e10vk
UNITED
STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
FORM 10-K
(Mark One)
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ANNUAL REPORT PURSUANT TO SECTION 13 OR 15(d) OF THE SECURITES EXCHANGE ACT OF 1934 |
For the Fiscal Year Ended December 31, 2006
OR
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TRANSITION REPORT PURSUANT TO SECTION 13 OR 15(d) OF THE SECURITIES EXCHANGE ACT OF 1934 |
Commission File Number 1-14316
APRIA HEALTHCARE GROUP INC.
(Exact Name of Registrant as Specified in its Charter)
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Delaware
(State of Incorporation)
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33-0488566
(I.R.S. Employer Identification Number) |
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26220 Enterprise Court, Lake Forest, CA
(Address of Principal Executive Offices)
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92630-8405
(Zip Code) |
Registrants telephone number: (949) 639-2000
Securities registered pursuant to Section 12(b) of the Act:
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Common Stock, $0.001 par value per share
(Title of each class)
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New York Stock Exchange
(Name of each exchange on which registered) |
Securities registered pursuant to Section 12(g) of the Act: None
Indicate by check mark if the registrant is a well-known seasoned issuer, as defined in Rule 405
of the Securities Act.
Yes þ No o
Indicate by check mark if the registrant is not required to file reports pursuant to Section 13
or Section 15(d) of the Act.
Yes o No þ
Indicate by check mark whether the registrant (1) has filed all reports required to be filed by
Section 13 or 15(d) of the Securities Exchange Act of 1934 during the preceding 12 months (or
for such shorter period that the registrant was required to file such reports), and (2) has been
subject to such filing requirements for the past 90 days. Yes þ No o
Indicate by check mark if disclosure of delinquent filers pursuant to Item 405 of Regulation S-K
is not contained herein, and will not be contained, to the best of registrants knowledge, in
definitive proxy or information statements incorporated by reference in Part III of this Form
10-K or any amendment to this Form 10-K. þ
Indicate by check mark whether the registrant is a large accelerated filer, an accelerated
filer, or a non-accelerated filer. See definition of accelerated filer and large accelerated
filer in Rule 12b-2 of the Exchange Act:
Large accelerated filer
þ
Accelerated filer o Non-accelerated filer o
Indicate by check mark whether the registrant is a shell company (as defined in Rule 12b-2 of
the Act). Yes o No þ
As of June 30, 2006 the aggregate market value of the shares of common stock held by
non-affiliates of the Registrant, computed based on the closing sale price of $18.90 per share
as reported by the New York Stock Exchange, was approximately $589,444,298 As of February 23,
2007, there were 60,321,963 shares of the Registrants
common stock issued and 43,322,891 shares
outstanding, par value $0.001, which is the only class of common stock of the Registrant.
Documents Incorporated by Reference:
The information called for by Part III is incorporated by reference to the Definitive Proxy
Statement for the 2006 Annual Meeting of Stockholders of the Registrant which will be filed with
the Securities and Exchange Commission not later than 120 days after December 31, 2006.
APRIA HEALTHCARE GROUP INC.
TABLE OF CONTENTS
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All information required to be disclosed in Part III is incorporated by
reference from Part I and the companys definitive Proxy Statement to be filed
with the Commission within 120 days after the end of the companys fiscal year. |
Forward Looking Statements
This report contains forward-looking statements that are not based on historical facts. All
such forward-looking statements are uncertain. Apria has based those forward-looking statements
on, among other things, projections and estimates regarding the economy in general, the healthcare
industry and other factors that impact Aprias results of operations. These statements involve
known and unknown risks, uncertainties and other factors that may cause Aprias actual results,
levels of activity, performance or achievements to be materially different from any results, levels
of activity, performance or achievements expressed or implied by any forward-looking statements.
In some cases, forward-looking statements that involve risks and uncertainties contain terminology
such as may, will, should, could, expects, intends, plans, anticipates, believes,
estimates, predicts, potential, or continue or variations of these terms or other
comparable terminology. See Certain of these risks, uncertainties and other factors are discussed
in Item 1A Risk Factors.
PART I
Item 1. BUSINESS
Apria Healthcare Group Inc., or the company, provides a broad range of home healthcare
services through approximately 475 branch locations that serve patients in all 50 states. Apria
has three major service lines: home respiratory therapy, home infusion therapy and home medical
equipment. The following table provides examples of the services and products in each:
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Service Line |
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Examples of Services and Products |
Home respiratory therapy
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Provision of oxygen systems, stationary and
portable ventilators, obstructive sleep apnea
equipment, nebulizers, respiratory medications
and related clinical/administrative support
services |
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Home infusion therapy
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Intravenous administration of anti-infectives,
pain management, chemotherapy, nutrients (also
administered through a feeding tube), immune
globulin, other medications and related
clinical/administrative support services |
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Home medical equipment
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Provision of patient safety items, ambulatory
aids and in-home equipment, such as wheelchairs
and hospital beds |
Strategy
Aprias strategy is to position itself in the marketplace as the low cost, quality provider of
a broad range of home healthcare services to managed care and Medicare customers. The specific
elements of its strategy are to :
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achieve strong organic sales growth and increase market share; |
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leverage its nationwide infrastructure to reduce costs and expand profits; |
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deliver superior customer service; and |
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attract, develop and advance leaders within the company. |
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Service Lines
In each of its three service lines, Apria provides patients with a variety of clinical and
administrative support services, as well as related products and supplies, most of which are
prescribed by a licensed physician as part of a care plan. These services include:
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providing in-home clinical respiratory care, infusion and respiratory pharmacy
management and high-tech infusion nursing; |
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educating patients and their caregivers about illnesses and providing them with
written instructions about home safety, self-care and the proper use of their
equipment; |
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monitoring patients individualized treatment plans; |
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reporting patient progress and status to the physician and/or managed care organization; |
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providing in-home delivery and set-up of equipment and/or supplies; |
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maintaining and repairing equipment; and |
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processing claims to third-party payors, billing and collecting patient co-pays and deductibles. |
The following table sets forth a summary of net revenues by service line, expressed as
percentages of total net revenues:
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Year Ended December 31, |
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2006 |
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2005 |
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2004 |
Home respiratory therapy |
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68 |
% |
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69 |
% |
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68 |
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Home infusion therapy |
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18 |
% |
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17 |
% |
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17 |
% |
Home medical equipment/other |
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14 |
% |
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14 |
% |
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15 |
% |
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Total net revenues |
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100 |
% |
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100 |
% |
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100 |
% |
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Home Respiratory Therapy. Apria provides home respiratory therapy services to patients with a
variety of conditions, including:
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chronic obstructive pulmonary diseases such as emphysema, chronic bronchitis and asthma; |
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nervous system-related respiratory conditions such as Lou Gehrigs disease and quadriplegia; |
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obstructive sleep apnea; |
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congestive heart failure; and |
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lung cancer. |
Apria employs a nationwide clinical staff of respiratory care professionals to provide direct
patient care, monitoring and other support services to its home respiratory therapy patients under
physician-directed treatment plans and in accordance with Aprias proprietary acuity program.
Apria derives its respiratory therapy revenues from the provision of oxygen systems,
ventilators, noninvasive positive pressure ventilators, continuous positive and bi-level airway
pressure devices, as well as from the provision of sleep apnea monitors, nebulizers and
home-delivered respiratory medications, and related services.
Home Infusion Therapy. Home infusion therapy involves the administration of drugs or
nutrients directly into the body intravenously through injection or catheterization. Examples of
such therapies include:
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total parenteral (intravenous) nutrition; |
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anti-infective and anti-fungal medications; |
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chemotherapy; and |
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pain management. |
The home infusion therapy service line also includes enteral nutrition, which is the administration
of nutrients directly into the gastrointestinal tract through a feeding tube.
Depending on the therapy, a broad range of venous access devices and pump technologies may be
used to facilitate homecare and patient independence. Apria employs licensed pharmacists and
registered high-tech infusion nurses who specialize in the delivery of home infusion therapy. They
are available to respond to emergencies and questions regarding therapy 24 hours a day, seven days
a week and to provide initial and ongoing training and education to the patient and caregiver.
Other support services include supply replenishment, pump management, preventive maintenance,
assistance with insurance questions and outcome reporting. Apria currently operates 31 pharmacy
locations nationwide to serve its home infusion patients.
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Home Medical Equipment/Other. Aprias primary emphasis in the home medical equipment service
line is on the provision of equipment to assist patients with ambulation, safety and general care
in and around the home. The company also offers rehabilitation products such as customized seating
and mobility equipment. Aprias integrated service approach allows patients, hospital and
physician referral sources and managed care systems accessing either respiratory or infusion
therapy services to also access needed home medical equipment through a single source.
As Aprias managed care customer base has grown, management has recognized the need to expand
its ability to provide value-added services to these customers. Rather than provide certain
non-core services directly, Apria sometimes aligns itself with other segment leaders, such as home
health nursing organizations, providers of home-delivered routine medical supplies or large
drug/supply wholesalers, through formal relationships or ancillary networks.
Organization and Operations
Organization. Aprias approximately 475 branch locations deliver home healthcare products
and services to patients in their homes and to other care sites through the companys delivery
fleet and its qualified delivery professionals and clinical employees. The branches are organized
into three geographic divisions that provide management oversight. The companys sales and business
operations functions are vertically integrated. The operations function is further divided into
receivables management, clinical services, logistics and regulatory compliance. Through this
structure, all functions that are performed at the division level have direct reporting and
accountability to corporate headquarters. Apria believes this structure provides control over and
consistency among its field locations. In accordance with Aprias strategy to identify
opportunities for efficiencies and productivity improvements, management continues to centralize
certain functions that are currently performed at the division or branch level.
Corporate Compliance. As a leader in the home healthcare industry, Apria has implemented a
compliance program to further the companys commitment to providing quality home healthcare
services and products while maintaining high standards of ethical and legal conduct. Apria
believes that it is essential to operate its business with integrity and in full compliance with
applicable regulations. Aprias Corporate Compliance Program includes a written Code of Ethical
Business Conduct that employees receive as part of their initial orientation process. The program
is designed to accomplish the goals described above through employee education, a confidential
disclosure program, written policy guidelines, periodic reviews, frequent reinforcement, compliance
audits, a formal disciplinary component and other programs. Compliance oversight is provided by
the Compliance Committee of the companys Board of Directors, which meets quarterly in conjunction
with Aprias internal Corporate Compliance Committee, consisting of senior and mid-level management
personnel from various functional disciplines.
Internal Audit. Apria has an internal audit department which reports directly to the Audit
Committee of the Board of Directors and which provides ongoing assessments of Aprias system of
disclosure controls and procedures, and internal control over financial reporting. The internal
audit department is responsible for both operational and financial reviews of the companys
operations, for monitoring compliance with policies and procedures, for the identification and
development of best practices within the organization and for confirming compliance with the
requirements of the Sarbanes-Oxley Act of 2002.
Operating Systems and Controls. Aprias business is dependent, to a substantial degree, upon
the quality of its operating and field information policies and procedures for proper contract
administration, accurate order entry and pricing, billing and collections, and inventory and
patient service equipment management. These policies and procedures also provide reporting that
enables management to monitor and evaluate contract profitability. Aprias information services
department works closely with all of the corporate departments to ensure that its policies and
procedures are compliant with government regulations and payor requirements and to support their
business improvement initiatives with technological solutions. See Item 1A Risk Factors
Operating Systems and Controls.
Apria has established performance indicators which measure operating results against expected
thresholds for the purpose of allowing all levels of management to identify and modify areas
requiring improvement and to monitor the resulting progress. Apria has also developed mechanisms
for measuring and reporting patient and customer satisfaction. Operating models with strategic
targets have been developed to move Apria toward more effective management of the sales, customer
service, accounts receivable, clinical and distribution areas of its business. Aprias management
team is compensated using performance-based incentives focused on criteria such as revenue growth
and improvement in operating income.
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Payors. Apria derives substantially all its revenues from third-party payors, including
private insurers, managed care organizations, Medicare and Medicaid. For 2006, approximately 30%
of Aprias net revenues were derived from Medicare and 6% from Medicaid. Generally, each
third-party payor has specific requirements which must be met before claim submission will result
in payment. Apria has policies and procedures in place to manage the claims submission process,
including verification procedures to facilitate complete and accurate documentation. See Item 1A
Risk Factors Medicare/Medicaid Reimbursement Rates.
Receivables Management. Apria operates in an environment with complex requirements governing
billing and reimbursement for its products and services. Initiatives focused specifically on
receivables management such as system enhancements, process refinements and organizational changes
have resulted in improvement and consistency in key accounts receivable indicators.
Apria is expanding its use of technology in areas such as electronic claims submission and
electronic funds transfer with managed care organizations to more efficiently process business
transactions. This use of technology can expedite claims processing and reduce the administrative
cost associated with this activity for both Apria and its customers/payors. Apria now submits
approximately 83% of its claims electronically. Management is also focusing its resources on
developing internal expertise with the unique reimbursement requirements of certain large
third-party payors, which should help reduce subsequent denials and shorten related collection
periods. Aprias policy is to collect co-payments from the patient or applicable secondary payor.
In the absence of a secondary payor, Apria generally requires the co-payment at the time the
patient is initially established with the product/service. Subsequent months rental fees are
billed to the patient. Management is also seeking to streamline related processes in order to
maximize the co-payment collection rate.
Marketing
Through its field sales force, Apria markets its services primarily to physicians, managed
care organizations, hospitals, medical groups, home health agencies and case managers. Apria has
developed and put into practice several marketing initiatives, including but not limited to:
Automated Call Routing Through a Single Toll-Free Number. This initiative allows select
managed care organizations to reach any of Aprias locations and to access the full range of Apria
services through a single central telephone number: 1-800-APRIA-88.
Accreditation by the Joint Commission on Accreditation of Healthcare Organizations or JCAHO.
JCAHO is a nationally recognized organization that develops standards for various healthcare
industry segments and monitors compliance with those standards through voluntary surveys of
participating providers. As the home healthcare industry has grown, the need for objective quality
measurements has increased. Accreditation by JCAHO entails a lengthy voluntary review process that
is conducted every three years. Accreditation is widely considered a prerequisite for entering
into contracts with managed care organizations at every level and is required for Medicare
competitive bidding. Because accreditation is expensive and time consuming, not all providers
choose to undergo the process. All of Aprias branch locations are accredited by or in the process
of receiving accreditation from JCAHO.
Essential Care Model. Apria has developed the Essential Care Model, a proprietary model that
defines the services, supplies and products delivered in conjunction with prescribed homecare
equipment and therapies. The Essential Care Model is used to establish consistent and clear
expectations for referral sources, payors and patients.
Patient Satisfaction and Complaint Resolution Process. Apria has a centralized patient
satisfaction survey function that periodically conducts targeted member satisfaction studies for
key managed care organizations as specified by the various contractual arrangements. The same
centralized group manages a complaint resolution process through which service improvements are
identified and implemented at the field level. The company believes that both centralized
processes afford it visibility to centralized performance improvement data and trends that enable
it to amend policies and procedures as necessary to meet the needs of patients and referral
sources.
Apria Great Escapes® Travel Program. Aprias 475-branch network facilitates
travel for patients who require oxygen, home infusion or other products, services and therapies.
Apria coordinates equipment and service needs for thousands of traveling patients annually, which
enhances their mobility and quality of life.
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Sales
Apria employs approximately 640 sales professionals whose primary responsibility is to
generate new referrals and to maintain existing relationships for all of the companys service
lines. Key customers include physicians and their staffs, hospital-based healthcare professionals
and managed care organizations, among others. Apria provides its sales professionals with the
necessary clinical and technical training to represent Aprias major service offerings of home
respiratory therapy, home infusion therapy and home medical equipment. As larger segments of the
marketplace become involved with managed care, specially trained members of Aprias sales force
provide the company with a competitive advantage based on their working knowledge of pricing,
contracting and negotiating, and specialty-care management programs.
An integral component of Aprias overall sales strategy is to increase volume through managed
care referral sources and traditional physician referral channels. Specific growth initiatives
designed to increase customer awareness of Aprias clinical and operational programs are in place
with the goal of securing a greater share of the traditional market. The ultimate decision makers
for healthcare services vary greatly, from closed model managed care organizations to preferred
provider networks, which are controlled by more traditional means. Aprias selling structure and
strategies are designed to adapt to changing market factors and will continue to adjust as further
changes in the industry occur. Managed care organizations continue to represent a significant
portion of Aprias business in several of its primary metropolitan markets. No single account,
however, represented more than 9% of Aprias total net revenues for 2006. Among its more
significant managed care agreements during 2006 were Aetna Health Management, CIGNA Health
Corporation, Kaiser Foundation Health Plan and United HealthCare Services. Apria also offers
discount agreements and various fee-for-service arrangements to hospitals or hospital systems whose
patients have home healthcare needs. See Risk Factors Pricing Pressures and Managements
Discussion and Analysis of Financial Condition and Results of Operations.
Competition
The segment of the healthcare market in which Apria operates is highly competitive. In each
of its service lines there are a limited number of national providers and numerous regional and
local providers. The competitive factors most important in the regional and local markets are:
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reputation with referral sources, including local physicians and hospital-based professionals; |
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accessibility and responsiveness; |
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price of services; |
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overall ease of doing business; |
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quality of patient care and associated services; and |
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range of home healthcare services and products. |
In addition to the foregoing, the most important competitive factors in the larger, national markets are:
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ability to service a wide geographic area; |
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ability to develop and maintain contractual relationships with managed care organizations; |
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access to capital; |
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information systems capabilities; and |
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accreditation by the JCAHO or a similar accrediting body. |
Apria believes that it competes effectively in each of its service lines with respect to all
of the above factors and that it has an established record as a quality provider of home
respiratory therapy, home medical equipment and home infusion therapy, as reflected by JCAHO
accreditation of Aprias branches.
In each of Aprias service lines there are a number of national providers and numerous
regional and local providers. Among the national providers with which Apria directly competes are,
American HomePatient, Coram Healthcare, Critical Care Systems, Lincare Holdings, Option Care and
Rotech Healthcare. Other types of healthcare providers, including industrial gas manufacturers,
individual hospitals and hospital systems, home health agencies and health maintenance
organizations have entered, and may continue to enter, the market to compete with Aprias various
service lines. Depending on their business strategies and financial position, it is possible that
Aprias competitors may have access to significantly greater financial and marketing resources than
Apria. This may increase pricing pressure and limit Aprias ability to maintain or increase its
market share. See Risk Factors Pricing Pressures.
5
Government Regulation
Apria is subject to extensive government regulation, including numerous laws directed at
preventing fraud and abuse and regulating reimbursement under various government programs, as more
fully described below. Apria maintains several programs designed to minimize the likelihood that
it would engage in conduct or enter into contracts in violation of the fraud and abuse laws.
Corporate contract services and/or legal department personnel review and approve contracts subject
to these laws. Apria also maintains various educational and audit programs designed to keep its
managers updated and informed on developments with respect to the fraud and abuse laws and to
reinforce to all employees the companys policy of strict compliance in this area. Apria believes
its discount agreements, billing contracts and various fee-for-service arrangements with other
healthcare providers comply with applicable laws and regulations. See Item 1A Risk Factors
Government Regulation; Healthcare Reform.
Medicare and Medicaid Reimbursement. In 2006, approximately 36% of Aprias revenues were
reimbursed under arrangements with Medicare and Medicaid. No other third-party payor represents
more than 9% of the companys revenues. The majority of the companys revenues are derived from
fees charged for patient care under fee-for-service arrangements. Revenues derived from capitation
arrangements represented 11% of total net revenues for 2006 and less than 10% of total net revenues
in 2005 and 2004.
Medicare Reimbursement. There are a number of legislative and regulatory activities by
the Centers for Medicare and Medicaid Services, or CMS, that affect or may affect Medicare
reimbursement policies for products and services provided by Apria. Certain material provisions are
outlined below in chronological order.
The Balanced Budget Act of 1997 granted streamlined authority to the U.S. Department of Health
and Human Services, or HHS, to increase or reduce the reimbursement for home medical equipment,
including oxygen, by up to 15% each year under an inherent reasonableness authority. CMS issued a
rule that established a process by which such adjustments may be made. The rule applies to all
Medicare Part B services except those paid under a physician fee schedule, a prospective payment
system, or a competitive bidding program. HHS has not issued any recent communication or
information on inherent reasonableness for several years and therefore management cannot predict
whether or when HHS would access its authority in this area or predict any negative impact of any
such change.
In September 2003, the HHS Office of Inspector General, or OIG, issued a proposed rule
intended to clarify certain terms and the application of program authority to exclude claims
containing excessive charges. Under the rule, absent good cause, a provider could be excluded if
its charges to Medicare or Medicaid were substantially in excess of the providers usual charges.
The proposed clarification defined substantially in excess as charges that are 120% or more of
the providers usual charges. The company, along with many other providers and members of the
public, submitted formal comments to the OIG regarding the proposed rule in the fall of 2003. Based
upon statements of federal legislators issued in early 2006, it is the companys understanding that
the OIG is continuing to work on a final rule. Because the company is unaware of what changes the
OIG may make to the proposed rule before it is finalized or when a final rule will be issued, Apria
cannot at this time quantify any negative impact that this rule may have on the company, if and
when it is issued.
In December 2003, the Medicare Prescription Drug, Improvement and Modernization Act of 2003,
also referred to as the Medicare Modernization Act, or MMA, became law. The provisions contained
therein that are significant to Apria are as follows:
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A freeze on annual payment increases for durable medical equipment The freeze
commenced in 2004 and will continue through 2008. |
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Reimbursement reductions for five durable medical equipment categories
Reimbursement for most of these categories is now based on the median price paid for
such items on behalf of beneficiaries of federal employee health benefit plans, or
FEHBP. The new fee schedules for most products went into effect January 1, 2005. The
revised pricing for oxygen and oxygen equipment was implemented on April 8, 2005.
Subsequent legislation has further modified some of these reimbursement methodologies. |
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Reimbursement reductions for inhalation drugs The previous reimbursement rate of
95% of the average wholesale price was reduced to 80% of the average wholesale price,
effective January 1, 2004. Beginning in January 2005, reimbursement for these drugs was
further reduced through a shift to the manufacturer-reported average sales price, or
ASP (subject to adjustment each quarter), plus 6%, plus a separate dispensing fee per
patient episode. Medicare publishes the ASP plus 6% payment levels several weeks
before the first day of each quarter, and the company has no way of knowing if the
quarterly ASPs for |
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inhalation drugs will increase or decrease since manufacturers report
applicable sales price information directly to CMS. Since 2006, dispensing fees have
been $57.00 for a 30-day supply for a new patient, $33.00 for each 30-day supply
thereafter, and $66.00 for each 90-day supply. |
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Establishment of a competitive bidding program for Medicare Part B Such a program
would require that suppliers wishing to provide certain durable medical equipment to
beneficiaries submit bids to Medicare. Although the specific durable medical equipment
items and services subject to this rule and the exact timeline for implementation
remain unspecified, the MMA states that the program is to be phased in as follows: (i)
10 of the largest metropolitan statistical areas, or MSAs, in 2007; (ii) 80 of the
largest MSAs in 2009; and (iii) additional areas after 2009. The legislation contains
special provisions exempting rural areas. |
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On April 24, 2006, CMS issued a proposed rule for the competitive bidding program. The
proposal outlined CMS general intent and proposed procedures and requirements for a
program beginning some time in 2007. However, CMS did not specify: (i) which DMEPOS
products will be included in the 10 initial competitive acquisition program areas; (ii)
which MSAs will be included in the initial phase of competitive bidding, although it
does explicitly exclude New York City, Chicago and Los Angeles from the first phase;
(iii) target cost savings; (iv) specific quality standards; or (v) specific provider
guidelines for preparing, completing and implementing the bids in each area. The
proposed rule also introduced certain concepts not previously addressed. CMS accepted
comments on all aspects of the proposed rule as of June 30, 2006, and Apria submitted
extensive comments. |
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On August 1, 2006, CMS issued a final rule limited to only selective aspects of the
competitive bidding program. The August 1 final rule finalized CMS plan to work with
Competitive Bidding Implementation Contractors, or CBICs, to administer the competitive
bidding program in conjunction with CMS and the DME Medicare Administrator Contractors,
or DME MACs. It also clarified CMS plan to administer certain aspects of the process
for accrediting providers in order for them to qualify to participate in competitive
bidding. CMS also issued final quality standards for competitive bidding participants on
August 14, 2006. Apria already complies with the final quality standards and has been
accredited by the Joint Commission on Accreditation of Healthcare Organizations, or
JCAHO, for almost two decades. |
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Throughout the fourth quarter of 2006 and the early portion of 2007, CMS informed the
supplier community that the final rule outlining the additional components of
competitive bidding would be released in the near future. To date, a final rule has not
been published. Given the limited information available regarding CMS final plan for
the competitive bidding program, such as the list of products and services and the MSAs
to be included, Apria cannot estimate at this time the impact of the competitive bidding
program on the companys operations or financial condition. |
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Incentives for expansion of Medicare Part C ¾ The Medicare Modernization Act
includes financial incentives for managed care plans to expand their provision of
Medicare Advantage plans in 2006 in an effort to attract more Medicare beneficiaries to
managed care models. The company maintains contracts to provide respiratory therapy,
infusion and medical equipment and related services to a significant number of managed
care plans nationwide, and believes that the Medicare Advantage expansion represents a
growth opportunity. |
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Reimbursement for home infusion therapy under Medicare Part D ¾ Currently, a
limited number of infusion therapies, supplies and equipment are covered by Medicare
Part B. The Medicare Modernization Act provides expanded coverage for the drugs only,
but excludes coverage for the supplies and clinical services needed to safely and
effectively provide home infusion therapy services to patients in the home. The company
has contracted with a limited number of Medicare Part D prescription drug plans in
order to provide continuity of care for certain patients. Due to nationwide Part D
implementation issues experienced by home infusion providers, the industry is
continuing to work with CMS and Congress to rectify the coverage and payment
limitations that are causing implementation challenges for providers, patients and
referral sources. In addition, a bill was introduced in Congress in the summer of 2006
to consolidate home infusion therapy coverage under Part B. The bill, which garnered 40
sponsors in 2006, is expected to be reintroduced in the new Congress and would provide
for infusion benefit coverage in a more comprehensive manner that is analogous to how
the therapy is covered by the managed care sector. |
The Deficit Reduction Act of 2005, or DRA, was signed by the President in February 2006. A
number of lawsuits were subsequently filed to prevent its implementation because the House and
Senate approved different
7
versions of the bill due to a clerical error. Three of these cases have
been dismissed at the district court level, two cases are being pursued on appeal and one other is
still pending in district court. As written, the legislation contains the following provisions
that will impact reimbursement to Apria:
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In 2007, durable medical equipment currently categorized in the capped rental
category by CMS, such as hospital beds, wheelchairs, nebulizers, patient lifts and
continuous positive airway pressure devices, will be considered purchased outright at
the end of a maximum rental period and the ownership of such devices will transfer
directly to the patients. The maximum rental period, which had been 15 months with an
option for the patients to purchase the equipment in the tenth month, is reduced to 13
months. The new 13-month rental period policy took effect on January 1, 2006, and
therefore the first month in which the new policy had an impact on the companys
revenue was February 2007. In addition, the service and maintenance fee, which had
been paid to suppliers twice yearly after the rental period ended in order to cover
various non-equipment service costs, was eliminated for those patients who commenced
service on or after January 1, 2006. In November 2006, CMS issued a final rule
outlining various aspects of implementing the DRA. For example, supplier replacement of
equipment during the rental period is limited, and suppliers must replace
beneficiary-owned equipment that does not last the useful lifetime of the equipment,
which CMS has generally defined as being five years. Management estimates that the reduction in rental revenues for impacted DME products and the loss
of the service and maintenance fees in 2007 will be approximately $4.0 million and $0.5 million,
respectively. The 2007 estimate assumes the loss of the service and maintenance fee component for
one quarter as the effect of the loss is expected to impact the latter part of the year only. This
estimate is subject to assumptions and uncertainties and the actual negative impact on revenue and
fees may be greater or less. |
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Under the DRA, reimbursement for oxygen equipment will also convert from an ongoing
rental method to a rent-to-purchase method. The law mandates that oxygen equipment
reimbursement will be limited to 36 months, after which time the ownership of the
equipment will transfer to the patient, who will assume primary responsibility for
identifying when repairs or preventive maintenance are needed. Such repairs and
preventive maintenance have historically been provided by home oxygen providers and
included in the bundled monthly rental payment from Medicare for oxygen therapy. The
final rule that CMS issued in November 2006 regarding the implementation of the DRA
establishes new payment classes for oxygen equipment, including transfilling and
portable equipment, new monthly rental payment rates, and new payment rates for the
delivery of oxygen contents for patient-owned equipment after title to the equipment
transfers. According to this final rule, beginning in 2008, Medicare will review the
utilization patterns and fee schedule rates and consider whether an adjustment to the
payment rates is needed in order to satisfy the statutory mandate of budget neutrality.
The new DRA payment amounts went into effect January 1, 2007, but the 36-month rental
period will be retroactively applied to January 1, 2006 for all beneficiaries requiring
oxygen as of December 31, 2005. Accordingly, January 2009 is the first month in which
the transfer of ownership for oxygen equipment and the new repair and maintenance
policy will impact the company. |
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Regarding repair and maintenance, the final rule permits payment to suppliers for
general maintenance and servicing of certain patient-owned oxygen equipment every six
months, beginning after the first six months the patient owns the equipment. The final
rule limits payment for general maintenance and servicing visits to 30 minutes of labor
based on rates the Medicare contractors establish. CMS declined to offer general
maintenance and servicing payments for beneficiary-owned liquid and gas equipment with
the exception of a single payment for pick-up and storage or disposal of such equipment
that a beneficiary no longer needs. Once title to the oxygen equipment transfers, CMS
will also pay for certain other reasonable and necessary but non-routine repairs which
remain as yet unspecified by the agency, but CMS will not make separate payment for
certain patient support services, which are currently covered by and included in the
monthly bundled payment rate for oxygen therapy. Apria may or may not continue to
provide repair and maintenance service on patient-owned equipment and is in the process
of evaluating the impact of these changes. |
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The final rule also limits supplier replacement of oxygen equipment during the rental
period, and requires suppliers to replace beneficiary-owned equipment that does not last
the useful lifetime of the equipment, which CMS has generally defined as being five
years. |
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The Presidents current healthcare proposals seek to further reduce the maximum
rental period for oxygen equipment from the now-mandated 36 months to 13 months. The
Presidents fiscal year 2008 budget includes such a recommendation, but the line item
lacks clarity as to whether the
recommendation applies to all home oxygen technologies or only certain ones. There are
other initiatives to reduce the rental period to 13 months, but it is uncertain whether
any of these initiatives |
8
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will ultimately be approved by Congress. For example, in
September 2006, the OIG published a report entitled Medicare Home Oxygen: Equipment
Cost and Servicing. The report was the result of an audit survey conducted by the OIG
beginning in the Fall of 2005. The surveys stated objective was to study the average
acquisition cost of oxygen concentrators. The final report included a recommendation
that Congress consider further reductions to oxygen payment levels, including the
possibility of limiting the maximum rental period for oxygen equipment from the
DRA-mandated 36 months to 13 months. The industry has analyzed the report and shared
concerns about the narrow scope of the report and its findings with the OIG, CMS,
members of Congress and other government agencies. There are also legislative provisions
that have been introduced in Congress that would repeal the current oxygen reimbursement
cap and equipment ownership mandate included in the DRA, but it is uncertain whether and
when any of the OIGs recommendations or the repeal legislation ultimately would be
adopted and passed by Congress. |
Other outstanding issues that will or could have an impact on Medicare reimbursement levels to
Apria are summarized as follows:
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In late December 2005, CMS issued the 2006 Health Care Procedure Coding System, or
HCPCS, fee schedule for Medicare Part B medications and the new two-tiered dispensing
fee for inhalation therapies. The fee schedule took effect on January 1, 2006, and
included two HCPCS codes for commercially manufactured budesonide
(Pulmicort®)1 and DuoNeb®2. The fee schedule also included a
revised definition for the HCPCS codes for commercially manufactured budesonide and
budesonide compounded from a powder, and separated these products into two unique
codes. |
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In October 2006, CMS issued the 2007 HCPCS list for Medicare Part B medications.
The 2007 list includes new codes for certain compounded medications, but does not
include the proposed Medicare allowable rates for the new codes. CMS has not released
any detailed allowable information for these compounded codes and has ascribed a
payment level of To Be Determined to them. However, management does not expect such
coding or reimbursement changes to have a material impact on the company due to the
extremely low volume of custom, patient-specific, physician-prescribed compounding
performed by its inhalation pharmacies. Additionally, according to the state licensing
agencies associated with the states in which the inhalation pharmacies operate, the
Companys inhalation pharmacies conform to current quality and sterility standards. |
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§ |
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In January 2006, CMS published a final regulation that would shift payment for
certain respiratory assist devices from the current frequent and substantial payment
category to the capped rental category. Under frequent and substantial payment,
Medicare payment continues for the duration of time the beneficiary requires the
device, while capped rental payment continues for 13 months (a reduction from 15
months, mandated by the recently enacted DRA.) The change in the payment category
became effective April 1, 2006. The policy applies to those respiratory assist devices
(known as BiPAP STs) that have a backup rate feature that delivers pressure whenever
the users spontaneous breathing efforts are insufficient. The first claims received
for each Medicare beneficiary with a date of service on or after April 1, 2006,
including beneficiaries with existing rental equipment, are counted as the first rental
month in the capped rental period. Thus, the first month in which the new
categorization will impact the companys revenue will be May 2007. The companys
estimate for this change in payment categories is a reduction in 2007 revenues of approximately $3 million. |
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In January 2006, CMS announced the designation of four specialty contractors, DME
MACs, which will be responsible for handling the administration of all Medicare claims
from suppliers of durable medical equipment. CIGNA Government Services, LLC (CGS)
protested the contract awards made in Regions C and D. The Government Accountability
Office denied CGS protest for Region D but CMS ultimately authorized CGS for Region C
on January 16, 2007. The following DME MACs are currently processing
claims: National Heritage Insurance Company (NHIC) for Region A (effective July 1,
2006), AdminaStar Federal for Region B (effective July 1, 2006), CGS for Region C
(effective January 16, 2007), and Noridian Administrative Services for Region D
(effective September 30, 2006). It is difficult at this time to |
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1 |
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Pulmicort® is a registered trademark of
Astra Zeneca AB Corporation |
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2 |
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DuoNeb® is a registered trademark of
Dey L.P. |
9
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predict precisely how
this change in claims administration will affect DME suppliers, nor can the company
predict or estimate the potential impact of this change on collections of its accounts
receivable. |
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On March 24, 2006, the three Program Safeguard Contractors, or PSCs, overseeing
durable medical equipment issued a proposed Local Coverage Determination, or LCD, for
nebulizer medications covered by Medicare Part B. In their respective geographic
regions, the PSC medical directors are responsible for implementing medical policies
that conform to Medicare rules, regulations, coverage guidelines and payment policies
for Part B as mandated by law or other regulations. The LCD for nebulizer medications
proposed to change the payment and coverage policies for certain inhalation therapies
that are provided in conjunction with the durable medical equipment known as a
nebulizer. Specifically, four provisions were proposed: (i) payment for levalbuterol
(commercially manufactured as brand-name Xopenex®)3 would be based on the
allowable for generic albuterol sulfate; (ii) payment for commercially-manufactured,
brand-name DuoNeb® would be based on the allowance for separate unit dose vials of
albuterol sulfate and ipratropium bromide; (iii) coverage for a variety of other
nebulizer drugs would be eliminated because the PSCs assert that there is inadequate
support in the medical literature for administration using a DME nebulizer; and (iv)
maximum monthly utilization limits for budesonide would be defined. |
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Apria, along with numerous other industry representatives, manufacturers, providers,
physician and patient advocacy groups, participated in the public hearings and has also
submitted formal written comments to the PSCs and CMS. The company believes that the MMA
is clear in its intent to prescribe the Part B average sales price reimbursement formula
for single-source drugs which applies to both DuoNeb® and Xopenex®. The company further
believes that the PSCs do not have the legal authority to circumvent the average sales
price methodology through the issuance of an LCD that invokes their authority to use the
Least Costly Alternative as the basis for reducing the reimbursement for these drugs.
Apria is continuing to work with industry representatives to further demonstrate to CMS
and the PSCs that such a decision would have a negative impact on access to prescription
medications used in the front-line treatment of chronic obstructive pulmonary disease.
The company has determined that if the four provisions of the LCD are implemented as
proposed in the March 24, 2006 document, it will generally not provide DuoNeb® and
Xopenex® to existing or future patients covered by Medicare, as the cost would far
exceed the reimbursement rate. The company would undertake an effort to inform existing
patients and physicians of the option to use the generic drugs that the PSCs have deemed
to be therapeutically equivalent to these brand-name drugs. Such an effort would be
intended to mitigate but likely would not eliminate the full effect of the change in
reimbursement. Managements current estimate of providing the replacement medications in lieu of the brand name
drugs is a quarterly gross profit reduction of approximately $3 million. (Given that the impact
for 2007 will only be for a partial year, a quarterly estimate is provided.) However, this
estimate is subject to assumptions and uncertainties and the actual negative impact on gross profit
may be greater or less. |
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The manufacturer of Xopenex® has announced that it is attempting to negotiate a solution
to this issue directly with CMS that would reduce the reimbursement rate while
maintaining patient access to the drug within the Medicare Part B program. Apria does
not have the particulars of such a proposal but believes that such a solution could also
have an adverse affect on its revenues and results of operations. |
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Subsequent to the actions taken by the PSCs in the spring of 2006, CMS initiated a
National Coverage Analysis on December 20, 2006, and sought public comments regarding
the same issues of coverage and payment for certain inhalation drugs. The company
provided comments by the January 24, 2007 deadline set by CMS. CMS has indicated that
it will consider public comments and then issue a final decision, new policy and/or
change to existing policy some time in the third quarter of 2007, for implementation
some time in the fourth quarter of 2007 at the earliest. Depending on the final outcome
of such a decision by CMS, the company may or may not continue to provide DuoNeb® and
Xopenex® to Medicare beneficiaries after a revised policy is implemented by CMS. |
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In late 2006, CMS announced that it has revised the LCD for power mobility
devices resulting in reductions to the power mobility devices fee schedule. The
revised fee schedule imposes reductions for certain power mobility
devices of about 15%. The changes took effect November 15, 2006. Managements
estimate of the reduction in Aprias revenues for 2007 resulting from these fee
schedule changes is $1 million. However, this estimate is subject to assumptions and
uncertainties and the actual negative impact on revenue may be greater or less. The
industry is continuing work with CMS
to obtain clarification and modification of the LCD. The industry also believes that
Medicare beneficiary |
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3 |
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Xopenex® is a registered trademark of
Sepracor, Inc. |
10
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access to power mobility will be restricted by this LCD and
therefore has requested revisions to the fee schedule. |
Apria cannot estimate the combined possible impact of all legislative, regulatory and
contemplated reimbursement changes that could have a material adverse effect on Aprias results of
operations, cash flow and capital resources.
Medicaid Reimbursement. For a number of years, some states have adopted alternative
pricing methodologies for certain drugs and biologicals under the Medicaid program. In at least 22
states, the changes reduced the level of reimbursement received by Apria without a corresponding
offset or increase to compensate for the service costs incurred. In several of those states, Apria
elected to stop accepting new Medicaid patient referrals for the affected drugs and biologicals.
Further, in 2005, some states implemented other payment policy changes or changed coverage criteria
altogether for medical equipment, enteral and infusion therapy. Other states have expanded coverage
for certain products and services. Currently, some states are considering reductions in Medicaid
reimbursement as they work through their respective budget processes. Apria cannot predict the
outcome of such budget negotiations or whether other states will consider reductions as well and
whether any such changes could have a material adverse effect on Aprias results of operations,
cash flow and capital resources.
HIPAA. The Health Insurance Portability and Accountability Act of 1996, or HIPAA, is
comprised of a number of components. Pursuant to the administrative simplification section of
HIPAA, HHS has issued multiple regulations, each with its own compliance date. For those
regulations with a compliance date that has already passed, Apria was materially compliant by the
date required. Regulations governing the standards for a unique national health identifier for
healthcare providers for use in connection with standard transactions will have a compliance date
of May 23, 2007. Apria expects to be materially compliant with these regulations by the compliance
date. The final HIPAA enforcement rule took effect on March 16, 2006 and adopted uniform
enforcement procedures for the privacy rules and other administrative simplification rules, such as
the security rule. Additionally, the final HIPAA enforcement rule established procedural and
substantive requirements for the imposition of civil monetary penalties for violations of HIPAA
provisions.
Apria faces potential criminal or civil sanctions if it does not comply with existing or new
laws and regulations related to patient health information, use of standard transaction and code
sets and use of standard identifiers. New health information standards, whether implemented
pursuant to HIPAA or otherwise, could have a significant effect on the manner in which Apria
handles healthcare related data and communicates with payors.
Anti-Kickback Statute. As a provider of services under the Medicare and Medicaid programs,
Apria is subject to the Medicare and Medicaid fraud and abuse laws, commonly known as the
anti-kickback statute. At the federal level, the anti-kickback statute prohibits any bribe,
kickback or rebate in return for the referral of patients, products or services covered by federal
healthcare programs. Federal healthcare programs have been defined to include plans and programs
that provide health benefits funded by the United States Government, including Medicare, Medicaid
and TRICARE (formerly known as the Civilian Health and Medical Program of the Uniformed Services),
among others. Violations of the anti-kickback statute may result in civil and criminal penalties
and exclusion from participation in federal healthcare programs.
Additionally, a number of states in which Apria operates have laws that prohibit certain
direct or indirect payments (similar to the anti-kickback statute) or fee-splitting arrangements
between healthcare providers, if such arrangements are designed to induce or encourage the referral
of patients to a particular provider. Possible sanctions for violations of these restrictions
include exclusion from state-funded healthcare programs, loss of licensure and civil and criminal
penalties. Such statutes vary from state to state, are often vague and have seldom been
interpreted by courts or regulatory agencies. See Risk Factors Government Regulation;
Healthcare Reform.
Physician Self-Referrals. Certain provisions of the Omnibus Budget Reconciliation Act of
1993, commonly known as Stark II, prohibit health service providers such as Apria, subject to
certain exceptions, from submitting claims to the Medicare and Medicaid programs for designated
health services if Apria has a financial relationship with the physician making the referral for
such services or with a member of such physicians immediate family. The term designated health
services includes several services commonly performed or supplied by Apria, including durable
medical equipment and home health services. In addition, financial relationship is broadly
defined to include any ownership or investment interest or compensation arrangement pursuant to which a physician
receives remuneration from
11
the provider at issue. Violations of Stark II may result in loss of
Medicare and Medicaid reimbursement, civil penalties and exclusion from participation in the
Medicare and Medicaid programs. In addition, a number of the states in which Apria operates have
similar prohibitions on physician self-referrals. Finally, recent enforcement activity and
resulting case law developments have increased the legal risks of physician compensation
arrangements that do not satisfy the terms of an exception to Stark II, especially in the area of
joint venture arrangements with physicians. See Business Risk Factors Government Regulation;
Healthcare Reform.
False Claims. The False Claims Act imposes civil and criminal liability on individuals or
entities that submit false or fraudulent claims for payment to the government. Violations of the
False Claims Act may result in treble damages, civil monetary penalties and exclusion from the
Medicare and Medicaid programs.
The False Claims Act also allows a private individual to bring a qui tam suit on behalf of the
government against a healthcare provider for violations of the False Claims Act. A qui tam suit
may be brought by, with only a few exceptions, any private citizen who has material information of
a false claim that has not yet been previously disclosed. Even if disclosed, the original source
of the information leading to the public disclosure may still pursue such a suit. Although a
corporate insider is often the plaintiff in such actions, an increasing number of outsiders are
pursuing such suits.
In a qui tam suit, the private plaintiff is responsible for initiating a lawsuit that may
eventually lead to the government recovering money of which it was defrauded. After the private
plaintiff has initiated the lawsuit, the government must decide whether to intervene in the lawsuit
and become the primary prosecutor. In the event the government declines to join the lawsuit, the
private plaintiff may choose to pursue the case alone, in which case the private plaintiffs
counsel will have primary control over the prosecution (although the government must be kept
apprised of the progress of the lawsuit and will still receive at least 70% of any recovered
amounts). In return for bringing the suit on the governments behalf, the statute provides that
the private plaintiff is entitled to receive up to 30% of the recovered amount from the litigation
proceeds if the litigation is successful. Recently, the number of qui tam suits brought against
healthcare providers has increased dramatically. In addition, a number of states have enacted laws
modeled after the False Claims Act that allow those states to recover money which was fraudulently
obtained by a healthcare provider from the state (e.g., Medicaid funds provided by the state). See
Risk Factors Government Regulation; Healthcare Reform.
Other Fraud and Abuse Laws. HIPAA created, in part, two new federal crimes: Health Care
Fraud and False Statements Relating to Health Care Matters. The Health Care Fraud statute
prohibits executing a knowing and willful scheme or artifice to defraud any healthcare benefit
program. A violation of this statute is a felony and may result in fines and/or imprisonment. The
False Statements statute prohibits knowingly and willfully falsifying, concealing or covering up a
material fact by any trick, scheme or device or making any materially false, fictitious or
fraudulent statement in connection with the delivery of or payment for healthcare benefits, items
or services. A violation of this statute is a felony and may result in fines and/or imprisonment.
In recent years, the federal government has made a policy decision to significantly increase
the financial resources allocated to enforcing the healthcare fraud and abuse laws. In addition,
private insurers and various state enforcement agencies have increased their level of scrutiny of
healthcare claims in an effort to identify and prosecute fraudulent and abusive practices in the
healthcare area. See Risk Factors Government Regulation; Healthcare Reform.
Healthcare Reform Legislation. Economic, political and regulatory influences are causing
fundamental changes in the healthcare industry in the United States. Various healthcare reform
proposals are formulated and proposed by the legislative and administrative branches of the federal
government on a regular basis. In addition, some of the states in which Apria operates
periodically consider various healthcare reform proposals. Apria anticipates that federal and
state governments will continue to review and assess alternative healthcare delivery systems and
payment methodologies and public debate of these issues will continue in the future. Due to
uncertainties regarding the ultimate features of reform initiatives and their enactment and
implementation, Apria cannot predict which, if any, of such reform proposals will be adopted, or
when they may be adopted, or that any such reforms will not have a material adverse effect on
Aprias business and results of operations.
Healthcare is an area of extensive and dynamic regulatory change. Changes in the law or new
interpretations of existing laws can have a dramatic effect on permissible activities, the relative
costs associated with doing business in the health care industry and the amount of reimbursement by
governmental and other third-party payors. Recommendations
for changes may result from an ongoing study of patient access by the General Accounting
Office and from the potential
12
findings of the National Bipartisan Commission on the Future of
Medicare. See Risk Factors Government Regulation; Healthcare Reform.
Employees
As of January 31, 2007, Apria had 11,258 employees, of which 10,657 were full-time and 601
were part-time. None of the companys employees is currently represented by a labor union or other
labor organization.
Website Access to Reports
Aprias Annual Reports on Form 10-K, Quarterly Reports on Form 10-Q, Current Reports on Form
8-K, all amendments thereto and all other reports filed or furnished pursuant to Section 13(a) or
15(d) of the Securities Exchange Act of 1934, as amended, are made available free of charge on the
companys website as soon as reasonably practicable after such reports are filed with or furnished
to the Securities and Exchange Commission. Aprias Code of Ethical Business Conduct is also
available on the companys website. In the event Apria makes any amendment to, or grants any
waiver from, a provision of the Code of Ethical Business Conduct that applies to the principal
executive officer, principal financial officer or principal accounting officer that requires
disclosure under applicable Securities and Exchange Commission rules, Apria will disclose such
amendment or waiver and the reasons therefor on its website. Aprias website can be found at
www.apria.com.
13
Executive Officers of the Registrant
Set forth below are the names, ages, titles with Apria and past and present positions of the
persons serving as Aprias executive officers as of February 23, 2007:
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Name and Age |
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Office and Experience |
Lawrence M. Higby, 61
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Chief Executive Officer and
Director. Mr.
Higby was appointed Chief Executive Officer
and Director in February 2002. Mr. Higby
also served as Aprias Chief Executive
Officer on an interim basis from January
through May 1998. He joined Apria in
November 1997 as President and Chief
Operating Officer. Prior to joining Apria,
Mr. Higby served as President and Chief
Operating Officer of Unocals 76 Products
Company and Group Vice President of Unocal
Corporation from 1994 to 1997. From 1986 to
1994, Mr. Higby held various positions with
the Times Mirror Company, including
Executive Vice President, Marketing of the
Los Angeles Times and Chairman of the Orange
County Edition. In 1986, Mr. Higby served
as President and Chief Operating Officer of
Americas Pharmacy, Inc., a division of
Caremark, Inc. |
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Lawrence A. Mastrovich, 45
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President and Chief Operating
Officer. Mr.
Mastrovich joined Apria as Chief Operating
Officer in April 2002 and was promoted to
President in August 2004. From August 2001
to April 2002, Mr. Mastrovich served as
President and Chief Operating Officer of
TechRx, a pharmacy technology company. From
April 2001 to August 2001, Mr. Mastrovich
served as Aprias Executive Vice President,
Sales. From October 1998 to April 2001, Mr.
Mastrovich served as Aprias Executive Vice
President, Revenue Management. From
December 1997 to October 1998, Mr.
Mastrovich served as Division Vice
President, Operations for Aprias Northeast
Division. Prior to that time, Mr.
Mastrovich had served as a Regional Vice
President for Apria and its predecessor,
Homedco, since 1994 and in various other
capacities from 1987 to 1994. |
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Chris A. Karkenny, 38
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Executive Vice President and Chief Financial
Officer. Mr. Karkenny joined Apria as
Executive Vice President and Chief Financial
Officer in November 2006. From January 2003
to February 2006, Mr. Karkenny served as
Senior Vice President of Corporate
Development and Treasury Operations of
PacifiCare Health Systems, Inc., a Fortune
500 company. From August 1999 to December
2002, Mr. Karkenny served as Chief Executive
Officer of NetCatalyst, a California
investment banking firm. From July 1998 to
August 1999, Mr. Karkenny served as a
partner in Technologz, a California-based
business incubator, and was a founder, board
member and initial Chief Financial Officer
of CardioNow, a healthcare application
service provider. Prior thereto, he served
as Treasurer of Quarterdeck Corporation from
1995 to March 1998. |
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W. Jeffrey Ingram, 39
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Executive Vice President, Sales. Mr. Ingram was promoted to
Executive Vice President, Sales in December of 2005. From January 2005 to November 2005, Mr.
Ingram served as Senior Vice President, National Accounts. From March 2003 to January 2005,
Mr. Ingram served as Division Vice President, Sales for Aprias Southeast Division. From May
2001 to February 2003, Mr. Ingram served as Region Vice President, Sales for Aprias Midsouth
Region. Prior to that time, Mr. Ingram had served in various other sales positions with Apria
since January 1994. |
14
Item 1A. RISK FACTORS
Apria has identified the following important factors, among others, that could cause its
actual results to differ materially from those projected in any forward-looking statements the
company may make from time to time. If any of these risks, or others, actually occurs, Aprias
business, financial condition and results of operations could suffer.
Collectibility of Accounts ReceivableAprias failure to maintain its controls and processes over
billing and collecting or the deterioration of the financial condition of its payors could have a
significant negative impact on its results of operations and financial condition.
The collection of accounts receivable is one of Aprias most significant challenges and
requires constant focus and involvement by management and ongoing enhancements to information
systems and billing center operating procedures. Further, some of Aprias payors and/or patients
may experience financial difficulties, or may otherwise not pay accounts receivable when due,
resulting in increased write-offs. There can be no assurance that Apria will be able to maintain
its controls and processes over billing or its current levels of collectibility and days sales
outstanding in future periods. If Apria is unable to properly bill and collect its accounts
receivable, its results will be adversely affected.
Operating Systems and ControlsAprias failure to successfully implement computer and other system
modifications designed to maximize productivity could ultimately have a significant negative impact
on its results of operations and financial condition.
Aprias management has identified a number of areas throughout its operations where it intends
to modify the current processes or systems in order to attain a higher level of productivity. The
ultimate cost savings expected from the successful design and implementation of such initiatives
will be necessary to help offset the impact of Medicare and Medicaid reimbursement reductions and
continued downward pressure on pricing. Aprias failure to successfully implement its planned
system modifications and other productivity improvements could have a significant impact on its
operations and financial condition. Further, the implementation of these system changes could have
a disruptive effect on related transaction processing and operations.
Medicare/Medicaid Reimbursement RatesContinued reductions in Medicare and Medicaid reimbursement
rates could have a material adverse effect on Aprias results of operations and financial
condition.
Medicare Reimbursement Reductions. There are a number of provisions contained within
recent legislation and proposed regulations that adversely affect or may adversely affect
reimbursement for products and services provided by Apria. For example, in December 2003, the
Medicare Prescription Drug, Improvement and Modernization Act of 2003, also referred to as the
Medicare Modernization Act, or MMA, became law. The MMA and related rules issued by the Centers
for Medicare and Medicaid Services, or CMS, implemented reimbursement reductions for a number of
products and services provided by Apria and established a proposed competitive bidding program for
Medicare Part B. Further, the Deficit Reduction Act of 2005, or DRA, was signed into law in
February 2006. Once fully implemented, the DRA and related rules issued by CMS would result in
reduced reimbursement rates for certain durable medical equipment, including home oxygen equipment
and services provided by Apria, a reduced period for rental revenue, and potential increased costs
associated with replacement of certain patient-owned equipment.
In addition to these laws, certain other proposed legislative and regulatory activities may
affect reimbursement policies for other items and services provided by Apria. These recently
enacted reductions and pending proposed reductions in Medicare reimbursement rates could have a
material adverse effect on Aprias net revenues, net income, cash flow and capital resources.
Medicaid Reimbursement Reductions. For a number of years, some states began adopting
alternative pricing methodologies for certain drugs and biologicals under the Medicaid program. In
a number of states, the changes reduced the level of reimbursement received by Apria without a
corresponding offset or increase to compensate for the service costs incurred. In several of those
states, Apria elected to stop accepting new Medicaid patient referrals for the affected drugs and
biologicals. Further, some states are considering other reductions in Medicaid reimbursement as
they work through their respective budget processes.
Apria cannot estimate the ultimate impact of all legislated and contemplated Medicare and
Medicaid reimbursement changes or provide assurance to investors that additional reimbursement
reductions will not be made or will not have an adverse effect on the companys operations and
financial condition. See Business Government Regulation Medicare and Medicaid Reimbursement.
15
Government Regulation; Healthcare ReformNon-compliance with laws and regulations applicable to
Aprias business and future changes in those laws and regulations could have a material adverse
effect on Apria.
Apria is subject to stringent laws and regulations at both the federal and state levels,
requiring compliance with burdensome and complex billing, substantiation and record-keeping
requirements. Financial relationships between Apria and physicians and other referral sources are
also subject to strict limitations. In addition, strict licensing and safety requirements apply to
the provision of services, pharmaceuticals and equipment. Violations of these laws and regulations
could subject Apria to severe fines, facility shutdowns and possible exclusion from participation
in federal healthcare programs such as Medicare and Medicaid. Government officials and the public
will continue to debate healthcare reform. Recently, proposed initiatives in certain states (California, Massachusetts) and potential new
federal or state public policy changes to cover the uninsured could ultimately also effect payment
rates to providers or initiate new provider fees or taxes. Changes in public policy, healthcare
law, new interpretations of existing laws, or changes in payment methodology may have a significant
effect on Aprias business and results of operations.
Economic and Political Events, International Conflicts and Natural DisastersSignificant global or
regional developments that are out of the companys control could have a material adverse effect on
Apria.
Further reductions in reimbursement from Medicare and Medicaid programs could result if there
is a significant change in government spending priorities. The costs of military and security
activities or prolonged relief efforts in response to a natural disaster could increase pressure to
reduce government expenditures for other purposes, including government-funded programs such as
Medicare and Medicaid. Such further reimbursement reductions could have a material adverse effect
on Aprias business and results of operations.
Pricing PressuresApria believes that continued pressure to reduce healthcare costs could have a
material adverse effect on the company.
The current market continues to exert pressure on healthcare companies to reduce healthcare
costs, resulting in reduced margins for home healthcare providers such as Apria. Larger group
purchasing organizations and supplier groups exert additional pricing pressure on home healthcare
providers. These include managed care organizations, which control an increasing portion of the
healthcare economy. Apria has a number of contractual arrangements with managed care organizations
and other parties, although no individual arrangement accounted for more than 9% of Aprias net
revenues in 2006.
The segment of the healthcare market in which Apria operates is highly competitive. In each
of its service lines, there are a number of national providers and numerous regional and local
providers. Other types of healthcare providers, including industrial gas manufacturers, individual
hospitals and hospital systems, home health agencies and health maintenance organizations have
entered, and may continue to enter the market to compete with Aprias various service lines. Some
of these competitors have access to significantly greater financial and marketing resources than
Apria and may be better positioned to compete in the market. This may increase pricing pressure
and limit Aprias ability to maintain or increase its market share.
Acquisitions Aprias strategic plan may include the acquisition of other companies, which involves a
number of risks.
Historically, Aprias growth has depended in part upon the acquisition of other companies.
Aprias strategic plan may or may not continue to include the acquisition of other businesses.
Apria faces the risk that the returns on acquisitions will not support the expenditures or
indebtedness incurred to acquire such businesses, or the capital expenditures needed to develop
such businesses.
Acquisitions such as these involve a number of other risks, including:
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|
difficulties related to integrating a previously separate businesses into the company; |
|
|
|
|
diversion of managements attention from day-to-day operations; |
|
|
|
|
assumption of liabilities of an acquired business, including unforeseen or contingent
liabilities, or liabilities in excess of the amounts the company estimates; |
|
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|
|
failure to realize anticipated benefits, such as cost savings and revenue
enhancements; |
|
|
|
|
dilution of existing stockholders due to the issuance of equity securities,
utilization of cash reserves, or incurrence of debt in order to fund the acquisitions; |
|
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|
potentially substantial transaction costs associated with acquisitions; |
|
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|
|
difficulties related to assimilating the products, personnel and systems of an
acquired business, including distribution and other operational capabilities; and |
|
|
|
|
difficulties in applying Aprias internal controls to an acquired business. |
While Apria generally pursues acquisitions of companies that are related to its principal
business, the company may also pursue acquisitions of companies that are ancillary to the companys
core business in the future which could exacerbate the risks described above.
If the company cannot effectively execute its acquisition strategy, its future growth may
suffer and its results of operations could be harmed. Accordingly, Apria may be unable to
identify, consummate and integrate future acquisitions successfully or operate acquired businesses
profitably.
Item 1B. UNRESOLVED STAFF COMMENTS
None.
Item 2. PROPERTIES
Apria leases its headquarters, located in Lake Forest, California, which consist of
approximately 100,000 square feet of office space. The lease expires in 2011.
Apria has approximately 550 locations. In addition to the approximately 475 branches, Aprias
total locations include billing centers, pharmacies, warehouse and storage facilities. The
regional facilities usually house a branch and various regional support functions such as repair,
billing and infusion pharmacy. The regional facilities are typically located in light industrial
areas and generally range from 27,000 to 148,000 square feet. The typical branch facility, other
than those that share a building with a region, is a combination warehouse and office and can range
from 650 to 50,000 square feet. Apria leases substantially all of its facilities with lease terms
of ten years or less.
16
Item 3. LEGAL PROCEEDINGS
Apria is the defendant in a California class action lawsuit containing blanket claims of
liability under various California employee protection statutes and regulations relating to payment
of regular and overtime wages, the timeliness of such payments, the maintenance and provision of
access to required payroll records, and the provision of meal and rest periods. Venegas vs. Apria
Healthcare, Inc., et al., was filed on February 21, 2006 in the California Superior Court for the
County of San Francisco (Case No. CGC 06 449669). No class has been certified at this time,
but on behalf of a purported class consisting of certain hourly employees of the company in the
State of California, the complaint seeks compensatory and punitive damages in an unspecified amount
as well as other relief. The company has filed an answer to the complaint denying all material
allegations and asserting a number of affirmative defenses. Based on the companys preliminary
investigation of the allegations, management believes there are meritorious defenses to the claims
and the company intends to vigorously defend the lawsuit. No assurance can be given, however, that
the ultimate disposition of this case will not have a material adverse effect on the companys
financial condition or results of operations.
Apria is also engaged in the defense of certain claims and lawsuits arising out of the
ordinary course and conduct of its business, the outcomes of which are not determinable at this
time. Apria has insurance policies covering such potential losses where such coverage is cost
effective. In the opinion of management, any liability that might be incurred by Apria upon the
resolution of these claims and lawsuits will not, in the aggregate, have a material adverse effect
on Aprias financial condition or results of operations.
Item 4. SUBMISSION OF MATTERS TO A VOTE OF SECURITY HOLDERS
No matters were submitted to a vote of Aprias stockholders during the fourth quarter of the
fiscal year covered by this report.
17
PART II
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|
Item 5. MARKET FOR REGISTRANTS COMMON EQUITY, RELATED STOCKHOLDER
MATTERS AND ISSUER PURCHASES OF EQUITY SECURITIES |
Market for the Registrants Common Equity
Aprias common stock is traded on the New York Stock Exchange under the symbol AHG. The
following table presents information on the range of high and low sales prices per share of Apria
common stock since January 1, 2005 for the quarterly periods indicated:
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High |
|
Low |
Year ended December 31, 2006 |
|
|
|
|
|
|
|
|
First quarter |
|
$ |
24.76 |
|
|
$ |
21.69 |
|
Second quarter |
|
|
22.92 |
|
|
|
17.37 |
|
Third quarter |
|
|
22.95 |
|
|
|
17.38 |
|
Fourth quarter |
|
|
27.70 |
|
|
|
19.25 |
|
|
|
|
|
|
|
|
|
|
Year ended December 31, 2005 |
|
|
|
|
|
|
|
|
First quarter |
|
$ |
33.56 |
|
|
$ |
29.78 |
|
Second quarter |
|
|
36.75 |
|
|
|
29.05 |
|
Third quarter |
|
|
35.55 |
|
|
|
31.56 |
|
Fourth quarter |
|
|
32.84 |
|
|
|
20.51 |
|
As of February 23, 2007, there were 316 holders of record of Apria common stock. Apria has
not declared or paid cash dividends on its common stock. While Apria regularly assess its
dividend policy, we have no current plans to declare a dividend. Earnings and other cash resources
will continue to be used in the expansion of our business.
Equity Compensation Plans
The following table summarizes the securities authorized for issuance under Aprias equity
compensation plans as of December 31, 2006:
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|
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|
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|
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|
|
Number of Securities |
|
|
|
|
|
Number of |
|
|
to be Issued Upon |
|
Weighted Average |
|
Securities Remaining |
|
|
Exercise of |
|
Exercise Price of |
|
Available for Future |
|
|
Outstanding Options, |
|
Outstanding Options, |
|
Issuance Under Equity |
Plan Category |
|
Warrants and Rights |
|
Warrants and Rights |
|
Compensation Plans |
Equity compensation plans
approved by stockholders |
|
|
4,511,460 |
|
|
$ |
21.14 |
|
|
|
3,582,017 |
|
Equity compensation plans not
approved by stockholders |
|
|
297,776 |
|
|
$ |
21.51 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Totals |
|
|
4,809,236 |
|
|
$ |
21.16 |
|
|
|
3,582,017 |
|
|
|
|
|
|
|
|
|
|
|
|
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|
Aprias 1998 Nonqualified Stock Incentive Plan is the only equity compensation plan that has
not been approved by stockholders. The plan was approved by the Board of Directors on December 15,
1998 and became effective as of that date. Upon stockholder approval of the 2003 Performance
Incentive Plan, the ability to grant additional awards under the 1998 Plan was terminated.
18
Item 6. SELECTED FINANCIAL DATA
The following table presents Aprias selected financial data for the five years ended December
31, 2006. The data set forth below have been derived from Aprias audited Consolidated Financial
Statements and are qualified by reference to, and should be read in conjunction with, the
Consolidated Financial Statements and related notes thereto and Managements Discussion and
Analysis of Financial Condition and Results of Operations included in this report.
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|
Year Ended December 31, |
|
(in thousands, except per share data) |
|
2006(1) |
|
|
2005(2) |
|
|
2004(3) |
|
|
2003(4) |
|
|
2002(5) |
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|
|
Statements of Income Data: |
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|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Net revenues |
|
$ |
1,517,307 |
|
|
$ |
1,474,101 |
|
|
$ |
1,451,449 |
|
|
$ |
1,380,945 |
|
|
$ |
1,252,196 |
|
Net income |
|
|
74,980 |
|
|
|
66,941 |
|
|
|
114,008 |
|
|
|
115,992 |
|
|
|
115,595 |
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|
|
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|
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|
Basic net income per common share |
|
$ |
1.77 |
|
|
$ |
1.39 |
|
|
$ |
2.31 |
|
|
$ |
2.17 |
|
|
$ |
2.12 |
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|
Diluted net income per common share |
|
$ |
1.75 |
|
|
$ |
1.37 |
|
|
$ |
2.27 |
|
|
$ |
2.15 |
|
|
$ |
2.08 |
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|
|
|
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Balance Sheet Data: |
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|
Total assets |
|
$ |
1,168,496 |
|
|
$ |
1,185,898 |
|
|
$ |
1,107,664 |
|
|
$ |
1,043,435 |
|
|
$ |
795,656 |
|
Long-term obligations, including
current maturities |
|
|
487,145 |
|
|
|
645,320 |
|
|
|
480,858 |
|
|
|
500,763 |
|
|
|
269,368 |
|
Stockholders equity |
|
|
410,431 |
|
|
|
327,164 |
|
|
|
406,185 |
|
|
|
365,948 |
|
|
|
351,309 |
|
|
|
|
(1) |
|
Net revenue for 2006 reflects $15.0 million in incremental Medicare reimbursement reductions
for respiratory drugs, oxygen and oxygen equipment. |
|
(2) |
|
Net income for 2005 reflects $16.3 million in settlement costs and legal fees associated with
the disposition of the previously-reported federal investigation and qui tam lawsuits, net of
taxes. Net revenues for 2005 were reduced by an incremental $27.4 million in Medicare
reimbursement reductions on respiratory medications, certain durable medical equipment items
and oxygen-related equipment. The balance sheet data at December 31, 2005 reflects the
repurchase of common stock with $175.0 million in debt borrowed from Aprias revolving line of
credit. Net income per share for 2005 reflects the effect of the share repurchase on weighted
average shares. |
|
(3) |
|
Net income for 2004 reflects the write-off of deferred debt issuance costs of $2.7 million
associated with the November 2004 refinancing of the companys bank loans. Net revenues for
2004 were reduced by $15.2 million in Medicare reimbursement reductions on respiratory
medications. |
|
(4) |
|
The balance sheet data at December 31, 2003 reflects the issuance of convertible senior notes
in the aggregate principal amount of $250 million and the concurrent repurchase of common
stock with $100.0 million of the proceeds. Net income per share for 2003 reflects the effect
of the share repurchase. |
|
(5) |
|
Net income for 2002 reflects the impact of the favorable outcome of an income tax dispute
that was settled in the fourth quarter of 2002. The components of this impact include: income
tax benefit of $11.1 million, interest income of $4.0 million and related professional fee
expense of $1.7 million. Effective January 1, 2002, Apria adopted Statement of Financial
Accounting Standards No. 142, Goodwill and Other Intangible Assets, and accordingly ceased
amortizing goodwill. |
Apria did not pay any cash dividends on its common stock during any of the periods set forth in the
table above.
19
Item 7. MANAGEMENTS DISCUSSION AND ANALYSIS OF FINANCIAL CONDITION AND
RESULTS OF OPERATIONS |
Overview. Apria operates in the home healthcare segment of the healthcare industry and
provides services in the home respiratory therapy, home infusion therapy and home medical equipment
areas. In all three lines, Apria provides patients with a variety of clinical and administrative
support services and related products and supplies, most of which are prescribed by a physician as
part of a care plan. Apria provides these services to patients in the home through approximately
475 branch locations throughout the United States.
Aprias branch locations are organized into three geographic divisions. Management evaluates
operating results on a geographic basis and, therefore, views each division as an operating
segment (previously 15 regions). All divisions provide the same products and services, including respiratory therapy,
infusion therapy and home medical equipment and supplies. For financial reporting purposes, all
the companys operating segments are aggregated into one reportable segment in accordance with the
aggregation criteria of Statement of Financial Accounting Standards (SFAS) No. 131, Disclosures
about Segments of an Enterprise and Related Information.
Strategy. Aprias strategy is to position itself in the marketplace as the low cost, quality
provider of a broad range of home healthcare services to managed care and Medicare customers. The
specific elements of its strategy are to:
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achieve strong organic sales growth and increase market share; |
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leverage its nationwide infrastructure to reduce costs and expand profits; |
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deliver superior customer service; and |
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attract, develop and advance leaders within the company. |
Critical Accounting Policies. Aprias management considers the accounting policies that
govern revenue recognition and the determination of the net realizable value of accounts receivable
to be the most critical in relation to the companys consolidated financial statements. These
policies require the most complex and subjective judgments of management. Additionally, the
accounting policies related to goodwill, long-lived assets and income taxes require significant
judgment.
Revenue and Accounts Receivable. Revenues are recognized on the date services and
related products are provided to patients and are recorded at amounts estimated to be received
under reimbursement arrangements with third-party payors, including private insurers, prepaid
health plans, Medicare and Medicaid. Due to the nature of the industry and the reimbursement
environment in which Apria operates, certain estimates are required to record net revenues and
accounts receivable at their net realizable values. Inherent in these estimates is the risk that
they will have to be revised or updated as additional information becomes available. Specifically,
the complexity of many third-party billing arrangements and the uncertainty of reimbursement
amounts for certain services from certain payors may result in adjustments to amounts originally
recorded. Such adjustments are typically identified and recorded at the point of cash application,
claim denial or account review. Accounts receivable are reduced by an allowance for doubtful
accounts which provides for those accounts from which payment is not expected to be received,
although services were provided and revenue was earned. Upon determination that an account is
uncollectible, it is written-off and charged to the allowance.
Management performs various analyses to evaluate accounts receivable balances to ensure that
recorded amounts reflect estimated net realizable value. Management applies specified percentages
to the accounts receivable aging to estimate the amount that will ultimately be uncollectible and
therefore should be reserved. The percentages are increased as the accounts age; accounts aged in
excess of 360 days are reserved at 100%. Management establishes and monitors these percentages
through analyses of historical realization data, accounts receivable aging trends, other operating
trends, the extent of contracted business and business combinations. Also considered are relevant
business conditions such as governmental and managed care payor claims processing procedures and
system changes. If indicated by such analyses, management may periodically adjust the
uncollectible estimate and corresponding percentages. Further, focused reviews of certain large
and/or problematic payors are performed to determine if overall reserve levels are sufficient.
Goodwill and Long-lived Assets. Goodwill arising from business combinations
represents the excess of the purchase price over the estimated fair value of the net assets of the
acquired business. Pursuant to SFAS No. 142, Goodwill and Other Intangible Assets, goodwill is
tested annually for impairment or more frequently if circumstances indicate the potential for
impairment. Also, management tests for impairment of its intangible assets and long-lived assets
on an ongoing basis and whenever events or changes in circumstances indicate that the carrying
amount of an
asset may not be recoverable. Aprias goodwill impairment test is conducted at a reporting unit
level and compares each
20
reporting units fair value to its carrying value. The company has
determined that its geographic divisions (previously its regions) are reporting units under SFAS No. 142. The measurement
of fair value for each division is based on an evaluation of future discounted cash flows and is
further tested using a multiple of earnings approach. In projecting its reporting units cash
flows, management considers industry growth rates and trends, known and potential reimbursement
reductions, cost structure changes and local circumstances specific to a division. Based on its
tests and reviews, no impairment of its goodwill, intangible assets or other long-lived assets
existed at December 31, 2006. However, future events or changes in current circumstances could
affect the recoverability of the carrying value of goodwill and long-lived assets. Should an asset
be deemed impaired, an impairment loss would be recognized to the extent the carrying value of the
asset exceeded its estimated fair market value.
Share-Based Compensation. Effective January 1, 2006, Apria adopted the provisions of
SFAS No. 123R, Share-Based Payment, which establishes accounting for equity instruments exchanged
for employee services. Under the provisions of SFAS No. 123R, share-based compensation cost is
measured at the grant date, based on the calculated fair value of the award, and is recognized as
an expense over the employees requisite service period (generally the vesting period of the equity
grant). Prior to January 1, 2006, the company accounted for share-based compensation to employees
in accordance with APB No. 25, Accounting for Stock Issued to Employees, and related
interpretations. The company also followed the disclosure requirements of SFAS No. 123, Accounting
for Stock-Based Compensation, as amended by SFAS No. 148, Accounting for Stock-Based Compensation
Transition and Disclosure. The company elected to employ the modified prospective transition
method as provided by SFAS No. 123R and, accordingly, financial statement amounts for the prior
periods presented have not been restated to reflect the fair value method of expensing share-based
compensation.
For the year ended December 31, 2006, the company recorded share-based compensation expense of
$5,762,000. All such compensation is reflected in the accompanying condensed consolidated income
statement within the selling, distribution and administrative expense line item. Share-based
compensation expense recognized in 2006 is based on awards ultimately expected to vest; therefore,
it has been reduced for estimated forfeitures. SFAS No. 123R requires forfeitures to be estimated
at the time of grant and revised, if necessary, in subsequent periods if actual forfeitures differ
from those estimates. In the pro forma information presented for periods prior to 2006, the company
accounted for forfeitures as they occurred.
For the year ended December 31, 2006, Aprias adoption of SFAS No. 123R reduced the companys
operating income and income before taxes by $2,323,000 and net income was reduced by $1,737,000.
Basic and diluted earnings per share were each reduced by $0.04 for the year ended December 31,
2006. The adoption of SFAS No. 123R did not affect cash flow.
The company estimates the fair value of stock options using the Black-Scholes valuation model.
Key input assumptions used to estimate the fair value of stock options include the exercise price
of the award, the expected option term, the expected volatility of the companys stock over the
options expected term, the risk-free interest rate over the options term, and the companys
expected annual dividend yield. Aprias management believes that the valuation technique and the
approach utilized to develop the underlying assumptions are appropriate in calculating the fair
values of the companys stock options granted in 2006. Estimates of fair value are not intended to
predict actual future events or the value ultimately realized by persons who receive equity awards.
The key input assumptions that were utilized in the valuation of the stock options granted
during the year ended December 31, 2006 are summarized in the table below.
|
|
|
|
|
Expected option term (1) |
|
4.8 years |
Expected volatility (2) |
|
|
27.3 |
% |
Risk-free interest rate (3) |
|
|
4.6 |
% |
Expected annual dividend yield |
|
|
0 |
% |
|
|
|
(1) |
|
The expected option term is based on historical exercise and post-vesting termination patterns. |
|
(2) |
|
Expected volatility represents a combination of historical stock price volatility and implied
volatility from publicly-traded options on Aprias common stock. |
|
(3) |
|
The risk-free interest rate is based on the implied yield on a U.S. Treasury zero coupon issue
with a remaining term equal to the expected term of the option. |
As of December 31, 2006, total unrecognized stock-based compensation cost related to unvested
stock options was $4,739,000, which is expected to be expensed over a weighted-average period of
1.44 years; the total unrecognized stock-based compensation cost related to unvested restricted
stock purchase rights was $3,503,000, which is expected to be expensed over a weighted-average
period of 3.10 years; and the total unrecognized stock-based compensation cost related to unvested
restricted stock awards and units was $9,388,000, which is expected to be expensed over a
weighted-average period of 2.73 years.
Income Taxes. Apria provides for income taxes in accordance with provisions specified
in SFAS No. 109, Accounting for Income Taxes. Accordingly, deferred income tax assets and
liabilities are computed for differences between the financial statement and tax bases of assets
and liabilities. These differences will result in taxable or deductible amounts in the future,
based on tax laws and rates applicable to the periods in which the differences are expected to
affect taxable income. The ultimate realization of deferred tax assets is dependent upon the
generation of future taxable income during the periods in which temporary differences become
deductible. In making an assessment regarding the probability of realizing a benefit from these
deductible differences, management considers the companys current and past performance, the market
environment in which the company operates, tax planning strategies and the length of carryforward
periods. Valuation allowances are established when necessary to reduce deferred tax assets to
amounts that are more likely than not to be realized. Further, the company provides for income tax
issues not yet resolved with federal, state and local tax authorities.
Clinical Expense Reclassification. Respiratory therapy expenses presented within cost of net
revenues are comprised primarily of employee salary and benefit costs or contract fees paid to
respiratory therapists and other related professionals who are deployed to service a patient.
Aprias respiratory therapy personnel are also engaged in a number of administrative and marketing
tasks, and accordingly, these costs are classified within selling, distribution and administrative
expenses and amounted to $15.7 million in 2006 and $18.8 million in 2005. This classification was
adopted in 2005. During prior years, the data was not captured in the detail necessary to make a
corresponding reclassification. Therefore, all respiratory therapy expenses for 2004 are
classified within selling, distribution and administrative expenses and totaled $50 million.
Nursing expenses presented within cost of net revenues are comprised primarily of employee
salary and benefit costs and fees paid to contracted workers who are deployed to service a patient.
The majority of these costs relate to the companys infusion therapy service line which were
previously classified as selling, distribution and administrative expenses. Additional nursing
costs that are currently, and were previously, presented within the cost of net revenues relate to
a small ancillary nursing service business that generates approximately $1 million in revenue
annually. This classification was adopted in 2005. Certain nursing expenses incurred by the
infusion therapy business, including administrative and marketing costs, remain within selling,
distribution and administrative expenses and totaled $4.0 million, $3.9 million and $4.2 million
for 2006, 2005 and 2004, respectively.
Medicare Reimbursement. As more fully discussed under Item 1 BusinessGovernment
Regulation, the following is a high-level summary of certain Medicare and governmental regulatory
issues.
There are a number of legislative and regulatory activities by the Centers for Medicare and
Medicaid Services, or CMS, that affect or may affect Medicare reimbursement policies for products
and services provided by Apria. Certain material provisions are outlined below in chronological
order.
In December 2003, the Medicare Prescription Drug, Improvement and Modernization Act of 2003,
also referred to as the Medicare Modernization Act, or MMA, became law. The provisions contained
therein that are significant to Apria are as follows:
|
|
|
A freeze on annual payment increases for durable medical equipment The freeze
commenced in 2004 and will continue through 2008. |
|
|
|
|
Reimbursement reductions for five durable medical equipment categories Under the
MMA, reimbursement is based on the median price paid for such items on behalf of
beneficiaries of federal employee health benefit plans. The new fee schedules for these
products went into effect January 1, 2005, with the exception of oxygen and oxygen
equipment which was implemented on April 8, 2005. Subsequent legislation has modified
some of these reimbursement methodologies. |
|
|
|
|
Reimbursement reductions for inhalation drugs The previous reimbursement rate of
95% of the average wholesale price was reduced to 80% of the average wholesale price,
effective January 1, 2004. Beginning in January 2005, reimbursement for these drugs was
further reduced to the quarterly manufacturer-reported average sales price, or ASP,
plus 6%, plus a separate dispensing fee per patient episode. The company has no way of
knowing if the quarterly ASPs for inhalation drugs will increase or decrease. Since
2006, dispensing fees have been $57.00 for a 30-day supply for a new patient, $33.00
for each 30-day supply thereafter, and $66.00 for each 90-day supply. Additionally, in
late December 2005, the 2006 fee schedule for Medicare Part B medications that took
effect on January 1, 2006 included commercially manufactured budesonide
(Pulmicort®)1 and DuoNeb®2. |
|
|
|
|
Establishment of a competitive bidding program for Medicare Part B The program
requires that suppliers wishing to provide certain durable medical equipment to
beneficiaries submit bids to Medicare. Although the specific durable medical equipment
items and services subject to this rule and the exact timeline for implementation
remain unspecified, the MMA states that the program is to be phased in as follows: (i)
10 of the largest metropolitan statistical areas, or MSAs, in 2007; (ii) 80 of the
largest MSAs in 2009; and (iii) additional urban areas after 2009. |
|
|
|
|
On August 1, 2006, CMS issued a final rule limited to only selective operational aspects
of the competitive bidding program. To date, a final rule for the remaining components
of the competitive bidding program has not been published. Given the limited information
available regarding CMS final plan for the competitive bidding program, such as the list
of products and services and the MSAs to be included, Apria cannot estimate at this time
the impact of the competitive bidding program on the companys operations or financial
condition. |
|
|
|
|
Reimbursement for home infusion therapy under Medicare Part D Currently, a
limited number of infusion therapies, supplies and equipment are covered by Medicare
Part B. A bill was introduced in Congress in the summer of 2006 to consolidate home
infusion therapy coverage under Part B and to provide for infusion benefit coverage in
a comprehensive manner. |
The Deficit Reduction Act of 2005, or DRA, was signed by the President in February 2006. The
legislation contains the following provisions that will impact reimbursement to Apria:
|
|
|
Effective on January 1, 2006, most items of durable medical equipment currently
categorized in the capped rental category by CMS, will be considered purchased outright
at the end of a 13 month maximum rental period (reduced from 15 months) and the
ownership of such devices will transfer directly to the patients. The first month in
which the new policy had an impact on the companys revenue was February 2007. In
addition, the service and maintenance fee, which had been paid to suppliers twice
yearly after the rental period ended in order to cover various non-equipment service
costs, was eliminated for those patients who commenced service on or after January 1,
2006. Management estimates that the reduction in rental revenues for
impacted DME
products and the loss of the service and maintenance fees in 2007 will be approximately
$4 million and $0.5 million, respectively. The 2007 estimate assumes the loss of
service and maintenance fees for one quarter as the effect of the loss is expected to
impact the latter part of the year only. However, this estimate is subject to
assumptions and uncertainties and the actual negative impact on revenue and fees may be
greater or less. |
|
|
|
Under the DRA, reimbursement for oxygen equipment will also convert from an ongoing
rental method to a |
|
|
|
1 |
|
Pulmicort® is a registered trademark of
Astra Zeneca AB Corporation |
|
2 |
|
DuoNeb® is a registered trademark of
Dey L.P. |
21
|
|
|
rent-to-purchase method. The law mandates that oxygen equipment reimbursement will be
limited to 36 months, after which time the ownership of the equipment will transfer to
the patient. The final rule that CMS issued in November 2006 regarding the
implementation of the DRA establishes new payment classes with varying reimbursement
amounts for oxygen equipment and contents. Beginning in 2008, Medicare will review the
utilization patterns and make adjustments to the payment rates if needed in order to
satisfy the statutory mandate of budget neutrality. The new DRA payment amounts went into
effect January 1, 2007, but the 36-month rental period will be retroactively applied to
January 1, 2006 for all beneficiaries requiring oxygen as of December 31, 2005.
Accordingly, January 2009 is the first month in which the transfer of ownership for
oxygen equipment and the new repair and maintenance policy will
impact the company. |
|
|
|
|
The final rule also limits supplier replacement of oxygen equipment during the rental
period, and requires suppliers to replace beneficiary-owned equipment that does not last
the useful lifetime of the equipment, which CMS has generally defined as being five
years. |
|
|
|
|
Regarding repair and maintenance, the final rule permits payment to suppliers for general
maintenance and servicing of certain patient-owned oxygen equipment every six months,
beginning after the first six months the patient owns the equipment. The final rule
limits payment for general maintenance and servicing visits to 30 minutes of labor based
on rates the Medicare contractors establish. CMS declined to offer general maintenance
and servicing payments for beneficiary-owned liquid and gas equipment with the exception
of a single payment for pick-up and storage or disposal of such equipment that a
beneficiary no longer needs. Once title to the oxygen equipment transfers, CMS will also
pay for certain other reasonable and necessary but non-routine repairs which remain as
yet unspecified by the agency, but CMS will not make separate payment for certain patient
support services, which are currently covered by and included in the monthly bundled
payment rate for oxygen therapy. Apria may or may not continue to provide repair and
maintenance service on patient-owned equipment and is in the process of evaluating the
impact of these changes. |
|
|
|
The Presidents current healthcare proposals seek to further reduce the maximum
rental period for oxygen equipment from the now-mandated 36 months to 13 months. There
are other initiatives to reduce the rental period to 13 months, but it is uncertain
whether any of these initiatives will ultimately be approved by Congress. There are
also legislative provisions that have been introduced in Congress that would repeal the
current oxygen reimbursement cap and equipment ownership mandate included in the DRA,
but it is uncertain whether and when any of the OIGs recommendations or the repeal
legislation ultimately would be adopted and passed by Congress. |
Other outstanding issues that will or could have an impact on Medicare reimbursement levels to
Apria are summarized as follows:
|
|
|
In late December 2005, CMS issued the 2006 Health Care Procedure Coding System, or
HCPCS, fee schedule for Medicare Part B medications and the new two-tiered dispensing
fee for inhalation therapies. The fee schedule took effect on January 1, 2006, and
included two HCPCS codes for commercially manufactured budesonide
(Pulmicort®)3 and DuoNeb®4. The fee schedule also included a
revised definition for the HCPCS codes for commercially manufactured budesonide and
budesonide compounded from a powder, and separated these products into two unique
codes. |
|
|
|
In January 2006, CMS published a final regulation that would shift payment for
certain respiratory assist devices from ongoing rental method to a rent-to-purchase
method The change in the payment method became effective April 1, 2006. The policy
applies to those respiratory assist devices (known as BiPAP STs) that have a backup
rate feature that delivers pressure whenever the users spontaneous breathing efforts
are insufficient. The first month in which the new categorization will impact the
companys revenue will be May 2007. The companys estimate for this change in payment
categories is a reduction in 2007 revenues of $3 million. |
|
|
|
In January 2006, CMS announced and later modified the designation of four specialty
contractors, DME MACs, which will be responsible for handling the administration of all
Medicare claims from suppliers of durable |
|
|
|
3 |
|
Pulmicort® is a registered trademark of
Astra Zeneca AB Corporation |
|
4 |
|
DuoNeb® is a registered trademark of
Dey L.P. |
22
medical equipment. It is difficult at this time to predict precisely how this change in
claims administration will affect DME suppliers, nor can the company predict or estimate
the potential impact of this change on collections of its accounts receivable.
|
|
|
On March 24, 2006, the three Program Safeguard Contractors, or PSCs, overseeing
durable medical equipment issued a proposed Local Coverage Determination, or LCD, for
nebulizer medications covered by Medicare Part B. Specifically, four provisions were
proposed: (i) payment for levalbuterol (commercially manufactured as brand-name
Xopenex®)5 would be based on the allowable for generic albuterol sulfate;
(ii) payment for commercially-manufactured, brand-name DuoNeb® would be based on the
allowance for separate unit dose vials of albuterol sulfate and ipratropium bromide;
(iii) coverage for a variety of other nebulizer drugs would be eliminated because the
PSCs assert that there is inadequate support in the medical literature for
administration using a DME nebulizer; and (iv) maximum monthly utilization limits for
budesonide would be defined. |
|
|
|
|
The company believes that the MMA is clear in its intent to prescribe the Part B average
sales price reimbursement formula for single-source drugs which applies to both DuoNeb®
and Xopenex®. The company further believes that the PSCs do not have the legal authority
to circumvent the average sales price methodology through the issuance of an LCD that
invokes their authority to use the Least Costly Alternative as the basis for reducing
the reimbursement for these drugs. The company has determined that if the four provisions
of the LCD are implemented as proposed in the March 24, 2006 document, it will generally
not provide DuoNeb® and Xopenex® to existing or future patients covered by Medicare.
Managements current estimate of providing the replacement medications in lieu of the
brand name drugs is a quarterly gross profit reduction of approximately $3 million.
(Given that the impact for 2007 will only be for a partial year, a quarterly estimate is
provided.) However, this estimate is subject to assumptions and uncertainties and the
actual negative impact on gross profit may be greater or less. |
|
|
|
|
Subsequent to the actions taken by the PSCs in the spring of 2006, CMS initiated a
National Coverage Analysis on December 20, 2006 regarding the same issues of coverage and
payment for certain inhalation drugs. CMS has indicated that it will issue a final
decision in the third quarter of 2007, for implementation in the fourth quarter of 2007
at the earliest. Depending on the final outcome of such a decision by CMS, the company
may or may not continue to provide DuoNeb® and Xopenex® to Medicare beneficiaries after a
revised policy is implemented by CMS. |
|
|
|
|
In late 2006, CMS announced that it has revised the LCD for power mobility devices
resulting in reductions to the power mobility devices fee schedule. The revised fee
schedule imposes reductions for certain power mobility devices of about 15%. The
changes took effect on November 15, 2006. Managements estimate of the annualized
reduction in Aprias revenues resulting from these fee schedule changes is
approximately $1 million. However, this estimate is subject to assumptions and
uncertainties and the actual negative impact on revenue may be greater or less. |
Apria cannot estimate the combined possible impact of all legislative, regulatory and
contemplated reimbursement changes that could have a material adverse effect on Aprias results of
operations, cash flow and capital resources.
|
|
|
5 |
|
Xopenex® is a registered trademark of
Sepracor, Inc. |
23
Results of Operations
Net Revenues. Net revenues were $1,517 million in 2006, $1,474 million in 2005 and $1,451
million in 2004. Growth rates were 2.9% and 1.6% in 2006 and 2005, respectively. The growth for
both years was volume- based. The growth rates for 2006 and 2005 were impacted by Medicare
reimbursement reductions newly imposed on each year. In 2005, Medicare reimbursement reductions
include those that went into effect January 1, 2005 for respiratory drugs and certain durable
medical equipment items. An additional reduction on oxygen and oxygen equipment went into effect
April 8, 2005. The combined reduction totaled $27.4 million in 2005. Growth for 2006 was impacted
by the oxygen reduction for the period in early 2006 prior to the April 8 anniversary date.
Further, a pricing reduction for dispensing fees for respiratory drugs went into effect January 1,
2006 and the average sales prices, which are used as the basis for Medicare reimbursement of
respiratory drugs and are updated each quarter, were generally lower in 2006 than in 2005. The
combined incremental effect on 2006 caused by these Medicare reductions was $15.0 million.
Adjusted for the Medicare pricing reductions, growth rates for 2006 and 2005 were 4.0% and 3.5%,
respectively. Incremental revenues from acquisitions during each year were estimated at $68.0
million for 2005 and $21.3 million for 2006.
Apria expects to continue to face pricing pressures from Medicare as well as from its managed
care customers as these payors seek to lower costs by obtaining more favorable pricing from
providers such as Apria. In addition to the pricing reductions, such changes could cause Apria to
provide reduced levels of certain products and services in the future, resulting in a corresponding
reduction in revenue. However, given Aprias high volume of managed care business, it is
well-positioned among its competitors with respect to the Medicare Advantage plan expansion. See
Medicare Reimbursement.
The following table sets forth a summary of net revenues by service line:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Year Ended December 31, |
|
(in thousands) |
|
2006 |
|
|
2005 |
|
|
2004 |
|
|
Home respiratory therapy |
|
$ |
1,033,267 |
|
|
$ |
1,009,752 |
|
|
$ |
990,857 |
|
Home infusion therapy |
|
|
274,723 |
|
|
|
256,225 |
|
|
|
246,662 |
|
Home medical equipment/other |
|
|
209,317 |
|
|
|
208,124 |
|
|
|
213,930 |
|
|
|
|
|
|
|
|
|
|
|
Total net revenues |
|
$ |
1,517,307 |
|
|
$ |
1,474,101 |
|
|
$ |
1,451,449 |
|
|
|
|
|
|
|
|
|
|
|
Respiratory Therapy. Respiratory therapy revenues are derived primarily from the
provision of oxygen systems, home ventilators, sleep apnea equipment, nebulizers, respiratory
medications and related services. Revenues from the respiratory therapy service line increased by
2.3% in 2006 and by 1.9% in 2005. The majority of the Medicare pricing reductions discussed above
impacted the respiratory therapy line. Such reductions were $15.0 million in 2006 and $24.3
million in 2005. Adjusted for the Medicare reductions, respiratory revenues increased by 3.8% and
4.4% in 2006 and 2005, respectively. The growth was largely related to revenues from the
continuous positive and bi-level airway pressure devices and related supplies. These revenues
currently comprise approximately 28% of total respiratory revenues, and grew by 15.3% in 2006.
Much of this growth was derived through a program the company has instituted to provide via mail
the necessary supplies to patients already utilizing the airway pressure devices. Oxygen revenues,
as adjusted for Medicare pricing reductions, increased by 1.2% in 2006 and respiratory medication
revenues increased by 5.0%, also on an adjusted basis. Acquisitions of respiratory businesses were
the primary driver of respiratory therapy revenue growth in 2005.
Infusion Therapy. The infusion therapy service line involves the administration of
drugs or nutrients directly into the body intravenously through a needle or catheter. Infusion
therapy services also include administering enteral nutrients directly into the gastrointestinal
tract through a feeding tube. Infusion therapy revenues increased by 7.2% in 2006 and 3.9% in 2005.
This growth was primarily related to revenues from enteral nutrition, which comprise just under
half of the infusion therapy line, and which grew by 12.7% in 2006 and by 9.0% in 2005. This
growth is due mainly to internal organizational changes and the management focus that has been
placed on this sub-category.
Home Medical Equipment/Other. Home medical equipment/other revenues are derived from
the provision of equipment to assist patients with ambulation, safety and general care in and
around the home. Home medical equipment/other revenues increased by 0.6% in 2006 and decreased by
2.7% in 2005. In 2005, $3.1 million of the Medicare reimbursement reductions impacted this line of
business. Additionally, hospital utilization rates for many of the companys managed care
contractors were down in the last half of 2005, which served to further depress growth in home
medical equipment/other revenues.
Gross Profit. Gross margins were 65.6% in 2006, 67.5% in 2005, and 71.2% in 2004. The
decline in 2006 from 2005 was primarily caused by the Medicare reimbursement reductions, managed
cared pricing reductions, as well as
24
shifts in product mix to lower margin items. Further, certain
of the Medicare reimbursement changes forced the company to provide higher cost items without
corresponding revenue increases. The comparison between 2005 and 2004 was impacted by many of the
same issues, but also reflects the change in classification of the clinical costs. The respiratory
therapy expenses that were reclassified in 2005 (detailed data was not available for 2004) accounts
for 2.2% of the variance between the two years. See Clinical Expense Reclassification above.
Provision for Doubtful Accounts. The provision for doubtful accounts is based on managements
estimate of the net realizable value of accounts receivable after considering actual write-offs of
specific receivables. Accounts receivable estimated to be uncollectible are provided for by
applying specific percentages to each receivables aging category, which is determined by the number
of days the receivable is outstanding. For 2006, 2005 and 2004, the provision for doubtful
accounts, expressed as percentages of net revenues, was 2.6%, 3.2% and 3.3%, respectively. The
improvement in 2006 from the 2005 and 2004 levels is due to increased cash collections and the
success of a credit card program designed to collect patient receivables upon delivery and
automatically on the rental due date thereafter.
Selling, Distribution and Administrative. Selling, distribution and administrative expenses
are comprised of expenses incurred in direct support of operations and those associated with
administrative functions. Expenses incurred by the operating locations include salaries and other
expenses in the following functional areas: selling, distribution, intake, reimbursement,
warehousing and repair. Many of these operating costs are directly variable with revenue growth
patterns. Some are also very sensitive to market-driven price fluctuations such as facility lease
and fuel costs. The administrative expenses include overhead costs incurred by the operating
locations and corporate support functions. These expenses do not fluctuate with revenue growth as
closely as do operating costs. Certain clinical expenses previously classified in this line have
been reclassified to cost of net revenues. See Clinical Expense Reclassification above.
Selling, distribution and administrative expenses, expressed as percentages of net revenues,
were 53.0% in 2006, 53.7% in 2005, and 53.6% in 2004. The decrease in 2006, as compared to 2005
reflects expense leveraging achieved through the successful implementation of a number of cost
saving initiatives. Such initiatives include those in the revenue management area whereby
productivity and efficiencies have been enhanced by consolidating and centralizing certain
functions. Billing and collection activities for several of the companys larger payors have been
centralized as have certain other related functions. Also, in the logistics area, the routing of
deliveries has been automated which has resulted in decreased miles per delivery and increased
deliveries per driver. The company has been successful in converting these productivity
improvements to cost savings. The decrease in the percentage in 2006 was achieved despite the
pricing reductions to the revenue base noted above.
The selling distribution and administrative percentages for 2005 are not comparable to 2004
due to the respiratory therapy costs that were not reclassified in 2004 to conform to the 2005
presentation. Adjusted for this impact, selling, distribution and administrative expense expressed
as a percentage of net revenues increased 2.4% in 2005 versus 2004. Approximately half of this
increase is attributable to the lower revenues resulting from the Medicare and managed care pricing
changes without a corresponding reduction in the companys actual cost of providing those products
and services. Higher fuel prices and vehicle maintenance expenditures, rising medical benefit
costs, outsourced collection fees and severance charges also factored into the increase. Further,
advertising costs related to the companys diabetic supply business increased year to year as a
result of the companys entry into this market late in the first quarter of 2004.
Qui Tam Settlement and Related Costs. As previously reported, Apria was the subject of an
investigation launched in mid-1998 by the U.S. Attorneys office in Los Angeles and the U.S.
Department of Health and Human Services. The investigation concerned the documentation supporting
Aprias billing for services provided to patients whose healthcare costs were paid by Medicare and
other federal programs. The investigation related to two civil qui tam lawsuits against Apria
filed by individuals suing on behalf of the government. Apria and representatives of the government
and the individual plaintiffs reached a preliminary agreement in early August 2005 to settle these
lawsuits for the aggregate sum of $17.6 million, without any admission of wrongdoing by Apria. The
settlement was finalized in a definitive agreement that was fully executed and became effective on
September 30, 2005, and Apria paid the settlement amount on that date. Apria also incurred $1.7
million in legal fees and other related costs during 2005.
Amortization of Intangible Assets. Amortization of intangible assets was $5.1 million in
2006, $6.9 million in 2005 and $6.7 million in 2004. The decrease in amortization expense in 2006,
when compared to 2005 and 2004, is due
to the slowdown in the companys acquisition activity. See Liquidity and Capital Resources
Business Combinations.
Interest Expense, Interest Income and Write-off of Deferred Debt Issuance Costs. Interest
expense was $31.2 million in 2006, $23.0 million in 2005 and $20.8 million in 2004. The increase
in interest expense in 2006 is primarily
25
attributable to the increase in long-term debt incurred
near the end of 2005 to repurchase $175 million of Aprias common stock. Higher interest rates in
2006 also contributed to the increase, which was mitigated by the debt repayments made over the
course of 2006. The increase in interest expense in 2005, when compared to 2004 was due to the
addition of the $175 million in debt noted above and higher base interest rates. Interest income
was $1.7 million, $853,000 and $779,000 in 2006, 2005 and 2004, respectively.
In 2004, the company wrote off $2.7 million in unamortized debt issuance costs in conjunction
with the November 2004 refinancing of the companys bank loans.
Income Tax Expense. Income taxes were $43.3 million in 2006. The increase was mitigated by the release of $4.0 million of federal and state tax
contingencies due to the completion of a federal income tax audit during 2006. Income taxes were
$40.4 million and $64.3 million for 2005 and 2004, respectively, and were provided at the effective
tax rates expected to be applicable for each year.
The company has various apportioned state net operating loss carryforwards of $8.4 million,
net of federal tax benefit, as of December 31, 2006.
The company believes it has adequately provided for income tax issues not yet resolved with
federal, state and local tax authorities. At December 31, 2006, $12.2 million, net of tax benefit,
was accrued for federal, state and local tax matters and is included in income tax payable.
Although not probable, the most adverse resolution of these federal, state and local issues could
result in additional charges to earnings in future periods in addition to the $12.2 million
currently provided. Based upon a consideration of all relevant facts and circumstances, the
company does not believe the ultimate resolution of tax issues for all open tax periods will have a
materially adverse effect upon its results of operations or financial condition.
Inflation. Apria experiences pricing pressures in the form of continued reductions in
reimbursement rates, particularly from managed care organizations and from governmental payors such
as Medicare and Medicaid. The company is also impacted by rising costs for certain
inflation-sensitive operating expenses such as labor and employee benefits, facility and equipment
leases, and vehicle fuel. However, Apria generally does not believe these impacts are material to
its revenues or net income.
Liquidity and Capital Resources
Aprias principal source of liquidity is its operating cash flow, which is supplemented by a
$500 million revolving credit facility. In recent years, Apria has generated operating cash flows
in excess of its operating needs, which has afforded it the ability to pursue acquisitions and fund
patient service equipment purchases to support revenue growth. Aprias management believes that
its operating cash flow will continue to be sufficient to fund its operations and growth
strategies. In September 2008, the holders of the $250 million convertible senior notes will have
an opportunity to require Apria to repurchase some or all of the notes. Accordingly, Apria
management continues to evaluate its financing alternatives regarding its ability to repurchase
these notes to the extent required by the holders.
Further, Apria has initiated a project to implement a new enterprise-wide information system.
The overall objective of the project is to deliver the necessary technology and automation across
the organization to enable improvements in service, productivity and access to information.
Development on certain modules commenced in 2006. The overall project plan is being designed and
developed and is expected to be implemented over several years.
Cash Flow. Cash provided by operating activities in 2006 was $280.9 million compared to
$206.3 million in 2005 and $271.6 million in 2004. The increase in 2006 is due primarily to a
favorable IRS ruling on the deductibility of interest on the companys convertible notes, increased
cash collections resulting from initiatives to optimize billing processes and to increase
collections of patient co-payments, and timing-related decreases in working capital requirements
The improvement was achieved despite the Medicare and managed care pricing decreases and related
product cost increases noted above. The decrease in operating cash flow in 2005, when compared to
2004 levels, was
primarily due to the Medicare reimbursement reductions and related product cost increases; the qui
tam lawsuit settlement and related fees and an increase in tax payments between the periods, each
as noted above.
Cash used in investing activities was $132.9 million, $223.6 million and $281.4 million in
2006, 2005 and 2004, respectively. The sharp drop in 2006 is due to the reduced level of business
combinations compared to the previous
26
years. The reduction in purchases of patient service and
other equipment in 2006 and 2005, when compared to 2004, is directly attributable to controls
placed on inventory and purchasing.
Cash used in financing activities was $156.6 million in 2006 versus $1.2 million provided in
2005 and $111.4 million used in 2004. The 2006 figure reflects the $155.0 million net
reduction of the companys revolving line of credit. In 2005, the company borrowed from its
revolving credit facility to repurchase $175.0 million worth of its common stock. Cash used in
2004 primarily relates to a $100.0 million stock repurchase and scheduled principal payments made
against term loans in place at the time.
Contractual Cash Obligations. The following table summarizes Aprias long-term cash payment
obligations to which the company is contractually bound:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
For the Year Ending December 31, |
|
|
|
|
(in millions) |
|
2007 |
|
|
2008 |
|
|
2009 |
|
|
2010 |
|
|
2011 |
|
|
2012+ |
|
|
Total |
|
|
Revolving loan |
|
$ |
|
|
|
$ |
|
|
|
$ |
|
|
|
$ |
|
|
|
$ |
235 |
|
|
$ |
|
|
|
$ |
235 |
|
Convertible senior notes |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
250 |
|
|
|
250 |
|
Other debt |
|
|
2 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
2 |
|
Operating leases |
|
|
56 |
|
|
|
47 |
|
|
|
36 |
|
|
|
26 |
|
|
|
18 |
|
|
|
22 |
|
|
|
205 |
|
Software licenses and related maintenance |
|
|
1 |
|
|
|
1 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
2 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Total contractual cash obligations |
|
$ |
59 |
|
|
$ |
48 |
|
|
$ |
36 |
|
|
$ |
26 |
|
|
$ |
253 |
|
|
$ |
272 |
|
|
$ |
694 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
(1) |
|
Interest on the outstanding borrowings is payable quarterly. |
|
(2) |
|
The holders of the convertible senior notes will first have the option to require Apria
to repurchase all or a portion of their notes in September 2008. Interest on these notes
is paid bi-annually in March and September. |
Accounts Receivable. Accounts receivable before allowance for doubtful accounts decreased to
$238.4 million as of December 31, 2006 from $268.0 million at December 31, 2005. Days sales
outstanding (calculated as of each period-end by dividing accounts receivable, less allowance for
doubtful accounts, by the 90-day rolling average of net revenues) were 49 days at December 31,
2006, compared to 57 days at December 31, 2005. The decrease in accounts receivable and days sales
outstanding is a direct result of the aforementioned improvement in cash collections.
Accounts aged in excess of 180 days of total receivables for certain major payor
categories, and in total, are as follows:
|
|
|
|
|
|
|
|
|
|
|
December 31, |
|
December 31, |
|
|
2006 |
|
2005 |
|
Total |
|
|
19.8 |
% |
|
|
21.1 |
% |
Medicare |
|
|
19.2 |
% |
|
|
22.8 |
% |
Medicaid |
|
|
28.6 |
% |
|
|
28.7 |
% |
Self pay |
|
|
36.5 |
% |
|
|
35.9 |
% |
Managed care/other |
|
|
19.1 |
% |
|
|
19.4 |
% |
Unbilled Receivables. Included in accounts receivable are earned but unbilled
receivables of $30.0 million and $39.0 million at December 31, 2006 and 2005, respectively.
Delays, ranging from a day up to several weeks, between the date of service and billing can occur
due to delays in obtaining certain required payor-specific documentation from internal and external
sources. Earned but unbilled receivables are aged from date of service and are considered in
Aprias analysis of historical performance and collectibility. The lower unbilled amount at the end
of 2006 is largely due to the significant decrease in acquisition activity in 2006. The
acquisitions executed in 2005 were the primary cause of the higher unbilled receivable balance at
the end of that year. The time-consuming processes of converting patient files onto Aprias
systems and obtaining provider numbers from governmental payors routinely delay billing of newly
acquired business.
Inventories and Patient Service Equipment. Inventories consist primarily of pharmaceuticals
and disposable products used in conjunction with patient service equipment. Patient service
equipment consists of respiratory and home medical equipment that is provided to in-home patients
for the course of their care plan, normally on a rental basis, and subsequently returned to Apria
for redistribution after cleaning and maintenance is performed.
The branch locations serve as the primary point from which inventories and patient service
equipment are delivered to patients. Certain products and services, such as infusion therapy and
respiratory medications, bypass the branches and are provided directly to patients from pharmacies
or other central locations. The branches are supplied with inventory and equipment from central
warehouses that service specific areas of the country. Such warehouses are also
27
responsible for
repairs and scheduled maintenance of patient service equipment, which adds to the frequent movement
of equipment between locations. Further, the majority of Aprias patient service equipment is
located in patients homes. While utilization varies widely between equipment types, on the
average, approximately 82% of equipment is on rent at any given time. Inherent in this asset flow
is the fact that losses will occur. Management has successfully instituted a number of controls
over the companys inventories and patient service equipment to minimize such losses. Depending on
the product type, the company performs physical inventories on an annual or quarterly basis.
Inventory and patient service equipment balances in the financial records are adjusted to reflect
the results of these physical inventories. Inventory and patient service equipment losses for
2006, 2005 and 2004, were $3.1 million, $868,000 and $2.0 million, respectively.
Long-term Debt. Aprias senior secured credit agreement with Bank of America and a syndicate
of lenders was amended effective June 23, 2006. The amendment extended the maturity
date from November 23, 2009 to June 23, 2011 and lowered the applicable interest rate margins and
commitment fees. The credit agreement is structured as a $500 million revolving credit facility.
The credit agreement permits Apria to select one of two variable interest rates. One option is the
base rate, which is expressed as the higher of (a) the Federal Funds rate plus 0.50% or (b) the
Bank of America prime rate. The other option is the Eurodollar rate, which is based on the London
Interbank Offered Rate. Interest on outstanding balances under the credit agreement is determined
by adding a margin to the Eurodollar rate or base rate in effect at each interest calculation date.
The applicable margin for the revolving credit facility is based on Aprias debt rating as
determined by Standard and Poors Ratings Services or Moodys Investor Services with respect to the
credit facility. The applicable margins, as amended, range from 0.625% to 1.25% for Eurodollar
loans and from zero to 0.25% for base rate loans. The credit agreement also requires payment of
commitment fees ranging from 0.10% to 0.20% (also based on Aprias debt rating) on the unused
portion of the revolving credit facility. The effective interest rate at December 31, 2006, after
consideration of the effect of the swap agreements described below, was 6.25%. See Hedging
Activities.
On December 31, 2006 outstanding borrowings on the revolving credit facility were $235.0
million outstanding letters of credit totaled $3.9 million and credit available under the
revolving facility was $261.1 million. At December 31, 2006, the company was in compliance with all of the financial
covenants required by the credit agreement. Borrowings under the credit facility are secured by a pledge of the common stock
of all of the companys subsidiaries.
Convertible Senior Notes. In August 2003, Apria issued convertible senior
notes in the aggregate principal amount of $250 million under an indenture between Apria and U.S.
Bank National Association. The notes were issued in a private placement at an issue price of
$1,000 per note (100% of the principal amount at maturity) and were subsequently registered with
the Securities and Exchange Commission. The notes will mature on September 1, 2033, unless earlier
converted, redeemed or repurchased by Apria. Apria may redeem some or all of the notes at any time
after September 8, 2010 at a redemption price equal to 100% of the principal amount of the notes to
be redeemed plus accrued and unpaid interest and contingent interest, if any, to the redemption
date. The holders of the notes may require Apria to repurchase some or all of the notes at a
repurchase price equal to 100% of the principal amount of the notes plus accrued and unpaid
interest, including contingent interest, up to but excluding the applicable repurchase date,
initially on September 1, 2008, and subsequently on September 1 of 2010, 2013, 2018, 2023 and 2028,
or at any time prior to their maturity following a fundamental change, as defined in the indenture.
Any notes that Apria is required to repurchase will be paid for in cash, pursuant to the terms of
a December 2004 amendment to the indenture which eliminated the companys option to pay part of the
repurchase price in shares of common stock.
The notes bear interest at the rate of 33/8% per year. Interest on the notes is payable on
September 1 and March 1 of each year, beginning on March 1, 2004. Also, during certain periods
commencing on September 8, 2010, Apria will pay contingent interest on the interest payment date
for the applicable interest period if the average trading price of the notes during the five
trading days ending on the third day immediately preceding the first day of the applicable interest
period equals or exceeds 120% of the principal amount of the notes. The contingent interest
payable per note will equal 0.25% per year of the average trading price of such note during the
applicable five trading-day reference period. Further, the notes are convertible, at the holders option, during certain
periods into shares of Apria common
stock, initially at a conversion rate of 28.6852 shares of common stock per $1,000 principal
amount of notes, subject to adjustment in certain events, under certain circumstances as outlined
in the indenture.
Hedging Activities. Apria is exposed to interest rate fluctuations on its underlying
variable rate long-term debt. Aprias policy for managing interest rate risk is to evaluate and
monitor all available relevant information, including but
28
not limited to, the structure of its
interest-bearing assets and liabilities, historical interest rate trends and interest rate
forecasts published by major financial institutions. The tools Apria may utilize to moderate its
exposure to fluctuations in the relevant interest rate indices include, but are not limited to: (1)
strategic determination of repricing periods and related principal amounts, and (2) derivative
financial instruments such as interest rate swap agreements, caps or collars. Apria does not use
derivative financial instruments for trading or other speculative purposes.
During 2006, Apria had two interest rate swap agreements in effect to fix its LIBOR-based
variable rate debt. One of the agreements, which expired in December 2006, had a notional amount
of $25.0 million and a fixed rate of 3.42%. The other agreement, a forward-starting contract with a
three-year term, became effective in January 2006, and has a
notional amount of $25.0 million that
fixes an equivalent amount of the companys variable rate debt at 4.44%.
In 2005, Apria had two interest rate swap agreements. Each agreement had a notional amount of
$25.0 million, with one agreement expiring in December 2005 and the other agreement expiring in
December 2006. In 2004, Apria also had two swap agreements with an aggregate notional amount of
$50.0 million that expired in December 2004.
The swap agreements are being accounted for as cash flow hedges under SFAS No. 133,
Accounting for Derivative Instruments and Hedging Activities. Accordingly, the difference
between the interest received and interest paid is reflected as an adjustment to interest expense.
For the years ended December 31, 2006, 2005 and 2004, Apria received (paid) net settlement amounts
of $540,000, $11,000 and ($1,381,000), respectively. At December 31, 2006, the aggregate fair
value of the swap agreements was an asset of $356,000 and is reflected in the accompanying
consolidated balance sheets in other assets. Unrealized gains and losses on the fair value of the
swap agreements are reflected, net of taxes, in operating income, as the transactions no longer qualify for hedge accounting treatment. Aprias exposure to credit loss
under the swap agreement is limited to the interest rate spread in the event of counterparty
nonperformance. Apria does not anticipate losses due to counterparty nonperformance as its
counterparties to the swap agreement are nationally recognized financial institutions with strong
credit ratings.
Treasury Stock. All repurchased shares of common stock are held as treasury shares.
In
2006, 7,672 shares of employee restricted stock shares, valued at
$141,000, were retained by the company upon vesting to satisfy the related tax obligation.
In October 2005, Aprias Board of Directors authorized the company to repurchase up to $250.0
million worth of its outstanding common stock. On November 7, 2005, Apria purchased 7.3 million
shares of its common stock for $175.0 million through an accelerated share repurchase program.
Under the agreement, Aprias counterparty borrowed shares that were sold to Apria at an initial
price of $23.83. The counterparty then repurchased shares over a period that commenced immediately
after the sale of shares to Apria. The repurchase transaction was completed in February 2006. The
agreement contained a provision that subjected Apria to a purchase price adjustment based on the
volume weighted average price of the companys common stock over the period during which the
counterparty purchased the shares. Such provision resulted in an additional $242,000 owed to the
counterparty that Apria elected to settle in cash in February 2006. This amount was recorded as a
liability at December 31, 2005, with a corresponding charge to interest expense reflecting the
change in the fair value of the settlement contract. The amount remaining on the aforementioned
Board authorization expires at the end of the first quarter of 2007.
In January 2004, Apria prepaid $50.0 million to repurchase 1.7 million shares of its common
stock at a strike price of $28.89 through an accelerated share repurchase program. The repurchase
of the shares was completed in April 2004 and the share price differential was settled in cash in
June 2004, for a total cost of $53 million. During the third quarter of 2004, the company
purchased an additional 1.7 million shares for $47.0 million.
Business Combinations. Apria periodically acquires complementary businesses in specific
geographic markets. Because of the potential for a higher gross margin, Apria targets respiratory
therapy businesses. These transactions are accounted for as purchases and the results of
operations of the acquired companies are included in the accompanying statements of operations from
the dates of acquisition. In accordance with SFAS No. 142, goodwill is no
longer being amortized. Covenants not to compete are being amortized over the life of the
respective agreements. Tradenames and customer lists are being amortized over the period of their
expected benefit.
In 2006, Apria closed 3 small acquisitions for an aggregate consideration of $3.6 million.
Allocation of this amount includes $2.0 million to patient service equipment, $1.3 million in
customer lists and $97,000 to goodwill. The aggregate consideration for the 21 acquisitions that
closed during 2005 was $103.0 million and $148.7 million for the 27
29
acquisitions executed in 2004.
Cash paid for acquisitions, which includes amounts deferred from prior year acquisitions, totaled
$8.1 million, $105.5 million and $144.2 million in 2006, 2005 and 2004, respectively.
Off-Balance Sheet Arrangements
Apria is not a party to off-balance sheet arrangements as defined by the Securities and
Exchange Commission. However, from time to time the company enters into certain types of contracts
that contingently require the company to indemnify parties against third-party claims. The
contracts primarily relate to: (i) certain asset purchase agreements, under which the company may
provide customary indemnification to the seller of the business being acquired; (ii) certain real
estate leases, under which the company may be required to indemnify property owners for
environmental and other liabilities, and other claims arising from the companys use of the
applicable premises; and (iii) certain agreements with the companys officers, directors and
employees, under which the company may be required to indemnify such persons for liabilities
arising out of their relationship with the company.
The terms of such obligations vary by contract and in most instances a specific or maximum
dollar amount is not explicitly stated therein. Generally, amounts under these contracts cannot be
reasonably estimated until a specific claim is asserted. Consequently, no liabilities have been
recorded for these obligations on the companys balance sheets
for any of the periods presented.
30
Item 7A. QUANTITATIVE AND QUALITATIVE DISCLOSURES ABOUT MARKET RISK
Apria is exposed to interest rate fluctuations on its underlying variable rate long-term debt.
Apria utilizes interest rate swap agreements to moderate such exposure. Apria does not use
derivative financial instruments for trading or other speculative purposes.
At December 31, 2006, Aprias revolving credit facility borrowings totaled $235.0 million.
The bank credit agreement governing the revolver provides interest rate options based on the
following indices: Federal Funds Rate, the Bank of America prime rate or the London Interbank
Offered Rate, or LIBOR and all such interest rate options are subject to the application of an
interest margin as specified in the bank credit agreement. At December 31, 2006, all of Aprias
outstanding revolving debt was tied to LIBOR. See Item 7 Managements Discussion and Analysis of
Financial Condition and Results of Operations Liquidity and Capital Resources Long Term Debt.
During 2006, Apria had two interest rate swap agreements in effect to fix its LIBOR-based
variable rate debt. One of the agreements, which expired in December 2006, had a notional amount
of $25.0 million and a fixed rate of 3.42%. The other agreement, a forward-starting contract with a
three-year term, became effective in January 2006, and has a
notional amount of $25.0 million that
fixes an equivalent amount of the companys variable rate debt at 4.44%. See Item 7 Managements
Discussion and Analysis of Financial Condition and Results of
Operations Liquidity and Capital
Resources Long Term Debt Hedging Activities.
Based on the revolving debt outstanding and the swap agreements in place at December 31, 2006,
a 100 basis point change in the applicable interest rates would increase or decrease Aprias annual
cash flow and pretax earnings by approximately $2.1 million. See Managements Discussion and
Analysis of Financial Condition and Results of Operations Long-term Debt Hedging Activities.
Item 8. FINANCIAL STATEMENTS AND SUPPLEMENTARY DATA
The Report of the Independent Registered Public Accounting Firm and the Consolidated Financial
Statements listed in the Index to Consolidated Financial Statements and Financial Statement
Schedule are filed as part of this report.
Item 9. CHANGES IN AND DISAGREEMENTS WITH ACCOUNTANTS ON ACCOUNTING AND FINANCIAL DISCLOSURE
None.
Item 9A. CONTROLS AND PROCEDURES
Disclosure Controls and Procedures
As of the end of the period covered by this report, the company carried out an evaluation,
under the supervision and with the participation of the companys management, including the
companys principal executive officer and principal financial officer, of the effectiveness of the
design and operation of the companys disclosure controls and procedures. Based upon that
evaluation, the principal executive officer and principal financial officer each concluded that the
companys disclosure controls and procedures are effective as of the end of the period covered by
this report.
Changes in Internal Control Over Financial Reporting
During the period covered by this report, there have been no significant changes to the
companys internal control over financial reporting or in other factors that have materially
affected, or are reasonably likely to materially affect, the companys internal control over
financial reporting.
31
MANAGEMENTS REPORT ON INTERNAL CONTROL OVER FINANCIAL REPORTING
Aprias management is responsible for establishing and maintaining adequate internal control
over financial reporting, as such term is defined in Exchange Act Rule 13a-15(f). The companys
internal control over financial reporting system is designed to provide reasonable assurance
regarding the reliability of financial reporting and the preparation of financial statements for
external purposes in accordance with accounting principles generally accepted in the United States
of America. All internal control systems, no matter how well designed, have inherent limitations.
Therefore, even those systems determined to be effective can provide only reasonable assurance that
material misstatements will be prevented or detected on a timely basis. Also, projections of any
evaluation of effectiveness to future periods are subject to the risk that controls may become
inadequate because of changes in conditions, or that the degree of compliance with the policies or
procedures may deteriorate.
Under the supervision and with the participation of management, including the principal
executive and financial officers, the company has conducted an evaluation of the effectiveness of
its internal control over financial reporting based on the framework in Internal Control -
Integrated Framework issued by the Committee of Sponsoring Organizations of the Treadway
Commission. Based on this evaluation, management has concluded that its internal control over
financial reporting was effective as of December 31, 2006.
Managements assessment of the effectiveness of internal control over financial reporting as
of December 31, 2006 has been audited by Deloitte & Touche LLP, an independent registered public
accounting firm, as stated in its report on managements assessment of Aprias internal control
over financial reporting, which is included herein.
March 1, 2007
32
REPORT OF INDEPENDENT REGISTERED PUBLIC ACCOUNTING FIRM
To the Board of Directors and Stockholders of
Apria Healthcare Group Inc.
Lake Forest, California
We have audited managements assessment, included in the accompanying Managements Report on
Internal Control Over Financial Reporting that Apria Healthcare Group, Inc. and subsidiaries (the
Company) maintained effective internal control over financial reporting as of December 31, 2006,
based on criteria established in Internal ControlIntegrated Framework issued by the Committee of
Sponsoring Organizations of the Treadway Commission. The Companys management is responsible for
maintaining effective internal control over financial reporting and for its assessment of the
effectiveness of internal control over financial reporting. Our responsibility is to express an
opinion on managements assessment and an opinion on the effectiveness of the Companys internal
control over financial reporting based on our audit.
We conducted our audit in accordance with the standards of the Public Company Accounting Oversight
Board (United States). Those standards require that we plan and perform the audit to obtain
reasonable assurance about whether effective internal control over financial reporting was
maintained in all material respects. Our audit included obtaining an understanding of internal
control over financial reporting, evaluating managements assessment, testing and evaluating the
design and operating effectiveness of internal control, and performing such other procedures as we
considered necessary in the circumstances. We believe that our audit provides a reasonable basis
for our opinions.
A companys internal control over financial reporting is a process designed by, or under the
supervision of, the companys principal executive and principal financial officers, or persons
performing similar functions, and effected by the companys board of directors, management, and
other personnel 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. A companys internal control over financial reporting includes
those policies and procedures that (1) pertain to the maintenance of records that, in reasonable
detail, accurately and fairly reflect the transactions and dispositions of the assets of the
company; (2) provide reasonable assurance that transactions are recorded as necessary to permit
preparation of financial statements in accordance with generally accepted accounting principles,
and that receipts and expenditures of the company are being made only in accordance with
authorizations of management and directors of the company; and (3) provide reasonable assurance
regarding prevention or timely detection of unauthorized acquisition, use, or disposition of the
companys assets that could have a material effect on the financial statements.
Because of the inherent limitations of internal control over financial reporting, including
the possibility of collusion or improper management override of controls, material misstatements
due to error or fraud may not be prevented or detected on a timely basis. Also, projections of any
evaluation of the effectiveness of the internal control over financial reporting to future periods
are subject to the risk that the controls may become inadequate because of changes in conditions,
or that the degree of compliance with the policies or procedures may deteriorate.
In our opinion, managements assessment that the Company maintained effective internal control over
financial reporting as of December 31, 2006, is fairly stated, in all material respects, based on
the criteria established in Internal ControlIntegrated Framework issued by the Committee of
Sponsoring Organizations of the Treadway Commission. Also in our opinion, the Company maintained,
in all material respects, effective internal control over financial reporting as of December 31,
2006, based on the criteria established in Internal ControlIntegrated Framework issued by the
Committee of Sponsoring Organizations of the Treadway Commission.
We have also audited, in accordance with the standards of the Public Company Accounting Oversight
Board (United States), the consolidated financial statements and financial statement schedule as of
and for the year ended December 31, 2006 of the Company and our report dated March 1, 2007
expressed an unqualified opinion on those financial statements and financial statement schedule and
included an explanatory paragraph regarding the Companys adoption of a new accounting standard,
Statement of Financial Accounting Standards No. 123(R), Share-Based Payment, and the Companys
adoption of Staff Accounting Bulletin No. 108, Considering the Effects of Prior Year Misstatements
when Quantifying Misstatements in Current Year Financial Statements.
/s/ DELOITTE & TOUCHE LLP
Costa Mesa, CA
March 1, 2007
33
Item 9B. OTHER INFORMATION
None.
PART III
Item 10. DIRECTORS, EXECUTIVE OFFICERS AND CORPORATE GOVERNANCE
Information with respect to this Item is incorporated by reference from the companys
definitive Proxy Statement to be filed with the Commission within 120 days after the end of the
companys fiscal year. Information regarding executive officers of the company is set forth in
Item 1 Business Executive Officers of the Registrant.
Item 11. EXECUTIVE COMPENSATION
Information with respect to this Item is incorporated by reference from the companys
definitive Proxy Statement to be filed with the Commission within 120 days after the end of the
companys fiscal year.
Item 12. SECURITY OWNERSHIP OF CERTAIN BENEFICIAL OWNERS AND MANAGEMENT
AND RELATED STOCKHOLDER MATTERS |
Information with respect to this Item is incorporated by reference from the companys
definitive Proxy Statement to be filed with the Commission within 120 days after the end of the
companys fiscal year. Information regarding securities authorized for issuance in Item 5
Market for Registrants Common Equity, Related Stockholder Matters and Issuer Purchases of Equity
Securities Equity Compensation Plans.
Item 13. CERTAIN RELATIONSHIPS AND RELATED TRANSACTIONS, AND DIRECTOR INDEPENDENCE |
Information with respect to this Item is incorporated by reference from the companys
definitive Proxy Statement to be filed with the Commission within 120 days after the end of the
companys fiscal year.
Item 14. PRINCIPAL ACCOUNTING FEES AND SERVICES
Information with respect to this Item is incorporated by reference from the companys
definitive Proxy Statement to be filed with the Commission within 120 days after the end of the
companys fiscal year.
PART IV
Item 15. EXHIBITS, FINANCIAL STATEMENT SCHEDULE
(a) |
1. |
|
The financial statements described in the Index to Consolidated
Financial Statements and Financial Statement Schedule are included in
this Annual Report on Form 10-K starting at page F-1. |
|
|
2. |
|
The financial statement schedule is included on page S-1.
|
|
|
|
|
All other schedules for which provision is made in the applicable
accounting regulations of the Securities and Exchange Commission are
not required under the related instructions or are inapplicable, and
therefore have been omitted. |
|
|
3. |
|
Exhibits included or incorporated by reference herein:
|
|
|
|
|
See exhibit index. |
34
INDEX TO CONSOLIDATED FINANCIAL STATEMENTS
AND FINANCIAL STATEMENT SCHEDULE
|
|
|
|
|
|
|
Page |
|
CONSOLIDATED FINANCIAL STATEMENTS |
|
|
|
|
|
|
|
|
|
|
|
|
F-1 |
|
|
|
|
F-2 |
|
|
|
|
F-3 |
|
|
|
|
F-4 |
|
|
|
|
F-5 |
|
|
|
|
F-6 |
|
|
|
|
|
|
FINANCIAL STATEMENT SCHEDULE |
|
|
|
|
|
|
|
|
|
|
|
|
S-1 |
|
35
REPORT OF INDEPENDENT REGISTERED PUBLIC ACCOUNTING FIRM
To the Board of Directors and Stockholders of
Apria Healthcare Group Inc.
Lake Forest, California
We have audited the accompanying consolidated balance sheets of Apria Healthcare Group, Inc. and
subsidiaries (the Company) as of December 31, 2006 and 2005, and the related consolidated
statements of income, stockholders equity and comprehensive income, and cash flows for each of the
three years in the period ended December 31, 2006. Our audits also included the financial
statement schedule listed in the Index at Item 15. These financial statements and the financial
statement schedule are the responsibility of the Companys management. Our responsibility is to
express an opinion on the financial statements and financial statement schedule based on our
audits.
We conducted our audits in accordance with the standards of the Public Company Accounting Oversight
Board (United States). Those standards require that we plan and perform the audit to obtain
reasonable assurance about whether the financial statements are free of material misstatement. An
audit includes examining, on a test basis, evidence supporting the amounts and disclosures in the
financial statements. An audit also includes assessing the accounting principles used and
significant estimates made by management, as well as evaluating the overall financial statement
presentation. We believe that our audits provide a reasonable basis for our opinion.
In our opinion, such consolidated financial statements present fairly, in all material respects,
the financial position of Apria Healthcare Group, Inc. and subsidiaries at December 31, 2006 and
2005, and the results of their operations and their cash flows for each of the three years in the
period ended December 31, 2006, in conformity with accounting principles generally accepted in the
United States of America. Also, in our opinion, such financial statement schedule, when considered
in relation to the basic consolidated financial statements taken as a whole, present fairly, in all
material respects, the information set forth therein.
We have also audited, in accordance with the standards of the Public Company Accounting Oversight
Board (United States), the effectiveness of the Companys internal control over financial reporting
as of December 31, 2006, based on the criteria established in Internal ControlIntegrated Framework
issued by the Committee of Sponsoring Organizations of the Treadway Commission and our report dated
March 1, 2007 expressed an unqualified opinion on managements assessment of the effectiveness of
the Companys internal control over financial reporting and an unqualified opinion on the
effectiveness of the Companys internal control over financial reporting.
As
discussed in Note 7 to the consolidated financial statements, the Company changed its method of
accounting for share based payments effective January 1, 2006, to conform to Statement of Financial
Accounting Standards No. 123(R), Share-Based Payment and prospectively adjusted the 2006 financial
statements for the change. Also as discussed in Note 1 to the consolidated financial statements,
the Company changed its method of evaluating misstatements effective for fiscal years ending after
November 15, 2006, to conform to Staff Accounting Bulletin No. 108, Considering the Effects of
Prior Year Misstatements when Quantifying Misstatements in Current Year Financial Statements.
/s/ DELOITTE & TOUCHE LLP
Costa Mesa, California
March 1, 2007
F-1
APRIA HEALTHCARE GROUP INC.
CONSOLIDATED BALANCE SHEETS
|
|
|
|
|
|
|
|
|
|
|
December 31, |
|
(in thousands, except share data ) |
|
2006 |
|
|
2005 |
|
ASSETS |
|
|
|
|
|
|
|
|
CURRENT ASSETS |
|
|
|
|
|
|
|
|
Cash and cash equivalents |
|
$ |
14,657 |
|
|
$ |
23,304 |
|
Accounts receivable, less allowance for doubtful accounts of $27,324 and
$41,527 at December 31, 2006 and 2005, respectively |
|
|
211,097 |
|
|
|
226,478 |
|
Inventories, net |
|
|
40,681 |
|
|
|
42,571 |
|
Deferred income taxes |
|
|
36,648 |
|
|
|
30,916 |
|
Deferred expenses |
|
|
22,712 |
|
|
|
|
|
Prepaid expenses and other current assets |
|
|
19,142 |
|
|
|
20,732 |
|
|
|
|
|
|
|
|
TOTAL CURRENT ASSETS |
|
|
344,937 |
|
|
|
344,001 |
|
|
|
|
|
|
|
|
|
|
PATIENT SERVICE EQUIPMENT, less accumulated depreciation of
$445,608 and $446,728 at December 31, 2006 and 2005, respectively |
|
|
212,068 |
|
|
|
225,575 |
|
PROPERTY, EQUIPMENT AND IMPROVEMENTS, NET |
|
|
52,975 |
|
|
|
46,087 |
|
DEFERRED INCOME TAXES |
|
|
|
|
|
|
4,059 |
|
GOODWILL |
|
|
539,187 |
|
|
|
540,985 |
|
INTANGIBLE ASSETS, NET |
|
|
6,551 |
|
|
|
10,580 |
|
DEFERRED DEBT ISSUANCE COSTS, NET |
|
|
4,612 |
|
|
|
5,248 |
|
OTHER ASSETS |
|
|
8,166 |
|
|
|
9,363 |
|
|
|
|
|
|
|
|
|
|
$ |
1,168,496 |
|
|
$ |
1,185,898 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
LIABILITIES AND STOCKHOLDERS EQUITY |
|
|
|
|
|
|
|
|
CURRENT LIABILITIES |
|
|
|
|
|
|
|
|
Accounts payable |
|
$ |
66,969 |
|
|
$ |
63,984 |
|
Accrued payroll and related taxes and benefits |
|
|
46,532 |
|
|
|
51,167 |
|
Income taxes payable |
|
|
10,793 |
|
|
|
8,664 |
|
Other accrued liabilities |
|
|
44,804 |
|
|
|
42,511 |
|
Deferred revenue |
|
|
32,280 |
|
|
|
|
|
Current portion of long-term debt |
|
|
2,145 |
|
|
|
4,465 |
|
|
|
|
|
|
|
|
TOTAL CURRENT LIABILITIES |
|
|
203,523 |
|
|
|
170,791 |
|
|
|
|
|
|
|
|
|
|
LONG-TERM DEBT, net of current portion |
|
|
485,000 |
|
|
|
640,855 |
|
DEFERRED INCOME TAXES |
|
|
60,815 |
|
|
|
38,079 |
|
OTHER NON-CURRENT LIABILITIES |
|
|
8,727 |
|
|
|
9,009 |
|
|
|
|
|
|
|
|
TOTAL LIABILITIES |
|
|
758,065 |
|
|
|
858,734 |
|
|
|
|
|
|
|
|
|
|
COMMITMENTS AND CONTINGENCIES (Notes 10 and 12) |
|
|
|
|
|
|
|
|
STOCKHOLDERS EQUITY |
|
|
|
|
|
|
|
|
Preferred stock, $.001 par value: |
|
|
|
|
|
|
|
|
10,000,000 shares authorized; none issued |
|
|
|
|
|
|
|
|
Common stock, $.001 par value: |
|
|
|
|
|
|
|
|
150,000,000 shares authorized; 59,762,307 and 59,215,749 shares issued
at December 31, 2006 and 2005, respectively; 42,789,450 and 42,250,564
outstanding at December 31, 2006 and 2005, respectively |
|
|
60 |
|
|
|
59 |
|
Additional paid-in capital |
|
|
482,123 |
|
|
|
468,099 |
|
Treasury stock, at cost; 16,972,857 and 16,965,185 shares at
December 31, 2006 and 2005, respectively |
|
|
(429,573 |
) |
|
|
(429,432 |
) |
Retained earnings |
|
|
357,470 |
|
|
|
287,982 |
|
Accumulated other comprehensive income |
|
|
351 |
|
|
|
456 |
|
|
|
|
|
|
|
|
TOTAL STOCKHOLDERS EQUITY |
|
|
410,431 |
|
|
|
327,164 |
|
|
|
|
|
|
|
|
|
|
$ |
1,168,496 |
|
|
$ |
1,185,898 |
|
|
|
|
|
|
|
|
See notes to consolidated financial statements.
F-2
APRIA HEALTHCARE GROUP INC.
CONSOLIDATED STATEMENTS OF INCOME
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Year Ended December 31, |
|
(in thousands, except per share data) |
|
2006 |
|
|
2005 |
|
|
2004 |
|
|
Net revenues: |
|
|
|
|
|
|
|
|
|
|
|
|
Fee for service arrangements |
|
$ |
1,355,818 |
|
|
$ |
1,327,777 |
|
|
$ |
1,312,269 |
|
Capitation arrangements |
|
|
161,489 |
|
|
|
146,324 |
|
|
|
139,180 |
|
|
|
|
|
|
|
|
|
|
|
TOTAL NET REVENUES |
|
|
1,517,307 |
|
|
|
1,474,101 |
|
|
|
1,451,449 |
|
|
|
|
|
|
|
|
|
|
|
Costs and expenses: |
|
|
|
|
|
|
|
|
|
|
|
|
Cost of net revenues: |
|
|
|
|
|
|
|
|
|
|
|
|
Product and supply costs |
|
|
345,552 |
|
|
|
309,413 |
|
|
|
271,723 |
|
Patient service equipment depreciation |
|
|
113,177 |
|
|
|
111,759 |
|
|
|
119,391 |
|
Respiratory therapy services |
|
|
38,501 |
|
|
|
34,669 |
|
|
|
|
|
Nursing services |
|
|
8,825 |
|
|
|
9,078 |
|
|
|
10,644 |
|
Other |
|
|
15,384 |
|
|
|
14,369 |
|
|
|
15,686 |
|
|
|
|
|
|
|
|
|
|
|
TOTAL COST OF NET REVENUES |
|
|
521,439 |
|
|
|
479,288 |
|
|
|
417,444 |
|
Provision for doubtful accounts |
|
|
38,723 |
|
|
|
46,948 |
|
|
|
48,567 |
|
Selling, distribution and administrative |
|
|
804,365 |
|
|
|
792,177 |
|
|
|
777,671 |
|
Qui tam settlement and related costs (Note 12) |
|
|
|
|
|
|
19,258 |
|
|
|
|
|
Amortization of intangible assets |
|
|
5,080 |
|
|
|
6,941 |
|
|
|
6,712 |
|
|
|
|
|
|
|
|
|
|
|
TOTAL COSTS AND EXPENSES |
|
|
1,369,607 |
|
|
|
1,344,612 |
|
|
|
1,250,394 |
|
|
|
|
|
|
|
|
|
|
|
OPERATING INCOME |
|
|
147,700 |
|
|
|
129,489 |
|
|
|
201,055 |
|
Interest expense |
|
|
31,205 |
|
|
|
22,972 |
|
|
|
20,799 |
|
Interest income |
|
|
(1,742 |
) |
|
|
(853 |
) |
|
|
(779 |
) |
Write-off of deferred debt issuance costs |
|
|
|
|
|
|
|
|
|
|
2,730 |
|
|
|
|
|
|
|
|
|
|
|
INCOME BEFORE TAXES |
|
|
118,237 |
|
|
|
107,370 |
|
|
|
178,305 |
|
Income tax expense |
|
|
43,257 |
|
|
|
40,429 |
|
|
|
64,297 |
|
|
|
|
|
|
|
|
|
|
|
NET INCOME |
|
$ |
74,980 |
|
|
$ |
66,941 |
|
|
$ |
114,008 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Basic net income per common share |
|
$ |
1.77 |
|
|
$ |
1.39 |
|
|
$ |
2.31 |
|
|
|
|
|
|
|
|
|
|
|
Diluted net income per common share |
|
$ |
1.75 |
|
|
$ |
1.37 |
|
|
$ |
2.27 |
|
|
|
|
|
|
|
|
|
|
|
See notes to consolidated financial statements.
F-3
APRIA HEALTHCARE GROUP INC.
CONSOLIDATED STATEMENTS OF STOCKHOLDERS EQUITY
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
(Accumulated |
|
|
Accumulated |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Additional |
|
|
|
|
|
|
|
|
|
|
Deficit) |
|
|
Other |
|
|
Total |
|
|
|
Common Stock |
|
|
Paid-In |
|
|
Treasury Stock |
|
|
Retained |
|
|
Comprehensive |
|
|
Stockholders |
|
(in thousands) |
|
Shares |
|
|
Par Value |
|
|
Capital |
|
|
Shares |
|
|
Cost |
|
|
Earnings |
|
|
(Loss) Income |
|
|
Equity |
|
|
Balance at December 31, 2003 |
|
|
57,317 |
|
|
$ |
57 |
|
|
$ |
414,220 |
|
|
|
6,210 |
|
|
$ |
(154,432 |
) |
|
$ |
107,033 |
|
|
$ |
(930 |
) |
|
$ |
365,948 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Exercise of stock options |
|
|
893 |
|
|
|
1 |
|
|
|
18,314 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
18,315 |
|
Tax benefits related to stock options |
|
|
|
|
|
|
|
|
|
|
2,587 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
2,587 |
|
Compensatory stock options and
awards |
|
|
26 |
|
|
|
|
|
|
|
4,423 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
4,423 |
|
Repurchases of common stock |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
3,418 |
|
|
|
(100,000 |
) |
|
|
|
|
|
|
|
|
|
|
(100,000 |
) |
Unrealized gain on interest rate
swap agreements, net of taxes |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
904 |
|
|
|
904 |
|
Net income |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
114,008 |
|
|
|
|
|
|
|
114,008 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Total comprehensive income |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
114,008 |
|
|
|
904 |
|
|
|
114,912 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Balance at December 31, 2004 |
|
|
58,236 |
|
|
$ |
58 |
|
|
$ |
439,544 |
|
|
|
9,628 |
|
|
$ |
(254,432 |
) |
|
$ |
221,041 |
|
|
$ |
(26 |
) |
|
$ |
406,185 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Exercise of stock options |
|
|
937 |
|
|
|
1 |
|
|
|
21,179 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
21,180 |
|
Tax benefits related to stock options |
|
|
|
|
|
|
|
|
|
|
4,117 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
4,117 |
|
Compensatory stock options and
awards |
|
|
43 |
|
|
|
|
|
|
|
3,259 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
3,259 |
|
Repurchases of common stock |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
7,337 |
|
|
|
(175,000 |
) |
|
|
|
|
|
|
|
|
|
|
(175,000 |
) |
Unrealized gain on interest rate
swap agreements, net of taxes |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
482 |
|
|
|
482 |
|
Net income |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
66,941 |
|
|
|
|
|
|
|
66,941 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Total comprehensive income |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
66,941 |
|
|
|
482 |
|
|
|
67,423 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Balance at December 31, 2005 |
|
|
59,216 |
|
|
$ |
59 |
|
|
$ |
468,099 |
|
|
|
16,965 |
|
|
$ |
(429,432 |
) |
|
$ |
287,982 |
|
|
$ |
456 |
|
|
$ |
327,164 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Cumulative effect adjustment pursuant
to adoption of SAB No. 108 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
(5,492 |
) |
|
|
|
|
|
|
(5,492 |
) |
Exercise of stock options |
|
|
508 |
|
|
|
1 |
|
|
|
8,244 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
8,245 |
|
Tax benefits related to stock options |
|
|
|
|
|
|
|
|
|
|
17 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
17 |
|
Compensatory stock options and
awards |
|
|
38 |
|
|
|
|
|
|
|
5,763 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
5,763 |
|
Restricted
stock retained in treasury upon vesting |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
8 |
|
|
|
(141 |
) |
|
|
|
|
|
|
|
|
|
|
(141 |
) |
Unrealized loss on interest rate
swap agreements, net of taxes |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
(105 |
) |
|
|
(105 |
) |
Net income |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
74,980 |
|
|
|
|
|
|
|
74,980 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Total comprehensive income |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
74,980 |
|
|
|
(105 |
) |
|
|
74,875 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Balance at December 31, 2006 |
|
|
59,762 |
|
|
$ |
60 |
|
|
$ |
482,123 |
|
|
|
16,973 |
|
|
$ |
(429,573 |
) |
|
$ |
357,470 |
|
|
$ |
351 |
|
|
$ |
410,431 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
See notes to consolidated financial statements.
F-4
APRIA HEALTHCARE GROUP INC.
CONSOLIDATED STATEMENTS OF CASH FLOWS
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Year Ended December 31, |
|
(in thousands) |
|
2006 |
|
|
2005 |
|
|
2004 |
|
|
OPERATING ACTIVITIES |
|
|
|
|
|
|
|
|
|
|
|
|
Net income |
|
$ |
74,980 |
|
|
$ |
66,941 |
|
|
$ |
114,008 |
|
Items included in net income not requiring cash: |
|
|
|
|
|
|
|
|
|
|
|
|
Provision for doubtful accounts |
|
|
38,723 |
|
|
|
46,948 |
|
|
|
48,567 |
|
Depreciation |
|
|
133,563 |
|
|
|
133,677 |
|
|
|
140,762 |
|
Amortization of intangible assets |
|
|
5,080 |
|
|
|
6,941 |
|
|
|
6,712 |
|
Amortization of deferred debt issuance costs |
|
|
1,755 |
|
|
|
1,729 |
|
|
|
5,153 |
|
Deferred income taxes |
|
|
24,673 |
|
|
|
(5,210 |
) |
|
|
20,798 |
|
Share-based compensation |
|
|
5,762 |
|
|
|
3,259 |
|
|
|
4,423 |
|
Loss on disposition of assets and other |
|
|
(81 |
) |
|
|
|
|
|
|
(682 |
) |
Changes in operating assets and liabilities, exclusive of effects of acquisitions: |
|
|
|
|
|
|
|
|
|
|
|
|
Accounts receivable |
|
|
(23,342 |
) |
|
|
(54,198 |
) |
|
|
(70,302 |
) |
Inventories, net |
|
|
2,025 |
|
|
|
(561 |
) |
|
|
(9,372 |
) |
Prepaid expenses and other assets |
|
|
7,094 |
|
|
|
3,451 |
|
|
|
832 |
|
Accounts payable, exclusive of book cash overdraft |
|
|
7,717 |
|
|
|
2,907 |
|
|
|
1,050 |
|
Accrued payroll and related taxes and benefits |
|
|
(4,775 |
) |
|
|
3,547 |
|
|
|
4,308 |
|
Income taxes payable |
|
|
2,145 |
|
|
|
(6,427 |
) |
|
|
7,935 |
|
Excess tax
benefits from shared-based compensation |
|
|
(403 |
) |
|
|
|
|
|
|
|
|
Deferred revenue, net of related expenses |
|
|
560 |
|
|
|
|
|
|
|
|
|
Accrued expenses |
|
|
5,438 |
|
|
|
3,295 |
|
|
|
(2,577 |
) |
|
|
|
|
|
|
|
|
|
|
NET CASH PROVIDED BY OPERATING ACTIVITIES |
|
|
280,914 |
|
|
|
206,299 |
|
|
|
271,615 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
INVESTING ACTIVITIES |
|
|
|
|
|
|
|
|
|
|
|
|
Purchases of patient service equipment and property, equipment
and improvements, exclusive of effects of acquisitions |
|
|
(125,628 |
) |
|
|
(118,867 |
) |
|
|
(137,358 |
) |
Proceeds from disposition of assets |
|
|
778 |
|
|
|
767 |
|
|
|
211 |
|
Cash paid for acquisitions, including payments of deferred consideration |
|
|
(8,082 |
) |
|
|
(105,471 |
) |
|
|
(144,235 |
) |
|
|
|
|
|
|
|
|
|
|
NET CASH USED IN INVESTING ACTIVITIES |
|
|
(132,932 |
) |
|
|
(223,571 |
) |
|
|
(281,382 |
) |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
FINANCING ACTIVITIES |
|
|
|
|
|
|
|
|
|
|
|
|
Proceeds from revolving credit facilities |
|
|
29,800 |
|
|
|
216,250 |
|
|
|
250,850 |
|
Payments on revolving credit facilities |
|
|
(184,800 |
) |
|
|
(51,000 |
) |
|
|
(26,100 |
) |
Payments on term loans |
|
|
|
|
|
|
|
|
|
|
(244,063 |
) |
Payments on other long-term debt |
|
|
(7,030 |
) |
|
|
(7,854 |
) |
|
|
(9,033 |
) |
Change in book cash overdraft included in accounts payable |
|
|
(2,128 |
) |
|
|
(2,384 |
) |
|
|
1,419 |
|
Capitalized debt issuance costs |
|
|
(1,119 |
) |
|
|
(15 |
) |
|
|
(2,775 |
) |
Repurchases of common stock |
|
|
|
|
|
|
(175,000 |
) |
|
|
(100,000 |
) |
Excess tax
benefits from shared-based compensation |
|
|
403 |
|
|
|
|
|
|
|
|
|
Issuances of common stock |
|
|
8,245 |
|
|
|
21,180 |
|
|
|
18,315 |
|
|
|
|
|
|
|
|
|
|
|
NET CASH (USED IN) PROVIDED BY FINANCING ACTIVITIES |
|
|
(156,629 |
) |
|
|
1,177 |
|
|
|
(111,387 |
) |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
NET DECREASE IN CASH AND CASH EQUIVALENTS |
|
|
(8,647 |
) |
|
|
(16,095 |
) |
|
|
(121,154 |
) |
Cash and cash equivalents at beginning of year |
|
|
23,304 |
|
|
|
39,399 |
|
|
|
160,553 |
|
|
|
|
|
|
|
|
|
|
|
CASH AND CASH EQUIVALENTS AT END OF YEAR |
|
$ |
14,657 |
|
|
$ |
23,304 |
|
|
$ |
39,399 |
|
|
|
|
|
|
|
|
|
|
|
SUPPLEMENTAL DISCLOSURES See Note 6 and Note 8 for cash paid for interest and income
taxes, respectively.
NON-CASH TRANSACTIONS See Statements of Stockholders Equity, Note 4 and Note 10 for tax benefit
from stock option exercises, non-cash treasury stock transaction, liabilities assumed in acquisitions and purchase of property and
equipment under capital leases, respectively.
Purchases of patient service equipment and property, equipment and improvements exclude purchases
that remain unpaid at the end of the respective year. Such amounts are then included in the
following years purchases. Unpaid purchases were $8,152, $10,754 and $10,895 at December 31, 2006,
2005 and 2004, respectively.
See notes to consolidated financial statements.
F-5
APRIA HEALTHCARE GROUP INC.
NOTES TO CONSOLIDATED FINANCIAL STATEMENTS
NOTE 1 SUMMARY OF SIGNIFICANT ACCOUNTING POLICIES
Basis of Presentation: The accompanying consolidated financial statements have been prepared
in accordance with accounting principles generally accepted in the United States of America. These
statements include the accounts of Apria Healthcare Group Inc. (Apria or the company) and its
subsidiaries. Intercompany transactions and accounts have been eliminated in consolidation.
Company Background and Segment Reporting: Apria operates in the home healthcare segment of
the healthcare industry, providing a variety of clinical services and related products and supplies
as prescribed by a physician or authorized by a case manager as part of a care plan. Essentially
all products and services offered by the company are provided through the companys network of
approximately 475 branch facilities, which are located throughout the United States and are
currently organized into three geographic divisions. The companys chief operating decision maker
evaluates operating results on a divisional basis and, therefore, each division is designated an
operating segment (previously companys 15 regions). All divisions provide the same products and services, including respiratory
therapy, infusion therapy and home medical equipment and supplies. For financial reporting
purposes, all of the companys operating segments are aggregated into one reportable segment in
accordance with the aggregation criteria of Statement of Financial Accounting Standards (SFAS)
No. 131, Disclosures about Segments of an Enterprise and Related Information.
Use of Accounting Estimates: The preparation of financial statements in conformity with
generally accepted accounting principles requires management to make estimates and assumptions that
affect the amounts reported in the financial statements and accompanying notes. Actual results
could differ from those estimates.
Revenue Recognition and Concentration of Credit Risk: Revenues are recognized on the date
services and related products are provided to patients and are recorded at amounts estimated to be
received under reimbursement arrangements with third-party payors, including private insurers,
prepaid health plans, Medicare and Medicaid. For the years 2006, 2005 and 2004, revenues
reimbursed under arrangements with Medicare and Medicaid were approximately 36%, 39% and 38%,
respectively, as a percentage of total revenues. In all three years presented, no other
third-party payor group represented more than 9% of the companys revenues. The majority of the
companys revenues are derived from fees charged for patient care under fee-for-service
arrangements. Revenues derived from capitation arrangements represented 11% of total net revenues
for 2006 and less than 10% of total net revenues for 2005 and 2004. Capitation revenue is earned
as a result of entering into a contract with a third party to provide its members certain services
without regard to the actual services provided, therefore revenue is recognized in the period that
the beneficiaries are entitled to health care services.
Cash and Cash Equivalents: Apria maintains cash with various financial institutions. These
financial institutions are located throughout the United States and the companys cash management
practices limit exposure to any one institution. Outstanding checks, which are reported as a
component of accounts payable, were $18,519,000 and $20,647,000 at December 31, 2006 and 2005,
respectively. Management considers all highly liquid instruments purchased with a maturity of less
than three months to be cash equivalents.
Accounts Receivable: Included in accounts receivable are earned but unbilled receivables of
$30,036,000 and $39,015,000 at December 31, 2006 and 2005, respectively. Delays ranging from a day
up to several weeks between the date of service and billing can occur due to delays in obtaining
certain required payor-specific documentation from internal and external sources. Earned but
unbilled receivables are aged from date of service and are considered in Aprias analysis of
historical performance and collectibility.
Due to the nature of the industry and the reimbursement environment in which Apria operates,
certain estimates are required to record net revenues and accounts receivable at their net
realizable values. Inherent in these estimates is the risk that they will have to be revised or
updated as additional information becomes available. Specifically, the complexity of many
third-party billing arrangements and the uncertainty of reimbursement amounts for certain services
from certain payors may result in adjustments to amounts originally recorded. Such adjustments are
typically identified and recorded at the point of cash application, claim denial or account review.
Management performs periodic analyses to evaluate accounts receivable balances to ensure that
recorded amounts reflect estimated net realizable value. Specifically, management considers
historical realization data, accounts receivable aging trends, other operating trends, the extent
of contracted business and business combinations. Also considered are relevant business conditions
such as governmental and managed care payor claims processing procedures and system changes.
Additionally, focused reviews of certain large and/or problematic payors are performed.
Due to continuing changes in the healthcare industry
F-6
NOTES TO CONSOLIDATED FINANCIAL STATEMENTS (continued)
and third-party reimbursement, it is possible that
managements estimates could change in the near term, which could have an impact on operations and
cash flows.
Accounts receivable are reduced by an allowance for doubtful accounts which provides for those
accounts from which payment is not expected to be received, although services were provided and
revenue was earned. Upon determination that an account is uncollectible, it is written-off and
charged to the allowance.
Inventories: Inventories are stated at the lower of cost (first-in, first-out method) or
market and consist primarily of pharmaceuticals and items used in conjunction with patient service
equipment.
Patient Service Equipment: Patient service equipment is stated at cost and consists of
medical equipment provided to in-home patients. Depreciation is provided using the straight-line
method over the estimated useful lives of the equipment, which range from one to ten years.
Property, Equipment and Improvements: Property, equipment and improvements are stated at
cost. Included in property and equipment are assets under capitalized leases which consist of
information systems hardware and software. Depreciation is provided using the straight-line method
over the estimated useful lives of the assets. Estimated useful lives for each of the categories
presented in Note 3 are as follows: leasehold improvements the shorter of the remaining lease
term or seven years; equipment and furnishings three to fifteen years; and information systems
three to six years.
Capitalized Software: Included in property, equipment and improvements are costs related to
internally developed and purchased software that are capitalized and amortized over periods not
exceeding five years. Capitalized costs include direct costs of materials and services incurred in
developing or obtaining internal-use software and payroll and benefit costs for employees directly
involved in the development of internal-use software.
Long-Lived Assets: The recoverability of long-lived assets, including property and equipment
and certain identifiable intangible assets, is evaluated in accordance with SFAS 144, Accounting
for the Impairment or Disposal of Long-Lived Assets. SFAS 144 requires the company to review for
impairment of long-lived assets whenever events or changes in circumstances indicate that the
carrying amount of an asset may not be recoverable. Factors considered important which could
trigger an impairment review include:
|
|
|
significant underperformance relative to historical or projected future operating results; |
|
|
|
|
significant changes in the manner of use of the assets or the strategy for our overall business; |
|
|
|
|
significant decrease in the market value of the assets; and |
|
|
|
|
significant negative industry or economic trends. |
When it is determined that the carrying amount of long-lived assets may not be recoverable based
upon the existence of one or more of the above indicators, management assesses the assets for
impairment based on the estimated future undiscounted cash flows expected to result from the use of
the asset and its eventual disposition. If the carrying amount of an asset exceeds its estimated
future undiscounted cash flows, an impairment loss is recorded for the excess of the assets
carrying amount over its fair value. Fair value is generally determined based on the estimated
future discounted cash flows over the remaining useful life of the asset using a discount rate
determined by management to be commensurate with the risk inherent in the companys current
business model. The assumptions supporting the cash flows, including the discount rates, are
determined using managements best estimates as of the date of the impairment review. If these
estimates or their related assumptions change in the future, the company may be required to record
additional impairment charges for these assets, and future results of operations could be adversely
affected.
Goodwill: Goodwill arising from business combinations represents the excess of the purchase
price over the estimated fair value of the net assets of the businesses acquired. In accordance
with the provisions of SFAS No. 142, Goodwill and Other Intangible Assets, goodwill is not
amortized but tested annually for impairment or more frequently if circumstances indicate the
possibility of impairment. Management does not believe any impairment of its goodwill existed at
December 31, 2006.
F-7
NOTES TO CONSOLIDATED FINANCIAL STATEMENTS (continued)
Intangible Assets: Intangible assets consist of covenants not to compete, tradenames and
customer lists, all of which arose from business combinations. The values assigned to the
covenants are amortized on a straight-line basis over their contractual terms, which range from
three to five years. The customer list and tradename valuations are amortized over their period of
expected benefit, which averages 9 months and 24 months, respectively. Management tests for impairment in accordance with SFAS No. 142.
Deferred Debt Issuance Costs: Apria capitalizes debt issuance costs which include those
associated with its revolving credit facility and the convertible senior notes. Such costs are
classified as non-current assets. Costs relating to the revolving credit facility are being
amortized through the maturity date of June, 2011. Costs relating to the convertible senior notes
are amortized from the issuance date through September, 2008. See Note 6 Long-term Debt.
Fair Value of Financial Instruments: The carrying value of Aprias bank debt approximates
fair value because the underlying instruments are variable notes that reprice frequently. The fair
value of the convertible senior notes, as determined by reference to quoted market prices, is
$242,398,000 and $240,625,000 at December 31, 2006 and 2005, respectively. The carrying amounts of
cash and cash equivalents, accounts receivable, trade payables and accrued expenses approximate
fair value due to their short maturity.
Respiratory Therapy Expenses: Respiratory therapy expenses presented within cost of net
revenues are comprised primarily of employee salary and benefit costs or contract fees paid to
respiratory therapists and other related professionals who are deployed to service a patient.
Aprias respiratory therapy personnel are also engaged in a number of administrative and marketing
tasks, and accordingly, these costs are classified within selling, distribution and administrative
expenses and amounted to $15,694,000 in 2006 and $18,807,000 in 2005.
Apria adopted the classification described above in 2005. During prior years, the data was
not captured in the detail necessary to make a corresponding reclassification. Therefore, all
respiratory therapy expenses for 2004 are classified within selling, distribution and
administrative expenses and totaled $50,004,000.
Nursing Expenses: Nursing expenses presented within cost of net revenues are comprised
primarily of employee salary and benefit costs, as well as fees paid to contracted workers who are deployed
to service a patient. The majority of these costs relate to the companys infusion therapy service
line which were previously classified as selling, distribution and administrative expenses.
Additional nursing costs that are currently, and were previously, presented within the cost of net
revenues relate to a small ancillary nursing service business that generates approximately
$1,000,000 in revenue annually.
Apria adopted the classification described above in 2005. Certain nursing expenses incurred
by the infusion therapy business, including administrative and marketing costs, remain within
selling, distribution and administrative expenses and totaled $4,000,000, $3,948,000 and $4,189,000
for 2006, 2005 and 2004, respectively.
Distribution Expenses: Distribution expenses are included in selling, distribution and
administrative expenses and totaled $174,273,000, $171,724,000 and $157,142,000 in 2006, 2005, and
2004, respectively. Such expense represents the cost incurred to deliver product to the end user.
Included are leasing, maintenance, licensing and fuel costs associated with the companys vehicle
fleet; salaries and other costs related to drivers and dispatch personnel; and amounts paid to
courier and other outside shipping vendors. Such expenses fall within the definition of shipping
and handling costs as discussed in Emerging Issues Task Force No. 00-10 Accounting for Shipping
and Handling Fees and Costs, which permits their income statement classification within selling
and administrative expenses.
Self-Insurance: Apria is self -insured for certain employee medical claims and benefits, as
well as workers compensation, vehicle liability, professional and general liability coverages.
Accruals for medical claims at December 31, 2006 and 2005 were $10,061,000 and $7,239,000,
respectively. Amounts accrued for costs of the other liability coverages totaled $10,977,000 and
$11,763,000 at December 31, 2006 and 2005, respectively. All such amounts are classified in other
accrued liabilities.
Advertising: Advertising costs are initially established as a prepaid expense and amortized
over the period of expected benefit. Such expenses are included in selling, distribution and
administrative expenses and amounted to $5,849,000, $6,844,000 and $4,799,000 for 2006, 2005 and
2004, respectively.
Income Taxes: Apria provides for income taxes in accordance with provisions specified in SFAS
No. 109, Accounting for Income Taxes. Accordingly, deferred income tax assets and liabilities
are computed for differences between the financial statement and tax bases of assets and
liabilities. These differences will result in taxable or deductible amounts in the future, based
on tax laws and rates applicable to the periods in which the differences are expected to affect
taxable income. Valuation allowances are established when necessary to reduce deferred tax assets
to amounts that are more likely than not to be realized.
Derivative Instruments and Hedging Activities: From time to time Apria uses derivative
financial instruments to limit exposure to interest rate fluctuations on the companys variable
rate long-term debt. The company accounts for derivative instruments pursuant to the provisions of
SFAS No. 133, Accounting for Derivative Instruments and Hedging Activities. The
companys derivatives are recorded on the balance sheet at their fair value and, for derivatives
accounted for as cash flow hedges, any unrealized gains or losses on their fair value are included,
net of tax in operating income.
F-8
NOTES TO CONSOLIDATED FINANCIAL STATEMENTS (continued)
Share-Based Compensation: Prior to 2006, the company accounted for its stock-based
compensation plans under the recognition and measurement principles of Accounting Principles Board
(APB) Opinion No. 25, Accounting for Stock Issued to Employees, and related interpretations.
For 2005 and 2004, net income reflects compensation expense for restricted stock awards and
restricted stock purchase rights valued in accordance with APB No. 25.
Apria adopted the provisions of SFAS No. 123R, Share-Based Payment on January 1, 2006. The
company elected to employ the modified prospective transition method and, accordingly, financial
statement amounts for prior periods presented have not been restated to reflect the fair value
method of expensing share-based compensation. The company elected to use the short-cut method, as
provided by SFAS No. 123R, for determining the historical pool of tax benefits. See Note 7
Share-Based Compensation and Stockholders Equity.
Comprehensive Income: For the years ended December 31, 2006, 2005 and 2004, the difference
between net income and comprehensive income is $(105,000), $482,000 and $904,000, respectively, net
of taxes, which is attributable to unrealized (losses) and gains on various interest rate swap
agreements.
Per Share Amounts: Basic net income per share is computed by dividing net income available to
common stockholders by the weighted-average number of common shares outstanding. Diluted net
income per share includes the effect of the potential shares outstanding, including dilutive stock
options and other awards, using the treasury stock method.
NOTE 2
RECENT ACCOUNTING PRONOUNCEMENTS
In December 2004, the FASB issued SFAS No. 123R, Share-Based Payment. This statement
replaces SFAS No. 123, Accounting for Stock-Based Compensation, and supersedes APB Opinion No.
25, Accounting for Stock Issued to Employees. SFAS No. 123R requires a company to measure the
cost of employee services received in exchange for an award of equity instruments based on the
grant date fair value of the award. The cost is recognized over the period during which the
employee is required to provide service in exchange for the award (usually the vesting period).
Apria adopted the statement January 1, 2006. See Note 7 Share-Based Compensation.
In May 2005, the FASB issued SFAS No. 154, Accounting Changes and Error Corrections, which
replaces APB Opinion No. 20, Accounting Changes, and FASB Statement No. 3, Reporting Accounting
Changes in Interim Financial Statements. SFAS No. 154 changes the accounting for, and the
reporting of, a change in accounting principle. The statement also defines and requires
retrospective application of a change in accounting principle to prior periods financial
statements unless impracticable. If retrospective application is impracticable, the new accounting
principle must be applied to the asset and liability balances as of the beginning of the earliest
period practicable and a corresponding adjustment to the opening balance of retained earnings for
the same period, rather than being reported in the income statement. Additionally, SFAS No. 154
addresses a change in accounting for estimates effected by a change in accounting principle and
redefines restatement as a revision to reflect the correction of an error. The statement is
effective for accounting changes and error corrections made in fiscal years beginning after
December 15, 2005. Accordingly, Apria adopted the statement January 1, 2006. The adoption of SFAS
No. 154 did not have a material effect on the companys consolidated financial statements.
In February 2006, the FASB issued SFAS No. 155, Accounting for Certain Hybrid Financial
Instruments. The statement amends SFAS No. 133, Accounting for Derivative Instruments and
Hedging Activities and SFAS No. 140, Accounting for Transfers and Servicing of Financial Assets
and Extinguishments of Liabilities. The statement is effective for all financial instruments
acquired or issued after the beginning of an entitys first fiscal year that begins after September
15, 2006. Accordingly, the company adopted SFAS No. 155 on January 1, 2007. Such adoption did not
have a material effect on the companys consolidated financial statements.
In June 2006, the FASB issued Interpretation No. 48 (FIN No. 48), Accounting for Uncertainty
in Income Taxes, an interpretation of FASB Statement No.109, Accounting for Income Taxes. This
standard creates a comprehensive model to address accounting for uncertainty in tax positions. FIN
No. 48, clarifies the accounting for income taxes, by prescribing a minimum recognition threshold a
tax position is required to meet before being recognized for financial statements. FIN No. 48 also
provides guidance on measurement, derecognition, classification, interest and penalties, accounting
in interim periods, disclosure and transition. The adoption of FIN No. 48 will be effective for
fiscal periods beginning after December 15, 2006. The Company
adopted FIN No. 48 as of January 1, 2007 and estimates that it will record a cumulative effect adjustment of a range
of approximately $3,000,000 to $5,000,000 to increase its uncertain tax positions accrual. This
estimated cumulative effect adjustment will be charged to opening retained earnings.
F-9
NOTES TO CONSOLIDATED FINANCIAL STATEMENTS (continued)
In September 2006, The FASB issued SFAS No. 157, Fair Value Measurements, which defines fair
value, establishes a framework for measuring fair value in generally accepted accounting
principles, and expands disclosures about fair value measurements. The statement is effective for
financial statements issued for fiscal years beginning after November 15, 2007, and interim periods
within those fiscal years. Management is currently evaluating the statement to determine what, if
any, impact it will have on the companys consolidated financial statements.
In September 2006, the Securities and Exchange Commission issued Staff Accounting Bulletin No.
108 (SAB No. 108), Considering the Effects of Prior Year Misstatements when Quantifying
Misstatements in Current Year Financial Statements, which provides guidance on quantifying
financial statement misstatements. SAB No. 108 was issued in order to eliminate the diversity of
practice surrounding how public companies quantify financial statement misstatements. SAB No. 108
is effective for annual financial statements covering the first fiscal year ending after November
15, 2006.
Traditionally, there have been two widely recognized methods for quantifying the effects of
financial statement misstatements: the roll-over method and the iron curtain method. The
roll-over method focuses primarily on the impact of a misstatement on the income statement,
including the reversing effect of prior year misstatements, but its use can lead to the
accumulation of misstatements in the balance sheet. The iron-curtain method, on the other hand,
focuses primarily on the effect of correcting the period-end balance sheet with less emphasis on
the reversing effects of prior year errors on the income statement. Prior to Aprias application of
the guidance in SAB No. 108, Apria management used the roll-over method for quantifying financial
statement misstatements.
In SAB No. 108, the SEC staff established an approach that requires quantification of
financial statement misstatements based on the effects of the misstatements on each of the
companys financial statements and the related financial statement disclosures. This model is
commonly referred to as a dual approach because it requires quantification of errors under both
the iron curtain and the roll-over methods.
SAB No. 108 permits existing public companies to initially apply its provisions either by (i)
restating prior financial statements as if the dual approach had always been applied or (ii)
recording the cumulative effect of initially applying the dual approach as adjustments to the
carrying values of assets and liabilities with an offsetting adjustment recorded to the opening
balance of retained earnings. Apria elected to record the effects of applying SAB No. 108 using the
cumulative effect transition method. The misstatement that has been corrected is described below.
Approximately
50% of Aprias net revenues are derived from rental arrangements to
provide respiratory and other home medical equipment to patients in the home. Apria bills for
these services on a monthly basis. The initial billing and revenue recognition is generated upon
proper qualification of the patient and confirmation of delivery. Subsequent billings are
processed monthly until the period of medical necessity ends. As a matter of process, Apria
generates the subsequent billings in 30-day cycles so that each months billing falls on
approximately the same day of the month as the initial billing. Prior to application of SAB No.
108, rental revenue was recognized in the month of billing.
This accounting treatment resulted in an overstatement of rental revenue at a given month-end,
as a portion of that revenue corresponding to the portion of the rental period that fell into the
subsequent month, had not yet been earned. As a result of the revenue misstatement, the
corresponding expenses were also recognized before actually incurred. Apria management previously
quantified these errors under the roll-over method and concluded that they were immaterial.
In its application of SAB No. 108, Apria corrected the aforementioned errors by deferring
unearned rental revenues and establishing a deferred revenue line item on its balance sheet. The
corresponding expenses have been deferred through the establishment of a deferred expense line
item. Such deferral of revenues and expenses also required adjustment to deferred income taxes.
Apria adopted SAB No. 108 in the fourth quarter of 2006 and elected the cumulative effect
transition method of application. Accordingly, Apria adjusted the carrying values of the
applicable assets and liabilities with an offsetting adjustment to its opening balance of retained
earnings. This correcting entry and the balance sheet line items that were affected are summarized
in the following table:
F-10
NOTES TO CONSOLIDATED FINANCIAL STATEMENTS (continued)
|
|
|
|
|
|
|
Adjustment |
|
|
|
Recorded as of |
|
(in thousands) |
|
December 31, 2006 |
|
|
Balance Sheet |
|
|
|
|
Deferred expenses |
|
$ |
22,712 |
|
Deferred income tax liability |
|
|
(8,867 |
) |
Deferred revenue |
|
|
(32,280 |
) |
Deferred income tax asset |
|
|
12,602 |
|
Retained earnings, beginning |
|
|
5,492 |
|
|
|
|
|
|
Statement of Income |
|
|
|
|
Net revenues |
|
$ |
466 |
|
Cost of net revenues |
|
|
(22 |
) |
Selling, distribution and administrative expenses |
|
|
(72 |
) |
|
|
|
|
Income before taxes |
|
|
560 |
|
Income taxes |
|
|
219 |
|
|
|
|
|
Net income |
|
$ |
341 |
|
|
|
|
|
NOTE 3 PROPERTY, EQUIPMENT AND IMPROVEMENTS
Property, equipment and improvements consist of the following:
|
|
|
|
|
|
|
|
|
|
|
December 31, |
|
(in thousands) |
|
2006 |
|
|
2005 |
|
|
Leasehold improvements |
|
$ |
36,770 |
|
|
$ |
33,942 |
|
Equipment and furnishings |
|
|
56,696 |
|
|
|
55,540 |
|
Information systems hardware |
|
|
88,396 |
|
|
|
77,559 |
|
Information systems software |
|
|
51,753 |
|
|
|
41,544 |
|
|
|
|
|
|
|
|
|
|
|
233,615 |
|
|
|
208,585 |
|
Less accumulated depreciation |
|
|
(180,640 |
) |
|
|
(162,498 |
) |
|
|
|
|
|
|
|
|
|
$ |
52,975 |
|
|
$ |
46,087 |
|
|
|
|
|
|
|
|
Depreciation expense for property, equipment and improvements was $20,387,000, $21,918,000 and
$21,371,000 for 2006, 2005 and 2004, respectively.
NOTE 4 BUSINESS COMBINATIONS
During 2006, Apria acquired three complementary businesses within specific geographic markets,
comprised primarily of home respiratory therapy businesses. Similarly, the company acquired 21
companies during 2005 and 27 in 2004. For all periods presented, these all-cash transactions were
accounted for as purchases and, accordingly, the results of operations of the acquired businesses
are included in the consolidated income statements from the dates of acquisition. The purchase
prices were allocated to the various underlying tangible and intangible assets and liabilities on
the basis of estimated fair value.
The following table summarizes the allocation of the purchase prices of all acquisitions made
by the company. Payments deferred from prior years totaled $4,523,000, $8,576,000 and $4,646,000
for the years 2006, 2005 and 2004, respectively. At December 31, 2006, 2005 and 2004, outstanding
deferred consideration totaled $108,000, $5,682,000 and $8,575,000, respectively, and is included
in the consolidated balance sheets in other accrued liabilities.
Cash paid (received) for acquisitions:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Year Ended December 31, |
|
(in thousands) |
|
2006 |
|
|
2005 |
|
|
2004 |
|
Fair value of patient service equipment acquired |
|
$ |
1,923 |
|
|
$ |
7,453 |
|
|
$ |
9,880 |
|
Fair value of property and equipment acquired |
|
|
4 |
|
|
|
985 |
|
|
|
1,995 |
|
Fair value of other assets acquired |
|
|
641 |
|
|
|
1,577 |
|
|
|
2,712 |
|
Intangible assets |
|
|
1,100 |
|
|
|
7,613 |
|
|
|
9,263 |
|
Goodwill |
|
|
(1,112 |
) |
|
|
85,362 |
|
|
|
125,091 |
|
|
|
|
|
|
|
|
|
|
|
Total assets acquired |
|
|
2,556 |
|
|
|
102,990 |
|
|
|
148,941 |
|
Liabilities assumed and accrued, net of payments
deferred from prior years |
|
|
5,526 |
|
|
|
2,481 |
|
|
|
(4,706 |
) |
|
|
|
|
|
|
|
|
|
|
Net assets acquired |
|
$ |
8,082 |
|
|
$ |
105,471 |
|
|
$ |
144,235 |
|
|
|
|
|
|
|
|
|
|
|
F-11
NOTES TO CONSOLIDATED FINANCIAL STATEMENTS (continued)
Cash paid (received) for acquisitions:
The following supplemental unaudited pro forma information presents the combined operating
results of Apria and the businesses that were acquired by Apria during 2006, 2005 and 2004, as if
the acquisitions had occurred at the beginning of each of the periods presented. The pro forma
information is based on the historical financial statements of Apria and those of the acquired
businesses. Amounts are not necessarily indicative of the results that may have been attained had
the combinations been in effect at the beginning of the periods presented or that may be achieved
in the future.
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Year Ended December 31, |
|
(in thousands, except per share data ) |
|
2006 |
|
|
2005 |
|
|
2004 |
|
|
Net revenues |
|
$ |
1,523,656 |
|
|
$ |
1,551,002 |
|
|
$ |
1,646,988 |
|
Net income |
|
|
76,012 |
|
|
|
70,865 |
|
|
|
127,217 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Basic net income per common share |
|
$ |
1.79 |
|
|
$ |
1.47 |
|
|
$ |
2.58 |
|
|
|
|
|
|
|
|
|
|
|
Diluted net income per common share |
|
$ |
1.77 |
|
|
$ |
1.45 |
|
|
$ |
2.54 |
|
|
|
|
|
|
|
|
|
|
|
NOTE 5 GOODWILL AND INTANGIBLE ASSETS
Apria accounts for its business combinations in accordance with SFAS No. 141, Business
Combinations, which requires that the purchase method of accounting be applied to all business
combinations and addresses the criteria for initial recognition of intangible assets and goodwill.
In accordance with SFAS No. 142, goodwill and other intangible assets with indefinite lives are not
amortized but are tested for impairment annually, or more frequently if circumstances indicate the
possibility of impairment. If the carrying value of goodwill or an intangible asset exceeds its
fair value, an impairment loss shall be recognized.
Aprias goodwill impairment test is conducted at a reporting unit level and compares each
reporting units fair value to its carrying value. The company has determined that its geographic
divisions are reporting units under SFAS No. 142 (previously its regions). The measurement of fair value for each division
is based on an evaluation of future discounted cash flows and is further tested using a multiple of
earnings approach. For all years presented, Aprias tests indicated that no impairment existed
and, accordingly, no loss has been recognized.
For the year ended December 31, 2006, the net decrease in the carrying amount of goodwill of
$1,798,000 is the result of the write off of goodwill in the sale of a previously-acquired business
back to the original seller; adjustments to preliminary acquisition valuations that resulted in
goodwill decreases; and goodwill recorded from 2006 acquisitions. All of the goodwill recorded in
conjunction with business combinations for the periods presented is expected to be deductible for
tax purposes.
Intangible assets, all of which are subject to amortization, consist of the following:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
December 31, 2006 |
|
|
December 31, 2005 |
|
|
|
Average |
|
|
Gross |
|
|
|
|
|
|
|
|
|
|
Gross |
|
|
|
|
|
|
|
|
|
Life in |
|
|
Carrying |
|
|
Accumulated |
|
|
Net Book |
|
|
Carrying |
|
|
Accumulated |
|
|
Net Book |
|
(dollars in thousands ) |
|
Years |
|
|
Amount |
|
|
Amortization |
|
|
Value |
|
|
Amount |
|
|
Amortization |
|
|
Value |
|
Covenants not to compete |
|
|
5.0 |
|
|
$ |
13,506 |
|
|
$ |
(7,313 |
) |
|
$ |
6,193 |
|
|
$ |
16,352 |
|
|
$ |
(6,316 |
) |
|
$ |
10,036 |
|
Tradenames |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
628 |
|
|
|
(440 |
) |
|
|
188 |
|
Customer lists |
|
|
1.0 |
|
|
|
1,283 |
|
|
|
(925 |
) |
|
|
358 |
|
|
|
1,588 |
|
|
|
(1,232 |
) |
|
|
356 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
3.6 |
|
|
$ |
14,789 |
|
|
$ |
(8,238 |
) |
|
$ |
6,551 |
|
|
$ |
18,568 |
|
|
$ |
(7,988 |
) |
|
$ |
10,580 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
F-12
NOTES TO CONSOLIDATED FINANCIAL STATEMENTS (continued)
Amortization expense amounted to $5,080,000, $6,941,000 and $6,712,000 for the years 2006, 2005 and 2004, respectively. Estimated amortization expense for each of the fiscal years ending December 31, is presented
below:
|
|
|
|
|
Year Ending December 31, |
|
(in thousands) |
|
|
2007 |
|
$ |
2,916 |
|
2008 |
|
|
2,066 |
|
2009 |
|
|
1,254 |
|
2010 |
|
|
315 |
|
NOTE 6 LONG-TERM DEBT
Long-term debt consists of the following:
|
|
|
|
|
|
|
|
|
|
|
December 31, |
|
(in thousands ) |
|
2006 |
|
|
2005 |
|
|
Notes payable relating to revolving credit facilities |
|
$ |
235,000 |
|
|
$ |
390,000 |
|
Convertible senior notes |
|
|
250,000 |
|
|
|
250,000 |
|
Capital lease obligations (see Note 10) |
|
|
|
|
|
|
1,111 |
|
Other |
|
|
2,145 |
|
|
|
4,209 |
|
|
|
|
|
|
|
|
|
|
|
487,145 |
|
|
|
645,320 |
|
Less: current maturities |
|
|
(2,145 |
) |
|
|
(4,465 |
) |
|
|
|
|
|
|
|
|
|
$ |
485,000 |
|
|
$ |
640,855 |
|
|
|
|
|
|
|
|
Revolving Credit Facility: Aprias senior secured credit agreement with Bank of America and a
syndicate of lenders was amended effective June 23, 2006. The amendment extended the maturity date
from November 23, 2009 to June 23, 2011 and lowered the applicable interest rate margins and
commitment fees.
The credit agreement is structured as a $500 million revolving credit facility and permits
Apria to select one of two variable interest rates. One option is the base rate, which is
expressed as the higher of (a) the Federal Funds rate plus 0.50% or (b) the Bank of America prime
rate. The other option is the Eurodollar rate, which is based on the London Interbank Offered Rate
(LIBOR). Interest on outstanding balances under the credit agreement is
determined by adding a margin to the Eurodollar rate or base rate in effect at each interest
calculation date. The applicable margin for the revolving credit facility is based on Aprias debt
rating as determined by either Standard and Poors Ratings Services or Moodys Investor Services
with respect to the credit facility.
The new applicable margins range from 0.625% to 1.25% for Eurodollar loans and from zero to
0.25% for base rate loans. The range for commitment fees on the unused portion of the revolving
credit facility is now 0.10% to 0.20%. The effective interest rate at December 31, 2006, after
consideration of the effect of the swap agreements, was 6.25%. Without the effect of the swap
agreements, such rate would have been 6.35%.
At December 31, 2006, borrowings under the revolving credit facility were $235,000,000,
outstanding letters of credit totaled $3,855,000 and credit available under the revolving facility
was $261,145,000. At December 31, 2006, the company was in compliance with all of the financial
covenants required by the credit agreement. Borrowings under the credit facility are secured by a
pledge of the common stock of all of the company's subsidiaries.
Convertible Senior Notes: In August 2003, Apria issued convertible senior notes in the
aggregate principal amount of $250,000,000 under an indenture between Apria and U.S. Bank National
Association. The notes were issued in a private placement at an issue price of $1,000 per note
(100% of the principal amount at maturity) and were subsequently registered with the Securities and
Exchange Commission. The notes will mature on September 1, 2033, unless earlier converted,
redeemed or repurchased by Apria. Apria may redeem some or all of the notes at any time after
September 8, 2010, at a redemption price equal to 100% of the principal amount of the notes to be
redeemed plus accrued and unpaid interest and contingent interest, if any, to the redemption date.
The holders of the notes may require Apria to repurchase some or all of the notes at a repurchase
price equal to 100% of the principal amount of the notes plus accrued and unpaid interest,
including contingent interest, up to but excluding the applicable repurchase date, initially on
September 1, 2008, and subsequently on September 1 of 2010, 2013, 2018, 2023 and 2028, or at any
time prior to their maturity following a fundamental change, as defined in the indenture. Any
notes that Apria is required to repurchase will be paid for in cash, pursuant to the terms of a
December 2004 amendment to the indenture which eliminated the companys option of paying part of
the repurchase price in common stock.
F-13
NOTES TO CONSOLIDATED FINANCIAL STATEMENTS (continued)
The
notes bear interest at the rate of 33/8% per annum, which is payable on September 1 and
March 1 of each year, beginning on March 1, 2004. Also, during certain periods commencing on
September 8, 2010, Apria will pay contingent interest on the interest payment date for the
applicable interest period if the average trading price of the notes during the five trading days
ending on the third day immediately preceding the first day of the applicable interest period
equals or exceeds 120% of the principal amount of the notes. The contingent interest payable per
note will equal 0.25% per year of the average trading price of such note during the applicable five
trading-day reference period. During certain periods, the notes are convertible, at the holders option, into shares of
Apria common stock, initially at a conversion rate of 28.6852 shares of common stock per $1,000
principal amount of notes, subject to adjustment and under certain circumstances as outlined in the
indenture.
The notes are unsecured and unsubordinated obligations and are senior in right of payment to
any subordinated debt of the company. The notes rank junior to the companys senior secured credit
facility to the extent of the assets securing such indebtedness.
Maturities of long-term debt are as follows:
|
|
|
|
|
Year Ending December 31, |
|
(in thousands) |
|
2007 |
|
$ |
2,145 |
|
2008 |
|
|
|
|
2009 |
|
|
|
|
2010 |
|
|
|
|
2011 |
|
|
235,000 |
|
Thereafter |
|
|
250,000 |
|
|
|
|
|
|
|
$ |
487,145 |
|
|
|
|
|
Total interest paid on debt in 2006, 2005 and 2004 amounted to $29,891,000, $18,783,000 and
$18,090,000, respectively.
Hedging Activities: Apria is exposed to interest rate fluctuations on its underlying variable
rate long-term debt. Aprias policy for managing interest rate risk is to evaluate and monitor all
available relevant information, including but not limited to, the structure of its interest-bearing
assets and liabilities, historical interest rate trends and interest rate forecasts published by
major financial institutions. The tools Apria may utilize to moderate its exposure to fluctuations
in the relevant interest rate indices include, but are not limited to: (1) strategic determination
of repricing periods and related principal amounts, and (2) derivative financial instruments such
as interest rate swap agreements, caps or collars. Apria does not use derivatives for trading or
other speculative purposes.
During 2006, Apria had two interest rate swap agreements in effect to fix its LIBOR-based
variable rate debt. One of the agreements, which expired in December 2006, had a notional amount
of $25,000,000 and a fixed rate of 3.42%. The other agreement, a forward-starting contract with a
three-year term, became effective in January 2006, and has a notional amount of $25,000,000 that
fixes an equivalent amount of the companys variable rate debt at 4.44%.
In 2005, Apria had two interest rate swap agreements. Each agreement had a notional amount of
$25,000,000, with one agreement expiring in December 2005 and the other agreement expiring in
December 2006. In 2004, Apria also had two swap agreements with an aggregate notional amount of
$50,000,000 that expired in December 2004.
The swap agreements are being accounted for as cash flow hedges under SFAS No. 133,
Accounting for Derivative Instruments and Hedging Activities. Accordingly, the difference
between the interest received and interest paid is reflected as an adjustment to interest expense.
For the years ended December 31, 2006, 2005 and 2004, Apria received (paid) net settlement amounts
of $540,000, $11,000 and ($1,381,000), respectively. At December 31, 2006 and 2005, the aggregate
fair value of the swap agreements was an asset of $356,000 and $769,000, respectively, and is
reflected in the accompanying consolidated balance sheets in other assets. Unrealized gains and
losses on the fair value of the swap agreements are reflected, net of taxes, in operating income as
the transactions no longer qualify for hedge accounting.
Aprias exposure to credit loss under the swap agreement is limited to the interest rate spread in
the event of counterparty nonperformance. Apria does not anticipate losses due to counterparty
nonperformance as its counterparties to the swap agreement are nationally recognized financial
institutions with strong credit ratings.
F-14
NOTES TO CONSOLIDATED FINANCIAL STATEMENTS (continued)
NOTE 7
SHARE-BASED COMPENSATION AND STOCKHOLDERS EQUITY
Effective January 1, 2006, Apria adopted the provisions of SFAS No. 123R, Share-Based
Payment, which establishes accounting for equity instruments exchanged for employee services.
Under the provisions of SFAS No. 123R, share-based compensation cost is measured at the grant date,
based on the calculated fair value of the award, and is recognized as an expense over the
employees requisite service period (generally the vesting period of the equity grant). Prior to
January 1, 2006, the company accounted for share-based compensation to employees in accordance with
APB No. 25, Accounting for Stock Issued to Employees, and related interpretations. The company
also followed the disclosure requirements of SFAS No. 123, Accounting for Stock-Based
Compensation, as amended by SFAS No. 148, Accounting for Stock-Based Compensation Transition
and Disclosure. The company elected to employ the modified prospective transition method as
provided by SFAS No. 123R and, accordingly, financial statement amounts for the prior periods
presented have not been restated to reflect the fair value method of expensing share-based
compensation.
For the
year ended December 31, 2006, the company recorded share-based compensation expense of
$5,762,000, of which $2,081,000 was related to awards issued prior to the adoption of SFAS No. 123R. All such compensation is reflected in the accompanying condensed consolidated income
statement within the selling, distribution and administrative expense line item. The related awards were granted to administrative personnel
or members of the companys Board of Directors and therefore no portion of the share-based compensation has been classified within cost of net revenues. Share-based
compensation expense recognized in 2006 is based on awards ultimately expected to vest; therefore,
it has been reduced for estimated forfeitures. SFAS No. 123R requires forfeitures to be estimated
at the time of grant and revised, if necessary, in subsequent periods if actual forfeitures differ
from those estimates. In the pro forma information presented for periods prior to 2006, the company
accounted for forfeitures as they occurred.
For the year ended December 31, 2006, Aprias adoption of SFAS No. 123R reduced the companys
operating income and income before taxes by $2,323,000 and net income was reduced by $1,737,000.
Basic and diluted earnings per share were each reduced by $0.04 for the year ended December 31,
2006. The adoption of SFAS No. 123R did not affect cash flow.
For the year ended December 31, 2006, cash received from the exercise of options totaled
$8,245,000. Income tax benefits related to stock-based compensation arrangements amounted to
$17,000.
The company estimates the fair value of stock options using the Black-Scholes valuation model.
Key input assumptions used to estimate the fair value of stock options include the exercise price
of the award, the expected option term, the expected volatility of the companys stock over the
options expected term, the risk-free interest rate over the options term, and the companys
expected annual dividend yield. Aprias management believes that the valuation technique and the
approach utilized to develop the underlying assumptions are appropriate in calculating the fair
values of the companys stock options granted in 2006. Estimates of fair value are not intended to
predict actual future events or the value ultimately realized by persons who receive equity awards.
The key input assumptions that were utilized in the valuation of the stock options granted
during the year ended December 31, 2006 are summarized in the table below.
|
|
|
|
Expected option term (1) |
|
4.8 years |
Expected volatility (2) |
|
27.3 |
% |
Risk-free interest rate (3) |
|
4.6 |
% |
Expected annual dividend yield |
|
0 |
% |
|
|
|
(1) |
|
The expected option term is based on historical exercise and post-vesting termination patterns. |
|
(2) |
|
Expected volatility represents a combination of historical stock price volatility and implied
volatility from publicly-traded options on Aprias common stock. |
|
(3) |
|
The risk-free interest rate is based on the implied yield on a U.S. Treasury zero coupon issue
with a remaining term equal to the expected term of the option. |
2003 Performance Incentive Plan: In July 2003, Aprias shareholders approved the 2003
Performance Incentive Plan (2003 Plan), which permits the grant of stock options, stock
appreciation rights (SARs), stock bonuses, restricted stock, performance stock, stock units,
phantom stock, dividend equivalents, or similar rights to purchase or acquire shares, and cash
awards. Any award may be paid or settled in cash. The 2003 Plan is currently the only plan from
which stock-based awards may be granted.
The maximum number of shares that may be issued as awards under the 2003 Plan equals the sum
of (1) 6,500,000 shares, plus (2) the number of shares subject to stock options granted under
previous plans, which expire or are cancelled or terminated without being exercised, after the
effective date of the 2003 Plan.
F-15
NOTES TO CONSOLIDATED FINANCIAL STATEMENTS (continued)
The 2003 Plan also contains the following limits:
|
|
grants of incentive stock options up to 2,000,000 shares, |
|
|
|
grants of options and SARs during any calendar year to any individual up to 500,000 shares, |
|
|
|
shares subject to all awards granted to an individual during any calendar year up to 1,000,000 shares, |
|
|
|
awards granted to non-employee directors up to 700,000 shares, |
|
|
|
awards granted, other than for stock options and SARs, up to 2,275,000 shares, |
|
|
|
performance-based awards, other than stock options and SARs, granted to an individual up to 500,000
shares in a calendar year, and |
|
|
|
performance-based awards, payable in cash, granted to an individual up to $10,000,000 in a calendar year. |
The per share exercise price of an option or SAR (collectively referred to as options)
generally may not be less than the per share fair market value on the date of grant. The maximum
term of an option is ten years from the date of grant. Performance based awards may also be issued
from the 2003 Plan. The vesting or payment of such awards will depend on the companys performance
to established measurement criteria. The performance measurement period may range from three months
to ten years. Performance based awards may be paid in stock or in cash. The company has
historically issued new shares when options or stock-based awards are exercised.
The company believes that share-based awards better align the interests of its senior
management and other key employees with those of its shareholders as well as serving as an
effective tool to attract, retain and motivate plan participants.
Stock Options: Aprias incentive plan provides for the granting of stock options to employees
and non-employee directors. Such grants to employees may include non-qualified and incentive stock
options. The exercise price of an option is established at the fair market value of a share of
Apria common stock on the date of grant. Vesting of stock options is time-based and is generally
over a three-year period.
The following table summarizes the activity for stock options for the years ended December 31,
2004, 2005 and 2006:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Weighted-Average |
|
|
|
|
|
|
|
|
|
|
|
Remaining |
|
|
Aggregate |
|
|
|
|
|
|
|
Weighted-Average |
|
|
Contractual Term |
|
|
Intrinsic |
|
|
|
Options |
|
|
Exercise Price |
|
|
(in Years) |
|
|
Value |
|
Outstanding at January 1, 2004 |
|
|
4,553,926 |
|
|
$ |
21.73 |
|
|
|
|
|
|
|
|
|
Granted |
|
|
1,647,000 |
|
|
|
31.45 |
|
|
|
|
|
|
|
|
|
Exercised |
|
|
(893,270 |
) |
|
|
20.90 |
|
|
|
|
|
|
|
|
|
Forfeited |
|
|
(193,511 |
) |
|
|
26.19 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Outstanding at December 31, 2004 |
|
|
5,114,145 |
|
|
$ |
24.84 |
|
|
|
7.37 |
|
|
$ |
41,774,469 |
|
Granted |
|
|
49,000 |
|
|
|
32.45 |
|
|
|
|
|
|
|
|
|
Exercised |
|
|
(920,385 |
) |
|
|
22.49 |
|
|
|
|
|
|
|
|
|
Forfeited |
|
|
(166,055 |
) |
|
|
29.20 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Outstanding at December 31, 2005 |
|
|
4,076,705 |
|
|
$ |
25.28 |
|
|
|
6.60 |
|
|
$ |
7,881,252 |
|
Granted |
|
|
1,056,000 |
|
|
|
23.23 |
|
|
|
|
|
|
|
|
|
Exercised |
|
|
(349,596 |
) |
|
|
20.64 |
|
|
|
|
|
|
|
|
|
Forfeited |
|
|
(726,795 |
) |
|
|
29.48 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Outstanding at December 31, 2006 |
|
|
4,056,314 |
|
|
$ |
24.59 |
|
|
|
6.38 |
|
|
$ |
13,750,742 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Vested or expected to vest as of December 31, 2006 |
|
|
3,933,107 |
|
|
$ |
24.63 |
|
|
|
6.25 |
|
|
$ |
13,346,073 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Exercisable at December 31, 2006 |
|
|
3,201,314 |
|
|
$ |
24.95 |
|
|
|
5.56 |
|
|
$ |
10,819,092 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
The weighted-average fair value of stock options granted during the year ended December 31,
2006 was $7.39. There were 49,000 stock options granted in the corresponding period in 2005. The
total intrinsic value of options exercised was $1,272,000 and $10,239,000 for the years ended
December 31, 2006 and 2005, respectively.
As of December 31, 2006, total unrecognized stock-based compensation cost related to unvested
stock options was $4,739,000, which is expected to be expensed over a weighted-average period of
1.44 years.
Restricted Stock Purchase Rights: In 2003 and 2004, Apria granted restricted stock purchase
rights to certain members of executive management. The awards represented the right to purchase a
certain number of shares of Apria common stock at a future date at a specified exercise price. The
exercise price was established at 25% of the fair market value of a share of Apria common stock on
the date of grant. Such awards generally require that certain performance conditions and service
conditions be met before the awards will vest.
F-16
NOTES TO CONSOLIDATED FINANCIAL STATEMENTS (continued)
The following table summarizes the activity for restricted stock purchase rights for the years
ended December 31, 2004, 2005 and 2006:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Restricted |
|
|
|
|
|
|
Weighted-Average |
|
|
|
Stock |
|
|
|
|
|
|
Remaining |
|
|
Aggregate |
|
|
|
Purchase |
|
|
Weighted-Average |
|
|
Contractual Term |
|
|
Intrinsic |
|
|
|
Rights |
|
|
Exercise Price |
|
|
(in Years) |
|
|
Value |
|
Outstanding at January 1, 2004 |
|
|
476,000 |
|
|
$ |
6.49 |
|
|
|
|
|
|
|
|
|
Granted |
|
|
110,000 |
|
|
|
7.60 |
|
|
|
|
|
|
|
|
|
Exercised |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Forfeited |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Outstanding at December 31, 2004 |
|
|
586,000 |
|
|
$ |
6.70 |
|
|
|
8.71 |
|
|
$ |
15,385,350 |
|
Granted |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Exercised |
|
|
(16,000 |
) |
|
|
6.46 |
|
|
|
|
|
|
|
|
|
Forfeited |
|
|
(24,000 |
) |
|
|
6.46 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Outstanding at December 31, 2005 |
|
|
546,000 |
|
|
$ |
6.71 |
|
|
|
7.72 |
|
|
$ |
9,499,110 |
|
Granted |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Exercised |
|
|
(158,500 |
) |
|
|
6.49 |
|
|
|
|
|
|
|
|
|
Forfeited |
|
|
(87,500 |
) |
|
|
6.85 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Outstanding at December 31, 2006 |
|
|
300,000 |
|
|
$ |
6.79 |
|
|
|
6.76 |
|
|
$ |
5,957,820 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Vested or expected to vest as of December 31, 2006 |
|
|
218,371 |
|
|
$ |
6.75 |
|
|
|
6.74 |
|
|
$ |
4,345,307 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Exercisable at December 31, 2006 |
|
|
16,000 |
|
|
$ |
6.46 |
|
|
|
6.61 |
|
|
$ |
323,040 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
The total intrinsic value of restricted stock purchase rights exercised was $2,592,000 and
$418,000 for the years ended December 31, 2006 and 2005, respectively. No such awards were granted
during these two periods.
As of December 31, 2006, total unrecognized stock-based compensation cost related to unvested
restricted stock purchase rights was $3,503,000, which is expected to be expensed over a
weighted-average period of 3.10 years.
Restricted Stock Awards and Units: Aprias incentive plan provides for the granting of
restricted stock and restricted stock units to its non-employee directors and employees (limited to
executive management). Such awards generally require that certain performance conditions and
service conditions be met before the awards will vest.
The following table summarizes the activity for restricted stock awards and units for the
years ended December 31, 2004, 2005 and 2006:
|
|
|
|
|
|
|
|
|
|
|
Shares |
|
|
Weighted-Average |
|
|
|
or |
|
|
Grant-Date |
|
|
|
Share Units |
|
|
Fair Value |
|
Nonvested restricted stock awards and units at January 1, 2004 |
|
|
26,000 |
|
|
$ |
25.73 |
|
Granted |
|
|
226,000 |
|
|
|
32.80 |
|
Vested and released |
|
|
(26,000 |
) |
|
|
25.73 |
|
Forfeited |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Nonvested restricted stock awards and units at December 31, 2004 |
|
|
226,000 |
|
|
|
32.80 |
|
Granted |
|
|
81,384 |
|
|
|
34.98 |
|
Vested and released |
|
|
(26,000 |
) |
|
|
28.21 |
|
Forfeited |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Nonvested restricted stock awards and units at December 31, 2005 |
|
|
281,384 |
|
|
|
33.86 |
|
Granted |
|
|
339,000 |
|
|
|
22.71 |
|
Vested and released |
|
|
(38,462 |
) |
|
|
33.95 |
|
Forfeited |
|
|
(95,000 |
) |
|
|
28.35 |
|
|
|
|
|
|
|
|
Nonvested restricted stock awards and units at December 31, 2006 |
|
|
486,922 |
|
|
$ |
27.16 |
|
|
|
|
|
|
|
|
The weighted-average fair value of restricted stock awards and units granted during the year
ended December 31, 2006 was $22.71. There were 81,384 awards granted in the corresponding period in
2005. Restricted stock awards or units released during the year ended December 31, 2006 and 2005,
were 38,462 and 26,000 shares, respectively. The total intrinsic value of restricted stock awards
or units released was $768,000 and $832,000 for the year ended December 31, 2006 and 2005,
respectively.
As of December 31, 2006, total unrecognized stock-based compensation cost related to unvested
restricted stock awards and units was $9,388,000, which is expected to be expensed over a
weighted-average period of 2.73 years.
Prior Period Pro Forma Presentation: Apria had previously adopted the provisions of SFAS No.
123 through disclosure only. The following table illustrates the effects on net income and earnings
per share for the years ended December 31, 2005 and 2004 as if the company had applied the fair
value recognition provisions of SFAS No. 123 to share-based employee awards.
F-17
NOTES TO CONSOLIDATED FINANCIAL STATEMENTS (continued)
|
|
|
|
|
|
|
|
|
|
|
Year Ended December 31, |
|
(in thousand, except per share datas ) |
|
2005 |
|
|
2004 |
|
|
Net income as reported |
|
$ |
66,941 |
|
|
$ |
114,008 |
|
Add: stock-based compensation expense included
in reported net income, net of related tax effects |
|
|
2,032 |
|
|
|
2,828 |
|
Deduct: total stock-based compensation expense
determined for all awards under fair value-based
method, net of related tax effects |
|
|
(13,070 |
) |
|
|
(12,869 |
) |
|
|
|
|
|
|
|
Pro forma net income |
|
$ |
55,903 |
|
|
$ |
103,967 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Basic net income per share: |
|
|
|
|
|
|
|
|
As reported |
|
$ |
1.39 |
|
|
$ |
2.31 |
|
Pro forma |
|
$ |
1.16 |
|
|
$ |
2.11 |
|
|
|
|
|
|
|
|
|
|
Diluted net income per share: |
|
|
|
|
|
|
|
|
As reported |
|
$ |
1.37 |
|
|
$ |
2.27 |
|
Pro forma |
|
$ |
1.14 |
|
|
$ |
2.07 |
|
The fair value of each option grant was estimated on the date of grant using the Black-Scholes
option-pricing model with the following weighted-average assumptions: risk-free interest rates of
3.78% and 3.19% for 2005 and 2004; respectively; dividend yield of 0% for both years; expected
lives of 4.13 years for 2005 and 4.51 years in 2004; and volatility of 31.73% for 2005 and 42.58%
for 2004.
Stock Option Acceleration: On November 30, 2005, the Compensation Committee of the
Board of Directors of Apria approved the acceleration of vesting of certain outstanding employee
stock options with per share prices above $26.00, so that each such option became fully vested. As
a result of this action, options to purchase 863,227 shares of Apria common stock became
immediately exercisable. The accelerated options represented approximately 18.6% of Aprias total
outstanding options at the time of the action.
The purpose of accelerating the vesting of these options was to eliminate the compensation expense
that Apria would otherwise recognize in the consolidated statements of income in future financial
statements with respect to these options upon the adoption of SFAS No. 123R. More than half of the
accelerated options would have vested according to their terms during 2006 and more than 77% would
have vested by February 2007. As a result of the acceleration, the company expects to reduce its
future share-based compensation expense by approximately $7,580,000.
Treasury Stock: All repurchased shares of common stock are held as treasury shares.
In 2006, 7,672 shares of employee restricted stock, valued at $141,000, were retained by the company upon vesting to satisfy related tax obligations.
In October 2005, Aprias Board of Directors authorized the company to repurchase up to
$250,000,000 worth of its outstanding common stock. On November 7, 2005, Apria purchased 7,337,526
shares of its common stock for $175,000,000 through an accelerated share repurchase program. Under
the agreement, Aprias counterparty borrowed shares that were sold to Apria at an initial price of
$23.83. The counterparty then repurchased shares over a period that commenced immediately after
the sale of shares to Apria. The repurchase transaction was completed in February 2006. The
agreement contained a provision that subjected Apria to a purchase price adjustment based on the
volume weighted average price of the companys common stock over the period during which the
counterparty purchased the shares. Such provision resulted in an additional $242,000 owed to the
counterparty that Apria elected to settle in cash in February 2006. This amount was recorded as a
liability at December 31, 2005, with a corresponding charge to interest expense reflecting the
change in the fair value of the settlement contract. The amount remaining on the aforementioned
Board authorization expires at the end of the first quarter of 2007.
F-18
NOTES TO CONSOLIDATED FINANCIAL STATEMENTS (continued)
In January 2004, Apria prepaid $50,000,000 to repurchase 1,730,703 shares of its common stock
at a strike price of $28.89 through an accelerated share repurchase program. The repurchase of the
shares was completed in April 2004 and the share price differential was settled in cash in June
2004, for a total cost of $53,033,000. During the third quarter of 2004, the company purchased an
additional 1,687,400 shares for $46,967,000.
NOTE 8 INCOME TAXES
Significant components of Aprias deferred tax assets and liabilities are as follows:
|
|
|
|
|
|
|
|
|
|
|
December 31, |
|
(in thousands ) |
|
2006 |
|
|
2005 |
|
|
Deferred tax assets: |
|
|
|
|
|
|
|
|
Allowance for doubtful accounts |
|
$ |
13,007 |
|
|
$ |
15,989 |
|
Accruals |
|
|
14,021 |
|
|
|
12,955 |
|
Asset valuation reserves |
|
|
14,301 |
|
|
|
8,622 |
|
Net operating loss carryforward |
|
|
8,448 |
|
|
|
8,827 |
|
Intangible assets |
|
|
8,994 |
|
|
|
8,423 |
|
Deferred revenue and expenses |
|
|
3,735 |
|
|
|
|
|
Other, net |
|
|
8,882 |
|
|
|
5,218 |
|
|
|
|
|
|
|
|
|
|
|
71,388 |
|
|
|
60,034 |
|
Less: valuation allowance |
|
|
(904 |
) |
|
|
(957 |
) |
|
|
|
|
|
|
|
Total deferred tax assets |
|
|
70,484 |
|
|
|
59,077 |
|
|
|
|
|
|
|
|
|
|
Deferred tax liabilities: |
|
|
|
|
|
|
|
|
Tax over book depreciation |
|
|
(28,213 |
) |
|
|
(29,491 |
) |
Tax over book goodwill amortization |
|
|
(43,737 |
) |
|
|
(28,658 |
) |
Contingent debt interest |
|
|
(19,353 |
) |
|
|
|
|
Other, net |
|
|
(3,348 |
) |
|
|
(4,032 |
) |
|
|
|
|
|
|
|
Total deferred tax liabilities |
|
|
(94,651 |
) |
|
|
(62,181 |
) |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Net deferred tax liabilities |
|
$ |
(24,167 |
) |
|
$ |
(3,104 |
) |
|
|
|
|
|
|
|
The ultimate realization of deferred tax assets is dependent upon the generation of
future taxable income during the periods in which temporary differences become deductible. In
making an assessment regarding the probability of realizing a benefit from these deductible
differences, management considers the companys current and past performance, the market
environment in which the company operates, tax planning strategies and the length of carryforward
periods.
During 2006, the valuation allowance decreased by $53,000 due to the fact that state net
operating loss carryforwards, that were previously expected to expire, became realizable.
F-19
NOTES TO CONSOLIDATED FINANCIAL STATEMENTS (continued)
Income tax expense (benefit) consists of the following:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Year Ended December 31, |
|
(in thousands ) |
|
2006 |
|
|
2005 |
|
|
2004 |
|
|
Current: |
|
|
|
|
|
|
|
|
|
|
|
|
Federal |
|
$ |
16,458 |
|
|
$ |
46,030 |
|
|
$ |
35,245 |
|
State |
|
|
2,490 |
|
|
|
(719 |
) |
|
|
8,254 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
18,948 |
|
|
|
45,311 |
|
|
|
43,499 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Deferred: |
|
|
|
|
|
|
|
|
|
|
|
|
Federal |
|
|
21,298 |
|
|
|
(5,605 |
) |
|
|
25,088 |
|
State |
|
|
3,011 |
|
|
|
723 |
|
|
|
(4,290 |
) |
|
|
|
|
|
|
|
|
|
|
|
|
|
24,309 |
|
|
|
(4,882 |
) |
|
|
20,798 |
|
|
|
|
|
|
|
|
|
|
|
|
|
$ |
43,257 |
|
|
$ |
40,429 |
|
|
$ |
64,297 |
|
|
|
|
|
|
|
|
|
|
|
Differences between Aprias income tax expense and an amount calculated utilizing the federal
statutory rate are as follows:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Year Ended December 31, |
|
(in thousands ) |
|
2006 |
|
|
2005 |
|
|
2004 |
|
|
Income tax expense at statutory rate |
|
$ |
41,382 |
|
|
$ |
37,580 |
|
|
$ |
62,407 |
|
Non-deductible expenses |
|
|
711 |
|
|
|
2,958 |
|
|
|
465 |
|
State taxes, net of federal benefit
and state loss carryforwards |
|
|
5,134 |
|
|
|
4,592 |
|
|
|
7,071 |
|
Change in valuation allowance |
|
|
(53 |
) |
|
|
(2,218 |
) |
|
|
(6,803 |
) |
Change in contingency reserve |
|
|
(4,063 |
) |
|
|
(2,483 |
) |
|
|
959 |
|
Other |
|
|
146 |
|
|
|
|
|
|
|
198 |
|
|
|
|
|
|
|
|
|
|
|
|
|
$ |
43,257 |
|
|
$ |
40,429 |
|
|
$ |
64,297 |
|
|
|
|
|
|
|
|
|
|
|
Net income taxes paid in 2006, 2005 and 2004 amounted to $16,406,000, $52,099,000 and
$35,564,000, respectively.
The company believes it has adequately provided for income tax issues not yet resolved with
federal, state and local tax authorities. At December 31, 2006, $12,195,000, net of tax benefit,
was accrued for such federal, state and local tax matters and is included in income taxes payable.
Although not probable, the most adverse resolution of these federal, state and local issues could
result in additional charges to earnings in future periods in addition to the $12,195,000 currently
provided. Based upon a consideration of all relevant facts and circumstances, the company does not
believe the ultimate resolution of tax issues for all open tax periods will have a materially
adverse effect upon its results of operations or financial condition.
F-20
NOTES TO CONSOLIDATED FINANCIAL STATEMENTS (continued)
NOTE 9 PER SHARE AMOUNTS
The following table sets forth the computation of basic and diluted per share amounts:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Year Ended December 31, |
|
(in thousands, except per share data) |
|
2006 |
|
|
2005 |
|
|
2004 |
|
|
Numerator: |
|
|
|
|
|
|
|
|
|
|
|
|
Net income |
|
$ |
74,980 |
|
|
$ |
66,941 |
|
|
$ |
114,008 |
|
Numerator for basic and diluted per share amounts
income available to common stockholders |
|
$ |
74,980 |
|
|
$ |
66,941 |
|
|
$ |
114,008 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Denominator: |
|
|
|
|
|
|
|
|
|
|
|
|
Denominator for basic per share
amounts weighted-average shares |
|
|
42,462 |
|
|
|
48,154 |
|
|
|
49,368 |
|
Effect of dilutive securities: |
|
|
|
|
|
|
|
|
|
|
|
|
Employee stock options
dilutive potential common shares |
|
|
473 |
|
|
|
831 |
|
|
|
812 |
|
|
|
|
|
|
|
|
|
|
|
Denominator for diluted per share amounts
adjusted weighted-average shares |
|
|
42,935 |
|
|
|
48,985 |
|
|
|
50,180 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Basic net income per common share |
|
$ |
1.77 |
|
|
$ |
1.39 |
|
|
$ |
2.31 |
|
|
|
|
|
|
|
|
|
|
|
Diluted net income per common share |
|
$ |
1.75 |
|
|
$ |
1.37 |
|
|
$ |
2.27 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Employee stock options excluded from the computation
of diluted per share amounts: |
|
|
|
|
|
|
|
|
|
|
|
|
Shares for which exercise price exceeds
average market price of common stock |
|
|
3,145 |
|
|
|
2,073 |
|
|
|
1,505 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Average exercise price per share that exceeds
average market price of common stock |
|
$ |
26.71 |
|
|
$ |
30.21 |
|
|
$ |
31.66 |
|
|
|
|
|
|
|
|
|
|
|
F-21
NOTES TO CONSOLIDATED FINANCIAL STATEMENTS (continued)
NOTE 10 LEASES
Apria leases all of its facilities. Lease terms are generally ten years or less with renewal
options for additional periods. The company occasionally subleases unused facility space when a
lease buyout is not a viable option. Sublease income is
recognized monthly and is offset against facility lease expense. Sublease income in 2006, 2005 and 2004 amounted to $1,046,000, $988,000 and $1,012,000, respectively. In addition, delivery vehicles and
office equipment are leased under operating leases. Many leases provide that the company pay
taxes, maintenance, insurance and other expenses. Rentals are generally increased annually by the
Consumer Price Index, subject to certain maximum amounts defined within individual agreements. Net
rent expense in 2006, 2005 and 2004 amounted to $73,293,000, $74,835,000 and $72,330,000,
respectively.
During 2004, Apria acquired information systems hardware and software totaling $3,156,000
under capital lease arrangements with lease terms ranging from 24 to 36 months. Related
amortization amounted to $796,000, $709,000 and $229,000 in 2006, 2005 and 2004, respectively.
There were no purchases of assets under capital lease arrangements during 2006 and 2005.
The following amounts for assets under capital lease obligations are included in property,
equipment and improvements:
|
|
|
|
|
|
|
|
|
|
|
December 31, |
|
(in thousands ) |
|
2006 |
|
|
2005 |
|
|
Information systems hardware and software |
|
$ |
3,156 |
|
|
$ |
3,156 |
|
Less accumulated depreciation |
|
|
(1,734 |
) |
|
|
(938 |
) |
|
|
|
|
|
|
|
|
|
$ |
1,422 |
|
|
$ |
2,218 |
|
|
|
|
|
|
|
|
Future minimum payments, by year and in the aggregate, required under noncancelable operating
leases consist of the following at December 31, 2006:
|
|
|
|
|
(in thousands ) |
|
|
|
|
|
2007 |
|
$ |
56,819 |
|
2008 |
|
|
46,841 |
|
2009 |
|
|
35,886 |
|
2010 |
|
|
26,145 |
|
2011 |
|
|
18,056 |
|
Thereafter |
|
|
21,684 |
|
|
|
|
|
|
|
$ |
205,431 |
|
|
|
|
|
NOTE 11 EMPLOYEE BENEFIT PLANS
401(k) Savings Plan: Apria has a 401(k) defined contribution plan, whereby eligible employees may contribute up to
35% of their annual base earnings. During the two years ended 2005, the company matched 50% of the
first 8% of employee contributions. Total expenses related to the defined contribution plan were
$4,970,000 and $4,588,000 in 2005 and 2004, respectively. In 2006 the company suspended the
employer match contribution.
Pension Plan: Apria contributes to a union pension fund in the
State of New York, for
which an unfunded liability of $685,000 and $706,000 was accrued at December 31, 2006 and 2005,
respectively. This liability is classified in other non-current liabilities.
Deferred Compensation Plan: Apria has a non-qualified deferred compensation plan
that is available for approximately 250 employees and members of the Board of Directors. The plan provides participants with the advantages of pre-tax contributions and tax deferred
compounding of interest. Plan assets, which represent the fair market value of the investments,
were $4,966,000 and $4,645,000, and plan liabilities were $4,128,000 and $3,947,000 at December 31,
2006 and 2005, respectively.
F-22
NOTES TO CONSOLIDATED FINANCIAL STATEMENTS (continued)
NOTE 12 COMMITMENTS AND CONTINGENCIES
Litigation: Apria is the defendant in a California class action lawsuit containing
blanket claims of liability under various California employee protection statutes and regulations
relating to payment of regular and overtime wages, the timeliness of such payments, the maintenance
and provision of access to required payroll records, and the provision of meal and rest periods.
Venegas vs. Apria Healthcare, Inc., et al., was filed on February 21, 2006 in the California
Superior Court for the County of San Francisco (Case No. CGC 06 449669). No class has been
certified at this time, but on behalf of a purported class consisting of certain hourly employees
of the company in the State of California, the complaint seeks compensatory and punitive damages in
an unspecified amount as well as other relief. The company has filed an answer to the complaint
denying all material allegations and asserting a number of affirmative defenses. Based on the
companys preliminary investigation of the allegations, management believes there are meritorious
defenses to the claims and the company intends to vigorously defend the lawsuit. No assurance can
be given, however, that the ultimate disposition of this case will not have a material adverse
effect on the companys financial condition or results of operations.
Apria is also engaged in the defense of certain claims and lawsuits arising out of the
ordinary course and conduct of its business, the outcomes of which are not determinable at this
time. Apria has insurance policies covering such potential losses where such coverage is cost
effective. In the opinion of management, any liability that might be incurred by Apria upon the
resolution of these claims and lawsuits will not, in the aggregate, have a material adverse effect
on Aprias financial condition or results of operations.
Qui Tam Settlement and Related Costs: As previously reported, Apria was the subject of an
investigation launched in mid-1998 by the U.S. Attorneys office in Los Angeles and the U.S.
Department of Health and Human Services. The investigation concerned the documentation supporting
Aprias billing for services provided to patients whose healthcare costs were paid by Medicare and
other federal programs. The investigation related to two civil qui tam lawsuits against Apria
filed by individuals suing on behalf of the government. Apria and representatives of the government
and the individual plaintiffs reached a preliminary agreement in early August 2005 to settle these
lawsuits for the aggregate sum of $17,600,000, without any admission of wrongdoing by Apria. The
settlement was finalized in a definitive agreement that was fully executed and became effective on
September 30, 2005, and Apria paid the settlement amount on that date. Apria also incurred
$1,658,000 in legal fees and other related costs during 2005.
Medicare Reimbursement: There are a number of provisions contained within recent legislation
or proposed legislation that affect or may affect Medicare reimbursement polices for items and
services provided by Apria. The company cannot be certain of the ultimate impact of all legislated
and contemplated changes, and therefore, cannot provide assurance that these changes will not have
a material adverse effect on Aprias results of operations.
Supplier Concentration: Apria currently purchases approximately 59% of its patient service
equipment and supplies from four vendors. Although there are a limited number of suppliers,
management believes that other vendors could provide similar products on comparable terms.
However, a change in suppliers could cause delays in service delivery and possible losses in
revenue, which could adversely affect operating results.
Guarantees and Indemnities: From time to time Apria enters into certain types of contracts
that contingently require the company to indemnify parties against third party claims. These
contracts primarily relate to (i) certain asset purchase agreements, under which the company may
provide customary indemnification to the seller of the business being acquired; (ii) certain
real estate leases, under which the company may be required to indemnify property owners for
environmental or other liabilities, and other claims arising from the companys use of the
applicable premises; and (iii) certain agreements with the companys officers, directors and
employees, under which the company may be required to indemnify such persons for liabilities
arising out of their relationship with the company.
The terms of such obligations vary by contract and in most instances a specific or maximum
dollar amount is not explicitly stated therein. Generally, amounts under these contracts cannot
be reasonably estimated until a specific claim is asserted. Consequently, no liabilities have
been recorded for these obligations on the companys balance sheets for any of the periods
presented.
F-23
NOTES TO CONSOLIDATED FINANCIAL STATEMENTS (continued)
NOTE 13 SERVICE/PRODUCT LINE DATA
The following table sets forth a summary of net revenues and gross profit by service line:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Year Ended December 31, |
|
(in thousands) |
|
2006 |
|
|
2005 |
|
|
2004 |
|
|
Net revenues: |
|
|
|
|
|
|
|
|
|
|
|
|
Respiratory therapy |
|
$ |
1,033,267 |
|
|
$ |
1,009,752 |
|
|
$ |
990,857 |
|
Infusion therapy |
|
|
274,723 |
|
|
|
256,225 |
|
|
|
246,662 |
|
Home medical equipment/other |
|
|
209,317 |
|
|
|
208,124 |
|
|
|
213,930 |
|
|
|
|
|
|
|
|
|
|
|
Total net revenues |
|
$ |
1,517,307 |
|
|
$ |
1,474,101 |
|
|
$ |
1,451,449 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Gross profit: |
|
|
|
|
|
|
|
|
|
|
|
|
Respiratory therapy |
|
$ |
737,476 |
|
|
$ |
746,486 |
|
|
$ |
774,149 |
|
Infusion therapy |
|
|
146,121 |
|
|
|
131,128 |
|
|
|
129,482 |
|
Home medical equipment/other |
|
|
112,271 |
|
|
|
117,199 |
|
|
|
130,374 |
|
|
|
|
|
|
|
|
|
|
|
Total gross profit |
|
$ |
995,868 |
|
|
$ |
994,813 |
|
|
$ |
1,034,005 |
|
|
|
|
|
|
|
|
|
|
|
Net
revenues for 2006 reflect Medicare reimbursement reductions of
$15.0 million on respiratory drugs and
dispensing fees plus oxygen and oxygen related equipment. Net revenues for 2005 reflect Medicare
reimbursement reductions of $27.4 million on respiratory medications, certain durable medical equipment items and
oxygen and oxygen-related equipment. Respiratory therapy revenues for 2004 reflect Medicare
reimbursement reductions of $15.2 million on respiratory medications.
Respiratory therapy and total gross profit for 2004 are not comparable to the other years
presented. For 2006 and 2005, certain respiratory therapy costs were reclassified from selling,
distribution and administrative expense to cost of net revenues, however, the corresponding
reclassification was not made for 2004. See Note 1 Respiratory Therapy Expenses.
F-24
NOTES TO CONSOLIDATED FINANCIAL STATEMENTS (continued)
NOTE 14 SELECTED QUARTERLY FINANCIAL DATA (unaudited)
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Quarter |
|
(in thousands, except per share data ) |
|
First |
|
|
Second |
|
|
Third |
|
|
Fourth |
|
|
2006 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Net revenues |
|
$ |
368,056 |
|
|
$ |
376,079 |
|
|
$ |
382,214 |
|
|
$ |
390,958 |
|
Gross profit |
|
|
241,082 |
|
|
|
247,109 |
|
|
|
251,120 |
|
|
|
256,557 |
|
Operating income |
|
|
31,944 |
|
|
|
37,355 |
|
|
|
38,209 |
|
|
|
40,192 |
|
Net income |
|
|
16,123 |
|
|
|
18,458 |
|
|
|
19,306 |
|
|
|
21,093 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Basic net income per common share |
|
$ |
0.38 |
|
|
$ |
0.44 |
|
|
$ |
0.45 |
|
|
$ |
0.50 |
|
Diluted net income per common share |
|
$ |
0.38 |
|
|
$ |
0.43 |
|
|
$ |
0.45 |
|
|
$ |
0.49 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
2005 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Net revenues |
|
$ |
371,863 |
|
|
$ |
374,931 |
|
|
$ |
367,615 |
|
|
$ |
359,692 |
|
Gross profit |
|
|
252,092 |
|
|
|
255,348 |
|
|
|
248,922 |
|
|
|
238,451 |
|
Operating income |
|
|
40,768 |
|
|
|
21,589 |
|
|
|
33,360 |
|
|
|
33,772 |
|
Net income |
|
|
25,170 |
|
|
|
3,016 |
|
|
|
19,255 |
|
|
|
19,500 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Basic net income per common share |
|
$ |
0.52 |
|
|
$ |
0.06 |
|
|
$ |
0.39 |
|
|
$ |
0.42 |
|
Diluted net income per common share |
|
$ |
0.51 |
|
|
$ |
0.06 |
|
|
$ |
0.38 |
|
|
$ |
0.42 |
|
Net income for the second quarter of 2005 was impacted by the initial accrual of $20,000,000
for the settlement costs and legal fees associated with the federal investigation and qui tam
lawsuits. The initial accrual recorded was subsequently adjusted to
$19,258,000 in the fourth quarter. See Note 12 Commitments and Contingencies.
F-25
APRIA HEALTHCARE GROUP INC.
SCHEDULE II VALUATION AND QUALIFYING ACCOUNTS
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Balance at |
|
Charged to |
|
|
|
|
|
Balance at |
|
|
Beginning |
|
Costs and |
|
|
|
|
|
End of |
(in thousands) |
|
of Period |
|
Expenses |
|
Deductions |
|
Period |
|
Year ended December 31, 2006 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Deducted from asset accounts: |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Allowance for doubtful accounts |
|
$ |
41,527 |
|
|
$ |
38,723 |
|
|
$ |
52,926 |
|
|
$ |
27,324 |
|
Reserve for inventory and patient
service equipment shortages |
|
$ |
3,753 |
|
|
$ |
3,623 |
|
|
$ |
2,956 |
|
|
$ |
4,420 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Year ended December 31, 2005 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Deducted from asset accounts: |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Allowance for doubtful accounts |
|
$ |
45,064 |
|
|
$ |
46,948 |
|
|
$ |
50,485 |
|
|
$ |
41,527 |
|
Reserve for inventory and patient
service equipment shortages |
|
$ |
3,230 |
|
|
$ |
2,309 |
|
|
$ |
1,786 |
|
|
$ |
3,753 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Year ended December 31, 2004 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Deducted from asset accounts: |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Allowance for doubtful accounts |
|
$ |
38,531 |
|
|
$ |
48,567 |
|
|
$ |
42,034 |
|
|
$ |
45,064 |
|
Reserve for inventory and patient
service equipment shortages |
|
$ |
1,377 |
|
|
$ |
3,909 |
|
|
$ |
2,056 |
|
|
$ |
3,230 |
|
S-1
SIGNATURES
Pursuant to the requirements of Section 13 or 15(d) of the Securities Exchange Act of 1934,
the registrant has duly caused this report to be signed on its behalf by the undersigned, thereunto
duly authorized.
Dated: March 1, 2007
|
|
|
|
|
|
APRIA HEALTHCARE GROUP INC.
|
|
|
By: |
/s/ LAWRENCE M. HIGBY
|
|
|
|
Chief Executive Officer |
|
|
|
|
|
|
Pursuant to the requirements of the Securities Exchange Act of 1934, this report has been
signed below by the following persons on behalf of the registrant and in the capacities and on the
dates indicated.
|
|
|
|
|
Signature |
|
Title |
|
Date |
|
|
|
|
|
/s/ LAWRENCE M. HIGBY |
|
|
|
|
|
|
|
|
|
Lawrence M. Higby
|
|
Chief Executive Officer and Director
(Principal Executive Officer)
|
|
March 1, 2007 |
|
|
|
|
|
/s/ CHRIS A. KARKENNY |
|
|
|
|
|
|
|
|
|
Chris A. Karkenny
|
|
Executive Vice President and
Chief Financial Officer
(Principal Financial Officer)
|
|
March 1, 2007 |
|
|
|
|
|
/s/ ALICIA PRICE |
|
|
|
|
|
|
|
|
|
Alicia Price
|
|
Vice President and Controller
(Principal Accounting Officer)
|
|
March 1, 2007 |
|
|
|
|
|
/s/ DAVID L. GOLDSMITH |
|
|
|
|
|
|
|
|
|
David L. Goldsmith
|
|
Director and Chairman of the Board
|
|
March 1, 2007 |
|
|
|
|
|
/s/ VICENTE ANIDO, JR. |
|
|
|
|
|
|
|
|
|
Vicente Anido, Jr.
|
|
Director
|
|
March 1, 2007 |
|
|
|
|
|
/s/ TERRY BAYER |
|
|
|
|
|
|
|
|
|
Terry Bayer
|
|
Director
|
|
March 1, 2007 |
|
|
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/s/ I. T. CORLEY |
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I. T. Corley
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Director
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March 1, 2007 |
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/s/ RICHARD H. KOPPES |
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Richard H. Koppes
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Director
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March 1, 2007 |
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/s/ PHILIP R. LOCHNER, JR. |
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Philip R. Lochner, Jr.
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Director
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March 1, 2007 |
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/s/ NORMAN C. PAYSON |
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Norman C. Payson
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Director
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March 1, 2007 |
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/s/ MAHVASH YAZDI |
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Mahvash Yazdi
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Director
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March 1, 2007 |
EXHIBIT INDEX
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Exhibit No. |
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Description |
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Reference |
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3.1
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Restated Certificate of Incorporation of Registrant.
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(c) |
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3.2
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Certificate of Ownership and Merger merging Registrant into Abbey and amending
Abbeys Restated Certificate of Incorporation to change Abbeys name to Apria
Healthcare Group Inc.
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(f) |
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3.3
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Certificate of Amendment of Certificate of Incorporation of Registrant.
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(m) |
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3.4
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Amended and Restated Bylaws of Registrant, as amended on March 1, 2006.
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(q) |
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4.1
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Specimen Stock Certificate of the Registrant.
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(f) |
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4.2
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Certificate of Designation of the Registrant.
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(c) |
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4.3
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Indenture dated August 20, 2003, between Registrant and U.S. Bank National
Association, as trustee, describing the Registrants issuance of 33/8% Convertible
Senior Notes due 2033.
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(i) |
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4.4
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First Supplemental Indenture dated December 14, 2004, supplementing and amending the
indenture dated August 20, 2003.
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(m) |
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10.1 #
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1991 Stock Option Plan.
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(a) |
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10.2 #
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401(k) Savings Plan, restated effective October 1, 1993, amended December 28, 1994.
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(d) |
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10.3 #
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Amended and Restated 1992 Stock Incentive Plan.
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(d) |
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10.4 #
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Amendment 1996-1 to the 1991 Stock Option Plan, dated October 28, 1996.
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(m) |
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10.5 #
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Amendment 1996-1 to the Amended and Restated 1992 Stock Incentive Plan, dated October
28, 1996.
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(m) |
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10.6 #
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Amended and Restated 1997 Stock Incentive Plan, dated February 27, 1997, as amended
through June 30, 1998.
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(m) |
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10.7 #
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1998 Nonqualified Stock Incentive Plan, dated December 15, 1998.
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(m) |
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10.8 #
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Amendment No. 1 to the 1998 Nonqualified Stock Incentive Plan, dated January 31, 2001.
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(e) |
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10.9
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International Swaps and Derivatives Association, Inc. Master Agreement dated December
3, 2002, between Registrant and Bank of Nova Scotia.
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(g) |
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10.10 #
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Apria Healthcare Group Inc. 2003 Performance Incentive Plan, dated July 17, 2003.
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(h) |
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10.11 #
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Form of Director Stock Option Agreement as granted under the Registrants 2003
Performance Incentive Plan.
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(p) |
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10.12 #
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Form of Director Restricted Stock Award Agreement as granted under the Registrants
2003 Performance Incentive Plan.
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(p) |
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Exhibit No. |
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Description |
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Reference |
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10.13 #
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Form of Employee Stock Option Agreement as granted under the Registrants 2003 Performance Incentive Plan.
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(p) |
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10.14 #
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Form of Employee Restricted Stock Purchase Rights Award Agreement as granted under the Registrants 2003
Performance Incentive Plan.
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(p) |
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10.15 #
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Form of Employee Time-Based Restricted Stock Award Agreement as granted under the Registrants 2003 Performance
Incentive Plan.
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(p) |
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10.16 #
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Form of Employee Performance-Based Restricted Stock Award Agreement as granted under the Registrants 2003
Performance Incentive Plan.
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(p) |
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10.17
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Fourth Amended and Restated Credit Agreement dated November 23, 2004, among Registrant and certain of its
subsidiaries, Bank of America, N.A., The Bank of Nova Scotia and certain other lending institutions.
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(l) |
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10.18
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Confirmation dated April 22, 2005, executed relative to the Master Agreement dated December 3, 2002, between
Registrant and Bank of Nova Scotia.
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(n) |
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10.19 #
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Executive Severance Agreement dated June 13, 2005, between Registrant and Jeri L. Lose.
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(n) |
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10.20 #
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Amended and Restated Employment Agreement dated October 20, 2005, between Registrant and Lawrence A. Mastrovich.
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(o) |
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10.21
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Letter Agreement with respect to the Accelerated Share Repurchase transaction dated November 7, 2005, between
Registrant and Citibank, N.A., acting through Citigroup Global Markets, Inc., as agent.
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(o) |
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10.22
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Form of Indemnity Agreement for Non-Employee Directors.
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(r) |
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10.23 #
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Executive Severance Agreement dated March 14, 2006, between Registrant and W. Jeffrey Ingram.
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(p) |
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10.24
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First Amendment to Fourth Amended and Restated Credit Agreement, dated June 23, 2006.
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(s) |
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10.25 #
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Employment Agreement and Non-Competition Agreement between registrant and Chris A. Karkenny, as Executive Vice
President and Chief Financial Officer effective November 13, 2006.
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(t) |
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14.1
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Registrants Code of Ethical Business Conduct.
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(j) |
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21.1
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List of Subsidiaries. |
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23.1
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Consent of Deloitte & Touche LLP, Independent Registered Public Accounting Firm. |
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31.1
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Certification of Chief Executive Officer pursuant to Securities Exchange Act Rule 13a-14(a). |
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31.2
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Certification of Chief Financial Officer pursuant to Securities Exchange Act Rule 13a-14(a). |
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32.1
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Certification of the Chief Executive Officer pursuant to 18 U.S.C. Section 1350. |
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32.2
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Certification of the Chief Financial Officer pursuant to 18 U.S.C Section 1350. |
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# Management contract or compensatory plan or arrangement. |
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Exhibit No. |
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Description |
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Reference |
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References Documents filed with the Securities and Exchange Commission |
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(a) |
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Incorporated by reference to Registration Statement on Form S-1 (Registration No. 33-44690), as filed on December 23,
1991. |
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(b) |
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Incorporated by reference to Registration Statement on Form S-4 (Registration No. 33-69094), as filed on September 17,
1993. |
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(c) |
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Incorporated by reference to Registration Statement on Form S-4 (Registration No. 33-90658), and its appendices, as filed
on March 27, 1995. |
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(d) |
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Incorporated by reference to Registration Statement on Form S-8 (Registration No. 33-80581), as filed on December 19,
1995. |
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(e) |
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Incorporated by reference to Annual Report on Form 10-K for the year ended December 31, 2000, as filed on March 22, 2001. |
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(f) |
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Incorporated by reference to Annual Report on Form 10-K for the year ended December 31, 2001, as filed on April 1, 2002. |
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(g) |
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Incorporated by reference to Annual Report on Form 10-K for the year ended December 31, 2002, as filed on March 31, 2003. |
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(h) |
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Incorporated by reference to Quarterly Report on Form 10-Q dated June 30, 2003, as filed on August 12, 2003. |
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(i) |
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Incorporated by reference to Quarterly Report on Form 10-Q dated September 30, 2003, as filed on November 14, 2003. |
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(j) |
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Incorporated by reference to Annual Report on Form 10-K for the year ended December 31, 2003. |
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(k) |
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Incorporated by reference to Quarterly Report on Form 10-Q dated June 30, 2004, as filed on August 6, 2004. |
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(l) |
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Incorporated by reference to Current Report on Form 8-K dated November 23, 2004, as filed on November 30, 2004. |
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(m) |
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Incorporated by reference to Annual Report on Form 10-K for the year ended December 31, 2004, as filed on March 15, 2004. |
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(n) |
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Incorporated by reference to Quarterly Report on Form 10-Q dated June 30, 2005, as filed on August 15, 2005. |
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(o) |
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Incorporated by reference to Quarterly Report on Form 10-Q dated September 30, 2005, as filed on November 9, 2005. |
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(p) |
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Incorporated by reference to Annual Report on Form 10-K for the year ended December 31, 2005, as filed on March 16, 2006. |
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(q) |
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Incorporated by reference to Current Report on Form 8-K dated March 1, 2006, as filed on March 7, 2006. |
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(r) |
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Incorporated by reference to Current Report on Form 8-K dated March 8, 2006, as filed on March 14, 2006. |
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(s) |
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Incorporated by reference to Quarterly Report on Form 10-Q dated June 30, 2006, as filed on August 9, 2006. |
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(t) |
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Incorporated by reference to Current Report on Form 8-K dated November 2, 2006, as filed on November 6, 2006 |