EX-99.1 2 tm2124192d1_ex99-1.htm EXHIBIT 99.1

Exhibit 99.1

 

 
   
FOR IMMEDIATE RELEASE

4714 Gettysburg Road

Mechanicsburg, PA 17055

 

NYSE Symbol: SEM

 

Select Medical Holdings Corporation Announces Results

For Its Second Quarter Ended June 30, 2021 and Cash Dividend

 

MECHANICSBURG, PENNSYLVANIA — August 5, 2021 — Select Medical Holdings Corporation (“Select Medical,” “we,” “us,” or “our”) (NYSE: SEM) today announced results for its second quarter ended June 30, 2021 and the declaration of a cash dividend.

 

For the second quarter ended June 30, 2021, revenue increased 26.9% to $1,564.0 million, compared to $1,232.7 million for the same quarter, prior year. Income from operations increased 137.6% to $284.0 million for the second quarter ended June 30, 2021, compared to $119.5 million for the same quarter, prior year. Income from operations included $98.0 million of other operating income related to the recognition of payments received under the Provider Relief Fund for the second quarter ended June 30, 2021, compared to $55.0 million for the same quarter, prior year. Refer to “CARES Act Provider Relief Fund” for further discussion. Net income increased 190.7% to $196.2 million for the second quarter ended June 30, 2021, compared to $67.5 million for the same quarter, prior year. Net income included a pre-tax gain on sale of businesses of $0.3 million for the second quarter ended June 30, 2020. Adjusted EBITDA increased 91.3% to $342.0 million for the second quarter ended June 30, 2021, compared to $178.8 million for the same quarter, prior year. Earnings per common share increased to $1.22 for the second quarter ended June 30, 2021, compared to $0.39 for the same quarter, prior year. Adjusted earnings per common share was $1.22 for the second quarter ended June 30, 2021, compared to $0.38 for the same quarter, prior year. Adjusted earnings per common share excluded the gain on sale of businesses and its related tax effects for the second quarter ended June 30, 2020. The definition of Adjusted EBITDA and a reconciliation of net income to Adjusted EBITDA are presented in table IX of this release. A reconciliation of earnings per common share to adjusted earnings per common share is presented in table X of this release.

 

1

 

 

For the six months ended June 30, 2021, revenue increased 17.5% to $3,110.5 million, compared to $2,647.4 million for the same period, prior year. Income from operations increased 95.8% to $486.0 million for the six months ended June 30, 2021, compared to $248.2 million for the same period, prior year. Income from operations included $114.1 million of other operating income related to the recognition of payments received under the Provider Relief Fund for the six months ended June 30, 2021, compared to $55.0 million for the same period, prior year. Refer to “CARES Act Provider Relief Fund” for further discussion. Net income increased 141.7% to $333.4 million for the six months ended June 30, 2021, compared to $137.9 million for the same period, prior year. Net income included a pre-tax gain on sale of businesses of $7.5 million for the six months ended June 30, 2020. Adjusted EBITDA increased 64.0% to $600.4 million for the six months ended June 30, 2021, compared to $366.1 million for the same period, prior year. Earnings per common share increased to $2.04 for the six months ended June 30, 2021, compared to $0.78 for the same period, prior year. Adjusted earnings per common share was $2.04 for the six months ended June 30, 2021, compared to $0.75 for the same period, prior year. Adjusted earnings per common share excluded the gain on sale of businesses and its related tax effects for the six months ended June 30, 2020. The definition of Adjusted EBITDA and a reconciliation of net income to Adjusted EBITDA are presented in table IX of this release. A reconciliation of earnings per common share to adjusted earnings per common share is presented in table X of this release.

 

Please refer to “Effects of the COVID-19 Pandemic on Select Medical’s Results of Operations during the Three and Six Months Ended June 30, 2020 and 2021” below for further discussion regarding the impact of the coronavirus disease 2019 (“COVID-19”) pandemic on Select Medical’s operating results.

 

Company Overview

 

Select Medical is one of the largest operators of critical illness recovery hospitals, rehabilitation hospitals, outpatient rehabilitation clinics, and occupational health centers in the United States based on number of facilities. Select Medical’s reportable segments include the critical illness recovery hospital segment, the rehabilitation hospital segment, the outpatient rehabilitation segment, and the Concentra segment. As of June 30, 2021, Select Medical operated 99 critical illness recovery hospitals in 28 states, 30 rehabilitation hospitals in 12 states, and 1,833 outpatient rehabilitation clinics in 38 states and the District of Columbia. Select Medical’s joint venture subsidiary Concentra operated 518 occupational health centers in 41 states. At June 30, 2021, Select Medical had operations in 46 states and the District of Columbia. Information about Select Medical is available at www.selectmedical.com.

 

CARES Act Provider Relief Fund

 

On March 27, 2020, the Coronavirus Aid, Relief, and Economic Security Act (“CARES Act”) was enacted. The CARES Act provided additional waivers, reimbursement, grants and other funds to assist health care providers during the COVID-19 pandemic, including $100.0 billion in appropriations for the Public Health and Social Services Emergency Fund, also referred to as the Provider Relief Fund, to be used for preventing, preparing, and responding to COVID-19, and for reimbursing eligible health care providers for health care related expenses and lost revenues that are attributable to COVID-19.

 

Select Medical recognized $98.0 million and $114.1 million of payments received under the Provider Relief Fund as other operating income during the three and six months ended June 30, 2021. Select Medical recognized $55.0 million of payments received under the Provider Relief Fund as other operating income during both the three and six months ended June 30, 2020.

 

2

 

 

Critical Illness Recovery Hospital Segment

 

For the second quarter ended June 30, 2021, revenue for the critical illness recovery hospital segment increased 4.7% to $544.1 million, compared to $519.6 million for the same quarter, prior year. Adjusted EBITDA for the critical illness recovery hospital segment was $72.9 million for the second quarter ended June 30, 2021, compared to $89.7 million for the same quarter, prior year. The Adjusted EBITDA margin for the critical illness recovery hospital segment was 13.4% for the second quarter ended June 30, 2021, compared to 17.3% for the same quarter, prior year. Certain critical illness recovery hospital key statistics are presented in table VII of this release for both the second quarters ended June 30, 2021 and 2020.

 

For the six months ended June 30, 2021, revenue for the critical illness recovery hospital segment increased 11.6% to $1,138.9 million, compared to $1,020.1 million for the same period, prior year. Adjusted EBITDA for the critical illness recovery hospital segment increased 4.4% to $186.2 million for the six months ended June 30, 2021, compared to $178.3 million for the same period, prior year. For the six months ended June 30, 2021, Adjusted EBITDA included $17.9 million of other operating income related to the outcome of litigation with the Centers for Medicare & Medicaid Services. The Adjusted EBITDA margin for the critical illness recovery hospital segment was 16.3% for the six months ended June 30, 2021, compared to 17.5% for the same period, prior year. Certain critical illness recovery hospital key statistics are presented in table VIII of this release for both the six months ended June 30, 2021 and 2020.

 

Rehabilitation Hospital Segment

 

For the second quarter ended June 30, 2021, revenue for the rehabilitation hospital segment increased 26.1% to $212.7 million, compared to $168.7 million for the same quarter, prior year. Adjusted EBITDA for the rehabilitation hospital segment increased 83.9% to $50.8 million for the second quarter ended June 30, 2021, compared to $27.6 million for the same quarter, prior year. The Adjusted EBITDA margin for the rehabilitation hospital segment was 23.9% for the second quarter ended June 30, 2021, compared to 16.4% for the same quarter, prior year. Certain rehabilitation hospital key statistics are presented in table VII of this release for both the second quarters ended June 30, 2021 and 2020.

 

For the six months ended June 30, 2021, revenue for the rehabilitation hospital segment increased 19.9% to $420.5 million, compared to $350.7 million for the same period, prior year. Adjusted EBITDA for the rehabilitation hospital segment increased 53.1% to $101.3 million for the six months ended June 30, 2021, compared to $66.2 million for the same period, prior year. The Adjusted EBITDA margin for the rehabilitation hospital segment was 24.1% for the six months ended June 30, 2021, compared to 18.9% for the same period, prior year. Certain rehabilitation hospital key statistics are presented in table VIII of this release for both the six months ended June 30, 2021 and 2020.

 

Outpatient Rehabilitation Segment

 

For the second quarter ended June 30, 2021, revenue for the outpatient rehabilitation segment increased 67.8% to $280.4 million, compared to $167.1 million for the same quarter, prior year. Adjusted EBITDA for the outpatient rehabilitation segment was $45.6 million for the second quarter ended June 30, 2021, compared to Adjusted EBITDA losses of $6.3 million for the same quarter, prior year. The Adjusted EBITDA margin for the outpatient rehabilitation segment was 16.3% for the second quarter ended June 30, 2021, compared to (3.8)% for the same quarter, prior year. Certain outpatient rehabilitation key statistics are presented in table VII of this release for both the second quarters ended June 30, 2021 and 2020.

 

3

 

 

For the six months ended June 30, 2021, revenue for the outpatient rehabilitation segment increased 26.0% to $532.4 million, compared to $422.4 million for the same period, prior year. Adjusted EBITDA for the outpatient rehabilitation segment increased to $72.0 million for the six months ended June 30, 2021, compared to $20.8 million for the same period, prior year. The Adjusted EBITDA margin for the outpatient rehabilitation segment was 13.5% for the six months ended June 30, 2021, compared to 4.9% for the same period, prior year. Certain outpatient rehabilitation key statistics are presented in table VIII of this release for both the six months ended June 30, 2021 and 2020.

 

Concentra Segment

 

For the second quarter ended June 30, 2021, revenue for the Concentra segment increased 46.1% to $456.4 million, compared to $312.3 million for the same quarter, prior year. Adjusted EBITDA for the Concentra segment increased to $137.1 million for the second quarter ended June 30, 2021, compared to $41.5 million for the same quarter, prior year. Adjusted EBITDA included other operating income of $32.3 million related to the recognition of payments received under the Provider Relief Fund for the second quarter ended June 30, 2021, compared to $0.8 million for the same quarter, prior year. The Adjusted EBITDA margin for the Concentra segment was 30.0% for the second quarter ended June 30, 2021, compared to 13.3% for the same quarter, prior year. Certain Concentra key statistics are presented in table VII of this release for both the second quarters ended June 30, 2021 and 2020.

 

For the six months ended June 30, 2021, revenue for the Concentra segment increased 23.7% to $879.2 million, compared to $710.9 million for the same period, prior year. Adjusted EBITDA for the Concentra segment increased to $219.1 million for the six months ended June 30, 2021, compared to $103.0 million for the same period, prior year. Adjusted EBITDA included other operating income of $32.3 million related to the recognition of payments received under the Provider Relief Fund for the six months ended June 30, 2021, compared to $0.8 million for the same period, prior year. The Adjusted EBITDA margin for the Concentra segment was 24.9% for the six months ended June 30, 2021, compared to 14.5% for the same period, prior year. Certain Concentra key statistics are presented in table VIII of this release for both the six months ended June 30, 2021 and 2020.

 

Effects of the COVID-19 Pandemic on Select Medical’s Results of Operations during the Three and Six Months Ended June 30, 2020 and 2021

 

Beginning in March 2020, state governments placed significant restrictions on businesses and mandated closures of non-essential or non-life sustaining businesses, causing many employers to furlough their workforce and temporarily cease or significantly reduce their operations. State governments also implemented restrictions on travel and individual activities outside of the home, closed schools, and mandated other social distancing measures. At the same time, hospitals and other facilities began suspending elective surgeries. In an effort to ensure hospitals and health systems had the capacity to absorb and effectively manage surges of COVID-19 patients, a number of waivers and modifications of certain requirements under the Medicare, Medicaid and Children’s Health Insurance Program (“CHIP”) programs were authorized in March 2020, including certain regulations under the Medicare program which govern admissions into Select Medical’s critical illness recovery hospitals and rehabilitation hospitals. Specifically, Select Medical’s critical illness recovery hospitals which are certified as long-term care hospitals (“LTCHs”) became exempt from the greater-than-25-day average length of stay requirement for all cost reporting periods that include the COVID-19 public health emergency period. Select Medical’s rehabilitation hospitals which are certified as inpatient rehabilitation facilities (“IRFs”) could exclude patients admitted solely to respond to the emergency from the calculation of the “60 percent rule” thresholds to receive payment as an IRF. The COVID-19 public health emergency period has been extended and is currently in effect through October 17, 2021.

 

4

 

 

The adverse effects of the COVID-19 pandemic, along with the actions of governmental authorities and those in the private sector to limit the spread of COVID-19, caused disruptions in each of Select Medical’s segments; these disruptions were most significant within the outpatient rehabilitation and Concentra segments. By mid-March 2020, Select Medical’s outpatient rehabilitation clinics began experiencing significantly less patient visit volume due to declines in patient referrals from physicians, a reduction in workers’ compensation injury visits resulting from the temporary closure of businesses, and the suspension of elective surgeries which would have required outpatient rehabilitation services. Select Medical’s Concentra centers experienced similar declines in patient visit volume due to businesses furloughing their workforce and temporarily ceasing or significantly reducing their operations. Since March 2021, Select Medical’s outpatient rehabilitation clinics and Concentra centers have experienced patient visit volumes which approximate or exceed the levels experienced in the months prior to the widespread emergence of COVID-19 in the United States. Although they have experienced temporary disruptions in their core businesses as a result of the COVID-19 pandemic, Select Medical’s outpatient rehabilitation and Concentra segments have been able to expand their services to provide COVID-19 screening and testing.

 

Select Medical’s critical illness recovery hospitals have played a critical role in caring for patients during the COVID-19 pandemic, and the relaxation of certain admission restrictions have contributed to volume increases in certain of its hospitals. The revenue of Select Medical’s critical illness recovery hospitals and rehabilitation hospitals has also benefited from the temporary suspension of the 2.0% cut to Medicare payments due to sequestration, which began May 1, 2020 following the enactment of the CARES Act, and has been extended through December 31, 2021. Certain of Select Medical’s rehabilitation hospitals experienced temporary declines in patient volume, beginning in March 2020, in areas more significantly impacted by the spread of COVID-19, and as a result of the suspension of elective surgeries at hospitals and other facilities, which consequently reduced the demand for inpatient rehabilitation services. Additionally, some of Select Medical’s rehabilitation hospitals temporarily restricted admissions as a result of the COVID-19 pandemic. Beginning at the onset of the COVID-19 pandemic, both Select Medical’s critical illness recovery hospitals and rehabilitation hospitals modified certain of their protocols in order to follow the guidelines and recommendations for patient treatment and for the protection of their patients and staff members. This has resulted in increased labor costs, including increased contracted labor usage, as well as additional costs resulting from the purchase of personal protective equipment.

 

5

 

 

The unpredictable effects of the COVID-19 pandemic, including the duration and extent of disruption on Select Medical’s operations, creates uncertainties about Select Medical’s future operating results and financial condition. Select Medical has provided revenue and certain operating statistics below for each of its segments for each of the periods presented. Please refer to our risk factors previously reported in our Annual Report on Form 10-K for the year ended December 31, 2020 for further discussion.

 

   Critical Illness Recovery Hospital 
   Revenue   Patient Days   Occupancy Rate     Number of Hospitals
Owned(1)
 
   2019   2020   2021   2019   2020   2021   2019   2020   2021     2019   2020   2021 
   (in thousands)                                       
January  $149,799   $163,238   $199,611    86,238    90,783    100,933    69%   69%   75%     96    100    99 
February   145,586    165,375    190,703    80,806    87,844    92,036    71%   72%   75%     96    100    99 
March   162,149    171,908    204,558    91,085    91,831    100,149    73%   70%   74%     96    100    99 
Three Months Ended March 31  $457,534   $500,521   $594,872    258,129    270,458    293,118    71%   70%   75%     96    100    99 
                                                               
April  $156,231    $171,445   $185,934    88,357    90,710    91,506    70%   71%   70%     99    100    99 
May   156,422    178,223    183,471    89,350    95,191    93,708    69%   72%   70%     99    100    99 
June   148,490    169,958    174,654    85,153    90,988    87,767    68%   71%   68%     99    100    99 
Three Months Ended June 30  $461,143   $519,626   $544,059    262,860    276,889    272,981    69%   72%   69%     99    100    99 
Six Months Ended June 30  $918,677   $1,020,147   $1,138,931    520,989    547,347    566,099    70%   71%   72%     99    100    99 

 

   Rehabilitation Hospital 
   Revenue   Patient Days   Occupancy Rate     Number of Hospitals
Owned(1)
 
   2019   2020   2021   2019   2020   2021   2019   2020   2021     2019   2020   2021 
   (in thousands)                                       
January  $50,615   $61,673   $68,297    27,434    32,111    34,404    74%   79%   82%     17    19    20 
February   48,080    60,690    64,202    25,442    31,813    32,178    76%   84%   84%     17    19    20 
March   55,863    59,656    75,305    29,940    30,644    35,857    78%   76%   85%     18    19    20 
Three Months Ended March 31  $154,558   $182,019   $207,804    82,816    94,568    102,439    76%   79%   84%     18    19    20 
                                                               
April  $51,991   $45,878   $70,295    28,266    23,553    34,861    76%   61%   85%     18    19    20 
May   56,019    57,815    71,190    29,730    29,787    35,604    75%   73%   84%     19    19    20 
June   52,364    64,974    71,181    28,529    30,741    34,483    73%   78%   84%     19    19    20 
Three Months Ended June 30  $160,374   $168,667   $212,666    86,525    84,081    104,948    75%   71%   85%     19    19    20 
Six Months Ended June 30  $314,932   $350,686   $420,470    169,341    178,649    207,387    76%   75%   84%     19    19    20 

 

6

 

 

   Outpatient Rehabilitation 
   Revenue   Visits   Working Days(2) 
   2019   2020   2021   2019   2020   2021   2019   2020   2021 
   (in thousands)                         
January  $83,185   $90,924   $76,763    687,007    757,171    625,964    22    22    20 
February   78,573    88,239    77,063    658,610    739,061    641,942    20    20    20 
March   85,147    76,086    98,135    708,866    626,433    832,248    21    22    23 
Three Months Ended March 31  $246,905   $255,249   $251,961    2,054,483    2,122,665    2,100,154    63    64    63 
                                              
April  $90,230   $49,084   $95,251    762,914    386,108    810,314    22    22    22 
May   90,272    51,186    89,030    759,829    409,703    758,773    22    20    20 
June   81,389    66,868    96,128    680,762    546,456    835,774    20    22    22 
Three Months Ended June 30  $261,891   $167,138   $280,409    2,203,505    1,342,267    2,404,861    64    64    64 
Six Months Ended June 30  $508,796   $422,387   $532,370    4,257,988    3,464,932    4,505,015    127    128    127 

 

   Concentra 
   Revenue   Visits   Working Days(2) 
   2019   2020   2021   2019   2020   2021   2019   2020   2021 
   (in thousands)                         
January  $133,507   $141,236   $127,103    985,598    1,032,069    867,793    22    22    20 
February   126,309    133,690    132,349    919,065    965,741    869,910    20    20    20 
March   136,505    123,609    163,388    1,006,944    879,585    1,057,871    21    22    23 
Three Months Ended March 31  $396,321   $398,535   $422,840    2,911,607    2,877,395    2,795,574    63    64    63 
                                              
April  $140,050   $91,178   $152,143    1,040,543    610,555    999,622    22    22    22 
May   143,183    99,228    142,228    1,073,763    674,629    956,250    22    20    20 
June   130,218    121,932    162,001    988,783    865,896    1,074,206    20    22    22 
Three Months Ended June 30  $413,451   $312,338   $456,372    3,103,089    2,151,080    3,030,078    64    64    64 
Six Months Ended June 30  $809,772   $710,873   $879,212    6,014,696    5,028,475    5,825,652    127    128    127 

 

 

(1)            Represents the number of hospitals owned at the end of each period presented.

(2)            Represents the number of days in which normal business operations were conducted during the periods presented.

 

Stock Repurchase Program

 

The board of directors of Select Medical has authorized a common stock repurchase program to repurchase up to $500.0 million worth of shares of its common stock. The program has been extended until December 31, 2021, and will remain in effect until then, unless further extended or earlier terminated by the board of directors. Stock repurchases under this program may be made in the open market or through privately negotiated transactions, and at times and in such amounts as Select Medical deems appropriate. Select Medical funds this program with cash on hand and borrowings under its revolving credit facility.

 

Select Medical did not repurchase shares during the quarter ended June 30, 2021. Since the inception of the program through June 30, 2021, Select Medical has repurchased 38,580,908 shares at a cost of approximately $356.6 million, or $9.24 per share, which includes transaction costs.

 

Dividend

 

On August 4, 2021, Select Medical’s board of directors declared a cash dividend of $0.125 per share. The dividend will be payable on or about August 30, 2021 to stockholders of record as of the close of business on August 18, 2021.

 

7

 

 

There is no assurance that future dividends will be declared. The declaration and payment of dividends in the future are at the discretion of Select Medical’s board of directors after taking into account various factors, including, but not limited to, our financial condition, operating results, available cash and current and anticipated cash needs, the terms of Select Medical’s indebtedness, and other factors Select Medical’s board of directors may deem to be relevant.

 

Financing Transactions

 

On June 2, 2021, Select Medical entered into Amendment No. 5 to its senior secured credit agreement which, among other things, increased the aggregate commitments available under its revolving credit facility from $450.0 million to $650.0 million, including a $125.0 million sublimit for the issuance of standby letters of credit.

 

On June 2, 2021, Concentra Inc. terminated its first lien credit agreement. The first lien credit agreement provided for commitments of $100.0 million under a revolving credit facility, which was set to mature on March 1, 2022.

 

Business Outlook

 

Select Medical is updating its business outlook for 2021 following the reporting of its second quarter 2021 results. Select Medical now expects revenue for the full year of 2021 to be in the range of $5.85 billion to $6.05 billion and Adjusted EBITDA for the full year of 2021 to be in the range of $970.0 million to $1.0 billion. Select Medical now expects fully diluted earnings per common share for the full year of 2021 to be in the range of $2.91 to $3.08. A reconciliation of net income to Adjusted EBITDA for the full year of 2021 is presented in table XI of this release.

 

Select Medical reaffirms its target compound annual growth rates, provided most recently in its May 6, 2021 press release, for revenue, Adjusted EBITDA, and earnings per common share. Select Medical continues to expect its compound annual growth for revenue to be in the range of 4% to 6% and compound annual growth for Adjusted EBITDA to be in the range of 7% to 8% from 2021 through 2023. Select Medical continues to expect compound annual growth for earnings per common share to be in the range of 17% to 20% from 2021 through 2023.

 

Conference Call

 

Select Medical will host a conference call regarding its second quarter results, as well as its business outlook and the impact of the COVID-19 pandemic on each of its reportable segments, on Friday, August 6, 2021, at 9:00am ET. The domestic dial in number for the call is 1-866-440-2669. The international dial in number is 1-409-220-9844. The conference ID for the call is 5819078. The conference call will be webcast simultaneously and can be accessed at Select Medical Holdings Corporation’s website www.selectmedicalholdings.com.

 

For those unable to participate in the conference call, a replay will be available until 12:00pm ET, August 13, 2021. The replay number is 1-855-859-2056 (domestic) or 1-404-537-3406 (international). The conference ID for the replay will be 5819078. The replay can also be accessed at Select Medical Holdings Corporation’s website, www.selectmedicalholdings.com.

 

8

 

 

Certain statements contained herein that are not descriptions of historical facts are “forward-looking” statements (as such term is defined in the Private Securities Litigation Reform Act of 1995), including statements related to Select Medical’s 2021 and long-term business outlook. Because such statements include risks and uncertainties, actual results may differ materially from those expressed or implied by such forward-looking statements due to factors including the following:

 

developments related to the COVID-19 pandemic including, but not limited to, the duration and severity of the pandemic, additional measures taken by government authorities and the private sector to limit the spread of COVID-19, and further legislative and regulatory actions which impact healthcare providers, including actions that may impact the Medicare program;

 

changes in government reimbursement for our services and/or new payment policies may result in a reduction in revenue, an increase in costs, and a reduction in profitability;

 

the failure of our Medicare-certified long term care hospitals or inpatient rehabilitation facilities to maintain their Medicare certifications may cause our revenue and profitability to decline;

 

the failure of our Medicare-certified long term care hospitals and inpatient rehabilitation facilities operated as “hospitals within hospitals” to qualify as hospitals separate from their host hospitals may cause our revenue and profitability to decline;

 

a government investigation or assertion that we have violated applicable regulations may result in sanctions or reputational harm and increased costs;

 

acquisitions or joint ventures may prove difficult or unsuccessful, use significant resources or expose us to unforeseen liabilities;

 

our plans and expectations related to our acquisitions and our ability to realize anticipated synergies;

 

private third-party payors for our services may adopt payment policies that could limit our future revenue and profitability;

 

the failure to maintain established relationships with the physicians in the areas we serve could reduce our revenue and profitability;

 

shortages in qualified nurses, therapists, physicians, or other licensed providers, or the inability to attract or retain healthcare professionals due to the heightened risk of infection related to the COVID-19 pandemic, could increase our operating costs significantly or limit our ability to staff our facilities;

 

competition may limit our ability to grow and result in a decrease in our revenue and profitability;

 

the loss of key members of our management team could significantly disrupt our operations;

 

the effect of claims asserted against us could subject us to substantial uninsured liabilities;

 

a security breach of our or our third-party vendors’ information technology systems may subject us to potential legal and reputational harm and may result in a violation of the Health Insurance Portability and Accountability Act of 1996 or the Health Information Technology for Economic and Clinical Health Act; and

 

other factors discussed from time to time in our filings with the Securities and Exchange Commission (the “SEC”), including factors discussed under the heading “Risk Factors” of the quarterly reports on Form 10-Q and of the annual report on Form 10-K for the year ended December 31, 2020.

 

9

 

 

Except as required by applicable law, including the securities laws of the United States and the rules and regulations of the SEC, we are under no obligation to publicly update or revise any forward-looking statements, whether as a result of any new information, future events, or otherwise. You should not place undue reliance on our forward-looking statements. Although we believe that the expectations reflected in forward-looking statements are reasonable, we cannot guarantee future results or performance.

 

Investor inquiries:

Joel T. Veit

Senior Vice President and Treasurer

717-972-1100

ir@selectmedical.com

 

SOURCE: Select Medical Holdings Corporation

 

10

 

 

I. Condensed Consolidated Statements of Operations

For the Three Months Ended June 30, 2020 and 2021

(In thousands, except per share amounts, unaudited)

 

   2020   2021   % Change 
Revenue  $1,232,718   $1,564,020    26.9%
Costs and expenses:               
Cost of services, exclusive of depreciation and amortization   1,082,456    1,291,448    19.3 
General and administrative   33,461    35,737    6.8 
Depreciation and amortization   52,271    50,954    (2.5)
Total costs and expenses   1,168,188    1,378,139    18.0 
Other operating income   54,988    98,087    N/M 
Income from operations   119,518    283,968    137.6 
Other income and expense:               
Equity in earnings of unconsolidated subsidiaries   8,324    11,809    41.9 
Gain on sale of businesses   346        N/M 
Interest expense   (37,366)   (33,888)   (9.3)
Income before income taxes   90,822    261,889    188.4 
Income tax expense   23,336    65,681    181.5 
Net income   67,486    196,208    190.7 
Less: Net income attributable to non-controlling interests   15,836    31,314    97.7 
Net income attributable to Select Medical  $51,650   $164,894    219.3%
Basic and diluted earnings per common share:(1)  $0.39   $1.22      

 

 

(1)Refer to table III for calculation of earnings per common share.

 

N/MNot meaningful.

 

11

 

 

II. Condensed Consolidated Statements of Operations

For the Six Months Ended June 30, 2020 and 2021

(In thousands, except per share amounts, unaudited)

 

   2020   2021   % Change 
Revenue  $2,647,350   $3,110,483    17.5%
Costs and expenses:               
Cost of services, exclusive of depreciation and amortization   2,282,827    2,584,897    13.2 
General and administrative   67,292    71,140    5.7 
Depreciation and amortization   104,023    100,574    (3.3)
Total costs and expenses   2,454,142    2,756,611    12.3 
Other operating income   54,988    132,108    N/M 
Income from operations   248,196    485,980    95.8 
Other income and expense:               
Equity in earnings of unconsolidated subsidiaries   10,912    21,728    99.1 
Gain on sale of businesses   7,547        N/M 
Interest income       4,749    N/M 
Interest expense   (83,473)   (68,290)   (18.2)
Income before income taxes   183,182    444,167    142.5 
Income tax expense   45,248    110,745    144.8 
Net income   137,934    333,422    141.7 
Less: Net income attributable to non-controlling interests   33,159    57,982    74.9 
Net income attributable to Select Medical  $104,775   $275,440    162.9%
Basic and diluted earnings per common share:(1)  $0.78   $2.04      

 

 

(1)Refer to table III for calculation of earnings per common share.

 

N/MNot meaningful.

 

12

 

 

III. Earnings per Share

For the Three and Six Months Ended June 30, 2020 and 2021

(In thousands, except per share amounts, unaudited)

 

Select Medical’s capital structure includes common stock and unvested restricted stock awards. To compute earnings per share (“EPS”), Select Medical applies the two-class method because its unvested restricted stock awards are participating securities which are entitled to participate equally with its common stock in undistributed earnings.

 

The following table sets forth the net income attributable to Select Medical, its common shares outstanding, and its participating securities outstanding for the three and six months ended June 30, 2020 and 2021:

 

   Basic and Diluted EPS 
  

Three Months Ended

June 30,

   Six Months Ended
June 30,
 
   2020   2021   2020   2021 
   (in thousands) 
Net income  $67,486   $196,208   $137,934   $333,422 
Less: net income attributable to non-controlling interests   15,836    31,314    33,159    57,982 
Net income attributable to Select Medical   51,650    164,894    104,775    275,440 
Less: net income attributable to participating securities   1,778    5,560    3,596    9,250 
Net income attributable to common shares  $49,872   $159,334   $101,179   $266,190 

 

The following tables set forth the computation of EPS under the two-class method for the three and six months ended June 30, 2020 and 2021:

 

   Three Months Ended June 30, 
   2020   2021 
    Net Income Allocation    Shares(1)    Basic and Diluted EPS    Net Income Allocation    Shares(1)    Basic and Diluted EPS 
Common shares  $49,872    129,319   $0.39   $159,334    130,396   $1.22 
Participating securities   1,778    4,610   $0.39    5,560    4,550   $1.22 
Total  $51,650             $164,894           

 

   Six Months Ended June 30, 
   2020   2021 
    Net Income Allocation    Shares(1)    Basic and Diluted EPS    Net Income Allocation    Shares(1)    Basic and Diluted EPS 
Common shares  $101,179    129,479   $0.78   $266,190    130,362   $2.04 
Participating securities   3,596    4,602   $0.78    9,250    4,530   $2.04 
Total  $104,775             $275,440           

 

 

(1)Represents the weighted average share count outstanding during the period.

 

13

 

 

IV. Condensed Consolidated Balance Sheets

(In thousands, unaudited)

 

   December 31, 2020   June 30, 2021 
Assets          
Current Assets:          
Cash and cash equivalents  $577,061   $803,493 
Accounts receivable   896,763    931,179 
Other current assets   120,176    133,498 
Total Current Assets   1,594,000    1,868,170 
Operating lease right-of-use assets   1,032,217    1,053,331 
Property and equipment, net   943,420    928,226 
Goodwill   3,379,014    3,391,040 
Identifiable intangible assets, net   387,541    380,302 
Other assets   319,207    335,310 
Total Assets  $7,655,399   $7,956,379 
Liabilities and Equity          
Current Liabilities:          
Payables and accruals  $800,918   $917,181 
Government advances   321,807    251,272 
Unearned government assistance   82,607    4,099 
Current operating lease liabilities   220,413    224,868 
Current portion of long-term debt and notes payable   12,621    11,608 
Total Current Liabilities   1,438,366    1,409,028 
Non-current operating lease liabilities   875,367    893,478 
Long-term debt, net of current portion   3,389,398    3,386,214 
Non-current deferred tax liability   132,421    123,559 
Other non-current liabilities   168,703    172,656 
Total Liabilities   6,004,255    5,984,935 
Redeemable non-controlling interests   398,171    521,552 
Total equity   1,252,973    1,449,892 
Total Liabilities and Equity  $7,655,399   $7,956,379 

 

14

 

 

V. Condensed Consolidated Statements of Cash Flows

For the Three Months Ended June 30, 2020 and 2021

(In thousands, unaudited)

 

   2020   2021 
Operating activities          
Net income  $67,486   $196,208 
Adjustments to reconcile net income to net cash provided by operating activities:          
Distributions from unconsolidated subsidiaries   2,744    7,751 
Depreciation and amortization   52,271    50,954 
Provision for expected credit losses   54    145 
Equity in earnings of unconsolidated subsidiaries   (8,324)   (11,809)
Loss (gain) on sale of assets and businesses   (542)   422 
Stock compensation expense   6,963    7,099 
Amortization of debt discount, premium and issuance costs   540    552 
Deferred income taxes   (12,780)   (7,426)
Changes in operating assets and liabilities, net of effects of business combinations:          
Accounts receivable   67,107    28,391 
Other current assets   686    (8,431)
Other assets   9,256    (12,945)
Accounts payable and accrued expenses   61,726    45,288 
Government advances   316,992    (73,703)
Unearned government assistance   45,505    (97,716)
Income taxes   32,330    (1,642)
Net cash provided by operating activities   642,014    123,138 
Investing activities          
Business combinations, net of cash acquired   (128)   (3,767)
Purchases of property and equipment   (32,045)   (36,723)
Investment in businesses   (4,901)   (4,614)
Proceeds from sale of assets and businesses   1,171    9,444 
Net cash used in investing activities   (35,903)   (35,660)
Financing activities          
Borrowings on revolving facilities   10,000     
Payments on revolving facilities   (175,000)    
Borrowings of other debt   25,000     
Principal payments on other debt   (27,634)   (5,972)
Dividends paid to common stockholders       (16,876)
Repurchase of common stock   (724)   (1,610)
Proceeds from issuance of non-controlling interests   7    5,688 
Distributions to and purchases of non-controlling interests   (1,186)   (15,489)
Net cash used in financing activities   (169,537)   (34,259)
Net increase in cash and cash equivalents   436,574    53,219 
Cash and cash equivalents at beginning of period   73,163    750,274 
Cash and cash equivalents at end of period  $509,737   $803,493 
Supplemental information          
Cash paid for interest  $18,239   $14,485 
Cash paid for taxes   3,785    74,751 

 

15

 

 

VI. Condensed Consolidated Statements of Cash Flows

For the Six Months Ended June 30, 2020 and 2021

(In thousands, unaudited)

 

   2020   2021 
Operating activities          
Net income  $137,934   $333,422 
Adjustments to reconcile net income to net cash provided by operating activities:          
Distributions from unconsolidated subsidiaries   11,223    19,384 
Depreciation and amortization   104,023    100,574 
Provision for expected credit losses   253    212 
Equity in earnings of unconsolidated subsidiaries   (10,912)   (21,728)
Loss (gain) on sale of assets and businesses   (7,881)   494 
Stock compensation expense   13,866    13,808 
Amortization of debt discount, premium and issuance costs   1,093    1,095 
Deferred income taxes   (3,416)   (8,323)
Changes in operating assets and liabilities, net of effects of business combinations:          
Accounts receivable   13,179    (31,751)
Other current assets   713    (12,856)
Other assets   11,504    (11,984)
Accounts payable and accrued expenses   8,279    89,915 
Government advances   316,992    (73,703)
Unearned government assistance   45,505    (78,509)
Income taxes   43,743    42,976 
Net cash provided by operating activities   686,098    363,026 
Investing activities          
Business combinations, net of cash acquired   (6,961)   (10,081)
Purchases of property and equipment   (71,253)   (76,442)
Investment in businesses   (14,749)   (11,185)
Proceeds from sale of assets and businesses   12,401    9,463 
Net cash used in investing activities   (80,562)   (88,245)
Financing activities          
Borrowings on revolving facilities   470,000     
Payments on revolving facilities   (470,000)    
Payments on term loans   (39,843)    
Borrowings of other debt   31,487    8,915 
Principal payments on other debt   (35,733)   (15,314)
Dividends paid to common stockholders       (16,876)
Repurchase of common stock   (9,415)   (1,610)
Proceeds from issuance of non-controlling interests   1,686    5,688 
Distributions to and purchases of non-controlling interests   (13,660)   (29,152)
Purchase of membership interests of Concentra Group Holdings Parent   (366,203)    
Net cash used in financing activities   (431,681)   (48,349)
Net increase in cash and cash equivalents   173,855    226,432 
Cash and cash equivalents at beginning of period   335,882    577,061 
Cash and cash equivalents at end of period  $509,737   $803,493 
Supplemental information          
Cash paid for interest  $86,124   $66,955 
Cash paid for taxes   4,920    76,094 

 

16

 

 

VII. Key Statistics

For the Three Months Ended June 30, 2020 and 2021

(unaudited)

 

   2020   2021   % Change 
Critical Illness Recovery Hospital               
Number of hospitals – end of period(a)   101    99      
Revenue (,000)  $519,626   $544,059    4.7%
Number of patient days(b)(c)   276,889    272,981    (1.4)%
Number of admissions(b)(d)   9,167    9,026    (1.5)%
Revenue per patient day(b)(e)  $1,867   $1,986    6.4%
Adjusted EBITDA (,000)  $89,743   $72,904    (18.8)%
Adjusted EBITDA margin   17.3%   13.4%     
Rehabilitation Hospital               
Number of hospitals – end of period(a)   29    30      
Revenue (,000)  $168,667   $212,666    26.1%
Number of patient days(b)(c)   84,081    104,948    24.8%
Number of admissions(b)(d)   5,713    7,360    28.8%
Revenue per patient day(b)(e)  $1,831   $1,849    1.0%
Adjusted EBITDA (,000)  $27,605   $50,768    83.9%
Adjusted EBITDA margin   16.4%   23.9%     
Outpatient Rehabilitation               
Number of clinics – end of period(a)   1,757    1,833      
Revenue (,000)  $167,138   $280,409    67.8%
Number of visits(b)(f)   1,342,267    2,404,861    79.2%
Revenue per visit(b)(g)  $106   $102    (3.8)%
Adjusted EBITDA (,000)  $(6,282)  $45,633    N/M 
Adjusted EBITDA margin   (3.8)%   16.3%     
Concentra               
Number of centers – end of period(b)   522    518      
Revenue (,000)  $312,338   $456,372    46.1%
Number of visits(b)(f)   2,151,080    3,030,078    40.9%
Revenue per visit(b)(g)  $124   $125    0.8%
Adjusted EBITDA (,000)  $41,497   $137,060    230.3%
Adjusted EBITDA margin   13.3%   30.0%     

 

 

(a)Includes managed locations.

 

(b)Excludes managed locations. For purposes of the Concentra segment, onsite clinics and community-based outpatient clinics are excluded.

 

(c)Each patient day represents one patient occupying one bed for one day during the periods presented.

 

(d)Represents the number of patients admitted to Select Medical’s hospitals during the periods presented.

 

(e)Represents the average amount of revenue recognized for each patient day. Revenue per patient day is calculated by dividing patient service revenues, excluding revenues from certain other ancillary and outpatient services provided at Select Medical’s hospitals, by the total number of patient days.

 

(f)Represents the number of visits in which patients were treated at Select Medical’s outpatient rehabilitation clinics and Concentra centers during the periods presented.

 

(g)Represents the average amount of revenue recognized for each patient visit. Revenue per visit is calculated by dividing patient service revenue, excluding revenues from certain other ancillary services, by the total number of visits. For purposes of this computation for the Concentra segment, patient service revenue does not include onsite clinics and community-based outpatient clinics.

 

17

 

 

VIII. Key Statistics

For the Six Months Ended June 30, 2020 and 2021

(unaudited)

 

   2020   2021   % Change 
Critical Illness Recovery Hospital               
Number of hospitals – end of period(a)   101    99      
Revenue (,000)  $1,020,147   $1,138,931    11.6%
Number of patient days(b)(c)   547,347    566,099    3.4%
Number of admissions(b)(d)   18,700    18,885    1.0%
Revenue per patient day(b)(e)  $1,853   $2,006    8.3%
Adjusted EBITDA (,000)  $178,313   $186,176    4.4%
Adjusted EBITDA margin   17.5%   16.3%     
Rehabilitation Hospital               
Number of hospitals – end of period(a)   29    30      
Revenue (,000)  $350,686   $420,470    19.9%
Number of patient days(b)(c)   178,649    207,387    16.1%
Number of admissions(b)(d)   12,046    14,491    20.3%
Revenue per patient day(b)(e)  $1,778   $1,851    4.1%
Adjusted EBITDA (,000)  $66,174   $101,302    53.1%
Adjusted EBITDA margin   18.9%   24.1%     
Outpatient Rehabilitation               
Number of clinics – end of period(a)   1,757    1,833      
Revenue (,000)  $422,387   $532,370    26.0%
Number of visits(b)(f)   3,464,932    4,505,015    30.0%
Revenue per visit(b)(g)  $105   $103    (1.9)%
Adjusted EBITDA (,000)  $20,840   $71,962    245.3%
Adjusted EBITDA margin   4.9%   13.5%     
Concentra               
Number of centers – end of period(b)   522    518      
Revenue (,000)  $710,873   $879,212    23.7%
Number of visits(b)(f)   5,028,475    5,825,652    15.9%
Revenue per visit(b)(g)  $124   $125    0.8%
Adjusted EBITDA (,000)  $102,963   $219,075    112.8%
Adjusted EBITDA margin   14.5%   24.9%     

 

 

(a)Includes managed locations.

 

(b)Excludes managed locations. For purposes of the Concentra segment, onsite clinics and community-based outpatient clinics are excluded.

 

(c)Each patient day represents one patient occupying one bed for one day during the periods presented.

 

(d)Represents the number of patients admitted to Select Medical’s hospitals during the periods presented.

 

(e)Represents the average amount of revenue recognized for each patient day. Revenue per patient day is calculated by dividing patient service revenues, excluding revenues from certain other ancillary and outpatient services provided at Select Medical’s hospitals, by the total number of patient days.

 

(f)Represents the number of visits in which patients were treated at Select Medical’s outpatient rehabilitation clinics and Concentra centers during the periods presented.

 

(g)Represents the average amount of revenue recognized for each patient visit. Revenue per visit is calculated by dividing patient service revenue, excluding revenues from certain other ancillary services, by the total number of visits. For purposes of this computation for the Concentra segment, patient service revenue does not include onsite clinics and community-based outpatient clinics.

 

18

 

 

IX. Net Income to Adjusted EBITDA Reconciliation

For the Three and Six Months Ended June 30, 2020 and 2021

(In thousands, unaudited)

 

The presentation of Adjusted EBITDA is important to investors because Adjusted EBITDA is commonly used as an analytical indicator of performance by investors within the healthcare industry. Adjusted EBITDA is used to evaluate financial performance and determine resource allocation for each of Select Medical’s operating segments. Adjusted EBITDA is not a measure of financial performance under generally accepted accounting principles (“GAAP”). Items excluded from Adjusted EBITDA are significant components in understanding and assessing financial performance. Adjusted EBITDA should not be considered in isolation or as an alternative to, or substitute for, net income, income from operations, cash flows generated by operations, investing or financing activities, or other financial statement data presented in the consolidated financial statements as indicators of financial performance or liquidity. Because Adjusted EBITDA is not a measurement determined in accordance with GAAP and is thus susceptible to varying definitions, Adjusted EBITDA as presented may not be comparable to other similarly titled measures of other companies.

 

The following table reconciles net income to Adjusted EBITDA for Select Medical. Adjusted EBITDA is used by Select Medical to report its segment performance. Adjusted EBITDA is defined as earnings excluding interest, income taxes, depreciation and amortization, gain (loss) on early retirement of debt, stock compensation expense, gain (loss) on sale of businesses, and equity in earnings (losses) of unconsolidated subsidiaries.

 

  

Three Months Ended

June 30,

  

Six Months Ended

June 30,

 
   2020   2021   2020   2021 
Net income  $67,486   $196,208   $137,934   $333,422 
Income tax expense   23,336    65,681    45,248    110,745 
Interest expense   37,366    33,888    83,473    68,290 
Interest income               (4,749)
Gain on sale of businesses   (346)       (7,547)    
Equity in earnings of unconsolidated subsidiaries   (8,324)   (11,809)   (10,912)   (21,728)
Income from operations   119,518    283,968    248,196    485,980 
Stock compensation expense:                    
Included in general and administrative   5,451    5,620    10,888    11,080 
Included in cost of services   1,512    1,479    2,978    2,728 
Depreciation and amortization   52,271    50,954    104,023    100,574 
Adjusted EBITDA  $178,752   $342,021   $366,085   $600,362 
                     
Critical illness recovery hospital(a)  $89,743   $72,904   $178,313   $186,176 
Rehabilitation hospital   27,605    50,768    66,174    101,302 
Outpatient rehabilitation   (6,282)   45,633    20,840    71,962 
Concentra(b)   41,497    137,060    102,963    219,075 
Other(c)(d)   26,189    35,656    (2,205)   21,847 
Adjusted EBITDA  $178,752   $342,021   $366,085   $600,362 

 

 

(a)For the six months ended June 30, 2021, Adjusted EBITDA included other operating income of $17.9 million. The other operating income related to the outcome of litigation with the Centers for Medicare & Medicaid Services.

 

(b)For both the three and six months ended June 30, 2021, Adjusted EBITDA included other operating income of $32.3 million. For both the three and six months ended June 30, 2020, Adjusted EBITDA included other operating income of $0.8 million. The other operating income related to the recognition of payments received under the Provider Relief Fund.

 

(c)For the three and six months ended June 30, 2021, Adjusted EBITDA included other operating income of $65.8 million and $81.9 million, respectively. For both the three and six months ended June 30, 2020, Adjusted EBITDA included other operating income of $54.2 million. The other operating income related to the recognition of payments under the Provider Relief Fund.

 

(d)Other primarily includes general and administrative costs and other operating income, as discussed further above.

 

19

 

 

X. Reconciliation of Earnings per Common Share to Adjusted Earnings per Common Share

For the Three and Six Months Ended June 30, 2020 and 2021

(In thousands, except per share amounts, unaudited)

 

Adjusted net income attributable to common shares and adjusted earnings per common share are not measures of financial performance under GAAP. Items excluded from adjusted net income attributable to common shares and adjusted earnings per common share are significant components in understanding and assessing financial performance. Select Medical believes that the presentation of adjusted net income attributable to common shares and adjusted earnings per common share are important to investors because they are reflective of the financial performance of Select Medical’s ongoing operations and provide better comparability of its results of operations between periods. Adjusted net income attributable to common shares and adjusted earnings per common share should not be considered in isolation or as alternatives to, or substitutes for, net income, cash flows generated by operations, investing or financing activities, or other financial statement data presented in the consolidated financial statements as indicators of financial performance or liquidity. Because adjusted net income attributable to common shares and adjusted earnings per common share are not measurements determined in accordance with GAAP and are thus susceptible to varying calculations, adjusted net income attributable to common shares and adjusted earnings per common share as presented may not be comparable to other similarly titled measures of other companies.

 

The following tables reconcile net income attributable to common shares and earnings per common share on a fully diluted basis to adjusted net income attributable to common shares and adjusted earnings per common share on a fully diluted basis.

 

   Three Months Ended June 30, 
   2020   Per Share(a)   2021   Per Share(a) 
Net income attributable to common shares(a)  $49,872   $0.39   $159,334   $1.22 
Adjustments:(b)                    
Gain on sale of businesses, net of tax effect of $88   (249)   (0.01)        
Adjusted net income attributable to common shares  $49,623   $0.38   $159,334   $1.22 

 

   Six Months Ended June 30, 
   2020   Per Share(a)   2021   Per Share(a) 
Net income attributable to common shares(a)  $101,179   $0.78   $266,190   $2.04 
Adjustments:(b)                    
Gain on sale of businesses, net of tax effect of $3,507   (3,900)   (0.03)        
Adjusted net income attributable to common shares  $97,279   $0.75   $266,190   $2.04 

 

 

(a)Net income attributable to common shares and earnings per common share are calculated based on the weighted average common shares outstanding, as presented in table III.

 

(b)Adjustments to net income attributable to common shares include estimated income tax and non-controlling interest impacts and are calculated based on the diluted weighted average common shares outstanding. The estimated income tax impact, which is determined using tax rates based on the nature of the adjustment and the jurisdiction in which the adjustment occurred, includes both current and deferred income tax expense or benefit.

 

20

 

 

XI. Net Income to Adjusted EBITDA Reconciliation

Business Outlook for the Year Ending December 31, 2021

(In millions, unaudited)

 

The following is a reconciliation of full year 2021 Adjusted EBITDA expectations as computed at the low and high points of the range to the closest comparable GAAP financial measure. Refer to table IX for the definition of Adjusted EBITDA and a discussion of Select Medical’s use of Adjusted EBITDA in evaluating financial performance. Each item presented in the below table is an estimation of full year 2021 expectations.

 

   Range 
  Low   High 
Non-GAAP Measure Reconciliation        
Net income attributable to Select Medical  $394   $417 
Net income attributable to non-controlling interests   94    94 
Net income   488    511 
Income tax expense   163    170 
Interest income   (5)   (5)
Interest expense   138    138 
Equity in earnings of unconsolidated subsidiaries   (43)   (43)
Income from operations   741    771 
Stock compensation expense   28    28 
Depreciation and amortization   201    201 
Adjusted EBITDA  $970   $1,000 

 

21