Delaware | 001-37955 | 62-1493316 |
(State or Other Jurisdiction of Incorporation) | (Commission File Number) | (I.R.S. Employer Identification No.) |
1A Burton Hills Boulevard | ||
Nashville, Tennessee | 37215 | |
(Address of Principal Executive Offices) | (Zip Code) |
Yes [X] | No [ ] |
Yes [X] | No [ ] |
Large accelerated filer [X] | Accelerated filer [ ] |
Non-accelerated filer [ ] | Smaller reporting company [ ] |
(Do not check if a smaller reporting company) | Emerging growth company [ ] |
Yes [ ] | No [X] |
i |
Envision Healthcare Corporation Consolidated Balance Sheets (unaudited) (Dollars in millions, shares in thousands) | |||||||
March 31, | December 31, | ||||||
2018 | 2017 | ||||||
Assets | |||||||
Current assets: | |||||||
Cash and cash equivalents | $ | 767.4 | $ | 312.2 | |||
Insurance collateral | 113.5 | 86.2 | |||||
Accounts receivable, net of allowance of $2,554.5 at December 31, 2017 | 1,532.8 | 1,405.8 | |||||
Supplies inventory | 22.1 | 22.7 | |||||
Prepaid and other current assets | 98.2 | 165.6 | |||||
Current assets held for sale | — | 2,751.8 | |||||
Total current assets | 2,534.0 | 4,744.3 | |||||
Property and equipment, net | 284.0 | 302.7 | |||||
Investments in unconsolidated affiliates | 157.4 | 156.7 | |||||
Goodwill | 7,570.7 | 7,536.1 | |||||
Intangible assets, net | 3,657.7 | 3,665.5 | |||||
Other assets | 180.7 | 167.3 | |||||
Total assets | $ | 14,384.5 | $ | 16,572.6 | |||
Liabilities and Equity | |||||||
Current liabilities: | |||||||
Current portion of long-term debt | $ | 12.7 | $ | 52.1 | |||
Accounts payable | 50.4 | 62.2 | |||||
Accrued salaries and benefits | 471.0 | 548.0 | |||||
Accrued interest | 35.1 | 52.1 | |||||
Other accrued liabilities | 549.1 | 281.6 | |||||
Current liabilities held for sale | — | 399.1 | |||||
Total current liabilities | 1,118.3 | 1,395.1 | |||||
Long-term debt, net of deferred financing costs of $93.0 and $97.3, respectively | 4,608.5 | 6,263.3 | |||||
Deferred income taxes | 902.8 | 1,089.3 | |||||
Insurance reserves | 323.5 | 318.5 | |||||
Other long-term liabilities | 155.6 | 149.9 | |||||
Commitments and contingencies | |||||||
Noncontrolling interests – redeemable | 186.3 | 187.1 | |||||
Equity: | |||||||
Common stock, $0.01 par value, 1,000,000 shares authorized, 121,105 and 121,021 shares issued and outstanding, respectively | 1.2 | 1.2 | |||||
Additional paid-in capital | 6,012.6 | 6,008.9 | |||||
Retained earnings | 436.9 | 521.2 | |||||
Accumulated other comprehensive income (loss) | 0.8 | (4.2 | ) | ||||
Total Envision Healthcare Corporation equity | 6,451.5 | 6,527.1 | |||||
Noncontrolling interests – non-redeemable | 638.0 | 642.3 | |||||
Total equity | 7,089.5 | 7,169.4 | |||||
Total liabilities and equity | $ | 14,384.5 | $ | 16,572.6 |
1 |
Item 1. Financial Statements - (continued) |
Envision Healthcare Corporation Consolidated Statements of Operations (unaudited) (Dollars in millions, except earnings per share) | |||||||
Three Months Ended March 31, | |||||||
2018 | 2017 | ||||||
Revenues | $ | 2,077.0 | $ | 2,855.8 | |||
Provision for uncollectibles (see Note 3) | — | (977.2 | ) | ||||
Net revenue | 2,077.0 | 1,878.6 | |||||
Operating expenses: | |||||||
Salaries and benefits | 1,538.9 | 1,359.0 | |||||
Supply cost | 54.4 | 54.1 | |||||
Insurance expense | 47.6 | 37.6 | |||||
Other operating expenses | 190.8 | 184.1 | |||||
Transaction and integration costs | 21.4 | 21.5 | |||||
Impairment charges | 0.7 | 0.3 | |||||
Depreciation and amortization | 70.6 | 71.3 | |||||
Total operating expenses | 1,924.4 | 1,727.9 | |||||
Net gain (loss) on disposals and deconsolidations | (1.0 | ) | 0.3 | ||||
Equity in earnings of unconsolidated affiliates | 5.8 | 4.9 | |||||
Operating income | 157.4 | 155.9 | |||||
Interest expense, net | 63.6 | 52.4 | |||||
Other income (expense), net | (0.2 | ) | 1.1 | ||||
Earnings from continuing operations before income taxes | 93.6 | 104.6 | |||||
Income tax expense | 5.5 | 17.5 | |||||
Net earnings from continuing operations | 88.1 | 87.1 | |||||
Discontinued operations: | |||||||
Earnings from discontinued operations | 3.5 | 10.0 | |||||
Income tax expense from discontinued operations | (126.8 | ) | (488.2 | ) | |||
Net loss from discontinued operations | (123.3 | ) | (478.2 | ) | |||
Net loss | (35.2 | ) | (391.1 | ) | |||
Less net earnings attributable to noncontrolling interests | 51.2 | 54.1 | |||||
Net loss attributable to Envision Healthcare Corporation stockholders | (86.4 | ) | (445.2 | ) | |||
Preferred stock dividends | — | (2.3 | ) | ||||
Net loss attributable to Envision Healthcare Corporation common stockholders | $ | (86.4 | ) | $ | (447.5 | ) | |
Amounts attributable to Envision Healthcare Corporation common stockholders: | |||||||
Earnings from continuing operations, net of income tax | $ | 36.9 | $ | 30.7 | |||
Loss from discontinued operations, net of income tax | (123.3 | ) | (478.2 | ) | |||
Net loss attributable to Envision Healthcare Corporation common stockholders | $ | (86.4 | ) | $ | (447.5 | ) | |
Basic earnings (loss) per share attributable to common stockholders: | |||||||
Net earnings from continuing operations | $ | 0.31 | $ | 0.26 | |||
Net loss from discontinued operations | (1.02 | ) | (4.10 | ) | |||
Net loss | $ | (0.72 | ) | $ | (3.84 | ) | |
Diluted earnings (loss) per share attributable to common stockholders: | |||||||
Net earnings from continuing operations | $ | 0.30 | $ | 0.26 | |||
Net loss from discontinued operations | (1.01 | ) | (4.10 | ) | |||
Net loss | $ | (0.71 | ) | $ | (3.84 | ) | |
Weighted average number of shares and share equivalents outstanding: | |||||||
Basic | 120,552 | 116,563 | |||||
Diluted | 122,354 | 119,475 |
2 |
Item 1. Financial Statements - (continued) |
Envision Healthcare Corporation Consolidated Statements of Comprehensive Income (unaudited) (In millions) | |||||||
Three Months Ended March 31, | |||||||
2018 | 2017 | ||||||
Net loss | $ | (35.2 | ) | $ | (391.1 | ) | |
Other comprehensive income, net of income tax: | |||||||
Unrealized holding gain during the period, net of income tax | 0.9 | 0.9 | |||||
Comprehensive loss, net of income tax | (34.3 | ) | (390.2 | ) | |||
Less comprehensive income attributable to noncontrolling interests | 51.2 | 54.1 | |||||
Comprehensive loss attributable to Envision Healthcare Corporation stockholders | $ | (85.5 | ) | $ | (444.3 | ) |
3 |
Item 1. Financial Statements - (continued) |
Envision Healthcare Corporation Consolidated Statements of Changes in Equity (unaudited) (Dollars in millions, shares in thousands) | |||||||||||||||||||||||||||||||||||||
Envision Healthcare Corporation Stockholders | Noncontrolling | ||||||||||||||||||||||||||||||||||||
Accumulated | Noncontrolling | Interests – | |||||||||||||||||||||||||||||||||||
Additional | Other | Interests – | Total | Redeemable | |||||||||||||||||||||||||||||||||
Common Stock | Preferred Stock | Paid-in | Retained | Comprehensive | Non- | Equity | (Temporary | ||||||||||||||||||||||||||||||
Shares | Amount | Shares | Amount | Capital | Earnings | Income (Loss) | Redeemable | (Permanent) | Equity) | ||||||||||||||||||||||||||||
Balance at December 31, 2017 | 121,021 | $ | 1.2 | — | $ | — | $ | 6,008.9 | $ | 521.2 | $ | (4.2 | ) | $ | 642.3 | $ | 7,169.4 | $ | 187.1 | ||||||||||||||||||
Net earnings (loss) | — | — | — | — | — | (86.4 | ) | — | 18.5 | (67.9 | ) | 32.7 | |||||||||||||||||||||||||
Issuance of restricted stock | 139 | — | — | — | — | — | — | — | — | — | |||||||||||||||||||||||||||
Stock options exercised | 39 | — | — | — | 0.3 | — | — | — | 0.3 | — | |||||||||||||||||||||||||||
Stock repurchased | (94 | ) | — | — | — | (6.3 | ) | — | — | — | (6.3 | ) | — | ||||||||||||||||||||||||
Share-based compensation | — | — | — | — | 7.4 | — | — | — | 7.4 | — | |||||||||||||||||||||||||||
Acquisitions and other transactions impacting noncontrolling interests | — | — | — | — | 3.5 | — | — | (4.7 | ) | (1.2 | ) | — | |||||||||||||||||||||||||
Distributions to noncontrolling interests, net of capital contributions | — | — | — | — | — | — | — | (18.9 | ) | (18.9 | ) | (33.9 | ) | ||||||||||||||||||||||||
Disposals and other transactions impacting noncontrolling interests | — | — | — | — | (1.2 | ) | — | 5.7 | 0.8 | 5.3 | 0.4 | ||||||||||||||||||||||||||
Unrealized holding gain on investments, net of income tax | — | — | — | — | — | — | 0.9 | — | 0.9 | — | |||||||||||||||||||||||||||
Cumulative effect of accounting change | — | — | — | — | — | 2.1 | (1.6 | ) | — | 0.5 | — | ||||||||||||||||||||||||||
Balance at March 31, 2018 | 121,105 | $ | 1.2 | — | $ | — | $ | 6,012.6 | $ | 436.9 | $ | 0.8 | $ | 638.0 | $ | 7,089.5 | $ | 186.3 | |||||||||||||||||||
Balance at January 1, 2017 | 117,478 | $ | 1.2 | 1,725 | $ | 0.1 | $ | 5,976.3 | $ | 753.7 | $ | (0.2 | ) | $ | 656.8 | $ | 7,387.9 | $ | 182.9 | ||||||||||||||||||
Net earnings (loss) | — | — | — | — | — | (445.2 | ) | — | 18.8 | (426.4 | ) | 35.3 | |||||||||||||||||||||||||
Issuance of restricted stock | 21 | — | — | — | — | — | — | — | — | — | |||||||||||||||||||||||||||
Stock options exercised | 149 | — | — | — | 1.1 | — | — | — | 1.1 | — | |||||||||||||||||||||||||||
Stock repurchased | (128 | ) | — | — | — | (8.7 | ) | — | — | — | (8.7 | ) | — | ||||||||||||||||||||||||
Share-based compensation | — | — | — | — | 16.1 | — | — | — | 16.1 | — | |||||||||||||||||||||||||||
Dividends paid on preferred stock | — | — | — | — | — | (2.3 | ) | — | — | (2.3 | ) | — | |||||||||||||||||||||||||
Acquisitions and other transactions impacting noncontrolling interests | — | — | — | — | 0.6 | — | — | 13.0 | 13.6 | — | |||||||||||||||||||||||||||
Distributions to noncontrolling interests, net of capital contributions | — | — | — | — | — | — | — | (23.6 | ) | (23.6 | ) | (36.0 | ) | ||||||||||||||||||||||||
Disposals and other transactions impacting noncontrolling interests | — | — | — | — | (2.6 | ) | — | — | (7.6 | ) | (10.2 | ) | 0.4 | ||||||||||||||||||||||||
Unrealized holding gain on investments, net of income tax | — | — | — | — | — | — | 0.9 | — | 0.9 | — | |||||||||||||||||||||||||||
Balance at March 31, 2017 | 117,520 | $ | 1.2 | 1,725 | $ | 0.1 | $ | 5,982.8 | $ | 306.2 | $ | 0.7 | $ | 657.4 | $ | 6,948.4 | $ | 182.6 |
4 |
Item 1. Financial Statements - (continued) |
Envision Healthcare Corporation Consolidated Statements of Cash Flows (unaudited) (In millions) | ||||||||
Three Months Ended March 31, | ||||||||
2018 | 2017 | |||||||
Cash flows from operating activities: | ||||||||
Net loss | $ | (35.2 | ) | $ | (391.1 | ) | ||
Adjustments to reconcile net loss to net cash flows provided by operating activities: | ||||||||
Depreciation and amortization | 100.0 | 105.5 | ||||||
Amortization of deferred loan costs | 4.3 | 4.2 | ||||||
Provision for uncollectibles | — | 1,196.2 | ||||||
Net (gain) loss on disposals and deconsolidations | 1.0 | (0.3 | ) | |||||
Share-based compensation | 7.4 | 16.1 | ||||||
Deferred income taxes | 27.9 | 504.2 | ||||||
Equity in earnings of unconsolidated affiliates | (5.8 | ) | (5.1 | ) | ||||
Impairment charges | 0.7 | 0.3 | ||||||
Gain on held for sale assets | (14.7 | ) | — | |||||
Increases (decreases) in cash, cash equivalents, restricted cash, and restricted cash equivalents net of acquisitions and dispositions: | ||||||||
Accounts receivable | (40.5 | ) | (1,243.2 | ) | ||||
Supplies inventory | 0.2 | (0.7 | ) | |||||
Prepaid and other current assets | (2.3 | ) | 1.9 | |||||
Accounts payable | (22.6 | ) | (8.9 | ) | ||||
Accrued expenses and other liabilities | 23.0 | (84.7 | ) | |||||
Other, net | (6.1 | ) | 3.7 | |||||
Net cash flows provided by operating activities | 37.3 | 98.1 | ||||||
Cash flows from investing activities: | ||||||||
Acquisitions and related expenses, net of cash acquired | (71.6 | ) | (73.1 | ) | ||||
Acquisition of property and equipment | (45.3 | ) | (40.7 | ) | ||||
Net proceeds from sale of medical transportation business | 2,279.7 | — | ||||||
Purchases of marketable securities | (57.3 | ) | (3.4 | ) | ||||
Maturities of marketable securities | 17.2 | 0.5 | ||||||
Other, net | 1.1 | 17.3 | ||||||
Net cash flows provided by (used in) investing activities | 2,123.8 | (99.4 | ) | |||||
Cash flows from financing activities: | ||||||||
Proceeds from long-term borrowings | 125.5 | 3.7 | ||||||
Repayment on long-term borrowings | (1,824.2 | ) | (11.9 | ) | ||||
Distributions to noncontrolling interests | (53.1 | ) | (60.5 | ) | ||||
Other, net | (6.3 | ) | (8.4 | ) | ||||
Net cash flows used in financing activities | (1,758.1 | ) | (77.1 | ) | ||||
Net increase (decrease) in cash, cash equivalents, restricted cash and restricted cash equivalents | 403.0 | (78.4 | ) | |||||
Cash and cash equivalents, beginning of period (including restricted cash and restricted cash equivalents of $30.8 and $28.8, respectively) | 383.0 | 360.4 | ||||||
Less cash, cash equivalents, restricted cash and restricted cash equivalents of held for sale assets, end of period | — | 17.7 | ||||||
Cash and cash equivalents, end of period (including restricted cash and restricted cash equivalents of $18.6 and $39.0, respectively) | $ | 786.0 | $ | 264.3 |
5 |
Item 1. Financial Statements - (continued) |
Three Months Ended March 31, | |||||||
2018 | 2017 | ||||||
Supplemental cash flow information: | |||||||
Interest payments | $ | 94.9 | $ | 87.1 | |||
Income tax paid, net of refunds | $ | (0.5 | ) | $ | 5.3 |
6 |
Item 1. Financial Statements - (continued) |
7 |
Item 1. Financial Statements - (continued) |
8 |
Item 1. Financial Statements - (continued) |
9 |
Item 1. Financial Statements - (continued) |
10 |
Item 1. Financial Statements - (continued) |
Three Months Ended March 31, 2018 | ||||||||||||||||||||
Physician Services | Ambulatory Services | Total | ||||||||||||||||||
Medicare | $ | 324.1 | 18 | % | $ | 69.4 | 23 | % | $ | 393.5 | 19 | % | ||||||||
Medicaid | 137.8 | 8 | 6.6 | 2 | 144.4 | 7 | ||||||||||||||
Commercial and managed care | 1,007.3 | 57 | 183.8 | 60 | 1,191.1 | 57 | ||||||||||||||
Self-pay | 33.2 | 2 | 41.4 | 13 | 74.6 | 4 | ||||||||||||||
Net fee for service revenue | 1,502.4 | 85 | 301.2 | 98 | 1,803.6 | 87 | ||||||||||||||
Contract and other revenue | 267.0 | 15 | 6.4 | 2 | 273.4 | 13 | ||||||||||||||
Net revenue | $ | 1,769.4 | 100 | % | $ | 307.6 | 100 | % | $ | 2,077.0 | 100 | % |
Three Months Ended March 31, 2017 | ||||||||||||||||||||
Physician Services | Ambulatory Services | Total | ||||||||||||||||||
Medicare | $ | 316.5 | 20 | % | $ | 74.7 | 24 | % | $ | 391.2 | 21 | % | ||||||||
Medicaid | 120.4 | 8 | 7.7 | 2 | 128.1 | 7 | ||||||||||||||
Commercial and managed care | 880.5 | 56 | 192.9 | 61 | 1,073.4 | 57 | ||||||||||||||
Self-pay | 23.6 | 2 | 34.7 | 11 | 58.3 | 3 | ||||||||||||||
Net fee for service revenue | 1,341.0 | 86 | 310.0 | 98 | 1,651.0 | 88 | ||||||||||||||
Contract and other revenue | 221.7 | 14 | 5.9 | 2 | 227.6 | 12 | ||||||||||||||
Net revenue | $ | 1,562.7 | 100 | % | $ | 315.9 | 100 | % | $ | 1,878.6 | 100 | % |
11 |
Item 1. Financial Statements - (continued) |
Accounts receivable | $ | 2.3 | |
Goodwill | 38.5 | ||
Intangible assets | 33.8 | ||
Other accrued liabilities | (1.0 | ) | |
Deferred income taxes | (2.3 | ) | |
Other long-term liabilities | (1.1 | ) | |
Acquisition date fair value of total consideration transferred | $ | 70.2 |
12 |
Item 1. Financial Statements - (continued) |
13 |
Item 1. Financial Statements - (continued) |
Three Months Ended March 31, | |||||||
2018 (1) | 2017 | ||||||
Net revenues | $ | 511.7 | $ | 593.5 | |||
Operating expenses: | |||||||
Salaries and benefits | 289.0 | 337.9 | |||||
Supply cost | 12.0 | 13.9 | |||||
Insurance expense | 22.2 | 18.7 | |||||
Other operating expenses | 137.8 | 152.3 | |||||
Transaction and integration costs | 14.8 | 4.3 | |||||
Depreciation and amortization | 29.4 | 34.2 | |||||
Total operating expenses | 505.2 | 561.3 | |||||
Equity in earnings of unconsolidated affiliates | 0.1 | 0.2 | |||||
Gain on assets held for sale | 14.7 | — | |||||
Operating income | 21.3 | 32.4 | |||||
Interest expense, net | 17.8 | 22.4 | |||||
Earnings before income taxes | $ | 3.5 | $ | 10.0 | |||
Results of discontinued operations: | |||||||
Earnings from discontinued operations | $ | 3.5 | $ | 10.0 | |||
Income tax expense of discontinued operations | (126.8 | ) | (488.2 | ) | |||
Net loss from discontinued operations | $ | (123.3 | ) | $ | (478.2 | ) |
(1) | January 1, 2018 through March 14, 2018 |
14 |
Item 1. Financial Statements - (continued) |
March 31, 2018 | |||||||||||||||
Level 1 | Level 2 | Level 3 | Total | ||||||||||||
Assets: | |||||||||||||||
U.S. Treasuries | $ | 1.3 | $ | — | $ | — | $ | 1.3 | |||||||
Corporate bonds/Fixed income | 60.4 | 22.7 | — | 83.1 | |||||||||||
Corporate equity securities | 10.5 | — | — | 10.5 | |||||||||||
Liabilities: | |||||||||||||||
Contingent consideration | — | — | 7.4 | 7.4 |
December 31, 2017 | |||||||||||||||
Level 1 | Level 2 | Level 3 | Total | ||||||||||||
Assets: | |||||||||||||||
U.S. Treasuries | $ | 1.8 | $ | — | $ | — | $ | 1.8 | |||||||
Corporate bonds/Fixed income | 10.4 | 30.8 | — | 41.2 | |||||||||||
Corporate equity securities | 12.4 | — | — | 12.4 | |||||||||||
Liabilities: | |||||||||||||||
Contingent consideration | — | — | 8.0 | 8.0 |
Balance at December 31, 2017 | $ | 8.0 | |
Decrease due to current period payments | (1.0 | ) | |
Increase due to current period acquisitions | 0.4 | ||
Balance at March 31, 2018 | $ | 7.4 |
15 |
Item 1. Financial Statements - (continued) |
March 31, 2018 | December 31, 2017 | ||||||
Available-for-sale securities: | |||||||
U.S. Treasuries | $ | 1.3 | $ | 1.8 | |||
Corporate bonds/Fixed income | 83.1 | 41.2 | |||||
Corporate equity securities | — | 12.4 | |||||
Total available-for-sale securities | 84.4 | 55.4 | |||||
Corporate equity securities | 10.5 | — | |||||
Restricted cash deposits and other | 18.6 | 30.8 | |||||
Insurance collateral | $ | 113.5 | $ | 86.2 |
16 |
Item 1. Financial Statements - (continued) |
March 31, 2018 | |||||||||||||||
Gross | Gross | ||||||||||||||
Cost | Unrealized | Unrealized | Fair | ||||||||||||
Basis | Gains | Losses | Value | ||||||||||||
Description: | |||||||||||||||
U.S. Treasuries | $ | 1.3 | $ | — | $ | — | $ | 1.3 | |||||||
Corporate bonds/Fixed income | 83.4 | 0.2 | (0.5 | ) | 83.1 | ||||||||||
Total available-for-sale securities | 84.7 | 0.2 | (0.5 | ) | 84.4 | ||||||||||
Corporate equity securities | 9.1 | 1.4 | — | 10.5 | |||||||||||
Total corporate equity and available-for-sale securities | $ | 93.8 | $ | 1.6 | $ | (0.5 | ) | $ | 94.9 |
December 31, 2017 | |||||||||||||||
Gross | Gross | ||||||||||||||
Cost | Unrealized | Unrealized | Fair | ||||||||||||
Basis | Gains | Losses | Value | ||||||||||||
Description: | |||||||||||||||
U.S. Treasuries | $ | 1.8 | $ | — | $ | — | $ | 1.8 | |||||||
Corporate bonds/Fixed income | 40.7 | 0.7 | (0.2 | ) | 41.2 | ||||||||||
Corporate equity securities | 10.5 | 1.9 | — | 12.4 | |||||||||||
Total available-for-sale securities | $ | 53.0 | $ | 2.6 | $ | (0.2 | ) | $ | 55.4 |
March 31, 2018 | December 31, 2017 | ||||||||||||||
Fair | Unrealized | Fair | Unrealized | ||||||||||||
Value | Loss | Value | Loss | ||||||||||||
Description: | |||||||||||||||
Corporate bonds/Fixed income | $ | 43.2 | $ | (0.5 | ) | $ | 16.0 | $ | (0.2 | ) |
17 |
Item 1. Financial Statements - (continued) |
March 31, | December 31, | ||||||
2018 | 2017 | ||||||
Income taxes receivable (1) | $ | — | $ | 74.3 | |||
Prepaid expenses | 64.7 | 59.9 | |||||
Other | 33.5 | 31.4 | |||||
Total prepaid and other current assets | $ | 98.2 | $ | 165.6 |
(1) | At March 31, 2018, the Company's income taxes receivable were reclassified against its income taxes payable as the Company expects to utilize such receivables to offset amounts due as a result of the sale of the medical transportation business. See Notes 5 and 10. |
18 |
Item 1. Financial Statements - (continued) |
Physician Services | Ambulatory Services | Total | |||||||||
Balance at December 31, 2017 | $ | 5,410.6 | $ | 2,125.5 | $ | 7,536.1 | |||||
Goodwill acquired, including post acquisition adjustments | 38.7 | (0.3 | ) | 38.4 | |||||||
Goodwill disposed, including impact of deconsolidation transactions | — | (3.8 | ) | (3.8 | ) | ||||||
Balance at March 31, 2018 | $ | 5,449.3 | $ | 2,121.4 | $ | 7,570.7 |
Amortizable Intangible Assets | Estimated Useful Life | Weighted Average Amortization Period | ||
Customer relationships | 17 to 20 years | 17.9 | ||
Capitalized software | 3 to 7 years | 5.4 | ||
Agreements, contracts and other | 3 to 10 years | 3.0 |
19 |
Item 1. Financial Statements - (continued) |
March 31, 2018 | December 31, 2017 | ||||||||||||||||||||||
Gross | Gross | ||||||||||||||||||||||
Carrying | Accumulated | Carrying | Accumulated | ||||||||||||||||||||
Amount | Amortization | Net | Amount | Amortization | Net | ||||||||||||||||||
Amortizable intangible assets: | |||||||||||||||||||||||
Customer relationships | $ | 3,480.1 | $ | (365.1 | ) | $ | 3,115.0 | $ | 3,446.7 | $ | (321.8 | ) | $ | 3,124.9 | |||||||||
Capitalized software | 179.6 | (83.6 | ) | 96.0 | 166.9 | (73.3 | ) | 93.6 | |||||||||||||||
Agreements, contracts and other | 13.9 | (5.6 | ) | 8.3 | 13.5 | (4.9 | ) | 8.6 | |||||||||||||||
Total amortizable intangible assets | 3,673.6 | (454.3 | ) | 3,219.3 | 3,627.1 | (400.0 | ) | 3,227.1 | |||||||||||||||
Non-amortizable intangible assets: | |||||||||||||||||||||||
Trade names | 430.0 | — | 430.0 | 430.0 | — | 430.0 | |||||||||||||||||
Restrictive covenant arrangements | 8.4 | — | 8.4 | 8.4 | — | 8.4 | |||||||||||||||||
Total non-amortizable intangible assets | 438.4 | — | 438.4 | 438.4 | — | 438.4 | |||||||||||||||||
Total intangible assets | $ | 4,112.0 | $ | (454.3 | ) | $ | 3,657.7 | $ | 4,065.5 | $ | (400.0 | ) | $ | 3,665.5 |
March 31, | December 31, | ||||||
2018 | 2017 | ||||||
Insurance reserves | $ | 80.0 | $ | 77.1 | |||
Refunds payable | 26.3 | 28.9 | |||||
Deferred revenue | 16.5 | 18.9 | |||||
Income taxes payable (1) | 241.8 | — | |||||
Other | 184.5 | 156.7 | |||||
Total other accrued liabilities | $ | 549.1 | $ | 281.6 |
(1) | Amount includes the income tax payable following the sale of the medical transportation business that will be paid in the second quarter of 2018. |
20 |
Item 1. Financial Statements - (continued) |
March 31, | December 31, | ||||||
2018 | 2017 | ||||||
ABL Facility | $ | — | $ | — | |||
Term Loan B - 2023 | 2,256.3 | 3,956.3 | |||||
Senior Unsecured Notes due 2022 (5.625%) | 1,100.0 | 1,100.0 | |||||
Senior Unsecured Notes due 2022 (5.125%) | 750.0 | 750.0 | |||||
Senior Unsecured Notes due 2024 (6.250%) | 550.0 | 550.0 | |||||
Other debt due through 2025 | 26.6 | 24.1 | |||||
Capitalized lease arrangements due through 2031 | 31.3 | 32.3 | |||||
4,714.2 | 6,412.7 | ||||||
Less current portion | 12.7 | 52.1 | |||||
Less net deferred financing costs | 93.0 | 97.3 | |||||
Long-term debt | $ | 4,608.5 | $ | 6,263.3 |
21 |
Item 1. Financial Statements - (continued) |
March 31, 2018 | December 31, 2017 | ||||||
Third-party insurance reserves | $ | 110.4 | $ | 111.3 | |||
Estimated losses under self-insured programs | 148.1 | 170.3 | |||||
Incurred but not reported losses | 145.0 | 114.0 | |||||
Total accrued insurance reserves | 403.5 | 395.6 | |||||
Less estimated losses payable within one year | 80.0 | 77.1 | |||||
Total | $ | 323.5 | $ | 318.5 |
Balance at December 31, 2017 | $ | 395.6 | |
Assumed liabilities through acquisitions | 0.5 | ||
Provision related to current period self-insurance reserves (1) | 20.4 | ||
Benefit related to changes in prior period self-insurance reserves | 9.0 | ||
Payments for prior period self-insurance reserves | (20.2 | ) | |
Change in third-party insurance self-insurance reserves | 1.7 | ||
Other, net including post-acquisition adjustments | (3.5 | ) | |
Balance at March 31, 2018 | $ | 403.5 |
(1) | Total insurance expense for the period ended March 31, 2018 and 2017 were $47.6 million and $37.6 million, respectively, which also included premiums paid to third-party insurers and premiums paid to captive insurance companies of certain of our joint venture partners. |
22 |
Item 1. Financial Statements - (continued) |
23 |
Item 1. Financial Statements - (continued) |
Weighted | ||||||
Number | Average | |||||
of Shares | Grant Price | |||||
Non-vested awards at December 31, 2017 | 1,410,461 | $ | 65.52 | |||
Shares granted | 682,119 | 40.01 | ||||
Shares vested | (512,103 | ) | 63.43 | |||
Shares forfeited | (104,924 | ) | 63.87 | |||
Non-vested awards at March 31, 2018 | 1,475,553 | 54.57 |
Weighted | ||||||||
Weighted | Average | |||||||
Average | Remaining | |||||||
Number | Exercise | Contractual | ||||||
of Shares | Price | Term (in years) | ||||||
Outstanding at December 31, 2017 | 2,826,021 | $ | 19.70 | 4.3 | ||||
Options exercised with total intrinsic value of $1.0 million | (38,611 | ) | 11.13 | |||||
Options canceled | (46,952 | ) | 66.88 | |||||
Outstanding at March 31, 2018 with an aggregate intrinsic value of $64.7 million | 2,740,458 | 19.01 | 2.8 | |||||
Vested and Exercisable at March 31, 2018 with an aggregate intrinsic value of $64.7 million | 2,666,440 | 17.70 | 2.7 |
Three Months Ended March 31, | |||||||
2018 | 2017 | ||||||
Share-based compensation expense from continuing operations | $ | 7.4 | $ | 14.6 | |||
Fair value of shares vested | 18.7 | 28.4 | |||||
Cash received from option exercises | 0.3 | 1.1 | |||||
Tax expense (benefit) from exercises of share based awards | 4.6 | (2.9 | ) |
24 |
Item 1. Financial Statements - (continued) |
Three Months Ended March 31, | ||||||||||
Earnings | Shares | Per Share | ||||||||
(Numerator) | (Denominator) | Amount | ||||||||
2018: | ||||||||||
Net earnings from continuing operations attributable to Envision Healthcare Corporation common stockholders (basic) | $ | 36.9 | 120,552 | $ | 0.31 | |||||
Effect of dilutive securities, options and non-vested shares | — | 1,802 | ||||||||
Net earnings from continuing operations attributable to Envision Healthcare Corporation common stockholders (diluted) | $ | 36.9 | 122,354 | $ | 0.30 | |||||
2017: | ||||||||||
Net earnings from continuing operations attributable to Envision Healthcare Corporation common stockholders (basic) | $ | 30.7 | 116,563 | $ | 0.26 | |||||
Effect of dilutive securities, options and non-vested shares | — | 2,912 | ||||||||
Net earnings attributable to Envision Healthcare Corporation common stockholders (diluted) | $ | 30.7 | 119,475 | $ | 0.26 |
25 |
Item 1. Financial Statements - (continued) |
26 |
Item 1. Financial Statements - (continued) |
27 |
Item 1. Financial Statements - (continued) |
Three Months Ended March 31, | |||||||
2018 | 2017 | ||||||
Net Revenue: | |||||||
Physician Services | $ | 1,769.4 | $ | 1,562.7 | |||
Ambulatory Services | 307.6 | 315.9 | |||||
Total | $ | 2,077.0 | $ | 1,878.6 | |||
Adjusted EBITDA: | |||||||
Physician Services | $ | 150.1 | $ | 150.1 | |||
Ambulatory Services | 57.5 | 60.2 | |||||
Total | $ | 207.6 | $ | 210.3 | |||
Adjusted EBITDA: | $ | 207.6 | $ | 210.3 | |||
Net earnings attributable to noncontrolling interests | 51.2 | 54.1 | |||||
Interest expense, net | (63.6 | ) | (52.4 | ) | |||
Depreciation and amortization | (70.6 | ) | (71.3 | ) | |||
Share-based compensation | (7.4 | ) | (14.6 | ) | |||
Transaction and integration costs | (21.4 | ) | (21.5 | ) | |||
Impairment charges | (0.7 | ) | (0.3 | ) | |||
Net gain (loss) on disposals and deconsolidations, net of noncontrolling interests | (0.6 | ) | 0.3 | ||||
Net unrealized loss on equity securities | (0.9 | ) | — | ||||
Earnings before income taxes | $ | 93.6 | $ | 104.6 | |||
Acquisition and Capital Expenditures: | |||||||
Physician Services | $ | 85.2 | $ | 66.0 | |||
Ambulatory Services | 7.4 | 27.8 | |||||
Total | $ | 92.6 | $ | 93.8 |
28 |
Item 1. Financial Statements - (continued) |
Condensed Consolidating Balance Sheet - March 31, 2018 (In millions) | |||||||||||||||||||
Parent Issuer | Guarantor Subsidiaries | Non-Guarantor Subsidiaries | Consolidating Adjustments | Total Consolidated | |||||||||||||||
Assets | |||||||||||||||||||
Current assets: | |||||||||||||||||||
Cash and cash equivalents | $ | 502.3 | $ | 57.6 | $ | 207.5 | $ | — | $ | 767.4 | |||||||||
Insurance collateral | — | — | 113.5 | — | 113.5 | ||||||||||||||
Accounts receivable, net | — | 361.5 | 1,171.3 | — | 1,532.8 | ||||||||||||||
Supplies inventory | — | — | 22.1 | — | 22.1 | ||||||||||||||
Prepaid and other current assets | 19.6 | 5.4 | 73.3 | (0.1 | ) | 98.2 | |||||||||||||
Total current assets | 521.9 | 424.5 | 1,587.7 | (0.1 | ) | 2,534.0 | |||||||||||||
Property and equipment, net | 20.3 | 80.4 | 183.3 | — | 284.0 | ||||||||||||||
Investments in and advances to affiliates | 8,545.0 | 929.7 | — | (9,317.3 | ) | 157.4 | |||||||||||||
Intercompany receivable | 2,991.1 | — | — | (2,991.1 | ) | — | |||||||||||||
Goodwill | — | 1,705.9 | — | 5,864.8 | 7,570.7 | ||||||||||||||
Intangible assets, net | 29.4 | 1,123.6 | 2,504.7 | — | 3,657.7 | ||||||||||||||
Other assets | 66.1 | 42.6 | 72.0 | — | 180.7 | ||||||||||||||
Total assets | $ | 12,173.8 | $ | 4,306.7 | $ | 4,347.7 | $ | (6,443.7 | ) | $ | 14,384.5 | ||||||||
Liabilities and Equity | |||||||||||||||||||
Current liabilities: | |||||||||||||||||||
Current portion of long-term debt | $ | — | $ | 0.1 | $ | 12.6 | $ | — | $ | 12.7 | |||||||||
Accounts payable | 15.5 | 11.4 | 23.5 | — | 50.4 | ||||||||||||||
Accrued salaries and benefits | 8.6 | 73.4 | 389.0 | — | 471.0 | ||||||||||||||
Accrued interest | 35.0 | — | 0.1 | — | 35.1 | ||||||||||||||
Other accrued liabilities | 324.7 | 162.5 | 62.0 | (0.1 | ) | 549.1 | |||||||||||||
Total current liabilities | 383.8 | 247.4 | 487.2 | (0.1 | ) | 1,118.3 | |||||||||||||
Long-term debt | 4,563.3 | 0.2 | 45.0 | — | 4,608.5 | ||||||||||||||
Deferred income taxes | 721.8 | — | 181.0 | — | 902.8 | ||||||||||||||
Insurance reserves | 6.2 | 89.8 | 227.5 | — | 323.5 | ||||||||||||||
Other long-term liabilities | 47.2 | 74.0 | 34.4 | — | 155.6 | ||||||||||||||
Intercompany payable | — | 2,553.9 | 437.2 | (2,991.1 | ) | — | |||||||||||||
Noncontrolling interests – redeemable | — | — | 74.1 | 112.2 | 186.3 | ||||||||||||||
Equity: | |||||||||||||||||||
Total Envision Healthcare Corporation equity | 6,451.5 | 1,341.4 | 2,760.6 | (4,102.0 | ) | 6,451.5 | |||||||||||||
Noncontrolling interests – non-redeemable | — | — | 100.7 | 537.3 | 638.0 | ||||||||||||||
Total equity | 6,451.5 | 1,341.4 | 2,861.3 | (3,564.7 | ) | 7,089.5 | |||||||||||||
Total liabilities and equity | $ | 12,173.8 | $ | 4,306.7 | $ | 4,347.7 | $ | (6,443.7 | ) | $ | 14,384.5 |
29 |
Item 1. Financial Statements - (continued) |
Condensed Consolidating Balance Sheet - December 31, 2017 (In millions) | |||||||||||||||||||
Parent Issuer | Guarantor Subsidiaries | Non-Guarantor Subsidiaries | Consolidating Adjustments | Total Consolidated | |||||||||||||||
Assets | |||||||||||||||||||
Current assets: | |||||||||||||||||||
Cash and cash equivalents | $ | 110.0 | $ | 10.2 | $ | 192.0 | $ | — | $ | 312.2 | |||||||||
Insurance collateral | — | — | 86.2 | — | 86.2 | ||||||||||||||
Accounts receivable, net | — | 275.1 | 1,130.7 | — | 1,405.8 | ||||||||||||||
Supplies inventory | — | — | 22.7 | — | 22.7 | ||||||||||||||
Prepaid and other current assets | 7.5 | 75.8 | 82.7 | (0.4 | ) | 165.6 | |||||||||||||
Current assets held for sale | — | 2,751.8 | — | — | 2,751.8 | ||||||||||||||
Total current assets | 117.5 | 3,112.9 | 1,514.3 | (0.4 | ) | 4,744.3 | |||||||||||||
Property and equipment, net | 10.8 | 103.2 | 188.7 | — | 302.7 | ||||||||||||||
Investments in and advances to affiliates | 10,713.9 | 1,971.9 | — | (12,529.1 | ) | 156.7 | |||||||||||||
Intercompany receivable | 2,924.9 | 227.7 | — | (3,152.6 | ) | — | |||||||||||||
Goodwill | — | 1,543.3 | — | 5,992.8 | 7,536.1 | ||||||||||||||
Intangible assets, net | 12.9 | 1,256.1 | 2,396.5 | — | 3,665.5 | ||||||||||||||
Other assets | 50.0 | 43.6 | 73.7 | — | 167.3 | ||||||||||||||
Total assets | $ | 13,830.0 | $ | 8,258.7 | $ | 4,173.2 | $ | (9,689.3 | ) | $ | 16,572.6 | ||||||||
Liabilities and Equity | |||||||||||||||||||
Current liabilities: | |||||||||||||||||||
Current portion of long-term debt | $ | 40.0 | $ | 0.1 | $ | 12.0 | $ | — | $ | 52.1 | |||||||||
Accounts payable | 2.0 | 23.1 | 37.1 | — | 62.2 | ||||||||||||||
Accrued salaries and benefits | 5.5 | 218.1 | 324.4 | — | 548.0 | ||||||||||||||
Accrued interest | 52.1 | — | — | — | 52.1 | ||||||||||||||
Other accrued liabilities | 3.1 | 162.5 | 116.4 | (0.4 | ) | 281.6 | |||||||||||||
Current liabilities held for sale | — | 399.1 | — | — | 399.1 | ||||||||||||||
Total current liabilities | 102.7 | 802.9 | 489.9 | (0.4 | ) | 1,395.1 | |||||||||||||
Long-term debt | 6,218.7 | 0.3 | 44.3 | — | 6,263.3 | ||||||||||||||
Deferred income taxes | 940.0 | — | 149.3 | — | 1,089.3 | ||||||||||||||
Insurance reserves | 6.0 | 106.3 | 206.2 | — | 318.5 | ||||||||||||||
Other long-term liabilities | 35.5 | 78.5 | 35.9 | — | 149.9 | ||||||||||||||
Intercompany payable | — | 2,673.6 | 479.0 | (3,152.6 | ) | — | |||||||||||||
Noncontrolling interests – redeemable | — | — | 75.3 | 111.8 | 187.1 | ||||||||||||||
Equity: | |||||||||||||||||||
Total Envision Healthcare Corporation equity | 6,527.1 | 4,597.1 | 2,544.4 | (7,141.5 | ) | 6,527.1 | |||||||||||||
Noncontrolling interests – non-redeemable | — | — | 148.9 | 493.4 | 642.3 | ||||||||||||||
Total equity | 6,527.1 | 4,597.1 | 2,693.3 | (6,648.1 | ) | 7,169.4 | |||||||||||||
Total liabilities and equity | $ | 13,830.0 | $ | 8,258.7 | $ | 4,173.2 | $ | (9,689.3 | ) | $ | 16,572.6 |
30 |
Item 1. Financial Statements - (continued) |
Condensed Consolidating Statement of Operations - For the Three Months Ended March 31, 2018 (In millions) | |||||||||||||||||||
Parent Issuer | Guarantor Subsidiaries | Non-Guarantor Subsidiaries | Consolidating Adjustments | Total Consolidated | |||||||||||||||
Net revenue | $ | 7.3 | $ | 590.3 | $ | 1,523.1 | $ | (43.7 | ) | $ | 2,077.0 | ||||||||
Operating expenses: | |||||||||||||||||||
Salaries and benefits | 16.6 | 531.7 | 990.8 | (0.2 | ) | 1,538.9 | |||||||||||||
Supply cost | — | 5.2 | 49.2 | — | 54.4 | ||||||||||||||
Insurance expense | — | 11.7 | 73.9 | (38.0 | ) | 47.6 | |||||||||||||
Other operating expenses | 7.6 | 5.3 | 183.4 | (5.5 | ) | 190.8 | |||||||||||||
Transaction and integration costs | 3.3 | 18.0 | 0.1 | — | 21.4 | ||||||||||||||
Impairment charges | — | 0.7 | — | — | 0.7 | ||||||||||||||
Depreciation and amortization | 1.6 | 52.0 | 17.0 | — | 70.6 | ||||||||||||||
Total operating expenses | 29.1 | 624.6 | 1,314.4 | (43.7 | ) | 1,924.4 | |||||||||||||
Net gain (loss) on disposals and deconsolidations | — | 0.2 | (1.2 | ) | — | (1.0 | ) | ||||||||||||
Equity in earnings of unconsolidated affiliates | (54.6 | ) | 147.1 | — | (86.7 | ) | 5.8 | ||||||||||||
Operating income (loss) | (76.4 | ) | 113.0 | 207.5 | (86.7 | ) | 157.4 | ||||||||||||
Interest expense, net | 7.1 | 40.8 | 15.7 | — | 63.6 | ||||||||||||||
Other income (expense), net | (0.5 | ) | 0.3 | — | — | (0.2 | ) | ||||||||||||
Earnings (loss) before income taxes | (84.0 | ) | 72.5 | 191.8 | (86.7 | ) | 93.6 | ||||||||||||
Income tax expense (benefit) | 2.4 | 3.8 | (0.7 | ) | — | 5.5 | |||||||||||||
Net earnings (loss) from continuing operations | (86.4 | ) | 68.7 | 192.5 | (86.7 | ) | 88.1 | ||||||||||||
Net loss from discontinued operations | — | (123.3 | ) | — | — | (123.3 | ) | ||||||||||||
Net earnings (loss) | (86.4 | ) | (54.6 | ) | 192.5 | (86.7 | ) | (35.2 | ) | ||||||||||
Less net earnings attributable to noncontrolling interests | — | — | 51.2 | — | 51.2 | ||||||||||||||
Net earnings (loss) attributable to Envision Healthcare Corporation common stockholders | $ | (86.4 | ) | $ | (54.6 | ) | $ | 141.3 | $ | (86.7 | ) | $ | (86.4 | ) | |||||
Comprehensive income (loss) attributable to Envision Healthcare Corporation | $ | (86.4 | ) | $ | (54.6 | ) | $ | 142.2 | $ | (86.7 | ) | $ | (85.5 | ) |
31 |
Item 1. Financial Statements - (continued) |
Condensed Consolidating Statement of Operations - For the Three Months Ended March 31, 2017 (In millions) | |||||||||||||||||||
Parent Issuer | Guarantor Subsidiaries | Non-Guarantor Subsidiaries | Consolidating Adjustments | Total Consolidated | |||||||||||||||
Net revenue | $ | 8.2 | $ | 440.1 | $ | 1,468.7 | $ | (38.4 | ) | $ | 1,878.6 | ||||||||
Operating expenses: | |||||||||||||||||||
Salaries and benefits | 22.7 | 403.9 | 932.6 | (0.2 | ) | 1,359.0 | |||||||||||||
Supply cost | — | 1.2 | 52.9 | — | 54.1 | ||||||||||||||
Insurance expense | 0.5 | 9.8 | 50.5 | (23.2 | ) | 37.6 | |||||||||||||
Other operating expenses | 6.7 | 35.4 | 157.0 | (15.0 | ) | 184.1 | |||||||||||||
Transaction and integration costs | 2.3 | 18.7 | 0.5 | — | 21.5 | ||||||||||||||
Impairment charges | — | 0.3 | — | — | 0.3 | ||||||||||||||
Depreciation and amortization | 1.5 | 54.3 | 15.5 | — | 71.3 | ||||||||||||||
Total operating expenses | 33.7 | 523.6 | 1,209.0 | (38.4 | ) | 1,727.9 | |||||||||||||
Net gain (loss) on disposals and deconsolidations | — | 1.8 | (1.5 | ) | — | 0.3 | |||||||||||||
Equity in earnings of unconsolidated affiliates | (399.3 | ) | 163.7 | — | 240.5 | 4.9 | |||||||||||||
Operating income (loss) | (424.8 | ) | 82.0 | 258.2 | 240.5 | 155.9 | |||||||||||||
Interest expense, net | 9.0 | 33.0 | 10.4 | — | 52.4 | ||||||||||||||
Other income, net | 1.0 | — | 0.1 | 1.1 | |||||||||||||||
Earnings (loss) before income taxes | (432.8 | ) | 49.0 | 247.9 | 240.5 | 104.6 | |||||||||||||
Income tax expense (benefit) | 12.4 | (29.9 | ) | 35.0 | — | 17.5 | |||||||||||||
Net earnings (loss) from continuing operations | (445.2 | ) | 78.9 | 212.9 | 240.5 | 87.1 | |||||||||||||
Net loss from discontinued operations | — | (478.2 | ) | — | — | (478.2 | ) | ||||||||||||
Net earnings (loss) | (445.2 | ) | (399.3 | ) | 212.9 | 240.5 | (391.1 | ) | |||||||||||
Less net earnings attributable to noncontrolling interests | — | — | 54.1 | — | 54.1 | ||||||||||||||
Net earnings (loss) attributable to Envision Healthcare Corporation stockholders | (445.2 | ) | (399.3 | ) | 158.8 | 240.5 | (445.2 | ) | |||||||||||
Preferred stock dividends | (2.3 | ) | — | — | — | (2.3 | ) | ||||||||||||
Net earnings (loss) attributable to Envision Healthcare Corporation common stockholders | $ | (447.5 | ) | $ | (399.3 | ) | $ | 158.8 | $ | 240.5 | $ | (447.5 | ) | ||||||
Comprehensive income (loss) attributable to Envision Healthcare Corporation | $ | (445.2 | ) | $ | (399.3 | ) | $ | 159.7 | $ | 240.5 | $ | (444.3 | ) |
32 |
Item 1. Financial Statements - (continued) |
Condensed Consolidating Statement of Cash Flows - For the Three Months Ended March 31, 2018 (In millions) | |||||||||||||||||||
Parent Issuer | Guarantor Subsidiaries | Non-Guarantor Subsidiaries | Consolidating Adjustments | Total Consolidated | |||||||||||||||
Cash flows from operating activities: | |||||||||||||||||||
Net cash flows provided by (used in) operating activities | $ | 26.4 | $ | (96.2 | ) | $ | 245.5 | $ | (138.4 | ) | $ | 37.3 | |||||||
Cash flows from investing activities: | |||||||||||||||||||
Acquisitions and related expenses | (66.1 | ) | (71.6 | ) | — | 66.1 | (71.6 | ) | |||||||||||
Acquisition of property and equipment | (0.5 | ) | (37.2 | ) | (7.6 | ) | — | (45.3 | ) | ||||||||||
Net proceeds from sale of medical transportation business | 2,279.7 | — | — | — | 2,279.7 | ||||||||||||||
Purchases of marketable securities | — | — | (57.3 | ) | — | (57.3 | ) | ||||||||||||
Maturities of marketable securities | — | — | 17.2 | — | 17.2 | ||||||||||||||
Other, net | — | 2.6 | (1.5 | ) | — | 1.1 | |||||||||||||
Net cash flows provided by (used in) investing activities | 2,213.1 | (106.2 | ) | (49.2 | ) | 66.1 | 2,123.8 | ||||||||||||
Cash flows from financing activities: | |||||||||||||||||||
Proceeds from long-term borrowings | 120.0 | 0.3 | 5.2 | — | 125.5 | ||||||||||||||
Repayment on long-term borrowings | (1,820.0 | ) | (0.8 | ) | (3.4 | ) | — | (1,824.2 | ) | ||||||||||
Distributions to owners, including noncontrolling interests | — | (69.2 | ) | (122.3 | ) | 138.4 | (53.1 | ) | |||||||||||
Capital contributions | — | 66.1 | — | (66.1 | ) | — | |||||||||||||
Changes in intercompany balances with affiliates, net | (143.7 | ) | 213.4 | (69.7 | ) | — | — | ||||||||||||
Other, net | (3.5 | ) | — | (2.8 | ) | — | (6.3 | ) | |||||||||||
Net cash flows provided by (used in) financing activities | (1,847.2 | ) | 209.8 | (193.0 | ) | 72.3 | (1,758.1 | ) | |||||||||||
Net increase in cash, cash equivalents, restricted cash and restricted cash equivalents | 392.3 | 7.4 | 3.3 | — | 403.0 | ||||||||||||||
Cash, cash equivalents, restricted cash and restricted cash equivalents, beginning of period | 110.0 | 50.2 | 222.8 | — | 383.0 | ||||||||||||||
Cash, cash equivalents, restricted cash and restricted cash equivalents, end of period | $ | 502.3 | $ | 57.6 | $ | 226.1 | $ | — | $ | 786.0 |
33 |
Item 1. Financial Statements - (continued) |
Condensed Consolidating Statement of Cash Flows - For the Three Months Ended March 31, 2017 (In millions) | |||||||||||||||||||
Parent Issuer | Guarantor Subsidiaries | Non-Guarantor Subsidiaries | Consolidating Adjustments | Total Consolidated | |||||||||||||||
Cash flows from operating activities: | |||||||||||||||||||
Net cash flows provided by operating activities | $ | 26.8 | $ | 123.2 | $ | 95.5 | $ | (147.4 | ) | $ | 98.1 | ||||||||
Cash flows from investing activities: | |||||||||||||||||||
Acquisitions and related expenses | — | (73.3 | ) | — | 0.2 | (73.1 | ) | ||||||||||||
Acquisition of property and equipment | (0.2 | ) | (27.7 | ) | (12.8 | ) | — | (40.7 | ) | ||||||||||
Purchases of marketable securities | — | — | (3.4 | ) | — | (3.4 | ) | ||||||||||||
Maturities of marketable securities | — | — | 0.5 | — | 0.5 | ||||||||||||||
Other, net | — | 11.7 | 5.6 | — | 17.3 | ||||||||||||||
Net cash flows used in investing activities | (0.2 | ) | (89.3 | ) | (10.1 | ) | 0.2 | (99.4 | ) | ||||||||||
Cash flows from financing activities: | |||||||||||||||||||
Proceeds from long-term borrowings | — | — | 3.7 | — | 3.7 | ||||||||||||||
Repayment on long-term borrowings | (8.7 | ) | (0.3 | ) | (2.9 | ) | — | (11.9 | ) | ||||||||||
Distributions to owners, including noncontrolling interests | — | (77.3 | ) | (130.6 | ) | 147.4 | (60.5 | ) | |||||||||||
Changes in intercompany balances with affiliates, net | 1.8 | 19.0 | (20.8 | ) | — | — | |||||||||||||
Other, net | (9.2 | ) | (2.3 | ) | 3.3 | (0.2 | ) | (8.4 | ) | ||||||||||
Net cash flows used in financing activities | (16.1 | ) | (60.9 | ) | (147.3 | ) | 147.2 | (77.1 | ) | ||||||||||
Net increase (decrease) in cash, cash equivalents, and restricted cash | 10.5 | (27.0 | ) | (61.9 | ) | — | (78.4 | ) | |||||||||||
Cash, cash equivalents, restricted cash and restricted cash equivalents, beginning of period | 41.6 | 59.7 | 259.1 | — | 360.4 | ||||||||||||||
Less cash, cash equivalents, restricted cash and restricted cash equivalents of held for sale assets, end of period | — | 17.7 | — | — | 17.7 | ||||||||||||||
Cash, cash equivalents, restricted cash and restricted cash equivalents, end of period | $ | 52.1 | $ | 15.0 | $ | 197.2 | $ | — | $ | 264.3 |
34 |
35 |
Item 2. Management’s Discussion and Analysis of Financial Condition and Results of Operations - (continued) |
36 |
Item 2. Management’s Discussion and Analysis of Financial Condition and Results of Operations - (continued) |
37 |
Item 2. Management’s Discussion and Analysis of Financial Condition and Results of Operations - (continued) |
38 |
Item 2. Management’s Discussion and Analysis of Financial Condition and Results of Operations - (continued) |
39 |
Item 2. Management’s Discussion and Analysis of Financial Condition and Results of Operations - (continued) |
Three Months Ended March 31, | |||||
2018 | 2017 | ||||
Net revenue | 100.0 | % | 100.0 | % | |
Operating expenses: | |||||
Salaries and benefits | 74.1 | 72.4 | |||
Supply cost | 2.6 | 2.9 | |||
Insurance expense | 2.3 | 2.0 | |||
Other operating expenses | 9.2 | 9.8 | |||
Transaction and integration costs | 1.0 | 1.1 | |||
Impairment charges | — | — | |||
Depreciation and amortization | 3.4 | 3.8 | |||
Total operating expenses | 92.7 | 92.0 | |||
Net gain (loss) on disposals and deconsolidations | — | — | |||
Equity in earnings of unconsolidated affiliates | 0.3 | 0.3 | |||
Operating income | 7.6 | 8.3 | |||
Interest expense, net | 3.1 | 2.8 | |||
Other income (expense), net | — | 0.1 | |||
Earnings from operations before income taxes | 4.5 | 5.6 | |||
Income tax expense | 0.3 | 0.9 | |||
Net earnings from continuing operations | 4.2 | 4.6 | |||
Discontinued operations: | |||||
Earnings from discontinued operations | 0.2 | 0.5 | |||
Income tax expense from discontinued operations | (6.1 | ) | (26.0 | ) | |
Net loss from discontinued operations | (5.9 | ) | (25.5 | ) | |
Net loss | (1.7 | ) | (20.8 | ) | |
Net earnings attributable to noncontrolling interests | 2.5 | 2.9 | |||
Net loss attributable to Envision Healthcare Corporation stockholders | (4.2 | )% | (23.7 | )% |
• | an increase of $206.7 million during the three months ended March 31, 2018 associated with our physician services segment, driven primarily by contributions from acquisitions completed during 2018 and 2017, and increases in our same-contract growth; and |
• | a decrease of $8.3 million during the three months ended March 31, 2018 associated with our ambulatory services segment, driven primarily by having eight less centers in operation in the current period as compared to the same period of prior year due to disposal and deconsolidation activity. |
• | an increase of $11.9 million associated with results from our physician services segment primarily due to contributions from acquisitions completed during 2018 and 2017 and same contract growth; and |
40 |
Item 2. Management’s Discussion and Analysis of Financial Condition and Results of Operations - (continued) |
• | a decrease of $10.4 million experienced by our ambulatory services segment primarily due to disposal and deconsolidation activity. |
Three Months Ended March 31, | |||||
2018 | 2017 | ||||
Contribution to Net Revenue Growth: | |||||
Same contract | 2.7 | % | 3.3 | % | |
New contracts | 8.0 | 6.3 | |||
Terminated contracts | (5.7 | ) | (10.1 | ) | |
Acquired contract and other | 8.2 | 9.7 | |||
Total net revenue growth | 13.2 | % | 9.2 | % | |
Patient encounters per day (day adjusted) | 2.3 | % | 2.3 | % | |
Net revenue per encounter | 0.8 | 2.7 | |||
Same contract revenue growth | 3.1 | % | 5.0 | % |
41 |
Item 2. Management’s Discussion and Analysis of Financial Condition and Results of Operations - (continued) |
Percentage of Net Revenue | Percentage of Total Volume | ||||||||||
Three Months Ended March 31, | Three Months Ended March 31, | ||||||||||
2018 | 2017 | 2018 | 2017 | ||||||||
Medicare | 18 | % | 20 | % | 30 | % | 33 | % | |||
Medicaid | 8 | 8 | 25 | 24 | |||||||
Commercial and managed care | 57 | 56 | 32 | 29 | |||||||
Self-pay | 2 | 2 | 13 | 14 | |||||||
Net fee for service revenue | 85 | 86 | 100 | % | 100 | % | |||||
Contract and other revenue | 15 | 14 | |||||||||
Net revenue for physician services | 100 | % | 100 | % |
Three Months Ended March 31, | |||||||||||||
2018 | 2017 | ||||||||||||
Net revenue | $ | 1,769.4 | 100.0 | % | $ | 1,562.7 | 100.0 | % | |||||
Operating expenses: | |||||||||||||
Salaries and benefits | 1,446.2 | 81.7 | 1,259.5 | 80.6 | |||||||||
Supply cost | 5.4 | 0.3 | 5.9 | 0.4 | |||||||||
Insurance expense | 46.3 | 2.6 | 35.7 | 2.3 | |||||||||
Other operating expenses | 126.9 | 7.2 | 120.3 | 7.7 | |||||||||
Transaction and integration costs | 18.1 | 1.0 | 19.2 | 1.2 | |||||||||
Impairment charges | 0.7 | — | 0.3 | — | |||||||||
Depreciation and amortization | 60.8 | 3.4 | 61.6 | 3.9 | |||||||||
Total operating expenses | 1,704.4 | 96.3 | 1,502.5 | 96.1 | |||||||||
Net loss on disposals and deconsolidations | — | — | (7.1 | ) | (0.5 | ) | |||||||
Equity in earnings (loss) of unconsolidated affiliates | (0.3 | ) | — | (0.3 | ) | — | |||||||
Operating income | $ | 64.7 | 3.7 | % | $ | 52.8 | 3.4 | % |
42 |
Item 2. Management’s Discussion and Analysis of Financial Condition and Results of Operations - (continued) |
Three Months Ended March 31, | |||||||
2018 | 2017 | ||||||
Procedures performed during the period at consolidated centers | 405,708 | 420,487 | |||||
Centers in operation, end of period (consolidated) | 230 | 238 | |||||
Centers in operation, end of period (unconsolidated) | 31 | 26 | |||||
Average number of continuing centers in operation (consolidated) | 231 | 239 | |||||
New centers added, during period | — | 4 | |||||
Centers disposed, during period | 3 | — | |||||
Surgical hospitals in operation, end of period (unconsolidated) | 1 | 1 | |||||
Centers under letter of intent, end of period | 4 | 2 | |||||
Average revenue per consolidated center (in thousands) | $ | 1,332 | $ | 1,324 | |||
Same center revenues increase (decrease), day adjusted (consolidated) | (0.7 | )% | 1.4 | % |
43 |
Item 2. Management’s Discussion and Analysis of Financial Condition and Results of Operations - (continued) |
Three Months Ended March 31, | |||||||||||||
2018 | 2017 | ||||||||||||
Net revenue | $ | 307.6 | 100.0 | % | $ | 315.9 | 100.0 | % | |||||
Operating expenses: | |||||||||||||
Salaries and benefits | 92.7 | 30.1 | 99.5 | 31.5 | |||||||||
Supply cost | 49.0 | 15.9 | 48.2 | 15.3 | |||||||||
Insurance expense | 1.3 | 0.4 | 1.9 | 0.6 | |||||||||
Other operating expenses | 63.9 | 20.8 | 63.8 | 20.2 | |||||||||
Transaction and integration costs | 3.3 | 1.1 | 2.3 | 0.7 | |||||||||
Depreciation and amortization | 9.8 | 3.2 | 9.7 | 3.1 | |||||||||
Total operating expenses | 220.0 | 71.5 | 225.4 | 71.4 | |||||||||
Net gain (loss) on disposals and deconsolidations | (1.0 | ) | (0.3 | ) | 7.4 | 2.3 | |||||||
Equity in earnings of unconsolidated affiliates | 6.1 | 2.0 | 5.2 | 1.6 | |||||||||
Operating income | $ | 92.7 | 30.1 | % | $ | 103.1 | 32.6 | % |
• | revenue decline of $2.1 million, or 0.7%, for the three months ended March 31, 2018 recognized by our 2018 same-center group, which was impacted by weather-related cancellations in the current year period; |
• | centers acquired in 2017, which contributed $3.9 million of additional revenues in the three months ended March 31, 2018 due to having a full period of operations in 2018; |
• | reduced revenue recognized during the three months ended March 31, 2018 of $6.9 million resulting from the deconsolidation of centers that were consolidated in prior periods. The deconsolidated centers represented a reduction of 10,295 procedures reported during the three months ended March 31, 2017. Our share of the results of operations from the deconsolidated centers is reflected in equity in earnings of unconsolidated affiliates in our consolidated statements of operations; and |
• | reduced revenue recognized during the three months ended March 31, 2018 of $2.7 million resulting from the disposal of centers that had a full period of operations during the three months ended March 31, 2017. |
• | an increase of $1.1 million in other operating expenses at our 2018 same-center group; |
• | centers acquired or opened during 2017, which resulted in an increase of $0.6 million; |
• | deconsolidation of centers in the current and prior periods, which resulted in a decrease of $1.9 million; and |
• | disposal of centers in the current and prior periods, which resulted in a decrease of $1.2 million. |
44 |
Item 2. Management’s Discussion and Analysis of Financial Condition and Results of Operations - (continued) |
Three Months Ended March 31, | |||||||
2018 | 2017 | ||||||
Net cash provided by (used in): | |||||||
Operating activities | $ | 37.3 | $ | 98.1 | |||
Investing activities | 2,123.8 | (99.4 | ) | ||||
Financing activities | (1,758.1 | ) | (77.1 | ) |
• | increase in interest payments due to increased borrowings in 2017; |
• | payments of transaction and integration costs of approximately; |
• | the timing of payments on accounts payable and certain accrued expenses, including incentive compensation based upon achieving certain performance goals for the year ended December 31, 2017. In accordance with most of our incentive plans, payments are typically made in the first six months of each fiscal year; and |
• | acceleration of approximately $45 million of incentive compensation payments into the first quarter, from the second quarter, to benefit from higher tax deductibility associated with those expenses as a result of the Act. |
45 |
Item 2. Management’s Discussion and Analysis of Financial Condition and Results of Operations - (continued) |
• | $70.2 million for the acquisition of physician practices; and |
• | $45.3 million for new or replacement property. |
46 |
Item 2. Management’s Discussion and Analysis of Financial Condition and Results of Operations - (continued) |
47 |
48 |
Issuer Purchases of Equity Securities | ||||||||||||||
(d) Maximum Number | ||||||||||||||
(or Approximate Dollar | ||||||||||||||
(a) Total | (c) Total Number of | Value) of Shares (or | ||||||||||||
Number of | (b) Average | Shares (or Units) | Units) That May Yet | |||||||||||
Shares | Price Paid | Purchased as Part of | Be Purchased Under | |||||||||||
(or Units) | per Share | Publicly Announced | the Plans or Programs | |||||||||||
Period | Purchased (1) | (or Unit) | Plans or Programs | (in millions) (2) | ||||||||||
January 1, 2018 through January 31, 2018 | 19,475 | $ | 36.24 | — | $ | — | ||||||||
February 1, 2018 through February 28, 2018 | 74,609 | 34.52 | — | — | ||||||||||
March 1, 2018 through March 31, 2018 | — | — | — | — | ||||||||||
Total | 94,084 | $ | 34.88 | — | $ | — |
(1) | During the three months ended March 31, 2018, we repurchased 94,084 shares with a value of approximately $3.3 million to cover payroll withholding taxes in connection with the vesting of restricted stock awards under the Envision Healthcare Corporation 2014 Equity and Incentive Plan. |
(2) | On September 17, 2017, the Board authorized a stock repurchase program that authorizes the Company to repurchase up to $250 million of its common stock. See “Management's Discussion & Analysis - Liquidity and Capital Resources” for further discussion of this authorization. |
49 |
Exhibit | Description | |
101 | Interactive data files pursuant to Rule 405 of Regulation S-T: (i) the Consolidated Balance Sheets at March 31, 2018 and December 31, 2017, (ii) the Consolidated Statements of Operations for the three month periods ended March 31, 2018 and 2017, (iii) the Consolidated Statements of Comprehensive Income for the three month periods ended March 31, 2018 and 2017,(iv) the Consolidated Statements of Changes in Equity for the three month periods ended March 31, 2018 and 2017, (v) the Consolidated Statements of Cash Flows for the three month periods ended March 31, 2018 and 2017 and (vi) the notes to the Unaudited Consolidated Financial Statements for the three month periods ended March 31, 2018 and 2017 |
50 |
ENVISION HEALTHCARE CORPORATION | ||||
Date: | May 10, 2018 | |||
By: | /s/ Kevin D. Eastridge | |||
Kevin D. Eastridge | ||||
Executive Vice President and | ||||
Chief Financial Officer | ||||
(Principal Financial and Duly Authorized Officer) |
51 |
1. | I have reviewed this quarterly report on Form 10-Q of Envision Healthcare Corporation; |
2. | Based on my knowledge, this report does not contain any untrue statement of a material fact or omit to state a material fact necessary to make the statements made, in light of the circumstances under which such statements were made, not misleading with respect to the period covered by this report; |
3. | Based on my knowledge, the financial statements, and other financial information included in this report, fairly present in all material respects the financial condition, results of operations and cash flows of the registrant as of, and for, the periods presented in this report; |
4. | The registrant's other certifying officer and I are responsible for establishing and maintaining disclosure controls and procedures (as defined in Exchange Act Rules 13a-15(e) and 15d-15(e)) and internal control over financial reporting (as defined in Exchange Act Rules 13a-15(f) and 15d-15(f)) for the registrant and have: |
a) | Designed such disclosure controls and procedures, or caused such disclosure controls and procedures to be designed under our supervision, to ensure that material information relating to the registrant, including its consolidated subsidiaries, is made known to us by others within those entities, particularly during the period in which this report is being prepared; |
b) | Designed such internal control over financial reporting, or caused such internal control over financial reporting to be designed under our supervision, to provide reasonable assurance regarding the reliability of financial reporting and the preparation of financial statements for external purposes in accordance with generally accepted accounting principles; |
c) | Evaluated the effectiveness of the registrant's disclosure controls and procedures and presented in this report our conclusions about the effectiveness of the disclosure controls and procedures, as of the end of the period covered by this report based on such evaluation; and |
d) | Disclosed in this report any change in the registrant’s internal control over financial reporting that occurred during the registrant’s most recent fiscal quarter (the registrant’s fourth fiscal quarter in the case of an annual report) that has materially affected, or is reasonably likely to materially affect, the registrant’s internal control over financial reporting; and |
5. | The registrant's other certifying officer and I have disclosed, based on our most recent evaluation of internal control over financial reporting, to the registrant's auditors and the audit committee of registrant's board of directors (or persons performing the equivalent functions): |
a) | All significant deficiencies and material weaknesses in the design or operation of internal control over financial reporting which are reasonably likely to adversely affect the registrant's ability to record, process, summarize and report financial information; and |
b) | Any fraud, whether or not material, that involves management or other employees who have a significant role in the registrant's internal control over financial reporting. |
By: | /s/ Christopher A. Holden | |
Name: | Christopher A. Holden | |
Title: | President and Chief Executive Officer |
1. | I have reviewed this quarterly report on Form 10-Q of Envision Healthcare Corporation; |
2. | Based on my knowledge, this report does not contain any untrue statement of a material fact or omit to state a material fact necessary to make the statements made, in light of the circumstances under which such statements were made, not misleading with respect to the period covered by this report; |
3. | Based on my knowledge, the financial statements, and other financial information included in this report, fairly present in all material respects the financial condition, results of operations and cash flows of the registrant as of, and for, the periods presented in this report; |
4. | The registrant's other certifying officer and I are responsible for establishing and maintaining disclosure controls and procedures (as defined in Exchange Act Rules 13a-15(e) and 15d-15(e)) and internal control over financial reporting (as defined in Exchange Act Rules 13a-15(f) and 15d-15(f)) for the registrant and have: |
a) | Designed such disclosure controls and procedures, or caused such disclosure controls and procedures to be designed under our supervision, to ensure that material information relating to the registrant, including its consolidated subsidiaries, is made known to us by others within those entities, particularly during the period in which this report is being prepared; |
b) | Designed such internal control over financial reporting, or caused such internal control over financial reporting to be designed under our supervision, to provide reasonable assurance regarding the reliability of financial reporting and the preparation of financial statements for external purposes in accordance with generally accepted accounting principles; |
c) | Evaluated the effectiveness of the registrant's disclosure controls and procedures and presented in this report our conclusions about the effectiveness of the disclosure controls and procedures, as of the end of the period covered by this report based on such evaluation; and |
d) | Disclosed in this report any change in the registrant’s internal control over financial reporting that occurred during the registrant’s most recent fiscal quarter (the registrant’s fourth fiscal quarter in the case of an annual report) that has materially affected, or is reasonably likely to materially affect, the registrant’s internal control over financial reporting; and |
5. | The registrant's other certifying officer and I have disclosed, based on our most recent evaluation of internal control over financial reporting, to the registrant's auditors and the audit committee of registrant's board of directors (or persons performing the equivalent functions): |
a) | All significant deficiencies and material weaknesses in the design or operation of internal control over financial reporting which are reasonably likely to adversely affect the registrant's ability to record, process, summarize and report financial information; and |
b) | Any fraud, whether or not material, that involves management or other employees who have a significant role in the registrant's internal control over financial reporting. |
By: | /s/ Kevin D. Eastridge | |
Name: | Kevin D. Eastridge | |
Title: | Executive Vice President and | |
Chief Financial Officer |
(1) | The Report fully complies with the requirements of Section 13(a) or 15(d) of the Securities Exchange Act of 1934; and |
(2) | The information contained in the Report fairly presents, in all material respects, the financial condition and results of operations of the Company. |
/s/ Christopher A. Holden | ||
Christopher A. Holden | ||
President and Chief Executive | ||
Officer of the Company | ||
May 10, 2018 |
/s/ Kevin D. Eastridge | ||
Kevin D. Eastridge | ||
Executive Vice President and | ||
Chief Financial Officer of the Company | ||
May 10, 2018 |
Document And Entity Information - shares |
3 Months Ended | |
---|---|---|
Mar. 31, 2018 |
May 04, 2018 |
|
Document And Entity Information [Abstract] | ||
Entity Registrant Name | Envision Healthcare Corporation | |
Entity Central Index Key | 0001678531 | |
Current Fiscal Year End Date | --12-31 | |
Entity Filer Category | Large Accelerated Filer | |
Document Type | 10-Q | |
Document Period End Date | Mar. 31, 2018 | |
Document Fiscal Year Focus | 2018 | |
Document Fiscal Period Focus (Q1,Q2,Q3,FY) | Q1 | |
Amendment Flag | false | |
Entity Common Stock, Shares Outstanding | 121,128,363 |
Consolidated Balance Sheets (unaudited) (Parenthetical) - USD ($) $ in Millions |
Mar. 31, 2018 |
Dec. 31, 2017 |
---|---|---|
Statement of Financial Position [Abstract] | ||
Allowances for accounts receivable | $ 2,554.5 | |
Deferred financing costs, net | $ 93.0 | $ 97.3 |
Common stock, par value (in dollars per share) | $ 0.01 | $ 0.01 |
Common stock, shares authorized (in shares) | 1,000,000,000 | 1,000,000,000 |
Common stock, shares issued (in shares) | 121,105,000 | 121,021,000 |
Common stock, shares outstanding (in shares) | 121,105,000 | 121,021,000 |
Consolidated Statements of Comprehensive Income (unaudited) - USD ($) $ in Millions |
3 Months Ended | |
---|---|---|
Mar. 31, 2018 |
Mar. 31, 2017 |
|
Statement of Comprehensive Income [Abstract] | ||
Net loss | $ (35.2) | $ (391.1) |
Other comprehensive income, net of income tax: | ||
Unrealized holding gain during the period, net of income tax | 0.9 | 0.9 |
Comprehensive loss, net of income tax | (34.3) | (390.2) |
Less comprehensive income attributable to noncontrolling interests | 51.2 | 54.1 |
Comprehensive loss attributable to Envision Healthcare Corporation stockholders | $ (85.5) | $ (444.3) |
Consolidated Statements of Cash Flows (unaudited) (Parenthetical) - USD ($) $ in Millions |
Mar. 31, 2018 |
Dec. 31, 2017 |
Mar. 31, 2017 |
Dec. 31, 2016 |
---|---|---|---|---|
Statement of Cash Flows [Abstract] | ||||
Restricted cash and cash equivalents | $ 18.6 | $ 30.8 | $ 39.0 | $ 28.8 |
Basis of Presentation |
3 Months Ended | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Mar. 31, 2018 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Accounting Policies [Abstract] | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Basis of Presentation | Basis of Presentation Basis of Presentation These unaudited consolidated financial statements have been prepared in accordance with accounting principles generally accepted in the United States of America (GAAP) for interim financial reporting and in accordance with Rule 10-01 of Regulation S-X. In the opinion of management, the unaudited interim consolidated financial statements contained in this report reflect all normal recurring adjustments, which are necessary for a fair presentation of the financial position and the results of operations for the interim periods presented. The results of operations for any interim period are not necessarily indicative of results for the full year. The accompanying unaudited consolidated financial statements should be read in conjunction with the consolidated financial statements and notes thereto included in the Company's Annual Report on Form 10-K for the fiscal year ended December 31, 2017. Cash and Cash Equivalents Cash and cash equivalents are comprised principally of demand deposits at banks and other highly liquid short-term investments with maturities generally three months or less when purchased. Cash and cash equivalents are reflected in the financial statements at cost, which approximates fair value. Restricted Cash and Marketable Securities As of March 31, 2018 and December 31, 2017, the Company held restricted cash and cash equivalents of $18.6 million and $30.8 million, respectively, classified within insurance collateral in the accompanying consolidated balance sheets. The cash was restricted for the purpose of satisfying the obligations of the Company's wholly owned captive insurance companies. Supplemental Cash Flow Data The following presents supplemental cash flow statement disclosure (in millions):
Use of Estimates The preparation of financial statements in conformity with GAAP requires management to make estimates and assumptions that affect the reported amounts of assets and liabilities and disclosure of contingent assets and liabilities at the date of the financial statements and the reported amounts of revenues and expenses during the reporting period. Actual results could differ from those estimates. Reclassifications Certain prior year amounts in the accompanying consolidated financial statements and these notes have been reclassified to conform to the current period presentation and prior annual period presentations. Recent Accounting Pronouncements In May 2014, the Financial Accounting Standards Board (FASB) issued Accounting Standards Update (ASU) No. 2014-09 “Revenue from Contracts with Customers,” Accounting Standards Codification (ASC) as topic 606 (ASC 606), which eliminated the transaction and industry-specific revenue recognition guidance under current GAAP and replaced it with a principle-based approach using the following steps: identify the contract(s) with a customer, identify the performance obligations in the contract, determine the transaction price, allocate the transaction price to the performance obligations in the contract and recognize revenue when (or as) the entity satisfies a performance obligation. The Company adopted the new standard effective January 1, 2018 using the modified retrospective method. As a result of using this approach, the Company recognized the cumulative effect adjustment to increase retained earnings $0.5 million for initial application of the guidance at the date of initial adoption. The adoption of the standard did not have a material impact on the Company's consolidated financial position, results of operations or cash flows. In February 2016, the FASB issued ASU No. 2016-02, “Leases,” and subsequently ASU No. 2017-13, which amend existing accounting standards for lease accounting, including requiring lessees to recognize most leases on the balance sheet and making changes to lessor accounting. The standard is effective for annual periods beginning after December 15, 2018, with early adoption permitted. The new standard requires a modified retrospective application for all leases existing at, or entered into after, the date of initial application, with an option to use certain transition relief. The Company will adopt the new standard effective January 1, 2019. The Company expects that nearly all leases currently classified as operating leases will be classified as operating leases under the new standard with a right-of-use asset and a corresponding obligation recognized on the balance sheet at the adoption date. The Company has not yet determined the impact this ASU will have on the Company's consolidated financial position, results of operations or cash flows. In January 2016, the FASB issued ASU 2016-01, "Financial Instruments - Overall," as amended by ASU 2018-03, "Technical Corrections and Improvements to Financial Instruments (Subtopic 825-10) – Recognition and Measurement of Financial Assets and Financial Liabilities” in February 2018, which among other changes in accounting and disclosure requirements, replaces the cost method of accounting for non-marketable equity securities with a model for recognizing impairments and observable price changes, and also eliminates the available-for-sale classification for marketable equity securities. Under the new guidance, other than when the consolidation or equity method of accounting is utilized, changes in the fair value of equity securities are to be recognized in earnings. The Company adopted the provisions of ASU 2016-01 and ASU 2018-03 as of January 1, 2018 resulting in a cumulative effect adjustment to retained earnings related to the unrealized gain on corporate equity securities. The adjustment of $1.6 million was reclassified out of accumulated other comprehensive income (loss) and into retained earnings. Prior to adoption, the corporate equity securities related unrealized gains and losses were reported as a separate component of accumulated other comprehensive income (loss). Effective January 1, 2018 the change in fair value on corporate equity securities is reported as a component of other income (expense), net in the accompanying consolidated statements of operations. In January 2017, the FASB issued ASU 2017-01, “Business Combinations (Topic 805) - Clarifying the Definition of a Business,” which changes the definition of a business to assist entities with evaluating when a set of transferred assets and activities is a business. The guidance requires an entity to evaluate if substantially all of the fair value of gross assets acquired is concentrated in a single identifiable asset or a group of similar identifiable assets. The guidance is effective for annual periods beginning after December 15, 2017, and interim periods within those years. The Company adopted ASU 2017-01 as of January 1, 2018. This standard did not have an impact on our consolidated financial statements, results of operations or cash flows upon adoption. Effective January 1, 2018, the Company retrospectively adopted a change in accounting principle related to the adoption of ASU No. 2016–18, Statement of Cash Flows (Topic 230)—Restricted Cash—a consensus of the FASB Emerging Issues Task Force. This revised standard is an effort by the FASB to reduce diversification in practice by providing specific guidance on the presentation of restricted cash or restricted cash equivalents in the statement of cash flows. The updated guidance requires that a statement of cash flows explain the change during the period in the total of cash, cash equivalents, and amounts generally described as restricted cash and restricted cash equivalents. As such, amounts generally described as restricted cash and restricted cash equivalents should be included in the “beginning–of–period” and “end–of–period” total amounts shown on the statement of cash flows. Accordingly, upon adoption the Company used the retrospective transition method by restating its consolidated statements of cash flows to include restricted cash of $28.8 million in the beginning and $39.0 million in the ending cash, cash equivalents, and restricted cash balances for the three months ended March 31, 2017. In February 2018, the FASB issued ASU No. 2018-02, "Income Statement – Reporting Comprehensive Income (Topic 220) - Reclassification of Certain Tax Effects from Accumulated Other Comprehensive Income," which will allow a reclassification from accumulated other comprehensive income (loss) to retained earnings for the tax effects resulting from the Tax Cuts and Jobs Act (the Act) that are stranded in accumulated other comprehensive income (loss). This standard also requires certain disclosures about stranded tax effects. ASU 2018-02, however, does not change the underlying guidance that requires that the effect of a change in tax laws or rates be included in income from continuing operations. The standard is effective for annual periods beginning after December 15, 2018, with early adoption permitted for interim periods within those years. The Company adopted ASU 2018-02 as of January 1, 2018. This standard did not have an impact on our consolidated financial statements, results of operations or cash flows upon adoption. In March 2018, the FASB issued ASU 2018-05, "Income Taxes (Topic 740) - Amendments to SEC Paragraphs Pursuant to SEC Staff Accounting Bulletin No. 118 (SAB 118)." The standard amends ASC 740, Income Taxes to provide guidance on accounting for the tax effects of the Tax Cuts and Jobs Act of 2017 pursuant to SAB 118. The guidance allows a company to record a provisional amount when it does not have the necessary information available, prepared, or analyzed in reasonable detail to complete its accounting for the change in the tax law. The measurement period ends when the company has obtained, prepared and analyzed the information necessary to finalize its accounting, but cannot extend beyond one year. Additional information regarding the adoption of this standard is contained in Note 14. |
Variable Interest Entities |
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Variable Interest Entity, Measure of Activity [Abstract] | |
Variable Interest Entities | Variable Interest Entities GAAP requires variable interest entities (VIEs) to be consolidated if an entity’s interest in the VIE is a controlling financial interest. Under the variable interest model, a controlling financial interest is determined based on which entity, if any, has (i) the power to direct the activities of the VIE that most significantly impacts the VIEs economic performance and (ii) the obligations to absorb the losses that could potentially be significant to the VIE or the right to receive benefits from the VIE that could potentially be significant to the VIE. The Company performs ongoing reassessments of (i) whether entities previously evaluated under the majority voting-interest framework have become VIEs, based on certain triggering events, and therefore would be subject to the VIE consolidation framework, and (ii) whether changes in the facts and circumstances regarding the Company’s involvement with a VIE cause the Company’s consolidation conclusion to change. The consolidation status of the VIEs with which the Company is involved may change as a result of such reassessments. Changes in consolidation status are applied prospectively with assets and liabilities of a newly consolidated VIE initially recorded at fair value. Physician Services Segment The physician services segment structures its contractual arrangements for services in various ways. In most states, a wholly owned subsidiary contracts with hospitals to provide management services. The consolidated financial statements include the accounts of the Company and its wholly owned subsidiaries along with the accounts of affiliated professional corporations (PCs) with which the Company has management arrangements. The Company's agreements with these PCs provide that the term of the arrangements is permanent, subject only to termination by the Company, except in the case of gross negligence, fraud or bankruptcy of the Company. The PC structure is necessary in states which prohibit the corporate practice of medicine but this structure is utilized by the Company in the majority of its physician practices regardless of the state where the PC operates. The arrangements are captive in nature as a majority of the outstanding voting equity instruments of the PCs are owned by nominee shareholders appointed at the sole discretion of the Company. The nominee shareholder is a medical doctor who is generally a senior corporate employee of the Company. The Company has a contractual right to transfer the ownership of the PCs at any time to any person it designates as the nominee shareholder. The Company has the right to all assets and to receive income, both as ongoing fees and as proceeds from the sale of any interest in the PCs, in an amount that fluctuates based on the performance of the PCs and the change in the fair value of the interest in the PCs. The Company has exclusive responsibility for the provision of all non-medical services required for the day-to-day operation and management of the PCs and establishes the guidelines for the employment and compensation of the physicians and other employees of the PCs, which is consistent with the operation of the Company's wholly owned subsidiaries. Based on the provisions of these agreements, the Company has determined that the PCs are variable interest entities and that the Company is the primary beneficiary as defined in ASC 810 “Consolidations.” The Company has a variable interest in the PCs through the management contracts and the PCs are considered VIEs due to its equity holder lacking the obligation to absorb expected losses or receive expected residual returns. The contractual arrangement to provide management services allows the Company to direct the economic activities considered most significant to the PC. Accordingly, the Company is the primary beneficiary of the PCs and consolidates the PCs under the variable interest model in ASC 810. The physician services segment also has partnerships with health systems that are considered VIEs. The Company consolidates the majority of the partnerships with health systems as the Company is the primary beneficiary due to its ability to direct the majority of activities that most significantly impact the economic performance of the partnership, which generally occurs through a management services agreement. Therefore, the results of consolidated partnerships are reflected as a component of the accompanying consolidated balance sheets, statements of operations and statements of cash flows. The total assets (excluding goodwill and intangible assets, net) of the consolidated VIEs within the physician services segment, which are included in the accompanying consolidated balance sheets, as of March 31, 2018 and December 31, 2017, were $1.29 billion and $1.56 billion, respectively, and the total liabilities of the consolidated VIEs were $1.06 billion and $1.31 billion, respectively. Included in total assets as of March 31, 2018 and December 31, 2017 were $261.1 million and $248.4 million, respectively, of assets which were restricted as to use due to the Company's ownership percentage in certain of the partnerships with health systems and could only be used to settle the obligations of the VIEs. The creditors of the consolidated VIEs within the physician services segment have no recourse to the Company. Ambulatory Services Segment The Company, through its wholly owned subsidiaries, owns interests, primarily 51%, in limited liability companies (LLCs) and limited partnerships (LPs) which own and operate ambulatory surgery centers (ASCs or surgery centers). The Company has variable interests in the LLCs and LPs through its equity ownership interests. Each LLC and LP is considered a VIE due to its structure as a limited partnership or functional equivalent under ASU No. 2015-02. For those LLCs and LPs which the Company consolidates, the Company is considered the primary beneficiary due to the partnership agreements allowing the Company to govern the day-to-day activities and thereby control the most significant economic activities. The total assets (excluding goodwill and intangible assets, net) of the consolidated VIEs within the ambulatory services segment, which are included in the accompanying consolidated balance sheets, as of March 31, 2018 and December 31, 2017, were $362.3 million and $375.3 million, respectively, and the total liabilities of the consolidated VIEs were $119.5 million and $119.8 million, respectively. Included in total assets as of March 31, 2018 and December 31, 2017, were $172.0 million and $178.4 million of assets, which were restricted as to use due to the Company's ownership percentage in these entities and could only be used to settle the obligations of the VIEs. The creditors of the VIEs have no recourse to the Company, with the exception of $22.1 million and $19.3 million of debt guaranteed by the Company at March 31, 2018 and December 31, 2017, respectively. Unconsolidated Variable Interest Entities The Company also has certain equity interests in unconsolidated affiliates which meet the definition of a VIE. The Company has a variable interest in 32 LLCs and LPs through its equity interests; however, the Company is not the primary beneficiary of these entities as it does not have the power to direct the activities that most significantly impact the entities' economic performance as a result of the Company's shared or lack of control. In each of the investments, the Company is not obligated to contribute any additional capital beyond its initial contribution and its maximum exposure to loss is limited to the initial capital contribution. As a result, the Company has accounted for these investments under the equity method of accounting and net earnings or loss from these investments is included in equity in earnings of unconsolidated affiliates in the accompanying consolidated statements of operations. See Note 8 for further information. The Company recognized management and billing fees associated with these investments totaling $1.8 million and $1.7 million during the three months ended March 31, 2018 and 2017, respectively, which are included in net revenue in the accompanying consolidated statements of operations. The Company has also recorded receivables from these entities in the amount of $3.8 million and $3.9 million as of March 31, 2018 and December 31, 2017, respectively. These receivables are included in the other current assets in the accompanying consolidated balance sheets. |
Revenue Recognition and Accounts Receivable |
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Revenue Recognition [Abstract] | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Revenue Recognition and Accounts Receivable | Revenue Recognition and Accounts Receivable Revenue Recognition On January 1, 2018 the Company adopted ASC 606. The presentation of the amount of earnings from operations and net earnings were unchanged upon adoption of the new standard; however, adoption of the new standard resulted in changes to the presentation of revenues and the provision for uncollectibles in the consolidated statements of operations. Previously, the estimate for unrealizable amounts was recorded to the provision for uncollectibles and presented as a separate deduction to arrive at net revenue. Upon adoption, the estimate for unrealizable amounts is now reflected as implicit price concession as a reduction to arrive at net revenue. The majority of our revenue is generated from fee for service patient revenue, which is derived principally through contracts originating from the provision of physician services during episodes of care to patients of healthcare facilities and from facility fees for procedures performed at surgery centers. These episodes of care and procedures qualify as distinct goods and services, provided simultaneously together with other readily available resources, in a single instance of service, and thereby constitute a single performance obligation for each patient encounter and, in most instances, occur at readily determinable transaction prices. As a practical expedient, the Company adopted a portfolio approach to sources of patient revenue, applied by specialty to each healthcare facility or surgery center. At this level, each portfolio shares the characteristics conducive to ensuring that the results do not materially differ from the new standard if it were to be applied to individual patient contracts related to each episode of care. Accordingly, there was not a change in the Company's method to recognize revenue. Additionally, through practical expedients, the Company did not adjust the transaction price for any financing components as those were deemed to be insignificant and expensed all incremental customer contract acquisition costs as incurred as such costs are not material and would be amortized over a period less than one year. Subsequent changes that are determined to be a result of an adverse change in the customer's ability to pay, are recorded as bad debt within other operating expenses. Due to the nature of ambulatory services segment, the Company has the ability to assess the ultimate collection for substantially all of the patient service revenue before services are provided as those services are pre-scheduled and non-emergent. Contract and other revenue primarily represents income earned from healthcare facilities and medical centers to supplement third-party and patient reimbursement and contract staffing assignments. The transaction price for these arrangements may be fixed or variable, with determination periods ranging from one month to 18 months. In these instances, the Company will estimate variable compensation at contract commencement and recognize revenue monthly on a straight-line basis, which correlates with the performance obligation to stand ready. Estimating net revenue is a complex process, largely due to the volume of transactions, the number and complexity of contracts with payors, the limited availability, at times, of certain patient and payor information at the time services are provided, and the length of time it takes for collections to fully mature. Patients are billed for services provided, and the Company receives payments for these services from patients or their third-party payors. Payments for services provided are generally less than billed charges. The Company recognizes fee for service revenue, net of contractual adjustments and discounts for uninsured patients, at the time services are provided by healthcare providers. In the period services are provided, the Company estimates gross charges based on billed services plus an estimate for unbilled services based on pending case data collected, estimates contractual allowances based on contracted rates and historical or actual cash collections (net of recoveries), when available, and estimates the discount for uninsured patients based on historical cash collections (net of recoveries) from uninsured patients. For third-party payors, the specific benefits provided for under each patients’ healthcare plan, mandated payment rates under the Medicare and Medicaid programs, as applicable, and historical cash collections are utilized. These expected collections are based on fees and negotiated payment rates in the case of third-party payors, the specific benefits provided for under each patient's healthcare plans, mandated payment rates in the case of Medicare and Medicaid programs, and historical cash collections (net of recoveries) in combination with expected collections from third party payors. In addition, the Company records net revenue from uninsured patients at an estimated realizable value based on historical cash collections (net of recoveries). The price concession includes an estimate of uncollectible balances due from uninsured patients, uncollectible co-pay and deductible balances due from insured patients and special charges, if any, for uncollectible balances due from managed care, commercial and governmental payors. The relationship between gross charges and the transaction price recognized is significantly influenced by payor mix, as collections on gross charges may vary significantly depending on whether and with whom the patients the Company provides services to in the period are insured and the Company's contractual relationships with those payors. Payor mix is subject to change as additional patient and payor information is obtained after the period services are provided. The Company periodically assesses the estimates of unbilled revenue, contractual adjustments and discounts for uninsured patients and payor mix for a period of at least one year following the date of service by analyzing actual results, including cash collections, against estimates. Changes in these estimates are charged or credited to the consolidated statement of operations in the period that the assessment is made. Significant changes in payor mix, contractual arrangements with payors, specialty mix, acuity, business office operations, general economic conditions and health care coverage provided by federal or state governments or private insurers may have a significant impact on estimates and significantly affect the results of operations and cash flows. Concentration of credit risk with respect to other payors is limited due to the large number of such payors. In certain circumstances, federal law requires providers to render emergency medical services to any patient who requires care regardless of their ability to pay. Services to these patients are not considered to be charity care and provisions for uncompensated care for these services are estimated accordingly. Although the Company provides a level of charity care, it is not significant to the Company's net revenues. The Company's billing and accounting systems provide historical trends of cash collections and contractual write-offs, accounts receivable agings and established fee adjustments from third-party payors. These estimates are recorded and monitored monthly as revenues are recognized. These estimates are not, however, established from billing system generated contractual adjustments based on fee schedules for the patient’s insurance plan for each patient encounter. The principal exposure for uncollectible fee for service visits is from self-pay patients and, to a lesser extent, for co-payments and deductibles from patients with insurance. Net revenue (after provision for uncollectibles in 2017) by the Company's segments consists of the following major payors (in millions):
Accounts Receivable The Company manages accounts receivable by regularly reviewing its accounts and contracts and by providing appropriate adjustments to the estimate of the transaction price. Some of the factors considered by management in determining the adjustments are the historical trends of cash collections, contractual and uninsured write-offs, accounts receivable agings, established fee schedules, contracts with payors, changes in payor mix and procedure statistics. Actual collections of accounts receivable in subsequent periods may require changes in the estimated transaction price. The Company tests its analysis by comparing cash collections to net fee for service revenues and monitoring self-pay utilization. In addition, when actual collection percentages differ from expected results, on a contract by contract basis, supplemental detailed reviews of the outstanding accounts receivable balances may be performed by the Company’s billing operations to determine whether there are facts and circumstances existing that may cause a different conclusion as to the estimate of the collectability of that contract’s accounts receivable from the estimate resulting from using the historical collection experience. The Company also supplements its analysis for its physician services segment quarterly using a hindsight calculation that utilizes write-off data for all payor classes during the previous twelve month period to estimate adjustments to the transaction price at a point in time. Changes in these estimates, if any, are charged or credited to the consolidated statements of operations in the period of change. Material changes in estimates may result from unforeseen write-offs of patient or third-party accounts receivable, unsuccessful disputes with managed care payors, adverse macro-economic conditions which limit patients’ ability to meet their financial obligations for the care provided by physicians, or broad changes to government regulations that adversely impact reimbursement rates for services provided by the Company. Significant changes in payor mix, changes in contractual arrangements with payors, business office operations, general economic conditions and health care coverage provided by federal or state governments or private insurers may have a significant impact on the Company’s estimates and significantly affect its results of operations and cash flows. Concentration of credit risk is limited by the diversity and number of facilities, patients, payors and by the geographic dispersion of the Company’s operations. |
Acquisitions and Disposals |
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Business Combinations [Abstract] | ||||||||||||||||||||||||||||||||||||||||
Acquisitions and Disposals | Acquisitions and Disposals The Company accounts for its business combinations under the fundamental requirements of the acquisition method of accounting and under the premise that an acquirer be identified for each business combination. The acquirer is the entity that obtains control of one or more businesses in the business combination and the acquisition date is the date the acquirer achieves control. The assets acquired, liabilities assumed and any noncontrolling interests in the acquired business at the acquisition date are recognized at their fair values as of that date, and the direct costs incurred in connection with the business combination are recorded and expensed separately from the business combination. Acquisitions in which the Company is able to exert significant influence but does not have control are accounted for using the equity method. Physician Services Activity The Company, through wholly owned subsidiaries, completed the acquisition of two physician practices in the three months ended March 31, 2018 and three physician practices in the three months ended March 31, 2017. The aggregate amount paid for the physician practices and for settlement of purchase price payable obligations during the three months ended March 31, 2018 and 2017 was approximately $70.2 million and $55.4 million, respectively, and was paid in cash and funded by either operating cash flow or borrowings under the Company's credit agreement or a combination thereof. Ambulatory Services Activity During the three months ended March 31, 2018, the Company did not acquire any surgery centers. During the three months ended March 31, 2017, the Company, through wholly-owned subsidiaries, acquired a controlling interest in two surgery centers. The aggregate amount paid for the centers and for settlement of purchase price payable obligations during the three months ended March 31, 2017 was approximately $17.7 million, and was paid in cash and funded by either operating cash flow or borrowings under the Company's credit agreement or a combination thereof. During the three months ended March 31, 2018, the Company disposed of three surgery centers. The Company recognized a net loss from the disposals of $1.7 million. During the three months ended March 31, 2017, the Company did not dispose of any surgery centers. Purchase Price Allocations Acquired assets and assumed liabilities include, but are not limited to, accounts receivable, fixed assets, intangible assets, deferred income taxes and insurance liabilities. The valuations are based on appraisal reports, discounted cash flow analyses, actuarial analyses or other appropriate valuation techniques to determine the fair value of the assets acquired or liabilities assumed. A majority of the deferred income taxes recognized as a component of the Company's purchase price allocation is a result of the difference between the book and tax basis of the intangible assets recognized. The acquisition date fair value of the total consideration transferred and acquisition date fair value of each major financial class for individual acquisitions completed in the three months ended March 31, 2018, including post acquisition date adjustments, are as follows (in millions):
Represents the preliminary allocation of fair value of acquired assets and liabilities associated with these acquisitions at March 31, 2018. During the three months ended March 31, 2018, no significant changes were made to the purchase price allocation of assets and liabilities, existing at the date of acquisition, related to individual acquisitions completed in 2017. For the three months ended March 31, 2018 and 2017 approximately $26.0 million and $23.4 million, respectively, of goodwill recorded was deductible for tax purposes. The total fair value of acquisitions completed by the Company include amounts allocated to goodwill, which result from the acquisitions' favorable reputations in their markets, their market positions and their ability to deliver quality care with high patient satisfaction consistent with the Company’s business model. Fair value attributable to noncontrolling interests is based on significant inputs that are not observable in the market. Key inputs used to determine the fair value include financial multiples used in the purchase of noncontrolling interests primarily from acquisitions of centers. Such multiples, based on earnings, are used as a benchmark for the discount to be applied for the lack of control or marketability. The fair value of noncontrolling interests for acquisitions where the purchase price allocation is not finalized may be subject to adjustment as the Company completes its initial accounting for acquired intangible assets. Additionally, the Company continues to obtain information relative to the fair values of assets acquired, liabilities assumed and any noncontrolling interests with acquisitions completed in the last 12 months. Acquired assets and assumed liabilities include, but are not limited to, accounts receivable, fixed assets, intangible assets, deferred income taxes and insurance liabilities. The valuations are based on appraisal reports, discounted cash flow analyses, actuarial analyses or other appropriate valuation techniques used to determine the fair value of the assets acquired or liabilities assumed. A majority of the deferred income taxes recognized as a component of the Company's purchase price allocation is a result of the difference between the book and tax basis of the amortizable intangible assets recognized. The amount allocated to the deferred income tax liability is subject to change as a result of the final allocation of purchase price to amortizable intangibles. The Company expects to finalize the purchase price allocation for its most recent acquisitions as soon as practical. During the three months ended March 31, 2018 and March 31, 2017, the Company incurred approximately $21.4 million and $21.5 million of transaction and integration costs, respectively. Such amounts excluded financing costs that were capitalized or debt extinguishment costs that were expensed as part of the financing transactions associated with acquisitions. |
Discontinued Operations |
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Discontinued Operations and Disposal Groups [Abstract] | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Discontinued Operations | Discontinued Operations On March 14, 2018, the Company completed the divestiture of its medical transportation business to an entity controlled by funds affiliated with KKR & Co. L.P. for approximately $2.28 billion in net cash proceeds. Accordingly, during the three months ended March 31, 2018, the Company recorded a gain of $14.7 million in discontinued operations upon the completion of the transaction. All historical operating results for the medical transportation business are reflected within discontinued operations in the consolidated statements of operations. At the date of the sale, as required by ASC 740, "Accounting for Income Taxes," after all deferred tax liabilities were reversed against the tax basis gain on sale, a one-time permanent book-tax difference of $127.1 million was recorded. Furthermore, all assets and liabilities associated with the medical transportation business were classified as assets and liabilities held for sale in our consolidated balance sheet for the year ended December 31, 2017. The following table summarizes the results of discontinued operations for the three months ended March 31, 2018 and 2017 (in millions):
In accordance with ASC 205, “Presentation of Financial Statements”, for purposes of discontinued operations presentation, general corporate expenses are not permitted to be allocated to the operations of a business to be disposed. Accordingly, for the three months ended March 31, 2018 and 2017 on a before tax basis, approximately $2.5 million and $14.5 million, respectively, of general corporate expenses, including allocations for corporate salaries and stock-based compensation, general and administrative costs and depreciation, were removed from the medical transportation business and reallocated to the Company's remaining segments. In addition, ASC 205 requires interest associated with debt that is required to be repaid as a result of the disposal transaction to be allocated to discontinued operations. Accordingly, during the three months ended March 31, 2018 and 2017, the Company allocated $17.6 million and $21.8 million, respectively, in interest expense to the medical transportation business, which is reflected in the loss from discontinued operations. The Company estimated the interest allocation by applying the effective interest rate of the Company's Term Loan B 2023 by the estimated proceeds, net of taxes and professional fees. For the three months ended March 31, 2018 and 2017, the net cash flows provided by operating activities attributable to discontinued operations were $77.4 million and $29.0 million, respectively, and the net cash flows used in investing activities attributable to discontinued operations were $23.9 million and $8.7 million, respectively. |
Fair Value Measurements |
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Fair Value Disclosures [Abstract] | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Fair Value Measurements | Fair Value Measurements The fair value of a financial instrument is the amount at which the instrument could be exchanged in an orderly transaction between market participants to sell the asset or transfer the liability. The inputs used by the Company to measure fair value are classified into the following hierarchy: Level 1: Quoted prices in active markets for identical assets or liabilities. Level 2: Inputs other than quoted prices included in Level 1 that are observable for the asset or liability through corroboration with market data at the measurement date. Level 3: Unobservable inputs that reflect management’s best estimate of what market participants would use in pricing the asset or liability at the measurement date. In determining the fair value of assets and liabilities that are measured on a recurring basis at March 31, 2018 and December 31, 2017, with the exception of contingent purchase price payables, the Company utilized Level 1 and 2 inputs to perform such measurements methods, which were commensurate with the market approach. The Company utilizes Level 3 inputs to measure the fair value of the contingent consideration. The fair value was determined utilizing future forecasts of both earnings and other performance metrics which are expected to be achieved during the performance period, in accordance with each respective purchase agreement. There were no significant transfers to or from Levels 1 and 2 during the three months ended March 31, 2018. The Company's non-patient receivables and accounts payable are reflected in the financial statements at cost, which approximates fair value. The following table summarizes the valuation of the Company’s financial instruments by the above fair value hierarchy levels as of March 31, 2018 and December 31, 2017 (in millions):
The following table summarizes the change in financial instruments classified as Level 3 in the fair value hierarchy as of March 31, 2018 (in millions):
Insurance Collateral Insurance collateral is comprised of investments in U.S. Treasuries and marketable equity and debt securities held by the Company’s wholly owned captive insurance subsidiaries that support the Company’s insurance programs and reserves, as well as cash deposits with third parties. Certain of these investments, if sold or otherwise liquidated, would have to be replaced by other suitable financial assurances and are, therefore, considered restricted. U.S. Treasuries and debt securities are designated as available-for-sale and reported at fair value with the related temporary unrealized gains and losses reported as a separate component of accumulated other comprehensive income (loss), net of deferred income tax. Declines in the fair value of an available-for-sale security which are determined to be other-than-temporary are recognized in the statements of operations, thus establishing a new cost basis for such investment. Investment income earned on these investments is reported as a component of other income (expense), net in the accompanying statements of operations. Effective January 1, 2018, the Company adopted ASU No. 2016-01 and corporate equity securities are no longer classified as available-for-sale. The change in fair value of corporate equity securities are reported in other income (expense), net in the accompanying consolidated statements of operations. As of March 31, 2018, the change in fair value in other income (expense), net was $0.9 million. Investments are generally classified within Level 1 or Level 2 of the fair value hierarchy because they are valued using quoted market prices, broker or dealer quotations, or alternative pricing sources with reasonable levels of price transparency. Insurance collateral consisted of the following as of March 31, 2018 and December 31, 2017 (in millions):
Amortized cost basis and aggregate fair value of the Company's available-for-sale and corporate equity securities as of March 31, 2018 and December 31, 2017 were as follows (in millions):
As of March 31, 2018, available-for-sale securities included U.S. Treasuries, corporate bonds and fixed income securities of $6.1 million with contractual maturities within one year and $49.9 million with contractual maturities extending longer than one year through five years and $28.4 million with contractual maturities extending longer than five years. Actual maturities may differ from contractual maturities as a result of the Company's ability to sell these securities prior to maturity. The Company's available-for-sale investment securities that were temporarily impaired as of March 31, 2018 and December 31, 2017 were as follows (in millions):
There were no available-for-sale investment securities that were other-than-temporarily impaired as of March 31, 2018. The Company evaluates the investment securities available-for-sale on a quarterly basis to determine whether declines in the fair value of these securities are other-than-temporary. The evaluation consists of reviewing the fair value of the security compared to the carrying amount, the historical volatility of the price of each security, and any industry and company specific factors related to each security. The Company is not aware of any specific factors indicating that the underlying issuers of the corporate bonds/fixed income securities would not be able to pay interest as it becomes due or repay the principal amount at maturity. Therefore, the Company believes that the changes in the estimated fair values of these debt securities are related to temporary market fluctuations and the Company does not intend to dispose of these investments. The Company received proceeds of $15.2 million on the sale and maturities of available-for-sale securities during the three months ended March 31, 2018. For the three months ended March 31, 2018, a loss of approximately $0.2 million was reclassified from accumulated other comprehensive income (loss) to other income (expense), net in the accompanying consolidated statements of operations. There were $0.9 million of unrealized gains for the three months ended March 31, 2018 recorded in accumulated other comprehensive income (loss) for available-for-sale securities. |
Prepaid and Other Current Assets |
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Deferred Costs, Capitalized, Prepaid, and Other Assets Disclosure [Abstract] | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Prepaid and Other Current Assets | Prepaid and Other Current Assets The following table presents a summary of items comprising prepaid and other current assets in the accompanying consolidated balance sheets as of March 31, 2018 and December 31, 2017 (in millions):
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Investments in Unconsolidated Affiliates |
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Equity Method Investments and Joint Ventures [Abstract] | |
Investments in Unconsolidated Affiliates | Investments in Unconsolidated Affiliates Investments in unconsolidated affiliates in which the Company exerts significant influence but does not control or otherwise consolidate are accounted for using the equity method. Equity method investments are initially recorded at cost, unless such investments are a result of the Company entering into a transaction whereby the Company loses control of a previously controlled entity but retains a noncontrolling interest. Such transactions, which result in the deconsolidation of a previously consolidated entity, are measured at fair value. The fair value measurement utilizes Level 3 inputs, which include unobservable data, to measure the fair value of the retained noncontrolling interest. The fair value determination is generally based on a combination of multiple valuation methods, which can include discounted cash flow, income approach, or market value approach, which incorporates estimates of future earnings and market valuation multiples for certain guideline companies. These investments are included as investments in unconsolidated affiliates in the accompanying consolidated balance sheets. The Company’s share of the profits and losses from these investments is reported in equity in earnings of unconsolidated affiliates in the accompanying consolidated statements of operations. The Company monitors its investments for other-than-temporary impairment by considering factors such as current economic and market conditions and the operating performance of the companies and records reductions in carrying values when necessary. As of March 31, 2018 and December 31, 2017, the Company recorded in the accompanying consolidated balance sheets its investments in unconsolidated affiliates of $157.4 million and $156.7 million, respectively. The Company's net earnings from these investments during the three months ended March 31, 2018 and 2017 were approximately $5.8 million and $4.9 million, respectively. During the three months ended March 31, 2018, the Company entered into one equity method investment. As a result of this investment, the Company contributed its controlling interest in one center in exchange for a noncontrolling interest in the new investment and net cash consideration of $0.2 million. This investment is jointly owned by a health system and the Company. The newly formed investment (including the contributed center) is controlled by the health system. In each transaction, the gain or loss on deconsolidation, which is primarily non-cash in nature, is determined based on the difference between the fair value of the Company’s interest, which is based on estimates of the expected future earnings, in the new entity and the carrying value of both the tangible and intangible assets of the contributed center immediately prior to the transaction. In certain cases, the Company evaluated likely scenarios which are weighted by a range of expected probabilities of 10% to 50% which are primarily based on third-party valuations received by the Company. Accordingly, the Company recognized a net gain on deconsolidation which is included in net gain (loss) on disposals and deconsolidations in the accompanying consolidated statements of operations of approximately $0.7 million during the three months ended March 31, 2018. During the three months ended March 31, 2017, the Company recognized a net gain on deconsolidation in the accompanying consolidated statements of operations of approximately $7.4 million. |
Goodwill and Intangible Assets |
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Goodwill and Intangible Assets Disclosure [Abstract] | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Goodwill and Intangible Assets | Goodwill and Intangible Assets The Company’s intangible assets include goodwill and other intangibles, which include the fair value of both the customer relationships with hospitals and certain trade names. The Company's indefinite-lived intangibles include goodwill, trade names and licenses. Goodwill represents the excess of purchase price over the fair value of net assets acquired. The Company evaluates indefinite-lived intangible assets, including goodwill, for impairment at least on an annual basis and more frequently if certain indicators are encountered. Indefinite-lived intangibles are to be tested at the reporting unit level, defined as an operating segment or one level below an operating segment (referred to as a component), with the fair value of the reporting unit being compared to its carrying amount. If the fair value of a reporting unit exceeds its carrying amount, the indefinite-lived intangibles associated with the reporting unit are not considered to be impaired. The Company will perform its annual goodwill impairment test during the fourth quarter of 2018 or sooner if events or circumstances occur that are more likely than not to reduce the fair value of the reporting units below their carrying value. There can be no assurance that the estimates and assumptions made for purposes of this qualitative evaluation will prove to be an accurate prediction of future results. Factors that could impact the final determination of fair value in connection with the completion of the annual goodwill impairment process include a sustained decline in market capitalization, changes in the estimated fair values of the physician services assets and liabilities, changes in projected future earnings and net cash flows, changes in market related multiples, and changes in valuation related assumptions such as discount rates and perpetual growth rates. Goodwill The changes in the carrying amount of goodwill for the three months ended March 31, 2018 are as follows (in millions):
During the three months ended March 31, 2018, goodwill was recorded in the Company's physician services segment due to the acquisition of two physician practices. In the Company's ambulatory services segment, goodwill decreased by $0.3 million as a result of adjustments to goodwill related to prior year acquisitions and by $3.8 million as a result of the disposal or deconsolidation of consolidated surgery centers within the ambulatory services segment. Intangible Assets
Intangible assets at March 31, 2018 and December 31, 2017 consisted of the following (in millions):
Amortization of intangible assets for the three months ended March 31, 2018 and 2017 was $54.7 million and $56.1 million, respectively. Estimated amortization of intangible assets for the remainder of 2018 and each of the following five years and thereafter is $162.0 million, $206.4 million, $195.8 million, $187.9 million, $179.4 million, $175.5 million and $2.11 billion, respectively. The Company expects to recognize amortization of all intangible assets over a weighted average period of 17.5 years with no expected residual values. |
Other Accrued Liabilities |
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Accrued Liabilities, Current [Abstract] | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Other Accrued Liabilities | Other Accrued Liabilities The following table presents a summary of items comprising other accrued liabilities in the accompanying consolidated balance sheets as of March 31, 2018 and December 31, 2017 (in millions):
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Long-term Debt |
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Debt Disclosure [Abstract] | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Long-term Debt | Long-term Debt Long-term debt at March 31, 2018 and December 31, 2017 consisted of the following (in millions):
The fair value of the Company's fixed rate long-term debt, with a carrying value of $2.46 billion, was $2.47 billion at March 31, 2018. The Company's variable rate long-term debt approximated its carrying value of $2.26 billion at March 31, 2018. With the exception of the Company’s senior unsecured notes, the fair value of fixed rate debt (Level 2) is determined based on an estimation of discounted future cash flows of the debt at rates currently quoted or offered to the Company for similar debt instruments of comparable maturities by its lenders. The fair value of the Company’s senior unsecured notes (Level 1 and 2) is determined based on quoted prices in an active market. Subsequent to the divestiture of the medical transportation business in March 2018, the Company utilized approximately $1.82 billion of the proceeds to repay indebtedness under the term loan facility and ABL facility. As a result of the payment on the term loan, the Company is no longer required to make mandatory principal payments through the remaining term. Previously, the Company was required to make principal payments of $40.0 million per year. |
Insurance Reserves |
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Insurance Reserves | Insurance Reserves Insurance reserves are established for professional and general liability claims utilizing policies with both fully-insured and self-insured components. This includes the use of an off-shore captive insurance program through wholly owned subsidiaries for certain professional (medical malpractice) and general liability programs. In those instances where the Company has obtained third-party insurance coverage, the Company normally retains liability for the first $1 million to $3 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 March 31, 2018. The Company establishes reserves for claims based upon an assessment of claims reported 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. Claim reserves are not discounted. Provisions for insurance expense included in the statements of operations include provisions determined in consultation with third-party actuaries and premiums paid to third-party insurers. At March 31, 2018 and December 31, 2017, the Company's accrued insurance reserves are presented in the accompanying consolidated balance sheets as a component of other accrued liabilities and insurance reserves as follows (in millions):
The changes to the Company's estimated losses under insurance programs as of March 31, 2018 were as follows (in millions):
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Stockholders' Equity |
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Equity [Abstract] | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Stockholders' Equity | Stockholders’ Equity Stock Incentive Plans Transactions in which the Company receives employee and non-employee services in exchange for the Company’s equity instruments or liabilities that are based on the fair value of the Company’s equity securities or may be settled by the issuance of these securities are accounted using a fair value method. The Company applies the Black-Scholes method of valuation in determining share-based compensation expense for option awards. For performance share units, the Company utilizes the Monte-Carlo method of valuation. For awards with graded vesting schedules, the Company recognizes compensation expense using the accelerated method. Forfeitures are recognized as incurred. Under Company policy, shares held by outside directors and senior management are subject to certain stock ownership guidelines and restrictions on hedging and pledging. In May 2014, the Company adopted the AmSurg Corp. 2014 Equity and Incentive Plan (the “2014 Plan”), which was amended in both 2016 and 2017, most recently to change the name of the plan to the Envision Healthcare Corporation 2014 Equity and Incentive Plan. Under this plan, the Company has granted restricted stock, non-qualified options and market-based performance share units to employees and outside directors. At March 31, 2018, 3,200,000 shares were authorized for grant under the 2014 Plan and 977,999 shares were available for future equity grants. Under the terms of the 2014 Plan, all equity awards granted thereunder are subject to a one year minimum vesting period. The Company withholds a portion of employee restricted stock that vests to cover payroll withholding taxes in accordance with the restricted stock agreements. During the three months ended March 31, 2018 and 2017, the Company withheld approximately 94,084 shares and 128,186 shares, respectively, of common stock for approximately $3.3 million and $8.8 million, respectively. On December 1, 2016, each outstanding option to purchase shares of Envision Healthcare Holdings, Inc. (EHH) common stock and each outstanding EHH stock unit (including stock units subject to time-based and performance-based vesting conditions) were converted into an option to purchase 0.334 shares of common stock of the Company and 0.334 stock units of the Company, respectively. Each option and stock unit continues to have the same terms and conditions as were in effect under the EHH 2013 Omnibus Incentive Plan prior to the completion of the merger. During the year ended December 31, 2017, the plan was renamed to the Envision Healthcare Corporation 2013 Omnibus Incentive Plan (the "2013 Plan"). At March 31, 2018, 5,580,568 shares were authorized for grant under the 2013 Plan and 3,720,175 shares were available for future equity grants. Non-performance and performance-based awards issued under the 2013 Plan are subject to time-based vesting ranging from one to three years. All options issued under the 2013 Plan have a term of ten years from the date of grant. Under the terms of the 2013 Plan, all equity awards granted thereunder are subject to a one year minimum vesting period. Restricted stock granted to outside directors vests on the first anniversary of the date of grant. Restricted stock granted to employees generally vests over three to four years in three equal installments. The fair value of restricted stock is determined based on the closing bid price of the Company’s common stock on the grant date. Performance Units During the three months ended March 31, 2018, the Company issued 70,615 market-based performance share units with a grant date fair value of approximately $40 per unit. Also, during the three months ended March 31, 2018, 26,249 market-based performance share units vested while 48,898 market-based performance shares were canceled. At March 31, 2018, 191,223 market-based performance shares were outstanding. The market-based performance share units vest based on achievement of both the three years service condition and market condition. The market-based performance share units continue to have the same terms and conditions as were in effect prior to the Merger. The Monte Carlo simulation used to calculate the fair value of the market-based performance share units simulates the present value of the potential outcomes of future stock prices of the Company and the companies included in the defined performance index over the performance cycle. The projection of stock prices are based on the risk-free rate of return, the volatilities of the stock price of the Company and the companies included in the defined performance index, and the correlation of the stock price of the Company with these companies. If the financial performance goal is not achieved, the market based performance share units will be forfeited. The number of market based performance share units that will ultimately be received by the holders range from 0% to 150% of the units granted, depending on the Company’s level of achievement with respect to the financial performance goal. During the three months ended March 31, 2018, the Company issued 453,938 performance-based share units which vest in a range from 0% to 150% of the number of target units awarded, depending on the Company’s level of achievement with respect to the financial performance goal, after three years. The Company has not recognized stock compensation expense for the performance-based share units during the three months ended March 31, 2018 as the performance conditions have not been determined as of March 31, 2018. The Company expects the performance conditions to be determined during the third year of vesting. During the three months ended March 31, 2018, 18,749 performance-based shares vested while 66,565 performance-based shares were canceled. At March 31, 2018, 678,775 performance-based share units were outstanding. Restricted Stock A summary of the status of and changes for non-vested restricted shares for the periods presented below is summarized as follows:
Stock Options A summary of stock option activity for the periods presented below is summarized as follows:
The aggregate intrinsic value represents the total pre-tax intrinsic value received by the option holders on the exercise date or that would have been received by the option holders had all holders of in-the-money outstanding options at March 31, 2018 exercised their options at the Company’s closing stock price on March 31, 2018. Other Information Other information pertaining to share-based activity during the three months ended March 31, 2018 and 2017 was as follows (in millions):
As of March 31, 2018, the Company had total unrecognized compensation cost of approximately $49.8 million related to non-vested awards, which the Company expects to recognize through 2021 and over a weighted average period of 1.0 year. For the three months ended March 31, 2018 and 2017, there were 370,416 and 66,463 options that were anti-dilutive, respectively. On September 17, 2017, the Board authorized a stock repurchase program that authorizes the Company to repurchase up to $250 million of its common stock. As of March 31, 2018, the Company had made no repurchases under the stock repurchase program. Earnings per Share Basic net earnings (loss) attributable to Envision Healthcare Corporation common stockholders, per common share, excludes dilution and is computed by dividing net earnings (loss) attributable to Envision Healthcare Corporation common stockholders by the weighted-average number of common shares outstanding during the period. Diluted net earnings (loss) attributable to Envision Healthcare Corporation common stockholders, per common share is computed by dividing net earnings (loss) attributable to Envision Healthcare Corporation common stockholders by the weighted-average number of common shares outstanding during the period plus any potential dilutive common share equivalents, including shares issuable (i) upon the vesting of restricted stock awards, restricted stock units and performance stock units as determined under the treasury stock method and (ii) prior to July 3, 2017, the mandatory conversion date, upon conversion of the Company preferred stock as determined under the if-converted method. For purposes of calculating diluted earnings (loss) per share, preferred stock dividends have been subtracted from both net earnings (loss) from continuing operations attributable to Envision Healthcare Corporation and net earnings (loss) attributable to Envision Healthcare Corporation common stockholders in periods in which utilizing the if-converted method would be anti-dilutive. The following is a reconciliation of the numerator and denominators of basic and diluted earnings (loss) per share (dollars in millions; per share amounts in thousands):
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Income Taxes |
3 Months Ended |
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Mar. 31, 2018 | |
Income Tax Disclosure [Abstract] | |
Income Taxes | Income Taxes Income taxes are accounted for under the asset and liability method. Deferred tax assets and liabilities are recognized for the future tax consequences attributable to differences between the financial statement carrying amounts of existing assets and liabilities and their respective tax bases. Deferred tax assets and liabilities are measured using enacted tax rates expected to apply to taxable income in the years in which those temporary differences are expected to be recovered or settled. The effect on deferred tax assets and liabilities of a change in tax rates is recognized in income in the period that includes the enactment date. The Company applies recognition thresholds and measurement attributes for the financial statement recognition and measurement of a tax position taken or expected to be taken in a tax return as it relates to accounting for uncertainty in income taxes. In addition, it is the Company’s policy to recognize interest accrued and penalties, if any, related to unrecognized benefits as income tax expense in its consolidated statements of operations. The Company does not expect significant changes to its tax positions or liability for tax uncertainties during the next 12 months. The Company and its subsidiaries file income tax returns in the U.S. federal jurisdiction and various state jurisdictions. The Company is no longer subject to U.S. federal income tax examinations for the years prior to 2014. With few exceptions, the Company is no longer subject to U.S. state income tax examinations for the years prior to 2013. On December 22, 2017, the Tax Cuts and Jobs Act of 2017 (the Act) was signed into law. The Act includes a number of changes to existing U.S. tax laws that impact the Company, most notably a reduction of the U.S. corporate tax rate from 35% to 21%, for tax years beginning after December 31, 2017. As a result of the enacted rate change, during the year ended December 31, 2017 we recorded a benefit of $596.6 million in deferred income tax expense for the change in the net deferred tax liability at the 21% tax rate. The Act also provides for acceleration of depreciation for certain assets placed into service after September 27, 2017, as well as prospective changes that began in 2018. These prospective changes include an increased limitation on deductibility of executive compensation, a limitation on the deductibility of interest expense, new rules surrounding meals and entertainment expense and fines and penalties. Also, while net operating losses generated in the future may be carried forward indefinitely under the new law, there is a limitation on the amount that may be used in any given year. The Act may also have an impact on projected future taxable income that could affect valuation allowance considerations. In addition to the Federal law, the Company awaits guidance from the states in which it files on how components of the Act may be treated in these jurisdictions. We currently expect our adjusted effective rate during 2018 to be approximately 26%. During the three months ended March 31, 2018, we recorded an additional $10.3 million as additional income tax benefit as a result of the Act, primarily due to 2017 acquisitions with subsequent purchase price allocation adjustments. The tax benefit represents the Company's assessment of the impact of the Act, the key component being re-measurement of deferred tax balances to the new corporate rate. As the benefit is based on currently available information and interpretations, which are continuing to evolve, the benefit should be considered provisional. The Company will continue to analyze additional information and guidance related to the Act as supplemental legislation, regulatory guidance, or evolving technical interpretations become available. The final impacts may differ from the recorded amounts as of March 31, 2018, and the Company will continue to refine such amounts within the measurement period provided by SAB 118 and ASU 2018-05. We continue to analyze the different aspects of the Act which could potentially affect the provisional estimates that were recorded at December 31, 2017 and March 31, 2018. Any subsequent adjustment to these amounts will be recorded to current tax expense in the first reporting period in which a reasonable estimate can be determined. The Company expects to complete the analysis no later than the fourth quarter of 2018. |
Commitments and Contingencies |
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Mar. 31, 2018 | |
Commitments and Contingencies Disclosure [Abstract] | |
Commitments and Contingencies | Commitments and Contingencies Litigation The Company is subject to litigation arising in the ordinary course of business, including litigation principally relating to professional liability, auto accident and workers’ compensation claims. There can be no assurance that the Company's insurance coverage and self-insured liabilities will be adequate to cover all liabilities occurring out of such claims. From time to time, in the ordinary course of business and like others in the Company's sector, the Company receives 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. The Company reviews such requests and notices and takes appropriate action. The Company has 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. In the opinion of the Company, it is not engaged in any legal proceedings that the Company expects will have a material adverse effect on the Company's business, financial condition, cash flows or results of operations, other than as set forth below. On August 4, 2017, a shareholder filed a purported class action in the United States District Court for the Middle District of Tennessee (M.D. Tenn.) against the Company and several of its officers and former officers alleging that the Company and the individual defendants violated the federal securities laws by making allegedly false and misleading statements and failing to disclose certain information. On September 29, 2017, and October 23, 2017, respectively, two purported class actions were filed in the same court making similar allegations. The Court subsequently consolidated these cases into a single action. On November 20, 2017, a shareholder filed a purported class action in the M.D. Tenn. against the Company and its Board. The plaintiff generally alleges that the Company and/or certain of its officers breached various fiduciary duties and violated the federal securities laws. On December 12, 2017, and December 15, 2017, respectively, two purported class actions were filed in the same court raising essentially the same allegations. The Company believes these claims are without merit and intends to vigorously defend these actions. Given the preliminary stage of these matters, the Company is unable to estimate the amount of potential damages, if any, in any of these actions. The Company filed a lawsuit against United HealthCare Insurance Company (“United”) on March 12, 2018 in U.S. District Court for the Southern District of Florida asserting, among other things, that United breached its medical group participation agreement with the Company (the “Participation Agreement”) by unilaterally lowering the contracted rates payable for certain healthcare services provided by the Company's clinicians to United’s health plan participants. On April 13, 2018, United filed a claim against the Company in arbitration, alleging that we breached the Participation Agreement by improperly affiliating new entities. On April 27, 2018, the court ordered that the Company should pursue our claims in arbitration and we refiled our complaint in arbitration. While the Company intends to vigorously assert its claims against United in binding arbitration, the Company is unable to estimate the amount of any potential award or damages, if any. Insurance Programs Given the nature of the services provided, the Company and its subsidiaries are subject to professional and general liability claims and related lawsuits in the ordinary course of business. The Company maintains professional insurance with third-party insurers generally on a claims-made basis, subject to self-insured retentions, exclusions and other restrictions. A substantial portion of the professional liability loss risks are being provided by a third-party insurer which is fully reinsured by the Company's wholly owned captive insurance subsidiary. The assets, liabilities and results of operations of the wholly owned captive are consolidated in the accompanying consolidated financial statements. The liabilities for self-insurance in the accompanying consolidated balance sheets include estimates of the ultimate costs related to both reported claims on an individual and aggregate basis and unreported claims. The Company also obtains professional liability insurance on a claims-made basis from third-party insurers for its surgery centers and certain of its owned practices and employed physicians. The Company’s reserves for professional liability claims within the self-insured retention are based upon periodic actuarial calculations. These actuarial estimates consider historical claims frequency and severity, loss development patterns and other actuarial assumptions and are not discounted to present value. The Company also maintains insurance for director and officer liability, workers’ compensation liability and property damage. Certain policies are subject to deductibles. In addition to the insurance coverage provided, the Company indemnifies its officers and directors for actions taken on behalf of the Company and its subsidiaries. Redeemable Noncontrolling Interests In the event of a change in current law that would prohibit the physicians’ current form of ownership in the partnerships within the ambulatory services segment, the Company would be obligated to purchase the physicians’ interests in a substantial amount of the Company’s partnerships. The purchase price to be paid in such event would be determined by a predefined formula, as specified in the partnership agreements. The Company believes the likelihood of a change in current law that would trigger such purchases was remote as of March 31, 2018. As a result, the noncontrolling interests that are subject to this redemption feature are not included as part of the Company’s equity and are classified as noncontrolling interests – redeemable on the Company’s consolidated balance sheets. In addition, certain wholly owned subsidiaries in the Company's ambulatory surgery segment are responsible for all debts incurred but unpaid by the Company's less than wholly owned partnerships as these subsidiaries are the general partner. As manager of the operations of these partnerships, the Company has the ability to limit potential liabilities by curtailing operations or taking other operating actions. |
Segment Reporting |
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Segment Reporting [Abstract] | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Segment Reporting | Segment Reporting The Company has aligned financial results into two operating and reportable segments: physician services and ambulatory services. The physician services segment includes the Company’s hospital-based and non-hospital-based physician services business. The ambulatory services segment includes the Company’s ambulatory surgery business, which acquires, develops, owns and operates ASCs and surgical hospitals in partnership with physicians and health systems. The Company’s financial information by segment is prepared on an internal management reporting basis and includes allocations of corporate expenses. This financial information is used by the chief operating decision maker to allocate resources and assess the performance of the segments. The Company’s segments have been defined based on the separate financial information that is regularly produced and reviewed by the Company’s chief operating decision maker, which is its Chief Executive Officer. The following table presents financial information for each reportable segment (in millions):
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Financial Information for the Company and Its Subsidiaries |
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Condensed Financial Information of Parent Company Only Disclosure [Abstract] | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Financial Information for the Company and Its Subsidiaries | Financial Information for the Company and Its Subsidiaries The 2022 Senior Unsecured Notes are senior unsecured obligations of the Company and are guaranteed by its existing and subsequently acquired or organized 100% owned domestic subsidiaries. The 2022 Senior Unsecured Notes are guaranteed on a full and unconditional and joint and several basis, with limited exceptions considered customary for such guarantees, including the release of the guarantee when a subsidiary's assets are sold. The following condensed consolidating financial statements present the Company (as parent issuer), the subsidiary guarantors, the subsidiary non-guarantors and consolidating adjustments. These condensed consolidating financial statements have been prepared and presented in accordance with Rule 3-10 of Regulation S-X “Financial Statements of Guarantors and Issuers of Guaranteed Securities Registered or Being Registered.” The operating and investing activities of the separate legal entities are fully interdependent and integrated. Accordingly, the results of the separate legal entities are not representative of what the operating results would be on a stand-alone basis. As a result of the refinancing related to the Merger, the guarantor structure of certain entities changed and these statements have been revised to reflect the current structure post-Merger.
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Basis of Presentation (Policies) |
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Accounting Policies [Abstract] | |||||||||||||||||||||||||||||||
Basis of Presentation | Basis of Presentation These unaudited consolidated financial statements have been prepared in accordance with accounting principles generally accepted in the United States of America (GAAP) for interim financial reporting and in accordance with Rule 10-01 of Regulation S-X. In the opinion of management, the unaudited interim consolidated financial statements contained in this report reflect all normal recurring adjustments, which are necessary for a fair presentation of the financial position and the results of operations for the interim periods presented. The results of operations for any interim period are not necessarily indicative of results for the full year. The accompanying unaudited consolidated financial statements should be read in conjunction with the consolidated financial statements and notes thereto included in the Company's Annual Report on Form 10-K for the fiscal year ended December 31, 2017. |
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Cash and Cash Equivalents | Cash and Cash Equivalents Cash and cash equivalents are comprised principally of demand deposits at banks and other highly liquid short-term investments with maturities generally three months or less when purchased. Cash and cash equivalents are reflected in the financial statements at cost, which approximates fair value. |
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Restricted Cash and Marketable Securities | Restricted Cash and Marketable Securities As of March 31, 2018 and December 31, 2017, the Company held restricted cash and cash equivalents of $18.6 million and $30.8 million, respectively, classified within insurance collateral in the accompanying consolidated balance sheets. The cash was restricted for the purpose of satisfying the obligations of the Company's wholly owned captive insurance companies. |
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Use of Estimates | Use of Estimates The preparation of financial statements in conformity with GAAP requires management to make estimates and assumptions that affect the reported amounts of assets and liabilities and disclosure of contingent assets and liabilities at the date of the financial statements and the reported amounts of revenues and expenses during the reporting period. Actual results could differ from those estimates. |
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Reclassifications | Reclassifications Certain prior year amounts in the accompanying consolidated financial statements and these notes have been reclassified to conform to the current period presentation |
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Recent Accounting Pronouncements | Recent Accounting Pronouncements In May 2014, the Financial Accounting Standards Board (FASB) issued Accounting Standards Update (ASU) No. 2014-09 “Revenue from Contracts with Customers,” Accounting Standards Codification (ASC) as topic 606 (ASC 606), which eliminated the transaction and industry-specific revenue recognition guidance under current GAAP and replaced it with a principle-based approach using the following steps: identify the contract(s) with a customer, identify the performance obligations in the contract, determine the transaction price, allocate the transaction price to the performance obligations in the contract and recognize revenue when (or as) the entity satisfies a performance obligation. The Company adopted the new standard effective January 1, 2018 using the modified retrospective method. As a result of using this approach, the Company recognized the cumulative effect adjustment to increase retained earnings $0.5 million for initial application of the guidance at the date of initial adoption. The adoption of the standard did not have a material impact on the Company's consolidated financial position, results of operations or cash flows. In February 2016, the FASB issued ASU No. 2016-02, “Leases,” and subsequently ASU No. 2017-13, which amend existing accounting standards for lease accounting, including requiring lessees to recognize most leases on the balance sheet and making changes to lessor accounting. The standard is effective for annual periods beginning after December 15, 2018, with early adoption permitted. The new standard requires a modified retrospective application for all leases existing at, or entered into after, the date of initial application, with an option to use certain transition relief. The Company will adopt the new standard effective January 1, 2019. The Company expects that nearly all leases currently classified as operating leases will be classified as operating leases under the new standard with a right-of-use asset and a corresponding obligation recognized on the balance sheet at the adoption date. The Company has not yet determined the impact this ASU will have on the Company's consolidated financial position, results of operations or cash flows. In January 2016, the FASB issued ASU 2016-01, "Financial Instruments - Overall," as amended by ASU 2018-03, "Technical Corrections and Improvements to Financial Instruments (Subtopic 825-10) – Recognition and Measurement of Financial Assets and Financial Liabilities” in February 2018, which among other changes in accounting and disclosure requirements, replaces the cost method of accounting for non-marketable equity securities with a model for recognizing impairments and observable price changes, and also eliminates the available-for-sale classification for marketable equity securities. Under the new guidance, other than when the consolidation or equity method of accounting is utilized, changes in the fair value of equity securities are to be recognized in earnings. The Company adopted the provisions of ASU 2016-01 and ASU 2018-03 as of January 1, 2018 resulting in a cumulative effect adjustment to retained earnings related to the unrealized gain on corporate equity securities. The adjustment of $1.6 million was reclassified out of accumulated other comprehensive income (loss) and into retained earnings. Prior to adoption, the corporate equity securities related unrealized gains and losses were reported as a separate component of accumulated other comprehensive income (loss). Effective January 1, 2018 the change in fair value on corporate equity securities is reported as a component of other income (expense), net in the accompanying consolidated statements of operations. In January 2017, the FASB issued ASU 2017-01, “Business Combinations (Topic 805) - Clarifying the Definition of a Business,” which changes the definition of a business to assist entities with evaluating when a set of transferred assets and activities is a business. The guidance requires an entity to evaluate if substantially all of the fair value of gross assets acquired is concentrated in a single identifiable asset or a group of similar identifiable assets. The guidance is effective for annual periods beginning after December 15, 2017, and interim periods within those years. The Company adopted ASU 2017-01 as of January 1, 2018. This standard did not have an impact on our consolidated financial statements, results of operations or cash flows upon adoption. Effective January 1, 2018, the Company retrospectively adopted a change in accounting principle related to the adoption of ASU No. 2016–18, Statement of Cash Flows (Topic 230)—Restricted Cash—a consensus of the FASB Emerging Issues Task Force. This revised standard is an effort by the FASB to reduce diversification in practice by providing specific guidance on the presentation of restricted cash or restricted cash equivalents in the statement of cash flows. The updated guidance requires that a statement of cash flows explain the change during the period in the total of cash, cash equivalents, and amounts generally described as restricted cash and restricted cash equivalents. As such, amounts generally described as restricted cash and restricted cash equivalents should be included in the “beginning–of–period” and “end–of–period” total amounts shown on the statement of cash flows. Accordingly, upon adoption the Company used the retrospective transition method by restating its consolidated statements of cash flows to include restricted cash of $28.8 million in the beginning and $39.0 million in the ending cash, cash equivalents, and restricted cash balances for the three months ended March 31, 2017. In February 2018, the FASB issued ASU No. 2018-02, "Income Statement – Reporting Comprehensive Income (Topic 220) - Reclassification of Certain Tax Effects from Accumulated Other Comprehensive Income," which will allow a reclassification from accumulated other comprehensive income (loss) to retained earnings for the tax effects resulting from the Tax Cuts and Jobs Act (the Act) that are stranded in accumulated other comprehensive income (loss). This standard also requires certain disclosures about stranded tax effects. ASU 2018-02, however, does not change the underlying guidance that requires that the effect of a change in tax laws or rates be included in income from continuing operations. The standard is effective for annual periods beginning after December 15, 2018, with early adoption permitted for interim periods within those years. The Company adopted ASU 2018-02 as of January 1, 2018. This standard did not have an impact on our consolidated financial statements, results of operations or cash flows upon adoption. In March 2018, the FASB issued ASU 2018-05, "Income Taxes (Topic 740) - Amendments to SEC Paragraphs Pursuant to SEC Staff Accounting Bulletin No. 118 (SAB 118)." The standard amends ASC 740, Income Taxes to provide guidance on accounting for the tax effects of the Tax Cuts and Jobs Act of 2017 pursuant to SAB 118. The guidance allows a company to record a provisional amount when it does not have the necessary information available, prepared, or analyzed in reasonable detail to complete its accounting for the change in the tax law. The measurement period ends when the company has obtained, prepared and analyzed the information necessary to finalize its accounting, but cannot extend beyond one year. Additional information regarding the adoption of this standard is contained in Note 14. |
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Revenue Recognition | Revenue Recognition On January 1, 2018 the Company adopted ASC 606. The presentation of the amount of earnings from operations and net earnings were unchanged upon adoption of the new standard; however, adoption of the new standard resulted in changes to the presentation of revenues and the provision for uncollectibles in the consolidated statements of operations. Previously, the estimate for unrealizable amounts was recorded to the provision for uncollectibles and presented as a separate deduction to arrive at net revenue. Upon adoption, the estimate for unrealizable amounts is now reflected as implicit price concession as a reduction to arrive at net revenue. The majority of our revenue is generated from fee for service patient revenue, which is derived principally through contracts originating from the provision of physician services during episodes of care to patients of healthcare facilities and from facility fees for procedures performed at surgery centers. These episodes of care and procedures qualify as distinct goods and services, provided simultaneously together with other readily available resources, in a single instance of service, and thereby constitute a single performance obligation for each patient encounter and, in most instances, occur at readily determinable transaction prices. As a practical expedient, the Company adopted a portfolio approach to sources of patient revenue, applied by specialty to each healthcare facility or surgery center. At this level, each portfolio shares the characteristics conducive to ensuring that the results do not materially differ from the new standard if it were to be applied to individual patient contracts related to each episode of care. Accordingly, there was not a change in the Company's method to recognize revenue. Additionally, through practical expedients, the Company did not adjust the transaction price for any financing components as those were deemed to be insignificant and expensed all incremental customer contract acquisition costs as incurred as such costs are not material and would be amortized over a period less than one year. Subsequent changes that are determined to be a result of an adverse change in the customer's ability to pay, are recorded as bad debt within other operating expenses. Due to the nature of ambulatory services segment, the Company has the ability to assess the ultimate collection for substantially all of the patient service revenue before services are provided as those services are pre-scheduled and non-emergent. Contract and other revenue primarily represents income earned from healthcare facilities and medical centers to supplement third-party and patient reimbursement and contract staffing assignments. The transaction price for these arrangements may be fixed or variable, with determination periods ranging from one month to 18 months. In these instances, the Company will estimate variable compensation at contract commencement and recognize revenue monthly on a straight-line basis, which correlates with the performance obligation to stand ready. Estimating net revenue is a complex process, largely due to the volume of transactions, the number and complexity of contracts with payors, the limited availability, at times, of certain patient and payor information at the time services are provided, and the length of time it takes for collections to fully mature. Patients are billed for services provided, and the Company receives payments for these services from patients or their third-party payors. Payments for services provided are generally less than billed charges. The Company recognizes fee for service revenue, net of contractual adjustments and discounts for uninsured patients, at the time services are provided by healthcare providers. In the period services are provided, the Company estimates gross charges based on billed services plus an estimate for unbilled services based on pending case data collected, estimates contractual allowances based on contracted rates and historical or actual cash collections (net of recoveries), when available, and estimates the discount for uninsured patients based on historical cash collections (net of recoveries) from uninsured patients. For third-party payors, the specific benefits provided for under each patients’ healthcare plan, mandated payment rates under the Medicare and Medicaid programs, as applicable, and historical cash collections are utilized. These expected collections are based on fees and negotiated payment rates in the case of third-party payors, the specific benefits provided for under each patient's healthcare plans, mandated payment rates in the case of Medicare and Medicaid programs, and historical cash collections (net of recoveries) in combination with expected collections from third party payors. In addition, the Company records net revenue from uninsured patients at an estimated realizable value based on historical cash collections (net of recoveries). The price concession includes an estimate of uncollectible balances due from uninsured patients, uncollectible co-pay and deductible balances due from insured patients and special charges, if any, for uncollectible balances due from managed care, commercial and governmental payors. The relationship between gross charges and the transaction price recognized is significantly influenced by payor mix, as collections on gross charges may vary significantly depending on whether and with whom the patients the Company provides services to in the period are insured and the Company's contractual relationships with those payors. Payor mix is subject to change as additional patient and payor information is obtained after the period services are provided. The Company periodically assesses the estimates of unbilled revenue, contractual adjustments and discounts for uninsured patients and payor mix for a period of at least one year following the date of service by analyzing actual results, including cash collections, against estimates. Changes in these estimates are charged or credited to the consolidated statement of operations in the period that the assessment is made. Significant changes in payor mix, contractual arrangements with payors, specialty mix, acuity, business office operations, general economic conditions and health care coverage provided by federal or state governments or private insurers may have a significant impact on estimates and significantly affect the results of operations and cash flows. Concentration of credit risk with respect to other payors is limited due to the large number of such payors. In certain circumstances, federal law requires providers to render emergency medical services to any patient who requires care regardless of their ability to pay. Services to these patients are not considered to be charity care and provisions for uncompensated care for these services are estimated accordingly. Although the Company provides a level of charity care, it is not significant to the Company's net revenues. The Company's billing and accounting systems provide historical trends of cash collections and contractual write-offs, accounts receivable agings and established fee adjustments from third-party payors. These estimates are recorded and monitored monthly as revenues are recognized. These estimates are not, however, established from billing system generated contractual adjustments based on fee schedules for the patient’s insurance plan for each patient encounter. The principal exposure for uncollectible fee for service visits is from self-pay patients and, to a lesser extent, for co-payments and deductibles from patients with insurance. |
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Accounts Receivable | Accounts Receivable The Company manages accounts receivable by regularly reviewing its accounts and contracts and by providing appropriate adjustments to the estimate of the transaction price. Some of the factors considered by management in determining the adjustments are the historical trends of cash collections, contractual and uninsured write-offs, accounts receivable agings, established fee schedules, contracts with payors, changes in payor mix and procedure statistics. Actual collections of accounts receivable in subsequent periods may require changes in the estimated transaction price. The Company tests its analysis by comparing cash collections to net fee for service revenues and monitoring self-pay utilization. In addition, when actual collection percentages differ from expected results, on a contract by contract basis, supplemental detailed reviews of the outstanding accounts receivable balances may be performed by the Company’s billing operations to determine whether there are facts and circumstances existing that may cause a different conclusion as to the estimate of the collectability of that contract’s accounts receivable from the estimate resulting from using the historical collection experience. The Company also supplements its analysis for its physician services segment quarterly using a hindsight calculation that utilizes write-off data for all payor classes during the previous twelve month period to estimate adjustments to the transaction price at a point in time. Changes in these estimates, if any, are charged or credited to the consolidated statements of operations in the period of change. Material changes in estimates may result from unforeseen write-offs of patient or third-party accounts receivable, unsuccessful disputes with managed care payors, adverse macro-economic conditions which limit patients’ ability to meet their financial obligations for the care provided by physicians, or broad changes to government regulations that adversely impact reimbursement rates for services provided by the Company. Significant changes in payor mix, changes in contractual arrangements with payors, business office operations, general economic conditions and health care coverage provided by federal or state governments or private insurers may have a significant impact on the Company’s estimates and significantly affect its results of operations and cash flows. Concentration of credit risk is limited by the diversity and number of facilities, patients, payors and by the geographic dispersion of the Company’s operations. |
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Acquisitions and Disposals | Acquisitions and Disposals The Company accounts for its business combinations under the fundamental requirements of the acquisition method of accounting and under the premise that an acquirer be identified for each business combination. The acquirer is the entity that obtains control of one or more businesses in the business combination and the acquisition date is the date the acquirer achieves control. The assets acquired, liabilities assumed and any noncontrolling interests in the acquired business at the acquisition date are recognized at their fair values as of that date, and the direct costs incurred in connection with the business combination are recorded and expensed separately from the business combination. Acquisitions in which the Company is able to exert significant influence but does not have control are accounted for using the equity method. |
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Investments in Unconsolidated Affiliates | Investments in Unconsolidated Affiliates Investments in unconsolidated affiliates in which the Company exerts significant influence but does not control or otherwise consolidate are accounted for using the equity method. Equity method investments are initially recorded at cost, unless such investments are a result of the Company entering into a transaction whereby the Company loses control of a previously controlled entity but retains a noncontrolling interest. Such transactions, which result in the deconsolidation of a previously consolidated entity, are measured at fair value. The fair value measurement utilizes Level 3 inputs, which include unobservable data, to measure the fair value of the retained noncontrolling interest. The fair value determination is generally based on a combination of multiple valuation methods, which can include discounted cash flow, income approach, or market value approach, which incorporates estimates of future earnings and market valuation multiples for certain guideline companies. These investments are included as investments in unconsolidated affiliates in the accompanying consolidated balance sheets. The Company’s share of the profits and losses from these investments is reported in equity in earnings of unconsolidated affiliates in the accompanying consolidated statements of operations. The Company monitors its investments for other-than-temporary impairment by considering factors such as current economic and market conditions and the operating performance of the companies and records reductions in carrying values when necessary. |
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Goodwill and Intangible Assets |
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Insurance Reserves | Insurance Reserves Insurance reserves are established for professional and general liability claims utilizing policies with both fully-insured and self-insured components. This includes the use of an off-shore captive insurance program through wholly owned subsidiaries for certain professional (medical malpractice) and general liability programs. In those instances where the Company has obtained third-party insurance coverage, the Company normally retains liability for the first $1 million to $3 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 March 31, 2018. The Company establishes reserves for claims based upon an assessment of claims reported 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. Claim reserves are not discounted. Provisions for insurance expense included in the statements of operations include provisions determined in consultation with third-party actuaries and premiums paid to third-party insurers. |
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Stock Incentive Plans | Stock Incentive Plans Transactions in which the Company receives employee and non-employee services in exchange for the Company’s equity instruments or liabilities that are based on the fair value of the Company’s equity securities or may be settled by the issuance of these securities are accounted using a fair value method. The Company applies the Black-Scholes method of valuation in determining share-based compensation expense for option awards. For performance share units, the Company utilizes the Monte-Carlo method of valuation. For awards with graded vesting schedules, the Company recognizes compensation expense using the accelerated method. Forfeitures are recognized as incurred. Under Company policy, shares held by outside directors and senior management are subject to certain stock ownership guidelines and restrictions on hedging and pledging. |
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Earnings per Share | Earnings per Share Basic net earnings (loss) attributable to Envision Healthcare Corporation common stockholders, per common share, excludes dilution and is computed by dividing net earnings (loss) attributable to Envision Healthcare Corporation common stockholders by the weighted-average number of common shares outstanding during the period. Diluted net earnings (loss) attributable to Envision Healthcare Corporation common stockholders, per common share is computed by dividing net earnings (loss) attributable to Envision Healthcare Corporation common stockholders by the weighted-average number of common shares outstanding during the period plus any potential dilutive common share equivalents, including shares issuable (i) upon the vesting of restricted stock awards, restricted stock units and performance stock units as determined under the treasury stock method and (ii) prior to July 3, 2017, the mandatory conversion date, upon conversion of the Company preferred stock as determined under the if-converted method. For purposes of calculating diluted earnings (loss) per share, preferred stock dividends have been subtracted from both net earnings (loss) from continuing operations attributable to Envision Healthcare Corporation and net earnings (loss) attributable to Envision Healthcare Corporation common stockholders in periods in which utilizing the if-converted method would be anti-dilutive. |
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Income Taxes | Income Taxes Income taxes are accounted for under the asset and liability method. Deferred tax assets and liabilities are recognized for the future tax consequences attributable to differences between the financial statement carrying amounts of existing assets and liabilities and their respective tax bases. Deferred tax assets and liabilities are measured using enacted tax rates expected to apply to taxable income in the years in which those temporary differences are expected to be recovered or settled. The effect on deferred tax assets and liabilities of a change in tax rates is recognized in income in the period that includes the enactment date. The Company applies recognition thresholds and measurement attributes for the financial statement recognition and measurement of a tax position taken or expected to be taken in a tax return as it relates to accounting for uncertainty in income taxes. In addition, it is the Company’s policy to recognize interest accrued and penalties, if any, related to unrecognized benefits as income tax expense in its consolidated statements of operations. The Company does not expect significant changes to its tax positions or liability for tax uncertainties during the next 12 months. The Company and its subsidiaries file income tax returns in the U.S. federal jurisdiction and various state jurisdictions. The Company is no longer subject to U.S. federal income tax examinations for the years prior to 2014. With few exceptions, the Company is no longer subject to U.S. state income tax examinations for the years prior to 2013. |
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Segments | Segment Reporting The Company has aligned financial results into two operating and reportable segments: physician services and ambulatory services. The physician services segment includes the Company’s hospital-based and non-hospital-based physician services business. The ambulatory services segment includes the Company’s ambulatory surgery business, which acquires, develops, owns and operates ASCs and surgical hospitals in partnership with physicians and health systems. The Company’s financial information by segment is prepared on an internal management reporting basis and includes allocations of corporate expenses. This financial information is used by the chief operating decision maker to allocate resources and assess the performance of the segments. The Company’s segments have been defined based on the separate financial information that is regularly produced and reviewed by the Company’s chief operating decision maker, which is its Chief Executive Officer. |
Basis of Presentation (Tables) |
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Accounting Policies [Abstract] | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Schedule of Supplemental Cash Flow Statement Disclosure | The following presents supplemental cash flow statement disclosure (in millions):
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Revenue Recognition and Accounts Receivable (Tables) |
3 Months Ended | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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Mar. 31, 2018 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Revenue Recognition [Abstract] | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Schedule of Net Revenue by Major Payors | Net revenue (after provision for uncollectibles in 2017) by the Company's segments consists of the following major payors (in millions):
|
Acquisitions and Disposals (Tables) |
3 Months Ended | |||||||||||||||||||||||||||||||||||||||
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Mar. 31, 2018 | ||||||||||||||||||||||||||||||||||||||||
Business Combinations [Abstract] | ||||||||||||||||||||||||||||||||||||||||
Schedule of Business Acquisition | The acquisition date fair value of the total consideration transferred and acquisition date fair value of each major financial class for individual acquisitions completed in the three months ended March 31, 2018, including post acquisition date adjustments, are as follows (in millions):
Represents the preliminary allocation of fair value of acquired assets and liabilities associated with these acquisitions at March 31, 2018. |
Discontinued Operations (Tables) |
3 Months Ended | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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Mar. 31, 2018 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Discontinued Operations and Disposal Groups [Abstract] | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Summary of Discontinued Operations | The following table summarizes the results of discontinued operations for the three months ended March 31, 2018 and 2017 (in millions):
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Fair Value Measurements (Tables) |
3 Months Ended | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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Mar. 31, 2018 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Fair Value Disclosures [Abstract] | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Summary of Financial Instruments by Fair Value Hierarchy Levels | The following table summarizes the valuation of the Company’s financial instruments by the above fair value hierarchy levels as of March 31, 2018 and December 31, 2017 (in millions):
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Summary of Change in Financial Instruments Classified as Level 3 | The following table summarizes the change in financial instruments classified as Level 3 in the fair value hierarchy as of March 31, 2018 (in millions):
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Schedule Of Insurance Collateral | Insurance collateral consisted of the following as of March 31, 2018 and December 31, 2017 (in millions):
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Schedule of Amortized Cost Basis and Aggregate Fair value of Company's Available-for-Sale Securities | Amortized cost basis and aggregate fair value of the Company's available-for-sale and corporate equity securities as of March 31, 2018 and December 31, 2017 were as follows (in millions):
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Schedule of Impairment Losses, Investments | The Company's available-for-sale investment securities that were temporarily impaired as of March 31, 2018 and December 31, 2017 were as follows (in millions):
|
Prepaid and Other Current Assets (Tables) |
3 Months Ended | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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Mar. 31, 2018 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Deferred Costs, Capitalized, Prepaid, and Other Assets Disclosure [Abstract] | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Schedule of Prepaid and Other Current Assets | The following table presents a summary of items comprising prepaid and other current assets in the accompanying consolidated balance sheets as of March 31, 2018 and December 31, 2017 (in millions):
|
Goodwill and Intangible Assets (Tables) |
3 Months Ended | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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Mar. 31, 2018 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Goodwill and Intangible Assets Disclosure [Abstract] | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Changes In Carrying Amount Of Goodwill | The changes in the carrying amount of goodwill for the three months ended March 31, 2018 are as follows (in millions):
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Schedule of Finite-Lived Intangible Assets | Intangible Assets
Intangible assets at March 31, 2018 and December 31, 2017 consisted of the following (in millions):
|
Other Accrued Liabilities (Tables) |
3 Months Ended | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Mar. 31, 2018 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Accrued Liabilities, Current [Abstract] | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Schedule of Other Accrued Liabilities | The following table presents a summary of items comprising other accrued liabilities in the accompanying consolidated balance sheets as of March 31, 2018 and December 31, 2017 (in millions):
|
Long-term Debt (Tables) |
3 Months Ended | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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Mar. 31, 2018 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Debt Disclosure [Abstract] | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Components Of Long-Term Debt | Long-term debt at March 31, 2018 and December 31, 2017 consisted of the following (in millions):
|
Insurance Reserves (Tables) |
3 Months Ended | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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Mar. 31, 2018 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Payables and Accruals [Abstract] | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Schedule of Accrued Professional Liabilities | At March 31, 2018 and December 31, 2017, the Company's accrued insurance reserves are presented in the accompanying consolidated balance sheets as a component of other accrued liabilities and insurance reserves as follows (in millions):
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Schedule of Self Insurance Reserve Roll Forward | The changes to the Company's estimated losses under insurance programs as of March 31, 2018 were as follows (in millions):
|
Stockholders' Equity (Tables) |
3 Months Ended | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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Mar. 31, 2018 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Equity [Abstract] | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Schedule Of Changes In Non-Vested Restricted Shares | A summary of the status of and changes for non-vested restricted shares for the periods presented below is summarized as follows:
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Schedule Of Stock Option Activity | A summary of stock option activity for the periods presented below is summarized as follows:
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Share-Based Activity | Other information pertaining to share-based activity during the three months ended March 31, 2018 and 2017 was as follows (in millions):
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Schedule of Earnings Per Share, Basic and Diluted | The following is a reconciliation of the numerator and denominators of basic and diluted earnings (loss) per share (dollars in millions; per share amounts in thousands):
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Segment Reporting (Tables) |
3 Months Ended | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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Mar. 31, 2018 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Segment Reporting [Abstract] | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Schedule of Segment Reporting Information | The following table presents financial information for each reportable segment (in millions):
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Financial Information for the Company and Its Subsidiaries (Tables) |
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Condensed Financial Information of Parent Company Only Disclosure [Abstract] | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Condensed Consolidating Balance Sheet |
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Condensed Consolidating Statement of Operations |
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Condensed Consolidating Statement of Cash Flows |
|
Basis of Presentation - Supplemental Cash Flow Data (Details) - USD ($) $ in Millions |
3 Months Ended | |
---|---|---|
Mar. 31, 2018 |
Mar. 31, 2017 |
|
Supplemental cash flow information: | ||
Interest payments | $ 94.9 | $ 87.1 |
Income tax paid, net of refunds | $ (0.5) | $ 5.3 |
Acquisitions and Disposals - Fair Value of Assets Acquired and Liabilities Assumed (Details) - USD ($) $ in Millions |
Mar. 31, 2018 |
Dec. 31, 2017 |
---|---|---|
Business Acquisition [Line Items] | ||
Goodwill | $ 7,570.7 | $ 7,536.1 |
Series of Individually Immaterial Business Acquisitions | ||
Business Acquisition [Line Items] | ||
Accounts receivable | 2.3 | |
Goodwill | 38.5 | |
Intangible assets | 33.8 | |
Other accrued liabilities | (1.0) | |
Deferred income taxes | (2.3) | |
Other long-term liabilities | (1.1) | |
Acquisition date fair value of total consideration transferred | $ 70.2 |
Acquisitions and Disposals - Purchase Price Allocations (Details) - USD ($) $ in Millions |
3 Months Ended | |
---|---|---|
Mar. 31, 2018 |
Mar. 31, 2017 |
|
Business Combinations [Abstract] | ||
Goodwill deductible for tax purposes | $ 26.0 | $ 23.4 |
Transaction and integration costs | $ 21.4 | $ 21.5 |
Discontinued Operations - Narrative (Details) - USD ($) $ in Millions |
3 Months Ended | ||
---|---|---|---|
Mar. 31, 2018 |
Mar. 31, 2017 |
Mar. 14, 2018 |
|
Income Statement, Balance Sheet and Additional Disclosures by Disposal Groups, Including Discontinued Operations [Line Items] | |||
Gain on assets held for sale | $ 14.7 | $ 0.0 | |
Net cash flows provided by operating activities attributable to discontinued operations | 77.4 | 29.0 | |
Net cash flows used in investing activities attributable to discontinued operations | 23.9 | 8.7 | |
Medical Transportation Segment | Discontinued Operations, Disposed of by Sale | |||
Income Statement, Balance Sheet and Additional Disclosures by Disposal Groups, Including Discontinued Operations [Line Items] | |||
Value of sale of business | $ 2,280.0 | ||
Gain on assets held for sale | 14.7 | 0.0 | |
Deferred tax expense and associated deferred tax liability | 127.1 | ||
Corporate overhead expense, before tax | 2.5 | 14.5 | |
Interest expense, net allocated to discontinued operations | $ 17.6 | $ 21.8 |
Fair Value Measurements - Summary of Change in Financial Instruments Classified as Level 3 (Details) - Contingent Consideration - Fair Value, Measurements, Recurring $ in Millions |
3 Months Ended |
---|---|
Mar. 31, 2018
USD ($)
| |
Fair Value, Liabilities Measured on Recurring Basis, Unobservable Input Reconciliation, Calculation [Roll Forward] | |
Balance at December 31, 2017 | $ 8.0 |
Decrease due to current period payments | (1.0) |
Increase due to current period acquisitions | 0.4 |
Balance at March 31, 2018 | $ 7.4 |
Fair Value Measurements - Schedule of Unrealized Loss Positions (Details) - Corporate bonds/Fixed income - USD ($) $ in Millions |
Mar. 31, 2018 |
Dec. 31, 2017 |
---|---|---|
Available-for-sale Securities [Abstract] | ||
Fair Value | $ 43.2 | $ 16.0 |
Unrealized loss | $ (0.5) | $ (0.2) |
Prepaid and Other Current Assets (Details) - USD ($) $ in Millions |
Mar. 31, 2018 |
Dec. 31, 2017 |
---|---|---|
Deferred Costs, Capitalized, Prepaid, and Other Assets Disclosure [Abstract] | ||
Income Taxes Receivable | $ 0.0 | $ 74.3 |
Prepaid expenses | 64.7 | 59.9 |
Other | 33.5 | 31.4 |
Total prepaid and other current assets | $ 98.2 | $ 165.6 |
Goodwill and Intangible Assets - Changes In Carrying Amount Of Goodwill (Details) $ in Millions |
3 Months Ended |
---|---|
Mar. 31, 2018
USD ($)
| |
Goodwill [Roll Forward] | |
Beginning balance | $ 7,536.1 |
Goodwill acquired, including post acquisition adjustments | 38.4 |
Goodwill disposed, including impact of deconsolidation transactions | (3.8) |
Ending balance | 7,570.7 |
Physician Services | |
Goodwill [Roll Forward] | |
Beginning balance | 5,410.6 |
Goodwill acquired, including post acquisition adjustments | 38.7 |
Goodwill disposed, including impact of deconsolidation transactions | 0.0 |
Ending balance | 5,449.3 |
Ambulatory Services | |
Goodwill [Roll Forward] | |
Beginning balance | 2,125.5 |
Goodwill acquired, including post acquisition adjustments | (0.3) |
Goodwill disposed, including impact of deconsolidation transactions | (3.8) |
Ending balance | $ 2,121.4 |
Other Accrued Liabilities (Details) - USD ($) $ in Millions |
Mar. 31, 2018 |
Dec. 31, 2017 |
---|---|---|
Accrued Liabilities, Current [Abstract] | ||
Insurance reserves | $ 80.0 | $ 77.1 |
Refunds payable | 26.3 | 28.9 |
Deferred revenue | 16.5 | 18.9 |
Income taxes payable | 241.8 | 0.0 |
Other | 184.5 | 156.7 |
Total other accrued liabilities | $ 549.1 | $ 281.6 |
Long-term Debt - Narrative (Details) $ in Millions |
1 Months Ended | 3 Months Ended |
---|---|---|
Mar. 31, 2018
USD ($)
|
Mar. 31, 2018
USD ($)
|
|
Fixed Interest Rate | ||
Schedule of Capitalization, Long-term Debt [Line Items] | ||
Carrying value | $ 2,460.0 | $ 2,460.0 |
Long-term debt, fair value | 2,470.0 | 2,470.0 |
Variable Interest Rate | ||
Schedule of Capitalization, Long-term Debt [Line Items] | ||
Long-term debt, fair value | 2,260.0 | 2,260.0 |
Term loan | Term Loan B - 2023 | ||
Schedule of Capitalization, Long-term Debt [Line Items] | ||
Repayments of debt | $ 1,820.0 | |
Principal payment | $ 40.0 |
Insurance Reserves - Narrative (Details) |
Mar. 31, 2018
USD ($)
|
---|---|
Minimum | |
Loss Contingencies [Line Items] | |
Amount of loss at which third party insurance becomes effective | $ 1,000,000 |
Maximum | |
Loss Contingencies [Line Items] | |
Amount of loss at which third party insurance becomes effective | $ 3,000,000 |
Insurance Reserves - Components of Reserves (Details) - USD ($) $ in Millions |
Mar. 31, 2018 |
Dec. 31, 2017 |
---|---|---|
Payables and Accruals [Abstract] | ||
Third-party insurance reserves | $ 110.4 | $ 111.3 |
Estimated losses under self-insured programs | 148.1 | 170.3 |
Incurred but not reported losses | 145.0 | 114.0 |
Total accrued insurance reserves | 403.5 | 395.6 |
Less estimated losses payable within one year | 80.0 | 77.1 |
Total | $ 323.5 | $ 318.5 |
Insurance Reserves - Rollforward of Reserves (Details) - USD ($) $ in Millions |
3 Months Ended | |
---|---|---|
Mar. 31, 2018 |
Mar. 31, 2017 |
|
Payables and Accruals [Abstract] | ||
Insurance expense | $ 47.6 | $ 37.6 |
Self Insurance Reserve [Roll Forward] | ||
Balance at December 31, 2017 | 395.6 | |
Assumed liabilities through acquisitions | 0.5 | |
Provision related to current period self-insurance reserves | 20.4 | |
Benefit related to changes in prior period self-insurance reserves | 9.0 | |
Payments for prior period self-insurance reserves | (20.2) | |
Change in third-party insurance self-insurance reserves | 1.7 | |
Other, net including post-acquisition adjustments | (3.5) | |
Balance at March 31, 2018 | $ 403.5 |
Stockholders' Equity - Schedule Of Changes In Non-Vested Restricted Shares (Details) - Restricted Stock Units |
3 Months Ended |
---|---|
Mar. 31, 2018
$ / shares
shares
| |
Number of Shares | |
Non-vested awards at December 31, 2017 (in shares) | shares | 1,410,461 |
Shares granted (in shares) | shares | 682,119 |
Shares vested (in shares) | shares | (512,103) |
Shares forfeited (in shares) | shares | (104,924) |
Non-vested awards at March 31, 2018 (in shares) | shares | 1,475,553 |
Weighted Average Grant Price | |
Non-vested awards at December 31, 2017 (in dollars per share) | $ / shares | $ 65.52 |
Shares granted (in dollars per share) | $ / shares | 40.01 |
Shares vested (in dollars per share) | $ / shares | 63.43 |
Shares forfeited (in dollars per share) | $ / shares | 63.87 |
Non-vested awards at March 31, 2018 (in dollars per share) | $ / shares | $ 54.57 |
Stockholders' Equity - Share-Based Activity (Details) - USD ($) $ in Millions |
3 Months Ended | |
---|---|---|
Mar. 31, 2018 |
Mar. 31, 2017 |
|
Equity [Abstract] | ||
Share-based compensation expense from continuing operations | $ 7.4 | $ 14.6 |
Fair value of shares vested | 18.7 | 28.4 |
Cash received from option exercises | 0.3 | 1.1 |
Tax expense (benefit) from exercises of share based awards | $ 4.6 | $ (2.9) |
Income Taxes - Narrative (Details) - USD ($) $ in Millions |
3 Months Ended | 12 Months Ended | |
---|---|---|---|
Mar. 31, 2018 |
Dec. 31, 2018 |
Dec. 31, 2017 |
|
Income Tax Contingency [Line Items] | |||
Provisional income tax expense (benefit) from the Act | $ 10.3 | $ 596.6 | |
Forecast | |||
Income Tax Contingency [Line Items] | |||
Effective income tax rate | 26.00% |
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