-----BEGIN PRIVACY-ENHANCED MESSAGE----- Proc-Type: 2001,MIC-CLEAR Originator-Name: webmaster@www.sec.gov Originator-Key-Asymmetric: MFgwCgYEVQgBAQICAf8DSgAwRwJAW2sNKK9AVtBzYZmr6aGjlWyK3XmZv3dTINen TWSM7vrzLADbmYQaionwg5sDW3P6oaM5D3tdezXMm7z1T+B+twIDAQAB MIC-Info: RSA-MD5,RSA, KPqVsg+doD3VvCKOMb9H/CBOERntrlkOv5ePNYYDFXQo72pL+Pyhn82B35Kp0Hu8 18401dm6ymofv7c01lvj5g== 0000950123-02-002051.txt : 20020415 0000950123-02-002051.hdr.sgml : 20020415 ACCESSION NUMBER: 0000950123-02-002051 CONFORMED SUBMISSION TYPE: 10-K PUBLIC DOCUMENT COUNT: 12 CONFORMED PERIOD OF REPORT: 20011231 FILED AS OF DATE: 20020301 FILER: COMPANY DATA: COMPANY CONFORMED NAME: TEAM HEALTH INC CENTRAL INDEX KEY: 0001086795 STANDARD INDUSTRIAL CLASSIFICATION: SERVICES-MISC HEALTH & ALLIED SERVICES, NEC [8090] IRS NUMBER: 621562558 STATE OF INCORPORATION: TN FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 10-K SEC ACT: 1934 Act SEC FILE NUMBER: 333-80337 FILM NUMBER: 02563619 BUSINESS ADDRESS: STREET 1: 1900 WINSTON RD CITY: KNOXVILLE STATE: TN ZIP: 37919 BUSINESS PHONE: 8003422898 MAIL ADDRESS: STREET 1: 1900 WINSTON RD CITY: KNOXVILLE STATE: TN ZIP: 37919 10-K 1 y57349e10-k.txt TEAM HEALTH, INC. - -------------------------------------------------------------------------------- - -------------------------------------------------------------------------------- UNITED STATES SECURITIES AND EXCHANGE COMMISSION WASHINGTON, D.C. 20549 --------------------- FORM 10-K (Mark One) [X] ANNUAL REPORT PURSUANT TO SECTION 13 OR 15(d) OF THE SECURITIES EXCHANGE ACT OF 1934. FOR THE FISCAL YEAR ENDED DECEMBER 31, 2001. [ ] TRANSITION REPORT PURSUANT TO SECTION 13 OR 15(d) OF THE SECURITIES EXCHANGE ACT OF 1934. FOR THE TRANSITION PERIOD FROM TO . COMMISSION FILE NUMBER 333-80337 TEAM HEALTH, INC. (Exact name of registrant as it appears in its charter) TENNESSEE 62-1562558 (State or other jurisdiction of (IRS Employer ID Number) Incorporation or organization) 1900 WINSTON ROAD, KNOXVILLE, TN 37919 (Address of principal executive offices) (Zip Code)
(865) 693-1000 (REGISTRANT'S TELEPHONE NUMBER, INCLUDING AREA CODE) SECURITIES REGISTERED PURSUANT TO SECTION 12(b) OF THE ACT: NONE SECURITIES REGISTERED PURSUANT TO SECTION 12(g) OF THE ACT: NONE (TITLE OF CLASS) Indicate by check mark whether the registrant (1) has filed all reports required to be filed by Section 13 or 15(d) of the Securities Exchange Act of 1934 during the preceding 12 months (or for such shorter period that the registrant was required to file such reports), and (2) has been subject to such filing requirements for the past 90 days. Yes [X] No [ ] Indicate the number of shares outstanding of each of the issuer's classes of common stock, as of the latest practical date. Common Stock, par value $.01 per share -- 10,000,000 shares as of March 1, 2002. Because the Company is privately held and there is no public trading market for the Company's equity securities, the Company is unable to calculate the aggregate market value of the voting and non-voting common equity held by non-affiliates. - -------------------------------------------------------------------------------- - -------------------------------------------------------------------------------- PART I ITEM 1. BUSINESS INTRODUCTION Terms used herein such as "we", "us" and "our" are references to Team Health, Inc. and its affiliates ("Team Health"), as the context requires. In a transaction that closed on March 12, 1999, Pacific Physician Services, Inc. ("Physician Services"), a wholly owned subsidiary of Caremark, Rx, Inc., formerly known as MedPartners, Inc. ("MedPartners"), sold 92.7% of its interest of the common stock of Team Health to affiliates of Madison Dearborn Partners, Inc., Cornerstone Equity Investors, LLC and Beecken Petty & Company, LLC, three private equity firms (the "Equity Sponsors") and some members of our senior management in a recapitalization transaction. As a result of the recapitalization, Team Health Holdings, L.L.C. ("Team Health Holdings") acquired 92.7% of our common stock and 94.3% of our preferred stock. Team Health Holdings is a holding company through which the Equity Sponsors and some members of our senior management invested in Team Health. We believe we are among the largest national providers of outsourced physician staffing and administrative services to hospitals in the United States with 350 hospital contracts in 29 states. Overall, we presently provide staffing, management and administrative services to over 400 hospitals, imaging centers, surgery centers and clinics in 30 states. Our regional operating model includes comprehensive programs for emergency medicine, radiology, anesthesiology, inpatient care, pediatrics and other hospital departments. We provide a full range of physician staffing and administrative services, including the: - recruiting, scheduling and credentials coordination for clinical and non-clinical medical professionals; - provision of administrative support services, such as payroll, insurance coverage and continuing education services; and - coding, billing and collection of fees for services provided by medical professionals and hospitals. Since our inception, we have focused primarily on providing outsourced services to emergency department and urgent care centers, which accounted for approximately 79% of our net revenue less provision for uncollectibles in 2001. We generally target larger hospitals with high volume hospital emergency departments whose patient volumes are more than 15,000 patient visits per year. In higher volume emergency departments, we believe we can generate attractive margins, establish stable long-term relationships, obtain attractive payor mixes and recruit and retain high quality physicians. The healthcare environment is becoming increasingly complex due to changes in regulations, reimbursement policies and the evolving nature of managed care. As a result, hospitals are under significant pressure to improve the quality and reduce the cost of care. In response, hospitals have increasingly outsourced the staffing and management of multiple clinical areas to contract management companies with specialized skills and standardized models to improve service, increase the quality of care and reduce administrative costs. Specifically, hospitals have become increasingly challenged to manage hospital clinical areas effectively due to: - increasing patient volume; - complex billing and collection procedures; and - the legal requirement that hospital emergency departments examine and treat all patients. We believe we are well positioned to continue to capitalize on the current outsourcing trends as a result of our: - national presence; - sophisticated information systems and standardized procedures that enable us to efficiently manage staffing and administrative services as well as the complexities of the billing and collections process; 1 - demonstrated ability to improve productivity, patient satisfaction and quality of care while reducing overall cost to the hospital; and - successful record of recruiting and retaining high quality physicians. In addition, our regional operating model allows us to deliver locally focused services while benefiting from the operating efficiencies, infrastructure and capital resources of a large national provider. We believe we are well positioned to capitalize on the growth of the overall healthcare industry as well as the growth of the hospital emergency department and urgent care center sector. According to the Centers for Medicare and Medicaid Services ("CMS", formerly the Health Care Financing Administration), national healthcare spending in 2000 increased 6.9%. Hospital services have historically represented the single largest component of these costs, accounting for approximately 32% of total healthcare spending in 1999. According to industry sources, approximately 4,500 U.S. community hospitals operated hospital emergency departments and 80% of these hospitals outsourced their physician staffing and administrative services. In 2000, emergency department expenditures were approximately $20 billion, with emergency departments physician services accounting for approximately $7 billion. According to the American Hospital Association, emergency departments handle approximately 103 million patient visits annually and up to 40% of all hospital inpatient admissions originate in the emergency department. In addition, the average number of patient visits per hospital emergency department increased at a compounded annual growth rate of approximately 3.0% between 1988 and 1996. COMPETITION The healthcare services industry is highly competitive and is subject to continuing changes in how services are provided and how providers are selected and paid. Competition for outsourced physician staffing and administrative service contracts is based primarily on: - the ability to improve department productivity and patient satisfaction while reducing overall costs; - the breadth of staffing and management services offered; - the ability to recruit and retain qualified physicians; - billing and reimbursement expertise; - a reputation for compliance with state and federal regulations; and - financial stability, demonstrating an ability to pay providers in a timely manner and provide professional liability insurance. While we compete in the Emergency Medicine marketplace with such national and regional groups as Emcare, Inc; PhyAmerica Physician Group, Inc.; The Schumacher Group; and NES, the majority of our competition comes from small, local groups as well as hospitals who employ their own physicians. There are two national Hospitalist groups -- Cogent Healthcare, Inc; and IPC-The Hospitalist Company. There are presently no direct national competitors in the Anesthesia or Radiology markets. In these service lines, we again compete with smaller groups and hospitals that employ their own physicians. We believe that evolution of the healthcare industry will tend to blur traditional distinctions among industry segments. We expect that other companies in other healthcare industry segments, such as managers of other hospital-based specialties and large physician group practices, some of which have financial and other resources greater than ours, may become competitors in the delivery of physician staffing and administrative services. 2 COMPETITIVE STRENGTHS Although the healthcare services industry is highly competitive, we believe we are able to compete effectively due to the following strengths: Leading Market Position. We believe we are among the largest national providers of outsourced emergency physician staffing and administrative services in the United States. In addition, we provide outsourced radiology staffing and administrative services and have a growing presence in other hospital departments such as anesthesiology, pediatrics and inpatient services. We believe our ability to spread the relatively fixed costs of our corporate infrastructure over a broad national contract and revenue base generates significant cost efficiencies that are generally not available to smaller competitors. As a full-service provider with a comprehensive understanding of changing healthcare regulations and policies and the management information systems that provide support to manage these changes, we believe we are well positioned to gain market share from other service providers. Furthermore, we have a geographically diverse base of 350 hospital contracts, with average contract tenure of approximately seven years. In 2001, the largest single contract accounted for no more than 1.2% of our net revenue less provision for uncollectibles, and as a result, the loss of any contract would not significantly impact our financial performance. Regional Operating Model Supported by a National Infrastructure. We service our client hospitals from 14 regional operating units, which allows us to deliver locally focused services with the resources and sophistication of a national provider. Our local presence creates closer relationships with hospitals, resulting in responsive service and high physician retention rates. Our strong relationships in local markets enable us to effectively market our services to local hospital administrators, who generally make decisions regarding contract awards and renewals. Our regional operating units are supported by our national infrastructure, which includes integrated information systems and standardized procedures that enable us to efficiently manage the operations and billing and collections processes. We also provide each of our regional operating units with centralized staffing support, purchasing economies of scale, payroll administration, coordinated marketing efforts and risk management. We believe our regional operating model supported by our national infrastructure improves productivity and quality of care while reducing the cost of care. Significant Investment in Information Systems and Procedures. Our proprietary information systems link our billing, collection, recruiting, scheduling, credentials coordination and payroll functions among our regional operating units, allowing our best practices and procedures to be delivered and implemented nationally while retaining the familiarity and flexibility of a locally-based service provider. Over the last five years, we have spent over $10 million to develop and maintain integrated, advanced systems to facilitate the exchange of information among our regional operating units and clients. These systems include our Lawson financial reporting system, IDX Billing System, our WaitLoss(TM) process improvement program and our TeamWorks(TM) physician database and software package. As a result of these investments and the company- wide application of best practices, we believe our average cost per patient billed and average cost per physician recruited are among the lowest in the industry. The strength of our information systems has enhanced our ability to collect patient payments and reimbursements in an orderly and timely fashion and has increased our billing and collections productivity. Ability to Recruit and Retain High Quality Physicians. A key to our success has been our ability to recruit and retain high quality physicians to service our contracts. While our local presence gives us the knowledge to properly match physicians and hospitals, our national presence and infrastructure enable us to provide physicians with a variety of attractive hospital locations, advanced information and reimbursement systems and standardized procedures. Furthermore, we offer physicians substantial flexibility in terms of geographic location, type of facility, scheduling of work hours, benefits packages and opportunities for relocation and career development. This flexibility, combined with fewer administrative burdens, improves physician retention rates and stabilizes our contract base. We believe we have among the highest physician retention rates in the industry. Experienced Management Team with Significant Equity Ownership. Our senior management team has extensive experience in the outsourced physician staffing and administrative services industry. Our Chief Executive Officer, H. Lynn Massingale, M.D., has been with Team Health and its predecessor entities since 3 1979. Our senior corporate and affiliate executives have an average of over 20 years experience in the outsourced physician staffing and medical services industry. Members of our management team have, with the inclusion of performance-based options, an indirect fully diluted ownership interest of approximately 18.7%. As a result of its substantial equity interest, we believe our management team has significant incentive to maintain its existing client base through the continued provision of high quality services to them and to continue to increase our revenue and profitability through new growth. GROWTH STRATEGY The key elements of our growth strategy are as follows: Increase Revenue from Existing Customers. We have a strong record of increasing revenue from existing customers. In 2001, net revenue less provision for uncollectibles from continuing contracts grew by approximately 4.7%. We plan to continue to increase revenue from existing customers by - continuing to improve documentation of care delivered, thereby capturing full reimbursement for services provided; - implementing fee schedule increases, where appropriate; - capitalizing on increasing patient volumes; - increasing the scope of services offered within contracted departments; and - cross-selling services to multiple hospital departments. Capitalize on Industry Trends to Win New Contracts. We seek to obtain new contracts by - replacing contract management companies at hospitals that currently outsource their services and - obtaining new contracts from hospitals that do not currently outsource. We believe the number of high volume hospital clinical departments will grow as patient visits increase and hospital consolidation continues. Furthermore, we believe that our ability to gain a greater market share of larger volume hospital clinical departments is enhanced as a result of our - national presence; - sophisticated information systems and standardized procedures that enable us to efficiently manage our core staffing and administrative services as well as the complexities of the billing and collections process; - demonstrated ability to improve productivity, patient satisfaction and quality of care while reducing overall cost to the hospital; and - successful record of recruiting and retaining high quality physicians. Since 1997, we have won 178 new outsourced contracts. Grow through Acquisitions. We intend to continue to pursue strategic acquisitions of contracts currently held by local and regional physician groups. Many of these physician groups are faced with increasing pressure to provide the systems and services of a larger organization. In addition, some smaller physician groups lacking in certain economies of scale have experienced recent significant increases in the cost of medical malpractice insurance beyond that experienced by us. This circumstance affords us a cost advantage in competing for new business and acquisitions. The market for outsourced emergency department physician staffing services for hospitals and other healthcare providers is highly fragmented. Approximately 54% of the market is served primarily by small, local and regional physician groups who generally lack the resources and depth of services necessary to compete with national providers. We have developed and implemented a disciplined acquisition methodology utilized by our in-house mergers and acquisitions team. Since 1997, we have completed 18 acquisitions. We expect to continue to fund acquisitions using our existing cash resources. 4 INDUSTRY According to CMS, national health spending in 2000 increased 6.9%, compared to an increase of 5.7% in 1999, the greatest acceleration in spending since 1988. The 1.2% gain in the rate of spending growth primarily reflects an increase in economy-wide inflation, with only a 0.3% gain in real spending. Public spending increased its pace in 2000 with growth of 7.0%, up from 5.4% in 1999. Private spending growth also accelerated from 6.0% in 1999 to 6.9% in 2000, led by 8.4% growth in private health insurance premiums. Growth in expenditures in 1999 and 2000 slightly outpaced growth in gross domestic product (GDP). The healthcare share of GDP in 2000 was 13.2%, approximately the same level since 1992. Recent reports of continuing health inflation suggest further increases in the near future. Hospital services have historically represented the single largest component of these costs, accounting for approximately 32.3% of total healthcare spending in 1999. In the increasingly complex healthcare regulatory, managed care and reimbursement environment, hospitals are under significant pressure from the government and private payors both to improve the quality and reduce the cost of care. In response, hospitals have increasingly outsourced the staffing and management of multiple clinical areas to contract management companies with specialized skills and a standardized model to improve service, increase the overall quality of care and reduce administrative costs. In addition, the healthcare industry is continuing to experience an increasing trend towards outpatient treatment rather than the traditional inpatient treatment. Healthcare reform efforts in recent years have placed an increasing emphasis on reducing the time patients spend in hospitals. As a result, the severity of illnesses and injuries treated in an emergency department or urgent care center is likely to continue to increase. Emergency Medicine. According to the American Hospital Association, slightly over 4,500 of all community hospitals in the United States operate emergency departments, and approximately 80% of these hospitals outsource their physician staffing and management for this department. In 1997, emergency department expenditures were approximately $20 billion, with emergency physician services accounting for approximately $7 billion. In 2000, emergency departments handled over 103 million patient visits, and up to 40% of all hospital inpatient admissions originate in the emergency department. In addition, the average number of patient visits per hospital emergency department increased at a compounded annual growth rate of approximately 3.0% between 1988 and 1996. The market for outsourced emergency department medical and administrative services is highly fragmented. Approximately 54% of the market is served by a large number of small, local and regional physician groups. These local providers generally lack the depth of services and administrative and systems infrastructure necessary to compete with national providers in the increasingly complex healthcare business and regulatory environment. Radiology. According to the 1998-1999 Medical and Healthcare Marketplace Guide, total spending on radiology services in the U.S. in 1998 was estimated at $69 billion or approximately 5% of annual healthcare expenditures, with 70% of this spending in hospital settings. According to the American College of Radiology, there were approximately 3,200 radiology groups in the U.S. in 1996, representing approximately 27,000 radiologists who performed approximately 350 million radiological procedures in 1995. The demand for radiologists has grown by approximately 4.5% a year due to an increasing population and advancements in radiological procedures, while the supply of radiologists is growing at a lower rate of 2-3% per year. The national shortage of radiologists poses advantages to large groups like Team Health who have the resources to effectively recruit in the tight marketplace. As with the outsourced hospital emergency department clinical and administrative services, the market for outsourced radiology services is highly fragmented and served by a large number of small, local and regional radiology groups. Competition for outsourced radiology services contracts is intense and based on the ability of the radiology group to provide a high level of medical and non-medical services. Smaller radiology groups are often at a competitive disadvantage since they often lack the capital, range of medical equipment and information systems required to meet the increasingly complex needs of hospitals. 5 Anesthesiology. The American Society of Anesthesiologists estimates that 40 million anesthetics are administered each year in America and that 90% involve an MD anesthesiologist ("MDA"). The net collected total revenue market for anesthesiologist services is estimated to be $11.5 billion. This market is served primarily by groups of physicians whose size ranges from 25 - 40 MDA's. There are very few groups having in excess of 60 MDA's per group. The groups are largely self-governed and many enjoy exclusive contracts with hospitals and outpatient centers requiring anesthesia services. The majority of the groups require various management services with most groups contracting out their billing needs to third-party providers of such services. There is not a dominant provider of management services to anesthesia groups. We believe that following an acquisition completed in January 2001, we are one of the largest single providers of management services to anesthesia groups. Inpatient Services (Hospitalist). According to the National Association of Inpatient Physicians (NAIP), a hospitalist is "a doctor whose primary professional focus is the general medical care of hospitalized patients." A recent study by the NAIP indicates that hospitals employed 50% more hospitalists in 1999 than in 1997. There are presently approximately 5,000 practicing hospitalists in the U.S., and a recent analysis projects an ultimate hospitalist workforce of approximately 19,000, making it comparable in size to cardiology. A recent article in the January 2002 issue of the Journal of the American Medical Association reported that the implementation of hospitalist programs was associated with significant reductions in resource use, usually measured as hospital costs (average decrease of 13.4%) or average length of stay (average decrease of 16.6%). Studies of patient satisfaction levels indicated no change in using a hospitalist model, and several studies have indicated improved clinical outcomes, such as inpatient mortality and readmission rates. There are several factors that portend continued growth of the hospitalist model, including cost pressures on hospitals, physician groups and managed care organizations; the increased acuity of hospitalized patients and the accelerated pace of their hospitalizations; and the time pressures of primary care physicians in the office. We anticipate the potential for significant growth in this service line over the coming years. CONTRACTUAL ARRANGEMENTS Hospitals. We provide outsourced physician staffing and administrative services to hospitals and healthcare providers under fee-for-service contracts and flat-rate contracts. Hospitals entering into fee-for-service contracts agree, in exchange for granting our affiliated physicians medical staff privileges and exclusivity for services, to authorize us to bill and collect the professional component of the charges for such medical services. Under the fee-for-service arrangements, we bill patients and third party payors for services rendered. Depending on the magnitude of services provided to the hospital and payor mix, we may also receive supplemental revenue from the hospital. In a fee-for service arrangement, we accept responsibility for billing and collection. Under flat-rate contracts, the hospital performs the billing and collection services of the professional component and assumes the risk of collectibility. In return for providing the physician staffing and administrative services, the hospital pays a contractually negotiated fee. In 2001, approximately 77.8% of our net revenue less provision for uncollectibles was generated under fee-for-service arrangements. Our contracts with hospitals do not require any significant financial outlay, investment obligation or equipment purchase by us other than the professional expenses associated with staffing the contracts. Contracts with hospitals generally have terms of three years and are generally automatically renewable under the same terms and conditions unless either party gives notice of an intent not to renew. While most contracts are terminable by either of the parties upon notice of as little as 30 days, the average tenure of our contracts is approximately seven years. Physicians. We contract with physicians as independent contractors or employees to provide services to fulfill our contractual obligations to our hospital clients. We typically pay the physicians a flat hourly rate for each hour of coverage provided at rates comparable to the market in which they work. The hourly rate varies depending on whether the physician is independently contracted or an employee. Independently contracted 6 physicians are required to pay a self-employment tax, social security, and workers' compensation insurance premiums. In contrast, we pay these taxes and expenses for employed physicians. Our contracts with physicians are generally perpetual and can be terminated at any time under certain circumstances by either party without cause, typically upon 180 days notice. In addition, we generally require the physician to sign a non-compete and non-solicitation agreement. Although the terms of our non-compete agreements vary from physician to physician, the non-compete agreements generally have terms of two years after the termination of the agreement. We also generally require our employed physicians to sign similar non-compete agreements. Under these agreements, the physician is restricted from divulging confidential information, soliciting or hiring our employees and physicians, inducing termination of our agreements and competing for and/or soliciting our clients. As of December 31, 2001, we had working relationships with approximately 2,900 physicians, of which approximately 2,200 were independently contracted, and approximately 500 other healthcare professionals. SERVICE LINES We provide a full range of outsourced physician staffing and administrative services in emergency medicine, radiology, anesthesiology, inpatient services, pediatrics, and other departments of the hospital. As hospitals and other healthcare providers experience growing pressure from managed care companies and other payors to reduce costs while maintaining or improving the quality of service, we believe hospitals and providers will increasingly turn to a single-source with an established track record of success for outsourced physician staffing and administrative services. As the outsourcing trend grows, we believe our delivery platform of regional operating units supported by a national infrastructure will result in higher customer satisfaction and a more stable contract base than many of our competitors. Emergency Department. We believe we are one of the largest providers of outsourced physician staffing and administrative services for hospital emergency departments in the United States. Approximately 79% of our net revenue less provision for uncollectibles in 2001 came from hospital emergency department contracts. As of December 31, 2001, we independently contracted with or employed approximately 2,500 hospital emergency department physicians. We contract with the hospital to provide qualified emergency physicians and other healthcare providers for the hospital emergency department. In addition to the core services of contract management, recruiting, credentials coordination, staffing and scheduling, we provide our client hospitals with enhanced services designed to improve the efficiency and effectiveness of the emergency department. Specific programs like WaitLoss(TM) apply proven process improvement methodologies to departmental operations. Publications such as the Emergency Physician Legal Bulletin(TM) and Case Studies of Customer Service in the Emergency Department(TM) are delivered to all client hospitals and physicians on a quarterly basis. Physician documentation templates promote compliance with federal documentation guidelines and allow for more accurate patient billing. By providing these enhanced services, we believe we increase the value of services we provide to our clients and improve client relations. Additionally, we believe these enhanced services also differentiate us in sales situations and improve the chances of being selected in a contract bidding process. Since 1997, Team Health has merged with or acquired the contracts of 13 hospital emergency department and physician groups. The acquired hospital emergency department contracts were generally with hospitals in large markets with an average patient volume exceeding 15,000 per year. Since 1997, we have also successfully negotiated 115 new outsourced hospital emergency department contracts. These contracts have been obtained either through direct selling or through a competitive bidding process initiated by hospitals. Partially offsetting the growth in the number of hospital emergency department contracts attributed to acquisitions and direct sales are contract terminations. Since 1997, 152 hospital emergency department contracts in total were terminated. Our cancellations can be attributed primarily to the elimination of low margin contracts obtained in connection with acquisitions. Hospital cancellations can be attributed to consolidation among hospitals, medical staff politics and pricing. In 2001, we had a net gain of six emergency department contracts. 7 Radiology. We provide outsourced radiology physician staffing and administrative services in the United States. We contract directly or through the regional operating units with selected radiologists to provide radiology physician staffing and administrative services. A typical radiology management team consists of clinical professionals, board certified radiologists that are trained in all modalities, and non-clinical professionals and support staff that are responsible for the scheduling, purchasing, billing and collections functions. As of December 31, 2001, we independently contracted with or employed approximately 75 radiologists. We have traditionally focused on the hospital-based radiology market, although we also maintain contracts with outpatient diagnostic imaging centers. We believe the advantages of contracting with us include our ability to provide 24-hour radiology coverage through a combination of on-site services and/or teleradiology coverage, a means of electronically transmitting patient images and consultative text from one location to another. Inpatient Services. We are one of the largest providers of outsourced physician staffing and administrative services for inpatient services, which include hospitalist services and house coverage services. Our inpatient services contracts with hospitals are generally on a cost plus or flat rate basis. As of December 31, 2001, we independently contracted with or employed approximately 150 inpatient physicians. Since 1997, we experienced net revenue and contract growth in our inpatient services business primarily due to new contract sales, acquisitions, and to a lesser extent, rate increases on existing contracts. Anesthesiology. We began providing a wide range of management services to anesthesiology practices on a fee basis in 2001 following our acquisition of Integrated Management Services, Inc. ("ISMS"). Services provided by ISMS include strategic management, management information systems, third-party payor contracting, financial and accounting support, benefits administration and risk management, scheduling support, operations management and quality improvement services using proprietary anesthesia management practice software. ISMS currently provides such services to five integrated anesthesia practices with approximately 358 providers under management. On January 1, 2002, we acquired the operations of L&S Medical Management, Inc. ("L&S"), a provider of billing as well as other management services to anesthesia practices. L&S provides services on a fee basis to eight anesthesia groups encompassing approximately 65 anesthesiologists. Overall, we are able to offer essential services to anesthesiologist groups that enable them to focus on the clinical practice of medicine while leaving the day-to-day management and governance issues related to their groups to us. Pediatrics. We also provide outsourced pediatrics physician staffing and administrative services for general and pediatrics hospitals. We provide these services on a cost plus or flat rate basis. These services include pediatrics emergency medicine and radiology, neonatal intensive care, pediatric intensive care, urgent care centers, primary care centers, observation units and inpatient services. As of December 31, 2001, we independently contracted with or employed approximately 25 pediatrics physicians. Since 1997, we have experienced net revenue and contract growth in our outsourced pediatrics physician staffing and administrative services business due primarily to new contract sales and acquisitions, and to a lesser extent, rate increases on existing contracts. Primary Care Clinics and Occupational Medicine. We provide primary care staffing and administrative services in stand-alone primary clinics and in clinics located within the work-site of industrial clients. While such clinics are not a major focus of our business, they are complementary to our hospital client's interests. We generally contract with hospitals or industrial employers to provide cost-effective, high quality primary care physician staffing and administrative services. SERVICES We provide a full range of outsourced physician staffing and administrative services for emergency medicine, radiology, anesthesiology, inpatient services, pediatrics, and other areas of the hospital. Our outsourced physician staffing and administrative services include: - Contract Management - Staffing 8 - Recruiting - Credentials Coordination - Scheduling - Payroll Administration and Benefits - Information Systems - Consulting Services - Billing and Collection - Risk Management - Continuing Education Services Contract Management. Our delivery of services for a clinical area of the hospital is led by an experienced contract management team of clinical and other healthcare professionals. The team includes a Regional Medical Director, an on-site Medical Director and a Client Services Manager. The Medical Director is a physician with the primary responsibility of managing the physician component of a clinical area of the hospital. The Medical Director works with the team, in conjunction with the nursing staff and private medical staff, to improve clinical quality and operational effectiveness. Additionally, the Medical Director works closely with the regional operating unit operations staff to meet the clinical area's ongoing recruiting and staffing needs. Staffing. We provide a full range of staffing services to meet the unique needs of each hospital and clinic. Our dedicated clinical teams include qualified, career-oriented physicians and other healthcare professionals responsible for the delivery of high quality, cost-effective care. These teams also rely on managerial personnel, many of whom have clinical experience, who oversee the administration and operations of the clinical area. As a result of our staffing services, hospitals can focus their efforts on improving their core business of providing healthcare services for their communities as opposed to recruiting and managing physicians. We also provide temporary staffing services of physicians and other healthcare professionals to hospitals and clinics on a national basis. Recruiting. Many hospitals lack the resources necessary to identify and attract specialized, career-oriented physicians. We have a staff of approximately 50 professionals dedicated to the recruitment of qualified physicians. These professionals are regionally located and are focused on matching qualified, career-oriented physicians with hospitals. Common recruiting methods include the use of our proprietary national physician database, attending trade shows, placing website and professional journal advertisements and telemarketing. We have committed significant resources to the development of a proprietary national physician database to be shared among our regional operating units. This database is in operation at all operating units. The database uses the American Medical Association Master file of over 1,000,000 physicians as the initial data source on potential candidates. Recruiters contact prospects through telemarketing, direct mail, conventions, journal advertising and our Internet site to confirm and update the information. Prospects expressing interest in one of our practice opportunities provide more extensive information on their training, experience, and references, all of which is added to our database. Our goal is to ensure that the practitioner is a good match with both the facility and the community before proceeding with an interview. Credentials Coordination. We gather primary source information regarding physicians to facilitate the review and evaluation of physicians' credentials by hospitals. Scheduling. Our scheduling department assists the Medical Directors in scheduling physicians and other healthcare professionals within the clinical area on a monthly basis. Payroll Administration and Benefits. We provide payroll administration services for the physicians and other healthcare professionals with whom we contract to provide physician staffing and administrative services. 9 Our clinical employees benefit significantly by our ability to aggregate physicians and other healthcare professionals to negotiate more favorable employee benefit packages and professional liability coverage than many hospitals or physicians could negotiate on a stand-alone basis. Additionally, hospitals benefit from the elimination of the overhead costs associated with the administration of the payroll and, where applicable, employee benefits. Information Systems. We have invested in advanced information systems and proprietary software packages designed to assist hospitals in lowering administrative costs while improving the efficiency and productivity of a clinical area. These systems include TeamWorks(TM), a national physician database and software package that facilitates the recruitment and retention of physicians and supports our contract requisition, credentials coordination, automated application generation, scheduling, and payroll operations. Consulting Services. We have a long history of providing outsourced physician staffing and administrative services to hospitals and, as a result, have developed extensive knowledge in the operations of some areas of the hospital. As such, we provide consulting services to hospitals to improve the productivity, quality and cost of care delivered by the hospital. Process Improvement. We have developed a number of utilization review programs designed to track patient flow and identify operating inefficiencies. To rectify such inefficiencies, we have developed a Fast Track system to expedite patient care in the hospital emergency department and urgent care center by separating patients who can be treated in a short period of time from patients who have more serious or time-consuming problems. Fast Track patients, once identified through appropriate triage categorization, are examined and treated in a separate area of the hospital emergency department and urgent care center, controlled by its own staff and operational system. We have substantial experience in all phases of development and management of Fast Track programs, including planning, equipping, policy and procedure development, and staffing. In addition, we employ WaitLoss(TM), a proprietary process improvement system designed to assist the hospital in improving the efficiency and productivity of a department. Quality Improvement. We provide a quality improvement program designed to assist the hospital in maintaining a consistent level of high quality care. It periodically measures the performance of the hospital, based on a variety of benchmarks, including patient volume, quality indicators and patient satisfaction. This program is typically integrated into our process improvement program to ensure seamless delivery of high quality, cost-effective care. Managed Care Contracting. We have developed extensive knowledge of the treatment protocols and related documentation requirements of a variety of managed care payors. As a result, we often participate in the negotiation of managed care contracts to make those managed care relationships effective for patients, payors, physicians and hospitals. We provide managed care consulting services in the areas of contracting, negotiating, reimbursement analysis/projections, payor/hospital relations, communications and marketing. We have existing managed care agreements with health maintenance organizations, preferred provider organizations and integrated delivery systems for commercial, Medicaid and Medicare products. While the majority of our agreements with payors continue to be traditional fee-for-service contracts, we are experienced in providing managed, prepaid healthcare to enrollees of managed care plans. Nursing Services. We maintain highly regarded, experienced nurse consultants on our client support staff. These nurse consultants provide assistance to nurse managers and Medical Directors of the client hospital on issues regarding risk management and total quality management. In addition, the nurse consultants are available to make site visits to client hospitals on request to assess overall operations, utilization of personnel and patient flow. Billing and Collection. Our billing and collection services are a critical component of our business. Our billing and collections operations are concentrated in six core-billing facilities and operate on a uniform billing system -- the IDX software system. The IDX system has proven to be a powerful billing and accounts receivable software package with strong reporting capabilities. We have interfaced a number of other software systems with the IDX system to further improve productivity and efficiency. Foremost among these is the electronic registration interface that gathers registration information directly from the hospitals' management 10 information systems. Additionally, we have invested in electronic submission of claims, as well as electronic remittance posting. These programs have markedly diminished labor and postage expenses. At the present time, substantially all six million billed annual patient encounters are being processed by one of the six billing facilities. We also operate an internal collection agency called IMBS. This agency utilizes an advanced collection agency software package linked to a predictive dialer. Substantially all collection placements generated from our billing facilities are sent to the IMBS agency. Comparative analysis has shown that the internal collection agency has markedly decreased expenses previously paid to outside agencies and improved the collectibility of existing placements. Our advanced comprehensive billing and collection systems allow us to have full control of accounts receivable at each step of the process. Risk Management. Our risk management function is designed to prevent or minimize medical professional liability claims and includes: - incident reporting systems, - tracking/trending the cause of accidents and claims, - physician education and service programs, including peer review and pre-deposition review, - loss prevention information such as audio tapes and risk alert bulletins, and - early intervention of malpractice claims. Through our risk management staff, quality assurance staff and the Medical Director, we conduct an aggressive risk management program for loss prevention and early intervention. We have a proactive role in promoting early reporting, evaluation and resolution of serious incidents that may evolve into claims or suits. Continuing Education Services. Our internal continuing education services are fully accredited by the Accreditation Council for Continuing Medical Education. This allows us to grant our physicians and nurses continuing education credits for internally developed educational programs at a lower cost than if such credits were earned through external programs. We have designed a series of customer relations seminars entitled Successful Customer Relations for physicians, nurses and other personnel to learn specific techniques for becoming effective communicators and delivering top-quality customer service. These seminars help the clinical team sharpen its customer service skills, further develop communication skills and provide techniques to help deal with people in many critical situations. SALES AND MARKETING Contracts with hospitals for outsourced physician staffing and administrative services are generally obtained either through direct selling efforts or requests for proposals. We have a team of eight sales professionals located throughout the country. Each sales professional is responsible for developing sales and acquisition opportunities for the operating unit in their territory. In addition to direct selling, the sales professionals are responsible for working in concert with the regional operating unit president and corporate development personnel to respond to a request for proposal. Although practices vary from hospital to hospital, hospitals generally issue a request for proposal with demographic information of the hospital department, a list of services to be performed, the length of the contract, the minimum qualifications of bidders, the selection criteria and the format to be followed in the bid. Supporting the sales professionals is a fully integrated marketing campaign comprised of a telemarketing program, Internet website, journal advertising, and a direct mail and lead referral program. OPERATIONS We currently operate through 14 regional operating units, which are listed in the table below. The emergency department and radiology operating units are managed semi-autonomously by senior physician leaders and are operated as profit centers with the responsibility for pricing new contracts, recruiting and scheduling physicians and other healthcare professionals, marketing locally and conducting day-to-day 11 operations. The management of corporate functions such as accounting, payroll, billing and collection, capital spending, information systems and legal are centralized.
NAME LOCATION PRINCIPAL SERVICES - ---- -------- ------------------ Daniel and Yeager............................ Huntsville, AL Locum Tenens Emergency Coverage Corporation............... Knoxville, TN ED Emergency Physician Associates............... Woodbury, NJ ED Emergency Professional Services.............. Middleburg Heights, OH ED InPhyNet Medical Management.................. Ft. Lauderdale, FL ED Integrated Specialists Management Services, San Diego, CA Anesthesiology Inc........................................ Northwest Emergency Physicians............... Seattle, WA ED Sheer, Ahearn & Associates................... Tampa, FL Radiology Southeastern Emergency Physicians............ Knoxville, TN ED Team Anesthesia.............................. Knoxville, TN Anesthesiology Team Health Southwest........................ Houston, TX ED Team Health West............................. Pleasanton, CA ED Team Radiology............................... Knoxville, TN Radiology The Emergency Associates for Medicine........ Tampa, FL ED
INSURANCE We require the physicians with whom we contract to obtain professional liability insurance coverage. For both our independently contracted and employed physicians, we typically arrange the provision of claims-made coverage of $1,000,000 per incident and $3,000,000 annual aggregate per physician and $1,000,000 per incident and $25,000,000 annual aggregate for all corporate entities. These limits are deemed appropriate by management based upon historical claims, the nature and risks of the business and standard industry practice. We are usually obligated to arrange for the provision of "tail" coverage for claims against our physicians for incidents that are incurred but not reported during periods for which the related risk was covered by claims-made insurance. With respect to those physicians for whom we are obligated to provide tail coverage, we accrue professional insurance expenses based on estimates of the cost of procuring tail coverage. We also maintain general liability, vicarious liability, automobile liability, property and other customary coverages in amounts deemed appropriate by management based upon historical claims and the nature and risks of the business. EMPLOYEES As of December 31, 2001, we had approximately 3,500 employees, of which approximately 1,200 were physicians and other healthcare professionals with remaining employees working in billing and collections, operations and administrative support functions. Our employees are not covered by any labor agreements nor affiliated with any unions. REGULATORY MATTERS General. As a participant in the healthcare industry, our operations and relationships with healthcare providers such as hospitals are subject to extensive and increasing regulations by numerous federal and state governmental entities as well as local governmental entities. The management services provided by us under contracts with hospitals and other clients include (collectively, "Management Services"): - the identification and recruitment of physicians and other healthcare professionals for the performance of emergency, medicine, radiology and other services at hospitals, out-patient imaging facilities and other facilities; 12 - utilization and review of services and administrative overhead; - scheduling of staff physicians and other healthcare professionals who provide clinical coverage in designated areas of hospitals; and - administrative services such as billing and collection of fees for professional services. All of the above services are subject to scrutiny and review by federal, state and local governmental entities and are subject to the rules and regulations promulgated by these governmental entities. Specifically, but without limitation, the following laws and regulations related to these laws may affect the operations and contractual relationships of Team Health: State Laws Regarding Prohibition of Corporate Practice of Medicine and Fee Splitting Arrangements. We currently provide outsourced physician staffing and administrative services to hospitals and clinics in 30 states. The laws and regulations relating to our operations vary from state to state. The laws of many states, including California, prohibit general business corporations, such as us, from practicing medicine, controlling physicians' medical decisions or engaging in some practices such as splitting fees with physicians. In 2001, we derived approximately 9.5% of our net revenue less provision for uncollectibles from California. The laws of some states, including Florida, do not prohibit non-physician entities from practicing medicine but generally retain a ban on some types of fee splitting arrangements. In 2001, we derived approximately 25.4% of our net revenues less provision for uncollectibles from Florida. While we seek to comply substantially with existing applicable laws relating to the corporate practice of medicine and fee splitting, we cannot assure you that our existing contractual arrangements, including noncompetition agreements with physicians, professional corporations and hospitals will not be successfully challenged in certain states as unenforceable or as constituting the unlicensed practice of medicine or prohibited fee-splitting. Debt Collection Regulation. Some of our operations are subject to compliance with the Fair Debt Collection Practices Act and comparable statutes in many states. Under the Fair Debt Collection Practices Act, a third-party collection company is restricted in the methods it uses in contacting consumer debtors and eliciting payments with respect to placed accounts. Requirements under state collection agency statutes vary, with most requiring compliance similar to that required under the Fair Debt Collection Practices Act. We believe that we are in substantial compliance with the Fair Debt Collection Practices Act and comparable state statutes. Anti-Kickback Statutes. We are subject to the federal healthcare fraud and abuse laws including the federal anti-kickback statute. The federal anti-kickback statute prohibits the knowing and willful offering, payment, solicitation or receipt of any bribe, kickback, rebate or other remuneration in return for the referral or recommendation of patients for items and services covered, in whole or in part, by federal healthcare programs. These fraud and abuse laws define federal healthcare programs to include plans and programs that provide health benefits funded by the United States government including Medicare, Medicaid, and the Civilian Health and Medical Program of the Uniformed Services, among others. Violations of the anti-kickback statute may result in civil and criminal penalties and exclusion from participation in federal and state healthcare programs. In addition, an increasing number of states in which we operate have laws that prohibit some direct or indirect payments, similar to the anti-kickback statute, if those payments are designed to induce or encourage the referral of patients to a particular provider. Possible sanctions for violation of these restrictions include exclusion from state funded healthcare programs, loss of licensure and civil and criminal penalties. Statutes vary from state to state, are often vague and have seldom been interpreted by the courts or regulatory agencies. The Health Insurance Portability and Accountability Act of 1996 created a mechanism for a provider to obtain written interpretative advisory opinions under the federal anti-kickback statute from the Department of Health and Human Services regarding existing or contemplated transactions. Advisory opinions are binding as to the Department of Health and Human Services but only with respect to the requesting party or parties. The advisory opinions are not binding as to other governmental agencies, e.g. the Department of Justice. 13 In 1998, the Department of Health and Human Services issued an advisory opinion in which it concluded that a proposed management services contract between a medical practice management company and a physician practice, which provided that the management company would be reimbursed for the fair market value of its operating services and its costs and paid a percentage of net practice revenues, might constitute illegal remuneration under the federal anti-kickback statute. The Department of Health and Human Services' analysis was apparently based on a determination that the proposed management services arrangement included financial incentives to increase patient referrals, contained no safeguards against over utilization, and included financial incentives that increased the risk of abusive billing practices. We believe that our contractual relationships with hospitals and physicians are distinguishable from the arrangement described in this advisory opinion with regard to both the types of services provided and the risk factors identified by the Department of Health and Human Services. Nevertheless, we cannot assure you that the Department of Health and Human Services will not be able to successfully challenge our arrangements under the federal anti-kickback statute in the future. In addition to the federal statutes discussed above, we are also subject to state statutes and regulations that prohibit, among other things, payments for referral of patients and referrals by physicians to healthcare providers with whom the physicians have a financial relationship. Violations of these state laws may result in prohibition of payment for services rendered, loss of licenses and fines and criminal penalties. State statutes and regulations typically require physicians or other healthcare professionals to disclose to patients any financial relationship the physicians or healthcare professionals have with a healthcare provider that is recommended to the patients. These laws and regulations vary significantly from state to state, are often vague, and, in many cases, have not been interpreted by courts or regulatory agencies. Exclusions and penalties, if applied to us, could result in significant loss of reimbursement to us, thereby significantly affecting our financial condition. Physician Self-Referral Laws. Our contractual arrangements with physicians and hospitals likely implicate the federal physician self-referral statute commonly known as Stark II. In addition, a number of the states in which we operate have similar prohibitions on physician self-referrals. In general, these state prohibitions closely track Stark II's prohibitions and exceptions. Stark II prohibits the referral of Medicare and Medicaid patients by a physician to an entity for the provision of particular "designated health services" if the physician or a member of such physician's immediate family has a "financial relationship" with the entity. Stark II provides that the entity which renders the "designated health services" may not present or cause to be presented a claim to the Medicare or Medicaid program for "designated health services" furnished pursuant to a prohibited referral. A person who engages in a scheme to circumvent Stark II's prohibitions may be fined up to $100,000 for each applicable arrangement or scheme. In addition, anyone who presents or causes to be presented a claim to the Medicare or Medicaid program in violation of Stark II is subject to monetary penalties of up to $15,000 per service, an assessment of up to twice the amount claimed, and possibly exclusion from participation in federal healthcare programs. Generally, these penalties are assessed against the entity that submitted the prohibited bill to Medicare or Medicaid; the government has, however, indicated that penalties would also apply to the referring physician because the physician "causes" the claim to be submitted by making the referral. The term "designated health services" includes several services commonly performed or supplied by hospitals or medical clinics to which we provide physician staffing. In addition, "financial relationship" is broadly defined to include any direct or indirect ownership or investment interest or compensation arrangement under which a physician receives remuneration. Stark II is broadly written, and at this point, the complete set of implementing regulations which clarify the statute have not been finalized. Currently, Phase I of the final regulations has been issued to clarify the meaning and application of only certain provisions of Stark II, including the general prohibition against physician self-referrals, certain exceptions for ownership and compensation arrangements, and definitions of key terms. However, as the Phase I regulations were subject to a comment period, these regulations may change as a result of the analysis of such comments. Phase II of the regulations will purportedly address the remaining provisions of Stark II as well as the comments received about Phase I regulations, but no date has been set for their issuance. 14 Until Phases I and II are complete, we lack definitive guidance as to the application of certain key aspects of Stark II as they relate to our arrangements with physicians and hospitals. We believe that we can present reasonable arguments that our arrangements with physicians and hospitals either do not implicate Stark II or, if they do, that they comply with its requirements. Likewise, we believe that these arrangements substantially comply with similar state physician self-referral statutes. However, we cannot assure you that the government will not be able to successfully challenge our existing organizational structure and our contractual arrangements with affiliated physicians, professional corporations and hospitals as being inconsistent with Stark II or its state law equivalents. Other Fraud and Abuse Laws. The federal government has made a policy decision to significantly increase the financial resources allocated to enforcing the general fraud and abuse laws. In addition, private insurers and various state enforcement agencies have increased their level of scrutiny of healthcare claims in an effort to identify and prosecute fraudulent and abusive practices in the healthcare area. The Company is subject to these increased enforcement activities and may be subject to specific subpoenas and requests for information. The federal Civil False Claims Act imposes civil liability on individuals and entities that submit false or fraudulent claims for payment to the government. Violations of the False Claims Act may include treble damages and penalties of up to $11,000 per false or fraudulent claim. In addition to actions being brought under the Civil False Claims Act by government officials, the False Claims Act also allows a private individual with direct knowledge of fraud to bring a "whistleblower" or qui tam suit on behalf of the government against a healthcare provider for violations of the False Claims Act. In that event, the "whistleblower" is responsible for initiating a lawsuit that sets in motion a chain of events that may eventually lead to the government recovering money. After the "whistleblower" has initiated the lawsuit, the government must decide whether to intervene in the lawsuit and to become the primary prosecutor. In the event the government declines to join the lawsuit, the "whistleblower" plaintiff may choose to pursue the case alone, in which case the "whistleblower's" counsel will have primary control over the prosecution, although the government must be kept apprised of the progress of the lawsuit and will still receive at least 70% of any recovered amounts. In return for bringing a "whistleblower" suit on the government's behalf, the "whistleblower" plaintiff receives a statutory amount of up to 30% of the recovered amount from the government's litigation proceeds if the litigation is successful. Recently, the number of "whistleblower" suits brought against healthcare providers has increased dramatically. In addition to the federal False Claims Act, at least five states -- California, Illinois, Florida, Tennessee, and Texas -- have enacted laws modeled after the False Claims Act that allow these states to recover money which was fraudulently obtained by a healthcare provider from the state such as Medicaid funds provided by the state. In addition to the False Claims Act, the Health Insurance Portability and Accountability Act of 1996 created two new federal crimes: "Health Care Fraud" and "False Statements Relating to Health Care Matters." The Health Care Fraud statute prohibits knowingly and willfully executing a scheme or artifice to defraud any healthcare benefit program, including private payors. A violation of this statute is a felony and may result in fines, imprisonment and/or exclusion from government-sponsored programs. The False Statements statute prohibits knowingly and willfully falsifying, concealing or covering up a material fact by any trick, scheme or device or making any materially false, fictitious or fraudulent statement in connection with the delivery of or payment for healthcare benefits, items or services. A violation of this statute is a felony and may result in fines and/or imprisonment. The Health Insurance Portability and Accountability Act of 1996 "HIPAA". HIPAA mandates the adoption of standards for the exchange of electronic health information in an effort to encourage overall administrative simplification and enhance the effectiveness and efficiency of the health care industry. Ensuring privacy and security of patient information is one of the key factors driving the legislation. In August 2000, the Health and Human Services agency ("HHS") issued final regulations establishing electronic data transmission standards that health care providers must use when submitting or receiving 15 certain health care data electronically. All affected entities, including our Company, are required to comply with these regulations by October 16, 2002. In December 2000, HHS issued final regulations concerning the privacy of health care information. These regulations regulate the use and disclosure of individuals' health care information, whether communicated electronically, on paper or verbally. All affected entities, including our Company, are required to comply with these regulations by April 2003. The regulations also provide patients with significant new rights related to understanding and controlling how their health information is used or disclosed. Although the enforcement provisions of HIPAA have not yet been finalized, sanctions are expected to include criminal penalties and civil sanctions. We have established a plan and engaged the resources necessary to comply with HIPAA. At this time, we anticipate that we will be able to fully comply with those HIPAA regulations that have been issued and with the proposed regulations. Based on the existing and proposed HIPAA regulations, we believe that the cost of its compliance with HIPAA will not have a material adverse effect on its business, financial condition or results of operations. Related Laws and Guidelines. Because we perform services at hospitals, outpatient facilities and other types of healthcare facilities, we and our affiliated physicians may be subject to laws, which are applicable to those entities. For example, we are subject to the Emergency Medical Treatment and Active Labor Act of 1986 which prohibits "patient dumping" by requiring hospitals and hospital emergency department or urgent care center physicians to provide care to any patient presenting to the hospital's emergency department or urgent care center in an emergent condition regardless of the patient's ability to pay. Many states, in which we operate, including California, have similar state law provisions concerning patient dumping. In addition to the Emergency Medical Treatment and Active Labor Act of 1986 and its state law equivalents, significant aspects of our operations are subject to state and federal statutes and regulations governing workplace health and safety, dispensing of controlled substances and the disposal of medical waste. Changes in ethical guidelines and operating standards of professional and trade associations and private accreditation commissions such as the American Medical Association and the Joint Commission on Accreditation of Health Care Organizations may also affect our operations. We believe our operations as currently conducted are in substantial compliance with these laws and guidelines. BUSINESS RISKS Our Substantial Indebtedness Could Make it More Difficult to Pay Our Debts, Divert Our Cash Flow from Operations for Debt Payments, Limit Our Ability to Borrow Funds and Increase Our Vulnerability To General Adverse Economic and Industry Conditions. We have a significant amount of indebtedness. As of December 31, 2001 we had total indebtedness of $217.3 million. Our substantial indebtedness could have important consequences to our business. For example, it could: - make it more difficult to pay our debts as they become due during general negative economic and market industry conditions because if our revenues decrease due to general economic or industry conditions, we may not have sufficient cash flow from operations to make our scheduled debt payments; - limit our flexibility in planning for, or reacting to, changes in our business and the industry in which we operate and, consequently, place us at a competitive disadvantage to our competitors with less debt; - require a substantial portion of our cash flow from operations for debt payments, thereby reducing the availability of our cash flow to fund working capital, capital expenditures, acquisitions and other general corporate purposes; and - limit our ability to borrow additional funds. Failure to Comply with Any of the Restrictions Contained in Our Senior Bank Facilities or the Indenture for the 12% Senior Subordinated Notes Could Result in Acceleration of Our Debt and We May Not Have Sufficient Cash to Repay Our Accelerated Indebtedness. Our senior bank facilities and the indenture governing our outstanding 12% senior subordinated notes due 2009 restrict our ability, and the ability of some 16 of our subsidiaries, to take various actions and enter into various types of transactions commonly undertaken by business entities including our ability to: - borrow money or retire debt that ranks behind the exchange notes, - pay dividends on stock or repurchase stock, - make investments, - enter into transactions with affiliates, - use assets as security in other transactions, - create liens, - sell substantially all of our assets or merge with or into other companies, - enter into sale and leaseback transactions, and - change the nature of our business. In addition, we must maintain minimum debt service and maximum leverage ratios under the senior bank facilities. Our failure to comply with the restrictions contained in the senior bank facilities and indenture could lead to an event of default, which could result in an acceleration of that indebtedness, and we may not have enough available cash to immediately repay such indebtedness. An acceleration under our senior credit facilities would also constitute an event of default under the indenture relating to the 12% senior subordinated notes due 2009. We Could Be Subject to Medical Malpractice Lawsuits, Some of Which We May not Be Fully Insured Against. In recent years, physicians, hospitals and other participants in the healthcare industry have become subject to an increasing number of lawsuits alleging medical malpractice and related legal theories such as negligent hiring, supervision and credentialing, and vicarious liability for acts of their employees or independent contractors. Many of these lawsuits involve large claims and substantial defense costs. Although we do not principally engage in the practice of medicine or provide medical services nor control the practice of medicine by our affiliated physicians or the compliance with regulatory requirements applicable to the physicians and physician groups with which we contract, we cannot assure you that we will not become involved in this type of litigation in the future. In addition, through our management of hospital departments and provision of non-physician healthcare personnel, patients who receive care from physicians or other healthcare providers affiliated with medical organizations and physician groups with whom we have a contractual relationship could sue us. We typically provide claims-made coverage to affiliated physicians and other healthcare practitioners with limits of $1,000,000 per incident and a total annual limit of $3,000,000 per physician for all incidents. In addition, we obtain claims-made coverage for Team Health and other corporate entities with limits of $1,000,000 per incident and a total annual aggregate of $25,000,000. We believe these limits are appropriate based on our historical claims, the nature and risks of our business and standard industry practice. Nevertheless, we cannot assure you that the limits of coverage will be adequate to cover losses in all instances. We could be liable for claims against our affiliated physicians for incidents incurred but not reported during periods for which claims-made insurance covered the related risk. Under generally accepted accounting principles, the cost of medical malpractice claims, which includes costs associated with litigating or settling claims, is accrued when the incidents that give rise to the claims occur. The accrual includes an estimate of the losses that will result from incidents, which occurred during the claims-made period, but were not reported during that period. These claims are referred to as incurred-but-not-reported claims. We provide insurance to cover such incurred-but-not-reported claims. This type of insurance is generally referred to as "tail coverage." With respect to those physicians for whom we provide tail coverage, we accrue professional insurance expenses based on estimates of the cost of procuring tail coverage. We cannot assure you that a future claim will not exceed the limits of available insurance coverage or that such accrual will be sufficient to cover any risks assumed by Team Health. We May Incur Substantial Costs Defending Our Interpretations of Government Regulations and if We Lose the Government Could Force Us to Restructure and Subject Us to Fines, Monetary Penalties and 17 Exclusion from Participation in Government Sponsored Programs such as Medicare and Medicaid. Our operations and arrangements with healthcare providers are subject to extensive government regulation, including numerous laws directed at preventing fraud and abuse, laws prohibiting general business corporations, such as us, from practicing medicine, controlling physicians' medical decisions or engaging in some practices such as splitting fees with physicians, and laws regulating billing and collection of reimbursement from governmental programs, such as the Medicare and Medicaid programs. Of particular importance are: (1) provisions of the Omnibus Budget Reconciliation Act of 1993, commonly referred to as Stark II, that, subject to limited exceptions, prohibit physicians from referring Medicare patients to an entity for the provision of certain "designated health services" if the physician or a member of such physician's immediate family has a direct or indirect financial relationship (including a compensation arrangement) with the entity; (2) provisions of the Social Security Act, commonly referred to as the "anti-kickback statute," that prohibit the knowing and willful offering, payment, solicitation or receipt of any bribe, kickback, rebate or other remuneration in return for the referral or recommendation of patients for items and services covered, in whole or in part, by federal health care programs, such as Medicare and Medicaid; (3) provisions of the Health Insurance Portability and Accountability Act of 1996 that prohibit knowingly and willfully executing a scheme or artifice to defraud any healthcare benefit program or falsifying, concealing or covering up a material fact or making any material false, fictitious or fraudulent statement in connection with the delivery of or payment for healthcare benefits, items, or services; (4) the federal False Claims Act that imposes civil and criminal liability on individuals or entities that submit false or fraudulent claims for payment to the government; (5) reassignment of payment rules that prohibit certain types of billing and collection practices in connection with claims payable by the Medicare programs; (6) similar state law provisions pertaining to anti-kickback, self-referral and false claims issues; (7) state laws that prohibit general business corporations, such as us, from practicing medicine, controlling physicians' medical decisions or engaging in some practices such as splitting fees with physicians; (8) laws that regulate debt collection practices as applied to our internal collection agency and debt collection practices; (9) federal laws such as the Emergency Medical Treatment and Active Labor Act of 1986 that require the hospital and emergency department or urgent care center physicians to provide care to any patient presenting to the emergency department or urgent care center in an emergent condition regardless of the patient's ability to pay, and similar state laws; and (10) state and federal statutes and regulations that govern workplace health and safety. Each of the above may have related rules and regulations which are subject to interpretation and may not provide definitive guidance as to the application of those laws, rules or regulations to our operations, including our arrangements with hospitals, physicians and professional corporations. We have structured our operations and arrangements with third parties in an attempt to comply with these laws, rules and regulations based upon what we believe are reasonable and defensible interpretations of these laws, rules and regulations. However, we cannot assure you that the government will not successfully challenge our interpretation as to the applicability of these laws, rules and regulations as they relate to our operations and arrangements with third parties. In the ordinary course of business and like others in the health care industry, we receive requests for information from government agencies in connection with their regulatory or investigational authority. We review such requests and notices and take appropriate action. We have been subject to certain requests for information in the past and could be subject to such requests for information in the future, which could result 18 in significant penalties, as well as adverse publicity. The results of any current or future investigation or action could have a material adverse effect. With respect to state laws that relate to the practice of medicine by general business corporations and to fee splitting, while we seek to comply substantially with existing applicable laws, we cannot assure you that state officials who administer these laws will not successfully challenge our existing organization and our contractual arrangements, including noncompetition agreements with physicians, professional corporations and hospitals as unenforceable or as constituting the unlicensed practice of medicine or prohibited fee-splitting. If federal or state government officials challenge our operations or arrangements with third parties which we have structured based upon our interpretation of these laws, rules and regulations, the challenge could potentially disrupt our business operations and we may incur substantial defense costs, even if we successfully defend our interpretation of these laws, rules and regulations. In the event regulatory action limited or prohibited us from carrying on our business as we presently conduct it or from expanding our operations to certain jurisdictions, we may need to make structural and organizational modifications of our company and/or our contractual arrangements with physicians, professional corporations and hospitals. Our operating costs could increase significantly as a result. We could also lose contracts or our revenues could decrease under existing contracts as a result of a restructuring. Moreover, our financing agreements, including the indenture relating to our outstanding 12% senior subordinated notes due 2009 or the senior bank facilities may also prohibit modifications to our current structure and consequently require us to obtain the consent of the holders of this indebtedness or require the refinancing of this indebtedness. Any restructuring would also negatively impact our operations because our management's time and attention would be diverted from running our business in the ordinary course. We have not obtained an opinion of counsel with regard to our compliance with applicable state laws and regulations, and you should not construe the information contained herein regarding our compliance with applicable state laws and regulations as being based on an opinion of counsel. For a more detailed discussion of the regulatory frameworks affecting our business, see Regulatory Matters. If Governmental Authorities Determine That We Violate Medicare Reimbursement Regulations, Our Revenues Might Decrease and We Might Have To Restructure Our Method of Billing and Collecting Medicare Payments. The Medicare program prohibits the reassignment of Medicare payments due to a physician or other healthcare provider to any other person or entity unless the billing arrangement between that physician or other healthcare provider and the other person or entity falls within an enumerated exception to the Medicare reassignment prohibition. There is no exception that allows us to receive directly Medicare payments related to the services of independent contractor physicians. We use a "lockbox" model which we believe complies with the Medicare reassignment rules and we have notified Medicare carriers of the details of our lockbox billing arrangement. With respect to Medicare services that our independently contracted physicians render, Medicare carriers send payments for the physician services to a "lockbox" bank account under the control of the physician. The physician, fulfilling his contractual obligations to us, then directs the bank to transfer the funds in that bank account into a company bank account. In return, we pay the physician an agreed amount for professional services provided and provide management and administrative services to or on behalf of the physician or physician group. However, we cannot assure you that government authorities will not challenge our lockbox model as a result of changes in the applicable statutes and regulations or new interpretations of existing statutes and regulations. With respect to Medicare services that physicians employed by physician-controlled professional corporations render, Medicare carriers send payments for physician services to a group account under our control. While we seek to comply substantially with applicable Medicare reimbursement regulations, we cannot assure you that government authorities would find that we comply in all respects with these regulations. If Future Regulation Forces Us to Restructure Our Operations, Including Our Arrangements with Physicians, Professional Corporations, Hospitals and Other facilities, We May Incur Additional Costs, Lose Contracts and Suffer a Reduction in Revenue under Existing Contracts and We May Need to Refinance Our 19 Debt Or Obtain Debt Holder Consent. Legislators have introduced and may introduce in the future numerous proposals into the United States Congress and state legislatures relating to healthcare reform in response to various healthcare issues. We cannot assure you as to the ultimate content, timing or effect of any healthcare reform legislation, nor is it possible at this time to estimate the impact of potential legislation. Further, although we exercise care in structuring our arrangements with physicians, professional corporations, hospitals and other facilities to comply in all significant respects with applicable law, we cannot assure you that: (1) government officials charged with responsibility for enforcing those laws will not assert that we, or transactions into which we have entered, violate those laws or (2) governmental entities or courts will ultimately interpret those laws in a manner consistent with our interpretation. The continual flux of healthcare rules and regulations at the federal, state and local level could revise the future of our relationships with the hospitals and physicians with whom we contract. In addition to the regulations referred to above, aspects of our operations are also subject to state and federal statutes and regulations governing workplace health and safety and, to a small extent, the disposal of medical waste. Changes in ethical guidelines and operating standards of professional and trade associations and private accreditation commissions such as the American Medical Association and the Joint Commission on Accreditation of Healthcare Organizations may also effect our operations. Accordingly, changes in existing laws and regulations, adverse judicial or administrative interpretations of these laws and regulations or enactment of new legislation could force us to restructure our relationships with physicians, professional corporations, hospitals and other facilities. This could cause our operating costs to increase significantly. A restructuring could also result in a loss of contracts or a reduction in revenues under existing contracts. Moreover, if these laws require us to modify our structure and organization to comply with these laws, our financing agreements, including the indenture relating to our outstanding 12% senior subordinated notes due 2009 and the senior credit facilities may prohibit such modifications and require us to obtain the consent of the holders of such indebtedness or require the refinancing of such indebtedness. Laws and Regulations That Regulate Payments for Medical Services By Government Sponsored Healthcare Programs Could Cause Our Revenues To Decrease. Our affiliated physician groups derive a significant portion of their net revenue less provision for uncollectibles from payments made by government sponsored healthcare programs such as Medicare and state reimbursed programs. There are increasing public and private sector pressures to restrain healthcare costs and to restrict reimbursement rates for medical services. Any change in reimbursement policies, practices, interpretations, regulations or legislation that places limitations on reimbursement amounts or practices could significantly affect hospitals, and consequently affect our operations unless we are able to renegotiate satisfactory contractual arrangements with our hospital clients and contracted physicians. We believe that regulatory trends in cost containment will continue to result in a reduction from historical levels in per-patient revenue for physician services. We cannot assure you that we will be able to offset reduced operating margins through cost reductions, increased volume, the introduction of additional procedures or otherwise. In addition, we cannot assure you that the federal government will not impose further reductions in the Medicare physician fee schedule in the future. These reductions could reduce our revenues. The Medicare program has announced its physician reimbursement rates for 2002 and certain of those physician reimbursement rates have decreased from their corresponding levels in 2001. The Company has estimated that such decreased rates announced for 2002 will result in lower revenues in 2002 based on 2001 Medicare patient volumes by approximately $9.5 million. We Could Experience a Loss of Contracts with Our Physicians or Be Required to Sever Relationships with Our Affiliated Professional Corporations in Order To Comply with Antitrust Laws. Our contracts with physicians include contracts with physicians organized as separate legal professional entities (e.g. professional medical corporations) and as individuals. As such, the antitrust laws deem each such physician/practice to be separate, both from Team Health and from each other and, accordingly, each such physician/practice is subject to a wide range of laws that prohibit anti-competitive conduct among separate legal entities or individuals. A review or action by regulatory authorities or the courts, which is negative in nature as to the relationship between our company and the physicians/practices we contract with, could force us to terminate 20 our contractual relationships with physicians and affiliated professional corporations. Since we derive a significant portion of our revenues from these relationships, our revenues could substantially decrease. Moreover, if any review or action by regulatory authorities required us to modify our structure and organization to comply with such action or review, the indenture relating to our outstanding 12% senior subordinated notes due 2009 and/or the senior bank facilities may not permit such modifications, thereby requiring us to obtain the consent of the holders of such indebtedness or requiring the refinancing of such indebtedness. A Reclassification of Our Independent Contractor Physicians by Tax Authorities Could Require Us to Pay Retroactive Taxes and Penalties. As of December 31, 2001, we contracted with approximately 2,200 affiliated physicians as independent contractors to fulfill our contractual obligations to clients. Because we consider many of the physicians with whom we contract to be independent contractors, as opposed to employees, we do not withhold federal or state income or other employment related taxes, make federal or state unemployment tax or Federal Insurance Contributions Act payments, except as described below, or provide workers' compensation insurance with respect to such affiliated physicians. Our contracts with our independent contractor physicians obligate these physicians to pay these taxes. The classification of physicians as independent contractors depends upon the facts and circumstances of the relationship. In the event of a determination by federal or state taxing authorities that the physicians engaged as independent contractors are employees, we may be adversely affected and subject to retroactive taxes and penalties. Under current federal tax law, a "safe harbor" from reclassification, and consequently retroactive taxes and penalties, is available if our current treatment is consistent with a long-standing practice of a significant segment of our industry and if we meet certain other requirements. If challenged, we may not prevail in demonstrating the applicability of the safe harbor to our operations. Further, interested persons have proposed in the recent past to eliminate the safe harbor and may do so again in the future. We Are Subject to the Financial Risks Associated with Our Fee-for-Service Contracts Which Could Decrease Our Revenue, Including Changes in Patient Volume, Mix of Insured and Uninsured Patients and Patients Covered by Government Sponsored Healthcare Programs and Third Party Reimbursement Rates. We derive our revenue through two primary types of arrangements. If we have a flat fee contract with a hospital, the hospital bills and collects fees for physician services and remits a negotiated amount to us monthly. If we have a fee-for-service contract with a hospital, either we or our affiliated physicians collect the fees for physician services. Consequently, under fee-for-service contracts, we assume the financial risks related to changes in mix of insured and uninsured patients and patients covered by government sponsored healthcare programs, third party reimbursement rates and changes in patient volume. We are subject to these risks because under our fee-for-service contracts, our fees decrease if a smaller number of patients receive physician services or if the patients who do receive services do not pay their bills for services rendered or we are not fully reimbursed for services rendered. Our fee-for-service contractual arrangements also involve a credit risk related to services provided to uninsured individuals. This risk is exacerbated in the hospital emergency department physician-staffing context because federal law requires hospital emergency departments to treat all patients regardless of the severity of illness or injury. We believe that uninsured patients are more likely to seek care at hospital emergency departments because they frequently do not have a primary care physician with whom to consult. We also collect a relatively smaller portion of our fees for services rendered to uninsured patients than for services rendered to insured patients. In addition, fee-for-service contracts also have less favorable cash flow characteristics in the start-up phase than traditional flat-rate contracts due to longer collection periods. Our Revenue Could Be Adversely Affected by a Net Loss of Contracts. The average tenure of our existing contracts with clients is approximately seven years. Typically, either party may automatically renew these contracts on the same terms unless the other party has given notice of an intent not to renew. Likewise, generally, either party may terminate these contracts upon notice of as little as 30 days. These contracts may not be renewed or, if renewed, may contain terms that are not as favorable to us as our current contracts. We cannot assure you that we will not experience a net loss of contracts in the future and that any such net loss would not have a material adverse effect on our operating results and financial condition. 21 We May Not Be Able to Find Suitable Acquisition Candidates or Successfully Integrate Completed Acquisitions into Our Current Operations in Order To Profitably Operate Our Consolidated Company. When we obtain new contracts with hospitals and managed care companies, which increasingly involves a competitive bidding process, we must accurately assess the costs we will incur in providing services in order to realize adequate profit margins or otherwise meet our objectives. Increasing pressures from healthcare payors to restrict or reduce reimbursement rates at a time when the costs of providing medical services continue to increase make the integration of new contracts, as well as maintenance of existing contracts, more difficult. A significant portion of our growth in net revenue has resulted from, and is expected to continue to result from, the acquisition of healthcare businesses. We engage in evaluations of potential acquisitions and are in various stages of discussion regarding possible acquisitions, certain of which, if consummated, could be significant to us. Our strategy of growing through acquisitions has presented some challenges in the past. Some of the difficulties we have encountered include, problems identifying all service and contractual commitments of the acquired entity, evaluating the stability of the acquired entity's hospital contracts, integrating financial and operational software, and accurately projecting physician and employee costs. Moreover, because we have grown by acquisitions, we have had some difficulty achieving consistent implementation of a compliance plan in the area of physician documentation, procedure coding, and billing practices. Our strategy of growing through acquisitions is also subject to the risk that we may not be able to identify suitable acquisition candidates in the future, we may not be able to obtain acceptable financing or we may not be able to consummate any future acquisitions, any of which could inhibit our growth. In addition, in connection with acquisitions, we may need to obtain the consent of third parties who have contracts with the entity to be acquired, such as managed care companies or hospitals contracting with the entity. We may be unable to obtain these consents. If we fail to integrate acquired operations, fail to manage the cost of providing our services or fail to price our services appropriately, our operating results may decline. Finally, as a result of our acquisitions of other healthcare businesses, we may be subject to the risk of unanticipated business uncertainties or legal liabilities relating to such acquired businesses for which we may not be indemnified by the sellers of the acquired businesses. We May Not Be Able to Successfully Recruit and Retain Qualified Physicians to Serve as Our Independent Contractors or Employees. Our ability to recruit and retain affiliated physicians and qualified personnel significantly affects our performance at hospitals and urgent care clinics. In the recent past, our client hospitals have increasingly demanded a greater degree of specialized skills in the physicians who staff their contracts. This decreases the number of physicians who are qualified to staff our contracts. Moreover, because of the scope of the geographic and demographic diversity of the hospitals and other facilities we contract with, we must recruit physicians to staff a broad spectrum of contracts. We have had difficulty in the past recruiting physicians to staff contracts in some regions of the country and at some less economically advantaged hospitals. Moreover, we compete with other entities to recruit and retain qualified physicians and other healthcare professionals to deliver clinical services. Our future success depends on our ability to recruit and retain competent physicians to serve as our employees or independent contractors. We may not be able to attract and retain a sufficient number of competent physicians and other healthcare professionals to continue to expand our operations. We believe that we have experienced a loss of contracts in the past because of our inability to staff those contracts with qualified physicians. In addition, there can be no assurance that our non-competition contractual arrangements with affiliated physicians and professional corporations will not be successfully challenged in certain states as unenforceable. We have contracts with physicians in many states. State law governing noncompete agreements varies from state to state. Some states are reluctant to strictly enforce noncompete agreements with physicians. In such event, we would be unable to prevent former affiliated physicians and professional corporations from competing with us -- potentially resulting in the loss of some of our hospital contracts and other business. The High Level of Competition in Our Industry Could Adversely Affect Our Contract and Revenue Base. The provision of outsourced physician staffing and administrative services to hospitals and clinics is characterized by a high degree of competition. Such competition could adversely affect our ability to obtain new contracts, retain existing contracts and increase our profit margins. We compete with both national and regional enterprises, some of which have substantially greater financial and other resources available to them. In addition, some of these firms may have greater access than us to physicians and potential clients. We also 22 compete against local physician groups and self-operated hospital emergency departments for satisfying staffing and scheduling needs. Failure to Timely or Accurately Bill for Our Services Could Have a Negative Impact On Our Net Revenues, Bad Debt Expense and Cash Flow. Billing for emergency department visits in a hospital setting and other physician-related services is complex. The practice of providing medical services in advance of payment or, in many cases, prior to assessment of ability to pay for such services, may have significant negative impact on our net revenues, bad debt expense, and cash flow. We bill numerous and varied payors, such as self-pay patients, various forms of commercial insurance companies and the Medicare and Medicaid Programs. These different payors typically have differing forms of billing requirements that must be met prior to receiving payment for services rendered. Reimbursement to us is typically conditioned on our providing the proper medical necessity and diagnosis codes. Incorrect or incomplete documentation and billing information could result in non payment for services rendered. Additional factors that could complicate our billing include: - disputes between payors as to which party is responsible for payment; - variation in coverage for similar services among various payors; and - the difficulty of adherence to specific compliance requirements, diagnosis coding and various other procedures mandated by responsible parties. To the extent that the complexity associated with billing for our services causes delays in our cash collections, we assume the financial risk of increased carrying costs associated with the aging of our accounts receivable as well as increased potential for bad debts. We Are Subject to the Risk That MedPartners Will Be Unable to Fulfill Its Obligations to Us Under the Recapitalization Agreement. Under the recapitalization agreement, each of MedPartners and Physician Services have indemnified, jointly and severally, subject to some limitations, Team Health Holdings and us against losses resulting from: (1) any misrepresentation or breach of any warranty or covenant of MedPartners or Physician Services contained in the recapitalization agreement, a claim for which is made in most cases within the 18 months following the closing of the recapitalization; (2) some claims or audits by governmental authorities; and (3) litigation matters specified in the recapitalization agreement, including some medical malpractice claims to the extent not covered by third-party insurance. With respect to some matters, we are only indemnified if our losses from certain indemnification claims exceed $3.7 million and do not exceed a total of $50 million. There is no basket or limit on the total payments with respect to other specified misrepresentations or breaches of warranties and some litigation matters. A significant negative change in the financial condition of MedPartners could prevent MedPartners from fulfilling its indemnification obligations. As such, with respect to the indemnification rights granted to us in connection with the recapitalization, we are subject to MedPartners' credit risk. This report contains forward-looking statements within the meaning of the Private Securities Litigation Reform Act of 1995. These statements relate to analyses and other information, which are based on forecasts of future results and estimates of amounts not yet determinable. These statements also relate to our future prospects, developments and business strategies. These forward looking statements are identified by the use of terms and phrases such as "anticipate", "that is", "could", "estimate", "intend", "may", "plan", "predict", "project", "will" and similar terms and phrases, including references to assumptions. However, these words are not the exclusive means of identifying such statements. These statements are contained in many sections of this report on Form 10-K, including those entitled "Business", "Legal Proceedings", and "Management's Discussion and Analysis of Financial Condition and Results of Operations". Although we believe that our plans, intentions and expectations reflected in or suggested by such forward-looking statements are reasonable, we cannot assure you that we will achieve the plans, intentions or expectations. Important factors that could cause actual results to differ materially from the forward-looking statements we make in this report on Form 10-K set forth elsewhere in 23 this report. All forward-looking statements attributable to Team Health or persons acting on our behalf are expressly qualified in their entirety by the cautionary statements contained in this "Business Risks" section. ITEM 2. PROPERTIES We lease approximately 38,000 square feet at 1900 Winston Road, Knoxville, Tennessee for our corporate headquarters. We also lease or sublease facilities for the operations of the clinics, billing centers, and certain regional operations. We believe our present facilities are adequate to meet our current and projected needs. The leases and subleases have various terms primarily ranging from one to seven years and monthly rents ranging from approximately $1,300 to $50,000. Our aggregate monthly lease payments total approximately $450,000. We expect to be able to renew each of our leases or to lease comparable facilities on terms commercially acceptable to us. ITEM 3. LEGAL PROCEEDINGS We are party to various pending legal actions arising in the ordinary operation of our business such as contractual disputes, employment disputes and general business actions as well as malpractice actions. We believe that any payment of damages resulting from these types of lawsuits would be covered by insurance, exclusive of deductibles, would not be in excess of the reserves and such liabilities, if incurred, should not have a significant negative effect on the operating results and financial condition of our company. Moreover, in connection with the recapitalization, subject to certain limitations, MedPartners and Physician Services have jointly and severally agreed to indemnify us against some losses relating to litigation arising out of incidents occurring prior to the recapitalization to the extent those losses are not covered by third party insurance. With respect to some litigation matters, we are only indemnified if our losses from all indemnification claims exceed a total of $3.7 million and do not exceed a total of $50 million. With respect to other litigation matters, we are indemnified for all losses. Finally, also in connection with the recapitalization, MedPartners agreed to purchase, at its sole cost and expense, for the benefit of Team Health Holdings, insurance policies covering all liabilities and obligations for any claim for medical malpractice arising at any time in connection with the operation of Team Health and its subsidiaries prior to the closing date of the recapitalization transactions for which Team Health or any of its subsidiaries or physicians becomes liable. ITEM 4. SUBMISSION OF MATTERS TO A VOTE OF SECURITYHOLDERS There were no matters submitted to a vote of securityholders during the year ended December 31, 2001. PART II ITEM 5. MARKET FOR REGISTRANT'S COMMON EQUITY AND RELATED STOCKHOLDER MATTERS There is no public market for the equity securities of the Company. There were two holders of record of the Company's equity securities as of December 31, 2001. The Company has not declared any dividends on its shares of its common stock during fiscal years 2001 and 2000. ITEM 6. SELECTED HISTORICAL FINANCIAL AND OTHER DATA The following selected financial data should be read in conjunction with "Management's Discussion and Analysis of Financial Condition and Results of Operations" and our consolidated financial statements and the related notes included elsewhere in this report. The selected statement of operations data presented below for the three-year period ended December 31, 2001 and the balance sheet data at December 31, 2001 and 2000 are derived from our audited consolidated financial statements that are included elsewhere in this report. The selected statement of operations data presented below for the two-year period ended December 31, 1998 and the balance sheet data at December 31, 1999, 1998 and 1997 are derived from audited consolidated financial statements that are not included in this report. 24 Team Health acquired the operating assets of several medical staffing and related companies in the periods presented below. The results of the selected historical financial data reflect these acquisitions since their respective dates of acquisition. See "Management's Discussion and Analysis of Financial Condition and Results of Operations" and the historical consolidated financial statements and the related notes thereto included elsewhere in this report.
YEAR ENDED DECEMBER 31, ---------------------------------------------------- 2001 2000 1999 1998 1997 -------- -------- -------- -------- -------- (DOLLARS IN THOUSANDS) STATEMENT OF OPERATIONS DATA: Net revenue............................. $965,285 $918,974 $852,153 $805,403 $737,018 Provision for uncollectibles............ 336,218 329,291 309,713 257,618 227,362 -------- -------- -------- -------- -------- Net revenue less provision for uncollectibles........................ 629,067 589,683 542,440 547,785 509,656 Professional expenses................... 523,154 468,596 441,506 441,625 409,623 -------- -------- -------- -------- -------- Gross profit............................ 105,913 121,087 100,934 106,160 100,033 General and administrative expenses..... 63,998 57,794 51,491 47,099 54,142 Terminated transaction expense.......... -- 2,000 -- -- -- Management fee and other expenses....... 649 591 506 3,812 2,428 Impairment of intangibles............... 4,137 -- -- 2,992 -- Depreciation and amortization........... 14,978 12,638 9,943 9,464 6,455 Recapitalization expense................ -- -- 16,013 -- -- Write down of assets.................... -- -- -- -- 2,117 Interest expense, net................... 22,739 25,467 20,909 5,301 886 Novation program expense allocation..... -- -- -- -- 11,000 Merger expense.......................... -- -- -- -- 13,563 -------- -------- -------- -------- -------- Earnings (loss) before income taxes..... (588) 22,597 2,072 37,492 9,442 Income tax expense...................... 871 9,317 1,250 15,883 5,761 -------- -------- -------- -------- -------- Net earnings (loss) before cumulative effect of change in accounting principle............................. (1,459) 13,280 822 21,609 3,681 Cumulative effect of change in accounting principle.................. -- -- -- 912 -- Dividends on preferred stock............ 11,889 10,783 8,107 -- -- -------- -------- -------- -------- -------- Net earnings (loss) available to common stockholders.......................... $(13,348) $ 2,497 $ (7,285) $ 20,697 $ 3,681 ======== ======== ======== ======== ======== OTHER DATA: EBITDA(1)............................... $ 66,422 $ 61,293 $ 58,443 $ 59,061 $ 32,328 NET CASH PROVIDED BY (USED FOR): Operating Activities.................... $ 49,737 $ 52,130 $ 37,963 $ 42,817 $ 42,475 Investing Activities.................... (22,826) (12,900) (14,984) (22,838) (34,339) Financing Activities.................... (12,132) (13,646) 3,369 (21,975) (8,255) Capital Expenditures.................... (5,955) (7,359) (10,615) (5,015) (7,474)
25
YEAR ENDED DECEMBER 31, ---------------------------------------------------- 2001 2000 1999 1998 1997 -------- -------- -------- -------- -------- (DOLLARS IN THOUSANDS) BALANCE SHEET DATA (AT END OF PERIOD): Cash and cash equivalents............... $ 70,183 $ 55,404 $ 29,820 $ 3,472 $ 5,468 Working capital......................... 104,039 124,105 107,550 98,780 90,487 Total assets............................ 361,443 372,727 350,450 210,457 197,684 Total debt.............................. 217,300 229,201 241,676 2,544 7,820 Mandatory redeemable preferred stock.... 130,779 118,890 108,107 -- -- Total shareholders' equity (deficit).... (99,690) (86,123) (88,620) 98,729 96,393
- --------------- (1) EBITDA represents earnings before income taxes plus depreciation and amortization, net interest expense, the change of estimate charge of $24.5 million in 2001 and what we consider non-operational and non-cash charges such as write down of assets, management fees and other expenses, Novation Program expense, and recapitalization expense. This definition is consistent with that of our credit agreement. We have included information concerning EBITDA because we believe that EBITDA is commonly used as providing useful information regarding a company's ability to service and/or incur debt. EBITDA is not intended to represent cash flows for the period, nor has it been presented as an alternative to operating earnings as an indicator of operating performance and should not be considered in isolation or as a substitute for measures of performance prepared in accordance with generally accepted accounting principles ("GAAP") in the United States and is not indicative of operating earnings or cash flow from operations as determined under GAAP. We understand that while EBITDA is frequently used by securities analysts in the evaluation of companies, EBITDA, as used herein, is not necessarily comparable to other similarly titled captions of other companies due to potential inconsistencies in the method of calculation. 26 ITEM 7. MANAGEMENT'S DISCUSSION AND ANALYSIS OF FINANCIAL CONDITION AND RESULTS OF OPERATIONS Certain matters discussed in this Management's Discussion and Analysis of Financial Condition and Results of Operations and other sections of this annual report are "forward-looking statements" intended to qualify for the safe harbors from liability established by the Private Securities Litigation Reform Act of 1995. These forward-looking statements can generally be identified as such because the context of the statement will include words such as the Company "believes," "anticipates," "expects" or words of similar import. Similarly, statements that describe the Company's future plans, objectives or goals are also forward-looking statements. Such forward-looking statements are subject to certain risks and uncertainties which are described in close proximity to such statements and which may cause actual results to differ materially from those currently anticipated. The forward-looking statements made herein are made only as of the date of this report and the Company undertakes no obligation to publicly update such forward-looking statements to reflect subsequent events or circumstances. INTRODUCTION We believe we are among the largest national providers of outsourced physician staffing and administrative services to hospitals and other healthcare providers in the United States, with 350 hospital contracts in 29 states. Since our inception, we have focused primarily on providing outsourced services to hospital emergency departments and urgent care centers, which accounted for approximately 79% of our net revenue less provision for uncollectibles in 2001. Our regional operating model includes comprehensive programs for emergency medicine, radiology, anesthesiology, inpatient care, pediatrics and other hospital departments. We provide a full range of physician staffing and administrative services. Acquisitions. During the past five years, we have successfully acquired and integrated the contracts of 13 hospital-based physician groups and related companies. Those contracts acquired from emergency department and urgent care center physician groups were generally with hospitals in large markets with an average patient volume exceeding 15,000 per year. In addition, during the past five years we have also acquired five businesses engaged in providing such services as billing and collection, physician management services and non-hospital-based physician services. Since June 1997, acquisitions have been financed through a combination of cash and future contingent payments. All of our acquisitions since June 1997 were accounted for using the purchase method of accounting. As such, operating results of those acquired businesses are included in our consolidated financial statements since their respective dates of acquisition. In June 1997, the Company combined with another company with the merger accounted for using the pooling of interests method of accounting whereby the historical results of the merged company are included in our consolidated financial statements. Following each acquisition, the acquired groups' financial accounting systems have been converted to our infrastructure systems. Strategic acquisitions continue to be a core component of our growth strategy. The market for outsourced medical services is highly fragmented and served primarily by small local and regional physician groups, which represent over 54% of the market and generally lack the resources and depth of services necessary to compete with national providers. Our acquisition strategy is to target those companies with strong clinical reputations and quality contracts with larger hospitals. Contracts. Our growth has historically resulted from increases in the number of patient visits and fees for services provided under existing contracts and the addition and acquisition of new contracts. Our 350 contracts with hospitals typically have terms of three years and are generally automatically renewable under the same terms and conditions unless either party to the contract gives notice of their intent not to renew the contract. Our average contract tenure is approximately seven years. Approximately 77.8% of our net revenue less provision for uncollectibles is generated under fee-for-service arrangements through which we bill and collect the professional fees for the services provided. Conversely, under our flat-rate contracts, hospitals pay us a fee based on the hours of physician coverage provided, but the hospital is responsible for its own billing and collection. Because of our billing and collection 27 expertise, our fee-for-service contracts typically result in higher margins. In states where physician employees service our contracts directly because there is no prohibition against such arrangements, Medicare payments for such services are made directly to us. In states where the physicians providing services are our independent contractors, Medicare payments for those services are paid into a lockbox account in the name of the independent contractor physician and subsequently directed into a Company account. Critical Accounting Policies and Estimates. The consolidated financial statements of the Company are prepared in accordance with United States generally accepted accounting principles, which requires us to make estimates and assumptions (see Note 1 to the consolidated financial statements). Management believes the following critical accounting policies, among others, affect its more significant judgments and estimates used in the preparation of its consolidated financial statements. Revenue Recognition Net Revenue. A significant portion (81.8%) of the Company's revenue in 2001 resulted from fee-for-service patient visits. The recognition of net revenue (gross charges less contractual allowances) from such visits is dependent on such factors as proper completion of medical charts following a patient visit, the forwarding of such charts to one of the Company's six billing centers for medical coding and entering into the Company's billing systems, and the verification of each patient's submission or representation at the time services are rendered as to the payor(s) responsible for payment of such services. Net revenues are recorded based on the information known at the time of entering of such information into our billing system as well as an estimate of the net revenues associated with medical charts for a given service period that have not been processed yet into the Company's billing systems. The above factors and estimates are subject to change. For example, patient payor information may change following an initial attempt to bill for services due to a change in payor status. Such changes in payor status have an impact on recorded net revenue due to differing payors being subject to different contractual allowance amounts. Such changes in net revenue are recognized in the period that such changes in payor become known. Similarly, the actual volume of medical charts not processed into our billing systems may be different from the amounts estimated. Such differences in net revenue are adjusted in the following month based on actual chart volumes processed. Net Revenue Less Provision For Uncollectibles. Net revenue less provision for uncollectibles reflects management's estimate of billed amounts to ultimately be collected. Management, in estimating the amounts to be collected resulting from its over six million annual patient visits and procedures, considers such factors as prior contract collection experience, current period changes in payor mix and patient acuity indicators, reimbursement rate trends in governmental and private sector insurance programs and trends in collections from self-pay patients. Such estimates are performed at the individual contract level, reviewed periodically and adjusted, if subsequent actual collection experience indicates a change in estimate is necessary. Such provisions and any subsequent changes in estimates may result in adjustments to our operating results with a corresponding adjustment to our accounts receivable allowance for uncollectibles on our balance sheet. Insurance Reserves The nature of the Company's business is such that it is subject to medical malpractice lawsuits. To mitigate a portion of this risk, the Company maintains insurance for individual malpractice claims with limits of $1 million per incident with a total annual aggregate limit of $3 million per physician for all incidents. Malpractice lawsuits are routinely reviewed by the Company's insurance carrier and management for purposes of establishing ultimate loss estimates. Provisions for estimated losses in excess of insurance limits are provided at the time such determinations are made. The Company's insurance limits have generally been adequate to cover losses experienced by the Company. Impairment of Intangible Assets In assessing the recoverability of the Company's intangibles the Company must make assumptions regarding estimated future cash flows and other factors to determine the fair value of the respective assets. If these estimates or their related assumptions change in the future, the Company may be required to record 28 impairment charges for these assets. During 2001, the Company recorded an impairment of intangibles provision of $4.1 million. Effective January 1, 2002, the Company will adopt Statement of Financial Standards No. 142, "Goodwill and Other Intangible Assets," and will be required to analyze its goodwill for impairment issues during the first three months of 2002, and then on a periodic basis thereafter. Net Revenues and Provision for Uncollectibles. Net revenue consists of three components: fee-for-service revenue, contract revenue, and other revenue. Fee-for-service revenue represents revenue earned under contracts for which we bill and collect the professional component of the charges for medical services rendered by our contracted and employed physicians. Under the fee-for-service arrangements, we bill patients for services provided and receive payments from patients or their third party payors. Contract revenue represents revenue generated under contracts in which we provide physician and administrative services in return for a contractually negotiated fee. Contract revenue also includes supplemental revenue from hospitals where we may have a fee-for-service contract arrangement. Other revenue consists primarily of revenue from management and billing services provided to outside parties. Revenues are recorded in the period the services are rendered as determined by the respective contracts with healthcare providers. As is standard in the healthcare industry, revenue is reported net of third party contractual adjustments. As a result, gross charges and net revenue differ considerably. Revenue in our financial statements is reported at net realizable amounts from patients, third-party payors and other payors. We also record a provision for uncollectibles, which represents our estimate of losses based on the experience of each individual contract. All services provided are expected to result in cash flows and are therefore reflected as revenues in the financial statements. Management, in estimating the amounts to be collected resulting from its over six million annual patient visits and procedures, considers such factors as prior contract collection experience, current period changes in payor mix and patient acuity indicators, reimbursement rate trends in governmental and private sector insurance programs and trends in collections from self-pay patients. Historically, management has taken this information regarding net collections and allocated the reductions from gross billings and estimated net collections between contractual allowances (a reduction from gross revenues to arrive at net revenue) and provision for uncollectibles based on trended historical data, particularly with respect to such factors as payor mix and its collection experience with self-pay accounts. In the fourth quarter of 2001, management determined that the use of a shorter trend period of the data used resulted in a better estimate of the allocation of estimated net collections between net revenue and provision for uncollectibles. As a result of this reallocation, the Company recorded a reduction in the provision for uncollectibles of $35.2 million and a corresponding decrease in net revenues. This reallocation did not change management's estimate of net collections. In 2001, the Company recorded a charge of $24.5 million to increase its contractual allowances for patient accounts receivable for periods prior to 2001. This charge resulted from a change in estimated collections rates based on a detailed analysis of the Company's outstanding accounts receivable using additional data developed during the period. The result of the additional research indicated that the Company's estimated collection rates for prior periods were lower that originally anticipated. The aforementioned estimation process includes both quantitative estimates as well as qualitative judgment dispersed among regional management of the Company and is subject to corporate oversight and review. The complexity of the estimation process associated with the Company's fee-for-service volumes and diverse payor mix, along with the difficulty of assessing such factors as changes in the economy impacting the number of health care insured versus uninsured patients and other socio-economic trends that can have an impact on collection rates, could result in subsequent adjustments to previously reported revenues. Management believes that it has implemented an improved revenue estimation process and more timely subsequent assessment and recognition of such changes in estimates in 2001. Net revenue less the provision for uncollectibles is an estimate of cash collections and, as such, is a key measurement by which management evaluates the performance of individual contracts as well as the Company as a whole. 29 Approximately 25% of our revenue less provision for uncollectibles in 2001 was derived from payments made by government sponsored healthcare programs, principally Medicare and Medicaid. These programs are subject to substantial regulation by federal and state governments. Funds received under Medicare and Medicaid are subject to audit and, accordingly, retroactive adjustments of these revenues may occur. We, however, have never had any substantial retroactive adjustment due to a Medicare or Medicaid audit. Reimbursable fee payments for Medicare and Medicaid patients for some services are defined and limited by CMS and some state laws and regulations. The Medicare Program has announced its physician reimbursement rates for 2002 and certain of those physician reimbursement rates have decreased from their corresponding levels in 2001. The Company has estimated that such decreased rates announced for 2002 will result in lower revenues in 2002 based on 2001 Medicare patient volumes by approximately $9.5 million. Professional Expenses. Professional expenses primarily consist of fees paid to physicians and other providers under contract with us, outside collection fees relating to independent billing contracts, operating expenses of our internal billing centers, professional liability insurance premiums for physicians under contract and other direct contract service costs. Approximately 75% of our physicians are independently contracted physicians who are not employed by us, and the remainder are our employees. We typically pay emergency department and urgent care center physicians a flat hourly rate for each hour of coverage provided. We typically pay radiologists and primary care physicians an annual salary. The hourly rate varies depending on whether the physician is independently contracted or an employee. Independently contracted physicians are required to pay a self-employment tax, social security and expenses that we pay for employed physicians. Medical malpractice liability expenses are recorded under professional expenses. The cost of medical malpractice claims, which includes costs associated with litigating or settling claims, is accrued when the incidents that give rise to the claims occur. Estimated losses from asserted and unasserted claims are accrued either individually or on a group basis, based on the best estimates of the ultimate costs of the claims and the relationship of past reported incidents to eventual claim payments. The accrual includes an estimate of the losses that will result from incidents which occurred during the reporting period, but were not reported that period. These claims are referred to as incurred-but-not-reported claims. Our historical statements of operations include a medical malpractice liability expense that is comprised of three components including insurance premiums, incurred-but-not-reported claims estimates, and self-insurance costs. MedPartners agreed as a condition of the recapitalization transactions to purchase insurance policies covering all liabilities and obligations for any claim for medical malpractice arising at any time in connection with our operation, our subsidiaries and any of the affiliated physicians or other healthcare providers prior to the closing date of the recapitalization transactions for which we or any of our subsidiaries become liable. This has resulted in our being insured for any malpractice liabilities originating prior to the recapitalization transactions. See "Certain Relationships and Related Transactions." We entered into an initial two-year agreement on March 12, 1999 with a major national provider of medical malpractice insurance for a medical malpractice liability insurance policy that we believe will cover us for all claims made during the term of the agreement. The term of the agreement was extended on March 12, 2001 through March 12, 2003. The policy does not cover incidents that occur during such term, but for which no claim is made during the term. In March 2003, we will have the option to purchase a policy from the insurer that will cover the liability for all medical malpractice claims relating to incidents that occur during the term of the policy but for which no claim is made during that period. At this time, we have not determined whether we will exercise our option to purchase this policy. The Company is accruing the incremental cost of the tail liability on a straight line basis over the term of the agreement. Results of Operations. The following discussion provides an analysis of our results of operations and should be read in conjunction with our consolidated financial statements. The operating results of the periods presented were not significantly affected by inflation. Net revenue less the provision for uncollectibles is an estimate of future cash collections and as such it is a key measurement by which management evaluates performance of individual contracts as well as the 30 Company as a whole. The following table sets forth the components of net earnings and EBITDA as a percentage of net revenue less provision for uncollectibles for the periods indicated:
YEAR ENDED DECEMBER 31, ------------------------ 2001 2000 1999 ------ ------ ------ Fee for service revenue..................................... 125.5% 130.0% 129.2% Contract revenue............................................ 25.3 23.8 26.0 Other revenue............................................... 2.6 2.0 1.9 Net revenue................................................. 153.4 155.8 157.1 Provision for uncollectibles................................ 53.4 55.8 57.1 Net revenue less provision for uncollectibles............... 100.0 100.0 100.0 ===== ===== ===== Professional expenses....................................... 83.2 79.5 81.4 Gross profit................................................ 16.8 20.5 18.6 General and administrative expenses......................... 10.2 9.8 9.5 Terminated transaction expense.............................. -- 0.3 -- Management fee and other expenses........................... 0.1 0.1 0.1 Impairment of intangibles................................... 0.6 -- -- Depreciation and amortization............................... 2.4 2.2 1.8 Recapitalization expenses................................... -- -- 3.0 Interest expense, net....................................... 3.6 4.3 3.8 Income tax expense.......................................... 0.1 1.6 0.2 Net earnings (loss)......................................... (0.2) 2.2 0.2 Dividends on preferred stock................................ 1.9 1.8 1.5 Net earnings (loss) available to common stockholders........ (2.1) 0.4 (1.3) OTHER FINANCIAL DATA EBITDA(1)................................................... 10.6 10.4 10.8 Net Cash provided by (used in): Operating Activities........................................ 7.9 8.8 7.0 Investing Activities........................................ (3.6) (2.2) (2.8) Financing Activities........................................ (1.9) (2.3) 0.6
- --------------- (1) See footnote 1 to the "Selected Historical Financial and Other Data" for a discussion of how EBITDA has been calculated and of the significance of EBITDA. YEAR ENDED DECEMBER 31, 2001 COMPARED TO THE YEAR ENDED DECEMBER 31, 2000 Net Revenues. Net revenues for 2001 increased $46.3 million, or 5.0%, to $965.3 million from $919.0 million in 2000. The increase in net revenues of $46.3 million included an increase of $23.0 million in fee-for-service revenue, $18.8 million in contract revenue and $4.6 million in other revenue. Fee-for-service revenue was 81.8% of net revenue in 2001 compared to 83.4% in 2000, contract revenue was 16.5% of net revenue in 2001 compared to 15.3% in 2000, and other revenue was 1.7 % of net revenue in 2001 compared to 1.3% in 2000. In 2001, the Company recorded a charge of $24.5 million to increase its contractual allowances for patient accounts receivable for periods prior to 2001. The charge resulted from a change in estimated collection rates based on a detailed analysis of the Company's outstanding accounts receivable using additional data developed during the period. The result of the additional research indicated that the Company's estimated collection rates for prior periods were lower that originally anticipated. 31 Management, in estimating the amounts to be collected resulting from its over six million annual patient visits and procedures, considers such factors as prior contract collection experience, current period changes in payor mix and patient acuity indicators, reimbursement rate trends in governmental and private sector insurance programs and trends in collections from self-pay patients. Historically, management has taken this information regarding net collections and allocated the reductions from gross billings and estimated net collections between contractual allowances (a reduction from gross revenues to arrive at net revenue) and provision for uncollectibles based on trended historical data, particularly with respect to such factors as payor mix and its collection experience with self-pay accounts. In the fourth quarter of 2001, management determined that the use of a shorter trend period of the data used resulted in a better estimate of the allocation of estimated net collections between net revenue and provision for uncollectibles. As a result of this reallocation, the Company recorded a reduction in the provision for uncollectibles of $35.2 million and a corresponding decrease in net revenues. This reallocation did not change management's estimate of net collections. Provision for Uncollectibles. Including the $35.2 million adjustment noted above, the provision for uncollectibles was $336.2 million in 2001 compared to $329.3 million in 2000, an increase of $6.9 million or 2.1%. As a percentage of net revenue, the provision for uncollectibles was 34.8% in 2001 compared to 35.8% in 2000. The provision for uncollectibles is primarily related to revenue generated under fee-for-service contracts, which is not expected to be fully collected. Net Revenue Less Provision for Uncollectibles. Net revenue less provision for uncollectibles in 2001 increased $39.4 million, or 6.7%, to $629.1 million from $589.7 million in 2000. Same contract revenue less provision for uncollectibles, which consists of contracts under management from the beginning of the prior period through the end of the subsequent period, increased $23.3 million, or 4.7%, to $522.5 million in 2001 from $499.2 million in 2000, principally as the result of increases in patient volume between periods. Excluding the effects of the $24.5 million charge discussed above, same contract revenue less provision for uncollectibles increased $47.8 million, or 9.6%. Acquisitions contributed $7.8 million and new contracts obtained through internal sales efforts contributed an additional $52.9 million of increased revenue. The increases noted above were partially offset by $44.6 million of revenue derived from contracts that terminated during the periods. Professional Expenses. Professional expenses for 2001 were $523.2 million compared to $468.6 million in 2000, an increase of $54.6 million or 11.6%. As a percentage of net revenue less provision for uncollectibles, professional expenses increased to 83.2% in 2001 (80.0% excluding the effect of the $24.5 million charge noted above) from 79.5% in 2000. Physician costs, billing and collection expenses and other professional expenses, excluding medical malpractice expense, increased $49.1 million, or 11.1% between years. The increase in these professional expenses was principally due to increased patient volume and increases in physician rates. In addition, the Company experienced increased usage of medical licensed practitioners in 2001 in an effort to improve emergency room productivity to help offset the effects of hospital nursing shortages and increased emergency room volumes. Malpractice expense was $29.8 million in 2001 compared with $24.3 million in 2000 resulting in an increase between years of $5.5 million or 22.6%. The Company renewed its malpractice insurance coverage effective March 12, 2001 and the increased premium level reflects a "hardening" of the insurance market for such coverage. Gross Profit. Gross profit decreased to $105.9 million in 2001 from $121.1 million in 2000, principally due to the charge of $24.5 million noted above. Gross profit as a percentage of revenues less provision for uncollectibles decreased to 16.8% in 2001 compared to 20.5% in 2000. General and Administrative Expenses. General and administrative expenses in 2001 increased to $64.0 million from $57.8 million in 2000 for an increase of $6.2 million, or 10.7%. General and administrative expenses as a percentage of net revenue less provision for uncollectibles increased to 10.2% in 2001 from 9.8% in 2000. The increase in general and administrative expenses between years included expenses associated with acquired operations of $2.0 million or 3.5% of the increase in total expenses between years. The remaining increase was principally due to increases in salaries and related benefit costs resulting from annual wage 32 increases and the full year effect of additional staff added in prior periods to further develop the Company's infrastructure. Management Fee and Other Operating Expenses. Management fee and other operating expenses were $0.6 million in both 2001 and 2000. Impairment of Intangibles. Impairment of intangibles in 2001 was $4.1 million. The Company concluded that certain of its intangible assets relating to a portion of its radiology related operations were impaired. The intangibles related to such operations were reduced to estimated fair value by recording an impairment charge of $4.1 million. Depreciation and Amortization. Depreciation and amortization for 2001 increased to $15.0 million from $12.6 million in 2000 for an increase of $2.4 million, or 18.5%. Depreciation expense increased by $0.6 million during 2001 while amortization expense increased by $1.8 million. The increase in depreciation expense was due to capital expenditures made in 2000 and 2001. Amortization expense increased due to initial acquisition payments and deferred contingent payments made during 2000 and 2001. Net Interest Expense. Net interest expense in 2001 decreased to $22.7 million from $25.5 million in 2000 for a decrease of $2.8 million, or 10.7%. The decrease in net interest expense is principally due to reductions in outstanding debt due to principal repayments and lower interest rates on floating rate debt obligations between years. Income Tax Expense. Income tax expense in 2001 was $0.9 million compared to $9.3 million in 2000. The decrease is due to the decreased level of earnings before income taxes in 2001. Net Earnings. Net loss for 2001 was $1.5 million as compared to net earnings of $13.3 million in 2000 as a result of the factors discussed above. Dividends on Preferred Stock. The Company accrued $11.9 million and $10.8 million in 2001 and 2000, respectively, of dividends on its outstanding Class A mandatory redeemable preferred stock. YEAR ENDED DECEMBER 31, 2000 COMPARED TO THE YEAR ENDED DECEMBER 31, 1999 Net Revenues. Net revenues for 2000 increased $66.8 million, or 7.8% to $919.0 million from $852.2 million in 1999. During 2000, fee-for-service revenue was 83.4% of net revenue compared to 82.2% in 1999. Contract revenue represented 15.3% of net revenue in 2000 and 16.6% in 1999. Other revenue represented 1.3% of 2000 revenue and 1.2% of 1999 revenue. The increase in fee-for-service revenue as a percentage of total revenue was driven by rate increases within fee-for-service contracts, new fee-for-service contracts, and the conversion of several contracts from flat rate contracts to fee-for-service contracts. Provision for Uncollectibles. The provision for uncollectibles was $329.3 million in 2000 as compared to $309.7 million 1999, an increase of $19.6 million or 6.3%. As a percentage of net revenue, the provision for uncollectibles was 35.8% in 2000 compared to 36.3% in 1999. The increase in the provision for uncollectibles is a result of increases in fee-for-service revenue during 2000. The provision for uncollectibles is primarily related to revenue generated under fee-for-service contracts which is not expected to be fully collected. Net Revenue Less Provision for Uncollectibles. Net revenue less provision for uncollectibles for 2000 increased $47.2 million, or 8.7%, to $589.7 million from $542.4 million in 1999. Same contract revenue less provision for uncollectibles, which consists of contracts under management from the beginning of the prior period through the end of the subsequent period, increased $39.6 million, or 8.5%, to $505.9 million in 2000 from $466.3 million in 1999 through a combination of increased patient volume and increased pricing during 2000. While acquisitions contributed $5.3 million and new contracts obtained through internal sales contributed $34.1 million of increased revenue, those increases were offset by $40.7 million of revenue associated with contract terminations during the periods. Professional Expenses. Professional expenses for 2000 were $468.6 million compared to $441.5 million in 1999 for an increase of $27.1 million or 6.1%. As a percentage of net revenue less provision for uncollectibles, professional expenses decreased to 79.5% in 2000 from 81.4% in 1999. Physician costs, billing 33 and collection expenses and other professional expenses, excluding medical malpractice expense, increased $24.7 million, or 5.9%, between years. The increase in these professional expenses was principally due to increased patient volume. In 2000, medical malpractice expense was $24.3 million as compared to $21.9 million in 1999, an increase of 11.0%. Gross Profit. Gross profit increased to $121.1 million in 2000 from $100.9 million in 1999, primarily due to the reasons discussed above. Gross profit as a percentage of revenues less provision for uncollectibles increased to 20.5% during 2000 from 18.6% during 1999 due to the factors described above. General and Administrative Expenses. General and administrative expenses for 2000 increased to $57.8 million from $51.5 million in 1999. General and administrative expenses as a percentage of net revenues less provision for uncollectibles increased to 9.8% in 2000 from 9.5% in 1999. The increase in general and administrative expenses was due primarily to the development of infrastructure during 1999 and 2000 that was required to operate as a stand-alone company. Terminated Transaction Expense. During 2000, we terminated discussions with respect to a potential acquisition target. Costs of $2.0 million incurred in connection with the potential acquisition were expensed in 2000. These costs consisted primarily of professional fees paid to legal and accounting firms who assisted us with due diligence and evaluation of the potential transaction. Depreciation and Amortization. Depreciation and amortization for 2000 increased to $12.6 million from $9.9 million in 1999. Depreciation expense increased by $1.8 million during the period while amortization expense increased by $0.9 million. The increase in depreciation expense was due to capital expenditures made in 1999 and 2000, principally to develop the Company's infrastructure as a stand-alone Company. Amortization expense increased due to initial acquisition payments and deferred contingent payments made during 1999 and 2000. Recapitalization Expense and Management Fee and Other Operating Expenses. Recapitalization expense and management fee and other operating expenses for 2000 were $0.6 million compared to $16.5 million in 1999. This decrease was primarily due to expenses of $16.0 million incurred in 1999 related to the recapitalization. Net Interest Expense. Net interest expense in 2000 increased to $25.5 million from $20.9 million in 1999. The increase in net interest expense is due to a full year of interest expense in 2000 related to the Senior Credit Facility and Notes issued on March 12, 1999. Income Tax Expense. Income tax expense in 2000 was $9.3 million compared to $1.3 million in 1999. The increase was due primarily to the increased level of earnings before income taxes in 2000. Net Earnings. Net earnings for 2000 was $13.3 million as compared to $0.8 million in 1999. This change was primarily due to the factors described above. Dividends on Preferred Stock. The Company accrued $10.8 million and $8.1 million in 2000 and 1999, respectively, of dividends on its outstanding Class A mandatory redeemable preferred stock. LIQUIDITY AND CAPITAL RESOURCES The Company's principal uses of cash are to meet working capital requirements, debt obligations and to finance its capital expenditures and acquisitions. Funds generated from operations since the recapitalization in March, 1999 have been sufficient to meet the Company's cash requirements. The Company as of December 31, 2001 had cash and cash equivalents of approximately $70.2 million and a revolving credit facility borrowing availability of $49.7 million. The Company believes that its cash needs, other than for significant acquisitions, will be met through the use of its existing available cash and cash generated from borrowings under its revolving credit facility. Cash provided by operating activities in 2001 was $49.7 million. Cash provided by operating activities in 2000 and 1999 was $52.1 million and $38.0 million, respectively. 34 The Company has made scheduled principal repayments of $8.8 million in 2001, $12.8 million in 2000 and $10.9 million in 1999 on its outstanding debt. The Company's Term Loan Facility includes a provision for the prepayment of a portion of the outstanding term loan amounts at any year end if the Company generates "excess cash flow," as defined in the Term Loan Facility agreement. The excess cash flow amount, which is payable on April 30 of the succeeding year, was $3.1 million for fiscal 2000 and was paid on April 30, 2001. The Company has estimated that it will be required to make an excess cash flow payment of approximately $6.0 million for fiscal 2001 by April 30, 2002. The estimated excess cash flow payment has been included within current maturities of long-term debt in the accompanying balance sheet at December 31, 2001. The Company spent $6.0 million in 2001, $7.4 million in 2000 and $10.6 million in 1999 on capital expenditures. The Company's capital expenditures in 2002 are expected to approximate $10.5 million. The expected capital expenditures are primarily for information technology related maintenance capital and development projects. The Company historically has acquired other physician staffing businesses and interests. Acquisitions since June 1997 have been acquired for cash. The acquisitions in many cases include contingent purchase price payment amounts that are payable in years subsequent to the years of acquisition. Cash payments made in association with acquisitions, including contingent payments, were $16.2 million in 2001, $5.1 million in 2000 and $4.0 million in 1999. Future contingent payment obligations are approximately $5.3 million as of December 31, 2001. During 2001, the Company's cash needs were met from internally generated operating sources and there were no borrowings by the Company under its revolving credit facility. The Company expects to meet its cash needs for debt repayment purposes and for its planned capital expenditures in 2002 from its existing cash balances and with cash flows derived from future operating results. The Company in March 2001 renewed its professional liability insurance, which provides coverage for potential liabilities on a "claims-made" basis. The coverage is in effect for a two-year period through March 12, 2003. The Company's options for continued coverage beyond March 12, 2003 for claims incurred but not reported before that date include the option of exercising a "tail" policy, which would cover such potential claims. The cost of such tail policy is approximately $30.0 million and, if exercised, would be payable in March 2003. At this time, we have not yet determined if we will exercise our option to purchase this "tail" policy. The following table reflects a summary of obligations and commitments outstanding with payment dates as of December 31, 2001 (in thousands):
PAYMENTS DUE BY PERIOD ------------------------------------------------------------------ LESS THAN 1 YEAR 1 - 3 YEARS 4 - 5 YEARS AFTER 5 YEARS TOTAL ----------- ----------- ----------- ------------- -------- Contractual cash obligations: Long-term debt................ $24,211 $77,388 $15,701 $100,000 $217,300 Operating leases.............. 5,152 7,207 6,062 6,115 24,536 ------- ------- ------- -------- -------- 29,363 84,595 21,763 106,115 241,836
35
AMOUNT OF COMMITMENT EXPIRATION PER PERIOD ------------------------------------------------------------------ LESS THAN 1 YEAR 1 - 3 YEARS 4 - 5 YEARS AFTER 5 YEARS TOTAL ----------- ----------- ----------- ------------- -------- Other commitments: Standby letter of credit...... $ -- $ 315 $ -- $ -- $ 315 Contingent acquisition payments.................... 3,331 2,008 -- -- 5,339 ------- ------- ------- -------- -------- 3,331 2,323 -- -- 5,654 ------- ------- ------- -------- -------- Total obligations and commitments... $32,694 $86,918 $21,763 $106,115 $247,490 ======= ======= ======= ======== ========
INFLATION We do not believe that inflation has had a material impact on our financial position or results of operations during the past three years. MEDICARE PROGRAM PHYSICIAN REIMBURSEMENT RATES A portion of the Company's revenues are derived from services provided to patients covered under the Medicare Program and commercial insurance plans whose reimbursement rates are tied to Medicare rates. Physician reimbursement rates for services provided to such Medicare Program beneficiaries are established annually by the Centers for Medicare and Medicaid Services. The Medicare Program has announced its physician reimbursement rates for 2002 and certain of those physician reimbursement rates have decreased from their corresponding levels in 2001. The Company has estimated that such decreased rates announced for 2002 will result in lower revenues in 2002 of approximately $9.5 million based on 2001 patient volumes from Medicare and commercial insurance plans with fee schedules based upon Medicare rates. SEASONALITY Historically, our revenues and operating results have reflected minimal seasonal variations due to our geographic diversification. RECENTLY ISSUED ACCOUNTING STANDARDS In June 1998, the Financial Accounting Standards Board issued SFAS No. 133, "Accounting for Derivative Instruments and Hedging Activities." SFAS No. 133 requires all derivatives to be measured at fair value and recognized as either assets or liabilities on the balance sheet. Changes in such fair value are required to be recognized immediately in net earnings to the extent the derivatives are not effective as hedges. SFAS No. 133 is effective for fiscal years beginning after June 15, 2000 and is effective for interim periods in the initial year of adoption. The adoption of SFAS No. 133 did not have a significant effect on our results of operations, financial position, or cash flows. In June 2001, the Financial Accounting Standards Board issued SFAS No. 141, Business Combinations, and No. 142, Goodwill and Other Intangible Assets, effective for fiscal years beginning after December 15, 2001. Under the new rules, goodwill will no longer be amortized but will be subject to annual impairment tests in accordance with the Statements. Other intangible assets will continue to be amortized over their estimated useful lives. The Company will apply the new rules on accounting for goodwill and other intangible assets beginning in the first quarter of 2002. The Company has, however, applied the nonamortization provisions of the Statement for acquisitions consummated after June 30, 2001. Application of the nonamortization provisions of the Statement is expected to result in an increase in net earnings of approximately $1.2 million per year. During the first quarter of 2002, the Company is anticipating that it will perform the first of the required impairment tests of goodwill and indefinite lived intangible assets as of January 1, 2002. The Company has not yet determined what the effect of these tests will be on the earnings and financial position of the Company. Any 36 impairment recognized at transition will be recorded as a change in accounting principle. The Company anticipates that its impairment assessment for goodwill will include a determination of the related reporting unit's fair value using a valuation technique based on multiples of EBITDA (earnings before interest, taxes, depreciation and amortization) as compared to the reporting unit's underlying net carrying value. The Company further anticipates that its impairment assessment for other intangibles, including contracts, will be based on a determination of the fair value of such intangibles using the income approach that includes discounting future cash flows related to the intangible asset. The resulting fair value using the income approach will be compared to the intangible asset's underlying net carrying value. In October 2001, the Financial Accounting Standards Board issued SFAS No. 144, Impairment or Disposal of Long-Lived Assets, effective for fiscal years after December 15, 2001. SFAS No. 144 significantly changes the criteria that would have to be met to classify an asset as held-for-sale, and will require expected future operating losses from discontinued operations to be displayed in discontinued operations in the period(s) in which the losses are incurred (rather than as of the measurement date as presently required). In addition, more dispositions will qualify for discontinued operations treatment in the income statement. The Company will apply the new rules on asset impairment beginning in the first quarter of 2002. The Company does not expect the implementation of SFAS No. 144 to have any impact on its results of operation or financial position. ITEM 7A. QUANTITATIVE AND QUALITATIVE DISCLOSURES ABOUT MARKET RISK The Company is exposed to market risk related to changes in interest rates. The Company does not use derivative financial instruments for speculative or trading purposes. The Company's earnings are affected by changes in short-term interest rates as a result of its borrowings under its senior credit facilities. Interest rate swap agreements are used to manage the Company's interest rate exposure. The Company has entered into interest rate swap agreements to effectively convert $50.0 million of floating-rate borrowings to fixed-rate borrowings. The agreements are contracts to exchange, on a quarterly basis, floating interest rate payments based on the eurodollar rate, for fixed interest rate payments over the life of the agreements. The contracts have a final expiration of March 13, 2002. These agreements expose the Company to credit losses in the event of non-performance by the counterparties to its financial instruments. The counterparties are creditworthy financial institutions and the Company believes the counterparties will be able to fully satisfy their obligations under the contracts. In 2001, the Company received a weighted average rate of 4.41% and paid a weighted average rate of 5.63% on the swaps. For the $50.0 million notional amount swaps at the expected maturity date of March 13, 2002 (assuming the options to extend or cancel are not exercised), the weighted average pay rate is 5.63% and the weighted average receive rate is 1.91%, using the rate in effect at December 31, 2001. At December 31, 2001, the fair value of the Company's total debt, which has a carrying value of approximately $217.3 million, was approximately $226.8 million. The Company had $117.3 million of variable debt outstanding at December 31, 2001, with interest rate swaps in place to offset the variability of $50.0 million of this balance. If market interest rates for such borrowings averaged 1% more during the fiscal year ended December 31, 2002 than they did during fiscal 2001, the Company's interest expense would increase, and earnings before income taxes would decrease by approximately $0.9 million. This analysis does not consider the effects of the reduced level of overall economic activity that could exist in such an environment. Further, in the event of a change of such magnitude, management could take actions to further mitigate its exposure to the change. However, due to the uncertainty of the specific actions that would be taken and their possible effects, the sensitivity analysis assumes no changes in the Company's financial structure. ITEM 8. FINANCIAL STATEMENTS AND SUPPLEMENTARY DATA The financial statements and schedules are listed in Part IV Item 14 of this Form 10-K. 37 ITEM 9. CHANGES IN AND DISAGREEMENTS WITH ACCOUNTANTS ON ACCOUNTING AND FINANCIAL DISCLOSURE None. PART III ITEM 10. DIRECTORS AND EXECUTIVE OFFICERS OF THE REGISTRANT MANAGEMENT DIRECTORS AND EXECUTIVE OFFICERS Our directors and executive officers are as follows:
NAME AGE* POSITION - ---- ---- -------- Lynn Massingale, M.D. ............... 49 President, Chief Executive Officer and Director Michael L. Hatcher................... 51 Chief Operating Officer Robert J. Abramowski................. 51 Executive Vice President, Finance and Administration Robert C. Joyner..................... 54 Executive Vice President, General Counsel Stephen Sherlin...................... 56 Executive Vice President, Billing and Reimbursement David P. Jones....................... 34 Chief Financial Officer Nicholas W. Alexos................... 38 Director Glenn A. Davenport................... 48 Director Earl P. Holland...................... 56 Director Dana J. O'Brien...................... 46 Director Kenneth W. O'Keefe................... 35 Director Timothy P. Sullivan.................. 43 Director
- --------------- * As of March 1, 2002 LYNN MASSINGALE, M.D. has been President, Chief Executive Officer and Director of Team Health since its founding in 1994. Prior to that, Dr. Massingale served as President and Chief Executive Officer of Southeastern Emergency Physicians, a major provider of emergency physician services to hospitals in the Southeast and the predecessor of Team Health, which Dr. Massingale co-founded in 1979. Dr. Massingale served as the director of Emergency Services for the state of Tennessee from 1989 to 1993. Dr. Massingale is a graduate of the University of Tennessee Medical Center for Health Services. MICHAEL L. HATCHER joined Team Health in 1990 and currently serves as Chief Operating Officer. Mr. Hatcher has served as Chief Financial Officer and President of Nutritional Support Services, Ltd. in Knoxville; and as Chief Financial Officer for Cherokee Textile Mills, Inc. in Sevierville, Tennessee and Spindale Mills, Inc. in Spindale, N.C. Mr. Hatcher is a member of the American Institute of Certified Public Accountants. Mr. Hatcher is responsible for the Company's operations, including development activities. Mr. Hatcher received a B.S. from the University of Tennessee and an M.B.A. from Vanderbilt University. ROBERT J. ABRAMOWSKI, CPA, joined Team Health in October 2000 as its Executive Vice President, Finance and Administration. Prior to joining Team Health, Mr. Abramowski was Senior Vice President of Finance and Chief Financial Officer of ProVantage Health Services, Inc., a publicly-traded pharmacy benefits management company, from October 1999 until its sale to Merck & Co., Inc. in June 2000. Mr. Abramowski served as Vice President and Controller with Extendicare Health Services, Inc. from October 1983 to December 1989, and as Vice President of Finance and Chief Financial Officer from January 1990 to March 1998. Following his tenure with Extendicare, Mr. Abramowski served as Chief Financial Advisor to Americorp Management Services, L.L.C. Mr. Abramowski also spent 11 years with Arthur Andersen & Co. Mr. Abramowski is a graduate of the University of Wisconsin-Milwaukee. 38 ROBERT C. JOYNER joined Team Health in August 1999 as Executive Vice President and General Counsel. Prior to joining Team Health, Mr. Joyner had a private practice of law from September 1998 to July 1999, and from May 1997 to September 1998 he served as the Senior Vice President and General Counsel for American Medical Providers, a regional physician practice management company. From May 1986 to May 1997, Mr. Joyner served as the Senior Vice President and General Counsel for Paracelsus Healthcare Corporation, a privately held hospital ownership and management company which became public in 1996. Mr. Joyner graduated with a BSBA degree in 1969 and a JD in 1972, both from the University of Florida. STEPHEN SHERLIN has served as Executive Vice President, Billing and Reimbursement since February 2000. Mr. Sherlin joined Team Health in January 1997 as Senior Vice President, Finance and Administration, and was promoted to Executive Vice President, Finance and Administration in July 1998. From 1993 until February 1996, when he retired for several months prior to joining Team Health, Mr. Sherlin served as Vice President and Chief Financial Officer of the Tennessee Division of Columbia/HCA. Mr. Sherlin has also served as Chief Financial Officer for the Athens Community Hospital in Athens, Tennessee; Park West Medical Center in Knoxville, Tennessee; and Doctors Hospital in Little Rock, Arkansas. Mr. Sherlin is a graduate of Indiana University. DAVID P. JONES has been our Chief Financial Officer since May 1996. From 1994 to 1996, Mr. Jones was our Controller. Prior to that, Mr. Jones worked at Pershing, Yoakley and Associates, a regional healthcare audit and consulting firm, as a Supervisor. Before joining Pershing, Yoakley and Associates, Mr. Jones worked at KPMG Peat Marwick as an Audit Senior. Mr. Jones is a certified public accountant and is a member of the American Institute of Certified Public Accountants. Mr. Jones received a B.S. in Business Administration from The University of Tennessee in Knoxville. NICHOLAS W. ALEXOS became a director in connection with the recapitalization. Prior to co-founding Madison Dearborn Partners, Inc., Mr. Alexos was with First Chicago Venture Capital for four years. Previously, he was with The First National Bank of Chicago. Mr. Alexos concentrates on investments in the healthcare and food manufacturing industries and currently serves on the Boards of Directors of Milnot Holding Company, National Mentor, Inc. and Spectrum Healthcare Services, Inc. Mr. Alexos received a B.B.A. from Loyola University and an M.B.A. from the University of Chicago Graduate School of Business. GLENN A. DAVENPORT became a director in 2001. Mr. Davenport serves as President and Chief Executive Officer of Morrison Management Specialists, which was acquired by Compass Group in April 2001. Mr. Davenport has served in this role since Morrison Management Specialists was spun off from Morrison Restaurants, Inc. in 1996. Prior thereto, he served in various management capacities with Morrison Restaurants, Inc. since 1973. EARL P. HOLLAND became a director of the Company in 2001. Prior to his retirement in January, 2001, Mr. Holland held several positions with Health Management Associates (HMA), including the positions of Vice President and Chief Operating Officer at the time of his retirement. HMA is a publicly traded health care company traded on the NYSE. Mr. Holland also serves on the board of directors of several other companies engaged in the business of providing health care services as well as other business services. Mr. Holland graduated from Southeast Missouri State University with a B.S. degree in business administration. DANA J. O'BRIEN became a director in connection with the recapitalization. Mr. O'Brien co-founded Prudential Equity Investors, Inc. in 1984. He and the other principals of Prudential Equity Investors, Inc. co-founded Cornerstone Equity Investors, LLC in 1996. He currently serves on the Boards of Directors of Guardian Care, Inc., International Language Engineering Corp., Interim Healthcare, Inc., Regent Assisted Living, Inc., Specialty Hospital of America, Inc., Spectrum Healthcare Services and VIPS Healthcare Information Solutions. Mr. O'Brien received a B.A. from Hobart College and an M.B.A. from the Wharton School of the University of Pennsylvania. KENNETH W. O'KEEFE became a director in connection with the recapitalization. Prior to co-founding Beecken Petty & Company, LLC, Mr. O'Keefe was with ABN AMRO Incorporated and an affiliated entity, The Chicago Dearborn Company, for four years. Previously, he was with The First National Bank of Chicago. 39 Mr. O'Keefe currently serves on the Boards of Directors of Spectrum Healthcare Services, Inc., Same Day Surgery, LLC, and Digineer, Inc. Mr. O'Keefe received a B.A. from Northwestern University and an M.B.A. from the University of Chicago Graduate School of Business. TIMOTHY P. SULLIVAN became a director in connection with the recapitalization. Prior to co-founding Madison Dearborn Partners, Inc. Mr. Sullivan was with First Chicago Venture Capital for three years after having served in the U.S. Navy. Mr. Sullivan concentrates on investments in the healthcare industry and currently serves on the Boards of Directors of Milnot Holding Corporation, National Mentor, Inc. and Spectrum Healthcare Services, Inc. Mr. Sullivan received a B.S. from the United States Naval Academy, an M.S. from the University of Southern California and an M.B.A. from Stanford University Graduate School of Business. ITEM 11. EXECUTIVE COMPENSATION The following table sets forth information concerning the annual and long-term compensation for services in all capacities to us for 2001 of those persons who served as (1) the chief executive officer during 2001 and (2) our other four most highly compensated executive officers for 2001 (collectively, the "Named Executive Officers"): SUMMARY COMPENSATION TABLE
LONG-TERM COMPENSATION AWARDS ------------ ANNUAL COMPENSATION SECURITIES -------------------------- UNDERLYING SPECIAL ALL OTHER TOTAL NAME AND PRINCIPAL POSITION YEAR SALARY BONUS OPTIONS(1) BONUS(2) COMPENSATION COMPENSATION - --------------------------- ---- -------- -------- ------------ ---------- ------------ ------------ Lynn Massingale, M.D. ..... 2001 $412,000 $206,929 -- $ -- $81,700(3) $ 700,629 President and Chief 2000 408,538 180,200 -- -- 43,666(3) 632,404 Executive Officer 1999 400,000 200,000 -- 1,445,205 43,055(3) 2,088,260 Michael L. Hatcher......... 2001 262,998 103,464 -- -- 26,076(4) 392,538 Chief Operating Officer 2000 255,337 90,100 -- -- 22,804(4) 368,241 1999 250,000 100,000 -- 403,253 21,091(4) 774,344 Stephen Sherlin............ 2001 229,803 90,406 -- -- 11,206(4) 331,415 Executive Vice President, 2000 217,308 63,070 20,000 -- 9,362(4) 289,740 Billing and Reimbursement 1999 175,000 52,500 -- 282,277 9,303(4) 519,080 Robert C. Joyner*.......... 2001 203,189 55,871 -- -- 16,048(5) 275,108 Executive Vice President, 2000 183,842 20,261 20,000 -- 81,203(5) 285,306 General Counsel 1999 69,231 -- 5,000 -- 11,816(5) 81,047 Robert J. Abramowski**..... 2001 282,989 21,000 -- -- 129,042(6) 433,031 Executive Vice President, 2000 58,154 -- 47,000 -- 1,329(6) 59,483 Finance and Administration
- --------------- * Mr. Joyner joined us as an employee in August 1999. ** Mr. Abramowski joined us as an employee in October 2000. (1) Represents options granted under the Team Health Option Plan (as defined below). During 2000, the options issued to Mr. Joyner in 1999 under the Team Health Option Plan were cancelled. (2) This bonus was paid in connection with the sale of Team Health by MedPartners, Inc. Of the aggregate amount of the bonus, the following amounts were withheld from the bonus on a pre-tax basis under a 40 deferred compensation plan and transferred to a rabbi trust. The rabbi trust used these funds to purchase preferred units in Team Health Holdings LLC, Team Health's parent holding company. Lynn Massingale, M.D. ............................ $936,495 Michael L. Hatcher................................ $323,303 Stephen Sherlin................................... $211,079
In addition, the following amounts were withheld from the bonus on an after-tax basis and invested in the common units of Team Health Holdings, LLC. Lynn Massingale, M.D. ............................ $345,315 Michael L. Hatcher................................ $ 51,717 Stephen Sherlin................................... $ 47,170
(3) All other compensation for Dr. Massingale includes the following:
2001 2000 1999 ------- ------- ------- Life insurance.................. $57,110 $17,003 $17,969 Other........................... 24,590 26,663 25,086
Life insurance represents premiums paid by the Company on behalf of Dr. Massingale. Such premiums are secured by a collateral interest in the policy and are repayable to the Company at the time any benefits under the policy are realized. (4) All other compensation for Mr. Hatcher and Mr. Sherlin is less than 10% of their annual compensation each year. (5) All other compensation for Mr. Joyner includes the following:
2001 2000 1999 ------ ------- ------ 401(k) matching contribution...... $5,100 $ -- $ -- Auto allowance.................... 6,000 6,000 2,308 Moving expenses................... -- 70,971 8,488 Other............................. 4,948 4,232 1,020
(6) All other compensation for Mr. Abramowski includes the following:
2001 2000 1999 -------- ------ ---- Moving expenses.................... $122,123 $ -- $-- Other.............................. 6,919 1,329 --
STOCK OPTION PLANS In March 1999, the Company adopted the Team Health Inc. Stock Option Plan (the "Team Health Option Plan"). See "Team Health Inc. Stock Option Plan." Information for the Team Health Option Plan is presented below. OPTION GRANTS IN LAST FISCAL YEAR No options were granted to any of the Named Executive Officers under the Team Health Option Plan during 2001. 41 Option Exercises in Last Fiscal Year and Fiscal Year End Option Values. The following table sets forth the number of shares underlying unexercised options held by each of the Named Executive Officers and the value of such options at the end of 2001. There were no options exercised during 2001.
NUMBERS OF SECURITIES VALUE OF UNDERLYING UNEXERCISED UNEXERCISED IN-THE-MONEY OPTIONS AT OPTIONS AT FISCAL FISCAL YEAR END YEAR END SHARES ACQUIRED (#)EXERCISABLE/ ($)EXERCISABLE/ NAME ON EXERCISE VALUE REALIZED UNEXERCISABLE UNEXERCISABLE(1) - ---- --------------- -------------- --------------- ----------------- Lynn Massingale, M.D. ...... -- -- -- $ -- Michael L. Hatcher.......... -- -- -- $ -- Stephen Sherlin............. -- -- 667/19,333 $0/0 Robert C. Joyner............ -- -- 667/19,333 $0/0 Robert J. Abramowski........ -- -- 2,350/44,650 $0/0
- --------------- (1) Value of unexercised options at fiscal year-end represents the difference between the exercise price of any outstanding-in-the-money options and the fair market value of such options on December 31, 2001. The fair market value of options under the Team Health, Inc. Stock Option Plan, as determined by the Company's Board of Directors, was $4.50 per share. PENSION PLANS Substantially all of the salaried employees, including our executive officers, participate in our 401(k) savings plan. Employees are permitted to defer a portion of their income under our 401(k) plan and we will match such contribution. The matching contribution is equal to 50% of the first 6% of the employee's contribution. EMPLOYMENT AGREEMENTS We entered into employment and non-compete agreements with certain members of our senior management, including the Named Executive Officers. The employment agreements for the Named Executive Officers include five-year terms beginning March 11, 1999 for Dr. Massingale, Mr. Hatcher, and Mr. Sherlin, and beginning August 1, 1999 for Mr. Joyner and beginning October 2, 2001 for Mr. Abramowski. The employment agreements include provision for the payment of an annual base salary, subject to annual review and adjustment, as well as the payment of a bonus as a percentage of such base salary based upon the achievement of certain financial performance criteria. The annual base salaries as of December 31, 2001 and the potential bonus that can be earned by each of the named Executive officers is as follows:
ANNUAL BASE SALARY BONUS % ----------- ------- Lynn Massingale, M.D. ...................................... $412,000 50% Michael L. Hatcher.......................................... 265,225 40% Stephen Sherlin............................................. 231,750 40% Robert C. Joyner............................................ 210,400 30% Robert J. Abramowski........................................ 284,200 30%
The terms of the employment agreements include that, if the executive is terminated by us without cause, or under certain conditions, such as death or disability, by the executive, the executive will receive a multiple of his base salary and may receive a portion of his bonus for the year of termination. The multiple of base salary in the case of Dr. Massingale and Mr. Hatcher is two years and in the case of Mr. Joyner, Mr. Sherlin and Mr. Abramowski is one year. 42 The executive, as a result of the non-compete agreements entered into by us with each of the Named Executive Officers, has agreed not to disclose our confidential information, solicit our employees or contractors, or compete with us or interfere with our business for two years after his employment with us has been terminated. Dr. Massingale's agreement, however, allows Dr. Massingale to practice medicine at any hospital that we do not staff. TEAM HEALTH, INC. STOCK OPTION PLAN Our board of directors has adopted a stock option plan, which provides for the grant to some of our key employees and/or directors of stock options that are non-qualified options for federal income tax purposes. The compensation committee of our board of directors administers the stock option plan. The compensation committee has broad powers under the stock option plan, including exclusive authority (except as otherwise provided in the stock option plan) to determine: (1) who will receive awards; (2) the type, size and terms of awards; (3) the time when awards will be granted; and (4) vesting criteria, if any, of the awards. Options awarded under the plan are exercisable into shares of our common stock. The total number of shares of common stock as to which options may be granted may not exceed 526,316 shares of common stock. Options may be granted to any of our employees, directors or consultants. If we undergo a reorganization, recapitalization, stock dividend or stock split or other change in shares of our common stock, the compensation committee may make adjustments to the plan in order to prevent dilution of outstanding options. The compensation committee may also cause options awarded under the plan to become immediately exercisable if we undergo specific types of changes in the control of our company. COMPENSATION OF DIRECTORS We will reimburse directors for any out-of-pocket expenses incurred by them in connection with services provided in such capacity. We do not compensate, or have plans to compensate, our directors for services they provide in their capacities as directors. We may, however, elect to do so in the future. COMPENSATION COMMITTEE INTERLOCKS AND INSIDER PARTICIPATION The compensation committee of our board of directors is comprised of Dana J. O'Brien, Timothy P. Sullivan and Earl P. Holland, none of which are officers of Team Health. Mr. O'Brien and Mr. Sullivan are directors of Team Health and principals of Cornerstone Equity Investors, LLC and Madison Dearborn Partners, Inc., respectively. Cornerstone and Madison Dearborn are two of our equity sponsors. ITEM 12. SECURITY OWNERSHIP OF CERTAIN BENEFICIAL OWNERS AND MANAGEMENT Team Health Holdings owns 92.7% of our outstanding common stock and voting interests and 94.3% of our outstanding preferred stock. Physician Services, Inc. owns the remaining 7.3% of our outstanding common stock and voting interests and the remaining 5.7% of our outstanding preferred stock. Physician Services, Inc. can be reached in care of Caremark Rx, Inc. at 3000 Galleria Tower, Suite 1000, Birmingham, Alabama 35244. The following table sets forth certain information regarding the actual beneficial ownership of Team Health Holdings' ownership units by: (1) each person, other than the directors and executive officers of Team Health Holdings, known to Team Health Holdings to own more than 5% of the outstanding membership units of Team Health Holdings and (2) certain executive officers and members of the board of directors of Team Health Holdings. 43 Except as otherwise indicated below, each of the following individuals can be reached in care of Team Health, Inc. at 1900 Winston Road, Suite 300, Knoxville, Tennessee 37919.
PERCENTAGE OF PERCENTAGE OF OUTSTANDING OUTSTANDING COMMON PERCENTAGE OF BENEFICIAL OWNER PREFERRED UNITS UNITS VOTING UNITS - ---------------- --------------- ------------- ------------- Cornerstone Equity Investors IV, L.P. ................ 41.8% 38.0% 38.0% c/o Cornerstone Equity Investors, LLC 717 Fifth Avenue, Suite 1100 New York, New York 10022 Attention: Dana J. O'Brien Madison Dearborn Capital Partners II, L.P. ........... 41.8 38.0 38.0 c/o Madison Dearborn Partners Three First National Plaza, Suite 3800 Chicago, Illinois 60602 Attention: Timothy P. Sullivan Healthcare Equity Partners, L.P. and Healthcare Equity Q.P. Partners, L.P. .............. 9.3 8.4 8.4 c/o Beecken Petty & Company, L.L.C 901 Warranville Road, Suite 205 Lisle, Illinois 60532 Attention: Kenneth W. O'Keefe Certain members of management......................... 7.1 15.6 15.6
ITEM 13. CERTAIN RELATIONSHIPS AND RELATED TRANSACTIONS RECAPITALIZATION AGREEMENT Under a recapitalization agreement, on March 12, 1999 the Company was acquired by the equity sponsors and members of its management team from MedPartners, Inc. The recapitalization agreement contains customary provisions for such agreements, including representations and warranties with respect to the condition and operations of the business, covenants with respect to the conduct of the business prior to the closing date of the recapitalization and various closing conditions, including the execution of a registration rights agreement and stockholders agreement, the obtaining of financing, and the continued accuracy of the representations and warranties. Pursuant to the recapitalization agreement, each of MedPartners and Physician Services have indemnified, jointly and severally, subject to certain limitations, Team Health Holdings and Team Health against losses resulting from: (1) any misrepresentation or breach of any warranty or covenant of MedPartners or Physician Services contained in the recapitalization agreement, a claim for which is made in most cases within the 18 months following the closing of the recapitalization; (2) claims or audits by governmental authorities arising out of the operations of Team Health prior to March 12, 1999; and (3) litigation matters specified in a schedule to the recapitalization agreement, including medical malpractice claims specified in a schedule to the recapitalization agreement to the extent not covered by third-party insurance. With respect to some matters, we are only indemnified if our losses from all indemnification claims exceed $3.7 million and do not exceed a total of $50 million. There is no basket or limit on the total payments with respect to other specified misrepresentations or breaches of warranties and some litigation matters. 44 In addition, each of MedPartners and Physician Services have agreed for a period of five years after March 12, 1999 not to compete with us in any business that provides outsourced staffing and related billing services. Each of MedPartners and Physician Services have also agreed for a period of five years after March 12, 1999 not to solicit employment of our employees. Under the recapitalization agreement, MedPartners agreed to purchase, at its sole cost and expense, for the benefit of Team Health Holdings, insurance policies covering all liabilities and obligations for any claim for medical malpractice arising at any time in connection with the operation of Team Health and its subsidiaries prior to the closing date of the recapitalization for which Team Health or any of its subsidiaries or physicians becomes liable. Such insurance policies are for amounts and contain terms and conditions mutually acceptable to MedPartners and Team Health Holdings. SECURITYHOLDERS AGREEMENTS In connection with the recapitalization, both Team Health and our stockholders, Team Health Holdings and Physician Services, and Team Health Holdings and all of its unitholders, entered into two separate securityholders agreements. The securityholders agreements: (1) restrict the transfer of the equity interests of Team Health and Team Health Holdings, respectively; and (2) grant tag-along rights on certain transfers of equity interests of Team Health and Team Health Holdings, respectively. Some of the foregoing provisions of the securityholders agreements will terminate upon the consummation of an initial public offering. REGISTRATION RIGHTS AGREEMENT In connection with the recapitalization, both Team Health and our stockholders, Team Health Holdings and Physician Services, and Team Health Holdings and all of its unitholders, entered into two separate registration rights agreements. Under the registration rights agreements, some of the holders of capital stock owned by Team Health Holdings (with respect to our shares) and Cornerstone, Madison Dearborn and Beecken Petty (with respect to units of Team Health Holdings), respectively, have the right, subject to various conditions, to require us or Team Health Holdings, as the case may be, to register any or all of their common equity interests under the Securities Act of 1933 at our or Team Health Holdings' expense. In addition, all holders of registrable securities are entitled to request the inclusion of any common equity interests of Team Health or Team Health Holdings covered by the registration rights agreements in any registration statement at our or Team Health Holdings' expense, whenever we or the Team Health Holdings propose to register any of our common equity interests under the Securities Act of 1933. In connection with all such registrations, we or the Team Health Holdings have agreed to indemnify all holders of registrable securities against some liabilities, including liabilities under the Securities Act of 1933. MANAGEMENT SERVICES AGREEMENT We have also entered into a management services agreement dated March 12, 1999 with Cornerstone, Madison Dearborn and Beecken Petty under which each of Cornerstone, Madison Dearborn and Beecken Petty have agreed to provide us with: (1) general management services; (2) assistance with the identification, negotiation and analysis of acquisitions and dispositions; (3) assistance with the negotiation and analysis of financial alternatives; and (4) other services agreed upon by us and each of Cornerstone, Madison Dearborn and Beecken Petty. 45 In exchange for such services, Cornerstone, Madison Dearborn and Beecken Petty collectively receive an annual advisory fee of $500,000, plus reasonable out-of-pocket expenses (payable quarterly). The management services agreement has an initial term of three years, subject to automatic one-year extensions unless we or Cornerstone, Madison Dearborn or Beecken Petty provides written notice of termination. The management services agreement will automatically terminate upon the consummation of an initial public offering. TEAM HEALTH HOLDINGS AMENDED AND RESTATED LIMITED LIABILITY COMPANY AGREEMENT Cornerstone, Madison Dearborn, Beecken Petty and some of the members of our management and board of directors (collectively, the "Members") entered into an Amended and Restated Limited Liability Company Agreement. The Limited Liability Company Agreement governs the relative rights and duties of the Members. Membership Interests. The ownership interests of the members in Team Health Holdings consist of preferred units and common units. The common units represent the common equity of Team Health Holdings and the preferred units represent the preferred equity of Team Health Holdings. Holders of the preferred units are entitled to return of capital contributions prior to any distributions made to holders of the common units. Distributions. Subject to any restrictions contained in any financing agreements to which Team Health Holdings or any of its affiliates is a party, the board of managers of Team Health Holdings may make distributions, whether in cash, property or securities of Team Health Holdings at any time or from time to time in the following order of priority: First, to the holders of preferred units, the aggregate unpaid amount accrued on such preferred units on a daily basis, at a rate of 10% per annum. Second, to the holders of preferred units, an amount determined by the aggregate Unreturned Capital (as defined and described in the Limited Liability Company Agreement). Third, to the holders of common units, an amount equal to the amount of such distribution that has not been distributed pursuant to clauses First through Second above. Team Health Holdings may distribute to each holder of units within 75 days after the close of each fiscal year such amounts as determined by the board of managers of Team Health Holdings to be appropriate to enable each holder of units to pay estimated income tax liabilities. OTHER RELATED PARTY TRANSACTIONS We lease office space for our corporate headquarters from Winston Road Properties, an entity that is owned 50% by Park Med Properties. Two of our executive officers, Dr. Massingale and Mr. Hatcher, each own 20% of Park Med Properties. We paid $609,255 in 2001 to Winston Road Properties in connection with the lease agreement. In addition, Park Med Properties owns a building, which houses a medical clinic that is operated by a consolidated affiliate of the Company. In 2001, the consolidated affiliate paid $74,594 to Park Med Properties in connection with the lease agreement. PART IV ITEM 14. EXHIBITS, FINANCIAL STATEMENT SCHEDULES AND REPORTS OF FORM 8-K (a)(1) CONSOLIDATED FINANCIAL STATEMENTS OF TEAM HEALTH, INC. Report of Ernst & Young LLP, Independent Auditors Consolidated Balance Sheets Consolidated Statements of Operations Consolidated Statements of Changes in Net Invested Capital and Stockholders' Equity (Deficit) 46 Consolidated Statements of Cash Flows Notes to the Consolidated Financial Statements (2) FINANCIAL STATEMENTS SCHEDULES Schedule II -- Valuation and Qualifying Accounts of Team Health, Inc. The following schedules are omitted as not applicable or not required under the rules of Regulation S-X: I, III, IV and V. (b) REPORTS ON FORM 8-K The Company filed no reports on Form 8-K during the quarter ended December 31, 2001. (c) EXHIBITS See Exhibit Index. 47 TEAM HEALTH, INC. CONSOLIDATED FINANCIAL STATEMENTS YEARS ENDED DECEMBER 31, 2001, 2000 AND 1999 CONTENTS Report of Independent Auditors.............................. 49 Consolidated Balance Sheets................................. 50 Consolidated Statements of Operations....................... 51 Consolidated Statements of Changes in Net Invested Capital and Stockholders' Equity (Deficit)........................ 52 Consolidated Statements of Cash Flows....................... 53 Notes to the Consolidated Financial Statements.............. 54
48 REPORT OF ERNST & YOUNG LLP, INDEPENDENT AUDITORS Board of Directors Team Health, Inc. We have audited the accompanying consolidated balance sheets of Team Health, Inc. as of December 31, 2001 and 2000, and the related consolidated statements of operations, changes in net invested capital and stockholders' equity (deficit) and cash flows for each of the three years in the period ended December 31, 2001. Our audits also included the financial statement schedule listed in Item 14(a). These financial statements and schedule are the responsibility of the Company's management. Our responsibility is to express an opinion on these financial statements and schedule based on our audits. We conducted our audits in accordance with auditing standards generally accepted in the United States. Those standards require that we plan and perform the audit to obtain reasonable assurance about whether the financial statements are free of material misstatement. An audit includes examining, on a test basis, evidence supporting the amounts and disclosures in the financial statements. An audit also includes assessing the accounting principles used and significant estimates made by management, as well as evaluating the overall financial statement presentation. We believe that our audits provide a reasonable basis for our opinion. In our opinion, the financial statements referred to above present fairly, in all material respects, the consolidated financial position of Team Health, Inc. at December 31, 2001 and 2000, and the consolidated results of operations and cash flows for each of the three years in the period ended December 31, 2001, in conformity with accounting principles generally accepted in the United States. Also, in our opinion, the related financial statement schedule referred to above, when considered in relation to the basic financial statements taken as a whole, presents fairly in all material respects the information set forth therein. /s/ ERNST & YOUNG LLP -------------------------------------- Nashville, Tennessee February 8, 2002 49 TEAM HEALTH, INC. CONSOLIDATED BALANCE SHEETS
DECEMBER 31, ------------------------- 2001 2000 ----------- ----------- (IN THOUSANDS, EXCEPT PER SHARE DATA) ASSETS CURRENT ASSETS: Cash and cash equivalents................................. $ 70,183 $ 55,404 Accounts receivable, less allowance for uncollectibles of $101,175 and $106,819 in 2001 and 2000, respectively... 119,776 149,724 Prepaid expenses and other current assets................. 7,732 5,590 Income tax receivable..................................... 8,721 8,619 -------- -------- Total current assets........................................ 206,412 219,337 Property and equipment, net................................. 18,806 19,555 Intangibles, net............................................ 43,692 37,726 Deferred income taxes....................................... 76,374 78,578 Other....................................................... 16,159 17,531 -------- -------- $361,443 $372,727 ======== ======== LIABILITIES, REDEEMABLE PREFERRED STOCK AND STOCKHOLDERS' EQUITY (DEFICIT) CURRENT LIABILITIES: Accounts payable.......................................... $ 12,758 $ 14,561 Accrued compensation and physician payable................ 49,521 44,849 Other accrued liabilities................................. 11,068 14,353 Current maturities of long-term debt...................... 24,211 12,623 Deferred income taxes..................................... 4,815 8,846 -------- -------- Total current liabilities................................... 102,373 95,232 Long-term debt, less current maturities..................... 193,089 216,578 Other non-current liabilities............................... 34,892 28,150 Mandatory redeemable preferred stock........................ 130,779 118,890 Commitments and Contingencies Common Stock, $0.01 par value 12,000 shares authorized, 10,000 shares issued and outstanding...................... 100 100 Retained earnings (deficit)................................. (99,571) (86,223) Accumulated other comprehensive loss........................ (219) -- -------- -------- $361,443 $372,727 ======== ========
See accompanying notes to the consolidated financial statements. 50 TEAM HEALTH, INC. CONSOLIDATED STATEMENTS OF OPERATIONS
YEAR ENDED DECEMBER 31, ------------------------------ 2001 2000 1999 -------- -------- -------- (IN THOUSANDS) Fee for service revenue..................................... $789,545 $766,583 $700,830 Contract revenue............................................ 159,194 140,424 141,129 Other revenue............................................... 16,546 11,967 10,194 -------- -------- -------- Net revenue............................................... 965,285 918,974 852,153 Provision for uncollectibles................................ 336,218 329,291 309,713 -------- -------- -------- Net revenue less provision for uncollectibles............. 629,067 589,683 542,440 Professional expenses....................................... 523,154 468,596 441,506 -------- -------- -------- Gross profit.............................................. 105,913 121,087 100,934 General and administrative expenses......................... 63,998 57,794 51,491 Terminated transaction expense.............................. -- 2,000 -- Management fee and other expenses........................... 649 591 506 Impairment of intangibles................................... 4,137 -- -- Depreciation and amortization............................... 14,978 12,638 9,943 Recapitalization expenses................................... -- -- 16,013 Interest expense, net....................................... 22,739 25,467 20,909 -------- -------- -------- Earnings (loss) before income taxes......................... (588) 22,597 2,072 Income tax expense.......................................... 871 9,317 1,250 -------- -------- -------- Net earnings (loss)....................................... (1,459) 13,280 822 Dividends on preferred stock................................ 11,889 10,783 8,107 -------- -------- -------- Net earnings (loss) available to common stockholders...... (13,348) 2,497 (7,285) ======== ======== ========
See accompanying notes to the consolidated financial statements. 51 TEAM HEALTH, INC. CONSOLIDATED STATEMENTS OF CHANGES IN NET INVESTED CAPITAL AND STOCKHOLDERS' EQUITY (DEFICIT)
ACCUMULATED NET COMMON STOCK OTHER INVESTED --------------- RETAINED COMPREHENSIVE CAPITAL SHARES AMOUNT DEFICIT LOSS TOTAL --------- ------ ------ -------- ------------- --------- (IN THOUSANDS) BALANCE AT DECEMBER 31, 1998........... $ 98,729 -- $ -- $ -- $ -- $ 98,729 Changes in tax accounts, included in net invested capital.............. 3,131 -- -- -- -- 3,131 Net transfers to parents and parents' subsidiaries...................... 2,507 -- -- -- -- 2,507 Net earnings from January 1, 1999 to date of recapitalization.......... 7,092 -- -- -- -- 7,092 Recapitalization..................... (111,459) 10,000 100 (74,343) -- (185,702) Dividends on preferred stock......... -- -- -- (8,107) -- (8,107) Net loss from recapitalization date to December 31, 1999.............. -- -- -- (6,270) -- (6,270) --------- ------ ---- -------- ----- --------- BALANCE AT DECEMBER 31, 1999........... -- 10,000 100 (88,720) -- (88,620) Net earnings......................... -- -- -- 13,280 -- 13,280 Dividends on preferred stock......... -- -- -- (10,783) -- (10,783) --------- ------ ---- -------- ----- --------- BALANCE AT DECEMBER 31, 2000........... -- 10,000 100 (86,223) -- (86,123) Comprehensive loss: Net loss............................. -- -- -- (1,459) -- (1,459) Other comprehensive loss, net of tax: Cumulative effect of change in accounting principle -- fair value of interest rate swaps, net of tax of $36............... -- -- -- -- 54 54 Net change in fair value of swaps, net of tax of $182.............. -- -- -- -- (273) (273) --------- ------ ---- -------- ----- --------- Total comprehensive loss............. (1,678) Dividends on preferred stock......... -- -- -- (11,889) -- (11,889) --------- ------ ---- -------- ----- --------- BALANCE AT DECEMBER 31, 2001........... $ -- 10,000 $100 $(99,571) $(219) $ (99,690) ========= ====== ==== ======== ===== =========
See accompanying notes to the consolidated financial statements. 52 TEAM HEALTH, INC. CONSOLIDATED STATEMENTS OF CASH FLOWS
YEAR ENDED DECEMBER 31, --------------------------------- 2001 2000 1999 --------- --------- --------- (IN THOUSANDS) OPERATING ACTIVITIES Net earnings (loss)..................................... $ (1,459) $ 13,280 $ 822 Adjustments to reconcile net earnings (loss): Depreciation and amortization........................ 14,978 12,638 9,943 Amortization of deferred financing costs............. 1,852 1,856 1,421 Provision for uncollectibles......................... 336,218 329,291 309,713 Impairment of intangibles............................ 4,137 -- -- Deferred income taxes................................ (1,767) 16,671 (10,406) Pre-recapitalization income tax expense.............. -- -- 3,131 Loss on sale of equipment............................ 240 50 68 Recapitalization expense............................. -- -- 16,013 Equity in joint venture income....................... (30) (324) (54) Changes in operating assets and liabilities, net of acquisitions: Accounts receivable................................ (308,289) (326,171) (314,597) Prepaids and other assets.......................... (15) 456 (1,964) Income tax receivable.............................. (75) (10,699) 1,751 Accounts payable................................... (2,260) 213 7,077 Accrued compensation and physician payable......... 4,101 5,580 1,308 Other accrued liabilities.......................... (3,421) (494) 4,578 Professional liability reserves.................... 5,527 9,783 9,159 --------- --------- --------- Net cash provided by operating activities................. 49,737 52,130 37,963 INVESTING ACTIVITIES Purchases of property and equipment..................... (5,955) (7,359) (10,615) Sale of property and equipment.......................... 170 108 29 Cash paid for merger costs.............................. -- -- (316) Cash paid for acquisitions, net......................... (16,162) (5,131) (3,952) Other investing activities.............................. (879) (518) (130) --------- --------- --------- Net cash used in investing activities..................... (22,826) (12,900) (14,984) FINANCING ACTIVITIES Payments on notes payable............................... (11,901) (12,815) (10,868) Proceeds from notes payable............................. -- -- 250,000 Payments of deferred financing costs.................... (231) (815) (11,496) Redemption of common stock in connection with recapitalization..................................... -- -- (210,761) Payments of recapitalization expense.................... -- (16) (16,013) Net transfers from parents and parents' subsidiaries.... -- -- 2,507 --------- --------- --------- Net cash (used in) provided by financing activities....... (12,132) (13,646) 3,369 --------- --------- --------- Increase (decrease) in cash and cash equivalents.......... 14,779 25,584 26,348 Cash and cash equivalents, beginning of year.............. 55,404 29,820 3,472 --------- --------- --------- Cash and cash equivalents, end of year.................... $ 70,183 $ 55,404 $ 29,820 ========= ========= ========= Supplemental cash flow information: Interest paid............................................. $ 24,260 $ 23,417 $ 16,941 ========= ========= ========= Taxes paid................................................ $ 9,129 $ 9,713 $ 6,421 ========= ========= =========
See accompanying notes to the consolidated financial statements. 53 TEAM HEALTH, INC. NOTES TO THE CONSOLIDATED FINANCIAL STATEMENTS DECEMBER 31, 2001 1. ORGANIZATION AND BASIS OF PRESENTATION Team Health, Inc. (the "Company") believes it is among the largest national providers of outsourced physician staffing and administrative services to hospitals and clinics in the United States. The Company's regional operating model includes comprehensive programs for emergency medicine, radiology, anesthesiology, inpatient care, pediatrics and other hospital departments. The Company provides a full range of physician staffing and administrative services, including the: (i) staffing and recruiting of and credentials coordination for clinical and non-clinical medical professionals; (ii) provision of administrative support services, such as payroll, insurance coverage and continuing education services; and (iii) billing and collection of fees for services provided by the medical professionals. Prior to March 12, 1999, the Company was a wholly-owned subsidiary of Caremark, Rx, Inc., formerly known as MedPartners, Inc. ("MedPartners"). Effective March 12, 1999, the Company was recapitalized in a transaction between the Company, MedPartners and Team Health Holdings, LLC, which is owned by certain equity sponsors and certain members of the Company's senior management. As a result of the recapitalization, Team Health Holdings, LLC owns 92.7% of the Company's $0.01 par value common stock and 94.3% of the Company's class A redeemable preferred stock with MedPartners owning the remaining outstanding securities. Prior to the recapitalization, all equity accounts of the Company were combined and reported as Net Invested Capital on the consolidated financial statements due to the Company's status as a subsidiary of MedPartners. 2. SIGNIFICANT ACCOUNTING POLICIES PRINCIPLES OF CONSOLIDATION The consolidated financial statements include the accounts of the Company and its wholly-owned subsidiaries and have been prepared in accordance with generally accepted accounting principles in the United States. All intercompany and inter-affiliate accounts and transactions have been eliminated. The Company consolidates its subsidiaries in accordance with the nominee shareholder model of EITF 97-2. The Company's arrangements with associated professional corporations ("PC") are captive in nature as a majority of the outstanding voting equity instruments of the different PCs are owned by a nominee shareholder appointed at the sole discretion of the Company. The Company has a contractual right to transfer the ownership of the PC at any time to any person it designates as the nominee shareholder. This transfer can occur without cause and any cost incurred as a result of the transfer is minimal. There would be no significant impact on the PC or the Company as a result of the transfer of ownership. The Company provides staffing services to its client hospitals through a management services agreement between a subsidiary of Team Health, Inc. and the PCs. CASH AND CASH EQUIVALENTS Cash consists primarily of funds on deposit in commercial banks. Cash equivalents are highly liquid investments with maturities of three months or less when acquired. ACCOUNTS RECEIVABLE Accounts receivable are primarily amounts due from hospitals and clinics, third-party payors, such as insurance companies, government-sponsored health care programs, including Medicare and Medicaid, and self-insured employers and patients. Accounts receivable are stated net of reserves for amounts estimated by management to not be collectible. Concentration of credit risk relating to accounts receivable is limited by the 54 TEAM HEALTH, INC. NOTES TO THE CONSOLIDATED FINANCIAL STATEMENTS -- (CONTINUED) diversity and number of contracting hospitals, patients, payors, and by the geographic dispersion of the Company's operations. PROPERTY AND EQUIPMENT Property and equipment are stated at cost. Depreciation is computed using the straight-line method over estimated useful lives, which generally range from 3 to 10 years for furniture and equipment, from 3 to 5 years for software and from 10 to 40 years for buildings and leasehold improvements. Property under capital lease is amortized using the straight-line method over the life of the respective lease and such amortization is included in depreciation expense. INTANGIBLE ASSETS Intangible assets consist of the following as of December 31 (in thousands):
2001 2000 -------- -------- Contracts acquired.......................................... $ 32,035 $ 28,202 Goodwill.................................................... 29,397 23,950 Other....................................................... 548 773 -------- -------- 61,980 52,925 Less-accumulated amortization............................... (18,288) (15,199) -------- -------- $ 43,692 $ 37,726 ======== ========
The cost of contracts acquired is amortized using the straight-line method over the average life of the Company's contracts, which is approximately seven years. Goodwill is amortized using the straight-line method over a life of 15 years. The carrying value of goodwill and other intangibles is evaluated by the Company when indicators are present to determine whether such assets may be impaired with respect to their recorded values. If this review indicates that certain intangibles will not be recoverable, as determined based on the undiscounted cash flows derived from the assets acquired over the remaining amortization period, the carrying value of the intangibles is reduced by the estimated shortfall of discounted cash flows. During 2001, the Company concluded that certain of its intangibles relating to a portion of its radiology operations were impaired. Accordingly, goodwill and contracts related to such operations were reduced to fair value by recording an impairment loss of $4.1 million. The impairment loss was recognized as a result of a reduction in the estimated fair market value of such intangibles due to lower than expected cash flows expected to be derived from services required to be provided over the remaining life of the intangibles. The reduction in cash flows is due to a shortage of radiologists in the affected markets resulting in higher than expected costs in the staffing of such contracts, as well as lower revenues than expected. DEFERRED FINANCING COSTS Deferred financing costs, which are included in other noncurrent assets and are amortized over the term of the related debt using the interest method, consist of the following as of December 31 (in thousands):
2001 2000 ------- ------- Deferred financing costs.................................... $12,514 $12,284 Less accumulated amortization............................... (5,128) (3,275) ------- ------- $ 7,386 $ 9,009 ======= =======
55 TEAM HEALTH, INC. NOTES TO THE CONSOLIDATED FINANCIAL STATEMENTS -- (CONTINUED) RISK MANAGEMENT Although the Company does not principally engage in the practice of medicine or provide medical services, it does require the physicians with whom it contracts to obtain professional liability insurance coverage and makes this insurance available to these physicians. The Company typically provides claims- made coverage of $1 million per incident and $3 million annual aggregate per physician to affiliated physicians and other healthcare practitioners. In addition, the Company has claims-made coverage of $1 million per incident and $25 million annual aggregate for all corporate entities. For the two year period ending March 12, 2003, the policy has an aggregate limit of $85 million inclusive of indemnity and expense. Prior to this period, the policy has no aggregate limits. These limits are deemed appropriate by management based upon historical claims, the nature and risks of the business and standard industry practice. Professional liability insurance expense consists of premium cost, an accrual to establish reserves for future payments under the self-insured retention component, and an accrual to establish a reserve for future claims incurred but not reported. In connection with the recapitalization in 1999, MedPartners retained the risk for all medical malpractice claims originating prior to the recapitalization. As a result, approximately $49.3 million of professional liability was transferred to MedPartners. A significant negative change in the financial condition of MedPartners could prevent MedPartners from fulfilling its indemnification obligations. As such, with respect to the indemnification rights granted to us in connection with the recapitalization, we are subject to MedPartners' credit risk. OTHER NONCURRENT LIABILITIES Other noncurrent liabilities consist of the following as of December 31 (in thousands):
2001 2000 ------- ------- Professional liability insurance reserves................... $25,182 $19,217 Deferred compensation....................................... 9,345 8,933 Other....................................................... 365 -- ------- ------- $34,892 $28,150 ======= =======
NET REVENUE Net revenues consist of fee-for-service revenue, contract revenue and other revenue. Net revenues are recorded in the period services are rendered. Fee-for-service revenue represents revenue earned under contracts in which the Company bills and collects the professional component of charges for medical services rendered by the Company's contracted and employed physicians. Under the fee-for-service arrangements, the Company bills patients for services provided and receives payment from patients or their third-party payors. Fee-for-service revenue is reported net of contractual allowances and policy discounts. All services provided are expected to result in cash flows and are therefore reflected as net revenues in the financial statements. Contract revenue represents revenue generated under contracts in which the Company provides physician and administrative services in return for a contractually negotiated fee. Contract revenue also includes supplemental revenue from hospitals where the Company may have a fee-for-service contract arrangement. Other revenue consists primarily of revenue from management and billing services provided to outside parties. Net revenues are reduced for management's estimates of amounts that will not be collected. The resulting net revenue less provision for uncollectibles reflects net cash collections for services rendered in the period plus 56 TEAM HEALTH, INC. NOTES TO THE CONSOLIDATED FINANCIAL STATEMENTS -- (CONTINUED) management's estimate of the remaining collections to be realized for services rendered in the period. Such estimates of amounts to be collected are subject to adjustment as actual experience is realized. If subsequent collections experience indicates that an adjustment to previously recorded collection estimates is necessary, such change of estimate adjustment is recorded in the current period in which such assessment is made. Management in estimating the amounts to be collected resulting from its over six million annual patient visits and procedures considers such factors as prior contract collection experience, current period changes in payor mix and patient acuity indicators, as well as reimbursement rate trends in governmental and private sector insurance programs. The aforementioned estimation process includes both quantitative estimates as well as qualitative judgment dispersed among regional management of the Company and is subject to corporate oversight and review. The complexity of the estimation process associated with the Company's fee-for-service volumes and diverse payor mix, along with the difficulty of assessing such factors as changes in the economy impacting the number of health care insured versus uninsured patients and other socio-economic trends that can have an impact on collection rates, could result in subsequent adjustments to previously reported revenues. Net revenue less provision for uncollectibles derived from the Medicare and Medicaid programs was approximately 25%, 22% and 22% of total net revenue less provision for uncollectibles in years 2001, 2000 and 1999, respectively. IMPLEMENTATION OF NEW ACCOUNTING STANDARDS Effective January 1, 2001, the Company implemented the provisions of Statements of Financial Accounting Standards (SFAS) No. 133 "Accounting for Derivative Instruments and Hedging Activities." This standard requires the Company to recognize all derivatives on the balance sheet at fair value. The Company's interest rate swaps are cash flow hedges which hedge the variability in expected cash flows of a portion of its floating rate liabilities. The Company believes that its hedges are highly effective with changes in effectiveness expected to be reported in other comprehensive earnings. Changes in any ineffectiveness will be reported through earnings. The adoption of this new FASB standard resulted in a cumulative effect of an accounting change, net of tax, of approximately $0.1 million being recognized as other comprehensive earnings. During 2001, the decrease in fair value of interest rate swaps, net of tax, of approximately $0.3 million was recognized through other comprehensive earnings. At December 31, 2001, the fair value of the interest rate swaps was a liability of $0.4 million. In June 2001, the Financial Accounting Standards Board issued SFAS No. 141, Business Combinations, and No. 142, Goodwill and Other Intangible Assets, effective for fiscal years beginning after December 15, 2001. Under the new rules, goodwill will no longer be amortized but will be subject to annual impairment tests in accordance with the Statements. Other intangible assets will continue to be amortized over their estimated useful lives. The Company will apply the new rules on accounting for goodwill and other intangible assets beginning in the first quarter of 2002. The Company has, however, applied the nonamortization provisions of the Statement for acquisitions consummated after June 30, 2001. Application of the nonamortization provisions of the Statement is expected to result in an increase in net earnings of approximately $1.2 million per year. During the first quarter of 2002, the Company is anticipating that it will perform the first of the required impairment tests of goodwill and indefinite lived intangible assets as of January 1, 2002. The Company has not yet determined what the effect of these tests will be on the earnings and financial position of the Company. Any impairment recognized at transition will be recorded as a change in accounting principle. The Company anticipates that its impairment assessment for goodwill will include a determination of the related reporting unit's fair value using valuation techniques based on multiples of EBITDA (earnings before interest, taxes, depreciation and amortization) and other measures compared to the reporting unit's underlying net carrying value. The Company further anticipates that its impairment assessment for other intangibles, including 57 TEAM HEALTH, INC. NOTES TO THE CONSOLIDATED FINANCIAL STATEMENTS -- (CONTINUED) contracts, will be based on a determination of the fair value of such intangibles using the income approach that includes discounting future cash flows related to the intangible asset. The resulting fair value using the income approach will be compared to the intangible asset's underlying net carrying value. In October 2001, the Financial Accounting Standards Board issued SFAS No. 144, Impairment or Disposal of Long-Lived Assets, effective for fiscal years after December 15, 2001. SFAS No. 144 significantly changes the criteria that would have to be met to classify an asset as held-for-sale, and will require expected future operating losses from discontinued operations to be displayed in discontinued operations in the period(s) in which the losses are incurred (rather than as of the measurement date as presently required). In addition, more dispositions will qualify for discontinued operations treatment in the income statement. The Company will apply the new rules on asset impairment beginning in the first quarter of 2002. The Company does not expect the implementation of SFAS No. 144 to have any impact on its results of operation or financial position. USE OF ESTIMATES The preparation of financial statements in conformity with United States generally accepted accounting principles requires management to make estimates and assumptions that affect the amounts reported in the financial statements and accompanying notes. Actual results could differ from those estimates. RECLASSIFICATIONS Certain prior year amounts have been reclassified to conform to the current year presentation. 3. ACQUISITIONS Effective March 1, 2001, the Company acquired all of the outstanding stock of an emergency staffing company for $1.5 million and may have to pay up to $0.7 million in future contingent payments. In addition, the Company acquired the assets of a diagnostic imaging center in February 2001 for $1.4 million. The acquisitions are being accounted for under the purchase method of accounting and results of operations are included in the accompanying financial statements since the date of acquisition. Effective August 1, 2001, the Company acquired all of the outstanding shares of Integrated Specialists Management Services, Inc. ("ISMS") for cash at an amount equal to a minimum price plus additional consideration equal to ISMS's net working capital as of July 31, 2001. The purchase price was subject to adjustment for post-closing net working capital adjustments and other agreed to items through January 31, 2002. The Company on August 1, 2001 paid an initial $7.4 million of the estimated purchase price to the selling shareholders of ISMS. The remaining portion of the purchase price of $1.1 million was paid on February 1, 2002. The acquisition is being accounted for using the purchase method of accounting and its results of operations are included in the accompanying financial statements since its date of acquisition. ISMS is a recognized leader in the management of large urban anesthesia medical groups. The management services offered by ISMS are provided to anesthesiology practices on a fee basis. Services include strategic management, management information systems, third-party payor contracting, financial and accounting support, benefits administration and risk management, scheduling support, operations management and quality improvement services. ISMS currently provides such services to four integrated anesthesia practices with approximately 330 providers under management. In addition to acquiring stable, long-term management agreements and proprietary anesthesia management practice software, the acquisition of ISMS provided the Company with management resources, experience and infrastructure support to allow the Company to evaluate and compete for additional anesthesia practice opportunities as they are presented. 58 TEAM HEALTH, INC. NOTES TO THE CONSOLIDATED FINANCIAL STATEMENTS -- (CONTINUED) During 2001, the Company also made payments of approximately $7.8 million with respect to contingent payments established as a result of certain previous acquisitions. These amounts represent payments of purchase price and have been recorded as goodwill. In January 2000, the Company acquired certain operating assets of a medical coding company for $0.8 million and may have to make up to $0.8 million in future contingent payments. In July 2000, the Company acquired certain operating assets of a billing company for $0.3 million. In 2000, the Company acquired an additional 50% of the outstanding shares of an ambulatory clinic joint venture in which the Company previously owned 50% of the shares for $0.1 million. In August 1999, the Company acquired certain operating assets of a primary care clinic for $1.3 million and may have to make up to $0.8 million in future contingent payments. Acquisitions and deferred contingent payments are summarized as follows (in thousands):
2001 2000 1999 ------- ------ ------ Fair value of net operating assets acquired (liabilities assumed)................................................ $(1,522) $ (834) $ 96 Fair value of contracts acquired.......................... 4,380 358 -- Goodwill.................................................. 13,304 5,607 3,856 ------- ------ ------ Cash paid for acquisitions, net........................... $16,162 $5,131 $3,952 ======= ====== ======
The foregoing acquisitions were accounted for using the purchase method of accounting. The operating results of acquired businesses are included in the accompanying consolidated financial statements from their respective dates of acquisition. The pro forma effect of the acquisitions on the Company's results of operations for the periods prior to their acquisition was not significant. 4. PROPERTY AND EQUIPMENT Property and equipment consists of the following at December 31 (in thousands):
2001 2000 -------- -------- Buildings and leasehold improvements........................ $ 2,696 $ 2,868 Furniture and equipment..................................... 24,537 23,422 Software.................................................... 10,545 8,188 -------- -------- 37,778 34,478 Less accumulated depreciation............................... (18,972) (14,923) -------- -------- $ 18,806 $ 19,555 ======== ========
Depreciation expense in 2001, 2000 and 1999 was approximately $8.1 million, $7.6 million and $5.7 million, respectively. 59 TEAM HEALTH, INC. NOTES TO THE CONSOLIDATED FINANCIAL STATEMENTS -- (CONTINUED) 5. LONG-TERM DEBT Long-term debt consists of the following at December 31 (in thousands):
2001 2000 -------- -------- 12% Senior Subordinated Notes............................... $100,000 $100,000 Term Loan Facility.......................................... 117,300 128,800 Other debt.................................................. -- 401 -------- -------- 217,300 229,201 Less current portion........................................ (24,211) (12,623) -------- -------- $193,089 $216,578 ======== ========
The 12% Senior Subordinated Notes ("Notes") are due March 15, 2009. The Notes are subordinated in right of payment to all senior debt of the Company and are senior in right of payment to all existing and future subordinated indebtedness of the Company. Interest on the Notes accrues at the rate of 12% per annum, payable semi-annually in arrears on March 15 and September 15 of each year. Beginning on March 15, 2004, the Company may redeem some or all of the Notes at any time at various redemption prices. The Notes are guaranteed jointly and severally on a full and unconditional basis by all of the Company's majority-owned operating subsidiaries ("Subsidiary Guarantors") as required by the Indenture Agreement. The Company is a holding company with no assets or operations apart from the ownership of its operating subsidiaries. The Company's Term Loan Facility is comprised of (i) a five-year revolving credit facility of up to $50.0 million, including a swing-line sub-facility of $5.0 million and a letter of credit sub-facility of $5.0 million, and (ii) a term loan facility, consisting of a $60.0 million 5-year term loan A facility and a $90.0 million 6-year term loan B facility. The Term Loan Facility is guaranteed by Team Health Holdings, LLC and all subsidiaries of the Company. Borrowings under the Term Loan Facility bear interest at variable rates based, at the Company's option, on the prime or the eurodollar rate. The interest rates at December 31, 2001 were 5.0% and 6.0% for the term loans A and B, respectively. The Company pays a commitment fee on the revolving credit facility, which was equal to 0.5% at December 31, 2001. No funds have been borrowed under the revolving credit facility as of December 31, 2001, but the Company has a $0.3 million standby letter of credit against the revolving credit facility outstanding as of December 31, 2001. Both the Notes and the Term Loan Facility contain both affirmative and negative covenants, including limitations on the Company's ability to incur additional indebtedness, sell material assets, retire, redeem or otherwise reacquire its capital stock, acquire the capital stock or assets of another business, pay dividends, and require the Company to meet or exceed certain coverage, leverage and indebtedness ratios. In addition, the Company's Term Loan Facility includes a provision for the prepayment of a portion of the outstanding term loan amounts at any year end if the Company generates "excess cash flow," as defined in the Term Loan Facility agreement. The excess cash flow amount, which is payable on April 30 of the succeeding year, was $3.1 million for fiscal 2000 and was paid on April 30, 2001. The Company has estimated that it will be required to make an excess cash flow payment of approximately $6.0 million for fiscal 2001 by April 30, 2002. The estimated excess cash flow payment has been included within current maturities of long-term debt in the accompanying balance sheet at December 31, 2001. 60 TEAM HEALTH, INC. NOTES TO THE CONSOLIDATED FINANCIAL STATEMENTS -- (CONTINUED) Aggregate maturities of long-term debt at December 31, 2001 (in thousands), including the estimated excess cash flow payment of $6.0 million to be made in 2002, are as follows: 2002........................................................ $ 24,211 2003........................................................ 15,373 2004........................................................ 62,015 2005........................................................ 15,701 Thereafter.................................................. 100,000 -------- $217,300 ========
Interest rate swap agreements are used to manage the Company's interest rate exposure on the term loans. On September 20, 1999, the Company entered into interest rate swap agreements to effectively convert $50.0 million of floating-rate borrowings to fixed-rate borrowings. The agreements are contracts to exchange, on a quarterly basis, floating interest rate payments based on the eurodollar rate, for fixed interest rate payments over the life of the agreements. The contracts have a final expiration date of March 13, 2002. In 2001, the Company received a weighted average rate of 4.41% and paid a weighted average of 5.63% on the swaps. These agreements expose the Company to credit losses in the event of non-performance by the counterparties to its financial instruments. The counterparties are creditworthy financial institutions and the Company anticipates that the counterparties will be able to fully satisfy their obligations under the contracts. 6. MANDATORY REDEEMABLE PREFERRED STOCK The Company has outstanding 100,000 shares of class A redeemable preferred stock held by holders of its common stock. The preferred stock is subject to mandatory redemption on December 31, 2009 at a redemption price equal to $1,000 per share plus all accrued and unpaid dividends. The preferred stock accrues cumulative preferential dividends from the date of issuance in the amount of 10% per year. As of December 31, 2001, approximately $30.8 million in dividends have been accrued. 7. STOCK OPTIONS The Company's 1999 Stock Option Plan (the "Plan") allows the granting of stock options to employees, consultants and directors of the Company. The Company has reserved 526,316 shares of common stock for issuance. The options vest at the end of an eight-year period, but allow for the possible acceleration of vesting if certain performance related criteria are met. Stock option activity during 1999, 2000 and 2001 was as follows (options in thousands):
NUMBER OF PRICE WEIGHTED AVERAGE OPTIONS RANGE EXERCISE PRICE --------- ---------- ---------------- Outstanding at December 31, 1998............... -- $ -- $ -- Granted........................................ 30 1.50 1.50 --- ---------- ----- Outstanding at December 31, 1999............... 30 1.50 1.50 Granted........................................ 467 1.50-4.50 2.11 Cancelled...................................... 39 1.50 1.50 --- ---------- ----- Outstanding at December 31, 2000............... 458 1.50-4.50 2.12 Granted........................................ 53 4.50 4.50 Cancelled...................................... 14 1.50 1.50 --- ---------- ----- Outstanding at December 31, 2001............... 497 $1.50-4.50 $2.39 === ========== =====
61 TEAM HEALTH, INC. NOTES TO THE CONSOLIDATED FINANCIAL STATEMENTS -- (CONTINUED) The following table summarizes information about stock options outstanding at December 31, 2001 (options in thousands):
WEIGHTED WEIGHTED AVERAGE OPTIONS AVERAGE OPTIONS REMAINING OUTSTANDING EXERCISE PRICE EXERCISABLE CONTRACTUAL LIFE ----------- -------------- ----------- ---------------- 350 $1.50 71 8.1 147 4.50 -- 9.1 --- ----- -- --- 497 $2.39 71 8.4 === ===== == ===
As of December 31, 2001, 70,613 options were vested and exercisable. No options were vested and exercisable at December 31, 2000 or December 31, 1999. The Company has adopted the disclosure-only provisions of SFAS No. 123 "Accounting for Stock Based Compensation." If the Company had elected to recognize compensation cost based on the fair value of the options granted at grant date as presented by SFAS No. 123, the effect on net earnings for 2001, 2000 and 1999 would not have been significant. Approximately 101,000 of the 497,150 options outstanding at December 31, 2001 were granted to affiliated independent contractor physicians during 2000. The Company recorded $9,000 of compensation expense in 2001 and 2000, based on a fair value of $0.68 per option, 6.0% risk-free interest rate and a 10 year expected option life relating to these options. The following table represents the weighted average fair value of options granted during 2001, 2000 and 1999:
WEIGHTED AVERAGE FAIR VALUE ---------- 2001........................................................ $1.74 2000........................................................ $0.95 1999........................................................ $0.52
The fair value of stock options was estimated at the date of grant using the minimal value option pricing model with the following assumptions: expected dividend yield of 0.0% in 2001, 2000 and 1999; risk-free interest rate of 4.9%, 6.0% and 5.38% in 2001, 2000 and 1999, respectively; expected volatility of 0% in 2001, 2000 and 1999; and an expected life of ten years in 2001, 2000 and 1999. 8. NET REVENUE ADJUSTMENT The Company recorded in 2001 a charge of $24.5 million to increase its contractual allowances for patient accounts receivable for periods prior to 2001. The charge resulted from a change in estimated collection rates based on a detailed analysis of the Company's outstanding accounts receivable using additional data developed during the period. The result of the additional research indicated that this Company's estimated collection rates for prior periods were lower than originally anticipated. The collection of fees for physician services rendered in a hospital setting and the estimation of net revenues to be derived from such services is a complex process. As a result of millions of patient visits annually with an average per visit collection of less than $100, the multitude of potential payors associated with a patient encounter and the length of time elapsing before a claim becomes fully adjudicated by such payors, the process for estimating future collections has many variables. The Company has invested in systems and personnel to upgrade its billing function since becoming a stand-alone entity. By so doing, it has improved its 62 TEAM HEALTH, INC. NOTES TO THE CONSOLIDATED FINANCIAL STATEMENTS -- (CONTINUED) collections and has generated enhanced analytical data to better assess its collection process and performance going forward. 9. INCOME TAXES The provision for income tax expense (benefit) consists of the following (in thousands):
YEAR ENDED DECEMBER 31, ---------------------------- 2001 2000 1999 ------- ------- -------- Current: Federal.............................................. $ 2,395 $(6,435) $ 10,199 State................................................ 304 (919) 1,457 ------- ------- -------- 2,699 (7,354) 11,656 Deferred: Federal.............................................. (1,593) 14,588 (9,105) State................................................ (235) 2,083 (1,301) ------- ------- -------- (1,828) 16,671 (10,406) ------- ------- -------- $ 871 $ 9,317 $ 1,250 ======= ======= ========
The reconciliation of income tax expense computed at the federal statutory tax rate to income tax expense is as follows (in thousands):
YEAR ENDED DECEMBER 31, ----------------------- 2001 2000 1999 ------- ----- ----- Tax at statutory rate....................................... 35.0% 35.0% 35.0% State income tax (net of federal tax benefit)............... 3.8 5.1 4.9 Other....................................................... (186.9) 1.1 20.4 ------ ---- ---- (148.1)% 41.2% 60.3% ====== ==== ====
63 TEAM HEALTH, INC. NOTES TO THE CONSOLIDATED FINANCIAL STATEMENTS -- (CONTINUED) Deferred income taxes reflect the net tax effects of temporary differences between the carrying amounts of assets and liabilities for financial reporting purposes and the amounts used for income tax purposes. The components of the Company's deferred tax assets and liabilities are as follows at December 31 (in thousands):
2001 2000 ------- ------- Deferred tax assets: Accounts receivable....................................... $15,547 $30,130 Accrued compensation and other accrued liabilities........ 2,280 2,407 Amortization and depreciation............................. 68,153 71,456 Professional liability reserves........................... 8,238 5,972 Net operating loss........................................ 702 307 Other..................................................... 139 604 ------- ------- Total deferred tax assets.............................. 95,059 110,876 Deferred tax liabilities: Affiliate deferred revenue................................ 20,838 39,290 Other..................................................... 2,662 1,854 ------- ------- Total deferred tax liabilities......................... 23,500 41,144 ------- ------- Net deferred tax assets................................ $71,559 $69,732 ======= =======
The Company as of December 31, 2001, had state net operating losses of approximately $0.7 million which begin to expire in 2014. 10. RETIREMENT PLANS The Company's employees participated in various employee benefit plans sponsored by the Company. The plans are primarily defined contribution plans. The various entities acquired or merged into the Company have various retirement plans that have been terminated, frozen or amended with terms consistent with the Company's plans. The Company's contributions to the plans were approximately $3.6 million, $3.6 million, and $3.5 million for the years ended December 31, 2001, 2000 and 1999, respectively. Effective October 1, 1999, the Company approved a retirement savings plan for its employees. The plan is a defined benefit contribution plan in accordance with the provisions of Section 401(k) of the Internal Revenue Code. The Company makes a matching contribution equal to 50% of the first 6% of compensation contributed by employees. The Company also maintains nonqualified deferred compensation plans for certain of its employees, including a Rabbi Trust for the benefit of certain members of the Company's senior management. Total deferred compensation payable as of December 31, 2001 and 2000 was approximately $10.1 million and $9.5 million, respectively. The Rabbi Trust holds preferred units in Team Health Holdings, LLC. The deferred compensation liability and related investment held by the Rabbi Trust are carried as a long-term liability and a long-term asset at December 31, 2001 and 2000 of $6.7 million and $6.1 million, respectively. 64 TEAM HEALTH, INC. NOTES TO THE CONSOLIDATED FINANCIAL STATEMENTS -- (CONTINUED) 11. COMMITMENTS AND CONTINGENCIES LEASES The Company leases office space for terms of primarily one to seven years with options to renew for additional periods. Future minimum payments due on these non-cancelable operating leases at December 31, 2001 are as follows (in thousands): 2002........................................................ $ 5,152 2003........................................................ 3,710 2004........................................................ 3,497 2005........................................................ 3,338 2006........................................................ 2,724 Thereafter.................................................. 6,115 ------- $24,536 =======
Operating lease costs were approximately $5.4 million, $4.9 million and $4.5 million for the years ended December 31, 2001, 2000 and 1999, respectively. LITIGATION We are party to various pending legal actions arising in the ordinary operation of our business such as contractual disputes, employment disputes and general business actions as well as malpractice actions. We believe that any payment of damages resulting from these types of lawsuits would be covered by insurance, exclusive of deductibles, would not be in excess of related reserves, and such liabilities, if incurred, should not have a significant negative effect on the results of operations and financial condition of our Company. Moreover, in connection with the recapitalization, subject to certain limitations, MedPartners and related entities have jointly and severally agreed to indemnify us against certain losses relating to litigation arising out of incidents occurring prior to the recapitalization in 1999 to the extent those losses are not covered by third party insurance. With respect to certain litigation matters, we are only indemnified if our losses from all indemnification claims exceed a total of $3.7 million and do not exceed a total of $50 million. With respect to other litigation matters, we are indemnified for all losses. Finally, also in connection with the recapitalization, MedPartners agreed to purchase, at its sole cost and expense, for the benefit of Team Health Holdings, insurance policies covering all liabilities and obligations for any claim for medical malpractice arising at any time in connection with the operations of the Company and its subsidiaries prior to the closing date of the recapitalization transactions for which the Company or any of its subsidiaries or physicians becomes liable. HEALTHCARE REGULATORY MATTERS Laws and regulations governing the Medicare and Medicaid programs are complex and subject to interpretation. Compliance with such laws and regulations can be subject to future governmental review and interpretation as well as significant regulatory action. From time to time, governmental regulatory agencies will conduct inquiries and audits of the Company's practices. It is the Company's current practice and future intent to cooperate fully with such inquiries. In addition to laws and regulations governing the Medicare and Medicaid programs, there are a number of federal and state laws and regulations governing such matters as the corporate practice of medicine and fee splitting arrangements, anti-kickback statutes, physician self-referral laws, false or fraudulent claims filing and patient privacy requirements. The failure to comply with any of such laws or regulations could have an adverse impact on our operations and financial results. It is the Company's current practice and future intent to comply with such laws and regulations. 65 TEAM HEALTH, INC. NOTES TO THE CONSOLIDATED FINANCIAL STATEMENTS -- (CONTINUED) CONTINGENT ACQUISITION PAYMENTS As of December 31, 2001, the Company may have to pay up to $5.3 million in future contingent payments as additional consideration for its acquisitions in prior years. These payments will be made and recorded as additional purchase price should the acquired operations achieve the financial targets contained in the respective agreements related to their acquisition. 12. RELATED PARTY TRANSACTIONS The Company leases office space from several partnerships that are partially or entirely owned by certain employees of the Company. The leases were assumed by the Company as part of merger or purchase transactions. Total related party lease costs were approximately $1.4 million, $1.4 million and $1.3 million in 2001, 2000 and 1999, respectively. The Company has contractual arrangements with billing and collection service companies that are owned or partially owned by certain employees of the Company. The majority of these arrangements were assumed as part of merger or purchase transactions. Billing fees paid for these services were $1.8 million, $3.3 million and $3.2 million in 2001, 2000 and 1999, respectively. 13. FAIR VALUES OF FINANCIAL INSTRUMENTS The following methods and assumptions were used by the Company in estimating the fair value of the Company's financial instruments: Cash and cash equivalents: The carrying amount reported in the balance sheets for cash and cash equivalents approximates its fair value. Accounts receivable: The carrying amount reported in the balance sheets for accounts receivable approximates its fair value. Long-term debt: The fair value of the Company's Term Loan Facility is estimated using discounted cash flow analyses, based on the Company's current incremental borrowing rates for similar types of borrowing arrangements. The carrying value of the Term Loans is approximately $117.3 million, which approximates fair value. The fair value of the 12% Senior Subordinated Notes at December 31, 2001 is approximately $109.5 million based on quoted market prices. Interest rate swap: The fair value of the Company's interest rate swap agreements is a liability of approximately $0.4 million at December 31, 2001 based on quoted market prices for similar interest rate contracts.
14. SUBSEQUENT EVENTS Effective January 1, 2002, the Company completed the acquisition of certain of the assets and related business operations of two businesses. The operations acquired include those of L&S Medical Management, Inc. ("L&S") and a pediatric services business. L&S provides billing and other management services on a management fee basis to anesthesiologist practices, principally in the Southeastern portion of the United States. As of January 1, 2002, L&S provided services under 18 anesthesia related contracts. The pediatric services operation provides evenings and weekend pediatric urgent care and non-trauma emergency practice 66 TEAM HEALTH, INC. NOTES TO THE CONSOLIDATED FINANCIAL STATEMENTS -- (CONTINUED) services at three locations in Florida. The pediatric services provided are billed by the Company on a fee-for-service basis. The assets and operations of L&S were acquired for $6.4 million in cash and the Company may have to make up to $3.9 million in future contingent payments for the existing L&S contracts as of December 31, 2001. In addition, the Company has agreed to pay the owners of L&S, as additional purchase price consideration, a multiple of earnings before interest, taxes and depreciation and amortization for certain potential new contract locations identified at the date of closing. The additional amount(s) of purchase price will only be paid if the owners of L&S are successful in the completion of their marketing efforts as evidenced by such locations having entered into contracts for services within specified time frames following December 31, 2001. The additional purchase price, if any, for such subsequent contracts is not able to be estimated at this time. The assets and operations of the three pediatric services locations were acquired for $4.7 million in cash. The Company may have to make up to $3.2 million in future contingent payments for the existing business operations if targeted future earnings levels are achieved. 67 SIGNATURES Pursuant to the requirements of Section 13 or 15(d) of the Securities Exchange Act of 1934, the registrant has duly caused this report on Form 10-K to be signed on its behalf by the undersigned, thereunto duly authorized in the City of Knoxville, Tennessee, on March 1, 2002. TEAM HEALTH, INC. /s/ H. LYNN MASSINGALE, M.D. -------------------------------------- H. Lynn Massingale Chief Executive Officer /s/ ROBERT J. ABRAMOWSKI -------------------------------------- Robert J. Abramowski Executive Vice President Finance and Administration /s/ DAVID JONES -------------------------------------- David Jones Vice President and Treasurer Pursuant to the requirements of the Securities Exchange Act of 1934, this report on Form 10-K has been signed below on March 1, 2002, by the following persons on behalf of the registrant and in the capacities indicated. TEAM HEALTH, INC. /s/ H. LYNN MASSINGALE, M.D. -------------------------------------- H. Lynn Massingale, M.D. President and Chief Executive Officer and Director /s/ NICHOLAS W. ALEXOS -------------------------------------- Nicholas W. Alexos Director 68 /s/ GLENN A. DAVENPORT -------------------------------------- Glenn A. Davenport Director /s/ EARL P. HOLLAND -------------------------------------- Earl P. Holland Director /s/ DANA J. O'BRIEN -------------------------------------- Dana J. O'Brien Director /s/ KENNETH W. O'KEEFE -------------------------------------- Kenneth W. O'Keefe Director /s/ TIMOTHY P. SULLIVAN -------------------------------------- Timothy P. Sullivan Director 69 EXHIBIT INDEX 2.1 Recapitalization Agreement dated January 25, 1999 by and among Team Health, Inc., MedPartners, Inc., Pacific Physician Services, Inc. and Team Health Holdings, L.L.C.* 3.1 Articles of Amendment to the Articles of Incorporation of Alliance Corporation dated January 15, 1997.* 3.2 By-laws of Alliance Corporation.* 3.3 Articles of Incorporation of Emergency Management Specialists, Inc. dated August 12, 1983.* 3.4 By-laws of Emergency Management Specialists, Inc.* 3.5 Articles of Incorporation of EMSA South Broward, Inc. dated December 3, 1996.* 3.6 By-laws of EMSA South Broward, Inc.* 3.7 Articles of Incorporation of Herschel Fischer, Inc. dated February 18, 1997.* 3.8 By-laws of Herschel Fischer, Inc. dated February 21, 1997.* 3.9 Articles of Incorporation of IMBS, Inc. dated November 30, 1995.* 3.10 By-laws of IMBS, Inc.* 3.11 Articles of Incorporation of InPhyNet Hospital Services, Inc. dated November 30, 1995.* 3.12 By-laws of InPhyNet Hospital Services, Inc.* 3.13 Certificate of Amendment of Certificate of Incorporation of InPhyNet Medical Management Institute, Inc. dated February 28, 1996.* 3.14 By-laws of InPhyNet Medical Management Institute, Inc.* 3.15 Articles of Incorporation of Karl G. Mangold, Inc. dated February 14, 1997.* 3.16 By-laws of Karl G. Mangold, Inc. dated February 20, 1997.* 3.17 Amended and Restated Articles of Incorporation of Charles L. Springfield, Inc. dated November 21, 1997.* 3.18 Amendment to By-laws of Charles L. Springfield, Inc. dated November 20, 1997.* 3.19 Articles of Amendment to the Charter of Clinic Management Services, Inc. dated March 25, 1994.* 3.20 By-laws of Clinic Management Services, Inc.* 3.21 Articles of Incorporation of Daniel & Yeager, Inc. dated October 25, 1989.* 3.22 By-laws of Daniel & Yeager, Inc. dated October 6, 1989.* 3.23 Articles of Incorporation of Drs. Sheer, Abeam & Associates, Inc. dated March 31, 1969.* 3.24 Amended and Restated By-laws of Drs. Sheer, Abeam & Associates, Inc. dated February 15, 1989.* 3.25 Articles of Amendment to the Charter of Emergency Coverage Corporation dated February 15, 1993.* 3.26 Amendment to By-laws of Emergency Coverage Corporation dated June 12, 1995.* 3.27 Restated Certificate of Incorporation of Emergency Physician Associates, Inc. dated June 25, 1996.* 3.28 By-laws of Emergency Physician Associates, Inc.* 3.29 Articles of Incorporation of Emergency Physicians of Manatee, Inc. dated June 1, 1988.* 3.30 By-laws of Emergency Physicians of Manatee, Inc.* 3.31 Certificate to Amend the Articles of Incorporation of Emergency Professional Services, Inc. dated September 30, 1997.* 3.32 Code Regulations of Emergency Professional Services, Inc. amended June 22, 1987.* 3.33 Amended and Restated Charter of Emergicare Management, Incorporated dated February 28, 1995.* 3.34 By-laws of Emergicare Management Incorporated dated December 29, 1972.* 3.35 Articles of Incorporation of EMSA Contracting Service, Inc. dated November 30, 1995.* 3.36 By-laws of EMSA Contracting Service, Inc.* 3.37 Articles of Amendment of EMSA Louisiana, Inc. dated May 28, 1989.* 3.38 By-laws of EMSA Louisiana, Inc.*
3.39 Articles of Amendment to the Charter of Hospital Based Physician Services, Inc. dated March 25, 1994.* 3.40 By-laws of Hospital Based Physician Services, Inc. dated July 18, 1993.* 3.41 Articles of Incorporation of InPhyNet Anesthesia of West Virginia, Inc. dated February 29, 1997.* 3.42 By-laws of InPhyNet Anesthesia of West Virginia, Inc.* 3.43 Articles of Amendment to the Charter of Med: Assure Systems, Inc. dated October 28, 1992.* 3.44 By-laws of Med: Assure Systems, Inc. dated February 25, 1987.* 3.45 Articles of Incorporation of MetroAmerican Radiology, Inc. dated April 19, 1989.* 3.46 By-laws of MetroAmerican Radiology, Inc. dated April 23, 1989.* 3.47 Articles of Incorporation of Neo-Med, Inc. dated November 15, 1993.* 3.48 By-laws of Neo-Med, Inc.* 3.49 Articles of Incorporation of Northwest Emergency Physicians, Incorporated dated June 4, 1985.* 3.50 By-laws of Northwest Emergency Physicians, Incorporated.* 3.51 Certificate of Amendment of Certificate of Incorporation of Paragon Anesthesia, Inc. dated September 20, 1994.* 3.52 By-laws of Paragon Anesthesia, Inc.* 3.53 Articles of Incorporation of Paragon Contracting Services, Inc. dated November 30, 1995.* 3.54 By-laws of Paragon Contracting Services, Inc.* 3.55 Certificate of Amendment of Certificate of Incorporation of Paragon Imaging Consultants, Inc. dated May 7, 1993.* 3.56 By-laws of Paragon Imaging Consultants, Inc.* 3.57 Articles of Incorporation of Quantum Plus, Inc. dated January 27, 1997.* 3.58 By-laws of Quantum Plus, Inc. dated February 1, 1997.* 3.59 Amendment and Restated Articles of Incorporation of Reich, Sceidelmann & Janicki Co. dated November 7, 1997.* 3.60 Code Regulations of Reich, Seidelmann & Janicki Co.* 3.61 Articles of Incorporation of Rosendorf, Marguiles, Borushok & Shoenbaum Radiology Associates of Hollywood, Inc. dated October 25, 1968.* 3.62 By-laws of Rosendorf, Marguiles, Borushok & Shoenbaum Radiology Associates of Hollywood, Inc.* 3.63 Articles of Amendment to the Articles of Incorporation of Sarasota Emergency Medical Consultants, Inc. dated August 7, 1997.* 3.64 By-laws of Sarasota Emergency Medical Consultants, Inc.* 3.65 Articles of Amendment to the Charter of Southeastern Emergency Physicians, Inc. dated November 5, 1992.* 3.66 By-laws of Southeastern Emergency Physicians, Inc. dated July 1, 1986.* 3.67 Articles of Amendment to the Charter of Southeastern Emergency Physicians of Memphis, Inc. dated June 15, 1992.* 3.68 By-laws of Southeastern Emergency Physicians Of Memphis, Inc.* 3.69 Charter of Team Health Financial Services, Inc. dated October 9, 1997.* 3.70 By-laws of Team Health Financial Services, Inc.* 3.71 Articles of Incorporation of Team Radiology, Inc. dated October 6, 1993.* 3.72 By-laws of Team Radiology, Inc. dated November 5, 1993.* 3.73 Certificate of Incorporation of THBS, Inc. dated October 20, 1997.* 3.74 By-laws of THBS, Inc.* 3.75 Amended and Restated Articles of Incorporation of The Emergency Associates for Medicine, Inc. dated August 30, 1996.* 3.76 By-laws of The Emergency Associates for Medicine, Inc.*
3.77 Articles of Incorporation of Virginia Emergency Physicians, Inc. dated June 25, 1992.* 3.78 Amended and Restated By-laws of Virginia Emergency Physicians, Inc.* 3.79 Articles of Incorporation of EMSA Joilet, Inc. dated December 30, 1988.* 3.80 By-laws of EMSA Joilet, Inc.* 3.81 Certificate of limited Partnership of Paragon Healthcare Limited Partnership, dated August 3, 1993.* 3.82 Certificate of Limited Partnership of Team Health Southwest, L.P., dated May 20, 1998.* 3.83 Certificate of Limited Partnership of Team Health Billing Services, L.P., dated October 21, 1997.* 3.84 Partnership Agreement of Fischer Mangold Group Partnership, dated February 21, 1996.* 3.85 Partnership Agreement of Mt. Diablo Emergency Physicians, a California General Partnership, dated June 1, 1997.* 3.86 Articles of Incorporation of Team Health, Inc.* 3.87 By-laws of Team Health, Inc.* 3.88 Articles of Incorporation of Integrated Specialists Management Services, Inc. dated January 20, 1994.** 3.89 Certificate of Amendment to Articles of Incorporation of Integrated Specialists Management Services, Inc. dated January 29, 1997.** 3.90 Bylaws of Integrated Specialists Management Services, Inc. dated July 18, 1994.** 3.91 Third Amendment to Bylaws of Integrated Specialists Management Services, Inc. dated February 23, 2001.** 3.92 Fifth Amendment to Bylaws of Integrated Specialists Management Services, Inc. dated June 12, 2001.** 3.93 Sixth Amendment to Bylaws of Integrated Specialists Management Services, Inc. dated July 30, 2001.** 3.94 Articles of Incorporation of Physician Integration Consulting Services, Inc. dated August 2, 1993.** 3.95 Bylaws of Physician Integration Consulting Services, Inc. dated August 11, 1993.** 3.96 Articles of Incorporation of Sentinel Medical Services, Inc. dated September 2, 1994.** 3.97 Bylaws of Sentinel Medical Services, Inc. (undated)** 4.1 Indenture dated as of March 12, 1999 by and among Team Health, Inc. the Guarantors listed on the signature pages thereto and the United States Trust Company of New York.* 9.1 Stockholders Agreement dated as of March 12, 1999 by and among Team Health, Inc., Team Health Holdings, L.L.C., Pacific Physicians Services, Inc., and certain other stockholders of the Team Health, Inc. who are from time to time party hereto.* 9.2 Securityholders Agreement dated as of March 12, 1999 by and among Team Health Holdings, L.L.C., each of the persons listed on Schedule A thereto and certain other securityholders of Team Health Holdings, L.L.C. who are from time to time party thereto.* 10.1 Registration Rights Agreement dated as of March 12, 1999 by and among Team Health, Inc., the guarantors listed on the signature pages thereto and Donaldson, Lufkin & Jenrette Securities Corporation, NationsBanc Montgomery Securities LLC and Fleet Securities, Inc.* 10.2 Purchase Agreement dated as of March 5, 1999 by and among Team Health, Inc. and the guarantors listed on the signature pages thereto and Donaldson, Lufkin & Jenrette Securities Corporation, NationsBanc Montgomery Securities LLC and Fleet Securities, Inc.* 10.3 Equity Deferred Compensation Plan of Team Health, Inc. effective January 25, 1999.* 10.4 Management Services Agreement dated as of March 12, 1999 by and among Team Health, Inc., Madison Dearborn Partners II, L.P., Beecken, Petty & Company, L.L.C. and Cornerstone Equity Investors LLC.* 10.5 Registration Agreement dated as of March 12, 1999 by and among Team Health, Inc., Team Health Holdings, L.L.C., Pacific Physician Services, Inc. and certain other stockholders of Team Health, Inc. who are from the to time party thereto.*
10.6 Registration Agreement dated as of March 12, 1999 by and among Team Health Holdings, L.L.C., each of the persons listed on Schedule A thereto and certain other securityholders of Team Health, Inc. who are from time to time party thereto.* 10.7 Trust Agreement dated as of January 25, 1999 by and among Team Health, Inc. and The Trust Company of Knoxville.* 10.8 Credit Agreement dated as of March 12, 1999 by and among Team Health, Inc., the banks, financial institutions and other institutional lenders named herein, Fleet National Bank, NationsBank, N.A., NationsBanc Montgomery Securities LLC and Donaldson, Lufkin & Jenrette Securities Corporation.* 10.9 Sheer Ahearn & Associates Plan Provision Nonqualified Excess Deferral Plan effective September 1, 1998.* 10.10 Amendment and Restatement of Emergency Professional Services, Inc. Deferred Compensation Plan effective January 31, 1996.* 10.11 Lease Agreement dated August 27, 1992 between Med: Assure Systems and Winston Road Properties for our corporate headquarters located at 1900 Winston Road, Knoxville, TN.* 10.12 Lease Agreement dated August 27, 1999 between Americare Medical Services, Inc. and Winston Road Properties for space located at 1900 Winston Road, Knoxville, TN.* 10.13 1999 Stock Option Plan of Team Health, Inc.* 10.14 Form of Employment Agreement for Dr. Massingale and Messrs. Hatcher, Sherlin, Joyner and Jones.* 10.15 Amendment No. 1 to Credit Agreement* 10.16 Amendment No. 1 to Security Agreement* 10.17 Amendment No. 2 to Credit Agreement* 21. Subsidiaries of Registrant.**
- --------------- * Previously filed by the Company in its prior S-4 Registration Statement and subsequent filings with the Securities and Exchange Commission. ** Filed herewith. ITEM 14(A) SCHEDULE II -- VALUATION AND QUALIFYING ACCOUNTS
BALANCE AT BEGINNING COSTS AND BALANCE AT OF PERIOD EXPENSES OTHER DEDUCTIONS END OF PERIOD ---------- --------- ----- ---------- ------------- 2001..................................... $106,819 $336,218 $-- $341,862 $101,175 2000..................................... 125,067 329,291 -- 347,539 106,819 1999..................................... 141,668 309,713 -- 326,314 125,067
EX-3.88 3 y57349ex3-88.txt ARTICLES OF INCORPORATION: INTEGRATED SPECIALISTS Exhibit 3.88 ARTICLES OF INCORPORATION OF INTEGRATED SPECIALISTS MANAGEMENT SERVICES, INC. ARTICLE ONE The name of the corporation shall be Integrated Specialists Management Services, Inc. ARTICLE TWO The purpose of the corporation is to engage in any lawful act or activity for which a corporation may be organized under the Corporations Code of the State of California other than the banking business, the trust company business or the practice of a professional permitted to be incorporated under the Corporations Code of the State of California. ARTICLE THREE The corporation's initial agent for service of process is Lesley A. Allison, who may be served at 3626 Ruffin Road, San Diego, California 92123. ARTICLE FOUR The total number of shares that the corporation is authorized to issue is one million shares. Such shared shall be of a single class. ARTICLE FIVE The liability of the directors of the corporation for monetary damages shall be eliminated to the fullest extent permissible under California Law. ARTICLE SIX The corporation is authorized to provide indemnification of agents (as defined in section 317 of the Corporations Code) for breach of duty to the corporation and its stockholders through bylaws provisions or through agreements with the agents, or both, in excess of the indemnification otherwise permitted by section 317 of the Corporations Code, subject to the limits on such excess indemnification set forth in section 204 of the Corporations Code. I declare that I am the Incorporator who has executed the foregoing Articles of Incorporation and hereby declare that this instrument is the act and deed of the undersigned. Dated: 1/20/1994 ------------- /s/ James B. Wyland ------------------------------- EX-3.89 4 y57349ex3-89.txt CERTIFCATE OF AMENDMENT OF AOI: INTEGRATED Exhibit 3.89 CERTIFICATE OF AMENDMENT OF ARTICLES OF INCORPORATION OF INTEGRATED SPECIALISTS MANAGEMENT SERVICES, INC. Stephen N. Rogers, MD and Christopher W. Cary certify that: 1. They are the President/Chairman and the Secretary, respectively, of Integrated Specialists Management Services, Inc., a California corporation. 2. The Board of Directors of Integrated Specialists Management Services, Inc. has approved the following amendment to the articles of incorporation: Article Four of the articles of incorporation is amended to read in its entirety as follows: The corporation is authorized to issue only one class of shares, which shall be Common Stock, in a total number of two million shares. On the amendment of this article, each outstanding share of Common Stock is split up and converted into two shares of Common Stock. 3. This amendment may be adopted with approval by the Board of Directors alone because the corporation has one class of shares outstanding and the amendment effectuates only a stock split, as defined in Corporations Code Section 188. Corporation Code Section 902(c) authorizes the adoption of this type of amendment with approval by the Board alone. We declare under penalty of perjury that the statements set forth in this certificate are true and correct of our own knowledge and that this declaration was executed on __________ at San Diego, California. Dated: January 29, 1997 /s/ Stephen N. Rogers, MD [signature] /s/ Christopher W. Cary, MD [signature] - ------------------------ --------------------------- Stephen N. Rogers, MD [printed name] Christopher W. Cary, MD [printed name] - ------------------------ --------------------------- President/Chairman [title] Secretary [title] - ------------------------ --------------------------- EX-3.90 5 y57349ex3-90.txt BYLAWS OF INTEGRATED SPECIALISTS Exhibit 3.90 BYLAWS OF INTEGRATED SPECIALISTS MANAGEMENT SERVICES, INC. CHAPTER 1. OFFICE 100. Office. The location of the principal executive office of the corporation is 3626 Ruffin Road, San Diego, California 92123. CHAPTER 2. DIRECTORS 200. Number of Directors. (a) The authorized number of Directors of the corporation shall be not less than five (5) and not more than nine (9). (b) The initial authorized number of Directors shall be seven (7). Thereafter, the exact authorized number of Directors within the range of paragraph (a) may from time to time be changed by a resolution adopted by the Board of Directors. 201. Term and Election of Directors. (a) Directors are elected for a term of one year, and may succeed themselves. (b) Directors shall be elected at the annual meeting of shareholders. (c) A vacancy occurring in the office of director may be filled by the Board of Directors for the balance of the unexpired term and until a successor has been elected and qualified (unless there is a intervening regular annual election in which case the appointee shall hold office until a successor has been elected and qualified.) An election to fill an unexpired term shall be held only if the vacancy occurs prior to the appointment of the nominating committee pursuant to Section 202 of the bylaws. 202. Nomination Procedure. (a) Annually the Board of Directors shall establish a date upon which the notices of annual meeting or the written ballots, as the case may be, will be mailed to the shareholders. (b) At least thirty (30) days prior to the date established pursuant to paragraph (a), the Board of Directors shall appoint a Nominating Committee composed of three (3) shareholders. Bylaws page 1 (c) At least twenty (20) days prior to the notice date established pursuant to paragraph (a), the Nominating Committee shall submit its report to the Board of Directors. (d) Other shareholders may be nominated by petition signed by ten percent (10%) of the shareholders of the corporation and delivered to the Secretary at least twenty (20) days prior to the date of the meeting or prior to the final date for the receipt of written ballots, as the case may be. A person may not be nominated except pursuant to paragraphs (c) or (d). 203. Resignation and Removal of Directors. (a) Any director may resign effective upon giving written notice to the Chairman of the Board, the President, the Secretary or the Board of Directors of the corporation, unless the notice specifies a later time for the effectiveness of such resignation. If the resignation is effective at a future time, a successor may be elected to take office when the resignation becomes effective. The Board of Directors may declare vacant the office of a director who has been declared of unsound mind by an order of court or convicted of a felony or has failed to attend three (3) consecutive meetings of the Board of Directors. (b) Any or all of the Directors may be removed without cause as follows: (1) If the corporation has fifty (50) or more shareholders, by the vote of a majority of the shareholders represented at a duly held regular or special meeting of the shareholders at which a quorum is present or by the written ballot of shareholders pursuant to Section 502 of the bylaws; or (2) If the corporation has fewer than fifty (50) shareholders, by the affirmative vote of a majority of the total number of shareholders of the corporation (whether or not all shareholders vote) at a duly held regular or special meeting of the shareholders or by the affirmative written ballot of a majority of the total number of shareholders of the corporation pursuant to Section 502 of the bylaws. 204. Meetings of the Board of Directors. (a) Meetings of the Board of Directors shall be held at the principal executive office of the corporation unless another place is stated in the notice of the meeting. (b) Regular meetings of the Board of Directors shall be held, if so provided in a resolution adopted by the Board of Directors, at the time and place specified in such resolution. (c) A special meeting of the Board of Directors may be called by the chairman, the Secretary or any two Directors. (d) Notice of all regular and special meetings of the Board of Directors shall be given. A notice need not include the purpose or agenda for the Bylaws page 2 meeting. The notice may be in writing and mailed at least four (4) days before the meeting. The notice may also be delivered personally or by telephone or telegraph at least forty-eight (48) hours before the meeting. (e) Notice of a meeting need not be given to any director who signs a waiver of notice or a consent to holding the meeting or an approval of the minutes thereof, whether before or after the meeting, or who attends the meeting without protesting, prior thereto or at its commencement, the lack of notice to such director. All such waiver, consents, and approvals shall be filed with the corporate records or made a part of the minutes of the meeting. (f) Directors may participate in a meeting through use of conference telephone or similar communications equipment, so long as all Directors participating in such meeting can hear one another. Participation in a meeting by this means constitutes presence in person at such meeting. (g) A majority of the authorized number of Directors constitutes a quorum of the Board of Directors for the transaction of business. (h) A majority of the Directors present, whether or not a quorum is present, may adjourn any meeting to another time and place. If the meeting is adjourned for more than 24 hours, notice of any adjournment to another time or place shall be given, prior to the time of the adjourned meeting, to the Directors who were not present at the time of the adjournment. 205. Required Vote of Directors. (a) Every act or decision done or made by a majority of the Directors present at a meeting duly held at which a quorum is present is the act of the Board of Directors. A meeting at which a quorum is initially present may continue to transact business notwithstanding the withdrawal of Directors, if any action taken is approved by at least a majority of the required quorum for such meeting. (b) Notwithstanding paragraph (a) and subject to the limitation in Section 601, the amendment or repeal of bylaws requires the affirmative approval of fifty percent (50%) of the authorized number of Directors then in office. (c) Notwithstanding paragraph (a), the issuance of additional shares of stock of corporation, after the initial offering, requires the vote of sixty-six and two-thirds percent (66-2/3%) of the Directors then in office. 206. Written consent of Directors. Any action required or permitted to be taken by the Board of Directors may be taken without a meeting, if all members of the board shall individually or collectively consent in writing to such action. Such written consent or consents shall be filed with the minutes of the proceedings of the board. Such action by written consent shall have the same force and effect as a unanimous vote of such Directors. 207. Committees. (a) Committees are of two kinds, those with legal authority to act for the corporation and advisory committees. The former are provided for in paragraph (b) below and the latter in paragraph (c) below. Bylaws page 3 (b) The Board of Directors may, by resolution adopted by a majority of the authorized number of Directors then in office, designated one or more committees with legal authority to act for the corporation to the extent specified in the resolution creating such committee, each such committee consisting of two or more Directors, to serve at the pleasure of the board. The board may designate one or more Directors as alternative members of any committee, who may replace any absent member at any meeting of the committee. The appointment of member or alternate members of a committee requires the vote of a majority of the Directors then in office. Sections 204, 205 and 206 of these bylaws, with appropriate adaptations to the circumstances, apply to the procedures of these committees. Any such committee, to the extent provided in the resolution of the board, shall have all the authority of the board, except with respect to: (1) The approval of any action which also requires shareholder approval. (2) The fixing of vacancies on the board or in any committee. (3) The fixing of compensation of the Directors for serving on the board or on any committee. (4) The amendment or repeal of bylaws or the adoption of new bylaws. (5) The amendment or repeal of any resolution of the board which by its express terms is not so amendable or repealable. (6) The appointment of other committees of the board or the members thereof. (7) The expenditure of corporate funds to support a nominee for director after there are more people nominated for director than can be elected. (8) Any action requiring a higher than majority vote under Section 205(c). (c) Advisory committees may be appointed to consist of one or more shareholders. Advisory committees have no legal authority to act for the corporation, but shall report their findings and recommendations to the Board of Directors. 208. Compensation of Directors. Directors shall be entitled to receive their actual, necessary expenses in attending meetings of the Board of Directors, of committees of the Board of Directors and of advisory committees. Directors who are also officers or employees of the corporation and who are compensated as such shall be entitled to receive compensation as Directors. The Directors shall receive such compensation as may be established by resolution of the Board of Directors. 209. Inspection Rights of Directors. Every director shall have the absolute right at any reasonable time to inspect and copy all books, records and documents of every kind and to inspect the physical properties of the corporation. Such inspection by Bylaws page 4 a director may be made in person or by agent or attorney and the right of inspection includes the right to copy and make extracts. CHAPTER 3. OFFICERS 300. Officers and Duties. (a) The officers of the corporation are the President or Chief Executive Officer, one or more Vice Presidents, the Secretary, the Treasurer and/or the Chief Financial Officer, and the Chairman of the Board. (b) The President is the Chief Executive Officer and general manager of the corporation. The President shall, subject to the control of the Board of Directors, have general supervision, direction and control of the business and affairs of the corporation and of its officers, employees and agents, including the right to employ, discharge and prescribe the duties and compensation of all officers, employees and agents of the corporation, except where such matters are prescribed in the bylaws or by the Board of Directors. The President shall preside at all meetings of the shareholders and of the Board of Directors, unless there is a Chairman of the Board. The President is authorized to sign all contracts, notes, conveyances and other papers, documents and instruments in writing in the name of the corporation. (c) The Vice President shall perform, under the direction of the President, duties and responsibilities in the management of the corporation or in one or more particular areas of its management. (d) The Secretary shall keep or cause to be kept the minute book of the corporation as prescribed by Section 700 of the bylaws. The Secretary shall sign in the name of the corporation, either alone or with one or more other officers, all documents authorized or required to be signed by the Secretary. If the corporation has a corporate seal, the Secretary shall keep the seal and shall affix the seal to documents as appropriate or desired. The Board of Directors may, by resolution, authorize one or more assistant secretaries to perform, under the direction of the Secretary, some or all of the duties of the Secretary. (e) The Chief Financial Officer is responsible for the receipt, maintenance and disbursement of all funds of the corporation and for the safekeeping of all securities of the corporation. The Chief Financial Officer shall keep or cause to be kept books and records of accounts and records of all properties of the corporation. The Chief Financial Officer shall prepare or cause to be prepared annually, or more often if so directed by the Board of Directors or President, financial statements of the corporation. (f) The Chairman of the Board shall preside at all meetings of the Board of Directors. Bylaws page 5 301. Appointment and Removal of Officers. (a) The officers provided for in paragraph (a) of Section 300 of the bylaws, shall be appointed as prescribed in the resolution of the Board of Directors establishing the office. (b) Any officer appointed by the Board of Directors may be removed from office at any time by the Board of Directors, with or without cause or prior notice. (c) When authorized by the Board of Directors, any appointed officer may be appointed for a specific term under a contract of employment. Notwithstanding that such officer is appointed for a specified term or under a contract of employment, any such officer may be removed from office at any time pursuant to paragraph (b) and shall have no claim against the corporation on account of such removal other than for such monetary compensation as the officer may be entitled to under the terms of the contract of employment. (d) Any officer may resign at any time upon written notice to the corporation without prejudice to the rights, if any, of the corporation under any contract to which the officer is a party. Such resignation is effective upon receipt of the written notice by the corporation unless the notice prescribes a later effective date or unless the notice prescribes a condition to the effectiveness of the resignation. (e) The same person may hold more than one appointed office except that neither the Secretary nor the Chief Financial Officer may serve concurrently as the President (or Chairman of the Board). 302. Execution of Instruments. (a) Any and all instruments executed in the name of the corporation, including, but not limited to, contracts, agreements, purchase orders, notes, deeds, deeds of trust, mortgages, leases, security agreements, checks and drafts issued, endorsements of checks and drafts received, certificates, applications and reports, shall be executed by any one or more officers, employees or agents of the corporation as authorized from time to time by the Board of Directors. Such authorization may be general or confined to specific instances. (b) The respective offices and duties thereof as established and defined in Section 300 of the bylaws and by resolution of the Board of Directors include, except as otherwise provided, the authority to executive instruments in the name of the corporation when the execution of the instrument is incident to carrying out the duties of the office. CHAPTER 4. INDEMNIFICATION 400. Indemnification of Directors, Officers, and Employees. The corporation shall indemnify all persons who have served or may serve at any time as officers or Directors of the corporation, and their heirs, executors, administrators, successors, and assigns, from and against any and all loss and expense, including amounts Bylaws page 6 made in settlement before or after suit is commenced, and reasonable attorneys' fees, actually and necessarily sustained as a result of any claim, demand, action, proceeding, or judgment that may be asserted against any such persons, or in which any such persons are made parties by reason of their being or having been officers or Directors of the corporation. However, this right of indemnification shall not exist in relation to matters where it is adjudged in any action, suit, or proceeding that any such persons committed gross negligence or willful misconduct in the performance of duty. The liability of the Directors of the corporation for monetary damages shall be eliminated to the fullest extent permissible under California law. CHAPTER 5. SHAREHOLDERS 500. Qualifications. Shareholders in the corporation shall be limited to: (a) Licensed physicians; or (b) Executive employees of the corporation 501. Transfer of Shares and Right of First Refusal. A share in the corporation is transferable subject to a right of first refusal in the corporation, as follows. Any shareholder intending to sell his or her shares in the corporation shall first give the corporation written notice of intent to sell, stating the identity of the proposed purchaser, the consideration to be paid and the payment term or terms. Corporation shall have forty-five (45) days from receipt of the written notice to either exercise or decline to exercise its right of first refusal by written notice to the shareholder. If the corporation exercises its right of first refusal, it shall purchase and the shareholder shall sell his or her shares on the terms and conditions set forth in the shareholder's notice of intent to sell. If the corporation declines to exercise its right of first refusal or fails to respond in writing within the foregoing forty-five (45) day period, then the shareholder shall be free to sell his or her shares in the corporation, but only to a qualified purchaser and on the terms stated in the shareholder's notice to the corporation of intent to sell. Written notices under this section shall be effective on receipt by the President or Secretary of the corporation or the shareholder, as the case may be, three (3) days after deposit in the United States Mail, postage paid, return receipt requested, addressed to the President or Secretary of the corporation or to the shareholder at his or her record address, as the case may be. 502. Written Ballot of Shareholders. (a) Whenever the shareholders are to vote for Directors or on any proposal for action which could be taken at any regular or special meeting of shareholders, the shareholders may, in the discretion of the Board of Directors (unless a specific method of voting is prescribed by Section 201 of the bylaws), vote by written ballot without a meeting pursuant to this section of the bylaws. (b) A written ballot shall be mailed to every shareholder entitled to vote on the matter pursuant to Section 506 of the bylaws. Bylaws page 7 (c) The written ballot shall set forth the time by which the ballot must be received in order to be counted and the minimum number of written ballots which must be returned to meet the quorum requirement. (d) If the vote is for other than Directors, the written ballot shall set forth: (1) The proposal to be voted on, and for this purpose related proposals may be grouped as a single proposal for the written ballot. (2) Offer the shareholder a choice between approval and disapproval on each such proposal. (3) Specify the proposal must be approved by a majority of the written ballots voting on the proposal, provided that sufficient written ballots are returned to meet the quorum requirement or such greater vote as may be required by applicable law or by the articles of incorporation or bylaws. (e) Approval by written ballot shall be valid only when the number of votes cast by ballot within the time period specified equals or exceeds the quorum required to be present at a meeting authorizing the action, and the number of approvals equals or exceeds the number of votes that would be required to approve at a meeting at which the total number of votes cast was the same as the number of votes by ballot. 503. Annual Meeting of Shareholders. (a) An annual meeting of shareholders shall be held between the 30th day of September and the 31st day of December in each year. The exact date and time of such annual meeting shall be fixed by resolution of the Board of Directors. The annual meeting shall be held at the principal office of the corporation unless the Board of Directors by resolution prescribes a different place. (b) At the annual meeting of shareholders, the shareholders shall elect and qualify Directors for those offices which terms expire that year. Any other proper business may be transacted at the annual meeting of shareholders. 504. Special Meetings of Shareholders. Special meetings of the shareholders may be called by the Board of Directors, the President or the Chairman of the Board or by the holders of shares entitled to cast not less than ten percent (10%) of the votes at the meeting. 505. Notice of Meeting of Shareholders. (a) Written notice of all annual meetings of shareholders shall be given not less than 30 nor more than 90 days before the date of the meeting to each member entitled to vote thereat. Written notice of all special meetings of shareholders shall be given not less than 10 nor more than 90 days before the date of the meeting to each member entitled to vote thereat. Such notice shall state the place, date and hour of the meeting and (1) in the case of a special meeting, the general nature of business to be transacted, and no other business may be transacted, or (2) in the case of the annual Bylaws page 8 meeting, those matters which the Board of Directors, at the time of the mailing of the notice, intends to present for action by the shareholders. The notice of any meeting at which Directors are to be elected shall include the names of the nominees pursuant to Section 202 of the bylaws. (b) Notice of a shareholders' meeting or any written ballot or report shall be given either personally or by first-class mail or other means of written communications, addressed to the shareholder at the address of such shareholder appearing on the books of the corporation or given by the member to the corporation for the purpose of notice; or if no such address appears or is given, at the place where the principal office of the corporation is located or by publication at least once in a newspaper of general circulation in the county in which the principal office is located. The notice, written ballot, or report shall be deemed to have been given at the time when delivered personally or deposited in the mail or sent by other means of written communication. An affidavit or mailing of any notice, written ballot or report in accordance with the provisions of this bylaw, executed by the Secretary or an assistant Secretary, shall be prima facie evidence of the giving of the notice, written ballot or report. If any notice, written ballot or report addressed to the shareholder at the address of such shareholder appearing on the books of the corporation is returned to the corporation by the United States Postal Service marked to indicate that the United States Postal Service is unable to deliver the notice, written ballot or report to the shareholder at such address, all future notices, written ballots or reports shall be deemed to have been duly given without further mailing if the same shall be available for the shareholder upon written demand of the shareholder at the principal office of the corporation for a period of one year from the date of the giving of the notice of written ballot or report to all other shareholders. (c) Except as otherwise prescribed by the Board of Directors in particular instances and except as otherwise provided by applicable law, the Secretary shall prepare and give, or cause to be prepared and given, the notice of meetings of shareholders and the written ballots of shareholders. 506. Record Date. (a) The Board of Directors may fix, in advance, a date as the record date for the purpose of determining the shareholders entitled to notice of or to vote at any meeting of shareholders. Such record date shall not be more than 90 nor less than 10 days before the date of the meeting. If no record date is fixed, shareholders at the close of business on the business day preceding the day on which notice is given or, if notice is waived, at the close of business on the business day preceding the day on which the meeting is held are entitled to notice of a meeting of shareholders. A determination of shareholders entitled to notice of or to vote at any meeting of shareholders shall apply to any adjournment of the meeting unless the board fixes a new record date for the adjourned meeting. (b) The Board of Directors may fix, in advance, a date as the record date for the purpose of determining the shareholders entitled to cast written ballots. Such record date shall not be more than 60 days before the day on which the first written ballot is mailed or solicited. If no record date if fixed, Bylaws page 9 shareholders on the day the first written ballot is mailed or solicited who are otherwise eligible to vote are entitled to cast written ballots. (c) The Board of Directors may fix, in advance, a date as the record date for the purpose of determining the shareholders entitled to exercise any rights in respect of any other lawful action. Such record date shall not be more than 60 days prior to such other action. If no record date is fixed, shareholders at the close of business on the day on which the board adopts the resolution relating thereto, or the 60th day prior to the date of such other action, whichever is later, are entitled to exercise such rights. 507. Multiple Person Share. If a share stands of record in the names of two or more persons, whether fiduciaries, shareholders of a partnership, joint tenants, tenants in common, husband and wife as community property, tenants by the entirety, or otherwise, or if two or more persons (including proxy-holders) have the same fiduciary relationship respecting the same share, unless the Secretary of the corporation is given written notice to the contrary and is furnished with a copy of the instrument or order appointing them or creating the relationship wherein it is so provided, their acts with respect to voting shall have the following effect: (1) If only one votes, such action binds all; (2) If more than one votes, the act of the majority so voting binds all. 508. Proxies. (a) Every person entitled to vote a share may authorize another person or persons to act by proxy with respect to such share. Any proxy purported to be executed in accordance with this bylaw shall be presumptively valid. (b) No proxy shall be valid after the expiration of 11 months from the date thereof unless otherwise provided in the proxy, except that the maximum term of any proxy shall be three years from the date of execution. Every proxy continues in full force and effect until revoked by the person executing it prior to the vote pursuant thereto. Such revocation may be effected by a writing delivered to the corporation stating that the proxy is revoked or by a subsequent proxy executed by the person executing the prior proxy and presented to the meeting, or as to any meeting by attendance at such meeting and voting in person by the person executing the proxy. The dates contained on the forms of proxy presumptively determine the order of execution, regardless of the postmark dates on the envelopes in which they are mailed. (c) A proxy is not revoked by the death or incapacity of the maker or the termination of a share as a result thereof unless, before the vote is counted, written notice of such death or incapacity is received by the corporation. (d) The proxy of a shareholder may not be irrevocable. 509. Quorum for meeting of shareholders. (a) A simple majority of all shareholders (or fifty-one percent of the total shares authorized to vote) entitled to vote, represented in person or by proxy, shall constitute a quorum at a meeting of shareholders. Bylaws page 10 (b) Except where a greater vote is required by the articles of incorporation or bylaws or by applicable law and except for the election of Directors or officers, if a quorum is present, the affirmative vote of a majority of the shareholders represented at the meeting, entitled to vote, and voting on any matter shall be the act of the shareholders. (c) The shareholders present at a duly called or held meeting at which a quorum is present may continue to transact business until adjournment notwithstanding the withdrawal of enough shareholders to leave less than a quorum, if any action taken (other than adjournment) is approved by at least a majority of the shareholders required to constitute a quorum. (d) In the absence of a quorum, any meeting of shareholders may be adjourned from time to time by the vote of a majority of the shareholders present, but no other business may be transacted, except as provided in paragraph (c). 510. Adjourned meeting of shareholders. When a shareholders' meeting is adjourned to another time or place, except as otherwise provided by this bylaw, notice need not be given of the adjourned meeting if the time and place thereof are announced at the meeting at which the adjournment is taken. The meeting shall not be adjourned for more than 45 days. At the adjourned meeting the corporation may transact any business which might have been transacted at the original meeting. If after the adjournment a new record date is fixed for the adjourned meeting, a notice of the adjourned meeting shall be given to each member who, on the record date for notice of the meeting, is entitled to vote at the meeting. 511. Cumulative voting for Directors. (a) Every shareholder entitled to vote at any election of Directors may cumulate such shareholder's votes and give one candidate a number of votes equal to the number of Directors to be elected multiplied by the number of votes to which the shareholder's shares are normally entitled, or distribute the shareholder's votes on the same principle among as many candidates as the shareholder thinks fit. (b) No shareholder shall be entitled to cumulate votes (i.e., cast for any candidate a number of votes greater than the number of votes which such shareholder normally is entitled to cast) unless such candidate or candidates' names have been placed in nomination prior to the voting and the shareholder has given notice at the meeting prior to the voting of the shareholder's intention to cumulate the shareholder's votes. If any one shareholder has given such notice, all shareholders may cumulate their votes for candidates in nomination. (c) In any election of Directors, the candidates receiving the highest number of affirmative votes of the shares entitled to be voted for them up to the number of Directors to be elected by such shares are elected; votes against the director and votes withheld shall have no legal effect. Bylaws page 11 512. Inspectors of election. (a) In advance of any meeting of shareholders the Board of Directors may appoint inspectors of election to act at the meeting and any adjournment thereof. If inspectors of election are not so appointed, or if any persons so appointed fail to appear or refuse to act, the chairman of any meeting of shareholders may, and on the request of any shareholder or a shareholder's proxy shall, appoint inspectors of election (or persons to replace those who so fail or refuse) at the meeting. The number of inspectors shall be either one or three. If appointed at a meeting on the request of one or more shareholders or proxies, the majority of shareholders represented in person or by proxy shall determine whether one or three inspectors are to be appointed. (b) The inspectors of election shall determine the number of shares outstanding and the voting power of each, the number represented at the meeting, the existence of a quorum and the authenticity, validity and effect of proxies, receive votes, ballots or consents, hear and determine all challenges and questions in any way arising in connection with the right to vote, count and tabulate all votes or consents, determine when the polls shall close, determine the result and do such acts as may be proper to conduct the election or vote with fairness to all shareholders. (c) The inspectors of election shall perform their duties impartially, in good faith, to the best of their ability and as expeditiously as is practical. If there are three inspectors of election, the decision, act or certificate of a majority is effective in all respects as the decision, act or certificate of all. Any report or certificate made by the inspectors of election is prima facie evidence of the facts stated therein. 513. Issuance of additional shares. After the initial offering, the issuance of additional shares will require the approval of the Board of Directors as set forth in Section 205(c). 514. Unanimous written consent of shareholders. Any action required or permitted to be taken by the shareholders may be taken without a meeting, if all shareholders shall individually or collectively consent in writing to the action. The written consent or consents shall be filed with the minutes of the proceedings of the shareholders. The action by written consent shall have the same force and effect as the unanimous vote of the shareholders. CHAPTER 6. AMENDMENTS 600. Amendment of articles. The amendment of articles of incorporation is provided for by state law and requires the approval of the Board of Directors, the approval of the shareholders, and the filing of a certificate of amendments in the Office of the Secretary of State. 601. Amendment of bylaws. The amendment of bylaws is provided for by state law and requires either the approval of the Board of Directors or the approval of the shareholders. However, in several situations too complex to describe in these bylaws but seldom encountered, when state law prohibits amendment of bylaws Bylaws page 12 by approval of the Board of Directors alone, approval of the shareholders of the bylaws is required. CHAPTER 7. MISCELLANEOUS 700. Records. The corporation shall keep or cause to be kept a minute book which shall contain: (a) The record of all meetings of the Board of Directors including date, place, those attending and the proceedings thereof, a copy of the notice of the meeting and when and how given, written waivers of notice of meeting, written consents to holding meeting, written approvals of minutes of meeting, and unanimous written consents to action of the Board of Directors without a meeting, and similarly as to meetings of committees of the Board of Directors established pursuant to paragraph (b) of Section 207 of the bylaws and as to meetings or written consents of the incorporator or incorporators of the corporation prior to the appointment of the initial Board of Directors. (b) The record of all meetings of the shareholders including date, place, shareholders present in person or by proxy (if proxies are permitted), proxies used, and the proceedings thereof, a copy of the notice of meeting and when and how given, any affidavit as to the mailing or giving of notice, written waivers of notice of meeting, written consents to the holding of the meeting, written approvals of the minutes of the meeting, unanimous written consents of shareholders to action without a meeting and the report of action by shareholders by written ballot, including a copy of the form of written ballot and any affidavit as to the mailing of written ballots. (c) A copy of the articles of incorporation and all amendments thereof and a copy of all certificates filed with the Secretary of State. (d) A copy of the bylaws as amended, duly certified by the Secretary. 702. Annual Report. The corporation shall send to all shareholders an annual report within 120 days after the close of the fiscal year. The annual report shall include a balance sheet as of the close of the fiscal year of the corporation and an income statement and a statement of changes in financial position for such fiscal year. The financial statements shall be prepared from and in accordance with the books of the corporation, in conformity with generally accepted accounting principles applied on a consistent basis, and shall be certified by an independent certified public accountant. 703. Inspection of shareholders. (a) The accounting books and records and minutes of proceedings of the shareholders and the Board of Directors and committees of the Board of Directors shall be open to inspection upon the written demand on the corporation of any shareholder at any reasonable time, for a purpose reasonable related to such person's interests as a shareholder. Bylaws page 13 (b) Inspection pursuant to this section of the bylaws by a shareholder may be made in person or by agent or attorney, and the right of inspection includes the right to copy and make extracts. (c) If any record subject to inspection pursuant to this section of the bylaws is not maintained in written form, the corporation shall at its expense make such record available in written form. CERTIFICATION OF SECRETARY The undersigned, Secretary of Integrated Specialists Management Services, Inc., a California corporation, hereby certifies that the foregoing bylaws are the true and correct, duly adopted bylaws of the corporation, that such bylaws were first adopted on July 18, 1994, and that such bylaws include all amendments, if any, to the date of this certificate. Dated: 7/18/94 ---------- /s/ Christopher W. Cary, MD ---------------------------- Secretary Bylaws page 14 EX-3.91 6 y57349ex3-91.txt 3RD AMENDMENT TO BYLAWS OF INTEGRATED Exhibit 3.91 THIRD AMENDMENT TO THE BYLAWS OF INTEGRATED SPECIALISTS MANAGEMENT SERVICES, INC. Chapter 5, Section 500, entitled "Qualifications" is amended by deleting the same in its entirety and substituting in lieu thereof: "Section 500. Reserved." CERTIFICATE BY SECRETARY I DO HEREBY CERTIFY AS FOLLOWS: That I am the duly elected, qualified, and acting Secretary of Integrated Specialists Management Services, Inc., and that the foregoing Third Amendment to the Bylaws of Integrated Specialists Management Services, Inc. was approved by the Board of Directors on February 23, 2001. /s/ [Signature Illegible] ------------------------------- Secretary EX-3.92 7 y57349ex3-92.txt 5TH AMENDMENT TO BYLAWS OF INTEGRATED SPECIALISTS Exhibit 3.92 FIFTH AMENDMENT TO THE BYLAWS OF INTEGRATED SPECIALISTS MANAGEMENT SERVICES, INC. Chapter 5, Section 501, entitled "Transfer of Shares and Right of First Refusal" is amended by deleting the same in its entirety and substituting in lieu thereof: "501. Transfer of Shares and Right of First Refusal. A share in the corporation is transferable subject to a right of first refusal in the corporation, as follows. Any shareholder intending to sell his or her shares in the corporation shall first give the corporation written notice of intent to sell, stating the identity of the proposed purchaser, the consideration to be paid and the payment term or terms. Corporation shall have forty-five (45) days from receipt of the written notice to either exercise or decline to exercise its right of first refusal by written notice to the shareholder. If the corporation exercises its right of first refusal, it shall purchase and the shareholder shall sell his or her shares on the terms and conditions set forth in the shareholder's notice of intent to sell. If the corporation declines to exercise its right of first refusal or fails to respond in writing within the foregoing forty-five (45) day period, then the shareholder shall be free to sell his or her shares in the corporation, but only to the purchaser and on the terms stated in the shareholder's notice to the corporation of intent to sell. Written notices under this section shall be effective on receipt by the President or Secretary of the corporation or the shareholder, as the case may be, three (3) days after deposit in the United States Mail, postage paid, return receipt requested, addressed to the President or Secretary of the corporation or to the shareholder at his or her record address, as the case may be. [THE REMAINDER OF THIS PAGE IS INTENTIONALLY LEFT BLANK.] Page 1 of 2 This Section 501 does not apply to the transaction contemplated by that certain Stock Purchase Agreement dated as June 12, 2001 among the corporation, Team Anesthesia, Inc. a Tennessee corporation, Team Health, Inc., a Tennessee corporation and the corporation's shareholders that elect to become a party to the agreement." CERTIFICATE BY SECRETARY I DO HEREBY CERTIFY AS FOLLOWS: That I am the duly elected, qualified and acting Secretary of Integrated Specialists Management Services, Inc., and that the foregoing Fifth Amendment to the Bylaws of Integrated Specialists Management Services, Inc., effective June 12, 2001, was approved by the Board of Directors on July 30, 2001. /s/ [Signature Illegible] ----------------------------------- Secretary Page 2 of 2 EX-3.93 8 y57349ex3-93.txt 6TH AMENDMENT TO BYLAWS OF INTEGRATED SPECIALISTS Exhibit 3.93 SIXTH AMENDMENT TO THE BYLAWS OF INTEGRATED SPECIALISTS MANAGEMENT SERVICES, INC. 1. Chapter 3, Section 300(a) entitled "Officer and Directors" is amended by deleting the same in its entirety and substituting in lieu thereof: "Section 300. Officers and Directors. (a) The officers of the corporation are the President or Chief Executive Officer, one or more Vice Presidents, the Secretary, the Treasurer and/or the Chief Financial Officer, and the Chairman of the Board; provided, however, that the Board of Directors shall not be required to elect any officer that is not required to be elected pursuant to the corporation law of the State of California." 2. Chapter 5, Section 502, entitled "Written Ballot of Shareholders" is amended by deleting the same in its entirety and substituting in lieu thereof: "Section 502. Reserved" 3. Chapter 5, Section 506(b), entitled "Record Date" is amended by deleting the same in its entirety and substituting in lieu thereof: "Section 506. Record Date. (b) Reserved." 4. Chapter 5, Section 514, entitled "Unanimous written consent of shareholders" is amended by deleting the same in its entirety and substituting in lieu thereof: "514. Written consent of shareholders. Subject to any applicable requirements of the corporation law, any action which may be taken by the shareholders at any annual or special meeting may be taken without a meeting and without prior notice if a consent in writing, setting forth the action so taken, shall be signed by the shareholders of outstanding shares having not less than the minimum [THE REMAINDER OF THIS PAGE IS INTENTIONALLY LEFT BLANK.] page 1 of 2 number of votes that would be necessary to authorize or take such action at a meeting at which all shares entitled to vote thereon were present and voted." CERTIFICATE BY SECRETARY I DO HEREBY CERTIFY AS FOLLOWS: That I am the duly elected, qualified, and acting Secretary of Integrated Specialists Management Services, Inc., and that the foregoing Sixth Amendment to the Bylaws of Integrated Specialists Management Services, Inc. was approved by the Board of Directors on July 30, 2001. /s/ [ILLEGIBLE] ---------------------------- Secretary Page 2 of 2 EX-3.94 9 y57349ex3-94.txt ARTICLES OF INCORPORATION OF PHYSICIAN INTEGRATION Exhibit 3.94 ARTICLES OF INCORPORATION OF PHYSICIAN INTEGRATION CONSULTING SERVICES, INC. I. The name of the corporation is: Physician Integration Consulting Services, Inc. II. The purpose of this corporation is to engage in any lawful act or activity for which a corporation may be organized under the General Corporation Law of California other than the banking business, the trust company business or the practice of a profession permitted to be incorporated by the California Corporations Code. III. The name and address in the State of California of this corporation's initial agent for service of process is: Lesley A. Allison 3626 Ruffin Road San Diego, California 92138-2807 IV. The corporation is authorized to provide indemnification of agents (as defined in Section 317 of the Corporations Code) for breach of duty to the corporation and its stockholders through bylaw provisions or through agreements with the agents, or both in excess of the indemnification otherwise permitted by Section 317 of the Corporations Code, subject to the limits on such excess indemnification set forth in Section 204 of the Corporations Code. V. This corporation is authorized to issue only one class of shares of stock and the total number of shares which is corporation is authorized to issue is 100,000,000. DATED: August 2, 1993. /s/ Joshua Weinman ---------------------------- Joshua Weinman, Incorporator EX-3.95 10 y57349ex3-95.txt BYLAWS OF PHYSICIAN INTEGRATION CONSULTING Exhibit 3.95 BY-LAWS OF PHYSICIAN INTEGRATION CONSULTING SERVICES, INC. A CALIFORNIA CORPORATION ARTICLE I Offices Section 1. Principal Office. The principal office for the transaction of business of the corporation is hereby fixed and located at 3626 Ruffin Road, City of San Diego, County of San Diego, State of California. The location may be changed by approval of a majority of the authorized Directors, and additional offices may be established and maintained at such other place or places, either within or without California, as the Board of Directors may from time to time designate. Section 2. Other Offices. Branch or subordinate offices may at any time be established by the Board of Directors at any place or places where the corporation is qualified to do business. ARTICLE II Directors - Management Section 1. Responsibility of Board of Directors. Subject to the provisions of the General Corporation Law and to any limitations in the Articles of Incorporation of the corporation relating to action required to be approved by the Shareholders, as that term is defined in Section 153 of the California Corporations Code, or by the outstanding shares, as that term is defined in Section 152 of the Code, the business and affairs of the corporation shall be managed and all corporate powers shall be exercised by or under the direction of the Board of Directors. The Board may delegate the management of the day-to-day operation of the business of the corporation to a management company or other person, provided that the business and affairs of the corporation shall be managed and all corporate powers shall be exercised under the ultimate direction of the Board. Section 2. Standard of Care. Each Director shall perform the duties of a Director, including the duties as a member of any committee of the Board upon which the Director may serve, in good faith, in a manner such Director 1 believes to be in the best interests of the corporation, and with such care, including reasonable inquiry, as an ordinary prudent person in a like position would use under similar circumstances. (Section 309) Section 3. Exception for Close Corporation. Notwithstanding the provisions of Section 1, in the event that this corporation shall elect to become a close corporation as defined in Section 158, its Shareholders may enter into a Shareholders' Agreement as defined in Section 186. Said Agreement may provide for the exercise of corporate powers and the management of the business and affairs of this corporation by the Shareholders, provided, however, such agreement shall, to the extent and so long as the discretion or the powers of the Board in its management of corporate affairs is controlled by such agreement, impose upon each Shareholder who is a party thereof, liability for managerial acts performed or omitted by such person pursuant thereto otherwise imposed upon Directors as provided in Section 300 (d); and the Directors shall be relieved to that extent from such liability. Section 4. Number and Qualifications of Directors. The authorized number of Directors shall be four (4) until changed by a duly adopted amendment to the Articles of Incorporation or by an amendment to this Bylaw adopted by the vote or written consent of holders of a majority of the outstanding shares entitled to vote, as provided in Section 212. Section 5. Election and Term of Office of Directors. Directors shall be elected at each annual meeting of the Shareholders to hold office until the next annual meeting. Each Director, including a Director elected to fill a vacancy, shall hold office until the expiration of the term for which elected and until a successor has been elected and qualified. Section 6. Vacancies. Vacancies in the Board of Directors may be filled by a majority of the remaining Directors, though less than a quorum, or by a sole remaining Director, except that a vacancy created by the removal of a Director by the vote or written consent of the Shareholders or by court order may be filled only by the vote of a majority of the shares entitled to vote represented at a duly held meeting at which a quorum is present, or by the written consent of holders of a majority of the outstanding shares entitled to vote. Each Director so elected shall hold office until the next annual meeting of the Shareholders and until a successor has been elected and qualified. 2 A vacancy or vacancies in the Board of Directors shall be deemed to exist in the event of the death, resignation, or removal of any Director, or if the Board of Directors by resolution declares vacant the office of a Director who has been declared of unsound mind by an order of court or convicted of a felony, or if the authorized number of Directors is increased, or if the Shareholders fail, at any meeting of Shareholders at which any Director or Directors are elected, to elect the number of Directors to be voted for at that meeting. The Shareholders may elect a Director or Directors at any time to fill any vacancy or vacancies not filled by the Directors, but any such election by written consent shall require the consent of a majority of the outstanding shares entitled to vote. No reduction of the authorized number of Directors shall have the effect of removing any Director before that Director's term of office expires. Section 7. Removal of Directors. The entire Board of Directors or any individual Director may be removed from office as provided by Sections 302, 303, and 304 of the Corporations Code of the State of California. In such case, the remaining Board members may elect a successor Director to fill such vacancy for the remaining unexpired term of the Director so removed. Section 8. Notice, Place and Manner of Meetings. Meetings of the Board of Directors may be called by the Chairman of the Board, or the President, or any Vice President, or the Secretary, or any two (2) Directors and shall be held at the principal executive office of the corporation, unless some other place is designated in the notice of the meeting. Members of the Board may participate in a meeting through use of a conference telephone or similar communications equipment so long as all members participating in such a meeting can hear one another. Accurate minutes of any meeting of the Board or any committee thereof, shall be maintained as required by Section 1500 of the Code by the Secretary or other Officer designated for that purpose. Section 9. Organizational Meetings. The organizational meetings of the Board of Directors shall be held immediately following the adjournment of the annual meetings of the Shareholders. Section 10. Other Regular Meetings. Regular meetings of the Board of Directors shall be held at the corporate offices, or such other place as may be designated by 3 the Board of Directors, as follows: Time of Regular Meeting: None Date of Regular Meeting: None If said day shall fall upon a holiday, such meetings shall be held on the next succeeding business day thereafter. No notice need to be given of such regular meetings. Section 11. Special Meetings - Notices - Waivers. Special meetings of the Board may be called at any time by any of the aforesaid officers; i.e., by the Chairman of the Board or the President or any Vice President or the Secretary or any two (2) Directors. At least forty-eight (48) hours' notice of the time and place of special meetings shall be delivered personally to the Directors or personally communicated to them by a corporate Officer by telephone or telegraph. If the notice is sent to a Director by letter, it shall be addressed to him other at his or her address as it is shown upon the records or is not readily ascertainable, at the place in which the meetings of the Directors are regularly held. In case such notice is mailed, it shall be deposited in the United States mail, postage prepaid, in the place in which the principal executive office of the corporation is located at least four (4) days prior to the time of the holding of the meeting. Such mailing, telegraphing, telephoning, or delivery as above provided shall be due, legal, and personal notice to such Director. When all of the Directors are present at any Directors' meeting, however called or noticed, an either (i) sign a written consent thereto on the records of such meeting, or (ii) if a majority of the Directors are present if those not present sign a waiver of notice of such meeting or a consent to holding the meeting or an approval of the minutes thereof, whether prior to or after the holding of such meeting, which said waiver, consent, or approval shall be filed with the Secretary of the corporation, or (iii) if a Director attends a meeting without notice but without protesting prior thereto or at its commencement the lack of notice, then the transactions thereof are as valid as if had at a meeting regularly called and noticed. Section 12. Sole Director Provided by Articles of Incorporation or Bylaws. In the event only one (1) Director is required by the By-Laws or Articles of Incorporation, then any reference herein to notices, waivers, consents, meetings, or other actions by a majority or quorum of the Directors shall be deemed to refer to such notice, 4 waiver, etc., by such sole Director, who shall have all the rights an duties and shall be entitled to exercise all of the powers an shall assume all the responsibilities otherwise herein described as given to a Board of Directors. Section 13. Directors Action by Unanimous Written Consent. Any action required or permitted to be taken by the Board of Directors may be taken without a meeting and with the same force and effect as if taken by a unanimous vote of Directors, if authorized by a writing signed individually or collectively by all members of the Board. Such consent shall be filed with the regular minutes of the Board. Section 14. Quorum. A majority of the number of Directors as fixed by the Articles of Incorporation or By-Laws shall be necessary to constitute a quorum for the transaction of business, and the action of a majority of the Directors present at any meeting at which there is a quorum, when duly assembled, is valid as a corporate act; provided that a minority of the Directors, in the absence of a quorum, may adjourn from time to time, but may not transact any business. A meeting at which a quorum is initially present may continue to transact business, notwithstanding the withdrawal of Directors, if any action is taken is approved by a majority of the required quorum for such meeting. Section 15. Notice of Adjournment. Notice of the time and place of holding an adjourned meeting need not be given to absent Directors if the time and place be fixed at the meeting adjourned and held within twenty-four (24) hours, but if adjourned more than twenty-four (24) hours, notice shall be given to all Directors not present at the time of the adjournment. Section 16. Compensation of Directors. Directors, as such, shall not receive any stated salary for their services, but by resolution of the Board a fixed sum and expense of attendance, if any, may be allowed for attendance at each regular and special meeting of the Board; provide that nothing herein contained shall be construed to preclude any Director from serving the corporation in any other capacity an receiving compensation therefor. Section 17. Committees. Committees of the Board may be appointed by resolution passed by a majority of the whole Board. Committees shall be composed of two (2) or more members of the Board, and shall have such powers of 5 the Board as may be expressly delegated to it by resolution of the Board of Directors, except those powers expressly made nondelegable by Section 311. Section 18. Advisory Directors. The board of Directors from time to time may elect one or more persons to be Advisory Directors who shall not by such appointment be members of the Board of Directors. Advisory Directors shall be available from time to time to perform special assignments specified by the President, to attend meetings of the Board of Directors upon invitation and to furnish consultation to the Board. The period during which the title shall be held may be prescribed by the Board of Directors. If no period is prescribed, the title shall be held at the pleasure of the Board. Section 19. Resignations. Any Director may resign effective upon giving written notice to the Chairman of the Board, the President, the Secretary, or the Board of Directors of the corporation, unless the notice specifies a later time for the effectiveness of such resignation. If the resignation is effective at a future time, a successor may be elected to take office when the resignation becomes effective. ARTICLE III Officers Section 1. Officers. The Officers of the corporation shall be a President, a Secretary, and a Chief Financial Officer. The corporation may also have, at the discretion of the Board of Directors, a Chairman of the Board, one or more Vice Presidents, one or more Assistant Secretaries, one or more Assistant Treasurers, and such other Officers as may be appointed in accordance with the provisions of Section 3 of this Article III. Any number of offices may be held by the same person. Section 2. Election. The Officers of the corporation, except such Officers as may be appointed in accordance with the provisions of Section 3 or Section 5 of this Article, shall be chosen annually by the Board of Directors, and each shall hold office until he or she shall resign or shall be removed or otherwise disqualified to serve, or a successor shall be elected and qualified. Section 3. Subordinate Officers, Etc. The Board of Directors may appoint such other Officers as the business of the corporation may require, each of whom shall hold 6 office for such period, have such authority, and perform such duties as are provided in the By-Laws or as the Board of Directors may from time to time determine. Section 4. Removal and Resignation of Officers. Subject to the rights, if any, of an Officer under any contract of employment, any Officer may be removed, either with or without cause, by the Board of Directors, at any regular or special meeting of the Board, or, except in case of an Officer chosen by the Board of Directors, by any Officer upon whom such power of removal may be conferred by the Board of Directors. Any Officer may resign at any time by giving written notice to the corporation. Any resignation shall take effect at the date of the receipt of that notice or at any later time specified in that notice; and, unless otherwise specified in that notice, the acceptance of the resignation shall not be necessary to make it effective. Any resignation is without prejudice to the rights, if any, of the corporation under any contract to which the Officer is a party. Section 5. Vacancies. A vacancy in an office because of death, resignation, removal, disqualification, or any other cause shall be filled in the manner prescribed in the By-Laws for regular appointments to that office. Section 6. Chairman of the Board. The Chairman of the Board, if such an officer be elected, shall, if present, preside at meetings of the Board of Directors and exercise and perform such other powers and duties as may be from time to time assigned by the Board of Directors or prescribed by the By-Laws. If there is no President, the Chairman of the Board shall in addition be the Chief Executive Officer of the corporation and shall have the powers and duties prescribed in Section 7 of this Article III. Section 7. President. Subject to such supervisory powers, if any, as may be given by the Board of Directors to the Chairman of the Board, if there be such an Officer, the President shall be the Chief Executive Officer of the corporation and shall, subject to the control of the Board of Directors, have general supervision, direction, an control of the business and Officers of the corporation. He or she shall preside at all meetings of the Shareholders and in the absence of the Chairman of the Board, or if there be none, at all meetings of the Board of Directors. The president shall be ex officio a member of all the standing committees, including the Executive Committee, if any, and shall have the general powers and duties of management 7 usually vested in the office of President of a corporation, and shall have such other powers and duties as may be prescribed by the Board of Directors or the By-Laws. Section 8. Vice President. In the absence or disability of the President, the Vice Presidents, if any, in order of their rank as fixed by the Board of Directors, or if not ranked, the Vice President designated by the Board of Directors, shall perform all the duties of the President, an when so acting shall have all the powers of, and be subject to, all the restrictions upon, the President. The Vice Presidents shall have such other powers and perform such other duties as from time to time may be prescribed for them respectively by the Board of Directors or the By-Laws. Section 9. Secretary. The Secretary shall keep, or cause to be kept, a book of minutes at the principal office or such other place as the Board of Directors may order, of all meetings of Directors and Shareholders, with the time and place of holding, whether regular or special, and if special, how authorized, the notice thereof given, the names of those present at Directors' meetings, the number of shares present or represented at Shareholders' meetings, and the proceedings thereof. The Secretary shall keep, or cause to be kept, at the principal office or at the office of the corporation's transfer agent, a share register, or duplicate share register, showing the names of the Shareholders and their addresses; the number and classes of shares held by each; the number and date of certificates issued for the same; and the number and date of cancellation of every certificate surrendered for cancellation. The Secretary shall give, or cause to be given, notice of all the meetings of the Shareholders and of the Board of Directors required by the By-Laws or by law to be given. He or she shall keep the seal of the corporation in safe custody, and shall have such other powers and perform such other duties as may be prescribed by the Board of Directors or by the By-Laws. Section 10. Chief Financial Officer. The Chief Financial Officer shall keep and maintain, or cause to be kept and maintained in accordance with generally accepted accounting principles, adequate and correct accounts of the properties and business transactions of the corporation, including accounts of its assets, liabilities, receipts, disbursements, gains, losses, capital, earnings (or surplus) and shares. The books of account shall at all reasonable times be open to inspection by any Director. 8 This Officer shall deposit all moneys and other valuables in the name and to the credit of the corporation with such depositaries as may be designated by the Board of Directors. He or she shall disburse the funds of the corporation as my be ordered by the Board of Directors, shall render to the President and Directors, whenever they request it, an account of all of his or her transactions an of the financial condition of the corporation, and shall have such other powers and perform such other duties as may be prescribed by the Board of Directors or the By-Laws. ARTICLE IV Shareholders' Meetings Section 1. Place of Meeting. All meetings of the Shareholders shall be held at the principal executive office of the corporation unless some other appropriate and convenient location be designed for that purpose from time to time by the Board of Directors. Section 2. Annual Meetings. The annual meetings of the Shareholders shall be held each year at the time and on the day following: Time of Meeting: 2:00 p.m. Date of Meeting: The last Tuesday of the last month of the fiscal year. If this day shall be a legal holiday, then the meeting shall be held on the next succeeding business day, at the same hour. At the annual meeting, the Shareholders shall elect a Board of Directors, consider reports of the affairs of the corporation, and transact such other business as may be properly brought before the meeting. Section 3. Special Meetings. Special meetings of the Shareholders may be called at any time by the Board of Directors, the Chairman of the Board, the President, a Vice President, the Secretary, or by one or more Shareholders holding not less than one-tenth (1/10) of the voting power of the corporation. Except as next provided, notice shall be given as for the annual meeting. Upon receipt of a written request addressed to the Chairman, President, Vice President, or Secretary, mailed or delivered personally to such Officer by any person (other than the Board) entitled to call a special meeting of Shareholders, such Officer shall cause 9 notice to be given to the Shareholders entitled to vote that a meeting will be held at a time requested by the person or persons calling the meeting, not less than thirty-five (35) nor more than sixty (60) days after the receipt of such request. If such notice is not given within twenty (20) after receipt of such request, the persons calling the meeting may give notice thereof in the manner provided by these By-Laws or apply to the Superior Court as provided in Section 305(c). Section 4. Notice of Meetings - Reports. Notice of meetings, annual or special, shall be given in writing not less than ten (10) nor more than sixty (60) days before the date of the meeting to Shareholders entitled to vote thereat. Such notice shall be given by the Secretary or the Assistant Secretary, or if there be no such Officer, or in the case of his or her neglect or refusal, by any Director or Shareholder. Such notices or an reports shall be given personally or by mail or other means of written communication as provided in Section 601 of the Code an shall be sent to the Shareholder's address appearing on the books of the corporation, or supplied by him or her to the corporation for the purpose of notice, an in the absence thereof, as provided in Section 601 of the Code. Notice of any meeting of Shareholders shall specify the place, the day, and the hour of meeting, and (1) in the case of an annual meeting, those matters which the Board at date of mailing intends to present for action by the Shareholders. At any meetings where Directors are to be elected, notice shall include the names of the nominees, if any, intended at date of notice to be presented by management for election. If a Shareholder supplies no address, notice shall be deemed to have been given if mailed to the place where the principal executive office of the corporation in California is situated, or published at least once in some newspaper of general circulation in the County of said principal office. Notice shall be deemed given at the time it is delivered personally or deposited in the mail or sent by other means of written communication. The Officer giving such notice or report shall prepare and file an affidavit or declaration thereof. When a meeting is adjourned for forty-five (45) days or more, notice of the adjourned meeting shall be given as in case of an original meeting. Save, as aforesaid, it shall not be necessary to give any notice of adjournment or of the business to be transacted at an adjourned meeting other than by announcement at the meeting at which such adjournment is taken. 10 Section 5. Waiver of Notice or Consent by Absent Shareholders. The transactions of any meeting of Shareholders, however called and noticed, shall be valid as though ad at a meeting duly held after regular call and notice, if a quorum be present either in person or by proxy, an if, either before or after the meeting, each of the Shareholders entitled to vote, not present in person or by proxy, sign a written waiver of notice, or a consent to the holding of such meeting or an approval of the minutes thereof. All such waivers, consents, or approvals shall be filed with the corporate records or make a part of the minutes of the meeting. Attendance shall constitute a waiver of notice, unless objection shall be made as provided in Section 601(e). Section 6. Shareholders Acting Without a Meeting - Directors. Any action which may be taken at a meeting of the Shareholders, may be taken without a meeting or notice of meeting if authorized by a writing signed by all of the Shareholders entitled to vote at a meeting for such purpose, and filed with the Secretary of the Corporation, provided, further, that while ordinarily Directors can only be elected by unanimous written consent under Section 603(d), if the Directors fail to fill a vacancy, then a Director to fill that vacancy may be elected by the written consent of persons holding a majority of shares entitled to vote for the election of Directors. Section 7. Other Actions Without a Meeting. Unless otherwise provided in the California Corporations Code or the Articles, any action which may be taken at any annual or special meeting of Shareholders may be taken without a meeting and without prior notice, if a consent in writing, setting forth the action so taken, signed by the holders of outstanding shares having not less than the minimum number of votes that would be necessary to authorize or take such action at a meeting at which all shares entitled to vote thereon were present and voted. Unless the consents of all Shareholders entitled to vote have been solicited in writing, (1) Notice of any Shareholder approval pursuant to Sections 310, 317, 1201, and 2007 without a meeting by less than unanimous written consent shall be given at least ten (10) days before the consummation of the action authorized by such approval, and (2) Prompt notice shall be given of the taking of any other corporate action approved by Shareholders without a 11 meeting by less than unanimous written consent, to each of those Shareholders entitled to vote who have not consented in writing. Any Shareholder giving a written consent, or the Shareholder's proxy holders, or a transferee of the shares of a personal representative of the Shareholder or their respective proxy-holders, may revoke the consent by a writing received by the corporation prior to the time that written consents of the number of shares required to authorize the proposed action have been filed with the Secretary of the corporation, but may not do so thereafter. Such revocation is effective upon its receipt by the Secretary of the corporation. Section 8. Quorum. The holder of a majority of the shares entitled to vote thereat, present in person or represented by proxy, shall constitute a quorum at all meetings of the Shareholders for the transaction of business except as otherwise provided by law, by the Articles of Incorporation, or by these By-Laws. If, however, such majority shall not be present or represented at any meeting of the Shareholders, the Shareholders entitled to vote thereat, present in person or by proxy, shall have the power to adjourn the meeting from time to time, until the requisite amount of voting shares shall be present. At such adjourned meeting at which the requisite amount of voting shares shall be represented, any business may be transacted which might have been transacted at a meeting as originally notified. If a quorum be initially present, the Shareholders may continue to transact business until adjournment, notwithstanding the withdrawal of enough Shareholders to leave less than a quorum, if any action taken is approved by a majority of the Shareholders required to initially constitute a quorum. Section 9. Voting. Only persons in whose names shares entitled to vote stand on the stock records of the corporation on the day of any meeting of Shareholders, unless some other day be fixed by the Board of Directors for the determination of Shareholders of record, and then on such other day, shall be entitled to vote at such meeting. Provided the candidate's name has been placed in nomination prior to the voting and one or more Shareholder has given notice at the meeting prior to the voting of the Shareholder's intent to cumulate the Shareholder's votes, every Shareholder entitled to vote at any election for Directors of any corporation for profit may cumulate their votes and give one candidate a number of votes equal to the number of Directors to be elected multiplied by the number of votes to which his or her shares are entitled, or 12 distribute his or her votes on the same principle among as many candidates as he or she thinks fit. The candidates receiving the highest number of votes up to the number of Directors to be elected are elected. The Board of Directors may fix a time in the future not exceeding sixty (60) days preceding the date of any meeting of Shareholders or the date fixed for the payment of any dividend or distribution, or for the allotment or rights, or when any change or conversion or exchange of shares shall go into effect, as a record date for the determination of the Shareholders entitled to notice of and to vote at any such meeting, or entitled to receive any such dividend or distribution, or any allotment of rights, or to exercise the rights in respect to any such change, conversion, or exchange of shares. In such case only Shareholders of record on the date so fixed shall be entitled to notice of and to vote at such meeting, or to receive such dividends, distribution, or allotment of rights, or to exercise such rights, as the case may be, notwithstanding any transfer of any share on the books of the corporation after any record date fixed as aforesaid. The Board of Directors may close the books of the corporation against transfers of shares during the whole or any part of such period. Section 10. Proxies. Every Shareholder entitled to vote, or to execute consents, may do so , either in person or by written proxy, executed in accordance with the provisions of Sections 604 and 705 of the Code and filed with the Secretary of the corporation. Section 11. Organization. The President, or in the absence of the President, any Vice President, shall call the meeting of the Shareholders to order, and shall act as chairman of the meeting. In the absence of the President and all of the Vice Presidents, Shareholders shall appoint a chairman for such meeting. The Secretary of the corporation shall act as Secretary of all meetings of the Shareholders, but in the absence of the Secretary at any meeting of the Shareholders, the presiding Officer may appoint any person to act as Secretary of the meeting. Section 12. Inspectors of Election. In advance of any meeting of Shareholders the Board of Directors may, if they so elect, appoint inspectors of election to act at such meeting or any adjournment thereof. If inspectors of election be not so appointed, or if any persons so appointed fail to appear or refuse to act, the chairman of any such meeting may, and on the request of any Shareholder or his or her proxy shall, make such appointment a the meeting in which case the number of 13 inspectors shall be either one (1) or three (3) as determined by a majority of the Shareholders represented at the meeting. Section 13. (A) Shareholders' Agreements. Notwithstanding the above provisions, in the event this corporation elects to become a close corporation, an agreement between two (2) or more Shareholders thereof, if in writing and signed by the parties thereof, may provide that in exercising any voting rights the shares held by them shall be voted as provided therein or in Section 706, and may otherwise modify these provisions as to Shareholders' meetings and actions. (B) Effect of Shareholders' Agreements. Any Shareholders' Agreement authorized by Section 300(b) shall only be effective to modify the terms of these By-Laws if this corporation elects to become a close corporation with appropriate filing of or amendment to its Articles as required by Section 202 and shall terminate when this corporation ceases to be a close corporation. Such an agreement cannot waive or alter Sections 158, (defining close corporations), 202 (requirements of Articles of Incorporation), 500 and 501 relative to distributions, 111 (merger), 1201(e) (reorganization), or Chapters 15 (Records and Reports) or 16 (Rights of Inspection), 18 (Involuntary Dissolution), or 22 (Crimes and Penalties) Any other provisions of the Code or these By-Laws may be altered or waived thereby, but to the extent they are not so altered or waived, these By-Laws shall be applicable. ARTICLE V Certificates and Transfers of Shares Section 1. Certificates for Shares. Certificates for shares shall be of such form and device as the Board of Directors may designate and shall state the name of the record holder of the shares represented thereby; its number; date of issuance; the number of shares for which it is issued; a statement of the rights, privileges, preferences, and restrictions, if any; a statement as to the redemption or conversion, if any; a statement of liens or restrictions upon transfer or voting, if any; if the shares be assessable or, if assessments are collectible by personal action, a plain statement of such facts. All certificates shall be signed in the name of the corporation by the Chairman of the Board or Vice Chairman of the Board or the President or Vice President and by the Chief Financial Officer or an Assistant Treasurer or the Secretary or any Assistant Secretary, certifying the number of shares and the class or series of shares owned by the Shareholder. 14 Any or all of the signatures on the certificate may be facsimile. In case any Officer, transfer agent, or registrar who has signed or whose facsimile signature has been placed on a certificate shall have ceased to be that Officer, transfer agent, or registrar before that certificate is issued, it may be issued by the corporation with the same effect as if that person were an Officer, transfer agent, or registrar at the date of issue. Section 2. Transfer on the Books. Upon surrender to the Secretary or transfer agent of the corporation of a certificate for shares duly endorsed or accompanied by proper evidence of succession, assignment or authority to transfer, it shall be the duty of the corporation to issue a new certificate to the person entitled thereto, cancel the old certificate, and record the transaction upon its books. Section 3. Lost or Destroyed Certificates. Any person claiming a certificate of stock to be lost or destroyed shall make an affidavit or affirmation of the fact and shall, if the Directors so require, give the corporation a bond of indemnity, in form and with one or more sureties satisfactory to the Board, in at least double the value of the stock represented by said certificate, whereupon a new certificate may be issued in the same tenor and for the same number of shares as the one alleged to be lost or destroyed. Section 4. Transfer Agents and Registrars. The Board of Directors may appoint one or more transfer agents or transfer clerks, and one or more registrars, which shall be an incorporated bank or trust company, either domestic or foreign, who shall be appointed at such times and places as the requirements of the corporation may necessitate and the Board of Directors may designate. Section 5. Closing Stock Transfer Books - Record Date. In order that the corporation may determine the Shareholders entitled to notice of any meeting or to vote or entitled to receive payment of any dividend or other distribution or allotment of any rights or entitled to exercise any rights in respect of any other lawful action, the Board may fix, in advance, a record date, which shall not be more than sixty (60) nor less than ten (10) days prior to the date of such meeting nor more than sixty (60) days prior to any other action. If no record date is fixed, the record date for determining Shareholders entitled to notice of or to vote at a meeting of Shareholders shall be at the close of business on the business day next preceding the date on which notice is given, or, if notice is 15 waived, at the close of business on the business day next preceding the day in which the meeting is held. The record date for determining Shareholders entitled to give consent to corporate action in writing without a meeting, when no prior action by the Board is necessary, shall be the day on which the first written consent is given. The record date for determining Shareholders for any other purpose shall be at the close of business on the day on which the Board adopts the resolution relating thereto, or the sixtieth (60th) day prior to the date of such other action, whichever is later. Section 6. Legend Condition. In the event any shares of this corporation are issued pursuant to a permit or exemption therefrom requiring the imposition of a legend condition, the person or persons issuing or transferring said shares shall make sure said legend appears on the certificate and shall not be required to transfer any shares free of such legend unless an amendment to such permit or a new permit be first issued so authorizing a deletion. Section 7. Close Corporation Certificates. All certificates representing shares of this corporation, in the event it shall elect to become a close corporation, shall contain the legend required by Section 418(c). ARTICLE VI Records - Reports - Inspections Section 1. Records. The corporation shall maintain, in accordance with generally accepted accounting principles, adequate and correct accounts, books, and records of its business and properties. All of such books, records, and accounts shall be kept at its principal executive office in the State of California, as fixed by the Board of Directors from time to time. Section 2. Inspection of Books and Records. All books and records provided for in Section 1500 shall be open to inspection of the Directors and Shareholders form time to time and in the manner provided in said Sections 1600-1602. 16 Section 3. Certification and Inspection of Bylaws. The original or a copy of these By-Laws, as amended or otherwise altered to date, certified by the Secretary, shall be kept at the corporation's principal executive office and shall be open to inspection by the Shareholders of the corporation at all reasonable times during office hours, as provided in Section 213 of the Corporations Code. Section 4. Checks, Drafts, Etc. All checks, drafts, or other orders for payment of money, notes, or other evidences of indebtedness, issued in the name of or payable to the corporation, shall be signed or endorsed by such person or persons and in such manner as shall be determined from time to time by resolution of the Board of Directors. Section 5. Contracts, Etc. - How Executed. The Board of Directors, except as in the By-Laws otherwise provided, may authorize any Officer or Officers, agent or agents, to enter into any contract or execute any instrument in the name of and on behalf of the corporation. Such authority may be general or confined to specific instances. Unless so authorized by the Board of Directors, no Officer, agent, or employee shall have any power or authority to bind the corporation by any contract or agreement, or to pledge its credit, or to render it liable for any purpose or to any amount, except as provided in Section 313 of the Corporations Code. ARTICLE VII Annual Reports Section 1. Report to Shareholders, Due Date. The Board of Directors shall cause an annual report to be sent to the Shareholders not later than one hundred twenty (120) days after the close of the fiscal or calendar year adopted by the corporation. This report shall be sent at least fifteen (15) days before the annual meeting of Shareholders to be held during the next fiscal year and in the manner specified in Section 4 of Article IV of these By-Laws for giving notice to Shareholders of the corporation. The annual report shall contain a balance sheet as of the end of the fiscal year and an income statement and statement of changes in financial position for the fiscal year, accompanied by any report of independent accountants or, if there is no such report, the certificate of an authorized Officer of the corporation that the statements were prepared without audit from the books and records of the corporation. 17 Section 2. Waiver. The annual report to Shareholders referred to in Section 1501 of the California General Corporation Law is expressly dispensed with so long as this corporation shall have less than one hundred (100) Shareholders. However, nothing herein shall be interpreted as prohibiting the Board of Directors from issuing annual or other periodic reports to the Shareholders of the corporation as they consider appropriate. ARTICLE VIII Amendments to Bylaws Section 1. Amendment by Shareholders. New Bylaws may be adopted or these Bylaws may be amended or repealed by the vote or written consent of holders of a majority of the outstanding shares entitled to vote; provided, however, that if the Articles of Incorporation of the corporation set forth the number of authorized Directors of the corporation, the authorized number of Directors may be changed only by an amendment of the Articles of Incorporation. Section 2. Powers of Directors. Subject to the right of the Shareholders to adopt, amend, or repeal By-Laws, as provided in Section 1 of this Article VIII, and the limitations of Section 204(a)(5) and Section 212, the Board of Directors may adopt, amend, or repeal any of these By-Laws other than a By-Law or amendment thereof changing the authorized number of Directors. Section 3. Record of Amendments. Whenever an amendment or new By-Law is adopted, it shall be copied in the book of By-Laws with the original By-Laws, in the appropriate place. If any By-Law is repealed, the fact of repeal with the date of the meeting at which the repeal was enacted or written assent was filed shall be stated in said book. ARTICLE IX Corporate Seal The corporate seal shall be circular in form, and shall have inscribed thereon the name of the corporation, the year or date of its incorporation, and the word "California." 18 ARTICLE X Miscellaneous Section 1. References to Code Sections. "Section" references herein refer to the equivalent Sections of the California Corporations Code effective January 1, 1977, as amended. Section 2. Representation of Shares in Other Corporations. Shares of other corporations standing in the name of this corporation may be voted or represented and all incidents thereto may be exercised on behalf of the corporation by the Chairman of the Board, the President or any Vice President and the Secretary or an Assistant Secretary. Section 3. Subsidiary Corporations. Shares of this corporation owned by a subsidiary shall not be entitled to vote on any matter. A subsidiary for these purposes is defined as a corporation, the shares of which possessing more than 25% of the total combined voting power of all classes of shares entitled to vote, are owned directly or indirectly through one (1) or more subsidiaries. Section 4. Indemnity. The corporation may indemnify agents of the corporation (as defined in Cal. Corp. Code Sec. 317(a)), for breach of duty to the corporation and its Shareholders where the approval required in Cal. Corp. Code Sec. 327(e) has been secured. However, an agent may not in any circumstance be indemnified for acts or omissions that constitute intentional misconduct, the knowing and culpable violation of the law, the absence of good faith, the receipt of an improper personal benefit, a reckless disregard or unexcused inattention to the agent's duty to act in the best interests of the corporation and its Shareholders. An agent also may not be indemnified for any act or omission which falls under Cal. Corp. Code Secs. 310 or 316, or where indemnification is expressly prohibited under Cal. Corp. Code Sec. 317. Section 5. Accounting Year. The accounting year of the corporation shall be fixed by resolution of the Board of Directors. 19 CERTIFICATE BY SECRETARY I do hereby certify as follows: That I am the duly elected, qualified, and acting Secretary of the above named corporation, that the foregoing By-Laws were adopted as the By-Laws of said corporation on the date set forth by the person named in the Articles of Incorporation as the Incorporator of said corporation. IN WITNESS WHEREOF, I have hereunto set my hand and affixed the corporate seal this 11th day of August, 1993. /s/ Michael G. Martin, M.D. ------------------------------------- Michael G. Martin, M.D., Secretary 20 EX-3.96 11 y57349ex3-96.txt ARTICLES OF INCORPORATION OF SENTINEL MEDICAL Exhibit 3.96 ARTICLES OF INCORPORATION OF SENTINEL MEDICAL SERVICES, INC. ARTICLE I. CORPORATE NAME The name of this corporation is: SENTINEL MEDICAL SERVICES, INC.. The principal office address and registered office address of the corporation shall be: 710 Yorktown Dr. - ------------------------------------------------------------------------------- Leesburg, Fl. 34748 - ------------------------------------------------------------------------------- ARTICLE II. NATURE OF BUSINESS AND POWERS The general nature of the business to be transacted by this Corporation is to engage in the business of contracting medical services to hospitals and other health care organizations and to perform any and all other business permitted under the laws of the State of Florida. ARTICLE III. CAPITAL STOCK The maximum number of shares of stock that this Corporation is authorized to issue and have outstanding at any one time is 1,000 shares of common stock having a par value of $1.00 per share. ARTICLE IV. TERM OF EXISTENCE This Corporation shall commence upon the signing of these articles. ARTICLE V. REGISTERED AGENT AND INITIAL REGISTERED OFFICE The Registered Agent and the street address of the initial Registered Office of this Corporation in the State of Florida shall be: EDWARD M. SCHLEIN 710 Yorktown Drive Leesburg, FL 34748 The Board of Directors from time to time may move the Registered Office to any other address in the State of Florida. ARTICLE VI. BOARD OF DIRECTORS This Corporation shall have one (1) director initially. The number of directors may be increased or diminished from time to time by Bylaws adopted by the stockholders, but shall never be less than one. ARTICLE VII. INITIAL DIRECTORS The name of the initial director of this Corporation and his street address is: EDWARD M. SCHLEIN 710 Yorktown Dr. Leesburg, FL 34748 The person named as initial director shall hold office for the first year of existence of this Corporation or until his successor(s) (is) (are) elected or appointed and (has) (have) qualified, whichever occurs first. ARTICLE VIII. INCORPORATOR The name and street address of the person signing those Articles of Incorporation as the Incorporator is: EDWARD M. SCHLEIN 710 Yorktown Drive Leesburg, FL 34748 ARTICLE IX. AMENDMENT These Articles of Incorporation may be amended in the manner provided by law. Every amendment shall be approved by the Board of Directors, proposed by them to the stockholders and approved at a stockholders' meeting by at least a majority of the stock entitled to vote, unless all of the directors and all of the stockholders sign a written statement manifesting their intention that a certain amendment of these Articles of Incorporation be made. IN WITNESS WHEREOF, the undersigned, as Incorporator, has executed the foregoing Articles of Incorporation on the 2nd day of September, 1994. /s/ Edward M. Schlein ---------------------------------- Incorporator, EDWARD M. SCHLEIN STATE OF FLORIDA COUNTY OF LAKE BEFORE ME, a Notary Public, personally appeared EDWARD M. SCHLEIN, to me known to be the person described as Incorporator and who executed the foregoing Articles of Incorporation, and acknowledged before me that he subscribed to these Articles of Incorporation on the 2nd day of September, 1994. /s/ Mary L. Rood ---------------------------------- Notary Public, State of Florida at Large My Commission Expires: [SEAL] Mary L. Rood Notary Public, State of Florida Commission No. CC 380943 My Commission Expires 06/06/98 1-800-3-NOTARY - Fla. Notary Service & Bonding Co. CERTIFICATE DESIGNATING PLACE OF BUSINESS OR DOMICILE FOR THE SERVICE OF PROCESS WITHIN FLORIDA, NAMING AGENT UPON WHOM PROCESS MAY BE SERVED IN COMPLIANCE WITH SECTION 48.091, FLORIDA STATUTES, THE FOLLOWING IS SUBMITTED: FIRST - THAT SENTINEL MEDICAL SERVICES, INC., DESIRING TO ORGANIZE OR QUALIFY UNDER THE LAWS OF THE STATE OF FLORIDA, WITH ITS PRINCIPAL PLACE OF BUSINESS AT 710 YORKTOWN DRIVE, CITY OF LEESBURG, STATE OF FLORIDA, HAS NAMED EDWARD M. SCHLEIN LOCATED AT 710 YORKTOWN DRIVE, LEESBURG, FL 34738 AS ITS AGENT TO ACCEPT SERVICE OF PROCESS WITHIN FLORIDA. SIGNATURE: /s/ Edward M. Schlein ---------------------- EDWARD M. SCHLEIN TITLE: PRESIDENT DATE: 9/2/94 HAVING BEEN NAMED TO ACCEPT SERVICE OF PROCESS FOR THE ABOVE STATED CORPORATION, AT THE PLACE DESIGNATED IN THIS CERTIFICATE, I HEREBY AGREE TO ACT IN THIS CAPACITY, AND I FURTHER AGREE TO COMPLY WITH THE PROVISION OF ALL STATUTES RELATIVE AND PROPER TO COMPLETE PERFORMANCE OF MY DUTIES SIGNATURE: /s/ Edward M. Schlein --------------------------------- EDWARD M. SCHLEIN, Resident Agent DATE: 9/2/94 --------------------------------- EX-3.97 12 y57349ex3-97.txt BYLAWS OF SENTINEL MEDICAL SERVICES, INC. Exhibit 3.97 BY-LAWS OF SENTINEL MEDICAL SERVICES, INC. ARTICLE I - OFFICES The principal office of the corporation shall be established and maintained at 710 Yorktown Drive in the City of Leesburg, County of Lake, State of Florida. The corporation may also have offices at such places within or without the State of Florida as the Board may from time establish. ARTICLE II - SHAREHOLDERS 1. PLACE OF MEETINGS Meetings of shareholders shall be held at the principal office of the corporation or at such place within or without the State of Florida as the board shall authorize. 2. ANNUAL MEETING The annual meeting of shareholders shall be held on the 1st Tuesday of September at 9 a.m. in each year; however, if such day falls on a Sunday or a legal holiday, then on the next business day following at the same time. At such meeting the shareholders shall elect a board of directors and transact such other business as may properly come before the meeting. 3. SPECIAL MEETINGS Special meetings of the shareholders may be called by the board or by the holders of not less than one-tenth of all the shares entitled to vote at the meeting. A meeting requested by shareholders shall be called for a date not less than ten (10) nor more than sixty (60) days after the request is made. The secretary shall issue the call for the meeting unless the president, the board or the shareholders shall designate another to make said call. 1 4. NOTICE OF MEETINGS Written notice of each meeting of shareholders shall state the place, day and hour of the meeting and in the case of a special meeting the purpose or purposes for which the meeting is called. Notice shall be delivered personally or by first class mail to each shareholder of record having the right and entitled to vote at such meeting at his last address as it appears on the records of the corporation, not less than ten (10) nor more than sixty (60) days before the date set for such meeting. Such notice shall be sufficient for the meeting and any adjournment thereof. If any shareholder shall transfer his stock after notice, it shall not be necessary to notify the transferee. Any shareholder may waive notice of any meeting either before, during or after the meeting. 5. CLOSING OF TRANSFER BOOKS AND FIXING RECORD DATE For the purpose of determining shareholders entitled to notice of or to vote at any meeting of shareholders or any adjournment thereof, or entitled to receive payment of any dividend, or in order to make a determination of shareholders for any other purpose, the board may provide that the stock transfer books shall be closed for a stated period but not to exceed, in any case, sixty (60) days. If the stock transfer books shall be closed for the purpose of determining shareholders entitled to notice of or to vote at a meeting of shareholders such books shall be closed for at least ten (10) days immediately preceding such meeting. In lieu of closing the stock transfer books, the board may fix in advance a date as the record date for any such determination of shareholders, such date in any case to be not more than sixty (60) days and, in case of a meeting of shareholders, not less than ten (10) days prior to the date on which the particular action, requiring such determination of shareholders, is to be taken. If the stock transfer books are not closed and no record date is fixed for the determination of shareholders entitled to notice or to vote at a meeting of shareholders, or shareholders entitled to receive payment of a dividend, the date on which notice of the meeting is mailed or the date on which the resolution of the board of directors declaring such dividend is adopted, as the case may be, shall be the record date for such determination of shareholders. 6. VOTING Every shareholder shall be entitled at each meeting and upon each proposal presented at each meeting to one vote for each share recorded in the shareholder's name on the books of the corporation on the record date. The books of records of shareholders shall be produced at the meeting upon the request of any shareholder. Upon the demand of any shareholder, the vote for directors and the vote upon any question before the meeting, shall be by ballot. The meeting shall be the act of the shareholders. 2 7. QUORUM The presence, in person or by proxy, of shareholders holding a majority of the shares of the corporation entitled to vote shall constitute a quorum at all meetings of the shareholders. In case a quorum shall not be present at any meeting, a majority of the shareholders entitled to vote thereat, present in person or by proxy, shall have power to adjourn the meeting from time to time, without notice other than announcement at the meeting, until the requisite amount of shares entitled to vote shall be present. At any such adjourned meeting at which the requisite amount of shares entitled to vote shall be presented, any business may be transacted which might have been transacted at the meeting as originally notice; but only those entitled to vote at the meeting as originally noticed shall be entitled to vote at any adjournment or adjournments thereof. 8. PROXIES At any shareholders meeting or any adjournment thereof, any shareholder of record having the right and entitled to vote thereat may be represented and vote by proxy appointed in a written instrument. No such proxy shall be voted after eleven months from the date thereof unless otherwise provided in the proxy. In the event a proxy provides for two or more persons to act as proxies, a majority of such persons present at the meeting, or if only one be present, that one, shall have all the powers conferred by the instrument upon all the persons so designated unless the proxy shall provide otherwise. ARTICLE III - DIRECTORS 1. BOARD OF DIRECTORS The business of the corporation shall be managed and its corporate powers exercised by a board of one (1) director. It shall not be necessary for directors to be residents of the State of Florida or shareholders. 2. ELECTION AND TERM OF DIRECTORS Directors shall be elected at the annual meeting of shareholders and each director elected shall hold office until the director's successor has been elected and qualified, or until prior resignation or removal. 3. VACANCIES Any vacancy occurring in the board including any vacancy created by reason of an increase in the number of directors, may be filled by the affirmative vote of a majority of the remaining directors through less than a quorum of the board. A director elected to fill a vacancy shall hold office only until the next election of directors by the shareholders. 3 4. REMOVAL OF DIRECTORS Any or all of the directors may be removed with or without cause by vote of a majority of all the shares outstanding and entitled to vote at a special meeting of shareholders called for that purpose. 5. RESIGNATION A director may resign at any time by giving written notice to the board, the president or the secretary of the corporation. Unless otherwise specified in the notice, the resignation shall take effect upon receipt thereof by the board or such officer, and the acceptance of the resignation shall not be necessary to make it effective. 6. QUORUM OF DIRECTORS A majority of the directors shall constitute a quorum for the transaction of business. If at any meeting of the board there shall be less than a quorum present, a majority of those present may adjourn the meeting from time to time until a quorum is obtained, and no further notice thereof need be given other than by announcement at the meeting which shall be so adjourned. 7. VOTING Notwithstanding any other provision of these By-Laws to the contrary, the following actions of the Board of Directors shall require the affirmative vote of all of the directors constituting the entire Board of Directors: (a) Any action outside the ordinary course of business of the corporation, which shall be deemed to mean an action that is probable of having a material effect on the revenues, gross profits, or net profits of the corporation. (b) Any change in the number of directors constituting the entire Board of Directors or any change in the persons presently constituting the Board of Directors. (c) Any change in the officers of the corporation from that provided for in paragraph 3 of the Stockholders Agreement or any change in the duties or compensation of such officers from that provided for in the Stockholders Agreement. (d) Amendment of the Articles of Incorporation of the corporation. (e) Amendment of these By-Laws. (f) Adoption of any plan or agreement for the merger or consolidation of the corporation into or with one or more other corporations. 4 (g) Approval of any sale, lease, exchange, mortgage, pledge, creation of a security interest in (other than as contemplated by the Stockholders Agreement) or other disposition of all or substantially all of the assets of the corporation. (h) Adoption of any plan of complete or partial liquidation of the corporation. (i) Any issuance, redemption, repurchase, reclassification or recapitalization of or relating to the capital stock of the corporation. 8. PLACE AND TIME OF BOARD MEETINGS The board may hold its meetings at the office of the corporation or at such other places, either within or without the State of Florida as it may from time to time determine. Participation in a meeting by communication methods whereby all persons can hear each other at the same time shall constitute presence in person at a meeting. 9. REGULAR ANNUAL MEETING A regular annual meeting of the board shall be held immediately following the annual meeting of shareholders at the place of such annual meeting of shareholders. 10. NOTICE OF MEETINGS OF THE BOARD Regular meetings of the board may be held without notice at such time and place as it shall from time to time determine. Special meetings of the board shall be held upon notice to the directors any may be called by the president upon three days notice to each director either personally or by mail or by wire; special meetings shall be called by the president or by the secretary in a like manner on written require of two directors. Notice of a meeting need not be given to any director who submits a waiver of notice whether before or after the meeting or who attends the meeting without protesting prior thereto or at its commencement the lack of notice to him. 11. EXECUTIVE AND OTHER COMMITTEES The board, by resolution, may designate from among its members two or more of their number to one or more committees, which, to the extent provided in said resolution or these By-Laws may exercise the powers of the board in the management of the business of the corporation, except as provided in Section 607.127 of the Florida General Corporation Act. 12. COMPENSATION The board shall have the authority to fix the compensation of directors. 5 ARTICLE IV -- OFFICERS 1. OFFICERS, ELECTION AND TERM a) The board may elect or appoint a president, a vice-president, a secretary and a treasurer, and such other officers as it may determine, who shall have such duties and powers as hereinafter provided. b) In the event of the death, resignation or removal of an officer, the board in its discretion may elect or appoint a successor to fill the unexpired term. c) Any two or more offices may be held by the same person. d) The salaries of all officers shall be fixed by the board. e) The directors may require any officer to give security for the faithful performance of his duties. 2. PRESIDENT The president shall be the chief executive officer of the corporation and shall have the general powers and duties of supervision and management usually vested in the office of president of a corporation. He shall preside at all meetings of the shareholders if present there and shall have general supervision, direction and control of the business of the corporation. Except as the board shall authorize the execution thereof in some other manner, he shall execute bonds, mortgages and other contracts in behalf of the corporation, and shall cause the seal to be affixed to any instrument requiring it and when so affixed, the seal shall be attested by the signature of the secretary or the treasurer or an assistant secretary or an assistant treasurer. 3. VICE-PRESIDENT During the absence or disability of the president, the vice-president, if one be elected, or if there are more than one, the executive vice-president, shall have all the powers and functions of the president. Each vice-president shall perform such other duties as the board shall prescribe. 4. SECRETARY The secretary shall attend all meetings of the board and of the shareholders, record all votes and minutes of all proceedings in a book to be kept for that purpose, give or cause to be given notice of all meetings of shareholders and of special meetings of the board, keep in safe custody the seal of the corporation and affix it to any instrument when authorized by the board, when required prepare or cause to be prepared and available at each 6 meeting of shareholders a certified list in alphabetical order of the names of shareholders entitled to vote thereat, indicating the number of shares of each respective class held by each, keep all the documents and records of the corporation as required by law or otherwise in a proper and safe manner, and perform such other duties as may be prescribed by the board, or assigned to him by the president. 5. ASSISTANT-SECRETARIES During the absence or disability of the secretary, the assistant- secretary, or if there are more than one, the one so designated by the secretary or by the board, shall have the powers and functions of the secretary. 6. TREASURER The treasurer shall have the custody of the corporate funds and securities, keep full and accurate accounts of receipts and disbursements in the corporate books, deposit all money and other valuables in the name and to the credit of the corporation in such depositories as may be designated by the board, disburse the funds of the corporation as may be ordered or authorized by the board and preserve proper vouchers for such disbursements, render to the president and board at the regular meetings of the board, or whenever they require it, an account of all transactions as treasurer and of the financial condition of the corporation, render a full financial report at the annual meeting of the shareholders if so requested, be furnished by all corporate officers and agents on request with such reports and statements as required as to all financial transactions of the corporation, and perform such other duties as are given by the By-Laws or as from time to time are assigned by the board or the president. 7. ASSISTANT-TREASURER During the absence or disability of the treasurer, the assistant- treasurer, or if there are more than one, the one so designated by the treasurer or by the board, shall have all the powers and functions of the treasurer. 8. SURETIES AND BONDS In case the board shall so require, any officer or agent of the corporation shall execute to the corporation a bond in such sum and with such surety or sureties as the board may direct, conditioned upon the faithful performance of their duties to the corporation and including responsibility for negligence and for the accounting for all property, funds or securities of the corporation which may come into their hands. 7 ARTICLE V - CERTIFICATES FOR SHARES 1. CERTIFICATES The shares of the corporation shall be represented by certificates. They shall be numbered and entered in the books of the corporation as they are issued. They shall exhibit the holder's name and the number of shares and shall be signed by the president or a vice-president and the secretary or an assistant secretary and shall bear the corporate seal. When such certificates are signed by a transfer agent or an assistant transfer agent or by a transfer clerk acting on behalf of the corporation and a registrar, the signatures of such officers may be facsimiles. 2. LOST OR DESTROYED CERTIFICATES The board may direct a new certificate or certificates to be issued in place of any certificate or certificates theretofore issued by the corporation, alleged to have been lost or destroyed, upon the making of an affidavit of that fact by the person claiming the certificate to be lost or destroyed. When authorizing such issue of a new certificate or certificates, the board may, in its discretion and as a condition precedent to the issuance thereof, require the owner of such lost or destroyed certificate or certificates, or the owner's legal representative, to advertise the same in such manner as it shall require and/or give the corporation a bond in such sum and with such surety or sureties as it may direct as indemnity against any claim that may be made against the corporation with respect to the certificate alleged to have been lost or destroyed. 3. TRANSFERS OF SHARES Upon surrender to the corporation or the transfer agent of the corporation of a certificate for shares duly endorsed or accompanied by proper evidence of succession, assignment or authority to transfer, it shall be the duty of the corporation to issue a new certificate to the person entitled thereto, to cancel the old certificate; every such transfer shall be entered on the transfer book of the corporation which shall be kept at its principal office. Whenever a transfer shall be made for collateral security, and not absolutely, it shall be so expressed on the entry of the transfer. No transfer shall be made within ten days next preceding the annual meeting of shareholders. ARTICLE VI - DIVIDENDS The board may out of funds legally available therefore at any regular or special meeting, declare dividends upon the shares of the corporation in cash, property or its own shares as and when it deems expedient. Before declaring any dividend there may be set apart out of any funds of the corporation available for dividends, 8 such sum or sums as the board from time to time in their discretion deem proper for working capital or as a reserve fund to meet contingencies or for equalizing dividends or for such other purposes as the board shall deem conducive to the interests of the corporations. ARTICLE VII - CORPORATE SEAL The seal of the corporation shall be circular in form and bear the name of the corporation, the year of its organization and the words "CORPORATE SEAL, FLORIDA." The seal may be used by causing it to be impressed directly on the instrument or writing to be sealed, or upon adhesive substance affixed thereto. The seal on the certificates for shares or on any corporate obligation for the payment of money may be facsimile, engraved or printed. ARTICLE VIII - EXECUTION OF INSTRUMENTS All corporate instruments and documents shall be signed or countersigned, executed, verified or acknowledged by such officer or officers or other person or persons as the board may from time to time designate. All checks, drafts or other orders for the payment of money, notes or other evidences of indebtedness issued in the name of the corporation shall be signed by such officer or officers, agent or agents of the corporation, and in such manner as shall be determined from time to time by resolution of the board. ARTICLE IX - FISCAL YEAR The fiscal year shall begin the first day of January in each year. ARTICLE X - NOTICE AND WAIVER OF NOTICE Whenever any notice is required by these By-Laws to be given, personal notice is not meant unless expressly so stated, and any notice so required shall be deemed to be sufficient if given by first class mail by depositing the same in a post office box in a sealed post-paid wrapper, addressed to the person entitled thereto at his post office address as it appears on the stock transfer books of the corporation and such notice shall be deemed to have been given on the day of such mailing. Shareholders not entitled to vote shall not be entitled to receive notice of any meetings except as otherwise provided by statute. Whenever any notice whatever is required to be given under the provision of any law, or under the provision of the Articles of Incorporation of the corporation or these By-Laws, a waiver thereof in writing, signed by the person or persons entitled to said notice, whether before or after the time stated therein, shall be deemed equivalent thereto. 9 ARTICLE XI - CONSTRUCTION Whenever a conflict arises between the language of these By-Laws and the Articles of Incorporation, the Articles of Incorporation shall govern. ARTICLE XII - INFORMAL MANAGEMENT 1. CONDUCT OF BUSINESS WITHOUT MEETINGS - UNANIMOUS CONSENT Any action of the shareholders, directors or committee may be taken without a meeting if a consent in writing, setting forth the action so taken, shall be signed by all persons who would be entitled to vote on such action at a meeting and filed with the secretary of the corporation as part of the proceedings of the shareholders, directors or committees as the case may be. Such consent shall have the same effect as a unanimous vote. No action of the shareholders may be taken without a meeting unless with unanimous consent. 2. MANAGEMENT BY SHAREHOLDERS In the event the shareholders are named in the Articles of Incorporation and are empowered therein to manage the affairs of the corporation in lieu of directors, the shareholders of the corporation shall be deemed directors for the purposes of these By-Laws and wherever the word "directors", "board of directors" and "board" appear in these By-Laws those words shall be taken to mean shareholders. ARTICLE XIII - AMENDMENTS The board may adopt, alter, amend or repeal these By-Laws. By-Laws adopted by the board or by the shareholders may be repealed or changed, new By-Laws may be adopted by the shareholders, and shareholders may prescribe in any By-Law made by them that such By-Laws shall not be altered, amended or repealed by the board. 10 EX-21 13 y57349ex21.txt SUBSIDIARIES EXHIBIT 21. SUBSIDIARIES OF REGISTRANT TEAM HEALTH SUBSIDIARIES SUBSIDIARY NAME/DOMESTIC STATE ------------------------------ 1. Access Nurse PM, Inc. (UT) 2. Acute Care Specialists, Co. (PA) 3. After Hours Pediatric Practices, Inc. (FL) 4. Alliance Corporation (WV) 5. Charles L. Springfield, Inc. (CA) 6. Clinic Management Services, Inc. (TN) 7. Daniel & Yeager, Inc. (AL) 8. Drs. Sheer, Ahearn & Associates, Inc. (FL) 9. Emergency Coverage Corporation (TN) 10. Emergency Management Specialists, Inc. (WV) 11. Emergency Physician Associates, Inc. (NJ) 12. Emergency Physicians of Manatee, Inc. (FL) 13. Emergency Professional Services, Inc. (OH) 14. Emergicare Management, Incorporated (TN) 15. Fischer Mangold, a California Partnership (CA) 16. Herschel Fischer, Inc. (CA) 17. Hospital Based Physician Services, Inc. (TN) 18. IMBS, Inc. (FL) 19. InPhyNet Anesthesia of West Virginia, Inc. (WV) 20. InPhyNet Contracting Services, Inc. (FL) 21. InPhyNet Hospital Services, Inc. (FL) 22. InPhyNet Joliet, Inc. (FL) 1 23. InPhyNet Louisiana, Inc. (FL) 24. InPhyNet Medical Management Institute, Inc. (FL) 25. InPhyNet South Broward, Inc. (FL) 26. Integrated Specialists Management Services, Inc. (CA) 27. Karl G. Mangold, Inc. (CA) 28. Med:Assure Systems, Inc. (TN) 29. Medical Management Resources, Inc. (FL) 30. MetroAmerican Radiology, Inc. (NC) 31. Mt. Diablo Emergency Physicians, a California General Partnership (CA) 32. Northwest Emergency Physicians, Incorporated (WA) 33. Paragon Anesthesia, Inc. (FL) 34. Paragon Contracting Services, Inc. (FL) 35. Paragon Healthcare Limited Partnership (FL) 36. Paragon Imaging Consultants, Inc. (FL) 37. Park Med of Florida, Inc. (FL) 38. Physician Integration Consulting Services, Inc. (CA) 39. Quantum Plus, Inc. (CA) 40. Reich, Seidelmann & Janicki Co. (OH) 41. Rosendorf, Margulies, Boruschok & Schoenbaum Radiology Associates of Hollywood, Inc. (FL) 42. Sarasota Emergency Medical Consultants, Inc. (FL) 43. Sentinel Medical Services, Inc. (FL) 44. Southeastern Emergency Physicians, Inc. (TN) 45. Southeastern Emergency Physicians of Memphis, Inc. (TN) 46. Team Anesthesia, Inc. (TN) 47. Team Health Billing Services, LP (TN) 2 48. Team Health Financial Services, Inc. (TN) 49. Team Health Southwest, LP (DE) 50. Team Radiology, Inc. (NC) 51. THBS, Inc. (DE) 52. The Emergency Associates for Medicine, Inc. (FL) 53. Virginia Emergency Physicians Inc. (VA) 3
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