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|
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☒
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Quarterly report pursuant to Section 13 or 15(d) of the Securities Exchange Act of 1934 for the quarterly period ended June 30, 2019
|
|
☐
|
Transition report pursuant to Section 13 or 15(d) of the Securities Exchange Act of 1934 for the transition period from to
|
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Nevada
|
95-2557091
|
|
(State of Incorporation)
|
(IRS Employer Identification No.)
|
|
Title of each class
|
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Trading symbol
|
|
Name of each exchange on which registered
|
|
|
Common stock
|
$0.05 par value
|
|
THC
|
|
New York Stock Exchange
|
|
6.875% Senior Notes due 2031
|
|
THC31
|
|
New York Stock Exchange
|
|
|
Large accelerated filer
|
x
|
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Accelerated filer
|
¨
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Non-accelerated filer
|
¨
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Smaller reporting company
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☐
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Emerging growth company
|
☐
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Page
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|||
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|||
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June 30,
|
|
December 31,
|
||||
|
|
|
2019
|
|
2018
|
||||
|
ASSETS
|
|
|
|
|
||||
|
Current assets:
|
|
|
|
|
||||
|
Cash and cash equivalents
|
|
$
|
249
|
|
|
$
|
411
|
|
|
Accounts receivable
|
|
2,734
|
|
|
2,595
|
|
||
|
Inventories of supplies, at cost
|
|
309
|
|
|
305
|
|
||
|
Income tax receivable
|
|
19
|
|
|
21
|
|
||
|
Assets held for sale
|
|
—
|
|
|
107
|
|
||
|
Other current assets
|
|
1,393
|
|
|
1,197
|
|
||
|
Total current assets
|
|
4,704
|
|
|
4,636
|
|
||
|
Investments and other assets
|
|
2,297
|
|
|
1,456
|
|
||
|
Deferred income taxes
|
|
268
|
|
|
312
|
|
||
|
Property and equipment, at cost, less accumulated depreciation and amortization
($5,526 at June 30, 2019 and $5,221 at December 31, 2018) |
|
6,995
|
|
|
6,993
|
|
||
|
Goodwill
|
|
7,298
|
|
|
7,281
|
|
||
|
Other intangible assets, at cost, less accumulated amortization
($1,051 at June 30, 2019 and $1,013 at December 31, 2018) |
|
1,645
|
|
|
1,731
|
|
||
|
Total assets
|
|
$
|
23,207
|
|
|
$
|
22,409
|
|
|
LIABILITIES AND EQUITY
|
|
|
|
|
||||
|
Current liabilities:
|
|
|
|
|
||||
|
Current portion of long-term debt
|
|
$
|
664
|
|
|
$
|
182
|
|
|
Accounts payable
|
|
1,088
|
|
|
1,207
|
|
||
|
Accrued compensation and benefits
|
|
720
|
|
|
838
|
|
||
|
Professional and general liability reserves
|
|
228
|
|
|
216
|
|
||
|
Accrued interest payable
|
|
233
|
|
|
240
|
|
||
|
Liabilities held for sale
|
|
—
|
|
|
43
|
|
||
|
Other current liabilities
|
|
1,217
|
|
|
1,131
|
|
||
|
Total current liabilities
|
|
4,150
|
|
|
3,857
|
|
||
|
Long-term debt, net of current portion
|
|
14,312
|
|
|
14,644
|
|
||
|
Professional and general liability reserves
|
|
669
|
|
|
666
|
|
||
|
Defined benefit plan obligations
|
|
507
|
|
|
521
|
|
||
|
Deferred income taxes
|
|
36
|
|
|
36
|
|
||
|
Other long-term liabilities
|
|
1,354
|
|
|
578
|
|
||
|
Total liabilities
|
|
21,028
|
|
|
20,302
|
|
||
|
Commitments and contingencies
|
|
|
|
|
|
|
||
|
Redeemable noncontrolling interests in equity of consolidated subsidiaries
|
|
1,462
|
|
|
1,420
|
|
||
|
Equity:
|
|
|
|
|
||||
|
Shareholders’ equity:
|
|
|
|
|
||||
|
Common stock, $0.05 par value; authorized 262,500,000 shares; 151,684,478 shares issued at
June 30, 2019 and 150,897,143 shares issued at December 31, 2018 |
|
7
|
|
|
7
|
|
||
|
Additional paid-in capital
|
|
4,755
|
|
|
4,747
|
|
||
|
Accumulated other comprehensive loss
|
|
(219
|
)
|
|
(223
|
)
|
||
|
Accumulated deficit
|
|
(2,237
|
)
|
|
(2,236
|
)
|
||
|
Common stock in treasury, at cost, 48,348,348 shares at June 30, 2019
and 48,359,705 shares at December 31, 2018 |
|
(2,414
|
)
|
|
(2,414
|
)
|
||
|
Total shareholders’ deficit
|
|
(108
|
)
|
|
(119
|
)
|
||
|
Noncontrolling interests
|
|
825
|
|
|
806
|
|
||
|
Total equity
|
|
717
|
|
|
687
|
|
||
|
Total liabilities and equity
|
|
$
|
23,207
|
|
|
$
|
22,409
|
|
|
|
|
Three Months Ended June 30,
|
|
Six Months Ended June 30,
|
||||||||||||
|
|
|
2019
|
|
2018
|
|
2019
|
|
2018
|
||||||||
|
Net operating revenues
|
|
$
|
4,560
|
|
|
$
|
4,506
|
|
|
$
|
9,105
|
|
|
$
|
9,205
|
|
|
Equity in earnings of unconsolidated affiliates
|
|
42
|
|
|
39
|
|
|
76
|
|
|
64
|
|
||||
|
Operating expenses:
|
|
|
|
|
|
|
|
|
||||||||
|
Salaries, wages and benefits
|
|
2,148
|
|
|
2,135
|
|
|
4,301
|
|
|
4,362
|
|
||||
|
Supplies
|
|
753
|
|
|
748
|
|
|
1,494
|
|
|
1,522
|
|
||||
|
Other operating expenses, net
|
|
1,044
|
|
|
1,027
|
|
|
2,118
|
|
|
2,087
|
|
||||
|
Electronic health record incentives
|
|
—
|
|
|
—
|
|
|
(1
|
)
|
|
(1
|
)
|
||||
|
Depreciation and amortization
|
|
214
|
|
|
194
|
|
|
422
|
|
|
398
|
|
||||
|
Impairment and restructuring charges, and acquisition-related costs
|
|
36
|
|
|
30
|
|
|
55
|
|
|
77
|
|
||||
|
Litigation and investigation costs
|
|
18
|
|
|
13
|
|
|
31
|
|
|
19
|
|
||||
|
Net losses (gains) on sales, consolidation and deconsolidation of facilities
|
|
1
|
|
|
(8
|
)
|
|
2
|
|
|
(118
|
)
|
||||
|
Operating income
|
|
388
|
|
|
406
|
|
|
759
|
|
|
923
|
|
||||
|
Interest expense
|
|
(247
|
)
|
|
(254
|
)
|
|
(498
|
)
|
|
(509
|
)
|
||||
|
Other non-operating expense, net
|
|
(1
|
)
|
|
(1
|
)
|
|
—
|
|
|
(2
|
)
|
||||
|
Loss from early extinguishment of debt
|
|
—
|
|
|
(1
|
)
|
|
(47
|
)
|
|
(2
|
)
|
||||
|
Income from continuing operations, before income taxes
|
|
140
|
|
|
150
|
|
|
214
|
|
|
410
|
|
||||
|
Income tax expense
|
|
(30
|
)
|
|
(44
|
)
|
|
(47
|
)
|
|
(114
|
)
|
||||
|
Income from continuing operations, before discontinued operations
|
|
110
|
|
|
106
|
|
|
167
|
|
|
296
|
|
||||
|
Discontinued operations:
|
|
|
|
|
|
|
|
|
||||||||
|
Income from operations
|
|
2
|
|
|
2
|
|
|
12
|
|
|
3
|
|
||||
|
Income tax expense
|
|
—
|
|
|
—
|
|
|
(2
|
)
|
|
—
|
|
||||
|
Income from discontinued operations
|
|
2
|
|
|
2
|
|
|
10
|
|
|
3
|
|
||||
|
Net income
|
|
112
|
|
|
108
|
|
|
177
|
|
|
299
|
|
||||
|
Less: Net income available to noncontrolling interests
|
|
95
|
|
|
82
|
|
|
179
|
|
|
174
|
|
||||
|
Net income available (loss attributable) to Tenet Healthcare Corporation common shareholders
|
|
$
|
17
|
|
|
$
|
26
|
|
|
$
|
(2
|
)
|
|
$
|
125
|
|
|
Amounts available (attributable) to Tenet Healthcare Corporation common shareholders
|
|
|
|
|
|
|
|
|
||||||||
|
Income (loss) from continuing operations, net of tax
|
|
$
|
15
|
|
|
$
|
24
|
|
|
$
|
(12
|
)
|
|
$
|
122
|
|
|
Income from discontinued operations, net of tax
|
|
2
|
|
|
2
|
|
|
10
|
|
|
3
|
|
||||
|
Net income available (loss attributable) to Tenet Healthcare Corporation common shareholders
|
|
$
|
17
|
|
|
$
|
26
|
|
|
$
|
(2
|
)
|
|
$
|
125
|
|
|
Earnings (loss) per share available (attributable) to Tenet Healthcare Corporation common shareholders:
|
|
|
|
|
|
|
|
|
||||||||
|
Basic
|
|
|
|
|
|
|
|
|
||||||||
|
Continuing operations
|
|
$
|
0.15
|
|
|
$
|
0.23
|
|
|
$
|
(0.12
|
)
|
|
$
|
1.20
|
|
|
Discontinued operations
|
|
0.02
|
|
|
0.02
|
|
|
0.10
|
|
|
0.03
|
|
||||
|
|
|
$
|
0.17
|
|
|
$
|
0.25
|
|
|
$
|
(0.02
|
)
|
|
$
|
1.23
|
|
|
Diluted
|
|
|
|
|
|
|
|
|
||||||||
|
Continuing operations
|
|
$
|
0.14
|
|
|
$
|
0.23
|
|
|
$
|
(0.12
|
)
|
|
$
|
1.18
|
|
|
Discontinued operations
|
|
0.02
|
|
|
0.02
|
|
|
0.10
|
|
|
0.03
|
|
||||
|
|
|
$
|
0.16
|
|
|
$
|
0.25
|
|
|
$
|
(0.02
|
)
|
|
$
|
1.21
|
|
|
Weighted average shares and dilutive securities outstanding (in thousands):
|
|
|
|
|
|
|
|
|
||||||||
|
Basic
|
|
103,198
|
|
|
102,147
|
|
|
102,993
|
|
|
101,770
|
|
||||
|
Diluted
|
|
104,629
|
|
|
104,177
|
|
|
102,993
|
|
|
103,416
|
|
||||
|
|
|
Three Months Ended June 30,
|
|
Six Months Ended June 30,
|
||||||||||||
|
|
|
2019
|
|
2018
|
|
2019
|
|
2018
|
||||||||
|
Net income
|
|
$
|
112
|
|
|
$
|
108
|
|
|
$
|
177
|
|
|
$
|
299
|
|
|
Other comprehensive income:
|
|
|
|
|
|
|
|
|
||||||||
|
Amortization of net actuarial loss included in other non-operating expense, net
|
|
3
|
|
|
4
|
|
|
6
|
|
|
8
|
|
||||
|
Foreign currency translation adjustments
|
|
—
|
|
|
(9
|
)
|
|
—
|
|
|
(3
|
)
|
||||
|
Other comprehensive income (loss) before income taxes
|
|
3
|
|
|
(5
|
)
|
|
6
|
|
|
5
|
|
||||
|
Income tax benefit (expense) related to items of other comprehensive income (loss)
|
|
(1
|
)
|
|
1
|
|
|
(2
|
)
|
|
(1
|
)
|
||||
|
Total other comprehensive income (loss), net of tax
|
|
2
|
|
|
(4
|
)
|
|
4
|
|
|
4
|
|
||||
|
Comprehensive net income
|
|
114
|
|
|
104
|
|
|
181
|
|
|
303
|
|
||||
|
Less: Comprehensive income available to noncontrolling interests
|
|
95
|
|
|
82
|
|
|
179
|
|
|
174
|
|
||||
|
Comprehensive income available to Tenet Healthcare Corporation common shareholders
|
|
$
|
19
|
|
|
$
|
22
|
|
|
$
|
2
|
|
|
$
|
129
|
|
|
|
|
Six Months Ended
June 30, |
||||||
|
|
|
2019
|
|
2018
|
||||
|
Net income
|
|
$
|
177
|
|
|
$
|
299
|
|
|
Adjustments to reconcile net income to net cash provided by operating activities:
|
|
|
|
|
||||
|
Depreciation and amortization
|
|
422
|
|
|
398
|
|
||
|
Deferred income tax expense
|
|
42
|
|
|
108
|
|
||
|
Stock-based compensation expense
|
|
23
|
|
|
20
|
|
||
|
Impairment and restructuring charges, and acquisition-related costs
|
|
55
|
|
|
77
|
|
||
|
Litigation and investigation costs
|
|
31
|
|
|
19
|
|
||
|
Net losses (gains) on sales, consolidation and deconsolidation of facilities
|
|
2
|
|
|
(118
|
)
|
||
|
Loss from early extinguishment of debt
|
|
47
|
|
|
2
|
|
||
|
Equity in earnings of unconsolidated affiliates, net of distributions received
|
|
(2
|
)
|
|
10
|
|
||
|
Amortization of debt discount and debt issuance costs
|
|
21
|
|
|
22
|
|
||
|
Pre-tax income from discontinued operations
|
|
(12
|
)
|
|
(3
|
)
|
||
|
Other items, net
|
|
(10
|
)
|
|
(1
|
)
|
||
|
Changes in cash from operating assets and liabilities:
|
|
|
|
|
|
|
||
|
Accounts receivable
|
|
(138
|
)
|
|
(13
|
)
|
||
|
Inventories and other current assets
|
|
(64
|
)
|
|
144
|
|
||
|
Income taxes
|
|
(2
|
)
|
|
(18
|
)
|
||
|
Accounts payable, accrued expenses and other current liabilities
|
|
(217
|
)
|
|
(371
|
)
|
||
|
Other long-term liabilities
|
|
4
|
|
|
(48
|
)
|
||
|
Payments for restructuring charges, acquisition-related costs, and litigation costs and settlements
|
|
(80
|
)
|
|
(63
|
)
|
||
|
Net cash used in operating activities from discontinued operations, excluding income taxes
|
|
(5
|
)
|
|
(3
|
)
|
||
|
Net cash provided by operating activities
|
|
294
|
|
|
461
|
|
||
|
Cash flows from investing activities:
|
|
|
|
|
|
|
||
|
Purchases of property and equipment — continuing operations
|
|
(336
|
)
|
|
(268
|
)
|
||
|
Purchases of businesses or joint venture interests, net of cash acquired
|
|
(13
|
)
|
|
(89
|
)
|
||
|
Proceeds from sales of facilities and other assets — continuing operations
|
|
40
|
|
|
481
|
|
||
|
Proceeds from sales of facilities and other assets — discontinued operations
|
|
17
|
|
|
—
|
|
||
|
Proceeds from sales of marketable securities, long-term investments and other assets
|
|
9
|
|
|
143
|
|
||
|
Purchases of equity investments
|
|
(9
|
)
|
|
(37
|
)
|
||
|
Other long-term assets
|
|
(4
|
)
|
|
3
|
|
||
|
Other items, net
|
|
(7
|
)
|
|
(8
|
)
|
||
|
Net cash provided by (used in) investing activities
|
|
(303
|
)
|
|
225
|
|
||
|
Cash flows from financing activities:
|
|
|
|
|
|
|
||
|
Repayments of borrowings under credit facility
|
|
(1,095
|
)
|
|
(360
|
)
|
||
|
Proceeds from borrowings under credit facility
|
|
1,285
|
|
|
360
|
|
||
|
Repayments of other borrowings
|
|
(1,668
|
)
|
|
(161
|
)
|
||
|
Proceeds from other borrowings
|
|
1,516
|
|
|
14
|
|
||
|
Debt issuance costs
|
|
(18
|
)
|
|
—
|
|
||
|
Distributions paid to noncontrolling interests
|
|
(144
|
)
|
|
(140
|
)
|
||
|
Proceeds from sales of noncontrolling interests
|
|
9
|
|
|
7
|
|
||
|
Purchases of noncontrolling interests
|
|
(6
|
)
|
|
(642
|
)
|
||
|
Proceeds from exercise of stock options and employee stock purchase plan
|
|
3
|
|
|
14
|
|
||
|
Other items, net
|
|
(35
|
)
|
|
14
|
|
||
|
Net cash used in financing activities
|
|
(153
|
)
|
|
(894
|
)
|
||
|
Net decrease in cash and cash equivalents
|
|
(162
|
)
|
|
(208
|
)
|
||
|
Cash and cash equivalents at beginning of period
|
|
411
|
|
|
611
|
|
||
|
Cash and cash equivalents at end of period
|
|
$
|
249
|
|
|
$
|
403
|
|
|
Supplemental disclosures:
|
|
|
|
|
|
|
||
|
Interest paid, net of capitalized interest
|
|
$
|
(484
|
)
|
|
$
|
(501
|
)
|
|
Income tax payments, net
|
|
$
|
(13
|
)
|
|
$
|
(21
|
)
|
|
|
|
Gross
Carrying Amount |
|
Accumulated
Amortization |
|
Net Book
Value |
||||||
|
At June 30, 2019:
|
|
|
|
|
|
|
||||||
|
Capitalized software costs
|
|
$
|
1,615
|
|
|
$
|
(881
|
)
|
|
$
|
734
|
|
|
Trade names
|
|
102
|
|
|
—
|
|
|
102
|
|
|||
|
Contracts
|
|
874
|
|
|
(86
|
)
|
|
788
|
|
|||
|
Other
|
|
105
|
|
|
(84
|
)
|
|
21
|
|
|||
|
Total
|
|
$
|
2,696
|
|
|
$
|
(1,051
|
)
|
|
$
|
1,645
|
|
|
|
|
Gross
Carrying Amount |
|
Accumulated
Amortization |
|
Net Book
Value |
||||||
|
At December 31, 2018:
|
|
|
|
|
|
|
||||||
|
Capitalized software costs
|
|
$
|
1,667
|
|
|
$
|
(858
|
)
|
|
$
|
809
|
|
|
Trade names
|
|
102
|
|
|
—
|
|
|
102
|
|
|||
|
Contracts
|
|
871
|
|
|
(76
|
)
|
|
795
|
|
|||
|
Other
|
|
104
|
|
|
(79
|
)
|
|
25
|
|
|||
|
Total
|
|
$
|
2,744
|
|
|
$
|
(1,013
|
)
|
|
$
|
1,731
|
|
|
|
|
|
|
Six Months
Ending |
|
Years Ending
|
|
Later Years
|
||||||||||||||||||||
|
|
|
|
|
December 31,
|
|
|||||||||||||||||||||||
|
|
|
Total
|
|
2019
|
|
2020
|
|
2021
|
|
2022
|
|
2023
|
|
|||||||||||||||
|
Amortization of intangible assets
|
|
$
|
964
|
|
|
$
|
76
|
|
|
$
|
130
|
|
|
$
|
115
|
|
|
$
|
99
|
|
|
$
|
89
|
|
|
$
|
455
|
|
|
|
|
Three Months Ended
June 30, |
|
Six Months Ended
June 30, |
||||||||||||
|
|
|
2019
|
|
2018
|
|
2019
|
|
2018
|
||||||||
|
Net operating revenues
|
|
$
|
619
|
|
|
$
|
547
|
|
|
$
|
1,187
|
|
|
$
|
1,121
|
|
|
Net income
|
|
$
|
141
|
|
|
$
|
132
|
|
|
$
|
291
|
|
|
$
|
248
|
|
|
Net income available to the investees
|
|
$
|
87
|
|
|
$
|
89
|
|
|
$
|
193
|
|
|
$
|
160
|
|
|
|
|
June 30, 2019
|
|
December 31, 2018
|
||||
|
Continuing operations:
|
|
|
|
|
|
|
||
|
Patient accounts receivable
|
|
$
|
2,525
|
|
|
$
|
2,427
|
|
|
Estimated future recoveries
|
|
158
|
|
|
148
|
|
||
|
Net cost reports and settlements receivable and valuation allowances
|
|
49
|
|
|
18
|
|
||
|
|
|
2,732
|
|
|
2,593
|
|
||
|
Discontinued operations
|
|
2
|
|
|
2
|
|
||
|
Accounts receivable, net
|
|
$
|
2,734
|
|
|
$
|
2,595
|
|
|
|
|
Three Months Ended
June 30, |
|
Six Months Ended
June 30, |
||||||||||||
|
|
|
2019
|
|
2018
|
|
2019
|
|
2018
|
||||||||
|
Estimated costs for:
|
|
|
|
|
|
|
|
|
|
|
|
|
||||
|
Uninsured patients
|
|
$
|
164
|
|
|
$
|
159
|
|
|
$
|
322
|
|
|
$
|
305
|
|
|
Charity care patients
|
|
41
|
|
|
28
|
|
|
75
|
|
|
63
|
|
||||
|
Total
|
|
$
|
205
|
|
|
$
|
187
|
|
|
$
|
397
|
|
|
$
|
368
|
|
|
December 31, 2018
|
|
$
|
169
|
|
|
June 30, 2019
|
|
160
|
|
|
|
Increase/(decrease)
|
|
$
|
(9
|
)
|
|
January 1, 2018
|
|
$
|
171
|
|
|
June 30, 2018
|
|
136
|
|
|
|
Increase/(decrease)
|
|
$
|
(35
|
)
|
|
|
|
|
|
|
|
Contract Liability-
|
|
Contract Liability-
|
||||||||
|
|
|
|
|
Contract Asset-
|
|
Current
|
|
Long-Term
|
||||||||
|
|
|
Receivables
|
|
Unbilled Revenue
|
|
Deferred Revenue
|
|
Deferred Revenue
|
||||||||
|
December 31, 2018
|
|
$
|
42
|
|
|
$
|
11
|
|
|
$
|
61
|
|
|
$
|
20
|
|
|
June 30, 2019
|
|
96
|
|
|
15
|
|
|
67
|
|
|
19
|
|
||||
|
Increase/(decrease)
|
|
$
|
54
|
|
|
$
|
4
|
|
|
$
|
6
|
|
|
$
|
(1
|
)
|
|
|
|
|
|
|
|
|
|
|
||||||||
|
January 1, 2018
|
|
$
|
89
|
|
|
$
|
10
|
|
|
$
|
80
|
|
|
$
|
21
|
|
|
June 30, 2018
|
|
90
|
|
|
11
|
|
|
78
|
|
|
21
|
|
||||
|
Increase/(decrease)
|
|
$
|
1
|
|
|
$
|
1
|
|
|
$
|
(2
|
)
|
|
$
|
—
|
|
|
|
|
Three Months Ended
June 30, |
|
Six Months Ended
June 30, |
||||||||||||
|
|
|
2019
|
|
2018
|
|
2019
|
|
2018
|
||||||||
|
Significant disposals:
|
|
|
|
|
|
|
|
|
||||||||
|
Income (loss) from continuing operations, before income taxes
|
|
|
|
|
|
|
|
|
||||||||
|
Chicago-area (includes a $6 million loss on sale in the 2019 year-to-date period and $17 million of impairment charges in the 2018 year-to-date period)
|
|
$
|
1
|
|
|
$
|
1
|
|
|
$
|
(11
|
)
|
|
$
|
(15
|
)
|
|
Philadelphia (includes a $2 million loss on sale in the 2018 year-to-date period)
|
|
—
|
|
|
(2
|
)
|
|
1
|
|
|
(11
|
)
|
||||
|
MacNeal (includes a $95 million gain on sale in the 2018 year-to-date period)
|
|
1
|
|
|
(4
|
)
|
|
2
|
|
|
97
|
|
||||
|
Aspen (includes a $4 million of impairment charges in the 2018 year-to-date period)
|
|
—
|
|
|
(3
|
)
|
|
—
|
|
|
—
|
|
||||
|
Total
|
|
$
|
2
|
|
|
$
|
(8
|
)
|
|
$
|
(8
|
)
|
|
$
|
71
|
|
|
Component of Lease Balances
|
|
Classification in Condensed Consolidated Balance Sheet
|
|
June 30, 2019
|
||
|
Assets:
|
|
|
|
|
||
|
Operating lease assets
|
|
Investments and other assets
|
|
$
|
874
|
|
|
Finance lease assets
|
|
Property and equipment, at cost, less
accumulated depreciation and amortization |
|
439
|
|
|
|
Total leased assets
|
|
|
|
$
|
1,313
|
|
|
|
|
|
|
|
||
|
Liabilities:
|
|
|
|
|
||
|
Operating lease liabilities:
|
|
|
|
|
||
|
Current
|
|
Other current liabilities
|
|
$
|
149
|
|
|
Long-term
|
|
Other long-term liabilities
|
|
819
|
|
|
|
Total operating lease liabilities
|
|
|
|
968
|
|
|
|
Finance lease liabilities:
|
|
|
|
|
||
|
Current
|
|
Current portion of long-term debt
|
|
141
|
|
|
|
Long-term
|
|
Long-term debt, net of current portion
|
|
214
|
|
|
|
Total finance lease liabilities
|
|
|
|
355
|
|
|
|
Total lease liabilities
|
|
|
|
$
|
1,323
|
|
|
|
|
Classification on Condensed Consolidated
|
|
Three Months Ended
|
|
Six Months Ended
|
||||
|
Component of Lease Expense
|
|
Statements of Operations
|
|
June 30, 2019
|
|
June 30, 2019
|
||||
|
Operating lease expense
|
|
Other operating expenses, net
|
|
$
|
52
|
|
|
$
|
102
|
|
|
Finance lease expense:
|
|
|
|
|
|
|
||||
|
Amortization of leased assets
|
|
Depreciation and amortization
|
|
23
|
|
|
41
|
|
||
|
Interest on lease liabilities
|
|
Interest expense
|
|
3
|
|
|
8
|
|
||
|
Total finance lease expense
|
|
|
|
26
|
|
|
49
|
|
||
|
Variable and short term-lease expense
|
|
Other operating expenses, net
|
|
33
|
|
|
67
|
|
||
|
Total lease expense
|
|
|
|
$
|
111
|
|
|
$
|
218
|
|
|
|
|
Six Months Ended
|
||
|
|
|
June 30, 2019
|
||
|
Cash paid for amounts included in the measurement of lease liabilities:
|
|
|
||
|
Operating cash outflows from operating leases
|
|
$
|
95
|
|
|
Operating cash outflows from finance leases
|
|
$
|
9
|
|
|
Financing cash outflows from finance leases
|
|
$
|
75
|
|
|
|
|
|
||
|
Right-of-use assets obtained in exchange for lease obligations:
|
|
|
||
|
Operating leases
|
|
$
|
139
|
|
|
Finance leases
|
|
$
|
58
|
|
|
|
|
Operating Leases
|
|
Finance Leases
|
|
Total
|
||||||
|
2019
|
|
$
|
149
|
|
|
$
|
141
|
|
|
$
|
290
|
|
|
2020
|
|
176
|
|
|
128
|
|
|
304
|
|
|||
|
2021
|
|
163
|
|
|
72
|
|
|
235
|
|
|||
|
2022
|
|
145
|
|
|
19
|
|
|
164
|
|
|||
|
2023
|
|
124
|
|
|
13
|
|
|
137
|
|
|||
|
Later years
|
|
492
|
|
|
124
|
|
|
616
|
|
|||
|
Total lease payments
|
|
1,249
|
|
|
497
|
|
|
1,746
|
|
|||
|
Less: Imputed interest
|
|
281
|
|
|
142
|
|
|
423
|
|
|||
|
Total lease obligations
|
|
968
|
|
|
355
|
|
|
1,323
|
|
|||
|
Less: Current obligations
|
|
149
|
|
|
141
|
|
|
290
|
|
|||
|
Long-term lease obligations
|
|
$
|
819
|
|
|
$
|
214
|
|
|
$
|
1,033
|
|
|
|
|
|
Years Ending December 31,
|
|
Later Years
|
||||||||||||||||||||||
|
|
Total
|
|
2019
|
|
2020
|
|
2021
|
|
2022
|
|
2023
|
|
|||||||||||||||
|
Capital lease obligations
|
$
|
425
|
|
|
$
|
140
|
|
|
$
|
95
|
|
|
$
|
57
|
|
|
$
|
37
|
|
|
$
|
21
|
|
|
$
|
75
|
|
|
Long-term non-cancelable operating leases
|
$
|
932
|
|
|
$
|
171
|
|
|
$
|
151
|
|
|
$
|
133
|
|
|
$
|
113
|
|
|
$
|
92
|
|
|
$
|
272
|
|
|
|
|
June 30, 2019
|
|
December 31, 2018
|
||||
|
Senior unsecured notes:
|
|
|
|
|
|
|
||
|
5.500% due 2019
|
|
$
|
—
|
|
|
$
|
468
|
|
|
6.750% due 2020
|
|
—
|
|
|
300
|
|
||
|
8.125% due 2022
|
|
2,800
|
|
|
2,800
|
|
||
|
6.750% due 2023
|
|
1,872
|
|
|
1,872
|
|
||
|
7.000% due 2025
|
|
478
|
|
|
478
|
|
||
|
6.875% due 2031
|
|
362
|
|
|
362
|
|
||
|
Senior secured first lien notes:
|
|
|
|
|
|
|
||
|
4.750% due 2020
|
|
500
|
|
|
500
|
|
||
|
6.000% due 2020
|
|
1,800
|
|
|
1,800
|
|
||
|
4.500% due 2021
|
|
850
|
|
|
850
|
|
||
|
4.375% due 2021
|
|
1,050
|
|
|
1,050
|
|
||
|
4.625% due 2024
|
|
1,870
|
|
|
1,870
|
|
||
|
Senior secured second lien notes:
|
|
|
|
|
||||
|
7.500% due 2022
|
|
—
|
|
|
750
|
|
||
|
5.125% due 2025
|
|
1,410
|
|
|
1,410
|
|
||
|
6.250% due 2027
|
|
1,500
|
|
|
—
|
|
||
|
Credit facility due 2020
|
|
190
|
|
|
—
|
|
||
|
Finance leases and mortgage notes
|
|
467
|
|
|
500
|
|
||
|
Unamortized issue costs and note discounts
|
|
(173
|
)
|
|
(184
|
)
|
||
|
Total long-term debt
|
|
14,976
|
|
|
14,826
|
|
||
|
Less current portion
|
|
664
|
|
|
182
|
|
||
|
Long-term debt, net of current portion
|
|
$
|
14,312
|
|
|
$
|
14,644
|
|
|
|
|
Options
|
|
Weighted Average
Exercise Price Per Share |
|
Aggregate
Intrinsic Value |
|
Weighted Average
Remaining Life |
|||||
|
|
|
|
|
|
|
(In Millions)
|
|
|
|||||
|
Outstanding at December 31, 2018
|
|
2,262,743
|
|
|
$
|
19.12
|
|
|
|
|
|
||
|
Granted
|
|
230,713
|
|
|
28.28
|
|
|
|
|
|
|||
|
Exercised
|
|
(76,159
|
)
|
|
4.56
|
|
|
|
|
|
|||
|
Forfeited/Expired
|
|
(120,871
|
)
|
|
19.25
|
|
|
|
|
|
|||
|
Outstanding at June 30, 2019
|
|
2,296,426
|
|
|
$
|
20.52
|
|
|
$
|
3
|
|
|
6.4 years
|
|
Vested and expected to vest at June 30, 2019
|
|
2,296,426
|
|
|
$
|
20.52
|
|
|
$
|
3
|
|
|
6.4 years
|
|
Exercisable at June 30, 2019
|
|
684,628
|
|
|
$
|
19.03
|
|
|
$
|
2
|
|
|
3.1 years
|
|
|
|
February 27, 2019
|
|
February 28, 2018
|
|
Expected volatility
|
|
48%
|
|
46%
|
|
Expected dividend yield
|
|
0%
|
|
0%
|
|
Expected life
|
|
6.2 years
|
|
6.2 years
|
|
Expected forfeiture rate
|
|
0%
|
|
0%
|
|
Risk-free interest rate
|
|
2.53%
|
|
2.72%
|
|
|
|
Options Outstanding
|
|
Options Exercisable
|
||||||||||||
|
Range of Exercise Prices
|
|
Number of
Options |
|
Weighted Average
Remaining Contractual Life |
|
Weighted Average
Exercise Price |
|
Number of
Options |
|
Weighted Average
Exercise Price |
||||||
|
$16.43 to $19.759
|
|
1,246,675
|
|
|
5.7 years
|
|
18.15
|
|
|
413,960
|
|
|
16.46
|
|
||
|
$19.76 to $35.430
|
|
1,049,751
|
|
|
7.1 years
|
|
23.33
|
|
|
270,668
|
|
|
22.94
|
|
||
|
|
|
2,296,426
|
|
|
6.4 years
|
|
$
|
20.52
|
|
|
684,628
|
|
|
$
|
19.03
|
|
|
|
|
Restricted Stock Units
|
|
Weighted Average Grant
Date Fair Value Per Unit |
|||
|
Unvested at December 31, 2018
|
|
1,884,130
|
|
|
$
|
32.25
|
|
|
Granted
|
|
1,235,876
|
|
|
26.20
|
|
|
|
Vested
|
|
(817,820
|
)
|
|
27.55
|
|
|
|
Forfeited
|
|
(298,680
|
)
|
|
25.02
|
|
|
|
Unvested at June 30, 2019
|
|
2,003,506
|
|
|
$
|
31.52
|
|
|
|
|
Common Stock
|
|
Additional
Paid-In Capital |
|
Accumulated
Other Comprehensive Loss |
|
Accumulated
Deficit |
|
Treasury
Stock |
|
Noncontrolling
Interests |
|
Total Equity
|
|||||||||||||||||
|
|
|
Shares
Outstanding |
|
Issued Par
Amount |
|
|
|
|
|
|
|||||||||||||||||||||
|
Balances at December 31, 2018
|
|
102,537
|
|
|
$
|
7
|
|
|
$
|
4,747
|
|
|
$
|
(223
|
)
|
|
$
|
(2,236
|
)
|
|
$
|
(2,414
|
)
|
|
$
|
806
|
|
|
$
|
687
|
|
|
Net income (loss)
|
|
—
|
|
|
—
|
|
|
—
|
|
|
—
|
|
|
(19
|
)
|
|
—
|
|
|
37
|
|
|
18
|
|
|||||||
|
Distributions paid to noncontrolling interests
|
|
—
|
|
|
—
|
|
|
—
|
|
|
—
|
|
|
—
|
|
|
—
|
|
|
(37
|
)
|
|
(37
|
)
|
|||||||
|
Other comprehensive income
|
|
—
|
|
|
—
|
|
|
—
|
|
|
2
|
|
|
—
|
|
|
—
|
|
|
—
|
|
|
2
|
|
|||||||
|
Accretion of redeemable noncontrolling interests
|
|
—
|
|
|
—
|
|
|
(5
|
)
|
|
—
|
|
|
—
|
|
|
—
|
|
|
—
|
|
|
(5
|
)
|
|||||||
|
Purchases (sales) of businesses and noncontrolling interests
|
|
—
|
|
|
—
|
|
|
(2
|
)
|
|
—
|
|
|
—
|
|
|
—
|
|
|
2
|
|
|
—
|
|
|||||||
|
Cumulative effect of accounting change
|
|
—
|
|
|
—
|
|
|
—
|
|
|
—
|
|
|
1
|
|
|
—
|
|
|
—
|
|
|
1
|
|
|||||||
|
Stock-based compensation expense, tax benefit and issuance of common stock
|
|
543
|
|
|
—
|
|
|
8
|
|
|
—
|
|
|
—
|
|
|
—
|
|
|
—
|
|
|
8
|
|
|||||||
|
Balances at March 31, 2019
|
|
103,080
|
|
|
$
|
7
|
|
|
$
|
4,748
|
|
|
$
|
(221
|
)
|
|
$
|
(2,254
|
)
|
|
$
|
(2,414
|
)
|
|
$
|
808
|
|
|
$
|
674
|
|
|
Net income
|
|
—
|
|
|
—
|
|
|
—
|
|
|
—
|
|
|
17
|
|
|
—
|
|
|
47
|
|
|
64
|
|
|||||||
|
Distributions paid to noncontrolling interests
|
|
—
|
|
|
—
|
|
|
—
|
|
|
—
|
|
|
—
|
|
|
—
|
|
|
(35
|
)
|
|
(35
|
)
|
|||||||
|
Other comprehensive income
|
|
—
|
|
|
—
|
|
|
—
|
|
|
2
|
|
|
—
|
|
|
—
|
|
|
—
|
|
|
2
|
|
|||||||
|
Accretion of redeemable noncontrolling interests
|
|
—
|
|
|
—
|
|
|
(4
|
)
|
|
—
|
|
|
—
|
|
|
—
|
|
|
—
|
|
|
(4
|
)
|
|||||||
|
Purchases of businesses and noncontrolling interests
|
|
—
|
|
|
—
|
|
|
—
|
|
|
—
|
|
|
—
|
|
|
—
|
|
|
5
|
|
|
5
|
|
|||||||
|
Stock-based compensation expense, tax benefit and issuance of common stock
|
|
256
|
|
|
—
|
|
|
11
|
|
|
—
|
|
|
—
|
|
|
—
|
|
|
—
|
|
|
11
|
|
|||||||
|
Balances at June 30, 2019
|
|
103,336
|
|
|
$
|
7
|
|
|
$
|
4,755
|
|
|
$
|
(219
|
)
|
|
$
|
(2,237
|
)
|
|
$
|
(2,414
|
)
|
|
$
|
825
|
|
|
$
|
717
|
|
|
|
|
Common Stock
|
|
Additional
Paid-In Capital |
|
Accumulated
Other Comprehensive Loss |
|
Accumulated
Deficit |
|
Treasury
Stock |
|
Noncontrolling
Interests |
|
Total Equity
|
|||||||||||||||||
|
|
|
Shares
Outstanding |
|
Issued Par
Amount |
|
|
|
|
|
|
|||||||||||||||||||||
|
Balances at December 31, 2017
|
|
100,972
|
|
|
$
|
7
|
|
|
$
|
4,859
|
|
|
$
|
(204
|
)
|
|
$
|
(2,390
|
)
|
|
$
|
(2,419
|
)
|
|
$
|
686
|
|
|
$
|
539
|
|
|
Net income
|
|
—
|
|
|
—
|
|
|
—
|
|
|
—
|
|
|
99
|
|
|
—
|
|
|
31
|
|
|
130
|
|
|||||||
|
Distributions paid to noncontrolling interests
|
|
—
|
|
|
—
|
|
|
—
|
|
|
—
|
|
|
—
|
|
|
—
|
|
|
(34
|
)
|
|
(34
|
)
|
|||||||
|
Other comprehensive income
|
|
—
|
|
|
—
|
|
|
—
|
|
|
8
|
|
|
—
|
|
|
—
|
|
|
—
|
|
|
8
|
|
|||||||
|
Accretion of redeemable noncontrolling interests
|
|
—
|
|
|
—
|
|
|
(37
|
)
|
|
—
|
|
|
—
|
|
|
—
|
|
|
—
|
|
|
(37
|
)
|
|||||||
|
Sales of businesses and noncontrolling interests
|
|
—
|
|
|
—
|
|
|
(4
|
)
|
|
—
|
|
|
—
|
|
|
—
|
|
|
(2
|
)
|
|
(6
|
)
|
|||||||
|
Cumulative effect of accounting change
|
|
—
|
|
|
—
|
|
|
—
|
|
|
(43
|
)
|
|
43
|
|
|
—
|
|
|
—
|
|
|
—
|
|
|||||||
|
Stock-based compensation expense, tax benefit and issuance of common stock
|
|
1,017
|
|
|
—
|
|
|
15
|
|
|
—
|
|
|
—
|
|
|
1
|
|
|
—
|
|
|
16
|
|
|||||||
|
Balances at March 31, 2018
|
|
101,989
|
|
|
$
|
7
|
|
|
$
|
4,833
|
|
|
$
|
(239
|
)
|
|
$
|
(2,248
|
)
|
|
$
|
(2,418
|
)
|
|
$
|
681
|
|
|
$
|
616
|
|
|
Net income
|
|
—
|
|
|
—
|
|
|
—
|
|
|
—
|
|
|
26
|
|
|
—
|
|
|
42
|
|
|
68
|
|
|||||||
|
Distributions paid to noncontrolling interests
|
|
—
|
|
|
—
|
|
|
—
|
|
|
—
|
|
|
—
|
|
|
—
|
|
|
(38
|
)
|
|
(38
|
)
|
|||||||
|
Other comprehensive loss
|
|
—
|
|
|
—
|
|
|
—
|
|
|
(4
|
)
|
|
—
|
|
|
—
|
|
|
—
|
|
|
(4
|
)
|
|||||||
|
Accretion of redeemable noncontrolling interests
|
|
—
|
|
|
—
|
|
|
(123
|
)
|
|
—
|
|
|
—
|
|
|
—
|
|
|
—
|
|
|
(123
|
)
|
|||||||
|
Purchases (sales) of businesses and noncontrolling interests
|
|
—
|
|
|
—
|
|
|
(2
|
)
|
|
—
|
|
|
—
|
|
|
—
|
|
|
45
|
|
|
43
|
|
|||||||
|
Stock-based compensation expense, tax benefit and issuance of common stock
|
|
312
|
|
|
—
|
|
|
14
|
|
|
—
|
|
|
—
|
|
|
—
|
|
|
—
|
|
|
14
|
|
|||||||
|
Balances at June 30, 2018
|
|
102,301
|
|
|
$
|
7
|
|
|
$
|
4,722
|
|
|
$
|
(243
|
)
|
|
$
|
(2,222
|
)
|
|
$
|
(2,418
|
)
|
|
$
|
730
|
|
|
$
|
576
|
|
|
|
|
Three Months Ended
June 30, |
|
Six Months Ended
June 30, |
||||||||||||
|
|
|
2019
|
|
2018
|
|
2019
|
|
2018
|
||||||||
|
Hospital Operations and other:
|
|
|
|
|
|
|
|
|
|
|
||||||
|
Net patient service revenues from hospitals and related outpatient facilities
|
|
|
|
|
|
|
|
|
||||||||
|
Medicare
|
|
$
|
721
|
|
|
$
|
701
|
|
|
$
|
1,479
|
|
|
$
|
1,483
|
|
|
Medicaid
|
|
316
|
|
|
314
|
|
|
630
|
|
|
635
|
|
||||
|
Managed care
|
|
2,330
|
|
|
2,273
|
|
|
4,684
|
|
|
4,641
|
|
||||
|
Uninsured
|
|
11
|
|
|
8
|
|
|
12
|
|
|
45
|
|
||||
|
Indemnity and other
|
|
169
|
|
|
147
|
|
|
324
|
|
|
282
|
|
||||
|
Total
|
|
3,547
|
|
|
3,443
|
|
|
7,129
|
|
|
7,086
|
|
||||
|
Physician practices revenues
|
|
282
|
|
|
271
|
|
|
552
|
|
|
551
|
|
||||
|
Health plans
|
|
1
|
|
|
—
|
|
|
1
|
|
|
6
|
|
||||
|
Revenue from other sources
|
|
(3
|
)
|
|
19
|
|
|
7
|
|
|
37
|
|
||||
|
Hospital Operations and other total prior to inter-segment eliminations
|
|
3,827
|
|
|
3,733
|
|
|
7,689
|
|
|
7,680
|
|
||||
|
Ambulatory Care
|
|
524
|
|
|
531
|
|
|
1,004
|
|
|
1,029
|
|
||||
|
Conifer
|
|
355
|
|
|
386
|
|
|
704
|
|
|
790
|
|
||||
|
Inter-segment eliminations
|
|
(146
|
)
|
|
(144
|
)
|
|
(292
|
)
|
|
(294
|
)
|
||||
|
Net operating revenues
|
|
$
|
4,560
|
|
|
$
|
4,506
|
|
|
$
|
9,105
|
|
|
$
|
9,205
|
|
|
|
|
Three Months Ended
June 30, |
|
Six Months Ended
June 30, |
||||||||||||
|
|
|
2019
|
|
2018
|
|
2019
|
|
2018
|
||||||||
|
Net patient service revenues
|
|
$
|
496
|
|
|
$
|
500
|
|
|
$
|
947
|
|
|
$
|
969
|
|
|
Management fees
|
|
23
|
|
|
23
|
|
|
46
|
|
|
46
|
|
||||
|
Revenue from other sources
|
|
5
|
|
|
8
|
|
|
11
|
|
|
14
|
|
||||
|
Net operating revenues
|
|
$
|
524
|
|
|
$
|
531
|
|
|
$
|
1,004
|
|
|
$
|
1,029
|
|
|
|
|
Three Months Ended
June 30, |
|
Six Months Ended
June 30, |
||||||||||||
|
|
|
2019
|
|
2018
|
|
2019
|
|
2018
|
||||||||
|
Revenue cycle services – Tenet
|
|
$
|
142
|
|
|
$
|
139
|
|
|
$
|
284
|
|
|
$
|
283
|
|
|
Revenue cycle services – other customers
|
|
187
|
|
|
220
|
|
|
367
|
|
|
452
|
|
||||
|
Other services – Tenet
|
|
4
|
|
|
5
|
|
|
8
|
|
|
11
|
|
||||
|
Other services – other customers
|
|
22
|
|
|
22
|
|
|
45
|
|
|
44
|
|
||||
|
Net operating revenues
|
|
$
|
355
|
|
|
$
|
386
|
|
|
$
|
704
|
|
|
$
|
790
|
|
|
|
|
|
|
Six Months
Ending |
|
Years Ending
|
|
Later Years
|
||||||||||||||||||||
|
|
|
|
|
December 31,
|
|
|||||||||||||||||||||||
|
|
|
Total
|
|
2019
|
|
2020
|
|
2021
|
|
2022
|
|
2023
|
|
|||||||||||||||
|
Performance obligations
|
|
$
|
7,587
|
|
|
$
|
298
|
|
|
$
|
597
|
|
|
$
|
594
|
|
|
$
|
594
|
|
|
$
|
594
|
|
|
$
|
4,910
|
|
|
|
|
Balances at
Beginning
of Period
|
|
Litigation and
Investigation
Costs
|
|
Cash
Payments
|
|
Balances at
End of
Period
|
||||||||
|
|
|
|
|
|
|
|
|
|
||||||||
|
Six Months Ended June 30, 2019
|
|
$
|
8
|
|
|
$
|
31
|
|
|
$
|
(24
|
)
|
|
$
|
15
|
|
|
Six Months Ended June 30, 2018
|
|
$
|
12
|
|
|
$
|
19
|
|
|
$
|
(11
|
)
|
|
$
|
20
|
|
|
|
|
Six Months Ended
June 30, |
||||||
|
|
|
2019
|
|
2018
|
||||
|
Balances at beginning of period
|
|
$
|
1,420
|
|
|
$
|
1,866
|
|
|
Net income
|
|
95
|
|
|
101
|
|
||
|
Distributions paid to noncontrolling interests
|
|
(72
|
)
|
|
(70
|
)
|
||
|
Accretion of redeemable noncontrolling interests
|
|
9
|
|
|
160
|
|
||
|
Purchases and sales of businesses and noncontrolling interests, net
|
|
10
|
|
|
(628
|
)
|
||
|
Balances at end of period
|
|
$
|
1,462
|
|
|
$
|
1,429
|
|
|
|
|
June 30, 2019
|
|
December 31, 2018
|
||||
|
Hospital Operations and other
|
|
$
|
408
|
|
|
$
|
431
|
|
|
Ambulatory Care
|
|
737
|
|
|
713
|
|
||
|
Conifer
|
|
317
|
|
|
276
|
|
||
|
Redeemable noncontrolling interests
|
|
$
|
1,462
|
|
|
$
|
1,420
|
|
|
|
|
Six Months Ended
June 30, |
||||||
|
|
|
2019
|
|
2018
|
||||
|
Hospital Operations and other
|
|
$
|
(15
|
)
|
|
$
|
(6
|
)
|
|
Ambulatory Care
|
|
69
|
|
|
70
|
|
||
|
Conifer
|
|
41
|
|
|
37
|
|
||
|
Net income available to redeemable noncontrolling interests
|
|
$
|
95
|
|
|
$
|
101
|
|
|
|
|
Three Months Ended
June 30, |
|
Six Months Ended
June 30, |
||||||||||||
|
|
|
2019
|
|
2018
|
|
2019
|
|
2018
|
||||||||
|
Tax expense at statutory federal rate of 21%
|
|
$
|
29
|
|
|
$
|
31
|
|
|
$
|
45
|
|
|
$
|
86
|
|
|
State income taxes, net of federal income tax benefit
|
|
6
|
|
|
7
|
|
|
9
|
|
|
17
|
|
||||
|
Tax attributable to noncontrolling interests
|
|
(19
|
)
|
|
(16
|
)
|
|
(36
|
)
|
|
(34
|
)
|
||||
|
Nondeductible goodwill
|
|
—
|
|
|
2
|
|
|
—
|
|
|
7
|
|
||||
|
Nontaxable gains
|
|
—
|
|
|
—
|
|
|
(1
|
)
|
|
—
|
|
||||
|
Stock-based compensation
|
|
1
|
|
|
—
|
|
|
—
|
|
|
4
|
|
||||
|
Change in valuation allowance-interest expense limitation
|
|
11
|
|
|
18
|
|
|
35
|
|
|
30
|
|
||||
|
Other items
|
|
2
|
|
|
2
|
|
|
(5
|
)
|
|
4
|
|
||||
|
Income tax expense
|
|
$
|
30
|
|
|
$
|
44
|
|
|
$
|
47
|
|
|
$
|
114
|
|
|
|
|
Net Income Available (Loss Attributable)
to Common Shareholders (Numerator) |
|
Weighted
Average Shares (Denominator) |
|
Per-Share
Amount |
|||||
|
Three Months Ended June 30, 2019
|
|
|
|
|
|
|
|
|
|
||
|
Net income available to Tenet Healthcare Corporation common shareholders
for basic earnings per share |
|
$
|
15
|
|
|
103,198
|
|
|
$
|
0.15
|
|
|
Effect of dilutive stock options, restricted stock units and deferred compensation units
|
|
—
|
|
|
1,431
|
|
|
(0.01
|
)
|
||
|
Net income available to Tenet Healthcare Corporation common shareholders for diluted earnings per share
|
|
$
|
15
|
|
|
104,629
|
|
|
$
|
0.14
|
|
|
|
|
|
|
|
|
|
|||||
|
Three Months Ended June 30, 2018
|
|
|
|
|
|
|
|
|
|
||
|
Net income available to Tenet Healthcare Corporation common shareholders
for basic earnings per share |
|
$
|
24
|
|
|
102,147
|
|
|
$
|
0.23
|
|
|
Effect of dilutive stock options, restricted stock units and deferred compensation units
|
|
—
|
|
|
2,030
|
|
|
—
|
|
||
|
Net income available to Tenet Healthcare Corporation common shareholders for diluted earnings per share
|
|
$
|
24
|
|
|
104,177
|
|
|
$
|
0.23
|
|
|
|
|
|
|
|
|
|
|||||
|
Six Months Ended June 30, 2019
|
|
|
|
|
|
|
|
|
|
||
|
Net loss attributable to Tenet Healthcare Corporation common shareholders
for basic loss per share |
|
$
|
(12
|
)
|
|
102,993
|
|
|
$
|
(0.12
|
)
|
|
Effect of dilutive stock options, restricted stock units and deferred compensation units
|
|
—
|
|
|
—
|
|
|
—
|
|
||
|
Net loss attributable to Tenet Healthcare Corporation common shareholders for diluted loss per share
|
|
$
|
(12
|
)
|
|
102,993
|
|
|
$
|
(0.12
|
)
|
|
|
|
|
|
|
|
|
|||||
|
Six Months Ended June 30, 2018
|
|
|
|
|
|
|
|
|
|
||
|
Net income available to Tenet Healthcare Corporation common shareholders
for basic earnings per share |
|
$
|
122
|
|
|
101,770
|
|
|
$
|
1.20
|
|
|
Effect of dilutive stock options, restricted stock units and deferred compensation units
|
|
—
|
|
|
1,646
|
|
|
(0.02
|
)
|
||
|
Net income available to Tenet Healthcare Corporation common shareholders for diluted earnings per share
|
|
$
|
122
|
|
|
103,416
|
|
|
$
|
1.18
|
|
|
|
|
December 31, 2018
|
|
Quoted Prices
in Active Markets for Identical Assets (Level 1) |
|
Significant Other
Observable Inputs (Level 2) |
|
Significant
Unobservable Inputs (Level 3) |
||||||||
|
Long-lived assets held for sale
|
|
$
|
39
|
|
|
$
|
—
|
|
|
$
|
39
|
|
|
$
|
—
|
|
|
Long-lived assets held and used
|
|
130
|
|
|
—
|
|
|
130
|
|
|
—
|
|
||||
|
|
|
Six Months Ended
June 30, |
||||||
|
|
|
2019
|
|
2018
|
||||
|
Current assets
|
|
$
|
6
|
|
|
$
|
3
|
|
|
Property and equipment
|
|
8
|
|
|
3
|
|
||
|
Other intangible assets
|
|
3
|
|
|
3
|
|
||
|
Goodwill
|
|
18
|
|
|
132
|
|
||
|
Other long-term assets, including previously held equity method investments
|
|
5
|
|
|
1
|
|
||
|
Current liabilities
|
|
(3
|
)
|
|
(2
|
)
|
||
|
Long-term liabilities
|
|
(6
|
)
|
|
(1
|
)
|
||
|
Redeemable noncontrolling interests in equity of consolidated subsidiaries
|
|
(9
|
)
|
|
(8
|
)
|
||
|
Noncontrolling interests
|
|
(4
|
)
|
|
(42
|
)
|
||
|
Cash paid, net of cash acquired
|
|
(13
|
)
|
|
(89
|
)
|
||
|
Gains on consolidations
|
|
$
|
5
|
|
|
$
|
—
|
|
|
|
|
June 30, 2019
|
|
December 31, 2018
|
||||
|
Assets:
|
|
|
|
|
|
|
||
|
Hospital Operations and other
|
|
$
|
16,072
|
|
|
$
|
15,684
|
|
|
Ambulatory Care
|
|
6,057
|
|
|
5,711
|
|
||
|
Conifer
|
|
1,078
|
|
|
1,014
|
|
||
|
Total
|
|
$
|
23,207
|
|
|
$
|
22,409
|
|
|
|
|
Three Months Ended
June 30, |
|
Six Months Ended
June 30, |
||||||||||||
|
|
|
2019
|
|
2018
|
|
2019
|
|
2018
|
||||||||
|
Capital expenditures:
|
|
|
|
|
|
|
|
|
|
|
|
|
||||
|
Hospital Operations and other
|
|
$
|
118
|
|
|
$
|
108
|
|
|
$
|
288
|
|
|
$
|
228
|
|
|
Ambulatory Care
|
|
21
|
|
|
13
|
|
|
41
|
|
|
28
|
|
||||
|
Conifer
|
|
5
|
|
|
4
|
|
|
7
|
|
|
12
|
|
||||
|
Total
|
|
$
|
144
|
|
|
$
|
125
|
|
|
$
|
336
|
|
|
$
|
268
|
|
|
|
|
|
|
|
|
|
|
|
||||||||
|
Net operating revenues:
|
|
|
|
|
|
|
|
|
|
|
|
|
||||
|
Hospital Operations and other total prior to inter-segment eliminations(1)
|
|
$
|
3,827
|
|
|
$
|
3,733
|
|
|
$
|
7,689
|
|
|
$
|
7,680
|
|
|
Ambulatory Care
|
|
524
|
|
|
531
|
|
|
1,004
|
|
|
1,029
|
|
||||
|
Conifer
|
|
|
|
|
|
|
|
|
|
|
||||||
|
Tenet
|
|
146
|
|
|
144
|
|
|
292
|
|
|
294
|
|
||||
|
Other customers
|
|
209
|
|
|
242
|
|
|
412
|
|
|
496
|
|
||||
|
Total Conifer revenues
|
|
355
|
|
|
386
|
|
|
704
|
|
|
790
|
|
||||
|
Inter-segment eliminations
|
|
(146
|
)
|
|
(144
|
)
|
|
(292
|
)
|
|
(294
|
)
|
||||
|
Total
|
|
$
|
4,560
|
|
|
$
|
4,506
|
|
|
$
|
9,105
|
|
|
$
|
9,205
|
|
|
|
|
|
|
|
|
|
|
|
||||||||
|
Equity in earnings of unconsolidated affiliates:
|
|
|
|
|
|
|
|
|
|
|
|
|
||||
|
Hospital Operations and other
|
|
$
|
8
|
|
|
$
|
6
|
|
|
$
|
11
|
|
|
$
|
4
|
|
|
Ambulatory Care
|
|
34
|
|
|
33
|
|
|
65
|
|
|
60
|
|
||||
|
Total
|
|
$
|
42
|
|
|
$
|
39
|
|
|
$
|
76
|
|
|
$
|
64
|
|
|
|
|
|
|
|
|
|
|
|
||||||||
|
Adjusted EBITDA(2):
|
|
|
|
|
|
|
|
|
|
|
|
|
||||
|
Hospital Operations and other(2)
|
|
$
|
347
|
|
|
$
|
345
|
|
|
$
|
684
|
|
|
$
|
747
|
|
|
Ambulatory Care
|
|
207
|
|
|
198
|
|
|
384
|
|
|
363
|
|
||||
|
Conifer
|
|
103
|
|
|
91
|
|
|
202
|
|
|
189
|
|
||||
|
Total
|
|
$
|
657
|
|
|
$
|
634
|
|
|
$
|
1,270
|
|
|
$
|
1,299
|
|
|
|
|
|
|
|
|
|
|
|
||||||||
|
Depreciation and amortization:
|
|
|
|
|
|
|
|
|
|
|
|
|
||||
|
Hospital Operations and other
|
|
$
|
185
|
|
|
$
|
164
|
|
|
$
|
364
|
|
|
$
|
339
|
|
|
Ambulatory Care
|
|
18
|
|
|
17
|
|
|
36
|
|
|
34
|
|
||||
|
Conifer
|
|
11
|
|
|
13
|
|
|
22
|
|
|
25
|
|
||||
|
Total
|
|
$
|
214
|
|
|
$
|
194
|
|
|
$
|
422
|
|
|
$
|
398
|
|
|
|
|
Three Months Ended
June 30, |
|
Six Months Ended
June 30, |
||||||||||||
|
|
|
2019
|
|
2018
|
|
2019
|
|
2018
|
||||||||
|
Adjusted EBITDA(2)
|
|
$
|
657
|
|
|
$
|
634
|
|
|
$
|
1,270
|
|
|
$
|
1,299
|
|
|
Income (loss) from divested and closed businesses
(i.e., the Company’s health plan businesses) |
|
—
|
|
|
1
|
|
|
(1
|
)
|
|
—
|
|
||||
|
Depreciation and amortization
|
|
(214
|
)
|
|
(194
|
)
|
|
(422
|
)
|
|
(398
|
)
|
||||
|
Impairment and restructuring charges, and acquisition-related costs
|
|
(36
|
)
|
|
(30
|
)
|
|
(55
|
)
|
|
(77
|
)
|
||||
|
Litigation and investigation costs
|
|
(18
|
)
|
|
(13
|
)
|
|
(31
|
)
|
|
(19
|
)
|
||||
|
Interest expense
|
|
(247
|
)
|
|
(254
|
)
|
|
(498
|
)
|
|
(509
|
)
|
||||
|
Loss from early extinguishment of debt
|
|
—
|
|
|
(1
|
)
|
|
(47
|
)
|
|
(2
|
)
|
||||
|
Other non-operating expense, net
|
|
(1
|
)
|
|
(1
|
)
|
|
—
|
|
|
(2
|
)
|
||||
|
Net gains (losses) on sales, consolidation and deconsolidation of facilities
|
|
(1
|
)
|
|
8
|
|
|
(2
|
)
|
|
118
|
|
||||
|
Income from continuing operations, before income taxes
|
|
$
|
140
|
|
|
$
|
150
|
|
|
$
|
214
|
|
|
$
|
410
|
|
|
|
|
(1)
|
Hospital Operations and other revenues includes health plan revenues of approximately $1 million for both the three and six months ended June 30, 2019, and less than $1 million and $6 million for the three and six months ended June 30, 2018, respectively.
|
|
(2)
|
Hospital Operations and other Adjusted EBITDA excludes health plan EBITDA of less than $1 million and $(1) million for the three and six months ended June 30, 2019, respectively, and $1 million and less than $1 million for the three and six months ended June 30, 2018, respectively.
|
|
•
|
Management Overview
|
|
•
|
Forward-Looking Statements
|
|
•
|
Sources of Revenue for Our Hospital Operations and Other Segment
|
|
•
|
Results of Operations
|
|
•
|
Liquidity and Capital Resources
|
|
•
|
Off-Balance Sheet Arrangements
|
|
•
|
Critical Accounting Estimates
|
|
|
|
Continuing Operations
Three Months Ended June 30, |
|
|||||||
|
Selected Operating Statistics
|
|
2019
|
|
2018
|
|
Increase
(Decrease) |
|
|||
|
Hospital Operations and other – hospitals and related outpatient facilities
|
|
|
|
|
|
|
|
|||
|
Number of hospitals (at end of period)
|
|
65
|
|
|
68
|
|
|
(3
|
)
|
(1)
|
|
Total admissions
|
|
169,352
|
|
|
168,453
|
|
|
0.5
|
%
|
|
|
Adjusted patient admissions(2)
|
|
304,066
|
|
|
306,063
|
|
|
(0.7
|
)%
|
|
|
Paying admissions (excludes charity and uninsured)
|
|
159,128
|
|
|
158,216
|
|
|
0.6
|
%
|
|
|
Charity and uninsured admissions
|
|
10,224
|
|
|
10,237
|
|
|
(0.1
|
)%
|
|
|
Emergency department visits
|
|
637,107
|
|
|
643,036
|
|
|
(0.9
|
)%
|
|
|
Total surgeries
|
|
105,577
|
|
|
110,079
|
|
|
(4.1
|
)%
|
|
|
Patient days — total
|
|
787,582
|
|
|
766,519
|
|
|
2.7
|
%
|
|
|
Adjusted patient days(2)
|
|
1,387,929
|
|
|
1,373,480
|
|
|
1.1
|
%
|
|
|
Average length of stay (days)
|
|
4.65
|
|
|
4.55
|
|
|
2.2
|
%
|
|
|
Average licensed beds
|
|
17,221
|
|
|
18,362
|
|
|
(6.2
|
)%
|
|
|
Utilization of licensed beds(3)
|
|
50.3
|
%
|
|
45.9
|
%
|
|
4.4
|
%
|
(1)
|
|
Total visits
|
|
1,693,805
|
|
|
1,749,847
|
|
|
(3.2
|
)%
|
|
|
Paying visits (excludes charity and uninsured)
|
|
1,581,530
|
|
|
1,633,372
|
|
|
(3.2
|
)%
|
|
|
Charity and uninsured visits
|
|
112,275
|
|
|
116,475
|
|
|
(3.6
|
)%
|
|
|
Ambulatory Care
|
|
|
|
|
|
|
|
|||
|
Total consolidated facilities (at end of period)
|
|
232
|
|
|
232
|
|
|
—
|
|
(1)
|
|
Total cases
|
|
514,567
|
|
|
500,516
|
|
|
2.8
|
%
|
|
|
|
|
|
|
(1)
|
The change is the difference between the 2019 and 2018 amounts shown.
|
|
|
(2)
|
Adjusted patient admissions/days represents actual patient admissions/days adjusted to include outpatient services provided by facilities in our Hospital Operations and other segment by multiplying actual patient admissions/days by the sum of gross inpatient revenues and outpatient revenues and dividing the results by gross inpatient revenues.
|
|
|
(3)
|
Utilization of licensed beds represents patient days divided by number of days in the period divided by average licensed beds.
|
|
|
|
|
Continuing Operations
Three Months Ended June 30, |
|||||||||
|
Revenues
|
|
2019
|
|
2018
|
|
Increase
(Decrease) |
|||||
|
Net operating revenues
|
|
|
|
|
|
|
|||||
|
Hospital Operations and other prior to inter-segment eliminations
|
|
$
|
3,827
|
|
|
$
|
3,733
|
|
|
2.5
|
%
|
|
Ambulatory Care
|
|
524
|
|
|
531
|
|
|
(1.3
|
)%
|
||
|
Conifer
|
|
355
|
|
|
386
|
|
|
(8.0
|
)%
|
||
|
Inter-segment eliminations
|
|
(146
|
)
|
|
(144
|
)
|
|
1.4
|
%
|
||
|
Total
|
|
$
|
4,560
|
|
|
$
|
4,506
|
|
|
1.2
|
%
|
|
|
|
Continuing Operations
Three Months Ended June 30, |
|||||||||
|
Selected Operating Expenses
|
|
2019
|
|
2018
|
|
Increase
(Decrease) |
|||||
|
Hospital Operations and other
|
|
|
|
|
|
|
|||||
|
Salaries, wages and benefits
|
|
$
|
1,804
|
|
|
$
|
1,756
|
|
|
2.7
|
%
|
|
Supplies
|
|
644
|
|
|
641
|
|
|
0.5
|
%
|
||
|
Other operating expenses
|
|
894
|
|
|
852
|
|
|
4.9
|
%
|
||
|
Total
|
|
$
|
3,342
|
|
|
$
|
3,249
|
|
|
2.9
|
%
|
|
Ambulatory Care
|
|
|
|
|
|
|
|
|
|
||
|
Salaries, wages and benefits
|
|
$
|
157
|
|
|
$
|
165
|
|
|
(4.8
|
)%
|
|
Supplies
|
|
108
|
|
|
106
|
|
|
1.9
|
%
|
||
|
Other operating expenses
|
|
86
|
|
|
95
|
|
|
(9.5
|
)%
|
||
|
Total
|
|
$
|
351
|
|
|
$
|
366
|
|
|
(4.1
|
)%
|
|
Conifer
|
|
|
|
|
|
|
|
|
|
||
|
Salaries, wages and benefits
|
|
$
|
187
|
|
|
$
|
214
|
|
|
(12.6
|
)%
|
|
Supplies
|
|
1
|
|
|
1
|
|
|
—
|
%
|
||
|
Other operating expenses
|
|
64
|
|
|
80
|
|
|
(20.0
|
)%
|
||
|
Total
|
|
$
|
252
|
|
|
$
|
295
|
|
|
(14.6
|
)%
|
|
Total
|
|
|
|
|
|
|
|
|
|
||
|
Salaries, wages and benefits
|
|
$
|
2,148
|
|
|
$
|
2,135
|
|
|
0.6
|
%
|
|
Supplies
|
|
753
|
|
|
748
|
|
|
0.7
|
%
|
||
|
Other operating expenses
|
|
1,044
|
|
|
1,027
|
|
|
1.7
|
%
|
||
|
Total
|
|
$
|
3,945
|
|
|
$
|
3,910
|
|
|
0.9
|
%
|
|
Rent/lease expense(1)
|
|
|
|
|
|
|
|
|
|
||
|
Hospital Operations and other
|
|
$
|
59
|
|
|
$
|
56
|
|
|
5.4
|
%
|
|
Ambulatory Care
|
|
21
|
|
|
20
|
|
|
5.0
|
%
|
||
|
Conifer
|
|
3
|
|
|
5
|
|
|
(40.0
|
)%
|
||
|
Total
|
|
$
|
83
|
|
|
$
|
81
|
|
|
2.5
|
%
|
|
|
|
|
|
(1)
|
Included in other operating expenses.
|
|
|
|
|
Continuing Operations
Three Months Ended June 30, |
|||||||||
|
Selected Operating Expenses per Adjusted Patient Admission
|
|
2019
|
|
2018
|
|
Increase
(Decrease) |
|||||
|
Hospital Operations and other
|
|
|
|
|
|
|
|||||
|
Salaries, wages and benefits per adjusted patient admission(1)
|
|
$
|
5,931
|
|
|
$
|
5,736
|
|
|
3.4
|
%
|
|
Supplies per adjusted patient admission(1)
|
|
2,118
|
|
|
2,092
|
|
|
1.2
|
%
|
||
|
Other operating expenses per adjusted patient admission(1)
|
|
2,939
|
|
|
2,791
|
|
|
5.3
|
%
|
||
|
Total per adjusted patient admission
|
|
$
|
10,988
|
|
|
$
|
10,619
|
|
|
3.5
|
%
|
|
|
|
|
|
(1)
|
Calculation excludes the expenses from our health plan businesses. Adjusted patient admissions represents actual patient admissions adjusted to include outpatient services provided by facilities in our Hospital Operations and other segment by multiplying actual patient admissions by the sum of gross inpatient revenues and outpatient revenues and dividing the results by gross inpatient revenues.
|
|
|
•
|
Net cash provided by operating activities before interest, taxes, discontinued operations and restructuring charges, acquisition-related costs, and litigation costs and settlements of $683 million;
|
|
•
|
Payments for restructuring charges, acquisition-related costs, and litigation costs and settlements of $48 million;
|
|
•
|
Capital expenditures of $144 million;
|
|
•
|
Interest payments of $326 million;
|
|
•
|
Purchases of businesses or joint venture interests of $11 million; and
|
|
•
|
$70 million of distributions paid to noncontrolling interests.
|
|
•
|
The impact of an increase in AR Days outstanding;
|
|
•
|
Decreased cash receipts of $16 million related to the California provider fee program;
|
|
•
|
Increased payments for restructuring charges, acquisition-related costs, and litigation costs and settlements of $17 million; and
|
|
•
|
The timing of other working capital items.
|
|
|
|
Three Months Ended
June 30, |
|
Six Months Ended
June 30, |
||||||||||||||
|
Net Patient Service Revenues Less Implicit Price Concessions from:
|
|
2019
|
|
2018
|
|
Increase
(Decrease)(1) |
|
2019
|
|
2018
|
|
Increase
(Decrease)(1) |
||||||
|
Medicare
|
|
20.3
|
%
|
|
20.4
|
%
|
|
(0.1
|
)%
|
|
20.7
|
%
|
|
20.9
|
%
|
|
(0.2
|
)%
|
|
Medicaid
|
|
8.9
|
%
|
|
9.1
|
%
|
|
(0.2
|
)%
|
|
8.9
|
%
|
|
9.0
|
%
|
|
(0.1
|
)%
|
|
Managed care(2)
|
|
65.7
|
%
|
|
66.0
|
%
|
|
(0.3
|
)%
|
|
65.7
|
%
|
|
65.5
|
%
|
|
0.2
|
%
|
|
Uninsured
|
|
0.3
|
%
|
|
0.2
|
%
|
|
0.1
|
%
|
|
0.2
|
%
|
|
0.6
|
%
|
|
(0.4
|
)%
|
|
Indemnity and other
|
|
4.8
|
%
|
|
4.3
|
%
|
|
0.5
|
%
|
|
4.5
|
%
|
|
4.0
|
%
|
|
0.5
|
%
|
|
|
|
|
|
(1)
|
The change is the difference between the 2019 and 2018 percentages shown.
|
|
|
(2)
|
Includes Medicare and Medicaid managed care programs.
|
|
|
|
|
Three Months Ended
June 30, |
|
Six Months Ended
June 30, |
||||||||||||||
|
Admissions from:
|
|
2019
|
|
2018
|
|
Increase
(Decrease)(1) |
|
2019
|
|
2018
|
|
Increase
(Decrease)(1) |
||||||
|
Medicare
|
|
24.8
|
%
|
|
25.3
|
%
|
|
(0.5
|
)%
|
|
25.5
|
%
|
|
26.1
|
%
|
|
(0.6
|
)%
|
|
Medicaid
|
|
6.1
|
%
|
|
6.2
|
%
|
|
(0.1
|
)%
|
|
6.1
|
%
|
|
6.2
|
%
|
|
(0.1
|
)%
|
|
Managed care(2)
|
|
60.3
|
%
|
|
59.8
|
%
|
|
0.5
|
%
|
|
60.0
|
%
|
|
59.4
|
%
|
|
0.6
|
%
|
|
Charity and uninsured
|
|
6.1
|
%
|
|
6.1
|
%
|
|
—
|
%
|
|
5.8
|
%
|
|
5.7
|
%
|
|
0.1
|
%
|
|
Indemnity and other
|
|
2.7
|
%
|
|
2.6
|
%
|
|
0.1
|
%
|
|
2.6
|
%
|
|
2.6
|
%
|
|
—
|
%
|
|
|
|
|
|
(1)
|
The change is the difference between the 2019 and 2018 percentages shown.
|
|
|
(2)
|
Includes Medicare and Medicaid managed care programs.
|
|
|
|
|
Three Months Ended
June 30, |
|
Six Months Ended
June 30, |
||||||||||||
|
Revenue Descriptions
|
|
2019
|
|
2018
|
|
2019
|
|
2018
|
||||||||
|
Medicare severity-adjusted diagnosis-related group — operating
|
|
$
|
368
|
|
|
$
|
373
|
|
|
$
|
772
|
|
|
$
|
797
|
|
|
Medicare severity-adjusted diagnosis-related group — capital
|
|
32
|
|
|
34
|
|
|
68
|
|
|
72
|
|
||||
|
Outliers
|
|
22
|
|
|
21
|
|
|
45
|
|
|
48
|
|
||||
|
Outpatient
|
|
185
|
|
|
189
|
|
|
375
|
|
|
383
|
|
||||
|
Disproportionate share
|
|
58
|
|
|
56
|
|
|
117
|
|
|
114
|
|
||||
|
Other(1)
|
|
56
|
|
|
28
|
|
|
102
|
|
|
69
|
|
||||
|
Total Medicare net patient service revenues
|
|
$
|
721
|
|
|
$
|
701
|
|
|
$
|
1,479
|
|
|
$
|
1,483
|
|
|
|
|
|
|
(1)
|
The other revenue category includes Medicare Direct Graduate Medical Education and Indirect Medical Education (“IME”) revenues, IME revenues earned by our children’s hospitals (one of which we divested in 2018) under the Children’s Hospitals Graduate Medical Education Payment Program administered by the Health Resources and Services Administration of HHS, inpatient psychiatric units, inpatient rehabilitation units, other revenue adjustments, and adjustments to the estimates for current and prior-year cost reports and related valuation allowances.
|
|
|
|
|
|
Six Months Ended
June 30, |
||||||
|
Hospital Location
|
|
|
2019
|
|
2018
|
||||
|
Alabama
|
|
|
$
|
46
|
|
|
$
|
45
|
|
|
Arizona
|
|
|
72
|
|
|
78
|
|
||
|
California
|
|
|
441
|
|
|
433
|
|
||
|
Florida
|
|
|
111
|
|
|
122
|
|
||
|
Georgia
|
|
|
—
|
|
|
(1
|
)
|
||
|
Illinois
|
|
|
5
|
|
|
57
|
|
||
|
Massachusetts
|
|
|
44
|
|
|
46
|
|
||
|
Michigan
|
|
|
361
|
|
|
356
|
|
||
|
Pennsylvania
|
|
|
—
|
|
|
9
|
|
||
|
South Carolina
|
|
|
28
|
|
|
27
|
|
||
|
Tennessee
|
|
|
18
|
|
|
18
|
|
||
|
Texas
|
|
|
222
|
|
|
186
|
|
||
|
|
|
|
$
|
1,348
|
|
|
$
|
1,376
|
|
|
•
|
A market basket increase of 3.0% for Medicare severity-adjusted diagnosis-related group (“MS-DRG”) operating payments for hospitals reporting specified quality measure data and that are meaningful users of electronic health record technology; CMS also finalized certain adjustments to the 3.0% market basket increase that result in a net operating payment update of 3.1% (before budget neutrality adjustments), including:
|
|
•
|
A multifactor productivity reduction required by the ACA of 0.4%; and
|
|
•
|
A 0.5% increase required under the Medicare Access and CHIP Reauthorization Act of 2015;
|
|
•
|
Updates to the three factors used to determine the amount and distribution of Medicare uncompensated care disproportionate share (“UC-DSH”) payments; in addition to adjusting the UC-DSH amounts, CMS will base the distribution of the FFY 2020 UC-DSH amounts on uncompensated care costs reported by hospitals in the 2015 cost reports, which reflects changes to the calculation of a hospital’s share of the UC-DSH amounts by: (1) removing low income days; and (2) using a single year of uncompensated care cost in lieu of the three-year averaging methodology used in recent years;
|
|
•
|
A 0.7% net increase in the capital federal MS-DRG rate;
|
|
•
|
An increase in the cost outlier threshold from $25,769 to $26,473; and
|
|
•
|
Changes in the calculation of the wage index areas that include:
|
|
•
|
Increasing the wage index for hospitals with a wage index below the 25th percentile and applying a uniform budget neutrality factor to the IPPS base rates to offset the estimated increase in IPPS payments to hospitals with wage index values below the 25th percentile;
|
|
•
|
A refinement to the calculation of the “rural floor” wage index; and
|
|
•
|
A one-year stop-loss transition for a hospital that experiences a decline of greater than 5% in its wage index.
|
|
•
|
An estimated net increase of 2.7% for the OPPS rates based on an estimated market basket increase of 3.2% reduced by a multifactor productivity adjustment required by the ACA of 0.5%;
|
|
•
|
A continuation of the reduced payment amount for separately payable drugs acquired with a discount under CMS’ 340B program (“340B Drugs”) equal to a rate of average sales price (“ASP”) minus 22.5%; CMS is also soliciting comments on alternative payment policies for 340B Drugs, as well as the appropriate remedy for CYs 2018 and 2019, in the event that CMS does not prevail on appeal in the pending litigation discussed in greater detail below;
|
|
•
|
A prior authorization process for five categories of services;
|
|
•
|
A 2.7% increase to the ASC payment rates; and
|
|
•
|
Codification of and additional standards relating to the requirements that hospitals disclose prices, including negotiated prices for certain services.
|
|
|
|
Three Months Ended
June 30, |
|
Six Months Ended
June 30, |
||||||||||||
|
|
|
2019
|
|
2018
|
|
2019
|
|
2018
|
||||||||
|
Estimated costs for:
|
|
|
|
|
|
|
|
|
|
|
|
|
||||
|
Uninsured patients
|
|
$
|
164
|
|
|
$
|
159
|
|
|
$
|
322
|
|
|
$
|
305
|
|
|
Charity care patients
|
|
41
|
|
|
28
|
|
|
75
|
|
|
63
|
|
||||
|
Total
|
|
$
|
205
|
|
|
$
|
187
|
|
|
$
|
397
|
|
|
$
|
368
|
|
|
|
|
Three Months Ended
June 30, |
|
Six Months Ended
June 30, |
||||||||||||
|
|
|
2019
|
|
2018
|
|
2019
|
|
2018
|
||||||||
|
Net operating revenues:
|
|
|
|
|
|
|
|
|
|
|
|
|
||||
|
Hospital Operations and other
|
|
$
|
3,827
|
|
|
$
|
3,733
|
|
|
$
|
7,689
|
|
|
$
|
7,680
|
|
|
Ambulatory Care
|
|
524
|
|
|
531
|
|
|
1,004
|
|
|
1,029
|
|
||||
|
Conifer
|
|
355
|
|
|
386
|
|
|
704
|
|
|
790
|
|
||||
|
Inter-segment eliminations
|
|
(146
|
)
|
|
(144
|
)
|
|
(292
|
)
|
|
(294
|
)
|
||||
|
Net operating revenues
|
|
4,560
|
|
|
4,506
|
|
|
9,105
|
|
|
9,205
|
|
||||
|
Equity in earnings of unconsolidated affiliates
|
|
42
|
|
|
39
|
|
|
76
|
|
|
64
|
|
||||
|
Operating expenses:
|
|
|
|
|
|
|
|
|
|
|
|
|
||||
|
Salaries, wages and benefits
|
|
2,148
|
|
|
2,135
|
|
|
4,301
|
|
|
4,362
|
|
||||
|
Supplies
|
|
753
|
|
|
748
|
|
|
1,494
|
|
|
1,522
|
|
||||
|
Other operating expenses, net
|
|
1,044
|
|
|
1,027
|
|
|
2,118
|
|
|
2,087
|
|
||||
|
Electronic health record incentives
|
|
—
|
|
|
—
|
|
|
(1
|
)
|
|
(1
|
)
|
||||
|
Depreciation and amortization
|
|
214
|
|
|
194
|
|
|
422
|
|
|
398
|
|
||||
|
Impairment and restructuring charges, and acquisition-related costs
|
|
36
|
|
|
30
|
|
|
55
|
|
|
77
|
|
||||
|
Litigation and investigation costs
|
|
18
|
|
|
13
|
|
|
31
|
|
|
19
|
|
||||
|
Net losses (gains) on sales, consolidation and deconsolidation of facilities
|
|
1
|
|
|
(8
|
)
|
|
2
|
|
|
(118
|
)
|
||||
|
Operating income
|
|
$
|
388
|
|
|
$
|
406
|
|
|
$
|
759
|
|
|
$
|
923
|
|
|
|
|
Three Months Ended
June 30, |
|
Six Months Ended
June 30, |
||||||||
|
|
|
2019
|
|
2018
|
|
2019
|
|
2018
|
||||
|
Net operating revenues
|
|
100.0
|
%
|
|
100.0
|
%
|
|
100.0
|
%
|
|
100.0
|
%
|
|
Equity in earnings of unconsolidated affiliates
|
|
0.9
|
%
|
|
0.9
|
%
|
|
0.8
|
%
|
|
0.7
|
%
|
|
Operating expenses:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Salaries, wages and benefits
|
|
47.1
|
%
|
|
47.4
|
%
|
|
47.3
|
%
|
|
47.5
|
%
|
|
Supplies
|
|
16.5
|
%
|
|
16.6
|
%
|
|
16.4
|
%
|
|
16.5
|
%
|
|
Other operating expenses, net
|
|
22.9
|
%
|
|
22.8
|
%
|
|
23.3
|
%
|
|
22.7
|
%
|
|
Electronic health record incentives
|
|
—
|
%
|
|
—
|
%
|
|
—
|
%
|
|
—
|
%
|
|
Depreciation and amortization
|
|
4.7
|
%
|
|
4.3
|
%
|
|
4.6
|
%
|
|
4.3
|
%
|
|
Impairment and restructuring charges, and acquisition-related costs
|
|
0.8
|
%
|
|
0.7
|
%
|
|
0.6
|
%
|
|
0.8
|
%
|
|
Litigation and investigation costs
|
|
0.4
|
%
|
|
0.3
|
%
|
|
0.3
|
%
|
|
0.2
|
%
|
|
Net losses (gains) on sales, consolidation and deconsolidation of facilities
|
|
—
|
%
|
|
(0.2
|
)%
|
|
—
|
%
|
|
(1.3
|
)%
|
|
Operating income
|
|
8.5
|
%
|
|
9.0
|
%
|
|
8.3
|
%
|
|
10.0
|
%
|
|
|
|
Three Months Ended
June 30, |
|
Six Months Ended
June 30, |
||||||||||||||||||
|
Selected Operating Expenses
|
|
2019
|
|
2018
|
|
Increase
(Decrease)
|
|
2019
|
|
2018
|
|
Increase
(Decrease)
|
||||||||||
|
Hospital Operations and other — Same-Hospital
|
|
|
|
|
|
|
|
|
|
|
|
|
||||||||||
|
Salaries, wages and benefits
|
|
$
|
1,805
|
|
|
$
|
1,706
|
|
|
5.8
|
%
|
|
$
|
3,603
|
|
|
$
|
3,452
|
|
|
4.4
|
%
|
|
Supplies
|
|
644
|
|
|
623
|
|
|
3.4
|
%
|
|
1,281
|
|
|
1,254
|
|
|
2.2
|
%
|
||||
|
Other operating expenses
|
|
891
|
|
|
807
|
|
|
10.4
|
%
|
|
1,809
|
|
|
1,613
|
|
|
12.2
|
%
|
||||
|
Total
|
|
$
|
3,340
|
|
|
$
|
3,136
|
|
|
6.5
|
%
|
|
$
|
6,693
|
|
|
$
|
6,319
|
|
|
5.9
|
%
|
|
Ambulatory Care
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
||||
|
Salaries, wages and benefits
|
|
$
|
157
|
|
|
$
|
165
|
|
|
(4.8
|
)%
|
|
$
|
310
|
|
|
$
|
327
|
|
|
(5.2
|
)%
|
|
Supplies
|
|
108
|
|
|
106
|
|
|
1.9
|
%
|
|
207
|
|
|
212
|
|
|
(2.4
|
)%
|
||||
|
Other operating expenses
|
|
86
|
|
|
95
|
|
|
(9.5
|
)%
|
|
168
|
|
|
187
|
|
|
(10.2
|
)%
|
||||
|
Total
|
|
$
|
351
|
|
|
$
|
366
|
|
|
(4.1
|
)%
|
|
$
|
685
|
|
|
$
|
726
|
|
|
(5.6
|
)%
|
|
Conifer
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
||||
|
Salaries, wages and benefits
|
|
$
|
187
|
|
|
$
|
214
|
|
|
(12.6
|
)%
|
|
$
|
372
|
|
|
$
|
439
|
|
|
(15.3
|
)%
|
|
Supplies
|
|
1
|
|
|
1
|
|
|
—
|
%
|
|
2
|
|
|
3
|
|
|
(33.3
|
)%
|
||||
|
Other operating expenses
|
|
64
|
|
|
80
|
|
|
(20.0
|
)%
|
|
128
|
|
|
159
|
|
|
(19.5
|
)%
|
||||
|
Total
|
|
$
|
252
|
|
|
$
|
295
|
|
|
(14.6
|
)%
|
|
$
|
502
|
|
|
$
|
601
|
|
|
(16.5
|
)%
|
|
Total
|
|
|
|
|
|
|
|
|
|
|
|
|
||||||||||
|
Salaries, wages and benefits
|
|
$
|
2,149
|
|
|
$
|
2,085
|
|
|
3.1
|
%
|
|
$
|
4,285
|
|
|
$
|
4,218
|
|
|
1.6
|
%
|
|
Supplies
|
|
753
|
|
|
730
|
|
|
3.2
|
%
|
|
1,490
|
|
|
1,469
|
|
|
1.4
|
%
|
||||
|
Other operating expenses
|
|
1,041
|
|
|
982
|
|
|
6.0
|
%
|
|
2,105
|
|
|
1,959
|
|
|
7.5
|
%
|
||||
|
Total
|
|
$
|
3,943
|
|
|
$
|
3,797
|
|
|
3.8
|
%
|
|
$
|
7,880
|
|
|
$
|
7,646
|
|
|
3.1
|
%
|
|
Rent/lease expense(1)
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
||||
|
Hospital Operations and other
|
|
$
|
59
|
|
|
$
|
54
|
|
|
9.3
|
%
|
|
$
|
118
|
|
|
$
|
110
|
|
|
7.3
|
%
|
|
Ambulatory Care
|
|
21
|
|
|
20
|
|
|
5.0
|
%
|
|
41
|
|
|
40
|
|
|
2.5
|
%
|
||||
|
Conifer
|
|
3
|
|
|
5
|
|
|
(40.0
|
)%
|
|
6
|
|
|
9
|
|
|
(33.3
|
)%
|
||||
|
Total
|
|
$
|
83
|
|
|
$
|
79
|
|
|
5.1
|
%
|
|
$
|
165
|
|
|
$
|
159
|
|
|
3.8
|
%
|
|
|
|
|
|
(1)
|
Included in other operating expenses.
|
|
|
•
|
Hospital Operations and other, which is comprised of our acute care and specialty hospitals, ancillary outpatient facilities, urgent care centers, microhospitals and physician practices.
|
|
•
|
Ambulatory Care, which is comprised of USPI’s ambulatory surgery centers, urgent care centers, imaging centers and surgical hospitals (and also included nine facilities in the United Kingdom until we divested Aspen effective August 17, 2018).
|
|
•
|
Conifer, which provides healthcare business process services in the areas of hospital and physician revenue cycle management and value-based care solutions to healthcare systems, as well as individual hospitals, physician practices, self-insured organizations, health plans and other entities.
|
|
|
|
Same-Hospital
Continuing Operations
|
|
Same-Hospital
Continuing Operations
|
||||||||||||||||
|
|
|
Three Months Ended
June 30, |
|
Six Months Ended
June 30, |
||||||||||||||||
|
Admissions, Patient Days and Surgeries
|
|
2019
|
|
2018
|
|
Increase
(Decrease) |
|
2019
|
|
2018
|
|
Increase
(Decrease)
|
||||||||
|
Number of hospitals (at end of period)
|
|
65
|
|
|
65
|
|
|
—
|
|
(1)
|
|
65
|
|
|
65
|
|
|
—
|
|
(1)
|
|
Total admissions
|
|
169,352
|
|
|
163,903
|
|
|
3.3
|
%
|
|
|
342,822
|
|
|
337,587
|
|
|
1.6
|
%
|
|
|
Adjusted patient admissions(2)
|
|
304,066
|
|
|
297,460
|
|
|
2.2
|
%
|
|
|
609,937
|
|
|
601,605
|
|
|
1.4
|
%
|
|
|
Paying admissions (excludes charity and uninsured)
|
|
159,129
|
|
|
153,816
|
|
|
3.5
|
%
|
|
|
322,761
|
|
|
318,055
|
|
|
1.5
|
%
|
|
|
Charity and uninsured admissions
|
|
10,223
|
|
|
10,087
|
|
|
1.3
|
%
|
|
|
20,061
|
|
|
19,532
|
|
|
2.7
|
%
|
|
|
Admissions through emergency department
|
|
121,088
|
|
|
111,902
|
|
|
8.2
|
%
|
|
|
246,316
|
|
|
231,859
|
|
|
6.2
|
%
|
|
|
Paying admissions as a percentage of total admissions
|
|
94.0
|
%
|
|
93.8
|
%
|
|
0.2
|
%
|
(1)
|
|
94.1
|
%
|
|
94.2
|
%
|
|
(0.1
|
)%
|
(1)
|
|
Charity and uninsured admissions as a percentage of total admissions
|
|
6.0
|
%
|
|
6.2
|
%
|
|
(0.2
|
)%
|
(1)
|
|
5.9
|
%
|
|
5.8
|
%
|
|
0.1
|
%
|
(1)
|
|
Emergency department admissions as a percentage of total admissions
|
|
71.5
|
%
|
|
68.3
|
%
|
|
3.2
|
%
|
(1)
|
|
71.8
|
%
|
|
68.7
|
%
|
|
3.1
|
%
|
(1)
|
|
Surgeries — inpatient
|
|
44,641
|
|
|
45,191
|
|
|
(1.2
|
)%
|
|
|
89,194
|
|
|
90,243
|
|
|
(1.2
|
)%
|
|
|
Surgeries — outpatient
|
|
60,936
|
|
|
62,205
|
|
|
(2.0
|
)%
|
|
|
118,832
|
|
|
121,925
|
|
|
(2.5
|
)%
|
|
|
Total surgeries
|
|
105,577
|
|
|
107,396
|
|
|
(1.7
|
)%
|
|
|
208,026
|
|
|
212,168
|
|
|
(2.0
|
)%
|
|
|
Patient days — total
|
|
787,582
|
|
|
743,442
|
|
|
5.9
|
%
|
|
|
1,602,911
|
|
|
1,560,442
|
|
|
2.7
|
%
|
|
|
Adjusted patient days(2)
|
|
1,387,929
|
|
|
1,329,915
|
|
|
4.4
|
%
|
|
|
2,795,982
|
|
|
2,735,483
|
|
|
2.2
|
%
|
|
|
Average length of stay (days)
|
|
4.65
|
|
|
4.54
|
|
|
2.4
|
%
|
|
|
4.68
|
|
|
4.62
|
|
|
1.3
|
%
|
|
|
Licensed beds (at end of period)
|
|
17,221
|
|
|
17,246
|
|
|
(0.1
|
)%
|
|
|
17,221
|
|
|
17,246
|
|
|
(0.1
|
)%
|
|
|
Average licensed beds
|
|
17,221
|
|
|
17,246
|
|
|
(0.1
|
)%
|
|
|
17,221
|
|
|
17,246
|
|
|
(0.1
|
)%
|
|
|
Utilization of licensed beds(3)
|
|
50.3
|
%
|
|
47.4
|
%
|
|
2.9
|
%
|
(1)
|
|
51.4
|
%
|
|
50.0
|
%
|
|
1.4
|
%
|
(1)
|
|
|
|
|
|
(1)
|
The change is the difference between 2019 and 2018 amounts shown.
|
|
|
(2)
|
Adjusted patient admissions/days represents actual patient admissions/days adjusted to include outpatient services provided by facilities in our Hospital Operations and other segment by multiplying actual patient admissions/days by the sum of gross inpatient revenues and outpatient revenues and dividing the results by gross inpatient revenues.
|
|
|
(3)
|
Utilization of licensed beds represents patient days divided by number of days in the period divided by average licensed beds.
|
|
|
|
|
Same-Hospital
Continuing Operations |
|
Same-Hospital
Continuing Operations |
||||||||||||||||
|
|
|
Three Months Ended
June 30, |
|
Six Months Ended
June 30, |
||||||||||||||||
|
Outpatient Visits
|
|
2019
|
|
2018
|
|
Increase
(Decrease) |
|
2019
|
|
2018
|
|
Increase
(Decrease) |
||||||||
|
Total visits
|
|
1,693,805
|
|
|
1,673,056
|
|
|
1.2
|
%
|
|
|
3,380,669
|
|
|
3,389,952
|
|
|
(0.3
|
)%
|
|
|
Paying visits (excludes charity and uninsured)
|
|
1,581,555
|
|
|
1,560,950
|
|
|
1.3
|
%
|
|
|
3,159,190
|
|
|
3,168,144
|
|
|
(0.3
|
)%
|
|
|
Charity and uninsured visits
|
|
112,250
|
|
|
112,106
|
|
|
0.1
|
%
|
|
|
221,479
|
|
|
221,808
|
|
|
(0.1
|
)%
|
|
|
Emergency department visits
|
|
637,107
|
|
|
622,898
|
|
|
2.3
|
%
|
|
|
1,288,959
|
|
|
1,286,620
|
|
|
0.2
|
%
|
|
|
Surgery visits
|
|
60,936
|
|
|
62,205
|
|
|
(2.0
|
)%
|
|
|
118,832
|
|
|
121,925
|
|
|
(2.5
|
)%
|
|
|
Paying visits as a percentage of total visits
|
|
93.4
|
%
|
|
93.3
|
%
|
|
0.1
|
%
|
(1)
|
|
93.4
|
%
|
|
93.5
|
%
|
|
(0.1
|
)%
|
(1)
|
|
Charity and uninsured visits as a percentage of total visits
|
|
6.6
|
%
|
|
6.7
|
%
|
|
(0.1
|
)%
|
(1)
|
|
6.6
|
%
|
|
6.5
|
%
|
|
0.1
|
%
|
(1)
|
|
|
|
|
|
(1)
|
The change is the difference between 2019 and 2018 amounts shown.
|
|
|
|
|
Same-Hospital
Continuing Operations |
|
Same-Hospital
Continuing Operations |
||||||||||||||||||
|
|
|
Three Months Ended
June 30, |
|
Six Months Ended
June 30, |
||||||||||||||||||
|
Revenues
|
|
2019
|
|
2018
|
|
Increase
(Decrease) |
|
2019
|
|
2018
|
|
Increase
(Decrease) |
||||||||||
|
Total segment net operating revenues(1)
|
|
$
|
3,681
|
|
|
$
|
3,477
|
|
|
5.9
|
%
|
|
$
|
7,371
|
|
|
$
|
7,077
|
|
|
4.2
|
%
|
|
Selected revenue data – hospitals and related outpatient facilities
|
|
|
|
|
|
|
|
|
|
|
|
|
||||||||||
|
Net patient service revenues(1)(2)
|
|
$
|
3,547
|
|
|
$
|
3,357
|
|
|
5.7
|
%
|
|
$
|
7,104
|
|
|
$
|
6,850
|
|
|
3.7
|
%
|
|
Net patient service revenue per adjusted patient admission(1)(2)
|
|
$
|
11,665
|
|
|
$
|
11,286
|
|
|
3.4
|
%
|
|
$
|
11,647
|
|
|
$
|
11,386
|
|
|
2.3
|
%
|
|
Net patient service revenue per adjusted patient day(1)(2)
|
|
$
|
2,556
|
|
|
$
|
2,524
|
|
|
1.3
|
%
|
|
$
|
2,541
|
|
|
$
|
2,504
|
|
|
1.5
|
%
|
|
|
|
|
|
(1)
|
Revenues are net of implicit price concessions.
|
|
|
(2)
|
Adjusted patient admissions/days represents actual patient admissions/days adjusted to include outpatient services provided by facilities in our Hospital Operations and other segment by multiplying actual patient admissions/days by the sum of gross inpatient revenues and outpatient revenues and dividing the results by gross inpatient revenues.
|
|
|
|
|
Same-Hospital
Continuing Operations |
|
Same-Hospital
Continuing Operations |
|||||||||||||||||
|
|
|
Three Months Ended
June 30, |
|
Six Months Ended
June 30, |
|||||||||||||||||
|
Total Segment Selected Operating Expenses
|
|
2019
|
|
2018
|
|
Increase
(Decrease) |
|
2019
|
|
2018
|
|
Increase
(Decrease) |
|||||||||
|
Salaries, wages and benefits as a percentage of net operating revenues
|
|
49.0
|
%
|
|
49.1
|
%
|
|
(0.1
|
)%
|
(1)
|
|
48.9
|
%
|
|
48.8
|
%
|
|
0.1
|
%
|
(1
|
)
|
|
Supplies as a percentage of net operating revenues
|
|
17.5
|
%
|
|
17.9
|
%
|
|
(0.4
|
)%
|
(1)
|
|
17.4
|
%
|
|
17.7
|
%
|
|
(0.3
|
)%
|
(1
|
)
|
|
Other operating expenses as a percentage of net operating revenues
|
|
24.2
|
%
|
|
23.2
|
%
|
|
1.0
|
%
|
(1)
|
|
24.5
|
%
|
|
22.8
|
%
|
|
1.7
|
%
|
(1
|
)
|
|
|
|
|
|
(1)
|
The change is the difference between 2019 and 2018 amounts shown.
|
|
|
|
|
June 30, 2019
|
|
December 31, 2018
|
||||
|
Medicare
|
|
$
|
218
|
|
|
$
|
229
|
|
|
Medicaid
|
|
74
|
|
|
74
|
|
||
|
Net cost report settlements receivable and valuation allowances
|
|
49
|
|
|
18
|
|
||
|
Managed care
|
|
1,579
|
|
|
1,467
|
|
||
|
Self-pay uninsured
|
|
37
|
|
|
47
|
|
||
|
Self-pay balance after insurance
|
|
112
|
|
|
94
|
|
||
|
Estimated future recoveries
|
|
157
|
|
|
148
|
|
||
|
Other payers
|
|
318
|
|
|
325
|
|
||
|
Total Hospital Operations and other
|
|
2,544
|
|
|
2,402
|
|
||
|
Ambulatory Care
|
|
188
|
|
|
191
|
|
||
|
Total discontinued operations
|
|
2
|
|
|
2
|
|
||
|
|
|
$
|
2,734
|
|
|
$
|
2,595
|
|
|
|
|
June 30, 2019
|
|||||||||||||
|
|
|
Medicare
|
|
Medicaid
|
|
Managed
Care |
|
Indemnity,
Self-Pay and Other |
|
Total
|
|||||
|
0-60 days
|
|
89
|
%
|
|
56
|
%
|
|
57
|
%
|
|
23
|
%
|
|
52
|
%
|
|
61-120 days
|
|
5
|
%
|
|
21
|
%
|
|
17
|
%
|
|
15
|
%
|
|
16
|
%
|
|
121-180 days
|
|
3
|
%
|
|
9
|
%
|
|
10
|
%
|
|
10
|
%
|
|
9
|
%
|
|
Over 180 days
|
|
3
|
%
|
|
14
|
%
|
|
16
|
%
|
|
52
|
%
|
|
23
|
%
|
|
Total
|
|
100
|
%
|
|
100
|
%
|
|
100
|
%
|
|
100
|
%
|
|
100
|
%
|
|
|
|
December 31, 2018
|
|||||||||||||
|
|
|
Medicare
|
|
Medicaid
|
|
Managed
Care |
|
Indemnity,
Self-Pay and Other |
|
Total
|
|||||
|
0-60 days
|
|
89
|
%
|
|
51
|
%
|
|
60
|
%
|
|
29
|
%
|
|
56
|
%
|
|
61-120 days
|
|
6
|
%
|
|
24
|
%
|
|
14
|
%
|
|
18
|
%
|
|
15
|
%
|
|
121-180 days
|
|
2
|
%
|
|
10
|
%
|
|
8
|
%
|
|
11
|
%
|
|
8
|
%
|
|
Over 180 days
|
|
3
|
%
|
|
15
|
%
|
|
18
|
%
|
|
42
|
%
|
|
21
|
%
|
|
Total
|
|
100
|
%
|
|
100
|
%
|
|
100
|
%
|
|
100
|
%
|
|
100
|
%
|
|
|
|
June 30,
|
|
December 31,
|
||||
|
|
|
2019
|
|
2018
|
||||
|
0-60 days
|
|
$
|
75
|
|
|
$
|
72
|
|
|
61-120 days
|
|
8
|
|
|
16
|
|
||
|
121-180 days
|
|
3
|
|
|
3
|
|
||
|
Over 180 days
|
|
4
|
|
|
5
|
|
||
|
Total
|
|
$
|
90
|
|
|
$
|
96
|
|
|
•
|
increased medical fees of $17 million;
|
|
•
|
increased software costs of $13 million;
|
|
•
|
increased legal and consulting fees of $13 million;
|
|
•
|
increased expenses of $6 million related to our risk contracting business in California; and
|
|
•
|
increased malpractice expense of $5 million.
|
|
•
|
increased malpractice expense of $47 million;
|
|
•
|
increased medical fees of $42 million;
|
|
•
|
increased software costs of $20 million;
|
|
•
|
increased expenses of $18 million related to our risk contracting business in California; and
|
|
•
|
increased legal and consulting fees of $11 million.
|
|
•
|
management services revenues, computed as a percentage of each facility’s net revenues (often net of implicit price concessions); and
|
|
•
|
our share of each facility’s net income (loss), which is computed by multiplying the facility’s net income (loss) times the percentage of each facility’s equity interests owned by USPI.
|
|
•
|
equity in earnings of unconsolidated affiliates—our share of the net income (loss) of each facility, which is based on the facility’s net income (loss) and the percentage of the facility’s outstanding equity interests owned by USPI; and
|
|
•
|
management and administrative services revenues, which is included in our net operating revenues—income we earn in exchange for managing the day-to-day operations of each facility, usually quantified as a percentage of each facility’s net revenues less implicit price concessions.
|
|
|
|
Three Months Ended
June 30, |
|
Six Months Ended
June 30, |
||||||||||||||||||
|
Ambulatory Care Results of Operations
|
|
2019
|
|
2018
|
|
Increase (Decrease)
|
|
2019
|
|
2018
|
|
Increase (Decrease)
|
||||||||||
|
Net operating revenues
|
|
$
|
524
|
|
|
$
|
531
|
|
|
(1.3
|
)%
|
|
$
|
1,004
|
|
|
$
|
1,029
|
|
|
(2.4
|
)%
|
|
Equity in earnings of unconsolidated affiliates
|
|
$
|
34
|
|
|
$
|
33
|
|
|
3.0
|
%
|
|
$
|
65
|
|
|
$
|
60
|
|
|
8.3
|
%
|
|
Salaries, wages and benefits
|
|
$
|
157
|
|
|
$
|
165
|
|
|
(4.8
|
)%
|
|
$
|
310
|
|
|
$
|
327
|
|
|
(5.2
|
)%
|
|
Supplies
|
|
$
|
108
|
|
|
$
|
106
|
|
|
1.9
|
%
|
|
$
|
207
|
|
|
$
|
212
|
|
|
(2.4
|
)%
|
|
Other operating expenses, net
|
|
$
|
86
|
|
|
$
|
95
|
|
|
(9.5
|
)%
|
|
$
|
168
|
|
|
$
|
187
|
|
|
(10.2
|
)%
|
|
Ambulatory Care Facility Growth
|
|
|
Three Months Ended
June 30, 2019 |
|
Six Months Ended
June 30, 2019 |
|
Net revenues
|
|
|
5.3%
|
|
4.8%
|
|
Cases
|
|
|
3.2%
|
|
2.1%
|
|
Net revenue per case
|
|
|
2.0%
|
|
2.7%
|
|
Ambulatory Care Facilities
|
|
Six Months Ended
June 30, 2019 |
|
|
Facilities:
|
|
|
|
|
With a healthcare system partner
|
|
214
|
|
|
Without a healthcare system partner
|
|
130
|
|
|
Total facilities operated
|
|
344
|
|
|
Change from December 31, 2018
|
|
|
|
|
Acquisitions
|
|
5
|
|
|
De novo
|
|
6
|
|
|
Dispositions/Mergers
|
|
(4
|
)
|
|
Total increase in number of facilities operated
|
|
7
|
|
|
|
|
Three Months Ended
June 30, |
|
Six Months Ended
June 30, |
||||||||||||
|
|
|
2019
|
|
2018
|
|
2019
|
|
2018
|
||||||||
|
Tax expense at statutory federal rate of 21%
|
|
$
|
29
|
|
|
$
|
31
|
|
|
$
|
45
|
|
|
$
|
86
|
|
|
State income taxes, net of federal income tax benefit
|
|
6
|
|
|
7
|
|
|
9
|
|
|
17
|
|
||||
|
Tax attributable to noncontrolling interests
|
|
(19
|
)
|
|
(16
|
)
|
|
(36
|
)
|
|
(34
|
)
|
||||
|
Nondeductible goodwill
|
|
—
|
|
|
2
|
|
|
—
|
|
|
7
|
|
||||
|
Nontaxable gains
|
|
—
|
|
|
—
|
|
|
(1
|
)
|
|
—
|
|
||||
|
Stock-based compensation
|
|
1
|
|
|
—
|
|
|
—
|
|
|
4
|
|
||||
|
Change in valuation allowance-interest expense limitation
|
|
11
|
|
|
18
|
|
|
35
|
|
|
30
|
|
||||
|
Other items
|
|
2
|
|
|
2
|
|
|
(5
|
)
|
|
4
|
|
||||
|
Income tax expense
|
|
$
|
30
|
|
|
$
|
44
|
|
|
$
|
47
|
|
|
$
|
114
|
|
|
|
|
Three Months Ended
June 30, |
|
Six Months Ended
June 30, |
||||||||||||
|
|
|
|
||||||||||||||
|
|
|
2019
|
|
2018
|
|
2019
|
|
2018
|
||||||||
|
Net income available (loss attributable) to Tenet Healthcare Corporation common shareholders
|
|
$
|
17
|
|
|
$
|
26
|
|
|
$
|
(2
|
)
|
|
$
|
125
|
|
|
Less: Net income available to noncontrolling interests
|
|
(95
|
)
|
|
(82
|
)
|
|
(179
|
)
|
|
(174
|
)
|
||||
|
Income from discontinued operations, net of tax
|
|
2
|
|
|
2
|
|
|
10
|
|
|
3
|
|
||||
|
Income from continuing operations
|
|
110
|
|
|
106
|
|
|
167
|
|
|
296
|
|
||||
|
Income tax expense
|
|
(30
|
)
|
|
(44
|
)
|
|
(47
|
)
|
|
(114
|
)
|
||||
|
Loss from early extinguishment of debt
|
|
—
|
|
|
(1
|
)
|
|
(47
|
)
|
|
(2
|
)
|
||||
|
Other non-operating expense, net
|
|
(1
|
)
|
|
(1
|
)
|
|
—
|
|
|
(2
|
)
|
||||
|
Interest expense
|
|
(247
|
)
|
|
(254
|
)
|
|
(498
|
)
|
|
(509
|
)
|
||||
|
Operating income
|
|
388
|
|
|
406
|
|
|
759
|
|
|
923
|
|
||||
|
Litigation and investigation costs
|
|
(18
|
)
|
|
(13
|
)
|
|
(31
|
)
|
|
(19
|
)
|
||||
|
Net gains (losses) on sales, consolidation and deconsolidation of facilities
|
|
(1
|
)
|
|
8
|
|
|
(2
|
)
|
|
118
|
|
||||
|
Impairment and restructuring charges, and acquisition-related costs
|
|
(36
|
)
|
|
(30
|
)
|
|
(55
|
)
|
|
(77
|
)
|
||||
|
Depreciation and amortization
|
|
(214
|
)
|
|
(194
|
)
|
|
(422
|
)
|
|
(398
|
)
|
||||
|
Income (loss) from divested and closed businesses (i.e., the Company’s health plan businesses)
|
|
—
|
|
|
1
|
|
|
(1
|
)
|
|
—
|
|
||||
|
Adjusted EBITDA
|
|
$
|
657
|
|
|
$
|
634
|
|
|
$
|
1,270
|
|
|
$
|
1,299
|
|
|
|
|
|
|
|
|
|
|
|
||||||||
|
Net operating revenues
|
|
$
|
4,560
|
|
|
$
|
4,506
|
|
|
$
|
9,105
|
|
|
$
|
9,205
|
|
|
Less: Net operating revenues from health plans
|
|
1
|
|
|
—
|
|
|
1
|
|
|
6
|
|
||||
|
Adjusted net operating revenues
|
|
$
|
4,559
|
|
|
$
|
4,506
|
|
|
$
|
9,104
|
|
|
$
|
9,199
|
|
|
|
|
|
|
|
|
|
|
|
||||||||
|
Net income available (loss attributable) to Tenet Healthcare Corporation common shareholders as a % of net operating revenues
|
|
0.4
|
%
|
|
0.6
|
%
|
|
—
|
%
|
|
1.4
|
%
|
||||
|
|
|
|
|
|
|
|
|
|
||||||||
|
Adjusted EBITDA as % of adjusted net operating revenues
(Adjusted EBITDA margin)
|
|
14.4
|
%
|
|
14.1
|
%
|
|
13.9
|
%
|
|
14.1
|
%
|
||||
|
•
|
The impact of an increase in AR Days outstanding;
|
|
•
|
Decreased cash receipts of $16 million related to the California provider fee program;
|
|
•
|
Increased payments for restructuring charges, acquisition-related costs, and litigation costs and settlements of $17 million; and
|
|
•
|
The timing of other working capital items.
|
|
|
|
Maturity Date, Years Ending December 31,
|
|
|
|
|
|
|
||||||||||||||||||||||||
|
|
|
2019
|
|
2020
|
|
2021
|
|
2022
|
|
2023
|
|
Thereafter
|
|
Total
|
|
Fair Value
|
||||||||||||||||
|
|
|
(Dollars in Millions)
|
||||||||||||||||||||||||||||||
|
Fixed rate long-term debt
|
|
$
|
165
|
|
|
$
|
2,435
|
|
|
$
|
1,980
|
|
|
$
|
2,827
|
|
|
$
|
1,897
|
|
|
$
|
5,655
|
|
|
$
|
14,959
|
|
|
$
|
15,276
|
|
|
Average effective interest rates
|
|
5.7
|
%
|
|
6.0
|
%
|
|
4.7
|
%
|
|
8.6
|
%
|
|
7.3
|
%
|
|
5.8
|
%
|
|
6.4
|
%
|
|
|
|||||||||
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
||||||||||||||||
|
Variable rate long-term debt
|
|
$
|
—
|
|
|
$
|
190
|
|
|
$
|
—
|
|
|
$
|
—
|
|
|
$
|
—
|
|
|
$
|
—
|
|
|
$
|
190
|
|
|
$
|
190
|
|
|
Average effective interest rates
|
|
—
|
|
|
3.8
|
%
|
|
—
|
|
|
—
|
|
|
—
|
|
|
—
|
|
|
3.8
|
%
|
|
|
|||||||||
|
|
|
|
|
|
(10)
|
|
Material Contracts
|
|
|
|
|
|
|
|
|
|
(a)
|
|
|
|
|
|
|
|
|
|
(b)
|
|
|
|
|
|
|
|
|
|
(c)
|
|
|
|
|
|
|
|
(31)
|
|
Rule 13a-14(a)/15d-14(a) Certifications
|
|
|
|
|
|
|
|
|
|
(a)
|
|
|
|
|
|
|
|
|
|
(b)
|
|
|
|
|
|
|
|
(32)
|
|
||
|
|
|
|
|
|
(101 SCH)
|
|
XBRL Taxonomy Extension Schema Document
|
|
|
|
|
|
|
|
(101 CAL)
|
|
XBRL Taxonomy Extension Calculation Linkbase Document
|
|
|
|
|
|
|
|
(101 DEF)
|
|
XBRL Taxonomy Extension Definition Linkbase Document
|
|
|
|
|
|
|
|
(101 LAB)
|
|
XBRL Taxonomy Extension Label Linkbase Document
|
|
|
|
|
|
|
|
(101 PRE)
|
|
XBRL Taxonomy Extension Presentation Linkbase Document
|
|
|
|
|
|
|
|
(101 INS)
|
|
XBRL Taxonomy Extension Instance Document - the instance document does not appear in the interactive data file because its XBRL tags are embedded within the inline XBRL document.
|
|
|
|
|
|
|
|
(104)
|
|
Cover page from the Company’s Quarterly Report on Form 10-Q for the quarter ended June 30, 2019 formatted in Inline XBRL
|
|
|
|
|
||
|
* Management contract or compensatory plan or arrangement.
|
|||
|
|
|
TENET HEALTHCARE CORPORATION
(Registrant)
|
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|
|
|
Date: August 5, 2019
|
By:
|
/s/ R. SCOTT RAMSEY
|
|
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|
R. Scott Ramsey
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|
|
|
Vice President and Controller
|
|
|
|
(Principal Accounting Officer)
|
|
|
Page
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1
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1
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2
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4
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4
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11
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12
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13
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13
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14
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15
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15
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15
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17
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18
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20
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20
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20
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20
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21
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21
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22
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22
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22
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22
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23
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23
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23
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23
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25
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25
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25
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26
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26
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26
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26
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26
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27
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27
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34
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35
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35
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36
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37
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37
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38
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38
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38
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38
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39
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40
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40
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40
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|
|
|
|
|
A-1
|
|
|
|
|
|
|
|
|
|
(a)
|
"Account" means one (1) or more of the bookkeeping accounts maintained by the Company or its agent on behalf of a Participant, as described in more detail in Section 4.3. A Participant's Account may be divided into one or more "Cash Accounts" or "Stock Unit Accounts" as defined in Section 4.3.
|
|
(b)
|
"Affiliate" means a corporation that is a member of a controlled group of corporations (as defined in section 414(b) of the Code) that includes the Company, any trade or business (whether or not incorporated) that is in common control (as defined in section 414(c) of the Code) with the Company, or any entity that is a member of the same affiliated service group (as defined in section 414(m) of the Code) as the Company; provided, however that effective January 1, 2015, for purposes of determining if an entity is an Affiliate under sections 414(b) or (c) of the Code ownership will be determined based on an ownership percentage of greater than fifty percent (50%).
|
|
(c)
|
"Alternate Payee" means any spouse, former spouse, child, or other dependent of a Participant who is recognized by a DRO as having a right to receive all, or a portion of the benefits payable under the ERA with respect to such Participant.
|
|
(d)
|
"Annual Contribution" means the contribution made by the Employer on behalf of a Participant as described in Section 4.1(a).
|
|
(e)
|
"Beneficiary" means the person designated by the Participant to receive a distribution of his benefits under the ERA upon the death of the Participant. If the Participant is married, his spouse will be his Beneficiary, unless his spouse consents in writing to the designation of an alternate Beneficiary. For this purpose, the term “spouse” means a Participant’s spouse under applicable state law, including effective August 3, 2011, a Participant's Domestic Partner as defined under the Criteria for Domestic Partnership Status under the Tenet Employee Benefit Plan, and effective September 16, 2013, a same sex spouse recognized as such in the state where the marriage is performed. In the event that a Participant fails to designate a Beneficiary, or if the Participant's Beneficiary does not survive the Participant, the Participant's Beneficiary will be his surviving spouse, if any, or if the Participant does not have a surviving spouse, his estate. The term "Beneficiary" also will mean a Participant's spouse or former spouse who is entitled to all or a portion of a Participant's benefit pursuant to Section 6.1.
|
|
(f)
|
"Board" means the Board of Directors of the Company.
|
|
(g)
|
"Cause" means
|
|
(i)
|
For any event occurring on or within two (2) years after a Change of Control, the same meaning as set forth in Section 2.1(f)(ii) of the ESP.
|
|
(ii)
|
For any Participant who is a Covered Executive under the Company’s Executive Severance Plan, with respect to any event not occurring on or within two (2) years after a Change of Control, the same meaning as set forth in Section 2.1(f)(i) of the ESP.
|
|
(iii)
|
for any Participant who is not a Covered Executive under the Company’s Executive Severance Plan, with respect to any event not occurring on or within two (2) years after a Change of Control, the same meaning as set forth in Section 2.5(b)(ii) of the Stock Incentive Plan.
|
|
(h)
|
“Change of Control” will have the meaning set forth in the ESP.
|
|
(i)
|
"Code" means the Internal Revenue Code of 1986, as amended from time to time and any regulations and rulings issued thereunder.
|
|
(j)
|
"Compensation" means the Participant's annual gross base salary including amounts reduced from the Participant's salary and contributed on the Participant's behalf as deferrals under any qualified or non-qualified employee benefit plans sponsored by the Employer or, to the extent provided in Section 4.1(a), an Affiliate. Compensation excludes bonuses, hardship withdrawal allowances, annual cash and/or stock bonuses, automobile allowances, housing allowances, relocation payments, deemed income, income payable under stock incentive plans, Christmas gifts, insurance premiums and other imputed income, pensions, and retirement benefits.
|
|
(k)
|
"Disability" means the inability of a Participant to engage in any substantial gainful activity by reason of a mental or physical impairment expected to result in death or last for at least twelve (12) months, or the Participant, because of such a condition. is receiving income replacement benefits for at least three (3) months under an accident or health plan covering the Employer's employees.
|
|
(l)
|
"Discretionary Contribution" means the contribution made by the Employer on behalf of a Participant as described in Section 4.1(b).
|
|
(m)
|
"DRO" means a domestic relations order that is a judgment, decree, or order (including one that approves a property settlement agreement) that relates to the provision of child support, alimony payments or marital property rights to a spouse, former spouse, child or other dependent of a Participant and is made under a state (within the meaning of section 7701(a)(10) of the Code) domestic relations law (including a community property law) and that:
|
|
(i)
|
Creates or recognizes the existence of an Alternate Payee's right to, or assigns to an Alternate Payee the right to receive all or a portion of the benefits payable with respect to a Participant under the ERA;
|
|
(ii)
|
Does not require the ERA to provide any type or form of benefit, or any option, not otherwise provided under the ERA;
|
|
(iii)
|
Does not require the ERA to provide increased benefits (determined on the basis of actuarial value);
|
|
(iv)
|
Does not require the payment of benefits to an Alternate Payee that are required to be paid to another Alternate Payee under another order previously determined to be a DRO; and
|
|
(v)
|
Clearly specifies: the name and last known mailing address of the Participant and of each Alternate Payee covered by the DRO; the amount or percentage of the Participant's benefits to be paid by the ERA to each such Alternate Payee, or the manner in which such amount or percentage is to be determined; the number of payments or payment periods to which such order applies; and that it is applicable with respect to this ERA.
|
|
(n)
|
"Early Retirement Age" means the date the Participant attains age fifty-five (55) and has completed ten (10) Years of Vesting Service.
|
|
(o)
|
"Early Retirement Benefit" means the benefit payable to a Participant who has attained Early Retirement Age as provided in Section 5.2.
|
|
(p)
|
"Effective Date" means April 26, 2019, except as provided otherwise herein.
|
|
(q)
|
"Eligible Person" means an Employee who is designated as eligible to participate in the ERA by the Executive Vice President & Chief Human Resources Officer or the Plan Administrator or an Employee who satisfied the definition of Eligible Person in a prior ERA document and, in each case, who is not a participant in the SERP. As provided in Section 3.1 the RPAC may at any time, in its sole and absolute discretion, limit the classification of Employees who are eligible to participate in the ERA for a Plan Year and/or may modify or terminate an Eligible Person's participation in the ERA without the need for an amendment to the ERA.
|
|
(r)
|
"Employee" means each select member of management or highly compensated employee receiving remuneration, or who is entitled to remuneration, for services provided to the Employer or an Affiliate, in the legal relationship of employer and employee.
|
|
(s)
|
"Employer" means the Company and each Affiliate who with the consent of the Executive Vice President & Chief Human Resources Officer or Plan Administrator has adopted the ERA as a participating employer. An Affiliate may evidence its adoption of the ERA either by a formal action of its governing body or by commencing deferrals and taking other administrative actions with respect to this ERA on behalf
|
|
(t)
|
"Employment" means any continuous period during which an employee is actively engaged in performing services for the Employer or, to the extent provided in Section 2.1(tt), an Affiliate, plus the term of any leave of absence approved by the Employer; provided, however, that if an employee takes an approved leave of absence and does not return to the employ of the Employer, such leave of absence will not count as Employment except as required by law.
|
|
(u)
|
"ERA" means the Seventh Amended and Restated Tenet Executive Retirement Account as set forth herein and as the same may be amended from time to time.
|
|
(v)
|
"ERISA" means the Employee Retirement Income Security Act of 1974, as amended from time to time.
|
|
(w)
|
"ESP" means the Tenet Executive Severance Plan, as amended from time to time.
|
|
(x)
|
“Fair Market Value” means the closing price of a share of Stock on the New York Stock Exchange on the date as of which fair market value is to be determined.
|
|
(y)
|
"Five Percent Owner" means any person who owns (or is considered as owning within the meaning of section 318 of the Code (as modified by section 416(i)(1)(B)(iii) of the Code)) more than five percent (5%) of the outstanding stock of the Company or an Affiliate or stock possessing more than five percent (5%) of the total combined voting power of all stock of the Company or an Affiliate. The rules of sections 414(b), (c) and (m) of the Code will not apply for purposes of applying these ownership rules. Thus, this ownership test will be applied separately with respect to the Company and each Affiliate.
|
|
(z)
|
"Good Reason" means
|
|
(i)
|
For an event occurring on or within two (2) years of a Change of Control, the same meaning as set forth in Section 2.1(x)(ii) of the ESP.
|
|
(ii)
|
For any event not occurring on or within two (2) years after a Change of Control, the same meaning as set forth in Section 2.1(x)(i) of the ESP.
|
|
(aa)
|
"Human Resources Committee" means the Human Resources Committee of the Board (including any predecessor or successor to such committee in name or form), which has the authority to amend and terminate the ERA as provided in Article X.
|
|
(bb)
|
“Inactive Participant” means a Participant under this ERA who separates from Employment with the Employer or who is no longer or ceases to be an Eligible Person. Generally, no future contributions or earnings will be credited to an Inactive Participant’s Account; provided, however, an Inactive Participant who is not a participant in the SERP will continue to have earnings credited to his Account on and after the Effective Date until he ceases employment with the Employer and all Affiliates.
|
|
(cc)
|
"Initial Enrollment Period" means the thirty (30) day period immediately following the date the Eligible Person first becomes eligible to participate in the ERA during which the Eligible Person may elect the time at which to receive a distribution of Early Retirement Benefits pursuant to Section 3.1(b).
|
|
(dd)
|
"Involuntary Termination" means:
|
|
(i)
|
the Participant's Termination of Employment by the Employer without Cause, or
|
|
(ii)
|
the Participant's resignation from Employment of the Employer for Good Reason;
|
|
(ee)
|
"Key Employee" means any employee or former employee (including any deceased employee) who at any time during the Plan Year was:
|
|
(i)
|
an officer of the Company or an Affiliate having compensation greater than one hundred thirty thousand dollars ($130,000) (as adjusted under section 416(i)(1) of the Code for Plan Years beginning after December 31, 2002);
|
|
(ii)
|
a Five Percent Owner; or
|
|
(iii)
|
a One Percent Owner having compensation of more than one hundred fifty thousand dollars ($150,000).
|
|
(ff)
|
"Normal Retirement Age" means the date the Participant attains age sixty-two (62).
|
|
(gg)
|
"Normal Retirement Benefit" means the benefit payable to a Participant at Normal Retirement Age pursuant to Section 5.1.
|
|
(hh)
|
"One Percent Owner" means any person who would be described as a Five Percent Owner if "one percent (1%)" were substituted for "five percent (5%)" each place where it appears therein.
|
|
(ii)
|
"Other Termination" means a Termination of Employment that is not an Involuntary Termination, including a Termination of Employment for Cause.
|
|
(jj)
|
"Participant" means each Eligible Person who participates in this ERA and each Eligible Person or former Eligible Person whose participation in this ERA has not terminated.
|
|
(kk)
|
"Plan Administrator" means the individual or entity appointed by the RPAC to handle the day-to-day administration of the ERA, including but not limited to determining an Employee's status as an Eligible Person, the Employee’s Annual Contribution amount, a Participant's eligibility for benefits and the amount of a Participant's benefits and complying with all applicable reporting and disclosure obligations imposed on the ERA. If the RPAC does not appoint an individual or entity as Plan Administrator, the RPAC will serve as the Plan Administrator.
|
|
(ll)
|
"Plan Year" means the fiscal year of this ERA, which will commence on January 1 each year and end on December 31 of such year. The initial Plan Year was a short Plan Year beginning July 1, 2007 and ending December 31. 2007.
|
|
(mm)
|
"Retirement" means a Termination of Employment on or after a Participant has attained Early Retirement Age or Normal Retirement Age.
|
|
(nn)
|
"RPAC" means the Retirement Plans Administration Committee of the Company established by the Human Resources Committee, and whose members have been appointed by such Human Resources Committee or a delegate thereof. The RPAC will have the responsibility to administer the ERA and make final determinations regarding claims for benefits, as described in Article VIII.
|
|
(oo)
|
"SERP" means the Tenet Healthcare Corporation Supplemental Executive Retirement Plan.
|
|
(pp)
|
"Stock" means the common stock, par value $0.05 per share, of the Company.
|
|
(qq)
|
"Stock Unit" means a non-voting, non-transferable unit of measurement that is deemed for bookkeeping and distribution purposes only to represent one outstanding share of Stock.
|
|
(rr)
|
"Stock Incentive Plan" means the Tenet Healthcare 2008 Stock Incentive Plan, as amended from time to time.
|
|
(ss)
|
"Target Bonus" means the target bonus percent applicable to the Participant under the Company's Annual Incentive Plan multiplied by his Compensation at the time of a Termination of Employment with the Employer. For example, if the Covered Executive earns one hundred and fifty thousand dollars ($150,000) and has a Target Bonus of fifty percent (50%), his Target Bonus equals seventy five thousand dollars ($75,000).
|
|
(tt)
|
"Termination of Employment" means the date that a Participant ceases performing services for the Employer and its Affiliates in the capacity of an employee, or a reduction in Employment or other provision of services that qualifies as a separation from service under Section 409A of the Code. For this purpose a Participant who is on a leave of absence that exceeds six (6) months and who does not have statutory or contractual reemployment rights with respect to such leave, will be deemed to have incurred a Termination of Employment on the first day of the seventh (7th) month of such leave. A Participant who transfers Employment from an Employer to an Affiliate, regardless of whether such Affiliate has adopted the ERA as a participating employer, will not incur a Termination of Employment and such Participant may continue to be credited with Annual Contributions pursuant to Section 4.1(a) and/or accrue age and/or Years of Vesting Service pursuant to Section 2.1(ww). A Termination of Employment will either be an Involuntary Termination or an Other Termination.
|
|
(uu)
|
“Trust” means the rabbi trust established with respect to the ERA the assets of which are to be used for the payment of benefits under the ERA.
|
|
(vv)
|
"Trustee" means the individual or entity appointed to serve as trustee of any Trust established as a possible source of funds for the payment of benefits under this ERA as provided in Section 7.1. After the occurrence of a Change of Control, the Trustee must be independent of any successor to the Company or any affiliate of such successor.
|
|
(ww)
|
"Year of Vesting Service" means each complete Plan Year in which an Eligible Person is employed as an Employee of the Employer, beginning with the Plan Year in which the Participant commences participation in the ERA, and has an Account balance under the ERA. Such Plan Years will be referred to as "Years of Plan Participation" for purposes of this Section 2.1(ww). At the time an Eligible Person first becomes eligible to participate in the ERA, his prior complete years of continuous Employment with the Employer, commencing on the Eligible Person's date of Employment with the Employer in any capacity, will be converted to an equivalent number of complete Years of Plan Participation and count as Years of Vesting Service under the ERA.
|
|
(i)
|
such Eligible Person's previously forfeited ERA Account balance will be restored at the time of such reemployment, and
|
|
(ii)
|
his Years of Plan Participation or years of Employment completed before such reemployment will be treated as Years of Vesting Service under the ERA to the extent provided in such Rehire and Reinstatement Policy (or any successor thereto).
|
|
|
|
(a)
|
Determination of Eligibility. An Employee who is designated as an Eligible Person by the Executive Vice President & Chief Human Resources Officer or Plan Administrator will automatically become a Participant in the ERA as of the effective date of such designation. An Employee who was a Participant under the terms of a prior ERA document will continue participation on and after the Effective Date in accordance with the terms of this document.
|
|
(b)
|
Early Retirement Election. An Eligible Person must elect during the Initial Enrollment Period whether he desires or does not desire to commence the distribution of the vested balance of his Account on the first day of the second calendar month following the date of his Retirement on or after attaining Early Retirement Age as provided pursuant to Section 5.2. If the Eligible Person fails to make this election during the Initial Enrollment Period, he will be deemed to have affirmatively elected to commence the distribution of the vested balance of his Account on the first day of the second calendar month following the date of his Retirement on or after attaining Early Retirement Age. Once made (or deemed made), this election cannot be revoked; however, the Participant may elect to defer payment of his vested Account balance pursuant to Section 5.7. Payment of such Early Retirement Benefit will be subject to the six (6) month restriction applicable to Key Employees, described in Section 5.4 of this ERA. The provisions of this Section 3.1(b) will apply to all Eligible Persons who are Employees on or after the Effective Date.
|
|
(c)
|
Limits on Eligibility. The RPAC may at any time, in its sole and absolute discretion, limit the classification of Employees eligible to participate in the ERA and/or may limit or terminate an Eligible Person's participation in the ERA. Any action taken by the RPAC that limits the classification of Employees eligible to participate in the ERA or that modifies or terminates an Eligible Person's participation in the ERA will be set forth in Exhibit A attached hereto. Exhibit A may be modified from time to time without a formal amendment to the ERA. in which case a revised Exhibit A will be attached hereto.
|
|
(d)
|
Loss of Eligibility Status. A Participant who becomes an Inactive Participant, under this ERA will retain such status until the Participant has received payment of any and all amounts payable to him under this ERA. An Inactive Participant who continues employment with an Affiliate who is not an Employer may continue to be credited with annual contributions pursuant to Section 4.1(a) and/or with age and/or Years of Vesting Service pursuant to Section 2.1(ww).
|
|
(e)
|
Subsequent SERP Participation. A Participant's participation and Account balances will be frozen upon being named to the SERP (i.e., he will become an Inactive Participant and no additional contributions or earnings credits will be made); however, the Participant will continue to earn age and Years of Vesting Service for purposes of this ERA. Upon termination or retirement, the Participant will receive
|
|
(f)
|
Initial SERP Participation. A Participant who participated in the SERP before becoming a Participant in the ERA will be entitled to a benefit under this ERA, if any, equal to the amount of his Account. The Participant's accrued benefit under the SERP will be paid pursuant to the terms of the SERP and his benefit under this ERA, if any, will be paid pursuant to the terms hereof.
|
|
(a)
|
Other Termination. Except as provided in section 4.2(a), if a Participant incurs an Other Termination before attaining age fifty-five (55), he will forfeit the entire balance of his Account. If a Participant incurs an Other Termination on or after attaining age fifty-five (55), he will forfeit the non-vested balance of his Account, as determined in accordance with Section 4.2(b) below.
|
|
(b)
|
Involuntary Termination. If a Participant incurs an Involuntary Termination either before or on or after attaining age fifty-five (55), he will forfeit the non-vested balance of his Account. The vested balance of a Participant's Account in the event of an Involuntary Termination is determined in accordance with Section 4.2(c) (or, if applicable, Section 4.2(a)) below.
|
|
(c)
|
Cause. If a Participant incurs a Termination of Employment for Cause, he will forfeit the entire balance, whether vested or not, of his Account.
|
|
|
|
(a)
|
Annual Contribution. The Company will make an Annual Contribution to the ERA each Plan Year on behalf of each Participant in an amount equal to ten percent (10%) of the Participant’s Compensation unless the Executive Vice President & Chief Human Resources Officer or the Plan Administrator determine a different amount will apply and communicate that to the Participant in an offer letter or other communication. Unless declared otherwise by the Executive Vice President & Chief Human Resources Officer or the Plan Administrator, such Annual Contribution will be based on the Participant's Compensation on the date on which the Annual Contribution is made. In addition, in the case of Retirement on or after Normal Retirement Age, death, Disability, or an Involuntary Termination or change in position that results in the termination of active participation in the ERA without establishment of a successor plan within two (2) years after a Change of Control, a Participant will receive a prorated Annual Contribution based on the number of months during which he was employed from July 1 immediately preceding the applicable event. An Inactive Participant will have a zero percent (0%) Annual Contribution.
|
|
(b)
|
Discretionary Contribution. The Chief Executive Officer (or any successor title to such position) of the Company may declare that a Discretionary Contribution be made by the Employer to a Participant's Account in such amount, and at such time, as he may determine in his sole and absolute discretion.
|
|
(a)
|
Full Vesting Events. A Participant will become one hundred percent (100%) vested in the balance of his Account upon the occurrence of any of the following events while an Employee:
|
|
(i)
|
the Participant's attainment of age sixty (60) and completion of five (5) Years of Vesting Service;
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(ii)
|
the Participant's attainment of sixty-two (62) regardless of Years of Vesting Service;
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(iii)
|
the Participant's death;
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(iv)
|
the Participant's Disability; or
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(v)
|
the occurrence of a Change of Control.
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(b)
|
Other Termination of Employment. Except in the case of a Termination of Employment for Cause, a Participant who incurs an Other Termination before the
|
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(c)
|
Involuntary Termination of Employment. A Participant who incurs an Involuntary Termination before the occurrence of a full vesting event described in Section 4.2(a) will vest in the balance of his Account as follows:
|
|
(a)
|
Cash Account. If a Participant has made an election to have the balance of his Account to be deemed invested in a fixed rate of return or benchmark mutual funds pursuant to Section 4.4(a) or Section 4.4(b), the Company may, in its sole and absolute discretion, establish and maintain a Cash Account for the Participant under this ERA. Each Cash Account will be adjusted at least monthly to reflect the Annual Contributions and Discretionary Contributions credited thereto, earnings credited on such Annual Contributions and Discretionary Contributions pursuant to Section 4.4, and any payment of such Annual Contributions or Discretionary Contributions under this ERA. Such Annual Contributions and any Discretionary Contributions made on behalf of the Participant will be credited to each Participant's Cash Account at such times as determined by the Human Resources Committee. In the sole discretion of the Plan Administrator. more than one (1) Cash Account may be established for each Participant to facilitate record keeping convenience and accuracy.
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|
(b)
|
Stock Unit Account. If a Participant has made an election to have the balance of his Account to be deemed invested in Stock Units pursuant to Section 4.4(c), the Plan Administrator may, in its sole and absolute discretion. establish and maintain a Stock Unit Account and credit the Participant's Stock Unit Account with a number of Stock Units determined by dividing an amount equal to the Annual Contributions and Discretionary Contributions made on behalf of the Participant for a Plan Year by the Fair Market Value of a share of Stock on the date such Contributions are made. Such Stock Units will be credited to the Participant's Stock Unit Account as soon as administratively practicable after the determination of the number of Stock Units is made pursuant to the preceding sentence. In the sole and absolute discretion of the Plan Administrator, more than one Stock Unit Account may be established for each Participant to facilitate record-keeping convenience and accuracy. Each such Stock Unit Account will be credited and adjusted as provided in this ERA.
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(c)
|
Unfunded Nature of Accounts. Amounts credited to the Participant's Cash and Stock Unit Accounts will be held with the general assets of the Employer and, as provided in Section 7.2, will be subject to the claims of the Employer's general creditors. Establishment and maintenance of a separate Account or Accounts for each Participant will not be construed as giving any person any interest in assets of the Employer, or a right to payment other than as provided under this ERA. Such Accounts will be maintained until all amounts credited as to such Account have been distributed in accordance with the terms and provisions of this ERA.
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(a)
|
The annual rate of interest based on the benchmark money market mutual fund, compounded daily, such benchmark money market mutual fund will be for periods before October 1, 2008, the Fidelity Money Market Fund and from October 1, 2008, through December 31, 2008, an annual rate of interest equal to one percent (1%) below the prime rate of interest as quoted by Bloomberg, compounded daily, and effective on and after January 1, 2009, an annual rate of interest equal to one hundred and twenty percent (120%) of the long-term applicable federal rate. compounded daily;
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(b)
|
One (1) or more benchmark mutual funds; or
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(c)
|
Stock Units; provided that any request to have the Participant's Account to be deemed invested in Stock Units is irrevocable (i.e., a Participant may only change such investment election on a prospective basis) and such amounts will be distributed in an equivalent whole number of shares of Stock pursuant to the provisions of Article V. Any fractional share interests will be paid in cash with the last distribution.
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|
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(a)
|
Involuntary Termination Distribution. If a Participant incurs an Involuntary Termination, he will receive payment of his vested Account balance, as determined in accordance with Section 4.2(c), commencing on the first day of the second calendar month following his attainment of age sixty-two (62) (regardless if the Participant has attained age fifty-five (55) and completed ten (10) Years of Vesting Service and has elected (or was deemed to have elected) an Early Retirement Benefit pursuant to Section 3.1(b)), unless he elected to defer payment pursuant to Section 5.7. Except as provided in Section 10.3, distribution of the Participant's vested Account balance will be made in equal annual installments through the date the Participant attains age eighty (80). Distributions will be made in the form of cash or Stock, depending on the Participant's investment crediting rates as provided in Section 4.4.
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|
(b)
|
Other Termination Distribution. Except in the case of a Termination of Employment for Cause, if a Participant incurs an Other Termination after attaining age fifty-five (55) and completing ten (10) Years of Vesting Service and the Participant elected (or was deemed to have elected) an Early Retirement Benefit pursuant to Section 3.1(b), distribution of the Participant's vested Account balance will be made pursuant to Section 5.2. If the Participant has not completed ten (10) Years of Vesting Service or did not elect (or was not deemed to have elected) an Early Retirement Benefit, distribution of the Participant's vested Account balance will commence on the first day of the second calendar month following the date he attains age sixty-two (62) unless he elected to defer payment pursuant to Section 5.7. Except as provided in Section 10.3, distribution of the Participant's vested Account balance will be made in the form of equal annual installments through the date the Participant attains age eighty (80). Distributions will be made in the form of cash or Stock, depending on the Participant's investment crediting rates as provided in Section 4.4.
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|
(a)
|
Death While an Employee. If the Participant dies while employed by the Employer, the Participant's vested Account balance, as determined pursuant to Section 4.2(a), will be paid to the Participant's Beneficiary in a lump sum, in cash and/or Stock depending on the Participant's investment crediting rates, by the later of the end of the Plan Year in which the Participant dies or ninety (90) days following the date of the Participant's death.
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(b)
|
Death Following Termination. If the Participant dies after his Termination of Employment while receiving installment payments from the ERA, the remaining amount of such installment payments will be paid to the Participant's Beneficiary in a lump sum, in cash and/or Stock depending on the Participant's investment crediting rates, by the later of the end of the Plan Year in which the Participant dies or ninety (90) days following the date of the Participant's death. If the Participant dies after his Termination of Employment before he begins receiving installment payments from the ERA, his vested Account balance will be paid in a to his Beneficiary in a lump sum, in cash and/or Stock depending on the Participant's investment crediting rates, by the later of the end of the Plan Year in which the Participant dies or ninety (90) days following the date of the Participant's death.
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(a)
|
Distribution of Benefit. In the event that an Alternate Payee is entitled to all or a portion of a Participant's vested Account balance pursuant to the terms of a DRO, such amount will be paid to the Alternate Payee in a lump sum, in cash or Stock, based on the Participant's investment crediting rates under the ERA as provided in Section 4.4 and the terms of the DRO, within ninety (90) days after the Plan Administrator approves the DRO.
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(b)
|
Determination of Qualification of DRO. The Plan Administrator will have sole and absolute discretion to determine whether a judgment, decree or order is a DRO, to determine whether a DRO will be accepted for purposes of this Section 6.1 and to make interpretations under this Section 6.1, including determining who is to receive benefits, the amount of such benefits, and the amount of taxes to be withheld. The decisions of the Plan Administrator will be binding on all parties with an interest.
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(c)
|
Subject to ERA Provisions. Any benefits payable to an Alternate Payee pursuant to the terms of a DRO will be subject to all provisions and restrictions of the ERA and any dispute regarding such benefits will be resolved pursuant to the ERA claims procedure in Article VIII.
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(a)
|
Directly to such person;
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(b)
|
To his legal guardian or conservator; or
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(c)
|
To his spouse or to any person charged with the duty of his support, to be expended for his benefit and/or that of his dependents.
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(a)
|
Employer Obligation. Benefits under this ERA will be funded solely by the Employer. Benefits under this ERA will constitute an unfunded general obligation of the Employer, but the Employer may create reserves, funds and/or provide for amounts to be held in trust to fund such benefits on its behalf. Payment of benefits may be made by the Employer, any trust established by the Employer or through a service or benefit provider to the Employer or such trust. Upon the occurrence of a Change of Control, the Company will establish a rabbi trust to fund the benefits accrued under the ERA as of the date of the Change of Control.
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(b)
|
Rabbi Trust. Upon a Change of Control, the following will occur:
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(i)
|
the Trust will become (or continue to be) irrevocable;
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(ii)
|
for three (3) years following a Change of Control, the Trustee can only be removed as set forth in the Trust;
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(iii)
|
if the Trustee is removed or resigns within three (3) years following a Change of Control, the Trustee will select a successor Trustee, as set forth in the Trust;
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(iv)
|
for three (3) years following a Change of Control, the Company will be responsible for directly paying all Trustee fees and expenses, together with all fees and expenses incurred under Article VIII relating to the RPAC, Plan Administrator, and ERA administrative expenses (unless otherwise paid by the Trust from the Trust’s expense reserve); and
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(v)
|
the Trust Agreement may be amended only as set forth in the Trust (with the Trustee's consent); provided, however, that no such amendment will (A) change the irrevocable nature of the Trust; (B) adversely affect a Participant's rights to benefits under the ERA without the consent of the Participant; (C) impair the rights of the Company's creditors under the Trust; or (D) cause the Trust to fail to be a "grantor trust" pursuant to Code sections 671 through 679.
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(a)
|
To appoint the Plan Administrator;
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(b)
|
To review and render decisions respecting a denial of a claim for benefits under the ERA;
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(c)
|
To construe the ERA and to make equitable adjustments for any mistakes or errors made in the administration of the ERA; and
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(d)
|
To determine and resolve, in its sole and absolute discretion, all questions relating to the administration of the ERA and the trust established to secure the assets of the ERA when differences of opinion arise between the Company, an Affiliate, the Plan Administrator, the Trustee, a Participant, or any of them, and whenever it is deemed advisable to determine such questions in order to promote the uniform and nondiscriminatory administration of the ERA for the greatest benefit of all parties concerned.
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(a)
|
To direct the administration of the ERA in accordance with the provisions herein set forth;
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(b)
|
To adopt rules of procedure and regulations necessary for the administration of the ERA, provided such rules are not inconsistent with the terms of the ERA:
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(c)
|
To determine all questions with regard to rights of Employees. Participants, and Beneficiaries under the ERA including, but not limited to, questions involving eligibility of an Employee to participate in the ERA, the amount of a Participant’s Annual Contribution and the value of a Participant's vested Account:
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(d)
|
To enforce the terms of the ERA and any rules and regulations adopted by the RPAC;
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(e)
|
To review and render decisions respecting a claim for a benefit under the ERA;
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(f)
|
To furnish the Employer with information that the Employer may require for tax or other purposes;
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(g)
|
To engage the service of counsel (who may, if appropriate, be counsel for the Employer), actuaries, and agents whom it may deem advisable to assist it with the performance of its duties;
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(h)
|
To prescribe procedures to be followed by Participants in obtaining benefits;
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(i)
|
To receive from the Employer and from Participants such information as is necessary for the proper administration of the ERA;
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(j)
|
To establish and maintain, or cause to be maintained, the individual Accounts described in Section 4.3;
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(k)
|
To create and maintain such records and forms as are required for the efficient administration of the ERA;
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(l)
|
To make all determinations and computations concerning the benefits, credits and debits to which any Participant, or other Beneficiary, is entitled under the ERA;
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(m)
|
To give the Trustee of the trust established to serve as a source of funds under the ERA specific directions in writing with respect to:
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|
(i)
|
making distribution payments, giving the names of the payees, specifying the amounts to be paid and the time or times when payments will be made; and
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(ii)
|
making any other payments which the Trustee is not by the terms of the trust agreement authorized to make without a direction in writing by the Plan Administrator;
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(n)
|
To comply with all applicable lawful reporting and disclosure requirements of ERISA;
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(o)
|
To comply (or transfer responsibility for compliance to the Trustee) with all applicable federal income tax withholding requirements for benefit distributions; and
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(p)
|
To construe the ERA, in its sole and absolute discretion, and make equitable adjustments for any errors made in the administration of the ERA.
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|
(a)
|
Initial Claim. In the event that an Employee, Eligible Person, Participant or his Beneficiary (a “claimant”) claims to be eligible for benefits, or claims any rights under this ERA, such claimant must complete and submit such claim forms and supporting documentation as will be required by the Plan Administrator, in its sole and absolute discretion. Likewise, any claimant who feels unfairly treated as a result of the administration of the ERA must file a written claim. setting forth the basis of the claim, with the Plan Administrator. In connection with the determination of a claim, or in connection with appeal of a denied claim. the claimant may examine this ERA, and any other pertinent documents generally available to Participants that are specifically related to the claim and may appoint an authorized representative to pursue the claim on his behalf. References to the claimant include his authorized representative, when applicable.
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|
(b)
|
Non-Disability Claims.
|
|
(i)
|
Initial Decision on Non-Disability Claim. If a claimant files a non-Disability claim, written notice of the disposition of such claim will be furnished to the claimant within ninety (90) days after the claim is filed with the Plan Administrator unless special circumstances require an extension of time for processing the claim. Such extension will not exceed ninety (90) days and no extension will be allowed unless, within the initial ninety (90)-day period, the claimant is sent an extension notice indicating the special circumstances requiring the extension and specifying a date by which the Plan Administrator expects to issue its final decision. If the claim is denied, the Plan Administrator's notice will set forth:
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|
(A)
|
The specific reason or reasons for the denial;
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|
(B)
|
Specific references to pertinent ERA provisions on which the Plan Administrator based its denial;
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|
(C)
|
A description of any additional material and information needed for the claimant to perfect his claim and an explanation of why the material or information is needed;
|
|
(D)
|
A statement that the claimant may:
|
|
(1)
|
Appeal the claim in writing to the RPAC, including a description of such appeal procedures and the time limits applicable to such procedures;
|
|
(2)
|
Review pertinent ERA documents;
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|
(3)
|
Submit issues and comments in writing; and
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|
(4)
|
Pursue arbitration following the denial of the claim on appeal;
|
|
(E)
|
A statement that any appeal that the claimant wishes to make of the adverse determination must be made in writing to the RPAC within ninety (90) days after receipt of the Plan Administrator's notice of denial of benefits; and
|
|
(F)
|
A statement that his failure to appeal the action to the RPAC in writing within the ninety (90)-day period will render the Plan Administrator's determination final, binding, and conclusive.
|
|
(ii)
|
Appeal of Denied Non-Disability Claim. Within ninety (90) days after receiving written notice of the Plan Administrator's denial of his initial non-Disability claim, the claimant may file with the RPAC a written appeal of his claim. If the claimant does not file an appeal within ninety (90) days after receiving written notice of the Plan Administrator's disposition of the claim, the claimant will be deemed to have accepted the Plan Administrator's written disposition, unless the claimant was physically or mentally incapacitated so as to be unable to file an appeal within the ninety (90) day period.
|
|
(iii)
|
Decision on Appeal of Non-Disability Claim. After receipt by the RPAC of a written appeal of a non-Disability claim, the RPAC will review the claim taking into account all comments, documents, records and other information submitted by the claimant regarding the claim without regard to whether such information was considered in the initial benefit determination. The RPAC will notify the claimant of its decision by delivery or by certified or registered mail to his last known address. A decision on appeal of the claim will be made by the RPAC at its next meeting following receipt of the appeal. If no meeting of the RPAC is scheduled within forty-five (45) days of receipt of the appeal, then the RPAC will hold a special meeting to review such appeal within such forty-five (45) day period. If special circumstances require an extension of the forty-five (45) day period, the RPAC will so notify the claimant and a decision will be made within ninety (90) days of receipt of the appeal. In any event, if a claim is not determined by the RPAC within ninety (90) days of receipt of the appeal, it will be deemed to be denied.
|
|
(c)
|
Disability Claims. The ERA will ensure that all Disability claims and appeals are adjudicated in a manner designed to ensure the independence and impartiality of the persons involved in making the decision by ensuring that decisions regarding hiring, compensation, termination, promotion, or other similar matters with respect to any individual, such as a medical or vocational expert, must not be based upon the likelihood that the individual will support the denial of benefits.
|
|
(i)
|
Initial Decision on Disability Claim. The Plan Administrator will notify the claimant the initial decision on a Disability claim no later than forty-five (45)-days after receipt of the claim by the Plan. This period may be extended by the Plan Administrator for up to thirty (30) days provided that the Plan Administrator determines that such an extension is necessary due to matters beyond the control of the ERA and the claimant is notified before the expiration of the initial forty-five (45)-day period of the circumstances requiring the extension of time and the date by which the Plan Administrator expects to make a decision. If, before the first thirty (30)-day extension period, the Plan Administrator determines that, due to matters beyond the control of the ERA, a decision can not be made within that extension period, the period for making the initial benefit determination may be extended for up to an additional thirty (30) days provided that the claimant is notified before the expiration of the first thirty (30)-day extension period of the circumstances requiring the extension and the date as of which the Plan Administrator expects to issue a decision. In the case of any extension, the notice of extension will specifically explain the standards on which entitlement to a benefit by reason of Disability is based, the unresolved issues that prevent a decision on the claim, and the additional information needed to resolve those issues and the claimant will be given at least forty-five (45) days within which to provide the specified information.
|
|
(A)
|
the specific reason or reasons for the denial;
|
|
(B)
|
reference to the specific ERA provisions on which the denial is based;
|
|
(C)
|
a description of any additional material or information necessary for the claimant to perfect the claim and an explanation of why such material or information is necessary;
|
|
(D)
|
a description of the ERA's review procedures and the time limits applicable to such procedures, including a statement of the claimant's right to bring a civil action under section 502 of ERISA following the denial of an appeal;
|
|
(E)
|
a discussion of the decision, including an explanation of the basis for disagreeing with or not following (i) the views presented by the claimant to the ERA of health care professionals treating the claimant and the vocational professionals who evaluated the claimant, (ii) the views of medical or vocational experts whose advice was obtained on behalf of the ERA in connection with the denial, without regard to whether the advice was relied on in making the benefit determination, and (iii) a disability determination regarding the claimant presented by the claimant to the ERA made by the Social Security Administration;
|
|
(F)
|
if the denial is based on a medical necessity or experimental treatment or similar exclusion or limit, either an explanation of the scientific or clinical judgement for the determination, applying the terms of the ERA to the claimant’s medical circumstances, or a statement that such explanation will be provided free of charge upon request;
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|
(G)
|
either the specific internal rules, guidelines, protocols, standards or other similar criteria of the ERA relied upon in denying the claim or, alternatively, a statement that such rules, guidelines, protocols, standards or other similar criteria do not exist; and
|
|
(H)
|
a statement that the claimant is entitled to receive, upon request and free of charge, reasonable access to, and copies of, all documents, records, and other information relevant to the claim for benefits.
|
|
(ii)
|
Appeal of Denial of Disability Claim
|
|
(A)
|
Opportunity for Full and Fair Review. A claimant will be provided a reasonable opportunity to appeal the denial of his Disability claim under which there will be a full and fair review of the claim and the denial. Accordingly:
|
|
(1)
|
a claimant will be provided one hundred and eighty (180) days following receipt of notice of the denial of the Disability claim to appeal such determination;
|
|
(2)
|
a claimant will be provided the opportunity to submit written comments, documents, records or other information relating to the Disability claim on appeal;
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|
(3)
|
a claimant will be provided, upon request and free of charge, reasonable access to and copies of all documents, records and other information relevant to the Disability claim;
|
|
(4)
|
appellant review will take into account all comments, documents, records and other information submitted by the claimant relating to the Disability claim without regard to other such information once submitted or considered in the initial benefit determination;
|
|
(5)
|
such appeal will not afford deference to the initial denial and will be conducted by the RPAC, which is an appropriate Named Fiduciary of the ERA and which will neither be the individual who denied the Disability claim that is subject to the appeal nor the subordinate of such individual;
|
|
(6)
|
in the case of any appeal of a denied Disability claim that is based in whole or in part on a medical judgment, the claimant will be entitled to a review by the RPAC based on the RPAC's consultation with a health care professional who has appropriate training and experience in the field of medicine involved in the medical judgment whereby such professional is neither an individual who was consulted in connection with the denial that is the subject of the appeal nor the subordinate of any such individual;
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(7)
|
the claimant will be provided with the identity of the medical or vocational experts whose advice was obtained on behalf of the ERA in connection with the denial of the Disability claim, without regard to whether the advice was relied upon in making the benefit determination; and
|
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(8)
|
as soon as possible and sufficiently in advance of the date on which the notice on the appeal is required to be provided, the RPAC or its delegate will provide the claimant, free of charge, with any new or additional evidence and/or rationale
|
|
(B)
|
Timing of Decision on Appeal of Disability Claim. The decision on appeal of the claim will be made by the RPAC at its next meeting following receipt of the appeal. If no meeting of the RPAC is scheduled within forty-five (45) days of receipt of the appeal, then the RPAC will hold a special meeting to review such appeal within such forty-five (45) day period. If special circumstances require an extension of the forty-five (45) day period, the RPAC will so notify the claimant and a decision will be made within ninety (90) days of receipt of the appeal. In any event, if the appeal is not determined by the RPAC within ninety (90) days after its receipt of the appeal, it will be deemed to be denied.
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(C)
|
Decision on Appeal of Disability Claim. The decision of the RPAC will be provided to the claimant as soon as possible but no later than five (5) days after the determination on appeal is made. The claimant will be provided with written or electronic notification of the ERA’s benefit determination on appeal in a culturally and linguistically appropriate manner by providing oral language services (such as a telephone customer assistance hotline) that includes answering questions in any “applicable non-English language,” as defined below, and providing assistance with filing claims and appeals in any applicable non-English language, providing, upon request, a notice in any applicable non-English language and including in the English version of all notices, a statement prominently displayed in any applicable non-English language clearly indicating how to access the language services provided by the ERA. For this purpose a non-English language is an applicable non-English language if ten percent (10%) or more of the population residing in the county to which a notice is sent is literate only in the same non-English language, as determined in guidance issued by the Secretary of the Department of Labor. If the appeal is denied, the notification will set forth, in a manner calculated to be understood by the claimant:
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|
(1)
|
the specific reason or reasons for the appeal decision;
|
|
(2)
|
reference to the specific ERA provisions on which the appeal decision is based;
|
|
(3)
|
a statement that the claimant is entitled to receive, upon request and free of charge, reasonable access to and copies of all documents, records and other information relevant to the Disability claim for benefits;
|
|
(4)
|
a statement describing the ERA's appeals procedures, the right to obtain information about such procedures, a statement of the claimant’s right to file a civil action under
|
|
(5)
|
a discussion of the appeal decision, including an explanation of the basis for disagreeing with or not following (i) the views presented by the claimant to the ERA of health care professionals treating the claimant and the vocational professionals who evaluated the claimant, (ii) the views of medical or vocational experts whose advice was obtained on behalf of the ERA in connection with the claimant’s appeal, without regard to whether the advice was relied on in denying the appeal, and (iii) a disability determination regarding the claimant presented by the claimant to the ERA made by the Social Security Administration;
|
|
(6)
|
if the denial on appeal is based on a medical necessity or experimental treatment or similar exclusion or limit, either an explanation of the scientific or clinical judgement for the denial on appeal, applying the terms of the ERA to the claimant’s medical circumstances, or a statement that such explanation will be provided free of charge upon request; and
|
|
(7)
|
either the specific internal rules, guidelines, protocols, standards or other similar criteria of the ERA relied upon in denying the appeal or, alternatively, a statement that such rules, guidelines, protocols, standards or other similar criteria do not exist.
|
|
|
|
|
|
(a)
|
Corporate Dissolution or Bankruptcy. The Human Resources Committee may terminate and liquidate the ERA within twelve (12) months of a corporate dissolution taxed under section 331 of the Code or with the approval of a bankruptcy court pursuant to 11 U.S.C. § 503(b)(1)(A); provided, that the amounts deferred under the ERA are included in Participants' gross income in the latest of the following years (or if earlier, the taxable year in which the amount is actually or constructively received):
|
|
(i)
|
The calendar year in which the ERA termination and liquidation occurs.
|
|
(ii)
|
The first calendar year in which the amount is no longer subject to a substantial risk of forfeiture.
|
|
(iii)
|
The first calendar year in which the payment is administratively practicable.
|
|
(b)
|
Change in Control. The Human Resources Committee may terminate and liquidate the ERA within the thirty (30) days preceding or the twelve (12) months following a Change in Control (except on account of a liquidation or dissolution of the Company), provided that all plans or arrangements that would be aggregated with the ERA under section 409A of the Code are also terminated and liquidated with respect to each Participant that experienced the Change in Control event so that under the terms of the ERA and all such arrangements the Participant is required to receive all amounts of compensation deferred under such arrangements within twelve (12) months of the termination of the ERA or arrangement, as applicable. In the case of a Change of Control event which constitutes a sale of assets, the termination of the ERA pursuant to this Section 10.3(b) may be made with respect to the Employer that is primarily liable immediately after the Change of Control transaction for the payment of benefits under the ERA.
|
|
(c)
|
Termination of ERA. The Human Resources Committee may terminate and liquidate the ERA provided that (i) the termination and liquidation does not occur by reason of a downturn of the financial health of the Company or an Employer, (ii) all plans all plans or arrangements that would be aggregated with the ERA under section 409A of the Code are also terminated and liquidated, (iii) no payments in liquidation of the ERA are made within twelve (12) months of the date of termination of the ERA other than payments that would be made in the ordinary course operation of the ERA, (iv) all payments are made within twenty-four (24) months of the date the ERA is terminated and (v) the Company or the Employer, as applicable depending on whether the ERA is terminated with respect to such entity, do not adopt a new plan that would be aggregated with the ERA within three (3) years of the date of the termination of the ERA.
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TENET HEALTHCARE CORPORATION
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By:
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/s/ Paul Slavin
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Paul Slavin, Vice President, Total Rewards
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Name
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TITLE
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Effective Date And
Applicable Modification |
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1.
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I have reviewed this quarterly report on Form 10-Q of Tenet Healthcare Corporation (the “Registrant”);
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2.
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Based on my knowledge, this report does not contain any untrue statement of a material fact or omit to state a material fact necessary to make the statements made, in light of the circumstances under which such statements were made, not misleading with respect to the period covered by this report;
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3.
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Based on my knowledge, the financial statements, and other financial information included in this report, fairly present in all material respects the financial condition, results of operations and cash flows of the Registrant as of, and for, the periods presented in this report;
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4.
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The Registrant’s other certifying officer and I are responsible for establishing and maintaining disclosure controls and procedures (as defined in Exchange Act Rules 13a-15(e) and 15d-15(e)) and internal control over financial reporting (as defined in Exchange Act Rules 13a-15(f) and 15d-15(f)) for the Registrant and have:
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(a)
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Designed such disclosure controls and procedures, or caused such disclosure controls and procedures to be designed under our supervision, to ensure that material information relating to the Registrant, including its consolidated subsidiaries, is made known to us by others within those entities, particularly during the period in which this report is being prepared;
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(b)
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Designed such internal control over financial reporting, or caused such internal control over financial reporting to be designed under our supervision, to provide reasonable assurance regarding the reliability of financial reporting and the preparation of financial statements for external purposes in accordance with generally accepted accounting principles;
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(c)
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Evaluated the effectiveness of the Registrant’s disclosure controls and procedures and presented in this report our conclusions about the effectiveness of the disclosure controls and procedures, as of the end of the period covered by this report based on such evaluation; and
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(d)
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Disclosed in this report any change in the Registrant’s internal control over financial reporting that occurred during the Registrant’s most recent fiscal quarter (the Registrant’s fourth fiscal quarter in the case of an annual report) that has materially affected, or is reasonably likely to materially affect, the Registrant’s internal control over financial reporting; and
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5.
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The Registrant’s other certifying officer and I have disclosed, based on our most recent evaluation of internal control over financial reporting, to the Registrant’s auditors and the audit committee of the Registrant’s board of directors (or persons performing the equivalent functions):
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(a)
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All significant deficiencies and material weaknesses in the design or operation of internal control over financial reporting which are reasonably likely to adversely affect the Registrant’s ability to record, process, summarize and report financial information; and
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(b)
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Any fraud, whether or not material, that involves management or other employees who have a significant role in the Registrant’s internal control over financial reporting.
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Date: August 5, 2019
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/s/ RONALD A. RITTENMEYER
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Ronald A. Rittenmeyer
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Executive Chairman and Chief Executive Officer
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1.
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I have reviewed this quarterly report on Form 10-Q of Tenet Healthcare Corporation (the “Registrant”);
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2.
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Based on my knowledge, this report does not contain any untrue statement of a material fact or omit to state a material fact necessary to make the statements made, in light of the circumstances under which such statements were made, not misleading with respect to the period covered by this report;
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3.
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Based on my knowledge, the financial statements, and other financial information included in this report, fairly present in all material respects the financial condition, results of operations and cash flows of the Registrant as of, and for, the periods presented in this report;
|
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4.
|
The Registrant’s other certifying officer and I are responsible for establishing and maintaining disclosure controls and procedures (as defined in Exchange Act Rules 13a-15(e) and 15d-15(e)) and internal control over financial reporting (as defined in Exchange Act Rules 13a-15(f) and 15d-15(f)) for the Registrant and have:
|
|
(a)
|
Designed such disclosure controls and procedures, or caused such disclosure controls and procedures to be designed under our supervision, to ensure that material information relating to the Registrant, including its consolidated subsidiaries, is made known to us by others within those entities, particularly during the period in which this report is being prepared;
|
|
(b)
|
Designed such internal control over financial reporting, or caused such internal control over financial reporting to be designed under our supervision, to provide reasonable assurance regarding the reliability of financial reporting and the preparation of financial statements for external purposes in accordance with generally accepted accounting principles;
|
|
(c)
|
Evaluated the effectiveness of the Registrant’s disclosure controls and procedures and presented in this report our conclusions about the effectiveness of the disclosure controls and procedures, as of the end of the period covered by this report based on such evaluation; and
|
|
(d)
|
Disclosed in this report any change in the Registrant’s internal control over financial reporting that occurred during the Registrant’s most recent fiscal quarter (the Registrant’s fourth fiscal quarter in the case of an annual report) that has materially affected, or is reasonably likely to materially affect, the Registrant’s internal control over financial reporting; and
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5.
|
The Registrant’s other certifying officer and I have disclosed, based on our most recent evaluation of internal control over financial reporting, to the Registrant’s auditors and the audit committee of the Registrant’s board of directors (or persons performing the equivalent functions):
|
|
(a)
|
All significant deficiencies and material weaknesses in the design or operation of internal control over financial reporting which are reasonably likely to adversely affect the Registrant’s ability to record, process, summarize and report financial information; and
|
|
(b)
|
Any fraud, whether or not material, that involves management or other employees who have a significant role in the Registrant’s internal control over financial reporting.
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Date: August 5, 2019
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/s/ DANIEL J. CANCELMI
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Daniel J. Cancelmi
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Executive Vice President and Chief Financial Officer
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Date: August 5, 2019
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/s/ RONALD A. RITTENMEYER
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|
|
Ronald A. Rittenmeyer
|
|
|
Executive Chairman and Chief Executive Officer
|
|
|
|
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Date: August 5, 2019
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/s/ DANIEL J. CANCELMI
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Daniel J. Cancelmi
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Executive Vice President and Chief Financial Officer
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