June 2, 2015 - Jefferies Revised.pdfCompany’s Annual Report on Form10-K filed with the SEC on...

26
June 2, 2015

Transcript of June 2, 2015 - Jefferies Revised.pdfCompany’s Annual Report on Form10-K filed with the SEC on...

Page 1: June 2, 2015 - Jefferies Revised.pdfCompany’s Annual Report on Form10-K filed with the SEC on February 27, 2015, as such factors may be updated from time to time in our periodic

June 2, 2015

Page 2: June 2, 2015 - Jefferies Revised.pdfCompany’s Annual Report on Form10-K filed with the SEC on February 27, 2015, as such factors may be updated from time to time in our periodic

Disclaimer

2

In addition to historical information, this presentation may contain “forward-looking statements” within the meaning of Section 27A of the Securities Act of 1933, as amended (the “Securities Act”), and Section 21E of the Securities Exchange Act of 1934, as amended (the “Exchange Act”), which are subject to the “safe harbor” created by those sections. All statements, other than statements of historical facts included in this presentation, including statements concerning our plans, objectives, goals, beliefs, business strategies, future events, business conditions, our results of operations, financial position and our business outlook, business trends and other information, may be forward-looking statements. Words such as “estimates,” “expects,” “contemplates,” “will,” “anticipates,” “projects,” “plans,” “intends,” “believes,” “forecasts,” “may,” “should” and variations of such words or similar expressions are intended to identify forward-looking statements. Such forward-looking statements are subject to various risks and uncertainties, including our ability to implement our growth strategy; our ability to maintain sufficient levels of cash flow to meet growth expectations; our ability to protect our brand; federal and state laws and regulations relating to our facilities, which could lead to the incurrence of significant penalties by us or require us to make significant changes to our operations; our ability to locate available facility sites on terms acceptable to us; competition from hospitals, clinics and other emergency care providers; our dependence on payments from third-party payors; our ability to source and procure new products and equipment to meet patient preferences; our reliance on Medical Properties Trust and the MPT Master Funding and Development Agreements; disruptions in the global financial markets leading to difficulty in borrowing sufficient amounts of capital to finance the carrying costs of inventory to pay for capital expenditures and operating costs; our ability or the ability of our healthcare system partners to negotiate favorable contracts or renew existing contracts with third-party payors on favorable terms; significant changes in our payor mix or case mix resulting from fluctuations in the types of cases treated at our facilities; significant changes in rules, regulations and systems governing Medicare and Medicaid reimbursements; material changes in IRS revenue rulings, case law or the interpretation of such rulings; shortages of, or quality control issues with, emergency care-related products, equipment and medical supplies that could result in a disruption of our operations; the intense competition we face for patients, physician use of our facilities, strategic relationships and commercial payor contracts; the fact that we are subject to significant malpractice and related legal claims; the growth of patient receivables or the deterioration in the ability to collect on those accounts; the impact on us of PPACA, which represents a significant change to the healthcare industry; and ensuring our continued compliance with HIPAA, which could require us to expend significant resources and capital; and the factors discussed in the section entitled “Risk Factors” in the Company’s Annual Report on Form10-K filed with the SEC on February 27, 2015, as such factors may be updated from time to time in our periodic filings with the SEC, which are accessible on the SEC’s website at www.sec.gov. These factors should not be construed as exhaustive and should be read in conjunction with the other cautionary statements that are included in this presentation and in our filings with the SEC. We undertake no obligation to publicly update or review any forward-looking statement, whether as a result of new information, future developments or otherwise, except as required by law. This presentation contains presentations of non-GAAP financial measures, including Adjusted EBITDA, which is defined as net income before interest, taxes, depreciation and amortization, further adjusted to eliminate the impact of certain additional items, including advisory services paid to a significant shareholder, facility preopening expenses, management recruiting expenses, stock compensation expense, costs associated with our public offerings and other non-recurring costs. For a reconciliation of Adjusted EBITDA to the most comparable GAAP measure, please refer to the Annex of this presentation and to our most recent report on Form 10-Q filed with the SEC in connection with our results for the period ended March 31, 2015 and report on Form 10-K filed with the SEC in connection with our results for the period ended December 31, 2014. See the “Investors” section at www.adhc.com.

Page 3: June 2, 2015 - Jefferies Revised.pdfCompany’s Annual Report on Form10-K filed with the SEC on February 27, 2015, as such factors may be updated from time to time in our periodic

Presenters

3

Thomas S. Hall Chairman & Chief Executive Officer

Timothy L. Fielding Chief Financial Officer

Page 4: June 2, 2015 - Jefferies Revised.pdfCompany’s Annual Report on Form10-K filed with the SEC on February 27, 2015, as such factors may be updated from time to time in our periodic

Mission

4

“We remain focused on our core mission: providing

access to the highest quality medical care to the

communities we serve. In doing so, we are helping to

transform the delivery of emergency care in America

and, importantly, we are saving lives every day.”

Facility Photo from Joel

Page 5: June 2, 2015 - Jefferies Revised.pdfCompany’s Annual Report on Form10-K filed with the SEC on February 27, 2015, as such factors may be updated from time to time in our periodic

Emergency Demand Greater Than Supply

5

Significant Supply and Demand Imbalance

Increase in ED visits

Source: American Hospital Association

ACEP National Report Card

Access to Emergency Care D- Overall D+

Source: American College of Emergency Physicians

Decrease in hospital EDs

Page 6: June 2, 2015 - Jefferies Revised.pdfCompany’s Annual Report on Form10-K filed with the SEC on February 27, 2015, as such factors may be updated from time to time in our periodic

ER Visits Rising in 2015

6

“A survey of 2,098 emergency-room doctors conducted in March showed about three-quarters said visits had risen since January 2014. That was a significant uptick from a year earlier, when less than half of doctors surveyed reported an increase.” “The ACEP survey also found that ERs are seeing sicker patients: About 90% of the doctors polled said the severity of illness has stayed the same or gotten worse. That might be explained in part by an aging population, newly insured people with multiple maladies, and people delaying care because they have high-deductible insurance plans.”

May 4, 2015

Page 7: June 2, 2015 - Jefferies Revised.pdfCompany’s Annual Report on Form10-K filed with the SEC on February 27, 2015, as such factors may be updated from time to time in our periodic

Leader in the FSED Market

7

• 24 / 7 access to emergency care

• Board-certified physicians

• Convenient and attractive locations

• Joint Commission accredited as a Healthcare System

• CLIA and COLA certified on-site laboratories

• Full radiology suite

• Short wait times

• Coordinated care

Page 8: June 2, 2015 - Jefferies Revised.pdfCompany’s Annual Report on Form10-K filed with the SEC on February 27, 2015, as such factors may be updated from time to time in our periodic

Innovative Facility Model

8

• “1-1-1-1” staffing model: Doctor, Nurse, Technologist and Front Office staff at all times

• Facility Medical Director for each facility

• Open 24 / 7

• Typically 6 to 9 exam rooms

• Includes 2 high-acuity and one “child friendly” pediatric room

• Joint Commission accredited as a Healthcare System

• CLIA / COLA certified labs: all tests performed in approximately 20 minutes

• Cardiac enzymes, CBC’s, chemistry, urine analysis and testing for flu, strep throat

• Full radiology suites including CT scanners, digital x-rays and ultrasound

AMBULANCE EXIT

PATIENT ENTRY

Page 9: June 2, 2015 - Jefferies Revised.pdfCompany’s Annual Report on Form10-K filed with the SEC on February 27, 2015, as such factors may be updated from time to time in our periodic

Unique Real Estate Capability

9

• 8 person team with over 150 years combined experience in multi-unit retail expansion

• Site-selection model that leverages proprietary data analytics

• Highly scalable business model

• Robust pipeline designed to support similar number of facilities in 2015

Letter of Intent & Purchase and Sale Agreement

in Place (1 - 4 Months) Due Diligence

(3 Months)

Construction Plans

(2 Months) Permits and Approvals

(2 - 4 Months) Build Facility

Shell (3 - 4 Months)

Build Interior (2 - 3 Months)

Pre-Open (1 Month);

Facility Opens

Approximately 14 – 21 months

Page 10: June 2, 2015 - Jefferies Revised.pdfCompany’s Annual Report on Form10-K filed with the SEC on February 27, 2015, as such factors may be updated from time to time in our periodic

Our Growth

10

January 1, 2014: 26 facilities • December 31, 2014: 55 facilities • Today: 66 facilities

Page 11: June 2, 2015 - Jefferies Revised.pdfCompany’s Annual Report on Form10-K filed with the SEC on February 27, 2015, as such factors may be updated from time to time in our periodic

Highly Rated

11

Top 1% Nationally #7 Best Company in Texas

Page 12: June 2, 2015 - Jefferies Revised.pdfCompany’s Annual Report on Form10-K filed with the SEC on February 27, 2015, as such factors may be updated from time to time in our periodic

Partnerships

12

Page 13: June 2, 2015 - Jefferies Revised.pdfCompany’s Annual Report on Form10-K filed with the SEC on February 27, 2015, as such factors may be updated from time to time in our periodic

Multiple Growth Drivers

13

1

2

3

• Grow our Presence in Existing Markets

• Build Strategic Alliances with Leading Health Systems

• Pursue a Disciplined Development Strategy in New States and

Markets

Page 14: June 2, 2015 - Jefferies Revised.pdfCompany’s Annual Report on Form10-K filed with the SEC on February 27, 2015, as such factors may be updated from time to time in our periodic

Experienced Management Team

14

Thomas S. Hall Chairman and CEO

Graham B. Cherrington President and Chief Operating Officer

Andrew M. Jordan Chief Marketing Officer

Timothy L. Fielding Chief Financial Officer

Page 15: June 2, 2015 - Jefferies Revised.pdfCompany’s Annual Report on Form10-K filed with the SEC on February 27, 2015, as such factors may be updated from time to time in our periodic

Hear From Our Patients

15

In our patients’ own words…

Page 16: June 2, 2015 - Jefferies Revised.pdfCompany’s Annual Report on Form10-K filed with the SEC on February 27, 2015, as such factors may be updated from time to time in our periodic

Hear From Our Patients

16

Page 17: June 2, 2015 - Jefferies Revised.pdfCompany’s Annual Report on Form10-K filed with the SEC on February 27, 2015, as such factors may be updated from time to time in our periodic

Hear From Our Patients

17

Page 18: June 2, 2015 - Jefferies Revised.pdfCompany’s Annual Report on Form10-K filed with the SEC on February 27, 2015, as such factors may be updated from time to time in our periodic

Hear From Our Patients

18

Page 19: June 2, 2015 - Jefferies Revised.pdfCompany’s Annual Report on Form10-K filed with the SEC on February 27, 2015, as such factors may be updated from time to time in our periodic

19

Financial Overview

Page 20: June 2, 2015 - Jefferies Revised.pdfCompany’s Annual Report on Form10-K filed with the SEC on February 27, 2015, as such factors may be updated from time to time in our periodic

Strong Track Record of Growth

20

Net Patient Service Revenue Quarterly Net Patient Service Revenue

(in $ millions)

# of Facilities 14 26 55

+42% YOY

# of Facilities 32 38 51 55 621

(in $ millions)

+109% Q1’14 – Q1’15 YOY

+105% YOY

$72.6

$102.9

$210.7

2012A 2013A 2014A

(1) 65 free standing facilities and 1 hospital as of 01-May-2015.

$ 38.8 $ 44.2

$ 57.6

$ 70.1

$ 80.9

Q1-14 Q2-14 Q3-14 Q4-14 Q1-15

Page 21: June 2, 2015 - Jefferies Revised.pdfCompany’s Annual Report on Form10-K filed with the SEC on February 27, 2015, as such factors may be updated from time to time in our periodic

Strong Track Record of Growth (continued)

21

Annual Adjusted EBITDA Quarterly Adjusted EBITDA

(in $ millions) (in $ millions)

$16.0

$28.2

2012 2013 2014A 2013A

+76% YOY +160% Q1’14 – Q1’15 YOY

$ 5.1 $ 5.9

$ 7.0

$ 10.2

$ 13.3

Q1-14 Q2-14 Q3-14 Q4-14 Q1-15

Page 22: June 2, 2015 - Jefferies Revised.pdfCompany’s Annual Report on Form10-K filed with the SEC on February 27, 2015, as such factors may be updated from time to time in our periodic

Attractive Payor Mix and In-Network Rates

22

• 98% of 2014 net patient service revenue was derived from third-party payors (including patient portion)

• Contracts in place with commercial insurance providers with in-network rates

• Charity care includes Medicare / Medicaid

• 100% of charity care charges written off

• Bad debt write-offs represent 15.6% of patient services revenue

BCBS 28%

United Healthcare

24%

Aetna 19%

Cigna 14%

Other 13%

Self-pay 2%

(in $ millions) Q1 2015 % of

revenue

Patient service revenue $96 -

Provision for bad debts (15) 15.6%

Net patient service revenue $81 84.4%

Patient Service Revenue Breakdown

Payor Mix (FY 2014)

Page 23: June 2, 2015 - Jefferies Revised.pdfCompany’s Annual Report on Form10-K filed with the SEC on February 27, 2015, as such factors may be updated from time to time in our periodic

Access to a Variety of Capital Sources to Support Facility Expansion

23

• Credit Facility: $250 million – $10 million Revolver (Working

Capital) – $75 million Term Loan (Facility

Development) – $165 million Delayed Draw Term

Loan

• Maturity: October 2018

• Total Facility Size: $500 million

• Lease Terms: Initial term of 15 years with 3 additional periods of 5 years each

– Treated as operating lease for accounting purposes

• Approved Projects: – Expect 20 new facilities in 2015

to be funded by agreement

Page 24: June 2, 2015 - Jefferies Revised.pdfCompany’s Annual Report on Form10-K filed with the SEC on February 27, 2015, as such factors may be updated from time to time in our periodic

Balance Sheet

24

(in $ millions) March 31, 2015

December 31, 2014

Cash $13.9 $2.0

Total Assets 302.3 282.8

Total Debt¹ 130.2 106.8

Shareholders’/Owners’ Equity 102.0 99.9

(1) Long-term debt, less current maturities and current maturities of long-term debt.

Page 25: June 2, 2015 - Jefferies Revised.pdfCompany’s Annual Report on Form10-K filed with the SEC on February 27, 2015, as such factors may be updated from time to time in our periodic

Appendix

Page 26: June 2, 2015 - Jefferies Revised.pdfCompany’s Annual Report on Form10-K filed with the SEC on February 27, 2015, as such factors may be updated from time to time in our periodic

Supplemental non GAAP Disclosures

(a) Consists of interest expense and fees of $11.9 million, $2.8 million, $1.1 million, $3.3 million and $2.2 million for the years ended December 31, 2014, 2013 and 2012 and the three months ended March 31, 2015 and 2014, respectively, a gain in fair market value of derivatives of $0.1 million for the year ended December 31, 2013, a loss in fair market value of derivatives of $0.5 million for the year ended December 31, 2012, and a write-off of deferred loan costs of $0.4 million for the year ended December 31, 2013. (b) Consists of management fees and expenses paid to a significant shareholder under our Advisory Services Agreement. The Advisory Services Agreement was terminated in connection with the consummation of our initial public offering in June 2014. (c) Includes labor, marketing costs and occupancy costs prior to opening a facility and the equity in loss of our unconsolidated joint venture in 2014. (d) Third-party costs and fees involved in recruiting our management team. (e) Stock compensation expense associated with grants of management incentive units. (f) Consists of costs incurred in conjunction with our initial public offering, including $2.4 million in bonuses for certain members of management, $2.3 million in costs related to the termination of our Advisory Services Agreement and $0.5 million of other offering costs. (g) For the year ended December 31, 2014, we incurred costs to develop long-term strategic goals and objectives totaling $1.7 million, real-estate development costs associated with potential real estate projects that were terminated totaling $0.6 million and board fees and travel expenses paid to members of the board of directors totaling $0.1 million. For the year ended December 31, 2013, we incurred costs to develop long-term strategic goals and objectives totaling approximately $0.5 million, real-estate development costs associated with potential real estate projects that were terminated totaling $0.4 million, board fees and travel expenses paid to members of the board of directors totaling $0.2 million and $0.25 million of termination costs paid to the former CEO. For the year ended December 31, 2012, we incurred terminated real-estate development costs totaling. $0.5 million, legal costs primarily associated with real estate development and litigation for violation of our trademark totaling $0.8 million and board fees and travel expenses paid to members of the board of directors totaling approximately $0.2 million. For the three months ended March 31, 2015, we incurred terminated real-estate development costs totaling $32,000 and costs to develop long-term strategic goals and objectives totaling $0.5 million. For the three months ended March 31, 2014, we incurred terminated real-estate development costs totaling $0.2 million, costs to develop long-term strategic goals and objectives totaling approximately $0.3 million and board fees and travel expenses paid to members of the board of directors totaling approximately $60,000.

Year Ended December 31, 3 Months Ended March 31,(in thousands) 2014 2013 2012 2015 2014Net income (loss) $(17,272) $(2,984) $ 3,201 $ 1,602 $(2,767)

Depreciation and amortization 15,037 7,920 4,640 4,756 3,057

Interest expense / other expenses (a) 11,966 3,155 1,589 3,274 2,206

(Benefit) Provision for income taxes (1,326) 720 467 478 220

Advisory Services Agreement fees and expenses (b) 293 559 553 - 138

Preopening expenses (c) 10,550 3,977 497 2,099 1,408

Management recruiting expenses (d) 376 719 970 - 99

Stock compensation expenses (e) 1,015 586 253 549 159

Initial Public Offering Costs (f) 5,157 - - - -

Other (g) 2,404 1,358 1,519 505 572

Total Adjustments $ 45,472 $ 18,994 $ 10,488 $ 11,661 $ 7,859

Adjusted EBITDA $ 28,200 $ 16,010 $ 13,689 $ 13,263 $ 5,092