FORM S-4
As filed with the Securities and Exchange Commission on
October 11, 2005
Registration
No. 333-
SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
Form S-4
REGISTRATION STATEMENT
UNDER
THE SECURITIES ACT OF 1933
EMERGENCY MEDICAL SERVICES L.P.
(Exact Name of Registrant as Specified in its Charter)
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Delaware |
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4119, 8011 and 8741 |
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20-2076535 |
(State or Other Jurisdiction of
Incorporation or Organization) |
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(Primary Standard Industrial
Classification Code Number) |
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(I.R.S. Employer
Identification No.) |
6200 S. Syracuse Way
Greenwood Village, Colorado 80111
(303) 495-1200
(Address, including zip code, and telephone number, including
area code, of registrant’s principal executive offices)
Todd Zimmerman, Esq.
General Counsel
Emergency Medical Services Corporation
6200 S. Syracuse Way
Greenwood Village, Colorado 80111
(303) 495-1200
(Name, address, including zip code, and telephone number,
including area code, of agent for service)
Copies To:
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Lynn Toby Fisher, Esq.
Joel I. Greenberg, Esq.
Kaye Scholer LLP
425 Park Avenue
New York, New York 10022
(212) 836-8000 |
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William A. Sanger
Chief Executive Officer
Emergency Medical Services Corporation
6200 S. Syracuse Way
Greenwood Village, Colorado 80111
(303) 495-1200 |
Approximate date of commencement of proposed sale to
public: As soon as practicable after this Registration
Statement becomes effective.
If the securities being registered on this form are being
offered in connection with the formation of a holding company
and there is compliance with General Instruction G, check the
following
box. o
If this form is filed to register additional securities for an
offering pursuant to Rule 462(b) under the Securities Act,
check the following box and list the Securities Act registration
statement number of the earlier effective registration statement
for the same
offering. o
If this form is a post-effective amendment filed pursuant to
Rule 462(d) under the Securities Act, check the following
box and list the Securities Act registration statement number of
the earlier effective registration statement for the same
offering. o
CALCULATION OF REGISTRATION FEE
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Proposed Maximum |
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Proposed Maximum |
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Title Of Each Class Of |
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Amount To Be |
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Offering Price |
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Aggregate Offering |
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Amount Of |
Securities To Be Registered |
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Registered |
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Per Unit |
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Price |
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Registration Fee |
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10% Senior Subordinated Notes due 2015
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$250,000,000 |
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100% |
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$250,000,000(1) |
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$29,425 |
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Guarantees of 10% Senior Subordinated Notes due 2015(2)
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$250,000,000 |
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100% |
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$250,000,000 |
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(3) |
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(1) |
Estimated solely for the purpose of calculating the registration
fee pursuant to Rule 457(f). |
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(2) |
The co-registrants identified as “guarantors” in the
Table of Additional Registrants have guaranteed the notes. |
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(3) |
Pursuant to Rule 457(n), no separate fee is payable with
respect to the guarantees of the notes being registered. |
The Registrant hereby amends this Registration Statement on
such date or dates as may be necessary to delay its effective
date until the Registrant shall file a further amendment which
specifically states that this Registration Statement shall
thereafter become effective in accordance with Section 8(a)
of the Securities Act of 1933 or until this Registration
Statement shall become effective on such date as the Commission,
acting pursuant to said Section 8(a), may determine.
Table of Additional Registrants
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State or Other | |
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Primary Standard |
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Jurisdiction of | |
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Industry |
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I.R.S. Employer | |
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Incorporation or | |
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Classification Code |
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Identification | |
Exact Name of Registrant as Specified in its Charter |
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Organization | |
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Number |
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No. | |
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ISSUERS |
AMR HoldCo, Inc.
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Delaware |
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6719 |
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20-2076468 |
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EmCare HoldCo, Inc.
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Delaware |
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6719 |
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20-2076495 |
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GUARANTORS |
EMS Management LLC
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Delaware |
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6719 |
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20-2076564 |
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American Medical Response, Inc.
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Delaware |
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4119 |
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04-3147881 |
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Hank’s Acquisition Corp.
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Alabama |
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4119 |
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33-0569883 |
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Fountain Ambulance Service, Inc.
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Alabama |
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4119 |
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63-1058995 |
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MedLife Emergency Medical Service, Inc.
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Alabama |
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4119 |
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63-1154514 |
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American Medical Response Northwest, Inc.
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Oregon |
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4119 |
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93-0567420 |
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American Medical Response West
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California |
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4119 |
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77-0324739 |
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Metropolitan Ambulance Service
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California |
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4119 |
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94-1701773 |
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American Medical Response of Inland Empire
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California |
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4119 |
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95-2223085 |
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Desert Valley Medical Transport, Inc.
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California |
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4119 |
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33-0753384 |
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Springs Ambulance Service, Inc.
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California |
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4119 |
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95-2426613 |
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American Medical Response of Colorado, Inc.
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Delaware |
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4119 |
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84-1231591 |
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International Life Support, Inc.
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Hawaii |
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4119 |
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99-0114256 |
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Medevac MidAmerica, Inc.
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Missouri |
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4119 |
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95-3743718 |
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Medevac Medical Response, Inc.
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Missouri |
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4119 |
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43-1097068 |
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American Medical Response of Oklahoma, Inc.
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Delaware |
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4119 |
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73-1462014 |
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American Medical Response of Texas, Inc.
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Delaware |
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4119 |
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76-0487923 |
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Kutz Ambulance Service, Inc.
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Wisconsin |
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4119 |
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39-0827456 |
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American Medical Response Holdings, Inc.
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Delaware |
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4119 |
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84-1370651 |
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American Medical Response Management, Inc.
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Delaware |
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4119 |
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84-1351841 |
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Regional Emergency Services, LP
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Delaware |
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4119 |
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59-3383586 |
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A1 Leasing, Inc.
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Florida |
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4119 |
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59-3403850 |
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Florida Emergency Partners, Inc.
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Texas |
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4119 |
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59-3383583 |
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Mobile Medic Ambulance Service, Inc.
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Delaware |
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4119 |
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04-3171173 |
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Metro Ambulance Service, Inc.
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Delaware |
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4119 |
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72-1275308 |
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Metro Ambulance Service (Rural), Inc.
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Delaware |
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4119 |
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72-1275309 |
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Medic One Ambulance Services, Inc.
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Delaware |
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4119 |
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72-1276358 |
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American Medical Response of South Carolina, Inc.
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Delaware |
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4119 |
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57-1024333 |
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American Medical Response of North Carolina, Inc.
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Delaware |
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4119 |
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56-1931968 |
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American Medical Response of Georgia, Inc.
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Delaware |
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4119 |
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58-2193430 |
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Troup County Emergency Medical Services, Inc.
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Georgia |
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4119 |
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58-1313603 |
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Randle Eastern Ambulance Service, Inc.
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Florida |
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4119 |
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59-0737717 |
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Medi-Car Systems, Inc.
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Florida |
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4119 |
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59-1996927 |
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Medi-Car Ambulance Service, Inc.
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Florida |
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4119 |
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59-1892079 |
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American Medical Response of Tennessee, Inc.
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Delaware |
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4119 |
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62-1642499 |
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Physicians & Surgeons Ambulance Service, Inc.
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Ohio |
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4119 |
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34-0859642 |
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American Medical Response of Illinois, Inc.
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Delaware |
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4119 |
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36-3978701 |
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Midwest Ambulance Management Company
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Delaware |
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4119 |
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36-3973137 |
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Paramed, Inc.
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Michigan |
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4119 |
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38-2142110 |
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Mercy Ambulance of Evansville, Inc.
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Indiana |
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4119 |
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35-1494500 |
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Tidewater Ambulance Service, Inc.
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Virginia |
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4119 |
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54-1244307 |
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American Medical Response of Connecticut, Incorporated
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Connecticut |
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4119 |
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06-1356148 |
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American Medical Response of Massachusetts, Inc.
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Massachusetts |
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4119 |
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04-2574482 |
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American Medical Response Mid-Atlantic, Inc.
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Pennsylvania |
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4119 |
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23-2195702 |
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American Medical Response Delaware Valley, LLC
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Delaware |
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4119 |
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74-2895618 |
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Ambulance Acquisition, Inc.
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Delaware |
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4119 |
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51-0352561 |
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Metro Ambulance Services, Inc.
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Georgia |
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4119 |
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72-1275308 |
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Broward Ambulance, Inc.
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Delaware |
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4119 |
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33-0506810 |
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Atlantic Ambulance Services Acquisition, Inc.
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Delaware |
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4119 |
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33-0506806 |
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Atlantic/ Key West Ambulance, Inc.
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Delaware |
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4119 |
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33-0506809 |
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Atlantic/ Palm Beach Ambulance, Inc.
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Delaware |
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4119 |
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33-0506808 |
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Seminole County Ambulance, Inc.
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Delaware |
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4119 |
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33-0506811 |
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LifeFleet Southeast, Inc.
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Florida |
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4119 |
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59-1395439 |
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American Medical Pathways, Inc.
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Delaware |
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4119 |
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75-2766681 |
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State or Other | |
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Primary Standard |
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Jurisdiction of | |
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Industry |
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I.R.S. Employer | |
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Incorporation or | |
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Classification Code |
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Identification | |
Exact Name of Registrant as Specified in its Charter |
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Organization | |
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Number |
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No. | |
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ProvidaCare, L.L.C.
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Texas |
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4119 |
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75-2643961 |
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Adam Transportation Service, Inc.
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New York |
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4119 |
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13-3541209 |
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Associated Ambulance Service, Inc.
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New York |
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4119 |
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11-2163989 |
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Park Ambulance Service Inc.
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New York |
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4119 |
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13-2508653 |
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Five Counties Ambulance Service, Inc.
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New York |
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4119 |
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11-2127997 |
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Sunrise Handicap Transport Corp.
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New York |
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4119 |
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11-2569671 |
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STAT Healthcare, Inc.
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Delaware |
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4119 |
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76-0496236 |
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Laidlaw Medical Transportation, Inc.
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Delaware |
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4119 |
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75-2474011 |
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Mercy, Inc.
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Nevada |
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4119 |
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88-0125707 |
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American Investment Enterprises, Inc.
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Nevada |
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4119 |
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88-0206998 |
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LifeCare Ambulance Service, Inc.
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Illinois |
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4119 |
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36-3799039 |
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TEK, Inc.
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Illinois |
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4119 |
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36-2915559 |
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Mercy Life Care
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California |
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4119 |
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94-2619315 |
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Hemet Valley Ambulance Service, Inc.
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California |
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4119 |
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95-2841215 |
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American Medical Response of Southern California
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California |
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4119 |
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95-1488421 |
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Medic One of Cobb, Inc.
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Georgia |
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4119 |
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58-1944370 |
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Puckett Ambulance Service, Inc.
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Georgia |
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4119 |
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58-1572034 |
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AMR Brockton, L.L.C.
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Delaware |
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4119 |
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04-3502200 |
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EmCare Holdings Inc.
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Delaware |
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6719 |
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13-3645287 |
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EmCare, Inc.
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Delaware |
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8011, 8060 and 8741 |
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75-1732351 |
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EmCare of Maryland LLC
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Maryland |
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8011, 8060 and 8741 |
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75-2584537 |
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EmCare of Alabama, Inc.
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Alabama |
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8011, 8060 and 8741 |
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75-2764325 |
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EmCare Contract of Arkansas, Inc.
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Arkansas |
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8011, 8060 and 8741 |
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75-2780794 |
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EmCare of Arizona, Inc.
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Arizona |
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8011, 8060 and 8741 |
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75-2764321 |
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EmCare of California, Inc.
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California |
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8011, 8060 and 8741 |
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94-2246075 |
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EmCare of Colorado, Inc.
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Colorado |
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8011, 8060 and 8741 |
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75-2764320 |
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EmCare of Connecticut, Inc.
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Connecticut |
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8011, 8060 and 8741 |
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33-1015195 |
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EmCare of Florida, Inc.
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Florida |
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8011, 8060 and 8741 |
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59-1317432 |
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EmCare of Georgia, Inc.
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Georgia |
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8011, 8060 and 8741 |
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75-2764317 |
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EmCare of Hawaii, Inc.
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Hawaii |
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8011, 8060 and 8741 |
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99-0158218 |
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EmCare of Indiana, Inc.
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Indiana |
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8011, 8060 and 8741 |
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75-2793483 |
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EmCare of Iowa, Inc.
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Iowa |
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8011, 8060 and 8741 |
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75-2764281 |
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EmCare of Kentucky, Inc.
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Kentucky |
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8011, 8060 and 8741 |
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75-2764280 |
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EmCare of Louisiana, Inc.
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Louisiana |
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8011, 8060 and 8741 |
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75-2759529 |
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EmCare of Maine, Inc.
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Maine |
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8011, 8060 and 8741 |
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20-0209933 |
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EmCare of Michigan, Inc.
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Michigan |
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8011, 8060 and 8741 |
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75-2764279 |
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EmCare of Minnesota, Inc.
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Minnesota |
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8011, 8060 and 8741 |
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75-2764277 |
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EmCare of Mississippi, Inc.
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Mississippi |
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8011, 8060 and 8741 |
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75-2760070 |
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EmCare of Missouri, Inc.
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Missouri |
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8011, 8060 and 8741 |
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75-2789939 |
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EmCare Nevada, Inc.
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Nevada |
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8011, 8060 and 8741 |
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75-2731501 |
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EmCare of New Hampshire, Inc.
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New Hampshire |
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8011, 8060 and 8741 |
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75-2764327 |
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EmCare of New Jersey, Inc.
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New Jersey |
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8011, 8060 and 8741 |
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75-2759525 |
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EmCare of New Mexico, Inc.
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New Mexico |
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8011, 8060 and 8741 |
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75-2764326 |
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EmCare of New York, Inc.
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New York |
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8011, 8060 and 8741 |
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75-2764324 |
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EmCare of North Carolina, Inc.
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North Carolina |
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8011, 8060 and 8741 |
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75-2764322 |
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EmCare of North Dakota, Inc.
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North Dakota |
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8011, 8060 and 8741 |
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75-2763877 |
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EmCare of Ohio, Inc.
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Ohio |
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8011, 8060 and 8741 |
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75-2763876 |
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EmCare of Oklahoma, Inc.
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Oklahoma |
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|
8011, 8060 and 8741 |
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75-2754565 |
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EmCare of Oregon, Inc.
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Oregon |
|
|
8011, 8060 and 8741 |
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75-2763874 |
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EmCare of Pennsylvania, Inc.
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Pennsylvania |
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8011, 8060 and 8741 |
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75-2763873 |
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EmCare of Rhode Island, Inc.
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Rhode Island |
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8011, 8060 and 8741 |
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75-2697459 |
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EmCare of South Carolina, Inc.
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South Carolina |
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|
8011, 8060 and 8741 |
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58-2479880 |
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EmCare of Tennessee, Inc.
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Tennessee |
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|
8011, 8060 and 8741 |
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75-2759523 |
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EmCare of Texas, Inc.
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Texas |
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8011, 8060 and 8741 |
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75-2849713 |
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EmCare of Vermont, Inc.
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Vermont |
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8011, 8060 and 8741 |
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75-2764310 |
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EmCare of Virginia, Inc.
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Virginia |
|
|
8011, 8060 and 8741 |
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75-2764309 |
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EmCare of Washington, Inc.
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Washington |
|
|
8011, 8060 and 8741 |
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75-2764308 |
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EmCare of West Virginia, Inc.
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West Virginia |
|
|
8011, 8060 and 8741 |
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34-1700097 |
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EmCare of Wisconsin, Inc.
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|
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Wisconsin |
|
|
8011, 8060 and 8741 |
|
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75-2764307 |
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EmCare Physician Providers, Inc.
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Missouri |
|
|
8011, 8060 and 8741 |
|
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43-0972570 |
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|
|
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|
|
|
|
|
|
|
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|
State or Other | |
|
Primary Standard |
|
|
|
|
Jurisdiction of | |
|
Industry |
|
I.R.S. Employer | |
|
|
Incorporation or | |
|
Classification Code |
|
Identification | |
Exact Name of Registrant as Specified in its Charter |
|
Organization | |
|
Number |
|
No. | |
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|
| |
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|
|
| |
EmCare Physician Services, Inc.
|
|
|
Delaware |
|
|
8011, 8060 and 8741 |
|
|
51-0345538 |
|
EmCare Services of Illinois, Inc.
|
|
|
Illinois |
|
|
8011, 8060 and 8741 |
|
|
36-2670076 |
|
EmCare Services of Massachusetts, Inc.
|
|
|
Massachusetts |
|
|
8011, 8060 and 8741 |
|
|
75-2772211 |
|
EmCare Anesthesia Services, Inc.
|
|
|
Delaware |
|
|
8011, 8060 and 8741 |
|
|
65-0743208 |
|
ECEP, Inc.
|
|
|
Missouri |
|
|
8011, 8060 and 8741 |
|
|
36-4330833 |
|
Coordinated Health Services, Inc.
|
|
|
Pennsylvania |
|
|
8011, 8060 and 8741 |
|
|
23-2666117 |
|
EM-CODE Reimbursement Solutions, Inc.
|
|
|
Delaware |
|
|
8011, 8060 and 8741 |
|
|
75-2790529 |
|
Emergency Medicine Education Systems, Inc.
|
|
|
Texas |
|
|
8011, 8060 and 8741 |
|
|
75-2706238 |
|
Emergency Specialists of Arkansas, Inc. II
|
|
|
Texas |
|
|
8011, 8060 and 8741 |
|
|
75-2599775 |
|
First Medical/ EmCare, Inc.
|
|
|
California |
|
|
8011, 8060 and 8741 |
|
|
95-3580100 |
|
Healthcare Administrative Services, Inc.
|
|
|
Delaware |
|
|
8011, 8060 and 8741 |
|
|
43-1787964 |
|
OLD STAT, Inc.
|
|
|
Delaware |
|
|
8011, 8060 and 8741 |
|
|
76-0443952 |
|
Reimbursement Technologies, Inc.
|
|
|
Pennsylvania |
|
|
8011, 8060 and 8741 |
|
|
23-2634599 |
|
STAT Physicians, Inc.
|
|
|
Florida |
|
|
8011, 8060 and 8741 |
|
|
59-3413300 |
|
The Gould Group, Inc.
|
|
|
Texas |
|
|
8011, 8060 and 8741 |
|
|
75-2378809 |
|
Tifton Management Services, Inc.
|
|
|
Georgia |
|
|
8011, 8060 and 8741 |
|
|
58-1327293 |
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Tucker Emergency Services, Inc.
|
|
|
Georgia |
|
|
8011, 8060 and 8741 |
|
|
58-1521816 |
|
Helix Physicians Management, Inc.
|
|
|
California |
|
|
8011, 8060 and 8741 |
|
|
68-0323716 |
|
Norman Bruce Jetton, Inc.
|
|
|
California |
|
|
8011, 8060 and 8741 |
|
|
95-3192465 |
|
Pacific Emergency Specialists Management, Inc.
|
|
|
California |
|
|
8011, 8060 and 8741 |
|
|
33-0082696 |
|
American Emergency Physicians Medical Group, Inc.
|
|
|
California |
|
|
8011, 8060 and 8741 |
|
|
95-4194045 |
|
Physician Account Management, Inc.
|
|
|
Florida |
|
|
8011, 8060 and 8741 |
|
|
03-0373713 |
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Provider Account Management, Inc.
|
|
|
Delaware |
|
|
8011, 8060 and 8741 |
|
|
75-2964700 |
|
Charles T. Mitchell, Inc.
|
|
|
Hawaii |
|
|
8011, 8060 and 8741 |
|
|
99-0175097 |
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Global Medical Response, Inc.
|
|
|
Delaware |
|
|
6719 |
|
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65-1242537 |
|
The address, including zip code, and telephone number, including
area code, of each of the Additional Registrant’s principal
executive office is c/o Emergency Medical Services
Corporation, 6200 S. Syracuse Way, Greenwood Village,
Colorado 80111, (303) 495-1200.
The name, address, including zip code, and telephone number,
including area code, of agent for service for each of the
Additional Registrants is Todd Zimmerman, General Counsel,
Emergency Medical Services Corporation,
6200 S. Syracuse Way, Greenwood Village, Colorado
80111, (303) 495-1200.
The information in
this prospectus is not complete and may be changed. We may not
sell these securities until the registration statement filed
with the Securities and Exchange Commission is effective. This
prospectus is not an offer to sell these securities and it is
not soliciting an offer to buy these securities in any
jurisdiction where the offer or sale is not permitted.
|
SUBJECT TO COMPLETION,
DATED ,
2005
Prospectus
AMR HoldCo, Inc.
EmCare HoldCo, Inc.
Offer to Exchange
$250,000,000 principal amount of our 10% senior
subordinated notes due 2015, which have been registered under
the Securities Act, for any and all of our outstanding
10% senior subordinated notes due 2015.
We are offering to exchange all of our 10% senior
subordinated notes due 2015, which we refer to as the
outstanding notes, for our registered 10% senior
subordinated notes due 2015, which we refer to as exchange notes
and which are described in this prospectus. We refer to the
outstanding notes and the exchange notes together as the notes.
The terms of the exchange notes are identical to the terms of
the outstanding notes except that the exchange notes have been
registered under the Securities Act of 1933 and, therefore, are
freely transferable. We will pay interest on the notes at the
rate of 10% per year. Interest on the notes will be payable
on February 15 and August 15 of each year, beginning on
August 15, 2005. The notes will mature on February 15,
2015.
We may redeem some or all of the notes at any time on or after
February 15, 2010 at the redemption prices set forth in
this prospectus. In addition, prior to February 15, 2008 we
may redeem up to 35% of the notes at a purchase price equal to
110% of the aggregate principal amount of the notes, plus
accrued and unpaid interest and liquidated damages, if any, from
the proceeds of certain equity offerings or contributions. The
redemption prices are discussed under the caption
“Description of Notes — Optional Redemption.”
The principal features of the exchange offer are as follows:
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• |
The exchange offer expires at 5:00 p.m., New York City
time,
on ,
2005, unless extended. |
|
|
• |
We will exchange all outstanding notes that are validly tendered
and not validly withdrawn prior to the expiration of the
exchange offer. |
|
|
• |
You may withdraw tendered outstanding notes at any time prior to
the expiration of the exchange offer. |
|
|
• |
The exchange of outstanding notes for exchange notes pursuant to
the exchange offer will not be a taxable event for
U.S. federal income tax purposes. |
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|
• |
We will not receive any proceeds from the exchange offer. |
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• |
We do not intend to apply for listing of the exchange notes on
any securities exchange or automated quotation system. |
Broker-dealers receiving exchange notes in exchange for
outstanding notes acquired for their own account through
market-making or other trading activities must deliver a
prospectus in any resale of the exchange notes.
Investing in the notes involves risks. See “Risk
Factors” beginning on page 15.
Neither the U.S. Securities and Exchange Commission nor
any other federal or state agency has approved or disapproved of
these securities to be distributed in the exchange offer, nor
have any of these organizations determined that this prospectus
is truthful or complete. Any representation to the contrary is a
criminal offense.
The date of this prospectus
is ,
2005
You should rely only on the information contained in this
prospectus. We have not authorized anyone to provide you with
different information. We are not making an offer to sell these
securities in any jurisdiction where the offer or sale is not
permitted. You should assume that the information in this
prospectus is accurate on the date on the front cover of this
prospectus only. Our business, financial condition, results of
operations and prospects may have changed since that date.
Each broker-dealer that receives the exchange notes for its
own account pursuant to the exchange offer must acknowledge that
it will deliver a prospectus in connection with any resale of
such exchange notes. The letter of transmittal delivered with
this prospectus states that by so acknowledging and by
delivering a prospectus, a broker-dealer will not be deemed to
admit that it is an “underwriter” within the meaning
of the Securities Act of 1933. This prospectus, as it may be
amended or supplemented from time to time, may be used by a
broker-dealer in connection with resales of exchange notes
received in exchange for outstanding notes where such
outstanding notes were acquired by such broker-dealers as a
result of market-making activities or other trading activities.
We have agreed that, for a period of up to 90 days
following the effective date of the registration statement, of
which this prospectus is a part, we will make this prospectus
available to any broker-dealer for use in connection with any
such resale. See “Plan of Distribution.”
TABLE OF CONTENTS
INDUSTRY AND MARKET DATA
The market data and other statistical information used
throughout this prospectus are based on independent industry
publications, government publications, reports by market
research firms or other published independent sources. Some data
are also based on our good faith estimates, which are derived
from our review of internal surveys, as well as the independent
sources listed above. Although we believe these sources are
reliable, we have not independently verified the information.
None of the independent industry publications used in this
prospectus were prepared on our or our affiliates’ behalf
and none of the sources cited in this prospectus consented to
the inclusion of any data from its reports, nor have we sought
their consent.
i
SUMMARY
This summary highlights selected information contained
elsewhere in this prospectus and does not contain all of the
information you need to consider in making your investment
decision. This summary is qualified in its entirety by the more
detailed information and the combined and consolidated financial
statements and notes thereto appearing elsewhere in this
prospectus. You should read carefully this entire prospectus and
should consider, among other things, the matters set forth in
the section entitled “Risk Factors.”
References to “we,” “us,”
“our,” the “company” and “Emergency
Medical Services” refer to Emergency Medical Services
Corporation and its subsidiaries, including its predecessors.
Unless the context otherwise requires, these references give
effect to (i) the formation of Emergency Medical Services
as a holding company, in which Emergency Medical Services L.P.,
or EMS L.P., will become a consolidated subsidiary of the
company, and (ii) the initial public offering of our common
stock and our intended use of the proceeds of that offering. See
“Formation of Holding Company.” References to AMR and
EmCare refer, respectively, to American Medical Response, Inc.
and its subsidiaries and to EmCare Holdings Inc. and its
subsidiaries, including its affiliated physician groups and
managed companies. “Our physicians” and “our
healthcare professionals” include physicians employed by,
or contracted with, these affiliated physician groups.
References to “the issuers” or “AMR
HoldCo” and “EmCare HoldCo” are references to AMR
HoldCo, Inc. and EmCare HoldCo, Inc., the holding companies of
AMR and EmCare, respectively, which were created for the sole
purpose of serving as joint and several co-issuers of the notes
and co-borrowers under our senior secured credit facility.
References to “our offering” or “our initial
public offering” are references to the proposed initial
public offering of Emergency Medical Services. See
“Formation of Holding Company”.
Company Overview
Emergency Medical Services Corporation is a leading provider of
emergency medical services in the United States. We operate our
business and market our services under the AMR and EmCare
brands. AMR is the leading provider of ambulance services in the
United States, based on net revenue and number of transports.
EmCare is the leading provider of outsourced emergency
department staffing and related management services in the
United States, based on number of contracts with hospitals and
affiliated physician groups. Approximately 86% of our fiscal
2004 net revenue was generated under exclusive contracts.
During fiscal 2004, we provided emergency medical services to
approximately 9 million patients in more than 2,000
communities nationwide. For the fiscal year ended
August 31, 2004, we generated net revenue of
$1.6 billion, of which AMR and EmCare represented
approximately 66% and 34%, respectively.
AMR. Over its 50 years of operating history, AMR has
developed the largest network of ambulance services in the
United States. AMR has an 8% share of the total ambulance
services market and a 21% share of the private provider
ambulance market. During fiscal 2004, AMR treated and
transported approximately 3.7 million patients in
34 states. AMR has approximately 2,550 contracts with
communities, government agencies, healthcare providers and
insurers to provide ambulance transport services. AMR’s
broad geographic footprint enables us to contract on a national
and regional basis with managed care and insurance companies.
AMR has made significant investments in technology, customer
service programs, employee training and risk mitigation programs
to enhance quality and reduce costs for our customers. We
believe this has resulted in our improvement in contract
retention, from 81% in fiscal 2001 to what we believe is our
industry-leading contract retention rate of 99% in fiscal 2004.
For fiscal 2004, approximately 57% of AMR’s net revenue was
generated from emergency 911 ambulance services, 32% from
non-emergency ambulance services and the balance generated from
the provision of training, dispatch centers and other services
to communities and public safety agencies.
EmCare. Over its 33 years of operating history,
EmCare has become the largest provider of outsourced emergency
department staffing and related management services to
healthcare facilities. EmCare has a 6%
1
share of the total emergency department services market and a 9%
share of the outsourced emergency department services market. In
addition, EmCare has become one of the leading providers of
hospitalist services, the staffing of physicians that specialize
in the care of acutely ill patients in an inpatient setting.
During fiscal 2004, EmCare had approximately 5.3 million
patient visits in 38 states. EmCare has 329 exclusive
contracts with hospitals and independent physician groups to
provide emergency department, hospitalist and radiology
staffing, management and other administrative services. We
believe that EmCare’s successful physician recruitment and
retention, high level of customer service and advanced risk
management programs have resulted in our improvement in contract
retention, from 74% in fiscal 2001 to what we believe is an
industry-leading contract retention rate of 91% in fiscal 2004.
Emergency Medical Services Industry
We operate in the ambulance and emergency department services
markets, two large and growing segments of the emergency medical
services market. Most communities are required by law to provide
emergency ambulance services and most hospitals are required to
provide emergency department services. Emergency medical
services are a core component of the range of care a patient
could potentially receive in the pre-hospital and hospital-based
settings. Accordingly, we believe that expenditures for
emergency medical services will continue to correlate closely
with growth in the U.S. hospital market. Approximately 43%
of all hospital admissions originated from the emergency
department in 2003, and a substantial portion of patients enter
the hospital by way of ambulance transport. We believe that
growth in our emergency medical services markets will also be
driven by an increase in outsourcing for these services and
increased federal funding for disaster preparedness and response.
Ambulance Services
Ambulance services encompass both 911 emergency response and
non-emergency transport services. We believe the ambulance
services market represents annual expenditures of approximately
$12 billion. The ambulance services market is highly
fragmented, with more than 14,000 private, public and
not-for-profit service providers accounting for an estimated
36 million ambulance transports in 2004. There are a
limited number of regional ambulance providers and we are one of
only two national ambulance providers. Given demographic trends,
we expect the total number of ambulance transports to continue
to grow at a steady rate of 1% to 2% per year.
Due to increased demand for effective use of technology,
cost-efficient services, improved patient outcomes and emergency
preparedness and response, we believe that the current trend by
communities and hospitals to outsource ambulance services will
contribute to growth for private providers. According to the
Journal of Emergency Medical Services, the percentage of
emergency medical transportation services delivered by private
ambulance providers in the nation’s 200 largest cities
increased from 34% in 1999 to 39% in 2003. Furthermore, we
expect private providers to benefit as hospitals continue to
outsource more of their ambulance services due to changes in
reimbursement rates and increased use of outpatient services.
Emergency Department Services
We believe the physician reimbursement component of the
emergency department services market represents annual
expenditures of approximately $10 billion. There are
approximately 4,700 hospitals in the United States that operate
emergency departments, of which approximately 67% outsource
their physician staffing and management for this department. The
market for outsourced emergency department staffing and related
management services is highly fragmented, with more than
800 national, regional and local providers. We believe we
are one of only five national providers.
Between 1993 and 2003, the total number of patient visits to
hospital emergency departments increased from 90.3 million
to 113.9 million, an increase of 26%. At the same time, the
number of hospital emergency departments declined 12%. As a
result, the average number of patient visits per hospital
emergency department increased substantially during that period.
We believe these trends are resulting in an increased focus by
hospitals on their emergency departments. As the per hospital
demand for emergency department visits
2
continues to increase, we believe that more hospitals will turn
to well-established providers, such as EmCare, which have a
demonstrated track record of improving productivity and
efficiency while providing high quality care.
Competitive Strengths
We believe the following competitive strengths position our
company to capitalize on the favorable trends occurring within
the healthcare industry and the emergency medical services
markets.
Leading, Established Provider of Emergency Medical
Services. We are a leading provider of emergency medical
services in the United States. AMR is the leading provider of
ambulance services, with net revenue approximately twice that of
our only national competitor. During fiscal 2004, AMR treated
and transported approximately 3.7 million patients in
34 states. We believe that EmCare is the leading provider
of outsourced staffing and related management services to
emergency departments, with 32% more emergency department
staffing contracts than our principal national competitor.
EmCare’s 4,500 affiliated physicians provide services to
over 300 client hospitals, including many of the top 100
hospitals in the United States. EmCare is also a leading
provider of hospitalist services, based on number of contracts
with hospitals.
Significant Scale and Geographic Presence. We believe our
significant scale and broad geographic presence provide a
competitive advantage over local and regional providers in most
areas, including our: (i) broad program offering and cost
efficiencies generated by our technology investment, which may
be too costly for certain providers to replicate;
(ii) national contracting and preferred provider
relationships with managed care organizations and healthcare
systems; and (iii) ability to recruit and retain quality
personnel, which also lowers our costs associated with employee
turnover and increases customer and patient satisfaction.
Long-Term Relationships with Existing Customers. We
believe our long-term, well-established relationships with
communities and healthcare facilities enhance our ability to
retain existing customers and win new contracts. AMR and EmCare
have maintained relationships with their ten largest customers
for an average of 34 and 12 years, respectively. We believe
our industry-leading contract retention rates reflect our
ability to deliver on our service commitments to our customers
over extended time periods.
Strong Financial Performance. When we compete for new
business, one of the key factors our potential customers
evaluate is financial stability. As a result, we believe our
track record of strong financial performance provides us with a
competitive advantage over our competitors. We believe our
ability to demonstrate consistently strong financial performance
will continue to differentiate our company and provide a
competitive advantage in winning new contracts and renewing
existing contracts.
Focus on Risk Management. Considered by certain insurance
industry consultants to be one of the leading programs of its
kind in the emergency department industry, EmCare’s risk
management initiatives are enhanced by the use of our
professional liability claims database and comprehensive claims
management. AMR’s risk/ safety program is aimed at reducing
worker injuries through training and improved equipment, and
increasing vehicle safety through the use of technology. Over
the last three years, our workers compensation, auto, general
and professional liability claims per 100,000 ambulance
transports decreased 8.4% at AMR and our professional liability
claims per 100,000 emergency department visits decreased 14.0%
at EmCare.
Investment in Core Technologies. We utilize technology as
a means to enhance quality, reduce the cost of our service
offerings, more effectively manage risk and improve our
profitability. At AMR, we expect our proprietary electronic
patient care records system to improve chart documentation and
reduce costs. AMR also utilizes proprietary software,
Millennium, to determine the appropriate level of transportation
services to be dispatched and track response times and other
data for hospitals. At EmCare, our proprietary physician
recruitment software has enhanced our recruitment efficiency and
improved our physician retention rate. EmCare also tracks risk
exposure trends through what we believe is one of the largest
emergency department risk databases, allowing us to assess,
develop and implement targeted risk intervention programs.
3
Proven and Committed Management Team. We are led by an
experienced senior management team with an average of
21 years of experience in the healthcare industry. Our
Chairman and Chief Executive Officer, William Sanger, has over
30 years of experience within the healthcare services
industry, with leadership roles in multi-system hospitals,
ambulatory care facilities, post-acute service facilities,
physician management companies and insurance entities. Since
Mr. Sanger joined us in 2001, our senior management team
has been successful in growing the market share of our
businesses, managing changes in reimbursement policy, reducing
professional liability risk and improving the profitability of
our operations.
Business Strategy
We intend to leverage Emergency Medical Services’
competitive strengths to pursue our business strategy:
Increase Revenue from Existing Customers. We believe our
long track record of delivering excellent service and quality
patient care and innovative programs for both communities and
hospitals, coupled with our breadth of services, creates
opportunities for us to increase revenue from our existing
customer base.
Grow Our Customer Base. We believe we have a unique
competency in the treatment, management and billing of episodic
and unscheduled care. We believe our significant scope and scale
and leading market position provide us with new and expanded
opportunities to grow our customer base. We will continue to
generate new revenue and client growth by pursuing additional
outsourcing opportunities for ambulance transports and emergency
department, hospitalist and radiology services, expanding our
public/private ambulance partnerships with local fire
departments and managing health-related transportation logistics.
Pursue Select Acquisition Opportunities. The emergency
medical services industry is highly fragmented. We plan to
pursue select acquisitions in our core businesses, including
acquisitions to enhance our presence in existing markets and our
entry into new geographic markets. We will also explore the
acquisition of complementary businesses, such as radiology,
hospitalist and managed health-related transportation services
and seek opportunities to expand the scope of services in which
we can leverage our core competencies.
Utilize Technology to Differentiate Our Services and Improve
Operating Efficiencies. We intend to continue to invest in
technologies that broaden our services in the marketplace,
improve patient care, enhance our billing efficiencies and
increase our profitability. We believe that the complexities of
the healthcare industry and customer demand for broader, more
cost-effective service offerings will continue to benefit those
providers that remain at the forefront of technological
innovation.
Continued Focus on Risk Management. Through our risk
management and quality assurance staffs, technology platform and
well-trained medical personnel, we will continue to conduct
aggressive risk management programs for loss prevention and
early intervention. We will continue to develop and utilize
clinical “fail safes” and use technology in our
ambulances to reduce vehicular incidents.
Implement Cost Rationalization Initiatives. We will
continue to rationalize our cost structure by aligning
compensation with productivity, developing risk management
initiatives that are focused on mitigating risk exposures, and
eliminating costs in our national and regional corporate support
structure.
Company History
In February 2005, an investor group led by Onex Partners LP and
Onex Corporation, and including members of our management,
purchased our operating subsidiaries — AMR and
EmCare — from Laidlaw International, Inc. Laidlaw had
acquired AMR and EmCare in 1997.
The purchase price for AMR and EmCare totaled
$828.8 million. We funded the purchase price and related
transaction costs with equity contributions of
$219.2 million, the issuance and sale of
$250.0 million principal amount of our senior subordinated
notes and borrowings under our senior secured credit facility,
including a term loan of $350.0 million and approximately
$20.2 million under our revolving credit facility.
4
We intend to use approximately
$ million
of the net proceeds from our initial public offering to repay
debt outstanding under our senior secured credit facility.
Since completing our acquisition of AMR and EmCare, we have
operated through a holding company, EMS L.P., that is a limited
partnership. As described in “Formation of Holding
Company”, our new holding company will be a Delaware
corporation upon completion of our initial public offering.
Risk Factors
Investing in the exchange notes involves risks. You should refer
to the section entitled “Risk Factors” for a
discussion of certain risks you should consider before deciding
whether to invest in the exchange notes.
Executive Offices
Our principal executive offices are located at
6200 S. Syracuse Way, Suite 200, Greenwood
Village, Colorado 80111 and our telephone number at that address
is (303) 495-1200. Our website address is
www.emsc.net. The website addresses for our business
segments are www.amr.net and www.emcare.com.
Information contained on these websites is not part of this
prospectus and is not incorporated in this prospectus by
reference.
5
The Exchange Offer
On February 10, 2005, we completed an offering of
$250,000,000 aggregate principal amount of 10% senior
subordinated notes due 2015, which was exempt from registration
under the Securities Act.
We sold the outstanding notes to the initial purchasers, which
subsequently resold the outstanding notes to qualified
institutional buyers pursuant to Rule 144A under the
Securities Act.
In connection with the sale of the outstanding notes,
EMS L.P., the issuers and the subsidiary guarantors entered
into a registration rights agreement with the initial
purchasers. Under the terms of that agreement, we agreed to use
commercially reasonable efforts to consummate the exchange offer
contemplated by this prospectus.
If we are not able to effect the exchange offer contemplated by
this prospectus, EMS L.P., the issuers and the subsidiary
guarantors will use commercially reasonable efforts to file and
cause to become effective a shelf registration statement
relating to the resales of the outstanding notes. We must pay
additional interest on the notes if we do not complete the
exchange offer within 30 days after the date that the
registration statement, of which this prospectus is a part, is
declared effective or, if required, the shelf registration
statement is not declared effective within 30 days after
the date it is filed.
The following is a brief summary of the terms of the exchange
offer. For a more complete description of the exchange offer,
see “The Exchange Offer.”
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Securities Offered |
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$250,000,000 aggregate principal amount of 10% senior
subordinated notes due 2015. |
|
Exchange Offer |
|
The exchange notes are being offered in exchange for a like
principal amount of outstanding notes. We will accept any and
all outstanding notes validly tendered and not withdrawn prior
to 5:00 p.m., New York City time,
on ,
2005. Holders may tender some or all of their outstanding notes
pursuant to the exchange offer. However, outstanding notes may
be tendered only in integral multiples of $1,000 in principal
amount. The form and terms of the exchange notes are the same as
the form and terms of the outstanding notes except that: |
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• the exchange notes have been registered under the
federal securities laws and will not bear any legend restricting
their transfer; |
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• the exchange notes will bear a different CUSIP
number than the outstanding notes; and |
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• the holders of the exchange notes will not be
entitled to certain rights under the registration rights
agreement, including the provisions for an increase in the
interest rate on the outstanding notes in some circumstances
relating to the timing of the exchange offer. |
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See “The Exchange Offer.” |
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Resale of the Exchange Notes |
|
Based on an interpretation by the staff of the Securities and
Exchange Commission, or the SEC, set forth in no-action letters
issued to third parties, we believe that the exchange notes
issued in the exchange offer in exchange for outstanding notes
may be offered for resale, resold and otherwise transferred by
you without |
6
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compliance with the registration and prospectus delivery
provisions of the Securities Act, provided that: |
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• you are acquiring the exchange notes in the ordinary
course of your business, |
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• you have not engaged in, do not intend to engage in,
and have no arrangement or understanding with any person to
participate in the distribution of exchange notes, and |
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• you are not an “affiliate” of Emergency
Medical Services within the meaning of Rule 405 of the
Securities Act. |
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|
Each participating broker-dealer that receives exchange notes
for its own account during the exchange offer in exchange for
outstanding notes that were acquired as a result of
market-making or other trading activity must acknowledge that it
will deliver a prospectus in connection with any resale of the
exchange notes. Prospectus delivery requirements are discussed
in greater detail in the section captioned “Plan of
Distribution.” |
|
|
|
Any holder of outstanding notes who: |
|
|
|
• is an affiliate of Emergency Medical Services, |
|
|
|
• does not acquire exchange notes in the ordinary
course of its business, or |
|
|
|
• tenders in the exchange offer with the intention to
participate, or for the purpose of participating, in a
distribution of exchange notes, |
|
|
|
cannot rely on the position of the staff of the SEC enunciated
in Exxon Capital Holdings Corporation, Morgan Stanley &
Co. Incorporated or similar no-action letters and, in the
absence of an exemption, must comply with the registration and
prospectus delivery requirements of the Securities Act in
connection with the resale of the exchange notes. |
|
Expiration Date |
|
The exchange offer will expire at 5:00 p.m., New York City
time,
on ,
2005, unless we decide to extend the exchange offer. Any
outstanding notes not accepted for exchange for any reason will
be returned without expense to the tendering holders promptly
after expiration or termination of the exchange offer. |
|
Conditions to the Exchange Offer |
|
The exchange offer is subject to certain customary conditions,
some of which may be waived by us. See “The Exchange
Offer — Conditions to the Exchange Offer.” |
|
Procedures for Tendering Notes |
|
If you wish to accept the exchange offer, you must complete,
sign and date the letter of transmittal, or a facsimile of the
letter of transmittal, in accordance with the instructions
contained in this prospectus and in the letter of transmittal.
You should then mail or otherwise deliver the letter of
transmittal, or facsimile, together with the outstanding notes
to be exchanged and any other required documentation, to the
exchange agent at the address set forth in this prospectus and
in the letter of transmittal. If you hold outstanding notes
through the Depository Trust Company, or DTC, and wish to
participate in the exchange offer, you must comply |
7
|
|
|
|
|
with the Automated Tender Offer Program procedures of DTC, by
which you will agree to be bound by the applicable letter of
transmittal. |
|
|
|
By executing or agreeing to be bound by the letter of
transmittal, you will represent to us that, among other things: |
|
|
|
• any exchange notes to be received by you will be
acquired in the ordinary course of business, |
|
|
|
• you have no arrangement or understanding with any
person to participate in the distribution (within the meaning of
the Securities Act) of exchange notes in violation of the
provisions of the Securities Act, |
|
|
|
• you are not an “affiliate” (within the
meaning of Rule 405 under the Securities Act) of Emergency
Medical Services or, if you are an affiliate, you will comply
with any applicable registration and prospectus delivery
requirements of the Securities Act, and |
|
|
|
• if you are a broker-dealer that will receive
exchange notes for your own account in exchange for outstanding
notes that were acquired as a result of market-making or other
trading activities, then you will deliver a prospectus in
connection with any resale of such exchange notes. |
|
|
|
See “The Exchange Offer — Procedures for
Tendering” and “Plan of Distribution.” |
|
Effect of Not Tendering |
|
Any outstanding notes that are not tendered or that are tendered
but not accepted will remain subject to the restrictions on
transfer. Since the outstanding notes have not been registered
under the federal securities laws, they bear a legend
restricting their transfer absent registration or the
availability of a specific exemption from registration. Upon the
completion of the exchange offer, we will have no further
obligations to register, and we do not currently anticipate that
we will register, the outstanding notes under the Securities
Act. See “The Exchange Offer — Effect of Not
Tendering.” |
|
Special Procedures for Beneficial Owners |
|
If you are a beneficial owner of outstanding notes which are not
registered in your name, and you wish to tender outstanding
notes in the exchange offer, you should contact the registered
holder promptly and instruct the registered holder to tender on
your behalf. If you wish to tender on your own behalf, you must,
prior to completing and executing the applicable letter of
transmittal and delivering your outstanding notes, either make
appropriate arrangements to register ownership of the
outstanding notes in your name or obtain a properly completed
bond power from the registered holder. |
|
Guaranteed Delivery Procedures |
|
If you wish to tender your outstanding notes and your
outstanding notes are not immediately available or you cannot
deliver your outstanding notes, the applicable letter of
transmittal or any other documents required by the applicable
letter of transmittal or |
8
|
|
|
|
|
comply with the applicable procedures under DTC’s Automated
Tender Offer Program prior to the expiration date, you must
tender your outstanding notes according to the guaranteed
delivery procedures set forth in this prospectus under “The
Exchange Offer — Guaranteed Delivery Procedures.” |
|
Interest on the Notes and the Outstanding Notes |
|
The exchange notes will bear interest from the most recent
interest payment date to which interest has been paid on the
outstanding notes. Interest on the outstanding notes accepted
for exchange will cease to accrue upon the issuance of the
exchange notes. |
|
Withdrawal Rights |
|
Tenders of outstanding notes may be withdrawn at any time prior
to 5:00 p.m., New York City time, on the expiration date. |
|
U.S. Federal Income Tax
Considerations |
|
The exchange of outstanding notes for exchange notes in the
exchange offer will not be a taxable event for U.S. federal
income tax purposes. Please read the section of this prospectus
captioned “Material United States Federal Income Tax
Considerations” for more information on tax considerations
of the exchange offer. |
|
Use of Proceeds |
|
We will not receive any cash proceeds from the issuance of
exchange notes in to the exchange offer. |
|
Exchange Agent |
|
U.S. Bank Trust National Association, the trustee
under the indenture, is serving as exchange agent in connection
with the exchange offer. |
9
Description of Exchange Notes
|
|
|
Issuers |
|
AMR HoldCo, Inc. and EmCare HoldCo, Inc. |
|
Notes Offered |
|
$250,000,000 aggregate principal amount of senior subordinated
notes due 2015. |
|
Maturity Date |
|
February 15, 2015. |
|
Interest |
|
10% per year on the principal amount, payable semi-annually
in cash in arrears on February 15 and August 15 of each year,
commencing August 15, 2005. |
|
Guarantees |
|
EMS L.P. and each of the issuers’ direct and indirect
domestic restricted subsidiaries will jointly, severally and
unconditionally guarantee the exchange notes on a senior
subordinated basis. |
|
Ranking |
|
The exchange notes will be the issuers’ general unsecured
senior subordinated obligations, will be subordinated in right
of payment to the issuers’ existing and future senior debt,
will be pari passu in right of payment with any of the
issuers’ future senior subordinated debt and will be senior
in right of payment to any of the issuers’ future
subordinated debt. |
|
|
|
The guarantee of each guarantor will be that guarantor’s
unsecured senior subordinated obligation, will be subordinated
in right of payment to all of that guarantor’s existing and
future senior debt, will be pari passu in right of payment with
any of that guarantor’s future senior subordinated debt and
will be senior in right of payment to any of that
guarantor’s future subordinated debt. In addition, the
exchange notes and the guarantees will effectively be
subordinated to all of the issuers’ and the
guarantors’ secured debt to the extent of the value of the
assets securing the debt and structurally subordinated to all
liabilities and commitments (including trade payables and lease
obligations) of the issuers’ subsidiaries that are not
guaranteeing the exchange notes. |
|
|
|
As of June 30, 2005, we had outstanding an aggregate of
$605.9 million of debt. This debt includes
$349.1 million of debt outstanding under our senior secured
credit facility that ranks senior to the notes. |
|
Optional Redemption |
|
On or after February 15, 2010, we may redeem some or all of
the notes at any time at the redemption prices described in
“Description of Notes — Optional
Redemption,” plus accrued and unpaid interest and
liquidated damages, if any, to the redemption date. |
|
|
|
In addition, prior to February 15, 2008, on one or more
occasions, we may redeem up to 35% of the aggregate principal
amount of the notes at a purchase price equal to 110% of the
aggregate principal amount of the notes, plus accrued and unpaid
interest and liquidated damages, if any, to the redemption date,
with the net proceeds of one or more equity offerings or
contributions, provided, that at least 65% of the
aggregate principal amount of notes originally issued under the
indenture remains outstanding after the redemption. We do not
expect to use any part of the net proceeds of our initial public
offering to redeem notes. See “Description of
Notes — Optional Redemption.” |
10
|
|
|
Mandatory Offer to Repurchase |
|
If we sell certain assets or we experience specific kinds of
changes of control, we must offer to repurchase the notes at the
prices described in “Description of Notes —
Repurchase at the Option of Holders.” Our ability to pay
cash to holders of notes upon a repurchase may be limited by our
then existing financial resources. See “Risk
Factors — Risk Factors Related to the
Notes — We may be unable to finance a change of
control offer.” |
|
Certain Covenants |
|
The indenture contains covenants that limit, among other things,
the issuers’ ability and the ability of their restricted
subsidiaries to: |
|
|
|
• incur additional indebtedness and issue certain
preferred stock; |
|
|
|
• pay dividends on their capital stock or repurchase
their capital stock or subordinated debt; |
|
|
|
• make investments; |
|
|
|
• incur liens securing debt other than senior debt; |
|
|
|
• sell certain assets or merge with or into other
companies; and |
|
|
|
• incur restrictions on the ability of their
subsidiaries to make distributions or transfer assets to the
issuers. |
|
|
|
These covenants are subject to important exceptions and
qualifications, which are described in “Description of
Notes — Certain Covenants.” |
|
Absence of a Public Market |
|
There is no public market for the exchange notes. We do not
intend to apply for the exchange notes to be listed on any
securities exchange or to arrange for any quotation system to
quote them. If an active public market does not develop, the
market price and liquidity of the exchange notes may be
adversely affected. |
|
Risk Factors |
|
Investing in the notes involves risks. You should refer to the
section entitled “Risk Factors” for a discussion of
certain risks you should consider before deciding whether to
invest in the notes. |
|
|
|
For more information about the exchange notes, see
“Description of Notes.” |
11
Summary of Historical Combined, Consolidated and Pro Forma
Consolidated Financial Information and Other Data
The summary combined financial data of AMR and EmCare for the
year ended August 31, 2002 (Predecessor —
Pre-Laidlaw Bankruptcy), the nine months ended May 31, 2003
(Predecessor — Pre-Laidlaw Bankruptcy), and as of and
for the three months ended August 31, 2003
(Predecessor — Post-Laidlaw Bankruptcy), the year
ended August 31, 2004 (Predecessor — Post-Laidlaw
Bankruptcy) and the five months ended January 31, 2005
(Predecessor — Post-Laidlaw Bankruptcy) are derived
from our audited combined historical financial statements
included in this prospectus. As a result of a correction to
AMR’s method of calculating its accounts receivable
allowances, we determined that the allowances were understated
at various balance sheet dates. The audited combined financial
statements included in this prospectus are restated to correct
this error. There were no adjustments necessary to income
subsequent to May 31, 2003.
The summary combined historical financial data for the five
months ended January 31, 2004 (Predecessor —
Post-Laidlaw Bankruptcy) and the three months and five months
ended June 30, 2004 (Predecessor — Post-Laidlaw
Bankruptcy) are derived from the unaudited combined historical
financial statements included in this prospectus. The summary
consolidated financial data for the three months and five months
ended June 30, 2005 (Successor) are derived from the
unaudited consolidated historical financial statements included
elsewhere in this prospectus. The interim financial statements
include, in the opinion of management, all adjustments,
consisting of normal accruals, necessary for a fair presentation
of the information for those periods. The results of operations
for the interim periods may not be indicative of results that
may be expected for the full fiscal year.
The summary pro forma consolidated financial information and
other data for the year ended August 31, 2004, the five
months ended January 31, 2005 and the five months ended
June 30, 2005 reflect the acquisition of AMR and EmCare by
Emergency Medical Services and the completion of this offering,
and should be read in conjunction with our unaudited pro forma
consolidated financial statements included elsewhere in this
prospectus which, with respect to statement of operations data,
give effect to the acquisition and this offering as if they
occurred as of September 1, 2003, September 1, 2004
and February 1, 2005, respectively, and with respect to
balance sheet data, give effect to this offering as if it
occurred as of June 30, 2005. The unaudited pro forma
consolidated financial information is presented for
informational purposes only and does not purport to represent
what our results of operations would have been if our
acquisition of AMR and EmCare and this offering had occurred as
of the dates indicated or what such results will be for future
periods.
Effective as of January 31, 2005, we acquired AMR and
EmCare from Laidlaw and, in connection with the acquisition, we
changed our fiscal year to December 31 from August 31. For all
periods prior to the acquisition, the AMR and EmCare businesses
formerly owned by Laidlaw are referred to as the
“Predecessor.” For all periods from and subsequent to
the acquisition, these businesses are referred to as the
“Successor.” As a result of the acquisition, we
include as a reporting period of the Predecessor our
pre-acquisition period ended January 31, 2005.
You should read the summary information in conjunction with
“Selected Combined and Consolidated Financial Information
and Other Data,” “Unaudited Pro Forma Consolidated
Financial Data,” “Management’s Discussion and
Analysis of Financial Condition and Results of Operations”
and the combined and consolidated financial statements and
related notes included in this prospectus.
12
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|
Predecessor (Pre-Acquisition) | |
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| |
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| |
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(Pre-Laidlaw | |
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Bankruptcy) | |
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|
Successor (Post- | |
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|
As Restated | |
|
|
(Post-Laidlaw Bankruptcy) | |
|
|
Acquisition) | |
|
Unaudited Pro Forma | |
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| |
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| |
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| |
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| |
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|
Nine | |
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Three | |
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Three | |
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Five | |
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Three | |
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Five | |
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Five | |
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Five | |
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Year | |
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Months | |
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|
Months | |
|
Year | |
|
Five Months Ended | |
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Months | |
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Months | |
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|
Months | |
|
Months | |
|
Year | |
|
Months | |
|
Months | |
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|
Ended | |
|
Ended | |
|
|
Ended | |
|
Ended | |
|
January 31, | |
|
Ended | |
|
Ended | |
|
|
Ended | |
|
Ended | |
|
Ended | |
|
Ended | |
|
Ended | |
|
|
August 31, | |
|
May 31, | |
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|
August 31, | |
|
August 31, | |
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| |
|
June 30, | |
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June 30, | |
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|
June 30, | |
|
June 30, | |
|
August 31, | |
|
January 31, | |
|
June 30, | |
|
|
2002 | |
|
2003 | |
|
|
2003 | |
|
2004 | |
|
2004 | |
|
2005 | |
|
2004 | |
|
2004 | |
|
|
2005 | |
|
2005 | |
|
2004 | |
|
2005 | |
|
2005 | |
|
|
| |
|
| |
|
|
| |
|
| |
|
| |
|
| |
|
| |
|
| |
|
|
| |
|
| |
|
| |
|
| |
|
| |
|
|
|
|
|
|
|
|
|
|
|
(unaudited) | |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
(unaudited) | |
|
|
(unaudited) | |
|
|
|
|
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|
|
|
|
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|
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|
(dollars in thousands) | |
|
|
|
|
|
|
|
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|
Statement of Operations Data:
|
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|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
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|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Net revenue
|
|
$ |
1,415,786 |
|
|
$ |
1,103,335 |
|
|
|
$ |
384,461 |
|
|
$ |
1,604,598 |
|
|
$ |
667,506 |
|
|
$ |
696,179 |
|
|
$ |
399,975 |
|
|
$ |
663,880 |
|
|
|
$ |
445,021 |
|
|
$ |
731,410 |
|
|
$ |
1,604,598 |
|
|
$ |
696,179 |
|
|
$ |
731,410 |
|
Compensation and benefits
|
|
|
960,590 |
|
|
|
757,183 |
|
|
|
|
264,604 |
|
|
|
1,117,890 |
|
|
|
461,923 |
|
|
|
481,305 |
|
|
|
280,364 |
|
|
|
464,610 |
|
|
|
|
307,308 |
|
|
|
502,998 |
|
|
|
1,117,890 |
|
|
|
481,305 |
|
|
|
502,998 |
|
Operating expenses
|
|
|
219,321 |
|
|
|
163,447 |
|
|
|
|
55,212 |
|
|
|
218,277 |
|
|
|
90,828 |
|
|
|
94,882 |
|
|
|
53,490 |
|
|
|
91,661 |
|
|
|
|
63,250 |
|
|
|
102,170 |
|
|
|
218,277 |
|
|
|
94,882 |
|
|
|
102,170 |
|
Insurance expense
|
|
|
66,479 |
|
|
|
69,576 |
|
|
|
|
34,671 |
|
|
|
80,255 |
|
|
|
40,393 |
|
|
|
39,002 |
|
|
|
22,865 |
|
|
|
36,865 |
|
|
|
|
22,427 |
|
|
|
39,334 |
|
|
|
80,255 |
|
|
|
39,002 |
|
|
|
39,334 |
|
Selling, general and administrative expenses
|
|
|
61,455 |
|
|
|
37,867 |
|
|
|
|
12,017 |
|
|
|
47,899 |
|
|
|
22,016 |
|
|
|
21,635 |
|
|
|
12,805 |
|
|
|
19,269 |
|
|
|
|
14,498 |
|
|
|
23,179 |
|
|
|
47,899 |
|
|
|
21,635 |
|
|
|
23,179 |
|
Laidlaw fees and compensation charges
|
|
|
5,400 |
|
|
|
4,050 |
|
|
|
|
1,350 |
|
|
|
15,449 |
|
|
|
6,436 |
|
|
|
19,857 |
|
|
|
3,862 |
|
|
|
6,436 |
|
|
|
|
— |
|
|
|
— |
|
|
|
15,449 |
|
|
|
19,857 |
|
|
|
— |
|
Depreciation and amortization expenses
|
|
|
67,183 |
|
|
|
32,144 |
|
|
|
|
12,560 |
|
|
|
52,739 |
|
|
|
22,079 |
|
|
|
18,808 |
|
|
|
13,160 |
|
|
|
21,958 |
|
|
|
|
14,136 |
|
|
|
23,988 |
|
|
|
55,873 |
|
|
|
23,232 |
|
|
|
23,988 |
|
Impairment losses
|
|
|
262,780 |
|
|
|
— |
|
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
Restructuring charges
|
|
|
3,777 |
|
|
|
1,288 |
|
|
|
|
1,449 |
|
|
|
2,115 |
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
1,381 |
|
|
|
|
— |
|
|
|
— |
|
|
|
2,115 |
|
|
|
— |
|
|
|
— |
|
Laidlaw reorganization charges
|
|
|
8,761 |
|
|
|
3,650 |
|
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Income (loss) from operations
|
|
|
(239,960 |
) |
|
|
34,130 |
|
|
|
|
2,598 |
|
|
|
69,974 |
|
|
|
23,831 |
|
|
|
20,690 |
|
|
|
13,429 |
|
|
|
21,700 |
|
|
|
|
23,402 |
|
|
|
39,741 |
|
|
|
66,840 |
|
|
|
16,266 |
|
|
|
39,741 |
|
Interest expense
|
|
|
(6,418 |
) |
|
|
(4,691 |
) |
|
|
|
(908 |
) |
|
|
(9,961 |
) |
|
|
(4,137 |
) |
|
|
(5,644 |
) |
|
|
(3,073 |
) |
|
|
(3,541 |
) |
|
|
|
(13,646 |
) |
|
|
(21,584 |
) |
|
|
|
|
|
|
|
|
|
|
|
|
Realized gain (loss) on investments
|
|
|
— |
|
|
|
— |
|
|
|
|
90 |
|
|
|
(1,140 |
) |
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
(52 |
) |
|
|
|
33 |
|
|
|
(6 |
) |
|
|
(1,140 |
) |
|
|
— |
|
|
|
(6 |
) |
Interest and other income
|
|
|
369 |
|
|
|
304 |
|
|
|
|
22 |
|
|
|
240 |
|
|
|
1,403 |
|
|
|
714 |
|
|
|
12 |
|
|
|
48 |
|
|
|
|
81 |
|
|
|
94 |
|
|
|
240 |
|
|
|
|
|
|
|
94 |
|
Fresh-start accounting adjustments(1)
|
|
|
— |
|
|
|
46,416 |
|
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Income (loss) before income taxes and cumulative change in
accounting principle
|
|
|
(246,009 |
) |
|
|
76,159 |
|
|
|
|
1,802 |
|
|
|
59,113 |
|
|
|
21,097 |
|
|
|
15,760 |
|
|
|
10,368 |
|
|
|
18,155 |
|
|
|
|
9,870 |
|
|
|
18,245 |
|
|
|
|
|
|
|
|
|
|
|
|
|
Income tax expense
|
|
|
(1,374 |
) |
|
|
(829 |
) |
|
|
|
(8,633 |
) |
|
|
(21,764 |
) |
|
|
(8,558 |
) |
|
|
(6,278 |
) |
|
|
(4,794 |
) |
|
|
(7,831 |
) |
|
|
|
(3,821 |
) |
|
|
(7,178 |
) |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Income (loss) before cumulative effect of a change in accounting
principle
|
|
|
(247,383 |
) |
|
|
75,330 |
|
|
|
|
(6,831 |
) |
|
|
37,349 |
|
|
|
12,539 |
|
|
|
9,482 |
|
|
|
5,574 |
|
|
|
10,324 |
|
|
|
|
6,049 |
|
|
|
11,067 |
|
|
|
|
|
|
|
|
|
|
|
|
|
Cumulative effect of a change in accounting principle(2)
|
|
|
— |
|
|
|
(223,721 |
) |
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Net income (loss)
|
|
$ |
(247,383 |
) |
|
$ |
(148,391 |
) |
|
|
$ |
(6,831 |
) |
|
$ |
37,349 |
|
|
$ |
12,539 |
|
|
$ |
9,482 |
|
|
$ |
5,574 |
|
|
$ |
10,324 |
|
|
|
$ |
6,049 |
|
|
$ |
11,067 |
|
|
$ |
|
|
|
$ |
|
|
|
$ |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Predecessor (Pre-Acquisition) | |
|
|
|
|
|
|
|
|
|
|
|
|
|
| |
|
|
| |
|
|
|
|
|
|
|
|
|
|
|
|
|
(Pre-Laidlaw | |
|
|
|
|
|
|
|
Successor | |
|
|
|
|
|
|
|
|
Bankruptcy) | |
|
|
|
|
|
|
|
(Post- | |
|
|
|
|
|
|
|
|
As Restated | |
|
|
(Post-Laidlaw Bankruptcy) | |
|
|
|
|
Acquisition) | |
|
|
|
|
|
|
|
|
| |
|
|
| |
|
|
|
|
| |
|
|
|
|
|
|
|
|
|
|
Nine | |
|
|
Three | |
|
|
|
|
|
|
|
Five | |
|
|
|
|
Five | |
|
|
|
|
|
|
|
|
Year | |
|
Months | |
|
|
Months | |
|
Year | |
|
Five Months Ended | |
|
|
|
Months | |
|
|
|
|
Months | |
|
|
|
|
|
|
|
|
Ended | |
|
Ended | |
|
|
Ended | |
|
Ended | |
|
January 31, | |
|
|
|
Ended | |
|
|
|
|
Ended | |
|
|
|
|
|
|
|
|
August 31, | |
|
May 31, | |
|
|
August 31, | |
|
August 31, | |
|
| |
|
|
|
June 30, | |
|
|
|
|
June 30, | |
|
|
|
|
|
|
|
|
2002 | |
|
2003 | |
|
|
2003 | |
|
2004 | |
|
2004 | |
|
2005 | |
|
|
|
2004 | |
|
|
|
|
2005 | |
|
|
|
|
|
|
|
|
| |
|
| |
|
|
| |
|
| |
|
| |
|
| |
|
|
|
| |
|
|
|
|
| |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
(unaudited) | |
|
|
|
|
|
(unaudited) | |
|
|
|
|
(unaudited) | |
|
|
|
|
|
|
|
|
|
|
|
|
|
(dollars in thousands) | |
|
|
|
|
|
|
|
|
|
|
|
Other Financial Data:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Cash flow provided by (used in):
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Operating activities
|
|
$ |
156,544 |
|
|
$ |
58,769 |
|
|
|
$ |
30,009 |
|
|
$ |
127,679 |
|
|
$ |
17,483 |
|
|
$ |
15,966 |
|
|
|
|
|
|
$ |
81,269 |
|
|
|
|
|
|
|
$ |
94,703 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Investing activities
|
|
|
(57,347 |
) |
|
|
(98,835 |
) |
|
|
|
(15,136 |
) |
|
|
(81,516 |
) |
|
|
(11,767 |
) |
|
|
(21,667 |
) |
|
|
|
|
|
|
(24,121 |
) |
|
|
|
|
|
|
|
(875,235 |
) |
|
|
|
|
|
|
|
|
|
|
|
|
|
Financing activities
|
|
|
(36,066 |
) |
|
|
(8,060 |
) |
|
|
|
(47,222 |
) |
|
|
(47,328 |
) |
|
|
(5,501 |
) |
|
|
10,856 |
|
|
|
|
|
|
|
(54,043 |
) |
|
|
|
|
|
|
|
797,266 |
|
|
|
|
|
|
|
|
|
|
|
|
|
Capital expenditures
|
|
|
57,438 |
(3) |
|
|
34,768 |
|
|
|
|
18,079 |
|
|
|
42,787 |
|
|
|
14,225 |
|
|
|
14,045 |
|
|
|
|
|
|
|
17,387 |
|
|
|
|
|
|
|
|
20,052 |
|
|
|
|
|
|
|
|
|
|
|
|
|
EBITDA(4)
|
|
$ |
(172,777 |
) |
|
$ |
66,274 |
|
|
|
$ |
15,158 |
|
|
$ |
122,713 |
|
|
$ |
45,910 |
|
|
$ |
39,498 |
|
|
|
|
|
|
$ |
43,658 |
|
|
|
|
|
|
|
$ |
63,729 |
|
|
|
|
|
|
|
|
|
|
|
|
|
EBITDA, as adjusted(4) |
|
$ |
59,355 |
|
|
|
|
|
|
$ |
51,475 |
|
|
|
|
|
|
|
$ |
64,146 |
|
|
|
|
|
|
|
|
|
|
|
|
|
Adjusted EBITDA(4) |
|
$ |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Ratio of earnings to fixed charges |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
As of June 30, 2005 | |
|
|
| |
|
|
Consolidated | |
|
Pro Forma | |
|
|
| |
|
| |
Balance Sheet Data:
|
|
|
|
|
|
|
|
|
Cash and cash equivalents
|
|
$ |
31,365 |
|
|
$ |
31,365 |
|
Total assets
|
|
|
1,223,552 |
|
|
|
1,223,552 |
|
Long-term debt and capital lease obligations, including current
maturities
|
|
|
605,924 |
|
|
|
|
|
Partners’/ Stockholders’ equity
|
|
$ |
230,860 |
|
|
$ |
|
|
|
|
(1) |
See note 1 to our combined financial statements with
respect to our fresh-start financial reporting. |
|
(2) |
Reflects an impairment of goodwill recorded in connection with
the adoption of SFAS No. 142. |
|
(3) |
Includes $26.3 million financed through capital leases. |
|
(4) |
EBITDA represents income (loss) from operations before
depreciation and amortization expenses. Adjusted EBITDA
represents EBITDA adjusted to remove the effect of the Laidlaw
allocations of management fees and compensation charges,
insurance expenses, rebates and reorganization costs and Onex
management fees. Management routinely calculates EBITDA and uses
it to allocate resources. Management believes that EBITDA is a
useful measure to investors because it is commonly used as an
analytical indicator within the healthcare industry to evaluate
operational performance, leverage capacity and ability to
service debt. Adjusted EBITDA is used as a measure for various
financial covenants in our senior secured credit facility, and
we use adjusted EBITDA as a measure for incentive compensation
purposes. EBITDA and adjusted EBITDA should not be considered as
a measure of financial performance under generally accepted
accounting principles, or GAAP, and the items excluded from
EBITDA and adjusted EBITDA are significant components in
understanding and assessing financial performance. EBITDA and
adjusted EBITDA should not be considered in isolation or as an
alternative to net income, cash flows generated by operating,
investing or financing activities or other financial statement
data presented in the combined and consolidated financial
statements as an indicator of financial performance or
liquidity. EBITDA and adjusted EBITDA, as presented, may not be
comparable to similarly titled measures of other companies. |
13
The following table reconciles EBITDA to net income (loss):
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Predecessor (Pre-Acquisition) | |
|
|
|
|
|
|
|
|
|
|
|
|
|
| |
|
|
| |
|
|
|
|
|
|
|
|
|
|
|
|
|
(Pre-Laidlaw | |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Bankruptcy) | |
|
|
|
|
|
Successor | |
|
|
|
|
As Restated | |
|
|
(Post-Laidlaw Bankruptcy) | |
|
|
(Post-Acquisition) | |
|
Unaudited Pro Forma | |
|
|
| |
|
|
| |
|
|
| |
|
| |
|
|
|
|
Nine | |
|
|
Three | |
|
|
|
|
|
Three | |
|
Five | |
|
|
Three | |
|
Five | |
|
|
|
Five |
|
Five | |
|
|
Year | |
|
Months | |
|
|
Months | |
|
Year | |
|
Five Months Ended | |
|
Months | |
|
Months | |
|
|
Months | |
|
Months | |
|
Year | |
|
Months |
|
Months | |
|
|
Ended | |
|
Ended | |
|
|
Ended | |
|
Ended | |
|
January 31, | |
|
Ended | |
|
Ended | |
|
|
Ended | |
|
Ended | |
|
Ended | |
|
Ended |
|
Ended | |
|
|
August 31, | |
|
May 31, | |
|
|
August 31, | |
|
August 31, | |
|
| |
|
June 30, | |
|
June 30, | |
|
|
June 30, | |
|
June 30, | |
|
August 31, | |
|
January 31, |
|
June 30, | |
|
|
2002 | |
|
2003 | |
|
|
2003 | |
|
2004 | |
|
2004 | |
|
2005 | |
|
2004 | |
|
2004 | |
|
|
2005 | |
|
2005 | |
|
2004 | |
|
2005 |
|
2005 | |
|
|
| |
|
| |
|
|
| |
|
| |
|
| |
|
| |
|
| |
|
| |
|
|
| |
|
| |
|
| |
|
|
|
| |
|
|
|
|
|
|
|
|
|
|
|
(unaudited) | |
|
|
|
(unaudited) | |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
(unaudited) | |
|
|
|
|
|
|
|
|
|
|
|
|
|
(dollars in thousands) | |
|
|
|
|
|
|
|
|
|
Combined/ Consolidated Results:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
EBITDA(a)
|
|
$ |
(172,777 |
) |
|
$ |
66,274 |
|
|
|
$ |
15,158 |
|
|
$ |
122,713 |
|
|
$ |
45,910 |
|
|
$ |
39,498 |
|
|
$ |
26,589 |
|
|
$ |
43,658 |
|
|
|
$ |
37,538 |
|
|
$ |
63,729 |
|
|
$ |
|
|
|
$ |
|
|
|
$ |
|
|
Deduct:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Depreciation and amortization expenses
|
|
|
(67,183 |
) |
|
|
(32,144 |
) |
|
|
|
(12,560 |
) |
|
|
(52,739 |
) |
|
|
(22,079 |
) |
|
|
(18,808 |
) |
|
|
(13,160 |
) |
|
|
(21,958 |
) |
|
|
|
(14,136 |
) |
|
|
(23,988 |
) |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Income (loss) from operations
|
|
$ |
(239,960 |
) |
|
$ |
34,130 |
|
|
|
$ |
2,598 |
|
|
$ |
69,974 |
|
|
$ |
23,831 |
|
|
$ |
20,690 |
|
|
$ |
13,429 |
|
|
$ |
21,700 |
|
|
|
$ |
23,402 |
|
|
$ |
39,741 |
|
|
$ |
|
|
|
$ |
|
|
|
$ |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Interest expense
|
|
|
(6,418 |
) |
|
|
(4,691 |
) |
|
|
|
(908 |
) |
|
|
(9,961 |
) |
|
|
(4,137 |
) |
|
|
(5,644 |
) |
|
|
(3,073 |
) |
|
|
(3,541 |
) |
|
|
|
(13,646 |
) |
|
|
(21,584 |
) |
|
|
|
|
|
|
|
|
|
|
|
|
Realized gain (loss) on investments
|
|
|
— |
|
|
|
— |
|
|
|
|
90 |
|
|
|
(1,140 |
) |
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
(52 |
) |
|
|
|
33 |
|
|
|
(6 |
) |
|
|
(1,140 |
) |
|
|
— |
|
|
|
(6 |
) |
Interest and other income
|
|
|
369 |
|
|
|
304 |
|
|
|
|
22 |
|
|
|
240 |
|
|
|
1,403 |
|
|
|
714 |
|
|
|
12 |
|
|
|
48 |
|
|
|
|
81 |
|
|
|
94 |
|
|
|
240 |
|
|
|
|
|
|
|
94 |
|
Fresh-start accounting adjustments(1)
|
|
|
— |
|
|
|
46,416 |
|
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Income (loss) before income taxes and cumulative change in
accounting principle
|
|
|
(246,009 |
) |
|
|
76,159 |
|
|
|
|
1,802 |
|
|
|
59,113 |
|
|
|
21,097 |
|
|
|
15,760 |
|
|
|
10,368 |
|
|
|
18,155 |
|
|
|
|
9,870 |
|
|
|
18,245 |
|
|
|
|
|
|
|
|
|
|
|
|
|
Income tax expense
|
|
|
(1,374 |
) |
|
|
(829 |
) |
|
|
|
(8,633 |
) |
|
|
(21,764 |
) |
|
|
(8,558 |
) |
|
|
(6,278 |
) |
|
|
(4,794 |
) |
|
|
(7,831 |
) |
|
|
|
(3,821 |
) |
|
|
(7,178 |
) |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Income (loss) before cumulative effect of a change in accounting
principle
|
|
|
(247,383 |
) |
|
|
75,330 |
|
|
|
|
(6,831 |
) |
|
|
37,349 |
|
|
|
12,539 |
|
|
|
9,482 |
|
|
|
5,574 |
|
|
|
10,324 |
|
|
|
|
6,049 |
|
|
|
11,067 |
|
|
|
|
|
|
|
|
|
|
|
|
|
Cumulative effect of a change in accounting principle(2)
|
|
|
— |
|
|
|
(223,721 |
) |
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Net income (loss)
|
|
$ |
(247,383 |
) |
|
$ |
(148,391 |
) |
|
|
$ |
(6,831 |
) |
|
$ |
37,349 |
|
|
$ |
12,539 |
|
|
$ |
9,482 |
|
|
$ |
5,574 |
|
|
$ |
10,324 |
|
|
|
$ |
6,049 |
|
|
$ |
11,067 |
|
|
$ |
|
|
|
$ |
|
|
|
$ |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
(a) |
EBITDA for periods presented includes Laidlaw’s allocation
to us of fees and compensation charges, insurance expenses and
rebates and reorganization costs. Laidlaw’s allocations to
us of fees and compensation charges and of reorganization costs
are based on allocations among all of Laidlaw’s business
units based on revenues, plus an additional amount allocated to
us in respect of a one-time compensation expense related to the
changes in the enterprise values of AMR and EmCare.
Laidlaw’s allocation to us of insurance expense and rebates
is based on an allocation of investment income of Laidlaw’s
captive insurance subsidiary among all of Laidlaw’s
business units based on revenues, and an allocation of claims
among Laidlaw’s business units based on each business
unit’s claims experience. We do not believe that
Laidlaw’s allocation of these expenses and rebates are
predictive of expenses and rebates we expect to incur as a
stand-alone company in respect of management services or for
comparable stand-alone insurance costs. Laidlaw’s
allocation of these expenses and rebates for the historical
periods presented were as follows: |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Predecessor (Pre-Acquisition) | |
|
|
| |
|
|
| |
|
|
(Pre-Laidlaw | |
|
|
|
|
|
Bankruptcy) | |
|
|
(Post-Laidlaw Bankruptcy) | |
|
|
| |
|
|
| |
|
|
|
|
Nine | |
|
|
Three | |
|
|
|
|
|
Three | |
|
Five | |
|
|
Year | |
|
Months | |
|
|
Months | |
|
Year | |
|
Five Months Ended | |
|
Months | |
|
Months | |
|
|
Ended | |
|
Ended | |
|
|
Ended | |
|
Ended | |
|
January 31, | |
|
Ended | |
|
Ended | |
|
|
August 31, | |
|
May 31, | |
|
|
August 31, | |
|
August 31, | |
|
| |
|
June 30, | |
|
June 30, | |
|
|
2002 | |
|
2003 | |
|
|
2003 | |
|
2004 | |
|
2004 | |
|
2005 | |
|
2004 | |
|
2004 | |
|
|
| |
|
| |
|
|
| |
|
| |
|
| |
|
| |
|
| |
|
| |
|
|
|
|
|
|
|
|
|
|
|
(unaudited) | |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
(unaudited) | |
|
|
(dollars in thousands) | |
Laidlaw insurance expense (rebate)(A)
|
|
$ |
(8,094 |
) |
|
$ |
3,058 |
|
|
|
$ |
11,522 |
|
|
$ |
(4,505 |
) |
|
$ |
— |
|
|
$ |
— |
|
|
$ |
— |
|
|
$ |
— |
|
Laidlaw fees and compensation charges
|
|
|
5,400 |
|
|
|
4,050 |
|
|
|
|
1,350 |
|
|
|
15,449 |
(B) |
|
|
6,436 |
|
|
|
19,857 |
(C) |
|
|
3,862 |
|
|
|
6,436 |
|
Laidlaw reorganization costs
|
|
|
8,761 |
|
|
|
3,650 |
|
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Total Laidlaw allocated expense
|
|
$ |
6,067 |
|
|
$ |
10,758 |
|
|
|
$ |
12,872 |
|
|
$ |
10,944 |
|
|
$ |
6,436 |
|
|
$ |
19,857 |
|
|
$ |
3,862 |
|
|
$ |
6,436 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
(A) |
Included in “Insurance expense” in our combined
statements of operations. |
|
|
(B) |
Includes compensation charges of $4.1 million. |
|
|
|
We estimate that the costs we will incur in respect of
management services and other costs as a stand-alone company
will total approximately $4.0 million a year. See note
(1) to the unaudited pro forma consolidated statement of
operations for the five months ended January 31, 2005
and the year ended August 31, 2004 in “Unaudited Pro
Forma Consolidated Financial Data.” We incurred
$1.1 million of such costs in the five months ended
June 30, 2005, excluding costs related to our acquisition
of AMR and EmCare.
|
|
|
(C) |
Includes compensation charges of $15.4 million. |
14
RISK FACTORS
An investment in the notes involves a high degree of risk. You
should carefully consider the factors described below in
addition to the other information set forth in this prospectus
before making an investment decision. Additional risks and
uncertainties not presently known to us or that we currently
believe to be immaterial may also materially and adversely
affect our business operations. Any of the following risks could
materially adversely affect our business, financial condition or
results of operations and your investment in the notes. In such
case, you may lose all or part of your original investment.
Risk Factors Related to the Exchange Offer
If you do not properly exchange your outstanding notes,
you will continue to hold unregistered outstanding notes which
will be subject to transfer restrictions.
We will issue exchange notes in exchange for outstanding notes
only after timely receipt by the exchange agent of your
outstanding notes, together with all required documents,
including a properly completed and signed letter of transmittal.
Therefore, if you would like to tender your outstanding notes,
please allow sufficient time to ensure timely delivery and
carefully follow the instructions on how to tender your
outstanding notes. We and the exchange agent are under no duty
to give you notice of defects or irregularities with respect to
your tender of the outstanding notes. If there are defects or
irregularities with respect to your tender of outstanding notes,
we will not accept your outstanding notes for exchange and you
will continue to hold outstanding notes that are subject to the
existing transfer restrictions. The exchange notes will not be
subject to any transfer restrictions.
We did not register the outstanding notes, nor do we intend to
do so following the exchange offer. As a result, the outstanding
notes may not be offered or sold unless registered under the
Securities Act and applicable state securities laws, or pursuant
to an exemption therefrom. If you do not exchange your
outstanding notes, you will lose your right to have your
outstanding notes registered under the Securities Act except in
limited circumstances. Therefore, if you continue to hold
outstanding notes after the exchange offer, you may be unable to
sell your outstanding notes. The aggregate principal amount of
the outstanding notes will be reduced to the extent outstanding
notes are tendered and accepted in this exchange offer, which
could adversely affect the trading market, if one were to
develop, for your outstanding notes.
|
|
|
In some instances, you may be obligated to deliver a
prospectus in connection with resales of the exchange
notes. |
Based on certain no-action letters issued by the staff of the
SEC, we believe that you may offer for resale, resell or
otherwise transfer the exchange notes without compliance with
the registration and prospectus delivery requirements of the
Securities Act. However, in some instances described in this
prospectus under “Plan of Distribution,” you will
remain obligated to comply with the registration and prospectus
delivery requirements of the Securities Act to transfer your
exchange notes. For example, if you exchange your outstanding
notes in the exchange offer for the purpose of participating in
a distribution of the exchange notes, you may be deemed to have
received restricted securities and, if so, will be required to
comply with the registration and prospectus delivery
requirements of the Securities Act in connection with any resale
transaction. In these cases, if you transfer any exchange note
without delivering a prospectus meeting the requirements of the
Securities Act or without an exemption from registration of your
exchange notes under the Securities Act, you may incur liability
under this act. We do not and will not assume, or indemnify you
against, this liability.
|
|
|
If no active trading market for the exchange notes
develops, you may not be able to resell your exchange notes at
their fair market value or at all. |
The exchange notes are new securities for which there currently
is no market. Accordingly, the development or liquidity of any
market for the exchange notes is uncertain. If no active trading
market develops, you may not be able to resell your exchange
notes at their fair market value or at all. We do not
15
intend to apply for listing of the exchange notes on any
securities exchange or for quotation through The Nasdaq National
Market or any other quotation system.
The liquidity of any market for the exchange notes will depend
upon various factors, including:
|
|
|
|
• |
the number of holders of the exchange notes, |
|
|
• |
the interest of securities dealers in making a market for the
exchange notes, |
|
|
• |
the overall market for high-yield securities, |
|
|
• |
our financial performance or prospects, and |
|
|
• |
the prospects for companies in our industry generally. |
Accordingly, we cannot assure you that a market or liquidity
will develop for the exchange notes.
Historically, the market for non-investment grade debt has been
subject to disruptions that have caused substantial volatility
in the prices of securities similar to the exchange notes. We
cannot assure you that the market for the exchange notes, if
any, will not be subject to similar disruptions. Any such
disruption may adversely affect you as a holder of the exchange
notes.
Risk Factors Related to the Notes
|
|
|
Servicing our debt will require a significant amount of
cash. Our ability to generate sufficient cash depends on
numerous factors beyond our control, and we may be unable to
generate sufficient cash flow to service our debt obligations,
including making payments on the notes. |
Our business may not generate sufficient cash flow from
operating activities. Our ability to make payments on and to
refinance our debt, including the notes, and to fund planned
capital expenditures will depend on our ability to generate cash
in the future. To some extent, this is subject to general
economic, financial, competitive, legislative, regulatory and
other factors that are beyond our control. Lower net revenues,
or higher provision for uncollectibles, generally will reduce
our cash flow.
We cannot assure you that our future cash flow from operations
or borrowings under our senior secured credit facility will be
sufficient to enable us to service our debt, including the
notes, or to meet our other obligations and commitments. If we
are unable to generate sufficient cash flow to service our debt
and meet our other commitments, we will be required to adopt one
or more alternatives, such as refinancing all or a portion of
our debt, including the notes, selling material assets or
operations or raising additional debt or equity capital. We
cannot assure you that we could effect any of these actions on a
timely basis, on commercially reasonable terms or at all, or
that these actions would be sufficient to meet our capital
requirements. In addition, the terms of our existing or future
debt agreements, including the credit agreement governing our
senior secured credit facility and the indenture governing the
notes, may restrict us from effecting any of these alternatives.
If we fail to make scheduled payments on our debt or otherwise
fail to comply with our covenants, we will be in default and, as
a result:
|
|
|
|
• |
our debt holders could declare all outstanding principal and
interest to be due and payable, |
|
|
• |
our secured debt lenders could terminate their commitments and
commence foreclosure proceedings against our assets, and |
|
|
• |
we could be forced into bankruptcy or liquidation. |
|
|
|
Our substantial debt could adversely affect our financial
condition and prevent us from fulfilling our obligations under
the notes. |
We have a substantial amount of debt. As of June 30, 2005,
we had total debt of $605.9 million, including
$349.1 million of borrowings under our senior secured
credit facility, $250.0 million of the outstanding notes
and $5.8 million of capital lease and other debt
obligations, and we had $24.3 million of
16
letters of credit outstanding. In addition, subject to
restrictions in the indenture governing the notes and the credit
agreement governing our senior secured credit facility, we may
incur additional debt.
Our substantial debt could have important consequences to you,
including the following:
|
|
|
|
• |
it may be more difficult for us to satisfy our obligations,
including debt service requirements under our outstanding debt,
including the notes, |
|
|
• |
our ability to obtain additional financing for working capital,
capital expenditures, debt service requirements or other general
corporate purposes may be impaired, |
|
|
• |
we must use a substantial portion of our cash flow for payments
on the notes and other debt, which will reduce the funds
available to us for other purposes, |
|
|
• |
we are more vulnerable to economic downturns and adverse
industry conditions and our flexibility to plan for, or react
to, changes in our business or industry is more limited, |
|
|
• |
our ability to capitalize on business opportunities and to react
to competitive pressures, as compared to our competitors, may be
compromised due to our high level of debt, and |
|
|
• |
our ability to borrow additional funds or to refinance debt may
be limited. |
Furthermore, all of our debt under our senior secured credit
facility will bear interest at variable rates. If these rates
were to increase significantly, our ability to borrow additional
funds may be reduced and the risks related to our substantial
debt would intensify. See “Description of Senior Secured
Credit Facility.”
|
|
|
The indenture governing the notes and the credit agreement
governing our senior secured credit facility impose significant
operating and financial restrictions on us. If we fail to comply
with any of these restrictions, our debt could be accelerated,
and we may not be able to make payments on the notes. |
The indenture governing the notes and the credit agreement
governing our senior secured credit facility impose significant
operating and financial restrictions on the issuers and the
guarantors. These restrictions may adversely affect our ability
to finance future operations or capital needs or to engage in
other business activities. Among other things, the agreements
limit the ability of the issuers and the restricted subsidiaries
to:
|
|
|
|
• |
incur additional indebtedness and issue certain preferred stock, |
|
|
• |
pay dividends on their capital stock or repurchase their capital
stock or subordinated debt, |
|
|
• |
repurchase or redeem their capital, |
|
|
• |
make investments, |
|
|
• |
incur liens, |
|
|
• |
make capital expenditures, |
|
|
• |
enter into transactions with their stockholders and affiliates, |
|
|
• |
sell certain assets or merge with or into other
companies, and |
|
|
• |
incur restrictions on the ability of their subsidiaries to make
distributions or transfer assets to the issuers. |
Our ability to comply with these covenants may be affected by
events beyond our control, and any material deviations from our
forecasts could require us to seek waivers or amendments of
covenants, alternative sources of financing or reductions in
expenditures. We cannot assure you that such waivers, amendments
or alternative financings could be obtained, or, if obtained,
would be on terms acceptable to us. In addition, the holders of
the notes will have no control over any waivers or amendments
with respect to any debt outstanding other than the notes
governed by the indenture. We cannot assure you that, even if
the holders of the notes agree to waive or amend the covenants
contained in the indenture, the holders of our other debt will
agree to do the same with respect to their debt instruments.
17
In addition, the credit agreement governing our senior secured
credit facility will require us to meet certain financial ratios
and restrict our ability to make capital expenditures or prepay
certain other debt. We may not be able to maintain these ratios,
and the restrictions could limit our ability to plan for or
react to market conditions or meet extraordinary capital needs
or otherwise restrict corporate activities. See
“Description of Senior Secured Credit Facility.”
If a breach of any covenant or restriction contained in our
financing agreements results in an event of default, those
lenders could discontinue lending, accelerate the related debt
(which could accelerate other debt) and declare all borrowings
outstanding thereunder to be due and payable. In addition, the
lenders could terminate any commitments they had made to supply
us with additional funds. In the event of an acceleration of our
debt, we may not have or be able to obtain sufficient funds to
make any accelerated payments, including those on the notes.
|
|
|
Your right to receive payments on the notes is junior to
our existing and future senior debt, and the existing and future
senior debt of the guarantors, including borrowings under our
senior secured credit facility. |
The notes and the guarantees will rank behind all of the
issuers’ and the guarantors’ existing senior debt,
including their obligations under the senior secured credit
facility, and all of the issuers’ and the guarantors’
future senior debt. As a result, upon any distribution to the
issuers’ or the guarantors’ creditors in a bankruptcy,
liquidation, reorganization or similar proceeding involving the
issuers or a guarantor or the issuers’ or their property,
the holders of senior debt would be entitled to be paid in full
before any payment could be made with respect to the notes or
the guarantees. In these cases, the issuers and the guarantors
may not have sufficient funds to pay all of their creditors, and
holders of notes may receive less, ratably, than holders of the
senior debt of the issuers and the guarantors.
In the event of a bankruptcy, liquidation, reorganization or
similar proceeding relating to the issuers or the guarantors or
the issuers’ or their property, holders of the notes would
participate with trade creditors and all other holders of the
issuers’ and the guarantors’ unsubordinated
obligations. Because the indenture governing the notes will
require that amounts otherwise payable to holders of the notes
in a bankruptcy or similar proceeding be paid to holders of
senior debt instead, holders of the notes may receive less,
ratably, than holders of unsubordinated obligations, including
trade payables.
In addition, all payments on the notes and the guarantees will
be blocked in the event of a payment default on designated
senior debt, including debt under our senior secured credit
facility, and may be blocked for up to 179 of 360 consecutive
days in the event of certain non-payment defaults on designated
senior debt. See “Description of Notes —
Subordination.”
At June 30, 2005, the notes and the guarantees were
subordinated to $349.1 million of senior debt and up to
$75.7 million of additional senior debt would have been
available to us for borrowing under our senior secured credit
facility. In addition, we may incur certain amounts of
additional debt, including senior debt, in the future as
permitted by the indenture governing the notes and the credit
agreement governing our senior secured credit facility. See
“Description of Senior Secured Credit Facility” and
“Description of Notes.”
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Despite our current levels of debt, we may still incur
substantially more debt and increase the risks associated with
our substantial leverage. |
At June 30, 2005, we had up to $75.7 million available
to us for additional borrowings under our senior secured credit
facility. Any amount borrowed under our senior secured credit
facility will be secured and senior to the notes. We may also be
able to incur substantial additional debt in the future. The
terms of the indenture governing the notes and the credit
agreement governing our senior secured credit facility will not
fully prohibit us from doing so. If we incur any additional debt
that ranks equally with the notes, the holders of that debt will
be entitled to share ratably with the holders of the notes in
any proceeds distributed in connection with any bankruptcy,
liquidation, reorganization or similar proceeding. If new debt
is added to our current debt levels, the related risks that we
now face could intensify. See “Description of Senior
Secured Credit Facility.”
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Your right to receive payments on the notes could be
adversely affected if our non-guarantor subsidiary declares
bankruptcy, liquidates or reorganizes. |
On the issue date of the notes, all of our domestic subsidiaries
guaranteed the notes. However, in the future a domestic
subsidiary may be released from its guarantee of the notes under
certain circumstances, and a newly formed domestic subsidiary
may not be required to guarantee the notes if it has not
guaranteed the debt under our senior secured credit facility or
incurred any other debt, other than certain permitted debt. In
addition, our foreign subsidiaries will not guarantee the notes.
The notes will be structurally subordinated to any existing and
future preferred stock, debt and other liabilities of any of our
subsidiaries that do not guarantee the notes. This is true even
if such obligations do not constitute senior debt. In the event
of a bankruptcy, liquidation, reorganization or similar
proceeding of one of our non-guarantor subsidiaries, holders of
a non-guarantor subsidiary’s debt and trade creditors will
generally be entitled to payment of their claims from the assets
of that subsidiary before any assets are made available for
distribution to us.
Our only existing foreign subsidiary is EMCA, our wholly-owned
self-insurance captive company domiciled in the Cayman Islands.
The notes effectively will be junior to all EMCA liabilities.
EMCA did not generate any of our combined net revenue in the
twelve months ended June 30, 2005 and, at June 30,
2005, had approximately $68.0 million of liabilities and
held $76.8 million, or 6.3%, of our consolidated assets.
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We may be unable to finance a change of control
offer. |
If certain change of control events occur, we will be required
to make an offer to purchase the notes for cash at 101% of their
principal amount, plus accrued and unpaid interest and special
interest (as defined in the indenture), if any. However, we
cannot assure you that we will have the financial resources
necessary to purchase the notes upon a change of control or that
we will have the ability to obtain the necessary funds on
satisfactory terms, if at all. A change of control would result
in an event of default under our senior secured credit facility
and may result in a default under other debt we may incur in the
future. Our senior secured credit facility prohibits the
purchase of notes prior to repayment of the borrowings under our
senior secured credit facility and any exercise by the holders
of the notes of their right to require us to repurchase the
notes will cause an event of default under our senior secured
credit facility. In addition, certain important corporate
events, such as leveraged recapitalizations that would increase
the level of our debt, would not constitute a “change of
control” under the indenture. See “Description of
Notes — Repurchase at the Option of
Holders — Change of Control.”
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Federal and state laws permit courts to void guarantees
under certain circumstances and would require you to return
payments received from guarantors in specific
circumstances. |
Under the federal bankruptcy law and comparable provisions of
state fraudulent transfer laws, a guarantee could be voided, or
claims in respect of a guarantee could be subordinated to all
other debts of a guarantor, if, among other things, the
guarantor, at the time it incurred the debt evidenced by its
guarantee, received less than reasonably equivalent value or
fair consideration for the issuance of such guarantee and:
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was insolvent or rendered insolvent by reason of such incurrence, |
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was engaged in a business or transaction for which the
guarantor’s remaining assets constituted unreasonably small
capital, or |
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intended to incur, or believed that it would incur, debts beyond
its ability to pay such debts as they mature. |
In addition, any payment by that guarantor pursuant to its
guarantee could be voided and required to be returned to the
guarantor, or to a fund for the benefit of the creditors of the
guarantor.
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The measures of insolvency for purposes of these fraudulent
transfer laws will vary depending upon the law applied in any
proceeding to determine whether a fraudulent transfer has
occurred. Generally, however, a guarantor would be considered
insolvent if:
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the sum of its debts, including contingent liabilities, were
greater than the fair saleable value of all of its assets, |
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the present fair saleable value of its assets were less than the
amount that would be required to pay its probable liability on
its existing debts, including contingent liabilities, as they
become absolute and mature, or |
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it could not pay its debts as they become due. |
On the basis of historical information, recent operating history
and other factors, we believe that each guarantor, after giving
effect to its guarantee of these notes and the obligations under
our senior secured credit facility, was not insolvent, did not
have unreasonably small capital for the business in which it was
engaged and had not incurred debts beyond its ability to pay
such debts as they mature. We cannot assure you, however, as to
what standard a court would apply in making such determinations
or that a court would agree with our conclusions in this regard.
Risk Factors Related to Our Business
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We could be subject to lawsuits for which we are not fully
reserved. |
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. Similarly, ambulance transport services may
result in lawsuits concerning vehicle collisions and personal
injuries, patient care incidents and employee job-related
injuries. Some of these lawsuits may involve large claim amounts
and substantial defense costs.
EmCare procures professional liability insurance coverage for
most of its affiliated medical professionals and professional
and corporate entities. Beginning January 1, 2002, this
insurance coverage has been provided by affiliates of CNA
Insurance Company, which then reinsure the entire program,
primarily through EmCare’s wholly-owned subsidiary, EMCA
Insurance Company, Ltd., or EMCA. Workers compensation coverage
for EmCare’s employees and applicable affiliated medical
professionals is provided under a similar structure for the
period. From September 1, 2004 to the closing date of our
acquisition of AMR and EmCare, AMR obtained insurance coverage
for losses with respect to workers compensation, auto and
general liability claims through Laidlaw’s captive
insurance company. AMR currently has a self-insurance program
fronted by an unrelated third party. AMR retains the risk of
loss under this coverage. Under these insurance programs, we
establish reserves, using actuarial estimates, for all losses
covered under the policies. Moreover, in the normal course of
our business, we are involved in lawsuits, claims, audits and
investigations, including those arising out of our billing and
marketing practices, employment disputes, contractual claims and
other business disputes for which we may have no insurance
coverage, and which are not subject to actuarial estimates. The
outcome of these matters could have a material effect on our
results of operations in the period when we identify the matter,
and the ultimate outcome could have a material adverse effect on
our financial position or results of operations.
Our liability to pay for EmCare’s insurance program losses
is collateralized by funds held through EMCA and, to the extent
these losses exceed the collateral and assets of EMCA or the
limits of our insurance policies, will have to be funded by us.
Should our AMR losses with respect to such claims exceed the
collateral held by Laidlaw in connection with our self-insurance
program or the limits of our insurance policies, we will have to
fund such amounts. See “Business — American
Medical Response — Insurance” and
“— EmCare — Insurance.”
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The reserves we establish with respect to our losses
covered under our insurance programs are subject to inherent
uncertainties. |
In connection with our insurance programs, we establish reserves
for losses and related expenses, which represent estimates
involving actuarial and statistical projections, at a given
point in time, of our expectations of the ultimate resolution
and administration costs of losses we have incurred in respect
of our liability risks. Insurance reserves inherently are
subject to uncertainty. Our reserves are based on historical
claims, demographic factors, industry trends, severity and
exposure factors and other actuarial assumptions calculated by
an independent actuary firm. The independent actuary firm
performs studies of projected ultimate losses on an annual basis
and provides quarterly updates to those projections. We use
these actuarial estimates to determine appropriate reserves. Our
reserves could be significantly affected if current and future
occurrences differ from historical claim trends and
expectations. While we monitor claims closely when we estimate
reserves, the complexity of the claims and the wide range of
potential outcomes may hamper timely adjustments to the
assumptions we use in these estimates. Actual losses and related
expenses may deviate, individually and in the aggregate, from
the reserve estimates reflected in our financial statements. If
we determine that our estimated reserves are inadequate, we will
be required to increase reserves at the time of the
determination, which would result in a reduction in our net
income in the period in which the deficiency is determined. See
“Management’s Discussion and Analysis of Financial
Condition and Results of Operations — Critical
Accounting Policies — Claims Liability and
Professional Liability Reserves” and note 12 of the
notes to our combined financial statements included elsewhere in
this prospectus.
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Insurance coverage for some of our losses may be
inadequate and may be subject to the credit risk of commercial
insurance companies. |
Some of our insurance coverage, for periods prior to the
initiation of our self-insurance programs as well as portions of
our current insurance coverage, is through various third party
insurers. To the extent we hold policies to cover certain groups
of claims, but either did not obtain sufficient insurance
limits, did not buy an extended reporting period policy, where
applicable, or the issuing insurance company is no longer
viable, we may be responsible for losses attributable to such
claims. Furthermore, for our losses that are insured or
reinsured through commercial insurance companies, we are subject
to the “credit risk” of those insurance companies.
While we believe our commercial insurance company providers
currently are creditworthy, there can be no assurance that such
insurance companies will remain so in the future.
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We are subject to decreases in our revenue and profit
margin under our fee-for-service contracts, where we bear the
risk of changes in volume, payor mix and third party
reimbursement rates. |
In our fee-for-service arrangements, which generated
approximately 84% of our fiscal 2004 net revenue, we, or our
affiliated physicians, collect the fees for transports and
physician services. Under these arrangements, we assume the
financial risks related to changes in the mix of insured and
uninsured patients and patients covered by government-sponsored
healthcare programs, third party reimbursement rates and
transports and patient volume. Our revenue decreases if our
volume or reimbursement decreases, but our expenses do not
decrease proportionately. See “— Risk Factors
Related to Healthcare Regulation — Changes in the
rates or methods of third party reimbursements may adversely
affect our revenue and operations.” In addition,
fee-for-service contracts have less favorable cash flow
characteristics in the start-up phase than traditional flat-rate
contracts due to longer collection periods.
We collect a smaller portion of our fees for services rendered
to uninsured patients than for services rendered to insured
patients. Our credit risk related to services provided to
uninsured individuals is exacerbated because the law requires
communities to provide 911 emergency response services and
hospital emergency departments to treat all patients presenting
to the emergency department seeking care for an emergency
medical condition regardless of their ability to pay. We also
believe 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.
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We may not be able to successfully recruit and retain
physicians and other healthcare professionals with the
qualifications and attributes desired by us and our
customers. |
Our ability to recruit and retain affiliated physicians and
other healthcare professionals significantly affects our
performance under our contracts. In the recent past, our
customer hospitals have increasingly demanded a greater degree
of specialized skills, training and experience in the healthcare
professionals providing services under their contracts with us.
This decreases the number of healthcare professionals who may be
permitted to staff our contracts. Moreover, because of the scope
of the geographic and demographic diversity of the hospitals and
other facilities with which we contract, we must recruit
healthcare professionals, and particularly 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 in retaining and
winning new hospital contracts depends on our ability to recruit
and retain healthcare professionals to maintain and expand our
operations.
Our non-compete agreements and other restrictive
covenants involving physicians may not be enforceable.
We have contracts with physicians and professional corporations
in many states. Some of these contracts, as well as our
contracts with hospitals, include provisions preventing these
physicians and professional corporations from competing with us
both during and after the term of our relationship with them.
The law governing non-compete agreements and other forms of
restrictive covenants varies from state to state. Some states
are reluctant to strictly enforce non-compete agreements and
restrictive covenants applicable to physicians. There can be no
assurance that our non-compete agreements related to affiliated
physicians and professional corporations will not be
successfully challenged as unenforceable in certain states. 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.
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We are required to make significant capital expenditures
for our ambulance services business in order to remain
competitive. |
Our capital expenditure requirements primarily relate to
maintaining and upgrading our vehicle fleet and medical
equipment to serve our customers and remain competitive. The
aging of our vehicle fleet requires us to make regular capital
expenditures to maintain our current level of service. Our
capital expenditures totaled $42.8 million and
$52.8 million in fiscal 2004 and fiscal 2003, respectively.
In addition, changing competitive conditions or the emergence of
any significant advances in medical technology could require us
to invest significant capital in additional equipment or
capacity in order to remain competitive. If we are unable to
fund any such investment or otherwise fail to invest in new
vehicles or medical equipment, our business, financial condition
or results of operations could be materially and adversely
affected.
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We depend on our senior management and may not be able to
retain those employees or recruit additional qualified
personnel. |
We depend on our senior management. The loss of services of any
of the members of our senior management could adversely affect
our business until a suitable replacement can be found. There
may be a limited number of persons with the requisite skills to
serve in these positions, and we cannot assure you that we would
be able to identify or employ such qualified personnel on
acceptable terms.
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We must perform on our own services that Laidlaw
previously performed for us, and we are subject to financial
reporting and other requirements for which our accounting and
other management systems and resources may not be
adequate. |
Laidlaw historically has provided various services to AMR and
EmCare, including income tax accounting, preparation of tax
returns, certain risk management, compliance and insurance
coverage services, cash management, certain benefit plan
administration and internal audit. Moreover, as subsidiaries of
a public
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company, AMR and EmCare have not themselves been subject to the
reporting and other requirements of the Securities Exchange Act
of 1934, or the Exchange Act. In connection with this offering,
we will become subject to reporting and other obligations under
the Exchange Act. We are working with our independent legal,
accounting and financial advisors to identify those areas in
which changes should be made to our financial and management
control systems to manage our growth and our obligations as a
public company. These areas include corporate governance,
corporate control, internal audit, disclosure controls and
procedures and financial reporting and accounting systems. These
reporting and other obligations will, together with the impact
of performing services previously provided to us by Laidlaw,
place significant demands on our management, administrative and
operational resources, including accounting resources.
We anticipate that we will need to hire additional tax,
accounting and finance staff. We are reviewing the adequacy of
our systems, financial and management controls, and reporting
systems and procedures, and we intend to make any necessary
changes. We believe these replacement services will result in
total annual stand-alone selling, general and administrative,
compensation and benefits and insurance expense of approximately
$4.0 million in fiscal 2005, including a management fee we
will pay to an affiliate of Onex Corporation. We believe this
represents our full incremental stand-alone expense, and
compares to the pre-acquisition fees and compensation charges of
$15.4 million we paid Laidlaw in fiscal 2004 and
$19.9 million for the five months ended January 31,
2005. We cannot assure you that our estimate is accurate or that
our separation from Laidlaw will progress smoothly, either of
which could adversely impact our results. Although we have not
fully implemented our replacement services, our costs for these
services (including the Onex management fee but excluding costs
related to our acquisition of AMR and EmCare) totaled
$1.1 million in the five months ended June 30, 2005.
Moreover, our stand-alone expenses may increase. If we are
unable to upgrade our financial and management controls,
reporting systems and procedures in a timely and effective
fashion, we may not be able to satisfy our obligations as a
public company on a timely basis.
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Our revenue would be adversely affected if we lose
existing contracts. |
A significant portion of our growth historically has resulted
from increases in the number of emergency and non-emergency
transports, and the number of patient visits and fees for
services, we provide under existing contracts and the addition
of new contracts. Substantially all of our fiscal 2004 net
revenue was generated under contracts, including exclusive
contracts that accounted for approximately 86% of our fiscal
2004 net revenue. Our contracts with hospitals generally
have terms of three years and the term of our contracts with
communities to provide 911 services generally ranges from three
to five years. Most of our contracts are terminable by either of
the parties upon notice of as little as 30 days. Any of our
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 be successful in retaining our
existing contracts or that any loss of contracts would not have
a material adverse effect on our business, financial condition
and results of operations.
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We may not accurately assess the costs we will incur under
new contracts. |
Our new contracts increasingly involve a competitive bidding
process. When we obtain new contracts, we must accurately assess
the costs we will incur in providing services in order to
realize adequate profit margins and otherwise meet our financial
and strategic 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 assessing the costs associated with the pricing of new
contracts, as well as maintenance of existing contracts, more
difficult. In addition, integrating new contracts, particularly
those in new geographic locations, could prove more costly, and
could require more management time, than we anticipate. Our
failure to accurately predict costs or to negotiate an adequate
profit margin could have a material adverse effect on our
business, financial condition and results of operations.
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The high level of competition in our segments of the
market for emergency medical services could adversely affect our
contract and revenue base. |
AMR. The market for providing ambulance transport
services to municipalities, other healthcare providers and third
party payors is highly competitive. In providing ambulance
transport services, we compete
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with governmental entities (including cities and fire
districts), hospitals, local and volunteer private providers,
and with several large national and regional providers, such as
Rural/ Metro Corporation, Southwest Ambulance and Acadian
Ambulance. In many communities, our most important competitors
are the local fire departments, which in many cases have acted
traditionally as the first response providers during
emergencies, and have been able to expand their scope of
services to include emergency ambulance transport and do not
wish to give up their franchises to a private competitor.
EmCare. The market for providing outsourced physician
staffing and related management services to hospitals and
clinics is highly competitive. Such competition could adversely
affect our ability to obtain new contracts, retain existing
contracts and increase or maintain profit margins. We compete
with both national and regional enterprises such as Team Health,
Sterling Healthcare, The Schumacher Group and National Emergency
Services Healthcare Group, some of which may have greater
financial and other resources available to them, greater access
to physicians and/or greater access to potential customers. We
also compete against local physician groups and self-operated
hospital emergency departments for satisfying staffing and
scheduling needs.
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Our business depends on numerous complex information
systems, and any failure to successfully maintain these systems
or implement new systems could materially harm our
operations. |
We had 3.7 million transports and 5.3 million patient
visits in fiscal 2004. We depend on complex, integrated
information systems and standardized procedures for operational
and financial information and our billing operations. We may not
have the necessary resources to enhance existing information
systems or implement new systems where necessary to handle our
volume and changing needs. Furthermore, we may experience
unanticipated delays, complications and expenses in
implementing, integrating and operating our systems, including
the integration of our AMR and EmCare systems. Any interruptions
in operations during periods of implementation would adversely
affect our ability to properly allocate resources and process
billing information in a timely manner, which could result in
customer dissatisfaction and delayed cash flow. We also use the
development and implementation of sophisticated and specialized
technology to differentiate our services from our competitors
and improve our profitability. The failure to successfully
implement and maintain operational, financial and billing
information systems could have an adverse effect on our ability
to obtain new business, retain existing business and maintain or
increase our profit margins.
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If we fail to implement our business strategy, our
financial performance and our growth could be materially and
adversely affected. |
Our future financial performance and success are dependent in
large part upon our ability to implement our business strategy
successfully. Our business strategy envisions several
initiatives, including increasing revenue from existing
customers, growing our customer base, pursuing select
acquisitions, implementing cost rationalization initiatives,
focusing on risk mitigation and utilizing technology to
differentiate our services and improve profitability. We may not
be able to implement our business strategy successfully or
achieve the anticipated benefits of our business plan. If we are
unable to do so, our long-term growth and profitability may be
adversely affected. Even if we are able to implement some or all
of the initiatives of our business plan successfully, our
operating results may not improve to the extent we anticipate,
or at all.
Implementation of our business strategy could also be affected
by a number of factors beyond our control, such as increased
competition, legal developments, government regulation, general
economic conditions or increased operating costs or expenses. In
addition, to the extent we have misjudged the nature and extent
of industry trends or our competition, we may have difficulty in
achieving our strategic objectives. Any failure to implement our
business strategy successfully may adversely affect our
business, financial condition and results of operations and thus
our ability to service our debt. In addition, we may decide to
alter or discontinue certain aspects of our business strategy at
any time.
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Our ability to obtain adequate bonding coverage, and
therefore maintain existing contracts and successfully bid on
new ones, could be adversely affected by our high
leverage. |
Our emergency ambulance transport service business is highly
dependent on our ability to obtain performance bond coverage
sufficient to meet bid requirements imposed by existing and
potential customers. In connection with the acquisition, Laidlaw
has agreed to provide to us any cash collateral required to
support the performance bonds in effect at the closing, and for
a three-year period to pay any bond premiums in excess of rates
in effect at the time of closing. We cannot assure you that we
will have access to adequate bonding capacity to meet new
contract requirements, or to obtain substitute performance bonds
for existing bonds at the end of the three-year period, or that
such bonding will be available on terms acceptable to us. If
adequate bonding is not available, or if the terms of the
bonding are too onerous, there would be a material adverse
effect on our business, financial condition and results of
operations.
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A successful challenge by tax authorities to our treatment
of certain physicians as independent contractors could require
us to pay past taxes and penalties. |
As of June 30, 2005, we contracted with approximately
1,115 physicians as independent contractors to fulfill our
contractual obligations to customers. Because we treat them as
independent contractors rather than as employees, we do not
(i) withhold federal or state income or other employment
related taxes from the compensation that we pay to them,
(ii) make federal or state unemployment tax or Federal
Insurance Contributions Act payments (except as described
below), (iii) provide workers compensation insurance with
respect to such affiliated physicians (except in states that
require us to do so even for independent contractors), or
(iv) allow them to participate in benefits and retirement
programs available to employed physicians. Our contracts with
our independent contractor physicians obligate these physicians
to pay these taxes and other costs. Whether these physicians are
properly classified as independent contractors depends upon the
facts and circumstances of our relationship with them. It is
possible that the nature of our relationship with these
physicians would support a challenge to our classification of
them. If such a challenge by federal or state taxing authorities
were successful, and the physicians at issue were instead
treated as employees, we could be adversely affected and liable
for past taxes and penalties to the extent that the physicians
did not fulfill their contractual obligations to pay those
taxes. Under current federal tax law, however, even if our
treatment were successfully challenged, if our current treatment
were found to be consistent with a long-standing practice of a
significant segment of our industry and we meet certain other
requirements, it is possible (but not certain) that our
treatment of the physicians would qualify under a “safe
harbor” and, consequently, we would be protected from the
imposition of past taxes and penalties. In the recent past,
however, there have been proposals to eliminate the safe harbor
and similar proposals could be made in the future.
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We may make acquisitions which could divert the attention
of management and which may not be integrated successfully into
our existing business. |
We may pursue acquisitions to increase our market penetration,
enter new geographic markets and expand the scope of services we
provide. We cannot assure you that we will identify suitable
acquisition candidates, that acquisitions will be completed on
acceptable terms or that we will be able to integrate
successfully the operations of any acquired business into our
existing business. The acquisitions could be of significant size
and involve operations in multiple jurisdictions. The
acquisition and integration of another business would divert
management attention from other business activities. This
diversion, together with other difficulties we may incur in
integrating an acquired business, could have a material adverse
effect on our business, financial condition and results of
operations. In addition, we may borrow money or issue capital
stock to finance acquisitions. Such borrowings might not be
available on terms as favorable to us as our current borrowing
terms and may increase our leverage, and the issuance of capital
stock could dilute the interests of our stockholders.
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If Laidlaw is unwilling or unable to satisfy any
indemnification claims made by us pursuant to the purchase
agreements relating to the acquisition of AMR and EmCare, we
will be forced to satisfy such claims ourselves. |
Laidlaw has agreed to indemnify us for certain claims or legal
actions brought against us arising out of the operations of AMR
and EmCare prior to the closing date of the acquisition. If we
make a claim against Laidlaw, and Laidlaw is unwilling or unable
to satisfy such claim, we would be required to satisfy the claim
ourselves and, as a result, our financial condition may be
adversely affected.
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Many of our employees are represented by labor unions and
any work stoppage could adversely affect our business. |
Approximately 48% of AMR’s employees are represented by 41
collective bargaining agreements with 40 different union locals.
Twelve of these collective bargaining agreements, representing
approximately 1,850 employees, are subject to renegotiation in
2005 and 14 agreements, representing approximately 4,000
employees, are subject to renegotiation in 2006. Although we
believe our relations with our employees are good, we cannot
assure you that we will be able to negotiate a satisfactory
renewal of these collective bargaining agreements or that our
employee relations will remain stable.
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The interests of our controlling stockholders may conflict
with your interests. |
Onex Partners LP and other entities affiliated with Onex
Corporation, which we refer to together as the Onex entities,
control % of our combined voting
power. Accordingly, the Onex entities will exercise a
controlling influence over our business affairs. The Onex
entities could cause corporate actions to be taken even if the
interests of these entities conflict with the interests of the
holders of our notes. In addition, Onex may have an interest in
pursuing acquisitions, divestitures or other transactions that,
in its judgment, could enhance its equity investment, even
though such transactions might involve risks to holders of the
notes. See “Principal Stockholders.”
Risk Factors Related to Healthcare Regulation
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We conduct business in a heavily regulated industry and if
we fail to comply with these laws and government regulations, we
could incur penalties or be required to make significant changes
to our operations. |
The healthcare industry is heavily regulated and closely
scrutinized by federal, state and local governments.
Comprehensive statutes and regulations govern the manner in
which we provide and bill for services, our contractual
relationships with our physicians and customers, our marketing
activities and other aspects of our operations. Failure to
comply with these laws can result in civil and criminal
penalties such as fines, damages and exclusion from the Medicare
and Medicaid programs. The risk of our being found in violation
of these laws and regulations is increased by the fact that many
of them have not been fully interpreted by the regulatory
authorities or the courts, and their provisions are sometimes
open to a variety of interpretations. Any action against us for
violation of these laws or regulations, even if we successfully
defend against it, could cause us to incur significant legal
expenses and divert our management’s attention from the
operation of our business.
Although they may not have the force of law, we, our
practitioners and our customers are also subject to ethical
guidelines and operating standards of professional and trade
associations and private accreditation agencies such as the
American Medical Association, the Joint Commission on
Accreditation of Healthcare Organizations and the Commission on
Accreditation of Ambulance Services. Compliance with these
guidelines and standards is often required by our contracts with
our customers or to maintain our reputation.
In addition, laws, regulations and standards governing the
provision of healthcare services may change significantly in the
future. We monitor these developments and modify our operations
from time to time where we perceive a need to do so in response
to regulatory changes. However, we cannot assure you that any
new healthcare laws, regulations or standards will not
materially adversely affect our business. We cannot assure you
that a review of our business by judicial, law enforcement,
regulatory or accreditation authorities will not result in a
determination that could adversely affect our operations or that
healthcare regulations or
26
standards will not change in a way that may have a material
adverse effect on our business, financial condition or results
of operations.
We are subject to comprehensive and complex laws and rules
that govern the manner in which we bill and are paid for our
services by third party payors, and the failure to comply with
these rules, or allegations that we have failed to do so, can
result in civil or criminal sanctions, including exclusion from
federal and state healthcare programs.
Like most healthcare providers, the majority of our services are
paid for by private and governmental third party payors, such as
Medicare and Medicaid. These third party payors typically have
differing and complex billing and documentation requirements
that we must meet in order to receive payment for our services.
Reimbursement to us is typically conditioned on our providing
the correct procedure and diagnostic codes and properly
documenting the services themselves, including the level of
service provided, the medical necessity for the services, and
the identity of the practitioner who provided the service.
We must also comply with numerous other laws applicable to our
documentation and the claims we submit for payment, including
but not limited to (1) “coordination of benefits”
rules that dictate which payor we must bill first when a patient
has potential coverage from multiple payors;
(2) requirements that we obtain the signature of the
patient or patient representative, when possible, or document
why we are unable to do so, prior to submitting a claim;
(3) requirements that we make repayment to any payor which
pays us more than the amount to which we are entitled;
(4) requirements that we bill a hospital or nursing home,
rather than Medicare, for certain ambulance transports provided
to Medicare patients of such facilities;
(5) “reassignment” rules governing our ability to
bill and collect professional fees on behalf of our physicians;
(6) requirements that our electronic claims for payment be
submitted using certain standardized transaction codes and
formats; and (7) laws requiring us to handle all health and
financial information of our patients in a manner that complies
with specified security and privacy standards. See
“Business — Regulatory Matters —
Medicare, Medicaid and Other Government Program
Reimbursement.”
Governmental and private third party payors and other
enforcement agencies carefully audit and monitor our compliance
with these and other applicable rules, and in some cases in the
past have found that we were not in compliance. We have received
in the past, and expect to receive in the future, repayment
demands from third party payors based on allegations that our
services were not medically necessary, were billed at an
improper level, or otherwise violated applicable billing
requirements. Our failure to comply with the billing and other
rules applicable to us could result in non-payment for services
rendered or refunds of amounts previously paid for such
services. In addition, non-compliance with these rules may cause
us to incur civil and criminal penalties, including exclusion
from government healthcare programs such as Medicare and
Medicaid, under a number of state and federal laws. These laws
include, but are not limited to:
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federal and state laws that prohibit providers from billing and
receiving payment from Medicare, Medicaid and other government
programs for services unless the services are medically
necessary, adequately and accurately documented, and billed
using codes that accurately reflect the type and level of
services rendered; |
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the federal False Claims Act and similar state statutes that
prohibit entities and individuals from knowingly or recklessly
making claims to Medicare, Medicaid and other government
programs, as well as third party payors, that contain false or
fraudulent information; |
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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; |
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provisions of the Health Insurance Portability and
Accountability Act of 1996 that impose civil and criminal
penalties for failing to comply with certain privacy and
security standards applicable to “protected health
information,” as defined, and for failing to use specified
codes and transaction formats when billing for services; and |
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a provision of the Social Security Act that imposes criminal
penalties on healthcare providers who fail to disclose or refund
known overpayments. |
If our operations are found to be in violation of these or any
of the other laws which govern our activities, any resulting
penalties, damages, fines or other sanctions could adversely
affect our ability to operate our business and our financial
results. See “Business — Regulatory
Matters — Federal False Claims Act” and
“— Other Healthcare Fraud and Abuse Laws.”
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Changes in the rates or methods of third party
reimbursements may adversely affect our revenue and
operations. |
We derive a majority of our revenue from direct billings to
patients and third party payors such as Medicare, Medicaid and
private health insurance companies. As a result, any changes in
the rates or methods of reimbursement for the services we
provide could have a significant adverse impact on our revenue
and financial results.
Government funding for healthcare programs is subject to
statutory and regulatory changes, administrative rulings,
interpretations of policy and determinations by intermediaries
and governmental funding restrictions, all of which could
materially impact program coverage and reimbursements for both
ambulance and physician services. In recent years, Congress has
consistently attempted to curb spending on Medicare, Medicaid
and other programs funded in whole or part by the federal
government. State and local governments have also attempted to
curb spending on those programs for which they are wholly or
partly responsible. This has resulted in cost containment
measures such as the imposition of new fee schedules that have
lowered reimbursement for some of our services and restricted
the rate of increase for others, and new utilization controls
that limit coverage of our services. For example, we estimate
that the impact of a national fee schedule promulgated in 2002,
as modified by subsequent legislation, resulted in a decrease in
AMR’s net revenue for fiscal 2003 and fiscal 2004 of
approximately $20 million and $11 million,
respectively, will result in an increase in AMR’s net
revenue of approximately $13 million in calendar 2005, and
will result in a decrease in AMR’s net revenue of
approximately $17 million in 2006 and continuing decreases
thereafter to 2010. We currently expect that the Medicare fee
schedule update for physician services fees will provide for a
4.3% decrease to physician rates effective January 1, 2006,
which would result in a decrease in EmCare’s 2006 net
revenue of approximately $5.7 million. See
“Business — Regulatory Matters —
Medicare, Medicaid and Other Government Program
Reimbursement.”
In addition, state and local government regulations or
administrative policies regulate ambulance rate structures in
some jurisdictions in which we conduct transport services. In
certain service areas in which we hold governmental franchise
agreements to provide ambulance services, the community sets the
rates we are permitted to charge for ambulance services pursuant
to the franchise agreement. We may be unable to receive
ambulance service rate increases on a timely basis where rates
are regulated, or to establish or maintain satisfactory rate
structures where rates are not regulated.
We believe that regulatory trends in cost containment will
continue. 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 federal, state and local
governments will not impose reductions in the fee schedules or
rate regulations applicable to our services in the future. Any
such reductions could have a material adverse effect on our
business, financial condition or results of operations.
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If current or future laws or regulations force us to
restructure our arrangements with physicians, professional
corporations and hospitals, we may incur additional costs, lose
contracts and suffer a reduction in net revenue under existing
contracts, and we may need to refinance our debt or obtain debt
holder consent. |
A number of laws bear on our relationships with our physicians.
EmCare employs or contracts with physicians or physician-owned
professional corporations to deliver services to our hospital
customers and their patients. We frequently enter into
management services contracts with these physicians and
professional corporations pursuant to which we provide them with
billing, scheduling and a wide range of other services,
28
and they pay us for those services out of the fees they collect
from patients and third-party payors. There is a risk that state
authorities in some jurisdictions may find that these
contractual relationships violate laws prohibiting the corporate
practice of medicine and fee-splitting prohibitions. These laws
prohibit the practice of medicine by general business
corporations and are intended to prevent unlicensed persons or
entities from interfering with or inappropriately influencing
the physician’s professional judgment. They may also
prevent the sharing of professional services income with
non-professional or business interests. From time to time,
including recently, we have been involved in litigation in which
private litigants have raised these issues. See
“Business — Regulatory Matters —
Fee-Splitting; Corporate Practice of Medicine.”
In addition, the Medicare program generally 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.
Historically, there was no exception that allowed us to receive
directly Medicare payments related to the services of
independent contractor physicians. However, the Medicare
Modernization Act amended the Medicare reassignment statute as
of December 8, 2003 and now permits our independent
contractor physicians to reassign their Medicare receivables to
us under certain circumstances. We rely on this provision in
billing for the services of these physicians. Because this
provision has only recently been implemented, it could be
interpreted in a manner adverse to us, which will negatively
impact our ability to bill for our physicians’ services.
Our physician contracts include contracts with individual
physicians and with physicians organized as separate legal
professional entities (e.g., professional medical
corporations). Antitrust laws may deem each such
physician/entity to be separate, both from EmCare and from each
other and, accordingly, each such physician/practice is subject
to a wide range of laws that prohibit anti-competitive conduct
between or among separate legal entities or individuals. A
review or action by regulatory authorities or the courts could
force us to terminate or modify our contractual relationships
with physicians and affiliated medical groups or revise them in
a manner that could be materially adverse to our business.
Although we have structured our relationships with physicians
and hospitals in an effort to comply with the state corporate
practice of medicine and fee-splitting laws, applicable
reassignment rules and antitrust laws, adverse judicial or
administrative interpretations could result in a finding that we
are not in compliance with one or more of these laws and rules.
These laws and rules, and their interpretations, may also change
in the future. Any adverse interpretations or changes could
force us to restructure our relationships with physicians,
professional corporations or our hospital customers, or to
restructure our operations. This could cause our operating costs
to increase significantly. A restructuring could also result in
a loss of contracts or a reduction in revenue under existing
contracts. Moreover, if we are required to modify our structure
and organization to comply with these laws and rules, our
financing agreements may prohibit such modifications and require
us to obtain the consent of the holders of such debt or require
the refinancing of such debt.
Our contracts with healthcare facilities and marketing
practices are subject to the federal Anti-Kickback Statute, and
we are currently under investigation for alleged violations of
that statute.
We are subject to the federal Anti-Kickback Statute, which
prohibits the knowing and willful offer, payment, solicitation
or receipt of any form of “remuneration” in return
for, or to induce, the referral of business or ordering of
services paid for by Medicare or other federal programs.
“Remuneration” includes discounts and in-kind goods or
services, as well as cash. Certain federal courts have held that
the Anti-Kickback Statute can be violated if “one
purpose” of a payment is to induce referrals. Violations of
the Anti-Kickback Statute can result in civil or criminal fines
or exclusion from Medicare and other governmental programs.
In 1999, the Office of Inspector General of the Department of
Health and Human Services, or the OIG, issued an Advisory
Opinion indicating that discounts provided to health facilities
on the transports for which they are financially responsible may
violate the Anti-Kickback Statute when the ambulance company
also receives referrals of Medicare and other government-funded
transports from the facility. The OIG has clarified that not all
discounts violate the Anti-Kickback Statute, but that the
statute may be violated if part
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of the purpose of the discount is to induce the referral of the
transports paid for by Medicare or other federal programs, and
the discount does not meet certain “safe harbor”
conditions. In the Advisory Opinion and subsequent
pronouncements, the OIG has provided guidance to ambulance
companies to help them avoid unlawful discounts. See
“Business — Regulatory Matters —
Federal Anti-Kickback Statute.”
Like other ambulance companies, we have in the past provided
discounts to our healthcare facility customers (nursing home and
hospital). Although we have attempted to comply with the
OIG’s guidance on this issue, the government has alleged
that certain of our contractual discounts in effect in Texas,
principally in periods prior to 1999, violate the Anti-Kickback
Statute. We are currently in discussions with the OIG regarding
these Texas allegations. Our contracting practices in Oregon and
possibly other jurisdictions may also be under investigation.
See “Business — American Medical
Response — Legal Matters.” If we are found to
have violated the Anti-Kickback Statute in these jurisdictions,
we may be subject to civil or criminal penalties, including
exclusion from the Medicare or Medicaid programs, or may be
required to enter into settlement agreements with the government
to avoid such sanctions.
In addition to AMR’s contracts with healthcare facilities,
other marketing practices or transactions entered into by AMR
and EmCare may implicate the Anti-Kickback Statute. Although we
have attempted to structure our past and current marketing
initiatives and business relationships to comply with the
Anti-Kickback Statute, we cannot assure you that the OIG or
other authorities will not find that our marketing practices and
relationships violate the statute.
Changes in our ownership structure and operations require
us to comply with numerous notification and reapplication
requirements in order to maintain our licensure, certification
or other authority to operate, and failure to do so, or an
allegation that we have failed to do so, can result in payment
delays, forfeiture of payment or civil and criminal
penalties.
We and our affiliated physicians are subject to various federal,
state and local licensing and certification laws with which we
must comply in order to maintain authorization to provide, or
receive payment for, our services. For example, Medicare and
Medicaid require that we complete and periodically update
enrollment forms in order to obtain and maintain certification
to participate in programs. Compliance with these requirements
is complicated by the fact that they differ from jurisdiction to
jurisdiction, and in some cases are not uniformly applied or
interpreted even within the same jurisdiction. Failure to comply
with these requirements can lead not only to delays in payment
and refund requests, but in extreme cases can give rise to civil
or criminal penalties.
In certain jurisdictions, changes in our ownership structure
require pre-or post-notification to governmental licensing and
certification agencies, or agencies with which we have
contracts. Relevant laws in some jurisdictions may also require
re-application or re-enrollment and approval to maintain or
renew our licensure, certification, contracts or other operating
authority. For example, in connection with our acquisition of
AMR from Laidlaw, two of our subsidiaries were required to apply
for state and local ambulance operating authority in New York.
Similarly, the change in corporate structure and ownership in
connection with our proposed initial public offering may require
us to give notice, re-enroll or make other applications for
authority to continue operating in various jurisdictions.
If an agency requires us to complete the re-enrollment process
prior to submitting reimbursement requests, we may be delayed in
payment, receive refund requests or be subject to recoupment for
services we provide in the interim. The change in ownership
effected by our acquisition of AMR and EmCare from Laidlaw has
required us to re-enroll in one jurisdiction, and reimbursement
from the relevant government program is likely to be deferred
for several months. This will affect our cash flow, but will not
affect our net revenue. We do not expect the impact of this
deferral to be material to us, but it is possible that other
jurisdictions will similarly require us to re-enroll.
While we have made reasonable efforts to substantially comply
with these requirements in connection with prior changes in our
operations and ownership structure, and will do so in connection
with our proposed initial public offering, we cannot assure you
that the agencies that administer these programs or have awarded
us contracts will not find that we have failed to comply in some
material respects. A finding of non-
30
compliance and any resulting payment delays, refund demands or
other sanctions could have a material adverse effect on our
business, financial condition or results of operations.
If we fail to comply with the terms of our settlement
agreements with the government, we could be subject to
additional litigation or other governmental actions which could
be harmful to our business.
In the last five years, we have entered into four settlement
agreements with the United States government. In June 2002, one
of our subsidiaries, AMR of Massachusetts, entered into a
settlement agreement to resolve a number of allegations,
including allegations related to billing and documentation
practices. In February 2003, another subsidiary, AMR of South
Dakota, entered into a settlement agreement to resolve
allegations that it incorrectly billed for transports performed
by other providers when an AMR paramedic accompanied the patient
during transport, and that it billed for certain non-emergency
transports using emergency codes. In July 2004, our
subsidiary, American Medical Response West, entered into a
settlement agreement in connection with billing matters related
to emergency transports and specialized services. In August
2004, AMR entered into a settlement agreement on behalf of a
subsidiary, Regional Emergency Services LP, or RES, to resolve
allegations of violations of the False Claims Act by RES and a
hospital system based on the absence of certificates of medical
necessity and other non-compliant billing practices. See
“Business — American Medical Response —
Legal Matters.”
As part of the settlements AMR of Massachusetts and
AMR West entered into with the government, we entered into
Corporate Integrity Agreements, or CIAs. Pursuant to these CIAs,
we are required to establish and maintain a compliance program
which includes, among other elements, the appointment of a
compliance officer and committee, claims review by an
independent review organization, and reporting of overpayments
and other “reportable events.” See
“Business — Regulatory Matters —
Corporate Compliance Program and Corporate Integrity
Obligations.”
We cannot assure you that the CIAs or the compliance program we
initiated has prevented, or will prevent, any repetition of the
conduct or allegations that were the subject of these settlement
agreements, or that the government will not raise similar
allegations in other jurisdictions or for other periods of time.
If such allegations are raised, or if we fail to comply with the
terms of the CIAs, we may be subject to fines and other
contractual and regulatory remedies specified in the CIAs or by
applicable laws, including exclusion from the Medicare program
and other federal and state healthcare programs. Such actions
could have a material adverse effect on the conduct of our
business, our financial condition or our results of operations.
If we are unable to effectively adapt to changes in the
healthcare industry, our business may be harmed.
Political, economic and regulatory influences are subjecting the
healthcare industry in the United States to fundamental change.
We anticipate that Congress and state legislatures may continue
to review and assess alternative healthcare delivery and payment
systems and may in the future propose and adopt legislation
effecting fundamental changes in the healthcare delivery system.
Congress and state legislatures have adopted and may further
consider statutory changes affecting healthcare reform. 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,
it is possible that future legislation enacted by Congress or
state legislatures could adversely affect our business or could
change the operating environment of our targeted customers. It
is possible that the changes to the Medicare or other government
program reimbursements may serve as precedent to possible
changes in other payor’s reimbursement policies in a manner
adverse to us. Similarly, changes in private payor
reimbursements could lead to adverse changes in Medicare and
other government payor programs which could have a material
adverse effect on our business, financial condition or results
of operations.
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CAUTIONARY STATEMENTS REGARDING FORWARD-LOOKING STATEMENTS
This prospectus contains “forward-looking statements.”
Forward-looking statements give our current expectations or
forecasts of future events. Forward-looking statements generally
can be identified by the use of forward-looking terminology such
as “may,” “will,” “expect,”
“intend,” “estimate,”
“anticipate,” “believe,”
“project,” or “continue,” or other similar
words. These statements reflect management’s current views
with respect to future events and are subject to risks and
uncertainties, both known and unknown. Our actual results may
vary materially from those anticipated in forward-looking
statements. We caution investors not to place undue reliance on
any forward-looking statements.
Important factors that could cause actual results to differ
materially from forward-looking statements include, but are not
limited to:
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the impact on our revenue of changes in transport volume, mix of
insured and uninsured patients, and third party reimbursement
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the adequacy of our insurance coverage and insurance reserves, |
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potential penalties or changes to our operations if we fail to
comply with extensive and complex government regulation of our
industry, |
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our ability to recruit and retain qualified physicians and other
healthcare professionals, and enforce our non-compete agreements
with our physicians, |
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the effect of changes in rates or methods of third party
reimbursement, |
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our ability to generate cash flow to service our debt
obligations, |
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the cost of capital expenditures to maintain and upgrade our
vehicle fleet and medical equipment, |
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the loss of services of one or more members of our senior
management team, |
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the outcome of government investigations of certain of our
business practices, |
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our ability to successfully restructure our operations to comply
with future changes in government regulation, |
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our ability to perform services previously performed for us by
Laidlaw, |
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the loss of existing contracts and the accuracy of our
assessment of costs under new contracts, |
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the high level competition in our industry, |
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our ability to maintain or implement complex information systems, |
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our ability to implement our business strategy, |
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our ability to obtain adequate bonding coverage, and |
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our ability to successfully integrate strategic acquisitions. |
These factors are not exhaustive, and new factors may emerge or
changes to the foregoing factors may occur that could impact our
business. Except to the extent required by law, we undertake no
obligation to publicly update or revise any forward-looking
statements, whether as a result of new information, future
events or otherwise.
You should review carefully the sections captioned “Risk
Factors” and “Management’s Discussion and
Analysis of Financial Condition and Results of Operations”
in this prospectus for a more complete discussion of these and
other factors that may affect our business.
32
FORMATION OF HOLDING COMPANY
Immediately prior to the completion of Emergency Medical
Services’ initial public offering, we will effect a
reorganization in which Emergency Medical Services Corporation,
a newly-formed Delaware corporation, becomes the parent of EMS
L.P. The equity of EMS L.P. held by persons other than the Onex
entities will be exchanged for shares of common stock of
Emergency Medical Services. The Onex entities will continue to
own limited partnership units in EMS L.P., designated “LP
exchangeable units,” which are exchangeable at any time for
common stock of Emergency Medical Services. The Onex entities
will own approximately % of
Emergency Medical Services’ combined voting power.
We estimate that the net proceeds of our initial public offering
will be approximately
$ million,
at an assumed initial public offering price of
$ per
share and after deducting underwriting discounts and estimated
offering expenses payable by us. We intend to use approximately
$ million
of the net proceeds to repay debt outstanding under our senior
secured credit facility, and the balance for working capital,
capital expenditures and other general corporate purposes.
EMS L.P. will be a consolidated subsidiary of Emergency Medical
Services, and Emergency Medical Services will own the general
partner interests of EMS L.P. Emergency Medical Services will
continue to conduct our operations through AMR and EmCare, our
operating subsidiaries.
[Emergency Medical Services will become a guarantor of the notes
on or prior to the completion of the exchange offer.]
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THE EXCHANGE OFFER
Exchange Offer
We hereby offer, upon the terms and subject to the conditions
set forth in this prospectus and the accompanying letter of
transmittal, to exchange up to $250,000,000 aggregate
principal amount of outstanding notes properly tendered on or
prior to the expiration date and not withdrawn as permitted
pursuant to the procedures described below. The exchange offer
is being made with respect to any and all of the outstanding
notes.
As of the date of this prospectus, $250,000,000 aggregate
principal amount of the notes is outstanding. This prospectus,
together with the accompanying letter of transmittal, is first
being sent on or
about ,
2005 to all holders of outstanding notes registered on our note
register. Our obligation to accept outstanding notes for
exchange pursuant to the exchange offer is subject to certain
conditions set forth under “— Conditions of the
Exchange Offer” below. We currently expect that each of the
conditions will be satisfied and that no waivers will be
necessary.
Purpose and Effect
We sold the outstanding notes on February 10, 2005 to Banc
of America Securities LLC and JP Morgan Securities,
Inc. as the initial purchasers pursuant to a purchase agreement
in a transaction exempt from the registration requirements of
the Securities Act. Accordingly, the outstanding notes may not
be reoffered, resold or otherwise transferred unless so
registered or unless an applicable exemption from the
registration and prospectus delivery requirements of the
Securities Act is available. The initial purchasers subsequently
resold the outstanding notes under Rule 144A under the
Securities Act. As part of the offering of the outstanding
notes, we entered into a registration rights agreement with the
initial purchasers. The registration rights agreement requires,
unless the exchange offer is not permitted by applicable law or
SEC policy, that we:
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within 240 days after the closing of the offering, file
with the SEC the registration statement of which this prospectus
forms a part with respect to the exchange offer; |
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within 300 days after the closing of the offering, use
commercially reasonable efforts to cause the exchange offer
registration statement to be declared effective by the SEC; |
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keep the exchange offer open for not less than 30 business
days; and |
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use commercially reasonable efforts to complete the exchange
offer not later than 30 business days after the exchange
offer registration statement is declared effective. |
Except as provided below, upon the completion of the exchange
offer, our obligations with respect to the registration of the
outstanding notes and the exchange notes will terminate. A copy
of the registration rights agreement has been incorporated by
reference as an exhibit to the registration statement of which
this prospectus forms a part, and this summary of the material
provisions of the registration rights agreement does not purport
to be complete and is qualified in its entirety by reference to
the complete registration rights agreement. Following the
completion of the exchange offer (except as set forth in the
paragraph immediately below), holders of outstanding notes not
tendered will not have any further registration rights and those
outstanding notes will continue to be subject to the
restrictions on transfer described above. Accordingly, the
liquidity of the market for the outstanding notes could be
adversely affected upon consummation of the exchange offer.
Under certain circumstances specified in the registration rights
agreement, we may be required to file a “shelf”
registration statement for a continuous offering in connection
with the outstanding notes pursuant to Rule 415 under the
Securities Act.
We and the guarantors of the notes will, in the event of the
shelf registration statement, provide to each holder of the
outstanding notes copies of the prospectus which is a part of
the shelf registration statement, notify each such holder when
the shelf registration statement for the outstanding notes has
become effective
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and take certain other actions as are required to permit
unrestricted resales of the outstanding notes. A holder of the
outstanding notes that sells such outstanding notes pursuant to
the shelf registration statement generally would be required to
be named as a selling securityholder in the related prospectus
and to deliver a prospectus to purchasers, will be subject to
certain of the civil liability provisions under the Securities
Act in connection with such sales and will be bound by the
provisions of the registration rights agreement which are
applicable to such a holder (including certain indemnification
rights and obligations).
Each holder of outstanding notes that wishes to exchange such
outstanding notes for exchange notes in the exchange offer will
be required to make certain representations, including
representations:
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• |
that any exchange notes to be received by it will be acquired in
the ordinary course of its business; |
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• |
that it has no arrangement or understanding with any person to
participate in the distribution of the exchange notes; |
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• |
that it is not an “affiliate,” as defined in the
Securities Act, of Emergency Medical Services; and |
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• |
any additional representations that in the written opinion of
our counsel are necessary under existing rules or regulations
(or interpretations thereof) of the SEC in order for the
registration statement of which this prospectus forms a part to
be declared effective. |
Based on an interpretation by the staff of the SEC set forth in
no-action letters issued to third parties, we believe that, with
the exceptions set forth below, the exchange notes issued in the
exchange offer in exchange for outstanding notes may be offered
for resale, resold and otherwise transferred by the holder of
exchange notes without compliance with the registration and
prospectus delivery requirements of the Securities Act, unless
the holder:
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• |
acquired the notes other than in the ordinary course of the
holder’s business; |
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• |
has an arrangement with any person to engage in the distribution
of the exchange notes; |
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• |
is an affiliate of Emergency Medical Services within the meaning
of Rule 405 under the Securities Act; |
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• |
is a broker-dealer who purchased outstanding notes directly from
us for resale under Rule 144A or any other available
exemption under the Securities Act; or |
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• |
is prohibited by law or policy of the SEC from participating in
the exchange offer. |
Any holder who tenders in the exchange offer for the purpose of
participating in a distribution of the exchange notes cannot
rely on this interpretation by the SEC’s staff and must
comply with the registration and prospectus delivery
requirements of the Securities Act in connection with a
secondary resale transaction. Each broker-dealer that receives
exchange notes for its own account in exchange for outstanding
notes, where such outstanding notes were acquired by such
broker-dealer as a result of market-making activities or other
trading activities, must acknowledge that it will deliver a
prospectus in connection with any resale of such exchange note.
See “Plan of Distribution.” Broker-dealers who
acquired outstanding notes directly from us and not as a result
of market-making activities or other trading activities may not
rely on the staff’s interpretations discussed above or
participate in the exchange offer, and must comply with the
prospectus delivery requirements of the Securities Act in order
to sell the outstanding notes.
Consequences of Failure to Exchange Outstanding Notes
Following the completion of the exchange offer, holders of
outstanding notes who did not tender their outstanding notes, or
who did not properly tender their outstanding notes, will not
have any further registration rights and such outstanding notes
will continue to be subject to restrictions on transfer.
Accordingly, the liquidity of the market for a holder’s
outstanding notes could be adversely affected upon expiration of
the exchange offer if such holder elects to not participate in
the exchange offer.
35
Terms of the Exchange Offer
Upon the terms and subject to the conditions set forth in this
prospectus and in the accompanying letter of transmittal, we
will accept for exchange any and all outstanding notes that are
validly tendered on or prior
to ,
2005, 5:00 p.m., New York City time, on the expiration
date. For each outstanding note surrendered to us pursuant to
the exchange offer, the holder of such outstanding note will
receive an exchange note having a principal amount equal to that
of the surrendered note. We will issue $1,000 principal
amount of exchange notes for each $1,000 principal amount
of outstanding notes accepted in the exchange offer. Holders who
have tendered their outstanding notes may withdraw their tender
of outstanding notes at any time prior
to ,
2005, 5:00 p.m., New York City time, on the expiration
date. The exchange offer is not conditioned upon any minimum
principal amount of outstanding notes being tendered for
exchange. However, the exchange offer is subject to the terms
and provisions of the registration rights agreement. See
“— Conditions of the Exchange Offer.”
The form and terms of the exchange notes are substantially the
same as the form and terms of the outstanding notes, except that
the exchange notes have been registered under the Securities Act
and will not bear legends restricting their transfer. The
exchange notes will evidence the same debt as the outstanding
notes and will be issued pursuant to, and entitled to the
benefits of, the indenture pursuant to which the outstanding
notes were issued.
As of the date of this prospectus, $250,000,000 aggregate
principal amount of the notes is outstanding. Only a holder of
the outstanding notes, or such holder’s legal
representative or attorney-in-fact, may participate in the
exchange offer. We will not fix a record date for determining
holders of the outstanding notes entitled to participate in the
exchange offer.
We will be deemed to have accepted validly tendered outstanding
notes when, as and if we have given oral or written notice
thereof to the exchange agent. The exchange agent will act as
agent for the tendering holders of outstanding notes and for the
purpose of receiving the exchange notes from us.
If any tendered outstanding notes are not accepted for exchange
because of an invalid tender, the occurrence of other events set
forth in this prospectus or otherwise, the certificates for any
such unaccepted outstanding notes will be returned, without
expense, to the tendering holder as promptly as practicable
after the expiration date.
Holders who tender outstanding notes in the exchange offer will
not be required to pay brokerage commissions or fees or, subject
to the instructions in the letter of transmittal, transfer taxes
with respect to the exchange of outstanding notes pursuant to
the exchange offer. We will pay all charges and expenses, other
than certain applicable taxes, in connection with the exchange
offer. See “— Fees and Expenses.”
Expiration Date; Extensions; Amendments
The expiration date shall
be ,
2005, at 5:00 p.m., New York City time, unless we, in our
sole discretion, extend the exchange offer, in which case the
expiration date shall be the latest date and time to which the
exchange offer is extended.
In order to extend the exchange offer, we will notify the
exchange agent in writing of any extension and make a public
announcement prior to 9:00 a.m., New York City time, on the
next business day after the previously scheduled expiration date.
36
We reserve the right, in our sole discretion:
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• |
to delay accepting any outstanding notes; |
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• |
to extend the exchange offer; |
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• |
if any of the conditions set forth below under
“— Conditions of the Exchange Offer” shall
not have been satisfied, to terminate the exchange offer, by
giving written notice of such delay, extension or termination to
the exchange agent; and |
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• |
to amend the terms of the exchange offer in any manner. |
If we amend the exchange offer in a manner we determine to
constitute a material change, we will promptly disclose such
amendments by means of a prospectus supplement that we will
distribute to the registered holders of the outstanding notes.
Modification of the exchange offer, including, but not limited
to:
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• |
extension of the period during which the exchange offer is
open; and |
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waiver of satisfaction of the conditions set forth below under
“— Conditions of the Exchange Offer” |
may require that at least five business days remain in the
exchange offer.
Conditions of the Exchange Offer
Notwithstanding any other term of the exchange offer, we are not
required to accept for exchange, or exchange the exchange notes
for, any outstanding notes not previously accepted for exchange,
and we may terminate or amend the exchange offer as provided
herein before the acceptance of the outstanding notes, if any of
the following events shall occur:
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• |
any action or proceeding is instituted or threatened in any
court or by or before any governmental agency which would be
reasonably likely to materially impair our ability to proceed
with the exchange offer, or there shall have occurred any
material adverse development in any existing action or
proceeding with respect to us or any of our subsidiaries; or |
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• |
the exchange offer shall violate any applicable law, rule,
regulation or interpretation of the staff of the SEC; or |
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• |
any governmental approval which we shall deem necessary for the
consummation of the exchange offer as contemplated by this
prospectus shall not have been obtained. |
If we determine in our reasonable discretion that any of these
conditions are not satisfied (or any of such events shall have
occurred), we may (1) refuse to accept any outstanding
notes and return all tendered outstanding notes to the tendering
holders and/or terminate the exchange offer, (2) extend the
exchange offer and retain all outstanding notes tendered prior
to the expiration of the exchange offer, subject, however, to
the rights of holders to withdraw such outstanding notes as
described in “— Withdrawal Rights” or
(3) waive such unsatisfied conditions with respect to the
exchange offer and accept all properly tendered outstanding
notes which have not been withdrawn. If such waiver constitutes
a material change to the exchange offer, we will promptly
disclose such waiver by means of a prospectus supplement that
will be distributed to the registered holders of the outstanding
notes, and we will extend the exchange offer for a period of
five to ten business days, depending upon the significance of
the waiver and the manner of disclosure to the registered
holders, if the exchange offer would otherwise expire during
such five to ten business day period.
Holders may have certain rights and remedies against us under
the registration rights agreement should we fail to consummate
the exchange offer, notwithstanding a failure of the conditions
stated above. Such conditions are not intended to modify those
rights or remedies in any respect.
The foregoing conditions are for our sole benefit and we may
assert them regardless of the circumstances giving rise to such
conditions or we may waive them in whole or in part at any time
and from time to time in our reasonable discretion. Any failure
by us at any time to exercise the foregoing rights shall
37
not be deemed a waiver of any such right and each such right
shall be deemed an ongoing right which may be asserted at any
time and from time to time.
Interest
The exchange notes will bear interest at a rate equal to
10% per annum. We will pay interest on the notes twice a
year, on each February 15 and August 15, beginning
August 15, 2005. See “Description of Notes.”
Procedures for Tendering Outstanding Notes
Only a holder of outstanding notes may tender the outstanding
notes in the exchange offer. Except as set forth under
“— Book-Entry Transfer,” to tender in the
exchange offer, a holder must complete, sign and date the letter
of transmittal, or a facsimile thereof, have the signatures
thereon guaranteed if required by the letter of transmittal, and
mail or otherwise deliver the letter of transmittal or copy to
the exchange agent prior to the expiration date. In addition,
(1) certificates for the outstanding notes must be received
by the exchange agent along with the letter of transmittal prior
to the expiration date, (2) a timely confirmation of a
book-entry transfer of such outstanding notes, if that procedure
is available, into the exchange agent’s account at DTC
pursuant to the procedure for book-entry transfer described
below, must be received by the exchange agent prior to the
expiration date or (3) the holder must comply with the
guaranteed delivery procedures described below. To be tendered
effectively, the letter of transmittal and other required
documents must be received by the exchange agent at the address
set forth under “— The Exchange Agent;
Assistance” prior to the expiration date.
The tender by a holder that is not withdrawn before the
expiration date will constitute an agreement between that holder
and us in accordance with the terms and subject to the
conditions set forth herein and in the letter of transmittal.
THE METHOD OF DELIVERY OF OUTSTANDING NOTES AND THE LETTER OF
TRANSMITTAL AND ALL OTHER REQUIRED DOCUMENTS TO THE EXCHANGE
AGENT IS AT THE ELECTION AND RISK OF THE HOLDER. INSTEAD OF
DELIVERY BY MAIL, IT IS RECOMMENDED THAT HOLDERS USE AN
OVERNIGHT OR HAND DELIVERY SERVICE. IN ALL CASES, SUFFICIENT
TIME SHOULD BE ALLOWED TO ASSURE DELIVERY TO THE EXCHANGE AGENT
BEFORE THE EXPIRATION DATE. NO LETTER OF TRANSMITTAL OR
OUTSTANDING NOTES SHOULD BE SENT TO US. HOLDERS MAY REQUEST
THEIR RESPECTIVE BROKERS, DEALERS, COMMERCIAL BANKS, TRUSTS
COMPANIES OR NOMINEES TO EFFECT THESE TRANSACTIONS FOR SUCH
HOLDERS.
Any beneficial owner whose outstanding notes are registered in
the name of a broker-dealer, commercial bank, trust company or
other nominee and who wishes to tender should contact the
registered holder promptly and instruct the registered holder to
tender on the beneficial owner’s behalf. If the beneficial
owner wishes to tender on the owner’s own behalf, the owner
must, prior to completing and executing the letter of
transmittal and delivering the owner’s outstanding notes,
either make appropriate arrangements to register ownership of
the outstanding notes in the beneficial owner’s name or
obtain a properly completed bond power from the registered
holder. The transfer of registered ownership may take
considerable time.
Signatures on a letter of transmittal or a notice of withdrawal,
as the case may be, must be guaranteed by an eligible guarantor
institution that is a member of or participant in the Securities
Transfer Agents Medallion Program, the New York Stock Exchange
Medallion Signature Program or an “eligible guarantor
institution” within the meaning of Rule 17Ad-15 under
the Securities Exchange Act of 1934, unless outstanding notes
tendered pursuant thereto are tendered (1) by a registered
holder who has not completed the box entitled “Special
Registration Instructions” or “Special Delivery
Instructions” in the letter of transmittal or (2) for
the account of such an eligible guarantor institution. If
signatures on a letter of transmittal or a notice of withdrawal,
as the case may be, are required to be guaranteed, the guarantee
must be by an eligible guarantor institution.
38
If the letter of transmittal is signed by a person other than
the registered holder of any outstanding notes listed therein,
the outstanding notes must be endorsed or accompanied by a
properly completed bond power, signed by the registered holder
as that registered holder’s name appears on the outstanding
notes.
If the letter of transmittal or any outstanding notes or bond
powers are signed by trustees, executors, administrators,
guardians, attorneys-in-fact, officers of corporations or others
acting in a fiduciary or representative capacity, such persons
should so indicate when signing, and evidence satisfactory to us
of their authority to so act must be submitted with the letter
of transmittal unless waived by us.
We will determine all questions as to the validity, form,
eligibility, including time of receipt, acceptance and
withdrawal of tendered outstanding notes in our sole discretion,
which determination will be final and binding. We reserve the
absolute right to reject any and all outstanding notes not
properly tendered or any outstanding notes our acceptance of
which would, in the opinion of our counsel, be unlawful. We also
reserve the right to waive any defects, irregularities or
conditions of tender as to particular outstanding notes. Our
interpretation of the terms and conditions of the exchange
offer, including the instructions in the letter of transmittal,
will be final and binding on all parties.
Unless waived, any defects or irregularities in connection with
tenders of outstanding notes must be cured within such time as
we shall determine. Although we intend to notify holders of
defects or irregularities with respect to tenders of outstanding
notes, neither we nor the exchange agent nor any other person
shall incur any liability for failure to give such notification.
Tenders of outstanding notes will not be deemed to have been
made until such defects or irregularities have been cured or
waived. Any outstanding notes received by the exchange agent
that are not properly tendered and as to which the defects or
irregularities have not been cured or waived will be returned by
the exchange agent to the tendering holders, unless otherwise
provided in the letter of transmittal, as soon as practicable
following the expiration date.
In addition, we reserve the right in our sole discretion to
purchase or make offers for any outstanding notes that remain
outstanding after the expiration date or to terminate the
exchange offer and, to the extent permitted by applicable law,
to purchase outstanding notes in the open market, in privately
negotiated transactions, or otherwise. The terms of any such
purchases or offers could differ from the terms of the exchange
offer.
By tendering, each holder will represent to us that, among other
things:
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• |
that any exchange notes to be received by it will be acquired in
the ordinary course of its business; |
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• |
that it has no arrangement or understanding with any person to
participate in the distribution of the exchange notes; |
|
|
• |
that it is not an “affiliate,” as defined in the
Securities Act, of Emergency Medical Services; and |
|
|
• |
any additional representations that in the written opinion of
our counsel are necessary under existing rules or regulations
(or interpretations thereof) of the SEC in order for the
registration statement of which this prospectus forms a part to
be declared effective. |
In all cases, issuance of exchange notes for outstanding notes
that are accepted for exchange pursuant to the exchange offer
will be made only after timely receipt by the exchange agent of
certificates for such outstanding notes or a timely confirmation
of a book-entry transfer of such outstanding notes into the
exchange agent’s account at DTC, a properly completed and
duly executed letter of transmittal (or, with respect to DTC and
its participants, electronic instructions in which the tendering
holder acknowledges its receipt of an agreement to be bound by
the letter of transmittal), and all other required documents. If
any tendered outstanding notes are not accepted for any reason
set forth in the terms and conditions of the exchange offer or
if outstanding notes are submitted for a greater principal
amount than the holder desires to exchange, such unaccepted or
non-exchanged outstanding notes will be returned without expense
to the tendering holder thereof, or, in the case of notes
tendered by book-entry transfer into the exchange agent’s
account at DTC pursuant to the book-entry transfer procedures
described below, such non-exchanged outstanding notes will be
credited to an account maintained with DTC, as promptly as
practicable after the expiration or termination of the exchange
offer.
39
Each broker-dealer that receives exchange notes for its own
account in exchange for outstanding notes, where such
outstanding notes were acquired by such broker-dealer as a
result of market-making activities or other trading activities,
must acknowledge that it will deliver a prospectus in connection
with any resale of such exchange notes. See “Plan of
Distribution.”
Book-Entry Transfer
The exchange agent will make a request to establish an account
with respect to the outstanding notes at DTC for purposes of the
exchange offer within two business days after the date of this
prospectus, and any financial institution that is a participant
in DTC’s systems may make book-entry delivery of
outstanding notes being tendered by causing DTC to transfer such
outstanding notes into the exchange agent’s account at DTC
in accordance with DTC’s procedures for transfer. However,
although delivery of outstanding notes may be effected through
book-entry transfer at DTC, the letter of transmittal or copy
thereof, with any required signature guarantees and any other
required documents, must, in any case other than as set forth in
the following paragraph, be transmitted to and received by the
exchange agent at the address set forth under
“— The Exchange Agent; Assistance” on or
prior to the expiration date or the guaranteed delivery
procedures described below must be complied with.
DTC’s Automated Tender Offer Program, or ATOP, is the only
method of processing exchange offers through DTC. To accept the
exchange offer through ATOP, participants in DTC must send
electronic instructions to DTC through DTC’s communication
system in lieu of sending a signed, hard copy letter of
transmittal. DTC is obligated to communicate those electronic
instructions to the exchange agent. To tender outstanding notes
through ATOP, the electronic instructions sent to DTC and
transmitted by DTC to the exchange agent must reflect that the
participant acknowledges its receipt of and agrees to be bound
by the letter of transmittal.
Guaranteed Delivery Procedures
Holders who wish to tender their outstanding notes and whose
outstanding notes are not immediately available, or who cannot
deliver their outstanding notes or any other documents required
by the letter of transmittal to the exchange agent prior to the
expiration date, may tender their outstanding notes according to
the guaranteed delivery procedures set forth in the letter of
transmittal. Pursuant to such procedures:
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• |
the holder tenders through an eligible guarantor institution and
signs a notice of guaranteed delivery; |
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• |
on or prior to the expiration date, the exchange agent receives
from the holder and the eligible guarantor institution a written
or facsimile copy of a properly completed and duly executed
notice of guaranteed delivery, substantially in the form
provided by us, setting forth the name and address of the
holder, the certificate number or numbers of the tendered
outstanding notes, and the principal amount of tendered
outstanding notes, stating that the tender is being made thereby
and guaranteeing that, within five business days after the date
of delivery of the notice of guaranteed delivery, the tendered
outstanding notes, a duly executed letter of transmittal and any
other required documents will be deposited by the eligible
guarantor institution with the exchange agent; and |
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• |
such properly completed and executed documents required by the
letter of transmittal and the tendered outstanding notes in
proper form for transfer are received by the exchange agent
within five business days after the expiration date. |
Any holder who wishes to tender outstanding notes pursuant to
the guaranteed delivery procedures described above must ensure
that the exchange agent receives the notice of guaranteed
delivery and letter of transmittal relating to such outstanding
notes prior to 5:00 p.m., New York City time, on the
expiration date.
Acceptance of Outstanding Notes for Exchange; Delivery of
Exchange Notes
Upon satisfaction or waiver of all the conditions to the
exchange offer, we will accept any and all outstanding notes
that are properly tendered in the exchange offer prior to
5:00 p.m., New York City time, on the expiration date. The
exchange notes issued pursuant to the exchange offer will be
delivered promptly after
40
acceptance of the outstanding notes. For purposes of the
exchange offer, we shall be deemed to have accepted validly
tendered outstanding notes, when, as, and if we have given oral
or written notice thereof to the exchange agent.
In all cases, issuances of exchange notes for outstanding notes
that are accepted for exchange pursuant to the exchange offer
will be made only after the exchange agent timely receives such
outstanding notes, a properly completed and duly executed letter
of transmittal and all other required documents; provided,
however, we reserve the absolute right to waive any defects
or irregularities in the tender or conditions of the exchange
offer. If we do not accept any tendered outstanding notes for
any reason, we will return such unaccepted outstanding notes
without expense to the tendering holder thereof as promptly as
practicable after the expiration or termination of the exchange
offer.
Withdrawal Rights
Holders may withdraw tenders of outstanding notes at any time
prior to 5:00 p.m., New York City time, on the expiration
date. For the withdrawal to be effective, the exchange agent
must receive a written notice of withdrawal at its address set
forth under “— The Exchange Agent;
Assistance.” The notice of withdrawal must:
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specify the name of the person who tendered the outstanding
notes to be withdrawn; |
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identify the outstanding notes to be withdrawn, including the
certificate number or numbers and principal amount of withdrawn
outstanding notes; |
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• |
be signed by the holder in the same manner as the original
signature on the letter of transmittal by which such outstanding
notes were tendered, including any required signature
guarantees, or be accompanied by a bond power in the name of the
person withdrawing the tender, in satisfactory form as
determined by us in our sole discretion, duly executed by the
registered holder, with the signature thereon guaranteed by an
eligible guarantor institution together with the other documents
required upon transfer by the indenture; and |
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• |
specify the name in which such outstanding notes are to be
registered, if different from the person who deposited the
outstanding notes, pursuant to such documents of transfer. |
We will determine all questions as to the validity, form and
eligibility, including time of receipt, of such withdrawal
notices in our sole discretion. The outstanding notes so
withdrawn will be deemed not to have been validly tendered for
exchange for purposes of the exchange offer. Any outstanding
notes which have been tendered for exchange but which are
withdrawn will be returned to their holder without cost to such
holder as soon as practicable after withdrawal. Properly
withdrawn outstanding notes may be re-tendered by following one
of the procedures described under “— Procedures
for Tendering Outstanding Notes” at any time on or prior to
the expiration date.
41
The Exchange Agent; Assistance
U.S. Bank Trust National Association is the exchange
agent. All tendered outstanding notes, executed letters of
transmittal and other related documents should be directed to
the exchange agent. Questions and requests for assistance and
requests for additional copies of this prospectus, the letter of
transmittal and other related documents should be addressed to
the exchange agent as follows:
By Registered or Certified Mail:
U.S. Bank Trust National Association
Corporate Trust Services
EP-MN-WS-2N
60 Livingston Avenue
St. Paul, Minnesota 55107
Attention: Specialized Finance
By Hand or Overnight Courier:
U.S. Bank Trust National Association
Corporate Trust Services
EP-MN-WS-2N
60 Livingston Avenue
St. Paul, Minnesota 55107
Attention: Specialized Finance
By Facsimile:
(Eligible Institutions Only)
U.S. Bank Trust National Association
Attention: Specialized Finance
(651) 495-8158
Confirm Facsimile by Telephone or for Information Call:
(800) 934-6802
Fees and Expenses
We have not retained any dealer-manager in connection with the
exchange offer and will not make any payments to brokers,
dealers or others soliciting acceptance of the exchange offer.
We will, however, pay the exchange agent reasonable and
customary fees for its services and will reimburse it for its
reasonable out-of-pocket expenses. The additional estimated cash
expenses to be incurred in connection with the exchange offer
will be paid by us and will include accounting, legal, printing
and related fees and expenses.
We will pay all transfer taxes, if any, applicable to the
exchange of outstanding notes pursuant to the exchange offer.
If, however, a transfer tax is imposed for any reason other than
the exchange of outstanding notes pursuant to the exchange
offer, then the amount of any such transfer taxes, whether
imposed on the registered holder or any other person, will be
payable by the tendering holder. If satisfactory evidence of
payment of such taxes or exemption is not submitted with the
letter of transmittal, the amount of such transfer taxes will be
billed directly to such tendering holder.
Accounting Treatment
We will record the exchange notes at the same carrying value as
the outstanding notes, as reflected in our accounting records on
the date of the exchange. Accordingly, we will not recognize any
gain or loss for accounting purposes. We will amortize expenses
of the exchange offer over the term of the exchange notes.
42
USE OF PROCEEDS
This exchange offer is intended to satisfy our obligations under
the registration rights agreement, dated February 10, 2005,
among EMS L.P., the issuers, the subsidiary guarantors and the
initial purchasers of the outstanding notes. We will not receive
any proceeds from the issuance of the exchange notes in the
exchange offer. Instead, we will receive in exchange outstanding
notes in like principal amount. We will retire or cancel all of
the outstanding notes tendered in the exchange offer.
Accordingly, issuance of the exchange notes will not result in
any change in our capitalization.
We used the net proceeds from the sale of the outstanding notes,
together with the initial borrowings under our senior secured
facility and the equity investment by the Onex entities and
members of senior management, to finance our acquisition of AMR
and EmCare in February 2005 and to pay related fees and expenses.
43
CAPITALIZATION
The following table sets forth our capitalization as of
June 30, 2005 on an actual basis, and on a pro forma basis
to give effect to our proposed initial public offering and our
intended use of proceeds from that offering. See
“Formation of Holding Company.” You should read
this table together with our “Management’s Discussion
and Analysis of Financial Condition and Results of
Operations” and our financial statements and the notes to
those statements included elsewhere in this prospectus.
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As of June 30, 2005 |
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(dollars in millions) |
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(unaudited) |
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Pro |
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Actual | |
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Forma |
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Long-term debt, including current portion:
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Revolving credit facility(1)
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$ |
— |
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$ |
— |
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Term loan
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349.1 |
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Capital leases and other debt
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6.8 |
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Total senior debt
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355.9 |
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Senior subordinated notes
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250.0 |
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Total debt
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$ |
605.9 |
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$ |
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Partners’ equity
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219.4 |
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Class A common stock
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— |
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— |
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Class B common stock
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— |
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— |
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LP exchangeable units
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— |
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— |
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Retained earnings
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11.1 |
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Comprehensive income
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0.4 |
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Total equity
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230.9 |
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|
|
|
|
|
|
|
|
|
|
|
|
Total capitalization
|
|
$ |
836.8 |
|
|
$ |
|
|
|
|
|
|
|
|
|
|
|
(1) |
The revolving credit facility provides for availability of
borrowings and issuances of letters of credit for up to
$100.0 million. As of June 30, 2005, we had
$75.7 million of availability under the revolving credit
facility, net of $24.3 million of letters of credit
outstanding. |
44
UNAUDITED PRO FORMA CONSOLIDATED FINANCIAL DATA
The following pro forma consolidated financial statements
present Emergency Medical Services’ financial position and
results of operations resulting from the acquisition of AMR and
EmCare, the sale
of shares of
class A common stock pursuant to our initial public
offering and the application of the proceeds therefrom as
described in “Formation of Holding Company.” AMR and
EmCare combined are the predecessor entity of Emergency Medical
Services for the periods prior to our acquisition of those
businesses.
The unaudited pro forma consolidated financial statements
include:
|
|
|
|
• |
the pro forma consolidated balance sheet as of June 30,
2005, assuming our offering occurred on June 30, 2005 and
the proceeds were applied as described in “Formation of
Holding Company,” |
|
|
• |
the pro forma consolidated statement of operations for the five
months ended June 30, 2005, assuming our offering occurred
on February 1, 2005 and the proceeds were applied as
described in “Formation of Holding Company,” |
|
|
• |
the pro forma consolidated statement of operations for the five
months ended January 31, 2005, assuming the transactions
described below occurred as of September 1, 2004, and |
|
|
• |
the pro forma consolidated statement of operations for the year
ended August 31, 2004, assuming the transactions described
below occurred as of September 1, 2003. |
The unaudited pro forma consolidated financial information is
presented for informational purposes only and does not purport
to represent our financial condition or our results of
operations had the acquisition and our initial public offering
occurred on or as of the dates noted above or to project the
results for any future date or period. In the opinion of
management, all adjustments have been made that are necessary to
present fairly the unaudited pro forma consolidated financial
information.
The unaudited pro forma consolidated financial statements for
periods prior to our acquisition of AMR and EmCare are based on
the historical combined financial statements of AMR and EmCare,
as predecessor to Emergency Medical Services, included elsewhere
in this prospectus, adjusted to give pro forma effect to the
following transactions, all of which are deemed to have occurred
concurrently:
|
|
|
|
• |
our acquisition of AMR and EmCare, including: |
|
|
|
|
• |
issuance of equity by Emergency Medical Services for aggregate
contributions of $219.2 million, |
|
|
• |
our senior secured credit facility, consisting of: |
|
|
|
|
• |
a revolving credit facility of $100.0 million, of which we
borrowed approximately $20.2 million at the closing date of
the acquisition and had outstanding $24.3 million of
letters of credit, and |
|
|
• |
a term loan of $350.0 million, all of which was borrowed on
the closing date, |
|
|
|
|
• |
the issuance and sale of $250.0 million in aggregate
principal amount of our outstanding notes, |
|
|
• |
our purchase of all of the outstanding common stock of AMR and
EmCare, and |
|
|
• |
the payment of related fees and expenses related to the
acquisition. |
The unaudited pro forma consolidated financial statements for
all periods are adjusted to give pro forma effect to the
following, which are deemed to have occurred concurrently:
|
|
|
|
• |
our formation as a holding company, with EMS L.P. and its
general partner as subsidiaries, the issuance of common stock to
our equityholders other than the Onex entities and
a -for- stock
split, and |
|
|
• |
the sale
of shares of
class A common stock in our initial public offering and the
application of the proceeds therefrom as described in
“Formation of Holding Company.” |
The unaudited pro forma consolidated financial statements are
based on the estimates and assumptions set forth in the notes to
these statements that management believes are reasonable. These
estimates include an
45
allocation of fair value to identifiable intangible assets other
than goodwill, and the resulting excess of the purchase price
over the carrying value of the net assets acquired is recorded
as goodwill. The pro forma adjustments reflected in the
following financial statements are based on management’s
preliminary assessment of the fair value of the tangible and
intangible assets we acquired and liabilities we assumed in our
acquisition of AMR and EmCare. The final purchase price
allocation will be performed when an independent appraisal of
certain assets acquired and liabilities assumed is finalized. We
expect that the final purchase price allocation may reflect
differences from our estimated amounts, as follows:
|
|
|
|
• |
the fair value of our finite life contract intangible asset, |
|
|
• |
the fair value adjustment for favorable or unfavorable leases, |
|
|
• |
the fair value adjustment for property and equipment, |
|
|
• |
changes in the excess purchase price allocated to
goodwill, and |
|
|
• |
changes in the fair value of other liabilities assumed and
incurred as part of the acquisition. |
The unaudited pro forma consolidated financial statements should
be read in conjunction with our historical financial statements
and related notes and other financial information included
elsewhere in this prospectus, including “Risk Factors”
and “Management’s Discussion and Analysis of Financial
Condition and Results of Operations.”
46
Emergency Medical Services Corporation
Unaudited Pro Forma Consolidated Balance Sheet
June 30, 2005
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Pro Forma Equity | |
|
|
|
|
|
|
Offering | |
|
Pro | |
|
|
Actual | |
|
Adjustments | |
|
Forma | |
|
|
| |
|
| |
|
| |
|
|
(dollars in thousands) | |
ASSETS |
Current assets:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Cash and cash equivalents
|
|
$ |
31,365 |
|
|
$ |
— |
|
|
$ |
31,365 |
|
|
Restricted cash and cash equivalents
|
|
|
12,785 |
|
|
|
— |
|
|
|
12,785 |
|
|
Restricted marketable securities
|
|
|
1,011 |
|
|
|
— |
|
|
|
1,011 |
|
|
Trade and other accounts receivable, net
|
|
|
346,491 |
|
|
|
— |
|
|
|
346,491 |
|
|
Parts and supplies inventory
|
|
|
18,404 |
|
|
|
— |
|
|
|
18,404 |
|
|
Other current assets
|
|
|
34,684 |
|
|
|
— |
|
|
|
34,684 |
|
|
Current deferred tax assets
|
|
|
19,774 |
|
|
|
— |
|
|
|
19,774 |
|
|
|
|
|
|
|
|
|
|
|
|
|
Total current assets
|
|
|
464,514 |
|
|
|
— |
|
|
|
464,514 |
|
Non-current assets:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Property, plant and equipment, net
|
|
|
130,061 |
|
|
|
— |
|
|
|
130,061 |
|
|
Intangible assets, net
|
|
|
84,542 |
|
|
|
— |
|
|
|
84,542 |
|
|
Non-current deferred tax assets
|
|
|
119,848 |
|
|
|
— |
|
|
|
119,848 |
|
|
Restricted long-term investments
|
|
|
57,734 |
|
|
|
— |
|
|
|
57,734 |
|
|
Goodwill
|
|
|
267,474 |
|
|
|
— |
|
|
|
267,474 |
|
|
Other long-term assets
|
|
|
99,379 |
|
|
|
|
(1) |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Total assets
|
|
$ |
1,223,552 |
|
|
$ |
|
|
|
$ |
|
|
|
|
|
|
|
|
|
|
|
|
|
LIABILITIES AND EQUITY |
Current liabilities:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Accounts payable
|
|
$ |
47,906 |
|
|
$ |
— |
|
|
$ |
47,906 |
|
|
Accrued liabilities
|
|
|
189,425 |
|
|
|
— |
|
|
|
189,425 |
|
|
Current portion of long-term debt
|
|
|
9,204 |
|
|
|
— |
|
|
|
9,204 |
|
|
|
|
|
|
|
|
|
|
|
|
|
Total current liabilities
|
|
|
246,535 |
|
|
|
— |
|
|
|
246,535 |
|
Long-term debt
|
|
|
596,720 |
|
|
|
|
(2) |
|
|
|
|
Other long-term liabilities
|
|
|
149,437 |
|
|
|
— |
|
|
|
149,437 |
|
|
|
|
|
|
|
|
|
|
|
|
|
Total liabilities
|
|
|
992,692 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Equity
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Partnership equity
|
|
|
219,429 |
|
|
|
(219,429 |
)(3) |
|
|
— |
|
|
Class A common stock
|
|
|
— |
|
|
|
|
(3) |
|
|
|
|
|
Class B common stock
|
|
|
— |
|
|
|
|
(3) |
|
|
— |
|
|
LP exchangeable units
|
|
|
— |
|
|
|
|
(3) |
|
|
|
|
|
Retained earnings
|
|
|
11,067 |
|
|
|
|
(1) |
|
|
|
|
|
Comprehensive income (loss)
|
|
|
364 |
|
|
|
— |
|
|
|
364 |
|
|
|
|
|
|
|
|
|
|
|
|
|
Total equity
|
|
|
230,860 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Total liabilities and equity
|
|
$ |
1,223,552 |
|
|
$ |
|
|
|
$ |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
(1) |
To record the write-off of certain deferred financing costs
associated with the portion of our senior secured credit
facility we will pay down with the net proceeds of our initial
public offering. |
|
(2) |
To record the pay-down of our senior secured credit facility
with the net proceeds of our initial public offering. The
results of this exchange offer will not change the outstanding
debt; accordingly, there is no pro forma impact of this exchange
offer. |
|
(3) |
To record (a) our formation as a holding company, with
EMS L.P. and its general partner as subsidiaries, the
(b) issuance of class A common stock and class B
common stock to certain of our existing equityholders and the
designation of the remaining class A partnership units as
LP exchangeable units, exchangeable for our class B common
stock and (c) net proceeds of our initial public offering. |
47
Emergency Medical Services Corporation
Unaudited Pro Forma Consolidated Statement of Operations
For the five months ended June 30, 2005
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Pro Forma Equity | |
|
|
|
|
|
|
Offering | |
|
|
|
|
Consolidated | |
|
Adjustments | |
|
Pro Forma | |
|
|
| |
|
| |
|
| |
|
|
(dollars in thousands) | |
Net revenue
|
|
$ |
731,410 |
|
|
$ |
— |
|
|
$ |
731,410 |
|
Compensation and benefits
|
|
|
502,998 |
|
|
|
— |
|
|
|
502,998 |
|
Operating expenses
|
|
|
102,170 |
|
|
|
— |
|
|
|
102,170 |
|
Insurance expense
|
|
|
39,334 |
|
|
|
— |
|
|
|
39,334 |
|
Selling, general and administrative expenses
|
|
|
23,179 |
|
|
|
— |
|
|
|
23,179 |
|
Laidlaw fees and compensation charges
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
Depreciation and amortization expenses
|
|
|
23,988 |
|
|
|
— |
|
|
|
23,988 |
|
|
|
|
|
|
|
|
|
|
|
Income from operations
|
|
|
39,741 |
|
|
|
— |
|
|
|
39,741 |
|
Interest expense
|
|
|
(21,584 |
) |
|
|
|
(1) |
|
|
|
|
Realized loss on investments
|
|
|
(6 |
) |
|
|
— |
|
|
|
(6 |
) |
Interest and other income
|
|
|
94 |
|
|
|
— |
|
|
|
94 |
|
|
|
|
|
|
|
|
|
|
|
Income before income taxes
|
|
|
18,245 |
|
|
|
|
|
|
|
|
|
Income tax expense
|
|
|
(7,178 |
) |
|
|
|
(2) |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Net income (loss)
|
|
$ |
11,067 |
|
|
$ |
|
|
|
$ |
|
|
|
|
|
|
|
|
|
|
|
|
Net income (loss) per share:
|
|
|
|
|
|
|
|
|
|
|
|
|
Basic |
|
$ |
|
|
Diluted |
|
$ |
|
|
Weighted average shares — basic |
|
|
|
|
Weighted average shares — diluted |
|
|
|
|
|
|
(1) |
To record reduction of interest expense on our senior secured
credit facility as a result of the pay-down with net proceeds of
our initial public offering. |
|
(2) |
To adjust income tax expense to reflect the reduction of
interest expense, at an effective tax rate of 40%. |
48
Emergency Medical Services Corporation
Unaudited Pro Forma Consolidated Statement of Operations
For the five months ended January 31, 2005
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
AMR and | |
|
Pro Forma | |
|
Pro Forma | |
|
|
|
|
EmCare | |
|
Acquisition | |
|
Equity Offering | |
|
|
|
|
Combined | |
|
Adjustments | |
|
Adjustments | |
|
Pro Forma | |
|
|
| |
|
| |
|
| |
|
| |
|
|
(dollars in thousands) | |
Net revenue
|
|
$ |
696,179 |
|
|
$ |
— |
|
|
$ |
— |
|
|
$ |
696,179 |
|
Compensation and benefits
|
|
|
481,305 |
|
|
|
— |
|
|
|
— |
|
|
|
481,305 |
|
Operating expenses
|
|
|
94,882 |
|
|
|
— |
|
|
|
— |
|
|
|
94,882 |
|
Insurance expense
|
|
|
39,002 |
|
|
|
— |
|
|
|
— |
|
|
|
39,002 |
|
Selling, general and administrative expenses
|
|
|
21,635 |
|
|
|
— |
|
|
|
— |
|
|
|
21,635 |
|
Laidlaw fees and compensation charges
|
|
|
19,857 |
|
|
|
— |
|
|
|
— |
|
|
|
19,857 |
(1) |
Depreciation and amortization expenses
|
|
|
18,808 |
|
|
|
4,424 |
(2) |
|
|
— |
|
|
|
23,232 |
|
Restructuring charges
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Income (loss) from operations
|
|
|
20,690 |
|
|
|
(4,424 |
) |
|
|
— |
|
|
|
16,266 |
|
Interest expense
|
|
|
(5,644 |
) |
|
|
5,254 |
(3) |
|
|
— |
|
|
|
|
|
|
|
|
|
|
|
|
(19,408 |
)(4)(5) |
|
|
|
(6) |
|
|
|
|
Interest and other income
|
|
|
714 |
|
|
|
— |
|
|
|
— |
|
|
|
714 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Income (loss) before income taxes
|
|
|
15,760 |
|
|
|
(18,578 |
) |
|
|
|
|
|
|
|
|
Income tax expense
|
|
|
(6,278 |
) |
|
|
7,500 |
(7) |
|
|
|
(7) |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Net income (loss)
|
|
$ |
9,482 |
|
|
$ |
(11,078 |
) |
|
$ |
|
|
|
$ |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Net income (loss) per share:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Basic |
|
|
|
|
|
$ |
|
|
Diluted |
|
|
|
|
|
$ |
|
|
Weighted average shares — basic |
|
|
|
|
|
|
|
|
Weighted average shares — diluted |
|
|
|
|
|
|
|
|
|
|
(1) |
Represents certain Laidlaw fees and compensation charges,
primarily relating to a compensation charge associated with the
increase in the enterprise values of AMR and EmCare. Our
estimated replacement costs for certain functions are not
recorded on the face of this pro forma statement of operations
because we do not have a contract for each element of these
costs. We will be required to replace certain functions and
costs previously provided to us by Laidlaw and which comprise
Laidlaw fees and compensation charges. Our estimate of these
costs on an annual basis ($1.67 million for a five-month
period) are: |
|
|
|
|
|
Compensation and benefits costs for personnel providing internal
audit and tax services
|
|
$ |
1,100 |
|
Directors and officers insurance
|
|
|
500 |
|
Selling, general and administrative expenses for external audit
fees, treasury services and other costs
|
|
|
1,400 |
|
Sponsor management fee
|
|
|
1,000 |
|
|
|
|
|
|
|
$ |
4,000 |
|
|
|
|
|
We incurred $1.1 million of such costs in the five months
ended June 30, 2005, excluding costs related to our
acquisition of AMR and EmCare.
|
|
(2) |
AMR and EmCare combined amortization expense includes
amortization (over a 7-year period) of the finite life
intangible assets of $89.0 million based on the preliminary
value of identifiable intangible assets determined by an
independent valuation group. |
|
(3) |
To eliminate interest expense charged on the Laidlaw payable. |
|
(4) |
To record amortization on $18.1 million of deferred
financing costs associated with our acquisition-related
borrowings, utilizing a weighted average maturity of eight years
on an effective yield basis. |
|
(5) |
To record interest expense on our acquisition-related
borrowings, assuming a weighted average interest rate of 7.14%. |
|
(6) |
To record reduction of interest expense on our senior secured
credit facility as a result of the pay-down with net proceeds of
our initial public offering. |
|
(7) |
To adjust income tax expense to reflect the adjustments
identified in notes (2) through (6), at an effective tax
rate of 40%. |
49
Emergency Medical Services Corporation
Unaudited Pro Forma Consolidated Statement of Operations
For the year ended August 31, 2004
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
AMR and | |
|
Pro Forma | |
|
Pro Forma | |
|
|
|
|
EmCare | |
|
Acquisition | |
|
Equity Offering | |
|
|
|
|
Combined | |
|
Adjustments | |
|
Adjustments | |
|
Pro Forma | |
|
|
| |
|
| |
|
| |
|
| |
|
|
(dollars in thousands) | |
Net revenue
|
|
$ |
1,604,598 |
|
|
$ |
— |
|
|
$ |
— |
|
|
$ |
1,604,598 |
|
Compensation and benefits
|
|
|
1,117,890 |
|
|
|
— |
|
|
|
— |
|
|
|
1,117,890 |
|
Operating expenses
|
|
|
218,277 |
|
|
|
— |
|
|
|
— |
|
|
|
218,277 |
|
Insurance expense
|
|
|
80,255 |
|
|
|
— |
|
|
|
— |
|
|
|
80,255 |
|
Selling, general and administrative expenses
|
|
|
47,899 |
|
|
|
— |
|
|
|
— |
|
|
|
47,899 |
|
Laidlaw fees and compensation charges
|
|
|
15,449 |
|
|
|
— |
|
|
|
— |
|
|
|
15,449 |
(1) |
Depreciation and amortization expenses
|
|
|
52,739 |
|
|
|
3,134 |
(2) |
|
|
— |
|
|
|
55,873 |
|
Restructuring charges
|
|
|
2,115 |
|
|
|
— |
|
|
|
— |
|
|
|
2,115 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Income (loss) from operations
|
|
|
69,974 |
|
|
|
(3,134 |
) |
|
|
— |
|
|
|
66,840 |
|
Interest expense
|
|
|
(9,961 |
) |
|
|
6,223 |
(3) |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
(46,528 |
) (4)(5) |
|
|
|
(6) |
|
|
|
|
Realized gain (loss) on investments
|
|
|
(1,140 |
) |
|
|
— |
|
|
|
— |
|
|
|
(1,140 |
) |
Early debt retirement costs
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
Interest and other income
|
|
|
240 |
|
|
|
— |
|
|
|
— |
|
|
|
240 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Income (loss) before income taxes
|
|
|
59,113 |
|
|
|
(43,439 |
) |
|
|
|
|
|
|
|
|
Income tax expense
|
|
|
(21,764 |
) |
|
|
17,375 |
(7) |
|
|
|
(7) |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Net income (loss)
|
|
$ |
37,349 |
|
|
$ |
(26,064 |
) |
|
$ |
|
|
|
$ |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Net income (loss) per share:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
(1) |
Represents certain Laidlaw fees and compensation charges,
primarily relating to a compensation charge associated with the
increase in the enterprise values of AMR and EmCare. Our
estimated replacement costs for certain functions, are not
recorded on the face of this pro forma statement of operations
because we do not have a contract for each element of these
costs. We will be required to replace certain functions and
costs previously provided to us by Laidlaw and which comprise
Laidlaw fees and compensation charges. Our estimate of these
costs on an annual basis are: |
|
|
|
|
|
Compensation and benefits costs for personnel providing internal
audit and tax services
|
|
$ |
1,100 |
|
Directors and officers insurance
|
|
|
500 |
|
Selling, general and administrative expenses for external audit
fees, treasury services and other costs
|
|
|
1,400 |
|
Sponsor management fee
|
|
|
1,000 |
|
|
|
|
|
|
|
$ |
4,000 |
|
|
|
|
|
We incurred $1.1 million of such costs in the five months
ended June 30, 2005, excluding costs related to our
acquisition of AMR and EmCare.
|
|
(2) |
AMR and EmCare combined amortization expense includes
amortization (over a 7-year period) of the finite life
intangible assets of $89.0 million based on the value of
identifiable intangible assets by an independent valuation group. |
|
(3) |
To eliminate interest expense charged on the Laidlaw payable. |
|
(4) |
To record amortization on $18.1 million of deferred
financing costs associated with our acquisition-related
borrowings, utilizing a weighted average maturity of eight years
on an effective yield basis. |
|
(5) |
To record interest expense on our acquisition-related
borrowings, assuming a weighted average interest rate of 7.14%. |
|
(6) |
To record reduction of interest expense on our senior secured
credit facility as a result of the pay-down with net proceeds of
our initial public offering. |
|
(7) |
To adjust income tax expense to reflect the adjustments
identified in notes (2) through (6), at an effective tax
rate of 40%. |
50
SELECTED COMBINED AND CONSOLIDATED FINANCIAL INFORMATION AND
OTHER DATA
The following table sets forth our selected combined or
consolidated financial data for each of the periods indicated.
Financial data for the year ended August 31, 2002
(Predecessor — Pre-Laidlaw Bankruptcy), nine months
ended May 31, 2003 (Predecessor — Pre-Laidlaw
Bankruptcy), as of and for the three months ended
August 31, 2003 (Predecessor — Post-Laidlaw
bankruptcy), the year ended August 31, 2004
(Predecessor — Post-Laidlaw Bankruptcy) and the five
months ended January 31, 2005 (Predecessor —
Post-Laidlaw Bankruptcy) are derived from our audited combined
financial statements included in this prospectus. As a result of
a correction to AMR’s method of calculating its accounts
receivable allowances, we determined that the allowances were
understated at various balance sheet dates. The audited combined
financial statements included in this prospectus are restated to
correct this error. There were no adjustments necessary to
income subsequent to May 31, 2003. Financial data as of and
for the five months ended January 31, 2004
(Predecessor — Post-Laidlaw Bankruptcy) and the three
months and five months ended June 30, 2004
(Predecessor — Post-Laidlaw Bankruptcy) are derived
from our unaudited combined financial statements included in
this prospectus. Financial data as of and for the three months
and five months ended June 30, 2005 are derived from our
unaudited consolidated financial statements. Interim results are
not necessarily indicative of the results to be expected for the
entire fiscal year. You should read the information presented
below in conjunction with “Capitalization,”
“Management’s Discussion and Analysis of Financial
Condition and Results of Operations” and our combined and
consolidated financial statements and related notes contained
elsewhere in this prospectus.
The comparability of our selected historical financial data has
been affected by a number of significant events and
transactions. As we discuss more fully in
note 1 — “Fresh-Start Accounting” of
the notes to our audited combined financial statements,
AMR’s and EmCare’s former parent, Laidlaw, and certain
of its affiliates filed voluntary petitions for reorganization
under Chapter 11 of the U.S. Bankruptcy Code. Although
subsidiaries of Laidlaw, neither AMR nor EmCare was included in
the bankruptcy filing. Laidlaw emerged from bankruptcy
protection in June 2003. Laidlaw applied fresh-start accounting
as of June 1, 2003 to AMR and EmCare and pushed down to us
our share of the fresh-start accounting adjustments. As a result
of the fresh-start change in the basis of accounting for our
underlying assets and liabilities, our results of operations and
cash flows have been separated as pre-June 1, 2003 and
post-May 31, 2003.
Effective as of January 31, 2005, we acquired AMR and
EmCare from Laidlaw and, in connection with the acquisition, we
changed our fiscal year to December 31 from August 31. For all
periods prior to the acquisition, the AMR and EmCare businesses
formerly owned by Laidlaw are referred to as the
“Predecessor.” For all periods from and subsequent to
the acquisition, these businesses are referred to as the
“Successor.” As a result of the acquisition, we
include as a reporting period of the Predecessor our
pre-acquisition period ended January 31, 2005.
51
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Predecessor (Pre-Acquisition) | |
|
|
|
|
|
|
|
| |
|
|
| |
|
|
|
|
|
|
|
Pre-Laidlaw Bankruptcy | |
|
|
|
|
|
Successor (Post- | |
|
|
As Restated | |
|
|
Post-Laidlaw Bankruptcy | |
|
|
Acquisition) | |
|
|
| |
|
|
| |
|
|
| |
|
|
|
|
Nine | |
|
|
Three | |
|
|
|
|
|
Three | |
|
Five | |
|
|
Three | |
|
Five | |
|
|
|
|
Months | |
|
|
Months | |
|
|
|
Five Months | |
|
Months | |
|
Months | |
|
|
Months | |
|
Months | |
|
|
Year Ended August 31, | |
|
Ended | |
|
|
Ended | |
|
Year Ended | |
|
Ended January 31, | |
|
Ended | |
|
Ended | |
|
|
Ended | |
|
Ended | |
|
|
| |
|
May 31, | |
|
|
August 31, | |
|
August 31, | |
|
| |
|
June 30, | |
|
June 30, | |
|
|
June 30, | |
|
June 30, | |
|
|
2000(1) | |
|
2001(2) | |
|
2002 | |
|
2003 | |
|
|
2003 | |
|
2004 | |
|
2004 | |
|
2005 | |
|
2004 | |
|
2004 | |
|
|
2005 | |
|
2005 | |
|
|
| |
|
| |
|
| |
|
| |
|
|
| |
|
| |
|
| |
|
| |
|
| |
|
| |
|
|
| |
|
| |
|
|
|
|
|
|
|
|
|
|
|
|
|
(unaudited) | |
|
|
|
|
|
|
|
|
|
(unaudited) | |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
(unaudited) | |
|
|
(unaudited) | |
|
|
(dollars in thousands) | |
Statement of Operations Data:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Net revenue
|
|
$ |
1,355,978 |
|
|
$ |
1,386,136 |
|
|
$ |
1,415,786 |
|
|
$ |
1,103,335 |
|
|
|
$ |
384,461 |
|
|
$ |
1,604,598 |
|
|
$ |
667,506 |
|
|
$ |
696,179 |
|
|
$ |
399,975 |
|
|
$ |
663,880 |
|
|
|
$ |
445,021 |
|
|
$ |
731,410 |
|
Compensation and benefits
|
|
|
980,731 |
|
|
|
976,330 |
|
|
|
960,590 |
|
|
|
757,183 |
|
|
|
|
264,604 |
|
|
|
1,117,890 |
|
|
|
461,923 |
|
|
|
481,305 |
|
|
|
280,364 |
|
|
|
464,610 |
|
|
|
|
307,308 |
|
|
|
502,998 |
|
Operating expenses
|
|
|
201,853 |
|
|
|
216,019 |
|
|
|
219,321 |
|
|
|
163,447 |
|
|
|
|
55,212 |
|
|
|
218,277 |
|
|
|
90,828 |
|
|
|
94,882 |
|
|
|
53,490 |
|
|
|
91,661 |
|
|
|
|
63,250 |
|
|
|
102,170 |
|
Insurance expense
|
|
|
78,079 |
|
|
|
117,374 |
|
|
|
66,479 |
|
|
|
69,576 |
|
|
|
|
34,671 |
|
|
|
80,255 |
|
|
|
40,393 |
|
|
|
39,002 |
|
|
|
22,865 |
|
|
|
36,865 |
|
|
|
|
22,427 |
|
|
|
39,334 |
|
Selling, general and administrative expenses
|
|
|
59,404 |
|
|
|
53,017 |
|
|
|
61,455 |
|
|
|
37,867 |
|
|
|
|
12,017 |
|
|
|
47,899 |
|
|
|
22,016 |
|
|
|
21,635 |
|
|
|
12,805 |
|
|
|
19,269 |
|
|
|
|
14,498 |
|
|
|
23,179 |
|
Laidlaw fees and compensation charges
|
|
|
7,320 |
|
|
|
7,260 |
|
|
|
5,400 |
|
|
|
4,050 |
|
|
|
|
1,350 |
|
|
|
15,449 |
|
|
|
6,436 |
|
|
|
19,857 |
|
|
|
3,862 |
|
|
|
6,436 |
|
|
|
|
— |
|
|
|
— |
|
Depreciation and amortization expense
|
|
|
99,957 |
|
|
|
66,286 |
|
|
|
67,183 |
|
|
|
32,144 |
|
|
|
|
12,560 |
|
|
|
52,739 |
|
|
|
22,079 |
|
|
|
18,808 |
|
|
|
13,160 |
|
|
|
21,958 |
|
|
|
|
14,136 |
|
|
|
23,988 |
|
Impairment losses
|
|
|
1,183,681 |
|
|
|
— |
|
|
|
262,780 |
|
|
|
— |
|
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
|
— |
|
|
|
— |
|
Restructuring charges
|
|
|
1,826 |
|
|
|
— |
|
|
|
3,777 |
|
|
|
1,288 |
|
|
|
|
1,449 |
|
|
|
2,115 |
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
1,381 |
|
|
|
|
— |
|
|
|
— |
|
Laidlaw reorganization charges
|
|
|
— |
|
|
|
9,198 |
|
|
|
8,761 |
|
|
|
3,650 |
|
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
|
— |
|
|
|
— |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Income (loss) from operations
|
|
$ |
(1,256,873 |
) |
|
$ |
(59,348 |
) |
|
$ |
(239,960 |
) |
|
$ |
34,130 |
|
|
|
$ |
2,598 |
|
|
$ |
69,974 |
|
|
$ |
23,831 |
|
|
$ |
20,690 |
|
|
$ |
13,429 |
|
|
$ |
21,700 |
|
|
|
$ |
23,402 |
|
|
$ |
39,741 |
|
Interest expense
|
|
|
(95,087 |
) |
|
|
(66,181 |
) |
|
|
(6,418 |
) |
|
|
(4,691 |
) |
|
|
|
(908 |
) |
|
|
(9,961 |
) |
|
|
(4,137 |
) |
|
|
(5,644 |
) |
|
|
(3,073 |
) |
|
|
(3,541 |
) |
|
|
|
(13,646 |
) |
|
|
(21,584 |
) |
Realized gain (loss) on investments
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
|
90 |
|
|
|
(1,140 |
) |
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
(52 |
) |
|
|
|
33 |
|
|
|
(6 |
) |
Interest and other income
|
|
|
86 |
|
|
|
222 |
|
|
|
369 |
|
|
|
304 |
|
|
|
|
22 |
|
|
|
240 |
|
|
|
1,403 |
|
|
|
714 |
|
|
|
12 |
|
|
|
48 |
|
|
|
|
81 |
|
|
|
94 |
|
Fresh-start accounting adjustments(3)
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
46,416 |
|
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
|
— |
|
|
|
— |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Income (loss) before income taxes and cumulative effect of
change in accounting principle
|
|
|
(1,351,874 |
) |
|
|
(125,307 |
) |
|
|
(246,009 |
) |
|
|
76,159 |
|
|
|
|
1,802 |
|
|
|
59,113 |
|
|
|
21,097 |
|
|
|
15,760 |
|
|
|
10,368 |
|
|
|
18,155 |
|
|
|
|
9,870 |
|
|
|
18,245 |
|
Income tax expense
|
|
|
(54,639 |
) |
|
|
17,538 |
|
|
|
(1,374 |
) |
|
|
(829 |
) |
|
|
|
(8,633 |
) |
|
|
(21,764 |
) |
|
|
(8,558 |
) |
|
|
(6,278 |
) |
|
|
(4,794 |
) |
|
|
(7,831 |
) |
|
|
|
(3,821 |
) |
|
|
(7,178 |
) |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Income (loss) before cumulative effect of change in accounting
principle
|
|
|
(1,406,513 |
) |
|
|
(107,769 |
) |
|
|
(247,383 |
) |
|
|
75,330 |
|
|
|
|
(6,831 |
) |
|
|
37,349 |
|
|
|
12,539 |
|
|
|
9,482 |
|
|
|
5,574 |
|
|
|
10,324 |
|
|
|
|
6,049 |
|
|
|
11,067 |
|
Cumulative effect of a change in accounting principle
|
|
|
(5,288 |
) |
|
|
— |
|
|
|
— |
|
|
|
(223,721 |
)(4) |
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
|
— |
|
|
|
— |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Net income (loss)
|
|
$ |
(1,411,801 |
) |
|
$ |
(107,769 |
) |
|
$ |
(247,383 |
) |
|
$ |
(148,391 |
) |
|
|
$ |
(6,831 |
) |
|
$ |
37,349 |
|
|
$ |
12,539 |
|
|
$ |
9,482 |
|
|
$ |
5,574 |
|
|
$ |
10,324 |
|
|
|
$ |
6,049 |
|
|
$ |
11,067 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Other Financial Data:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Cash flows provided by (used in):
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Operating activities
|
|
$ |
30,133 |
|
|
$ |
28,044 |
|
|
$ |
156,544 |
|
|
$ |
58,769 |
|
|
|
$ |
30,009 |
|
|
$ |
127,679 |
|
|
$ |
17,483 |
|
|
$ |
15,966 |
|
|
|
|
|
|
$ |
81,269 |
|
|
|
|
|
|
|
$ |
94,703 |
|
|
Investing activities
|
|
|
(40,983 |
) |
|
|
(36,442 |
) |
|
|
(57,347 |
) |
|
|
(98,835 |
) |
|
|
|
(15,136 |
) |
|
|
(81,516 |
) |
|
|
(11,767 |
) |
|
|
(21,667 |
) |
|
|
|
|
|
|
(24,121 |
) |
|
|
|
|
|
|
|
(875,235 |
) |
|
Financing activities
|
|
|
22,402 |
|
|
|
11,376 |
|
|
|
(36,066 |
) |
|
|
(8,060 |
) |
|
|
|
(47,222 |
) |
|
|
(47,328 |
) |
|
|
(5,501 |
) |
|
|
10,856 |
|
|
|
|
|
|
|
(54,043 |
) |
|
|
|
|
|
|
|
797,266 |
|
Capital expenditures
|
|
$ |
37,698 |
|
|
$ |
39,347 |
|
|
$ |
57,438 |
(5) |
|
$ |
34,768 |
|
|
|
$ |
18,079 |
|
|
$ |
42,787 |
|
|
$ |
14,225 |
|
|
$ |
14,045 |
|
|
|
|
|
|
$ |
17,387 |
|
|
|
|
|
|
|
|
20,052 |
|
Ratio of earnings to fixed charges
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
As of | |
|
|
June 30, 2005 | |
|
|
| |
|
|
(dollars in | |
|
|
thousands) | |
Balance Sheet Data:
|
|
|
|
|
Cash and cash equivalents
|
|
$ |
31,365 |
|
Total assets
|
|
|
1,223,552 |
|
Long-term debt and capital lease obligations, including current
maturities
|
|
|
605,924 |
|
Partners’ equity
|
|
|
230,860 |
|
|
|
(1) |
Represents the combination of the audited financial statements
of AMR and the unaudited financial statements of EmCare for the
year ended August 31, 2000. |
|
(2) |
Represents the combination of the audited financial statements
of AMR and EmCare for the year ended August 31, 2001. |
|
(3) |
See note 1 to our combined financial statements with
respect to our fresh-start financial reporting. |
|
(4) |
Reflects an impairment of goodwill recorded in connection with
the adoption of SFAS No. 142. |
|
(5) |
Includes $26.3 million financed through capital leases. |
52
MANAGEMENT’S DISCUSSION AND ANALYSIS OF
FINANCIAL CONDITION AND RESULTS OF OPERATIONS
You should read the following discussion of our financial
condition and results of operations with the audited combined
financial statements, the notes to the audited combined
financial statements and the “Selected Combined and
Consolidated Financial Information and Other Data”
appearing elsewhere in this prospectus. The following covers
periods before the closing of the acquisition of AMR and EmCare.
Accordingly, the discussion and analysis of historical periods
do not reflect the impact the acquisition will have on us. In
addition, this discussion contains forward-looking statements
and involves numerous risks and uncertainties, including, but
not limited to, those described in the “Risk Factors”
section of this prospectus. Our results may differ materially
from those anticipated in any forward-looking statements.
Company Overview
We are a leading provider of emergency medical services in the
United States. We operate our business and market our services
under the AMR and EmCare brands. AMR is the leading provider of
ambulance transport services in the United States. EmCare is the
leading provider of outsourced emergency department staffing and
management services in the United States. Approximately 86% of
our fiscal 2004 net revenue was generated under exclusive
contracts. During fiscal 2004, we treated and transported
approximately 9 million patients in more than 2,050
communities nationwide. For the fiscal year ended
August 31, 2004, we generated net revenue of
$1.6 billion, of which AMR and EmCare represented
approximately 66% and 34%, respectively. Over the past two
fiscal years, we increased our net revenue and EBITDA
organically at compound annual growth rates, or CAGRs, of 6.5%
and 14.7%, respectively.
American Medical Response
Over its 50 years of operating history, AMR has developed
the largest network of ambulance transport services in the
United States. AMR has an 8% share of the total ambulance
services market and a 21% share of the private provider
ambulance market. During fiscal 2004, AMR treated and
transported approximately 3.7 million patients in
34 states. AMR has approximately 2,550 contracts with
communities, government agencies, healthcare providers and
insurers to provide ambulance services. AMR’s broad
geographic footprint enables us to contract on a national and
regional basis with managed care and insurance companies. AMR
has made significant investments in technology, customer service
plans, employee training and risk mitigation programs to deliver
a compelling value proposition to our customers, which we
believe has led to industry-leading contract retention rates.
For fiscal 2004, approximately 57% of AMR’s net revenue was
generated from emergency 911 ambulance transport services.
Non-emergency ambulance transport services, including critical
care transfer, wheelchair transports and other interfacility
transports, or IFTs, accounted for 32% of AMR’s net revenue
for the same period, with the balance generated from the
provision of training, dispatch centers and other services to
communities and public safety agencies. For fiscal 2004, AMR
generated net revenue of $1,054.8 million.
EmCare
Over its 33 years of operating history, EmCare has become
the largest provider of outsourced emergency department staffing
and related management services to healthcare facilities. EmCare
has a 6% share of the total emergency department services market
and a 9% share of the outsourced emergency department services
market. In addition, EmCare has become one of the leading
providers of hospitalist services, with hospitalist-related net
revenue increasing from $7.2 million in fiscal 2001 to
$23.5 million in fiscal 2004. A hospitalist is a physician
who specializes in the care of acutely ill patients in an
in-patient setting. During fiscal 2004, EmCare had approximately
5.3 million patient visits in 38 states.
EmCare primarily provides emergency department staffing and
related management services to healthcare facilities. EmCare
recruits and hires or subcontracts with physicians and other
healthcare professionals, who then provide professional services
within the healthcare facilities with which we contract. We also
provide
53
billing and collection, risk management and other administrative
services to our healthcare professionals and to independent
physicians. EmCare has 329 contracts with hospitals and
independent physician groups to provide emergency department,
hospitalist and radiology staffing, and related management and
other administrative services. We believe that EmCare’s
successful physician recruitment and retention, high level of
customer service and advanced risk management programs have
resulted in high contract retention rates and continued growth
in new customers. For the year ended August 31, 2004,
EmCare generated net revenue of $549.8 million.
Key Factors and Measures We Use to Evaluate Our Business
The key factors and measures we use to evaluate our business
focus on the number of patients we treat and transport and the
costs we incur to provide the necessary care and transportation
for each of our patients.
We evaluate our revenue net of provisions for contractual payor
discounts and provisions for uncompensated care. Medicaid,
Medicare and certain other payors receive discounts from our
standard charges, which we refer to as contractual discounts. In
addition, individuals we treat and transport may be personally
responsible for a deductible or co-pay under their third party
payor coverage, and most of our contracts require us to treat
and transport patients who have no insurance or other third
party payor coverage. Due to the uncertainty regarding
collectibility of charges associated with services we provide to
these patients, which we refer to as uncompensated care, our net
revenue recognition is based on expected cash collections. Our
net revenue is gross billings after provisions for contractual
discounts and estimated uncompensated care. Provisions for
contractual discounts and uncompensated care have increased
historically primarily as a result of increases in gross billing
rates. The table below summarizes our approximate payor mix as a
percentage of both net revenue and total transports and patient
visits for fiscal years 2003 and 2004.
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Percentage of | |
|
Percentage of Total | |
|
|
Net Revenue | |
|
Transports and Visits | |
|
|
Year Ended August 31, | |
|
Year Ended August 31, | |
|
|
| |
|
| |
|
|
2003 | |
|
2004 | |
|
2003 | |
|
2004 | |
|
|
| |
|
| |
|
| |
|
| |
Medicare
|
|
|
27.4 |
% |
|
|
27.3 |
% |
|
|
25.5 |
% |
|
|
25.8 |
% |
Medicaid
|
|
|
5.3 |
|
|
|
5.2 |
|
|
|
11.8 |
|
|
|
12.3 |
|
Commercial insurance and managed care
|
|
|
47.3 |
|
|
|
47.7 |
|
|
|
42.2 |
|
|
|
41.4 |
|
Self-pay
|
|
|
4.7 |
|
|
|
4.0 |
|
|
|
20.5 |
|
|
|
20.5 |
|
Subsidies and fees
|
|
|
15.3 |
|
|
|
15.8 |
|
|
|
0.0 |
|
|
|
0.0 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Total
|
|
|
100.0 |
% |
|
|
100.0 |
% |
|
|
100.0 |
% |
|
|
100.0 |
% |
|
|
|
|
|
|
|
|
|
|
|
|
|
In addition to continually monitoring our payor mix, we also
analyze the following key factors and measures in each of our
business segments:
AMR
Approximately 89% of AMR’s fiscal 2004 net revenue was
transport revenue derived from the treatment and transportation
of patients based on billings to third party payors and
healthcare facilities. The balance of AMR’s net revenue is
derived from direct billings to communities and government
agencies for the provision of training, dispatch center and
other services. AMR’s measures for transport net revenue
include:
|
|
|
|
• |
Transports. We utilize transport data, including the
number and types of transports, to evaluate net revenue and as
the basis by which we measure certain costs of the business. We
segregate transports into two main categories —
ambulance transports (including emergency, as well as
non-emergency critical care and other interfacility transports)
and wheelchair transports — due to the significant
differences in reimbursement and the associated costs of
providing ambulance and wheelchair transports. As a result of
these differences, in certain analyses we weight our transport
numbers according to category in an effort to better measure net
revenue and costs. |
54
|
|
|
|
• |
Net revenue per transport. Net revenue per transport
reflects the expected net revenue for each transport based on
gross billings less all estimated provisions for contractual
discounts and uncompensated care. In order to better understand
the trends across business segments and in our transport rates,
we analyze our net revenue per transport based on weighted
transports to reflect the differences in our transportation mix. |
The change from period to period in the number of transports is
influenced by increases in transports in existing markets from
both new and existing facilities we serve for non-emergency
transports, and the effects of general community conditions for
emergency transports. The general community conditions may
include (1) the timing, location and severity of influenza,
allergens and other annually recurring viruses, (2) severe
weather that affects a region’s health status and/or
infrastructure and (3) community-specific demographic
changes.
The costs we incur in our AMR business segment consist primarily
of compensation and benefits for ambulance crews and support
personnel, direct and indirect operating costs to provide
transportation services, and costs related to accident and
insurance claims. AMR’s key cost measures include:
|
|
|
|
• |
Unit hours and cost per unit hour. Our measurement of a
unit hour is based on a fully staffed ambulance or wheelchair
van for one operating hour. We use unit hours and cost per unit
hour to measure compensation-related costs and the efficiency of
our deployed resources. We monitor unit hours and cost per unit
hour on a combined basis, as well as on a segregated basis
between ambulance and wheelchair transports. |
|
|
• |
Operating costs per transport. Operating costs per
transport is comprised of certain direct operating costs,
including vehicle operating costs, medical supplies and other
transport-related costs, but excluding compensation-related
costs. Monitoring operating costs per transport allows us to
better evaluate cost trends and operating practices of our
regional and local management teams. |
|
|
• |
Accident and insurance claims. We monitor the number and
magnitude of all accident and insurance claims in order to
measure the effectiveness of our risk management programs.
Depending on the type of claim (workers compensation, auto,
general or professional liability), we monitor our performance
by utilizing various bases of measurement, such as net revenue,
miles driven, number of vehicles operated, compensation dollars,
and number of transports. |
We estimate that the impact of the Balanced Budget Act of 1997,
or BBA, ambulance service rate decreases, as modified by the
phase-in provisions of the Medicare Modernization Act, resulted
in a decrease in AMR’s net revenue for fiscal 2003 and
fiscal 2004 of approximately $20 million and
$11 million, respectively, will result in an increase in
AMR’s net revenue of approximately $13 million in
calendar 2005, and will result in a decrease in AMR’s net
revenue of approximately $17 million in 2006 and continuing
decreases thereafter to 2010. Although we have been able to
substantially mitigate the phased-in reductions of the BBA
through additional fee and subsidy increases, we may not be able
to continue to do so.
We have focused our risk mitigation efforts on employee training
for proper patient handling techniques, development of clinical
and medical equipment protocols, driving safety, implementation
of technology to reduce auto incidents and other risk mitigation
processes which we believe has resulted in a reduction in the
frequency, severity and development of claims. We continue to
see positive trends in our claims costs but cannot assure you
that these trends will continue.
EmCare
Of EmCare’s fiscal 2004 net revenue, approximately 96% was
derived from our hospital contracts for emergency department
staffing, hospitalist and radiology services and other
management services. Of this revenue, approximately 75% was
generated from billings to third party payors for patient visits
and approximately 25% was generated from billings to hospitals
and affiliated physician groups for professional services.
EmCare’s key net revenue measures are:
|
|
|
|
• |
Number of contracts. This reflects the number of
contractual relationships we have for outsourced emergency
department staffing and related management services, hospitalist
services and other |
55
|
|
|
|
|
management services. We analyze the change in our number of
contracts from period to period based on “net new
contracts,” which is the difference between total new
contracts and contracts that have terminated. |
|
|
• |
Revenue per patient visit. This reflects the expected net
revenue for each patient visit based on gross billings less all
estimated provisions for contractual discounts and uncompensated
care. Net revenue per patient visit also includes net revenue
from billings to third party payors and hospitals. |
The change from period to period in the number of patient visits
under our “same store” contracts is influenced by
general community conditions as well as hospital-specific
elements, many of which are beyond our direct control. The
general community conditions include (1) the timing,
location and severity of influenza, allergens and other annually
recurring viruses and (2) severe weather that affects a
region’s health status and/or infrastructure.
Hospital-specific elements include the timing and extent of
facility renovations, hospital staffing issues and regulations
that affect patient flow through the hospital.
The costs incurred in our EmCare business segment consist
primarily of compensation and benefits for physicians and other
professional providers, professional liability costs, and
contract and other support costs. EmCare’s key cost
measures include:
|
|
|
|
• |
Provider compensation per patient visit. Provider
compensation per patient visit includes all compensation and
benefit costs for all professional providers, including
physicians, physician assistants and nurse practitioners, during
each patient visit. Providers include all full-time, part-time
and independently contracted providers. Analyzing provider
compensation per patient visit enables us to monitor our most
significant cost in performing under our contracts. |
|
|
• |
Professional liability costs. These costs include
provisions for estimated losses for actual claims, and claims
likely to be incurred in the period, within our self-insurance
limits based on our past loss experience, as well as actual
direct costs, including investigation and defense costs, claims
payments, reinsurance costs and other costs related to provider
professional liability. |
Medicare pays for all physicians’ services based upon a
national fee schedule. The rate formula may result in
significant yearly fluctuations which may be unrelated to
changes in the actual cost of providing physician services.
Initially, the physician fee schedule update for 2004 called for
a payment decrease of 4.5%. Subsequently, Congress authorized a
1.5% increase that negated the planned rate cuts, and also
provided a 1.5% rate increase for 2005. We currently expect that
the fee schedule will provide for a 4.3% decrease to physician
rates effective January 1, 2006, which would result in a
decrease in EmCare’s 2006 net revenue of approximately
$5.7 million.
We have developed extensive professional liability risk
mitigation processes, including risk assessments on medical
professionals and hospitals, extensive incident reporting and
tracking processes, clinical fail-safe programs, training and
education and other risk mitigation programs which we believe
have resulted in a continued reduction in the frequency,
severity and development of claims. We continue to see positive
trends in our claims costs but cannot assure you that these
trends will continue.
Results of Operations
As we discuss more fully in note 1 —
“Fresh-Start Accounting” of the notes to our audited
combined financial statements, AMR’s and EmCare’s
former parent, Laidlaw, and certain of its affiliates filed
voluntary petitions for reorganization under Chapter 11 of
the U.S. Bankruptcy Code. Although subsidiaries of Laidlaw,
neither AMR nor EmCare was included in the bankruptcy filing.
Laidlaw emerged from bankruptcy protection in June 2003. Laidlaw
applied push-down accounting as of June 1, 2003 to AMR and
EmCare and allocated to us our share of the fresh-start
accounting adjustments. For financial statement purposes, for
periods prior to February 1, 2005, AMR and EmCare combined
are our Predecessor. As a result of the application of push-down
accounting and the fresh-start change in the basis of accounting
for our underlying assets and liabilities, our results of
operations and cash flows have been separated further as
pre-June 1, 2003
56
(referred to as the Predecessor — Pre-Laidlaw
Bankruptcy) and post-May 31, 2003 and pre-February 1,
2005 (referred to as the Predecessor — Post-Laidlaw
Bankruptcy).
Effective as of January 31, 2005, we acquired EmCare and
AMR from Laidlaw and in connection with the acquisition we
changed our fiscal year to December 31 from August 31.
For all periods prior to the acquisition, the AMR and EmCare
businesses formerly owned by Laidlaw are referred to as the
“Predecessor.” For all periods subsequent to the
acquisition, the business is referred to as the
“Successor.” As a result of the acquisition, we
include as a reporting period of the Predecessor our
pre-acquisition period ended January 31, 2005.
We have made no comparisons for our financial results or cash
flows and other liquidity measures for the
Predecessor — Post-Laidlaw Bankruptcy’s three
months ended August 31, 2003 or for the
Predecessor — Post-Laidlaw Bankruptcy’s financial
results or cash flows and other liquidity measures for the nine
months ended May 31, 2003. As the length of these periods
is significantly different from the length of any corresponding
comparative periods, these results are not comparable in
absolute dollar terms.
However, to facilitate the identification of certain business
trends, we compare the financial results and cash flows for the
year ended August 31, 2004 for the Predecessor —
Post-Laidlaw Bankruptcy to:
|
|
|
|
• |
the combined financial results and cash flows for the year ended
August 31, 2003, which represents the financial results and
cash flows for the Predecessor — Post-Laidlaw
Bankruptcy for the three months ended August 31, 2003 and
the financial results and cash flows for the
Predecessor — Pre-Laidlaw Bankruptcy for the nine
months ended May 31, 2003, and |
|
|
• |
our Predecessor — Pre-Laidlaw Bankruptcy’s
financial results for the year ended August 31, 2002. |
The combined year ended August 31, 2003 presented below
does not comply with SOP 90-7, which calls for separate
reporting for the Predecessor — Post-Laidlaw
Bankruptcy and the Predecessor — Pre-Laidlaw
Bankruptcy. Additionally, for the reasons described in
note 1 and due to other non-recurring adjustments, the
Predecessor — Pre-Laidlaw Bankruptcy’s financial
statements for the periods prior to Laidlaw’s emergence
from bankruptcy may not be comparable to our
Predecessor — Post-Laidlaw Bankruptcy’s financial
statements and results of operations which are for periods after
Laidlaw’s emergence from bankruptcy. Investors should,
therefore, review this material with caution and should not rely
solely on the information concerning the Predecessor —
Pre-Laidlaw Bankruptcy or the combined financial results for the
year ended August 31, 2003 as being indicative of our
future results or as providing an accurate comparison of
financial performance from period to period.
The following table presents, for the periods indicated,
information expressed as a percentage of net revenue. This
information has been derived from our audited combined
statements of operations, which include both our AMR and our
EmCare business segments, for the years ended August 31,
2002, 2003 and 2004 and the five months ended January 31,
2005, respectively, from our unaudited combined statements of
operations for the five months ended January 31, 2004 and
the three months and five months ended June 30, 2004,
respectively, and from our unaudited consolidated statements of
operations for the three months and five months ended
June 30, 2005.
Hurricane Katrina and our Gulf Coast Operations
AMR provides ambulance services in Gulfport and Biloxi,
Mississippi and several other Gulf Coast communities. Although
our dispatch center was damaged by Hurricane Katrina and we had
damage to a small number of vehicles, we were able to maintain
communications through our use of back-up generators and other
emergency supplies. We have worked closely with FEMA and other
federal, state and local agencies and have deployed additional
ambulance transportation resources where they were most needed,
particularly in the coastal areas of Mississippi, Louisiana and
Alabama. We have deployed more than 100 additional ambulances
and nearly 300 paramedics, EMTs and other professionals to aid
the rescue effort in the Gulf Coast, including the deployment of
additional resources to aid in the transport of evacuees to
medical facilities in Texas.
57
EmCare operations were generally unaffected by Katrina, with
only one facility in the affected area. EmCare deployed
additional resources to assist those operations, and we have
experienced a volume increase in certain facilities in adjacent
states where evacuees were relocated.
We have been able to maintain our normal operations in areas
outside the Gulf Coast, notwithstanding our transfer of
resources to that area. We expect that, for the foreseeable
future, our AMR operations in Mississippi will continue to be
negatively affected by the aftermath of Hurricane Katrina, and
that we will continue to provide additional resources to assist
local recovery efforts throughout the region.
58
Combined and Consolidated Results of Operations and as a
Percentage of Net Revenue
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Predecessor | |
|
|
|
|
|
|
|
| |
|
|
|
|
|
|
|
|
Successor | |
|
|
|
|
|
|
|
| |
|
|
Year Ended August 31, | |
|
|
|
|
|
|
|
|
|
| |
|
Five Months | |
|
Three Months | |
|
Five Months | |
|
|
Three Months | |
|
Five Months | |
|
|
|
|
|
|
Ended | |
|
Ended | |
|
Ended | |
|
|
Ended | |
|
Ended | |
|
|
As Restated | |
|
|
|
January 31, | |
|
June 30, | |
|
June 30, | |
|
|
June 30, | |
|
June 30, | |
|
|
| |
|
|
|
| |
|
| |
|
| |
|
|
| |
|
| |
|
|
2002 | |
|
2003 | |
|
2004 | |
|
2004 | |
|
2005 | |
|
2004 | |
|
2004 | |
|
|
2005 | |
|
2005 | |
|
|
| |
|
| |
|
| |
|
| |
|
| |
|
| |
|
| |
|
|
| |
|
| |
|
|
|
|
|
|
|
|
(unaudited) | |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
(unaudited) | |
|
|
(unaudited) | |
Net revenue
|
|
$ |
1,415,786 |
|
|
$ |
1,487,796 |
|
|
$ |
1,604,598 |
|
|
$ |
667,506 |
|
|
$ |
696,179 |
|
|
$ |
399,975 |
|
|
$ |
663,880 |
|
|
|
$ |
445,021 |
|
|
$ |
731,410 |
|
Compensation and benefits
|
|
|
960,590 |
|
|
|
1,021,787 |
|
|
|
1,117,890 |
|
|
|
461,923 |
|
|
|
481,305 |
|
|
|
280,364 |
|
|
|
464,610 |
|
|
|
|
307,308 |
|
|
|
502,998 |
|
Operating expenses
|
|
|
219,321 |
|
|
|
218,659 |
|
|
|
218,277 |
|
|
|
90,828 |
|
|
|
94,882 |
|
|
|
53,490 |
|
|
|
91,661 |
|
|
|
|
63,250 |
|
|
|
102,170 |
|
Insurance expense
|
|
|
66,479 |
|
|
|
104,247 |
|
|
|
80,255 |
|
|
|
40,393 |
|
|
|
39,002 |
|
|
|
22,865 |
|
|
|
36,865 |
|
|
|
|
22,427 |
|
|
|
39,334 |
|
Selling, general and administrative expenses
|
|
|
61,455 |
|
|
|
49,884 |
|
|
|
47,899 |
|
|
|
22,016 |
|
|
|
21,635 |
|
|
|
12,805 |
|
|
|
19,269 |
|
|
|
|
14,498 |
|
|
|
23,179 |
|
Laidlaw fees and compensation charges(1)
|
|
|
5,400 |
|
|
|
5,400 |
|
|
|
15,449 |
|
|
|
6,436 |
|
|
|
19,857 |
|
|
|
3,862 |
|
|
|
6,436 |
|
|
|
|
— |
|
|
|
— |
|
Depreciation and amortization expenses
|
|
|
67,183 |
|
|
|
44,704 |
|
|
|
52,739 |
|
|
|
22,079 |
|
|
|
18,808 |
|
|
|
13,160 |
|
|
|
21,958 |
|
|
|
|
14,136 |
|
|
|
23,988 |
|
Impairment losses
|
|
|
262,780 |
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
|
— |
|
|
|
— |
|
Restructuring charges
|
|
|
3,777 |
|
|
|
2,737 |
|
|
|
2,115 |
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
1,381 |
|
|
|
|
— |
|
|
|
— |
|
Laidlaw reorganization costs
|
|
|
8,761 |
|
|
|
3,650 |
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
|
— |
|
|
|
— |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Income (loss) from operations
|
|
|
(239,960 |
) |
|
|
36,728 |
|
|
|
69,974 |
|
|
|
23,831 |
|
|
|
20,690 |
|
|
|
13,429 |
|
|
|
21,700 |
|
|
|
|
23,402 |
|
|
|
39,741 |
|
Interest expense
|
|
|
(6,418 |
) |
|
|
(5,599 |
) |
|
|
(9,961 |
) |
|
|
(4,137 |
) |
|
|
(5,644 |
) |
|
|
(3,073 |
) |
|
|
(3,541 |
) |
|
|
|
(13,646 |
) |
|
|
(21,584 |
) |
Realized gain (loss) on investments
|
|
|
— |
|
|
|
90 |
|
|
|
(1,140 |
) |
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
(52 |
) |
|
|
|
33 |
|
|
|
(6 |
) |
Interest and other income
|
|
|
369 |
|
|
|
326 |
|
|
|
240 |
|
|
|
1,403 |
|
|
|
714 |
|
|
|
12 |
|
|
|
48 |
|
|
|
|
81 |
|
|
|
94 |
|
Fresh-start accounting adjustments
|
|
|
— |
|
|
|
46,416 |
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
|
— |
|
|
|
— |
|
Income tax expense
|
|
|
(1,374 |
) |
|
|
(9,462 |
) |
|
|
(21,764 |
) |
|
|
(8,558 |
) |
|
|
(6,278 |
) |
|
|
(4,794 |
) |
|
|
(7,831 |
) |
|
|
|
(3,821 |
) |
|
|
(7,178 |
) |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Net income
|
|
$ |
(247,383 |
) |
|
$ |
68,499 |
|
|
$ |
37,349 |
|
|
$ |
12,539 |
|
|
$ |
9,482 |
|
|
$ |
5,574 |
|
|
$ |
10,324 |
|
|
|
$ |
6,049 |
|
|
$ |
11,067 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
(1) |
Amounts include specifically allocated compensation costs and
the Laidlaw fees and compensation charges allocated to AMR and
EmCare by Laidlaw pursuant to a formula based upon each
company’s share of Laidlaw’s consolidated revenue. |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Predecessor | |
|
|
Successor | |
|
|
| |
|
| |
|
|
| |
|
|
Year Ended August 31, | |
|
|
|
|
|
|
|
|
|
| |
|
Five Months | |
|
Three Months | |
|
Five Months | |
|
|
Three Months | |
|
Five Months | |
|
|
|
|
|
|
Ended | |
|
Ended | |
|
Ended | |
|
|
Ended | |
|
Ended | |
|
|
As Restated | |
|
|
|
January 31, | |
|
June 30, | |
|
June 30, | |
|
|
June 30, | |
|
June 30, | |
|
|
| |
|
|
|
| |
|
| |
|
| |
|
|
| |
|
| |
|
|
2002 | |
|
2003 | |
|
2004 | |
|
2004 | |
|
2005 | |
|
2004 | |
|
2004 | |
|
|
2005 | |
|
2005 | |
|
|
| |
|
| |
|
| |
|
| |
|
| |
|
| |
|
| |
|
|
| |
|
| |
|
|
|
|
|
|
|
|
(unaudited) | |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
(unaudited) | |
|
|
(unaudited) | |
Net revenue
|
|
|
100.0 |
% |
|
|
100.0 |
% |
|
|
100.0 |
% |
|
|
100.0 |
% |
|
|
100.0 |
% |
|
|
100.0 |
% |
|
|
100.0 |
% |
|
|
|
100.0 |
% |
|
|
100.0 |
% |
Compensation and benefits
|
|
|
67.8 |
|
|
|
68.7 |
|
|
|
69.7 |
|
|
|
69.2 |
|
|
|
69.1 |
|
|
|
70.1 |
|
|
|
70.0 |
|
|
|
|
69.1 |
|
|
|
68.8 |
|
Operating expenses
|
|
|
15.5 |
|
|
|
14.7 |
|
|
|
13.6 |
|
|
|
13.6 |
|
|
|
13.6 |
|
|
|
13.4 |
|
|
|
13.8 |
|
|
|
|
14.2 |
|
|
|
14.0 |
|
Insurance expense
|
|
|
4.7 |
|
|
|
7.0 |
|
|
|
5.0 |
|
|
|
6.1 |
|
|
|
5.6 |
|
|
|
5.7 |
|
|
|
5.6 |
|
|
|
|
5.0 |
|
|
|
5.4 |
|
Selling, general and administrative expenses
|
|
|
4.3 |
|
|
|
3.4 |
|
|
|
3.0 |
|
|
|
3.3 |
|
|
|
3.1 |
|
|
|
3.2 |
|
|
|
2.9 |
|
|
|
|
3.3 |
|
|
|
3.2 |
|
Laidlaw fees and compensation charges(1)
|
|
|
0.4 |
|
|
|
0.4 |
|
|
|
1.0 |
|
|
|
1.0 |
|
|
|
2.9 |
|
|
|
1.0 |
|
|
|
1.0 |
|
|
|
|
— |
|
|
|
— |
|
Depreciation and amortization expense
|
|
|
4.7 |
|
|
|
3.0 |
|
|
|
3.3 |
|
|
|
3.3 |
|
|
|
2.7 |
|
|
|
3.3 |
|
|
|
3.3 |
|
|
|
|
3.1 |
|
|
|
3.3 |
|
Impairment losses
|
|
|
18.6 |
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
|
— |
|
|
|
— |
|
Restructuring charges
|
|
|
0.3 |
|
|
|
0.2 |
|
|
|
0.1 |
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
0.2 |
|
|
|
|
— |
|
|
|
— |
|
Laidlaw reorganization costs
|
|
|
0.6 |
|
|
|
0.2 |
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
|
— |
|
|
|
— |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Income (loss) from operations
|
|
|
(16.9 |
)% |
|
|
2.5 |
% |
|
|
4.4 |
% |
|
|
3.6 |
% |
|
|
3.0 |
% |
|
|
3.4 |
% |
|
|
3.3 |
% |
|
|
|
5.3 |
% |
|
|
5.4 |
% |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
(1) |
Amounts include specifically allocated compensation costs and
the Laidlaw fees and compensation charges allocated to AMR and
EmCare by Laidlaw pursuant to a formula based upon each
company’s share of Laidlaw’s consolidated revenue. |
59
AMR
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Predecessor | |
|
|
|
|
|
|
|
|
|
|
|
| |
|
|
|
|
|
|
|
|
|
|
|
Year Ended August 31, | |
|
Five Months Ended January 31, | |
|
|
|
|
Successor | |
|
|
| |
|
| |
|
| |
|
|
| |
|
|
As Restated | |
|
|
|
|
|
Three | |
|
|
|
Five | |
|
|
|
|
Three | |
|
|
|
Five | |
|
|
|
|
| |
|
|
|
|
|
Months | |
|
|
|
Months | |
|
|
|
|
Months | |
|
|
|
Months | |
|
|
|
|
|
|
% of | |
|
|
|
% of | |
|
|
|
% of | |
|
|
|
% of | |
|
|
|
% of | |
|
Ended | |
|
% of | |
|
Ended | |
|
% of | |
|
|
Ended | |
|
% of | |
|
Ended | |
|
% of | |
|
|
|
|
Net | |
|
|
|
Net | |
|
|
|
Net | |
|
|
|
Net | |
|
|
|
Net | |
|
June 30, | |
|
Net | |
|
June 30, | |
|
Net | |
|
|
June 30, | |
|
Net | |
|
June 30, | |
|
Net | |
|
|
2002 | |
|
Revenue | |
|
2003 | |
|
Revenue | |
|
2004 | |
|
Revenue | |
|
2004 | |
|
Revenue | |
|
2005 | |
|
Revenue | |
|
2004 | |
|
Revenue | |
|
2004 | |
|
Revenue | |
|
|
2005 | |
|
Revenue | |
|
2005 | |
|
Revenue | |
|
|
| |
|
| |
|
| |
|
| |
|
| |
|
| |
|
| |
|
| |
|
| |
|
| |
|
| |
|
| |
|
| |
|
| |
|
|
| |
|
| |
|
| |
|
| |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
(unaudited) | |
|
(unaudited) | |
|
|
(unaudited) | |
|
|
(dollars in thousands) | |
Net revenue
|
|
$ |
984,451 |
|
|
|
100.0 |
% |
|
$ |
1,007,151 |
|
|
|
100.0 |
% |
|
$ |
1,054,800 |
|
|
|
100.0 |
% |
|
$ |
441,956 |
|
|
|
100.0 |
% |
|
$ |
455,059 |
|
|
|
100.0 |
% |
|
$ |
259,713 |
|
|
|
100.0 |
% |
|
$ |
434,294 |
|
|
|
100.0 |
% |
|
|
$ |
284,694 |
|
|
|
100.0 |
% |
|
$ |
469,804 |
|
|
|
100.0 |
% |
Compensation and benefits
|
|
|
627,818 |
|
|
|
63.8 |
|
|
|
647,255 |
|
|
|
64.3 |
|
|
|
687,221 |
|
|
|
65.2 |
|
|
|
287,736 |
|
|
|
65.1 |
|
|
|
289,733 |
|
|
|
63.7 |
|
|
|
169,914 |
|
|
|
65.4 |
|
|
|
282,869 |
|
|
|
65.1 |
|
|
|
|
180,765 |
|
|
|
63.5 |
|
|
|
296,139 |
|
|
|
63.0 |
|
Operating expenses
|
|
|
195,335 |
|
|
|
19.8 |
|
|
|
195,105 |
|
|
|
19.4 |
|
|
|
194,398 |
|
|
|
18.4 |
|
|
|
80,277 |
|
|
|
18.2 |
|
|
|
83,910 |
|
|
|
18.4 |
|
|
|
47,676 |
|
|
|
18.4 |
|
|
|
81,827 |
|
|
|
18.8 |
|
|
|
|
56,138 |
|
|
|
19.7 |
|
|
|
91,282 |
|
|
|
19.4 |
|
Insurance expense
|
|
|
36,079 |
|
|
|
3.7 |
|
|
|
67,409 |
|
|
|
6.7 |
|
|
|
44,272 |
|
|
|
4.2 |
|
|
|
22,669 |
|
|
|
5.1 |
|
|
|
22,437 |
|
|
|
4.9 |
|
|
|
12,380 |
|
|
|
4.8 |
|
|
|
19,504 |
|
|
|
4.5 |
|
|
|
|
11,798 |
|
|
|
4.1 |
|
|
|
20,937 |
|
|
|
4.5 |
|
Selling, general and administrative expenses
|
|
|
44,686 |
|
|
|
4.5 |
|
|
|
35,078 |
|
|
|
3.5 |
|
|
|
32,217 |
|
|
|
3.1 |
|
|
|
16,175 |
|
|
|
3.7 |
|
|
|
15,721 |
|
|
|
3.5 |
|
|
|
7,812 |
|
|
|
3.0 |
|
|
|
12,052 |
|
|
|
2.8 |
|
|
|
|
10,553 |
|
|
|
3.7 |
|
|
|
16,202 |
|
|
|
3.4 |
|
Laidlaw fees and compensation charges(1)
|
|
|
3,600 |
|
|
|
0.4 |
|
|
|
3,600 |
|
|
|
0.4 |
|
|
|
9,020 |
|
|
|
0.9 |
|
|
|
3,758 |
|
|
|
0.9 |
|
|
|
9,399 |
|
|
|
2.1 |
|
|
|
2,255 |
|
|
|
0.9 |
|
|
|
3,758 |
|
|
|
0.9 |
|
|
|
|
— |
|
|
|
|
|
|
|
— |
|
|
|
|
|
Depreciation and amortization expense
|
|
|
62,223 |
|
|
|
6.3 |
|
|
|
39,273 |
|
|
|
3.9 |
|
|
|
43,629 |
|
|
|
4.1 |
|
|
|
18,278 |
|
|
|
4.1 |
|
|
|
16,394 |
|
|
|
3.6 |
|
|
|
10,849 |
|
|
|
4.2 |
|
|
|
18,127 |
|
|
|
4.2 |
|
|
|
|
11,490 |
|
|
|
4.0 |
|
|
|
19,465 |
|
|
|
4.1 |
|
Impairment losses
|
|
|
262,780 |
|
|
|
26.7 |
|
|
|
— |
|
|
|
|
|
|
|
— |
|
|
|
|
|
|
|
— |
|
|
|
|
|
|
|
— |
|
|
|
|
|
|
|
— |
|
|
|
|
|
|
|
— |
|
|
|
— |
|
|
|
|
— |
|
|
|
|
|
|
|
— |
|
|
|
|
|
Restructuring charges
|
|
|
3,777 |
|
|
|
0.4 |
|
|
|
2,737 |
|
|
|
0.3 |
|
|
|
2,115 |
|
|
|
0.2 |
|
|
|
— |
|
|
|
|
|
|
|
— |
|
|
|
|
|
|
|
— |
|
|
|
|
|
|
|
1,381 |
|
|
|
0.3 |
|
|
|
|
— |
|
|
|
|
|
|
|
— |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Income (loss) from operations
|
|
$ |
(251,847 |
) |
|
|
(25.6 |
)% |
|
$ |
16,694 |
|
|
|
1.7 |
% |
|
$ |
41,928 |
|
|
|
4.0 |
% |
|
$ |
13,063 |
|
|
|
3.0 |
% |
|
$ |
17,465 |
|
|
|
3.8 |
% |
|
$ |
8,827 |
|
|
|
3.4 |
% |
|
$ |
14,776 |
|
|
|
3.4 |
% |
|
|
$ |
13,950 |
|
|
|
4.9 |
% |
|
$ |
25,779 |
|
|
|
5.5 |
% |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
(1) |
Amounts include specifically allocated compensation costs and
the Laidlaw fees and compensation charges allocated to AMR by
Laidlaw pursuant to a formula based upon AMR’s share of
Laidlaw’s consolidated revenue. |
EmCare
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Predecessor | |
|
|
|
|
|
|
|
|
|
|
|
| |
|
|
|
|
|
|
|
|
|
|
|
Year Ended August 31, | |
|
Five Months Ended January 31, | |
|
|
|
|
Successor | |
|
|
| |
|
| |
|
| |
|
|
| |
|
|
|
|
|
|
Three | |
|
|
|
Five | |
|
|
|
|
Three | |
|
|
|
Five | |
|
|
|
|
|
|
|
|
Months | |
|
|
|
Months | |
|
|
|
|
Months | |
|
|
|
Months | |
|
|
|
|
|
|
% of | |
|
|
|
% of | |
|
|
|
% of | |
|
|
|
% of | |
|
|
|
% of | |
|
Ended | |
|
% of | |
|
Ended | |
|
% of | |
|
|
Ended | |
|
% of | |
|
Ended | |
|
% of | |
|
|
|
|
Net | |
|
|
|
Net | |
|
|
|
Net | |
|
|
|
Net | |
|
|
|
Net | |
|
June 30, | |
|
Net | |
|
June 30, | |
|
Net | |
|
|
June 30, | |
|
Net | |
|
June 30, | |
|
Net | |
|
|
2002 | |
|
Revenue | |
|
2003 | |
|
Revenue | |
|
2004 | |
|
Revenue | |
|
2004 | |
|
Revenue | |
|
2005 | |
|
Revenue | |
|
2004 | |
|
Revenue | |
|
2004 | |
|
Revenue | |
|
|
2005 | |
|
Revenue | |
|
2005 | |
|
Revenue | |
|
|
| |
|
| |
|
| |
|
| |
|
| |
|
| |
|
| |
|
| |
|
| |
|
| |
|
| |
|
| |
|
| |
|
| |
|
|
| |
|
| |
|
| |
|
| |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
(unaudited) | |
|
(unaudited) | |
|
|
(unaudited) | |
|
|
(dollars in thousands) | |
Net revenue
|
|
$ |
431,335 |
|
|
|
100.0 |
% |
|
$ |
480,645 |
|
|
|
100.0 |
% |
|
$ |
549,798 |
|
|
|
100.0 |
% |
|
$ |
225,550 |
|
|
|
100.0 |
% |
|
$ |
241,120 |
|
|
|
100.0 |
% |
|
$ |
140,262 |
|
|
|
100.0 |
% |
|
$ |
229,586 |
|
|
|
100.0 |
% |
|
|
$ |
160,327 |
|
|
|
100.0 |
% |
|
$ |
261,606 |
|
|
|
100.0 |
% |
Compensation and benefits
|
|
|
332,772 |
|
|
|
77.1 |
|
|
|
374,532 |
|
|
|
77.9 |
|
|
|
430,669 |
|
|
|
78.3 |
|
|
|
174,187 |
|
|
|
77.2 |
|
|
|
191,572 |
|
|
|
79.5 |
|
|
|
110,450 |
|
|
|
78.7 |
|
|
|
181,741 |
|
|
|
79.2 |
|
|
|
|
126,543 |
|
|
|
78.9 |
|
|
|
206,859 |
|
|
|
79.1 |
|
Operating expenses
|
|
|
23,986 |
|
|
|
5.6 |
|
|
|
23,554 |
|
|
|
4.9 |
|
|
|
23,879 |
|
|
|
4.3 |
|
|
|
10,551 |
|
|
|
4.7 |
|
|
|
10,972 |
|
|
|
4.6 |
|
|
|
5,814 |
|
|
|
4.1 |
|
|
|
9,834 |
|
|
|
4.3 |
|
|
|
|
7,112 |
|
|
|
4.4 |
|
|
|
10,888 |
|
|
|
4.2 |
|
Insurance expense
|
|
|
30,400 |
|
|
|
7.0 |
|
|
|
36,838 |
|
|
|
7.7 |
|
|
|
35,983 |
|
|
|
6.5 |
|
|
|
17,724 |
|
|
|
7.9 |
|
|
|
16,565 |
|
|
|
6.9 |
|
|
|
10,485 |
|
|
|
7.5 |
|
|
|
17,361 |
|
|
|
7.6 |
|
|
|
|
10,629 |
|
|
|
6.6 |
|
|
|
18,397 |
|
|
|
7.0 |
|
Selling, general and administrative expenses
|
|
|
16,769 |
|
|
|
3.9 |
|
|
|
14,806 |
|
|
|
3.1 |
|
|
|
15,682 |
|
|
|
2.9 |
|
|
|
5,841 |
|
|
|
2.6 |
|
|
|
5,914 |
|
|
|
2.5 |
|
|
|
4,993 |
|
|
|
3.6 |
|
|
|
7,217 |
|
|
|
3.1 |
|
|
|
|
3,945 |
|
|
|
2.5 |
|
|
|
6,977 |
|
|
|
2.7 |
|
Laidlaw fees and compensation charges(1)
|
|
|
1,800 |
|
|
|
0.4 |
|
|
|
1,800 |
|
|
|
0.4 |
|
|
|
6,429 |
|
|
|
1.2 |
|
|
|
2,678 |
|
|
|
1.2 |
|
|
|
10,458 |
|
|
|
4.3 |
|
|
|
1,607 |
|
|
|
1.1 |
|
|
|
2,678 |
|
|
|
1.2 |
|
|
|
|
— |
|
|
|
|
|
|
|
— |
|
|
|
|
|
Depreciation and amortization expense
|
|
|
4,960 |
|
|
|
1.1 |
|
|
|
5,431 |
|
|
|
1.1 |
|
|
|
9,110 |
|
|
|
1.7 |
|
|
|
3,801 |
|
|
|
1.7 |
|
|
|
2,414 |
|
|
|
1.0 |
|
|
|
2,311 |
|
|
|
1.6 |
|
|
|
3,831 |
|
|
|
1.7 |
|
|
|
|
2,646 |
|
|
|
1.7 |
|
|
|
4,523 |
|
|
|
1.7 |
|
Impairment losses
|
|
|
— |
|
|
|
|
|
|
|
— |
|
|
|
|
|
|
|
— |
|
|
|
|
|
|
|
— |
|
|
|
|
|
|
|
— |
|
|
|
|
|
|
|
— |
|
|
|
|
|
|
|
— |
|
|
|
|
|
|
|
|
— |
|
|
|
|
|
|
|
— |
|
|
|
|
|
Laidlaw reorganization costs
|
|
|
8,761 |
|
|
|
2.0 |
|
|
|
3,650 |
|
|
|
0.8 |
|
|
|
— |
|
|
|
|
|
|
|
— |
|
|
|
|
|
|
|
— |
|
|
|
|
|
|
|
— |
|
|
|
|
|
|
|
— |
|
|
|
|
|
|
|
|
— |
|
|
|
|
|
|
|
— |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Income (loss) from operations
|
|
$ |
11,887 |
|
|
|
2.8 |
% |
|
$ |
20,034 |
|
|
|
4.2 |
% |
|
$ |
28,046 |
|
|
|
5.1 |
% |
|
$ |
10,768 |
|
|
|
4.8 |
% |
|
$ |
3,225 |
|
|
|
1.3 |
% |
|
$ |
4,602 |
|
|
|
3.3 |
% |
|
$ |
6,924 |
|
|
|
3.0 |
% |
|
|
$ |
9,452 |
|
|
|
5.9 |
% |
|
$ |
13,962 |
|
|
|
5. 3 |
% |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
(1) |
Amounts include specifically allocated compensation costs and
the Laidlaw fees and compensation charges allocated to EmCare by
Laidlaw pursuant to a formula based upon EmCare’s share of
Laidlaw’s consolidated revenue. |
60
Five months ended June 30, 2005 (Successor) compared
to the five months ended June 30, 2004 (Predecessor)
Interest expense. Interest expense for the five months
ended June 30, 2005 was $21.6 million compared to
$3.5 million for the five months ended June 30, 2004.
The $18.1 million increase relates to the additional debt
incurred as part of the acquisition of AMR and EmCare by EMS L.P.
Income tax expense. Income tax expense for the five
months ended June 30, 2005 was $7.2 million compared
to $7.8 million for the five months ended June 30,
2004. The $0.6 million decrease relates primarily to the
additional interest expense recorded during the 2005 period.
AMR
Net revenue. Net revenue for the five months ended
June 30, 2005 was $469.8 million, an increase of
$35.5 million, or 8.2%, from $434.3 million for the
five months ended June 30, 2004. The increase in net
revenue was due primarily to an increase in our net revenue per
weighted transport of approximately 7.2%. The increase in net
revenue per weighted transport was the result of rate increases
in several of our operating markets and Medicare rate increases
under the Medicare Modernization Act. In addition, we had a net
increase of approximately 10,800 weighted transports. We had an
increase in weighted transports of 55,300, or 4.7%, offset by a
decrease of approximately 44,500 weighted transports and
$8.9 million in net revenue for the five months ended
June 30, 2005 as a result of exiting the Pinellas County,
Florida market in September 2004.
Compensation and benefits. Compensation and benefits
costs for the five months ended June 30, 2005 were
$296.1 million, or 63.0% of net revenue, compared to
$282.9 million, or 65.1% of net revenue, for the five
months ended June 30, 2004. Total unit hours increased
period over period by approximately 19,800 due to the increase
in ambulance transport volume. In addition, ambulance crew wages
per ambulance unit hour increased by 5.0%, which increased
compensation costs by $7.7 million. The ambulance crew
wages per ambulance unit hour increase resulted principally from
annual salary increases. Benefits costs increased
$2.8 million due to increased health benefit claim costs
and health insurance premiums. The exit from the Pinellas
County, Florida market decreased ambulance unit hours by 97,400
and compensation and benefits costs by $6.7 million in 2005
compared to 2004.
Operating expenses. Operating expenses for the five
months ended June 30, 2005 were $91.3 million, or
19.4% of net revenue, compared to $81.8 million, or 18.8%
of net revenue, for the five months ended June 30, 2004.
Operating expenses per weighted transport increased 10.6% in
2005 compared to the prior period. The change is due primarily
to additional fuel and vehicle repair costs of approximately
$3.1 million and an increase in external services of
$1.9 million. Costs for external services grew as a result
of increased ambulance transport volumes and professional fees
of $1.2 million, primarily related to audit fees and
consulting fees for valuations we incurred in connection with
our acquisition of AMR. Other operating costs, including medical
supplies, occupancy, telecommunications and other expenses,
increased by approximately $3.3 million, but remained flat
as a percentage of net revenue compared to the prior period.
Insurance expense. Insurance expense for the five months
ended June 30, 2005 was $20.9 million, or 4.5% of net
revenue, compared to $19.5 million, or 4.5% of net revenue,
for the same period in 2004. The five months ended June 30,
2005 and 2004 included comparable reductions of reserves based
on favorable development of claims costs and reserve estimates.
Selling, general and administrative. Selling, general and
administrative expense for the five months ended June 30,
2005 was $16.2 million, or 3.4% of net revenue, compared to
$12.1 million, or 2.8% of net revenue, for the five months
ended June 30, 2004. The five months ended June 30,
2004 includes a one-time reversal of an accrued liability of
$1.8 million and payroll tax refunds related to prior
periods of $2.0 million offset by $0.2 million of Onex
management fees and D&O insurance coverage.
Laidlaw fees and compensation charges. AMR did not incur
Laidlaw fees and compensation charges for the five months ended
June 30, 2005 as it was no longer a subsidiary of Laidlaw
International, Inc. For the five months ended June 30,
2004, these fees and charges were $3.8 million, or 0.9% of
net revenue. Costs
61
of $1.5 million that we have incurred to date to replace
the services previously performed by Laidlaw are included in the
statement of operations for the five months ended June 30,
2005.
Restructuring charges. AMR did not incur restructuring
charges during the five months ended June 30, 2005.
Restructuring charges of $1.4 million recorded during the
five months ended June 30, 2004 relate to a reduction in
the number of operating regions. Oversight of the affected
operations was shifted to the remaining regional management
teams.
Depreciation and amortization. Depreciation and
amortization expense for the five months ended June 30,
2005 was $19.5 million, or 4.1% of net revenue, compared to
$18.1 million, or 4.2% of net revenue, for the five months
ended June 30, 2004.
EmCare
Net revenue. Net revenue for the five months ended
June 30, 2005 was $261.6 million, an increase of
$32.0 million, or 13.9%, from $229.6 million for the
five months ended June 30, 2004. The increase was due
primarily to an increase in patient visits from net new hospital
contracts and net revenue increases in existing contracts.
Following June 30, 2004, we added 27 net new contracts
which accounted for a net revenue increase of $17.8 million
for the five months ended June 30, 2005. Net revenue under
our “same store” contracts (contracts in existence for
the entirety of both fiscal periods) increased
$14.2 million in the five months ended June 30, 2005
due to a 4.4% increase in patient visits and by a 2.1% increase
in net revenue per patient visit.
Compensation and benefits. Compensation and benefits
costs for the five months ended June 30, 2005 were
$206.9 million, or 79.1% of net revenue, compared to
$181.7 million, or 79.2% of net revenue, for the five
months ended June 30, 2004. Provider compensation and
benefits costs increased $12.5 million from net new
contract additions. Of this increase, $8.6 million was
attributable to an increase in provider compensation costs
related primarily to an increase in patient visits.
Operating expenses. Operating expenses for the five
months ended June 30, 2005 were $10.9 million, or 4.2%
of net revenue, compared to $9.8 million, or 4.3% of net
revenue, for the five months ended June 30, 2004. Operating
expenses increased due to net new contract additions but
remained consistent as a percentage of net revenue.
Insurance expense. Professional liability insurance
expense for the five months ended June 30, 2005 was
$18.4 million, or 7.0% of net revenue, compared to
$17.4 million, or 7.6% of net revenue, for the five months
ended June 30, 2004. The decrease as a percent of revenue
is due to continued favorable improvement in ultimate claims
costs.
Selling, general and administrative. Selling, general and
administrative expense for the five months ended June 30,
2005 was $7.0 million, or 2.7% of net revenue, compared to
$7.2 million, or 3.1% of net revenue, for the five months
ended June 30, 2004. The $0.2 million decrease in
selling, general and administrative expense includes a decrease
of $1.1 million related to the Laidlaw long-term incentive
compensation plan which is no longer in effect, offset by
$0.9 million of legal fees and settlements, Onex management
fees and D&O insurance coverage.
Laidlaw fees and compensation charges. EmCare did not
incur Laidlaw fees and compensation charges for the five months
ended June 30, 2005 as it was no longer a subsidiary of
Laidlaw International, Inc. For the five months ended
June 30, 2004, these fees and charges were
$2.7 million, or 1.2% of net revenue. Costs of
$0.8 million that we have incurred to date to replace the
services previously performed by Laidlaw are included in the
statement of operations for the five months ended June 30,
2005.
Depreciation and amortization. Depreciation and
amortization expense for the five months ended June 30,
2005 was $4.5 million, or 1.7% of net revenue, compared to
$3.8 million, or 1.7% of net revenue, for the five months
ended June 30, 2004.
62
Three months ended June 30, 2005 (Successor) compared
to the three months ended June 30, 2004
(Predecessor)
Interest expense. Interest expense for the three months
ended June 30, 2005 was $13.6 million compared to
$3.1 million for the three months ended June 30, 2004.
The $10.5 million increase relates to the additional debt
incurred as part of the acquisition of AMR and EmCare by EMS L.P.
Income tax expense. Income tax expense for the three
months ended June 30, 2005 was $3.8 million compared
to $4.8 million for the three months ended June 30,
2004. The $1.0 million decrease relates primarily to the
additional interest expense recorded during the 2005 period.
AMR
Net revenue. Net revenue for the three months ended
June 30, 2005 was $284.7 million, an increase of
$25.0 million, or 9.6%, from $259.7 million for the
three months ended June 30, 2004. The increase in net
revenue was due primarily to an increase in our net revenue per
weighted transport of approximately 7.9%. The increase in net
revenue per weighted transport was the result of rate increases
in several of our operating markets and Medicare rate increases
under the Medicare Modernization Act. In addition, we had a net
increase of approximately 11,700 weighted transports. We had an
increase in weighted transports of 38,000, or 5.4%, primarily as
a result of an increase in ambulance transports from new and
existing facilities we serve in our current markets and from
favorable demographic growth. This increase was offset by a
decrease of approximately 26,300 weighted transports and
$5.2 million in net revenue for the three months ended
June 30, 2005 as a result of exiting the Pinellas County,
Florida market in late September 2004.
Compensation and benefits. Compensation and benefits
costs for the three months ended June 30, 2005 were
$180.8 million, or 63.5% of net revenue, compared to
$169.9 million, or 65.4% of net revenue, for the three
months ended June 30, 2004. Total unit hours increased
period over period by approximately 47,400, due to the increase
in ambulance transport volume. In addition, ambulance crew wages
per ambulance unit hour increased by approximately 4.7%, which
increased compensation costs by $4.4 million. The ambulance
crew wages per ambulance unit hour increase resulted principally
from annual salary increases. Benefits costs increased
$1.5 million due to rising costs of health insurance
premiums and increased health benefit claims. The exit from the
Pinellas County, Florida market decreased ambulance unit hours
by 57,400 and compensation and benefits costs by $3.9 million.
Operating expenses. Operating expenses for the three
months ended June 30, 2005 were $56.1 million, or
19.7% of net revenue, compared to $47.7 million, or 18.4%
of net revenue, for the three months ended June 30, 2004.
Operating expenses per weighted transport increased 15.9% in
2005 compared to the prior period. The change is due primarily
to additional fuel and vehicle repair costs of approximately
$2.2 million, and increases in medical supplies, external
services and professional fees of $1.1 million,
$1.8 million and $1.4 million, respectively. External
services increased due to contract changes, increased ambulance
transport volumes and professional fees related to audit and
consulting fees for valuations we incurred in connection with
our acquisition of AMR. Other operating costs, including
occupancy, telecommunications and other expenses, increased by
approximately $1.9 million, but remained relatively flat as
a percentage of net revenue compared to the prior period.
Insurance expense. Insurance expense for the three months
ended June 30, 2005 was $11.8 million, or 4.1% of net
revenue, compared to $12.4 million, or 4.8% of net revenue,
for the same period in 2004. The three months ended
June 30, 2005 included a $2.2 million reduction of
ultimate claims estimates based on favorable development of
claims costs and reserve estimates.
Selling, general and administrative. Selling, general and
administrative expense for the three months ended June 30,
2005 was $10.6 million, or 3.7% of net revenue, compared to
$7.8 million, or 3.0% of net revenue, for the three months
ended June 30, 2004. The three months ended June 30,
2004 includes payroll tax refunds related to prior periods of
approximately $2.0 million.
Laidlaw fees and compensation charges. AMR did not incur
Laidlaw fees and compensation charges for the three months ended
June 30, 2005 as it was no longer a subsidiary of Laidlaw
International, Inc. For
63
the three months ended June 30, 2004, these fees and
charges were $2.3 million, or 0.9% of net revenue. Costs of
$1.1 million that we incurred to date to replace the
services previously performed by Laidlaw are included in the
statement of operations for the three months ended June 30,
2005.
Depreciation and amortization. Depreciation and
amortization expense for the three months ended June 30,
2005 was $11.5 million, or 4.0% of net revenue, compared to
$10.8 million, or 4.2% of net revenue, for the three months
ended June 30, 2004.
EmCare
Net revenue. Net revenue for the three months ended
June 30, 2005 was $160.3 million, an increase of
$20.0 million, or 14.3%, from $140.3 million for the
three months ended June 30, 2004. The increase was due
primarily to an increase in patient visits from net new hospital
contracts and net revenue increases in existing contracts.
Following June 30, 2004, we added 27 net new contracts
which accounted for a net revenue increase of $12.1 million
for the three months ended June 30, 2005. Net revenue under
our “same store” contracts (contracts in existence for
the entirety of both fiscal periods) increased $8.0 million
in the three months ended June 30, 2005 due to a 3.7%
increase in patient visits and a 2.3% increase in net revenue
per patient visit.
Compensation and benefits. Compensation and benefits
costs for the three months ended June 30, 2005 were
$126.5 million, or 78.9% of net revenue, compared to
$110.5 million, or 78.7% of net revenue, for the three
months ended June 30, 2004. Provider compensation and
benefits costs increased $8.3 million from net new contract
additions. Of this increase, $5.5 million was attributable
to an increase in provider compensation costs related to an
increase in patient visits.
Operating expenses. Operating expenses for the three
months ended June 30, 2005 were $7.1 million, or 4.4%
of net revenue, compared to $5.8 million, or 4.1% of net
revenue, for the three months ended June 30, 2004.
Operating expenses, as a percentage of net revenue, increased
slightly due to higher collection fees incurred by our billing
operation.
Insurance expense. Professional liability insurance
expense for the three months ended June 30, 2005 was
$10.6 million, or 6.6% of net revenue, compared to
$10.5 million, or 7.5% of net revenue, for the three months
ended June 30, 2004. The decrease as a percent of revenue
is due to continued favorable improvement in ultimate claims
costs.
Selling, general and administrative. Selling, general and
administrative expense for the three months ended June 30,
2005 was $3.9 million, or 2.5% of net revenue, compared to
$5.0 million, or 3.6% of net revenue, for the three months
ended June 30, 2004. The $1.1 million decrease in
selling, general and administrative expense is related to a
Laidlaw administered long-term incentive compensation plan which
is no longer in effect.
Laidlaw fees and compensation charges. EmCare did not
incur Laidlaw fees and compensation charges for the three months
ended June 30, 2005 as it was no longer a subsidiary of
Laidlaw International, Inc. For the three months ended
June 30, 2004, these fees and charges were
$1.6 million, or 1.1% of net revenue. Costs of
$0.6 million that we incurred to date to replace the
services previously performed by Laidlaw are included in the
statement of operations for the three months ended June 30,
2005.
Depreciation and amortization. Depreciation and
amortization expense for the three months ended June 30,
2005 was $2.6 million, or 1.7% of net revenue, compared to
$2.3 million, or 1.6% of net revenue, for the three months
ended June 30, 2004.
Five months ended January 31, 2005 (Successor)
compared to the five months ended January 31, 2004
(Predecessor)
Interest expense. Interest expense for the five months
ended January 31, 2005 was $5.6 million compared to
$4.1 million for the five months ended January 31,
2004. The $1.5 million difference relates to
64
an increase in the amount owed to Laidlaw during the five months
ended January 31, 2005 compared to the same period in 2004.
Income tax expense. Income tax expense for the five
months ended January 31, 2005 was $6.3 million
compared to $8.6 million for the five months ended
January 31, 2004. The $2.3 million decrease relates
primarily to additional interest expense and added costs
incurred by AMR and EmCare as a result of the acquisition.
AMR
Net revenue. Net revenue for the five months ended
January 31, 2005 was $455.1 million, an increase of
$13.1 million, or 3.0%, from $442.0 million for the
five months ended January 31, 2004. The increase in net
revenue was due primarily to an increase in our net revenue per
weighted transport of approximately 6%, offset by approximately
38,700 fewer weighted transports, including a 30,220 ambulance
transport decrease. The decrease in ambulance transports was due
primarily to exiting the Pinellas County, Florida market in late
September 2004, which accounted for a decrease of approximately
35,000 ambulance transports and $6.2 million in net revenue
for the five months ended January 31, 2005.
Compensation and benefits. Compensation and benefits
costs for the five months ended January 31, 2005 were
$289.7 million, or 63.7% of net revenue, compared to
$287.7 million, or 65.1% of net revenue, for the five
months ended January 31, 2004. Total unit hours decreased
period over period by 100,800 primarily as a result of the exit
from the Pinellas County, Florida market, which decreased
ambulance unit hours by 79,800 and compensation and benefits
costs by $5.3 million. The decrease in total unit hours was
offset by an increase in our ambulance crew wages per ambulance
unit hour of 6.6%, which increased compensation costs by
$10.1 million. The ambulance crew wages per ambulance unit
hour increase resulted principally from annual salary increases.
Benefits costs decreased $1.7 million due to our shift of
employees previously covered under premium-based health
insurance plans to self-insured health plans.
Operating expenses. Operating expenses for the five
months ended January 31, 2005 were $83.9 million, or
18.4% of net revenue, compared to $80.3 million, or 18.2%
of net revenue, for the five months ended January 31, 2004.
Operating expenses per weighted transport increased 7.9% in 2005
compared to the prior period. This $3.6 million increase
was due primarily to higher fuel costs, which were 2.0% of net
revenue for the five months ended January 31, 2005,
compared to 1.6% of net revenue for the same period in 2004.
Insurance expense. Insurance expense for the five months
ended January 31, 2005 was $22.4 million, or 4.9% of
net revenue, compared to $22.7 million, or 5.1% of net
revenue, for the same period in 2004. This $0.3 million
decrease was primarily a result of improvements in ultimate
claims costs.
Selling, general and administrative. Selling, general and
administrative expense for the five months ended
January 31, 2005 was $15.7 million, or 3.5% of net
revenue, compared to $16.2 million, or 3.7% of net revenue,
for the five months ended January 31, 2004. The
$0.5 million decrease in selling, general and
administrative expense related primarily to deferred
compensation expense recorded as part of management incentive
programs that were implemented by Laidlaw during fiscal 2004 and
which were expensed as a component of Laidlaw fees and
compensation charges in 2005.
Laidlaw fees and compensation charges. Laidlaw fees and
compensation charges for the five months ended January 31,
2005 were $9.4 million, or 2.1% of net revenue, compared to
$3.8 million, or 0.9% of net revenue, for the five months
ended January 31, 2004. This $5.6 million increase was
primarily due to charges related to senior management incentive
plans expensed as part of the sale to Onex and additional
Laidlaw overhead costs allocated to AMR during the five months
ended January 31, 2005.
Depreciation and amortization. Depreciation and
amortization expense for the five months ended January 31,
2005 was $16.4 million, or 3.6% of net revenue, compared to
$18.3 million, or 4.1% of net revenue, for the five months
ended January 31, 2004. The $1.9 million decrease
resulted from the elimination of the contract intangible asset
recorded in fiscal 2003 as part of our fresh-start accounting
adjustments. As
65
this asset was eliminated in the fourth quarter of fiscal 2004,
no amortization expense was recorded for this intangible asset
in the five months ended January 31, 2005.
EmCare
Net revenue. Net revenue for the five months ended
January 31, 2005 was $241.1 million, an increase of
$15.5 million, or 6.9%, from $225.6 million for the
five months ended January 31, 2004. The increase was due
primarily to an increase in patient visits from net new hospital
contracts and net revenue increases in existing contracts.
Following January 31, 2004, we added 33 net new
contracts which accounted for a net revenue increase of
$11.9 million for the five months ended January 31,
2005. Net revenue under our “same store” contracts
(contracts in existence for the entirety of both fiscal periods)
increased $3.6 million in the five months ended
January 31, 2005 due to a 0.7% decrease in patient visits,
offset by a 2.4% increase in net revenue per patient visit.
Compensation and benefits. Compensation and benefits
costs for the five months ended January 31, 2005 were
$191.6 million, or 79.5% of net revenue, compared to
$174.2 million, or 77.2% of net revenue, for the five
months ended January 31, 2004. Provider compensation and
benefits costs increased $10.8 million from net new
contract additions. Of this increase, $4.8 million was
attributable to an increase in provider compensation costs
related primarily to an increase in patient visits.
Operating expenses. Operating expenses for the five
months ended January 31, 2005 were $11.0 million, or
4.6% of net revenue, compared to $10.6 million, or 4.7% of
net revenue, for the five months ended January 31, 2004.
Operating expenses, as a percentage of net revenue, decreased
due to our leveraging of fixed billing and other fixed contract
costs.
Insurance expense. Professional liability insurance
expense for the five months ended January 31, 2005 was
$16.6 million, or 6.9% of net revenue, compared to
$17.7 million, or 7.9% of net revenue, for the five months
ended January 31, 2004. Insurance expense, as a percentage
of net revenue, decreased due to an improvement in expected
ultimate claims costs.
Selling, general and administrative. Selling, general and
administrative expense for the five months ended
January 31, 2005 was $5.9 million, or 2.5% of net
revenue, compared to $5.8 million, or 2.6% of net revenue,
for the five months ended January 31, 2004.
Laidlaw fees and compensation charges. Laidlaw fees and
compensation charges for the five months ended January 31,
2005 was $10.5 million, or 4.3% of net revenue, compared to
$2.7 million, or 1.2% of net revenue, for the five months
ended January 31, 2004. This $7.8 million increase was
primarily due to charges related to senior management incentive
plans expensed as part of the sale to Onex and additional
Laidlaw overhead costs allocated to EmCare during the five
months ended January 31, 2005.
Depreciation and amortization. Depreciation and
amortization expense for the five months ended January 31,
2005 was $2.4 million, or 1.0% of net revenue, compared to
$3.8 million, or 1.7% of net revenue, for the five months
ended January 31, 2004. The $1.4 million decrease was
the result of the elimination of the contract intangible asset
recorded in fiscal 2003 as part of our fresh-start accounting
adjustments. As this asset was eliminated in the fourth quarter
of fiscal 2004, no amortization expense was recorded for this
intangible asset in the five months ended January 31, 2005.
Year ended August 31, 2004 compared to the year ended
August 31, 2003
Interest expense. Interest expense for the year ended
August 31, 2004 was $10.0 million compared to
$5.6 million for the year ended August 31, 2003. The
increase is a result of Laidlaw suspending certain related party
interest charges during the Laidlaw bankruptcy in 2003.
Income tax expense. Income tax expense for the year ended
August 31, 2004 was $21.8 million compared to
$9.5 million for the year ended August 31, 2003. The
$12.3 million increase is a result of the release of full
valuation allowances on all deferred tax assets for the 2003
period in connection with Laidlaw’s exit from bankruptcy.
66
AMR
Net revenue. Net revenue for the year ended
August 31, 2004 was $1,054.8 million, an increase of
$47.6 million, or 4.7%, from $1,007.2 million for the
year ended August 31, 2003. The increase was due primarily
to an increase in weighted transports of 65,800, or 2.3%,
resulting in a net revenue increase of $22.9 million. The
balance of the increase resulted from rate increases in several
of our markets that offset Medicare rate reductions in effect
prior to the July 1, 2004 effective date of the Medicare
Modernization Act, together increasing our net revenue per
weighted transport by 2.4%, or $24.7 million.
Compensation and benefits. Compensation and benefits
costs for the year ended August 31, 2004 were
$687.2 million, or 65.2% of net revenue, compared to
$647.3 million, or 64.3%, for the year ended
August 31, 2003. The increase of $39.9 million
includes an increase in ambulance unit hours of 242,200, or
2.5%, associated with the increase in weighted transports,
totaling $8.9 million of compensation-related costs.
Ambulance salaries per unit hour increased 3.5%, or
$12.6 million. In fiscal 2004 we expanded our sales and
marketing team and our senior management, resulting in
$3.7 million of compensation and benefits costs. Our health
insurance costs and other employee benefits also increased year
over year by $11.0 million.
Operating expenses. Operating expenses for the year ended
August 31, 2004 were $194.4 million, or 18.4% of net
revenue, compared to $195.1 million, or 19.4% of net
revenue, for the year ended August 31, 2003. Operating
expenses per weighted transport decreased 2.6% from fiscal 2003
to fiscal 2004. These expenses decreased primarily as a result
of improvements in telecommunications contract rates, totaling
$0.6 million, and a reduction in medical supplies expense,
totaling $0.6 million, from improved purchasing contracts
and more efficient inventory management. These decreases were
offset in part by increases in vehicle operating costs, totaling
$0.6 million, resulting primarily from higher fuel costs
incurred in late fiscal 2004.
Insurance expense. Insurance expense for the year ended
August 31, 2004 was $44.3 million, or 4.2% of net
revenue, compared to $67.4 million, or 6.7% of net revenue,
for the year ended August 31, 2003. This decrease of
$23.1 million primarily relates to insurance expense
recorded in fiscal 2003 of $14.6 million resulting from
increases in actuarially-computed estimates of costs required to
settle prior years’ claims. In fiscal 2004, we recorded a
reduction of insurance expense of $4.5 million due to
favorable developments with respect to these claims. We funded
these claims through Laidlaw’s captive insurance program.
Excluding these adjustments, insurance expense decreased
$4.0 million from fiscal 2003 to fiscal 2004 as a result of
improvements in ultimate claims costs. Management implemented a
number of additional risk mitigation programs at the beginning
of fiscal 2003 that we believe positively impacted claims costs
in fiscal 2004.
Selling, general and administrative. Selling, general and
administrative expense for the year ended August 31, 2004
was $32.2 million, or 3.1% of net revenue, compared to
$35.1 million, or 3.5% of net revenue, for the year ended
August 31, 2003. This decrease of $2.9 million relates
primarily to a one-time expense reduction to eliminate a
contingent liability of $1.8 million.
Laidlaw fees and compensation charges. Laidlaw fees and
compensation charges for the year ended August 31, 2004
increased from $3.6 million, or 0.4% of net revenue, to
$9.0 million, or 0.9% of net revenue, from the year ended
August 31, 2003. The $5.4 million increase was due to
charges related to senior management incentive plans and
additional Laidlaw overhead costs allocated to AMR.
Depreciation and amortization. Depreciation and
amortization expense for the year ended August 31, 2004 was
$43.6 million, or 4.1% of net revenue, compared to
$39.3 million, or 3.9% of net revenue, for the year ended
August 31, 2003. The $4.3 million increase includes
$3.3 million attributable to amortization of a contract
intangible asset recorded as part of our fresh-start accounting
adjustments. The balance of the increase is related primarily to
vehicle acquisitions made in late fiscal 2003 and fiscal 2004.
Restructuring charges. Restructuring charges were
$2.1 million, or 0.2% of net revenue, for the year ended
August 31, 2004, a decrease from $2.7 million, or 0.3%
of net revenue, for the year ended August 31, 2003. Fiscal
2003 restructuring charges included severance-related costs for
several members of senior management who were replaced during
the year and costs incurred in restructuring and consolidating
our
67
billing offices. In fiscal 2004, we reduced the number of
operating regions and shifted the oversight of the affected
operations to the remaining regional management teams.
EmCare
Net revenue. Net revenue for the year ended
August 31, 2004 was $549.8 million, an increase of
$69.2 million, or 14.4%, from $480.6 million for the
year ended August 31, 2003. The increase was due primarily
to an increase in patient visits from net new hospital contracts
and net revenue increases in existing contracts. During fiscal
2004, we added 35 net new contracts (58 new contracts,
including 50 new emergency department contracts and 8 new
hospitalist contracts, offset by 23 contract terminations), for
a net revenue increase of $21.6 million. Net revenue
increased $23.6 million as a result of the net impact of
contract additions and terminations in fiscal 2003. “Same
store” net revenue increased $24.0 million due to a
4.5% increase in patient visits and an increase of 1.1% in net
revenue per patient visit.
Compensation and benefits. Compensation and benefits
costs for the year ended August 31, 2004 were
$430.7 million, or 78.3% of net revenue, compared to
$374.5 million, or 77.9% of net revenue, for the year ended
August 31, 2003. Provider compensation and benefit costs
increased $32.7 million from net new contract additions in
fiscal 2003 and 2004. “Same store” contract
compensation and benefits costs increased $12.8 million, or
0.2% per patient visit, as a result of increased net revenue per
visit and an increase in volume of patient visits, as a number
of our contracts include productivity-based compensation plans.
Operating expenses. Operating expenses for the year ended
August 31, 2004 were $23.9 million, or 4.3% of net
revenue, compared to $23.6 million, or 4.9% of net revenue,
for the year ended August 31, 2003. Operating expenses
decreased as a percent of net revenue from 4.9% in fiscal 2003
to 4.3% in fiscal 2004 due to our leveraging of fixed billing
and other contract costs.
Insurance expense. Professional liability insurance
expense for the year ended August 31, 2004 was
$36.0 million, or 6.5% of net revenue, compared to
$36.8 million, or 7.7% of net revenue, for the year ended
August 31, 2003. The reduction as a percent of net revenue
represents a combination of improved investment returns, changes
in actuarial estimates of costs required to settle prior
years’ claims and a reduction in the estimate of ultimate
claims costs.
Selling, general and administrative. Selling, general and
administrative expense for the year ended August 31, 2004
was $15.7 million, or 2.9% of net revenue, compared to
$14.8 million, or 3.1% of net revenue, for the year ended
August 31, 2003. The $0.9 million increase in selling,
general and administrative expense includes $0.6 million of
deferred compensation expense recorded as part of management
incentive programs during fiscal 2004 that were terminated in
connection with the acquisition and additional support costs
required for net new contracts.
Laidlaw fees and compensation charges. Laidlaw fees and
compensation charges for the year ended August 31, 2004
were $6.4 million, or 1.2% of net revenue, compared to
$1.8 million, or 0.4% of net revenue, for the year ended
August 31, 2003. The increase was due to charges related to
senior management incentive plans and additional Laidlaw
overhead costs allocated to EmCare.
Depreciation and amortization. Depreciation and
amortization expense for the year ended August 31, 2004 was
$9.1 million, or 1.7% of net revenue, compared to
$5.4 million, or 1.1% of net revenue, for the year ended
August 31, 2003. The increase of $3.7 million was due
to amortization of a contract intangible asset recorded as part
of our fresh-start accounting adjustments.
Laidlaw reorganization costs. There were no allocated
reorganization costs in fiscal 2004. Laidlaw reorganization
costs for the year ended August 31, 2003 were
$3.7 million, or 0.8% of net revenue. These costs were
allocated to EmCare by Laidlaw and reflect costs borne by
Laidlaw during its Chapter 11 restructuring.
68
Year ended August 31, 2003 compared to the year ended
August 31, 2002
Interest expense. Interest expense for the year ended
August 31, 2003 was $5.6 million compared to
$6.4 million for the year ended August 31, 2002. The
decrease of $0.8 million is due to higher interest costs on
vehicle capital leases in fiscal 2002.
Income tax expense. Income tax expense for the year ended
August 31, 2003 was $9.5 million compared to
$1.4 million for the year ended August 31, 2002. The
$8.1 million increase is due to increased income from
operations during fiscal 2003.
AMR
Net revenue. Net revenue for the year ended
August 31, 2003 was $1,007.2 million, an increase of
$22.7 million, or 2.3%, from $984.5 million for the
same period in 2002. The increase for fiscal 2003 is due
primarily to rate increases we negotiated with several
communities and payors during fiscal 2003, partially in response
to Medicare rate reductions beginning in April 2002. Our rate
per weighted transport increased 2.9%, resulting in a
$28.4 million increase in net revenue. This increase was
offset, in part, by a decrease in weighted transports of 16,900,
or 0.6%, resulting in a $5.7 million decrease in net
revenue, due principally to fewer non-emergency transports.
Compensation and benefits. Compensation and benefits
costs for the year ended August 31, 2003 were
$647.3 million, or 64.3% of net revenue, compared to
$627.8 million, or 63.8% of net revenue, for the year ended
August 31, 2002. The $19.5 million increase relates
primarily to ambulance crew wage per unit hour increases of
approximately 2.9%, or $9.8 million, in addition to an
increase in unit hours of approximately 90,900, or 0.9%,
resulting in a $2.5 million increase. Benefits also
increased $3.6 million from period to period as a result of
rising health insurance premium costs.
Operating expenses. Operating expenses for the year ended
August 31, 2003 were $195.1 million, or 19.4% of net
revenue, compared to $195.3 million, or 19.8% of net
revenue, for the year ended August 31, 2002. Operating
expenses per weighted transport decreased 0.5% from fiscal 2002
to fiscal 2003. The $0.2 million decrease was a result of a
$3.1 million decrease in occupancy costs from consolidating
certain regional facilities and a $6.1 million decrease in
professional services from legal costs incurred in fiscal 2002
for compliance-related matters, offset in part by a
$6.5 million increase in external provider costs. The
increase in external provider costs resulted principally from a
significant expansion in our national and regional relationships
with managed care and insurance providers and the resulting
costs we incurred to subcontract certain transports to local
ambulance providers.
Insurance expense. Insurance expense for the year ended
August 31, 2003 was $67.4 million, or 6.7% of net
revenue, compared to $36.1 million, or 3.7% of net revenue,
for the year ended August 31, 2002. In fiscal 2003, we
recorded $14.6 million of expense related to reserve
adjustments resulting from increases in actuarially-computed
estimates of costs required to settle prior years’ claims.
We funded these claims through Laidlaw’s captive insurance
program. In fiscal 2002, we recorded a reduction of insurance
expense of $8.1 million related to the favorable
development of claims reserves on insurance liabilities prior to
fiscal 2002. Excluding these adjustments, the $8.6 million
increase in insurance expense related to increasing premium and
claims costs associated with our workers compensation, and auto,
general and professional liability programs.
Selling, general and administrative. Selling, general and
administrative expense for the year ended August 31, 2003
was $35.1 million, or 3.5% of net revenue, compared to
$44.7 million, or 4.5% of net revenue, for the year ended
August 31, 2002. The $9.6 million reduction in
selling, general and administrative expense from fiscal 2002 to
fiscal 2003 is the result of severance recorded in fiscal 2002
to replace certain members of management, totaling
$3.7 million, associated costs to close operations,
totaling $0.9 million, and compliance-related penalties of
approximately $1.9 million incurred in fiscal 2002. In
fiscal 2003, we recorded a one-time reduction of selling,
general and administrative expense relating to the release of
$1.2 million in accrued liabilities and a reduction to
expense related to payroll tax refunds of $0.6 million.
69
Depreciation and amortization. Depreciation and
amortization expense for the year ended August 31, 2003 was
$39.3 million, or 3.9% of net revenue, compared to
$62.2 million, or 6.3% of net revenue, for the year ended
August 31, 2002. The decrease of $22.9 million
includes $21.3 million attributable to the amortization of
goodwill. Beginning in fiscal 2003, this intangible asset was no
longer amortized, but evaluated annually for impairment under
applicable accounting guidance.
Impairment losses. In fiscal 2002, we recorded an
impairment charge of $262.8 million or 26.7% of net
revenue, on long-lived assets based on the evaluation at that
time that future operating cash flows would not be sufficient to
recover the carrying value of certain long-lived assets,
primarily goodwill.
Restructuring charges. Restructuring charges were
$2.7 million, or 0.3% of net revenue, in the year ended
August 31, 2003, a decrease from $3.8 million, or 0.4%
of net revenue, in the year ended August 31, 2002. Fiscal
2003 restructuring charges included severance-related costs for
several members of senior management who were replaced during
the year and costs incurred in restructuring and consolidating
our billing offices. In fiscal 2002, AMR reduced the number of
operating regions, exited certain facilities, and shifted the
oversight of the impacted operations to the remaining regional
management teams.
EmCare
Net revenue. Net revenue for the year ended
August 31, 2003 was $480.6 million, an increase of
$49.3 million, or 11.4%, from $431.3 million for the
year ended August 31, 2002. The increase was due primarily
to an increase in patient visits from net new hospital contracts
and net revenue increases in existing contracts. During fiscal
2003, we added 27 net new contracts (55 new contracts,
including 48 new emergency department contracts and 7 new
hospitalist contracts, offset by 28 contract terminations), for
a net revenue increase of $30.4 million. Net revenue
increased $3.9 million as a result of the net impact of
2002 contract additions and terminations. “Same store”
net revenue increased $15.0 million due to a 2.0% increase
in patient visits and a 1.8% increase in net revenue per patient
visit.
Compensation and benefits. Compensation and benefits
costs for the year ended August 31, 2003 were
$374.5 million, or 77.9% of net revenue, compared to
$332.8 million, or 77.1% of net revenue, for the year ended
August 31, 2002. Provider compensation and benefit costs
increased $26.4 million from net new contract additions in
fiscal 2003 and 2002. “Same store” contract
compensation and benefits costs increased $11.0 million,
or % per patient visit, as a
result of increased volume of patient visits and increased net
revenue per visit, as a number of our contracts include
productivity-based compensation plans.
Operating expenses. Operating expenses for the year ended
August 31, 2003 were $23.6 million, or 4.9% of net
revenue, compared to $24.0 million, or 5.6% of net revenue,
for the year ended August 31, 2002. Operating expenses
decreased as a percent of net revenue due to our leveraging of
fixed billing and other contract costs.
Insurance expense. Professional liability insurance
expense for the year ended August 31, 2003 was
$36.8 million, or 7.7% of net revenue, compared to
$30.4 million, or 7.0% of net revenue, for the year ended
August 31, 2002 due to an increase in expected ultimate
losses.
Selling, general and administrative. Selling, general and
administrative expense for the year ended August 31, 2003
was $14.8 million, or 3.1% of net revenue, compared to
$16.8 million, or 3.9% of net revenue, for the year ended
August 31, 2002. The $2.0 million decrease was a
result of reduced management contract costs, as contracted
management costs were converted to employee costs in fiscal 2003.
Depreciation and amortization. Depreciation and
amortization expense for the year ended August 31, 2003 was
$5.4 million, or 1.1% of net revenue, compared to
$5.0 million, or 1.1% of net revenue, for the year ended
August 31, 2002. The $0.4 million increase was due to
additional billing technology investments completed at the end
of fiscal 2002.
Laidlaw reorganization costs. Allocated reorganization
costs for the year ended August 31, 2003 were
$3.7 million, or 0.8% of net revenue, compared to
$8.8 million, or 2.0% of net revenue, for the year ended
70
August 31, 2002. These costs were allocated to EmCare by
Laidlaw and reflect costs borne by Laidlaw during its
Chapter 11 restructuring.
Liquidity and Capital Resources
Our primary sources of liquidity are cash flow provided by our
operating activities and, prior to the acquisition, related
party advances from Laidlaw. We are now using our revolving
senior secured credit facility, described below, to supplement
our cash flow provided by our operating activities. Our
liquidity needs are primarily to fund our working capital
requirements, capital expenditures related to the acquisition of
vehicles and medical equipment, technology-related assets and
insurance-related deposits.
For the five months ended June 30, 2005 and 2004, we
generated cash flow from operating activities of
$94.7 million and $81.3 million, respectively. For the
five months ended June 30, 2005, we had net income of
$11.1 million, compared to $10.3 million for the same
period in 2004. Operating cash flow from changes in working
capital for the five months ended June 30, 2005 increased
$18.1 million from the same period in 2004, primarily
reflecting improved collections on accounts receivable,
partially offset by a reduction in accrued compensation
liability.
Net cash used in investing activities was $875.2 million
for the five months ended June 30, 2005, compared to
$24.1 million for the same period in 2004. The
$851.1 million increase was attributable principally to our
net cash outflow to fund the acquisition of AMR and EmCare.
For the five months ended June 30, 2005, net cash provided
by financing activities was $797.3 million, compared to net
cash used in financing activities of $54.0 million for the
five months ended June 30, 2004. The increase in net cash
provided by financing activities relates primarily to borrowings
received from our senior secured credit facility and senior
subordinated notes. Net cash used in financing activities
included financing costs of $20.1 million and repayments of
debt, including capital lease and senior secured credit facility
obligations totaling $23.7 million.
For the five months ended January 31, 2005 and 2004, we
generated cash flow from operating activities of
$16.0 million and $17.5 million, respectively.
Operating cash flow from changes in working capital for the five
months ended January 31, 2005 increased $7.4 million
from the same period in 2004, primarily reflecting improved
collections on accounts receivables.
Net cash used in investing activities was $21.7 million for
the five months ended January 31, 2005, compared to
$11.8 million for the same period in 2004. The
$9.9 million increase was attributable principally to our
net cash outflow to fund insurance-related deposits in our
EmCare business segment. The balance resulted primarily from the
purchase of new ambulance vehicles and certain medical equipment.
For the five months ended January 31, 2005, net cash
provided by financing activities was $10.9 million compared
to net cash used in financing activities of $5.5 million
for the five months ended January 31, 2004. Net cash used
in financing activities relates primarily to borrowings received
from Laidlaw and payments on our capital lease obligations.
During fiscal 2004, our operating activities generated
$127.7 million in cash flow compared to $88.8 million
in fiscal 2003, an increase of $38.9 million. Operating
cash flow from changes in working capital for fiscal 2004
increased $2.9 million compared to fiscal 2003. The balance
of the change in cash flow provided by operating activities was
attributable principally to an increase in net income, which
includes increases in depreciation and amortization expense and
changes in deferred taxes.
Net cash used in investing activities was $81.5 million and
$114.0 million during fiscal years 2004 and 2003,
respectively. In fiscal 2004, we spent $42.8 million on
property and equipment, of which $20.4 million related to
the acquisition of vehicles, and medical and communications
equipment, technology-related acquisition and leasehold
improvements accounted for $22.4 million. Our
$22.5 million net decrease in insurance-related deposits
and investments, which consist of restricted cash and cash
equivalents, short-term deposits, marketable securities and
long-term investments, resulted from a reduction in cash
outflows to fund certain insurance-related programs consistent
with improved claims development trends. This increase was
71
principally to support our increase in claims liabilities and
professional liability reserves. In fiscal 2003, we spent
$52.8 million on property and equipment, of which
$29.1 million was related to the acquisition of vehicles,
and medical and communications equipment, technology-related
acquisition and leasehold improvements accounted for
$23.8 million.
Net cash used in financing activities was $47.3 million and
$55.3 million during fiscal years 2004 and 2003,
respectively. In fiscal 2004, we made payments to Laidlaw of
$31.1 million and made mandatory debt repayments of
$8.7 million. Our bank overdrafts also decreased in fiscal
2004 by $4.5 million. In fiscal 2003, we made payments to
Laidlaw of $58.8 million and made mandatory debt repayments
of $8.2 million. Bank overdrafts also increased
$7.9 million during the year ended August 31, 2003.
Certain government programs, including Medicare and Medicaid
programs, require notice or re-enrollment when certain ownership
changes occur. If the payor requires us to complete the
re-enrollment process prior to submitting reimbursement
requests, we may be delayed in payment, receive refund requests
or be subject to recoupment for services we provide in the
interim. The change in ownership effected by the acquisition
from Laidlaw has required us to re-enroll in one jurisdiction,
and reimbursement from the relevant government program is likely
to be deferred for several months. This will affect our cash
flow, but will not affect our net revenue. We do not expect the
impact of this deferral to be material to us.
We expect to continue to fund the liquidity requirements of our
business principally with cash from operations and amounts
available under the revolving credit portion of our senior
secured credit facility. We have available to us, upon
compliance with customary conditions, $100.0 million under
the revolving credit facility, less any letters of credit
outstanding. Outstanding letters of credit at June 30, 2005
were $24.3 million.
The acquisition of AMR and EmCare resulted in a significant
increase in the level of our outstanding debt. We have a
$450.0 million senior secured credit facility bearing
interest at variable rates at specified margins above either the
agent bank’s alternate base rate or its LIBOR rate. The
senior secured credit facility consists of a
$100.0 million, six-year revolving credit facility and a
$350.0 million, seven-year term loan. We borrowed the full
amount of the term loan, and $20.2 million under the
revolving credit facility, on February 10, 2005 to fund the
acquisition of AMR and EmCare and pay related fees and expenses.
On February 10, 2005, we also issued $250.0 million
principal amount of 10% senior subordinated notes due 2015.
We used the net proceeds of this notes issuance to fund the
acquisition.
Our $350.0 million term loan initially carried interest at
the alternate base rate, plus a margin of 1.75%, or the LIBOR
rate, plus a margin of 2.75%. We refinanced this term loan on
March 29, 2005 for a term loan with identical terms except
that the margins were reduced by 0.25%. The term loan is subject
to quarterly amortization of principal (in quarterly
installments), with 1% of the aggregate principal payable in
each of the first six years, with the remaining balance due in
the final year. We intend to use
$ million of the
proceeds of our initial public offering to prepay
$ million of the
term loan. Our $100.0 million revolving credit facility
initially bears interest at the alternate base rate, plus a
margin of 1.75%, or the LIBOR rate, plus a margin of 2.75%. At
June 30, 2005, we had repaid the outstanding balance of the
revolving credit facility with cash flow from operations and we
had no amounts outstanding under that facility. Under the terms
of our senior secured credit facility, our letters of credit
outstanding reduce our available borrowings under the revolving
credit facility. At June 30, 2005, our outstanding letters
of credit totaled $24.3 million, including
$16.0 million to support our self-insurance program for
fiscal 2002 and 2003 and $8.3 million to secure our
performance under certain 911 emergency response contracts.
We have a conditional right under our senior secured credit
facility to request new or existing lenders to provide up to an
additional $100 million of term debt (in $20 million
increments).
72
All amounts borrowed under our senior secured credit facility
are secured by, among other things:
|
|
|
|
• |
substantially all present and future shares of the capital stock
of AMR HoldCo, Inc. and EmCare HoldCo, Inc., our wholly-owned
subsidiaries which are the co-borrowers, and each of their
present and future domestic subsidiaries and 65% of the capital
stock of controlled foreign corporations; |
|
|
• |
substantially all present and future intercompany debt of the
co-borrowers and each guarantor; and |
|
|
• |
substantially all of the present and future property and assets,
real and personal, of the co-borrowers and each guarantor. |
The agreements governing our senior secured credit facility
contains customary affirmative and negative covenants,
including, among other things, restrictions on indebtedness,
liens, mergers and consolidations, sales of assets, loans,
acquisitions, joint ventures, restricted payments, transactions
with affiliates, dividends and other payment restrictions
affecting subsidiaries, a change in control of the company and
other matters customarily restricted in such agreements. The
agreement governing our senior secured credit facility also
contains financial covenants, including a maximum total leverage
ratio (5.50 to 1.00 as of June 30, 2005), maximum senior
leverage ratio (3.25 to 1.00 as of June 30, 2005) and a
minimum fixed charge coverage ratio (1.05 to 1.00 as of
June 30, 2005), all of which are based on adjusted EBITDA,
which is the amount of our income (loss) from operations before
depreciation and amortization expenses and other specifically
identified exclusions. Each financial covenant ratio adjusts
over time as set forth in our senior secured credit facility.
Our failure to meet any of these financial covenants could be an
event of default under our senior secured credit facility.
We will not incur a prepayment penalty or any similar charges in
connection with our repayment of amounts outstanding under our
senior secured credit facility with proceeds from our initial
public offering. Amounts repaid under the term loan will not be
available for future borrowing.
The indenture governing our senior subordinated notes contains a
number of covenants that, among other things, restrict our
ability and the ability of our subsidiaries, subject to certain
exceptions, to sell assets, incur additional debt or issue
preferred stock, repay other debt, pay dividends and
distributions or repurchase our capital stock, create liens on
assets, make investments, loans or advances, make certain
acquisitions, engage in mergers or consolidations and engage in
certain transactions with affiliates.
Quantitative and Qualitative Disclosures about Market Risk
As of June 30, 2005, we had $605.9 million of debt, of
which $349.1 million was variable rate debt under our
senior secured credit facility and the balance was fixed rate
debt, including the $250.0 million aggregate principal
amount of our senior subordinated notes. An increase or decrease
in interest rates will affect our interest costs. For
comparative purposes, for every 0.125% change in interest rates,
our interest costs on our senior secured credit facility will
change by approximately $0.44 million per year based on our
outstanding indebtedness at June 30, 2005.
Off-Balance Sheet Arrangements
We do not have any relationships with unconsolidated entities or
financial partnerships, such as entities often referred to as
structured finance or special purpose entities, established for
the purpose of facilitating off-balance sheet arrangements or
other contractually narrow or limited purposes. Accordingly, we
are not materially exposed to any financing, liquidity, market
or credit risk that could arise if we had engaged in such
relationships.
73
Tabular Disclosure of Contractual Obligations and Other
Commitments
The following tables reflect a summary of obligations and
commitments outstanding as of June 30, 2005, including our
borrowings under our senior secured credit facility and our
senior subordinated notes.
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|
|
|
|
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|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Payments Due by Period | |
|
|
| |
|
|
Less than | |
|
|
|
More than | |
|
|
|
|
1 Year | |
|
1-3 Years | |
|
3-5 Years | |
|
5 Years | |
|
Total | |
|
|
| |
|
| |
|
| |
|
| |
|
| |
|
|
(in thousands) | |
Contractual obligations:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Long-term debt(1)
|
|
$ |
130 |
|
|
$ |
588 |
|
|
$ |
235 |
|
|
$ |
38 |
|
|
$ |
991 |
|
Senior secured credit facility(2)
|
|
|
3,500 |
|
|
|
7,000 |
|
|
|
7,000 |
|
|
|
331,625 |
|
|
|
349,125 |
|
Capital lease obligations (principal)
|
|
|
5,550 |
|
|
|
258 |
|
|
|
— |
|
|
|
— |
|
|
|
5,808 |
|
Capital lease obligations (interest)
|
|
|
279 |
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
279 |
|
Senior subordinated notes
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
250,000 |
|
|
|
250,000 |
|
Interest on debt(3)
|
|
|
44,985 |
|
|
|
89,438 |
|
|
|
88,604 |
|
|
|
145,908 |
|
|
|
368,935 |
|
Operating lease obligations
|
|
|
23,370 |
|
|
|
32,595 |
|
|
|
18,437 |
|
|
|
16,141 |
|
|
|
90,543 |
|
Other contractual obligations(4)
|
|
|
6,788 |
|
|
|
3,982 |
|
|
|
3,618 |
|
|
|
485 |
|
|
|
14,873 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Subtotal
|
|
|
84,602 |
|
|
|
133,861 |
|
|
|
117,894 |
|
|
|
744,197 |
|
|
|
1,080,554 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Amount of Commitment Expiration Per Period | |
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| |
|
|
Less than | |
|
|
|
More than | |
|
|
|
|
1 Year | |
|
1-3 Years | |
|
3-5 Years | |
|
5 Years | |
|
Total | |
|
|
| |
|
| |
|
| |
|
| |
|
| |
|
|
(in thousands) | |
Other commitments:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Guarantees of surety bonds
|
|
|
32,022 |
|
|
|
310 |
|
|
|
— |
|
|
|
2,850 |
|
|
|
35,182 |
|
Letters of credit(5)
|
|
|
500 |
|
|
|
— |
|
|
|
— |
|
|
|
23,797 |
|
|
|
24,297 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Subtotal
|
|
|
32,522 |
|
|
|
310 |
|
|
|
— |
|
|
|
26,647 |
|
|
|
59,479 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Total obligations and commitments
|
|
$ |
116,570 |
|
|
$ |
134,713 |
|
|
$ |
117,894 |
|
|
$ |
770,856 |
|
|
$ |
1,140,033 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
(1) |
Excludes capital lease obligations. |
|
(2) |
Excludes interest on our senior secured credit facility and
senior subordinated notes. |
|
(3) |
Interest on our floating rate debt was calculated for all years
using the effective rate as of June 30, 2005 of 5.63%. |
|
(4) |
Includes Onex management fees, dispatch fees and responder fees. |
|
(5) |
Evergreen renewals are deemed to have expiration dates in excess
of 5 years. |
We have one capital lease relating to approximately 450
ambulances. The term of the lease extends to August 2007.
Critical Accounting Policies
The preparation of financial statements requires management to
make estimates and assumptions relating to the reporting of
results of operations, financial condition and related
disclosure of contingent assets and liabilities at the date of
the financial statements. Actual results may differ from those
estimates under different assumptions or conditions. The
following are our most critical accounting policies, which are
those that require management’s most difficult, subjective
and complex judgments, requiring the need to make estimates
about the effect of matters that are inherently uncertain and
may change in subsequent periods.
Claims Liability and Professional Liability
Reserves
We are self-insured up to certain limits for costs associated
with workers compensation claims, automobile, professional
liability claims and general business liabilities. Reserves are
established for estimates of the loss that we will ultimately
incur on claims that have been reported but not paid and claims
that have been incurred but not reported. These reserves are
based upon actuarial valuations that are prepared by our
74
outside actuaries. The actuarial valuations consider a number of
factors, including historical claim payment patterns and changes
in case reserves, the assumed rate of increase in healthcare
costs and property damage repairs. Historical experience and
recent trends in the historical experience are the most
significant factors in the determination of these reserves. We
believe the use of actuarial methods to account for these
reserves provides a consistent and effective way to measure
these subjective accruals. However, given the magnitude of the
claims involved and the length of time until the ultimate cost
is known, the use of any estimation technique in this area is
inherently sensitive. Accordingly, our recorded reserves could
differ from our ultimate costs related to these claims due to
changes in our accident reporting, claims payment and settlement
practices or claims reserve practices, as well as differences
between assumed and future cost increases.
Trade and Other Accounts Receivable
We determine our allowances based on payor reimbursement
schedules, historical write-off experience and other economic
data. The allowances for contractual discounts and uncompensated
care are reviewed monthly. Account balances are charged off
against the uncompensated care allowance when it is probable the
receivable will not be recovered. Write-offs to the contractual
allowance occur when payment is received. The allowance for
uncompensated care is related principally to receivables
recorded for self-pay patients.
Revenue Recognition
A significant portion of our revenue is derived from Medicare,
Medicaid and private insurance payors that receive discounts
from our standard charges (referred to as contractual
provisions). Additionally, we are also subject to collection
risk for services provided to uninsured patients or for the
deductible or co-pay portion of services for insured patients
(referred to as uncompensated care). We record our healthcare
services revenue net of estimated provisions for the contractual
allowances and uncompensated care.
Healthcare reimbursement is complex and may involve lengthy
delays. Third party payors are continuing their efforts to
control expenditures for healthcare and may disallow, in whole
or in part, claims for reimbursement based on determinations
that certain amounts are not reimbursable under plan coverage,
were for services provided that were not determined medically
necessary, or insufficient supporting information was provided.
In addition, multiple payors with different requirements can be
involved with each claim.
Management utilizes sophisticated information systems and
financial models to estimate the provisions for contractual
allowances and uncompensated care. The estimate for contractual
allowances is determined on a payor-specific basis and is
predominantly based on prior collection experience, adjusted as
needed for known changes in reimbursement rates and recent
changes in payor mix and patient acuity factors. The estimate
for uncompensated care is based principally on historical
collection rates, write-off percentages and accounts receivable
agings. These estimates are analyzed continually and updated by
management by monitoring reimbursement rate trends from
governmental and private insurance payors, recent trends in
collections from self-pay patients, the ultimate cash collection
patterns from all payors, accounts receivable aging trends,
operating statistics and ratios, and the overall trends in
accounts receivable write-offs.
The evaluation of these factors, as well as the interpretation
of governmental regulations and private insurance contract
provisions, involves complex, subjective judgments. As a result
of the inherent complexity of these calculations, our actual
revenues and net income, and our accounts receivable, could vary
from the amounts reported.
Income Tax Valuation Allowance
We have significant net deferred tax assets resulting from net
operating losses, or NOLs, and interest deduction carryforwards
and other deductible temporary differences that will reduce
taxable income in future periods. Statement of Financial
Accounting Standards No. 109 “Accounting for Income
Taxes” requires that a valuation allowance be established
when it is “more likely than not” that all or a
portion of net deferred tax assets will not be realized. A
review of all available positive and negative evidence needs to
be considered, including expected reversals of significant
deductible temporary differences, a company’s recent
financial performance, the market environment in which a company
operates, tax planning strategies and the length of the NOL and
interest deduction carryforward periods. Furthermore, the weight
given to the potential effect of negative and positive evidence
should be commensurate with the extent to which it can be
objectively verified.
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We routinely monitor the reliability of our deferred tax assets.
Changes in management’s assessment of recoverability could
result in additions to the valuation allowance, and such
additions could be significant.
Contingencies
As discussed in note 10 — Commitments and
Contingencies of notes to our combined financial statements,
management may not be able to make a reasonable estimate of
liabilities that result from the final resolution of certain
contingencies disclosed. Further assessments of the potential
liability will be made as additional information becomes
available. Management currently does not believe that these
matters will have a material adverse effect on our consolidated
financial position. It is possible, however, that results of
operations could be materially affected by changes in
management’s assumptions relating to these matters or the
actual final resolution of these proceedings.
Intangible Assets
Definite life intangible assets are subject to impairment
reviews when evidence or triggering events suggest that an
impairment may have occurred. Should such triggering events
occur that cause us to review our definite life intangibles and
the fair value of our definite life intangible asset proves to
be less than our unamortized carrying amount, we would take a
charge to earnings for the decline. Should factors affecting the
value of our definite life intangibles change significantly,
such as declining contract retention rates or reduced
contractual cash flows, we may need to record an impairment
charge in amounts that are significant to our financial
statements.
Goodwill
Goodwill is not amortized and is required to be tested annually
for impairment, or more frequently if changes in circumstances,
such as an adverse change to our business environment, cause us
to believe that goodwill may be impaired. Goodwill is allocated
at the reporting unit level. If the fair value of the reporting
unit falls below the book value of the reporting unit at an
impairment assessment date, an impairment charge would be
recorded.
Should our business environment or other factors change, our
goodwill may become impaired and may result in charges to our
income statement that are material.
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INDUSTRY
According to the Centers for Medicare and Medicaid Services, or
CMS, national healthcare spending increased 7.3% to $1.7
trillion in 2003, and increased 8.6% in 2002. This represents
faster growth than the overall economy, which grew 4.8% and 3.4%
during 2003 and 2002, respectively, as measured by the growth of
the gross domestic product.
Hospital care represents the largest individual segment of the
healthcare industry, accounting for an estimated 30.8% of total
healthcare spending in 2003. Hospital care expenditures
increased 5.1% to $511 billion in 2003. CMS estimates that
hospital care expenditures will increase to approximately
$934 billion by 2013, representing a compound annual growth
rate of 6.1% from 2003. The aging population and longer life
expectancy are increasing demand for healthcare services in the
United States, and hospitals are expected to be among the
principal beneficiaries.
Emergency Medical Services Industry
We operate in the ambulance and emergency department services
markets, two large and growing segments of the emergency medical
services market. By law, most communities are required to
provide emergency ambulance services and most hospitals are
required to provide emergency department services. Emergency
medical services are a core component of the range of care a
patient could potentially receive in the pre-hospital and
hospital-based settings. Accordingly, we believe that
expenditures for emergency medical services will continue to
correlate closely to growth in the U.S. hospital market.
Approximately 43% of all hospital admissions originated from the
emergency department in 2003, and a substantial portion of
patients enter the emergency department by way of ambulance
transport. We believe that the following key factors will
continue to drive growth in our emergency medical services
markets:
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Increase in outsourcing. Communities, government agencies
and healthcare facilities are under significant pressure both to
improve the quality and to reduce the cost of care. The
outsourcing of certain medical services has become a preferred
means to alleviate these pressures. |
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From 2000 to 2003, we believe outsourced emergency department
services increased from 55% to 65% of total emergency department
services. |
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From 1999 to 2003, the percentage of emergency medical
transportation services supplied by private ambulance providers
increased from 34% to 39% in the country’s largest
200 cities. |
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Favorable demographics. The growth and aging of the
population will be a significant demand driver for healthcare
services, and we believe it will result in an increase in
ambulance transports, emergency department visits and hospital
admissions. |
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The U.S. Census Bureau estimates that the number of
Americans over 65 will increase to 39 million by 2010 from
31 million in 1990. It is also expected that Americans over
the age of 65 will increase from one in eight Americans in 2000
to one in five by 2030. |
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A 2003 CDC Emergency Department Summary noted that patients aged
65 or over represent 38% of patients delivered to emergency
departments by ambulance. Emergency department visits for
persons aged 65 or over increased to 17.5 million in 2003,
a 26% increase from 1993. |
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Increased federal funding for disaster preparedness and other
federal programs. The United States government has increased
its focus on our nation’s ability to respond quickly and
effectively to emergencies, including both terrorist attacks and
natural disasters. Federal programs, such as Homeland Security,
FEMA and funding for services for undocumented aliens, have made
increased funding available which is aimed directly at emergency
services, including ambulance providers and emergency physician
services. |
Additional factors that may affect the emergency medical
services industry are described elsewhere in this prospectus.
See “Risk Factors — Risk Factors Related to
Healthcare Regulation” and “Business —
Regulatory Matters.”
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We believe the ambulance services market represents annual
expenditures of approximately $12 billion. The ambulance
services market is highly fragmented, with more than 14,000
private, public and not-for-profit service providers accounting
for an estimated 36 million ambulance transports in 2004.
There are a limited number of regional ambulance providers and
we are one of only two national ambulance providers.
Ambulance services encompass both 911 emergency response and
non-emergency transport services, including critical care
transfers, wheelchair transports and other inter-facility
transports. Emergency response services include the dispatch of
ambulances equipped with life support equipment and staffed with
paramedics and/or emergency medical technicians, or EMTs, to
provide immediate medical care to injured or ill patients.
Non-emergency services utilize paramedics and EMTs to transport
patients between healthcare facilities or between facilities and
patient residences. Given demographic trends, we expect the
total number of ambulance transports to continue to grow at a
steady rate of 1% to 2% per year.
911 emergency response services are provided primarily under
long-term contracts with communities and government agencies. In
2003, approximately 39% of 911 ambulance services were provided
by private, for profit providers and 38% were provided by fire
departments, with the balance of 911 services being provided
principally by hospitals and city and county agencies.
Non-emergency services generally are provided pursuant to
non-exclusive contracts with healthcare facilities, managed care
and insurance companies. Usage tends to be controlled by the
facility discharge planners, nurses and physicians who are
responsible for requesting transport services. Non-emergency
services are provided primarily by private ambulance companies.
Quality of service, dependability and name recognition are
critical factors in winning non-emergency business.
Due to increased demand for effective use of technology,
cost-efficient services, improved patient outcomes and emergency
preparedness and response, we believe that the current trend by
communities and hospitals to outsource ambulance services will
contribute to growth for private providers. According to the
Journal of Emergency Medical Services, the percentage of
emergency medical transportation services delivered by private
ambulance providers in the nation’s 200 largest cities
increased from 34% in 1999 to 39% in 2003. Furthermore, we
expect private providers to benefit as hospitals continue to
outsource more of their ambulance services due to changes in
reimbursement rates and increased use of outpatient services.
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Emergency Department Services |
We believe the physician reimbursement component of the
emergency department services market represents annual
expenditures of approximately $10 billion. There are
approximately 4,700 hospitals in the United States that
operate emergency departments, of which approximately 67% of
these hospitals outsource their physician staffing and
management for this department. The market for outsourced
emergency department staffing and related management services is
highly fragmented, with more than 800 national, regional
and local providers. We believe we are one of only five national
providers.
Between 1993 and 2003, the total number of patient visits to
hospital emergency departments increased from 90.3 million
to 113.9 million, an increase of 26%. At the same time, the
number of hospital emergency departments declined 12%. As a
result, the average number of patient visits per hospital
emergency department increased substantially during that period.
We believe these trends are resulting in an increased focus by
hospitals on their emergency departments. As the per hospital
demand for emergency department visits continues to increase, we
believe that more hospitals will turn to well-established
providers, such as EmCare, which have a demonstrated track
record of improving productivity and efficiency while providing
high quality care.
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BUSINESS
Company Overview
Emergency Medical Services Corporation is a leading provider of
emergency medical services in the United States. We operate our
business and market our services under the AMR and EmCare
brands. AMR is the leading provider of ambulance services in the
United States, based on net revenue and number of transports.
EmCare is the leading provider of outsourced emergency
department staffing and related management services in the
United States, based on number of contracts with hospitals and
affiliated physician groups. Approximately 86% of our fiscal
2004 net revenue was generated under exclusive contracts.
During fiscal 2004, we provided emergency medical services to
approximately 9 million patients in more than 2,000
communities nationwide. For the fiscal year ended
August 31, 2004, we generated net revenue of
$1.6 billion, of which AMR and EmCare represented 66% and
34%, respectively.
We offer a broad range of essential emergency medical services
through our two business segments:
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AMR |
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EmCare |
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Core Services: |
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• Pre- and post-hospital medical transportation |
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• Hospital-based medical care |
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• Emergency (“911”) ambulance transports |
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• Emergency department staffing and related management |
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• Non-emergency ambulance |
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services |
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transports |
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• Hospitalist services |
Customers:
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• Communities |
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• Hospitals |
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• Government agencies |
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• Independent physician groups |
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• Healthcare facilities |
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• Attending medical staff |
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• Insurers |
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National Market Position:
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• #1 provider of ambulance transports |
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• #1 provider of outsourced emergency department
services |
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• 8% share of total ambulance market |
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• 6% share of emergency department services market |
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• 21% of private provider ambulance market |
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• 9% of outsourced emergency department services market |
Number of Contracts:
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At June 30, 2005
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• 153 “911” contracts |
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• 329 hospital contracts |
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• 2,400 non-emergency transport contracts |
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Volume:
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For fiscal 2004
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• 3.7 million transports |
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• 5.3 million patient visits |
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Competitive Strengths
We believe the following competitive strengths position our
company to capitalize on the favorable trends occurring within
the healthcare industry and the emergency medical services
markets.
Leading, Established Provider of Emergency Medical
Services. We are a leading provider of emergency medical
services in the United States. AMR is the leading provider of
ambulance services, with net revenue approximately twice that of
our only national competitor. During fiscal 2004, AMR treated
and transported approximately 3.7 million patients in
34 states. AMR has made significant investments in
technology, which we believe enhances quality and reduces costs
for our customers. We believe that EmCare is the leading
provider of outsourced staffing and related management services
to emergency departments, with 32% more emergency department
staffing contracts than our principal national competitor.
EmCare’s 4,500 affiliated physicians provide services to
over 300 client hospitals in 39 states, including many of
the top 100 hospitals in the United States. Our client hospitals
range from high volume urban hospital emergency department to
79
lower volume community facilities. EmCare is also one of the
leading providers of hospitalist services, based on number of
hospital contracts. We believe our track record of consistently
meeting or exceeding our customers’ service expectations,
coupled with our ability to leverage our infrastructure and
technology to drive increased productivity and efficiency, have
contributed to our ability to retain existing and win new
contracts.
Significant Scale and Geographic Presence. We believe our
significant scale and broad geographic presence provide a
competitive advantage over local and regional providers in most
areas, including:
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Cost efficiencies and broad program offering. Our
investments in technology may be too costly for certain
providers to replicate, and provide us with several competitive
advantages, including: (i) operating cost efficiencies,
(ii) scalability and (iii) the capability to provide
broad, high quality service offerings to our customers at
competitive rates. In addition, our technology, including
electronic patient records, and our expertise in providing both
pre-hospital and hospital-based emergency care uniquely
positions us to respond to community demand for enhanced
coordination among their emergency service providers. |
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National contracting and preferred provider
relationships. We are able to enter into national and
regional contracts with managed care organizations and insurance
companies. We have an exclusive provider contract with one of
the largest managed care organizations and we have preferred
provider status with several healthcare systems and many managed
care organizations. |
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Ability to recruit and retain quality personnel. We are
able to recruit and retain clinical and support employees by
providing attractive compensation packages, comprehensive
training programs, risk mitigation strategies, career
development and greater breadth of job transferability. This
lowers our costs associated with employee turnover and increases
customer and patient satisfaction. |
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One of the keys to our success has been our ability to recruit
and retain high quality medical personnel. AMR has a competitive
advantage in recruiting quality medical personnel through our
in-house paramedic training institute, which we believe is the
largest in the United States. EmCare has developed proprietary
software that allows us to identify physicians, based on
multiple characteristics, matching the specific needs of our
customers. We provide continuing education to our affiliated
medical professionals through EMEDS, our in-house Emergency
Medical Education Systems. |
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We believe our 79% and 94% retention rates in fiscal 2004 for
full-time medical personnel at AMR and EmCare, respectively, are
among the highest in the emergency medical services segments in
which they compete. We believe that successfully recruiting and
retaining highly qualified clinicians and healthcare
professionals improves the overall experience and outcomes for
our customers and patients while significantly reducing our
operating costs. |
Long-Term Relationships with Existing Customers. We
believe our long-term, well-established relationships with
communities and healthcare facilities enhance our ability to
retain existing customers and win new contracts. AMR and EmCare
have maintained relationships with their ten largest customers
for an average of 34 and 12 years, respectively, and during
that time have continually demonstrated an ability to meet and
exceed contractual commitments. As a result, we believe we are
in an advantageous position at the time of contract renewal when
a community or hospital is faced with a decision whether to
retain its existing provider or explore other alternatives. We
believe our industry-leading contract retention rates during
fiscal 2004 reflect our ability to deliver on our service
commitments to our customers over extended time periods.
Strong Financial Performance. When we compete for new
business, one of the key factors our potential customers
evaluate is financial stability. As a result, we believe our
track record of strong financial performance provides us with a
competitive advantage over our competitors. We believe the
quality and breadth of our service offerings has allowed us to
increase our net revenue at a faster rate than the market for
emergency medical services. We believe our ability to
demonstrate consistently strong financial performance will
continue to differentiate our company and provide a competitive
advantage in winning new contracts and renewing existing
contracts.
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Focus on Risk Management. Considered by certain insurance
industry consultants to be one of the leading programs of its
kind in the emergency department industry, EmCare’s risk
management initiatives are enhanced by the use of our
professional liability claims database and comprehensive claims
management. We analyze this data to demonstrate claim trends on
a national, hospital, physician and procedure level, helping to
manage and mitigate risk exposure. AMR’s risk/ safety
program is aimed at reducing worker injuries through training
and improved equipment, and increasing vehicle safety through
the use of technology. Over the last three years, our workers
compensation, auto, general and professional liability claims
per 100,000 ambulance transports decreased 8.4% at AMR and our
professional liability claims per 100,000 emergency department
visits decreased 14.0% at EmCare.
Investment in Core Technologies. We utilize technology as
a means to enhance the quality, reduce the cost of our service
offerings, more effectively manage risk and improve our
profitability. For example:
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We believe AMR is the largest user of ambulance electronic
patient care records, or e-PCR. Our proprietary system enables
us to eliminate the use of manual patient records by replacing
them with electronic records, which we expect will reduce both
chart errors and costs. |
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AMR utilizes proprietary software, Millennium, to determine the
appropriate level of transportation services to be dispatched
and track response times and other data for hospitals. Our
initial implementation of these technologies has improved our
ability to capture revenue, decrease our billing costs and bid
more effectively for 911 contracts. |
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EmCare has developed proprietary physician recruitment software
that has enhanced our recruitment efficiency and improved our
physician retention rate. |
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At EmCare, we track risk exposure trends through what we believe
is one of the largest emergency department risk databases,
allowing us to assess, develop and implement targeted risk
intervention programs. |
Proven and Committed Management Team. We are led by an
experienced senior management team with an average of
21 years of experience in the healthcare industry. Our
Chairman and Chief Executive Officer, William Sanger, has over
30 years of experience within the healthcare services
industry, with leadership roles in multi-system hospitals,
ambulatory care facilities, post-acute service facilities,
physician management companies and insurance entities. Since
Mr. Sanger joined us in 2001, our senior management team
has been successful in growing the market share of our
businesses, managing changes in reimbursement policy, reducing
professional liability risk and improving the profitability of
our operations.
Business Strategy
We intend to leverage our competitive strengths to pursue our
business strategy:
Increase Revenue from Existing Customers. We believe our
long track record of delivering excellent service and quality
patient care, as well as the breadth of our services, creates
opportunities for us to increase revenue from our existing
customer base. We have established strategies aimed at assisting
communities and facilities to manage their cost of emergency
medical services. Some of our initiatives with existing
customers include:
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Implementing innovative productivity-enhancing programs |
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At EmCare, we have developed and implemented programs, such as
“fast track” and advanced triage protocols, to improve
throughput and wait times, thereby improving patient
satisfaction and reducing the number of patients who leave
without being seen. |
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At AMR, we have developed and implemented innovative programs to
improve our productivity through decreased “drop” and
“on scene” time. For example, we have recently
established transition units at several hospitals to hold and
monitor discharged patients awaiting transport, thereby
increasing our productivity while accelerating inpatient bed
availability and overall hospital throughput. |
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Continuing to broaden product and service offerings to our
customers |
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In 2002, we began marketing hospitalist services. Since that
time, our hospitalist services revenue increased at a compound
annual growth rate of 48.3% from $7.2 million to
$23.5 million in fiscal 2004. Approximately fifty percent
of our hospitalist contracts are with our emergency department
customers. |
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At certain facilities, AMR provides a dedicated on-site
non-emergency transport coordinator during times of peak demand
to increase efficiency and ensure appropriate utilization of all
medical transportation service levels. |
Grow Our Customer Base. We believe we have a unique
competency in the treatment, management and billing of episodic
and unscheduled care. We believe our long operating history,
significant scope and scale and leading market position provide
us with new and expanded opportunities to grow our customer
base. We will continue to generate new revenue and client growth
through:
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Targeted geographic sales and marketing programs, |
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Pursuing new outsourcing opportunities for emergency department,
hospitalist, radiology and ambulance services, |
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Expanding our public/private ambulance partnerships with local
fire departments, |
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Evaluating opportunities that leverage our core businesses,
including our communications center infrastructure, to manage
health-related transportation logistics. |
EmCare was awarded 52 new contracts with net revenue of
$79.0 million in 2003 and 58 new contracts with net revenue
of $79.4 million in 2004. AMR was awarded 109 new contracts
with net revenue of $17.1 million in 2003 and 60 new
contracts with net revenue of $12.2 million in 2004.
Pursue Select Acquisition Opportunities. The emergency
medical services industry is highly fragmented, with only a few
large national providers, and presents opportunities for
consolidation. We plan to pursue select acquisitions in our core
businesses, including acquisitions to enhance our presence in
existing markets and our entry into new geographic markets. We
will also explore the acquisition of complementary businesses,
such as radiology, hospitalist and managed transportation
services and seek opportunities to expand the scope of services
in which we can leverage our core competencies.
Utilize Technology to Differentiate Our Services and Improve
Operating Efficiencies. We intend to continue to invest in
technologies that broaden our services in the marketplace,
improve patient care, enhance our billing efficiencies and
increase our profitability. We believe that the complexities of
the healthcare industry and customer demand for broader, more
cost-effective service offerings will continue to benefit those
providers that remain at the forefront of technological
innovation. The following outlines certain technologies we
utilize:
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System Status Management (SSM): Enables AMR to use
current incident data to position our vehicles efficiently,
minimizing response time while maximizing asset utilization. We
currently utilize SSM in all communities in which we operate
under contracts to provide 911 emergency ambulance services. We
believe we are one of only a few ambulance services providers
that have begun to implement “real-time” SSM
technology. |
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Electronic patient care record (e-PCR): Where
implemented, allows AMR to capture billable revenue, decrease
our billing costs and optimize reimbursement. In addition, our
proprietary e-PCR enables us to shorten our billing cycle and
reduce risk by utilizing defined clinical and rules-based
protocols to capture patient information electronically. |
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Millennium software: Millennium, our proprietary
software, allows us greater flexibility in meeting our
customers’ needs. This rules-based software program
integrates medical protocol, managed care criteria and other
detailed data prescribed by our customers, enabling AMR to
efficiently dispatch appropriate transport and more effectively
track response time. |
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EmSource: EmSource, our proprietary physician recruitment
system, enables EmCare to more effectively recruit physicians
who meet the needs of our customers. The system consists of a
database of approximately 800,000 physicians that is updated
weekly to provide the most current physician contact available. |
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EmBillz: EmBillz, our proprietary coding, billing and
accounts receivable management system, enables EmCare to more
effectively process more than five million emergency department
visits each year. |
Continued Focus on Risk Management. Through our risk
management and quality assurance staffs, technology platform and
well-trained medical personnel, we will continue to conduct
aggressive risk management programs for loss prevention and
early intervention. We will continue to develop and utilize
clinical “fail safes” and use technology in our
ambulances to reduce vehicular incidents.
Implement Cost Rationalization Initiatives. We will
continue to rationalize our cost structure by aligning
compensation with productivity, developing risk management
initiatives that are focused on mitigating risk exposures, and
eliminating costs in our national and regional corporate support
structure. Since our acquisition of AMR and EmCare, we have
completed our preliminary analysis of certain of our support
areas, including accounting, legal, information services and
human resources, and have begun to implement initiatives to
increase productivity and achieve further economies of scale
across the company.
Company History
Effective January 31, 2005, an investor group led by Onex
Partners LP and Onex Corporation, and including members of our
management, purchased our operating subsidiaries — AMR
and EmCare — from Laidlaw International, Inc. Laidlaw
had acquired AMR and EmCare in 1997.
The purchase price for AMR and EmCare totaled
$828.8 million. We funded the purchase price and related
transaction costs with equity contributions of
$219.2 million, the issuance and sale of
$250.0 million principal amount of our senior subordinated
notes and borrowings under our senior secured credit facility,
including a term loan of $350.0 million and approximately
$20.2 million under our revolving credit facility. We
intend to use approximately
$ million
of the net proceeds from this offering to repay debt outstanding
under our senior secured credit facility.
Since completing our acquisition of AMR and EmCare, we have
operated through a holding company, EMS L.P., that is a limited
partnership. As described in “Formation of Holding
Company”, our new holding company will be a Delaware
corporation upon completion of this offering.
Business Segments
We operate our business and market our services under our two
business segments: AMR and EmCare. We provide ambulance
transport services in 34 states and the District of
Columbia and provide services to emergency department and
hospitalist programs in 39 states.
We believe that our operational structure enhances service
delivery and maintains favorable executive contact with key
contract decision-makers and community leaders. Each region
provides operational support and management of our local
business operating sites and facilities. Our regional management
is responsible for growing the business in the region,
overseeing key community and facility relationships, managing
labor and employee relations and providing regional support
activities to our operating sites.
We provide strategic planning, centralized financial support,
payroll administration, legal services, human resources,
coordinated marketing and purchasing efforts and risk management
through our National Resource Center. We also support our
operating sites with integrated information systems and
standardized procedures that enable us to efficiently manage the
billing and collections processes.
The following is a detailed business description for our two
business segments.
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American Medical
Response
American Medical Response, Inc., or AMR, is the leading provider
of ambulance services in the United States. AMR and our
predecessor companies have a long history in emergency medical
services, having provided services to some communities for more
than 50 years. We have an 8% share of the total ambulance
services market and a 21% share of the private provider
ambulance market. During fiscal 2004, AMR treated and
transported approximately 3.7 million patients in
34 states utilizing more than 4,200 vehicles that operated
out of more than 200 sites. AMR has approximately 2,550
contracts with communities, government agencies, healthcare
providers and insurers to provide ambulance transport services.
AMR’s broad geographic footprint enables us to contract on
a national and regional basis with managed care and insurance
companies. AMR has made significant investments in technology,
customer service programs, employee training and risk mitigation
programs to deliver a compelling value proposition to our
customers, which has led to what we believe is our
industry-leading contract retention rate of 99% in fiscal year
2004 and significant new contract wins.
For fiscal 2004, approximately 57% of AMR’s net revenue was
generated from emergency 911 ambulance services, which include
treating and stabilizing patients, transporting the patient to a
hospital or other healthcare facility and providing attendant
medical care en-route. Non-emergency ambulance services,
including critical care transfer, wheelchair transports and
other interfacility transports, accounted for 32% of AMR’s
net revenue for the same period, with the balance generated from
the provision of training, dispatch centers and other services
to communities and public safety agencies. For the fiscal year
ended August 31, 2004, AMR generated net revenue of
$1.1 billion.
We have been instrumental in the development of protocols and
policies applicable to the emergency services industry. We
believe our key business competencies in communications and
logistics management and our partnerships with local fire
departments, which represented approximately 21% of AMR’s
net revenue in fiscal 2004, enable us to operate profitably in
both large and small communities and position us to continue our
growth organically.
We provide substantially all of our ambulance services under our
AMR brand name. We operate under other names when required to do
so by local statute or contractual agreement.
Services
We provide a full range of emergency and non-emergency ambulance
transport and related services, which include:
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Emergency Response Services (911). We provide emergency
response services primarily under long-term exclusive contracts
with communities and hospitals. Our contracts typically
stipulate that we must respond to 911 calls in the designated
area within a specified response time. We utilize two types of
ambulance units — Advanced Life Support, or ALS, units
and Basic Life Support, or BLS, units. ALS units, which are
staffed by two paramedics or one paramedic and an emergency
medical technician, or EMT, are equipped with high-acuity life
support equipment such as cardiac monitors, defibrillators and
oxygen delivery systems, and carry pharmaceutical and medical
supplies. BLS units are usually staffed by two EMTs and are
outfitted with medical supplies and equipment necessary to
administer first aid and basic medical treatment. The decision
to dispatch an ALS or BLS unit is determined by our contractual
requirements, as well as by the nature of the medical situation. |
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Under certain of our 911 emergency response contracts, we are
the first responder to an emergency scene. However, under most
of our 911 contracts, the local fire department is the first
responder. In these situations, the fire department typically
begins stabilization of the patient. Upon our arrival, we
continue stabilization through the provision of attendant
medical care and transport the patient to the closest
appropriate healthcare facility. In certain communities where
the fire department historically has been responsible for both
first response and emergency services, we seek to develop
public/private partnerships with fire departments rather than
compete with them to provide the emergency service. These
partnerships emphasize collaboration with the fire departments
and afford us the opportunity to |
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provide 911 emergency services in communities that, for a
variety of reasons, may not otherwise have outsourced this
service to a private provider. In most instances, the provision
of emergency services under our partnerships closely resembles
that of our most common 911 contracts described above. What
differentiates the public/private partnerships is the level of
contractually negotiated collaboration and coordination between
AMR and the fire department. As an example, in several of our
public/private partnerships, we utilize a fire
department-employed paramedic when we transport the patient and
subsequently reimburse the fire department for its
employee’s time. These partnerships benefit both
parties — they create a new revenue source for the
fire department while relieving it of the complexities
associated with the emergency transport business, and they
enable us to provide emergency response services in communities
that may not otherwise have outsourced this service. In
addition, the public/private partnerships lower our costs by
reducing the number of full-time paramedics we would otherwise
require. We estimate that these public/private partnerships
represented approximately 20% of AMR’s net revenue in
fiscal 2004. |
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Non-Emergency Transport Services. With non-emergency
services, we provide transportation to patients requiring
ambulance or wheelchair transport with varying degrees of
medical care needs between healthcare facilities or between
healthcare facilities and their homes. Unlike emergency response
services, which typically are provided by communities or private
providers under exclusive or semi-exclusive contracts,
non-emergency transportation usually involves multiple contract
providers at a given facility, with one or more of the
competitors designated as the “preferred” provider.
Non-emergency transport business generally is awarded by a
healthcare facility, such as a hospital or nursing home, or a
healthcare payor, such as an HMO, managed care organization or
insurance company. |
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Non-emergency transport services include: (i) critical care
transport, (ii) wheelchair and stretcher-car transports,
and (iii) other inter-facility transports. |
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Critical care transports are provided to medically unstable
patients (such as cardiac patients and neonatal patients) who
require critical care while being transported between healthcare
facilities. Critical care services differ from ALS services in
that the ambulance may be equipped with additional medical
equipment and may be staffed by one of our medical specialists
or by an employee of a healthcare facility to attend to a
patient’s specific medical needs. |
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• |
Wheelchair and stretcher-car transports are non-medical
transportation provided to handicapped and certain
non-ambulatory persons in some service areas. In providing this
service, we use vans that contain hydraulic wheelchair lifts or
ramps operated by drivers who generally are trained in
cardiopulmonary resuscitation, or CPR. |
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Other inter-facility transports, that require advanced or basic
levels of medical supervision during transfer, may be provided
when a home-bound patient requires examination or treatment at a
healthcare facility or when a hospital inpatient requires tests
or treatments (such as magnetic resonance imaging, or MRI,
testing, CAT scans, dialysis or chemotherapy treatment)
available at another facility. We use ALS or BLS ambulance units
to provide general ambulance services depending on the
patient’s needs. |
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Other Services. In addition to our 911 emergency and
non-emergency ambulance services, we provide the following
services: |
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• |
Dispatch Services. Our dispatch centers manage our own
calls and, in certain communities, also manage dispatch centers
for public safety agencies, such as police and fire departments,
aeromedical transport programs and others. |
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Event Medical Services. We provide medical stand-by
support for concerts, athletic events, parades, conventions,
international conferences and VIP appearances in conjunction
with local and federal law enforcement and fire protection
agencies. We have contracts to provide stand-by support for
numerous sports franchises, such as the Oakland Raiders, Oakland
Athletics, Detroit Lions and Los Angeles Dodgers, as well as for
various NASCAR events, Hollywood production studios and other
specialty events. |
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Managed Transportation Services. Managed care
organizations and insurance companies contract with us to manage
various of their medical transportation-related needs, including
call-taking and scheduling, management of a network of
transportation providers and billing and reporting through our
e-PCR system. |
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• |
Paramedic Training. We own and operate Northern
California Training Institute, or NCTI, the largest paramedic
training school in the United States and the only accredited
institution of its size, with over 500 graduates each year. |
Medical Personnel and Quality Assurance
Approximately 76% of our 18,000 employees have daily contact
with patients, including approximately 5,100 paramedics, 7,500
EMTs and 200 nurses. Paramedics and EMTs must be state-certified
to transport patients and perform emergency care services.
Certification as an EMT requires completion of a minimum of
140 hours of training in a program designated by the United
States Department of Transportation, such as those offered at
our training institute, NCTI. Once this program is completed,
state-certified EMTs are then eligible to participate in a
state-certified paramedic training program. The average
paramedic program involves over 1,000 hours of academic
training in advanced life support and assessment skills.
Local physician advisory boards develop medical protocols to be
followed by paramedics and EMTs in a service area. In addition,
instructions are conveyed on a case-by-case basis through direct
communications between the ambulance crew and hospital emergency
room physicians during the administration of advanced life
support procedures. Both paramedics and EMTs must complete
continuing education programs and, in some cases, state
supervised refresher training examinations to maintain their
certifications.
We maintain a commitment to provide high quality pre- and
post-hospital emergency medical care. In each location in which
we provide services, a medical director, who usually is a
physician associated with a hospital we serve, monitors
adherence to medical protocol and conducts periodic audits of
the care provided. In addition, we hold retrospective care
audits with our employees to evaluate compliance with medical
and performance standards.
Our commitment to quality is reflected in the fact that 15 of
our dispatch centers across the country are accredited by the
Commission on Accreditation of Ambulance Services, or CAAS,
representing 16% of the total CAAS accredited agencies. CAAS is
a joint program between the American Ambulance Association and
the American College of Emergency Physicians. The accreditation
process is voluntary and evaluates numerous qualitative factors
in the delivery of services. We believe communities and managed
care providers increasingly will consider accreditation as one
of the criteria in awarding contracts.
Billing and Collections
Our internal patient billing services, or PBS, offices located
across the United States invoice and collect for our services.
We receive payment from the following sources:
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the federal and state governments, primarily under the Medicare
and Medicaid programs, |
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health maintenance organizations, preferred provider
organizations and private insurers, |
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individual patients, and |
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community subsidies and fees. |
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Over the last three fiscal years, our self-pay revenue has
remained stable as a percentage of AMR’s net revenue. The
table below presents the approximate percentages of AMR’s
net revenue from the following sources:
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Percentage of AMR | |
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Net Revenue | |
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| |
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|
Year Ended | |
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August 31, | |
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| |
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2002 | |
|
2003 | |
|
2004 | |
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| |
|
| |
|
| |
Medicare
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35 |
% |
|
|
33 |
% |
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33 |
% |
Medicaid
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6 |
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6 |
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|
6 |
|
Commercial insurance/managed care
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41 |
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44 |
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45 |
|
Self-pay
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6 |
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6 |
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5 |
|
Subsidies/fees
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12 |
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|
|
11 |
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|
|
11 |
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|
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|
|
|
|
|
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Total net revenue
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100 |
% |
|
|
100 |
% |
|
|
100 |
% |
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We have substantial experience in processing claims to third
party payors and employ a billing staff trained in third party
coverage and reimbursement procedures. Our integrated billing
and collection systems allow us to tailor the submission of
claims to Medicare, Medicaid and certain other third party
payors and has the capability to electronically submit claims to
the extent third party payors’ systems permit. This system
also provides for tracking of accounts receivable and status
pending payment. When collecting from individuals, we sometimes
use an automated dialer that pre-selects and dials accounts
based on their status within the billing and collection cycle,
which we believe improved our collection rate.
Companies in the ambulance services industry maintain
significant provisions for doubtful accounts compared to
companies in other industries. Collection of complete and
accurate patient billing information during an emergency service
call is sometimes difficult, and incomplete information hinders
post-service collection efforts. In addition, we cannot evaluate
the creditworthiness of patients requiring emergency transport
services. Our allowance for doubtful accounts generally is
higher for transports resulting from emergency ambulance calls
than for non-emergency ambulance requests. See “Risk
Factors — Risk Factors Related to Healthcare
Regulation — Changes in the rates or methods of third
party reimbursements may adversely affect our revenue and
operations.”
State licensing requirements, as well as contracts with
communities and healthcare facilities, typically require us to
provide ambulance services without regard to a patient’s
insurance coverage or ability to pay. As a result, we often
receive partial or no compensation for services provided to
patients who are not covered by Medicare, Medicaid or private
insurance. The anticipated level of uncompensated care and
uncollectible accounts is considered in negotiating a
government-paid subsidy to provide for uncompensated care, and
permitted rates under contracts with a community or government
agency.
A significant portion of our ambulance transport revenue is
derived from Medicare payments. The Balanced Budget Act of 1997,
or BBA, modified Medicare reimbursement rates for emergency
transportation with the introduction of a national fee schedule.
The BBA provided for a phase-in of the national fee schedule by
blending the new national fee schedule rates with ambulance
service suppliers’ pre-existing “reasonable
charge” reimbursement rates. The BBA provided for this
phase-in period to begin on April 1, 2002, with full
transition to the national fee schedule rates to be effective
January 1, 2006. In some regions, the national fee schedule
would have resulted in a decrease in Medicare reimbursement
rates of approximately 25% by the end of the phase-in period.
Partially in response to the dramatic decrease in rates dictated
by the BBA in some regions, the Medicare Modernization Act
established regional rates, certain of which are higher than the
BBA’s national rates, and provided for the blending of the
regional and national rates until January 1, 2010. Other
rate provisions included in the Medicare Modernization Act
provide further temporary mitigation of the impact of the BBA
decreases, including a provision that provides for 1% to 2%
increases for blended rates for the period from January 1,
2004 through December 31, 2006. Because the Medicare
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Modernization Act relief is of limited duration, we will
continue to pursue strategies to offset the decreases mandated
by the BBA, including seeking fee and subsidy increases.
We estimate that the impact of the BBA rate decreases for fiscal
2003 and fiscal 2004 on AMR’s net revenue was
$20 million and $17 million, respectively. We have
been able to substantially mitigate the phase-in reductions of
the BBA through additional fee and subsidy increases. As a 911
emergency response provider, we are uniquely positioned to
offset changes in reimbursement by requesting increases in the
rates we are permitted to charge for 911 services from the
communities we serve. In response, these communities often
permit us to increase rates for ambulance services from patients
and their third party payors in order to ensure the maintenance
of required community-wide 911 emergency response services.
While these rate increases do not result in higher payments from
Medicare and certain other public or private payors, overall
they increase our revenue.
See “Regulatory Matters — Medicare, Medicaid and
Other Government Program Reimbursement” for additional
information on reimbursement from Medicare, Medicaid and other
government-sponsored programs.
Contracts
As of June 30, 2005, we had approximately 153 contracts
with communities and government agencies to provide 911
emergency response services. Contracts with communities to
provide emergency transport services are typically exclusive,
three to five years in length and generally are obtained through
a competitive bidding process. In some instances where we are
the existing provider, communities elect to renegotiate existing
contracts rather than initiate new bidding processes. Our 911
contracts often contain options for earned extensions or
evergreen provisions. We have improved our contract retention
rate to 99% for fiscal 2004 compared to 81% in fiscal 2001. In
fiscal 2004, our top ten 911 contracts accounted for
approximately $243.3 million, or 23.1% of AMR’s net
revenue. We have served these ten customers on a continual basis
for an average of 34 years.
Our 911 emergency response contracts typically specify maximum
fees we may charge and set forth minimum requirements, such as
response times, staffing levels, types of vehicles and
equipment, quality assurance and insurance coverage. Communities
and government agencies may also require us to provide a
performance bond or other assurances of financial
responsibility. The rates we are permitted to charge for
services under a contract for emergency ambulance services and
the amount of the subsidy, if any, we receive from a community
or government agency depend in large part on the nature of the
services we provide, payor mix and performance requirements.
We have approximately 2,400 contracts to provide non-emergency
ambulance services with hospitals, nursing homes and other
healthcare facilities that require a stable and reliable source
of medical transportation for their patients. These contracts
typically designate us as the preferred ambulance service
provider of non-emergency ambulance services to those facilities
and permit us to charge a base fee, mileage reimbursement, and
additional fees for the use of particular medical equipment and
supplies. We also provide a significant portion of our
non-emergency transports to facilities and organizations in
competitive markets without specific contracts.
Non-emergency transports often are provided to managed care or
insurance plan members who are stabilized at the closest
available hospital and are then moved to facilities within their
health plan’s network. We believe the increased prevalence
of managed care benefits larger ambulance service providers,
which can service a higher percentage of a managed care
provider’s members. This allows the managed care provider
to reduce its number of vendors, thus reducing administrative
costs and allowing it to negotiate more favorable rates with
healthcare facilities. Our scale and broad geographic footprint
enable us to contract on a national and regional basis with
managed care and insurance companies. We have multi-year
contracts with large healthcare networks and insurers including
Kaiser, Aetna, Healthnet, Cigna and SummaCare. None of these
customers represent revenue that amounts to 10% of our fiscal
2004 total net revenue.
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We believe that communities, government agencies, healthcare
facilities, managed care companies and insurers consider the
quality of care, historical response time performance and total
cost to be among the most important factors in awarding and
renewing contracts.
Dispatch and Communications
Dispatch centers control the deployment and dispatch of
ambulances in response to calls through the use of sophisticated
communications equipment 24 hours a day, seven days a week.
In many operating sites, we communicate with our vehicles over
dedicated radio frequencies licensed by the Federal
Communications Commission. In certain service areas with a large
volume of calls, we analyze data on traffic patterns,
demographics, usage frequency and similar factors with the aid
of System Status Management, or SSM technology, to help
determine optimal ambulance deployment and selection. In
addition to dispatching our own ambulances, we also provide and
staff 52 dispatch centers for communities where we are not an
ambulance service provider. Our dispatch centers are staffed by
EMTs and other experienced personnel who use local medical
protocols to analyze and triage a medical situation and
determine the best mode of transport.
Emergency Transport. Depending on the emergency medical
dispatch system used in a designated service area, the public
authority that receives 911 emergency medical calls either
dispatches our ambulances directly from the public control
center or communicates information regarding the location and
type of medical emergency to our control center which, in turn,
dispatches ambulances to the scene. While the ambulance is
en-route to the scene, the ambulance receives information
concerning the patient’s condition prior to the
ambulance’s arrival at the scene. Our communication systems
allow the ambulance crew to communicate directly with the
destination hospital to alert hospital medical personnel of the
arrival of the patient and the patient’s condition and to
receive instructions directly from emergency room personnel on
specific pre-hospital medical treatment. These systems also
facilitate close and direct coordination with other emergency
service providers, such as the appropriate police and fire
departments, that also may be responding to a call.
Non-Emergency Transport. Requests for non-emergency
transports typically are made by physicians, nurses, case
managers and hospital discharge coordinators who are interested
primarily in prompt ambulance arrival at the requested pick-up
time. We are also offering on-line, web-enabled transportation
ordering to certain facilities. We use our Millennium software
to track and manage requests for transportation services for
large healthcare facilities and managed care companies.
Management Information Systems
We support our regions with integrated information systems and
standardized procedures that enable us to efficiently manage the
billing and collections processes and financial support
functions. Our recently developed technology solutions provide
information for operations personnel, including real-time
operating statistics, tracking of strategic plan initiatives,
electronic purchasing and inventory management solutions.
We have three management information systems that we believe
have significantly enhanced our operations — our e-PCR
technology, our Millennium call-taking system and our SSM
ambulance positioning system.
e-PCR. In those operating sites where we have implemented
it, our e-PCR technology, has enhanced the process of capturing
clinical patient data. The electronic record replaces the paper
patient care record and provides the paramedic with clinical
flowcharts to document each assessment and procedure performed.
The technology also integrates patient clinical and demographic
information with billing information, allowing the ambulance
crew to ensure that patient information is updated at the scene.
Billing information can be transmitted electronically while the
ambulance is en-route, thus reducing the billing cycle time and
the cost associated with the manual input of patient care record
information. Our initial implementation of this technology has
improved our ability to capture billable revenue and decrease
our billing costs. We currently employ e-PCR technology on
ruggedized laptops in five of our operating sites and we plan to
implement it in six additional operating sites in fiscal 2005.
This technology currently is available in operating sites that
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accounted for approximately 9% of AMR’s fiscal 2004
ambulance transports and approximately 12% of AMR’s fiscal
2004 net transport revenue. Together with the operating
sites to be added in fiscal 2005, the e-PCR technology would
have accounted for 11% of AMR’s fiscal 2004 ambulance
transports and 13% of its fiscal 2004 net transport
revenue. Our per unit e-PCR capital costs continue to decline as
hardware costs decline.
Millennium. Our proprietary Millennium system is a
call-taking application that tracks and manages requests for
transportation services for large healthcare facilities and
managed care companies. The system is designed to make certain
medical necessity and benefit level determinations prior to
transport. These determinations can be customized to fit an
individual customer’s needs. Customers call a single
toll-free telephone number and are routed to the appropriate AMR
call center. The telephone system is integrated into the
Millennium application, which gives the answering agent specific
call information, including customized greetings, patient
information and priority of the call. The system logic verifies
whether the transport is authorized by the health plan. If the
transport is determined to be appropriate, the system then
assigns a response time and level of service based on the
information obtained from the requestor. In fiscal 2004, we
utilized Millennium for approximately 217,000 transactions
resulting in 210,000 transports in the year. We have initiated a
campaign to promote the benefits of this system to other
potential customers.
SSM. Our SSM technology enables us to use historical data
on fleet usage patterns to predict where our emergency transport
services are likely to be required. SSM also creates a visual
display of current demand, allowing us to position our ambulance
units more effectively. This flexible deployment allows us to
improve response times and increase asset utilization.
Additionally, we have recently begun to implement
“real-time” SSM. This state-of-the-art SSM technology
will allow us to continuously position our ambulances in
optimized locations, thereby further improving response times
and maximizing asset utilization. We believe our ability to
continue deploying real-time SSM will further differentiate us
from our competitors in terms of both service quality and cost.
Sales and Marketing
Our 100-person sales and marketing team is comprised of two
distinct groups — one focused primarily on contract
retention and the other on generating new sales. Many of our
sales and marketing employees are former paramedics or EMTs who
began their careers in the emergency transportation industry and
are therefore well-qualified to understand the needs of our
customers. Our sales force is incentivized through a
compensation package that includes base salary and significant
bonus potential based on achieving specified performance targets.
We continue to seek expansion in both the geographic markets we
serve and the scope of services we provide in existing markets.
Ownership of the local emergency response contract can be
advantageous to us when bidding for non-emergency business,
because our existing fleet of ambulances and dispatch centers
maintained for emergency response can also be used for
non-emergency business. For the same reason, our ownership of a
successful non-emergency business can be advantageous to us when
trying to unseat an incumbent emergency response operator or to
obtain a contract in a newly privatized market.
Risk Management
We are committed to the safety of our employees and the patients
and communities we serve. Our commitment is manifested in our
World Class Safety Program, which has gained distinction
with the National Safety Council and has served as a benchmark
for other companies. This program consists of two important
goals:
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To be the leader for safety in the emergency medical services
industry, and |
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To be recognized as a leader for safety among all industries. |
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Our World Class Safety Program is built upon five important
components:
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Selecting highly qualified employees, |
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• |
Providing exemplary safety policies and programs to control
losses, |
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Effective training and education programs, |
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Accountability of management and employees for safety of the
operation, and |
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Continuous review of new opportunities and existing programs for
improvement. |
We train and educate all new employees about our safety programs
including, among others, emergency vehicle operations, various
medical protocols, use of equipment and patient focused care and
advocacy. Our safety training also involves continuing education
programs and a monthly safety awareness campaign. We also work
directly with manufacturers to design equipment modifications
that enhance both patient and clinician safety.
Our safety and risk management team develops and executes
strategic planning initiatives focused on mitigating the factors
that drive losses in our operations. We aggressively investigate
and respond to all incidents we believe may result in a claim.
Operations supervisors submit documentation of such incidents to
the third party administrator handling the claim. We have a
dedicated liability unit with our third party administrator
which actively engages with our staff to gain valuable
information for closure of claims. Information from the claims
database is an important resource for identifying trends and
developing future safety initiatives.
We utilize an on-board monitoring system, RoadSafety, which
measures operator performance against our safe driving
standards. Our operations using RoadSafety have experienced
improved driving behaviors within 90 days of installation.
RoadSafety has been implemented in 49% of our vehicles in the
emergency response markets and is being expanded to 58% of our
emergency fleet in fiscal 2006. We expect to recover the average
cost per vehicle over a period of approximately 24 months
from installation due to reduced vehicle maintenance and repair
expenses.
We estimate that, in fiscal 2004, our costs for vehicle
collisions were 19% lower than in fiscal 2000 and our average
cost per vehicle claim was 37% lower than in fiscal 2000. Over
the same period, we estimate that we reduced patient care
incidents and employee injuries by 8% and 25%, respectively.
Competition
Our predominant competitors are fire departments, with 35% of
the ambulance transport services market. Firefighters have
traditionally acted as the first responders during emergencies,
and in many communities provide emergency medical care and
transport as well. In many communities we have established
public/private partnerships, in which we integrate our transport
services with the first responder services of the local fire
department. We believe these public/private partnerships provide
a model for us to collaborate, rather than compete, with fire
departments to increase the number of communities we serve.
Competition in the ambulance transport market is based primarily
on:
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pricing, |
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the ability to improve customer service, such as on-time
performance and efficient call intake, |
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the ability to recruit, train and motivate employees,
particularly ambulance crews who have direct contact with
patients and healthcare personnel, and |
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billing and reimbursement expertise. |
Our largest competitor, Rural/ Metro Corporation, is the only
other national provider of ambulance transport services and
generates less than half of AMR’s net revenue. Our other
private provider competitors include Southwest Ambulance in
Arizona and New Mexico, Acadian Ambulance Service in Louisiana
and small, locally owned operators that principally serve the
inter-facility transport market.
91
Insurance
Workers Compensation, Auto and General Liability. For
periods prior to September 1, 2001, we are fully-insured
for our workers compensation, auto and general liability
programs through Laidlaw’s captive insurance program. We
have retained liability for the first $1 million to
$2 million of the loss under these programs since
September 1, 2001. Our self-insurance program, fronted by
ACE American Insurance Co. in fiscal 2002 and 2003 and funded
through Laidlaw’s captive insurance program in fiscal 2004
and 2005 to the date of our acquisition of AMR and EmCare,
covers the first $2 million of auto and general liability
claims per occurrence and the first $1 million of workers
compensation claims per occurrence. From the date of the
acquisition, our self-insurance program has been fronted by ACE.
Generally, our umbrella policies covering claims that exceed our
deductible levels have an annual cap of approximately
$100 million.
Professional Liability. For periods prior to
April 15, 2001, we are insured for our professional
liability claims through third party insurers. Since
April 15, 2001, we have a self-insured retention for our
professional liability coverage. The self-insured retention
covers the first $2 million for policy year ending
April 15, 2002, the first $5 million for policy years
ending April 15, 2003 and 2004 and the first
$5.5 million for the policy years ending April 15,
2005 and 2006. In addition, we have umbrella policies with third
party insurers covering claims exceeding these retention levels
with an aggregate cap of $10 million for each separate
policy period.
Property
Vehicle Fleet. We operate approximately 4,200 vehicles.
Of these, approximately 3,100 are ambulances, 600 are wheelchair
vans and 500 are support vehicles. We own approximately 89% of
our vehicles and lease the balance. We replace ambulances based
upon age and usage, but generally every eight to ten years. The
average age of our existing ambulance fleet is approximately
five years. We primarily use in-house maintenance services to
maintain our fleet. In those operations where our fleet is small
and quality external maintenance services that agree to maintain
our fleet in accordance with AMR standards are available, we
utilize these maintenance services. We are exploring ways to
decrease our overall capital expenditures for vehicles,
including major refurbishing and overhaul of our vehicles to
extend their useful life.
Facilities. We lease approximately 55,000 square
feet in an office building at 6200 S. Syracuse Way,
Greenwood Village, Colorado for the AMR and Emergency Medical
Services corporate headquarters. We also lease administrative
facilities and other facilities used principally for ambulance
basing, garaging and maintenance in those areas in which we
provide ambulance services. We own 14 facilities used
principally for administrative services and stationing for our
ambulances. We believe our present facilities are sufficient to
meet our current and projected needs, and that suitable space is
readily available should our need for space increase. Our leases
expire at various dates through 2014.
Environmental Matters
We are subject to federal, state and local laws and regulations
relating to the presence of hazardous materials and pollution
and the protection of the environment, including those governing
emissions to air, discharges to water, storage, treatment and
disposal of wastes, including medical waste, remediation of
contaminated sites, and protection of worker health and safety.
We believe our current operations are in substantial compliance
with all applicable environmental requirements and that we
maintain all material permits required to operate our business.
Certain environmental laws impose strict, and under certain
circumstances joint and several, liability for investigation and
remediation of the release of regulated substances into the
environment. Such liability can be imposed on current or former
owners or operators of contaminated sites, or on persons who
dispose or arrange for disposal of wastes at a contaminated
site. Releases have occurred at a few of the facilities we lease
as a result of historical practices of the owners or former
operators. Based on available information, we do not believe
that any known compliance obligations, releases or
investigations under environmental laws or regulations will have
a material adverse effect on our business, financial position
and results of operations. However, there can be no guarantee
that these releases or newly discovered information, more
stringent
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enforcement of or changes in environmental requirements, or our
inability to enforce available indemnification agreements will
not result in significant costs.
Employees
At June 30, 2005, we had approximately
18,000 employees, including approximately 5,100 paramedics,
7,500 EMTs, 200 nurses and 5,200 support
personnel. Approximately 48% of our employees are represented by
41 collective bargaining agreements with 40 different
union locals. Twelve of these collective bargaining agreements,
representing approximately 1,850 employees, are subject to
renegotiation in 2005, and 14 agreements, representing
approximately 4,000 employees, are subject to renegotiation
in 2006. We believe we have a good relationship with our
employees. We have reduced our employee turnover to 19.9% in
fiscal 2004, a 44.3% reduction since fiscal 2002. We have never
experienced any union-related work stoppages.
Legal Matters
We are subject to litigation arising in the ordinary course of
our business, including litigation principally relating to
professional liability, auto accident and workers compensation
claims. There can be no assurance that our insurance coverage
will be adequate to cover all liabilities occurring out of such
claims. In the opinion of management, we are not engaged in any
legal proceedings that we expect will have a material adverse
effect on our business, financial condition, cash flows or
results of our operations other than as set forth below.
From time to time, in the ordinary course of business and like
others in the industry, we receive requests for information from
government agencies in connection with their regulatory or
investigational authority. Such requests can include subpoenas
or demand letters for documents to assist the government in
audits or investigations. We review such requests and notices
and take appropriate action. We have been subject to certain
requests for information and investigations in the past and
could be subject to such requests for information and
investigations in the future.
We are subject to the Medicare and Medicaid fraud and abuse
laws, which prohibit, among other things, any false claims, or
any bribe, kick-back, rebate or other remuneration, in cash or
in kind, in return for the referral of Medicare and Medicaid
patients. Violation of these prohibitions may result in civil
and criminal penalties and exclusion from participation in the
Medicare and Medicaid programs. We have implemented policies and
procedures that management believes will assure that we are in
substantial compliance with these laws, but we cannot assure you
that the government or a court will not find that some of our
business practices violate these laws.
On May 9, 2002, we received a subpoena from the Office of
Inspector General for the United States Department of Health and
Human Services, or OIG. The subpoena requested copies of
documents for the period from January 1993 through May 2002. The
subpoena required us to produce a broad range of documents
relating to Regional Emergency Services, or RES, contracts in
Texas, Georgia and Colorado. The Department of Justice
ultimately added allegations involving contracts in Texas to its
other claims against RES and a hospital system arising from a
contract between RES and the hospital system in Florida. These
claims, including both Texas and Florida, were settled by RES
and the hospital system for approximately $20.0 million, of
which we were responsible for, and have paid, $5.0 million.
The government investigations in Georgia and Colorado have not
been resolved.
During the first quarter of fiscal 2004, we were advised by the
U.S. Department of Justice that it was investigating
certain business practices at AMR. The specific practices at
issue were (1) whether ambulance transports involving
Medicare eligible patients complied with the “medical
necessity” requirement imposed by Medicare regulations,
(2) whether patient signatures, when required, were
properly obtained from Medicare eligible patients, and
(3) whether discounts in violation of the federal
Anti-Kickback Statute were provided by AMR to hospitals and
nursing homes in exchange for referrals involving Medicare
eligible patients. This investigation has not yet been resolved.
In connection with the third issue, the government has alleged
that certain of our hospital and nursing home contracts in
effect in Texas, primarily certain contracts in effect in 1996
and 1997, contained discounts in violation of the federal
Anti-Kickback Statute. The government
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recently has provided us with an analysis of the investigation
conducted in connection with this contract issue, and invited us
to respond. We are considering the government’s analysis
and intend to provide our views, as requested. The government
may also be investigating whether our contracts with health
facilities in Oregon and other jurisdictions violate the
Anti-Kickback Statute.
On July 12, 2005, we received a letter and draft Audit
Report from the OIG requesting our response to its draft
findings that our Massachusetts subsidiary received
$1.9 million in overpayments from Medicare for services
performed between July 1, 2002 and December 31, 2002.
The draft findings state that some of these services did not
meet Medicare medical necessity and reimbursement requirements.
We disagree with the OIG’s finding and are in the process
of responding to the draft Audit Report. If we are unsuccessful
in challenging the OIG’s draft findings, and in any
administrative appeals to which we may be entitled following the
release of a final Audit Report, we may be required to make a
substantial repayment.
EmCare
EmCare is the largest provider of outsourced emergency
department staffing and related management services to
healthcare facilities in the United States. EmCare has a 6%
share of the total emergency department services market and a 9%
share of the outsourced emergency department services market.
During fiscal 2004, EmCare had approximately 5.3 million
patient visits in 39 states. EmCare has 329 exclusive
contracts with hospitals and independent physician groups to
provide emergency department and hospitalist staffing,
management and other administrative services. We believe that
EmCare’s successful physician recruitment and retention,
high level of customer service and advanced risk management
programs have resulted in what we believe is our
industry-leading contract retention rate of 91% in fiscal 2004
and new contract wins.
EmCare primarily provides emergency department staffing and
related management services to healthcare facilities. We recruit
and hire or subcontract with physicians and other healthcare
professionals, who then provide professional services to the
hospitals with whom we contract. We also have practice support
agreements with independent physician groups and hospitals
pursuant to which we provide unbundled management services such
as billing and collection, recruiting, risk management and
certain other administrative services. For the fiscal year ended
August 31, 2004, EmCare generated net revenue of
$549.8 million.
In addition, we have become one of the leading providers of
hospitalist services. A hospitalist is a physician who
specializes in the care of acutely ill patients in an in-patient
setting. While we have provided limited hospitalist services for
the past 10 years, it is only in the last 18 months
that we have focused on expanding this program. We have
increased our hospitalist programs from 8 contracts at
August 31, 2003 to 28 contracts at June 30, 2005,
increasing our net revenue for this program from approximately
$7.2 million in fiscal 2001 to approximately
$23.5 million, or approximately 4% of EmCare’s net
revenue, for fiscal 2004. As of June 30, 2005, we
independently contracted with or employed approximately
170 hospitalist physicians.
EmCare was founded in Dallas, Texas in 1972. Initially we grew
by targeting larger hospitals in the Texas marketplace. We then
expanded our presence nationally, primarily through a series of
acquisitions in the 1990s. Throughout our history, EmCare has
enjoyed a strong reputation as a quality provider of emergency
department staffing and related management services.
The range of staffing and related management services we provide
includes:
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recruiting, scheduling and credentials coordination for clinical
professionals, |
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support services, such as payroll, insurance coverage,
continuing education services and management training, and |
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coding, billing and collection of fees for services provided by
medical professionals. |
We are a leading provider of outsourcing services to both market
segments, and have developed specific competencies and operating
groups to address the unique needs of each. In fiscal 2004, the
high volume and
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medium to low volume segments represented 88% and 12%,
respectively, of our emergency department net revenue.
Services
We provide a full range of outsourced physician staffing and
related management services for emergency department and
hospitalist programs, which include:
Contract Management. We utilize an integrated approach to
contract management that involves physicians, non-clinical
business experts, operational efficiency specialists and
hospital representatives. Together, the team works to improve
the quality and reduce the cost of care. We believe that our
approach fosters the culture that is necessary to operate
effectively in high stress emergency environments. An on-site
medical director is responsible for the day-to-day oversight of
the operation, including clinical quality, and works closely
with the hospital’s management in developing strategic
initiatives and objectives. The regional director of operations,
which is a clinical position, provides systems analysis and
improvement plans. A quality manager develops site-specific
quality improvement programs, and practice improvement staff
focuses on chart documentation and physician utilization
patterns. The regional-based management staff provides support
for these efforts and ensures that each customer’s
expectations are identified, that service plans are developed
and executed to meet those expectations, and that the
company’s and the customer’s financial objectives are
achieved.
Staffing. We provide a full range of staffing services to
meet the unique needs of each healthcare facility. 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, healthcare facilities can
focus their efforts on improving their core business of
providing healthcare services for their communities rather than
recruiting and managing physicians. Ensuring that each contract
is staffed with the appropriately qualified physicians and that
coverage is provided without any service deficiencies is
critical to the success of the contract. We believe that our
approach to recruiting, staffing and scheduling provides us with
a unique advantage in achieving these objectives.
Recruiting. Many healthcare facilities lack the resources
necessary to identify and attract specialized, career-oriented
physicians. We have committed significant resources to the
development of a proprietary national physician database that we
utilize in our recruiting programs across the country. Our
marketing and recruiting staff continuously updates our database
of more than 800,000 physicians with relevant data to allow us
to match potential physician candidates to specific openings
based upon personal preferences. This targeted recruiting method
increases the success and efficiency of our recruiters, and we
believe significantly increases our physician retention rates.
We actively recruit physicians through various media options
including telemarketing, direct mail, conventions, journal
advertising and our Internet site.
Scheduling. Our scheduling departments assist our medical
directors in scheduling physicians and other healthcare
professionals in accordance with the coverage model at each
facility. We provide 24-hour service to ensure that unscheduled
shift vacancies, due to situations such as physician illness and
personal emergencies, are filled with alternative coverage.
Payroll Administration and Benefits. We provide payroll
administration services for the physicians and other healthcare
professionals with whom we contract to provide services at
customer sites. Our clinical employees benefit significantly by
our ability to aggregate physicians to provide professional
liability coverage at lower rates than many hospitals or
physicians could negotiate on a stand-alone basis. Additionally,
healthcare facilities benefit from the elimination of the
overhead costs associated with the administration of payroll
and, where applicable, employee benefits.
Customer Satisfaction Programs. We design and implement
customized patient satisfaction programs for our hospital
customers. These programs are designed to improve patient
satisfaction through the use of
95
communication, family inclusion and hospitality techniques.
These programs are delivered to the clinical and non-clinical
members of the hospital emergency department.
Other Services. We provide a substantial portion of our
services to hospitals through our affiliate physician groups.
Because we have also identified situations in which hospitals
and physicians are interested in receiving stand-alone
management services such as billing and collection, scheduling,
recruitment and risk management, we often unbundle our services
to meet this need. Pursuant to these practice support
agreements, which generally will have a term of one to three
years, we provide these services to independent physician groups
and healthcare facilities. As of August 31, 2004, we had 19
practice support agreements which generated $5.6 million in
net revenue in fiscal 2004, a 33% increase over fiscal 2003. We
are working to commercialize our expertise in staffing and
billing and expect to enter into similar stand-alone practice
support agreements.
Operational Assessments. We undertake operational
assessments for our hospital customers that include
comprehensive reviews of critical operational matrices,
including turnaround times, triage systems, “left without
being seens,” throughput times and operating systems. These
assessments establish baseline values, develop and implement
process improvement programs, and then monitor the success of
the initiatives. This is an ongoing process that we continually
monitor and modify.
Practice Improvement. We provide ongoing comprehensive
documentation review and training for our affiliated physicians.
We review certain statistical indicators that allow us to
provide specific training to individual physicians regarding
documentation, and we tailor training for broader groups of
physicians as we see trends developing in documentation-related
areas. Our training focuses on the completeness of the medical
record or chart, specific payor requirements, and government
rules and regulations.
Risk Management
We utilize our risk management department, senior medical
leadership and on-site medical directors to conduct aggressive
risk management and quality assurance programs. We take a
proactive role in promoting early reporting, evaluation and
resolution of incidents that may evolve into claims. Our risk
management function is designed to mitigate risk associated with
the delivery of care and to prevent or minimize costs associated
with medical professional liability claims and includes:
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Incident Reporting Systems. We have established a
comprehensive support system for medical professionals. Our Risk
Management Hotline provides each physician with the ability to
discuss medical issues with a peer. In the event of a negative
patient outcome, the physician may discuss legal and medical
issues in anticipation of litigation directly with an EmCare
attorney experienced with medical malpractice issues. |
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Tracking and Trending Claims. We have an extensive claims
database developed from our experience in the emergency
department setting. From this database, we track multiple data
points on each professional liability claim. We utilize the
database to identify claim trends and risk factors so that we
can better target our risk management initiatives. Each year, we
target the medical conditions associated with our most frequent
professional liability claims, and provide detailed education to
assist our affiliated medical professionals in treating these
medical conditions. |
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Professional Risk Assessment. We conduct risk assessments
of our medical professionals. Typically, a risk assessment
includes a thorough review of professional liability claims
against the professional, assessment of issues raised by
hospital risk management and identification of areas where
additional education may be advantageous for the professional. |
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Hospital Risk Assessment. We conduct risk assessments of
potential hospital customers in conjunction with our sales and
contracting process. As part of the risk assessment, registered
nurses or physicians employed by us conduct a detailed analysis
of the hospital’s operations affecting the emergency
department or hospitalist services, including the triage
procedures, on-call coverage, transfer procedures, nursing
staffing and related matters in an effort to address risk
factors contractually during negotiations with potential
customer hospitals. |
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Clinical Fail-Safe Programs. We review and identify key
risk areas which we believe may result in increased incidence of
patient injuries and resulting claims against us and our
affiliated medical professionals. We continue to develop
“fail-safe” clinical tools and make them available to
our affiliated physicians for use in conjunction with their
practice and to our customer hospitals for use as a part of
their peer review process. These “fail-safe” tools
assist physicians in identifying common patient attributes and
complaints that may identify the patient as being at high risk
for certain conditions (e.g., a heart attack). |
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Quality Improvement Programs. Our medical directors are
actively engaged in their respective hospital’s quality
improvement committees and initiatives. In addition, we provide
tools that provide guidance to the medical directors on how to
conduct quality reviews of their physicians and help them track
their physicians’ medical practices. |
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Physician Education Programs. Our wholly owned
subsidiary, Emergency Medical Education Systems, Inc, or EMEDS,
conducts physician education through risk management and board
review conferences and on-line teaching modules. Our affiliated
medical professionals can access EMEDS to obtain valuable
medical information. 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. Our risk management department
also provides other forms of education, including articles in
the company newsletter that highlight current medical literature
on important emergency medicine topics. |
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Proactive Professional Liability Claims Handling. We
utilize a third party claims administrator to manage
professional liability claims against companies and medical
professionals covered under our insurance program. For each
case, detailed reports are reviewed to ensure proactively that
the defense is comprehensive and aggressive. Each professional
liability claim brought against an EmCare affiliated medical
professional or EmCare affiliated company is reviewed by
EmCare’s Claims Committee, consisting of physicians,
attorneys and company executives, before any resolution of the
claim. The Claims Committee periodically instructs EmCare’s
risk management department to undertake an analysis of
particular physicians or hospital locations associated with a
given claim. |
Billing and Collections
We receive payment for patient services from:
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the federal and state governments, primarily under the Medicare
and Medicaid programs, |
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health maintenance organizations, preferred provider
organizations and private insurers, |
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hospitals, and |
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individual patients. |
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Over the last three fiscal years, our self-pay revenue has
remained stable as a percentage of EmCare’s net revenue.
The table below presents the approximate percentages of
EmCare’s net revenue from the following sources:
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Percentage of EmCare’s | |
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Net Revenue | |
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Year Ended August 31, | |
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2002 | |
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2003 | |
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2004 | |
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Medicare
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15 |
% |
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16 |
% |
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17 |
% |
Medicaid
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2 |
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3 |
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3 |
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Commercial insurance/managed care
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57 |
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54 |
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53 |
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Self-pay
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4 |
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3 |
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2 |
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Subsidies/fees
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22 |
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24 |
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25 |
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Total net revenue
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100 |
% |
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100 |
% |
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100 |
% |
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See “— Regulatory Matters — Medicare,
Medicaid and Other Government Program Reimbursement” for
additional information on reimbursement from Medicare, Medicaid
and other government-sponsored programs.
We code and bill for physician services through our wholly-owned
subsidiary, Reimbursement Technologies, Inc. We utilize
state-of-the-art document imaging and paperless workflow
processes to expedite the billing cycle and improve compliance
and customer service. Currently, at approximately 45% of our
customer locations, medical records and emergency department
logs are scanned and transmitted electronically to us. We are in
the process of transitioning additional customers to on-site
scanning. By providing these enhanced services, we believe we
increase the value of services we provide to our customers and
improve customer relations. Additionally, we believe these
comprehensive services differentiate us in sales situations and
improve the chance of being selected in competitive bidding
processes.
We do substantially all of the billing for our affiliated
physicians, and we have extensive experience in processing
claims to third party payors. We employ a billing staff of
approximately 600 employees who are trained in third party
coverage and reimbursement procedures. Our integrated billing
and collection system uses proprietary software to tailor the
submission of claims to Medicare, Medicaid and certain other
third party payors and has the capability to electronically
submit most claims to the third party payors’ systems. We
forward uncollected accounts electronically to two outside
collection agencies automatically, based on established
parameters. Each of these collection agencies have on-site
employees working at our in-house billing company to assist in
providing patients with quality customer service. Our
comprehensive billing and collection system allows us to have
full control of accounts receivable at each step of the process.
Contracts
We have contracts with (i) hospital customers to provide
professional staffing and related management services,
(ii) healthcare facilities and independent physician groups
to provide management services, and (iii) affiliated
physician groups and medical professionals to provide management
services and various benefits.
Hospital and Practice Support Contracts. As of
June 30, 2005, EmCare provides services under 329
contracts. Typically, the agreements with the hospitals are
awarded on a competitive basis, and have an initial term of
three years with one-year automatic renewals and termination by
either party on specified notice. We have improved our contract
retention rate to 91% for fiscal 2004, up from 74% in fiscal
2001.
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Our contracts with hospitals provide for one of three payment
models:
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we bill patients and third party payors directly for physician
fees, |
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we bill patients and third party payors directly for physician
fees, with the hospital paying us an additional pre-arranged fee
for our services, and |
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we bill the hospitals directly for the services of the
physicians. |
In all cases, the hospitals are responsible for billing and
collecting for non-physician-related services.
We have established long-term relationships with some of the
largest names in healthcare services, including Baylor Health
System, Community Health Systems, HCA, Quorum Healthcare, Tenet
Healthcare and Universal Health System. None of these customers
represent revenue that amounts to 10% of our fiscal 2004 total
net revenue. Our top ten hospital emergency department contracts
represent $68.3 million, or 12.4%, of EmCare’s fiscal
2004 net revenue. We have maintained our relationships with
these customers for an average of 12 years.
Affiliated Physician Group Contracts. In most states, we
contract directly with our hospital customers to provide
physician staffing and related management services. We, in turn,
contract with a professional corporation that is wholly-owned by
one or more physicians, which we refer to as an affiliated
physician group, or with independent contractor physicians. It
is these physicians who provide the medical professional
services. We then provide comprehensive management services to
the physicians. We typically provide professional liability and
workers compensation coverage to our affiliated physicians.
Certain states have laws that prohibit or restrict unlicensed
persons or business entities from practicing medicine. The laws
vary in scope and application from state to state. Some of these
states may prohibit us from contracting directly with hospitals
or physicians to provide professional medical services. In those
states, the affiliated physician groups contract with the
hospital, as well as all medical professionals. We provide
management services to the affiliated physician groups.
Medical Professional Contracts. We contract with medical
professionals as either independent contractors or employees to
provide services to our customers. The medical professionals
generally are paid an hourly rate for each hour of coverage, a
variable rate based upon productivity or contract margin, or a
combination of both a fixed hourly rate and a variable rate
component. We typically provide professional liability and
workers compensation coverage to our medical professionals.
The contracts with medical professionals typically have one-year
terms with automatic renewal clauses for additional one-year
terms. The contracts can be terminated with cause for various
reasons, and usually contain provisions allowing for termination
without cause by either party upon 90 days’ notice.
Agreements with physicians generally contain a non-compete or
non-solicitation provision and, in the case of medical
directors, a non-compete provision. The enforceability of these
provisions varies from state to state.
Management Information Systems
We have invested in scalable information systems and proprietary
software packages designed to allow us to grow efficiently and
to deliver and implement our best practice procedures
nationally, while retaining local and regional flexibility. We
have developed and maintain integrated systems to facilitate the
exchange of information between our regions and our customers.
Our customers, affiliated physicians and employees throughout
the country access a wide variety of information through our
custom portal, www.emcare.com. Designed as a forum to
deliver information and communicate with our various
constituencies, this website provides a unifying platform to
promote the growth in our business. It includes individualized
content, including physician schedules, rosters and performance
reports, all delivered securely to the intended individuals
through the use of a password.
We have developed and implemented the following proprietary
applications that we believe provides us with a competitive
advantage in billing and collections, and in recruiting,
credentialing, enrolling, scheduling and compensating healthcare
professionals.
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EmSource is our system for our recruiting staff to source
physician candidates. The system consists of a database of
approximately 800,000 physicians that is updated weekly to
provide the most current physician contact information available.
EmTrac is our primary operations support system that
supports credentialing and scheduling. Information collected in
EmSource during the recruiting process populates
EmTrac, forms the basis for the credentialing module, and
is used to provide alerts on license and privilege expirations.
EmTrac is used by our schedulers to match physician
availability and preferences with the needs of the hospital
customer.
EmComp is our system for calculating physician’s
gross pay and is an important tool supporting our compensation
strategy. Physicians are compensated by a wide variety of pay
plans ranging from simple hourly wages to “fee for
service” plans linked to productivity. EmComp has
been designed to support an unlimited variety of pay plans,
thereby giving EmCare a competitive advantage in physician
recruitment and retention. The system takes the actual hours
worked from EmTrac and the production data from
EmBillz, and applies the pay rules from the
physician’s contract to calculate gross pay.
EmBillz is the coding, billing and accounts receivable
management system through which we process more than five
million emergency department visits each year. This proprietary
system supports the full collection process: from capturing the
emergency department patient logs, coding and issuing bills in
accordance with applicable federal and state regulations, and
payment follow-up and cash receipt posting.
Edison is a system that automates much of our physician
enrollment. To bill Medicare, Medicaid and some other third
party payors, each physician must have an approved provider
number for that payor. There are hundreds of unique forms from
the combination of states and payors. Edison facilitates
the completion of the forms, thereby relieving physicians of
significant administrative workload and enabling us to track
pending receivables and ensure timely completion.
Sales and Marketing
Contracts for outsourced emergency department and hospitalist
services are obtained through strategic marketing programs and
responses to requests for proposals. EmCare’s business
development team includes five Vice Presidents of Practice
Development located throughout the United States who are
responsible for developing sales and acquisition opportunities
for the operating group in his or her territory. A significant
portion of the compensation program for these sales
professionals is commission-based, with incentive compensation
based on the profitability of the contracts they sell and actual
contract performance in the first year. Leads for new hospital
customers are developed through our business development group,
which telemarkets the United States hospital industry. In
addition, leads are generated through our website, journal
advertising and a lead referral program. Each Vice President of
Practice Development is responsible for working with the
regional chief executive officer to structure and provide
customer proposals for new prospects in their respective regions.
Emergency medicine practices vary among healthcare facilities. A
healthcare facility request for proposal generally will include
demographic information of the facility department, a list of
services to be performed, the length of the contract, the
minimum qualifications of bidders, billing information,
selection criteria and the format to be followed in the bid.
Prior to responding to a request for proposal, EmCare’s
senior management ensures that the proposal is in line with
certain financial parameters. Senior management evaluates all
aspects of each proposal, including financial projections,
staffing model, resource requirements and competition, to
determine how to best achieve our business objectives and the
customer goals.
Competition
The market for outsourced emergency department staffing and
related management services is highly fragmented, with more than
800 national, regional and local providers handling over
113 million patient visits in 2003. There are more than
4,700 hospitals in the United States with emergency
departments, of which approximately 67% currently outsource
physician services. Of these hospitals that outsource, we believe
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approximately 50% contract with a local provider, 25% contract
with a regional provider and 25% contract with a national
provider.
Competition for outsourced physician and other healthcare
staffing and management service contracts is based primarily on:
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the ability to recruit and retain qualified physicians, |
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the ability to improve department productivity and patient
satisfaction while reducing overall costs, |
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the ability to integrate the emergency department with other
hospital departments and to provide value added services, |
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billing and reimbursement expertise, |
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a reputation for compliance with state and federal regulations, |
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the breadth of staffing and management services offered, and |
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financial stability, demonstrating an ability to pay providers
in a timely manner and provide professional liability insurance. |
Team Health is our largest competitor and has the second largest
share of the emergency department services market with an
approximately 4.4% share. The other national providers of
outsourced emergency department services are Sterling
Healthcare, National Emergency Service and the Schumacher Group,
which tend to focus on hospitals with lower to medium volume
emergency departments.
Insurance
Professional Liability Program. For the period
January 1, 2001 through December 31, 2004, our
professional liability insurance program provided claims made
insurance coverage with limits of $1 million per loss
event, with a $3 million annual per physician aggregate,
for all medical professionals for whom we have agreed to procure
coverage. Our subsidiaries and affiliated corporate entities are
provided with coverage of $1 million per loss event, but
share a $10 million annual corporate aggregate.
For the 2001 calendar year, Lexington Insurance Company provided
the majority of the professional liability insurance coverage,
subject to an aggregate policy limit of $10 million. We
also procured coverage on a regional basis under separate
policies of insurance during this period.
For the 2002, 2003 and 2004 calendar years, Columbia Casualty
Company and Continental Casualty Company, collectively referred
to as CCC, provided our professional liability insurance
coverage, covering all claims occurring and reported during
those calendar years. The CCC policies have a retroactive date
of January 1, 2001, thereby covering all claims occurring
during the 2001 calendar year but reported in the 2002, 2003 and
2004 calendar years. We also procured coverage on a regional
basis under separate policies of insurance during this period.
We are maintaining our calendar year 2004 professional liability
insurance program for calendar year 2005.
Captive Insurance Arrangement. On December 10, 2001,
we formed EMCA Insurance Company, Ltd., or EMCA, as a wholly
owned subsidiary under the Companies Law of the Cayman Islands.
EMCA reinsures CCC for all losses associated with the CCC
insurance policies under the professional liability insurance
program, and provides collateral for the reinsurance arrangement
through a trust agreement.
Workers Compensation Program. For the period
September 1, 2002 through August 31, 2004, we procured
workers compensation insurance coverage for employees of EmCare
and affiliated physician groups through Continental Casualty
Company. Continental reinsures a portion of this workers
compensation exposure, on both a per claim and an aggregate
basis, with EMCA.
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From September 1, 2004, EmCare has insured its workers
compensation exposure through The Travelers Indemnity Company,
which reinsures a portion of the exposure with EMCA.
Properties
We lease approximately 48,990 square feet in an office
building at 1717 Main Street, Dallas, Texas for our
corporate headquarters. We also lease 16 facilities to
house administrative, billing and other support functions for
our regional operations. We believe our present facilities are
sufficient to meet our current and projected needs, and that
suitable space is readily available should our need for space
increase. Our leases expire at various dates through 2014.
Employees
The following is an approximate break down of our affiliated
physicians, independent contractors and employees by job
classification as of June 30, 2005.
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|
Job Classification |
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Full-Time | |
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Part-Time | |
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Total | |
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| |
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| |
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| |
Physicians*
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|
|
1,887 |
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|
|
714 |
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|
|
2,601 |
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Physician assistants
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|
|
162 |
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|
|
142 |
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|
|
304 |
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Nurse practitioners
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|
|
104 |
|
|
|
94 |
|
|
|
198 |
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Non-clinical employees
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|
|
1,076 |
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|
|
119 |
|
|
|
1,195 |
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|
|
|
|
|
|
|
|
|
|
Total
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|
|
3,229 |
|
|
|
1,069 |
|
|
|
4,298 |
|
|
|
* |
We have approximately 4,500 affiliated physicians. These figures
represent clinicians providing services at a particular time. |
We believe that our relations with our employees are good. None
of our physicians, physician assistants, nurse practitioners or
non-clinical employees are subject to any collective bargaining
agreement.
We offer our physicians substantial flexibility in terms of type
of facility, scheduling of work hours, benefit packages,
opportunities for relocation and career development. This
flexibility, combined with fewer administrative burdens,
improves physician retention rates and stabilizes our contract
base.
Legal Matters
We are subject to litigation arising in the ordinary course of
our business, including litigation principally relating to
professional liability claims. There can be no assurance that
our insurance coverage will be adequate to cover all liabilities
occurring out of such claims. In the opinion of management, we
are not engaged in any legal proceedings that we expect will
have a material adverse effect on our business, financial
condition, cash flows or results of our operations other than as
set forth below.
From time to time, in the ordinary course of business and like
others in the industry, we receive requests for information from
government agencies in connection with their regulatory or
investigational authority. Such requests can include subpoenas
or demand letters for documents to assist the government in
audits or investigations. We review such requests and notices
and take appropriate action. We have been subject to certain
requests for information and investigations in the past and
could be subject to such requests for information and
investigations in the future.
Our healthcare businesses are subject to the Medicare and
Medicaid fraud and abuse laws, which prohibit, among other
things, any false claims, or any bribe, kick-back or rebate in
return for the referral of Medicare and Medicaid patients.
Violation of these prohibitions may result in civil and criminal
penalties and exclusion from participation in the Medicare and
Medicaid programs. We have implemented policies and procedures
that management believes will assure that we are in substantial
compliance with these laws.
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EmCare has been named a defendant in two collective action
lawsuits brought by a number of nurse practitioners and
physician assistants under the Fair Labor Standards Act. The
plaintiffs are seeking to recover overtime pay for the hours
they worked in excess of 40 in a workweek and reclassification
as non-exempt employees. Certain of the plaintiffs brought a
related action under California state law. We have entered into
a settlement of the California state law claims.
REGULATORY MATTERS
As a participant in the healthcare industry, our operations and
relationships with healthcare providers such as hospitals, other
healthcare facilities and healthcare professionals are subject
to extensive and increasing regulation by numerous federal and
state government entities as well as local government agencies.
Specifically, but without limitation, we are subject to the
following laws and regulations.
Medicare, Medicaid and Other Government Program
Reimbursement
We derive a significant portion of our revenue from services
rendered to beneficiaries of Medicare, Medicaid and other
government-sponsored healthcare programs. For fiscal 2004, we
received approximately 27.3% of our net revenue from Medicare
and 5.2% from Medicaid. To participate in these programs, we
must comply with stringent and often complex enrollment and
reimbursement requirements from the federal and state
governments. We are subject to governmental reviews and audits
of our bills and claims for reimbursement. Retroactive
adjustments to amounts previously reimbursed from these programs
can and do occur on a regular basis as a result of these reviews
and audits. In addition, these programs are subject to statutory
and regulatory changes, administrative rulings, interpretations
and determinations, all of which may materially increase or
decrease the payments we receive for our services as well as
affect the cost of providing services. In recent years, Congress
has consistently attempted to curb federal spending on such
programs.
Reimbursement to us typically is conditioned on our providing
the correct procedure and diagnosis codes and properly
documenting both the service itself and the medical necessity
for the service. Incorrect or incomplete documentation and
billing information, or the incorrect selection of codes for the
level of service provided, could result in non-payment for
services rendered or lead to allegations of billing fraud.
Moreover, third party payors may disallow, in whole or in part,
requests for reimbursement based on determinations that certain
amounts are not reimbursable, they were for services provided
that were not medically necessary, there was a lack of
sufficient supporting documentation, or for a number of other
reasons. Retroactive adjustments, recoupments or refund demands
may change amounts realized from third party payors. Additional
factors that could complicate our billing include:
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• |
disputes between payors as to which party is responsible for
payment, |
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• |
the difficulty of adherence to specific compliance requirements,
diagnosis coding and various other procedures mandated by the
government, and |
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• |
failure to obtain proper physician credentialing and
documentation in order to bill governmental payors. |
Due to the nature of our business and our participation in the
Medicare and Medicaid reimbursement programs, we are involved
from time to time in regulatory reviews, audits or
investigations by government agencies of matters such as
compliance with billing regulations and rules. We may be
required to repay these agencies if a finding is made that we
were incorrectly reimbursed, or we may lose eligibility for
certain programs in the event of certain types of
non-compliance. Delays and uncertainties in the reimbursement
process adversely affect our level of accounts receivable,
increase the overall cost of collection, and may adversely
affect our working capital and cause us to incur additional
borrowing costs. Unfavorable resolutions of pending or future
regulatory reviews or investigations, either individually or in
the aggregate, could have a material adverse effect on our
business, financial condition and results of operations.
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We establish an allowance for discounts applicable to Medicare,
Medicaid and other third party payors and for doubtful accounts
based on credit risk applicable to certain types of payors,
historical trends, and other relevant information. We review our
allowance for doubtful accounts on an ongoing basis and may
increase or decrease such allowance from time to time, including
in those instances when we determine that the level of effort
and cost of collection of certain accounts receivable is
unacceptable.
We believe that regulatory trends in cost containment will
continue. 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.
Ambulance Services Fee Schedule. In February 2002, the
Health Care Financing Administration, now renamed the Centers
for Medicare and Medicaid Services, issued the Medicare
Ambulance Fee Schedule Final Rule, or Final Rule, that
revised Medicare policy on the coverage of ambulance transport
services, effective April 1, 2002. The Final Rule was the
result of a mandate under the Balanced Budget Act of 1997, or
BBA, to establish a national fee schedule for payment of
ambulance transport services that would control increases in
expenditures under Part B of the Medicare program,
establish definitions for ambulance transport services that link
payments to the type of services furnished, consider appropriate
regional and operational differences and consider adjustments to
account for inflation, among other provisions.
The Final Rule provided for a five-year phase-in of a national
fee schedule, beginning April 1, 2002. Prior to that date,
Medicare used a charge-based reimbursement system for ambulance
transport services and reimbursed 80% of charges determined to
be reasonable, subject to the limits fixed for the particular
geographic area. The patient was responsible for co-pay amounts,
deductibles and the remaining balance of the transport cost, if
we did not accept the assigned reimbursement, and Medicare
required us to expend reasonable efforts to collect the balance.
In determining reasonable charges, Medicare considered and
applied the lowest of various charge factors, including the
actual charge, the customary charge, the prevailing charge in
the same locality, the amount of reimbursement for comparable
services, and the inflation-indexed charge limit.
On April 1, 2002, the Final Rule became effective. The
Final Rule categorizes seven levels of ground ambulance
services, ranging from basic life support to specialty care
transport, and two categories of air ambulance services. Ground
providers are paid based on a base rate conversion factor
multiplied by the number of relative value units assigned to
each level of transport, plus an additional amount for each mile
of patient transport. The base rate conversion factor for
services to Medicare patients is adjusted each year by the
Consumer Price Index. Additional adjustments to the base rate
conversion factor are included to recognize differences in
relative practice costs among geographic areas, and higher
transportation costs that may be incurred by ambulance providers
in rural areas with low population density. The Final Rule
requires ambulance providers to accept assignment on Medicare
claims, which means a provider must accept Medicare’s
allowed reimbursement rate as full payment. Medicare typically
reimburses 80% of that rate and the remaining 20% is collectible
from a secondary insurance or the patient. Originally, the Final
Rule called for a five-year phase-in period to allow providers
time to adjust to the new payment rates. The national fee
schedule was to be phased in at 20% increments each year, with
payments being made at 100% of the national fee schedule in 2006
and thereafter.
With the passage of the Medicare Prescription Drug Improvement
and Modernization Act of 2003, or the Medicare Modernization
Act, temporary modifications were made to the amounts payable
under the ambulance fee schedule in order to mitigate decreases
in reimbursement in some regions caused by the Final Rule. The
Medicare Modernization Act established regional fee schedules
based on historic costs in each region. Effective July 1,
2004, in those regions where the regional fee schedule exceeds
the national fee schedule, the regional fee schedule is blended
with the national fee schedule on a temporary basis, until 2010.
In addition to the regional fee schedule change, the Medicare
Modernization Act included other provisions for additional
reimbursement for ambulance transport services provided to
Medicare patients. Among other relief, the Medicare
Modernization Act provides for a 1% increase in reimbursement
for urban transports and a 2%
104
increase for rural transports for the remainder of the original
phase-in period of the national ambulance fee schedule, through
2006.
We estimate that the impact of the ambulance service rate
decreases under the national fee schedule, as modified by the
provisions of the Medicare Modernization Act, resulted in a
decrease in AMR’s net revenue for fiscal 2003 and fiscal
2004 of approximately $20 million and $11 million,
respectively, will result in an increase in AMR’s net
revenue of approximately $13 million in calendar 2005, and
will result in a decrease in AMR’s net revenue of
approximately $17 million in 2006 and continuing decreases
thereafter to 2010. Although we have been able to substantially
mitigate the phased-in reductions of the fee schedule through
additional fee and subsidy increases, we cannot assure you that
we will be able to continue to do so, and the rate decreases
could have a material adverse effect on our results of
operations. We cannot predict whether Congress may make further
refinements and technical corrections to the law or pass a new
cost containment statute in a manner and in a form that could
adversely impact our business.
Local Ambulance Rate Regulation. State or local
government regulations or administrative policies regulate rate
structures in some states in which we provide ambulance
transport services. For example, in certain service areas in
which we are the exclusive provider of ambulance transport
services, the community sets the rates for emergency ambulance
services pursuant to an ordinance or master contract and may
also establish the rates for general ambulance services that we
are permitted to charge. We may be unable to receive ambulance
service rate increases on a timely basis where rates are
regulated or to establish or maintain satisfactory rate
structures where rates are not regulated.
Emergency Physician Services Fee Schedule. Medicare pays
for all physician services based upon a national fee schedule,
or Fee Schedule, which contains a list of uniform rates. The
payment rates under the Fee Schedule are determined based on:
(1) national uniform relative value units for the services
provided, (2) a geographic adjustment factor and (3) a
conversion factor. The Centers for Medicare and Medicaid
Services, or CMS, updates the conversion factor annually. The
Fee Schedule uses a target-setting formula system called the
Sustainable Growth Rate, or SGR, to update annually the
conversion factor. The SGR is a target rate of growth in
spending for physician services which is intended to control the
growth of Medicare expenditures for physicians’ services.
The Fee Schedule update is adjusted to reflect the comparison of
actual expenditures to target expenditures.
Because one of the factors for calculating the SGR system is
linked to the growth in the U.S. gross domestic product,
the SGR formula may result in a negative payment update if
growth in Medicare beneficiaries’ use of services exceeds
GDP growth. The SGR formula may result in significant yearly
fluctuations in Fee Schedule updates, which may be unrelated to
changes in the actual cost of providing physician services.
Unless Congress takes additional action in the future to modify
or reform the mechanism by which the physician fee schedule
conversion factor update is undertaken in the future,
significant reductions in Medicare reimbursement could occur,
and these reductions could have a material adverse effect on our
business, financial condition or results of operations. We
currently expect that the Medicare fee schedule update for
physician services fees will provide for a 4.3% decrease to
physician rates effective January 1, 2006, which would
result in a decrease in EmCare’s 2006 net revenue of
approximately $5.7 million.
Medicare Reassignment. 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.
Historically, there was no exception that allowed us to receive
directly Medicare payments related to the services of
independent contractor physicians. However, the Medicare
Modernization Act amended the Medicare reassignment statute as
of December 8, 2003 and now permits our independent
contractor physicians to reassign their Medicare receivables to
us under certain circumstances.
Rules Applicable to Midlevel Practitioners. EmCare
utilizes physician assistants and nurse practitioners, sometimes
referred to collectively as “midlevel practitioners,”
to provide care under the supervision of our
105
physicians. State and federal laws require that such supervision
be performed and documented using specific procedures. For
example, in some states some or all of the midlevel
practitioner’s chart entries must be countersigned. Under
applicable Medicare rules, the midlevel practitioner’s
services are reimbursed at a rate equal to 85% of the physician
fee schedule amount and we do not bill separately for the
supervising physician’s services. However, when a midlevel
practitioner assists a physician who is directly and personally
involved in the patient’s care, we often bill for the
services of the physician at the full physician fee schedule
rates and do not bill separately for the midlevel
practitioner’s services. We believe our billing and
documentation practices related to our use of midlevel
practitioners comply with applicable state and federal laws, but
we cannot assure you that enforcement authorities will not find
that our practices violate such laws.
Ambulance Rates Payable by Medicare HMOs. One of the
changes made by ambulance fee schedule Final Rule was to require
ambulance providers to “accept assignment” from
Medicare and Medicare HMOs. Medicare HMOs are private insurance
companies which operate managed care plans that enroll Medicare
beneficiaries who elect to enroll in a plan in lieu of regular
Medicare coverage. When a provider accepts assignment, it agrees
to accept the rate established by Medicare as payment in full
for services covered by Medicare or the Medicare HMO and to
write off the balance of its charges. Prior to the
implementation of the Final Rule, ambulance providers were not
required to accept assignment and could obtain payment from
Medicare patients or Medicare HMOs for the provider’s full
charges, which typically are higher than the Medicare rate. When
the requirement to accept assignment became effective on
April 1, 2002, many Medicare HMOs continued to pay
ambulance providers their full charges, even though they could
have paid them the Medicare rate. Many Medicare HMOs
subsequently have taken the position that the amount paid to
such providers in excess of the Medicare rate constituted an
overpayment that must be refunded by the provider. We have
received such refund demands from some Medicare HMOs and, in
order to minimize litigation costs, have agreed to partial
repayment of amounts received from the plans in excess of the
Medicare rate. We have no reason to believe that additional HMOs
will make such demands, but we cannot assure you that there will
be no further demands.
The SNF Prospective Payment System. Under the Medicare
prospective payment system, or PPS, applicable to skilled
nursing facilities, or SNFs, beginning in 1999 SNFs are
financially responsible for some ancillary services, including
certain ambulance transports, or PPS transports, rendered to
certain of their Medicare patients. Ambulance companies must
bill the SNF, rather than Medicare, for PPS transports, but may
bill Medicare for other covered transports provided to the
SNF’s Medicare patients. Ambulance companies are
responsible for obtaining sufficient information from the SNF to
determine which transports are PPS transports and which ones may
be billed to Medicare. The Office of Inspector General of the
Department of Health and Human Services, or the OIG, has issued
two industry-wide audit reports indicating that, in many cases,
SNFs do not provide, or ambulance companies and other ancillary
service providers do not obtain, sufficient information to make
this determination accurately. As a result, the OIG asserts that
some PPS transports that should have been billed by ambulance
providers to SNFs have been improperly billed to Medicare. The
OIG has recommended that Medicare recoup the amounts paid to
ancillary service providers, including ambulance companies, for
such services. Although we believe AMR currently has procedures
in place to correctly identify and bill for PPS transports, we
cannot assure you that AMR will not be subject to such
recoupments and other possible penalties.
Paramedic Intercepts. Medicare regulations permit
ambulance transport providers to subcontract with other
organizations for paramedic services. Generally, only the
transport provider may bill Medicare, and the paramedic services
subcontractor must receive any payment to which it is entitled
from that provider. Based on these rules, in some jurisdictions
we have established “paramedic intercept” arrangements
in which we may provide paramedic services to a municipal or
volunteer transport provider. Our subsidiary, AMR of South
Dakota, previously entered into a settlement agreement with the
United States government arising from allegations that we
improperly billed Medicare for a small number of transports for
which we performed paramedic intercept services, even though we
were not the transport provider. Although we believe AMR
currently has procedures in place to assure that we do not bill
Medicare for paramedic intercept services we provide, we cannot
assure you that enforcement agencies will not find that we have
failed to comply with these requirements.
106
Patient Signatures. Medicare regulations require that
providers obtain the signature of the patient or, if the patient
is unable to provide a signature, the signature of a
representative, prior to submitting a claim for payment from
Medicare. An exception exists for situations where it is not
reasonably possible to do so, provided that the reason for the
exception is clearly documented. This requirement historically
has been difficult for ambulance companies and other emergency
medical services providers to meet, because even when the
patient is competent, the exigency of the situation often makes
it impracticable to obtain a signature. Although we believe AMR
currently has procedures in place to assure that these signature
requirements are met, we cannot assure you that enforcement
agencies will not find that we have failed to comply with these
requirements.
Physician Certification Statements. Under applicable
Medicare rules, ambulance providers are required to obtain a
certification of medical necessity from the ordering physician
in order to bill Medicare for repetitive non-emergency
transports provided to patients with chronic conditions, such as
end-stage renal disease. For certain other non-emergency
transports, ambulance providers are required to attempt to
obtain a certification of medical necessity from a physician or
certain other practitioners. In the event the provider is not
able to obtain such certification within 21 days, it may
submit a claim for the transport if it can document reasonable
attempts to obtain the certification. Acceptable documentation
includes any U.S. postal document (e.g., signed
return receipt or Postal Service Proof of Service Form) showing
that the ordering practitioner was sent a request for the
certification. Although we believe AMR currently has procedures
in place to assure we are in compliance with these requirements,
we cannot assure you that enforcement agencies will not find
that we have failed to comply.
Coordination of Benefits Rules. When our services are
covered by multiple third party payors, such as a primary and a
secondary payor, financial responsibility must be allocated
among the multiple payors in a process known as
“coordination of benefits”, or COB. The rules
governing COB are complex, particularly when one of the payors
is Medicare or another government program. Under these rules, in
some cases Medicare or other government payors can be billed as
a “secondary payor” only after recourse to a primary
payor (e.g., a liability insurer) has been exhausted. In
some instances, multiple payors may reimburse us an amount
which, in the aggregate, exceeds the amount to which we are
entitled. In such cases, we are obligated to process a refund.
If we improperly bill Medicare or other government payors as the
primary payor when that program should be billed as the
secondary payor, or if we fail to process a refund when
required, we may be subject to civil or criminal penalties.
Although we believe we currently have procedures in place to
assure that we comply with applicable COB rules, and that we
process refunds when we receive overpayments, we cannot assure
you that payors or enforcement agencies will not find that we
have violated these requirements.
Consequences of Noncompliance. In the event any of our
billing and collection practices, including but not limited to
those described above, violate applicable laws such as those
described below, we could be subject to refund demands and
recoupments. If our violations are deemed to be willing, knowing
or reckless, we may be subject to civil and criminal penalties
under the False Claims Act or other statutes, including
exclusion from federal and state healthcare programs. 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 which could have a material adverse effect on our
revenue, provision for uncompensated care and cash flow.
Federal False Claims Act
Both federal and state government agencies have continued civil
and criminal enforcement efforts as part of numerous ongoing
investigations of healthcare companies, and their executives and
managers. Although there are a number of civil and criminal
statutes that can be applied to healthcare providers, a
significant number of these investigations involve the federal
False Claims Act. These investigations can be initiated not only
by the government but also by a private party asserting direct
knowledge of fraud. These “qui tam” whistleblower
lawsuits may be initiated against any person or entity alleging
such person or entity has knowingly or recklessly presented, or
caused to be presented, a false or fraudulent request for
payment from
107
the federal government, or has made a false statement or used a
false record to get a claim approved. Penalties for False Claims
Act violations include fines ranging from $5,500 to $11,000 for
each false claim, plus up to three times the amount of damages
sustained by the federal government. A False Claims Act
violation may provide the basis for exclusion from the
federally-funded healthcare programs. In addition, some states
have adopted similar insurance fraud, whistleblower and false
claims provisions.
The government and some courts have taken the position that
claims presented in violation of the various statutes, including
the federal Anti-Kickback Statute and the Stark Law, described
below, can be considered a violation of the federal False Claims
Act based on the contention that a provider impliedly certifies
compliance with all applicable laws, regulations and other rules
when submitting claims for reimbursement.
Federal Anti-Kickback Statute
We are subject to the federal Anti-Kickback Statute. The
Anti-Kickback Statute is broadly worded and prohibits the
knowing and willful offer, payment, solicitation or receipt of
any form of remuneration in return for, or to induce,
(1) the referral of a person covered by Medicare, Medicaid
or other governmental programs, (2) the furnishing or
arranging for the furnishing of items or services reimbursable
under Medicare, Medicaid or other governmental programs or
(3) the purchase, lease of order or arranging or
recommending purchasing, leasing or ordering of any item or
service reimbursable under Medicare, Medicaid or other
governmental programs. Certain federal courts have held that the
Anti-Kickback Statute can be violated if “one purpose”
of a payment is to induce referrals. Violations of the
Anti-Kickback Statute can result in exclusion from Medicare,
Medicaid or other governmental programs as well as civil and
criminal penalties, including fines of up to $50,000 per
violation and three times the amount of the unlawful
remuneration. Imposition of any of these remedies could have a
material adverse effect on our business, financial condition and
results of operations.
In addition to a few statutory exceptions, the OIG has published
safe harbor regulations that outline categories of activities
that are deemed protected from prosecution under the
Anti-Kickback Statute provided all applicable criteria are met.
The failure of a financial relationship to meet all of the
applicable safe harbor criteria does not necessarily mean that
the particular arrangement violates the Anti-Kickback Statute.
In order to obtain additional clarification on arrangements that
may not be subject to a statutory exception or may not satisfy
the criteria of a safe harbor, Congress established a process
under the Health Insurance Portability and Accountability Act of
1996 in which parties can seek an advisory opinion from the OIG.
We and others in the healthcare community have taken advantage
of the advisory opinion process, and a number of advisory
opinions have addressed issues that pertain to our various
operations, such as discounted ambulance services being provided
to skilled nursing facilities, patient co-payment
responsibilities, compensation formulas under a management
services arrangement, and ambulance restocking arrangements. In
a number of these advisory opinions the government concluded
that such arrangements could be problematic if the requisite
intent were present. Although advisory opinions are binding only
on HHS and the requesting party or parties, when new advisory
opinions are issued, regardless of the requestor, we review them
and their application to our operations as part of our ongoing
corporate compliance program and endeavor to make appropriate
changes where we perceive the need to do so. See
“— Corporate Compliance Program and Corporate
Integrity Obligations.”
Health facilities such as hospitals and nursing homes refer two
categories of ambulance transports to us and other ambulance
companies: (1) transports for which the facility must pay
the ambulance company, and (2) transports which the
ambulance company can bill directly to Medicare or other public
or private payors. In Advisory Opinion 99-2, which we requested,
the OIG addressed the issue of whether substantial contractual
discounts provided to nursing homes on the transports for which
the nursing homes are financially responsible may violate the
Anti-Kickback Statute when the ambulance company also receives
referrals of Medicare and other government-funded transports.
The OIG opined that such discounts implicate the Anti-Kickback
Statute if even one purpose of the discounts is to induce the
referral of the transports paid for by Medicare and other
federal programs. The OIG further indicated that a violation may
exist even if there is no
108
contractual obligation on the part of the facility to refer
federally funded patients, and even if similar discounts are
provided by other ambulance companies in the same marketplace.
Following our receipt of this Advisory Opinion in March of 1999,
we took steps to bring our contracts with health facilities into
compliance with the OIG’s views. However, the government
has alleged that certain of our contracts in effect in Texas,
principally in periods prior to the issuance of the Advisory
Opinion, violated the Anti-Kickback Statute. Our contracting
practices in Oregon and possibly other jurisdictions may also be
under investigation. See “ — American
Medical Response — Legal Matters.” We cannot
assure you that the OIG or other authorities will not find that
our discounting practices in such other jurisdictions, or for
other periods of time, violate the Anti-Kickback Statute.
The OIG has also addressed potential violations of the
Anti-Kickback Statute (as well as other risk areas) in its
Compliance Program Guidance for Ambulance Suppliers. In addition
to discount arrangements with health facilities, the OIG notes
that arrangements between local governmental agencies that
control 911 patient referrals and ambulance companies which
receive such referrals may violate the Anti-Kickback Statute if
the ambulance companies provide inappropriate remuneration in
exchange for such referrals. Although we believe we have
structured our arrangements with local agencies in a manner
which complies with the Anti-Kickback Statute, we cannot assure
you that enforcement agencies will not find that some of those
arrangements violate that statute.
Fee-Splitting; Corporate Practice of Medicine
We are subject to various state laws that prohibit the practice
of medicine by corporations and are intended to prevent
unlicensed persons from interfering with or influencing the
physician’s professional judgment and the sharing of
professional services income with non-professional or business
interests. Activities other than those directly related to the
delivery of healthcare may be considered an element of the
practice of medicine in many states. Under the corporate
practice of medicine restrictions of certain states, decisions
and activities such as scheduling, contracting, setting rates
and the hiring and management of non-clinical personnel may
implicate the restrictions on corporate practice of medicine. In
such states, we maintain long-term management contracts with
affiliated physician groups, which employ or contract with
physicians to provide physician services. We believe that we are
in material compliance with applicable state laws relating to
the corporate practice of medicine and fee-splitting. However,
regulatory authorities or other parties, including our
affiliated physicians, may assert that, despite these
arrangements, we are engaged in the corporate practice of
medicine or that our contractual arrangements with affiliated
physician groups constitute unlawful fee-splitting. In this
event, we could be subject to adverse judicial or administrative
interpretations, to civil or criminal penalties, our contracts
could be found legally invalid and unenforceable or we could be
required to restructure our contractual arrangements with our
affiliated physician groups.
Federal Stark Law
We are also subject to a provision of the Social Security Act,
commonly known as the “Stark Law.” Where applicable,
this law prohibits a physician from referring Medicare patients
and Medicaid patients to an entity providing “designated
health services” if the physician or a member of such
physician’s immediate family has a “financial
relationship” with the entity, unless an exception applies.
The penalties for violating the Stark Law include the denial of
payment for services ordered in violation of the statute,
mandatory refunds of any sums paid for such services and civil
penalties of up to $15,000 for each violation, and twice the
dollar value of each such service and possible exclusion from
future participation in the federally-funded healthcare
programs. A person who engages in a scheme to circumvent the
Stark Law’s prohibitions may be fined up to $100,000 for
each applicable arrangement or scheme. Although we believe that
we have structured our agreements with physicians so as to not
violate the Stark Law and related regulations, a determination
of liability under the Stark Law could have an adverse effect on
our business, financial condition and results of operations.
109
Other Federal Healthcare Fraud and Abuse Laws
We are also subject to other federal healthcare fraud and abuse
laws. Under the Health Insurance Portability and Accountability
Act of 1996, there are two additional federal crimes that could
have an impact on our business: “Healthcare Fraud” and
“False Statements Relating to Healthcare Matters.” The
Healthcare Fraud statute prohibits knowingly and recklessly
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 Relating to Healthcare Matters 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. This statute
could be used by the government to assert criminal liability if
a healthcare provider knowingly fails to refund an overpayment.
Another statute, commonly referred to as the Civil Monetary
Penalties Law, imposes civil administrative sanctions for, among
other violations, inappropriate billing of services to federally
funded healthcare programs, inappropriately reducing hospital
care lengths of stay for such patients, and employing
individuals who are excluded from participation in federally
funded healthcare programs.
Although we intend and endeavor to conduct our business in
compliance with all applicable fraud and abuse laws, we cannot
assure you that our arrangements or business practices will not
be subject to government scrutiny or be found to violate
applicable fraud and abuse laws.
Administrative Simplification Provisions of the Health
Insurance Portability and Accountability Act of 1996
The Administrative Simplification Provisions of the Health
Insurance Portability and Accountability Act of 1996, or HIPAA,
required the Department of Health and Human Services, or HHS, to
adopt standards to protect the privacy and security of
health-related information. All healthcare providers were
required to be compliant with the new federal privacy
requirements enacted by HHS no later than April 14, 2003.
We believe we have taken reasonable measures to comply with
these requirements.
The HIPAA privacy requirements contain detailed requirements
regarding the use and disclosure of individually identifiable
health information. Improper use or disclosure of identifiable
health information covered by the HIPAA privacy regulations can
result in the following civil and criminal penalties:
(1) civil money penalties for HIPAA privacy violations are
$100 per incident, to a maximum of $25,000, per person, per
year, per standard violated; (2) a person who knowingly and
in violation of the HIPAA privacy regulations obtains
individually identifiable health information or discloses such
information to another person may be fined up to $50,000 and
imprisoned up to one year, or both; (3) if the offense is
committed under false pretenses, the fine may be up to $100,000
and imprisonment for up to five years; and (4) if the
offense is done with the intent to sell, transfer or use
individually identifiable health information for commercial
advantage, personal gain or malicious harm, the fine may be up
to $250,000 and imprisonment for up to ten years.
In addition to enacting the foregoing privacy requirements, HHS
issued a final rule creating security requirements for
healthcare providers and other covered entities on
February 20, 2003. The final security rule requires covered
entities to meet specified standards by April 25, 2005. The
security standards contained in the final rule do not require
the use of specific technologies (e.g., no specific
hardware or software is required), but instead require
healthcare providers and other covered entities to comply with
certain minimum security procedures in order to protect data
integrity, confidentiality and availability. We believe we have
taken reasonable steps to comply with these standards.
HIPAA also required HHS to adopt national standards establishing
electronic transaction standards that all healthcare providers
must use when submitting or receiving certain healthcare
transactions electronically. Although these standards were to
become effective October 2002, Congress extended the compliance
deadline
110
until October 2003 for organizations, such as ours, that
submitted a request for an extension. We believe we have taken
reasonable steps to comply with these standards.
Fair Debt Collection Practices Act
Some of our operations may be subject to compliance with certain
provisions of 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 to contact consumer debtors
and elicit 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 we are in
substantial compliance with the Fair Debt Collection Practices
Act and comparable state statutes where applicable.
State Fraud and Abuse Provisions
We are subject to state fraud and abuse statutes and
regulations. Most of the states in which we operate have adopted
a form of anti-kickback law, almost all of those states also
have adopted self-referral laws and some have adopted separate
false claims or insurance fraud provisions. The scope of these
laws and the interpretations of them vary from state to state
and are enforced by state courts and regulatory authorities,
each with broad discretion. Generally, state laws cover all
healthcare services and not just those covered under a
federally-funded healthcare program. A determination of
liability under such laws could result in fines and penalties
and restrictions on our ability to operate in these
jurisdictions.
Although we intend and endeavor to conduct our business in
compliance with all applicable fraud and abuse laws, we cannot
assure you that our arrangements or business practices will not
be subject to government scrutiny or be found to violate
applicable fraud and abuse laws.
Licensing, Certification, Accreditation and Related Laws and
Guidelines
In certain jurisdictions, changes in our ownership structure
require pre-or post-notification to governmental licensing and
certification agencies. Relevant laws and regulations may also
require re-application and approval to maintain or renew our
operating authorities or require formal application and approval
to continue providing services under certain government
contracts. For example, in connection with our acquisition of
AMR from Laidlaw, two of our subsidiaries were required to apply
for state and local ambulance operating authority in New York.
We and our affiliated physicians are subject to various federal,
state and local licensing and certification laws and regulations
and accreditation standards and other laws, relating to, among
other things, the adequacy of medical care, equipment, personnel
and operating policies and procedures. We are also subject to
periodic inspection by governmental and other authorities to
assure continued compliance with the various standards necessary
for licensing and accreditations.
Because we perform services at hospitals and other types of
healthcare facilities, we and our affiliated physicians may be
subject to laws which are applicable to those entities. For
example, our operations are impacted by the Emergency Medical
Treatment and Active Labor Act of 1986, which prohibits
“patient dumping” by requiring hospitals and hospital
emergency department and others to assess and stabilize any
patient presenting to the hospital’s emergency department
or urgent care center requesting care for an emergency medical
condition, regardless of the patient’s ability to pay. Many
states in which we operate have similar state law provisions
concerning patient dumping. Violations of the Emergency Medical
Treatment and Active Labor Act of 1986 can result in civil
penalties and exclusion of the offending physician from the
Medicare and Medicaid programs.
In addition to the Emergency Medical Treatment and Active Labor
Act of 1986 and its state law equivalents, significant aspects
of our operations are affected by state and federal statutes and
regulations
111
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 Healthcare Organizations may also affect our
operations. We believe our operations as currently conducted are
in substantial compliance with these laws and guidelines.
Antitrust Laws
Antitrust laws such as the Sherman Act and state counterparts
prohibit anticompetitive conduct by separate competitors, such
as price fixing or the division of markets. Our physician
contracts include contracts with individual physicians and with
physicians organized as separate legal professional entities
(e.g., professional medical corporations). Antitrust laws
may deem each such physician/entity to be separate, both from
EmCare and from each other and, accordingly, each such
physician/practice is subject to antitrust laws that prohibit
anti-competitive conduct between or among separate legal
entities or individuals. Although we believe we have structured
our physician contracts to substantially comply with these laws,
we cannot assure you that antitrust regulatory agencies or a
court would not find us to be non-compliant.
Corporate Compliance Program and Corporate Integrity
Obligations
We have developed a corporate compliance program in an effort to
monitor compliance with federal and state laws and regulations
applicable to healthcare entities, to ensure that we maintain
high standards of conduct in the operation of our business and
to implement policies and procedures so that employees act in
compliance with all applicable laws, regulations and company
policies. Our program also attempts to monitor compliance with
our Corporate Compliance Plan, which details our standards for:
(1) business ethics, (2) compliance with applicable
federal, state and local laws, and (3) business conduct. We
have an Ethics and Compliance Department whose focus is to
prevent, detect and mitigate regulatory risks. We attempt to
accomplish this mission through:
|
|
|
|
• |
providing guidance, education and proper controls based on the
regulatory risks associated with our business model and
strategic plan, |
|
|
• |
conducting internal audits and reviews to identify any improper
practices that may be occurring, |
|
|
• |
resolving regulatory matters, and |
|
|
• |
enhancing the ethical culture and leadership of the organization. |
The OIG has issued a series of Compliance Program Guidance
documents in which the OIG has set out the elements of an
effective compliance program. We believe our compliance program
has been structured appropriately in light of this guidance. The
primary compliance program components recommended by the OIG,
all of which we have attempted to implement, include:
|
|
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|
• |
formal policies and written procedures, |
|
|
• |
designation of a Compliance Officer, |
|
|
• |
education and training programs, |
|
|
• |
internal monitoring and reviews, |
|
|
• |
responding appropriately to detected misconduct, |
|
|
• |
open lines of communication, and |
|
|
• |
discipline and accountability. |
Our corporate compliance program is based on the overall goal of
promoting a culture that encourages employees to conduct
activities with integrity, dignity and care for those we serve,
and in compliance with all
112
applicable laws and policies. Notwithstanding the foregoing, we
audit compliance with our compliance program on a sample basis.
Although such an approach reflects a reasonable and accepted
approach in the industry, we cannot assure you that our program
will detect and rectify all compliance issues in all markets and
for all time periods.
As do other healthcare companies which operate effective
compliance programs, from time to time we identify practices
that may have resulted in Medicare or Medicaid overpayments or
other regulatory issues. For example, we have previously
identified situations in which we may have inadvertently
utilized incorrect billing codes for some of the services we
have billed to government programs such as Medicare or Medicaid.
In such cases, it is our practice to disclose the issue to the
affected government programs and, if appropriate, to refund any
resulting overpayments. The government usually accepts such
disclosures and repayments without taking further enforcement
action, and we generally expect that to be the case with respect
to our past and future disclosures and repayments. However, it
is possible that such disclosures or repayments will result in
allegations by the government that we have violated the False
Claims Act or other laws, leading to investigations and possibly
civil or criminal enforcement actions.
When the United States government settles a case involving
allegations of billing misconduct with a healthcare provider, it
typically requires the provider to enter into a Corporate
Integrity Agreement, or CIA, with the OIG. As a condition to
settlement of two government investigations, certain of our
operations are subject to CIAs with the OIG. As part of these
CIAs, AMR was required to establish and maintain a compliance
program that includes the following elements: (1) a
compliance officer and committee, (2) written standards
including a code of conduct and policies and procedures,
(3) general and specific training and education,
(4) claims review by an independent review organization,
(5) disclosure program for reporting of compliance issues
or questions, (6) screening and removal processes for
ineligible persons, (7) notification of government
investigations or legal proceedings and (8) reporting of
overpayments and other “reportable events.”
If we fail or if we are accused of failing to comply with the
terms of the settlements, we may be subject to additional
litigation or other government actions, including being excluded
from participating in the Medicare program and other federal
healthcare programs.
See “Risk Factors — Risk Factors Related to
Healthcare Regulation” for additional information related
to regulatory matters.
113
MANAGEMENT
Directors and Executive Officers
The following table sets forth information regarding our
directors and executive officers.
|
|
|
|
|
|
|
Name |
|
Age | |
|
Position* |
|
|
| |
|
|
William A. Sanger
|
|
|
55 |
|
|
Director, Chairman and Chief Executive Officer |
Don S. Harvey
|
|
|
48 |
|
|
Director, President and Chief Operating Officer |
Randel G. Owen
|
|
|
46 |
|
|
Chief Financial Officer |
Dighton C. Packard, M.D.
|
|
|
57 |
|
|
Chief Medical Officer |
Todd G. Zimmerman
|
|
|
40 |
|
|
General Counsel |
Robert M. Le Blanc
|
|
|
39 |
|
|
Lead Director |
Steven B. Epstein
|
|
|
61 |
|
|
Director |
James T. Kelly
|
|
|
59 |
|
|
Director |
Michael L. Smith
|
|
|
57 |
|
|
Director |
|
|
* |
Unless otherwise noted, the positions identified are the
positions held with the general partner of EMS L.P. prior to our
initial public offering and with Emergency Medical Services
Corporation following that offering, and it is the entity that
will survive the reorganization of Emergency Medical Services
L.P. |
William A. Sanger has been a director, chairman and Chief
Executive Officer of Emergency Medical Services Corporation
since February 10, 2005. Mr. Sanger was appointed
President of EmCare in 2001 and Chief Executive Officer of AMR
and EmCare in June 2002. Mr. Sanger is a co-founder of
BIDON Companies where he has been a Managing Partner since 1999.
Mr. Sanger served as President and Chief Executive Officer
of Cancer Treatment Centers of America, Inc. from 1997 to 2001.
From 1994 to 1997, Mr. Sanger was co-founder and Executive
Vice President of PhyMatrix Corp., then a publicly traded
diversified health services company. In addition,
Mr. Sanger was president and chief executive officer of
various other healthcare entities, including JFK Health Care
System. Mr. Sanger has an MBA from the Kellogg School of
Management at Northwestern University. Mr. Sanger has been
a leader in the healthcare industry for more than three decades.
Don S. Harvey has been President and Chief Operating
Officer of Emergency Medical Services Corporation since
February 10, 2005, and was elected a director of Emergency
Medical Services Corporation in July 2005. Mr. Harvey
joined EmCare as an executive officer in 2001 and was appointed
President in June 2002. Mr. Harvey is a co-founder of BIDON
Companies where he has been a Managing Partner since 1999. Prior
to that, he served as President of the Eastern Region of Cancer
Treatment Centers of America, Inc. from 1997 to 1999. Prior to
that, Mr. Harvey was an executive officer of PhyMatrix
Corp. and Executive Vice President of JFK Healthcare System.
Mr. Harvey is a director of several organizations,
including the emergency medicine industry trade association
EDPMA. Mr. Harvey has more than 20 years of experience
in healthcare services serving the public, governmental and
private markets.
Randel G. Owen has been Chief Financial Officer of
Emergency Medical Services Corporation since February 10,
2005. Mr. Owen was appointed Executive Vice President and
Chief Financial Officer of AMR in March 2003. He joined EmCare
in July 1999 and served as Executive Vice President and Chief
Financial Officer from June 2001 to March 2003. Before joining
EmCare, Mr. Owen was Vice President of Group Financial
Operations for PhyCor, Inc. in Nashville, Tennessee from 1995 to
1999. Mr. Owen has more than 20 years of financial
experience in the health care industry. Mr. Owen received
an accounting degree from Abilene Christian University.
Dighton C. Packard, M.D. has been Chief Medical
Officer of EmCare since 1990 and became Chief Medical Officer of
Emergency Medical Services Corporation in April 2005.
Dr. Packard is also the Chairman of the Department of
Emergency Medicine at Baylor University Medical Center in
Dallas, Texas and a member of the Board of Trustees for Baylor
University Medical Center and for Baylor Heart and Vascular
114
Hospital. Dr. Packard has practiced emergency medicine for
more than 25 years. He received his BS from Baylor
University at Waco and his MD from the University of Texas
Medical School at San Antonio.
Todd G. Zimmerman has been General Counsel of Emergency
Medical Services Corporation since February 10, 2005.
Mr. Zimmerman was appointed General Counsel and Executive
Vice President of EmCare in July 2002 and of AMR in May 2004.
Mr. Zimmerman joined EmCare in October 1997 in connection
with EmCare’s acquisition of Spectrum Emergency Care, Inc.
where he served as Corporate Counsel. Prior to joining Spectrum
in 1997, Mr. Zimmerman worked in the private practice of
law for seven years, providing legal advice and support to
various large corporations. Mr. Zimmerman received his BS
in Business Administration from St. Louis University and
his J.D. from the University of Virginia School of Law.
Robert M. Le Blanc has served as Managing Director of
Onex Investment Corp., an affiliate of Onex Corporation, a
diversified industrial corporation, since 1999. Prior to joining
Onex in 1999, he was with Berkshire Hathaway for seven years.
From 1988 to 1992, Mr. Le Blanc held numerous positions
with GE Capital, with responsibility for corporate finance and
corporate strategy. Mr. Le Blanc serves as a Director of
Magellan Health Services, Inc., Res-Care, Inc., Center for
Diagnostic Imaging, Inc. and First Berkshire Hathaway Life.
Mr. Le Blanc became a director of Emergency Medical
Services Corporation in December 2004.
Steven B. Epstein became a director of Emergency Medical
Services Corporation in July 2005. Mr. Epstein is the
founder and senior healthcare partner of the law firm of Epstein
Becker & Green, P.C. Epstein Becker &
Green, P.C. generally is recognized as one of the
country’s leading healthcare law firms. Mr. Epstein
serves as a legal advisor to healthcare entities throughout the
U.S. Mr. Epstein received his B.A. from Tufts
University, where he serves on the Board of Trustees and the
Executive Committee, and his J.D. from Columbia Law School,
where he serves as Chairman of the Law School’s Board of
Visitors. In addition, Mr. Epstein serves as a director of
many healthcare companies and venture capital and private equity
firms, including HealthExtras, Inc. (a pharmacy benefit company).
James T. Kelly became a director of Emergency Medical
Services Corporation in July 2005. From 1986 to 1996,
Mr. Kelly served as President and Chief Executive Officer
of Lincare Holding Inc., and he served as Chairman of the Board
of Lincare from 1994 to 2000. Lincare is a publicly traded
company that provides respiratory care, infusion therapy and
medical equipment to patients in the home. Prior to joining
Lincare, Mr. Kelly was with Union Carbide Corporation for
19 years, where he served in various management positions.
Mr. Kelly also serves as a director of American Dental
Partners, Inc. (a provider of dental management services) and
HMS Holdings Corp. (a provider of consulting and business office
outsourcing and reimbursement services to healthcare providers).
Michael L. Smith became a director of Emergency Medical
Services Corporation in July 2005. Mr. Smith served as
Executive Vice President and Chief Financial and Accounting
Officer of Anthem, Inc. and its subsidiaries, Anthem Blue Cross
and Blue Shield, from 2001 until his retirement in January 2005.
Mr. Smith was Executive Vice President and Chief Financial
Officer of Anthem Insurance from 1999, and from 1996 to 1998 he
served as Chief Operating Officer and Chief Financial Officer of
American Health Network Inc., then a subsidiary of Anthem.
Mr. Smith was Chairman, President and Chief Executive
Officer of Mayflower Group, Inc. (a transportation company) from
1989 to 1995, and held various other management positions with
that company from 1974 to 1989. Mr. Smith also serves as a
director of First Indiana Corporation and its principal
subsidiary, First Indiana Bank, Finishmaster, Inc. (auto paint
distribution), InterMune, Inc. (a biopharmaceutical company) and
Kite Realty Group Trust (a retail property REIT). Mr. Smith
also serves as a member of the Board of Trustees of DePauw
University, a Trustee of the Indianapolis Museum of Art and a
Trustee of the Michigan Maritime Museum.
Except as described in this prospectus, there are no
arrangements or understandings between any member of the board
of directors or executive officer and any other person pursuant
to which that person was elected or appointed to his or her
position.
115
Our board of directors has the power to appoint our executive
officers. Each executive officer will hold office for the term
determined by the board of directors and until such
person’s successor is chosen or until such person’s
death, resignation or removal.
Mr. Le Blanc is serving as our Lead Director. In that role,
his primary responsibility is to preside over periodic executive
sessions of our board of directors in which management directors
and other members of management do not participate, and he has
the authority to call meetings of the non-management directors.
The Lead Director also chairs certain portions of board
meetings, serves as liaison between the Chairman of the Board
and the non-management directors, and develops, together with
the Chairman, the agenda for board meetings. The Lead Director
will also perform other duties the board delegates from time to
time to assist the board in fulfilling its responsibilities.
There are no family relationships among any of our directors and
executive officers.
Committees of the Board of Directors
Prior to the completion of our initial public offering, our
board of directors will have established several committees,
including an audit committee and a compensation committee.
Audit Committee. The audit committee is responsible for
(1) selecting the independent auditor, (2) approving
the overall scope of the audit, (3) assisting the board of
directors in monitoring the integrity of our financial
statements, the independent accountant’s qualifications and
independence, the performance of the independent accountants and
our internal audit function and our compliance with legal and
regulatory requirements, (4) annually reviewing our
independent auditor’s report describing the auditing
firms’ internal quality-control procedures, and any
material issues raised by the most recent internal
quality-control review, or peer review, of the auditing firm,
(5) discussing the annual audited financial and quarterly
statements with management and the independent auditor,
(6) discussing earnings press releases, as well as
financial information and earnings guidance provided to analysts
and rating agencies, (7) discussing policies with respect
to risk assessment and risk management, (8) meeting
separately, periodically, with management, internal auditors and
the independent auditor, (9) reviewing with the independent
auditor any audit problems or difficulties and management’s
response, (10) setting clear hiring policies for employees
or former employees of the independent auditors,
(11) handling such other matters that are specifically
delegated to the audit committee by the board of directors from
time to time and (12) reporting regularly to the full board
of directors.
Upon completion of our initial public offering, our audit
committee will consist of Messrs. Epstein, Kelly and Smith,
with Mr. Smith serving as chairman of the committee. All of
the committee members have been determined to be independent
and and
Mr. Smith have each been determined to be an “audit
committee financial expert,” as such term is defined in
Item 401(h) of Regulation S-K.
Compensation Committee. The compensation committee is
responsible for (1) reviewing key employee compensation
policies, plans and programs, (2) reviewing and approving
the compensation of our executive officers, (3) reviewing
and approving employment contracts and other similar
arrangements between us and our executive officers,
(4) reviewing and consulting with the chief executive
officer on the selection of officers and evaluation of executive
performance and other related matters, (5) administration
of stock plans and other incentive compensation plans and
(6) such other matters that are specifically delegated to
the compensation committee by the board of directors from time
to time.
Upon completion of our initial public offering, our compensation
committee will consist of Messrs. Kelly, Le Blanc
and ,
with Mr. Kelly serving as chairman.
116
Compensation of Directors
Following our initial public offering, directors who are not our
employees will receive an annual cash payment of $35,000,
payable quarterly, $2,000 for each board meeting attended in
person and $1,000 for each board meeting attended via conference
call, and $1,000 and $500, respectively, for each committee
meeting attended in person or via conference call. The chair of
the audit committee and the compensation committee will receive
an additional $15,000 and $10,000, respectively. Consistent with
corporate policy, Mr. Le Blanc, as chairman of the
compliance committee, will receive no compensation for his
services to the company. When they were elected to the board, we
granted to each of Messrs. Epstein, Kelly and Smith an
option to
purchase shares
of class A common stock at an exercise price
of per
share, with the same vesting schedule as is applicable to our
executive officers. See “Management — Option
Grants and Stock Awards”. All directors are reimbursed for
their out-of-pocket expenses incurred in connection with such
services.
Executive Compensation
The following table sets forth the compensation of our chief
executive officer and the four other most highly compensated
executive officers during fiscal 2004. We refer to these
officers as our named executive officers.
Summary Compensation Table
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|
Annual Compensation | |
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| |
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|
Other Annual | |
|
Long-Term | |
|
All Other | |
Name and Principal Position(1) |
|
Year | |
|
Salary | |
|
Bonus | |
|
Compensation(2) | |
|
Compensation Awards(3) | |
|
Compensation(4) | |
|
|
| |
|
| |
|
| |
|
| |
|
| |
|
| |
William A. Sanger
|
|
|
2004 |
|
|
$ |
571,411 |
|
|
$ |
488,750 |
|
|
|
— |
|
|
|
— |
|
|
$ |
9,957 |
|
|
Chief Executive Officer of AMR and of EmCare |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Don S. Harvey
|
|
|
2004 |
|
|
$ |
391,667 |
|
|
$ |
337,500 |
|
|
|
— |
|
|
|
— |
|
|
$ |
3,925 |
|
|
President and Chief Operating Officer of EmCare |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Randel G. Owen
|
|
|
2004 |
|
|
$ |
286,422 |
|
|
$ |
117,500 |
|
|
$ |
55,944(5 |
) |
|
$ |
35,245 |
|
|
$ |
7,745 |
|
|
Chief Financial Officer of AMR |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Dighton C. Packard, M.D.
|
|
|
2004 |
|
|
$ |
211,467 |
|
|
$ |
83,200 |
|
|
|
— |
|
|
$ |
21,333 |
|
|
$ |
4,571 |
|
|
Chief Medical Officer of EmCare |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Todd G. Zimmerman
|
|
|
2004 |
|
|
$ |
201,955 |
|
|
$ |
146,997 |
|
|
|
— |
|
|
$ |
11,594 |
|
|
$ |
5,157 |
|
|
General Counsel of EmCare |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
(1) |
Represents each person’s principal position in fiscal 2004.
All of these individuals became executive officers of Emergency
Medical Services in connection with our acquisition of AMR and
EmCare. |
|
(2) |
In accordance with the rules of the SEC, other annual
compensation disclosed in this table does not include various
perquisites and other personal benefits received by a named
executive officer that does not exceed the lesser of $50,000 or
10% of such officer’s total annual salary and bonus
disclosed in this table. |
|
(3) |
Represents the vesting of restricted share awards granted to the
named executive officers by Laidlaw on November 24, 2004,
as follows: Mr. Owen — 1,900 shares;
Dr. Packard — 1,150 shares;
Mr. Zimmerman — 625 shares. In connection
with our acquisition of AMR and EmCare, these awards terminated
and no further restricted shares will vest. |
|
(4) |
Represents matching contributions to company 401(k) plans. |
|
(5) |
Other annual compensation for Mr. Owen includes a
relocation allowance of $47,544. |
Substantially all of our salaried employees, including our named
executive officers, participate in our 401(k) savings plans. We
maintain three 401(k) plans for eligible AMR employees.
Employees may contribute a maximum of 40% of their compensation
up to a maximum of $13,000. We match the contribution up to a
maximum of 3% to 6% of the employee’s salary per year,
depending on the plan. Eligible EmCare employees
117
may elect to contribute 1% to 25% of their annual compensation
and we match 50% of the first 6% of base compensation that an
employee contributes.
Prior to our acquisition of AMR and EmCare, our named executive
officers participated in the Laidlaw, Inc. U.S. Supplemental
Executive Retirement Arrangement, or SERP. The benefit amount
payable under the plan at age 65 is based upon an
employee’s final average earnings. The form of the benefit
would be an annuity, guaranteed for five years. Based on the
number of years of service and their respective salaries prior
to the acquisition, the following are the total estimated
accrued values of future benefits payable under the Laidlaw SERP
to the named executive officers on retirement, calculated at
August 31, 2004: Mr. Sanger — $169,532;
Mr. Harvey — $69,782; Mr. Owen —
$141,190; Dr. Packard — $169,030; and
Mr. Zimmerman — $92,481. No additional benefits
will accrue under the SERP. See “Certain Relationships and
Related Party Transactions — Transactions with
Laidlaw — Management Bonuses in Connection with Our
Acquisition of AMR and EmCare” for information relating to
amounts paid by Laidlaw to the named executive officers in
connection with our acquisition of AMR and EmCare.
118
Option Grants and Stock Awards
There were no stock option grants or restricted stock awards to
the named executive officers in fiscal 2004.
The following table sets forth information regarding options
granted to each of our named executive officers in February 2005
in connection with our acquisition of AMR and EmCare. Potential
realizable value is based upon the assumed initial public
offering of
$ per
share, and is net of the exercise price of
$ per
share. The potential realizable value set forth in the last
column of the table is calculated based on the term of the
option at the time of the grant, which is ten years. The assumed
5% and 10% rates of appreciation comply with the rules of the
SEC and do not represent our estimate of future stock price.
Actual gains, if any, on stock option exercises will be
dependent on future performance of our class A common
stock. We have not granted any stock appreciation rights to any
of the named executive officers.
The exercise price of each option listed below is equal to the
price paid per share by our initial investors. Each option may
be exercised only upon the vesting of such options. One-half of
the options held by each named executive officer vest ratably
over a four-year period as of the one-year anniversaries of the
grant (the 6-month anniversaries, in the case of
Mr. Sanger), and one-half vest ratably over the same period
but are exercisable only if a specified performance target is
met. See “— Equity Plans — Equity Option
Plan.” The percentage of total options is based upon
options to purchase an aggregate
of shares
of class A common stock granted to employees under the
equity option plan we adopted in connection with the acquisition
of AMR and EmCare. The terms of all option grants described
below give effect to adjustments to our capitalization that will
be made in connection with this offering. See “Equity
Plans — Equity Option Plans.”
Option Grants in Fiscal 2005
|
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|
|
|
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|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Individual Grants | |
|
Potential Realizable | |
| |
|
Value of Assumed | |
|
|
Number of | |
|
% of Total | |
|
|
|
Annual Rates of Stock | |
|
|
Securities | |
|
Options | |
|
|
|
Price Appreciation for | |
|
|
Underlying | |
|
Granted to | |
|
|
|
Option Term | |
|
|
Options | |
|
Employees in | |
|
Exercise | |
|
|
|
| |
Name |
|
Granted(1) | |
|
Fiscal Year | |
|
Price | |
|
Expiration Date(1) | |
|
5% | |
|
10% | |
|
|
| |
|
| |
|
| |
|
| |
|
| |
|
| |
William A. Sanger
|
|
|
|
(2) |
|
|
42 |
% |
|
$ |
|
|
|
|
February 10, 2015 |
|
|
|
|
|
|
|
|
|
Don S. Harvey
|
|
|
|
(3) |
|
|
11 |
% |
|
$ |
|
|
|
|
February 10, 2015 |
|
|
|
|
|
|
|
|
|
Randel G. Owen
|
|
|
|
(3) |
|
|
11 |
% |
|
$ |
|
|
|
|
February 10, 2015 |
|
|
|
|
|
|
|
|
|
Todd G. Zimmerman
|
|
|
|
(3) |
|
|
4 |
% |
|
$ |
|
|
|
|
February 10, 2015 |
|
|
|
|
|
|
|
|
|
Dighton C. Packard, M.D.
|
|
|
|
(3) |
|
|
1 |
% |
|
$ |
|
|
|
|
February 10, 2015 |
|
|
|
|
|
|
|
|
|
|
|
(1) |
The options may expire earlier, upon termination of employment
or certain corporate events. See “— Equity
Plans — Equity Option Plan.” If the
employee’s employment is terminated prior to
February 10, 2015, his options will expire earlier as
follows: (a) upon the termination of employment if the
termination is for “cause”, (b) 30 days
after the termination of employment, or such other date as
determined by the compensation committee, following termination
by the employee for “good reason” or by us without
“cause” or due to retirement, or (c) 90 days
after termination of employment due to death or disability.
Vesting of the options may accelerate, and all options will
terminate if not exercised, upon (i) a sale of our equity
(other than a sale as part of an initial public offering)
whereby any person other than existing equity holders as of the
grant date acquire our voting power to elect a majority of our
board of directors or (ii) a sale of all or substantially
all of our assets. |
|
(2) |
The options vest ratably on the first eight six-month
anniversaries of the grant date, provided, that the
exercisability of one-half of the options is conditioned upon
meeting certain specified performance targets. See “—
Equity Plans — Equity Option Plan.” If
Mr. Sanger is terminated, the options will vest as
scheduled to the nearest six-month anniversary of the grant date. |
|
(3) |
The options vest ratably on the first four anniversaries of the
grant date, provided, that the exercisability of one-half of the
options is conditioned upon meeting certain specified
performance targets. See “— Equity Plans —
Equity Option Plan.” |
None of the named executive officers held any stock options
during the fiscal year ended August 31, 2004 and none of
them held unexercised stock options at that date.
Employment Agreements
We have entered into employment agreements with
Messrs. Sanger, Harvey, Owen and Zimmerman, each effective
February 10, 2005, and with Dr. Packard effective
April 19, 2005. Mr. Sanger’s employment
119
agreement has a five-year term and Mr. Harvey’s
employment agreement has a four-year term. The employment
agreements of Mr. Owen, Mr. Zimmerman and
Dr. Packard have a three-year, a two-year term and a
one-year term, respectively, and renew automatically for
successive one-year terms unless either party gives notice at
least 90 days prior to the expiration of the then current
term. Each executive has the right to terminate his agreement on
90 days’ notice, in which event he will be subject to
the non-compete provisions described below, provided he receives
specified severance benefits. The employment agreements include
provisions for the payment of an annual base salary as well as
the payment of a bonus based upon the achievement of performance
criteria established by our board of directors or, in the case
of Dr. Packard, our Chief Executive Officer or President.
The target bonus percentage, expressed as a percentage of annual
salary, set forth in each agreement represents the bonus amount
payable to the executive if all of the performance criteria are
achieved. The annual base salary of Mr. Sanger is subject
to annual review and adjustment after the second anniversary of
the effectiveness of the agreement. The annual base salary of
Messrs. Harvey, Owen and Zimmerman are subject to annual
review and adjustment after the first anniversary of the
effectiveness of the agreements. Dr. Packard’s base
salary is subject to a $100,000 increase if he reduces his
clinical activities and increases the time he provides services
to us.
If we terminate a named executive officer’s employment
without cause or any of them leaves after a change of control
for one of several specified reasons, we have agreed to continue
the executive’s base salary and provide his benefits for a
period of 24 months from the date of termination for
Messrs. Sanger, Harvey and Owen, 18 months for
Mr. Zimmerman, and 12 months for Dr. Packard.
These agreements contain non-competition and non-solicitation
provisions pursuant to which the executive agrees not to compete
with AMR or EmCare or solicit or recruit our employees for a
period from the date of termination for 24 months in the
case of Mr. Sanger, Mr. Harvey, Mr. Owen and
Dr. Packard and 12 months in the case of
Mr. Zimmerman.
The annual base salary and target bonus for each named executive
officer is as follows:
|
|
|
|
|
|
|
|
|
|
|
|
|
Target | |
|
|
Annual | |
|
Bonus | |
Executive |
|
Base Salary | |
|
Percentage | |
|
|
| |
|
| |
William A. Sanger
|
|
$ |
850,000 |
|
|
|
100 |
% |
Don S. Harvey
|
|
$ |
500,000 |
|
|
|
75 |
% |
Randel G. Owen
|
|
$ |
350,000 |
|
|
|
50 |
% |
Todd G. Zimmerman
|
|
$ |
325,000 |
|
|
|
50 |
% |
Dighton C. Packard, M.D.
|
|
$ |
260,000 |
|
|
|
50 |
% |
Pursuant to their employment agreements, effective
February 10, 2005, we granted options to purchase our
class A common stock to each named executive officer. See
“— Option Grants and Stock Awards” and
“— Equity Plans — Equity Option
Plan.” The option grant to each of these named executive
officers was conditioned upon his investment in our equity in an
amount as indicated in his respective employment agreement.
Our executive employment agreements with Messrs. Sanger,
Harvey, Owen and Zimmerman include indemnification provisions.
Under those agreements, we agree to indemnify each of these
individuals against claims arising out of events or occurrences
related to that individual’s service as our agent or the
agent of any of our subsidiaries to the fullest extent legally
permitted. Under Delaware law, an officer may be indemnified,
except to the extent any claim arises from conduct that was not
in good faith or in a manner reasonably believed to be in, or
not opposed to, our best interest or, with respect to any
criminal action or proceedings, there was reasonable cause to
believe such conduct was unlawful.
Equity Plans
We adopted our equity option plan in connection with the
acquisition of AMR and EmCare. We have granted options to
purchase shares
of class A common stock under the plan and have reserved an
additional shares
for future grants.
120
The compensation committee of our board of directors, or the
board itself if there is no committee, administers the equity
option plan.
The plan provides that if Emergency Medical Services undergoes a
reorganization, recapitalization or other change in its equity,
the compensation committee may make adjustments to the plan in
order to prevent dilution of outstanding options. In connection
with this offering, each option to purchase one partnership unit
at a price
of per
unit will be adjusted to become the right to
purchase shares
of class A common stock at a price
of per
share, and the option terms we refer to give effect to these
adjustments.
The options to
purchase shares
of class A common stock we have granted under the plan are
non-qualified options for federal income tax purposes. These
options have the following terms:
|
|
|
|
• |
exercise price equal to
$ per
share, being the equity purchase price paid by the initial
investors, |
|
|
• |
vesting ratably on each of the first four anniversaries of the
grant date (the first eight 6-month anniversaries in the case of
Mr. Sanger), provided, that the exercisability of
one-half of the options granted to each employee is subject to
the further condition that Onex has realized a 15% internal rate
of return, as defined, or, on the fourth anniversary of the
grant date, we have achieved an aggregate EBITDA of not less
than $617.4 million, subject to certain adjustments, for
the four fiscal years ending December 31, 2008, |
|
|
• |
each option expires on the tenth anniversary of the grant date
unless the employee’s employment is terminated earlier, in
which case the options will expire as follows: (i) upon the
termination of employment if the termination is for
“cause”, (ii) 30 days after the termination
of employment, or such other date as determined by the
compensation committee, following termination by the employee
for “good reason” or by us without “cause”
or due to retirement, or (iii) 90 days after
termination of employment due to death or disability, and |
|
|
• |
upon (i) a sale of the equity of Emergency Medical Services
(other than a sale as part of this offering) whereby any person
other than existing equity holders as of the grant date acquire
voting power to elect a majority of our board of directors or
(ii) a sale of all or substantially all of our assets, all
options granted to each employee will accelerate (although still
subject to the performance target) and will terminate if not
exercised. |
All options and Emergency Medical Services equity held by our
senior management are governed by agreements which:
|
|
|
|
• |
restrict transfer of their equity until the fifth anniversary of
purchase, and |
|
|
• |
grant “piggyback” registration rights. |
|
|
|
Management Investment and Equity Purchase Plan |
In connection with our acquisition of AMR and EmCare, our named
executive officers purchased an aggregate
of shares
of class A common stock. See “Certain Relationships
and Related Party Transactions — Issuance of
Shares.” Approximately 160 employees and affiliated
physicians, physician assistants and nurse practitioners
purchased in the aggregate an
additional shares
of class A common stock pursuant to our equity purchase
plan.
The shares
held by these investors, including our named executive officers,
are governed by equityholders agreements. These agreements
contain restrictions on transfer of the equity.
121
PRINCIPAL STOCKHOLDERS
The following table shows information with respect to the
beneficial ownership of our common stock as
of ,
2005, giving effect to our initial public offering, by:
|
|
|
|
• |
each person known by us to own beneficially 5% or more of our
class A or class B common stock, |
|
|
• |
each of our directors, |
|
|
• |
each of our named executive officers, and |
|
|
• |
all of our directors and executive officers as a group. |
In addition, up
to LP
exchangeable units owned by the Onex entities may be exchanged
for shares of our class B common stock, converted into
class A common stock and sold if the underwriters of our
offering exercise their over-allotment option. No member of
management, and no other stockholder, is selling common stock as
a part of our initial public offering.
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Number of | |
|
Percentage | |
|
|
|
|
Shares | |
|
of Class/All | |
|
Percentage | |
|
|
Beneficially | |
|
Common | |
|
of Voting | |
Name of Beneficial Owner |
|
Owned(1)(2) | |
|
Stock | |
|
Power | |
|
|
| |
|
| |
|
| |
Five Percent Stockholders
|
|
|
|
|
|
|
|
|
|
|
|
|
Onex Corporation(3)
|
|
|
class B |
|
|
|
|
|
|
|
|
|
Onex Partners LP(4)
|
|
|
class B |
|
|
|
|
|
|
|
|
|
Onex Partners LLC(5)
|
|
|
class B |
|
|
|
|
|
|
|
|
|
Onex EMSC Co-Invest LP(6)
|
|
|
class B |
|
|
|
|
|
|
|
|
|
Directors and Executive Officers
|
|
|
|
|
|
|
|
|
|
|
|
|
Robert M. Le Blanc(7)
|
|
|
class B |
|
|
|
|
|
|
|
|
|
Steven B. Epstein(8)
|
|
|
class A |
|
|
|
|
|
|
|
|
|
James T. Kelly(8)
|
|
|
class A |
|
|
|
|
|
|
|
|
|
Michael L. Smith(8)
|
|
|
class A |
|
|
|
|
|
|
|
|
|
William A. Sanger(8)
|
|
|
class A |
|
|
|
|
|
|
|
|
|
Don S. Harvey(8)
|
|
|
class A |
|
|
|
|
|
|
|
|
|
Dighton C. Packard, M.D.(9)
|
|
|
class A |
|
|
|
|
|
|
|
|
|
Randel G. Owen(8)
|
|
|
class A |
|
|
|
|
|
|
|
|
|
Todd G. Zimmerman(8)
|
|
|
class A |
|
|
|
|
|
|
|
|
|
All directors and executive officers as a group (9 persons)
|
|
|
class B
class A |
|
|
|
|
|
|
|
|
|
|
|
* |
Represents beneficial ownership of less than 1%. |
|
|
(1) |
The amounts and percentages of our common stock beneficially
owned are reported on the basis of regulations of the SEC
governing the determination of beneficial ownership of
securities. Under the rules of the SEC, a person is deemed to be
a “beneficial owner” of a security if that person has
or shares “voting power,” which includes the power to
vote or direct the voting of such security, or “investment
power,” which includes the power to dispose of or to direct
the disposition of such security. A |
122
|
|
|
person is also deemed to be a
beneficial owner of any securities of which that person has a
right to acquire beneficial ownership within 60 days,
including our common stock subject to an option that is
exercisable within 60 days. Under these rules, more than
one person may be deemed to be a beneficial owner of such
securities as to which such person has an economic interest.
None of the options granted under our equity option plan is
exercisable within 60 days.
|
|
|
The LP exchangeable units are
exchangeable on a one-for-one basis for shares of class B
common stock at any time at the option of the holder.
Accordingly, this table assumes the exchange of all LP
exchangeable units for class B common stock. Until such
exchange, the holders of the LP exchangeable units have the
benefit of the class B special voting stock through which
the holders may exercise voting rights as though they held the
same number of shares of class B common stock.
|
|
(2) |
On each matter submitted to the
stockholders for their vote, our class A common stock is
entitled to one vote per share, and our class B common
stock is entitled to ten votes per share, reducing to one vote
per share under certain limited circumstances. Except as
required by law, our class A and class B common stock vote
together on all matters submitted to stockholders for their vote.
|
|
(3) |
Includes the following:
(i) LP exchangeable
units held by Onex Partners LP;
(ii) LP exchangeable
units held by Onex Partners LLC;
(iii) LP exchangeable
units held by Onex EMSC Co-Invest LP;
(iv) LP exchangeable
units held by EMS Executive Investco LLC;
(v) LP exchangeable
units held by Onex US Principals LP; and
(vi) LP exchangeable
units held by Emergency Medical Services Corporation. Onex
Corporation may be deemed to own beneficially the LP
exchangeable units held by (a) Onex Partners LP,
through Onex’ ownership of all of the common stock of Onex
Partners GP, Inc., the general partner of Onex
Partners GP LP, the general partner of Onex
Partners LP; (b) Onex Partners LLC, through
Onex’ ownership of all of the equity of Onex
Partners LLC; (c) Onex EMS Co-Invest LP, through
Onex’ ownership of all of the common stock of Onex
Partners GP, Inc., the general partner of Onex
Partners GP LP, the general partner of Onex EMSC
Co-Invest LP; (d) EMS Executive Investco LLC,
through Onex’ ownership of Onex American
Holdings II LLC which owns 33.33% of the voting power
of EMS Executive Investco LLC; and (e) Onex
US Principals LP through Onex’ ownership of all
of the equity of Onex American Holdings GP LLC, the
general partner of Onex US Principals LP. Onex
Corporation disclaims such beneficial ownership.
|
|
|
In addition, prior to the formation
of our holding company, Onex Corporation’s subsidiary, Onex
American Holdings II LLC, owns 50% of the voting stock
of Emergency Medical Services Corporation, the general partner
of EMS L.P., and a 99.9% economic interest in Emergency
Medical Services Corporation. Emergency Medical Services
Corporation owns directly less than .001% of the equity interest
of EMS L.P. However, as its general partner, Emergency
Medical Services Corporation may be deemed to own beneficially
all of the equity of the partnership. The equity owned by
Emergency Medical Services Corporation may be deemed
beneficially owned 50% by Mr. Le Blanc and 50% by Onex
American Holdings II LLC and Onex Corporation.
Mr. Le Blanc disclaims such beneficial ownership.
|
|
|
Mr. Gerald W. Schwartz, the
Chairman, President and Chief Executive Officer of Onex
Corporation, owns shares representing a majority of the voting
rights of the shares of Onex Corporation and as such may be
deemed to own beneficially all of the LP exchangeable units
owned beneficially by Onex Corporation. Mr. Schwartz
disclaims such beneficial ownership. The address for Onex
Corporation is 161 Bay Street, Toronto, ON M5J 2S1
|
|
(4) |
All of the LP exchangeable
units owned by Onex Partners LP may be deemed owned beneficially
by each of Onex Partners GP LP, Onex Partners GP, Inc.
and Onex Corporation. The address for Onex Partners LP is
c/o Onex Investment Corporation, 712 Fifth Avenue, New
York, New York 10019.
|
|
(5) |
All of the LP exchangeable units
owned by Onex Partners LLC may be deemed owned beneficially by
Onex Corporation. The address for Onex Partners LLC is 421
Leader Street, Marion, Ohio 43302.
|
|
(6) |
All of the LP exchangeable units
owned by Onex EMSC Co-Invest LP may be deemed owned beneficially
by each of Onex Partners GP LP, Onex Partners GP, Inc. and Onex
Corporation. The address for Onex EMSC Co-Invest LP is
c/o Onex Investment Corporation, 712 Fifth Avenue, New
York, New York 10019.
|
|
(7) |
Includes
(i) LP
exchangeable units held by Onex US Principals LP which may
be deemed owned beneficially by Mr. Le Blanc by reason
of his pecuniary interest in the LP exchangeable units owned by
Onex US Principals LP,
(ii) LP
exchangeable units owned by Onex EMSC Co-Invest LP which may be
deemed to be owned beneficially by Mr. Le Blanc by reason
of his pecuniary interest in Onex EMSC Co-Invest LP and
(iii) shares
of LP exchangeable units owned by Emergency Medical Services
Corporation. Prior to our reorganization into a holding company,
Mr. Le Blanc owns 50% of the voting common stock of
Emergency Medical Service Corporation and a 0.01% economic
interest in Emergency Medical Services Corporation. See note
(3) with respect to Emergency Medical Services
Corporation’s equity interest in EMS L.P., as to which
Mr. Le Blanc disclaims beneficial ownership. Mr. Le
Blanc also disclaims beneficial interest in the LP exchangeable
units owned by Onex US Principals LP and Onex EMSC
Co-Invest LP. Mr. Le Blanc’s address is
c/o Onex Investment Corporation, 712 Fifth Avenue, New
York, New York 10019.
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(8) |
The address of these stockholders
is c/o Emergency Medical Services Corporation, 6200 S. Syracuse
Way, Suite 200, Greenwood Village, Colorado 80111-4737.
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(9) |
The address of this stockholder is
c/o EmCare Holdings Inc., 1717 Main Street, Suite 5200,
Dallas, Texas 75201.
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123
CERTAIN RELATIONSHIPS AND RELATED PARTY TRANSACTIONS
Since September 2001, we have not engaged in any transactions
valued in excess of $60,000 with any of our executive officers,
directors or holders of more than 5% of our outstanding voting
securities, other than the transactions described below.
Transactions with Laidlaw
Our Acquisition of AMR and EmCare
Pursuant to stock purchase agreements with Laidlaw
International, Inc. and a subsidiary of Laidlaw, on
February 10, 2005 we purchased all of the capital stock of
AMR and EmCare for an aggregate purchase price of
$815.8 million, subject to certain post-closing
adjustments. These adjustments included a decrease to reflect
debt assumed by us and an increase to reflect the increase in
the combined net worth of AMR and EmCare from August 31,
2004 through the date of closing, subject to the contractual
provision that the aggregate purchase price would not be more
than $835.8 million minus outstanding debt we
assumed. For purposes of these adjustments, the closing was
deemed to be effective as of the close of business on
January 31, 2005, and we had the benefit and the risks of
the businesses from that date. The aggregate purchase price we
paid was $826.6 million.
Pursuant to the stock purchase agreement, in March 2005 we
purchased an AMR subsidiary from Laidlaw for a purchase price of
approximately $2.2 million. This deferred purchase enabled
Laidlaw to prepay an outstanding debt obligation of the
subsidiary that was secured by the subsidiary’s property.
The purchase price paid to Laidlaw at the closing of the
acquisition had been reduced by approximately $2.2 million.
Accordingly, the aggregate purchase price for the acquisition,
including this subsidiary, was $828.8 million.
The stock purchase agreements contain customary representations,
warranties and covenants. Pursuant to the stock purchase
agreements, we are indemnified by the seller (a subsidiary of
Laidlaw that directly owned AMR and EmCare) and Laidlaw, subject
to specified exceptions, for losses arising from:
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breaches by the seller of its representations, warranties,
covenants and agreements contained in the stock purchase
agreements, |
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• |
damages relating to certain government investigations, and |
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• |
tax liabilities for periods prior to closing. |
Claims for indemnification are subject to an aggregate
deductible equal to 1% of the aggregate purchase price and may
not exceed 15% of the aggregate purchase price (in each case,
without giving effect to any purchase price adjustment), each
subject to certain specified exceptions. Most claims for
indemnification must be made by the date that is 18 months
from the closing date; claims for environmental matters, taxes
and certain healthcare matters may be made for periods ranging
from three years to the applicable statute of limitations
(solely for certain tax matters), and certain representations,
such as those relating to corporate organization and ownership
of the capital stock of AMR and EmCare, do not expire.
Prior to the acquisition, Laidlaw provided various services to
AMR and EmCare, including income tax accounting, preparation of
tax returns, certain risk management/compliance/insurance
coverage services, cash management, certain benefit plan
administration and internal audit, and AMR and EmCare guaranteed
certain Laidlaw debt. See notes 10, 11 and 12 to the audited
combined financial statements included in this prospectus.
Management Bonuses in Connection with Our Acquisition of
AMR and EmCare
In connection with our acquisition of AMR and EmCare, Laidlaw
paid bonuses to Mr. Sanger and Mr. Harvey of
$12,691,032 and $2,270,002, respectively, pursuant to their
employment agreements. Each agreement set forth a formula to
determine the amount of bonus payable in connection with a sale
by Laidlaw of 50% or more of EmCare, in the case of
Mr. Harvey, and of 50% or more of AMR and/or EmCare, in the
case of Mr. Sanger. Also in connection with our acquisition
of AMR and EmCare, Laidlaw
124
paid Mr. Owen, Mr. Zimmerman and Dr. Packard
$200,363, $174,301 and $325,188, respectively, under
Laidlaw’s equity plan. Pursuant to that plan, in 2003,
units were granted to the named executive officers and other
members of senior management of AMR and EmCare. These units
vested in installments and were valued based upon the difference
between the initial value and the final value of AMR or EmCare,
as applicable. Participation in this plan by AMR and EmCare
management, including the named executive officers, terminated
upon the completion of our acquisition of AMR and EmCare.
Transition Services Agreement
In connection with our acquisition of AMR and EmCare, we entered
into a transition services agreement with Laidlaw. Pursuant to
this agreement:
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we agreed to hire a tax employee who will work for Laidlaw on a
consulting basis, until about December 31, 2005, to assist
in Laidlaw’s preparation of pre-closing period state and
federal tax returns relating to AMR and EmCare, |
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Laidlaw agreed to make its tax personnel available to us on a
consulting basis until December 31, 2005, and |
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Laidlaw agreed to lease certain Arlington, Texas office space to
us for 120 days at a lease price of $3,500 per month. |
We will pay Laidlaw for tax consulting services based on a fixed
hourly rate. Laidlaw will reimburse us for 120% of our tax
employee’s salary through June 30, 2005 and thereafter
for 75% of the 120% of salary, it will pay the out-of-pocket
expenses related to the tax employee’s services to Laidlaw
and it will pay 50% of any search firm fee with respect to the
tax employee. For the five months ended June 30, 2005,
under the transition services agreement we paid Laidlaw $19,515.
Performance Bond Arrangement
Certain of AMR’s ambulance transport services contracts
require that AMR or its subsidiary post a surety or performance
bond. In the AMR stock purchase agreement, Laidlaw agrees to
continue to provide to us any cash required as collateral to
support the performance bonds in effect at January 31,
2005, and for a three-year period to pay any bond premiums in
excess of the rates in effect at the closing date. We have
agreed to indemnify Laidlaw for any claims against Laidlaw in
connection with these performance bonds. Under this agreement,
at June 30, 2005, Laidlaw continued to hold the performance
bond collateral amount of $16.4 million, which represents
50% of the face amount of the performance bonds at
January 31, 2005. The cash collateral relating to each bond
will be delivered to us, or to a new surety for our benefit,
when Laidlaw is released from its indemnity obligations with
respect to the outstanding bond; until that release, Laidlaw and
we share equally investment income on the cash collateral.
Risk Financing Program
AMR is party to separate risk financing agreements with Laidlaw
for the period September 1, 1993 to August 31, 2001
and the period September 1, 2003 to the date of the closing
of our acquisition of AMR and EmCare. Pursuant to these
agreements, AMR had insured its workers compensation, auto and
general liability claims through Laidlaw’s captive
insurance company and participated in Laidlaw’s group
policies with respect to other types of coverage for occurrences
during the specific period of each agreement.
For the period September 1, 1993 to August 31, 2001,
we are fully-insured for AMR’s workers compensation, auto
and general liability programs. We have no further payment
obligation to Laidlaw under that agreement, having previously
made all premium payments, and Laidlaw has agreed to bear the
cost of any claims relating to such claims for this period. For
the period September 1, 2003 to February 10, 2005, we
retain the risk of loss as to the first $2 million of auto
and general liability claims per occurrence and the first
$1 million of workers compensation claims per occurrence,
as a self-insurance program funded through Laidlaw’s
captive insurance program. AMR had collateral deposited with
Laidlaw totaling approximately $42.2 million at
February 10, 2005 and $37.7 million at June 30,
2005. This collateral is held in a trust fund
125
owned by Laidlaw, and is applied by Laidlaw to cover AMR’s
claims and related expenses. We are responsible to Laidlaw for
any claims costs in excess of the collateral amount, and any
excess collateral will be repaid to us by Laidlaw. This
self-insurance program for the period September 1, 2003 to
February 10, 2005 can be terminated by either party on
60 days’ written notice. See
“Business — American Medical Response —
Insurance.”
Management Agreement
We are party to a management agreement dated February 10,
2005 with Onex Partners Manager LP, or Onex Manager, a
wholly-owned subsidiary of Onex Corporation. In exchange for an
annual management fee of $1.0 million, Onex Manager
provides us with corporate finance and strategic planning
consulting services. The annual fee may be increased, to a
maximum of $2.0 million, with the approval of directors who
are not affiliated with Onex. We also reimburse Onex Manager for
out-of-pocket expenses incurred in connection with the provision
of services pursuant to the agreement, and reimburse Onex
Manager for out-of-pocket expenses incurred in connection with
our acquisition of AMR and EmCare. The management agreement has
an initial term of five years, subject to automatic one-year
renewals, unless terminated by either party by notice given at
least 90 days prior to the scheduled expiration date.
Issuance of Shares
The following table summarizes the purchases of our common stock
by our directors, executive officers and holders who
beneficially own more than 5% of our outstanding voting
securities. The information in this table, as to the type and
number of shares purchased, gives effect to the exchange of
EMS L.P. partnership units for our common stock effective
immediately prior to our initial public offering and assumes the
exchange of all LP exchangeable units for Emergency Medical
Services’ class B common stock.
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Aggregate | |
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Number and | |
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Purchase | |
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Name |
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Type of Shares | |
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Price | |
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Date of Purchase |
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5% Holders
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Onex Corporation
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class B |
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$ |
214,050,010 |
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February 10, 2005 |
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Onex Partners LP
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class B |
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$ |
114,844,820 |
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February 10, 2005 |
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Onex Partners LLC
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class B |
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$ |
74,046,160 |
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February 10, 2005 |
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Onex EMSC Co-Invest LP
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class B |
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$ |
18,965,700 |
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February 28, 2005 |
Executive Officers
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William A. Sanger
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class A |
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$ |
3,000,000 |
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February 10, 2005 |
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Don S. Harvey
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class A |
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$ |
500,000 |
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February 10, 2005 |
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Randel G. Owen
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class A |
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$ |
225,000 |
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February 10, 2005 |
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Dighton S. Packard, M.D.
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class A |
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$ |
225,000 |
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February 10, 2005 |
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Todd G. Zimmerman
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class A |
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$ |
125,000 |
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February 10, 2005 |
Non-Officer Directors
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Robert M. Le Blanc
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class B |
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$ |
373,991 |
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February 10, 2005 |
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Steven B. Epstein
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class A |
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$ |
250,000 |
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April 22, 2005 |
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James T. Kelly
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class A |
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$ |
750,000 |
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March 10, 2005 |
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Michael L. Smith
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class A |
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$ |
250,000 |
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June 30, 2005 |
Employment Agreements and Indemnification Agreements
We have an employment agreement and an option agreement with
Mr. Sanger, our Chairman and Chief Executive Officer, and
with certain of our other senior executives. For a description,
see “Management — Employment Agreements.”
Pursuant to his employment agreement, Mr. Sanger leased
from us a personal residence we purchased when we asked him to
re-locate to Colorado. Mr. Sanger terminated the lease in
May 2005, at which time we
126
sold the residence. As provided in his employment agreement, in
September 2005 we reimbursed Mr. Sanger for the $463,000 he
had spent on leasehold improvements to the residence.
In November 1999, Texas EM-I Medical Services, P.A., a physician
group affiliated with EmCare, entered into an employment
agreement with Dighton C. Packard, M.D. Dr. Packard’s
employment agreement automatically renews for successive
two-year terms unless either party gives notice 180 days
prior to the expiration of the then current term.
Dr. Packard has the right to terminate his agreement upon
180 days’ notice, in which event he agrees to not
compete with Texas EM-I for 12 months following termination
of employment. Under the employment agreement, Dr. Packard
is to receive an annual base salary plus a bonus based on the
performance of the group under the agreements with Baylor
University Medical Center.
We have entered into indemnification agreements with each of our
directors, and our executive employment agreements include
indemnification provisions. Under those agreements, we agree to
indemnify each of these individuals against claims arising out
of events or occurrences related to that individual’s
service as our agent or the agent of any of our subsidiaries to
the fullest extent legally permitted.
Equityholder Agreements and Registration Agreement
On February 10, 2005, we entered into an investor
equityholders agreement and a registration rights agreement with
certain of our equityholders, including each of the named
executive officers. We are also party to an equityholders
agreement with certain of our employee, affiliated physician,
physician assistant and nurse practitioner equityholders.
Consulting Agreement with BIDON Companies
On January 16, 2001, EmCare entered into a management
services agreement with BIDON, Inc., the stock of which is owned
by William A. Sanger, Don S. Harvey and a third partner.
Pursuant to the agreement, BIDON provided consulting and
management services to EmCare, including the services of
Messrs. Sanger and Harvey on a substantially full-time
basis. The agreement provided that BIDON was entitled to a
management fee and an incentive bonus, as well as a performance
fee payable upon a change in control of EmCare. The agreement
expired in March 31, 2003 and Messrs. Sanger and
Harvey entered into employment agreements with EmCare at that
time. Pursuant to the agreement, EmCare paid total fees and
bonuses to BIDON, including expense reimbursement, of
$2.6 million and $2.3 million in fiscal 2002 and
fiscal 2003, respectively.
Other Related Party Transactions and Business
Relationships
Steven B. Epstein, one of our directors, is a founding member
and the senior health law partner in the Washington, D.C. firm
of Epstein, Becker & Green, P.C., or EBG. EBG provided
healthcare-related legal services to Onex in connection with our
acquisition of AMR and EmCare.
127
DESCRIPTION OF SENIOR SECURED CREDIT FACILITY
On February 10, 2005, we entered into a new senior secured
credit facility provided by a syndicate of banks and other
financial institutions led by Banc of America Securities LLC and
J.P. Morgan Securities Inc., as joint lead arrangers and
joint bookrunning managers, Bank of America, N.A., as
administrative agent and collateral agent, and JPMorgan Chase
Bank, N.A., as syndication agent. The senior secured credit
facility provides financing of $450 million, consisting of
a $350 million term loan with a maturity of seven years and
a $100 million revolving credit facility with a maturity of
six years.
Each of AMR HoldCo, Inc. and EmCare HoldCo, Inc., the issuers of
the notes, is a borrower under, and Emergency Medical Services
L.P. and all domestic subsidiaries of Emergency Medical Services
L.P. (other than the issuers) are the guarantors of, the senior
secured credit facility. The issuers’ obligations under the
senior secured credit facility are joint and several.
Term Loan. The full amount of the term loan was drawn on
February 10, 2005 and the proceeds were used to finance in
part our acquisition of AMR and EmCare and to pay related costs
and expenses. Amounts borrowed under the term loan are due in
quarterly installments, with 1% of the initial principal amount
of such loan to be payable in each of the first six years and
94% of the initial principal amount of such loan to be payable
in the final year. If we complete our initial public offering,
we intend to use a portion of the net proceeds to repay a
portion of the term loan. Amounts repaid under the term loan
will not be available for future borrowing.
Revolving Credit Facility. The revolving credit facility
includes a subfacility for letters of credit as well as a
swingline subfacility. The revolving credit facility financed a
portion of the acquisition on the closing date and, thereafter,
is available for general corporate purposes.
Interest Rates and Fees. The borrowings under the senior
secured credit facility bears interest at a rate equal to an
applicable margin plus, at the issuers’ option, either
(a) a base rate determined by reference to the higher of
(1) the base rate of Bank of America prime rate and
(2) the federal funds rate plus
1/2
of 1% or (b) a LIBOR rate. The current applicable margins
for borrowings under our senior secured credit facility are:
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in respect of the revolving credit facility, 1.75% with respect
to base rate loans and 2.75% with respect to LIBOR loans, and |
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in respect of the term loan, 1.50% with respect to base rate
loans and 2.50% with respect to LIBOR loans. |
The applicable margin in respect of our senior secured credit
facility will be adjusted from time to time based on the total
leverage ratio of Emergency Medical Services and its
subsidiaries.
In addition to paying interest on outstanding principal under
the senior secured credit facility, the issuers pay a commitment
fee to the lenders under the revolving credit facility in
respect of unutilized commitments thereunder at a rate equal to
0.50% per annum. The issuers also pay customary letter of
credit fees and fees of the administrative agent.
Prepayments. Subject to certain exceptions, the senior
secured credit facility must be prepaid in an amount equal to:
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100% of the net cash proceeds (1) from certain asset
dispositions by EMS L.P. or any of its subsidiaries, (2) of
extraordinary receipts received by EMS L.P. or any of its
subsidiaries, which include insurance proceeds and condemnation
awards and (3) from the incurrence after the date of the
initial borrowing under the senior secured credit facility of
certain additional debt by EMS L.P. or any of its subsidiaries, |
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50% of excess cash flow of EMS L.P. and its subsidiaries
(subject to reduction to a lower percentage based upon the total
leverage ratio of Emergency Medical Services and its
subsidiaries), and |
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50% of the net cash proceeds from the issuance of equity by, or
equity contributions to, EMS L.P. |
128
The issuers may prepay the senior secured credit facility at any
time in whole or in part without premium or penalty, except that
any prepayment of LIBOR rate advances other than at the end of
the applicable interest periods therefor shall be made with
reimbursement for any funding losses and redeployment costs of
the lenders resulting therefrom.
Collateral. The obligations under the senior secured
credit facility and all the guarantees are secured by
substantially all of the assets of the issuers and each
guarantor, including, but not limited to, the following, and
subject to certain exceptions:
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a pledge of 100% of the capital stock of the issuers and each
other direct and indirect domestic subsidiary of EMS L.P. and of
65% of the capital stock of each direct foreign subsidiary of
either of the issuers or any guarantor, and |
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a security interest in substantially all tangible and intangible
assets of EMS L.P., the other guarantors and the issuers. |
Certain Covenants and Events of Default. The senior
secured credit facility contains a number of covenants, that,
among other things, restrict, subject to certain exceptions, EMS
L.P.’s ability and the ability of EMS L.P.’s
subsidiaries to:
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create liens on assets, |
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make investments, loans, guarantees or advances, |
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incur additional indebtedness or issue capital stock, |
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engage in mergers, acquisitions or consolidations, |
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sell assets, |
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pay dividends, repurchase equity interests or make other
restricted payments, |
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change the business conducted by the issuers and their
subsidiaries, |
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engage in transactions with affiliates, |
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make capital expenditures, and |
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repay certain indebtedness (including the notes), or amend or
otherwise modify agreements governing subordinated indebtedness. |
In addition, the senior secured credit facility requires that
the issuers comply with certain financial covenants, including a
maximum total leverage ratio, a maximum senior leverage ratio
and a minimum fixed charge coverage ratio. The senior secured
credit facility contains customary representations and
warranties, affirmative covenants and events of default,
including, but not limited to, payment defaults, breach of
representations and warranties, covenant defaults,
cross-defaults to certain indebtedness, certain events of
bankruptcy, material judgments, the occurrence of certain ERISA
events and the occurrence of a change of control. If such an
event of default occurs, the lenders under the senior secured
credit facility are entitled to take various actions, including
the acceleration of the amounts due thereunder and all actions
permitted to be taken by a secured creditor.
129
DESCRIPTION OF NOTES
You can find the definitions of certain terms used in this
description under the subheading “— Certain
Definitions.” In this description, the word
“Issuers” refers only to AMR HoldCo and EmCare HoldCo,
and not to any of their respective subsidiaries,
“Parent” refers to Emergency Medical Services L.P. and
“Notes” or “these Notes” refers to the
outstanding notes and the exchange notes.
The Issuers issued the outstanding notes and will issue the
exchange notes, jointly and severally, under an Indenture (the
“Indenture”) among the Issuers, the Guarantors and
U.S. Bank Trust National Association, as trustee (the
“Trustee”), a copy of which is incorporated by
reference as an exhibit to the registration statement of which
this prospectus forms a part. The terms of the notes include
those stated in the Indenture and those made part of the
Indenture by reference to the Trust Indenture Act of 1939, as
amended (the “Trust Indenture Act”).
Brief Description of the Notes and the Guarantees
These Notes are:
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joint and several general unsecured obligations of the Issuers; |
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subordinated in right of payment to all Senior Debt of the
Issuers; |
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senior in right of payment to any future Indebtedness of the
Issuers that is expressly subordinated in right of payment to
the Notes; and |
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unconditionally guaranteed by the Guarantors. |
These Notes are initially guaranteed by Parent and each Domestic
Restricted Subsidiary of each of the Issuers.
The Parent Guarantee of these Notes is:
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a general unsecured obligation of Parent; |
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subordinated in right of payment to all Senior Debt of
Parent; and |
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senior in right of payment to any future Indebtedness of Parent
that is expressly subordinated in right of payment to the Parent
Guarantee. |
The Subsidiary Guarantees of these Notes are:
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general unsecured obligations of each Subsidiary Guarantor; |
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subordinated in right of payment to all Senior Debt of each
Subsidiary Guarantor; and |
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senior in right of payment to any future Indebtedness of each
Subsidiary Guarantor that is expressly subordinated in right of
payment to the Subsidiary Guarantee of that Subsidiary Guarantor. |
At June 30, 2005, the Issuers and the Guarantors have total
Senior Debt of approximately $349.1 million. As indicated
above and as discussed in detail below under the subheading
“Subordination,” payments on the Notes and under the
Guarantees are subordinated to the payment of Senior Debt. The
Indenture permits us, the Issuers and the Guarantors to incur
additional Senior Debt.
In addition, the Notes and the Guarantees are effectively
subordinated to all of Parent’s and the Guarantors’
secured Indebtedness to the extent of the value of the assets
securing such Indebtedness, and are structurally subordinated to
all liabilities and commitments (including trade payables and
lease obligations) of our Subsidiaries that are not guaranteeing
the Notes.
130
All of our subsidiaries are “Restricted Subsidiaries”
other than EMCA Insurance Company, Ltd. However, under the
circumstances described below under the subheading
“— Certain Covenants — Designation of
Restricted and Unrestricted Subsidiaries,” we are permitted
to designate certain of our subsidiaries as “Unrestricted
Subsidiaries.” Unrestricted Subsidiaries are not subject to
many of the restrictive covenants in the Indenture. Unrestricted
Subsidiaries are not guaranteeing the Notes.
Principal, Maturity and Interest
The Issuers initially issued $250.0 million aggregate
principal amount of notes in a private offering. The Issuers
issued the outstanding notes and will issue the exchange notes
in denominations of $1,000 and integral multiples of $1,000. The
Notes will mature on February 15, 2015.
Interest on these Notes will accrue at the rate of 10% per
annum and will be payable semi-annually in arrears on February
15 and August 15, commencing on August 15, 2005. The
Issuers will make each interest payment to the Holders of record
of these Notes on the immediately preceding February 1 and
August 1. Interest on these Notes accrues from the date of
original issuance or, if interest has already been paid, from
the date it was most recently paid. Interest is computed on the
basis of a 360-day year comprised of twelve 30-day months.
Additional Notes may be issued from time to time after this
exchange offer, subject to the provisions of the Indenture
described below under the caption “— Certain
Covenants — Incurrence of Indebtedness and Issuance of
Preferred Stock.” The outstanding notes, the exchange notes
and any additional Notes subsequently issued under the Indenture
would be treated as a single class for all purposes under the
Indenture, including, without limitation, waivers, amendments,
redemptions and offers to purchase.
Methods of Receiving Payments on the Notes
All payments on these Notes are to be made at the office or
agency of the Paying Agent and Registrar within the City and
State of New York unless the Issuers elect to make interest
payments by check mailed to the Holders at their address set
forth in the register of Holders.
Paying Agents and Registrar for the Notes
The Trustee is initially acting as Paying Agent and Registrar.
The Issuers may change the Paying Agent or Registrar without
prior notice to the Holders of the Notes, and the Issuers or any
of the Guarantors may act as Paying Agent or Registrar.
Transfer and Exchange
A Holder may transfer or exchange Notes in accordance with the
Indenture. The Registrar and the Trustee may require a Holder,
among other things, to furnish appropriate endorsements and
transfer documents and the Issuers may require a Holder to pay
any taxes and fees required by law or permitted by the
Indenture. The Issuers are not required to transfer or exchange
any Note selected for redemption. Also, the Issuers are not
required to transfer or exchange any Note for a period of
15 days before a selection of Notes to be redeemed.
The registered Holder of a Note is treated as the owner of it
for all purposes.
Guarantees
The Guarantors jointly and severally guarantee, on a senior
subordinated basis, the Issuers’ obligations under the
Notes. The Parent Guarantee is subordinated to the prior payment
in full of all Senior Debt of Parent. Each Subsidiary Guarantee
is subordinated to the prior payment in full of all Senior Debt
of that Subsidiary Guarantor. The obligations of each Guarantor
under its Guarantee are limited as necessary to prevent such
Guarantee from constituting a fraudulent conveyance under
applicable law. See “Risk Factors — Risk Factors
Related to the Notes — Federal and state laws permit
courts to void guarantees under certain circumstances and would
require you to return payments received from guarantors in
specific circumstances.”
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The Subsidiary Guarantee of a Subsidiary Guarantor will be
released:
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(1) in connection with any sale or
other disposition of all or substantially all of the assets of
such Subsidiary Guarantor (including by way of merger or
consolidation), if the Issuer that directly or indirectly owns
such Subsidiary Guarantor applies the Net Proceeds of such sale
or other disposition in accordance with the applicable
provisions of the Indenture; or |
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(2) in connection with the sale of
all of the capital stock of a Subsidiary Guarantor, if the
Issuer that directly or indirectly owns such Subsidiary
Guarantor applies the Net Proceeds of such sale in accordance
with the applicable provisions of the Indenture; or |
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(3) in connection with any
transaction which results in a Subsidiary Guarantor ceasing to
be a Restricted Subsidiary of an Issuer, if the transaction is
not in violation of the applicable provisions of the
Indenture; or |
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(4) if an Issuer designates any
Restricted Subsidiary of such Issuer that is a Subsidiary
Guarantor as an Unrestricted Subsidiary, in accordance with the
applicable provisions of the Indenture; or |
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(5) if a Subsidiary Guarantor has
no outstanding Indebtedness after giving effect to such release
other than pursuant to clause (2), (4), (5), (6) (with
respect to Permitted Refinancing Indebtedness in respect of
Indebtedness initially incurred under clause (2) or
(5) only), (7), (10), (11), (12), (13), (14) or
(15) of the “Incurrence of Indebtedness and Issuance
of Preferred Stock” covenant or pursuant to clause (9)
of such covenant (with respect to Indebtedness incurred under
any of the foregoing clauses) and an Officers’ Certificate
certifying the foregoing is presented to the Trustee together
with a request to release such Subsidiary Guarantor from its
Subsidiary Guarantee. |
See “— Repurchase at the Option of
Holders — Asset Sales.”
Subordination
The payment of all Obligations on these Notes and the Guarantees
is subordinated to the prior payment in full of all Senior Debt
of the Issuers and the Guarantors.
The holders of Senior Debt will be entitled to receive payment
in full in cash or Cash Equivalents of all amounts due or to
become due in respect of Senior Debt before the Holders of Notes
will be entitled to receive any payment with respect to the
Notes (except that Holders of Notes may receive Reorganization
Securities) or the Guarantees, in the event of any distribution
to creditors of an Issuer or a Guarantor in any Insolvency or
Liquidation Proceeding with respect to such Person. Upon any
such Insolvency or Liquidation Proceeding, any payment or
distribution of assets of an Issuer or a Guarantor of any kind
or character, whether in cash, property or securities (other
than Reorganization Securities), to which the Holders of the
Notes or the Trustee would be entitled will be paid by such
Person or by any receiver, trustee in bankruptcy, liquidating
trustee, agent or other person making such payment or
distribution, or by the Holders of the Notes or by the Trustee
if received by them, directly to the holders of Senior Debt (pro
rata to such holders on the basis of the amounts of Senior Debt
held by such holders) or their Representative or
Representatives, as their interests may appear, for application
to the payment of the Senior Debt remaining unpaid until all
such Senior Debt has been paid in full in cash or Cash
Equivalents, after giving effect to any concurrent payment,
distribution or provision therefor to or for the holders of
Senior Debt.
Also, no Issuer or Guarantor may make any payment in respect of
the Notes or the Guarantees, as the case may be (except in
Reorganization Securities), if:
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(1) a payment default on Designated
Senior Debt occurs and is continuing; or |
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(2) any other default occurs and is
continuing on Designated Senior Debt that permits holders of the
Designated Senior Debt to accelerate its maturity and the
Trustee receives a notice of such default (a “Payment
Blockage Notice”) from the Administrative Agent or the
holders or the Representative of any Designated Senior Debt. |
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Payments on the Notes and the Guarantees may and shall be
resumed:
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(1) in the case of a payment
default, upon the date on which such default is cured or
waived; and |
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(2) in case of a nonpayment
default, the earliest of (a) the date on which such
nonpayment default is cured or waived, (b) 179 days
after the date on which the applicable Payment Blockage Notice
is received and (c) the date on which the Trustee receives
written notice from the Administrative Agent or the
Representative for such Designated Senior Debt, as the case may
be, rescinding the applicable Payment Blockage Notice, unless
the maturity of any Designated Senior Debt has been accelerated. |
During any 360-day period, the aggregate of all periods for
which a Payment Blockage Notice shall be effective (each, a
“Payment Blockage Period”) shall not exceed
179 days and there shall be a period of at least 181
consecutive days in each consecutive 360-day period when no
Payment Blockage Period is in effect. No event of default which
existed or was continuing with respect to the Senior Debt for
which a any Payment Blockage Notice was given on the date such
Payment Blockage Period commenced shall be made if the basis for
the commencement of any subsequent Payment Blockage Period
unless such event of default is cured or waived for a period of
not less than 90 consecutive days.
Notwithstanding anything to the contrary, payments and
distributions made from the trust established pursuant to the
provisions described under “— Satisfaction and
Discharge” or “— Legal Defeasance and
Covenant Defeasance” will be permitted and will not be
subordinated so long as the payments into the trust were made in
accordance with the requirements described under
“— Satisfaction and Discharge” or
“— Legal Defeasance and Covenant Defeasance”
and did not violate the subordination provisions when they were
made.
As a result of the subordination provisions described above, in
the event of a bankruptcy, liquidation or reorganization of an
Issuer, Holders of these Notes may recover less ratably than
creditors of such Issuer who are holders of Senior Debt. See
“Risk Factors — Risk Factors Related to the
Notes — Your right to receive payments on the notes is
junior to our existing and future senior debt, and the existing
and future senior debt of the guarantors, including borrowings
under our senior secured credit facility.” The Issuers and
their Restricted Subsidiaries are subject to certain financial
tests limiting the amount of additional Indebtedness that the
Issuers and their Restricted Subsidiaries can incur. See
“— Certain Covenants — Incurrence of
Indebtedness and Issuance of Preferred Stock.”
Optional Redemption
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Redemption with Proceeds from Equity Offerings |
At any time prior to February 15, 2008, the Issuers may, on
one or more occasions, redeem up to 35% of the aggregate
principal amount of Notes issued under the Indenture (calculated
after giving effect to the issuance of additional Notes) at a
redemption price of 110% of the principal amount thereof, plus
accrued and unpaid interest to the redemption date, with the net
cash proceeds of one or more Equity Offerings; provided
that:
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(1) at least 65% of the aggregate
principal amount of Notes (calculated after giving effect to the
issuance of additional Notes) issued under the Indenture remains
outstanding immediately after the occurrence of such redemption
(excluding Notes held by the Issuers and their
Subsidiaries); and |
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(2) the redemption must occur
within 90 days of the date of the closing of such Equity
Offering. |
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Redemption on or after February 15, 2010 |
On or after February 15, 2010, the Issuers may, on one or
more occasions, redeem all or a part of these Notes, upon not
less than 30 nor more than 60 days’ notice, at the
redemption prices (expressed as percentages of principal amount)
set forth below plus accrued and unpaid interest thereon, to the
applicable
133
redemption date, if redeemed during the twelve-month period
beginning on February 15 of the years indicated below:
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Year |
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Percentage | |
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2010
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105.000% |
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2011
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103.333% |
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2012
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101.667% |
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2013 and thereafter
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100.000% |
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Selection and Notice
If less than all of the Notes are to be redeemed at any time,
the Trustee will select Notes for redemption as follows:
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(1) if the Notes are listed, in
compliance with the requirements of the principal national
securities exchange on which the Notes are listed; or |
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(2) if the Notes are not so listed,
on a pro rata basis, by lot or by such method as the Trustee
shall deem fair and appropriate. |
In addition, if a partial redemption is made pursuant to the
provisions described under “— Optional
Redemption — Redemption with Proceeds from Equity
Offerings,” selection of the Notes or portions thereof for
redemption shall be made by the Trustee only on a
pro rata basis or on as nearly a
pro rata basis as is practicable (subject to the
procedures of The Depository Trust Company), unless that method
is otherwise prohibited.
No Notes of $1,000 or less shall be redeemed in part. Notices of
redemption shall be mailed by first class mail at least 30 but
not more than 60 days before the redemption date to each
Holder of Notes to be redeemed at its registered address.
Notices of redemption may not be conditional.
If any Note is to be redeemed in part only, the notice of
redemption that relates to that Note shall state the portion of
the principal amount thereof to be redeemed. A new Note in
principal amount equal to the unredeemed portion of the original
Note will be issued in the name of the Holder thereof upon
cancellation of the original Note. Notes called for redemption
become due on the date fixed for redemption. On and after the
redemption date, interest ceases to accrue on Notes or portions
of them called for redemption.
Mandatory Redemption
Except as set forth below under “— Repurchase at
the Option of Holders,” the Issuers are not required to
make mandatory redemption or sinking fund payments with respect
to the Notes.
Repurchase at the Option of Holders
If a Change of Control occurs, each Holder of Notes will have
the right to require the Issuers to repurchase all or any part
(equal to $1,000 or an integral multiple thereof) of that
Holder’s Notes pursuant to the Change of Control Offer. In
the Change of Control Offer, the Issuers will offer a Change of
Control Payment in cash equal to 101% of the aggregate principal
amount of Notes repurchased plus accrued and unpaid interest
thereon, if any, to the date of purchase. Within 60 days
following any Change of Control, the Issuers will mail a notice
to each Holder describing the transaction or transactions that
constitute the Change of Control and offering to repurchase
Notes on a date no earlier than 30 days and no later than
60 days from the date the notice is mailed, other than as
may be required by law, (the “Change of Control Payment
Date”), pursuant to the procedures required by the
Indenture and described in such notice. The Issuers will comply
with the requirements of Rule 14e-l under the Exchange Act
and any other securities laws and regulations thereunder to the
extent such laws and regulations are applicable in connection
with the repurchase of the Notes as a result of a Change of
Control. To the extent that the provisions of any securities
134
laws or regulations conflict with the provisions of the
Indenture relating to such Change of Control Offer, the Issuers
will comply with the applicable securities laws and regulations
and shall not be deemed to have breached their obligations
described in the Indenture by virtue thereof.
On the Change of Control Payment Date, the Issuers will, to the
extent lawful:
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(1) accept for payment all Notes or
portions thereof in minimum amounts equal to $1,000 or an
integral multiple of $1,000 in excess thereof properly tendered
pursuant to the Change of Control Offer; |
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(2) deposit with the Paying Agent
an amount equal to the Change of Control Payment in respect of
all Notes or portions thereof so tendered; and |
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(3) deliver or cause to be
delivered to the Trustee the Notes so accepted together with an
Officers’ Certificate stating the aggregate principal
amount of Notes or portions thereof being purchased by the
Issuers. |
The Paying Agent will promptly mail to each Holder of Notes so
tendered the Change of Control Payment for such Notes, and the
Trustee will promptly authenticate and mail (or cause to be
transferred by book entry) to each Holder a new Note equal in
principal amount to any unpurchased portion of the Notes
surrendered, if any; provided that each such new Note
will be in a principal amount of $1,000 or an integral multiple
thereof.
Prior to complying with any of the provisions of this
“Change of Control” covenant, but in any event within
90 days following a Change of Control, the Issuers will
either repay all outstanding Senior Debt or obtain the requisite
consents, if any, under all agreements governing outstanding
Senior Debt to permit the repurchase of Notes required by this
covenant. The Issuers will publicly announce the results of the
Change of Control Offer on or as soon as practicable after the
Change of Control Payment Date.
The provisions described above that require the Issuers to make
a Change of Control Offer following a Change of Control will be
applicable regardless of whether or not any other provisions of
the Indenture are applicable. Except as described above with
respect to a Change of Control, the Indenture does not contain
provisions that permit the Holders of the Notes to require that
the Issuers repurchase or redeem the Notes in the event of a
takeover, recapitalization or similar transaction.
The Issuers’ Senior Debt prohibits the Issuers from
purchasing any Notes in the event of a Change of Control, and
also provides that certain change of control events with respect
to the Issuers would constitute a default under the agreements
governing the Senior Debt. Any future credit agreements or other
agreements relating to Senior Debt to which the Issuers become a
party may contain similar restrictions and provisions. In the
event a Change of Control occurs at a time when the Issuers are
prohibited from purchasing Notes, the Issuers could seek the
consent of their senior lenders to the purchase of Notes or
could attempt to refinance the borrowings that contain such
prohibition. If the Issuers do not obtain such a consent or
repay such borrowings, the Issuers will remain prohibited from
purchasing Notes. In such case, the Issuers’ failure to
purchase tendered Notes would constitute an Event of Default
under the Indenture which would, in turn, constitute a default
under such Senior Debt. In such circumstances, the subordination
provisions in the Indenture would likely restrict payments to
the Holders of Notes.
The Issuers will not be required to make a Change of Control
Offer upon a Change of Control if a third party makes the Change
of Control Offer in the manner, at the times and otherwise in
compliance with the requirements set forth in the Indenture
applicable to a Change of Control Offer made by the Issuers and
purchases all Notes validly tendered and not withdrawn under
such Change of Control Offer.
The definition of Change of Control includes a phrase relating
to the sale, lease, transfer, conveyance or other disposition of
“all or substantially all” of the assets of the
Issuers and their respective Subsidiaries taken as a whole.
Although there is a limited body of case law interpreting the
phrase “substantially all,” no precise, established
definition of the phrase exists under applicable law.
Accordingly, the ability of a Holder of Notes to require the
Issuers to repurchase such Notes as a result of a sale, lease,
transfer, conveyance or other disposition of less than all of
the assets of the Issuers and their respective Subsidiaries
taken as a whole to another Person or group may be uncertain.
135
The Issuers will not, and will not permit any of their
respective Restricted Subsidiaries to, consummate an Asset Sale
unless:
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(1) such Issuer (or such Restricted
Subsidiary, as the case may be) receives consideration at the
time of such Asset Sale at least equal to the fair market value
of the assets or Equity Interests issued or sold or otherwise
disposed of; |
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(2) such fair market value, if
greater than $5.0 million, is certified to the Trustee in
an Officers’ Certificate; |
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(3) at least 75% of the
consideration received therefor by such Issuer (or such
Restricted Subsidiary, as the case may be) is in the form of
cash or Cash Equivalents. For purposes of this provision, each
of the following shall be deemed to be cash: |
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(a) |
any liabilities of an Issuer or any Restricted Subsidiary (as
shown on the most recent consolidated balance sheet of either
Issuer and its Restricted Subsidiaries other than contingent
liabilities and liabilities that are by their terms subordinated
to the Notes or any Subsidiary Guarantee) that are assumed by
the transferee of any such assets pursuant to an agreement that
releases any such Issuer or any such Restricted Subsidiary from
further liability with respect to such liabilities; |
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(b) |
any securities, notes or other obligations received by such
Issuer or any such Restricted Subsidiary from such transferee
that are converted by such Issuer or such Restricted Subsidiary
into cash or Cash Equivalents within 180 days (to the
extent of the cash or Cash Equivalents received in that
conversion); and |
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(c) |
any Equity Interests or assets of the kind referred to in
clause (2) or (4) of the following paragraph. |
Within 365 days after the receipt of any Net Proceeds from
an Asset Sale, such Issuer or any such Restricted Subsidiary may
apply such Net Proceeds, at its option:
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(1) to repay or repurchase Senior
Debt of such Issuer or any such Guarantor or any Indebtedness of
any Restricted Subsidiary that is not a Guarantor; |
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(2) to acquire Equity Interests in
a Person engaged in a Permitted Business if such Person is, or
will become as a result thereof, a Restricted Subsidiary; |
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(3) to make a capital expenditure
in a Permitted Business; or |
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(4) to acquire assets (other than
securities) to be used in a Permitted Business. |
Pending the final application of any such Net Proceeds, the
Issuers may temporarily reduce the revolving Indebtedness under
the Senior Credit Facilities or otherwise invest such Net
Proceeds in any manner that is not prohibited by the Indenture.
Any Net Proceeds from Asset Sales that are not applied or
invested as provided in the preceding paragraph will constitute
Excess Proceeds. When the aggregate amount of Excess Proceeds
exceeds $15.0 million, the Issuers will be required to make
an offer to purchase from all Holders of Notes (an “Asset
Sale Offer”) and, if applicable, redeem or purchase (or
make an offer to do so) any Pari Passu Indebtedness of the
Issuers, the provisions of which require the Issuers to redeem
or purchase (or make an offer to do so) such Indebtedness with
the proceeds from any Asset Sales, the maximum aggregate
principal amount of Notes and such Pari Passu Indebtedness that
may be purchased (on a pro rata basis) with such Excess
Proceeds. The offer price for the Notes in any Asset Sale Offer
will be equal to 100% of principal amount plus accrued and
unpaid interest, if any, to the date of purchase, and will be
payable in cash and the redemption or purchase price for such
Pari Passu Indebtedness shall be as set forth in the related
documentation governing such Indebtedness. If any Excess
Proceeds remain after consummation of an Asset Sale Offer, the
Issuers may use such Excess Proceeds for general corporate
purposes. If the aggregate
136
principal amount of Notes and other Pari Passu Indebtedness
tendered and into such Asset Sale Offer exceeds the amount of
Excess Proceeds, the Trustee shall select the Notes to be
purchased on a pro rata basis. Upon completion of each Asset
Sale Offer, the amount of Excess Proceeds shall be reset at zero.
Certain Covenants
The Issuers will not, and will not permit any of their
respective Restricted Subsidiaries to, directly or indirectly:
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(1) declare or pay any dividend or
make any other payment or distribution on account of an
Issuer’s or any of their respective Restricted
Subsidiary’s Equity Interests (including, without
limitation, any payment on such Equity Interests in connection
with any merger or consolidation involving an Issuer) or to the
direct or indirect holders of an Issuer’s or any of their
respective Restricted Subsidiary’s Equity Interests in
their capacity as such other than dividends or distributions
payable in Qualified Equity Interests; |
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(2) purchase, redeem or otherwise
acquire or retire for value (including without limitation, in
connection with any merger or consolidation involving an Issuer)
any Equity Interests of an Issuer or any direct or indirect
parent of an Issuer; |
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(3) make any payment on or with
respect to, or purchase, redeem, defease or otherwise acquire or
retire for value any Indebtedness that is subordinated to the
Notes or the Subsidiary Guarantees, except (i) payments of
interest or principal at Stated Maturity thereof,
(ii) payments of interest or principal on or in respect of
Indebtedness owed to and held by an Issuer or any Restricted
Subsidiary and (iii) payments, purchases, redemptions,
defeasances or other acquisitions or retirements for value in
anticipation of satisfying a scheduled maturity, sinking fund or
amortization or other installment obligation or mandatory
redemption, in each case, due within one year of the Stated
Maturity thereof; or |
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(4) make any Restricted Investment |
(all such payments and other actions set forth in
clauses (1) through (4) above being collectively referred
to as “Restricted Payments”); unless, at the time of
and after giving effect to such Restricted Payment:
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(1) no Default or Event of Default
shall have occurred and be continuing or would occur as a
consequence thereof; |
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(2) the Issuers would, after giving
pro forma effect thereto as if such Restricted Payment had been
made at the beginning of the applicable four-quarter period,
have been permitted to incur at least $1.00 of additional
Indebtedness pursuant to the Fixed Charge Coverage Ratio test
set forth in the first paragraph of the covenant described below
under the caption “— Incurrence of Indebtedness
and Issuance of Preferred Stock”; and |
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(3) such Restricted Payment,
together with the aggregate amount of all other Restricted
Payments made by the Issuers and their respective Restricted
Subsidiaries after the Issue Date (excluding Restricted Payments
permitted by clauses (2), (3), (4), (6), (7), (8), (9) and
(10) of the next succeeding paragraph), is not greater than the
sum, without duplication, of: |
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(a) 50% of the combined
Consolidated Net Income of the Issuers for the period (taken as
one accounting period) from the beginning of the fiscal quarter
in which the Issue Date occurs to the end of the Issuers’
most recently ended fiscal quarter for which internal financial
statements are available at the time of such Restricted Payment
(or, if such Consolidated Net Income for such period is a
deficit, less 100% of such deficit); plus |
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(b) 100% of the aggregate net cash
proceeds received by an Issuer as a contribution to such
Issuer’s capital or received by an Issuer from the issue or
sale since the Issue Date (other than to a Subsidiary of such
Issuer) of Qualified Equity Interests or of Disqualified Stock
or debt securities of such Issuer that have been converted into
Qualified Equity Interests; plus |
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(c) to the extent that any
Restricted Investment that was made after the Issue Date is sold
for cash or Cash Equivalents or otherwise liquidated or repaid
for cash or Cash Equivalents or becomes an interest in a
Restricted Subsidiary of an Issuer, the lesser of (i) the
return of capital with respect to such Restricted Investment
(less the cost of disposition, if any) and (ii) the initial
amount of such Restricted Investment; plus |
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(d) if any Unrestricted Subsidiary
(i) is redesignated as a Restricted Subsidiary, the fair
market value of such redesignated Unrestricted Subsidiary (as
certified to the Trustee in an Officers’ Certificate) as of
the date of its redesignation or (ii) pays any cash
dividends or cash distributions to an Issuer or any Restricted
Subsidiary of an Issuer, 100% of any such cash dividends or cash
distributions made after the Issue Date. |
The preceding provisions will not prohibit:
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(1) the payment of any dividend
within 60 days after the date of declaration thereof, if at
such date of declaration such payment would have complied with
the provisions of the Indenture; |
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(2) the redemption, repurchase,
retirement, defeasance or other acquisition of any subordinated
Indebtedness or Equity Interests of an Issuer or any Restricted
Subsidiary of an Issuer in exchange for, or out of the net cash
proceeds of the substantially concurrent sale or issuance (other
than to a Subsidiary of such Issuer) of, Qualified Equity
Interests; provided that the amount of any such net cash
proceeds that are utilized for any such redemption, repurchase,
retirement, defeasance or other acquisition shall be excluded
from clause (3)(b) of the preceding paragraph; |
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(3) the defeasance, redemption,
repurchase, repayment or other acquisition of subordinated
Indebtedness of an Issuer or any Restricted Subsidiaries of an
Issuer with the net cash proceeds from an incurrence of
Permitted Refinancing Indebtedness; |
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(4) the payment of any dividend (or
in the case of any partnership or limited liability company, any
similar distribution) by a Restricted Subsidiary of an Issuer to
the holders of its Equity Interests on a pro rata basis, taking
into account the relative preferences, if any, of the various
classes of equity interests in such Restricted Subsidiary; |
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(5) the repurchase, redemption or
other acquisition or retirement for value of any Equity
Interests of an Issuer held by any current or former officer,
director, consultant or employee of an Issuer or any Restricted
Subsidiary of an Issuer (or any permitted transferees, assigns,
estates or heirs of any of the foregoing); provided,
however, the aggregate price paid by the Issuers and their
respective Restricted Subsidiaries shall not exceed
$5.0 million in any calendar year (excluding for purposes
of calculating such amount the purchase price of Equity
Interests repurchased, redeemed, acquired or retired with the
proceeds from the repayment of loans by an Issuer or a
Restricted Subsidiary of an Issuer made for the purpose of
purchasing such Equity Interests), with unused amounts in any
calendar year being carried over for one additional calendar
year; |
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(6) the declaration and payment of
dividends on Disqualified Stock in accordance with the
certificate of designations therefor; provided that at
the time of issuance of such Disqualified Stock, the Issuers
would, after giving pro forma effect thereto as if such issuance
had been made at the beginning of the applicable four-quarter
period, have been permitted to incur at least $1.00 of
additional Indebtedness pursuant to the Fixed Charge Coverage
Ratio test set forth in the first paragraph of the covenant
described below under the caption “— Incurrence
of Indebtedness and Issuance of Preferred Stock”; |
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(7) repurchases of Equity Interests
deemed to occur upon the exercise of stock options to the extent
that such Equity Interests represent a portion of the exercise
price thereof; |
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(8) payments permitted under
clauses (7), (8) and (9) under the caption
“— Transactions with Affiliates”; |
138
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(9) payments made to purchase,
redeem, defease or otherwise acquire or retire for value any
Equity Interests of an Issuer or any Restricted Subsidiary of an
Issuer or any subordinated Indebtedness of an Issuer or a
Guarantor (other than Equity Interests or subordinated
Indebtedness issued to or at any time held by an Affiliate of
any such Person), in each case, pursuant to provisions requiring
such Person to offer to purchase, redeem, defease or otherwise
acquire or retire for value such Equity Interests or
subordinated Indebtedness upon the occurrence of a Change of
Control or with the proceeds of Asset Sales as defined in the
charter provisions, agreements or instruments governing such
Equity Interests or subordinated Indebtedness; provided,
however, that a Change of Control Offer or Asset Sale Offer,
as applicable, has been made and the Issuer has purchased all
Notes validly tendered in connection with that Change of Control
Offer or Asset Sale Offer; and |
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(10) other Restricted Payments in
an aggregate amount up to $20.0 million; |
provided that, in the case of clause (5), (6), (9)
or (10), no Default or Event of Default shall have occurred and
be continuing or would occur as a consequence of the making of
the Restricted Payment contemplated thereby.
The amount of all Restricted Payments (other than cash) shall be
the fair market value on the date of the Restricted Payment of
the asset(s) or securities proposed to be transferred or issued
by such Issuers or such Restricted Subsidiary, as the case may
be, pursuant to the Restricted Payment. Not later than the date
of making any Restricted Payment, the Issuers shall deliver to
the Trustee an Officers’ Certificate stating that such
Restricted Payment is permitted and setting forth the basis upon
which the calculations required by this “Restricted
Payments” covenant were computed, together with a copy of
any fairness opinion or appraisal required by the Indenture. The
fair market value of any non-cash Restricted Payment shall be
certified to the Trustee in such Officers’ Certificate.
Such Officers’ Certificate must be based upon an opinion or
appraisal issued by an accounting, appraisal or investment
banking firm of national standing if such fair market value
exceeds $20.0 million.
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Incurrence of Indebtedness and Issuance of Preferred
Stock |
The Issuers will not, and will not permit any of their
respective Restricted Subsidiaries to, directly or indirectly,
create, incur, issue, assume, guarantee or otherwise become
directly or indirectly liable, contingently or otherwise, with
respect to (collectively, “incur”) any Indebtedness
(including Acquired Debt) and the Issuers will not issue any
Disqualified Stock and will not permit any of their respective
Restricted Subsidiaries to issue any shares of preferred stock;
provided, however, that the Issuers or any of the
Subsidiary Guarantors may incur Indebtedness (including Acquired
Debt), the Issuers may issue Disqualified Stock and any of the
Subsidiary Guarantors may issue preferred stock if the Fixed
Charge Coverage Ratio for the Issuers’ most recently ended
four full fiscal quarters for which internal financial
statements are available immediately preceding the date on which
such additional Indebtedness is incurred or such Disqualified
Stock or preferred stock is issued would have been at least 2.0
to 1.0, determined on a pro forma basis (including a pro forma
application of the net proceeds therefrom), as if the additional
Indebtedness had been incurred, or the Disqualified Stock or
preferred stock had been issued, as the case may be, at the
beginning of such four-quarter period.
The first paragraph of this covenant will not prohibit the
incurrence of any or the following items of Indebtedness
(collectively, “Permitted Debt”):
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(1) the incurrence by an Issuer or
any Restricted Subsidiary of an Issuer of Indebtedness and
reimbursement obligations in respect of letters of credit
pursuant to the Senior Credit Facilities; provided that
the aggregate amount of all Indebtedness then classified as
having been incurred in reliance upon this clause (1) that
remains outstanding under the Senior Credit Facilities after
giving effect to such incurrence does not exceed an amount equal
to $450.0 million less, to the extent a permanent
repayment and/or commitment reduction is required thereunder as
a result of such application, the aggregate amount of Net
Proceeds applied to repayments under the Senior Credit
Facilities in accordance with the covenant described under
“— Repurchase at the Option of
Holders — Asset Sales”; |
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(2) the incurrence by an Issuer or
any Restricted Subsidiary of an Issuer of Existing Indebtedness; |
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(3) the incurrence by the Issuers
and the Subsidiary Guarantors of Indebtedness represented by the
Notes originally issued on the Issue Date and the Subsidiary
Guarantees, and the Exchange Securities to be issued pursuant to
the Registration Rights Agreement in respect thereof; |
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(4) the incurrence by an Issuer or
any Restricted Subsidiary of an Issuer of Indebtedness
represented by Capital Lease Obligations, mortgage financings or
purchase money obligations, in each case incurred for the
purpose of financing all or any part of the purchase price or
cost of construction or improvement of property, plant or
equipment used or useful in the business of an Issuer or such
Restricted Subsidiary (whether through the direct purchase of
assets or the Capital Stock of any Person owning such Assets) in
an aggregate principal amount or accreted value, as applicable,
not to exceed at any time outstanding the greater of
$25.0 million and 2.5% of Total Assets at the time of any
incurrence under this clause (4); |
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(5) the incurrence by an Issuer or
any Restricted Subsidiary of an Issuer of Indebtedness in
connection with the acquisition of assets or a new Restricted
Subsidiary; provided that such Indebtedness was incurred
by the prior owner of such assets or such Restricted Subsidiary
prior to such acquisition by an Issuer or one of its
Subsidiaries and was not incurred in connection with, or in
contemplation of, such acquisition by an Issuer or a Subsidiary
of an Issuer; provided further, that the principal amount
(or accreted value, as applicable) of such Indebtedness,
together with any other outstanding Indebtedness incurred
pursuant to this clause (5), and Permitted Refinancing
Indebtedness in respect thereof, does not exceed
$25.0 million; |
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(6) the incurrence by an Issuer or
any Restricted Subsidiary of an Issuer of Permitted Refinancing
Indebtedness in exchange for, or the net proceeds of which are
used to refund, refinance or replace Indebtedness incurred
pursuant to the first paragraph of this “Incurrence of
Indebtedness and Issuance of Preferred Stock” covenant,
clause (2) or (3) above or this clause (6); |
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(7) the incurrence by an Issuer or
any Restricted Subsidiary of an Issuer of intercompany
Indebtedness between or among an Issuer and another Issuer or
between an Issuer and any Restricted Subsidiary of an Issuer;
provided, however, that: |
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(a) if an Issuer or any Subsidiary
Guarantor is the obligor on such Indebtedness and the payee is
not the Issuer or a Subsidiary Guarantor, such Indebtedness must
be expressly subordinated to the prior payment in full in cash
of all Obligations with respect to the Notes, in the case of an
Issuer, or the Guarantee of such Subsidiary Guarantor, in the
case of a Subsidiary Guarantor; and |
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(b) (i) any subsequent
issuance or transfer of Equity Interests that results in any
such Indebtedness being held by a Person other than an Issuer or
a Restricted Subsidiary of an Issuer or (ii) any sale or
other transfer of any such Indebtedness to a Person that is not
either an Issuer or a Restricted Subsidiary of an Issuer shall
be deemed, in each case, to constitute an incurrence of such
Indebtedness by such Issuer or such Restricted Subsidiary, as
the case may be, not permitted by this clause (7); |
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(8) the incurrence by an Issuer or
any Restricted Subsidiary of an Issuer of Hedging Obligations
incurred for the purpose of fixing or hedging interest rate risk
with respect to any floating rate Indebtedness that is permitted
by the terms of the Indenture to be outstanding; |
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(9) the Guarantee by an Issuer or a
Subsidiary Guarantor of Indebtedness of an Issuer or a
Subsidiary Guarantor that was permitted to be incurred by
another provision of this covenant; |
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(10) the issuance by a Restricted
Subsidiary of an Issuer to an Issuer or any Restricted
Subsidiary that is a Wholly-Owned Subsidiary of an Issuer of
preferred stock; provided that (a) any subsequent
issuance or transfer of Equity Interests that results in any
such preferred stock being held by a Person other than an Issuer
or a Subsidiary Guarantor and (b) any sale or other
transfer of any such preferred stock to a Person that is neither
an Issuer nor a Restricted Subsidiary of an Issuer shall be
deemed, in |
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each case, to constitute an issuance of such preferred stock by
such Subsidiary Guarantor that is not permitted by this
clause (10); |
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(11) the incurrence by an Issuer or
any Restricted Subsidiary of an Issuer in respect of
workers’ compensation claims, self-insurance obligations,
indemnities, bankers’ acceptances, performance, completion
and surety bonds or guarantees, and similar types of obligations
in the ordinary course of business; |
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(12) Indebtedness arising from
agreements of an Issuer or any Restricted Subsidiary of an
Issuer providing for indemnification, adjustment of purchase
price or similar obligations, in each case, incurred or assumed
in connection with the disposition of any business, asset or
Subsidiary, other than guarantees of Indebtedness incurred by
any Person acquiring all or any portion of such business, assets
or Subsidiary for the purpose of financing such acquisition;
provided that (a) such Indebtedness is not reflected
on the balance sheet of an Issuer or any Restricted Subsidiary
of an Issuer (contingent obligations referred to in a footnote
or footnotes to financial statements and not otherwise reflected
on the balance sheet will not be deemed to be reflected on such
balance sheet for purposes of this clause (a)) and
(b) the maximum assumable liability in respect of such
Indebtedness shall at no time exceed the gross proceeds
including non-cash proceeds (the fair market value of such
non-cash proceeds being measured at the time received and
without giving effect to any such subsequent changes in value)
actually received by such Issuer and/or such Restricted
Subsidiary in connection with such disposition; |
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(13) the incurrence by an Issuer or
any Restricted Subsidiary of an Issuer of Indebtedness arising
from the honoring by a bank or other financial institution of a
check, draft or similar instrument inadvertently drawn against
insufficient funds, so long as such Indebtedness is covered
within five business days; |
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(14) Indebtedness of the type
described in clause (6)(a) of the definition thereof
together with contingent liabilities arising out of transactions
contemplated thereby not to exceed $20.0 million at any one
time outstanding; and |
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(15) the incurrence by an Issuer or
any Restricted Subsidiary of an Issuer of additional
Indebtedness in an aggregate principal amount (or accreted
value, as applicable) at any time outstanding, including all
Permitted Refinancing Indebtedness incurred to refund, refinance
or replace any other Indebtedness incurred pursuant to this
clause (15), not to exceed $25.0 million. |
For purposes of determining compliance with this
“Incurrence of Indebtedness and Issuance of Preferred
Stock” covenant, in the event that an item of proposed
Indebtedness meets the criteria of more than one of the
categories of Permitted Debt described in clauses (1)
through (15) above or is entitled to be incurred pursuant
to the first paragraph of this covenant, the Issuers will be
permitted to classify such item of Indebtedness in any manner
that complies with this covenant (except that Indebtedness
incurred under the Senior Credit Facilities on the Issue Date
shall be deemed to have been incurred pursuant to
clause (1) above). In addition, the Issuers may, at any
time, change the classification of an item of Indebtedness (or
any portion thereof) to any other clause or to the first
paragraph hereof; provided that the Issuers would be
permitted to incur such item of Indebtedness (or portion
thereof) pursuant to such other clause or the first paragraph
hereof, as the case may be, at such time of reclassification.
The accrual of interest, the accrual of dividends, the accretion
or amortization of original issue discount, the payment of
interest on any Indebtedness in the form of additional
Indebtedness with the same terms, and the payment of dividends
on Disqualified Stock in the form of additional shares of the
same class of Disqualified Stock shall not be deemed to be an
incurrence of Indebtedness or an issuance of Disqualified Stock
for purposes of this covenant.
Parent and the Issuers will not, and will not permit any
Restricted Subsidiary of an Issuer to, create, incur, assume or
otherwise cause or suffer to exist or become effective any Lien
of any kind (other than
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Permitted Liens) securing Indebtedness that does not constitute
Senior Debt upon any of their property or assets, now owned or
hereafter acquired unless:
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(1) in the case of Liens securing
Indebtedness that is expressly subordinated or junior in right
of payment to the Notes, the Notes are secured on a senior basis
to the obligations so secured until such time as such
obligations are no longer secured by a Lien; and |
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(2) in all other cases, the Notes
are secured on an equal and ratable basis with the obligations
so secured until such time as such obligations are no longer
secured by a Lien. |
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Dividend and Other Payment Restrictions |
The Issuers will not, and will not permit the Restricted
Subsidiaries to, directly or indirectly, create or permit to
exist or become effective any encumbrance or restriction on the
ability of any Restricted Subsidiary of an Issuer to:
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(1) pay dividends or make any other
distributions to an Issuer or any Restricted Subsidiary of an
Issuer (i) on its Capital Stock or (ii) with respect
to any other interest or participation in, or measured by, its
profits; |
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(2) pay any Indebtedness owed to an
Issuer or any Restricted Subsidiary of an Issuer; |
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(3) make loans or advances to an
Issuer or any Restricted Subsidiary of an Issuer; or |
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(4) transfer any of its properties
or assets to an Issuer or any Restricted Subsidiary of an Issuer. |
However, the preceding restrictions will not apply to
encumbrances or restrictions existing under or by reason of:
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(1) Existing Indebtedness as in
effect on the Issue Date; |
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(2) the Senior Credit Facilities as
in effect as of the Issue Date, and any amendments,
modifications, restatements, renewals, increases, supplements,
refundings, replacements or refinancings, of any thereof,
provided that such amendments, modifications,
restatements, renewals, increases, supplements, refundings,
replacement or refinancings are not, taken as a whole,
materially more restrictive with respect to such dividend and
other payment restrictions than those contained in such Existing
Indebtedness or Senior Credit Facilities as in effect on the
Issue Date; |
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(3) the Indenture, the Notes, the
Guarantees, the Exchange Securities or the Registration Rights
Agreement; |
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(4) any applicable law, rule,
regulation or order; |
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(5) any instrument or agreement of
a Person acquired by an Issuer or any Restricted Subsidiary of
an Issuer as in effect at the time of such acquisition (except
to the extent incurred in connection with or in contemplation of
such acquisition), which encumbrance or restriction is not
applicable to any Person, or the properties or assets of any
Person, other than the Person, or the property or assets of the
Person, so acquired, provided that, in the case of
Indebtedness, such Indebtedness was permitted by the terms of
the Indenture to be incurred; |
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(6) customary non-assignment
provisions in contracts and licenses entered into in the
ordinary course of business; |
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(7) purchase money obligations for
property acquired in the ordinary course of business and Capital
Lease Obligations that impose restrictions on the property so
acquired of the nature described in clause (4) of the
preceding paragraph; |
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(8) secured Indebtedness otherwise
permitted under the Indenture, the terms of which limit the
right of the debtor to dispose of the assets securing such
Indebtedness; |
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(9) Permitted Refinancing
Indebtedness, provided that the material restrictions
contained in the agreements governing such Permitted Refinancing
Indebtedness are not, taken as a whole, materially more
restrictive to the Holders of Notes than those contained in the
agreements governing the Indebtedness being refinanced; |
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(10) any agreement for the sale or
other disposition of a Restricted Subsidiary or an asset that
restricts distributions by such Restricted Subsidiary or
transfers such asset pending the sale or other disposition; |
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(11) provisions limiting the
disposition, dividend or distribution of assets or property in
joint venture agreements, partnership agreements, limited
liability company operating agreements, asset sale agreements,
sale-leaseback agreements, stock or equity sale agreements and
other similar agreements, which limitation is applicable only to
the assets or property that are the subject of such
agreements; and |
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(12) restrictions on cash or other
deposits or net worth imposed by customers under contracts
entered into in the ordinary course of business. |
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Merger, Consolidation or Sale of Assets |
An Issuer may not: (1) consolidate or merge with or into
another Person (whether or not such Issuer is the surviving
corporation); or (2) sell, assign, transfer, convey or
otherwise dispose of all or substantially all of its properties
or assets, in one or more related transactions, to another
Person unless:
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(1) either: (a) an Issuer is
the surviving corporation; or (b) the Person formed by or
surviving any such consolidation or merger (if other than an
Issuer) or to which such sale, assignment, transfer, conveyance
or other disposition shall have been made is a corporation,
limited liability company or limited partnership organized or
existing under the laws of the United States, any State thereof
or the District of Columbia; |
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(2) the entity or Person formed by
or surviving any such consolidation or merger (if other than an
Issuer) or the entity or Person to which such sale, assignment,
transfer, conveyance or other disposition shall have been made
assumes all the obligations of the applicable Issuer under the
Notes and the Indenture pursuant to a supplemental indenture in
a form reasonably satisfactory to the Trustee; |
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(3) immediately after such
transaction no Default or Event of Default exists; and |
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(4) (a) an Issuer or the
entity or Person formed by or surviving any such consolidation
or merger (if other than the Issuers), or to which such sale,
assignment, transfer, conveyance or other disposition shall have
been made will, after giving pro forma effect thereto as if such
transaction had occurred at the beginning of the applicable
four-quarter period, be permitted to incur at least $1.00 of
additional Indebtedness pursuant to the Fixed Charge Coverage
Ratio test set forth in the first paragraph of the covenant
described above under the caption “— Incurrence
of Indebtedness and Issuance of Preferred Stock” or
(b) the Fixed Charge Coverage Ratio of an Issuer or the
Person formed by or surviving any such consolidation,
amalgamation or merger (if other than the Issuer), or to which
such sale, assignment, transfer, conveyance or other disposition
has been made, after giving effect to the transaction and any
related financings, would not be less than the Fixed Charge
Coverage Ratio of such Issuer immediately prior to such
transaction. |
The preceding clause (4) will not prohibit:
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(a) a merger between an Issuer and
a Restricted Subsidiary that is a Wholly Owned Subsidiary of
such Issuer; or |
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(b) a merger between an Issuer and
an Affiliate incorporated solely for the purpose of
reincorporating an Issuer in another state of the United States; |
so long as, in each case, the amount of Indebtedness of the
Issuers and their respective Restricted Subsidiaries is not
increased thereby.
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The preceding paragraph will not prohibit the sale of EmCare
HoldCo substantially in its entirety that otherwise complies
with the other provisions of the Indenture including
“— Asset Sales”; provided that
(i) the proceeds of such transaction are contributed,
transferred or otherwise applied for the benefit of AMR HoldCo
to the extent required by the “— Asset
Sales” covenant of the Indenture and (ii) such
transaction does not constitute a sale, assignment, transfer,
conveyance or other disposition of all or substantially all of
the properties or assets of the Issuers and their subsidiaries
taken as a whole.
In addition, an Issuer may not, directly or indirectly, lease
all or substantially all of its properties or assets, in one or
more related transactions, to any other Person. This
“Merger, Consolidation or Sale of Assets” covenant
will not be applicable to a sale, assignment, transfer,
conveyance or other disposition of assets between or among the
Issuers and any of their Restricted Subsidiaries that are Wholly
Owned Subsidiaries.
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Transactions with Affiliates |
An Issuer will not, and will not permit any of its Restricted
Subsidiaries to, make any payment to, or sell, lease, transfer
or otherwise dispose of any of its properties or assets to, or
purchase any property or assets from, or enter into or make or
amend any transaction, contract, agreement, understanding, loan,
advance or guarantee with, or for the benefit of, any of its
Affiliates (each, an “Affiliate Transaction”), unless:
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(1) such Affiliate Transaction is
on terms that are not materially less favorable to such Issuer
or such Restricted Subsidiary than those that would have been
obtained in a comparable transaction by such Issuer or such
Restricted Subsidiary with an unrelated Person; and |
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(2) the Parent delivers to the
Trustee: |
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(a) with respect to any Affiliate
Transaction or series of related Affiliate Transactions
involving aggregate consideration in excess of
$5.0 million, a resolution of the Board of Directors of
Parent and an Officers’ Certificate certifying that such
Affiliate Transaction complies with clause (1) above and
that such Affiliate Transaction has been approved by a majority
of the disinterested members of such Board of Directors; and |
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(b) with respect to any Affiliate
Transaction or series of related Affiliate Transactions
involving aggregate consideration in excess of
$20.0 million, an opinion as to the fairness to the Holders
of such Affiliate Transaction from a financial point of view
issued by an accounting, appraisal or investment banking firm of
national standing. |
The following items shall not be deemed to be Affiliate
Transactions and, therefore, will not be subject to the
provisions of the prior paragraph:
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(1) transactions between or among
the Issuers and/or their Restricted Subsidiaries; |
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(2) Permitted Investments and
Restricted Payments that are permitted by the provisions of the
Indenture described above under the caption
“— Restricted Payments”; |
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(3) reasonable loans, advances,
fees, benefits and compensation paid or provided to, and
indemnity provided on behalf of, officers, directors, employees
or consultants of Parent, any Issuers or any Restricted
Subsidiary of an Issuer; |
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(4) transactions pursuant to any
contract or agreement in effect on the Issue Date as the same
may be amended, modified or replaced from time to time so long
as any such amendment, modification or replacement, taken as a
whole, is no less favorable in any material respect to such
Issuer or such Restricted Subsidiary than the contract or
agreement as in effect on the Issue Date; |
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(5) transactions with a Person
(other than an Unrestricted Subsidiary of an Issuer) that is an
Affiliate of an Issuer solely because such Issuer owns, directly
or through a Restricted Subsidiary, an Equity Interest in, or
controls, such Person, so long as Affiliates of such Issuer
(other than a Restricted |
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Subsidiary of such Issuer) own, in the aggregate, no more than
10% of the Equity Interests of such Person; |
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(6) the issuance or sale of
Qualified Equity Interests (and the exercise of any warrants,
options or other rights to acquire Qualified Equity Interests); |
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(7) to the extent that an Issuer
and one or more of its Restricted Subsidiaries are members of a
consolidated, combined or similar income tax group of which a
direct or indirect parent of such Issuer is the common parent,
payment of dividends or other distributions by such Issuer or
one or more of its Restricted Subsidiaries pursuant to a tax
sharing agreement or otherwise to the extent necessary to pay,
and which are used to pay, any income taxes of such tax group
that are attributable to such Issuer and/or its Restricted
Subsidiaries and are not payable directly by such Issuer and/or
its Restricted Subsidiaries; provided that the amount of
any such dividends or distributions (plus any such taxes payable
directly by such Issuer and/or its Restricted Subsidiaries)
shall not exceed the amount of such taxes that would have been
payable directly by such Issuer and/or its Restricted
Subsidiaries had such Issuer been the U.S. common parent of
a separate tax group that included only such Issuer and its
Restricted Subsidiaries; |
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(8) (a) the payment of fees to
Sponsor pursuant to the Management Agreement not to exceed
$2.0 million (plus any amounts accrued pursuant to the
following proviso) in any fiscal year of the Issuers;
provided that such payments may accrue but may not be
paid during the existence of an Event of Default arising from
clause (1), (2) or (9) of the provisions
described under the caption “Events of Default and
Remedies,” and (b) payments by an Issuer to or on
behalf of Parent in an amount sufficient to pay out-of-pocket
legal, accounting and filing and other general corporate
overhead costs of Parent, and franchise taxes and other fees
require to maintain its existence, actually incurred by Parent; |
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(9) reimbursements of bona fide
out-of-pocket expenses of Sponsor incurred in connection with
the general administration and management of Parent, the Issuers
and any Restricted Subsidiaries of an Issuer; |
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(10) Restricted Payments that are
permitted to be made under the covenant described above under
the caption “— Restricted Payments”; |
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(11) loans or advances to employees
of an Issuer or any Restricted Subsidiary of an Issuer
(x) in the ordinary course of business or (y) in
connection with the purchase by such Persons of Equity Interests
of Parent or any other direct or indirect parent of an Issuer so
long as the cash proceeds of such purchase received by Parent
(or such direct or indirect parent) are contemporaneously
contributed to the common equity capital of an Issuer; |
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(12) management, practice support
and similar agreements with Related Professional Corporations
entered into in the ordinary course of business and transactions
pursuant thereto; |
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(13) transactions and any series of
transactions with an Insurance Subsidiary that is an
Unrestricted Subsidiary in the ordinary course of business that
otherwise have been approved by the Board of Directors of Parent
and are consistent with clause (1) of the preceding
paragraph; and |
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(14) transactions with customers,
clients, suppliers or purchasers or sellers of goods or
services, in each case in the ordinary course of business and
otherwise in compliance with the terms of the Indenture that are
on terms no less favorable than those that would have been
obtained in a comparable transaction with an unrelated party or
on terms that are approved by the Board of Directors of Parent,
including a majority of the disinterested directors. |
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Designation of Restricted and Unrestricted
Subsidiaries |
The Board of Directors of Parent may designate any Restricted
Subsidiary of an Issuer to be an Unrestricted Subsidiary if that
designation would not cause a Default and the conditions set
forth in the definition of “Unrestricted Subsidiary”
are met. If a Restricted Subsidiary is designated as an
Unrestricted Subsidiary, all outstanding Investments owned by an
Issuer and its Restricted Subsidiaries (except to the
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extent repaid in cash or Cash Equivalents) in the Subsidiary so
designated will be deemed to be Restricted Payments at the time
of such designation (to the extent not designated a Permitted
Investment) and will reduce the amount available for Restricted
Payments under the first paragraph of the covenant described
above under the caption “— Restricted
Payments.” All such outstanding Investments will be valued
at their fair market value at the time of such designation, as
certified to the Trustee in an Officers’ Certificate. That
designation will only be permitted if such Restricted Payment
would be permitted at that time and if such Restricted
Subsidiary otherwise meets the definition of an Unrestricted
Subsidiary.
Parent and the Issuers will not, and will not permit the
Issuers’ Restricted Subsidiaries to, incur, create, issue,
assume, guarantee or otherwise become liable for any
Indebtedness that is both:
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(1) subordinate or junior in right
of payment to any Senior Debt; and |
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(2) senior in any respect in right
of payment to the Notes or any Guarantee. |
Neither the existence nor lack of a security interest nor the
priority of any such security interest shall be deemed to affect
the ranking or right of payment of any Indebtedness.
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Limitations on Issuances of Guarantees of
Indebtedness |
The Issuers will not permit any Domestic Restricted Subsidiary,
directly or indirectly, to incur Indebtedness, or Guarantee or
pledge any assets to secure the payment of any other
Indebtedness of the Issuers or any Restricted Subsidiary, unless
(1) such Indebtedness is incurred by such Restricted
Subsidiary pursuant to clause (2), (4), (5), (6) (with
respect to Permitted Refinancing Indebtedness in respect of
Indebtedness initially incurred under clause (2) or
(5) only), (7), (10), (11), (12), (13), (14) or
(15) of the “Incurrence of Indebtedness and Issuance
of Preferred Stock” covenant or pursuant to clause (9)
of such covenant (with respect to Indebtedness incurred under
any of the foregoing clauses), (2) such Restricted
Subsidiary is a Subsidiary Guarantor, or (3) such
Restricted Subsidiary simultaneously executes and delivers a
supplemental indenture to the Indenture and becomes a Subsidiary
Guarantor, which Guarantee shall (a) with respect to any
Guarantee of Senior Debt, be subordinated in right of payment on
the same terms as the Notes are subordinated to such Senior Debt
and (b) with respect to any Guarantee of any other
Indebtedness, be senior to or pari passu with such
Restricted Subsidiary’s other Indebtedness or Guarantee of
or pledge to secure such other Indebtedness.
Notwithstanding the preceding paragraph, any such Guarantee by a
Restricted Subsidiary of the Notes shall provide by its terms
that it shall be automatically and unconditionally released and
discharged upon any sale, exchange or transfer, to any Person
not an Affiliate of the Issuers, of all of the Issuers’
stock in, or all or substantially all the assets of, such
Restricted Subsidiary, which sale, exchange or transfer is made
in compliance with the applicable provisions of the Indenture.
The Issuers will not, and will not permit any Restricted
Subsidiary to, engage in any business other than a Permitted
Business, except to such extent as would not be material to the
Issuers and their Restricted Subsidiaries taken as a whole.
Parent will not engage in any business other than
(i) performing its obligations and other activities
incidental thereto under the Senior Credit Facilities, the
Parent Guarantee, the Indenture and the purchase agreements and
the other instruments, agreements and documents entered into by
the Parent in connection with the Transactions,
(ii) issuing Equity Interests and making dividends and
distributions with respect thereto, (iii) its ownership of
Equity Interests of the Issuers and (iv) providing credit
support to the Issuers and their respective Restricted
Subsidiaries.
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So long as any Notes are outstanding, the Issuers will furnish
to the Holders or cause the Trustee to furnish to the Holders,
in each case within the time periods that such information would
have otherwise been required to have been provided to the SEC if
the rules and regulations applicable to the filing of such
information were applicable to the Issuers:
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(1) all quarterly and annual
information that would be required to be contained in a filing
with the SEC on Forms 10-Q and 10-K if the Issuers
were required to file such Forms, including a
“Management’s Discussion and Analysis of Financial
Condition and Results of Operations” and, with respect to
the annual information only, a report on the annual financial
statements by the Issuers’ certified independent
accountants; and |
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(2) all current reports that would
be required to be filed with the SEC on Form 8-K if the
Issuers were required to file such reports. |
The availability of the foregoing materials on the SEC’s
EDGAR service shall be deemed to satisfy the Issuers’
delivery obligation. To the extent permitted by the Exchange Act
and the rules and regulations promulgated thereunder assuming
the Issuers and Parent were subject thereto, Parent or the
Issuers may satisfy the Issuers’ obligations under this
“— Reports” covenant by filing all or any
portion of the foregoing reports (including, but not limited to,
any financial statements contained therein) on a consolidated
basis as among Parent, the Issuers and the Issuers’ several
Subsidiaries.
Prior to the consummation of the exchange offer or registration
of the Notes contemplated by the Registration Rights Agreement
and at any time during which the SEC will not accept filing of
the foregoing reports for inclusion in the EDGAR system, the
posting of the foregoing reports on the Issuers’ web sites
shall be deemed to satisfy the Issuers’ delivery
obligation; provided that the Issuers’ shall use
reasonable efforts to inform holders of Notes of the
availability of such reports, which may be satisfied by, among
other things, a press release on any national business press
release wire service.
Following the consummation of the exchange offer or registration
of the Notes contemplated by the Registration Rights Agreement,
whether or not required by the SEC, the Issuers will file a copy
of all the information and reports referred to in
clauses (1) and (2) above with the SEC for public
availability within the time periods specified in the SEC’s
rules and regulations (unless the SEC will not accept such a
filing) and make such information available to securities
analysts and prospective investors upon request. In addition,
the Issuers have agreed that, for so long as any Notes remain
outstanding, they will furnish to the Holders and to securities
analysts and prospective investors, upon their request, the
information required to be delivered pursuant to
Rule 144A(d) (4) under the Securities Act. The Issuers
will at all times comply with Trust Indenture Act
Section 314(a).
Events of Default and Remedies
Each of the following is an Event of Default:
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(1) default for 30 days in the
payment when due of interest on the Notes whether or not
prohibited by the subordination provisions of the Indenture; |
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(2) default in payment when due of
the principal of or premium, if any, on the Notes, whether or
not prohibited by the subordination provisions of the Indenture; |
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(3) failure by the Issuers to
comply with the provisions described under the caption
“— Repurchase at the Option of
Holders — Change of Control” or
“— Merger, Consolidation or Sale of Assets”; |
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(4) failure by the Issuers for
30 days after notice from the Trustee or holders of at
least 25% in principal amount of the Notes then outstanding to
comply with the provisions described under the captions
“— Repurchase at the Option of
Holders — Asset Sales,”
“— Restricted Payments” or
“— Incurrence of Indebtedness and Issuance of
Preferred Stock”; |
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(5) failure by the Issuers for
60 days after notice from the Trustee or holders of at
least 25% in principal amount of the Notes then outstanding
voting as a single class to comply with any of its other
agreements in the Indenture or the Notes; |
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(6) default under any mortgage,
indenture or instrument under which there may be issued or by
which there may be secured or evidenced any Indebtedness for
money borrowed by an Issuer or any Restricted Subsidiary of an
Issuer (or the payment of which is guaranteed by the Parent, an
Issuer or any Restricted Subsidiary of an Issuer) whether such
Indebtedness or Guarantee now exists, or is created after the
Issue Date, if that default: |
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(a) is caused by a failure to pay
principal of or premium, if any, such Indebtedness at stated
final maturity prior to the expiration of the grace period
provided in such Indebtedness on the date of such default (a
“Payment Default”); or |
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(b) results in the acceleration of
such Indebtedness prior to its stated final maturity, and, in
each case, the principal amount of any such Indebtedness,
together with the principal amount of any other such
Indebtedness under which there has been a Payment Default or the
maturity of which has been so accelerated, aggregates
$25.0 million or more; |
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(7) failure by an Issuer or any
Subsidiary of an Issuer to pay final non-appealable judgments
not covered by undisputed insurance aggregating in excess of
$25.0 million in excess of amounts that are covered by
insurance, which judgments are not paid, discharged or stayed
for a period of 60 days; |
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(8) except as permitted by the
Indenture, any Guarantee provided by Parent or a Significant
Subsidiary shall be held in any judicial proceeding to be
unenforceable or invalid or shall cease for any reason to be in
full force and effect or Parent or any Guarantor that is a
Significant Subsidiary of an Issuer or any Person acting on
behalf of Parent or any Guarantor that is a Significant
Subsidiary of an Issuer, shall deny or disaffirm its obligations
under its Guarantee; and |
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(9) certain events of bankruptcy or
insolvency with respect to Parent, an Issuer or any Restricted
Subsidiary of an Issuer that is a Significant Subsidiary of
Parent. |
In the event of a declaration of acceleration of the Notes
because an Event of Default has occurred and is continuing as a
result of the acceleration of any Indebtedness described in
clause (6) of the preceding paragraph, the declaration of
acceleration of the Notes shall be automatically annulled if the
holders of any Indebtedness described in clause (6) of the
preceding paragraph have rescinded the declaration of
acceleration in respect of such Indebtedness within 30 days
of the date of such declaration and if:
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(1) the annulment of the
acceleration of Notes would not conflict with any judgment or
decree of a court of competent jurisdiction; and |
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(2) all existing Events of Default,
except nonpayment of principal or interest on the Notes that
became due solely because of the acceleration of the Notes, have
been cured or waived. |
If any Event of Default occurs and is continuing, the Trustee or
the Holders of at least 25% in principal amount of the then
outstanding Notes may declare all the Notes to be due and
payable immediately; provided that so long as any
Indebtedness permitted to be incurred pursuant to the Senior
Credit Facilities shall be outstanding, such acceleration shall
not be effective until the earlier of:
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(1) an acceleration of any such
indebtedness under the Senior Credit Facilities; or |
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(2) five business days after
receipt by the Issuers of written notice of such acceleration. |
Notwithstanding the preceding paragraph, in the case of an Event
of Default arising from certain events of bankruptcy or
insolvency with respect to an Issuer or a Significant Subsidiary
thereof, all outstanding Notes will become due and payable
without further action or notice.
Holders of the Notes may not enforce the Indenture or the Notes
except as provided in the Indenture. Subject to certain
limitations, Holders of a majority in principal amount of the
then outstanding Notes may direct the Trustee in its exercise of
any trust or power. The Trustee may withhold from Holders of the
Notes
148
notice of any continuing Default or Event of Default (except a
Default or Event of Default relating to the payment of principal
or interest) if it determines that withholding notice is in
their interest.
The Holders of a majority in aggregate principal amount of the
Notes then outstanding by notice to the Trustee may on behalf of
the Holders of all of the Notes waive any existing Default or
Event of Default and its consequences under the Indenture except
a continuing Default or Event of Default in the payment of
interest on, or the principal of, the Notes.
The Issuers will be required to deliver to the Trustee annually
a statement regarding compliance with the Indenture. Upon
becoming aware of any Default or Event of Default, the Issuers
are required to deliver to the Trustee a statement specifying
such Default or Event of Default.
No Personal Liability of Directors, Officers, Employees and
Stockholders
No director, officer, employee, incorporator or stockholder of
the Issuers, or any Guarantor, as such, shall have any liability
for any obligations of the Issuers, Parent or the Guarantors
under the Notes, the Indenture, the Parent Guarantee, the
Subsidiary Guarantees or for any claim based on, in respect of,
or by reason of, such obligations or their creation. Each Holder
of Notes by accepting a Note waives and releases all such
liability. The waiver and release are part of the consideration
for issuance of the Notes. The waiver may not be effective to
waive liabilities under the federal securities laws.
Satisfaction and Discharge
The Indenture will be discharged and will cease to be of further
effect (except as to rights of the registration of transfer or
exchange of Notes, which shall survive until all Notes have been
canceled) as to all Notes issued thereunder, when:
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(a) all Notes that have been
authenticated (except lost, stolen or destroyed Notes that have
been replaced or paid and Notes for whose payment money has
theretofore been deposited in trust and thereafter repaid to the
Issuers) have been delivered to the Trustee for
cancellation; or |
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(b) all Notes that have not been
delivered to the Trustee for cancellation have become due and
payable by reason of the making of a notice of redemption or
otherwise or will become due and payable within one year and an
Issuer or any Guarantor has irrevocably deposited or caused to
be deposited with the Trustee as trust funds in trust solely for
the benefit of the Holders, cash in U.S. dollars,
non-callable Government Securities, or a combination thereof, in
such amounts as will be sufficient without consideration of any
reinvestment of interest, to pay and discharge the entire
indebtedness on the Notes not delivered to the Trustee for
cancellation for principal, premium and additional interest, if
any, and accrued interest to the date of maturity or redemption; |
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(2) no Default or Event of Default
(other than one resulting solely from the borrowing of funds to
provide such deposit) shall have occurred and be continuing on
the date of such deposit or shall occur as a result of such
deposit and such deposit will not result in a breach or
violation of, or constitute a default under, any other
instrument to which an Issuer or any Guarantor is a party or by
which an Issuer or any Guarantor is bound; |
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(3) an Issuer or any Guarantor has
paid or caused to be paid all sums payable by it under the
Indenture; and |
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(4) the Issuers have delivered
irrevocable instructions to the Trustee under the Indenture to
apply the deposited money toward the payment of the Notes at
maturity or the redemption date, as the case may be. |
In addition, the Issuers must deliver an Officers’
Certificate and an Opinion of Counsel to the Trustee stating
that all conditions precedent to satisfaction and discharge have
been satisfied.
149
Legal Defeasance and Covenant Defeasance
The Issuers may, at their option and at any time, elect to have
all of their obligations discharged with respect to the
outstanding Notes and all obligations of the Guarantors
discharged with respect to their Subsidiary Guarantees
(“Legal Defeasance”) except for:
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(1) the rights of Holders of
outstanding Notes to receive payments in respect of the
principal of, premium, if any, and interest on such Notes when
such payments are due from the trust referred to below; |
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(2) the Issuers’ obligations
with respect to the Notes concerning issuing temporary Notes,
registration of Notes, mutilated, destroyed, lost or stolen
Notes and the maintenance of an office or agency for payment and
money for security payments held in trust; |
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(3) the rights, powers, trusts,
duties and immunities of the Trustee, and the Issuers’
obligations in connection therewith; and |
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(4) the Legal Defeasance provisions
of the Indenture. |
In addition, the Issuers may, at their option and at any time,
elect to have the obligations of Parent, the Issuers and the
Guarantors released with respect to certain covenants that are
described in the Indenture (“Covenant Defeasance”) and
thereafter any omission to comply with those covenants shall not
constitute a Default or Event of Default with respect to the
Notes. In the event Covenant Defeasance occurs, certain events
(not including non-payment, bankruptcy, receivership,
rehabilitation and insolvency events) described under the
caption “Events of Default and Remedies” will no
longer constitute an Event of Default with respect to the Notes.
In order to exercise either Legal Defeasance or Covenant
Defeasance:
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(1) the Issuers must irrevocably
deposit or cause to be deposited with the Trustee, in trust, for
the benefit of the Holders of the Notes, cash in
U.S. dollars, non-callable Government Securities, or a
combination thereof, in such amounts as will be sufficient
without consideration of any reinvestment of interest, in the
opinion of an investment bank, appraisal firm, or firm of
independent public accountants nationally recognized in the
United States, to pay the principal of, premium, if any, and
interest on the outstanding Notes on the stated maturity or on
the applicable redemption date, as the case may be, and the
Issuers must specify whether the Notes are being defeased to
maturity or to a particular redemption date; |
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(2) in the case of Legal
Defeasance, the Issuers shall have delivered to the Trustee an
opinion of counsel in the United States reasonably acceptable to
the Trustee confirming that (a) the Issuers have received
from, or there has been published by, the Internal Revenue
Service a ruling or (b) since the Issue Date, there has
been a change in the applicable federal income tax law, in
either case to the effect that, and based thereon such opinion
of counsel shall confirm that, subject to customary assumptions
and exclusions, the Holders of the outstanding Notes will not
recognize income, gain or loss for federal income tax purposes
as a result of such Legal Defeasance and will be subject to
federal income tax on the same amounts, in the same manner and
at the same times as would have been the case if such Legal
Defeasance had not occurred; |
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(3) in the case of Covenant
Defeasance, the Issuers shall have delivered to the Trustee an
opinion of counsel in the United States reasonably acceptable to
the Trustee confirming that, subject to customary assumptions
and exclusions, the Holders of the outstanding Notes will not
recognize income, gain or loss for federal income tax purposes
as a result of such Covenant Defeasance and will be subject to
federal income tax on the same amounts, in the same manner and
at the same times as would have been the case if such Covenant
Defeasance had not occurred; |
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(4) no Default or Event of Default
shall have occurred and be continuing on the date of such
deposit (other than a Default or Event of Default resulting from
the borrowing of funds to be applied to such deposit); |
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(5) such Legal Defeasance or
Covenant Defeasance will not result in a breach or violation of,
or constitute a default under any material agreement (including
the Senior Credit Facilities) or instrument (other than the
Indenture) to which an Issuer or any Subsidiary of an Issuer is
a party or by which an Issuer or any Subsidiary of an Issuer is
bound; |
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(6) the Issuers must deliver to the
Trustee an Officers’ Certificate stating that the deposit
was not made by the Issuers with the intent of preferring the
Holders of Notes over the other creditors of the Issuers or
others; and |
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(7) the Issuers must deliver to the
Trustee an Officers’ Certificate and an opinion of counsel,
which opinion may be subject to customary assumptions and
exclusions, each stating that all conditions precedent relating
to the Legal Defeasance or the Covenant Defeasance have been
complied with. |
Amendment, Supplement and Waiver
With the consent of the Holders of not less than a majority in
principal amount of the Notes at the time outstanding, the
Issuers and the Trustee are permitted to amend or supplement the
Indenture or any supplemental indenture or modify the rights of
the Holders; provided that without the consent of each
Holder affected, no amendment, supplement, modification or
waiver may (with respect to any Notes held by a non-consenting
Holder):
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(1) reduce the principal amount of
Notes whose Holders must consent to an amendment, supplement or
waiver; |
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(2) reduce the principal of or
change the fixed maturity of any Note or alter the provisions
with respect to the redemption of the Notes (other than
provisions relating to the covenants described above under the
caption “— Repurchase at the Option of
Holders”); |
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(3) reduce the rate of or change
the time for payment of interest on any Note; |
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(4) waive a Default or Event of
Default in the payment of principal of or premium, if any, or
interest on the Notes (except a rescission of acceleration of
the Notes by the Holders of at least a majority in aggregate
principal amount of the Notes and a waiver of the payment
default that resulted from such acceleration); |
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(5) make any Note payable in money
other than that stated in the Notes; |
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(6) make any change in the
provisions of the Indenture relating to waivers of past Defaults
or the rights of Holders of Notes to receive payments of
principal of or premium, if any, or interest on the Notes; |
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(7) waive a redemption payment with
respect to any Note (other than a payment required by one of the
covenants described above under the caption
“— Repurchase at the Option of Holders”); |
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(8) modify or change any provision
of the Indenture or the related definitions affecting the
subordination of the Notes or any Guarantee in a manner that
materially adversely affects the Holders of Notes; |
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(9) make any change in the
preceding amendment and waiver provisions; or |
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(10) release any Guarantor from any
of its obligations under its guarantee of the Notes or the
Indenture, except in accordance with the terms of the Indenture. |
No amendment of, or supplement or waiver to, the Indenture shall
adversely affect the rights of any holder of Senior Debt under
the subordination provisions of the Indenture, without the
consent of such holder or, in accordance with the terms of such
Senior Debt, the consent of the agent or representative of such
holder or the requisite holders of such Senior Debt or
Designated Senior Debt.
151
Notwithstanding the preceding, without the consent of any Holder
of Notes, the Issuers and the Trustee may amend or supplement
the Indenture or the Notes:
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(1) to cure any ambiguity, defect
or inconsistency; |
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(2) to provide for uncertificated
Notes in addition to or in place of certificated Notes; |
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(3) to provide for the assumption
of the Issuers’ obligations to Holders of Notes in the case
of a merger or consolidation or the sale of all or substantially
all of the Issuers’ assets; |
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(4) to make any change that would
provide any additional rights or benefits to the Holders of
Notes or that does not materially adversely affect the legal
rights under the Indenture of any such Holder; |
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(5) to comply with requirements of
the SEC in order to effect or maintain the qualification of the
Indenture under the Trust Indenture Act; |
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(6) to provide for the issuance of
Additional Notes in accordance with the limitations set forth in
the Indenture; |
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(7) to allow any Subsidiary to
guarantee the Notes; or |
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(8) to evidence and provide for the
acceptance of appointment under the Indenture by a successor
Trustee. |
Concerning the Trustee
If the Trustee becomes a creditor of an Issuer or any Guarantor,
the Indenture limits the Trustee’s right to obtain payment
of claims in certain cases, or to realize on certain property
received in respect of any such claim as security or otherwise.
The Trustee will be permitted to engage in other transactions;
however, if it acquires any conflicting interest it must
eliminate such conflict within 90 days, apply to the SEC
for permission to continue or resign.
The Holders of a majority in principal amount of the then
outstanding Notes will have the right to direct the time, method
and place of conducting any proceeding for exercising any remedy
available to the Trustee, subject to certain exceptions. The
Indenture provides that in case an Event of Default shall occur
and be continuing, the Trustee will be required, in the exercise
of its power, to use the degree of care of a prudent man in the
conduct of his own affairs. Subject to such provisions, the
Trustee will be under no obligation to exercise any of its
rights or powers under the Indenture at the request of any
Holder of Notes, unless such Holder shall have offered to the
Trustee security and indemnity satisfactory to it against any
loss, liability or expense.
Book-Entry, Delivery and Form
The exchange notes will be represented by one or more notes in
registered, global form without interest coupons (collectively,
the “Global Notes”). The Global Notes will be
deposited upon issuance with the trustee as custodian for The
Depository Trust Company (“DTC”), in New York, New
York, and registered in the name of DTC or its nominee, in each
case, for credit to an account of a direct or indirect
participant in DTC as described below, including the Euroclear
System (“Euroclear”) and Clearstream Banking, S.A.
(“Clearstream”).
Except as set forth below, the Global Notes may be transferred,
in whole and not in part, only to another nominee of DTC or to a
successor of DTC or its nominee. Beneficial interests in the
Global Notes may not be exchanged for definitive notes in
registered certificated form (“Certificated Notes”)
except in the limited circumstances described below. See
“—Exchange of Global Notes for Certificated
Notes.” Except in the limited circumstances described
below, owners of beneficial interests in the Global Notes will
not be entitled to receive physical delivery of notes in
certificated form.
152
Depository Procedures
The following description of the operations and procedures of
DTC, Euroclear and Clearstream are provided solely as a matter
of convenience. These operations and procedures are solely
within the control of the respective settlement systems and are
subject to changes by them. The Issuers take no responsibility
for these operations and procedures and urge investors to
contact the system or their participants directly to discuss
these matters.
DTC has advised the Issuers that DTC is a limited-purpose trust
company created to hold securities for its participating
organizations (collectively, the “Participants”) and
to facilitate the clearance and settlement of transactions in
those securities between the Participants through electronic
book-entry changes in accounts of its Participants. The
Participants include securities brokers and dealers (including
the initial purchasers), banks, trust companies, clearing
corporations and certain other organizations. Access to
DTC’s system is also available to other entities such as
banks, brokers, dealers and trust companies that clear through
or maintain a custodial relationship with a Participant, either
directly or indirectly (collectively, the “Indirect
Participants”). Persons who are not Participants may
beneficially own securities held by or on behalf of DTC only
through the Participants or the Indirect Participants. The
ownership interests in, and transfers of ownership interests in,
each security held by or on behalf of DTC are recorded on the
records of the Participants and Indirect Participants.
DTC has also advised the Issuers that, pursuant to procedures
established by it:
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(1) upon deposit of the Global Notes, DTC will credit the
accounts of the Participants designated by the initial
purchasers with portions of the principal amount of the Global
Notes; and |
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(2) ownership of these interests in the Global Notes will
be shown on, and the transfer of ownership of these interests
will be effected only through, records maintained by DTC (with
respect to the Participants) or by the Participants and the
Indirect Participants (with respect to other owners of
beneficial interest in the Global Notes). |
Investors in the Global Notes who are Participants may hold
their interests therein directly through DTC. Investors in the
Global Notes who are not Participants may hold their interests
therein indirectly through organizations (including Euroclear
and Clearstream) which are Participants. All interests in a
Global Note, including those held through Euroclear or
Clearstream, may be subject to the procedures and requirements
of DTC. Those interests held through Euroclear or Clearstream
may also be subject to the procedures and requirements of such
systems. The laws of some states require that certain Persons
take physical delivery in definitive form of securities that
they own. Consequently, the ability to transfer beneficial
interests in a Global Note to such Persons will be limited to
that extent. Because DTC can act only on behalf of the
Participants, which in turn act on behalf of the Indirect
Participants, the ability of a Person having beneficial
interests in a Global Note to pledge such interests to Persons
that do not participate in the DTC system, or otherwise take
actions in respect of such interests, may be affected by the
lack of a physical certificate evidencing such interests.
Except as described below, owners of interests in the Global
Notes will not have notes registered in their names, will not
receive physical delivery of notes in certificated form and will
not be considered the registered owners or “holders”
thereof under the Indenture for any purpose.
Payments in respect of the principal of, and interest and
premium, if any, and Liquidated Damages, if any, on, a Global
Note registered in the name of DTC or its nominee will be
payable to DTC in its capacity as the registered holder under
the Indenture. Under the terms of the Indenture, the Issuers and
the Trustee will treat the Persons in whose names the notes,
including the Global Notes, are registered as the owners of the
notes for the purpose of receiving payments and for all other
purposes. Consequently, neither the Issuers, the Trustee nor any
agent of the Issuers or the Trustee has or will have any
responsibility or liability for:
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(1) any aspect of DTC’s records or any
Participant’s or Indirect Participant’s records
relating to or payments made on account of beneficial ownership
interest in the Global Notes or for maintaining, |
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supervising or reviewing any of DTC’s records or any
Participant’s or Indirect Participant’s records
relating to the beneficial ownership interests in the Global
Notes; or |
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(2) any other matter relating to the actions and practices
of DTC or any of its Participants or Indirect Participants. |
DTC has advised the Issuers that its current practice, upon
receipt of any payment in respect of securities such as the
notes (including principal and interest), is to credit the
accounts of the relevant Participants with the payment on the
payment date unless DTC has reason to believe that it will not
receive payment on such payment date. Each relevant Participant
is credited with an amount proportionate to its beneficial
ownership of an interest in the principal amount of the relevant
security as shown on the records of DTC. Payments by the
Participants and the Indirect Participants to the beneficial
owners of notes will be governed by standing instructions and
customary practices and will be the responsibility of the
Participants or the Indirect Participants and will not be the
responsibility of DTC, the trustee or the Issuers. Neither the
Issuers nor the Trustee will be liable for any delay by DTC or
any of the Participants or the Indirect Participants in
identifying the beneficial owners of the notes, and the Issuers
and the Trustee may conclusively rely on and will be protected
in relying on instructions from DTC or its nominee for all
purposes.
Transfers between the Participants will be effected in
accordance with DTC’s procedures, and will be settled in
same-day funds, and transfers between participants in Euroclear
and Clearstream will be effected in accordance with their
respective rules and operating procedures.
Cross-market transfers between the Participants, on the one
hand, and Euroclear or Clearstream participants, on the other
hand, will be effected through DTC in accordance with DTC’s
rules on behalf of Euroclear or Clearstream, as the case may be,
by their respective depositories; however, such cross-market
transactions will require delivery of instructions to Euroclear
or Clearstream, as the case may be, by the counterparty in such
system in accordance with the rules and procedures and within
the established deadlines (Brussels time) of such system.
Euroclear or Clearstream, as the case may be, will, if the
transaction meets its settlement requirements, deliver
instructions to its respective depository to take action to
effect final settlement on its behalf by delivering or receiving
interests in the relevant Global Note in DTC, and making or
receiving payment in accordance with normal procedures for
same-day funds settlement applicable to DTC. Euroclear
participants and Clearstream participants may not deliver
instructions directly to the depositories for Euroclear or
Clearstream.
DTC has advised the Issuers that it will take any action
permitted to be taken by a holder of notes only at the direction
of one or more Participants to whose account DTC has credited
the interests in the Global Notes and only in respect of such
portion of the aggregate principal amount of the notes as to
which such Participant or Participants has or have given such
direction. However, if there is an Event of Default under the
notes, DTC reserves the right to exchange the Global Notes for
legended notes in certificated form, and to distribute such
notes to its Participants.
Although DTC, Euroclear and Clearstream have agreed to the
foregoing procedures to facilitate transfers of interests in the
Global Notes among participants in DTC, Euroclear and
Clearstream, they are under no obligation to perform or to
continue to perform such procedures, and may discontinue such
procedures at any time. None of the Issuers, the Trustee and any
of their respective agents will have any responsibility for the
performance by DTC, Euroclear or Clearstream or their respective
participants or indirect participants of their respective
obligations under the rules and procedures governing their
operations.
Exchange of Global Notes for Certificated Notes
A Global Note is exchangeable for Certificated Notes if:
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(1) DTC (a) notifies the Issuers that it is unwilling
or unable to continue as depository for the Global Notes or
(b) has ceased to be a clearing agency registered under the
Exchange Act and, in either case, the Issuers fail to appoint a
successor depository; |
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(2) the Issuers, at their option, notify the Trustee in
writing that they elect to cause the issuance of the
Certificated Notes; or |
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(3) there has occurred and is continuing an Event of
Default with respect to the notes. |
In addition, beneficial interests in a Global Note may be
exchanged for Certificated Notes upon prior written notice given
to the Trustee by or on behalf of DTC in accordance with the
Indenture. In all cases, Certificated Notes delivered in
exchange for any Global Note or beneficial interests in Global
Notes will be registered in the names, and issued in any
approved denominations, requested by or on behalf of the
depository (in accordance with its customary procedures) and
will bear the applicable restrictive legend unless that legend
is not required by applicable law.
Exchange of Certificated Notes for Global Notes
Certificated Notes may not be exchanged for beneficial interests
in any Global Note unless the transferor first delivers to the
Trustee a written certificate (in the form provided in the
Indenture) to the effect that such transfer will comply with the
appropriate transfer restrictions applicable to such notes.
Same Day Settlement and Payment
The Issuers will make payments in respect of the notes
represented by the Global Notes (including principal, premium,
if any, interest and Liquidated Damages, if any) by wire
transfer of immediately available funds to the accounts
specified by DTC or its nominee. The Issuers will make all
payments of principal, interest and premium, if any, and
Liquidated Damages, if any, with respect to Certificated Notes
by wire transfer of immediately available funds to the accounts
specified by the holders of the Certificated Notes or, if no
such account is specified, by mailing a check to each such
holder’s registered address. The Issuers expect that
secondary trading in any Certificated Notes will also be settled
in immediately available funds.
Because of time zone differences, the securities account of a
Euroclear or Clearstream participant purchasing an interest in a
Global Note from a Participant will be credited, and any such
crediting will be reported to the relevant Euroclear or
Clearstream participant, during the securities settlement
processing day (which must be a business day for Euroclear and
Clearstream) immediately following the settlement date of DTC.
DTC has advised the Issuers that cash received in Euroclear or
Clearstream as a result of sales of interests in a Global Note
by or through a Euroclear or Clearstream participant to a
Participant will be received with value on the settlement date
of DTC but will be available in the relevant Euroclear or
Clearstream cash account only as of the business day for
Euroclear or Clearstream following DTC’s settlement date.
Registration Rights; Liquidated Damages
On February 10, 2005, the Issuers, the guarantors and the
initial purchasers entered into the Registration Rights
Agreement, a copy of which is incorporated by reference as an
exhibit to the registration statement of which this prospectus
forms a part. Acceptance of the exchange offer either by
execution of the letter of transmittal in connection with the
exchange offer or by transmittal of acceptance to The Depository
Trust Company through the Automated Tender Offer Program
procedures will be deemed to constitute each new
noteholder’s signature to the Registration Rights
Agreement. Pursuant to the Registration Rights Agreement, the
Issuers agreed to file with the SEC the registered exchange
offer registration statement on the appropriate form under the
Securities Act with respect to the registered exchange notes.
Upon the effectiveness of the registered exchange offer
registration statement, the Issuers will offer to the holders of
Transfer Restricted Securities pursuant to the registered
exchange offer who are able to make certain representations the
opportunity to exchange their Transfer Restricted Securities for
registered exchange notes.
If:
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(i) the Issuers are not required to file the registered
exchange offer registration statement or permitted to consummate
the registered exchange offer because the registered exchange
offer is not permitted by applicable law or SEC policy; or |
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(ii) any holder of Transfer Restricted Securities notifies
the Issuers prior to the 20th day following consummation of the
registered exchange offer that |
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(A) it is prohibited by law or SEC policy from
participating in the registered exchange offer, or |
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(B) that it may not resell the registered exchange notes
acquired by it in the registered exchange offer to the public
without delivering this prospectus and this prospectus is not
appropriate or available for such resales, or |
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(C) that it is a broker-dealer and owns notes acquired
directly from the Issuers or one of their affiliates, |
the Issuers will file with the SEC a shelf registration
statement to cover resales of the notes by the holders thereof
who satisfy certain conditions relating to the provision of
information in connection with the shelf registration statement.
The Issuers will use their commercially reasonable efforts to
cause the applicable registration statement to be declared
effective as promptly as possible by the SEC.
For purposes of the preceding, “Transfer Restricted
Securities” means each outstanding note until (i) the
date on which such outstanding note has been exchanged by a
person other than a broker-dealer for a registered exchange note
in the registered exchange offer, (ii) following the
exchange by a broker-dealer in the registered exchange offer of
an outstanding note for a registered exchange note, the date on
which such registered exchange note is sold to a purchaser who
receives from such broker-dealer on or prior to the date of such
sale a copy of this prospectus, (iii) the date on which
such outstanding note has been effectively registered under the
Securities Act and disposed of in accordance with the shelf
registration statement or (iv) the date on which such note
is distributed to the public pursuant to Rule 144 under the
Securities Act.
The Registration Rights Agreement provides that (i) the
Issuers will file a registered exchange offer registration
statement with the SEC on or prior to 240 days after the
closing date of the initial offering, (ii) the Issuers will
use their commercially reasonable efforts to cause the
registered exchange offer registration statement to be declared
effective by the SEC on or prior to 300 days after the
closing date of the initial offering, (iii) unless the
registered exchange offer would not be permitted by applicable
law or SEC policy, the Issuers will commence the registered
exchange offer and use their commercially reasonable efforts to
issue on or prior to 30 business days after the date on which
the registered exchange offer registration statement was
declared effective by the SEC, registered exchange notes in
exchange for all outstanding notes tendered prior thereto in the
registered exchange offer and (iv) if obligated to file the
shelf registration statement, the Issuers will use their
commercially reasonable efforts to file the shelf registration
statement with the SEC on or prior to 30 days after such
filing obligation arises (and any event within 300 days of
the closing date of the initial offering) (the “Shelf
Filing Deadline”) and to cause the shelf registration
statement to be declared effective by the SEC on or prior to the
30th day after the Shelf Filing Deadline.
If:
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(a) the Issuers fail to file any of the Registration
Statements required by the Registration Rights Agreement on or
before the date specified for such filing, |
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(b) any of such Registration Statements is not declared
effective by the SEC on or prior to the date specified for such
effectiveness (the “Effectiveness Target Date”), or |
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(c) the Issuers fail to consummate the Registered Exchange
Offer within 30 business days of the Effectiveness Target Date
with respect to the Registered Exchange Offer Registration
Statement, or |
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(d) the shelf registration statement or the registered
exchange offer registration statement is declared effective but
thereafter ceases to be effective or usable in connection with
resales of Transfer Restricted Securities during the periods
specified in the Registration Rights Agreement (each such event
referred to in clauses (a) through (d) above a
“Registration Default”), |
then the Issuers will pay Liquidated Damages to each holder of
outstanding notes, with respect to the first 90-day period
immediately following the occurrence of the first Registration
Default, in an amount equal to
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$.05 per week per $1,000 principal amount of outstanding notes
held by such holder. The amount of the Liquidated Damages will
increase by an additional $.05 per week per $1,000 principal
amount of outstanding notes with respect to each subsequent
90-day period until all Registration Defaults have been cured,
up to a maximum amount of Liquidated Damages of $.30 per week
per $1,000 principal amount of outstanding notes. All accrued
Liquidated Damages will be paid by the Issuers on each Damages
Payment Date to the Global Note holder by wire transfer of
immediately available funds or by federal funds check and to the
holders of certificated outstanding notes by wire transfer to
the accounts specified by them or by mailing checks to their
registered addresses if no such accounts have been specified.
Following the cure of all Registration Defaults, the accrual of
Liquidated Damages will cease.
Holders of outstanding notes will be required to make certain
representations to the Issuers (as described in the Registration
Rights Agreement) in order to participate in the registered
exchange offer and will be required to deliver certain
information to be used in connection with the shelf registration
statement and to provide comments on the shelf registration
statement within the time periods set forth in the Registration
Rights Agreement in order to have their outstanding notes
included in the shelf registration statement and benefit from
the provisions regarding Liquidated Damages set forth above.
Certain Definitions
Set forth below are certain defined terms used in the Indenture.
Reference is made to the Indenture for a full disclosure of all
such terms, as well as any other capitalized terms used herein
for which no definition is provided.
“Acquired Debt” means, with respect to any
specified Person:
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(1) Indebtedness of any other
Person existing at the time such other Person is merged with or
into or became a Subsidiary of such specified Person, whether or
not such Indebtedness is incurred in connection with, or in
contemplation of, such other Person merging with or into, or
becoming a Subsidiary of such specified Person; and |
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(2) Indebtedness secured by a Lien
encumbering any asset acquired by such specified Person. |
“Administrative Agent” means Bank of America,
N.A., in its capacity as Administrative Agent for the lenders
party to the Senior Credit Facilities, or any successor thereto
or any person otherwise appointed.
“Affiliate” of any specified Person means any
other Person directly or indirectly controlling or controlled by
or under direct or indirect common control with such specified
Person. For purposes of this definition,
“control,” as used with respect to any Person,
shall mean the possession, directly or indirectly, of the power
to direct or cause the direction of the management or policies
of such Person, whether through the ownership of voting
securities, by agreement or otherwise; provided that for
the purposes of the “— Transactions with
Affiliates” and “— Limitation on Issuances
of Guarantees of Indebtedness” covenants only, beneficial
ownership of 10% or more of the Voting Stock in a Person shall
be deemed to be control. For purposes of this definition, the
terms “controlling,” “controlled by” and
“under common control with” shall have correlative
meanings.
“Asset Sale” means:
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(1) the sale, lease, conveyance or
other disposition (a “Disposition”) of any
assets or rights (including, without limitation, by way of a
sale and leaseback) (provided that the sale, lease,
conveyance or other disposition of all or substantially all of
the assets of the Issuers and their Restricted Subsidiaries
taken as a whole will be governed by the provisions of the
Indenture described above under the caption
“— Repurchase at the Option of
Holders — Change of Control” and/or the
provisions described above under the caption
“— Merger, Consolidation or Sale of Assets”
and not by the provisions of the Asset Sale covenant); and |
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(2) the issue or sale by an Issuer
or any Restricted Subsidiary of an Issuer of Equity Interests of
any of such Issuer’s Restricted Subsidiaries; |
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in the case of either clause (1) or (2), whether in a
single transaction or a series of related transactions:
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(a) that have a fair market value
in excess of $2.0 million; or |
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(b) for net proceeds in excess of
$2.0 million; |
provided that the sale of EmCare HoldCo substantially in
its entirety shall be deemed to be an Asset Sale by AMR HoldCo.
Notwithstanding the preceding, the following items shall not be
deemed to be Asset Sales:
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(1) a disposition of assets by an
Issuer to an Issuer or a Restricted Subsidiary of an Issuer or
by a Restricted Subsidiary of an Issuer to an Issuer or to any
other Restricted Subsidiary of an Issuer; |
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(2) an issuance of Equity Interests
by a Restricted Subsidiary of an Issuer to an Issuer or to
another Restricted Subsidiary of such Issuer; |
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(3) the issuance of Equity
Interests by a Restricted Subsidiary of an Issuer in which the
percentage interest (direct and indirect) in the Equity
Interests of such Person owned by the Issuers, after giving
effect to such issuance, is at least equal to their percentage
interest prior to such issuance; |
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(4) a Restricted Payment that is
permitted by the covenant described above under the caption
“— Restricted Payments”; |
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(5) a disposition in the ordinary
course of business; |
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(6) any Liens permitted by the
Indenture and foreclosures thereon; |
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(7) any exchange of property
pursuant to Section 1031 on the Internal Revenue Code of
1986, as amended, for use in a Permitted Business; |
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(8) the license or sublicense of
intellectual property or other general intangibles; |
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(9) the lease or sublease of
property in the ordinary course of business so long as the same
does not materially interfere with the business of the Issuers
and their Restricted Subsidiaries taken as a whole; and |
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(10) the sale or other disposition
of cash or Cash Equivalents. |
“Attributable Debt” in respect of a Sale and
Leaseback Transaction means, at the time of determination, the
present value of the total obligations of the lessee for net
rental payments during the remaining term of the lease included
in such Sale and Leaseback Transaction. For purposes hereof such
present value shall be calculated using a discount rate equal to
the rate of interest implicit in such Sale and Leaseback
Transaction, determined by lessee in good faith on a basis
consistent with comparable determinations of Capital Lease
Obligations under GAAP.
“Board of Directors” means (1) with
respect to a Person that is a corporation or limited liability
company, the board of directors, board of managers or equivalent
governing board of such Person or any duly authorized committee
thereof, (2) with respect to a Person that is a limited
partnership, the board of directors, board of managers or
equivalent governing board of such Person’s general
partner, and (3) with respect to any other Person, the
governing body of such Person most closely approximating the
governing bodies contemplated in the preceding clauses (1)
and (2).
“Board Resolution” means a copy of a resolution
certified by the secretary or an assistant secretary of any
Person to have been duly adopted by the Board of Directors of
such Person and to be in full force and effect on the date of
such certification, and delivered to the trustee.
“Capital Lease Obligation” means, at the time
any determination thereof is to be made, the amount of the
liability in respect of a capital lease that would at such time
be required to be capitalized on a balance sheet in accordance
with GAAP.
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“Capital Stock” means:
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(1) in the case of a corporation,
corporate stock; |
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(2) in the case of an association
or business entity, any and all shares, interests,
participations, rights or other equivalents (however designated)
of corporate stock; |
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(3) in the case of a partnership or
limited liability company, partnership or membership interests
(whether general or limited); and |
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(4) any other interest or
participation that confers on a Person the right to receive a
share of the profits and losses of, or distributions of assets
of, the issuing Person. |
“Cash Equivalents” means:
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(1) United States dollars; |
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(2) Government Securities having
maturities of not more than twelve months from the date of
acquisition; |
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(3) time deposit accounts, term
deposit accounts, money market deposit accounts, time deposits,
bankers’ acceptances, certificates of deposit and
eurodollar time deposits with maturities of twelve months or
less from the date of acquisition, bankers’ acceptances
with maturities of twelve months or less from the date of
acquisition, overnight bank deposits, and demand deposit
accounts in each case with any lender party to the Senior Credit
Facilities or with any domestic commercial bank having capital
and surplus in excess of $500 million and a Thompson Bank
Watch Rating of “B” or better; |
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(4) repurchase obligations with a
term of not more than 30 days for underlying securities of
the types described in clauses (2) and (3) above
entered into with any financial institution meeting the
qualifications specified in clause (3) above; |
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(5) commercial paper having the
rating of “P-2” (or higher) from Moody’s
Investors Service, Inc. or “A-2” (or higher) from
Standard & Poor’s Corporation and in each case
maturing within twelve months after the date of
acquisition; and |
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(6) any fund investing
substantially all its assets in investments that constitute Cash
Equivalents of the kinds described in clauses (1) through
(5) of this definition. |
“Change of Control” means the occurrence of any
of the following:
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(1) the sale, lease, transfer,
conveyance or other disposition (other than by way of merger or
consolidation), in one or a series of related transactions, of
all or substantially all of the assets of the Issuers and their
Subsidiaries taken as a whole to any “person” (as such
term is used in Section 13(d)(3) of the Exchange Act) other
than the Sponsor or a Related Party of the Sponsor; |
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(2) the adoption of a plan relating
to the liquidation or dissolution of the Issuers; |
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(3) prior to the first Public
Equity Offering that results in a Public Market, the Sponsor and
its Related Parties cease to be the “beneficial
owners” (as defined in Rule 13d-3 under the Exchange
Act, except that a Person will be deemed to have
“beneficial ownership” of all shares that any such
Person has the right to acquire, whether such right is
exercisable immediately or only after the passage of time),
directly or indirectly, of a majority of the total voting power
of the Voting Stock of Parent, whether as a result of the
issuance of securities of Parent, any merger, consolidation,
liquidation or dissolution of Parent, any direct or indirect
transfer of securities by the Sponsor and its Related Parties or
otherwise; |
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(4) on or after the first Public
Equity Offering that results in a Public Market, if any
“person” or “group” (as such terms are used
in Sections 13(d) and 14(d) of the Exchange Act or any
successor provisions to either of the foregoing), including any
group acting for the purpose of acquiring, holding, voting or
disposing of securities within the meaning of
Rule 13d-5(b)(1) under the Exchange Act, other than the
Sponsor and its Related Parties, becomes the “beneficial
owner” (as defined in Rule 13d-3 under the Exchange
Act, except that a Person will be deemed to have
“beneficial ownership” of all |
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shares that any such Person has the right to acquire, whether
such right is exercisable immediately or only after the passage
of time), directly or indirectly, of 35.0% or more of the total
voting power of the Voting Stock of Parent; provided,
however, that the Sponsor and its Related Parties are the
“beneficial owners” (as defined in Rule 13d-3
under the Exchange Act, except that a Person will be deemed to
have “beneficial ownership” of all shares that any
such Person has the right to acquire, whether such right is
exercisable immediately or only after the passage of time),
directly or indirectly, in the aggregate of a lesser percentage
of the total voting power of the Voting Stock of Parent than
such other Person or group; |
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(5) the first day on which a
majority of the members of the Board of Directors of Parent are
not Continuing Directors of Parent; |
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(6) Parent ceases to own all of the
outstanding Capital Stock of each of the Issuers (other than
Disqualified Stock properly incurred under the
“— Limitation on Indebtedness and Issuance of
Preferred Stock” covenant) other than as a consequence of a
sale of all of Capital Stock of EmCare HoldCo in a transaction
that otherwise complies with the other provisions of the
Indenture including “— Asset Sales”;
provided that such transaction does not constitute a
transaction of the type described in clause (1) of this
definition; or |
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(7) (a) the consolidation or merger
of Parent or an Issuer with or into another portfolio operating
company of Sponsor (whether or not Parent or such Issuer is the
surviving corporation) (other than a transaction that would not
constitute a Change of Control under clause (6) above),
(b) the sale, assignment, transfer, conveyance or other
disposition of all or substantially all of the assets of Parent
or an Issuer to another portfolio operating company of Sponsor
or (c) the sale, assignment, transfer, conveyance or other
disposition of all or substantially all of the assets or a
majority of the Voting Stock of a portfolio operating company of
Sponsor to Parent, an Issuer or a Restricted Subsidiary of an
Issuer, in each of the foregoing clauses (a), (b) and
(c), pursuant to a transaction in which the fair market value of
the portfolio operating company exceeds the combined fair market
value at such time of the Issuers, each as certified to the
Trustee in an Officers’ Certificate based upon an opinion
or appraisal issued by an accounting, appraisal or investment
banking firm of national standing. |
“Consolidated Cash Flow” means, with respect to
any Person for any period, the Consolidated Net Income of such
Person for such period, plus (minus) to the extent
deducted (added) in computing such Consolidated Net Income:
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(1) provision for taxes based on
income or profits of such Person and its Subsidiaries for such
period; plus (minus) |
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(2) consolidated interest expense
of such Person and its Subsidiaries for such period, whether
paid or accrued and whether or not capitalized (including,
without limitation, amortization of debt issuance costs and
original issue discount, non-cash interest payments, the
interest component of any deferred payment obligations, the
interest component of all payments associated with Capital Lease
Obligations, commissions, discounts and other fees and charges
incurred in respect of letter of credit or bankers’
acceptance financings, and net payments, if any, pursuant to
Hedging Obligations); plus (minus) |
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(3) depreciation, amortization
(including amortization of goodwill and other intangibles but
excluding amortization of prepaid cash expenses that were paid
in a prior period) and other non-cash charges (excluding any
such non-cash charge to the extent that it represents an accrual
of or reserve for cash expenses in any future period or
amortization of a prepaid cash expense that was paid in a prior
period) of such Person and its Subsidiaries for such period;
plus (minus) |
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(4) expenses and charges of the
Issuers related to the Transactions which are paid, taken or
otherwise accounted for within one year of the consummation of
the Transactions; plus (minus) |
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(5) any non-capitalized transaction
costs incurred in connection with actual or proposed financings,
acquisitions or divestitures (including, but not limited to,
financing and refinancing fees and costs incurred in connection
with the Transactions); plus (minus) |
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(6) amounts paid pursuant to the
Management Agreement; plus (minus) |
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(7) non-recurring, extraordinary or
unusual non-operating charges or gains (excluding any write-offs
of accounts receivable presented on the November 30, 2004
combined balance sheet of the Issuers included in this offering
memorandum); plus (minus) |
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(8) Minority Interest with respect
to any Restricted Subsidiary of an Issuer; plus |
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(9) all lease payments in respect
of operating leases arising out of Sale and Leaseback
Transactions with respect to which and to the extent that an
Issuer or any Restricted Subsidiary was deemed to have incurred
Attributable Debt. |
Notwithstanding the preceding, the provision for taxes on the
income or profits of, and the depreciation and amortization and
other non-cash charges of, a Subsidiary of the referent Person
shall be added to Consolidated Net Income to compute
Consolidated Cash Flow only to the extent (and in the same
proportion) that Net Income of such Subsidiary was included in
calculating Consolidated Net Income of such Person.
“Consolidated Interest Expense” means, with
respect to any Person for any period, the sum of, without
duplication:
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(1) the interest expense of such
Person and its Restricted Subsidiaries for such period, on a
combined, consolidated basis, determined in accordance with GAAP
(including amortization of original issue discount, non-cash
interest payments, the interest component of all payments
associated with Capital Lease Obligations, commissions,
discounts and other fees and charges incurred in respect of
letter of credit or bankers’ acceptance financings, and net
payments, if any, pursuant to Hedging Obligations; provided
that in no event shall any amortization of deferred
financing costs be included in Consolidated Interest Expense)
plus the interest component of all payments associated
with Attributable Debt determined by such Person in good faith
on a basis consistent with comparable determinations for Capital
Lease Obligations under GAAP; plus |
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(2) the consolidated capitalized
interest of such Person and its Restricted Subsidiaries for such
period, whether paid or accrued. |
Notwithstanding the preceding, the Consolidated Interest Expense
with respect to any Restricted Subsidiary that is not a Wholly
Owned Subsidiary shall be included only to the extent (and in
the same proportion) that the net income of such Restricted
Subsidiary was included in calculating Consolidated Net Income.
“Consolidated Net Income” means, with respect
to any Person for any period, the aggregate of the Net Income of
such Person and its Restricted Subsidiaries for such period, on
a consolidated basis, determined in accordance with GAAP;
provided that
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(1) the Net Income (but not loss)
of any Person that is not a Restricted Subsidiary or that is
accounted for by the equity method of accounting shall be
included only to the extent of the amount of dividends or
distributions paid in cash to the referent Person or (subject to
clause (2) below) a Restricted Subsidiary thereof; |
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(2) the Net Income of any
Restricted Subsidiary shall be excluded to the extent that the
declaration or payment of dividends or similar distributions by
such Restricted Subsidiary of such Net Income is not at the date
of determination permitted without any prior governmental
approval that has not been obtained or, directly or indirectly,
by operation of the terms of its charter or any agreement,
instrument, judgment, decree, order, statute, rule or
governmental regulation applicable to such Subsidiary; and |
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(3) the cumulative effect of a
change in accounting principles shall be excluded; |
provided, further, that Consolidated Net Income shall be
reduced by the amount of all dividends on Disqualified Stock
(other than dividends paid in Qualified Equity Interests) paid,
accrued or scheduled to be paid or accrued during such period.
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“Continuing Directors” means, as of any date of
determination, any member of the Board of Directors of Parent
who:
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(1) was a member of such Board of
Directors of Parent on the Issue Date; |
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(2) was nominated for election or
elected to such Board of Directors of Parent with the approval
of a majority of the Continuing Directors who were members of
such Board of Directors at the time of such nomination or
election; or |
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(3) was nominated by the Sponsor or
a Related Party thereof. |
“Default” means any event that is, or with the
passage of time or the giving of notice or both would be, an
Event of Default.
“Designated Senior Debt” means:
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(1) any Indebtedness outstanding
under the Senior Credit Facilities; and |
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(2) any other Senior Debt permitted
under the Indenture the principal amount of which is
$50.0 million or more and that has been designated by the
Issuers as “Designated Senior Debt.” |
“Disqualified Stock” means any Capital Stock
that, by its terms (or by the terms of any security into which
it is convertible or for which it is exchangeable), or upon the
happening of any event, matures or is mandatorily redeemable,
pursuant to a sinking fund obligation or otherwise, or
redeemable at the option of the Holder thereof, in whole or in
part, on or prior to the date that is 91 days after the
date on which the Notes mature. Notwithstanding the preceding
sentence, any Capital Stock that would not qualify as
Disqualified Stock but for change of control or asset sale
provisions shall not constitute Disqualified Stock if the
provisions are not more favorable to the holders of such Capital
Stock than the provisions described under
“— Repurchase at the Option of
Holders — Change of Control” and “Repurchase
at the Option of Holders — Asset Sales,”
respectively, and such Capital Stock specifically provide that
the Issuers will not redeem or repurchase any such Capital Stock
pursuant to such provisions prior to the Issuers’ purchase
of the Notes as required pursuant to the provisions described
under “— Repurchase at the Option of
Holders — Change of Control” and “Repurchase
at the Option of Holders — Asset Sales,”
respectively.
“Domestic Restricted Subsidiary” means, with
respect to the Issuers, any Wholly Owned Restricted Subsidiary
of an Issuer that was formed under the laws of the United States
of America.
“Equity Interests” means Capital Stock and all
warrants, options or other rights to acquire Capital Stock (but
excluding any debt security that is convertible into, or
exchangeable for, Capital Stock).
“Equity Offering” means an offering of the
Qualified Equity Interests of Parent; provided, however,
that such net proceeds therefrom equal to not less than 100% of
the aggregate principal amount of any Notes to be redeemed plus
the amount of any applicable premium thereon are received by an
Issuer as a capital contribution or consideration for the
issuance and sale of Qualified Equity Interests immediately
prior to such redemption.
“Existing Indebtedness” means Indebtedness of
the Issuers and their respective Subsidiaries (other than
Indebtedness under the Senior Credit Facilities) in existence on
the Issue Date, until such amounts are repaid.
“Fixed Charge Coverage Ratio” means with
respect to any Person or Persons for any period, the ratio of
the combined (if applicable, but without duplication)
Consolidated Cash Flow of such Person for such period to the
combined (if applicable, but without duplication) Fixed Charges
of such Person for such period. In the event that an Issuer or
any Restricted Subsidiary of an Issuer incurs, assumes,
guarantees or redeems any Indebtedness (other than revolving
credit borrowings) or issues or redeems preferred stock
subsequent to the commencement of the period for which the Fixed
Charge Coverage Ratio is being calculated but prior to the date
on which the event for which the calculation of the Fixed Charge
Coverage Ratio is made (the “Calculation Date”), then
the Fixed Charge Coverage Ratio shall be calculated giving pro
forma effect to such incurrence, assumption, guarantee or
redemption of Indebtedness, or such issuance or redemption of
preferred stock, as if the same had occurred at the beginning of
the applicable four-quarter reference period.
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In addition, for purposes of calculating the Fixed Charge
Coverage Ratio:
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(1) acquisitions that have been
made by an Issuer or any Restricted Subsidiary of an Issuer,
including through mergers or consolidations and including any
related financing transactions, during the four-quarter
reference period or subsequent to such reference period and on
or prior to the Calculation Date shall be calculated to include
the Consolidated Cash Flow of the acquired entities on a pro
forma basis (to be calculated in accordance with
Article 11-02 of Regulation S-X, but giving effect to
Pro Forma Cost Savings) after giving effect to Pro Forma Cost
Savings, shall be deemed to have occurred on the first day of
the four-quarter reference period; |
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(2) the Consolidated Cash Flow
attributable to operations or businesses disposed of prior to
the Calculation Date shall be excluded; |
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(3) the Fixed Charges attributable
to operations or businesses disposed of prior to the Calculation
Date shall be excluded, but only to the extent that the
obligations giving rise to such Fixed Charges will not be
obligations of the specified Person or any of its Restricted
Subsidiaries following the Calculation Date; and |
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(4) if any Indebtedness bears a
floating rate of interest, the interest expense on such
Indebtedness shall be calculated as if the rate in effect on the
Calculation Date had been the applicable rate for the entire
period (taking into account any Hedging Obligation applicable to
such Indebtedness if such Hedging Obligation has a remaining
term as at the Calculation Date in excess of 12 months). |
“Fixed Charges” means, with respect to any
Person for any period, the sum, without duplication, of:
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(1) the Consolidated Interest
Expense of such Person for such period; plus |
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(2) any interest expense on
Indebtedness of another Person that is Guaranteed by such Person
or one of its Restricted Subsidiaries or secured by a Lien on
assets of such Person or one of its Restricted Subsidiaries,
whether or not such Guarantee or Lien is called upon; plus |
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(3) the product of (a) all
dividend payments, whether or not in cash, on any series of
preferred stock of such Person or any of its Restricted
Subsidiaries, other than dividend payments on Equity Interests
payable solely in Qualified Equity Interests, times (b) a
fraction, the numerator of which is one and the denominator of
which is one minus the then current combined federal, state and
local statutory tax rate of such Person, expressed as a decimal,
in each case, on a consolidated basis and in accordance with
GAAP. |
“Foreign Subsidiary” means any Subsidiary of an
Issuer that is not organized under the laws of a state or
territory of the United States or the District of Columbia.
“GAAP” means generally accepted accounting
principles set forth in the opinions and pronouncements of the
Accounting Principles Board of the American Institute of
Certified Public Accountants and statements and pronouncements
of the Financial Accounting Standards Board or in such other
statements by such other entity as have been approved by a
significant segment of the accounting profession, which are in
effect on the Issue Date.
“Global Notes” means, individually and
collectively, each of the Restricted Global Notes and the
Unrestricted Global Notes, issued in accordance with certain
sections of the Indenture.
“Government Securities” means direct
obligations of, or obligations guaranteed by, the United States
of America for the payment of which guarantee or obligations the
full faith and credit of the United States is pledged.
“guarantee” means a guarantee other than by
endorsement of negotiable instruments for collection in the
ordinary course of business, direct or indirect, in any manner
including, without limitation, letters of credit and
reimbursement agreements in respect thereof, of all or any part
of any Indebtedness.
“Guarantees” means the Subsidiary Guarantees
and the Parent Guarantee.
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“Guarantors” means Parent and each Subsidiary
of an Issuer that executes a Subsidiary Guarantee in accordance
with the provisions of the Indenture, and their respective
successors and assigns.
“Hedging Obligations” means, with respect to
any Person, the obligations of such Person under:
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(1) interest rate swap agreements,
interest rate cap agreements and interest rate collar
agreements; and |
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(2) other agreements or
arrangements designed to change the allocation of risk due to
fluctuations in interest rates, currency exchange rates or
commodity prices. |
“Indebtedness” means, with respect to any
specified Person, any indebtedness of such Person, in respect of:
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(1) borrowed money; |
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(2) obligations evidenced by bonds,
notes, debentures or similar instruments or letters of credit
(or reimbursement agreements in respect thereof); |
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(3) bankers’ acceptances; |
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(4) Capital Lease Obligations; |
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(5) Attributable Debt; or |
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(6) (a) the balance deferred
and unpaid of the purchase price of any property, except any
such balance that constitutes an accrued expense or trade
payable or (b) representing the net amount payable in
respect of any Hedging Obligations; |
if and to the extent any of the preceding items (other than
letters of credit and Hedging Obligations) would appear as a
liability upon a balance sheet of the specified Person prepared
in accordance with GAAP. In addition, the term
“Indebtedness” includes all Indebtedness of others
secured by a Lien on any asset of the specified Person (whether
or not such Indebtedness is assumed by the specified Person),
but only to the extent that the aggregate amount of such
Indebtedness does not exceed fair market value of the asset and,
to the extent not otherwise included, the Guarantee by such
Person of any indebtedness of any other Person; provided
that Indebtedness shall not include the pledge by an Issuer
of the Capital Stock of an Unrestricted Subsidiary of such
Issuer to secure Non-Recourse Debt of such Unrestricted
Subsidiary. In no event shall non-contractual obligations or
liabilities in respect of any Capital Stock constitute
Indebtedness under this definition.
The amount of any Indebtedness outstanding as of any date shall
be:
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(1) the accreted value thereof, in
the case of any Indebtedness that does not require current
payments of interest; and |
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(2) the principal amount thereof in
the case of any other Indebtedness. |
“Insolvency or Liquidation Proceedings” means,
with respect to any Person:
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(1) any insolvency or bankruptcy
case or proceeding, or any receivership, liquidation,
reorganization or other similar case or proceeding, relative to
such Person or to the creditors of such Person, as such, or to
the assets of such Person; |
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(2) any liquidation, dissolution,
reorganization or winding up of such Person, whether voluntary
or involuntary, and involving insolvency or bankruptcy; or |
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(3) any assignment for the benefit
of creditors or any other marshaling of assets and liabilities
of such Person. |
“Insurance Subsidiary” means any Subsidiary of
an Issuer (including without limitation EMCA Insurance Company,
Ltd.) that is engaged solely in the medical malpractice
insurance business, workers compensation and other insurance
business for the underwriting of insurance policies for, or for
the benefit
164
of, the Parent and its Subsidiaries and Related Professional
Corporations and those employees, officers, directors and
contractors of the foregoing Persons who provide professional
medical services to patients.
“Investments” means, with respect to any
Person, all investments by such Person in other Persons
(including Affiliates) in the forms of direct or indirect loans
(including guarantees of Indebtedness or other obligations),
advances or capital contributions (excluding commission, travel
advances and other loans and advances to officers and employees
made in the ordinary course of business), purchases or other
acquisitions for consideration of Indebtedness, Equity Interests
or other securities, together with all items that are or would
be classified as investments on a balance sheet prepared in
accordance with GAAP. If an Issuer or any Restricted Subsidiary
of an Issuer sells or otherwise disposes of any Equity Interests
of any direct or indirect Restricted Subsidiary of such Issuer
such that, after giving effect to any such sale or disposition,
such Person is no longer a Restricted Subsidiary of such Issuer,
then such Issuer shall be deemed to have made an Investment on
the date of any such sale or disposition equal to the fair
market value of the Equity Interests of such Restricted
Subsidiary not sold or disposed of in an amount determined as
provided in the final paragraph of the covenant described above
under the caption “— Restricted Payments.”
Notwithstanding the foregoing, purchases, redemptions or other
acquisitions of Equity Interests of an Issuer or any direct or
indirect parent of an Issuer shall not be deemed Investments.
The amount of an Investment shall be determined at the time the
Investment is made and without giving effect to subsequent
changes in value. Notwithstanding the foregoing, Restricted
Payments of the type described in clause (2) of the
definition thereof shall not be deemed to be Investments.
“Issue Date” means the date on which the
initial $250.0 million in aggregate principal amount of the
Notes is originally issued under the Indenture.
“Lien” means, with respect to any asset, any
mortgage, lien, pledge, charge, security interest or encumbrance
of any kind in respect of such asset, whether or not filed,
recorded or otherwise perfected under applicable law including
any conditional sale or other title retention agreement, any
option or other agreement to sell or give a security interest in
and any consensual filing of any financing statement under the
Uniform Commercial Code (or equivalent statutes) of any
jurisdiction other than filings in respect of leases otherwise
permitted under the Indenture.
“Liquidated Damages” means the additional
interest (if any) payable by the Issuers under the Registration
Rights Agreement.
“Management Agreement” means the Management
Agreement dated February 10, 2005 among the Issuers and
Onex Partners Manager LP, as the same may be amended, modified
or replaced from time to time so long as any such amendment,
modification or replacement, taken as a whole, is no less
favorable in any material respect to such Issuer or such
Restricted Subsidiary than the contract or agreement as in
effect on the Issue Date.
“Minority Interest” means, with respect to any
Person, interests in income (loss) of any of such Person’s
Subsidiaries held by one or more Persons other than such Person
or another Subsidiary of such Person, as reflected on such
Person’s consolidated financial statements.
“Net Income” means, with respect to any Person,
the net income (loss) of such Person, determined in accordance
with GAAP and before any reduction in respect of preferred stock
dividends, excluding, however:
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(1) for purposes of calculating
Consolidated Cash Flow only, any gain or loss, together with any
related provision for taxes on such gain or loss, realized in
connection with: (a) any Asset Sale or (b) the
acquisition or disposition of any securities by such Person or
any of its Restricted Subsidiaries; |
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(2) any income or expense incurred
in connection with the extinguishment of any Indebtedness of
such Person or any of its Restricted Subsidiaries; |
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(3) for purposes of calculating
Consolidated Cash Flow only, any extraordinary or nonrecurring
gain or loss, together with any related provision for taxes on
such extraordinary or nonrecurring gain or loss; |
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(4) any depreciation, amortization,
non-cash impairment or other non-cash charges or expenses
recorded as a result of the application of purchase accounting
in accordance with Accounting Principles Board Opinion Nos. 16
and 17 or SFAS Nos. 141 and 142; |
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(5) any gain, loss, income, expense
or other charge recognized or incurred in connection with
changes in value or dispositions of Investments made pursuant to
clause (6) of the definition of Permitted Investments (it
being understood that this clause (5) shall not apply to
any expenses incurred in connection with the funding of
contributions to any plan); and |
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(6) to the extent not otherwise
deducted in calculating such Person’s Net Income, the
amount of any Restricted Payments of the type contemplated by
clauses (8) or (9) of the second paragraph of the
“— Restricted Payments” covenant made during
the applicable period. |
“Net Proceeds” means the aggregate cash
proceeds received by an Issuer or any Restricted Subsidiary of
an Issuer in respect of any Asset Sale (including, without
limitation, any cash received upon the sale or other disposition
of any non-cash consideration received in any Asset Sale), net
of the direct costs relating to such Asset Sale, including,
without limitation, (a) fees and expenses related to such
Asset Sale (including legal, accounting and investment banking
fees and discounts, and sales and brokerage commissions, and any
relocation expenses incurred as a result of the Asset Sale),
(b) taxes paid or payable as a result of the Asset Sale, in
each case, after taking into account any available tax credits
or deductions and any tax sharing arrangements, (c) amounts
required to be applied to the repayment of Indebtedness, other
than Indebtedness under a Credit Facility, secured by a Lien on
the asset or assets that were the subject of such Asset Sale,
(d) any reserve in accordance with GAAP against any
liabilities associated with such Asset Sale and retained by the
seller after such Asset Sale, including pension and other
post-employment benefit liabilities, liabilities related to
environmental matters and liabilities under any indemnification
obligations associated with such Asset Sale and (e) cash
escrows (until released from escrow to the seller).
“Non-Recourse Debt” means Indebtedness:
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(1) as to which neither any Issuer
nor any Restricted Subsidiary of an Issuer: |
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(a) provides credit support of any
kind (including any undertaking, agreement or instrument that
would constitute Indebtedness); |
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(b) is directly or indirectly
liable as a guarantor or otherwise; or |
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(c) constitutes the lender; |
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(2) no default with respect to
which (including any rights that the holders thereof may have to
take enforcement action against an Unrestricted Subsidiary)
would permit upon notice, lapse of time or both any holder of
any other Indebtedness (other than the Notes) of an Issuer or
any Restricted Subsidiary of an Issuer to declare a default on
such other Indebtedness or cause the payment thereof to be
accelerated or payable prior to its stated maturity; and |
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(3) as to which the lenders have
been notified in writing that they will not have any recourse to
the stock (other than stock of an Unrestricted Subsidiary
pledged by an Issuer to secure debt of such Unrestricted
Subsidiary) or assets of such Issuer or such Restricted
Subsidiary. |
“Obligations” means any principal, interest,
penalties, fees, indemnifications, reimbursements, damages and
other liabilities payable under the documentation governing any
Indebtedness.
“Officers’ Certificate” means a
certificate signed by any two of the following officers of
Parent: the Chairman of the Board of Directors, the Chief
Executive Officer, the Chief Financial Officer, the President,
any Vice President, the Treasurer or the Secretary.
“Parent” means Emergency Medical Services L.P.
“Parent Guarantee” means the senior
subordinated guarantee by Parent of the Issuers’ payment
obligations under the Indenture and the Notes, executed pursuant
to the Indenture.
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“Pari Passu Indebtedness” means any
Indebtedness of an Issuer or any Guarantor that ranks pari
passu in right of payment with the Notes or the Guarantees,
as applicable.
“Permitted Business” means any business in
which the Issuers and their respective Restricted Subsidiaries
are engaged on the Issue Date or any business reasonably
related, ancillary or complementary thereto, or reasonable
extensions thereof.
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“Permitted Investments” means: |
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(1) any Investment in an Issuer or
in any Restricted Subsidiary of an Issuer; |
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(2) any Investment in Cash
Equivalents; |
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(3) any Investment by an Issuer or
any Restricted Subsidiary of an Issuer in a Person, if as a
result of such Investment: |
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(a) such Person becomes a
Restricted Subsidiary of an Issuer; or |
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(b) such Person is merged,
consolidated or amalgamated with or into, or transfers or
conveys substantially all of its assets to, or is liquidated
into, an Issuer or a Restricted Subsidiary of an Issuer; |
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(4) any Investment made as a result
of the receipt of non-cash consideration from an Asset Sale that
was made pursuant to and in compliance with the covenant
described above under the caption “— Repurchase
at the Option of Holders — Asset Sales”; |
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(5) any Investment made for
consideration consisting solely of Qualified Equity Interests; |
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(6) Investments made in connection
with the funding of contributions under any non-qualified
employee retirement plan or similar employee compensation plan
in an amount not to exceed the amount of compensation expense
recognized by an Issuer and any Restricted Subsidiary of an
Issuer in connection with such plans; |
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(7) any Investment received in
compromise or resolution of (a) obligations of trade
creditors or customers that were incurred in the ordinary course
of business of an Issuer or any Restricted Subsidiary of an
Issuer, including pursuant to any plan of reorganization or
similar arrangement upon the bankruptcy or insolvency of any
trade creditor or customer or (b) litigation, arbitration
or other disputes with Persons that are not Affiliates; |
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(8) Hedging Obligations permitted
under the “— Incurrence of Indebtedness and
Issuance of Preferred Stock” covenant; |
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(9) Investments in prepaid
expenses, negotiable instruments held for collection and lease,
endorsements for deposit or collection in the ordinary course of
business, utility or workers compensation, performance and
similar deposits entered into as a result of the operations of
the business in the ordinary course of business; |
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(10) pledges or deposits by a
Person under workers compensation laws, unemployment insurance
laws or similar legislation, or deposits in connection with
bids, tenders, contracts (other than for the payment of
Indebtedness) or leases to which such Person is a party, or
deposits as security for contested taxes or import duties or for
the payment of rent, in each case incurred in the ordinary
course of business; |
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(11) loans or advances to officers,
directors or employees of an Issuer or a Restricted Subsidiary
of an Issuer in connection with the purchase by such Persons of
Equity Interests of Parent or any direct or indirect parent of
the Issuers so long as the cash proceeds of such purchase
received by Parent or such other Person are contemporaneously
contributed to the common equity capital of an Issuer; |
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(12) loans and advances to Related
Professional Corporations made pursuant to management, practice
support and similar agreements entered into in the ordinary
course of business; and |
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(13) other Investments made after
the Issue Date in any Person having an aggregate fair market
value (measured on the date each such Investment was made and
without giving effect to subsequent changes in value), when
taken together with all other Investments made pursuant to this
clause (13) since the Issue Date, not to exceed the
greater of (a) $25.0 million or (b) 20% of the
combined Consolidated Cash Flow of the Issuers for the four full
fiscal quarters of the Issuers immediately preceding such
Investment for which financial statements are available. |
“Permitted Liens” means:
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(1) Liens in favor of an Issuer or
any Restricted Subsidiary of an Issuer; |
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(2) Liens on property of a Person
existing at the time such Person is merged into or consolidated
with an Issuer or any Restricted Subsidiary of an Issuer,
provided that such Liens were not incurred in
contemplation of such merger or consolidation and do not extend
to any assets other than those of the Person merged into or
consolidated with an Issuer or any Restricted Subsidiary of an
Issuer; |
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(3) Liens on property existing at
the time of acquisition thereof by an Issuer or any Restricted
Subsidiary of an Issuer, provided that such Liens were
not incurred in contemplation of such acquisition; |
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(4) Liens to secure Indebtedness
(including Capital Lease Obligations) permitted by
clause (4) of the second paragraph of the covenant entitled
“Incurrence of Indebtedness and Issuance of Preferred Stock; |
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(5) Liens to secure Refinancing
Indebtedness of Indebtedness secured by Liens referred to in the
foregoing clauses (2), (3) and (4) and this
clause (5); provided that in the case of Liens
securing Permitted Refinancing Indebtedness of Indebtedness
secured by Liens referred to in the foregoing clauses (2),
(3) and (4) and this clause (5), such Liens do
not extend to any additional assets (other than improvements
thereon and replacements thereof); |
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(6) Liens incurred in the ordinary
course of business of an Issuer or any Restricted Subsidiary of
an Issuer with respect to obligations that do not exceed
$7.5 million at any one time outstanding and that:
(a) are not incurred in connection with the borrowing of
money or the obtaining of advances or credit (other than trade
credit in the ordinary course of business) and (b) do not
in the aggregate materially detract from the value of the
property or materially impair the use thereof in the operation
of business by such Issuer or such Restricted Subsidiary; |
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(7) Liens securing reimbursement
obligations with respect to commercial letters of credit which
encumber documents and other property relating to such letters
of credit and products and proceeds thereof; |
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(8) Liens created for the benefit
of (or to secure) the Notes (or the Guarantees) or payment
obligations to the Trustee; |
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(9) Liens and rights of setoff in
favor of a bank imposed by law and incurred in the ordinary
course of business on deposit accounts maintained with such bank
and cash and Cash Equivalents in such accounts; and |
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(10) Liens securing Hedging
Obligations incurred for the purpose of fixing or hedging
interest rate risk with respect to any floating rate
Indebtedness which Hedging Obligations relate to Indebtedness
that is otherwise permitted under the Indenture. |
“Permitted Refinancing Indebtedness” means any
Indebtedness of an Issuer or any Restricted Subsidiary of an
Issuer issued in exchange for, or the net proceeds of which are
used to extend, refinance, renew, replace, defease or refund
other Indebtedness of an Issuer or any Restricted Subsidiary of
an Issuer; provided that:
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(1) the principal amount (or
accreted value, if applicable) of such Permitted Refinancing
Indebtedness does not exceed the principal amount of (or
accreted value, if applicable), plus accrued |
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interest on, the Indebtedness so extended, refinanced, renewed,
replaced, defeased or refunded (plus the amount of reasonable
expenses and premiums incurred in connection therewith); |
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(2) such Permitted Refinancing
Indebtedness has a final maturity date no earlier than the final
maturity date of, and has a Weighted Average Life to Maturity
equal to or greater than the Weighted Average Life to Maturity
of, the Indebtedness being extended, refinanced, renewed,
replaced, defeased or refunded; and |
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(3) if the Indebtedness being
extended, refinanced, renewed, replaced, defeased or refunded is
subordinated in right of payment to the Notes, such Permitted
Refinancing Indebtedness has a final maturity date later than
the final maturity date of, and is subordinated in right of
payment to, the Notes on terms at least as favorable to the
Holders of Notes as those contained in the documentation
governing the Indebtedness being extended, refinanced, renewed,
replaced, defeased or refunded. |
“Pro Forma Cost Savings” means, with respect to
any period, the reductions in costs (including, without
limitation, such reductions resulting from employee
terminations, facilities consolidations and closings,
standardization of employee benefits and compensation policies,
consolidation of property, casualty and other insurance coverage
and policies, standardization of sales and distribution methods,
reductions in taxes other than income taxes) that occurred
during such period that are (1) directly attributable to an
asset acquisition and calculated on a basis that is consistent
with Article 11 of Regulation S-X under the Securities
Act or (2) implemented, committed to be implemented,
specifically identified to be implemented or the commencement of
implementation of which has begun in good faith by the business
that was the subject of any such asset acquisition within six
months of the date of the asset acquisition and that are
supportable and quantifiable by the underlying records of such
business, as if, in the case of each of clauses (1) and
(2), all such reductions in costs had been effected as of the
beginning of such period, decreased by any incremental expenses
incurred or to be incurred during such period in order to
achieve such reduction in costs.
“Public Equity Offering” means an underwritten
public offering of common stock (or, if Parent is not a
corporation, other Qualified Equity Interests substantially
analogous to common stock) of Parent pursuant to an effective
registration statement under the Securities Act.
“Public Market” means any time after (a) a
Public Equity Offering has been consummated and (b) at
least 20.0% of the total issued and outstanding common equity of
Parent has been distributed by means of an effective
registration statement under the Securities Act or sales
pursuant to Rule 144 under the Securities Act.
“Qualified Equity Interests” means Equity
Interests of the Issuers other than Disqualified Stock.
“Registration Rights Agreement” means the
Registration Rights Agreement, dated as of February 10,
2005, by and among Parent, the Issuers and the other parties
named on the signature pages thereof, as such agreement may be
amended, modified or supplemented from time to time and, with
respect to any Additional Notes, one or more registration rights
agreements between the Issuers and the other parties thereto, as
such agreement(s) may be amended, modified or supplemented from
time to time, relating to rights given by the Issuers to the
purchasers of Additional Notes to register such Additional Notes
under the Securities Act.
“Related Party” with respect to any Sponsor
means:
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(1) any controlling stockholder or
partner, 80% (or more) owned Subsidiary, or spouse or immediate
family member (in the case of an individual) of such
Sponsor; or |
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(2) any trust, corporation,
partnership or other entity, the beneficiaries, stockholders,
partners, owners or Persons beneficially holding a 51% or more
controlling interest of which consist of such Sponsor and/or
such other Persons referred to in the immediately preceding
clause (1); |
provided that “Related Party” shall not include any
portfolio operating companies of Sponsor.
“Related Professional Corporation” means a
professional corporation that is owned by one or more
physicians, independent contractor physicians and/or healthcare
facilities in each case (a) to whom an Issuer, any
Restricted Subsidiary of an Issuer or another Related
Professional Corporation provides management
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services pursuant to a management services, practice support or
similar agreement and (b) except for the effect of the
preceding clause (a), is not otherwise an Affiliate of the
Issuers and their respective Restricted Subsidiaries.
“Reorganization Securities” means securities
distributed to Holders of the Notes in an Insolvency or
Liquidation Proceeding pursuant to a plan of reorganization
consented to by each class of the Senior Debt, but only if all
of the terms and conditions of such securities including,
without limitation, term, tenor, interest, amortization,
subordination, standstills, covenants and defaults are at least
as favorable (and provide the same relative benefits) to the
holders of Senior Debt and to the holders of any security
distributed in such Insolvency or Liquidation Proceeding on
account of any such Senior Debt as the terms and conditions of
the Notes and the Indenture are, and provide to the holders of
Senior Debt.
“Representative” means the Trustee, agent or
representative for any Senior Debt.
“Restricted Investment” means an Investment
other than a Permitted Investment.
“Restricted Subsidiary” of a Person means any
Subsidiary of the referent Person that is not an Unrestricted
Subsidiary.
“Rule 144A” means Rule 144A
promulgated under the Securities Act.
“Sale and Leaseback Transaction” means any
direct or indirect arrangement with any Person or to which any
such Person is a party, providing for the leasing to an Issuer
or a Restricted Subsidiary of an Issuer of any property, whether
owned by an Issuer or any such Restricted Subsidiary at the
Issue Date or later acquired, which has been or is to be sold or
transferred by an Issuer or any such Restricted Subsidiary to
such Person or any other Person from whom funds have been or are
to be advanced by such Person on the security of such property.
“Senior Credit Facilities” means the Credit
Agreement dated the Issue Date among the Issuers the guarantors
party thereto, the Administrative Agent and Banc of America
Securities LLC and J.P. Morgan Securities Inc., as
co-arrangers, and the other agents and lenders named therein,
providing for revolving credit borrowings and term loans,
including any related notes, guarantees, collateral documents,
instruments and agreements executed in connection therewith, and
in each case as amended, modified, renewed, refunded, replaced
or refinanced from time to time including increases in principal
amount.
“Senior Debt” means:
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(1) all Indebtedness outstanding
under the Senior Credit Facilities, including any Guarantees
thereof and all Hedging Obligations incurred for the purpose of
fixing or hedging interest rate risk with respect to any
floating rate Indebtedness thereunder; |
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(2) any other Indebtedness properly
incurred by the Issuers or the Guarantors under the terms of the
Indenture, unless the instrument under which such Indebtedness
is incurred expressly provides that it is on a parity with or
subordinated in right of payment to the Notes and/or the
Guarantees, as applicable; and |
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(3) all Obligations with respect to
the preceding clauses (1) and (2) (including any interest
accruing subsequent to the filing of a petition of bankruptcy at
the rate provided for in the documentation with respect thereto,
whether or not such interest is allowed as a claim under
applicable law). |
Notwithstanding anything to the contrary in the preceding,
Senior Debt will not include:
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(1) any Indebtedness that is, by
its express terms, subordinated in right of payment to any other
Indebtedness of an Issuer or any Guarantor; |
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(2) any liability for federal,
state, local or other taxes owed or owing by an Issuer or any
Guarantor; |
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(3) any Indebtedness of an Issuer
to Parent or any Subsidiary of an Issuer; |
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(4) any trade payables; |
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(5) any Indebtedness that is
incurred in violation of the Indenture; provided that as to any
such obligation, no such violation shall be deemed to exist for
purposes of this clause (5) if the Holder(s) of such
obligation or their representative and the Trustee shall have
received an Officers’ Certificate of an Issuer to the
effect that the incurrence of such Indebtedness does not (or, in
the case of revolving credit Indebtedness, that the incurrence
of the entire committed amount thereof at the date on which the
initial borrowing thereunder is made would not) violate such
provisions of the Indenture; |
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(6) obligations or liabilities in
respect of Capital Stock; or |
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(7) Indebtedness to, or guaranteed
on behalf of, any Affiliate of Parent or any of its Subsidiaries. |
“Significant Subsidiary” means any Restricted
Subsidiary, or group of Restricted Subsidiaries when taken
together, that would be a “significant subsidiary” as
defined in Article 1, Rule 1-02 of
Regulation S-X, promulgated pursuant to the Act, as such
Regulation is in effect on the date of the Indenture.
“Sponsor” means Onex Partners LP, Onex
Corporation and their respective Affiliates other than portfolio
operating companies of any of the foregoing.
“Stated Maturity” means, with respect to any
installment of interest or principal on any series of
Indebtedness, the date on which such payment of interest or
principal was scheduled to be paid in the original documentation
governing such Indebtedness, and shall not include any
contingent obligations to repay, redeem or repurchase any such
interest or principal prior to the date originally scheduled for
the payment thereof.
“Subsidiary” means, with respect to any Person:
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(1) any corporation, association or
other business entity of which more than 50% of the total voting
power of shares of Capital Stock entitled (without regard to the
occurrence of any contingency) to vote in the election of
directors, managers or trustees thereof is at the time owned or
controlled, directly or indirectly, by such Person or one or
more of the other Subsidiaries of that Person (or a combination
thereof); and |
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(2) any partnership or limited
liability company (a) the sole general partner or the
managing general partner or managing member of which is such
Person or a Subsidiary of such Person or (b) the only
general partners of which are such Person or of one or more
Subsidiaries of such Person (or any combination thereof). |
“Subsidiary Guarantee” means the senior
subordinated guarantee by each Subsidiary of an Issuer’s
payment obligations under Indenture and the Notes, executed
pursuant to the Indenture.
“Subsidiary Guarantor” means the Subsidiary of
an Issuer that guarantees such Issuer’s payment obligations
under the Indenture and the Notes.
“Total Assets” means the total combined,
consolidated assets of the Issuers and their respective
Restricted Subsidiaries, as would be shown on the Issuers’
consolidated balance sheet in accordance with GAAP on the date
of determination.
“Transactions” means the acquisition of
American Medical Response, Inc. and EmCare Holdings Inc.
(together, the “Targets”), the cash equity
contribution relating thereto, the issuance and sale of these
notes, the execution and delivery of the Credit Agreement
relating to the Senior Credit Facilities and documents related
thereto and the initial extension of credit thereunder, and
other transactions contemplated by the purchase agreements
entered into and consummated in connection with the acquisition
of the Targets and the payment of fees and expenses in
connection with the foregoing.
“Unrestricted Subsidiary” means with respect to
any Person, any Subsidiary of such Person that is designated by
the Board of Directors of such Person as an Unrestricted
Subsidiary pursuant to a Board Resolution, but only to the
extent that such Subsidiary:
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(1) has no Indebtedness other than
Non-Recourse Debt; |
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(2) except as permitted under the
covenant described above under the caption
“— Certain Covenants — Affiliate
Transactions,” is not party to any agreement, contract,
arrangement or understanding with an Issuer or any Restricted
Subsidiary of an Issuer unless the terms of any such agreement,
contract, arrangement or understanding are no less favorable to
such Issuer or such Restricted Subsidiary than those that might
be obtained at the time from Persons who are not Affiliates of
an Issuer; |
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(3) is a Person with respect to
which neither an Issuer nor any Restricted Subsidiary of an
Issuer has any direct or indirect obligation (a) to
subscribe for additional Equity Interests or (b) to
maintain or preserve such Person’s financial condition or
to cause such Person to achieve any specified levels of
operating results; and |
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(4) has not guaranteed or otherwise
directly or indirectly provided credit support for any
Indebtedness of an Issuer or any Restricted Subsidiary of an
Issuer. |
Any designation of a Subsidiary of an Issuer as an Unrestricted
Subsidiary shall be evidenced to the Trustee by filing with the
Trustee a certified copy of the Board Resolution giving effect
to such designation and an Officers’ Certificate certifying
that such designation complied with the preceding conditions and
was permitted by the covenant described above under the caption
“Certain Covenants — Restricted Payments.”
On the Issue Date, EMCA Insurance Company, Ltd. will be an
Unrestricted Subsidiary without any further action on the part
of the Issuers. If, at any time, any Unrestricted Subsidiary
would fail to meet the preceding requirements as an Unrestricted
Subsidiary, it shall thereafter cease to be an Unrestricted
Subsidiary for purposes of the Indenture and any Indebtedness of
such Subsidiary shall be deemed to be incurred by a Restricted
Subsidiary of an Issuer as of such date and, if such
Indebtedness is not permitted to be incurred as of such date
under the covenant described under the caption “Incurrence
of Indebtedness and Issuance of Preferred Stock,” the
Issuers shall be in default of such covenant. The Board of
Directors of Parent may at any time designate any Unrestricted
Subsidiary of an Issuer to be a Restricted Subsidiary;
provided that such designation shall be deemed to be an
incurrence of Indebtedness by a Restricted Subsidiary of such
Issuer of any outstanding Indebtedness of such Unrestricted
Subsidiary and such designation shall be permitted only if:
(1) such Indebtedness is permitted under the covenant
described under the caption “Certain Covenants —
Incurrence of Indebtedness and Issuance of Preferred
Stock,” and (2) no Default or Event of Default would
be in existence following such designation.
“Voting Stock” of any Person as of any date
means the Capital Stock of such Person that is at the time
entitled to vote in the election of the Board of Directors of
such Person.
“Weighted Average Life to Maturity” means, when
applied to any Indebtedness at any date, the number of years
obtained by dividing:
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(1) the sum of the products
obtained by multiplying: (a) the amount of each then
remaining installment, sinking fund, serial maturity or other
required payments of principal, including payment at final
maturity, in respect thereof, by (b) the number of years
(calculated to the nearest one-twelfth) that will elapse between
such date and the making of such payment, by |
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(2) the then outstanding principal
amount of such Indebtedness. |
“Wholly Owned Subsidiary” of any Person means a
Subsidiary of such Person all of the outstanding Capital Stock
or other ownership interests of which (other than
directors’ qualifying shares or shares of Foreign
Subsidiaries required to be owned by foreign nationals pursuant
to applicable law) shall at the time be owned by such Person
and/or by one or more Wholly Owned Subsidiaries of such Person.
172
MATERIAL UNITED STATES FEDERAL INCOME TAX CONSIDERATIONS
The following is a general discussion of material
U.S. federal income and, in the case of
Non-U.S. Holders (as defined below), estate tax
considerations of the acquisition, ownership and disposition of
the notes by you if you acquired the notes on original issuance
for cash at the initial offering price. The discussion is based
on the Internal Revenue Code of 1986, as amended, Treasury
regulations, judicial authorities, published positions of the
Internal Revenue Service, or the IRS, and other applicable
authorities, all as in effect on the date of this offering
memorandum and all of which are subject to change or differing
interpretations (possibly with retroactive effect). This
discussion is limited to persons who will hold the notes as
capital assets for U.S. federal income tax purposes
(generally, assets held for investment). This summary does not
address all of the tax consequences that may be relevant to you,
particularly if you are subject to special treatment under
U.S. federal income tax laws (such as if you are a
financial institution, tax-exempt organization, real estate
investment company, regulated investment company, insurance
company, expatriate or a broker dealer, you are, or will hold
the notes through, a pass-through entity, you will hold the
notes as part of a straddle, hedge or synthetic security
transaction for U.S. federal income tax purposes or if you
are a U.S. Holder (as defined below) that has a functional
currency other than the U.S. dollar). No ruling has been or
will be sought from the IRS regarding any matter discussed
herein. No assurance can be given that the IRS would not assert,
or that a court would not sustain, a position contrary to any of
the tax aspects set forth below. You are urged to consult your
own tax advisors as to the U.S. federal income tax
consequences of acquiring, holding and disposing of the notes,
as well as the effects of state, local and non-U.S. tax
laws.
For purposes of this discussion, a “U.S. Holder”
means any of the following:
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an individual who is a citizen or resident of the United States, |
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a corporation or other entity treated as a corporation for
U.S. federal income tax purposes created or organized under
the laws of the United States or any state or political
subdivision thereof, |
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an estate, the income of which is subject to U.S. federal
income taxation regardless of its source, or |
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a trust that (i) is subject to the primary supervision of a
U.S. court and which has one or more U.S. fiduciaries
who have the authority to control all substantial decisions of
the trust, or (ii) has a valid election in effect under
applicable U.S. Treasury regulations to be treated as a
U.S. person. |
If a partnership (including any entity treated as a pass-through
entity for U.S. federal income tax purposes) holds the
notes, the tax treatment of a partner generally will depend upon
the status of the partner and upon the activities of the
partnership. If you are a partner of a partnership holding the
notes, we suggest that you consult your tax advisor.
As used herein, the term “Non-U.S. Holder” means
a beneficial owner of the notes that is not a partnership or a
U.S. person.
The notes provide for the payment of liquidated damages under
certain circumstances described under “Description of
Notes — Registration Rights; Liquidated Damages.”
The notes may be subject to Treasury Regulations applicable to
debt instruments that provide for one or more contingent
payments. Under such Treasury Regulations, if the payment of
liquidated damages on the notes is, as of the issue date, either
a “remote” or “incidental” contingency, the
payment of liquidated damages, if any, would not be considered a
contingent payment and such liquidated damages would generally
be included in income in the same manner as stated interest, as
described below. We believe that the likelihood that liquidated
damages will become payable due to a failure to register the
notes is remote. Accordingly, we intend to take the position
that the notes are not contingent interest notes. Our
determination that such payments are a remote or incidental
contingency for these purposes is binding on you unless you
disclose to the IRS that you are taking a contrary position. Our
determination is not, however, binding on the IRS, and if the
IRS were to challenge this determination, you might be required
to accrue income on the notes in excess of stated interest
regardless of your regular method of accounting, and to treat as
ordinary income rather than capital gain any income realized on
the taxable disposition of a note. The remainder of this
discussion assumes that the notes are not contingent interest
notes.
173
Tax Consequences to U.S. Holders
The following discussion is limited to the material
U.S. federal income tax consequences relevant to
U.S. Holders. Material U.S. federal income tax
consequences relevant to Non-U.S. Holders are discussed
separately below.
Payments of stated interest on the notes generally will be
taxable to a you as ordinary interest income at the time such
payments are accrued or received, in accordance with the your
regular method of accounting for U.S. federal income tax
purposes.
A sale, redemption or other taxable disposition of a note
generally will result in capital gain or loss equal to the
difference between the amount of cash and fair market value of
other property that you receive for the note and your adjusted
tax basis for the note (except to the extent that such cash or
other property is attributable to the payment of accrued and
unpaid interest, which amount will be taxable as interest as
discussed above). Capital gain or loss recognized on the sale,
redemption or other taxable disposition of a note held for more
than one year will be long-term capital gain or loss. Under
current U.S. federal income tax law, long-term capital
gains of certain noncorporate taxpayers (including individuals)
may be taxed at preferential rates. Certain limitations,
however, apply to your ability to deduct capital losses. An
exchange of the notes for registered notes pursuant to the
exchange offer described under “Description of
Notes — Registration Rights; Liquidated Damages”
is not anticipated to be a taxable event for U.S. federal
income tax purposes. In the event of such an exchange, your
holding period for the exchange note received in the exchange
will include the holding period for the note so exchanged, and
your adjusted tax basis for the exchange note will be the same
as your adjusted tax basis for the note so exchanged (determined
immediately before the exchange).
As a U.S. Holder, you will not recognize taxable gain or
loss for U.S. Federal income tax purposes on the exchange
of initial notes pursuant to the exchange offer, and your tax
basis and holding period for such registered notes will be the
same as for the notes immediately before the exchange.
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Information Reporting and Backup Withholding |
You may be subject, under certain circumstances, to information
reporting and “backup withholding” with respect to
certain “reportable payments,” including interest
payments and, under certain circumstances, principal payments on
and gross proceeds from your disposition of a note. The backup
withholding rules apply if you, among other things,
(i) have been informed by the IRS that you are subject to
backup withholding for failing properly to furnish your social
security number or other taxpayer identification number, or TIN,
(ii) furnish an incorrect TIN, (iii) fail to properly
report the receipt of interest or dividends or (iv) under
certain circumstances, fail to provide a certified statement,
signed under penalties of perjury, that the TIN furnished is the
correct number and that you are not subject to backup
withholding. If you do not provide us with your correct TIN you
may also be subject to penalties imposed by the IRS. Backup
withholding will not apply with respect to payments made to
certain holders, including corporations and tax-exempt
organizations, provided their exemptions from backup withholding
are properly established. To the extent required by law, we will
report annually to the IRS and to you the amount of any
reportable payments and the amount, if any, of tax withheld with
respect to such payments.
Backup withholding is not an additional tax. Any amounts we
withhold under the backup withholding rules will be allowed as a
refund or a credit against your U.S. federal income tax
liability, provided that the requisite procedures are followed
and certain information is provided to the IRS.
174
Tax Consequences to Non-U.S. Holders
The following discussion is limited to the material
U.S. federal income tax consequences relevant to
Non-U.S. Holders.
Subject to the discussion below concerning information reporting
and backup withholding, payments of interest on a note to you
will qualify for the “portfolio interest exemption”
and therefore will not be subject to U.S. federal income
tax or withholding tax, provided that all of the following are
true:
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the interest is not effectively connected with the conduct by
you of a trade or business in the United States; |
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you do not actually or constructively own 10% or more of the
total combined voting power of all classes of our stock entitled
to vote; |
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you are not a controlled foreign corporation that is related,
directly or indirectly, to us for U.S. federal income tax
purposes; |
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you are not a bank with respect to which the receipt of interest
on the notes is described in Section 881(c)(3)(A) of the
Internal Revenue Code; and |
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you certify, on Form W-8BEN (or a permissible substitute)
under penalties of perjury, that you are a Non-U.S. Holder
and provide your name and address or you hold your notes
directly through a “qualified intermediary,” and the
qualified intermediary has sufficient information in its files
indicating that you are not a U.S. Holder. A qualified
intermediary is a bank, broker or other intermediary that
(1) is either a U.S. or a non-U.S. entity,
(2) is acting out of a non-U.S. branch or office and
(3) has signed an agreement with the IRS providing that it
will administer all or part of the U.S. tax withholding
rules under specified procedures. |
Interest paid to you that does not qualify for the above
exemption from withholding tax will generally be subject to
withholding of U.S. federal income tax at the rate of 30%,
unless you provide us with a properly executed:
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IRS Form W-8BEN (or a permissible substitute) claiming an
exemption from (or reduction in) withholding under the benefit
of an applicable income tax treaty; or |
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IRS Form W-8ECI stating that the interest paid on the note
is not subject to withholding tax because it is effectively
connected with your conduct of a trade or business in the United
States. If, however, the interest is effectively connected with
the conduct of a trade or business in the United States, the
interest will generally be subject to the U.S. federal
income tax as if you were a U.S. Holder unless an
applicable income tax treaty provides otherwise. In addition, if
you are a foreign corporation, under certain circumstances you
may be subject to a branch profits tax equal to 30% (or lower
applicable treaty rate) of your earnings and profits for the
taxable year (subject to adjustments) that are effectively
connected to a trade or business conducted by you in the United
States. |
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Disposition of Notes; Exchange Offer |
Subject to the discussion below concerning information reporting
and backup withholding, any gain you realize on the sale,
redemption or other disposition of a note generally will not be
subject to U.S. federal income tax unless (i) such
gain is effectively connected with your conduct of a trade or
business within the United States or (ii) you are an
individual who is present in the United States for 183 days
or more in the taxable year of the disposition and certain other
conditions are satisfied. You will not recognize gain or loss
for U.S. Federal income tax purposes on the exchange of
initial notes pursuant to the exchange offer and your tax basis
and holding period for such registered notes will be the same as
for the notes immediately before the exchange.
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Information Reporting and Backup Withholding |
Payments of principal and interest made in respect of notes held
by you generally will not be subject to information reporting
and backup withholding if you properly certify as to your
non-U.S. status under penalties of perjury or otherwise
establish an exemption. You generally will provide such
information (and other required certifications) on IRS
Form W-8BEN. However, the exemption does not apply if the
withholding agent or an intermediary knows or has reason to know
that you should be subject to the usual information reporting or
backup withholding rules.
The payment to you of the proceeds of the sale or other taxable
disposition of a note (including a redemption) by or through the
U.S. office of a broker is subject to information reporting
and backup withholding unless you properly certify your
non-U.S. status under penalties of perjury or otherwise
establish an exemption. Information reporting requirements, but
not backup withholding, will also generally apply to payments of
proceeds of sales or other taxable dispositions of notes
(including a redemption) by or through non-U.S. offices of
U.S. brokers or by or through non-U.S. brokers with
certain types of relationships to the United States unless the
broker has documentary evidence in its files that you are not a
U.S. person and such broker has no actual knowledge or
reason to know to the contrary or you otherwise establish an
exemption. Neither information reporting nor backup withholding
generally will apply to a payment of the proceeds of a sale or
other taxable disposition of a note by or through a foreign
office of a foreign broker not subject to the preceding sentence.
Backup withholding is not an additional tax. Any amounts we
withhold under the backup withholding rules will be allowed as a
refund or a credit against your U.S. federal income tax
liability, provided that the requisite procedures are followed
and certain information is provided to the IRS.
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Treatment of the Notes for U.S. Federal Estate Tax
Purposes |
Notes held by an individual who is a Non-U.S. Holder at the
time of his or her death generally will not be subject to
U.S. federal estate tax provided that, at the time of
death, the Non-U.S. Holder is exempt from withholding of
U.S. federal income tax under the rules described above.
176
PLAN OF DISTRIBUTION
With respect to the resale of exchange notes, based on an
interpretation by the staff of the SEC set forth in no-action
letters issued to third parties, we believe that a holder (other
than a person that is an affiliate of ours within the meaning of
Rule 405 under the Securities Act or “broker” or
“dealer” registered under the Exchange Act) who
exchanges outstanding notes for exchange notes in the ordinary
course of business and who is not participating, does not intend
to participate, and has no arrangement or understanding with any
person to participate, in the distribution of the exchange
notes, will be allowed to resell the exchange notes to the
public without further registration under the Securities Act and
without delivering to the purchasers of the exchange notes a
prospectus that satisfies the requirements of Section 10
thereof. However, if any holder acquires exchange notes in the
exchange offer for the purpose of distributing or participating
in a distribution of the exchange notes, such holder cannot rely
on the position of the staff of the SEC enunciated in Exxon
Capital Holdings Corporation (available May 13, 1988) or
similar no-action or interpretive letters and must comply with
the registration and prospectus delivery requirements of the
Securities Act in connection with a secondary resale
transaction; any such secondary resale transaction must be
covered by an effective registration statement containing the
selling security holder information required by Item 507 of
Regulation S-K if the resales are of exchange notes
obtained by such holder in exchange for outstanding notes
acquired by such holder directly from us or an affiliate of
ours, unless an exemption from registration is otherwise
available.
As contemplated by the above no-action letters and the
registration rights agreement, each holder accepting the
exchange offer is required to represent to us in the letter of
transmittal that:
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any exchange notes to be received by it will be acquired in the
ordinary course of its business; |
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it has no arrangement or understanding with any person to
participate in the distribution of the exchange notes; |
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it is not an “affiliate,” as defined in the Securities
Act, of ours; and |
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any additional representations that in the written opinion of
our counsel are necessary under existing rules or regulations
(or interpretations thereof) of the SEC in order for the
registration statement of which this prospectus forms a part to
be declared effective. |
If the holder is not a broker-dealer, it will be required to
represent that it is not engaged in, and does not intend to
engage in, the distribution of the exchange notes. If the holder
is a broker-dealer that will receive exchange notes for its own
account in exchange for outstanding notes that were acquired as
a result of market-making activities or other trading
activities, it will be required to acknowledge that it will
deliver a prospectus in connection with any resale of such
exchange notes.
Any broker or dealer registered under the Exchange Act who holds
outstanding notes that were acquired for its own account as a
result of market-making activities or other trading activities
(other than outstanding notes acquired directly from us) may
exchange such outstanding notes for exchange notes pursuant to
the exchange offer; however, such broker-dealer may be deemed an
underwriter within the meaning of the Securities Act and,
therefore, must deliver a prospectus meeting the requirements of
the Securities Act in connection with any resales of the
exchange notes received by it in the exchange offer, which
prospectus delivery requirement may be satisfied by the delivery
by such broker-dealer of this prospectus. We have agreed to use
commercially reasonable efforts to keep the registration
statement of which this prospectus forms a part effective for a
period beginning when exchange notes are first issued in the
exchange offer and ending upon the earlier of the expiration of
the 90th day after the exchange offer has been completed
and such time as broker-dealers are no longer required to comply
with the prospectus delivery requirements in connection with
offers and sales of exchange notes.
177
A broker-dealer that delivers such a prospectus to purchasers in
connection with such resales will be subject to certain of the
civil liability provisions under the Securities Act, and will be
bound by the provisions of the registration rights agreement
(including certain indemnification rights and obligations).
The information described above concerning interpretations of,
and positions taken by, the SEC is not intended to constitute
legal advice, and broker-dealers should consult their own legal
advisors with respect to these matters.
We will not receive any proceeds from any sale of exchange notes
by broker-dealers. Exchange notes received by broker-dealers for
their own account pursuant to the exchange offer may be sold
from time to time in one or more transactions in the
over-the-counter market, in negotiated transactions, through the
writing of options on the exchange notes or a combination of
such methods of resale, at market prices prevailing at the time
of resale, at prices related to such prevailing market prices or
negotiated prices. Any such resale may be made directly to a
purchaser or to or through brokers or dealers who may receive
compensation in the form of commissions or concessions from any
such broker-dealer and/or the purchasers of any such exchange
notes.
We have agreed to pay all expenses incident to the exchange
offer. See “The Exchange Offer — Fees and
Expenses.”
LEGAL MATTERS
The validity of the exchange notes offered hereby and certain
other legal matters will be passed upon for us by Kaye Scholer
LLP, New York, New York. Certain regulatory matters will be
passed upon for us by Foley & Lardner LLP,
San Diego, California.
EXPERTS
The combined financial statements of American Medical Response,
Inc. and its subsidiaries and EmCare Holdings Inc. and its
subsidiaries for the year ended August 31, 2002
(Predecessor), the nine months ended May 31, 2003
(Predecessor), and as of and for the three months ended
August 31, 2003, the year ended August 31, 2004 and
the five months ended January 31, 2005 included in this
prospectus, have been so included in reliance on the reports
(which contain an explanatory paragraph relating to the
companies’ restatement of their combined financial
statements, as well as the parent’s emergence from
bankruptcy as described in Note 1) of
PricewaterhouseCoopers LLP, an independent registered public
accounting firm, given on the authority of said firm as experts
in auditing and accounting.
WHERE YOU CAN FIND MORE INFORMATION
This prospectus, which constitutes a part of the registration
statement, does not contain all of the information included in
the registration statement or the schedules, exhibits and
amendments to the registration statement. You should refer to
the registration statement and its exhibits and schedules for
further information. Statements made in this prospectus as to
any of our contracts, agreements or other documents referred to
are not necessarily complete. In each instance, if we have filed
a copy of such contract, agreement or other document as an
exhibit to the registration statement, you should read the
exhibit for a more complete understanding of the matter
involved. Each statement regarding a contract, agreement or
other document is qualified in all respects by reference to the
actual document.
178
You may read and copy information omitted from this prospectus
but contained in the registration statement at the public
reference facilities maintained by the SEC at 100 F Street N.E.,
Washington, D.C. 20549. You may also request copies of all
or any portion of such material from the Public Reference
Section of the SEC at 100 F Street N.E., Room 1580,
Washington, D.C. 20549 at prescribed rates. Please call the
Securities and Exchange Commission at 1-800-SEC-0330 for further
information on the operation of the public reference rooms. In
addition, materials filed electronically with the SEC are
available at the SEC’s World Wide Web site at
http://www.sec.gov.
Upon completion of our initial public offering, we will be
subject to the information and periodic reporting requirements
of the Securities Exchange Act of 1934, and, in accordance
therewith, will file periodic reports, proxy statements and
other information with the SEC. Such periodic reports, proxy
statements and other information will be available for
inspection and copying at the public reference room and web site
of the SEC referred to above. We maintain a web site at
www.emsc.net. You may access our annual report on
Form 10-K, quarterly reports on Form 10-Q, current
reports on Form 8-K, and amendments to those reports, filed
or furnished pursuant to section 13(a) or 15(d) of the
Exchange Act with the SEC free of charge at our web site as soon
as reasonably practicable after this material is electronically
filed with, or furnished to, the SEC. The reference to our web
address does not constitute incorporation by reference of the
information contained at that site.
179
AMERICAN MEDICAL RESPONSE, INC. & EMCARE HOLDINGS
INC.
INDEX TO COMBINED AND CONSOLIDATED FINANCIAL STATEMENTS
|
|
|
|
|
|
|
|
Page | |
|
|
| |
Combined Financial Statements (as Restated) for the Five
Months Ended January 31, 2005, for the Year Ended
August 31, 2004, for the Three Months Ended August 31,
2003, for the Nine Months Ended May 31, 2003 (Predecessor)
for the Year Ended August 31, 2002 (Predecessor)
|
|
|
|
|
|
Report of Independent Registered Public Accounting Firm
|
|
|
F-2 |
|
|
Combined Balance Sheets at January 31, 2005,
August 31, 2004 and 2003
|
|
|
F-5 |
|
|
Combined Statements of Operations and Comprehensive Income
(Loss) for the five months ended January 31, 2005, for the
year ended August 31, 2004, for the three months ended
August 31, 2003, for the nine months ended May 31,
2003 (Predecessor) and for the year ended August 31, 2002
(Predecessor)
|
|
|
F-6 |
|
|
Statements of Changes in Combined Equity for the five months
ended January 31, 2005, for the year ended August 31,
2004, for the three months ended August 31, 2003, for the
nine months ended May 31, 2003 (Predecessor) and for the
year ended August 31, 2002 (Predecessor)
|
|
|
F-7 |
|
|
Combined Statements of Cash Flows for the five months ended
January 31, 2005, for the year ended August 31, 2004,
for the three months ended August 31, 2003, for the nine
months ended May 31, 2003 (Predecessor), and for the year
ended August 31, 2002 (Predecessor)
|
|
|
F-8 |
|
|
Notes to Combined Financial Statements
|
|
|
F-9 |
|
|
|
|
|
|
|
|
|
Page | |
|
|
| |
Unaudited Consolidated/ Combined Financial Statements for the
Three Months and Five Months Ended June 30, 2005 and
June 30, 2004
|
|
|
|
|
|
Unaudited Consolidated Balance Sheet at June 30, 2005 and
Combined Balance Sheet at January 31, 2005
|
|
|
F-49 |
|
|
Unaudited Consolidated/ Combined Statements of Operations and
Comprehensive Income for the three months and five months ended
June 30, 2005 and 2004
|
|
|
F-50 |
|
|
Unaudited Consolidated/Combined Statements of Cash Flows for
five months ended June 30, 2005 and 2004
|
|
|
F-51 |
|
|
Notes to Unaudited Consolidated/ Combined Financial Statements
|
|
|
F-52 |
|
F-1
REPORT OF INDEPENDENT REGISTERED PUBLIC ACCOUNTING FIRM
To the Stockholders of American Medical Response, Inc.
and EmCare Holdings, Inc.:
In our opinion, the accompanying combined balance sheets
(successor basis) and the related combined statements of
operations and comprehensive income (loss) (successor basis),
changes in combined equity (successor basis) and cash flows
(successor basis) present fairly, in all material respects, the
financial position of American Medical Response, Inc. and its
subsidiaries (“AMR”) and EmCare Holdings, Inc. and its
subsidiaries (“EmCare”) (collectively, the
“Company”) as of January 31, 2005 and
August 31, 2004 and 2003 and the results of their
operations and changes in combined equity and cash flows for the
five-month period ended January 31, 2005, for the year
ended August 31, 2004 and for the three-month period ended
August 31, 2003, in conformity with accounting principles
generally accepted in the United States of America. These
combined financial statements are the responsibility of the AMR
and EmCare management; our responsibility is to express an
opinion on these financial statements based on our audits. We
conducted our audits of these statements in accordance with the
standards of the Public Company Accounting Oversight Board
(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,
assessing the accounting principles used and significant
estimates made by management, and evaluating the overall
financial statement presentation. We believe that our audits
provide a reasonable basis for our opinion.
As discussed in Note 1 to the combined financial
statements, AMR and EmCare are wholly-owned subsidiaries of
Laidlaw International, Inc., previously Laidlaw, Inc.
(“Laidlaw”). The United States Bankruptcy Court for
the Western District for New York confirmed Laidlaw’s Third
Amended Plan of Reorganization (the “plan”) on
February 27, 2003. Confirmation of the plan resulted in the
discharge of all claims against Laidlaw that arose on or before
June 28, 2001 and terminated all rights and interest of
equity security holders as provided for in the plan. The plan
was implemented in June 2003 and Laidlaw emerged from
bankruptcy. In connection with its emergence from bankruptcy,
Laidlaw adopted fresh-start accounting and recorded fresh-start
accounting adjustments in the separate financial statements of
AMR and EmCare on June 1, 2003. As a result, the
Company’s post-emergence (successor basis) financial
statements reflect a different basis of accounting than its
pre-emergence (predecessor basis) financial statements.
As discussed in Note 1 to the combined financial
statements, the Company has restated its financial statements as
of August 31, 2004 and 2003.
PricewaterhouseCoopers LLP
Denver, Colorado
August 1, 2005, except as to the information disclosed
in Note 17, as to which the date is October 7, 2005
F-2
REPORT OF INDEPENDENT REGISTERED PUBLIC ACCOUNTING FIRM
To the Stockholders of American Medical Response, Inc.
and EmCare Holdings, Inc.:
In our opinion, the accompanying combined statements of
operations and comprehensive income (loss) (predecessor basis),
changes in combined equity (predecessor basis) and cash flows
(predecessor basis) present fairly, in all material respects,
the results of operations and changes in combined equity and
cash flows of American Medical Response, Inc. and its
subsidiaries (“AMR”) and EmCare Holdings, Inc. and its
subsidiaries (“EmCare”) (collectively, the
“Company”) for the nine-month period ended
May 31, 2003, and for the year ended August 31, 2002,
in conformity with accounting principles generally accepted in
the United States of America. These combined financial
statements are the responsibility of the AMR and EmCare
management; our responsibility is to express an opinion on these
financial statements based on our audits. We conducted our
audits of these statements in accordance with the standards of
the Public Company Accounting Oversight Board (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, assessing the
accounting principles used and significant estimates made by
management, and evaluating the overall financial statement
presentation. We believe that our audits provide a reasonable
basis for our opinion.
As discussed in Note 1 to the combined financial
statements, AMR and EmCare are wholly-owned subsidiaries of
Laidlaw International, Inc., previously Laidlaw, Inc.
(“Laidlaw”). The United States Bankruptcy Court for
the Western District of New York confirmed Laidlaw’s Third
Amended Plan of Reorganization (the “plan”) on
February 27, 2003. Confirmation of the plan resulted in the
discharge of all claims against Laidlaw that arose on or before
June 28, 2001 and terminated all rights and interest of
equity security holders as provided for in the plan. The plan
was implemented in June 2003 and Laidlaw emerged from
bankruptcy. In connection with its emergence from bankruptcy,
Laidlaw adopted fresh-start accounting and recorded fresh-start
accounting adjustments in the separate financial statements of
AMR and EmCare on June 1, 2003. As a result, the
Company’s post-emergence (successor basis) financial
statements reflect a different basis of accounting than its
pre-emergence (predecessor basis) financial statements.
As discussed in Note 2 to the combined financial
statements, on September 1, 2002, AMR and EmCare changed
their method of accounting for goodwill.
As discussed in Note 1 to the combined financial
statements, the Company has restated its financial statements
for the nine-month period ended May 31, 2003 and the year
ended August 31, 2002.
PricewaterhouseCoopers LLP
Denver, Colorado
January 14, 2005, except as to the restatement described in
Note 1, as to which the date is August 1, 2005 and as
to the information disclosed
in Note 17, as to which the date is October 7, 2005
F-3
American Medical Response, Inc.
& EmCare Holdings Inc.
(The Healthcare Transportation and Emergency Management
Services
Businesses of Laidlaw International, Inc.)
Combined Financial Statements
January 31, 2005 and August 31, 2004 and 2003 (as
restated)
F-4
American Medical Response, Inc. and EmCare Holdings Inc.
(The Healthcare Transportation and Emergency Management
Services
Businesses of Laidlaw International, Inc.)
Combined Balance Sheets
January 31, 2005, August 31, 2004 and 2003
(dollars in thousands)
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
As Restated — | |
|
|
|
|
See Note 1 | |
|
|
|
|
| |
|
|
January 31, | |
|
August 31, | |
|
August 31, | |
|
|
2005 | |
|
2004 | |
|
2003 | |
|
|
| |
|
| |
|
| |
ASSETS |
Current assets:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Cash and cash equivalents
|
|
$ |
14,631 |
|
|
$ |
9,476 |
|
|
$ |
10,641 |
|
|
Restricted cash and cash equivalents
|
|
|
9,846 |
|
|
|
5,691 |
|
|
|
939 |
|
|
Restricted marketable securities
|
|
|
2,473 |
|
|
|
6,756 |
|
|
|
201 |
|
|
Trade and other accounts receivable, net
|
|
|
369,767 |
|
|
|
344,210 |
|
|
|
320,452 |
|
|
Parts and supplies inventory
|
|
|
18,499 |
|
|
|
18,577 |
|
|
|
17,444 |
|
|
Prepaids and other current assets
|
|
|
40,135 |
|
|
|
32,015 |
|
|
|
32,207 |
|
|
Current deferred tax assets
|
|
|
65,092 |
|
|
|
52,981 |
|
|
|
58,836 |
|
|
|
|
|
|
|
|
|
|
|
|
|
Current assets
|
|
|
520,443 |
|
|
|
469,706 |
|
|
|
440,720 |
|
|
|
|
|
|
|
|
|
|
|
Non-current assets:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Property, plant and equipment, net
|
|
|
128,766 |
|
|
|
132,685 |
|
|
|
133,546 |
|
|
Intangible assets, net
|
|
|
16,075 |
|
|
|
15,758 |
|
|
|
148,205 |
|
|
Non-current deferred tax assets
|
|
|
202,469 |
|
|
|
214,389 |
|
|
|
96,596 |
|
|
Restricted long-term investments
|
|
|
41,810 |
|
|
|
47,285 |
|
|
|
40,608 |
|
|
Other long-term assets
|
|
|
73,947 |
|
|
|
69,776 |
|
|
|
55,071 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Assets
|
|
$ |
983,510 |
|
|
$ |
949,599 |
|
|
$ |
914,746 |
|
|
|
|
|
|
|
|
|
|
|
|
LIABILITIES AND COMBINED EQUITY |
Current liabilities:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Accounts payable
|
|
$ |
55,818 |
|
|
$ |
50,915 |
|
|
$ |
50,182 |
|
|
Accrued liabilities
|
|
|
171,645 |
|
|
|
166,784 |
|
|
|
146,179 |
|
|
Current portion of long-term debt
|
|
|
5,846 |
|
|
|
7,565 |
|
|
|
8,270 |
|
|
|
|
|
|
|
|
|
|
|
|
|
Current liabilities
|
|
|
233,309 |
|
|
|
225,264 |
|
|
|
204,631 |
|
|
Long-term debt
|
|
|
5,651 |
|
|
|
7,915 |
|
|
|
15,787 |
|
|
Other long-term liabilities
|
|
|
146,273 |
|
|
|
142,580 |
|
|
|
133,789 |
|
|
|
|
|
|
|
|
|
|
|
|
|
Liabilities
|
|
|
385,233 |
|
|
|
375,759 |
|
|
|
354,207 |
|
|
|
|
|
|
|
|
|
|
|
Commitments and contingencies (notes 7, 9 and 10)
|
|
|
|
|
|
|
|
|
|
|
|
|
Laidlaw payable
|
|
|
202,042 |
|
|
|
186,778 |
|
|
|
22,416 |
|
Laidlaw investment
|
|
|
356,550 |
|
|
|
356,550 |
|
|
|
546,144 |
|
Retained earnings (deficit)
|
|
|
40,000 |
|
|
|
30,518 |
|
|
|
(6,831 |
) |
Comprehensive loss
|
|
|
(315 |
) |
|
|
(6 |
) |
|
|
(1,190 |
) |
|
|
|
|
|
|
|
|
|
|
|
|
Combined equity
|
|
|
598,277 |
|
|
|
573,840 |
|
|
|
560,539 |
|
|
|
|
|
|
|
|
|
|
|
|
|
Liabilities and combined equity
|
|
$ |
983,510 |
|
|
$ |
949,599 |
|
|
$ |
914,746 |
|
|
|
|
|
|
|
|
|
|
|
The accompanying notes are an integral part of these combined
financial statements.
F-5
American Medical Response, Inc. and EmCare Holdings Inc.
(The Healthcare Transportation and Emergency Management
Services
Businesses of Laidlaw International, Inc.)
Combined Statements of Operations and Comprehensive Income
(Loss)
For the Five Months Ended January 31, 2005, for the Year
Ended August 31, 2004, for the Three Months Ended
August 31, 2003, for the Nine Months Ended May 31,
2003 (Predecessor) and for the Year Ended August 31, 2002
(Predecessor)
(dollars in thousands)
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Predecessor — as Restated | |
|
|
|
|
|
|
|
|
|
See note 1 | |
|
|
Five | |
|
|
|
Three | |
|
|
| |
|
|
Months | |
|
Year | |
|
Months | |
|
|
Nine Months | |
|
Year | |
|
|
Ended | |
|
Ended | |
|
Ended | |
|
|
Ended | |
|
Ended | |
|
|
January 31, | |
|
August 31, | |
|
August 31, | |
|
|
May 31, | |
|
August 31, | |
|
|
2005 | |
|
2004 | |
|
2003 | |
|
|
2003 | |
|
2002 | |
|
|
| |
|
| |
|
| |
|
|
| |
|
| |
Net revenue
|
|
$ |
696,179 |
|
|
$ |
1,604,598 |
|
|
$ |
384,461 |
|
|
|
$ |
1,103,335 |
|
|
$ |
1,415,786 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Compensation and benefits
|
|
|
481,305 |
|
|
|
1,117,890 |
|
|
|
264,604 |
|
|
|
|
757,183 |
|
|
|
960,590 |
|
Operating expenses
|
|
|
94,882 |
|
|
|
218,277 |
|
|
|
55,212 |
|
|
|
|
163,447 |
|
|
|
219,321 |
|
Insurance expense
|
|
|
39,002 |
|
|
|
80,255 |
|
|
|
34,671 |
|
|
|
|
69,576 |
|
|
|
66,479 |
|
Selling, general and administrative expenses
|
|
|
21,635 |
|
|
|
47,899 |
|
|
|
12,017 |
|
|
|
|
37,867 |
|
|
|
61,455 |
|
Laidlaw fees and compensation charges
|
|
|
19,857 |
|
|
|
15,449 |
|
|
|
1,350 |
|
|
|
|
4,050 |
|
|
|
5,400 |
|
Depreciation and amortization expense
|
|
|
18,808 |
|
|
|
52,739 |
|
|
|
12,560 |
|
|
|
|
32,144 |
|
|
|
67,183 |
|
Impairment losses
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
|
— |
|
|
|
262,780 |
|
Restructuring charges
|
|
|
— |
|
|
|
2,115 |
|
|
|
1,449 |
|
|
|
|
1,288 |
|
|
|
3,777 |
|
Laidlaw reorganization costs
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
|
3,650 |
|
|
|
8,761 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Income (loss) from operations
|
|
|
20,690 |
|
|
|
69,974 |
|
|
|
2,598 |
|
|
|
|
34,130 |
|
|
|
(239,960 |
) |
Interest expense
|
|
|
(5,644 |
) |
|
|
(9,961 |
) |
|
|
(908 |
) |
|
|
|
(4,691 |
) |
|
|
(6,418 |
) |
Realized gain (loss) on investments
|
|
|
— |
|
|
|
(1,140 |
) |
|
|
90 |
|
|
|
|
— |
|
|
|
— |
|
Interest and other income
|
|
|
714 |
|
|
|
240 |
|
|
|
22 |
|
|
|
|
304 |
|
|
|
369 |
|
Fresh-start accounting adjustments
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
|
46,416 |
|
|
|
— |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Income (loss) before income taxes and cumulative effect of
change in accounting principle
|
|
|
15,760 |
|
|
|
59,113 |
|
|
|
1,802 |
|
|
|
|
76,159 |
|
|
|
(246,009 |
) |
Income tax expense
|
|
|
(6,278 |
) |
|
|
(21,764 |
) |
|
|
(8,633 |
) |
|
|
|
(829 |
) |
|
|
(1,374 |
) |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Income (loss) before cumulative effect of a change in accounting
principle
|
|
|
9,482 |
|
|
|
37,349 |
|
|
|
(6,831 |
) |
|
|
|
75,330 |
|
|
|
(247,383 |
) |
Cumulative effect of a change in accounting principle
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
|
(223,721 |
) |
|
|
— |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Net income (loss)
|
|
|
9,482 |
|
|
|
37,349 |
|
|
|
(6,831 |
) |
|
|
|
(148,391 |
) |
|
|
(247,383 |
) |
Other comprehensive income (loss), net of tax
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Unrealized holding gains (losses) during the period
|
|
|
(309 |
) |
|
|
1,184 |
|
|
|
(1,190 |
) |
|
|
|
603 |
|
|
|
116 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Comprehensive income (loss)
|
|
$ |
9,173 |
|
|
$ |
38,533 |
|
|
$ |
(8,021 |
) |
|
|
$ |
(147,788 |
) |
|
$ |
(247,267 |
) |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
The accompanying notes are an integral part of these combined
financial statements.
F-6
American Medical Response, Inc. and EmCare Holdings Inc.
(The Healthcare Transportation and Emergency Management
Services
Businesses of Laidlaw International, Inc.)
Statements of Changes in Combined Equity
For the Five Months Ended January 31, 2005, for the Year
Ended August 31, 2004, for the Three Months Ended
August 31, 2003, for the Nine Months Ended May 31,
2003 (Predecessor) and for the Year Ended August 31, 2002
(Predecessor)
(dollars in thousands)
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Accumulated | |
|
|
|
|
|
|
|
|
Retained | |
|
Other | |
|
Total | |
|
|
Laidlaw | |
|
Laidlaw | |
|
Earnings | |
|
Comprehensive | |
|
Combined | |
|
|
Payable | |
|
Investment | |
|
(Deficit) | |
|
Income (Loss) | |
|
Equity | |
|
|
| |
|
| |
|
| |
|
| |
|
| |
Balances August 31, 2001 (Predecessor)
|
|
$ |
1,422,088 |
|
|
$ |
2,089,376 |
|
|
$ |
(2,437,836 |
) |
|
$ |
— |
|
|
$ |
1,073,628 |
|
Prior period adjustment — see note 1
|
|
|
— |
|
|
|
— |
|
|
|
(41,020 |
) |
|
|
— |
|
|
|
(41,020 |
) |
Net loss
|
|
|
— |
|
|
|
— |
|
|
|
(247,383 |
) |
|
|
— |
|
|
|
(247,383 |
) |
Payments made to Laidlaw, net
|
|
|
(24,823 |
) |
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
(24,823 |
) |
Unrealized holding gains
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
116 |
|
|
|
116 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Balances August 31, 2002 (Predecessor) as
restated — see note 1
|
|
|
1,397,265 |
|
|
|
2,089,376 |
|
|
|
(2,726,239 |
) |
|
|
116 |
|
|
|
760,518 |
|
Net loss
|
|
|
— |
|
|
|
— |
|
|
|
(148,391 |
) |
|
|
— |
|
|
|
(148,391 |
) |
Payments made to Laidlaw, net
|
|
|
(83 |
) |
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
(83 |
) |
Unrealized holding gains
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
603 |
|
|
|
603 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Balances May 31, 2003 (Predecessor) as restated —
see note 1
|
|
$ |
1,397,182 |
|
|
$ |
2,089,376 |
|
|
$ |
(2,874,630 |
) |
|
$ |
719 |
|
|
$ |
612,647 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Fresh-start balances June 1, 2003 as restated —
see note 1
|
|
$ |
66,503 |
|
|
$ |
546,144 |
|
|
$ |
— |
|
|
$ |
— |
|
|
$ |
612,647 |
|
Net loss
|
|
|
— |
|
|
|
— |
|
|
|
(6,831 |
) |
|
|
— |
|
|
|
(6,831 |
) |
Payments made to Laidlaw, net
|
|
|
(44,087 |
) |
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
(44,087 |
) |
Unrealized holding losses
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
(1,190 |
) |
|
|
(1,190 |
) |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Balances August 31, 2003, as restated — see
note 1
|
|
|
22,416 |
|
|
|
546,144 |
|
|
|
(6,831 |
) |
|
|
(1,190 |
) |
|
|
560,539 |
|
Dividend to Laidlaw
|
|
|
200,000 |
|
|
|
(200,000 |
) |
|
|
— |
|
|
|
— |
|
|
|
— |
|
Net income
|
|
|
— |
|
|
|
— |
|
|
|
37,349 |
|
|
|
— |
|
|
|
37,349 |
|
Fresh-start adjustments (note 1)
|
|
|
— |
|
|
|
10,406 |
|
|
|
— |
|
|
|
— |
|
|
|
10,406 |
|
Payments made to Laidlaw, net
|
|
|
(35,638 |
) |
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
(35,638 |
) |
Unrealized holding gains
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
1,184 |
|
|
|
1,184 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Balances August 31, 2004 as restated — see
note 1
|
|
|
186,778 |
|
|
|
356,550 |
|
|
|
30,518 |
|
|
|
(6 |
) |
|
|
573,840 |
|
Net income
|
|
|
— |
|
|
|
— |
|
|
|
9,482 |
|
|
|
— |
|
|
|
9,482 |
|
Advances from Laidlaw, net
|
|
|
15,264 |
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
15,264 |
|
Unrealized holding losses
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
(309 |
) |
|
|
(309 |
) |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Balances January 31, 2005
|
|
$ |
202,042 |
|
|
$ |
356,550 |
|
|
$ |
40,000 |
|
|
$ |
(315 |
) |
|
$ |
598,277 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
The accompanying notes are an integral part of these combined
financial statements.
F-7
American Medical Response, Inc. and EmCare Holdings Inc.
(The Healthcare Transportation and Emergency Management
Services
Businesses of Laidlaw International, Inc.)
Combined Statements of Cash Flows
For the Five Months Ended January 31, 2005, for the Year
Ended August 31, 2004, for the Three Months Ended
August 31, 2003, for the Nine Months Ended May 31,
2003 (Predecessor)
and for the Year Ended August 31, 2002 (Predecessor)
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Predecessor — as | |
|
|
|
|
|
|
|
|
|
restated | |
|
|
|
|
|
|
|
|
|
see note 1 | |
|
|
|
|
|
|
|
|
|
| |
|
|
Five Months | |
|
|
|
Three Months | |
|
|
Nine Months | |
|
|
|
|
Ended | |
|
Year Ended | |
|
Ended | |
|
|
Ended | |
|
Year Ended | |
|
|
January 31, | |
|
August 31, | |
|
August 31, | |
|
|
May 31, | |
|
August 31, | |
|
|
2005 | |
|
2004 | |
|
2003 | |
|
|
2003 | |
|
2002 | |
|
|
| |
|
| |
|
| |
|
|
| |
|
| |
|
|
(dollars in thousands) | |
|
|
(dollars in thousands) | |
Cash Flows from Operating Activities
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Net income (loss)
|
|
$ |
9,482 |
|
|
$ |
37,349 |
|
|
$ |
(6,831 |
) |
|
|
$ |
(148,391 |
) |
|
$ |
(247,383 |
) |
Adjustments to reconcile net income (loss) to net cash provided
by operating activities:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Depreciation and amortization
|
|
|
18,808 |
|
|
|
53,957 |
|
|
|
12,775 |
|
|
|
|
32,359 |
|
|
|
67,205 |
|
|
Loss (gain) on disposal of property, plant and equipment
|
|
|
145 |
|
|
|
(446 |
) |
|
|
(316 |
) |
|
|
|
(349 |
) |
|
|
(1,140 |
) |
|
Impairment charge
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
|
— |
|
|
|
262,780 |
|
|
Cumulative effect of a change in accounting principle
(note 3)
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
|
223,721 |
|
|
|
— |
|
|
Non-cash allocated expenses (income)
|
|
|
— |
|
|
|
(4,505 |
) |
|
|
11,522 |
|
|
|
|
3,058 |
|
|
|
(8,094 |
) |
|
Restructuring charges
|
|
|
— |
|
|
|
2,115 |
|
|
|
1,449 |
|
|
|
|
1,288 |
|
|
|
3,777 |
|
|
Notes payable discount
|
|
|
213 |
|
|
|
132 |
|
|
|
50 |
|
|
|
|
218 |
|
|
|
422 |
|
|
Loss (gain) on restricted investments
|
|
|
197 |
|
|
|
1,140 |
|
|
|
(90 |
) |
|
|
|
— |
|
|
|
— |
|
|
Deferred income taxes
|
|
|
6,278 |
|
|
|
21,899 |
|
|
|
(8,421 |
) |
|
|
|
— |
|
|
|
— |
|
|
Fresh-start accounting adjustments (note 1)
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
|
(46,416 |
) |
|
|
— |
|
|
Changes in operating assets/liabilities (net of acquisitions):
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Trade and other accounts receivable
|
|
|
(26,057 |
) |
|
|
(23,764 |
) |
|
|
1,522 |
|
|
|
|
(14,049 |
) |
|
|
21,352 |
|
|
|
Parts and supplies inventory
|
|
|
78 |
|
|
|
(1,133 |
) |
|
|
(517 |
) |
|
|
|
233 |
|
|
|
(153 |
) |
|
|
Prepaids and other current assets
|
|
|
(269 |
) |
|
|
5,892 |
|
|
|
3,700 |
|
|
|
|
(12,257 |
) |
|
|
(10,345 |
) |
|
|
Accounts payable and accrued liabilities
|
|
|
3,046 |
|
|
|
17,322 |
|
|
|
3,553 |
|
|
|
|
(6,614 |
) |
|
|
22,350 |
|
|
|
Compliance and insurance accruals
|
|
|
4,045 |
|
|
|
20,402 |
|
|
|
12,520 |
|
|
|
|
31,312 |
|
|
|
46,575 |
|
|
|
Restructuring charges and acquisition accruals
|
|
|
— |
|
|
|
(2,681 |
) |
|
|
(907 |
) |
|
|
|
(5,344 |
) |
|
|
(802 |
) |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Net cash provided by operating activities
|
|
|
15,966 |
|
|
|
127,679 |
|
|
|
30,009 |
|
|
|
|
58,769 |
|
|
|
156,544 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Cash Flows from Investing Activities
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Purchase of property, plant and equipment
|
|
|
(14,045 |
) |
|
|
(42,787 |
) |
|
|
(18,079 |
) |
|
|
|
(34,768 |
) |
|
|
(31,118 |
) |
Purchase of business
|
|
|
(1,200 |
) |
|
|
— |
|
|
|
— |
|
|
|
|
— |
|
|
|
— |
|
Proceeds from sale of business
|
|
|
1,300 |
|
|
|
— |
|
|
|
— |
|
|
|
|
— |
|
|
|
— |
|
Proceeds from sale of property, plant and equipment
|
|
|
175 |
|
|
|
858 |
|
|
|
341 |
|
|
|
|
624 |
|
|
|
2,549 |
|
Purchase of restricted cash and investments
|
|
|
(31,257 |
) |
|
|
(64,357 |
) |
|
|
(11,287 |
) |
|
|
|
(66,266 |
) |
|
|
(50,946 |
) |
Proceeds from sale and maturity of restricted investments
|
|
|
35,960 |
|
|
|
46,389 |
|
|
|
12,530 |
|
|
|
|
36,748 |
|
|
|
32,215 |
|
Other investing activities
|
|
|
(79 |
) |
|
|
6,814 |
|
|
|
1,359 |
|
|
|
|
(35,173 |
) |
|
|
(10,047 |
) |
Increase in Laidlaw insurance deposits
|
|
|
(12,521 |
) |
|
|
(28,433 |
) |
|
|
— |
|
|
|
|
— |
|
|
|
— |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Net cash used in investing activities
|
|
|
(21,667 |
) |
|
|
(81,516 |
) |
|
|
(15,136 |
) |
|
|
|
(98,835 |
) |
|
|
(57,347 |
) |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Cash Flows from Financing Activities
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Repayments of capital lease obligations and other debt
|
|
|
(3,992 |
) |
|
|
(8,709 |
) |
|
|
(1,851 |
) |
|
|
|
(6,338 |
) |
|
|
(17,817 |
) |
Increase (decrease) in bank overdrafts
|
|
|
5,866 |
|
|
|
(4,544 |
) |
|
|
8,675 |
|
|
|
|
(815 |
) |
|
|
(1,134 |
) |
Advances from (payments to) Laidlaw
|
|
|
8,982 |
|
|
|
(31,133 |
) |
|
|
(55,609 |
) |
|
|
|
(3,141 |
) |
|
|
(16,729 |
) |
Increase (decrease) in other non-current liabilities
|
|
|
— |
|
|
|
(2,942 |
) |
|
|
1,563 |
|
|
|
|
2,234 |
|
|
|
(386 |
) |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Net cash provided by (used in) financing activities
|
|
|
10,856 |
|
|
|
(47,328 |
) |
|
|
(47,222 |
) |
|
|
|
(8,060 |
) |
|
|
(36,066 |
) |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Increase (decrease) in cash and cash equivalents
|
|
|
5,155 |
|
|
|
(1,165 |
) |
|
|
(32,349 |
) |
|
|
|
(48,126 |
) |
|
|
63,131 |
|
Cash and cash equivalents, beginning of period
|
|
|
9,476 |
|
|
|
10,641 |
|
|
|
42,990 |
|
|
|
|
91,116 |
|
|
|
27,985 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Cash and cash equivalents, end of period
|
|
$ |
14,631 |
|
|
$ |
9,476 |
|
|
$ |
10,641 |
|
|
|
$ |
42,990 |
|
|
$ |
91,116 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
The accompanying notes are an integral part of these combined
financial statements.
F-8
American Medical Response, Inc. & EmCare Holdings
Inc.
(The Healthcare Transportation and Emergency Management
Services
Businesses of Laidlaw International, Inc.)
Notes to Combined Financial Statements
(dollars in thousands)
Basis of Presentation of Financial Statements
These financial statements have been prepared in accordance with
accounting principles generally accepted in the United States of
America (“GAAP”) to reflect the combined financial
position, results of operations and cash flows of American
Medical Response, Inc. and its subsidiaries (“AMR”)
and EmCare Holdings Inc. and its subsidiaries
(“EmCare”) (combined or each individually, the
“Company”). These financial statements have been
prepared in connection with the definitive sale agreement
referred to in note 17 to reflect the businesses that were
purchased. AMR and EmCare are indirect, wholly owned
subsidiaries of Laidlaw International Inc., previously Laidlaw
Inc. (“Laidlaw” or the “Parent”). The
Company operates in two segments, AMR in the Healthcare
Transportation Service business and EmCare in the Emergency
Management Service business.
AMR operates in 34 states, providing a full range of
medical transportation services from basic patient transit to
the most advanced emergency care and pre-hospital assistance. In
addition, AMR operates emergency (911) call and response
services for large and small communities all across the United
States, offers medical staff for large entertainment venues like
stadiums and arenas, and provides telephone triage,
transportation dispatch and demand management services.
EmCare provides outsourced business services to hospitals
primarily for emergency departments, related urgent care centers
and for certain inpatient departments for 313 hospitals in
38 states. EmCare recruits physicians, gathers their
credentials, arranges contracts for their services, assists in
monitoring their performance and arranges their scheduling. In
addition, EmCare assists clients in such operational areas as
staff coordination, quality assurance, departmental
accreditation, billing, record-keeping, third-party payment
programs, and other administrative services.
Restatement
Accounts receivable allowance. The Company determined
that because of an error in its reserving methodology, its
accounts receivable allowances were understated at various
balance sheet dates prior to and including the periods presented
herein. As a result, AMR has recorded an adjustment of
$50 million to increase the accounts receivable allowance
as of May 31, 2003, of which $39 million reduces
previously reported retained earnings (deficit) as of
August 31, 2001. Adjustments were also required for the
nine-month period ended May 31, 2003 and the year ended
August 31, 2002, reflecting a reduction of net revenue and
a corresponding increase in accounts receivable allowances of
$8.0 million and $3.0 million, respectively. There
were no further adjustments necessary subsequent to May 31,
2003. In addition, the Company made other adjustments related to
certain deferred rent and leasehold amortization matters,
reducing previously reported retained earnings (deficit) as of
August 31, 2001 by $2.0 million and reducing earnings
for the nine-month period ended May 31, 2003 by
$0.1 million and for the year ended August 31, 2002 by
$0.2 million.
AMR adopted SFAS No. 142, Goodwill and Other
Intangible Assets (“SFAS No. 142”), on
September 1, 2002 and recorded a charge associated with a
change in accounting principle based on a fair value assessment
of goodwill. The impact of reducing the net accounts receivable
balance prior to the assessment reduced the charge necessary
upon adoption of SFAS No. 142 by $42 million.
Effective June 1, 2003, the Company’s parent emerged
from bankruptcy and applied fresh-start accounting. The impact
of the correction made to the nine-month period ended
May 31, 2003 increased the fresh-start income adjustment by
$8.1 million.
F-9
American Medical Response, Inc. & EmCare Holdings
Inc.
(The Healthcare Transportation and Emergency Management
Services
Businesses of Laidlaw International, Inc.)
Notes to Combined Financial
Statements — (Continued)
Also as a part of applying fresh-start accounting, the Company
adjusted its assets and liabilities to fair value. As a result
of the restatement which reduced net assets by
$52.3 million, as discussed above, the Company allocated
$52.3 million to goodwill at June 1, 2003 as the
reorganization value exceeded the fair value of the assets and
liabilities. See “— Chapter 11
Reorganization — Laidlaw”, below, for further
information.
As a result of these corrections, as of May 31, 2003,
deferred tax assets of $20.3 million have been recorded
with a corresponding full valuation allowance. In fiscal 2004,
AMR had reversed all of its valuation allowance, which reversal
now includes the valuation allowance referred to above. In
accordance with fresh-start accounting, the reversal of
valuation allowances first reduces intangible assets to zero,
and then any excess is credited to the Laidlaw investment in the
Statement of Changes in Combined Equity. As a result of the
increased goodwill of $52.3 million and the release of the
valuation allowance of $20.3 million discussed above, the
Company reduced its previously recorded credit to Laidlaw
investment by $32.0 million. See note 5 for further
information.
Following is a summary of the effects of these changes on the
Company’s Combined Balance Sheet as of August 31, 2004
and 2003 and Combined Statements of Operations for the nine
months ended May 31, 2003 and for the fiscal year ended
August 31, 2002. Correcting for the error did not require
adjustment to total net cash flows provided by operating
activities, net cash flows used in investing activities, or net
cash flows provided by (used in) financing activities.
Combined Balance Sheets
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
As Previously | |
|
|
|
As | |
|
|
Reported | |
|
Adjustments | |
|
Restated | |
|
|
| |
|
| |
|
| |
August 31, 2004
|
|
|
|
|
|
|
|
|
|
|
|
|
Trade and other accounts receivable, net
|
|
$ |
394,210 |
|
|
$ |
(50,000 |
) |
|
$ |
344,210 |
|
Current deferred tax assets
|
|
|
33,935 |
|
|
|
19,046 |
|
|
|
52,981 |
|
Current assets
|
|
|
500,660 |
|
|
|
(30,954 |
) |
|
|
469,706 |
|
Property, plant & equipment
|
|
|
133,362 |
|
|
|
(677 |
) |
|
|
132,685 |
|
Non-current deferred tax assets
|
|
|
213,127 |
|
|
|
1,262 |
|
|
|
214,389 |
|
Assets
|
|
|
979,968 |
|
|
|
(30,369 |
) |
|
|
949,599 |
|
Other long-term liabilities
|
|
|
140,897 |
|
|
|
1,683 |
|
|
|
142,580 |
|
Liabilities
|
|
|
374,076 |
|
|
|
1,683 |
|
|
|
375,759 |
|
Laidlaw investment
|
|
|
388,602 |
|
|
|
(32,052 |
) |
|
|
356,550 |
|
Combined equity
|
|
|
605,892 |
|
|
|
(32,052 |
) |
|
|
573,840 |
|
Liabilities and combined equity
|
|
|
979,968 |
|
|
|
(30,369 |
) |
|
|
949,599 |
|
|
August 31, 2003
|
|
|
|
|
|
|
|
|
|
|
|
|
Trade and other accounts receivable, net
|
|
|
370,452 |
|
|
|
(50,000 |
) |
|
|
320,452 |
|
Current assets
|
|
|
490,720 |
|
|
|
(50,000 |
) |
|
|
440,720 |
|
Property, plant & equipment
|
|
|
134,223 |
|
|
|
(677 |
) |
|
|
133,546 |
|
Intangible assets, net
|
|
|
95,845 |
|
|
|
52,360 |
|
|
|
148,205 |
|
Assets
|
|
|
913,063 |
|
|
|
1,683 |
|
|
|
914,746 |
|
Other long-term liabilities
|
|
|
132,106 |
|
|
|
1,683 |
|
|
|
133,789 |
|
Liabilities
|
|
|
352,524 |
|
|
|
1,683 |
|
|
|
354,207 |
|
Liabilities and combined equity
|
|
$ |
913,063 |
|
|
$ |
1,683 |
|
|
$ |
914,746 |
|
F-10
American Medical Response, Inc. & EmCare Holdings
Inc.
(The Healthcare Transportation and Emergency Management
Services
Businesses of Laidlaw International, Inc.)
Notes to Combined Financial
Statements — (Continued)
Combined Statements of Operations and Comprehensive Income
(Loss)
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
As Previously | |
|
|
|
As | |
|
|
Reported | |
|
Adjustments | |
|
Restated | |
|
|
| |
|
| |
|
| |
Nine months ended May 31, 2003 (predecessor)
|
|
|
|
|
|
|
|
|
|
|
|
|
Net revenue
|
|
$ |
1,111,335 |
|
|
$ |
(8,000 |
) |
|
$ |
1,103,335 |
|
Operating expenses
|
|
|
163,293 |
|
|
|
154 |
|
|
|
163,447 |
|
Depreciation and amortization expense
|
|
|
32,156 |
|
|
|
(12 |
) |
|
|
32,144 |
|
Income (loss) from operations
|
|
|
42,272 |
|
|
|
(8,142 |
) |
|
|
34,130 |
|
Fresh-start accounting adjustments
|
|
|
38,274 |
|
|
|
8,142 |
|
|
|
46,416 |
|
Cumulative effect of a change in accounting principle
|
|
|
(267,939 |
) |
|
|
44,218 |
|
|
|
(223,721 |
) |
Net income (loss)
|
|
|
(192,609 |
) |
|
|
44,218 |
|
|
|
(148,391 |
) |
Comprehensive income (loss)
|
|
|
(192,006 |
) |
|
|
44,218 |
|
|
|
(147,788 |
) |
Year ended August 31, 2002 (predecessor)
|
|
|
|
|
|
|
|
|
|
|
|
|
Net revenue
|
|
|
1,418,786 |
|
|
|
(3,000 |
) |
|
|
1,415,786 |
|
Operating expenses
|
|
|
219,121 |
|
|
|
200 |
|
|
|
219,321 |
|
Depreciation and amortization expense
|
|
|
67,185 |
|
|
|
(2 |
) |
|
|
67,183 |
|
Income (loss) from operations
|
|
|
(236,762 |
) |
|
|
(3,198 |
) |
|
|
(239,960 |
) |
Income (loss) before income taxes and cumulative effect of a
change in accounting principle
|
|
|
(242,811 |
) |
|
|
(3,198 |
) |
|
|
(246,009 |
) |
Income (loss) before cumulative effect of a change in accounting
principle
|
|
|
(244,185 |
) |
|
|
(3,198 |
) |
|
|
(247,383 |
) |
Net income (loss)
|
|
|
(244,185 |
) |
|
|
(3,198 |
) |
|
|
(247,383 |
) |
Comprehensive income (loss)
|
|
$ |
(244,069 |
) |
|
$ |
(3,198 |
) |
|
$ |
(247,267 |
) |
Chapter 11 Reorganization — Laidlaw
On June 28, 2001, Laidlaw and certain of its affiliates
filed voluntary petitions for reorganization under
Chapter 11 of the Bankruptcy Code. During the pendency of
the Chapter 11 case, Laidlaw continued to operate its
businesses in accordance with the applicable provisions of the
Bankruptcy Code. Although subsidiaries of Laidlaw, neither AMR
nor EmCare filed for reorganization under Chapter 11 of the
Bankruptcy Code.
Laidlaw emerged from bankruptcy protection during fiscal 2003,
and on June 1, 2003 adopted Statement of
Position 90-7, “Financial Reporting by Entities in
Reorganization Under the Bankruptcy Code” (SOP 90-7),
applying fresh-start accounting to its balance sheet as of the
close of business on May 31, 2003. In accordance with the
principles of fresh-start accounting, Laidlaw determined the
reorganization value of its individual business units and
adjusted their assets and liabilities to estimated fair values
as of May 31, 2003. On May 31, 2003, Laidlaw applied
“push-down” accounting and allocated to the Company
its share of reorganization value aggregating
$939.9 million. Reorganization value, as defined in
SOP 90-7, is the amount that approximates the fair value of
the assets of an entity before considering liabilities. The
reorganization value allocated to the Company was based on the
consideration of factors such as the industries in which the
Company operates, the general economic conditions that impact
the health care industry, and application of certain valuation
methods, including a discounted cash flow analysis, an analysis
of comparable publicly traded company multiples and a comparable
acquisitions analysis. The net effect of all fresh-start
accounting
F-11
American Medical Response, Inc. & EmCare Holdings
Inc.
(The Healthcare Transportation and Emergency Management
Services
Businesses of Laidlaw International, Inc.)
Notes to Combined Financial
Statements — (Continued)
adjustments pushed down to the Company resulted in additional
income of $46.4 million, which is reflected as an
adjustment to the financial results for the period from
September 1, 2002 through May 31, 2003.
As a result of the application of push-down accounting, the
Company’s balance sheet as of the close of business
May 31, 2003 and financial statements for periods beginning
on June 1, 2003, referred to as “Successor
Company”, may not be comparable with its financial
statements for periods before June 1, 2003, referred to as
Predecessor Company” because they are, in effect, those
reflecting the application of a new basis of accounting. The
balances below have been adjusted for the restatement described
above. As a result, trade receivables, property plant and
equipment, intangible assets and other long-term liabilities
changed by $(50) million, $(0.6) million,
$44.2 million and $1.6 million, respectively, in the
Predecessor and Successor columns. Retained earnings (deficit)
increased by $8.1 million in the Predecessor fair value
adjustment column and the adjustment to intangible fair value
decreased by $8.1 million. The effects of fresh-start
reporting on the Company’s combined balance sheet as of the
close of business May 31, 2003 are as follows:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Restated | |
|
|
| |
|
|
Predecessor | |
|
Fair Value | |
|
Successor | |
|
|
Company | |
|
Adjustments | |
|
Company | |
|
|
| |
|
| |
|
| |
Assets
|
|
|
|
|
|
|
|
|
|
|
|
|
Current assets:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Cash and cash equivalents
|
|
$ |
42,990 |
|
|
$ |
— |
|
|
$ |
42,990 |
|
|
Restricted cash and cash equivalents
|
|
|
1,154 |
|
|
|
— |
|
|
|
1,154 |
|
|
Trade and other accounts receivable, net
|
|
|
321,974 |
|
|
|
— |
|
|
|
321,974 |
|
|
Parts and supplies inventory
|
|
|
16,927 |
|
|
|
— |
|
|
|
16,927 |
|
|
Other current assets
|
|
|
35,907 |
|
|
|
— |
|
|
|
35,907 |
|
|
Current deferred tax assets
|
|
|
— |
(c) |
|
|
72,493 |
|
|
|
72,493 |
|
|
|
|
|
|
|
|
|
|
|
|
|
Current assets
|
|
|
418,952 |
|
|
|
72,493 |
|
|
|
491,445 |
|
|
|
|
|
|
|
|
|
|
|
Property, plant, and equipment, net
|
|
|
130,212 |
(a) |
|
|
(4,683 |
) |
|
|
125,529 |
|
Intangible assets, net
|
|
|
230,222 |
(b) |
|
|
(79,843 |
) |
|
|
150,379 |
|
Non-current deferred tax assets
|
|
|
— |
(c) |
|
|
73,918 |
|
|
|
73,918 |
|
Restricted long-term investments — trust
|
|
|
43,764 |
|
|
|
— |
|
|
|
43,764 |
|
Other long-term assets
|
|
|
56,596 |
|
|
|
— |
|
|
|
56,596 |
|
|
|
|
|
|
|
|
|
|
|
|
|
Assets
|
|
$ |
879,746 |
|
|
$ |
61,885 |
|
|
$ |
941,631 |
|
|
|
|
|
|
|
|
|
|
|
F-12
American Medical Response, Inc. & EmCare Holdings
Inc.
(The Healthcare Transportation and Emergency Management
Services
Businesses of Laidlaw International, Inc.)
Notes to Combined Financial
Statements — (Continued)
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Restated | |
|
|
| |
|
|
Predecessor | |
|
Fair Value | |
|
Successor | |
|
|
Company | |
|
Adjustments | |
|
Company | |
|
|
| |
|
| |
|
| |
|
Liabilities and Combined Equity
|
|
|
|
|
|
|
|
|
|
|
|
|
Current liabilities:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Accounts payable
|
|
$ |
40,156 |
|
|
$ |
— |
|
|
$ |
40,156 |
|
|
Accrued liabilities
|
|
|
140,777 |
(d) |
|
|
1,000 |
|
|
|
141,777 |
|
|
Current portion of long-term debt
|
|
|
8,807 |
|
|
|
— |
|
|
|
8,807 |
|
|
|
|
|
|
|
|
|
|
|
|
|
Current liabilities
|
|
|
189,740 |
|
|
|
1,000 |
|
|
|
190,740 |
|
Long-term debt
|
|
|
17,052 |
|
|
|
— |
|
|
|
17,052 |
|
Other long-term liabilities
|
|
|
106,723 |
(e) |
|
|
14,469 |
|
|
|
121,192 |
|
|
|
|
|
|
|
|
|
|
|
|
|
Liabilities
|
|
|
313,515 |
|
|
|
15,469 |
|
|
|
328,984 |
|
|
|
|
|
|
|
|
|
|
|
Laidlaw payable
|
|
|
59,355 |
(f) |
|
|
7,148 |
|
|
|
66,503 |
|
Laidlaw investment
|
|
|
3,419,470 |
(f) |
|
|
(2,873,326 |
) |
|
|
546,144 |
|
Retained earnings (deficit)
|
|
|
(2,913,313 |
) (f) |
|
|
2,913,313 |
|
|
|
— |
|
Comprehensive income
|
|
|
719 |
(f) |
|
|
(719 |
) |
|
|
— |
|
|
|
|
|
|
|
|
|
|
|
|
Combined equity
|
|
|
566,231 |
|
|
|
46,416 |
|
|
|
612,647 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Liabilities and combined equity
|
|
$ |
879,746 |
|
|
$ |
61,885 |
|
|
$ |
941,631 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
(a) |
|
Adjusts property, plant and equipment to reflect the estimated
fair value of the assets based on independent appraisals. |
|
(b) |
|
Eliminates the Predecessor Company’s historic goodwill,
records identifiable intangible assets at estimated fair value
based upon independent appraisals and records the remaining
reorganization value to goodwill. |
|
(c) |
|
Records the net deferred income tax assets of the Company. |
|
(d) |
|
Records the operating leases at their estimated fair value based
on independent valuations and the current borrowing rate of the
Company. |
|
(e) |
|
Adjusts the Company’s insurance reserves to their estimated
fair value. |
|
(f) |
|
Reflects the elimination of the accumulated deficit and
comprehensive income and establishes the payable account to
Laidlaw. |
|
|
2. |
Summary of Significant Accounting Policies |
Combination
The combined financial statements include the accounts of the
Company or of the Predecessor Company consolidated with all of
their respective subsidiaries. All significant intracompany
transactions are eliminated.
Use of Estimates
The preparation of financial statements in accordance with GAAP
requires the Company to make estimates and assumptions that
affect reported amounts of assets, liabilities, revenue and
expenses, and disclosure of contingencies. Future events could
alter such estimates.
Cash and Cash Equivalents
Cash and cash equivalents are composed of highly liquid
investments with an original maturity of three months or less
and are recorded at market value.
At January 31, 2005 and August 31, 2004 and 2003, bank
overdrafts of $22.0 million, $16.1 million and
$20.6 million, respectively, were included in accounts
payable on the accompanying combined balance sheets.
F-13
American Medical Response, Inc. & EmCare Holdings
Inc.
(The Healthcare Transportation and Emergency Management
Services
Businesses of Laidlaw International, Inc.)
Notes to Combined Financial
Statements — (Continued)
Restricted Cash and Cash Equivalents
Restricted cash and cash equivalents include short-term
investments that are part of the portfolio of the Company’s
captive insurance arrangement. These investments are highly
liquid and have original maturities of three months or less.
These assets are used to support the current portion of claim
liabilities under the captive arrangement.
Restricted Marketable Securities
Marketable securities were pledged as collateral against the
Company’s claim liabilities under the captive insurance
arrangement. Restricted marketable securities are
income-yielding securities that can be converted readily into
cash and include commercial paper, corporate and foreign notes
and bonds, and U.S. Treasury and agency obligations. Such
securities are stated at market value and are classified as
available-for-sale under Financial Accounting Standards Board
Statement of Financial Accounting Standards No. 115,
Accounting for Certain Investments in Debt and Equity
Securities (“SFAS No. 115”), with
unrealized gains and losses reported, net of tax, in other
comprehensive income as a component of combined equity.
Trade and Other Accounts Receivable, net
The Company determines its allowances based on payor
reimbursement schedules, historical write-off experience and
other economic data. The allowances for contractual discounts
and uncompensated care are reviewed monthly. Account balances
are charged off against the uncompensated care allowance when it
is probable the receivable will not be recovered. Write-offs to
the contractual allowance occur when payment is received. The
allowance for uncompensated care is related principally to
receivables recorded for self-pay patients.
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
August 31, | |
|
|
January 31, | |
|
| |
|
|
2005 | |
|
2004 | |
|
2003 | |
|
|
| |
|
| |
|
| |
Accounts receivable, net
|
|
|
|
|
|
|
|
|
|
|
|
|
AMR
|
|
$ |
229,798 |
|
|
$ |
210,177 |
|
|
$ |
196,473 |
|
EmCare
|
|
|
139,969 |
|
|
|
134,033 |
|
|
|
123,979 |
|
|
|
|
|
|
|
|
|
|
|
|
Total
|
|
$ |
369,767 |
|
|
$ |
344,210 |
|
|
$ |
320,452 |
|
|
|
|
|
|
|
|
|
|
|
Accounts receivable allowances
|
|
|
|
|
|
|
|
|
|
|
|
|
AMR
|
|
|
|
|
|
|
|
|
|
|
|
|
Allowance for contractual discounts
|
|
$ |
126,771 |
|
|
$ |
103,412 |
|
|
$ |
89,856 |
|
Allowance for uncompensated care |
|
|
124,699 |
|
|
|
111,766 |
|
|
|
104,833 |
|
|
|
|
|
|
|
|
|
|
|
|
Total
|
|
$ |
251,470 |
|
|
$ |
215,178 |
|
|
$ |
194,689 |
|
|
|
|
|
|
|
|
|
|
|
EmCare
|
|
|
|
|
|
|
|
|
|
|
|
|
Allowance for contractual discounts
|
|
$ |
188,092 |
|
|
$ |
168,060 |
|
|
$ |
168,912 |
|
Allowance for uncompensated care
|
|
|
556,605 |
|
|
|
499,512 |
|
|
|
382,757 |
|
|
|
|
|
|
|
|
|
|
|
|
Total
|
|
$ |
744,697 |
|
|
$ |
667,572 |
|
|
$ |
551,669 |
|
|
|
|
|
|
|
|
|
|
|
The increase in the allowances and provisions for contractual
discounts and uncompensated care is primarily a result of
increases in the Company’s gross fee-for-service rate
schedules. These gross fee schedules, including any changes to
existing fee schedules, generally are negotiated with various
contracting entities, including municipalities and facilities.
Fee schedule increases are billed to all revenue and all payors
under that specific contract; however, reimbursement in the case
of certain state and federal payors, including
F-14
American Medical Response, Inc. & EmCare Holdings
Inc.
(The Healthcare Transportation and Emergency Management
Services
Businesses of Laidlaw International, Inc.)
Notes to Combined Financial
Statements — (Continued)
Medicare and Medicaid, will not change as a result of the
contract change. In certain cases, this results in a higher
level of contractual and uncompensated care provisions and
allowances, requiring a higher percentage of contractual
discount and uncompensated care provisions compared to gross
charges.
The allowance for uncompensated care at EmCare includes accounts
that have been sent to collection agencies and are listed as
delinquent within the billing system. These accounts are fully
reserved at each balance sheet date and total $254.2 million,
$218.6 million and $150.3 million at January 31, 2005,
August 31, 2004 and August 31, 2003, respectively.
Parts and Supplies Inventory
Parts and supplies inventory is valued at cost, determined on a
first-in, first-out basis. Durable medical supplies, including
stretchers, oximeters and other miscellaneous items, are
capitalized as inventory and expensed as used.
Property, Plant and Equipment, net
Property, plant and equipment were reflected at their fair
values as of June 1, 2003. Additions to property, plant and
equipment subsequent to this date are recorded at cost.
Maintenance and repairs that do not extend the useful life of
the property are charged to expense as incurred. Gains and
losses from dispositions of property, plant and equipment are
recorded in the period incurred. Depreciation of property, plant
and equipment is provided substantially on a straight-line basis
over their estimated useful lives, which are as follows:
|
|
|
Buildings
|
|
35 to 40 years |
Leasehold improvements
|
|
Shorter of expected life or life of lease |
Vehicles
|
|
5 to 7 years |
Computer hardware and software
|
|
3 to 5 years |
Other
|
|
3 to 10 years |
Goodwill
The Predecessor Company adopted SFAS No. 142 on
September 1, 2002. SFAS No. 142 requires that any
goodwill recorded in connection with an acquisition consummated
on or after July 1, 2001 not be amortized, and instead
requiring a periodic assessment of recoverability utilizing a
fair value measurement. In connection with the adoption of this
standard, the Predecessor Company impaired $223.7 million
of restated goodwill, which is included in the accompanying
combined financial statements for the nine months ended
F-15
American Medical Response, Inc. & EmCare Holdings
Inc.
(The Healthcare Transportation and Emergency Management
Services
Businesses of Laidlaw International, Inc.)
Notes to Combined Financial
Statements — (Continued)
May 31, 2003, as a cumulative effect of a change in
accounting principle. Recording this change had no tax-related
benefit or expense. Goodwill balances are as follows:
|
|
|
|
|
|
|
|
Restated | |
|
|
| |
Predecessor Company:
|
|
|
|
|
|
Balance on August 31, 2002
|
|
$ |
453,943 |
|
|
Impairment loss under SFAS No. 142, September 1,
2002
|
|
|
(223,721 |
) |
|
|
|
|
|
Balance on May 31, 2003
|
|
$ |
230,222 |
|
|
|
|
|
Successor Company:
|
|
|
|
|
|
Fresh-start adjustment
|
|
$ |
(177,862 |
) |
|
|
|
|
|
Balance on June 1, 2003 and August 31, 2003
|
|
|
52,360 |
|
|
Deferred tax valuation adjustment, August 31, 2004
|
|
|
(52,360 |
) |
|
|
|
|
|
Balance on August 31, 2004 and January 31, 2005
|
|
$ |
— |
|
|
|
|
|
Had the change in the accounting policy for amortizing goodwill
been in effect in the prior year, the Predecessor Company’s
income (loss) before cumulative effect of a change in accounting
principle for the year ended August 31, 2002 would have
been ($226.0) million compared to ($247.4) million as
originally recorded. There would have been no changes to the
results recorded for the five months ended January 31,
2005, the year ended August 31, 2004, the three months
ended August 31, 2003 or the Predecessor Company nine
months ended May 31, 2003.
Impairment of Long-lived Assets other than Goodwill and
Other Indefinite Lived Intangibles
Long-lived assets other than goodwill and other indefinite lived
intangibles are assessed for impairment whenever events or
changes in circumstances indicate that the carrying value may
not be recoverable. Important factors which could trigger
impairment review include significant underperformance relative
to historical or projected future operating results, significant
changes in the use of the acquired assets or the strategy for
the overall business, and significant negative industry or
economic trends. If indicators of impairment are present,
management evaluates the carrying value of long-lived assets
other than goodwill and other indefinite lived intangibles in
relation to the projection of future undiscounted cash flows of
the underlying business. Projected cash flows are based on
historical results adjusted to reflect management’s best
estimate of future market and operating conditions, which may
differ from actual cash flows.
Contract Value
At January 31, 2005, August 31, 2004 and 2003, the
Company’s contracts and customer relationships, recorded as
part of fresh-start push-down accounting, represent the
amortized fair value of such assets held by the Company at
June 1, 2003. Contract Assets are amortized on a
straight-line basis over the average length of the contracts and
the expected contract renewal period of 10 years. In
accordance with the provisions of fresh-start accounting, the
reversal of the income tax valuation allowance resulted in a
reduction in certain Contract Assets at August 31, 2004
(note 5).
Radio Frequencies
The radio frequency licenses, recorded as part of push-down
accounting and included in net intangible assets on the
accompanying combined balance sheet, total $4.0 million at
August 31, 2003 and are considered to be indefinite lived
intangible assets. As such, they are not amortized. The radio
frequency licenses are reviewed for impairment on an annual
basis. In accordance with the provisions of fresh-start
accounting, the
F-16
American Medical Response, Inc. & EmCare Holdings
Inc.
(The Healthcare Transportation and Emergency Management
Services
Businesses of Laidlaw International, Inc.)
Notes to Combined Financial
Statements — (Continued)
reversal of the income tax valuation allowance resulted in the
radio frequency asset being reduced to zero at August 31,
2004 (note 5).
Restricted Long-Term Investments
Restricted long-term investments include investments that are
part of the portfolio of the Company’s captive insurance
subsidiary. In accordance with SFAS No. 115,
the Company determines the classification of securities as
held-to-maturity or available-for-sale at the time of purchase
and re-evaluates such designation at each balance sheet date.
Securities are classified as held-to-maturity when the Company
has the positive intent and ability to hold securities to
maturity. Held-to-maturity securities are stated at cost,
adjusted for amortization of premiums and discounts to maturity.
Investments not classified as held-to-maturity are classified as
available-for-sale. Available-for-sale securities are carried at
fair value, with unrealized gains and losses reported as a
separate component of equity. The cost of securities sold is
based on the specific identification method. Restricted
long-term investments are available-for-sale.
These investments are used to support the Company’s
self-insurance program. The investments are comprised
principally of government securities and investment grade debt
securities.
Other Long-Term Liabilities
Long-term portions of insurance reserves, acquisition-related
liabilities and other liabilities are classified as other
long-term liabilities.
Contractual Arrangements
EmCare structures its contractual arrangements for emergency
department management services in various ways. In most states,
a wholly-owned subsidiary of EmCare (“EmCare
Subsidiary”) contracts with hospitals to provide emergency
department management services. The EmCare Subsidiary enters
into an agreement (“PA Management Agreement”) with a
professional association or professional corporation
(“PA”), whereby the EmCare Subsidiary provides the PA
with management services, and the PA agrees to provide physician
services for the hospital contract. The PA employs physicians
directly or subcontracts with another entity for the physician
services. In certain states, the PA contracts directly with the
hospital, but provides physician services and obtains management
services in the same manner as described above. In all
arrangements, decisions regarding patient care are made
exclusively by the physicians. In consideration for these
services, the EmCare Subsidiary receives a monthly fee that may
be adjusted from time to time to reflect industry practice,
business conditions, and actual expenses for administrative
costs and uncollectible accounts. In most states, these fees
approximate the excess of the PA’s revenues over its
expenses.
Each PA is wholly-owned by a physician who enters into a Stock
Transfer and Option Agreement with EmCare. This agreement gives
EmCare the right to replace the physician owner with another
physician in accordance with the terms of the agreement.
Historically, EmCare had determined that these management
contracts met Emerging Issues Task Force 97-2, Application of
FASB Statement No. 94 and APB Opinion No. 16 to
Physician Practice Entities, requirements for consolidation.
Upon adoption of FIN 46(R), Consolidation of Variable
Interest Entities, the Company concluded that these
management contracts resulted in a variable interest in the PAs
and that the Company is the primary beneficiary. Accordingly,
the consolidated financial statements of EmCare and these
combined financial statements include the accounts of EmCare and
its subsidiaries and the PAs. The financial statements of the
PAs are consolidated with EmCare and its subsidiaries because
EmCare has ultimate control over the assets and business
operations of the PAs as described above. Notwithstanding the
lack of technical
F-17
American Medical Response, Inc. & EmCare Holdings
Inc.
(The Healthcare Transportation and Emergency Management
Services
Businesses of Laidlaw International, Inc.)
Notes to Combined Financial
Statements — (Continued)
majority ownership, consolidation of the PAs is necessary to
present fairly the financial position and results of operations
of EmCare because of the existence of a control relationship by
means other than record ownership of the PAs’ voting stock.
Control of a PA by EmCare is perpetual and other than temporary
because EmCare may replace the physician owner of the PA at any
time and thereby continue EmCare’s relationship with the PA.
Financial Instruments and Concentration of Credit
Risk
The Company’s cash and cash equivalents, accounts
receivable, accounts payable, accrued liabilities (other than
current portion of self-insurance estimates), long-term debt and
long-term liabilities (other than self-insurance estimates)
constitute financial instruments. Based on management’s
estimates, the carrying value of the Company’s cash and
cash equivalents, accounts receivable, accounts payable, accrued
liabilities (other than current portion of self-insurance
estimates), long-term debt and long-term liabilities (other than
self-insurance estimates) approximates their fair value as of
January 31, 2005 and August 31, 2004 and 2003.
Concentration of credit risks in accounts receivable is limited,
due to the large number of customers comprising the
Company’s customer base throughout the United States. A
significant component of the Company’s revenue is derived
from Medicare and Medicaid. Given that these are government
programs, the credit risk for these customers is considered low.
The Company performs ongoing credit evaluations of its other
customers, but does not require collateral to support customer
accounts receivable. The Company establishes an allowance for
uncompensated care based on the credit risk applicable to
particular customers, historical trends and other relevant
information. For each of the periods presented, the Company
derived approximately 35% of its net revenue from Medicare and
Medicaid, 60% from insurance providers and contracted payors,
and 5% directly from patients.
Revenue Recognition
Revenue is recognized at the time of service and is recorded net
of provisions for contractual discounts and estimated
uncompensated care. Provisions for contractual discounts and
estimated uncompensated care by segment, as a percentage of
gross revenue, are as follows:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Predecessor | |
|
|
|
|
|
|
|
|
| |
|
|
Five Months | |
|
|
|
Three Months | |
|
Nine Months | |
|
|
|
|
Ended | |
|
Year Ended | |
|
Ended | |
|
Ended | |
|
Year Ended | |
|
|
January 31, | |
|
August 31, | |
|
August 31, | |
|
May 31, | |
|
August 31, | |
|
|
2005 | |
|
2004 | |
|
2003 | |
|
2003 | |
|
2002 | |
|
|
| |
|
| |
|
| |
|
| |
|
| |
AMR
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Gross revenue
|
|
|
100% |
|
|
|
100% |
|
|
|
100% |
|
|
|
100% |
|
|
|
100% |
|
Provision for contractual discounts
|
|
|
35% |
|
|
|
35% |
|
|
|
30% |
|
|
|
30% |
|
|
|
26% |
|
Provision for uncompensated care
|
|
|
14% |
|
|
|
14% |
|
|
|
16% |
|
|
|
15% |
|
|
|
16% |
|
EmCare
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Gross revenue
|
|
|
100% |
|
|
|
100% |
|
|
|
100% |
|
|
|
100% |
|
|
|
100% |
|
Provision for contractual discounts
|
|
|
42% |
|
|
|
41% |
|
|
|
40% |
|
|
|
40% |
|
|
|
38% |
|
Provision for uncompensated care
|
|
|
25% |
|
|
|
24% |
|
|
|
24% |
|
|
|
23% |
|
|
|
23% |
|
Total
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Gross revenue
|
|
|
100% |
|
|
|
100% |
|
|
|
100% |
|
|
|
100% |
|
|
|
100% |
|
Provision for contractual discounts
|
|
|
39% |
|
|
|
37% |
|
|
|
35% |
|
|
|
34% |
|
|
|
31% |
|
Provision for uncompensated care
|
|
|
19% |
|
|
|
18% |
|
|
|
19% |
|
|
|
18% |
|
|
|
19% |
|
Healthcare reimbursement is complex and may involve lengthy
delays. Third-party payors are continuing their efforts to
control expenditures for healthcare, including proposals to
revise reimbursement policies. The
F-18
American Medical Response, Inc. & EmCare Holdings
Inc.
(The Healthcare Transportation and Emergency Management
Services
Businesses of Laidlaw International, Inc.)
Notes to Combined Financial
Statements — (Continued)
Company has from time to time experienced delays in
reimbursement from third-party payors. In addition, third-party
payors may disallow, in whole or in part, claims for
reimbursement based on determinations that certain amounts are
not reimbursable under plan coverage, determinations of medical
necessity, or the need for additional information. Laws and
regulations governing the Medicare and Medicaid programs are
very complex and subject to interpretation. As a result, there
is a reasonable possibility that recorded estimates will change
materially in the short-term. Retroactive adjustments may change
the amounts realized from third-party payors and are considered
in the recognition of revenue on an estimated basis in the
period the related services are rendered. Such amounts are
adjusted in future periods, as adjustments become known.
Subsidies and fees in connection with community contracts are
recognized ratably over the service period the payment covers.
The Company also provides services to patients who have no
insurance or other third-party payor coverage. In certain
circumstances, federal law requires providers to render services
to any patient who requires emergency care regardless of their
ability to pay.
Income Taxes
The Company accounts for income taxes under SFAS 109.
Deferred income taxes reflect the impact of temporary
differences between the reported amounts of assets and
liabilities for financial reporting purposes and such amounts as
measured by tax laws and regulations. The deferred tax assets
and liabilities represent the future tax return consequences of
those differences, which will either be taxable or deductible
when the assets and liabilities are recovered or settled. A
valuation allowance is provided for deferred tax assets when
management concludes it is more likely than not that some
portion of the deferred tax assets will not be recognized.
AMR and EmCare are included in the consolidated U.S. income
tax return with other Laidlaw U.S. subsidiaries. The tax
allocation agreement calculates tax liability on a separate
company basis and provides for reimbursement or payment for
utilization of carryovers among members of the group.
Consequently, AMR and EmCare only receive the benefits of net
operating loss and interest carryforwards to the extent utilized
in Laidlaw’s consolidated return. Costs related to income
taxes are included as payable to or receivable from Laidlaw.
Recent Accounting Pronouncements
In December 2004, the Financial Accounting Standards Board
(“FASB”) issued Statement No. 123 (revised 2004),
“Share-Based Payment.” This Statement is a
revision of FASB Statement No. 123, “Accounting for
Stock-Based Compensation” and is effective as of the
beginning of the first interim or annual reporting period that
begins after June 15, 2005. The Statement requires public
companies to measure the cost of employee services received in
exchange for an award of equity instruments based on the
grant-date fair value of the award. The Company anticipates that
the adoption of this Statement will not have a material impact
on its financial statements.
F-19
American Medical Response, Inc. & EmCare Holdings
Inc.
(The Healthcare Transportation and Emergency Management
Services
Businesses of Laidlaw International, Inc.)
Notes to Combined Financial
Statements — (Continued)
|
|
3. |
Property, Plant and Equipment, net |
Property, plant and equipment, net consisted of the following at
January 31, 2005 and August 31, 2004 and 2003:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Restated | |
|
|
|
|
| |
|
|
2005 | |
|
2004 | |
|
2003 | |
|
|
| |
|
| |
|
| |
Land
|
|
$ |
2,079 |
|
|
$ |
2,079 |
|
|
$ |
2,079 |
|
Building and leasehold improvements
|
|
|
14,293 |
|
|
|
14,147 |
|
|
|
11,670 |
|
Vehicles
|
|
|
91,114 |
|
|
|
85,172 |
|
|
|
65,163 |
|
Computer hardware and software
|
|
|
42,006 |
|
|
|
35,585 |
|
|
|
29,290 |
|
Other
|
|
|
46,891 |
|
|
|
45,622 |
|
|
|
32,130 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
196,383 |
|
|
|
182,605 |
|
|
|
140,332 |
|
Less: accumulated depreciation
|
|
|
(67,617 |
) |
|
|
(49,920 |
) |
|
|
(6,786 |
) |
|
|
|
|
|
|
|
|
|
|
Property, plant and equipment, net
|
|
$ |
128,766 |
|
|
$ |
132,685 |
|
|
$ |
133,546 |
|
|
|
|
|
|
|
|
|
|
|
Vehicles include certain vehicles held under capital leases with
a net book value of $11.7 million, $13.9 million and
$19.0 million at January 31, 2005 and August 31,
2004 and 2003, respectively. Accumulated depreciation and
amortization at January 31, 2005 and August 31, 2004
and 2003 includes $8.4 million, $6.3 million and
$1.3 million, respectively, relating to such vehicles.
Depreciation expense was $18.0 million for the five months
ended January 31, 2005, $43.2 million for the year
ended August 31, 2004, $10.2 million for the three
months ended August 31, 2003, $32.2 million for the
nine months ended May 31, 2003 and $45.7 million for
the year ended August 31, 2002.
|
|
4. |
Intangible Assets, net |
Intangible assets, net consisted of the following at
January 31, 2005 and August 31, 2004 and 2003:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Restated | |
|
|
|
|
|
|
| |
|
|
2005 | |
|
2004 | |
|
2003 | |
|
|
| |
|
| |
|
| |
Goodwill
|
|
$ |
— |
|
|
$ |
— |
|
|
$ |
52,360 |
|
Contract value
|
|
|
22,544 |
|
|
|
22,106 |
|
|
|
94,177 |
|
Radio frequencies
|
|
|
— |
|
|
|
— |
|
|
|
4,000 |
|
Covenant not to compete
|
|
|
250 |
|
|
|
— |
|
|
|
19 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
22,794 |
|
|
|
22,106 |
|
|
|
150,556 |
|
Less: accumulated amortization
|
|
|
(6,719 |
) |
|
|
(6,348 |
) |
|
|
(2,351 |
) |
|
|
|
|
|
|
|
|
|
|
Intangible assets, net
|
|
$ |
16,075 |
|
|
$ |
15,758 |
|
|
$ |
148,205 |
|
|
|
|
|
|
|
|
|
|
|
Amortization expense of intangible assets was $0.8 million
for the five months ended January 31, 2005,
$9.5 million for the year ended August 31, 2004 and
$2.4 million for the three months ended August 31,
2003, $0 for the nine months ended May 31, 2003 and
$21.4 million for the year ended August 31, 2002.
Covenants and the contract value are amortized over a life of
10 years. As a result of the reversal of the separate
company tax valuation allowance as of August 31, 2004 under
fresh-start accounting, AMR reduced its intangible assets to
zero and EmCare reduced its intangible assets to
$15.8 million. Estimated annual amortization over each of
the next five years is approximately $2.2 million.
F-20
American Medical Response, Inc. & EmCare Holdings
Inc.
(The Healthcare Transportation and Emergency Management
Services
Businesses of Laidlaw International, Inc.)
Notes to Combined 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. Significant components of the
Company’s deferred taxes were as follows at
January 31, 2005 and August 31, 2004 and 2003:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Restated | |
|
|
|
|
| |
|
|
2005 | |
|
2004 | |
|
2003 | |
|
|
| |
|
| |
|
| |
Deferred tax assets:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Accounts receivable
|
|
$ |
38,817 |
|
|
$ |
34,726 |
|
|
$ |
54,447 |
|
|
Accrued liabilities
|
|
|
58,508 |
|
|
|
56,803 |
|
|
|
62,120 |
|
|
Intangible assets
|
|
|
42,732 |
|
|
|
46,047 |
|
|
|
24,311 |
|
|
Interest carryforwards
|
|
|
84,590 |
|
|
|
85,188 |
|
|
|
84,474 |
|
|
Net operating loss carryforwards
|
|
|
54,565 |
|
|
|
55,055 |
|
|
|
94,576 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
279,212 |
|
|
|
277,819 |
|
|
|
319,928 |
|
Deferred tax liabilities:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Excess of tax over book depreciation
|
|
|
(11,651 |
) |
|
|
(10,449 |
) |
|
|
(8,544 |
) |
|
|
|
|
|
|
|
|
|
|
Net deferred tax assets
|
|
|
267,561 |
|
|
|
267,370 |
|
|
|
311,384 |
|
Valuation allowance
|
|
|
— |
|
|
|
— |
|
|
|
(155,952 |
) |
|
|
|
|
|
|
|
|
|
|
Net deferred tax assets
|
|
$ |
267,561 |
|
|
$ |
267,370 |
|
|
$ |
155,432 |
|
|
|
|
|
|
|
|
|
|
|
The Company has significant net deferred tax assets resulting
from net operating loss (“NOL”) and interest deduction
carryforwards and other deductible temporary differences that
will reduce taxable income in future periods.
SFAS No. 109 “Accounting for Income
Taxes” requires that a valuation allowance be
established when it is “more likely than not” that
all, or a portion, of net deferred tax assets will not be
realized. A review of all available positive and negative
evidence needs to be considered, including expected reversals of
significant deductible temporary differences, a company’s
recent financial performance, the market environment in which a
company operates, tax planning strategies and the length of NOL
and interest deduction carryforward periods. Furthermore, the
weight given to the potential effect of negative and positive
evidence should be commensurate with the extent to which it can
be objectively verified.
At the fresh-start accounting date, May 31, 2003, the
Company recorded a valuation allowance of $156.0 million,
based on the criteria required under SFAS No. 109
discussed above. During fiscal 2004, write-offs of net operating
loss carryforwards and realization of other assets reduced the
valuation allowance by $48.2 million. As a result of the
Company’s improved financial performance during fiscal
2004, management reduced the deferred tax valuation allowance by
an additional $107.8 million during the year ended
August 31, 2004. As required under fresh-start accounting,
this change also resulted in a reduction in intangible assets
and goodwill and an increase in Laidlaw equity of AMR.
The Company has interest carryovers of $222.6 million at
January 31, 2005 limited by Internal Revenue Code
Section 163(j) without expiration, and federal net
operating loss carryforwards of $143.7 million which expire
in the years 2005 to 2024. The interest carryovers and
$134.0 million of the net operating loss carryforwards are
subject to Laidlaw’s annual Section 382 limitation of
$58 million.
In connection with the sale described in note 17, the value
of deferred tax assets and liabilities will be adjusted.
F-21
American Medical Response, Inc. & EmCare Holdings
Inc.
(The Healthcare Transportation and Emergency Management
Services
Businesses of Laidlaw International, Inc.)
Notes to Combined Financial
Statements — (Continued)
The components of income tax benefit (expense) were as follows:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Predecessor | |
|
|
|
|
|
|
|
|
| |
|
|
Five Months | |
|
Year | |
|
Three Months | |
|
Nine Months | |
|
Year | |
|
|
Ended | |
|
Ended | |
|
Ended | |
|
Ended | |
|
Ended | |
|
|
January 31, | |
|
August 31, | |
|
August 31, | |
|
May 31, | |
|
August 31, | |
|
|
2005 | |
|
2004 | |
|
2003 | |
|
2003 | |
|
2002 | |
|
|
| |
|
| |
|
| |
|
| |
|
| |
Current tax expense
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
State
|
|
$ |
— |
|
|
$ |
559 |
|
|
$ |
(162 |
) |
|
$ |
829 |
|
|
$ |
1,374 |
|
Federal
|
|
|
— |
|
|
|
(694 |
) |
|
|
17,216 |
|
|
|
— |
|
|
|
— |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Total
|
|
|
— |
|
|
|
(135 |
) |
|
|
17,054 |
|
|
|
829 |
|
|
|
1,374 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Deferred tax expense
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
State
|
|
|
762 |
|
|
|
2,496 |
|
|
|
(76 |
) |
|
|
— |
|
|
|
— |
|
Federal
|
|
|
5,516 |
|
|
|
19,403 |
|
|
|
(8,345 |
) |
|
|
— |
|
|
|
— |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Total
|
|
|
6,278 |
|
|
|
21,899 |
|
|
|
(8,421 |
) |
|
|
— |
|
|
|
— |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Total tax expense
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
State
|
|
|
762 |
|
|
|
3,055 |
|
|
|
(238 |
) |
|
|
829 |
|
|
|
1,374 |
|
Federal
|
|
|
5,516 |
|
|
|
18,709 |
|
|
|
8,871 |
|
|
|
— |
|
|
|
— |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Total
|
|
$ |
6,278 |
|
|
$ |
21,764 |
|
|
$ |
8,633 |
|
|
$ |
829 |
|
|
$ |
1,374 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
A reconciliation of the provision (benefit) for income taxes at
the federal statutory rate compared to the Company’s
effective tax rate is as follows:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
As Restated | |
|
|
|
|
|
|
|
|
Predecessor | |
|
|
|
|
|
|
|
|
| |
|
|
Five Months | |
|
Year | |
|
Three Months | |
|
Nine Months | |
|
Year | |
|
|
Ended | |
|
Ended | |
|
Ended | |
|
Ended | |
|
Ended | |
|
|
January 31, | |
|
August 31, | |
|
August 31, | |
|
May 31, | |
|
August 31, | |
|
|
2005 | |
|
2004 | |
|
2003 | |
|
2003 | |
|
2002 | |
|
|
| |
|
| |
|
| |
|
| |
|
| |
Income tax expense (benefit) at the statutory rate
|
|
$ |
5,516 |
|
|
$ |
20,690 |
|
|
$ |
631 |
|
|
$ |
26,656 |
|
|
$ |
(86,103 |
) |
Decrease(increase) in income taxes resulting from:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
State taxes, net of federal
|
|
|
495 |
|
|
|
1,986 |
|
|
|
(155 |
) |
|
|
539 |
|
|
|
893 |
|
|
Goodwill amortization/impairment
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
76,517 |
|
|
Fresh start accounting adjustments
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
(16,246 |
) |
|
|
— |
|
|
Parent Company allocations
|
|
|
— |
|
|
|
(1,577 |
) |
|
|
7,990 |
|
|
|
(2,826 |
) |
|
|
(40,377 |
) |
|
Change in valuation allowance
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
(7,607 |
) |
|
|
50,158 |
|
|
Other
|
|
|
267 |
|
|
|
665 |
|
|
|
167 |
|
|
|
313 |
|
|
|
286 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Provision for income taxes
|
|
$ |
6,278 |
|
|
$ |
21,764 |
|
|
$ |
8,633 |
|
|
$ |
829 |
|
|
$ |
1,374 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
F-22
American Medical Response, Inc. & EmCare Holdings
Inc.
(The Healthcare Transportation and Emergency Management
Services
Businesses of Laidlaw International, Inc.)
Notes to Combined Financial
Statements — (Continued)
Accrued liabilities were as follows at January 31, 2005 and
August 31, 2004 and 2003:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
2005 | |
|
2004 | |
|
2003 | |
|
|
| |
|
| |
|
| |
Accrued wages and benefits
|
|
$ |
53,231 |
|
|
$ |
65,757 |
|
|
$ |
56,960 |
|
Accrued paid time off
|
|
|
20,141 |
|
|
|
19,828 |
|
|
|
16,896 |
|
Current portion of self-insurance reserve
|
|
|
41,283 |
|
|
|
36,384 |
|
|
|
28,206 |
|
Accrued restructuring
|
|
|
1,118 |
|
|
|
1,611 |
|
|
|
3,088 |
|
Current portion of compliance and legal
|
|
|
3,607 |
|
|
|
5,660 |
|
|
|
8,056 |
|
Accrued billing and collection fees
|
|
|
3,522 |
|
|
|
3,466 |
|
|
|
3,300 |
|
Accrued profit sharing
|
|
|
23,802 |
|
|
|
7,566 |
|
|
|
6,552 |
|
Other
|
|
|
24,941 |
|
|
|
26,512 |
|
|
|
23,121 |
|
|
|
|
|
|
|
|
|
|
|
Total accrued liabilities
|
|
$ |
171,645 |
|
|
$ |
166,784 |
|
|
$ |
146,179 |
|
|
|
|
|
|
|
|
|
|
|
Long-term debt consisted of the following at January 31,
2005 and August 31, 2004 and 2003:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
2005 | |
|
2004 | |
|
2003 | |
|
|
| |
|
| |
|
| |
Notes due at various dates from 2004 to 2022 with interest rates
from 6% to 10%
|
|
$ |
1,219 |
|
|
$ |
2,959 |
|
|
$ |
6,478 |
|
Mortgage loan due 2010 with an interest rate of 7%
|
|
|
2,168 |
|
|
|
2,190 |
|
|
|
2,242 |
|
Capital lease obligations due at various dates from 2006 to 2007
(note 10)
|
|
|
8,110 |
|
|
|
10,331 |
|
|
|
15,337 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
11,497 |
|
|
|
15,480 |
|
|
|
24,057 |
|
Less current portion
|
|
|
(5,846 |
) |
|
|
(7,565 |
) |
|
|
(8,270 |
) |
|
|
|
|
|
|
|
|
|
|
Total long-term debt
|
|
$ |
5,651 |
|
|
$ |
7,915 |
|
|
$ |
15,787 |
|
|
|
|
|
|
|
|
|
|
|
The aggregate amount of minimum payments (deposit refunds)
required on long-term debt in each of the years indicated is as
follows:
|
|
|
|
|
Year ending January 31, |
|
|
|
|
|
2006
|
|
$ |
5,846 |
|
2007
|
|
|
3,771 |
|
2008
|
|
|
(878 |
) |
2009
|
|
|
121 |
|
2010
|
|
|
108 |
|
Thereafter
|
|
|
2,529 |
|
|
|
|
|
|
|
$ |
11,497 |
|
|
|
|
|
F-23
American Medical Response, Inc. & EmCare Holdings
Inc.
(The Healthcare Transportation and Emergency Management
Services
Businesses of Laidlaw International, Inc.)
Notes to Combined Financial
Statements — (Continued)
|
|
8. |
Restructuring Charges and Impairment Losses |
The activity in the accrued restructuring balance is as follows:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
2002 Plan | |
|
2003 Plan | |
|
2004 Plan | |
|
|
|
|
| |
|
| |
|
| |
|
|
|
|
Severance | |
|
Lease | |
|
Total | |
|
Severance | |
|
Severance | |
|
Total | |
|
|
| |
|
| |
|
| |
|
| |
|
| |
|
| |
Incurred
|
|
$ |
1,517 |
|
|
$ |
2,260 |
|
|
$ |
3,777 |
|
|
|
|
|
|
|
|
|
|
$ |
3,777 |
|
Paid
|
|
|
(456 |
) |
|
|
(149 |
) |
|
|
(605 |
) |
|
|
|
|
|
|
|
|
|
|
(605 |
) |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
August 31, 2002
|
|
|
1,061 |
|
|
|
2,111 |
|
|
|
3,172 |
|
|
|
|
|
|
|
|
|
|
|
3,172 |
|
Incurred April 2003
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
$ |
1,288 |
|
|
|
|
|
|
|
1,288 |
|
Incurred August 2003
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
1,449 |
|
|
|
|
|
|
|
1,449 |
|
Paid
|
|
|
(559 |
) |
|
|
(561 |
) |
|
|
(1,120 |
) |
|
|
(1,701 |
) |
|
|
|
|
|
|
(2,821 |
) |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
August 31, 2003
|
|
|
502 |
|
|
|
1,550 |
|
|
|
2,052 |
|
|
|
1,036 |
|
|
|
|
|
|
|
3,088 |
|
Incurred
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
$ |
2,115 |
|
|
|
2,115 |
|
Paid
|
|
|
(502 |
) |
|
|
(566 |
) |
|
|
(1,068 |
) |
|
|
(1,036 |
) |
|
|
(1,488 |
) |
|
|
(3,592 |
) |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
August 31, 2004
|
|
|
— |
|
|
|
984 |
|
|
|
984 |
|
|
|
— |
|
|
|
627 |
|
|
|
1,611 |
|
Incurred
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
Paid
|
|
|
— |
|
|
|
(238 |
) |
|
|
(238 |
) |
|
|
— |
|
|
|
(255 |
) |
|
|
(493 |
) |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
January 31, 2005
|
|
$ |
— |
|
|
$ |
746 |
|
|
$ |
746 |
|
|
$ |
— |
|
|
$ |
372 |
|
|
$ |
1,118 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Restructuring Plans
During fiscal year 2004, AMR was re-aligned into three
geographic regions. The billing centers and operating units
within the four original AMR regions were shifted to create the
new structure and the administrative office of the former
South-Central region was closed. The functions previously
performed by this group were distributed to the remaining
regions. This restructuring plan is expected to be completed by
December 2005.
During fiscal year 2003, AMR’s Northern Pacific Region
re-aligned the management structure of its operations. The first
phase occurred in April 2003 and the second and final phase
occurred in August 2003.
During fiscal year 2002, in an effort to eliminate the
differences in size among regions, AMR was re-aligned into four
geographic regions. The operating units within the five original
regions were shifted to create the new structure and the
administrative offices of the former South region and one
billing center were closed. National Products and Services was
also closed. The functions previously performed by this group
were distributed to the remaining regions and the corporate
office. This restructuring plan is expected to be completed by
December 2008.
2002 Impairment Losses
During fiscal year 2002, AMR incurred an impairment charge of
$262.8 million, including $254.9 goodwill impairment and
$7.9 million property, plant and equipment impairment. The
impairment losses resulted from the inability of AMR to recover
the carrying value of the long-lived assets from expected future
operating cash flows.
F-24
American Medical Response, Inc. & EmCare Holdings
Inc.
(The Healthcare Transportation and Emergency Management
Services
Businesses of Laidlaw International, Inc.)
Notes to Combined Financial
Statements — (Continued)
|
|
9. |
Retirement Plans and Employee Benefits |
AMR maintains three 401(k) plans (the “AMR Plans”) for
its employees and employees of its subsidiaries who meet the
eligibility requirements set forth in the AMR Plans. Employees
may contribute a maximum of 40% of their compensation up to a
maximum of $13 (thousand). Generally 50% of the contribution is
matched by AMR up to a maximum of 3% to 6% of the
employee’s salary per year, depending on the plan.
AMR’s contributions to the AMR Plans for the five months
ended January 31, 2005 were $3.7 million, the year
ended August 31, 2004 were $8.1 million, for the three
months ended August 31, 2003 were $1.9 million and for
the nine months ended May 31, 2003 were $5.7 million.
For the year ended August 31, 2002, AMR’s
contributions to the AMR Plans were $6.9 million.
Contributions are included in operating expenses on the
accompanying combined statements of operations.
EmCare established the EmCare Holdings Inc. 401(k) Savings Plan
(the “EmCare Plan”) in 1994 to provide retirement
benefits to its employees. Employees may elect to participate in
the EmCare Plan at the beginning of each calendar quarter and
may contribute 1% to 25% of their annual compensation on a
tax-deferred basis subject to limits established by the Internal
Revenue Service. EmCare contributes 50% of the first 6% of base
compensation that a participant contributes to the EmCare Plan
during any calendar year. The EmCare Plan follows a calendar
year-end. Accordingly, EmCare makes its matching contributions
based on eligible employee contributions for each calendar year.
EmCare contributed $0.1 million to the EmCare Plan during
the five months ended January 31, 2005. During calendar
years 2004, 2003 and 2002, EmCare contributed $0.5 million,
$0.4 and $0.4 million, respectively, to the EmCare Plan.
In fiscal 2004, Laidlaw issued Value Appreciation Rights
(“VAR”) to various employees of AMR and EmCare. There
were no VARs issued prior to fiscal 2004. The VARs vest 100% on
the third anniversary of the date of the grant. The VARs
compensation is based on prescribed formulas that estimate
changes in the enterprise values of AMR and EmCare. The Company
recognizes compensation expense on a straight-line basis over
the vesting period with compensation expense of
$4.1 million for fiscal 2004. The Company recognized
$15.3 million of expense related to the VARs for the period
ended January 31, 2005 which is included in Laidlaw fees
and compensation charges. This expense related to the sale
transaction discussed in note 17 and was funded by Laidlaw
in accordance with the terms of the sale agreements. The VAR
program was terminated in connection with the sale of AMR and
EmCare in February 2005 and employees and executives will earn
no further rights.
|
|
10. |
Commitments and Contingencies |
Lease Commitments
The Company leases various facilities and equipment under
operating lease agreements. Rental expense incurred under these
leases was $12.4 million, $27.9 million,
$7.2 million and $23.2 million for the five months
ended January 31, 2005, the year ended August 31,
2004, the three months ended August 31, 2003 and the nine
months ended May 31, 2003, respectively, and was
$32.4 million in fiscal 2002.
In addition, the Company leases certain vehicles under capital
leases. Assets under capital lease are capitalized using
inherent interest rates at the inception of each lease. Capital
leases are collateralized by the leased vehicles.
F-25
American Medical Response, Inc. & EmCare Holdings
Inc.
(The Healthcare Transportation and Emergency Management
Services
Businesses of Laidlaw International, Inc.)
Notes to Combined Financial
Statements — (Continued)
Future commitments under capital and operating leases for
vehicle, premises, equipment and other recurring commitments are
as follows (the balances below include fair value adjustments as
described in note 2):
|
|
|
|
|
|
|
|
|
|
|
|
|
Operating | |
|
|
Capital | |
|
Leases & | |
|
|
Leases | |
|
Other | |
|
|
| |
|
| |
Year ending January 31,
|
|
|
|
|
|
|
|
|
2006
|
|
$ |
6,000 |
|
|
$ |
27,289 |
|
2007
|
|
|
3,558 |
|
|
|
20,335 |
|
2008
|
|
|
(948 |
) |
|
|
16,242 |
|
2009
|
|
|
— |
|
|
|
12,785 |
|
2010
|
|
|
— |
|
|
|
8,810 |
|
Thereafter
|
|
|
— |
|
|
|
20,659 |
|
|
|
|
|
|
|
|
|
|
|
8,610 |
|
|
$ |
106,120 |
|
|
|
|
|
|
|
|
Less imputed interest
|
|
|
(500 |
) |
|
|
|
|
|
|
|
|
|
|
|
Total capital lease obligations
|
|
|
8,110 |
|
|
|
|
|
Less current portion
|
|
|
(5,530 |
) |
|
|
|
|
|
|
|
|
|
|
|
Long-term capital lease obligations
|
|
$ |
2,580 |
|
|
|
|
|
|
|
|
|
|
|
|
Other commitments consisting of dispatch and responder fees
totaling $5,362, $1,133, $991, $989, $2,912 and $243 and Onex
management fees of $889, $1,000, $1,000, $1,000, $1,000 and $0
for the years ending January 31, 2006, 2007, 2008, 2009,
2010 and thereafter, respectively.
Services
The Company is subject to the Medicare and Medicaid fraud and
abuse laws which prohibit, among other things, any false claims,
or any bribe, kick-back or rebate in return for the referral of
Medicare and Medicaid patients. Violation of these prohibitions
may result in civil and criminal penalties and exclusion from
participation in the Medicare and Medicaid programs. Management
has implemented policies and procedures that management believes
will assure that the Company is in substantial compliance with
these laws. From time to time, we receive requests for
information from government agencies pursuant to their
regulatory or investigational authority. Such requests can
include subpoenas or demand letters for documents to assist the
government in audits or investigations. The Company is
cooperating with the government agencies conducting these
investigations and is providing requested information to the
government agencies. Other than the investigations described
below, management believes that the outcome of any of these
investigations would not have a material adverse effect on the
Company.
During the first quarter of fiscal 2004, AMR was advised by the
U.S. Department of Justice (“DOJ”) that it was
investigating certain of AMR’s business practices. The
specific practices at issue were (1) whether ambulance
transports involving Medicare eligible patients complied with
the “medical necessity” requirement imposed by
Medicare regulations, (2) whether patient signatures, when
required, were properly obtained from Medicare eligible
patients, and (3) whether discounts in violation of the
federal Anti-Kickback Statute were provided by AMR in exchange
for referrals involving Medicare eligible patients. In
connection with the third issue, the government has alleged that
certain of AMR’s hospital and nursing home contracts
in effect in Texas, primarily certain contracts in effect in
1996 and 1997, contained discounts in violation of the federal
Anti-Kickback Statute. The government recently has provided the
Company with an analysis of the
F-26
American Medical Response, Inc. & EmCare Holdings
Inc.
(The Healthcare Transportation and Emergency Management
Services
Businesses of Laidlaw International, Inc.)
Notes to Combined Financial
Statements — (Continued)
investigation conducted in connection with this contract issue,
and invited the Company to respond. The Company is considering
the government’s analysis and intends to provide its views,
as requested. The government may also be investigating whether
AMR’s contracts with health facilities in Oregon and other
jurisdictions violate the Anti-Kickback Statute. At this time,
it is not possible to predict the ultimate conclusion of these
investigations, nor is it possible to estimate possible
financial exposure, if any, to the Company.
From August 1998 until August 2000, American Medical Response
West (“AMR West”), a subsidiary of AMR, received six
subpoenas duces tecum from the United States Attorney’s
Office. These subpoenas related to billing matters for emergency
transports during the periods January 1, 1995 to
December 31, 1999. Pursuant to a settlement agreement with
the United States Attorney’s Office, AMR West paid
$3.5 million in 2004 and entered into a five-year agreement
with the Department of Health and Human Services covering
various administrative processes and procedures. AMR reserved
for these matters in periods prior to the statements of
operations presented herein.
In June 1999, the DOJ began an investigation of the billing
processes of Regional Emergency Services L.P., or RES, a
subsidiary of AMR, and one of RES’ hospital clients.
The DOJ alleged violations by the companies of the False Claims
Act based on the absence of certificates of medical necessity
and other non-compliant billing practices from October 1992 to
May 2002. Pursuant to a settlement agreement to resolve these
allegations, including settlement of claims in Texas described
below, in April 2004 AMR paid $5.0 million of a total
$20.0 million settlement amount, with the balance paid by the
hospital. AMR reserved for these matters in periods prior to the
statements of operations presented herein.
On May 9, 2002, AMR received a subpoena duces tecum from
the Office of Inspector General for the United States Department
of Health and Human Services. The subpoena required AMR to
produce a broad range of documents relating to RES contracts in
Texas, Georgia and Colorado for the period from January 1993
through May 2002. The Texas claims were resolved pursuant to the
settlement agreement described above. The government
investigations in Georgia and Colorado are continuing; it is not
currently possible to estimate the financial exposure, if any,
to the Company.
On July 12, 2005, the Company received a letter and draft
Audit Report from the Office of Inspector General for the United
States Department of Health and Human Services, or OIG,
requesting the Company’s response to its draft findings
that the Company’s Massachusetts subsidiary received
$1.9 million in overpayments from Medicare for services
performed between July 1, 2002 and December 31, 2002.
The draft findings state that some of these services did not
meet Medicare medical necessity and reimbursement requirements.
The Company disagrees with the OIG’s finding and is in the
process of responding to the draft Audit Report. If the Company
is unsuccessful in challenging the OIG’s draft findings,
and in any administrative appeals to which the Company may be
entitled following the release of a final Audit Report, the
Company may be required to make a substantial repayment.
Letters of Credit
At January 31, 2005 and August 31, 2004 and 2003, AMR
had $23,297, $8,212 and $9,112, respectively, in outstanding
letters of credit. At January 31, 2005 and August 31,
2004 and 2003, Laidlaw also had issued letters of credit on
behalf of AMR for $1,000, $23,328 and $28,185, respectively.
Other Legal Matters
EmCare has been named as a defendant in two collective action
lawsuits brought by a number of nurse practitioners and
physician assistants under the federal Fair Labor Standards Act.
The plaintiffs are seeking to
F-27
American Medical Response, Inc. & EmCare Holdings
Inc.
(The Healthcare Transportation and Emergency Management
Services
Businesses of Laidlaw International, Inc.)
Notes to Combined Financial
Statements — (Continued)
recover overtime pay for the hours they worked in excess of 40
in a workweek and reclassification as non-exempt employees.
Certain of the plaintiffs brought a related action under
California state law. EmCare has entered into a settlement of
the California state law claims for $1.5 million. EmCare
reserved the amount of this settlement in fiscal 2004 and it was
included as a component of selling, general and administrative
expenses.
Guarantees
Upon emergence from Chapter 11, Laidlaw established a new
senior secured credit facility (the “Facility”). The
Facility is guaranteed by Laidlaw and certain Laidlaw
subsidiaries, including AMR and EmCare. In addition, the
Facility is secured by the assets of Laidlaw and certain Laidlaw
subsidiaries, including AMR and EmCare, except for certain
assets of the Company contractually excluded from the
securitization. Under the terms of the Facility, Laidlaw is
required to meet certain financial covenants, including a fixed
charge coverage ratio, leverage ratio, interest coverage ratio,
net tangible asset ratio and maximum senior secured leverage
ratio, as well as certain non-financial covenants. As of
January 31, 2005, Laidlaw was in compliance with all
covenants and the outstanding balance under the Facility and
issued letters of credit aggregated $597.3 million.
As a result of emergence from Chapter 11, Laidlaw also
issued unsecured senior notes. These notes are also guaranteed
by Laidlaw and certain Laidlaw subsidiaries, including AMR and
EmCare. The outstanding balance under the notes at
January 31, 2005 aggregated $406 million.
In connection with the sale discussed in note 17, AMR and
EmCare have been released from these guarantees.
Income Tax Matters
The respective tax authorities, in the normal course, audit
previous tax filings. It is not possible at this time to predict
the final outcome of these audits or establish a reasonable
estimate of possible additional taxes owing, if any.
Allocation of Costs from Laidlaw
Laidlaw charges AMR and EmCare for the estimated cost of certain
functions that are managed by Laidlaw and can reasonably be
attributed directly to the operations of the Company. The
charges to the Company are based on management’s estimate
of such services specifically used by the Company. Where
determinations based on specific usage alone have been
impracticable, other methods and criteria were used that Laidlaw
management believes are reasonable. Such allocations are not
intended to represent the costs that would be or would have been
incurred if the Company were an independent business.
The amount of Laidlaw’s combined equity and the Laidlaw
payable included in the balance sheet represents a net balance
as a result of various transactions between the Company and
Laidlaw. There are no terms of settlement associated with the
account balance. The balance is primarily the result of the
Company’s participation in Laidlaw’s central cash
management program, wherein all the subsidiaries’ cash
receipts are remitted to Laidlaw and all cash disbursements are
funded by Laidlaw. Other transactions include certain direct
obligations administered by Laidlaw, as well as the
Company’s share of the current portion of the Laidlaw
consolidated federal and state income tax liability and various
other administrative expenses allocated by Laidlaw. As a result,
obligations for these matters are not reflected on the
accompanying balance sheet.
F-28
American Medical Response, Inc. & EmCare Holdings
Inc.
(The Healthcare Transportation and Emergency Management
Services
Businesses of Laidlaw International, Inc.)
Notes to Combined Financial
Statements — (Continued)
Self-insurance obligations and related deposits administered by
Laidlaw are reflected on the accompanying balance sheet.
Laidlaw charges or cost allocations included in the accompanying
combined statements of operations include the following:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Predecessor | |
|
|
|
|
|
|
|
|
|
| |
|
|
Five Months | |
|
Year | |
|
Three Months | |
|
|
Nine Months | |
|
Year | |
|
|
Ended | |
|
Ended | |
|
Ended | |
|
|
Ended | |
|
Ended | |
|
|
January 31, | |
|
August 31, | |
|
August 31, | |
|
|
May 31, | |
|
August 31, | |
|
|
2005 | |
|
2004 | |
|
2003 | |
|
|
2003 | |
|
2002 | |
|
|
| |
|
| |
|
| |
|
|
| |
|
| |
Allocated insurance expense (income)
|
|
$ |
— |
|
|
$ |
(4,505 |
) |
|
$ |
11,522 |
|
|
|
$ |
3,058 |
|
|
$ |
(8,094 |
) |
Direct insurance expense
|
|
|
17,069 |
|
|
|
40,554 |
|
|
|
— |
|
|
|
|
— |
|
|
|
— |
|
Laidlaw fees and compensation charges
|
|
|
19,857 |
|
|
|
15,449 |
|
|
|
1,350 |
|
|
|
|
4,050 |
|
|
|
5,400 |
|
Reorganization costs
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
|
3,650 |
|
|
|
8,761 |
|
Interest
|
|
|
4,480 |
|
|
|
6,225 |
|
|
|
403 |
|
|
|
|
3,081 |
|
|
|
4,585 |
|
Included in insurance expense are allocations of charges and
credits made to AMR related to the operating costs and
investment activities of Laidlaw’s captive insurance
company. These allocations also include changes in actuarial
estimates of insurance reserves for fiscal year 2001 and prior
years’ claims estimates. For fiscal year 2002 and 2003, AMR
obtained insurance coverage from outside parties, rather than
through Laidlaw. In fiscal 2004, AMR returned to the Laidlaw
insurance program for workers compensation, auto and general
liability. EmCare’s participation in the Laidlaw insurance
program is limited to directors’ and officers, and general
liability insurance which is allocated as a component of Laidlaw
fees and compensation charges.
Management costs have been calculated using a formula based upon
the Company’s share of Laidlaw’s consolidated revenue
and represent Laidlaw’s general and administrative costs
incurred for the benefit of the Company. Fiscal 2004 management
costs include $4.1 million of charges related to incentive
plans for management of the Company.
During the nine months ended May 31, 2003 and fiscal year
2002, Laidlaw charged the Company additional costs incurred by
Laidlaw as a result of its reorganization of $3.7 million
and $8.8 million, respectively.
Interest expense has been recorded by the Company based on an
average intercompany balance and applicable interest rates
(prime + 2%). During fiscal 2002 and for the nine months ended
May 31, 2003, Laidlaw, as a result of its bankruptcy,
suspended interest on purchase acquisition debt pushed down to
AMR.
On March 1, 2004, AMR declared a $200 million dividend
payable to Laidlaw. The dividend has been recorded as an
increase in the Laidlaw payable account on the balance sheet and
as a decrease to combined equity. There are no specific
repayment terms related to the Laidlaw payable account which has
been included as a component of equity on the accompanying
combined balance sheets and combined statements of changes in
equity.
At January 31, 2005, Laidlaw maintained deposits of
$16.4 million for collateral on behalf of AMR supporting
performance bonds held by a related party. AMR’s interest
in the collateral is included in other long-term assets. As
described in note 12, Laidlaw also maintains
insurance-related deposits on behalf of AMR.
F-29
American Medical Response, Inc. & EmCare Holdings
Inc.
(The Healthcare Transportation and Emergency Management
Services
Businesses of Laidlaw International, Inc.)
Notes to Combined Financial
Statements — (Continued)
The Company transfers surplus funds to Laidlaw as necessary and,
as described above, bears the cost of various allocated
expenses. The Company’s operating results, cash flows and
financial position may significantly differ from those that
would have been achieved in the absence of the Company’s
relationship with Laidlaw.
Insurance reserves are established for automobile, workers
compensation, general liability and professional liability
claims utilizing policies with both fully-insured and
self-insured components. This includes the use of an off-shore
captive insurance program through a wholly-owned subsidiary for
certain professional liability (malpractice) programs for
EmCare. In those instances where the Company has obtained
third-party insurance coverage, either directly through an
independent outside party or through participation in a Laidlaw
administered program, the Company normally retains liability for
the first $1 to $2 million of the loss. Insurance reserves
cover known claims and incidents within the level of Company
retention that may result in the assertion of additional claims,
as well as claims from unknown incidents that may be asserted
arising from activities through January 31, 2005.
The Company establishes reserves for claims based upon an
assessment of actual claims and claims incurred but not
reported. The reserves are established based on consultation
with third-party independent actuaries using actuarial
principles and assumptions that consider a number of factors,
including historical claim payment patterns (including legal
costs) and changes in case reserves and the assumed rate of
inflation in health care costs and property damage repairs. All
claims arising and not settled before June 1, 2003 were
recorded at estimated fair value as of the fresh-start date.
Claims, other than auto and general liability claims, that arose
after June 1, 2003 are discounted at a rate commensurate
with the interest rate on monetary assets that essentially are
risk free and have a maturity comparable to the underlying
liabilities. Auto and general liability claims that arose after
June 1, 2003 are not discounted. The table below summarizes
the non-health and welfare insurance reserves included in the
accompanying combined balance sheets.
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Accrued | |
|
Other Long-Term | |
|
Total | |
January 31, 2005 |
|
Liabilities | |
|
Liabilities | |
|
Liabilities | |
|
|
| |
|
| |
|
| |
Automobile
|
|
$ |
4,054 |
|
|
$ |
10,558 |
|
|
$ |
14,612 |
|
Workers compensation
|
|
|
11,554 |
|
|
|
34,636 |
|
|
|
46,190 |
|
General/ Professional liability
|
|
|
25,675 |
|
|
|
97,905 |
|
|
|
123,580 |
|
|
|
|
|
|
|
|
|
|
|
|
|
$ |
41,283 |
|
|
$ |
143,099 |
|
|
$ |
184,382 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Accrued | |
|
Other Long-Term | |
|
Total | |
August 31, 2004 |
|
Liabilities | |
|
Liabilities | |
|
Liabilities | |
|
|
| |
|
| |
|
| |
Automobile
|
|
$ |
4,007 |
|
|
$ |
8,887 |
|
|
$ |
12,894 |
|
Workers compensation
|
|
|
10,903 |
|
|
|
32,406 |
|
|
|
43,309 |
|
General/ Professional liability
|
|
|
21,474 |
|
|
|
96,887 |
|
|
|
118,361 |
|
|
|
|
|
|
|
|
|
|
|
|
|
$ |
36,384 |
|
|
$ |
138,180 |
|
|
$ |
174,564 |
|
|
|
|
|
|
|
|
|
|
|
F-30
American Medical Response, Inc. & EmCare Holdings
Inc.
(The Healthcare Transportation and Emergency Management
Services
Businesses of Laidlaw International, Inc.)
Notes to Combined Financial
Statements — (Continued)
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Accrued | |
|
Other Long-term | |
|
Total | |
August 31, 2003 |
|
Liabilities | |
|
Liabilities | |
|
Liabilities | |
|
|
| |
|
| |
|
| |
Automobile
|
|
$ |
4,845 |
|
|
$ |
6,244 |
|
|
$ |
11,089 |
|
Workers compensation
|
|
|
10,152 |
|
|
|
23,870 |
|
|
|
34,022 |
|
General/ Professional liability
|
|
|
13,209 |
|
|
|
88,897 |
|
|
|
102,106 |
|
|
|
|
|
|
|
|
|
|
|
|
|
$ |
28,206 |
|
|
$ |
119,011 |
|
|
$ |
147,217 |
|
|
|
|
|
|
|
|
|
|
|
Certain insurance programs also require the Company to maintain
deposits with third-party insurers, trustees or with Laidlaw to
cover future claims costs and are included in other assets in
the combined balance sheets. Investments supporting insurance
programs are comprised principally of government securities and
investment grade securities and are presented as restricted
assets in the combined balance sheets. These investments are
designated as available-for-sale and reported at fair value.
Investment income/loss earned on these investments is reported
as a component of insurance expense in the combined statement of
operations. The following table summarizes these deposits and
restricted investments:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
January 31, | |
|
August 31, | |
|
August 31, | |
|
|
2005 | |
|
2004 | |
|
2003 | |
|
|
| |
|
| |
|
| |
Restricted cash and cash equivalents
|
|
$ |
9,846 |
|
|
$ |
5,691 |
|
|
$ |
939 |
|
Restricted marketable securities
|
|
|
2,473 |
|
|
|
6,756 |
|
|
|
201 |
|
Short-term deposits (included in other current assets)
|
|
|
8,044 |
|
|
|
9,889 |
|
|
|
14,997 |
|
Short-term deposits with Laidlaw (included in other current
assets)
|
|
|
11,541 |
|
|
|
5,700 |
|
|
|
— |
|
Restricted long-term investments
|
|
|
41,810 |
|
|
|
47,285 |
|
|
|
40,608 |
|
Long-term deposits (included in other long-term assets)
|
|
|
20,006 |
|
|
|
23,708 |
|
|
|
28,626 |
|
Long-term deposits with Laidlaw (included in other long-term
assets)
|
|
|
29,413 |
|
|
|
22,733 |
|
|
|
— |
|
|
|
|
|
|
|
|
|
|
|
Total insurance deposits
|
|
$ |
123,133 |
|
|
$ |
121,762 |
|
|
$ |
85,371 |
|
|
|
|
|
|
|
|
|
|
|
Provisions for insurance expense included in the combined
statement of operations includes annual provisions determined in
consultation with Company actuaries, premiums paid to
third-party insurers net of retrospective policy adjustments,
interest accretion and earnings/loss on investments. Fiscal 2004
expense was reduced by a $3.8 million experience refund
received during the year.
F-31
American Medical Response, Inc. & EmCare Holdings
Inc.
(The Healthcare Transportation and Emergency Management
Services
Businesses of Laidlaw International, Inc.)
Notes to Combined Financial
Statements — (Continued)
|
|
13. |
Supplemental Cash Flow Information |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Predecessor | |
|
|
|
|
Restated | |
|
|
|
|
| |
|
|
Five Months | |
|
Year | |
|
Three Months | |
|
|
Nine Months | |
|
Year | |
|
|
Ended | |
|
Ended | |
|
Ended | |
|
|
Ended | |
|
Ended | |
|
|
January 31, | |
|
August 31, | |
|
August 31, | |
|
|
May 31, | |
|
August 31, | |
|
|
2005 | |
|
2004 | |
|
2003 | |
|
|
2003 | |
|
2002 | |
|
|
| |
|
| |
|
| |
|
|
| |
|
| |
Cash paid during the period for interest
|
|
$ |
488 |
|
|
$ |
556 |
|
|
$ |
436 |
|
|
|
$ |
1,605 |
|
|
$ |
1,278 |
|
Finance and investing activities not requiring the use of cash:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Dividend to Laidlaw
|
|
|
— |
|
|
|
200,000 |
|
|
|
— |
|
|
|
|
— |
|
|
|
— |
|
|
Acquisition of equipment through capital leases
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
|
— |
|
|
|
26,320 |
|
|
Reduction of deferred tax asset valuation allowance through:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Reduction of ambulance service contracts and other intangibles
|
|
|
— |
|
|
|
124,977 |
|
|
|
— |
|
|
|
|
— |
|
|
|
— |
|
|
|
Reduction of associated deferred tax asset
|
|
|
— |
|
|
|
(27,606 |
) |
|
|
— |
|
|
|
|
— |
|
|
|
— |
|
|
|
Laidlaw equity
|
|
$ |
— |
|
|
$ |
10,406 |
|
|
$ |
— |
|
|
|
$ |
— |
|
|
$ |
— |
|
The Company is organized around two separately managed business
units: healthcare transportation services and emergency
management services, which have been identified as operating
segments. The healthcare transportation services reportable
segment focuses on providing a full range of medical
transportation services from basic patient transit to the most
advanced emergency care and pre-hospital assistance. The
emergency management services reportable segment provides
outsourced business services to hospitals primarily for
emergency departments, urgent care centers and for certain
inpatient departments. The Chief Executive Officer has been
identified as the chief operating decision maker (CODM) for
purposes of SFAS No. 131 “Disclosures about
Segments of an Enterprise and Related Information”
(SFAS 131), as he assesses the performance of the business
units and decides how to allocate resources to the business
units. Pre-tax income from continuing operations before
interest, taxes and depreciation and amortization (“Segment
EBITDA”) is the measure of profit and loss that the CODM
uses to assess performance and make decisions. Pre-tax income
from continuing operations represents net revenue less direct
operating expenses incurred
F-32
American Medical Response, Inc. & EmCare Holdings
Inc.
(The Healthcare Transportation and Emergency Management
Services
Businesses of Laidlaw International, Inc.)
Notes to Combined Financial
Statements — (Continued)
within the operating segments. The accounting policies for
reported segments are the same as for the Company as a whole
(see note 2).
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Predecessor Company — | |
|
|
|
|
|
|
|
|
|
Restated | |
|
|
|
|
|
|
|
|
|
| |
|
|
Five Months | |
|
Year | |
|
Three Months | |
|
|
Nine Months | |
|
Year | |
|
|
Ended | |
|
Ended | |
|
Ended | |
|
|
Ended | |
|
Ended | |
|
|
January 31, | |
|
August 31, | |
|
August 31, | |
|
|
May 31, | |
|
August 31, | |
|
|
2005 | |
|
2004 | |
|
2003 | |
|
|
2003 | |
|
2002 | |
|
|
| |
|
| |
|
| |
|
|
| |
|
| |
Healthcare Transportation Services
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Revenue
|
|
$ |
455,059 |
|
|
$ |
1,054,800 |
|
|
$ |
255,807 |
|
|
|
$ |
751,344 |
|
|
$ |
984,451 |
|
Segment EBITDA
|
|
|
33,859 |
|
|
|
85,557 |
|
|
|
7,941 |
|
|
|
|
48,026 |
|
|
|
(189,624 |
)(1) |
Total identifiable assets
|
|
|
645,441 |
|
|
|
628,635 |
|
|
|
605,268 |
|
|
|
|
638,495 |
(2) |
|
|
894,943 |
|
Capital expenditures
|
|
|
12,054 |
|
|
|
38,573 |
|
|
|
17,581 |
|
|
|
|
30,888 |
|
|
|
26,670 |
|
Emergency Management Services
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Revenue
|
|
|
241,120 |
|
|
|
549,798 |
|
|
|
128,654 |
|
|
|
|
351,991 |
|
|
|
431,335 |
|
Segment EBITDA
|
|
|
5,639 |
|
|
|
37,156 |
|
|
|
7,217 |
|
|
|
|
18,248 |
|
|
|
16,847 |
|
Total identifiable assets
|
|
|
338,069 |
|
|
|
320,964 |
|
|
|
309,478 |
|
|
|
|
303,136 |
(2) |
|
|
163,132 |
|
Capital expenditures
|
|
|
1,991 |
|
|
|
4,214 |
|
|
|
498 |
|
|
|
|
3,880 |
|
|
|
4,448 |
|
Total
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Total revenue
|
|
|
696,179 |
|
|
|
1,604,598 |
|
|
|
384,461 |
|
|
|
|
1,103,335 |
|
|
|
1,415,786 |
|
Total segment EBITDA
|
|
|
39,498 |
|
|
|
122,713 |
|
|
|
15,158 |
|
|
|
|
66,274 |
|
|
|
(172,777 |
) |
Total identifiable assets
|
|
|
983,510 |
|
|
|
949,599 |
|
|
|
914,746 |
|
|
|
|
941,631 |
(2) |
|
|
1,058,075 |
|
Total capital expenditures
|
|
|
14,045 |
|
|
|
42,787 |
|
|
|
18,079 |
|
|
|
|
34,768 |
|
|
|
31,118 |
|
Reconciliation of EBITDA to Net Income (Loss)
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
EBITDA
|
|
|
39,498 |
|
|
|
122,713 |
|
|
|
15,158 |
|
|
|
|
66,274 |
|
|
|
(172,777 |
)(1) |
Depreciation and amortization expense
|
|
|
(18,808 |
) |
|
|
(52,739 |
) |
|
|
(12,560 |
) |
|
|
|
(32,144 |
) |
|
|
(67,183 |
) |
Interest expense
|
|
|
(5,644 |
) |
|
|
(9,961 |
) |
|
|
(908 |
) |
|
|
|
(4,691 |
) |
|
|
(6,418 |
) |
Realized gain (loss) on investments
|
|
|
— |
|
|
|
(1,140 |
) |
|
|
90 |
|
|
|
|
— |
|
|
|
— |
|
Interest and other income
|
|
|
714 |
|
|
|
240 |
|
|
|
22 |
|
|
|
|
304 |
|
|
|
369 |
|
Fresh-start accounting adjustments
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
|
46,416 |
|
|
|
— |
|
Income tax expense
|
|
|
(6,278 |
) |
|
|
(21,764 |
) |
|
|
(8,633 |
) |
|
|
|
(829 |
) |
|
|
(1,374 |
) |
Cumulative effect of a change in accounting principle
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
|
(223,721 |
) |
|
|
— |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Net income (loss)
|
|
$ |
9,482 |
|
|
$ |
37,349 |
|
|
$ |
(6,831 |
) |
|
|
$ |
(148,391 |
) |
|
$ |
(247,383 |
) |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
(1) |
Includes an impairment loss of $262,780. |
|
(2) |
Total assets of the Company at June 1, 2003 after fair
value adjustments. |
F-33
American Medical Response, Inc. & EmCare Holdings
Inc.
(The Healthcare Transportation and Emergency Management
Services
Businesses of Laidlaw International, Inc.)
Notes to Combined Financial
Statements — (Continued)
|
|
15. |
Valuation and Qualifying Accounts |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Total | |
|
Valuation | |
|
|
|
|
Allowance for | |
|
Allowance for | |
|
Accounts | |
|
Allowance for | |
|
|
|
|
Contractual | |
|
Uncompensated | |
|
Receivable | |
|
Deferred Tax | |
|
|
|
|
Discounts | |
|
Care | |
|
Allowances | |
|
Assets | |
|
Total | |
|
|
| |
|
| |
|
| |
|
| |
|
| |
Balance at August 31, 2001 (Predecessor) —
restated
|
|
$ |
242,172 |
|
|
$ |
423,562 |
|
|
$ |
665,734 |
|
|
$ |
309,275 |
|
|
$ |
975,009 |
|
|
Additions
|
|
|
858,590 |
|
|
|
521,277 |
|
|
|
1,379,867 |
|
|
|
6,383 |
|
|
|
1,386,250 |
|
|
Reductions
|
|
|
(850,862 |
) |
|
|
(532,030 |
) |
|
|
(1,382,892 |
) |
|
|
(4,964 |
) |
|
|
(1,387,856 |
) |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Balance at August 31, 2002 (Predecessor) —
restated
|
|
|
249,900 |
|
|
|
412,809 |
|
|
|
662,709 |
|
|
|
310,694 |
|
|
|
973,403 |
|
|
Additions
|
|
|
795,809 |
|
|
|
428,578 |
|
|
|
1,224,387 |
|
|
|
3,200 |
|
|
|
1,227,587 |
|
|
Reductions
|
|
|
(786,770 |
) |
|
|
(377,363 |
) |
|
|
(1,164,133 |
) |
|
|
(157,942 |
) |
|
|
(1,322,075 |
) |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Balance at May 31, 2003 (Predecessor) — restated
|
|
$ |
258,939 |
|
|
$ |
464,024 |
|
|
$ |
722,963 |
|
|
$ |
155,952 |
|
|
$ |
878,915 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Fresh-start balance at June 1, 2003 — restated
|
|
$ |
258,939 |
|
|
$ |
464,024 |
|
|
$ |
722,963 |
|
|
$ |
155,952 |
|
|
$ |
878,915 |
|
|
Additions
|
|
|
289,329 |
|
|
|
161,100 |
|
|
|
450,429 |
|
|
|
— |
|
|
|
450,429 |
|
|
Reductions
|
|
|
(289,500 |
) |
|
|
(137,533 |
) |
|
|
(427,033 |
) |
|
|
— |
|
|
|
(427,033 |
) |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Balance at August 31, 2003 — restated
|
|
|
258,768 |
|
|
|
487,591 |
|
|
|
746,359 |
|
|
|
155,952 |
|
|
|
902,311 |
|
|
Additions
|
|
|
1,361,708 |
|
|
|
666,116 |
|
|
|
2,027,824 |
|
|
|
— |
|
|
|
2,027,824 |
|
|
Reductions
|
|
|
(1,349,005 |
) |
|
|
(542,429 |
) |
|
|
(1,891,434 |
) |
|
|
(155,952 |
) |
|
|
(2,047,386 |
) |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Balance at August 31, 2004 — restated
|
|
|
271,471 |
|
|
|
611,278 |
|
|
|
882,749 |
|
|
|
— |
|
|
|
882,749 |
|
|
Additions
|
|
|
632,959 |
|
|
|
312,310 |
|
|
|
945,269 |
|
|
|
— |
|
|
|
945,269 |
|
|
Reductions
|
|
|
(589,568 |
) |
|
|
(242,284 |
) |
|
|
(831,852 |
) |
|
|
— |
|
|
|
(831,852 |
) |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Balance at January 31, 2005
|
|
$ |
314,862 |
|
|
$ |
681,304 |
|
|
$ |
996,166 |
|
|
$ |
— |
|
|
$ |
996,166 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
16. |
Prior Period Results (unaudited) |
We have included below an unaudited combined statement of
operations and comprehensive income for the five months ended
January 31, 2004 and an unaudited combined statement of
cash flows for the five months ended January 31, 2004 for
comparison purposes only to the audited statements included
herein.
|
|
|
|
|
|
|
Five Months | |
|
|
Ended | |
|
|
January 31, | |
|
|
2004 | |
|
|
| |
|
|
(unaudited) | |
Combined Statement of Operations |
Net revenue
|
|
$ |
667,506 |
|
|
|
|
|
Compensation and benefits
|
|
|
461,923 |
|
Operating expenses
|
|
|
90,828 |
|
Insurance expense
|
|
|
40,393 |
|
Selling, general and administrative expenses
|
|
|
22,016 |
|
F-34
American Medical Response, Inc. & EmCare Holdings
Inc.
(The Healthcare Transportation and Emergency Management
Services
Businesses of Laidlaw International, Inc.)
Notes to Combined Financial
Statements — (Continued)
|
|
|
|
|
|
|
|
|
|
Five Months | |
|
|
Ended | |
|
|
January 31, | |
|
|
2004 | |
|
|
| |
|
|
(unaudited) | |
Laidlaw fees and compensation charges
|
|
|
6,436 |
|
Depreciation and amortization expense
|
|
|
22,079 |
|
|
|
|
|
Income from operations
|
|
|
23,831 |
|
Interest expense
|
|
|
(4,137 |
) |
Interest and other income
|
|
|
1,403 |
|
|
|
|
|
Income before income taxes
|
|
|
21,097 |
|
Income tax expense
|
|
|
(8,558 |
) |
|
|
|
|
Net income
|
|
$ |
12,539 |
|
|
|
|
|
Combined Statement of Cash Flows |
Cash Flows from Operating Activities
|
|
|
|
|
Net income
|
|
$ |
12,539 |
|
Adjustments to reconcile net income to net cash provided by
operating activities:
|
|
|
|
|
|
Depreciation and amortization
|
|
|
22,079 |
|
|
Loss on disposal of property, plant and equipment
|
|
|
309 |
|
|
Gain on restricted investments
|
|
|
52 |
|
|
Deferred income taxes
|
|
|
9,020 |
|
|
Changes in operating assets/liabilities:
|
|
|
|
|
|
|
Trade and other accounts receivable
|
|
|
(33,822 |
) |
|
|
Other current assets
|
|
|
5,123 |
|
|
|
Accounts payable and accrued liabilities
|
|
|
2,183 |
|
|
|
|
|
|
|
|
Net cash provided by operating activities
|
|
|
17,483 |
|
|
|
|
|
Cash Flows from Investing Activities
|
|
|
|
|
Purchase of property, plant and equipment
|
|
|
(14,225 |
) |
Proceeds from sale of property, plant and equipment
|
|
|
83 |
|
Purchase of restricted cash and investments
|
|
|
(9,585 |
) |
Proceeds from sale of restricted investments
|
|
|
14,107 |
|
Net change in deposits and other assets
|
|
|
(2,147 |
) |
|
|
|
|
|
|
|
Net cash used in investing activities
|
|
|
(11,767 |
) |
|
|
|
|
Cash Flows from Financing Activities
|
|
|
|
|
Repayments of capital lease obligations and other debt
|
|
|
(3,784 |
) |
Increase in bank overdrafts
|
|
|
(3,216 |
) |
Payments made to Laidlaw
|
|
|
(184 |
) |
Increase in other non-current liabilities
|
|
|
1,683 |
|
|
|
|
|
|
|
|
Net cash used in financing activities
|
|
|
(5,501 |
) |
|
|
|
|
Increase in cash and cash equivalents
|
|
|
215 |
|
Cash and cash equivalents, beginning of period
|
|
|
10,641 |
|
|
|
|
|
Cash and cash equivalents, end of period
|
|
$ |
10,856 |
|
|
|
|
|
F-35
American Medical Response, Inc. & EmCare Holdings
Inc.
(The Healthcare Transportation and Emergency Management
Services
Businesses of Laidlaw International, Inc.)
Notes to Combined Financial
Statements — (Continued)
Emergency Medical Services L.P. financed the acquisition of AMR
and EmCare, described in note 18 in part by issuing
$250.0 million principal amount of senior subordinated
notes and borrowing $370.2 million under its senior secured
credit facility. Its wholly-owned subsidiaries, AMR HoldCo, Inc.
and EmCare HoldCo, Inc., are the issuers of the senior
subordinated notes and the borrowers under the senior secured
credit facility. As part of the transaction, AMR and its
subsidiaries became wholly-owned subsidiaries of AMR HoldCo,
Inc. and EmCare and its subsidiaries became wholly-owned
subsidiaries of EmCare HoldCo, Inc. The senior subordinated
notes and the senior secured credit facility include a full,
unconditional and joint and several guarantee by all of the
Company’s subsidiaries other than its captive insurance
subsidiary. All of the operating income and cash flow of EMS
L.P., AMR HoldCo, Inc. and EmCare HoldCo, Inc. is generated by
AMR, EmCare and their subsidiaries. As a result, funds necessary
to meet the debt service obligations under the senior secured
notes and senior secured credit facility described above are
provided by the distributions or advances from the subsidiary
companies, AMR and EmCare. Investments in subsidiary operating
companies are accounted for on the equity method. Accordingly,
entries necessary to consolidate the parent company, AMR HoldCo,
Inc., EmCare HoldCo, Inc. and all of their subsidiaries are
reflected in the Eliminations/ Adjustments column. Separate
complete financial statements of the issuers and subsidiary
guarantors would not provide additional material information
that would be useful in assessing the financial composition of
the issuers or the subsidiary guarantors. The condensed
combining financial statements for the parent company, the
issuers, the guarantors and the non-guarantor are as follows:
F-36
Combining Balance Sheet
As of January 31, 2005
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Issuer |
|
Issuer |
|
|
|
Subsidiary | |
|
|
|
|
|
|
|
|
AMR |
|
EmCare |
|
Subsidiary | |
|
Non- | |
|
Eliminations/ | |
|
|
|
|
Parent Co. |
|
HoldCo, Inc. |
|
HoldCo, Inc. |
|
Guarantors | |
|
guarantor | |
|
Adjustments | |
|
Total | |
|
|
|
|
|
|
|
|
| |
|
| |
|
| |
|
| |
Assets |
Current assets:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Cash and cash equivalents
|
|
$ |
— |
|
|
$ |
— |
|
|
$ |
— |
|
|
$ |
4,778 |
|
|
$ |
9,853 |
|
|
$ |
— |
|
|
$ |
14,631 |
|
|
Restricted cash and cash equivalents
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
9,846 |
|
|
|
— |
|
|
|
9,846 |
|
|
Restricted marketable securities
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
2,473 |
|
|
|
— |
|
|
|
2,473 |
|
|
Trade and other accounts receivable, net
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
359,945 |
|
|
|
43,339 |
|
|
|
(33,517 |
) |
|
|
369,767 |
|
|
Parts and supplies inventory
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
18,499 |
|
|
|
— |
|
|
|
— |
|
|
|
18,499 |
|
|
Other current assets
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
81,818 |
|
|
|
6,097 |
|
|
|
(47,780 |
) |
|
|
40,135 |
|
|
Current deferred tax assets
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
62,433 |
|
|
|
2,659 |
|
|
|
— |
|
|
|
65,092 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Current assets
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
527,473 |
|
|
|
74,267 |
|
|
|
(81,297 |
) |
|
|
520,443 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Non-current assets:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Property, plant, and equipment, net
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
128,766 |
|
|
|
— |
|
|
|
— |
|
|
|
128,766 |
|
|
Intangible assets, net
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
16,075 |
|
|
|
— |
|
|
|
— |
|
|
|
16,075 |
|
|
Non-current deferred tax assets
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
203,391 |
|
|
|
(922 |
) |
|
|
— |
|
|
|
202,469 |
|
|
Restricted long-term investments
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
41,810 |
|
|
|
— |
|
|
|
41,810 |
|
|
Goodwill
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
Other long-term assets
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
73,947 |
|
|
|
— |
|
|
|
— |
|
|
|
73,947 |
|
|
Investment and advances in subsidiaries
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
6,404 |
|
|
|
— |
|
|
|
(6,404 |
) |
|
|
— |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Assets
|
|
$ |
— |
|
|
$ |
— |
|
|
$ |
— |
|
|
$ |
956,056 |
|
|
$ |
115,155 |
|
|
$ |
(87,701 |
) |
|
$ |
983,510 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Liabilities and Equity |
Current liabilities:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Accounts payable
|
|
$ |
— |
|
|
$ |
— |
|
|
$ |
— |
|
|
$ |
82,167 |
|
|
$ |
5,186 |
|
|
$ |
(31,535 |
) |
|
$ |
55,818 |
|
|
Accrued liabilities
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
147,291 |
|
|
|
24,354 |
|
|
|
— |
|
|
|
171,645 |
|
|
Current portion of long-term debt
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
5,846 |
|
|
|
— |
|
|
|
— |
|
|
|
5,846 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Current liabilities
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
235,304 |
|
|
|
29,540 |
|
|
|
(31,535 |
) |
|
|
233,309 |
|
Long-term debt
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
5,651 |
|
|
|
— |
|
|
|
— |
|
|
|
5,651 |
|
Other long-term liabilities
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
116,824 |
|
|
|
79,211 |
|
|
|
(49,762 |
) |
|
|
146,273 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Liabilities
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
357,779 |
|
|
|
108,751 |
|
|
|
(81,297 |
) |
|
|
385,233 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Laidlaw payable
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
202,042 |
|
|
|
— |
|
|
|
— |
|
|
|
202,042 |
|
Laidlaw investment
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
356,550 |
|
|
|
— |
|
|
|
— |
|
|
|
356,550 |
|
Common stock
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
30 |
|
|
|
(30 |
) |
|
|
— |
|
Additional paid-in capital
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
5,054 |
|
|
|
(5,054 |
) |
|
|
— |
|
Retained earnings
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
40,000 |
|
|
|
1,635 |
|
|
|
(1,635 |
) |
|
|
40,000 |
|
Comprehensive income (loss)
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
(315 |
) |
|
|
(315 |
) |
|
|
315 |
|
|
|
(315 |
) |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Equity
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
598,277 |
|
|
|
6,404 |
|
|
|
(6,404 |
) |
|
|
598,277 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Liabilities and Equity
|
|
$ |
— |
|
|
$ |
— |
|
|
$ |
— |
|
|
$ |
956,056 |
|
|
$ |
115,155 |
|
|
$ |
(87,701 |
) |
|
$ |
983,510 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
F-37
Combining Balance Sheet
As of August 31, 2004
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Issuer |
|
Issuer |
|
|
|
Subsidiary | |
|
|
|
|
|
|
|
|
AMR |
|
EmCare |
|
Subsidiary | |
|
Non- | |
|
Eliminations/ | |
|
|
|
|
Parent Co. |
|
HoldCo, Inc. |
|
HoldCo, Inc. |
|
Guarantors | |
|
guarantor | |
|
Adjustments | |
|
Total | |
|
|
|
|
|
|
|
|
| |
|
| |
|
| |
|
| |
Assets |
Current assets:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Cash and cash equivalents
|
|
$ |
— |
|
|
$ |
— |
|
|
$ |
— |
|
|
$ |
9,436 |
|
|
$ |
40 |
|
|
$ |
— |
|
|
$ |
9,476 |
|
|
Restricted cash and cash equivalents
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
5,691 |
|
|
|
— |
|
|
|
5,691 |
|
|
Restricted marketable securities
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
6,756 |
|
|
|
— |
|
|
|
6,756 |
|
|
Trade and other accounts receivable, net
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
339,896 |
|
|
|
17,321 |
|
|
|
(13,007 |
) |
|
|
344,210 |
|
|
Parts and supplies inventory
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
18,577 |
|
|
|
— |
|
|
|
— |
|
|
|
18,577 |
|
|
Other current assets
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
45,254 |
|
|
|
1,820 |
|
|
|
(15,059 |
) |
|
|
32,015 |
|
|
Current deferred tax assets
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
50,322 |
|
|
|
2,659 |
|
|
|
— |
|
|
|
52,981 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Current assets
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
463,485 |
|
|
|
34,287 |
|
|
|
(28,066 |
) |
|
|
469,706 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Non-current assets:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Property, plant, and equipment, net
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
132,685 |
|
|
|
— |
|
|
|
— |
|
|
|
132,685 |
|
|
Intangible assets, net
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
15,758 |
|
|
|
— |
|
|
|
— |
|
|
|
15,758 |
|
|
Non-current deferred tax assets
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
215,520 |
|
|
|
(1,131 |
) |
|
|
— |
|
|
|
214,389 |
|
|
Restricted long-term investments
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
47,285 |
|
|
|
— |
|
|
|
47,285 |
|
|
Other long-term assets
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
69,776 |
|
|
|
— |
|
|
|
— |
|
|
|
69,776 |
|
|
Investment and advances in subsidiaries
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
6,694 |
|
|
|
— |
|
|
|
(6,694 |
) |
|
|
— |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Assets
|
|
$ |
— |
|
|
$ |
— |
|
|
$ |
— |
|
|
$ |
903,918 |
|
|
$ |
80,441 |
|
|
$ |
(34,760 |
) |
|
$ |
949,599 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Liabilities and Equity |
Current liabilities:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Accounts payable
|
|
$ |
— |
|
|
$ |
— |
|
|
$ |
— |
|
|
$ |
59,631 |
|
|
$ |
1,129 |
|
|
$ |
(9,845 |
) |
|
$ |
50,915 |
|
|
Accrued liabilities
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
146,722 |
|
|
|
20,062 |
|
|
|
— |
|
|
|
166,784 |
|
|
Current portion of long-term debt
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
7,565 |
|
|
|
— |
|
|
|
— |
|
|
|
7,565 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Current liabilities
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
213,918 |
|
|
|
21,191 |
|
|
|
(9,845 |
) |
|
|
225,264 |
|
Long-term debt
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
7,915 |
|
|
|
— |
|
|
|
— |
|
|
|
7,915 |
|
Other long-term liabilities
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
108,245 |
|
|
|
52,556 |
|
|
|
(18,221 |
) |
|
|
142,580 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Liabilities
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
330,078 |
|
|
|
73,747 |
|
|
|
(28,066 |
) |
|
|
375,759 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Laidlaw payable
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
186,778 |
|
|
|
— |
|
|
|
— |
|
|
|
186,778 |
|
Laidlaw investment
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
356,550 |
|
|
|
— |
|
|
|
— |
|
|
|
356,550 |
|
Common stock
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
30 |
|
|
|
(30 |
) |
|
|
— |
|
Additional paid-in capital
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
5,035 |
|
|
|
(5,035 |
) |
|
|
— |
|
Retained earnings
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
30,518 |
|
|
|
1,635 |
|
|
|
(1,635 |
) |
|
|
30,518 |
|
Comprehensive income (loss)
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
(6 |
) |
|
|
(6 |
) |
|
|
6 |
|
|
|
(6 |
) |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Equity
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
573,840 |
|
|
|
6,694 |
|
|
|
(6,694 |
) |
|
|
573,840 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Liabilities and Equity
|
|
$ |
— |
|
|
$ |
— |
|
|
$ |
— |
|
|
$ |
903,918 |
|
|
$ |
80,441 |
|
|
$ |
(34,760 |
) |
|
$ |
949,599 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
F-38
Combining Balance Sheet
As of August 31, 2003
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Issuer |
|
Issuer |
|
|
|
Subsidiary | |
|
|
|
|
|
|
|
|
AMR |
|
EmCare |
|
Subsidiary | |
|
Non- | |
|
Eliminations/ | |
|
|
|
|
Parent Co. |
|
HoldCo, Inc. |
|
HoldCo, Inc. |
|
Guarantors | |
|
Guarantor | |
|
Adjustments | |
|
Total | |
|
|
|
|
|
|
|
|
| |
|
| |
|
| |
|
| |
Assets
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Current assets:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Cash and cash equivalents
|
|
$ |
— |
|
|
$ |
— |
|
|
$ |
— |
|
|
$ |
10,604 |
|
|
$ |
37 |
|
|
$ |
— |
|
|
$ |
10,641 |
|
|
Restricted cash and cash equivalents
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
939 |
|
|
|
— |
|
|
|
939 |
|
|
Restricted marketable securities
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
201 |
|
|
|
— |
|
|
|
201 |
|
|
Trade and other accounts receivable, net
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
316,395 |
|
|
|
4,057 |
|
|
|
|
|
|
|
320,452 |
|
|
Parts and supplies inventory
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
17,444 |
|
|
|
— |
|
|
|
— |
|
|
|
17,444 |
|
|
Other current assets
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
40,259 |
|
|
|
5,059 |
|
|
|
(13,111 |
) |
|
|
32,207 |
|
|
Current deferred tax assets
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
55,921 |
|
|
|
2,915 |
|
|
|
— |
|
|
|
58,836 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Current assets
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
440,623 |
|
|
|
13,208 |
|
|
|
(13,111 |
) |
|
|
440,720 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Non-current assets:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Property, plant, and equipment, net
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
133,546 |
|
|
|
— |
|
|
|
— |
|
|
|
133,546 |
|
|
Intangible assets, net
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
148,205 |
|
|
|
— |
|
|
|
— |
|
|
|
148,205 |
|
|
Non-current deferred tax assets
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
96,596 |
|
|
|
— |
|
|
|
— |
|
|
|
96,596 |
|
|
Restricted long-term investments
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
40,608 |
|
|
|
— |
|
|
|
40,608 |
|
|
Other long-term assets
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
55,071 |
|
|
|
— |
|
|
|
— |
|
|
|
55,071 |
|
|
Investment and advances in subsidiaries
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
3,859 |
|
|
|
— |
|
|
|
(3,859 |
) |
|
|
— |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Assets
|
|
$ |
— |
|
|
$ |
— |
|
|
$ |
— |
|
|
$ |
877,900 |
|
|
$ |
53,816 |
|
|
$ |
(16,790 |
) |
|
$ |
914,746 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Liabilities and Equity
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Current liabilities:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Accounts payable
|
|
$ |
— |
|
|
$ |
— |
|
|
$ |
— |
|
|
$ |
50,148 |
|
|
$ |
34 |
|
|
$ |
— |
|
|
$ |
50,182 |
|
|
Accrued liabilities
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
146,772 |
|
|
|
9,529 |
|
|
|
(10,122 |
) |
|
|
146,179 |
|
|
Current portion of long-term debt
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
8,270 |
|
|
|
— |
|
|
|
— |
|
|
|
8,270 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Current liabilities
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
205,190 |
|
|
|
9,563 |
|
|
|
(10,122 |
) |
|
|
204,631 |
|
Long-term debt
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
15,787 |
|
|
|
— |
|
|
|
— |
|
|
|
15,787 |
|
Other long-term liabilities
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
96,384 |
|
|
|
40,394 |
|
|
|
(2,989 |
) |
|
|
133,789 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Liabilities
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
317,361 |
|
|
|
49,957 |
|
|
|
(13,111 |
) |
|
|
354,207 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Laidlaw payable
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
22,416 |
|
|
|
— |
|
|
|
— |
|
|
|
22,416 |
|
Laidlaw investment
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
546,144 |
|
|
|
— |
|
|
|
— |
|
|
|
546,144 |
|
Additional paid-in capital
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
5,049 |
|
|
|
(5,049 |
) |
|
|
— |
|
Retained earnings
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
(6,831 |
) |
|
|
— |
|
|
|
— |
|
|
|
(6,831 |
) |
Comprehensive income (loss)
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
(1,190 |
) |
|
|
(1,190 |
) |
|
|
1,190 |
|
|
|
(1,190 |
) |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Equity
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
560,539 |
|
|
|
3,859 |
|
|
|
(3,859 |
) |
|
|
560,539 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Liabilities and Equity
|
|
$ |
— |
|
|
$ |
— |
|
|
$ |
— |
|
|
$ |
877,900 |
|
|
$ |
53,816 |
|
|
$ |
(16,970 |
) |
|
$ |
914,746 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
F-39
Combining Statement of Operations
For the Five Months Ended January 31, 2005
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Issuer |
|
Issuer |
|
|
|
Subsidiary | |
|
|
|
|
|
|
|
|
AMR |
|
EmCare |
|
Subsidiary | |
|
Non- | |
|
Eliminations/ | |
|
|
|
|
Parent Co. |
|
HoldCo, Inc. |
|
HoldCo, Inc. |
|
Guarantors | |
|
Guarantor | |
|
Adjustments | |
|
Total | |
|
|
|
|
|
|
|
|
| |
|
| |
|
| |
|
| |
Net revenue
|
|
$ |
— |
|
|
$ |
— |
|
|
$ |
— |
|
|
$ |
696,179 |
|
|
$ |
15,913 |
|
|
$ |
(15,913 |
) |
|
$ |
696,179 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Compensation and benefits
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
481,305 |
|
|
|
— |
|
|
|
— |
|
|
|
481,305 |
|
Operating expenses
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
94,882 |
|
|
|
— |
|
|
|
— |
|
|
|
94,882 |
|
Insurance expense
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
39,002 |
|
|
|
15,913 |
|
|
|
(15,913 |
) |
|
|
39,002 |
|
Selling, general and administrative expenses
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
21,635 |
|
|
|
— |
|
|
|
— |
|
|
|
21,635 |
|
Laidlaw fees and compensation charges
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
19,857 |
|
|
|
— |
|
|
|
— |
|
|
|
19,857 |
|
Depreciation and amortization expense
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
18,808 |
|
|
|
— |
|
|
|
— |
|
|
|
18,808 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Income from operations
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
20,690 |
|
|
|
— |
|
|
|
— |
|
|
|
20,690 |
|
Interest expense
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
(5,644 |
) |
|
|
— |
|
|
|
— |
|
|
|
(5,644 |
) |
Interest and other income
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
714 |
|
|
|
— |
|
|
|
— |
|
|
|
714 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Income before income taxes
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
15,760 |
|
|
|
— |
|
|
|
— |
|
|
|
15,760 |
|
Income tax expense
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
(6,278 |
) |
|
|
— |
|
|
|
— |
|
|
|
(6,278 |
) |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Net income
|
|
$ |
— |
|
|
$ |
— |
|
|
$ |
— |
|
|
$ |
9,482 |
|
|
$ |
— |
|
|
$ |
— |
|
|
$ |
9,482 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Combining Statement of Operations
For the Year Ended August 31, 2004
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Issuer |
|
Issuer |
|
|
|
Subsidiary | |
|
|
|
|
|
|
|
|
AMR |
|
EmCare |
|
Subsidiary | |
|
Non- | |
|
Eliminations/ | |
|
|
|
|
Parent Co. |
|
HoldCo, Inc. |
|
HoldCo, Inc. |
|
Guarantors | |
|
Guarantor | |
|
Adjustments | |
|
Total | |
|
|
|
|
|
|
|
|
| |
|
| |
|
| |
|
| |
Net revenue
|
|
$ |
— |
|
|
$ |
— |
|
|
$ |
— |
|
|
$ |
1,604,598 |
|
|
$ |
29,803 |
|
|
$ |
(29,803 |
) |
|
$ |
1,604,598 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Compensation and benefits
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
1,117,890 |
|
|
|
— |
|
|
|
— |
|
|
|
1,117,890 |
|
Operating expenses
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
218,277 |
|
|
|
— |
|
|
|
— |
|
|
|
218,277 |
|
Insurance expense
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
81,395 |
|
|
|
28,663 |
|
|
|
(29,803 |
) |
|
|
80,255 |
|
Selling, general and administrative expenses
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
47,899 |
|
|
|
— |
|
|
|
— |
|
|
|
47,899 |
|
Laidlaw fees and compensation charges
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
15,449 |
|
|
|
— |
|
|
|
— |
|
|
|
15,449 |
|
Depreciation and amortization expense
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
52,739 |
|
|
|
— |
|
|
|
|
|
|
|
52,739 |
|
Restructuring charges
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
2,115 |
|
|
|
— |
|
|
|
— |
|
|
|
2,115 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Income from operations
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
68,834 |
|
|
|
1,140 |
|
|
|
— |
|
|
|
69,974 |
|
Interest expense
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
(9,961 |
) |
|
|
— |
|
|
|
— |
|
|
|
(9,961 |
) |
Realized loss on investments
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
(1,140 |
) |
|
|
— |
|
|
|
(1,140 |
) |
Interest and other income
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
240 |
|
|
|
— |
|
|
|
— |
|
|
|
240 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Income before income taxes
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
59,113 |
|
|
|
— |
|
|
|
— |
|
|
|
59,113 |
|
Income tax expense
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
(23,399 |
) |
|
|
1,635 |
|
|
|
— |
|
|
|
(21,764 |
) |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Income before equity in earnings of subsidiary
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
35,714 |
|
|
|
1,635 |
|
|
|
— |
|
|
|
37,349 |
|
Equity in earnings of subsidiary
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
1,635 |
|
|
|
— |
|
|
|
(1,635 |
) |
|
|
— |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Net income
|
|
$ |
— |
|
|
$ |
— |
|
|
$ |
— |
|
|
$ |
37,349 |
|
|
$ |
1,635 |
|
|
$ |
(1,635 |
) |
|
$ |
37,349 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
F-40
Combining Statement of Operations
For the Three Months Ended August 31, 2003
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Issuer |
|
Issuer |
|
|
|
Subsidiary | |
|
|
|
|
|
|
|
|
AMR |
|
EmCare |
|
Subsidiary | |
|
Non- | |
|
Eliminations/ | |
|
|
|
|
Parent Co. |
|
HoldCo, Inc. |
|
HoldCo, Inc. |
|
Guarantors | |
|
Guarantor | |
|
Adjustments | |
|
Total | |
|
|
|
|
|
|
|
|
| |
|
| |
|
| |
|
| |
Net revenue
|
|
$ |
— |
|
|
$ |
— |
|
|
$ |
— |
|
|
$ |
384,461 |
|
|
$ |
9,807 |
|
|
$ |
(9,807 |
) |
|
$ |
384,461 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Compensation and benefits
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
264,604 |
|
|
|
— |
|
|
|
— |
|
|
|
264,604 |
|
Operating expenses
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
55,212 |
|
|
|
— |
|
|
|
— |
|
|
|
55,212 |
|
Insurance expense
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
36,239 |
|
|
|
8,239 |
|
|
|
(9,807 |
) |
|
|
34,671 |
|
Selling, general and administrative expenses
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
12,017 |
|
|
|
— |
|
|
|
— |
|
|
|
12,017 |
|
Laidlaw fees and compensation charges
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
1,350 |
|
|
|
— |
|
|
|
— |
|
|
|
1,350 |
|
Depreciation and amortization expense
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
12,560 |
|
|
|
— |
|
|
|
|
|
|
|
12,560 |
|
Restructuring charges
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
1,449 |
|
|
|
— |
|
|
|
— |
|
|
|
1,449 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Income from operations
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
1,030 |
|
|
|
1,568 |
|
|
|
— |
|
|
|
2,598 |
|
Interest expense
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
(908 |
) |
|
|
— |
|
|
|
— |
|
|
|
(908 |
) |
Realized gain on investments
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
90 |
|
|
|
— |
|
|
|
90 |
|
Interest and other income
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
22 |
|
|
|
— |
|
|
|
— |
|
|
|
22 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Income before income taxes
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
144 |
|
|
|
1,658 |
|
|
|
— |
|
|
|
1,802 |
|
Income tax expense
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
(8,053 |
) |
|
|
(580 |
) |
|
|
— |
|
|
|
(8,633 |
) |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Income (loss) before equity in earnings of subsidiary
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
(7,909 |
) |
|
|
1,078 |
|
|
|
— |
|
|
|
(5,382 |
) |
Equity in earnings of subsidiary
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
1,078 |
|
|
|
— |
|
|
|
(1,078 |
) |
|
|
— |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Net income (loss)
|
|
$ |
— |
|
|
$ |
— |
|
|
$ |
— |
|
|
$ |
(6,831 |
) |
|
$ |
1,078 |
|
|
$ |
(1,078 |
) |
|
$ |
(6,831 |
) |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Predecessor Company
Combining Statement of Operations
For the Nine Months Ended May 31, 2003
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Issuer |
|
Issuer |
|
|
|
|
|
|
|
|
|
|
|
|
AMR |
|
EmCare |
|
Subsidiary | |
|
Subsidiary | |
|
Eliminations/ | |
|
|
|
|
Parent Co. |
|
HoldCo, Inc. |
|
HoldCo, Inc. |
|
Guarantors | |
|
Non-guarantor | |
|
Adjustments | |
|
Total | |
|
|
|
|
|
|
|
|
| |
|
| |
|
| |
|
| |
Net revenue
|
|
$ |
— |
|
|
$ |
— |
|
|
$ |
— |
|
|
$ |
1,103,335 |
|
|
$ |
16,640 |
|
|
$ |
(16,640 |
) |
|
$ |
1,103,335 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Compensation and benefits
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
757,183 |
|
|
|
— |
|
|
|
— |
|
|
|
757,183 |
|
Operating expenses
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
163,447 |
|
|
|
— |
|
|
|
— |
|
|
|
163,447 |
|
Insurance expense
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
69,576 |
|
|
|
16,640 |
|
|
|
(16,640 |
) |
|
|
69,576 |
|
Selling, general and administrative expenses
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
37,867 |
|
|
|
— |
|
|
|
— |
|
|
|
37,867 |
|
Laidlaw fees and compensation charges
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
4,050 |
|
|
|
— |
|
|
|
— |
|
|
|
4,050 |
|
Depreciation and amortization expense
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
32,144 |
|
|
|
— |
|
|
|
|
|
|
|
32,144 |
|
Restructuring charges
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
1,288 |
|
|
|
— |
|
|
|
— |
|
|
|
1,288 |
|
Laidlaw reorganization costs
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
3,650 |
|
|
|
— |
|
|
|
— |
|
|
|
3,650 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Income from operations
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
34,130 |
|
|
|
— |
|
|
|
— |
|
|
|
34,130 |
|
Interest expense
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
(4,691 |
) |
|
|
— |
|
|
|
— |
|
|
|
(4,691 |
) |
Interest and other income
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
304 |
|
|
|
— |
|
|
|
— |
|
|
|
304 |
|
Fresh-start accounting adjustments
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
46,416 |
|
|
|
— |
|
|
|
— |
|
|
|
46,416 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Income before income taxes and cumulative effect of a change in
accounting principle
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
76,159 |
|
|
|
— |
|
|
|
— |
|
|
|
76,159 |
|
Income tax expense
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
(829 |
) |
|
|
— |
|
|
|
— |
|
|
|
(829 |
) |
|
Cumulative effect of a change in accounting principle
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
(223,721 |
) |
|
|
— |
|
|
|
— |
|
|
|
(223,721 |
) |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Net loss
|
|
$ |
— |
|
|
$ |
— |
|
|
$ |
— |
|
|
$ |
(148,391 |
) |
|
$ |
— |
|
|
$ |
— |
|
|
$ |
(148,391 |
) |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
F-41
Predecessor Company
Combining Statement of Operations
For the Year Ended August 31, 2002
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Issuer |
|
Issuer |
|
|
|
|
|
|
|
|
|
|
|
|
AMR |
|
EmCare |
|
Subsidiary | |
|
Subsidiary | |
|
Eliminations/ | |
|
|
|
|
Parent Co. |
|
HoldCo, Inc. |
|
HoldCo, Inc. |
|
Guarantors | |
|
Non-guarantor | |
|
Adjustments | |
|
Total | |
|
|
|
|
|
|
|
|
| |
|
| |
|
| |
|
| |
Net revenue
|
|
$ |
— |
|
|
$ |
— |
|
|
$ |
— |
|
|
$ |
1,415,786 |
|
|
$ |
12,004 |
|
|
$ |
(12,004 |
) |
|
$ |
1,415,786 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Compensation and benefits
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
960,590 |
|
|
|
— |
|
|
|
— |
|
|
|
960,590 |
|
Operating expenses
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
219,321 |
|
|
|
— |
|
|
|
— |
|
|
|
219,321 |
|
Insurance expense
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
66,479 |
|
|
|
12,004 |
|
|
|
(12,004 |
) |
|
|
66,479 |
|
Selling, general and administrative expenses
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
61,455 |
|
|
|
— |
|
|
|
— |
|
|
|
61,455 |
|
Laidlaw fees and compensation charges
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
5,400 |
|
|
|
— |
|
|
|
— |
|
|
|
5,400 |
|
Depreciation and amortization expense
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
67,183 |
|
|
|
— |
|
|
|
|
|
|
|
67,183 |
|
Impairment losses
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
262,780 |
|
|
|
— |
|
|
|
— |
|
|
|
262,780 |
|
Restructuring charges
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
3,777 |
|
|
|
— |
|
|
|
— |
|
|
|
3,777 |
|
Laidlaw reorganization costs
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
8,761 |
|
|
|
— |
|
|
|
— |
|
|
|
8,761 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Loss from operations
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
(239,960 |
) |
|
|
— |
|
|
|
— |
|
|
|
(239,960 |
) |
Interest expense
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
(6,418 |
) |
|
|
— |
|
|
|
— |
|
|
|
(6,418 |
) |
Interest and other income
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
369 |
|
|
|
— |
|
|
|
— |
|
|
|
369 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Loss before income taxes
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
(246,009 |
) |
|
|
— |
|
|
|
— |
|
|
|
(246,009 |
) |
Income tax expense
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
(1,374 |
) |
|
|
— |
|
|
|
— |
|
|
|
(1,374 |
) |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Net loss
|
|
$ |
— |
|
|
$ |
— |
|
|
$ |
— |
|
|
$ |
(247,383 |
) |
|
$ |
— |
|
|
$ |
— |
|
|
$ |
(247,383 |
) |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
F-42
Condensed Combining Statement of Cash Flows
For the Five Months ended January 31, 2005
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Issuer |
|
Issuer |
|
|
|
|
|
|
|
|
|
|
AMR |
|
EmCare |
|
Subsidiary | |
|
Subsidiary | |
|
|
|
|
Parent Co. |
|
HoldCo, Inc. |
|
HoldCo, Inc. |
|
Guarantors | |
|
Non-guarantors | |
|
Total | |
|
|
|
|
|
|
|
|
| |
|
| |
|
| |
Cash Flows from Operating Activities
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Net cash provided by operating activities
|
|
$ |
— |
|
|
$ |
— |
|
|
$ |
— |
|
|
$ |
10,856 |
|
|
$ |
5,110 |
|
|
$ |
15,966 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Cash Flows from Investing Activities
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Purchase of property, plant and equipment
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
(14,045 |
) |
|
|
— |
|
|
|
(14,045 |
) |
Purchase of business
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
(1,200 |
) |
|
|
— |
|
|
|
(1,200 |
) |
Proceeds from sale of business
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
1,300 |
|
|
|
— |
|
|
|
1,300 |
|
Proceeds from sale of property, plant and equipment
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
175 |
|
|
|
— |
|
|
|
175 |
|
Purchase of restricted cash and investments
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
(31,257 |
) |
|
|
(31,257 |
) |
Proceeds from sale and maturity of restricted investments
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
35,960 |
|
|
|
35,960 |
|
Other investing activities
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
(79 |
) |
|
|
— |
|
|
|
(79 |
) |
Increase in Laidlaw insurance deposits
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
(12,521 |
) |
|
|
— |
|
|
|
(12,521 |
) |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Net cash (used in) provided by investing activities
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
(26,370 |
) |
|
|
4,703 |
|
|
|
(21,667 |
) |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Cash Flows from Financing Activities
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Repayments of capital lease obligations and other debt
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
(3,992 |
) |
|
|
— |
|
|
|
(3,992 |
) |
Advances from Laidlaw
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
8,982 |
|
|
|
— |
|
|
|
8,982 |
|
Increase in bank overdrafts
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
5,866 |
|
|
|
— |
|
|
|
5,866 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Net cash provided by financing activities
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
10,856 |
|
|
|
— |
|
|
|
10,856 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Change in cash and cash equivalents
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
(4,658 |
) |
|
|
9,813 |
|
|
|
5,155 |
|
Cash and cash equivalents, beginning of period
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
9,436 |
|
|
|
40 |
|
|
|
9,476 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Cash and cash equivalents, end of period
|
|
$ |
— |
|
|
$ |
— |
|
|
$ |
— |
|
|
$ |
4,778 |
|
|
$ |
9,853 |
|
|
$ |
14,631 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
F-43
Condensed Combining Statement of Cash Flows
For the Year Ended August 31, 2004
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Issuer |
|
Issuer |
|
|
|
|
|
|
|
|
|
|
AMR |
|
EmCare |
|
Subsidiary | |
|
Subsidiary Non- | |
|
|
|
|
Parent Co. |
|
HoldCo, Inc. |
|
HoldCo, Inc. |
|
Guarantors | |
|
guarantors | |
|
Total | |
|
|
|
|
|
|
|
|
| |
|
| |
|
| |
Cash Flows from Operating Activities
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Net cash provided by operating activities
|
|
$ |
— |
|
|
$ |
— |
|
|
$ |
— |
|
|
$ |
109,708 |
|
|
$ |
17,971 |
|
|
$ |
127,679 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Cash Flows from Investing Activities
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Purchase of property, plant and equipment
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
(42,787 |
) |
|
|
— |
|
|
|
(42,787 |
) |
Proceeds from sale of property, plant and equipment
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
858 |
|
|
|
— |
|
|
|
858 |
|
Purchase of restricted cash and investments
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
(64,357 |
) |
|
|
(64,357 |
) |
Proceeds from sale and maturity of restricted investments
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
46,389 |
|
|
|
46,389 |
|
Other investing activities
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
6,814 |
|
|
|
— |
|
|
|
6,814 |
|
Increase in Laidlaw insurance deposits
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
(28,433 |
) |
|
|
— |
|
|
|
(28,433 |
) |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Net cash used in investing activities
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
(63,548 |
) |
|
|
(17,968 |
) |
|
|
(81,516 |
) |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Cash Flows from Financing Activities
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Repayments of capital lease obligations and other debt
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
(8,709 |
) |
|
|
— |
|
|
|
(8,709 |
) |
Payments to Laidlaw
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
(31,133 |
) |
|
|
— |
|
|
|
(31,133 |
) |
Decrease in bank overdrafts
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
(4,544 |
) |
|
|
— |
|
|
|
(4,544 |
) |
Decrease in other non-current liabilities
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
(2,942 |
) |
|
|
— |
|
|
|
(2,942 |
) |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Net cash used in financing activities
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
(47,328 |
) |
|
|
— |
|
|
|
(47,328 |
) |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Change in cash and cash equivalents
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
(1,168 |
) |
|
|
3 |
|
|
|
(1,165 |
) |
Cash and cash equivalents, beginning of period
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
10,604 |
|
|
|
37 |
|
|
|
10,641 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Cash and cash equivalents, end of period
|
|
$ |
— |
|
|
$ |
— |
|
|
$ |
— |
|
|
$ |
9,436 |
|
|
$ |
40 |
|
|
$ |
9,476 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
F-44
Condensed Combining Statement of Cash Flows
For the Three Months Ended August 31, 2003
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Issuer |
|
Issuer |
|
|
|
|
|
|
|
|
|
|
AMR |
|
EmCare |
|
Subsidiary | |
|
Subsidiary Non- | |
|
|
|
|
Parent Co. |
|
HoldCo, Inc. |
|
HoldCo, Inc. |
|
Guarantors | |
|
guarantors | |
|
Total | |
|
|
|
|
|
|
|
|
| |
|
| |
|
| |
Cash Flows from Operating Activities
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Net cash provided by (used in) operating activities
|
|
$ |
— |
|
|
$ |
— |
|
|
$ |
— |
|
|
$ |
31,268 |
|
|
$ |
(1,259 |
) |
|
$ |
30,009 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Cash Flows from Investing Activities
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Purchase of property, plant and equipment
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
(18,079 |
) |
|
|
— |
|
|
|
(18,079 |
) |
Proceeds from sale of property, plant and equipment
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
341 |
|
|
|
— |
|
|
|
341 |
|
Purchase of restricted cash and investments
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
(11,287 |
) |
|
|
(11,287 |
) |
Proceeds from sale and maturity of restricted investments
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
12,530 |
|
|
|
12,530 |
|
Other investing activities
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
1,359 |
|
|
|
— |
|
|
|
1,359 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Net cash (used in) provided by investing activities
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
(16,379 |
) |
|
|
1,243 |
|
|
|
(15,136 |
) |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Cash Flows from Financing Activities
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Repayments of capital lease obligations and other debt
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
(1,851 |
) |
|
|
— |
|
|
|
(1,851 |
) |
Payments to Laidlaw
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
(55,609 |
) |
|
|
— |
|
|
|
(55,609 |
) |
Increase in bank overdrafts
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
8,675 |
|
|
|
— |
|
|
|
8,675 |
|
Increase in other non-current liabilities
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
1,563 |
|
|
|
— |
|
|
|
1,563 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Net cash used in financing activities
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
(47,222 |
) |
|
|
— |
|
|
|
(47,222 |
) |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Change in cash and cash equivalents
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
(32,333 |
) |
|
|
(16 |
) |
|
|
(32,349 |
) |
Cash and cash equivalents, beginning of period
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
42,937 |
|
|
|
53 |
|
|
|
42,990 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Cash and cash equivalents, end of period
|
|
$ |
— |
|
|
$ |
— |
|
|
$ |
— |
|
|
$ |
10,604 |
|
|
$ |
37 |
|
|
$ |
10,641 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
F-45
Predecessor Company
Condensed Combining Statement of Cash Flows
For the Nine Months Ended May 31, 2003
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Issuer |
|
Issuer |
|
|
|
Subsidiary | |
|
|
|
|
|
|
|
|
AMR |
|
EmCare |
|
Subsidiary | |
|
Non- | |
|
Eliminations/ | |
|
|
|
|
Parent Co. |
|
HoldCo, Inc. |
|
HoldCo, Inc. |
|
Guarantors | |
|
guarantors | |
|
Adjustments | |
|
Total | |
|
|
|
|
|
|
|
|
| |
|
| |
|
| |
|
| |
Cash Flows from Operating Activities
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Net cash provided by operating activities
|
|
$ |
— |
|
|
$ |
— |
|
|
$ |
— |
|
|
$ |
34,398 |
|
|
$ |
24,371 |
|
|
$ |
— |
|
|
$ |
58,769 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Cash Flows from Investing Activities
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Purchase of property, plant and equipment
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
(34,768 |
) |
|
|
— |
|
|
|
— |
|
|
|
(34,768 |
) |
Proceeds from sale of property, plant and equipment
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
624 |
|
|
|
— |
|
|
|
— |
|
|
|
624 |
|
Capital contribution
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
(2,721 |
) |
|
|
— |
|
|
|
2,721 |
|
|
|
— |
|
Purchase of restricted cash and investments
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
(2,400 |
) |
|
|
(63,866 |
) |
|
|
— |
|
|
|
(66,266 |
) |
Proceeds from sale and maturity of restricted investments
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
36,748 |
|
|
|
— |
|
|
|
36,748 |
|
Other investing activities
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
(35,173 |
) |
|
|
— |
|
|
|
— |
|
|
|
(35,173 |
) |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Net cash used in investing activities
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
(74,438 |
) |
|
|
(27,118 |
) |
|
|
2,721 |
|
|
|
(98,835 |
) |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Cash Flows from Financing Activities
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Repayments of capital lease obligations and other debt
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
(6,338 |
) |
|
|
— |
|
|
|
— |
|
|
|
(6,338 |
) |
Payments to Laidlaw
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
(3,141 |
) |
|
|
— |
|
|
|
— |
|
|
|
(3,141 |
) |
Decrease in bank overdrafts
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
(815 |
) |
|
|
— |
|
|
|
— |
|
|
|
(815 |
) |
Capital contribution
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
2,721 |
|
|
|
(2,721 |
) |
|
|
— |
|
Increase in other non-current liabilities
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
2,234 |
|
|
|
— |
|
|
|
— |
|
|
|
2,234 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Net cash used in financing activities
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
(8,060 |
) |
|
|
2,721 |
|
|
|
(2,721 |
) |
|
|
(8,060 |
) |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Change in cash and cash equivalents
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
(48,100 |
) |
|
|
(26 |
) |
|
|
— |
|
|
|
(48,126 |
) |
Cash and cash equivalents, beginning of period
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
91,037 |
|
|
|
79 |
|
|
|
— |
|
|
|
91,116 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Cash and cash equivalents, end of period
|
|
$ |
— |
|
|
$ |
— |
|
|
$ |
— |
|
|
$ |
42,937 |
|
|
$ |
53 |
|
|
$ |
— |
|
|
$ |
42,990 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
F-46
Predecessor Company
Condensed Combining Statement of Cash Flows
For the Year Ended August 31, 2002
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Issuer |
|
Issuer |
|
|
|
Subsidiary | |
|
|
|
|
|
|
|
|
AMR |
|
EmCare |
|
Subsidiary | |
|
Non- | |
|
Eliminations/ | |
|
|
|
|
Parent Co. |
|
HoldCo, Inc. |
|
HoldCo, Inc. |
|
Guarantors | |
|
guarantors | |
|
Adjustments | |
|
Total | |
|
|
|
|
|
|
|
|
| |
|
| |
|
| |
|
| |
Cash Flows from Operating Activities
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Net cash provided by operating activities
|
|
$ |
— |
|
|
$ |
— |
|
|
$ |
— |
|
|
$ |
140,296 |
|
|
$ |
16,248 |
|
|
$ |
— |
|
|
$ |
156,544 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Cash Flows from Investing Activities
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Purchase of property, plant and equipment
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
(31,118 |
) |
|
|
— |
|
|
|
— |
|
|
|
(31,118 |
) |
Proceeds from sale of property, plant and equipment
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
2,549 |
|
|
|
— |
|
|
|
— |
|
|
|
2,549 |
|
Capital contribution
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
(1,150 |
) |
|
|
— |
|
|
|
1,150 |
|
|
|
— |
|
Purchase of restricted cash and investments
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
(1,412 |
) |
|
|
(49,534 |
) |
|
|
— |
|
|
|
(50,946 |
) |
Proceeds from sale and maturity of restricted investments
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
32,215 |
|
|
|
— |
|
|
|
32,215 |
|
Other investing activities
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
(10,047 |
) |
|
|
— |
|
|
|
— |
|
|
|
(10,047 |
) |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Net cash used in investing activities
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
(41,178 |
) |
|
|
(17,319 |
) |
|
|
1,150 |
|
|
|
(57,347 |
) |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Cash Flows from Financing Activities
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Repayments of capital lease obligations and other debt
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
(17,817 |
) |
|
|
— |
|
|
|
— |
|
|
|
(17,817 |
) |
Payments to Laidlaw
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
(16,729 |
) |
|
|
— |
|
|
|
— |
|
|
|
(16,729 |
) |
Decrease in bank overdrafts
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
(1,134 |
) |
|
|
— |
|
|
|
— |
|
|
|
(1,134 |
) |
Capital contributions
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
1,150 |
|
|
|
(1,150 |
) |
|
|
— |
|
Decrease in other non-current liabilities
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
(386 |
) |
|
|
— |
|
|
|
— |
|
|
|
(386 |
) |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Net cash used in financing activities
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
(36,066 |
) |
|
|
1,150 |
|
|
|
(1,150 |
) |
|
|
(36,066 |
) |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Change in cash and cash equivalents
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
63,052 |
|
|
|
79 |
|
|
|
— |
|
|
|
63,131 |
|
Cash and cash equivalents, beginning of period
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
27,985 |
|
|
|
— |
|
|
|
— |
|
|
|
27,985 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Cash and cash equivalents, end of period
|
|
$ |
— |
|
|
$ |
— |
|
|
$ |
— |
|
|
$ |
91,037 |
|
|
$ |
79 |
|
|
$ |
— |
|
|
$ |
91,116 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
On December 6, 2004, Laidlaw announced it had entered into
definitive agreements to sell 100% of the capital stock of AMR
and EmCare to Onex Partners LP, an affiliate of Onex
Corporation. Completion of the transaction occurred
February 10, 2005 with an effective date after the close of
business on January 31, 2005. Emergency Medical Services
L.P. was formed as the entity which ultimately acquired American
Medical Response, Inc. and EmCare Holdings Inc. from Laidlaw
International, Inc. The purchase price was $828.8 million,
subject to working capital and other purchase price adjustments.
F-47
Emergency Medical Services L.P.
Consolidated/Combined Financial Statements
June 30, 2005
F-48
Emergency Medical Services L.P.
Balance Sheets
(in thousands)
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Unaudited | |
|
|
Predecessor | |
|
|
Consolidated | |
|
|
Combined | |
|
|
June 30, | |
|
|
January 31, | |
|
|
2005 | |
|
|
2005 | |
|
|
| |
|
|
| |
ASSETS
|
|
|
|
|
|
|
|
|
|
Current assets:
|
|
|
|
|
|
|
|
|
|
|
Cash and cash equivalents
|
|
$ |
31,365 |
|
|
|
$ |
14,631 |
|
|
Restricted cash and cash equivalents
|
|
|
12,785 |
|
|
|
|
9,846 |
|
|
Restricted marketable securities
|
|
|
1,011 |
|
|
|
|
2,473 |
|
|
Trade and other accounts receivable, net
|
|
|
346,491 |
|
|
|
|
369,767 |
|
|
Parts and supplies inventory
|
|
|
18,404 |
|
|
|
|
18,499 |
|
|
Other current assets
|
|
|
34,684 |
|
|
|
|
40,135 |
|
|
Current deferred tax assets
|
|
|
19,774 |
|
|
|
|
65,092 |
|
|
|
|
|
|
|
|
|
|
|
Current assets
|
|
|
464,514 |
|
|
|
|
520,443 |
|
|
|
|
|
|
|
|
|
Non-current assets:
|
|
|
|
|
|
|
|
|
|
|
Property, plant, and equipment, net
|
|
|
130,061 |
|
|
|
|
128,766 |
|
|
Intangible assets, net
|
|
|
84,542 |
|
|
|
|
16,075 |
|
|
Non-current deferred tax assets
|
|
|
119,848 |
|
|
|
|
202,469 |
|
|
Restricted long-term investments
|
|
|
57,734 |
|
|
|
|
41,810 |
|
|
Goodwill
|
|
|
267,474 |
|
|
|
|
— |
|
|
Other long-term assets
|
|
|
99,379 |
|
|
|
|
73,947 |
|
|
|
|
|
|
|
|
|
|
|
|
Assets
|
|
$ |
1,223,552 |
|
|
|
$ |
983,510 |
|
|
|
|
|
|
|
|
|
|
|
LIABILITIES AND EQUITY
|
|
|
|
|
|
|
|
|
|
Current liabilities:
|
|
|
|
|
|
|
|
|
|
|
Accounts payable
|
|
$ |
47,906 |
|
|
|
$ |
55,818 |
|
|
Accrued liabilities
|
|
|
189,425 |
|
|
|
|
171,645 |
|
|
Current portion of long-term debt
|
|
|
9,204 |
|
|
|
|
5,846 |
|
|
|
|
|
|
|
|
|
|
|
Current liabilities
|
|
|
246,535 |
|
|
|
|
233,309 |
|
|
Long-term debt
|
|
|
596,720 |
|
|
|
|
5,651 |
|
|
Other long-term liabilities
|
|
|
149,437 |
|
|
|
|
146,273 |
|
|
|
|
|
|
|
|
|
|
|
|
Liabilities
|
|
|
992,692 |
|
|
|
|
385,233 |
|
|
|
|
|
|
|
|
|
Laidlaw payable
|
|
|
— |
|
|
|
|
202,042 |
|
Laidlaw investment
|
|
|
— |
|
|
|
|
356,550 |
|
Partnership equity
|
|
|
219,429 |
|
|
|
|
— |
|
Retained earnings
|
|
|
11,067 |
|
|
|
|
40,000 |
|
Comprehensive income (loss)
|
|
|
364 |
|
|
|
|
(315 |
) |
|
|
|
|
|
|
|
|
|
Equity
|
|
|
230,860 |
|
|
|
|
598,277 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Liabilities and equity
|
|
$ |
1,223,552 |
|
|
|
$ |
983,510 |
|
|
|
|
|
|
|
|
|
The accompanying notes are an integral part of these financial
statements.
F-49
Emergency Medical Services L.P.
Unaudited Statements of Operations and Comprehensive
Income
(in thousands, except per unit amounts)
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Consolidated | |
|
|
Combined | |
|
|
| |
|
|
| |
|
|
|
|
|
Predecessor | |
|
Predecessor | |
|
|
Five Months | |
|
Three Months | |
|
|
Five Months | |
|
Three Months | |
|
|
Ended | |
|
Ended | |
|
|
Ended | |
|
Ended | |
|
|
June 30, | |
|
June 30, | |
|
|
June 30, | |
|
June 30, | |
|
|
2005 | |
|
2005 | |
|
|
2004 | |
|
2004 | |
|
|
| |
|
| |
|
|
| |
|
| |
Net revenue
|
|
$ |
731,410 |
|
|
$ |
445,021 |
|
|
|
$ |
663,880 |
|
|
$ |
399,975 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Compensation and benefits
|
|
|
502,998 |
|
|
|
307,308 |
|
|
|
|
464,610 |
|
|
|
280,364 |
|
Operating expenses
|
|
|
102,170 |
|
|
|
63,250 |
|
|
|
|
91,661 |
|
|
|
53,490 |
|
Insurance expense
|
|
|
39,334 |
|
|
|
22,427 |
|
|
|
|
36,865 |
|
|
|
22,865 |
|
Selling, general and administrative expenses
|
|
|
23,179 |
|
|
|
14,498 |
|
|
|
|
19,269 |
|
|
|
12,805 |
|
Laidlaw fees and compensation charges
|
|
|
— |
|
|
|
— |
|
|
|
|
6,436 |
|
|
|
3,862 |
|
Depreciation and amortization expense
|
|
|
23,988 |
|
|
|
14,136 |
|
|
|
|
21,958 |
|
|
|
13,160 |
|
Restructuring charges
|
|
|
— |
|
|
|
— |
|
|
|
|
1,381 |
|
|
|
— |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Income from operations
|
|
|
39,741 |
|
|
|
23,402 |
|
|
|
|
21,700 |
|
|
|
13,429 |
|
Interest expense
|
|
|
(21,584 |
) |
|
|
(13,646 |
) |
|
|
|
(3,541 |
) |
|
|
(3,073 |
) |
Realized gain (loss) on investments
|
|
|
(6 |
) |
|
|
33 |
|
|
|
|
(52 |
) |
|
|
— |
|
Interest and other income
|
|
|
94 |
|
|
|
81 |
|
|
|
|
48 |
|
|
|
12 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Income before income taxes
|
|
|
18,245 |
|
|
|
9,870 |
|
|
|
|
18,155 |
|
|
|
10,368 |
|
Income tax expense
|
|
|
(7,178 |
) |
|
|
(3,821 |
) |
|
|
|
(7,831 |
) |
|
|
(4,794 |
) |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Net income
|
|
|
11,067 |
|
|
|
6,049 |
|
|
|
|
10,324 |
|
|
|
5,574 |
|
Other comprehensive income, net of tax Unrealized holding gains
(losses) during the period
|
|
|
364 |
|
|
|
636 |
|
|
|
|
(493 |
) |
|
|
(1,118 |
) |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Comprehensive income
|
|
$ |
11,431 |
|
|
$ |
6,685 |
|
|
|
$ |
9,831 |
|
|
$ |
4,456 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Net income per share—basic
|
|
$ |
|
|
|
$ |
|
|
|
|
|
|
|
|
|
|
|
Net income per share—diluted
|
|
$ |
|
|
|
$ |
|
|
|
|
|
|
|
|
|
|
|
Weighted average shares—basic
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Weighted average shares—diluted
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
The accompanying notes are an integral part of these financial
statements.
F-50
Emergency Medical Services L.P.
Unaudited Statements of Cash Flows
(in thousands)
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Combined | |
|
|
|
|
|
Predecessor | |
|
|
Consolidated | |
|
|
Five | |
|
|
Five Months | |
|
|
Months | |
|
|
Ended | |
|
|
Ended | |
|
|
June 30, | |
|
|
June 30, | |
|
|
2005 | |
|
|
2004 | |
|
|
| |
|
|
| |
Cash Flows from Operating Activities
|
|
|
|
|
|
|
|
|
|
Net income
|
|
$ |
11,067 |
|
|
|
$ |
10,324 |
|
Adjustments to reconcile net income to net cash provided by
operating activities:
|
|
|
|
|
|
|
|
|
|
|
Depreciation and amortization
|
|
|
24,991 |
|
|
|
|
21,958 |
|
|
Gain (loss) on disposal of property, plant and equipment
|
|
|
(400 |
) |
|
|
|
(208 |
) |
|
Deferred income taxes
|
|
|
(456 |
) |
|
|
|
7,831 |
|
|
Changes in operating assets/liabilities:
|
|
|
|
|
|
|
|
|
|
|
|
Trade and other accounts receivable
|
|
|
23,276 |
|
|
|
|
18,106 |
|
|
|
Other current assets
|
|
|
5,546 |
|
|
|
|
(789 |
) |
|
|
Accounts payable and accrued liabilities
|
|
|
30,679 |
|
|
|
|
24,047 |
|
|
|
|
|
|
|
|
|
|
|
|
Net cash provided by operating activities
|
|
|
94,703 |
|
|
|
|
81,269 |
|
|
|
|
|
|
|
|
|
Cash Flows from Investing Activities
|
|
|
|
|
|
|
|
|
|
EMS purchase of AMR and EmCare
|
|
|
(828,775 |
) |
|
|
|
— |
|
Purchase of property, plant and equipment
|
|
|
(20,052 |
) |
|
|
|
(17,387 |
) |
Proceeds from sale of property, plant and equipment
|
|
|
456 |
|
|
|
|
518 |
|
Purchase of restricted cash and investments
|
|
|
(27,103 |
) |
|
|
|
(43,535 |
) |
Proceeds from sale and maturity of restricted investments
|
|
|
10,066 |
|
|
|
|
30,595 |
|
Net change in deposits and other assets
|
|
|
(9,827 |
) |
|
|
|
5,688 |
|
|
|
|
|
|
|
|
|
|
|
|
Net cash used in investing activities
|
|
|
(875,235 |
) |
|
|
|
(24,121 |
) |
|
|
|
|
|
|
|
|
Cash Flows from Financing Activities
|
|
|
|
|
|
|
|
|
|
Borrowings under new senior secured credit facility
|
|
|
350,000 |
|
|
|
|
— |
|
Proceeds from issuance of senior subordinated notes
|
|
|
250,000 |
|
|
|
|
— |
|
Borrowings under new revolving credit facility
|
|
|
20,200 |
|
|
|
|
— |
|
Issuance of partnership equity
|
|
|
221,155 |
|
|
|
|
— |
|
Financing costs
|
|
|
(20,122 |
) |
|
|
|
— |
|
Repayments of capital lease obligations and other debt
|
|
|
(3,499 |
) |
|
|
|
(3,956 |
) |
Repayments of revolving credit facility
|
|
|
(20,200 |
) |
|
|
|
— |
|
Increase (decrease) in bank overdrafts
|
|
|
(2,091 |
) |
|
|
|
(353 |
) |
Payments made to Laidlaw
|
|
|
— |
|
|
|
|
(49,734 |
) |
Increase (decrease) in other non-current liabilities
|
|
|
1,823 |
|
|
|
|
— |
|
|
|
|
|
|
|
|
|
|
|
|
Net cash provided by (used in) financing activities
|
|
|
797,266 |
|
|
|
|
(54,043 |
) |
|
|
|
|
|
|
|
|
Increase in cash and cash equivalents
|
|
|
16,734 |
|
|
|
|
3,105 |
|
Cash and cash equivalents, beginning of period
|
|
|
14,631 |
|
|
|
|
10,856 |
|
|
|
|
|
|
|
|
|
Cash and cash equivalents, end of period
|
|
$ |
31,365 |
|
|
|
$ |
13,961 |
|
|
|
|
|
|
|
|
|
Cash paid for:
|
|
|
|
|
|
|
|
|
|
|
Interest
|
|
$ |
8,457 |
|
|
|
$ |
3,878 |
|
|
|
|
|
|
|
|
|
|
Taxes
|
|
$ |
4,709 |
|
|
|
$ |
— |
|
|
|
|
|
|
|
|
|
The accompanying notes are an integral part of these financial
statements.
F-51
Emergency Medical Services L.P.
Notes to Unaudited Financial Statements
(dollars in thousands)
Basis of Presentation of Financial Statements
The accompanying unaudited, interim consolidated financial
statements of Emergency Medical Services L.P. (“EMS”
or the “Company”) reflect all adjustments of a normal,
recurring nature that are, in the opinion of management,
necessary for a fair presentation of results for these interim
periods but do not include all of the information and note
disclosures required by accounting principles generally accepted
in the United States (“GAAP”) for complete financial
statements. The results of operations for the five months and
three months ended June 30, 2005 are not necessarily
indicative of the results that may be expected for the
eleven-month period ending December 31, 2005.
Emergency Medical Services L.P. acquired American Medical
Response, Inc. and EmCare Holdings Inc. from Laidlaw
International, Inc. on February 10, 2005 with an effective
transaction date after the close of business January 31,
2005. The purchase price was $828.8 million, subject to
working capital and other purchase adjustments. The Company
currently is completing its allocation of purchase price, but
goodwill associated with the transaction is expected to be
between approximately $265 and $275 million. To finance the
acquisition, we entered into a new $450 million senior
secured credit facility and issued senior subordinated notes for
gross proceeds of $250 million (see note 8). We also
issued approximately 22.1 million limited partnership units
for $221 million. For this reason, the financial statements
for periods prior to February 1, 2005
(“Predecessor”) may not be comparable to the financial
statements for periods from and including February 1, 2005
(“Successor”).
The following table summarizes the estimated fair value of the
assets acquired and liabilities assumed at the date of
acquisition. The Company is in the process of obtaining
third-party valuations of certain intangible assets acquired and
liabilities assumed, and is evaluating the carryover of tax
attributes from the Predecessor; accordingly, the allocation of
the purchase price is subject to adjustment.
|
|
|
|
|
|
Current assets
|
|
$ |
476,757 |
|
Property, plant & equipment
|
|
|
128,766 |
|
Intangible assets
|
|
|
89,850 |
|
Goodwill
|
|
|
267,474 |
|
Other long-term assets
|
|
|
253,740 |
|
|
|
|
|
|
Total assets acquired
|
|
|
1,216,587 |
|
|
|
|
|
Current liabilities
|
|
|
233,144 |
|
Long-term debt
|
|
|
620,183 |
|
Other long-term liabilities
|
|
|
144,381 |
|
|
|
|
|
|
Total liabilities assumed
|
|
|
997,708 |
|
|
|
|
|
|
Net assets acquired
|
|
$ |
218,879 |
|
|
|
|
|
Intangible assets include $0.6 million of radio frequency
licenses, $0.3 million of covenants not to compete and
$89.0 million for customer relationships. Covenants not to
compete and customer relationships are subject to amortization
and have a weighted average useful life of approximately
7 years.
The $267.5 million of goodwill currently has been
preliminarily assigned to AMR and EmCare in the amounts of
$122.9 million and $144.5 million, respectively, based
on the sales agreements and valuations, and is not subject to
amortization. EmCare goodwill is deductible for tax purposes.
Pro forma net revenue, income from operations and net income for
the five months ended June 30, 2004, when adjusted for the
acquisition described above, would be $663.9 million,
$20.4 million and $1.0 million, respectively.
F-52
Emergency Medical Services L.P.
Notes to Unaudited Financial
Statements — (Continued)
The Company is a party to a management agreement with a
wholly-owned subsidiary of Onex Corporation, its principal
equityholder. In exchange for an annual management fee of
$1.0 million, the Onex subsidiary provides us with
corporate finance and strategic planning consulting services.
For the five months ended June 30, 2005, we expensed
$0.4 million in fees pursuant to this agreement.
The Predecessor companies had a fiscal year ending
August 31. EMS adopted a fiscal year end of
December 31. Accordingly, the financial statements
presented herein include the five-month period beginning the
effective date of acquisition and ending June 30, 2005 and
the three-month period ending June 30, 2005.
The preparation of financial statements in conformity with GAAP
requires management to make certain estimates and assumptions
that affect the amounts reported in the consolidated and
combined financial statements and accompanying notes. Actual
results may differ from those estimates. Estimates are used for,
but not limited to, the establishment of, allowances for
contractual discounts and uncompensated care, reserves for
insurance related liabilities, taxes and contingencies.
|
|
2. |
Summary of Significant Accounting Policies |
Consolidation
The unaudited consolidated financial statements include all
wholly-owned subsidiaries of EMS, including American Medical
Response, Inc. (“AMR”) and EmCare Holdings Inc.
(“EmCare”) and their respective subsidiaries.
Intercompany transactions and balances have been eliminated.
Combination
The unaudited combined financial statements for the five months
and three months ended June 30, 2004 include the accounts
of AMR and EmCare (combined, the “Predecessor”). AMR
and EmCare were indirect, wholly-owned subsidiaries of Laidlaw
International, Inc. (“Laidlaw”). All significant
intracompany transactions have been eliminated.
Recent Accounting Pronouncements
In December 2004, the Financial Accounting Standards Board
(“FASB”) issued Statement No. 123 (revised
2004),“Share-Based Payment”. This Statement is
a revision of FASB Statement No. 123, “Accounting
for Stock-Based Compensation” and is effective as of
the beginning of the first interim or annual reporting period
that begins after June 15, 2005. The Statement requires
public companies to measure the cost of employee services
received in exchange for an award of equity instruments based on
the grant-date fair value of the award. The Company currently is
evaluating the impact that the adoption of this Statement will
have on its financial statements, including the alternative
transition methods.
|
|
3. |
Equity-based Compensation |
Under the Company’s Equity Option Plan approved in February
2005, key employees have been granted options to purchase
partnership units of the Company. The options allow the grantee
to purchase partnership units at $10 per unit (subject to
appropriate adjustment upon a recapitalization or similar
event). The grants vest ratably over a period of 4 years
and, in addition, certain performance measures must be met for
50% of each grant to become exercisable. The Company has adopted
FASB Statement No. 123, “Accounting for
Stock-Based Compensation”. This Statement requires
companies to measure the cost of employee services received in
exchange for an award of equity instruments based on the
grant-date fair value of the award. The Company recorded a
charge of $300 for the five months ended June 30, 2005
associated with the grant of these options.
The Black-Scholes option pricing model was used to estimate fair
values as of the date of grant using 0% volatility, risk free
interest rates ranging from 3.95% to 4.20%, 0% dividend yield
and expected terms of 3.5 and 5 years.
The Company granted 2,289,979 options from the inception of
the plan through June 30, 2005.
F-53
Emergency Medical Services L.P.
Notes to Unaudited Financial
Statements — (Continued)
Accrued liabilities were as follows at June 30, 2005 and
January 31, 2005:
|
|
|
|
|
|
|
|
|
|
|
|
Successor | |
|
|
Predecessor | |
|
|
June 30, | |
|
|
January 31, | |
|
|
2005 | |
|
|
2005 | |
|
|
| |
|
|
| |
Accrued wages and benefits
|
|
$ |
56,864 |
|
|
|
$ |
53,231 |
|
Accrued paid time off
|
|
|
22,409 |
|
|
|
|
20,141 |
|
Current portion of self-insurance reserve
|
|
|
43,856 |
|
|
|
|
41,283 |
|
Accrued restructuring
|
|
|
475 |
|
|
|
|
1,118 |
|
Current portion of compliance and legal
|
|
|
2,282 |
|
|
|
|
3,607 |
|
Accrued billing and collection fees
|
|
|
3,794 |
|
|
|
|
3,522 |
|
Accrued incentive compensation
|
|
|
15,796 |
|
|
|
|
23,802 |
|
Accrued interest
|
|
|
12,124 |
|
|
|
|
— |
|
Other
|
|
|
31,825 |
|
|
|
|
24,941 |
|
|
|
|
|
|
|
|
|
Total accrued liabilities
|
|
$ |
189,425 |
|
|
|
$ |
171,645 |
|
|
|
|
|
|
|
|
|
|
|
5. |
Commitments and Contingencies |
Services
The Company is subject to the Medicare and Medicaid fraud and
abuse laws which prohibit, among other things, any false claims,
or any bribe, kick-back or rebate in return for the referral of
Medicare and Medicaid patients. Violation of these prohibitions
may result in civil and criminal penalties and exclusion from
participation in the Medicare and Medicaid programs. Management
has implemented policies and procedures that management believes
will assure that the Company is in substantial compliance with
these laws. From time to time, we receive requests for
information from government agencies pursuant to their
regulatory or investigational authority. Such requests can
include subpoenas or demand letters for documents to assist the
government in audits or investigations. The Company is
cooperating with the government agencies conducting these
investigations and is providing requested information to the
government agencies. Other than the investigations described
below, management believes that the outcome of any of these
investigations would not have a material adverse effect on the
Company.
During the first quarter of fiscal 2004, AMR was advised by the
U.S. Department of Justice that it was investigating
certain of AMR’s business practices. The specific practices
at issue are (1) whether ambulance transports involving
Medicare eligible patients complied with the “medically
necessary” requirement imposed by Medicare regulations,
(2) whether patient signatures, when required, were
properly obtained from Medicare eligible patients, and
(3) whether discounts in violation of the federal
Anti-Kickback Statute were provided by AMR in exchange for
referrals involving Medicare eligible patients. In connection
with the third issue, the government has alleged that certain of
our hospital and nursing home contracts in effect in Texas,
primarily certain contracts in effect in 1996 and 1997,
contained discounts in violation of the federal Anti-Kickback
Statute. The government recently has provided the Company with
an analysis of the investigation conducted in connection with
this contract issue, and invited the Company to respond. The
Company is considering the government’s analysis and
intends to provide its views, as requested. The government may
also be investigating whether AMR’s contracts with health
facilities in Oregon and other jurisdictions violate the
Anti-Kickback Statute. At this juncture, it is not possible to
predict the ultimate conclusion of these investigations, nor is
it possible to estimate possible financial exposure, if any, to
the Company.
F-54
Emergency Medical Services L.P.
Notes to Unaudited Financial
Statements — (Continued)
On May 9, 2002, AMR received a subpoena duces tecum from
the Office of Inspector General for the United States Department
of Health and Human Services (“HHS”). The subpoena
requested copies of documents for the period from January 1993
through May 2002. The subpoena required AMR to produce a broad
range of documents relating to Regional Emergency Services’
contracts in Texas, Georgia and Colorado. The claims in Texas
have been resolved. However, the government investigations in
Georgia and Colorado are continuing and it is not possible at
this time to estimate the financial exposure, if any, to the
Company.
EmCare has been named a defendant in a collective action lawsuit
brought by a number of nurse practitioners and physician
assistants under the federal Fair Labor Standards Act. The
plaintiffs are seeking to recover overtime pay for the hours
they worked in excess of 40 in a workweek and reclassification
as non-exempt employees. Certain of the plaintiffs brought a
related action under California state law. EmCare has entered
into a settlement of the California state law claims.
On July 12, 2005, the Company received a letter and draft
Audit Report from the Office of Inspector General for the United
States Department of Health and Human Services, or OIG,
requesting the Company’s response to its draft findings
that the Company’s Massachusetts subsidiary received
substantial overpayments from Medicare for services performed
between July 1, 2002 and December 31, 2002. The draft
findings state that some of these services did not meet Medicare
medical necessity and reimbursement requirements. The Company
disagrees with the OIG’s finding and is in the process of
responding to the draft Audit Report. If the Company is
unsuccessful in challenging the OIG’s draft findings, and
in any administrative appeals to which the Company may be
entitled following the release of a final Audit Report, the
Company may be required to make a substantial repayment.
Income Tax Matters
The respective tax authorities, in the normal course, audit
previous tax filings. It is not possible at this time to predict
the final outcome of these audits or establish a reasonable
estimate of possible additional taxes owing, if any.
In connection with the acquisition of AMR and EmCare, a
section 338(h)(10) election was made for EmCare which
eliminated $85 million of deferred tax assets and
stepped-up EmCare’s tax basis to fair value. Differences
between book and tax depreciation and amortization for these
assets will create future deferred tax assets.
AMR HoldCo, Inc. and EmCare HoldCo, Inc. are commonly owned by a
partnership, Emergency Medical Services L.P., and therefore
are required to file two separate consolidated tax returns. The
disclosed tax amounts relate to the corporate income taxes of
these two corporate consolidated groups combined.
Insurance reserves are established for automobile, workers
compensation, general liability and professional liability
claims utilizing policies with both fully-insured and
self-insured components. This includes use of an off-shore
captive insurance program through a wholly-owned subsidiary for
certain professional liability (malpractice) programs for
EmCare. In those instances where the Company has obtained
third-party insurance coverage, either directly through an
independent outside party or through participation in a
Laidlaw-administered program, the Company normally retains
liability for the first $1 to $2 million of the loss.
Insurance reserves cover known claims and incidents within the
level of Company retention that may result in the assertion of
additional claims, as well as claims from unknown incidents that
may be asserted arising from activities through the balance
sheet dates.
F-55
Emergency Medical Services L.P.
Notes to Unaudited Financial
Statements — (Continued)
The Company establishes reserves for claims based upon an
assessment of actual claims and claims incurred but not
reported. The reserves are established based on consultation
with third-party independent actuaries using actuarial
principles and assumptions that consider a number of factors,
including historical claim payment patterns (including legal
costs) and changes in case reserves and the assumed rate of
inflation in healthcare costs and property damage repairs.
Certain insurance programs also require the Company to maintain
deposits with third-party insurers, trustees or with Laidlaw to
cover future claims costs, and these deposits are included as
assets in the accompanying consolidated balance sheets.
Investments supporting insurance programs are comprised
principally of government securities and investment grade
securities and are presented as restricted assets in the
combined balance sheets. These investments are designated as
available-for-sale and reported at fair value. Investment
income/loss earned on these investments is reported as a
component of insurance expense in the consolidated/combined
statements of operations.
Operating segments are defined by SFAS No. 131,
Disclosures about Segments of an Enterprise and Related
Information, as components of an enterprise about which
separate financial information is available that is evaluated
regularly by the chief operating decision maker in deciding how
to allocate resources and in assessing performance. The
operating segments are managed separately because each operating
segment represents a strategic business unit providing
healthcare transportation services or emergency management
services.
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Predecessor | |
|
|
|
|
|
|
|
| |
|
|
Five | |
|
Three | |
|
|
Five | |
|
Three | |
|
|
Months | |
|
Months | |
|
|
Months | |
|
Months | |
|
|
Ended | |
|
Ended | |
|
|
Ended | |
|
Ended | |
|
|
June 30, | |
|
June 30, | |
|
|
June 30, | |
|
June 30, | |
|
|
2005 | |
|
2005 | |
|
|
2004 | |
|
2004 | |
|
|
| |
|
| |
|
|
| |
|
| |
Healthcare Transportation Services
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Net revenue
|
|
$ |
469,804 |
|
|
$ |
284,694 |
|
|
|
$ |
434,294 |
|
|
$ |
259,713 |
|
Segment EBITDA
|
|
|
45,244 |
|
|
|
25,440 |
|
|
|
|
32,903 |
|
|
|
19,676 |
|
Capital expenditures
|
|
|
18,344 |
|
|
|
8,506 |
|
|
|
|
15,838 |
|
|
|
9,891 |
|
Emergency Management Services
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Net revenue
|
|
|
261,606 |
|
|
|
160,327 |
|
|
|
|
229,586 |
|
|
|
140,262 |
|
Segment EBITDA
|
|
|
18,485 |
|
|
|
12,098 |
|
|
|
|
10,755 |
|
|
|
6,913 |
|
Capital expenditures
|
|
|
1,708 |
|
|
|
790 |
|
|
|
|
1,553 |
|
|
|
1,230 |
|
Total
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Net revenue
|
|
|
731,410 |
|
|
|
445,021 |
|
|
|
|
663,880 |
|
|
|
399,975 |
|
Segment EBITDA
|
|
|
63,729 |
|
|
|
37,538 |
|
|
|
|
43,658 |
|
|
|
26,589 |
|
Capital expenditures
|
|
|
20,052 |
|
|
|
9,296 |
|
|
|
|
17,391 |
|
|
|
11,121 |
|
Reconciliation of EBITDA to Net Income
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
EBITDA
|
|
|
63,729 |
|
|
|
37,538 |
|
|
|
|
43,658 |
|
|
|
26,589 |
|
Depreciation and amortization expense
|
|
|
(23,988 |
) |
|
|
(14,136 |
) |
|
|
|
(21,958 |
) |
|
|
(13,160 |
) |
Interest expense
|
|
|
(21,584 |
) |
|
|
(13,646 |
) |
|
|
|
(3,541 |
) |
|
|
(3,073 |
) |
Realized gain (loss) on investments
|
|
|
(6 |
) |
|
|
33 |
|
|
|
|
(52 |
) |
|
|
— |
|
Interest and other income (loss)
|
|
|
94 |
|
|
|
81 |
|
|
|
|
48 |
|
|
|
12 |
|
Income tax expense
|
|
|
(7,178 |
) |
|
|
(3,821 |
) |
|
|
|
(7,831 |
) |
|
|
(4,794 |
) |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Net income
|
|
$ |
11,067 |
|
|
$ |
6,049 |
|
|
|
$ |
10,324 |
|
|
$ |
5,574 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
F-56
Emergency Medical Services L.P.
Notes to Unaudited Financial
Statements — (Continued)
On February 10, 2005, the Company issued $250 million
of senior subordinated unsecured notes and executed a
$450 million senior secured credit facility agreement.
The senior subordinated notes have a fixed interest rate of 10%,
payable semi-annually, and mature in February 2015.
The senior secured credit facility consists of a
$350 million senior secured term loan and a
$100 million revolving credit facility commitment, each
collateralized by a pledge of 100% of the capital stock of the
Company and its direct and indirect domestic subsidiaries and
65% of the capital stock of any direct foreign subsidiaries, and
a security interest in substantially all tangible and intangible
assets of EMS and its subsidiaries. The term loan matures in
February 2012 and requires quarterly principal payments of $875
commencing May 2005. The revolving credit facility, which is
limited by outstanding letter of credit obligations, requires
principal and interest to be paid at maturity in February 2011.
The revolving credit facility is also subject to an annual
commitment fee of 0.5% on unused commitments. Under the terms of
the agreement, the Company may select between various interest
rate arrangements based on LIBOR or the Prime Rate plus
additional basis points within a range of 2.0% to 3.0%,
determined by reference to a leverage ratio. At June 30,
2005, net of letters of credit outstanding of
$24.3 million, the maximum available under the revolving
credit facility was $75.7 million. No amounts were
outstanding under the revolving credit facility at June 30,
2005.
The senior secured credit facility agreement contains various
customary operating and financial covenants. The more
restrictive of these covenants limit the Company’s and its
subsidiaries ability to create liens on assets; make certain
investments, loans, guarantees or advances; incur additional
indebtedness or issue capital stock; engage in mergers,
acquisitions or consolidations; dispose of assets; pay
dividends, repurchase equity interests or make other restricted
payments; change the business conducted by the Company; engage
in transactions with affiliates; and repay certain indebtedness,
including the senior unsecured notes, or amend or otherwise
modify agreements governing the subordinated indebtedness. The
financial maintenance covenants establish a maximum leverage
ratio, a maximum senior leverage ratio, a minimum fixed charge
coverage ratio and an annual capital expenditure limit. The
Company is in compliance with its borrowing agreement covenants
as of June 30, 2005.
Following is a summary of the Company’s borrowings as of
the respective balance sheet dates:
|
|
|
|
|
|
|
|
|
|
|
|
Successor | |
|
|
Predecessor | |
|
|
June 30, | |
|
|
January 31, | |
|
|
2005 | |
|
|
2005 | |
|
|
| |
|
|
| |
Senior subordinated notes due 2015
|
|
$ |
250,000 |
|
|
|
$ |
— |
|
Senior secured term loan due 2012 (5.67% at June 30, 2005)
|
|
|
349,125 |
|
|
|
|
— |
|
Capital lease obligations
|
|
|
5,808 |
|
|
|
|
8,110 |
|
Notes due at various dates from 2005 to 2022 with interest rates
from 6% to 10%
|
|
|
991 |
|
|
|
|
3,387 |
|
|
|
|
|
|
|
|
|
Total long-term debt
|
|
|
605,924 |
|
|
|
|
11,497 |
|
Less current maturities
|
|
|
(9,204 |
) |
|
|
|
(5,846 |
) |
|
|
|
|
|
|
|
|
Long-term debt, less current maturities
|
|
$ |
596,720 |
|
|
|
$ |
5,651 |
|
|
|
|
|
|
|
|
|
F-57
Emergency Medical Services L.P.
Notes to Unaudited Financial
Statements — (Continued)
The aggregate maturities of debt are as follows:
|
|
|
|
|
Year ended June 30,
|
|
|
|
|
2006
|
|
$ |
9,204 |
|
2007
|
|
|
5,291 |
|
2008
|
|
|
2,638 |
|
2009
|
|
|
3,547 |
|
2010
|
|
|
3,688 |
|
Thereafter
|
|
|
581,556 |
|
|
|
|
|
|
|
$ |
605,924 |
|
|
|
|
|
Emergency Medical Services L.P. financed the acquisition of AMR
and EmCare in part by issuing $250.0 million principal
amount of senior subordinated notes and borrowing
$370.2 million under its senior secured credit facility.
Its wholly-owned subsidiaries, AMR HoldCo, Inc. and EmCare
HoldCo, Inc., are the issuers of the senior subordinated notes
and the borrowers under the senior secured credit facility. As
part of the transaction, AMR and its subsidiaries became
wholly-owned subsidiaries of AMR HoldCo, Inc. and EmCare and its
subsidiaries became wholly-owned subsidiaries of EmCare HoldCo,
Inc. The senior subordinated notes and the senior secured credit
facility include a full, unconditional and joint and several
guarantee by all of the Company’s subsidiaries other than
its captive insurance subsidiary. All of the operating income
and cash flow of EMS L.P., AMR HoldCo, Inc. and EmCare HoldCo,
Inc. is generated by AMR, EmCare and their subsidiaries. As a
result, funds necessary to meet the debt service obligations
under the senior secured notes and senior secured credit
facility described above are provided in large part by the
distributions or advances from the subsidiary companies, AMR and
EmCare. Investments in subsidiary operating companies are
accounted for on the equity method. Accordingly, entries
necessary to consolidate the parent company, AMR HoldCo, Inc.,
EmCare HoldCo, Inc. and all of their subsidiaries are reflected
in the Eliminations/Adjustments column. Separate complete
financial statements of the issuers and subsidiary guarantors
would not provide additional material information that would be
useful in assessing the financial composition of the issuers or
the subsidiary guarantors. The condensed combining financial
statements for the parent company, the issuers, the guarantors
and the non-guarantor are as follows:
F-58
Consolidating Balance Sheet
As of June 30, 2005
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Issuer | |
|
Issuer | |
|
|
|
|
|
|
|
|
|
|
|
|
AMR | |
|
EmCare | |
|
Subsidiary | |
|
Subsidiary | |
|
Eliminations/ | |
|
|
|
|
Parent Co. | |
|
HoldCo, Inc. | |
|
HoldCo, Inc. | |
|
Guarantors | |
|
Non-guarantor | |
|
Adjustments | |
|
Total | |
|
|
| |
|
| |
|
| |
|
| |
|
| |
|
| |
|
| |
Assets |
Current assets:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Cash and cash equivalents
|
|
$ |
24,886 |
|
|
$ |
— |
|
|
$ |
58 |
|
|
$ |
6,403 |
|
|
$ |
18 |
|
|
$ |
— |
|
|
$ |
31,365 |
|
|
Restricted cash and cash equivalents
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
12,785 |
|
|
|
— |
|
|
|
12,785 |
|
|
Restricted marketable securities
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
1,011 |
|
|
|
— |
|
|
|
1,011 |
|
|
Trade and other accounts receivable, net
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
346,006 |
|
|
|
7,481 |
|
|
|
(6,996 |
) |
|
|
346,491 |
|
|
Parts and supplies inventory
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
18,404 |
|
|
|
— |
|
|
|
— |
|
|
|
18,404 |
|
|
Other current assets
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
54,528 |
|
|
|
3,243 |
|
|
|
(23,087 |
) |
|
|
34,684 |
|
|
Current deferred tax assets
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
17,115 |
|
|
|
2,659 |
|
|
|
— |
|
|
|
19,774 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Current assets
|
|
|
24,886 |
|
|
|
— |
|
|
|
58 |
|
|
|
442,456 |
|
|
|
27,197 |
|
|
|
(30,083 |
) |
|
|
464,514 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Non-current assets:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Property, plant, and equipment, net
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
130,061 |
|
|
|
— |
|
|
|
— |
|
|
|
130,061 |
|
|
Intercompany receivable
|
|
|
252 |
|
|
|
421,784 |
|
|
|
189,452 |
|
|
|
17,389 |
|
|
|
20,660 |
|
|
|
(649,537 |
) |
|
|
— |
|
|
Intangible assets, net
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
84,542 |
|
|
|
— |
|
|
|
— |
|
|
|
84,542 |
|
|
Non-current deferred tax assets
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
120,979 |
|
|
|
(1,131 |
) |
|
|
— |
|
|
|
119,848 |
|
|
Restricted long-term investments
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
57,734 |
|
|
|
— |
|
|
|
57,734 |
|
|
Goodwill
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
267,474 |
|
|
|
— |
|
|
|
— |
|
|
|
267,474 |
|
|
Other long-term assets
|
|
|
— |
|
|
|
12,172 |
|
|
|
5,469 |
|
|
|
81,738 |
|
|
|
— |
|
|
|
— |
|
|
|
99,379 |
|
|
Investment and advances in subsidiaries
|
|
|
230,860 |
|
|
|
157,738 |
|
|
|
73,108 |
|
|
|
6,338 |
|
|
|
— |
|
|
|
(468,044 |
) |
|
|
— |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Assets
|
|
$ |
255,998 |
|
|
$ |
591,694 |
|
|
$ |
268,087 |
|
|
$ |
1,150,977 |
|
|
$ |
104,460 |
|
|
$ |
(1,147,664 |
) |
|
$ |
1,223,552 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Liabilities and Equity |
Current liabilities:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Accounts payable
|
|
$ |
— |
|
|
$ |
— |
|
|
$ |
— |
|
|
$ |
46,614 |
|
|
$ |
1,292 |
|
|
$ |
— |
|
|
$ |
47,906 |
|
|
Accrued liabilities
|
|
|
(540 |
) |
|
|
8,387 |
|
|
|
3,768 |
|
|
|
150,317 |
|
|
|
27,493 |
|
|
|
— |
|
|
|
189,425 |
|
|
Current portion of long-term debt
|
|
|
— |
|
|
|
2,415 |
|
|
|
1,085 |
|
|
|
5,704 |
|
|
|
— |
|
|
|
— |
|
|
|
9,204 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Current liabilities
|
|
|
(540 |
) |
|
|
10,802 |
|
|
|
4,853 |
|
|
|
202,635 |
|
|
|
28,785 |
|
|
|
— |
|
|
|
246,535 |
|
Long-term debt
|
|
|
— |
|
|
|
410,982 |
|
|
|
184,643 |
|
|
|
1,095 |
|
|
|
— |
|
|
|
— |
|
|
|
596,720 |
|
Other long-term liabilities
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
110,183 |
|
|
|
69,337 |
|
|
|
(30,083 |
) |
|
|
149,437 |
|
Intercompany
|
|
|
25,678 |
|
|
|
12,172 |
|
|
|
5,469 |
|
|
|
606,218 |
|
|
|
— |
|
|
|
(649,537 |
) |
|
|
— |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Liabilities
|
|
|
25,138 |
|
|
|
433,956 |
|
|
|
194,965 |
|
|
|
920,131 |
|
|
|
98,122 |
|
|
|
(679,620 |
) |
|
|
992,692 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Common stock
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
30 |
|
|
|
(30 |
) |
|
|
— |
|
Additional paid-in capital
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
6,690 |
|
|
|
(6,690 |
) |
|
|
— |
|
Partnership equity
|
|
|
219,429 |
|
|
|
151,374 |
|
|
|
68,055 |
|
|
|
219,429 |
|
|
|
— |
|
|
|
(438,858 |
) |
|
|
219,429 |
|
Retained earnings
|
|
|
11,067 |
|
|
|
6,364 |
|
|
|
4,703 |
|
|
|
11,053 |
|
|
|
— |
|
|
|
(22,120 |
) |
|
|
11,067 |
|
Comprehensive income (loss)
|
|
|
364 |
|
|
|
— |
|
|
|
364 |
|
|
|
364 |
|
|
|
(382 |
) |
|
|
(346 |
) |
|
|
364 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Equity
|
|
|
230,860 |
|
|
|
157,738 |
|
|
|
73,122 |
|
|
|
230,846 |
|
|
|
6,338 |
|
|
|
(468,044 |
) |
|
|
230,860 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Liabilities and Equity
|
|
$ |
255,998 |
|
|
$ |
591,694 |
|
|
$ |
268,087 |
|
|
$ |
1,150,977 |
|
|
$ |
104,460 |
|
|
$ |
(1,147,664 |
) |
|
$ |
1,223,552 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
F-59
Predecessor
Combining Balance Sheet
As of January 31, 2005
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Issuer |
|
Issuer |
|
|
|
|
|
|
|
|
|
|
|
|
AMR |
|
EmCare |
|
Subsidiary | |
|
Subsidiary | |
|
Eliminations/ | |
|
|
|
|
Parent Co. |
|
HoldCo, Inc. |
|
HoldCo, Inc. |
|
Guarantors | |
|
Non-guarantor | |
|
Adjustments | |
|
Total | |
|
|
|
|
|
|
|
|
| |
|
| |
|
| |
|
| |
Assets |
Current assets:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Cash and cash equivalents
|
|
$ |
— |
|
|
$ |
— |
|
|
$ |
— |
|
|
$ |
4,778 |
|
|
$ |
9,853 |
|
|
$ |
— |
|
|
$ |
14,631 |
|
|
Restricted cash and cash equivalents
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
9,846 |
|
|
|
— |
|
|
|
9,846 |
|
|
Restricted marketable securities
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
2,473 |
|
|
|
— |
|
|
|
2,473 |
|
|
Trade and other accounts receivable, net
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
359,945 |
|
|
|
43,339 |
|
|
|
(33,517 |
) |
|
|
369,767 |
|
|
Parts and supplies inventory
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
18,499 |
|
|
|
— |
|
|
|
— |
|
|
|
18,499 |
|
|
Other current assets
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
81,818 |
|
|
|
6,097 |
|
|
|
(47,780 |
) |
|
|
40,135 |
|
|
Current deferred tax assets
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
62,433 |
|
|
|
2,659 |
|
|
|
— |
|
|
|
65,092 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Current assets
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
527,473 |
|
|
|
74,267 |
|
|
|
(81,297 |
) |
|
|
520,443 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Non-current assets:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Property, plant, and equipment, net
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
128,766 |
|
|
|
— |
|
|
|
— |
|
|
|
128,766 |
|
|
Intangible assets, net
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
16,075 |
|
|
|
— |
|
|
|
— |
|
|
|
16,075 |
|
|
Non-current deferred tax assets
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
203,391 |
|
|
|
(922 |
) |
|
|
— |
|
|
|
202,469 |
|
|
Restricted long-term investments
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
41,810 |
|
|
|
— |
|
|
|
41,810 |
|
|
Goodwill
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
Other long-term assets
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
73,947 |
|
|
|
— |
|
|
|
— |
|
|
|
73,947 |
|
|
Investment and advances in subsidiaries
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
6,404 |
|
|
|
— |
|
|
|
(6,404 |
) |
|
|
— |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Assets
|
|
$ |
— |
|
|
$ |
— |
|
|
$ |
— |
|
|
$ |
956,056 |
|
|
$ |
115,155 |
|
|
$ |
(87,701 |
) |
|
$ |
983,510 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Liabilities and Equity |
Current liabilities:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Accounts payable
|
|
$ |
— |
|
|
$ |
— |
|
|
$ |
— |
|
|
$ |
82,167 |
|
|
$ |
5,186 |
|
|
$ |
(31,535 |
) |
|
$ |
55,818 |
|
|
Accrued liabilities
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
147,291 |
|
|
|
24,354 |
|
|
|
— |
|
|
|
171,645 |
|
|
Current portion of long-term debt
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
5,846 |
|
|
|
— |
|
|
|
— |
|
|
|
5,846 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Current liabilities
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
235,304 |
|
|
|
29,540 |
|
|
|
(31,535 |
) |
|
|
233,309 |
|
Long-term debt
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
5,651 |
|
|
|
— |
|
|
|
— |
|
|
|
5,651 |
|
Other long-term liabilities
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
116,824 |
|
|
|
79,211 |
|
|
|
(49,762 |
) |
|
|
146,273 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Liabilities
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
357,779 |
|
|
|
108,751 |
|
|
|
(81,297 |
) |
|
|
385,233 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Laidlaw payable
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
202,042 |
|
|
|
— |
|
|
|
— |
|
|
|
202,042 |
|
Laidlaw investment
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
356,550 |
|
|
|
— |
|
|
|
— |
|
|
|
356,550 |
|
Common stock
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
30 |
|
|
|
(30 |
) |
|
|
— |
|
Additional paid-in capital
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
5,054 |
|
|
|
(5,054 |
) |
|
|
— |
|
Retained earnings
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
40,000 |
|
|
|
1,635 |
|
|
|
(1,635 |
) |
|
|
40,000 |
|
Comprehensive income (loss)
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
(315 |
) |
|
|
(315 |
) |
|
|
315 |
|
|
|
(315 |
) |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Equity
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
598,277 |
|
|
|
6,404 |
|
|
|
(6,404 |
) |
|
|
598,277 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Liabilities and Equity
|
|
$ |
— |
|
|
$ |
— |
|
|
$ |
— |
|
|
$ |
956,056 |
|
|
$ |
115,155 |
|
|
$ |
(87,701 |
) |
|
$ |
983,510 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
F-60
Consolidating Statement of Operations
For the Five Months Ended June 30, 2005
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Issuer | |
|
Issuer | |
|
|
|
Subsidiary | |
|
|
|
|
|
|
|
|
AMR | |
|
EmCare | |
|
Subsidiary | |
|
Non- | |
|
Eliminations/ | |
|
|
|
|
Parent Co. | |
|
HoldCo, Inc. | |
|
HoldCo, Inc. | |
|
Guarantors | |
|
guarantor | |
|
Adjustments | |
|
Total | |
|
|
| |
|
| |
|
| |
|
| |
|
| |
|
| |
|
| |
Net revenue
|
|
$ |
— |
|
|
$ |
— |
|
|
$ |
— |
|
|
$ |
731,410 |
|
|
$ |
22,425 |
|
|
$ |
(22,425 |
) |
|
$ |
731,410 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Compensation and benefits
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
502,998 |
|
|
|
— |
|
|
|
— |
|
|
|
502,998 |
|
Operating expenses
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
102,170 |
|
|
|
— |
|
|
|
— |
|
|
|
102,170 |
|
Insurance expense
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
39,340 |
|
|
|
22,419 |
|
|
|
(22,425 |
) |
|
|
39,334 |
|
Selling, general and administrative expenses
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
23,179 |
|
|
|
— |
|
|
|
— |
|
|
|
23,179 |
|
Depreciation and amortization expense
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
23,988 |
|
|
|
— |
|
|
|
— |
|
|
|
23,988 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Income from operations
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
39,735 |
|
|
|
6 |
|
|
|
— |
|
|
|
39,741 |
|
Interest expense
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
(21,584 |
) |
|
|
— |
|
|
|
— |
|
|
|
(21,584 |
) |
Realized loss on investments
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
(6 |
) |
|
|
— |
|
|
|
(6 |
) |
Interest and other income
|
|
|
— |
|
|
|
— |
|
|
|
14 |
|
|
|
80 |
|
|
|
— |
|
|
|
— |
|
|
|
94 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Income before income taxes
|
|
|
— |
|
|
|
— |
|
|
|
14 |
|
|
|
18,231 |
|
|
|
— |
|
|
|
— |
|
|
|
18,245 |
|
Income tax expense
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
(7,178 |
) |
|
|
— |
|
|
|
— |
|
|
|
(7,178 |
) |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Income before equity in earnings of unconsolidated subsidiaries
|
|
|
— |
|
|
|
— |
|
|
|
14 |
|
|
|
11,053 |
|
|
|
— |
|
|
|
— |
|
|
|
11,067 |
|
Equity in earnings of unconsolidated subsidiaries
|
|
|
11,067 |
|
|
|
6,364 |
|
|
|
4,689 |
|
|
|
— |
|
|
|
— |
|
|
|
(22,120 |
) |
|
|
— |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Net income
|
|
$ |
11,067 |
|
|
$ |
6,364 |
|
|
$ |
4,703 |
|
|
$ |
11,053 |
|
|
$ |
— |
|
|
$ |
(22,120 |
) |
|
$ |
11,067 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
F-61
Predecessor Combining Statement of Operations
For the Five Months Ended June 30, 2004
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Issuer |
|
Issuer |
|
|
|
Subsidiary | |
|
|
|
|
|
|
|
|
AMR |
|
EmCare |
|
Subsidiary | |
|
Non- | |
|
Eliminations/ | |
|
|
|
|
Parent Co. |
|
HoldCo, Inc. |
|
HoldCo, Inc. |
|
Guarantors | |
|
guarantor | |
|
Adjustments | |
|
Total | |
|
|
|
|
|
|
|
|
| |
|
| |
|
| |
|
| |
Net revenue
|
|
$ |
— |
|
|
$ |
— |
|
|
$ |
— |
|
|
$ |
663,880 |
|
|
$ |
27,859 |
|
|
$ |
(27,859 |
) |
|
$ |
663,880 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Compensation and benefits
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
464,610 |
|
|
|
— |
|
|
|
— |
|
|
|
464,610 |
|
Operating expenses
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
91,661 |
|
|
|
— |
|
|
|
— |
|
|
|
91,661 |
|
Insurance expense
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
36,917 |
|
|
|
27,807 |
|
|
|
(27,859 |
) |
|
|
36,865 |
|
Selling, general and administrative expenses
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
19,269 |
|
|
|
— |
|
|
|
— |
|
|
|
19,269 |
|
Laidlaw fees and compensation charges
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
6,436 |
|
|
|
— |
|
|
|
— |
|
|
|
6,436 |
|
Depreciation and amortization expense
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
21,958 |
|
|
|
— |
|
|
|
— |
|
|
|
21,958 |
|
Restructuring charges
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
1,381 |
|
|
|
— |
|
|
|
— |
|
|
|
1,381 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Income from operations
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
21,648 |
|
|
|
52 |
|
|
|
— |
|
|
|
21,700 |
|
Interest expense
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
(3,541 |
) |
|
|
— |
|
|
|
— |
|
|
|
(3,541 |
) |
Realized loss on investments
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
(52 |
) |
|
|
— |
|
|
|
(52 |
) |
Interest and other income
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
48 |
|
|
|
— |
|
|
|
— |
|
|
|
48 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Income before income taxes
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
18,155 |
|
|
|
— |
|
|
|
— |
|
|
|
18,155 |
|
Income tax expense
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
(7,831 |
) |
|
|
— |
|
|
|
— |
|
|
|
(7,831 |
) |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Net income
|
|
$ |
— |
|
|
$ |
— |
|
|
$ |
— |
|
|
$ |
10,324 |
|
|
$ |
— |
|
|
$ |
— |
|
|
$ |
10,324 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Consolidating Statement of Operations
For the Three Months Ended June 30, 2005
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Issuer | |
|
Issuer | |
|
|
|
Subsidiary | |
|
|
|
|
|
|
|
|
AMR | |
|
EmCare | |
|
Subsidiary | |
|
Non- | |
|
Eliminations/ | |
|
|
|
|
Parent Co. | |
|
HoldCo, Inc. | |
|
HoldCo, Inc. | |
|
Guarantors | |
|
guarantor | |
|
Adjustments | |
|
Total | |
|
|
| |
|
| |
|
| |
|
| |
|
| |
|
| |
|
| |
Net revenue
|
|
$ |
— |
|
|
$ |
— |
|
|
$ |
— |
|
|
$ |
445,021 |
|
|
$ |
13,455 |
|
|
$ |
(13,455 |
) |
|
$ |
445,021 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Compensation and benefits
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
307,308 |
|
|
|
— |
|
|
|
— |
|
|
|
307,308 |
|
Operating expenses
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
63,250 |
|
|
|
— |
|
|
|
— |
|
|
|
63,250 |
|
Insurance expense
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
22,394 |
|
|
|
13,488 |
|
|
|
(13,455 |
) |
|
|
22,427 |
|
Selling, general and administrative expenses
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
14,498 |
|
|
|
— |
|
|
|
— |
|
|
|
14,498 |
|
Depreciation and amortization expense
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
14,136 |
|
|
|
— |
|
|
|
— |
|
|
|
14,136 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Income from operations
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
23,435 |
|
|
|
(33 |
) |
|
|
— |
|
|
|
23,402 |
|
Interest expense
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
(13,646 |
) |
|
|
— |
|
|
|
— |
|
|
|
(13,646 |
) |
Realized gain on investments
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
33 |
|
|
|
— |
|
|
|
33 |
|
Interest and other income
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
81 |
|
|
|
— |
|
|
|
— |
|
|
|
81 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Income before income taxes
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
9,870 |
|
|
|
— |
|
|
|
— |
|
|
|
9,870 |
|
Income tax expense
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
(3,821 |
) |
|
|
— |
|
|
|
— |
|
|
|
(3,821 |
) |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Income before equity in earnings of unconsolidated subsidiaries
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
6,049 |
|
|
|
— |
|
|
|
— |
|
|
|
6,049 |
|
Equity in earnings of unconsolidated subsidiaries
|
|
|
6,049 |
|
|
|
2,298 |
|
|
|
3,751 |
|
|
|
— |
|
|
|
— |
|
|
|
(12,098 |
) |
|
|
— |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Net income
|
|
$ |
6,049 |
|
|
$ |
2,298 |
|
|
$ |
3,751 |
|
|
$ |
6,049 |
|
|
$ |
— |
|
|
$ |
(12,098 |
) |
|
$ |
6,049 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
F-62
Predecessor
Combining Statement of Operations
For the Three Months Ended June 30, 2004
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Issuer |
|
Issuer |
|
|
|
Subsidiary | |
|
|
|
|
|
|
|
|
AMR |
|
EmCare |
|
Subsidiary | |
|
Non- | |
|
Eliminations/ | |
|
|
|
|
Parent Co. |
|
HoldCo, Inc. |
|
HoldCo, Inc. |
|
Guarantors | |
|
guarantor | |
|
Adjustments | |
|
Total | |
|
|
|
|
|
|
|
|
| |
|
| |
|
| |
|
| |
Net revenue
|
|
$ |
— |
|
|
$ |
— |
|
|
$ |
— |
|
|
$ |
399,975 |
|
|
$ |
16,715 |
|
|
$ |
(16,715 |
) |
|
$ |
399,975 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Compensation and benefits
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
280,364 |
|
|
|
— |
|
|
|
— |
|
|
|
280,364 |
|
Operating expenses
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
53,490 |
|
|
|
— |
|
|
|
— |
|
|
|
53,490 |
|
Insurance expense
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
22,865 |
|
|
|
16,715 |
|
|
|
(16,715 |
) |
|
|
22,865 |
|
Selling, general and administrative expenses
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
12,805 |
|
|
|
— |
|
|
|
— |
|
|
|
12,805 |
|
Laidlaw fees and compensation charges
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
3,862 |
|
|
|
— |
|
|
|
— |
|
|
|
3,862 |
|
Depreciation and amortization expense
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
13,160 |
|
|
|
— |
|
|
|
— |
|
|
|
13,160 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Income from operations
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
13,429 |
|
|
|
— |
|
|
|
— |
|
|
|
13,429 |
|
Interest expense
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
(3,073 |
) |
|
|
— |
|
|
|
— |
|
|
|
(3,073 |
) |
Interest and other income
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
12 |
|
|
|
— |
|
|
|
— |
|
|
|
12 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Income before income taxes
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
10,368 |
|
|
|
— |
|
|
|
— |
|
|
|
10,368 |
|
Income tax expense
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
(4,794 |
) |
|
|
— |
|
|
|
— |
|
|
|
(4,794 |
) |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Net income
|
|
$ |
— |
|
|
$ |
— |
|
|
$ |
— |
|
|
$ |
5,574 |
|
|
$ |
— |
|
|
$ |
— |
|
|
$ |
5,574 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
F-63
Condensed Consolidating Statement of Cash Flows
For the Five Months Ended June 30, 2005
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Issuer | |
|
Issuer | |
|
|
|
Subsidiary | |
|
|
|
|
|
|
AMR | |
|
EmCare | |
|
Subsidiary | |
|
Non- | |
|
|
|
|
Parent Co. | |
|
HoldCo Inc. | |
|
HoldCo Inc. | |
|
Guarantors | |
|
guarantors | |
|
Total | |
|
|
| |
|
| |
|
| |
|
| |
|
| |
|
| |
Cash Flows from Operating Activities
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Net cash provided by operating activities
|
|
$ |
— |
|
|
$ |
— |
|
|
$ |
14 |
|
|
$ |
87,487 |
|
|
$ |
7,202 |
|
|
$ |
94,703 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Cash Flows from Investing Activities
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
EMS purchase of AMR and EmCare
|
|
|
(828,775 |
) |
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
(828,775 |
) |
Purchase of property, plant and equipment
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
(20,052 |
) |
|
|
— |
|
|
|
(20,052 |
) |
Proceeds from sale of property, plant and equipment
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
456 |
|
|
|
— |
|
|
|
456 |
|
Purchase of restricted cash and investments
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
(27,103 |
) |
|
|
(27,103 |
) |
Proceeds from sale and maturity of restricted investments
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
10,066 |
|
|
|
10,066 |
|
Net change in deposits and other assets
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
(9,827 |
) |
|
|
— |
|
|
|
(9,827 |
) |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Net cash used in investing activities
|
|
|
(828,775 |
) |
|
|
— |
|
|
|
— |
|
|
|
(29,423 |
) |
|
|
(17,037 |
) |
|
|
(875,235 |
) |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Cash Flows from Financing Activities
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Borrowings under new senior secured credit facility
|
|
|
— |
|
|
|
241,500 |
|
|
|
108,500 |
|
|
|
— |
|
|
|
— |
|
|
|
350,000 |
|
Proceeds from issuance of senior subordinated notes
|
|
|
— |
|
|
|
172,500 |
|
|
|
77,500 |
|
|
|
— |
|
|
|
— |
|
|
|
250,000 |
|
Borrowings under new revolving credit facility
|
|
|
— |
|
|
|
13,938 |
|
|
|
6,262 |
|
|
|
— |
|
|
|
— |
|
|
|
20,200 |
|
Issuance of partnership equity
|
|
|
221,155 |
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
221,155 |
|
Financing costs
|
|
|
(1,737 |
) |
|
|
(12,686 |
) |
|
|
(5,699 |
) |
|
|
— |
|
|
|
— |
|
|
|
(20,122 |
) |
Repayments of capital lease obligations and other debt
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
(3,499 |
) |
|
|
— |
|
|
|
(3,499 |
) |
Repayments of revolving credit facility
|
|
|
— |
|
|
|
(13,938 |
) |
|
|
(6,262 |
) |
|
|
— |
|
|
|
— |
|
|
|
(20,200 |
) |
Net intercompany borrowings (payments)
|
|
|
634,243 |
|
|
|
(401,314 |
) |
|
|
(180,257 |
) |
|
|
(52,672 |
) |
|
|
— |
|
|
|
— |
|
Increase (decrease) in bank overdrafts
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
(2,091 |
) |
|
|
— |
|
|
|
(2,091 |
) |
Increase (decrease) in other non-current liabilities
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
1,823 |
|
|
|
— |
|
|
|
1,823 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Net cash provided by (used in) financing activities
|
|
|
853,661 |
|
|
|
— |
|
|
|
44 |
|
|
|
(56,439 |
) |
|
|
— |
|
|
|
797,266 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Increase in cash and cash equivalents
|
|
|
24,886 |
|
|
|
— |
|
|
|
58 |
|
|
|
1,625 |
|
|
|
(9,835 |
) |
|
|
16,734 |
|
Cash and cash equivalents, beginning of period
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
4,778 |
|
|
|
9,853 |
|
|
|
14,631 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Cash and cash equivalents, end of period
|
|
$ |
24,886 |
|
|
$ |
— |
|
|
$ |
58 |
|
|
$ |
6,403 |
|
|
$ |
18 |
|
|
$ |
31,365 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
F-64
Predecessor
Condensed Combining Statement of Cash Flows
For the Five Months Ended June 30, 2004
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Issuer |
|
Issuer |
|
|
|
Subsidiary | |
|
|
|
|
|
|
AMR |
|
EmCare |
|
Subsidiary | |
|
Non- | |
|
|
|
|
Parent Co. |
|
HoldCo, Inc. |
|
HoldCo, Inc. |
|
Guarantors | |
|
guarantors | |
|
Total | |
|
|
|
|
|
|
|
|
| |
|
| |
|
| |
Cash Flows from Operating Activities
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Net cash provided by operating activities
|
|
$ |
— |
|
|
$ |
— |
|
|
$ |
— |
|
|
$ |
67,440 |
|
|
$ |
13,829 |
|
|
$ |
81,269 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Cash Flows from Investing Activities
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Purchase of property, plant and equipment
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
(17,387 |
) |
|
|
— |
|
|
|
(17,387 |
) |
Proceeds from sale of property, plant and equipment
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
518 |
|
|
|
— |
|
|
|
518 |
|
Purchase of restricted cash and investments
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
(43,535 |
) |
|
|
(43,535 |
) |
Proceeds from sale and maturity of restricted investments
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
30,595 |
|
|
|
30,595 |
|
Other investing activities
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
5,688 |
|
|
|
— |
|
|
|
5,688 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Net cash used in investing activities
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
(11,181 |
) |
|
|
(12,940 |
) |
|
|
(24,121 |
) |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Cash Flows from Financing Activities
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Repayments of capital lease obligations and other debt
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
(3,956 |
) |
|
|
— |
|
|
|
(3,956 |
) |
Payments to Laidlaw
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
(49,734 |
) |
|
|
— |
|
|
|
(49,734 |
) |
Decrease in bank overdrafts
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
(353 |
) |
|
|
— |
|
|
|
(353 |
) |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Net cash used in financing activities
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
(54,043 |
) |
|
|
— |
|
|
|
(54,043 |
) |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Change in cash and cash equivalents
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
2,216 |
|
|
|
889 |
|
|
|
3,105 |
|
Cash and cash equivalents, beginning of period
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
10,830 |
|
|
|
26 |
|
|
|
10,856 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Cash and cash equivalents, end of period
|
|
$ |
— |
|
|
$ |
— |
|
|
$ |
— |
|
|
$ |
13,046 |
|
|
$ |
915 |
|
|
$ |
13,961 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
On July 28, 2005, the Company’s board of directors
authorized the filing of a registration statement on
Form S-1 in connection with a proposed initial public
offering of the Company’s equity. The Company currently
anticipates that, in connection with a public offering, it will
effect a reorganization pursuant to which the Company becomes a
consolidated subsidiary of a newly-formed Delaware corporation
and that corporation, to be named Emergency Medical Services
Corporation, will issue common stock in the offering.
In connection with the offering and the related reorganization,
the outstanding options described in note 3 will become
options to purchase shares of Emergency Medical Services
Corporation’s common stock; the number of shares subject to
each option and the exercise price will be determined based on
Emergency Medical Services Corporation’s capitalization and
the offering price per share of common stock.
F-65
$250,000,000
AMR HoldCo, Inc.
EmCare HoldCo, Inc.
Offer to Exchange
10% Senior Subordinated Notes
due 2015
Prospectus
,
2005
Until ,
2005, all dealers that effect transactions in these securities,
whether or not participating in the exchange offer may be
required to deliver a prospectus. This is in addition to the
dealers’ obligations to deliver a prospectus when acting as
underwriters and with respect to their unsold allotments or
subscriptions.
PART II
Information Not Required in Prospectus
|
|
Item 20. |
Indemnification of Directors and Officers |
Under Section 145 of the Delaware General Corporation Law,
the DGCL, a corporation may indemnify its directors, officers,
employees and agents and its former directors, officers,
employees and agents and those who serve, at the
corporation’s request, in such capacities with another
enterprise, against expenses, including attorneys’ fees, as
well as judgments, fines and settlements in nonderivative
lawsuits, actually and reasonably incurred in connection with
the defense of any action, suit or proceeding in which they or
any of them were or are made parties or are threatened to be
made parties by reason of their serving or having served in such
capacity. The DGCL provides, however, that such person must have
acted in good faith and in a manner such person reasonably
believed to be in, or not opposed to, the best interests of the
corporation and, in the case of a criminal action, such person
must have had no reasonable cause to believe his or her conduct
was unlawful. In addition, the DGCL does not permit
indemnification in an action or suit by or in the right of the
corporation, where such person has been adjudged liable to the
corporation, unless, and only to the extent that, a court
determines that such person fairly and reasonably is entitled to
indemnity for costs the court deems proper in light of liability
adjudication. Indemnity is mandatory to the extent a claim,
issue or matter has been successfully defended.
|
|
|
Certificate of Incorporation and By-Laws |
Our certificates of incorporation provide that none of our
directors shall be personally liable for breach of fiduciary
duty as a director. Any repeal or modification of that provision
shall not adversely affect any right or protection, or any
limitation of the liability of, any of our directors existing
at, or arising out of facts or incidents occurring prior to, the
effective date of such repeal or modification. Both our
certificates of incorporation and our by-laws will provide for
the indemnification of our directors and officers to the fullest
extent permitted by the DGCL.
|
|
|
Indemnification Agreements |
Additionally, we have entered into indemnification agreements
with certain of our directors and officers which may, in certain
cases, be broader than the specific indemnification provisions
contained under current applicable law. The indemnification
agreements may require us, among other things, to indemnify such
officers and directors against certain liabilities that may
arise by reason of their status or service as directors,
officers or employees of the company and to advance the expenses
incurred by such parties as a result of any threatened claims or
proceedings brought against them as to which they could be
indemnified.
Our directors and officers are covered by insurance policies
maintained by us against certain liabilities for actions taken
in their capacities as such, including liabilities under the
Securities Act of 1933, or the Securities Act. Insofar as
indemnification for liabilities arising under the Securities Act
may be permitted to directors, officers and controlling persons
of the registrant pursuant to the foregoing provisions, or
otherwise, the registrant has been advised that in the opinion
of the Securities and Exchange Commission such indemnification
is against public policy as expressed in the Securities Act and
is, therefore, unenforceable. In the event that a claim for
indemnification against such liabilities (other than the payment
by the registrant of expenses incurred or paid by a director,
officer or controlling person of the registrant in the
successful defense of any action, suit or proceeding) is
asserted by such director, officer or controlling person in
connection with the securities being registered, the registrant
will, unless in the opinion of its counsel the matter has been
settled by controlling precedent, submit to a court of
appropriate jurisdiction the question whether such
indemnification by it is against public policy as expressed in
the Securities Act and will be governed by the final
adjudication of such issue.
II-1
|
|
Item 21. |
Exhibits and Financial Data Schedules |
(A) Exhibits
|
|
|
|
|
|
2 |
.1 |
|
Stock Purchase Agreement, dated as of December 6, 2004, by
and among Laidlaw International, Inc., Laidlaw Medical Holdings,
Inc. and Emergency Medical Services Corporation* |
|
2 |
.2 |
|
Amendment to Stock Purchase Agreement, dated February 10,
2005, by and among Laidlaw International, Inc., Laidlaw
Medical Holdings, Inc. and Emergency Medical Services
Corporation* |
|
2 |
.3 |
|
Stock Purchase Agreement, dated as of December 6, 2004, by
and among Laidlaw International, Inc., Laidlaw Medical Holdings,
Inc. and Emergency Medical Services Corporation* |
|
2 |
.4 |
|
Amendment to Stock Purchase Agreement, dated as of
February 10, 2005, by and among Laidlaw International,
Inc., Laidlaw Medical Holdings, Inc. and Emergency Medical
Services Corporation* |
|
2 |
.5 |
|
Letter, dated March 25, 2005, to AMR Holdco, Inc. from
Laidlaw Medical Holdings, Inc.* |
|
3 |
.1 |
|
Form of Amended and Restated Certificate of Incorporation of
Emergency Medical Services Corporation† |
|
3 |
.2 |
|
Form of Amended and Restated By-Laws of Emergency Medical
Services Corporation† |
|
3 |
.3 |
|
Certificate of Formation of Emergency Medical Services L.P.* |
|
3 |
.4 |
|
Agreement of Limited Partnership of Emergency Medical Services
L.P., dated February 10, 2005, by and among Emergency
Medical Services Corporation and the persons listed on
Schedule A thereto* |
|
3 |
.5 |
|
Amended and Restated Agreement of Limited Partnership of
Emergency Medical Services L.P., dated
September , 2005, by and among Emergency
Medical Services Corporation and the persons listed on
Schedule A thereto† |
|
3 |
.6 |
|
Certificate of Incorporation of AMR HoldCo, Inc. |
|
3 |
.7 |
|
Amended and Restated By-Laws of AMR HoldCo, Inc. |
|
3 |
.8 |
|
Certificate of Incorporation of EmCare HoldCo, Inc. |
|
3 |
.9 |
|
Amended and Restated By-Laws of EmCare HoldCo, Inc. |
|
3 |
.10 |
|
Certificate of Incorporation of Ambulance Acquisition, Inc.,
with amendments thereto |
|
3 |
.11 |
|
By-Laws of Ambulance Acquisition, Inc. |
|
3 |
.12 |
|
Articles of Incorporation of American Investment Enterprises,
Inc. |
|
3 |
.13 |
|
By-Laws of American Investment Enterprises, Inc. |
|
3 |
.14 |
|
Certificate of Incorporation of American Medical Pathways, Inc.,
with amendments thereto |
|
3 |
.15 |
|
By-Laws of American Medical Pathways, Inc. |
|
3 |
.16 |
|
Articles of Incorporation of American Medical Response
Northwest, Inc., with amendments thereto |
|
3 |
.17 |
|
By-Laws of American Medical Response Northwest, Inc. |
|
3 |
.18 |
|
Articles of Incorporation of American Medical Response West,
with amendments thereto |
|
3 |
.19 |
|
By-Laws of American Medical Response West |
|
3 |
.20 |
|
Certificate of Formation of American Medical Response Delaware
Valley, LLC |
|
3 |
.21 |
|
Limited Liability Company Agreement of American Medical Response
Delaware Valley, LLC |
|
3 |
.22 |
|
Certificate of Incorporation of American Medical Response of
Inland Empire, with amendments thereto |
|
3 |
.23 |
|
By-Laws of American Medical Response of Inland Empire (f.k.a.
Courtesy Services of San Bernardino, Inc.) |
|
3 |
.24 |
|
Articles of Incorporation of American Medical Response
Mid-Atlantic, Inc., with amendments thereto |
|
3 |
.25 |
|
By-Laws of American Medical Response Mid-Atlantic, Inc. |
|
3 |
.26 |
|
Certificate of Incorporation of American Medical Response, Inc.,
with amendments thereto |
|
3 |
.27 |
|
By-Laws of American Medical Response, Inc. |
|
3 |
.28 |
|
Certificate of Incorporation of American Medical Response of
Colorado, Inc., with amendments thereto |
|
3 |
.29 |
|
By-Laws of American Medical Response of Colorado, Inc. |
|
3 |
.30 |
|
Certificate of Incorporation of American Medical Response of
Connecticut, Incorporated, with amendments thereto |
|
3 |
.31 |
|
By-Laws of American Medical Response of Connecticut, Incorporated |
II-2
|
|
|
|
|
|
3 |
.32 |
|
Certificate of Incorporation of American Medical Response of
Illinois, Inc., with amendments thereto |
|
3 |
.33 |
|
By-Laws of American Medical Response of Illinois, Inc. |
|
3 |
.34 |
|
Certificate of Incorporation of American Medical Response of
Tennessee, Inc., with amendments thereto |
|
3 |
.35 |
|
By-Laws of American Medical Response of Tennessee, Inc. |
|
3 |
.36 |
|
Certificate of Incorporation of American Medical Response of
Oklahoma, Inc. |
|
3 |
.37 |
|
By-Laws of American Medical Response of Oklahoma, Inc. |
|
3 |
.38 |
|
Certificate of Incorporation of American Medical Response of
Texas, Inc., with amendments thereto |
|
3 |
.39 |
|
By-Laws of American Medical Response of Texas, Inc. |
|
3 |
.40 |
|
Articles of Incorporation of American Medical Response of
Southern California, with amendments thereto |
|
3 |
.41 |
|
By-Laws of American Medical Response of Southern California
(f.k.a. Goodhew American
Service, Inc.) |
|
3 |
.42 |
|
Certificate of Incorporation of American Medical Response
Holdings, Inc., with amendments thereto |
|
3 |
.43 |
|
By-Laws of American Medical Response Holdings, Inc. |
|
3 |
.44 |
|
Certificate of Incorporation of American Medical Response
Management, Inc., with amendments thereto |
|
3 |
.45 |
|
By-Laws of American Medical Response Management, Inc. |
|
3 |
.46 |
|
Certificate of Incorporation of American Medical Response of
Georgia, Inc., with amendments thereto |
|
3 |
.47 |
|
By-Laws of American Medical Response of Georgia, Inc. |
|
3 |
.48 |
|
Articles of Incorporation of American Medical Response of
Massachusetts, Inc., with amendments thereto |
|
3 |
.49 |
|
By-Laws of American Medical Response of Massachusetts, Inc. |
|
3 |
.50 |
|
Certificate of Incorporation of American Medical Response of
North Carolina, Inc., with amendments thereto |
|
3 |
.51 |
|
By-Laws of American Medical Response of North Carolina, Inc. |
|
3 |
.52 |
|
Certificate of Incorporation of American Medical Response of
South Carolina, Inc., with amendments thereto |
|
3 |
.53 |
|
By-Laws of American Medical Response of South Carolina, Inc. |
|
3 |
.54 |
|
Articles of Incorporation of A1 Leasing, Inc. |
|
3 |
.55 |
|
By-Laws of A1 Leasing, Inc. |
|
3 |
.56 |
|
Certificate of Formation of AMR Brockton, L.L.C. |
|
3 |
.57 |
|
Limited Liability Company Agreement of AMR Brockton, L.L.C. |
|
3 |
.58 |
|
Certificate of Incorporation of Associated Ambulance Service,
Inc., with amendments thereto |
|
3 |
.59 |
|
By-Laws of Associated Ambulance Service, Inc. |
|
3 |
.60 |
|
Certificate of Incorporation of Atlantic/ Palm Beach Ambulance,
Inc., with amendments thereto |
|
3 |
.61 |
|
By-Laws of Atlantic/ Palm Beach Ambulance, Inc. |
|
3 |
.62 |
|
Certificate of Incorporation of Atlantic/ Key West Ambulance,
Inc., with amendments thereto |
|
3 |
.63 |
|
By-Laws of Atlantic/ Key West Ambulance, Inc. |
|
3 |
.64 |
|
Certificate of Incorporation of Atlantic Ambulance Services
Acquisition, Inc., with amendments thereto |
|
3 |
.65 |
|
By-Laws of Atlantic Ambulance Services Acquisition, Inc. |
|
3 |
.66 |
|
Certificate of Incorporation of Broward Ambulance, Inc., with
amendments thereto |
|
3 |
.67 |
|
By-Laws of Broward Ambulance, Inc. |
|
3 |
.68 |
|
Articles of Incorporation of Desert Valley Medical Transport,
Inc., with amendments thereto |
|
3 |
.69 |
|
Amended and Restated By-Laws of Desert Valley Medical Transport,
Inc. |
|
3 |
.70 |
|
Certificate of Incorporation of Five Counties Ambulance Service,
Inc., with amendments thereto |
|
3 |
.71 |
|
By-Laws of Five Counties Ambulance Service, Inc. |
|
3 |
.72 |
|
Articles of Incorporation of Florida Emergency Partners, Inc. |
|
3 |
.73 |
|
By-Laws of Florida Emergency Partners, Inc. |
|
3 |
.74 |
|
Articles of Incorporation of Fountain Ambulance Service, Inc.,
with amendments thereto |
II-3
|
|
|
|
|
|
3 |
.75 |
|
By-Laws of Fountain Ambulance Service, Inc. |
|
3 |
.76 |
|
Certificate of Incorporation of Global Medical Response, Inc. |
|
3 |
.77 |
|
By-Laws of Global Medical Response, Inc. |
|
3 |
.78 |
|
Articles of Incorporation of Charles T. Mitchell, M.D.,
Inc., with amendments thereto |
|
3 |
.79 |
|
By-Laws of Charles T. Mitchell, M.D., Inc. |
|
3 |
.80 |
|
Articles of Incorporation of Coordinated Health Services, Inc.,
with amendments thereto |
|
3 |
.81 |
|
By-Laws of Coordinated Health Services, Inc. |
|
3 |
.82 |
|
Articles of Incorporation of Hank’s Acquisition Corp., with
amendments thereto |
|
3 |
.83 |
|
By-Laws of Hank’s Acquisition Corp. |
|
3 |
.84 |
|
Articles of Incorporation of Hemet Valley Ambulance Service, Inc. |
|
3 |
.85 |
|
By-Laws of Hemet Valley Ambulance Service, Inc. |
|
3 |
.86 |
|
Articles of Incorporation of International Life Support, Inc.,
with amendments thereto |
|
3 |
.87 |
|
By-Laws of International Life Support, Inc. |
|
3 |
.88 |
|
Articles of Incorporation of Kutz Ambulance Service, Inc., with
amendments thereto |
|
3 |
.89 |
|
Restated By-Laws of Kutz Ambulance Service, Inc. |
|
3 |
.90 |
|
Certificate of Incorporation of Laidlaw Medical Transportation,
Inc., with amendments thereto |
|
3 |
.91 |
|
By-Laws of Laidlaw Medical Transportation, Inc. |
|
3 |
.92 |
|
Articles of Incorporation of LifeCare Ambulance Service, Inc. |
|
3 |
.93 |
|
By-Laws of LifeCare Ambulance Service, Inc. |
|
3 |
.94 |
|
Articles of Incorporation of LifeFleet Southeast, Inc., with
amendments thereto |
|
3 |
.95 |
|
By-Laws of LifeFleet Southeast, Inc. (f.k.a. Pinellas Ambulance
Services, Inc.) |
|
3 |
.96 |
|
Articles of Incorporation of Medevac MidAmerica, Inc., with
amendments thereto |
|
3 |
.97 |
|
By-Laws of Medevac MidAmerica, Inc. |
|
3 |
.98 |
|
Articles of Incorporation Medevac Medical Response, Inc., with
amendments thereto |
|
3 |
.99 |
|
By-Laws of Medevac Medical Response, Inc. |
|
3 |
.100 |
|
Articles of Incorporation of Medi-Car Systems, Inc., with
amendments thereto |
|
3 |
.101 |
|
By-Laws of Medi-Car Systems, Inc. |
|
3 |
.102 |
|
Articles of Incorporation of Medi-Car Ambulance Service, Inc.,
with amendments thereto |
|
3 |
.103 |
|
By-Laws of Medi-Car Ambulance Service, Inc. |
|
3 |
.104 |
|
Articles of Incorporation of Medic One of Cobb, Inc. |
|
3 |
.105 |
|
By-Laws of Medic One of Cobb, Inc. |
|
3 |
.106 |
|
Certificate of Incorporation Medic One Ambulance Services, Inc.,
with amendments thereto |
|
3 |
.107 |
|
By-Laws of Medic One Ambulance Services, Inc. |
|
3 |
.108 |
|
Articles of Incorporation of MedLife Emergency Medical Service,
Inc., with amendments thereto |
|
3 |
.109 |
|
By-Laws of MedLife Emergency Medical Service, Inc. |
|
3 |
.110 |
|
Articles of Incorporation Mercy Ambulance of Evansville, Inc.,
with amendments thereto |
|
3 |
.111 |
|
By-Laws of Mercy Ambulance of Evansville, Inc. (f.k.a. Alexander
Ambulance Services, Inc.) |
|
3 |
.112 |
|
Articles of Incorporation Mercy, Inc., with amendments thereto |
|
3 |
.113 |
|
By-Laws of Mercy, Inc. |
|
3 |
.114 |
|
Restated Articles of Incorporation of Mercy Life Care |
|
3 |
.115 |
|
By-Laws of Mercy Life Care |
|
3 |
.116 |
|
Articles of Incorporation of The Gould Group, Inc., with
amendments thereto |
|
3 |
.117 |
|
By-Laws of The Gould Group, Inc. |
|
3 |
.118 |
|
Certificate of Incorporation of Metro Ambulance Service (Rural),
Inc., with amendments thereto |
|
3 |
.119 |
|
By-Laws of Metro Ambulance Service (Rural), Inc. |
|
3 |
.120 |
|
Certificate of Incorporation of Metro Ambulance Services, Inc.,
with amendments thereto |
|
3 |
.121 |
|
By-Laws of Metro Ambulance Services, Inc. |
|
3 |
.122 |
|
Articles of Incorporation of Metropolitan Ambulance Service,
with amendments thereto |
|
3 |
.123 |
|
By-Laws of Metropolitan Ambulance Service |
|
3 |
.124 |
|
Certificate of Incorporation of Midwest Ambulance Management
Company, with amendments thereto |
|
3 |
.125 |
|
By-Laws of Midwest Ambulance Management Company |
|
3 |
.126 |
|
Certificate of Incorporation of Mobile Medic Ambulance Service,
Inc. |
|
3 |
.127 |
|
By-Laws of Mobile Medic Ambulance Service, Inc. |
|
3 |
.128 |
|
Articles of Incorporation of Paramed, Inc., with amendments
thereto |
II-4
|
|
|
|
|
|
3 |
.129 |
|
By-Laws of Paramed, Inc. |
|
3 |
.130 |
|
Certificate of Incorporation of Park Ambulance Service Inc.,
with amendments thereto |
|
3 |
.131 |
|
By-Laws of Park Ambulance Service Inc. |
|
3 |
.132 |
|
Articles of Incorporation of Physicians & Surgeons
Ambulance Service, Inc., with amendments thereto |
|
3 |
.133 |
|
By-Laws of Physicians & Surgeons Ambulance Service, Inc. |
|
3 |
.134 |
|
Articles of Organization of ProvidaCare, L.L.C., with amendments
thereto |
|
3 |
.135 |
|
Limited Liability Company Agreement of ProvidaCare, L.L.C. |
|
3 |
.136 |
|
Articles of Incorporation of Puckett Ambulance Service, Inc.,
with amendments thereto |
|
3 |
.137 |
|
By-Laws of Puckett Ambulance Service, Inc. |
|
3 |
.138 |
|
Certificate of Incorporation of Randle Eastern Ambulance
Service, Inc., with amendments thereto |
|
3 |
.139 |
|
By-Laws of Randle Eastern Ambulance Service, Inc. (f.k.a. Dade
Miami Eastern Ambulance Services, Inc.) |
|
3 |
.140 |
|
Certificate of Limited Partnership of Regional Emergency
Services, LP |
|
3 |
.141 |
|
Amended and Restated Agreement of Limited Partnership of
Regional Emergency Services, LP |
|
3 |
.142 |
|
Certificate of Incorporation of Seminole County Ambulance, Inc.,
with amendments thereto |
|
3 |
.143 |
|
By-Laws of Seminole County Ambulance, Inc. |
|
3 |
.144 |
|
Articles of Incorporation of Springs Ambulance Service, Inc.,
with amendments thereto |
|
3 |
.145 |
|
By-Laws of Springs Ambulance Service, Inc. |
|
3 |
.146 |
|
Certificate of Incorporation of STAT Healthcare, Inc., with
amendments thereto |
|
3 |
.147 |
|
By-Laws of STAT Healthcare, Inc. (f.k.a. New STAT
Healthcare, Inc.) |
|
3 |
.148 |
|
Certificate of Incorporation of Sunrise Handicap Transport
Corp., with amendments thereto |
|
3 |
.149 |
|
By-Laws of Sunrise Handicap Transport Corp. |
|
3 |
.150 |
|
Articles of Incorporation of TEK, Inc. |
|
3 |
.151 |
|
By-Laws of TEK, Inc., with amendments thereto |
|
3 |
.152 |
|
Articles of Incorporation of Tidewater Ambulance Service, Inc.,
with amendments thereto |
|
3 |
.153 |
|
By-Laws of Tidewater Ambulance Service, Inc. |
|
3 |
.154 |
|
Articles of Incorporation of Troup County Emergency Medical
Services, Inc., with amendments thereto |
|
3 |
.155 |
|
By-Laws of Troup County Emergency Medical Services, Inc. |
|
3 |
.156 |
|
Restated Articles of Incorporation of American Emergency
Physicians Management, Inc. |
|
3 |
.157 |
|
By-Laws of American Emergency Physicians Management, Inc.
(f.k.a. American Emergency Physicians Medical Group, Inc.) |
|
3 |
.158 |
|
Restated Articles of Incorporation of Norman Bruce Jetton, Inc. |
|
3 |
.159 |
|
Amended and Restated By-Laws of Norman Bruce Jetton, Inc. |
|
3 |
.160 |
|
Articles of Incorporation of Tifton Management Services, Inc.,
with amendments thereto |
|
3 |
.161 |
|
By-Laws of Tifton Management Services, Inc. |
|
3 |
.162 |
|
Articles of Incorporation of Tucker Emergency Services, Inc.,
with amendments thereto |
|
3 |
.163 |
|
By-Laws of Tucker Emergency Services, Inc. |
|
3 |
.164 |
|
Certificate of Incorporation of Adams Transportation Services,
Inc., with amendments thereto |
|
3 |
.165 |
|
By-Laws of Adams Transportation Services, Inc. |
|
3 |
.166 |
|
Certificate of Incorporation of EM-CODE Reimbursement Solutions,
Inc., with amendments thereto |
|
3 |
.167 |
|
By-Laws of EM-CODE Reimbursement Solutions, Inc. |
|
3 |
.168 |
|
Articles of Incorporation of EmCare of Arizona, Inc., with
amendments thereto |
|
3 |
.169 |
|
By-Laws of EmCare of Arizona, Inc. |
|
3 |
.170 |
|
Restated and Amended Articles of Incorporation of EmCare of
California, Inc., with amendments thereto |
|
3 |
.171 |
|
By-Laws of EmCare of California, Inc. |
|
3 |
.172 |
|
Articles of Incorporation of EmCare of Colorado, Inc. |
|
3 |
.173 |
|
By-Laws of EmCare of Colorado, Inc. |
|
3 |
.174 |
|
Certificate of Incorporation of EmCare of Connecticut, Inc.,
with amendments thereto |
|
3 |
.175 |
|
By-Laws of EmCare of Connecticut, Inc. |
|
3 |
.176 |
|
Articles of Incorporation of EmCare of Florida, Inc., with
amendments thereto |
|
3 |
.177 |
|
By-Laws of EmCare of Florida, Inc. |
|
3 |
.178 |
|
Articles of Incorporation of EmCare of Georgia, Inc. |
II-5
|
|
|
|
|
|
3 |
.179 |
|
By-Laws of EmCare of Georgia, Inc. |
|
3 |
.180 |
|
Articles of Incorporation of EmCare of Hawaii, Inc., with
amendments thereto |
|
3 |
.181 |
|
By-Laws of EmCare of Hawaii, Inc. |
|
3 |
.182 |
|
Articles of Incorporation of EmCare of Indiana, Inc., with
amendments thereto |
|
3 |
.183 |
|
By-Laws of EmCare of Indiana, Inc. |
|
3 |
.184 |
|
Articles of Incorporation of EmCare of Iowa, Inc., with
amendments thereto |
|
3 |
.185 |
|
By-Laws of EmCare of Iowa, Inc. |
|
3 |
.186 |
|
Articles of Incorporation of EmCare of Kentucky, Inc. |
|
3 |
.187 |
|
By-Laws of EmCare of Kentucky, Inc. |
|
3 |
.188 |
|
Articles of Incorporation of EmCare of Louisiana, Inc., with
amendments thereto |
|
3 |
.189 |
|
By-Laws of EmCare of Louisiana, Inc. |
|
3 |
.190 |
|
Articles of Incorporation of EmCare of Maine, Inc. |
|
3 |
.191 |
|
By-Laws of EmCare of Maine, Inc. |
|
3 |
.192 |
|
Articles of Incorporation of EmCare of Michigan, Inc., with
amendments thereto |
|
3 |
.193 |
|
By-Laws of EmCare of Michigan, Inc. |
|
3 |
.194 |
|
Articles of Incorporation of EmCare of Minnesota, Inc. |
|
3 |
.195 |
|
By-Laws of EmCare of Minnesota, Inc. |
|
3 |
.196 |
|
Articles of Incorporation of EmCare of Mississippi, Inc. |
|
3 |
.197 |
|
By-Laws of EmCare of Mississippi, Inc. |
|
3 |
.198 |
|
Articles of Incorporation of EmCare of Missouri, Inc. |
|
3 |
.199 |
|
By-Laws of EmCare of Missouri, Inc. |
|
3 |
.200 |
|
Articles of Incorporation of EmCare of Nevada, Inc., with
amendments thereto |
|
3 |
.201 |
|
By-Laws of EmCare of Nevada, Inc. |
|
3 |
.202 |
|
Articles of Incorporation of EmCare of New Hampshire, Inc. |
|
3 |
.203 |
|
By-Laws of EmCare of New Hampshire, Inc. |
|
3 |
.204 |
|
Certificate of Incorporation of EmCare of New Jersey, Inc. |
|
3 |
.205 |
|
By-Laws of EmCare of New Jersey, Inc. |
|
3 |
.206 |
|
Articles of Incorporation of EmCare Contract of Arkansas, Inc.,
with amendments thereto |
|
3 |
.207 |
|
By-Laws of EmCare Contract of Arkansas, Inc. |
|
3 |
.208 |
|
Certificate of Incorporation of EmCare of New York, Inc., with
amendments thereto |
|
3 |
.209 |
|
By-Laws of EmCare of New York, Inc. |
|
3 |
.210 |
|
Articles of Incorporation of EmCare of North Carolina, Inc.,
with amendments thereto |
|
3 |
.211 |
|
By-Laws of EmCare of North Carolina, Inc. |
|
3 |
.212 |
|
Articles of Incorporation of EmCare of North Dakota, Inc. |
|
3 |
.213 |
|
By-Laws of EmCare of North Dakota, Inc. |
|
3 |
.214 |
|
Articles of Incorporation of EmCare of Ohio, Inc., with
amendments thereto |
|
3 |
.215 |
|
By-Laws of EmCare of Ohio, Inc. |
|
3 |
.216 |
|
Certificate of Incorporation of EmCare of Oklahoma, Inc., with
amendments thereto |
|
3 |
.217 |
|
By-Laws of EmCare of Oklahoma, Inc. |
|
3 |
.218 |
|
Articles of Incorporation of EmCare of Oregon, Inc. |
|
3 |
.219 |
|
By-Laws of EmCare of Oregon, Inc. |
|
3 |
.220 |
|
Articles of Incorporation of EmCare of Pennsylvania, Inc., with
amendments thereto |
|
3 |
.221 |
|
By-Laws of EmCare of Pennsylvania, Inc. |
|
3 |
.222 |
|
Articles of Incorporation of EmCare of Rhode Island, Inc., with
amendments thereto |
|
3 |
.223 |
|
By-Laws of EmCare of Rhode Island, Inc. |
|
3 |
.224 |
|
Articles of Incorporation of EmCare of South Carolina, Inc.,
with amendments thereto |
|
3 |
.225 |
|
By-Laws of EmCare of South Carolina, Inc. |
|
3 |
.226 |
|
Charter of EmCare of Tennessee, Inc., with amendments thereto |
|
3 |
.227 |
|
By-Laws of EmCare of Tennessee, Inc. |
|
3 |
.228 |
|
Articles of Incorporation of EmCare of Texas, Inc., with
amendments thereto |
|
3 |
.229 |
|
By-Laws of EmCare of Texas, Inc. |
|
3 |
.230 |
|
Articles of Incorporation of EmCare of Vermont, Inc. |
|
3 |
.231 |
|
By-Laws of EmCare of Vermont, Inc. |
|
3 |
.232 |
|
Articles of Incorporation of EmCare of Virginia, Inc. |
|
3 |
.233 |
|
By-Laws of EmCare of Virginia, Inc. |
II-6
|
|
|
|
|
|
3 |
.234 |
|
Articles of Incorporation of EmCare of Washington, Inc. |
|
3 |
.235 |
|
By-Laws of EmCare of Washington, Inc. |
|
3 |
.236 |
|
Articles of Incorporation of EmCare of West Virginia, Inc. |
|
3 |
.237 |
|
By-Laws of EmCare of West Virginia, Inc. |
|
3 |
.238 |
|
Articles of Incorporation of EmCare of Wisconsin, Inc. |
|
3 |
.239 |
|
By-Laws of EmCare of Wisconsin, Inc. |
|
3 |
.240 |
|
Articles of Incorporation of EmCare Physician Providers, Inc.,
with amendments thereto |
|
3 |
.241 |
|
By-Laws of EmCare Physician Providers, Inc. (f.k.a. Spectrum
Emergency Care, Inc.) |
|
3 |
.242 |
|
Certificate of Incorporation of EmCare Physician Services, Inc.,
with amendments thereto |
|
3 |
.243 |
|
By-Laws of EmCare Physician Services, Inc. (f.k.a. Spectrum
Physician and Allied Health
Services, Inc.) |
|
3 |
.244 |
|
Articles of Incorporation of EmCare Services of Illinois, Inc.,
with amendments thereto |
|
3 |
.245 |
|
By-Laws of EmCare Services of Illinois, Inc. |
|
3 |
.246 |
|
Articles of Organization of EmCare Services of Massachusetts,
Inc., with amendments thereto |
|
3 |
.247 |
|
By-Laws of EmCare Services of Massachusetts, Inc. |
|
3 |
.248 |
|
Certificate of Incorporation of EmCare Anesthesia Services,
Inc., with amendments thereto |
|
3 |
.249 |
|
By-Laws of EmCare Anesthesia Services, Inc. (f.k.a. Spectrum
Anesthesia Services, Inc.) |
|
3 |
.250 |
|
Articles of Organization of EmCare of Maryland LLC, with
amendments thereto |
|
3 |
.251 |
|
Operating Agreement of EmCare of Maryland LLC (f.k.a. Capital
Equity Associates, LLC) |
|
3 |
.252 |
|
Articles of Incorporation of EmCare of Alabama, Inc. |
|
3 |
.253 |
|
By-Laws of EmCare of Alabama, Inc. |
|
3 |
.254 |
|
Restated Certificate of Incorporation of EmCare Holdings Inc. |
|
3 |
.255 |
|
By-Laws of EmCare Holdings Inc. |
|
3 |
.256 |
|
Certificate of Incorporation of EmCare, Inc., with amendments
thereto |
|
3 |
.257 |
|
By-Laws of EmCare, Inc. |
|
3 |
.258 |
|
Certificate of Incorporation of ECEP, Inc. |
|
3 |
.259 |
|
By-Laws of ECEP, Inc. |
|
3 |
.260 |
|
Articles of Incorporation of EmCare of New Mexico, Inc., with
amendments thereto |
|
3 |
.261 |
|
By-Laws of EmCare of New Mexico, Inc. |
|
3 |
.262 |
|
Articles of Incorporation of Emergency Medicine Education
Systems, Inc. |
|
3 |
.263 |
|
By-Laws of Emergency Medicine Education Systems, Inc. |
|
3 |
.264 |
|
Articles of Incorporation of Emergency Specialists of Arkansas,
Inc. II |
|
3 |
.265 |
|
By-Laws of Emergency Specialists of Arkansas, Inc. II |
|
3 |
.266 |
|
Amended and Restated Articles of Incorporation of First Medical/
EmCare, Inc. |
|
3 |
.267 |
|
By-Laws of First Medical/ EmCare, Inc. |
|
3 |
.268 |
|
Certificate of Incorporation of Healthcare Administrative
Services, Inc., with amendments thereto |
|
3 |
.269 |
|
By-Laws of Healthcare Administrative Services, Inc. (f.k.a.
Spectrum Healthcare Administrative Services, Inc.) |
|
3 |
.270 |
|
Restated Articles of Incorporation of Helix Physicians
Management, Inc. |
|
3 |
.271 |
|
By-Laws of Helix Physicians Management, Inc. |
|
3 |
.272 |
|
Restated and Amended Articles of Incorporation of OLD STAT,
Inc., with amendments thereto |
|
3 |
.273 |
|
By-Laws of OLD STAT, Inc. (f.k.a. STAT Healthcare, Inc.) |
|
3 |
.274 |
|
Restated Articles of Incorporation of Pacific Emergency
Specialists Management, Inc., with amendments thereto |
|
3 |
.275 |
|
Amended and Restated By-Laws of Pacific Emergency Specialists
Management, Inc. |
|
3 |
.276 |
|
Articles of Incorporation of Physician Account Management,
Inc. |
|
3 |
.277 |
|
By-Laws of Physician Account Management, Inc. |
|
3 |
.278 |
|
Certificate of Incorporation of Provider
Account Management, Inc. |
|
3 |
.279 |
|
By-Laws of Provider Account Management, Inc. |
|
3 |
.280 |
|
Articles of Incorporation of Reimbursement Technologies, Inc. |
|
3 |
.281 |
|
Amended and Restated By-Laws of Reimbursement Technologies, Inc. |
|
3 |
.282 |
|
Articles of Incorporation of STAT Physicians, Inc. |
|
3 |
.283 |
|
By-Laws of STAT Physicians, Inc. |
|
3 |
.284 |
|
Certificate of Formation of EMS Management LLC |
|
3 |
.285 |
|
Operating Agreement of EMS Management LLC |
II-7
|
|
|
|
|
|
4 |
.1 |
|
Form of Class A Common Stock Certificate† |
|
4 |
.2 |
|
Form of Class B Common Stock Certificate† |
|
4 |
.3 |
|
Investor Equityholders Agreement, dated February 10, 2005,
by and among Emergency Medical Services L.P., Onex
Partners LP and the equityholders listed on the signature
pages thereto* |
|
4 |
.4 |
|
Equityholders Agreement, dated as of February 10, 2005, by
and among Emergency Medical Services L.P., Onex
Partners LP and the equityholders listed on the signature
pages thereto** |
|
4 |
.5 |
|
Registration Agreement, dated February 10, 2005, by and
among Emergency Medical Services L.P. and the persons
listed on Schedule A thereto and amendment thereto** |
|
4 |
.6 |
|
Indenture, dated February 10, 2005, by and among AMR
HoldCo, Inc., EmCare HoldCo, Inc., the guarantors named therein
and U.S. Bank Trust National Association, as trustee* |
|
4 |
.7 |
|
Supplemental Indenture, dated April 15, 2005, by and among
AMR Brockton L.L.C., AMR HoldCo, Inc., EmCare HoldCo, Inc., the
guarantors named therein and U.S. Bank Trust National
Association, as trustee* |
|
4 |
.8 |
|
Registration Rights Agreement, dated as of February 10,
2005, by and among AMR HoldCo, Inc., EmCare HoldCo, Inc., the
guarantors named therein, Banc of America Securities LLC and
J.P. Morgan Securities Inc.* |
|
4 |
.9 |
|
Voting and Exchange Trust Agreement, dated as
of ,
2005, among Emergency Medical Services Corporation, Emergency
Medical Services L.P. and Onex Corporation† |
|
4 |
.10 |
|
Form of 10% Senior Subordinated Note due 2015 (included in
Exhibit 4.6) |
|
4 |
.11 |
|
Notation of Guarantee, dated as of February 10, 2005,
executed by the guarantors identified therein |
|
5 |
.1 |
|
Opinion of Kaye Scholer LLP with respect to legality of
securities being registered† |
|
5 |
.2 |
|
Opinion of Todd G. Zimmerman, Esq.† |
|
9 |
.1 |
|
Voting and Exchange Trust Agreement, dated as
of ,
2005, among Emergency Medical Services Corporation, Emergency
Medical Services L.P. and Onex Corporation (incorporated by
reference to Exhibit 4.9 to this Registration Statement)† |
|
10 |
.1 |
|
Employment Agreement, dated December 6, 2004, between
William A. Sanger and Emergency Medical Services Corporation* |
|
10 |
.2 |
|
Employment Agreement, dated as of February 10, 2005,
between Don S. Harvey and Emergency Medical Services L.P., and
assignment to Emergency Medical Services Corporation* |
|
10 |
.3 |
|
Employment Agreement, dated as of February 10, 2005,
between Randel G. Owen and Emergency Medical Services L.P., and
assignment to Emergency Medical Services Corporation* |
|
10 |
.4 |
|
Employment Agreement, dated as of February 10, 2005,
between Todd Zimmerman and Emergency Medical Services L.P., and
assignment to Emergency Medical Services Corporation* |
|
10 |
.5 |
|
Employment Agreement, dated as of April 19, 2005, by and
between Emergency Medical Services L.P. and Dighton Packard,
M.D., and assignment to Emergency Medical Services Corporation.* |
|
10 |
.6 |
|
Emergency Medical Services L.P. Equity Option Plan* |
|
10 |
.7 |
|
Emergency Medical Services L.P. Equity Purchase Plan* |
|
10 |
.8 |
|
Management Agreement, dated February 10, 2005, by and among
Onex Partners Manager LP, AMR HoldCo, Inc. and EmCare HoldCo,
Inc.* |
|
10 |
.9 |
|
Purchase Agreement, dated January 27, 2005, among AMR
HoldCo, Inc., EmCare HoldCo, Inc., the Registrant, the
guarantors party thereto, Banc of America LLC Securities and
J.P. Morgan Securities Inc.* |
|
10 |
.10 |
|
Credit Agreement, dated as of February 10, 2005, among AMR
HoldCo, Inc., EmCare HoldCo, Inc., Emergency Medical Services
L.P., the guarantors party thereto, Bank of America, N.A. and
the other lenders party thereto* |
|
10 |
.11 |
|
Amendment No. 1, dated March 29, 2005, among AMR
HoldCo, Inc., EmCare HoldCo, Emergency Medical Services L.P.,
the guarantors and the lenders party thereto, to the Credit
Agreement dated as of February 10, 2005, among AMR HoldCo,
Inc., EmCare HoldCo, Inc., Emergency Medical Services L.P., the
guarantors party thereto, Bank of America, N.A. and the other
lenders party thereto* |
|
10 |
.12 |
|
Security Agreement, dated as of February 10, 2005, made by
AMR HoldCo, Inc., EmCare HoldCo., Inc., the guarantors party
thereto, in favor of Bank of America, N.A.* |
|
11 |
.1 |
|
Statement regarding computation of earnings per share† |
|
12 |
.1 |
|
Statement regarding computation of ratios† |
|
21 |
.1 |
|
Subsidiaries of Emergency Medical Services L.P.* |
II-8
|
|
|
|
|
|
23 |
.1 |
|
Consent of PricewaterhouseCoopers LLP |
|
23 |
.2 |
|
Consent of Kaye Scholer LLP (included in Exhibit 5.1)† |
|
24 |
.1 |
|
Powers of Attorney of the directors of Emergency Medical
Services L.P. (included in the signature pages to the
registration statement) |
|
24 |
.2 |
|
Powers of Attorney of the directors and certain officers of the
Additional Registrants (included in the signature pages to the
Registration Statement) |
|
25 |
.1 |
|
Statement of Eligibility on Form T-1 of Trustee under the
Indenture, dated as of September 30, 2005, among AMR
HoldCo, Inc., EmCare HoldCo, Inc., the guarantors named therein
and U.S. Bank Trust National Association, as Trustee |
|
99 |
.1 |
|
Form of Letter of Transmittal |
|
99 |
.2 |
|
Form of Notice of Guaranteed Delivery |
|
|
* |
Incorporated by reference to Exhibits to the Emergency Medical
Services’ Registration Statement on Form S-1 filed on
August 2, 2005 |
|
|
** |
Incorporated by reference to Exhibits to the Emergency Medical
Services’ Amendment No. 1 to Registration Statement on
Form S-1 filed on September 14, 2005 |
|
† |
To be filed by amendment |
(B) Financial Data Schedule
1. The undersigned registrants hereby undertake:
|
|
|
(a) To file, during any period in which offers or sales are
being made, a post-effective amendment to this registration
statement: |
|
|
|
(i) To include any prospectus required by
Section 10(a)(3) of the Securities Act of 1933; |
|
|
(ii) To reflect in the prospectus any facts or events
arising after the effective date of the registration statement
(or the most recent post-effective amendment thereof) which,
individually or in the aggregate, represent a fundamental change
in the information set forth in the registration statement.
Notwithstanding the foregoing, any increase or decrease in
volume of securities offered (if the total dollar value of
securities offered would not exceed that which was registered)
and any deviation from the low or high end of the estimated
maximum offering range may be reflected in the form of
prospectus filed with the Commission pursuant to
Rule 424(b) if, in the aggregate, the changes in volume and
price represent no more than a 20% change in the maximum
aggregate offering price set forth in the “Calculation of
Registration Fee” table in the effective registration
statement; |
|
|
(iii) To include any material information with respect to
the plan of distribution not previously disclosed in the
registration statement or any material change to such
information in the registration statement; |
|
|
|
(b) That, for the purpose of determining any liability
under the Securities Act of 1933, each such post-effective
amendment shall be deemed to be a new registration statement
relating to the securities offered therein, and the offering of
such securities at that time shall be deemed to be the initial
bona fide offering thereof; and |
|
|
(c) To remove from registration by means of a
post-effective amendment any of the securities being registered
which remain unsold at the termination of the offering. |
2. The undersigned registrants hereby undertake to respond
to requests for information that is incorporated by reference
into the prospectus pursuant to Item 4, 10(b), 11 or 13 of
this Form, within one business day of receipt of such request,
and to send the incorporated documents by first class mail or
other
II-9
equally prompt means. This includes information contained in
documents filed subsequent to the effective date of the
registration statement through the date of responding to the
request.
3. The undersigned registrants hereby undertake to supply
by means of a post-effective amendment all information
concerning a transaction, and the company being acquired
involved therein, that was not the subject of and included in
the registration statement when it became effective.
II-10
SIGNATURES
Pursuant to the requirements of the Securities Act, Emergency
Medical Services L.P. has duly caused this registration
statement to be signed on its behalf by the undersigned,
thereunto duly authorized, in Greenwood Village, State of
Colorado, on October 11, 2005.
|
|
|
EMERGENCY MEDICAL SERVICES L.P. |
|
|
|
|
By: |
Emergency Medical Services Corporation,
its General Partner |
|
|
By: |
/s/ William A. Sanger
|
|
|
|
|
|
William A. Sanger |
|
Chief Executive Officer |
POWER OF ATTORNEY
KNOW ALL PERSON BY THESE PRESENTS that each individual whose
signature appears below constitute and appoints William A.
Sanger and Randel G. Owen, and each of them, his or her true and
lawful attorneys-in-fact and agents, with full power of
substitution and resubstitution, for him or her and in his or
her name, place and stead, in any and all capacities (including
his or her capacity as a director and/or officer), to sign any
and all amendments (including post-effective amendments) to this
Registration Statement, and to file the same, with all exhibits
thereto, and all other documents in connection therewith, with
the Securities and Exchange Commission, granting unto said
attorneys-in-fact and agents, and each of them, full power and
authority to do and perform each and every act and thing
requisite and necessary to be done in and about the premises, as
fully to all intents and purposes as he or she might or could do
in person, hereby ratifying and confirming all that said
attorneys-in-fact and agents or either of them, or his, her or
their substitute or substitutes, may lawfully do or cause to be
done or by virtue hereof.
* * *
Pursuant to the requirements of the Securities Act, this
Registration Statement on Form S-4 and Power of Attorney
has been signed by the following persons in the capacities
indicated for Emergency Medical Services Corporation, as general
partner of Emergency Medical Services L.P., and on the date
indicated.
|
|
|
|
|
|
|
Signature |
|
Title |
|
Date |
|
|
|
|
|
|
/s/ William A. Sanger
William
A. Sanger |
|
Chairman, Chief Executive Officer and Director (Principal
Executive Officer) |
|
October 11, 2005 |
|
/s/ Randel G. Owen
Randel
G. Owen |
|
Chief Financial Officer (Principal Financial and Accounting
Officer) |
|
October 11, 2005 |
|
/s/ Robert M. Le Blanc
Robert
M. Le Blanc |
|
Director |
|
October 11, 2005 |
II-11
|
|
|
|
|
|
|
Signature |
|
Title |
|
Date |
|
|
|
|
|
|
/s/ Steven B. Epstein
Steven
B. Epstein |
|
Director |
|
October 11, 2005 |
|
/s/ Don S. Harvey
Don
S. Harvey |
|
Director |
|
October 11, 2005 |
|
/s/ James T. Kelly
James
T. Kelly |
|
Director |
|
October 11, 2005 |
|
/s/ Michael L. Smith
Michael
L. Smith |
|
Director |
|
October 11, 2005 |
II-12
SIGNATURES
Pursuant to the requirements of the Securities Act, Emergency
Medical Services L.P. has duly caused this registration
statement to be signed on its behalf by the undersigned,
thereunto duly authorized, in Greenwood Village, State of
Colorado, on October 11, 2005.
|
|
|
AMR HOLDCO, INC. |
|
EMCARE HOLDCO, INC. |
|
|
|
|
By: |
/s/ William A. Sanger
|
|
|
|
|
|
William A. Sanger |
|
Chief Executive Officer |
POWER OF ATTORNEY
KNOW ALL PERSON BY THESE PRESENTS that each individual whose
signature appears below constitute and appoints William A.
Sanger and Randel G. Owen, and each of them, his or her true and
lawful attorneys-in-fact and agents, with full power of
substitution and resubstitution, for him or her and in his or
her name, place and stead, in any and all capacities (including
his or her capacity as a director and/or officer), to sign any
and all amendments (including post-effective amendments) to this
Registration Statement, and to file the same, with all exhibits
thereto, and all other documents in connection therewith, with
the Securities and Exchange Commission, granting unto said
attorneys-in-fact and agents, and each of them, full power and
authority to do and perform each and every act and thing
requisite and necessary to be done in and about the premises, as
fully to all intents and purposes as he or she might or could do
in person, hereby ratifying and confirming all that said
attorneys-in-fact and agents or either of them, or his, her or
their substitute or substitutes, may lawfully do or cause to be
done or by virtue hereof.
* * *
Pursuant to the requirements of the Securities Act, this
Registration Statement on Form S-4 and Power of Attorney
has been signed by the following persons in the capacities
indicated for Emergency Medical Services Corporation, as general
partner of Emergency Medical Services L.P., and on the date
indicated.
|
|
|
|
|
|
|
Signature |
|
Title |
|
Date |
|
|
|
|
|
|
/s/ William A. Sanger
William
A. Sanger |
|
Chief Executive Officer and Director
(Principal Executive Officer) |
|
October 11, 2005 |
|
/s/ Randel G. Owen
Randel
G. Owen |
|
Chief Financial Officer (Principal
Financial and Accounting Officer) |
|
October 11, 2005 |
|
/s/ Robert M. Le Blanc
Robert
M. Le Blanc |
|
Director |
|
October 11, 2005 |
II-13
SIGNATURES
Pursuant to the requirements of the Securities Act, Emergency
Medical Services L.P. has duly caused this registration
statement to be signed on its behalf by the undersigned,
thereunto duly authorized, in Greenwood Village, State of
Colorado, on October 11, 2005.
|
|
|
EMCARE HOLDINGS INC. |
|
EMCARE, INC. |
|
EMCARE OF ALABAMA, INC. |
|
EMCARE CONTRACT OF ARKANSAS, INC. |
|
EMCARE OF ARIZONA, INC. |
|
EMCARE OF CALIFORNIA, INC. |
|
EMCARE OF COLORADO, INC. |
|
EMCARE OF CONNECTICUT, INC. |
|
EMCARE OF FLORIDA, INC. |
|
EMCARE OF GEORGIA, INC. |
|
EMCARE OF INDIANA, INC. |
|
EMCARE OF IOWA, INC. |
|
EMCARE OF KENTUCKY, INC. |
|
EMCARE OF LOUISIANA, INC. |
|
EMCARE OF MAINE, INC. |
|
EMCARE OF MICHIGAN, INC. |
|
EMCARE OF MINNESOTA, INC. |
|
EMCARE OF MISSISSIPPI, INC. |
|
EMCARE OF MISSOURI, INC. |
|
EMCARE OF NEVADA, INC. |
|
EMCARE OF NEW HAMPSHIRE, INC. |
|
EMCARE OF NEW JERSEY, INC. |
|
EMCARE OF NEW MEXICO, INC. |
|
EMCARE OF NEW YORK, INC. |
|
EMCARE OF NORTH CAROLINA, INC. |
|
EMCARE OF NORTH DAKOTA, INC. |
|
EMCARE OF OHIO, INC. |
|
EMCARE OF OKLAHOMA, INC. |
|
EMCARE OF OREGON, INC. |
|
EMCARE OF PENNSYLVANIA, INC. |
|
EMCARE OF RHODE ISLAND, INC. |
|
EMCARE OF SOUTH CAROLINA, INC. |
|
EMCARE OF TENNESSEE, INC. |
|
EMCARE OF TEXAS, INC. |
|
EMCARE OF VERMONT, INC. |
|
EMCARE OF VIRGINIA, INC. |
|
EMCARE OF WASHINGTON, INC. |
|
EMCARE OF WEST VIRGINIA, INC. |
|
EMCARE OF WISCONSIN, INC. |
|
EMCARE PHYSICIAN PROVIDERS, INC. |
|
EMCARE PHYSICIAN SERVICES, INC. |
|
EMCARE SERVICES OF ILLINOIS, INC. |
|
EMCARE SERVICES OF MASSACHUSETTS, INC. |
|
EMCARE ANESTHESIA SERVICES, INC. |
|
ECEP, INC. |
|
COORDINATED HEALTH SERVICES, INC. |
|
EM-CODE REIMBURSEMENT SOLUTIONS, INC. |
II-14
|
|
|
EMERGENCY MEDICINE EDUCATION SYSTEMS, INC. |
|
EMERGENCY SPECIALISTS OF ARKANSAS, INC. II |
|
FIRST MEDICAL/ EMCARE, INC. |
|
HEALTHCARE ADMINISTRATIVE SERVICES, INC. |
|
OLD STAT, INC. |
|
REIMBURSEMENT TECHNOLOGIES, INC. |
|
STAT PHYSICIANS, INC. |
|
THE GOULD GROUP, INC. |
|
TIFTON MANAGEMENT SERVICES, INC. |
|
TUCKER EMERGENCY SERVICES, INC. |
|
HELIX PHYSICIANS MANAGEMENT, INC. |
|
NORMAN BRUCE JETTON, INC. |
|
PACIFIC EMERGENCY SPECIALISTS |
|
MANAGEMENT, INC. |
|
AMERICAN EMERGENCY PHYSICIANS |
|
MANAGEMENT, INC. |
|
PHYSICIAN ACCOUNT MANAGEMENT, INC. |
|
PROVIDER ACCOUNT MANAGEMENT, INC. |
|
CHARLES T. MITCHELL, INC. |
|
|
EMCARE OF MARYLAND LLC, |
|
|
|
|
By: |
EmCare Holdings Inc. and EmCare, |
|
|
|
Inc., its members |
|
|
EMS MANAGEMENT LLC |
|
|
|
|
By: |
AMR HoldCo, Inc. and EmCare HoldCo, Inc., |
|
|
|
|
By: |
/s/ William A. Sanger
|
|
|
|
|
|
William A. Sanger |
|
Chief Executive Officer |
POWER OF ATTORNEY
KNOW ALL PERSON BY THESE PRESENTS that each individual whose
signature appears below constitute and appoints William A.
Sanger and Randel G. Owen, and each of them, his or her true and
lawful attorneys-in-fact and agents, with full power of
substitution and resubstitution, for him or her and in his or
her name, place and stead, in any and all capacities (including
his or her capacity as a director and/or officer), to sign any
and all amendments (including post-effective amendments) to this
Registration Statement, and to file the same, with all exhibits
thereto, and all other documents in connection therewith, with
the Securities and Exchange Commission, granting unto said
attorneys-in-fact and agents, and each of them, full power and
authority to do and perform each and every act and thing
requisite and necessary to be done in and about the premises, as
fully to all intents and purposes as he or she might or could do
in person, hereby
II-15
ratifying and confirming all that said attorneys-in-fact and
agents or either of them, or his, her or their substitute or
substitutes, may lawfully do or cause to be done or by virtue
hereof.
* * *
Pursuant to the requirements of the Securities Act, this
Registration Statement on Form S-4 and Power of Attorney
has been signed by the following persons in the capacities and
on the date indicated.
|
|
|
|
|
|
|
Signature |
|
Title |
|
Date |
|
|
|
|
|
|
/s/ William A. Sanger
William
A. Sanger |
|
Chairman, Chief Executive Officer and Director (Principal
Executive Officer) |
|
October 11, 2005 |
|
/s/ Randel G. Owen
Randel
G. Owen |
|
Chief Financial Officer (Principal Financial and Accounting
Officer) |
|
October 11, 2005 |
II-16
SIGNATURES
Pursuant to the requirements of the Securities Act, Emergency
Medical Services L.P. has duly caused this registration
statement to be signed on its behalf by the undersigned,
thereunto duly authorized, in Greenwood Village, State of
Colorado, on October 11, 2005.
|
|
|
|
By: |
/s/ William A. Sanger
|
|
|
|
|
|
William A. Sanger |
|
Chief Executive Officer |
POWER OF ATTORNEY
KNOW ALL PERSON BY THESE PRESENTS that each individual whose
signature appears below constitute and appoints William A.
Sanger and Randel G. Owen, and each of them, his or her true and
lawful attorneys-in-fact and agents, with full power of
substitution and resubstitution, for him or her and in his or
her name, place and stead, in any and all capacities (including
his or her capacity as a director and/or officer), to sign any
and all amendments (including post-effective amendments) to this
Registration Statement, and to file the same, with all exhibits
thereto, and all other documents in connection therewith, with
the Securities and Exchange Commission, granting unto said
attorneys-in-fact and agents, and each of them, full power and
authority to do and perform each and every act and thing
requisite and necessary to be done in and about the premises, as
fully to all intents and purposes as he or she might or could do
in person, hereby ratifying and confirming all that said
attorneys-in-fact and agents or either of them, or his, her or
their substitute or substitutes, may lawfully do or cause to be
done or by virtue hereof.
* * *
Pursuant to the requirements of the Securities Act, this
Registration Statement on Form S-4 and Power of Attorney
has been signed by the following persons in the capacities and
on the date indicated.
|
|
|
|
|
|
|
Signature |
|
Title |
|
Date |
|
|
|
|
|
|
/s/ William A. Sanger
William
A. Sanger |
|
Chairman, Chief Executive Officer and Director (Principal
Executive Officer) |
|
October 11, 2005 |
|
/s/ Randel G. Owen
Randel
G. Owen |
|
Chief Financial Officer (Principal Financial and Accounting
Officer) |
|
October 11, 2005 |
II-17
SIGNATURES
Pursuant to the requirements of the Securities Act, Emergency
Medical Services L.P. has duly caused this registration
statement to be signed on its behalf by the undersigned,
thereunto duly authorized, in Greenwood Village, State of
Colorado, on October 11, 2005.
|
|
|
AMERICAN MEDICAL RESPONSE, INC. |
|
|
|
|
By: |
/s/ William A. Sanger
|
|
|
|
|
|
William A. Sanger |
|
Chief Executive Officer |
POWER OF ATTORNEY
KNOW ALL PERSON BY THESE PRESENTS that each individual whose
signature appears below constitute and appoints William A.
Sanger and Randel G. Owen, and each of them, his or her true and
lawful attorneys-in-fact and agents, with full power of
substitution and resubstitution, for him or her and in his or
her name, place and stead, in any and all capacities (including
his or her capacity as a director and/or officer), to sign any
and all amendments (including post-effective amendments) to this
Registration Statement, and to file the same, with all exhibits
thereto, and all other documents in connection therewith, with
the Securities and Exchange Commission, granting unto said
attorneys-in-fact and agents, and each of them, full power and
authority to do and perform each and every act and thing
requisite and necessary to be done in and about the premises, as
fully to all intents and purposes as he or she might or could do
in person, hereby ratifying and confirming all that said
attorneys-in-fact and agents or either of them, or his, her or
their substitute or substitutes, may lawfully do or cause to be
done or by virtue hereof.
* * *
Pursuant to the requirements of the Securities Act, this
Registration Statement on Form S-4 and Power of Attorney
has been signed by the following persons in the capacities and
on the date indicated.
|
|
|
|
|
|
|
Signature |
|
Title |
|
Date |
|
|
|
|
|
|
/s/ William A. Sanger
William
A. Sanger |
|
President and Chief Executive Officer and Director (Principal
Executive Officer) |
|
October 11, 2005 |
|
/s/ Randel G. Owen
Randel
G. Owen |
|
Chief Financial Officer (Principal Financial and Accounting
Officer) |
|
October 11, 2005 |
II-18
SIGNATURES
Pursuant to the requirements of the Securities Act, Emergency
Medical Services L.P. has duly caused this registration
statement to be signed on its behalf by the undersigned,
thereunto duly authorized, in Greenwood Village, State of
Colorado, on October 11, 2005.
|
|
|
|
|
A1 LEASING, INC. |
|
|
ADAM TRANSPORTATION SERVICE, INC. |
|
|
AMERICAN MEDICAL RESPONSE MID-ATLANTIC, INC. |
|
|
AMERICAN MEDICAL RESPONSE OF CONNECTICUT, INCORPORATED |
|
|
AMERICAN MEDICAL RESPONSE OF GEORGIA, INC. |
|
|
AMERICAN MEDICAL RESPONSE OF MASSACHUSETTS, INC. |
|
|
AMERICAN MEDICAL RESPONSE OF NORTH CAROLINA, INC. |
|
|
AMERICAN MEDICAL RESPONSE OF SOUTH CAROLINA, INC. |
|
|
AMERICAN MEDICAL RESPONSE OF TENNESSEE, INC. |
|
|
AMR BROCKTON, L.L.C. |
|
|
ASSOCIATED AMBULANCE SERVICE, INC. |
|
|
ATLANTIC AMBULANCE SERVICES ACQUISITION, INC. |
|
|
ATLANTIC/ KEY WEST AMBULANCE, INC. |
|
|
ATLANTIC/ PALM BEACH AMBULANCE, INC. |
|
|
BROWARD AMBULANCE, INC. |
|
|
FIVE COUNTIES AMBULANCE SERVICE, INC. |
|
|
FOUNTAIN AMBULANCE SERVICE, INC. |
|
|
HANK’S ACQUISITION CORP. |
|
|
LIFEFLEET SOUTHEAST, INC. |
|
|
MEDIC ONE AMBULANCE SERVICES, INC. |
|
|
MEDIC ONE OF COBB, INC. |
|
|
MEDLIFE EMERGENCY MEDICAL SERVICE, INC. |
|
|
MERCY AMBULANCE OF EVANSVILLE, INC. |
|
|
METRO AMBULANCE SERVICE (RURAL), INC. |
|
|
METRO AMBULANCE SERVICE, INC. |
|
|
METRO AMBULANCE SERVICES, INC. |
|
|
MIDWEST AMBULANCE MANAGEMENT COMPANY |
|
|
MOBILE MEDIC AMBULANCE SERVICE, INC. |
|
|
PARAMED, INC. |
|
|
PARK AMBULANCE SERVICE, INC. |
|
|
PHYSICIANS & SURGEONS AMBULANCE SERVICE, INC. |
|
|
PUCKETT AMBULANCE SERVICE, INC. |
|
|
RESCUE CARE, INC. |
|
|
SEMINOLE COUNTY AMBULANCE, INC. |
|
|
SUNRISE HANDICAP TRANSPORT CORP. |
|
|
TIDEWATER AMBULANCE SERVICE, INC. |
|
|
TROUP COUNTY EMERGENCY MEDICAL SERVICES, INC. |
II-19
|
|
|
AMERICAN MEDICAL RESPONSE DELAWARE VALLEY, LLC |
|
|
|
By: American Medical Response Mid-Atlantic, Inc., its sole
member |
|
|
|
REGIONAL EMERGENCY SERVICES, LP |
|
|
|
|
|
By: Florida Emergency Partners, Inc., its general partner |
|
|
|
|
|
By: American Medical Pathways, Inc., its sole member |
|
|
|
|
|
By: American Medical Response of Massachusetts, its manager |
|
|
|
|
|
Robert LaTorraca |
|
Chief Executive Officer |
POWER OF ATTORNEY
KNOW ALL PERSON BY THESE PRESENTS that each individual whose
signature appears below constitute and appoints William A.
Sanger and Randel G. Owen, and each of them, his or her true and
lawful attorneys-in-fact and agents, with full power of
substitution and resubstitution, for him or her and in his or
her name, place and stead, in any and all capacities (including
his or her capacity as a director and/or officer), to sign any
and all amendments (including post-effective amendments) to this
Registration Statement, and to file the same, with all exhibits
thereto, and all other documents in connection therewith, with
the Securities and Exchange Commission, granting unto said
attorneys-in-fact and agents, and each of them, full power and
authority to do and perform each and every act and thing
requisite and necessary to be done in and about the premises, as
fully to all intents and purposes as he or she might or could do
in person, hereby ratifying and confirming all that said
attorneys-in-fact and agents or either of them, or his, her or
their substitute or substitutes, may lawfully do or cause to be
done or by virtue hereof.
* * *
II-20
Pursuant to the requirements of the Securities Act, this
Registration Statement on Form S-4 and Power of Attorney
has been signed by the following persons in the capacities and
on the date indicated.
|
|
|
|
|
|
|
Signature |
|
Title |
|
Date |
|
|
|
|
|
|
/s/ Robert LaTorraca
Robert
LaTorraca |
|
President and Chief Executive Officer
(Principal Executive Officer) |
|
October 11, 2005 |
|
/s/ Randel G. Owen
Randel
G. Owen |
|
Chief Financial Officer (Principal
Financial and Accounting Officer) |
|
October 11, 2005 |
|
/s/ William A. Sanger
William
A. Sanger |
|
Director |
|
October 11, 2005 |
II-21
SIGNATURES
Pursuant to the requirements of the Securities Act, Emergency
Medical Services L.P. has duly caused this registration
statement to be signed on its behalf by the undersigned,
thereunto duly authorized, in Greenwood Village, State of
Colorado, on October 11, 2005.
|
|
|
AMERICAN MEDICAL RESPONSE OF SOUTHERN CALIFORNIA |
|
AMERICAN INVESTMENT ENTERPRISES, INC. |
|
AMERICAN MEDICAL RESPONSE OF INLAND EMPIRE |
|
AMERICAN MEDICAL RESPONSE OF OKLAHOMA, INC. |
|
AMERICAN MEDICAL RESPONSE OF TEXAS, INC. |
|
DESERT VALLEY MEDICAL TRANSPORT, INC. |
|
FLORIDA EMERGENCY PARTNERS, INC. |
|
HEMET VALLEY AMBULANCE SERVICE, INC. |
|
MERCY, INC. |
|
SPRINGS AMBULANCE SERVICE, INC. |
|
|
|
|
|
David Mintz |
|
Chief Executive Officer |
POWER OF ATTORNEY
KNOW ALL PERSON BY THESE PRESENTS that each individual whose
signature appears below constitute and appoints William A.
Sanger and Randel G. Owen, and each of them, his or her true and
lawful attorneys-in-fact and agents, with full power of
substitution and resubstitution, for him or her and in his or
her name, place and stead, in any and all capacities (including
his or her capacity as a director and/or officer), to sign any
and all amendments (including post-effective amendments) to this
Registration Statement, and to file the same, with all exhibits
thereto, and all other documents in connection therewith, with
the Securities and Exchange Commission, granting unto said
attorneys-in-fact and agents, and each of them, full power and
authority to do and perform each and every act and thing
requisite and necessary to be done in and about the premises, as
fully to all intents and purposes as he or she might or could do
in person, hereby ratifying and confirming all that said
attorneys-in-fact and agents or either of them, or his, her or
their substitute or substitutes, may lawfully do or cause to be
done or by virtue hereof.
* * *
II-22
Pursuant to the requirements of the Securities Act, this
Registration Statement on Form S-4 and Power of Attorney
has been signed by the following persons in the capacities and
on the date indicated.
|
|
|
|
|
|
|
Signature |
|
Title |
|
Date |
|
|
|
|
|
|
/s/ David Mintz
David
Mintz |
|
President and Chief Executive Officer
(Principal Executive Officer) |
|
October 11, 2005 |
|
/s/ Randel G. Owen
Randel
G. Owen |
|
Chief Financial Officer (Principal
Financial and Accounting Officer) |
|
October 11, 2005 |
|
/s/ William A. Sanger
William
A. Sanger |
|
Director |
|
October 11, 2005 |
II-23
SIGNATURES
Pursuant to the requirements of the Securities Act, Emergency
Medical Services L.P. has duly caused this registration
statement to be signed on its behalf by the undersigned,
thereunto duly authorized, in Greenwood Village, State of
Colorado, on October 11, 2005.
|
|
|
AMERICAN MEDICAL RESPONSE NORTHWEST, INC. |
|
AMERICAN MEDICAL RESPONSE OF COLORADO, INC. |
|
AMERICAN MEDICAL RESPONSE OF ILLINOIS, INC. |
|
AMERICAN MEDICAL RESPONSE WEST |
|
INTERNATIONAL LIFE SUPPORT, INC. |
|
KUTZ AMBULANCE SERVICE, INC. |
|
LIFECARE AMBULANCE SERVICE, INC. |
|
MEDEVAC MEDICAL RESPONSE, INC. |
|
MEDEVAC MIDAMERICA, INC. |
|
MERCY LIFE CARE |
|
METROPOLITAN AMBULANCE SERVICETEK, INC. |
|
|
|
|
|
Louis Meyer |
|
Chief Executive Officer |
POWER OF ATTORNEY
KNOW ALL PERSON BY THESE PRESENTS that each individual whose
signature appears below constitute and appoints William A.
Sanger and Randel G. Owen, and each of them, his or her true and
lawful attorneys-in-fact and agents, with full power of
substitution and resubstitution, for him or her and in his or
her name, place and stead, in any and all capacities (including
his or her capacity as a director and/or officer), to sign any
and all amendments (including post-effective amendments) to this
Registration Statement, and to file the same, with all exhibits
thereto, and all other documents in connection therewith, with
the Securities and Exchange Commission, granting unto said
attorneys-in-fact and agents, and each of them, full power and
authority to do and perform each and every act and thing
requisite and necessary to be done in and about the premises, as
fully to all intents and purposes as he or she might or could do
in person, hereby ratifying and confirming all that said
attorneys-in-fact and agents or either of them, or his, her or
their substitute or substitutes, may lawfully do or cause to be
done or by virtue hereof.
* * *
II-24
Pursuant to the requirements of the Securities Act, this
Registration Statement on Form S-4 and Power of Attorney
has been signed by the following persons in the capacities and
on the date indicated.
|
|
|
|
|
|
|
Signature |
|
Title |
|
Date |
|
|
|
|
|
|
/s/ Louis Meyer
Louis
Meyer |
|
President and Chief Executive Officer
(Principal Executive Officer) |
|
October 11, 2005 |
|
/s/ Randel G. Owen
Randel
G. Owen |
|
Chief Financial Officer (Principal
Financial and Accounting Officer) |
|
October 11, 2005 |
|
/s/ William A. Sanger
William
A. Sanger |
|
Director |
|
October 11, 2005 |
II-25
SIGNATURES
Pursuant to the requirements of the Securities Act, Emergency
Medical Services L.P. has duly caused this registration
statement to be signed on its behalf by the undersigned,
thereunto duly authorized, in Greenwood Village, State of
Colorado, on October , 2005.
|
|
|
MEDI-CAR AMBULANCE SERVICE, INC. |
|
MEDI-CAR SYSTEMS, INC. |
|
RANDLE EASTERN AMBULANCE SERVICE, INC. |
|
|
|
|
|
Robert Garner |
|
Chief Executive Officer |
POWER OF ATTORNEY
KNOW ALL PERSON BY THESE PRESENTS that each individual whose
signature appears below constitute and appoints William A.
Sanger and Randel G. Owen, and each of them, his or her true and
lawful attorneys-in-fact and agents, with full power of
substitution and resubstitution, for him or her and in his or
her name, place and stead, in any and all capacities (including
his or her capacity as a director and/or officer), to sign any
and all amendments (including post-effective amendments) to this
Registration Statement, and to file the same, with all exhibits
thereto, and all other documents in connection therewith, with
the Securities and Exchange Commission, granting unto said
attorneys-in-fact and agents, and each of them, full power and
authority to do and perform each and every act and thing
requisite and necessary to be done in and about the premises, as
fully to all intents and purposes as he or she might or could do
in person, hereby ratifying and confirming all that said
attorneys-in-fact and agents or either of them, or his, her or
their substitute or substitutes, may lawfully do or cause to be
done or by virtue hereof.
* * *
Pursuant to the requirements of the Securities Act, this
Registration Statement on Form S-4 and Power of Attorney
has been signed by the following persons in the capacities and
on the date indicated.
|
|
|
|
|
|
|
Signature |
|
Title |
|
Date |
|
|
|
|
|
|
/s/ Robert Garner
Robert
Garner |
|
President and Chief Executive Officer
(Principal Executive Officer) |
|
October 11, 2005 |
|
/s/ Randel G. Owen
Randel
G. Owen |
|
Chief Financial Officer (Principal
Financial and Accounting Officer) |
|
October 11, 2005 |
|
/s/ William A. Sanger
William
A. Sanger |
|
Director |
|
October 11, 2005 |
II-26
SIGNATURES
Pursuant to the requirements of the Securities Act, Emergency
Medical Services L.P. has duly caused this registration
statement to be signed on its behalf by the undersigned,
thereunto duly authorized, in Greenwood Village, State of
Colorado, on October 11, 2005.
|
|
|
GLOBAL MEDICAL RESPONSE, INC. |
|
|
|
|
By: |
/s/ William A. Sanger
|
|
|
|
|
|
William A. Sanger |
|
Chief Executive Officer |
POWER OF ATTORNEY
KNOW ALL PERSON BY THESE PRESENTS that each individual whose
signature appears below constitute and appoints William A.
Sanger and Randel G. Owen, and each of them, his or her true and
lawful attorneys-in-fact and agents, with full power of
substitution and resubstitution, for him or her and in his or
her name, place and stead, in any and all capacities (including
his or her capacity as a director and/or officer), to sign any
and all amendments (including post-effective amendments) to this
Registration Statement, and to file the same, with all exhibits
thereto, and all other documents in connection therewith, with
the Securities and Exchange Commission, granting unto said
attorneys-in-fact and agents, and each of them, full power and
authority to do and perform each and every act and thing
requisite and necessary to be done in and about the premises, as
fully to all intents and purposes as he or she might or could do
in person, hereby ratifying and confirming all that said
attorneys-in-fact and agents or either of them, or his, her or
their substitute or substitutes, may lawfully do or cause to be
done or by virtue hereof.
* * *
Pursuant to the requirements of the Securities Act, this
Registration Statement on Form S-4 and Power of Attorney
has been signed by the following persons in the capacities and
on the date indicated.
|
|
|
|
|
|
|
Signature |
|
Title |
|
Date |
|
|
|
|
|
|
/s/ William A. Sanger
William
A. Sanger |
|
Chairman, Chief Executive Officer and Director (Principal
Executive Officer) |
|
October 11, 2005 |
|
/s/ Randel G. Owen
Randel
G. Owen |
|
Chief Financial Officer (Principal
Financial and Accounting Officer) |
|
October 11, 2005 |
|
/s/ Stephen Murphy
Stephen
Murphy |
|
President |
|
October 11, 2005 |
II-27
EXHIBIT INDEX
|
|
|
|
|
|
2 |
.1 |
|
Stock Purchase Agreement, dated as of December 6, 2004, by
and among Laidlaw International, Inc., Laidlaw Medical Holdings,
Inc. and Emergency Medical Services Corporation* |
|
2 |
.2 |
|
Amendment to Stock Purchase Agreement, dated February 10,
2005, by and among Laidlaw International, Inc., Laidlaw
Medical Holdings, Inc. and Emergency Medical Services
Corporation* |
|
2 |
.3 |
|
Stock Purchase Agreement, dated as of December 6, 2004, by
and among Laidlaw International, Inc., Laidlaw Medical Holdings,
Inc. and Emergency Medical Services Corporation* |
|
2 |
.4 |
|
Amendment to Stock Purchase Agreement, dated as of
February 10, 2005, by and among Laidlaw International,
Inc., Laidlaw Medical Holdings, Inc. and Emergency Medical
Services Corporation* |
|
2 |
.5 |
|
Letter, dated March 25, 2005, to AMR Holdco, Inc. from
Laidlaw Medical Holdings, Inc.* |
|
3 |
.1 |
|
Form of Amended and Restated Certificate of Incorporation of
Emergency Medical Services Corporation† |
|
3 |
.2 |
|
Form of Amended and Restated By-Laws of Emergency Medical
Services Corporation† |
|
3 |
.3 |
|
Certificate of Formation of Emergency Medical Services L.P.* |
|
3 |
.4 |
|
Agreement of Limited Partnership of Emergency Medical Services
L.P., dated February 10, 2005, by and among Emergency
Medical Services Corporation and the persons listed on
Schedule A thereto* |
|
3 |
.5 |
|
Amended and Restated Agreement of Limited Partnership of
Emergency Medical Services L.P., dated
September , 2005, by and among Emergency
Medical Services Corporation and the persons listed on
Schedule A thereto† |
|
3 |
.6 |
|
Certificate of Incorporation of AMR HoldCo, Inc. |
|
3 |
.7 |
|
Amended and Restated By-Laws of AMR HoldCo, Inc. |
|
3 |
.8 |
|
Certificate of Incorporation of EmCare HoldCo, Inc. |
|
3 |
.9 |
|
Amended and Restated By-Laws of EmCare HoldCo, Inc. |
|
3 |
.10 |
|
Certificate of Incorporation of Ambulance Acquisition, Inc.,
with amendments thereto |
|
3 |
.11 |
|
By-Laws of Ambulance Acquisition, Inc. |
|
3 |
.12 |
|
Articles of Incorporation of American Investment Enterprises,
Inc. |
|
3 |
.13 |
|
By-Laws of American Investment Enterprises, Inc. |
|
3 |
.14 |
|
Certificate of Incorporation of American Medical Pathways, Inc.,
with amendments thereto |
|
3 |
.15 |
|
By-Laws of American Medical Pathways, Inc. |
|
3 |
.16 |
|
Articles of Incorporation of American Medical Response
Northwest, Inc., with amendments thereto |
|
3 |
.17 |
|
By-Laws of American Medical Response Northwest, Inc. |
|
3 |
.18 |
|
Articles of Incorporation of American Medical Response West,
with amendments thereto |
|
3 |
.19 |
|
By-Laws of American Medical Response West |
|
3 |
.20 |
|
Certificate of Formation of American Medical Response Delaware
Valley, LLC |
|
3 |
.21 |
|
Limited Liability Company Agreement of American Medical Response
Delaware Valley, LLC |
|
3 |
.22 |
|
Certificate of Incorporation of American Medical Response of
Inland Empire, with amendments thereto |
|
3 |
.23 |
|
By-Laws of American Medical Response of Inland Empire (f.k.a.
Courtesy Services of San Bernardino, Inc.) |
|
3 |
.24 |
|
Articles of Incorporation of American Medical Response
Mid-Atlantic, Inc., with amendments thereto |
|
3 |
.25 |
|
By-Laws of American Medical Response Mid-Atlantic, Inc. |
|
3 |
.26 |
|
Certificate of Incorporation of American Medical Response, Inc.,
with amendments thereto |
|
3 |
.27 |
|
By-Laws of American Medical Response, Inc. |
|
3 |
.28 |
|
Certificate of Incorporation of American Medical Response of
Colorado, Inc., with amendments thereto |
|
3 |
.29 |
|
By-Laws of American Medical Response of Colorado, Inc. |
|
3 |
.30 |
|
Certificate of Incorporation of American Medical Response of
Connecticut, Incorporated, with amendments thereto |
|
3 |
.31 |
|
By-Laws of American Medical Response of Connecticut, Incorporated |
|
3 |
.32 |
|
Certificate of Incorporation of American Medical Response of
Illinois, Inc., with amendments thereto |
|
3 |
.33 |
|
By-Laws of American Medical Response of Illinois, Inc. |
|
3 |
.34 |
|
Certificate of Incorporation of American Medical Response of
Tennessee, Inc., with amendments thereto |
|
3 |
.35 |
|
By-Laws of American Medical Response of Tennessee, Inc. |
|
|
|
|
|
|
3 |
.36 |
|
Certificate of Incorporation of American Medical Response of
Oklahoma, Inc. |
|
3 |
.37 |
|
By-Laws of American Medical Response of Oklahoma, Inc. |
|
3 |
.38 |
|
Certificate of Incorporation of American Medical Response of
Texas, Inc., with amendments thereto |
|
3 |
.39 |
|
By-Laws of American Medical Response of Texas, Inc. |
|
3 |
.40 |
|
Articles of Incorporation of American Medical Response of
Southern California, with amendments thereto |
|
3 |
.41 |
|
By-Laws of American Medical Response of Southern California
(f.k.a. Goodhew American
Service, Inc.) |
|
3 |
.42 |
|
Certificate of Incorporation of American Medical Response
Holdings, Inc., with amendments thereto |
|
3 |
.43 |
|
By-Laws of American Medical Response Holdings, Inc. |
|
3 |
.44 |
|
Certificate of Incorporation of American Medical Response
Management, Inc., with amendments thereto |
|
3 |
.45 |
|
By-Laws of American Medical Response Management, Inc. |
|
3 |
.46 |
|
Certificate of Incorporation of American Medical Response of
Georgia, Inc., with amendments thereto |
|
3 |
.47 |
|
By-Laws of American Medical Response of Georgia, Inc. |
|
3 |
.48 |
|
Articles of Incorporation of American Medical Response of
Massachusetts, Inc., with amendments thereto |
|
3 |
.49 |
|
By-Laws of American Medical Response of Massachusetts, Inc. |
|
3 |
.50 |
|
Certificate of Incorporation of American Medical Response of
North Carolina, Inc., with amendments thereto |
|
3 |
.51 |
|
By-Laws of American Medical Response of North Carolina, Inc. |
|
3 |
.52 |
|
Certificate of Incorporation of American Medical Response of
South Carolina, Inc., with amendments thereto |
|
3 |
.53 |
|
By-Laws of American Medical Response of South Carolina, Inc. |
|
3 |
.54 |
|
Articles of Incorporation of A1 Leasing, Inc. |
|
3 |
.55 |
|
By-Laws of A1 Leasing, Inc. |
|
3 |
.56 |
|
Certificate of Formation of AMR Brockton, L.L.C. |
|
3 |
.57 |
|
Limited Liability Company Agreement of AMR Brockton, L.L.C. |
|
3 |
.58 |
|
Certificate of Incorporation of Associated Ambulance Service,
Inc., with amendments thereto |
|
3 |
.59 |
|
By-Laws of Associated Ambulance Service, Inc. |
|
3 |
.60 |
|
Certificate of Incorporation of Atlantic/ Palm Beach Ambulance,
Inc., with amendments thereto |
|
3 |
.61 |
|
By-Laws of Atlantic/ Palm Beach Ambulance, Inc. |
|
3 |
.62 |
|
Certificate of Incorporation of Atlantic/ Key West Ambulance,
Inc., with amendments thereto |
|
3 |
.63 |
|
By-Laws of Atlantic/ Key West Ambulance, Inc. |
|
3 |
.64 |
|
Certificate of Incorporation of Atlantic Ambulance Services
Acquisition, Inc., with amendments thereto |
|
3 |
.65 |
|
By-Laws of Atlantic Ambulance Services Acquisition, Inc. |
|
3 |
.66 |
|
Certificate of Incorporation of Broward Ambulance, Inc., with
amendments thereto |
|
3 |
.67 |
|
By-Laws of Broward Ambulance, Inc. |
|
3 |
.68 |
|
Articles of Incorporation of Desert Valley Medical Transport,
Inc., with amendments thereto |
|
3 |
.69 |
|
Amended and Restated By-Laws of Desert Valley Medical Transport,
Inc. |
|
3 |
.70 |
|
Certificate of Incorporation of Five Counties Ambulance Service,
Inc., with amendments thereto |
|
3 |
.71 |
|
By-Laws of Five Counties Ambulance Service, Inc. |
|
3 |
.72 |
|
Articles of Incorporation of Florida Emergency Partners, Inc. |
|
3 |
.73 |
|
By-Laws of Florida Emergency Partners, Inc. |
|
3 |
.74 |
|
Articles of Incorporation of Fountain Ambulance Service, Inc.,
with amendments thereto |
|
3 |
.75 |
|
By-Laws of Fountain Ambulance Service, Inc. |
|
3 |
.76 |
|
Certificate of Incorporation of Global Medical Response, Inc. |
|
3 |
.77 |
|
By-Laws of Global Medical Response, Inc. |
|
3 |
.78 |
|
Articles of Incorporation of Charles T. Mitchell, M.D.,
Inc., with amendments thereto |
|
3 |
.79 |
|
By-Laws of Charles T. Mitchell, M.D., Inc. |
|
3 |
.80 |
|
Articles of Incorporation of Coordinated Health Services, Inc.,
with amendments thereto |
|
3 |
.81 |
|
By-Laws of Coordinated Health Services, Inc. |
|
3 |
.82 |
|
Articles of Incorporation of Hank’s Acquisition Corp., with
amendments thereto |
|
3 |
.83 |
|
By-Laws of Hank’s Acquisition Corp. |
|
|
|
|
|
|
3 |
.84 |
|
Articles of Incorporation of Hemet Valley Ambulance Service, Inc. |
|
3 |
.85 |
|
By-Laws of Hemet Valley Ambulance Service, Inc. |
|
3 |
.86 |
|
Articles of Incorporation of International Life Support, Inc.,
with amendments thereto |
|
3 |
.87 |
|
By-Laws of International Life Support, Inc. |
|
3 |
.88 |
|
Articles of Incorporation of Kutz Ambulance Service, Inc., with
amendments thereto |
|
3 |
.89 |
|
Restated By-Laws of Kutz Ambulance Service, Inc. |
|
3 |
.90 |
|
Certificate of Incorporation of Laidlaw Medical Transportation,
Inc., with amendments thereto |
|
3 |
.91 |
|
By-Laws of Laidlaw Medical Transportation, Inc. |
|
3 |
.92 |
|
Articles of Incorporation of LifeCare Ambulance Service, Inc. |
|
3 |
.93 |
|
By-Laws of LifeCare Ambulance Service, Inc. |
|
3 |
.94 |
|
Articles of Incorporation of LifeFleet Southeast, Inc., with
amendments thereto |
|
3 |
.95 |
|
By-Laws of LifeFleet Southeast, Inc. (f.k.a. Pinellas Ambulance
Services, Inc.) |
|
3 |
.96 |
|
Articles of Incorporation of Medevac MidAmerica, Inc., with
amendments thereto |
|
3 |
.97 |
|
By-Laws of Medevac MidAmerica, Inc. |
|
3 |
.98 |
|
Articles of Incorporation Medevac Medical Response, Inc., with
amendments thereto |
|
3 |
.99 |
|
By-Laws of Medevac Medical Response, Inc. |
|
3 |
.100 |
|
Articles of Incorporation of Medi-Car Systems, Inc., with
amendments thereto |
|
3 |
.101 |
|
By-Laws of Medi-Car Systems, Inc. |
|
3 |
.102 |
|
Articles of Incorporation of Medi-Car Ambulance Service, Inc.,
with amendments thereto |
|
3 |
.103 |
|
By-Laws of Medi-Car Ambulance Service, Inc. |
|
3 |
.104 |
|
Articles of Incorporation of Medic One of Cobb, Inc. |
|
3 |
.105 |
|
By-Laws of Medic One of Cobb, Inc. |
|
3 |
.106 |
|
Certificate of Incorporation Medic One Ambulance Services, Inc.,
with amendments thereto |
|
3 |
.107 |
|
By-Laws of Medic One Ambulance Services, Inc. |
|
3 |
.108 |
|
Articles of Incorporation of MedLife Emergency Medical Service,
Inc., with amendments thereto |
|
3 |
.109 |
|
By-Laws of MedLife Emergency Medical Service, Inc. |
|
3 |
.110 |
|
Articles of Incorporation Mercy Ambulance of Evansville, Inc.,
with amendments thereto |
|
3 |
.111 |
|
By-Laws of Mercy Ambulance of Evansville, Inc. (f.k.a. Alexander
Ambulance Services, Inc.) |
|
3 |
.112 |
|
Articles of Incorporation Mercy, Inc., with amendments thereto |
|
3 |
.113 |
|
By-Laws of Mercy, Inc. |
|
3 |
.114 |
|
Restated Articles of Incorporation of Mercy Life Care |
|
3 |
.115 |
|
By-Laws of Mercy Life Care |
|
3 |
.116 |
|
Articles of Incorporation of The Gould Group, Inc., with
amendments thereto |
|
3 |
.117 |
|
By-Laws of The Gould Group, Inc. |
|
3 |
.118 |
|
Certificate of Incorporation of Metro Ambulance Service (Rural),
Inc., with amendments thereto |
|
3 |
.119 |
|
By-Laws of Metro Ambulance Service (Rural), Inc. |
|
3 |
.120 |
|
Certificate of Incorporation of Metro Ambulance Services, Inc.,
with amendments thereto |
|
3 |
.121 |
|
By-Laws of Metro Ambulance Services, Inc. |
|
3 |
.122 |
|
Articles of Incorporation of Metropolitan Ambulance Service,
with amendments thereto |
|
3 |
.123 |
|
By-Laws of Metropolitan Ambulance Service |
|
3 |
.124 |
|
Certificate of Incorporation of Midwest Ambulance Management
Company, with amendments thereto |
|
3 |
.125 |
|
By-Laws of Midwest Ambulance Management Company |
|
3 |
.126 |
|
Certificate of Incorporation of Mobile Medic Ambulance Service,
Inc. |
|
3 |
.127 |
|
By-Laws of Mobile Medic Ambulance Service, Inc. |
|
3 |
.128 |
|
Articles of Incorporation of Paramed, Inc., with amendments
thereto |
|
3 |
.129 |
|
By-Laws of Paramed, Inc. |
|
3 |
.130 |
|
Certificate of Incorporation of Park Ambulance Service Inc.,
with amendments thereto |
|
3 |
.131 |
|
By-Laws of Park Ambulance Service Inc. |
|
3 |
.132 |
|
Articles of Incorporation of Physicians & Surgeons
Ambulance Service, Inc., with amendments thereto |
|
3 |
.133 |
|
By-Laws of Physicians & Surgeons Ambulance Service, Inc. |
|
3 |
.134 |
|
Articles of Organization of ProvidaCare, L.L.C., with amendments
thereto |
|
3 |
.135 |
|
Limited Liability Company Agreement of ProvidaCare, L.L.C. |
|
3 |
.136 |
|
Articles of Incorporation of Puckett Ambulance Service, Inc.,
with amendments thereto |
|
3 |
.137 |
|
By-Laws of Puckett Ambulance Service, Inc. |
|
3 |
.138 |
|
Certificate of Incorporation of Randle Eastern Ambulance
Service, Inc., with amendments thereto |
|
|
|
|
|
|
3 |
.139 |
|
By-Laws of Randle Eastern Ambulance Service, Inc. (f.k.a. Dade
Miami Eastern Ambulance Services, Inc.) |
|
3 |
.140 |
|
Certificate of Limited Partnership of Regional Emergency
Services, LP |
|
3 |
.141 |
|
Amended and Restated Agreement of Limited Partnership of
Regional Emergency Services, LP |
|
3 |
.142 |
|
Certificate of Incorporation of Seminole County Ambulance, Inc.,
with amendments thereto |
|
3 |
.143 |
|
By-Laws of Seminole County Ambulance, Inc. |
|
3 |
.144 |
|
Articles of Incorporation of Springs Ambulance Service, Inc.,
with amendments thereto |
|
3 |
.145 |
|
By-Laws of Springs Ambulance Service, Inc. |
|
3 |
.146 |
|
Certificate of Incorporation of STAT Healthcare, Inc., with
amendments thereto |
|
3 |
.147 |
|
By-Laws of STAT Healthcare, Inc. (f.k.a. New STAT
Healthcare, Inc.) |
|
3 |
.148 |
|
Certificate of Incorporation of Sunrise Handicap Transport
Corp., with amendments thereto |
|
3 |
.149 |
|
By-Laws of Sunrise Handicap Transport Corp. |
|
3 |
.150 |
|
Articles of Incorporation of TEK, Inc. |
|
3 |
.151 |
|
By-Laws of TEK, Inc., with amendments thereto |
|
3 |
.152 |
|
Articles of Incorporation of Tidewater Ambulance Service, Inc.,
with amendments thereto |
|
3 |
.153 |
|
By-Laws of Tidewater Ambulance Service, Inc. |
|
3 |
.154 |
|
Articles of Incorporation of Troup County Emergency Medical
Services, Inc., with amendments thereto |
|
3 |
.155 |
|
By-Laws of Troup County Emergency Medical Services, Inc. |
|
3 |
.156 |
|
Restated Articles of Incorporation of American Emergency
Physicians Management, Inc. |
|
3 |
.157 |
|
By-Laws of American Emergency Physicians Management, Inc.
(f.k.a. American Emergency Physicians Medical Group, Inc.) |
|
3 |
.158 |
|
Restated Articles of Incorporation of Norman Bruce Jetton, Inc. |
|
3 |
.159 |
|
Amended and Restated By-Laws of Norman Bruce Jetton, Inc. |
|
3 |
.160 |
|
Articles of Incorporation of Tifton Management Services, Inc.,
with amendments thereto |
|
3 |
.161 |
|
By-Laws of Tifton Management Services, Inc. |
|
3 |
.162 |
|
Articles of Incorporation of Tucker Emergency Services, Inc.,
with amendments thereto |
|
3 |
.163 |
|
By-Laws of Tucker Emergency Services, Inc. |
|
3 |
.164 |
|
Certificate of Incorporation of Adams Transportation Services,
Inc., with amendments thereto |
|
3 |
.165 |
|
By-Laws of Adams Transportation Services, Inc. |
|
3 |
.166 |
|
Certificate of Incorporation of EM-CODE Reimbursement Solutions,
Inc., with amendments thereto |
|
3 |
.167 |
|
By-Laws of EM-CODE Reimbursement Solutions, Inc. |
|
3 |
.168 |
|
Articles of Incorporation of EmCare of Arizona, Inc., with
amendments thereto |
|
3 |
.169 |
|
By-Laws of EmCare of Arizona, Inc. |
|
3 |
.170 |
|
Restated and Amended Articles of Incorporation of EmCare of
California, Inc., with amendments thereto |
|
3 |
.171 |
|
By-Laws of EmCare of California, Inc. |
|
3 |
.172 |
|
Articles of Incorporation of EmCare of Colorado, Inc. |
|
3 |
.173 |
|
By-Laws of EmCare of Colorado, Inc. |
|
3 |
.174 |
|
Certificate of Incorporation of EmCare of Connecticut, Inc.,
with amendments thereto |
|
3 |
.175 |
|
By-Laws of EmCare of Connecticut, Inc. |
|
3 |
.176 |
|
Articles of Incorporation of EmCare of Florida, Inc., with
amendments thereto |
|
3 |
.177 |
|
By-Laws of EmCare of Florida, Inc. |
|
3 |
.178 |
|
Articles of Incorporation of EmCare of Georgia, Inc. |
|
3 |
.179 |
|
By-Laws of EmCare of Georgia, Inc. |
|
3 |
.180 |
|
Articles of Incorporation of EmCare of Hawaii, Inc., with
amendments thereto |
|
3 |
.181 |
|
By-Laws of EmCare of Hawaii, Inc. |
|
3 |
.182 |
|
Articles of Incorporation of EmCare of Indiana, Inc., with
amendments thereto |
|
3 |
.183 |
|
By-Laws of EmCare of Indiana, Inc. |
|
3 |
.184 |
|
Articles of Incorporation of EmCare of Iowa, Inc., with
amendments thereto |
|
3 |
.185 |
|
By-Laws of EmCare of Iowa, Inc. |
|
3 |
.186 |
|
Articles of Incorporation of EmCare of Kentucky, Inc. |
|
3 |
.187 |
|
By-Laws of EmCare of Kentucky, Inc. |
|
3 |
.188 |
|
Articles of Incorporation of EmCare of Louisiana, Inc., with
amendments thereto |
|
3 |
.189 |
|
By-Laws of EmCare of Louisiana, Inc. |
|
3 |
.190 |
|
Articles of Incorporation of EmCare of Maine, Inc. |
|
3 |
.191 |
|
By-Laws of EmCare of Maine, Inc. |
|
3 |
.192 |
|
Articles of Incorporation of EmCare of Michigan, Inc., with
amendments thereto |
|
|
|
|
|
|
3 |
.193 |
|
By-Laws of EmCare of Michigan, Inc. |
|
3 |
.194 |
|
Articles of Incorporation of EmCare of Minnesota, Inc. |
|
3 |
.195 |
|
By-Laws of EmCare of Minnesota, Inc. |
|
3 |
.196 |
|
Articles of Incorporation of EmCare of Mississippi, Inc. |
|
3 |
.197 |
|
By-Laws of EmCare of Mississippi, Inc. |
|
3 |
.198 |
|
Articles of Incorporation of EmCare of Missouri, Inc. |
|
3 |
.199 |
|
By-Laws of EmCare of Missouri, Inc. |
|
3 |
.200 |
|
Articles of Incorporation of EmCare of Nevada, Inc., with
amendments thereto |
|
3 |
.201 |
|
By-Laws of EmCare of Nevada, Inc. |
|
3 |
.202 |
|
Articles of Incorporation of EmCare of New Hampshire, Inc. |
|
3 |
.203 |
|
By-Laws of EmCare of New Hampshire, Inc. |
|
3 |
.204 |
|
Certificate of Incorporation of EmCare of New Jersey, Inc. |
|
3 |
.205 |
|
By-Laws of EmCare of New Jersey, Inc. |
|
3 |
.206 |
|
Articles of Incorporation of EmCare Contract of Arkansas, Inc.,
with amendments thereto |
|
3 |
.207 |
|
By-Laws of EmCare Contract of Arkansas, Inc. |
|
3 |
.208 |
|
Certificate of Incorporation of EmCare of New York, Inc., with
amendments thereto |
|
3 |
.209 |
|
By-Laws of EmCare of New York, Inc. |
|
3 |
.210 |
|
Articles of Incorporation of EmCare of North Carolina, Inc.,
with amendments thereto |
|
3 |
.211 |
|
By-Laws of EmCare of North Carolina, Inc. |
|
3 |
.212 |
|
Articles of Incorporation of EmCare of North Dakota, Inc. |
|
3 |
.213 |
|
By-Laws of EmCare of North Dakota, Inc. |
|
3 |
.214 |
|
Articles of Incorporation of EmCare of Ohio, Inc., with
amendments thereto |
|
3 |
.215 |
|
By-Laws of EmCare of Ohio, Inc. |
|
3 |
.216 |
|
Certificate of Incorporation of EmCare of Oklahoma, Inc., with
amendments thereto |
|
3 |
.217 |
|
By-Laws of EmCare of Oklahoma, Inc. |
|
3 |
.218 |
|
Articles of Incorporation of EmCare of Oregon, Inc. |
|
3 |
.219 |
|
By-Laws of EmCare of Oregon, Inc. |
|
3 |
.220 |
|
Articles of Incorporation of EmCare of Pennsylvania, Inc., with
amendments thereto |
|
3 |
.221 |
|
By-Laws of EmCare of Pennsylvania, Inc. |
|
3 |
.222 |
|
Articles of Incorporation of EmCare of Rhode Island, Inc., with
amendments thereto |
|
3 |
.223 |
|
By-Laws of EmCare of Rhode Island, Inc. |
|
3 |
.224 |
|
Articles of Incorporation of EmCare of South Carolina, Inc.,
with amendments thereto |
|
3 |
.225 |
|
By-Laws of EmCare of South Carolina, Inc. |
|
3 |
.226 |
|
Charter of EmCare of Tennessee, Inc., with amendments thereto |
|
3 |
.227 |
|
By-Laws of EmCare of Tennessee, Inc. |
|
3 |
.228 |
|
Articles of Incorporation of EmCare of Texas, Inc., with
amendments thereto |
|
3 |
.229 |
|
By-Laws of EmCare of Texas, Inc. |
|
3 |
.230 |
|
Articles of Incorporation of EmCare of Vermont, Inc. |
|
3 |
.231 |
|
By-Laws of EmCare of Vermont, Inc. |
|
3 |
.232 |
|
Articles of Incorporation of EmCare of Virginia, Inc. |
|
3 |
.233 |
|
By-Laws of EmCare of Virginia, Inc. |
|
3 |
.234 |
|
Articles of Incorporation of EmCare of Washington, Inc. |
|
3 |
.235 |
|
By-Laws of EmCare of Washington, Inc. |
|
3 |
.236 |
|
Articles of Incorporation of EmCare of West Virginia, Inc. |
|
3 |
.237 |
|
By-Laws of EmCare of West Virginia, Inc. |
|
3 |
.238 |
|
Articles of Incorporation of EmCare of Wisconsin, Inc. |
|
3 |
.239 |
|
By-Laws of EmCare of Wisconsin, Inc. |
|
3 |
.240 |
|
Articles of Incorporation of EmCare Physician Providers, Inc.,
with amendments thereto |
|
3 |
.241 |
|
By-Laws of EmCare Physician Providers, Inc. (f.k.a. Spectrum
Emergency Care, Inc.) |
|
3 |
.242 |
|
Certificate of Incorporation of EmCare Physician Services, Inc.,
with amendments thereto |
|
3 |
.243 |
|
By-Laws of EmCare Physician Services, Inc. (f.k.a. Spectrum
Physician and Allied Health
Services, Inc.) |
|
3 |
.244 |
|
Articles of Incorporation of EmCare Services of Illinois, Inc.,
with amendments thereto |
|
3 |
.245 |
|
By-Laws of EmCare Services of Illinois, Inc. |
|
3 |
.246 |
|
Articles of Organization of EmCare Services of Massachusetts,
Inc., with amendments thereto |
|
3 |
.247 |
|
By-Laws of EmCare Services of Massachusetts, Inc. |
|
3 |
.248 |
|
Certificate of Incorporation of EmCare Anesthesia Services,
Inc., with amendments thereto |
|
3 |
.249 |
|
By-Laws of EmCare Anesthesia Services, Inc. (f.k.a. Spectrum
Anesthesia Services, Inc.) |
|
|
|
|
|
|
3 |
.250 |
|
Articles of Organization of EmCare of Maryland LLC, with
amendments thereto |
|
3 |
.251 |
|
Operating Agreement of EmCare of Maryland LLC (f.k.a. Capital
Equity Associates, LLC) |
|
3 |
.252 |
|
Articles of Incorporation of EmCare of Alabama, Inc. |
|
3 |
.253 |
|
By-Laws of EmCare of Alabama, Inc. |
|
3 |
.254 |
|
Restated Certificate of Incorporation of EmCare Holdings Inc. |
|
3 |
.255 |
|
By-Laws of EmCare Holdings Inc. |
|
3 |
.256 |
|
Certificate of Incorporation of EmCare, Inc., with amendments
thereto |
|
3 |
.257 |
|
By-Laws of EmCare, Inc. |
|
3 |
.258 |
|
Certificate of Incorporation of ECEP, Inc. |
|
3 |
.259 |
|
By-Laws of ECEP, Inc. |
|
3 |
.260 |
|
Articles of Incorporation of EmCare of New Mexico, Inc., with
amendments thereto |
|
3 |
.261 |
|
By-Laws of EmCare of New Mexico, Inc. |
|
3 |
.262 |
|
Articles of Incorporation of Emergency Medicine Education
Systems, Inc. |
|
3 |
.263 |
|
By-Laws of Emergency Medicine Education Systems, Inc. |
|
3 |
.264 |
|
Articles of Incorporation of Emergency Specialists of Arkansas,
Inc. II |
|
3 |
.265 |
|
By-Laws of Emergency Specialists of Arkansas, Inc. II |
|
3 |
.266 |
|
Amended and Restated Articles of Incorporation of First Medical/
EmCare, Inc. |
|
3 |
.267 |
|
By-Laws of First Medical/ EmCare, Inc. |
|
3 |
.268 |
|
Certificate of Incorporation of Healthcare Administrative
Services, Inc., with amendments thereto |
|
3 |
.269 |
|
By-Laws of Healthcare Administrative Services, Inc. (f.k.a.
Spectrum Healthcare Administrative Services, Inc.) |
|
3 |
.270 |
|
Restated Articles of Incorporation of Helix Physicians
Management, Inc. |
|
3 |
.271 |
|
By-Laws of Helix Physicians Management, Inc. |
|
3 |
.272 |
|
Restated and Amended Articles of Incorporation of OLD STAT,
Inc., with amendments thereto |
|
3 |
.273 |
|
By-Laws of OLD STAT, Inc. (f.k.a. STAT Healthcare, Inc.) |
|
3 |
.274 |
|
Restated Articles of Incorporation of Pacific Emergency
Specialists Management, Inc., with amendments thereto |
|
3 |
.275 |
|
Amended and Restated By-Laws of Pacific Emergency Specialists
Management, Inc. |
|
3 |
.276 |
|
Articles of Incorporation of Physician Account Management,
Inc. |
|
3 |
.277 |
|
By-Laws of Physician Account Management, Inc. |
|
3 |
.278 |
|
Certificate of Incorporation of Provider
Account Management, Inc. |
|
3 |
.279 |
|
By-Laws of Provider Account Management, Inc. |
|
3 |
.280 |
|
Articles of Incorporation of Reimbursement Technologies, Inc. |
|
3 |
.281 |
|
Amended and Restated By-Laws of Reimbursement Technologies, Inc. |
|
3 |
.282 |
|
Articles of Incorporation of STAT Physicians, Inc. |
|
3 |
.283 |
|
By-Laws of STAT Physicians, Inc. |
|
3 |
.284 |
|
Certificate of Formation of EMS Management LLC |
|
3 |
.285 |
|
Operating Agreement of EMS Management LLC |
|
4 |
.1 |
|
Form of Class A Common Stock Certificate† |
|
4 |
.2 |
|
Form of Class B Common Stock Certificate† |
|
4 |
.3 |
|
Investor Equityholders Agreement, dated February 10, 2005,
by and among Emergency Medical Services L.P., Onex
Partners LP and the equityholders listed on the signature
pages thereto* |
|
4 |
.4 |
|
Equityholders Agreement, dated as of February 10, 2005, by
and among Emergency Medical Services L.P., Onex
Partners LP and the equityholders listed on the signature
pages thereto** |
|
4 |
.5 |
|
Registration Agreement, dated February 10, 2005, by and
among Emergency Medical Services L.P. and the persons
listed on Schedule A thereto and amendment thereto** |
|
4 |
.6 |
|
Indenture, dated February 10, 2005, by and among AMR
HoldCo, Inc., EmCare HoldCo, Inc., the guarantors named therein
and U.S. Bank Trust National Association, as trustee* |
|
4 |
.7 |
|
Supplemental Indenture, dated April 15, 2005, by and among
AMR Brockton L.L.C., AMR HoldCo, Inc., EmCare HoldCo, Inc., the
guarantors named therein and U.S. Bank Trust National
Association, as trustee* |
|
4 |
.8 |
|
Registration Rights Agreement, dated as of February 10,
2005, by and among AMR HoldCo, Inc., EmCare HoldCo, Inc., the
guarantors named therein, Banc of America Securities LLC and
J.P. Morgan Securities Inc.* |
|
4 |
.9 |
|
Voting and Exchange Trust Agreement, dated as
of ,
2005, among Emergency Medical Services Corporation, Emergency
Medical Services L.P. and Onex Corporation† |
|
4 |
.10 |
|
Form of 10% Senior Subordinated Note due 2015 (included in
Exhibit 4.6) |
|
4 |
.11 |
|
Notation of Guarantee, dated as of February 10, 2005,
executed by the Guarantors identified therein |
|
|
|
|
|
|
5 |
.1 |
|
Opinion of Kaye Scholer LLP with respect to legality of
securities being registered† |
|
5 |
.2 |
|
Opinion of Todd G. Zimmerman, Esq.† |
|
9 |
.1 |
|
Voting and Exchange Trust Agreement, dated as
of ,
2005, among Emergency Medical Services Corporation, Emergency
Medical Services L.P. and Onex Corporation (incorporated by
reference to Exhibit 4.9 to this Registration Statement)† |
|
10 |
.1 |
|
Employment Agreement, dated December 6, 2004, between
William A. Sanger and Emergency Medical Services Corporation* |
|
10 |
.2 |
|
Employment Agreement, dated as of February 10, 2005,
between Don S. Harvey and Emergency Medical Services L.P., and
assignment to Emergency Medical Services Corporation* |
|
10 |
.3 |
|
Employment Agreement, dated as of February 10, 2005,
between Randel G. Owen and Emergency Medical Services L.P., and
assignment to Emergency Medical Services Corporation* |
|
10 |
.4 |
|
Employment Agreement, dated as of February 10, 2005,
between Todd Zimmerman and Emergency Medical Services L.P., and
assignment to Emergency Medical Services Corporation* |
|
10 |
.5 |
|
Employment Agreement, dated as of April 19, 2005, by and
between Emergency Medical Services L.P. and Dighton Packard,
M.D., and assignment to Emergency Medical Services Corporation.* |
|
10 |
.6 |
|
Emergency Medical Services L.P. Equity Option Plan* |
|
10 |
.7 |
|
Emergency Medical Services L.P. Equity Purchase Plan* |
|
10 |
.8 |
|
Management Agreement, dated February 10, 2005, by and among
Onex Partners Manager LP, AMR HoldCo, Inc. and EmCare HoldCo,
Inc.* |
|
10 |
.9 |
|
Purchase Agreement, dated January 27, 2005, among AMR
HoldCo, Inc., EmCare HoldCo, Inc., the Registrant, the
guarantors party thereto, Banc of America LLC Securities and
J.P. Morgan Securities Inc.* |
|
10 |
.10 |
|
Credit Agreement, dated as of February 10, 2005, among AMR
HoldCo, Inc., EmCare HoldCo, Inc., Emergency Medical Services
L.P., the guarantors party thereto, Bank of America, N.A. and
the other lenders party thereto* |
|
10 |
.11 |
|
Amendment No. 1, dated March 29, 2005, among AMR
HoldCo, Inc., EmCare HoldCo, Emergency Medical Services L.P.,
the guarantors and the lenders party thereto, to the Credit
Agreement dated as of February 10, 2005, among AMR HoldCo,
Inc., EmCare HoldCo, Inc., Emergency Medical Services L.P., the
guarantors party thereto, Bank of America, N.A. and the other
lenders party thereto* |
|
10 |
.12 |
|
Security Agreement, dated as of February 10, 2005, made by
AMR HoldCo, Inc., EmCare HoldCo., Inc., the guarantors party
thereto, in favor of Bank of America, N.A.* |
|
11 |
.1 |
|
Statement regarding computation of earnings per share† |
|
12 |
.1 |
|
Statement regarding computation of ratios† |
|
21 |
.1 |
|
Subsidiaries of Emergency Medical Services L.P.* |
|
23 |
.1 |
|
Consent of PriceWaterhouseCoopers LLP |
|
23 |
.2 |
|
Consent of Kaye Scholer LLP (included in Exhibit 5.1)† |
|
24 |
.1 |
|
Powers of Attorney of the directors of Emergency Medical
Services L.P. (included in the signature pages to the
registration statement) |
|
24 |
.2 |
|
Powers of Attorney of the directors and certain officers of the
Additional Registrants (included in the signature pages to the
Registration Statement) |
|
25 |
.1 |
|
Statement of Eligibility on Form T-1 of Trustee under the
Indenture, dated as of September 30, 2005, among AMR
HoldCo, Inc., EmCare HoldCo, Inc., the guarantors named therein
and U.S. Bank Trust National Association, as Trustee |
|
99 |
.1 |
|
Form of Letter of Transmittal |
|
99 |
.2 |
|
Form of Notice of Guaranteed Delivery |
|
|
* |
Incorporated by reference to Exhibits to the Emergency Medical
Services’ Registration Statement on Form S-1 filed on
August 2, 2005 |
|
|
** |
Incorporated by reference to Exhibits to the Emergency Medical
Services’ Amendment No. 1 to Registration Statement on
Form S-1 filed on September 14, 2005 |
|
† |
To be filed by amendment |