**UNITED STATESSECURITIES AND EXCHANGE COMMISSION****WASHINGTON, D.C. 20549**

_______________**FORM 10-K**_______________

| **(Mark One)** |  |                                                                |
|----------------|--|----------------------------------------------------------------|
| ** **     |  |                                                                |
| **x**          |  | **ANNUAL REPORT PURSUANT TO SECTION 13 OR 15(d) OF**           |
|           |  | **THE SECURITIES EXCHANGE ACT OF 1934**                        |
|           |  |                                                                |
|           |  | **For the fiscal year ended June 30, 2003**                    |
|           |  |                                                                |
|           |  | **OR**                                                         |
| ** **     |  |                                                                |
| **o**          |  | **TRANSITION REPORT PURSUANT TO SECTION 13 OR 15(d) OF**       |
|           |  | **THE SECURITIES EXCHANGE ACT OF 1934**                        |
|           |  |                                                                |
|           |  | **For the transition period from ____________ to____________** |

**Commission File Number: 333-71934**_______________

**VANGUARD HEALTH SYSTEMS, INC.******(Exact name of registrant as specified in its charter)

| **Delaware**                                                    |          | **62-1698183**                         |
|-----------------------------------------------------------------|----------|----------------------------------------|
| *(State or other jurisdiction of incorporationor organization)* | * * | *(I.R.S. Employer Identification No.)* |

**20 Burton Hills Boulevard, Suite 100Nashville, TN 37215**(Address and zip code of principal executive offices)

**(615) 665-6000**(Registrant’s telephone number, including areacode)

Securities Registered Pursuant to Section 12(b)of the Act:   NoneSecurities Registered Pursuant to Section 12(g) of theAct:   None
|      Indicate by check mark whether theregistrant (1) has filed all reports required to be filed underSection 13 or 15(d) of the Securities Exchange Act of 1934 duringthe preceding 12 months (or for such shorter period that theregistrant was required to file such reports) and (2) has beensubject to such filing requirements for the past 90days.   Yesx   Noo                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        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                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          |
|      Indicate by check mark ifdisclosure of delinquent filers pursuant to Item 405 of RegulationS-K is not contained herein, and will not be contained, to the bestof the registrant’s knowledge, in definitive proxy orinformation statements incorporated by reference in Part III ofthis Form 10-K or any amendments to this Form 10-K. x
 

     Indicate by check mark whether theregistrant is an accelerated filer (as defined in Rule 12b-2 of theAct).     Yeso   Nox

 

     There were 232,713 shares ofregistrant’s common stock outstanding as of September 15,2003 (all of which are privately owned and not traded on a publicmarket).
****
**VANGUARD HEALTHSYSTEMS, INC.ANNUAL REPORT ON FORM 10-KTABLE OF CONTENTS**

**PART I**

** **

**Page**

Item 1.

Business...................................................................................................................................................

1

Item 2.

Properties.................................................................................................................................................

33

Item 3.

LegalProceedings..................................................................................................................................

33

Item 4.

Submission of Matters to a Vote of SecurityHolders......................................................................

33

 

 

 

**PART II**

 

 

Item 5.

Market for Registrant’s Common Equity and RelatedStockholder Matters.................................

34

Item 6.

Selected FinancialData..........................................................................................................................

34

Item 7.

Management’s Discussion and Analysis of FinancialCondition and Results of Operations...

36

Item 7A.

Quantitative and Qualitative Disclosures About MarketRisk........................................................

53

Item 8.

Financial Statements and SupplementaryData..................................................................................

53

Item 9.

Changes in and Disagreements with Accountants on Accounting andFinancial Disclosure..

53

Item 9A.

Controls andProcedures.......................................................................................................................

53

 

 

 

**PART III**

 

 

Item 10.

Directors and Executive Officers of theRegistrant...........................................................................

54

Item 11.

ExecutiveCompensation.......................................................................................................................

58

Item 12.

Security Ownership of Certain Beneficial Owners andManagement.............................................

61

Item 13.

Certain Relationships and RelatedTransactions...............................................................................

63

Item 14.

Principal Accounting Fees andServices............................................................................................

68

 

 

 

**PART IV**

 

 

Item 15.

Exhibits, Financial Statement Schedules, and Reports on Form8-K..............................................

69

 

 

 

**SIGNATURES**

....................................................................................................................................................................

73

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Table of Contents

**VANGUARD HEALTH SYSTEMS, INC.**

**PART I**

**Item 1.    Business.**

****

**Company Overview**

               We are an owner and operator of acute care hospitals and otherhealth care facilities principally in urban and suburbanmarkets.  We were incorporated in the State of Delaware inJuly 1997 and acquired our first hospital in 1998.  We havegrown steadily since 1998 through a series of acquisitions. As of June 30, 2003, we owned fifteen acute care hospitals with atotal of 3,666 licensed beds and complementary outpatient servicefacilities providing health care services in the following fourmetropolitan areas:

               •   Phoenix, Arizona               •   Los Angeles/Orange County, California               •   Chicago, Illinois               •   San Antonio, Texas

We also owned two health plans:  a Medicaid managed healthplan, Phoenix Health Plan, which served approximately 78,700members in Arizona as of June 30, 2003; and MacNeal HealthProviders which had responsibility for, under capitated contracts,approximately 52,000 member lives in metropolitan Chicago, Illinoisas of June 30, 2003.

               We selectively acquire hospitals where we identify an opportunityto improve operating performance and profitability and increasemarket share, either through a network of hospitals and othercomplementary health care facilities or a single well-positionedfacility.  We have financed our acquisitions with equitycapital provided by management and various funds controlled byMorgan Stanley Capital Partners and with debt.  During fiscalyear 2003, through a majority-owned acquisition subsidiary, weacquired substantially all of the assets of five acute carehospitals with a total of 1,537 beds and related health carebusinesses in San Antonio, Texas, (the “BHS hospitals”)from Baptist Health Services (formerly known as Baptist HealthSystem) in San Antonio.

               Our principal executive offices are located at 20 Burton HillsBoulevard, Suite 100, Nashville, Tennessee, 37215 and our telephonenumber at that address is (615) 665-6000.  Our corporatewebsite address is www.vanguardhealth.com.  Informationcontained on our website does not constitute part of this AnnualReport on Form 10-K.  The terms “we”,“our”, “the Company”, “us”,“registrant” and “Vanguard” as used in thisreport refer to Vanguard Health Systems, Inc. and its subsidiariesas a consolidated entity, except where it is clear from the contextthat such terms mean only Vanguard Health Systems, Inc. “Subsidiaries” means direct and indirect corporatesubsidiaries of Vanguard Health Systems, Inc. and partnerships,joint ventures and limited liability companies in which suchsubsidiaries are partners or members.

**Competitive Strengths**

               *Diversified portfolio of assets with a broad range ofservices*.  We own and operate high-quality facilities infour separate geographic markets, which diversifies our revenuebase and reduces our exposure to any one market.  Ourhospitals offer general acute care services, including intensivecare and coronary care units, radiology, orthopedic, oncology andoutpatient services and selected tertiary care services, includingopen-heart surgery and level II neonatal intensive care.  Indetermining the types of services we provide, we actively assessthe specific local needs of our communities.  We utilize ourindividual facilities or a network of integrated facilities in thearea to meet these needs.  We believe that our ability toleverage our network of facilities allows us not only to provide abroad range of services in a market, but also to provide them in anefficient and cost-effective manner.  We continuously assessthe types and levels of services provided at each of our facilitiesand seek opportunities to consolidate or expand services within ourmarkets to achieve the most effective and efficient mix of servicesfor the communities we serve.

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Table of Contents

               *Concentrated local market positions in attractivemarkets*.  Thirteen of our fifteen hospitals are located inthe metropolitan Phoenix, Arizona, metropolitan San Antonio, Texas,and metropolitan Los Angeles/Orange County, California,markets.  We entered these markets because of their favorabledemographics, competitive landscape, payer mix and potential forfuture complementary acquisitions and expansion.  The U.S.Census Bureau and other sources estimate the population for thePhoenix, San Antonio and Los Angeles/Orange County markets to growby 14.3%, 6.6% and 6.0%, respectively, between 2002 and 2007, ratesthat exceed the projected national average of 4.5%.  We havefurther strengthened our presence in these markets through theacquisitions we have made and the networks of facilities we haveformed.  Our acquisition of Paradise Valley Hospital inNovember 2001 has enabled us to broaden our delivery of health careservices to the northeast region of metropolitan Phoenix.  Inaddition, in September 2003, we opened our newly constructed WestValley Hospital Medical Center in Goodyear, Arizona, a growing areain western metropolitan Phoenix.  In July 2003, we reopenedthe emergency department and began preparations for expanding acuteservices at one of our Phoenix hospitals.  In August 2003, alarge multi-specialty group in Phoenix purchased a minorityinterest in this hospital.  Our acquisition of the BHShospitals provided us the second largest market share in the SanAntonio market and gave us a platform of well-respected,geographically-diverse hospitals upon which to achieve ourin-market growth strategies.  We entered the metropolitanChicago, Illinois, market by acquiring a single, well-positionedand highly-regarded hospital (MacNeal Hospital) and a network ofprimary care centers in a market that has a favorable payerbase.  Moreover, in June 2002, we added a second facility inChicago (Louis A. Weiss Memorial Hospital) by acquiring an 80.1%interest in a distinguished community hospital linked to a leadingacademic medical center, and we are pleased that a health careaffiliate of the University of Chicago has chosen to remain ourjoint venture partner in this hospital.  These two hospitalsin the Chicago area offer us opportunities to improve further thequality and breadth of services being provided, as well as toreduce operating costs.

               *Proven ability to complete and integrate acquisitions*. As of June 30, 2003, we have successfully completed the acquisitionof fifteen hospitals and related complementary outpatient servicelocations and two managed care health plans.  We believe oursuccess at completing acquisitions is due in large part to ourdisciplined approach to making acquisitions.  Before weacquire a facility we carefully review its financial results andoperating environment and develop a strategic plan that willconfirm the feasibility of improving its operatingperformance.  In identifying ways to achieve this improvement,we consider a variety of alternatives such as expanding services,reducing operating costs, upgrading or rationalizing informationsystems, implementing more efficient care management, improvingsupply arrangements and improving billing and collectionprocedures.

               *Strong management team with significant equityinvestment*.  Our senior management has an average of morethan 20 years of experience in the health care industry at variousorganizations, including OrNda Healthcorp, HCA, Inc., andHealthTrust, Inc.  Almost all of our senior management hasbeen with us since our founding in 1997, and fourteen of oursixteen members of senior management have worked together managinghealth care companies for up to twenty years, either continuouslyor from time to time.  We believe that the experience andcontinuity of our management team greatly enhances the effectiveoperation of the Company.  Our senior management also has ahistory of success in managing private and publicly-owned hospitalcompanies through periods of rapid growth, operating turnaround andfinancial restructuring.  As of June 30, 2003, seniormanagement has invested over $24.9 million in the Company and ownsmore than 16% of its outstanding shares of common stock.  Wealso rely on strong local management teams at each of ourfacilities.  Our local management teams work with ourpatients, payers and medical staffs to identify the medical serviceneeds of the local communities we serve and develop clinicalprograms and capital expenditure plans to meet those needs. In addition, the local management teams recruit physicians to ourhospitals and directly supervise the quality of patient care.

**Business Strategy**

               Our objective is to provide high-quality, cost-effective healthcare services in the communities we serve.  The followingrepresent key elements of our business strategy:

               *Improve Operating Margins and Efficiency*.  We seek toposition ourselves as a cost-effective provider of health careservices in each of our markets.  As a result, we willcontinue to implement initiatives at each of our facilities tofurther improve the financial performance and operating efficiencyof their operations.  Some of our key initiatives include:

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Table of Contents

               •   implementing more efficient care management,supply utilization and inventory management;                   centralizing certain administrative and business office functionswithin a local market or at the corporate                   level; and reducing outsourcing arrangements;

               •   improving our billing and collection processesto maximize collections and reduce bad debts;

               •   capitalizing on purchasing efficiencies throughour relationship with HealthTrust Purchasing Group, a                   leading national health care group purchasing organization; and

               •   selectively upgrading information systems toprovide more accurate and timely clinical and financial                   information or rationalizing legacy systems to provide informationon a more cost-effective basis.

               *Increase Revenues Through Expansion of Services*.  Wewill continue to expand our facilities and range of services basedon the needs of the communities we serve.  For example, wecurrently have major expansion projects underway or in the planningstages at ten of our fifteen hospitals which include both newservices and added capacity for existing services.  We intendto continue to make investments at our facilities to:

               •  expand emergency room and operating roomcapacity;               •  improve the convenience, quality and breadth ofour outpatient services;               •  upgrade and expand specialty services, includingcardiology, oncology and obstetrics;               •  update our medical equipment technology,including diagnostic and imaging equipment; and               •  construct new facilities in underserved areas ofthe community.

               *Recruit New Physicians and Maintain Strong Relationships withExisting Physicians.*  We believe that maintaining strongrelationships with physicians in each of our markets improves thequality of services that our hospitals provide and broadens ouraccess to patients and payers.  We recruit both primary andspecialty physicians who can provide services that we believe arecurrently underserved and in demand at our facilities.  Weintend to sustain and strengthen our recruitment and retentioninitiatives by:

               •  providing physicians high quality facilities inwhich to practice;               •  providing a broad array of services within theintegrated health network;               •  offering quality training programs;               •  providing remote access to clinical information;and               •  arranging for convenient office space adjacent toour facilities.

               In the metropolitan Chicago market, we have affiliations with theUniversity of Chicago, since one of their health care affiliates isour joint venture partner in Louis A. Weiss Memorial Hospital andsince we host some of their residency programs at Louis A. WeissMemorial Hospital and MacNeal Hospital.  These affiliationshave been particularly important elements in our ability to attractquality physicians to our hospitals and the local community. We believe that as we continue to strengthen our position in eachof our markets, we will be even better positioned to attractphysicians to our facilities.

               *Improve Quality.*  We have implemented various programsto ensure improvement in the quality of care provided.  Wehave developed training programs for senior hospital management,chief nursing officers, quality directors, physicians and otherclinical staff.  We share information among our hospitalmanagement to implement best practices and assist in complying withregulatory requirements.  Corporate support is provided toeach hospital to assist with accreditation reviews.  Allhospitals conduct patient, physician, and staff satisfactionsurveys to help identify methods of improving the quality ofcare.  In addition, we maintain quality assurance programs tosupport and monitor quality of care standards and to meet Medicareand Medicaid accreditation and regulatory requirements. Patient care evaluations and other quality of care assessmentactivities are reviewed and monitored continuously.

               *Grow Through Selective Acquisitions*.  We will continueto pursue acquisitions that either expand our network and presencein our existing markets or allow us to enter new urban or suburbanmarkets.  In evaluating potential acquisitions, we willcontinue to focus on several important factors, including thefollowing:

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Table of Contents

               •  population growth               •  demographics               •  payer mix               •  existing competition               •  opportunities to improve financialperformance               •  opportunities to expand services

               Further, in entering a new market, we evaluate the opportunity todevelop a local network of hospitals through additionalacquisitions within the market as we have done in most of ourcurrent markets.  We believe that we will continue to havesubstantial acquisition opportunities as other health careproviders choose to divest facilities and as independent hospitals,particularly not-for-profit hospitals, seek to capitalize on thebenefits of becoming part of a larger hospital company.  Inaddition to acquisitions, we will also evaluate the possibility ofconstructing new facilities and pursuing strategic partnerships orjoint ventures to expand our presence in existing markets or toenter new markets.  We just recently opened our sixteenthhospital in the western part of metropolitan Phoenix, Arizona,which will expand our presence in a growing part of the Phoenixmarket that is currently underserved.

               *Continue to Develop Favorable Managed CareRelationships.*  We plan to increase the number of patientsat our facilities and improve our profitability by negotiating morefavorable terms with managed care plans, including addingprovisions for financial incentives to the plans in exchange forexceeding specified patient volume thresholds, and by entering intocontracts with additional managed care plans.  We believe thatwe are attractive to managed care plans because of the geographicand demographic coverage of our facilities in their respectivemarkets, the quality and breadth of our services and the expertiseof our physicians.  Further, we believe that as we increaseour presence and competitive position in our markets, particularlyas we develop our networks of hospitals, we will be increasinglyattractive to managed care plans and will be even better positionedto negotiate more favorable managed care contracts.

               *Continue to Strengthen and Retain Local and Regional ManagementTeams*.  We recruit and retain experienced senior managersto give our hospitals their own dedicated management teams. We believe a strong, local management team at each facility,including a chief executive officer, chief financial officer andchief nursing officer, enhances physician, employee and communityrelations.  In addition, we have regional management teamsthat oversee our local management teams, implement corporateinitiatives, and provide managed care contracting, revenue cyclemanagement, marketing and other services.

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Table of Contents

**Our Facilities**

               We owned and operated fifteen acute care hospitals as of June 30,2003.  The following table contains information concerning ourhospitals:

**Hospital**

**City**

**State**

**Licensed Beds(3)**

**Date Acquired**

Arrowhead Community Hospital and Medical Center

Glendale

AZ

115

June 1, 2000

Maryvale Hospital Medical Center

Phoenix

AZ

239

June 1, 1998

Phoenix Baptist Hospital and Medical Center

Phoenix

AZ

216

June 1, 2000

Phoenix Memorial Hospital

Phoenix

AZ

109

May 1, 2001

Paradise Valley Hospital

Phoenix

AZ

163

November 1, 2001

Huntington Beach Hospital

Huntington Beach

CA

131

September 1, 1999

La Palma Intercommunity Hospital

La Palma

CA

141

April 1, 2000

West Anaheim Medical Center

Anaheim

CA

219

September 1, 1999

Louis A. Weiss Memorial Hospital (1)

Chicago

IL

369

June 1, 2002

MacNeal Hospital

Berwyn

IL

427

February 1, 2000

Baptist Medical Center (2)

San Antonio

TX

654

January 1, 2003

Northeast Baptist Hospital (2)

San Antonio

TX

291

January 1, 2003

North Central Baptist Hospital (2)

San Antonio

TX

126

January 1, 2003

Southeast Baptist Hospital (2)

San Antonio

TX

175

January 1, 2003

St. Luke’s Baptist Hospital (2)

San Antonio

TX

291

January 1, 2003

Total Licensed Beds

3,666

____________________

(1)

This hospital is operated by us in a consolidated joint venturecorporation in which we own 80.1%  of the equity interests andthe University of Chicago Hospitals owns 19.9% of the equityinterests.

 

 

 

(2)

This hospital is operated by us in a consolidated limitedpartnership in which two of our subsidiaries own 100% of the equityinterests.  However, Baptist Health Services (formerly knownas Baptist Health System), a non-profit corporation and the formerowner of this hospital, owns 19.9% of the equity interests of oursubsidiary which owns a 2% general partnership interest in thelimited partnership.  Our other subsidiary is indirectlywholly-owned by us and owns a 98% limited partnership interest inthe limited partnership.

 

 

 

(3)

Our sixteenth hospital, 74-bed West Valley Hospital MedicalCenter, will open on September 4, 2003, in Goodyear, Arizona.

               In certain circumstances involving the purchase of a not-for-profithospital, we have agreed and in the future may agree to certainlimitations on our ability to sell those facilities.  Inparticular, when we acquired Phoenix Baptist Hospital and MedicalCenter and Arrowhead Community Hospital and Medical Center in June2000, we agreed not to sell either hospital for five years afterclosing and granted to a foundation affiliated with the seller forten years after closing a right of first refusal to purchase eitherhospital if we agreed to sell it to a third party, at the sameprice on which we agreed to sell that hospital to the thirdparty.  In addition, upon the purchase of the BHS hospitals,we agreed not to sell the hospitals for seven years without theconsent of the seller.

**Hospital Operations**

****

               Our hospitals typically provide the full range of services commonlyavailable in acute care hospitals, such as internal medicine,general surgery, cardiology, oncology, neurosurgery, orthopedics,obstetrics, diagnostic and emergency services, as well as selecttertiary services such as open-heart surgery and level II neonatalintensive care.  Our hospitals also generally provideoutpatient and ancillary health care services such as outpatientsurgery, laboratory, radiology, respiratory therapy and physicaltherapy.  We also provide outpatient services at ourambulatory surgery centers.  Certain of our hospitals have alimited number of psychiatric, skilled nursing and rehabilitationbeds.

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               Our senior management team has extensive experience in operatingmulti-facility hospital networks and focuses on strategic planningfor our facilities.  A hospital’s local management teamis generally comprised of a chief executive officer, chieffinancial officer and chief nursing officer.  Local managementteams, in consultation with our corporate staff, develop annualoperating plans setting forth revenue growth strategies through theexpansion of offered services and the recruitment of physicians ineach community, as well as plans to improve operating efficienciesand reduce costs.  We believe that the ability of each localmanagement team to identify and meet the needs of our patients,medical staffs and the community as a whole is critical to thesuccess of our hospitals.  We base the compensation for eachlocal management team in part on its ability to achieve the goalsset forth in the annual operating plan.

               Boards of trustees at each hospital, consisting of local communityleaders, members of the medical staff and the hospitaladministrator, advise the local management teams.  Members ofeach board of trustees are identified and recommended by our localmanagement teams and serve three-year staggered terms.  Theboards of trustees establish policies concerning medical,professional and ethical practices, monitor these practices andensure that they conform to our high standards.  We maintaincompany-wide compliance and quality assurance programs and usepatient care evaluations and other assessment methods to supportand monitor quality of care standards and to meet accreditation andregulatory requirements.

               We believe that the most important factors affecting theutilization of a hospital are the quality and market position ofthe hospital and the number, quality and specialties of physiciansand medical staff caring for patients at the facility. Overall, we believe that the attractiveness of a hospital topatients, physicians and payers depends on its breadth of services,level of technology and emphasis on quality of care and conveniencefor patients and physicians.  Other factors that affectutilization include local demographics and population growth, localeconomic conditions and managed care market penetration.

               The following table sets forth certain operating statistics forhospitals owned by us for the periods indicated.  Acute carehospital operations are subject to certain fluctuations due toseasonal cycles of illness and weather, including increased patientutilization during the cold weather months and decreases duringholiday periods.

**Year ended June 30,**

**1999**

**2000**

**2001**

**2002**

**2003**

Number of hospitals at end of period

1

7

8

10

15

Number of licensed beds at end of period (a)

239

1,481

1,676

2,207

3,666

Weighted average licensed beds (b)

239

771

1,514

1,815

2,898

Discharges (c)

12,447

31,864

65,175

75,364

114,327

Adjusted discharges-hospitals (d)

19,811

50,661

96,774

110,758

166,508

Patient days (e)

40,906

101,599

266,007

305,370

477,791

Adjusted patient days-hospitals (f)

64,359

194,496

402,353

452,768

694,695

Average length of stay (days) (g)

3.2

4.1

4.1

4.1

4.2

Average daily census (h)

112.0

278.4

728.8

837.0

1,309.0

Occupancy rate (i)

46.9%

46.1%

48.0%

46.0%

44.9%

____________________

(a)

Licensed beds are those beds for which a facility has beengranted approval to operate from the applicable state licensingagency.

 

 

 

(b)

Represents the average number of licensed beds, weighted basedon periods owned.

 

 

 

(c)

Represents the total number of patients discharged (in thefacility for a period in excess of 23 hours) from our hospitals andis used by management and certain investors as a general measure ofinpatient volume.

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(d)

Adjusted discharges-hospitals is used by management and certaininvestors as a general measure of combined inpatient and outpatientvolume and is computed by multiplying discharges by the sum ofgross hospital inpatient and outpatient revenues and then dividingthe result by gross hospital inpatient revenues.  Thiscomputation enables management to assess hospital volume by acombined measure of inpatient and outpatient volume.

 

 

 

(e)

Patient days represent the number of days in which patients stayovernight at the hospital during the respective period (overnightstay defined as patients who occupy beds as of midnight of anygiven day).  Management and certain investors commonly usepatient days as an indicator of hospital volume including length ofstay factors.

 

 

 

(f)

Adjusted patient days-hospitals is used by management andcertain investors as a general measure of combined inpatient andoutpatient hospital volume representative of admissions and lengthof stay data.  Adjusted patient days-hospitals is calculatedby multiplying patient days by the sum of gross hospital inpatientand outpatient revenues and then dividing the result by grosshospital inpatient revenues.

 

 

 

(g)

Average length of stay represents the average number of daysadmitted patients stay in our hospitals.

 

 

 

(h)

Average daily census represents the average number of patientsin our hospitals each day during our ownership.

 

 

 

(i)

Occupancy rate represents the percentage of hospital licensedbeds occupied by patients.  Both average daily census andoccupancy rate provide measures of utilization of inpatientrooms.

               The health care industry has experienced a general shift during thepast few years from inpatient services to outpatient services asMedicare, Medicaid and managed care payers have sought to reducecosts by shifting lower-acuity cases to an outpatientsetting.  Advances in medical equipment technology andpharmacology have supported the shift to outpatient utilization,which has resulted in an increase in the acuity of inpatientadmissions.  However, recent trends seem to indicate thatinpatient admissions are starting to recover and will continue toincrease as the baby boomer population reaches ages where inpatientadmissions become more prevalent.  We have responded to theshift to outpatient services through our ambulatory surgery centersin metropolitan Los Angeles/Orange County, California, ourinterests in surgery centers and diagnostic imaging centers inmetropolitan San Antonio, Texas, our outpatient diagnostic imagingcenters in metropolitan Phoenix, Arizona and our network of primarycare and occupational medicine centers in metropolitan Chicago,Illinois, along with continued expansion of emergency andoutpatient services at our acute hospitals.  We have theresources in place or are in the process of procuring theresources, including quality physicians and nursing staff andtechnologically advanced equipment, to support our comprehensiveservice offerings to capture inpatient volume from the baby boomersand have focused on core services including cardiology, neurology,oncology and orthopedics.  We have also implemented sub-acuteunits such as rehabilitation and psychiatric services, whereappropriate, to meet the needs of our patients while increasingvolume and increasing care management efficiencies.

**Phoenix Health Plan and MacNeal Health Providers**

               Phoenix Health Plan is a prepaid Medicaid managed health plan thatserves Maricopa, Pinal and Gila counties in the Phoenix, Arizonaarea.  We acquired Phoenix Health Plan in connection with theacquisition of Phoenix Memorial Hospital, effective May 1,2001.  This acquisition enables us to enroll patients in ourhospitals into Phoenix Health Plan or other Arizona Health CareCost Containment System (“AHCCCS”) plans who otherwisewould not be able to pay for their hospital expenses.  Inaddition, we believe we will also increase the availability ofmedically necessary services to such patients at ourhospitals.  We believe the volume of patients generatedthrough the health plan will help attract quality physicians to ourhospitals.

               For the year ended June 30, 2003, we derived approximately $179.0million of our revenues from Phoenix Health Plan.  PhoenixHealth Plan had approximately 78,700 enrollees as of June 30, 2003,and derives substantially all of its revenues through a contractwith AHCCCS, which is Arizona’s state Medicaid program. The contract requires Phoenix Health Plan to arrange for healthcare services for enrolled Medicaid patients in exchange for fixedperiodic payments and supplemental payments from AHCCCS. Phoenix Health Plan subcontracts with physicians, hospitals andother health care providers to provide services to itsenrollees.  These services are provided regardless of theactual costs incurred to provide these services.  We receivereinsurance and other supplemental payments from AHCCCS to covercertain costs of health care services that exceed certainthresholds.

               We have provided a performance guaranty in the form of a suretybond with an independent third party insurer in the amount of $5.0million and a letter of credit of $10.0 million for the benefit ofAHCCCS to support

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our obligations under the contract to provide and pay for thehealth care services required.  We also provided a $1.0million letter of credit to collateralize the $5.0 million suretybond.  The amount of the performance guaranty that AHCCCSrequires is based upon the membership in the health plan and therelated capitation amounts paid to us.  We currently do notexpect a material increase in the amount of the performanceguaranty during the next fiscal year.

               Our current contract with AHCCCS commenced on October 1, 1997, foran initial term of one year and originally reserved to AHCCCS theannual option to extend the term of the contract through September30, 2002.  AHCCCS and Phoenix Health Plan amended the contractin October 2001 to extend the term through September 30,2003.  We recently obtained a new contract with AHCCCS for thethree years ended September 30, 2006, with an option for AHCCCS torenew it for two additional one-year periods.

               The operations of MacNeal Health Providers are somewhat integratedwith our MacNeal Hospital in Berwyn, Illinois. For the year endedJune 30, 2003, we derived approximately $39.8 million of ourrevenues from MacNeal Health Providers. Substantially all of therevenues of MacNeal Health Providers arose from its contracts withhealth maintenance organizations from whom it took assignment ofcapitated-member lives.  As of June 30, 2003, MacNeal HealthProviders had five such contracts in effect covering approximately52,000 capitated-member lives. Such capitation is limited tophysician services and outpatient ancillary services and does notcover inpatient hospital services. We try to utilize MacNealHospital and its medical staff as much as possible for thephysician and outpatient ancillary services that are required bysuch capitation arrangements.  Revenues of MacNeal HealthProviders could decrease significantly if the health maintenanceorganizations in the metropolitan Chicago area move away fromassigning capitated-member lives to health plans like MacNealHealth Providers and enter into direct fee-for-service arrangementswith health care providers.

******

***Proposition 204***

******

               Proposition 204 was passed by Arizona voters in November 2000 andrequires that tobacco settlement funds be used to increase theAHCCCS eligibility income limits for full acute care medicalcoverage to 100% of the federal poverty level. Arizona’s share of such settlement funds has been estimatedby the State to be $3.2 billion.  Prior to Proposition 204,AHCCCS coverage generally excluded those persons earning more than34% of the federal poverty level, but as of October 1, 2001,coverage was expanded to 100% of the federal poverty level in mostcases.  Since January 1, 2001, approximately 400,000 membershave been enrolled in AHCCCS health plans primarily due toProposition 204.  The federal poverty level is a federalstandard that changes each year in April.  Usually, it isadjusted upward by a small percentage.  As of June 30, 2003,the federal poverty level for a single individual was $8,980 ofincome per year.  As we expected, the effect of Proposition204 has been to increase enrollment in the Phoenix Health Plan byour share of the new enrollees, with a corresponding increase inthe health plan’s revenues.  In addition, our hospitalsin the Phoenix market are now serving more low-income patients whoare covered by AHCCCS.  This has increased paid admissionswith a governmental payer which provides reimbursement for hospitalservices.

**Sources of Revenues**

****

               We receive payment for patient services from:

               •  the federal government, primarily under theMedicare program;

               •  state Medicaid programs; and

               •  health maintenance organizations, preferredprovider organizations, other private insurers and individual                  patients.

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               The table below presents the approximate percentage of grosspatient revenues we received from the following sources for theperiods indicated:

   

  

**Year ended June 30,**

**Patient revenues by payer source**

  

**2001**

**2002**

**2003**

 

  

Medicare

  

20

%

25

%

30

%

Medicaid

  

9

7

9

Managed care plans (1)

  

62

60

55

Indemnity and other

  

9

8

6

 

  

     Total

  

100

%

100

%

100

%

 

  

 

 

 

 

 

(1) Revenues under managed Medicare, managed Medicaid and othergovernmental managed plans in addition to commercial managed careplans are included in the managed care plans category.

               Most of our hospitals offer discounts from established charges toprivate managed care plans if they are large group purchasers ofhealth care services.  These discount programs limit ourability to increase charges in response to increasing costs. Patients generally are not responsible for any difference betweenestablished hospital charges and amounts reimbursed for suchservices under Medicare, Medicaid, some private insurance plans,health maintenance organizations or preferred providerorganizations, but are generally responsible for exclusions,deductibles and co-insurance features of their coverages.  Dueto rising health care costs, many payers have increased the numberof excluded services and the levels of deductibles and co-insuranceresulting in a higher portion of the contracted rate due from theindividual patients.  Collecting amounts due from individualpatients is typically more difficult than collecting fromgovernmental or private managed care plans.

               Certain other hospital companies have recently proposed policies toprovide discounts from gross charges to certain uninsuredpatients.  The federal government has apparently grantedpreliminary approval to at least one of these proposals pendingfinal approval from federal regulators.  If final approval forthese discount policies is received, we intend to adopt similarpolicies during fiscal 2004.

**Competition**

****

               The hospital industry is highly competitive.  We currentlyface competition from established, not-for-profit health carecompanies, investor-owned hospital companies, large tertiary carecenters, specialty hospitals and outpatient serviceproviders.  In the future, we expect to encounter increasedcompetition from companies, like ours, that consolidate hospitalsand health care companies in specific geographic markets. Continued consolidation in the health care industry will be aleading factor contributing to increased competition in our currentmarkets and markets we may enter in the future.  Due to theshift to outpatient care and more stringent payer-imposedpre-authorization requirements during the past few years, mosthospitals have significant unused capacity resulting in increasedcompetition for patients.  Many of our competitors are largerthan us and have more financial resources available than wedo.  Other not-for-profit competitors have endowment andcharitable contribution resources available to them and canpurchase equipment and other assets on a tax-free basis.

               One of the most important factors in the competitive position of ahospital is its location, including its geographic coverage andaccess to patients.  A location convenient to a largepopulation of potential patients or a wide geographic coverage areathrough hospital networks can make a hospital significantly morecompetitive.  Another important factor is the scope andquality of services a hospital offers, whether at a single facilityor a network of facilities, compared to the services offered by itscompetitors.  A hospital or network of hospitals that offers abroad range of services and has a strong local market presence ismore likely to obtain favorable managed care contracts.  Weintend to evaluate changing circumstances in the geographic areasin which we operate on an ongoing basis to ensure that we offer theservices and have the access to patients necessary to compete inthese managed care markets and, as appropriate, to form our own, orjoin with others to form, local hospital networks.

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               A hospital’s competitive position also depends in largemeasure on the quality and scope of the practices of physiciansassociated with the hospital.  Physicians refer patients to ahospital primarily on the basis of the quality and scope ofservices provided by the hospital, the quality of the medical staffand employees affiliated with the hospital, the hospital’slocation and the quality and age of the hospital’s equipmentand physical plant.  Although physicians may terminate theiraffiliation with our hospitals, we seek to retain physicians ofvaried specialties on our medical staffs and to recruit otherqualified physicians by maintaining and improving our level of careand providing quality facilities, equipment, employees and servicesfor physicians and their patients.

               Another major factor in the competitive position of a hospital isthe ability of its management to obtain contracts with managed careplans and other group payers.  The importance of obtainingmanaged care contracts has increased in recent years and isexpected to continue to increase as private and government payorsand others increasingly turn to managed care organizations to helpcontrol rising health care costs. Our markets have experiencedsignificant managed care penetration.  The revenue andoperating results of our hospitals are significantly affected byour hospitals’ ability to negotiate favorable contracts withmanaged care plans.  Health maintenance organizations andpreferred provider organizations use managed care contracts toencourage patients to use certain hospitals in exchange fordiscounts from the hospitals’ established charges. Traditional health insurers and large employers also are interestedin containing costs through similar contracts with hospitals.

               The hospital industry and our hospitals continue to havesignificant unused capacity.  Inpatient utilization, averagelengths of stay and average occupancy rates have historically beennegatively affected by payer-required pre-admission authorization,utilization review and payer pressure to maximize outpatient andalternative health care delivery services for less acutely illpatients.  Admissions constraints, payer pressures andincreased competition are expected to continue.  We endeavorto meet these challenges by expanding many of our facilities toinclude outpatient centers, offering discounts to private payergroups, upgrading facilities and equipment and offering new orexpanded programs and services.

A number of other factors affect our competitive position,including:

               •  our reputation               •  the amounts we charge for our services               •  parking availability or access to publictransportation               •  the restrictions of state Certificate of Needlaws

**Employees and Medical Staff**

****

               As of June 30, 2003, we had approximately 13,500 employees,including approximately 3,800 part-time employees.  None ofour employees are subject to collective bargaining agreements, andwe consider our employee relations to be good.  While some ofour hospitals experience union organizing activity from time totime, we do not expect these efforts to materially affect ourfuture operations.  Our hospitals, like most hospitals, haveexperienced labor costs rising faster than the general inflationrate.

               In the industry as a whole, and in our markets, there is currentlya shortage of nurses and other medical support personnel.  Toaddress the nursing shortage, we have implemented comprehensiverecruiting and retention plans for nurses that focuses oncompetitive salaries and benefits as well as employee satisfaction,best practices, tuition assistance, effective training and careerdevelopment programs and workplace environment.  As part ofthis initiative, we have expanded our relationships with colleges,universities and other medical institutions in our markets and willalso recruit nurses from abroad.  We anticipate that demandfor nurses will continue to exceed supply especially as the babyboomer population reaches the ages where inpatient stays becomemore frequent.  However, we expect our initiatives to helpstabilize our nursing resources over time.

               Our hospitals grant staff privileges to licensed physicians who mayserve on the medical staffs of multiple hospitals, includinghospitals not owned by us.  A physician who is not an employeecan terminate his or her affiliation with our hospital at anytime.  Although we employ a limited number of physicians, aphysician does not have to be an employee of ours to be a member ofthe medical staff of one of our hospitals.  Any licensedphysician may apply to be admitted to the medical staff of any ofour hospitals, but admission to the staff must be approved by eachhospital’s medical staff and board of trustees in accordancewith established credentialing criteria.

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**Compliance Program**

****

               We voluntarily maintain a company-wide compliance program designedto ensure that we maintain high standards of ethics and conduct inthe operation of our business and implement policies and proceduresso that all our employees act in compliance with all applicablelaws, regulations and company policies.  The organizationalstructure of our compliance program includes oversight by our Boardof Directors and a high-level corporate management compliancecommittee.  The Board of Directors and compliance committeeare responsible for ensuring that the compliance program meets itsstated goals and remains up-to-date to address the currentregulatory environment and other issues affecting the health careindustry.  Our Senior Vice President of Compliance and Ethicsreports jointly to our Chairman and Chief Executive Officer and toour Board of Directors, serves as Chief Compliance Officer and ischarged with direct responsibility for the day-to-day management ofour compliance program.  Other features of our complianceprogram include initial and periodic ethics and compliance trainingand effectiveness reviews, a toll-free hotline for employees toreport, without fear of retaliation, any suspected legal or ethicalviolations, annual “fraud and abuse” audits to look atall of our payments to physicians and other referral sources andannual “coding audits” to make sure our hospitals billthe proper service codes in respect of obtaining payment from theMedicare and Medicaid programs.

               A recent focus of our compliance program is the interpretation andimplementation of the new standards set forth by the HealthInsurance Portability and Accountability Act (“HIPAA”)for privacy and security. To facilitate reporting of potentialHIPAA compliance concerns by patients, family or employees, we haveestablished a second toll-free hotline dedicated to HIPAA and otherprivacy matters and placed it in service in April 2003. Corporate HIPAA compliance staff monitors all reports to theprivacy hotline and each phone call is responded toappropriately.  Ongoing HIPAA compliance also includesself-monitoring of HIPAA policy and procedure implementation byeach of our health care facilities  and corporate complianceoversight.

**Our Information Systems**

****

               We believe that our information systems must cost-effectively meetthe needs of our hospital management, medical staff and nurses inthe following areas of our business operations:

               •  patient accounting, including billing andcollection of revenues;               •  accounting, financial reporting andpayroll;               •  coding and compliance;               •  laboratory, radiology and pharmacy systems;               •  medical records and document storage;               •  materials and asset management; and               •  negotiating, pricing and administering ourmanaged care contracts.

               Although we map the information systems from each of our hospitalsto one centralized database, we do not automatically standardizeour information systems among all of our hospitals.  Wecarefully review existing systems at the hospitals we acquire and,if a particular information system is unable to cost-effectivelymeet the operational needs of the hospital, we will convert orupgrade the information system at that hospital to one of severalstandardized information systems that can cost-effectively meetthese needs.

**Insurance**

****

               As is typical in the health care industry, we are subject to claimsand legal actions by patients and others in the ordinary course ofbusiness.  Through May 31, 2002, we maintained third-partyinsurance coverage on a claims-made basis for individualmalpractice claims exceeding $1.0 million and annual aggregateclaims exceeding $13.6 million.  Due to pricing pressures andthe limited availability of carriers willing to underwriteprofessional and general liability coverage, we were unable torenew our previous policy with favorable terms upon its expirationon May 31, 2002.  Effective June 1, 2002, we established awholly owned captive subsidiary to insure our professional andgeneral liability risks at a $10.0 million retention level. We maintain excess coverage from independent third-party carriersfor individual claims exceeding $10.0 million per occurrence up to$100.0 million in the aggregate.  The captive subsidiaryintends to fund claims costs from proceeds of premium paymentsreceived from us.  As a result of these changes, our insuranceexpense increased by $11.5 million during fiscal 2002.  Whilepremiums

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increased significantly during fiscal 2003, such increase waseffectively counterbalanced by an equal increase in the malpracticereserve during fiscal 2002 resulting from the change in ourmalpractice coverage effective June 1, 2002.  As a result, ourinsurance expense for fiscal 2003 was consistent with that offiscal 2002, absent the effects of acquisitions.

               We believe that the professional and general liability insurancemarket will remain depressed in the near term, and future increasesto excess coverage premiums and captive subsidiary retention levelscould significantly affect our operating margins.  Should weexperience significant adverse claims, our future cash flows maynot be adequate to fund such liabilities and our financialcondition could be materially adversely affected.

**Reimbursement**

****

***               Medicare Overview***

****

               Medicare is a federal program that provides hospital and medicalinsurance benefits to persons age 65 and over, some disabledpersons and persons with end-stage renal disease.  Under theMedicare program, acute care hospitals generally receivereimbursement under a prospective payment system for inpatient andoutpatient hospital services.  Currently, certain types offacilities such as psychiatric hospitals, specially designatedchildren’s hospitals and certain designated cancer researchhospitals, as well as psychiatric units that are distinct parts ofa hospital and meet the Centers for Medicare and Medicaid Services(“CMS”, formerly the Health Care FinancingAdministration) criteria for exemption, are exempt from theprospective payment system and are reimbursed on a cost-basedsystem, subject to certain cost limits known as TEFRA (an acronymfor the Tax Equity and Fiscal Responsibility Act of 1982)limits.  A prospective payment system (“PPS”) forrehabilitation hospitals and units began a two year phase-in onJanuary 1, 2002.  CMS implemented PPS for long-term carehospitals and units effective with cost reporting periods beginningon or after October 1, 2002, with a five-year transitionperiod.  A prospective payment system has not yet beenimplemented for psychiatric hospitals and units, but CMS announcedin August 2000 that it will implement PPS for psychiatric hospitalsduring 2004; however, no regulations have been proposed todate.

               ***Medicare Inpatient***

               Under the inpatient prospective payment system, a hospital receivesa fixed payment per inpatient discharge based on thepatient’s assigned diagnosis related group(“DRG”).  DRGs classify treatments for illnessesaccording to the estimated intensity of hospital resourcesnecessary to provide the treatment.  While DRGs are updatedannually to recalibrate the expected treatment cost and areadjusted for wage differentials for different geographic regions,they do not consider a specific hospital’s costs.  Theindex used to adjust DRGs, the “market basket index”,gives consideration to the inflation experienced by hospitals inpurchasing goods and services, but has historically fallen short ofthe actual increased costs incurred by hospitals.  TheBenefits Improvement and Protection Act of 2000 improvedreimbursement rates from the low increases prescribed by theBalanced Budget Act of 1997.  Under the Benefits Improvementand Protection Act of 2000, hospital reimbursement rates forfederal fiscal year 2001 increased by 2.3% (market basket of 3.4%less 1.1%) from the federal fiscal 2000 rates, increased by 2.75%(market basket of 3.3% less 0.55%) for federal fiscal year 2002 andincreased by 2.95% (market basket of 3.5% less 0.55%) for federalfiscal year 2003.  On August 1, 2003, CMS announced a rateincrease equal to the full market basket of 3.40% effective October1, 2003.  However, Congress currently is considering proposalsthat, if enacted into law, could result in a reduction from thefull market basket for the fiscal year 2004 rates, as Congress hasoften done in previous years.  Historically, the rateincreases have been below the cost increases for goods and servicespurchased by our hospitals.  We expect that future rateincreases also will be below such cost increases.

               Hospitals may also be eligible for additional reimbursement oncertain inpatient stays that qualify for Medicare outlierpayments.  Medicare outlier payments are additional fundsprovided to hospitals for the treatment of patients who requiremore costly treatment than the typical patient.  Congress hasmandated that CMS limit Medicare outlier payments to between fiveand six percent of total DRG payments.  To achieve thismandate, in recent years CMS periodically adjusted the costthreshold used to determine eligibility and allocation of availableMedicare outlier payments.  In December 2002, CMS begananalyzing data to identify hospitals with high outlier payments forfurther audit or review and announced its intent to revise thecurrent rules for determining outlier payments.  Based upondata from our most recently filed Medicare cost reports, ourMedicare outlier payments as a percentage of total Medicare DRGpayments and as a percentage of total gross charges from all payercategories are

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2.7% and 0.2%, respectively, which includes the effects of theacquisition of the BHS hospitals and Weiss Hospital for a fullone-year period.  Thus, we do not believe that we have a highlevel of outlier payments.  In June 2003, CMS published afinal rule that modifies the outlier formula in an effort to moreaccurately distribute outlier payments from the outlier pool tohospitals and to ensure that hospitals cannot inappropriatelymanipulate outlier payments.  The final rule did not increasethe current outlier threshold of $33,560 for the balance of federalfiscal year 2003.  Moreover, in July 2003 CMS decreased theoutlier threshold for federal fiscal year 2004 to $31,000. Based on the guidelines set forth in the final rule, we do notbelieve that our current level of outlier payments will bematerially affected.

               Medicare also reimburses acute care hospitals for their capitalcosts in providing services to inpatients.  The majority ofinpatient capital costs for acute care hospitals are reimbursedunder the Medicare program on a prospective system based ondiagnosis related group weights multiplied by a geographicallyadjusted federal rate.

               ***Medicare Outpatient***

               Until August 1, 2000, Medicare typically reimbursed general acutecare hospitals for outpatient services based on a feeschedule.  The Balanced Budget Act of 1997 established aprospective payment system for outpatient hospital services thatcommenced on August 1, 2000.  Nevertheless, CMS is continuingto use existing fee schedules to pay for physical, occupational andspeech therapies, durable medical equipment, clinical diagnosticlaboratory services and nonimplantable orthotics andprosthetics.  Freestanding ambulatory surgery centers are alsoreimbursed on a fee schedule.

               All services paid under the new prospective payment system forhospital outpatient services are classified into groups calledambulatory payment classifications (“APCs”). Services in each APC are similar clinically and in terms of theresources they require.  A payment rate is established foreach APC.  Depending on the services provided, a hospital maybe paid for more than one APC for a patient visit.  The feeschedule for the outpatient prospective payment system was updatedby the market basket index for the calendar year 2001 and was to beupdated by the market basket index of 3.3% minus 1% (or 2.3%) forthe calendar year 2002 under the Benefits Improvement andProtection Act of 2000.  However, CMS delayed theimplementation of the 2002 rates and reimbursed hospitals under the2001 rates until April 1, 2002.  The update for calendar year2003 is the market basket index of 3.5%.  CMS has proposed arate increase of 3.8% for calendar year 2004.   However,future legislation may decrease the rate of increase for APCpayments.

               For calendar year 2002, CMS set aside 2.5% of APC payments to covercertain approved medical devices, pharmaceuticals and biologicalsto be paid on a pass-through basis.  However, the paymentsmade on or after April 1, 2002, were reduced on a pro-rata basis by63.6% due to interim payments that were on track to significantlyexceed the 2.5% amount set aside.  For calendar year 2003, CMSset aside 2.3% of APC payments for these pass-through payments, buthas not made a pro-rata reduction to these payments.

               ***Skilled Nursing Units***

               Medicare historically reimbursed skilled nursing units withinhospitals on the basis of actual costs, subject to limits. The Balanced Budget Act of 1997 required the establishment of aprospective payment system for Medicare skilled nursing units,under which units will be paid a federal per diem rate forvirtually all covered services.  Payment rates were adjustedby the Benefits Improvement Act of 2000.  The new paymentsystem was phased in during the period July 1998 to June2002.  The effect of the new payment system generally has beento significantly reduce reimbursement for skilled nursing services,which has led many hospitals, including some of our hospitals, toclose those units.  We will monitor closely and evaluate thefew remaining skilled nursing units in our hospitals and relatedfacilities to determine whether it is feasible to continue to offersuch services under the new reimbursement policy.  As of June30, 2003, we operated 3 skilled nursing units within our acute carehospitals.

               ***Rehabilitation Units***

               Rehabilitation hospitals and rehabilitation units of hospitalsbegan a two-year phase-in to PPS for cost report periods ending onor after January 1, 2002.  Rehabilitation units are reimburseda predetermined rate per discharge based upon the case mix groupassigned to the patient, which is primarily determined by theseverity of

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the patient’s condition and the patient’s age, andis adjusted for multiple demographic factors.  CMS updated thePPS rate by the full market basket rate of 3% for federal fiscalyear 2003.  As of June 30, 2003, we operated 5 rehabilitationunits within our acute care hospitals.

               ***Psychiatric Units***

               Payments to prospective payment system-exempt hospitals and units,such as inpatient psychiatric services, are based upon reasonablecost, subject to a cost-per-discharge target.  These limitsare updated annually by a market basket index.  The BenefitsImprovement and Protection Act of 2000 increases payments toprospective payment system-exempt hospitals and units.  Inparticular, the Benefits Improvement and Protection Act of 2000increased the incentive payments paid for inpatient psychiatricservices from 2% to 3% of the TEFRA limit.  As of June 30,2003, we operated 7 psychiatric units within our acute carehospitals.

               ***Home Health***

               On October 1, 2000, PPS became effective for home healthservices.  The Benefits Improvement and Protection Act of 2000delayed a 15.0% payment reduction for home health services,originally expected to take effect upon implementation of PPS,until October 1, 2002.  The 15.0% payment reduction wasadopted on October 1, 2002 and was included in the PPS ratesestablished for 2003.  As of June 30, 2003, we operated 4entities providing home health services.

***               Medicaid***

               Medicaid is a federal-state program, administered by the states,which provides hospital and medical benefits to qualifyingindividuals who are unable to afford health care.  Most stateMedicaid payments are made under a prospective payment system orunder programs that negotiate payment levels with individualhospitals.  In Arizona, AHCCCS administers the state Medicaidprogram through the use of prepaid health plans.  AHCCCSreimburses Phoenix Health Plan for health care costs that exceedstated levels at a rate of 75% (85% for catastrophic cases) ofqualified health care costs in excess of the stated levels of$5,000 to $35,000, depending on the rate code assigned to themember.  Qualified health care costs are the lesser of theamount paid by Phoenix Health Plan or the AHCCCS feeschedule.  Phoenix Health Plan then reimburses the hospital atwhich the patient received care.

               Medicaid reimbursement is often less than a hospital’s costof services.  State and federal governments currently jointlyfund Medicaid.  Many states, including certain states in whichwe operate, have reported budget deficits as a result of increasedcosts and lower than expected tax collections.  Health andhuman service programs, including Medicaid and similar programs,represent a significant component of state spending.  Toaddress these budgetary concerns, certain states have proposed andothers may propose decreased funding for these programs.  Weare cautiously monitoring the budgetary crisis and politicalenvironment in California and its potential future effects onMediCal funding.  As part of the 2003 omnibus spending federallegislation signed into law in February 2003, states are to receive$20 billion in additional funding from the federal government, $10billion of which is earmarked for Medicaid and similarprograms.  The states in which we operate received significantallocations of this funding.  We are unable to predict whetherthe additional amounts set aside for Medicaid spending will besufficient to avoid future reductions in Medicaid reimbursementrates.

***               Annual Cost Reports***

******

               All hospitals participating in the Medicare and Medicaid programsare required to meet specific financial reportingrequirements.  Federal regulations require submission ofannual cost reports identifying medical costs and expensesassociated with the services provided by each hospital to Medicarebeneficiaries and Medicaid recipients.  However, in recentyears CMS has extended the filing dates for cost reports as aresult of problems fiscal intermediaries have experienced withupdating the payment reports used to complete cost reports. Moreover, annual cost reports required under the Medicare andMedicaid programs are subject to routine audits, which may resultin adjustments to the amounts ultimately determined to be due to usunder these reimbursement programs.  The audit process takesseveral years to reach the final determination of allowable amountsunder the programs.  Providers also have the right of appeal,and it is common to contest issues raised in audits of prioryears’ reports.

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               Many prior year cost reports of our facilities are stillopen.  If any of our facilities is found to have been inviolation of federal or state laws relating to preparing and filingof Medicare or Medicaid cost reports, whether prior to or after ourownership of these facilities, we and our facilities could besubject to substantial monetary fines, civil and criminal penaltiesand exclusion from participation in the Medicare and Medicaidprograms.  If an allegation is lodged against one of ourfacilities for a violation occurring during the time period beforewe acquired the facility, we may have indemnification rightsagainst the seller of the facility to us.  In each of ouracquisitions, we have negotiated customary indemnification and holdharmless provisions for any damages we may incur in theseareas.

***               Managed Care***

               During the past few years, the hospital industry has experienced ashift in admissions and revenues from commercial insurance payersto managed care payers due to pressures to control the cost ofhealth care services.  We expect this industry trend tocontinue although its effect on us may be mitigated due to theheavy managed care penetration that currently exists in the marketswe serve.  Generally, we receive lower payments from managedcare plans than from traditional commercial or indemnity insurers;however, as part of our business strategy, we have been able torenegotiate payment rates on many of our managed care contracts toimprove our operating margin.  While the majority of ouradmissions and revenues are generated from patients covered bymanaged care plans, the percentage may decrease in the future dueto increased Medicare utilization associated with the aging U.S.population.  We experienced a slight decrease in managed careutilization during fiscal 2003 due primarily to the payer mix shiftrelated to our acquisition of the BHS hospitals.

               ***Commercial Insurance***

******

               Our hospitals also provide services to a decreasing number ofindividuals covered by private health care insurance.  Privateinsurance carriers make direct payments to a hospital or, in somecases, reimburse their policy holders, based upon thehospital’s established charges and the particular coverageprovided in the insurance policy.

               Commercial insurers are continuing efforts to limit the paymentsfor hospital services by adopting discounted payment mechanisms,including prospective payment or diagnosis related group-basedpayment systems, for more inpatient and outpatient services. To the extent that such efforts are successful and reduce theinsurers’ reimbursement to hospitals for the costs ofproviding services to their beneficiaries, such reduced levels ofreimbursement may have a negative impact on our operatingresults.

**Government Regulation and Other Factors**

****

               ***Overview***

               All participants in the health care industry are required to complywith extensive government regulation at the federal, state andlocal levels.  In addition, these laws, rules and regulationsare extremely complex and the health care industry has had thebenefit of little or no regulatory or judicial interpretation ofmany of them.  Although we believe we are in compliance in allmaterial respects with such laws, rules and regulations, if adetermination is made that we were in material violation of suchlaws, rules or regulations, our business, financial condition orresults of operations could be materially adversely affected. If we fail to comply with applicable laws and regulations, we canbe subject to criminal penalties and civil sanctions, our hospitalscan lose their licenses and their ability to participate in theMedicare and Medicaid programs.

               ***Licensing, Certification and Accreditation***

******

               Health care facilities are subject to federal, state and localregulations relating to the adequacy of medical care, equipment,personnel, operating policies and procedures, fire prevention,rate-setting and compliance with building codes and environmentalprotection laws.  Facilities are subject to periodicinspection by governmental and other authorities to assurecontinued compliance with the various standards necessary forlicensing and accreditation.  All of our health carefacilities are properly licensed under appropriate state laws.

               All of the hospitals affiliated with us are certified under theMedicare and Medicaid programs and are accredited by the JointCommission on Accreditation of Healthcare Organizations(“JCAHO”), the effect of which is

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to permit the facilities to participate in the Medicare andMedicaid programs.  Should any facility lose its accreditationfrom JCAHO or otherwise lose its certification under the Medicareor Medicaid programs, the facility would be unable to receivereimbursement from the Medicare and Medicaid programs.  Webelieve that our facilities are in substantial compliance withcurrent applicable federal, state, local and independent reviewbody regulations and standards.  The requirements forlicensing, certification and accreditation are subject to changeand, in order to remain qualified, it may be necessary for us tochange our facilities, equipment, personnel or services.

               ***Certificates of Need***

               In some states, the construction of new facilities, acquisition ofexisting facilities or addition of new beds or services may besubject to review by state regulatory agencies under a Certificateof Need program.  Illinois is the only state in which wecurrently operate that requires approval under a Certificate ofNeed program.  These laws generally require appropriate stateagency determination of public need and approval prior to theaddition of beds or services or other capital expenditures. Failure to obtain necessary state approval can result in theinability to expand facilities, add services, acquire a facility orchange ownership.  Further, violation of such laws may resultin the imposition of civil sanctions or the revocation of afacility’s license.

               ***Utilization Review***

******

               Federal law contains numerous provisions designed to ensure thatservices rendered by hospitals to Medicare and Medicaid patientsmeet professionally recognized standards and are medicallynecessary, and that claims for reimbursement are properlyfiled.  These provisions include a requirement that a samplingof admissions of Medicare and Medicaid patients be examined byquality improvement organizations or QIOs (formerly known as peerreview organizations or PROs) to review the appropriateness ofMedicare and Medicaid patient admissions and discharges, thequality of care provided, the validity of diagnosis related groupclassifications and the appropriateness of cases of extraordinarylength of stay or cost.  QIOs may deny payment for servicesprovided, assess fines and recommend to the Department of Healthand Human Services that a provider that is in substantialnoncompliance with the standards of the peer review organization beexcluded from participation in the Medicare or Medicaidprograms.  Each Medicare participating hospital is required tomaintain an agreement with the QIO operating in its local area. Wehave contracted with QIOs in each state where our hospitals dobusiness. Under Medicaid, states must undertake directly, orcontract with QIOs or QIO-like entities to undertake, quality ofcare and medical necessity reviews of hospitals.  Utilizationreview is also a requirement of most non-governmental managed careorganizations.

               ***Federal Health Care Program Statutes andRegulations***

               Participation in any federal health care program, including theMedicare and Medicaid programs, is heavily regulated by statute andregulation.  If a hospital fails to substantially comply withthe numerous conditions of participation in the Medicare andMedicaid programs or performs certain prohibited acts, thehospital’s participation in the federal health care programsmay be terminated, or civil or criminal penalties may be imposedunder certain provisions of the Social Security Act or both.

               ***Anti-Kickback and Stark Statutes***

******

               The most important of these Medicare regulatory statutes is asection of the Social Security Act that prohibits providers andothers from soliciting, receiving, offering or paying, directly orindirectly, any remuneration intended to induce referrals ofpatients to receive goods or services covered by a federal healthcare program (the “Anti-Kickback Statute”).  Inaddition to felony criminal penalties (fines of up to $25,000 andimprisonment), the Social Security Act establishes civil monetarypenalties and the sanction of excluding violators fromparticipation in the federal health care programs.

               Federal regulators and the courts have interpreted theAnti-Kickback Statute broadly in order to prohibit the intentionalpayment of anything of value even if only one purpose of thepayment is to influence the referral of Medicare or Medicaidbusiness.  Therefore, many commonplace commercial arrangementsbetween hospitals and physicians could be considered by thegovernment to violate the Anti-Kickback Statute.

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               As authorized by Congress, the Office of the Inspector General atthe Department of Health and Human Services has published finalsafe harbor regulations that outline categories of activities thatare deemed protected from prosecution under the Anti-KickbackStatute.  Currently, there are safe harbors for variousactivities, including investment interests, space rental, equipmentrental, practitioner recruitment, personal services and managementcontracts, sale of practice, discounts, waiver of beneficiarycoinsurance and deductibles and investments in group practices andambulatory surgery centers.  The fact that conduct or abusiness arrangement does not fall within a safe harbor does notautomatically render the conduct or business arrangement illegalunder the Anti-Kickback Statute.  The conduct and businessarrangement, however, do risk increased scrutiny by governmentenforcement authorities.

               The Office of Inspector General is responsible for identifyingfraud and abuse activities in government programs.  In orderto fulfill its duties, the Office of Inspector General performsaudits, investigations and inspections.  In addition, itprovides guidance to health care providers by identifying types ofactivities that could violate the Anti-Kickback Statute.  TheOffice of the Inspector General has identified the followingincentive arrangements between hospitals and physicians aspotential violations:

               •   payment of any incentive by the hospital eachtime a physician refers a patient to the hospital;

               •   use of free or significantly discounted officespace or equipment for physicians in facilities usually                   located close to the hospital;

               •   provision of free or significantly discountedbilling, nursing, or other staff services;

               •   free training for a physician’s officestaff (excluding compliance training);

               •   guarantees which provide that, if thephysician’s income fails to reach a predetermined level, thehospital                   will pay any portion of the remainder;

               •   low-interest or interest-free loans, or loanswhich may be forgiven if a physician refers patients to the                   hospital;

               •   payment of the costs of a physician’stravel and expenses for conferences;

               •   payment of services which require few, if any,substantive duties by the physician, or payment for                   services in excess of the fair market value of the servicesrendered;

               •   purchasing goods or services from physicians atprices in excess of their fair market value;

               •   coverage in the hospital’s group healthinsurance plan at an inappropriately low cost to the physician;or

               •   “gainsharing,” the practice ofgiving physicians a share of any reduction in a hospital’scosts for patient                   care attributable in part to the physician’s efforts.

               In addition, the Office of Inspector General has encouraged personshaving information about hospitals who offer to physicians any ofthe of incentives described above to report such information to theOffice of Inspector General.

               We have a variety of financial relationships with physicians whorefer patients to our hospitals.  We also have contracts withphysicians providing for a variety of financial arrangements,including employment contracts, leases, and professional serviceagreements.  Moreover, we provide financial incentives,including loans and minimum revenue guarantees, to recruitphysicians into the communities served by our hospitals.  Eachof our two free-standing surgery centers and one of our hospitalshas physician investors.  Some of our arrangements withphysicians do not meet all of the requirements for safe harborprotection.  Although we have established policies andprocedures to ensure that our arrangements with physicians complywith current law, we cannot assure you that regulatory authoritiesthat enforce the Anti-Kickback Statute will not in the futuredetermine that one or more of these arrangements violate theAnti-Kickback Statute or other applicable laws.  Thisdetermination could subject us

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to liabilities under the Social Security Act, including criminalpenalties of imprisonment or fines, civil penalties up to $50,000,damages up to three times the total amount of remuneration andexclusion from participation in the Medicare, Medicaid or otherfederal health care programs, any of which could have a materialadverse effect on our business, financial condition or results ofoperations.

               The Social Security Act also imposes very broad criminal and civilpenalties for submitting false claims to Medicare andMedicaid.  False claims include, but are not limited to,billing for services not rendered, misrepresenting actual servicesrendered in order to obtain higher reimbursement and cost reportfraud.  Further, the Health Insurance Portability andAccountability Act of 1996 (“HIPAA”) created civilpenalties for impermissible conduct, including improper coding andbilling for unnecessary goods and services.  HIPAA alsobroadened the scope of these so-called fraud and abuse laws byadding several criminal provisions for health care fraud offensesthat apply to all health benefit programs.

               The Social Security Act also includes a provision important to thehospital industry commonly known as the “StarkLaw.”  This law prohibits physicians from referringMedicare and Medicaid patients to entities with which they or anyof their immediate family members have a financial relationship ifthese entities provide certain designated health services that arereimbursable by Medicare, including inpatient and outpatienthospital services.  These types of referrals are commonlyknown as “self referrals”.  Sanctions forviolating the Stark Law include civil monetary penalties up to$15,000 per prohibited service provided, assessments equal to twicethe dollar value of each such service provided and exclusion fromthe federal health care programs.  There are a number ofexceptions to the self-referral prohibition, including an exceptionfor a physician’s ownership interest in an entire hospital asopposed to an ownership interest in a hospital department. There are also exceptions for many of the customary financialarrangements between physicians and providers, including employmentcontracts, leases and recruitment agreements.

               On January 4, 2001, CMS issued final regulations subject to commentintended to clarify parts of the Stark Law and some of theexceptions to it.  These regulations are considered Phase I ofa two-phase process, with the remaining Phase II regulations to bepublished, according to the most recent CMS indication, no laterthan January 7, 2004.  Phase I of the regulations becameeffective January 4, 2002.  However, CMS delayed until January7, 2004 the effective date of one important portion of the Phase Iregulations which relates to whether percentage-based compensationis deemed to be “set in advance” for purposes of therelevant exceptions to the Stark Law and therefore a legal form ofcompensation under the Stark Law.

               We have structured our financial arrangements with physicians tocomply with the statutory exceptions included in the Stark Law andsubsequent regulations.  However, the new Stark regulationsmay interpret provisions of this law in a manner different from themanner with which we have interpreted them.  We cannot predictthe final form that these regulations will take or the effect thatthey will have on our operations.

               Many of the states in which we operate also have adopted laws thatprohibit payments to physicians in exchange for referrals similarto the Anti-Kickback Statute and the Stark Law, some of which applyregardless of the source of payment for care.  These statutestypically provide criminal and civil penalties as well as loss oflicensing.  Little precedent exists for the interpretation orenforcement of these state laws.

***               The Federal False Claims Act and Similar Laws***

******

               A trend affecting the health industry today is the increased use ofthe federal False Claims Act, and, in particular, an increasednumber of actions brought by individuals on the government’sbehalf under the False Claims Act’s *qui tam*, orwhistleblower, provisions.  Whistleblower provisions allowprivate individuals to bring actions on behalf of the governmentalleging that the defendant has defrauded the federalgovernment.  If the government intervenes in the action andprevails, the party filing the initial complaint may share in anysettlement or judgment.  If the government does not intervenein the action, the whistleblower plaintiff may pursue the actionindependently.  When a private party brings a *qui tam*action under the False Claims Act, the defendant generally will notbe made aware of the lawsuit for some time until the governmentmakes a determination whether it will intervene and take the leadin the litigation.

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               When a defendant is determined by a court of law to be liable underthe False Claims Act, the defendant must pay three times the actualdamages sustained by the government, plus mandatory civil penaltiesof $5,500 to $11,000 for each separate false claim. Settlements entered into prior to litigation usually involve a lesssevere damages methodology.  There are many potential basesfor liability under the False Claims Act, although liability mostoften arises when an entity knowingly submits a false claim forreimbursement to the federal government and the False Claims Actdefines the term “knowingly” very broadly.  Insome cases, whistleblowers or the federal government have taken theposition that providers who allegedly have violated other statutes,such as the Anti-kickback statute and the Stark Law, have therebysubmitted false claims under the False Claims Act.  A numberof states have adopted their own false claims provisions as well astheir own whistleblower provisions whereby a private party may filea civil lawsuit in state court.  From time to time, companiesin the health care industry, including our company, may be subjectto actions under the False Claims Act or similar state laws. We currently are not aware of any actions against us under theFalse Claims Act or similar state laws.

               ***Corporate Practice of Medicine and Fee Splitting***

******

               The states in which we operate have laws that prohibit unlicensedpersons or business entities, including corporations, fromemploying physicians or that prohibit direct or indirect paymentsor fee-splitting arrangements between physicians and unlicensedpersons or business entities.  Possible sanctions forviolations of these restrictions include loss of aphysician’s license, civil and criminal penalties andrescission of business arrangements that may violate theserestrictions.  These statutes vary from state to state, areoften vague and seldom have been interpreted by the courts orregulatory agencies.  We exercise care to structure ourarrangements with health care providers to comply with the relevantstate law.  While we believe our arrangements comply withapplicable laws in all material respects, governmental officialscharged with responsibility for enforcing these laws may in thefuture assert that we, or transactions in which we are involved,are in violation of such laws.  In addition, the courts mayultimately interpret such laws in a manner inconsistent with ourinterpretations.

               ***The Health Insurance Portability and Accountability Act of1996***

               The Health Insurance Portability and Accountability Act(“HIPAA”) was enacted in August, 1996 to assure healthinsurance portability, reduce health care fraud and abuse,guarantee security and privacy of health information and enforcestandards for health information. Some of the HIPAA regulations arenow effective and the remainder of them will become effectivewithin the next two years.  If we are found not to becompliant with any of the HIPAA regulations in effect, any suchviolation could result in civil penalties of up to $25,000 per typeof violation in each calendar year and criminal penalties of up to$250,000 per violation.

               Regulations related to HIPAA are expected to impact us and othersin the health care industry by:

             (i)

   

Establishing standardized code sets for financial and clinicalelectronic data interchange (“EDI”) transactions toenable more efficient flow of information. Currently, there is nocommon standard for the transfer of information between theconstituents in health care and therefore providers have had toconform to each standard utilized by every party with which theyinteract. One of the goals of HIPAA is to create one commonnational standard for EDI and once these HIPAA regulations on EDItake effect, payers will be required to accept the nationalstandard employed by providers. The final regulations establishingelectronic data transmission standards that all health careproviders must use when submitting or receiving certain health caretransactions electronically were published on August 17, 2000.Compliance with the final regulations is required for our coveredentities by October 16, 2003, although the government required usto submit a plan for each of our covered entities by October 16,2002, showing how we planned to meet the transaction standardscompliance date.  We made such submissions in a timely manner.However, as a result of final implementation of EDI in October2003, there is a significant risk that our reimbursement from someor all of our significant payers will be delayed and such delay maymaterially adversely affect us until there is full implementationamong payers and providers of the standardized code sets.

 

 

 

            (ii)

   

Mandating the adoption of privacy standards to protect theconfidentiality and privacy of health information.  Prior toHIPAA there were no federally recognized health care standardsgoverning the privacy and confidentiality of a patient’spersonal health record.  The final regulations restrict howwe

 

 

 

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can use a patient’s health information within ourfacilities and when we can also disclose a patient’s healthinformation to others outside our facilities. The final regulationsalso provide patients with significant new rights related tounderstanding and controlling how their health information is usedor disclosed. The final modifications to the privacy regulationswere published in August 2002 and our covered entities wererequired to comply with the privacy regulations by April 14,2003.  We have implemented privacy policies and procedures tocomply with the final privacy regulations and, as a result, webelieve that we are in substantial compliance with these privacyregulations.

 

 

 

           (iii)

   

Requiring covered entities to establish procedures andmechanisms to protect the security, integrity and availability ofelectronic protected health information. These regulations wereissued on February 20, 2003 and require covered entities toimplement administrative, physical and technical safeguards toprotect the security of the electronic protected health informationthat they receive, store or transmit. We will have until April 21,2005 to comply with these regulations governing  securitystandards. The security regulations could impose significant costson our facilities and other health care businesses in order tocomply with these standards. We believe that we will be able tocomply with the security regulations.  However, the cost ofcompliance cannot yet be ascertained.

               We are in the process of implementing the necessary changesrequired pursuant to the terms of HIPAA and expect to besubstantially complete within the required dates. However, failureby us or third parties on which we rely, including payers, toresolve HIPAA-related implementation issues could have a materialadverse effect on our results of operations and our ability toprovide health care services. Consequently, we can give you noassurance that issues related to the full  implementation ofHIPAA will not have a material adverse effect on our financialcondition or future results of operations.

               ***Conversion Legislation***

******

               Many states have enacted or are considering enacting laws affectingthe conversion or sale of not-for-profit hospitals.  Theselaws, in general, include provisions relating to attorney generalapproval, advance notification and community involvement.  Inaddition, state attorneys general in states without specificconversion legislation may exercise authority over thesetransactions based upon existing law.  These legislative andadministrative efforts primarily focus on the appropriate valuationof the assets divested and the use of the proceeds of the sale bythe not-for-profit seller.  In many states there has been anincreased interest in the oversight of not-for-profitconversions.  The adoption of conversion legislation and theincreased review of not-for-profit hospital conversions mayincrease the cost and difficulty of, or prevent the completion oftransactions with, not-for-profit organizations in some states inthe future.  Moreover, as a condition to approving anacquisition, the attorney general of the state in which thehospital is located may require us to maintain specific services,such as emergency departments, or to continue to provide specificlevels of charity care.  While these review and, in someinstances, approval processes can add additional time to theclosing of a hospital acquisition, we have not had any significantdifficulties or delays in completing any of our hospitalacquisitions.  There can be no assurance, however, that futureactions on the state level will not seriously delay or even preventour ability to acquire hospitals.  If these activities arewidespread, they could have a negative impact on our ability toacquire additional hospitals.  See “BusinessStrategy.”

               ***The Emergency Medical Treatment and Active LaborAct***

******

               Congress adopted the federal Emergency Medical Treatment and ActiveLabor Act in response to reports of a widespread hospital emergencyroom practice of “patient dumping.”  At the timeof the enactment, patient dumping was considered to have occurredwhen a hospital capable of providing the needed care sent a patientto another facility or simply turned the patient away based on thepatient’s inability to pay for his or her care.  Thisfederal law requires any hospital that participates in the Medicareprogram to conduct an appropriate medical screening examination ofevery person who presents to the hospital’s emergencydepartment for treatment, and if the patient is suffering from anemergency medical condition, to either stabilize that condition ormake an appropriate transfer of the patient to a facility that canhandle the condition.  The obligation to screen and stabilizeemergency medical conditions exists regardless of a patient’sability to pay for treatment.  Sanctions for violations ofthis statute are severe and include termination of ahospital’s participation in the Medicare and Medicaidprograms and civil monetary penalties.  In addition, the lawcreates private civil remedies that enable an individual whosuffers personal harm as a direct result of a violation of the law,and a medical facility that suffers a financial loss as a directresult of

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another participating hospital’s violation of the law, tosue the offending hospital for damages and equitable relief. The government broadly interprets the reach of this law and alsohas expressed its intent to investigate and enforce violations ofit actively in the future.  Although we believe that ourpractices are in material compliance with the law, we can give noassurance that governmental officials responsible for enforcing thelaw will not assert from time to time that our facilities are inviolation of this statute.

               ***Health Care Reform***

******

               The health care industry, as one of the largest industries in theUnited States, continues to attract much legislative interest andpublic attention.  Changes in Medicare, Medicaid and otherprograms, hospital cost-containment initiatives by public andprivate payers, proposals to limit payments and health carespending and industry-wide competitive factors are highlysignificant to the health care industry.  In addition, aframework of extremely complex federal and state laws, rules andregulations governs the health care industry and, for manyprovisions, there is little history of regulatory or judicialinterpretation on which to rely.

               Many states have enacted or are considering enacting measuresdesigned to reduce their Medicaid expenditures and change privatehealth care insurance.  Most states, including the states inwhich we operate, have applied for and been granted federal waiversfrom current Medicaid regulations to allow them to serve some orall of their Medicaid participants through managed careproviders.  We are unable to predict the future course offederal, state or local health care legislation.  Furtherchanges in the law or regulatory framework that reduce our revenuesor increase our costs could have a material adverse effect on ourbusiness, financial condition or results of operations.

               ***Health Care Industry Investigations***

******

               Significant media and public attention has focused in recent yearson the hospital industry.  There are numerous ongoing federaland state investigations regarding multiple issues, including costreporting and billing practices, especially those relating toclinical laboratory test claims and home health agency costs,physician recruitment practices and physician ownership of healthcare providers and joint ventures with hospitals.  Recently,increased attention has been paid to hospitals with high Medicareoutlier payments.  These investigations have targeted hospitalcompanies as well as their executives and managers.  We havesubstantial Medicare, Medicaid and other governmental billings,which would result in heightened scrutiny of our operations. We continue to monitor these and all other aspects of our businessand have developed a compliance program to assist us in gainingcomfort that our business practices are consistent with both legalprinciples and current industry standards.  However, becausethe law in this area is complex and constantly evolving,governmental investigations could result in interpretations thatare inconsistent with industry practices, including ours.  Inpublic statements surrounding current investigations, governmentalauthorities have taken positions on a number of issues, includingsome for which little official interpretation previously has beenavailable, that appear to be inconsistent with practices that havebeen common within the industry and that previously have not beenchallenged in this manner.  In some instances, governmentalinvestigations that have in the past been conducted under the civilprovisions of federal law may now be conducted as criminalinvestigations.

               Many current health care investigations are national initiatives inwhich federal agencies target an entire segment of the health careindustry.  One example is the federal government’sinitiative regarding hospital providers’ improper requestsfor separate payments for services rendered to a patient on anoutpatient basis within three days prior to the patient’sadmission to the hospital, where reimbursement for such services isincluded as part of the reimbursement for services furnished duringan inpatient stay.  In particular, the government has targetedall hospital providers to ensure conformity with this reimbursementrule.  Another example involves the federal government’sinitiative regarding health care providers “unbundling”and separately billing for laboratory tests that should have beenbilled as a “bundled unit.”  The federalgovernment has also launched a national investigative initiativetargeting the billing of claims for inpatient services related tobacterial pneumonia, as the government has found that many hospitalproviders have attempted to bill for pneumonia cases under morecomplex and expensive reimbursement codes.  Further, thefederal government continues to investigate Medicare overpaymentsto prospective payment hospitals that incorrectly report transfersof patients to other prospective payment system hospitals asdischarges.

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               While we are aware that several of our hospitals have been or arebeing investigated in connection with activities conducted prior toour acquisition of them, we are not aware of any governmentalinvestigations involving the operation of those facilities by us,or involving any of our executives or managers.  Under theterms of our various acquisition agreements, the prior owners ofour hospitals are responsible for any liabilities arising frompre-closing violations.  The prior owners’ resolution ofthese matters or failure to resolve these matters, in the eventthat any resolution was deemed necessary, could have a materialadverse effect on our business, financial condition or results ofoperation.  It is possible that governmental entities couldinitiate investigations in the future at facilities operated by usand that such investigations could result in significant penaltiesto us as well as adverse publicity.  It is also possible thatour executives and managers, many of whom have worked at otherhealth care companies that are or may become the subject of federaland state investigations and private litigation, could be includedin governmental investigations or named as defendants in privatelitigation.  The positions taken by authorities in any futureinvestigations of us, our executives or our managers, or otherhealth care providers, and the penalties that may be imposed couldhave a material adverse effect on our business, financial conditionand results of operations.

               ***Health Plan Regulatory Matters***

******

               Our health plans are subject to state and federal laws andregulations.  CMS has the right to audit our health plans todetermine the plans’ compliance with such standards.  Inaddition, AHCCCS has the right to audit Phoenix Health Plan todetermine the Plan’s compliance with such standards. Also, Phoenix Health Plan is required to file periodic reports withAHCCCS, meet certain financial viability standards, provide itsenrollees with certain mandated benefits and meet certain qualityassurance and improvement requirements.  Our health plans mustalso comply with the standardized formats for electronictransmissions set forth in the Administrative SimplificationsProvisions of HIPAA by October 16, 2003, and each health plan hasfiled a compliance plan demonstrating how it intends to achievecompliance by that extended deadline date.  Our health planshave implemented the necessary privacy policies and procedures tocomply with the final privacy regulations and expect to comply withfederal security standards by the April 21, 2005 deadline. However, we can not yet ascertain the cost of our healthplans’ compliance with such regulations.

               The Anti-Kickback Statute has been interpreted to prohibit thepayment, solicitation, offering or receipt of any form ofremuneration in return for the referral of federal health programpatients or any item or service that is reimbursed, in whole or inpart, by any federal health care program.  Similar statuteshave been adopted in Illinois and Arizona that apply regardless ofthe source of reimbursement.  The Department of Health andHuman Services has adopted safe harbor regulations specifyingcertain relationships and activities that are deemed not to violatethe Anti-Kickback Statute which specifically relate to managed careincluding:

               •   waivers by health maintenance organizations ofMedicare and Medicaid beneficiaries’ obligations to pay                   cost-sharing amounts or to provide other incentives in order toattract Medicare and Medicaid enrollees;

               •   certain discounts offered to prepaid healthplans by contracting providers;

               •   certain price reductions offered to eligiblemanaged care organizations; and

               •   certain price reductions offered by contractorswith substantial financial risk to managed care                   organizations.

               We believe that the incentives offered by our health plans to theirenrollees and the discounts they receive from contracting healthcare providers satisfy the requirements of the safe harborregulations.  However, the failure to satisfy each criterionof the applicable safe harbor does not mean that the arrangementconstitutes a violation of the law; rather, the safe harborregulations provide that an arrangement which does not fit within asafe harbor must be analyzed on the basis of its specific facts andcircumstances.  We believe that our health plans’arrangements comply in all material respects with the federalAnti-Kickback Statute and similar state statutes.

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               ***Environmental Matters***

******

               We are subject to various federal, state and local laws andregulations relating to environmental protection.  Ourhospitals are not highly regulated under environmental laws becausewe do not engage in any industrial activities at thoselocations.  The principal environmental requirements andconcerns applicable to our operations relate to:

               •   the proper handling and disposal of hazardousand low level medical radioactive waste;

               •   ownership or historical use of underground andabove-ground storage tanks;

               •   management of impacts from leaks of hydraulicfluid or oil associated with elevators, chiller units or                   incinerators;

               •   appropriate management of asbestos-containingmaterials present or likely to be present at some                   locations; and

               •   the potential acquisition of, or maintenance ofair emission permits for, boilers or other equipment.

               We do not expect our compliance with environmental laws andregulations to have a material effect on us.  We may also besubject to requirements related to the remediation of substancesthat have been released into the environment at properties owned oroperated by us or at properties where substances were sent foroff-site treatment or disposal.  These remediationrequirements may be imposed without regard to fault and whether ornot we owned or operated the property at the time that the relevantreleases or discharges occurred.  Liability for environmentalremediation can be substantial.

**Risk Factors**

*               If any of the events discussed in the following risks were tooccur, our business, financial position, results of operations,cash flows or prospects could be materially adverselyaffected.  Additional risks and uncertainties not presentlyknown, or currently deemed immaterial by us, may also constrain ourbusiness and operations.*

               ***If we are unable to enter into favorable contracts withmanaged care plans, our operating revenues may bereduced.***

               Our ability to negotiate favorable contracts with healthmaintenance organizations, preferred provider organizations andother managed care plans significantly affects the revenue andoperating results of our hospitals. Revenues derived from healthmaintenance organizations, preferred provider organizations andother managed care plans accounted for approximately 47% of our netpatient revenues for the year ended June 30, 2003.  Managedcare organizations offering prepaid and discounted medical servicespackages represent an increasing portion of our admissions, ageneral trend in the industry which has limited hospital revenuegrowth nationwide. In addition, private payers are increasinglyattempting to control health care costs through direct contractingwith hospitals to provide services on a discounted basis, increasedutilization review, including the use of hospitalists, and greaterenrollment in managed care programs such as health maintenanceorganizations and preferred provider organizations.  In mostcases, we negotiate our managed care contracts annually as theycome up for renewal at various times during the year.  Ourfuture success will depend, in part, on our ability to renewexisting managed care contracts and enter into new managed carecontracts on terms favorable to us. Other health care companies,including some with greater financial resources, greater geographiccoverage or a wider range of services, may compete with us forthese opportunities. If we are unable to contain costs throughincreased operational efficiencies or to obtain higherreimbursements and payments from managed care or government payers,our results of operations and cash flow will be adverselyaffected.  West Anaheim Medical Center in Anaheim, Californiareceives payments under a long term “take-or-pay”contract with a managed care payer which generated approximately$26.8 million, or 2.0%, of our net revenues for the year ended June30, 2003.  Under this “take or pay” arrangementthe payer has agreed to purchase in each contractual year a fixedamount of inpatient and outpatient days at a fixed rate per dayprimarily from West Anaheim Medical Center, except that a portionof the outpatient days can also be purchased, at the option of thepayer, at our Huntington Beach Hospital in Huntington Beach,California or at our

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North Anaheim Surgical Center in Orange County,California.  The rate is adjusted annually to reflect anyincreases in the consumer price index and may also be adjustedpursuant to a contractual formula if the level of acuity for thepatients which the payer directs to our facilities increases. Under this contract, the payer is obligated to purchase from ourfacilities patient days which will cost the payer a fixed aggregateamount.  If annual patient days costing less than the fixedaggregate amount are purchased during the contract year ended March31, 2004, then the payer must reimburse the West Anaheim MedicalCenter for the difference between the fixed aggregate amount andthe total amount of patient days purchased even though noadditional patient days are provided.  The managed care payerof this contract has given us notice that it intends to terminatethis contract, effective May 18, 2005. We do not know at this timewhether we will be able to extend or renew this contract beyondMay 18, 2005, even if we agreed to reduce our health carecharges to such payer, or replace these revenues with other newbusiness. If we are unable to renew or replace this contract, ourearnings will be adversely impacted.

               ***Our revenues may decline if federal or state programs reduceour Medicare or Medicaid payments or managed care companies reduceour reimbursements.***

               Approximately 38% of our  net patient revenues for the yearended June 30, 2003 came  from the Medicare and Medicaidprograms.  In recent years, federal and state governments havemade significant changes in the Medicare and Medicaidprograms.  In addition, due to budget deficits in many states,significant decreases in state funding for the Medicaid programshave occurred or are being proposed.  These changes in theMedicare and Medicaid programs have decreased the amounts of moneywe receive for our services who participate in these programs.

               In recent years, Congress and some state legislatures haveintroduced a number of other proposals to make major changes in thehealth care system. Medicare-reimbursed, hospital outpatientservices converted to a prospective payment system on August 1,2000.  This system creates limitations on levels of paymentfor a substantial portion of hospital outpatient procedures. Future federal and state legislation may further reduce thepayments we receive for our services.

               A number of states have adopted legislation designed to reducetheir Medicaid expenditures.  Some states have enrolledMedicaid recipients in managed care programs (which generally tendto reduce the level of hospital utilization) and have imposedadditional taxes on hospitals to help finance or expand thestates’ Medicaid systems.  Some states have also reducethe scope of Medicaid eligibility and coverage, making anincreasing number of residents unable to pay for their care. Other states have proposed to take similar steps.

               In addition, insurance and managed care companies and other thirdparties from whom we receive payment for our services increasinglyattempt to control health care costs by requiring that hospitalsdiscount their fees in exchange for exclusive or preferredparticipation in their benefit plans.  We believe that thistrend may continue and may reduce the payments we receive for ourservices.

               ***We are subject to uncertainties regarding health care reformwhich could materially and adversely affect ourbusiness.***

               In recent years, an increasing number of legislative initiativeshave been introduced or proposed in Congress and in statelegislatures that would result in major changes in the health caresystem, either nationally or at the state level.  Among theproposals that have been introduced are price controls onhospitals, insurance market reforms to increase the availability ofgroup health insurance to small businesses, requirements that allbusinesses offer health insurance coverage to their employees andthe creation of a government health insurance plan or plans thatwould cover all citizens and increase payments bybeneficiaries.  Increased regulations, mandated benefits andmore oversight, audits and investigations and changes in lawsallowing access to federal and state courts to challenge healthcare decisions may increase our administrative, litigation andhealth care costs.  We cannot predict whether any of the aboveproposals or any other proposals will be adopted, and if adopted,no assurance can be given that the implementation of such reformswill not have a material adverse effect on our business, financialposition or results of operations.

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               ***Competition from other hospitals or health care providers(especially specialty hospitals) may reduce our patient volume andprofitability.***

               The health care business is highly competitive and competitionamong hospitals and other health care providers for patients hasintensified in recent years. Generally, other hospitals in thelocal communities served by most of our hospitals provide servicessimilar to those offered by our hospitals. In addition, the numberof freestanding specialty hospitals and surgery and diagnosticcenters in the geographic areas in which we operate has increasedsignificantly in recent years. As a result, most of our hospitalsoperate in an increasingly competitive environment. Some of thehospitals that compete with our hospitals are owned by governmentalagencies or not-for-profit corporations supported by endowments andcharitable contributions and can finance capital expenditures andoperations on a tax-exempt basis. Increasingly, we are facingcompetition by physician-owned specialty hospitals and freestandingsurgery centers that compete for market share in high marginservices and for quality physicians and personnel.  If ourcompetitors are better able to attract patients, recruitphysicians, expand services or obtain favorable managed contractsat their facilities, we may experience a decline in patientvolume.

               Phoenix Health Plan, our prepaid Medicaid managed health care plan,also faces competition within the Arizona market which it serves.As in the case of our hospitals, some of our competitors in thismarket are owned by governmental agencies or not-for-profitcorporations with greater financial resources than we have. Other competitors have larger membership bases, are moreestablished and have greater geographic coverage areas which givethem an advantage in competing for a limited pool of eligiblehealth plan members. Moreover, because our leverage in negotiatingwith Arizona’s state Medicaid program for higherreimbursement fees depends, to an extent, upon the number ofenrollees in our health plan eligible for the program, a failure toattract future enrollees may negatively impact our ability tomaintain our profitability in this market.

***               Our high level of debt may limit our ability to successfullyoperate our business and our ability to grow and otherwise executeour business strategy.***

               We have a substantial amount of debt.  As of June 30, 2003, wehad $479.4 million of outstanding debt, excluding letters of creditand guarantees.  This represented 56.1% of our totalcapitalization as of June 30, 2003.  The amount of ouroutstanding indebtedness is large compared to the net book value ofour assets, and we have significant repayment obligations under ouroutstanding indebtedness. Also, we may be able to incur substantialadditional indebtedness in the future. Our principal creditfacility permits revolving borrowings and letters of credit of upto $125.0 million in the aggregate outstanding at any one time, ofwhich $99.2 million was available to be borrowed by us as of June30, 2003. We may in the future borrow all available amounts underthis revolving facility, and in addition we may borrow substantialadditional indebtedness in the future under new debtagreements.

               Our substantial indebtedness could:

               •   increase our vulnerability to general adverseeconomic, market and industry conditions and limit our                   flexibility in planning for, or reacting to, these conditions;

               •   make us vulnerable to increases in interestrates since certain existing borrowings are, and additional                   borrowings may be,  at variable interest rates;

               •   limit our ability to use operating cash in otherareas of our business because we must use a substantial                   portion of these funds to make principal and interest payments;

               •   limit our ability to obtain additional financingto fund future capital expenditures (a substantial portion of                   which are legally required under certain of our acquisitionagreements), working capital, acquisitions or                   other needs; and

               •   limit our ability to compete with others who arenot as highly-leveraged.

               Our ability to make scheduled payments of principal and interest orto satisfy our other debt obligations, to refinance ourindebtedness or to fund capital expenditures will depend on ourfuture operating performance. Prevailing economic conditions andfinancial, business and other factors, many of which are beyond ourcontrol,

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will also affect our ability to meet these needs. We may not beable to generate sufficient cash flow from operations or realizeanticipated revenue growth or operating improvements, or obtainfuture borrowings in an amount sufficient to enable us to pay ourdebt, or to fund our other liquidity needs. We may need torefinance all or a portion of our debt on or before maturity. Wemay not be able to refinance any of our debt when needed oncommercially reasonable terms or at all.

               ***Operating and financial restrictions in our debt agreementswill limit our operational and financial flexibility.***

               Restrictions and covenants in our existing debt agreements, and anyfuture financing agreements, may adversely affect our ability tofinance future operations or capital needs or to engage in otherbusiness activities. Specifically, our debt agreements restrict ourability to:

               •  declare dividends or redeem or repurchase capitalstock;               •  prepay, redeem or repurchase debt;               •  incur liens;               •  make loans and investments;               •  incur additional indebtedness;               •  amend or otherwise change debt and other materialagreements;               •  make capital expenditures;               •  engage in mergers, acquisitions and assetsales;               •  enter into transactions with affiliates;and               •  change our primary business.

               Our capital expenditure and acquisition strategy requiressubstantial capital resources, and the building of new hospitalsand the operations of our existing hospitals and newly acquiredhospitals require ongoing capital expenditures for construction,renovation, expansion and the addition of medical equipment andtechnology. More specifically, we are currently, and may in thefuture be, contractually obligated to make significant capitalexpenditures relating to the facilities we acquire. Also,construction costs to build new hospitals are substantial. Our debtagreements may restrict our ability to incur additionalindebtedness to fund these expenditures.

               A breach of any of the restrictions or covenants in our debtagreements could cause a cross-default under  major debtagreements. A significant portion of our indebtedness then maybecome immediately due and payable. We are not certain whether wewould have, or be able to obtain, sufficient funds to make theseaccelerated payments.  If any senior debt is accelerated, ourassets may not be sufficient to repay in full such indebtedness andour other indebtedness.

               ***Our performance depends on our ability to recruit and retainquality physicians.***

               The success of our hospitals depends in part on the followingfactors:

               •  the number and quality of the physicians on themedical staffs of our hospitals;               •  the admitting practices of those physicians;and               •  the maintenance of good relations with thosephysicians.

               We generally do not employ physicians.  Most physicians at ourhospitals also have admitting privileges at other hospitals. If weare unable to provide adequate support personnel or technologicallyadvanced equipment and facilities that meet the needs ofphysicians, they may be discouraged from referring patients to ourfacilities, which could adversely affect our profitability.

               ***We may be unable to achieve our acquisition and growthstrategy and we may have difficulty acquiring not-for-profithospitals due to regulatory scrutiny.***

               An important element of our business strategy is expansion byacquiring hospitals in our existing and in new urban and suburbanmarkets and by entering into partnerships or affiliations withother health care service providers. The competition to acquirehospitals is significant, including competition from health carecompanies

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with greater financial resources than ours, and we may not beable to make suitable acquisitions on favorable terms, and we mayhave difficulty obtaining financing, if necessary, for suchacquisitions on satisfactory terms. In addition, we may not be ableto effectively integrate any acquired facilities with ouroperations. Even if we continue to acquire additional facilitiesand/or enter into partnerships or affiliations with other healthcare service providers, federal and state regulatory agencies mayconstrain our ability to grow.

               Additionally, many states, including some where we have hospitalsand others where we may in the future attempt to acquire hospitals,have adopted legislation regarding the sale or other disposition ofhospitals operated by not-for-profit entities. In other states thatdo not have specific legislation, the attorneys general havedemonstrated an interest in these transactions under their generalobligations to protect charitable assets from waste. Theselegislative and administrative efforts focus primarily on theappropriate valuation of the assets divested and the use of thesale proceeds by the not-for-profit seller. These review andapproval processes can add time to the consummation of anacquisition of a not-for-profit hospital, and future actions on thestate level could seriously delay or even prevent futureacquisitions of not-for-profit hospitals. Furthermore, as acondition to approving an acquisition, the attorney general of thestate in which the hospital is located may require us to maintainspecific services, such as emergency departments, or to continue toprovide specific levels of charity care, which may affect ourdecision to acquire or the terms of an acquisition of thesehospitals.

               ***Difficulties with integrating our acquisitions may disruptour ongoing operations.***

               We may not be able to profitably or effectively integrate theoperations of, or otherwise achieve the intended benefits from, anyacquisitions we make or partnerships or affiliations we may form.The process of integrating acquired hospitals may require adisproportionate amount of management’s time and attention,potentially distracting management from its day-to-dayresponsibilities. This process may be even more difficult in thecase of hospitals we may acquire out of bankruptcy or otherwise infinancial distress. In addition, poor integration of acquiredfacilities could cause interruptions to our business activities,including those of the acquired facilities. As a result, we mayincur significant costs related to acquiring or integrating thesefacilities and may not realize the anticipated benefits.

               Moreover, acquired businesses may have unknown or contingentliabilities, including liabilities for failure to comply withhealth care laws and regulations. Although our policy is to conformthe practices of acquired facilities to our standards, andgenerally to obtain indemnification from sellers covering thesematters, we could in the future become liable for past activitiesof acquired businesses and such liabilities could be material.

               ***Our hospitals face competition for staffing, which mayincrease our labor costs and reduce profitability.***

               We compete with other health care providers in recruiting andretaining qualified management and staff personnel responsible forthe day-to-day operations of each of our hospitals, includingnurses and other non-physician health care professionals. In thehealth care industry generally, including in our markets, thescarcity of nurses and other medical support personnel has become asignificant operating issue. This shortage may require us toincrease wages and benefits to recruit and retain nurses and othermedical support personnel or to hire more expensive temporarypersonnel. We have raised on several occasions in the past, andexpect to raise in the future, wages for our nurses and othermedical support personnel.  We also depend on the availablelabor pool of semi-skilled and unskilled employees in each of themarkets in which we operate. If our labor costs increase, we maynot be able to raise rates to offset these increased costs. Becauseapproximately 85% of our net patient revenues for the year endedJune 30, 2003, consist of payments based on fixed or negotiatedrates, our ability to pass along increased labor costs isconstrained. Our failure to recruit and retain qualifiedmanagement, nurses and other medical support personnel, or tocontrol our labor costs, could have a material adverse effect onour profitability.

               ***We conduct business in a heavily regulated industry, andchanges in regulations or violations of regulations may result inincreased costs or sanctions that could reduce our revenues andprofitability.***

               The health care industry is subject to extensive federal, state andlocal laws and regulations relating to licensing, the conduct ofoperations, the ownership of facilities, the addition of facilitiesand services, confidentiality, maintenance and security issuesassociated with medical records, billing for services and pricesfor services.  Although we believe that our facilities are insubstantial compliance with such laws and regulations, if a

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determination were made that we were in material violation ofsuch laws or regulations, our operations and financial resultscould be materially adversely affected.

               In many instances, the industry does not have the benefit ofsignificant regulatory or judicial interpretations of these lawsand regulations, particularly in the case of Medicare and Medicaidstatute codified under section 1128B(b) of the Social Security Actand known as the “Anti-Kickback Statute.” This lawprohibits providers and others from soliciting, receiving, offeringor paying, directly or indirectly, any remuneration with the intentto generate referrals of orders for services or items reimbursableunder Medicare, Medicaid and other federal health careprograms.  As authorized by Congress, the United StatesDepartment of Health and Human Services has issued regulationswhich describe some of the conduct and business relationshipsimmune from prosecution under the Anti-Kickback Statute. The factthat a given business arrangement does not fall within one of these“safe harbor” provisions does not render thearrangement illegal, but business arrangements of health careservice providers that fail to satisfy the applicable safe harborcriteria risk increased scrutiny by enforcement authorities.

               Some of the financial arrangements which we maintain with ourphysicians do not meet all of the requirements for safe harborprotection. The regulatory authorities that enforce theAnti-Kickback Statute may in the future determine that one or moreof these arrangements violate the Anti-Kickback Statute or otherfederal or state laws. A determination that we have violated theAnti-Kickback Statute or other federal laws could subject us toliability under the Social Security Act, including criminal andcivil penalties, as well as exclusion from participation ingovernment programs such as Medicare and Medicaid or other federalhealth care programs.

               In addition, the portion of the Social Security Act commonly knownas the “Stark Law” prohibits physicians from referringMedicare and Medicaid patients to providers of designated healthservices if the physician or a member of his or her immediatefamily has an ownership interest in or compensation arrangementwith that provider.  There are exceptions to the Stark Law forphysicians maintaining an ownership interest in an entire hospital,employment agreements, leases, physician recruitment and certainother physician arrangements.

               All of the states in which we operate have adopted or haveconsidered adopting similar anti-kickback and physicianself-referral legislation, some of which extends beyond the scopeof the federal law to prohibit the payment or receipt ofremuneration for the referral of patients and physicianself-referrals, regardless of the source of payment for the care.Little precedent exists for the interpretation or enforcement ofthese laws. Both federal and state government agencies haveannounced heightened and coordinated civil and criminal enforcementefforts.

               Government officials responsible for enforcing health care lawscould assert that we, or any of the transactions in which we areinvolved, are in violation of any of these laws. It is alsopossible that the courts could ultimately interpret these laws in amanner that is different from our interpretations. A determinationthat we have violated these laws, or the public announcement thatwe are being investigated for possible violations of these laws,could have a material adverse effect on our business, financialcondition, results of operations or prospects, and our businessreputation could suffer significantly.

               Some states require prior approval for the purchase of majormedical equipment or the purchase, construction, expansion, sale orclosure of health care facilities, based upon a determination ofneed for additional or expanded health care facilities or services.The governmental determinations, embodied in Certificates of Need,may be required for capital expenditures exceeding a prescribedamount, changes in bed capacity or services and certain othermatters.  Illinois, a state in which we own two hospitals, hasCertificate of Need laws affecting acute care hospitalservices.  We cannot predict whether we will be able to obtainrequired Certificates of Need in the future. A failure to obtainany required Certificates of Need may impair our ability to operateprofitably in the state of Illinois.

               The laws, rules and regulations described above are complex andsubject to interpretation. In the event of a determination that weare in violation of any of these laws, rules or regulations, or iffurther changes in the regulatory framework occur, our results ofoperations could be significantly harmed.  For a more detaileddiscussion of the laws, rules and regulations described above, see“Government Regulation and Other Factors.”

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               ***Providers in the health care industry have been the subjectof federal and state investigations or whistleblower lawsuits, andwe may become subject to investigations or whistleblower lawsuitsin the future.***

               Both federal and state government agencies have heightened andcoordinated civil and criminal enforcement efforts as part ofnumerous ongoing investigations of hospital companies, as well astheir executives and managers. These investigations relate to awide variety of topics, including:

               •  referral, cost reporting and billingpractices;               •  laboratory and home health care services;and               •  physician ownership and joint ventures involvinghospitals.

               In addition, the federal False Claims Act permits private partiesto bring *qui tam*, or whistleblower, lawsuits againstcompanies.  Whistleblower provisions allow private individualsto bring actions on behalf of the government alleging that thedefendant has defrauded the federal government.  Because*qui tam* lawsuits are filed under seal, we could be named inone or more such lawsuits of which we are not aware. Defendants determined to be liable under the False Claims Act maybe required to pay three times the actual damages sustained by thegovernment, plus mandatory civil penalties of between $5,500 and$11,000 for each separate false claim.  Typically, eachfraudulent bill submitted by a provider is considered a separatefalse claim, and thus the penalties under false claim may besubstantial.  Liability arises when an entity knowinglysubmits a false claim for reimbursement to the federalgovernment.  In some cases, whistleblowers or the federalgovernment have taken the position that providers who allegedlyhave violated other statutes and have submitted claims to agovernmental payor during the time period they allegedly violatedthese other statutes, have thereby submitted false claims under theFalse Claims Act.  Some states have adopted similarwhistleblower and false claims provisions.

               The Office of the Inspector General of the Department of Health andHuman Services and the Department of Justice have, from time totime, established national enforcement initiatives that focus onspecific billing practices or other suspected areas of abuse.Initiatives include a focus on hospital billing for outpatientcharges associated with inpatient services, as well as hospitallaboratory billing practices.

               As a result of these regulations and initiatives, some of ouractivities could become the subject of governmental investigationsor inquiries. For example, we have significant Medicare andMedicaid billings, we provide some durable medical equipment andhome health care services, and we have joint venture arrangementsinvolving physician investors. In addition, our executives andmanagers, many of whom have worked at other health care companiesthat are or may become the subject of federal and stateinvestigations and private litigation, could be included ingovernmental investigations or named as defendants in privatelitigation. We are aware that several of our hospitals have been orare being investigated in connection with activities conductedprior to our acquisition of them. Under the terms of our variousacquisition agreements, the prior owners of our hospitals areresponsible for any liabilities arising from pre-closingviolations.  The prior owners’ resolution of thesematters or failure to resolve these matters, in the event that anyresolution was deemed necessary, may have a material adverse effecton our business, financial condition or results of operation. Any investigations of us, our executives, managers, facilities oroperations could result in significant liabilities or penalties tous, as well as adverse publicity.

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               ***If any one of the regions in which we operate experiences aneconomic downturn or other material change, our overall businessresults may suffer.***

               Among our operations as of June 30, 2003, five hospitals, fivediagnostic imaging centers and a prepaid Medicaid managed healthplan were located in metropolitan Phoenix, Arizona; three hospitalsand two ambulatory surgery centers were located in Orange County,California; five hospitals and various related health carebusinesses were located in San Antonio, Texas; and two hospitalsand related clinics were located in metropolitan Chicago, Illinois.For the year ended June 30, 2003, our revenues were generated asfollows:

 

 

 

**Year ended June 30, 2003**

 

 

 
****
**Operations**

 

 

 

 

 

Phoenix

 

 

28.7

%

 

Orange County

 

 

11.6

%

 

San Antonio

 

 

18.4

%

 

Metropolitan Chicago (1)

 

 

27.8

%

 

Phoenix Health Plan and other

 

 

13.5

%

 

 

 

 

 

 

 

 

 

100.0

%

 

 

 

 

 

 

(1) Includes MacNeal Health Providers.

 

               Any material change in the current demographic, economic,competitive or regulatory conditions in any of these regions couldadversely affect our overall business results because of thesignificance of our operations in each of these regions to ouroverall operating performance. Moreover, due to the concentrationof our revenues in only four regions, our business is lessdiversified and, accordingly, is subject to greater regional riskthan that of some of our larger competitors.

               California has statutes and regulations that require hospitals tomeet seismic performance standards, and hospitals that do not meetthe standards may be required to retrofit their facilities. Our estimated cost to comply with the seismic regulations andstandards required by 2008, subject to extension to 2013 upon thestate’s approval of our request for extension, is $11.2million.  Upon completion of the $11.2 million inimprovements, our California facilities will be compliant with therequirements of the seismic regulations through 2029.  Weestimate that the majority of the square footage in our facilitieswill be compliant with the seismic regulations and standardsrequired by 2030 once we have completed such $11.2 million inimprovements, but we are unable at this time to estimate our costsfor full compliance with the 2030 requirements.  Moreover, inthe event that our California facilities are found not to be incompliance with these seismic standards, we may be required to makesignificant capital expenditures to bring the California facilitiesinto compliance, which could impact our financial positionnegatively.

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               ***We may fail to comply with the privacy, security andelectronic transaction requirements under the Health InsurancePortability and Accountability Act of 1996 and we may  bematerially adversely effected as a result.***

               HIPAA was enacted in August 1996 to assure health insuranceportability, reduce healthcare fraud and abuse, guarantee securityand privacy of health information and enforce standards for healthinformation.  If we are found not to be compliant with any ofthe HIPAA regulations in effect, any such violation could result incivil penalties of up to $25,000 per type of violation in eachcalendar year and criminal penalties of up to $250,000 perviolation.

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               Regulations related to HIPAA are expected to impact us and othersin the health care industry by:

             (i)

   

Establishing standardized code sets for financial and clinicalelectronic data interchange (“EDI”) transactions toenable more efficient flow of information. The final regulationsestablishing electronic data transmission standards that all healthcare providers must use when submitting or receiving certain healthcare transactions electronically were published on August 17, 2000.Compliance with the final  regulations is required for ourcovered entities by October 16, 2003. However, as a result of finalimplementation of EDI in October 2003, there is a significant riskthat our reimbursement from some or all of our significant payerswill be delayed and such delay may affect us materially adverselyuntil payer implementation is fully achieved.

 

 

 

            (ii)

   

Mandating the adoption of privacy standards to protect theconfidentiality and privacy of health information.  The finalregulations restrict how we can use a patient’s healthinformation within our facilities and when we can also disclose apatient’s health information to others outside ourfacilities. The final regulations also provide patients withsignificant new rights related to understanding and controlling howtheir health information is used or disclosed. The finalmodifications to the privacy regulations were published in August,2002 and our covered entities were required to comply with theprivacy regulations by April 14, 2003.  We have implementedprivacy policies and procedures to comply with the final privacyregulations and, as a result, we believe that we are in substantialcompliance with these privacy regulations.

 

 

 

           (iii)

   

Requiring covered entities to establish procedures andmechanisms to protect the security, integrity and availability ofelectronic protected health information. These regulations wereissued on February 20, 2003 and require covered entities toimplement administrative, physical and technical safeguards toprotect the security of the electronic protected health informationthat they receive, store or transmit. We will have until April 21,2005 to comply with these regulations governing  securitystandards. The security regulations could impose significant costson our facilities and other health care businesses in order tocomply with these standards. We believe that we will be able tocomply with the security regulations.  However, the cost ofcompliance cannot yet be ascertained.

               We are in the process of implementing the necessary changesrequired pursuant to the terms of HIPAA and expect to besubstantially complete within the required dates. However, failureby us or third parties on which we rely, including payers, toresolve HIPAA-related implementation issues could have a materialadverse effect on our results of operations and our ability toprovide health care services. Consequently, we can give you noassurance that issues related to the full  implementation ofHIPAA will not have a material adverse effect on our financialcondition or future results of operations.

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***               We are dependent on our senior management team and local managementpersonnel, and the loss of the services of one or more of oursenior management team or key local management personnel could havea material adverse effect on our business.***

               The success of our business is largely dependent upon the servicesand management experience of our senior management team, whichincludes Charles N. Martin, Jr., our Chairman and Chief ExecutiveOfficer; William L. Hough, our President and Chief OperatingOfficer; Joseph D. Moore, our Executive Vice President, ChiefFinancial Officer and Treasurer, and Keith B. Pitts, our ViceChairman.  In addition, we depend on our ability to attractand retain local managers at our hospitals and related facilities,on the ability of our senior officers and key employees to managegrowth successfully and on our ability to attract and retainskilled employees.  We do not maintain key man life insurancepolicies on any of our officers.  If we were to lose any ofour senior management team or members of our local managementteams, or if we are unable to attract other necessary personnel inthe future, it could have a material adverse effect on ourbusiness, financial condition and results of operations.  Ifwe were to lose the services of one or more members of our seniormanagement team or a significant portion of our hospital managementstaff at one or more of our hospitals, we would likely experience asignificant disruption in our operations and failures of theaffected hospitals to adhere to their respective businessplans.

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               ***If we are unable to control our health care costs at PhoenixHealth Plan, if the health plan should lose its governmentalcontract, or if state budgetary cuts reduce the scope of Medicaidcoverage, our profitability may be adversely affected.***

               For the year ended June 30, 2003 our Phoenix Health Plan generatedapproximately 13.3% of our net revenues.  Phoenix Health Planderives substantially all of its revenues through a contract withthe AHCCCS, which is the state agency that administersArizona’s state Medicaid program.  AHCCCS pays capitatedrates to Phoenix Health Plan, and Phoenix Health Plan subcontractswith physicians, hospitals and other health care providers toprovide services to its enrollees. If we fail to effectively manageour health care costs, these costs may exceed the payments wereceive. Many factors can cause actual health care costs to exceedthe capitated rates paid by AHCCCS, including:

               •  our ability to contract with cost-effectivehealth care providers;               •  the increased cost of individual health careservices;               •  the type and number of individual health careservices delivered; and               •  the occurrence of catastrophes, epidemics orother unforeseen occurrences.

               We recently entered into a new contract with AHCCCS for the threeyear period ending September 30, 2006.  If this contract wereterminated or not renewed or further extended, our profitabilitycould be adversely affected by the loss of these revenues and cashflow.  Also, should the scope of the Medicaid program bereduced as a result of state budgetary cuts or other politicalfactors, our results of operations could be adversely affected.

               ***The cost of our malpractice insurance and the malpracticeinsurance of physicians who practice at our facilities continues torise. Successful malpractice or tort claims asserted against us,our physicians or our employees could materially adversely affectour financial condition and profitability.***

               In recent years, physicians, hospitals and other health careproviders have become subject to an increasing number of legalactions alleging malpractice, product liability or related legaltheories. Many of these actions involve large monetary claims andsignificant defense costs.  Hospitals and physicians havetypically maintained a special type of insurance (commonly calledmalpractice or professional liability insurance) and generalliability insurance to protect against the costs of these types oflegal actions.  However, as a result of insurance carrierpayments in recent years of these large claims, the pricing  in the professional and general liability insurancemarkets has risen greatly and there is currently limitedavailability of this type of insurance. Due to these unfavorablepricing and availability trends, we created an insurance subsidiaryon June 1, 2002, to assume a substantial  portion of theprofessional and general liability risks of our facilities. For claims reported since June 1, 2002, we maintain all of ourprofessional and general liability insurance through this insurancesubsidiary in respect of losses up to $10.0 million per occurrence.This is in comparison to our $1 million retention for the periodJune 1, 2001 to May 31, 2002.  We have also purchased anumbrella excess policy for  professional and general liabilityinsurance with unrelated commercial carriers for losses in excessof $10.0 million per occurrence up to $100.0 million in theaggregate through May 31, 2004.  However, in the future excessinsurance coverage may not continue to be available at a costallowing us to maintain adequate levels of such insurance. Moreover, due to the increased retention limits insured by ourcaptive subsidiary, if actual payment of claims materially exceedour projected estimates of malpractice claims, our financialcondition could be materially adversely affected.

               In addition, physicians’ professional liability insurancecosts have dramatically increased to the point where somephysicians are either choosing to retire early or leave certainmarkets. If physician professional liability insurance costscontinue to escalate in markets in which we operate, somephysicians may choose not to practice at our facilities, whichcould reduce our patient volume and thus our revenue.

**Available Information**

               Our Annual Reports on Form 10-K, Quarterly Reports on Form 10-Q,Current Reports on Form 8-K and amendments to those reports areavailable free of charge on our internet website atwww.vanguardhealth.com under “Investor Relations-SECFilings-SEC Filings on the Edgar Database” as soon asreasonably practicable after such reports are electronically filedwith or furnished to the Securities and Exchange Commission.

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**Item 2.    Properties.**

               A listing of our owned acute hospitals is included in Item 1 ofthis report under the caption “Business-OurFacilities”.  We also own or lease space for outpatientservice facilities complementary to our hospitals and own andoperate certain medical office buildings (some of which are jointventures) associated with our hospitals that are occupied primarilyby physicians who practice at our hospitals.  The mostsignificant of these complementary outpatient health carefacilities are two surgery centers in Orange County, California andfive diagnostic imaging centers in metropolitan Phoenix,Arizona.  All of these outpatient facilities are in leasedfacilities, and the surgery centers are owned in joint ventureswhere we have minority partners.  Also, we just completedconstruction on West Valley Hospital Medical Center, a 74-bed acutecare hospital in Goodyear, Arizona, which admitted its firstpatient on September 4, 2003.

               We currently lease approximately 37,150 square feet of office spaceat 20 Burton Hills Boulevard, Nashville, Tennessee, for ourcorporate headquarters.

               Our headquarters, hospitals and other facilities are suitable fortheir respective uses and are, in general, adequate for our presentneeds.  Our obligations under our amended 2001 credit facilityare secured by a pledge of substantially all of our assets,including first priority mortgages on each of our hospitals. Also, our properties are subject to various federal, state andlocal statutes and ordinances regulating their operation. Management does not believe that compliance with such statutes andordinances will materially affect our financial position or resultsfrom operations.

**Item 3.    Legal Proceedings.**

               We are subject to claims and lawsuits arising in the ordinarycourse of business, including potential claims related to care andtreatment provided at our hospitals and our complementaryoutpatient service facilities.  Although the results of theseclaims and lawsuits cannot be predicted with certainty, we believethat the ultimate resolution of these claims and lawsuits will nothave a material adverse effect on our business, financial conditionor results of operations.

               We have received a notice objecting to our use of the mark“Vanguard.”  We have also filed an opposition tothe objecting party’s registration of the mark,“Vanguard Healthcare.”  The Patent and TrademarkOffice has approved our service mark application in respect of themark “Vanguard” as it regards hospital and health careservices for form and registration, subject to the issuance orabandonment of the objecting party’s application.  We donot brand our hospitals with the Vanguard name, and we do notbelieve that a negative outcome in this administrative proceedingwould have a material effect upon our business, financial conditionor results of operations.

**Item 4.    Submission of Matters to a Vote ofSecurity Holders.**

               No matters were submitted to a vote of stockholders during thefourth quarter ended June 30, 2003.

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**PART II**

**Item 5.    Market for Registrant’sCommon Equity and Related Stockholder Matters.**

               There is no established public trading market for our commonstock.  At September 15, 2003, there were 47 holders of recordof our common stock.

               The Company has not declared or paid any dividends on its commonstock.  We intend to retain all current and foreseeable futureearnings to support operations and finance expansion.  Oursenior secured credit facility and the indenture governing our9.75% Notes restrict our ability to pay cash dividends on ourcommon stock.

               On April 14, 2003, we issued to Linda W. Hischke, a former memberof management, 13 shares of our common stock, for an aggregatepurchase price of $22,115.45, upon her exercise of stock optionspreviously issued to her under our 1998 Stock Option Plan. This purchase of common stock was for cash consideration at apurchase price of $1,701.18 per share.  This transaction wasnot registered under the Securities Act of 1933, as amended,pursuant to the exemption provided by Section 4(2) thereof for atransaction not involving any public offering.

**Item 6.    Selected Financial Data.**

               The following table sets forth selected consolidated financial dataof our Company for, or as the end of, each of the five years endedJune 30, 2003.  The selected financial data for the yearsended June 30, 1999, 2000, 2001, 2002 and 2003 are derived from ouraudited financial statements.  The timing of acquisitionscompleted during fiscal years 2000, 2001, 2002 and 2003 affects thecomparability of the selected historical financial data. Please read this table in conjunction with the “Item 7. Management’s Discussion and Analysis of Financial Conditionand Results of Operations” and our consolidated financialstatements and related notes, appearing elsewhere in thisreport.

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**Year Ended June 30,**

**1999**

**2000**

**2001**

**2002**

**2003**

 
****
**(dollars in millions)**

**Summary of Operations:**

 

Revenues

$

91.5

$

304.7

$

667.8

$

910.6

$

1,340.5

 

 

 

Salaries and benefits

39.3

146.5

323.6

384.4

578.4

 

Supplies

12.5

40.5

92.9

116.1

202.6

 

Medical claims expense

–

7.4

30.8

132.0

160.8

 

Other operating expenses

15.5

56.6

111.4

152.8

216.6

 

Provision for doubtful accounts

17.3

33.1

56.8

53.3

73.4

 

Depreciation and amortization

3.9

11.8

23.8

29.5

46.9

 

Interest, net

4.2

8.8

16.6

26.7

34.9

 

Non-cash stock compensation

5.0

–

–

–

–

 

Debt extinguishment costs

–

1.1

–

6.6

–

 

Minority interests and other

0.2

0.2

1.2

(0.5

)

(0.9

)

 

 

 

   Total costs and expenses

97.9

306.0

657.1

900.9

1,312.7

 

 

 

Income (loss) before income taxes

(6.4

)

(1.3

)

10.7

9.7

27.8

 

Income tax expense

–

(0.1

)

(0.5

)

(2.9

)

(10.9

)

 

 

 

Net income (loss)

(6.4

)

(1.4

)

10.2

6.8

16.9

 

Accrued preferred dividends

–

(0.7

)

(1.7

)

(1.8

)

(2.8

)

 

 

 

Net income (loss) attributable to common    shareholders

$

(6.4

)

$

(2.1

)

$

8.5

$

5.0

$

14.1

 

** **

 

**Balance Sheet Data (End of Period):**

 

Assets

$

98.1

$

549.9

$

640.4

$

851.9

$

1,226.9

 

Long-term debt, including current portion

56.2

153.3

163.4

314.8

479.4

 

Payable-In-Kind Preferred Stock

–

20.7

22.3

24.1

57.0

 

Working capital

11.9

39.5

15.3

87.9

37.1

 

 

 

**Other Data:**

 

Number of hospitals at end of period

1

7

8

10

15

 

Number of licensed beds at end of period (a)

239

1,481

1,676

2,207

3,666

 

Weighted average licensed beds (b)

239

771

1,514

1,815

2,898

 

Discharges (c)

12,447

31,864

65,237

75,364

114,327

 

Adjusted discharges-hospitals (d)

19,811

50,661

96,774

110,758

166,508

 

Average length of stay (days) (e)

3.2

4.1

4.1

4.1

4.2

 

Average daily census (f)

112.0

278.4

728.8

837.0

1,309.0

 

Occupancy rate (g)

46.9

%

46.1

%

48.0

%

46.1

%

44.9

%

 

____________________

(a)

Licensed beds are those beds for which a facility has beengranted approval to operate from the applicable state licensingagency.

 

 

 

(b)

Weighted average licensed beds represents the average number oflicensed beds, weighted based on periods owned.

 

 

 

(c)

Discharges represents the total number of patients discharged(in the facility for a period in excess of 23 hours) from ourhospitals and used by management and certain investors as a generalmeasure of inpatient volume.

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(d)

Adjusted discharges-hospitals is used by management and certaininvestors as a general measure of combined inpatient and outpatientvolume and is computed by multiplying discharges by the sum ofgross hospital inpatient and outpatient revenues and then dividingthe result by gross hospital inpatient revenues.  Thiscomputation enables management to assess hospital volume by acombined measure of inpatient and outpatient utilization.

 

 

 

(e)

Average length of stay represents the average number of days anadmitted patient stays in our hospitals.

 

 

 

(f)

Average daily census represents the average number of patientsin our hospitals each day during our ownership.

 

 

 

(g)

Occupancy rate represents the percentage of hospital licensedbeds occupied by patients.  Both average daily census andoccupancy rate provide measures of the utilization of inpatientrooms.

**Item 7.    Management’s Discussion andAnalysis of Financial Condition and Results of Operations.**

               The following discussion and analysis of financial conditions andresults of operations should be read in conjunction with ourconsolidated financial statements, notes to our consolidatedfinancial statements and other financial information appearingelsewhere in this report.

**Forward Looking Statements**

               This annual report on Form 10-K contains “forward-lookingstatements” within the meaning of the federal securities lawsthat are intended to be covered by safe harbors createdthereby.  Forward-looking statements are those statements thatare based upon management’s current plans and expectations asopposed to historical and current facts and are often identifiedherein by use of words including but not limited to“may,” “believe,” “will,”“project,” “expect,”“estimate,” “anticipate,” and“plan.”  These statements are based upon estimatesand assumptions made by the Company’s management that,although believed to be reasonable, are subject to numerousfactors, risks and uncertainties that could cause actual outcomesand results to be materially different from those projected. These factors, risks and uncertainties include, among others, thefollowing:

               •   Our high degree of leverage               •   Our ability to incur substantially moredebt               •   Operating and financial restrictions in our debtagreements               •   Our ability to successfully implement ourbusiness strategies               •   Our ability to successfully integrate any futureacquisitions               •   The highly competitive nature of the health careindustry               •   Governmental regulation of the industryincluding Medicare and Medicaid reimbursement levels               •   Pressures to contain costs by managed careorganizations and other insurers and our ability to negotiate                   acceptable terms with these third party payers               •   Our ability to attract and retain qualifiedmanagement and medical personnel, including physicians andnurses               •   Our ability to complete value-added acquisitionsand to effectively and efficiently integrate those                   operations within our corporate goals and objectives               •   Potential federal or state reform of healthcare               •   Future governmental investigations               •   Costs associated with newly enacted HIPAAregulations and other management information systemintegrations               •   The availability of capital to fund ourcorporate growth strategy               •   Potential lawsuits or other claims assertedagainst us               •   Our ability to maintain or increase patientmembership and control costs of our managed health care plans               •   Changes in general economic conditions               •   Increased cost of professional and generalliability insurance and increases in the quantity andseverity                   of professional liability claims               •   The ability to maintain and increase patientvolumes and control the costs of providing services including                   supplies costs               •   Our failure to comply, or allegations of ourfailure to comply, with applicable laws and regulations               •   The geographic concentration of ouroperations               •   Technological and pharmaceutical improvementsthat increase the cost of providing, or reduce                   the demand for, health care services

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               Except as required by law, we undertake no obligation to publiclyupdate any forward-looking statements, whether as a result of newinformation, future events or otherwise.  We advise you,however, to consult any additional disclosures of risks we make inour filings with the Securities and Exchange Commission, including,without limitation, the discussion of risks and other uncertaintiesunder the caption “Risk Factors” contained in Item 1 ofthis report under the caption “Business-RiskFactors”.  You are cautioned not to rely on suchforward-looking statements when evaluating the informationcontained in this report.  In light of the significantuncertainties inherent in the forward-looking statements in thisreport, you should not regard the inclusion of such information asa representation by us that objectives and plans anticipated by theforward-looking statements will occur or be achieved, or if any ofthem do occur or are achieved, the impact they will have on ourresults of operations and financial condition.

**Impact of Acquisitions**

               Acquiring acute care hospitals in urban and suburban markets is akey part of our business strategy.  Since we have grown mostyears through acquisitions, it is difficult to make meaningfulcomparisons between our financial statements for the fiscal periodspresented.  In addition, we own a relatively small number ofhospitals, which can cause an individual acquisition to have amaterial effect on our overall operating performance.  When weacquire a hospital, we generally implement a number of measures tolower costs and may also make significant investments in thefacility to expand services, strengthen the medical staff andimprove our overall market position.  The effects of theseinitiatives are not generally realized immediately. Therefore, the financial performance of a newly acquired hospitalmay adversely affect our overall performance in the short term.

***               Fiscal 2001 Acquisitions***

**

               On May 1, 2001, we acquired Phoenix Memorial Hospital and thePhoenix Health Plan in Phoenix, Arizona.  We financed thisacquisition through sales of our common stock to existingstockholders and the assumption of certain liabilities of theseller.  The fiscal 2001 results of operations include twomonths of operations for the hospital and health plan.

               We also acquired non-significant health care related businessesduring fiscal 2001 through the assumption of certain liabilities ofthe seller and use of available cash.  The fiscal 2001 resultsof operations include operations for each of these acquisitionsfrom the date of acquisition through June 30, 2001.  The totalpurchase price for net assets acquired for the 2001 acquisitionswas $31.6 million, comprised of assets acquired of $87.9 millionand liabilities assumed of $56.3 million.  We financed thepurchase price for net assets acquired with cash raised from thesale of approximately $32.9 million of our common stock to ourexisting stockholders and the assumption of certain liabilities ofthe sellers.

*               **Fiscal 2002 Acquisitions***

               On November 1, 2001, we acquired the assets of Paradise ValleyHospital in Phoenix, Arizona.  We paid cash of $55.3 millionto satisfy the purchase price for net assets acquired.  Wefinanced the acquisition with a portion of our cash proceeds fromthe July 30, 2001 issuance of our 9.75% Senior Subordinated Notesdue 2011 (the “9.75% Notes”).  The fiscal 2002results of operations include eight months of operations for thishospital.

               On June 3, 2002, but effective June 1, 2002, we acquired, through amajority-owned acquisition subsidiary, substantially all of theassets of Louis A. Weiss Memorial Hospital in Chicago,Illinois.  We paid cash of $44.0 million, net of a $2.5million payment received for the minority joint venturepartner’s 19.9% interest in the acquisition subsidiary, tosatisfy the purchase price for net assets acquired.  Wefinanced the acquisition with a portion of the proceeds from theJuly 30, 2001 issuance of the 9.75% Notes.  The fiscal 2002results of operations include one month of operations for thishospital.

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               ***Fiscal 2003 Acquisitions***

               On January 3, 2003, but effective January 1, 2003, we acquired,through a majority-owned subsidiary, substantially all of theassets of five acute care hospitals with a total of 1,537 beds andrelated health care businesses located in San Antonio, Texas, andsurrounding areas of south Texas from Baptist Health Services,formerly known as Baptist Health System (“BHS”). The BHS purchase price for net assets acquired was $293.8 million,comprised of cash of $246.2 million, $30.0 million of our Series Bpayable-in-kind redeemable convertible preferred stock andapproximately $17.6 million of our convertible subordinated notesdue 2013 bearing interest at 8.18%.  We funded the cashportion of the purchase price with $150.0 million of proceeds underthe amended 2001 credit facility, $50.0 million from private salesof our common stock and cash on hand of $46.2 million.  TheBHS acquisition was accounted for using the purchase method ofaccounting.  The fiscal 2003 results of operations include sixmonths of operations for the BHS assets.

*               **Operational Strategies and Related Risks***

**

               In order to increase revenues and enhance operating margins, wehave implemented several operating initiatives including thefollowing:

               •

   

Expanding the spectrum of health care services provided by ourfacilities.  We believe that a key factor in increasingpatient volume is to provide the communities we serve acomprehensive medical solution.  This strategy requireseffective recruiting and retention programs for generalpractitioners and specialists and maintaining quality nursingsupport as well as a commitment to capital projects to providecurrent technology, service our existing facility framework and toexpand facilities and services where necessary to meet the healthcare needs of the communities we serve.  Also, we believecompleting strategic acquisitions to achieve in-market or newmarket growth and efficiencies will allow us to better serve ourpatients while improving our operating performance.  Ourfacility expansion strategies include construction of newfacilities in underserved areas of our markets as demonstrated byour construction of West Valley Hospital Medical Center in westernmetropolitan Phoenix.

 

 

 

               •

   

Providing continuous training and education to our hospitalmanagement teams to identify areas in which operating efficienciescan realistically be achieved.  We believe that one of thekeys to providing effective and efficient health care services andadministrative support lies in effective recruiting and retentionprograms, including continual training and educationalsupport.  Our relationships with the University of Chicago atour MacNeal and Weiss hospitals in metropolitan Chicago, Illinois,demonstrate one of our many commitments to professional developmentfor both health care and administrative staff.  Ourcomprehensive recruiting and retention strategy serves as acornerstone upon which we build partnering relationships with ouremployees and physicians to ensure we have the expertise necessaryto carry out our mission in all areas of our health carefacilities.

 

 

 

               •

   

Identifying geographic markets that provide a strategic fit withour goals and objectives.  We expect to continue pursuingacquisition activities in markets where we can obtain significantmarket share and capture additional volume of the aging U.S.population.  According to the U.S. Census Bureau, there areapproximately 35 million Americans aged 65 or older in the UnitedStates today, comprising approximately 13% of the total U.S.population.  By the year 2030, the number of these elderlypersons is expected to reach 69 million, or 20% of the totalpopulation.  We believe that our initiatives will position usto capitalize on this demographic trend.  Obtainingsignificant market share in key geographic markets providesopportunities to expand services to those communities, providesflexibility in negotiations with managed care and other third partypayers and strengthens our base for recruitment of health careprofessionals.

               Although we expect the initiatives above to increase our patientvolumes and revenues, the following risk factors could offset thoseincreases:

               •

   

Managed care, Medicare and Medicaid revenues are significant toour business and are subject to pricing pressures.  For theyear ended June 30, 2003, patient days attributable to managedcare, Medicare and Medicaid were 45%, 40% and 12% of total patientdays, respectively.  For the year ended

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June 30, 2003, managed care, Medicare and Medicaid payersaccounted for 55%, 30% and 9% of gross patient revenues,respectively.  These payers receive significant discountscompared to other payers, and these payers continually seek toreduce payments to lower the cost of health care for theirmembers.  We are also at risk for highly acute cases forpayers using a prospective payment system.

 

 

 

               •

   

Many procedures once performed exclusively at hospitals are nowbeing provided on an outpatient basis.  Advances in technologyand the focus of payers on treating lower acuity patients in a lessexpensive setting have driven the increase in outpatientutilization.  For the year ended June 30, 2003, 65% of thetotal surgeries performed by our hospitals were outpatientsurgeries.  Outpatient revenues as a percentage of grosspatient revenues were 34.5% for the year ended June 30, 2003. The significance of outpatient utilization is offset somewhat bythe aging of the baby boomer population and population growth ratesthat exceed the national average in certain of our markets, whichsupports increased inpatient days and surgeries. Typically, thepayments we receive for outpatient procedures are less than thosefor the same procedures performed in an inpatient setting.

 

 

 

•

   

Intense market competition may limit our ability to enter choicemarkets or recruit and retain quality health careprofessionals.  We face growing competition in ourindustry.  Consolidation of hospitals into for-profit ornot-for-profit systems continues to increase as other hospitalcompanies realize that regional market strength is pivotal inefficiently providing comprehensive health care services,recruiting and retaining qualified health care professionals andeffectively managing payer relationships.  In addition, thefinancial resources of some of our competitors exceed ourresources.  We anticipate consolidation of hospitals andincreased competition in the market place to continue in the nearfuture.

 

 

 

               •

Our strategies to achieve in-market growth through facilityexpansion and medical upgrades require that we have access tocapital to sufficiently fund these projects.  To the extentour operating results and the availability of third party funds donot sufficiently support these projects, our strategies may not befully realized.

**General Trends**

               Federal regulators, including the U.S. Department of Justice, theOffice of the Inspector General of the U.S. Department of Healthand Human Services and the Centers for Medicare and MedicaidServices (“CMS”), have recently intensified theirscrutiny of Medicare outlier payments to hospitals.  Medicareoutlier payments are additional funds provided to hospitals for thetreatment of patients who require more costly treatment than thetypical patient.  Congress has mandated that CMS limitMedicare outlier payments to between five and six percent of totalDRG payments.  To achieve this mandate, in recent years CMSperiodically adjusted the cost threshold used to determineeligibility and allocation of available Medicare outlierpayments.  In December 2002, CMS began analyzing data toidentify hospitals with high outlier payments for further audit orreview and announced its intent to revise the current rules fordetermining outlier payments.  Based upon data from our mostrecently filed Medicare cost reports, our Medicare outlier paymentsas a percentage of total Medicare DRG payments and as a percentageof total gross charges from all payer categories are 2.7% and 0.2%,respectively, which include the effects of the acquisition of theBHS hospitals and Weiss Hospital for a full one-year period. Thus, we do not believe that we have a high level of outlierpayments.  In June 2003, CMS published a final rule thatmodifies the outlier formula in an effort to more accuratelydistribute outlier payments from the outlier pool to hospitals andto ensure that hospitals cannot inappropriately manipulate outlierpayments.  The final rule did not increase the current outlierthreshold of $33,560 for the balance of federal fiscal year2003.  Moreover, in July 2003 CMS decreased the outlierthreshold for federal fiscal year 2004 to $31,000.  The othermodifications made by CMS include allowing fiscal intermediaries toutilize more recent tentative cost report information to determineoutlier payments, requiring the use of hospital-specific cost tocharge ratios in most cases and establishing a mechanism ofrecoupment of previous overpayments.  Based on the guidelinesset forth in the final rule, we do not believe that our currentlevel of outlier payments will be materially affected.

               Certain other hospital companies have recently proposed policies toprovide discounts from gross charges to certain patients withoutqualifying insurance.  CMS has granted preliminary approval toat least one of these proposals pending final approval from certainfederal regulators.  If final approval for these discountpolicies is received, we intend to adopt similar policies duringfiscal 2004.

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               Many states, including certain states in which we operate, havereported budget deficits as a result of increased costs and lowerthan expected tax collections.  Health and human serviceprograms, including Medicaid and similar programs, represent asignificant component of state spending.  To address thesebudgetary concerns, certain states have proposed and others maypropose decreased funding for these programs.  If thesefunding decreases are approved by the states in which we operate,our operating results and cash flows could be materiallyreduced.

****

               Upon renewal of our insurance policies effective June 1, 2002, weexperienced a significant increase in premiums paid to insurancecarriers, especially for professional and general liabilitycoverage.  Prior to June 1, 2002, we maintained third-partyinsurance coverage on a claims-made basis for individualmalpractice claims exceeding $1.0 million and annual aggregateclaims exceeding $13.6 million.  Effective June 1, 2002, weestablished a wholly owned captive insurance subsidiary to insureour professional and general liability risks for individual claimsup to $10.0 million, which resulted in a significant increase inaccrual for claims incurred prior to June 1, 2002, but not reporteduntil after June 1, 2002.  The cost of insurance hasnegatively affected operating results and cash flows throughout thehealth care industry due to pricing pressures on insurers and fewercarriers willing to underwrite professional and general liabilityinsurance.  We recently renewed our insurance coverage for thepolicy year June 1, 2003 to May 31, 2004.  We remain insuredduring this new policy year for professional and general liabilityrisks for individual claims through our captive insurancesubsidiary at a retention level of $10.0 million. Additionally, we have purchased excess coverage from independentinsurers for individual claims exceeding $10.0 million peroccurrence up to $100.0 million in the aggregate.  We expectour professional and general liability costs will increase by 10%to 15% during fiscal 2004 compared to a comparable annualized costduring fiscal 2003.  Although we have not experienced asignificant increase in the quantity and severity of professionalliability claims during the past year, the current industryenvironment appears to indicate an increase in the quantity andseverity of such claims.  This environment has led toincreased costs in professional liability premiums, which we expectto continue into the foreseeable future.

               In February 2002, the Pennsylvania Insurance Commissioner placedPHICO Insurance Company into liquidation.  PHICO provided ourprofessional and general liability coverage during the period June1, 1999 to May 31, 2000.  We are aware of two claims for whichPHICO is responsible under this policy.  Our costs for theseclaims may be subject to partial reimbursement from certain stateguaranty funds, PHICO’s estate or certain of its reinsurancecompanies.  While we are unable to predict the outcome ofthese claims, management believes that our professional and generalliability reserve is adequate to cover such claims should PHICO notbe able to pay all or a portion of the claims.

               During the years ended June 30, 2002 and 2003, we renegotiated manyof our contracts with managed care payers to improve reimbursementrates and improve operating results and cash flows.  Managedcare payers are subject to pricing pressures, which oftencomplicates our renegotiation efforts.  When renegotiatingcontracts with improved reimbursement, we have, in some cases,experienced volume declines from the managed care payers. Management continually reviews its portfolio of managed carerelationships and attempts to balance pricing and volume issues;however, as long as strong competition remains in the markets weserve, these challenges will continue.  Our future operatingresults and cash flows could be materially adversely impacted tothe extent we are unable to achieve positive reimbursementarrangements while maintaining patient volume.

               The hospital industry continues to face a nationwide shortage ofnurses.  We have experienced particular difficulty inretaining and recruiting nurses in our Phoenix, Arizona, SanAntonio, Texas and Los Angeles/Orange County, Californiamarkets.  Recent reports forecast this shortage to continueinto the near future.  During fiscal 2003 we implementedcomprehensive recruiting and retention plans for nurses thatfocuses on competitive salaries and benefits as well as employeesatisfaction, best practices, tuition assistance, effectivetraining programs and workplace environment.  However, shouldwe be unsuccessful in our attempts to maintain nursing coverageadequate for our present and future needs, our future operatingresults could be adversely impacted.

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**Selected Operating Statistics**

               The following table sets forth certain operating statistics for theyears ended June 30, 2001, 2002 and 2003.  Same hospitalresults for 2001 are not presented because the acquisitions duringfiscal 2001 affect the comparability between the periods as aresult of how the same hospital indicators are defined below.

**2001**

**2002**

**2003**
****
Number of hospitals at end of period

8

10

15

Licensed beds

1,676

2,207

3,666

Discharges (a)

65,175

75,364

114,327

Adjusted discharges-hospitals (b)

96,774

110,758

166,508

Average length of stay (c)

4.1

4.1

4.2

Patient days (d)

266,007

305,370

477,791

Adjusted patient days-hospitals (e)

402,353

452,768

694,695

Net revenue per adjusted discharge-hospitals (f)

$

5,726

$

6,062

$

6,381

Gross inpatient revenue per discharge (g)

$

17,163

$

18,100

$

18,851

Outpatient surgeries (h)

32,297

37,245

50,073

Emergency room visits (i)

247,697

296,732

392,972

 

 

 

 

 

 

 

 

 

 

 

 

 

 

**2002**

**2003**

 

Same hospital indicators:

   Number of hospitals

8

8

   Total revenues (in millions) (j)

$

850.8

$

909.6

   Patient service revenues (in millions) (k)

$

666.4

$

690.8

   Discharges (l)

68,729

69,305

   Average length of stay (m)

4.1

4.0

   Patient days (n)

279,685

278,964

   Adjusted discharges-hospitals (o)

100,167

102,460

   Adjusted patient days-hospitals (p)

411,911

416,083

   Net revenue per adjusted discharge-hospitals(q)

$

6,110

$

6,281

   Gross inpatient revenue per discharge (r)

$

18,388

$

20,282

   Outpatient surgeries (s)

33,830

34,281

   Emergency room visits (t)

273,725

264,193

____________________

(a)

Discharges represent the total number of patients discharged (inthe facility for a period in excess of 23 hours) from our hospitalsand is used by management and certain investors as a generalmeasure of inpatient volume.

 

 

 

(b)

Adjusted discharges-hospitals is used by management and certaininvestors as a general measure of combined hospital inpatient andoutpatient volume.  Adjusted discharges-hospitals is computedby multiplying discharges by the sum of gross hospital inpatientand outpatient revenues and then dividing the result by grosshospital inpatient revenues.  This computation enablesmanagement to assess hospital volume by a combined measure ofinpatient and outpatient utilization.

 

 

 

(c)

Average length of stay represents the average number of days anadmitted patient stays in our hospitals.

 

 

 

(d)

Patient days represent the number of days (calculated asovernight stays) our beds were occupied by patients during theperiods.

 

 

 

(e)

Adjusted patient days-hospitals is calculated by multiplyingpatient days by the sum of gross hospital inpatient and outpatientrevenues and then dividing the result by gross hospital inpatientrevenues.  This computation is an indicator of combinedinpatient and outpatient volume.

 

 

 

(f)

Net revenue per adjusted discharge-hospitals is calculated bydividing net hospital patient revenues by adjusteddischarges-hospitals and measures the average net payment expectedto be received for a patient’s stay in the hospital.

 

 

 

(g)

Gross inpatient revenue per discharge represents the averageundiscounted charge for a patient stay and is an indicator ofhospital pricing and acuity factors.

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(h)

Outpatient surgeries represent the number of surgeries performedat hospitals or ambulatory surgery centers on an outpatient basis(patient overnight stays not necessary).

 

 

 

(i)

Emergency room visits represent the number of patient visits toa hospital or freestanding emergency room where treatment isreceived, regardless of whether an overnight stay is subsequentlyrequired.

 

 

 

(j)

Same hospital total revenues represent revenues from entitiesowned (including health plans) for the full twelve months of bothyears presented.

 

 

 

(k)

Same hospital patient service revenues represent patient servicerevenues (excluding health plan premium revenues) from entitiesowned for the full twelve months of both years presented.

 

 

 

(l)

Same hospital discharges represent discharges for hospitalsowned for the full twelve months of both years presented.

 

 

 

(m)

Same hospital average length stay represents average length ofstay for hospitals owned for the full twelve months of both yearspresented.

 

 

 

(n)

Same hospital patient days represent patient days for hospitalsowned for the full twelve months of both years presented.

 

 

 

(o)

Same hospital adjusted discharges-hospitals is calculated bymultiplying discharges by the sum of gross hospital inpatient andoutpatient patient revenues and then dividing the result by grosshospital inpatient revenues for all hospitals owned for the fulltwelve months of both years presented.

 

 

 

(p)

Same hospital adjusted patient days-hospitals is calculated bymultiplying patient days by the sum of gross hospital inpatient andoutpatient revenues and then dividing the result by gross hospitalinpatient revenues for all hospitals owned for the full twelvemonths of both years presented.

 

 

 

(q)

Same hospital net revenue per adjusted discharge-hospitals iscalculated by dividing net hospital patient revenues by adjusteddischarges-hospitals for those hospitals owned for the full twelvemonths of both years presented.  This statistic measures theaverage net payment expected to be received for a patient’sstay in the those hospitals owned during both respectiveperiods.

 

 

 

(r)

Same hospital gross inpatient revenue per discharge representsthe average undiscounted charge for a patient stay for thosehospitals owned for the full twelve months of both years presentedand is an indicator of pricing and acuity factors for thosehospitals owned during both respective periods.

 

 

 

(s)

Same hospital outpatient surgeries represent the number ofsurgeries performed at hospitals or ambulatory surgery centersowned for the full twelve months of both years presented, on anoutpatient basis (patient overnight stays not necessary).

 

 

 

(t)

Same hospital emergency room visits represent the number ofpatient visits to receive treatment at a hospital or freestandingemergency room owned  for the full twelve months of both yearspresented, regardless of whether an overnight stay is subsequentlyrequired.

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**Results of Operations**

               The following table presents a summary of our operating results forthe years ended June 30, 2001, 2002 and 2003.

** **

**Year ended June 30,**

 

** **
****
 

** **

**2001**

 

**2002**

 

**2003**

 

 

** **

**Amount**

 

**%**

 

**Amount**

 

**%**

 

**Amount**

 

**%**

 

 

** **

 

 

** **

(In millions)

 

 

Revenues

$

667.8

100.0

%

$

910.6

100.0 

%

$

1,340.5

100.0

%

 

 

Salaries and benefits

323.6

48.5

384.4

42.2 

578.4

43.2

 

Supplies

92.9

13.9

116.1

12.7 

202.6

15.1

 

Medical claims expense

30.8

4.6

132.0

14.5 

160.8

12.0

 

Insurance

8.2

1.2

19.7

2.2 

28.4

2.1

 

Other operating expenses

103.2

15.5

133.1

14.6 

188.2

14.0

 

Provision for doubtful accounts

56.8

8.5

53.3

5.9 

73.4

5.5

 

Depreciation and amortization

23.8

3.5

29.5

3.3 

46.9

3.5

 

Interest expense, net

16.6

2.5

26.7

2.9 

34.9

2.6

 

Debt extinguishment costs

–

–

6.6

0.7 

–

–

 

Minority interests and other

1.2

0.2

(0.5

)

(0.1

)

(0.9

)

(0.1

)

 

 

Income before income taxes

10.7

1.6

9.7

1.1 

27.8

2.1

 

Provision for income taxes

0.5

0.1

2.9

0.3 

10.9

0.8

 

 

Net income

$

10.2

1.5

%

$

6.8

0.8 

%

$

16.9

1.3

%

 

               ***Year Ended June 30, 2003 Compared to the Year Ended June 30,2002***

               *Revenues*.  The $429.9 million increase in revenuesduring fiscal 2003 was attributable to revenues from acquisitionsof $371.1 million and same hospital revenue improvement of $58.8million.  On a same hospital basis, discharges increased by0.8% during fiscal 2003, while adjusted discharges-hospitals (whichincludes a factor for outpatient volume) increased by 2.3% duringfiscal 2003.  Revenues, exclusive of health plan premium andother non-hospital revenues, per adjusted discharge increased 2.8%on a same-hospital basis during fiscal 2003 as a result of oursuccessful negotiations of managed care contracts with improvedreimbursement rates in certain markets and also improved Medicarereimbursement rates.  However, with certain of our managedcare payers, higher negotiated reimbursement rates resulted involume declines.  We expect net revenues on a same hospitalbasis to improve as we continue renegotiation efforts and recovervolumes from certain managed care payers.

               We continue to develop and implement strategies to increase volumesat our hospitals including physician recruitment, expansion ofspecialty services and resource sharing within geographicmarkets.  Current capital projects underway, or initiativesexpected to begin during the next 12 months, include expansions andupgraded technology for obstetrics, emergency room, psychiatric,rehabilitation, cardiac, radiology, and surgery units as well asreal estate projects to support hospital buildouts and constructionof medical office buildings.  During fiscal 2003, we added asignificant number of credentialed specialists and generalpractitioners to our hospitals.  We will continue ourphysician recruiting and retention strategies to increase hospitalvolumes and provide the services needed in the communities weserve.

               *Salaries and benefits*.  The $194.0 million increase insalaries and benefits is primarily attributable to acquisitions,which account for $172.2 million of the increase.  Salariesand benefits as a percentage of revenues increased from 42.2% in2002 to 43.2% during 2003 primarily due to the BHS acquisition asit typically takes an

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extended period of time to fully implement our staffing mixmodel at acquired hospitals, especially significant acquisitionssuch as the BHS assets.  On a same hospital basis, salariesand benefits as a percentage of revenues decreased from 41.9% to41.6% during fiscal 2003.

               We successfully managed staffing levels at our hospitals andimproved labor productivity during fiscal 2003.  However, ourproductivity efficiencies were partially offset by increasednursing compensation and utilization of contract labor.  Thehospital industry continues to face a nationwide shortage ofnurses.  We have experienced particular difficulty inretaining and recruiting nurses in our Phoenix, Arizona, SanAntonio, Texas, and Los Angeles/Orange County, Californiamarkets.  Recent reports forecast this shortage to continueinto the near future, especially in California where state mandatedincreased nurse-staffing ratios begin to go into effect on January1, 2004.  Our comprehensive recruiting and retention plans fornurses that focuses on competitive salaries and benefits as well asemployee satisfaction, best practices, tuition assistance,effective training programs and workplace environment has mitigatedsome of the effects of the nursing shortage.  However, shouldwe be unsuccessful in our attempts to maintain nursing coverageadequate for our present and future needs, and especially ifadditional states in which we operate enact new laws regardingnurse-staffing ratios, our future operating results could beadversely impacted by increased salaries and benefits expense.

               *Supplies*.  Acquisitions accounted for $78.9 million ofthe $86.5 million increase in supplies during fiscal 2003. Increased volume and acuity of surgeries on a same hospital basisaccounted for the remaining increase.  Same hospital surgeriesincreased by 0.9% during fiscal 2003.  Surgeries typicallyrequire greater utilization of supplies than do non-surgicaladmissions. 

               Supplies expense as a percentage of revenues increased to 15.1%during fiscal 2003 from 12.7% during fiscal 2002.  Thisincrease is due to the BHS and Weiss hospital acquisitions. Supplies expense as a percentage of revenues are much higher at theBHS and Weiss hospitals compared to our other hospitals.  On asame hospital basis, supplies expense as a percentage of revenuesremained flat year over year.  We expect this ratio to improveas we continue to transition supplies contracts at the BHS andWeiss hospitals to our purchasing group contract rates and fullyimplement materials management strategies.  These improvementsmay be offset, however, by continued price increases forpharmaceuticals and medical supplies, including the impact ofincreased use of drug eluting stents.

               *Medical claims*.  The $28.8 million increase in medicalclaims is due to the significant increase in enrollees and revenuesfor Phoenix Health Plan.  Medical claims expense as apercentage of premium revenues increased from 71.4% to 73.5% duringfiscal 2003 due to slight increases in member inpatient utilizationand severity during fiscal 2003.  Medical claims expenserepresents the amounts paid by the health plans for health careservices provided to their members, including an estimate ofincurred but not reported claims that is determined based upon lagdata and other actuarial assumptions.  Revenues and expensesbetween the health plans and our hospitals and related outpatientservice providers of approximately $24.9 million, or 13.4% of grosshealth plan medical claims expense, were eliminated inconsolidation during fiscal 2003.

               *Insurance*.  Acquisitions accounted for $8.9 million ofthe increase in insurance expense during fiscal 2003. Insurance expense on a same hospital basis decreased slightlyduring fiscal 2003.  The slight decrease is a result ofincreases in professional and general liability premiums and claimsexperience during fiscal 2003 offset by the adjustment to expenseduring fiscal 2002 related to the changes in our professional andgeneral liability coverage as described in the comparison ofinsurance for fiscal 2002 versus fiscal 2003.  Effective June1, 2002, we established a wholly owned captive subsidiary to insureour professional and general liability risks at a $10.0 millionretention as compared to our $1.0 million self-insured retentionunder our previous insurance policy.  We changed our coveragedue to pricing pressures and the limited availability of carrierswilling to underwrite professional and general liabilityinsurance.  We anticipate continued increases in insurancecosts in the near future since the professional and generalliability market remains depressed.

               *Other operating expenses*.  Other operating expensesinclude costs such as rents and leases, professional fees,purchased services, marketing, repairs, utilities, licenses andnon-income taxes.  Acquisitions accounted for $54.3 million ofthe $55.1 increase in other operating expenses during fiscal2003.  Other operating expenses remained flat on a samehospital basis between the two periods.  Other operatingexpenses as a percentage of

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revenues decreased from 14.6% to 14.0% during fiscal 2003 as wemanaged these costs in relation to the rate of revenue growthduring fiscal 2003.

               *Provision for doubtful accounts*.  During fiscal 2003,the provision for doubtful accounts increased by $28.0 million dueto acquisitions and decreased by $7.9 million on a same hospitalbasis resulting in a net increase of $20.1 million.  The samehospital improvement during fiscal 2003 was primarily a result ofour efforts to improve cash collection processes and increaseproductivity of our hospital business offices.  These effortsresulted in expedited cash collections and greater than expectedrecoveries of amounts previously considered uncollectible. The enactment of Proposition 204 in Arizona also positivelyaffected our bad debt rate as many previously uninsured patientsbecame qualified for state Medicaid coverage under Proposition204.

               *Depreciation and amortization*.  During fiscal 2003,depreciation and amortization related to acquisitions was $12.3million, while same hospital depreciation and amortizationincreased by $5.1 million.  As part of our commitment toexpand and improve our capital infrastructure, we spentapproximately $98.5 million for capital improvements in fiscal2003, including $26.6 million related to our construction of a newhospital in the Phoenix market.  These capital purchasesresulted in increased depreciation and amortization during fiscal2003.  On July 1, 2001, we adopted the provisions of SFAS 141and 142 resulting in re-allocations of the excess purchase priceover net assets acquired to goodwill and identifiable intangibleassets.  Under SFAS 142, goodwill and indefinite-livedintangible assets are no longer amortized but are subject to annualimpairment tests.  The suspension of goodwill amortization andthe changes in classifications of identifiable intangible assetsand related remaining useful lives is fully reflected in both thefiscal 2003 and 2002 amounts.

               *Interest*.  The $8.2 million increase in net interestexpense during fiscal 2003 primarily relates to $150.0 million ofnew term loan borrowings and related loan costs under the amended2001 credit facility and issuance of $17.6 million of convertiblesubordinated notes to fund the BHS acquisition in January 2003 aswell as the impact of paying an extra month of interest on our9.75% Notes during fiscal 2003 as compared to fiscal 2002.

               *Debt extinguishment costs*.  During fiscal 2002, weincurred $6.6 million in debt extinguishment costs from the earlybuyout of certain capital leases, the write-off of deferred loancosts incurred as part of the 2000 credit facility and feesincurred to terminate the interest rate collar agreement requiredby the 2000 credit facility.  On April 1, 2002, we adopted theprovisions of SFAS 145 resulting in the treatment of these debtextinguishment costs as operating costs as opposed to extraordinaryitems.

               *Minority interests and other*.  Minority interests andother expenses decreased $0.4 million during fiscal 2003 comparedto fiscal 2002.  Minority interests represent the third partyportion of earnings of certain of our non-wholly owned affiliatesincluded in our consolidated income statements.  Minorityinterests for fiscal 2003 decreased slightly to $0.7 millioncompared to $0.8 million for fiscal 2002.  Other itemscontributing to the $0.4 million decrease in minority interests andother expenses during fiscal 2003 were increased equity methodincome during fiscal of $1.1 million, primarily from equity methodinvestments acquired as part of the BHS acquisition, and decreasedgains on sales of assets of $0.8 million.

               *Income taxes.*  The provision for income taxes increasedfrom $2.9 million for fiscal 2002 to $10.9 million for fiscal 2003resulting in an increase in the effective tax rate from 29.8% to39.2%.  The valuation allowance that offsets our deferred taxassets decreased by $1.4 million for the year ended June 30, 2002,resulting in a lower effective tax rate in 2002.

               *Net income*.  Net income increased from $6.8 million infiscal 2002 to $16.9 million in fiscal 2003.  The increaserelates to increased revenues as described above in excess ofincreases expenses.  Net income in fiscal 2003 was adverselyaffected by increases in depreciation and amortization, netinterest and income taxes of $17.4 million, $8.2 million and $8.0million, respectively.  We view these costs as products of ourstrategic growth initiative.

***               Year Ended June 30, 2002 Compared to the Year Ended June 30,2001***

               *Revenues*.  The $242.8 million increase in revenuesduring fiscal 2002 was attributable to revenues from acquisitionsof $239.9 million and same hospital revenue improvement of $2.9million.  Although same hospital discharges decreased by 1.3%during fiscal 2002, same hospital revenues increased slightly dueto our ability to

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negotiate more favorable payment rates with certain managed careproviders in certain markets and improved Medicarereimbursements.

               *Salaries and benefits*.  The $60.8 million increase insalaries and benefits is primarily attributable to acquisitions,which account for $58.1 million of the increase.  Salaries andbenefits as a percentage of revenues decreased from 48.5% in 2001to 42.2% in 2002 due to having a full year of Phoenix Health Planoperations during fiscal 2002.  Excluding the impact ofPhoenix Health Plan, salaries and benefits as a percentage ofrevenues decreased to 49.5% during fiscal 2002 from 49.7% duringfiscal 2001.  We successfully managed staffing levels at ourhospitals and improved labor productivity.  However, ourproductivity efficiencies were partially offset by increasednursing compensation.  The hospital industry continues to facea nationwide shortage of nurses.  We experienced particulardifficulty in retaining and recruiting nurses in our Phoenix,Arizona and Los Angeles/Orange County, California markets. During the first quarter of fiscal 2003, we initiated acomprehensive recruiting and retention plan for nurses that focuseson competitive salaries and benefits as well as employeesatisfaction, best practices, tuition assistance, effectivetraining programs and workplace environment.

               *Supplies*.  Acquisitions accounted for $16.8 million ofthe $23.2 million increase in supplies during fiscal 2002. Increased volume and acuity of surgeries on a same hospital basisaccounted for the remaining increase.  Same hospital surgeriesincreased by 3.0% during fiscal 2002.  Surgeries typicallyrequire greater utilization of supplies than do non-surgicaladmissions, which explains the increase in supplies expense during2002 when same hospital discharges decreased by 1.3% and samehospital surgeries increased by 3.0%.

               *Medical claims*.  The $101.2 million increase in medicalclaims is almost exclusively due to the acquisition of PhoenixHealth Plan on May 1, 2001.  Medical claims expense representsthe amounts paid by the health plans for health care servicesprovided to their members,  including an estimate of incurredbut not reported claims that is determined based upon lag data andother actuarial assumptions.  Revenues and expenses betweenthe health plans and our hospitals and related outpatient serviceproviders of approximately $26.2 million, or 16.6% of gross healthplan medical claims expense, were eliminated in consolidationduring fiscal 2002.

               *Insurance*.  Acquisitions accounted for $2.1 million ofthe $11.5 million increase in insurance expense during fiscal2002.  Insurance expense on a same hospital basis increased by$9.4 million primarily due to changes in our professional andgeneral liability coverage effective June 1, 2002.  EffectiveJune 1, 2002, we established a wholly owned captive subsidiary toinsure our professional and general liability risks at a $10.0million retention as compared to our $1.0 million self-insuredretention under our previous insurance policy.  Werestructured our coverage due to pricing pressures and the limitedavailability of carriers willing to underwrite professional andgeneral liability insurance.  The $11.5 million increase iscomprised of the following factors:  (1) a $5.7 millionincrease in the professional and general liability reserve for theincreased retention related to incurred but not reported claims;(2) a $2.6 million increase in our professional and generalliability reserve at the $1.0 million retention level due to thelack of maturity of our claims; (3) professional and generalliability and property premiums increases of $2.1 million and (4)an increase in our professional and general liability reserve of$1.1 million related to the liquidation of PHICO.

               *Other operating expenses*.  Other operating expensesinclude costs such as rents and leases, professional fees,purchased services, marketing, repairs, utilities, licenses andnon-income taxes.  Acquisitions accounted for $30.8 million ofthe $29.9 million increase in other operating expenses duringfiscal 2002.  Other operating expenses decreased by $0.9million on a same hospital basis between the two periods.

               *Provision for doubtful accounts*.  During fiscal 2002,the provision for doubtful accounts increased by $5.5 million dueto acquisitions and decreased by $9.0 million on a same hospitalbasis resulting in a net decrease of $3.5 million.  The samehospital improvement during fiscal 2002 was primarily a result ofour efforts to improve cash collection processes and increaseproductivity of our hospital business offices.  The enactmentof Proposition 204 in Arizona also positively affected our bad debtrate as many previously uninsured patients qualified for Medicaidunder Proposition 204.  Additionally, the provision fordoubtful accounts was negatively affected during the first quarterof fiscal 2001 as we transitioned the hospitals acquired during2000 to our corporate policy regarding the allowance for doubtfulaccounts.

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               *Depreciation and amortization*.  The $5.7 millionincrease in depreciation and amortization during fiscal 2002related to acquired fixed assets during the year both fromacquisitions of hospitals and capital expenditures.  On July1, 2001, we adopted the provisions of SFAS 141 and 142 resulting inre-allocations of the excess purchase price over net assetsacquired to goodwill and identifiable intangible assets. Under SFAS 142, goodwill and indefinite-lived intangible assets areno longer amortized but are subject to annual impairmenttests.  The suspension of goodwill amortization and thechanges in classifications of identifiable intangible assets andrelated remaining useful lives resulted in a net decrease inamortization expense of approximately $2.8 million for the yearended June 30, 2002.

               *Interest*.  The $10.1 million increase in net interestexpense during fiscal 2002 primarily relates to the issuance of the9.75% Notes on July 30, 2001, offset by the repayment ofoutstanding term loans under the 2000 credit facility.  Inaddition, the Company incurred deferred loan costs of approximately$11.5 million related to the issuance of the 9.75% Notes and $3.5million for the establishment of the 2001 credit facility. The aforementioned increases to net interest expense were offset byan increase in interest income on invested cash of approximately$2.1 million during fiscal 2002.  On February 15, 2002, weentered into an interest rate swap agreement with Bank of America,N.A. for a notional amount of $100 million of the 9.75%Notes.  Under this agreement, the 9.75% coupon interest rateon the $100 million notional amount is swapped for a variable ratebased upon the 6-month LIBOR rate in effect on each semi-annualsettlement date plus a fixed margin of 3.63%.  The swapagreement resulted in a decrease to net interest expense of $1.5million during fiscal 2002.

               *Debt extinguishment costs*.  During fiscal 2002, weincurred $6.6 million in debt extinguishment costs from the earlybuyout of certain capital leases, the write-off of deferred loancosts incurred as part of the 2000 credit facility and feesincurred to terminate the interest rate collar agreement requiredby the 2000 credit facility.  On April 1, 2002, we adopted theprovisions of SFAS 145 resulting in the treatment of these debtextinguishment costs as operating costs as opposed to extraordinaryitems.

               *Minority interests and other*.  Minority interests andother expenses decreased $1.7 million in fiscal 2002 compared tofiscal 2001.  Minority interests represent the third partyportion of earnings of certain of our non-wholly owned affiliatesincluded in our consolidated statements of operations. Minority interests for fiscal 2002 remained comparable to fiscal2001 at $0.8 million.  The $1.7 million decrease in minorityinterests and other expenses during fiscal 2002 primarily relatesto gains on sales of land and other assets of $0.8 million duringfiscal 2002 as compared to losses on sales of assets of $0.5million during fiscal 2001.

               *Income taxes.*  The provision for income taxes increasedfrom $0.5 million for 2001 to $2.9 million for 2002 resulting in anincrease in the effective tax rate from 4.7% in 2001 to 29.9% in2002.  The valuation allowance that offsets our deferred taxassets decreased by $4.1 million and $1.4 million for the yearsended June 30, 2001 and 2002, respectively, resulting in a decreasein our effective tax rates.

               *Net income*.  Net income decreased from $10.2 million infiscal 2001 to $6.8 million in fiscal 2002.  The decrease wasprimarily a result of increases in depreciation and amortizationand interest resulting from the 2001 and 2002 acquisitions and theissuance of the 9.75% Notes, respectively.  We also incurreddebt extinguishment costs of $6.6 million during fiscal 2002. We view these costs as products of the Company’s strategicgrowth initiative.

**Summary Results of Operations by Quarter**

****

               The following table presents summarized unaudited quarterly resultsof operations for the fiscal years ended June 30, 2002 and2003.  We believe that all necessary adjustments have beenincluded in the amounts stated below for a fair presentation of theresults of operations for the periods presented when read inconjunction with the consolidated financial statements for thefiscal years ended June 30, 2002 and 2003.  Results ofoperations for a particular quarter are not necessarily indicativeof results of operations for an annual period and are notpredictive of future periods.

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**September 30, 2001**

**December 31, 2001**

**March 31, 2002**

**June 30, 2002**

 

 

 

 

*(In millions)*

Net revenues

 

$

207.3

 

 

$

223.1

 

 

$

235.9

 

 

$

244.3

Net income (loss)

 

 

(4.2

)

 

 

2.6

 

 

 

6.4

 

 

 

2.0

 

 

 

 

 

**September 30, 2002**

**December 31, 2002**

**March 31, 2003**

**June 30, 2003**

 

 

 

 

*(In millions)*

Net revenues

 

$

267.9

 

 

$

267.3

 

 

$

402.4

 

 

$

402.9

Net income

 

 

2.4

 

 

2.6

 

 

 

6.6

 

 

 

5.3

**Liquidity and Capital Resources**

****

               At June 30, 2003, we had working capital of $37.1 million,including cash and cash equivalents of $27.2 million.  $11.1million of the cash balance was restricted for use by our captiveinsurance subsidiary.  Working capital at June 30, 2002 was$87.9 million.  The decrease in working capital is primarilydue to the use of cash on hand to fund a portion of the BHSacquisition purchase price and to fund liabilities assumed in theBHS acquisition.  Cash provided by operating activitiesincreased from $44.7 million for the year ended June 30, 2002 to$117.7 million for the year ended June 30, 2003.  We generatedcash flows from operations through increased revenues overexpenses, an improvement in collections of net accounts receivableand the timing of payment of accrued expenses and otherliabilities.

               Cash used in investing activities increased from $135.4 million forthe year ended June 30, 2002 to $344.0 million for the year endedJune 30, 2003.  Cash used to fund hospital acquisitions, netof cash received, increased from $100.3 million for the year endedJune 30, 2002 to $249.4 million for the year ended June 30, 2003,primarily as a result of the BHS acquisition.  Cash used forcapital expenditures also increased by approximately $63.4 millionto $98.5 million for the year ended June 30, 2003, $26.6 million ofwhich related to construction of West Valley Hospital MedicalCenter (“West Valley”), our new hospital recentlyopened in Goodyear, Arizona.  The funding of capitalexpenditures is in part subject to the timing of certain capitalprojects at the BHS hospitals, Arrowhead Community Hospital andPhoenix Baptist Hospital that are required under the respectivepurchase agreements for these hospitals as well as the constructionof West Valley.  As of June 30, 2003, we have funded orcommitted to fund approximately $30.8 million of our $200.0 millioncommitment in respect of the BHS hospitals and $26.8 million of our$50.0 million contractual commitment in respect of Arrowhead andPhoenix Baptist hospitals.  We anticipate spending duringfiscal year 2004 an additional $24.0 million of the estimatedproject cost of $55.0 million for the construction of WestValley.  We expect to complete all of these capital projectsand commitments during the next one to six years.

               Our amended 2001 credit facility contains provisions that limitannual capital expenditures.  For the year ended June 30,2003, we are in compliance with these capital expenditureprovisions.  We believe our capital expenditure program issufficient to service, expand and improve our existing facilitiesto meet our quality objectives.

               Cash provided by financing activities increased from $134.0 millionfor the year ended June 30, 2002 to $198.1 million for the yearended June 30, 2003.  The increase was attributable to our newterm loan borrowings under the amended 2001 credit facility and ourissuance of Common Stock to finance the BHS acquisition asdescribed below.

               On January 3, 2003, in connection with the BHS acquisition, weexpanded our 2001 credit facility by adding a $150.0 million termloan facility to our existing revolving loan facility.  Weutilized the proceeds of the $150.0 million in term loans to fund aportion of the purchase price paid to the Seller.  Therevolving loan facility

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capacity remains at $125.0 million under the amended 2001 creditfacility, subject to reduction for outstanding letters ofcredit.  Additionally, as part of the BHS purchase price, weissued approximately $17.6 million of our convertible subordinatednotes which provide for annual interest payments at 8.18% untiltheir maturity on January 3, 2013.  The notes are convertibleat any time into our Common Stock at a $3,500 per share conversionprice.  We may not redeem the notes prior to January 1, 2008,and must pay premiums of 102% and 101% for redemptions during thetwo years subsequent to January 1, 2008, respectively, withredemptions thereafter being available at par.

               As of June 30, 2003, we had 55,194 shares of two series ofPayable-In-Kind Convertible Redeemable Preferred Stock (“PIKPreferred Stock”) outstanding with a liquidation value of$1,000 per share.  We issued 20,000 shares of our first seriesof PIK Preferred Stock on February 1, 2000 in connection with theacquisition of MacNeal Hospital.  We currently intend to issueand record paid-in-kind dividends annually at 8% of the liquidationvalue of our first series of PIK Preferred Stock until January 31,2008 and to pay cash dividends thereafter until the January 31,2015 redemption date for the stock.  As of June 30, 2003,25,194 shares of this series were outstanding.  Our firstseries of PIK Preferred Stock will automatically convert to CommonStock upon an initial public offering of our Common Stock withgross proceeds to us of at least $50.0 million at a conversionprice equal to the initial public offering price.  Inconnection with our purchase of the health care assets of BHS onJanuary 3, 2003, we issued 30,000 shares of our Series B PIKPreferred Stock with a liquidation value of $1,000 per share. We currently intend to issue and record paid-in-kind dividendsannually at 6.25% of the liquidation value of the Series B PIKPreferred Stock until January 1, 2010 and to pay cash dividendsannually thereafter until the January 31, 2015 redemption dateapplicable to such shares.  The Series B PIK Preferred Stockis convertible to our Common Stock at any time at a $3,500 pershare conversion price.

               On January 9, 2003, subsequent to our purchase of the health careassets of BHS and expansion of the 2001 credit facility, Standardand Poor’s 1) lowered our corporate credit rating from“B+” to “B”; 2) lowered the credit ratingon the 9.75% Notes from “B-” to “CCC+”; and3) affirmed the “B+” credit rating on our amended 2001credit facility.  Standard and Poor’s stated that itmade the downgrades due to its concerns about the size of the BHSacquisition and our ability to generate sufficient returns inrelation to our indebtedness.  On December 2, 2002,Moody’s affirmed its existing rating of “Ba3” forthe $125.0 million revolving loan facility under the existing 2001credit facility, affirmed its existing rating of “B3”for the 9.75% Notes and assigned a “Ba3” rating to the$150.0 million term loans under the amended 2001 creditfacility.

               We believe that the working capital on hand and the availability ofrevolving borrowings under our amended 2001 credit facility aresufficient to meet our operating and capital needs for theforeseeable future.  Additionally, certain funds controlled byMorgan Stanley Capital Partners (the “MSCP Funds”) haveentered into a subscription agreement with us to purchase anadditional $273.4 million of our Common Stock to fund futureacquisitions and cash flow needs.  Common Stock purchases bythe MSCP Funds are subject to several conditions outside ourcontrol, including the approval of the Investment Committee ofMorgan Stanley Capital Partners.  No assurance can be giventhat any or all of such conditions to additional Common Stockpurchases will be met.  We anticipate spending approximately$155.0 million on facilities expansions, renovation projects andmedical upgrades during fiscal year 2004, including the remainingamounts owed for the construction of West Valley.  Funding forthese capital projects may require that we draw upon our revolvingloan facility during the first or second quarter of fiscal2004.

               We also intend to acquire additional hospitals and will continue toseek acquisitions that fit our corporate growth strategy. These acquisitions would require financing in addition to theworking capital on hand, availability of funds under our revolvingloan facility and our future operating cash flows.  Wecontinually assess our capital needs and may seek additionalfinancing, including debt or equity, as considered necessary tofund potential acquisitions or for other corporate purposes. However, should our operating results and borrowing capacities notsufficiently support these capital projects or acquisitionopportunities, our in-market growth strategies may not be fullyrealized.

               We are subject to certain restrictive and financial covenants underthe amended 2001 credit facility including a total leverage ratio,a senior leverage ratio, an interest coverage ratio and capitalexpenditure restrictions.  As of June 30, 2003, we were incompliance with each of these covenants.  As of June 30, 2003,the only amounts drawn against the revolving facility under amended2001 credit facility were letters of credit totaling approximately$25.8 million.

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               On January 17, 2003, we entered into an agreement with Bank ofAmerica, N.A., to swap the variable 90-day LIBOR rate applicable toa notional amount of $147.0 million of our $150.0 million of termsloans under the amended 2001 credit facility for a fixed LIBOR rateof 1.77% for the one-year period beginning July 3, 2003 and endingJuly 3, 2004.

**Guarantees**

               We are a party to certain rent shortfall or master lease agreementswith certain unconsolidated entities and other guaranteearrangements, including parent-subsidiary guarantees, in theordinary course of business.  We have not engaged in anytransaction or arrangement with an unconsolidated entity that isreasonably likely to materially affect liquidity.

**Obligations and Commitments**

               The following table reflects a summary of obligations andcommitments outstanding, including both the principal and interestportions of long-term debt and capital leases, with payment datesas of June 30, 2003.

 

 

**Payments due by period**

** **

** **

 

 
****
** **

** **

 

 

**Less than 1 year**
 
**1-3 years**

** **

**4-5 years**

** **

**After 5 years**

** **

**Total**

 

 
**
**Contractual Cash Obligations:**

 

*(In millions)*

Long-term debt

 

$

41.1

 

 

$

84.9

 

 

$

84.5

 

 

$

580.1

 

 

$ 

790.6

Capital lease obligations

 

 

5.5

 

 

5.7

 

 

 

0.6

 

 

 

–

 

 

11.8

Operating leases

 

 

17.0

 

 

 

22.3

 

 

 

14.0

 

 

 

29.1

 

 

 

82.4

Other long-term obligations

 

 

2.1

 

 

 

–

 

 

 

–

 

 

 

–

 

 

 

2.1

Purchase obligations

 

 

19.9

 

 

 

–

 

 

 

–

 

 

 

–

 

 

 

19.9

 

 

 

 

 

 

 

 

 

 

 

 

 

 

    Subtotal

 

$

85.6

 

 

$

112.9

 

 

$

99.1

 

 

$

609.2

 

 

$

906.8

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

**Amount of commitment expiration perperiod**

** **

** **

 

 

 
****
** **

** **

 

 

 

**Less than 1 year**
 
**1-3 years**

** **

**4-5 years**

** **

**After 5 years**

** **

**Total**

 

 

 
**
**Other Commitments:**

 

*(In  millions)*

Construction and improvement commitments

 

$

35.3

 

 

$

0.1

 

 

$

0.5

 

 

$

10.6

 

 

$ 

46.5

Guarantees of surety bonds

 

5.0

 

 

–

 

 

–

 

 

–

 

 

 

5.0

Letters of credit

 

–

 

 

25.8

 

–

 

 

–

 

 

 

25.8

Capital expenditure commitments

 

 

33.7

 

 

 

63.6

 

77.2

 

 

 

17.9

 

 

 

192.4

Physician commitments

 

 

2.8

 

 

 

–

 

–

 

 

 

–

 

 

 

2.8

Rental shortfall agreements

 

 

0.3

 

 

 

0.1

 

 

 

0.1

 

 

 

0.6

 

 

 

1.1

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

    Subtotal

 

$

77.1

 

 

$

89.6

 

 

$

77.8

 

 

$

29.1

 

 

$

273.6

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

    Total obligations and commitments

 

$

162.7

 

 

$

202.5

 

 

$

176.9

 

 

$

638.3

 

 

$

1,180.4

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

               California has a statute and regulations that require hospitals tomeet certain seismic performance standards.  Hospitals that donot meet the standards may be required to retrofit theirfacilities.  We have filed our 

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required compliance plans with the State of California.  Werecently filed a request to extend the deadline for seismiccompliance from the current state-imposed deadline of 2008 to 2013and expect to comply with the seismic requirements at all of ourCalifornia facilities by the final deadline required.  Weexpect to incur approximately $11.2 million in costs to meet ourcompliance plan.  Upon completion of the $11.2 million inimprovements, our California facilities will be compliant with theseismic regulations and standards through 2029.  We estimatethat the majority of the square footage in our Californiafacilities will be compliant with the seismic regulations andstandards that come into effect during 2030 once we have completedour $11.2 million in improvements, but we are unable at this timeto estimate our costs for full compliance with the 2030requirements.

***Critical Accounting Policies***

******

               The consolidated financial statements have been prepared inaccordance with accounting principles generally accepted in theUnited States.  In preparing the consolidated financialstatements, we make estimates and assumptions that affect thereported amounts of assets, liabilities, revenues and expensesincluded in the financial statements.  Management bases itsestimates on historical experience and other available information,the results of which form the basis of the estimates andassumptions.  We consider the following accounting policies tobe most critical to our operating performance and involve the mostsubjective and complex assumptions and assessments.

               *Allowance for Doubtful Accounts*

**

               Our ability to collect outstanding receivables from third partypayers is critical to our operating performance and cashflows.  The allowance for doubtful accounts was approximately17.6% of accounts receivable, net of contractual discounts, as ofJune 30, 2003.  The primary collection risk lies withuninsured patient accounts or patient accounts in respect of whichthe primary insurance carrier has paid but patient deductibles orco-insurance portions remain outstanding.  We estimate theallowance for doubtful accounts primarily based upon the age of theaccounts since patient discharge date.  We continually monitorour accounts receivable balances and utilize cash collections dataand subsequent write-off data to support the basis for ourestimates of the provision for doubtful accounts.  Significantchanges in payer mix or business office operations may have asignificant impact on our results of operations and cash flows.

*               Allowance for Contractual Discounts and SettlementEstimates*

**

               We typically receive payments from third party payers, includingMedicare, Medicaid and managed care payers, that are less thanbilled charges requiring the estimation of contractual discountallowances.  The Medicare and Medicaid regulations and variousmanaged care contracts are often complex and may include multiplereimbursement mechanisms for different types of services providedin our health care facilities and cost settlement provisionsrequiring complex calculations and assumptions subject tointerpretation.  We estimate the allowance for contractualdiscounts on a payer-specific basis based upon our interpretationof the applicable regulations or contract terms.  We have madesignificant investments in human resources and information systemsto improve the estimation process.  However, the servicesauthorized and provided and related reimbursement are often subjectto different interpretation that may result in payments that differfrom our estimates.  Additionally, updated regulations andcontract renegotiations occur frequently necessitatingmanagement’s continual review and assessment of theestimation process.

*               Insurance Reserves*

**

               Given the nature of our operating environment, we are continuallysubject to medical malpractice or workers compensation claims orlawsuits.  Through May 31, 2002, we maintained third-partyinsurance coverage for individual malpractice claims exceeding $1.0million and workers compensation claims exceeding $250,000 tomitigate a portion of this risk.  Effective June 1, 2002, weestablished a wholly owned captive subsidiary to insure ourprofessional and general liability risks at a $10.0 millionretention level.  We maintain excess coverage for individualclaims exceeding $10.0 million per occurrence up to $100.0 millionin the aggregate.  We estimate our reserve for professionaland general liability and workers compensation risks usinghistorical claims data, demographic factors, severity factors,current incident logs and other actuarial data.  As of June30, 2003, our professional and general liability accrual forasserted and unasserted claims was approximately $26.5million.  The estimated accrual for malpractice and workerscompensation claims could be significantly increased shouldcurrent

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and future occurrences differ from historical claimstrends.  The estimation process is also complicated by therelatively short period of time in which we have owned our healthcare facilities as occurrence data under previous ownership may notnecessarily reflect occurrence data under our ownership. While management monitors current claims closely and considersoutcomes when estimating its reserve, the complexity of the claimsand wide range of potential outcomes often hampers timelyadjustments to the assumptions used in the estimates.

               *Medical Claims Reserves*

               For the year ended June 30, 2003, medical claims expense wasapproximately $160.8 million, primarily representing medical claimsof enrollees in our Medicaid managed health plan in Phoenix,Arizona, Phoenix Health Plan.  We estimate our reserve formedical claims incurred but not reported using historical claimsexperience (including severity and payment lag time) and otheractuarial data including number of enrollees, age of enrollees andcertain enrollee health indicators.  The reserve for medicalclaims incurred but not reported for our health plans wasapproximately $33.5 million as of June 30, 2003.  Whilemanagement believes that its estimation methodology effectivelycaptures trends in medical claims costs, actual payments coulddiffer significantly from our estimates given changes in the healthcare cost structure or adverse experience.  For the year endedJune 30, 2003, approximately $24.9 million of health plan paymentsto hospitals and other health care facilities owned by us forservices provided to health plan enrollees were eliminated inconsolidation.  Our operating results and cash flows could bematerially affected by increased or decreased utilization of ourowned health care facilities by enrollees of our health plans.

**Contingencies and Health Care Regulation**

               *Effects of Inflation and Changing Prices*.  Thehealth care industry is labor intensive.  Wages and otherexpenses increase during periods of inflation and when laborshortages occur in the marketplace.  Various federal, stateand local laws have been enacted that, in certain cases, limit ourability to increase prices.  Revenues for acute care hospitalservices rendered to Medicare patients are established under thefederal government’s prospective payment system.  Webelieve that hospital industry operating margins have been, and maycontinue to be, under significant pressure because of deteriorationin inpatient volumes, changes in payer mix and growth in operatingexpenses in excess of the annual increases we obtain in prospectivepayments under the Medicare program.

               *Health Care Reform*.  In recent years, anincreasing number of legislative proposals have been introduced orproposed to Congress and in some state legislatures that wouldsignificantly affect the services provided by and reimbursement tohealth care providers in our markets.  The cost of certainproposals would be funded in significant part by reduction inpayments by government programs, including Medicare and Medicaid,to health care providers or by taxes levied on hospitals or otherproviders.  While we are unable to predict which, if any,proposals for health care reform will be adopted, we can not assureyou that proposals adverse to our business will not be adopted.

               *Federal and State Regulation andInvestigations*.  The health care industry is subjectto extensive federal, state and local laws and regulations relatingto licensing, conduct of operations, ownership of facilities,addition of facilities and services, confidentiality and securityissues associated with medical records, billing for services andprices for services.  These laws and regulations are extremelycomplex.  In many instances, the industry does not have thebenefit of significant regulatory or judicial interpretation ofthese laws and regulations.  As a result of these laws andregulations, some of our activities could become the subject ofgovernmental investigations or inquiries.  Both federal andstate government agencies have heightened and coordinated civil andcriminal enforcement efforts as part of numerous ongoinginvestigations of hospital companies.  In the event of adetermination that we are in violation of any of these laws, rulesor regulations, or if further changes in the regulatory frameworkoccur, our results of operations could be significantly harmed.

               *Medicare Cost Reports*.  Hospitals participating in theMedicare program are required to meet certain financial reportingrequirements, including submission of annual cost reportsidentifying medical costs and expenses associated with hospitalservices to Medicare recipients.  Since implementation ofoutpatient PPS in August 2000, the due dates of all Medicare costreports were extended due to delays in receiving necessary reportsfrom the Medicare fiscal intermediaries.  We have now filedall Medicare cost reports relating to Medicare fiscal year-ends2002 and prior periods; however, we are still experiencing delayswith fiscal intermediary audits of filed cost reports.

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**Item 7A. Quantitative and Qualitative Disclosures AboutMarket Risk.**

               We are exposed to market risk related to changes in interestrates.  We utilize interest rate swap derivatives from time totime to manage this risk.  We do not hold or issue derivativeinstruments for trading purposes and are not a party to anyinstruments with leverage features.  As of June 30, 2002, wemaintained an interest swap agreement on a notional amount of$100.0 million of our outstanding $300.0 million of 9.75% SeniorSubordinated Notes due 2011 (the “9.75 Notes”). The swap agreement effectively converted the 9.75% fixed rate ofthe $100.0 million notional amount to a variable rate, calculatedas the 6-month LIBOR rate in effect on each semi-annual settlementdate plus a fixed margin of 3.63%.  As of June 30, 2002, thevariable rate was 5.69%.  Effective August 13, 2002, wevoluntarily terminated the interest rate swap agreement inconsideration of a net cash payment to us from the counter-party of$5.5 million.  Upon the termination of the interest rate swapagreement and, as of June 30, 2003, we bear the full 9.75% interestrate risk for all $300.0 million of the 9.75% Notes.  The fairvalue of the 9.75% Notes was approximately $306.0 million as ofJune 30, 2003, based upon quoted market prices.

               In order to fund a portion of the purchase price of the BHSacquisition, we entered into the amended 2001 creditfacility.  The $150.0 million in term loans borrowed under theamended 2001 credit facility bear interest at a variable interestrate based upon the LIBOR rate in effect on certain interest resetdates plus an applicable fixed margin.  To mitigate a portionof the interest rate risk for our variable rate debt, in January2003 we entered into an agreement with Bank of America, N.A. toswap the variable LIBOR rate for a notional amount of $147.0million of our $150.0 million of term loans under the amended 2001credit facility for a fixed LIBOR rate of 1.77% for the one-yearperiod commencing on July 3, 2003 and ending on July 3, 2004. Based upon a hypothetical 1% increase to the current interest rateunder our credit facility debt, annualized interest expense on thecredit facility debt would increase by $1.5 million beginning afterthe termination of our interest rate swap on July 3, 2004.  Ahypothetical 1% change in interest rates would not have a materialimpact on the fair value of our outstanding fixed rate convertiblesubordinated notes.  As of the date of this report, there isalso $25.8 million in letters of credit outstanding under theamended 2001 credit facility.

**Item 8.    Financial Statements andSupplementary Data.**

               Information with respect to this Item is contained in ourconsolidated financial statements indicated in the Index on PageF-1 of this Annual Report on Form 10-K.

**Item 9.    Changes in and Disagreements WithAccountants on Accounting and Financial Disclosure.**

               None.

**Item 9A.        Controls and Procedures.**

****

**                       Evaluation of Disclosure Control and Procedures**

                       As of the end of the period covered by this report, our managementconducted an evaluation, with the participation of our chiefexecutive officer and chief financial officer, of the effectivenessof our disclosure controls and procedures (as defined in Rules13a-15(e) and 15d-15(e) under the Securities Exchange Act of 1934(the “Exchange Act”)).  Based on this evaluation,our chief executive officer and chief financial officer haveconcluded that our disclosure controls and procedures are effectiveto ensure that information required to be disclosed by us in thereports that we file or submit under the Exchange Act is recorded,processed, summarized and reported within the time periodsspecified in Securities and Exchange Commission’s rules andforms and that such information is accumulated and communicated tomanagement, including our chief executive officer and chieffinancial officer, as appropriate to allow timely decisionsregarding required disclosure.

**                       Changes in Internal Control Over Financial Reporting**

                       There was no change in our internal control over financialreporting during our fiscal quarter ended June 30, 2003, that hasmaterially affected, or is reasonably likely to materially affect,our internal control over financial reporting.

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**PART III**

**Item 10.        Directors and Executive Officers of the Registrant.**

                       The table below presents information with respect to our directorsand executive officers as of September 1, 2003.

Name

Age

 

Charles N. Martin, Jr.

60

 

Chairman of the Board & Chief Executive Officer;Director

William L. Hough

51

 

President & Chief Operating Officer; Director

Joseph D. Moore

56

 

Executive Vice President, Chief Financial Officer &Treasurer; Director

Ronald P. Soltman

57

 

Executive Vice President, General Counsel & Secretary;Director

Reginald M. Ballantyne III

59

 

Senior Vice President-Market Strategy & GovernmentAffairs

Bruce F. Chafin

47

 

Senior Vice President-Compliance & Ethics

Robert E. Galloway

58

 

Senior Vice President-Development

James Johnston

59

 

Senior Vice President-Human Resources

Robert M. Martin

54

Senior Vice President-Operations

Phillip W. Roe

42

 

Senior Vice President, Controller & Chief AccountingOfficer

Dale S. St. Arnold

49

 

Senior Vice President-Operations

James H. Spalding

44

 

Senior Vice President, Assistant General Counsel & AssistantSecretary

Alan G. Thomas

49

 

Senior Vice President-Operations Finance

Kent H. Wallace

48

Senior Vice President-Operations

Thomas M. Ways

53

 

Senior Vice President-Managed Care & PhysicianIntegration

Keith B. Pitts

46

 

Vice Chairman; Director

Karen H. Bechtel

54

 

Director

Eric T. Fry

36

 

Director

Howard I. Hoffen

39

 

Director

                       *Charles N. Martin, Jr.* has served as Chairman of the Boardof Directors and Chief Executive Officer of Vanguard since July1997. Until May 31, 2001, he was also Vanguard’s President.From January 1992 until January 1997, Mr. Martin was Chairman,President and Chief Executive Officer of OrNda HealthCorp(“OrNda”), a hospital management company. Prior theretoMr. Martin was President and Chief Operating Officer ofHealthTrust, Inc., a hospital management company, from September1987 until October 1991. Mr. Martin is also a director of severalprivately held companies.

                       *William L. Hough* has served as Chief Operating Officer and adirector of Vanguard since July 1997. Mr. Hough was electedVanguard’s President on May 31, 2001, and prior thereto hehad been an Executive Vice President. From August 1995 untilJanuary 1997, he was Executive Vice President and Chief OperatingOfficer of OrNda. From September 1987 to April 1995, Mr. Houghserved in various executive positions with HealthTrust, Inc.,including Group Vice President from May 1994 to April 1995, andRegional Vice President from April 1990 to April 1994.

                       *Joseph D. Moore* has served as Executive Vice President,Treasurer, Chief Financial Officer and a director of Vanguard sinceJuly 1997. From February 1994 to April 1997, he was Senior VicePresident-Development of Columbia/HCA Healthcare Corporation(“Columbia”), a hospital management company. Mr. Moorefirst joined Hospital Corporation of America (a predecessor ofColumbia) in April 1970, rising to Senior Vice President-Financeand Development in January 1993.

                       *Ronald P. Soltman* has been Executive Vice President, GeneralCounsel, Secretary and a director of Vanguard since July 1997. FromApril 1994 until January 1997, he was Senior Vice President,General Counsel and Secretary of OrNda. From February 1994 untilMarch 1994, he was Vice President and Assistant General Counsel ofColumbia. From 1984 until February 1994, he was Vice President andAssistant General Counsel of Hospital Corporation of America.

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                       *Reginald M. Ballantyne III,* joined Vanguard in May 2001 andhas served as Senior Vice President-Market Strategy &Government Affairs of Vanguard since January 2002.  From 1984to 2001, he served as President of PMH Health Resources, Inc.(“PMH”), an Arizona based multi-unit health caresystem.  In February 2001, PMH filed a Chapter 11 proceedingin order to implement the sale of the business and assets of PMH toVanguard.  Prior to 1984, Mr. Ballantyne served as Presidentof Phoenix Memorial Hospital in Phoenix, Arizona.  Mr.Ballantyne served as Chairman of the American Hospital Association(“AHA”) in 1997 and as Speaker of the AHA House ofDelegates in 1998.  He is a Fellow of the American College ofHealthcare Executives (“ACHE”) and a recipient of theACHE Gold Medal Award for Management Excellence.  Mr.Ballantyne also served as a member of the national Board ofCommissioners for the Joint Commission on Accreditation ofHealthcare Organizations and as Chairman of the AHA Committee ofCommissioners from 1992 until 1995.  Mr. Ballantyne is also adirector of Superior Consultant Holdings Corporation and severalprivately held companies.

                       *Bruce F. Chafin* has served as Senior VicePresident-Compliance & Ethics of Vanguard since July 1997.Prior thereto, from April 1995 to January 1997, he served as VicePresident–Compliance & Ethics of OrNda.

                       *Robert E. Galloway* has served as Senior VicePresident-Development of Vanguard since October 1997. Prior theretofrom August 1993 to September 1997, he was VicePresident–Development of Columbia and its predecessor,Columbia Hospital Corporation.

                       *James Johnston* has served as Senior Vice President-HumanResources of Vanguard since July 1997. Prior thereto from November1995 to January 1997, he served as Senior VicePresident–Human Resources of OrNda.

                       *Robert M. Martin* has been a Senior Vice President-Operationsof Vanguard since February 2003.  Prior thereto from September2000 to December 2001 Mr. Martin served as Chairman of the Board,President and Chief Executive Officer of Healthstar Corporation ofBrentwood, Tennessee, a corporation he founded to own and operaterural acute care hospitals in the United States.  From May1995 to February 1999 Mr. Martin was Chairman of the Board,President and Chief Executive Officer of New American HealthcareCorporation of Brentwood, Tennessee, a corporation also founded byMr. Martin which acquired and operated 11 rural and non-urban,acute care hospitals in 9 different states of the UnitedStates.  In April 2000 New American Healthcare Corporationfiled a voluntary petition for relief under Chapter 11 of theUnited States Bankruptcy Code.

                       *Phillip W. Roe* has been Senior Vice President, Controller& Chief Accounting Officer of Vanguard since July 1997. Priorthereto he was Senior Vice President, Controller and ChiefAccounting Officer of OrNda from September 1996 until January 1997.Prior thereto, from October 1994 until September 1996, Mr. Roe wasVice President, Controller and Chief Accounting Officer ofOrNda.

                       *Dale S. St. Arnold* has been a Senior VicePresident-Operations of Vanguard since June 2002.  Priorthereto from 1998 until June 2002, he was President and ChiefExecutive Officer of Catholic Health System of Buffalo, New York, anon-profit, integrated health care system which included fourhospitals, fourteen nursing homes and three home carecompanies.  Prior thereto, he had various positions from 1991to 1998 with Mount Carmel Health System of Columbus, Ohio and itspredecessor organization, Mount Carmel Health, a non-profit,integrated health care system which included three hospitals, ahome care company and a Medicare HMO.  He served as Presidentand Chief Executive Officer of Mount Carmel Health and Mount CarmelHealth System from 1992 to 1998.

                       *James H. Spalding* has served as Senior Vice President,Assistant General Counsel and Assistant Secretary of Vanguard sinceNovember 1998. Prior thereto he was Vice President, AssistantGeneral Counsel and Assistant Secretary of Vanguard from July 1997until November 1998. Prior thereto from April 1994 until January1997, he served as Vice President, Assistant General Counsel andAssistant Secretary of OrNda.

                       *Alan G. Thomas* has been Senior Vice President-OperationsFinance of Vanguard since July 1997. Prior thereto, Mr. Thomas wasSenior Vice President–Hospital Financial Operations of OrNdafrom April 1995 until January 1997. Prior thereto he was VicePresident–Reimbursement and Revenue Enhancement of OrNda fromJune 1994 until April 1995.

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                       *Kent H. Wallace*   has been a Senior VicePresident-Operations of Vanguard since February 2003. Prior theretofrom July 2001 to December 2002 he was Regional Vice President ofProvince Healthcare Company of Brentwood, Tennessee, an owner andoperator of 20 non-urban, acute care hospitals in 13 states of theUnited States. During this time Mr. Wallace had managerialresponsibility for seven of these hospitals.  From June 1999until June 2001 Mr. Wallace was President and Chief ExecutiveOfficer of  Custom Curb, Inc. of Chattanooga, Tennessee, afamily owned company which manufactured roof accessories. Prior thereto from January 1997 until May 1999 Mr. Wallace was aVice President–Acquisitions and Development of TenetHealthcare Corporation, a hospital management company.

                       *Thomas M. Ways* has served as Senior Vice President-ManagedCare & Physician Integration of Vanguard since March 1998.Prior thereto from February 1997 to February 1998, he was ChiefExecutive Officer of MSO/Physician Practice Development for theSouthern California Region of Tenet Health Care Corporation, ahospital management company. Prior thereto from August 1994 toJanuary 1997, he was Vice President–Physician Integration ofOrNda.

                       *Keith B. Pitts* has been Vanguard’s Vice Chairman sinceMay 2001, a director of Vanguard since August 1999, and was anExecutive Vice President of Vanguard from August 1999 until May2001. Prior thereto, from November 1997 until June 1999, he was theChairman and Chief Executive Officer of Mariner Post-Acute Network,Inc. and its predecessor, Paragon Health Network, Inc., which is anursing home management company. In January 2000, MarinerPost-Acute Network, Inc. filed a voluntary petition for reliefunder Chapter 11 of the United States Bankruptcy Code.  In May2002, Mariner-Post Acute Network, Inc. emerged from such Chapter 11proceedings pursuant to a confirmed plan of reorganization andchanged its name to Mariner Health Care, Inc.  Prior theretofrom August 1992 until January 1997, Mr. Pitts served as ExecutiveVice President and Chief Financial Officer of OrNda.

                       *Karen H. Bechtel* has served as a Director of Vanguard sinceMarch 2000. Ms. Bechtel has been a Managing Director of MorganStanley Private Equity since 1998 and a Managing Director of MorganStanley & Co. Incorporated since 1986. She is also a directorof Cross Country Healthcare, Inc. and several privately heldcompanies.

                       *Eric T. Fry* has served as a Director of Vanguard since May1998. He joined Morgan Stanley & Co. Incorporated in 1989 andhas been a Managing Director of both Morgan Stanley & Co.Incorporated and Morgan Stanley Private Equity since December 2001.He is also a director of ACG Holdings, Inc., American ColorGraphics, Inc. and several privately held companies.

                       *Howard I. Hoffen* has served as a Director of Vanguard sinceJanuary 2001. Mr. Hoffen is currently the Chairman and ChiefExecutive Officer of Morgan Stanley Private Equity, and has been aManaging Director of Morgan Stanley & Co. Incorporated since1997.  He joined Morgan Stanley & Co. Incorporated in 1985and Morgan Stanley Private Equity in 1986.  Mr. Hoffen is alsoa director of Catalytica Energy Systems, Inc., Choice OneCommunications Inc. and several privately held companies.

                       ***Board of Directors***

                       The Board of Directors of Vanguard manages its business. Under ourcertificate of incorporation and bylaws, the Vanguard Board ofDirectors must consist of not less than three nor more than twentymembers, with the exact number of members being fixed from time totime by our Board of Directors. Currently, eight members compriseour Board of Directors.

                       Pursuant to our shareholders agreement, our Board of Directors isto be made up of eight members, five of which are to be nominatedby the management shareholders and three of which are to benominated by the Morgan Stanley Capital Partners Funds (the“MSCP Funds”).  In conformity with the foregoing,at the current time Ms. Bechtel and Messrs. Fry and Hoffen aredirectors nominated by the MSCP Funds and Messrs. Hough, Martin,Moore, Pitts and Soltman are directors nominated by the managementshareholders. Despite the foregoing, at all times the MSCP Fundshave the right to nominate four members to our Board, in whichevent one of the management directors will resign. Also, at anytime after January 1, 2005, the MSCP Funds have the right tonominate a majority of our Board if the MSCP Funds exercise theiradditional rights under the shareholders

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agreement to require all other shareholders to transfer theirshares to the same prospective purchaser to whom and at the sameprice at which the MSCP Funds have agreed to sell all their sharesof our common stock.  Pursuant to our shareholders agreementeach shareholder has agreed to vote his shares of common stock toelect directors nominated in the manner described above.

                       Our directors are elected by the affirmative vote of a plurality ofthe votes cast by our shareholders at Vanguard’s annualmeeting of shareholders. Once elected, each director serves untilthe next annual meeting of shareholders and until his or hersuccessor is duly elected and qualified, or until his or herearlier death, resignation or removal.

                       We currently have no standing committees of our Board of Directors.Pursuant to our shareholders agreement, the MSCP Funds have theright to appoint one member to each committee of our Board ofDirectors.

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**Item 11.        Executive Compensation.**

                       The following table sets forth, for our last three fiscal yearsended June 30, 2003, the compensation earned by our Chief ExecutiveOfficer and our four other most highly compensated executiveofficers.  We refer to these persons as our named executiveofficers.

**Summary Compensation Table**

** **

 

**Annual Compensation**

 

**Long-Term Compensation**

** **

 
****
 
****
**Name and Principal Position**

 

**Fiscal Year**

 

**Salary ($)**

 

**Bonus ($)**

 

**Other Annual Compensation ($) (a)**

 

**Securities Underlying Options (#)**

 

**All Other Compensation ($) (b)**

 

**Charles N. Martin, Jr.**    Chairman of the Board & Chief ExecutiveOfficer

2003

900,000

540,000

0

0

9,564

 

2002

 

900,000

 

0

 

0

 

975

 

7,422

 

 

 

2001

 

700,008

 

0

 

0

 

0

 

7,422

 

 

 

 

 

 

 

 

 

 

 

 

 

 

**William L. Hough**    President & Chief Operating Officer

2003

550,000

330,000

0

0

5,500

 

2002

 

550,000

 

0

 

0

 

293

 

5,100

 

 

 

2001

 

428,016

 

0

 

0

 

0

 

5,100

 

 

 

 

 

 

 

 

 

 

 

 

 

 

**Joseph D. Moore**    Executive Vice President, Chief FinancialOfficer    & Treasurer

2003

500,000

200,000

0

0

0

 

2002

 

500,000

 

0

 

0

 

293

 

0

 

 

 

2001

 

369,504

 

0

 

0

 

0

 

0

 

 

 

 

 

 

 

 

 

 

 

 

 

 

**Keith B. Pitts**    Vice Chairman

2003

550,000

330,000

0

0

6,310

 

2002

 

550,000

 

0

 

0

 

293

 

5,640

 

 

 

2001

 

428,016

 

0

 

374,365

 

8,409

 

5,640

 

 

 

 

 

 

 

 

 

 

 

 

 

 

**Dale S. St. Arnold (c)**    Senior Vice President-Operations

2003

378,000

378,000

2,496

250

405

 

2002

 

7,269

 

50,000

 

5,000

 

200

 

0

 

** **

 

2001

 

0

 

0

 

0

 

0

 

0

 

____________________

(a)

An “0” in this column means that no suchcompensation was paid other than perquisites and other personalbenefits which have not been included because their aggregate valueprovided to any of the named executive officers was below thereporting threshold established by the Securities and ExchangeCommission.  Other Annual Compensation of $374,365 for Mr.Pitts in fiscal 2001 represents our payment to him of this amountto reimburse him for certain relocation expenses in his move toNashville to commence employment with Vanguard.  Other AnnualCompensation for Mr. St. Arnold in fiscal 2002 and 2003 of $5,000and $2,496, respectively, represents payment to him to reimbursehim for certain relocation expenses in his move to Phoenix,Arizona, to commence employment with Vanguard.

 

 

 

(b)

The amounts disclosed under All Other Compensation in theSummary Compensation Table represent for the named executiveofficers in fiscal 2003 (i) the following amounts of our matchingcontributions made under our 401(k) Plan:  Mr. Martin: $6,000;Mr. Hough: $5,500; Mr. Moore: $0; Mr. Pitts: $5,500; and Mr. St.Arnold: $0; and (ii) the following amounts of insurance premiumspaid by Vanguard with respect to group term life insurance: Mr. Martin: $3,564; Mr. Hough: $0; Mr. Moore: $0; Mr. Pitts: $810;and Mr. St. Arnold: $405.  The amounts disclosed under AllOther Compensation in the Summary Compensation Table represent forthe named executive officers in fiscal 2002 (i) the followingamounts of our matching contributions made under our 401(k)Plan:  Mr. Martin: $5,100; Mr. Hough: $5,100; Mr. Moore: $0;Mr. Pitts: $5,100; and Mr. St. Arnold: $0; and (ii) the followingamounts of insurance premiums paid by Vanguard with respect togroup term life insurance:  Mr. Martin: $2,322; Mr. Hough: $0;Mr. Moore: $0; Mr. Pitts: $540; and Mr. St. Arnold: $0.  Theamounts disclosed under All Other Compensation in the SummaryCompensation Table represent for the named executive officers infiscal 2001 (i) the following amounts of our matching contributionsmade under our 401(k) Plan:  Mr. Martin: $5,100; Mr. Hough:$5,100; Mr. Moore: $0; and Mr. Pitts: $5,100; and (ii) thefollowing amounts of insurance premiums paid by Vanguard withrespect to group term life insurance:  Mr. Martin: $2,322; Mr.Hough: $0; Mr. Moore: $0; and Mr. Pitts: $540.

 

 

 

(c)

Mr. St. Arnold commenced employment with us in June 2002.

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**Stock Option Grants During Fiscal 2003**

                       In the fiscal year ended June 30, 2003, the grants of stock optionsunder our stock-based employee benefit plans to the named executiveofficers were as follows:

 

 

**Number of Securities Underlying Options Granted (#)**

** **

**Percent of Total Options Granted to Employees in Fiscal Year (%)**

 

**Exercise Price ($/Sh)**

 

**Market Price on Date of Grant ($/Sh)**

 

**Expiration Date**

** **

**Potential Realizable Values at Assumed Annual Rates of Stock Price Appreciation for Option Term ($)(a)**
****
 

 

 

 

 

 

 

 

 

 

**0%**

** **

**5%**

** **

**10%**

Charles N. Martin, Jr.

 

–

 

–

 

–

 

–

 

–

 

–

 

–

–

William L. Hough

 

–

 

–

 

–

 

–

 

–

 

–

 

–

–

Joseph D. Moore

 

–

 

–

 

–

 

–

 

–

 

–

 

–

–

Keith B. Pitts

 

–

 

–

 

–

 

–

 

–

 

–

 

–

–

Dale S. St. Arnold

 

200 (b)

 

 

1,701.18

 

1,701.18

 

8/09/12

 

0

213,973

 

542,249

50 (c)

1,701.18

1,701.18

5/08/13

0

53,493

135,562

250

5.0

____________________

(a)

In accordance with the rules of the Securities and ExchangeCommission (the “SEC”), shown are the gains or“option spreads” that would exist for the respectiveoptions granted.  These gains are based on the assumed ratesof annual compound stock price appreciation of 5% and 10% from thedate the option was granted over the full option term.  Theseassumed annual compound rates of stock price appreciation aremandated by the rules of the SEC and do not represent our estimateor projection of our future common stock prices.

 

 

 

(b)

These options vest on the following schedule if Mr. St. Arnoldis still employed by us on each such date: 26 on January 1, 2004;51 on January 1, 2005; 50 on January 1, 2006; 49 on January 1,2007; and 24 on January 1, 2008. Vested options become exercisableupon the occurrence of a Liquidity Event (as defined in Item 13under the caption “Shareholders Agreement”).

 

 

 

(c)

25% of the stock options vest on each of the first fouranniversaries of the May 8, 2003 grant date of these options if Mr.St. Arnold is still employed by us on each such date.  Vestedoptions become exercisable upon the occurrence of a LiquidityEvent.

**Stock Option Exercises, Holdings and Fiscal Year-EndValues**

                       The following table sets forth information with respect to thenamed executive officers concerning their exercise of stock optionsduring the fiscal year ended June 30, 2003 and in respect of thenumber and value of unexercised options held by each of them as ofJune 30, 2003.

**Name**

 

**Shares Acquired on Exercise (#)**

 

**Value Realized ($)**

 

**Number of Securities Underlying Unexercised Options At Fiscal Year-End(#)**

 

**Value of Unexercised In-the-Money Options At Fiscal Year-End($)(a)**
****
 

 
****
 
****
 
****
** **

 

 

 

 

 

**Exercisable**

  

**Unexercisable (b)**

 

**Exercisable**

 

**Unexercisable**

** **

 

 

 

 

 
****
 
****
Charles N. Martin, Jr.

0

 

0

 

587

 

 

11,423

   

 

898,732

 

17,489,298

William L. Hough

0

 

0

 

359

 

 

3,427

   

 

549,650

 

5,246,943

Joseph D. Moore

0

 

0

 

310

 

 

3,427

   

 

474,629

 

5,246,943

Keith B. Pitts

0

 

0

 

0

 

 

8,702

   

 

0

 

13,323,284

Dale S. St. Arnold

0

 

0

 

0

 

 

450

   

 

0

 

0

____________________

(a)

There was no public market for our common stock at June 30,2003.  The dollar values of unexercised in-the-money optionsrepresent the difference between the assumed fair market value of$1,701.18 per share at June 30, 2003 and the exercise prices of theoptions.

 

 

 

(b)

All of the options set forth in this column (except for 5,275 ofthe options granted to Mr. Pitts and the 450 options granted to Mr.St. Arnold) were options granted under our Carry Option Plan, asdescribed in Item 13 under the caption “Our OptionPlans.”

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**Director Compensation**

                       Directors do not receive any compensation for their services. Wedo, however, reimburse them for travel expenses and otherout-of-pocket costs incurred in connection with attendance atmeetings of our Board of Directors, and they are eligible toreceive options pursuant to certain of our option plans, asdescribed in Item 13 under the caption “Our OptionPlans.” To date, however, no non-employee directors have beengranted options.

**Our Employment Agreements**

                       On June 1, 1998, we entered into written employment agreements withour Chief Executive Officer, Chief Operating Officer and ChiefFinancial Officer (Messrs. Martin, Hough, and Moore, respectively)for terms expiring on June 1, 2003, with provisions forrenewal.  Pursuant to the renewal provisions of theseagreements, on June 1, 2003 the term of each of these agreementswas automatically extended until June 1, 2004,  and on June 1,2004, and on each anniversary of such date, the term of each suchagreement will automatically renew for another one year term,unless any such agreement in terminated by us or by the employee bydelivering notice of termination no later than 90 days before theend of any such renewal term.  On September 1, 1999, weentered into a written employment agreement with Keith B. Pitts tobe our Executive Vice President for a term expiring on September 1,2004, with provisions for renewal. Effective May 31, 2001, Mr.Pitts was promoted to the position of Vice Chairman of our Board.The base salaries of Messrs. Martin, Hough, Moore and Pitts undersuch written employment agreements are, as of June 30, 2003,$900,000, $550,000, $500,000, and $550,000, respectively. Pursuant to these agreements these officers are to have an annualbonus plan giving each of them an opportunity to earn an annualbonus in such amount as our Board of Directors should determine, aswell as pension, medical and other customary employeebenefits.  The terms of these agreements state that if theemployee terminates his employment for Good Reason or if we breachthe terms of the agreement and terminate the employee, he willreceive within a specified time after the termination a payment ofup to three times his annual salary plus the average of the bonusesgiven to him in the two years immediately preceding histermination.

**Our Severance Protection Agreements**

                       We provide our executives at the Vice President level and above(other than Messrs. Martin, Hough, Moore, Pitts and our GeneralCounsel, Ronald P. Soltman, who has a written employment agreementcontaining severance provisions) with severance protectionagreements granting them severance payments in amounts of 200% to250% of annual salary and bonus. Generally, severance payments aredue under these agreements if a change in control (as defined)should occur and employment of the officer is terminated during theterm of the agreement by us (or our successor) or by the employeefor Good Reason. In addition, these agreements state that in theevent of a Potential Change in Control (defined as the time atwhich an agreement which would result in a change in control issigned, an acquisition attempt relating to us is publicly announcedor there is an increase in the number of shares owned by one of ourten-percent shareholders by five percent or more), the employeeshave an obligation to remain in our employ until the earliest of(i) six months after the Potential Change in Control; (ii) a changein control; (iii) a termination of employment by us; or (iv) atermination of employment by the employee for Good Reason (treatingPotential Change in Control as a change in control for the purposesof determining whether the employee had a Good Reason) or due todeath, disability or retirement.

                       Mr. Dale S. St. Arnold, one of the named executive officers, has aseverance protection agreement granting him severance payments,after a change of control, in the amount of 250% of his annualsalary and bonus and otherwise having the provisions describedabove.  In addition, Mr. St. Arnold has an arrangement with usto pay him 100% of his salary, in monthly installments over twelvemonths, plus employer-subsidized medical benefits for twelvemonths, if he is terminated without cause prior to a change ofcontrol and prior to June 30, 2004.

**Compensation Committee Interlocks and InsiderParticipation**

                       During fiscal 2003, we had no compensation committee of our Boardof Directors.  Messrs. Martin, Hough, Moore and Pitts, four ofthe named executive officers, during fiscal 2003 participated indeliberations of our Board of Directors concerning executiveofficer compensation.

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                       During fiscal 2003, three of our executive officers, Charles N.Martin, Jr., Keith B. Pitts, and James H. Spalding, served asexecutive officers and members of the Board of Directors ofNetContent, Inc. and during fiscal 2003 NetContent had nocompensation committee of its Board of Directors.  Two of suchexecutive officers, Messrs. Martin and Pitts, served on our Boardof Directors during fiscal 2003.  Messrs. Martin, Pitts andSpalding received no compensation for serving as executive officersand directors of NetContent during such period.

**Item 12.        Security Ownership of Certain Beneficial Owners andManagement.**

                       The following table presents information regarding beneficialownership of shares of our Common Stock and Preferred Stock, as ofSeptember 15, 2003, by:

                    •

  

each person we know to be the beneficial owner of 5% or more ofour Common Stock or our Preferred Stock;

 

 

 

                    •

 

each of our executive officers listed in the summarycompensation table;

 

 

 

                    •

 

the members of our Board of Directors; and

 

 

 

                    •

 

all our current directors and executive officers as a group.

                       When reviewing the following table, you should be aware that:

                   •

   

The amounts and percentage of Common Stock and Preferred Stockbeneficially owned are reported on the basis of regulations of theSEC governing the determination of beneficial ownership ofsecurities. Under the rules of the SEC, a person is deemed to be a“beneficial owner” of a security if that person has orshares “voting power,” which includes the power to voteor to direct the voting of such security, or “investmentpower,” which includes the power to dispose of or to directthe disposition of such security. A person is also deemed to be abeneficial owner of any securities of which that person has a rightto acquire beneficial ownership within 60 days. Under these rules,more than one person may be deemed a beneficial owner of securitiesas to which he has no economic interest.

 

  

 

                   •

   

Except as otherwise indicated in the footnotes to the table,each stockholder identified in the table possesses sole voting andinvestment power over all shares of stock shown as beneficiallyowned by such stockholder.

 

  

 

                   •

   

We have one series outstanding of Preferred Stock, ourPayable-In-Kind Cumulative Redeemable Convertible PreferredStock.

 

  

 

                   •

   

Unless otherwise indicated below, the address of each individualor entity listed in the table is 20 Burton Hills Boulevard, Suite100, Nashville, Tennessee 37215.

** **

** **

**Common Stock of Vanguard**

**Preferred Stock of Vanguard**

** **

** **
********
** **

** **

**Number of Shares**

** **

**Percent of Class**

** **

**Number of Shares**

** **

**Percent of Class**

** **

** **
********
**Beneficial Owners:**

 

 

 

 

 

 

 

 

   

 

 

   

MSCP Funds(1)

 

 

191,416

 

 

 

81.0

 %

 

 

–

 

 

 

–

   

The MacNeal Memorial Hospital Association(2)

 

 

–

 

 

 

–

 

 

 

25,194

 

 

 

100.0

%

Baptist Health Services(3)

–

–

30,000

100.0

%

Charles N. Martin, Jr.(4)

 

 

44,678

 

 

 

18.9

 

 

 

 

 

 

–

    

William L. Hough(5)

 

 

5,487

 

 

 

2.3

 

 

 

–

 

 

 

–

    

Joseph D. Moore(6)

 

 

5,144

 

 

 

2.2

 

 

 

–

 

 

–

    

Keith B. Pitts

 

 

118

 

 

 

*

 

 

 

–

 

 

 

–

    

Dale S. St. Arnold

90

*

–

–

Ronald P. Soltman(7)

 

 

3,952

 

 

 

1.7

 

 

 

–

 

 

 

–

    

Karen H. Bechtel(8)

 

 

–

 

 

 

–

 

 

 

–

 

 

 

–

    

Eric T. Fry(8)

 

 

–

 

 

 

–

 

 

 

–

 

 

 

–

    

Howard I. Hoffen(8)

 

 

–

 

 

 

–

 

 

 

–

 

 

 

–

    

All directors and executive officers as a group (19 persons)

 

 

44,678

 

 

 

18.9

 

 

 

–

 

 

 

–

    

____________________

*

Signifies less than 1%.

 

 

 

(1)

The MSCP Funds consist of Morgan Stanley Capital Partners III,L.P., MSCP III 892 Investors, L.P., Morgan Stanley CapitalInvestors III, L.P., Morgan Stanley Dean Witter Capital PartnersIV, L.P., MSDW IV 892 Investors, L.P., and Morgan Stanley DeanWitter Capital Investors IV, L.P.  The address of each suchentity is 1585 Broadway, New York, New York 10036.

 

 

 

(2)

Michael P. Kenahan, President of MacNeal Memorial HospitalAssociation, possesses sole voting and investment power over thepreferred shares listed in this table as being owned by The MacNealMemorial Hospital Association, subject to specific direction at anytime by the Board of Directors of MacNeal Memorial HospitalAssociation.  The address of both The MacNeal MemorialHospital Association and of Mr. Kenahan is 3249 South Oak ParkAvenue, Berwyn, Illinois 60402.  The shares of our preferredstock owned by The MacNeal Memorial Hospital Association and listedin this table are shares of our Payable In Kind CumulativeRedeemable Convertible Preferred Stock, with an annual dividendrate of $80.00 per share, issued  pursuant to a Certificate ofDesignations, Preferences and Rights filed with the Secretary ofState of the State of Delaware on January 31, 2000. These shareshave a liquidation preference over our common stock (and any otherclass of equity securities that we may issue that is junior tothese shares) equal to $1,000 per share plus all accrued and unpaiddividends to the date of any liquidation, dissolution or windingup. These shares rank on a parity (with respect to dividends andupon liquidation, dissolution, winding up or otherwise) with theshares of preferred stock listed in this table as being held byBaptist Health Services.  20,000 of the shares were issued inpartial payment of the purchase price for our acquisition onFebruary 1, 2000 of MacNeal Hospital, Berwyn, Illinois, and thebalance of the shares were subsequently issued as pay-in-kinddividends on outstanding shares.

 

 

 

(3)

Jerry Probst, President and Chief Executive Officer of BaptistHealth Services (formerly known as Baptist Health System),possesses sole voting and investment power over the preferredshares listed in this table as being owned by Baptist HealthServices, subject to specific direction at any time by the Board ofDirectors of Baptist Health Services. The address of both BaptistHealth Services and Mr. Probst is 615 Soledad Street, Suite 315,San Antonio, Texas 78209. The shares of our preferred stock ownedby Baptist Health Services and listed in this table are shares ofour Payable In Kind Cumulative Redeemable Convertible PreferredStock, Series B, with an annual dividend rate of $62.50 per share,issued  pursuant to a Certificate of Designations, Preferencesand Rights filed with the Secretary of State of the State ofDelaware on December 17, 2002. These shares have a liquidationpreference over our common stock (and any other class of equitysecurities that we may issue that is junior to these shares) equalto $1,000 per share plus all accrued and unpaid dividends to thedate of any liquidation, dissolution or winding up. These sharesrank on a parity (with respect to dividends and upon liquidation,dissolution, winding up or otherwise) with the shares of preferredstock listed in this table as being held by The MacNeal MemorialHospital Association. These 30,000 shares were issued in partialpayment of the purchase price for our acquisition on January 3,2003 of the assets constituting five acute care hospitals (andrelated health care assets) known as the Baptist Health System inand around San Antonio, Texas.

 

 

 

(4)

Includes 3,396 shares which Mr. Martin has the right to acquireupon the exercise of stock options. Includes 25,096 sharesbeneficially owned by Mr. Martin solely as a result of his rightsto vote these 25,096 shares under the Voting Proxy Agreementdiscussed below. Mr. Martin has no economic interest in these25,096 shares. Mr. Martin beneficially owns 19,582 shares in whichhe has an economic interest (including 587 shares which wouldresult from the exercise of stock options) and which represent 8.3%of the class.

 

 

 

(5)

Includes 359 shares which Mr. Hough has the right to acquireupon the exercise of stock options.

 

 

 

(6)

Includes 310 shares which Mr. Moore has the right to acquireupon the exercise of stock options.

 

 

 

(7)

Includes 228 shares which Mr. Soltman has the right to acquireupon the exercise of stock options.

 

 

 

(8)

Mr. Hoffen is the Chairman and Chief Executive Officer of MorganStanley Private Equity.  Ms. Bechtel and Mr. Fry are ManagingDirectors of Morgan Stanley Private Equity.  Messrs. Fry andHoffen and Ms. Bechtel each disclaim beneficial ownership of theshares of common stock beneficially owned by the MSCP Funds whichare managed by Morgan Stanley Private Equity, except to the extentof any direct pecuniary interest therein.  The address of eachsuch person is 1585 Broadway, New York, New York 10036.

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**EQUITY COMPENSATION PLAN INFORMATION**

                       The following table gives information about our common stock thatmay be issued upon the exercise of options, warrants and rightsunder all of our existing equity compensation plans as of June 30,2003.

** **

** **

**Equity Compensation Plan Information**

** **

** **
****
**Plan Category**

** **

**Number of securities to be issued upon exercise of outstanding options, warrants and rights**

** **

**Weighted-average exercise price of outstanding options, warrants and rights**

** **

**Number of securities remaining available for future issuance under equity compensation plans (excluding securities reflected in column (a))**

** **

** **
****
 

** **

**(a)**

 

**(b)**

**(c)**

 Equity compensation plans approved by    security holders

**  **

              55,161

 

$   652

             1,792 (1)(2)

 Equity compensation plans not approved    by security holders

**  **

                       0

 

         0

                    0

 Total

** **

              55,161

 

$   652

             1,792

____________________

(1)

Represents 382 shares remaining available for future issuancesof options under our 1998 Stock Option Plan and 1,410 sharesremaining available for future issuances of options under our 2000Stock Option Plan.

 

 

 

(2)

Up to 2,977 more shares would become available for futureissuance of options under our 1998 Stock Option Plan if a LiquidityEvent should occur and a certain financial test is met relating toshareholder returns on their investment in our shares.  Up to28,697 more shares would become available for the issuance ofoptions under the 2000 Stock Option Plan if the MSCP Funds and/orCharles N. Martin, Jr. were to purchase additional shares of ourcommon stock pursuant to the subscription agreement dated June 1,2000, and if so, shares would be added to the 2000 Stock OptionPlan at the rate of 17.647% of the shares so purchased by the MSCPFunds and 10% of the shares so purchased by Mr. Martin.

**Item 13.        Certain Relationships and Related Transactions.**

**                       *Founders***

                       Vanguard was founded in July 1997 by four of its directors andexecutive officers mentioned above, Messrs. Martin, Hough, Mooreand Soltman, and by an affiliate of the MSCP Funds. Initially, the individual founders funded the start-up operationsof Vanguard with short-term loans.  In August 1997 the fourindividual founders and certain other current members of managementpurchased for cash shares of our common stock and the short-termloans were repaid with the proceeds of the share purchases. In addition, in August 1997 the affiliate of the MSCP Fundspurchased for cash shares of our preferred stock.  We redeemedthose preferred shares for cash in June 1998.

**                       *Shareholders Agreement***

                       As noted above, the MSCP Funds currently own, collectively, 81% ofour outstanding shares of common stock. The MSCP Funds and all theother shareholders in Vanguard have entered into a shareholdersagreement governing their ownership of our common stock. Thefollowing is a summary of the material terms included in theshareholders agreement.

                   •

 

The shareholders agreement provides that our Board of Directorsis to be made up of eight members, five of which are to benominated by management shareholders and three of which are to benominated by the MSCP Funds. Despite the foregoing, at all timesthe MSCP Funds have the right to nominate a fourth member to ourBoard, in which event one of the management directors

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will resign. Currently, Ms. Bechtel and Messrs. Fry and Hoffenare directors nominated by the MSCP Funds. Also, at any time afterJanuary 1, 2005, the MSCP Funds have the right to nominate amajority of our Board if the MSCP Funds exercise their additionalright under the shareholders agreement to require all othershareholders to transfer their shares to the same prospectivepurchaser to whom and at the same price at which the MSCP Fundshave agreed to sell their shares of our common stock. The MSCPFunds also have the right to designate one member of each committeeof our Board.

 

 

 

                   •

 

The shareholders have agreed not to transfer any of their sharesother than to permitted transferees, and that their shares will besubject to certain “tag along” and “firstoffer” rights upon share transfer.

 

 

 

                   •

 

If the MSCP Funds decide to sell all of their shares to a thirdparty, they can require that the other shareholders who are partiesto the shareholders agreement sell all of their shares to athird-party purchaser chosen by the MSCP Funds, at the pricenegotiated by the MSCP Funds and the third-party purchaser but, ifthe sale is prior to January 1, 2005, the other shareholders havethe right to purchase all of the shares held by the MSCP Funds inlieu of selling their shares to the third-party purchaser.

 

 

 

                   •

 

Mr. Martin is generally prohibited from disposing of sharesunless, at the time of the disposition, the proportion of hisshareholdings that he has disposed of does not exceed theproportion of shareholdings disposed of by the MSCP Funds.

 

 

 

                   •

 

The MSCP Funds and the other shareholders, under specifiedcircumstances and subject to certain conditions, have the right torequire us to register their shares under the Securities Act and toparticipate in specified registrations of shares by us.

 

 

 

                   •

 

We have agreed to pay reasonable fees and expenses of the MSCPFunds incurred in reviewing the health care facilities which wepropose to purchase from time to time.

 

 

 

                   •

 

If the MSCP Funds receive aggregate net proceeds upon aLiquidity Event that are less than what they have invested inVanguard, they may require us to repurchase from our ManagementInvestors an aggregate of 24,187 shares at the lower of cost ormarket value at the time of such notice. Morgan Stanley Dean WitterCapital Partners IV, L.P. (“MSCP IV”) can require thatwe, or we can elect under certain circumstances to, pay thepurchase price by delivery of a 3-year note, bearing interest at 1%over the 3-year U.S. Treasury bond rate, in lieu of cash. If ourcredit agreements do not permit such a purchase, then the MSCPFunds are permitted to purchase the shares directly from theManagement Investors for cash.

 

 

 

                   •

 

So long as the MSCP Funds own at least 15% of our outstandingcommon stock, we have agreed not to take certain important actionswithout the prior approval of MSCP IV including, but not limitedto, the following:

 

 

 

 

                   

 

•

issuances of equity or equity-type securities or payments ofdividends on our capital stock;

 

 

 

 

 

 

•

approval of our annual business plan and budget and of anylong-term strategic plan;

 

 

 

 

 

 

•

the appointment or removal of our Chief Executive Officer or anychange in the compensation of our executive management;

 

 

 

 

 

 

•

incurrence, refinancing or discharge of indebtedness in excessof 10% of our consolidated assets;

 

 

 

 

 

 

•

purchases or sales of assets having a value in excess of 10% ofour consolidated assets, other than in the ordinary course of our business;

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•

a merger, consolidation, reclassification, reorganization,liquidation, dissolution, voluntary bankruptcy or similar significant corporate events;

 

 

 

 

 

 

•

changes in our auditors, financial accounting policies or taxpolicies;

 

 

 

 

 

 

•

transactions with our affiliates or affiliates of ourmanagement;

 

 

 

 

 

 

•

capital expenditures exceeding 5% of our consolidated assets forany given project or in any fiscal year;

 

 

 

 

 

 

•

employment of investment bankers; and

 

 

 

 

 

 

•

any other material transaction.

                       The above-mentioned provisions of the shareholders agreement willterminate in the event of an initial public offering of our commonstock, the sale of our company or the sale by the MSCP Funds oftheir shares of our Common Stock (each a “LiquidityEvent”). Upon the occurrence of a Liquidity Event, a separateshareholders agreement will become effective which will govern theownership of our Common Stock among our current shareholders. Thefollowing is a summary of the material terms included in thisseparate shareholders agreement.

                   •

 

Shares received upon the exercise of options granted under theCarry Option Plan described below may not be transferred for aperiod of one year after our initial public offering.

 

 

 

                   •

 

Mr. Martin is generally prohibited from disposing of sharesunless, at the time of the disposition, the proportion of hisshareholdings that he has disposed of does not exceed theproportion of shareholdings disposed of by the MSCP Funds.

 

 

 

                   •

 

The MSCP Funds and the other shareholders, under specifiedcircumstances and subject to certain conditions, have the right torequire us to register their shares under the Securities Act and toparticipate in specified registrations of shares by us.

 

 

 

                   •

 

As long as the MSCP Funds own at least 5% of our outstandingshares, they will have the right to designate two Board members andone member of each committee of our Board.

                       As a result of their stock ownership, their positions with Vanguardand the shareholders and related agreements described herein, ourexecutive management and the MSCP Funds control us and have thepower to elect all of our directors. As a result of their holding81% of our outstanding shares of common stock and their rightsunder the shareholders agreement, the MSCP Funds have significantinfluence over our management and policies and over any actionrequiring the approval of the holders of our common stock,including amendments to our certificate of incorporation,acquisitions or sales of all or substantially all of our assets.Circumstances may occur in which the interests of the MSCP Fundscould be in conflict with the interests of our other shareholdersor the holders of our 9.75% Notes.  In addition, the MSCPFunds may have an interest in pursuing transactions that, in theirjudgment, enhance the value of their equity investment in ourcompany, even though those transactions may involve risks to ourshareholders or the holders of the 9.75% Notes.

**                       *Subscription Agreement***

                       Under a subscription agreement dated June 1, 2000, between us andcertain investors, including the MSCP Funds and our executiveofficers, to fund the purchase of hospitals, hospital systems,hospital management companies and related assets, we authorized theissuance and sale of 235,521 shares of common stock at a price of$1,701.18 per share. As of September 15, 2003, we have sold 75,443shares pursuant to this subscription agreement. According to itsterms, the obligation of the MSCP Funds to purchase shares issubject to the approval of the Investment Committee of MorganStanley Capital Partners. The subscription agreement also entitlesthe MSCP Funds and their affiliates an exclusive right of firstoffer to provide equity and equity-linked financing to us (exceptfor equity issued by us or our subsidiaries in connection withhospital or hospital system acquisitions).

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**                       *Letter Agreement***

                       On June 1, 1998, we signed a letter agreement with our existingshareholders at that date under which we agreed that if, inconnection with a Management Investor’s ownership of sharesof our common stock acquired prior to June 1, 1998 (“InitialShares”), we become entitled to any tax deduction in respectof the Initial Shares, we will pay to such Management Investor theamount of the benefit, when we actually receive the economicbenefit of the deduction.  As of this time, we have notreceived any benefits which we would be obligated to pay to theManagement Investors under this agreement.

**                       *Our Option Plans***

                       In June 1998, we established a stock option plan (the “1998Stock Option Plan”) which is available for stock optionawards from time to time to our officers, key employees, directorsand consultants, including key employees of acquired hospitals.Except as described below, the terms of this option plan state thatthe options will vest ratably over a term of four years and thatall options will accelerate immediately upon a change in control(as defined in the plan). In addition, all optionees must consentin their option agreements to be bound by the terms of theshareholders agreements referred to above. A certain percentage ofthe options granted pursuant to the 1998 Stock Option Plan (atleast 75% percent of those issued) must be forfeited to us if theinvestment gains received by the MSCP Funds upon a Liquidity Eventare less than a predetermined amount and, accordingly, theseoptions may not be exercised prior to a Liquidity Event. Themaximum number of shares of our Common Stock reserved for the grantof options under this plan is 13,306, subject to a readjustmentupon the occurrence of a Liquidity Event. As of June 30, 2003,options to purchase 9,920 shares have been granted and remainoutstanding under this plan and 27 shares of common stock have beenissued upon the exercise of options under this plan. Of theremaining authorized options, 382 are available for grant, while2,977 are held in suspense until a Liquidity Event shall occur anda certain financial test set forth in the plan relating toshareholder returns on their investment in our shares is met.

                       In June 2000, we established another stock option plan (the“2000 Stock Option Plan”) which is available for stockoption awards from time to time to our officers, key employees,directors and consultants, including key employees of acquiredhospitals. The terms of this option plan are substantially similarto those of the 1998 Stock Option Plan, including the forfeitureprovisions described above. The maximum number of shares of CommonStock reserved for the grant of options under this plan is 41,931shares or a lesser number based upon a formula relating to recentissuances of our common stock to our shareholders. As of June 30,2003, options to purchase 13,234 shares are authorized for grantunder this plan and options to purchase 11,824 shares have beengranted and remain outstanding under this plan.

                       In June 1998, we established a Carry Option Plan under whichoptions to purchase our shares may be granted to certain keyemployees. The options granted under this plan vest ratably overseven years and become fully vested upon a Liquidity Event. Theseoptions are exercisable only upon a Liquidity Event and only to anextent determined pursuant to a schedule based on the returnsearned by the MSCP Funds on their aggregate investment in ourCommon Stock. Pursuant to our shareholders agreement, the MSCPFunds and certain other shareholders may be obligated to forfeit upto 25% of the shares of our common stock which they own, dependingupon the extent of the investment gains of the MSCP Funds upon aLiquidity Event, to fund options granted under this plan toemployees. Options to purchase 29,822 shares were authorized forgrant under this plan at a price per option equal to 10% of thefair market value of the related underlying share, and, as of June30, 2003, options to purchase all 29,822 shares have been grantedunder this plan to key employees, including Messrs. Martin, Hough,Moore, Pitts and Soltman.

                       Effective June 1998, we established a Nonqualified Initial OptionPlan under which we granted options to purchase an aggregate of3,595 shares to certain of our employees on June 1, 1998. Most ofthe options granted under this plan were made to our employees whoworked for us during 1997 and 1998 either with no cash salaries orwith salaries below fair market value. These options were grantedwith an exercise price equal to 10% of the purchase price that wecharged purchasers of our shares of Common Stock on June 1,1998.

                       All of the options which we have granted under the 1998 StockOption Plan, the 2000 Stock Option Plan, the Nonqualified InitialOption Plan and the Carry Option Plan have been granted to ourofficers and other employees. We believe that the past and futuregrants of options to purchase our Common Stock under theseplans

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have assisted and will assist us in retaining and recruitingemployees of outstanding ability. Stock option grants provide anincentive that focuses the employee’s attention on managingor working for the business of our company from the perspective ofan owner with an equity stake in the business and helps ensure thatoperating decisions are based on long-term results that benefit thebusiness and ultimately our shareholders. Usually, each stockoption granted under these plans becomes vested and exercisableonly over a period of time or upon a Liquidity Event. Generally,the exercise prices of options granted under the 1998 Stock OptionPlan and the 2000 Stock Option Plan have been equal to the fairmarket value of our shares at the time of grant, subject todownward adjustment in the event of superior investment gains bythe MSCP Funds upon a Liquidity Event, while options granted underthe Carry Option Plan and the Initial Option Plan are granted atexercise prices equal to 10% of such fair market value. The numberof shares covered by each grant is intended to reflect thegrantee’s level of responsibility and past and anticipatedcontributions.

                       Each of our option plans provides that, in the event of anyrecapitalization, reclassification, merger, consolidation, stocksplit, or combination or exchange of shares, or other similartransaction, the number of shares of our common stock available forawards, the number of such shares covered by outstanding awards,the option price and any other relevant provisions of the plan willbe equitably adjusted by our board or compensation committee toreflect such event and preserve the value of such options.

***                       Our Voting Proxy Agreement***

                       Each of our shareholders (other than the MSCP Funds) has enteredinto a voting proxy agreement in which the shareholder has grantedMr. Martin (or, if Mr. Martin is no longer employed by us or is nolonger one of our directors, Mr. Moore) an irrevocable proxy tovote that shareholder’s shares of Common Stock in such manneras Mr. Martin, in his sole discretion, deems proper. Furthermore,Mr. Martin has been authorized under the voting proxy agreement toissue any consent or waiver on behalf of the shareholder under ourshareholders agreement and related agreements. The voting proxyagreement terminates upon the earlier of (i) the consummation of aLiquidity Event and (ii) June 1, 2008.

                       Mr. Martin has used his rights under the voting proxy agreement tonominate himself and Messrs. Hough, Moore, Pitts and Soltman as thedirectors to be nominated by the management shareholders pursuantto our shareholders agreement.

**                       *Our Related Party Transactions***

                       Charles N. Martin, Jr., our Chairman and Chief Executive Officer,beneficially owns in excess of 97% of the membership interests inThe Healthcare Airplane Group, LLC, a Tennessee limited liabilitycompany, and is its Chief Executive Officer.  We own anapproximately 0.4% membership interest in The Healthcare AirplaneGroup.  The Healthcare Airplane Group’s principal assetis a Falcon model 20F-731 10-passenger jet airplane.  We paidThe Healthcare Airplane Group approximately $506,000 during thefiscal year ended June 30, 2003 to charter the plane from time totime, to fly our employees to and from the sites of our proposedacquisitions and for other corporate purposes.  These charterpayments were made in the ordinary course of our business, and webelieve that the prices paid to The Healthcare Airplane Group forthese charter services were more favorable to us than those charterrates which we could have obtained for comparable plane servicesfrom an independent airplane charter company.

                       During fiscal 2003, we paid $150,000 of the out-of-pocket expensesof the MSCP Funds related to their review of our proposedtransactions and travel and related expenses.  During fiscal2003, we also paid Morgan Stanley Senior Funding, Inc. a consentfee of $12,500 in respect of their agreement to an amendment to our2001 credit facility.  As of September 15, 2003, the MSCPFunds owned 81.0% of our common stock. In addition, three of ourdirectors, Karen H. Bechtel, Eric T. Fry and Howard I. Hoffen, aremanaging directors of Morgan Stanley & Co. Incorporated and twoof them, Karen H. Bechtel and Eric T. Fry, are managing directorsof Morgan Stanley Private Equity while Howard I. Hoffen is Chairmanand Chief Executive Officer of Morgan Stanley Private Equity.Morgan Stanley & Co. Incorporated, Morgan Stanley PrivateEquity and Morgan Stanley Senior Funding, Inc. are affiliates ofthe MSCP Funds.

                       During fiscal 2003, certain of our facilities paid approximately$415,000 to Coactive Systems Corporation for nurse triage,physician referral and class registration services and CoactiveSystems reimbursed us

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approximately $31,800 for our full rental cost in connectionwith its month-to-month occupancy of certain office space in ourheadquarters not currently needed by us.  In addition, infiscal 2003 Coactive Systems paid us approximately $20,800 toreimburse us for our costs of its phone use while occupying suchoffice space in our headquarters and for an allocation in respectof our cost of certain office services.  The above aggregateamount paid by our facilities to Coactive Systems resulted fromseveral contracts separately negotiated with Coactive Systems bylocal management of each facility on an arms-length basis and inour opinion such amount paid by our facilities does not exceed thefair market value for such services.  Until Coactive Systemswas acquired by means of a merger with First Consulting Group, Inc.on May 30, 2003, our Chairman & Chief Executive Officer,Charles N. Martin, Jr., owned approximately 41.5% of the CommonStock of Coactive Systems and served as the non-executive chairmanof its Board of Directors.  In addition, prior to the merger,certain of our other executive officers (Robert E. Galloway, W.Lawrence Hough, Joseph D. Moore, Keith B. Pitts, Phillip W. Roe,Ronald P. Soltman and Alan G. Thomas) owned, in the aggregate,approximately 5.5% of the Common Stock of Coactive Systems. In addition, prior to the merger, our Vice Chairman, Keith B.Pitts, was on its Board of Directors; our Senior Vice President,Assistant General Counsel and Assistant Secretary, James H.Spalding, was its assistant secretary and our Executive VicePresident, General Counsel and Secretary, Ronald P. Soltman, wasits secretary.

                       During fiscal 2003, Phyve Corporation reimbursed us approximately$99,400 for our full rental cost in connection with itsmonth-to-month occupancy of certain office space in ourheadquarters not currently needed by us.  In addition, duringfiscal 2003 Phyve paid us approximately $20,200 to reimburse us forour costs of its phone use while occupying such office space in ourheadquarters and for an allocation in respect of our cost ofcertain office services.  Also, during fiscal 2003, we paidPhyve approximately $28,000 for computer consulting services. Phyve sold all of its assets to First Consulting Group, Inc. anddiscontinued its business operations on or about February 20,2003.  Our Chairman & Chief Executive Officer, Charles N.Martin, Jr., owns approximately 16.9% of the outstanding commonstock and 11.6% of the outstanding preferred stock of Phyve and isthe non-executive chairman of its board of directors.  Certainof our other executive officers (Bruce F. Chafin, Robert E.Galloway, W. Lawrence Hough, James Johnston, Joseph D. Moore, KeithB. Pitts, Phillip W. Roe, Ronald P. Soltman, James H. Spalding, andAlan G. Thomas) own, in the aggregate, approximately 12.8% of itsCommon Stock and Messrs. Galloway, Johnston and Moore  own, inthe aggregate, approximately 0.5% of its outstanding preferredstock.  In addition, prior to discontinuing its operations,Mr. Spalding served as its secretary and Mr. Soltman served as itsassistant secretary.

                       During fiscal 2003, NetContent, Inc. reimbursed us approximately$74,600 for our full rental cost in connection with itsmonth-to-month occupancy of certain office space in ourheadquarters  not currently needed by us.  In addition,during fiscal 2003 NetContent paid us approximately $20,300 toreimburse us for our costs of its phone use while occupying suchoffice space in our headquarters and for an allocation in respectof our cost of certain office services.  Our Chairman &Chief Executive Officer, Charles N. Martin, Jr., owns 51% of theoutstanding Common Stock of NetContent and is a member of its Boardof Directors.  Two of our other executive officers, Keith B.Pitts and James H. Spalding, own 30% and 19%, respectively, of theoutstanding Common Stock of NetContent.  Additionally, Mr.Pitts is a member of its Board of Directors; and Mr. Spalding isSecretary of NetContent and a member of its Board ofDirectors.  NetContent’s revenues in its most recentfiscal year were approximately $382,000.

**Item 14.        Principal Accounting Fees and Services.**

                       Not applicable because this report is filed for a period endingprior to December 15, 2003.

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**PART IV**

**Item 15.        Exhibits, Financial Statement Schedules, and Reports on Form8-K.**

                       (a)   Documents filed as part of this report.

                               (1)   Financial Statements.  The accompanying indexto financial statements on page F-1 of this                                       Annual Report on Form 10-K is provided in response to thisitem.

                               (2)   List of Financial Statement Schedules.  Allschedules are omitted because the required                                       information is either not present, not present in material amountsor presented within the                                       consolidated financial statements.

                               (3)   List of Exhibits.

                       The following exhibits are filed with this report.

**Exhibit No.**

**Document**

 

3.1

      

Certificate of Incorporation(1)

 

 

 

3.2

 

By-Laws(2)

 

 

 

4.1

 

Indenture, dated as of July 30, 2001 between Vanguard HealthSystems, Inc., other Guarantors and the Trustee(2)

 

 

 

4.2

 

First Supplemental Indenture, dated as of September 21, 2001between Vanguard Health Systems, Inc., other Guarantors and theTrustee(1)

 

 

 

4.3

 

Second Supplemental Indenture, dated as of October 2, 2001between Vanguard Health Systems, Inc., other Guarantors and theTrustee(2)

 

 

 

4.4

 

Amended and Restated Subscription Agreement dated June 1, 2000between Vanguard Health Systems, Inc., funds controlled by MorganStanley Capital Partners and certain investors(2)

 

 

 

4.5

 

Voting Proxy Agreement dated as of June 1, 1998, among certainholders and Vanguard Health Systems, Inc.(2)

 

 

 

4.6

 

Amended and Restated Shareholders Agreement, dated as of June 1,2000 among Vanguard Health Systems, Inc., funds controlled byMorgan Stanley Capital Partners and certain holders(2)

 

 

 

4.7

 

Surviving Shareholders Agreement dated as of June 1, 1998 amongVanguard Health Systems, Inc., funds controlled by Morgan StanleyCapital Partners and certain holders(2)

 

 

 

4.8

 

Letter Agreement dated as of June 1, 1998 among Vanguard HealthSystems, Inc., funds controlled by Morgan Stanley Capital Partnersand certain investors(2)

 

 

 

4.9

 

8.18% Convertible Subordinated Notes due 2013 of Vanguard HealthSystems, Inc. dated January 1, 2003(1)

 

 

 

4.10

 

Third Supplemental Indenture, dated as of October 31, 2002,among Vanguard, other Guarantors and the Trustee(3)

 

 

 

10.1

 

Security Agreement, dated as of July 30, 2001 between VanguardHealth Systems, Inc. and the Collateral Agent(2)

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10.2

      

Pledge Agreement, dated as of July 30, 2001 between VanguardHealth Systems, Inc. and the Collateral Trustee(2)

 

 

 

10.3

 

Credit Agreement, dated as of July 30, 2001 between VanguardHealth Systems, Inc. and various lenders(2)

 

 

 

10.4

 

1998 Stock Option Plan(2) (4)

 

 

 

10.5

 

2000 Stock Option Plan(2) (4)

 

 

 

10.6

 

Nonqualified Initial Option Plan(2) (4)

 

 

 

10.7

 

Carry Option Plan(2) (4)

 

 

 

10.8

 

Employment Agreement between Vanguard Health Systems, Inc. andCharles N. Martin, Jr. dated as of June 1, 1998 and amendment datedas of May 31, 2001(2) (4)

 

 

 

10.9

 

Employment Agreement between Vanguard Health Systems, Inc. andWilliam L. Hough dated as of June 1, 1998 and amendment dated as ofMay 31, 2001(2) (4)

 

 

 

10.10

 

Employment Agreement between Vanguard Health Systems, Inc. andJoseph D. Moore dated as of June 1, 1998 and amendment dated as ofJuly 31, 2001(2) (4)

 

 

 

10.11

 

Employment Agreement between Vanguard Health Systems, Inc. andRonald P. Soltman dated as of June 1, 1998 and amendment dated asof July 31, 2001(2) (4)

 

 

 

10.12

 

Employment Agreement between Vanguard Health Systems, Inc. andKeith B. Pitts dated as of June 1, 1998 and amendment dated as ofMay 31, 2001(2) (4)

 

 

 

10.13

 

Purchase and Sale Agreement, dated as of April 23, 2002, amongThe University of Chicago Hospitals, Louis A. Weiss MemorialHospital, Vanguard Health Financial Company, Inc., VHS AcquisitionSubsidiary Number 3, Inc. and Vanguard Health Systems, Inc.(5)

 

 

 

10.14

 

First Amendment to Purchase and Sale Agreement dated as of May31, 2002, among The University of Chicago Hospitals, Louis A. WeissMemorial Hospital, Vanguard Health Financial Company, Inc., VHSAcquisition Subsidiary Number 3, Inc. and Vanguard Health Systems,Inc.(5)

 

 

 

10.15

 

Subscription and Contribution Agreement dated as of June 1,2002, among The University of Chicago Hospitals, Vanguard HealthFinancial Company, Inc. and VHS Acquisition Subsidiary Number 3,Inc.(5)

10.16

 

Purchase and Sale Agreement, dated as of October 8, 2002, by andamong Baptist Health System, VHS San Antonio Partners, L.P. andVanguard Health Systems, Inc.(6)

 

 

 

10.17

 

Arizona Health Care Cost Containment System AdministrationContract No. YH04-0001-06 with VHS Phoenix Health Plan, awarded May1, 2003

 

 

 

10.18

 

Solicitation Amendments numbers One, Two, Three and Four andContract Amendment No. 01, dated May 1, 2003, to Arizona HealthCare Cost Containment System Administration Contract No.YH04-0001-06 with VHS Phoenix Health Plan

 

 

 

10.19

 

Agreement Between the Shareholders of VHS Acquisition SubsidiaryNumber 5, Inc. dated as of January 1, 2003(1)

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10.20

      

License Agreement between Baptist Health System and VHS SanAntonio Partners, L.P. dated as of January 1, 2003(1)

 

 

 

10.21

 

First Amendment to Credit Agreement, dated October 8, 2002,among Vanguard Health Systems, Inc., as Borrower, Bank of America,N.A., as Administrative Agent, and the lenders partiesthereto(6)

 

 

 

10.22

 

Second Amendment to Credit Agreement, dated as of December 31,2002, among Vanguard Health Systems, Inc., as Borrower, Bank ofAmerica, N.A., as Administrative Agent, and the lenders partiesthereto(1)

 

 

 

10.23

 

Incremental Term Loan Commitment Agreement, dated as of January3, 2003, among Vanguard Health Systems, Inc., as Borrower, Bank ofAmerica, N.A., as Administrative Agent, and the term loan lendersparty thereto(1)

 

 

 

10.24

Arizona Health Care Containment System Administration ContractNo. YH8-0001-08, effective October 1, 2002, with VHS Phoenix HealthPlan (restated contract and Amendment No. 24) (7)

 

 

 

10.25

Amendment No. 25, effective January 1, 2003, to the ArizonaHealth Care Cost Containment System Administration Contract No.YH8-0001-08 with VHS Phoenix Health Plan (3)

 

 

 

10.26

Vanguard Health Systems, Inc. 2001 Annual Incentive Plan(2)(4)

 

 

 

10.27

Letter of Understanding dated September 12, 2003, betweenVanguard Health Systems, Inc. and Dale S. St. Arnold(4)

 

 

 

21.1

 

Subsidiaries of Vanguard Health Systems, Inc.

 

 

 

31.1

 

Certification of CEO pursuant to Rule 13a-14(a)/15d-14(a), asadopted pursuant to Section 302 of the Sarbanes-Oxley Act of2002

 

 

 

31.2

 

Certification of CFO pursuant to Rule 13a-14(a)/15d-14(a), asadopted pursuant to Section 302 of the Sarbanes-Oxley Act of2002

 

 

 

32.1

 

Certification of CEO pursuant to 18 U.S.C. Section 1350, asadopted pursuant to Section 906 of the Sarbanes-Oxley Act of2002

 

 

 

32.2

 

Certification of CFO pursuant to 18 U.S.C. Section 1350, asadopted pursuant to Section 906 of the Sarbanes-Oxley Act of2002

____________________

(1)

Incorporated by reference from exhibits to the Company’sCurrent Report on Form 8-K dated January 14, 2003, File No.333-71934.

(2)

Incorporated by reference from exhibits to the Company’sRegistration Statement on Form S-1 (Registration No.333-71934).

(3)

Incorporated by reference from exhibits to the Company’sQuarterly Report on Form 10-Q for the quarterly period endedDecember 31, 2002, File No. 333-71934.

(4)

Management compensatory plan or arrangement.

(5)

Incorporated by reference from exhibits to the Company’sCurrent Report on Form 8-K dated June 7, 2002, File No.333-71934.

(6)

Incorporated by reference from exhibits to the Company’sCurrent Report on Form 8-K dated October 9, 2002, File No.333-71934.

(7)

Incorporated by reference from exhibits to the Company’sQuarterly Report on Form 10-Q for the quarterly period endedSeptember 30, 2002, File No. 333-71934.

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                       (b)   Reports on Form 8-K.                               On May 12, 2003, we filed a Current Report on Form 8-K reporting,pursuant to Item 12 under                               Item 9, as directed by the United States Securities and ExchangeCommission in it Release No.                               34-47583, that we had issued a press release announcing our thirdquarter operating results and                               gave certain information about our use of a non-GAAP financialmeasure, EBITDA, in such                               earnings release and for other purposes; and we also provided underItem 7 a copy of such press                               release as well as some supplementary financial disclosuresrelating to Regulation G.

                       (c)   Exhibits.                               See Item 15(a)(3) of this report.

                       (d)   Financial Statement Schedules.                               See Item 15(a)(2) of this report.

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**SIGNATURES**

                       Pursuant to the requirements of Section 13 or 15(d) of theSecurities Exchange Act of 1934, the registrant has duly causedthis report to be signed on its behalf by the undersigned,thereunto duly authorized.

VANGUARD HEALTH SYSTEMS, INC.

 

Date

 

 

 

By: /s/ Charles N. Martin,Jr.                             

 

September 23, 2003

     

Charles N. Martin, Jr. Chairman of the Board & Chief Executive Officer

 

 

                       Pursuant to the requirements of the Securities Exchange Act of1934, this report has been signed below by the following persons onbehalf of the registrant and in the capacities and on the datesindicated.

**Signature**

 

**Title**

 

**Date**

 

 

 

 

 

/s/ Charles N. Martin, Jr.    

 

Chairman of the Board & Chief Executive Officer;Director (Principal Executive Officer)

 

September 23, 2003

Charles N. Martin, Jr.

 

 

 

 

 

 

 

 

 

 

/s/ William L.Hough          

 

President & Chief Operating Officer; Director

 

September 23, 2003

William L. Hough

 

 

 

 

 

 

 

 

 

 

 

 

 

 

/s/ Joseph D.Moore           

 

Executive Vice President, Chief Financial Officer &Treasurer; Director (Principal Financial Officer)

 

September 23, 2003

Joseph D. Moore

 

 

 

 

 

 

 

 

 

 

/s/ Ronald P.Soltman         

 

Executive Vice President, General Counsel & Secretary;Director

 

September 23, 2003

Ronald P. Soltman

 

 

 

 

 

 

 

 

 

 

/s/ Phillip W.Roe                

 

Senior Vice President, Controller & Chief AccountingOfficer (Principal Accounting Officer)

 

September 23, 2003

Phillip W. Roe

 

 

 

 

 

 

 

 

 

 

 

/s/ Keith B.Pitts                  

 

Vice Chairman; Director

 

September 23, 2003

Keith B. Pitts

 

 

 

 

 

 

 

 

 

 

/s/ Karen H.Bechtel           

 

Director

 

September 23, 2003

Karen H. Bechtel

 

 

 

 

 

 

 

 

 

 

/s/ Eric T.Fry                       

 

Director

 

September 23, 2003

Eric T. Fry

 

 

 

 

 

 

 

 

 

 

/s/ Howard I.Hoffen           

 

Director

 

September 23, 2003

Howard I. Hoffen

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**Supplemental Information to be Furnished with Reports filedPursuant to Section 15(d) of the Act by  Registrants whichhave not registered securities pursuant to Section 12 of theAct.**

No annual report or proxy material has been sent to securityholders.

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**INDEX TO FINANCIAL STATEMENTS**

****

**Vanguard Health Systems, Inc.Consolidated Financial Statements**

** **

** **

**Page**

** **

 

Report of Independent Auditors

F-2

Consolidated Balance Sheets

F-3

Consolidated Income Statements

F-4

Consolidated Statements of Stockholders’ Equity

F-5

Consolidated Statements of Cash Flows

F-6

Notes to Consolidated Financial Statements

F-8

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**Report of Independent Auditors**

Board of DirectorsVanguard Health Systems, Inc.

We have audited the accompanying consolidated balance sheets ofVanguard Health Systems, Inc. (the “Company”) as ofJune 30, 2003 and 2002, and the related consolidated incomestatements, stockholders’ equity, and cash flows for each ofthe three years in the period ended June 30, 2003. These financialstatements are the responsibility of the Company’smanagement.  Our responsibility is to express an opinion onthese financial statements based on our audits.

We conducted our audits in accordance with auditing standardsgenerally accepted in the United States. Those standards requirethat we plan and perform the audits to obtain reasonable assuranceabout whether the financial statements are free of materialmisstatement.  An audit includes examining, on a test basis,evidence supporting the amounts and disclosures in the financialstatements.  An audit also includes assessing the accountingprinciples used and significant estimates made by management, aswell as evaluating the overall financial statement presentation. Webelieve that our audits provide a reasonable basis for ouropinion.

In our opinion, the consolidated financial statements referredto above present fairly, in all material respects, the consolidatedfinancial position of Vanguard Health Systems, Inc. at June 30,2002 and 2003, and the consolidated results of its operations andits cash flows for each of the three years in the period ended June30, 2003, in conformity with accounting principles generallyaccepted in the United States.

As discussed in Note 1 to the consolidated financial statements,effective July 1, 2001, the Company changed its method ofaccounting for goodwill and other intangible assets to conform withthe provisions of Statement of Financial Accounting Standards No.142, “Goodwill and Other Intangible Assets.”

As discussed in Note 1 to the consolidated financial statements,the Company adopted Statement of Financial Accounting Standards No.145, “Rescission of FASB Statements No. 4, 44, and 64,Amendment of FASB Statement No. 13, and TechnicalCorrections,” effective April 1, 2002 resulting in areclassification of debt extinguishment costs from an extraordinaryloss to a component of income from continuing operations.

                                                                                                               ERNST & YOUNG LLP

Nashville, TennesseeAugust 15, 2003

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**VANGUARD HEALTH SYSTEMS, INC.CONSOLIDATED BALANCE SHEETS**

 

**June 30, 2002**

 

 

 

**June 30, 2003**

 

 

 

 

**ASSETS**

*(In millions except share and per share amounts)*

 

 
**
 

Current assets:

   Cash and cash equivalents

$

55.4

$

27.2

   Accounts receivable, net of allowance foruncollectible accounts of       approximately $23.2 and $45.5at June 30, 2002 and       June 30, 2003,respectively

169.3

213.9

   Supplies

15.5

32.1

   Income tax receivable

0.9

–

   Prepaid expenses and other current assets

27.6

25.0

   Deferred income taxes

1.9

–

 

        Total currentassets

270.6

298.2

Property, plant and equipment, net of accumulateddepreciation

454.8

777.2

Goodwill

79.1

100.2

Intangible assets, net of accumulated amortization

38.3

38.6

Other assets

9.1

12.7

 

        Total assets

$

851.9

$

1,226.9

 

**LIABILITIES AND STOCKHOLDERS’EQUITY**

Current liabilities:

   Accounts payable

$

49.7

$

91.7

   Accrued health claims

22.4

33.5

   Accrued interest

14.3

16.1

   Other accrued expenses and currentliabilities

92.5

111.5

   Current maturities of long-term debt

3.8

8.3

 

        Total currentliabilities

182.7

261.1

Other liabilities

22.5

62.6

 

Long-term debt, less current maturities

311.0

471.1

 

Payable-In-Kind Preferred Stock; $.01 par value, 150,000combined shares of     Preferred Stock and Payable-In-Kind PreferredStock authorized, 23,328 and 25,194   shares ofPayable-In-Kind Preferred Stock issued and outstanding at     June 30, 2002 and June 30, 2003, respectively,and 30,000 shares of Series B     Payable-in-Kind Preferred Stock issued andoutstanding at June 30, 2003     at redemption value

24.1

57.0

Commitments and contingencies

Stockholders’ Equity:

Preferred Stock; $1,000 par value, 150,000 combined shares ofPreferred Stock     and Payable-In-Kind Preferred Stock authorized,no shares of Preferred     Stock issued and outstanding

–

–

Common Stock; $.01 par value, 600,000 shares authorized, 203,308and     232,713 shares issued and outstanding at June30, 2002 and     June 30, 2003, respectively

–

–

Additional paid-in capital

305.3

352.5

Accumulated other comprehensive loss

–

(0.6

)

Retained earnings

6.3

23.2

 

 

 

 

311.6

 

 

 

375.1

 

        Totalliabilities and stockholders’ equity

$

851.9

$

1,226.9

 

See accompanying notes.

F-3
****
Table of Contents

**VANGUARD HEALTH SYSTEMS, INC.CONSOLIDATED INCOME STATEMENTS**

 

**For the year ended June 30,**

 

 

** **

**2001**

** **

**2002**

** **

**2003**

 

 

 

*(In millions)*

 

Patient service revenues

 

$

612.7

 

$

725.8

 

$

1,121.7

 

Premium revenues

 

55.1

184.8

218.8

 

 

 

      Total revenues

 

667.8

910.6

1,340.5

 

 

 

 

Costs and expenses:

 

 

   Salaries and benefits

 

323.6

384.4

578.4

 

   Supplies

 

92.9

116.1

202.6

 

   Medical claims expense

 

30.8

132.0

160.8

 

   Purchased services

 

48.6

66.4

86.7

 

   Provision for doubtful accounts

 

56.8

53.3

73.4

 

   Insurance

8.2

19.7

28.4

 

   Other operating expenses

 

43.2

53.1

83.9

 

   Rents and leases

 

12.2

14.4

18.3

 

   Depreciation and amortization

 

23.8

29.5

46.9

 

   Interest, net

 

16.6

26.7

34.9

 

   Debt extinguishment costs

–

6.6

–

 

   Other

 

0.4

(1.3

)

(1.6

)

 

 

 

 

Income before income taxes

 

10.7

9.7

27.8

 

Income tax expense

 

0.5

2.9

10.9

 

 

 

 

Net income

 

10.2

6.8

16.9

 

Preferred stock dividends

 

(1.7

)

(1.8

)

(2.8

)

 

 

 

 

Net income attributable to common stockholders

 

$

8.5

$

5.0

$

14.1

 

 

 

See accompanying notes.

F-4
****
Table of Contents

**VANGUARD HEALTH SYSTEMS, INC.CONSOLIDATED STATEMENTS OF STOCKHOLDERS’ EQUITY**

Preferred Stock

Common Stock

Additional Paid-in Capital

Retained Earnings (Deficit)

Accumulated Other Comprehensive Loss

Total Stockholders’ Equity

 

Shares

Amount

Shares

Amount

(in millions, except share amounts)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Balance at June 30, 2000

 

 

–

 

$

–

 

 

183,954

 

$

–

 

 

$

275.9

 

 

$

(10.7

)

 

$

–

 

 

$

265.2

 

      Issuance of common stock

 

 

–

 

 

–

 

 

19,340

 

 

–

 

 

 

32.9

 

 

 

–

 

 

 

–

 

 

 

32.9

 

      Payable-In-Kind Preferred          Stockdividends

 

 

–

 

 

–

 

 

–

 

 

–

 

 

 

(1.7

)

 

 

–

 

 

 

–

 

 

 

(1.7

)

      Comprehensive income:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

         Cumulativeeffect of change in            accounting principle - fair value of            interest rate collar

 

 

–

 

 

–

 

 

–

 

 

–

 

 

 

–

 

 

 

–

 

 

 

(0.2

)

 

 

(0.2

)

         Net change infair value of interest            rate collar

 

 

–

 

 

–

 

 

–

 

 

–

 

 

 

–

 

 

 

–

 

 

 

(1.6

)

 

 

(1.6

)

         Amortization oftransition adjustment

 

 

–

 

 

–

 

 

–

 

 

–

 

 

 

–

 

 

 

–

 

 

 

0.1

 

 

 

0.1

 

         Net income

 

 

–

 

 

–

 

 

–

 

 

–

 

 

 

–

 

 

 

10.2

 

 

 

–

 

 

 

10.2

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

      Comprehensive income

 

 

–

 

 

–

 

 

–

 

 

–

 

 

 

–

 

 

 

10.2

 

 

 

(1.7

)

 

 

8.5

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Balance at June 30, 2001

 

 

–

 

 

–

 

 

203,294

 

 

–

 

 

 

307.1

 

 

 

(0.5

)

 

 

(1.7

)

 

 

304.9

 

      Issuance of common stock

 

 

–

 

 

–

 

 

14

 

 

–

 

 

 

–

 

 

 

–

 

 

 

–

 

 

 

–

 

      Payable-In-Kind Preferred Stockdividends

 

 

–

 

 

–

 

 

–

 

 

–

 

 

 

(1.8

)

 

 

–

 

 

 

–

 

 

 

(1.8

)

      Comprehensive income:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

         Termination ofinterest rate collar

 

 

–

 

 

–

 

 

–

 

 

–

 

 

 

–

 

 

 

–

 

 

 

1.7

 

 

 

1.7

 

         Net Income

 

 

–

 

 

–

 

 

–

 

 

–

 

 

 

–

 

 

 

6.8

 

 

 

–

 

 

 

6.8

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

      Comprehensive income

 

 

–

 

 

–

 

 

–

 

 

–

 

 

 

–

 

 

 

6.8

 

 

 

1.7

 

 

 

8.5

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Balance at June 30, 2002

 

 

–

 

–

 

 

203,308

 

–

 

 

305.3

 

 

6.3

 

 

–

 

 

311.6

 

      Issuance of common stock

–

–

29,405

–

50.0

–

–

50.0

      Payable-In-Kind Preferred Stockdividends

–

–

–

–

(2.8

)

–

–

(2.8

)

      Comprehensive income:

         Interest rateswap mark-to-market adjustment            (net of taxes)

–

–

–

–

–

–

(0.6

)

(0.6

)

         Net income

–

–

–

–

–

16.9

–

16.9

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

      Comprehensive income

–

–

–

–

–

16.9

(0.6

)

16.3

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Balance at June 30, 2003

–

$

–

232,713

$

–

$

352.5

$

23.2

$

(0.6

)

$

375.1

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

****

See accompanying notes.

F-5
****
Table of Contents

**VANGUARD HEALTH SYSTEMS, INC.CONSOLIDATED STATEMENTS OF CASH FLOWS**

**For the year ended June 30,**

 

 

** **

**2001**

** **

**2002**

** **

**2003**

 

 

 

**Operating activities:**

*(In millions)*

 

Net income

 

$

10.2

 

$

6.8

 

$

16.9

 

Adjustments to reconcile net income to net    cash provided by operating activities

 

 

      Depreciation andamortization

 

23.8

29.5

46.9

 

      Provision for doubtfulaccounts

 

56.8

53.3

73.4

 

      Amortization of loancosts

 

0.9

1.4

1.5

 

      Debt extinguishmentcosts

 

–

6.6

–

 

      Loss (gain) on disposal ofassets

 

0.6

(0.8

)

–

 

      Deferred income taxes

 

(0.9

)

2.8

3.5

 

      Interest on interest ratecollar agreement

 

0.1

–

–

 

      Changes in operating assetsand liabilities,          net ofeffects of acquisitions:

 

 

         Accountsreceivable

 

(68.6

)

(64.9

)

(67.6

)

 

         Establishmentof accounts receivable of             recentacquisitions

 

(7.2

)

(1.5

)

–

 

         Supplies

(0.5

)

(0.7

)

(3.6

)

 

         Prepaidexpenses and other current assets

1.3

(9.8

)

6.7

 

         Income taxreceivable

–

(0.9

)

0.7

 

         Accountspayable

8.5

(2.5

)

15.6

 

         Income taxpayable

0.3

(0.8

)

0.5

 

         Accruedexpenses and other long-term liabilities

 

(18.6

)

26.2

23.2

 

 

 

Net cash provided by operating activities

 

6.7

44.7

117.7

 

 

**Investing activities:**

 

 

Acquisitions

 

(10.6

)

(100.3

)

(249.4

)

 

Capital expenditures

 

(26.6

)

(35.1

)

(98.5

)

 

Proceeds from asset sales

–

1.2

1.6

 

Other

 

(0.9

)

(1.2

)

2.3

 

 

 

Net cash used in investing activities

(38.1

)

(135.4

)

(344.0

)

 

 

**Financing activities:**

 

Proceeds from issuance of common stock

32.9

–

50.0

 

Proceeds from termination of interest rate swap

–

–

5.5

 

Proceeds from syndication of joint venture interests

–

–

0.2

 

Equity contribution from joint venture partner

–

2.5

–

 

Proceeds from long-term debt

–

300.0

150.0

 

Payments of long-term debt

(5.9

)

(153.8

)

(5.3

)

 

Payments of loan costs

(0.3

)

(14.7

)

(2.3

)

 

Proceeds from the exercise of stock options

–

–

–

 

 

Net cash provided by financing activities

26.7

134.0

198.1

 

 

Increase (decrease) in cash and cash equivalents

(4.7

)

43.3

(28.2

)

 

Cash and cash equivalents at beginning of year

 

16.8

12.1

55.4

 

 

Cash and cash equivalents at end of year

$

12.1

$

55.4

$

27.2

 

F-6
****
Table of Contents
****
**VANGUARD HEALTH SYSTEMS, INC.CONSOLIDATED STATEMENTS OF CASH FLOWS(CONTINUED)**

**For the year ended June 30,**

**2001**

**2002**

**2003**

*(In millions)*

**Supplemental cash flow information:**

     Net interest paid

$

13.7

$

22.2

$

32.3

     Net income taxes paid(received)

$

0.2

$

0.1

$

(0.2

)

**Supplemental noncash activities:**

     Payable-In-Kind Preferred Stockissued

$

–

$

–

$

30.0

     8.18% Convertible SubordinatedNotes issued

$

–

$

–

$

17.6

     Payable-In-Kind Preferred Stockdividends

$

1.7

$

1.8

$

2.8

     Capitalized interest

$

–

$

0.1

$

1.1

**Acquisitions:**

     Cash paid, net of cashreceived

$

10.6

$

100.3

$

249.4

     Payable-In-Kind Preferred Stockissued

–

–

30.0

     Subordinated convertible notesissued

–

–

17.6

          Totalconsideration

10.6

100.3

297.0

     Fair value of assets acquired

38.4

115.4

332.2

     Liabilities assumed

59.0

23.2

58.4

     Net assets acquired

(20.6

)

92.2

273.8

     Goodwill and intangible assetsacquired

$

31.2

$

8.1

$

23.2

 

 

 

 

 

 

 

 

 

 

 

 

 

Liabilities assumed as part of the fiscal 2001, 2002 and 2003acquisitions include capital lease obligations of $13.7, $2.0 and$6.1, respectively.

See accompanying notes.

F-7
****
Table of Contents

**VANGUARD HEALTH SYSTEMS, INC.NOTES TO CONSOLIDATED FINANCIAL STATEMENTS**

**June 30, 2003**

**1.            Basis of Presentation and Summary of Significant AccountingPolicies**

****

***Organization***

******

               Vanguard Health Systems, Inc. (“the Company”), aDelaware corporation, was incorporated on July 1, 1997.  As ofJune 30, 2003, the Company owned and managed fifteen acute carehospitals with 3,666 licensed beds and related outpatient servicelocations complementary to the hospitals providing health careservices to the metropolitan Los Angeles/Orange County, California;Chicago, Illinois; San Antonio, Texas; and Phoenix, Arizonamarkets.  The Company also owns managed health plans inChicago, Illinois and Phoenix, Arizona.

***Basis of Presentation***

******

               The accompanying consolidated financial statements include theaccounts of the Company and its wholly-owned and majority-ownedsubsidiaries.  All material intercompany accounts andtransactions have been eliminated.  As none of theCompany’s common shares are publicly held, no earnings pershare information is presented in the accompanying consolidatedfinancial statements.  The majority of the Company’sexpenses are “cost of revenue” items.

***Recently Issued Accounting Pronouncements***

******

               In May 2003, the FASB issued Statement of Financial AccountingStandards No. 150, *Accounting for Certain Financial Instrumentswith Characteristics of both Liabilities and Equity*(“SFAS 150”).  SFAS 150 represents the first phaseof the FASB’s project to clarify the accounting treatment ofcertain instruments that possess characteristics of bothliabilities and equity.  SFAS 150 generally requires thatfreestanding financial instruments that obligate the issuer toredeem the holder’s shares, or are indexed to such anobligation, and are settled in cash or settled with shares meetingcertain conditions be treated as liabilities.  The provisionsof SFAS 150 are effective immediately for instruments entered intoor modified after May 31, 2003 and to all other instruments thatexist as of the beginning of the first interim financial reportingperiod beginning after June 15, 2003, with the exception ofmandatorily redeemable instruments of non-public companies, whichbecome subject to SFAS 150 for fiscal periods beginning afterDecember 15, 2003.  The Company does not expect SFAS 150 toimpact the classification of its outstanding preferred stockinstruments upon the Company’s adoption effective July 1,2003.

               In May 2003, the FASB issued Statement of Financial AccountingStandards No. 149, *Amendment of Statement 133 on DerivativeInstruments and Hedging Activities* (“SFAS149”).  SFAS 149 amends and clarifies financialaccounting and reporting for derivative instruments and for hedgingactivities.  SFAS 149 is effective for contracts entered intoor modified after June 30, 2003.  The Company does not expectSFAS 149 to have a significant impact on its future results ofoperations or cash flows.

               In January 2003, the FASB issued Interpretation No. 46,*Consolidation of Variable Interest Entities*.  Thisinterpretation of ARB No. 51, *Consolidated FinancialStatements*, sets forth criteria under which a company mustconsolidate certain variable interest entities. Interpretation No. 46 places increased emphasis on controllingfinancial interests when determining if a company shouldconsolidate a variable interest entity.  The Company willadopt the provisions of Interpretation No. 46 during the firstquarter of its fiscal year 2004 for existing variable interestentities and is currently in the process of assessing the impact ofthis interpretation.

               In November 2002, the FASB issued Interpretation No. 45,*Guarantor’s Accounting and Disclosure Requirements forGuarantors, Including Indirect Guarantees of Indebtedness ofOthers*.  Interpretation No. 45 requires that certainguarantees be recorded at fair value at inception and requiresadditional disclosures on existing guarantees even if thelikelihood of future liability under the guarantees is deemedremote.  The provisions of Interpretation No. 45 are effectivefor financial statements of interim or annual periods ending afterDecember 15, 2002.  The Company does not expect InterpretationNo. 45 to have a significant impact on its future results ofoperations or cash flows.

F-8
****
Table of Contents

               In July 2002, the FASB issued Statement of Financial AccountingStandards No. 146, *Accounting for Costs Associated with Exit orDisposal Activities* (“SFAS 146”), which supersedesthe provisions of EITF No. 94-3, *Liability Recognition forCertain Employee Termination Benefits and Other Costs to Exit anActivity*.  SFAS 146 requires companies to establishliabilities for costs to exit an activity when the costs areincurred as opposed to the date when the companies commit to theexit plan.  Exit costs covered by SFAS 146 include, but arenot limited to, certain employee severance and relocation costs,lease termination costs and other costs related to restructuring ordiscontinuing operations.  SFAS 146 is effective for exitactivities initiated after December 31, 2002.  The Companydoes not expect SFAS 146 to have a significant impact on its futureresults of operations or cash flows.

***Critical Accounting Policies***

******

               The consolidated financial statements have been prepared inaccordance with accounting principles generally accepted in theUnited States.  In preparing the consolidated financialstatements, the Company makes estimates and assumptions that affectthe reported amounts of assets, liabilities, revenues and expensesincluded in the consolidated financial statements.  Managementbases its estimates on historical experience and other availableinformation, the results of which form the basis of the estimatesand assumptions.  The Company considers the followingaccounting policies to be most critical to its operatingperformance and involve the most subjective and complex assumptionsand assessments.

*               Allowance for Doubtful Accounts*

**

               The Company’s ability to collect outstanding receivables fromthird party payers is critical to its operating performance andcash flows.  The allowance for doubtful accounts wasapproximately 17.6% of accounts receivable, net of contractualdiscounts, as of June 30, 2003.  The primary collection risklies with uninsured patient accounts or patient accounts for whichprimary insurance has paid but patient deductibles or co-insuranceportions remain outstanding.  The Company estimates theallowance for doubtful accounts primarily based upon the age of theaccounts since patient discharge date.  The Companycontinually monitors its accounts receivable balances and utilizescash collections data and subsequent write-off data to support thebasis for its estimates of the provision for doubtfulaccounts.  Significant changes in payer mix or business officeoperations may have a significant impact on the Company’sresults of operations and cash flows.

               A summary of activity in the Company’s allowance for doubtfulaccounts follows (in millions).

 

 

**Balance at beginning of period**

 

**Additions charged to costs and expenses**

 

**Additions (1) charged to other accounts**

 

**Accounts, written off, net of recoveries**

 

**Balance at end of period**

Allowance for doubtful accounts:

   Year ended June 30, 2001

 

$          45.2

 

$            56.8

 

$               –

 

$         71.3

 

$          30.7

   Year ended June 30, 2002

 

$          30.7

 

$            53.3

 

$          17.4

 

$         78.2

 

$          23.2

   Year ended June 30, 2003

 

$          23.2

 

$            73.4

 

$          23.2

 

$         74.3

 

$          45.5

 

 

 

 

 

 

 

 

 

 

 

(1) Allowances as a result of acquisitions.

 

 

 

 

 

 

 

 

 

 

*               Allowance for Contractual Discounts and SettlementEstimates*

**

               The Company typically receives payments from third party payers,including Medicare and managed care payers, that are less thanbilled charges requiring the estimation of contractual discountallowances.  The Medicare regulations and various managed carecontracts are often complex and may include multiple reimbursementmechanisms for different types of services provided in theCompany’s health care facilities and cost settlementprovisions requiring complex calculations and assumptions subjectto interpretation.  The Company estimates the allowance forcontractual discounts on a payer-specific basis given itsinterpretation of the applicable regulations or contractterms.  The Company has made significant investments in humanresources and information systems to improve the estimationprocess.  However, the services authorized and provided andrelated reimbursement are often subject to interpretation that mayresult in payments that differ from the Company’sestimates.  Additionally, updated regulations and contractrenegotiations occur frequently necessitating management’scontinual review and assessment of the estimation process.

F-9
****
Table of Contents

               *Insurance Reserves*

**

               Given the nature of the Company’s operating environment, theCompany is subject to medical malpractice or workers compensationclaims or lawsuits.  Through May 31, 2002, the Companymaintained third-party insurance coverage for individualmalpractice claims exceeding $1.0 million and workers compensationclaims exceeding $250,000 to mitigate a portion of this risk. Effective June 1, 2002, the Company established a wholly ownedcaptive subsidiary to insure its professional and general liabilityrisks at a $10.0 million retention level.  The Companymaintains excess coverage from third party insurers for claimsexceeding $10.0 million per occurrence up to $100.0 million in theaggregate.  The Company estimates its reserve for professionaland general liability and workers compensation risks usinghistorical claims data, demographic factors, severity factors,current incident logs and other actuarial data.  As of June30, 2002 and 2003, the Company’s professional and generalliability accrual for asserted and unasserted claims wasapproximately $16.3 million and $26.5 million, respectively, and isincluded within accrued expenses and other current liabilities andother liabilities on the accompanying consolidated balancesheets.  For the year ended June 30, 2003, the Company’stotal premiums and retention cost for professional and generalliability insurance was approximately $25.8 million, compared to$17.2 million for the year ended June 30, 2002.  The estimatedaccrual for malpractice and workers compensation claims could besignificantly affected should current and future occurrences differfrom historical claims trends.  The estimation process is alsocomplicated by the relatively short period of time in which theCompany has owned its health care facilities as occurrence dataunder previous ownership may not necessarily reflect occurrencedata under the Company’s ownership.  While managementmonitors current claims closely and considers outcomes whenestimating its reserve, the complexity of the claims and wide rangeof potential outcomes often hamper timely adjustments to theassumptions used in the estimates.

               *Medical Claims Reserves*

               For the year ended June 30, 2003, medical claims expense wasapproximately $160.8 million, primarily representing medical claimsof enrollees in the Company’s Medicaid managed health plan inPhoenix, Arizona.  The Company estimates its reserve formedical claims incurred but not reported using historical claimsexperience (including severity and payment lag time) and otheractuarial data including number of enrollees, age of enrollees andcertain enrollee health indicators.  The reserve for medicalclaims incurred but not reported for the Company’s healthplans was approximately $22.4 million and $33.5 million as of June30, 2002 and 2003, respectively.  While management believesthat its estimation methodology effectively captures trends inmedical claims costs, actual payments could differ significantlyfrom its estimates given changes in the health care cost structureor adverse experience.  For the year ended June 30, 2003,approximately $24.9 million of health plan payments to hospitalsand other health care facilities owned by the Company for servicesprovided to health plan enrollees were eliminated inconsolidation.  The Company’s operating results and cashflows could be materially affected by increased or decreasedutilization of its owned health care facilities by enrollees of itshealth plans.

***Cash and Equivalents***

******

               The Company considers all highly liquid investments with maturityof 90 days or less when purchased to be cash equivalents.  TheCompany maintains its cash and cash equivalents balances primarilywith high credit quality financial institutions.  The Companymanages its credit exposure by placing its investments in highquality securities and by periodically evaluating the relativecredit standing of the financial institution.  Approximately$11.1 million of the Company’s cash balance at June 30, 2003,is restricted for use by the Company’s wholly owned captiveinsurance subsidiary.

***Accounts Receivable***

******

               The Company’s primary concentration of credit risk is patientaccounts receivable, which consists of amounts owed by variousgovernmental agencies, insurance companies and privatepatients.  The Company manages the receivables by regularlyreviewing its accounts and contracts and by providing appropriateallowances for contractual discounts and uncollectibleamounts.  Medicare program receivables comprised approximately16% and 18% of net patient receivables for the years ended June 30,2002 and 2003, respectively.  Medicaid programs comprisedapproximately 13% of net patient receivables for the years endedJune 30, 2002 and 2003.  Remaining receivables relateprimarily to various HMO and PPO payers, commercial insurers andprivate patients.  Concentration of credit risk for thesepayers is limited by the number of patients and payers.

F-10
****
Table of Contents

***Supplies***

******

               Supply inventory is stated at the lower of cost (first-in,first-out) or market.

***Property, Plant and Equipment***

******

               Property, plant and equipment are stated at cost.  Routinemaintenance and repairs are charged to expense as incurred. Expenditures that increase values, change capacities or extenduseful lives are capitalized.  Depreciation is computed usingthe straight-line method over the estimated useful lives of theassets, which approximate 3 to 40 years.  Depreciation expensewas approximately $18.5 million, $26.0 million and $44.5 millionfor the years ended June 30, 2001, 2002 and 2003,respectively.  During 2003, the Company capitalized $1.1million of interest associated with its construction of West ValleyHospital Medical Center in Goodyear, Arizona.  The estimatedcost to complete projects classified as construction in progress is$35.3 million and is expected to be expended during fiscal2004.  The following table provides the gross asset balancesfor each major class of depreciable assets and total accumulateddepreciation as of June 30, 2002 and 2003 (in millions).

 

 

 

**June 30,**

 

 

 

 
****
 

 

 

 

**2002**

 

 

 

**2003**

 

 

 

 

 

Class of depreciable asset:

 

 

 

 

 

 

 

 

   Land and improvements

$

65.1

$

91.9

   Buildings and improvements

283.3

479.4

   Equipment

149.9

248.3

   Construction in progress

10.8

56.0

509.1

875.6

Less:  accumulated depreciation

(54.3

)

(98.4

)

   Net property, plant and equipment

$

454.8

$

777.2

***Goodwill and Other Intangible Assets***

               The Company adopted SFAS 141 and SFAS 142 effective July 1, 2001resulting in adjustments to the allocation of the excess purchaseprice for acquired entities between goodwill and intangible assetsbased upon appraisal data and assumptions.  Amounts allocatedto intangible assets are amortized over their useful lives, whichrange from 3 years to 40 years, except for those indefinite-livedintangible assets for which no amortization is recorded. Goodwill is no longer amortized but is subject to annual impairmentreviews.  Deferred loan costs and syndication costs areamortized over the life of the applicable credit facility orsubordinated notes.  See Note 4 for a summary of goodwill andother intangible assets and the effects of adopting SFAS 141 and142.

***Employee Health Insurance***

******

               The Company maintains self-insured medical and dental plans forcertain of its employees.  During 2003, the Company’semployees in Arizona transitioned to a premium-based medical planwith a third-party, independent carrier.  Claims are accruedunder the self-insured plans as the incidents that give rise tothem occur.  Unpaid claims accruals are based on the estimatedultimate cost of settlement, including claim settlement expenses,in accordance with an average lag time and historicalexperience.  The reserve for self-insured medical and dentalplans was approximately $4.2 million and $2.3 million as of June30, 2002 and 2003, respectively, and is included in accruedexpenses and other current liabilities on the accompanyingconsolidated balance sheets.

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Table of Contents

***Revenues***

               *Patient Service Revenues*

               The Company has agreements with third-party payers that provide forpayments to the Company at amounts different from its establishedrates.  A summary of the payment arrangements with majorthird-party payers follows:

               •

   

*Medicare* – Inpatient acute care services renderedto Medicare program beneficiaries are paid at prospectivelydetermined rates per diagnosis (“PPS”).  Theserates vary according to a patient classification system that isbased on clinical, diagnostic and other factors.  Inpatientnon-acute services, certain other services and medical educationcosts related to Medicare beneficiaries are paid based on a costreimbursement methodology subject to various cost limits.  TheCompany is reimbursed for cost reimbursable items at a tentativerate with final settlement determined after submission of annualcost reports by the Company and audits thereof by the Medicarefiscal intermediary.  Outpatient and home health servicesrelated to Medicare beneficiaries provided after August 1, 2000 andOctober 1, 2000, respectively, are reimbursed based onprospectively determined rates.  The Company’sclassification of patients under the Medicare program and theappropriateness of their admissions are subject to an independentreview.  Estimates recorded for amounts due to or fromMedicare for cost reimbursed services may change upon review by thefiscal intermediary.  The Company derived approximately 20%,25% and 30% of gross patient service revenues from servicesprovided under the Medicare program for the years ended June 30,2001, 2002 and 2003, respectively.  These percentages do notinclude revenues from managed Medicare payers, which are classifiedby the Company as managed care revenues.

 

 

 

               •

   

*Medicaid* – Inpatient services rendered tobeneficiaries under the Medi-Cal program (California’sMedicaid program) are reimbursed either under contracted rates or acost reimbursement methodology at a tentative rate with finalsettlement determined after submission of annual cost reports bythe Company and audits thereof by Medi-Cal.  The Company ownsthree hospitals in California.  Inpatient and outpatientservices rendered to Medicaid program beneficiaries in the otherstates in which the Company owns hospitals are reimbursed undercontracted rates that generally do not have retroactive cost reportsettlement procedures.  The Company derived approximately 9%,7% and 9% of gross patient service revenues from services providedunder the Medicaid program in each of the states in which theCompany owns hospitals for the years ended June 30, 2001, 2002 and2003, respectively.  These percentages do not include revenuesfrom managed Medicaid payers, which are classified by the Companyas managed care revenues.

 

 

 

               •

   

*Other* – The Company has also entered into paymentagreements with certain commercial insurance carriers, healthmaintenance organizations and preferred providerorganizations.  The basis for payment to the Company underthese agreements includes prospectively determined rates perdischarge, discounts from established charges, prospectivelydetermined daily rates and fixed monthly premiums based uponnegotiated per member rates (generally referred to as capitationarrangements).  Capitation premiums received by theCompany’s hospitals are recognized as revenues in the monththat members are entitled to health care services regardless ofservices actually provided.  The Company’s hospitalsreceived capitation premiums of $30.6 million, $17.6 million, and$7.7 million for the years ended June 30, 2001, 2002 and 2003,respectively, which are included in patient service revenues on theaccompanying consolidated income statements.  Other thanMedicare and Medicaid, the Company has no individual payer thatrepresents more than 10% of aggregate gross or net patient servicerevenues.

               Patient service revenues are recorded at estimated amounts due frompatients and third party payers for the health care servicesprovided in the period the services are provided.  Theseestimates are based on calculations made according to the terms ofthe agreements noted above under which the Company is paid based ona percentage of established charges, the cost of providingservices, predetermined rates per diagnosis, fixed per diem ratesor discounts from established charges.

               Final determinations of amounts earned under the Medicare andMedi-Cal programs often occur in subsequent years because of auditsby the programs, rights of appeal and the application of numeroustechnical provisions.  Differences between original estimatesand subsequent revisions (including final settlements) are includedin the consolidated income statements in the period in which therevisions are made.  Management believes that adequateprovision has been made for adjustments that may result from finaldetermination of amounts earned under the Medicare and Medi-Calprograms.  Net

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adjustments to estimated settlements resulted in an increase topatient service revenues of $6.2 million and $6.4 million for theyears ended June 30, 2002 and 2003, respectively.  As part ofits acquisitions, the Company did not assume any settlements underthese programs estimated by the sellers through the dates ofpurchase.  Since implementation of outpatient PPS in August2000, the due dates of all Medicare cost reports have been extendeddue to delays in receiving necessary reports from Medicare fiscalintermediaries.  The Company has now filed all Medicare costreports relating to Medicare fiscal year ends in calendar 2002 andfor periods prior to 2002.  However, a backlog of fiscalintermediary reviews remains that could result in significantchanges to the Company’s third party settlementestimates.

               Patient service revenues include certain revenues incidental to thedelivery of health care services including medical office buildingrent revenues, cafeteria sales and other miscellaneousrevenues.  For the year ended June 30, 2002, patient servicerevenues include $2.6 million of proceeds from a net profitsdistribution of an entity for which the Company acquired aninterest in connection with its acquisition of MacNealHospital.  Patient service revenues are net of contractualadjustments and policy discounts of approximately $1.2 billion,$1.4 billion and $2.2 billion for the years ended June 30, 2001,2002 and 2003, respectively.

               *Premium Revenues*

**

               The Company’s health plans have agreements with the ArizonaHealth Care Cost Containment System (“AHCCCS”) andvarious health maintenance organizations (“HMOs”) tocontract to provide medical services to subscribingparticipants.  Under these agreements, the Company’shealth plans receive monthly payments based on the number of eachHMO’s participants and, in the case of the contract withAHCCCS, the number of enrollees in its Medicaid health planaffiliate, Phoenix Health Plan.  The Company’s healthplans receive these monthly payments and recognize them as revenuein the month in which members are entitled to health careservices.

***Market Risks***

               The Company operates in four geographic markets.  Shouldeconomic or other factors limit the Company’s ability toprovide health care services in one or more of these markets, theCompany’s cash flows and results of operations could besignificantly impacted.

***Stock-Based Compensation***

******

               For the years ended June 30, 2001, 2002 and 2003, the Companyelected to record stock options in accordance with AccountingPrinciples Board Opinion No. 25, *Accounting for Stock Issued toEmployees* (“APB 25”), and related interpretationsthereof and, accordingly, recognized no compensation expense foroptions granted prior to June 30, 2003, when the exercise price isat least equal to the market price of the underlying stock on thegrant date.  During the fiscal year ended June 30, 2003, theCompany adopted the provisions of Statement of Financial AccountingStandards No. 148, *Accounting for Stock-BasedCompensation-Transition and Disclosure* (“SFAS148”).  Among other things, SFAS 148 provides threemethods of transition to the fair value method of accounting forstock-based employee compensation as required by Statement ofFinancial Accounting Standards No. 123, *Accounting forStock-Based Compensation* (“SFAS 123”), shouldcompanies elect to adopt SFAS 123.  These transition methodsinclude the prospective method, the retroactive restatement methodand the modified prospective method.  Effective July 1, 2003,the Company adopted the fair value method of accounting forstock-based employee compensation under SFAS 123 and elected to usethe prospective method of transition set forth in SFAS 148. The Company is unable to predict the effects of its transition tothe fair value method of accounting for stock-based employeecompensation on its future operating results.

               SFAS 123 requires those entities electing to account for stockoptions under APB 25 to provide certain net income pro formainformation in the footnotes to its financial statements.  Thefair value of the Company’s stock options was estimated atthe date of grant using a Minimum Value option pricing model withthe following weighted-average assumptions for 2001, 2002 and2003:  risk-free interest rate of approximately 5.2%, dividendyield of 0.0% and expected option life of 10 years.

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               For purposes of pro forma disclosures, the estimated fair value ofoptions is amortized to expense over the options’ vestingperiod.  The Company’s pro forma information follows (inmillions).

 

 

 

**2001**

 

 

 

**2002**

 

 

**2003**

 

 

 

 

 

Net income

 

$

10.2

 

$

6.8

 

$

16.9

 

Pro forma compensation expense from stock options, net oftaxes

 

 

(1.1

)

 

 

(1.8

)

 

(1.7

)

 

 

 

 

 

 

 

 

 

Pro forma net income

 

$

9.1

 

$

5.0

 

$

15.2

 

 

 

 

 

 

 

 

 

 

               The pro forma effects of applying SFAS 123 are not likely to berepresentative of the effects on reported net income for futureyears.

***Income Taxes***

******

               Income taxes are computed based on the liability method ofaccounting whereby deferred tax assets and liabilities aredetermined based on differences between financial reporting and taxbases of assets and liabilities and are measured using the enactedtax rates and laws that will be in effect when the differences areexpected to reverse.

***Fair Value of Financial Instruments***

******

*               Cash and Cash Equivalents*

**

               The carrying amounts reported for cash and cash equivalentsapproximate fair value because of the short-term maturity of theseinstruments.

               *Accounts Receivable and Accounts Payable*

**

               The carrying amounts reported for accounts receivable and accountspayable approximate fair value because of the short-term maturityof these instruments.

               *Long-term Debt*

**

               The fair value of the Company’s $300.0 million SeniorSubordinated Notes due 2011 as of June 30, 2003, is approximately$306.0 million based upon stated market prices.  The fairvalue is subject to change as market conditions change.

               *Interest Rate Swap*

               In order to manage its exposure to interest rate risk, managementutilizes derivative instruments from time to time.  TheCompany currently utilizes an interest rate swap agreement on anotional $147.0 million of its $150.0 million of term loansoutstanding under the Company’s principal senior securedfacility (the “amended 2001 credit facility”). Under the interest rate swap agreement, the variable 90-day LIBORinterest rate is swapped for a fixed LIBOR rate of 1.77% for theone-year period commencing July 3, 2003 and ending July 3,2004.  The Company utilizes mark-to-market accounting for theinterest rate swap agreement under the provisions of SFAS 133,*Accounting for Derivative Instruments and HedgingActivities*, and has determined that its interest rate swapinstrument qualifies for the shortcut method of accounting forhighly effective hedges.

***Reclassifications***

               Certain reclassifications have been made to the prior yearfinancial statements to conform to current year presentation.

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Table of Contents

**2.            Acquisitions**

***Fiscal 2003 Acquisition***

               On January 3, 2003, but effective January 1, 2003, the Companyacquired, through a majority-owned subsidiary, substantially all ofthe assets of five acute care hospitals with a total of 1,537 bedsand related health care businesses located in San Antonio, Texas,and surrounding areas of south Texas from Baptist Health Services,formerly known as Baptist Health System (“BHS”), aTexas not-for-profit corporation.  The purchase price of thenet assets acquired was $293.8 million, comprised of cash of $246.2million, $30.0 million of the Company’s Series Bpayable-in-kind redeemable convertible preferred stock andapproximately $17.6 million of the Company’s convertiblesubordinated notes due 2013 bearing interest at 8.18%.  TheCompany funded the cash portion of the purchase price with $150.0million of proceeds under the amended 2001 credit facility, $50.0million from private sales of its common stock and cash on hand of$46.2 million.  The BHS acquisition was accounted for usingthe purchase method of accounting.  The results of operationsof BHS are included in the accompanying consolidated financialstatements for the last six months of fiscal 2003.  Thepurchase price allocation for the BHS acquisition is tentative andmay be materially affected by the final working capital and othersettlements expected to occur during fiscal 2004.

               The purchase price for the fiscal 2003 acquisition was allocated asfollows (in millions).

**BHS**

Fair value of assets acquired:

 

 

 

 

 

 

 

   Cash

 

 

 

$

–

   Accounts receivable, net

 

 

 

 

50.7

   Other current assets

 

 

 

 

14.9

   Property, plant and equipment

 

 

 

 

255.1

   Other assets

9.4

   Goodwill and intangible assets

 

 

 

 

24.6

 

 

 

 

 

Assets acquired

 

 

 

 

354.7

Liabilities assumed

 

 

 

 

60.9

Purchase price of net assets acquired 

293.8

Payable-In-Kind Preferred Stock issued

 

 

 

 

30.0

Subordinated notes issued 

17.6

 

 

 

 

Cash paid for net assets acquired

 

 

 

$

246.2

 

 

 

 

 

 

 

***Fiscal 2002 Acquisitions***

               On June 3, 2002, but effective June 1, 2002, the Company, through amajority-owned acquisition subsidiary, acquired substantially allof the assets of Louis A. Weiss Memorial Hospital(“Weiss”), a 369-bed acute care hospital located inChicago, Illinois.  The acquisition subsidiary was formed as ajoint venture corporation owned 80.1% by the Company and 19.9% byan affiliate of the former owner of Weiss.  The Company paidcash of $44.0 million, net of a $2.5 million payment received forthe minority joint venture partner’s 19.9% interest in theacquisition subsidiary, to satisfy the purchase price for the netassets acquired.  The net assets acquired consisted of assetsof $63.2 million and liabilities assumed of $19.2 million. The Company funded the acquisition with a portion of the proceedsremaining from its issuance of $300 million of its SeniorSubordinated Notes due 2011 (the “9.75% Notes”) on July30, 2001.  The Weiss acquisition was accounted for using thepurchase method of accounting, and the operating results of Weisshave been included in the accompanying consolidated financialstatements from the date of acquisition.

               On November 1, 2001, the Company completed the acquisition of theassets of Paradise Valley Hospital (“Paradise Valley”),a 162-bed acute care hospital located in Phoenix, Arizona. The Company paid cash of $55.3 million to satisfy the purchaseprice for the net assets acquired.  The net assets acquiredconsisted of assets of $59.8 million and liabilities assumed

F-15
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of $4.5 million.  The excess of the purchase price over netassets acquired was $4.3 million and has been allocated to netintangible assets and goodwill on the accompanying consolidatedbalance sheets.  The Company funded the acquisition with aportion of its cash proceeds from its July 30, 2001 issuance of the9.75% Notes.  The Paradise Valley acquisition was accountedfor using the purchase method of accounting, and its operatingresults have been included in the accompanying consolidatedfinancial statements from the date of acquisition.

               The purchase price for the 2002 acquisitions was allocated asfollows (in millions):

 

 

**Weiss**

 

**Paradise Valley**

 

**Total**

 

 

Fair value of assets acquired:

 

 

 

 

 

 

 

 

 

 

 

   Cash

 

$

–

 

 

$

–

 

 

$

–

   Accounts receivable, net

 

 

17.1

 

 

 

9.7

 

 

 

26.8

   Other current assets

 

 

3.9

 

 

 

1.9

 

 

 

5.8

   Property, plant and equipment

 

 

40.9

 

 

 

43.9

 

 

 

84.8

   Goodwill and intangible assets

 

 

1.3

 

 

 

4.3

 

 

 

5.6

 

 

 

 

 

 

 

 

 

Assets acquired

 

 

63.2

 

 

 

59.8

 

 

 

123.0

Liabilities assumed

 

 

19.2

 

 

 

4.5

 

 

 

23.7

 

 

 

 

 

 

 

 

 

Cash paid for net assets acquired

 

$

44.0

 

 

$

55.3

 

 

$

99.3

 

 

 

 

 

 

 

 

 

***Fiscal 2001 Acquisitions***

****

               During the fiscal year ended June 30, 2001, the Company completedthe following acquisitions:

**Date**

   

**Entity**

**   **

**Location**

   

   

July 2000

   

Trinity MedCare, Inc.

   

Nashville, TN

September 2000

   

Pleasant Properties, Inc.

   

Phoenix, AZ

May 2001

   

PMH Health Resources, Inc.

   

Phoenix, AZ

June 2001

   

Touchstone Imaging of Arizona, LLC

   

Phoenix, AZ

               The Company acquired certain net assets of the aforementionedentities, which include a hospital, health plan and imaging centersfor a total net asset cash purchase price of $31.6 million. The net assets acquired consisted of assets of $87.9 million andliabilities assumed of $56.3 million.  The excess of thepurchase price over the net assets acquired was $32.2 million andis included as part of goodwill and net intangible assets on theaccompanying consolidated balance sheets.  The acquisitionswere financed with the proceeds from equity issuances to variousaffiliates of Morgan Stanley Capital Partners (“MSCP”)and certain members of management and internally generatedcash.  The 2001 acquisitions were accounted for using thepurchase method of accounting, and the operating results of theacquired entities have been included in the accompanyingconsolidated financial statements from the respective dates ofacquisition.

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Table ofContents

               The following table summarizes the allocation of the aggregatepurchase price of the 2001 acquisitions (in millions):

** **

** **

**PMH Health Resources**

** **

**Touchstone Imaging**

** **

**Other**

** **

**Total**

** **

** **
****
 

Fair value of assets acquired:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

   Cash

 

$

16.7

 

$

–

$

0.5

$

17.2

 

   Other current assets

3.1

0.1

0.2

3.4

 

   Property, plant and equipment

 

 

18.8

10.2

4.3

33.3

 

   Other assets

 

 

1.8

–

–

1.8

 

   Goodwill and intangible assets

 

 

17.1

14.5

0.6

32.2

 

 

 

 

Assets acquired

57.5

24.8

5.6

87.9

 

Liabilities assumed

 

 

42.8

10.2

3.3

56.3

 

 

Cash paid for net assets acquired

 

$

14.7

$

14.6

$

2.3

$

31.6

 

***Other Information***

               *Pro Forma Results*

               The following table shows the unaudited pro forma results ofconsolidated operations as if the 2001, 2002 and 2003 acquisitionshad occurred at the beginning of the immediate preceding period,after giving effect to certain adjustments, including thedepreciation and amortization of the assets acquired based upontheir fair values, changes in net interest expense resulting fromchanges in consolidated debt and changes in allocated overheadexpenses (in millions):

 

 

 

**2001**

 

 

 

**2002**

 

 

 

**2003**

 

 

 

 

Revenues

 

$

975.5

 

 

$

1,460.3

 

 

$

1,575.3

 

Income (loss) before income taxes 

 

$

(8.4

)

 

$

(32.2

)

 

$

16.8

 

Income tax expense (benefit)

 

 

0.1

(0.4

)

6.6

 

 

 

 

 

 

 

 

 

 

Net income (loss)

 

$

(8.5

)

 

$

(31.8

)

 

$

10.2

 

 

 

 

               The pro forma information presented above does not purport to beindicative of what the Company’s results of operations wouldhave been if the acquisitions had in fact occurred at the beginningof the periods presented, and is not intended to be a projection ofthe impact on future results or trends.

**3.            Prepaid Expenses and Other Current Assets**

               Prepaid expenses and other current assets in the accompanyingconsolidated balance sheets consist of the following at June 30 (inmillions).

 

 

 

**2002**

 

 

 

**2003**

 

 

Other receivables

 

$

12.9

 

 

$

8.9

Prepaid expenses

 

 

10.9

 

 

 

15.8

Other

 

 

3.8

 

 

 

0.3

 

 

 

 

 

 

 

 

$

27.6

 

 

$

25.0

 

 

 

 

 

 

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**4.            Goodwill and Intangible Assets**

               Effective July 1, 2001, the Company adopted the provisions of SFASNo. 141 and SFAS No. 142.  In accordance with theseprovisions, the Company reclassified its previous allocations ofexcess purchase price over net assets acquired between goodwill andintangible assets and re-assessed the amortization lives assignedto intangible assets.  The following table providesinformation regarding the intangible assets, including deferredloan costs, included on the accompanying consolidated balancesheets as of June 30, 2002 and June 30, 2003 (in millions).

 

 

** **

**Gross Carrying Amount**

** **

**Accumulated Amortization**

 

  

** **
****
 

 

**June 30, 2002**

** **

**June 30, 2003**

** **

**June 30, 2002**

** **

**June 30, 2003**

 

 

**Class of Intangible Asset**
****
 

Amortized intangible assets:

 

    Deferred loan costs

$

15.0

$

17.2

$

1.2

$

2.7

 

    Contracts

7.9

7.9

1.3

2.4

 

    Customer lists

2.3

2.3

1.5

2.3

 

    Other

3.5

3.8

0.9

1.5

 

 

 

        Subtotal

28.7

31.2

4.9

8.9

 

 

 

Indefinite-lived intangible assets:

 

    License and accreditation

8.0

9.8

–

–

 

    Other

6.5

6.5

–

–

 

 

 

        Subtotal

14.5

16.3

–

–

 

 

 

Total

$

43.2

$

47.5

$

4.9

$

8.9

 

 

 

               Amortization expense for the year ended June 30, 2003 wasapproximately $2.4 million.  The Company estimatesamortization expense for these intangible assets, excludingdeferred loan costs which are amortized to interest expense, toapproximate $1.3 million, $1.3 million, $1.2 million, $1.2 millionand $1.1 million for the fiscal years ending June 30, 2004, 2005,2006, 2007 and 2008, respectively.  The lives over whichintangible assets are amortized range from three years to fortyyears.

               The following table presents the changes in the carrying amount ofgoodwill from the date of transition to June 30, 2003 (inmillions).

**Acute Care Services**

**Health Plans**

**Total**

 

 

 

Balance as of June 30, 2002

$

67.7

$

11.4

 

$

79.1

 

Accrual of working capital settlement liability

1.1

 

–

 

1.1

 

Adjustments to accrued acquisition costs

(1.2

)

(2.7

)

(3.9

)

 

Acquisition of BHS

23.9

 

–

 

23.9

 

 

 

 

 

Balance as of June 30, 2003

$

91.5

$

8.7

 

$

100.2

 

 

 

 

               The Company completed its annual impairment test of goodwill andindefinite-lived intangible assets during 2003 noting noimpairment.  Amortization of goodwill and indefinite-livedintangible assets has been suspended in the accompanyingconsolidated income statements for years ended June 30, 2002 andJune 30, 2003.  The following table presents net income forthe year ended June 30, 2001 assuming SFAS 141 and 142 had beenadopted on July 1, 2000 (in millions).

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**June 30, 2001**

Reported net income

 

$

10.2

 

Add back: Goodwill amortization

 

 

3.9

 

 

Adjust: Amortization of intangible assets previouslyclassified as goodwill (net of taxes of $0)

 

 

(1.1

)

 

 

 

 

 

 

      Adjusted net income

 

$

13.0

 

 

 

 

 

 

 

****

**5.            Other Accrued Expenses and Current Liabilities**

****

               Accrued expenses and other current liabilities in the accompanyingconsolidated balance sheets consist of the following at June 30 (inmillions):

 

 

 

**2002**

 

 

 

**2003**

 

 

 

Salaries and benefits

 

$

27.9

 

 

$

45.6

Due to third-party payers

 

 

25.0

 

 

 

11.4

Property taxes

 

 

8.1

 

 

 

13.9

Self-insured employee health claims

 

 

4.2

 

 

 

2.3

Current portion of insurance risks

 

 

5.6

 

 

 

10.0

Insurance premiums

 

 

6.9

 

 

 

7.1

Other

 

 

14.8

 

 

 

21.0

 

 

 

 

 

 

 

 

$

92.5

 

 

$

111.3

 

 

 

 

 

 

**6.            Long-Term Debt**

               A summary of the Company’s long-term debt at June 30, 2002and 2003 follows (in millions):

**June 30, 2002**

**June 30, 2003**

9.75% Senior Subordinated Notes

$

300.0

 

$

300.0

Term loans payable under the amended 2001 credit facility

 

–

 

149.3

8.18% Convertible Subordinated Notes

 

–

 

17.6

Capital leases

9.3

10.4

FAS 133 valuation adjustment

3.3

–

Other

2.2

2.1

 

 

314.8

479.4

Less: current maturities

(3.8

)

(8.3

)

 

 

$

311.0

$

471.1

 

 

 

***9.75% Senior Subordinated Notes***

               On July 30, 2001, the Company received gross proceeds of $300.0million through the issuance of the 9.75% Notes which mature inAugust 2011.  Interest on the 9.75% Notes is payablesemi-annually on February 1 and August 1.  The Company mayredeem the 9.75% Notes, in whole or in part, at any time fromAugust 1, 2006 to July 31, 2009 at redemption prices ranging from104.875% to 101.625%, plus accrued and unpaid interest.  TheCompany may redeem the 9.75% Notes on or after August 1, 2009 at a100% redemption price plus accrued and unpaid interest. Additionally, at any time prior to

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August 1, 2004, the Company may redeem up to 35% of theprincipal amount of the 9.75% Notes with the net cash proceeds ofone or more sales of its capital stock at a redemption price of109.75% plus accrued and unpaid interest to the redemption date;provided that at least 65% of the aggregate principal amount of the9.75% Notes originally issued on July 30, 2001 remains outstandingafter each such redemption and notice of any such redemption ismailed within 90 days of each such sale of capital stock.

               Payment of the principal and interest of the 9.75% Notes issubordinate to amounts owed for existing and future seniorindebtedness of the Company and is guaranteed, jointly andseverally, on an unsecured senior subordinated basis by most of theCompany’s subsidiaries.  The Company is subject tocertain restrictive covenants under the Indenture governing the9.75% Notes.  The Company used a portion of the proceeds fromthe offering of the 9.75% Notes to repay all amounts outstandingunder its then existing credit facility (the “2000 creditfacility”) of approximately $147.0 million.

***Credit facility debt***

               Concurrent with the issuance of the 9.75% Notes, the Companyentered into a new senior secured credit facility (the “2001credit facility”) with a syndicate of lenders, with Banc ofAmerica Securities LLC and Morgan Stanley Senior Funding, Inc.serving as joint lead arrangers and book managers and Bank ofAmerica, N.A. as administrative agent.  The 2001 creditfacility initially provided for up to $125.0 million of outstandingloans and letters of credit on a revolving basis and contemplated,but the lenders did not commit to, additional term loans of up to$250.0 million.  The Company would have been required toobtain commitments from its existing or new lenders to obtain theterm loans, but no approval of the existing lenders was necessaryfor such term loans.  The applicable interest rate under the2001 credit facility was based upon either: 1) LIBOR plus a marginranging from 2.25% to 3.25% depending on the Company’sleverage ratio for the most recent four quarters or 2) a base rateplus a margin ranging from 1.25% to 2.25% depending on theCompany’s leverage ratio for the most recent fourquarters.  The Company was subject to certain restrictive andfinancial covenants under the 2001 credit facility. Obligations under the 2001 credit facility were guaranteed by mostof the Company’s wholly owned domestic subsidiaries and weresecured by liens on substantially all of the assets of the Companyand its subsidiaries and by pledges of the stock of theCompany’s subsidiaries.

               Upon the acquisition of the BHS assets in January 2003, the Companyexpanded its 2001 credit facility by adding a $150.0 million termloan facility to its existing $125.0 million revolving loanfacility (“the amended 2001 credit facility”). The Company utilized proceeds from the $150.0 million in term loansto fund a portion of the cash purchase price of the BHSacquisition.  The interest rate of the term loans is either:1) LIBOR plus a margin of 4.25% or 2) a base rate plus a margin of3.25%.  The outstanding term loans mature on January 3, 2010,and principal repayments of $375,000 are due at the end of eachquarter starting on March 31, 2003 through December 31, 2008, afterwhich four quarterly repayments of $35,250,000 are due starting onMarch 31, 2009 and continuing through the maturity date.  Theamended 2001 credit facility no longer contemplates any specifiedamount of additional term loans to the Company under the facilityand, in addition, it now requires the approval of the existinglenders representing two-thirds of the then outstanding term loansand revolving loan commitments in order for the Company to borrowany such additional term loans.  As of June 30, 2003, theCompany had outstanding letters of credit of $25.8 million,relating to its self-insured workers compensation program and aperformance guaranty required by the contract between AHCCCS andPhoenix Health Plan, which is owned by a subsidiary of theCompany.  Otherwise, there were no amounts outstanding underthe revolving loan facility of the amended 2001 creditfacility.  The Company is subject to certain restrictive andfinancial covenants under the amended 2001 credit facilityincluding a total leverage ratio, senior leverage ratio, interestcoverage ratio and capital expenditure restrictions.  TheCompany was in compliance with all such covenants as of June 30,2003.

               The Company incurred offering costs and loan costs of approximately$11.5 million, $3.5 million and $2.3 million for the 9.75% Notes,the 2001 credit facility and the amended 2001 credit facility,respectively.  The Company capitalized the costs associatedwith the offering of the 9.75% Notes and the procurement of the2001 credit facility and amended 2001 credit facility and isamortizing such costs to interest expense over the 10-year life ofthe 9.75% Notes, the 5-year life of the 2001 credit facility andthe 7-year life of the amended 2001 credit facility.

F-20
****
Table of Contents

***8.18% Convertible Subordinated Notes***

**

               Upon the acquisition of the BHS assets in January 2003, the Companyissued approximately $17.6 million of its convertible subordinatednotes that provide for annual interest payments at 8.18% untilmaturity on January 3, 2013.  The notes are convertible at anytime into the Company’s common stock at a $3,500 per shareconversion price.  The Company may not redeem the notes priorto January 1, 2008, and must pay premiums of 102% for redemptionsduring the first year subsequent to January 1, 2008, and 101% forredemptions during the second year subsequent to January 1, 2008,with redemptions thereafter available at par.  Payment of theprincipal and interest of the 8.18% convertible subordinated notesis subordinate to amounts owed for existing and future seniorindebtedness of the Company.

***Derivatives***

               On May 3, 2000, the Company entered into a three-year interest ratecollar having a notional principal amount of $67.0 million with alarge financial institution as a result of a provision of the 2000credit facility requiring the Company to maintain a form ofinterest rate protection.  The Company adopted the provisionsof SFAS 133 effective July 1, 2000 for the collar agreement. The instrument qualified as a cash flow hedge under SFAS 133 andinitially expired on May 3, 2003.  The collar agreementincluded a 90-day settlement period at which time the Company madepayments to the hedging financial institution for instances inwhich 90-day LIBOR dropped below the designated rate floor of6.865% or received payments from the hedging financial institutionfor instances in which the 90-day LIBOR exceeded the designatedrate ceiling of 8.0%.  The Company terminated the collar inJuly 2001 concurrently with the issuance of the 9.75% Notes andrepayment of the amounts outstanding under the 2000 creditfacility, resulting in the recognition of debt extinguishmentcosts.

               On February 15, 2002, the Company entered into an interest rateswap agreement with Bank of America, N.A., to swap its 9.75% fixedinterest rate on a notional amount of $100.0 million of the 9.75%Notes for a floating rate designated at the 6-month LIBOR rate (thebenchmark interest rate) plus a fixed percentage of 3.63%. The swap agreement matured upon the maturity or redemption of the9.75% Notes but was also subject to termination by either party atany time.  The floating interest rate was determined for thesix-month period in arrears on semi-annual settlement dates ofFebruary 1 and August 1.  The swap qualified as a fair valuehedge under SFAS 133, and the Company elected the shortcut methodof accounting due to the highly effective nature of the swap. On August 13, 2002, the Company terminated the swap agreement inconsideration of a cash payment to the Company from Bank ofAmerica, N.A. of $5.5 million.  Approximately $5.3 million ofthe cash received represented the fair value of the swap as of thetermination date, net of interest accrued since the previoussettlement date.  The $5.3 million portion of the payment wasrecorded as a deferred gain and will be amortized as an offset tointerest expense using the effective interest method over theremaining life of the 9.75% Notes.  The remaining unamortizeddeferred gain is included in other liabilities on the accompanyingconsolidated balance sheet as of June 30, 2003.

               On January 17, 2003, the Company entered into an agreement withBank of America, N.A. to swap the variable 90-day LIBOR rateapplicable to a notional amount of $147.0 million of its $150.0million of term loans under the amended 2001 credit facility for afixed LIBOR rate of 1.77% for the one-year period commencing July3, 2003 and ending July 3, 2004.  The swap agreement qualifiesas a cash flow hedge under SFAS 133, and the Company has electedthe shortcut method of accounting due to the highly effectivenature of the swap.  The fair market value of the swapagreement as of June 30, 2003, was a liability of $0.6 million, netof taxes, and is included in other accrued expenses and currentliabilities with an offsetting adjustment to accumulated othercomprehensive loss on the accompanying consolidated balance sheetas of June 30, 2003.

F-21
****
Table of Contents

***Future Maturities***

               Future maturities of long-term debt, excluding capital leaseobligations, as of June 30, 2003 are as follows (in millions):

**Year**

**Amount**

2004

$

3.6

2005

1.5

2006

1.5

2007

1.5

2008

1.5

Thereafter

459.4

$

469.0

******

***Other Information***

               The Company conducts substantially all of its business through itssubsidiaries.  Most of the Company’s subsidiaries havejointly and severally guaranteed the Company’s 9.75% Notes onan unsecured senior subordinated basis.  Certain otherconsolidated entities that are not wholly owned by the Company havenot guaranteed the 9.75% Notes in conformity with the provisions ofthe indenture governing the 9.75% Notes and have not guaranteed theamended 2001 credit facility in conformity with the provisionsthereof.  The condensed consolidating financial informationfor the parent company, the subsidiary guarantors, thenon-guarantor subsidiaries, certain eliminations and theconsolidated Company as of June 30, 2002 and 2003, and for theyears ended June 30, 2001, 2002 and 2003, follows.

F-22
****
Table of Contents

**VANGUARD HEALTH SYSTEMS, INC.CONDENSED CONSOLIDATING BALANCE SHEETSJune 30, 2002**

 

** **

**Parent**
 
**Guarantor Subsidiaries**

** **

**Combined Non-Guarantors**

** **

**Eliminations**

** **

**Total Consolidated**

 

 

** **

 

 

** **

*(In millions)*

 

**ASSETS**

** **

 

Current assets:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Cash and cash equivalents

 

$

–

 

 

$

56.3

 

 

$

(0.9

)

 

$

–

 

 

$

55.4

 

Accounts receivable, net

 

 

–

 

 

 

144.8

 

 

 

24.5

 

 

 

–

 

 

 

169.3

 

Supplies

 

 

–

 

 

 

13.6

 

 

 

1.9

 

 

 

–

 

 

 

15.5

 

Prepaid expenses and other current assets

 

 

2.8

 

 

 

9.0

 

 

 

18.6

 

 

 

–

 

 

 

30.4

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

    Total current assets

 

 

2.8

 

 

 

223.7

 

 

 

44.1

 

 

 

–

 

 

 

270.6

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

–

 

 

 

 

 

Property, plant and equipment, net

 

 

–

 

 

 

411.7

 

 

 

43.1

 

 

 

–

 

 

 

454.8

 

Goodwill

 

 

–

 

 

 

79.1

 

 

 

–

 

 

 

–

 

 

 

79.1

 

Intangible assets, net

 

 

–

 

 

 

38.0

 

 

 

0.3

 

 

 

–

 

 

 

38.3

 

Investments in subsidiaries

 

 

323.8

 

 

 

–

 

 

 

–

 

 

 

(323.8

)

 

 

–

 

Other assets

 

 

–

 

 

 

9.0

 

 

 

0.1

 

 

 

–

 

 

 

9.1

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

    Total assets

 

$

326.6

 

 

$

761.5

 

 

$

87.6

 

 

$

(323.8

)

 

$

851.9

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

**LIABILITIES AND STOCKHOLDERS’ EQUITY**

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Current liabilities:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Accounts payable

 

$

–

 

 

$

41.1

 

 

$

8.6

 

 

$

–

 

 

$

49.7

 

Accrued expenses and other current liabilities

 

 

–

 

 

 

117.9

 

 

 

11.3

 

 

 

–

 

 

 

129.2

 

Current maturities of long-term debt

 

 

–

 

 

 

3.1

 

 

 

0.7

 

 

 

–

 

 

 

3.8

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

    Total current liabilities

 

 

–

 

 

 

162.1

 

 

 

20.6

 

 

 

–

 

 

 

182.7

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

–

 

 

 

 

 

Other liabilities

 

 

5.1

 

 

 

2.5

 

 

 

14.9

 

 

 

–

 

 

 

22.5

 

Long-term debt, less current maturities

 

 

–

 

 

 

306.8

 

 

 

4.2

 

 

 

–

 

 

 

311.0

 

Intercompany

 

 

(4.6

)

 

 

(23.8

)

 

 

28.4

 

 

 

–

 

 

 

–

 

Payable-In-Kind Preferred Stock

 

 

24.1

 

 

 

–

 

 

 

–

 

 

 

–

 

 

 

24.1

 

Stockholders’ equity

 

 

302.0

 

 

 

313.9

 

 

 

19.5

 

 

 

(323.8

)

 

 

311.6

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

    Total liabilities and stockholders’equity

 

$

326.6

 

 

$

761.5

 

 

$

87.6

 

 

$

(323.8

)

 

$

851.9

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

F-23
****
Table of Contents
****
**VANGUARD HEALTH SYSTEMS, INC.CONDENSED CONSOLIDATING BALANCE SHEETSJune 30, 2003**

 

 

**Parent**
 
**Guarantor Subsidiaries**

** **

**Combined Non-Guarantors**

** **

**Eliminations**

** **

**Total Consolidated**

 

 

 
**
 

 

 

*(In millions)*

 

**ASSETS**

 

Current assets:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Cash and cash equivalents

 

$

–

 

 

$

21.2

 

 

$

6.0

 

 

$

–

 

$

 

27.2

 

Accounts receivable, net

 

 

–

 

 

 

189.2

 

 

 

24.7

 

 

 

–

 

 

 

213.9

 

Supplies

 

 

–

 

 

 

29.7

 

 

 

2.4

 

 

 

–

 

 

 

32.1

 

Prepaid expenses and other current assets

 

 

–

 

 

 

4.2

 

 

 

20.8

 

 

 

–

 

 

 

25.0

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

    Total current assets

 

 

–

 

 

 

244.3

 

 

 

53.9

 

 

 

–

 

 

 

298.2

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Property, plant and equipment, net

 

 

–

 

 

 

721.8

 

 

 

55.4

 

 

 

–

 

 

 

777.2

 

Goodwill

 

 

–

 

 

 

100.2

 

 

 

–

 

 

 

–

 

 

 

100.2

 

Intangible assets, net

 

 

–

 

 

 

37.0

 

 

 

1.6

 

 

 

–

 

 

 

38.6

 

Investments in subsidiaries

 

 

408.8

 

 

 

–

 

 

 

–

 

 

 

(408.8

)

 

 

–

 

Other assets

 

 

–

 

 

 

2.5

 

 

 

10.2

 

 

 

–

 

 

 

12.7

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

    Total assets

 

$

408.8

 

 

$

1,105.8

 

 

$

121.1

 

 

$

(408.8

)

 

$

1,226.9

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

**LIABILITIES AND STOCKHOLDERS’ EQUITY**

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Current liabilities:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Accounts payable

 

$

–

 

 

$

85.5

 

 

$

6.2

 

 

$

–

 

 

$

91.7

 

Accrued expenses and other current liabilities

 

 

–

 

 

 

147.0

 

 

 

14.1

 

 

 

–

 

 

 

161.1

 

Current maturities of long-term debt

 

 

–

 

 

 

7.5

 

 

 

0.8

 

 

 

–

 

 

 

8.3

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

    Total current liabilities

 

 

–

 

 

 

240.0

 

 

 

21.1

 

 

 

–

 

 

 

261.1

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Other liabilities

 

 

13.6

 

 

 

14.8

 

 

 

34.2

 

 

 

–

 

 

 

62.6

 

Long-term debt, less current maturities

 

 

–

 

 

 

467.6

 

 

 

3.5

 

 

 

–

 

 

 

471.1

 

Intercompany

 

 

(5.1

)

 

 

(32.4

)

 

 

37.5

 

 

–

 

 

 

–

 

Payable-In-Kind Preferred Stock

 

 

57.0

 

 

 

–

 

 

 

–

 

 

 

–

 

 

 

57.0

 

Stockholders’ equity

 

 

343.3

 

 

 

415.8

 

 

 

24.8

 

 

 

(408.8

)

 

 

375.1

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

    Total liabilities and stockholders’equity

 

$

408.8

 

 

$

1,105.8

 

 

$

121.1

 

 

$

(408.8

)

 

$

1,226.9

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

F-24
****
Table of Contents

**VANGUARD HEALTH SYSTEMS, INC.CONDENSED CONSOLIDATING INCOME STATEMENTSFor the year ended June 30, 2001**

 

** **

**Parent**
 
**Guarantor Subsidiaries**

** **

**Combined Non-Guarantors**

** **

**Eliminations**

** **

**Total Consolidated**

 

 

** **

 

 

** **

*(In millions)*

 

** **

** **

 

Patient service revenues

 

$

–

 

 

$

604.7

 

 

$

8.0

 

 

$

–

 

 

$

612.7

 

Premium revenues

 

 

–

 

 

 

55.1

 

 

 

–

 

 

 

–

 

 

 

55.1

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

    Total revenues

 

 

–

 

 

 

659.8

 

 

 

8.0

 

 

 

–

 

 

 

667.8

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Salaries and benefits

 

 

–

 

 

 

321.8

 

 

 

1.8

 

 

 

–

 

 

 

323.6

 

Supplies

 

 

–

 

 

 

91.7

 

 

 

1.2

 

 

 

–

 

 

 

92.9

 

Medical claims expense

 

 

–

 

 

 

30.8

 

 

 

–

 

 

 

–

 

 

 

30.8

 

Purchased services

 

 

–

 

 

 

48.3

 

 

 

0.3

 

 

 

–

 

 

 

48.6

 

Provision for doubtful accounts

 

 

–

 

 

 

56.7

 

 

 

0.1

 

 

 

–

 

 

 

56.8

 

Insurance

 

 

–

 

 

 

8.1

 

 

 

0.1

 

 

 

–

 

 

 

8.2

 

Other operating expenses

 

 

–

 

 

 

42.6

 

 

 

0.6

 

 

 

–

 

 

 

43.2

 

Rents and leases

 

 

–

 

 

 

11.7

 

 

 

0.5

 

 

 

–

 

 

 

12.2

 

Depreciation and amortization

 

 

–

 

 

 

23.4

 

 

 

0.4

 

 

 

–

 

 

 

23.8

 

Interest, net

 

 

–

 

 

16.7

 

 

 

(0.1

)

 

 

–

 

 

 

16.6

 

Management fees

 

 

–

 

 

 

(0.4

)

 

 

0.4

 

 

 

–

 

 

 

–

 

Other

 

 

–

 

 

 

0.4

 

 

 

–

 

 

 

–

 

 

 

0.4

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

–

 

 

651.8

 

 

 

5.3

 

 

 

–

 

 

 

657.1

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Income before income taxes

 

 

–

 

 

 

8.0

 

 

 

2.7

 

 

 

–

 

 

 

10.7

 

Income tax expense

 

 

0.4

 

 

 

0.1

 

 

 

–

 

 

 

–

 

 

 

0.5

 

Equity in earnings of subsidiaries

 

 

10.6

 

 

 

–

 

 

 

–

 

 

 

(10.6

)

 

 

–

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Net income

 

$

10.2

 

 

$

7.9

 

 

$

2.7

 

 

$

(10.6

)

 

$

10.2

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

F-25
****
Table of Contents

**VANGUARD HEALTH SYSTEMS, INC.CONDENSED CONSOLIDATING INCOME STATEMENTSFor the year ended June 30, 2002**

**Parent**

**Guarantor Subsidiaries**

**Combined Non-Guarantors**

**Eliminations**

**Total Consolidated**

 

 

*(In millions)*

 

** **

 

Patient service revenues

$

–

$

707.9

$

17.9

$

–

$

725.8

Premium revenues

–

184.8

1.2

(1.2

)

184.8

    Total revenues

–

892.7

19.1

(1.2

)

910.6

Salaries and benefits

–

378.4

6.0

–

384.4

Supplies

–

113.2

2.9

–

116.1

Medical claims expense

–

132.0

–

–

132.0

Purchased services

–

65.3

1.1

–

66.4

Provision for doubtful accounts

–

52.6

0.7

–

53.3

Insurance

–

19.2

1.7

(1.2

)

19.7

Other operating expenses

–

51.2

1.9

–

53.1

Rents and leases

–

13.8

0.6

–

14.4

Depreciation and amortization

–

29.0

0.5

–

29.5

Interest, net

–

26.4

0.3

–

26.7

Management fees

–

(0.4

)

0.4

–

–

Debt extinguishment costs

–

6.6

–

–

6.6

Other

–

(1.3

)

–

–

(1.3

)

–

886.0

16.1

(1.2

)

900.9

Income before income taxes

–

6.7

3.0

–

9.7

Income tax expense

2.9

–

–

–

2.9

Equity in earnings of subsidiaries

9.6

–

–

(9.6

)

–

Net income

$

6.7

$

6.7

$

3.0

$

(9.6

)

$

6.8

F-26
****
Table of Contents

**VANGUARD HEALTH SYSTEMS, INC.CONDENSED CONSOLIDATING INCOME STATEMENTSFor the year ended June 30, 2003**

 

 

**Parent**
 
**Guarantor Subsidiaries**

** **

**Combined Non-Guarantors**

** **

**Eliminations**

** **

**Total Consolidated**

 

 

 

 

 

 

*(In millions)*

 

 

 

 

Patient service revenues

 

$

–

 

 

$

1,003.2

 

 

$

118.5

 

 

$

–

 

 

$

1,121.7

 

Premium revenues

 

 

–

 

 

 

218.8

 

 

 

17.6

 

 

 

(17.6

)

 

 

218.8

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

    Total revenues

 

 

–

 

 

 

1,222.0

 

 

 

136.1

 

 

 

(17.6

)

 

 

1,340.5

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Salaries and benefits

 

 

–

 

 

 

522.8

 

 

 

55.6

 

 

 

–

 

 

 

578.4

 

Supplies

 

 

–

 

 

 

181.3

 

 

 

21.3

 

 

 

–

 

 

 

202.6

 

Medical claims expense

 

 

–

 

 

 

160.8

 

 

 

–

 

 

 

–

 

 

 

160.8

 

Purchased services

 

 

–

 

 

 

77.7

 

 

 

9.0

 

 

 

–

 

 

 

86.7

 

Provision for doubtful accounts

 

 

–

 

 

 

66.7

 

 

 

6.7

 

 

 

–

 

 

 

73.4

 

Insurance

–

23.8

22.2

(17.6

)

28.4

 

Other operating expenses

 

 

–

 

 

 

75.1

 

 

 

8.8

 

 

 

–

 

 

 

83.9

 

Rents and leases

 

 

–

 

 

 

16.5

 

 

 

1.8

 

 

 

–

 

 

 

18.3

 

Depreciation and amortization

 

 

–

 

 

 

44.5

 

 

 

2.4

 

 

 

–

 

 

 

46.9

 

Interest, net

 

 

–

 

 

 

33.1

 

 

 

1.8

 

 

 

–

 

 

 

34.9

 

Management fees

 

 

–

 

 

 

(2.3

)

 

 

2.3

 

 

 

–

 

 

 

–

 

Debt extinguishment costs

 

 

–

 

 

 

–

 

 

 

–

 

 

 

–

 

 

 

–

 

Other

 

 

–

 

 

 

(1.6

)

 

 

–

 

 

 

–

 

 

 

(1.6

)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

–

 

 

 

1,198.4

 

 

 

131.9

 

 

 

(17.6

)

 

 

1,312.7

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Income before income taxes

 

 

–

 

 

23.6

 

 

 

4.2

 

 

 

–

 

 

 

27.8

 

Income tax expense

 

 

10.9

 

 

 

–

 

 

 

–

 

 

 

–

 

 

 

10.9

 

Equity in earnings of subsidiaries

 

 

27.8

 

 

–

 

 

 

–

 

 

 

(27.8

)

 

 

–

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Net income

 

$

16.9

 

 

$

23.6

 

 

$

4.2

 

 

$

(27.8

)

 

$

16.9

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

F-27
****
Table of Contents

**VANGUARD HEALTH SYSTEMS, INC.CONDENSED CONSOLIDATING STATEMENTS OF CASH FLOWSFor the year ended June 30, 2001**

**Parent**

**Wholly-Owned Guarantor Subsidiaries**

**Combined Non-Guarantors**

**Eliminations**

**Total Consolidated**

 

 

*(In millions)*

 

** **

 

**Operating activities:**

Net income

$

10.2

$

7.9

$

2.7

$

(10.6

)

$

10.2

Adjustments to reconcile net income to net cash     provided by operating activities:

    Depreciation and amortization

–

23.4

0.4

–

23.8

    Provision for doubtful accounts

–

56.7

0.1

–

56.8

    Amortization of loan costs

–

0.9

–

–

0.9

    Loss on disposal of assets

–

0.6

–

–

0.6

    Interest on interest collar agreement

–

0.1

–

–

0.1

    Deferred income taxes

(0.1

)

(0.8

)

–

–

(0.9

)

Changes in operating assets and liabilities, net of     effects of acquisitions:

    Equity in earnings (losses) ofsubsidiaries

(10.6

)

–

–

10.6

–

    Accounts receivable

–

(68.1

)

(0.5

)

–

(68.6

)

    Establishment of accounts receivable ofrecent         acquisitions

–

(7.2

)

–

–

(7.2

)

    Supplies

–

(0.5

)

–

–

(0.5

)

    Prepaid expenses and other current assets

–

2.6

(1.3

)

–

1.3

    Accounts payable

–

8.4

0.1

–

8.5

    Accrued expenses and other long-termliabilities

1.1

(19.5

)

0.1

–

(18.3

)

Net cash provided by operating activities

0.6

4.5

1.6

–

6.7

**Investing activities:**

Acquisitions

–

(10.6

)

–

–

(10.6

)

Capital expenditures

–

(26.3

)

(0.3

)

–

(26.6

)

Other

–

(0.9

)

–

–

(0.9

)

Net cash used in investing activities

–

(37.8

)

(0.3

)

–

(38.1

)

**Financing activities:**

Proceeds from issuance of common stock

–

32.9

–

–

32.9

Proceeds from long-term debt

–

–

–

–

–

Payments of long-term debt

–

(5.8

)

(0.1

)

–

(5.9

)

Payments of loan costs

–

(0.3

)

–

–

(0.3

)

Cash provided by (used in) intercompany activity

(0.6

)

1.7

(1.1

)

–

–

Proceeds from the exercise of stock options

–

–

–

–

–

Net cash provided by (used in) financing activities

(0.6

)

28.5

(1.2

)

–

26.7

Net (decrease) increase in cash and cash equivalents

–

(4.8

)

0.1

–

(4.7

)

Cash and cash equivalents, beginning of period

–

16.6

0.2

–

16.8

Cash and cash equivalents, end of period

$

–

$

11.8

$

0.3

$

–

$

12.1

F-28
****
Table of Contents

**VANGUARD HEALTH SYSTEMS, INC.CONDENSED CONSOLIDATING STATEMENTS OF CASH FLOWSFor the year ended June 30, 2002**

**Parent**

**Wholly-Owned Guarantor Subsidiaries**

**Combined Non-Guarantors**

**Eliminations**

**Total Consolidated**

 

 

*(In millions)*

 

** **

 

**Operating activities:**

Net income

$

6.8

$

6.6

$

3.0

$

(9.6

)

$

6.8

Adjustments to reconcile net income to net cash     (used in) provided by operating activities:

    Depreciation and amortization

–

29.0

0.5

–

29.5

    Provision for doubtful accounts

–

52.6

0.7

–

53.3

    Amortization of loan costs

–

1.4

–

–

1.4

    Debt extinguishment costs

–

6.6

–

–

6.6

    Loss (gain) on disposal of assets

–

(0.8

)

–

–

(0.8

)

    Deferred income taxes

2.8

–

–

–

2.8

Changes in operating assets and liabilities, net of     effects of acquisitions:

    Equity in earnings of subsidiaries

(9.6

)

–

–

9.6

–

    Accounts receivable

–

(58.5

)

(6.4

)

–

(64.9

)

    Establishment of accounts receivable ofrecent         acquisitions

–

(1.5

)

–

–

(1.5

)

    Supplies

–

(0.6

)

(0.1

)

–

(0.7

)

    Prepaid expenses and other current assets

(0.3

)

5.7

(16.1

)

–

(10.7

)

    Accounts payable

―

(2.3

)

(0.2

)

–

(2.5

)

    Accrued expenses and other long-termliabilities

(0.4

)

8.1

17.7

–

25.4

Net cash (used in) provided by operating activities

(0.7

)

46.3

(0.9

)

–

44.7

**Investing activities:**

Acquisitions

–

(100.3

)

–

–

(100.3

)

Capital expenditures

–

(34.7

)

(0.4

)

–

(35.1

)

Other

–

–

–

–

–

Net cash used in investing activities

–

(135.0

)

(0.4

)

–

(135.4

)

**Financing activities:**

Equity contribution from joint venture partner

–

2.5

–

–

2.5

Proceeds from long-term debt

–

300.0

–

–

300.0

Payments of long-term debt

–

(153.5

)

(0.3

)

–

(153.8

)

Payments of loan costs

–

(14.7

)

–

–

(14.7

)

Cash provided by (used in) intercompany activity

0.7

(1.1

)

0.4

–

–

Proceeds from the exercise of stock options

–

–

–

–

–

Net cash provided by financing activities

0.7

133.2

0.1

–

134.0

Net increase (decrease) in cash and cash equivalents

–

44.5

(1.2

)

–

43.3

Cash and cash equivalents, beginning of period

–

11.8

0.3

–

12.1

Cash and cash equivalents, end of period

$

–

$

56.3

$

(0.9

)

$

–

$

55.4

F-29
****
Table of Contents
****
**VANGUARD HEALTH SYSTEMS, INC.CONDENSED CONSOLIDATING STATEMENTS OF CASH FLOWSFor the year ended June 30, 2003**

**Parent**

**Wholly-Owned Guarantor Subsidiaries**

**Combined Non-Guarantors**

**Eliminations**

**Total Consolidated**

 

 

*(In millions)*

 

** **

 

**Operating activities:**

Net income

$

16.9

$

23.6

$

4.2

$

(27.8

)

$

16.9

Adjustments to reconcile net income to net cash     provided by operating activities:

    Depreciation and amortization

–

44.5

2.4

–

46.9

    Provision for doubtful accounts

–

66.7

6.7

–

73.4

    Amortization of loan costs

–

1.5

–

–

1.5

    Loss on sale of assets

–

–

–

–

–

    Debt extinguishment costs

–

–

–

–

–

    Deferred income taxes

3.5

–

–

–

3.5

Changes in operating assets and liabilities, net of     effects of acquisitions:

    Equity in earnings of subsidiaries

(27.8

)

–

–

27.8

–

    Accounts receivable

–

(60.2

)

(7.4

)

–

(67.6

)

    Establishment of accounts receivable ofrecent         acquisitions

–

–

–

–

–

    Supplies

–

(3.1

)

(0.5

)

–

(3.6

)

    Prepaid expenses and other current assets

2.8

7.1

 

(2.2

)

–

7.4

    Accounts payable

–

18.1

(2.5

)

–

15.6

    Accrued expenses and other liabilities

5.0

(3.1

)

21.5

–

23.7

Net cash provided by operating activities

0.4

95.1

22.2

–

117.7

**Investing activities:**

Acquisitions, including working capital settlement     payments

–

(249.4

)

–

–

(249.4

)

Capital expenditures

–

(87.6

)

(10.9

)

–

(98.5

)

Other

(55.0

)

70.3

(11.4

)

–

3.9

Net cash used in investing activities

(55.0

)

(266.7

)

(22.3

)

–

(344.0

)

**Financing activities:**

Proceeds from issuance of common stock

50.0

–

–

–

50.0

Proceeds from long-term debt

–

150.0

–

–

150.0

Payments of long-term debt and capital leases

–

(4.7

)

(0.6

)

–

(5.3

)

Payments of loan costs

–

(2.3

)

–

–

(2.3

)

Cash provided by (used in) intercompany activity

4.6

(12.7

)

8.1

–

–

Other

–

5.7

–

–

5.7

Net cash provided by financing activities

54.6

136.0

7.5

–

198.1

Net increase (decrease) in cash and cash equivalents

–

(35.6

)

7.4

–

(28.2

)

Cash and cash equivalents, beginning of period

–

56.3

(0.9

)

–

55.4

Cash and cash equivalents, end of period

$

–

$

20.7

$

6.5

$

–

$

27.2

F-30
****
Table of Contents

**7.            Income Taxes**

               Significant components of the provision for income taxesattributable to continuing operations are as follows (inmillions):

 

 

 

**2001**

 

 

 

**2002**

 

 

**2003**

 

 

 

 

 

Current:

 

 

 

 

 

 

 

 

 

 

   Federal

 

$

1.2

 

 

$

(0.1

)

$

–

   State

 

 

0.2

 

 

 

0.1

 

 

0.4

 

 

 

 

 

 

 

 

 

 

Total current

 

 

1.4

 

 

 

–

 

 

0.4

 

 

 

 

 

 

 

 

 

 

 

  

 

Deferred:

 

 

 

 

 

 

 

 

 

  

 

   Federal

 

 

(0.9

)

 

 

2.5

 

9.9

 

   State

 

 

–

 

 

0.4

 

 

0.6

 

 

 

 

 

 

 

 

 

 

Total deferred

 

 

(0.9

)

 

 

2.9

 

10.5

 

 

 

 

 

 

 

 

 

 

 

 

$

0.5

 

 

$

2.9

 

$

10.9

 

 

 

 

 

 

 

 

 

 

               The effective income tax rate differed from the federal statutoryrate for the years ended June 30, 2001, 2002 and 2003 asfollows:

 

 

**2001**

 

 

**2002**

 

 

**2003**

 

 

 

 

Income tax expense at federal statutory rate

 

35.0

 %

 

35.0

 %

 

35.0

 %

Income tax expense at state statutory rate

 

7.3

 

 

5.2

 

 

3.6

 

Nondeductible expenses and other

 

1.3

 

 

4.4

 

 

0.6

 

Decrease in valuation allowance

 

(38.8

) 

 

(14.8

)

 

–

 

 

 

 

 

 

 

Effective income tax rate

 

4.8

 %

 

29.8

 %

 

39.2

 %

 

 

 

 

 

 

 

F-31
****
Table of Contents

               Deferred income taxes reflect the net tax effects of temporarydifferences between the carrying amounts of assets and liabilitiesfor financial reporting purposes and the amounts used for incometax purposes.  Significant components of the Company’sdeferred tax assets and liabilities as of June 30, 2002 and 2003,were approximately as follows (in millions):

**2002**

**2003**

Deferred tax assets:

   Net operating loss carryover

$

9.6

$

12.0

   Excess tax basis over book basis of accountsreceivable

0.4

2.2

   Deferred compensation and other costs

2.2

2.6

   Accrued expenses

1.0

2.9

   Interest rate swap liability

–

0.3

   Professional liabilities reserves

6.0

3.9

   Self-insurance reserves

1.4

2.1

   Unearned revenue and deferred gains

1.0

3.9

   Equity method of accounting forpartnerships

0.4

0.4

Total deferred tax assets

22.0

30.3

   Valuation allowance

–

–

Total deferred tax assets, net of valuation allowance

$

22.0

$

30.3

Deferred tax liabilities:

   Depreciation, amortization and fixed assetsbasis differences

$

21.5

$

32.9

   Excess book basis over tax basis of prepaidassets

3.7

10.8

Total deferred tax liabilities

25.2

43.7

Net deferred tax assets and liabilities

$

(3.2

)

$

(13.4

)

               Net non-current deferred tax liabilities of $5.1 million and $13.1million as of June 30, 2002 and 2003, respectively, are included inthe accompanying consolidated balance sheet in otherliabilities.  Net current deferred tax assets were $1.9million as of June 30, 2002.  Net current deferred taxliabilities of $0.3 million as of June 30, 2003, are included inother accrued expenses and current liabilities on the accompanyingconsolidated balance sheet.

               As of June 30, 2003, the Company generated net operating loss(“NOL”) carryforwards for federal income tax purposesof approximately $31.5 million and for state purposes ofapproximately $20.0 million that expire from 2012 to 2022. Approximately $4.9 million of these NOLs are subject to annuallimitation for federal purposes.  These limitations are notexpected to significantly affect the Company’s ability toultimately recognize the benefit of these NOLs in future years.

               The Company must make estimates in recording its provision forincome taxes, including the determination of deferred tax assetsand liabilities and any valuation allowance that may be requiredagainst the deferred tax assets.  The Company has not recordedany valuation allowance as of June 30, 2003, because managementbelieves that future taxable income will, more likely than not, besufficient to realize the benefits of those assets as the temporarydifferences reverse in the future.

**8.            Stockholder’s Equity**

               The Company has the authority to issue 750,000 shares of capitalstock, classified as (i) 150,000 shares of preferred stock, parvalue $.01 per share, and (ii) 600,000 shares of common stock, parvalue $.01 per share (the “Common Stock”).

F-32
****
Table of Contents

***Common Stock Issuances***

               In August 1997, the Company issued 25,000 shares of Common Stock(“Initial Shares”) to certain officers(“Management Investors”) of the Company at $100 pershare. An additional 695 shares were issued to an officer of theCompany in October 1997 at  $100 per share.

               On June 1, 1998 (the “Effective Date”), theCompany’s Board of Directors (the “Board”)approved the (i) Subscription Agreement, providing for the issuanceand sale of the Company’s Common Stock, (ii) ShareholdersAgreement, providing for, among other things, registration rightsfor stockholders and restrictions on the sale, transfer,encumbrance or other disposition of shares of the Common Stock andto provide for certain rights and obligations relating to thecapital stock of the Company and certain matters relating to theconduct of the business and the affairs of the Company, and (iii)Surviving Shareholders Agreement, providing for, upon an initialpublic offering, among other things, registration rights forstockholders and restrictions on the sale, transfer or thedisposition of shares of the Common Stock. The Company wasauthorized to issue 135,535 shares of Common Stock pursuant to theSubscription Agreement.

               Under the Amended and Restated Subscription Agreement dated June 1,2000, the Company authorized the issuance of 235,521 shares ofCommon Stock in addition to the 135,535 shares originallyauthorized pursuant to the original Subscription Agreement datedJune 1, 1998.  As of June 30, 2003, the Company had issued232,686 shares of its Common Stock in August 1997 and under theSubscription Agreement and the Amended and Restated SubscriptionAgreement and 27 shares as a result of the exercise of employeestock options.

               Subject to certain terms and conditions of the Amended and RestatedSubscription Agreement, the Company has agreed to issue and sell,and certain investors have agreed to purchase on one or more futuredates, additional shares of Common Stock aggregating 164,065 sharesat a per share price of $1,701.18.  The Company expects toutilize the proceeds from any subsequent issuance of Common Stockto purchase, from time to time, hospitals, hospital systems,hospital management companies and assets related thereto.

***Forfeiture of Common Shares by CertainInvestors***

               Each of certain investors in the Company has also agreed totransfer to the Company upon the occurrence of a Liquidity Event,as defined below, in exchange for no consideration, its allocatedportion of an aggregate number of shares of Common Stock equal tothe Aggregate Carry Amount (as defined in the Carry Option Plan).The determination of the Aggregate Carry Amount is contingent upon,among other things, the computed amount of the Net MSCP InternalRate of Return (“IRR”), as applicable and as defined inthe Carry Option Plan, immediately after giving effect to theLiquidity Event. Any such transfer to the Company shall be made assoon as practicable following the date on which options grantedpursuant to certain provisions of the Carry Option Plan becomevested and exercisable.

               A Liquidity Event means the first to occur of (i) the consummationof an initial public offering of the Common Stock, (ii) the sale byMSCP of all or substantially all of its aggregate equity interestsin the Company, (iii) the sale of all or substantially all of theassets of the Company, or (iv) the liquidation or dissolution ofthe Company.

**

***Repurchase of Common Shares Held by ManagementInvestors***

               Upon any Liquidity Event in connection with which MSCP receivesaggregate net proceeds in an amount that is less than the aggregateamount of capital invested by MSCP in the Company, MSCP may requirethe Company to purchase from each Management Investor any and allInitial Shares then owned by such Management Investor for apurchase price per share equal to the lesser of the cost or fairmarket value thereof.

***Payable-In-Kind Preferred Stock***

**

               On February 1, 2000, to satisfy a portion of the purchase price forthe acquisition of MacNeal Hospital and related assets, the Companyissued 20,000 shares of its payable-in-kind convertible redeemablepreferred stock (“PIK Preferred Shares”) with a parvalue of $0.01 per share.  On January 3, 2003, the Companyissued 30,000 shares of payable-in-kind convertible redeemablepreferred stock (“Series B PIK Preferred Shares”) withpar value of $0.01 per share to satisfy a portion of the purchaseprice of its acquisition of the BHS assets.  Each series ofpreferred stock was valued by an independent appraiser at $1,000per share for purposes of the acquisitions.

F-33
****
Table of Contents

               *PIK Preferred Shares*

               Upon the liquidation, dissolution, or winding up of the Company, orupon the Company’s exercise of its option to redeem suchshares, the holders of the PIK Preferred Shares are entitled to bepaid in cash equal to $1,000 per each outstanding share plusaccrued dividends.  To the extent the Company shall have fundslegally available for payment, the Company is required to redeemall outstanding PIK Preferred Shares at $1,000 per share plusaccrued dividends upon the earlier of (i) a change in control ofthe Company; (ii) the sale of the assets purchased from MacNealHealth Services; or (iii) January 31, 2015. Otherwise, there are nomandatory redemption or put features associated with the PIKPreferred Shares.  The PIK Preferred Shares are, with respectto dividend rights and rights on liquidation, dissolution andwinding up, senior to all common shares and may only be junior toother preferred shares designated as such, with such designationrequiring the majority vote of the holders of the PIK PreferredShares voting as a separate class.  The PIK Preferred Sharesautomatically convert to common shares, upon consummation of aninitial public offering of the Common Stock that produces proceedsto the Company of at least $50.0 million at a conversion priceequal to the initial public offering price.

**

               Dividends for the PIK Preferred Shares accrue at an annual rate of$80 per share.  The dividends are payable when, as and ifdeclared by the Board, in cash or, at the Company’s option,during any period prior to January 31, 2008 (“Pay-In-KindPeriod”) in additional PIK Preferred Shares at the rate of0.08 shares for each $80 of such dividend not paid in cash. ThePay-In-Kind Period terminates upon the Company’s payment of acash dividend upon any share of its capital stock. However, theprovisions of the amended 2001 credit facility limit the payment ofsuch dividends to the issuance of additional PIK PreferredShares.

**

               The holders of the PIK Preferred Shares are not entitled to anyvoting rights except to the extent voting rights vest under one ofthe following occurrences:  (i) when dividends become payable,whether in the form of cash or PIK Preferred Shares, shall be inarrears and unpaid in an amount equal to two full annual dividendsor (ii) the Company’s failure to discharge its mandatoryredemption obligation.  In the event the voting rights vestunder one of these occurrences, the Board will automaticallyincrease by two members, and the holders of the PIK PreferredShares shall have the exclusive right, voting as a separate class,to elect the two additional directors.  The voting rights areterminated once the accrued dividends have been paid or themandatory redemption obligation has been fulfilled.

               *Series B PIK Preferred Shares*

               Upon the liquidation, dissolution or winding up of the Company, orupon the Company’s exercise of its option to redeem suchshares on January 1, 2011 or thereafter, the holders of the SeriesB PIK Preferred Shares are entitled to receive cash equal to $1,000per each outstanding share plus accrued dividends.  TheCompany may not redeem any shares prior to January 1, 2008, and theredemption price as of January 1, 2008, 2009 and 2010 is $1,030,$1,020, and $1,010 per share, respectively.  In the event theCompany has the funds legally available, it must redeem theoutstanding Series B PIK Preferred Shares on the earlier of (1)January 31, 2015 or (2) 90 days after a change in control of theCompany, at a redemption price of $1,000 per share plus accrueddividends.  The Series B PIK Preferred Shares are senior toall common shares and are on parity with the PIK Preferred Shareswith respect to dividend rights and rights on liquidation,dissolution or winding up of the Company.  The Series B PIKPreferred Shares are convertible at any time into theCompany’s Common Stock at a $3,500 per share conversionprice.

               Dividends for the Series B PIK Preferred Shares accrue at an annualrate of $62.50 per share.  The dividends are payable when, asand if declared by the Board of Directors, in cash or, at theCompany’s option, during any period through the dividendperiod ending December 31, 2011 (“Series BPay-In-Kind-Period”) in additional Series B PIK PreferredShares at the rate of .0625 shares for each $62.50 of such dividendnot paid in cash.  The Series B Pay-In-Kind Period terminatesupon the Company’s payment of a cash dividend upon any shareof its capital stock.   However, the provisions of the amended2001 credit facility limit the payment of such dividends to theissuance of additional Series B PIK Preferred Shares.

               The holders of the Series B PIK Preferred Shares are not entitledto any voting rights except to the extent voting rights vest underone of the following circumstances: (i) when dividends becomepayable, whether in the form of cash or Series B PIK PreferredShares, shall be in arrears and unpaid in any amount equal to fullannual dividends or (ii) the Company’s failure to dischargeits mandatory redemption obligation.  In the event the votingrights vest under one of these occurrences, the Board willautomatically increase by two members, and the holders of theSeries B PIK Preferred Shares shall have the exclusive right,voting as a separate class, to elect the two additionaldirectors.  The voting rights are terminated once the accrueddividends have been paid or the mandatory redemption obligation hasbeen fulfilled.

F-34
****
Table of Contents

***Put and Call Features of Acquisition SubsidiaryStock***

**

               For a period of 30 days commencing June 1, 2007 and each June 1thereafter, University of Chicago Hospitals (“UCH”) hasthe right to require the Company to purchase its shares in thesubsidiary that acquired Louis A. Weiss Memorial Hospital for apurchase price equal to four times the acquisitionsubsidiary’s Adjusted EBITDA (as defined in the shareholdersagreement between the parties) for the most recent 12 months ofoperations less all indebtedness of the acquisition subsidiary(including capital leases) at such time, times UCH’spercentage interest in the acquisition subsidiary on the date ofpurchase.  Similarly, during the same 30-day periods, theCompany has the right to require UCH to sell to us UCH’sshares in the acquisition subsidiary for a purchase price equal tothe greater of (i) six times the acquisition subsidiary’sAdjusted EBITDA (as defined in the shareholders agreement among theparties) for the most recent 12 months of operations less allindebtedness of the acquisition subsidiary (including capitalleases) at such time, times UCH’s percentage interest in theacquisition subsidiary on the date of purchase, and (ii) the pricepaid by UCH for its interest in the acquisition subsidiary minusdividends or other distributions to UCH in respect of thatinterest.

**9.            Stock Based Compensation**

               As previously discussed, the Company adopted the provisions of SFAS148 during fiscal 2003 and, effective July 1, 2003, elected toadopt the fair value method of accounting for stock-based employeecompensation under SFAS 123 using the prospective method oftransition set forth by SFAS 148.  As of June 30, 2003, theCompany continued to account for previously granted options underAPB No. 25.  Information regarding the Company’s variousoption plans and option transactions follows.

***Carry Option Plan***

               On June 1, 1998, the Board approved the grant of 23,883 options,each exercisable for one share of Common Stock, at an exerciseprice of $170.12 under the Vanguard Health Systems, Inc. CarryOption Plan (the “Carry Option Plan”). In August 2000,the Board approved a grant of 3,134 options to an officer of theCompany under the Carry Option Plan.  In November 2001, theBoard approved the grant of 2,805 options under the Carry OptionPlan, bringing the total number of outstanding options to 29,822,the maximum allowed pursuant to the Amended and RestatedShareholders Agreement and Carry Option Plan dated June 1,2000.  Additional options may only be granted upon thecancellation of previously issued options.  Upon and after theoccurrence of a Liquidity Event, no options shall be available forgrant under the Carry Option Plan.

               Subject to the terms and conditions of the Carry Option Plan, theoptions granted under the Carry Option Plan shall vest upon theearlier of a Liquidity Event or ratably over seven years. None of the options shall be exercisable prior to a LiquidityEvent. Upon a Liquidity Event, a number of options equal to theExercisable Options, as defined in the Carry Option Plan, shallbecome exercisable. The determination of Exercisable Options iscontingent upon, among other things, the computed amount of the NetMSCP IRR immediately after giving effect to such Liquidity Event.Such number of options may only be exercised commencing at suchtime and ending on the tenth anniversary of the Effective Date, atwhich time such options shall expire. All options held by a granteein excess of the Exercisable Options shall, upon the occurrence ofa Liquidity Event, be irrevocably and unconditionally forfeited andcanceled without any consideration payable to the grantee, and thegrantee shall have no further right or consideration therein.

               Upon the occurrence of a Liquidity Event, the Company will incur animmediate compensation expense on all Excercisable Optionsoutstanding at that time based on the excess of the fair marketvalue of each share of Common Stock over the exercise price.

***Initial Option Plan***

               The purpose of the Vanguard Health Systems, Inc. NonqualifiedInitial Option Plan (the “Initial Option Plan”) wasprimarily to grant option awards to those employees who agreed towork for the Company for no cash salaries or cash salaries belowfair market value during the eleven months ended May 31, 1998.

               On June 1, 1998, the Board approved the grant of 3,595 options,each exercisable for one share of Common Stock, at an exerciseprice of $170.12 per share. The maximum number of shares of CommonStock reserved for grant of awards under the Initial Option Planwas 3,595.  Each of the 3,595 granted options vested on June1, 1999 (one-year vesting period). 

F-35
****
Table of Contents

3,396 of the options became exercisable on June 1, 1999, and theother 199 options are exercisable upon a Liquidity Event. These options expire ten years subsequent to the date of the grantof the option.

               Since the exercise price of the options granted was below the fairvalue of the Company’s Common Stock on the date of grant, theCompany recorded approximately $5.0 million of non-cash stockcompensation for the year ended June 30, 1999, with an offsettingincrease to additional paid in capital.

***1998 Stock Option Plan***

               The purpose of the Vanguard Health Systems, Inc. 1998 Stock OptionPlan, as amended effective June 1, 2000 (the “1998 StockOption Plan”), is to afford an incentive to executiveofficers, other key employees, directors and consultants of theCompany to acquire a proprietary interest in the Company, tocontinue as employees, directors, or consultants, to increase theirefforts on behalf of the Company and to promote the success of theCompany’s business. The 1998 Option Plan is administered bythe Board.

               The maximum number of shares of Common Stock reserved for the grantof options under the 1998 Stock Option Plan (the “MaximumShare Number”) shall be recomputed as of a Liquidity Eventand under such calculations the options available for grant may beincreased up to an additional 2,977 options.  In no eventshall the number of shares of Common Stock with respect to whichoptions are granted hereunder exceed 50% of the number of shares ofCommon Stock authorized as of the effective date of the 1998 StockOption Plan.  As of June 30, 2003, the Maximum Share Numberwas 10,302.

               Options granted under the 1998 Stock Option Plan may be designatedas (i) incentive stock options or non-qualified stock options and(ii) a Liquidity Event Option or a Non-Liquidity Event Option;although certain restrictions exist as to the number of optionswhich can be granted, outstanding, and exercisable under eachdesignation. The Liquidity Event Options and Non-Liquidity EventOptions vest over a four-year period from the date of grant but arenot exercisable until the occurrence of a Liquidity Event, althoughthe vested portion of Non-Liquidity Event Options may be exercisedwithin 90 days of an employee’s separation from theCompany.  The Liquidity Event Options are subject toforfeiture if a minimum Net MSCP IRR is not met at the date of theLiquidity Event.  The Non-Liquidity Event Options are notsubject to this forfeiture provision.  All options under the1998 Stock Option plan have a ten-year exercise period.

               As of June 30, 2003, 9,920 options were outstanding with 75% ofeach grant having been designated as Liquidity Event Options and25% designated as Non-Liquidity Event Options.  Of the 9,920outstanding options, 4,645 options were granted at fair marketvalue but provide that the exercise price will be reduced to$425.32 if the Net MSCP IRR at the date of the Liquidity Eventmeets or exceeds certain target amounts.  Should theapplicable target amount be met, the Company will incur animmediate compensation expense on all affected options equal to theexcess of fair market value of a share of Common Stock over theexercise price of each of the affected options.

               5,275 options under the 1998 Stock Option Plan were granted to aCompany executive in August 2000 at an exercise price of $425.32,combined with the Company’s agreement to pay such executive abonus equal to $351.63 per option exercised upon suchexercise.  The 5,275 options and related bonus are accountedfor as a combined fixed award and may not be exercised until theoccurrence of a Liquidity Event.  On the date of the LiquidityEvent, the Company will incur an immediate compensation expense onthe exercisable options equal to the excess of fair market value ofa share of Common Stock over the exercise price of theseoptions.

               If, while any options remain outstanding under the 1998 StockOption Plan, an event occurs which constitutes a change in controlof the Company, as defined in the 1998 Stock Option Plan, theoptions shall be exercisable or otherwise non-forfeitable in full,whether or not otherwise exercisable or forfeitable; provided that,if a Liquidity Event occurs which results in a Net MSCP IRR that isless than or equal to 12.5%, then all Liquidity Event Options shallbe forfeited and canceled.

***2000 Stock Option Plan***

               Effective June 1, 2000, the Vanguard Health Systems 2000 StockOption Plan (the “2000 Stock Option Plan”) was approvedby the Board for the same purpose as the 1998 Stock OptionPlan.  The 2000 Option Plan is administered by the Board.

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               The maximum number of shares of Common Stock reserved for the grantof options under the 2000 Stock Option Plan (the “MaximumShare Number”) shall as of any date be the lesser of (i) thesum of (x) 17.647% of the total number of the 235,131 common sharesset forth on Division I of Schedule 2.01(c) to, and issued by theCompany and purchased by investors pursuant to, the Amended andRestated Subscription Agreement prior to such date and (y) 10.00%of the total number of the 4,377 common shares set forth onDivision II of Schedule 2.01(c) to, and issued by the Company andpurchased by investors pursuant to, the Amended and RestatedSubscription Agreement prior to such date and (ii) 41,931 shares ofCommon Stock.

               Options granted under the 2000 Stock Option Plan may be designatedas (i) incentive stock options or non-qualified stock options and(ii) a Liquidity Event Option or a Non-Liquidity Event Option;although certain restrictions exist as to the number of optionswhich can be granted, outstanding, and excercisable under eachdesignation.

               Substantially all of the Liquidity Event Options and Non-LiquidityEvent Options vest over a four-year period from the date of grantbut are not exercisable until the occurrence of a Liquidity Event,although the vested portion of Non-Liquidity Event Options may beexercised within 90 days of an employee’s separation from theCompany.  Liquidity Event Options are subject to forfeiture ifa minimum Net MSCP IRR is not met at the date of the LiquidityEvent.  The Non-Liquidity Event Options are not subject tothis forfeiture provision.  All options under the 2000 StockOption Plan have a ten-year exercise period.  As of June 30,2003, the Maximum Share Number was 13,234.

               As of June 30, 2003, 11,824 options were outstanding under the 2000Stock Option Plan with 75% of each grant having been designated asLiquidity Event Options and 25% designated as Non-Liquidity EventOptions.  Should the fair market value of a share of CommonStock exceed the exercise price of each affected option at the dateof the Liquidity Event, the Company will incur an immediatecompensation expense equal to such excess.

               If, while any options remain outstanding under the 2000 StockOption Plan, an event occurs that constitutes a change in controlof the Company, as defined in the 2000 Stock Option Plan, theoptions shall be exercisable or otherwise non-forfeitable in full,whether or not otherwise exercisable or forfeitable; provided that,if a Liquidity Event occurs which results in a Net MSCP IRR that isless than or equal to 12.5%, then all Liquidity Event Options shallbe forfeited and canceled.

F-37
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Table of Contents

***Summary of Option Transactions***

               The following is a summary of options transactions during the yearsended June 30, 2001, 2002 and 2003:

 

 

**Carry Option Plan**

** **

**Initial Option Plan**

** **

**1998 Stock Option Plan**

** **

**2000 Stock Option Plan**

 

 
****
** **
****
 

 

**# of options**

** **

**Weighted average exercise price**

**# of options**

** **

**Weighted average exercise price**

** **

**# of options**

** **

**Weighted average exercise price**

** **

**# of options**

** **

**Weighted average exercise price**

 

 
****
** **
****
Options outstanding at June 30, 2000

23,883

$

170.12

3,595

$

170.12

2,852

$

1,701.18

–

$

–

 

      Options granted

3,134

170.12

–

–

7,477

801.06

7,557

1,701.18

 

      Options exercised

–

–

–

–

–

–

–

–

 

      Options canceled

–

–

–

–

391

1,701.18

85

1,701.18

 

 

Options outstanding at June 30, 2001

27,017

170.12

3,595

170.12

9,938

1,023.97

7,472

1,701.18

 

      Options granted

2,805

170.12

–

–

509

1,701.18

791

1,701.18

 

      Options exercised

–

–

–

–

14

1,701.18

–

–

 

      Options canceled

–

–

–

–

131

1,701.18

861

1,701.18

 

 

Options outstanding at June 30, 2002

29,822

170.12

3,595

170.12

10,302

1,049.38

7,402

1,701.18

 

      Options granted

–

–

–

–

–

–

5,015

1,701.18

 

      Options exercised

–

–

–

–

13

1,701.18

–

–

 

      Options canceled

–

–

–

–

369

1,701.18

593

1,701.18

 

 

Total outstanding at June 30, 2003

29,822

$

170.12

3,595

$

170.12

9,920

$

1,022.74

11,824

$

1,701.18

 

 

Options available for grant at June 30, 2003

–

$

–

–

$

–

382

$

1,701.18

1,410

$

1,701.18

 

 

Options exercisable at June 30, 2003

–

$

–

3,396

$

170.12

75

$

–

9

$

1,701.18

 

 

 

**Options Outstanding**

** **

**Options Exercisable**

 
****
** **
****
 

**Range of Exercisable Prices**

** **

**Number Outstanding June 30, 2003**

** **

**Weighted Average Remaining ContractualLife**

** **

**Weighted Average Exercise Price**

** **

**Number Exercisable June 30, 2003**

** **

**Weighted Average Exercise Price**

 
****
** **
****
 

$

 

170.12

 

 

 

33,417

 

 

 

5.4 years

 

 

$

170.12

 

 

 

3,396

 

 

$

170.12

$

 

425.32

 

 

 

5,275

 

 

 

7.1 years

 

 

$

425.32

 

 

 

–

 

 

$

–

$

 

1,701.18

 

 

 

16,469

 

 

 

8.0 years

 

 

$

1,701.18

 

 

 

84

 

 

$

1,701.18

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

$170.12 - $1,701.18

 

 

 

55,161

*

 

 

 

 

 

 

 

 

 

 

3,480

 

 

$

206.65

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

*Includes options granted under all plans

**10.         401(k) Plan**

               Effective June 1, 1998, the Company adopted the Vanguard 401(k)Retirement Savings Plan (the “401(k) Plan”).  The401(k) Plan is a multiple employer defined contribution planwhereby employees who are age 21 or older are eligible toparticipate.

               The 401(k) Plan was restated January 1, 2000 to incorporate theadoption agreements of a number of employers whereby the respectiveemployer tailored the terms of the 401(k) Plan, including: contribution limits, vesting schedule and employer match.  The401(k) Plan was adopted by the Company’s subsidiary employingits home office and other certain employees as of July 1, 1998 andby each acquired entity upon the respective acquisition date.

               For purposes of determining vesting percentages in the 401(k) Plan,many employees received credit for years of service with theirrespective predecessor companies.  The 401(k) Plan allowseligible employees to make contributions of 2%

F-38
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Table of Contents

to 20% of their annual compensation.  Employer matchingcontributions, which vary by employer, vest 20% after three yearsof service and continue vesting at 20% per year until fullyvested.  The Company’s matching expense for the yearsended June 30, 2001, 2002 and 2003 was approximately $3.7 million,$4.3 million and $5.3 million, respectively.

**11.         Leases**

               The Company leases real estate properties and equipment underoperating and capital leases having various expiration dates. Future minimum operating and capital lease payments at June 30,2003 are approximately as follows (in millions).

 

 

 

**Operating Leases**

 

 

 

**Capital Leases**

 

 

**Total**

 

 

 

2004

 

$

17.0

 

 

$

5.5

 

$

22.5

2005

 

 

12.2

 

 

 

3.5

 

 

15.7

2006

 

 

10.1

 

 

 

2.2

 

 

12.3

2007

 

 

7.8

 

 

 

0.6

 

 

8.4

2008

 

 

6.2

 

 

 

–

 

 

6.2

Thereafter

 

 

29.1

 

 

 

–

 

 

29.1

 

 

 

 

 

 

 

 

Total minimum payments

 

$

82.4

 

 

 

11.8

 

$

94.2

 

 

 

 

 

 

 

 

 

Less amounts representing interest

 

 

 

 

 

 

(1.4

)

 

 

 

 

 

 

 

 

 

 

 

 

Present value of future minimum lease payments

 

 

 

 

 

$

10.4

 

 

 

 

 

 

 

 

 

 

 

 

 

***Assets Under Capital Leases***

               The carrying value of assets under capital leases, which areincluded with owned assets in the accompanying consolidated balancesheets, are approximately as follows (in millions).

 

 

 

**June 30, 2002**

 

 

 

**June 30, 2003**

 

 

 

 

 

Equipment

 

$

16.9

 

 

$

16.6

 

Less:  accumulated depreciation

 

 

4.1

 

 

 

4.9

 

 

 

 

 

 

 

 

Net equipment under capital leases

 

$

12.8

 

 

$

11.7

 

 

 

 

 

 

 

 

               Amortization of the capitalized amounts is included in depreciationand amortization expense in the accompanying consolidated incomestatements.  Other operating expenses for the fiscal yearsended June 30, 2001, 2002 and 2003 include rent expense onoperating leases of approximately $12.2 million, $14.4 million and$18.3 million, respectively.

**12.         Contingencies and Health Care Regulation**

***Contingencies***

               The Company is presently, and from time to time, subject to variousclaims and lawsuits arising in the normal course of business. In the opinion of management, the ultimate resolution of thesematters will not have a material adverse effect on theCompany’s financial position or results of operations.

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Table of Contents

***Current Operations***

               Final determination of amounts earned under prospective payment andcost-reimbursement activities is subject to review by appropriategovernmental authorities or their agents.  In the opinion ofthe Company’s management, adequate provision has been madefor any adjustments that may result from such reviews.

               Laws and regulations governing the Medicare and Medicaid and otherfederal health care programs are complex and subject tointerpretation.  The Company’s management believes thatthe Company is in compliance with all applicable laws andregulations in all material respects and is not aware of anypending or threatened investigations involving allegations ofpotential wrongdoing. While no such regulatory inquiries have beenmade, the Company’s compliance with such laws and regulationsis subject to future government review and interpretation. Non-compliance with such laws and regulations could result insignificant regulatory action including fines, penalties, andexclusion from the Medicare, Medicaid and other federal health careprograms.

               The Company has acquired and will continue to acquire businesseswith prior operating histories. Acquired companies may have unknownor contingent liabilities, including liabilities for failure tocomply with health care laws and regulations, such as billing andreimbursement, fraud and abuse and similar anti-referral laws.Although the Company institutes policies designed to conformpractices to its standards following the completion of itsacquisitions, there can be no assurance that the Company will notbecome liable for past activities of prior owners that may later beasserted to be improper by private plaintiffs or governmentagencies. Although the Company generally seeks to obtainindemnification from prospective sellers covering such matters,there can be no assurance that any such matter will be covered byindemnification, or if covered, that such indemnification will beadequate to cover potential losses and fines.

***Employment-Related Agreements***

               Effective June 1, 1998, the Company executed employment agreementswith four of the Company’s senior executive officers. The Company executed an employment agreement with a fifth seniorexecutive officer on September 1, 1999.  The employmentagreements have a term of five years and contain provisions forterm extensions. The employment agreements provide, among otherthings, for minimum salary levels, for participation in bonusplans, and for amounts to be paid as liquidated damages in theevent of a change in control as defined in the employmentagreements.

               The Company has executed severance protection agreements(“severance agreements”) between the Company and eachof its senior vice presidents and vice presidents.  Theseverance agreements are automatically extended for successive oneyear terms at the discretion of the Company unless an event of achange in control occurs, as defined in the severance agreement, atwhich time the severance agreement continues ****in effect for aperiod of not less than three years beyond the date of such event.The Company is obligated to pay severance payments as set forth inthe severance agreements in the event of a change in control.

               In conjunction with the Company’s issuance of 695 stockoptions to an officer under the Initial Option Plan in June 1998,the Company agreed to grant a cash bonus to reimburse the officerfor the taxes payable upon the exercise of the options. The bonusis to be paid upon the exercise of the options and is to becalculated using tax rates in effect and the fair market value ofthe underlying stock at the time of exercise of the options.

               In August 2000, the Company issued 8,409 stock options to anofficer of the Company with 5,275 options granted under the 1998Option Plan, and 3,134 options granted under the Carry OptionPlan.  In conjunction with the grant of the options under the1998 Option Plan, the Company agreed to grant a cash bonus to theofficer upon the exercise of the options not to exceedapproximately $1.9 million.

***Capital Expenditures Commitments***

               In accordance with the terms of the acquisition agreement, theCompany has agreed to expend, to commit to expend or cause orpermit third parties to expend, in the aggregate, not less than$50.0 million for capital expenditures at or for the benefit ofArrowhead Community Hospital and Medical Center and Phoenix BaptistHospital and Medical Center during the first seven years subsequentto the June 1, 2000 acquisition date of these hospitals, with anaverage annual expenditure as of the end of each of the first sevenanniversaries of the closing date of not less than $6.0million.  If the Company fails to expend at least $50.0million, the Company is obligated to pay to the seller thedifference between $50.0 million and the

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Table of Contents

amount actually expended by the Company.  The Company hasfulfilled approximately $26.8 million of this requirement as ofJune 30, 2003 and intends to fulfill an additional $14.0 million ofthe requirement during 2004.

               Additionally, the Company has agreed to expend, to commit to expendor cause third parties to expend not less than $200.0 million forcapital expenditures at or for the benefit of the BHS hospitalsacquired in January 2003, in accordance with the terms of theacquisition agreement, over the six-year period subsequent to theacquisition date.   The Company has agreed to fulfill$75.0 million of this commitment during the first two years of thesix-year period.  If the Company fails to fulfill itscommitment, the Company is obligated to pay to the seller thedifference between the required commitment and the actual expendedand committed amounts.  The Company has fulfilledapproximately $30.8 million of this requirement as of June 30, 2003and expects to expend an additional $66.0 million of therequirement during fiscal 2004.

               California has statutes and regulations that require hospitals tomeet seismic performance standards.  Hospitals that do notmeet the standards may be required to retrofit theirfacilities.  California law required that hospitals inCalifornia evaluate their facilities and develop a plan andschedule for complying with the standards.  Compliance plans,if necessary, were required to be filed with the State ofCalifornia by January 2002.  The Company filed its requiredcompliance plans on a timely basis.  Any facilities notcurrently in compliance with the seismic regulations and standardsmust be brought into compliance by 2008, or by 2013 if the facilityobtains an extension.  The Company expects to expendapproximately $11.2 million to comply with the seismicstandards.

**13.         Related Party Transactions**

****

               Charles N. Martin, Jr., the Company’s Chairman and ChiefExecutive Officer, beneficially owns in excess of 97% of themembership interests in The Healthcare Airplane Group, LLC. The Company purchases charter airplane services from The HealthcareAirplane Group. Total costs for such services incurred during theyears ended June 30, 2001, 2002 and 2003 and reported in theaccompanying consolidated income statements approximated $300,000,$434,000 and $506,000, respectively.

****

               Prepaid expenses and other current assets in the accompanyingconsolidated balance sheets include receivables from variousunrelated entities that are affiliated with certain of theCompany’s officers of approximately $0.1 million as of June30, 2001, 2002 and 2003.  Such balances represent amounts duefor rent and certain shared office services allocable to theaffiliates.

               During fiscal 2002 and 2003, the Company paid $142,000 and$150,000, respectively, of the out-of-pocket expenses of the MSCPFunds related to their review of the Company’s proposedtransactions and reimbursement for filing fees paid on theCompany’s behalf and travel and related expenses. Duringfiscal 2002, the Company also paid Morgan Stanley & Co.Incorporated or Morgan Stanley Senior Funding, Inc. underwritingfees of $3,163,000 in respect of the 9.75% Notes, loan originationfees of $743,000 in respect of the 2001 credit facility andreimbursed them for $60,000 of their out-of-pocket travel, clericaland word processing fees in connection with such matters. During fiscal 2003, the Company paid Morgan Stanley Senior Funding,Inc. a consent fee of $12,500 in respect of their agreement to anamendment to our 2001 credit facility.  The MSCP Fundscurrently owns 81.0% of the Company’s Common Stock.  Inaddition, three of the Company’s directors, Karen H. Bechtel,Eric T. Fry and Howard I. Hoffen, are managing directors of MorganStanley & Co. Incorporated and two of them, Karen H. Bechteland Eric T. Fry,  are managing directors of  MorganStanley Private Equity while Howard I. Hoffen is Chairman and ChiefExecutive Officer of Morgan Stanley Private Equity.  MorganStanley & Co. Incorporated, Morgan Stanley Private Equity andMorgan Stanley Senior Funding, Inc. are affiliates of the MSCPFunds.  During fiscal 2001, the Company paid Morgan StanleySenior Funding, Inc. $275,000 representing their review of ourproposed transactions and travel and related expenses.  Duringfiscal 2001, the Company paid $671,000 of the out-of-pocketexpenses of the MSCP Funds related to their review of theCompany’s proposed acquisitions and travel and relatedexpenses.

               During fiscal 2002 and 2003, certain of the Company’sfacilities paid approximately $440,000 and $415,000, respectively,to Coactive Systems Corporation for nurse triage, physicianreferral and class registration services, and Coactive Systemsreimbursed the Company approximately $50,000 and $31,800,respectively, for its full rental cost in connection with itsmonth-to-month occupancy of certain office space in theCompany’s headquarters not currently needed by theCompany.  In addition, in fiscal 2002 and 2003, CoactiveSystems paid the Company approximately $21,000 and $20,800,respectively, to reimburse the Company for the costs of its phoneuse while occupying such office space in the Company’sheadquarters and for an allocation in respect of its cost ofcertain office services.  The above aggregate amount paid bythe Company’s facilities to Coactive Systems resulted fromseveral contracts separately negotiated with Coactive Systems bylocal

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management of each facility on an arms-length basis, and inmanagement’s opinion such amount paid by the Company’sfacilities does not exceed the fair market value for suchservices.  Until Coactive Systems was acquired by means of amerger with First Consulting Group, Inc. on May 20, 2003, theCompany’s Chairman & Chief Executive Officer, Charles N.Martin, Jr., owned approximately 41.5% of the common stock ofCoactive Systems and served as the non-executive chairman of itsboard of directors.  Certain of the Company’s otherexecutive officers (Robert E. Galloway, W. Lawrence Hough, JosephD. Moore, Keith B. Pitts, Phillip W. Roe, Ronald P. Soltman andAlan G. Thomas) owned, in the aggregate, approximately 5.5% of thecommon stock of Coactive Systems.  In addition, theCompany’s Vice Chairman, Keith B. Pitts, was on its board ofdirectors; the Company’s Senior Vice President, AssistantGeneral Counsel and Assistant Secretary, James H. Spalding, was itsassistant secretary and the Company’s Executive VicePresident, General Counsel and Secretary, Ronald P. Soltman, wasits secretary.

               During fiscal 2002 and 2003, Phyve Corporation reimbursed theCompany approximately $169,000 and $99,400, respectively, for theCompany’s full rental cost in connection with itsmonth-to-month occupancy of certain office space in theCompany’s headquarters not currently needed by theCompany.  In addition, in fiscal 2002 and 2003, Phyve paid theCompany approximately $39,000 and $20,200, respectively, toreimburse the Company for the costs of its phone use whileoccupying such office space in the Company’s headquarters andfor an allocation in respect of the Company’s cost of certainoffice services.  Phyve sold all of its assets to FirstConsulting Group, Inc. and discontinued its business operations onor about February 20, 2003.  The Company’s Chairman& Chief Executive Officer, Charles N. Martin, Jr., ownsapproximately 16.9% of the outstanding common stock and 11.6% ofthe outstanding preferred stock of Phyve and is the non-executivechairman of its board of directors.  Certain of theCompany’s other executive officers (Bruce F. Chafin, RobertE. Galloway, W. Lawrence Hough, James Johnston, Joseph D. Moore,Keith B. Pitts, Phillip W. Roe, Ronald P. Soltman, James H.Spalding, and Alan G. Thomas) own, in the aggregate, approximately12.8% of its common stock and Messrs. Galloway, Johnston andMoore  own, in the aggregate, approximately 0.5% of itsoutstanding preferred stock.  In addition, Mr. Spalding is itssecretary and Mr. Soltman is its assistant secretary.

               During fiscal 2002 and 2003, NetContent, Inc. reimbursed theCompany approximately $87,000 and $74,600, respectively, for theCompany’s full rental cost in connection with itsmonth-to-month occupancy of certain office space in theCompany’s headquarters not currently needed by theCompany.  In addition, in fiscal 2002 NetContent paid theCompany approximately $31,000 and $20,300, respectively, toreimburse the Company for the costs of its phone use whileoccupying such office space in the Company’s headquarters andfor an allocation in respect of the Company’s cost of certainoffice services.  The Company’s Chairman & ChiefExecutive Officer, Charles N. Martin, Jr., owns 51% of theoutstanding common stock of NetContent and is a member of its boardof directors.  Two of the Company’s other executiveofficers, Keith B. Pitts and James H. Spalding, own 30% and 19%,respectively, of the outstanding common stock of NetContent. Additionally, Mr. Pitts is a member of its board of directors; andMr. Spalding is Secretary of NetContent and a member of its boardof directors.

               On July 1, 2000, the Company purchased 100% of the outstandingstock of Trinity MedCare, Inc. from its nine shareholders. The shareholders of Trinity MedCare, Inc. included certain membersof management and directors of the Company.  These members ofmanagement and directors received an aggregate of approximately$457,000 for their interests.

**14.         Segment Information**

               The Company’s acute care hospitals and related health carebusinesses are similar in their activities and economicenvironments in which they operate (i.e. urban markets). Accordingly, the Company’s reportable operating segmentsconsist of 1) acute care hospitals and related health carebusinesses, collectively, and 2) health plans consisting of MacNealHealth Providers, a contracting entity for MacNeal Hospital, andPhoenix Health Plan, a Medicaid managed health plan inArizona.  Prior to the acquisitions of these entities, theCompany determined that it did not have separately reportablesegments as defined under Statement of Financial AccountingStandards No. 131, *Disclosures about Segments of an Enterpriseand Related Information*.  The following table providesfinancial information by business segment for the years ended June30, 2001, 2002 and 2003.

F-42
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Table of Contents

 

 

**For the year ended June 30, 2001**

 

 

 

 

**Health Plans**
 
**Acute Care Services**

** **

**Eliminations**

** **

**Consolidated**

 

 
**
 

 

*(In millions)*

 

 

Patient service revenues

 

$

–

 

 

$

612.7

 

 

$

–

 

 

$

612.7

 

Capitation premiums

 

 

55.1

 

 

 

–

 

 

 

–

 

 

 

55.1

 

Inter-segment revenues

 

 

–

 

 

 

16.7

 

 

 

(16.7

)

 

 

–

 

 

 

 

 

 

 

 

 

 

 

 

 

 

    Total revenues

 

 

55.1

 

 

 

629.4

 

 

(16.7

)

 

 

667.8

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Salaries and benefits

 

 

3.8

 

 

 

319.8

 

 

 

–

 

 

 

323.6

 

Supplies

 

 

0.1

 

 

 

92.8

 

 

 

–

 

 

 

92.9

 

Medical claims expense

 

 

30.8

 

 

 

–

 

 

 

–

 

 

 

30.8

 

Provision for doubtful accounts

 

 

–

 

 

 

56.8

 

 

 

–

 

 

 

56.8

 

Other operating expenses - external

 

 

1.3

 

 

 

110.1

 

 

 

–

 

 

 

111.4

 

Operating expenses - inter-segment

 

 

16.7

 

 

 

–

 

 

 

(16.7

)

 

 

–

 

 

 

 

 

 

 

 

 

 

 

 

 

 

    Total operating expenses

 

 

52.7

 

 

 

579.5

 

 

 

(16.7

)

 

 

615.5

 

** **

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

    Segment EBITDA (1)

 

 

2.4

 

 

 

49.9

 

 

 

–

 

 

 

52.3

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Depreciation and amortization

 

 

0.5

 

 

 

23.3

 

 

 

–

 

 

 

23.8

 

Interest, net

 

 

(0.4

)

 

 

17.0

 

 

 

–

 

 

 

16.6

 

Minority interests

 

 

–

 

 

 

0.8

 

 

 

–

 

 

 

0.8

 

Equity method loss (income)

–

(0.1

)

–

(0.1

)

Loss on sale of assets

–

0.5

–

0.5

Debt extinguishment costs

–

–

–

–

 

 

 

 

 

 

 

 

 

 

 

 

 

    Income before income taxes

 

$

2.3

 

 

$

8.4

 

 

$

–

 

 

$

10.7

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Segment assets

 

$

44.2

 

 

$

596.2

 

 

$

–

 

 

$

640.4

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Capital expenditures

 

$

–

 

$

26.6

 

 

$

–

 

 

$ 

26.6

 

 

 

 

 

 

 

 

 

 

 

 

 

 

____________________

(1)

Segment EBITDA is defined as income before interest expense (netof interest income), income taxes, depreciation, amortization,minority interests, gain or loss on sale of assets, equity methodincome or loss and debt extinguishment costs.  Management usesSegment EBITDA to measure performance for the Company’ssegments and to develop strategic objectives and operating plansfor those segments.   Segment EBITDA eliminates theuneven effect of non-cash depreciation of tangible assets andamortization of intangible assets, much of which results fromacquisitions accounted for under the purchase method ofaccounting.  Segment EBITDA also eliminates the effects ofchanges in interest rates which management believes relate togeneral trends in global capital markets, but are not necessarilyindicative of the operating performance of the Company’ssegments.  Management believes that Segment EBITDA providesuseful information about the financial performance of theCompany’s segments to investors, lenders, financial analystsand rating agencies.  Additionally, management believes thatinvestors and lenders view Segment EBITDA as an important factor inmaking investment decisions and assessing the value of theCompany.  Segment EBITDA is not a substitute for net income,operating cash flows or other cash flow statement data determinedin accordance with accounting principles generally accepted in theUnited States.  Segment EBITDA, as presented, may not becomparable to similarly titled measures of other companies.

F-43
****
Table of Contents

**For the year ended June 30, 2002**

 

 

**Health Plans**

**Acute Care Services**

**Eliminations**

**Consolidated**

 

 
**
*(In millions)*

Patient service revenues

 

$

–

 

 

$

725.8

 

 

$

–

 

 

$

725.8

 

Capitation premiums

 

184.8

–

–

184.8

 

Inter-segment revenues

 

 

–

26.2

(26.2

)

–

 

 

 

 

 

 

 

 

 

 

 

 

    Total revenues

 

 

184.8

752.0

(26.2

)

910.6

 

 

 

 

Salaries and benefits

 

 

9.3

375.1

–

384.4

 

Supplies

 

 

0.2

115.9

–

116.1

 

Medical claims expense

 

 

132.0

–

–

132.0

 

Provision for doubtful accounts

 

 

–

53.3

–

53.3

Other operating expenses - external

 

 

6.6

146.2

–

152.8

 

Operating expenses - inter-segment

26.2

–

(26.2

)

–

 

 

 

 

 

 

 

 

 

 

    Total operating expenses

 

174.3

690.5

(26.2

)

838.6

    Segment EBITDA (1)

 

 

10.5

61.5

–

72.0

 

Depreciation and amortization

 

1.5

28.0

–

29.5

 

Interest, net

 

 

(0.7

)

27.4

–

26.7

 

Minority interests

 

 

–

0.8

–

0.8

 

Equity method loss (income)

–

(0.5

)

–

(0.5

)

Loss (gain) on sale of assets

–

(0.8

)

–

(0.8

)

Debt extinguishment costs

–

6.6

–

6.6

 

 

 

 

 

 

 

 

 

 

    Income before income taxes

 

$

9.7

 

 

$

–

 

$

–

 

 

$

9.7

 

 

 

 

 

 

 

 

 

 

Segment assets

 

$

49.1

 

 

$

802.8

 

$

–

 

 

$

851.9

 

 

 

 

 

 

 

 

 

 

 

Capital expenditures

 

$

1.7

 

$

33.4

 

$

–

 

$ 

35.1

 

 

 

 

 

 

 

 

 

 

 

____________________

(1)

Segment EBITDA is defined as income before interest expense (netof interest income), income taxes, depreciation, amortization,minority interests, gain or loss on sale of assets, equity methodincome or loss and debt extinguishment costs.  Management usesSegment EBITDA to measure performance for the Company’ssegments and to develop strategic objectives and operating plansfor those segments.   Segment EBITDA eliminates theuneven effect of non-cash depreciation of tangible assets andamortization of intangible assets, much of which results fromacquisitions accounted for under the purchase method ofaccounting.  Segment EBITDA also eliminates the effects ofchanges in interest rates which management believes relate togeneral trends in global capital markets, but are not necessarilyindicative of the operating performance of the Company’ssegments.  Management believes that Segment EBITDA providesuseful information about the financial performance of theCompany’s segments to investors, lenders, financial analystsand rating agencies.  Additionally, management believes thatinvestors and lenders view Segment EBITDA as an important factor inmaking investment decisions and assessing the value of theCompany.  Segment EBITDA is not a substitute for net income,operating cash flows or other cash flow statement data determinedin accordance with accounting principles generally accepted in theUnited States.  Segment EBITDA, as presented, may not becomparable to similarly titled measures of other companies.

F-44
****
Table of Contents

 

 

**For the year ended June 30, 2003**

 

 

 

 

**Health Plans**
 
**Acute Care Services**

** **

**Eliminations**

** **

**Consolidated**

 

 

 

 

*(In millions)*

 

 

Patient service revenues

 

$

–

 

 

$

1,121.7

 

 

$

–

 

 

$

1,121.7

 

Capitation premiums

 

 

218.8

 

 

 

–

 

 

 

 

 

 

 

218.8

 

Inter-segment revenues

 

 

–

 

 

 

24.9

 

 

 

(24.9

)

 

 

–

 

 

 

 

 

 

 

 

 

 

 

 

 

 

    Total revenues

 

 

218.8

 

 

 

1,146.6

 

 

 

(24.9

)

 

 

1,340.5

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Salaries and benefits

 

 

9.7

 

 

 

568.7

 

 

 

–

 

 

 

578.4

 

Supplies

 

 

0.2

 

 

 

202.4

 

 

 

–

 

 

 

202.6

 

Medical claims expense

 

 

160.8

 

 

 

–

 

 

 

–

 

 

 

160.8

 

Provision for doubtful accounts

 

 

–

 

 

 

73.4

 

 

 

–

 

 

 

73.4

 

Other operating expenses - external

 

 

8.6

 

 

 

208.0

 

 

 

–

 

 

 

216.6

 

Operating expenses - inter-segment

 

 

24.9

 

 

 

–

 

 

 

(24.9

)

 

 

–

 

 

 

 

 

 

 

 

 

 

 

 

 

 

    Total operating expenses

 

204.2

 

 

1,052.5

 

 

 

(24.9

)

 

1,231.8

 

** **

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

    Segment EBITDA (1)

 

 

14.6

 

 

 

94.1

 

 

 

–

 

 

 

108.7

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Depreciation and amortization

 

1.7

 

 

 

45.2

 

 

 

–

 

 

 

46.9

 

Interest, net

 

 

0.2

 

 

 

34.7

 

 

 

–

 

 

 

34.9

 

Minority interests

–

0.7

–

0.7

Equity method loss (income)

–

(1.6

)

–

(1.6

)

Loss (gain) on sale of assets

–

–

–

–

Debt extinguishment costs

–

–

–

–

 

 

 

 

 

 

 

 

 

 

 

 

 

    Income before income taxes

 

$

12.7

 

 

$

15.1

 

$

–

 

 

$

27.8

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Segment assets

 

$

54.7

 

 

$

1,172.2

 

 

$

–

 

 

$

1,226.9

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Capital expenditures

 

$

0.5

 

$

98.0

 

 

$

–

 

 

$ 

98.5

 

 

 

 

 

 

 

 

 

 

 

 

 

 

____________________

(1)

Segment EBITDA is defined as income before interest expense (netof interest income), income taxes, depreciation, amortization,minority interests, gain or loss on sale of assets, equity methodincome or loss and debt extinguishment costs.  Management usesSegment EBITDA to measure performance for the Company’ssegments and to develop strategic objectives and operating plansfor those segments.   Segment EBITDA eliminates theuneven effect of non-cash depreciation of tangible assets andamortization of intangible assets, much of which results fromacquisitions accounted for under the purchase method ofaccounting.  Segment EBITDA also eliminates the effects ofchanges in interest rates which management believes relate togeneral trends in global capital markets, but are not necessarilyindicative of the operating performance of the Company’ssegments.  Management believes that Segment EBITDA providesuseful information about the financial performance of theCompany’s segments to investors, lenders, financial analystsand rating agencies.  Additionally, management believes thatinvestors and lenders view Segment EBITDA as an important factor inmaking investment decisions and assessing the value of theCompany.  Segment EBITDA is not a substitute for net income,operating cash flows or other cash flow statement data determinedin accordance with accounting principles generally accepted in theUnited States.  Segment EBITDA, as presented, may not becomparable to similarly titled measures of other companies.

F-45
****
Table of Contents**14.         Comprehensive Income**

****

               The components of comprehensive income, net of related taxesfollows (in millions).

 

 

 

**Year ended June 30**

 

 

 

 

**2001**

 

 

 

**2002**

 

 

**2003**

 

 

 

 

 

Net income

 

$

10.2

 

 

$

6.8

$

16.9

 

 

 

 

 

 

 

 

Cumulative effect of change in accounting principle - fair valueof interest rate collar

 

 

(0.2

)

 

 

0.2

–

Net change in fair value of interest rate collar

 

 

(1.6

)

 

 

1.6

–

Amortization of transition adjustment

 

 

0.1

 

 

 

(0.1

)

–

Interest rate swap market-to-market adjustment, net of taxes

–

–

(0.6

)

 

 

 

 

 

 

Other comprehensive loss

 

 

(1.7

)

 

 

1.7

(0.6

)

 

 

 

 

 

 

Comprehensive income

 

$

8.5

 

 

$

8.5

$

16.3

 

 

 

 

 

 

               Accumulated other comprehensive loss at June 30, 2001 and June 30,2003 is comprised of the adjusted fair value of the interest ratecollar of approximately ($1.7) million (net of taxes of $1.2million) and the fair market value of the interest rate swap of$(0.6) million (net of taxes of $0.3 million), respectively.

F-46 |