Fiscal Year 2013 Outlook Confirmed
NASHVILLE, Tenn.--(BUSINESS WIRE)--Oct. 30, 2012--
Vanguard Health Systems, Inc. (NYSE: VHS) today announced financial and
operating results for its first fiscal quarter of 2013 and confirmed its
outlook for fiscal year 2013.
First Quarter Fiscal 2013 Key Metrics
(all percentage changes compare Q1 FY2013 to Q1 FY2012):
Consolidated:
-
Net income attributable to Vanguard Health Systems, Inc. stockholders
was $13.9 million, or $0.17 per diluted share, compared to a net loss
of $21.7 million, or $(0.29) per diluted share, during the prior year
period
-
Adjusted EBITDA increased 12.2 percent to $133.2 million
Same Store:
-
Patient revenue per adjusted discharge increased 2.0 percent
-
Discharges decreased 1.9 percent
-
Adjusted discharges decreased 0.8 percent
A reconciliation of Adjusted EBITDA, a non-GAAP financial measure, to
net income (loss) attributable to Vanguard Health Systems, Inc.
stockholders for the quarters ended September 30, 2011 and 2012 is
included in this release.
First Quarter Analysis
Consolidated total revenues increased $34.4 million during the first
quarter of fiscal 2013 compared to the prior year period, primarily due
to the acquisition of Valley Baptist Health System in September 2011.
Same store net patient service revenues increased 0.6 percent during the
first quarter of fiscal 2013 resulting from a 2.0 percent increase in
patient revenue per adjusted discharge combined with a 0.8 percent
decrease in adjusted discharges. Health plan premium revenues, on a same
store basis, decreased 21.5 percent during the first quarter of fiscal
2013 due to the impact on Phoenix Health Plan of a combination of
capitation rate decreases, program eligibility cuts and health plan
profitability limitations for certain groups of covered members adopted
by the Arizona Health Care Cost Containment System (“AHCCCS”) during
fiscal 2012.
Same store uncompensated care as a percentage of net patient revenues
(prior to the uncompensated care deductions) increased from 17.9 percent
during the first quarter of fiscal 2012 to 20.8 percent during the first
quarter of fiscal 2013 primarily due to an increase in uninsured
discharges as a percentage of total discharges.
Balance Sheet and Cash Flows
As of September 30, 2012, we had cash of $330.2 million and total debt
of $2,704.6 million.
Cash flows from operating activities improved by $31.4 million during
the first quarter of fiscal 2013 compared to the prior year period.
Changes in net operating assets and liabilities negatively impacted
operating cash flows by $144.6 million during the first quarter of
fiscal 2013 compared to a negative impact of $166.5 million during the
prior year period. We made $89.0 million of interest and income tax
payments during the first quarter of fiscal 2013, which was $17.9
million higher than these payments during the prior year period. Cash
flows from operations during the first quarter of fiscal 2013 were
negatively impacted by the timing of payments of accounts payable and
certain accrued expenses and significant employer contributions to The
Detroit Medical Center (“DMC”) defined benefit pension plan, but were
positively impacted by improved cash collections of accounts receivable
and the receipt of certain settlement receivables from the federal
government.
Capital expenditures increased 30.4 percent to $82.7 million during the
first quarter of fiscal 2013 compared to the prior year period due to
increased spending related to the DMC specified capital project
commitments and the start of construction of a new hospital in New
Braunfels, Texas.
Outlook for Fiscal Year 2013
We are confirming our previously issued fiscal year 2013 outlook for
ranges of projected Adjusted EBITDA, projected net income attributable
to Vanguard Health Systems, Inc. stockholders, projected diluted
earnings per share and projected capital expenditures.
Earnings Conference Call
We will host a conference call at 11:00 a.m. EDT on October 31, 2012.
All interested parties are invited to access a live webcast of the
conference call on the Investor Relations Section of our website at http://vanguardhealth.com.
If you are unable to participate during the live webcast, the
webcast will be available on a replay basis for 90 days.
We own and operate 28 acute care and specialty hospitals and
complementary facilities and services in metropolitan Chicago, Illinois;
metropolitan Detroit, Michigan; metropolitan Phoenix, Arizona; San
Antonio, Texas; Harlingen and Brownsville, Texas; and Worcester and
metropolitan Boston, Massachusetts. Our strategy is to develop locally
branded, comprehensive health care delivery networks in urban markets.
Cautionary Statement about Forward-Looking Information
This press release contains “forward-looking statements” within the
meaning of the federal securities laws that are intended to be covered
by safe harbors created thereby. Forward-looking statements are those
statements that are based upon management’s plans, objectives, goals,
strategies, future events, future revenue or performance, capital
expenditures, financing needs, plans or intentions relating to
acquisitions, business trends and other information that is not
historical information. These statements are based upon estimates and
assumptions made by our management that, although believed to be
reasonable, are subject to numerous factors, risks and uncertainties
that could cause actual outcomes and results to be materially different
from those projected. When used in this press release, the words
“estimates,” “expects,” “anticipates,” “projects,” “plans,” “intends,”
“believes,” “forecasts,” “continues” or future or conditional verbs,
such as “will,” “should,” “could” or “may,” and variations of such words
or similar expressions are intended to identify forward-looking
statements. These factors, risks and uncertainties include, among
others, the following: our high degree of leverage and interest rate
risk; our ability to incur substantially more debt; operating and
financial restrictions in our debt agreements; our ability to generate
cash necessary to service our debt; weakened economic conditions and
volatile capital markets; potential liability related to disclosures of
relationships between physicians and our hospitals; potential adverse
impact of pre-payment and post-payment claims reviews by governmental
agencies; our ability to grow our business and successfully implement
our business strategies, including growing our ambulatory care services
platform; our ability to successfully integrate hospitals or ambulatory
care facilities acquired in the future or to recognize expected
synergies from such acquisitions; potential acquisitions could be
costly, unsuccessful or subject us to unexpected liabilities; conflicts
of interest that may arise as a result of our control by a small number
of stockholders; the highly competitive nature of the health care
industry; the geographic concentration of our operations; governmental
regulation of the health care industry, including Medicare and Medicaid
reimbursement levels in general and with respect to the impact of the
Budget Control Act of 2011 and other future deficit reduction plans; a
reduction or elimination of supplemental Medicare and Medicaid payments
on which we depend, including disproportionate share payments, indirect
medical education/graduate medical education payments, upper payment
limit programs and other similar payments; pressures to contain costs by
managed care organizations and other insurers and our ability to
negotiate acceptable terms with these third party payers; our ability to
attract and retain qualified management and health care professionals,
including physicians and nurses; the currently unknown effect on us of
the major federal health care reforms enacted by Congress in March 2010,
including the Patient Protection and Affordable Care Act, as amended by
the Health Care and Education Reconciliation Act of 2010, or other
potential additional federal or state health care reforms, including
that states may opt out of the Medicaid expansion; potential adverse
impact of known and unknown governmental investigations and audits;
increased compliance costs from further government regulation of the
health care industry and our failure to comply, or allegations of our
failure to comply, with applicable laws and regulations; our failure to
adequately enhance our facilities with technologically advanced
equipment; the availability of capital to fund our corporate growth
strategy and improvements to our existing facilities; potential lawsuits
or other claims asserted against us; our ability to maintain or increase
patient membership in and to control the costs of our managed health
care plans; failure of AHCCCS to renew its contract with, or award
future contracts to, Phoenix Health Plan; Phoenix Health Plan’s ability
to comply with the terms of its contract with AHCCCS; our inability to
manage health plan claims expense within our health plans; reductions in
the enrollment of our health plans; changes in general economic
conditions nationally and regionally in our markets; our exposure to the
increased amounts of and collection risks associated with uninsured
accounts and the co-pay and deductible portions of insured accounts;
dependence on our senior management team and local management personnel;
volatility of professional and general liability insurance for us and
the physicians who practice at our hospitals and increases in the
quantity and severity of professional liability claims; our ability to
achieve operating and financial targets and to maintain and increase
patient volumes and control the costs of providing services, including
salaries and benefits, supplies and other operating expenses;
technological and pharmaceutical improvements that increase the cost of
providing, or reduce the demand for, health care services and shift
demand for inpatient services to outpatient settings; a failure of our
information systems; delays in receiving payments for services provided,
especially from governmental payers; changes in revenue mix, including
changes in Medicaid eligibility criteria and potential declines in the
population covered under managed care agreements; costs and compliance
risks associated with Section 404 of the Sarbanes-Oxley Act of 2002;
material non-cash charges to earnings from impairment of goodwill
associated with declines in the fair market value of our reporting
units; cash payments that may be necessary to fund an underfunded
defined benefit pension plan of the DMC; volatility of materials and
labor costs for, or state efforts to regulate, potential construction
projects that may be necessary for future growth; our reliance on
payments from our subsidiaries, which may be restricted by our credit
agreement and the indentures governing our senior notes; changes in
accounting practices; our ability to demonstrate meaningful use of
certified electronic health record technology and to receive the related
Medicare or Medicaid incentive payments; and other risk factors
described in our Annual Report on Form 10-K and other filings with the
Securities and Exchange Commission.
Our forward-looking statements speak only as of the date made. Except as
required by law, we undertake no obligation to publicly update or revise
any forward-looking statements contained herein, whether as a result of
new information, future events or otherwise. You are cautioned not to
rely on such forward-looking statements when evaluating the information
contained in this press release. In light of significant uncertainties
inherent in the forward-looking statements included in this press
release, you should not regard the inclusion of such information as a
representation by us that the objectives and plans anticipated by the
forward-looking statements will occur or be achieved or, if any of them
do, what impact they will have on our financial condition, results of
operations or cash flows.
We use our company website to provide important information to
investors about the company, including the posting of important
announcements regarding financial performance and corporate developments.
|
|
|
VANGUARD HEALTH SYSTEMS, INC.
|
|
Condensed Consolidated Statements of Operations (Unaudited)
|
|
(In millions, except share and per share amounts)
|
|
|
|
|
|
|
|
|
Quarter ended September 30,
|
|
|
|
|
|
|
2011
|
|
|
2012
|
|
Patient service revenues
|
|
|
|
|
$
|
1,351.5
|
|
|
|
94.1
|
%
|
|
|
$
|
1,463.9
|
|
|
|
99.5
|
%
|
|
Less: Provision for doubtful accounts
|
|
|
|
|
|
(126.2
|
)
|
|
|
(8.8
|
)
|
|
|
|
(169.6
|
)
|
|
|
(11.5
|
)
|
|
Patient service revenues, net
|
|
|
|
|
|
1,225.3
|
|
|
|
85.3
|
|
|
|
|
1,294.3
|
|
|
|
88.0
|
|
|
Premium revenues
|
|
|
|
|
|
211.0
|
|
|
|
14.7
|
|
|
|
|
176.4
|
|
|
|
12.0
|
|
|
Total revenues
|
|
|
|
|
|
1,436.3
|
|
|
|
100.0
|
|
|
|
|
1,470.7
|
|
|
|
100.0
|
|
|
Costs and expenses:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Salaries and benefits (includes stock compensation)
|
|
|
|
|
|
665.0
|
|
|
|
46.3
|
|
|
|
|
680.2
|
|
|
|
46.3
|
|
|
Health plan claims expense
|
|
|
|
|
|
164.7
|
|
|
|
11.5
|
|
|
|
|
134.3
|
|
|
|
9.1
|
|
|
Supplies
|
|
|
|
|
|
213.6
|
|
|
|
14.9
|
|
|
|
|
226.1
|
|
|
|
15.4
|
|
|
Purchased services
|
|
|
|
|
|
127.0
|
|
|
|
8.8
|
|
|
|
|
147.2
|
|
|
|
10.0
|
|
|
Non-income taxes
|
|
|
|
|
|
34.5
|
|
|
|
2.4
|
|
|
|
|
34.9
|
|
|
|
2.4
|
|
|
Rents and leases
|
|
|
|
|
|
18.0
|
|
|
|
1.3
|
|
|
|
|
19.0
|
|
|
|
1.3
|
|
|
Other operating expenses
|
|
|
|
|
|
98.6
|
|
|
|
6.9
|
|
|
|
|
109.3
|
|
|
|
7.4
|
|
|
Medicare and Medicaid EHR incentives
|
|
|
|
|
|
(3.1
|
)
|
|
|
(0.2
|
)
|
|
|
|
(11.3
|
)
|
|
|
(0.8
|
)
|
|
Depreciation and amortization
|
|
|
|
|
|
62.6
|
|
|
|
4.4
|
|
|
|
|
65.6
|
|
|
|
4.5
|
|
|
Interest, net
|
|
|
|
|
|
45.8
|
|
|
|
3.2
|
|
|
|
|
50.8
|
|
|
|
3.5
|
|
|
Debt extinguishment costs
|
|
|
|
|
|
38.9
|
|
|
|
2.7
|
|
|
|
|
—
|
|
|
|
—
|
|
|
Acquisition related expenses
|
|
|
|
|
|
12.2
|
|
|
|
0.8
|
|
|
|
|
—
|
|
|
|
—
|
|
|
Other
|
|
|
|
|
|
(2.4
|
)
|
|
|
(0.2
|
)
|
|
|
|
(5.1
|
)
|
|
|
(0.3
|
)
|
|
Total costs and expenses
|
|
|
|
|
|
1,475.4
|
|
|
|
102.7
|
|
|
|
|
1,451.0
|
|
|
|
98.7
|
|
|
Income (loss) from continuing operations before income taxes
|
|
|
|
|
|
(39.1
|
)
|
|
|
(2.7
|
)
|
|
|
|
19.7
|
|
|
|
1.3
|
|
|
Income tax benefit (expense)
|
|
|
|
|
|
15.2
|
|
|
|
1.1
|
|
|
|
|
(4.9
|
)
|
|
|
(0.3
|
)
|
|
Income (loss) from continuing operations
|
|
|
|
|
|
(23.9
|
)
|
|
|
(1.7
|
)
|
|
|
|
14.8
|
|
|
|
1.0
|
|
|
Income (loss) from discontinued operations, net of taxes
|
|
|
|
|
|
(0.1
|
)
|
|
|
—
|
|
|
|
|
0.1
|
|
|
|
—
|
|
|
Net income (loss)
|
|
|
|
|
|
(24.0
|
)
|
|
|
(1.7
|
)
|
|
|
|
14.9
|
|
|
|
1.0
|
|
|
Net loss (income) attributable to non-controlling interests
|
|
|
|
|
|
2.3
|
|
|
|
0.2
|
|
|
|
|
(1.0
|
)
|
|
|
(0.1
|
)
|
|
Net income (loss) attributable to Vanguard Health Systems, Inc.
stockholders
|
|
|
|
|
$
|
(21.7
|
)
|
|
|
(1.5
|
)%
|
|
|
$
|
13.9
|
|
|
|
0.9
|
%
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Earnings (loss) per share attributable to Vanguard Health Systems,
Inc. stockholders
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Basic earnings (loss) per share
|
|
|
|
|
$
|
(0.29
|
)
|
|
|
|
|
|
$
|
0.18
|
|
|
|
|
|
Diluted earnings (loss) per share
|
|
|
|
|
$
|
(0.29
|
)
|
|
|
|
|
|
$
|
0.17
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Weighted average shares outstanding (in thousands):
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Basic
|
|
|
|
|
|
74,854
|
|
|
|
|
|
|
|
75,697
|
|
|
|
|
|
Diluted
|
|
|
|
|
|
74,854
|
|
|
|
|
|
|
|
78,813
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
VANGUARD HEALTH SYSTEMS, INC.
|
|
Supplemental Financial Information (Unaudited)
|
|
Reconciliation of Adjusted EBITDA to Net Income (Loss)
|
|
Attributable to Vanguard Health Systems, Inc. Stockholders
|
|
(In millions)
|
|
|
|
|
|
|
|
|
Quarter ended
|
|
|
|
|
|
|
September 30,
|
|
|
|
|
|
|
2011
|
|
|
2012
|
|
Net income (loss) attributable to Vanguard Health Systems, Inc.
stockholders
|
|
|
|
|
$
|
(21.7
|
)
|
|
|
$
|
13.9
|
|
|
Interest, net
|
|
|
|
|
|
45.8
|
|
|
|
|
50.8
|
|
|
Income tax expense (benefit)
|
|
|
|
|
|
(15.2
|
)
|
|
|
|
4.9
|
|
|
Depreciation and amortization
|
|
|
|
|
|
62.6
|
|
|
|
|
65.6
|
|
|
Non-controlling interests
|
|
|
|
|
|
(2.3
|
)
|
|
|
|
1.0
|
|
|
Gain on disposal of assets
|
|
|
|
|
|
(1.2
|
)
|
|
|
|
(0.9
|
)
|
|
Equity method income
|
|
|
|
|
|
(0.1
|
)
|
|
|
|
(0.6
|
)
|
|
Stock compensation
|
|
|
|
|
|
0.7
|
|
|
|
|
2.2
|
|
|
Realized losses on investments
|
|
|
|
|
|
—
|
|
|
|
|
0.2
|
|
|
Acquisition related expenses
|
|
|
|
|
|
12.2
|
|
|
|
|
—
|
|
|
Debt extinguishment costs
|
|
|
|
|
|
38.9
|
|
|
|
|
—
|
|
|
Impairment and restructuring charges
|
|
|
|
|
|
(0.1
|
)
|
|
|
|
—
|
|
|
Pension credits
|
|
|
|
|
|
(1.0
|
)
|
|
|
|
(3.8
|
)
|
|
Discontinued operations, net of taxes
|
|
|
|
|
|
0.1
|
|
|
|
|
(0.1
|
)
|
|
Adjusted EBITDA (1)
|
|
|
|
|
$
|
118.7
|
|
|
|
$
|
133.2
|
|
____________________
(1) Adjusted EBITDA is defined as income (loss) before interest expense
(net of interest income), income taxes, depreciation and amortization,
non-controlling interests, gain or loss on disposal of assets, equity
method income or loss, stock compensation, monitoring fees and expenses,
realized gains or losses on investments, acquisition related expenses,
debt extinguishment costs, impairment and restructuring charges, pension
expense (credits) and discontinued operations, net of taxes. Adjusted
EBITDA is not intended as a substitute for net income (loss)
attributable to Vanguard Health Systems, Inc. stockholders, operating
cash flows or other cash flow data determined in accordance with
accounting principles generally accepted in the United States. Due to
varying methods of calculation, Adjusted EBITDA as presented may not be
comparable to similarly titled measures of other companies.
|
|
|
VANGUARD HEALTH SYSTEMS, INC.
|
|
Condensed Consolidated Balance Sheets (Unaudited)
|
|
(In millions)
|
|
|
|
ASSETS
|
|
|
|
|
June 30, 2012
|
|
|
September 30, 2012
|
|
Current assets:
|
|
|
|
|
|
|
|
|
|
Cash and cash equivalents
|
|
|
|
|
$
|
455.5
|
|
|
|
$
|
330.2
|
|
|
Restricted cash
|
|
|
|
|
|
2.4
|
|
|
|
|
3.9
|
|
|
Accounts receivable, net of allowance for doubtful accounts of
approximately $366.5 and $363.8, respectively
|
|
|
|
|
|
702.1
|
|
|
|
|
672.4
|
|
|
Inventories
|
|
|
|
|
|
97.0
|
|
|
|
|
96.8
|
|
|
Deferred tax assets
|
|
|
|
|
|
89.6
|
|
|
|
|
89.8
|
|
|
Prepaid expenses and other current assets
|
|
|
|
|
|
236.4
|
|
|
|
|
214.8
|
|
|
Total current assets
|
|
|
|
|
|
1,583.0
|
|
|
|
|
1,407.9
|
|
|
Property, plant and equipment, net of accumulated depreciation
|
|
|
|
|
|
2,110.1
|
|
|
|
|
2,106.7
|
|
|
Goodwill
|
|
|
|
|
|
768.4
|
|
|
|
|
768.4
|
|
|
Intangible assets, net of accumulated amortization
|
|
|
|
|
|
89.0
|
|
|
|
|
87.5
|
|
|
Deferred tax assets, noncurrent
|
|
|
|
|
|
71.2
|
|
|
|
|
67.9
|
|
|
Investments in securities
|
|
|
|
|
|
51.8
|
|
|
|
|
56.8
|
|
|
Escrowed cash for capital commitments
|
|
|
|
|
|
20.3
|
|
|
|
|
—
|
|
|
Other assets
|
|
|
|
|
|
94.3
|
|
|
|
|
96.2
|
|
|
Total assets
|
|
|
|
|
$
|
4,788.1
|
|
|
|
$
|
4,591.4
|
|
|
|
|
|
|
|
|
|
|
|
|
LIABILITIES AND EQUITY
|
|
|
|
|
|
|
|
|
|
Current liabilities:
|
|
|
|
|
|
|
|
|
|
Accounts payable
|
|
|
|
|
$
|
390.6
|
|
|
|
$
|
343.2
|
|
|
Accrued salaries and benefits
|
|
|
|
|
|
226.0
|
|
|
|
|
216.4
|
|
|
Accrued health plan claims and settlements
|
|
|
|
|
|
67.8
|
|
|
|
|
66.4
|
|
|
Accrued interest
|
|
|
|
|
|
73.2
|
|
|
|
|
35.8
|
|
|
Other accrued expenses and current liabilities
|
|
|
|
|
|
219.9
|
|
|
|
|
152.3
|
|
|
Current maturities of long-term debt
|
|
|
|
|
|
11.2
|
|
|
|
|
12.5
|
|
|
Total current liabilities
|
|
|
|
|
|
988.7
|
|
|
|
|
826.6
|
|
|
Professional and general liability and workers compensation reserves
|
|
|
|
|
|
304.8
|
|
|
|
|
303.7
|
|
|
Unfunded pension liability
|
|
|
|
|
|
269.9
|
|
|
|
|
234.1
|
|
|
Other liabilities
|
|
|
|
|
|
174.7
|
|
|
|
|
161.5
|
|
|
Long-term debt, less current maturities
|
|
|
|
|
|
2,695.4
|
|
|
|
|
2,692.1
|
|
|
Commitments and contingencies
|
|
|
|
|
|
|
|
|
|
Redeemable non-controlling interests
|
|
|
|
|
|
53.1
|
|
|
|
|
54.2
|
|
|
Equity:
|
|
|
|
|
|
|
|
|
|
Vanguard Health Systems, Inc. stockholders’ equity:
|
|
|
|
|
|
|
|
|
|
Common stock
|
|
|
|
|
|
0.8
|
|
|
|
|
0.8
|
|
|
Additional paid-in capital
|
|
|
|
|
|
403.3
|
|
|
|
|
403.9
|
|
|
Accumulated other comprehensive loss
|
|
|
|
|
|
(48.4
|
)
|
|
|
|
(47.2
|
)
|
|
Retained deficit
|
|
|
|
|
|
(60.6
|
)
|
|
|
|
(46.7
|
)
|
|
Total Vanguard Health Systems, Inc. stockholders’ equity
|
|
|
|
|
|
295.1
|
|
|
|
|
310.8
|
|
|
Non-controlling interests
|
|
|
|
|
|
6.4
|
|
|
|
|
8.4
|
|
|
Total equity
|
|
|
|
|
|
301.5
|
|
|
|
|
319.2
|
|
|
Total liabilities and equity
|
|
|
|
|
$
|
4,788.1
|
|
|
|
$
|
4,591.4
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
VANGUARD HEALTH SYSTEMS, INC.
|
|
Condensed Consolidated Statements of Cash Flows (Unaudited)
|
|
(In millions)
|
|
|
|
|
|
|
|
|
Quarter ended
|
|
|
|
|
|
|
September 30,
|
|
|
|
|
|
|
2011
|
|
|
2012
|
|
Operating activities:
|
|
|
|
|
|
|
|
|
|
Net income (loss)
|
|
|
|
|
$
|
(24.0
|
)
|
|
|
$
|
14.9
|
|
|
Adjustments to reconcile net income (loss) to net cash used in
operating activities:
|
|
|
|
|
|
|
|
|
|
Loss (income) from discontinued operations
|
|
|
|
|
|
0.1
|
|
|
|
|
(0.1
|
)
|
|
Depreciation and amortization
|
|
|
|
|
|
62.6
|
|
|
|
|
65.6
|
|
|
Amortization of loan costs and accretion of principal on notes
|
|
|
|
|
|
5.7
|
|
|
|
|
3.3
|
|
|
Debt extinguishment costs
|
|
|
|
|
|
38.9
|
|
|
|
|
—
|
|
|
Acquisition related expenses
|
|
|
|
|
|
12.2
|
|
|
|
|
—
|
|
|
Stock compensation
|
|
|
|
|
|
0.7
|
|
|
|
|
2.2
|
|
|
Deferred income taxes
|
|
|
|
|
|
(16.1
|
)
|
|
|
|
2.9
|
|
|
Other
|
|
|
|
|
|
(1.3
|
)
|
|
|
|
(0.7
|
)
|
|
Changes in operating assets and liabilities
|
|
|
|
|
|
(166.5
|
)
|
|
|
|
(144.6
|
)
|
|
Net cash used in operating activities - continuing operations
|
|
|
|
|
|
(87.7
|
)
|
|
|
|
(56.5
|
)
|
|
Net cash provided by (used in) operating activities - discontinued
operations
|
|
|
|
|
|
(0.1
|
)
|
|
|
|
0.1
|
|
|
Net cash used in operating activities
|
|
|
|
|
|
(87.8
|
)
|
|
|
|
(56.4
|
)
|
|
|
|
|
|
|
|
|
|
|
|
Investing activities:
|
|
|
|
|
|
|
|
|
|
Acquisitions and related expenses, net of cash acquired
|
|
|
|
|
|
(210.1
|
)
|
|
|
|
(0.4
|
)
|
|
Capital expenditures
|
|
|
|
|
|
(63.4
|
)
|
|
|
|
(82.7
|
)
|
|
Proceeds from sales of investments in securities
|
|
|
|
|
|
22.7
|
|
|
|
|
27.1
|
|
|
Purchases of investments in securities
|
|
|
|
|
|
(21.0
|
)
|
|
|
|
(30.1
|
)
|
|
Net reimbursements from restricted cash and escrow fund
|
|
|
|
|
|
—
|
|
|
|
|
18.8
|
|
|
Other
|
|
|
|
|
|
2.2
|
|
|
|
|
1.5
|
|
|
Net cash used in investing activities
|
|
|
|
|
|
(269.6
|
)
|
|
|
|
(65.8
|
)
|
|
|
|
|
|
|
|
|
|
|
|
Financing activities:
|
|
|
|
|
|
|
|
|
|
Payments of long-term debt and capital leases
|
|
|
|
|
|
(456.5
|
)
|
|
|
|
(3.1
|
)
|
|
Payments of debt issuance costs
|
|
|
|
|
|
—
|
|
|
|
|
(0.2
|
)
|
|
Proceeds from the issuance of common stock
|
|
|
|
|
|
67.5
|
|
|
|
|
—
|
|
|
Payments of IPO costs
|
|
|
|
|
|
(6.9
|
)
|
|
|
|
—
|
|
|
Payments of tender premiums on note redemptions
|
|
|
|
|
|
(27.6
|
)
|
|
|
|
—
|
|
|
Distributions paid to non-controlling interests and other
|
|
|
|
|
|
(1.0
|
)
|
|
|
|
0.2
|
|
|
Net cash used in financing activities
|
|
|
|
|
|
(424.5
|
)
|
|
|
|
(3.1
|
)
|
|
Net decrease in cash and cash equivalents
|
|
|
|
|
|
(781.9
|
)
|
|
|
|
(125.3
|
)
|
|
Cash and cash equivalents, beginning of period
|
|
|
|
|
|
936.6
|
|
|
|
|
455.5
|
|
|
Cash and cash equivalents, end of period
|
|
|
|
|
$
|
154.7
|
|
|
|
$
|
330.2
|
|
|
|
|
|
|
|
|
|
|
|
|
Supplemental cash flow information:
|
|
|
|
|
|
|
|
|
|
Net cash paid for interest
|
|
|
|
|
$
|
70.8
|
|
|
|
$
|
85.0
|
|
|
Net cash paid for income taxes
|
|
|
|
|
$
|
0.3
|
|
|
|
$
|
4.0
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
VANGUARD HEALTH SYSTEMS, INC.
|
|
Segment Information (Unaudited)
|
|
(In millions)
|
|
|
|
|
|
|
|
|
Quarter ended September 30, 2011
|
|
|
|
|
|
|
Acute Care
|
|
|
% of
|
|
|
Health
|
|
|
% of
|
|
|
|
|
|
|
|
|
|
|
|
|
Services
|
|
|
Revenues
|
|
|
Plans
|
|
|
Revenues
|
|
|
Eliminations
|
|
|
Consolidated
|
|
Patient service revenues, net (1)
|
|
|
|
|
$
|
1,233.9
|
|
|
|
100.0
|
%
|
|
|
$
|
—
|
|
|
|
—
|
%
|
|
|
$
|
(8.6
|
)
|
|
|
$
|
1,225.3
|
|
|
Premium revenues
|
|
|
|
|
|
—
|
|
|
|
—
|
|
|
|
|
211.0
|
|
|
|
100.0
|
|
|
|
|
—
|
|
|
|
|
211.0
|
|
|
Total revenues
|
|
|
|
|
|
1,233.9
|
|
|
|
100.0
|
|
|
|
|
211.0
|
|
|
|
100.0
|
|
|
|
|
(8.6
|
)
|
|
|
|
1,436.3
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Salaries and benefits (excludes stock compensation)
|
|
|
|
|
|
655.2
|
|
|
|
53.1
|
|
|
|
|
9.1
|
|
|
|
4.3
|
|
|
|
|
—
|
|
|
|
|
664.3
|
|
|
Health plan claims expense (1)
|
|
|
|
|
|
—
|
|
|
|
—
|
|
|
|
|
173.3
|
|
|
|
82.1
|
|
|
|
|
(8.6
|
)
|
|
|
|
164.7
|
|
|
Supplies
|
|
|
|
|
|
213.6
|
|
|
|
17.3
|
|
|
|
|
—
|
|
|
|
—
|
|
|
|
|
—
|
|
|
|
|
213.6
|
|
|
Other operating expenses
|
|
|
|
|
|
267.4
|
|
|
|
21.7
|
|
|
|
|
10.7
|
|
|
|
5.1
|
|
|
|
|
—
|
|
|
|
|
278.1
|
|
|
Medicare and Medicaid EHR incentives
|
|
|
|
|
|
(3.1
|
)
|
|
|
(0.3
|
)
|
|
|
|
—
|
|
|
|
—
|
|
|
|
|
—
|
|
|
|
|
(3.1
|
)
|
|
Segment EBITDA (2)
|
|
|
|
|
|
100.8
|
|
|
|
8.2
|
|
|
|
|
17.9
|
|
|
|
8.5
|
|
|
|
|
—
|
|
|
|
|
118.7
|
|
|
Less:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Interest, net
|
|
|
|
|
|
46.1
|
|
|
|
3.7
|
|
|
|
|
(0.3
|
)
|
|
|
(0.1
|
)
|
|
|
|
—
|
|
|
|
|
45.8
|
|
|
Depreciation and amortization
|
|
|
|
|
|
61.4
|
|
|
|
5.0
|
|
|
|
|
1.2
|
|
|
|
0.6
|
|
|
|
|
—
|
|
|
|
|
62.6
|
|
|
Equity method income
|
|
|
|
|
|
(0.1
|
)
|
|
|
—
|
|
|
|
|
—
|
|
|
|
—
|
|
|
|
|
—
|
|
|
|
|
(0.1
|
)
|
|
Stock compensation
|
|
|
|
|
|
0.7
|
|
|
|
0.1
|
|
|
|
|
—
|
|
|
|
—
|
|
|
|
|
—
|
|
|
|
|
0.7
|
|
|
Gain on disposal of assets
|
|
|
|
|
|
(1.2
|
)
|
|
|
(0.1
|
)
|
|
|
|
—
|
|
|
|
—
|
|
|
|
|
—
|
|
|
|
|
(1.2
|
)
|
|
Debt extinguishment costs
|
|
|
|
|
|
38.9
|
|
|
|
3.2
|
|
|
|
|
—
|
|
|
|
—
|
|
|
|
|
—
|
|
|
|
|
38.9
|
|
|
Acquisition related expenses
|
|
|
|
|
|
12.2
|
|
|
|
1.0
|
|
|
|
|
—
|
|
|
|
—
|
|
|
|
|
—
|
|
|
|
|
12.2
|
|
|
Impairment and restructuring charges
|
|
|
|
|
|
(0.1
|
)
|
|
|
—
|
|
|
|
|
—
|
|
|
|
—
|
|
|
|
|
—
|
|
|
|
|
(0.1
|
)
|
|
Pension credits
|
|
|
|
|
|
(1.0
|
)
|
|
|
(0.1
|
)
|
|
|
|
—
|
|
|
|
—
|
|
|
|
|
—
|
|
|
|
|
(1.0
|
)
|
|
Income (loss) from continuing operations before income taxes
|
|
|
|
|
$
|
(56.1
|
)
|
|
|
(4.4
|
)%
|
|
|
$
|
17.0
|
|
|
|
8.1
|
%
|
|
|
$
|
—
|
|
|
|
$
|
(39.1
|
)
|
____________________
(1) We eliminate in consolidation those patient service revenues earned
by our health care facilities attributable to services provided to
enrollees in our owned health plans and eliminate the corresponding
medical claims expenses incurred by our health plans for those services.
(2) Segment EBITDA is defined as income (loss) from continuing
operations before income taxes less interest expense (net of interest
income), depreciation and amortization, equity method income or loss,
stock compensation, gain or loss on disposal of assets, realized gains
or losses on investments, monitoring fees and expenses, acquisition
related expenses, debt extinguishment costs, impairment and
restructuring charges and pension expense (credits). Management uses
Segment EBITDA to measure the performance of our segments and develop
strategic objectives and operating plans for those segments. Segment
EBITDA eliminates the uneven effect of non-cash depreciation of tangible
assets and amortization of intangible assets, much of which results from
acquisitions accounted for under the purchase method of accounting.
Segment EBITDA also eliminates the effects of changes in interest rates,
which management believes relate to general trends in global capital
markets, but are not necessarily indicative of the operating performance
of our segments. Management believes that Segment EBITDA provides useful
information to investors, lenders, financial analysts and rating
agencies about the financial performance of our segments. Additionally,
management believes that investors and lenders view Segment EBITDA as an
important factor in making investment decisions concerning us. Segment
EBITDA is not a substitute for net income (loss), operating cash flows
or other cash flow statement data determined in accordance with
accounting principles generally accepted in the United States. Segment
EBITDA, as presented, may not be comparable to similar measures of other
companies.
|
|
|
VANGUARD HEALTH SYSTEMS, INC.
|
|
Segment Information (Unaudited) (continued)
|
|
(In millions)
|
|
|
|
|
|
|
|
|
Quarter ended September 30, 2012
|
|
|
|
|
|
|
Acute Care
|
|
|
% of
|
|
|
Health
|
|
|
% of
|
|
|
|
|
|
|
|
|
|
|
|
|
Services
|
|
|
Revenues
|
|
|
Plans
|
|
|
Revenues
|
|
|
Eliminations
|
|
|
Consolidated
|
|
Patient service revenues, net (1)
|
|
|
|
|
$
|
1,304.5
|
|
|
|
100.0
|
%
|
|
|
$
|
—
|
|
|
|
—
|
%
|
|
|
$
|
(10.2
|
)
|
|
|
$
|
1,294.3
|
|
|
Premium revenues
|
|
|
|
|
|
—
|
|
|
|
—
|
|
|
|
|
176.4
|
|
|
|
100.0
|
|
|
|
|
—
|
|
|
|
|
176.4
|
|
|
Total revenues
|
|
|
|
|
|
1,304.5
|
|
|
|
100.0
|
|
|
|
|
176.4
|
|
|
|
100.0
|
|
|
|
|
(10.2
|
)
|
|
|
|
1,470.7
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Salaries and benefits (excludes stock compensation)
|
|
|
|
|
|
669.1
|
|
|
|
51.3
|
|
|
|
|
8.9
|
|
|
|
5.0
|
|
|
|
|
—
|
|
|
|
|
678.0
|
|
|
Health plan claims expense (1)
|
|
|
|
|
|
—
|
|
|
|
—
|
|
|
|
|
144.5
|
|
|
|
81.9
|
|
|
|
|
(10.2
|
)
|
|
|
|
134.3
|
|
|
Supplies
|
|
|
|
|
|
226.1
|
|
|
|
17.3
|
|
|
|
|
—
|
|
|
|
—
|
|
|
|
|
—
|
|
|
|
|
226.1
|
|
|
Other operating expenses
|
|
|
|
|
|
299.2
|
|
|
|
22.9
|
|
|
|
|
11.2
|
|
|
|
6.3
|
|
|
|
|
—
|
|
|
|
|
310.4
|
|
|
Medicare and Medicaid EHR incentives
|
|
|
|
|
|
(11.3
|
)
|
|
|
(0.9
|
)
|
|
|
|
—
|
|
|
|
—
|
|
|
|
|
—
|
|
|
|
|
(11.3
|
)
|
|
Segment EBITDA (2)
|
|
|
|
|
|
121.4
|
|
|
|
9.3
|
|
|
|
|
11.8
|
|
|
|
6.7
|
|
|
|
|
—
|
|
|
|
|
133.2
|
|
|
Less:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Interest, net
|
|
|
|
|
|
51.3
|
|
|
|
3.9
|
|
|
|
|
(0.5
|
)
|
|
|
(0.3
|
)
|
|
|
|
—
|
|
|
|
|
50.8
|
|
|
Depreciation and amortization
|
|
|
|
|
|
64.6
|
|
|
|
5.0
|
|
|
|
|
1.0
|
|
|
|
0.6
|
|
|
|
|
—
|
|
|
|
|
65.6
|
|
|
Equity method income
|
|
|
|
|
|
(0.6
|
)
|
|
|
—
|
|
|
|
|
—
|
|
|
|
—
|
|
|
|
|
—
|
|
|
|
|
(0.6
|
)
|
|
Stock compensation
|
|
|
|
|
|
2.2
|
|
|
|
0.2
|
|
|
|
|
—
|
|
|
|
—
|
|
|
|
|
—
|
|
|
|
|
2.2
|
|
|
Gain on disposal of assets
|
|
|
|
|
|
(0.9
|
)
|
|
|
(0.1
|
)
|
|
|
|
—
|
|
|
|
—
|
|
|
|
|
—
|
|
|
|
|
(0.9
|
)
|
|
Realized losses on investments
|
|
|
|
|
|
0.2
|
|
|
|
—
|
|
|
|
|
—
|
|
|
|
—
|
|
|
|
|
—
|
|
|
|
|
0.2
|
|
|
Pension credits
|
|
|
|
|
|
(3.8
|
)
|
|
|
(0.3
|
)
|
|
|
|
—
|
|
|
|
—
|
|
|
|
|
—
|
|
|
|
|
(3.8
|
)
|
|
Income from continuing operations before income taxes
|
|
|
|
|
$
|
8.4
|
|
|
|
0.6
|
%
|
|
|
$
|
11.3
|
|
|
|
6.5
|
%
|
|
|
$
|
—
|
|
|
|
$
|
19.7
|
|
____________________
(1) We eliminate in consolidation those patient service revenues earned
by our health care facilities attributable to services provided to
enrollees in our owned health plans and eliminate the corresponding
medical claims expenses incurred by our health plans for those services.
(2) Segment EBITDA is defined as income (loss) from continuing
operations before income taxes less interest expense (net of interest
income), depreciation and amortization, equity method income or loss,
stock compensation, gain or loss on disposal of assets, realized gains
or losses on investments, monitoring fees and expenses, acquisition
related expenses, debt extinguishment costs, impairment and
restructuring charges and pension expense (credits). Management uses
Segment EBITDA to measure the performance of our segments and develop
strategic objectives and operating plans for those segments. Segment
EBITDA eliminates the uneven effect of non-cash depreciation of tangible
assets and amortization of intangible assets, much of which results from
acquisitions accounted for under the purchase method of accounting.
Segment EBITDA also eliminates the effects of changes in interest rates,
which management believes relate to general trends in global capital
markets, but are not necessarily indicative of the operating performance
of our segments. Management believes that Segment EBITDA provides useful
information to investors, lenders, financial analysts and rating
agencies about the financial performance of our segments. Additionally,
management believes that investors and lenders view Segment EBITDA as an
important factor in making investment decisions concerning us. Segment
EBITDA is not a substitute for net income (loss), operating cash flows
or other cash flow statement data determined in accordance with
accounting principles generally accepted in the United States. Segment
EBITDA, as presented, may not be comparable to similar measures of other
companies.
|
|
|
VANGUARD HEALTH SYSTEMS, INC.
|
|
Selected Operating Statistics
|
|
(Unaudited)
|
|
|
|
|
|
|
|
|
Quarter ended
|
|
|
|
|
CONSOLIDATED:
|
|
|
|
|
September 30,
|
|
|
|
|
|
|
|
|
|
2011
|
|
|
2012
|
|
|
% Change
|
|
Number of hospitals at end of period
|
|
|
|
|
|
28
|
|
|
|
|
28
|
|
|
|
|
|
Licensed beds at end of period
|
|
|
|
|
|
7,064
|
|
|
|
|
7,064
|
|
|
|
|
|
Discharges
|
|
|
|
|
|
68,161
|
|
|
|
|
71,481
|
|
|
|
4.9
|
%
|
|
Adjusted discharges
|
|
|
|
|
|
125,320
|
|
|
|
|
131,502
|
|
|
|
4.9
|
|
|
Average length of stay
|
|
|
|
|
|
4.34
|
|
|
|
|
4.41
|
|
|
|
1.6
|
|
|
Patient days
|
|
|
|
|
|
296,079
|
|
|
|
|
315,555
|
|
|
|
6.6
|
|
|
Adjusted patient days
|
|
|
|
|
|
544,366
|
|
|
|
|
580,521
|
|
|
|
6.6
|
|
|
Patient revenue per adjusted discharge
|
|
|
|
|
$
|
9,279
|
|
|
|
$
|
9,403
|
|
|
|
1.3
|
|
|
Inpatient surgeries
|
|
|
|
|
|
16,077
|
|
|
|
|
16,592
|
|
|
|
3.2
|
|
|
Outpatient surgeries
|
|
|
|
|
|
29,976
|
|
|
|
|
31,131
|
|
|
|
3.9
|
|
|
Observation cases
|
|
|
|
|
|
16,357
|
|
|
|
|
19,228
|
|
|
|
17.6
|
|
|
Emergency room visits
|
|
|
|
|
|
292,839
|
|
|
|
|
315,035
|
|
|
|
7.6
|
|
|
Health plan member lives
|
|
|
|
|
|
245,000
|
|
|
|
|
235,800
|
|
|
|
(3.8
|
)
|
|
Health plan claims expense percentage
|
|
|
|
|
|
78.1
|
%
|
|
|
|
76.1
|
%
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Uncompensated care as a percent of net patient revenues (prior to
these uncompensated care adjustments)
|
|
|
|
|
|
17.9
|
%
|
|
|
|
21.8
|
%
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Net patient revenue payer mix:
|
|
|
|
|
|
|
|
|
|
|
|
|
Medicare
|
|
|
|
|
|
26.6
|
%
|
|
|
|
27.5
|
%
|
|
|
|
|
Medicaid
|
|
|
|
|
|
14.7
|
|
|
|
|
13.5
|
|
|
|
|
|
Managed Medicare
|
|
|
|
|
|
10.2
|
|
|
|
|
11.3
|
|
|
|
|
|
Managed Medicaid
|
|
|
|
|
|
10.6
|
|
|
|
|
10.0
|
|
|
|
|
|
Managed care
|
|
|
|
|
|
35.1
|
|
|
|
|
34.2
|
|
|
|
|
|
Commercial
|
|
|
|
|
|
1.4
|
|
|
|
|
1.5
|
|
|
|
|
|
Self-pay
|
|
|
|
|
|
1.4
|
|
|
|
|
2.0
|
|
|
|
|
|
Total
|
|
|
|
|
|
100.0
|
%
|
|
|
|
100.0
|
%
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Discharges by payer:
|
|
|
|
|
|
|
|
|
|
|
|
|
Medicare
|
|
|
|
|
|
28.3
|
%
|
|
|
|
27.9
|
%
|
|
|
|
|
Medicaid
|
|
|
|
|
|
10.4
|
|
|
|
|
9.6
|
|
|
|
|
|
Managed Medicare
|
|
|
|
|
|
12.3
|
|
|
|
|
12.2
|
|
|
|
|
|
Managed Medicaid
|
|
|
|
|
|
17.8
|
|
|
|
|
18.6
|
|
|
|
|
|
Managed care
|
|
|
|
|
|
23.2
|
|
|
|
|
22.7
|
|
|
|
|
|
Commercial
|
|
|
|
|
|
0.5
|
|
|
|
|
0.5
|
|
|
|
|
|
Self-pay
|
|
|
|
|
|
7.5
|
|
|
|
|
8.5
|
|
|
|
|
|
Total
|
|
|
|
|
|
100.0
|
%
|
|
|
|
100.0
|
%
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
VANGUARD HEALTH SYSTEMS, INC.
|
|
Selected Operating Statistics
|
|
(Unaudited) (continued)
|
|
|
|
|
|
|
|
|
Quarter ended
|
|
|
|
|
SAME STORE:
|
|
|
|
|
September 30,
|
|
|
|
|
|
|
|
|
|
2011
|
|
|
2012
|
|
|
% Change
|
|
Number of hospitals at end of period
|
|
|
|
|
|
26
|
|
|
|
|
26
|
|
|
|
|
|
Licensed beds at end of period
|
|
|
|
|
|
6,198
|
|
|
|
|
6,198
|
|
|
|
|
|
Total revenues, including health plan revenues (in millions)
|
|
|
|
|
$
|
1,404.0
|
|
|
|
$
|
1,365.7
|
|
|
|
(2.7
|
)%
|
|
Net patient service revenues (in millions)
|
|
|
|
|
$
|
1,193.0
|
|
|
|
$
|
1,200.0
|
|
|
|
0.6
|
|
|
Discharges
|
|
|
|
|
|
65,890
|
|
|
|
|
64,669
|
|
|
|
(1.9
|
)
|
|
Adjusted discharges
|
|
|
|
|
|
121,870
|
|
|
|
|
120,871
|
|
|
|
(0.8
|
)
|
|
Average length of stay
|
|
|
|
|
|
4.33
|
|
|
|
|
4.39
|
|
|
|
1.4
|
|
|
Patient days
|
|
|
|
|
|
285,479
|
|
|
|
|
283,825
|
|
|
|
(0.6
|
)
|
|
Adjusted patient days
|
|
|
|
|
|
528,021
|
|
|
|
|
530,488
|
|
|
|
0.5
|
|
|
Patient revenue per adjusted discharge
|
|
|
|
|
$
|
9,285
|
|
|
|
$
|
9,471
|
|
|
|
2.0
|
|
|
Inpatient surgeries
|
|
|
|
|
|
15,415
|
|
|
|
|
14,583
|
|
|
|
(5.4
|
)
|
|
Outpatient surgeries
|
|
|
|
|
|
29,509
|
|
|
|
|
28,593
|
|
|
|
(3.1
|
)
|
|
Observation cases
|
|
|
|
|
|
15,792
|
|
|
|
|
17,416
|
|
|
|
10.3
|
|
|
Emergency room visits
|
|
|
|
|
|
286,126
|
|
|
|
|
293,163
|
|
|
|
2.5
|
|
|
Health plan member lives
|
|
|
|
|
|
245,000
|
|
|
|
|
225,300
|
|
|
|
(8.0
|
)
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Uncompensated care as a percent of net patient revenues (prior to
these uncompensated care adjustments)
|
|
|
|
|
|
17.9
|
%
|
|
|
|
20.8
|
%
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Net patient revenue payer mix:
|
|
|
|
|
|
|
|
|
|
|
|
|
Medicare
|
|
|
|
|
|
26.3
|
%
|
|
|
|
26.0
|
%
|
|
|
|
|
Medicaid
|
|
|
|
|
|
13.9
|
|
|
|
|
13.3
|
|
|
|
|
|
Managed Medicare
|
|
|
|
|
|
10.4
|
|
|
|
|
11.6
|
|
|
|
|
|
Managed Medicaid
|
|
|
|
|
|
10.8
|
|
|
|
|
10.7
|
|
|
|
|
|
Managed care
|
|
|
|
|
|
35.6
|
|
|
|
|
35.1
|
|
|
|
|
|
Commercial
|
|
|
|
|
|
1.3
|
|
|
|
|
1.4
|
|
|
|
|
|
Self-pay
|
|
|
|
|
|
1.7
|
|
|
|
|
1.9
|
|
|
|
|
|
Total
|
|
|
|
|
|
100.0
|
%
|
|
|
|
100.0
|
%
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Discharges by payer:
|
|
|
|
|
|
|
|
|
|
|
|
|
Medicare
|
|
|
|
|
|
28.1
|
%
|
|
|
|
27.8
|
%
|
|
|
|
|
Medicaid
|
|
|
|
|
|
9.9
|
|
|
|
|
9.2
|
|
|
|
|
|
Managed Medicare
|
|
|
|
|
|
12.6
|
|
|
|
|
12.8
|
|
|
|
|
|
Managed Medicaid
|
|
|
|
|
|
18.3
|
|
|
|
|
18.2
|
|
|
|
|
|
Managed care
|
|
|
|
|
|
23.4
|
|
|
|
|
23.1
|
|
|
|
|
|
Commercial
|
|
|
|
|
|
0.6
|
|
|
|
|
0.5
|
|
|
|
|
|
Self-pay
|
|
|
|
|
|
7.1
|
|
|
|
|
8.4
|
|
|
|
|
|
Total
|
|
|
|
|
|
100.0
|
%
|
|
|
|
100.0
|
%
|
|
|
|

Source: Vanguard Health Systems, Inc.
Vanguard Health Systems, Inc. Investor Contact: Gary
Willis, 615-665-6098 Senior Vice President and Chief Accounting
Officer gwillis@vanguardhealth.com or Media
Contact: Suzanne Towry, 615-665-6016 Director of Media
Relations setowry@vanguardhealth.com
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