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Outlook Range Raised to $925 Million to $975 Million for 2009 Adjusted EBITDA; 2009 Net Income Outlook Range of $66 Million to $130 Million
Key Metrics (all percentage changes compare Q3'09 data to Q3'08 unless otherwise noted):
-- $240 million in total-hospital adjusted EBITDA, an increase of 50%
o 10.6% Adjusted EBITDA margin, an increase of 310 basis points
o $236 million in same-hospital Adjusted EBITDA, an increase of 45.7%
-- Operating income increased to $133 million, compared to $70 million in
Q3'08
-- Net loss attributable to common shareholders of $3 million, compared to
net income attributable to common shareholders of $104 million in Q3'08,
which included pre-tax gains of $140 million on sales of investments
o Net loss per share of $0.01, compared net income of $0.22 per share in
Q3'08
-- $731 million in cash and cash equivalents at Sept. 30, 2009, an increase
of $224 million since Dec. 31, 2008
-- Adjusted Free Cash Flow from continuing operations of $142 million, an
increase of $106 million from Q3'08
o Net cash provided by operating activities of $284 million in
year-to-date 2009, compared to $141 million in the nine months ended
Sept. 30, 2008
o $91 million in capital expenditures in continuing operations in Q3'08
-- Same-hospital bad debt ratio of 8.5% of net revenues, an increase of 90
basis points from 7.6% in Q3'08, and an increase of 110 basis points
from 7.4% in Q2'09
-- 0.6% decrease in controllable expenses per adjusted patient day
(same-hospital)
-- 4.2% increase in commercial managed care revenues (same-hospital)
-- Volume Metrics (same-hospital)
o 0.1% increase in total admissions; 0.1% decrease in paying admissions
o 4.8% increase in outpatient visits; 5.3% increase in paying outpatient
visits
o 2.2% increase in total surgeries; 4.4% increase in outpatient
surgeries
o 4.5% decrease in commercial managed care admissions; flat commercial
managed care outpatient visits
DALLAS--(BUSINESS WIRE)-- Tenet Healthcare Corporation (NYSE: THC) today reported Adjusted EBITDA, a non-GAAP term defined below, of $240 million for the third quarter ended Sept. 30, 2009, an increase of $80 million, or 50 percent, as compared to $160 million for the third quarter of 2008. On a same-hospital basis, Adjusted EBITDA was $236 million for the third quarter of 2009, an increase of $74 million, or 45.7 percent, as compared to $162 million in the third quarter of 2008. The net loss attributable to common shareholders for the third quarter of 2009 was $3 million, or $0.01 per share, compared to net income attributable to common shareholders of $104 million, or $0.22 per share, for the third quarter of 2008. Net income attributable to common shareholders in the third quarter of 2008 included pre-tax gains on sales of investments of $140 million.
"Our strategies drove a significant enhancement in earnings through the first three quarters of 2009, making this the second consecutive quarter in which we've generated year-over-year Adjusted EBITDA growth of 50 percent or better," said Trevor Fetter, president and chief executive officer. "Adjusted free cash flow from continuing operations was also solid at $142 million. Strong revenue growth, excellent cost control, and robust growth in our outpatient business were more than sufficient to offset an adverse shift in payer mix. While the economy has had some effect year-to-date, it remains less than we would have expected in the context of rising unemployment levels in many of our markets. Given our strong year-to-date performance, we are raising our range for 2009 Adjusted EBITDA to $925 million to $975 million. Additionally, it is important to recognize the strong reception Tenet received from the capital markets this year as it successfully extended more than $2.3 billion of near-term debt maturities and raised fresh capital by accessing the preferred equity market. These actions reduced our leverage and created a much stronger and liquid balance sheet."
Continuing Operations
Net loss attributable to common shareholders was $3 million in the third quarter of 2009, or $0.01 per share, including the following items with an aggregate, net unfavorable impact of $18 million after-tax, or $0.04 per share:
1. Loss from discontinued operations, net of tax, of $5 million, or $0.01 per share;
2. Favorable income tax adjustments of $3 million, or zero cents per share, primarily related to a decrease in the Company's valuation allowance for deferred tax assets and other tax adjustments;
3. Loss from early extinguishment of debt of $16 million pre-tax, $10 million after-tax before the deferred tax valuation allowance, or $0.02 per share;
4. Litigation and investigation costs of $3 million pre-tax, $2 million after-tax before the deferred tax valuation allowance, or zero cents per share; and
5. Impairment of long lived-assets and goodwill, and restructuring charges of $7 million pre-tax, $4 million after-tax before the tax valuation allowance, or $0.01 per share.
Adjusted EBITDA
Adjusted EBITDA, a non-GAAP term defined below, was $240 million, or a margin of 10.6 percent of net operating revenues, in the third quarter of 2009. This represents an increase of $80 million, or 50 percent, from Adjusted EBITDA of $160 million in the third quarter of 2008, and a margin increase of 310 basis points as compared to an Adjusted EBITDA margin of 7.5 percent in the third quarter of 2008.
Same-hospital Adjusted EBITDA was $236 million in the third quarter of 2009, an increase of $74 million, or 45.7 percent, from the $162 million in the third quarter of 2008. The same-hospital Adjusted EBITDA margin increased by 290 basis points to 10.5 percent in the third quarter of 2009 compared to 7.6 percent in the third quarter of 2008. Same-hospital financial data excludes the results from one of the Company's hospitals as discussed below.
Adjusted EBITDA is a non-GAAP term defined by the Company as net income (loss) attributable to common shareholders of Tenet Healthcare Corporation before: (1) the cumulative effect of changes in accounting principle, net of tax; (2) net income attributable to noncontrolling interests; (3) preferred stock dividends, (4) income (loss) from discontinued operations, net of tax; (5) income tax (expense) benefit; (6) net gains (losses) on sales of investments; (7) investment earnings (loss); (8) gain (loss) from early extinguishment of debt; (9) interest expense; (10) litigation and investigation (costs) benefit, net of insurance recoveries; (11) hurricane insurance recoveries, net of costs; (12) impairment of long-lived assets and goodwill and restructuring charges, net of insurance recoveries; (13) amortization; and (14) depreciation. A reconciliation of Adjusted EBITDA to net income (loss) attributable to Tenet Healthcare Corporation common shareholders is provided in Table #1 at the end of this release.
Same-Hospital Data
Same-hospital continuing operations data excludes Sierra Providence East Medical Center, in El Paso, which opened on May 21, 2008. Same-hospital continuing operations data is the primary form of tabular data presentation in the narrative sections of this document. There are currently 48 hospitals in same-hospital continuing operations. Sierra Providence East Medical Center will be added to our same-hospital reporting beginning in the first quarter of 2010.
Admissions, Patient Days and Surgeries
Same-Hospital
Admissions, Patient Days and
Continuing Operations
Surgeries
Q3'09 Q3'08 Change (%)
Commercial Managed Care Admissions 33,204 34,759 (4.5)
Governmental Managed Care Admissions 29,539 27,065 9.1
Medicare Admissions 37,131 38,127 (2.6)
Medicaid Admissions 16,694 16,531 1.0
Uninsured Admissions 6,107 6,301 (3.1)
Charity Care Admissions 2,620 2,164 21.1
Other Admissions 3,357 3,578 (6.2)
Total Admissions 128,652 128,525 0.1
Paying Admissions (excludes Charity + 119,925 120,060 (0.1)
Uninsured)
Charity Admissions + Uninsured 8,727 8,465 3.1
Admissions
Admissions through Emergency Department 73,082 70,741 3.3
Commercial Managed Care Admits / Total (%) 25.8 27.0 (1.2) (a)
Admits
Emergency Department Admissions / Total (%) 56.8 55.0 1.8(a)
Admits
Uninsured Admissions / Total Admissions (%) 4.7 4.9 (0.2) (a)
Charity Admissions / Total Admissions (%) 2.0 1.7 0.3 (a)
Surgeries - Inpatient 38,828 39,121 (0.7)
Surgeries - Outpatient 52,906 50,655 4.4
Surgeries - Total 91,734 89,776 2.2
Patient Days - Total 616,850 625,702 (1.4)
Adjusted Patient Days (b) 926,344 916,104 1.1
Patient Days - Commercial Managed Care 132,119 136,970 (3.5)
Average Length of Stay (days) 4.8 4.9 (0.1) (a)
Adjusted Patient Admissions (b) 194,568 189,536 2.7
(a) This change is the difference between the Q3'09 and Q3'08 amounts shown.
(b) "Adjusted Patient Days / Admissions" represents actual patient days /
admissions adjusted to include outpatient services by multiplying actual
patient days / admissions by the sum of gross inpatient revenues and outpatient
revenues and dividing the results by gross inpatient revenues.
Total admissions were relatively flat in the third quarter with an increase of 0.1 percent as compared to the third quarter of 2008. In the third quarter of 2008, total admissions had increased by 1.9 percent as compared to the third quarter of 2007, providing a strong prior-year comparative. Commercial managed care admissions declined by 4.5 percent, which compared favorably to the 5.7 percent decline in the second quarter of 2009.
The Company's California Region and its Philadelphia Market each reported positive total admissions growth in the quarter. Tenet's other regions reported admissions declines in the third quarter. Total surgery growth remained strong growing by 2.2 percent with outpatient surgeries growing by 4.4 percent but inpatient surgeries declining by 0.7 percent.
Flu related admissions were not a major factor in the quarter, adding 339 admissions to the third quarter of 2009 as compared to 17 flu related admissions in the third quarter of 2008, an increase of 322 admissions.
Outpatient Visits
Same-Hospital
Outpatient Visits Continuing Operations
Q3'09 Q3'08 Change (%)
Commercial Managed Care OP Visits 351,592 351,594 -
Governmental Managed Care OP Visits 186,544 155,156 20.2
Medicare OP Visits 212,008 207,515 2.2
Medicaid OP Visits 75,936 68,103 11.5
Uninsured OP Visits 97,189 98,282 (1.1)
Charity Care OP Visits 7,135 5,320 34.1
Other OP Visits 52,685 52,028 1.3
Total OP Visits 983,089 937,998 4.8
Paying OP Visits (excludes Uninsured + 878,765 834,396 5.3
Charity)
OP Surgery Visits 52,906 50,655 4.4
Emergency Department OP Visits 357,122 326,769 9.3
Charity + Uninsured OP Visits 104,324 103,602 0.7
Charity + Uninsured OP Visits / Total OP (%) 10.6 11.0 (0.4) (a)
Visits
Paying OP Visits / Total OP Visits 89.4 89.0 0.4 (a)
Commercial OP Visits / Total Visits (%) 35.8 37.5 (1.7) (a)
(a) This change is the difference between the Q3'09 and Q3'08 amounts shown.
Total same-hospital outpatient volume grew by 45,091 visits, or 4.8 percent, in the third quarter of 2009 compared to the third quarter of 2008. Tenet has now reported year-over-year growth in outpatient visits in six of the last seven quarters.
Changes in outpatient payer mix included growth in paying patients which rose to 89.4 percent of total outpatient visits, an increase of 40 basis points as compared to 89.0 percent in the third quarter of 2008, and a smaller contribution from commercial outpatient visits, which declined to 35.8 percent of total outpatient visits, a decline of 170 basis points as compared to 37.5 percent in the third quarter of 2008.
Newly opened or acquired facilities contributed 1,814 visits, net of the loss of visits from centers which were closed in the period following September 30, 2008. Excluding this net incremental volume from new facilities, organic growth in outpatient visits would have been an increase of 43,277 visits, or growth of 4.6 percent.
Outpatient surgeries also reported a strong quarter increasing by 4.4 percent. Outpatient surgeries grew by 3.5 percent in the second quarter of 2009. Outpatient imaging also continued its growth trend, increasing by 2.7 percent relative to the third quarter of 2008. Emergency Department outpatient visits increased by 30,353 visits, or 9.3 percent, in the third quarter of 2009 as compared to the third quarter of 2008. This increase in Emergency Department outpatient visits contributed 67 percent of the increase in total outpatient visits in the quarter.
Charity plus uninsured outpatient visits increased by 0.7 percent as compared to a decline rate of 3.4 percent in the second quarter of 2009.
Flu-related outpatient visits were 5,271 in the third quarter of 2009 as compared to 214 in the third quarter of 2008. This increase of 5,057 visits accounted for 11 percent of the total increase in outpatient visits of 45,091.
All of the Company's regions exhibited growth in outpatient visits in the third quarter with the strongest growth coming from the Central and Florida Regions and the Philadelphia Market, each of which saw outpatient visit growth in excess of 8 percent. The Company's California and Southern States Regions grew outpatient visits by more than one percent.
Revenues
Same-Hospital
Revenues
Continuing Operations
($ in millions)
Q3'09 Q3'08 Change (%)
Net Operating Revenues 2,238 2,127 5.2
Net Patient Revenue from Commercial Managed Care 886 850 4.2
Revenues from the Uninsured 166 152 9.2
Revenue growth remained robust in the third quarter of 2009 with an increase of $111 million, or 5.2 percent, on a same-hospital basis. Favorable prior-year cost report adjustments contributed $11 million to net operating revenues in the third quarter of 2009 as compared to a contribution of $10 million in the third quarter of 2008. Excluding prior year cost report adjustments from both quarters, same-hospital revenues would have shown the same increase of 5.2 percent. Net operating revenues in the third quarter of 2009 include $6 million of revenue recognized by the Company's Philadelphia Market related to calendar year 2008 that was approved for distribution to Tenet in the third quarter of 2009 by a Philadelphia HMO in which Tenet holds a minority interest.
Commercial managed care revenues grew by 4.2 percent on a same-hospital basis, a rate of growth significantly stronger than the 4.5 percent decline in commercial managed care admissions and the flat commercial managed care outpatient visits as compared to the third quarter of 2008.
Pricing
Same-Hospital
Pricing
Continuing Operations
($)
Q3'09 Q3'08 Change (%)
Net Inpatient Revenue per Admission 11,286 10,885 3.7
Net Inpatient Revenue per Patient Day 2,354 2,236 5.3
Net Outpatient Revenue per Visit 711 692 2.7
Net Patient Revenue per Adjusted Patient 11,055 10,805 2.3
Admission
Net Patient Revenue per Adjusted Patient Day 2,322 2,236 3.8
Managed Care: Net Inpatient Revenue per Admission 12,133 11,469 5.8
Managed Care: Net Outpatient Revenue per Visit 823 813 1.2
Pricing improvement was evident across all key metrics, primarily reflecting the improved terms of our commercial managed care contracts. The growth in net inpatient revenue per admission of 3.7 percent was adversely impacted by a mix shift, including a decline in commercial managed care admissions as a percent of total admissions to 25.8 percent in the third quarter of 2009 as compared to 27.0 percent of total admissions in the third quarter of 2008.
In a similar fashion, the 2.7 percent growth in outpatient revenue per visit was constrained by the decline of commercial outpatient visits as a percent of total outpatient visits to 35.8 percent in the third quarter of 2009 as compared to 37.5 percent of total outpatient visits in the third quarter of 2008.
Controllable Operating Expenses
Same-Hospital
Controllable Operating Expenses Continuing Operations
Q3'09 Q3'08 Change (%)
Salaries, Wages & Benefits ($mm) 945 937 0.9
Supplies ($mm) 386 375 2.9
Other Operating Expenses ($mm) 481 491 (2.0)
Total Controllable Operating Expenses ($mm) 1,812 1,803 0.5
Rent / Lease Expense (a) ($mm) 34 35 (2.9)
Unit Cost Statistics
Salaries, Wages & Benefits per Adjusted ($) 1,020 1,023 (0.3)
Patient Day
Supplies per Adjusted Patient Day ($) 417 409 2.0
Other Operating Expenses per Adjusted Patient ($) 519 536 (3.2)
Day
Total Controllable Operating Expenses per ($) 1,956 1,968 (0.6)
Adjusted Patient Day
(a) Included in Other Operating Expenses
Salaries, wages and benefits per adjusted patient day decreased by 0.3 percent in the third quarter of 2009 compared to the third quarter of 2008. This decrease is primarily due to a decline in full-time employee headcount, reduced contract labor expense, lower 401(k) match expense, and lower overtime costs. These cost efficiencies were partially offset by higher health benefits costs, and increased accruals for annual incentive compensation. Contract labor expense, which is included in salaries, wages and benefits, was $16 million in the third quarter of 2009, a decrease of $18 million, or 53 percent, compared to the third quarter of 2008. The third quarter of 2009 also included a $3 million favorable pension expense adjustment related to the termination of a fully funded and frozen retirement plan of a previously acquired company.
Supplies expense per adjusted patient day increased by 2.0 percent compared to the third quarter of 2008. The increase in supplies expense is primarily due to the increase in the number of surgeries which grew by 2.2 percent, and the increased utilization of high cost implants. A portion of the increase in supplies expense was offset by revenue growth related to payments we receive from certain payers.
Other operating expenses per adjusted patient day decreased by 3.2 percent compared to the third quarter of 2008. Contributing to this decrease was a $4 million, or 12.9 percent, decline in total hospital malpractice expense to $27 million, compared to $31 million in the third quarter of 2008. This decrease is primarily attributable to improved claims experience. Declines in consulting costs, utility costs and information systems implementation costs also had a favorable impact on other operating expenses. The favorable impact of these items was partially offset by increases in costs of contracted services and a reduction in information systems and business office costs allocable to discontinued operations.
Total controllable operating expenses, which is defined as salaries, wages & benefits, supplies, and other operating expenses, declined by 0.6 percent on a per adjusted patient day basis compared to the third quarter of 2008.
Provision for Doubtful Accounts
Same-Hospital
Bad Debt Continuing Operations
Q3'09 Q3'08 Change (%)
Provision for Doubtful Accounts ("Bad Debt") ($mm) 190 162 17.3
Bad Debt / Net Operating Revenues (%) 8.5 7.6 0.9 (a)
Collection Rate from Self-Pay (b) 30.3 33.3 (3.0) (a)
Collection Rate from Managed Care Payers (%) 97.8 97.9 (0.1) (a)
(a) This change is the difference between the Q3'09 and Q3'08 amounts shown.
(b) "Self-pay" accounts receivable are comprised of both uninsured and
balance-after insurance receivables.
Bad debt expense increased by $28 million, or 17.3 percent, compared to the third quarter of 2008. The increase in bad debt expense was related to higher pricing, and decreased collection rates from self-pay accounts, partially offset by a decline in uninsured volumes and improved managed care accounts receivable aging categories.
The Company's self-pay collection rate, which is the aggregate collection rate for uninsured and balance-after insurance accounts receivable, declined to approximately 30.3 percent in the third quarter of 2009 compared to 33.3 percent in the third quarter of 2008, and 30.8 percent in the second quarter of 2009.
The estimated direct and allocated costs (based on selected operating expenses, which include salaries, wages and benefits, supplies and other operating expenses) of caring for uninsured patients were $100 million and $93 million, respectively, for the third quarters of 2009 and 2008.
Accounts Receivable
Consolidated accounts receivable were approximately $1.195 billion at September 30, 2009 and $1.225 billion at June 30, 2009. Accounts receivable days outstanding from continuing operations were 47 days at September 30, 2009 compared to 48 days at June 30, 2009 and 50 days at December 31, 2008. This amount is calculated as accounts receivable from continuing operations divided by net revenue from continuing operations divided by the number of days in the quarter.
Cash Flow
Cash and cash equivalents were $731 million at September 30, 2009, a decrease of $27 million from $758 million at June 30, 2009.
Significant cash flow items in the three months ended September 30, 2009 included:
-- Payments of $383 million to purchase $376 million aggregate principal
amount of our senior notes due in 2011, 2012, 2014, 2015 and 2031;
-- Net proceeds of $334 million from the issuance of 345,000 shares of 7.0%
mandatory convertible preferred stock;
-- Interest payments of $100 million, including $4 million of payments that
were accelerated and paid in the three months ended September 30, 2009
as a result of our repurchase of $308 million aggregate principal amount
of our senior notes due in 2015 and $20 million of interest payments
under an interest rate swap agreement that has the effect of converting
our 73/8% senior notes due 2013 from a fixed interest rate paid
semi-annually to a variable interest rate paid monthly based on the
one-month LIBOR plus a floating rate spread of approximately 5.46%;
-- $18 million received under the interest rate swap agreement discussed
above;
-- Cash distributions of $3 million received related to the Company's
investment in the Reserve Yield Plus Fund, which are classified as
investing activity cash flows;
-- Capital expenditures of $91 million;
-- $23 million in principal payments classified as operating cash outflows
from continuing operations related to our 2006 civil settlement with the
federal government;
-- $81 million in payments classified as operating cash outflows from
continuing operations related to our 2009 settlement of wage and hour
actions; and;
-- Income tax payments of $7 million.
Outlook for 2009
The Company is raising its 2009 outlook range for Adjusted EBITDA by $25 million to a new 2009 outlook range of $925 million to $975 million. The outlook for net income attributable to common shareholders for 2009 is in a range from $66 million to $130 million. A reconciliation of the Company's outlook for 2009 Adjusted EBITDA to the outlook for net income attributable to common shareholders of Tenet Healthcare Corporation for the year ending Dec. 31, 2009 is provided in Table #3 below.
This favorable refinement to the 2009 outlook range reflects the Company's stronger than anticipated results of operations in the third quarter.
Management's Webcast Discussion of Third Quarter Results
Tenet management will discuss third quarter 2009 results on a webcast scheduled for 10:00 AM (ET) on Nov. 3, 2009. This webcast may be accessed through Tenet's website at www.tenethealth.com/investors. A set of slides, which the Company will refer to on the call, will be posted to the Company's website at approximately 7:30 AM (ET).
Tenet Healthcare Corporation is a health care services company whose subsidiaries and affiliates own and operate acute care hospitals, ambulatory surgery centers and diagnostic imaging centers. Tenet's hospitals and related healthcare facilities are committed to providing high quality care to patients in the communities they serve. For more information, please visit www.tenethealth.com.
Some of the statements in this release may constitute forward-looking statements. Such forward-looking statements are based on our current expectations and could be affected by numerous factors and are subject to various risks and uncertainties discussed in our filings with the Securities and Exchange Commission, including our annual report on Form 10-K for the year ended Dec. 31, 2008, our quarterly reports on Form 10-Q, and periodic reports on Form 8-K. Do not rely on any forward-looking statement, as we cannot predict or control many of the factors that ultimately may affect our ability to achieve the results estimated. We make no promise to update any forward-looking statement, whether as a result of changes in underlying factors, new information, future events or otherwise.
TENET HEALTHCARE CORPORATION
CONSOLIDATED OPERATIONS DATA
(Unaudited)
(Dollars in millions
except per share Three Months Ended September 30,
amounts)
2009 % 2008 % Change
Net operating $ 2,262 100.0 % $ 2,140 100.0 % 5.7 %
revenues
Operating expenses:
Salaries, wages and (954 ) (42.2 %) (943 ) (44.1 %) 1.2 %
benefits
Supplies (389 ) (17.2 %) (376 ) (17.6 %) 3.5 %
Provision for (193 ) (8.5 %) (164 ) (7.7 %) 17.7 %
doubtful accounts
Other operating (486 ) (21.5 %) (497 ) (23.1 %) (2.2 %)
expenses, net
Depreciation (85 ) (3.8 %) (84 ) (3.9 %) 1.2 %
Amortization (12 ) (0.5 %) (10 ) (0.5 %) 20.0 %
Impairment of
long-lived assets
and goodwill, and (7 ) (0.3 %) (1 ) --
restructuring
charges
Litigation and
investigation
(costs) benefit, net (3 ) (0.1 %) 5 0.2 %
of insurance
recoveries
Operating income 133 5.9 % 70 3.3 %
Interest expense (112 ) (106 )
Loss from early
extinguishment of (16 ) --
debt
Investment earnings 2 12
Net gain on sales of -- 140
investments
Income from
continuing 7 116
operations, before
income taxes
Income tax (expense) (3 ) 4
benefit
Income from
continuing
operations, before 4 120
discontinued
operations
Discontinued
operations:
Loss from operations (2 ) (33 )
Impairment of
long-lived assets
and goodwill, and (1 ) (21 )
restructuring
charges
Net losses on sales -- (3 )
of facilities
Litigation
settlements, net of -- 39
insurance recoveries
Income tax (expense) (2 ) 4
benefit
Loss from
discontinued (5 ) (14 )
operations
Net income (loss) (1 ) 106
Less: Preferred -- --
stock dividends
Less: Net income
attributable to 2 2
noncontrolling
interests
Net income (loss)
attributable to
Tenet Healthcare $ (3 ) $ 104
Corporation common
shareholders
Earnings (loss) per
share attributable
to Tenet Healthcare
Corporation common
shareholders
Basic
Continuing $ -- $ 0.25
operations
Discontinued (0.01 ) (0.03 )
operations
$ (0.01 ) $ 0.22
Diluted
Continuing $ -- $ 0.25
operations
Discontinued (0.01 ) (0.03 )
operations
$ (0.01 ) $ 0.22
Weighted average
shares and dilutive
securities
outstanding (in
thousands):
Basic 481,008 476,898
Diluted 498,084 480,789
TENET HEALTHCARE CORPORATION
CONSOLIDATED OPERATIONS DATA
(Unaudited)
(Dollars in millions
except per share Nine Months Ended September 30,
amounts)
2009 % 2008 % Change
Net operating $ 6,753 100.0 % $ 6,408 100.0 % 5.4 %
revenues
Operating expenses:
Salaries, wages and (2,868 ) (42.5 %) (2,822 ) (44.0 %) 1.6 %
benefits
Supplies (1,175 ) (17.4 %) (1,126 ) (17.6 %) 4.4 %
Provision for (516 ) (7.6 %) (462 ) (7.2 %) 11.7 %
doubtful accounts
Other operating (1,430 ) (21.2 %) (1,459 ) (22.8 %) (2.0 %)
expenses, net
Depreciation (257 ) (3.8 %) (249 ) (3.9 %) 3.2 %
Amortization (34 ) (0.5 %) (28 ) (0.4 %) 21.4 %
Impairment of
long-lived assets
and goodwill, and (13 ) (0.2 %) (4 ) (0.1 %)
restructuring
charges
Litigation and
investigation costs, (13 ) (0.2 %) (45 ) (0.7 %)
net of insurance
recoveries
Operating income 447 6.6 % 213 3.3 %
Interest expense (342 ) (312 )
Gain from early
extinguishment of 97 --
debt
Investment earnings (1 ) 21
(loss)
Net gain on sales of 15 140
investments
Income from
continuing 216 62
operations, before
income taxes
Income tax (expense) (12 ) 19
benefit
Income from
continuing
operations, before 204 81
discontinued
operations
Discontinued
operations:
Loss from operations (14 ) (25 )
Impairment of
long-lived assets
and goodwill, and (16 ) (38 )
restructuring
charges
Net gains (losses)
on sales of (2 ) 5
facilities
Litigation
settlements, net of -- 39
insurance recoveries
Income tax expense (4 ) (1 )
Loss from
discontinued (36 ) (20 )
operations
Net income 168 61
Less: Preferred -- --
stock dividends
Less: Net income
attributable to 8 3
noncontrolling
interests
Net income
attributable to
Tenet Healthcare $ 160 $ 58
Corporation common
shareholders
Earnings (loss) per
share attributable
to Tenet Healthcare
Corporation common
shareholders
Basic
Continuing $ 0.41 $ 0.16
operations
Discontinued (0.08 ) (0.04 )
operations
$ 0.33 $ 0.12
Diluted
Continuing $ 0.40 $ 0.16
operations
Discontinued (0.07 ) (0.04 )
operations
$ 0.33 $ 0.12
Weighted average
shares and dilutive
securities
outstanding (in
thousands):
Basic 479,942 476,091
Diluted 489,688 478,662
TENET HEALTHCARE CORPORATION
CONSOLIDATED BALANCE SHEET DATA
(Unaudited)
September 30, December 31,
(Dollars in Millions) 2009 2008
ASSETS
Current assets:
Cash and cash equivalents $ 731 $ 507
Investments in Reserve Yield Plus Fund 3 14
Investments in marketable securities 16 2
Accounts receivable, less allowance for doubtful 1,195 1,337
accounts
Inventories of supplies, at cost 153 161
Income tax receivable -- 6
Deferred income taxes 80 82
Assets held for sale 37 310
Other current assets 324 290
Total current assets 2,539 2,709
Investments and other assets 181 242
Property and equipment, at cost, less accumulated 4,172 4,291
depreciation and amortization
Goodwill 607 609
Other intangible assets, at cost, less 377 323
accumulated amortization
Total assets $ 7,876 $ 8,174
LIABILITIES AND EQUITY
Current liabilities:
Current portion of long-term debt $ 2 $ 2
Accounts payable 638 686
Accrued compensation and benefits 380 414
Professional and general liability reserves 114 127
Accrued interest payable 123 125
Accrued legal settlement costs 96 168
Other current liabilities 419 427
Total current liabilities 1,772 1,949
Long-term debt, net of current portion 4,267 4,778
Professional and general liability reserves 486 536
Accrued legal settlement costs -- 72
Other long-term liabilities 562 591
Deferred income taxes 116 101
Total liabilities 7,203 8,027
Commitments and contingencies
Equity:
Shareholders' equity:
Preferred stock 334 --
Common stock 26 26
Additional paid-in capital 4,464 4,445
Accumulated other comprehensive loss (27 ) (37 )
Accumulated deficit (2,692 ) (2,852 )
Less common stock in treasury, at cost (1,479 ) (1,479 )
Total shareholders' equity 626 103
Noncontrolling interests 47 44
Total equity 673 147
Total liabilities and equity $ 7,876 $ 8,174
TENET HEALTHCARE CORPORATION
CONSOLIDATED CASH FLOW DATA
(Unaudited)
Nine Months Ended
(Dollars in Millions)
September 30,
2009 2008
Net income $ 168 $ 61
Adjustments to reconcile net income to net cash provided
by operating activities:
Depreciation and amortization 291 277
Provision for doubtful accounts 516 462
Net gain on sales of investments (15 ) (140 )
Deferred income tax expense 17 11
Stock-based compensation expense 18 27
Impairment of long-lived assets and goodwill, and 13 4
restructuring charges
Litigation and investigation costs, net of insurance 13 45
recoveries
Net gain from early extinguishment of debt (97 ) --
Fair market value adjustments related to interest rate (1 ) --
swap and LIBOR cap agreements
Proceeds from interest rate swap agreement 18 --
Pretax loss from discontinued operations 32 19
Other items, net (2 ) (3 )
Changes in cash from changes in operating assets and
liabilities:
Accounts receivable (498 ) (478 )
Inventories and other current assets (25 ) 6
Income taxes 13 (32 )
Accounts payable, accrued expenses and other current (37 ) (45 )
liabilities
Other long-term liabilities (6 ) (27 )
Payments against reserves for restructuring charges and (165 ) (79 )
litigation costs
Net cash provided by operating activities from 31 33
discontinued operations, excluding income taxes
Net cash provided by operating activities 284 141
Cash flows from investing activities:
Purchases of property and equipment--Continuing (216 ) (332 )
operations
Purchases of property and equipment--Discontinued (1 ) (16 )
operations
Construction of new and replacement hospitals (47 ) (65 )
Purchase of business -- (92 )
Proceeds from sales of facilities and other assets - 221 160
discontinued operations
Proceeds from sales of marketable securities, long-term 55 192
investments and other assets
Proceeds from hospital authority bonds 49 8
Purchases of marketable securities (17 ) (17 )
Distributions received from (reclassification of) 11 (48 )
investments in Reserve Yield Plus Fund
Proceeds from cash surrender value or basis reduction of -- 4
insurance policies
Other items, net -- 3
Net cash provided by (used in) investing activities 55 (203 )
Cash flows from financing activities:
Repayments of borrowings (1,285 ) (1 )
Proceeds from borrowings 885 1
Deferred debt issuance costs (47 ) (3 )
Proceeds from issuance of mandatory convertible 334 --
preferred stock
Cash dividends on preferred stock -- --
Contributions from noncontrolling interests -- 7
Distributions paid to noncontrolling interests (5 ) (2 )
Other items, net 3 --
Net cash provided by (used in) financing activities (115 ) 2
Net increase (decrease) in cash and cash equivalents 224 (60 )
Cash and cash equivalents at beginning of period 507 572
Cash and cash equivalents at end of period $ 731 $ 512
Supplemental disclosures:
Interest paid, net of capitalized interest $ (340 ) $ (321 )
Income tax refunds (payments), net $ 15 $ (3 )
TENET HEALTHCARE CORPORATION
SELECTED STATISTICS - CONTINUING SAME HOSPITALS
(Unaudited)
(Dollars in
millions
except per
patient day,
per Three Months Ended September 30, Nine Months Ended September 30,
admission
and per
visit
amounts)
2009 2008 Change 2009 2008 Change
Net
inpatient $ 1,452 $ 1,399 3.8 % $ 4,380 $ 4,254 3.0 %
revenues
Net
outpatient $ 699 $ 649 7.7 % $ 2,050 $ 1,914 7.1 %
revenues
Number of
general
hospitals 48 48 -- * 48 48 -- *
(at end of
period)
Licensed
beds (at end 13,309 13,256 0.4 % 13,309 13,256 0.4 %
of period)
Average
licensed 13,309 13,261 0.4 % 13,303 13,276 0.2 %
beds
Utilization
of licensed 50.4 % 51.3 % (0.9 %) * 52.5 % 53.8 % (1.3 %) *
beds
Patient days 616,850 625,702 (1.4 %) 1,908,053 1,955,366 (2.4 %)
Adjusted 926,344 916,104 1.1 % 2,828,112 2,815,525 0.4 %
patient days
Net
inpatient $ 2,354 $ 2,236 5.3 % $ 2,296 $ 2,176 5.5 %
revenue per
patient day
Admissions 128,652 128,525 0.1 % 391,362 393,378 (0.5 %)
Adjusted
patient 194,568 189,536 2.7 % 584,011 570,619 2.3 %
admissions
Net
inpatient $ 11,286 $ 10,885 3.7 % $ 11,192 $ 10,814 3.5 %
revenue per
admission
Average
length of 4.8 4.9 (0.1 ) * 4.9 5.0 (0.1 ) *
stay (days)
Surgeries 91,734 89,776 2.2 % 272,385 266,719 2.1 %
Net
outpatient $ 711 $ 692 2.7 % $ 701 $ 676 3.7 %
revenue per
visit
Outpatient 983,089 937,998 4.8 % 2,924,685 2,829,706 3.4 %
visits
Sources of
net patient
revenue
Medicare 24.4 % 25.1 % (0.7 %) * 25.2 % 25.5 % (0.3 %) *
Medicaid 8.5 % 8.6 % (0.1 %) * 8.3 % 8.5 % (0.2 %) *
Managed care 14.8 % 13.2 % 1.6 % * 14.8 % 13.2 % 1.6 % *
governmental
Managed care 41.2 % 41.5 % (0.3 %) * 41.2 % 41.2 % -- *
commercial
Indemnity,
self-pay and 11.1 % 11.6 % (0.5 %) * 10.5 % 11.6 % (1.1 %) *
other
* This change is the difference between the 2009 and 2008 amounts shown
TENET HEALTHCARE CORPORATION
SELECTED STATISTICS - CONTINUING TOTAL HOSPITALS
(Unaudited)
(Dollars in
millions
except per
patient day,
per Three Months Ended September 30, Nine Months Ended September 30,
admission
and per
visit
amounts)
2009 2008 Change 2009 2008 Change
Net
inpatient $ 1,466 $ 1,405 4.3 % $ 4,421 $ 4,261 3.8 %
revenues
Net
outpatient $ 709 $ 657 7.9 % $ 2,079 $ 1,924 8.1 %
revenues
Number of
general
hospitals 49 49 -- * 49 49 -- *
(at end of
period)
Licensed
beds (at end 13,419 13,366 0.4 % 13,419 13,366 0.4 %
of period)
Average
licensed 13,419 13,371 0.4 % 13,413 13,337 0.6 %
beds
Utilization
of licensed 50.4 % 51.0 % (0.6 %) * 52.6 % 53.6 % (1.0 %) *
beds
Patient days 622,427 627,942 (0.9 %) 1,924,777 1,958,219 (1.7 %)
Adjusted 935,375 920,430 1.6 % 2,854,688 2,821,176 1.2 %
patient days
Net
inpatient $ 2,355 $ 2,237 5.3 % $ 2,297 $ 2,176 5.6 %
revenue per
patient day
Admissions 130,258 129,205 0.8 % 395,901 394,276 0.4 %
Adjusted
patient 197,164 190,843 3.3 % 591,223 572,398 3.3 %
admissions
Net
inpatient $ 11,255 $ 10,874 3.5 % $ 11,167 $ 10,807 3.3 %
revenue per
admission
Average
length of 4.8 4.9 (0.1 ) * 4.9 5.0 (0.1 ) *
stay (days)
Surgeries 92,437 90,146 2.5 % 274,243 267,199 2.6 %
Net
outpatient $ 712 $ 695 2.4 % $ 702 $ 678 3.5 %
revenue per
visit
Outpatient 995,968 945,569 5.3 % 2,962,755 2,839,708 4.3 %
visits
Sources of
net patient
revenue
Medicare 24.4 % 25.1 % (0.7 %) * 25.1 % 25.5 % (0.4 %) *
Medicaid 8.5 % 8.6 % (0.1 %) * 8.3 % 8.5 % (0.2 %) *
Managed care 14.8 % 13.3 % 1.5 % * 14.8 % 13.1 % 1.7 % *
governmental
Managed care 41.2 % 41.6 % (0.4 %) * 41.2 % 41.2 % -- % *
commercial
Indemnity,
self-pay and 11.1 % 11.4 % (0.3 %) * 10.6 % 11.7 % (1.1 %) *
other
* This change is the difference between the 2009 and 2008 amounts shown
TENET HEALTHCARE CORPORATION
CONSOLIDATED OPERATIONS DATA
Fiscal 2009 by Calendar Quarter
(Unaudited)
Nine
(Dollars in millions
except per share Three Months Ended Months
amounts)
Ended
3/31/09 6/30/09 9/30/09 9/30/09
Net operating revenues $ 2,262 $ 2,229 $ 2,262 $ 6,753
Operating expenses:
Salaries, wages and (965 ) (949 ) (954 ) (2,868 )
benefits
Supplies (391 ) (395 ) (389 ) (1,175 )
Provision for doubtful (156 ) (167 ) (193 ) (516 )
accounts
Other operating (472 ) (472 ) (486 ) (1,430 )
expenses, net
Depreciation (85 ) (87 ) (85 ) (257 )
Amortization (11 ) (11 ) (12 ) (34 )
Impairment of
long-lived assets and (5 ) (1 ) (7 ) (13 )
goodwill, and
restructuring charges
Litigation and (1 ) (9 ) (3 ) (13 )
investigation costs
Operating income 176 138 133 447
Interest expense (110 ) (120 ) (112 ) (342 )
Gain (loss) from early 134 (21 ) (16 ) 97
extinguishment of debt
Investment earnings 2 (5 ) 2 (1 )
(loss)
Net gain on sales of -- 15 -- 15
investments
Income from continuing
operations, before 202 7 7 216
income taxes
Income tax expense (5 ) (4 ) (3 ) (12 )
Income from continuing
operations, before 197 3 4 204
discontinued
operations
Discontinued
operations:
Loss from operations (1 ) (11 ) (2 ) (14 )
Impairment of
long-lived assets and (9 ) (6 ) (1 ) (16 )
goodwill, and
restructuring charges
Net losses on sales of (2 ) -- -- (2 )
facilities
Income tax expense (2 ) -- (2 ) (4 )
Loss from discontinued (14 ) (17 ) (5 ) (36 )
operations
Net income (loss) 183 (14 ) (1 ) 168
Less: Preferred stock -- -- -- --
dividends
Less: Net income
attributable to 5 1 2 8
noncontrolling
interests
Net income (loss)
attributable to Tenet $ 178 $ (15 ) $ (3 ) $ 160
Healthcare Corporation
common shareholders
Diluted earnings
(loss) per share
attributable to Tenet
Healthcare Corporation
common shareholders
Continuing operations $ 0.40 $ 0.01 $ -- $ 0.40
Discontinued (0.03 ) (0.04 ) (0.01 ) (0.07 )
operations
$ 0.37 $ (0.03 ) $ (0.01 ) $ 0.33
Weighted average
shares and dilutive
securities outstanding
(in thousands):
Basic 478,372 480,447 481,008 479,942
Diluted 479,512 488,244 498,084 489,688
TENET HEALTHCARE CORPORATION
SELECTED STATISTICS - CONTINUING SAME HOSPITALS
Fiscal 2009 by Calendar Quarter
(Unaudited)
(Dollars in millions Nine
except per patient
day, per admission Three Months Ended Months
and per visit
amounts) Ended
3/31/09 6/30/09 9/30/09 9/30/09
Net inpatient $ 1,501 $ 1,427 $ 1,452 $ 4,380
revenues
Net outpatient $ 659 $ 692 $ 699 $ 2,050
revenues
Number of general
hospitals (at end of 48 48 48 48
period)
Licensed beds (at 13,305 13,309 13,309 13,309
end of period)
Average licensed 13,299 13,301 13,309 13,303
beds
Utilization of 55.7 % 51.6 % 50.4 % 52.5 %
licensed beds
Patient days 667,078 624,125 616,850 1,908,053
Adjusted patient 970,266 931,502 926,344 2,828,112
days
Net inpatient
revenue per patient $ 2,250 $ 2,286 $ 2,354 $ 2,296
day
Admissions 133,892 128,818 128,652 391,362
Adjusted patient 195,871 193,572 194,568 584,011
admissions
Net inpatient
revenue per $ 11,211 $ 11,078 $ 11,286 $ 11,192
admission
Average length of 5.0 4.9 4.8 4.9
stay (days)
Surgeries 89,076 91,575 91,734 272,385
Net outpatient $ 688 $ 704 $ 711 $ 701
revenue per visit
Outpatient visits 958,501 983,095 983,089 2,924,685
Sources of net
patient revenue
Medicare 27.0 % 24.0 % 24.4 % 25.2 %
Medicaid 8.0 % 8.4 % 8.5 % 8.3 %
Managed care 14.8 % 14.8 % 14.8 % 14.8 %
governmental
Managed care 40.6 % 41.8 % 41.2 % 41.2 %
commercial
Indemnity, self-pay 9.6 % 11.0 % 11.1 % 10.5 %
and other
TENET HEALTHCARE CORPORATION
SELECTED STATISTICS - CONTINUING TOTAL HOSPITALS
Fiscal 2009 by Calendar Quarter
(Unaudited)
(Dollars in millions Nine
except per patient
day, per admission Three Months Ended Months
and per visit
amounts) Ended
3/31/09 6/30/09 9/30/09 9/30/09
Net inpatient $ 1,514 $ 1,441 $ 1,466 $ 4,421
revenues
Net outpatient $ 668 $ 702 $ 709 $ 2,079
revenues
Number of general
hospitals (at end of 49 49 49 49
period)
Licensed beds (at 13,415 13,419 13,419 13,419
end of period)
Average licensed 13,409 13,411 13,419 13,413
beds
Utilization of 55.7 % 51.6 % 50.4 % 52.6 %
licensed beds
Patient days 672,636 629,714 622,427 1,924,777
Adjusted patient 978,841 940,472 935,375 2,854,688
days
Net inpatient
revenue per patient $ 2,251 $ 2,288 $ 2,355 $ 2,297
day
Admissions 135,335 130,308 130,258 395,901
Adjusted patient 198,097 195,962 197,164 591,223
admissions
Net inpatient
revenue per $ 11,187 $ 11,058 $ 11,255 $ 11,167
admission
Average length of 5.0 4.8 4.8 4.9
stay (days)
Surgeries 89,640 92,166 92,437 274,243
Net outpatient $ 688 $ 704 $ 712 $ 702
revenue per visit
Outpatient visits 970,319 996,468 995,968 2,962,755
Sources of net
patient revenue
Medicare 26.9 % 24.0 % 24.4 % 25.1 %
Medicaid 7.9 % 8.3 % 8.5 % 8.3 %
Managed care 14.8 % 14.9 % 14.8 % 14.8 %
governmental
Managed care 40.6 % 41.9 % 41.2 % 41.2 %
commercial
Indemnity, self-pay 9.8 % 10.9 % 11.1 % 10.6 %
and other
TENET HEALTHCARE CORPORATION
CONSOLIDATED OPERATIONS DATA
Fiscal 2008 by Calendar Quarter
(Unaudited)
(Dollars in
millions Three Months Ended Year Ended
except per
share amounts)
3/31/08 6/30/08 9/30/08 12/31/08 12/31/08
Net operating $ 2,156 $ 2,112 $ 2,140 $ 2,177 $ 8,585
revenues
Operating
expenses:
Salaries,
wages and (945 ) (934 ) (943 ) (957 ) (3,779 )
benefits
Supplies (374 ) (376 ) (376 ) (385 ) (1,511 )
Provision for
doubtful (145 ) (153 ) (164 ) (166 ) (628 )
accounts
Other
operating (476 ) (486 ) (497 ) (469 ) (1,928 )
expenses, net
Depreciation (81 ) (84 ) (84 ) (84 ) (333 )
Amortization (9 ) (9 ) (10 ) (10 ) (38 )
Impairment of
long-lived
assets and (1 ) (2 ) (1 ) (12 ) (16 )
goodwill, and
restructuring
charges
Litigation and
investigation
(costs) (47 ) (3 ) 5 4 (41 )
benefit, net
of insurance
recoveries
Operating 78 65 70 98 311
income
Interest (104 ) (102 ) (106 ) (106 ) (418 )
expense
Investment 5 4 12 1 22
earnings
Net gain
(loss) on -- -- 140 (1 ) 139
sales of
investments
Income (loss)
from
continuing (21 ) (33 ) 116 (8 ) 54
operations,
before income
taxes
Income tax
(expense) (1 ) 16 4 6 25
benefit
Income (loss)
from
continuing
operations, (22 ) (17 ) 120 (2 ) 79
before
discontinued
operations
Discontinued
operations:
Income (loss)
from 4 4 (33 ) 23 (2 )
operations
Impairment of
long-lived
assets and (10 ) (7 ) (21 ) (57 ) (95 )
goodwill, and
restructuring
charges
Net gains
(losses) on -- 8 (3 ) 1 6
sales of
facilities
Litigation
settlements,
net of -- -- 39 -- 39
insurance
recoveries
Income tax
(expense) (2 ) (3 ) 4 6 5
benefit
Income (loss)
from (8 ) 2 (14 ) (27 ) (47 )
discontinued
operations
Net income (30 ) (15 ) 106 (29 ) 32
(loss)
Less: Net
income
attributable 1 -- 2 4 7
to
noncontrolling
interests
Net income
(loss)
attributable
to Tenet $ (31 ) $ (15 ) $ 104 $ (33 ) $ 25
Healthcare
Corporation
common
shareholders
Diluted
earnings
(loss) per
share
attributable
to Tenet
Healthcare
Corporation
common
shareholders:
Continuing $ (0.05 ) $ (0.03 ) $ 0.25 $ (0.01 ) $ 0.15
operations
Discontinued (0.01 ) -- (0.03 ) (0.06 ) (0.10 )
operations
$ (0.06 ) $ (0.03 ) $ 0.22 $ (0.07 ) $ 0.05
Weighted
average shares
and dilutive
securities
outstanding
(in
thousands):
Basic 475,066 476,308 476,898 477,126 476,349
Diluted 475,066 476,308 480,789 477,126 478,606
TENET HEALTHCARE CORPORATION
SELECTED STATISTICS - CONTINUING SAME HOSPITALS
Fiscal 2008 by Calendar Quarter
(Unaudited)
(Dollars in
millions
except per
patient day,
per Three Months Ended Year Ended
admission
and per
visit
amounts)
3/31/08 6/30/08 9/30/08 12/31/08 12/31/08
Net
inpatient $ 1,464 $ 1,391 $ 1,399 $ 1,431 $ 5,685
revenues
Net
outpatient $ 620 $ 645 $ 649 $ 641 $ 2,555
revenues
Number of
general
hospitals 48 48 48 48 48
(at end of
period)
Licensed
beds (at end 13,273 13,270 13,256 13,287 13,287
of period)
Average
licensed 13,292 13,272 13,261 13,272 13,274
beds
Utilization
of licensed 57.0 % 53.1 % 51.3 % 51.7 % 53.2 %
beds
Patient days 688,852 640,812 625,702 630,821 2,586,187
Adjusted 971,476 927,945 916,104 918,560 3,734,085
patient days
Net
inpatient $ 2,125 $ 2,171 $ 2,236 $ 2,268 $ 2,198
revenue per
patient day
Admissions 135,513 129,340 128,525 129,235 522,613
Adjusted
patient 192,387 188,696 189,536 189,357 759,976
admissions
Net
inpatient $ 10,803 $ 10,755 $ 10,885 $ 11,073 $ 10,878
revenue per
admission
Average
length of 5.1 5.0 4.9 4.9 4.9
stay (days)
Surgeries 86,690 90,253 89,776 89,744 356,463
Net
outpatient $ 652 $ 686 $ 692 $ 694 $ 681
revenue per
visit
Outpatient 951,195 940,513 937,998 923,317 3,753,023
visits
Sources of
net patient
revenue
Medicare 26.3 % 25.1 % 25.1 % 25.6 % 25.5 %
Medicaid 8.4 % 8.4 % 8.6 % 8.2 % 8.4 %
Managed care 13.2 % 13.0 % 13.2 % 13.9 % 13.3 %
governmental
Managed care 40.2 % 41.9 % 41.5 % 41.9 % 41.4 %
commercial
Indemnity,
self-pay and 11.9 % 11.6 % 11.6 % 10.4 % 11.4 %
other
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