities from discontinued operations, excluding income taxes
|
|
(2
|
)
|
|
—
|
|
||
Net cash provided by operating activities
|
|
401
|
|
|
582
|
|
||
Cash flows from investing activities:
|
|
|
|
|
|
|
||
Purchases of property and equipment — continuing operations
|
|
(348
|
)
|
|
(413
|
)
|
||
Purchases of businesses or joint venture interests, net of cash acquired
|
|
(26
|
)
|
|
(94
|
)
|
||
Proceeds from sales of facilities and other assets
|
|
74
|
|
|
573
|
|
||
Proceeds from sales of marketable securities, long-term investments and other assets
|
|
16
|
|
|
24
|
|
||
Purchases of equity investments
|
|
(2
|
)
|
|
(35
|
)
|
||
Other long-term assets
|
|
(12
|
)
|
|
(3
|
)
|
||
Other items, net
|
|
(10
|
)
|
|
2
|
|
||
Net cash provided by (used in) investing activities
|
|
(308
|
)
|
|
54
|
|
||
Cash flows from financing activities:
|
|
|
|
|
|
|
||
Repayments of borrowings under credit facility
|
|
(100
|
)
|
|
(1,195
|
)
|
||
Proceeds from borrowings under credit facility
|
|
100
|
|
|
1,195
|
|
||
Repayments of other borrowings
|
|
(1,029
|
)
|
|
(76
|
)
|
||
Proceeds from other borrowings
|
|
837
|
|
|
—
|
|
||
Debt issuance costs
|
|
(29
|
)
|
|
—
|
|
||
Distributions paid to noncontrolling interests
|
|
(123
|
)
|
|
(95
|
)
|
||
Proceeds from sales of noncontrolling interests
|
|
14
|
|
|
15
|
|
||
Purchases of noncontrolling interests
|
|
(5
|
)
|
|
(177
|
)
|
||
Proceeds from employee stock plan purchases
|
|
3
|
|
|
3
|
|
||
Other items, net
|
|
(2
|
)
|
|
(6
|
)
|
||
Net cash used in financing activities
|
|
(334
|
)
|
|
(336
|
)
|
||
Net increase (decrease) in cash and cash equivalents
|
|
(241
|
)
|
|
300
|
|
||
Cash and cash equivalents at beginning of period
|
|
716
|
|
|
356
|
|
||
Cash and cash equivalents at end of period
|
|
$
|
475
|
|
|
$
|
656
|
|
Supplemental disclosures:
|
|
|
|
|
|
|
||
Interest paid, net of capitalized interest
|
|
$
|
(468
|
)
|
|
$
|
(467
|
)
|
Income tax payments, net
|
|
$
|
(44
|
)
|
|
$
|
(29
|
)
|
|
|
Three Months Ended
June 30, |
|
Six Months Ended
June 30, |
||||||||||||
|
|
2017
|
|
2016
|
|
2017
|
|
2016
|
||||||||
Hospital Operations and other:
|
|
|
|
|
|
|
|
|
|
|
|
|
||||
Net patient revenues from acute care hospitals, related outpatient facilities and physician practices
|
|
|
|
|
|
|
|
|
||||||||
Medicare
|
|
$
|
852
|
|
|
$
|
915
|
|
|
$
|
1,754
|
|
|
$
|
1,814
|
|
Medicaid
|
|
291
|
|
|
296
|
|
|
566
|
|
|
670
|
|
||||
Managed care
|
|
2,664
|
|
|
2,539
|
|
|
5,343
|
|
|
5,302
|
|
||||
Indemnity, self-pay and other
|
|
449
|
|
|
484
|
|
|
874
|
|
|
936
|
|
||||
Net patient revenues
(1)
|
|
4,256
|
|
|
4,234
|
|
|
8,537
|
|
|
8,722
|
|
||||
Health plans
|
|
25
|
|
|
136
|
|
|
90
|
|
|
263
|
|
||||
Revenue from other sources
|
|
164
|
|
|
174
|
|
|
309
|
|
|
324
|
|
||||
Hospital Operations and other total prior to inter-segment eliminations
|
|
4,445
|
|
|
4,544
|
|
|
8,936
|
|
|
9,309
|
|
||||
Ambulatory Care
|
|
483
|
|
|
452
|
|
|
945
|
|
|
889
|
|
||||
Conifer
|
|
400
|
|
|
386
|
|
|
802
|
|
|
771
|
|
||||
Inter-segment eliminations
|
|
(155
|
)
|
|
(162
|
)
|
|
(314
|
)
|
|
(329
|
)
|
||||
Net operating revenues before provision for doubtful accounts
|
|
$
|
5,173
|
|
|
$
|
5,220
|
|
|
$
|
10,369
|
|
|
$
|
10,640
|
|
|
(1)
|
Net patient revenues include revenues from physician practices of
$190 million
and
$186 million
for the three months ended
June 30, 2017
and
2016
, respectively, and
$380 million
and
$379 million
for the
six
months ended
June 30, 2017
and
2016
, respectively.
|
|
|
Gross
Carrying Amount |
|
Accumulated
Amortization |
|
Net Book
Value |
||||||
At June 30, 2017:
|
|
|
|
|
|
|
||||||
Capitalized software costs
|
|
$
|
1,581
|
|
|
$
|
(728
|
)
|
|
$
|
853
|
|
Trade names
|
|
106
|
|
|
—
|
|
|
106
|
|
|||
Contracts
|
|
849
|
|
|
(51
|
)
|
|
798
|
|
|||
Other
|
|
109
|
|
|
(60
|
)
|
|
49
|
|
|||
Total
|
|
$
|
2,645
|
|
|
$
|
(839
|
)
|
|
$
|
1,806
|
|
|
|
Gross
Carrying Amount |
|
Accumulated
Amortization |
|
Net Book
Value |
||||||
At December 31, 2016:
|
|
|
|
|
|
|
||||||
Capitalized software costs
|
|
$
|
1,572
|
|
|
$
|
(681
|
)
|
|
$
|
891
|
|
Trade names
|
|
106
|
|
|
—
|
|
|
106
|
|
|||
Contracts
|
|
845
|
|
|
(43
|
)
|
|
802
|
|
|||
Other
|
|
94
|
|
|
(48
|
)
|
|
46
|
|
|||
Total
|
|
$
|
2,617
|
|
|
$
|
(772
|
)
|
|
$
|
1,845
|
|
|
|
Three Months Ended
June 30, |
|
Six Months Ended
June 30, |
||||||||||||
|
|
2017
|
|
2016
|
|
2017
|
|
2016
|
||||||||
Net operating revenues
|
|
$
|
600
|
|
|
$
|
615
|
|
|
$
|
1,184
|
|
|
$
|
1,193
|
|
Net income
|
|
$
|
118
|
|
|
$
|
130
|
|
|
$
|
233
|
|
|
$
|
235
|
|
Net income attributable to the investees
|
|
$
|
73
|
|
|
$
|
89
|
|
|
$
|
149
|
|
|
$
|
158
|
|
|
|
June 30,
2017
|
|
December 31, 2016
|
||||
Continuing operations:
|
|
|
|
|
|
|
||
Patient accounts receivable
|
|
$
|
3,558
|
|
|
$
|
3,799
|
|
Allowance for doubtful accounts
|
|
(966
|
)
|
|
(1,031
|
)
|
||
Estimated future recoveries
|
|
129
|
|
|
141
|
|
||
Net cost reports and settlements payable and valuation allowances
|
|
(17
|
)
|
|
(14
|
)
|
||
|
|
2,704
|
|
|
2,895
|
|
||
Discontinued operations
|
|
2
|
|
|
2
|
|
||
Accounts receivable, net
|
|
$
|
2,706
|
|
|
$
|
2,897
|
|
|
|
Three Months Ended
June 30, |
|
Six Months Ended
June 30, |
||||||||||||
|
|
2017
|
|
2016
|
|
2017
|
|
2016
|
||||||||
Estimated costs for:
|
|
|
|
|
|
|
|
|
|
|
|
|
||||
Self-pay patients
|
|
$
|
160
|
|
|
$
|
151
|
|
|
$
|
320
|
|
|
$
|
295
|
|
Charity care patients
|
|
33
|
|
|
29
|
|
|
63
|
|
|
68
|
|
||||
Total
|
|
$
|
193
|
|
|
$
|
180
|
|
|
$
|
383
|
|
|
$
|
363
|
|
Medicaid DSH and other supplemental revenues
|
|
$
|
164
|
|
|
$
|
215
|
|
|
$
|
322
|
|
|
$
|
442
|
|
Accounts receivable
|
|
$
|
113
|
|
Other current assets
|
|
25
|
|
|
Investments and other long-term assets
|
|
3
|
|
|
Property and equipment
|
|
217
|
|
|
Other intangible assets
|
|
37
|
|
|
Goodwill
|
|
310
|
|
|
Current liabilities
|
|
(48
|
)
|
|
Long-term liabilities
|
|
(3
|
)
|
|
Net assets held for sale
|
|
$
|
654
|
|
•
|
Our Eastern region included all of our segment operations in Alabama, Florida, Illinois, Massachusetts, Michigan, Missouri, Pennsylvania, South Carolina and Tennessee;
|
•
|
Our Texas region included all of our segment operations in New Mexico and Texas; and
|
•
|
Our Western region included all of our segment operations in Arizona and California.
|
|
|
June 30,
2017
|
|
December 31,
2016 |
||||
Senior unsecured notes:
|
|
|
|
|
|
|
||
5.000% due 2019
|
|
$
|
1,100
|
|
|
$
|
1,100
|
|
5.500% due 2019
|
|
500
|
|
|
500
|
|
||
6.750% due 2020
|
|
300
|
|
|
300
|
|
||
8.000% due 2020
|
|
750
|
|
|
750
|
|
||
8.125% due 2022
|
|
2,800
|
|
|
2,800
|
|
||
6.750% due 2023
|
|
1,900
|
|
|
1,900
|
|
||
6.875% due 2031
|
|
430
|
|
|
430
|
|
||
Senior secured notes:
|
|
|
|
|
|
|
||
6.250% due 2018
|
|
1,041
|
|
|
1,041
|
|
||
4.750% due 2020
|
|
500
|
|
|
500
|
|
||
6.000% due 2020
|
|
1,800
|
|
|
1,800
|
|
||
Floating % due 2020
|
|
—
|
|
|
900
|
|
||
4.500% due 2021
|
|
850
|
|
|
850
|
|
||
4.375% due 2021
|
|
1,050
|
|
|
1,050
|
|
||
7.500% due 2022
|
|
750
|
|
|
750
|
|
||
4.625% due 2024
|
|
830
|
|
|
—
|
|
||
Capital leases
|
|
684
|
|
|
735
|
|
||
Mortgage notes
|
|
81
|
|
|
84
|
|
||
Unamortized issue costs, note discounts and premiums
|
|
(211
|
)
|
|
(235
|
)
|
||
Total long-term debt
|
|
15,155
|
|
|
15,255
|
|
||
Less current portion
|
|
143
|
|
|
191
|
|
||
Long-term debt, net of current portion
|
|
$
|
15,012
|
|
|
$
|
15,064
|
|
|
|
Options
|
|
Weighted Average
Exercise Price Per Share |
|
Aggregate
Intrinsic Value |
|
Weighted Average
Remaining Life |
|||||
|
|
|
|
|
|
(In Millions)
|
|
|
|||||
Outstanding at December 31, 2016
|
|
1,435,921
|
|
|
$
|
22.87
|
|
|
|
|
|
||
Granted
|
|
987,781
|
|
|
18.99
|
|
|
|
|
|
|||
Exercised
|
|
(11,175
|
)
|
|
4.56
|
|
|
|
|
|
|||
Forfeited/Expired
|
|
(187,458
|
)
|
|
26.07
|
|
|
|
|
|
|||
Outstanding at June 30, 2017
|
|
2,225,069
|
|
|
$
|
20.97
|
|
|
$
|
3
|
|
|
5.4 years
|
Vested and expected to vest at June 30, 2017
|
|
2,225,069
|
|
|
$
|
20.97
|
|
|
$
|
3
|
|
|
5.4 years
|
Exercisable at June 30, 2017
|
|
1,237,288
|
|
|
$
|
22.55
|
|
|
$
|
2
|
|
|
1.9 years
|
|
|
Six Months Ended June 30, 2017
|
Expected volatility
|
|
49%
|
Expected dividend yield
|
|
0%
|
Expected life
|
|
6.2 years
|
Expected forfeiture rate
|
|
0%
|
Risk-free interest rate
|
|
2.15%
|
|
|
Options Outstanding
|
|
Options Exercisable
|
||||||||||||
Range of Exercise Prices
|
|
Number of
Options |
|
Weighted Average
Remaining Contractual Life |
|
Weighted Average
Exercise Price |
|
Number of
Options |
|
Weighted Average
Exercise Price |
||||||
$0.00 to $4.569
|
|
159,711
|
|
|
1.7 years
|
|
$
|
4.56
|
|
|
159,711
|
|
|
$
|
4.56
|
|
$4.57 to $19.759
|
|
988,081
|
|
|
9.7 years
|
|
18.99
|
|
|
300
|
|
|
14.52
|
|
||
$19.76 to $32.569
|
|
822,890
|
|
|
2.3 years
|
|
20.87
|
|
|
822,890
|
|
|
20.87
|
|
||
$32.57 to $42.529
|
|
254,387
|
|
|
0.7 years
|
|
39.31
|
|
|
254,387
|
|
|
39.31
|
|
||
|
|
2,225,069
|
|
|
5.4 years
|
|
$
|
20.97
|
|
|
1,237,288
|
|
|
$
|
22.55
|
|
|
|
Restricted Stock
Units |
|
Weighted Average Grant
Date Fair Value Per Unit |
|||
Unvested at December 31, 2016
|
|
3,174,533
|
|
|
$
|
38.75
|
|
Granted
|
|
614,208
|
|
|
18.72
|
|
|
Vested
|
|
(1,291,475
|
)
|
|
35.95
|
|
|
Forfeited
|
|
(52,135
|
)
|
|
36.64
|
|
|
Unvested at June 30, 2017
|
|
2,445,131
|
|
|
$
|
35.46
|
|
|
|
Tenet Healthcare Corporation Shareholders’ Equity
|
|
|
|
|
|||||||||||||||||||||||||
|
|
Common Stock
|
|
Additional
Paid-In Capital |
|
Accumulated
Other Comprehensive Loss |
|
Accumulated
Deficit |
|
Treasury
Stock |
|
Noncontrolling
Interests |
|
Total Equity
|
|||||||||||||||||
|
|
Shares
Outstanding |
|
Issued Par
Amount |
|
|
|
|
|
|
|||||||||||||||||||||
Balances at December 31, 2016
|
|
99,686
|
|
|
$
|
7
|
|
|
$
|
4,827
|
|
|
$
|
(258
|
)
|
|
$
|
(1,742
|
)
|
|
$
|
(2,417
|
)
|
|
$
|
665
|
|
|
$
|
1,082
|
|
Net income (loss)
|
|
—
|
|
|
—
|
|
|
—
|
|
|
—
|
|
|
(108
|
)
|
|
—
|
|
|
71
|
|
|
(37
|
)
|
|||||||
Distributions paid to noncontrolling interests
|
|
—
|
|
|
—
|
|
|
—
|
|
|
—
|
|
|
—
|
|
|
—
|
|
|
(65
|
)
|
|
(65
|
)
|
|||||||
Other comprehensive income
|
|
—
|
|
|
—
|
|
|
—
|
|
|
16
|
|
|
—
|
|
|
—
|
|
|
—
|
|
|
16
|
|
|||||||
Accretion of redeemable noncontrolling interests
|
|
—
|
|
|
—
|
|
|
(29
|
)
|
|
—
|
|
|
—
|
|
|
—
|
|
|
—
|
|
|
(29
|
)
|
|||||||
Purchases (sales) of businesses and noncontrolling interests
|
|
—
|
|
|
—
|
|
|
(4
|
)
|
|
—
|
|
|
—
|
|
|
—
|
|
|
11
|
|
|
7
|
|
|||||||
Cumulative effect of accounting change
|
|
—
|
|
|
—
|
|
|
—
|
|
|
—
|
|
|
56
|
|
|
—
|
|
|
—
|
|
|
56
|
|
|||||||
Stock-based compensation expense, tax benefit and issuance of common stock
|
|
1,024
|
|
|
—
|
|
|
25
|
|
|
—
|
|
|
—
|
|
|
—
|
|
|
—
|
|
|
25
|
|
|||||||
Balances at June 30, 2017
|
|
100,710
|
|
|
$
|
7
|
|
|
$
|
4,819
|
|
|
$
|
(242
|
)
|
|
$
|
(1,794
|
)
|
|
$
|
(2,417
|
)
|
|
$
|
682
|
|
|
$
|
1,055
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|||||||||||||||
Balances at December 31, 2015
|
|
98,495
|
|
|
$
|
7
|
|
|
$
|
4,815
|
|
|
$
|
(164
|
)
|
|
$
|
(1,550
|
)
|
|
$
|
(2,417
|
)
|
|
$
|
267
|
|
|
$
|
958
|
|
Net income (loss)
|
|
—
|
|
|
—
|
|
|
—
|
|
|
—
|
|
|
(105
|
)
|
|
—
|
|
|
62
|
|
|
(43
|
)
|
|||||||
Distributions paid to noncontrolling interests
|
|
—
|
|
|
—
|
|
|
—
|
|
|
—
|
|
|
—
|
|
|
—
|
|
|
(51
|
)
|
|
(51
|
)
|
|||||||
Other comprehensive loss
|
|
—
|
|
|
—
|
|
|
—
|
|
|
(39
|
)
|
|
—
|
|
|
—
|
|
|
—
|
|
|
(39
|
)
|
|||||||
Purchases (sales) of businesses and noncontrolling interests
|
|
—
|
|
|
—
|
|
|
(36
|
)
|
|
—
|
|
|
—
|
|
|
—
|
|
|
114
|
|
|
78
|
|
|||||||
Purchase accounting adjustments
|
|
—
|
|
|
—
|
|
|
—
|
|
|
—
|
|
|
—
|
|
|
—
|
|
|
237
|
|
|
237
|
|
|||||||
Stock-based compensation expense and issuance of common stock
|
|
1,021
|
|
|
—
|
|
|
12
|
|
|
—
|
|
|
—
|
|
|
—
|
|
|
—
|
|
|
12
|
|
|||||||
Balances at June 30, 2016
|
|
99,516
|
|
|
$
|
7
|
|
|
$
|
4,791
|
|
|
$
|
(203
|
)
|
|
$
|
(1,655
|
)
|
|
$
|
(2,417
|
)
|
|
$
|
629
|
|
|
$
|
1,152
|
|
|
|
Balances at
Beginning
of Period
|
|
Litigation and
investigation
Costs
|
|
Cash
Payments
|
|
Balances at
End of
Period
|
||||||||
Six Months Ended June 30, 2017
|
|
|
|
|
|
|
|
|
||||||||
Continuing operations
|
|
$
|
12
|
|
|
$
|
6
|
|
|
$
|
(13
|
)
|
|
$
|
5
|
|
Discontinued operations
|
|
—
|
|
|
—
|
|
|
—
|
|
|
—
|
|
||||
|
|
$
|
12
|
|
|
$
|
6
|
|
|
$
|
(13
|
)
|
|
$
|
5
|
|
Six Months Ended June 30, 2016
|
|
|
|
|
|
|
|
|
||||||||
Continuing operations
|
|
$
|
299
|
|
|
$
|
287
|
|
|
$
|
(57
|
)
|
|
$
|
529
|
|
Discontinued operations
|
|
—
|
|
|
—
|
|
|
—
|
|
|
—
|
|
||||
|
|
$
|
299
|
|
|
$
|
287
|
|
|
$
|
(57
|
)
|
|
$
|
529
|
|
|
|
Six Months Ended
June 30, |
||||||
|
|
2017
|
|
2016
|
||||
Balances at beginning of period
|
|
$
|
2,393
|
|
|
$
|
2,266
|
|
Net income
|
|
105
|
|
|
116
|
|
||
Distributions paid to noncontrolling interests
|
|
(58
|
)
|
|
(44
|
)
|
||
Purchase accounting adjustments
|
|
—
|
|
|
(47
|
)
|
||
Accretion of redeemable noncontrolling interests
|
|
29
|
|
|
—
|
|
||
Purchases and sales of businesses and noncontrolling interests, net
|
|
(688
|
)
|
|
(16
|
)
|
||
Balances at end of period
|
|
$
|
1,781
|
|
|
$
|
2,275
|
|
|
|
June 30,
2017
|
|
December 31, 2016
|
||||
Hospital Operations and other
|
|
$
|
528
|
|
|
$
|
520
|
|
Ambulatory Care
|
|
1,071
|
|
|
1,715
|
|
||
Conifer
|
|
182
|
|
|
158
|
|
||
Redeemable noncontrolling interests
|
|
$
|
1,781
|
|
|
$
|
2,393
|
|
|
|
Six Months Ended
June 30, |
||||||
|
|
2017
|
|
2016
|
||||
Hospital Operations and other
|
|
$
|
12
|
|
|
$
|
15
|
|
Ambulatory Care
|
|
70
|
|
|
78
|
|
||
Conifer
|
|
23
|
|
|
23
|
|
||
Net income attributable to redeemable noncontrolling interests
|
|
$
|
105
|
|
|
$
|
116
|
|
|
Three Months Ended
June 30, |
|
Six Months Ended
June 30, |
||||||||||||
|
2017
|
|
2016
|
|
2017
|
|
2016
|
||||||||
Tax expense at statutory federal rate of 35%
|
$
|
7
|
|
|
$
|
9
|
|
|
$
|
8
|
|
|
$
|
46
|
|
State income taxes, net of federal income tax benefit
|
12
|
|
|
(6
|
)
|
|
5
|
|
|
7
|
|
||||
Tax benefit attributable to noncontrolling interests
|
(28
|
)
|
|
(26
|
)
|
|
(54
|
)
|
|
(47
|
)
|
||||
Nondeductible goodwill
|
—
|
|
|
—
|
|
|
—
|
|
|
29
|
|
||||
Nontaxable gains
|
—
|
|
|
—
|
|
|
—
|
|
|
(17
|
)
|
||||
Nondeductible litigation
|
—
|
|
|
7
|
|
|
—
|
|
|
33
|
|
||||
Change in tax contingency reserves, including interest
|
—
|
|
|
—
|
|
|
(2
|
)
|
|
(3
|
)
|
||||
Stock-based compensation
|
1
|
|
|
—
|
|
|
9
|
|
|
—
|
|
||||
Other items
|
(4
|
)
|
|
—
|
|
|
(11
|
)
|
|
3
|
|
||||
|
$
|
(12
|
)
|
|
$
|
(16
|
)
|
|
$
|
(45
|
)
|
|
$
|
51
|
|
|
|
Loss Attributable
to Common Shareholders (Numerator) |
|
Weighted
Average Shares (Denominator) |
|
Per-Share
Amount |
|||||
Three Months Ended June 30, 2017
|
|
|
|
|
|
|
|
|
|
||
Net loss attributable to Tenet Healthcare Corporation common shareholders
for basic loss per share |
|
$
|
(56
|
)
|
|
100,612
|
|
|
$
|
(0.56
|
)
|
Effect of dilutive stock options, restricted stock units and deferred compensation units
|
|
—
|
|
|
—
|
|
|
—
|
|
||
Net loss attributable to Tenet Healthcare Corporation common shareholders for diluted loss per share
|
|
$
|
(56
|
)
|
|
100,612
|
|
|
$
|
(0.56
|
)
|
|
|
|
|
|
|
|
|||||
Three Months Ended June 30, 2016
|
|
|
|
|
|
|
|
|
|
||
Net loss attributable to Tenet Healthcare Corporation common shareholders
for basic loss per share |
|
$
|
(44
|
)
|
|
99,341
|
|
|
$
|
(0.44
|
)
|
Effect of dilutive stock options, restricted stock units and deferred compensation units
|
|
—
|
|
|
—
|
|
|
—
|
|
||
Net loss attributable to Tenet Healthcare Corporation common shareholders for diluted loss per share
|
|
$
|
(44
|
)
|
|
99,341
|
|
|
$
|
(0.44
|
)
|
|
|
|
|
|
|
|
|||||
Six Months Ended June 30, 2017
|
|
|
|
|
|
|
|||||
Net loss attributable to Tenet Healthcare Corporation common shareholders
for basic loss per share |
|
$
|
(108
|
)
|
|
100,306
|
|
|
$
|
(1.08
|
)
|
Effect of dilutive stock options, restricted stock units and deferred compensation units
|
|
—
|
|
|
—
|
|
|
—
|
|
||
Net loss attributable to Tenet Healthcare Corporation common shareholders for diluted loss per share
|
|
$
|
(108
|
)
|
|
100,306
|
|
|
$
|
(1.08
|
)
|
|
|
|
|
|
|
|
|||||
Six Months Ended June 30, 2016
|
|
|
|
|
|
|
|
|
|
||
Net loss attributable to Tenet Healthcare Corporation common shareholders
for basic loss per share |
|
$
|
(99
|
)
|
|
99,054
|
|
|
$
|
(1.00
|
)
|
Effect of dilutive stock options, restricted stock units and deferred compensation units
|
|
—
|
|
|
—
|
|
|
—
|
|
||
Net loss attributable to Tenet Healthcare Corporation common shareholders for diluted loss per share
|
|
$
|
(99
|
)
|
|
99,054
|
|
|
$
|
(1.00
|
)
|
Investments
|
|
June 30, 2017
|
|
Quoted Prices
in Active
Markets for
Identical Assets
(Level 1)
|
|
Significant Other
Observable Inputs
(Level 2)
|
|
Significant
Unobservable
Inputs
(Level 3)
|
||||||||
Marketable debt securities — noncurrent
|
|
$
|
54
|
|
|
$
|
39
|
|
|
$
|
15
|
|
|
$
|
—
|
|
|
|
$
|
54
|
|
|
$
|
39
|
|
|
$
|
15
|
|
|
$
|
—
|
|
Investments
|
|
December 31, 2016
|
|
Quoted Prices
in Active Markets for Identical Assets (Level 1) |
|
Significant Other
Observable Inputs (Level 2) |
|
Significant
Unobservable Inputs (Level 3) |
||||||||
Marketable debt securities — noncurrent
|
|
$
|
49
|
|
|
$
|
23
|
|
|
$
|
26
|
|
|
$
|
—
|
|
|
|
$
|
49
|
|
|
$
|
23
|
|
|
$
|
26
|
|
|
$
|
—
|
|
|
|
June 30, 2017
|
|
Quoted Prices
in Active
Markets for
Identical Assets
(Level 1)
|
|
Significant Other
Observable Inputs
(Level 2)
|
|
Significant
Unobservable
Inputs
(Level 3)
|
||||||||
Other than temporarily impaired equity method investments
|
|
$
|
127
|
|
|
$
|
—
|
|
|
$
|
127
|
|
|
$
|
—
|
|
|
|
$
|
127
|
|
|
$
|
—
|
|
|
$
|
127
|
|
|
$
|
—
|
|
|
|
December 31, 2016
|
|
Quoted Prices
in Active Markets for Identical Assets (Level 1) |
|
Significant Other
Observable Inputs (Level 2) |
|
Significant
Unobservable Inputs (Level 3) |
||||||||
Other than temporarily impaired equity method investments
|
|
$
|
27
|
|
|
$
|
—
|
|
|
$
|
27
|
|
|
$
|
—
|
|
|
|
$
|
27
|
|
|
$
|
—
|
|
|
$
|
27
|
|
|
$
|
—
|
|
Current assets
|
|
$
|
3
|
|
Property and equipment
|
|
4
|
|
|
Other intangible assets
|
|
5
|
|
|
Goodwill
|
|
43
|
|
|
Current liabilities
|
|
(2
|
)
|
|
Long-term liabilities
|
|
(1
|
)
|
|
Redeemable noncontrolling interests
|
|
(10
|
)
|
|
Noncontrolling interests
|
|
(13
|
)
|
|
Cash paid, net of cash acquired
|
|
(26
|
)
|
|
Gains on consolidations
|
|
$
|
3
|
|
|
|
June 30,
2017
|
|
December 31,
2016 |
||||
Assets:
|
|
|
|
|
|
|
||
Hospital Operations and other
|
|
$
|
17,422
|
|
|
$
|
17,871
|
|
Ambulatory Care
|
|
5,792
|
|
|
5,722
|
|
||
Conifer
|
|
1,127
|
|
|
1,108
|
|
||
Total
|
|
$
|
24,341
|
|
|
$
|
24,701
|
|
|
|
Three Months Ended
June 30, |
|
Six Months Ended
June 30, |
||||||||||||
|
|
2017
|
|
2016
|
|
2017
|
|
2016
|
||||||||
Capital expenditures:
|
|
|
|
|
|
|
|
|
|
|
|
|
||||
Hospital Operations and other
|
|
$
|
136
|
|
|
$
|
184
|
|
|
$
|
319
|
|
|
$
|
375
|
|
Ambulatory Care
|
|
10
|
|
|
16
|
|
|
21
|
|
|
28
|
|
||||
Conifer
|
|
4
|
|
|
5
|
|
|
8
|
|
|
10
|
|
||||
Total
|
|
$
|
150
|
|
|
$
|
205
|
|
|
$
|
348
|
|
|
$
|
413
|
|
|
|
|
|
|
|
|
|
|
||||||||
Net operating revenues:
|
|
|
|
|
|
|
|
|
|
|
|
|
||||
Hospital Operations and other total prior to inter-segment eliminations
(1)
|
|
$
|
4,085
|
|
|
$
|
4,202
|
|
|
$
|
8,200
|
|
|
$
|
8,599
|
|
Ambulatory Care
|
|
472
|
|
|
442
|
|
|
927
|
|
|
871
|
|
||||
Conifer
|
|
|
|
|
|
|
|
|
|
|
|
|||||
Tenet
|
|
155
|
|
|
162
|
|
|
314
|
|
|
329
|
|
||||
Other customers
|
|
245
|
|
|
224
|
|
|
488
|
|
|
442
|
|
||||
Total Conifer
|
|
400
|
|
|
386
|
|
|
802
|
|
|
771
|
|
||||
Inter-segment eliminations
|
|
(155
|
)
|
|
(162
|
)
|
|
(314
|
)
|
|
(329
|
)
|
||||
Total
|
|
$
|
4,802
|
|
|
$
|
4,868
|
|
|
$
|
9,615
|
|
|
$
|
9,912
|
|
|
|
|
|
|
|
|
|
|
||||||||
Equity in earnings of unconsolidated affiliates:
|
|
|
|
|
|
|
|
|
|
|
|
|
||||
Hospital Operations and other
|
|
$
|
(2
|
)
|
|
$
|
4
|
|
|
$
|
—
|
|
|
$
|
3
|
|
Ambulatory Care
|
|
30
|
|
|
26
|
|
|
57
|
|
|
51
|
|
||||
Total
|
|
$
|
28
|
|
|
$
|
30
|
|
|
$
|
57
|
|
|
$
|
54
|
|
|
|
|
|
|
|
|
|
|
||||||||
Adjusted EBITDA:
|
|
|
|
|
|
|
|
|
|
|
|
|
||||
Hospital Operations and other
(2)
|
|
$
|
346
|
|
|
$
|
427
|
|
|
$
|
655
|
|
|
$
|
845
|
|
Ambulatory Care
|
|
164
|
|
|
139
|
|
|
317
|
|
|
275
|
|
||||
Conifer
|
|
60
|
|
|
63
|
|
|
125
|
|
|
126
|
|
||||
Total
|
|
$
|
570
|
|
|
$
|
629
|
|
|
$
|
1,097
|
|
|
$
|
1,246
|
|
|
|
|
|
|
|
|
|
|
||||||||
Depreciation and amortization:
|
|
|
|
|
|
|
|
|
|
|
|
|
||||
Hospital Operations and other
|
|
$
|
188
|
|
|
$
|
181
|
|
|
$
|
375
|
|
|
$
|
355
|
|
Ambulatory Care
|
|
22
|
|
|
22
|
|
|
44
|
|
|
47
|
|
||||
Conifer
|
|
12
|
|
|
12
|
|
|
24
|
|
|
25
|
|
||||
Total
|
|
$
|
222
|
|
|
$
|
215
|
|
|
$
|
443
|
|
|
$
|
427
|
|
|
|
|
|
|
|
|
|
|
||||||||
Adjusted EBITDA
|
|
$
|
570
|
|
|
$
|
629
|
|
|
$
|
1,097
|
|
|
$
|
1,246
|
|
Loss from divested and closed businesses
(i.e., the Company’s health plan businesses) |
|
(19
|
)
|
|
(5
|
)
|
|
(35
|
)
|
|
(2
|
)
|
||||
Depreciation and amortization
|
|
(222
|
)
|
|
(215
|
)
|
|
(443
|
)
|
|
(427
|
)
|
||||
Impairment and restructuring charges, and acquisition-related costs
|
|
(41
|
)
|
|
(22
|
)
|
|
(74
|
)
|
|
(50
|
)
|
||||
Litigation and investigation costs
|
|
(1
|
)
|
|
(114
|
)
|
|
(6
|
)
|
|
(287
|
)
|
||||
Interest expense
|
|
(260
|
)
|
|
(244
|
)
|
|
(518
|
)
|
|
(487
|
)
|
||||
Loss from early extinguishment of debt
|
|
(26
|
)
|
|
—
|
|
|
(26
|
)
|
|
—
|
|
||||
Other non-operating expense, net
|
|
(5
|
)
|
|
(5
|
)
|
|
(10
|
)
|
|
(11
|
)
|
||||
Gains on sales, consolidation and deconsolidation of facilities
|
|
23
|
|
|
1
|
|
|
38
|
|
|
148
|
|
||||
Net income from continuing operations before income taxes
|
|
$
|
19
|
|
|
$
|
25
|
|
|
$
|
23
|
|
|
$
|
130
|
|
|
(1)
|
Hospital Operations and other revenues includes health plan revenues of
$25 million
and
$90 million
for the
three and six
months ended
June 30, 2017
, respectively, and
$136 million
and
$263 million
for the
three and six
months ended
June 30, 2016
, respectively.
|
(2)
|
Hospital Operations and other Adjusted EBITDA excludes health plan EBITDA of
$(19) million
and
$(35) million
for the
three and six
months ended
June 30, 2017
, respectively, and
$(5) million
and
$(2) million
for the
three and six
months ended
June 30, 2016
, respectively.
|
•
|
Management Overview
|
•
|
Forward-Looking Statements
|
•
|
Sources of Revenue
|
•
|
Results of Operations
|
•
|
Liquidity and Capital Resources
|
•
|
Off-Balance Sheet Arrangements
|
•
|
Critical Accounting Estimates
|
|
|
Continuing Operations
Three Months Ended June 30, |
|
|||||||
Selected Operating Statistics
|
|
2017
|
|
2016
|
|
Increase
(Decrease) |
|
|||
Hospital Operations and other – acute care hospitals and related outpatient facilities
|
|
|
|
|
|
|
|
|||
Number of hospitals (at end of period)
|
|
76
|
|
|
75
|
|
|
1
|
|
(1)
|
Total admissions
|
|
190,394
|
|
|
193,898
|
|
|
(1.8
|
)%
|
|
Adjusted patient admissions
(2)
|
|
342,439
|
|
|
342,813
|
|
|
(0.1
|
)%
|
|
Paying admissions (excludes charity and uninsured)
|
|
179,889
|
|
|
183,539
|
|
|
(2.0
|
)%
|
|
Charity and uninsured admissions
|
|
10,505
|
|
|
10,359
|
|
|
1.4
|
%
|
|
Emergency department visits
|
|
724,785
|
|
|
715,692
|
|
|
1.3
|
%
|
|
Total surgeries
|
|
123,449
|
|
|
130,201
|
|
|
(5.2
|
)%
|
|
Patient days — total
|
|
874,930
|
|
|
897,313
|
|
|
(2.5
|
)%
|
|
Adjusted patient days
(2)
|
|
1,552,302
|
|
|
1,569,272
|
|
|
(1.1
|
)%
|
|
Average length of stay (days)
|
|
4.60
|
|
|
4.63
|
|
|
(0.6
|
)%
|
|
Average licensed beds
|
|
20,435
|
|
|
20,380
|
|
|
0.3
|
%
|
|
Utilization of licensed beds
(3)
|
|
47.0
|
%
|
|
48.4
|
%
|
|
(1.4
|
)%
|
(1)
|
Total visits
|
|
1,981,848
|
|
|
2,038,287
|
|
|
(2.8
|
)%
|
|
Paying visits (excludes charity and uninsured)
|
|
1,849,697
|
|
|
1,896,394
|
|
|
(2.5
|
)%
|
|
Charity and uninsured visits
|
|
132,151
|
|
|
141,893
|
|
|
(6.9
|
)%
|
|
Ambulatory Care
|
|
|
|
|
|
|
|
|||
Total consolidated facilities (at end of period)
|
|
219
|
|
|
214
|
|
|
5
|
|
(1)
|
Total cases
|
|
462,174
|
|
|
444,955
|
|
|
3.9
|
%
|
|
|
|
|
(1)
|
The change is the difference between the 2017 and 2016 amounts shown.
|
|
(2)
|
Adjusted patient admissions/days represents actual patient admissions/days adjusted to include outpatient services provided by facilities in our Hospital Operations and other segment by multiplying actual patient admissions/days by the sum of gross inpatient revenues and outpatient revenues and dividing the results by gross inpatient revenues.
|
|
(3)
|
Utilization of licensed beds represents patient days divided by number of days in the period divided by average licensed beds.
|
|
|
Continuing Operations
Three Months Ended June 30, |
|
|||||||||
Revenues
|
|
2017
|
|
2016
|
|
Increase
(Decrease) |
|
|||||
Net operating revenues before provision for doubtful accounts
|
|
|
|
|
|
|
|
|||||
Hospital Operations and other prior to inter-segment eliminations
|
|
$
|
4,445
|
|
|
$
|
4,544
|
|
|
(2.2
|
)%
|
|
Ambulatory Care
|
|
483
|
|
|
452
|
|
|
6.9
|
%
|
|
||
Conifer
|
|
400
|
|
|
386
|
|
|
3.6
|
%
|
|
||
Inter-segment eliminations
|
|
(155
|
)
|
|
(162
|
)
|
|
(4.3
|
)%
|
|
||
Total
|
|
$
|
5,173
|
|
|
$
|
5,220
|
|
|
(0.9
|
)%
|
|
Selected Hospital Operations and other – acute care hospitals and related outpatient facilities revenue data
|
|
|
|
|
|
|
|
|
|
|
||
Net inpatient revenues
|
|
$
|
2,555
|
|
|
$
|
2,588
|
|
|
(1.3
|
)%
|
|
Net outpatient revenues
|
|
1,511
|
|
|
1,460
|
|
|
3.5
|
%
|
|
||
Net patient revenues
|
|
$
|
4,066
|
|
|
$
|
4,048
|
|
|
0.4
|
%
|
|
|
|
|
|
|
|
|
|
|||||
Self-pay net inpatient revenues
|
|
$
|
113
|
|
|
$
|
118
|
|
|
(4.2
|
)%
|
|
Self-pay net outpatient revenues
|
|
162
|
|
|
131
|
|
|
23.7
|
%
|
|
||
Total self-pay revenues
|
|
$
|
275
|
|
|
$
|
249
|
|
|
10.4
|
%
|
|
|
|
Continuing Operations
Three Months Ended June 30, |
|
|||||||||
Provision for Doubtful Accounts
|
|
2017
|
|
2016
|
|
Increase
(Decrease) |
||||||
Provision for doubtful accounts
|
|
|
|
|
|
|
|
|||||
Hospital Operations and other
|
|
$
|
360
|
|
|
$
|
342
|
|
|
5.3
|
%
|
|
Ambulatory Care
|
|
11
|
|
|
10
|
|
|
10.0
|
%
|
|
||
Total
|
|
$
|
371
|
|
|
$
|
352
|
|
|
5.4
|
%
|
|
Provision for doubtful accounts as a percentage of net operating revenues before provision for doubtful accounts
|
|
|
|
|
|
|
|
|||||
Hospital Operations and other
|
|
8.1
|
%
|
|
7.5
|
%
|
|
0.6
|
%
|
(1)
|
||
Ambulatory Care
|
|
2.3
|
%
|
|
2.2
|
%
|
|
0.1
|
%
|
(1)
|
||
Total
|
|
7.2
|
%
|
|
6.7
|
%
|
|
0.5
|
%
|
(1)
|
|
|
|
(1)
|
The change is the difference between the 2017 and 2016 amounts shown.
|
|
|
Continuing Operations
Three Months Ended June 30, |
|||||||||
Selected Operating Expenses
|
|
2017
|
|
2016
|
|
Increase
(Decrease) |
|||||
Hospital Operations and other
|
|
|
|
|
|
|
|||||
Salaries, wages and benefits
|
|
$
|
1,943
|
|
|
$
|
1,924
|
|
|
1.0
|
%
|
Supplies
|
|
682
|
|
|
682
|
|
|
—
|
%
|
||
Other operating expenses
|
|
982
|
|
|
1,037
|
|
|
(5.3
|
)%
|
||
Total
|
|
$
|
3,607
|
|
|
$
|
3,643
|
|
|
(1.0
|
)%
|
Ambulatory Care
|
|
|
|
|
|
|
|
|
|
||
Salaries, wages and benefits
|
|
$
|
153
|
|
|
$
|
147
|
|
|
4.1
|
%
|
Supplies
|
|
96
|
|
|
91
|
|
|
5.5
|
%
|
||
Other operating expenses
|
|
89
|
|
|
91
|
|
|
(2.2
|
)%
|
||
Total
|
|
$
|
338
|
|
|
$
|
329
|
|
|
2.7
|
%
|
Conifer
|
|
|
|
|
|
|
|
|
|
||
Salaries, wages and benefits
|
|
$
|
250
|
|
|
$
|
238
|
|
|
5.0
|
%
|
Supplies
|
|
2
|
|
|
—
|
|
|
100.0
|
%
|
||
Other operating expenses
|
|
88
|
|
|
85
|
|
|
3.5
|
%
|
||
Total
|
|
$
|
340
|
|
|
$
|
323
|
|
|
5.3
|
%
|
Total
|
|
|
|
|
|
|
|
|
|
||
Salaries, wages and benefits
|
|
$
|
2,346
|
|
|
$
|
2,309
|
|
|
1.6
|
%
|
Supplies
|
|
780
|
|
|
773
|
|
|
0.9
|
%
|
||
Other operating expenses
|
|
1,159
|
|
|
1,213
|
|
|
(4.5
|
)%
|
||
Total
|
|
$
|
4,285
|
|
|
$
|
4,295
|
|
|
(0.2
|
)%
|
Rent/lease expense
(1)
|
|
|
|
|
|
|
|
|
|
||
Hospital Operations and other
|
|
$
|
61
|
|
|
$
|
61
|
|
|
—
|
%
|
Ambulatory Care
|
|
19
|
|
|
20
|
|
|
(5.0
|
)%
|
||
Conifer
|
|
5
|
|
|
5
|
|
|
—
|
%
|
||
Total
|
|
$
|
85
|
|
|
$
|
86
|
|
|
(1.2
|
)%
|
|
|
|
(1)
|
Included in other operating expenses.
|
|
|
Continuing Operations
Three Months Ended June 30, |
|||||||||
Selected Operating Expenses per Adjusted Patient Admission
|
|
2017
|
|
2016
|
|
Increase
(Decrease) |
|||||
Hospital Operations and other
|
|
|
|
|
|
|
|||||
Salaries, wages and benefits per adjusted patient admission
(1)
|
|
$
|
5,662
|
|
|
$
|
5,595
|
|
|
1.2
|
%
|
Supplies per adjusted patient admission
(1)
|
|
1,995
|
|
|
1,983
|
|
|
0.6
|
%
|
||
Other operating expenses per adjusted patient admission
(1)
|
|
2,737
|
|
|
2,579
|
|
|
6.1
|
%
|
||
Total per adjusted patient admission
|
|
$
|
10,394
|
|
|
$
|
10,157
|
|
|
2.3
|
%
|
|
|
|
(1)
|
Calculation excludes the expenses from our health plan businesses. Adjusted patient admissions represents actual patient admissions adjusted to include outpatient services provided by facilities in our Hospital Operations and other segment by multiplying actual patient admissions by the sum of gross inpatient revenues and outpatient revenues and dividing the results by gross inpatient revenues.
|
•
|
Net cash provided by operating activities before interest, taxes and restructuring charges, acquisition-related costs, and litigation costs and settlements of
$634 million
;
|
•
|
Payments for restructuring charges, acquisition-related costs, and litigation costs and settlements of
$38 million
;
|
•
|
Capital expenditures of
$150 million
;
|
•
|
Proceeds from the sale of facilities and other assets of
$54 million
;
|
•
|
Interest payments of
$338 million
;
|
•
|
Income tax payments of
$43 million
;
|
•
|
$830 million of proceeds from the issuance of our 4.625% senior secured notes due 2024;
|
•
|
$912 million of payments to defease our
floating rate
senior secured notes due 2020;
|
•
|
$27 million
of payments for debt issuance costs; and
|
•
|
$60 million
of distributions paid to noncontrolling interests.
|
•
|
Decreased income from continuing operations before income taxes of
$149 million
,
excluding investment earnings (losses), gain (loss) from early extinguishment of debt, interest expense, gains on sales, consolidation and deconsolidation of facilities, litigation and investigation costs, impairment and restructuring charges, and acquisition-related costs, depreciation and amortization, and income (loss) from divested operations and closed businesses (i.e., our health plan businesses)
in the
six
months ended
June 30, 2017
compared to the
six
months ended
June 30, 2016
;
|
•
|
A
$37 million
decrease
in payments on reserves for restructuring charges, acquisition-related costs, and litigation costs and settlements;
|
•
|
Reduced cash flows from our health plan businesses of $65 million due to cash outflows in the 2017 period resulting from the sales and wind-down of these businesses in 2017, compared to slightly positive cash flows in the 2016 period; and
|
•
|
The timing of other working capital items.
|
|
|
Three Months Ended
June 30, |
|
Six Months Ended
June 30, |
||||||||||||||
Net Patient Revenues from:
|
|
2017
|
|
2016
|
|
Increase
(Decrease) (1) |
|
2017
|
|
2016
|
|
Increase
(Decrease) (1) |
||||||
Medicare
|
|
20.1
|
%
|
|
21.7
|
%
|
|
(1.6
|
)%
|
|
20.6
|
%
|
|
20.8
|
%
|
|
(0.2
|
)%
|
Medicaid
|
|
6.9
|
%
|
|
7.4
|
%
|
|
(0.5
|
)%
|
|
6.8
|
%
|
|
8.0
|
%
|
|
(1.2
|
)%
|
Managed care
|
|
62.5
|
%
|
|
59.4
|
%
|
|
3.1
|
%
|
|
62.4
|
%
|
|
60.4
|
%
|
|
2.0
|
%
|
Indemnity, self-pay and other
|
|
10.5
|
%
|
|
11.5
|
%
|
|
(1.0
|
)%
|
|
10.2
|
%
|
|
10.8
|
%
|
|
(0.6
|
)%
|
|
|
|
(1)
|
The increase (decrease) is the difference between the 2017 and 2016 percentages shown.
|
|
|
Three Months Ended
June 30, |
|
Six Months Ended
June 30, |
||||||||||||||
Admissions from:
|
|
2017
|
|
2016
|
|
Increase
(Decrease) (1) |
|
2017
|
|
2016
|
|
Increase
(Decrease) (1) |
||||||
Medicare
|
|
25.9
|
%
|
|
25.9
|
%
|
|
—
|
%
|
|
26.5
|
%
|
|
26.6
|
%
|
|
(0.1
|
)%
|
Medicaid
|
|
6.5
|
%
|
|
6.7
|
%
|
|
(0.2
|
)%
|
|
6.5
|
%
|
|
7.0
|
%
|
|
(0.5
|
)%
|
Managed care
|
|
59.7
|
%
|
|
59.4
|
%
|
|
0.3
|
%
|
|
59.3
|
%
|
|
58.7
|
%
|
|
0.6
|
%
|
Indemnity, self-pay and other
|
|
7.9
|
%
|
|
8.0
|
%
|
|
(0.1
|
)%
|
|
7.7
|
%
|
|
7.7
|
%
|
|
—
|
%
|
|
|
|
(1)
|
The increase (decrease) is the difference between the 2017 and 2016 percentages shown.
|
|
|
Three Months Ended
June 30, |
|
Six Months Ended
June 30, |
||||||||||||
Revenue Descriptions
|
|
2017
|
|
2016
|
|
2017
|
|
2016
|
||||||||
Medicare severity-adjusted diagnosis-related group — operating
|
|
$
|
410
|
|
|
$
|
415
|
|
|
$
|
860
|
|
|
$
|
889
|
|
Medicare severity-adjusted diagnosis-related group — capital
|
|
37
|
|
|
38
|
|
|
78
|
|
|
81
|
|
||||
Outliers
|
|
22
|
|
|
16
|
|
|
43
|
|
|
38
|
|
||||
Outpatient
|
|
224
|
|
|
252
|
|
|
465
|
|
|
474
|
|
||||
Disproportionate share
|
|
68
|
|
|
72
|
|
|
139
|
|
|
150
|
|
||||
Direct Graduate and Indirect Medical Education
(1)
|
|
65
|
|
|
61
|
|
|
131
|
|
|
125
|
|
||||
Other
(2)
|
|
12
|
|
|
44
|
|
|
12
|
|
|
27
|
|
||||
Adjustments for prior-year cost reports and related valuation allowances
|
|
14
|
|
|
17
|
|
|
26
|
|
|
30
|
|
||||
Total Medicare net patient revenues
|
|
$
|
852
|
|
|
$
|
915
|
|
|
$
|
1,754
|
|
|
$
|
1,814
|
|
|
|
|
(1)
|
Includes Indirect Medical Education revenues earned by our children’s hospitals under the Children’s Hospitals Graduate Medical Education Payment Program administered by the Health Resources and Services Administration of HHS.
|
|
(2)
|
The other revenue category includes inpatient psychiatric units, inpatient rehabilitation units, one long-term acute care hospital, other revenue adjustments, and adjustments related to the estimates for current-year cost reports and related valuation allowances.
|
|
|
Six Months Ended
June 30, |
||||||||||||||
|
|
2017
|
|
2016
|
||||||||||||
Hospital Location
|
|
Medicaid
|
|
Managed
Medicaid |
|
Medicaid
|
|
Managed
Medicaid |
||||||||
Alabama
|
|
$
|
55
|
|
|
$
|
—
|
|
|
$
|
40
|
|
|
$
|
—
|
|
Arizona
|
|
(1
|
)
|
|
107
|
|
|
(1
|
)
|
|
110
|
|
||||
California
|
|
84
|
|
|
219
|
|
|
191
|
|
|
216
|
|
||||
Florida
|
|
38
|
|
|
89
|
|
|
36
|
|
|
86
|
|
||||
Georgia
|
|
—
|
|
|
—
|
|
|
13
|
|
|
9
|
|
||||
Illinois
|
|
37
|
|
|
38
|
|
|
34
|
|
|
36
|
|
||||
Massachusetts
|
|
15
|
|
|
27
|
|
|
19
|
|
|
29
|
|
||||
Michigan
|
|
190
|
|
|
176
|
|
|
189
|
|
|
155
|
|
||||
Missouri
|
|
—
|
|
|
1
|
|
|
—
|
|
|
—
|
|
||||
North Carolina
|
|
—
|
|
|
—
|
|
|
(2
|
)
|
|
—
|
|
||||
Pennsylvania
|
|
40
|
|
|
121
|
|
|
36
|
|
|
118
|
|
||||
South Carolina
|
|
7
|
|
|
19
|
|
|
8
|
|
|
19
|
|
||||
Tennessee
|
|
2
|
|
|
16
|
|
|
2
|
|
|
17
|
|
||||
Texas
|
|
99
|
|
|
125
|
|
|
105
|
|
|
127
|
|
||||
|
|
$
|
566
|
|
|
$
|
938
|
|
|
$
|
670
|
|
|
$
|
922
|
|
•
|
A market basket increase of 2.7% for Medicare severity-adjusted diagnosis-related group (“MS-DRG”) operating payments for hospitals reporting specified quality measure data and that are meaningful users of electronic health record (“EHR”) technology (hospitals that do not report specified quality measure data and/or are not meaningful users of EHR technology will receive a reduced market basket increase); CMS is also proposing certain adjustments to the estimated 2.7% market basket increase that result in a net operating payment update of 1.21% (before budget neutrality adjustments), including:
|
•
|
Market basket index and multifactor productivity reductions required by the ACA of 0.75% and 0.6%, respectively;
|
•
|
A 0.4588% increase required under the 21st Century Cures Act; and
|
•
|
A reduction of 0.6% to reverse the one-time increase of 0.6% made in FFY 2017 to address the effects of the 0.2% reduction in effect for FFYs 2014 through 2016 related to the two-midnight rule.
|
•
|
Updates to the three factors used to determine the amount and distribution of Medicare uncompensated care disproportionate share (“UC-DSH”) payments, including a transition from using low-income days to estimated uncompensated care costs for the distribution of the UC-DSH pool;
|
•
|
A 1.61% net increase in the capital federal MS-DRG rate; and
|
•
|
An increase in the cost outlier threshold from $23,573 to $26,601.
|
•
|
An estimated net increase in the OPPS rates of 1.75% based on an estimated market basket increase of 2.9% reduced by market basket index and multifactor productivity reductions required by the ACA of 0.75% and 0.4%, respectively;
|
•
|
A proposal to remove total knee arthroplasty (“TKA”) from the CMS list of procedures that can be performed only on an inpatient basis (the “Inpatient Only List”); if finalized, this policy would permit TKAs to be performed in a hospital outpatient department; CMS is also soliciting public comments on whether the TKA procedure meets the criteria to be added to the ASC list of covered surgical procedures; and
|
•
|
A 1.9% update to the ASC payment rates.
|
|
|
Three Months Ended
June 30, |
|
Six Months Ended
June 30, |
||||||||||||
|
|
2017
|
|
2016
|
|
2017
|
|
2016
|
||||||||
Estimated costs for:
|
|
|
|
|
|
|
|
|
|
|
|
|
||||
Self-pay patients
|
|
$
|
160
|
|
|
$
|
151
|
|
|
$
|
320
|
|
|
$
|
295
|
|
Charity care patients
|
|
33
|
|
|
29
|
|
|
63
|
|
|
68
|
|
||||
Total
|
|
$
|
193
|
|
|
$
|
180
|
|
|
$
|
383
|
|
|
$
|
363
|
|
Medicaid DSH and other supplemental revenues
|
|
$
|
164
|
|
|
$
|
215
|
|
|
$
|
322
|
|
|
$
|
442
|
|
|
|
Three Months Ended
June 30, |
|
Six Months Ended
June 30, |
||||||||||||
|
|
2017
|
|
2016
|
|
2017
|
|
2016
|
||||||||
Net operating revenues:
|
|
|
|
|
|
|
|
|
|
|
|
|
||||
General hospitals
|
|
$
|
4,084
|
|
|
$
|
4,062
|
|
|
$
|
8,179
|
|
|
$
|
8,364
|
|
Other operations
|
|
1,089
|
|
|
1,158
|
|
|
2,190
|
|
|
2,276
|
|
||||
Net operating revenues before provision for doubtful accounts
|
|
5,173
|
|
|
5,220
|
|
|
10,369
|
|
|
10,640
|
|
||||
Less provision for doubtful accounts
|
|
371
|
|
|
352
|
|
|
754
|
|
|
728
|
|
||||
Net operating revenues
|
|
4,802
|
|
|
4,868
|
|
|
9,615
|
|
|
9,912
|
|
||||
Equity in earnings of unconsolidated affiliates
|
|
28
|
|
|
30
|
|
|
57
|
|
|
54
|
|
||||
Operating expenses:
|
|
|
|
|
|
|
|
|
|
|
|
|
||||
Salaries, wages and benefits
|
|
2,346
|
|
|
2,309
|
|
|
4,726
|
|
|
4,704
|
|
||||
Supplies
|
|
780
|
|
|
773
|
|
|
1,545
|
|
|
1,584
|
|
||||
Other operating expenses, net
|
|
1,159
|
|
|
1,213
|
|
|
2,346
|
|
|
2,455
|
|
||||
Electronic health record incentives
|
|
(6
|
)
|
|
(21
|
)
|
|
(7
|
)
|
|
(21
|
)
|
||||
Depreciation and amortization
|
|
222
|
|
|
215
|
|
|
443
|
|
|
427
|
|
||||
Impairment and restructuring charges, and acquisition-related costs
|
|
41
|
|
|
22
|
|
|
74
|
|
|
50
|
|
||||
Litigation and investigation costs
|
|
1
|
|
|
114
|
|
|
6
|
|
|
287
|
|
||||
Gains on sales, consolidation and deconsolidation of facilities
|
|
(23
|
)
|
|
(1
|
)
|
|
(38
|
)
|
|
(148
|
)
|
||||
Operating income
|
|
$
|
310
|
|
|
$
|
274
|
|
|
$
|
577
|
|
|
$
|
628
|
|
|
|
Three Months Ended
June 30, |
|
Six Months Ended
June 30, |
||||||||
|
|
2017
|
|
2016
|
|
2017
|
|
2016
|
||||
Net operating revenues
|
|
100.0
|
%
|
|
100.0
|
%
|
|
100.0
|
%
|
|
100.0
|
%
|
Equity in earnings of unconsolidated affiliates
|
|
0.6
|
%
|
|
0.6
|
%
|
|
0.6
|
%
|
|
0.5
|
%
|
Operating expenses:
|
|
|
|
|
|
|
|
|
|
|
|
|
Salaries, wages and benefits
|
|
48.9
|
%
|
|
47.4
|
%
|
|
49.2
|
%
|
|
47.5
|
%
|
Supplies
|
|
16.2
|
%
|
|
15.9
|
%
|
|
16.1
|
%
|
|
16.0
|
%
|
Other operating expenses, net
|
|
24.1
|
%
|
|
24.9
|
%
|
|
24.4
|
%
|
|
24.8
|
%
|
Electronic health record incentives
|
|
(0.1
|
)%
|
|
(0.4
|
)%
|
|
(0.1
|
)%
|
|
(0.2
|
)%
|
Depreciation and amortization
|
|
4.6
|
%
|
|
4.4
|
%
|
|
4.6
|
%
|
|
4.3
|
%
|
Impairment and restructuring charges, and acquisition-related costs
|
|
0.9
|
%
|
|
0.5
|
%
|
|
0.8
|
%
|
|
0.5
|
%
|
Litigation and investigation costs
|
|
—
|
%
|
|
2.3
|
%
|
|
0.1
|
%
|
|
2.9
|
%
|
Gains on sales, consolidation and deconsolidation of facilities
|
|
(0.5
|
)%
|
|
—
|
%
|
|
(0.4
|
)%
|
|
(1.5
|
)%
|
Operating income
|
|
6.5
|
%
|
|
5.6
|
%
|
|
6.0
|
%
|
|
6.3
|
%
|
|
|
Three Months Ended
June 30, |
|
Six Months Ended
June 30, |
||||||||||||||||||
Selected Operating Expenses
|
|
2017
|
|
2016
|
|
Increase
(Decrease)
|
|
2017
|
|
2016
|
|
Increase
(Decrease)
|
||||||||||
Hospital Operations and other — Same-Hospital
|
|
|
|
|
|
|
|
|
|
|
|
|
||||||||||
Salaries, wages and benefits
|
|
$
|
1,930
|
|
|
$
|
1,917
|
|
|
0.7
|
%
|
|
$
|
3,897
|
|
|
$
|
3,845
|
|
|
1.4
|
%
|
Supplies
|
|
680
|
|
|
681
|
|
|
(0.1
|
)%
|
|
1,348
|
|
|
1,383
|
|
|
(2.5
|
)%
|
||||
Other operating expenses
|
|
966
|
|
|
1,022
|
|
|
(5.5
|
)%
|
|
1,966
|
|
|
2,042
|
|
|
(3.7
|
)%
|
||||
Total
|
|
$
|
3,576
|
|
|
$
|
3,620
|
|
|
(1.2
|
)%
|
|
$
|
7,211
|
|
|
$
|
7,270
|
|
|
(0.8
|
)%
|
Ambulatory Care
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
||||
Salaries, wages and benefits
|
|
$
|
153
|
|
|
$
|
147
|
|
|
4.1
|
%
|
|
$
|
303
|
|
|
$
|
293
|
|
|
3.4
|
%
|
Supplies
|
|
95
|
|
|
91
|
|
|
4.4
|
%
|
|
189
|
|
|
177
|
|
|
6.8
|
%
|
||||
Other operating expenses
|
|
89
|
|
|
91
|
|
|
(2.2
|
)%
|
|
174
|
|
|
177
|
|
|
(1.7
|
)%
|
||||
Total
|
|
$
|
337
|
|
|
$
|
329
|
|
|
2.4
|
%
|
|
$
|
666
|
|
|
$
|
647
|
|
|
2.9
|
%
|
Conifer
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
||||
Salaries, wages and benefits
|
|
$
|
250
|
|
|
$
|
238
|
|
|
5.0
|
%
|
|
$
|
500
|
|
|
$
|
477
|
|
|
4.8
|
%
|
Supplies
|
|
2
|
|
|
—
|
|
|
100.0
|
%
|
|
2
|
|
|
—
|
|
|
100.0
|
%
|
||||
Other operating expenses
|
|
88
|
|
|
85
|
|
|
3.5
|
%
|
|
175
|
|
|
168
|
|
|
4.2
|
%
|
||||
Total
|
|
$
|
340
|
|
|
$
|
323
|
|
|
5.3
|
%
|
|
$
|
677
|
|
|
$
|
645
|
|
|
5.0
|
%
|
Total
|
|
|
|
|
|
|
|
|
|
|
|
|
||||||||||
Salaries, wages and benefits
|
|
$
|
2,333
|
|
|
$
|
2,302
|
|
|
1.3
|
%
|
|
$
|
4,700
|
|
|
$
|
4,615
|
|
|
1.8
|
%
|
Supplies
|
|
777
|
|
|
772
|
|
|
0.6
|
%
|
|
1,539
|
|
|
1,560
|
|
|
(1.3
|
)%
|
||||
Other operating expenses
|
|
1,143
|
|
|
1,198
|
|
|
(4.6
|
)%
|
|
2,315
|
|
|
2,387
|
|
|
(3.0
|
)%
|
||||
Total
|
|
$
|
4,253
|
|
|
$
|
4,272
|
|
|
(0.4
|
)%
|
|
$
|
8,554
|
|
|
$
|
8,562
|
|
|
(0.1
|
)%
|
Rent/lease expense
(1)
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
||||
Hospital Operations and other
|
|
$
|
59
|
|
|
$
|
59
|
|
|
—
|
%
|
|
$
|
119
|
|
|
$
|
118
|
|
|
0.8
|
%
|
Ambulatory Care
|
|
19
|
|
|
20
|
|
|
(5.0
|
)%
|
|
37
|
|
|
37
|
|
|
—
|
%
|
||||
Conifer
|
|
5
|
|
|
5
|
|
|
—
|
%
|
|
10
|
|
|
9
|
|
|
11.1
|
%
|
||||
Total
|
|
$
|
83
|
|
|
$
|
84
|
|
|
(1.2
|
)%
|
|
$
|
166
|
|
|
$
|
164
|
|
|
1.2
|
%
|
|
|
|
(1)
|
Included in other operating expenses.
|
•
|
Hospital Operations and other, which
is comprised of our acute care hospitals, ancillary outpatient facilities, urgent care centers, microhospitals and physician practices
;
|
•
|
Ambulatory Care, which is comprised of our USPI joint venture’s ambulatory surgery centers, urgent care centers, imaging centers and short-stay surgical hospitals, as well as Aspen’s hospitals and clinics; and
|
•
|
Conifer, which
provides healthcare business process services in the areas of hospital and physician revenue cycle management and value-based care solutions to healthcare systems, as well as individual hospitals, physician practices, self-insured organizations, health plans and other entities
.
|
|
|
Same-Hospital
Continuing Operations
|
|
Same-Hospital
Continuing Operations
|
||||||||||||||||
|
|
Three Months Ended
June 30, |
|
Six Months Ended
June 30, |
||||||||||||||||
Admissions, Patient Days and Surgeries
|
|
2017
|
|
2016
|
|
Increase
(Decrease) |
|
2017
|
|
2016
|
|
Increase
(Decrease)
|
||||||||
Number of hospitals (at end of period)
|
|
75
|
|
|
75
|
|
|
—
|
|
(1)
|
|
75
|
|
|
75
|
|
|
—
|
|
(1)
|
Total admissions
|
|
189,473
|
|
|
193,779
|
|
|
(2.2
|
)%
|
|
|
385,655
|
|
|
396,652
|
|
|
(2.8
|
)%
|
|
Adjusted patient admissions
(2)
|
|
335,915
|
|
|
340,792
|
|
|
(1.4
|
)%
|
|
|
675,437
|
|
|
689,013
|
|
|
(2.0
|
)%
|
|
Paying admissions (excludes charity and uninsured)
|
|
179,101
|
|
|
183,474
|
|
|
(2.4
|
)%
|
|
|
365,180
|
|
|
376,760
|
|
|
(3.1
|
)%
|
|
Charity and uninsured admissions
|
|
10,372
|
|
|
10,305
|
|
|
0.7
|
%
|
|
|
20,475
|
|
|
19,892
|
|
|
2.9
|
%
|
|
Admissions through emergency department
|
|
121,212
|
|
|
122,239
|
|
|
(0.8
|
)%
|
|
|
247,279
|
|
|
251,845
|
|
|
(1.8
|
)%
|
|
Paying admissions as a percentage of total admissions
|
|
94.5
|
%
|
|
94.7
|
%
|
|
(0.2
|
)%
|
(1)
|
|
94.7
|
%
|
|
95.0
|
%
|
|
(0.3
|
)%
|
(1)
|
Charity and uninsured admissions as a
percentage of total admissions |
|
5.5
|
%
|
|
5.3
|
%
|
|
0.2
|
%
|
(1)
|
|
5.3
|
%
|
|
5.0
|
%
|
|
0.3
|
%
|
(1)
|
Emergency department admissions as a
percentage of total admissions |
|
64.0
|
%
|
|
63.1
|
%
|
|
0.9
|
%
|
(1)
|
|
64.1
|
%
|
|
63.5
|
%
|
|
0.6
|
%
|
(1)
|
Surgeries — inpatient
|
|
51,913
|
|
|
54,376
|
|
|
(4.5
|
)%
|
|
|
103,636
|
|
|
108,115
|
|
|
(4.1
|
)%
|
|
Surgeries — outpatient
|
|
71,253
|
|
|
75,825
|
|
|
(6.0
|
)%
|
|
|
140,806
|
|
|
150,185
|
|
|
(6.2
|
)%
|
|
Total surgeries
|
|
123,166
|
|
|
130,201
|
|
|
(5.4
|
)%
|
|
|
244,442
|
|
|
258,300
|
|
|
(5.4
|
)%
|
|
Patient days — total
|
|
871,816
|
|
|
897,127
|
|
|
(2.8
|
)%
|
|
|
1,792,830
|
|
|
1,858,125
|
|
|
(3.5
|
)%
|
|
Adjusted patient days
(2)
|
|
1,538,940
|
|
|
1,568,680
|
|
|
(1.9
|
)%
|
|
|
3,122,902
|
|
|
3,206,088
|
|
|
(2.6
|
)%
|
|
Average length of stay (days)
|
|
4.60
|
|
|
4.63
|
|
|
(0.6
|
)%
|
|
|
4.65
|
|
|
4.68
|
|
|
(0.6
|
)%
|
|
Licensed beds (at end of period)
|
|
20,329
|
|
|
20,380
|
|
|
(0.3
|
)%
|
|
|
20,329
|
|
|
20,380
|
|
|
(0.3
|
)%
|
|
Average licensed beds
|
|
20,329
|
|
|
20,380
|
|
|
(0.3
|
)%
|
|
|
20,331
|
|
|
20,378
|
|
|
(0.2
|
)%
|
|
Utilization of licensed beds
(3)
|
|
47.1
|
%
|
|
48.4
|
%
|
|
(1.3
|
)%
|
(1)
|
|
48.7
|
%
|
|
50.4
|
%
|
|
(1.7
|
)%
|
(1)
|
|
|
|
(1)
|
The change is the difference between 2017 and 2016 amounts shown.
|
|
(2)
|
Adjusted patient admissions/days represents actual patient admissions/days adjusted to include outpatient services provided by facilities in our Hospital Operations and other segment by multiplying actual patient admissions/days by the sum of gross inpatient revenues and outpatient revenues and dividing the results by gross inpatient revenues.
|
|
(3)
|
Utilization of licensed beds represents patient days divided by number of days in the period divided by average licensed beds.
|
|
|
Same-Hospital
Continuing Operations |
|
Same-Hospital
Continuing Operations |
||||||||||||||||
|
|
Three Months Ended
June 30, |
|
Six Months Ended
June 30, |
||||||||||||||||
Outpatient Visits
|
|
2017
|
|
2016
|
|
Increase
(Decrease) |
|
2017
|
|
2016
|
|
Increase
(Decrease) |
||||||||
Total visits
|
|
1,950,251
|
|
|
2,025,946
|
|
|
(3.7
|
)%
|
|
|
3,959,659
|
|
|
4,078,115
|
|
|
(2.9
|
)%
|
|
Paying visits (excludes charity and uninsured)
|
|
1,823,601
|
|
|
1,884,716
|
|
|
(3.2
|
)%
|
|
|
3,706,836
|
|
|
3,792,714
|
|
|
(2.3
|
)%
|
|
Charity and uninsured visits
|
|
126,650
|
|
|
141,230
|
|
|
(10.3
|
)%
|
|
|
252,823
|
|
|
285,401
|
|
|
(11.4
|
)%
|
|
Emergency department visits
|
|
694,213
|
|
|
703,276
|
|
|
(1.3
|
)%
|
|
|
1,397,248
|
|
|
1,437,032
|
|
|
(2.8
|
)%
|
|
Surgery visits
|
|
71,253
|
|
|
75,825
|
|
|
(6.0
|
)%
|
|
|
140,806
|
|
|
150,185
|
|
|
(6.2
|
)%
|
|
Paying visits as a percentage of total visits
|
|
93.5
|
%
|
|
93.0
|
%
|
|
0.5
|
%
|
(1)
|
|
93.6
|
%
|
|
93.0
|
%
|
|
0.6
|
%
|
(1)
|
Charity and uninsured visits as a percentage of total visits
|
|
6.5
|
%
|
|
7.0
|
%
|
|
(0.5
|
)%
|
(1)
|
|
6.4
|
%
|
|
7.0
|
%
|
|
(0.6
|
)%
|
(1)
|
|
|
|
(1)
|
The change is the difference between 2017 and 2016 amounts shown.
|
|
|
Same-Hospital
Continuing Operations |
|
Same-Hospital
Continuing Operations |
||||||||||||||||||
|
|
Three Months Ended
June 30, |
|
Six Months Ended
June 30, |
||||||||||||||||||
Revenues
|
|
2017
|
|
2016
|
|
Increase
(Decrease) |
|
2017
|
|
2016
|
|
Increase
(Decrease) |
||||||||||
Total segment net operating revenues
|
|
$
|
3,900
|
|
|
$
|
4,026
|
|
|
(3.1
|
)%
|
|
$
|
7,837
|
|
|
$
|
8,086
|
|
|
(3.1
|
)%
|
Selected acute care hospitals and related outpatient facilities revenue data
|
|
|
|
|
|
|
|
|
|
|
|
|
||||||||||
Net inpatient revenues
|
|
$
|
2,545
|
|
|
$
|
2,568
|
|
|
(0.9
|
)%
|
|
$
|
5,150
|
|
|
$
|
5,231
|
|
|
(1.5
|
)%
|
Net outpatient revenues
|
|
1,491
|
|
|
1,451
|
|
|
2.8
|
%
|
|
2,954
|
|
|
2,896
|
|
|
2.0
|
%
|
||||
Net patient revenues
|
|
$
|
4,036
|
|
|
$
|
4,019
|
|
|
0.4
|
%
|
|
$
|
8,104
|
|
|
$
|
8,127
|
|
|
(0.3
|
)%
|
|
|
|
|
|
|
|
|
|
|
|
|
|
||||||||||
Self-pay net inpatient revenues
|
|
$
|
112
|
|
|
$
|
114
|
|
|
(1.8
|
)%
|
|
$
|
218
|
|
|
$
|
187
|
|
|
16.6
|
%
|
Self-pay net outpatient revenues
|
|
161
|
|
|
134
|
|
|
20.1
|
%
|
|
311
|
|
|
270
|
|
|
15.2
|
%
|
||||
Total self-pay revenues
|
|
$
|
273
|
|
|
$
|
248
|
|
|
10.1
|
%
|
|
$
|
529
|
|
|
$
|
457
|
|
|
15.8
|
%
|
|
|
Same-Hospital
Continuing Operations |
|
Same-Hospital
Continuing Operations |
||||||||||||||||||
|
|
Three Months Ended
June 30, |
|
Six Months Ended
June 30, |
||||||||||||||||||
Revenues on a Per Admission,
Per Patient Day and Per Visit Basis |
|
2017
|
|
2016
|
|
Increase
(Decrease) |
|
2017
|
|
2016
|
|
Increase
(Decrease) |
||||||||||
Net inpatient revenue per admission
|
|
$
|
13,432
|
|
|
$
|
13,252
|
|
|
1.4
|
%
|
|
$
|
13,354
|
|
|
$
|
13,188
|
|
|
1.3
|
%
|
Net inpatient revenue per patient day
|
|
$
|
2,919
|
|
|
$
|
2,862
|
|
|
2.0
|
%
|
|
$
|
2,873
|
|
|
$
|
2,815
|
|
|
2.1
|
%
|
Net outpatient revenue per visit
|
|
$
|
765
|
|
|
$
|
716
|
|
|
6.8
|
%
|
|
$
|
746
|
|
|
$
|
710
|
|
|
5.1
|
%
|
Net patient revenue per adjusted patient admission
(1)
|
|
$
|
12,015
|
|
|
$
|
11,793
|
|
|
1.9
|
%
|
|
$
|
11,998
|
|
|
$
|
11,795
|
|
|
1.7
|
%
|
Net patient revenue per adjusted patient day
(1)
|
|
$
|
2,623
|
|
|
$
|
2,562
|
|
|
2.4
|
%
|
|
$
|
2,595
|
|
|
$
|
2,535
|
|
|
2.4
|
%
|
|
|
|
(1)
|
Adjusted patient admissions/days represents actual patient admissions/days adjusted to include outpatient services provided by facilities in our Hospital Operations and other segment by multiplying actual patient admissions/days by the sum of gross inpatient revenues and outpatient revenues and dividing the results by gross inpatient revenues.
|
|
|
Same-Hospital
Continuing Operations |
|
Same-Hospital
Continuing Operations |
||||||||||||||||||||
|
|
Three Months Ended
June 30, |
|
Six Months Ended
June 30, |
||||||||||||||||||||
Total Segment Provision for Doubtful Accounts
|
|
2017
|
|
2016
|
|
Increase
(Decrease) |
|
2017
|
|
2016
|
|
Increase
(Decrease) |
||||||||||||
Provision for doubtful accounts
|
|
$
|
358
|
|
|
$
|
327
|
|
|
9.5
|
%
|
|
|
$
|
730
|
|
|
$
|
665
|
|
|
9.8
|
%
|
|
Provision for doubtful accounts as a percentage of net operating revenues before provision for doubtful accounts
|
|
8.4
|
%
|
|
7.5
|
%
|
|
0.9
|
%
|
(1)
|
|
8.5
|
%
|
|
7.6
|
%
|
|
0.9
|
%
|
(1)
|
|
|
|
(1)
|
The change is the difference between 2017 and 2016 amounts shown.
|
|
|
Same-Hospital
Continuing Operations |
|
Same-Hospital
Continuing Operations |
|||||||||||||||||
|
|
Three Months Ended
June 30, |
|
Six Months Ended
June 30, |
|||||||||||||||||
Total Segment Selected Operating Expenses
|
|
2017
|
|
2016
|
|
Increase
(Decrease) |
|
2017
|
|
2016
|
|
Increase
(Decrease) |
|||||||||
Salaries, wages and benefits as a percentage of net
operating revenues |
|
49.5
|
%
|
|
47.6
|
%
|
|
1.9
|
%
|
(1)
|
|
49.7
|
%
|
|
47.6
|
%
|
|
2.1
|
%
|
(1
|
)
|
Supplies as a percentage of net operating revenues
|
|
17.4
|
%
|
|
16.9
|
%
|
|
0.5
|
%
|
(1)
|
|
17.2
|
%
|
|
17.1
|
%
|
|
0.1
|
%
|
(1
|
)
|
Other operating expenses as a percentage of net operating revenues
|
|
24.8
|
%
|
|
25.4
|
%
|
|
(0.6
|
)%
|
(1)
|
|
25.1
|
%
|
|
25.3
|
%
|
|
(0.2
|
)%
|
(1
|
)
|
|
|
|
(1)
|
The change is the difference between 2017 and 2016 amounts shown.
|
|
|
June 30, 2017
|
|
December 31, 2016
|
||||||||||||||||||||
|
|
Accounts
Receivable
Before
Allowance
for Doubtful
Accounts
|
|
Allowance
for Doubtful
Accounts
|
|
Net
|
|
Accounts
Receivable
Before
Allowance
for Doubtful
Accounts
|
|
Allowance
for Doubtful
Accounts
|
|
Net
|
||||||||||||
Medicare
|
|
$
|
269
|
|
|
$
|
—
|
|
|
$
|
269
|
|
|
$
|
294
|
|
|
$
|
—
|
|
|
$
|
294
|
|
Medicaid
|
|
109
|
|
|
—
|
|
|
109
|
|
|
125
|
|
|
—
|
|
|
125
|
|
||||||
Net cost report settlements payable and valuation allowances
|
|
(17
|
)
|
|
—
|
|
|
(17
|
)
|
|
(14
|
)
|
|
—
|
|
|
(14
|
)
|
||||||
Managed care
|
|
1,754
|
|
|
178
|
|
|
1,576
|
|
|
1,911
|
|
|
190
|
|
|
1,721
|
|
||||||
Self-pay uninsured
|
|
444
|
|
|
388
|
|
|
56
|
|
|
479
|
|
|
412
|
|
|
67
|
|
||||||
Self-pay balance after insurance
|
|
227
|
|
|
136
|
|
|
91
|
|
|
226
|
|
|
147
|
|
|
79
|
|
||||||
Estimated future recoveries
|
|
129
|
|
|
—
|
|
|
129
|
|
|
141
|
|
|
—
|
|
|
141
|
|
||||||
Other payers
|
|
538
|
|
|
218
|
|
|
320
|
|
|
537
|
|
|
239
|
|
|
298
|
|
||||||
Total Hospital Operations and other
|
|
3,453
|
|
|
920
|
|
|
2,533
|
|
|
3,699
|
|
|
988
|
|
|
2,711
|
|
||||||
Ambulatory Care
|
|
217
|
|
|
46
|
|
|
171
|
|
|
227
|
|
|
43
|
|
|
184
|
|
||||||
Total discontinued operations
|
|
2
|
|
|
—
|
|
|
2
|
|
|
2
|
|
|
—
|
|
|
2
|
|
||||||
|
|
$
|
3,672
|
|
|
$
|
966
|
|
|
$
|
2,706
|
|
|
$
|
3,928
|
|
|
$
|
1,031
|
|
|
$
|
2,897
|
|
|
|
June 30, 2017
|
|||||||||||||
|
|
Medicare
|
|
Medicaid
|
|
Managed
Care |
|
Indemnity,
Self-Pay and Other |
|
Total
|
|||||
0-60 days
|
|
93
|
%
|
|
72
|
%
|
|
65
|
%
|
|
28
|
%
|
|
60
|
%
|
61-120 days
|
|
4
|
%
|
|
15
|
%
|
|
13
|
%
|
|
14
|
%
|
|
12
|
%
|
121-180 days
|
|
1
|
%
|
|
6
|
%
|
|
7
|
%
|
|
9
|
%
|
|
7
|
%
|
Over 180 days
|
|
2
|
%
|
|
7
|
%
|
|
15
|
%
|
|
49
|
%
|
|
21
|
%
|
Total
|
|
100
|
%
|
|
100
|
%
|
|
100
|
%
|
|
100
|
%
|
|
100
|
%
|
|
|
December 31, 2016
|
|||||||||||||
|
|
Medicare
|
|
Medicaid
|
|
Managed
Care |
|
Indemnity,
Self-Pay and Other |
|
Total
|
|||||
0-60 days
|
|
92
|
%
|
|
75
|
%
|
|
61
|
%
|
|
24
|
%
|
|
60
|
%
|
61-120 days
|
|
5
|
%
|
|
15
|
%
|
|
15
|
%
|
|
14
|
%
|
|
13
|
%
|
121-180 days
|
|
2
|
%
|
|
4
|
%
|
|
8
|
%
|
|
10
|
%
|
|
6
|
%
|
Over 180 days
|
|
1
|
%
|
|
6
|
%
|
|
16
|
%
|
|
52
|
%
|
|
21
|
%
|
Total
|
|
100
|
%
|
|
100
|
%
|
|
100
|
%
|
|
100
|
%
|
|
100
|
%
|
|
|
June 30,
|
|
December 31,
|
||||
|
|
2017
|
|
2016
|
||||
0-60 days
|
|
$
|
72
|
|
|
$
|
84
|
|
61-120 days
|
|
8
|
|
|
13
|
|
||
121-180 days
|
|
4
|
|
|
4
|
|
||
Over 180 days
|
|
3
|
|
|
4
|
|
||
Total
|
|
$
|
87
|
|
|
$
|
105
|
|
•
|
decreased
expenses associated with our health plan businesses
of
$96 million
due to the sale and wind-down of these businesses in 2017; and
|
•
|
gains on the sales of assets of $23 million primarily related to the sale of home health and hospice assets; partially offset by
|
•
|
increased
medical fees
of
$10 million
;
|
•
|
increased
costs of
contracted services
of
$11 million
;
|
•
|
increased costs associated with funding indigent care services of $16 million, which costs were substantially offset by additional net patient revenues;
|
•
|
increased
malpractice expense
of
$27 million
; and
|
•
|
the effect of lower volumes on operating leverage due to certain fixed costs.
|
•
|
decreased
expenses associated with our health plan businesses
of
$139 million
due to the sale and wind-down of these businesses in 2017; and
|
•
|
gains on the sales of assets of $23 million primarily related to the sale of home health and hospice assets; partially offset by
|
•
|
increased
medical fees
of
$19 million
;
|
•
|
increased
costs of
contracted services
of
$32 million
;
|
•
|
increased costs associated with funding indigent care services of $18 million, which costs were substantially offset by additional net patient revenues;
|
•
|
increased
malpractice expense
of
$7 million
; and
|
•
|
the effect of lower volumes on operating leverage due to certain fixed costs.
|
•
|
management services revenues, computed as a percentage of each facility’s net revenues (often net of bad debt expense); and
|
•
|
our share of each facility’s net income (loss), which is computed by multiplying the facility’s net income (loss) times the percentage of each facility’s equity interests owned by our USPI joint venture.
|
•
|
equity in earnings of unconsolidated affiliates
—our share of the net income of each facility, which is based on the facility’s net income and the percentage of the facility’s outstanding equity interests owned by us; and
|
•
|
management and administrative services revenues, which is included in our net operating revenues
—income we earn for managing the day-to-day operations of each facility, usually quantified as a percentage of each facility’s net revenues less bad debt expense.
|
|
|
Three Months Ended
June 30, |
|
Six Months Ended
June 30, |
||||||||||||||||||
Ambulatory Care Results of Operations
|
|
2017
|
|
2016
|
|
Increase
(Decrease) |
|
2017
|
|
2016
|
|
Increase
(Decrease) |
||||||||||
Net operating revenues
|
|
$
|
472
|
|
|
$
|
442
|
|
|
6.8
|
%
|
|
$
|
927
|
|
|
$
|
871
|
|
|
6.4
|
%
|
Equity in earnings of unconsolidated affiliates
|
|
$
|
30
|
|
|
$
|
26
|
|
|
15.4
|
%
|
|
$
|
57
|
|
|
$
|
51
|
|
|
11.8
|
%
|
Salaries, wages and benefits
|
|
$
|
153
|
|
|
$
|
147
|
|
|
4.1
|
%
|
|
$
|
303
|
|
|
$
|
293
|
|
|
3.4
|
%
|
Supplies
|
|
$
|
96
|
|
|
$
|
91
|
|
|
5.5
|
%
|
|
$
|
190
|
|
|
$
|
177
|
|
|
7.3
|
%
|
Other operating expenses, net
|
|
$
|
89
|
|
|
$
|
91
|
|
|
(2.2
|
)%
|
|
$
|
174
|
|
|
$
|
177
|
|
|
(1.7
|
)%
|
Ambulatory Care Facility Growth
|
|
Three Months Ended
June 30, 2017 |
|
Six Months Ended
June 30, 2017 |
||
Net revenues
|
|
3.8
|
%
|
|
4.9
|
%
|
Cases
|
|
(0.5
|
)%
|
|
—
|
%
|
Net revenue per case
|
|
4.3
|
%
|
|
4.9
|
%
|
Ambulatory Care Facilities with Healthcare System Partners
|
|
Six Months Ended
June 30, 2017 |
|
Facilities:
|
|
|
|
With a healthcare system partner
|
|
180
|
|
Without a healthcare system partner
|
|
146
|
|
Total facilities operated
|
|
326
|
|
Change from December 31, 2016
|
|
|
|
Acquisitions
|
|
4
|
|
De novo
|
|
—
|
|
Dispositions/Mergers
|
|
(1
|
)
|
Total increase in number of facilities operated
|
|
3
|
|
|
Three Months Ended
June 30, |
|
Six Months Ended
June 30, |
||||||||||||
|
2017
|
|
2016
|
|
2017
|
|
2016
|
||||||||
Tax expense at statutory federal rate of 35%
|
$
|
7
|
|
|
$
|
9
|
|
|
$
|
8
|
|
|
$
|
46
|
|
State income taxes, net of federal income tax benefit
|
12
|
|
|
(6
|
)
|
|
5
|
|
|
7
|
|
||||
Tax benefit attributable to noncontrolling interests
|
(28
|
)
|
|
(26
|
)
|
|
(54
|
)
|
|
(47
|
)
|
||||
Nondeductible goodwill
|
—
|
|
|
—
|
|
|
—
|
|
|
29
|
|
||||
Nontaxable gains
|
—
|
|
|
—
|
|
|
—
|
|
|
(17
|
)
|
||||
Nondeductible litigation
|
—
|
|
|
7
|
|
|
—
|
|
|
33
|
|
||||
Change in tax contingency reserves, including interest
|
—
|
|
|
—
|
|
|
(2
|
)
|
|
(3
|
)
|
||||
Stock-based compensation
|
1
|
|
|
—
|
|
|
9
|
|
|
—
|
|
||||
Other items
|
(4
|
)
|
|
—
|
|
|
(11
|
)
|
|
3
|
|
||||
|
$
|
(12
|
)
|
|
$
|
(16
|
)
|
|
$
|
(45
|
)
|
|
$
|
51
|
|
|
|
Three Months Ended
|
Six Months Ended
|
|||||||||||||
|
|
June 30,
|
June 30,
|
|||||||||||||
|
|
2017
|
|
2016
|
|
2017
|
|
2016
|
||||||||
Net loss attributable to Tenet Healthcare Corporation common shareholders
|
|
$
|
(55
|
)
|
|
$
|
(46
|
)
|
|
$
|
(108
|
)
|
|
$
|
(105
|
)
|
Less: Net income attributable to noncontrolling interests
|
|
(87
|
)
|
|
(85
|
)
|
|
(176
|
)
|
|
(178
|
)
|
||||
Net income (loss) from discontinued operations, net of tax
|
|
1
|
|
|
(2
|
)
|
|
—
|
|
|
(6
|
)
|
||||
Net income from continuing operations
|
|
31
|
|
|
41
|
|
|
68
|
|
|
79
|
|
||||
Income tax benefit (expense)
|
|
12
|
|
|
16
|
|
|
45
|
|
|
(51
|
)
|
||||
Loss from early extinguishment of debt
|
|
(26
|
)
|
|
—
|
|
|
(26
|
)
|
|
—
|
|
||||
Other non-operating expense, net
|
|
(5
|
)
|
|
(5
|
)
|
|
(10
|
)
|
|
(11
|
)
|
||||
Interest expense
|
|
(260
|
)
|
|
(244
|
)
|
|
(518
|
)
|
|
(487
|
)
|
||||
Operating income
|
|
310
|
|
|
274
|
|
|
577
|
|
|
628
|
|
||||
Litigation and investigation costs
|
|
(1
|
)
|
|
(114
|
)
|
|
(6
|
)
|
|
(287
|
)
|
||||
Gains on sales, consolidation and deconsolidation of facilities
|
|
23
|
|
|
1
|
|
|
38
|
|
|
148
|
|
||||
Impairment and restructuring charges, and acquisition-related costs
|
|
(41
|
)
|
|
(22
|
)
|
|
(74
|
)
|
|
(50
|
)
|
||||
Depreciation and amortization
|
|
(222
|
)
|
|
(215
|
)
|
|
(443
|
)
|
|
(427
|
)
|
||||
Loss from divested and closed businesses
(i.e., the Company’s health plan businesses) |
|
(19
|
)
|
|
(5
|
)
|
|
(35
|
)
|
|
(2
|
)
|
||||
Adjusted EBITDA
|
|
$
|
570
|
|
|
$
|
629
|
|
|
$
|
1,097
|
|
|
$
|
1,246
|
|
|
|
|
|
|
|
|
|
|
||||||||
Net operating revenues
|
|
$
|
4,802
|
|
|
$
|
4,868
|
|
|
$
|
9,615
|
|
|
$
|
9,912
|
|
Less: Net operating revenues from health plans
|
|
25
|
|
|
136
|
|
|
90
|
|
|
263
|
|
||||
Adjusted net operating revenues
|
|
$
|
4,777
|
|
|
$
|
4,732
|
|
|
$
|
9,525
|
|
|
$
|
9,649
|
|
|
|
|
|
|
|
|
|
|
||||||||
Net loss attributable to Tenet Healthcare Corporation common shareholders as a % of net operating revenues
|
|
(1.1
|
)%
|
|
(0.9
|
)%
|
|
(1.1
|
)%
|
|
(1.1
|
)%
|
||||
|
|
|
|
|
|
|
|
|
||||||||
Adjusted EBITDA as % of adjusted net operating revenues (Adjusted EBITDA margin)
|
|
11.9
|
%
|
|
13.3
|
%
|
|
11.5
|
%
|
|
12.9
|
%
|
•
|
Decreased income from continuing operations before income taxes of
$149 million
,
excluding investment earnings (losses), gain (loss) from early extinguishment of debt, interest expense, gains on sales, consolidation and deconsolidation of facilities, litigation and investigation costs, impairment and restructuring charges, and acquisition-related costs, depreciation and amortization, and income (loss) from divested operations and closed businesses (i.e., our health plan businesses)
in the
six
months ended
June 30, 2017
compared to the
six
months ended
June 30, 2016
;
|
•
|
A
$37 million
decrease
in payments on reserves for restructuring charges, acquisition-related costs, and litigation costs and settlements;
|
•
|
Reduced cash flows from our health plan businesses of $65 million due to cash outflows in the 2017 period resulting from the sales and wind-down of these businesses in 2017, compared to slightly positive cash flows in the 2016 period; and
|
•
|
The timing of other working capital items.
|
|
|
Maturity Date, Years Ending December 31,
|
|
|
|
|
|
|
||||||||||||||||||||||||
|
|
2017
|
|
2018
|
|
2019
|
|
2020
|
|
2021
|
|
Thereafter
|
|
Total
|
|
Fair Value
|
||||||||||||||||
|
|
(Dollars in Millions)
|
||||||||||||||||||||||||||||||
Fixed rate long-term debt
|
|
$
|
105
|
|
|
$
|
1,148
|
|
|
$
|
1,684
|
|
|
$
|
3,406
|
|
|
$
|
1,942
|
|
|
$
|
7,081
|
|
|
$
|
15,366
|
|
|
$
|
15,901
|
|
Average effective interest rates
|
|
5.4
|
%
|
|
6.5
|
%
|
|
5.5
|
%
|
|
6.7
|
%
|
|
4.7
|
%
|
|
7.7
|
%
|
|
6.7
|
%
|
|
|
(4
|
)
|
|
Instruments Defining the Rights of Security Holders, Including Indentures
|
|
|
|
|
|
|
|
|
(a)
|
Twenty-Ninth Supplemental Indenture, dated as of June 14, 2017, among the Registrant, The Bank of New York Mellon Trust Company, N.A., as successor trustee to The Bank of New York, and the guarantors party thereto, relating to 4.625% Senior Secured First Lien Notes due 2024 (Incorporated by reference to Exhibit 4.2 to Registrant’s Current Report on Form 8-K, dated June 14, 2017 and filed June 16, 2017)
|
|
|
|
|
|
|
|
|
(b)
|
Senior Secured First Lien Notes Indenture, dated as of June 14, 2017, between THC Escrow Corporation III and The Bank of New York Mellon Trust Company, N.A., as trustee, relating to 4.625% Senior Secured First Lien Notes due 2024 (Incorporated by reference to Exhibit 4.3 to Registrant’s Current Report on Form 8-K, dated June 14, 2017 and filed June 16, 2017)
|
|
|
|
|
|
|
|
|
(c)
|
Senior Secured Second Lien Notes Indenture, dated as of June 14, 2017, between THC Escrow Corporation III and The Bank of New York Mellon Trust Company, N.A., as trustee, relating to 5.125% Senior Secured Second Lien Notes due 2025 (Incorporated by reference to Exhibit 4.4 to Registrant’s Current Report on Form 8-K, dated June 14, 2017 and filed June 16, 2017)
|
|
|
|
|
|
|
|
|
(d)
|
Unsecured Notes Indenture, dated as of June 14, 2017, between THC Escrow Corporation III and The Bank of New York Mellon Trust Company, N.A., as trustee, relating to 7.000% Senior Notes due 2025 (Incorporated by reference to Exhibit 4.5 to Registrant’s Current Report on Form 8-K, dated June 14, 2017 and filed June 16, 2017)
|
|
|
|
|
||
(10)
|
|
|
Material Contracts
|
|
|
|
|
||
|
|
(a)
|
Exchange and Registration Rights Agreement, dated as of June 14, 2017, among the Registrant, certain of its subsidiaries and Barclays Capital Inc. as representative of the other initial purchasers of the Notes named therein (Incorporated by reference to Exhibit 10.1 to Registrant’s Current Report on Form 8-K, dated June 14, 2017 and filed June 16, 2017)
|
|
|
|
|
|
|
(31)
|
|
|
Rule 13a-14(a)/15d-14(a) Certifications
|
|
|
|
|
|
|
|
|
(a)
|
Certification of Trevor Fetter, Chief Executive Officer and Chairman of the Board of Directors
|
|
|
|
|
|
|
|
|
(b)
|
Certification of Daniel J. Cancelmi, Chief Financial Officer
|
|
|
|
|
|
|
(32)
|
|
|
Section 1350 Certification of Trevor Fetter, Chief Executive Officer and Chairman of the Board of Directors, and Daniel J. Cancelmi, Chief Financial Officer
|
|
|
|
|
|
|
(101 INS)
|
|
|
XBRL Instance Document
|
|
|
|
|
||
(101 SCH)
|
|
|
XBRL Taxonomy Extension Schema Document
|
|
|
|
|
|
|
(101 CAL)
|
|
|
XBRL Taxonomy Extension Calculation Linkbase Document
|
|
|
|
|
||
(101 DEF)
|
|
|
XBRL Taxonomy Extension Definition Linkbase Document
|
|
|
|
|
||
(101 LAB)
|
|
|
XBRL Taxonomy Extension Label Linkbase Document
|
|
|
|
|
||
(101 PRE)
|
|
|
XBRL Taxonomy Extension Presentation Linkbase Document
|
|
|
TENET HEALTHCARE CORPORATION
(Registrant)
|
|
|
|
Date: August 7, 2017
|
By:
|
/s/ R. SCOTT RAMSEY
|
|
|
R. Scott Ramsey
|
|
|
Vice President and Controller
|
|
|
(Principal Accounting Officer)
|
1 Year Tenet Healthcare Chart |
1 Month Tenet Healthcare Chart |
It looks like you are not logged in. Click the button below to log in and keep track of your recent history.
Support: +44 (0) 203 8794 460 | support@advfn.com
By accessing the services available at ADVFN you are agreeing to be bound by ADVFN's Terms & Conditions