Community Health Systems, Inc. Announces First Quarter 2019 Results
The following highlights the financial and operating results for the three months ended
- Net operating revenues totaled
$3.376 billion . - Net loss attributable to
Community Health Systems, Inc. common stockholders was$(118) million , or$(1.04) per share (diluted), compared with net loss of$(25) million , or$(0.22) per share (diluted), for the same period in 2018. Excluding the adjusting items as presented in the table in footnote (e) on page 12, net loss attributable toCommunity Health Systems, Inc. common stockholders was$(0.53) per share (diluted), compared with net income of$0.13 per share (diluted) for the same period in 2018. - Adjusted EBITDA was
$391 million . - Net cash provided by operating activities was
$133 million , compared with$106 million for the same period in 2018. - On a same-store basis, admissions decreased 0.1 percent and adjusted admissions increased 0.8 percent, compared with the same period in 2018.
Net operating revenues for the three months ended
Net loss attributable to
Adjusted EBITDA for the three months ended
The consolidated operating results for the three months ended
Commenting on the results,
The Company completed seven hospital divestitures during the three months ended
Financial and statistical data for 2018 and the three months ended
Information About Non-GAAP Financial Measures
This earnings release presents Adjusted EBITDA, a non-GAAP financial measure, which is EBITDA adjusted to add back net income attributable to noncontrolling interests and to exclude the effect of discontinued operations, loss (gain) from early extinguishment of debt, impairment and (gain) loss on sale of businesses, expense incurred related to the sale of a majority ownership interest in the Company’s home care division, expense (income) related to government and other legal settlements and related costs, expense related to employee termination benefits and other restructuring charges, expense (income) from settlement and fair value adjustments on the CVR agreement liability related to the HMA legal proceedings and related legal expenses, and the overall impact of the change in estimate related to net patient revenue recorded in the fourth quarter of 2017 resulting from the increase in contractual allowances and the provision for bad debts.
For information regarding why the Company believes Adjusted EBITDA provides useful information to investors, and for a reconciliation of Adjusted EBITDA to net income attributable to
Additionally, this earnings release presents adjusted net (loss) income attributable to
Included on pages 13, 14, 15 and 16 of this press release are tables setting forth the Company’s 2019 updated annual earnings guidance. The 2019 guidance is based on the Company’s historical operating performance, current trends and other assumptions that the Company believes are reasonable at this time, and reflects the impact of planned divestitures in 2019.
The Company’s headquarters are located in
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Financial Highlights (a)(b) | |||||||
(In millions, except per share amounts) | |||||||
(Unaudited) | |||||||
Three Months Ended | |||||||
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2019 | 2018 | ||||||
Net operating revenues | $ | 3,376 | $ | 3,689 | |||
Net loss (f), (g) | (101) | (6) | |||||
Net loss attributable to |
(118) | (25) | |||||
Adjusted EBITDA (c) | 391 | 440 | |||||
Net cash provided by operating activities | 133 | 106 | |||||
Loss per share attributable to |
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Basic (f), (g) | $ | (1.04) | $ | (0.22) | |||
Diluted (e), (f), (g) | (1.04) | (0.22) | |||||
Weighted-average number of shares outstanding (d): | |||||||
Basic | 113 | 112 | |||||
Diluted | 113 | 112 | |||||
____ For footnotes, see pages 10, 11 and 12. |
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Condensed Consolidated Statements of Loss (a)(b) | ||||||||||||||||
(In millions, except per share amounts) | ||||||||||||||||
(Unaudited) | ||||||||||||||||
Three Months Ended |
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2019 | 2018 | |||||||||||||||
% of Net Operating | % of Net Operating | |||||||||||||||
Amount | Revenues | Amount | Revenues | |||||||||||||
Net operating revenues | $ | 3,376 | 100.0 | % | $ | 3,689 | 100.0 | % | ||||||||
Operating costs and expenses: | ||||||||||||||||
Salaries and benefits | 1,542 | 45.7 | % | 1,648 | 44.7 | % | ||||||||||
Supplies | 558 | 16.5 | % | 616 | 16.7 | % | ||||||||||
Other operating expenses | 811 | 24.1 | % | 911 | 24.7 | % | ||||||||||
Government and other legal settlements and related costs (g) | 5 | 0.1 | % | 5 | 0.1 | % | ||||||||||
Electronic health records incentive reimbursement | - | - | % | (1) | - | % | ||||||||||
Lease cost and rent | 80 | 2.4 | % | 89 | 2.4 | % | ||||||||||
Depreciation and amortization | 153 | 4.5 | % | 181 | 4.9 | % | ||||||||||
Impairment and (gain) loss on sale of businesses, net (f) | 38 | 1.1 | % | 28 | 0.8 | % | ||||||||||
Total operating costs and expenses | 3,187 | 94.4 | % | 3,477 | 94.3 | % | ||||||||||
Income from operations (f), (g) | 189 | 5.6 | % | 212 | 5.7 | % | ||||||||||
Interest expense, net | 257 | 7.6 | % | 228 | 6.2 | % | ||||||||||
Loss from early extinguishment of debt | 31 | 0.9 | % | 4 | 0.1 | % | ||||||||||
Equity in earnings of unconsolidated affiliates | (5) | (0.1) | % | (7) | (0.2) | % | ||||||||||
Loss before income taxes | (94) | (2.8) | % | (13) | (0.4) | % | ||||||||||
Provision for (benefit from) income taxes | 7 | 0.2 | % | (7) | (0.2) | % | ||||||||||
Net loss (f), (g) | (101) | (3.0) | % | (6) | (0.2) | % | ||||||||||
Less: Net income attributable to noncontrolling interests | 17 | 0.5 | % | 19 | 0.5 | % | ||||||||||
Net loss attributable to |
$ | (118) | (3.5) | % | $ | (25) | (0.7) | % | ||||||||
Loss per share attributable to |
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Basic (f), (g) | $ | (1.04) | $ | (0.22) | ||||||||||||
Diluted (e), (f), (g) | $ | (1.04) | $ | (0.22) | ||||||||||||
Weighted-average number of shares outstanding (d): | ||||||||||||||||
Basic | 113 | 112 | ||||||||||||||
Diluted | 113 | 112 | ||||||||||||||
____ For footnotes, see pages 10, 11 and 12. |
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Condensed Consolidated Statements of Comprehensive Loss | ||||||||
(In millions) | ||||||||
(Unaudited) | ||||||||
Three Months Ended | ||||||||
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2019 | 2018 | |||||||
Net loss | $ | (101) | $ | (6) | ||||
Other comprehensive (loss) income, net of income taxes: | ||||||||
Net change in fair value of interest rate swaps, net of tax | (2) | 18 | ||||||
Net change in fair value of available-for-sale securities, net of tax | 2 | (2) | ||||||
Amortization and recognition of unrecognized pension cost components, net of tax |
- | 1 | ||||||
Other comprehensive income | - | 17 | ||||||
Comprehensive (loss) income | (101) | 11 | ||||||
Less: Comprehensive income attributable to noncontrolling interests | 17 | 19 | ||||||
Comprehensive loss attributable to |
$ | (118) | $ | (8) | ||||
____ For footnotes, see pages 10, 11 and 12. |
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Selected Operating Data (a) | |||||||||||||||||||||
(Dollars in millions) | |||||||||||||||||||||
(Unaudited) | |||||||||||||||||||||
Three Months Ended |
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Consolidated | Same-Store | ||||||||||||||||||||
2019 | 2018 | % Change | 2019 | 2018 | % Change | ||||||||||||||||
Number of hospitals (at end of period) | 106 | 127 | 106 | 106 | |||||||||||||||||
Licensed beds (at end of period) | 16,956 | 21,051 | 16,956 | 17,044 | |||||||||||||||||
Beds in service (at end of period) | 15,195 | 18,525 | 15,195 | 15,147 | |||||||||||||||||
Admissions | 147,888 | 170,680 | -13.4% | 144,433 | 144,617 | -0.1% | |||||||||||||||
Adjusted admissions | 309,875 | 355,448 | -12.8% | 302,100 | 299,823 | 0.8% | |||||||||||||||
Patient days | 677,081 | 784,305 | 658,478 | 662,007 | |||||||||||||||||
Average length of stay (days) | 4.6 | 4.6 | 4.6 | 4.6 | |||||||||||||||||
Occupancy rate (average beds in service) | 48.0% | 46.9% | 48.2% | 48.6% | |||||||||||||||||
Net operating revenues | $ | 3,376 | $ | 3,689 | -8.5% | $ | 3,306 | $ | 3,207 | 3.1% | |||||||||||
Net inpatient revenues as a % of net operating revenues |
48.7% | 49.2% | 48.7% | 49.0% | |||||||||||||||||
Net outpatient revenues as a % of net operating revenues |
51.3% | 50.8% | 51.3% | 51.0% | |||||||||||||||||
Income from operations (f), (g) | $ | 189 | $ | 212 | -10.8% | ||||||||||||||||
Income from operations as a % of net operating revenues |
5.6% | 5.7% | |||||||||||||||||||
Depreciation and amortization | $ | 153 | $ | 181 | |||||||||||||||||
Equity in earnings of unconsolidated affiliates | $ | (5) | $ | (7) | |||||||||||||||||
Net loss attributable to |
$ | (118) | $ | (25) | 372.0% | ||||||||||||||||
Net loss attributable to |
-3.5% | -0.7% | |||||||||||||||||||
Adjusted EBITDA (c) | $ | 391 | $ | 440 | -11.1% | ||||||||||||||||
Adjusted EBITDA as a % of net operating revenues |
11.6% | 11.9% | |||||||||||||||||||
Net cash provided by operating activities | $ | 133 | $ | 106 | 25.5% | ||||||||||||||||
____ For footnotes, see pages 10, 11 and 12. |
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Condensed Consolidated Balance Sheets | ||||||||
(In millions, except share data) | ||||||||
(Unaudited) | ||||||||
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ASSETS | ||||||||
Current assets | ||||||||
Cash and cash equivalents | $ | 277 | $ | 196 | ||||
Patient accounts receivable | 2,360 | 2,352 | ||||||
Supplies | 397 | 402 | ||||||
Prepaid income taxes | 3 | 3 | ||||||
Prepaid expenses and taxes | 197 | 196 | ||||||
Other current assets | 361 | 400 | ||||||
Total current assets | 3,595 | 3,549 | ||||||
Property and equipment | 10,331 | 10,301 | ||||||
Less accumulated depreciation and amortization | (4,245) | (4,162) | ||||||
Property and equipment, net | 6,086 | 6,139 | ||||||
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4,553 | 4,559 | ||||||
Deferred income taxes | 66 | 69 | ||||||
Other assets, net (i) | 2,009 | 1,543 | ||||||
Total assets | $ | 16,309 | $ | 15,859 | ||||
LIABILITIES AND STOCKHOLDERS’ DEFICIT | ||||||||
Current liabilities | ||||||||
Current maturities of long-term debt | $ | 205 | $ | 204 | ||||
Current operating lease liabilities (i) | 143 | - | ||||||
Accounts payable | 863 | 887 | ||||||
Accrued liabilities: | ||||||||
Employee compensation | 628 | 627 | ||||||
Accrued interest | 250 | 206 | ||||||
Other | 419 | 468 | ||||||
Total current liabilities | 2,508 | 2,392 | ||||||
Long-term debt (h) | 13,385 | 13,392 | ||||||
Deferred income taxes | 29 | 26 | ||||||
Long-term operating lease liabilities (i) | 495 | - | ||||||
Other long-term liabilities | 977 | 1,008 | ||||||
Total liabilities | 17,394 | 16,818 | ||||||
Redeemable noncontrolling interests in equity of consolidated subsidiaries | 505 | 504 | ||||||
STOCKHOLDERS’ DEFICIT | ||||||||
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Preferred stock, |
- | - | ||||||
Common stock, |
1 | 1 | ||||||
Additional paid-in capital | 2,007 | 2,017 | ||||||
Accumulated other comprehensive loss | (10) | (10) | ||||||
Accumulated deficit | (3,661) | (3,543) | ||||||
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(1,663) | (1,535) | ||||||
Noncontrolling interests in equity of consolidated subsidiaries | 73 | 72 | ||||||
Total stockholders’ deficit | (1,590) | (1,463) | ||||||
Total liabilities and stockholders’ deficit | $ | 16,309 | $ | 15,859 | ||||
____ For footnotes, see pages 10, 11 and 12. |
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Condensed Consolidated Statements of Cash Flows | ||||||||
(In millions) | ||||||||
(Unaudited) | ||||||||
Three Months Ended |
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2019 | 2018 | |||||||
Cash flows from operating activities | ||||||||
Net loss | $ | (101) | $ | (6) | ||||
Adjustments to reconcile net loss to net cash provided by operating activities: | ||||||||
Depreciation and amortization | 153 | 181 | ||||||
Government and other legal settlements and related costs (g) | 5 | 5 | ||||||
Stock-based compensation expense | 3 | 4 | ||||||
Impairment and (gain) loss on sale of businesses, net (f) | 38 | 28 | ||||||
Loss from early extinguishment of debt | 31 | 4 | ||||||
Other non-cash expenses, net | 36 | 12 | ||||||
Changes in operating assets and liabilities, net of effects of acquisitions and divestitures: | ||||||||
Patient accounts receivable | (10) | (66) | ||||||
Supplies, prepaid expenses and other current assets | 14 | (21) | ||||||
Accounts payable, accrued liabilities and income taxes | 23 | (33) | ||||||
Other | (59) | (2) | ||||||
Net cash provided by operating activities | 133 | 106 | ||||||
Cash flows from investing activities | ||||||||
Acquisitions of facilities and other related businesses | (4) | (8) | ||||||
Purchases of property and equipment | (121) | (170) | ||||||
Proceeds from disposition of hospitals and other ancillary operations | 161 | 11 | ||||||
Proceeds from sale of property and equipment | - | 3 | ||||||
Purchases of available-for-sale securities and equity securities | (15) | (19) | ||||||
Proceeds from sales of available-for-sale securities and equity securities | 32 | 34 | ||||||
Increase in other investments | (34) | (28) | ||||||
Net cash provided by (used in) investing activities | 19 | (177) | ||||||
Cash flows from financing activities | ||||||||
Repurchase of restricted stock shares for payroll tax withholding requirements | (1) | (1) | ||||||
Deferred financing costs and other debt-related costs | (25) | (11) | ||||||
Proceeds from noncontrolling investors in joint ventures | 1 | - | ||||||
Redemption of noncontrolling investments in joint ventures | (1) | (3) | ||||||
Distributions to noncontrolling investors in joint ventures | (27) | (23) | ||||||
Borrowings under credit agreements | 12 | 10 | ||||||
Issuance of long-term debt | 1,840 | - | ||||||
Proceeds from ABL facility | 25 | 49 | ||||||
Repayments of long-term indebtedness | (1,895) | (89) | ||||||
Net cash used in financing activities | (71) | (68) | ||||||
Net change in cash and cash equivalents | 81 | (139) | ||||||
Cash and cash equivalents at beginning of period | 196 | 563 | ||||||
Cash and cash equivalents at end of period | $ | 277 | $ | 424 | ||||
____ For footnotes, see pages 10, 11 and 12. |
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Footnotes to Financial Highlights, Financial Statements and Selected Operating Data |
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(a) | Both financial and statistical results include the operating results of divested hospitals through the effective closing date of each respective divestiture. Same-store operating results and statistical information exclude the results of the hospitals divested or closed in 2018 and during the three months ended |
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(b) | The following table provides information needed to calculate loss per share, which is adjusted for income attributable to noncontrolling interests (in millions): | |
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Three Months Ended | ||||||||
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2019 | 2018 | |||||||
Net loss attributable to |
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Net loss | $ | (101) | $ | (6) | ||||
Less: Income attributable to noncontrolling interests, net of taxes |
17 | 19 | ||||||
Net loss attributable to |
$ | (118) | $ | (25) | ||||
(c) | EBITDA is a non-GAAP financial measure which consists of net loss attributable to |
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Adjusted EBITDA is not a measurement of financial performance under |
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Footnotes to Financial Highlights, Financial Statements and Selected Operating Data (Continued)
The following table reflects the reconciliation of Adjusted EBITDA, as defined, to net loss attributable to
Three Months Ended | ||||||||
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2019 | 2018 | |||||||
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Net loss attributable to |
$ | (118) | $ | (25) | ||||
Adjustments: | ||||||||
Provision for (benefit from) income taxes |
7 | (7) | ||||||
Depreciation and amortization | 153 | 181 | ||||||
Net income attributable to noncontrolling interests | 17 | 19 | ||||||
Interest expense, net | 257 | 228 | ||||||
Loss from early extinguishment of debt | 31 | 4 | ||||||
Impairment and (gain) loss on sale of businesses, net | 38 | 28 | ||||||
Expense from government and other legal settlements and related costs |
5 | 5 | ||||||
Expense from settlement and fair value adjustments and legal expenses related to cases covered by the CVR |
1 | 5 | ||||||
Expense related to employee termination benefits and other restructuring charges |
- | 2 | ||||||
Adjusted EBITDA | $ | 391 | $ | 440 | ||||
(d) | The following table sets forth components reconciling the basic weighted-average number of shares to the diluted weighted-average number of shares (in millions): | |
Three Months Ended | ||||||
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2019 | 2018 | |||||
Weighted-average number of shares outstanding - basic |
113 | 112 | ||||
Add effect of dilutive securities: | ||||||
Stock awards and options | - | - | ||||
Weighted-average number of shares outstanding - diluted |
113 | 112 | ||||
The Company generated a net loss attributable to
Footnotes to Financial Highlights, Financial Statements and Selected Operating Data (Continued) |
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(e) | The following supplemental table reconciles net loss attributable to |
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Three Months Ended | ||||||||
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2019 | 2018 | |||||||
Net loss, as reported | $ | (1.04) | $ | (0.22) | ||||
Adjustments: | ||||||||
Loss from early extinguishment of debt | 0.20 | 0.03 | ||||||
Impairment and (gain) loss on sale of businesses, net | 0.26 | 0.24 | ||||||
Expense from government and other legal settlements and related costs |
0.03 | 0.04 | ||||||
Expense from settlement and fair value adjustments and legal expenses related to cases covered by the CVR |
0.01 | 0.03 | ||||||
Expense related to employee termination benefits and other restructuring charges |
- | 0.01 | ||||||
Net (loss) income, excluding adjustments | $ | (0.53) | $ | 0.13 | ||||
(f) | Both income from operations and net loss for the three months ended |
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(g) | The |
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(h) | For the 12-month period ended |
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(i) | On |
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Upon adoption, the Company recorded operating lease liabilities and the related right-of-use assets of approximately |
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Regulation FD Disclosure
Set forth below is selected information concerning the Company’s projected consolidated operating results for the year ending
The following is provided as guidance to analysts and investors:
2019 |
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Net operating revenues (in millions) | $ | 12,800 | to | $ | 13,100 | |||||||
Adjusted EBITDA (in millions) | $ | 1,625 | to | $ | 1,725 | |||||||
Net loss per share - diluted | $ | (1.85) | to | $ | (1.50) | |||||||
Same-store hospital annual adjusted admissions growth | 0.0 | % | to | 1.0 | % | |||||||
Weighted-average diluted shares | 114.0 | to | 114.5 | |||||||||
The following assumptions were used in developing the 2019 guidance provided above:
- The 2019 projections include the impact of completed divestitures and the divestiture subject to a definitive agreement which is expected to close in 2019.
- The Company’s projections also exclude the following:
- Effect of debt refinancing activities, including gains and losses from early extinguishment of debt;
- Impairment of goodwill and long-lived assets;
- Gains or losses from the sales of businesses;
- Employee termination benefits and restructuring costs;
- Resolution of government investigations or other significant legal settlements;
- Costs incurred in connection with divestitures;
- Insurance recoveries that may be received for property losses and business interruption coverage related to Hurricanes Florence and Michael; and
- Other significant gains or losses that neither relate to the ordinary course of business nor reflect the Company’s underlying business performance.
Other assumptions used in the above guidance:
• Same-store hospital annual adjusted admissions growth of 0.0% to 1.0% for 2019, which does not take into account service closures and weather-related or other unusual events.
• Expressed as a percentage of net operating revenues, depreciation and amortization of approximately 4.9% for 2019. Additionally, this is a fixed cost and the percentages may change as revenue varies. Such amounts exclude the possible impact of any future hospital fixed asset impairments.
• Interest expense, expressed as a percentage of net operating revenues, of approximately 8.0%; however, this percentage may vary as revenue varies. Interest expense has been adjusted to reflect the repayment of debt with proceeds from the divestitures noted above, based on the expected timing of those divestitures. Total fixed rate debt, including swaps, is expected to average approximately 90% to 95% of total debt during 2019.
• Expressed as a percentage of net operating revenues, net income attributable to noncontrolling interests of approximately 0.6% to 0.7% for 2019.
• Expressed as a percentage of net operating revenues, provision for income taxes of approximately 0.8% to 0.9% for 2019.
A reconciliation of the Company’s projected 2019 Adjusted EBITDA, a forward-looking non-GAAP financial measure, to the Company’s projected net loss attributable to
Year Ending | ||||||||
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Low | High | |||||||
Net loss attributable to |
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stockholders (1) | $ | (211) | $ | (172) | ||||
Adjustments: | ||||||||
Depreciation and amortization | 630 | 640 | ||||||
Interest expense, net | 1,025 | 1,045 | ||||||
Provision for income taxes | 101 | 122 | ||||||
Net income attributable to noncontrolling interests | 80 | 90 | ||||||
Adjusted EBITDA (1) | $ | 1,625 | $ | 1,725 |
(1) | The Company does not include in this reconciliation the impact of certain items not included in the Company’s forecast set forth above that would be included in a reconciliation of historical net loss attributable to |
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• Capital expenditures are projected as follows (in millions):
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2019 | ||||||
Guidance | ||||||
Total | |
to | |
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- Net cash provided by operating activities is projected as follows (in millions):
2019 | ||||||
Guidance | ||||||
Total | |
to | |
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- Diluted weighted-average shares outstanding are projected to be approximately 114.0 million to 114.5 million for 2019.
This press release contains forward-looking statements within the meaning of Section 27A of the Securities Act of 1933, as amended, Section 21E of the Securities Exchange Act of 1934, as amended, and the Private Securities Litigation Reform Act of 1995 that involve risk and uncertainties. All statements in this press release other than statements of historical fact, including statements regarding projections, expected operating results, and other events that depend upon or refer to future events or conditions or that include words such as “expects,” “anticipates,” “intends,” “plans,” “believes,” “estimates,” “thinks,” and similar expressions, are forward-looking statements. Although the Company believes that these forward-looking statements are based on reasonable assumptions, these assumptions are inherently subject to significant economic and competitive uncertainties and contingencies, which are difficult or impossible to predict accurately and may be beyond the control of the Company. Accordingly, the Company cannot give any assurance that its expectations will in fact occur and cautions that actual results may differ materially from those in the forward-looking statements. A number of factors could affect the future results of the Company or the healthcare industry generally and could cause the Company’s expected results to differ materially from those expressed in this press release.
These factors include, among other things:
• general economic and business conditions, both nationally and in the regions in which we operate;
• the impact of current or future federal and state health reform initiatives, including, without limitation, the Affordable Care Act, and the potential for the Affordable Care Act to be repealed or found unconstitutional or for additional changes to the law, its implementation or its interpretation (including through executive orders and court challenges);
• the extent to which states support increases, decreases or changes in Medicaid programs, implement health insurance exchanges or alter the provision of healthcare to state residents through regulation or otherwise;
• the future and long-term viability of health insurance exchanges and potential changes to the beneficiary enrollment process;
• risks associated with our substantial indebtedness, leverage and debt service obligations, and the fact that a substantial portion of our indebtedness will mature and become due in the near future, including our ability to refinance such indebtedness on acceptable terms or to incur additional indebtedness;
• demographic changes;
• changes in, or the failure to comply with, federal, state or local laws or governmental regulations affecting our business;
• potential adverse impact of known and unknown government investigations, audits, and federal and state false claims act litigation and other legal proceedings;
• our ability, where appropriate, to enter into and maintain provider arrangements with payors and the terms of these arrangements, which may be further affected by the increasing consolidation of health insurers and managed care companies and vertical integration efforts involving payors and healthcare providers;
• changes in, or the failure to comply with, contract terms with payors and changes in reimbursement rates paid by federal or state healthcare programs or commercial payors;
• any potential additional impairments in the carrying value of goodwill, other intangible assets, or other long-lived assets, or changes in the useful lives of other intangible assets;
• changes in inpatient or outpatient Medicare and Medicaid payment levels and methodologies;
• the effects related to the continued implementation of the sequestration spending reductions and the potential for future deficit reduction legislation;
• increases in the amount and risk of collectability of patient accounts receivable, including decreases in collectability which may result from, among other things, self-pay growth and difficulties in recovering payments for which patients are responsible, including co-pays and deductibles;
• the efforts of insurers, healthcare providers, large employer groups and others to contain healthcare costs, including the trend toward value-based purchasing;
• increases in wages as a result of inflation or competition for highly technical positions and rising supply and drug costs due to market pressure from pharmaceutical companies and new product releases;
• liabilities and other claims asserted against us, including self-insured malpractice claims;
• competition;
• our ability to attract and retain, at reasonable employment costs, qualified personnel, key management, physicians, nurses and other healthcare workers;
• trends toward treatment of patients in less acute or specialty healthcare settings, including ambulatory surgery centers or specialty hospitals;
• changes in medical or other technology;
• changes in
• the availability and terms of capital to fund any additional acquisitions or replacement facilities or other capital expenditures;
• our ability to successfully make acquisitions or complete divestitures, including the disposition of hospitals and non-hospital businesses pursuant to our portfolio rationalization and deleveraging strategy, our ability to complete any such acquisitions or divestitures on desired terms or at all, the timing of the completion of any such acquisitions or divestitures, and our ability to realize the intended benefits from any such acquisitions or divestitures;
• the impact that changes in our relationships with joint venture or syndication partners could have on effectively operating our hospitals or ancillary services or in advancing strategic opportunities;
• our ability to successfully integrate any acquired hospitals, or to recognize expected synergies from acquisitions;
• the impact of seasonal severe weather conditions, including the timing and amount of insurance recoveries in relation to severe weather events;
• our ability to obtain adequate levels of general and professional liability insurance;
• timeliness of reimbursement payments received under government programs;
• effects related to outbreaks of infectious diseases;
• the impact of prior or potential future cyber-attacks or security breaches;
• any failure to comply with the terms of the Corporate Integrity Agreement;
• the concentration of our revenue in a small number of states;
• our ability to realize anticipated cost savings and other benefits from our current strategic and operational cost savings initiatives;
• changes in interpretations, assumptions and expectations regarding the Tax Cuts and Jobs Act; and
• the other risk factors set forth in our Annual Report on Form 10-K for the year ended
The consolidated operating results for the three months ended
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Cincinnati Financial Corporation Changes Name of MSP Underwriting Ltd. to Cincinnati Global Underwriting Ltd.
Arch MI Secures Over $621 Million of Indemnity Reinsurance through Bellemeade Re Insurance-Linked Note Transaction
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